|
CT thorax low dose for lung screening without contrast
|
$57.60 |
$57.60 |
$57.60 |
$359.90
|
|
CT t-spine w /wo contrast
|
$1,302.75 |
$1,302.75 |
$1,302.75 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$947.70 |
$947.70 |
$947.70 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$829.35 |
$829.35 |
$829.35 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$953.10 |
$953.10 |
$953.10 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$41.85 |
$41.85 |
$41.85 |
$68.64
|
|
Culture afb any source
|
$46.80 |
$46.80 |
$46.80 |
$107.92
|
|
Culture anaerobic additional method definitive id each
|
$95.40 |
$95.40 |
$95.40 |
$77.31
|
|
Culture anaerobic except blood
|
$179.55 |
$179.55 |
$179.55 |
$119.20
|
|
Culture bact stool aero addl path ea
|
$83.25 |
$83.25 |
$83.25 |
$52.50
|
|
Culture body fluid
|
$53.55 |
$53.55 |
$53.55 |
$126.75
|
|
Culture fungi definitive id yeast
|
$50.40 |
$50.40 |
$50.40 |
$79.00
|
|
Culture fungi other (except blood)
|
$65.25 |
$65.25 |
$65.25 |
$108.80
|
|
Culture fungi skin/hair/nail
|
$150.75 |
$150.75 |
$150.75 |
$77.37
|
|
Culture mycoplasma any source
|
$53.55 |
$53.55 |
$53.55 |
$86.40
|
|
Culture quantitative aerobic other source
|
$17.10 |
$17.10 |
$17.10 |
$89.40
|
|
Culture screening strep group a
|
$222.30 |
$222.30 |
$222.30 |
$85.80
|
|
Culture typing immunologic
|
$95.40 |
$95.40 |
$95.40 |
$40.86
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$330.75 |
$330.75 |
$330.75 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$49.50 |
$49.50 |
$49.50 |
$123.76
|
|
Culture urine each isolate
|
$41.40 |
$41.40 |
$41.40 |
$51.35
|
|
Cyanocobalamin unsat binding capacity
|
$48.60 |
$48.60 |
$48.60 |
$64.28
|
|
Cyclic citrullinated peptide antibody
|
$45.90 |
$45.90 |
$45.90 |
$70.98
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,448.21 |
$1,448.21 |
$1,448.21 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$100.80 |
$100.80 |
$100.80 |
$126.10
|
|
Cystatin c
|
$45.90 |
$45.90 |
$45.90 |
$78.75
|
|
Cystic fibrosis cftr
|
$757.80 |
$757.80 |
$757.80 |
$1,060.00
|
|
Cystine urine quantitative
|
$489.15 |
$489.15 |
$489.15 |
$101.60
|
|
Cystoscopy and treatment
|
$2,501.10 |
$2,501.10 |
$2,501.10 |
$2,896.40
|
|
Cystoscopy (Bladder Scope)
|
$723.60 |
$723.60 |
$723.60 |
$1,594.35
|
|
Cystourethroscop/calib/dilat stric 52281
|
$1,150.20 |
$1,150.20 |
$1,150.20 |
$3,015.50
|
|
Cytogenomic neo microra alys
|
$1,832.40 |
$1,832.40 |
$1,832.40 |
$2,020.20
|
|
Cytog genom-wid alys hem mal
|
$994.50 |
$994.50 |
$994.50 |
$1,263.53
|
|
Cytomegalovirus (cmv) antibody igg
|
$17.10 |
$17.10 |
$17.10 |
$95.45
|
|
Cytomegalovirus (cmv) antibody igm
|
$125.55 |
$125.55 |
$125.55 |
$95.00
|
|
Cytomegalovirus dfa
|
$174.15 |
$174.15 |
$174.15 |
$74.88
|
|
Cytopathology cellular enhancement technique non-gyn
|
$84.15 |
$84.15 |
$84.15 |
$162.50
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$54.45 |
$54.45 |
$54.45 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$24.75 |
$24.75 |
$24.75 |
$87.50
|
|
Cytp urine 3-5 probes cmptr
|
$482.85 |
$482.85 |
$482.85 |
$745.00
|
|
Dactinomycin 0.5 mg intravenous solution
|
$1,896.49 |
$1,896.49 |
$1,896.49 |
$3,703.37
|
|
Daptomycin (xellia) unrefrig
|
$56.19 |
$56.19 |
$56.19 |
$0.05
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$385.91 |
$385.91 |
$385.91 |
$259.58
|
|
Dch validity tests
|
$43.20 |
$43.20 |
$43.20 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$17.10 |
$17.10 |
$17.10 |
$44.20
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$340.65 |
$340.65 |
$340.65 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$640.35 |
$640.35 |
$640.35 |
$274.56
|
|
Debridement bone <= 20 sq cm
|
$1,717.20 |
$1,717.20 |
$1,717.20 |
$2,359.20
|
|
Debridement/bone/20 sq cm or less 11046
|
$640.35 |
$640.35 |
$640.35 |
$681.60
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,717.20 |
$1,717.20 |
$1,717.20 |
$1,418.55
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$481.05 |
$481.05 |
$481.05 |
$825.60
|
|
Debride nail1-5 11720
|
$117.90 |
$117.90 |
$117.90 |
$164.56
|
|
Debride nail6 or more 11721
|
$148.50 |
$148.50 |
$148.50 |
$179.20
|
|
Debride skin bone at fx site
|
$1,641.15 |
$1,641.15 |
$1,641.15 |
$3,015.00
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$640.35 |
$640.35 |
$640.35 |
$663.30
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$749.25 |
$749.25 |
$749.25 |
$1,146.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$640.35 |
$640.35 |
$640.35 |
$1,193.40
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$489.15 |
$489.15 |
$489.15 |
$540.00
|
|
Delivery of placenta 59414
|
$1,216.35 |
$1,216.35 |
$1,216.35 |
$3,073.67
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$108.00 |
$108.00 |
$108.00 |
$414.78
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,003.52 |
$1,003.52 |
$1,003.52 |
$88.74
|
|
Destroy cervthor facet jnt 64633
|
$1,154.25 |
$1,154.25 |
$1,154.25 |
$3,003.84
|
|
Destroy cth facet jnt addl 64634
|
$561.60 |
$561.60 |
$561.60 |
$1,441.44
|
|
Destroy premlg lesns;1st lesn 17000
|
$117.90 |
$117.90 |
$117.90 |
$203.04
|
|
Destruct ben lesion 15/> 17111
|
$175.50 |
$175.50 |
$175.50 |
$235.13
|
|
Destruction 2-14 lesions 17003
|
$117.90 |
$117.90 |
$117.90 |
$78.61
|
|
Destruction benign lesions < 14 lesions
|
$117.90 |
$117.90 |
$117.90 |
$248.25
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$561.60 |
$561.60 |
$561.60 |
$1,648.00
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,154.25 |
$1,154.25 |
$1,154.25 |
$3,205.20
|
|
Detect agent nos dna dir
|
$65.25 |
$65.25 |
$65.25 |
$80.08
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$244.78 |
$244.78 |
$244.78 |
$842.89
|
|
Dhea-s (dehydroepiand sulfate)
|
$30.15 |
$30.15 |
$30.15 |
$109.00
|
|
Diabetes (HbA1c) Test
|
$52.20 |
$52.20 |
$52.20 |
$79.52
|
|
Diab manage trn ind/group
|
$15.30 |
$15.30 |
$15.30 |
$57.75
|
|
Diagnostic digital breast tomosynthesis bil
|
$47.25 |
$47.25 |
$47.25 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$47.25 |
$47.25 |
$47.25 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$95.40 |
$95.40 |
$95.40 |
$374.65
|
|
Diagnostic Mammogram (both breasts)
|
$279.90 |
$279.90 |
$279.90 |
$405.00
|
|
Diagnostic Mammogram (one breast)
|
$192.60 |
$192.60 |
$192.60 |
$313.29
|
|
Digoxin total therapeutic drug level
|
$76.95 |
$76.95 |
$76.95 |
$100.20
|
|
Dilate urethra stricture
|
$296.55 |
$296.55 |
$296.55 |
$514.79
|
|
Disaccharidases
|
$161.10 |
$161.10 |
$161.10 |
$214.40
|
|
Dna antibody native/double stranded
|
$55.35 |
$55.35 |
$55.35 |
$100.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$319.95 |
$319.95 |
$319.95 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$549.45 |
$549.45 |
$549.45 |
$481.65
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$1,561.11 |
$1,561.11 |
$1,561.11 |
$1,718.24
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$411.75 |
$411.75 |
$411.75 |
$820.50
|
|
Drainage ext aud canal abscess 69020
|
$411.75 |
$411.75 |
$411.75 |
$973.71
|
|
Drainage external ear complex 69005
|
$1,025.55 |
$1,025.55 |
$1,025.55 |
$2,888.03
|
|
Drainage external ear simple 69000
|
$126.90 |
$126.90 |
$126.90 |
$794.82
|
|
Drainage mouth roof lesion
|
$230.85 |
$230.85 |
$230.85 |
$418.07
|
|
Drainage of arm bursa 23931
|
$1,640.70 |
$1,640.70 |
$1,640.70 |
$2,439.75
|
|
Drainage of eye
|
$3,152.70 |
$3,152.70 |
$3,152.70 |
$2,360.00
|
|
Drainage of mouth lesion
|
$3,701.70 |
$3,701.70 |
$3,701.70 |
$3,783.78
|
|
Drainage of nose lesion int 30000
|
$131.40 |
$131.40 |
$131.40 |
$548.00
|
|
Drain blood from under nail 11740
|
$53.10 |
$53.10 |
$53.10 |
$182.95
|
|
Drain cerebro spinal fluid 62272
|
$464.85 |
$464.85 |
$464.85 |
$1,045.65
|
|
Drain finger abscess;simple 26010
|
$88.65 |
$88.65 |
$88.65 |
$450.40
|
|
Drain thigh/knee lesion 27301
|
$246.15 |
$246.15 |
$246.15 |
$3,687.20
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$640.35 |
$640.35 |
$640.35 |
$402.93
|
