|
CT neck soft tissue without contrast
|
$353.10 |
$353.10 |
$353.10 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$543.51 |
$543.51 |
$543.51 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$488.73 |
$488.73 |
$488.73 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$371.25 |
$371.25 |
$371.25 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$329.34 |
$329.34 |
$329.34 |
$1,360.00
|
|
CT scan for localization
|
$612.48 |
$612.48 |
$612.48 |
$1,205.14
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,306.14 |
$1,306.14 |
$1,306.14 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$871.20 |
$871.20 |
$871.20 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$871.20 |
$871.20 |
$871.20 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$598.62 |
$598.62 |
$598.62 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$598.62 |
$598.62 |
$598.62 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$524.70 |
$524.70 |
$524.70 |
$331.50
|
|
CT t-spine w /wo contrast
|
$897.93 |
$897.93 |
$897.93 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$863.94 |
$863.94 |
$863.94 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$724.02 |
$724.02 |
$724.02 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$986.70 |
$986.70 |
$986.70 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$26.73 |
$26.73 |
$26.73 |
$68.64
|
|
Culture afb any source
|
$35.97 |
$35.97 |
$35.97 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$26.73 |
$26.73 |
$26.73 |
$79.00
|
|
Culture anaerobic except blood
|
$31.35 |
$31.35 |
$31.35 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$7.92 |
$7.92 |
$7.92 |
$51.45
|
|
Culture body fluid
|
$28.71 |
$28.71 |
$28.71 |
$126.75
|
|
Culture fungi definitive id mold
|
$46.53 |
$46.53 |
$46.53 |
$77.28
|
|
Culture fungi definitive id yeast
|
$58.41 |
$58.41 |
$58.41 |
$79.10
|
|
Culture fungi other (except blood)
|
$28.05 |
$28.05 |
$28.05 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$25.74 |
$25.74 |
$25.74 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$46.53 |
$46.53 |
$46.53 |
$89.70
|
|
Culture screening strep group a
|
$22.11 |
$22.11 |
$22.11 |
$81.00
|
|
Culture typing immunologic
|
$16.83 |
$16.83 |
$16.83 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$77.55 |
$77.55 |
$77.55 |
$133.90
|
|
Culture urine each isolate
|
$27.06 |
$27.06 |
$27.06 |
$57.00
|
|
Cv line/pic reposition
|
$282.48 |
$282.48 |
$282.48 |
$1,720.93
|
|
Cv stress test i&r only 93018
|
$14.67 |
$14.67 |
$14.67 |
$40.20
|
|
Cv stress test/supervision only 93016
|
$14.67 |
$14.67 |
$14.67 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$8.58 |
$8.58 |
$8.58 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$14.85 |
$14.85 |
$14.85 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,647.60 |
$1,647.60 |
$1,647.60 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$5.67 |
$5.67 |
$5.67 |
$19.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$139.14 |
$139.14 |
$139.14 |
$140.78
|
|
Cyclosporine 2 hour
|
$21.45 |
$21.45 |
$21.45 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$1.90 |
$1.90 |
$1.90 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$6.62 |
$6.62 |
$6.62 |
$34.88
|
|
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
|
|
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
|
|
Deamidated gliadin antibody iga
|
$16.17 |
$16.17 |
$16.17 |
$43.60
|
|
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
|
|
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)
|
$69.96 |
$69.96 |
$69.96 |
$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
|
|
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
|
|
Dilator fascial 10fx20cm
|
$415.80 |
$415.80 |
$415.80 |
$402.10
|
|
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 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
|