|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$299.40 |
$299.40 |
$329.34 |
$1,342.20
|
|
CT scan for localization
|
$556.80 |
$556.80 |
$612.48 |
$1,216.80
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,187.40 |
$1,187.40 |
$1,306.14 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$792.00 |
$792.00 |
$871.20 |
$2,825.55
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$792.00 |
$792.00 |
$871.20 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$544.20 |
$544.20 |
$598.62 |
$1,667.05
|
|
CT thoracic spine without contrast
|
$544.20 |
$544.20 |
$598.62 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$477.00 |
$477.00 |
$524.70 |
$341.04
|
|
CT t-spine w /wo contrast
|
$816.30 |
$816.30 |
$897.93 |
$1,972.80
|
|
CT upper extremity w/contrast (both sides)
|
$785.40 |
$785.40 |
$863.94 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$658.20 |
$658.20 |
$724.02 |
$1,407.00
|
|
CT uppr extremity w/o&w/dye
|
$897.00 |
$897.00 |
$986.70 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$37.29 |
$37.29 |
$71.19 |
$69.60
|
|
Culture afb any source
|
$35.97 |
$35.97 |
$68.67 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$26.73 |
$26.73 |
$51.03 |
$82.80
|
|
Culture anaerobic except blood
|
$31.35 |
$31.35 |
$59.85 |
$119.40
|
|
Culture bact stool aero addl path ea
|
$7.92 |
$7.92 |
$15.12 |
$51.20
|
|
Culture body fluid
|
$28.71 |
$28.71 |
$54.81 |
$125.45
|
|
Culture fungi definitive id mold
|
$46.53 |
$46.53 |
$88.83 |
$78.12
|
|
Culture fungi definitive id yeast
|
$58.41 |
$58.41 |
$111.51 |
$79.10
|
|
Culture fungi other (except blood)
|
$28.05 |
$28.05 |
$53.55 |
$105.95
|
|
Culture fungi skin/hair/nail
|
$25.74 |
$25.74 |
$49.14 |
$73.60
|
|
Culture mycobacteria definitive id each isolate
|
$46.53 |
$46.53 |
$88.83 |
$96.00
|
|
Culture screening strep group a
|
$24.75 |
$24.75 |
$47.25 |
$82.17
|
|
Culture typing immunologic
|
$16.83 |
$16.83 |
$32.13 |
$43.20
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$503.58 |
$503.58 |
$961.38 |
$408.37
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$77.55 |
$77.55 |
$148.05 |
$134.16
|
|
Culture urine each isolate
|
$27.06 |
$27.06 |
$51.66 |
$55.25
|
|
Cutter lead
|
$3,382.50 |
$3,382.50 |
$4,591.95 |
$6,152.59
|
|
Cv line/pic reposition
|
$256.80 |
$256.80 |
$282.48 |
$1,681.20
|
|
Cv stress test i&r only 93018
|
$13.34 |
$13.34 |
$13.34 |
$40.20
|
|
Cv stress test/supervision only 93016
|
$13.34 |
$13.34 |
$13.34 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$7.80 |
$7.80 |
$8.58 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$14.85 |
$14.85 |
$28.35 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,497.82 |
$1,497.82 |
$1,647.60 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$5.15 |
$5.15 |
$5.67 |
$19.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$126.49 |
$126.49 |
$139.14 |
$140.78
|
|
Cyclosporine 2 hour
|
$40.95 |
$40.95 |
$61.05 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$1.73 |
$1.73 |
$1.90 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$6.02 |
$6.02 |
$6.62 |
$34.88
|
|
Cylinder pump set 20cm titan zero angl
|
$20,050.80 |
$20,050.80 |
$22,055.88 |
$24,131.60
|
|
Cystatin c
|
$42.90 |
$42.90 |
$81.90 |
$76.48
|
|
Cystogram >= 3 views supervision & interpretation
|
$169.20 |
$169.20 |
$186.12 |
$565.61
|
|
Cystourethroscop/calib/dilat stric 52281
|
$763.20 |
$763.20 |
$763.20 |
$3,036.00
|
|
Cytarabine 20 mg/ml injection solution
|
$59.58 |
$59.58 |
$65.54 |
$89.94
|
|
Cytogenetics 25-99
|
$20.79 |
$20.79 |
$20.79 |
$189.80
|
|
Cytomegalovirus (cmv) antibody igg
|
$25.83 |
$25.83 |
$99.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$14.19 |
$14.19 |
$27.09 |
$100.00
|
|
Cytopath fl nongyn filter
|
$102.06 |
$102.06 |
$102.06 |
$93.74
|
|
Cytopathology cellular enhancement technique non-gyn
|
$41.91 |
$41.91 |
$80.01 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$47.52 |
$47.52 |
$90.72 |
$126.00
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$49.50 |
$49.50 |
$94.50 |
$124.30
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$7.59 |
$7.59 |
$14.49 |
$67.68
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$21.78 |
$21.78 |
$41.58 |
$187.80
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$101.31 |
$101.31 |
$193.41 |
$208.60
|
|
Cytopath smear other source
|
$55.77 |
$55.77 |
$106.47 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$57.75 |
$57.75 |
$110.25 |
$95.00
|
|
Dacarbazine 100 mg intravenous solution
|
$21.59 |
$21.59 |
$23.75 |
$59.15
|
|
Dactinomycin 0.5 mg intravenous solution
|
$511.20 |
$511.20 |
$562.32 |
$3,047.85
|
|
Dalbavancin 500 mg intravenous solution
|
$1,818.99 |
$1,818.99 |
$2,000.89 |
$3,469.30
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$10,247.14 |
$10,247.14 |
$11,271.85 |
$21,050.42
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$3,956.69 |
$3,956.69 |
$4,352.36 |
$6,281.29
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$11,225.95 |
$11,225.95 |
$12,348.55 |
$20,196.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$233.73 |
$233.73 |
$257.10 |
$259.58
|
|
Dch pulmonary stress test
|
$325.05 |
$325.05 |
$325.05 |
$963.30
|
|
Dch validity tests
|
$8.58 |
$8.58 |
$16.38 |
$24.61
|
|
Deamidated gliadin antibody iga
|
$16.17 |
$16.17 |
$30.87 |
$43.35
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$302.94 |
$302.94 |
$302.94 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$49.50 |
$49.50 |
$49.50 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$530.64 |
$530.64 |
$530.64 |
$2,320.80
|
|
Debridement/bone/20 sq cm or less 11046
|
$437.58 |
$437.58 |
$437.58 |
$668.37
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$530.64 |
$530.64 |
$530.64 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$397.80 |
$397.80 |
$437.58 |
$810.50
|
|
Debride nail1-5 11720
|
$250.47 |
$250.47 |
$250.47 |
$148.80
|
|
Debride nail6 or more 11721
|
$250.47 |
$250.47 |
$250.47 |
$169.60
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$437.58 |
$437.58 |
$437.58 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$437.58 |
$437.58 |
$437.58 |
$1,160.00
|
|
Decalcification
|
$9.24 |
$9.24 |
$17.64 |
$67.50
|
|
Decitabine 50 mg intravenous solution
|
$1,661.86 |
$1,661.86 |
$1,828.04 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$783.00 |
$783.00 |
$861.30 |
$546.84
|
|
Deferoxamine 500 mg solution for injection
|
$70.96 |
$70.96 |
$78.05 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$779.16 |
$779.16 |
$857.08 |
$1,807.08
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$836.10 |
$836.10 |
$836.10 |
$6,758.25
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,527.02 |
$3,527.02 |
$3,879.72 |
$6,324.98
|
|
Depo-estradiol cypionate inj
|
$428.03 |
$428.03 |
$470.84 |
$90.27
|
|
Design mlc device for imrt
|
$172.20 |
$172.20 |
$189.42 |
$1,669.85
|
|
Desmopressin 4 mcg/ml injection solution
|
$688.25 |
$688.25 |
$757.07 |
$85.94
|
|
Des thora aorta rpr without left sub art 33881
|
$567.60 |
$567.60 |
$567.60 |
$5,419.00
|
|
Des thor aorta/prox ext prosth/ini 33883
|
$567.60 |
$567.60 |
$567.60 |
$2,906.00
|
|
Destroy premlg lesns;1st lesn 17000
|
$250.47 |
$250.47 |
$250.47 |
$208.80
|
|
Destruction 2-14 lesions 17003
|
$250.47 |
$250.47 |
$250.47 |
$78.61
|
|
Determination venous press
|
$60.30 |
$60.30 |
$66.33 |
$134.40
|
|
Device ablt adv novasure
|
$9,081.24 |
$9,081.24 |
$9,081.24 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$3,750.00 |
$3,750.00 |
$4,125.00 |
$4,200.00
|
|
Device intraute mirena
|
$1,241.84 |
$1,241.84 |
$1,366.03 |
$2,125.00
|
|
Device tiss remov myosure reach
|
$1,449.00 |
$1,449.00 |
$1,593.90 |
$2,466.14
|
|
Devlopment test interpt&rep
|
$46.80 |
$46.80 |
$51.48 |
$109.46
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$68.70 |
$68.70 |
$75.57 |
$227.25
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$85.59 |
$85.59 |
$94.15 |
$21.26
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$468.78 |
$468.78 |
$515.66 |
$884.80
|