|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,952.72 |
$1,952.72 |
$1,952.72 |
$1,379.95
|
|
Ctrl nosebld postir subsq 30906
|
$750.38 |
$750.38 |
$750.38 |
$456.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$9,704.56 |
$9,704.56 |
$9,704.56 |
$3,329.15
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$8,872.35 |
$8,872.35 |
$8,872.35 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$8,469.36 |
$8,469.36 |
$8,469.36 |
$2,325.05
|
|
CT thoracic spine w/contrast
|
$5,582.20 |
$5,582.20 |
$5,582.20 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$4,614.13 |
$4,614.13 |
$4,614.13 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$2,172.18 |
$2,172.18 |
$2,172.18 |
$420.60
|
|
CT t-spine w /wo contrast
|
$5,783.07 |
$5,783.07 |
$5,783.07 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$4,266.15 |
$4,266.15 |
$4,266.15 |
$1,706.10
|
|
CT upper extremity without contrast (both sides)
|
$3,778.58 |
$3,778.58 |
$3,778.58 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$6,947.76 |
$6,947.76 |
$6,947.76 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$154.61 |
$154.61 |
$154.61 |
$63.75
|
|
Culture afb any source
|
$249.72 |
$249.72 |
$249.72 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$93.68 |
$93.68 |
$93.68 |
$78.65
|
|
Culture anaerobic except blood
|
$236.93 |
$236.93 |
$236.93 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$254.29 |
$254.29 |
$254.29 |
$52.65
|
|
Culture body fluid
|
$434.13 |
$434.13 |
$434.13 |
$130.50
|
|
Culture fungi definitive id mold
|
$23.29 |
$23.29 |
$23.29 |
$70.00
|
|
Culture fungi definitive id yeast
|
$334.50 |
$334.50 |
$334.50 |
$80.40
|
|
Culture fungi other (except blood)
|
$249.72 |
$249.72 |
$249.72 |
$104.00
|
|
Culture fungi skin/hair/nail
|
$164.04 |
$164.04 |
$164.04 |
$77.37
|
|
Culture mycobacteria definitive id each isolate
|
$331.41 |
$331.41 |
$331.41 |
$88.14
|
|
Culture quantitative aerobic other source
|
$327.32 |
$327.32 |
$327.32 |
$85.80
|
|
Culture screening strep group a
|
$325.80 |
$325.80 |
$325.80 |
$80.60
|
|
Culture typing added method
|
$26.88 |
$26.88 |
$26.88 |
$34.45
|
|
Culture typing immunologic
|
$406.21 |
$406.21 |
$406.21 |
$43.46
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$631.08 |
$631.08 |
$631.08 |
$408.75
|
|
Cyanocobalamin unsat binding capacity
|
$136.52 |
$136.52 |
$136.52 |
$58.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$37.79 |
$37.79 |
$37.79 |
$27.88
|
|
Cyclic citrullinated peptide antibody
|
$25.61 |
$25.61 |
$25.61 |
$82.00
|
|
Cyclosporine 2 hour
|
$54.86 |
$54.86 |
$54.86 |
$119.40
|
|
Cyclosporine oral 100 mg
|
$23.28 |
$23.28 |
$23.28 |
$43.04
|
|
Cyp2c9 gene com variants
|
$607.09 |
$607.09 |
$607.09 |
$275.10
|
|
Cystatin c
|
$56.28 |
$56.28 |
$56.28 |
$82.26
|
|
Cystine urine quantitative
|
$107.02 |
$107.02 |
$107.02 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,811.23 |
$1,811.23 |
$1,811.23 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$71.25 |
$71.25 |
$71.25 |
$79.98
|
|
Cytomegalovirus (cmv) antibody igg
|
$41.65 |
$41.65 |
$41.65 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$20.62 |
$20.62 |
$20.62 |
$98.35
|
|
Cyto/molecular report
|
$97.51 |
$97.51 |
$97.51 |
$144.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$398.24 |
$398.24 |
$398.24 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$91.65 |
$91.65 |
$91.65 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$360.87 |
$360.87 |
$360.87 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$263.63 |
$263.63 |
$263.63 |
$124.30
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$139.42 |
$139.42 |
$139.42 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$442.45 |
$442.45 |
$442.45 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$442.45 |
$442.45 |
$442.45 |
$205.00
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$27,661.70 |
$27,661.70 |
$27,661.70 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$5,328.67 |
$5,328.67 |
$5,328.67 |
$5,546.48
|
|
Deamidated gliadin antibody iga
|
$33.37 |
$33.37 |
$33.37 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$634.59 |
$634.59 |
$634.59 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$4,896.34 |
$4,896.34 |
$4,896.34 |
$2,494.27
|
|
Debridement/bone/20 sq cm or less 11046
|
$792.33 |
$792.33 |
$792.33 |
$681.60
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,390.60 |
$1,390.60 |
$1,390.60 |
$798.23
|
|
Debride nail1-5 11720
|
$164.54 |
$164.54 |
$164.54 |
$173.25
|
|
Debride nail6 or more 11721
|
$142.21 |
$142.21 |
$142.21 |
$199.32
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$791.37 |
$791.37 |
$791.37 |
$661.09
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,493.60 |
$1,493.60 |
$1,493.60 |
$1,161.05
|
|
Decalcification
|
$78.07 |
$78.07 |
$78.07 |
$75.38
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$817.09 |
$817.09 |
$817.09 |
$510.95
|
|
Deferoxamine 500 mg solution for injection
|
$363.48 |
$363.48 |
$363.48 |
$116.00
|
|
Delivery of placenta 59414
|
$7,664.35 |
$7,664.35 |
$7,664.35 |
$3,135.14
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$170.75 |
$170.75 |
$170.75 |
$193.05
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$8,419.62 |
$8,419.62 |
$8,419.62 |
$7,744.96
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$410.81 |
$410.81 |
$410.81 |
$460.50
|
|
Design mlc device for imrt
|
$727.48 |
$727.48 |
$727.48 |
$1,641.90
|
|
Desmopressin 4 mcg/ml injection solution
|
$603.97 |
$603.97 |
$603.97 |
$121.30
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$425.83 |
$425.83 |
$425.83 |
$221.90
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$27.63 |
$27.63 |
$27.63 |
$24.28
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$124.31 |
$124.31 |
$124.31 |
$57.07
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$124.31 |
$124.31 |
$124.31 |
$68.93
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$39.22 |
$39.22 |
$39.22 |
$49.68
|
|
Dextrose 5 % IV bolus
|
$124.31 |
$124.31 |
$124.31 |
$68.93
|
|
Dhea-s (dehydroepiand sulfate)
|
$64.34 |
$64.34 |
$64.34 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$228.11 |
$228.11 |
$228.11 |
$78.41
|
|
Diab manage trn ind/group
|
$78.88 |
$78.88 |
$78.88 |
$49.50
|
|
Diagnostic anoscopy spx 46600
|
$656.40 |
$656.40 |
$656.40 |
$228.48
|
|
Diagnostic digital breast tomosynthesis bil
|
$270.73 |
$270.73 |
$270.73 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$270.73 |
$270.73 |
$270.73 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$497.24 |
$497.24 |
$497.24 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$627.61 |
$627.61 |
$627.61 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$433.40 |
$433.40 |
$433.40 |
$295.10
|
|
Dialysis one evaluation
|
$1,662.17 |
$1,662.17 |
$1,662.17 |
$827.97
|
|
Diatrizoate meglumine 18 % urethral solution
|
$191.62 |
$191.62 |
$191.62 |
$106.27
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$45.49 |
$45.49 |
$45.49 |
$70.87
|
|
Dicyclomine injection
|
$153.29 |
$153.29 |
$153.29 |
$211.00
|
|
Diffusing capacity
|
$361.39 |
$361.39 |
$361.39 |
$359.70
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$27.18 |
$27.18 |
$27.18 |
$64.31
|
|
Digoxin total therapeutic drug level
|
$147.72 |
$147.72 |
$147.72 |
$102.00
|
|
Dilate biliary duct/ampulla
|
$2,997.18 |
$2,997.18 |
$2,997.18 |
$2,304.60
|
|
Dilat xst trc ndurlgc px
|
$6,068.72 |
$6,068.72 |
$6,068.72 |
$4,081.37
|
|
Dilat xst trc new access rcs
|
$9,797.28 |
$9,797.28 |
$9,797.28 |
$4,881.00
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$23.44 |
$23.44 |
$23.44 |
$25.12
|
|
Disability dlco
|
$300.28 |
$300.28 |
$300.28 |
$300.28
|
|
Disaccharidases
|
$469.83 |
$469.83 |
$469.83 |
$223.80
|
|
Dna antibody native/double stranded
|
$127.67 |
$127.67 |
$127.67 |
$101.40
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$455.83 |
$455.83 |
$455.83 |
$101.04
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$545.97 |
$545.97 |
$545.97 |
$712.02
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$156.95 |
$156.95 |
$156.95 |
$74.39
|