|
CT thorax low dose for lung screening without contrast
|
$293.04 |
$293.04 |
$293.04 |
$400.20
|
|
CT t-spine w /wo contrast
|
$1,228.92 |
$1,228.92 |
$1,228.92 |
$2,030.60
|
|
CT upper extremity w/contrast (both sides)
|
$1,058.64 |
$1,058.64 |
$1,058.64 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$895.62 |
$895.62 |
$895.62 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$1,302.84 |
$1,302.84 |
$1,302.84 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$57.20 |
$57.20 |
$57.20 |
$63.75
|
|
Culture afb any source
|
$56.10 |
$56.10 |
$56.10 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$47.85 |
$47.85 |
$47.85 |
$77.31
|
|
Culture anaerobic except blood
|
$47.85 |
$47.85 |
$47.85 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$72.05 |
$72.05 |
$72.05 |
$52.80
|
|
Culture body fluid
|
$116.05 |
$116.05 |
$116.05 |
$130.50
|
|
Culture fungi definitive id mold
|
$56.10 |
$56.10 |
$56.10 |
$70.00
|
|
Culture fungi definitive id yeast
|
$100.65 |
$100.65 |
$100.65 |
$80.60
|
|
Culture fungi other (except blood)
|
$47.85 |
$47.85 |
$47.85 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$63.80 |
$63.80 |
$63.80 |
$77.40
|
|
Culture mycobacteria definitive id each isolate
|
$62.70 |
$62.70 |
$62.70 |
$84.75
|
|
Culture mycoplasma any source
|
$47.30 |
$47.30 |
$47.30 |
$90.37
|
|
Culture quantitative aerobic other source
|
$151.25 |
$151.25 |
$151.25 |
$87.02
|
|
Culture screening strep group a
|
$117.70 |
$117.70 |
$117.70 |
$81.60
|
|
Culture typing immunologic
|
$36.30 |
$36.30 |
$36.30 |
$41.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$240.35 |
$240.35 |
$240.35 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$99.55 |
$99.55 |
$99.55 |
$124.40
|
|
Culture urine each isolate
|
$66.00 |
$66.00 |
$66.00 |
$46.20
|
|
Cutter lead
|
$664.56 |
$664.56 |
$664.56 |
$5,538.98
|
|
Cv line/pic reposition
|
$5,076.06 |
$5,076.06 |
$5,076.06 |
$1,829.42
|
|
Cyanocobalamin unsat binding capacity
|
$77.00 |
$77.00 |
$77.00 |
$60.00
|
|
Cyclic citrullinated peptide antibody
|
$79.75 |
$79.75 |
$79.75 |
$80.05
|
|
Cyclosporine 2 hour
|
$113.30 |
$113.30 |
$113.30 |
$121.80
|
|
Cyp2c19 gene com variants
|
$963.05 |
$963.05 |
$963.05 |
$567.75
|
|
Cystatin c
|
$55.55 |
$55.55 |
$55.55 |
$82.26
|
|
Cystic fibrosis cftr
|
$977.35 |
$977.35 |
$977.35 |
$1,041.95
|
|
Cystine urine quantitative
|
$205.15 |
$205.15 |
$205.15 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$798.60 |
$798.60 |
$798.60 |
$539.55
|
|
Cystoscopy (Bladder Scope)
|
$884.59 |
$884.59 |
$884.59 |
$1,610.20
|
|
Cystoscopy & ureter catheter
|
$2,194.50 |
$2,194.50 |
$2,194.50 |
$3,416.48
|
|
Cystostomy cystotomy w/drainage 51040
|
$4,902.62 |
$4,902.62 |
$4,902.62 |
$3,774.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$162.25 |
$162.25 |
$162.25 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$345.95 |
$345.95 |
$345.95 |
$96.80
|
|
Cyto/molecular report
|
$180.95 |
$180.95 |
$180.95 |
$144.75
|
|
Cytopath fl nongyn filter
|
$139.70 |
$139.70 |
$139.70 |
$73.70
|
|
Cytopathology cellular enhancement technique non-gyn
|
$261.25 |
$261.25 |
$261.25 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$85.80 |
$85.80 |
$85.80 |
$90.75
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$114.95 |
$114.95 |
$114.95 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$112.20 |
$112.20 |
$112.20 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$151.25 |
$151.25 |
$151.25 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$74.25 |
$74.25 |
$74.25 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$104.50 |
$104.50 |
$104.50 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$155.65 |
$155.65 |
$155.65 |
$205.00
|
|
Cytopath smear other source
|
$120.45 |
$120.45 |
$120.45 |
$85.80
|
|
Cytopath smear oth prep screen & interp
|
$120.45 |
$120.45 |
$120.45 |
$95.89
|
|
Cytopath tbs c/v manual
|
$85.80 |
$85.80 |
$85.80 |
$57.94
|
|
Cytotoxic antibody screening
|
$212.85 |
$212.85 |
$212.85 |
$157.60
|
|
Cytp urine 3-5 probes cmptr
|
$415.25 |
$415.25 |
$415.25 |
$690.00
|
|
D&c after delivery 59160
|
$2,297.43 |
$2,297.43 |
$2,297.43 |
$3,762.53
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$2,641.32 |
$2,641.32 |
$2,641.32 |
$3,774.81
|
|
Dch validity tests
|
$30.25 |
$30.25 |
$30.25 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$54.45 |
$54.45 |
$54.45 |
$44.16
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$594.66 |
$594.66 |
$594.66 |
$692.00
|
|
Debridement (>20 cm) charge pt
|
$332.64 |
$332.64 |
$332.64 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$2,212.98 |
$2,212.98 |
$2,212.98 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$602.58 |
$602.58 |
$602.58 |
$688.80
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,710.72 |
$1,710.72 |
$1,710.72 |
$1,283.44
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,311.42 |
$1,311.42 |
$1,311.42 |
$810.50
|
|
Debride nail1-5 11720
|
$86.46 |
$86.46 |
$86.46 |
$173.25
|
|
Debride nail6 or more 11721
|
$199.32 |
$199.32 |
$199.32 |
$195.20
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$2,052.60 |
$2,052.60 |
$2,052.60 |
$1,265.16
|
|
Debride skin bone at fx site
|
$2,166.78 |
$2,166.78 |
$2,166.78 |
$3,278.34
|
|
Debride skn/sq/musc/abd wall 11004
|
$791.45 |
$791.45 |
$791.45 |
$1,184.95
|
|
Debride skn/sq t/m/f necro infctj abdl wall 11005
|
$1,075.80 |
$1,075.80 |
$1,075.80 |
$2,291.20
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$821.04 |
$821.04 |
$821.04 |
$663.30
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,939.08 |
$1,939.08 |
$1,939.08 |
$1,129.45
|
|
Debr inf skin add-on 11001
|
$124.08 |
$124.08 |
$124.08 |
$113.05
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,836.12 |
$1,836.12 |
$1,836.12 |
$1,193.40
|
|
Decalcification
|
$64.90 |
$64.90 |
$64.90 |
$73.60
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$669.24 |
$669.24 |
$669.24 |
$545.90
|
|
Delay flap eye/nos/ear/lip
|
$446.05 |
$446.05 |
$446.05 |
$2,190.24
|
|
Delay flap fccnaxghf 15620
|
$421.85 |
$421.85 |
$421.85 |
$2,164.64
|
|
Delivery of placenta 59414
|
$3,175.92 |
$3,175.92 |
$3,175.92 |
$3,271.20
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$99.00 |
$99.00 |
$99.00 |
$196.26
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$194.04 |
$194.04 |
$194.04 |
$460.50
|
|
Derma-fat-fascia graft 15770
|
$877.25 |
$877.25 |
$877.25 |
$4,326.42
|
|
Design mlc device for imrt
|
$1,477.68 |
$1,477.68 |
$1,477.68 |
$1,669.85
|
|
Destroy cervthor facet jnt 64633
|
$323.14 |
$323.14 |
$323.14 |
$3,164.80
|
|
Destroy cth facet jnt addl 64634
|
$179.04 |
$179.04 |
$179.04 |
$1,441.44
|
|
Destroy premlg lesns;1st lesn 17000
|
$77.62 |
$77.62 |
$77.62 |
$220.12
|
|
Destruct cut vasl lesions >50cm 17108
|
$693.55 |
$693.55 |
$693.55 |
$1,999.13
|
|
Destruction 2-14 lesions 17003
|
$8.71 |
$8.71 |
$8.71 |
$72.60
|
|
Destruction benign lesions < 14 lesions
|
$181.50 |
$181.50 |
$181.50 |
$250.60
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$177.16 |
$177.16 |
$177.16 |
$1,879.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$325.10 |
$325.10 |
$325.10 |
$3,375.00
|
|
Device ablt adv novasure
|
$5,004.93 |
$5,004.93 |
$5,004.93 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$2,690.19 |
$2,690.19 |
$2,690.19 |
$4,298.87
|
|
Device tiss remov myosure reach
|
$1,111.99 |
$1,111.99 |
$1,111.99 |
$2,440.98
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$166.98 |
$166.98 |
$166.98 |
$220.43
|
|
Dhea-s (dehydroepiand sulfate)
|
$205.15 |
$205.15 |
$205.15 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$58.30 |
$58.30 |
$58.30 |
$78.03
|
|
Diab manage trn ind/group
|
$71.50 |
$71.50 |
$71.50 |
$49.50
|
|
Diagnostic anoscopy spx 46600
|
$71.06 |
$71.06 |
$71.06 |
$245.35
|
|
Diagnostic digital breast tomosynthesis bil
|
$103.00 |
$103.00 |
$103.00 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$51.50 |
$51.50 |
$51.50 |
$75.93
|
