|
CT lower extremity without contrast (both sides)
|
$2,273.04 |
$2,273.04 |
$2,273.04 |
$1,421.85
|
|
CT lwr extremity w/o&w/dye
|
$2,658.24 |
$2,658.24 |
$2,658.24 |
$1,854.05
|
|
CT neck soft tissue w/contrast
|
$2,841.84 |
$2,841.84 |
$2,841.84 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$2,060.64 |
$2,060.64 |
$2,060.64 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$3,743.28 |
$3,743.28 |
$3,743.28 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$3,295.44 |
$3,295.44 |
$3,295.44 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,895.84 |
$2,895.84 |
$2,895.84 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$2,493.36 |
$2,493.36 |
$2,493.36 |
$1,360.00
|
|
Ctrl nosebld postir subsq 30906
|
$437.04 |
$437.04 |
$437.04 |
$437.04
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$7,193.52 |
$7,193.52 |
$7,193.52 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$5,604.48 |
$5,604.48 |
$5,604.48 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,636.00 |
$3,636.00 |
$3,636.00 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$3,547.44 |
$3,547.44 |
$3,547.44 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,957.04 |
$2,957.04 |
$2,957.04 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$248.40 |
$248.40 |
$248.40 |
$331.50
|
|
CT t-spine w /wo contrast
|
$3,793.68 |
$3,793.68 |
$3,793.68 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$2,380.32 |
$2,380.32 |
$2,380.32 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$2,062.08 |
$2,062.08 |
$2,062.08 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,903.76 |
$2,903.76 |
$2,903.76 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$80.64 |
$80.64 |
$80.64 |
$68.64
|
|
Culture afb any source
|
$82.80 |
$82.80 |
$82.80 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$89.28 |
$89.28 |
$89.28 |
$79.00
|
|
Culture anaerobic except blood
|
$202.32 |
$202.32 |
$202.32 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$82.80 |
$82.80 |
$82.80 |
$51.45
|
|
Culture body fluid
|
$104.40 |
$104.40 |
$104.40 |
$126.75
|
|
Culture fungi definitive id mold
|
$90.00 |
$90.00 |
$90.00 |
$77.28
|
|
Culture fungi definitive id yeast
|
$75.60 |
$75.60 |
$75.60 |
$79.10
|
|
Culture fungi other (except blood)
|
$118.08 |
$118.08 |
$118.08 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$65.52 |
$65.52 |
$65.52 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$92.16 |
$92.16 |
$92.16 |
$89.70
|
|
Culture mycoplasma any source
|
$102.96 |
$102.96 |
$102.96 |
$85.26
|
|
Culture screening strep group a
|
$89.28 |
$89.28 |
$89.28 |
$81.00
|
|
Culture typing immunologic
|
$15.12 |
$15.12 |
$15.12 |
$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
|
$42.48 |
$42.48 |
$42.48 |
$57.00
|
|
Cutter lead
|
$864.00 |
$864.00 |
$864.00 |
$6,092.06
|
|
Cyanocobalamin unsat binding capacity
|
$20.16 |
$20.16 |
$20.16 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$77.11 |
$77.11 |
$77.11 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$239.04 |
$239.04 |
$239.04 |
$70.72
|
|
Cyclosporine 2 hour
|
$200.88 |
$200.88 |
$200.88 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$1.98 |
$1.98 |
$1.98 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$7.92 |
$7.92 |
$7.92 |
$34.88
|
|
Cylinder pump set 20cm titan zero angl
|
$25,020.00 |
$25,020.00 |
$25,020.00 |
$22,803.38
|
|
Cyp2c19 gene com variants
|
$526.32 |
$526.32 |
$526.32 |
$504.00
|
|
Cystatin c
|
$102.96 |
$102.96 |
$102.96 |
$77.50
|
|
Cystic fibrosis cftr
|
$3,049.92 |
$3,049.92 |
$3,049.92 |
$1,100.00
|
|
Cystine urine quantitative
|
$127.44 |
$127.44 |
$127.44 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$719.28 |
$719.28 |
$719.28 |
$542.10
|
|
Cystoscopy (Bladder Scope)
|
$1,435.68 |
$1,435.68 |
$1,435.68 |
$1,493.80
|
|
Cystourethroscop/calib/dilat stric 52281
|
$4,480.56 |
$4,480.56 |
$4,480.56 |
$3,065.15
|
|
Cytomegalovirus (cmv) antibody igg
|
$129.60 |
$129.60 |
$129.60 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$117.36 |
$117.36 |
$117.36 |
$97.50
|
|
Cyto/molecular report
|
$76.32 |
$76.32 |
$76.32 |
$133.20
|
|
Cytopath fl nongyn filter
|
$79.92 |
$79.92 |
$79.92 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$185.76 |
$185.76 |
$185.76 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$180.00 |
$180.00 |
$180.00 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$116.64 |
$116.64 |
$116.64 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$160.56 |
$160.56 |
$160.56 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$133.20 |
$133.20 |
$133.20 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$54.72 |
$54.72 |
$54.72 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$187.92 |
$187.92 |
$187.92 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$427.68 |
$427.68 |
$427.68 |
$209.23
|
|
Cytopath smear other source
|
$54.00 |
$54.00 |
$54.00 |
$88.13
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.76 |
$0.76 |
$0.76 |
$168.53
|
|
Dch validity tests
|
$43.20 |
$43.20 |
$43.20 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$30.96 |
$30.96 |
$30.96 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$435.60 |
$435.60 |
$435.60 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$2,620.80 |
$2,620.80 |
$2,620.80 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$722.16 |
$722.16 |
$722.16 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$2,381.76 |
$2,381.76 |
$2,381.76 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$842.40 |
$842.40 |
$842.40 |
$810.50
|
|
Debride nail1-5 11720
|
$241.92 |
$241.92 |
$241.92 |
$148.80
|
|
Debride nail6 or more 11721
|
$241.92 |
$241.92 |
$241.92 |
$169.60
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$842.40 |
$842.40 |
$842.40 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$994.32 |
$994.32 |
$994.32 |
$1,160.00
|
|
Decalcification
|
$109.44 |
$109.44 |
$109.44 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$639.36 |
$639.36 |
$639.36 |
$543.00
|
|
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
|
$415.44 |
$415.44 |
$415.44 |
$408.10
|
|
Dermagraft
|
$132.48 |
$132.48 |
$132.48 |
$85.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$104.52 |
$104.52 |
$104.52 |
$89.78
|
|
Destroy cervthor facet jnt 64633
|
$5,983.20 |
$5,983.20 |
$5,983.20 |
$3,011.50
|
|
Destroy cth facet jnt addl 64634
|
$770.40 |
$770.40 |
$770.40 |
$1,441.44
|
|
Destruction benign lesions < 14 lesions
|
$371.52 |
$371.52 |
$371.52 |
$235.13
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,229.76 |
$1,229.76 |
$1,229.76 |
$1,616.72
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$5,983.20 |
$5,983.20 |
$5,983.20 |
$3,202.98
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$528.48 |
$528.48 |
$528.48 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$0.27 |
$0.27 |
$0.27 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$7.94 |
$7.94 |
$7.94 |
$21.17
|
|
Dextran 40 infusion
|
$736.49 |
$736.49 |
$736.49 |
$151.20
|
|
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
|
|
Dextrose 5 % IV bolus
|
$32.40 |
$32.40 |
$32.40 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$106.56 |
$106.56 |
$106.56 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$120.96 |
$120.96 |
$120.96 |
$79.20
|
|
Diab manage trn ind/group
|
$44.64 |
$44.64 |
$44.64 |
$56.55
|
|
Diagnostic laryngoscopy 31505
|
$432.00 |
$432.00 |
$432.00 |
$236.60
|
|
Diagnostic Mammogram (both breasts)
|
$562.32 |
$562.32 |
$562.32 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$476.64 |
$476.64 |
$476.64 |
$301.55
|
