|
CT t-spine w /wo contrast
|
$861.41 |
$1,081.47 |
$2,856.80 |
|
|
CT uppr extremity w/o&w/dye
|
$1,079.71 |
$2,281.22 |
$3,199.20 |
|
|
Cuffs adj lock with active con
|
$1,547.39 |
$2,055.42 |
$2,055.42 |
|
|
Culture aerobic additional method definitive id each
|
$90.40 |
$316.46 |
$397.77 |
|
|
Culture afb any source
|
$45.22 |
$52.75 |
$136.00 |
|
|
Culture anaerobic additional method definitive id each
|
$44.80 |
$161.60 |
$439.25 |
|
|
Culture anaerobic except blood
|
$50.01 |
$55.10 |
$166.40 |
|
|
Culture bacteria anaerobic
|
$27.38 |
$27.38 |
$27.38 |
|
|
Culture bact stool aero addl path ea
|
$30.10 |
$35.11 |
$80.00 |
|
|
Culture body fluid
|
$48.00 |
$58.18 |
$159.20 |
|
|
Culture fungi definitive id mold
|
$60.80 |
$143.58 |
$218.62 |
|
|
Culture fungi definitive id yeast
|
$31.86 |
$34.94 |
$176.00 |
|
|
Culture fungi other (except blood)
|
$66.40 |
$77.95 |
$148.00 |
|
|
Culture fungi skin/hair/nail
|
$47.71 |
$48.05 |
$116.00 |
|
|
Culture mycobacteria definitive id each isolate
|
$92.00 |
$313.10 |
$345.02 |
|
|
Culture mycoplasma any source
|
$164.00 |
$164.00 |
$164.00 |
|
|
Culture quantitative aerobic other source
|
$44.74 |
$44.74 |
$50.93 |
|
|
Culture screening strep group a
|
$41.60 |
$110.16 |
$138.82 |
|
|
Culture typing immunologic
|
$19.26 |
$21.12 |
$90.40 |
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$576.00 |
$1,504.50 |
$1,851.64 |
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$138.40 |
$264.60 |
$316.46 |
|
|
Culture urine each isolate
|
$21.56 |
$23.62 |
$113.60 |
|
|
Curette/treat cornea
|
$2,028.80 |
$2,028.80 |
$2,028.80 |
|
|
Custom shape cover ak
|
$1,817.98 |
$2,414.83 |
$2,414.83 |
|
|
Custom shape cover bk
|
$991.59 |
$1,317.18 |
$1,317.18 |
|
|
Custom shape cvr hip disart
|
$2,382.35 |
$3,164.50 |
$3,164.50 |
|
|
Custom shape cvr knee disart
|
$1,773.24 |
$2,355.42 |
$2,355.42 |
|
|
Cutter lead
|
$12,250.95 |
$16,946.16 |
$17,483.68 |
|
|
Cv line/pic reposition
|
$310.80 |
$310.80 |
$2,237.60 |
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$24.98 |
$46.15 |
$1,134.83 |
|
|
Cyclic citrullinated peptide antibody
|
$42.06 |
$46.03 |
$173.60 |
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$324.07 |
$625.66 |
$1,149.72 |
|
|
Cyclophosphamide 25 mg capsule
|
$10.43 |
$57.51 |
$57.51 |
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$137.98 |
$137.98 |
$137.98 |
|
|
Cyclosporine 2 hour
|
$53.60 |
$112.70 |
$214.40 |
|
|
Cyclosporine modified 25 mg capsule
|
$3.79 |
$5.64 |
$10.18 |
|
|
Cyclosporine oral 100 mg
|
$35.57 |
$1,368.25 |
$1,368.25 |
|
|
Cylinder pump set 20cm titan zero angl
|
$32,402.40 |
$32,402.40 |
$32,402.40 |
|
|
Cyp2c19 gene com variants
|
$200.02 |
$264.94 |
$677.15 |
|
|
Cyp2c9 gene com variants
|
$197.57 |
$197.57 |
$265.66 |
|
|
Cyp2d6 gene com variants
|
$227.08 |
$227.08 |
$341.60 |
|
|
Cystatin c
|
$62.50 |
$72.91 |
$99.20 |
|
|
Cystine urine quantitative
|
$80.00 |
$80.00 |
$80.00 |
|
|
Cystogram >= 3 views supervision & interpretation
|
$478.40 |
$696.43 |
$1,832.15 |
|
|
Cystometrogram w/up 51727
|
$770.00 |
$770.00 |
$1,171.97 |
|
|
Cystoscopy and treatment
|
$1,962.43 |
$1,962.43 |
$4,893.60 |
|
|
Cystoscopy (Bladder Scope)
|
$899.42 |
$1,180.80 |
$3,840.80 |
|
|
Cystoscopy chemodenervation
|
$4,696.00 |
$4,696.00 |
$4,696.00 |
|
|
Cystoscopy & ureter catheter
|
$818.35 |
$818.35 |
$5,012.80 |
|
|
Cystostomy cystotomy w/drainage 51040
|
$5,825.90 |
$5,825.90 |
$6,255.20 |
|
|
Cystouretero w/biopsy
|
$3,613.44 |
$3,613.44 |
$3,613.44 |
|
|
Cystouretero w/stone remove
|
$2,441.52 |
$2,441.52 |
$2,441.52 |
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,794.45 |
$3,794.45 |
$5,693.60 |
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$2,846.59 |
$2,846.59 |
$5,371.20 |
|
|
Cystourethro w/addl implant 52442
|
$1,493.60 |
$1,493.60 |
$1,493.60 |
|
|
Cystourethro w/implant
|
$1,493.60 |
$1,493.60 |
$1,493.60 |
|
|
Cysto w/ureter stricture tx
|
$4,327.87 |
$4,327.87 |
$4,327.87 |
|
|
Cytarabine 20 mg/ml injection solution
|
$132.22 |
$139.01 |
$171.16 |
|
|
Cytarabine liposome inj
|
$4,529.43 |
$4,529.43 |
$4,529.43 |
|
|
Cytogenetics 25-99
|
$62.98 |
$64.79 |
$224.00 |
|
|
Cytogenetics 3-5
|
$84.95 |
$99.20 |
$135.22 |
|
|
Cytogenomic neo microra alys
|
$2,716.00 |
$3,415.94 |
$3,675.11 |
|
|
Cytomegalovirus (cmv) antibody igg
|
$66.40 |
$176.98 |
$205.74 |
|
|
Cytomegalovirus (cmv) antibody igm
|
$61.60 |
$114.91 |
$158.40 |
|
|
Cytopathology cellular enhancement technique non-gyn
|
$75.15 |
$119.20 |
$233.60 |
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$89.60 |
$131.60 |
$157.25 |
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$70.40 |
$153.72 |
$211.54 |
|
|
Cytopathology concentration technique smears & interpretation
|
$83.50 |
$117.60 |
$467.20 |
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$93.94 |
$110.40 |
$245.56 |
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$112.00 |
$112.00 |
$112.00 |
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$339.20 |
$339.20 |
$395.20 |
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$230.40 |
$378.22 |
$452.20 |
|
|
Cytopath smear other source
|
$82.85 |
$106.90 |
$275.69 |
|
|
Cytopath smear oth prep screen & interp
|
$26.94 |
$35.57 |
$144.80 |
|
|
Cytopath tbs c/v manual
|
$49.60 |
$169.34 |
$223.63 |
|
|
Dacarbazine 100 mg intravenous solution
|
$124.92 |
$180.11 |
$291.50 |
|
|
Dactinomycin 0.5 mg intravenous solution
|
$4,522.58 |
$4,522.58 |
$4,522.58 |
|
|
Dalbavancin 500 mg intravenous solution
|
$1,007.00 |
$1,524.18 |
$3,493.11 |
|
|
Dalteparin sodium
|
$1,025.79 |
$1,025.79 |
$1,025.79 |
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$50.65 |
$117.12 |
$884.83 |
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$9,315.64 |
$15,510.40 |
$15,782.10 |
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$603.21 |
$5,011.49 |
$7,219.87 |
|
|
Darbepoetin alfa, esrd use
|
$1,807.56 |
$2,079.83 |
$2,524.80 |
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$14,300.64 |
$14,300.64 |
$14,300.64 |
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$321.72 |
$321.72 |
$321.72 |
|
|
Daunorubicin citrate inj
|
$585.31 |
$585.31 |
$585.31 |
|
|
D&c after delivery 59160
|
$4,656.00 |
$4,656.00 |
$4,656.00 |
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$3,304.00 |
$3,304.00 |
$3,304.00 |
|
|
Dch glucoscan
|
$16.80 |
$36.80 |
$51.20 |
|
|
Dch pulmonary stress test
|
$807.26 |
$1,181.88 |
$1,181.88 |
|
|
Dch validity tests
|
$19.20 |
$42.40 |
$42.40 |
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$5,883.64 |
$5,883.64 |
$6,620.00 |
|
|
Deamidated gliadin antibody iga
|
$54.40 |
$78.48 |
$146.40 |
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$236.66 |
$687.12 |
$1,019.20 |
|
|
Debridement (>20 cm) charge pt
|
$117.77 |
$146.61 |
$384.80 |
|
|
Debridement bone <= 20 sq cm
|
$429.13 |
$429.13 |
$2,809.20 |
|
|
Debridement/bone/20 sq cm or less 11046
|
$416.81 |
$416.81 |
$1,156.80 |
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,502.40 |
$2,863.10 |
$2,863.10 |
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$271.66 |
$779.23 |
$1,383.20 |
|
|
Debride nail1-5 11720
|
$50.79 |
$140.00 |
$175.58 |
|
