|
CT colonography dx
|
$521.00 |
$521.00 |
$521.00 |
$791.00
|
|
CT colonography dx w/dye
|
$1,089.50 |
$1,089.50 |
$1,089.50 |
$1,037.00
|
|
CT colonography screening
|
$521.00 |
$521.00 |
$521.00 |
$1,084.20
|
|
CT guidance for needle placement
|
$680.00 |
$680.00 |
$680.00 |
$1,494.00
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,069.00 |
$1,069.00 |
$1,069.00 |
$1,178.52
|
|
CT guid parench tis ablat
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$1,281.75
|
|
CT heart w/evaluation of calcium without contrast
|
$297.00 |
$297.00 |
$297.00 |
$171.60
|
|
CT hrt c+ strux cgen hrt ds
|
$830.50 |
$830.50 |
$830.50 |
$1,371.50
|
|
CT limited or localized follow-up study
|
$291.65 |
$291.65 |
$291.65 |
$642.75
|
|
CT lower extremity w/contrast (both sides)
|
$1,137.50 |
$1,137.50 |
$1,137.50 |
$1,652.00
|
|
CT lower extremity without contrast (both sides)
|
$860.50 |
$860.50 |
$860.50 |
$1,421.85
|
|
CT lwr extremity w/o&w/dye
|
$1,076.50 |
$1,076.50 |
$1,076.50 |
$1,854.05
|
|
CT neck soft tissue w/contrast
|
$643.50 |
$643.50 |
$643.50 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$545.00 |
$545.00 |
$545.00 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$812.00 |
$812.00 |
$812.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$888.00 |
$888.00 |
$888.00 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$763.50 |
$763.50 |
$763.50 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$633.00 |
$633.00 |
$633.00 |
$1,360.00
|
|
CT scan for localization
|
$812.00 |
$812.00 |
$812.00 |
$1,205.14
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,706.00 |
$1,706.00 |
$1,706.00 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$879.00 |
$879.00 |
$879.00 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$868.00 |
$868.00 |
$868.00 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$742.50 |
$742.50 |
$742.50 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$49.50 |
$49.50 |
$49.50 |
$331.50
|
|
CT t-spine w /wo contrast
|
$1,093.00 |
$1,093.00 |
$1,093.00 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,137.50 |
$1,137.50 |
$1,137.50 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,036.00 |
$1,036.00 |
$1,036.00 |
$1,430.20
|
|
Culture aerobic additional method definitive id each
|
$61.00 |
$61.00 |
$61.00 |
$68.64
|
|
Culture afb any source
|
$58.50 |
$58.50 |
$58.50 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$78.50 |
$78.50 |
$78.50 |
$79.00
|
|
Culture anaerobic except blood
|
$146.00 |
$146.00 |
$146.00 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$21.00 |
$21.00 |
$21.00 |
$51.45
|
|
Culture body fluid
|
$134.50 |
$134.50 |
$134.50 |
$126.75
|
|
Culture fungi definitive id mold
|
$77.50 |
$77.50 |
$77.50 |
$77.28
|
|
Culture fungi definitive id yeast
|
$62.00 |
$62.00 |
$62.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$81.50 |
$81.50 |
$81.50 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$115.50 |
$115.50 |
$115.50 |
$74.88
|
|
Culture mycoplasma any source
|
$137.50 |
$137.50 |
$137.50 |
$85.26
|
|
Culture screening strep group a
|
$56.00 |
$56.00 |
$56.00 |
$81.00
|
|
Culture typing immunologic
|
$44.00 |
$44.00 |
$44.00 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$385.00 |
$385.00 |
$385.00 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$80.50 |
$80.50 |
$80.50 |
$133.90
|
|
Culture urine each isolate
|
$72.00 |
$72.00 |
$72.00 |
$57.00
|
|
Cutter lead
|
$8,850.00 |
$8,850.00 |
$8,850.00 |
$6,092.06
|
|
Cv line/pic reposition
|
$2,072.00 |
$2,072.00 |
$2,072.00 |
$1,720.93
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$27.70 |
$27.70 |
$27.70 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$52.00 |
$52.00 |
$52.00 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,890.20 |
$1,890.20 |
$1,890.20 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$3.30 |
$3.30 |
$3.30 |
$19.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$360.82 |
$360.82 |
$360.82 |
$140.78
|
|
Cyclosporine 2 hour
|
$100.00 |
$100.00 |
$100.00 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$5.52 |
$5.52 |
$5.52 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$145.62 |
$145.62 |
$145.62 |
$34.88
|
|
Cylinder pump set 20cm titan zero angl
|
$38,545.26 |
$38,545.26 |
$38,545.26 |
$22,803.38
|
|
Cyp2c19 gene com variants
|
$504.00 |
$504.00 |
$504.00 |
$504.00
|
|
Cystatin c
|
$55.50 |
$55.50 |
$55.50 |
$77.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$508.00 |
$508.00 |
$508.00 |
$542.10
|
|
Cystoscopy and treatment
|
$173.08 |
$173.08 |
$173.08 |
$2,874.36
|
|
Cystoscopy (Bladder Scope)
|
$112.00 |
$112.00 |
$112.00 |
$1,493.80
|
|
Cystourethroscop/calib/dilat stric 52281
|
$223.12 |
$223.12 |
$223.12 |
$3,065.15
|
|
Cytarabine 20 mg/ml injection solution
|
$69.38 |
$69.38 |
$69.38 |
$89.94
|
|
Cytomegalovirus (cmv) antibody igg
|
$94.50 |
$94.50 |
$94.50 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$101.00 |
$101.00 |
$101.00 |
$97.50
|
|
Cytomegalovirus imm IV /vial
|
$5,648.38 |
$5,648.38 |
$5,648.38 |
$3,072.34
|
|
Cytopath fl nongyn filter
|
$152.50 |
$152.50 |
$152.50 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$142.50 |
$142.50 |
$142.50 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$152.50 |
$152.50 |
$152.50 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$128.00 |
$128.00 |
$128.00 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$57.50 |
$57.50 |
$57.50 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$211.00 |
$211.00 |
$211.00 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$227.00 |
$227.00 |
$227.00 |
$209.23
|
|
Dacarbazine 100 mg intravenous solution
|
$54.56 |
$54.56 |
$54.56 |
$58.22
|
|
Dactinomycin 0.5 mg intravenous solution
|
$2,024.52 |
$2,024.52 |
$2,024.52 |
$3,024.59
|
|
Dalbavancin 500 mg intravenous solution
|
$3,959.85 |
$3,959.85 |
$3,959.85 |
$3,480.35
|
|
Dalteparin sodium
|
$111.45 |
$111.45 |
$111.45 |
$469.55
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$171.19 |
$171.19 |
$171.19 |
$168.53
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$22,216.48 |
$22,216.48 |
$22,216.48 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$6,927.02 |
$6,927.02 |
$6,927.02 |
$6,072.48
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$26,477.15 |
$26,477.15 |
$26,477.15 |
$20,196.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$127.58 |
$127.58 |
$127.58 |
$257.10
|
|
Dch pulmonary stress test
|
$1,557.00 |
$1,557.00 |
$1,557.00 |
$963.30
|
|
Dch validity tests
|
$10.00 |
$10.00 |
$11.00 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$71.50 |
$71.50 |
$71.50 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$222.00 |
$222.00 |
$222.00 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$5,064.50 |
$5,064.50 |
$5,064.50 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,485.00 |
$1,485.00 |
$1,485.00 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,231.50 |
$1,231.50 |
$1,231.50 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$973.50 |
$973.50 |
$973.50 |
$810.50
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$801.50 |
$801.50 |
$801.50 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$2,492.50 |
$2,492.50 |
$2,492.50 |
$1,160.00
|
|
Decalcification
|
$63.00 |
$63.00 |
$63.00 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$410.37 |
$410.37 |
$410.37 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$608.00 |
$608.00 |
$608.00 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$73.98 |
$73.98 |
$73.98 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$1,807.08 |
$1,807.08 |
$1,807.08 |
$1,807.08
|
|
Demonstrate use home inr mon
|
$415.50 |
$415.50 |
$415.50 |
$294.75
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$98.00 |
$98.00 |
$98.00 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$7,951.40 |
$7,951.40 |
$7,951.40 |
$6,324.98
|
|
Depo-estradiol cypionate inj
|
$883.18 |
$883.18 |
$883.18 |
$71.51
|