|
CT thoracic spine without contrast
|
$1,086.40 |
$1,086.40 |
$1,086.40 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$140.40 |
$140.40 |
$140.40 |
$331.50
|
|
CT t-spine w /wo contrast
|
$1,280.00 |
$1,280.00 |
$1,280.00 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,542.60 |
$1,542.60 |
$1,542.60 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$1,740.00 |
$1,740.00 |
$1,740.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$28.20 |
$28.20 |
$28.20 |
$68.64
|
|
Culture afb any source
|
$7.00 |
$7.00 |
$7.00 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$52.60 |
$52.60 |
$52.60 |
$79.00
|
|
Culture anaerobic except blood
|
$46.80 |
$46.80 |
$46.80 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$28.80 |
$28.80 |
$28.80 |
$51.45
|
|
Culture body fluid
|
$53.80 |
$53.80 |
$53.80 |
$126.75
|
|
Culture fungi definitive id mold
|
$55.40 |
$55.40 |
$55.40 |
$77.28
|
|
Culture fungi definitive id yeast
|
$43.00 |
$43.00 |
$43.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$25.40 |
$25.40 |
$25.40 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$40.80 |
$40.80 |
$40.80 |
$74.88
|
|
Culture mycoplasma any source
|
$8.78 |
$8.78 |
$8.78 |
$85.26
|
|
Culture screening strep group a
|
$20.60 |
$20.60 |
$20.60 |
$81.00
|
|
Culture typing added method
|
$11.11 |
$11.11 |
$11.11 |
$38.58
|
|
Culture typing immunologic
|
$28.00 |
$28.00 |
$28.00 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$218.00 |
$218.00 |
$218.00 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$239.60 |
$239.60 |
$239.60 |
$133.90
|
|
Culture urine each isolate
|
$25.20 |
$25.20 |
$25.20 |
$57.00
|
|
Curette/treat cornea
|
$290.00 |
$290.00 |
$290.00 |
$1,345.80
|
|
Curette/treat cornea
|
$273.60 |
$273.60 |
$273.60 |
$2,818.14
|
|
Cv line/pic reposition
|
$40.00 |
$40.00 |
$40.00 |
$1,720.93
|
|
Cv stress test i&r only 93018
|
$11.20 |
$11.20 |
$11.20 |
$40.20
|
|
Cv stress test/supervision only 93016
|
$16.40 |
$16.40 |
$16.40 |
$51.20
|
|
Cyanocobalamin unsat binding capacity
|
$2.55 |
$2.55 |
$2.55 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$14.76 |
$14.76 |
$14.76 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$4.00 |
$4.00 |
$4.00 |
$70.72
|
|
Cyclosporine 2 hour
|
$3.21 |
$3.21 |
$3.21 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$1.58 |
$1.58 |
$1.58 |
$7.48
|
|
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
|
$172.99 |
$172.99 |
$172.99 |
$1,100.00
|
|
Cysto cgen post urtl valves
|
$325.80 |
$325.80 |
$325.80 |
$4,175.60
|
|
Cystogram >= 3 views supervision & interpretation
|
$412.20 |
$412.20 |
$412.20 |
$542.10
|
|
Cystometrogram w/up 51727
|
$246.00 |
$246.00 |
$246.00 |
$908.59
|
|
Cystorrhaphy wound comp 51865
|
$610.60 |
$610.60 |
$610.60 |
$1,756.80
|
|
Cystorrhaphy wound simple 51860
|
$508.60 |
$508.60 |
$508.60 |
$5,855.00
|
|
Cysto rx balo cath urtl strx
|
$111.20 |
$111.20 |
$111.20 |
$6,015.75
|
|
Cystoscopy and biopsy
|
$112.60 |
$112.60 |
$112.60 |
$4,081.37
|
|
Cystoscopy and treatment
|
$324.40 |
$324.40 |
$324.40 |
$4,081.37
|
|
Cystoscopy and treatment
|
$1,114.80 |
$1,114.80 |
$1,114.80 |
$4,160.10
|
|
Cystoscopy and treatment
|
$1,114.80 |
$1,114.80 |
$1,114.80 |
$5,162.50
|
|
Cystoscopy and treatment
|
$1,114.80 |
$1,114.80 |
$1,114.80 |
$5,995.60
|
|
Cystoscopy and treatment
|
$1,654.60 |
$1,654.60 |
$1,654.60 |
$6,475.26
|
|
Cystoscopy and treatment
|
$141.80 |
$141.80 |
$141.80 |
$3,213.14
|
|
Cystoscopy and treatment
|
$109.60 |
$109.60 |
$109.60 |
$2,424.12
|
|
Cystoscopy and treatment
|
$178.20 |
$178.20 |
$178.20 |
$4,045.60
|
|
Cystoscopy and treatment
|
$217.20 |
$217.20 |
$217.20 |
$4,061.71
|
|
Cystoscopy and treatment
|
$136.60 |
$136.60 |
$136.60 |
$2,424.12
|
|
Cystoscopy and treatment
|
$234.00 |
$234.00 |
$234.00 |
$958.81
|
|
Cystoscopy and treatment
|
$164.40 |
$164.40 |
$164.40 |
$3,587.87
|
|
Cystoscopy and treatment
|
$188.40 |
$188.40 |
$188.40 |
$4,081.37
|
|
Cystoscopy and treatment
|
$651.20 |
$651.20 |
$651.20 |
$2,874.36
|
|
Cystoscopy and treatment
|
$184.60 |
$184.60 |
$184.60 |
$3,203.50
|
|
Cystoscopy and treatment
|
$165.80 |
$165.80 |
$165.80 |
$4,061.71
|
|
Cystoscopy and treatment
|
$177.00 |
$177.00 |
$177.00 |
$3,820.84
|
|
Cystoscopy (Bladder Scope)
|
$218.60 |
$218.60 |
$218.60 |
$1,493.80
|
|
Cystoscopy chemodenervation
|
$651.20 |
$651.20 |
$651.20 |
$2,704.80
|
|
Cystoscopy inject material
|
$173.00 |
$173.00 |
$173.00 |
$5,986.78
|
|
Cystoscopy removal of clots
|
$1,975.20 |
$1,975.20 |
$1,975.20 |
$4,081.37
|
|
Cystoscopy & revise urethra
|
$167.60 |
$167.60 |
$167.60 |
$2,874.36
|
|
Cystoscopy stone removal
|
$214.60 |
$214.60 |
$214.60 |
$5,741.00
|
|
Cystoscopy & ureter catheter
|
$90.80 |
$90.80 |
$90.80 |
$3,786.00
|
|
Cystostomy cystotomy w/drainage 51040
|
$204.60 |
$204.60 |
$204.60 |
$3,863.60
|
|
Cystotomy/cystostomy fulg+/insj radact matrl 51020
|
$327.40 |
$327.40 |
$327.40 |
$4,081.37
|
|
Cystouretero & or pyeloscope
|
$2,907.20 |
$2,907.20 |
$2,907.20 |
$4,315.98
|
|
Cysto/uretero stricture tx
|
$248.20 |
$248.20 |
$248.20 |
$4,846.99
|
|
Cystouretero w/biopsy
|
$280.00 |
$280.00 |
$280.00 |
$5,986.78
|
|
Cystouretero w/excise tumor
|
$313.60 |
$313.60 |
$313.60 |
$5,584.80
|
|
Cysto/uretero w/lithotripsy
|
$2,351.80 |
$2,351.80 |
$2,351.80 |
$9,002.88
|
|
Cystouretero w/lithotripsy
|
$263.00 |
$263.00 |
$263.00 |
$7,061.60
|
|
Cystouretero w/stone remove
|
$238.20 |
$238.20 |
$238.20 |
$5,110.00
|
|
Cysto/uretero w/up stricture
|
$264.60 |
$264.60 |
$264.60 |
$4,081.37
|
|
Cystourethroscop/calib/dilat stric 52281
|
$651.20 |
$651.20 |
$651.20 |
$3,065.15
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$156.80 |
$156.80 |
$156.80 |
$4,045.60
|
|
Cystourethro w/addl implant 52442
|
$34.00 |
$34.00 |
$34.00 |
$2,161.60
|
|
Cystourethro w/implant
|
$141.20 |
$141.20 |
$141.20 |
$2,298.40
|
|
Cysto w/up stricture tx
|
$208.00 |
$208.00 |
$208.00 |
$4,081.37
|
|
Cysto w/ureter stricture tx
|
$191.00 |
$191.00 |
$191.00 |
$4,081.37
|
|
Cytogenom microarray copy nmbr var
|
$223.00 |
$223.00 |
$223.00 |
$1,433.77
|
|
Cytomegalovirus (cmv) antibody igg
|
$2.48 |
$2.48 |
$2.48 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$2.87 |
$2.87 |
$2.87 |
$97.50
|
|
Cyto/molecular report
|
$27.60 |
$27.60 |
$27.60 |
$133.20
|
|
Cytopathology cellular enhancement technique non-gyn
|
$105.80 |
$105.80 |
$105.80 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$26.80 |
$26.80 |
$26.80 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$7.08 |
$7.08 |
$7.08 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$37.80 |
$37.80 |
$37.80 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$87.20 |
$87.20 |
$87.20 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$10.20 |
$10.20 |
$10.20 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$119.20 |
$119.20 |
$119.20 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$90.80 |
$90.80 |
$90.80 |
$209.23
|
|
Cytopath smear other source
|
$47.00 |
$47.00 |
$47.00 |
$88.13
|