|
CT angio pelvis
|
$2,612.85 |
$2,612.85 |
$2,612.85 |
$1,837.80
|
|
Cta upper extremity w &/or without contrast left
|
$4,135.20 |
$4,135.20 |
$4,135.20 |
$1,697.80
|
|
CT guidance for needle placement
|
$2,155.95 |
$2,155.95 |
$2,155.95 |
$1,494.00
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,221.45 |
$1,221.45 |
$1,221.45 |
$1,168.20
|
|
CT heart w/evaluation of calcium without contrast
|
$136.50 |
$136.50 |
$136.50 |
$171.60
|
|
CT limited or localized follow-up study
|
$789.60 |
$789.60 |
$789.60 |
$642.75
|
|
CT lower extremity w/contrast (both sides)
|
$2,612.85 |
$2,612.85 |
$2,612.85 |
$1,619.25
|
|
CT lower extremity without contrast (both sides)
|
$2,394.15 |
$2,394.15 |
$2,394.15 |
$1,420.00
|
|
Ctlso a-p-l control molded
|
$3,746.69 |
$3,746.69 |
$3,746.69 |
$3,746.69
|
|
Ctlso a-p-l control with inter
|
$4,186.78 |
$4,186.78 |
$4,186.78 |
$4,186.78
|
|
CT lwr extremity w/o&w/dye
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$1,851.60
|
|
CT neck soft tissue w/contrast
|
$2,394.15 |
$2,394.15 |
$2,394.15 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$2,068.50 |
$2,068.50 |
$2,068.50 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$2,927.85 |
$2,927.85 |
$2,927.85 |
$1,952.25
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,264.55 |
$2,264.55 |
$2,264.55 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,046.60 |
$2,046.60 |
$2,046.60 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$2,046.60 |
$2,046.60 |
$2,046.60 |
$1,360.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,407.45 |
$4,407.45 |
$4,407.45 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,920.40 |
$3,920.40 |
$3,920.40 |
$2,945.40
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,356.10 |
$3,356.10 |
$3,356.10 |
$2,368.80
|
|
CT thoracic spine w/contrast
|
$2,612.85 |
$2,612.85 |
$2,612.85 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,394.15 |
$2,394.15 |
$2,394.15 |
$1,464.00
|
|
CT t-spine w /wo contrast
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$2,025.00
|
|
CT upper extremity w/contrast (both sides)
|
$1,991.85 |
$1,991.85 |
$1,991.85 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$1,991.85 |
$1,991.85 |
$1,991.85 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$145.80 |
$145.80 |
$145.80 |
$68.64
|
|
Culture afb any source
|
$221.70 |
$221.70 |
$221.70 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$164.55 |
$164.55 |
$164.55 |
$79.00
|
|
Culture anaerobic except blood
|
$273.45 |
$273.45 |
$273.45 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$24.45 |
$24.45 |
$24.45 |
$51.51
|
|
Culture body fluid
|
$239.10 |
$239.10 |
$239.10 |
$126.72
|
|
Culture fungi definitive id mold
|
$129.30 |
$129.30 |
$129.30 |
$76.72
|
|
Culture fungi definitive id yeast
|
$138.00 |
$138.00 |
$138.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$185.70 |
$185.70 |
$185.70 |
$108.00
|
|
Culture mycobacteria definitive id each isolate
|
$311.40 |
$311.40 |
$311.40 |
$89.70
|
|
Culture quantitative aerobic other source
|
$206.40 |
$206.40 |
$206.40 |
$90.35
|
|
Culture screening strep group a
|
$178.50 |
$178.50 |
$178.50 |
$81.00
|
|
Culture typing added method
|
$154.95 |
$154.95 |
$154.95 |
$38.58
|
|
Culture typing immunologic
|
$153.90 |
$153.90 |
$153.90 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$163.20 |
$163.20 |
$163.20 |
$133.90
|
|
Cutter lead
|
$7,740.00 |
$7,740.00 |
$7,740.00 |
$6,092.06
|
|
Cyanocobalamin unsat binding capacity
|
$87.00 |
$87.00 |
$87.00 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$18.91 |
$18.91 |
$18.91 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$58.80 |
$58.80 |
$58.80 |
$70.98
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,450.35 |
$1,450.35 |
$1,450.35 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$18.05 |
$18.05 |
$18.05 |
$19.49
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$98.55 |
$98.55 |
$98.55 |
$140.78
|
|
Cyclosporine 2 hour
|
$200.40 |
$200.40 |
$200.40 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$5.44 |
$5.44 |
$5.44 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$902.34 |
$902.34 |
$902.34 |
$34.88
|
|
Cygnus matrix, per sq cm
|
$295.20 |
$295.20 |
$295.20 |
$295.20
|
|
Cygnus, per sq cm
|
$295.20 |
$295.20 |
$295.20 |
$356.54
|
|
Cylinder pump set 20cm titan zero angl
|
$29,220.00 |
$29,220.00 |
$29,220.00 |
$22,803.38
|
|
Cymetra injectable
|
$371.46 |
$371.46 |
$371.46 |
$578.24
|
|
Cystogram >= 3 views supervision & interpretation
|
$622.35 |
$622.35 |
$622.35 |
$539.55
|
|
Cytarabine 20 mg/ml injection solution
|
$71.40 |
$71.40 |
$71.40 |
$89.94
|
|
Cytogenetics 25-99
|
$315.90 |
$315.90 |
$315.90 |
$190.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$165.15 |
$165.15 |
$165.15 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$27.45 |
$27.45 |
$27.45 |
$97.50
|
|
Cytopathology concentration technique smears & interpretation
|
$114.90 |
$114.90 |
$114.90 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$148.20 |
$148.20 |
$148.20 |
$129.28
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$632.10 |
$632.10 |
$632.10 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$322.35 |
$322.35 |
$322.35 |
$208.60
|
|
Cytopath smear oth prep screen & interp
|
$193.05 |
$193.05 |
$193.05 |
$96.20
|
|
Dacarbazine 100 mg intravenous solution
|
$45.00 |
$45.00 |
$45.00 |
$58.22
|
|
Dactinomycin 0.5 mg intravenous solution
|
$5,362.91 |
$5,362.91 |
$5,362.91 |
$3,024.59
|
|
Dalbavancin 500 mg intravenous solution
|
$3,522.68 |
$3,522.68 |
$3,522.68 |
$3,469.30
|
|
Dalteparin sodium
|
$469.55 |
$469.55 |
$469.55 |
$469.55
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$140.40 |
$140.40 |
$140.40 |
$168.53
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$19,192.29 |
$19,192.29 |
$19,192.29 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$4,597.56 |
$4,597.56 |
$4,597.56 |
$6,269.40
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$20,196.00 |
$20,196.00 |
$20,196.00 |
$20,196.00
|
|
Deamidated gliadin antibody iga
|
$46.05 |
$46.05 |
$46.05 |
$43.35
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$668.55 |
$668.55 |
$668.55 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$317.25 |
$317.25 |
$317.25 |
$260.61
|
|
Decalcification
|
$246.30 |
$246.30 |
$246.30 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$1,188.00 |
$1,188.00 |
$1,188.00 |
$1,026.60
|
|
Deferoxamine 500 mg solution for injection
|
$44.43 |
$44.43 |
$44.43 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$1,508.94 |
$1,508.94 |
$1,508.94 |
$1,807.08
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$6,324.98 |
$6,324.98 |
$6,324.98 |
$6,324.98
|
|
Deodorant ostmy adapt lube 8ml
|
$1.98 |
$1.98 |
$1.98 |
$1.98
|
|
Depo-estradiol cypionate inj
|
$16.04 |
$16.04 |
$16.04 |
$71.51
|
|
Dermagraft
|
$193.11 |
$193.11 |
$193.11 |
$85.00
|
|
Dermapure 1 square cm
|
$608.85 |
$608.85 |
$608.85 |
$3,822.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$68.79 |
$68.79 |
$68.79 |
$91.56
|
|
Destroy cervthor facet jnt 64633
|
$3,138.15 |
$3,138.15 |
$3,138.15 |
$3,011.50
|
|
Destroy cth facet jnt addl 64634
|
$1,569.15 |
$1,569.15 |
$1,569.15 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,569.15 |
$1,569.15 |
$1,569.15 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,138.15 |
$3,138.15 |
$3,138.15 |
$3,202.98
|
|
Device ablt adv novasure
|
$12,003.00 |
$12,003.00 |
$12,003.00 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$4,867.20 |
$4,867.20 |
$4,867.20 |
$4,200.00
|
|
Device intraute mirena
|
$2,236.07 |
$2,236.07 |
$2,236.07 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,894.50 |
$1,894.50 |
$1,894.50 |
$1,894.50
|
|
Dexamethasone 4 mg tablet
|
$33.77 |
$33.77 |
$33.77 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$20.52 |
$20.52 |
$20.52 |
$21.18
|
|
Dexmedetomidine film, 1 mcg
|
$56.70 |
$56.70 |
$56.70 |
$171.39
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,086.05 |
$1,086.05 |
$1,086.05 |
$858.00
|
|
Dextran 40 infusion
|
$100.80 |
$100.80 |
$100.80 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$30.00 |
$30.00 |
$30.00 |
$39.60
|