|
CT thoracic spine w/contrast
|
$1,468.20 |
$1,468.20 |
$1,468.20 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$851.40 |
$851.40 |
$851.40 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$229.20 |
$229.20 |
$229.20 |
$331.50
|
|
CT t-spine w /wo contrast
|
$1,689.00 |
$1,689.00 |
$1,689.00 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,578.00 |
$1,578.00 |
$1,578.00 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$544.80 |
$544.80 |
$544.80 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,646.60 |
$2,646.60 |
$2,646.60 |
$1,845.36
|
|
Cuffs adj lock with active con
|
$2,688.50 |
$2,688.50 |
$2,688.50 |
$1,472.80
|
|
Culture aerobic additional method definitive id each
|
$54.60 |
$54.60 |
$54.60 |
$68.64
|
|
Culture afb any source
|
$129.00 |
$129.00 |
$129.00 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$73.80 |
$73.80 |
$73.80 |
$79.00
|
|
Culture anaerobic except blood
|
$88.80 |
$88.80 |
$88.80 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$23.40 |
$23.40 |
$23.40 |
$51.45
|
|
Culture body fluid
|
$60.60 |
$60.60 |
$60.60 |
$126.75
|
|
Culture fungi definitive id mold
|
$36.00 |
$36.00 |
$36.00 |
$77.28
|
|
Culture fungi definitive id yeast
|
$57.00 |
$57.00 |
$57.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$87.00 |
$87.00 |
$87.00 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$141.00 |
$141.00 |
$141.00 |
$74.88
|
|
Culture mycoplasma any source
|
$198.00 |
$198.00 |
$198.00 |
$85.26
|
|
Culture quantitative aerobic other source
|
$100.80 |
$100.80 |
$100.80 |
$90.35
|
|
Culture screening strep group a
|
$115.80 |
$115.80 |
$115.80 |
$81.00
|
|
Culture typing added method
|
$111.00 |
$111.00 |
$111.00 |
$38.58
|
|
Culture typing immunologic
|
$61.20 |
$61.20 |
$61.20 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$278.40 |
$278.40 |
$278.40 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$33.60 |
$33.60 |
$33.60 |
$133.90
|
|
Culture urine each isolate
|
$39.60 |
$39.60 |
$39.60 |
$57.00
|
|
Cutter lead
|
$10,885.86 |
$10,885.86 |
$10,885.86 |
$6,092.06
|
|
Cv line/pic reposition
|
$2,240.40 |
$2,240.40 |
$2,240.40 |
$1,720.93
|
|
Cyanocobalamin unsat binding capacity
|
$177.00 |
$177.00 |
$177.00 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$9.00 |
$9.00 |
$9.00 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$82.80 |
$82.80 |
$82.80 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$279.66 |
$279.66 |
$279.66 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$139.80 |
$139.80 |
$139.80 |
$129.48
|
|
Cygnus, per sq cm
|
$13,721.67 |
$13,721.67 |
$13,721.67 |
$356.54
|
|
Cylinder pump set 20cm titan zero angl
|
$44,430.92 |
$44,430.92 |
$44,430.92 |
$22,803.38
|
|
Cyp2c19 gene com variants
|
$258.60 |
$258.60 |
$258.60 |
$504.00
|
|
Cyp2c9 gene com variants
|
$139.80 |
$139.80 |
$139.80 |
$275.10
|
|
Cyp2d6 gene com variants
|
$353.40 |
$353.40 |
$353.40 |
$554.00
|
|
Cyp3a4 gene common variants
|
$132.60 |
$132.60 |
$132.60 |
$245.31
|
|
Cyp3a5 gene common variants
|
$103.80 |
$103.80 |
$103.80 |
$245.31
|
|
Cystatin c
|
$151.20 |
$151.20 |
$151.20 |
$77.50
|
|
Cystic fibrosis cftr
|
$1,068.60 |
$1,068.60 |
$1,068.60 |
$1,100.00
|
|
Cystine urine quantitative
|
$184.20 |
$184.20 |
$184.20 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$273.60 |
$273.60 |
$273.60 |
$542.10
|
|
Cysto, litho, vacuum kidney
|
$15,871.07 |
$15,871.07 |
$15,871.07 |
$10,942.71
|
|
Cystoscopy and treatment
|
$15,384.71 |
$15,384.71 |
$15,384.71 |
$4,160.10
|
|
Cystoscopy and treatment
|
$13,169.04 |
$13,169.04 |
$13,169.04 |
$5,162.50
|
|
Cystoscopy and treatment
|
$13,419.01 |
$13,419.01 |
$13,419.01 |
$5,995.60
|
|
Cystoscopy and treatment
|
$13,466.65 |
$13,466.65 |
$13,466.65 |
$6,475.26
|
|
Cystoscopy and treatment
|
$17,872.37 |
$17,872.37 |
$17,872.37 |
$4,045.60
|
|
Cystoscopy and treatment
|
$2,860.80 |
$2,860.80 |
$2,860.80 |
$2,874.36
|
|
Cystoscopy and treatment
|
$3,006.00 |
$3,006.00 |
$3,006.00 |
$3,203.50
|
|
Cystoscopy (Bladder Scope)
|
$5,800.74 |
$5,800.74 |
$5,800.74 |
$1,493.80
|
|
Cystoscopy & ureter catheter
|
$3,579.60 |
$3,579.60 |
$3,579.60 |
$3,786.00
|
|
Cystouretero & or pyeloscope
|
$11,328.01 |
$11,328.01 |
$11,328.01 |
$4,315.98
|
|
Cysto/uretero w/lithotripsy
|
$14,380.25 |
$14,380.25 |
$14,380.25 |
$9,002.88
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,220.80 |
$3,220.80 |
$3,220.80 |
$3,065.15
|
|
Cysto w/ureter stricture tx
|
$10,552.22 |
$10,552.22 |
$10,552.22 |
$4,081.37
|
|
Cytarabine 20 mg/ml injection solution
|
$90.00 |
$90.00 |
$90.00 |
$89.94
|
|
Cytogenetics 25-99
|
$170.40 |
$170.40 |
$170.40 |
$190.00
|
|
Cytogenom microarray copy nmbr var
|
$868.20 |
$868.20 |
$868.20 |
$1,433.77
|
|
Cytomegalovirus (cmv) antibody igg
|
$128.40 |
$128.40 |
$128.40 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$156.60 |
$156.60 |
$156.60 |
$97.50
|
|
Cytopath c/v thin layer redo
|
$129.00 |
$129.00 |
$129.00 |
$61.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$136.80 |
$136.80 |
$136.80 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$105.60 |
$105.60 |
$105.60 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$135.00 |
$135.00 |
$135.00 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$265.80 |
$265.80 |
$265.80 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$258.60 |
$258.60 |
$258.60 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$178.80 |
$178.80 |
$178.80 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$943.80 |
$943.80 |
$943.80 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$178.80 |
$178.80 |
$178.80 |
$209.23
|
|
Cytopath smear other source
|
$199.20 |
$199.20 |
$199.20 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$183.00 |
$183.00 |
$183.00 |
$96.20
|
|
Cytopath tbs c/v manual
|
$73.80 |
$73.80 |
$73.80 |
$59.28
|
|
Cytotoxic antibody screening
|
$282.60 |
$282.60 |
$282.60 |
$189.00
|
|
Dacarbazine 100 mg intravenous solution
|
$90.00 |
$90.00 |
$90.00 |
$58.22
|
|
Dalbavancin 500 mg intravenous solution
|
$5,337.42 |
$5,337.42 |
$5,337.42 |
$3,480.35
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$32,793.96 |
$32,793.96 |
$32,793.96 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$11,610.00 |
$11,610.00 |
$11,610.00 |
$6,072.48
|
|
D&c after delivery 59160
|
$12,210.96 |
$12,210.96 |
$12,210.96 |
$3,827.25
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$7,977.60 |
$7,977.60 |
$7,977.60 |
$3,774.81
|
|
Dch pulmonary stress test
|
$1,849.80 |
$1,849.80 |
$1,849.80 |
$963.30
|
|
Dch validity tests
|
$20.40 |
$20.40 |
$20.40 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$30.00 |
$30.00 |
$30.00 |
$43.60
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$1,113.00 |
$1,113.00 |
$1,113.00 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$315.00 |
$315.00 |
$315.00 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$1,387.20 |
$1,387.20 |
$1,387.20 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$19,360.32 |
$19,360.32 |
$19,360.32 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$625.80 |
$625.80 |
$625.80 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$262.20 |
$262.20 |
$262.20 |
$810.50
|
|
Debride skin bone at fx site
|
$5,301.60 |
$5,301.60 |
$5,301.60 |
$3,015.00
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$233.40 |
$233.40 |
$233.40 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$19,360.32 |
$19,360.32 |
$19,360.32 |
$1,160.00
|
|
Decalcification
|
$49.80 |
$49.80 |
$49.80 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$143.88 |
$143.88 |
$143.88 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$406.20 |
$406.20 |
$406.20 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$152.76 |
$152.76 |
$152.76 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$2,364.06 |
$2,364.06 |
$2,364.06 |
$1,807.08
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$130.20 |
$130.20 |
$130.20 |
$185.17
|
