|
Critical care each additional 30 minutes
|
$1,906.45 |
$1,906.45 |
$1,906.45 |
$777.00
|
|
Cryoprecipitate each unit
|
$146.17 |
$146.17 |
$146.17 |
$198.60
|
|
Crystal identification light microscopy
|
$217.41 |
$217.41 |
$217.41 |
$65.25
|
|
CT 3d report other modality w/workstation
|
$939.84 |
$939.84 |
$939.84 |
$613.47
|
|
Cta abdomen without & /or w/contrast
|
$8,576.59 |
$8,576.59 |
$8,576.59 |
$2,050.28
|
|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$9,814.20 |
$9,814.20 |
$9,814.20 |
$2,092.73
|
|
Cta lower extremity without & w/contrast (both sides)
|
$5,011.62 |
$5,011.62 |
$5,011.62 |
$2,075.53
|
|
Cta neck without &/or w/contrast
|
$5,534.91 |
$5,534.91 |
$5,534.91 |
$1,977.25
|
|
CT Angiogram of Abdomen and Pelvis
|
$8,576.59 |
$8,576.59 |
$8,576.59 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$5,247.52 |
$5,247.52 |
$5,247.52 |
$2,032.54
|
|
CT Angiogram of the Head
|
$6,401.42 |
$6,401.42 |
$6,401.42 |
$2,075.26
|
|
CT angio hrt w/3d image
|
$1,395.80 |
$1,395.80 |
$1,395.80 |
$1,601.60
|
|
Cta upper extremity w &/or without contrast left
|
$5,807.84 |
$5,807.84 |
$5,807.84 |
$1,661.13
|
|
CT guidance for needle placement
|
$3,887.40 |
$3,887.40 |
$3,887.40 |
$1,506.04
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$3,037.52 |
$3,037.52 |
$3,037.52 |
$1,077.80
|
|
CT guid parench tis ablat
|
$1,380.38 |
$1,380.38 |
$1,380.38 |
$1,282.50
|
|
CT heart w/evaluation of calcium without contrast
|
$115.76 |
$115.76 |
$115.76 |
$196.67
|
|
CT limited or localized follow-up study
|
$1,437.73 |
$1,437.73 |
$1,437.73 |
$630.75
|
|
CT lower extremity w/contrast (both sides)
|
$4,008.47 |
$4,008.47 |
$4,008.47 |
$1,728.39
|
|
CT lower extremity without contrast (both sides)
|
$3,984.31 |
$3,984.31 |
$3,984.31 |
$1,420.00
|
|
CT neck soft tissue w/contrast
|
$3,618.76 |
$3,618.76 |
$3,618.76 |
$1,677.39
|
|
CT neck soft tissue without contrast
|
$3,277.02 |
$3,277.02 |
$3,277.02 |
$1,363.35
|
|
CT neck soft tissue without & w/contrast
|
$3,946.26 |
$3,946.26 |
$3,946.26 |
$1,959.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$4,170.00 |
$4,170.00 |
$4,170.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$3,799.77 |
$3,799.77 |
$3,799.77 |
$1,379.95
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$13,309.46 |
$13,309.46 |
$13,309.46 |
$3,337.20
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$11,911.36 |
$11,911.36 |
$11,911.36 |
$2,883.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$9,679.06 |
$9,679.06 |
$9,679.06 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$4,280.91 |
$4,280.91 |
$4,280.91 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$3,907.08 |
$3,907.08 |
$3,907.08 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$2,211.69 |
$2,211.69 |
$2,211.69 |
$427.43
|
|
CT upper extremity w/contrast (both sides)
|
$4,008.47 |
$4,008.47 |
$4,008.47 |
$1,714.05
|
|
CT upper extremity without contrast (both sides)
|
$3,609.30 |
$3,609.30 |
$3,609.30 |
$1,473.75
|
|
Culture aerobic additional method definitive id each
|
$147.25 |
$147.25 |
$147.25 |
$66.00
|
|
Culture afb any source
|
$201.83 |
$201.83 |
$201.83 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$16.30 |
$16.30 |
$16.30 |
$78.82
|
|
Culture anaerobic except blood
|
$32.00 |
$32.00 |
$32.00 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$242.18 |
$242.18 |
$242.18 |
$52.50
|
|
Culture body fluid
|
$413.46 |
$413.46 |
$413.46 |
$130.50
|
|
Culture fungi definitive id mold
|
$22.18 |
$22.18 |
$22.18 |
$72.15
|
|
Culture fungi definitive id yeast
|
$318.57 |
$318.57 |
$318.57 |
$80.60
|
|
Culture fungi other (except blood)
|
$29.00 |
$29.00 |
$29.00 |
$100.20
|
|
Culture fungi skin/hair/nail
|
$15.55 |
$15.55 |
$15.55 |
$77.37
|
|
Culture mycobacteria definitive id each isolate
|
$21.78 |
$21.78 |
$21.78 |
$88.14
|
|
Culture quantitative aerobic other source
|
$252.08 |
$252.08 |
$252.08 |
$85.80
|
|
Culture screening strep group a
|
$310.29 |
$310.29 |
$310.29 |
$81.25
|
|
Culture typing added method
|
$25.60 |
$25.60 |
$25.60 |
$34.45
|
|
Culture typing immunologic
|
$92.00 |
$92.00 |
$92.00 |
$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
|
$23.89 |
$23.89 |
$23.89 |
$58.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$41.22 |
$41.22 |
$41.22 |
$27.22
|
|
Cyclic citrullinated peptide antibody
|
$24.39 |
$24.39 |
$24.39 |
$82.00
|
|
Cyclosporine 2 hour
|
$54.86 |
$54.86 |
$54.86 |
$119.40
|
|
Cyclosporine oral 100 mg
|
$29.55 |
$29.55 |
$29.55 |
$42.97
|
|
Cystatin c
|
$76.48 |
$76.48 |
$76.48 |
$82.50
|
|
Cystine urine quantitative
|
$79.81 |
$79.81 |
$79.81 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,399.30 |
$1,399.30 |
$1,399.30 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$80.18 |
$80.18 |
$80.18 |
$71.71
|
|
Cytomegalovirus (cmv) antibody igg
|
$39.67 |
$39.67 |
$39.67 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$19.64 |
$19.64 |
$19.64 |
$100.75
|
|
Cyto/molecular report
|
$193.42 |
$193.42 |
$193.42 |
$150.30
|
|
Cytopathology cellular enhancement technique non-gyn
|
$130.00 |
$130.00 |
$130.00 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$295.93 |
$295.93 |
$295.93 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$17.27 |
$17.27 |
$17.27 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$36.86 |
$36.86 |
$36.86 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$162.00 |
$162.00 |
$162.00 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$162.00 |
$162.00 |
$162.00 |
$203.08
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$33,732.08 |
$33,732.08 |
$33,732.08 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$7,257.62 |
$7,257.62 |
$7,257.62 |
$5,546.48
|
|
Deamidated gliadin antibody iga
|
$31.78 |
$31.78 |
$31.78 |
$43.60
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$362.92 |
$362.92 |
$362.92 |
$798.23
|
|
Decalcification
|
$84.23 |
$84.23 |
$84.23 |
$75.38
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$1,031.67 |
$1,031.67 |
$1,031.67 |
$510.95
|
|
Deferoxamine 500 mg solution for injection
|
$437.15 |
$437.15 |
$437.15 |
$112.87
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$183.21 |
$183.21 |
$183.21 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$11,472.55 |
$11,472.55 |
$11,472.55 |
$7,737.00
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$759.19 |
$759.19 |
$759.19 |
$460.50
|
|
Design mlc device for imrt
|
$2,066.62 |
$2,066.62 |
$2,066.62 |
$1,641.90
|
|
Desmopressin 4 mcg/ml injection solution
|
$814.85 |
$814.85 |
$814.85 |
$148.77
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$548.52 |
$548.52 |
$548.52 |
$225.60
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$29.53 |
$29.53 |
$29.53 |
$23.79
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$93.11 |
$93.11 |
$93.11 |
$46.35
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$93.11 |
$93.11 |
$93.11 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$30.38 |
$30.38 |
$30.38 |
$48.56
|
|
Dextrose 5 % IV bolus
|
$93.11 |
$93.11 |
$93.11 |
$68.93
|
|
Dhea-s (dehydroepiand sulfate)
|
$64.34 |
$64.34 |
$64.34 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$164.89 |
$164.89 |
$164.89 |
$79.30
|
|
Diab manage trn ind/group
|
$97.73 |
$97.73 |
$97.73 |
$49.50
|
|
Diagnostic digital breast tomosynthesis bil
|
$240.84 |
$240.84 |
$240.84 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$240.84 |
$240.84 |
$240.84 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$287.70 |
$287.70 |
$287.70 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$714.48 |
$714.48 |
$714.48 |
$421.20
|
|
Diagnostic Mammogram (one breast)
|
$436.39 |
$436.39 |
$436.39 |
$291.90
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,054.09 |
$3,054.09 |
$3,054.09 |
$6,311.00
|
|
Dialysis one evaluation
|
$1,024.00 |
$1,024.00 |
$1,024.00 |
$827.97
|
|
Diatrizoate meglumine 18 % urethral solution
|
$191.62 |
$191.62 |
$191.62 |
$112.61
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$51.19 |
$51.19 |
$51.19 |
$70.40
|
|
Dicyclomine injection
|
$180.58 |
$180.58 |
$180.58 |
$210.83
|
|
Diffusing capacity
|
$413.11 |
$413.11 |
$413.11 |
$357.60
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$28.89 |
$28.89 |
$28.89 |
$62.20
|