|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,052.40 |
$3,052.40 |
$3,052.40 |
$2,272.00
|
|
Culture aerobic additional method definitive id each
|
$62.40 |
$62.40 |
$62.40 |
$72.00
|
|
Culture afb any source
|
$76.05 |
$76.05 |
$76.05 |
$110.60
|
|
Culture anaerobic except blood
|
$82.55 |
$82.55 |
$82.55 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$52.65 |
$52.65 |
$52.65 |
$52.50
|
|
Culture body fluid
|
$94.90 |
$94.90 |
$94.90 |
$126.75
|
|
Culture fungi other (except blood)
|
$92.95 |
$92.95 |
$92.95 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$55.25 |
$55.25 |
$55.25 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$210.60 |
$210.60 |
$210.60 |
$100.00
|
|
Culture quantitative aerobic other source
|
$85.80 |
$85.80 |
$85.80 |
$87.02
|
|
Culture screening strep group a
|
$65.65 |
$65.65 |
$65.65 |
$84.60
|
|
Culture typing immunologic
|
$29.90 |
$29.90 |
$29.90 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$325.00 |
$325.00 |
$325.00 |
$408.37
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$157.30 |
$157.30 |
$157.30 |
$140.80
|
|
Cutter lead
|
$3,329.03 |
$3,329.03 |
$3,329.03 |
$6,581.45
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$3.00 |
$3.00 |
$3.00 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$97.50 |
$97.50 |
$97.50 |
$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
|
$126.10 |
$126.10 |
$126.10 |
$130.40
|
|
Cyclosporine modified 25 mg capsule
|
$1.00 |
$1.00 |
$1.00 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$1.55 |
$1.55 |
$1.55 |
$37.31
|
|
Cylinder pump set 20cm titan zero angl
|
$15,794.15 |
$15,794.15 |
$15,794.15 |
$24,728.89
|
|
Cystatin c
|
$72.80 |
$72.80 |
$72.80 |
$77.60
|
|
Cytarabine 20 mg/ml injection solution
|
$135.00 |
$135.00 |
$135.00 |
$90.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$94.90 |
$94.90 |
$94.90 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$109.85 |
$109.85 |
$109.85 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$226.00 |
$226.00 |
$226.00 |
$159.90
|
|
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
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$127.00 |
$127.00 |
$127.00 |
$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
|
$63.70 |
$63.70 |
$63.70 |
$43.35
|
|
Debridement (>20 cm) charge pt
|
$178.10 |
$178.10 |
$178.10 |
$284.00
|
|
Decalcification
|
$72.15 |
$72.15 |
$72.15 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$224.90 |
$224.90 |
$224.90 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$762.45 |
$762.45 |
$762.45 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$187.30 |
$187.30 |
$187.30 |
$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
|
$240.50 |
$240.50 |
$240.50 |
$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
|
$0.06 |
$0.06 |
$0.06 |
$1.98
|
|
Desmopressin 4 mcg/ml injection solution
|
$51.55 |
$51.55 |
$51.55 |
$91.84
|
|
Device ablt adv novasure
|
$6,237.48 |
$6,237.48 |
$6,237.48 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$2,599.67 |
$2,599.67 |
$2,599.67 |
$4,200.00
|
|
Device intraute mirena
|
$2,105.82 |
$2,105.82 |
$2,105.82 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,534.26 |
$1,534.26 |
$1,534.26 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$3,961.70 |
$3,961.70 |
$3,961.70 |
$2,515.00
|
|
Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr
|
$21.00 |
$21.00 |
$21.00 |
$21.00
|
|
Dexamethasone 4 mg tablet
|
$1.00 |
$1.00 |
$1.00 |
$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
|
$2,752.60 |
$2,752.60 |
$2,752.60 |
$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 % IV bolus
|
$30.00 |
$30.00 |
$30.00 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$185.90 |
$185.90 |
$185.90 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$79.30 |
$79.30 |
$79.30 |
$79.30
|
|
Diagnostic Mammogram (both breasts)
|
$445.90 |
$445.90 |
$445.90 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$297.05 |
$297.05 |
$297.05 |
$314.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$68.15 |
$68.15 |
$68.15 |
$79.71
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$25.30 |
$25.30 |
$25.30 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$13,725.30 |
$13,725.30 |
$13,725.30 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$91.65 |
$91.65 |
$91.65 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$184.00 |
$184.00 |
$184.00 |
$297.86
|
|
Dilator fascial 10fx20cm
|
$274.98 |
$274.98 |
$274.98 |
$402.10
|
|
Diltiazem 5 mg/ml intravenous solution
|
$26.00 |
$26.00 |
$26.00 |
$45.60
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$3.70 |
$3.70 |
$3.70 |
$18.32
|
|
Dna antibody native/double stranded
|
$101.40 |
$101.40 |
$101.40 |
$100.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$183.75 |
$183.75 |
$183.75 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$2,567.60 |
$2,567.60 |
$2,567.60 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$72.50 |
$72.50 |
$72.50 |
$65.40
|
|
Dornhoffer fixed part w/window
|
$20,628.52 |
$20,628.52 |
$20,628.52 |
$34,278.00
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$36,812.65 |
$36,812.65 |
$36,812.65 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$1,578.20 |
$1,578.20 |
$1,578.20 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$7,093.75 |
$7,093.75 |
$7,093.75 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$86.65 |
$86.65 |
$86.65 |
$89.34
|
|
Drain blood from under nail 11740
|
$133.00 |
$133.00 |
$133.00 |
$182.40
|
|
Drain chst dry seal exp thorastat
|
$138.44 |
$138.44 |
$138.44 |
$119.43
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$182.65 |
$182.65 |
$182.65 |
$349.50
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$978.05 |
$978.05 |
$978.05 |
$3,789.86
|
|
Droperidol 2.5 mg/ml injection solution
|
$32.80 |
$32.80 |
$32.80 |
$31.25
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$3,826.54 |
$3,826.54 |
$3,826.54 |
$1,818.32
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$156.82 |
$156.82 |
$156.82 |
$119.50
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$34.84 |
$34.84 |
$34.84 |
$53.60
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$41.79 |
$41.79 |
$41.79 |
$193.15
|
|
Drsg sht 5.625x4.625in std
|
$80.11 |
$80.11 |
$80.11 |
$123.24
|
|
Drsg surg adh 11x11 3/4 occl drap wnd 28x30
|
$0.47 |
$0.47 |
$0.47 |
$19.10
|
|
Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm
|
$94.94 |
$94.94 |
$94.94 |
$94.94
|
|
Drsg wnd hyalomatrix 10x10cm -cost per sq cm
|
$46.92 |
$46.92 |
$46.92 |
$135.72
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$6,228.55 |
$6,228.55 |
$6,228.55 |
$7,465.97
|
|
Drsg wound/burn 18x10cm suprathel resorb cost per sq cm
|
$16.74 |
$16.74 |
$16.74 |
$1.00
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$247.88 |
$247.88 |
$247.88 |
$376.50
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$137.15 |
$137.15 |
$137.15 |
$278.85
|
|
Duragen 1x1 5ea/bx
|
$1,503.57 |
$1,503.57 |
$1,503.57 |
$10,564.87
|
|
Dura-guard dura repair patch 10x16cm -q4432-cost per sq cm-160sq cm
|
$171.82 |
$171.82 |
$171.82 |
$16,549.00
|
|
Durvalumab 50 mg/ml intravenous solution
|
$13,206.10 |
$13,206.10 |
$13,206.10 |
$8,445.90
|