|
Culture afb any source
|
$27.93 |
$27.93 |
$27.93 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$39.33 |
$39.33 |
$39.33 |
$77.31
|
|
Culture anaerobic except blood
|
$64.41 |
$64.41 |
$64.41 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$19.95 |
$19.95 |
$19.95 |
$52.80
|
|
Culture body fluid
|
$47.88 |
$47.88 |
$47.88 |
$130.50
|
|
Culture fungi definitive id mold
|
$25.65 |
$25.65 |
$25.65 |
$70.00
|
|
Culture fungi definitive id yeast
|
$25.65 |
$25.65 |
$25.65 |
$80.60
|
|
Culture fungi other (except blood)
|
$19.38 |
$19.38 |
$19.38 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$19.95 |
$19.95 |
$19.95 |
$77.40
|
|
Culture mycobacteria definitive id each isolate
|
$64.98 |
$64.98 |
$64.98 |
$84.75
|
|
Culture mycoplasma any source
|
$62.70 |
$62.70 |
$62.70 |
$90.37
|
|
Culture quantitative aerobic other source
|
$23.37 |
$23.37 |
$23.37 |
$87.02
|
|
Culture screening strep group a
|
$35.34 |
$35.34 |
$35.34 |
$81.60
|
|
Culture typing immunologic
|
$16.53 |
$16.53 |
$16.53 |
$41.60
|
|
Culture urine each isolate
|
$21.09 |
$21.09 |
$21.09 |
$46.20
|
|
Cv line/pic reposition
|
$2,850.00 |
$2,850.00 |
$2,850.00 |
$1,829.42
|
|
Cyanocobalamin unsat binding capacity
|
$16.53 |
$16.53 |
$16.53 |
$60.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$9.13 |
$9.13 |
$9.13 |
$33.37
|
|
Cyclic citrullinated peptide antibody
|
$32.49 |
$32.49 |
$32.49 |
$80.05
|
|
Cyclophosphamide 25 mg capsule
|
$1.55 |
$1.55 |
$1.55 |
$23.49
|
|
Cyclosporine 2 hour
|
$43.89 |
$43.89 |
$43.89 |
$121.80
|
|
Cyclosporine modified 25 mg capsule
|
$3.21 |
$3.21 |
$3.21 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$8.61 |
$8.61 |
$8.61 |
$39.04
|
|
Cyp2d6 gene com variants
|
$669.75 |
$669.75 |
$669.75 |
$537.50
|
|
Cystatin c
|
$46.17 |
$46.17 |
$46.17 |
$82.26
|
|
Cystine urine quantitative
|
$26.79 |
$26.79 |
$26.79 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$257.07 |
$257.07 |
$257.07 |
$539.55
|
|
Cystoscopy removal of clots
|
$4,567.41 |
$4,567.41 |
$4,567.41 |
$3,970.98
|
|
Cytarabine 20 mg/ml injection solution
|
$2.27 |
$2.27 |
$2.27 |
$89.95
|
|
Cytomegalovirus (cmv) antibody igg
|
$29.07 |
$29.07 |
$29.07 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$14.82 |
$14.82 |
$14.82 |
$96.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$83.22 |
$83.22 |
$83.22 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$138.51 |
$138.51 |
$138.51 |
$90.75
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$72.39 |
$72.39 |
$72.39 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$38.19 |
$38.19 |
$38.19 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$57.00 |
$57.00 |
$57.00 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$71.25 |
$71.25 |
$71.25 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$157.89 |
$157.89 |
$157.89 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$136.23 |
$136.23 |
$136.23 |
$205.00
|
|
Cytopath smear oth prep screen & interp
|
$38.19 |
$38.19 |
$38.19 |
$95.89
|
|
Cytp urine 3-5 probes cmptr
|
$501.60 |
$501.60 |
$501.60 |
$690.00
|
|
Dalbavancin 500 mg intravenous solution
|
$31.84 |
$31.84 |
$31.84 |
$3,469.30
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1.57 |
$1.57 |
$1.57 |
$315.32
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$83.19 |
$83.19 |
$83.19 |
$28,415.40
|
|
Dch validity tests
|
$3.99 |
$3.99 |
$3.99 |
$25.20
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$7,241.85 |
$7,241.85 |
$7,241.85 |
$4,021.68
|
|
Deamidated gliadin antibody iga
|
$27.93 |
$27.93 |
$27.93 |
$44.16
|
|
Debridement (>20 cm) charge pt
|
$132.24 |
$132.24 |
$132.24 |
$262.60
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$634.98 |
$634.98 |
$634.98 |
$810.50
|
|
Debride nail1-5 11720
|
$137.94 |
$137.94 |
$137.94 |
$173.25
|
|
Debride nail6 or more 11721
|
$214.89 |
$214.89 |
$214.89 |
$195.20
|
|
Decalcification
|
$26.79 |
$26.79 |
$26.79 |
$73.60
|
|
Decitabine 50 mg intravenous solution
|
$4.48 |
$4.48 |
$4.48 |
$975.45
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$350.55 |
$350.55 |
$350.55 |
$545.90
|
|
Degarelix 120 mg subcutaneous solution
|
$12.04 |
$12.04 |
$12.04 |
$2,086.82
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$2,371.20 |
$2,371.20 |
$2,371.20 |
$7,763.47
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$215.46 |
$215.46 |
$215.46 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$55.94 |
$55.94 |
$55.94 |
$7,933.81
|
|
Dermagraft
|
$1,105.23 |
$1,105.23 |
$1,105.23 |
$1,912.31
|
|
Design mlc device for imrt
|
$2,340.42 |
$2,340.42 |
$2,340.42 |
$1,669.85
|
|
Desmopressin 4 mcg/ml injection solution
|
$25.57 |
$25.57 |
$25.57 |
$102.32
|
|
Destroy cervthor facet jnt 64633
|
$2,028.06 |
$2,028.06 |
$2,028.06 |
$3,164.80
|
|
Destroy cth facet jnt addl 64634
|
$1,014.60 |
$1,014.60 |
$1,014.60 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,574.34 |
$1,574.34 |
$1,574.34 |
$1,879.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,148.11 |
$3,148.11 |
$3,148.11 |
$3,375.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$58.71 |
$58.71 |
$58.71 |
$220.43
|
|
Dexamethasone 4 mg tablet
|
$4.70 |
$4.70 |
$4.70 |
$6.01
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$1.25 |
$1.25 |
$1.25 |
$30.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$53.58 |
$53.58 |
$53.58 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$34.20 |
$34.20 |
$34.20 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$711.93 |
$711.93 |
$711.93 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$570.00 |
$570.00 |
$570.00 |
$301.55
|
|
Dialysis circuit perm vascular embolization 36909
|
$10,710.30 |
$10,710.30 |
$10,710.30 |
$7,145.00
|
|
Dialysis one evaluation
|
$536.94 |
$536.94 |
$536.94 |
$842.10
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$27.99 |
$27.99 |
$27.99 |
$72.34
|
|
Dicyclomine injection
|
$153.53 |
$153.53 |
$153.53 |
$211.81
|
|
Diffusing capacity
|
$189.24 |
$189.24 |
$189.24 |
$360.10
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$7.50 |
$7.50 |
$7.50 |
$69.79
|
|
Digoxin total therapeutic drug level
|
$51.87 |
$51.87 |
$51.87 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$294.84 |
$294.84 |
$294.84 |
$334.68
|
|
Dilat xst trc ndurlgc px
|
$3,256.98 |
$3,256.98 |
$3,256.98 |
$4,081.37
|
|
Dilat xst trc new access rcs
|
$5,647.56 |
$5,647.56 |
$5,647.56 |
$5,020.00
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$7.33 |
$7.33 |
$7.33 |
$26.87
|
|
Disability dlco
|
$163.02 |
$163.02 |
$163.02 |
$307.58
|
|
Disaccharidases
|
$224.58 |
$224.58 |
$224.58 |
$223.80
|
|
Dissolve clot heart vessel
|
$1,905.51 |
$1,905.51 |
$1,905.51 |
$1,396.47
|
|
Dna antibody native/double stranded
|
$33.63 |
$33.63 |
$33.63 |
$102.60
|
|
Dna gardnerella
|
$41.04 |
$41.04 |
$41.04 |
$67.68
|
|
Dna trichomonas
|
$35.34 |
$35.34 |
$35.34 |
$68.75
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$56.43 |
$56.43 |
$56.43 |
$101.04
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$3.94 |
$3.94 |
$3.94 |
$712.02
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$3.35 |
$3.35 |
$3.35 |
$84.30
|
|
Doppler intravascular pressure flow initial vessel
|
$6,603.45 |
$6,603.45 |
$6,603.45 |
$3,006.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$729.03 |
$729.03 |
$729.03 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$369.36 |
$369.36 |
$369.36 |
$482.03
|
|
Dornase alfa non-comp unit
|
$95.19 |
$95.19 |
$95.19 |
$479.80
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$12.51 |
$12.51 |
$12.51 |
$299.52
|
|
Dpyd gene common variants
|
$253.08 |
$253.08 |
$253.08 |
$380.50
|
|
Drain cath image guided visceral pq
|
$5,845.92 |
$5,845.92 |
$5,845.92 |
$3,073.90
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$451.44 |
$451.44 |
$451.44 |
$420.00
|
