|
CT thoracic spine without contrast
|
$2,811.90 |
$2,811.90 |
$2,811.90 |
$1,430.20
|
|
CT thorax low dose for lung screening without contrast
|
$781.20 |
$781.20 |
$781.20 |
$332.00
|
|
CT t-spine w /wo contrast
|
$3,208.80 |
$3,208.80 |
$3,208.80 |
$1,968.47
|
|
CT upper extremity w/contrast (both sides)
|
$2,812.60 |
$2,812.60 |
$2,812.60 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$2,563.40 |
$2,563.40 |
$2,563.40 |
$1,404.36
|
|
CT uppr extremity w/o&w/dye
|
$3,768.10 |
$3,768.10 |
$3,768.10 |
$1,845.36
|
|
Cultr oocyte/embryo <4 days
|
$441.00 |
$441.00 |
$441.00 |
$441.00
|
|
Culture aerobic additional method definitive id each
|
$140.70 |
$140.70 |
$140.70 |
$71.40
|
|
Culture afb any source
|
$214.20 |
$214.20 |
$214.20 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$110.60 |
$110.60 |
$110.60 |
$84.76
|
|
Culture anaerobic except blood
|
$146.30 |
$146.30 |
$146.30 |
$120.54
|
|
Culture bact stool aero addl path ea
|
$80.50 |
$80.50 |
$80.50 |
$52.50
|
|
Culture body fluid
|
$450.80 |
$450.80 |
$450.80 |
$126.00
|
|
Culture fungi definitive id mold
|
$84.00 |
$84.00 |
$84.00 |
$80.00
|
|
Culture fungi definitive id yeast
|
$130.90 |
$130.90 |
$130.90 |
$79.50
|
|
Culture fungi other (except blood)
|
$177.10 |
$177.10 |
$177.10 |
$109.20
|
|
Culture fungi skin/hair/nail
|
$132.30 |
$132.30 |
$132.30 |
$74.40
|
|
Culture mycobacteria definitive id each isolate
|
$112.70 |
$112.70 |
$112.70 |
$100.00
|
|
Culture mycoplasma any source
|
$217.00 |
$217.00 |
$217.00 |
$81.62
|
|
Culture quantitative aerobic other source
|
$184.80 |
$184.80 |
$184.80 |
$90.35
|
|
Culture screening strep group a
|
$218.40 |
$218.40 |
$218.40 |
$83.16
|
|
Culture type pulse field gel
|
$685.30 |
$685.30 |
$685.30 |
$38.58
|
|
Culture typing added method
|
$101.50 |
$101.50 |
$101.50 |
$38.70
|
|
Culture typing immunologic
|
$68.60 |
$68.60 |
$68.60 |
$43.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$529.20 |
$529.20 |
$529.20 |
$408.37
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$135.80 |
$135.80 |
$135.80 |
$138.40
|
|
Culture urine each isolate
|
$133.70 |
$133.70 |
$133.70 |
$54.78
|
|
Cutter lead
|
$7,762.23 |
$7,762.23 |
$7,762.23 |
$6,685.72
|
|
Cv line/pic reposition
|
$2,184.00 |
$2,184.00 |
$2,184.00 |
$1,608.00
|
|
Cyanocobalamin unsat binding capacity
|
$84.70 |
$84.70 |
$84.70 |
$58.65
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$12.07 |
$12.07 |
$12.07 |
$25.16
|
|
Cyclic citrullinated peptide antibody
|
$308.70 |
$308.70 |
$308.70 |
$72.15
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$3,787.70 |
$3,787.70 |
$3,787.70 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$24.15 |
$24.15 |
$24.15 |
$19.49
|
|
Cyclosporine 2 hour
|
$439.60 |
$439.60 |
$439.60 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$4.90 |
$4.90 |
$4.90 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$438.02 |
$438.02 |
$438.02 |
$35.57
|
|
Cylinder pump set 20cm titan zero angl
|
$42,558.07 |
$42,558.07 |
$42,558.07 |
$24,372.98
|
|
Cymetra injectable
|
$579.07 |
$579.07 |
$579.07 |
$578.24
|
|
Cyp2c19 gene com variants
|
$656.60 |
$656.60 |
$656.60 |
$502.45
|
|
Cyp2c9 gene com variants
|
$403.20 |
$403.20 |
$403.20 |
$266.50
|
|
Cyp2d6 gene com variants
|
$1,073.80 |
$1,073.80 |
$1,073.80 |
$573.65
|
|
Cyp3a5 gene common variants
|
$403.20 |
$403.20 |
$403.20 |
$245.31
|
|
Cystatin c
|
$30.80 |
$30.80 |
$30.80 |
$76.48
|
|
Cystic fibrosis cftr
|
$1,877.40 |
$1,877.40 |
$1,877.40 |
$1,104.40
|
|
Cystine urine quantitative
|
$121.10 |
$121.10 |
$121.10 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$921.20 |
$921.20 |
$921.20 |
$564.85
|
|
Cysto rx balo cath urtl strx
|
$30,033.60 |
$30,033.60 |
$30,033.60 |
$6,853.60
|
|
Cystoscopy and treatment
|
$27,844.63 |
$27,844.63 |
$27,844.63 |
$4,081.37
|
|
Cystoscopy and treatment
|
$16,747.25 |
$16,747.25 |
$16,747.25 |
$4,350.00
|
|
Cystoscopy and treatment
|
$23,013.24 |
$23,013.24 |
$23,013.24 |
$5,304.00
|
|
Cystoscopy and treatment
|
$25,389.57 |
$25,389.57 |
$25,389.57 |
$5,995.60
|
|
Cystoscopy and treatment
|
$34,979.85 |
$34,979.85 |
$34,979.85 |
$6,593.60
|
|
Cystoscopy and treatment
|
$15,590.77 |
$15,590.77 |
$15,590.77 |
$3,213.14
|
|
Cystoscopy and treatment
|
$27,954.55 |
$27,954.55 |
$27,954.55 |
$4,045.60
|
|
Cystoscopy and treatment
|
$12,423.83 |
$12,423.83 |
$12,423.83 |
$2,850.95
|
|
Cystoscopy and treatment
|
$18,939.01 |
$18,939.01 |
$18,939.01 |
$4,081.37
|
|
Cystoscopy (Bladder Scope)
|
$20,435.95 |
$20,435.95 |
$20,435.95 |
$1,445.41
|
|
Cystoscopy chemodenervation
|
$38,014.56 |
$38,014.56 |
$38,014.56 |
$2,831.92
|
|
Cystoscopy removal of clots
|
$25,490.04 |
$25,490.04 |
$25,490.04 |
$4,051.50
|
|
Cystoscopy & ureter catheter
|
$23,207.92 |
$23,207.92 |
$23,207.92 |
$3,688.80
|
|
Cystouretero & or pyeloscope
|
$17,326.35 |
$17,326.35 |
$17,326.35 |
$4,315.98
|
|
Cystouretero w/biopsy
|
$30,410.86 |
$30,410.86 |
$30,410.86 |
$6,015.75
|
|
Cysto/uretero w/lithotripsy
|
$26,204.96 |
$26,204.96 |
$26,204.96 |
$7,573.50
|
|
Cystouretero w/lithotripsy
|
$29,471.01 |
$29,471.01 |
$29,471.01 |
$7,061.60
|
|
Cystouretero w/stone remove
|
$23,676.30 |
$23,676.30 |
$23,676.30 |
$5,339.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$23,644.29 |
$23,644.29 |
$23,644.29 |
$3,131.20
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$19,752.99 |
$19,752.99 |
$19,752.99 |
$4,045.60
|
|
Cystourethro w/addl implant 52442
|
$30,628.98 |
$30,628.98 |
$30,628.98 |
$2,161.60
|
|
Cystourethro w/implant
|
$30,628.98 |
$30,628.98 |
$30,628.98 |
$2,777.60
|
|
Cysto w/up stricture tx
|
$27,493.30 |
$27,493.30 |
$27,493.30 |
$4,081.37
|
|
Cytarabine 20 mg/ml injection solution
|
$82.77 |
$82.77 |
$82.77 |
$90.00
|
|
Cytogenetics 25-99
|
$230.30 |
$230.30 |
$230.30 |
$189.80
|
|
Cytogenomic neo microra alys
|
$6,578.60 |
$6,578.60 |
$6,578.60 |
$2,156.05
|
|
Cytomegalovirus (cmv) antibody igg
|
$338.10 |
$338.10 |
$338.10 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$366.80 |
$366.80 |
$366.80 |
$100.00
|
|
Cyto/molecular report
|
$205.10 |
$205.10 |
$205.10 |
$144.75
|
|
Cytopath c/v auto rescreen
|
$375.20 |
$375.20 |
$375.20 |
$39.20
|
|
Cytopathology cellular enhancement technique non-gyn
|
$360.50 |
$360.50 |
$360.50 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$103.60 |
$103.60 |
$103.60 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$83.30 |
$83.30 |
$83.30 |
$86.86
|
|
Cytopathology concentration technique smears & interpretation
|
$407.40 |
$407.40 |
$407.40 |
$131.36
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$357.70 |
$357.70 |
$357.70 |
$124.00
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$105.00 |
$105.00 |
$105.00 |
$68.51
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$590.10 |
$590.10 |
$590.10 |
$189.67
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$590.10 |
$590.10 |
$590.10 |
$209.92
|
|
Cytotoxic antibody screening
|
$795.20 |
$795.20 |
$795.20 |
$193.80
|
|
Cytotoxic antibody screening
|
$800.80 |
$800.80 |
$800.80 |
$133.25
|
|
Dacarbazine 100 mg intravenous solution
|
$51.80 |
$51.80 |
$51.80 |
$62.70
|
|
Dactinomycin 0.5 mg intravenous solution
|
$12,801.42 |
$12,801.42 |
$12,801.42 |
$3,047.85
|
|
Dalbavancin 500 mg intravenous solution
|
$7,401.97 |
$7,401.97 |
$7,401.97 |
$3,480.87
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,953.00 |
$1,953.00 |
$1,953.00 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$49,965.82 |
$49,965.82 |
$49,965.82 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$713.30 |
$713.30 |
$713.30 |
$6,273.69
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$247.10 |
$247.10 |
$247.10 |
$259.58
|
|
D&c after delivery 59160
|
$15,141.01 |
$15,141.01 |
$15,141.01 |
$3,827.25
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$21,579.95 |
$21,579.95 |
$21,579.95 |
$3,774.81
|
|
Dch glucoscan
|
$37.80 |
$37.80 |
$37.80 |
$29.16
|
|
Dch pulmonary stress test
|
$2,764.30 |
$2,764.30 |
$2,764.30 |
$963.30
|
|
Dch validity tests
|
$110.60 |
$110.60 |
$110.60 |
$25.00
|
