|
Cystatin c
|
$42.90 |
$42.90 |
$42.90 |
$77.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$186.12 |
$186.12 |
$186.12 |
$542.10
|
|
Cytarabine 20 mg/ml injection solution
|
$65.54 |
$65.54 |
$65.54 |
$89.94
|
|
Cytomegalovirus (cmv) antibody igg
|
$13.53 |
$13.53 |
$13.53 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$14.19 |
$14.19 |
$14.19 |
$97.50
|
|
Cytopath fl nongyn filter
|
$53.46 |
$53.46 |
$53.46 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$41.91 |
$41.91 |
$41.91 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$47.52 |
$47.52 |
$47.52 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$49.50 |
$49.50 |
$49.50 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$7.59 |
$7.59 |
$7.59 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$21.78 |
$21.78 |
$21.78 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$101.31 |
$101.31 |
$101.31 |
$209.23
|
|
Cytopath smear other source
|
$55.77 |
$55.77 |
$55.77 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$57.75 |
$57.75 |
$57.75 |
$96.20
|
|
Dacarbazine 100 mg intravenous solution
|
$23.75 |
$23.75 |
$23.75 |
$58.22
|
|
Dactinomycin 0.5 mg intravenous solution
|
$562.32 |
$562.32 |
$562.32 |
$3,024.59
|
|
Dalbavancin 500 mg intravenous solution
|
$2,000.89 |
$2,000.89 |
$2,000.89 |
$3,480.35
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$11,271.85 |
$11,271.85 |
$11,271.85 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$4,352.36 |
$4,352.36 |
$4,352.36 |
$6,072.48
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$12,348.55 |
$12,348.55 |
$12,348.55 |
$20,196.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$257.10 |
$257.10 |
$257.10 |
$257.10
|
|
Dch validity tests
|
$8.58 |
$8.58 |
$8.58 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$16.17 |
$16.17 |
$16.17 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$49.50 |
$49.50 |
$49.50 |
$260.61
|
|
Decalcification
|
$9.24 |
$9.24 |
$9.24 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$1,828.04 |
$1,828.04 |
$1,828.04 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$861.30 |
$861.30 |
$861.30 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$78.05 |
$78.05 |
$78.05 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$857.08 |
$857.08 |
$857.08 |
$1,807.08
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,879.72 |
$3,879.72 |
$3,879.72 |
$6,324.98
|
|
Depo-estradiol cypionate inj
|
$470.84 |
$470.84 |
$470.84 |
$71.51
|
|
Desmopressin 4 mcg/ml injection solution
|
$757.07 |
$757.07 |
$757.07 |
$89.78
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$4,125.00 |
$4,125.00 |
$4,125.00 |
$4,200.00
|
|
Device intraute mirena
|
$1,366.03 |
$1,366.03 |
$1,366.03 |
$2,125.00
|
|
Device tiss remov myosure reach
|
$1,593.90 |
$1,593.90 |
$1,593.90 |
$2,541.00
|
|
Devlopment test interpt&rep
|
$51.48 |
$51.48 |
$51.48 |
$109.46
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$75.57 |
$75.57 |
$75.57 |
$227.15
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$94.15 |
$94.15 |
$94.15 |
$21.17
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$515.66 |
$515.66 |
$515.66 |
$858.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$17.82 |
$17.82 |
$17.82 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$32.34 |
$32.34 |
$32.34 |
$79.20
|
|
Diagnostic Mammogram (both breasts)
|
$114.84 |
$114.84 |
$114.84 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$89.43 |
$89.43 |
$89.43 |
$301.55
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,708.87 |
$3,708.87 |
$3,708.87 |
$5,419.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$127.83 |
$127.83 |
$127.83 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$64.52 |
$64.52 |
$64.52 |
$74.76
|
|
Dicyclomine injection
|
$47.15 |
$47.15 |
$47.15 |
$153.29
|
|
Diffusing capacity
|
$84.81 |
$84.81 |
$84.81 |
$332.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$5,593.96 |
$5,593.96 |
$5,593.96 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$44.22 |
$44.22 |
$44.22 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$118.09 |
$118.09 |
$118.09 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$586.08 |
$586.08 |
$586.08 |
$1,866.73
|
|
Dilat xst trc new access rcs
|
$3,305.28 |
$3,305.28 |
$3,305.28 |
$4,213.20
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,398.63 |
$1,398.63 |
$1,398.63 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$25.71 |
$25.71 |
$25.71 |
$17.75
|
|
Disability dlco
|
$109.23 |
$109.23 |
$109.23 |
$282.40
|
|
Dna antibody native/double stranded
|
$7.92 |
$7.92 |
$7.92 |
$97.50
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$92.38 |
$92.38 |
$92.38 |
$98.43
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$5,475.50 |
$5,475.50 |
$5,475.50 |
$904.81
|
|
Dolasetron mesylate
|
$44.65 |
$44.65 |
$44.65 |
$44.65
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$20.63 |
$20.63 |
$20.63 |
$65.40
|
|
Doppler echo complete
|
$76.23 |
$76.23 |
$76.23 |
$540.00
|
|
Doppler intravascular pressure flow initial vessel
|
$896.94 |
$896.94 |
$896.94 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$155.43 |
$155.43 |
$155.43 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$87.45 |
$87.45 |
$87.45 |
$471.17
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$13,529.72 |
$13,529.72 |
$13,529.72 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$295.82 |
$295.82 |
$295.82 |
$423.95
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$2,724.53 |
$2,724.53 |
$2,724.53 |
$1,718.24
|
|
Dpyd gene common variants
|
$277.20 |
$277.20 |
$277.20 |
$380.50
|
|
Drainage of kidney lesion
|
$884.40 |
$884.40 |
$884.40 |
$1,506.00
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$875.16 |
$875.16 |
$875.16 |
$2,540.00
|
|
Drain cath image guided visceral pq
|
$899.58 |
$899.58 |
$899.58 |
$2,850.35
|
|
Drug admin & hemodynmic meas
|
$130.02 |
$130.02 |
$130.02 |
$569.75
|
|
Drug assay voriconazole
|
$52.80 |
$52.80 |
$52.80 |
$96.75
|
|
Drug test def 1-7 classes
|
$153.78 |
$153.78 |
$153.78 |
$250.52
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$123.09 |
$123.09 |
$123.09 |
$278.85
|
|
Drvvt confirm - quest
|
$66.99 |
$66.99 |
$66.99 |
$109.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$274.23 |
$274.23 |
$274.23 |
$887.25
|
|
Durvalumab 50 mg/ml intravenous solution
|
$4,829.95 |
$4,829.95 |
$4,829.95 |
$7,973.90
|
|
Dxa bone density axl vrt fx
|
$182.82 |
$182.82 |
$182.82 |
$392.60
|
|
Ecg 12 lead tracing only
|
$51.81 |
$51.81 |
$51.81 |
$226.50
|
|
Ecg external < 48 hours recording
|
$171.93 |
$171.93 |
$171.93 |
$462.00
|
|
Echocardiogram (Heart Ultrasound)
|
$412.17 |
$412.17 |
$412.17 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$76.56 |
$76.56 |
$76.56 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$412.17 |
$412.17 |
$412.17 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$259.05 |
$259.05 |
$259.05 |
$703.25
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$259.05 |
$259.05 |
$259.05 |
$851.50
|
|
Echocardiograpy doppler follow up/limited study
|
$38.28 |
$38.28 |
$38.28 |
$362.50
|
|
Echo exam of fetal heart
|
$93.39 |
$93.39 |
$93.39 |
$431.41
|
|
Echo guide for amniocentesis
|
$133.65 |
$133.65 |
$133.65 |
$456.30
|
|
Echo tee probe placement image acquisition interpretation & report
|
$396.33 |
$396.33 |
$396.33 |
$1,849.50
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$259.05 |
$259.05 |
$259.05 |
$985.15
|
|
E coli 0157 ag ia
|
$37.95 |
$37.95 |
$37.95 |
$72.15
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$7,336.03 |
$7,336.03 |
$7,336.03 |
$18,199.20
|
|
Eeg monitor/record/awake/drowsy 95816
|
$198.33 |
$198.33 |
$198.33 |
$835.00
|
|
Eeg over 1 hour 95813 - 26
|
$264.33 |
$264.33 |
$264.33 |
$1,102.05
|
|
Eeg recording awake and asleep
|
$224.07 |
$224.07 |
$224.07 |
$931.20
|
|
E equine encephalitis igg
|
$8.58 |
$8.58 |
$8.58 |
$49.92
|
|
Elec analys infus pump w/reprog 62368
|
$616.11 |
$616.11 |
$616.11 |
$616.11
|
|
Elect analysis of infusion pump 62367
|
$616.11 |
$616.11 |
$616.11 |
$563.20
|