|
CT neck soft tissue w/contrast
|
$2,689.05 |
$2,689.05 |
$2,689.05 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$2,338.67 |
$2,338.67 |
$2,338.67 |
$1,332.50
|
|
CT neck soft tissue without & w/contrast
|
$3,222.24 |
$3,222.24 |
$3,222.24 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$3,007.31 |
$3,007.31 |
$3,007.31 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,610.20 |
$2,610.20 |
$2,610.20 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$2,338.67 |
$2,338.67 |
$2,338.67 |
$1,351.20
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,321.72 |
$5,321.72 |
$5,321.72 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$5,186.90 |
$5,186.90 |
$5,186.90 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$4,487.07 |
$4,487.07 |
$4,487.07 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$2,592.56 |
$2,592.56 |
$2,592.56 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,848.11 |
$1,848.11 |
$1,848.11 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,146.18 |
$1,146.18 |
$1,146.18 |
$400.20
|
|
CT t-spine w /wo contrast
|
$3,757.22 |
$3,757.22 |
$3,757.22 |
$2,030.60
|
|
CT upper extremity w/contrast (both sides)
|
$2,427.81 |
$2,427.81 |
$2,427.81 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$2,097.48 |
$2,097.48 |
$2,097.48 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$2,698.40 |
$2,698.40 |
$2,698.40 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$91.46 |
$91.46 |
$91.46 |
$63.75
|
|
Culture afb any source
|
$145.74 |
$145.74 |
$145.74 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$152.57 |
$152.57 |
$152.57 |
$77.31
|
|
Culture anaerobic except blood
|
$119.60 |
$119.60 |
$119.60 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$85.47 |
$85.47 |
$85.47 |
$52.80
|
|
Culture body fluid
|
$119.60 |
$119.60 |
$119.60 |
$130.50
|
|
Culture fungi definitive id mold
|
$106.47 |
$106.47 |
$106.47 |
$70.00
|
|
Culture fungi definitive id yeast
|
$189.16 |
$189.16 |
$189.16 |
$80.60
|
|
Culture fungi other (except blood)
|
$154.04 |
$154.04 |
$154.04 |
$105.60
|
|
Culture quantitative aerobic other source
|
$119.60 |
$119.60 |
$119.60 |
$87.02
|
|
Culture screening strep group a
|
$124.74 |
$124.74 |
$124.74 |
$81.60
|
|
Culture typing immunologic
|
$76.65 |
$76.65 |
$76.65 |
$41.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$777.95 |
$777.95 |
$777.95 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$65.05 |
$65.05 |
$65.05 |
$124.40
|
|
Culture urine each isolate
|
$91.46 |
$91.46 |
$91.46 |
$46.20
|
|
Cv stress test i&r only 93018
|
$91.35 |
$91.35 |
$91.35 |
$40.50
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$37.83 |
$37.83 |
$37.83 |
$28.00
|
|
Cyclic citrullinated peptide antibody
|
$211.58 |
$211.58 |
$211.58 |
$80.05
|
|
Cyclosporine 2 hour
|
$131.04 |
$131.04 |
$131.04 |
$121.80
|
|
Cyclosporine oral 100 mg
|
$19.26 |
$19.26 |
$19.26 |
$34.00
|
|
Cystatin c
|
$160.65 |
$160.65 |
$160.65 |
$82.26
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,393.35 |
$1,393.35 |
$1,393.35 |
$539.55
|
|
Cytarabine 20 mg/ml injection solution
|
$48.81 |
$48.81 |
$48.81 |
$104.83
|
|
Cytogenomic neo microra alys
|
$4,872.00 |
$4,872.00 |
$4,872.00 |
$1,911.78
|
|
Cytomegalovirus (cmv) antibody igg
|
$178.61 |
$178.61 |
$178.61 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$24.89 |
$24.89 |
$24.89 |
$96.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$275.94 |
$275.94 |
$275.94 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$283.82 |
$283.82 |
$283.82 |
$142.94
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$217.00 |
$217.00 |
$217.00 |
$205.00
|
|
Cytopath smear oth prep screen & interp
|
$254.99 |
$254.99 |
$254.99 |
$95.89
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$31,430.11 |
$31,430.11 |
$31,430.11 |
$23,789.22
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$10,305.29 |
$10,305.29 |
$10,305.29 |
$5,500.25
|
|
Dch validity tests
|
$39.48 |
$39.48 |
$39.48 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$65.73 |
$65.73 |
$65.73 |
$44.16
|
|
Decalcification
|
$22.05 |
$22.05 |
$22.05 |
$73.60
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$792.54 |
$792.54 |
$792.54 |
$545.90
|
|
Deferoxamine 500 mg solution for injection
|
$648.02 |
$648.02 |
$648.02 |
$96.41
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$200.87 |
$200.87 |
$200.87 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$16,291.72 |
$16,291.72 |
$16,291.72 |
$6,508.51
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$784.56 |
$784.56 |
$784.56 |
$460.50
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,154.69 |
$1,154.69 |
$1,154.69 |
$116.22
|
|
Destroy cervthor facet jnt 64633
|
$3,599.51 |
$3,599.51 |
$3,599.51 |
$3,164.80
|
|
Destroy cth facet jnt addl 64634
|
$1,782.17 |
$1,782.17 |
$1,782.17 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$2,211.93 |
$2,211.93 |
$2,211.93 |
$1,879.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,878.81 |
$3,878.81 |
$3,878.81 |
$3,375.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$473.87 |
$473.87 |
$473.87 |
$220.43
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$26.80 |
$26.80 |
$26.80 |
$27.00
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$96.76 |
$96.76 |
$96.76 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$96.76 |
$96.76 |
$96.76 |
$61.49
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$30.99 |
$30.99 |
$30.99 |
$47.22
|
|
Dextrose 5 % IV bolus
|
$96.76 |
$96.76 |
$96.76 |
$48.58
|
|
Dhea-s (dehydroepiand sulfate)
|
$165.69 |
$165.69 |
$165.69 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$73.50 |
$73.50 |
$73.50 |
$78.03
|
|
Diagnostic anoscopy spx 46600
|
$169.16 |
$169.16 |
$169.16 |
$245.35
|
|
Diagnostic digital breast tomosynthesis bil
|
$68.00 |
$68.00 |
$68.00 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$34.00 |
$34.00 |
$34.00 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$367.19 |
$367.19 |
$367.19 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$550.10 |
$550.10 |
$550.10 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$342.20 |
$342.20 |
$342.20 |
$301.55
|
|
Diatrizoate meglumine 18 % urethral solution
|
$501.26 |
$501.26 |
$501.26 |
$122.25
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$45.73 |
$45.73 |
$45.73 |
$73.22
|
|
Dicyclomine injection
|
$265.64 |
$265.64 |
$265.64 |
$202.91
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$26.36 |
$26.36 |
$26.36 |
$78.40
|
|
Digoxin total therapeutic drug level
|
$174.62 |
$174.62 |
$174.62 |
$102.00
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$22.71 |
$22.71 |
$22.71 |
$24.70
|
|
Disaccharidases
|
$371.39 |
$371.39 |
$371.39 |
$223.80
|
|
Dna antibody native/double stranded
|
$218.50 |
$218.50 |
$218.50 |
$102.60
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$354.96 |
$354.96 |
$354.96 |
$101.04
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$368.36 |
$368.36 |
$368.36 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$121.37 |
$121.37 |
$121.37 |
$76.20
|
|
Doppler echo complete
|
$1,174.53 |
$1,174.53 |
$1,174.53 |
$608.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$686.60 |
$686.60 |
$686.60 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$510.93 |
$510.93 |
$510.93 |
$482.03
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$34,197.88 |
$34,197.88 |
$34,197.88 |
$25,883.50
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$92.73 |
$92.73 |
$92.73 |
$409.84
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$5,477.33 |
$5,477.33 |
$5,477.33 |
$2,242.17
|
|
Dpyd gene common variants
|
$769.13 |
$769.13 |
$769.13 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$700.67 |
$700.67 |
$700.67 |
$820.50
|
|
Drainage mouth roof lesion
|
$852.08 |
$852.08 |
$852.08 |
$474.39
|
|
Drainage of arm bursa 23931
|
$4,890.90 |
$4,890.90 |
$4,890.90 |
$2,419.30
|
|
Drain blood from under nail 11740
|
$204.75 |
$204.75 |
$204.75 |
$190.33
|
|
Drain finger abscess;simple 26010
|
$935.87 |
$935.87 |
$935.87 |
$492.81
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$805.98 |
$805.98 |
$805.98 |
$420.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$558.60 |
$558.60 |
$558.60 |
$365.60
|