|
CT thoracic spine without contrast
|
$2,637.36 |
$2,637.36 |
$2,637.36 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$197.28 |
$197.28 |
$197.28 |
$331.50
|
|
CT t-spine w /wo contrast
|
$3,294.72 |
$3,294.72 |
$3,294.72 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,908.00 |
$1,908.00 |
$1,908.00 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,815.12 |
$1,815.12 |
$1,815.12 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,306.88 |
$2,306.88 |
$2,306.88 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$148.32 |
$148.32 |
$148.32 |
$68.64
|
|
Culture afb any source
|
$97.20 |
$97.20 |
$97.20 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$167.76 |
$167.76 |
$167.76 |
$79.00
|
|
Culture anaerobic except blood
|
$213.84 |
$213.84 |
$213.84 |
$120.00
|
|
Culture bacteria anaerobic
|
$215.28 |
$215.28 |
$215.28 |
$84.24
|
|
Culture bact stool aero addl path ea
|
$114.48 |
$114.48 |
$114.48 |
$51.45
|
|
Culture body fluid
|
$97.20 |
$97.20 |
$97.20 |
$126.75
|
|
Culture fungi definitive id mold
|
$15.84 |
$15.84 |
$15.84 |
$77.28
|
|
Culture fungi definitive id yeast
|
$176.40 |
$176.40 |
$176.40 |
$79.10
|
|
Culture fungi other (except blood)
|
$226.08 |
$226.08 |
$226.08 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$72.72 |
$72.72 |
$72.72 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$90.72 |
$90.72 |
$90.72 |
$89.70
|
|
Culture mycoplasma any source
|
$142.56 |
$142.56 |
$142.56 |
$85.26
|
|
Culture quantitative aerobic other source
|
$191.52 |
$191.52 |
$191.52 |
$90.35
|
|
Culture screening strep group a
|
$164.16 |
$164.16 |
$164.16 |
$81.00
|
|
Culture typing immunologic
|
$187.92 |
$187.92 |
$187.92 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$807.84 |
$807.84 |
$807.84 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$189.36 |
$189.36 |
$189.36 |
$133.90
|
|
Culture urine each isolate
|
$105.84 |
$105.84 |
$105.84 |
$57.00
|
|
Cyanocobalamin unsat binding capacity
|
$54.00 |
$54.00 |
$54.00 |
$64.00
|
|
Cyclic citrullinated peptide antibody
|
$188.64 |
$188.64 |
$188.64 |
$70.72
|
|
Cyclosporine 2 hour
|
$59.04 |
$59.04 |
$59.04 |
$129.48
|
|
Cyp2c19 gene com variants
|
$882.00 |
$882.00 |
$882.00 |
$504.00
|
|
Cyp2c9 gene com variants
|
$529.20 |
$529.20 |
$529.20 |
$275.10
|
|
Cyp2d6 gene com variants
|
$1,365.12 |
$1,365.12 |
$1,365.12 |
$554.00
|
|
Cyp3a4 gene common variants
|
$529.20 |
$529.20 |
$529.20 |
$245.31
|
|
Cyp3a5 gene common variants
|
$529.20 |
$529.20 |
$529.20 |
$245.31
|
|
Cystatin c
|
$123.12 |
$123.12 |
$123.12 |
$77.50
|
|
Cystic fibrosis cftr
|
$2,639.52 |
$2,639.52 |
$2,639.52 |
$1,100.00
|
|
Cystine urine quantitative
|
$60.48 |
$60.48 |
$60.48 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$732.24 |
$732.24 |
$732.24 |
$542.10
|
|
Cystoscopy (Bladder Scope)
|
$1,186.56 |
$1,186.56 |
$1,186.56 |
$1,493.80
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,701.52 |
$3,701.52 |
$3,701.52 |
$3,065.15
|
|
Cytomegalovirus (cmv) antibody igg
|
$136.08 |
$136.08 |
$136.08 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$95.76 |
$95.76 |
$95.76 |
$97.50
|
|
Cyto/molecular report
|
$49.68 |
$49.68 |
$49.68 |
$133.20
|
|
Cytopath fl nongyn filter
|
$158.40 |
$158.40 |
$158.40 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$123.84 |
$123.84 |
$123.84 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$104.40 |
$104.40 |
$104.40 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$152.64 |
$152.64 |
$152.64 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$169.20 |
$169.20 |
$169.20 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$116.64 |
$116.64 |
$116.64 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$143.28 |
$143.28 |
$143.28 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$261.36 |
$261.36 |
$261.36 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$207.36 |
$207.36 |
$207.36 |
$209.23
|
|
Cytopath smear other source
|
$100.08 |
$100.08 |
$100.08 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$132.48 |
$132.48 |
$132.48 |
$96.20
|
|
Cytopath tbs c/v manual
|
$138.96 |
$138.96 |
$138.96 |
$59.28
|
|
Cytp urine 3-5 probes cmptr
|
$351.36 |
$351.36 |
$351.36 |
$690.00
|
|
Dch glucoscan
|
$37.44 |
$37.44 |
$37.44 |
$28.10
|
|
Deamidated gliadin antibody iga
|
$105.84 |
$105.84 |
$105.84 |
$43.60
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$812.88 |
$812.88 |
$812.88 |
$810.50
|
|
Debride nail1-5 11720
|
$200.88 |
$200.88 |
$200.88 |
$148.80
|
|
Debride nail6 or more 11721
|
$329.76 |
$329.76 |
$329.76 |
$169.60
|
|
Debride skn/sq/musc/abd wall 11004
|
$1,808.64 |
$1,808.64 |
$1,808.64 |
$903.00
|
|
Debride skn/sq t/m/f necro infctj abdl wall 11005
|
$2,522.88 |
$2,522.88 |
$2,522.88 |
$1,820.00
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,660.32 |
$1,660.32 |
$1,660.32 |
$1,129.45
|
|
Decalcification
|
$55.44 |
$55.44 |
$55.44 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$358.56 |
$358.56 |
$358.56 |
$543.00
|
|
Delivery of placenta 59414
|
$6,868.08 |
$6,868.08 |
$6,868.08 |
$3,070.56
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$190.80 |
$190.80 |
$190.80 |
$185.17
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$321.84 |
$321.84 |
$321.84 |
$408.10
|
|
Destroy cervthor facet jnt 64633
|
$7,765.20 |
$7,765.20 |
$7,765.20 |
$3,011.50
|
|
Destroy cth facet jnt addl 64634
|
$4,997.52 |
$4,997.52 |
$4,997.52 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$5,248.08 |
$5,248.08 |
$5,248.08 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$7,765.20 |
$7,765.20 |
$7,765.20 |
$3,202.98
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$387.36 |
$387.36 |
$387.36 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$0.54 |
$0.54 |
$0.54 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$2.59 |
$2.59 |
$2.59 |
$21.17
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$32.40 |
$32.40 |
$32.40 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$32.40 |
$32.40 |
$32.40 |
$47.48
|
|
Dhea-s (dehydroepiand sulfate)
|
$59.04 |
$59.04 |
$59.04 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$108.72 |
$108.72 |
$108.72 |
$79.20
|
|
Diab manage trn ind/group
|
$105.84 |
$105.84 |
$105.84 |
$56.55
|
|
Diagnostic laryngoscopy 31505
|
$357.12 |
$357.12 |
$357.12 |
$236.60
|
|
Diagnostic Mammogram (both breasts)
|
$480.96 |
$480.96 |
$480.96 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$367.92 |
$367.92 |
$367.92 |
$301.55
|
|
Diathermy eg microwave
|
$139.68 |
$139.68 |
$139.68 |
$29.68
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$42.55 |
$42.55 |
$42.55 |
$74.76
|
|
Dicyclomine injection
|
$134.78 |
$134.78 |
$134.78 |
$153.29
|
|
Diffusing capacity
|
$365.76 |
$365.76 |
$365.76 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.01 |
$19.01 |
$19.01 |
$69.03
|
|
Digoxin total therapeutic drug level
|
$102.96 |
$102.96 |
$102.96 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$516.67 |
$516.67 |
$516.67 |
$297.86
|
|
Diltiazem 5 mg/ml intravenous solution
|
$0.26 |
$0.26 |
$0.26 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$12.96 |
$12.96 |
$12.96 |
$17.75
|
|
#d/lmeth-l-methamphetamine
|
$43.20 |
$43.20 |
$43.20 |
$72.14
|
|
Dna antibody native/double stranded
|
$126.72 |
$126.72 |
$126.72 |
$97.50
|
|
Doppler echo complete
|
$330.48 |
$330.48 |
$330.48 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,368.72 |
$1,368.72 |
$1,368.72 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$611.28 |
$611.28 |
$611.28 |
$471.17
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$0.91 |
$0.91 |
$0.91 |
$84.80
|
|
Dpyd gene common variants
|
$529.20 |
$529.20 |
$529.20 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$1,764.72 |
$1,764.72 |
$1,764.72 |
$800.00
|
