|
CT neck soft tissue without & w/contrast
|
$2,568.51 |
$2,568.51 |
$2,568.51 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,545.38 |
$2,545.38 |
$2,545.38 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,142.01 |
$1,142.01 |
$1,142.01 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,039.32 |
$1,039.32 |
$1,039.32 |
$1,351.20
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,545.54 |
$4,545.54 |
$4,545.54 |
$3,329.15
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,300.92 |
$4,300.92 |
$4,300.92 |
$2,883.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,631.68 |
$3,631.68 |
$3,631.68 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$2,254.05 |
$2,254.05 |
$2,254.05 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,599.75 |
$1,599.75 |
$1,599.75 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$120.42 |
$120.42 |
$120.42 |
$420.60
|
|
CT t-spine w /wo contrast
|
$1,865.34 |
$1,865.34 |
$1,865.34 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$1,312.11 |
$1,312.11 |
$1,312.11 |
$1,697.85
|
|
CT upper extremity without contrast (both sides)
|
$1,942.65 |
$1,942.65 |
$1,942.65 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$2,083.05 |
$2,083.05 |
$2,083.05 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$67.05 |
$67.05 |
$67.05 |
$63.02
|
|
Culture afb any source
|
$118.98 |
$118.98 |
$118.98 |
$107.50
|
|
Culture anaerobic additional method definitive id each
|
$77.31 |
$77.31 |
$77.31 |
$76.35
|
|
Culture anaerobic except blood
|
$284.13 |
$284.13 |
$284.13 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$62.10 |
$62.10 |
$62.10 |
$52.50
|
|
Culture body fluid
|
$195.57 |
$195.57 |
$195.57 |
$130.40
|
|
Culture fungi definitive id mold
|
$41.04 |
$41.04 |
$41.04 |
$70.00
|
|
Culture fungi definitive id yeast
|
$149.22 |
$149.22 |
$149.22 |
$79.10
|
|
Culture fungi other (except blood)
|
$225.09 |
$225.09 |
$225.09 |
$94.90
|
|
Culture fungi skin/hair/nail
|
$47.61 |
$47.61 |
$47.61 |
$76.05
|
|
Culture mycobacteria definitive id each isolate
|
$65.97 |
$65.97 |
$65.97 |
$88.14
|
|
Culture mycoplasma any source
|
$86.94 |
$86.94 |
$86.94 |
$90.37
|
|
Culture quantitative aerobic other source
|
$59.04 |
$59.04 |
$59.04 |
$85.80
|
|
Culture screening strep group a
|
$195.57 |
$195.57 |
$195.57 |
$78.47
|
|
Culture typing added method
|
$24.84 |
$24.84 |
$24.84 |
$34.45
|
|
Culture typing immunologic
|
$53.64 |
$53.64 |
$53.64 |
$41.19
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$96.03 |
$96.03 |
$96.03 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$35.64 |
$35.64 |
$35.64 |
$115.05
|
|
Culture urine each isolate
|
$44.73 |
$44.73 |
$44.73 |
$46.20
|
|
Culture virus isolation
|
$30.69 |
$30.69 |
$30.69 |
$39.20
|
|
Cyanocobalamin unsat binding capacity
|
$150.66 |
$150.66 |
$150.66 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$25.30 |
$25.30 |
$25.30 |
$26.75
|
|
Cyclic citrullinated peptide antibody
|
$44.64 |
$44.64 |
$44.64 |
$85.03
|
|
Cyclophosphamide 25 mg capsule
|
$41.67 |
$41.67 |
$41.67 |
$25.00
|
|
Cyclosporine 2 hour
|
$264.78 |
$264.78 |
$264.78 |
$119.40
|
|
Cystatin c
|
$76.41 |
$76.41 |
$76.41 |
$82.50
|
|
Cystic fibrosis cftr
|
$520.29 |
$520.29 |
$520.29 |
$1,041.95
|
|
Cystine urine quantitative
|
$145.53 |
$145.53 |
$145.53 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$378.27 |
$378.27 |
$378.27 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$59.31 |
$59.31 |
$59.31 |
$67.00
|
|
Cytogenetics 25-99
|
$94.32 |
$94.32 |
$94.32 |
$180.00
|
|
Cytogenomic neo microra alys
|
$1,414.26 |
$1,414.26 |
$1,414.26 |
$1,742.40
|
|
Cytogenom microarray copy nmbr var
|
$1,454.22 |
$1,454.22 |
$1,454.22 |
$1,433.77
|
|
Cytomegalovirus (cmv) antibody igg
|
$336.78 |
$336.78 |
$336.78 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$178.65 |
$178.65 |
$178.65 |
$102.83
|
|
Cytomegalovirus dfa
|
$135.81 |
$135.81 |
$135.81 |
$51.20
|
|
Cyto/molecular report
|
$376.29 |
$376.29 |
$376.29 |
$150.30
|
|
Cytopath c/v index add-on
|
$57.15 |
$57.15 |
$57.15 |
$29.60
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$122.67 |
$122.67 |
$122.67 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$298.44 |
$298.44 |
$298.44 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$334.80 |
$334.80 |
$334.80 |
$124.30
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$82.26 |
$82.26 |
$82.26 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$104.76 |
$104.76 |
$104.76 |
$203.08
|
|
Cytopath smear other source
|
$26.37 |
$26.37 |
$26.37 |
$135.27
|
|
Cytopath smear oth prep screen & interp
|
$80.10 |
$80.10 |
$80.10 |
$95.00
|
|
Cytopath tbs c/v manual
|
$82.26 |
$82.26 |
$82.26 |
$57.94
|
|
Cytotoxic antibody screening
|
$244.44 |
$244.44 |
$244.44 |
$157.60
|
|
Cytotoxic antibody screening
|
$1,116.72 |
$1,116.72 |
$1,116.72 |
$75.20
|
|
Dacarbazine 100 mg intravenous solution
|
$24.75 |
$24.75 |
$24.75 |
$61.64
|
|
Dalbavancin 500 mg intravenous solution
|
$2,866.32 |
$2,866.32 |
$2,866.32 |
$3,753.91
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$2.07 |
$2.07 |
$2.07 |
$544.35
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$3,272.04 |
$3,272.04 |
$3,272.04 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$334.35 |
$334.35 |
$334.35 |
$5,500.25
|
|
Darbepoetin alfa, esrd use
|
$5,145.12 |
$5,145.12 |
$5,145.12 |
$3.04
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$14,514.57 |
$14,514.57 |
$14,514.57 |
$22,284.19
|
|
Dch validity tests
|
$23.04 |
$23.04 |
$23.04 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$19.44 |
$19.44 |
$19.44 |
$44.20
|
|
Debridement (>20 cm) charge pt
|
$121.05 |
$121.05 |
$121.05 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$145.98 |
$145.98 |
$145.98 |
$2,553.60
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$75.87 |
$75.87 |
$75.87 |
$810.50
|
|
Debr musc/fascia 20sq cm/< 11043
|
$162.00 |
$162.00 |
$162.00 |
$1,193.40
|
|
Decalcification
|
$43.56 |
$43.56 |
$43.56 |
$75.38
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$44.10 |
$44.10 |
$44.10 |
$498.00
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$265.41 |
$265.41 |
$265.41 |
$182.40
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$42.76 |
$42.76 |
$42.76 |
$7,737.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$163.62 |
$163.62 |
$163.62 |
$168.50
|
|
Detect agent nos dna dir
|
$275.76 |
$275.76 |
$275.76 |
$67.15
|
|
Developmental screen/score/document 96110
|
$165.69 |
$165.69 |
$165.69 |
$139.10
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$4.95 |
$4.95 |
$4.95 |
$23.56
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$743.31 |
$743.31 |
$743.31 |
$465.34
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$14.48 |
$14.48 |
$14.48 |
$43.65
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$34.33 |
$34.33 |
$34.33 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$33.85 |
$33.85 |
$33.85 |
$69.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$62.01 |
$62.01 |
$62.01 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$108.63 |
$108.63 |
$108.63 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$264.51 |
$264.51 |
$264.51 |
$407.04
|
|
Diagnostic Mammogram (one breast)
|
$167.22 |
$167.22 |
$167.22 |
$282.50
|
|
Diathermy eg microwave
|
$32.13 |
$32.13 |
$32.13 |
$13.60
|
|
Diatrizoate meglumine 18 % urethral solution
|
$1.44 |
$1.44 |
$1.44 |
$122.25
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$105.12 |
$105.12 |
$105.12 |
$69.55
|
|
Dicyclomine injection
|
$275.61 |
$275.61 |
$275.61 |
$210.00
|
|
Diffusing capacity
|
$196.56 |
$196.56 |
$196.56 |
$357.60
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$20.98 |
$20.98 |
$20.98 |
$54.00
|
|
Digoxin total therapeutic drug level
|
$61.56 |
$61.56 |
$61.56 |
$99.35
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$22.58
|
|
Disability dlco
|
$192.96 |
$192.96 |
$192.96 |
$302.40
|