|
CT Angiogram of the Chest (for blood clot)
|
$3,282.60 |
$3,282.60 |
$3,282.60 |
$1,915.30
|
|
CT Angiogram of the Head
|
$3,282.60 |
$3,282.60 |
$3,282.60 |
$1,940.00
|
|
CT Angiogram of the Neck
|
$3,282.60 |
$3,282.60 |
$3,282.60 |
$1,881.75
|
|
CT angio pelvis
|
$3,282.60 |
$3,282.60 |
$3,282.60 |
$1,806.60
|
|
Cta upper extremity w &/or without contrast left
|
$3,282.60 |
$3,282.60 |
$3,282.60 |
$1,691.30
|
|
CT guidance for needle placement
|
$2,392.20 |
$2,392.20 |
$2,392.20 |
$1,494.00
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,334.40 |
$1,334.40 |
$1,334.40 |
$1,215.06
|
|
CT guid cryo ablat intramuscular
|
$5,122.20 |
$5,122.20 |
$5,122.20 |
$2,039.76
|
|
CT limited or localized follow-up study
|
$1,035.60 |
$1,035.60 |
$1,035.60 |
$636.55
|
|
CT lwr extremity w/o&w/dye
|
$3,242.40 |
$3,242.40 |
$3,242.40 |
$1,818.96
|
|
Ctrl nosebld postir subsq 30906
|
$2,281.20 |
$2,281.20 |
$2,281.20 |
$422.80
|
|
CT scan for therapy guide
|
$903.60 |
$903.60 |
$903.60 |
$694.60
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,632.80 |
$5,632.80 |
$5,632.80 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$5,632.80 |
$5,632.80 |
$5,632.80 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,930.60 |
$3,930.60 |
$3,930.60 |
$2,272.00
|
|
CT t-spine w /wo contrast
|
$3,242.40 |
$3,242.40 |
$3,242.40 |
$1,975.00
|
|
CT uppr extremity w/o&w/dye
|
$3,242.40 |
$3,242.40 |
$3,242.40 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$133.20 |
$133.20 |
$133.20 |
$72.00
|
|
Culture afb any source
|
$226.20 |
$226.20 |
$226.20 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$269.40 |
$269.40 |
$269.40 |
$84.76
|
|
Culture anaerobic except blood
|
$141.00 |
$141.00 |
$141.00 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$48.60 |
$48.60 |
$48.60 |
$52.50
|
|
Culture body fluid
|
$128.40 |
$128.40 |
$128.40 |
$126.75
|
|
Culture fungi definitive id mold
|
$213.00 |
$213.00 |
$213.00 |
$80.00
|
|
Culture fungi definitive id yeast
|
$216.00 |
$216.00 |
$216.00 |
$80.00
|
|
Culture fungi other (except blood)
|
$125.40 |
$125.40 |
$125.40 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$129.60 |
$129.60 |
$129.60 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$119.40 |
$119.40 |
$119.40 |
$100.00
|
|
Culture quantitative aerobic other source
|
$96.60 |
$96.60 |
$96.60 |
$87.02
|
|
Culture screening strep group a
|
$88.20 |
$88.20 |
$88.20 |
$84.60
|
|
Culture typing immunologic
|
$118.20 |
$118.20 |
$118.20 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$404.40 |
$404.40 |
$404.40 |
$140.80
|
|
Cutter lead
|
$2,460.60 |
$2,460.60 |
$2,460.60 |
$6,581.45
|
|
Cv line/pic reposition
|
$975.60 |
$975.60 |
$975.60 |
$1,681.20
|
|
Cyanocobalamin unsat binding capacity
|
$169.20 |
$169.20 |
$169.20 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$11.00 |
$11.00 |
$11.00 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$259.20 |
$259.20 |
$259.20 |
$72.36
|
|
Cyclophosphamide 25 mg capsule
|
$19.00 |
$19.00 |
$19.00 |
$19.49
|
|
Cyclosporine 2 hour
|
$269.40 |
$269.40 |
$269.40 |
$130.40
|
|
Cyclosporine modified 25 mg capsule
|
$16.40 |
$16.40 |
$16.40 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$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
|
$272.40 |
$272.40 |
$272.40 |
$77.60
|
|
Cystine urine quantitative
|
$250.20 |
$250.20 |
$250.20 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,785.00 |
$1,785.00 |
$1,785.00 |
$586.95
|
|
Cystoscopy and treatment
|
$4,030.20 |
$4,030.20 |
$4,030.20 |
$2,867.70
|
|
Cystoscopy (Bladder Scope)
|
$2,213.40 |
$2,213.40 |
$2,213.40 |
$1,493.80
|
|
Cystoscopy & ureter catheter
|
$4,147.80 |
$4,147.80 |
$4,147.80 |
$3,728.50
|
|
Cystouretero w/stone remove
|
$6,187.80 |
$6,187.80 |
$6,187.80 |
$5,741.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,824.40 |
$3,824.40 |
$3,824.40 |
$3,245.90
|
|
Cytarabine 20 mg/ml injection solution
|
$320.40 |
$320.40 |
$320.40 |
$90.00
|
|
Cytogenetics 25-99
|
$666.60 |
$666.60 |
$666.60 |
$189.80
|
|
Cytogenomic neo microra alys
|
$1,343.40 |
$1,343.40 |
$1,343.40 |
$2,198.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$214.80 |
$214.80 |
$214.80 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$264.60 |
$264.60 |
$264.60 |
$100.00
|
|
Cyto/molecular report
|
$81.00 |
$81.00 |
$81.00 |
$144.75
|
|
Cytopathology cellular enhancement technique non-gyn
|
$776.40 |
$776.40 |
$776.40 |
$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
|
$108.60 |
$108.60 |
$108.60 |
$135.20
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$35.40 |
$35.40 |
$35.40 |
$68.06
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$147.00 |
$147.00 |
$147.00 |
$191.66
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$197.40 |
$197.40 |
$197.40 |
$213.85
|
|
Cytp urine 3-5 probes cmptr
|
$2,329.80 |
$2,329.80 |
$2,329.80 |
$664.80
|
|
Dalbavancin 500 mg intravenous solution
|
$5,142.60 |
$5,142.60 |
$5,142.60 |
$3,493.11
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,282.20 |
$1,282.20 |
$1,282.20 |
$171.19
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$6,335.40 |
$6,335.40 |
$6,335.40 |
$6,281.29
|
|
Darbepoetin alfa, esrd use
|
$2,385.00 |
$2,385.00 |
$2,385.00 |
$7.20
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$0.80 |
$0.80 |
$0.80 |
$20,196.00
|
|
Dch validity tests
|
$53.40 |
$53.40 |
$53.40 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$100.20 |
$100.20 |
$100.20 |
$43.35
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$459.60 |
$459.60 |
$459.60 |
$668.55
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$3,055.20 |
$3,055.20 |
$3,055.20 |
$835.20
|
|
Debride nail1-5 11720
|
$197.40 |
$197.40 |
$197.40 |
$149.60
|
|
Debride nail6 or more 11721
|
$297.00 |
$297.00 |
$297.00 |
$169.80
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$315.60 |
$315.60 |
$315.60 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$3,734.40 |
$3,734.40 |
$3,734.40 |
$1,165.50
|
|
Decalcification
|
$250.20 |
$250.20 |
$250.20 |
$68.34
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$266.40 |
$266.40 |
$266.40 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$96.00 |
$96.00 |
$96.00 |
$95.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$155.40 |
$155.40 |
$155.40 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,144.60 |
$3,144.60 |
$3,144.60 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$2,281.20 |
$2,281.20 |
$2,281.20 |
$401.60
|
|
Design mlc device for imrt
|
$1,882.80 |
$1,882.80 |
$1,882.80 |
$1,753.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$765.60 |
$765.60 |
$765.60 |
$91.84
|
|
Destroy cervthor facet jnt 64633
|
$3,417.60 |
$3,417.60 |
$3,417.60 |
$3,138.15
|
|
Destroy cth facet jnt addl 64634
|
$3,025.20 |
$3,025.20 |
$3,025.20 |
$1,441.44
|
|
Destruction benign lesions < 14 lesions
|
$718.80 |
$718.80 |
$718.80 |
$240.24
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$3,205.20 |
$3,205.20 |
$3,205.20 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,205.20 |
$3,205.20 |
$3,205.20 |
$3,296.80
|
|
Device ablt adv novasure
|
$5,392.80 |
$5,392.80 |
$5,392.80 |
$6,237.48
|
|
Device intraute mirena
|
$3,052.80 |
$3,052.80 |
$3,052.80 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,993.80 |
$1,993.80 |
$1,993.80 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$2,529.60 |
$2,529.60 |
$2,529.60 |
$2,515.00
|
|
Dexametha opth insert 0.1 mg
|
$505.60 |
$505.60 |
$505.60 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$81.00 |
$81.00 |
$81.00 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$11.00 |
$11.00 |
$11.00 |
$20.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$122.40 |
$122.40 |
$122.40 |
$36.05
|
