|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$596.00 |
$596.00 |
$596.00 |
$1,351.20
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,699.62 |
$1,699.62 |
$1,699.62 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,531.26 |
$1,531.26 |
$1,531.26 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,485.42 |
$1,485.42 |
$1,485.42 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$757.74 |
$757.74 |
$757.74 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$721.82 |
$721.82 |
$721.82 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$72.85 |
$72.85 |
$72.85 |
$400.20
|
|
CT t-spine w /wo contrast
|
$844.34 |
$844.34 |
$844.34 |
$2,030.60
|
|
CT upper extremity w/contrast (both sides)
|
$670.63 |
$670.63 |
$670.63 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$563.66 |
$563.66 |
$563.66 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$704.51 |
$704.51 |
$704.51 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$36.43 |
$36.43 |
$36.43 |
$63.75
|
|
Culture afb any source
|
$26.24 |
$26.24 |
$26.24 |
$110.50
|
|
Culture anaerobic except blood
|
$47.63 |
$47.63 |
$47.63 |
$123.20
|
|
Culture body fluid
|
$33.12 |
$33.12 |
$33.12 |
$130.50
|
|
Culture fungi definitive id mold
|
$15.80 |
$15.80 |
$15.80 |
$70.00
|
|
Culture fungi other (except blood)
|
$45.85 |
$45.85 |
$45.85 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$11.72 |
$11.72 |
$11.72 |
$77.40
|
|
Culture mycoplasma any source
|
$27.51 |
$27.51 |
$27.51 |
$90.37
|
|
Culture screening strep group a
|
$36.17 |
$36.17 |
$36.17 |
$81.60
|
|
Cutter lead
|
$1,495.86 |
$1,495.86 |
$1,495.86 |
$4,834.73
|
|
Cyanocobalamin unsat binding capacity
|
$11.47 |
$11.47 |
$11.47 |
$60.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$6.88 |
$6.88 |
$6.88 |
$28.00
|
|
Cyclic citrullinated peptide antibody
|
$41.52 |
$41.52 |
$41.52 |
$80.05
|
|
Cyclosporine 2 hour
|
$39.74 |
$39.74 |
$39.74 |
$121.80
|
|
Cyclosporine modified 25 mg capsule
|
$3.73 |
$3.73 |
$3.73 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$14.59 |
$14.59 |
$14.59 |
$34.00
|
|
Cylinder pump set 20cm titan zero angl
|
$10,131.97 |
$10,131.97 |
$10,131.97 |
$24,131.60
|
|
Cystatin c
|
$17.32 |
$17.32 |
$17.32 |
$82.26
|
|
Cystogram >= 3 views supervision & interpretation
|
$169.89 |
$169.89 |
$169.89 |
$539.55
|
|
Cytomegalovirus (cmv) antibody igg
|
$9.17 |
$9.17 |
$9.17 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$30.82 |
$30.82 |
$30.82 |
$96.80
|
|
Cytomegalovirus dfa
|
$15.29 |
$15.29 |
$15.29 |
$59.59
|
|
Cytopath fl nongyn filter
|
$30.06 |
$30.06 |
$30.06 |
$73.70
|
|
Cytopathology cellular enhancement technique non-gyn
|
$30.82 |
$30.82 |
$30.82 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$23.44 |
$23.44 |
$23.44 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$22.93 |
$22.93 |
$22.93 |
$124.80
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$9.43 |
$9.43 |
$9.43 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$35.92 |
$35.92 |
$35.92 |
$205.00
|
|
Cytopath smear other source
|
$17.58 |
$17.58 |
$17.58 |
$85.80
|
|
Cytopath smear other source
|
$26.49 |
$26.49 |
$26.49 |
$122.19
|
|
Cytopath smear oth prep screen & interp
|
$17.83 |
$17.83 |
$17.83 |
$95.89
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$1,261.79 |
$1,261.79 |
$1,261.79 |
$3,774.81
|
|
Dch validity tests
|
$21.91 |
$21.91 |
$21.91 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$7.65 |
$7.65 |
$7.65 |
$44.16
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$135.51 |
$135.51 |
$135.51 |
$692.00
|
|
Debridement (>20 cm) charge pt
|
$197.40 |
$197.40 |
$197.40 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$984.17 |
$984.17 |
$984.17 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$599.57 |
$599.57 |
$599.57 |
$688.80
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$984.17 |
$984.17 |
$984.17 |
$1,283.44
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$478.08 |
$478.08 |
$478.08 |
$810.50
|
|
Debride nail1-5 11720
|
$17.32 |
$17.32 |
$17.32 |
$173.25
|
|
Debride nail6 or more 11721
|
$24.20 |
$24.20 |
$24.20 |
$195.20
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$478.08 |
$478.08 |
$478.08 |
$663.30
|
|
Debr inf skin add-on 11001
|
$61.64 |
$61.64 |
$61.64 |
$113.05
|
|
Debr musc/fascia 20sq cm/< 11043
|
$599.57 |
$599.57 |
$599.57 |
$1,193.40
|
|
Decalcification
|
$5.61 |
$5.61 |
$5.61 |
$73.60
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$245.79 |
$245.79 |
$245.79 |
$545.90
|
|
Delivery of placenta 59414
|
$588.11 |
$588.11 |
$588.11 |
$3,271.20
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$57.31 |
$57.31 |
$57.31 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,510.18 |
$3,510.18 |
$3,510.18 |
$6,508.51
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$150.28 |
$150.28 |
$150.28 |
$460.50
|
|
Destroy premlg lesns;1st lesn 17000
|
$35.66 |
$35.66 |
$35.66 |
$220.12
|
|
Destruction 2-14 lesions 17003
|
$9.94 |
$9.94 |
$9.94 |
$72.60
|
|
Destruction benign lesions < 14 lesions
|
$57.82 |
$57.82 |
$57.82 |
$250.60
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$51.20 |
$51.20 |
$51.20 |
$220.43
|
|
Dexamethasone 4 mg tablet
|
$1.70 |
$1.70 |
$1.70 |
$5.17
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$2.25 |
$2.25 |
$2.25 |
$27.00
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$439.63 |
$439.63 |
$439.63 |
$641.76
|
|
Dhea-s (dehydroepiand sulfate)
|
$4.59 |
$4.59 |
$4.59 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$30.31 |
$30.31 |
$30.31 |
$78.03
|
|
Diab manage trn ind/group
|
$25.22 |
$25.22 |
$25.22 |
$58.08
|
|
Diagnostic digital breast tomosynthesis bil
|
$32.61 |
$32.61 |
$32.61 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$32.61 |
$32.61 |
$32.61 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$187.72 |
$187.72 |
$187.72 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$150.28 |
$150.28 |
$150.28 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$78.96 |
$78.96 |
$78.96 |
$239.25
|
|
Digoxin total therapeutic drug level
|
$62.41 |
$62.41 |
$62.41 |
$102.00
|
|
Dilator fascial 10fx20cm
|
$57.31 |
$57.31 |
$57.31 |
$334.34
|
|
Diltiazem 5 mg/ml intravenous solution
|
$8.50 |
$8.50 |
$8.50 |
$54.21
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$0.57 |
$0.57 |
$0.57 |
$24.70
|
|
Disaccharidases
|
$52.98 |
$52.98 |
$52.98 |
$223.80
|
|
Discography cerv/thor spine
|
$1,545.78 |
$1,545.78 |
$1,545.78 |
$2,404.00
|
|
Dis site tele svcs rhc/fqhc
|
$17.32 |
$17.32 |
$17.32 |
$94.80
|
|
Dna antibody native/double stranded
|
$32.10 |
$32.10 |
$32.10 |
$102.60
|
|
Dna probe chlamydia
|
$40.76 |
$40.76 |
$40.76 |
$82.20
|
|
Dna probe gc
|
$40.76 |
$40.76 |
$40.76 |
$88.67
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$52.35 |
$52.35 |
$52.35 |
$101.04
|
|
Doppler echo complete
|
$311.76 |
$311.76 |
$311.76 |
$608.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$227.96 |
$227.96 |
$227.96 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$145.95 |
$145.95 |
$145.95 |
$482.03
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$45.22 |
$45.22 |
$45.22 |
$88.05
|
|
Dpyd gene common variants
|
$184.92 |
$184.92 |
$184.92 |
$380.50
|
|
Drainage ext aud canal abscess 69020
|
$146.71 |
$146.71 |
$146.71 |
$900.80
|
|
Drainage external ear complex 69005
|
$1,223.33 |
$1,223.33 |
$1,223.33 |
$2,967.58
|
|
Drainage external ear simple 69000
|
$155.63 |
$155.63 |
$155.63 |
$809.25
|
|
Drainage mouth roof lesion
|
$268.46 |
$268.46 |
$268.46 |
$474.39
|
|
Drainage of arm bursa 23931
|
$447.26 |
$447.26 |
$447.26 |
$2,419.30
|
|
Drainage of kidney lesion
|
$999.96 |
$999.96 |
$999.96 |
$1,706.65
|
|
Drainage of nose lesion int 30000
|
$221.08 |
$221.08 |
$221.08 |
$548.00
|