|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,179.50 |
$1,179.50 |
$1,179.50 |
$1,351.20
|
|
CT scan for therapy guide
|
$1,665.65 |
$1,665.65 |
$1,665.65 |
$777.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$7,343.00 |
$7,343.00 |
$7,343.00 |
$3,329.15
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$6,736.45 |
$6,736.45 |
$6,736.45 |
$2,883.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$5,658.80 |
$5,658.80 |
$5,658.80 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$4,334.05 |
$4,334.05 |
$4,334.05 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$3,308.20 |
$3,308.20 |
$3,308.20 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$127.05 |
$127.05 |
$127.05 |
$420.60
|
|
CT t-spine w /wo contrast
|
$5,094.95 |
$5,094.95 |
$5,094.95 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$1,965.95 |
$1,965.95 |
$1,965.95 |
$1,697.85
|
|
CT upper extremity without contrast (both sides)
|
$1,572.55 |
$1,572.55 |
$1,572.55 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$2,437.75 |
$2,437.75 |
$2,437.75 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$139.65 |
$139.65 |
$139.65 |
$63.02
|
|
Culture afb any source
|
$110.60 |
$110.60 |
$2,354.40 |
$107.50
|
|
Culture anaerobic additional method definitive id each
|
$93.10 |
$93.10 |
$752.67 |
$76.35
|
|
Culture anaerobic except blood
|
$143.50 |
$143.50 |
$2,064.46 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$97.65 |
$97.65 |
$1,888.00 |
$52.50
|
|
Culture body fluid
|
$263.55 |
$263.55 |
$263.55 |
$130.40
|
|
Culture fungi definitive id mold
|
$115.15 |
$115.15 |
$123.51 |
$70.00
|
|
Culture fungi definitive id yeast
|
$79.10 |
$79.10 |
$1,111.57 |
$79.10
|
|
Culture fungi other (except blood)
|
$135.80 |
$135.80 |
$1,040.35 |
$94.90
|
|
Culture fungi skin/hair/nail
|
$1,040.35 |
$1,040.35 |
$1,040.35 |
$76.05
|
|
Culture mycobacteria definitive id each isolate
|
$1,040.35 |
$1,040.35 |
$1,040.35 |
$88.14
|
|
Culture mycoplasma any source
|
$40.25 |
$40.25 |
$640.79 |
$90.37
|
|
Culture quantitative aerobic other source
|
$14.00 |
$14.00 |
$2,156.02 |
$85.80
|
|
Culture screening strep group a
|
$110.60 |
$110.60 |
$110.60 |
$78.47
|
|
Culture typing added method
|
$1,548.00 |
$1,548.00 |
$1,548.00 |
$34.45
|
|
Culture typing immunologic
|
$77.70 |
$77.70 |
$671.30 |
$41.19
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$437.15 |
$437.15 |
$437.15 |
$115.05
|
|
Culture urine each isolate
|
$1,763.62 |
$1,763.62 |
$1,763.62 |
$46.20
|
|
Cutter lead
|
$6,829.20 |
$6,829.20 |
$6,829.20 |
$2,205.00
|
|
Cv line/pic reposition
|
$1,410.50 |
$1,410.50 |
$3,645.06 |
$1,789.77
|
|
Cyanocobalamin unsat binding capacity
|
$25.90 |
$25.90 |
$233.94 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$19.46 |
$19.46 |
$44.83 |
$26.75
|
|
Cyclic citrullinated peptide antibody
|
$119.70 |
$119.70 |
$392.32 |
$85.03
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$376.38 |
$376.38 |
$779.37 |
$779.37
|
|
Cyclophosphamide 25 mg capsule
|
$1.81 |
$1.81 |
$1.81 |
$25.00
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$101.89 |
$101.89 |
$101.89 |
$150.79
|
|
Cyclosporine 2 hour
|
$143.50 |
$143.50 |
$3,934.90 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$1.50 |
$1.50 |
$1.50 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$938.25 |
$938.25 |
$938.25 |
$42.97
|
|
Cylinder pump set 20cm titan zero angl
|
$55,839.42 |
$55,839.42 |
$55,839.42 |
$20,422.59
|
|
Cyp2c9 gene com variants
|
$275.10 |
$275.10 |
$275.10 |
$275.10
|
|
Cystatin c
|
$36.05 |
$36.05 |
$467.77 |
$82.50
|
|
Cystine urine quantitative
|
$166.96 |
$166.96 |
$166.96 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$480.90 |
$480.90 |
$5,674.22 |
$527.50
|
|
Cystometrogram w/up 51727
|
$306.25 |
$306.25 |
$306.25 |
$857.38
|
|
Cystoscopy and treatment
|
$2,703.05 |
$2,703.05 |
$11,648.26 |
$2,874.36
|
|
Cystoscopy (Bladder Scope)
|
$1,101.80 |
$1,101.80 |
$1,101.80 |
$1,619.67
|
|
Cystoscopy removal of clots
|
$2,499.35 |
$2,499.35 |
$2,499.35 |
$3,820.84
|
|
Cystourethroscop/calib/dilat stric 52281
|
$968.45 |
$968.45 |
$968.45 |
$2,845.50
|
|
Cytarabine 20 mg/ml injection solution
|
$156.90 |
$156.90 |
$177.55 |
$67.00
|
|
Cytogenomic neo microra alys
|
$9,017.45 |
$9,017.45 |
$9,017.45 |
$1,742.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$217.00 |
$217.00 |
$1,012.75 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$217.70 |
$217.70 |
$1,012.75 |
$102.83
|
|
Cytomegalovirus imm IV /vial
|
$3,857.81 |
$3,857.81 |
$3,857.81 |
$2,635.28
|
|
Cytopathology concentration technique smears & interpretation
|
$160.65 |
$160.65 |
$980.79 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$68.95 |
$68.95 |
$68.95 |
$124.30
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$120.75 |
$120.75 |
$120.75 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$249.55 |
$249.55 |
$694.54 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$186.20 |
$186.20 |
$895.05 |
$203.08
|
|
Cytopath smear oth prep screen & interp
|
$419.92 |
$419.92 |
$419.92 |
$95.00
|
|
Cytopath tbs c/v manual
|
$117.70 |
$117.70 |
$117.70 |
$57.94
|
|
Cytotoxic antibody screening
|
$180.95 |
$180.95 |
$180.95 |
$157.60
|
|
Cytp urine 3-5 probes cmptr
|
$1,085.41 |
$1,085.41 |
$1,085.41 |
$690.00
|
|
Dacarbazine 100 mg intravenous solution
|
$160.26 |
$160.26 |
$160.26 |
$61.64
|
|
Dactinomycin 0.5 mg intravenous solution
|
$5,912.84 |
$5,912.84 |
$5,912.84 |
$2,281.50
|
|
Dalbavancin 500 mg intravenous solution
|
$4,021.94 |
$4,021.94 |
$4,021.94 |
$3,753.91
|
|
Dalteparin sodium
|
$124.09 |
$124.09 |
$124.09 |
$124.09
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,150.92 |
$1,150.92 |
$1,150.92 |
$544.35
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$27,169.47 |
$27,169.47 |
$27,169.47 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$3,903.74 |
$3,903.74 |
$3,903.74 |
$5,500.25
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$26,349.55 |
$26,349.55 |
$26,349.55 |
$22,284.19
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$419.11 |
$419.11 |
$419.11 |
$194.08
|
|
Dch validity tests
|
$13.65 |
$13.65 |
$13.65 |
$25.00
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$518.00 |
$518.00 |
$518.00 |
$677.54
|
|
Debridement (>20 cm) charge pt
|
$286.65 |
$286.65 |
$1,276.24 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$2,955.05 |
$2,955.05 |
$2,955.05 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$688.80 |
$688.80 |
$688.80 |
$688.80
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,220.45 |
$1,220.45 |
$1,220.45 |
$1,430.40
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$778.05 |
$778.05 |
$778.05 |
$810.50
|
|
Debride nail1-5 11720
|
$37.80 |
$37.80 |
$37.80 |
$173.25
|
|
Debride nail6 or more 11721
|
$58.10 |
$58.10 |
$58.10 |
$200.21
|
|
Debride skin bone at fx site
|
$2,342.90 |
$2,342.90 |
$2,342.90 |
$3,167.89
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$336.00 |
$336.00 |
$336.00 |
$663.30
|
|
Debr inf skin add-on 11001
|
$64.40 |
$64.40 |
$64.40 |
$78.00
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,977.15 |
$1,977.15 |
$1,977.15 |
$1,193.40
|
|
Decalcification
|
$127.05 |
$127.05 |
$733.79 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$2,903.28 |
$2,903.28 |
$2,903.28 |
$1,026.60
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$274.40 |
$274.40 |
$274.40 |
$498.00
|
|
Decomp fasct leg ant+/lat+pst cmprt 27602
|
$1,780.10 |
$1,780.10 |
$1,780.10 |
$4,881.00
|
|
Deferoxamine 500 mg solution for injection
|
$241.97 |
$241.97 |
$248.67 |
$116.00
|
|
Degarelix 120 mg subcutaneous solution
|
$1,354.83 |
$1,354.83 |
$1,354.83 |
$1,963.06
|
|
Delivery of placenta 59414
|
$1,294.65 |
$1,294.65 |
$1,294.65 |
$3,135.14
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$54.95 |
$54.95 |
$5,680.38 |
$8,127.00
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$172.55 |
$172.55 |
$172.55 |
$182.40
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$7,933.81 |
$7,933.81 |
$7,933.81 |
$7,737.00
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$90.65 |
$90.65 |
$90.65 |
$450.40
|
|
Depo-estradiol cypionate inj
|
$1,133.36 |
$1,133.36 |
$1,133.36 |
$87.27
|
|
Descend thora aorta rpr/lt sub art 33880
|
$6,288.45 |
$6,288.45 |
$16,202.28 |
$5,702.04
|