|
CT neck soft tissue without contrast
|
$1,706.20 |
$1,706.20 |
$1,706.20 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$1,965.00 |
$1,965.00 |
$1,965.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,156.00 |
$2,156.00 |
$2,156.00 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,779.00 |
$1,779.00 |
$1,779.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,615.20 |
$1,615.20 |
$1,615.20 |
$1,360.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,062.20 |
$4,062.20 |
$4,062.20 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,445.20 |
$3,445.20 |
$3,445.20 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,940.60 |
$2,940.60 |
$2,940.60 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$2,350.00 |
$2,350.00 |
$2,350.00 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,033.80 |
$2,033.80 |
$2,033.80 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$109.80 |
$109.80 |
$109.80 |
$331.50
|
|
CT t-spine w /wo contrast
|
$2,544.00 |
$2,544.00 |
$2,544.00 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,734.20 |
$1,734.20 |
$1,734.20 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,196.40 |
$1,196.40 |
$1,196.40 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$1,850.00 |
$1,850.00 |
$1,850.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$52.80 |
$52.80 |
$52.80 |
$68.64
|
|
Culture afb any source
|
$174.80 |
$174.80 |
$174.80 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$57.60 |
$57.60 |
$57.60 |
$79.00
|
|
Culture anaerobic except blood
|
$241.60 |
$241.60 |
$241.60 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$37.20 |
$37.20 |
$37.20 |
$51.45
|
|
Culture body fluid
|
$178.00 |
$178.00 |
$178.00 |
$126.75
|
|
Culture fungi definitive id mold
|
$72.20 |
$72.20 |
$72.20 |
$77.28
|
|
Culture fungi definitive id yeast
|
$66.60 |
$66.60 |
$66.60 |
$79.10
|
|
Culture fungi other (except blood)
|
$178.80 |
$178.80 |
$178.80 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$97.00 |
$97.00 |
$97.00 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$9.00 |
$9.00 |
$9.00 |
$89.70
|
|
Culture mycoplasma any source
|
$8.78 |
$8.78 |
$8.78 |
$85.26
|
|
Culture screening strep group a
|
$102.60 |
$102.60 |
$102.60 |
$81.00
|
|
Culture typing added method
|
$4.11 |
$4.11 |
$4.11 |
$38.58
|
|
Culture typing immunologic
|
$35.60 |
$35.60 |
$35.60 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$130.84 |
$130.84 |
$130.84 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$42.40 |
$42.40 |
$42.40 |
$133.90
|
|
Culture urine each isolate
|
$49.80 |
$49.80 |
$49.80 |
$57.00
|
|
Cutter lead
|
$501.40 |
$501.40 |
$501.40 |
$6,092.06
|
|
Cyanocobalamin unsat binding capacity
|
$2.55 |
$2.55 |
$2.55 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$5.40 |
$5.40 |
$5.40 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$28.20 |
$28.20 |
$28.20 |
$70.72
|
|
Cyclosporine 2 hour
|
$3.21 |
$3.21 |
$3.21 |
$129.48
|
|
Cyp2c19 gene com variants
|
$26.00 |
$26.00 |
$26.00 |
$504.00
|
|
Cyp2c9 gene com variants
|
$20.00 |
$20.00 |
$20.00 |
$275.10
|
|
Cyp2d6 gene com variants
|
$36.00 |
$36.00 |
$36.00 |
$554.00
|
|
Cyp3a4 gene common variants
|
$14.00 |
$14.00 |
$14.00 |
$245.31
|
|
Cyp3a5 gene common variants
|
$14.00 |
$14.00 |
$14.00 |
$245.31
|
|
Cystatin c
|
$2.96 |
$2.96 |
$2.96 |
$77.50
|
|
Cystic fibrosis cftr
|
$176.40 |
$176.40 |
$176.40 |
$1,100.00
|
|
Cystine urine quantitative
|
$3.67 |
$3.67 |
$3.67 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$484.60 |
$484.60 |
$484.60 |
$542.10
|
|
Cytogenomic neo microra alys
|
$307.00 |
$307.00 |
$307.00 |
$2,020.20
|
|
Cytomegalovirus (cmv) antibody igg
|
$4.40 |
$4.40 |
$4.40 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$3.60 |
$3.60 |
$3.60 |
$97.50
|
|
Cytopath c/v manual
|
$5.40 |
$5.40 |
$5.40 |
$36.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$17.00 |
$17.00 |
$17.00 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$7.08 |
$7.08 |
$7.08 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$17.40 |
$17.40 |
$17.40 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$12.40 |
$12.40 |
$12.40 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$2.00 |
$2.00 |
$2.00 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$54.40 |
$54.40 |
$54.40 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$19.80 |
$19.80 |
$19.80 |
$209.23
|
|
Cytopath smear other source
|
$12.60 |
$12.60 |
$12.60 |
$88.13
|
|
Cytopath smear other source
|
$20.60 |
$20.60 |
$20.60 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$10.90 |
$10.90 |
$10.90 |
$96.20
|
|
Cytopath tbs c/v manual
|
$6.00 |
$6.00 |
$6.00 |
$59.28
|
|
Cytp urine 3-5 probes cmptr
|
$89.40 |
$89.40 |
$89.40 |
$690.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$59.04 |
$59.04 |
$59.04 |
$168.53
|
|
Dch glucoscan
|
$95.60 |
$95.60 |
$95.60 |
$28.10
|
|
Dch validity tests
|
$5.60 |
$5.60 |
$5.60 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$3.20 |
$3.20 |
$3.20 |
$43.60
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$174.60 |
$174.60 |
$174.60 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$103.40 |
$103.40 |
$103.40 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$981.00 |
$981.00 |
$981.00 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$233.00 |
$233.00 |
$233.00 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$564.20 |
$564.20 |
$564.20 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$282.20 |
$282.20 |
$282.20 |
$810.50
|
|
Debride nail1-5 11720
|
$45.20 |
$45.20 |
$45.20 |
$148.80
|
|
Debride nail6 or more 11721
|
$54.20 |
$54.20 |
$54.20 |
$169.60
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$131.20 |
$131.20 |
$131.20 |
$639.60
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$223.40 |
$223.40 |
$223.40 |
$1,129.45
|
|
Debr inf skin add-on 11001
|
$56.60 |
$56.60 |
$56.60 |
$114.10
|
|
Debr musc/fascia 20sq cm/< 11043
|
$503.00 |
$503.00 |
$503.00 |
$1,160.00
|
|
Decalcification
|
$2.00 |
$2.00 |
$2.00 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$197.60 |
$197.60 |
$197.60 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$9.69 |
$9.69 |
$9.69 |
$95.85
|
|
Delivery of placenta 59414
|
$280.00 |
$280.00 |
$280.00 |
$3,070.56
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$54.20 |
$54.20 |
$54.20 |
$185.17
|
|
Desmopressin 4 mcg/ml injection solution
|
$44.21 |
$44.21 |
$44.21 |
$89.78
|
|
Desoxycorticosterone
|
$6.35 |
$6.35 |
$6.35 |
$109.28
|
|
Destroy premlg lesns;1st lesn 17000
|
$96.60 |
$96.60 |
$96.60 |
$199.50
|
|
Destruct cut vasl lesions <10cm 17106
|
$127.00 |
$127.00 |
$127.00 |
$660.00
|
|
Destruction 2-14 lesions 17003
|
$95.60 |
$95.60 |
$95.60 |
$72.60
|
|
Destruction benign lesions < 14 lesions
|
$103.20 |
$103.20 |
$103.20 |
$235.13
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$95.60 |
$95.60 |
$95.60 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$620.20 |
$620.20 |
$620.20 |
$3,202.98
|
|
Device ablt adv novasure
|
$450.00 |
$450.00 |
$450.00 |
$6,097.50
|
|
Device intraute mirena
|
$345.18 |
$345.18 |
$345.18 |
$2,125.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$25.00 |
$25.00 |
$25.00 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$3.63 |
$3.63 |
$3.63 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$7.38 |
$7.38 |
$7.38 |
$21.17
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$13.80 |
$13.80 |
$13.80 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$13.80 |
$13.80 |
$13.80 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$13.80 |
$13.80 |
$13.80 |
$47.48
|
