|
CT Angiogram of Abdomen and Pelvis
|
$2,719.98 |
$2,719.98 |
$2,719.98 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$1,818.14 |
$1,818.14 |
$1,818.14 |
$1,955.80
|
|
CT Angiogram of the Head
|
$1,505.85 |
$1,505.85 |
$1,505.85 |
$2,021.40
|
|
CT angio hrt w/3d image
|
$2,184.75 |
$2,184.75 |
$2,184.75 |
$1,588.60
|
|
CT angio pelvis
|
$1,333.28 |
$1,333.28 |
$1,333.28 |
$1,775.28
|
|
Cta upper extremity w &/or without contrast left
|
$919.80 |
$919.80 |
$919.80 |
$1,652.25
|
|
CT colonography dx
|
$1,783.54 |
$1,783.54 |
$1,783.54 |
$770.90
|
|
CT colonography dx w/dye
|
$1,923.70 |
$1,923.70 |
$1,923.70 |
$1,009.98
|
|
CT colonography screening
|
$792.78 |
$792.78 |
$792.78 |
$1,084.20
|
|
CT guidance for needle placement
|
$1,722.66 |
$1,722.66 |
$1,722.66 |
$1,506.04
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$629.41 |
$629.41 |
$629.41 |
$1,085.05
|
|
CT guid parench tis ablat
|
$377.12 |
$377.12 |
$377.12 |
$1,281.75
|
|
CT heart w/evaluation of calcium without contrast
|
$196.67 |
$196.67 |
$196.67 |
$192.00
|
|
CT hrt c+ strux cgen hrt ds
|
$2,184.75 |
$2,184.75 |
$2,184.75 |
$1,217.45
|
|
CT hrt w/3d image
|
$2,184.75 |
$2,184.75 |
$2,184.75 |
$1,418.60
|
|
CT limited or localized follow-up study
|
$130.53 |
$130.53 |
$130.53 |
$625.63
|
|
CT lower extremity w/contrast (both sides)
|
$836.15 |
$836.15 |
$836.15 |
$1,693.20
|
|
CT lower extremity without contrast (both sides)
|
$1,266.70 |
$1,266.70 |
$1,266.70 |
$1,398.82
|
|
CT lwr extremity w/o&w/dye
|
$1,254.00 |
$1,254.00 |
$1,254.00 |
$1,817.40
|
|
CT neck soft tissue w/contrast
|
$1,988.52 |
$1,988.52 |
$1,988.52 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$954.41 |
$954.41 |
$954.41 |
$1,332.50
|
|
CT neck soft tissue without & w/contrast
|
$1,630.68 |
$1,630.68 |
$1,630.68 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,618.41 |
$1,618.41 |
$1,618.41 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,985.90 |
$1,985.90 |
$1,985.90 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,839.17 |
$1,839.17 |
$1,839.17 |
$1,351.20
|
|
CT scan for therapy guide
|
$742.85 |
$742.85 |
$742.85 |
$729.40
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$3,262.23 |
$3,262.23 |
$3,262.23 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,198.28 |
$3,198.28 |
$3,198.28 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,038.41 |
$3,038.41 |
$3,038.41 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$1,527.31 |
$1,527.31 |
$1,527.31 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,678.42 |
$1,678.42 |
$1,678.42 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,445.84 |
$1,445.84 |
$1,445.84 |
$400.20
|
|
CT t-spine w /wo contrast
|
$2,148.39 |
$2,148.39 |
$2,148.39 |
$2,030.60
|
|
CT upper extremity w/contrast (both sides)
|
$1,367.00 |
$1,367.00 |
$1,367.00 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$1,314.44 |
$1,314.44 |
$1,314.44 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$1,261.88 |
$1,261.88 |
$1,261.88 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$115.20 |
$115.20 |
$115.20 |
$63.75
|
|
Culture afb any source
|
$133.59 |
$133.59 |
$133.59 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$35.92 |
$35.92 |
$35.92 |
$77.31
|
|
Culture anaerobic except blood
|
$265.87 |
$265.87 |
$265.87 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$22.34 |
$22.34 |
$22.34 |
$52.80
|
|
Culture body fluid
|
$281.20 |
$281.20 |
$281.20 |
$130.50
|
|
Culture fungi definitive id mold
|
$77.53 |
$77.53 |
$77.53 |
$70.00
|
|
Culture fungi definitive id yeast
|
$30.26 |
$30.26 |
$30.26 |
$80.60
|
|
Culture fungi other (except blood)
|
$195.35 |
$195.35 |
$195.35 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$65.27 |
$65.27 |
$65.27 |
$77.40
|
|
Culture mycoplasma any source
|
$7.34 |
$7.34 |
$7.34 |
$90.37
|
|
Culture screening strep group a
|
$175.20 |
$175.20 |
$175.20 |
$81.60
|
|
Culture typing immunologic
|
$46.87 |
$46.87 |
$46.87 |
$41.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$124.40 |
$124.40 |
$124.40 |
$124.40
|
|
Cutter lead
|
$6,152.59 |
$6,152.59 |
$6,152.59 |
$5,538.98
|
|
Cv line/pic reposition
|
$848.41 |
$848.41 |
$848.41 |
$1,829.42
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$29.35 |
$29.35 |
$29.35 |
$33.37
|
|
Cyclic citrullinated peptide antibody
|
$27.60 |
$27.60 |
$27.60 |
$80.05
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$399.02 |
$399.02 |
$399.02 |
$1,048.28
|
|
Cyclophosphamide 25 mg capsule
|
$19.51 |
$19.51 |
$19.51 |
$23.49
|
|
Cyclosporine 2 hour
|
$54.75 |
$54.75 |
$54.75 |
$121.80
|
|
Cyclosporine modified 25 mg capsule
|
$6.57 |
$6.57 |
$6.57 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$545.31 |
$545.31 |
$545.31 |
$39.04
|
|
Cylinder pump set 20cm titan zero angl
|
$20,865.01 |
$20,865.01 |
$20,865.01 |
$22,594.80
|
|
Cystic fibrosis cftr
|
$277.41 |
$277.41 |
$277.41 |
$1,041.95
|
|
Cystogram >= 3 views supervision & interpretation
|
$453.77 |
$453.77 |
$453.77 |
$539.55
|
|
Cytarabine 20 mg/ml injection solution
|
$37.23 |
$37.23 |
$37.23 |
$89.95
|
|
Cytomegalovirus (cmv) antibody igg
|
$92.42 |
$92.42 |
$92.42 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$5.78 |
$5.78 |
$5.78 |
$96.80
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$35.50 |
$35.50 |
$35.50 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$78.84 |
$78.84 |
$78.84 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$67.46 |
$67.46 |
$67.46 |
$124.80
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$84.10 |
$84.10 |
$84.10 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$67.46 |
$67.46 |
$67.46 |
$205.00
|
|
Cytopath smear other source
|
$42.05 |
$42.05 |
$42.05 |
$85.80
|
|
Cytopath tbs c/v manual
|
$34.61 |
$34.61 |
$34.61 |
$57.94
|
|
Cytp urine 3-5 probes cmptr
|
$172.30 |
$172.30 |
$172.30 |
$690.00
|
|
Dacarbazine 100 mg intravenous solution
|
$37.23 |
$37.23 |
$37.23 |
$82.91
|
|
Dactinomycin 0.5 mg intravenous solution
|
$2,446.23 |
$2,446.23 |
$2,446.23 |
$2,526.62
|
|
Dalbavancin 500 mg intravenous solution
|
$1,723.10 |
$1,723.10 |
$1,723.10 |
$3,469.30
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,314.00 |
$1,314.00 |
$1,314.00 |
$315.32
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$69.69 |
$69.69 |
$69.69 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$12.79 |
$12.79 |
$12.79 |
$5,546.48
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$211.56 |
$211.56 |
$211.56 |
$260.95
|
|
Dch validity tests
|
$42.05 |
$42.05 |
$42.05 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$4.26 |
$4.26 |
$4.26 |
$44.16
|
|
Debridement (>20 cm) charge pt
|
$260.61 |
$260.61 |
$260.61 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$2,056.33 |
$2,056.33 |
$2,056.33 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$412.93 |
$412.93 |
$412.93 |
$688.80
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$730.82 |
$730.82 |
$730.82 |
$1,283.44
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$598.85 |
$598.85 |
$598.85 |
$810.50
|
|
Debride nail1-5 11720
|
$92.96 |
$92.96 |
$92.96 |
$173.25
|
|
Debride nail6 or more 11721
|
$92.96 |
$92.96 |
$92.96 |
$195.20
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$412.93 |
$412.93 |
$412.93 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$995.17 |
$995.17 |
$995.17 |
$1,193.40
|
|
Decalcification
|
$56.07 |
$56.07 |
$56.07 |
$73.60
|
|
Decitabine 50 mg intravenous solution
|
$90.19 |
$90.19 |
$90.19 |
$975.45
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$314.49 |
$314.49 |
$314.49 |
$545.90
|
|
Deferoxamine 500 mg solution for injection
|
$49.06 |
$49.06 |
$49.06 |
$110.82
|
|
Degarelix 120 mg subcutaneous solution
|
$13.71 |
$13.71 |
$13.71 |
$2,086.82
|
|
Delivery of placenta 59414
|
$1,720.47 |
$1,720.47 |
$1,720.47 |
$3,271.20
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$192.72 |
$192.72 |
$192.72 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$2,920.15 |
$2,920.15 |
$2,920.15 |
$7,933.81
|
|
Dermagraft
|
$2,797.95 |
$2,797.95 |
$2,797.95 |
$1,912.31
|