|
CT Angiogram of Abdomen and Pelvis
|
$12,008.00 |
$12,008.00 |
$12,008.00 |
$2,839.85
|
|
CT Angiogram of the Head
|
$6,517.00 |
$6,517.00 |
$6,517.00 |
$2,021.40
|
|
CT angio pelvis
|
$5,585.00 |
$5,585.00 |
$5,585.00 |
$1,775.28
|
|
CT limited or localized follow-up study
|
$3,522.00 |
$3,522.00 |
$3,522.00 |
$625.63
|
|
CT neck soft tissue w/contrast
|
$9,976.00 |
$9,976.00 |
$9,976.00 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$9,890.00 |
$9,890.00 |
$9,890.00 |
$1,332.50
|
|
CT neck soft tissue without & w/contrast
|
$10,602.00 |
$10,602.00 |
$10,602.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$7,379.00 |
$7,379.00 |
$7,379.00 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$7,076.00 |
$7,076.00 |
$7,076.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$5,947.00 |
$5,947.00 |
$5,947.00 |
$1,351.20
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$19,520.00 |
$19,520.00 |
$19,520.00 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$16,588.00 |
$16,588.00 |
$16,588.00 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$15,070.00 |
$15,070.00 |
$15,070.00 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$10,527.00 |
$10,527.00 |
$10,527.00 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$10,101.00 |
$10,101.00 |
$10,101.00 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$186.00 |
$186.00 |
$186.00 |
$400.20
|
|
CT t-spine w /wo contrast
|
$10,992.00 |
$10,992.00 |
$10,992.00 |
$2,030.60
|
|
Culture afb any source
|
$315.00 |
$315.00 |
$315.00 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$538.00 |
$538.00 |
$538.00 |
$77.31
|
|
Culture anaerobic except blood
|
$360.00 |
$360.00 |
$360.00 |
$123.20
|
|
Culture fungi definitive id mold
|
$592.00 |
$592.00 |
$592.00 |
$70.00
|
|
Culture fungi definitive id yeast
|
$324.00 |
$324.00 |
$324.00 |
$80.60
|
|
Culture fungi skin/hair/nail
|
$269.00 |
$269.00 |
$269.00 |
$77.40
|
|
Culture mycobacteria definitive id each isolate
|
$686.00 |
$686.00 |
$686.00 |
$84.75
|
|
Culture mycoplasma any source
|
$403.00 |
$403.00 |
$403.00 |
$90.37
|
|
Culture quantitative aerobic other source
|
$30.00 |
$30.00 |
$30.00 |
$87.02
|
|
Culture typing added method
|
$23.00 |
$23.00 |
$23.00 |
$34.45
|
|
Culture typing immunologic
|
$57.00 |
$57.00 |
$57.00 |
$41.60
|
|
Culture urine each isolate
|
$382.00 |
$382.00 |
$382.00 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$124.00 |
$124.00 |
$124.00 |
$28.00
|
|
Cyclic citrullinated peptide antibody
|
$475.00 |
$475.00 |
$475.00 |
$80.05
|
|
Cyclosporine 2 hour
|
$384.00 |
$384.00 |
$384.00 |
$121.80
|
|
Cyclosporine oral 100 mg
|
$46.00 |
$46.00 |
$46.00 |
$34.00
|
|
Cyp2c19 gene com variants
|
$874.00 |
$874.00 |
$874.00 |
$567.75
|
|
Cystatin c
|
$215.00 |
$215.00 |
$215.00 |
$82.26
|
|
Cytogenetics 3-5
|
$814.00 |
$814.00 |
$814.00 |
$127.64
|
|
Cytomegalovirus (cmv) antibody igg
|
$337.00 |
$337.00 |
$337.00 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$713.00 |
$713.00 |
$713.00 |
$96.80
|
|
Cytomegalovirus dfa
|
$686.00 |
$686.00 |
$686.00 |
$59.59
|
|
Cytopath c/v auto in fluid
|
$441.00 |
$441.00 |
$441.00 |
$35.01
|
|
Cytopath c/v index add-on
|
$94.00 |
$94.00 |
$94.00 |
$29.60
|
|
Cytopathology cellular enhancement technique non-gyn
|
$539.00 |
$539.00 |
$539.00 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$483.00 |
$483.00 |
$483.00 |
$90.75
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$812.00 |
$812.00 |
$812.00 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$551.00 |
$551.00 |
$551.00 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$434.00 |
$434.00 |
$434.00 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$421.00 |
$421.00 |
$421.00 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$861.00 |
$861.00 |
$861.00 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$1,197.00 |
$1,197.00 |
$1,197.00 |
$205.00
|
|
Cytopath smear other source
|
$544.00 |
$544.00 |
$544.00 |
$122.19
|
|
Cytopath smear oth prep screen & interp
|
$611.00 |
$611.00 |
$611.00 |
$95.89
|
|
Cytopath tbs c/v manual
|
$303.00 |
$303.00 |
$303.00 |
$57.94
|
|
Dacarbazine 100 mg intravenous solution
|
$169.00 |
$169.00 |
$169.00 |
$73.20
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$17,030.00 |
$17,030.00 |
$17,030.00 |
$23,789.22
|
|
Decalcification
|
$326.00 |
$326.00 |
$326.00 |
$73.60
|
|
Decitabine 50 mg intravenous solution
|
$6,732.00 |
$6,732.00 |
$6,732.00 |
$1,350.27
|
|
Deferoxamine 500 mg solution for injection
|
$615.00 |
$615.00 |
$615.00 |
$96.41
|
|
Detect agnt mult dna direc
|
$519.00 |
$519.00 |
$519.00 |
$109.60
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$364.00 |
$364.00 |
$364.00 |
$220.43
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,089.00 |
$1,089.00 |
$1,089.00 |
$641.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$174.00 |
$174.00 |
$174.00 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$188.00 |
$188.00 |
$188.00 |
$61.49
|
|
Dextrose 5 % IV bolus
|
$203.00 |
$203.00 |
$203.00 |
$48.58
|
|
Dhea-s (dehydroepiand sulfate)
|
$521.00 |
$521.00 |
$521.00 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$359.00 |
$359.00 |
$359.00 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$1,442.00 |
$1,442.00 |
$1,442.00 |
$424.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$336.00 |
$336.00 |
$336.00 |
$78.40
|
|
Digoxin immune fab 40 mg intravenous solution
|
$12,744.00 |
$12,744.00 |
$12,744.00 |
$10,388.97
|
|
Digoxin total therapeutic drug level
|
$409.00 |
$409.00 |
$409.00 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$642.00 |
$642.00 |
$642.00 |
$309.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$124.00 |
$124.00 |
$124.00 |
$24.70
|
|
Dna antibody native/double stranded
|
$458.00 |
$458.00 |
$458.00 |
$102.60
|
|
Dna probe chlamydia
|
$283.00 |
$283.00 |
$283.00 |
$82.20
|
|
Dna probe gc
|
$259.00 |
$259.00 |
$259.00 |
$88.67
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$170.00 |
$170.00 |
$170.00 |
$76.20
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$6,320.00 |
$6,320.00 |
$6,320.00 |
$2,242.17
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$369.00 |
$369.00 |
$369.00 |
$88.05
|
|
Droperidol 2.5 mg/ml injection solution
|
$128.00 |
$128.00 |
$128.00 |
$34.85
|
|
Drug assay caffeine
|
$676.00 |
$676.00 |
$676.00 |
$81.61
|
|
Drug assay posaconazole
|
$501.00 |
$501.00 |
$501.00 |
$96.39
|
|
Drug assay vedolizumab
|
$327.00 |
$327.00 |
$327.00 |
$164.16
|
|
Drug of abuse screen urine
|
$327.00 |
$327.00 |
$327.00 |
$63.75
|
|
Drug screen quant tiagabine
|
$676.00 |
$676.00 |
$676.00 |
$91.80
|
|
Drug test def 1-7 classes
|
$513.00 |
$513.00 |
$513.00 |
$268.00
|
|
Drug test prsmv instrmnt
|
$501.00 |
$501.00 |
$501.00 |
$83.20
|
|
Echo guidance radiotherapy
|
$2,887.00 |
$2,887.00 |
$2,887.00 |
$774.80
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$10,532.00 |
$10,532.00 |
$10,532.00 |
$17,051.72
|
|
Edetate calcium disodium inj
|
$452.00 |
$452.00 |
$452.00 |
$6,086.32
|
|
Ehrlicha chaffeensis amp prb
|
$829.00 |
$829.00 |
$829.00 |
$105.00
|
|
Electrolyte panel
|
$470.00 |
$470.00 |
$470.00 |
$86.33
|
|
Entamoeba histolytica ag eia - sendout
|
$713.00 |
$713.00 |
$713.00 |
$66.47
|
|
Enzyme histochemistry
|
$781.00 |
$781.00 |
$781.00 |
$460.32
|
|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$148.00 |
$148.00 |
$148.00 |
$967.12
|
|
Epstein barr early antigen antibody
|
$283.00 |
$283.00 |
$283.00 |
$72.08
|
|
Epstein barr nuclear antigen antibody
|
$349.00 |
$349.00 |
$349.00 |
$81.81
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$718.00 |
$718.00 |
$718.00 |
$265.40
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$124.00 |
$124.00 |
$124.00 |
$248.39
|
|
Estradiol total
|
$740.00 |
$740.00 |
$740.00 |
$153.00
|
|
Estrogens total-sendout
|
$781.00 |
$781.00 |
$781.00 |
$89.25
|
|
Ethylene glycol -sendout
|
$322.00 |
$322.00 |
$322.00 |
$75.00
|
