|
Cyclosporine oral 100 mg
|
$7.84 |
$7.84 |
$7.84 |
$34.88
|
|
Cyp2c19 gene com variants
|
$238.56 |
$238.56 |
$238.56 |
$504.00
|
|
Cystatin c
|
$43.68 |
$43.68 |
$43.68 |
$77.50
|
|
Cystine urine quantitative
|
$40.60 |
$40.60 |
$40.60 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$157.92 |
$157.92 |
$157.92 |
$542.10
|
|
Cytomegalovirus (cmv) antibody igg
|
$8.96 |
$8.96 |
$8.96 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$14.84 |
$14.84 |
$14.84 |
$97.50
|
|
Cytopath fl nongyn filter
|
$45.36 |
$45.36 |
$45.36 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$35.56 |
$35.56 |
$35.56 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$40.32 |
$40.32 |
$40.32 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$42.00 |
$42.00 |
$42.00 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$6.44 |
$6.44 |
$6.44 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$18.48 |
$18.48 |
$18.48 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$85.96 |
$85.96 |
$85.96 |
$209.23
|
|
Cytopath smear other source
|
$47.32 |
$47.32 |
$47.32 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$49.00 |
$49.00 |
$49.00 |
$96.20
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$7.56 |
$7.56 |
$7.56 |
$6,072.48
|
|
Dch validity tests
|
$5.04 |
$5.04 |
$5.04 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$11.48 |
$11.48 |
$11.48 |
$43.60
|
|
Decalcification
|
$7.84 |
$7.84 |
$7.84 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$730.80 |
$730.80 |
$730.80 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$15.96 |
$15.96 |
$15.96 |
$95.85
|
|
Depo-estradiol cypionate inj
|
$8.40 |
$8.40 |
$8.40 |
$71.51
|
|
Desmopressin 4 mcg/ml injection solution
|
$10.64 |
$10.64 |
$10.64 |
$89.78
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$64.12 |
$64.12 |
$64.12 |
$227.15
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$1.12 |
$1.12 |
$1.12 |
$21.17
|
|
Dhea-s (dehydroepiand sulfate)
|
$7.84 |
$7.84 |
$7.84 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$19.60 |
$19.60 |
$19.60 |
$79.20
|
|
Diagnostic Mammogram (both breasts)
|
$97.44 |
$97.44 |
$97.44 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$75.88 |
$75.88 |
$75.88 |
$301.55
|
|
Diatrizoate meglumine 18 % urethral solution
|
$19.32 |
$19.32 |
$19.32 |
$115.15
|
|
Dicyclomine injection
|
$21.56 |
$21.56 |
$21.56 |
$153.29
|
|
Diffusing capacity
|
$71.96 |
$71.96 |
$71.96 |
$332.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$967.96 |
$967.96 |
$967.96 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$26.88 |
$26.88 |
$26.88 |
$102.00
|
|
Dilator fascial 10fx20cm
|
$191.52 |
$191.52 |
$191.52 |
$402.10
|
|
Dimethyl sulfoxide 50% 50 ml
|
$50.12 |
$50.12 |
$50.12 |
$1,258.20
|
|
Disability dlco
|
$92.68 |
$92.68 |
$92.68 |
$282.40
|
|
Dna antibody native/double stranded
|
$7.00 |
$7.00 |
$7.00 |
$97.50
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$7.00 |
$7.00 |
$7.00 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$0.67 |
$0.67 |
$0.67 |
$65.40
|
|
Doppler echo complete
|
$64.68 |
$64.68 |
$64.68 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$131.88 |
$131.88 |
$131.88 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$74.20 |
$74.20 |
$74.20 |
$471.17
|
|
Drainage lymph node lesion 38300
|
$433.16 |
$433.16 |
$433.16 |
$3,088.80
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$742.56 |
$742.56 |
$742.56 |
$2,540.00
|
|
Drain cath image guided visceral pq
|
$763.28 |
$763.28 |
$763.28 |
$2,850.35
|
|
Drain cerebro spinal fluid 62272
|
$302.96 |
$302.96 |
$302.96 |
$1,044.00
|
|
Drug assay voriconazole
|
$87.64 |
$87.64 |
$87.64 |
$96.75
|
|
Drug of abuse screen urine
|
$27.72 |
$27.72 |
$27.72 |
$63.75
|
|
Drug test def 1-7 classes
|
$60.76 |
$60.76 |
$60.76 |
$250.52
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$100.80 |
$100.80 |
$100.80 |
$278.85
|
|
Drvvt confirm - quest
|
$26.88 |
$26.88 |
$26.88 |
$109.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$232.68 |
$232.68 |
$232.68 |
$887.25
|
|
Ecg 12 lead tracing only
|
$43.96 |
$43.96 |
$43.96 |
$226.50
|
|
Ecg external < 48 hours recording
|
$145.88 |
$145.88 |
$145.88 |
$462.00
|
|
Ecg external > 48 hours up to 7 days recording
|
$145.88 |
$145.88 |
$145.88 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$145.88 |
$145.88 |
$145.88 |
$161.85
|
|
Echocardiogram (Heart Ultrasound)
|
$349.72 |
$349.72 |
$349.72 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$64.96 |
$64.96 |
$64.96 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$349.72 |
$349.72 |
$349.72 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$219.80 |
$219.80 |
$219.80 |
$703.25
|
|
E equine encephalitis igg
|
$12.88 |
$12.88 |
$12.88 |
$49.92
|
|
Egfr gene com variants
|
$201.60 |
$201.60 |
$201.60 |
$657.00
|
|
Electrolyte panel
|
$15.68 |
$15.68 |
$15.68 |
$84.24
|
|
Encephalitis, california igg/igm
|
$12.88 |
$12.88 |
$12.88 |
$53.55
|
|
Encephalitis, st louis igg/igm
|
$12.88 |
$12.88 |
$12.88 |
$48.57
|
|
Encephalitis, western equine igg/igm
|
$12.88 |
$12.88 |
$12.88 |
$53.10
|
|
Endoluminal bx urtr rnl plvs
|
$928.48 |
$928.48 |
$928.48 |
$2,290.60
|
|
Enoxaparin 30 mg/0.3 ml subcutaneous syringe
|
$3.36 |
$3.36 |
$3.36 |
$109.71
|
|
Enzyme histochemistry
|
$95.20 |
$95.20 |
$95.20 |
$471.60
|
|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$11.90 |
$11.90 |
$11.90 |
$1,289.71
|
|
Epstein barr early antigen antibody
|
$8.96 |
$8.96 |
$8.96 |
$60.48
|
|
Epstein barr nuclear antigen antibody
|
$75.04 |
$75.04 |
$75.04 |
$78.65
|
|
Epstein barr viral capsid antigen antibody igm
|
$36.96 |
$36.96 |
$36.96 |
$91.00
|
|
Eptifibatide 0.75 mg/ml intravenous solution
|
$10.64 |
$10.64 |
$10.64 |
$393.98
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$14.28 |
$14.28 |
$14.28 |
$222.98
|
|
ER Visit (level 1, minor)
|
$91.00 |
$91.00 |
$91.00 |
$246.24
|
|
ER Visit (level 2)
|
$164.08 |
$164.08 |
$164.08 |
$452.20
|
|
ER Visit (level 3)
|
$210.00 |
$210.00 |
$210.00 |
$770.04
|
|
ER Visit (level 4)
|
$280.00 |
$280.00 |
$280.00 |
$1,273.68
|
|
ER Visit (level 5, high severity)
|
$320.32 |
$320.32 |
$320.32 |
$1,820.02
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$14.84 |
$14.84 |
$14.84 |
$223.99
|
|
Established Patient Office Visit (level 2)
|
$21.00 |
$21.00 |
$21.00 |
$132.72
|
|
Established Patient Office Visit (level 3)
|
$28.56 |
$28.56 |
$28.56 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$43.68 |
$43.68 |
$43.68 |
$231.75
|
|
Estradiol total
|
$14.00 |
$14.00 |
$14.00 |
$146.50
|
|
Estrogens total-sendout
|
$21.28 |
$21.28 |
$21.28 |
$96.20
|
|
Ethylene glycol -sendout
|
$7.00 |
$7.00 |
$7.00 |
$89.40
|
|
Eval/fit voice prosthesis iii, st
|
$79.52 |
$79.52 |
$79.52 |
$356.00
|
|
Evaluation of speech fluency 92521
|
$50.96 |
$50.96 |
$50.96 |
$311.50
|
|
Event monitor
|
$40.60 |
$40.60 |
$40.60 |
$242.65
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$212.80 |
$212.80 |
$212.80 |
$454.20
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$36.68 |
$36.68 |
$36.68 |
$108.60
|
|
Facial bones <3
|
$45.36 |
$45.36 |
$45.36 |
$252.60
|
|
Factor ix
|
$35.28 |
$35.28 |
$35.28 |
$156.13
|
|
Factor ix non-recombinant
|
$0.42 |
$0.42 |
$0.42 |
$4.63
|
|
Factor viii
|
$35.28 |
$35.28 |
$35.28 |
$133.81
|
|
Factor viii recombinant nos
|
$0.56 |
$0.56 |
$0.56 |
$6.56
|
|
Fat/lipids feces qualitative
|
$12.32 |
$12.32 |
$12.32 |
$38.35
|