|
CT neck soft tissue w/contrast
|
$1,711.20 |
$1,711.20 |
$1,711.20 |
$1,577.55
|
|
CT neck soft tissue without contrast
|
$1,369.20 |
$1,369.20 |
$1,369.20 |
$1,151.00
|
|
CT neck soft tissue without & w/contrast
|
$2,054.40 |
$2,054.40 |
$2,054.40 |
$1,752.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,027.40 |
$2,027.40 |
$2,027.40 |
$1,647.20
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,689.00 |
$1,689.00 |
$1,689.00 |
$1,487.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,351.20 |
$1,351.20 |
$1,351.20 |
$1,250.00
|
|
CT scan for therapy guide
|
$904.20 |
$904.20 |
$904.20 |
$656.13
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$3,788.40 |
$3,788.40 |
$3,788.40 |
$3,133.65
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,224.40 |
$3,224.40 |
$3,224.40 |
$2,737.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,651.40 |
$2,651.40 |
$2,651.40 |
$2,240.40
|
|
CT thoracic spine w/contrast
|
$1,829.40 |
$1,829.40 |
$1,829.40 |
$1,604.85
|
|
CT thoracic spine without contrast
|
$1,464.00 |
$1,464.00 |
$1,464.00 |
$1,381.20
|
|
CT thorax low dose for lung screening without contrast
|
$574.80 |
$574.80 |
$574.80 |
$418.50
|
|
CT t-spine w /wo contrast
|
$2,195.40 |
$2,195.40 |
$2,195.40 |
$1,817.25
|
|
CT upper extremity w/contrast (both sides)
|
$1,525.80 |
$1,525.80 |
$1,525.80 |
$1,651.65
|
|
CT upper extremity without contrast (both sides)
|
$1,220.40 |
$1,220.40 |
$1,220.40 |
$1,408.54
|
|
CT uppr extremity w/o&w/dye
|
$3,661.20 |
$3,661.20 |
$3,661.20 |
$1,688.20
|
|
Culture aerobic additional method definitive id each
|
$119.40 |
$119.40 |
$119.40 |
$61.03
|
|
Culture afb any source
|
$253.80 |
$253.80 |
$253.80 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$163.80 |
$163.80 |
$163.80 |
$73.00
|
|
Culture anaerobic except blood
|
$249.00 |
$249.00 |
$249.00 |
$110.00
|
|
Culture bact stool aero addl path ea
|
$120.00 |
$120.00 |
$120.00 |
$49.40
|
|
Culture body fluid
|
$208.20 |
$208.20 |
$208.20 |
$111.15
|
|
Culture fungi definitive id mold
|
$210.60 |
$210.60 |
$210.60 |
$70.00
|
|
Culture fungi definitive id yeast
|
$166.80 |
$166.80 |
$166.80 |
$68.00
|
|
Culture fungi other (except blood)
|
$241.80 |
$241.80 |
$241.80 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$176.40 |
$176.40 |
$176.40 |
$74.75
|
|
Culture quantitative aerobic other source
|
$235.20 |
$235.20 |
$235.20 |
$63.45
|
|
Culture screening strep group a
|
$151.80 |
$151.80 |
$151.80 |
$76.00
|
|
Culture typing immunologic
|
$95.40 |
$95.40 |
$95.40 |
$38.58
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$392.40 |
$392.40 |
$392.40 |
$392.40
|
|
Culture urine each isolate
|
$129.60 |
$129.60 |
$129.60 |
$44.80
|
|
Cv line/pic reposition
|
$2,049.60 |
$2,049.60 |
$2,049.60 |
$1,681.20
|
|
Cyanocobalamin unsat binding capacity
|
$154.20 |
$154.20 |
$154.20 |
$64.28
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$42.47 |
$42.47 |
$42.47 |
$17.58
|
|
Cyclic citrullinated peptide antibody
|
$244.80 |
$244.80 |
$244.80 |
$91.20
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1.27 |
$1.27 |
$1.27 |
$2.42
|
|
Cyclosporine 2 hour
|
$345.00 |
$345.00 |
$345.00 |
$126.10
|
|
Cystatin c
|
$129.60 |
$129.60 |
$129.60 |
$83.20
|
|
Cystine urine quantitative
|
$545.40 |
$545.40 |
$545.40 |
$112.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$530.40 |
$530.40 |
$530.40 |
$487.04
|
|
Cystoscopy and treatment
|
$1,400.40 |
$1,400.40 |
$1,400.40 |
$2,874.36
|
|
Cytarabine 20 mg/ml injection solution
|
$179.58 |
$179.58 |
$179.58 |
$59.31
|
|
Cytogenetics 25-99
|
$439.80 |
$439.80 |
$439.80 |
$188.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$247.80 |
$247.80 |
$247.80 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$280.80 |
$280.80 |
$280.80 |
$95.00
|
|
Cytomegalovirus imm IV /vial
|
$2,635.28 |
$2,635.28 |
$2,635.28 |
$2,635.28
|
|
Cyto/molecular report
|
$120.60 |
$120.60 |
$120.60 |
$91.65
|
|
Cytopath fl nongyn filter
|
$221.40 |
$221.40 |
$221.40 |
$91.20
|
|
Cytopathology cellular enhancement technique non-gyn
|
$300.60 |
$300.60 |
$300.60 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$210.60 |
$210.60 |
$210.60 |
$98.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$163.80 |
$163.80 |
$163.80 |
$90.88
|
|
Cytopathology concentration technique smears & interpretation
|
$283.80 |
$283.80 |
$283.80 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$198.00 |
$198.00 |
$198.00 |
$129.90
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$198.60 |
$198.60 |
$198.60 |
$179.44
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$351.60 |
$351.60 |
$351.60 |
$205.00
|
|
Cytopath smear other source
|
$139.80 |
$139.80 |
$139.80 |
$88.13
|
|
Cytopath smear other source
|
$216.60 |
$216.60 |
$216.60 |
$145.31
|
|
Cytopath smear oth prep screen & interp
|
$225.60 |
$225.60 |
$225.60 |
$95.00
|
|
Cytopath tbs c/v manual
|
$83.40 |
$83.40 |
$83.40 |
$57.94
|
|
Cytp urine 3-5 probes cmptr
|
$776.40 |
$776.40 |
$776.40 |
$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
|
$3,483.00 |
$3,483.00 |
$3,483.00 |
$4,542.99
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$363.03 |
$363.03 |
$363.03 |
$14,514.57
|
|
Dch glucoscan
|
$39.60 |
$39.60 |
$39.60 |
$28.10
|
|
Debridement (>20 cm) charge pt
|
$894.00 |
$894.00 |
$894.00 |
$313.30
|
|
Debridement bone <= 20 sq cm
|
$2,530.80 |
$2,530.80 |
$2,530.80 |
$2,481.05
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,425.60 |
$1,425.60 |
$1,425.60 |
$717.92
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$2,530.80 |
$2,530.80 |
$2,530.80 |
$1,738.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$814.80 |
$814.80 |
$814.80 |
$779.35
|
|
Debride nail1-5 11720
|
$595.80 |
$595.80 |
$595.80 |
$186.88
|
|
Debride nail6 or more 11721
|
$402.00 |
$402.00 |
$402.00 |
$200.21
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$814.80 |
$814.80 |
$814.80 |
$728.40
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,425.60 |
$1,425.60 |
$1,425.60 |
$1,101.10
|
|
Decalcification
|
$117.00 |
$117.00 |
$117.00 |
$72.15
|
|
Decitabine 50 mg intravenous solution
|
$41.80 |
$41.80 |
$41.80 |
$225.55
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$880.80 |
$880.80 |
$880.80 |
$482.35
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$4,681.80 |
$4,681.80 |
$4,681.80 |
$4,681.80
|
|
Desmopressin 4 mcg/ml injection solution
|
$20.43 |
$20.43 |
$20.43 |
$37.26
|
|
Desoxycorticosterone
|
$196.80 |
$196.80 |
$196.80 |
$109.28
|
|
Destroy premlg lesns;1st lesn 17000
|
$163.80 |
$163.80 |
$163.80 |
$199.50
|
|
Destruction 2-14 lesions 17003
|
$119.40 |
$119.40 |
$119.40 |
$78.61
|
|
Destruction benign lesions < 14 lesions
|
$295.80 |
$295.80 |
$295.80 |
$231.52
|
|
Destruction premal lesions 15/> 17004
|
$520.80 |
$520.80 |
$520.80 |
$442.61
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$213.00 |
$213.00 |
$213.00 |
$220.43
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$112.07 |
$112.07 |
$112.07 |
$8.23
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$78.83 |
$78.83 |
$78.83 |
$37.50
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$78.67 |
$78.67 |
$78.67 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$79.62 |
$79.62 |
$79.62 |
$48.56
|
|
Dextrose 5 % IV bolus
|
$78.86 |
$78.86 |
$78.86 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$426.60 |
$426.60 |
$426.60 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$195.00 |
$195.00 |
$195.00 |
$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
|
|
Diagnostic Mammogram (both breasts)
|
$378.00 |
$378.00 |
$378.00 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$276.60 |
$276.60 |
$276.60 |
$276.60
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.22 |
$0.22 |
$0.22 |
$58.24
|