|
CT orbit/sella/fossa w/wo contrast
|
$542.40 |
$542.40 |
$542.40 |
$1,647.20
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$542.40 |
$542.40 |
$542.40 |
$1,487.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$542.40 |
$542.40 |
$542.40 |
$1,250.00
|
|
CT scan for therapy guide
|
$542.40 |
$542.40 |
$542.40 |
$656.13
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$542.40 |
$542.40 |
$542.40 |
$3,133.65
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$542.40 |
$542.40 |
$542.40 |
$2,737.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$542.40 |
$542.40 |
$542.40 |
$2,240.40
|
|
CT thoracic spine w/contrast
|
$542.40 |
$542.40 |
$542.40 |
$1,604.85
|
|
CT thoracic spine without contrast
|
$542.40 |
$542.40 |
$542.40 |
$1,381.20
|
|
CT thorax low dose for lung screening without contrast
|
$542.40 |
$542.40 |
$542.40 |
$418.50
|
|
CT t-spine w /wo contrast
|
$542.40 |
$542.40 |
$542.40 |
$1,817.25
|
|
CT upper extremity w/contrast (both sides)
|
$1,084.80 |
$1,084.80 |
$1,084.80 |
$1,651.65
|
|
CT upper extremity without contrast (both sides)
|
$1,084.80 |
$1,084.80 |
$1,084.80 |
$1,408.54
|
|
CT uppr extremity w/o&w/dye
|
$1,084.80 |
$1,084.80 |
$1,084.80 |
$1,688.20
|
|
Culture aerobic additional method definitive id each
|
$119.40 |
$119.40 |
$119.40 |
$61.03
|
|
Culture afb any source
|
$252.00 |
$252.00 |
$252.00 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$142.80 |
$142.80 |
$142.80 |
$73.00
|
|
Culture anaerobic except blood
|
$267.60 |
$267.60 |
$267.60 |
$110.00
|
|
Culture bact stool aero addl path ea
|
$103.20 |
$103.20 |
$103.20 |
$49.40
|
|
Culture body fluid
|
$159.00 |
$159.00 |
$159.00 |
$111.15
|
|
Culture fungi definitive id mold
|
$136.20 |
$136.20 |
$136.20 |
$70.00
|
|
Culture fungi definitive id yeast
|
$136.80 |
$136.80 |
$136.80 |
$68.00
|
|
Culture fungi other (except blood)
|
$237.00 |
$237.00 |
$237.00 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$144.60 |
$144.60 |
$144.60 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$117.00 |
$117.00 |
$117.00 |
$79.00
|
|
Culture mycoplasma any source
|
$130.80 |
$130.80 |
$130.80 |
$94.00
|
|
Culture quantitative aerobic other source
|
$215.40 |
$215.40 |
$215.40 |
$63.45
|
|
Culture screening strep group a
|
$153.00 |
$153.00 |
$153.00 |
$76.00
|
|
Culture typing immunologic
|
$78.00 |
$78.00 |
$78.00 |
$38.58
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$392.40 |
$392.40 |
$392.40 |
$392.40
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$63.00 |
$63.00 |
$63.00 |
$100.20
|
|
Culture urine each isolate
|
$147.00 |
$147.00 |
$147.00 |
$44.80
|
|
Cv line/pic reposition
|
$2,023.80 |
$2,023.80 |
$2,023.80 |
$1,681.20
|
|
Cyanocobalamin unsat binding capacity
|
$159.60 |
$159.60 |
$159.60 |
$64.28
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$42.47 |
$42.47 |
$42.47 |
$17.58
|
|
Cyclic citrullinated peptide antibody
|
$171.00 |
$171.00 |
$171.00 |
$91.20
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1.27 |
$1.27 |
$1.27 |
$2.42
|
|
Cyclophosphamide 25 mg capsule
|
$22.51 |
$22.51 |
$22.51 |
$22.51
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$179.92 |
$179.92 |
$179.92 |
$179.92
|
|
Cyclosporine 2 hour
|
$280.80 |
$280.80 |
$280.80 |
$126.10
|
|
Cyclosporine modified 25 mg capsule
|
$9.79 |
$9.79 |
$9.79 |
$4.42
|
|
Cyclosporine oral 100 mg
|
$19.50 |
$19.50 |
$19.50 |
$19.50
|
|
Cystatin c
|
$136.80 |
$136.80 |
$136.80 |
$83.20
|
|
Cystine urine quantitative
|
$547.20 |
$547.20 |
$547.20 |
$112.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$315.60 |
$315.60 |
$315.60 |
$487.04
|
|
Cytarabine 20 mg/ml injection solution
|
$179.23 |
$179.23 |
$179.23 |
$59.31
|
|
Cytogenetics 25-99
|
$267.60 |
$267.60 |
$267.60 |
$188.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$239.40 |
$239.40 |
$239.40 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$237.60 |
$237.60 |
$237.60 |
$95.00
|
|
Cyto/molecular report
|
$225.60 |
$225.60 |
$225.60 |
$91.65
|
|
Cytopathology cellular enhancement technique non-gyn
|
$306.00 |
$306.00 |
$306.00 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$183.60 |
$183.60 |
$183.60 |
$98.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$148.80 |
$148.80 |
$148.80 |
$90.88
|
|
Cytopathology concentration technique smears & interpretation
|
$245.40 |
$245.40 |
$245.40 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$241.80 |
$241.80 |
$241.80 |
$129.90
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$247.80 |
$247.80 |
$247.80 |
$71.25
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$219.60 |
$219.60 |
$219.60 |
$179.44
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$363.00 |
$363.00 |
$363.00 |
$205.00
|
|
Cytp urine 3-5 probes cmptr
|
$759.60 |
$759.60 |
$759.60 |
$779.00
|
|
Dacarbazine 100 mg intravenous solution
|
$180.07 |
$180.07 |
$180.07 |
$39.53
|
|
Dalbavancin 500 mg intravenous solution
|
$3,070.44 |
$3,070.44 |
$3,070.44 |
$3,480.61
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$2.18 |
$2.18 |
$2.18 |
$1.80
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$15,683.37 |
$15,683.37 |
$15,683.37 |
$15,683.37
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$5,500.25 |
$5,500.25 |
$5,500.25 |
$4,542.99
|
|
Dch glucoscan
|
$65.40 |
$65.40 |
$65.40 |
$28.10
|
|
Dch validity tests
|
$46.80 |
$46.80 |
$46.80 |
$25.00
|
|
Debridement (>20 cm) charge pt
|
$327.60 |
$327.60 |
$327.60 |
$313.30
|
|
Debridement bone <= 20 sq cm
|
$4,072.80 |
$4,072.80 |
$4,072.80 |
$2,481.05
|
|
Debridement/bone/20 sq cm or less 11046
|
$724.20 |
$724.20 |
$724.20 |
$717.92
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$724.20 |
$724.20 |
$724.20 |
$1,738.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$2,699.40 |
$2,699.40 |
$2,699.40 |
$779.35
|
|
Debride nail1-5 11720
|
$471.00 |
$471.00 |
$471.00 |
$186.88
|
|
Debride nail6 or more 11721
|
$346.80 |
$346.80 |
$346.80 |
$200.21
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$724.20 |
$724.20 |
$724.20 |
$728.40
|
|
Debr musc/fascia 20sq cm/< 11043
|
$2,832.60 |
$2,832.60 |
$2,832.60 |
$1,101.10
|
|
Decalcification
|
$120.60 |
$120.60 |
$120.60 |
$72.15
|
|
Decitabine 50 mg intravenous solution
|
$94.38 |
$94.38 |
$94.38 |
$225.55
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$780.00 |
$780.00 |
$780.00 |
$482.35
|
|
Deferoxamine 500 mg solution for injection
|
$42.43 |
$42.43 |
$42.43 |
$47.62
|
|
Degarelix 120 mg subcutaneous solution
|
$2,303.24 |
$2,303.24 |
$2,303.24 |
$2,303.24
|
|
Demonstrate use home inr mon
|
$405.00 |
$405.00 |
$405.00 |
$340.79
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$107.40 |
$107.40 |
$107.40 |
$165.60
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$4,681.80 |
$4,681.80 |
$4,681.80 |
$4,681.80
|
|
Dermagraft
|
$2,866.80 |
$2,866.80 |
$2,866.80 |
$100.50
|
|
Design mlc device for imrt
|
$967.20 |
$967.20 |
$967.20 |
$1,677.86
|
|
Desmopressin 4 mcg/ml injection solution
|
$20.43 |
$20.43 |
$20.43 |
$37.26
|
|
Destruct cut vasl lesions <10cm 17106
|
$1,291.80 |
$1,291.80 |
$1,291.80 |
$664.05
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$6,622.80 |
$6,622.80 |
$6,622.80 |
$3,101.88
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$145.20 |
$145.20 |
$145.20 |
$220.43
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$319.80 |
$319.80 |
$319.80 |
$8.23
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$849.53 |
$849.53 |
$849.53 |
$465.34
|
|
Dextran 40 infusion
|
$173.97 |
$173.97 |
$173.97 |
$173.97
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$78.83 |
$78.83 |
$78.83 |
$37.50
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$78.65 |
$78.65 |
$78.65 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$79.60 |
$79.60 |
$79.60 |
$48.56
|
|
Dextrose 5 % IV bolus
|
$78.86 |
$78.86 |
$78.86 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$389.40 |
$389.40 |
$389.40 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$100.20 |
$100.20 |
$100.20 |
$70.00
|
|
Diagnostic digital breast tomosynthesis bil
|
$53.40 |
$53.40 |
$53.40 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$53.40 |
$53.40 |
$53.40 |
$75.93
|