|
Culture fungi definitive id mold
|
$54.60 |
$54.60 |
$54.60 |
$80.00
|
|
Culture fungi definitive id yeast
|
$54.60 |
$54.60 |
$54.60 |
$80.00
|
|
Culture fungi other (except blood)
|
$100.20 |
$100.20 |
$100.20 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$60.00 |
$60.00 |
$60.00 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$133.20 |
$133.20 |
$133.20 |
$100.00
|
|
Culture mycoplasma any source
|
$54.60 |
$54.60 |
$54.60 |
$83.21
|
|
Culture quantitative aerobic other source
|
$51.60 |
$51.60 |
$51.60 |
$87.02
|
|
Culture screening strep group a
|
$51.00 |
$51.00 |
$51.00 |
$84.60
|
|
Culture typing immunologic
|
$18.00 |
$18.00 |
$18.00 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$357.00 |
$357.00 |
$357.00 |
$140.80
|
|
Culture urine each isolate
|
$25.80 |
$25.80 |
$25.80 |
$55.50
|
|
Cutter lead
|
$1,444.80 |
$1,444.80 |
$1,444.80 |
$6,581.45
|
|
Cv line/pic reposition
|
$1,065.60 |
$1,065.60 |
$1,065.60 |
$1,681.20
|
|
Cyanocobalamin unsat binding capacity
|
$39.00 |
$39.00 |
$39.00 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$7.00 |
$7.00 |
$7.00 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$85.20 |
$85.20 |
$85.20 |
$72.36
|
|
Cyclosporine 2 hour
|
$186.00 |
$186.00 |
$186.00 |
$130.40
|
|
Cyclosporine modified 25 mg capsule
|
$9.00 |
$9.00 |
$9.00 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$77.60 |
$77.60 |
$77.60 |
$37.31
|
|
Cylinder pump set 20cm titan zero angl
|
$1,438.20 |
$1,438.20 |
$1,438.20 |
$24,728.89
|
|
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
|
$78.60 |
$78.60 |
$78.60 |
$77.60
|
|
Cystic fibrosis cftr
|
$3,002.40 |
$3,002.40 |
$3,002.40 |
$1,104.40
|
|
Cystine urine quantitative
|
$102.60 |
$102.60 |
$102.60 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$474.60 |
$474.60 |
$474.60 |
$586.95
|
|
Cystoscopy & ureter catheter
|
$3,688.80 |
$3,688.80 |
$3,688.80 |
$3,728.50
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,521.40 |
$3,521.40 |
$3,521.40 |
$3,245.90
|
|
Cytogenetics 25-99
|
$357.60 |
$357.60 |
$357.60 |
$189.80
|
|
Cytogenomic neo microra alys
|
$1,343.40 |
$1,343.40 |
$1,343.40 |
$2,198.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$67.80 |
$67.80 |
$67.80 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$67.80 |
$67.80 |
$67.80 |
$100.00
|
|
Cyto/molecular report
|
$54.60 |
$54.60 |
$54.60 |
$144.75
|
|
Cytopathology cellular enhancement technique non-gyn
|
$119.40 |
$119.40 |
$119.40 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$78.00 |
$78.00 |
$78.00 |
$92.40
|
|
Cytopathology concentration technique smears & interpretation
|
$51.00 |
$51.00 |
$51.00 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$54.60 |
$54.60 |
$54.60 |
$127.50
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$58.80 |
$58.80 |
$58.80 |
$68.06
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$109.20 |
$109.20 |
$109.20 |
$191.66
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$66.60 |
$66.60 |
$66.60 |
$213.85
|
|
Dalbavancin 500 mg intravenous solution
|
$5,142.60 |
$5,142.60 |
$5,142.60 |
$3,493.11
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$369.60 |
$369.60 |
$369.60 |
$171.19
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$1,430.40 |
$1,430.40 |
$1,430.40 |
$6,281.29
|
|
Dch pulmonary stress test
|
$3,041.40 |
$3,041.40 |
$3,041.40 |
$963.30
|
|
Dch validity tests
|
$27.00 |
$27.00 |
$27.00 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$75.60 |
$75.60 |
$75.60 |
$43.35
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$500.40 |
$500.40 |
$500.40 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$200.40 |
$200.40 |
$200.40 |
$284.00
|
|
Debridement bone <= 20 sq cm
|
$1,475.40 |
$1,475.40 |
$1,475.40 |
$2,320.80
|
|
Debridement/bone/20 sq cm or less 11046
|
$765.60 |
$765.60 |
$765.60 |
$702.28
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$979.80 |
$979.80 |
$979.80 |
$1,388.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$5,052.60 |
$5,052.60 |
$5,052.60 |
$835.20
|
|
Debride nail1-5 11720
|
$123.60 |
$123.60 |
$123.60 |
$149.60
|
|
Debride nail6 or more 11721
|
$154.80 |
$154.80 |
$154.80 |
$169.80
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$440.40 |
$440.40 |
$440.40 |
$663.30
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$3,774.00 |
$3,774.00 |
$3,774.00 |
$1,149.50
|
|
Debr musc/fascia 20sq cm/< 11043
|
$5,416.80 |
$5,416.80 |
$5,416.80 |
$1,165.50
|
|
Decalcification
|
$36.60 |
$36.60 |
$36.60 |
$68.34
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$369.60 |
$369.60 |
$369.60 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$53.60 |
$53.60 |
$53.60 |
$95.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$158.40 |
$158.40 |
$158.40 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$1,707.60 |
$1,707.60 |
$1,707.60 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$613.20 |
$613.20 |
$613.20 |
$401.60
|
|
Desmopressin 4 mcg/ml injection solution
|
$31.20 |
$31.20 |
$31.20 |
$91.84
|
|
Desoxycorticosterone
|
$100.20 |
$100.20 |
$100.20 |
$109.28
|
|
Destroy cervthor facet jnt 64633
|
$2,396.40 |
$2,396.40 |
$2,396.40 |
$3,138.15
|
|
Destroy cth facet jnt addl 64634
|
$2,396.40 |
$2,396.40 |
$2,396.40 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$2,267.40 |
$2,267.40 |
$2,267.40 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,267.40 |
$2,267.40 |
$2,267.40 |
$3,296.80
|
|
Device intraute mirena
|
$3,052.80 |
$3,052.80 |
$3,052.80 |
$2,125.00
|
|
Dexametha opth insert 0.1 mg
|
$505.60 |
$505.60 |
$505.60 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$0.80 |
$0.80 |
$0.80 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$5.40 |
$5.40 |
$5.40 |
$20.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$60.00 |
$60.00 |
$60.00 |
$36.05
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$52.20 |
$52.20 |
$52.20 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$55.40 |
$55.40 |
$55.40 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$42.00 |
$42.00 |
$42.00 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$94.80 |
$94.80 |
$94.80 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$31.20 |
$31.20 |
$31.20 |
$79.30
|
|
Diab manage trn ind/group
|
$93.00 |
$93.00 |
$93.00 |
$54.99
|
|
Diagnostic anoscopy spx 46600
|
$341.40 |
$341.40 |
$341.40 |
$195.50
|
|
Diagnostic Mammogram (both breasts)
|
$306.00 |
$306.00 |
$306.00 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$175.80 |
$175.80 |
$175.80 |
$314.00
|
|
Dialysis one evaluation
|
$2,373.00 |
$2,373.00 |
$2,373.00 |
$936.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$11.40 |
$11.40 |
$11.40 |
$79.71
|
|
Dicyclomine injection
|
$55.20 |
$55.20 |
$55.20 |
$154.33
|
|
Diffusing capacity
|
$1,176.60 |
$1,176.60 |
$1,176.60 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$7.00 |
$7.00 |
$7.00 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$7,908.00 |
$7,908.00 |
$7,908.00 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$51.00 |
$51.00 |
$51.00 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$104.00 |
$104.00 |
$104.00 |
$297.86
|
|
Dilate esophagus 1/mult pass
|
$1,872.60 |
$1,872.60 |
$1,872.60 |
$1,548.00
|
|
Dilate urethra stricture
|
$424.20 |
$424.20 |
$424.20 |
$513.00
|
|
Dilator fascial 10fx20cm
|
$427.20 |
$427.20 |
$427.20 |
$402.10
|
|
Dimenhydrinate injection
|
$14.40 |
$14.40 |
$14.40 |
$30.48
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$7.00 |
$7.00 |
$7.00 |
$18.32
|
|
Disability dlco
|
$213.00 |
$213.00 |
$213.00 |
$293.76
|
|
Disaccharidases
|
$216.00 |
$216.00 |
$216.00 |
$230.40
|
|
Dlyd plmt xtn prosth ea addl
|
$1,991.40 |
$1,991.40 |
$1,991.40 |
$1,810.80
|
