|
Cystatin c
|
$100.01 |
$100.01 |
$100.01 |
$77.50
|
|
Cystine urine quantitative
|
$1,888.98 |
$1,888.98 |
$1,888.98 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,747.31 |
$1,747.31 |
$1,747.31 |
$542.10
|
|
Cytomegalovirus (cmv) antibody igg
|
$2,229.87 |
$2,229.87 |
$2,229.87 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$516.99 |
$516.99 |
$516.99 |
$97.50
|
|
Cytopath c/v manual
|
$336.61 |
$336.61 |
$336.61 |
$36.80
|
|
Cytopath fl nongyn filter
|
$316.72 |
$316.72 |
$316.72 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$938.81 |
$938.81 |
$938.81 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$191.74 |
$191.74 |
$191.74 |
$91.84
|
|
Cytopathology concentration technique smears & interpretation
|
$938.81 |
$938.81 |
$938.81 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$556.75 |
$556.75 |
$556.75 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$316.72 |
$316.72 |
$316.72 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$316.72 |
$316.72 |
$316.72 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$1,019.77 |
$1,019.77 |
$1,019.77 |
$209.23
|
|
Cytopath smear other source
|
$646.23 |
$646.23 |
$646.23 |
$88.13
|
|
Cytopath smear other source
|
$845.08 |
$845.08 |
$845.08 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$590.84 |
$590.84 |
$590.84 |
$96.20
|
|
Dacarbazine 100 mg intravenous solution
|
$183.28 |
$183.28 |
$183.28 |
$58.22
|
|
Dalbavancin 500 mg intravenous solution
|
$12,784.07 |
$12,784.07 |
$12,784.07 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$5,245.27 |
$5,245.27 |
$5,245.27 |
$168.53
|
|
Dark field exam spec collj
|
$782.58 |
$782.58 |
$782.58 |
$31.20
|
|
Deamidated gliadin antibody iga
|
$134.95 |
$134.95 |
$134.95 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$197.19 |
$197.19 |
$197.19 |
$260.61
|
|
Decalcification
|
$299.69 |
$299.69 |
$299.69 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$259.29 |
$259.29 |
$259.29 |
$1,073.52
|
|
Deferoxamine 500 mg solution for injection
|
$314.86 |
$314.86 |
$314.86 |
$95.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$592.36 |
$592.36 |
$592.36 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$26,631.71 |
$26,631.71 |
$26,631.71 |
$6,324.98
|
|
Design mlc device for imrt
|
$1,081.25 |
$1,081.25 |
$1,081.25 |
$1,677.86
|
|
Des thora aorta/ea add prox prosth 33884
|
$13,735.22 |
$13,735.22 |
$13,735.22 |
$1,285.78
|
|
Detect agent nos dna dir
|
$71.01 |
$71.01 |
$71.01 |
$115.20
|
|
Developmental screen/score/document 96110
|
$187.40 |
$187.40 |
$187.40 |
$130.65
|
|
Devel tst phys/qhp 1st hr
|
$1,185.94 |
$1,185.94 |
$1,185.94 |
$337.50
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$592.97 |
$592.97 |
$592.97 |
$200.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$839.67 |
$839.67 |
$839.67 |
$227.15
|
|
Dextran 40 infusion
|
$1,427.27 |
$1,427.27 |
$1,427.27 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$112.54 |
$112.54 |
$112.54 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$35.72 |
$35.72 |
$35.72 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$104.30 |
$104.30 |
$104.30 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$112.54 |
$112.54 |
$112.54 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$1,840.69 |
$1,840.69 |
$1,840.69 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$1,012.66 |
$1,012.66 |
$1,012.66 |
$79.20
|
|
Diagnostic digital breast tomosynthesis bil
|
$450.09 |
$450.09 |
$450.09 |
$117.94
|
|
Diagnostic Mammogram (both breasts)
|
$924.61 |
$924.61 |
$924.61 |
$399.30
|
|
Diagnostic radio unlisted proc
|
$382.41 |
$382.41 |
$382.41 |
$214.08
|
|
Dialysis circuit perm vascular embolization 36909
|
$1,427.78 |
$1,427.78 |
$1,427.78 |
$5,419.00
|
|
Dialysis one evaluation
|
$3,236.34 |
$3,236.34 |
$3,236.34 |
$919.55
|
|
Dialysis training incompl
|
$3,186.60 |
$3,186.60 |
$3,186.60 |
$356.80
|
|
Diathermy eg microwave
|
$96.50 |
$96.50 |
$96.50 |
$29.68
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$303.38 |
$303.38 |
$303.38 |
$74.76
|
|
Dicyclomine injection
|
$890.68 |
$890.68 |
$890.68 |
$153.29
|
|
Diffusing capacity
|
$2,145.16 |
$2,145.16 |
$2,145.16 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$251.15 |
$251.15 |
$251.15 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$41,873.99 |
$41,873.99 |
$41,873.99 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$1,239.92 |
$1,239.92 |
$1,239.92 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,672.94 |
$1,672.94 |
$1,672.94 |
$297.86
|
|
Dimecaprol injection
|
$979.88 |
$979.88 |
$979.88 |
$293.38
|
|
Dimenhydrinate injection
|
$112.07 |
$112.07 |
$112.07 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$2,999.28 |
$2,999.28 |
$2,999.28 |
$1,258.20
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$12.72 |
$12.72 |
$12.72 |
$1.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$191.43 |
$191.43 |
$191.43 |
$17.75
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$371.37 |
$371.37 |
$371.37 |
$91.53
|
|
Dissolve clot heart vessel
|
$6,226.34 |
$6,226.34 |
$6,226.34 |
$1,579.93
|
|
Dna antibody native/double stranded
|
$1,232.81 |
$1,232.81 |
$1,232.81 |
$97.50
|
|
Dna probe chlamydia
|
$380.64 |
$380.64 |
$380.64 |
$79.38
|
|
Dna probe gc
|
$380.64 |
$380.64 |
$380.64 |
$80.80
|
|
Doppler echo complete
|
$3,271.22 |
$3,271.22 |
$3,271.22 |
$540.00
|
|
Doppler intravascular pressure flow initial vessel
|
$12,095.62 |
$12,095.62 |
$12,095.62 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,624.63 |
$1,624.63 |
$1,624.63 |
$662.35
|
|
Dornase alfa non-comp unit
|
$1,350.42 |
$1,350.42 |
$1,350.42 |
$446.75
|
|
Dorsi & plantar flex ass/res
|
$518.00 |
$518.00 |
$518.00 |
$163.50
|
|
Drainable plastic pch w fcpl
|
$86.00 |
$86.00 |
$86.00 |
$33.77
|
|
Drain cerebro spinal fluid 62272
|
$1,898.84 |
$1,898.84 |
$1,898.84 |
$1,044.00
|
|
Drain ostomy pouch w/flange
|
$31.00 |
$31.00 |
$31.00 |
$8.80
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$100,495.00 |
$100,495.00 |
$100,495.00 |
$8,131.20
|
|
Dronabinol 2.5mg oral
|
$30.96 |
$30.96 |
$30.96 |
$10.17
|
|
Droperidol 2.5 mg/ml injection solution
|
$328.01 |
$328.01 |
$328.01 |
$31.07
|
|
Drop lock knee
|
$1,001.00 |
$1,001.00 |
$1,001.00 |
$204.95
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$607.00 |
$607.00 |
$607.00 |
$1,575.70
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$443.00 |
$443.00 |
$443.00 |
$289.05
|
|
Drsg wnd hyalomatrix 10x10cm -cost per sq cm
|
$169.00 |
$169.00 |
$169.00 |
$135.72
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$2,672.00 |
$2,672.00 |
$2,672.00 |
$400.98
|
|
Drug admin & hemodynmic meas
|
$7,265.01 |
$7,265.01 |
$7,265.01 |
$569.75
|
|
Drug assay caffeine
|
$123.57 |
$123.57 |
$123.57 |
$83.40
|
|
Drug of abuse screen urine
|
$2,205.72 |
$2,205.72 |
$2,205.72 |
$63.75
|
|
Drug test def 1-7 classes
|
$2,979.76 |
$2,979.76 |
$2,979.76 |
$250.52
|
|
Drug test prsmv instrmnt
|
$1,183.10 |
$1,183.10 |
$1,183.10 |
$90.75
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$2,205.72 |
$2,205.72 |
$2,205.72 |
$278.85
|
|
Duplex scan unilateral study 93986
|
$360.33 |
$360.33 |
$360.33 |
$360.75
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,436.27 |
$2,436.27 |
$2,436.27 |
$887.25
|
|
Dxa bone density axl vrt fx
|
$734.23 |
$734.23 |
$734.23 |
$392.60
|
|
Ecg/1-3 leads/tracing only 93041
|
$149.50 |
$149.50 |
$149.50 |
$135.80
|
|
Echocardiogram (Heart Ultrasound)
|
$13,043.98 |
$13,043.98 |
$13,043.98 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$2,908.54 |
$2,908.54 |
$2,908.54 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$10,043.71 |
$10,043.71 |
$10,043.71 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$4,637.29 |
$4,637.29 |
$4,637.29 |
$703.25
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$3,688.95 |
$3,688.95 |
$3,688.95 |
$851.50
|
|
Echocardiograpy doppler follow up/limited study
|
$4,443.96 |
$4,443.96 |
$4,443.96 |
$362.50
|
|
Echo exam uterus 76831-
|
$2,112.82 |
$2,112.82 |
$2,112.82 |
$523.71
|
|
Echo guidance radiotherapy
|
$1,905.80 |
$1,905.80 |
$1,905.80 |
$812.00
|