|
Cta abdomen without & /or w/contrast
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$2,050.23
|
|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$1,940.00
|
|
Cta lower extremity without & w/contrast (both sides)
|
$4,482.60 |
$4,482.60 |
$4,482.60 |
$2,047.80
|
|
Cta neck without &/or w/contrast
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$1,931.40
|
|
CT Angiogram of Abdomen and Pelvis
|
$5,170.80 |
$5,170.80 |
$5,170.80 |
$2,849.55
|
|
CT Angiogram of the Chest (for blood clot)
|
$2,874.60 |
$2,874.60 |
$2,874.60 |
$1,940.00
|
|
CT Angiogram of the Head
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$1,996.80
|
|
CT angio hrt w/3d image
|
$235.20 |
$235.20 |
$235.20 |
$1,500.38
|
|
CT angio pelvis
|
$2,928.60 |
$2,928.60 |
$2,928.60 |
$1,837.80
|
|
Cta upper extremity w &/or without contrast left
|
$4,482.60 |
$4,482.60 |
$4,482.60 |
$1,698.00
|
|
CT guidance for needle placement
|
$1,471.20 |
$1,471.20 |
$1,471.20 |
$1,494.00
|
|
CT lower extremity w/contrast (both sides)
|
$1,970.40 |
$1,970.40 |
$1,970.40 |
$1,652.00
|
|
CT lower extremity without contrast (both sides)
|
$3,120.00 |
$3,120.00 |
$3,120.00 |
$1,421.85
|
|
CT lwr extremity w/o&w/dye
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$1,854.05
|
|
CT neck soft tissue w/contrast
|
$1,970.40 |
$1,970.40 |
$1,970.40 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$1,560.00 |
$1,560.00 |
$1,560.00 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,560.00 |
$1,560.00 |
$1,560.00 |
$1,360.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,283.60 |
$5,283.60 |
$5,283.60 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,492.20 |
$4,492.20 |
$4,492.20 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,452.40 |
$3,452.40 |
$3,452.40 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$2,428.20 |
$2,428.20 |
$2,428.20 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,145.00 |
$2,145.00 |
$2,145.00 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,892.40 |
$1,892.40 |
$1,892.40 |
$331.50
|
|
CT t-spine w /wo contrast
|
$2,874.60 |
$2,874.60 |
$2,874.60 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,970.40 |
$1,970.40 |
$1,970.40 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,560.00 |
$1,560.00 |
$1,560.00 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,241.00 |
$2,241.00 |
$2,241.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$120.60 |
$120.60 |
$120.60 |
$68.64
|
|
Culture afb any source
|
$153.60 |
$153.60 |
$153.60 |
$109.20
|
|
Culture anaerobic except blood
|
$171.00 |
$171.00 |
$171.00 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$29.40 |
$29.40 |
$29.40 |
$51.45
|
|
Culture body fluid
|
$153.60 |
$153.60 |
$153.60 |
$126.75
|
|
Culture fungi skin/hair/nail
|
$316.20 |
$316.20 |
$316.20 |
$74.88
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$25.80 |
$25.80 |
$25.80 |
$392.50
|
|
Cv stress test i&r only 93018
|
$136.20 |
$136.20 |
$136.20 |
$40.20
|
|
Cv stress test/supervision only 93016
|
$79.80 |
$79.80 |
$79.80 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$24.00 |
$24.00 |
$24.00 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$82.20 |
$82.20 |
$82.20 |
$70.72
|
|
Cyclosporine 2 hour
|
$179.40 |
$179.40 |
$179.40 |
$129.48
|
|
Cystatin c
|
$127.20 |
$127.20 |
$127.20 |
$77.50
|
|
Cystine urine quantitative
|
$301.80 |
$301.80 |
$301.80 |
$103.35
|
|
Cytomegalovirus (cmv) antibody igg
|
$82.20 |
$82.20 |
$82.20 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$82.20 |
$82.20 |
$82.20 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$97.80 |
$97.80 |
$97.80 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$39.00 |
$39.00 |
$39.00 |
$91.84
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$100.80 |
$100.80 |
$100.80 |
$209.23
|
|
Dalbavancin 500 mg intravenous solution
|
$5,117.40 |
$5,117.40 |
$5,117.40 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$116.40 |
$116.40 |
$116.40 |
$168.53
|
|
Dch glucoscan
|
$30.00 |
$30.00 |
$30.00 |
$28.10
|
|
Dch validity tests
|
$39.00 |
$39.00 |
$39.00 |
$24.50
|
|
Debridement (>20 cm) charge pt
|
$40.20 |
$40.20 |
$40.20 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$427.80 |
$427.80 |
$427.80 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$93.00 |
$93.00 |
$93.00 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$153.00 |
$153.00 |
$153.00 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$145.80 |
$145.80 |
$145.80 |
$810.50
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$243.00 |
$243.00 |
$243.00 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$335.40 |
$335.40 |
$335.40 |
$1,160.00
|
|
Decalcification
|
$25.80 |
$25.80 |
$25.80 |
$68.90
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$7,392.60 |
$7,392.60 |
$7,392.60 |
$6,324.98
|
|
Desmopressin 4 mcg/ml injection solution
|
$265.80 |
$265.80 |
$265.80 |
$89.78
|
|
Dest mal lesion feenlm <0.5cm 17280
|
$75.60 |
$75.60 |
$75.60 |
$275.88
|
|
Destroy premlg lesns;1st lesn 17000
|
$81.60 |
$81.60 |
$81.60 |
$199.50
|
|
Destruct ben lesion 15/> 17111
|
$157.80 |
$157.80 |
$157.80 |
$235.13
|
|
Destruction 2-14 lesions 17003
|
$30.00 |
$30.00 |
$30.00 |
$72.60
|
|
Destruction benign lesions < 14 lesions
|
$124.20 |
$124.20 |
$124.20 |
$235.13
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$161.40 |
$161.40 |
$161.40 |
$513.60
|
|
Destruction penis lesion(s) exten 54065
|
$529.80 |
$529.80 |
$529.80 |
$2,507.31
|
|
Destruction rectal tumor 45190
|
$912.60 |
$912.60 |
$912.60 |
$3,245.23
|
|
Dexametha opth insert 0.1 mg
|
$2,553.60 |
$2,553.60 |
$2,553.60 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$6.00 |
$6.00 |
$6.00 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$18.00 |
$18.00 |
$18.00 |
$21.17
|
|
Dhea-s (dehydroepiand sulfate)
|
$263.40 |
$263.40 |
$263.40 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$73.20 |
$73.20 |
$73.20 |
$79.20
|
|
Diag laparo separate proc 49320
|
$1,051.80 |
$1,051.80 |
$1,051.80 |
$6,904.15
|
|
Diagnostic anoscopy spx 46600
|
$87.00 |
$87.00 |
$87.00 |
$190.68
|
|
Diagnostic Mammogram (both breasts)
|
$460.20 |
$460.20 |
$460.20 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$460.20 |
$460.20 |
$460.20 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$113.40 |
$113.40 |
$113.40 |
$214.08
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$91.80 |
$91.80 |
$91.80 |
$74.76
|
|
Dicyclomine injection
|
$268.20 |
$268.20 |
$268.20 |
$153.29
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.20 |
$19.20 |
$19.20 |
$69.03
|
|
Digoxin total therapeutic drug level
|
$169.20 |
$169.20 |
$169.20 |
$102.00
|
|
Dilate esophagus 1/mult pass
|
$246.60 |
$246.60 |
$246.60 |
$1,484.17
|
|
Diltiazem 5 mg/ml intravenous solution
|
$45.60 |
$45.60 |
$45.60 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$17.75
|
|
Dna antibody native/double stranded
|
$286.80 |
$286.80 |
$286.80 |
$97.50
|
|
Dna gardnerella
|
$34.20 |
$34.20 |
$34.20 |
$62.50
|
|
Dna trichomonas
|
$34.20 |
$34.20 |
$34.20 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$42.60 |
$42.60 |
$42.60 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$65.40 |
$65.40 |
$65.40 |
$65.40
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$823.80 |
$823.80 |
$823.80 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$280.80 |
$280.80 |
$280.80 |
$471.17
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$96.60 |
$96.60 |
$96.60 |
$84.80
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$198.60 |
$198.60 |
$198.60 |
$800.00
|
|
Drainage of nose lesion sept 30020
|
$232.20 |
$232.20 |
$232.20 |
$781.44
|
|
Drain blood from under nail 11740
|
$126.00 |
$126.00 |
$126.00 |
$170.50
|
|
Drain cerebro spinal fluid 62272
|
$917.40 |
$917.40 |
$917.40 |
$1,044.00
|
|
Drain finger abscess;simple 26010
|
$91.80 |
$91.80 |
$91.80 |
$419.00
|