|
CT lower extremity without contrast (both sides)
|
$1,307.20 |
$1,307.20 |
$1,307.20 |
$1,403.73
|
|
CT lwr extremity w/o&w/dye
|
$1,716.80 |
$1,716.80 |
$1,716.80 |
$1,844.52
|
|
CT neck soft tissue w/contrast
|
$1,098.40 |
$1,098.40 |
$1,098.40 |
$1,669.00
|
|
CT neck soft tissue without contrast
|
$917.60 |
$917.60 |
$917.60 |
$1,344.60
|
|
CT neck soft tissue without & w/contrast
|
$1,142.40 |
$1,142.40 |
$1,142.40 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,110.40 |
$1,110.40 |
$1,110.40 |
$1,681.95
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$886.40 |
$886.40 |
$886.40 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$50.40 |
$50.40 |
$50.40 |
$1,369.73
|
|
Ctrl nosebld postir subsq 30906
|
$560.00 |
$560.00 |
$560.00 |
$481.00
|
|
CT scan for therapy guide
|
$700.00 |
$700.00 |
$700.00 |
$777.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$3,709.60 |
$3,709.60 |
$3,709.60 |
$3,472.30
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,883.20 |
$2,883.20 |
$2,883.20 |
$2,979.85
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,518.40 |
$2,518.40 |
$2,518.40 |
$2,412.75
|
|
CT thoracic spine w/contrast
|
$1,646.40 |
$1,646.40 |
$1,646.40 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$293.60 |
$293.60 |
$293.60 |
$427.70
|
|
CT t-spine w /wo contrast
|
$1,824.80 |
$1,824.80 |
$1,824.80 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$1,364.80 |
$1,364.80 |
$1,364.80 |
$1,706.10
|
|
CT upper extremity without contrast (both sides)
|
$1,345.60 |
$1,345.60 |
$1,345.60 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$1,592.00 |
$1,592.00 |
$1,592.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$132.80 |
$132.80 |
$132.80 |
$63.75
|
|
Culture afb any source
|
$80.80 |
$80.80 |
$80.80 |
$110.00
|
|
Culture anaerobic additional method definitive id each
|
$96.00 |
$96.00 |
$96.00 |
$77.31
|
|
Culture anaerobic except blood
|
$147.20 |
$147.20 |
$147.20 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$132.80 |
$132.80 |
$132.80 |
$52.65
|
|
Culture body fluid
|
$118.40 |
$118.40 |
$118.40 |
$130.50
|
|
Culture fungi definitive id mold
|
$142.40 |
$142.40 |
$142.40 |
$70.00
|
|
Culture fungi definitive id yeast
|
$112.80 |
$112.80 |
$112.80 |
$79.10
|
|
Culture fungi other (except blood)
|
$108.80 |
$108.80 |
$108.80 |
$99.88
|
|
Culture fungi skin/hair/nail
|
$59.20 |
$59.20 |
$59.20 |
$77.37
|
|
Culture mycoplasma any source
|
$94.40 |
$94.40 |
$94.40 |
$92.91
|
|
Culture screening strep group a
|
$109.60 |
$109.60 |
$109.60 |
$80.60
|
|
Culture typing immunologic
|
$102.40 |
$102.40 |
$102.40 |
$42.12
|
|
Culture urine each isolate
|
$23.20 |
$23.20 |
$23.20 |
$47.45
|
|
Cv stress test i&r only 93018
|
$21.60 |
$21.60 |
$21.60 |
$42.00
|
|
Cv stress test/supervision only 93016
|
$32.00 |
$32.00 |
$32.00 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$72.48 |
$72.48 |
$72.48 |
$26.73
|
|
Cyclic citrullinated peptide antibody
|
$83.20 |
$83.20 |
$83.20 |
$88.51
|
|
Cyclosporine 2 hour
|
$101.60 |
$101.60 |
$101.60 |
$120.20
|
|
Cyp2d6 gene com variants
|
$1,379.20 |
$1,379.20 |
$1,379.20 |
$537.50
|
|
Cystine urine quantitative
|
$169.60 |
$169.60 |
$169.60 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$481.60 |
$481.60 |
$481.60 |
$527.50
|
|
Cystometrogram w/up 51727
|
$507.20 |
$507.20 |
$507.20 |
$857.38
|
|
Cystorrhaphy wound simple 51860
|
$1,090.40 |
$1,090.40 |
$1,090.40 |
$4,296.14
|
|
Cystoscopy and treatment
|
$1,052.80 |
$1,052.80 |
$1,052.80 |
$4,031.47
|
|
Cystoscopy and treatment
|
$1,101.60 |
$1,101.60 |
$1,101.60 |
$4,160.10
|
|
Cystoscopy and treatment
|
$362.40 |
$362.40 |
$362.40 |
$4,078.65
|
|
Cystoscopy and treatment
|
$424.80 |
$424.80 |
$424.80 |
$4,881.00
|
|
Cystoscopy and treatment
|
$576.00 |
$576.00 |
$576.00 |
$5,855.00
|
|
Cystoscopy and treatment
|
$304.00 |
$304.00 |
$304.00 |
$2,874.36
|
|
Cystoscopy and treatment
|
$565.60 |
$565.60 |
$565.60 |
$2,269.38
|
|
Cystoscopy and treatment
|
$389.60 |
$389.60 |
$389.60 |
$2,412.45
|
|
Cystoscopy and treatment
|
$500.00 |
$500.00 |
$500.00 |
$2,355.42
|
|
Cystoscopy and treatment
|
$496.00 |
$496.00 |
$496.00 |
$936.00
|
|
Cystoscopy and treatment
|
$359.20 |
$359.20 |
$359.20 |
$2,355.42
|
|
Cystoscopy and treatment
|
$412.00 |
$412.00 |
$412.00 |
$3,769.31
|
|
Cystoscopy and treatment
|
$448.80 |
$448.80 |
$448.80 |
$3,174.25
|
|
Cystoscopy and treatment
|
$670.40 |
$670.40 |
$670.40 |
$3,219.80
|
|
Cystoscopy and treatment
|
$363.20 |
$363.20 |
$363.20 |
$3,891.34
|
|
Cystoscopy and treatment
|
$856.80 |
$856.80 |
$856.80 |
$3,817.53
|
|
Cystoscopy (Bladder Scope)
|
$363.20 |
$363.20 |
$363.20 |
$1,619.67
|
|
Cystoscopy chemodenervation
|
$544.80 |
$544.80 |
$544.80 |
$2,269.38
|
|
Cystoscopy implant stent
|
$416.00 |
$416.00 |
$416.00 |
$3,820.84
|
|
Cystoscopy removal of clots
|
$624.80 |
$624.80 |
$624.80 |
$3,786.00
|
|
Cystoscopy stone removal
|
$470.40 |
$470.40 |
$470.40 |
$3,997.70
|
|
Cystoscopy & ureter catheter
|
$422.40 |
$422.40 |
$422.40 |
$3,416.48
|
|
Cystostomy cystotomy w/drainage 51040
|
$440.00 |
$440.00 |
$440.00 |
$3,986.00
|
|
Cystouretero & or pyeloscope
|
$446.40 |
$446.40 |
$446.40 |
$4,315.98
|
|
Cystouretero w/biopsy
|
$613.60 |
$613.60 |
$613.60 |
$4,447.24
|
|
Cystouretero w/lithotripsy
|
$576.00 |
$576.00 |
$576.00 |
$5,986.78
|
|
Cystouretero w/stone remove
|
$521.60 |
$521.60 |
$521.60 |
$4,846.99
|
|
Cysto/uretero w/up stricture
|
$580.00 |
$580.00 |
$580.00 |
$3,817.53
|
|
Cystourethroscop/calib/dilat stric 52281
|
$456.00 |
$456.00 |
$456.00 |
$2,861.18
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$572.00 |
$572.00 |
$572.00 |
$3,970.98
|
|
Cystourethro w/addl implant 52442
|
$1,338.40 |
$1,338.40 |
$1,338.40 |
$1,502.96
|
|
Cystourethro w/implant
|
$1,947.20 |
$1,947.20 |
$1,947.20 |
$3,312.80
|
|
Cysto w/ureter stricture tx
|
$418.40 |
$418.40 |
$418.40 |
$4,074.86
|
|
Cytomegalovirus (cmv) antibody igg
|
$80.00 |
$80.00 |
$80.00 |
$102.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$88.00 |
$88.00 |
$88.00 |
$105.23
|
|
Cytomegalovirus dfa
|
$51.20 |
$51.20 |
$51.20 |
$79.34
|
|
Cyto/molecular report
|
$144.80 |
$144.80 |
$144.80 |
$150.30
|
|
Cytopathology cellular enhancement technique non-gyn
|
$211.20 |
$211.20 |
$211.20 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$94.40 |
$94.40 |
$94.40 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$148.80 |
$148.80 |
$148.80 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$47.20 |
$47.20 |
$47.20 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$154.40 |
$154.40 |
$154.40 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$102.40 |
$102.40 |
$102.40 |
$205.00
|
|
Cytopath smear other source
|
$109.60 |
$109.60 |
$109.60 |
$85.80
|
|
Cytopath tbs c/v manual
|
$59.20 |
$59.20 |
$59.20 |
$57.94
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$121.39 |
$121.39 |
$121.39 |
$544.35
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$13,815.66 |
$13,815.66 |
$13,815.66 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$9,534.50 |
$9,534.50 |
$9,534.50 |
$5,500.25
|
|
Dbrdmt prmlg les w/pdt
|
$401.60 |
$401.60 |
$401.60 |
$288.60
|
|
D&c after delivery 59160
|
$412.00 |
$412.00 |
$412.00 |
$3,441.98
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$444.80 |
$444.80 |
$444.80 |
$3,627.00
|
|
Dch glucoscan
|
$20.00 |
$20.00 |
$20.00 |
$24.20
|
|
Dch validity tests
|
$25.60 |
$25.60 |
$25.60 |
$25.00
|
|
D&c of cervical stump
|
$4,557.60 |
$4,557.60 |
$4,557.60 |
$3,519.29
|
|
Deamidated gliadin antibody iga
|
$80.00 |
$80.00 |
$80.00 |
$45.31
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$86.40 |
$86.40 |
$86.40 |
$668.98
|
