|
CT upper extremity without contrast (both sides)
|
$2,728.08 |
$2,728.08 |
$2,728.08 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$4,262.40 |
$4,262.40 |
$4,262.40 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$156.24 |
$156.24 |
$156.24 |
$68.64
|
|
Culture afb any source
|
$100.08 |
$100.08 |
$100.08 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$146.88 |
$146.88 |
$146.88 |
$79.00
|
|
Culture anaerobic except blood
|
$352.80 |
$352.80 |
$352.80 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$99.36 |
$99.36 |
$99.36 |
$51.45
|
|
Culture body fluid
|
$353.52 |
$353.52 |
$353.52 |
$126.75
|
|
Culture fungi definitive id mold
|
$108.72 |
$108.72 |
$108.72 |
$77.28
|
|
Culture fungi definitive id yeast
|
$283.68 |
$283.68 |
$283.68 |
$79.10
|
|
Culture fungi other (except blood)
|
$220.32 |
$220.32 |
$220.32 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$211.68 |
$211.68 |
$211.68 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$159.12 |
$159.12 |
$159.12 |
$89.70
|
|
Culture screening strep group a
|
$203.76 |
$203.76 |
$203.76 |
$81.00
|
|
Culture typing immunologic
|
$56.16 |
$56.16 |
$56.16 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$807.84 |
$807.84 |
$807.84 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$456.48 |
$456.48 |
$456.48 |
$133.90
|
|
Culture urine each isolate
|
$378.72 |
$378.72 |
$378.72 |
$57.00
|
|
Cutter lead
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$6,092.06
|
|
Cyanocobalamin unsat binding capacity
|
$128.16 |
$128.16 |
$128.16 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$86.36 |
$86.36 |
$86.36 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$159.84 |
$159.84 |
$159.84 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$4.77 |
$4.77 |
$4.77 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$187.20 |
$187.20 |
$187.20 |
$129.48
|
|
Cyp2c19 gene com variants
|
$550.80 |
$550.80 |
$550.80 |
$504.00
|
|
Cyp2d6 gene com variants
|
$1,530.00 |
$1,530.00 |
$1,530.00 |
$554.00
|
|
Cystatin c
|
$145.44 |
$145.44 |
$145.44 |
$77.50
|
|
Cystine urine quantitative
|
$231.84 |
$231.84 |
$231.84 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,153.44 |
$1,153.44 |
$1,153.44 |
$542.10
|
|
Cystoscopy (Bladder Scope)
|
$6,006.24 |
$6,006.24 |
$6,006.24 |
$1,493.80
|
|
Cystourethroscop/calib/dilat stric 52281
|
$4,425.12 |
$4,425.12 |
$4,425.12 |
$3,065.15
|
|
Cytogenetics 25-99
|
$644.40 |
$644.40 |
$644.40 |
$190.00
|
|
Cytogenomic neo microra alys
|
$3,465.36 |
$3,465.36 |
$3,465.36 |
$2,020.20
|
|
Cytomegalovirus (cmv) antibody igg
|
$185.04 |
$185.04 |
$185.04 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$185.04 |
$185.04 |
$185.04 |
$97.50
|
|
Cytomegalovirus dfa
|
$101.52 |
$101.52 |
$101.52 |
$79.34
|
|
Cyto/molecular report
|
$340.56 |
$340.56 |
$340.56 |
$133.20
|
|
Cytopath fl nongyn filter
|
$182.88 |
$182.88 |
$182.88 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$261.36 |
$261.36 |
$261.36 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$169.20 |
$169.20 |
$169.20 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$173.52 |
$173.52 |
$173.52 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$308.16 |
$308.16 |
$308.16 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$289.44 |
$289.44 |
$289.44 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$95.04 |
$95.04 |
$95.04 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$370.08 |
$370.08 |
$370.08 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$529.20 |
$529.20 |
$529.20 |
$209.23
|
|
Cytopath smear other source
|
$425.52 |
$425.52 |
$425.52 |
$88.13
|
|
Cytopath tbs c/v manual
|
$123.12 |
$123.12 |
$123.12 |
$59.28
|
|
Cytotoxic antibody screening
|
$513.36 |
$513.36 |
$513.36 |
$189.00
|
|
Cytp urine 3-5 probes cmptr
|
$1,185.84 |
$1,185.84 |
$1,185.84 |
$690.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$4.32 |
$4.32 |
$4.32 |
$168.53
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$89.01 |
$89.01 |
$89.01 |
$21,063.03
|
|
Dch glucoscan
|
$25.92 |
$25.92 |
$25.92 |
$28.10
|
|
Dch validity tests
|
$41.04 |
$41.04 |
$41.04 |
$24.50
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$9,337.68 |
$9,337.68 |
$9,337.68 |
$4,952.36
|
|
Deamidated gliadin antibody iga
|
$91.44 |
$91.44 |
$91.44 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$1,194.48 |
$1,194.48 |
$1,194.48 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$3,499.92 |
$3,499.92 |
$3,499.92 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$514.80 |
$514.80 |
$514.80 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$3,197.52 |
$3,197.52 |
$3,197.52 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,194.48 |
$1,194.48 |
$1,194.48 |
$810.50
|
|
Debride nail1-5 11720
|
$195.84 |
$195.84 |
$195.84 |
$148.80
|
|
Debride nail6 or more 11721
|
$401.04 |
$401.04 |
$401.04 |
$169.60
|
|
Debride skin bone at fx site
|
$6,181.92 |
$6,181.92 |
$6,181.92 |
$3,015.00
|
|
Debride skn/sq/musc/abd wall 11004
|
$1,242.72 |
$1,242.72 |
$1,242.72 |
$903.00
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$514.80 |
$514.80 |
$514.80 |
$639.60
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,519.92 |
$1,519.92 |
$1,519.92 |
$1,129.45
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,321.92 |
$1,321.92 |
$1,321.92 |
$1,160.00
|
|
Decalcification
|
$172.08 |
$172.08 |
$172.08 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$1,049.04 |
$1,049.04 |
$1,049.04 |
$543.00
|
|
Delivery of placenta 59414
|
$6,868.08 |
$6,868.08 |
$6,868.08 |
$3,070.56
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$54.01 |
$54.01 |
$54.01 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$1,005.84 |
$1,005.84 |
$1,005.84 |
$408.10
|
|
Dermagraft
|
$91.44 |
$91.44 |
$91.44 |
$85.00
|
|
Descend thora aorta rpr/lt sub art 33880
|
$15,626.88 |
$15,626.88 |
$15,626.88 |
$6,687.93
|
|
Design mlc device for imrt
|
$1,810.08 |
$1,810.08 |
$1,810.08 |
$1,677.86
|
|
Desmopressin 4 mcg/ml injection solution
|
$126.72 |
$126.72 |
$126.72 |
$89.78
|
|
Desoxycorticosterone
|
$251.28 |
$251.28 |
$251.28 |
$109.28
|
|
Des thora aorta rpr without left sub art 33881
|
$20,447.28 |
$20,447.28 |
$20,447.28 |
$5,698.68
|
|
Destroy cervthor facet jnt 64633
|
$10,784.16 |
$10,784.16 |
$10,784.16 |
$3,011.50
|
|
Destroy cth facet jnt addl 64634
|
$2,424.96 |
$2,424.96 |
$2,424.96 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$2,237.76 |
$2,237.76 |
$2,237.76 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$5,392.08 |
$5,392.08 |
$5,392.08 |
$3,202.98
|
|
Devel tst phys/qhp 1st hr
|
$520.56 |
$520.56 |
$520.56 |
$337.50
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$520.56 |
$520.56 |
$520.56 |
$200.00
|
|
Dexamethasone 4 mg tablet
|
$0.65 |
$0.65 |
$0.65 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$11.97 |
$11.97 |
$11.97 |
$21.17
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$76.32 |
$76.32 |
$76.32 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$79.20 |
$79.20 |
$79.20 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$79.20 |
$79.20 |
$79.20 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$155.52 |
$155.52 |
$155.52 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$155.52 |
$155.52 |
$155.52 |
$79.20
|
|
Diagnostic anoscopy spx 46600
|
$480.24 |
$480.24 |
$480.24 |
$190.68
|
|
Diagnostic laryngoscopy 31505
|
$419.04 |
$419.04 |
$419.04 |
$236.60
|
|
Diagnostic laryngoscopy 31575
|
$461.52 |
$461.52 |
$461.52 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$354.24 |
$354.24 |
$354.24 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$311.04 |
$311.04 |
$311.04 |
$301.55
|
|
Dialysis circuit perm vascular embolization 36909
|
$9,428.40 |
$9,428.40 |
$9,428.40 |
$5,419.00
|
|
Dialysis one evaluation
|
$919.44 |
$919.44 |
$919.44 |
$919.55
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$119.79 |
$119.79 |
$119.79 |
$74.76
|
