|
CT neck soft tissue without & w/contrast
|
$557.50 |
$557.50 |
$557.50 |
$1,940.00
|
|
CT orbit/sella/fossa w/wo contrast
|
$557.50 |
$557.50 |
$557.50 |
$1,705.20
|
|
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 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 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
|
|
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
|
|
Cystatin c
|
$77.60 |
$77.60 |
$77.60 |
$76.48
|
|
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 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
|
$36.20 |
$36.20 |
$36.20 |
$171.19
|
|
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 subcutaneous tissue <= 20 sq cm
|
$1,563.20 |
$1,563.20 |
$1,563.20 |
$820.15
|
|
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
|
|
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
|
|
Desmopressin 4 mcg/ml injection solution
|
$147.40 |
$147.40 |
$147.40 |
$93.84
|
|
Device intraute mirena
|
$2,656.00 |
$2,656.00 |
$2,656.00 |
$2,125.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$323.20 |
$323.20 |
$323.20 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$2.00 |
$2.00 |
$2.00 |
$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
|
$13.60 |
$13.60 |
$13.60 |
$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)
|
$7.60 |
$7.60 |
$7.60 |
$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
|
|
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
|
|
Diltiazem 5 mg/ml intravenous solution
|
$33.80 |
$33.80 |
$33.80 |
$46.56
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$11.20 |
$11.20 |
$11.20 |
$18.35
|
|
Disability dlco
|
$782.40 |
$782.40 |
$782.40 |
$292.03
|
|
Disaccharidases
|
$92.00 |
$92.00 |
$92.00 |
$224.31
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$118.40 |
$118.40 |
$118.40 |
$98.29
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$43.20 |
$43.20 |
$43.20 |
$67.28
|
|
Doppler echo complete
|
$622.40 |
$622.40 |
$622.40 |
$558.00
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$40.00 |
$40.00 |
$40.00 |
$84.80
|
|
Drainage external ear simple 69000
|
$829.60 |
$829.60 |
$829.60 |
$779.45
|
|
Drainage of nose lesion int 30000
|
$346.40 |
$346.40 |
$346.40 |
$548.00
|
|
Drain blood from under nail 11740
|
$284.00 |
$284.00 |
$284.00 |
$177.04
|
|
Drain cath image guided visceral pq
|
$3,033.60 |
$3,033.60 |
$3,033.60 |
$2,885.30
|
|
Drain finger abscess;simple 26010
|
$525.60 |
$525.60 |
$525.60 |
$428.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$456.80 |
$456.80 |
$456.80 |
$352.00
|
|
Drng of finger abscess comp 26011
|
$2,483.20 |
$2,483.20 |
$2,483.20 |
$2,029.60
|
|
Drng of scrotum abscess 55100
|
$4,390.40 |
$4,390.40 |
$4,390.40 |
$1,997.89
|
|
Droperidol 2.5 mg/ml injection solution
|
$31.80 |
$31.80 |
$31.80 |
$31.26
|
|
Drug assay posaconazole
|
$95.20 |
$95.20 |
$95.20 |
$96.75
|
|
Drug assay voriconazole
|
$95.20 |
$95.20 |
$95.20 |
$96.75
|
|
Drug test def 1-7 classes
|
$332.80 |
$332.80 |
$332.80 |
$263.25
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$258.40 |
$258.40 |
$258.40 |
$280.95
|
|
Drvvt confirm - quest
|
$122.40 |
$122.40 |
$122.40 |
$109.20
|