|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,376.80 |
$3,376.80 |
$3,376.80 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$3,061.80 |
$3,061.80 |
$3,061.80 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,469.60 |
$2,469.60 |
$2,469.60 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$176.40 |
$176.40 |
$176.40 |
$331.50
|
|
CT t-spine w /wo contrast
|
$3,152.40 |
$3,152.40 |
$3,152.40 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$4,178.40 |
$4,178.40 |
$4,178.40 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$3,832.80 |
$3,832.80 |
$3,832.80 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$3,832.80 |
$3,832.80 |
$3,832.80 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$63.00 |
$63.00 |
$63.00 |
$68.64
|
|
Culture afb any source
|
$103.80 |
$103.80 |
$103.80 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$172.20 |
$172.20 |
$172.20 |
$79.00
|
|
Culture anaerobic except blood
|
$159.00 |
$159.00 |
$159.00 |
$120.00
|
|
Culture bacteria anaerobic
|
$124.80 |
$124.80 |
$124.80 |
$84.24
|
|
Culture bact stool aero addl path ea
|
$106.80 |
$106.80 |
$106.80 |
$51.45
|
|
Culture body fluid
|
$198.60 |
$198.60 |
$198.60 |
$126.75
|
|
Culture fungi definitive id mold
|
$107.40 |
$107.40 |
$107.40 |
$77.28
|
|
Culture fungi definitive id yeast
|
$84.00 |
$84.00 |
$84.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$148.80 |
$148.80 |
$148.80 |
$108.00
|
|
Culture mycobacteria definitive id each isolate
|
$270.00 |
$270.00 |
$270.00 |
$89.70
|
|
Culture quantitative aerobic other source
|
$84.60 |
$84.60 |
$84.60 |
$90.35
|
|
Culture screening strep group a
|
$115.80 |
$115.80 |
$115.80 |
$81.00
|
|
Culture typing immunologic
|
$78.00 |
$78.00 |
$78.00 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$627.60 |
$627.60 |
$627.60 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$463.80 |
$463.80 |
$463.80 |
$133.90
|
|
Culture urine each isolate
|
$85.20 |
$85.20 |
$85.20 |
$57.00
|
|
Cv line/pic reposition
|
$3,075.60 |
$3,075.60 |
$3,075.60 |
$1,720.93
|
|
Cyanocobalamin unsat binding capacity
|
$161.40 |
$161.40 |
$161.40 |
$64.00
|
|
Cyclic citrullinated peptide antibody
|
$146.40 |
$146.40 |
$146.40 |
$70.72
|
|
Cyclosporine 2 hour
|
$175.20 |
$175.20 |
$175.20 |
$129.48
|
|
Cyp2c19 gene com variants
|
$1,521.60 |
$1,521.60 |
$1,521.60 |
$504.00
|
|
Cyp2d6 gene com variants
|
$938.40 |
$938.40 |
$938.40 |
$554.00
|
|
Cystatin c
|
$96.60 |
$96.60 |
$96.60 |
$77.50
|
|
Cystic fibrosis cftr
|
$4,014.60 |
$4,014.60 |
$4,014.60 |
$1,100.00
|
|
Cystine urine quantitative
|
$288.60 |
$288.60 |
$288.60 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$468.60 |
$468.60 |
$468.60 |
$542.10
|
|
Cystourethroscop/calib/dilat stric 52281
|
$2,464.20 |
$2,464.20 |
$2,464.20 |
$3,065.15
|
|
Cytogenetics 25-99
|
$522.60 |
$522.60 |
$522.60 |
$190.00
|
|
Cytogenomic neo microra alys
|
$5,088.00 |
$5,088.00 |
$5,088.00 |
$2,020.20
|
|
Cytogenom microarray copy nmbr var
|
$1,300.80 |
$1,300.80 |
$1,300.80 |
$1,433.77
|
|
Cytomegalovirus (cmv) antibody igg
|
$186.60 |
$186.60 |
$186.60 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$233.40 |
$233.40 |
$233.40 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$163.20 |
$163.20 |
$163.20 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$116.40 |
$116.40 |
$116.40 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$157.20 |
$157.20 |
$157.20 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$85.20 |
$85.20 |
$85.20 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$184.80 |
$184.80 |
$184.80 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$572.40 |
$572.40 |
$572.40 |
$209.23
|
|
Cytopath smear other source
|
$121.20 |
$121.20 |
$121.20 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$141.60 |
$141.60 |
$141.60 |
$96.20
|
|
Cytotoxic antibody screening
|
$741.00 |
$741.00 |
$741.00 |
$133.25
|
|
Dch validity tests
|
$39.00 |
$39.00 |
$39.00 |
$24.50
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$9,703.20 |
$9,703.20 |
$9,703.20 |
$4,952.36
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$731.40 |
$731.40 |
$731.40 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$616.80 |
$616.80 |
$616.80 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$2,226.00 |
$2,226.00 |
$2,226.00 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,028.40 |
$1,028.40 |
$1,028.40 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$2,226.00 |
$2,226.00 |
$2,226.00 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$858.00 |
$858.00 |
$858.00 |
$810.50
|
|
Debride nail1-5 11720
|
$478.80 |
$478.80 |
$478.80 |
$148.80
|
|
Debride nail6 or more 11721
|
$492.00 |
$492.00 |
$492.00 |
$169.60
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$784.80 |
$784.80 |
$784.80 |
$639.60
|
|
Debr inf skin add-on 11001
|
$260.40 |
$260.40 |
$260.40 |
$114.10
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,028.40 |
$1,028.40 |
$1,028.40 |
$1,160.00
|
|
Decalcification
|
$103.20 |
$103.20 |
$103.20 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$789.60 |
$789.60 |
$789.60 |
$543.00
|
|
Delivery of placenta 59414
|
$3,564.60 |
$3,564.60 |
$3,564.60 |
$3,070.56
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$102.00 |
$102.00 |
$102.00 |
$185.17
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$782.40 |
$782.40 |
$782.40 |
$408.10
|
|
Design mlc device for imrt
|
$976.20 |
$976.20 |
$976.20 |
$1,677.86
|
|
Desoxycorticosterone
|
$204.00 |
$204.00 |
$204.00 |
$109.28
|
|
Destroy cervthor facet jnt 64633
|
$4,261.80 |
$4,261.80 |
$4,261.80 |
$3,011.50
|
|
Destroy cth facet jnt addl 64634
|
$2,480.40 |
$2,480.40 |
$2,480.40 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$3,025.80 |
$3,025.80 |
$3,025.80 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$4,261.80 |
$4,261.80 |
$4,261.80 |
$3,202.98
|
|
Developmental screen/score/document 96110
|
$164.40 |
$164.40 |
$164.40 |
$130.65
|
|
Devel tst phys/qhp 1st hr
|
$331.80 |
$331.80 |
$331.80 |
$337.50
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$186.00 |
$186.00 |
$186.00 |
$200.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$433.80 |
$433.80 |
$433.80 |
$227.15
|
|
Dhea-s (dehydroepiand sulfate)
|
$244.20 |
$244.20 |
$244.20 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$69.60 |
$69.60 |
$69.60 |
$79.20
|
|
Diagnostic laryngoscopy 31575
|
$458.40 |
$458.40 |
$458.40 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$652.20 |
$652.20 |
$652.20 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$532.20 |
$532.20 |
$532.20 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$306.60 |
$306.60 |
$306.60 |
$214.08
|
|
Dialysis one evaluation
|
$2,214.00 |
$2,214.00 |
$2,214.00 |
$919.55
|
|
Diatrizoate meglumine 18 % urethral solution
|
$3.00 |
$3.00 |
$3.00 |
$115.15
|
|
Diffusing capacity
|
$513.00 |
$513.00 |
$513.00 |
$332.00
|
|
Digoxin total therapeutic drug level
|
$128.40 |
$128.40 |
$128.40 |
$102.00
|
|
Disability dlco
|
$570.60 |
$570.60 |
$570.60 |
$282.40
|
|
Disaccharidases
|
$1,270.80 |
$1,270.80 |
$1,270.80 |
$216.00
|
|
Discography cerv/thor spine
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$2,565.00
|
|
Dna antibody native/double stranded
|
$153.60 |
$153.60 |
$153.60 |
$97.50
|
|
Dna gardnerella
|
$56.40 |
$56.40 |
$56.40 |
$62.50
|
|
Dna trichomonas
|
$56.40 |
$56.40 |
$56.40 |
$67.80
|
|
Doppler echo complete
|
$463.80 |
$463.80 |
$463.80 |
$540.00
|
|
Doppler intravascular pressure flow initial vessel
|
$1,580.40 |
$1,580.40 |
$1,580.40 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,459.20 |
$1,459.20 |
$1,459.20 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$374.40 |
$374.40 |
$374.40 |
$471.17
|
|
Dpyd gene common variants
|
$1,615.80 |
$1,615.80 |
$1,615.80 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$800.00
|
