|
CT Angiogram of the Chest (for blood clot)
|
$1,222.65 |
$1,222.65 |
$1,222.65 |
$2,015.65
|
|
CT Angiogram of the Head
|
$1,222.65 |
$1,222.65 |
$1,222.65 |
$2,032.54
|
|
CT angio hrt w/3d image
|
$536.80 |
$536.80 |
$536.80 |
$1,601.60
|
|
CT angio pelvis
|
$1,018.60 |
$1,018.60 |
$1,018.60 |
$1,775.28
|
|
Cta upper extremity w &/or without contrast left
|
$1,222.65 |
$1,222.65 |
$1,222.65 |
$1,652.25
|
|
CT colonography dx
|
$672.65 |
$672.65 |
$672.65 |
$770.90
|
|
CT colonography dx w/dye
|
$1,018.60 |
$1,018.60 |
$1,018.60 |
$1,009.98
|
|
CT colonography screening
|
$672.65 |
$672.65 |
$672.65 |
$1,084.20
|
|
CT guidance for needle placement
|
$1,150.60 |
$1,150.60 |
$1,150.60 |
$1,506.04
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,462.45 |
$1,462.45 |
$1,462.45 |
$1,085.05
|
|
CT guid cryo ablat intramuscular
|
$2,136.75 |
$2,136.75 |
$2,136.75 |
$1,693.00
|
|
CT guid parench tis ablat
|
$591.25 |
$591.25 |
$591.25 |
$1,282.50
|
|
CT heart w/evaluation of calcium without contrast
|
$88.55 |
$88.55 |
$88.55 |
$192.00
|
|
CT hrt c+ strux cgen hrt ds
|
$343.20 |
$343.20 |
$343.20 |
$1,217.45
|
|
CT hrt w/3d image
|
$624.80 |
$624.80 |
$624.80 |
$1,424.40
|
|
CT limited or localized follow-up study
|
$457.60 |
$457.60 |
$457.60 |
$626.07
|
|
CT lower extremity w/contrast (both sides)
|
$1,018.60 |
$1,018.60 |
$1,018.60 |
$1,693.20
|
|
CT lower extremity without contrast (both sides)
|
$815.10 |
$815.10 |
$815.10 |
$1,400.00
|
|
CT lwr extremity w/o&w/dye
|
$1,562.00 |
$1,562.00 |
$1,562.00 |
$1,817.40
|
|
CT neck soft tissue w/contrast
|
$1,018.60 |
$1,018.60 |
$1,018.60 |
$1,669.00
|
|
CT neck soft tissue without contrast
|
$883.30 |
$883.30 |
$883.30 |
$1,357.54
|
|
CT neck soft tissue without & w/contrast
|
$1,222.65 |
$1,222.65 |
$1,222.65 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,222.65 |
$1,222.65 |
$1,222.65 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,018.60 |
$1,018.60 |
$1,018.60 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$883.30 |
$883.30 |
$883.30 |
$1,370.85
|
|
Ctrl nosebld postir subsq 30906
|
$616.55 |
$616.55 |
$616.55 |
$470.73
|
|
CT scan for therapy guide
|
$815.10 |
$815.10 |
$815.10 |
$729.40
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$2,581.15 |
$2,581.15 |
$2,581.15 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,309.45 |
$2,309.45 |
$2,309.45 |
$2,855.63
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,037.75 |
$2,037.75 |
$2,037.75 |
$2,299.15
|
|
CT thoracic spine w/contrast
|
$1,018.60 |
$1,018.60 |
$1,018.60 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$815.10 |
$815.10 |
$815.10 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$771.65 |
$771.65 |
$771.65 |
$420.60
|
|
CT t-spine w /wo contrast
|
$1,222.65 |
$1,222.65 |
$1,222.65 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$1,018.60 |
$1,018.60 |
$1,018.60 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$815.10 |
$815.10 |
$815.10 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$1,222.65 |
$1,222.65 |
$1,222.65 |
$1,841.10
|
|
Culture aerobic additional method definitive id each
|
$40.70 |
$40.70 |
$40.70 |
$63.60
|
|
Culture afb any source
|
$140.25 |
$140.25 |
$140.25 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$45.65 |
$45.65 |
$45.65 |
$77.31
|
|
Culture anaerobic except blood
|
$70.95 |
$70.95 |
$70.95 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$41.25 |
$41.25 |
$41.25 |
$52.80
|
|
Culture body fluid
|
$179.85 |
$179.85 |
$179.85 |
$130.50
|
|
Culture fungi definitive id mold
|
$50.60 |
$50.60 |
$50.60 |
$70.00
|
|
Culture fungi definitive id yeast
|
$48.95 |
$48.95 |
$48.95 |
$79.10
|
|
Culture fungi other (except blood)
|
$78.10 |
$78.10 |
$78.10 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$28.05 |
$28.05 |
$28.05 |
$77.37
|
|
Culture mycobacteria definitive id each isolate
|
$155.65 |
$155.65 |
$155.65 |
$84.80
|
|
Culture mycoplasma any source
|
$156.20 |
$156.20 |
$156.20 |
$90.37
|
|
Culture quantitative aerobic other source
|
$92.40 |
$92.40 |
$92.40 |
$87.02
|
|
Culture screening strep group a
|
$53.35 |
$53.35 |
$53.35 |
$79.20
|
|
Culture typing immunologic
|
$39.05 |
$39.05 |
$39.05 |
$42.12
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$594.00 |
$594.00 |
$594.00 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$74.25 |
$74.25 |
$74.25 |
$124.02
|
|
Culture urine each isolate
|
$42.90 |
$42.90 |
$42.90 |
$46.20
|
|
Cutter lead
|
$701.82 |
$701.82 |
$701.82 |
$4,328.06
|
|
Cv line/pic reposition
|
$2,247.85 |
$2,247.85 |
$2,247.85 |
$1,801.20
|
|
Cyanocobalamin unsat binding capacity
|
$31.35 |
$31.35 |
$31.35 |
$58.20
|
|
Cyclic citrullinated peptide antibody
|
$39.05 |
$39.05 |
$39.05 |
$81.60
|
|
Cyclosporine 2 hour
|
$94.05 |
$94.05 |
$94.05 |
$120.20
|
|
Cylinder pump set 20cm titan zero angl
|
$14,599.39 |
$14,599.39 |
$14,599.39 |
$22,244.69
|
|
Cystatin c
|
$62.15 |
$62.15 |
$62.15 |
$81.00
|
|
Cystic fibrosis cftr
|
$1,200.10 |
$1,200.10 |
$1,200.10 |
$1,041.95
|
|
Cystine urine quantitative
|
$120.45 |
$120.45 |
$120.45 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$395.45 |
$395.45 |
$395.45 |
$527.50
|
|
Cystometrogram w/up 51727
|
$1,102.75 |
$1,102.75 |
$1,102.75 |
$857.38
|
|
Cystorrhaphy wound comp 51865
|
$9,077.75 |
$9,077.75 |
$9,077.75 |
$2,256.00
|
|
Cystorrhaphy wound simple 51860
|
$3,020.05 |
$3,020.05 |
$3,020.05 |
$4,627.00
|
|
Cystoscopy and treatment
|
$669.64 |
$669.64 |
$669.64 |
$4,081.37
|
|
Cystoscopy and treatment
|
$211.07 |
$211.07 |
$211.07 |
$4,081.37
|
|
Cystoscopy and treatment
|
$2,660.35 |
$2,660.35 |
$2,660.35 |
$3,070.20
|
|
Cystoscopy and treatment
|
$2,731.30 |
$2,731.30 |
$2,731.30 |
$3,219.80
|
|
Cystoscopy (Bladder Scope)
|
$1,493.80 |
$1,493.80 |
$1,493.80 |
$1,610.20
|
|
Cystoscopy chemodenervation
|
$145.07 |
$145.07 |
$145.07 |
$2,424.12
|
|
Cystoscopy removal of clots
|
$1,900.80 |
$1,900.80 |
$1,900.80 |
$3,970.98
|
|
Cystoscopy & ureter catheter
|
$2,392.50 |
$2,392.50 |
$2,392.50 |
$3,416.48
|
|
Cystostomy cystotomy w/drainage 51040
|
$1,803.45 |
$1,803.45 |
$1,803.45 |
$3,776.04
|
|
Cystourethroscop/calib/dilat stric 52281
|
$2,075.15 |
$2,075.15 |
$2,075.15 |
$2,849.55
|
|
Cytogenetics 25-99
|
$364.10 |
$364.10 |
$364.10 |
$177.45
|
|
Cytogenetics 3-5
|
$123.20 |
$123.20 |
$123.20 |
$127.64
|
|
Cytogenomic neo microra alys
|
$1,742.40 |
$1,742.40 |
$1,742.40 |
$1,911.78
|
|
Cytogenom microarray copy nmbr var
|
$4,225.10 |
$4,225.10 |
$4,225.10 |
$1,433.77
|
|
Cytomegalovirus (cmv) antibody igg
|
$194.15 |
$194.15 |
$194.15 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$155.65 |
$155.65 |
$155.65 |
$96.80
|
|
Cyto/molecular report
|
$191.95 |
$191.95 |
$191.95 |
$144.75
|
|
Cytopath c/v index add-on
|
$15.40 |
$15.40 |
$15.40 |
$29.60
|
|
Cytopath fl nongyn filter
|
$82.50 |
$82.50 |
$82.50 |
$66.61
|
|
Cytopathology cellular enhancement technique non-gyn
|
$80.85 |
$80.85 |
$80.85 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$62.70 |
$62.70 |
$62.70 |
$90.75
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$55.00 |
$55.00 |
$55.00 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$99.55 |
$99.55 |
$99.55 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$67.65 |
$67.65 |
$67.65 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$51.70 |
$51.70 |
$51.70 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$198.55 |
$198.55 |
$198.55 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$132.55 |
$132.55 |
$132.55 |
$205.00
|
|
Cytopath smear other source
|
$56.65 |
$56.65 |
$56.65 |
$85.80
|
|
Cytopath smear oth prep screen & interp
|
$116.05 |
$116.05 |
$116.05 |
$96.20
|
|
Cytopath tbs c/v manual
|
$62.70 |
$62.70 |
$62.70 |
$57.94
|
|
Cytotoxic antibody screening
|
$137.50 |
$137.50 |
$137.50 |
$157.60
|
|
D&c after delivery 59160
|
$2,605.90 |
$2,605.90 |
$2,605.90 |
$3,744.41
|