|
CT Angiogram of the Chest (for blood clot)
|
$1,513.00 |
$1,513.00 |
$1,513.00 |
$1,915.30
|
|
CT Angiogram of the Head
|
$3,890.00 |
$3,890.00 |
$3,890.00 |
$1,940.00
|
|
CT Angiogram of the Neck
|
$3,936.00 |
$3,936.00 |
$3,936.00 |
$1,881.75
|
|
CT heart w/evaluation of calcium without contrast
|
$100.00 |
$100.00 |
$100.00 |
$150.00
|
|
CT limited or localized follow-up study
|
$852.00 |
$852.00 |
$852.00 |
$636.55
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$6,331.00 |
$6,331.00 |
$6,331.00 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$5,637.00 |
$5,637.00 |
$5,637.00 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$4,696.00 |
$4,696.00 |
$4,696.00 |
$2,272.00
|
|
Culture aerobic additional method definitive id each
|
$392.00 |
$392.00 |
$392.00 |
$72.00
|
|
Culture afb any source
|
$117.00 |
$117.00 |
$117.00 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$82.00 |
$82.00 |
$82.00 |
$84.76
|
|
Culture anaerobic except blood
|
$127.00 |
$127.00 |
$127.00 |
$121.22
|
|
Culture body fluid
|
$339.00 |
$339.00 |
$339.00 |
$126.75
|
|
Culture fungi definitive id mold
|
$560.00 |
$560.00 |
$560.00 |
$80.00
|
|
Culture fungi definitive id yeast
|
$172.00 |
$172.00 |
$172.00 |
$80.00
|
|
Culture fungi other (except blood)
|
$143.00 |
$143.00 |
$143.00 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$85.00 |
$85.00 |
$85.00 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$324.00 |
$324.00 |
$324.00 |
$100.00
|
|
Culture quantitative aerobic other source
|
$132.00 |
$132.00 |
$132.00 |
$87.02
|
|
Culture screening strep group a
|
$101.00 |
$101.00 |
$101.00 |
$84.60
|
|
Culture typing immunologic
|
$46.00 |
$46.00 |
$46.00 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$500.00 |
$500.00 |
$500.00 |
$408.37
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$242.00 |
$242.00 |
$242.00 |
$140.80
|
|
Culture urine each isolate
|
$85.00 |
$85.00 |
$85.00 |
$55.50
|
|
Cutter lead
|
$5,121.59 |
$5,121.59 |
$5,121.59 |
$6,581.45
|
|
Cv stress test i&r only 93018
|
$47.00 |
$47.00 |
$47.00 |
$36.40
|
|
Cv stress test/supervision only 93016
|
$70.00 |
$70.00 |
$70.00 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$7.20 |
$7.20 |
$7.20 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$150.00 |
$150.00 |
$150.00 |
$72.36
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$5,154.25 |
$5,154.25 |
$5,154.25 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$17.10 |
$17.10 |
$17.10 |
$19.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$137.50 |
$137.50 |
$137.50 |
$140.78
|
|
Cyclosporine 2 hour
|
$194.00 |
$194.00 |
$194.00 |
$130.40
|
|
Cylinder pump set 20cm titan zero angl
|
$24,298.69 |
$24,298.69 |
$24,298.69 |
$24,728.89
|
|
Cystatin c
|
$112.00 |
$112.00 |
$112.00 |
$77.60
|
|
Cystoscopy and treatment
|
$9,250.00 |
$9,250.00 |
$9,250.00 |
$4,638.40
|
|
Cystoscopy and treatment
|
$13,399.61 |
$13,399.61 |
$13,399.61 |
$5,304.00
|
|
Cystoscopy and treatment
|
$1,169.00 |
$1,169.00 |
$1,169.00 |
$2,867.70
|
|
Cystoscopy (Bladder Scope)
|
$2,938.00 |
$2,938.00 |
$2,938.00 |
$1,493.80
|
|
Cystoscopy chemodenervation
|
$10,793.15 |
$10,793.15 |
$10,793.15 |
$2,874.36
|
|
Cystoscopy & ureter catheter
|
$4,863.00 |
$4,863.00 |
$4,863.00 |
$3,728.50
|
|
Cysto/uretero w/lithotripsy
|
$15,383.00 |
$15,383.00 |
$15,383.00 |
$9,430.00
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$6,146.00 |
$6,146.00 |
$6,146.00 |
$4,057.50
|
|
Cytarabine 20 mg/ml injection solution
|
$135.00 |
$135.00 |
$135.00 |
$90.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$146.00 |
$146.00 |
$146.00 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$169.00 |
$169.00 |
$169.00 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$246.00 |
$246.00 |
$246.00 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$123.00 |
$123.00 |
$123.00 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$109.00 |
$109.00 |
$109.00 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$192.00 |
$192.00 |
$192.00 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$150.00 |
$150.00 |
$150.00 |
$127.50
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$139.00 |
$139.00 |
$139.00 |
$68.06
|
|
Cytopath smear other source
|
$164.00 |
$164.00 |
$164.00 |
$92.50
|
|
Cytopath tbs c/v manual
|
$91.00 |
$91.00 |
$91.00 |
$59.28
|
|
Dacarbazine 100 mg intravenous solution
|
$56.45 |
$56.45 |
$56.45 |
$62.41
|
|
Dactinomycin 0.5 mg intravenous solution
|
$13,542.70 |
$13,542.70 |
$13,542.70 |
$3,264.26
|
|
Dalbavancin 500 mg intravenous solution
|
$7,773.10 |
$7,773.10 |
$7,773.10 |
$3,493.11
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$152.45 |
$152.45 |
$152.45 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$33,713.70 |
$33,713.70 |
$33,713.70 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$18,648.65 |
$18,648.65 |
$18,648.65 |
$6,281.29
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$34,410.00 |
$34,410.00 |
$34,410.00 |
$20,196.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$308.50 |
$308.50 |
$308.50 |
$259.58
|
|
Deamidated gliadin antibody iga
|
$98.00 |
$98.00 |
$98.00 |
$43.35
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$17,181.33 |
$17,181.33 |
$17,181.33 |
$835.20
|
|
Debride nail1-5 11720
|
$739.00 |
$739.00 |
$739.00 |
$149.60
|
|
Debride nail6 or more 11721
|
$186.00 |
$186.00 |
$186.00 |
$169.80
|
|
Decalcification
|
$111.00 |
$111.00 |
$111.00 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$224.90 |
$224.90 |
$224.90 |
$1,073.52
|
|
Deferoxamine 500 mg solution for injection
|
$98.80 |
$98.80 |
$98.80 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$4,556.35 |
$4,556.35 |
$4,556.35 |
$1,856.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$370.00 |
$370.00 |
$370.00 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$15,865.45 |
$15,865.45 |
$15,865.45 |
$6,324.98
|
|
Deodorant ostmy adapt lube 8ml
|
$0.10 |
$0.10 |
$0.10 |
$1.98
|
|
Desmopressin 4 mcg/ml injection solution
|
$174.80 |
$174.80 |
$174.80 |
$91.84
|
|
Destroy premlg lesns;1st lesn 17000
|
$386.00 |
$386.00 |
$386.00 |
$202.40
|
|
Destruction benign lesions < 14 lesions
|
$376.00 |
$376.00 |
$376.00 |
$240.24
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$16,463.08 |
$16,463.08 |
$16,463.08 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$13,535.90 |
$13,535.90 |
$13,535.90 |
$3,296.80
|
|
Developmental screen/score/document 96110
|
$71.00 |
$71.00 |
$71.00 |
$142.38
|
|
Device ablt adv novasure
|
$9,596.13 |
$9,596.13 |
$9,596.13 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$3,999.50 |
$3,999.50 |
$3,999.50 |
$4,200.00
|
|
Device intraute mirena
|
$3,250.58 |
$3,250.58 |
$3,250.58 |
$2,125.00
|
|
Device sut capio slim opn
|
$2,360.40 |
$2,360.40 |
$2,360.40 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$6,094.92 |
$6,094.92 |
$6,094.92 |
$2,515.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$265.00 |
$265.00 |
$265.00 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$13.00 |
$13.00 |
$13.00 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$20.20 |
$20.20 |
$20.20 |
$20.76
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$884.80 |
$884.80 |
$884.80 |
$884.80
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$20.00 |
$20.00 |
$20.00 |
$36.05
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$20.00 |
$20.00 |
$20.00 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$35.00 |
$35.00 |
$35.00 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$30.00 |
$30.00 |
$30.00 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$286.00 |
$286.00 |
$286.00 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$122.00 |
$122.00 |
$122.00 |
$79.30
|
|
Diab manage trn ind/group
|
$122.00 |
$122.00 |
$122.00 |
$54.99
|
|
Diagnostic Mammogram (both breasts)
|
$686.00 |
$686.00 |
$686.00 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$457.00 |
$457.00 |
$457.00 |
$314.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$172.55 |
$172.55 |
$172.55 |
$79.71
|
|
Diffusing capacity
|
$548.00 |
$548.00 |
$548.00 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$25.30 |
$25.30 |
$25.30 |
$65.84
|
