|
CT lwr extremity w/o&w/dye
|
$2,383.50 |
$2,383.50 |
$4,573.43 |
$1,817.40
|
|
CT neck soft tissue w/contrast
|
$2,198.05 |
$2,198.05 |
$2,769.34 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$1,802.38 |
$1,802.38 |
$2,270.84 |
$1,332.50
|
|
CT neck soft tissue without & w/contrast
|
$2,593.71 |
$2,593.71 |
$3,267.84 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,564.26 |
$1,564.26 |
$1,970.83 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,435.10 |
$1,435.10 |
$1,808.10 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,219.68 |
$1,219.68 |
$1,536.68 |
$1,351.20
|
|
CT scan for therapy guide
|
$213.65 |
$213.65 |
$213.65 |
$729.40
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,795.61 |
$4,795.61 |
$6,042.04 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,244.00 |
$4,244.00 |
$5,347.06 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,716.06 |
$2,716.06 |
$3,421.99 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$3,211.60 |
$3,211.60 |
$4,046.33 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,597.86 |
$1,597.86 |
$2,013.16 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$76.96 |
$76.96 |
$111.54 |
$400.20
|
|
CT upper extremity w/contrast (both sides)
|
$3,071.54 |
$3,071.54 |
$3,869.87 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$2,517.66 |
$2,517.66 |
$3,172.03 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$2,601.65 |
$2,601.65 |
$4,948.38 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$57.21 |
$57.21 |
$72.08 |
$63.75
|
|
Culture afb any source
|
$40.18 |
$40.18 |
$50.63 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$76.73 |
$76.73 |
$96.67 |
$77.31
|
|
Culture anaerobic except blood
|
$377.05 |
$377.05 |
$475.05 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$62.66 |
$62.66 |
$78.94 |
$52.80
|
|
Culture body fluid
|
$365.47 |
$365.47 |
$460.46 |
$130.50
|
|
Culture fungi definitive id mold
|
$18.39 |
$18.39 |
$23.17 |
$70.00
|
|
Culture fungi definitive id yeast
|
$15.67 |
$15.67 |
$19.74 |
$80.60
|
|
Culture fungi other (except blood)
|
$25.88 |
$25.88 |
$32.61 |
$105.60
|
|
Culture mycoplasma any source
|
$30.65 |
$30.65 |
$38.61 |
$90.37
|
|
Culture screening strep group a
|
$177.29 |
$177.29 |
$223.37 |
$81.60
|
|
Culture typing immunologic
|
$32.47 |
$32.47 |
$40.90 |
$41.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$79.68 |
$79.68 |
$100.39 |
$124.40
|
|
Culture urine each isolate
|
$136.66 |
$136.66 |
$172.18 |
$46.20
|
|
Cutter lead
|
$1,242.39 |
$1,242.39 |
$3,301.95 |
$5,538.98
|
|
Cv line/pic reposition
|
$758.18 |
$758.18 |
$758.18 |
$1,829.42
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$7.44 |
$7.44 |
$12.26 |
$33.37
|
|
Cyclic citrullinated peptide antibody
|
$16.58 |
$16.58 |
$20.88 |
$80.05
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$309.63 |
$309.63 |
$309.63 |
$1,048.28
|
|
Cyclophosphamide 25 mg capsule
|
$9.77 |
$9.77 |
$9.77 |
$23.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$50.63 |
$50.63 |
$50.63 |
$179.10
|
|
Cyclosporine 2 hour
|
$92.62 |
$92.62 |
$116.69 |
$121.80
|
|
Cyclosporine modified 25 mg capsule
|
$3.41 |
$3.41 |
$3.41 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$625.39 |
$625.39 |
$625.39 |
$39.04
|
|
Cylinder pump set 20cm titan zero angl
|
$13,549.63 |
$13,549.63 |
$13,549.63 |
$22,594.80
|
|
Cyp2c19 gene com variants
|
$114.41 |
$114.41 |
$144.15 |
$567.75
|
|
Cyp2c9 gene com variants
|
$136.20 |
$136.20 |
$171.60 |
$275.10
|
|
Cystatin c
|
$39.28 |
$39.28 |
$49.48 |
$82.26
|
|
Cystic fibrosis cftr
|
$436.98 |
$436.98 |
$550.55 |
$1,041.95
|
|
Cystine urine quantitative
|
$12.94 |
$12.94 |
$16.31 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$576.36 |
$576.36 |
$726.16 |
$539.55
|
|
Cysto, litho, vacuum kidney
|
$6,828.16 |
$6,828.16 |
$6,828.16 |
$10,942.71
|
|
Cytarabine 20 mg/ml injection solution
|
$22.70 |
$22.70 |
$22.70 |
$89.95
|
|
Cytogenetics 25-99
|
$55.85 |
$55.85 |
$70.36 |
$180.32
|
|
Cytogenomic neo microra alys
|
$762.72 |
$762.72 |
$960.96 |
$1,911.78
|
|
Cytomegalovirus (cmv) antibody igg
|
$35.87 |
$35.87 |
$45.19 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$43.36 |
$43.36 |
$54.63 |
$96.80
|
|
Cytomegalovirus imm IV /vial
|
$2,148.79 |
$2,148.79 |
$2,148.79 |
$3,113.07
|
|
Cytopathology cellular enhancement technique non-gyn
|
$21.34 |
$21.34 |
$26.89 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$17.03 |
$17.03 |
$21.45 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$93.07 |
$93.07 |
$117.26 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$14.76 |
$14.76 |
$18.59 |
$124.80
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$12.72 |
$12.72 |
$16.02 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$22.93 |
$22.93 |
$28.89 |
$205.00
|
|
Dacarbazine 100 mg intravenous solution
|
$14.76 |
$14.76 |
$14.76 |
$82.91
|
|
Dactinomycin 0.5 mg intravenous solution
|
$17.26 |
$17.26 |
$17.26 |
$2,526.62
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$544.35 |
$544.35 |
$685.83 |
$315.32
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$946.82 |
$946.82 |
$946.82 |
$5,546.48
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$3,359.60 |
$3,359.60 |
$3,359.60 |
$26,349.55
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$164.13 |
$164.13 |
$164.13 |
$260.95
|
|
Dch validity tests
|
$8.40 |
$8.40 |
$10.59 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$10.45 |
$10.45 |
$13.16 |
$44.16
|
|
Debridement (>20 cm) charge pt
|
$153.00 |
$153.00 |
$192.77 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$2,578.95 |
$2,578.95 |
$2,578.95 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$604.05 |
$604.05 |
$604.05 |
$688.80
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,065.54 |
$1,065.54 |
$1,065.54 |
$1,283.44
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$678.73 |
$678.73 |
$678.73 |
$810.50
|
|
Debride nail1-5 11720
|
$37.23 |
$37.23 |
$37.23 |
$173.25
|
|
Debride nail6 or more 11721
|
$62.88 |
$62.88 |
$62.88 |
$195.20
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$291.93 |
$291.93 |
$291.93 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,723.84 |
$1,723.84 |
$1,723.84 |
$1,193.40
|
|
Decalcification
|
$9.31 |
$9.31 |
$11.73 |
$73.60
|
|
Decitabine 50 mg intravenous solution
|
$1,019.23 |
$1,019.23 |
$1,019.23 |
$975.45
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$655.58 |
$655.58 |
$825.97 |
$545.90
|
|
Deferoxamine 500 mg solution for injection
|
$37.91 |
$37.91 |
$37.91 |
$110.82
|
|
Delivery of placenta 59414
|
$1,150.44 |
$1,150.44 |
$1,150.44 |
$3,271.20
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$68.33 |
$68.33 |
$86.09 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$1,019.23 |
$1,019.23 |
$1,019.23 |
$7,933.81
|
|
Dermagraft
|
$1,501.61 |
$1,501.61 |
$1,501.61 |
$1,912.31
|
|
Desmopressin 4 mcg/ml injection solution
|
$81.95 |
$81.95 |
$103.25 |
$102.32
|
|
Desoxycorticosterone
|
$32.69 |
$32.69 |
$41.19 |
$109.28
|
|
Developmental screen/score/document 96110
|
$110.11 |
$110.11 |
$110.11 |
$139.10
|
|
Devel tst phys/qhp 1st hr
|
$227.66 |
$227.66 |
$227.66 |
$339.30
|
|
Device ablt adv novasure
|
$5,581.48 |
$5,581.48 |
$5,581.48 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$1,952.66 |
$1,952.66 |
$1,952.66 |
$4,298.87
|
|
Device sut capio slim opn
|
$986.09 |
$986.09 |
$986.09 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$1,501.61 |
$1,501.61 |
$1,501.61 |
$2,440.98
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$79.51 |
$79.51 |
$79.51 |
$196.30
|
|
Dexamethasone 4 mg tablet
|
$1.15 |
$1.15 |
$5.68 |
$6.01
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$5.91 |
$5.91 |
$7.44 |
$30.00
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$560.92 |
$560.92 |
$560.92 |
$560.92
|
|
Dextran 40 infusion
|
$40.86 |
$40.86 |
$40.86 |
$171.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$12.26 |
$12.26 |
$15.45 |
$60.00
|