|
CT lower extremity w/contrast (both sides)
|
$3,043.75 |
$3,043.75 |
$3,043.75 |
$1,700.00
|
|
CT lower extremity without contrast (both sides)
|
$2,919.60 |
$2,919.60 |
$2,919.60 |
$1,403.73
|
|
CT lwr extremity w/o&w/dye
|
$3,809.10 |
$3,809.10 |
$3,809.10 |
$1,829.75
|
|
CT neck soft tissue w/contrast
|
$5,419.79 |
$5,419.79 |
$5,419.79 |
$1,677.39
|
|
CT neck soft tissue without contrast
|
$4,118.03 |
$4,118.03 |
$4,118.03 |
$1,363.35
|
|
CT neck soft tissue without & w/contrast
|
$5,948.97 |
$5,948.97 |
$5,948.97 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$6,320.84 |
$6,320.84 |
$6,320.84 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$4,483.35 |
$4,483.35 |
$4,483.35 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$4,022.35 |
$4,022.35 |
$4,022.35 |
$1,379.95
|
|
Ctrl nosebld postir subsq 30906
|
$1,336.80 |
$1,336.80 |
$1,336.80 |
$456.00
|
|
CT scan for therapy guide
|
$2,289.94 |
$2,289.94 |
$2,289.94 |
$741.78
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$11,690.74 |
$11,690.74 |
$11,690.74 |
$3,329.15
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$10,563.14 |
$10,563.14 |
$10,563.14 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$9,009.61 |
$9,009.61 |
$9,009.61 |
$2,325.05
|
|
CT thoracic spine w/contrast
|
$4,693.17 |
$4,693.17 |
$4,693.17 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$4,266.14 |
$4,266.14 |
$4,266.14 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$3,003.94 |
$3,003.94 |
$3,003.94 |
$420.60
|
|
CT t-spine w /wo contrast
|
$5,164.69 |
$5,164.69 |
$5,164.69 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$2,858.86 |
$2,858.86 |
$2,858.86 |
$1,706.10
|
|
CT upper extremity without contrast (both sides)
|
$2,576.03 |
$2,576.03 |
$2,576.03 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$6,053.98 |
$6,053.98 |
$6,053.98 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$359.52 |
$359.52 |
$359.52 |
$63.75
|
|
Culture afb any source
|
$700.64 |
$700.64 |
$700.64 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$353.12 |
$353.12 |
$353.12 |
$78.65
|
|
Culture anaerobic except blood
|
$498.68 |
$498.68 |
$498.68 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$165.92 |
$165.92 |
$165.92 |
$52.65
|
|
Culture body fluid
|
$365.92 |
$365.92 |
$365.92 |
$130.50
|
|
Culture fungi definitive id mold
|
$80.48 |
$80.48 |
$80.48 |
$70.00
|
|
Culture fungi definitive id yeast
|
$311.53 |
$311.53 |
$311.53 |
$80.40
|
|
Culture fungi other (except blood)
|
$371.92 |
$371.92 |
$371.92 |
$104.00
|
|
Culture fungi skin/hair/nail
|
$390.31 |
$390.31 |
$390.31 |
$77.37
|
|
Culture mycobacteria definitive id each isolate
|
$451.52 |
$451.52 |
$451.52 |
$88.14
|
|
Culture mycoplasma any source
|
$124.73 |
$124.73 |
$124.73 |
$90.37
|
|
Culture screening strep group a
|
$434.18 |
$434.18 |
$434.18 |
$80.60
|
|
Culture typing immunologic
|
$82.37 |
$82.37 |
$82.37 |
$43.46
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$1,749.29 |
$1,749.29 |
$1,749.29 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$357.16 |
$357.16 |
$357.16 |
$124.02
|
|
Cv line/pic reposition
|
$8,430.07 |
$8,430.07 |
$8,430.07 |
$1,801.20
|
|
Cyanocobalamin unsat binding capacity
|
$73.20 |
$73.20 |
$73.20 |
$58.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$51.42 |
$51.42 |
$51.42 |
$27.88
|
|
Cyclic citrullinated peptide antibody
|
$104.57 |
$104.57 |
$104.57 |
$82.00
|
|
Cyclosporine 2 hour
|
$438.32 |
$438.32 |
$438.32 |
$119.40
|
|
Cyclosporine oral 100 mg
|
$29.83 |
$29.83 |
$29.83 |
$43.04
|
|
Cyp2c19 gene com variants
|
$1,873.40 |
$1,873.40 |
$1,873.40 |
$553.00
|
|
Cystatin c
|
$222.85 |
$222.85 |
$222.85 |
$82.26
|
|
Cystine urine quantitative
|
$276.53 |
$276.53 |
$276.53 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$996.74 |
$996.74 |
$996.74 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$89.95 |
$89.95 |
$89.95 |
$79.98
|
|
Cytomegalovirus (cmv) antibody igg
|
$173.15 |
$173.15 |
$173.15 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$202.76 |
$202.76 |
$202.76 |
$98.35
|
|
Cyto/molecular report
|
$383.99 |
$383.99 |
$383.99 |
$144.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$630.50 |
$630.50 |
$630.50 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$390.90 |
$390.90 |
$390.90 |
$91.20
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$304.56 |
$304.56 |
$304.56 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$352.91 |
$352.91 |
$352.91 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$333.46 |
$333.46 |
$333.46 |
$124.30
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$161.70 |
$161.70 |
$161.70 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$161.70 |
$161.70 |
$161.70 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$203.08 |
$203.08 |
$203.08 |
$205.00
|
|
Cytopath smear other source
|
$285.28 |
$285.28 |
$285.28 |
$85.80
|
|
Cytopath smear oth prep screen & interp
|
$313.82 |
$313.82 |
$313.82 |
$96.20
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$43,777.27 |
$43,777.27 |
$43,777.27 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$7,301.58 |
$7,301.58 |
$7,301.58 |
$5,546.48
|
|
Dch validity tests
|
$55.34 |
$55.34 |
$55.34 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$222.47 |
$222.47 |
$222.47 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$814.96 |
$814.96 |
$814.96 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$3,944.13 |
$3,944.13 |
$3,944.13 |
$2,494.27
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,336.28 |
$1,336.28 |
$1,336.28 |
$798.23
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$1,336.28 |
$1,336.28 |
$1,336.28 |
$661.09
|
|
Decalcification
|
$226.99 |
$226.99 |
$226.99 |
$75.38
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$991.93 |
$991.93 |
$991.93 |
$510.95
|
|
Deferoxamine 500 mg solution for injection
|
$555.09 |
$555.09 |
$555.09 |
$116.00
|
|
Delivery of placenta 59414
|
$6,260.09 |
$6,260.09 |
$6,260.09 |
$3,135.14
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$309.28 |
$309.28 |
$309.28 |
$193.05
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$11,540.95 |
$11,540.95 |
$11,540.95 |
$7,744.96
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$977.77 |
$977.77 |
$977.77 |
$460.50
|
|
Desmopressin 4 mcg/ml injection solution
|
$821.46 |
$821.46 |
$821.46 |
$121.30
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$218.49 |
$218.49 |
$218.49 |
$221.90
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$35.08 |
$35.08 |
$35.08 |
$24.28
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$98.42 |
$98.42 |
$98.42 |
$57.07
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$98.42 |
$98.42 |
$98.42 |
$68.93
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$30.65 |
$30.65 |
$30.65 |
$49.68
|
|
Dextrose 5 % IV bolus
|
$98.42 |
$98.42 |
$98.42 |
$68.93
|
|
Dhea-s (dehydroepiand sulfate)
|
$272.25 |
$272.25 |
$272.25 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$258.48 |
$258.48 |
$258.48 |
$78.41
|
|
Diab manage trn ind/group
|
$100.82 |
$100.82 |
$100.82 |
$49.50
|
|
Diagnostic anoscopy spx 46600
|
$726.86 |
$726.86 |
$726.86 |
$228.48
|
|
Diagnostic digital breast tomosynthesis bil
|
$293.04 |
$293.04 |
$293.04 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$203.52 |
$203.52 |
$203.52 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$1,071.65 |
$1,071.65 |
$1,071.65 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$725.48 |
$725.48 |
$725.48 |
$295.10
|
|
Dialysis circuit perm vascular embolization 36909
|
$5,366.71 |
$5,366.71 |
$5,366.71 |
$7,145.00
|
|
Dialysis one evaluation
|
$1,331.27 |
$1,331.27 |
$1,331.27 |
$827.97
|
|
Diatrizoate meglumine 18 % urethral solution
|
$501.68 |
$501.68 |
$501.68 |
$106.27
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$64.23 |
$64.23 |
$64.23 |
$70.87
|
|
Dicyclomine injection
|
$228.46 |
$228.46 |
$228.46 |
$211.00
|
|
Diffusing capacity
|
$1,431.24 |
$1,431.24 |
$1,431.24 |
$359.70
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$34.31 |
$34.31 |
$34.31 |
$64.31
|
|
Digoxin total therapeutic drug level
|
$217.60 |
$217.60 |
$217.60 |
$102.00
|
|
Dilate biliary duct/ampulla
|
$2,109.39 |
$2,109.39 |
$2,109.39 |
$2,304.60
|