|
Critical Care (first 30 to 74 minutes)
|
$592.50 |
$1,569.15 |
$5,173.40 |
|
|
Cryofibrinogen qualitative - sendout
|
$21.80 |
$50.40 |
$100.85 |
|
|
Cryoprecipitate each unit
|
$182.25 |
$286.10 |
$554.00 |
|
|
Crystal identification light microscopy
|
$54.55 |
$83.75 |
$153.00 |
|
|
Csf leakage imaging
|
$3,638.75 |
$3,880.20 |
$5,068.55 |
|
|
Csf ventriculography
|
$1,243.00 |
$1,243.00 |
$1,243.00 |
|
|
CT 3d report other modality w/workstation
|
$213.20 |
$533.90 |
$614.05 |
|
|
Cta lower extremity without & w/contrast (both sides)
|
$530.55 |
$1,901.10 |
$5,904.85 |
|
|
CT Angiogram of Abdomen and Pelvis
|
$1,647.60 |
$2,229.85 |
$3,725.10 |
|
|
CT Angiogram of the Abdomen
|
$1,647.60 |
$2,658.80 |
$5,904.85 |
|
|
CT Angiogram of the Abdomen and Both Legs
|
$2,154.60 |
$2,658.80 |
$5,904.85 |
|
|
CT Angiogram of the Chest (for blood clot)
|
$1,774.40 |
$2,658.80 |
$5,904.85 |
|
|
CT Angiogram of the Head
|
$1,539.95 |
$2,658.80 |
$5,904.85 |
|
|
CT Angiogram of the Neck
|
$1,577.90 |
$2,658.80 |
$5,904.85 |
|
|
CT angio hrt w/3d image
|
$500.75 |
$500.75 |
$2,214.85 |
|
|
CT angio pelvis
|
$1,647.60 |
$2,658.80 |
$5,904.85 |
|
|
Cta upper extremity w &/or without contrast left
|
$1,449.85 |
$1,816.20 |
$5,904.85 |
|
|
CT bone density axial
|
$220.00 |
$220.00 |
$526.45 |
|
|
CT colonography dx
|
$1,446.85 |
$1,446.85 |
$1,446.85 |
|
|
CT colonography dx w/dye
|
$1,587.20 |
$1,587.20 |
$1,587.20 |
|
|
CT colonography screening
|
$1,446.85 |
$1,446.85 |
$1,446.85 |
|
|
CT guidance for needle placement
|
$716.50 |
$1,035.30 |
$1,861.20 |
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$253.45 |
$697.80 |
$2,523.85 |
|
|
CT guid cryo ablat intramuscular
|
$556.30 |
$1,226.00 |
$3,274.35 |
|
|
CT heart w/evaluation of calcium without contrast
|
$245.25 |
$245.25 |
$1,297.05 |
|
|
CT hrt c+ strux cgen hrt ds
|
$2,214.85 |
$2,214.85 |
$2,214.85 |
|
|
CT hrt w/3d image
|
$2,214.85 |
$2,214.85 |
$2,214.85 |
|
|
CT limited or localized follow-up study
|
$734.25 |
$775.10 |
$1,456.35 |
|
|
CT lwr extremity w/o&w/dye
|
$548.05 |
$2,504.65 |
$3,248.75 |
|
|
Ctrl nosebld postir subsq 30906
|
$128.40 |
$326.65 |
$1,453.60 |
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,901.10 |
$2,589.55 |
$6,057.45 |
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,791.20 |
$1,961.30 |
$4,781.90 |
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,028.50 |
$1,267.40 |
$3,679.25 |
|
|
CT t-spine w /wo contrast
|
$2,504.65 |
$2,812.75 |
$3,248.75 |
|
|
CT uppr extremity w/o&w/dye
|
$1,596.55 |
$2,812.75 |
$3,248.75 |
|
|
Culture aerobic additional method definitive id each
|
$32.85 |
$93.60 |
$105.20 |
|
|
Culture afb any source
|
$87.45 |
$102.60 |
$145.80 |
|
|
Culture anaerobic additional method definitive id each
|
$21.00 |
$50.45 |
$159.95 |
|
|
Culture anaerobic except blood
|
$103.80 |
$184.60 |
$266.20 |
|
|
Culture bact stool aero addl path ea
|
$13.50 |
$61.60 |
$134.95 |
|
|
Culture body fluid
|
$79.80 |
$136.45 |
$181.60 |
|
|
Culture fungi definitive id mold
|
$17.05 |
$26.85 |
$79.35 |
|
|
Culture fungi definitive id yeast
|
$30.70 |
$32.40 |
$133.65 |
|
|
Culture fungi other (except blood)
|
$94.40 |
$124.25 |
$165.00 |
|
|
Culture fungi skin/hair/nail
|
$69.15 |
$121.45 |
$220.95 |
|
|
Culture mycobacteria definitive id each isolate
|
$37.95 |
$37.95 |
$37.95 |
|
|
Culture mycoplasma any source
|
$100.40 |
$100.40 |
$100.40 |
|
|
Culture quantitative aerobic other source
|
$288.80 |
$288.80 |
$288.80 |
|
|
Culture screening strep group a
|
$47.00 |
$66.10 |
$107.95 |
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$87.75 |
$87.75 |
$87.75 |
|
|
Curette/treat cornea
|
$1,754.55 |
$1,754.55 |
$1,754.55 |
|
|
Cutter lead
|
$228.00 |
$1,596.55 |
$1,596.55 |
|
|
Cv line/pic reposition
|
$1,176.80 |
$2,313.80 |
$2,655.20 |
|
|
Cv stress test i&r only 93018
|
$37.10 |
$37.10 |
$37.10 |
|
|
Cv stress test/supervision only 93016
|
$55.65 |
$55.65 |
$55.65 |
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$34.81 |
$53.30 |
$112.58 |
|
|
Cyclic citrullinated peptide antibody
|
$139.35 |
$141.55 |
$253.75 |
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,311.06 |
$2,046.09 |
$6,379.93 |
|
|
Cyclophosphamide 25 mg capsule
|
$32.82 |
$32.82 |
$32.82 |
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$681.04 |
$681.04 |
$681.04 |
|
|
Cyclosporine 2 hour
|
$65.60 |
$196.80 |
$209.15 |
|
|
Cylinder pump set 20cm titan zero angl
|
$2,875.00 |
$2,875.00 |
$9,906.00 |
|
|
Cystatin c
|
$48.15 |
$48.15 |
$112.95 |
|
|
Cystine urine quantitative
|
$167.55 |
$173.40 |
$434.30 |
|
|
Cystogram >= 3 views supervision & interpretation
|
$371.10 |
$1,194.50 |
$2,395.65 |
|
|
Cystoscopy and treatment
|
$3,803.40 |
$3,803.40 |
$3,803.40 |
|
|
Cystoscopy (Bladder Scope)
|
$723.50 |
$1,610.20 |
$1,861.35 |
|
|
Cystoscopy removal of clots
|
$711.30 |
$711.30 |
$711.30 |
|
|
Cystoscopy & ureter catheter
|
$4,100.35 |
$4,100.35 |
$4,100.35 |
|
|
Cystostomy cystotomy w/drainage 51040
|
$674.85 |
$3,623.90 |
$6,064.65 |
|
|
Cystourethroscop/calib/dilat stric 52281
|
$4,100.35 |
$4,100.35 |
$5,549.90 |
|
|
Cytarabine 20 mg/ml injection solution
|
$113.31 |
$205.46 |
$246.87 |
|
|
Cytogenetics 25-99
|
$147.10 |
$334.65 |
$648.60 |
|
|
Cytomegalovirus (cmv) antibody igg
|
$27.30 |
$166.00 |
$546.95 |
|
|
Cytomegalovirus (cmv) antibody igm
|
$26.70 |
$157.70 |
$334.65 |
|
|
Cyto/molecular report
|
$37.85 |
$150.30 |
$258.25 |
|
|
Cytopath c/v manual
|
$14.00 |
$14.00 |
$26.00 |
|
|
Cytopathology cellular enhancement technique non-gyn
|
$143.00 |
$179.00 |
$1,022.30 |
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$33.35 |
$73.85 |
$189.75 |
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$71.55 |
$119.55 |
$228.10 |
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$163.65 |
$239.15 |
$538.45 |
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$121.90 |
$267.25 |
$730.65 |
|
|
Cytopath smear other source
|
$75.85 |
$98.50 |
$226.50 |
|
|
Dacarbazine 100 mg intravenous solution
|
$62.41 |
$139.24 |
$150.53 |
|
|
Dalbavancin 500 mg intravenous solution
|
$2,181.75 |
$4,248.21 |
$7,747.94 |
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$93.64 |
$364.47 |
$2,379.61 |
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$25,243.50 |
$27,623.23 |
$27,827.27 |
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$3,530.83 |
$7,835.98 |
$13,482.70 |
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$3,229.90 |
$4,372.70 |
$4,856.25 |
|
|
Dch glucoscan
|
$10.65 |
$29.65 |
$45.00 |
|
|
Dch pulmonary stress test
|
$897.50 |
$897.50 |
$897.50 |
|
|
Dch validity tests
|
$13.35 |
$18.35 |
$23.45 |
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$1,430.70 |
$1,430.70 |
$1,430.70 |
|
|
Deamidated gliadin antibody iga
|
$15.25 |
$34.25 |
$96.40 |
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$95.85 |
$121.45 |
$1,773.00 |
|
|
Debridement (>20 cm) charge pt
|
$52.00 |
$250.70 |
$604.60 |
|
|
Debridement bone <= 20 sq cm
|
$1,063.55 |
$2,347.90 |
$4,417.65 |
|
|
Debridement/bone/20 sq cm or less 11046
|
$163.30 |
$1,231.50 |
$1,231.50 |
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$278.05 |
$2,308.80 |
$2,347.90 |
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$156.20 |
$562.10 |
$967.75 |
|