|
Culture anaerobic additional method definitive id each
|
$41.60 |
$55.20 |
$124.80 |
|
|
Culture anaerobic except blood
|
$82.40 |
$114.40 |
$147.20 |
|
|
Culture bact stool aero addl path ea
|
$40.00 |
$55.20 |
$65.60 |
|
|
Culture body fluid
|
$44.00 |
$81.60 |
$141.60 |
|
|
Culture fungi definitive id mold
|
$51.20 |
$64.00 |
$92.80 |
|
|
Culture fungi definitive id yeast
|
$72.00 |
$100.00 |
$120.00 |
|
|
Culture fungi other (except blood)
|
$65.60 |
$96.00 |
$143.20 |
|
|
Culture fungi skin/hair/nail
|
$58.40 |
$73.60 |
$117.60 |
|
|
Culture mycobacteria definitive id each isolate
|
$66.40 |
$84.80 |
$171.20 |
|
|
Culture mycoplasma any source
|
$153.60 |
$153.60 |
$158.40 |
|
|
Culture screening strep group a
|
$49.60 |
$58.40 |
$79.20 |
|
|
Culture typing immunologic
|
$29.60 |
$40.80 |
$46.40 |
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$493.60 |
$576.00 |
$604.80 |
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$140.80 |
$164.00 |
$183.20 |
|
|
Culture urine each isolate
|
$37.60 |
$50.40 |
$72.00 |
|
|
Curette/treat cornea
|
$1,365.60 |
$1,365.60 |
$1,626.40 |
|
|
Cutter lead
|
$1,102.40 |
$1,102.40 |
$19,004.00 |
|
|
Cv line/pic reposition
|
$1,601.60 |
$1,601.60 |
$2,243.20 |
|
|
Cyanocobalamin unsat binding capacity
|
$75.20 |
$75.20 |
$75.20 |
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$60.72 |
$61.72 |
$313.56 |
|
|
Cyclic citrullinated peptide antibody
|
$62.40 |
$136.00 |
$176.80 |
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$915.05 |
$915.05 |
$1,542.60 |
|
|
Cyclophosphamide 25 mg capsule
|
$2.97 |
$2.97 |
$2.97 |
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$360.98 |
$360.98 |
$360.98 |
|
|
Cyclosporine 2 hour
|
$97.60 |
$135.20 |
$186.40 |
|
|
Cyclosporine modified 25 mg capsule
|
$3.10 |
$3.10 |
$3.10 |
|
|
Cyclosporine oral 100 mg
|
$272.56 |
$272.56 |
$272.56 |
|
|
Cylinder pump set 20cm titan zero angl
|
$32,402.40 |
$32,402.40 |
$32,402.40 |
|
|
Cyp2c19 gene com variants
|
$256.00 |
$256.00 |
$256.00 |
|
|
Cyp2c9 gene com variants
|
$256.00 |
$256.00 |
$256.00 |
|
|
Cystatin c
|
$99.20 |
$99.20 |
$160.00 |
|
|
Cystine urine quantitative
|
$70.40 |
$148.80 |
$192.80 |
|
|
Cystogram >= 3 views supervision & interpretation
|
$536.00 |
$826.40 |
$896.00 |
|
|
Cystoscopy and treatment
|
$4,006.40 |
$4,006.40 |
$4,056.00 |
|
|
Cystoscopy (Bladder Scope)
|
$1,525.60 |
$1,525.60 |
$2,540.80 |
|
|
Cystoscopy & duct catheter
|
$650.40 |
$650.40 |
$982.40 |
|
|
Cystoscopy & ureter catheter
|
$3,891.20 |
$3,891.20 |
$3,891.20 |
|
|
Cystostomy cystotomy w/drainage 51040
|
$6,206.40 |
$6,206.40 |
$6,206.40 |
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,622.40 |
$3,622.40 |
$3,622.40 |
|
|
Cysto w/ureter stricture tx
|
$4,446.40 |
$4,446.40 |
$4,446.40 |
|
|
Cytarabine 20 mg/ml injection solution
|
$239.15 |
$239.15 |
$270.57 |
|
|
Cytogenetics 25-99
|
$103.20 |
$103.20 |
$103.20 |
|
|
Cytogenetics 3-5
|
$99.20 |
$99.20 |
$99.20 |
|
|
Cytomegalovirus (cmv) antibody igg
|
$63.20 |
$70.40 |
$115.20 |
|
|
Cytomegalovirus (cmv) antibody igm
|
$66.40 |
$78.40 |
$115.20 |
|
|
Cytopath c/v manual
|
$58.40 |
$58.40 |
$58.40 |
|
|
Cytopathology cellular enhancement technique non-gyn
|
$113.60 |
$134.40 |
$236.80 |
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$68.00 |
$91.20 |
$116.80 |
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$69.60 |
$69.60 |
$92.00 |
|
|
Cytopathology concentration technique smears & interpretation
|
$129.60 |
$160.00 |
$253.60 |
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$122.40 |
$140.80 |
$162.40 |
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$43.20 |
$43.20 |
$43.20 |
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$64.80 |
$64.80 |
$192.80 |
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$215.20 |
$244.00 |
$249.60 |
|
|
Cytopath smear other source
|
$116.00 |
$138.40 |
$149.60 |
|
|
Cytopath smear oth prep screen & interp
|
$106.40 |
$106.40 |
$128.80 |
|
|
Cytopath tbs c/v manual
|
$42.40 |
$43.20 |
$89.60 |
|
|
Dacarbazine 100 mg intravenous solution
|
$223.33 |
$223.33 |
$223.33 |
|
|
Dactinomycin 0.5 mg intravenous solution
|
$4,178.95 |
$4,178.95 |
$4,178.95 |
|
|
Dalbavancin 500 mg intravenous solution
|
$2,720.64 |
$2,720.64 |
$2,720.64 |
|
|
Dalteparin sodium
|
$66.64 |
$66.64 |
$66.64 |
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$71.87 |
$71.88 |
$362.16 |
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$10,207.40 |
$10,207.40 |
$21,302.48 |
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$1,265.88 |
$2,156.00 |
$5,155.89 |
|
|
Darbepoetin alfa, esrd use
|
$5,047.59 |
$5,047.59 |
$5,047.59 |
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$25,882.93 |
$25,882.93 |
$25,882.93 |
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$547.96 |
$547.96 |
$547.96 |
|
|
D&c after delivery 59160
|
$3,757.60 |
$3,757.60 |
$3,757.60 |
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$3,079.20 |
$3,079.20 |
$4,010.40 |
|
|
Dch pulmonary stress test
|
$1,609.60 |
$1,609.60 |
$1,609.60 |
|
|
Dch validity tests
|
$17.60 |
$32.80 |
$36.80 |
|
|
Deamidated gliadin antibody iga
|
$44.00 |
$54.40 |
$79.20 |
|
|
Debr g/per/abd wall 11006
|
$2,506.40 |
$2,506.40 |
$2,506.40 |
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$684.80 |
$711.20 |
$890.40 |
|
|
Debridement (>20 cm) charge pt
|
$114.40 |
$323.20 |
$395.20 |
|
|
Debridement bone <= 20 sq cm
|
$1,749.60 |
$1,749.60 |
$1,749.60 |
|
|
Debridement/bone/20 sq cm or less 11046
|
$575.20 |
$575.20 |
$901.60 |
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,430.40 |
$1,430.40 |
$1,872.00 |
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$501.60 |
$885.60 |
$1,257.60 |
|
|
Debride nail1-5 11720
|
$114.40 |
$114.40 |
$141.60 |
|
|
Debride nail6 or more 11721
|
$165.60 |
$166.40 |
$301.60 |
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$3,684.00 |
$3,684.00 |
$3,684.00 |
|
|
Debride skin bone at fx site
|
$4,253.60 |
$4,253.60 |
$4,253.60 |
|
|
Debride skn/sq/musc/abd wall 11004
|
$2,965.60 |
$2,965.60 |
$2,965.60 |
|
|
Debride skn/sq t/m/f necro infctj abdl wall 11005
|
$3,739.20 |
$3,739.20 |
$3,739.20 |
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$724.80 |
$724.80 |
$783.20 |
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,717.60 |
$1,717.60 |
$1,717.60 |
|
|
Debr inf skin add-on 11001
|
$191.20 |
$191.20 |
$234.40 |
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,008.00 |
$1,008.00 |
$1,034.40 |
|
|
Decalcification
|
$29.60 |
$65.60 |
$96.80 |
|
|
Decitabine 50 mg intravenous solution
|
$288.26 |
$288.26 |
$4,990.80 |
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$368.00 |
$596.00 |
$636.80 |
|
|
Decomp fasct leg ant+/lat+pst cmprt 27602
|
$5,836.00 |
$5,836.00 |
$5,836.00 |
|
|
Decompression of lower leg
|
$5,373.60 |
$5,373.60 |
$5,373.60 |
|
|
Decompression unspecified nerve 64722
|
$5,134.40 |
$5,134.40 |
$5,134.40 |
|
|
Deferoxamine 500 mg solution for injection
|
$68.31 |
$83.64 |
$336.50 |
|
|
Degarelix 120 mg subcutaneous solution
|
$1,161.24 |
$1,161.24 |
$2,181.93 |
|
|
Delivery of placenta 59414
|
$2,192.80 |
$2,258.40 |
$3,455.20 |
|
|
Demonstrate use home inr mon
|
$265.60 |
$268.00 |
$270.40 |
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$142.40 |
$210.40 |
$283.20 |
|
