|
CT t-spine w /wo contrast
|
$6,748.47 |
$6,748.47 |
$6,748.47 |
$2,027.52
|
|
Culture afb any source
|
$702.64 |
$702.64 |
$702.64 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$812.79 |
$812.79 |
$812.79 |
$79.00
|
|
Culture anaerobic except blood
|
$964.62 |
$964.62 |
$964.62 |
$120.00
|
|
Culture fungi definitive id mold
|
$741.33 |
$741.33 |
$741.33 |
$77.28
|
|
Culture fungi definitive id yeast
|
$567.15 |
$567.15 |
$567.15 |
$79.10
|
|
Culture fungi other (except blood)
|
$885.73 |
$885.73 |
$885.73 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$905.08 |
$905.08 |
$905.08 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$291.79 |
$291.79 |
$291.79 |
$89.70
|
|
Culture quantitative aerobic other source
|
$905.08 |
$905.08 |
$905.08 |
$90.35
|
|
Culture typing added method
|
$812.79 |
$812.79 |
$812.79 |
$38.58
|
|
Culture typing immunologic
|
$468.92 |
$468.92 |
$468.92 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$421.29 |
$421.29 |
$421.29 |
$133.90
|
|
Culture urine each isolate
|
$446.59 |
$446.59 |
$446.59 |
$57.00
|
|
Cyanocobalamin unsat binding capacity
|
$1,866.72 |
$1,866.72 |
$1,866.72 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$46.21 |
$46.21 |
$46.21 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$473.38 |
$473.38 |
$473.38 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$16.51 |
$16.51 |
$16.51 |
$1,305.02
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$464.89 |
$464.89 |
$464.89 |
$140.78
|
|
Cyclosporine 2 hour
|
$1,024.16 |
$1,024.16 |
$1,024.16 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$43.05 |
$43.05 |
$43.05 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$118.42 |
$118.42 |
$118.42 |
$34.88
|
|
Cyp2c9 gene com variants
|
$491.25 |
$491.25 |
$491.25 |
$275.10
|
|
Cystatin c
|
$305.18 |
$305.18 |
$305.18 |
$77.50
|
|
Cystic fibrosis cftr
|
$4,123.44 |
$4,123.44 |
$4,123.44 |
$1,100.00
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,467.90 |
$1,467.90 |
$1,467.90 |
$542.10
|
|
Cytogenetics 25-99
|
$202.45 |
$202.45 |
$202.45 |
$190.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$826.19 |
$826.19 |
$826.19 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$1,037.56 |
$1,037.56 |
$1,037.56 |
$97.50
|
|
Cytomegalovirus imm IV /vial
|
$9,993.36 |
$9,993.36 |
$9,993.36 |
$3,072.34
|
|
Cytopath c/v manual
|
$388.52 |
$388.52 |
$388.52 |
$36.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$546.33 |
$546.33 |
$546.33 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$168.21 |
$168.21 |
$168.21 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$617.79 |
$617.79 |
$617.79 |
$129.35
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$180.12 |
$180.12 |
$180.12 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$220.31 |
$220.31 |
$220.31 |
$209.23
|
|
Cytopath smear other source
|
$117.61 |
$117.61 |
$117.61 |
$88.13
|
|
Cytopath smear other source
|
$168.21 |
$168.21 |
$168.21 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$117.61 |
$117.61 |
$117.61 |
$96.20
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$307.00 |
$307.00 |
$307.00 |
$168.53
|
|
Dark field exam spec collj
|
$1,376.97 |
$1,376.97 |
$1,376.97 |
$31.20
|
|
Dark field exam without collj
|
$1,376.97 |
$1,376.97 |
$1,376.97 |
$28.80
|
|
Decalcification
|
$269.44 |
$269.44 |
$269.44 |
$68.90
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$1,191.38 |
$1,191.38 |
$1,191.38 |
$185.17
|
|
Depo-estradiol cypionate inj
|
$360.13 |
$360.13 |
$360.13 |
$71.51
|
|
Dermapure 1 square cm
|
$1,087.00 |
$1,087.00 |
$1,087.00 |
$3,822.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$560.12 |
$560.12 |
$560.12 |
$89.78
|
|
Detect agent nos dna dir
|
$826.19 |
$826.19 |
$826.19 |
$115.20
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$45,607.00 |
$45,607.00 |
$45,607.00 |
$4,200.00
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$377.29 |
$377.29 |
$377.29 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$337.40 |
$337.40 |
$337.40 |
$45.40
|
|
Dextrose 5 % IV bolus
|
$249.07 |
$249.07 |
$249.07 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$1,990.25 |
$1,990.25 |
$1,990.25 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$693.69 |
$693.69 |
$693.69 |
$79.20
|
|
Diagnostic Mammogram (both breasts)
|
$1,367.01 |
$1,367.01 |
$1,367.01 |
$399.30
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$268.63 |
$268.63 |
$268.63 |
$74.76
|
|
Diffusing capacity
|
$2,920.16 |
$2,920.16 |
$2,920.16 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$42.80 |
$42.80 |
$42.80 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$31,088.64 |
$31,088.64 |
$31,088.64 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$473.38 |
$473.38 |
$473.38 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,858.85 |
$1,858.85 |
$1,858.85 |
$297.86
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$42.80 |
$42.80 |
$42.80 |
$17.75
|
|
Disability dlco
|
$1,562.19 |
$1,562.19 |
$1,562.19 |
$282.40
|
|
Dna antibody native/double stranded
|
$791.96 |
$791.96 |
$791.96 |
$97.50
|
|
Dna gardnerella
|
$318.55 |
$318.55 |
$318.55 |
$62.50
|
|
Dna probe chlamydia
|
$372.16 |
$372.16 |
$372.16 |
$79.38
|
|
Dna probe gc
|
$588.00 |
$588.00 |
$588.00 |
$80.80
|
|
Dna trichomonas
|
$318.55 |
$318.55 |
$318.55 |
$67.80
|
|
Doppler echo complete
|
$2,822.07 |
$2,822.07 |
$2,822.07 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$4,345.74 |
$4,345.74 |
$4,345.74 |
$662.35
|
|
Dornase alfa non-comp unit
|
$1,295.51 |
$1,295.51 |
$1,295.51 |
$446.75
|
|
Dorsi & plantar flex ass/res
|
$589.00 |
$589.00 |
$589.00 |
$163.50
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$213.84 |
$213.84 |
$213.84 |
$84.80
|
|
Drug assay caffeine
|
$486.78 |
$486.78 |
$486.78 |
$83.40
|
|
Drug assay voriconazole
|
$647.57 |
$647.57 |
$647.57 |
$96.75
|
|
Drug of abuse screen urine
|
$190.54 |
$190.54 |
$190.54 |
$63.75
|
|
Drug test def 15-21 classes
|
$2,143.60 |
$2,143.60 |
$2,143.60 |
$263.25
|
|
Drug test def 1-7 classes
|
$2,143.60 |
$2,143.60 |
$2,143.60 |
$250.52
|
|
Drug test def 22+ classes
|
$2,143.60 |
$2,143.60 |
$2,143.60 |
$423.00
|
|
Drug test def 8-14 classes
|
$2,143.60 |
$2,143.60 |
$2,143.60 |
$282.00
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$336.97 |
$336.97 |
$336.97 |
$278.85
|
|
Drvvt confirm - quest
|
$1,088.17 |
$1,088.17 |
$1,088.17 |
$109.20
|
|
Duplex scan bilateral study 93985
|
$4,345.74 |
$4,345.74 |
$4,345.74 |
$690.95
|
|
Duplex scan unilateral study 93986
|
$2,172.85 |
$2,172.85 |
$2,172.85 |
$360.75
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$3,452.20 |
$3,452.20 |
$3,452.20 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$4,345.74 |
$4,345.74 |
$4,345.74 |
$887.25
|
|
Ecg 12 lead tracing only
|
$1,314.44 |
$1,314.44 |
$1,314.44 |
$226.50
|
|
Echocardiogram (Heart Ultrasound)
|
$8,660.97 |
$8,660.97 |
$8,660.97 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$1,482.68 |
$1,482.68 |
$1,482.68 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$8,598.18 |
$8,598.18 |
$8,598.18 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$2,814.01 |
$2,814.01 |
$2,814.01 |
$703.25
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$4,072.92 |
$4,072.92 |
$4,072.92 |
$851.50
|
|
Echocardiograpy doppler follow up/limited study
|
$2,165.24 |
$2,165.24 |
$2,165.24 |
$362.50
|
|
Echo guide for amniocentesis
|
$2,413.56 |
$2,413.56 |
$2,413.56 |
$456.30
|
|
Echo guide for artery repair
|
$2,433.85 |
$2,433.85 |
$2,433.85 |
$664.00
|
|
Echo stress
|
$8,158.70 |
$8,158.70 |
$8,158.70 |
$1,592.05
|
|
Echo tee guidance
|
$13,445.42 |
$13,445.42 |
$13,445.42 |
$1,821.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$6,722.72 |
$6,722.72 |
$6,722.72 |
$1,849.50
|
|
Echo transesophageal
|
$10,409.26 |
$10,409.26 |
$10,409.26 |
$1,559.35
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$5,811.54 |
$5,811.54 |
$5,811.54 |
$985.15
|
