|
Cyclosporine 2 hour
|
$56.00 |
$56.00 |
$56.00 |
$126.10
|
|
Cyp2c19 gene com variants
|
$404.40 |
$404.40 |
$404.40 |
$583.20
|
|
Cystatin c
|
$38.00 |
$38.00 |
$38.00 |
$83.20
|
|
Cystogram >= 3 views supervision & interpretation
|
$496.00 |
$496.00 |
$496.00 |
$487.04
|
|
Cytomegalovirus (cmv) antibody igg
|
$123.20 |
$123.20 |
$123.20 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$91.60 |
$91.60 |
$91.60 |
$95.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$48.00 |
$48.00 |
$48.00 |
$163.43
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$48.40 |
$48.40 |
$48.40 |
$129.90
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$81.60 |
$81.60 |
$81.60 |
$179.44
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$130.00 |
$130.00 |
$130.00 |
$205.00
|
|
Cytopath smear oth prep screen & interp
|
$54.00 |
$54.00 |
$54.00 |
$95.00
|
|
Dch pulmonary stress test
|
$833.20 |
$833.20 |
$833.20 |
$964.41
|
|
Dch validity tests
|
$15.60 |
$15.60 |
$15.60 |
$25.00
|
|
Debridement (>20 cm) charge pt
|
$252.40 |
$252.40 |
$252.40 |
$313.30
|
|
Decalcification
|
$28.80 |
$28.80 |
$28.80 |
$72.15
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$240.00 |
$240.00 |
$240.00 |
$482.35
|
|
Destroy cervthor facet jnt 64633
|
$1,785.20 |
$1,785.20 |
$1,785.20 |
$2,963.07
|
|
Destroy cth facet jnt addl 64634
|
$852.80 |
$852.80 |
$852.80 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$1,879.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,785.20 |
$1,785.20 |
$1,785.20 |
$3,101.88
|
|
Dhea-s (dehydroepiand sulfate)
|
$79.20 |
$79.20 |
$79.20 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$58.00 |
$58.00 |
$58.00 |
$70.00
|
|
Diagnostic digital breast tomosynthesis bil
|
$174.00 |
$174.00 |
$174.00 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$64.00 |
$64.00 |
$64.00 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$179.60 |
$179.60 |
$179.60 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$140.80 |
$140.80 |
$140.80 |
$276.60
|
|
Dialysis one evaluation
|
$716.40 |
$716.40 |
$716.40 |
$920.00
|
|
Diffusing capacity
|
$167.60 |
$167.60 |
$167.60 |
$336.80
|
|
Digoxin total therapeutic drug level
|
$52.80 |
$52.80 |
$52.80 |
$92.95
|
|
Dilate biliary duct/ampulla
|
$270.00 |
$270.00 |
$270.00 |
$1,866.73
|
|
Dilat xst trc ndurlgc px
|
$2,158.80 |
$2,158.80 |
$2,158.80 |
$4,031.47
|
|
Dilat xst trc new access rcs
|
$3,632.00 |
$3,632.00 |
$3,632.00 |
$5,842.20
|
|
Disaccharidases
|
$83.20 |
$83.20 |
$83.20 |
$224.58
|
|
Dna antibody native/double stranded
|
$84.40 |
$84.40 |
$84.40 |
$101.40
|
|
Doppler echo complete
|
$399.20 |
$399.20 |
$399.20 |
$517.94
|
|
Doppler intravascular pressure flow initial vessel
|
$1,844.00 |
$1,844.00 |
$1,844.00 |
$3,026.62
|
|
Drain blood from under nail 11740
|
$63.60 |
$63.60 |
$63.60 |
$173.21
|
|
Drain cath image guided visceral pq
|
$1,499.60 |
$1,499.60 |
$1,499.60 |
$2,999.34
|
|
Drain finger abscess;simple 26010
|
$55.60 |
$55.60 |
$55.60 |
$451.20
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$444.00 |
$444.00 |
$444.00 |
$387.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$232.40 |
$232.40 |
$232.40 |
$353.60
|
|
Dress/debrid prtl-thick burn l 16030
|
$743.60 |
$743.60 |
$743.60 |
$515.00
|
|
Drug admin & hemodynmic meas
|
$1,653.60 |
$1,653.60 |
$1,653.60 |
$612.15
|
|
Drug of abuse screen urine
|
$78.00 |
$78.00 |
$78.00 |
$58.50
|
|
Drug test prsmv instrmnt
|
$39.20 |
$39.20 |
$39.20 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$128.40 |
$128.40 |
$128.40 |
$278.85
|
|
Ductogram sgl duct
|
$304.40 |
$304.40 |
$304.40 |
$346.42
|
|
Duplex scan bilateral study 93985
|
$730.00 |
$730.00 |
$730.00 |
$692.40
|
|
Dup scan/hemodialysis access 93990
|
$209.60 |
$209.60 |
$209.60 |
$499.38
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$502.80 |
$502.80 |
$502.80 |
$852.57
|
|
Ecg 12 lead tracing only
|
$152.00 |
$152.00 |
$152.00 |
$222.30
|
|
Ecg/1-3 leads/tracing only 93041
|
$65.20 |
$65.20 |
$65.20 |
$129.83
|
|
Ecg < 30 days transmission & analysis
|
$254.40 |
$254.40 |
$254.40 |
$404.21
|
|
Ecg external < 48 hours recording
|
$323.60 |
$323.60 |
$323.60 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$372.80 |
$372.80 |
$372.80 |
$541.73
|
|
Echocardiogram (Heart Ultrasound)
|
$908.80 |
$908.80 |
$908.80 |
$2,021.12
|
|
Echocardiography doppler color flow mapping
|
$354.00 |
$354.00 |
$354.00 |
$450.40
|
|
Echocardiography transthoracic 2d followup/limited
|
$250.80 |
$250.80 |
$250.80 |
$720.60
|
|
Echocardiograpy doppler follow up/limited study
|
$209.60 |
$209.60 |
$209.60 |
$348.80
|
|
Echo exam uterus 76831-
|
$300.00 |
$300.00 |
$300.00 |
$497.93
|
|
Echo stress
|
$836.80 |
$836.80 |
$836.80 |
$1,401.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$1,288.40 |
$1,288.40 |
$1,288.40 |
$1,946.10
|
|
Echo transesophageal
|
$827.60 |
$827.60 |
$827.60 |
$1,737.60
|
|
Echo transthoracic
|
$900.40 |
$900.40 |
$900.40 |
$1,361.75
|
|
Echo transthoracic
|
$304.00 |
$304.00 |
$304.00 |
$765.00
|
|
Edu/train/pt/nonmd/in person/30 min98960
|
$17.60 |
$17.60 |
$17.60 |
$94.32
|
|
Eeg monitor/record/awake/drowsy 95816
|
$405.20 |
$405.20 |
$405.20 |
$835.00
|
|
Eeg over 1 hour 95813 - 26
|
$726.00 |
$726.00 |
$726.00 |
$1,072.93
|
|
Egfr gene com variants
|
$262.80 |
$262.80 |
$262.80 |
$619.04
|
|
Electrical stimulation/unattended 97014
|
$50.40 |
$50.40 |
$50.40 |
$79.20
|
|
Electric stim/w chemodenervation 95873
|
$32.80 |
$32.80 |
$32.80 |
$128.40
|
|
Electrolyte panel
|
$55.60 |
$55.60 |
$55.60 |
$68.56
|
|
Electron microscopy diagnostic
|
$540.40 |
$540.40 |
$540.40 |
$1,107.84
|
|
Electrophysiology evaluation
|
$1,158.80 |
$1,158.80 |
$1,158.80 |
$2,845.10
|
|
Embolization s&i
|
$1,667.20 |
$1,667.20 |
$1,667.20 |
$2,869.75
|
|
Embo or occlude vascular arterial s&i
|
$3,692.00 |
$3,692.00 |
$3,692.00 |
$16,060.54
|
|
Encephalitis, western equine igg/igm
|
$96.00 |
$96.00 |
$96.00 |
$55.25
|
|
Endo abl/incom vein/ext/rad fre/#1 36475
|
$4,648.00 |
$4,648.00 |
$4,648.00 |
$6,527.25
|
|
Endo cath bile duct s&i
|
$856.80 |
$856.80 |
$856.80 |
$525.00
|
|
Endoluminl ivus oct c 1st
|
$3,222.00 |
$3,222.00 |
$3,222.00 |
$3,315.00
|
|
Endoscopy swallow (fees) vid
|
$176.40 |
$176.40 |
$176.40 |
$457.50
|
|
Endovenous rf abl vein addl
|
$2,002.40 |
$2,002.40 |
$2,002.40 |
$3,226.73
|
|
Epidural/lumbar/sacral/ea add level64484
|
$752.80 |
$752.80 |
$752.80 |
$1,341.04
|
|
Episiotomy/vag rpr oth/thn attending phys 59300
|
$1,933.20 |
$1,933.20 |
$1,933.20 |
$3,522.35
|
|
Epstein barr early antigen antibody
|
$51.60 |
$51.60 |
$51.60 |
$85.20
|
|
Epstein barr nuclear antigen antibody
|
$78.80 |
$78.80 |
$78.80 |
$88.80
|
|
Epstein barr viral capsid antigen antibody igm
|
$51.60 |
$51.60 |
$51.60 |
$112.50
|
|
Ercp biliary & pancreas
|
$847.20 |
$847.20 |
$847.20 |
$885.80
|
|
Ercp remove duct calculi 43264
|
$1,839.20 |
$1,839.20 |
$1,839.20 |
$3,955.50
|
|
ER Visit (level 1, minor)
|
$153.60 |
$153.60 |
$153.60 |
$270.00
|
|
ER Visit (level 2)
|
$316.00 |
$316.00 |
$316.00 |
$469.39
|
|
ER Visit (level 3)
|
$457.60 |
$457.60 |
$457.60 |
$821.52
|
|
ER Visit (level 4)
|
$855.60 |
$855.60 |
$855.60 |
$1,320.00
|
|
ER Visit (level 5, high severity)
|
$1,585.20 |
$1,585.20 |
$1,585.20 |
$1,900.20
|
|
Esophageal dilat s&i
|
$422.00 |
$422.00 |
$422.00 |
$457.86
|
|
Esophagoscopy/flex/diagnostic 43200
|
$606.00 |
$606.00 |
$606.00 |
$1,048.28
|
|
Established Patient Office Visit (level 1)
|
$198.40 |
$198.40 |
$198.40 |
$118.20
|
|
Established Patient Office Visit (level 2)
|
$152.80 |
$152.80 |
$152.80 |
$138.60
|
|
Established Patient Office Visit (level 3)
|
$3,724.40 |
$3,724.40 |
$3,724.40 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$263.20 |
$263.20 |
$263.20 |
$213.21
|
