|
Culture screening strep group a
|
$136.20 |
$136.20 |
$136.20 |
$81.00
|
|
Culture typing immunologic
|
$73.20 |
$73.20 |
$73.20 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$832.80 |
$832.80 |
$832.80 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$135.00 |
$135.00 |
$135.00 |
$133.90
|
|
Culture urine each isolate
|
$94.80 |
$94.80 |
$94.80 |
$57.00
|
|
Cutter lead
|
$18,560.43 |
$18,560.43 |
$18,560.43 |
$6,092.06
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$48.00 |
$48.00 |
$48.00 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$121.20 |
$121.20 |
$121.20 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,027.75 |
$1,027.75 |
$1,027.75 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$67.40 |
$67.40 |
$67.40 |
$19.49
|
|
Cyclosporine 2 hour
|
$226.80 |
$226.80 |
$226.80 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$43.11 |
$43.11 |
$43.11 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$148.91 |
$148.91 |
$148.91 |
$34.88
|
|
Cygnus, per sq cm
|
$23,395.50 |
$23,395.50 |
$23,395.50 |
$356.54
|
|
Cylinder pump set 20cm titan zero angl
|
$75,754.89 |
$75,754.89 |
$75,754.89 |
$22,803.38
|
|
Cyp2c9 gene com variants
|
$550.80 |
$550.80 |
$550.80 |
$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
|
$130.80 |
$130.80 |
$130.80 |
$77.50
|
|
Cystine urine quantitative
|
$74.40 |
$74.40 |
$74.40 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$839.40 |
$839.40 |
$839.40 |
$542.10
|
|
Cysto impl 4 or more
|
$35,400.73 |
$35,400.73 |
$35,400.73 |
$6,860.21
|
|
Cysto, litho, vacuum kidney
|
$39,912.74 |
$39,912.74 |
$39,912.74 |
$10,942.71
|
|
Cysto rx balo cath urtl strx
|
$27,275.55 |
$27,275.55 |
$27,275.55 |
$6,015.75
|
|
Cystoscopy and treatment
|
$15,574.50 |
$15,574.50 |
$15,574.50 |
$5,162.50
|
|
Cystoscopy and treatment
|
$11,892.81 |
$11,892.81 |
$11,892.81 |
$5,995.60
|
|
Cystoscopy and treatment
|
$19,865.86 |
$19,865.86 |
$19,865.86 |
$6,475.26
|
|
Cystoscopy and treatment
|
$7,674.94 |
$7,674.94 |
$7,674.94 |
$2,874.36
|
|
Cystoscopy and treatment
|
$1,546.20 |
$1,546.20 |
$1,546.20 |
$3,203.50
|
|
Cystoscopy (Bladder Scope)
|
$7,444.28 |
$7,444.28 |
$7,444.28 |
$1,493.80
|
|
Cystoscopy & ureter catheter
|
$19,023.41 |
$19,023.41 |
$19,023.41 |
$3,786.00
|
|
Cystouretero & or pyeloscope
|
$14,519.98 |
$14,519.98 |
$14,519.98 |
$4,315.98
|
|
Cystouretero w/biopsy
|
$39,912.74 |
$39,912.74 |
$39,912.74 |
$5,986.78
|
|
Cysto/uretero w/lithotripsy
|
$23,274.23 |
$23,274.23 |
$23,274.23 |
$9,002.88
|
|
Cystouretero w/lithotripsy
|
$16,651.03 |
$16,651.03 |
$16,651.03 |
$7,061.60
|
|
Cystourethroscop/calib/dilat stric 52281
|
$11,040.84 |
$11,040.84 |
$11,040.84 |
$3,065.15
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$14,605.66 |
$14,605.66 |
$14,605.66 |
$4,045.60
|
|
Cytogenomic neo microra alys
|
$1,837.80 |
$1,837.80 |
$1,837.80 |
$2,020.20
|
|
Cytomegalovirus (cmv) antibody igg
|
$158.40 |
$158.40 |
$158.40 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$162.00 |
$162.00 |
$162.00 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$544.20 |
$544.20 |
$544.20 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$67.80 |
$67.80 |
$67.80 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$152.40 |
$152.40 |
$152.40 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$80.40 |
$80.40 |
$80.40 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$105.60 |
$105.60 |
$105.60 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$187.80 |
$187.80 |
$187.80 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$423.00 |
$423.00 |
$423.00 |
$209.23
|
|
Cytopath smear other source
|
$93.60 |
$93.60 |
$93.60 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$113.40 |
$113.40 |
$113.40 |
$96.20
|
|
Dalbavancin 500 mg intravenous solution
|
$9,714.05 |
$9,714.05 |
$9,714.05 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$163.80 |
$163.80 |
$163.80 |
$168.53
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$21,130.20 |
$21,130.20 |
$21,130.20 |
$6,072.48
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$7,428.17 |
$7,428.17 |
$7,428.17 |
$3,774.81
|
|
Dch validity tests
|
$51.00 |
$51.00 |
$51.00 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$40.20 |
$40.20 |
$40.20 |
$43.60
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$1,210.80 |
$1,210.80 |
$1,210.80 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$307.80 |
$307.80 |
$307.80 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$4,845.60 |
$4,845.60 |
$4,845.60 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$481.80 |
$481.80 |
$481.80 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,496.40 |
$1,496.40 |
$1,496.40 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$8,962.20 |
$8,962.20 |
$8,962.20 |
$810.50
|
|
Debride nail6 or more 11721
|
$229.80 |
$229.80 |
$229.80 |
$169.60
|
|
Debride skin bone at fx site
|
$11,593.06 |
$11,593.06 |
$11,593.06 |
$3,015.00
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$3,163.80 |
$3,163.80 |
$3,163.80 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$4,436.40 |
$4,436.40 |
$4,436.40 |
$1,160.00
|
|
Decalcification
|
$79.20 |
$79.20 |
$79.20 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$264.30 |
$264.30 |
$264.30 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$606.00 |
$606.00 |
$606.00 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$432.60 |
$432.60 |
$432.60 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$4,343.92 |
$4,343.92 |
$4,343.92 |
$1,807.08
|
|
Delayed breast prosthesis 19342
|
$69,032.87 |
$69,032.87 |
$69,032.87 |
$10,457.82
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$185.40 |
$185.40 |
$185.40 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$18,835.58 |
$18,835.58 |
$18,835.58 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$97.20 |
$97.20 |
$97.20 |
$408.10
|
|
Dermapure 1 square cm
|
$10,372.01 |
$10,372.01 |
$10,372.01 |
$3,822.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$103.69 |
$103.69 |
$103.69 |
$89.78
|
|
Desoxycorticosterone
|
$166.20 |
$166.20 |
$166.20 |
$109.28
|
|
Dest mal lesion tal <0.5 17260
|
$378.60 |
$378.60 |
$378.60 |
$238.40
|
|
Destroy cervthor facet jnt 64633
|
$3,745.80 |
$3,745.80 |
$3,745.80 |
$3,011.50
|
|
Destroy cth facet jnt addl 64634
|
$3,745.80 |
$3,745.80 |
$3,745.80 |
$1,441.44
|
|
Destruction anal lesion(s)
|
$10,990.89 |
$10,990.89 |
$10,990.89 |
$3,363.79
|
|
Destruction benign lesions < 14 lesions
|
$9,613.31 |
$9,613.31 |
$9,613.31 |
$235.13
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$3,745.80 |
$3,745.80 |
$3,745.80 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,745.80 |
$3,745.80 |
$3,745.80 |
$3,202.98
|
|
Developmental screen/score/document 96110
|
$17.40 |
$17.40 |
$17.40 |
$130.65
|
|
Device ablt adv novasure
|
$25,215.15 |
$25,215.15 |
$25,215.15 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$12,997.50 |
$12,997.50 |
$12,997.50 |
$4,200.00
|
|
Device intraute mirena
|
$1,241.40 |
$1,241.40 |
$1,241.40 |
$2,125.00
|
|
Device sut capio slim opn
|
$5,947.66 |
$5,947.66 |
$5,947.66 |
$1,894.50
|
|
Device tiss remov myosure reach
|
$4,815.58 |
$4,815.58 |
$4,815.58 |
$2,541.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$147.60 |
$147.60 |
$147.60 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$9.54 |
$9.54 |
$9.54 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$48.00 |
$48.00 |
$48.00 |
$21.17
|
|
Dextran 40 infusion
|
$698.25 |
$698.25 |
$698.25 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$201.60 |
$201.60 |
$201.60 |
$38.08
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$193.20 |
$193.20 |
$193.20 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$201.60 |
$201.60 |
$201.60 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$167.40 |
$167.40 |
$167.40 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$117.00 |
$117.00 |
$117.00 |
$79.20
|
|
Diag laparo separate proc 49320
|
$17,829.51 |
$17,829.51 |
$17,829.51 |
$6,904.15
|
