|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$8,838.15 |
$8,838.15 |
$8,838.15 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$7,791.67 |
$7,791.67 |
$7,791.67 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$6,499.93 |
$6,499.93 |
$6,499.93 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$3,895.85 |
$3,895.85 |
$3,895.85 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$3,250.31 |
$3,250.31 |
$3,250.31 |
$1,464.00
|
|
CT t-spine w /wo contrast
|
$7,055.35 |
$7,055.35 |
$7,055.35 |
$2,027.52
|
|
Culture afb any source
|
$675.10 |
$675.10 |
$675.10 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$568.04 |
$568.04 |
$568.04 |
$79.00
|
|
Culture anaerobic except blood
|
$903.84 |
$903.84 |
$903.84 |
$120.00
|
|
Culture fungi definitive id mold
|
$504.00 |
$504.00 |
$504.00 |
$77.28
|
|
Culture fungi definitive id yeast
|
$405.32 |
$405.32 |
$405.32 |
$79.10
|
|
Culture fungi other (except blood)
|
$1,069.09 |
$1,069.09 |
$1,069.09 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$598.76 |
$598.76 |
$598.76 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$102.27 |
$102.27 |
$102.27 |
$89.70
|
|
Culture quantitative aerobic other source
|
$69.86 |
$69.86 |
$69.86 |
$90.35
|
|
Culture typing added method
|
$54.18 |
$54.18 |
$54.18 |
$38.58
|
|
Culture typing immunologic
|
$36.26 |
$36.26 |
$36.26 |
$44.00
|
|
Culture urine each isolate
|
$629.81 |
$629.81 |
$629.81 |
$57.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$55.60 |
$55.60 |
$55.60 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$99.94 |
$99.94 |
$99.94 |
$70.72
|
|
Cyclophosphamide 25 mg capsule
|
$71.58 |
$71.58 |
$71.58 |
$19.49
|
|
Cyclosporine 2 hour
|
$634.52 |
$634.52 |
$634.52 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$38.75 |
$38.75 |
$38.75 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$34.56 |
$34.56 |
$34.56 |
$34.88
|
|
Cystogram >= 3 views supervision & interpretation
|
$890.16 |
$890.16 |
$890.16 |
$542.10
|
|
Cytomegalovirus (cmv) antibody igm
|
$326.95 |
$326.95 |
$326.95 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$179.37 |
$179.37 |
$179.37 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$404.58 |
$404.58 |
$404.58 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$404.58 |
$404.58 |
$404.58 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$138.30 |
$138.30 |
$138.30 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$404.58 |
$404.58 |
$404.58 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$404.58 |
$404.58 |
$404.58 |
$209.23
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$38.79 |
$38.79 |
$38.79 |
$6,072.48
|
|
Decalcification
|
$188.18 |
$188.18 |
$188.18 |
$68.90
|
|
Deferoxamine 500 mg solution for injection
|
$188.33 |
$188.33 |
$188.33 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$1,777.68 |
$1,777.68 |
$1,777.68 |
$1,807.08
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$647.91 |
$647.91 |
$647.91 |
$185.17
|
|
Design mlc device for imrt
|
$9,616.16 |
$9,616.16 |
$9,616.16 |
$1,677.86
|
|
Device intraute mirena
|
$2,833.38 |
$2,833.38 |
$2,833.38 |
$2,125.00
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$6.47 |
$6.47 |
$6.47 |
$858.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$102.77 |
$102.77 |
$102.77 |
$45.40
|
|
Dextrose 5 % IV bolus
|
$93.27 |
$93.27 |
$93.27 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$1,490.76 |
$1,490.76 |
$1,490.76 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$300.50 |
$300.50 |
$300.50 |
$79.20
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$134.22 |
$134.22 |
$134.22 |
$74.76
|
|
Dicyclomine injection
|
$400.57 |
$400.57 |
$400.57 |
$153.29
|
|
Diffusing capacity
|
$1,040.92 |
$1,040.92 |
$1,040.92 |
$332.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$3,769.51 |
$3,769.51 |
$3,769.51 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$1,097.31 |
$1,097.31 |
$1,097.31 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$2,680.51 |
$2,680.51 |
$2,680.51 |
$297.86
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$57.13 |
$57.13 |
$57.13 |
$17.75
|
|
Disability dlco
|
$1,035.39 |
$1,035.39 |
$1,035.39 |
$282.40
|
|
Disaccharidases
|
$598.61 |
$598.61 |
$598.61 |
$216.00
|
|
Discography cerv/thor spine
|
$8,876.96 |
$8,876.96 |
$8,876.96 |
$2,565.00
|
|
Dna antibody native/double stranded
|
$696.87 |
$696.87 |
$696.87 |
$97.50
|
|
Dna probe chlamydia
|
$335.77 |
$335.77 |
$335.77 |
$79.38
|
|
Dna probe gc
|
$487.51 |
$487.51 |
$487.51 |
$80.80
|
|
Doppler echo complete
|
$2,668.77 |
$2,668.77 |
$2,668.77 |
$540.00
|
|
Dornase alfa non-comp unit
|
$1,794.92 |
$1,794.92 |
$1,794.92 |
$446.75
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$239.49 |
$239.49 |
$239.49 |
$84.80
|
|
Droperidol 2.5 mg/ml injection solution
|
$87.23 |
$87.23 |
$87.23 |
$31.07
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$105.00 |
$105.00 |
$105.00 |
$289.05
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$230.00 |
$230.00 |
$230.00 |
$8,040.27
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$400.98
|
|
Drug test def 1-7 classes
|
$995.02 |
$995.02 |
$995.02 |
$250.52
|
|
Duplex scan bilateral study 93985
|
$1,587.01 |
$1,587.01 |
$1,587.01 |
$690.95
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,960.69 |
$1,960.69 |
$1,960.69 |
$887.25
|
|
Ecg 12 lead tracing only
|
$664.25 |
$664.25 |
$664.25 |
$226.50
|
|
Ecg/1-3 leads/tracing only 93041
|
$302.22 |
$302.22 |
$302.22 |
$135.80
|
|
Ecg external < 48 hours recording
|
$830.19 |
$830.19 |
$830.19 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$2,313.82 |
$2,313.82 |
$2,313.82 |
$541.20
|
|
Echocardiogram (Heart Ultrasound)
|
$5,439.58 |
$5,439.58 |
$5,439.58 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$1,880.06 |
$1,880.06 |
$1,880.06 |
$469.95
|
|
Echocardiography transthoracic 2d followup/limited
|
$4,079.72 |
$4,079.72 |
$4,079.72 |
$703.25
|
|
Echocardiograpy doppler follow up/limited study
|
$2,606.33 |
$2,606.33 |
$2,606.33 |
$362.50
|
|
Echo guide for artery repair
|
$1,682.72 |
$1,682.72 |
$1,682.72 |
$664.00
|
|
Echo stress
|
$5,543.28 |
$5,543.28 |
$5,543.28 |
$1,592.05
|
|
Eeg recording awake and asleep
|
$2,391.59 |
$2,391.59 |
$2,391.59 |
$931.20
|
|
Eeg without vid 2-12 hr unmntr
|
$2,391.61 |
$2,391.61 |
$2,391.61 |
$601.30
|
|
Egfr gene com variants
|
$1,370.32 |
$1,370.32 |
$1,370.32 |
$657.00
|
|
Ehrlicha chaffeensis amp prb
|
$1,914.70 |
$1,914.70 |
$1,914.70 |
$93.00
|
|
Elec stim unattend for press
|
$217.75 |
$217.75 |
$217.75 |
$83.20
|
|
Electrolyte panel
|
$977.35 |
$977.35 |
$977.35 |
$84.24
|
|
Embolization s&i
|
$4,788.50 |
$4,788.50 |
$4,788.50 |
$3,199.00
|
|
Epoetin alfa, 100 units esrd
|
$4,039.83 |
$4,039.83 |
$4,039.83 |
$4.82
|
|
Epstein barr nuclear antigen antibody
|
$1,200.81 |
$1,200.81 |
$1,200.81 |
$78.65
|
|
Ercp biliary & pancreas
|
$3,232.98 |
$3,232.98 |
$3,232.98 |
$967.04
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,802.62 |
$1,802.62 |
$1,802.62 |
$222.98
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$1,061.43 |
$1,061.43 |
$1,061.43 |
$223.99
|
|
Esophagus motility study
|
$4,313.23 |
$4,313.23 |
$4,313.23 |
$1,289.20
|
|
Esoph balloon distension tst
|
$2,758.18 |
$2,758.18 |
$2,758.18 |
$1,040.00
|
|
Estradiol total
|
$1,403.68 |
$1,403.68 |
$1,403.68 |
$146.50
|
|
Ethylene glycol -sendout
|
$790.34 |
$790.34 |
$790.34 |
$89.40
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$713.30 |
$713.30 |
$713.30 |
$219.60
|
|
Evaluation of speech fluency 92521
|
$127.96 |
$127.96 |
$127.96 |
$311.50
|
|
External chromosome analysis 20-25 cells
|
$760.36 |
$760.36 |
$760.36 |
$384.15
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$129.96 |
$129.96 |
$129.96 |
$61.10
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$767.41 |
$767.41 |
$767.41 |
$454.20
|
|
Facial bones <3
|
$571.55 |
$571.55 |
$571.55 |
$252.60
|
|
Factor ix
|
$1,638.34 |
$1,638.34 |
$1,638.34 |
$156.13
|