|
Culture fungi definitive id mold
|
$169.20 |
$169.20 |
$169.20 |
$70.00
|
|
Culture fungi definitive id yeast
|
$129.60 |
$129.60 |
$129.60 |
$68.00
|
|
Culture fungi other (except blood)
|
$243.00 |
$243.00 |
$243.00 |
$92.95
|
|
Culture mycobacteria definitive id each isolate
|
$117.00 |
$117.00 |
$117.00 |
$79.00
|
|
Culture mycoplasma any source
|
$332.40 |
$332.40 |
$332.40 |
$94.00
|
|
Culture quantitative aerobic other source
|
$231.00 |
$231.00 |
$231.00 |
$63.45
|
|
Culture screening strep group a
|
$169.80 |
$169.80 |
$169.80 |
$76.00
|
|
Culture typing immunologic
|
$76.80 |
$76.80 |
$76.80 |
$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
|
$117.60 |
$117.60 |
$117.60 |
$44.80
|
|
Cyanocobalamin unsat binding capacity
|
$145.20 |
$145.20 |
$145.20 |
$64.28
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$42.47 |
$42.47 |
$42.47 |
$17.58
|
|
Cyclic citrullinated peptide antibody
|
$220.20 |
$220.20 |
$220.20 |
$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
|
$334.80 |
$334.80 |
$334.80 |
$126.10
|
|
Cyclosporine modified 25 mg capsule
|
$9.79 |
$9.79 |
$9.79 |
$4.42
|
|
Cyclosporine oral 100 mg
|
$1,187.49 |
$1,187.49 |
$1,187.49 |
$19.50
|
|
Cystatin c
|
$135.00 |
$135.00 |
$135.00 |
$83.20
|
|
Cystine urine quantitative
|
$694.20 |
$694.20 |
$694.20 |
$112.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$315.60 |
$315.60 |
$315.60 |
$487.04
|
|
Cytarabine 20 mg/ml injection solution
|
$197.47 |
$197.47 |
$197.47 |
$59.31
|
|
Cytogenetics 25-99
|
$419.40 |
$419.40 |
$419.40 |
$188.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$263.40 |
$263.40 |
$263.40 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$356.40 |
$356.40 |
$356.40 |
$95.00
|
|
Cytomegalovirus imm IV /vial
|
$2,635.28 |
$2,635.28 |
$2,635.28 |
$2,635.28
|
|
Cyto/molecular report
|
$207.00 |
$207.00 |
$207.00 |
$91.65
|
|
Cytopath fl nongyn filter
|
$202.20 |
$202.20 |
$202.20 |
$91.20
|
|
Cytopathology cellular enhancement technique non-gyn
|
$328.80 |
$328.80 |
$328.80 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$211.20 |
$211.20 |
$211.20 |
$98.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$175.80 |
$175.80 |
$175.80 |
$90.88
|
|
Cytopathology concentration technique smears & interpretation
|
$246.60 |
$246.60 |
$246.60 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$235.80 |
$235.80 |
$235.80 |
$129.90
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$238.20 |
$238.20 |
$238.20 |
$71.25
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$227.40 |
$227.40 |
$227.40 |
$179.44
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$367.20 |
$367.20 |
$367.20 |
$205.00
|
|
Cytopath smear other source
|
$148.20 |
$148.20 |
$148.20 |
$88.13
|
|
Cytopath smear other source
|
$227.40 |
$227.40 |
$227.40 |
$145.31
|
|
Cytopath smear oth prep screen & interp
|
$235.80 |
$235.80 |
$235.80 |
$95.00
|
|
Cytotoxic antibody screening
|
$48.00 |
$48.00 |
$48.00 |
$184.63
|
|
Cytotoxic antibody screening
|
$567.00 |
$567.00 |
$567.00 |
$96.46
|
|
Dacarbazine 100 mg intravenous solution
|
$182.06 |
$182.06 |
$182.06 |
$39.53
|
|
Dactinomycin 0.5 mg intravenous solution
|
$3,019.83 |
$3,019.83 |
$3,019.83 |
$1,225.86
|
|
Dalbavancin 500 mg intravenous solution
|
$3,070.44 |
$3,070.44 |
$3,070.44 |
$3,480.61
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$647.87 |
$647.87 |
$647.87 |
$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
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$363.03 |
$363.03 |
$363.03 |
$14,514.57
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$194.08 |
$194.08 |
$194.08 |
$130.13
|
|
Dch glucoscan
|
$54.00 |
$54.00 |
$54.00 |
$28.10
|
|
Dch validity tests
|
$59.40 |
$59.40 |
$59.40 |
$25.00
|
|
Debridement (>20 cm) charge pt
|
$575.40 |
$575.40 |
$575.40 |
$313.30
|
|
Decalcification
|
$132.60 |
$132.60 |
$132.60 |
$72.15
|
|
Decitabine 50 mg intravenous solution
|
$41.80 |
$41.80 |
$41.80 |
$225.55
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$1,277.40 |
$1,277.40 |
$1,277.40 |
$482.35
|
|
Deferoxamine 500 mg solution for injection
|
$192.68 |
$192.68 |
$192.68 |
$47.62
|
|
Degarelix 120 mg subcutaneous solution
|
$2,303.24 |
$2,303.24 |
$2,303.24 |
$2,303.24
|
|
Demonstrate use home inr mon
|
$435.60 |
$435.60 |
$435.60 |
$340.79
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$165.60 |
$165.60 |
$165.60 |
$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
|
|
Depo-estradiol cypionate inj
|
$337.07 |
$337.07 |
$337.07 |
$337.07
|
|
Desmopressin 4 mcg/ml injection solution
|
$50.62 |
$50.62 |
$50.62 |
$37.26
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$6,622.80 |
$6,622.80 |
$6,622.80 |
$3,101.88
|
|
Developmental screen/score/document 96110
|
$151.80 |
$151.80 |
$151.80 |
$126.75
|
|
Device intraute mirena
|
$1,803.72 |
$1,803.72 |
$1,803.72 |
$3,052.80
|
|
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
|
$112.07 |
$112.07 |
$112.07 |
$8.23
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$4,745.71 |
$4,745.71 |
$4,745.71 |
$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
|
$78.67 |
$78.67 |
$78.67 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$79.76 |
$79.76 |
$79.76 |
$48.56
|
|
Dextrose 5 % IV bolus
|
$78.86 |
$78.86 |
$78.86 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$541.20 |
$541.20 |
$541.20 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$250.80 |
$250.80 |
$250.80 |
$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 laryngoscopy 31575
|
$841.80 |
$841.80 |
$841.80 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$378.00 |
$378.00 |
$378.00 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$276.60 |
$276.60 |
$276.60 |
$276.60
|
|
Dialysis one evaluation
|
$1,568.40 |
$1,568.40 |
$1,568.40 |
$920.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$122.25 |
$122.25 |
$122.25 |
$58.24
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$80.83 |
$80.83 |
$80.83 |
$42.12
|
|
Dicyclomine injection
|
$193.54 |
$193.54 |
$193.54 |
$153.53
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$191.62 |
$191.62 |
$191.62 |
$29.85
|
|
Digoxin immune fab 40 mg intravenous solution
|
$6,815.78 |
$6,815.78 |
$6,815.78 |
$6,815.78
|
|
Digoxin total therapeutic drug level
|
$220.80 |
$220.80 |
$220.80 |
$92.95
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$308.90 |
$308.90 |
$308.90 |
$297.86
|
|
Dimecaprol injection
|
$199.46 |
$199.46 |
$199.46 |
$147.91
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,001.55 |
$1,001.55 |
$1,001.55 |
$1,001.55
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$38.80 |
$38.80 |
$38.80 |
$9.29
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$43.03 |
$43.03 |
$43.03 |
$67.32
|
|
Disaccharidases
|
$306.60 |
$306.60 |
$306.60 |
$224.58
|
|
Discography cerv/thor spine
|
$1,227.60 |
$1,227.60 |
$1,227.60 |
$2,161.44
|
|
Dna antibody native/double stranded
|
$321.00 |
$321.00 |
$321.00 |
$101.40
|
|
Dna gardnerella
|
$84.60 |
$84.60 |
$84.60 |
$67.68
|
|
Dna probe chlamydia
|
$252.00 |
$252.00 |
$252.00 |
$98.40
|
|
Dna trichomonas
|
$84.60 |
$84.60 |
$84.60 |
$69.60
|