|
CT angio pelvis
|
$3,527.10 |
$3,527.10 |
$3,527.10 |
$1,775.28
|
|
CT colonography dx
|
$159.30 |
$159.30 |
$159.30 |
$770.90
|
|
CT guidance for needle placement
|
$2,683.35 |
$2,683.35 |
$2,683.35 |
$1,506.04
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,998.45 |
$1,998.45 |
$1,998.45 |
$1,085.05
|
|
CT guid parench tis ablat
|
$305.10 |
$305.10 |
$305.10 |
$1,281.75
|
|
CT heart w/evaluation of calcium without contrast
|
$244.80 |
$244.80 |
$244.80 |
$192.00
|
|
CT limited or localized follow-up study
|
$2,751.75 |
$2,751.75 |
$2,751.75 |
$625.63
|
|
CT neck soft tissue w/contrast
|
$3,887.10 |
$3,887.10 |
$3,887.10 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$3,226.50 |
$3,226.50 |
$3,226.50 |
$1,332.50
|
|
CT neck soft tissue without & w/contrast
|
$4,626.00 |
$4,626.00 |
$4,626.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$3,849.75 |
$3,849.75 |
$3,849.75 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$3,499.65 |
$3,499.65 |
$3,499.65 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$2,974.50 |
$2,974.50 |
$2,974.50 |
$1,351.20
|
|
CT scan for therapy guide
|
$1,822.95 |
$1,822.95 |
$1,822.95 |
$729.40
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$10,388.70 |
$10,388.70 |
$10,388.70 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$8,879.40 |
$8,879.40 |
$8,879.40 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$5,949.00 |
$5,949.00 |
$5,949.00 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$6,393.15 |
$6,393.15 |
$6,393.15 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$5,073.75 |
$5,073.75 |
$5,073.75 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$141.75 |
$141.75 |
$141.75 |
$400.20
|
|
Culture aerobic additional method definitive id each
|
$296.10 |
$296.10 |
$296.10 |
$63.75
|
|
Culture afb any source
|
$11.25 |
$11.25 |
$11.25 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$402.30 |
$402.30 |
$402.30 |
$77.31
|
|
Culture anaerobic except blood
|
$252.00 |
$252.00 |
$252.00 |
$123.20
|
|
Culture body fluid
|
$391.05 |
$391.05 |
$391.05 |
$130.50
|
|
Culture fungi definitive id mold
|
$15.75 |
$15.75 |
$15.75 |
$70.00
|
|
Culture fungi definitive id yeast
|
$133.20 |
$133.20 |
$133.20 |
$80.60
|
|
Culture fungi other (except blood)
|
$11.25 |
$11.25 |
$11.25 |
$105.60
|
|
Culture mycoplasma any source
|
$16.20 |
$16.20 |
$16.20 |
$90.37
|
|
Culture screening strep group a
|
$223.65 |
$223.65 |
$223.65 |
$81.60
|
|
Culture typing immunologic
|
$123.75 |
$123.75 |
$123.75 |
$41.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$76.63 |
$76.63 |
$76.63 |
$124.40
|
|
Culture urine each isolate
|
$326.70 |
$326.70 |
$326.70 |
$46.20
|
|
Cutter lead
|
$1,882.80 |
$1,882.80 |
$1,882.80 |
$5,538.98
|
|
Cv line/pic reposition
|
$1,311.30 |
$1,311.30 |
$1,311.30 |
$1,829.42
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$16.89 |
$16.89 |
$16.89 |
$33.37
|
|
Cyclic citrullinated peptide antibody
|
$2.70 |
$2.70 |
$2.70 |
$80.05
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,483.65 |
$1,483.65 |
$1,483.65 |
$1,048.28
|
|
Cyclophosphamide 25 mg capsule
|
$33.75 |
$33.75 |
$33.75 |
$23.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$179.10 |
$179.10 |
$179.10 |
$179.10
|
|
Cyclosporine 2 hour
|
$6.75 |
$6.75 |
$6.75 |
$121.80
|
|
Cyclosporine modified 25 mg capsule
|
$11.70 |
$11.70 |
$11.70 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$45.90 |
$45.90 |
$45.90 |
$39.04
|
|
Cylinder pump set 20cm titan zero angl
|
$23,723.55 |
$23,723.55 |
$23,723.55 |
$22,594.80
|
|
Cystatin c
|
$4.50 |
$4.50 |
$4.50 |
$82.26
|
|
Cystine urine quantitative
|
$26.95 |
$26.95 |
$26.95 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$441.00 |
$441.00 |
$441.00 |
$539.55
|
|
Cystoscopy (Bladder Scope)
|
$1,075.50 |
$1,075.50 |
$1,075.50 |
$1,610.20
|
|
Cystouretero & or pyeloscope
|
$3,813.75 |
$3,813.75 |
$3,813.75 |
$4,315.98
|
|
Cytarabine 20 mg/ml injection solution
|
$29.25 |
$29.25 |
$29.25 |
$89.95
|
|
Cytomegalovirus (cmv) antibody igg
|
$24.81 |
$24.81 |
$24.81 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$4.50 |
$4.50 |
$4.50 |
$96.80
|
|
Cytopath fl nongyn filter
|
$53.55 |
$53.55 |
$53.55 |
$73.70
|
|
Cytopathology concentration technique smears & interpretation
|
$61.65 |
$61.65 |
$61.65 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$43.65 |
$43.65 |
$43.65 |
$124.80
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$148.05 |
$148.05 |
$148.05 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$44.10 |
$44.10 |
$44.10 |
$205.00
|
|
Cytopath smear other source
|
$89.55 |
$89.55 |
$89.55 |
$85.80
|
|
Dacarbazine 100 mg intravenous solution
|
$52.20 |
$52.20 |
$52.20 |
$82.91
|
|
Dactinomycin 0.5 mg intravenous solution
|
$60.75 |
$60.75 |
$60.75 |
$2,526.62
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,922.40 |
$1,922.40 |
$1,922.40 |
$315.32
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$10,224.90 |
$10,224.90 |
$10,224.90 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$5,224.50 |
$5,224.50 |
$5,224.50 |
$5,546.48
|
|
Darbepoetin alfa, esrd use
|
$4,558.95 |
$4,558.95 |
$4,558.95 |
$3.04
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$579.50 |
$579.50 |
$579.50 |
$260.95
|
|
Dch validity tests
|
$23.40 |
$23.40 |
$23.40 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$4.37 |
$4.37 |
$4.37 |
$44.16
|
|
Debridement (>20 cm) charge pt
|
$225.45 |
$225.45 |
$225.45 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$2,569.50 |
$2,569.50 |
$2,569.50 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$909.90 |
$909.90 |
$909.90 |
$688.80
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,655.55 |
$1,655.55 |
$1,655.55 |
$1,283.44
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$639.45 |
$639.45 |
$639.45 |
$810.50
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$611.55 |
$611.55 |
$611.55 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$995.40 |
$995.40 |
$995.40 |
$1,193.40
|
|
Decalcification
|
$39.15 |
$39.15 |
$39.15 |
$73.60
|
|
Decitabine 50 mg intravenous solution
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$975.45
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$644.40 |
$644.40 |
$644.40 |
$545.90
|
|
Deferoxamine 500 mg solution for injection
|
$127.44 |
$127.44 |
$127.44 |
$110.82
|
|
Degarelix 120 mg subcutaneous solution
|
$2,110.50 |
$2,110.50 |
$2,110.50 |
$2,086.82
|
|
Delivery of placenta 59414
|
$3,086.10 |
$3,086.10 |
$3,086.10 |
$3,271.20
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$16,983.45 |
$16,983.45 |
$16,983.45 |
$7,763.47
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$256.95 |
$256.95 |
$256.95 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$7,933.81
|
|
Depo-estradiol cypionate inj
|
$228.42 |
$228.42 |
$228.42 |
$132.72
|
|
Descend thora aorta rpr/lt sub art 33880
|
$19,835.10 |
$19,835.10 |
$19,835.10 |
$5,702.04
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,706.40 |
$1,706.40 |
$1,706.40 |
$102.32
|
|
Des thora aorta/ea add prox prosth 33884
|
$12,486.60 |
$12,486.60 |
$12,486.60 |
$1,285.78
|
|
Des thora aorta rpr without left sub art 33881
|
$16,529.40 |
$16,529.40 |
$16,529.40 |
$5,698.68
|
|
Des thor aorta/prox ext prosth/ini 33883
|
$12,486.60 |
$12,486.60 |
$12,486.60 |
$2,498.88
|
|
Destroy premlg lesns;1st lesn 17000
|
$36.45 |
$36.45 |
$36.45 |
$220.12
|
|
Device ablt adv novasure
|
$11,826.00 |
$11,826.00 |
$11,826.00 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$5,380.65 |
$5,380.65 |
$5,380.65 |
$4,298.87
|
|
Device sut capio slim opn
|
$1,111.95 |
$1,111.95 |
$1,111.95 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$2,447.55 |
$2,447.55 |
$2,447.55 |
$2,440.98
|
|
Dexamethasone 4 mg tablet
|
$20.25 |
$20.25 |
$20.25 |
$6.01
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$11.70 |
$11.70 |
$11.70 |
$30.00
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,980.90 |
$1,980.90 |
$1,980.90 |
$560.92
|
|
Dextran 40 infusion
|
$144.00 |
$144.00 |
$144.00 |
$171.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$36.00 |
$36.00 |
$36.00 |
$60.00
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$33.75 |
$33.75 |
$33.75 |
$49.75
|