|
Cyclic citrullinated peptide antibody
|
$43.20 |
$43.20 |
$43.20 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$162.26 |
$162.26 |
$162.26 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$44.12 |
$44.12 |
$44.12 |
$19.49
|
|
Cyclosporine 2 hour
|
$43.20 |
$43.20 |
$43.20 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$11.36 |
$11.36 |
$11.36 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$14.12 |
$14.12 |
$14.12 |
$34.88
|
|
Cygnus, per sq cm
|
$17,810.55 |
$17,810.55 |
$17,810.55 |
$356.54
|
|
Cylinder pump set 20cm titan zero angl
|
$57,670.76 |
$57,670.76 |
$57,670.76 |
$22,803.38
|
|
Cyp2c9 gene com variants
|
$524.40 |
$524.40 |
$524.40 |
$275.10
|
|
Cyp3a4 gene common variants
|
$524.40 |
$524.40 |
$524.40 |
$245.31
|
|
Cyp3a5 gene common variants
|
$524.40 |
$524.40 |
$524.40 |
$245.31
|
|
Cystatin c
|
$61.80 |
$61.80 |
$61.80 |
$77.50
|
|
Cystine urine quantitative
|
$76.80 |
$76.80 |
$76.80 |
$103.35
|
|
Cystoscopy and treatment
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$2,874.36
|
|
Cystoscopy and treatment
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$3,203.50
|
|
Cystoscopy (Bladder Scope)
|
$450.60 |
$450.60 |
$450.60 |
$1,493.80
|
|
Cystoscopy & ureter catheter
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$3,786.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$3,065.15
|
|
Cytarabine 20 mg/ml injection solution
|
$90.00 |
$90.00 |
$90.00 |
$89.94
|
|
Cytogenomic neo microra alys
|
$1,587.60 |
$1,587.60 |
$1,587.60 |
$2,020.20
|
|
Cytomegalovirus (cmv) antibody igg
|
$61.80 |
$61.80 |
$61.80 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$74.40 |
$74.40 |
$74.40 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$322.80 |
$322.80 |
$322.80 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$79.80 |
$79.80 |
$79.80 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$83.40 |
$83.40 |
$83.40 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$36.60 |
$36.60 |
$36.60 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$91.20 |
$91.20 |
$91.20 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$205.80 |
$205.80 |
$205.80 |
$209.23
|
|
Cytopath smear other source
|
$91.20 |
$91.20 |
$91.20 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$116.40 |
$116.40 |
$116.40 |
$96.20
|
|
Dalbavancin 500 mg intravenous solution
|
$2,882.20 |
$2,882.20 |
$2,882.20 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$90.00 |
$90.00 |
$90.00 |
$168.53
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$19,029.36 |
$19,029.36 |
$19,029.36 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$6,269.40 |
$6,269.40 |
$6,269.40 |
$6,072.48
|
|
Dch validity tests
|
$12.00 |
$12.00 |
$12.00 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$34.80 |
$34.80 |
$34.80 |
$43.60
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$418.80 |
$418.80 |
$418.80 |
$668.55
|
|
Debridement bone <= 20 sq cm
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$2,316.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$430.20 |
$430.20 |
$430.20 |
$810.50
|
|
Debride skin bone at fx site
|
$1,860.00 |
$1,860.00 |
$1,860.00 |
$3,015.00
|
|
Debr musc/fascia 20sq cm/< 11043
|
$7,117.59 |
$7,117.59 |
$7,117.59 |
$1,160.00
|
|
Decalcification
|
$36.00 |
$36.00 |
$36.00 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$180.00 |
$180.00 |
$180.00 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$611.40 |
$611.40 |
$611.40 |
$543.00
|
|
Decompression of tibia nerve
|
$4,535.33 |
$4,535.33 |
$4,535.33 |
$2,625.60
|
|
Degarelix 120 mg subcutaneous solution
|
$879.21 |
$879.21 |
$879.21 |
$1,807.08
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$163.20 |
$163.20 |
$163.20 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$5,588.58 |
$5,588.58 |
$5,588.58 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$84.00 |
$84.00 |
$84.00 |
$408.10
|
|
Dermapure 1 square cm
|
$7,896.01 |
$7,896.01 |
$7,896.01 |
$3,822.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$38.76 |
$38.76 |
$38.76 |
$89.78
|
|
Desoxycorticosterone
|
$115.20 |
$115.20 |
$115.20 |
$109.28
|
|
Destruction benign lesions < 14 lesions
|
$130.20 |
$130.20 |
$130.20 |
$235.13
|
|
Device ablt adv novasure
|
$19,195.82 |
$19,195.82 |
$19,195.82 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$9,894.75 |
$9,894.75 |
$9,894.75 |
$4,200.00
|
|
Device sut capio slim opn
|
$4,527.84 |
$4,527.84 |
$4,527.84 |
$1,894.50
|
|
Device tiss remov myosure reach
|
$3,666.01 |
$3,666.01 |
$3,666.01 |
$2,541.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$133.80 |
$133.80 |
$133.80 |
$227.15
|
|
Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr
|
$2,427.60 |
$2,427.60 |
$2,427.60 |
$21.00
|
|
Dexamethasone 4 mg tablet
|
$4.80 |
$4.80 |
$4.80 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$15.30 |
$15.30 |
$15.30 |
$21.17
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$312.65 |
$312.65 |
$312.65 |
$858.00
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$36.00 |
$36.00 |
$36.00 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$36.00 |
$36.00 |
$36.00 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$36.00 |
$36.00 |
$36.00 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$36.00 |
$36.00 |
$36.00 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$87.00 |
$87.00 |
$87.00 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$39.00 |
$39.00 |
$39.00 |
$79.20
|
|
Diagnostic anoscopy spx 46600
|
$84.00 |
$84.00 |
$84.00 |
$190.68
|
|
Diagnostic laryngoscopy 31575
|
$129.00 |
$129.00 |
$129.00 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$317.40 |
$317.40 |
$317.40 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$247.80 |
$247.80 |
$247.80 |
$301.55
|
|
Diatrizoate meglumine 18 % urethral solution
|
$202.03 |
$202.03 |
$202.03 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$25.10 |
$25.10 |
$25.10 |
$74.76
|
|
Diffusing capacity
|
$171.60 |
$171.60 |
$171.60 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$584.36 |
$584.36 |
$584.36 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$8,057.88 |
$8,057.88 |
$8,057.88 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$52.20 |
$52.20 |
$52.20 |
$102.00
|
|
Dilation/urethral strict/male/ini 53620
|
$450.60 |
$450.60 |
$450.60 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$1,256.24 |
$1,256.24 |
$1,256.24 |
$402.10
|
|
Diltiazem 5 mg/ml intravenous solution
|
$46.56 |
$46.56 |
$46.56 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$17.75
|
|
Disability dlco
|
$185.40 |
$185.40 |
$185.40 |
$282.40
|
|
Disaccharidases
|
$244.20 |
$244.20 |
$244.20 |
$216.00
|
|
Dmpk gene detc abnor allele
|
$411.00 |
$411.00 |
$411.00 |
$313.60
|
|
Dna antibody native/double stranded
|
$54.60 |
$54.60 |
$54.60 |
$97.50
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$163.20 |
$163.20 |
$163.20 |
$98.43
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$502.45 |
$502.45 |
$502.45 |
$904.81
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$92.82 |
$92.82 |
$92.82 |
$65.40
|
|
Doppler echo complete
|
$600.60 |
$600.60 |
$600.60 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$273.60 |
$273.60 |
$273.60 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$140.40 |
$140.40 |
$140.40 |
$471.17
|
|
Dornhoffer fixed part w/window
|
$101,915.93 |
$101,915.93 |
$101,915.93 |
$34,278.00
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$473.45 |
$473.45 |
$473.45 |
$423.95
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$576.29 |
$576.29 |
$576.29 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$70.71 |
$70.71 |
$70.71 |
$84.80
|
|
Dpyd gene common variants
|
$578.40 |
$578.40 |
$578.40 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$467.40 |
$467.40 |
$467.40 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$467.40 |
$467.40 |
$467.40 |
$914.34
|
|
Drainage external ear complex 69005
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$2,726.90
|
