|
Culture fungi definitive id yeast
|
$86.10 |
$86.10 |
$86.10 |
$79.50
|
|
Culture fungi other (except blood)
|
$137.90 |
$137.90 |
$137.90 |
$109.20
|
|
Culture fungi skin/hair/nail
|
$72.80 |
$72.80 |
$72.80 |
$74.40
|
|
Culture mycobacteria definitive id each isolate
|
$112.70 |
$112.70 |
$112.70 |
$100.00
|
|
Culture quantitative aerobic other source
|
$168.00 |
$168.00 |
$168.00 |
$90.35
|
|
Culture screening strep group a
|
$102.20 |
$102.20 |
$102.20 |
$83.16
|
|
Culture typing added method
|
$75.60 |
$75.60 |
$75.60 |
$38.70
|
|
Culture typing immunologic
|
$46.90 |
$46.90 |
$46.90 |
$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
|
$71.40 |
$71.40 |
$71.40 |
$54.78
|
|
Cyanocobalamin unsat binding capacity
|
$84.70 |
$84.70 |
$84.70 |
$58.65
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$47.07 |
$47.07 |
$47.07 |
$25.16
|
|
Cyclic citrullinated peptide antibody
|
$198.10 |
$198.10 |
$198.10 |
$72.15
|
|
Cyclosporine 2 hour
|
$116.20 |
$116.20 |
$116.20 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$38.15 |
$38.15 |
$38.15 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$946.75 |
$946.75 |
$946.75 |
$35.57
|
|
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
|
$1,041.60 |
$1,041.60 |
$1,041.60 |
$573.65
|
|
Cyp3a5 gene common variants
|
$403.20 |
$403.20 |
$403.20 |
$245.31
|
|
Cystatin c
|
$78.40 |
$78.40 |
$78.40 |
$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
|
|
Cystoscopy chemodenervation
|
$5,490.80 |
$5,490.80 |
$5,490.80 |
$2,831.92
|
|
Cystoscopy removal of clots
|
$8,536.50 |
$8,536.50 |
$8,536.50 |
$4,051.50
|
|
Cystoscopy & ureter catheter
|
$7,205.80 |
$7,205.80 |
$7,205.80 |
$3,688.80
|
|
Cystourethroscop/calib/dilat stric 52281
|
$7,727.30 |
$7,727.30 |
$7,727.30 |
$3,131.20
|
|
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
|
$125.30 |
$125.30 |
$125.30 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$105.00 |
$105.00 |
$105.00 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$179.20 |
$179.20 |
$179.20 |
$159.45
|
|
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 fna adequacy evaluation first episode each site interp/rpt
|
$242.20 |
$242.20 |
$242.20 |
$209.92
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$161.00 |
$161.00 |
$161.00 |
$171.19
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$1,541.57 |
$1,541.57 |
$1,541.57 |
$6,273.69
|
|
D&c after delivery 59160
|
$5,761.00 |
$5,761.00 |
$5,761.00 |
$3,827.25
|
|
Dch glucoscan
|
$37.80 |
$37.80 |
$37.80 |
$29.16
|
|
Dch validity tests
|
$31.50 |
$31.50 |
$31.50 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$163.10 |
$163.10 |
$163.10 |
$42.75
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$1,899.80 |
$1,899.80 |
$1,899.80 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$475.30 |
$475.30 |
$475.30 |
$278.50
|
|
Debride nail1-5 11720
|
$160.30 |
$160.30 |
$160.30 |
$149.04
|
|
Debride skin bone at fx site
|
$1,523.20 |
$1,523.20 |
$1,523.20 |
$2,921.60
|
|
Debride skn/sq t/m/f necro infctj abdl wall 11005
|
$1,899.80 |
$1,899.80 |
$1,899.80 |
$1,899.80
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,985.90 |
$1,985.90 |
$1,985.90 |
$1,129.45
|
|
Decalcification
|
$75.60 |
$75.60 |
$75.60 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$478.10 |
$478.10 |
$478.10 |
$546.84
|
|
Decompression of leg
|
$7,102.90 |
$7,102.90 |
$7,102.90 |
$4,094.02
|
|
Decompression of lower leg
|
$7,102.90 |
$7,102.90 |
$7,102.90 |
$3,839.54
|
|
Delivery of placenta 59414
|
$2,444.40 |
$2,444.40 |
$2,444.40 |
$2,822.68
|
|
Desoxycorticosterone
|
$65.10 |
$65.10 |
$65.10 |
$98.80
|
|
Dest mal lesion tal 2.1-3.0cm 17263
|
$425.60 |
$425.60 |
$425.60 |
$364.50
|
|
Destroy cervthor facet jnt 64633
|
$8,549.10 |
$8,549.10 |
$8,549.10 |
$3,018.00
|
|
Destroy cth facet jnt addl 64634
|
$8,549.10 |
$8,549.10 |
$8,549.10 |
$1,441.44
|
|
Destruction anal lesion(s)
|
$4,953.90 |
$4,953.90 |
$4,953.90 |
$3,711.00
|
|
Destruction anal lesion(s) smpl chem 46900
|
$678.30 |
$678.30 |
$678.30 |
$557.90
|
|
Destruction benign lesions < 14 lesions
|
$154.70 |
$154.70 |
$154.70 |
$235.13
|
|
Destruction by injection tx of nerve 64630
|
$2,856.00 |
$2,856.00 |
$2,856.00 |
$1,626.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$9,423.40 |
$9,423.40 |
$9,423.40 |
$1,618.65
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$9,423.40 |
$9,423.40 |
$9,423.40 |
$3,295.50
|
|
Detect agent nos dna dir
|
$105.00 |
$105.00 |
$105.00 |
$145.80
|
|
Detect agnt mult dna direc
|
$209.30 |
$209.30 |
$209.30 |
$166.77
|
|
Devel tst phys/qhp 1st hr
|
$399.00 |
$399.00 |
$399.00 |
$350.40
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$199.50 |
$199.50 |
$199.50 |
$199.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$368.20 |
$368.20 |
$368.20 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$9.10 |
$9.10 |
$9.10 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$69.82 |
$69.82 |
$69.82 |
$21.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$41.47 |
$41.47 |
$41.47 |
$36.00
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$33.60 |
$33.60 |
$33.60 |
$46.12
|
|
Dextrose 5 % IV bolus
|
$36.22 |
$36.22 |
$36.22 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$163.10 |
$163.10 |
$163.10 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$116.90 |
$116.90 |
$116.90 |
$79.20
|
|
Diag laparo separate proc 49320
|
$13,423.20 |
$13,423.20 |
$13,423.20 |
$6,904.15
|
|
Diagnostic anoscopy
|
$618.80 |
$618.80 |
$618.80 |
$392.70
|
|
Diagnostic anoscopy & biopsy
|
$3,735.90 |
$3,735.90 |
$3,735.90 |
$2,288.00
|
|
Diagnostic anoscopy spx 46600
|
$261.80 |
$261.80 |
$261.80 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$112.70 |
$112.70 |
$112.70 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$102.20 |
$102.20 |
$102.20 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$513.80 |
$513.80 |
$513.80 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$464.80 |
$464.80 |
$464.80 |
$312.72
|
|
Diagnostic radio unlisted proc
|
$5,055.40 |
$5,055.40 |
$5,055.40 |
$243.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,066.70 |
$3,066.70 |
$3,066.70 |
$5,663.50
|
|
Dialysis one evaluation
|
$1,194.90 |
$1,194.90 |
$1,194.90 |
$936.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$460.77 |
$460.77 |
$460.77 |
$77.25
|
|
Digoxin total therapeutic drug level
|
$97.30 |
$97.30 |
$97.30 |
$102.07
|
|
Dilate urethra stricture
|
$1,451.10 |
$1,451.10 |
$1,451.10 |
$496.00
|
|
Dilation of cervical canal 57800
|
$4,780.30 |
$4,780.30 |
$4,780.30 |
$4,376.00
|
|
Dilation of rectal stricture 45910
|
$3,345.30 |
$3,345.30 |
$3,345.30 |
$2,263.80
|
|
Dilation of salivary duct
|
$6,040.30 |
$6,040.30 |
$6,040.30 |
$750.00
|
|
Dilat xst trc ndurlgc px
|
$3,789.80 |
$3,789.80 |
$3,789.80 |
$3,883.16
|
|
Dilat xst trc new access rcs
|
$7,464.80 |
$7,464.80 |
$7,464.80 |
$4,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$2.80 |
$2.80 |
$2.80 |
$18.35
|
|
Disaccharidases
|
$623.70 |
$623.70 |
$623.70 |
$224.31
|
|
Dissolve clot heart vessel
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$1,560.00
|
|
Dlyd plmt xtn prosth ea addl
|
$4,795.00 |
$4,795.00 |
$4,795.00 |
$1,875.00
|
|
Dmd dup/delet analysis
|
$644.70 |
$644.70 |
$644.70 |
$418.50
|
