|
CT lower extremity without contrast (both sides)
|
$710.61 |
$710.61 |
$710.61 |
$1,403.73
|
|
CT lwr extremity w/o&w/dye
|
$888.35 |
$888.35 |
$888.35 |
$1,844.52
|
|
CT neck soft tissue w/contrast
|
$760.82 |
$760.82 |
$760.82 |
$1,669.00
|
|
CT neck soft tissue without contrast
|
$639.15 |
$639.15 |
$639.15 |
$1,344.60
|
|
CT neck soft tissue without & w/contrast
|
$844.38 |
$844.38 |
$844.38 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$805.53 |
$805.53 |
$805.53 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$738.83 |
$738.83 |
$738.83 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$642.81 |
$642.81 |
$642.81 |
$1,365.36
|
|
Ctrl nosebld postir subsq 30906
|
$293.56 |
$293.56 |
$293.56 |
$481.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,965.07 |
$1,965.07 |
$1,965.07 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,665.29 |
$1,665.29 |
$1,665.29 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,432.21 |
$1,432.21 |
$1,432.21 |
$2,412.75
|
|
CT thoracic spine w/contrast
|
$835.95 |
$835.95 |
$835.95 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$819.46 |
$819.46 |
$819.46 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$633.65 |
$633.65 |
$633.65 |
$427.44
|
|
CT t-spine w /wo contrast
|
$1,024.32 |
$1,024.32 |
$1,024.32 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$856.84 |
$856.84 |
$856.84 |
$1,706.10
|
|
CT upper extremity without contrast (both sides)
|
$745.06 |
$745.06 |
$745.06 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$931.23 |
$931.23 |
$931.23 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$26.03 |
$26.03 |
$26.03 |
$63.60
|
|
Culture afb any source
|
$70.37 |
$70.37 |
$70.37 |
$108.63
|
|
Culture anaerobic additional method definitive id each
|
$28.22 |
$28.22 |
$28.22 |
$77.31
|
|
Culture anaerobic except blood
|
$64.14 |
$64.14 |
$64.14 |
$120.59
|
|
Culture bact stool aero addl path ea
|
$14.30 |
$14.30 |
$14.30 |
$52.65
|
|
Culture body fluid
|
$89.79 |
$89.79 |
$89.79 |
$130.50
|
|
Culture fungi definitive id mold
|
$48.38 |
$48.38 |
$48.38 |
$70.00
|
|
Culture fungi definitive id yeast
|
$19.06 |
$19.06 |
$19.06 |
$79.10
|
|
Culture fungi other (except blood)
|
$74.03 |
$74.03 |
$74.03 |
$98.80
|
|
Culture mycoplasma any source
|
$22.36 |
$22.36 |
$22.36 |
$92.91
|
|
Culture quantitative aerobic other source
|
$77.70 |
$77.70 |
$77.70 |
$87.02
|
|
Culture screening strep group a
|
$56.08 |
$56.08 |
$56.08 |
$79.20
|
|
Culture typing immunologic
|
$25.66 |
$25.66 |
$25.66 |
$42.12
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$199.74 |
$199.74 |
$199.74 |
$121.00
|
|
Culture urine each isolate
|
$49.11 |
$49.11 |
$49.11 |
$46.20
|
|
Cutter lead
|
$738.61 |
$738.61 |
$738.61 |
$2,205.00
|
|
Cyanocobalamin unsat binding capacity
|
$23.46 |
$23.46 |
$23.46 |
$64.28
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$24.37 |
$24.37 |
$24.37 |
$26.73
|
|
Cyclic citrullinated peptide antibody
|
$85.03 |
$85.03 |
$85.03 |
$85.58
|
|
Cyclophosphamide 25 mg capsule
|
$252.79 |
$252.79 |
$252.79 |
$22.51
|
|
Cyclosporine 2 hour
|
$121.68 |
$121.68 |
$121.68 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$25.12 |
$25.12 |
$25.12 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$926.40 |
$926.40 |
$926.40 |
$42.97
|
|
Cylinder pump set 20cm titan zero angl
|
$5,568.45 |
$5,568.45 |
$5,568.45 |
$18,784.86
|
|
Cyp2c19 gene com variants
|
$1,137.93 |
$1,137.93 |
$1,137.93 |
$572.00
|
|
Cyp2c9 gene com variants
|
$222.09 |
$222.09 |
$222.09 |
$287.82
|
|
Cyp2d6 gene com variants
|
$264.60 |
$264.60 |
$264.60 |
$537.50
|
|
Cystatin c
|
$90.89 |
$90.89 |
$90.89 |
$82.50
|
|
Cystine urine quantitative
|
$48.01 |
$48.01 |
$48.01 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$171.88 |
$171.88 |
$171.88 |
$527.50
|
|
Cysto/uretero w/lithotripsy
|
$4,246.41 |
$4,246.41 |
$4,246.41 |
$5,631.74
|
|
Cytomegalovirus (cmv) antibody igg
|
$113.25 |
$113.25 |
$113.25 |
$102.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$52.05 |
$52.05 |
$52.05 |
$104.65
|
|
Cytopath c/v index add-on
|
$56.44 |
$56.44 |
$56.44 |
$29.60
|
|
Cytopathology cellular enhancement technique non-gyn
|
$59.01 |
$59.01 |
$59.01 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$89.06 |
$89.06 |
$89.06 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$73.30 |
$73.30 |
$73.30 |
$124.80
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$147.70 |
$147.70 |
$147.70 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$24.19 |
$24.19 |
$24.19 |
$205.00
|
|
Cytopath smear other source
|
$64.51 |
$64.51 |
$64.51 |
$85.80
|
|
Cytopath smear other source
|
$23.83 |
$23.83 |
$23.83 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$45.82 |
$45.82 |
$45.82 |
$96.20
|
|
Cytopath tbs c/v manual
|
$59.01 |
$59.01 |
$59.01 |
$57.94
|
|
Cytotoxic antibody screening
|
$173.35 |
$173.35 |
$173.35 |
$158.48
|
|
Dacarbazine 100 mg intravenous solution
|
$146.47 |
$146.47 |
$146.47 |
$61.64
|
|
Dalbavancin 500 mg intravenous solution
|
$3,741.49 |
$3,741.49 |
$3,741.49 |
$3,746.85
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,077.57 |
$1,077.57 |
$1,077.57 |
$544.35
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$21,050.42 |
$21,050.42 |
$21,050.42 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$4,108.62 |
$4,108.62 |
$4,108.62 |
$5,500.25
|
|
Darbepoetin alfa, esrd use
|
$139.28 |
$139.28 |
$139.28 |
$152.66
|
|
Dch glucoscan
|
$5.14 |
$5.14 |
$5.14 |
$24.20
|
|
Dch validity tests
|
$0.74 |
$0.74 |
$0.74 |
$25.00
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$120.21 |
$120.21 |
$120.21 |
$668.98
|
|
Debridement (>20 cm) charge pt
|
$224.66 |
$224.66 |
$224.66 |
$262.60
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$195.71 |
$195.71 |
$195.71 |
$1,407.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$387.01 |
$387.01 |
$387.01 |
$810.50
|
|
Debride nail1-5 11720
|
$94.19 |
$94.19 |
$94.19 |
$173.25
|
|
Debr musc/fascia 20sq cm/< 11043
|
$778.04 |
$778.04 |
$778.04 |
$1,193.40
|
|
Decalcification
|
$18.70 |
$18.70 |
$18.70 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$1,026.54 |
$1,026.54 |
$1,026.54 |
$1,026.60
|
|
Deferoxamine 500 mg solution for injection
|
$49.51 |
$49.51 |
$49.51 |
$112.87
|
|
Degarelix 120 mg subcutaneous solution
|
$1,258.25 |
$1,258.25 |
$1,258.25 |
$1,930.00
|
|
Delivery of placenta 59414
|
$1,062.80 |
$1,062.80 |
$1,062.80 |
$3,135.14
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$34.45 |
$34.45 |
$34.45 |
$182.00
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$6,346.15 |
$6,346.15 |
$6,346.15 |
$7,599.00
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$190.94 |
$190.94 |
$190.94 |
$460.50
|
|
Depo-estradiol cypionate inj
|
$45.97 |
$45.97 |
$45.97 |
$87.27
|
|
Dermagraft
|
$41.05 |
$41.05 |
$41.05 |
$220.24
|
|
Design mlc device for imrt
|
$2,047.90 |
$2,047.90 |
$2,047.90 |
$1,669.85
|
|
Desmopressin 4 mcg/ml injection solution
|
$707.12 |
$707.12 |
$707.12 |
$168.50
|
|
Destroy cth facet jnt addl 64634
|
$153.56 |
$153.56 |
$153.56 |
$1,441.44
|
|
Destruction benign lesions < 14 lesions
|
$110.32 |
$110.32 |
$110.32 |
$234.00
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$153.56 |
$153.56 |
$153.56 |
$1,879.50
|
|
Developmental screen/score/document 96110
|
$146.23 |
$146.23 |
$146.23 |
$136.64
|
|
Device ablt adv novasure
|
$1,632.67 |
$1,632.67 |
$1,632.67 |
$5,201.82
|
|
Device sut capio slim opn
|
$192.41 |
$192.41 |
$192.41 |
$1,350.00
|
|
Device tiss remov myosure reach
|
$364.65 |
$364.65 |
$364.65 |
$1,280.86
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$122.41 |
$122.41 |
$122.41 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$36.04 |
$36.04 |
$36.04 |
$5.17
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$30.91 |
$30.91 |
$30.91 |
$23.27
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$366.55 |
$366.55 |
$366.55 |
$506.56
|