|
CT lower extremity without contrast (both sides)
|
$640.52 |
$640.52 |
$640.52 |
$1,302.00
|
|
CT lwr extremity w/o&w/dye
|
$718.02 |
$718.02 |
$718.02 |
$1,618.50
|
|
CT neck soft tissue w/contrast
|
$807.06 |
$807.06 |
$807.06 |
$1,577.55
|
|
CT neck soft tissue without contrast
|
$706.80 |
$706.80 |
$706.80 |
$1,151.00
|
|
CT neck soft tissue without & w/contrast
|
$826.35 |
$826.35 |
$826.35 |
$1,752.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$705.11 |
$705.11 |
$705.11 |
$1,647.20
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$672.63 |
$672.63 |
$672.63 |
$1,487.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$540.69 |
$540.69 |
$540.69 |
$1,250.00
|
|
CT scan for therapy guide
|
$403.28 |
$403.28 |
$403.28 |
$656.13
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,946.21 |
$1,946.21 |
$1,946.21 |
$3,133.65
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,692.89 |
$1,692.89 |
$1,692.89 |
$2,737.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,409.82 |
$1,409.82 |
$1,409.82 |
$2,240.40
|
|
CT thoracic spine w/contrast
|
$745.83 |
$745.83 |
$745.83 |
$1,604.85
|
|
CT thoracic spine without contrast
|
$709.85 |
$709.85 |
$709.85 |
$1,381.20
|
|
CT t-spine w /wo contrast
|
$834.83 |
$834.83 |
$834.83 |
$1,817.25
|
|
CT upper extremity w/contrast (both sides)
|
$668.72 |
$668.72 |
$668.72 |
$1,651.65
|
|
CT upper extremity without contrast (both sides)
|
$573.59 |
$573.59 |
$573.59 |
$1,408.54
|
|
CT uppr extremity w/o&w/dye
|
$811.20 |
$811.20 |
$811.20 |
$1,688.20
|
|
Culture aerobic additional method definitive id each
|
$27.60 |
$27.60 |
$27.60 |
$61.03
|
|
Culture afb any source
|
$77.37 |
$77.37 |
$77.37 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$54.47 |
$54.47 |
$54.47 |
$73.00
|
|
Culture anaerobic except blood
|
$254.52 |
$254.52 |
$254.52 |
$110.00
|
|
Culture bact stool aero addl path ea
|
$105.90 |
$105.90 |
$105.90 |
$49.40
|
|
Culture body fluid
|
$79.49 |
$79.49 |
$79.49 |
$111.15
|
|
Culture fungi definitive id mold
|
$83.42 |
$83.42 |
$83.42 |
$70.00
|
|
Culture fungi definitive id yeast
|
$34.70 |
$34.70 |
$34.70 |
$68.00
|
|
Culture fungi other (except blood)
|
$77.37 |
$77.37 |
$77.37 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$77.37 |
$77.37 |
$77.37 |
$74.75
|
|
Culture mycoplasma any source
|
$122.48 |
$122.48 |
$122.48 |
$94.00
|
|
Culture quantitative aerobic other source
|
$10.49 |
$10.49 |
$10.49 |
$63.45
|
|
Culture screening strep group a
|
$120.29 |
$120.29 |
$120.29 |
$76.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$1,093.32 |
$1,093.32 |
$1,093.32 |
$100.20
|
|
Cv line/pic reposition
|
$1,582.79 |
$1,582.79 |
$1,582.79 |
$1,681.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$14.87 |
$14.87 |
$14.87 |
$17.58
|
|
Cyclic citrullinated peptide antibody
|
$99.14 |
$99.14 |
$99.14 |
$91.20
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$7.88 |
$7.88 |
$7.88 |
$2.42
|
|
Cyclophosphamide 25 mg capsule
|
$2.67 |
$2.67 |
$2.67 |
$22.51
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$147.03 |
$147.03 |
$147.03 |
$179.92
|
|
Cyclosporine modified 25 mg capsule
|
$1.64 |
$1.64 |
$1.64 |
$4.42
|
|
Cyclosporine oral 100 mg
|
$17.00 |
$17.00 |
$17.00 |
$19.50
|
|
Cystatin c
|
$175.49 |
$175.49 |
$175.49 |
$83.20
|
|
Cystogram >= 3 views supervision & interpretation
|
$473.94 |
$473.94 |
$473.94 |
$487.04
|
|
Cysto, litho, vacuum kidney
|
$7,758.90 |
$7,758.90 |
$7,758.90 |
$10,235.30
|
|
Cytarabine 20 mg/ml injection solution
|
$13.64 |
$13.64 |
$13.64 |
$59.31
|
|
Cytomegalovirus (cmv) antibody igg
|
$51.12 |
$51.12 |
$51.12 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$72.51 |
$72.51 |
$72.51 |
$95.00
|
|
Cytomegalovirus dfa
|
$101.58 |
$101.58 |
$101.58 |
$101.58
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$121.64 |
$121.64 |
$121.64 |
$90.88
|
|
Cytopathology concentration technique smears & interpretation
|
$67.86 |
$67.86 |
$67.86 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$28.98 |
$28.98 |
$28.98 |
$129.90
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$31.35 |
$31.35 |
$31.35 |
$71.25
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$104.07 |
$104.07 |
$104.07 |
$179.44
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$27.65 |
$27.65 |
$27.65 |
$205.00
|
|
Cytopath smear other source
|
$26.81 |
$26.81 |
$26.81 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$26.81 |
$26.81 |
$26.81 |
$95.00
|
|
Dacarbazine 100 mg intravenous solution
|
$13.79 |
$13.79 |
$13.79 |
$39.53
|
|
Dactinomycin 0.5 mg intravenous solution
|
$3,264.26 |
$3,264.26 |
$3,264.26 |
$1,225.86
|
|
Dalbavancin 500 mg intravenous solution
|
$38.24 |
$38.24 |
$38.24 |
$3,480.61
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1.70 |
$1.70 |
$1.70 |
$1.80
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$16.64 |
$16.64 |
$16.64 |
$4,542.99
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$144.14 |
$144.14 |
$144.14 |
$130.13
|
|
Deamidated gliadin antibody iga
|
$13.20 |
$13.20 |
$13.20 |
$53.95
|
|
Debridement (>20 cm) charge pt
|
$410.72 |
$410.72 |
$410.72 |
$313.30
|
|
Debridement bone <= 20 sq cm
|
$2,147.55 |
$2,147.55 |
$2,147.55 |
$2,481.05
|
|
Debridement/bone/20 sq cm or less 11046
|
$471.44 |
$471.44 |
$471.44 |
$717.92
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,264.47 |
$1,264.47 |
$1,264.47 |
$1,738.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$538.44 |
$538.44 |
$538.44 |
$779.35
|
|
Debride nail1-5 11720
|
$248.84 |
$248.84 |
$248.84 |
$186.88
|
|
Debride nail6 or more 11721
|
$248.84 |
$248.84 |
$248.84 |
$200.21
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$489.56 |
$489.56 |
$489.56 |
$728.40
|
|
Debr musc/fascia 20sq cm/< 11043
|
$538.44 |
$538.44 |
$538.44 |
$1,101.10
|
|
Decalcification
|
$51.62 |
$51.62 |
$51.62 |
$72.15
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$359.58 |
$359.58 |
$359.58 |
$482.35
|
|
Deferoxamine 500 mg solution for injection
|
$20.33 |
$20.33 |
$20.33 |
$47.62
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$54.38 |
$54.38 |
$54.38 |
$8,127.00
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$130.50 |
$130.50 |
$130.50 |
$165.60
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$63.98 |
$63.98 |
$63.98 |
$4,681.80
|
|
Design mlc device for imrt
|
$997.56 |
$997.56 |
$997.56 |
$1,677.86
|
|
Desmopressin 4 mcg/ml injection solution
|
$43.59 |
$43.59 |
$43.59 |
$37.26
|
|
Detect agnt mult dna direc
|
$166.77 |
$166.77 |
$166.77 |
$115.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$69.42 |
$69.42 |
$69.42 |
$220.43
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$1.61 |
$1.61 |
$1.61 |
$8.23
|
|
Dextran 40 infusion
|
$83.91 |
$83.91 |
$83.91 |
$173.97
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$46.35 |
$46.35 |
$46.35 |
$48.56
|
|
Dextrose 5 % IV bolus
|
$46.35 |
$46.35 |
$46.35 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$71.87 |
$71.87 |
$71.87 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$71.00 |
$71.00 |
$71.00 |
$70.00
|
|
Diab manage trn ind/group
|
$36.50 |
$36.50 |
$36.50 |
$56.55
|
|
Diag bronchoscope/catheter
|
$1,345.43 |
$1,345.43 |
$1,345.43 |
$1,910.40
|
|
Diagnostic laryngoscopy 31505
|
$132.83 |
$132.83 |
$132.83 |
$229.07
|
|
Diagnostic laryngoscopy 31575
|
$585.17 |
$585.17 |
$585.17 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$244.26 |
$244.26 |
$244.26 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$215.58 |
$215.58 |
$215.58 |
$276.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$7,822.05 |
$7,822.05 |
$7,822.05 |
$9,395.77
|
|
Dialysis one evaluation
|
$753.99 |
$753.99 |
$753.99 |
$920.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.39 |
$0.39 |
$0.39 |
$58.24
|
|
Dicyclomine injection
|
$180.66 |
$180.66 |
$180.66 |
$153.53
|
|
Diffusing capacity
|
$263.46 |
$263.46 |
$263.46 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$296.01 |
$296.01 |
$296.01 |
$29.85
|
|
Digoxin immune fab 40 mg intravenous solution
|
$10,279.62 |
$10,279.62 |
$10,279.62 |
$6,815.78
|