|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$461.50 |
$461.50 |
$461.50 |
$1,543.00
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$268.00 |
$268.00 |
$268.00 |
$1,345.05
|
|
Ctrl nosebld postir subsq 30906
|
$408.80 |
$408.80 |
$408.80 |
$444.50
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$525.00 |
$525.00 |
$525.00 |
$3,408.50
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$437.50 |
$437.50 |
$437.50 |
$2,871.05
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$242.50 |
$242.50 |
$242.50 |
$2,295.00
|
|
CT thoracic spine w/contrast
|
$472.00 |
$472.00 |
$472.00 |
$1,655.85
|
|
CT thoracic spine without contrast
|
$286.50 |
$286.50 |
$286.50 |
$1,430.20
|
|
CT thorax low dose for lung screening without contrast
|
$266.00 |
$266.00 |
$266.00 |
$332.00
|
|
CT t-spine w /wo contrast
|
$568.50 |
$568.50 |
$568.50 |
$1,968.47
|
|
CT upper extremity w/contrast (both sides)
|
$475.50 |
$475.50 |
$475.50 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$285.50 |
$285.50 |
$285.50 |
$1,404.36
|
|
CT uppr extremity w/o&w/dye
|
$572.00 |
$572.00 |
$572.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$33.60 |
$33.60 |
$33.60 |
$71.40
|
|
Culture afb any source
|
$54.40 |
$54.40 |
$54.40 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$40.00 |
$40.00 |
$40.00 |
$84.76
|
|
Culture anaerobic except blood
|
$47.20 |
$47.20 |
$47.20 |
$120.54
|
|
Culture bact stool aero addl path ea
|
$47.20 |
$47.20 |
$47.20 |
$52.50
|
|
Culture body fluid
|
$43.20 |
$43.20 |
$43.20 |
$126.00
|
|
Culture fungi definitive id mold
|
$51.20 |
$51.20 |
$51.20 |
$80.00
|
|
Culture fungi definitive id yeast
|
$51.20 |
$51.20 |
$51.20 |
$79.50
|
|
Culture fungi other (except blood)
|
$41.60 |
$41.60 |
$41.60 |
$109.20
|
|
Culture fungi skin/hair/nail
|
$32.80 |
$32.80 |
$32.80 |
$74.40
|
|
Culture mycobacteria definitive id each isolate
|
$60.80 |
$60.80 |
$60.80 |
$100.00
|
|
Culture mycoplasma any source
|
$64.00 |
$64.00 |
$64.00 |
$81.62
|
|
Culture quantitative aerobic other source
|
$48.80 |
$48.80 |
$48.80 |
$90.35
|
|
Culture screening strep group a
|
$33.60 |
$33.60 |
$33.60 |
$83.16
|
|
Culture typing immunologic
|
$25.60 |
$25.60 |
$25.60 |
$43.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$175.20 |
$175.20 |
$175.20 |
$138.40
|
|
Cutter lead
|
$890.98 |
$890.98 |
$890.98 |
$6,685.72
|
|
Cv line/pic reposition
|
$1,317.60 |
$1,317.60 |
$1,317.60 |
$1,608.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$5.40 |
$5.40 |
$5.40 |
$25.16
|
|
Cyclic citrullinated peptide antibody
|
$54.40 |
$54.40 |
$54.40 |
$72.15
|
|
Cyclosporine 2 hour
|
$75.20 |
$75.20 |
$75.20 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$6.20 |
$6.20 |
$6.20 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$22.80 |
$22.80 |
$22.80 |
$35.57
|
|
Cystatin c
|
$77.60 |
$77.60 |
$77.60 |
$76.48
|
|
Cystogram >= 3 views supervision & interpretation
|
$531.20 |
$531.20 |
$531.20 |
$564.85
|
|
Cystoscopy and treatment
|
$2,661.60 |
$2,661.60 |
$2,661.60 |
$2,850.95
|
|
Cystoscopy (Bladder Scope)
|
$2,470.40 |
$2,470.40 |
$2,470.40 |
$1,445.41
|
|
Cytomegalovirus (cmv) antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$69.60 |
$69.60 |
$69.60 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$198.40 |
$198.40 |
$198.40 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$101.60 |
$101.60 |
$101.60 |
$86.86
|
|
Cytopathology concentration technique smears & interpretation
|
$171.20 |
$171.20 |
$171.20 |
$131.36
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$171.20 |
$171.20 |
$171.20 |
$124.00
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$49.60 |
$49.60 |
$49.60 |
$68.51
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$598.40 |
$598.40 |
$598.40 |
$189.67
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$250.40 |
$250.40 |
$250.40 |
$209.92
|
|
Cytp urine 3-5 probes cmptr
|
$268.00 |
$268.00 |
$268.00 |
$664.80
|
|
Dalbavancin 500 mg intravenous solution
|
$3,743.00 |
$3,743.00 |
$3,743.00 |
$3,480.87
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,247.40 |
$1,247.40 |
$1,247.40 |
$171.19
|
|
Dch validity tests
|
$17.60 |
$17.60 |
$17.60 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$60.00 |
$60.00 |
$60.00 |
$42.75
|
|
Debridement (>20 cm) charge pt
|
$612.80 |
$612.80 |
$612.80 |
$278.50
|
|
Debridement bone <= 20 sq cm
|
$1,048.80 |
$1,048.80 |
$1,048.80 |
$2,293.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$829.60 |
$829.60 |
$829.60 |
$687.35
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,048.00 |
$1,048.00 |
$1,048.00 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,563.20 |
$1,563.20 |
$1,563.20 |
$820.15
|
|
Debride nail1-5 11720
|
$188.00 |
$188.00 |
$188.00 |
$149.04
|
|
Debride nail6 or more 11721
|
$155.20 |
$155.20 |
$155.20 |
$167.63
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$596.80 |
$596.80 |
$596.80 |
$641.52
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,432.00 |
$1,432.00 |
$1,432.00 |
$1,160.00
|
|
Decalcification
|
$115.20 |
$115.20 |
$115.20 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$1,252.00 |
$1,252.00 |
$1,252.00 |
$546.84
|
|
Deferoxamine 500 mg solution for injection
|
$52.80 |
$52.80 |
$52.80 |
$95.85
|
|
Delivery of placenta 59414
|
$3,380.00 |
$3,380.00 |
$3,380.00 |
$2,822.68
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$303.20 |
$303.20 |
$303.20 |
$182.40
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$5,273.80 |
$5,273.80 |
$5,273.80 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$737.60 |
$737.60 |
$737.60 |
$399.93
|
|
Design mlc device for imrt
|
$1,832.80 |
$1,832.80 |
$1,832.80 |
$1,739.10
|
|
Desmopressin 4 mcg/ml injection solution
|
$128.80 |
$128.80 |
$128.80 |
$93.84
|
|
Device intraute mirena
|
$2,656.00 |
$2,656.00 |
$2,656.00 |
$2,125.00
|
|
Device tiss remov myosure reach
|
$1,221.00 |
$1,221.00 |
$1,221.00 |
$2,466.14
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$323.20 |
$323.20 |
$323.20 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$2.60 |
$2.60 |
$2.60 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$19.80 |
$19.80 |
$19.80 |
$21.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$23.80 |
$23.80 |
$23.80 |
$36.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$8.00 |
$8.00 |
$8.00 |
$42.50
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$4.40 |
$4.40 |
$4.40 |
$46.12
|
|
Dhea-s (dehydroepiand sulfate)
|
$92.00 |
$92.00 |
$92.00 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$25.00 |
$25.00 |
$25.00 |
$79.20
|
|
Diagnostic digital breast tomosynthesis bil
|
$157.60 |
$157.60 |
$157.60 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$104.80 |
$104.80 |
$104.80 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$540.80 |
$540.80 |
$540.80 |
$334.95
|
|
Diagnostic Mammogram (both breasts)
|
$208.00 |
$208.00 |
$208.00 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$222.00 |
$222.00 |
$222.00 |
$312.72
|
|
Dialysis circuit perm vascular embolization 36909
|
$29,771.20 |
$29,771.20 |
$29,771.20 |
$5,663.50
|
|
Dialysis one evaluation
|
$960.00 |
$960.00 |
$960.00 |
$936.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.24 |
$0.24 |
$0.24 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$78.40 |
$78.40 |
$78.40 |
$77.25
|
|
Dicyclomine injection
|
$50.00 |
$50.00 |
$50.00 |
$150.91
|
|
Diffusing capacity
|
$477.60 |
$477.60 |
$477.60 |
$335.20
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$9.60 |
$9.60 |
$9.60 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$11,317.00 |
$11,317.00 |
$11,317.00 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$55.20 |
$55.20 |
$55.20 |
$102.07
|
|
Dilate urethra stricture
|
$468.00 |
$468.00 |
$468.00 |
$496.00
|
|
Dilator fascial 10fx20cm
|
$93.70 |
$93.70 |
$93.70 |
$402.10
|
|
Diltiazem 5 mg/ml intravenous solution
|
$12.40 |
$12.40 |
$12.40 |
$46.56
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$11.20 |
$11.20 |
$11.20 |
$18.35
|
