|
CT orbit/sella/fossa w/wo contrast
|
$4,781.77 |
$4,781.77 |
$4,781.77 |
$1,681.95
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,551.16 |
$2,551.16 |
$2,551.16 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$2,503.50 |
$2,503.50 |
$2,503.50 |
$1,369.73
|
|
Ctrl nosebld postir subsq 30906
|
$1,362.63 |
$1,362.63 |
$1,362.63 |
$481.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,531.68 |
$5,531.68 |
$5,531.68 |
$3,472.30
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$9,768.59 |
$9,768.59 |
$9,768.59 |
$2,979.85
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$8,907.77 |
$8,907.77 |
$8,907.77 |
$2,412.75
|
|
CT thoracic spine w/contrast
|
$3,649.43 |
$3,649.43 |
$3,649.43 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$3,318.54 |
$3,318.54 |
$3,318.54 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,150.32 |
$1,150.32 |
$1,150.32 |
$427.70
|
|
CT t-spine w /wo contrast
|
$4,829.15 |
$4,829.15 |
$4,829.15 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$4,480.42 |
$4,480.42 |
$4,480.42 |
$1,706.10
|
|
CT upper extremity without contrast (both sides)
|
$4,229.24 |
$4,229.24 |
$4,229.24 |
$1,473.75
|
|
Culture aerobic additional method definitive id each
|
$221.26 |
$221.26 |
$221.26 |
$63.75
|
|
Culture afb any source
|
$206.88 |
$206.88 |
$206.88 |
$110.00
|
|
Culture anaerobic additional method definitive id each
|
$314.01 |
$314.01 |
$314.01 |
$77.31
|
|
Culture anaerobic except blood
|
$261.03 |
$261.03 |
$261.03 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$169.12 |
$169.12 |
$169.12 |
$52.65
|
|
Culture body fluid
|
$208.38 |
$208.38 |
$208.38 |
$130.50
|
|
Culture fungi definitive id mold
|
$570.33 |
$570.33 |
$570.33 |
$70.00
|
|
Culture fungi definitive id yeast
|
$220.99 |
$220.99 |
$220.99 |
$79.10
|
|
Culture fungi other (except blood)
|
$228.13 |
$228.13 |
$228.13 |
$99.88
|
|
Culture screening strep group a
|
$159.48 |
$159.48 |
$159.48 |
$80.60
|
|
Culture typing added method
|
$94.94 |
$94.94 |
$94.94 |
$34.45
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$1,783.10 |
$1,783.10 |
$1,783.10 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$364.06 |
$364.06 |
$364.06 |
$124.02
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$68.01 |
$68.01 |
$68.01 |
$26.73
|
|
Cyclic citrullinated peptide antibody
|
$147.05 |
$147.05 |
$147.05 |
$88.51
|
|
Cyclosporine 2 hour
|
$197.10 |
$197.10 |
$197.10 |
$120.20
|
|
Cyclosporine oral 100 mg
|
$48.03 |
$48.03 |
$48.03 |
$42.97
|
|
Cystatin c
|
$153.21 |
$153.21 |
$153.21 |
$82.50
|
|
Cytarabine 20 mg/ml injection solution
|
$137.80 |
$137.80 |
$137.80 |
$66.95
|
|
Cytomegalovirus (cmv) antibody igg
|
$176.49 |
$176.49 |
$176.49 |
$102.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$206.67 |
$206.67 |
$206.67 |
$105.23
|
|
Cyto/molecular report
|
$1,226.48 |
$1,226.48 |
$1,226.48 |
$150.30
|
|
Cytopathology cellular enhancement technique non-gyn
|
$642.68 |
$642.68 |
$642.68 |
$163.43
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$207.01 |
$207.01 |
$207.01 |
$205.00
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$77,794.61 |
$77,794.61 |
$77,794.61 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$13,707.91 |
$13,707.91 |
$13,707.91 |
$5,500.25
|
|
Deamidated gliadin antibody iga
|
$435.65 |
$435.65 |
$435.65 |
$45.31
|
|
Debridement (>20 cm) charge pt
|
$934.77 |
$934.77 |
$934.77 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$4,905.10 |
$4,905.10 |
$4,905.10 |
$2,578.95
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,332.11 |
$1,332.11 |
$1,332.11 |
$681.60
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$3,678.83 |
$3,678.83 |
$3,678.83 |
$1,407.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,141.80 |
$1,141.80 |
$1,141.80 |
$810.50
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$856.36 |
$856.36 |
$856.36 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,776.15 |
$1,776.15 |
$1,776.15 |
$1,193.40
|
|
Decalcification
|
$67.01 |
$67.01 |
$67.01 |
$75.38
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$500.27 |
$500.27 |
$500.27 |
$510.95
|
|
Deferoxamine 500 mg solution for injection
|
$686.93 |
$686.93 |
$686.93 |
$112.87
|
|
Delivery of placenta 59414
|
$9,089.82 |
$9,089.82 |
$9,089.82 |
$3,135.14
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$140.16 |
$140.16 |
$140.16 |
$180.00
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$21,673.52 |
$21,673.52 |
$21,673.52 |
$7,737.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,532.01 |
$1,532.01 |
$1,532.01 |
$172.46
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$43.69 |
$43.69 |
$43.69 |
$23.27
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$66.59 |
$66.59 |
$66.59 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$66.59 |
$66.59 |
$66.59 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$24.04 |
$24.04 |
$24.04 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$66.59 |
$66.59 |
$66.59 |
$68.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$787.28 |
$787.28 |
$787.28 |
$108.00
|
|
Diabetes (HbA1c) Test
|
$193.18 |
$193.18 |
$193.18 |
$79.30
|
|
Diagnostic digital breast tomosynthesis bil
|
$298.70 |
$298.70 |
$298.70 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$207.45 |
$207.45 |
$207.45 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$1,523.40 |
$1,523.40 |
$1,523.40 |
$421.20
|
|
Diagnostic Mammogram (one breast)
|
$994.26 |
$994.26 |
$994.26 |
$289.85
|
|
Diatrizoate meglumine 18 % urethral solution
|
$510.98 |
$510.98 |
$510.98 |
$122.25
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$86.17 |
$86.17 |
$86.17 |
$67.89
|
|
Dicyclomine injection
|
$281.35 |
$281.35 |
$281.35 |
$210.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$42.64 |
$42.64 |
$42.64 |
$53.00
|
|
Digoxin total therapeutic drug level
|
$125.00 |
$125.00 |
$125.00 |
$99.35
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$33.95 |
$33.95 |
$33.95 |
$22.58
|
|
Disaccharidases
|
$375.20 |
$375.20 |
$375.20 |
$231.67
|
|
Dna antibody native/double stranded
|
$258.02 |
$258.02 |
$258.02 |
$103.20
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$230.12 |
$230.12 |
$230.12 |
$98.43
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$1,430.79 |
$1,430.79 |
$1,430.79 |
$712.02
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$84.56 |
$84.56 |
$84.56 |
$64.77
|
|
Doppler echo complete
|
$1,173.70 |
$1,173.70 |
$1,173.70 |
$644.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,581.10 |
$1,581.10 |
$1,581.10 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$767.63 |
$767.63 |
$767.63 |
$495.30
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$84,649.45 |
$84,649.45 |
$84,649.45 |
$33,342.33
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$369.53 |
$369.53 |
$369.53 |
$232.80
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$15,456.00 |
$15,456.00 |
$15,456.00 |
$2,759.64
|
|
Drainage mouth roof lesion
|
$1,539.03 |
$1,539.03 |
$1,539.03 |
$528.80
|
|
Drainage of arm bursa 23931
|
$8,856.88 |
$8,856.88 |
$8,856.88 |
$2,419.30
|
|
Drainage of nose lesion int 30000
|
$1,297.74 |
$1,297.74 |
$1,297.74 |
$615.20
|
|
Drain blood from under nail 11740
|
$525.00 |
$525.00 |
$525.00 |
$190.10
|
|
Drain finger abscess;simple 26010
|
$1,295.65 |
$1,295.65 |
$1,295.65 |
$492.81
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$780.53 |
$780.53 |
$780.53 |
$403.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$624.41 |
$624.41 |
$624.41 |
$359.45
|
|
Dress/debrid prtl-thick burn l 16030
|
$352.36 |
$352.36 |
$352.36 |
$523.00
|
|
Drng of scrotum abscess 55100
|
$10,037.11 |
$10,037.11 |
$10,037.11 |
$1,997.89
|
|
Droperidol 2.5 mg/ml injection solution
|
$49.45 |
$49.45 |
$49.45 |
$33.99
|
|
Drug assay voriconazole
|
$122.71 |
$122.71 |
$122.71 |
$96.75
|
|
Drug test def 1-7 classes
|
$463.64 |
$463.64 |
$463.64 |
$270.05
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$1,189.51 |
$1,189.51 |
$1,189.51 |
$285.97
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,272.01 |
$2,272.01 |
$2,272.01 |
$887.25
|
|
Durvalumab 50 mg/ml intravenous solution
|
$92,943.56 |
$92,943.56 |
$92,943.56 |
$7,876.43
|
|
Dxa bone density axl vrt fx
|
$453.22 |
$453.22 |
$453.22 |
$383.80
|
|
Ear irrigation 69209
|
$461.34 |
$461.34 |
$461.34 |
$155.20
|
|
Ecg 12 lead tracing only
|
$323.59 |
$323.59 |
$323.59 |
$245.30
|