|
Culture anaerobic except blood
|
$75.60 |
$75.60 |
$75.60 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$80.40 |
$80.40 |
$80.40 |
$52.50
|
|
Culture body fluid
|
$114.60 |
$114.60 |
$114.60 |
$126.75
|
|
Culture fungi definitive id mold
|
$115.80 |
$115.80 |
$115.80 |
$80.00
|
|
Culture fungi definitive id yeast
|
$115.80 |
$115.80 |
$115.80 |
$80.00
|
|
Culture fungi other (except blood)
|
$139.20 |
$139.20 |
$139.20 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$139.20 |
$139.20 |
$139.20 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$114.00 |
$114.00 |
$114.00 |
$100.00
|
|
Culture quantitative aerobic other source
|
$50.40 |
$50.40 |
$50.40 |
$87.02
|
|
Culture screening strep group a
|
$84.60 |
$84.60 |
$84.60 |
$84.60
|
|
Culture typing immunologic
|
$52.80 |
$52.80 |
$52.80 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$415.80 |
$415.80 |
$415.80 |
$140.80
|
|
Cutter lead
|
$2,514.00 |
$2,514.00 |
$2,514.00 |
$6,581.45
|
|
Cv line/pic reposition
|
$1,326.60 |
$1,326.60 |
$1,326.60 |
$1,681.20
|
|
Cyanocobalamin unsat binding capacity
|
$102.00 |
$102.00 |
$102.00 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$8.20 |
$8.20 |
$8.20 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$99.00 |
$99.00 |
$99.00 |
$72.36
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1.20 |
$1.20 |
$1.20 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$119.40 |
$119.40 |
$119.40 |
$130.40
|
|
Cyclosporine modified 25 mg capsule
|
$18.20 |
$18.20 |
$18.20 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$2,148.00 |
$2,148.00 |
$2,148.00 |
$37.31
|
|
Cyp2c19 gene com variants
|
$1,017.60 |
$1,017.60 |
$1,017.60 |
$524.00
|
|
Cyp2c9 gene com variants
|
$1,870.20 |
$1,870.20 |
$1,870.20 |
$275.10
|
|
Cyp2d6 gene com variants
|
$269.40 |
$269.40 |
$269.40 |
$570.70
|
|
Cystatin c
|
$138.00 |
$138.00 |
$138.00 |
$77.60
|
|
Cystine urine quantitative
|
$130.20 |
$130.20 |
$130.20 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,735.20 |
$1,735.20 |
$1,735.20 |
$586.95
|
|
Cystoscopy (Bladder Scope)
|
$2,685.00 |
$2,685.00 |
$2,685.00 |
$1,493.80
|
|
Cystoscopy & ureter catheter
|
$3,787.80 |
$3,787.80 |
$3,787.80 |
$3,728.50
|
|
Cystostomy cystotomy w/drainage 51040
|
$5,534.40 |
$5,534.40 |
$5,534.40 |
$4,129.45
|
|
Cystourethroscop/calib/dilat stric 52281
|
$6,072.00 |
$6,072.00 |
$6,072.00 |
$3,245.90
|
|
Cytarabine 20 mg/ml injection solution
|
$85.20 |
$85.20 |
$85.20 |
$90.00
|
|
Cytogenetics 25-99
|
$303.00 |
$303.00 |
$303.00 |
$189.80
|
|
Cytogenomic neo microra alys
|
$1,343.40 |
$1,343.40 |
$1,343.40 |
$2,198.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$119.40 |
$119.40 |
$119.40 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$137.40 |
$137.40 |
$137.40 |
$100.00
|
|
Cyto/molecular report
|
$42.60 |
$42.60 |
$42.60 |
$144.75
|
|
Cytopathology cellular enhancement technique non-gyn
|
$354.00 |
$354.00 |
$354.00 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$78.00 |
$78.00 |
$78.00 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$61.20 |
$61.20 |
$61.20 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$76.80 |
$76.80 |
$76.80 |
$135.20
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$75.60 |
$75.60 |
$75.60 |
$68.06
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$85.80 |
$85.80 |
$85.80 |
$191.66
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$131.40 |
$131.40 |
$131.40 |
$213.85
|
|
Cytp urine 3-5 probes cmptr
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$664.80
|
|
Dacarbazine 100 mg intravenous solution
|
$99.00 |
$99.00 |
$99.00 |
$62.41
|
|
Dalbavancin 500 mg intravenous solution
|
$68.20 |
$68.20 |
$68.20 |
$3,493.11
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,282.20 |
$1,282.20 |
$1,282.20 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$109.20 |
$109.20 |
$109.20 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$4,911.00 |
$4,911.00 |
$4,911.00 |
$6,281.29
|
|
Darbepoetin alfa, esrd use
|
$29.40 |
$29.40 |
$29.40 |
$7.20
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$510.00 |
$510.00 |
$510.00 |
$20,196.00
|
|
D&c after delivery 59160
|
$7,135.80 |
$7,135.80 |
$7,135.80 |
$3,827.25
|
|
Dch validity tests
|
$25.20 |
$25.20 |
$25.20 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$100.20 |
$100.20 |
$100.20 |
$43.35
|
|
Debridement (>20 cm) charge pt
|
$321.00 |
$321.00 |
$321.00 |
$284.00
|
|
Debridement bone <= 20 sq cm
|
$2,908.80 |
$2,908.80 |
$2,908.80 |
$2,320.80
|
|
Debridement/bone/20 sq cm or less 11046
|
$665.40 |
$665.40 |
$665.40 |
$702.28
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$2,074.80 |
$2,074.80 |
$2,074.80 |
$1,388.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$3,229.80 |
$3,229.80 |
$3,229.80 |
$835.20
|
|
Debride nail1-5 11720
|
$213.60 |
$213.60 |
$213.60 |
$149.60
|
|
Debride nail6 or more 11721
|
$325.20 |
$325.20 |
$325.20 |
$169.80
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$665.40 |
$665.40 |
$665.40 |
$663.30
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$4,214.40 |
$4,214.40 |
$4,214.40 |
$1,149.50
|
|
Debr musc/fascia 20sq cm/< 11043
|
$2,908.80 |
$2,908.80 |
$2,908.80 |
$1,165.50
|
|
Decalcification
|
$198.60 |
$198.60 |
$198.60 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$177.60 |
$177.60 |
$177.60 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$362.40 |
$362.40 |
$362.40 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$196.00 |
$196.00 |
$196.00 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$46.80 |
$46.80 |
$46.80 |
$1,856.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$122.40 |
$122.40 |
$122.40 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,451.80 |
$3,451.80 |
$3,451.80 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$2,310.00 |
$2,310.00 |
$2,310.00 |
$401.60
|
|
Design mlc device for imrt
|
$1,725.60 |
$1,725.60 |
$1,725.60 |
$1,753.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$38.20 |
$38.20 |
$38.20 |
$91.84
|
|
Destroy cervthor facet jnt 64633
|
$3,213.60 |
$3,213.60 |
$3,213.60 |
$3,138.15
|
|
Destroy cth facet jnt addl 64634
|
$2,844.60 |
$2,844.60 |
$2,844.60 |
$1,441.44
|
|
Destruction benign lesions < 14 lesions
|
$583.80 |
$583.80 |
$583.80 |
$240.24
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$3,012.60 |
$3,012.60 |
$3,012.60 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,012.60 |
$3,012.60 |
$3,012.60 |
$3,296.80
|
|
Device ablt adv novasure
|
$2,854.20 |
$2,854.20 |
$2,854.20 |
$6,237.48
|
|
Device intraute mirena
|
$3,052.80 |
$3,052.80 |
$3,052.80 |
$2,125.00
|
|
Device sut capio slim opn
|
$898.20 |
$898.20 |
$898.20 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$2,842.20 |
$2,842.20 |
$2,842.20 |
$2,515.00
|
|
Dexametha opth insert 0.1 mg
|
$505.60 |
$505.60 |
$505.60 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$9.00 |
$9.00 |
$9.00 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$11.40 |
$11.40 |
$11.40 |
$20.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$94.40 |
$94.40 |
$94.40 |
$36.05
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$114.40 |
$114.40 |
$114.40 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$75.00 |
$75.00 |
$75.00 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$100.00 |
$100.00 |
$100.00 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$260.40 |
$260.40 |
$260.40 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$154.80 |
$154.80 |
$154.80 |
$79.30
|
|
Diab manage trn ind/group
|
$93.00 |
$93.00 |
$93.00 |
$54.99
|
|
Diagnostic laryngoscopy 31575
|
$1,134.60 |
$1,134.60 |
$1,134.60 |
$338.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$18.00 |
$18.00 |
$18.00 |
$79.71
|
|
Dicyclomine injection
|
$150.40 |
$150.40 |
$150.40 |
$154.33
|
|
Diffusing capacity
|
$733.20 |
$733.20 |
$733.20 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$13.60 |
$13.60 |
$13.60 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$11,176.80 |
$11,176.80 |
$11,176.80 |
$10,279.62
|
