|
CT lower extremity w/contrast (both sides)
|
$1,945.44 |
$1,945.44 |
$1,945.44 |
$1,652.00
|
|
CT lower extremity without contrast (both sides)
|
$1,881.36 |
$1,881.36 |
$1,881.36 |
$1,421.85
|
|
CT lwr extremity w/o&w/dye
|
$2,152.08 |
$2,152.08 |
$2,152.08 |
$1,854.05
|
|
CT neck soft tissue w/contrast
|
$2,376.72 |
$2,376.72 |
$2,376.72 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$1,974.96 |
$1,974.96 |
$1,974.96 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$2,330.64 |
$2,330.64 |
$2,330.64 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,551.68 |
$2,551.68 |
$2,551.68 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,090.88 |
$2,090.88 |
$2,090.88 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,796.40 |
$1,796.40 |
$1,796.40 |
$1,360.00
|
|
Ctrl nosebld postir subsq 30906
|
$483.12 |
$483.12 |
$483.12 |
$437.04
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,145.12 |
$5,145.12 |
$5,145.12 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$5,075.28 |
$5,075.28 |
$5,075.28 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$4,476.96 |
$4,476.96 |
$4,476.96 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$505.44 |
$505.44 |
$505.44 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$318.24 |
$318.24 |
$318.24 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$202.32 |
$202.32 |
$202.32 |
$331.50
|
|
CT t-spine w /wo contrast
|
$2,404.08 |
$2,404.08 |
$2,404.08 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,676.16 |
$1,676.16 |
$1,676.16 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,864.80 |
$1,864.80 |
$1,864.80 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$1,746.72 |
$1,746.72 |
$1,746.72 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$130.32 |
$130.32 |
$130.32 |
$68.64
|
|
Culture afb any source
|
$66.96 |
$66.96 |
$66.96 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$105.84 |
$105.84 |
$105.84 |
$79.00
|
|
Culture anaerobic except blood
|
$415.44 |
$415.44 |
$415.44 |
$120.00
|
|
Culture bacteria anaerobic
|
$141.12 |
$141.12 |
$141.12 |
$84.24
|
|
Culture bact stool aero addl path ea
|
$55.44 |
$55.44 |
$55.44 |
$51.45
|
|
Culture body fluid
|
$150.48 |
$150.48 |
$150.48 |
$126.75
|
|
Culture fungi definitive id mold
|
$14.40 |
$14.40 |
$14.40 |
$77.28
|
|
Culture fungi definitive id yeast
|
$80.64 |
$80.64 |
$80.64 |
$79.10
|
|
Culture fungi other (except blood)
|
$232.56 |
$232.56 |
$232.56 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$188.64 |
$188.64 |
$188.64 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$87.84 |
$87.84 |
$87.84 |
$89.70
|
|
Culture mycoplasma any source
|
$98.64 |
$98.64 |
$98.64 |
$85.26
|
|
Culture quantitative aerobic other source
|
$192.96 |
$192.96 |
$192.96 |
$90.35
|
|
Culture screening strep group a
|
$97.92 |
$97.92 |
$97.92 |
$81.00
|
|
Culture typing immunologic
|
$19.44 |
$19.44 |
$19.44 |
$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
|
$123.84 |
$123.84 |
$123.84 |
$57.00
|
|
Cyanocobalamin unsat binding capacity
|
$97.92 |
$97.92 |
$97.92 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$25.20 |
$25.20 |
$25.20 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$160.56 |
$160.56 |
$160.56 |
$70.72
|
|
Cyclosporine 2 hour
|
$589.68 |
$589.68 |
$589.68 |
$129.48
|
|
Cygnus matrix, per sq cm
|
$640.80 |
$640.80 |
$640.80 |
$295.20
|
|
Cyp2c19 gene com variants
|
$636.48 |
$636.48 |
$636.48 |
$504.00
|
|
Cyp2c9 gene com variants
|
$236.88 |
$236.88 |
$236.88 |
$275.10
|
|
Cyp2d6 gene com variants
|
$568.08 |
$568.08 |
$568.08 |
$554.00
|
|
Cyp3a4 gene common variants
|
$236.88 |
$236.88 |
$236.88 |
$245.31
|
|
Cyp3a5 gene common variants
|
$236.88 |
$236.88 |
$236.88 |
$245.31
|
|
Cystatin c
|
$106.56 |
$106.56 |
$106.56 |
$77.50
|
|
Cystic fibrosis cftr
|
$4,376.16 |
$4,376.16 |
$4,376.16 |
$1,100.00
|
|
Cystine urine quantitative
|
$121.68 |
$121.68 |
$121.68 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$587.52 |
$587.52 |
$587.52 |
$542.10
|
|
Cystoscopy (Bladder Scope)
|
$1,249.92 |
$1,249.92 |
$1,249.92 |
$1,493.80
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,900.24 |
$3,900.24 |
$3,900.24 |
$3,065.15
|
|
Cytomegalovirus (cmv) antibody igg
|
$117.36 |
$117.36 |
$117.36 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$146.88 |
$146.88 |
$146.88 |
$97.50
|
|
Cyto/molecular report
|
$630.72 |
$630.72 |
$630.72 |
$133.20
|
|
Cytopath fl nongyn filter
|
$70.56 |
$70.56 |
$70.56 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$141.84 |
$141.84 |
$141.84 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$173.52 |
$173.52 |
$173.52 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$105.12 |
$105.12 |
$105.12 |
$87.50
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$81.36 |
$81.36 |
$81.36 |
$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
|
$231.12 |
$231.12 |
$231.12 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$120.24 |
$120.24 |
$120.24 |
$209.23
|
|
Cytp urine 3-5 probes cmptr
|
$325.44 |
$325.44 |
$325.44 |
$690.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.21 |
$0.21 |
$0.21 |
$168.53
|
|
Dch glucoscan
|
$54.72 |
$54.72 |
$54.72 |
$28.10
|
|
Dch validity tests
|
$38.16 |
$38.16 |
$38.16 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$92.16 |
$92.16 |
$92.16 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$280.80 |
$280.80 |
$280.80 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$2,017.44 |
$2,017.44 |
$2,017.44 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$627.84 |
$627.84 |
$627.84 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,580.40 |
$1,580.40 |
$1,580.40 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$917.28 |
$917.28 |
$917.28 |
$810.50
|
|
Debride nail1-5 11720
|
$149.04 |
$149.04 |
$149.04 |
$148.80
|
|
Debride nail6 or more 11721
|
$241.92 |
$241.92 |
$241.92 |
$169.60
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$641.52 |
$641.52 |
$641.52 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,231.92 |
$1,231.92 |
$1,231.92 |
$1,160.00
|
|
Decalcification
|
$84.24 |
$84.24 |
$84.24 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$635.04 |
$635.04 |
$635.04 |
$543.00
|
|
Delivery of placenta 59414
|
$3,433.68 |
$3,433.68 |
$3,433.68 |
$3,070.56
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$195.12 |
$195.12 |
$195.12 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$108.03 |
$108.03 |
$108.03 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$138.96 |
$138.96 |
$138.96 |
$408.10
|
|
Dermagraft
|
$79.92 |
$79.92 |
$79.92 |
$85.00
|
|
Destroy cervthor facet jnt 64633
|
$6,451.20 |
$6,451.20 |
$6,451.20 |
$3,011.50
|
|
Destroy cth facet jnt addl 64634
|
$6,451.20 |
$6,451.20 |
$6,451.20 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,240.56 |
$1,240.56 |
$1,240.56 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,887.92 |
$2,887.92 |
$2,887.92 |
$3,202.98
|
|
Dexamethasone 4 mg tablet
|
$0.54 |
$0.54 |
$0.54 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$3.24 |
$3.24 |
$3.24 |
$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
|
|
Diabetes (HbA1c) Test
|
$10.80 |
$10.80 |
$10.80 |
$79.20
|
|
Diab manage trn ind/group
|
$68.40 |
$68.40 |
$68.40 |
$56.55
|
|
Diagnostic anoscopy spx 46600
|
$203.04 |
$203.04 |
$203.04 |
$190.68
|
|
Diagnostic laryngoscopy 31505
|
$209.52 |
$209.52 |
$209.52 |
$236.60
|
|
Diagnostic Mammogram (both breasts)
|
$529.20 |
$529.20 |
$529.20 |
$399.30
|
