|
CT hrt c+ strux cgen hrt ds
|
$1,344.85 |
$1,344.85 |
$1,344.85 |
|
|
CT hrt w/3d image
|
$2,689.05 |
$2,689.05 |
$2,689.05 |
|
|
CT limited or localized follow-up study
|
$236.00 |
$236.00 |
$556.00 |
|
|
CT lower extremity w/contrast (both sides)
|
$730.00 |
$1,018.00 |
$1,896.05 |
|
|
CT lower extremity without contrast (both sides)
|
$836.40 |
$894.40 |
$1,981.85 |
|
|
CT lwr extremity w/o&w/dye
|
$1,008.00 |
$1,039.60 |
$1,892.15 |
|
|
CT neck soft tissue w/contrast
|
$1,136.80 |
$1,178.40 |
$1,947.40 |
|
|
CT neck soft tissue without contrast
|
$773.60 |
$887.20 |
$1,667.25 |
|
|
CT neck soft tissue without & w/contrast
|
$1,154.80 |
$1,154.80 |
$2,208.05 |
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,001.60 |
$1,004.00 |
$1,849.90 |
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$887.20 |
$974.80 |
$1,639.95 |
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$941.60 |
$1,045.20 |
$2,052.05 |
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$2,551.20 |
$2,579.20 |
$3,472.30 |
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,256.00 |
$2,354.00 |
$3,012.10 |
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,987.60 |
$2,138.40 |
$2,868.45 |
|
|
CT thoracic spine w/contrast
|
$1,127.20 |
$1,261.60 |
$1,807.65 |
|
|
CT thoracic spine without contrast
|
$887.20 |
$1,330.00 |
$1,436.50 |
|
|
CT thorax low dose for lung screening without contrast
|
$356.20 |
$534.00 |
$562.00 |
|
|
CT upper extremity w/contrast (both sides)
|
$939.20 |
$1,038.40 |
$1,942.85 |
|
|
CT upper extremity without contrast (both sides)
|
$809.20 |
$981.60 |
$1,551.55 |
|
|
CT uppr extremity w/o&w/dye
|
$1,058.80 |
$1,087.60 |
$1,892.15 |
|
|
Culture aerobic additional method definitive id each
|
$35.75 |
$42.40 |
$58.00 |
|
|
Culture afb any source
|
$57.85 |
$57.85 |
$123.60 |
|
|
Culture anaerobic additional method definitive id each
|
$22.80 |
$22.80 |
$267.80 |
|
|
Culture anaerobic except blood
|
$98.00 |
$98.00 |
$131.30 |
|
|
Culture bact stool aero addl path ea
|
$26.00 |
$49.20 |
$53.30 |
|
|
Culture body fluid
|
$116.35 |
$154.40 |
$154.40 |
|
|
Culture fungi definitive id mold
|
$56.00 |
$56.00 |
$56.00 |
|
|
Culture fungi definitive id yeast
|
$78.65 |
$78.65 |
$113.20 |
|
|
Culture fungi other (except blood)
|
$82.00 |
$82.00 |
$166.40 |
|
|
Culture fungi skin/hair/nail
|
$22.80 |
$81.90 |
$123.60 |
|
|
Culture mycobacteria definitive id each isolate
|
$80.40 |
$80.40 |
$80.40 |
|
|
Culture screening strep group a
|
$86.80 |
$90.35 |
$137.60 |
|
|
Culture typing immunologic
|
$20.40 |
$20.40 |
$60.45 |
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$292.50 |
$292.50 |
$292.50 |
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$138.80 |
$138.80 |
$147.60 |
|
|
Culture urine each isolate
|
$53.60 |
$53.60 |
$76.70 |
|
|
Cv stress test i&r only 93018
|
$36.40 |
$36.40 |
$36.40 |
|
|
Cyanocobalamin unsat binding capacity
|
$64.40 |
$64.40 |
$64.40 |
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$7.15 |
$7.15 |
$7.15 |
|
|
Cyclic citrullinated peptide antibody
|
$91.60 |
$95.60 |
$136.50 |
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$508.64 |
$508.64 |
$508.64 |
|
|
Cyclophosphamide 25 mg capsule
|
$35.75 |
$35.75 |
$35.75 |
|
|
Cyclosporine 2 hour
|
$40.00 |
$40.00 |
$56.00 |
|
|
Cyp2c19 gene com variants
|
$404.40 |
$404.40 |
$404.40 |
|
|
Cystatin c
|
$38.00 |
$38.00 |
$132.60 |
|
|
Cystogram >= 3 views supervision & interpretation
|
$496.00 |
$496.00 |
$908.05 |
|
|
Cystometrogram w/up 51727
|
$963.30 |
$963.30 |
$963.30 |
|
|
Cystoscopy and treatment
|
$22,796.42 |
$22,796.42 |
$22,796.42 |
|
|
Cystoscopy and treatment
|
$23,449.19 |
$23,449.19 |
$23,449.19 |
|
|
Cystoscopy and treatment
|
$19,486.68 |
$19,486.68 |
$19,486.68 |
|
|
Cystoscopy and treatment
|
$13,443.93 |
$13,443.93 |
$13,443.93 |
|
|
Cystoscopy and treatment
|
$12,049.18 |
$12,049.18 |
$12,049.18 |
|
|
Cystoscopy and treatment
|
$11,613.63 |
$11,613.63 |
$11,613.63 |
|
|
Cystoscopy and treatment
|
$7,941.07 |
$7,941.07 |
$7,941.07 |
|
|
Cystoscopy (Bladder Scope)
|
$10,104.83 |
$10,104.83 |
$10,104.83 |
|
|
Cystoscopy & ureter catheter
|
$11,796.25 |
$11,796.25 |
$11,796.25 |
|
|
Cystostomy cystotomy w/drainage 51040
|
$9,560.28 |
$9,560.28 |
$9,560.28 |
|
|
Cystouretero & or pyeloscope
|
$11,474.38 |
$11,474.38 |
$11,474.38 |
|
|
Cystouretero w/biopsy
|
$12,973.52 |
$12,973.52 |
$12,973.52 |
|
|
Cysto/uretero w/lithotripsy
|
$21,805.73 |
$21,805.73 |
$21,805.73 |
|
|
Cystouretero w/lithotripsy
|
$32,008.47 |
$32,008.47 |
$32,008.47 |
|
|
Cystouretero w/stone remove
|
$12,360.37 |
$12,360.37 |
$12,360.37 |
|
|
Cystourethroscop/calib/dilat stric 52281
|
$9,023.42 |
$9,023.42 |
$9,023.42 |
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$12,973.52 |
$12,973.52 |
$12,973.52 |
|
|
Cytogenom microarray copy nmbr var
|
$594.00 |
$594.00 |
$594.00 |
|
|
Cytomegalovirus (cmv) antibody igg
|
$64.40 |
$122.20 |
$123.20 |
|
|
Cytomegalovirus (cmv) antibody igm
|
$91.60 |
$117.20 |
$126.10 |
|
|
Cyto/molecular report
|
$68.40 |
$68.40 |
$68.40 |
|
|
Cytopathology cellular enhancement technique non-gyn
|
$47.20 |
$48.00 |
$163.80 |
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$123.50 |
$123.50 |
$123.50 |
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$48.40 |
$48.40 |
$48.40 |
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$81.60 |
$81.60 |
$81.60 |
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$126.00 |
$130.00 |
$161.20 |
|
|
Cytopath smear oth prep screen & interp
|
$54.00 |
$54.00 |
$54.00 |
|
|
Dactinomycin 0.5 mg intravenous solution
|
$901.55 |
$901.55 |
$901.55 |
|
|
Dalbavancin 500 mg intravenous solution
|
$4,047.52 |
$4,047.52 |
$4,047.52 |
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$126.75 |
$126.75 |
$126.75 |
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$20,095.54 |
$20,095.54 |
$20,095.54 |
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,641.27 |
$2,641.27 |
$2,641.27 |
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$9,853.92 |
$9,853.92 |
$9,853.92 |
|
|
Dch pulmonary stress test
|
$363.35 |
$363.35 |
$833.20 |
|
|
Dch validity tests
|
$15.60 |
$15.60 |
$17.20 |
|
|
Deamidated gliadin antibody iga
|
$61.60 |
$61.60 |
$83.20 |
|
|
Debridement (>20 cm) charge pt
|
$167.05 |
$167.05 |
$252.40 |
|
|
Debride skin bone at fx site
|
$2,901.60 |
$2,901.60 |
$2,901.60 |
|
|
Decalcification
|
$28.80 |
$30.80 |
$20,845.17 |
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$240.00 |
$240.00 |
$1,341.28 |
|
|
Deferoxamine 500 mg solution for injection
|
$62.36 |
$62.36 |
$62.36 |
|
|
Degarelix 120 mg subcutaneous solution
|
$2,732.27 |
$2,732.27 |
$2,732.27 |
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$162.50 |
$162.50 |
$162.50 |
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$6,359.20 |
$6,359.20 |
$6,359.20 |
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$223.20 |
$223.20 |
$223.20 |
|
|
Depo-estradiol cypionate inj
|
$1,089.80 |
$1,089.80 |
$1,089.80 |
|
|
Design mlc device for imrt
|
$4,680.00 |
$4,680.00 |
$4,680.00 |
|
|
Desmopressin 4 mcg/ml injection solution
|
$55.46 |
$55.46 |
$55.46 |
|
|
Destroy cervthor facet jnt 64633
|
$1,700.00 |
$1,700.00 |
$1,785.20 |
|
|
Destroy cth facet jnt addl 64634
|
$812.00 |
$812.00 |
$852.80 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,072.00 |
$1,072.00 |
$1,125.60 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,700.00 |
$1,700.00 |
$1,785.20 |
|
