|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,781.00 |
$1,781.00 |
$1,781.00 |
$1,487.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,600.30 |
$1,600.30 |
$1,600.30 |
$1,250.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$3,589.95 |
$3,589.95 |
$3,589.95 |
$3,133.65
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,116.10 |
$3,116.10 |
$3,116.10 |
$2,737.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,638.35 |
$2,638.35 |
$2,638.35 |
$2,240.40
|
|
CT thoracic spine w/contrast
|
$1,641.90 |
$1,641.90 |
$1,641.90 |
$1,604.85
|
|
CT thoracic spine without contrast
|
$1,595.10 |
$1,595.10 |
$1,595.10 |
$1,381.20
|
|
CT thorax low dose for lung screening without contrast
|
$666.90 |
$666.90 |
$666.90 |
$418.50
|
|
CT t-spine w /wo contrast
|
$1,796.60 |
$1,796.60 |
$1,796.60 |
$1,817.25
|
|
CT upper extremity w/contrast (both sides)
|
$2,711.80 |
$2,711.80 |
$2,711.80 |
$1,651.65
|
|
CT upper extremity without contrast (both sides)
|
$1,945.45 |
$1,945.45 |
$1,945.45 |
$1,408.54
|
|
CT uppr extremity w/o&w/dye
|
$3,306.55 |
$3,306.55 |
$3,306.55 |
$1,688.20
|
|
Culture aerobic additional method definitive id each
|
$109.85 |
$109.85 |
$109.85 |
$61.03
|
|
Culture afb any source
|
$110.50 |
$110.50 |
$110.50 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$95.55 |
$95.55 |
$95.55 |
$73.00
|
|
Culture anaerobic except blood
|
$379.60 |
$379.60 |
$379.60 |
$110.00
|
|
Culture bact stool aero addl path ea
|
$49.40 |
$49.40 |
$49.40 |
$49.40
|
|
Culture body fluid
|
$240.50 |
$240.50 |
$240.50 |
$111.15
|
|
Culture fungi definitive id mold
|
$183.30 |
$183.30 |
$183.30 |
$70.00
|
|
Culture fungi definitive id yeast
|
$80.60 |
$80.60 |
$80.60 |
$68.00
|
|
Culture fungi other (except blood)
|
$113.75 |
$113.75 |
$113.75 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$115.05 |
$115.05 |
$115.05 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$113.10 |
$113.10 |
$113.10 |
$79.00
|
|
Culture mycoplasma any source
|
$592.15 |
$592.15 |
$592.15 |
$94.00
|
|
Culture quantitative aerobic other source
|
$81.90 |
$81.90 |
$81.90 |
$63.45
|
|
Culture screening strep group a
|
$230.75 |
$230.75 |
$230.75 |
$76.00
|
|
Culture typing added method
|
$120.90 |
$120.90 |
$120.90 |
$31.00
|
|
Culture typing immunologic
|
$110.50 |
$110.50 |
$110.50 |
$38.58
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$677.30 |
$677.30 |
$677.30 |
$392.40
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$18.85 |
$18.85 |
$18.85 |
$100.20
|
|
Culture urine each isolate
|
$116.35 |
$116.35 |
$116.35 |
$44.80
|
|
Cutter lead
|
$5,644.60 |
$5,644.60 |
$5,644.60 |
$5,644.60
|
|
Cv line/pic reposition
|
$2,706.30 |
$2,706.30 |
$2,706.30 |
$1,681.20
|
|
Cyanocobalamin unsat binding capacity
|
$89.05 |
$89.05 |
$89.05 |
$64.28
|
|
Cyclic citrullinated peptide antibody
|
$109.20 |
$109.20 |
$109.20 |
$91.20
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$5,387.39 |
$5,387.39 |
$5,387.39 |
$2.42
|
|
Cyclophosphamide 25 mg capsule
|
$63.11 |
$63.11 |
$63.11 |
$22.51
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$317.57 |
$317.57 |
$317.57 |
$179.92
|
|
Cyclosporine 2 hour
|
$325.65 |
$325.65 |
$325.65 |
$126.10
|
|
Cyclosporine modified 25 mg capsule
|
$13.19 |
$13.19 |
$13.19 |
$4.42
|
|
Cyclosporine oral 100 mg
|
$1,827.23 |
$1,827.23 |
$1,827.23 |
$19.50
|
|
Cylinder pump set 20cm titan zero angl
|
$20,831.20 |
$20,831.20 |
$20,831.20 |
$25,255.20
|
|
Cyp2c19 gene com variants
|
$572.00 |
$572.00 |
$572.00 |
$583.20
|
|
Cyp3a4 gene common variants
|
$412.75 |
$412.75 |
$412.75 |
$245.31
|
|
Cystatin c
|
$106.60 |
$106.60 |
$106.60 |
$83.20
|
|
Cystic fibrosis cftr
|
$994.50 |
$994.50 |
$994.50 |
$1,041.95
|
|
Cystine urine quantitative
|
$294.45 |
$294.45 |
$294.45 |
$112.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$663.65 |
$663.65 |
$663.65 |
$487.04
|
|
Cystorrhaphy wound simple 51860
|
$10,534.97 |
$10,534.97 |
$10,534.97 |
$4,296.14
|
|
Cysto rx balo cath urtl strx
|
$11,863.22 |
$11,863.22 |
$11,863.22 |
$6,853.60
|
|
Cystoscopy and treatment
|
$5,071.90 |
$5,071.90 |
$5,071.90 |
$3,970.98
|
|
Cystoscopy and treatment
|
$6,441.10 |
$6,441.10 |
$6,441.10 |
$4,160.10
|
|
Cystoscopy and treatment
|
$6,644.15 |
$6,644.15 |
$6,644.15 |
$4,846.99
|
|
Cystoscopy and treatment
|
$6,980.76 |
$6,980.76 |
$6,980.76 |
$4,846.99
|
|
Cystoscopy and treatment
|
$7,400.17 |
$7,400.17 |
$7,400.17 |
$5,949.75
|
|
Cystoscopy and treatment
|
$4,756.97 |
$4,756.97 |
$4,756.97 |
$2,355.42
|
|
Cystoscopy and treatment
|
$6,076.26 |
$6,076.26 |
$6,076.26 |
$2,331.55
|
|
Cystoscopy and treatment
|
$6,869.43 |
$6,869.43 |
$6,869.43 |
$2,267.41
|
|
Cystoscopy and treatment
|
$4,184.36 |
$4,184.36 |
$4,184.36 |
$2,874.36
|
|
Cystoscopy and treatment
|
$5,160.67 |
$5,160.67 |
$5,160.67 |
$3,769.20
|
|
Cystoscopy (Bladder Scope)
|
$3,471.90 |
$3,471.90 |
$3,471.90 |
$1,633.60
|
|
Cystoscopy chemodenervation
|
$6,859.52 |
$6,859.52 |
$6,859.52 |
$2,412.45
|
|
Cystoscopy removal of clots
|
$6,148.69 |
$6,148.69 |
$6,148.69 |
$3,970.98
|
|
Cystoscopy & ureter catheter
|
$5,919.06 |
$5,919.06 |
$5,919.06 |
$3,416.48
|
|
Cystostomy cystotomy w/drainage 51040
|
$5,214.31 |
$5,214.31 |
$5,214.31 |
$3,276.00
|
|
Cystouretero & or pyeloscope
|
$8,451.22 |
$8,451.22 |
$8,451.22 |
$4,061.71
|
|
Cysto/uretero stricture tx
|
$10,130.43 |
$10,130.43 |
$10,130.43 |
$3,820.84
|
|
Cystouretero w/biopsy
|
$9,504.27 |
$9,504.27 |
$9,504.27 |
$4,447.24
|
|
Cysto/uretero w/lithotripsy
|
$15,912.44 |
$15,912.44 |
$15,912.44 |
$7,372.68
|
|
Cystouretero w/lithotripsy
|
$14,791.96 |
$14,791.96 |
$14,791.96 |
$7,372.68
|
|
Cystouretero w/stone remove
|
$9,473.63 |
$9,473.63 |
$9,473.63 |
$4,846.99
|
|
Cystourethroscop/calib/dilat stric 52281
|
$4,600.46 |
$4,600.46 |
$4,600.46 |
$2,874.36
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$5,465.41 |
$5,465.41 |
$5,465.41 |
$3,970.98
|
|
Cysto w/ureter stricture tx
|
$12,946.03 |
$12,946.03 |
$12,946.03 |
$4,074.86
|
|
Cytarabine 20 mg/ml injection solution
|
$142.97 |
$142.97 |
$142.97 |
$59.31
|
|
Cytogenetics 25-99
|
$95.55 |
$95.55 |
$95.55 |
$188.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$91.00 |
$91.00 |
$91.00 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$91.00 |
$91.00 |
$91.00 |
$95.00
|
|
Cyto/molecular report
|
$107.25 |
$107.25 |
$107.25 |
$91.65
|
|
Cytopathology cellular enhancement technique non-gyn
|
$165.75 |
$165.75 |
$165.75 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$84.50 |
$84.50 |
$84.50 |
$98.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$213.20 |
$213.20 |
$213.20 |
$90.88
|
|
Cytopathology concentration technique smears & interpretation
|
$70.20 |
$70.20 |
$70.20 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$145.60 |
$145.60 |
$145.60 |
$129.90
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$73.45 |
$73.45 |
$73.45 |
$71.25
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$200.20 |
$200.20 |
$200.20 |
$179.44
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$143.00 |
$143.00 |
$143.00 |
$205.00
|
|
Cytopath smear other source
|
$99.45 |
$99.45 |
$99.45 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$146.25 |
$146.25 |
$146.25 |
$95.00
|
|
Cytopath tbs c/v manual
|
$79.95 |
$79.95 |
$79.95 |
$57.94
|
|
Cytotoxic antibody screening
|
$465.40 |
$465.40 |
$465.40 |
$184.63
|
|
Dacarbazine 100 mg intravenous solution
|
$81.02 |
$81.02 |
$81.02 |
$39.53
|
|
Dactinomycin 0.5 mg intravenous solution
|
$1,862.25 |
$1,862.25 |
$1,862.25 |
$1,225.86
|
|
Dalbavancin 500 mg intravenous solution
|
$5,214.38 |
$5,214.38 |
$5,214.38 |
$3,480.61
|
|
Dalteparin sodium
|
$425.68 |
$425.68 |
$425.68 |
$55.19
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$262.47 |
$262.47 |
$262.47 |
$1.80
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$41,087.78 |
$41,087.78 |
$41,087.78 |
$15,683.37
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$12,602.65 |
$12,602.65 |
$12,602.65 |
$4,542.99
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$41,935.66 |
$41,935.66 |
$41,935.66 |
$14,514.57
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$525.77 |
$525.77 |
$525.77 |
$130.13
|