|
Culture fungi other (except blood)
|
$134.20 |
$134.20 |
$134.20 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$5.80 |
$5.80 |
$5.80 |
$74.88
|
|
Culture mycoplasma any source
|
$100.20 |
$100.20 |
$100.20 |
$85.26
|
|
Culture quantitative aerobic other source
|
$159.00 |
$159.00 |
$159.00 |
$90.35
|
|
Culture screening strep group a
|
$140.80 |
$140.80 |
$140.80 |
$81.00
|
|
Culture typing immunologic
|
$7.40 |
$7.40 |
$7.40 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$147.00 |
$147.00 |
$147.00 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$22.00 |
$22.00 |
$22.00 |
$133.90
|
|
Cutter lead
|
$19.80 |
$19.80 |
$19.80 |
$6,092.06
|
|
Cv line/pic reposition
|
$618.80 |
$618.80 |
$618.80 |
$1,720.93
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$148.54 |
$148.54 |
$148.54 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$37.40 |
$37.40 |
$37.40 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$643.65 |
$643.65 |
$643.65 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$3.18 |
$3.18 |
$3.18 |
$19.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$54.29 |
$54.29 |
$54.29 |
$140.78
|
|
Cyclosporine 2 hour
|
$175.40 |
$175.40 |
$175.40 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$0.98 |
$0.98 |
$0.98 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$30.01 |
$30.01 |
$30.01 |
$34.88
|
|
Cyp2c19 gene com variants
|
$147.20 |
$147.20 |
$147.20 |
$504.00
|
|
Cyp2c9 gene com variants
|
$118.00 |
$118.00 |
$118.00 |
$275.10
|
|
Cyp2d6 gene com variants
|
$420.20 |
$420.20 |
$420.20 |
$554.00
|
|
Cystatin c
|
$9.60 |
$9.60 |
$9.60 |
$77.50
|
|
Cystic fibrosis cftr
|
$336.80 |
$336.80 |
$336.80 |
$1,100.00
|
|
Cystine urine quantitative
|
$64.40 |
$64.40 |
$64.40 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$136.20 |
$136.20 |
$136.20 |
$542.10
|
|
Cystoscopy and treatment
|
$1,144.20 |
$1,144.20 |
$1,144.20 |
$2,874.36
|
|
Cystoscopy (Bladder Scope)
|
$321.40 |
$321.40 |
$321.40 |
$1,493.80
|
|
Cystourethroscop/calib/dilat stric 52281
|
$580.20 |
$580.20 |
$580.20 |
$3,065.15
|
|
Cytarabine 20 mg/ml injection solution
|
$11.11 |
$11.11 |
$11.11 |
$89.94
|
|
Cytogenomic neo microra alys
|
$814.40 |
$814.40 |
$814.40 |
$2,020.20
|
|
Cytogenom microarray copy nmbr var
|
$1,085.40 |
$1,085.40 |
$1,085.40 |
$1,433.77
|
|
Cytog genom-wid alys hem mal
|
$758.20 |
$758.20 |
$758.20 |
$1,263.53
|
|
Cytomegalovirus (cmv) antibody igg
|
$81.00 |
$81.00 |
$81.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$81.00 |
$81.00 |
$81.00 |
$97.50
|
|
Cytomegalovirus dfa
|
$77.40 |
$77.40 |
$77.40 |
$79.34
|
|
Cytopath fl nongyn filter
|
$12.60 |
$12.60 |
$12.60 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$27.80 |
$27.80 |
$27.80 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$24.20 |
$24.20 |
$24.20 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$22.40 |
$22.40 |
$22.40 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$12.60 |
$12.60 |
$12.60 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$12.60 |
$12.60 |
$12.60 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$2.00 |
$2.00 |
$2.00 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$53.60 |
$53.60 |
$53.60 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$27.80 |
$27.80 |
$27.80 |
$209.23
|
|
Cytopath smear oth prep screen & interp
|
$12.60 |
$12.60 |
$12.60 |
$96.20
|
|
Cytp urine 3-5 probes cmptr
|
$214.60 |
$214.60 |
$214.60 |
$690.00
|
|
Dacarbazine 100 mg intravenous solution
|
$6.81 |
$6.81 |
$6.81 |
$58.22
|
|
Dactinomycin 0.5 mg intravenous solution
|
$842.89 |
$842.89 |
$842.89 |
$3,024.59
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$618.16 |
$618.16 |
$618.16 |
$168.53
|
|
Daptomycin (xellia) unrefrig
|
$24.97 |
$24.97 |
$24.97 |
$56.19
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$171.52 |
$171.52 |
$171.52 |
$257.10
|
|
Dch pulmonary stress test
|
$393.40 |
$393.40 |
$393.40 |
$963.30
|
|
Dch validity tests
|
$40.40 |
$40.40 |
$40.40 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$7.60 |
$7.60 |
$7.60 |
$43.60
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$157.40 |
$157.40 |
$157.40 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$95.60 |
$95.60 |
$95.60 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$415.80 |
$415.80 |
$415.80 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$153.80 |
$153.80 |
$153.80 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$415.80 |
$415.80 |
$415.80 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$146.60 |
$146.60 |
$146.60 |
$810.50
|
|
Debride nail1-5 11720
|
$33.60 |
$33.60 |
$33.60 |
$148.80
|
|
Debride skin bone at fx site
|
$758.60 |
$758.60 |
$758.60 |
$3,015.00
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$146.60 |
$146.60 |
$146.60 |
$639.60
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$346.40 |
$346.40 |
$346.40 |
$1,129.45
|
|
Debr musc/fascia 20sq cm/< 11043
|
$157.40 |
$157.40 |
$157.40 |
$1,160.00
|
|
Decalcification
|
$7.60 |
$7.60 |
$7.60 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$490.05 |
$490.05 |
$490.05 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$234.80 |
$234.80 |
$234.80 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$57.18 |
$57.18 |
$57.18 |
$95.85
|
|
Delivery of placenta 59414
|
$968.80 |
$968.80 |
$968.80 |
$3,070.56
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$52.00 |
$52.00 |
$52.00 |
$408.10
|
|
Dermagraft
|
$129.60 |
$129.60 |
$129.60 |
$85.00
|
|
Design mlc device for imrt
|
$676.40 |
$676.40 |
$676.40 |
$1,677.86
|
|
Desmopressin 4 mcg/ml injection solution
|
$446.01 |
$446.01 |
$446.01 |
$89.78
|
|
Desoxycorticosterone
|
$343.00 |
$343.00 |
$343.00 |
$109.28
|
|
Destruction benign lesions < 14 lesions
|
$43.20 |
$43.20 |
$43.20 |
$235.13
|
|
Device ablt adv novasure
|
$1,222.00 |
$1,222.00 |
$1,222.00 |
$6,097.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$92.00 |
$92.00 |
$92.00 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$80.94 |
$80.94 |
$80.94 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$47.11 |
$47.11 |
$47.11 |
$21.17
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$108.79 |
$108.79 |
$108.79 |
$858.00
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$46.00 |
$46.00 |
$46.00 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$50.60 |
$50.60 |
$50.60 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$36.80 |
$36.80 |
$36.80 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$55.20 |
$55.20 |
$55.20 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$86.80 |
$86.80 |
$86.80 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$55.20 |
$55.20 |
$55.20 |
$79.20
|
|
Diab manage trn ind/group
|
$31.40 |
$31.40 |
$31.40 |
$56.55
|
|
Diagnostic digital breast tomosynthesis bil
|
$21.00 |
$21.00 |
$21.00 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$21.00 |
$21.00 |
$21.00 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$56.20 |
$56.20 |
$56.20 |
$236.60
|
|
Diagnostic laryngoscopy 31575
|
$101.00 |
$101.00 |
$101.00 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$179.20 |
$179.20 |
$179.20 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$143.80 |
$143.80 |
$143.80 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$73.60 |
$73.60 |
$73.60 |
$214.08
|
|
Dialysis circuit perm vascular embolization 36909
|
$2,151.00 |
$2,151.00 |
$2,151.00 |
$5,419.00
|
|
Dialysis one evaluation
|
$269.20 |
$269.20 |
$269.20 |
$919.55
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$92.42 |
$92.42 |
$92.42 |
$74.76
|
|
Dicyclomine injection
|
$54.12 |
$54.12 |
$54.12 |
$153.29
|
|
Diffusing capacity
|
$134.20 |
$134.20 |
$134.20 |
$332.00
|
