|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$6.00 |
$6.00 |
$6.00 |
$25.16
|
|
Cyclic citrullinated peptide antibody
|
$35.40 |
$35.40 |
$35.40 |
$72.00
|
|
Cyclophosphamide 25 mg capsule
|
$5.10 |
$5.10 |
$5.10 |
$19.49
|
|
Cyclosporine 2 hour
|
$93.60 |
$93.60 |
$93.60 |
$126.10
|
|
Cyclosporine modified 25 mg capsule
|
$10.62 |
$10.62 |
$10.62 |
$7.48
|
|
Cygnus, per sq cm
|
$11,808.99 |
$11,808.99 |
$11,808.99 |
$356.54
|
|
Cylinder pump set 20cm titan zero angl
|
$38,237.64 |
$38,237.64 |
$38,237.64 |
$24,107.80
|
|
Cyp2c19 gene com variants
|
$239.40 |
$239.40 |
$239.40 |
$433.00
|
|
Cyp2c9 gene com variants
|
$291.60 |
$291.60 |
$291.60 |
$266.50
|
|
Cyp2d6 gene com variants
|
$508.80 |
$508.80 |
$508.80 |
$525.95
|
|
Cystatin c
|
$72.00 |
$72.00 |
$72.00 |
$76.41
|
|
Cystic fibrosis cftr
|
$1,597.20 |
$1,597.20 |
$1,597.20 |
$1,060.00
|
|
Cystine urine quantitative
|
$121.20 |
$121.20 |
$121.20 |
$101.60
|
|
Cystogram >= 3 views supervision & interpretation
|
$307.80 |
$307.80 |
$307.80 |
$542.10
|
|
Cysto impl 4 or more
|
$29,387.27 |
$29,387.27 |
$29,387.27 |
$6,900.08
|
|
Cysto, litho, vacuum kidney
|
$28,094.75 |
$28,094.75 |
$28,094.75 |
$10,942.71
|
|
Cystoscopy and treatment
|
$22,828.57 |
$22,828.57 |
$22,828.57 |
$4,081.37
|
|
Cystoscopy and treatment
|
$8,790.78 |
$8,790.78 |
$8,790.78 |
$4,160.10
|
|
Cystoscopy and treatment
|
$12,317.71 |
$12,317.71 |
$12,317.71 |
$4,918.76
|
|
Cystoscopy and treatment
|
$13,702.14 |
$13,702.14 |
$13,702.14 |
$5,741.00
|
|
Cystoscopy and treatment
|
$18,605.04 |
$18,605.04 |
$18,605.04 |
$6,015.75
|
|
Cystoscopy and treatment
|
$12,311.28 |
$12,311.28 |
$12,311.28 |
$2,874.36
|
|
Cystoscopy and treatment
|
$8,741.94 |
$8,741.94 |
$8,741.94 |
$2,874.36
|
|
Cystoscopy and treatment
|
$19,594.69 |
$19,594.69 |
$19,594.69 |
$3,970.98
|
|
Cystoscopy (Bladder Scope)
|
$9,339.30 |
$9,339.30 |
$9,339.30 |
$1,522.50
|
|
Cystoscopy chemodenervation
|
$12,436.92 |
$12,436.92 |
$12,436.92 |
$2,424.12
|
|
Cystoscopy & ureter catheter
|
$13,061.93 |
$13,061.93 |
$13,061.93 |
$3,786.00
|
|
Cystostomy cystotomy w/drainage 51040
|
$12,601.44 |
$12,601.44 |
$12,601.44 |
$3,863.60
|
|
Cystouretero & or pyeloscope
|
$12,509.57 |
$12,509.57 |
$12,509.57 |
$4,315.98
|
|
Cysto/uretero stricture tx
|
$29,278.22 |
$29,278.22 |
$29,278.22 |
$4,384.91
|
|
Cystouretero w/biopsy
|
$21,351.73 |
$21,351.73 |
$21,351.73 |
$5,650.88
|
|
Cysto/uretero w/lithotripsy
|
$39,858.48 |
$39,858.48 |
$39,858.48 |
$7,372.68
|
|
Cystouretero w/lithotripsy
|
$20,399.12 |
$20,399.12 |
$20,399.12 |
$7,061.60
|
|
Cystouretero w/stone remove
|
$31,899.96 |
$31,899.96 |
$31,899.96 |
$4,892.09
|
|
Cystourethroscop/calib/dilat stric 52281
|
$8,782.44 |
$8,782.44 |
$8,782.44 |
$3,015.50
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$15,986.36 |
$15,986.36 |
$15,986.36 |
$4,045.60
|
|
Cytarabine 20 mg/ml injection solution
|
$90.00 |
$90.00 |
$90.00 |
$90.00
|
|
Cytogenetics 25-99
|
$73.80 |
$73.80 |
$73.80 |
$189.80
|
|
Cytogenomic neo microra alys
|
$4,171.20 |
$4,171.20 |
$4,171.20 |
$1,911.78
|
|
Cytomegalovirus (cmv) antibody igg
|
$66.00 |
$66.00 |
$66.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$62.40 |
$62.40 |
$62.40 |
$95.00
|
|
Cytopath c/v index add-on
|
$37.80 |
$37.80 |
$37.80 |
$34.20
|
|
Cytopathology cellular enhancement technique non-gyn
|
$87.60 |
$87.60 |
$87.60 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$103.80 |
$103.80 |
$103.80 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$103.80 |
$103.80 |
$103.80 |
$87.29
|
|
Cytopathology concentration technique smears & interpretation
|
$164.40 |
$164.40 |
$164.40 |
$134.70
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$163.80 |
$163.80 |
$163.80 |
$129.90
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$118.80 |
$118.80 |
$118.80 |
$70.00
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$193.80 |
$193.80 |
$193.80 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$162.00 |
$162.00 |
$162.00 |
$207.50
|
|
Cytopath smear other source
|
$114.00 |
$114.00 |
$114.00 |
$88.13
|
|
Cytopath smear other source
|
$190.20 |
$190.20 |
$190.20 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$143.40 |
$143.40 |
$143.40 |
$95.89
|
|
Cytopath tbs c/v manual
|
$38.40 |
$38.40 |
$38.40 |
$59.15
|
|
Cytotoxic antibody screening
|
$193.80 |
$193.80 |
$193.80 |
$184.63
|
|
Cytp urine 3-5 probes cmptr
|
$941.40 |
$941.40 |
$941.40 |
$690.00
|
|
Dalbavancin 500 mg intravenous solution
|
$7,685.88 |
$7,685.88 |
$7,685.88 |
$3,493.11
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$10,031.04 |
$10,031.04 |
$10,031.04 |
$5,546.48
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$135.12 |
$135.12 |
$135.12 |
$259.58
|
|
Dch validity tests
|
$4.20 |
$4.20 |
$4.20 |
$24.00
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$5,121.00 |
$5,121.00 |
$5,121.00 |
$4,478.50
|
|
Deamidated gliadin antibody iga
|
$19.80 |
$19.80 |
$19.80 |
$44.00
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$827.40 |
$827.40 |
$827.40 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$523.80 |
$523.80 |
$523.80 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$11,161.80 |
$11,161.80 |
$11,161.80 |
$2,320.80
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,579.20 |
$1,579.20 |
$1,579.20 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$13,422.60 |
$13,422.60 |
$13,422.60 |
$1,407.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$6,172.20 |
$6,172.20 |
$6,172.20 |
$814.80
|
|
Debride nail1-5 11720
|
$265.80 |
$265.80 |
$265.80 |
$148.80
|
|
Debride nail6 or more 11721
|
$404.40 |
$404.40 |
$404.40 |
$166.17
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$1,337.40 |
$1,337.40 |
$1,337.40 |
$973.71
|
|
Debride skin bone at fx site
|
$5,495.40 |
$5,495.40 |
$5,495.40 |
$3,015.00
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$2,059.20 |
$2,059.20 |
$2,059.20 |
$639.60
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,476.60 |
$1,476.60 |
$1,476.60 |
$1,129.45
|
|
Debr inf skin add-on 11001
|
$719.40 |
$719.40 |
$719.40 |
$106.86
|
|
Debr musc/fascia 20sq cm/< 11043
|
$2,005.80 |
$2,005.80 |
$2,005.80 |
$1,193.40
|
|
Decalcification
|
$53.40 |
$53.40 |
$53.40 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$324.60 |
$324.60 |
$324.60 |
$540.00
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$203.40 |
$203.40 |
$203.40 |
$186.00
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$14,902.92 |
$14,902.92 |
$14,902.92 |
$6,324.98
|
|
Dermapure 1 square cm
|
$5,235.32 |
$5,235.32 |
$5,235.32 |
$2,319.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$42.90 |
$42.90 |
$42.90 |
$70.80
|
|
Desoxycorticosterone
|
$83.40 |
$83.40 |
$83.40 |
$109.28
|
|
Destruction benign lesions < 14 lesions
|
$516.00 |
$516.00 |
$516.00 |
$235.13
|
|
Device ablt adv novasure
|
$12,727.47 |
$12,727.47 |
$12,727.47 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$6,560.55 |
$6,560.55 |
$6,560.55 |
$4,265.58
|
|
Device sut capio slim opn
|
$3,002.11 |
$3,002.11 |
$3,002.11 |
$1,894.50
|
|
Device tiss remov myosure reach
|
$2,430.68 |
$2,430.68 |
$2,430.68 |
$2,518.78
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$256.80 |
$256.80 |
$256.80 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$71.58 |
$71.58 |
$71.58 |
$6.01
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$16.92 |
$16.92 |
$16.92 |
$21.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$37.80 |
$37.80 |
$37.80 |
$37.80
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$37.80 |
$37.80 |
$37.80 |
$43.65
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$37.80 |
$37.80 |
$37.80 |
$44.16
|
|
Dextrose 5 % IV bolus
|
$37.80 |
$37.80 |
$37.80 |
$47.69
|
|
Dhea-s (dehydroepiand sulfate)
|
$139.80 |
$139.80 |
$139.80 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$90.60 |
$90.60 |
$90.60 |
$79.30
|
|
Diagnostic Mammogram (both breasts)
|
$212.40 |
$212.40 |
$212.40 |
$397.50
|
|
Diagnostic Mammogram (one breast)
|
$174.60 |
$174.60 |
$174.60 |
$297.05
|
|
Diagnostic radio unlisted proc
|
$598.80 |
$598.80 |
$598.80 |
$239.25
|
