|
CT angio pelvis
|
$202.80 |
$202.80 |
$202.80 |
$1,806.60
|
|
Cta upper extremity w &/or without contrast left
|
$202.80 |
$202.80 |
$202.80 |
$1,691.30
|
|
CT guidance for needle placement
|
$0.60 |
$0.60 |
$0.60 |
$1,494.00
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$0.60 |
$0.60 |
$0.60 |
$1,215.06
|
|
CT guid parench tis ablat
|
$0.60 |
$0.60 |
$0.60 |
$1,281.75
|
|
CT heart w/evaluation of calcium without contrast
|
$59.40 |
$59.40 |
$59.40 |
$150.00
|
|
CT hrt c+ strux cgen hrt ds
|
$220.80 |
$220.80 |
$220.80 |
$1,395.79
|
|
CT hrt w/3d image
|
$163.80 |
$163.80 |
$163.80 |
$1,350.03
|
|
CT limited or localized follow-up study
|
$80.40 |
$80.40 |
$80.40 |
$636.55
|
|
CT lwr extremity w/o&w/dye
|
$178.80 |
$178.80 |
$178.80 |
$1,818.96
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$211.80 |
$211.80 |
$211.80 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$184.80 |
$184.80 |
$184.80 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$95.40 |
$95.40 |
$95.40 |
$2,272.00
|
|
CT t-spine w /wo contrast
|
$172.80 |
$172.80 |
$172.80 |
$1,975.00
|
|
CT uppr extremity w/o&w/dye
|
$98.40 |
$98.40 |
$98.40 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$16.20 |
$16.20 |
$16.20 |
$72.00
|
|
Culture afb any source
|
$97.20 |
$97.20 |
$97.20 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$16.20 |
$16.20 |
$16.20 |
$84.76
|
|
Culture anaerobic except blood
|
$64.80 |
$64.80 |
$64.80 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$16.20 |
$16.20 |
$16.20 |
$52.50
|
|
Culture body fluid
|
$64.80 |
$64.80 |
$64.80 |
$126.75
|
|
Culture fungi definitive id mold
|
$16.20 |
$16.20 |
$16.20 |
$80.00
|
|
Culture fungi definitive id yeast
|
$16.20 |
$16.20 |
$16.20 |
$80.00
|
|
Culture fungi other (except blood)
|
$40.20 |
$40.20 |
$40.20 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$40.20 |
$40.20 |
$40.20 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$123.00 |
$123.00 |
$123.00 |
$100.00
|
|
Culture mycoplasma any source
|
$49.80 |
$49.80 |
$49.80 |
$83.21
|
|
Culture quantitative aerobic other source
|
$64.80 |
$64.80 |
$64.80 |
$87.02
|
|
Culture screening strep group a
|
$32.40 |
$32.40 |
$32.40 |
$84.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$40.20 |
$40.20 |
$40.20 |
$140.80
|
|
Culture virus isolation
|
$162.00 |
$162.00 |
$162.00 |
$162.00
|
|
Cutter lead
|
$3,494.40 |
$3,494.40 |
$3,494.40 |
$6,581.45
|
|
Cv line/pic reposition
|
$0.60 |
$0.60 |
$0.60 |
$1,681.20
|
|
Cyanocobalamin unsat binding capacity
|
$37.20 |
$37.20 |
$37.20 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$2.40 |
$2.40 |
$2.40 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$40.20 |
$40.20 |
$40.20 |
$72.36
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$39.00 |
$39.00 |
$39.00 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$32.40 |
$32.40 |
$32.40 |
$130.40
|
|
Cylinder pump set 20cm titan zero angl
|
$17,175.60 |
$17,175.60 |
$17,175.60 |
$24,728.89
|
|
Cystatin c
|
$81.00 |
$81.00 |
$81.00 |
$77.60
|
|
Cystine urine quantitative
|
$97.20 |
$97.20 |
$97.20 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$0.60 |
$0.60 |
$0.60 |
$586.95
|
|
Cytarabine 20 mg/ml injection solution
|
$8.40 |
$8.40 |
$8.40 |
$90.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$24.00 |
$24.00 |
$24.00 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$40.20 |
$40.20 |
$40.20 |
$100.00
|
|
Cytomegalovirus dfa
|
$40.20 |
$40.20 |
$40.20 |
$77.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$64.80 |
$64.80 |
$64.80 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$113.40 |
$113.40 |
$113.40 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$48.60 |
$48.60 |
$48.60 |
$127.50
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$145.80 |
$145.80 |
$145.80 |
$213.85
|
|
Cytopath smear other source
|
$48.60 |
$48.60 |
$48.60 |
$92.50
|
|
Cytopath smear oth prep screen & interp
|
$113.40 |
$113.40 |
$113.40 |
$96.20
|
|
Cytopath tbs c/v manual
|
$32.40 |
$32.40 |
$32.40 |
$59.28
|
|
Dacarbazine 100 mg intravenous solution
|
$10.80 |
$10.80 |
$10.80 |
$62.41
|
|
Dalbavancin 500 mg intravenous solution
|
$18.00 |
$18.00 |
$18.00 |
$3,493.11
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$21.00 |
$21.00 |
$21.00 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$9,477.00 |
$9,477.00 |
$9,477.00 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,336.40 |
$2,336.40 |
$2,336.40 |
$6,281.29
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$107.40 |
$107.40 |
$107.40 |
$259.58
|
|
Dch validity tests
|
$6.00 |
$6.00 |
$6.00 |
$25.00
|
|
Debridement (>20 cm) charge pt
|
$91.20 |
$91.20 |
$91.20 |
$284.00
|
|
Decalcification
|
$7.80 |
$7.80 |
$7.80 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$108.00 |
$108.00 |
$108.00 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$292.80 |
$292.80 |
$292.80 |
$572.95
|
|
Deep muscle biopsy 20205
|
$0.60 |
$0.60 |
$0.60 |
$3,386.84
|
|
Deferoxamine 500 mg solution for injection
|
$27.00 |
$27.00 |
$27.00 |
$95.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$23.40 |
$23.40 |
$23.40 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$24.00 |
$24.00 |
$24.00 |
$6,324.98
|
|
Descend thora aorta rpr/lt sub art 33880
|
$0.60 |
$0.60 |
$0.60 |
$6,288.45
|
|
Design mlc device for imrt
|
$475.80 |
$475.80 |
$475.80 |
$1,753.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$357.60 |
$357.60 |
$357.60 |
$91.84
|
|
Desoxycorticosterone
|
$40.20 |
$40.20 |
$40.20 |
$109.28
|
|
Des thora aorta rpr without left sub art 33881
|
$0.60 |
$0.60 |
$0.60 |
$5,267.20
|
|
Destroy cervthor facet jnt 64633
|
$0.60 |
$0.60 |
$0.60 |
$3,138.15
|
|
Destroy cth facet jnt addl 64634
|
$0.60 |
$0.60 |
$0.60 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$0.60 |
$0.60 |
$0.60 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$0.60 |
$0.60 |
$0.60 |
$3,296.80
|
|
Detect agent nos dna dir
|
$194.40 |
$194.40 |
$194.40 |
$138.00
|
|
Detect agnt mult dna direc
|
$194.40 |
$194.40 |
$194.40 |
$166.77
|
|
Developmental screen/score/document 96110
|
$34.20 |
$34.20 |
$34.20 |
$142.38
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$89.40 |
$89.40 |
$89.40 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$0.60 |
$0.60 |
$0.60 |
$5.85
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$397.80 |
$397.80 |
$397.80 |
$884.80
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$0.60 |
$0.60 |
$0.60 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$24.00 |
$24.00 |
$24.00 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$32.40 |
$32.40 |
$32.40 |
$79.30
|
|
Diagnostic digital breast tomosynthesis bil
|
$124.80 |
$124.80 |
$124.80 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$124.80 |
$124.80 |
$124.80 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$607.80 |
$607.80 |
$607.80 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$464.40 |
$464.40 |
$464.40 |
$314.00
|
|
Dialysis one evaluation
|
$150.00 |
$150.00 |
$150.00 |
$936.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$35.40 |
$35.40 |
$35.40 |
$79.71
|
|
Diffusing capacity
|
$65.40 |
$65.40 |
$65.40 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$3.60 |
$3.60 |
$3.60 |
$65.84
|
|
Digoxin total therapeutic drug level
|
$24.00 |
$24.00 |
$24.00 |
$102.07
|
|
Dilate biliary duct/ampulla
|
$0.60 |
$0.60 |
$0.60 |
$1,866.73
|
|
Dilat xst trc ndurlgc px
|
$0.60 |
$0.60 |
$0.60 |
$3,900.60
|
|
Dilat xst trc new access rcs
|
$0.60 |
$0.60 |
$0.60 |
$4,258.20
|
|
Dimethyl sulfoxide 50% 50 ml
|
$644.40 |
$644.40 |
$644.40 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$0.60 |
$0.60 |
$0.60 |
$18.32
|
