|
Culture quantitative aerobic other source
|
$680.90 |
$680.90 |
$680.90 |
$87.02
|
|
Culture typing immunologic
|
$170.43 |
$170.43 |
$170.43 |
$41.60
|
|
Culture urine each isolate
|
$561.60 |
$561.60 |
$561.60 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$76.10 |
$76.10 |
$76.10 |
$28.00
|
|
Cyclic citrullinated peptide antibody
|
$647.26 |
$647.26 |
$647.26 |
$80.05
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$2,905.20 |
$2,905.20 |
$2,905.20 |
$1,348.50
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$725.81 |
$725.81 |
$725.81 |
$140.78
|
|
Cyclosporine 2 hour
|
$945.52 |
$945.52 |
$945.52 |
$121.80
|
|
Cyclosporine modified 25 mg capsule
|
$49.17 |
$49.17 |
$49.17 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$44.61 |
$44.61 |
$44.61 |
$34.00
|
|
Cystatin c
|
$441.72 |
$441.72 |
$441.72 |
$82.26
|
|
Cytomegalovirus (cmv) antibody igg
|
$587.76 |
$587.76 |
$587.76 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$862.13 |
$862.13 |
$862.13 |
$96.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$1,219.54 |
$1,219.54 |
$1,219.54 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$369.17 |
$369.17 |
$369.17 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$1,060.50 |
$1,060.50 |
$1,060.50 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$609.77 |
$609.77 |
$609.77 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$609.77 |
$609.77 |
$609.77 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$609.77 |
$609.77 |
$609.77 |
$205.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$2,186.09 |
$2,186.09 |
$2,186.09 |
$362.16
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$1,625.93 |
$1,625.93 |
$1,625.93 |
$300.73
|
|
Decalcification
|
$333.37 |
$333.37 |
$333.37 |
$73.60
|
|
Decitabine 50 mg intravenous solution
|
$155.63 |
$155.63 |
$155.63 |
$1,350.27
|
|
Deferoxamine 500 mg solution for injection
|
$250.98 |
$250.98 |
$250.98 |
$96.41
|
|
Design mlc device for imrt
|
$11,824.20 |
$11,824.20 |
$11,824.20 |
$1,669.85
|
|
Desmopressin 4 mcg/ml injection solution
|
$538.01 |
$538.01 |
$538.01 |
$116.22
|
|
Device intraute mirena
|
$9,065.26 |
$9,065.26 |
$9,065.26 |
$2,211.85
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$2,145.15 |
$2,145.15 |
$2,145.15 |
$641.76
|
|
Dextrose 5 % IV bolus
|
$319.37 |
$319.37 |
$319.37 |
$48.58
|
|
Dhea-s (dehydroepiand sulfate)
|
$351.53 |
$351.53 |
$351.53 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$544.23 |
$544.23 |
$544.23 |
$78.03
|
|
Diab manage trn ind/group
|
$157.17 |
$157.17 |
$157.17 |
$58.08
|
|
Diagnostic Mammogram (both breasts)
|
$1,315.73 |
$1,315.73 |
$1,315.73 |
$424.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$219.62 |
$219.62 |
$219.62 |
$73.22
|
|
Dicyclomine injection
|
$541.25 |
$541.25 |
$541.25 |
$202.91
|
|
Digoxin immune fab 40 mg intravenous solution
|
$16,922.48 |
$16,922.48 |
$16,922.48 |
$10,388.97
|
|
Digoxin total therapeutic drug level
|
$410.43 |
$410.43 |
$410.43 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,016.31 |
$1,016.31 |
$1,016.31 |
$309.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$155.68 |
$155.68 |
$155.68 |
$24.70
|
|
Disaccharidases
|
$1,976.55 |
$1,976.55 |
$1,976.55 |
$223.80
|
|
Discography cerv/thor spine
|
$7,245.62 |
$7,245.62 |
$7,245.62 |
$2,404.00
|
|
Dna antibody native/double stranded
|
$551.73 |
$551.73 |
$551.73 |
$102.60
|
|
Dna gardnerella
|
$166.86 |
$166.86 |
$166.86 |
$67.68
|
|
Dna trichomonas
|
$166.86 |
$166.86 |
$166.86 |
$68.75
|
|
Doppler echo complete
|
$1,804.33 |
$1,804.33 |
$1,804.33 |
$608.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,111.17 |
$1,111.17 |
$1,111.17 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$1,028.22 |
$1,028.22 |
$1,028.22 |
$482.03
|
|
Dornase alfa non-comp unit
|
$573.56 |
$573.56 |
$573.56 |
$350.67
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$20,364.51 |
$20,364.51 |
$20,364.51 |
$2,242.17
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$297.60 |
$297.60 |
$297.60 |
$88.05
|
|
Drain ostomy pouch w/flange
|
$31.00 |
$31.00 |
$31.00 |
$9.75
|
|
Droperidol 2.5 mg/ml injection solution
|
$126.21 |
$126.21 |
$126.21 |
$34.85
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$94.00 |
$94.00 |
$94.00 |
$127.14
|
|
Drug test def 1-7 classes
|
$1,581.36 |
$1,581.36 |
$1,581.36 |
$268.00
|
|
Dup scan/hemodialysis access 93990
|
$2,177.60 |
$2,177.60 |
$2,177.60 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$2,739.68 |
$2,739.68 |
$2,739.68 |
$757.57
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,782.57 |
$2,782.57 |
$2,782.57 |
$903.00
|
|
Ecg 12 lead tracing only
|
$665.76 |
$665.76 |
$665.76 |
$245.00
|
|
Echocardiogram (Heart Ultrasound)
|
$7,143.14 |
$7,143.14 |
$7,143.14 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$1,599.37 |
$1,599.37 |
$1,599.37 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$7,143.14 |
$7,143.14 |
$7,143.14 |
$2,070.12
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,145.35 |
$1,145.35 |
$1,145.35 |
$724.20
|
|
Echocardiograpy doppler follow up/limited study
|
$783.15 |
$783.15 |
$783.15 |
$353.46
|
|
Echo exam uterus 76831-
|
$2,481.32 |
$2,481.32 |
$2,481.32 |
$547.20
|
|
Echo guide for artery repair
|
$5,068.14 |
$5,068.14 |
$5,068.14 |
$680.28
|
|
Echo tee probe placement image acquisition interpretation & report
|
$6,568.62 |
$6,568.62 |
$6,568.62 |
$1,871.10
|
|
Echo transthoracic
|
$4,763.19 |
$4,763.19 |
$4,763.19 |
$1,492.50
|
|
Echo transthoracic
|
$835.32 |
$835.32 |
$835.32 |
$953.10
|
|
Eeg over 1 hour 95813 - 26
|
$3,142.21 |
$3,142.21 |
$3,142.21 |
$1,119.54
|
|
Eeg/record in coma or sleep only 95822
|
$2,348.20 |
$2,348.20 |
$2,348.20 |
$936.00
|
|
Eeg recording awake and asleep
|
$2,402.10 |
$2,402.10 |
$2,402.10 |
$1,030.27
|
|
Egfr gene com variants
|
$1,774.95 |
$1,774.95 |
$1,774.95 |
$619.04
|
|
Electrolyte panel
|
$775.59 |
$775.59 |
$775.59 |
$86.33
|
|
Electrophysiologic study
|
$22,380.43 |
$22,380.43 |
$22,380.43 |
$6,758.40
|
|
Electrophysiology evaluation
|
$23,782.17 |
$23,782.17 |
$23,782.17 |
$8,979.45
|
|
Electrophysiology evaluation
|
$23,782.17 |
$23,782.17 |
$23,782.17 |
$11,175.42
|
|
Electrophysiology evaluation
|
$3,700.87 |
$3,700.87 |
$3,700.87 |
$7,769.30
|
|
Electrophysiology evaluation
|
$3,700.87 |
$3,700.87 |
$3,700.87 |
$6,516.00
|
|
Electrophysiology evaluation
|
$3,305.99 |
$3,305.99 |
$3,305.99 |
$2,845.10
|
|
Electrophysiology evaluation
|
$3,061.10 |
$3,061.10 |
$3,061.10 |
$2,803.20
|
|
Electrophys map 3d add-on
|
$707.12 |
$707.12 |
$707.12 |
$6,534.00
|
|
Embolization s&i
|
$15,185.87 |
$15,185.87 |
$15,185.87 |
$3,060.05
|
|
Ep & ablate supravent arrhyt
|
$41,923.64 |
$41,923.64 |
$41,923.64 |
$29,766.10
|
|
Ep & ablate ventric tachy
|
$41,923.64 |
$41,923.64 |
$41,923.64 |
$30,975.00
|
|
Ep induct arrhy by elect pacing
|
$3,700.87 |
$3,700.87 |
$3,700.87 |
$2,753.40
|
|
Epinephrine 0.1 mg/ml injection syringe
|
$153.90 |
$153.90 |
$153.90 |
$37.86
|
|
Epinephrine 1 mg/ml im kit - adult
|
$162.81 |
$162.81 |
$162.81 |
$50.40
|
|
Epirubicin 200 mg/100 ml intravenous solution
|
$670.83 |
$670.83 |
$670.83 |
$203.16
|
|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$1,166.40 |
$1,166.40 |
$1,166.40 |
$967.12
|
|
Epstein barr early antigen antibody
|
$210.11 |
$210.11 |
$210.11 |
$72.08
|
|
Epstein barr nuclear antigen antibody
|
$249.18 |
$249.18 |
$249.18 |
$81.81
|
|
Eptinezumab-jjmr 100 mg/ml intravenous solution
|
$7,370.48 |
$7,370.48 |
$7,370.48 |
$4,539.76
|
|
Ercp biliary & pancreas
|
$1,637.08 |
$1,637.08 |
$1,637.08 |
$943.50
|
|
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution
|
$7,753.48 |
$7,753.48 |
$7,753.48 |
$2,568.00
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,081.25 |
$1,081.25 |
$1,081.25 |
$265.40
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$527.07 |
$527.07 |
$527.07 |
$248.39
|
|
Esoph balloon distension tst
|
$2,292.19 |
$2,292.19 |
$2,292.19 |
$780.00
|
|
Estradiol total
|
$1,093.97 |
$1,093.97 |
$1,093.97 |
$153.00
|
|
Estrogens total-sendout
|
$1,063.29 |
$1,063.29 |
$1,063.29 |
$89.25
|
|
Ethylene glycol -sendout
|
$237.30 |
$237.30 |
$237.30 |
$75.00
|
