|
Ctlso a-p-l control with inter
|
$3,462.93 |
$3,462.93 |
$3,462.93 |
$4,186.78
|
|
Ctlso axilla sling
|
$132.44 |
$132.44 |
$132.44 |
$155.04
|
|
Ctlso milwauke initial model
|
$3,208.80 |
$3,208.80 |
$3,208.80 |
$4,262.27
|
|
CT lwr extremity w/o&w/dye
|
$2,119.26 |
$2,119.26 |
$2,119.26 |
$1,818.96
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,986.77 |
$1,986.77 |
$1,986.77 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,589.34 |
$1,589.34 |
$1,589.34 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,192.13 |
$1,192.13 |
$1,192.13 |
$2,272.00
|
|
CT uppr extremity w/o&w/dye
|
$1,986.77 |
$1,986.77 |
$1,986.77 |
$1,845.36
|
|
Cuffs adj lock with active con
|
$1,547.39 |
$1,547.39 |
$1,547.39 |
$1,472.80
|
|
Culture aerobic additional method definitive id each
|
$397.77 |
$397.77 |
$397.77 |
$72.00
|
|
Culture afb any source
|
$56.95 |
$56.95 |
$56.95 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$47.88 |
$47.88 |
$47.88 |
$84.76
|
|
Culture anaerobic except blood
|
$73.02 |
$73.02 |
$73.02 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$37.91 |
$37.91 |
$37.91 |
$52.50
|
|
Culture body fluid
|
$63.56 |
$63.56 |
$63.56 |
$126.75
|
|
Culture fungi definitive id mold
|
$218.62 |
$218.62 |
$218.62 |
$80.00
|
|
Culture fungi definitive id yeast
|
$38.14 |
$38.14 |
$38.14 |
$80.00
|
|
Culture fungi other (except blood)
|
$84.17 |
$84.17 |
$84.17 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$52.47 |
$52.47 |
$52.47 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$158.87 |
$158.87 |
$158.87 |
$100.00
|
|
Culture screening strep group a
|
$138.82 |
$138.82 |
$138.82 |
$84.60
|
|
Culture typing immunologic
|
$23.13 |
$23.13 |
$23.13 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$1,851.64 |
$1,851.64 |
$1,851.64 |
$408.37
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$316.46 |
$316.46 |
$316.46 |
$140.80
|
|
Culture urine each isolate
|
$22.18 |
$22.18 |
$22.18 |
$55.50
|
|
Custom shape cover ak
|
$1,817.98 |
$1,817.98 |
$1,817.98 |
$1,125.60
|
|
Custom shape cover bk
|
$991.59 |
$991.59 |
$991.59 |
$686.00
|
|
Custom shape cvr hip disart
|
$2,382.35 |
$2,382.35 |
$2,382.35 |
$1,587.60
|
|
Custom shape cvr knee disart
|
$1,773.24 |
$1,773.24 |
$1,773.24 |
$1,117.20
|
|
Cutter lead
|
$12,250.95 |
$12,250.95 |
$12,250.95 |
$6,581.45
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$34.82 |
$34.82 |
$34.82 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$50.34 |
$50.34 |
$50.34 |
$72.36
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$324.07 |
$324.07 |
$324.07 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$130.93 |
$130.93 |
$130.93 |
$130.40
|
|
Cyclosporine modified 25 mg capsule
|
$10.18 |
$10.18 |
$10.18 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$35.57 |
$35.57 |
$35.57 |
$37.31
|
|
Cyp2c19 gene com variants
|
$677.15 |
$677.15 |
$677.15 |
$524.00
|
|
Cyp2c9 gene com variants
|
$265.66 |
$265.66 |
$265.66 |
$275.10
|
|
Cyp2d6 gene com variants
|
$341.60 |
$341.60 |
$341.60 |
$570.70
|
|
Cystatin c
|
$78.74 |
$78.74 |
$78.74 |
$77.60
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,832.15 |
$1,832.15 |
$1,832.15 |
$586.95
|
|
Cytarabine 20 mg/ml injection solution
|
$137.61 |
$137.61 |
$137.61 |
$90.00
|
|
Cytogenetics 25-99
|
$70.00 |
$70.00 |
$70.00 |
$189.80
|
|
Cytogenetics 3-5
|
$110.21 |
$110.21 |
$110.21 |
$147.36
|
|
Cytogenomic neo microra alys
|
$3,675.11 |
$3,675.11 |
$3,675.11 |
$2,198.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$205.74 |
$205.74 |
$205.74 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$154.45 |
$154.45 |
$154.45 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$89.82 |
$89.82 |
$89.82 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$157.25 |
$157.25 |
$157.25 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$153.72 |
$153.72 |
$153.72 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$99.85 |
$99.85 |
$99.85 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$245.56 |
$245.56 |
$245.56 |
$127.50
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$452.20 |
$452.20 |
$452.20 |
$213.85
|
|
Cytopath smear other source
|
$275.69 |
$275.69 |
$275.69 |
$92.50
|
|
Dacarbazine 100 mg intravenous solution
|
$124.92 |
$124.92 |
$124.92 |
$62.41
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$50.65 |
$50.65 |
$50.65 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$14,685.67 |
$14,685.67 |
$14,685.67 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$6,996.96 |
$6,996.96 |
$6,996.96 |
$6,281.29
|
|
Deamidated gliadin antibody iga
|
$91.56 |
$91.56 |
$91.56 |
$43.35
|
|
Debridement (>20 cm) charge pt
|
$117.77 |
$117.77 |
$117.77 |
$284.00
|
|
Decalcification
|
$40.04 |
$40.04 |
$40.04 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$3,036.68 |
$3,036.68 |
$3,036.68 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$218.29 |
$218.29 |
$218.29 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$41.00 |
$41.00 |
$41.00 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$1,009.67 |
$1,009.67 |
$1,009.67 |
$1,856.85
|
|
Delivery of placenta 59414
|
$1,012.26 |
$1,012.26 |
$1,012.26 |
$2,912.46
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$83.05 |
$83.05 |
$83.05 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$6,251.87 |
$6,251.87 |
$6,251.87 |
$6,324.98
|
|
Desmopressin 4 mcg/ml injection solution
|
$97.14 |
$97.14 |
$97.14 |
$91.84
|
|
Destroy cervthor facet jnt 64633
|
$1,520.51 |
$1,520.51 |
$1,520.51 |
$3,138.15
|
|
Destroy cth facet jnt addl 64634
|
$2,440.42 |
$2,440.42 |
$2,440.42 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$140.17 |
$140.17 |
$140.17 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,520.51 |
$1,520.51 |
$1,520.51 |
$3,296.80
|
|
Devel tst phys/qhp 1st hr
|
$192.92 |
$192.92 |
$192.92 |
$350.40
|
|
Device ablt adv novasure
|
$5,839.57 |
$5,839.57 |
$5,839.57 |
$6,237.48
|
|
Device intraute mirena
|
$2,246.32 |
$2,246.32 |
$2,246.32 |
$2,125.00
|
|
Device tiss remov myosure reach
|
$1,387.90 |
$1,387.90 |
$1,387.90 |
$2,515.00
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$96.49 |
$96.49 |
$96.49 |
$199.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$114.58 |
$114.58 |
$114.58 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$25.87 |
$25.87 |
$25.87 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$32.51 |
$32.51 |
$32.51 |
$20.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$21.06 |
$21.06 |
$21.06 |
$36.05
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$25.09 |
$25.09 |
$25.09 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$26.10 |
$26.10 |
$26.10 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$21.06 |
$21.06 |
$21.06 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$45.53 |
$45.53 |
$45.53 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$47.10 |
$47.10 |
$47.10 |
$79.30
|
|
Diab shoe for density insert
|
$116.70 |
$116.70 |
$116.70 |
$147.56
|
|
Diagnostic anoscopy spx 46600
|
$88.98 |
$88.98 |
$88.98 |
$195.50
|
|
Diagnostic Mammogram (both breasts)
|
$358.57 |
$358.57 |
$358.57 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$286.83 |
$286.83 |
$286.83 |
$314.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$1.68 |
$1.68 |
$1.68 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$58.08 |
$58.08 |
$58.08 |
$79.71
|
|
Diffusing capacity
|
$279.55 |
$279.55 |
$279.55 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$23.26 |
$23.26 |
$23.26 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$7,298.12 |
$7,298.12 |
$7,298.12 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$47.88 |
$47.88 |
$47.88 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$265.75 |
$265.75 |
$265.75 |
$297.86
|
|
Dilator fascial 10fx20cm
|
$170.30 |
$170.30 |
$170.30 |
$402.10
|
|
Diltiazem 5 mg/ml intravenous solution
|
$39.98 |
$39.98 |
$39.98 |
$45.60
|