|
Culture screening strep group a
|
$36.10 |
$36.10 |
$36.10 |
$81.60
|
|
Culture urine each isolate
|
$26.95 |
$26.95 |
$26.95 |
$46.20
|
|
Cutter lead
|
$1,492.92 |
$1,492.92 |
$1,492.92 |
$4,834.73
|
|
Cyanocobalamin unsat binding capacity
|
$47.29 |
$47.29 |
$47.29 |
$60.00
|
|
Cyclic citrullinated peptide antibody
|
$66.86 |
$66.86 |
$66.86 |
$80.05
|
|
Cyclosporine 2 hour
|
$63.81 |
$63.81 |
$63.81 |
$121.80
|
|
Cyclosporine oral 100 mg
|
$8.56 |
$8.56 |
$8.56 |
$34.00
|
|
Cylinder pump set 20cm titan zero angl
|
$10,116.15 |
$10,116.15 |
$10,116.15 |
$24,131.60
|
|
Cystatin c
|
$40.68 |
$40.68 |
$40.68 |
$82.26
|
|
Cystine urine quantitative
|
$55.93 |
$55.93 |
$55.93 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$169.56 |
$169.56 |
$169.56 |
$539.55
|
|
Cystoscopy and treatment
|
$492.14 |
$492.14 |
$492.14 |
$3,174.25
|
|
Cystoscopy and treatment
|
$1,720.68 |
$1,720.68 |
$1,720.68 |
$3,219.80
|
|
Cystostomy cystotomy w/drainage 51040
|
$1,927.35 |
$1,927.35 |
$1,927.35 |
$3,774.40
|
|
Cystourethroscop/calib/dilat stric 52281
|
$873.94 |
$873.94 |
$873.94 |
$2,874.36
|
|
Cytomegalovirus (cmv) antibody igg
|
$54.91 |
$54.91 |
$54.91 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$54.15 |
$54.15 |
$54.15 |
$96.80
|
|
Cyto/molecular report
|
$82.87 |
$82.87 |
$82.87 |
$144.75
|
|
Cytopath c/v manual
|
$34.83 |
$34.83 |
$34.83 |
$25.59
|
|
Cytopath fl nongyn filter
|
$66.61 |
$66.61 |
$66.61 |
$73.70
|
|
Cytopathology cellular enhancement technique non-gyn
|
$128.63 |
$128.63 |
$128.63 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$50.34 |
$50.34 |
$50.34 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$55.67 |
$55.67 |
$55.67 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$66.61 |
$66.61 |
$66.61 |
$124.80
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$186.08 |
$186.08 |
$186.08 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$99.65 |
$99.65 |
$99.65 |
$205.00
|
|
Cytopath smear other source
|
$27.97 |
$27.97 |
$27.97 |
$85.80
|
|
Cytopath smear other source
|
$104.23 |
$104.23 |
$104.23 |
$122.19
|
|
Cytopath smear oth prep screen & interp
|
$66.61 |
$66.61 |
$66.61 |
$95.89
|
|
Dalbavancin 500 mg intravenous solution
|
$3,323.41 |
$3,323.41 |
$3,323.41 |
$3,469.30
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$771.50 |
$771.50 |
$771.50 |
$362.16
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$1,259.31 |
$1,259.31 |
$1,259.31 |
$3,774.81
|
|
Dch validity tests
|
$10.68 |
$10.68 |
$10.68 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$7.63 |
$7.63 |
$7.63 |
$44.16
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$367.07 |
$367.07 |
$367.07 |
$692.00
|
|
Debridement (>20 cm) charge pt
|
$145.41 |
$145.41 |
$145.41 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$982.23 |
$982.23 |
$982.23 |
$2,553.60
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$477.14 |
$477.14 |
$477.14 |
$810.50
|
|
Debride nail1-5 11720
|
$49.32 |
$49.32 |
$49.32 |
$173.25
|
|
Debride skin bone at fx site
|
$1,594.86 |
$1,594.86 |
$1,594.86 |
$3,278.34
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,425.05 |
$1,425.05 |
$1,425.05 |
$1,129.45
|
|
Debr musc/fascia 20sq cm/< 11043
|
$598.39 |
$598.39 |
$598.39 |
$1,193.40
|
|
Decalcification
|
$8.39 |
$8.39 |
$8.39 |
$73.60
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$245.31 |
$245.31 |
$245.31 |
$545.90
|
|
Degarelix 120 mg subcutaneous solution
|
$912.43 |
$912.43 |
$912.43 |
$1,936.32
|
|
Delivery of placenta 59414
|
$586.95 |
$586.95 |
$586.95 |
$3,271.20
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$951.98 |
$951.98 |
$951.98 |
$7,763.47
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$57.20 |
$57.20 |
$57.20 |
$196.26
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$149.98 |
$149.98 |
$149.98 |
$460.50
|
|
Descend thora aorta rpr/lt sub art 33880
|
$2,645.72 |
$2,645.72 |
$2,645.72 |
$5,702.04
|
|
Desmopressin 4 mcg/ml injection solution
|
$109.83 |
$109.83 |
$109.83 |
$116.22
|
|
Des thora aorta/ea add prox prosth 33884
|
$624.83 |
$624.83 |
$624.83 |
$1,285.78
|
|
Des thora aorta rpr without left sub art 33881
|
$1,584.94 |
$1,584.94 |
$1,584.94 |
$5,698.68
|
|
Des thor aorta/prox ext prosth/ini 33883
|
$1,554.95 |
$1,554.95 |
$1,554.95 |
$2,498.88
|
|
Destruction vag lesions simple 57061
|
$1,410.05 |
$1,410.05 |
$1,410.05 |
$3,762.53
|
|
Detect agent nos dna dir
|
$66.35 |
$66.35 |
$66.35 |
$67.15
|
|
Device ablt adv novasure
|
$1,386.41 |
$1,386.41 |
$1,386.41 |
$6,097.50
|
|
Device sut capio slim opn
|
$928.65 |
$928.65 |
$928.65 |
$1,946.41
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$33.31 |
$33.31 |
$33.31 |
$220.43
|
|
Dexamethasone 4 mg tablet
|
$1.70 |
$1.70 |
$1.70 |
$5.17
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$11.79 |
$11.79 |
$11.79 |
$27.00
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,024.61 |
$1,024.61 |
$1,024.61 |
$641.76
|
|
Dhea-s (dehydroepiand sulfate)
|
$73.47 |
$73.47 |
$73.47 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$40.17 |
$40.17 |
$40.17 |
$78.03
|
|
Diagnostic anoscopy spx 46600
|
$50.84 |
$50.84 |
$50.84 |
$245.35
|
|
Diagnostic laryngoscopy 31575
|
$125.07 |
$125.07 |
$125.07 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$187.35 |
$187.35 |
$187.35 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$149.98 |
$149.98 |
$149.98 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$78.81 |
$78.81 |
$78.81 |
$239.25
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,554.48 |
$3,554.48 |
$3,554.48 |
$7,145.00
|
|
Dialysis one evaluation
|
$215.57 |
$215.57 |
$215.57 |
$842.10
|
|
Diffusing capacity
|
$69.40 |
$69.40 |
$69.40 |
$360.10
|
|
Digoxin total therapeutic drug level
|
$41.69 |
$41.69 |
$41.69 |
$102.00
|
|
Dilate biliary duct/ampulla
|
$337.58 |
$337.58 |
$337.58 |
$2,304.60
|
|
Dilate esophagus
|
$886.65 |
$886.65 |
$886.65 |
$2,003.04
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$1,670.86 |
$1,670.86 |
$1,670.86 |
$4,322.56
|
|
Dilate ic vasospasm ea add vsl same territory
|
$1,670.86 |
$1,670.86 |
$1,670.86 |
$2,299.05
|
|
Dilate ic vasospasm init
|
$3,833.34 |
$3,833.34 |
$3,833.34 |
$6,280.95
|
|
Dilation/urethral strict/male/ini 53620
|
$1,071.46 |
$1,071.46 |
$1,071.46 |
$1,550.25
|
|
Dilator fascial 10fx20cm
|
$209.97 |
$209.97 |
$209.97 |
$334.34
|
|
Dilat xst trc ndurlgc px
|
$251.41 |
$251.41 |
$251.41 |
$4,081.37
|
|
Dipyridamole injection
|
$18.35 |
$18.35 |
$18.35 |
$45.09
|
|
Disaccharidases
|
$59.49 |
$59.49 |
$59.49 |
$223.80
|
|
Discography cerv/thor spine
|
$1,542.74 |
$1,542.74 |
$1,542.74 |
$2,404.00
|
|
Dlyd plmt xtn prosth ea addl
|
$951.98 |
$951.98 |
$951.98 |
$2,001.55
|
|
Dna antibody native/double stranded
|
$52.62 |
$52.62 |
$52.62 |
$102.60
|
|
Dna probe chlamydia
|
$66.35 |
$66.35 |
$66.35 |
$82.20
|
|
Dna probe gc
|
$66.35 |
$66.35 |
$66.35 |
$88.67
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$10.37 |
$10.37 |
$10.37 |
$101.04
|
|
Doppler echo complete
|
$311.15 |
$311.15 |
$311.15 |
$608.25
|
|
Doppler intravascular pressure flow initial vessel
|
$766.42 |
$766.42 |
$766.42 |
$3,006.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$227.51 |
$227.51 |
$227.51 |
$696.80
|
|
Dornhoffer fixed part w/window
|
$21,031.88 |
$21,031.88 |
$21,031.88 |
$36,072.59
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$45.13 |
$45.13 |
$45.13 |
$88.05
|
|
Dpyd gene common variants
|
$184.55 |
$184.55 |
$184.55 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$125.58 |
$125.58 |
$125.58 |
$820.50
|
|
Drainage ext aud canal abscess 69020
|
$146.42 |
$146.42 |
$146.42 |
$900.80
|
|
Drainage external ear complex 69005
|
$1,220.93 |
$1,220.93 |
$1,220.93 |
$2,967.58
|
|
Drainage external ear simple 69000
|
$311.65 |
$311.65 |
$311.65 |
$809.25
|
|
Drainage mouth roof lesion
|
$267.93 |
$267.93 |
$267.93 |
$474.39
|