|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$118.00 |
$118.00 |
$118.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$712.00 |
$712.00 |
$712.00 |
$1,360.00
|
|
CT scan for therapy guide
|
$979.50 |
$979.50 |
$979.50 |
$694.60
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$2,182.00 |
$2,182.00 |
$2,182.00 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,070.50 |
$2,070.50 |
$2,070.50 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,712.50 |
$1,712.50 |
$1,712.50 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$118.00 |
$118.00 |
$118.00 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$706.50 |
$706.50 |
$706.50 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$120.00 |
$120.00 |
$120.00 |
$331.50
|
|
CT t-spine w /wo contrast
|
$1,383.50 |
$1,383.50 |
$1,383.50 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$2,182.00 |
$2,182.00 |
$2,182.00 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$712.00 |
$712.00 |
$712.00 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$1,395.50 |
$1,395.50 |
$1,395.50 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$126.00 |
$126.00 |
$126.00 |
$68.64
|
|
Culture afb any source
|
$195.00 |
$195.00 |
$195.00 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$168.00 |
$168.00 |
$168.00 |
$79.00
|
|
Culture anaerobic except blood
|
$49.00 |
$49.00 |
$49.00 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$51.00 |
$51.00 |
$51.00 |
$51.45
|
|
Culture body fluid
|
$46.50 |
$46.50 |
$46.50 |
$126.75
|
|
Culture fungi definitive id mold
|
$34.00 |
$34.00 |
$34.00 |
$77.28
|
|
Culture fungi definitive id yeast
|
$34.00 |
$34.00 |
$34.00 |
$79.10
|
|
Culture fungi skin/hair/nail
|
$71.50 |
$71.50 |
$71.50 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$140.00 |
$140.00 |
$140.00 |
$89.70
|
|
Culture screening strep group a
|
$35.00 |
$35.00 |
$35.00 |
$81.00
|
|
Culture typing immunologic
|
$51.00 |
$51.00 |
$51.00 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$202.00 |
$202.00 |
$202.00 |
$133.90
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$52.72 |
$52.72 |
$52.72 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$66.50 |
$66.50 |
$66.50 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$750.70 |
$750.70 |
$750.70 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$93.50 |
$93.50 |
$93.50 |
$129.48
|
|
Cygnus matrix, per sq cm
|
$221.50 |
$221.50 |
$221.50 |
$295.20
|
|
Cyp2c9 gene com variants
|
$282.50 |
$282.50 |
$282.50 |
$275.10
|
|
Cystatin c
|
$32.00 |
$32.00 |
$32.00 |
$77.50
|
|
Cystine urine quantitative
|
$87.00 |
$87.00 |
$87.00 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$719.00 |
$719.00 |
$719.00 |
$542.10
|
|
Cysto impl 4 or more
|
$3,014.50 |
$3,014.50 |
$3,014.50 |
$6,860.21
|
|
Cystoscopy and treatment
|
$3,435.00 |
$3,435.00 |
$3,435.00 |
$4,160.10
|
|
Cystoscopy and treatment
|
$4,051.50 |
$4,051.50 |
$4,051.50 |
$5,162.50
|
|
Cystoscopy and treatment
|
$3,587.00 |
$3,587.00 |
$3,587.00 |
$5,995.60
|
|
Cystoscopy and treatment
|
$13,087.00 |
$13,087.00 |
$13,087.00 |
$6,475.26
|
|
Cystoscopy and treatment
|
$2,403.00 |
$2,403.00 |
$2,403.00 |
$3,213.14
|
|
Cystoscopy and treatment
|
$2,304.50 |
$2,304.50 |
$2,304.50 |
$2,424.12
|
|
Cystoscopy and treatment
|
$3,334.50 |
$3,334.50 |
$3,334.50 |
$4,045.60
|
|
Cystoscopy and treatment
|
$714.50 |
$714.50 |
$714.50 |
$958.81
|
|
Cystoscopy and treatment
|
$1,713.00 |
$1,713.00 |
$1,713.00 |
$2,874.36
|
|
Cystoscopy (Bladder Scope)
|
$1,713.00 |
$1,713.00 |
$1,713.00 |
$1,493.80
|
|
Cystoscopy chemodenervation
|
$2,872.00 |
$2,872.00 |
$2,872.00 |
$2,704.80
|
|
Cystoscopy prostatic imp 1-3
|
$3,270.50 |
$3,270.50 |
$3,270.50 |
$5,741.40
|
|
Cystoscopy & revise urethra
|
$8,844.50 |
$8,844.50 |
$8,844.50 |
$2,874.36
|
|
Cystoscopy & ureter catheter
|
$3,694.00 |
$3,694.00 |
$3,694.00 |
$3,786.00
|
|
Cystostomy cystotomy w/drainage 51040
|
$3,465.00 |
$3,465.00 |
$3,465.00 |
$3,863.60
|
|
Cystouretero & or pyeloscope
|
$7,324.00 |
$7,324.00 |
$7,324.00 |
$4,315.98
|
|
Cystouretero w/excise tumor
|
$3,776.50 |
$3,776.50 |
$3,776.50 |
$5,584.80
|
|
Cysto/uretero w/lithotripsy
|
$19,039.00 |
$19,039.00 |
$19,039.00 |
$9,002.88
|
|
Cystouretero w/lithotripsy
|
$4,189.00 |
$4,189.00 |
$4,189.00 |
$7,061.60
|
|
Cystouretero w/stone remove
|
$3,359.00 |
$3,359.00 |
$3,359.00 |
$5,110.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,886.00 |
$3,886.00 |
$3,886.00 |
$3,065.15
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$7,832.50 |
$7,832.50 |
$7,832.50 |
$4,045.60
|
|
Cytogenetics 25-99
|
$115.00 |
$115.00 |
$115.00 |
$190.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$83.50 |
$83.50 |
$83.50 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$87.50 |
$87.50 |
$87.50 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$124.50 |
$124.50 |
$124.50 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$32.50 |
$32.50 |
$32.50 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$94.00 |
$94.00 |
$94.00 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$65.50 |
$65.50 |
$65.50 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$71.00 |
$71.00 |
$71.00 |
$129.35
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$166.50 |
$166.50 |
$166.50 |
$209.23
|
|
Cytopath smear other source
|
$71.00 |
$71.00 |
$71.00 |
$88.13
|
|
Dacarbazine 100 mg intravenous solution
|
$43.56 |
$43.56 |
$43.56 |
$58.22
|
|
Dalbavancin 500 mg intravenous solution
|
$6,201.23 |
$6,201.23 |
$6,201.23 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,012.92 |
$1,012.92 |
$1,012.92 |
$168.53
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$21,038.01 |
$21,038.01 |
$21,038.01 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$17.00 |
$17.00 |
$17.00 |
$6,072.48
|
|
Darbepoetin alfa, esrd use
|
$17.00 |
$17.00 |
$17.00 |
$4.48
|
|
D&c after delivery 59160
|
$4,579.50 |
$4,579.50 |
$4,579.50 |
$3,827.25
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$3,845.50 |
$3,845.50 |
$3,845.50 |
$3,774.81
|
|
Dch validity tests
|
$12.50 |
$12.50 |
$12.50 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$66.50 |
$66.50 |
$66.50 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$512.50 |
$512.50 |
$512.50 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$2,143.00 |
$2,143.00 |
$2,143.00 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$942.33 |
$942.33 |
$942.33 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,170.33 |
$1,170.33 |
$1,170.33 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$5,256.50 |
$5,256.50 |
$5,256.50 |
$810.50
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$814.00 |
$814.00 |
$814.00 |
$1,012.80
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$1,094.33 |
$1,094.33 |
$1,094.33 |
$639.60
|
|
Debrid mastoidectomy cavity simple 69220
|
$238.00 |
$238.00 |
$238.00 |
$235.13
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$3,886.00 |
$3,886.00 |
$3,886.00 |
$1,129.45
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,884.67 |
$1,884.67 |
$1,884.67 |
$1,160.00
|
|
Decalcification
|
$71.00 |
$71.00 |
$71.00 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$62.22 |
$62.22 |
$62.22 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$557.00 |
$557.00 |
$557.00 |
$543.00
|
|
Decomp forearm 1 space 25020
|
$9,028.50 |
$9,028.50 |
$9,028.50 |
$3,137.60
|
|
Decompress spinal cord lmbr
|
$5,605.50 |
$5,605.50 |
$5,605.50 |
$8,446.03
|
|
Deep muscle biopsy 20205
|
$3,046.00 |
$3,046.00 |
$3,046.00 |
$3,339.00
|
|
Deferoxamine 500 mg solution for injection
|
$46.22 |
$46.22 |
$46.22 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$2,151.09 |
$2,151.09 |
$2,151.09 |
$1,807.08
|
|
Delay flap eye/nos/ear/lip
|
$2,817.00 |
$2,817.00 |
$2,817.00 |
$2,190.24
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$121.00 |
$121.00 |
$121.00 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$7,489.51 |
$7,489.51 |
$7,489.51 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$205.00 |
$205.00 |
$205.00 |
$408.10
|
