|
CT lwr extremity w/o&w/dye
|
$1,694.00 |
$1,694.00 |
$1,694.00 |
$1,854.05
|
|
CT neck soft tissue w/contrast
|
$1,098.00 |
$1,098.00 |
$1,098.00 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$957.00 |
$957.00 |
$957.00 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$90.50 |
$90.50 |
$90.50 |
$1,959.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$843.00 |
$843.00 |
$843.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$754.00 |
$754.00 |
$754.00 |
$1,360.00
|
|
Ctrl nosebld postir subsq 30906
|
$227.00 |
$227.00 |
$227.00 |
$437.04
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$3,491.50 |
$3,491.50 |
$3,491.50 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,357.00 |
$2,357.00 |
$2,357.00 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,898.00 |
$1,898.00 |
$1,898.00 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$1,519.50 |
$1,519.50 |
$1,519.50 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$957.00 |
$957.00 |
$957.00 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$120.00 |
$120.00 |
$120.00 |
$331.50
|
|
CT upper extremity w/contrast (both sides)
|
$1,131.00 |
$1,131.00 |
$1,131.00 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$969.00 |
$969.00 |
$969.00 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$68.50 |
$68.50 |
$68.50 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$50.50 |
$50.50 |
$50.50 |
$68.64
|
|
Culture afb any source
|
$195.00 |
$195.00 |
$195.00 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$24.00 |
$24.00 |
$24.00 |
$79.00
|
|
Culture anaerobic except blood
|
$66.00 |
$66.00 |
$66.00 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$51.00 |
$51.00 |
$51.00 |
$51.45
|
|
Culture body fluid
|
$66.00 |
$66.00 |
$66.00 |
$126.75
|
|
Culture fungi definitive id mold
|
$94.00 |
$94.00 |
$94.00 |
$77.28
|
|
Culture fungi definitive id yeast
|
$50.50 |
$50.50 |
$50.50 |
$79.10
|
|
Culture fungi other (except blood)
|
$66.00 |
$66.00 |
$66.00 |
$108.00
|
|
Culture mycobacteria definitive id each isolate
|
$140.00 |
$140.00 |
$140.00 |
$89.70
|
|
Culture screening strep group a
|
$50.50 |
$50.50 |
$50.50 |
$81.00
|
|
Culture typing immunologic
|
$76.50 |
$76.50 |
$76.50 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$352.00 |
$352.00 |
$352.00 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$202.00 |
$202.00 |
$202.00 |
$133.90
|
|
Culture urine each isolate
|
$25.50 |
$25.50 |
$25.50 |
$57.00
|
|
Curette/treat cornea
|
$72.50 |
$72.50 |
$72.50 |
$1,345.80
|
|
Curette/treat cornea
|
$381.50 |
$381.50 |
$381.50 |
$2,818.14
|
|
Cv line/pic reposition
|
$64.50 |
$64.50 |
$64.50 |
$1,720.93
|
|
Cv stress test i&r only 93018
|
$16.50 |
$16.50 |
$16.50 |
$40.20
|
|
Cv stress test/supervision only 93016
|
$25.50 |
$25.50 |
$25.50 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$5.05 |
$5.05 |
$5.05 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$121.00 |
$121.00 |
$121.00 |
$70.72
|
|
Cyclosporine 2 hour
|
$136.00 |
$136.00 |
$136.00 |
$129.48
|
|
Cygnus matrix, per sq cm
|
$221.50 |
$221.50 |
$221.50 |
$295.20
|
|
Cystatin c
|
$33.00 |
$33.00 |
$33.00 |
$77.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$18.50 |
$18.50 |
$18.50 |
$542.10
|
|
Cysto, litho, vacuum kidney
|
$422.50 |
$422.50 |
$422.50 |
$10,942.71
|
|
Cystometrogram w/up 51727
|
$129.50 |
$129.50 |
$129.50 |
$908.59
|
|
Cystorrhaphy wound comp 51865
|
$989.00 |
$989.00 |
$989.00 |
$1,756.80
|
|
Cystorrhaphy wound simple 51860
|
$831.00 |
$831.00 |
$831.00 |
$5,855.00
|
|
Cysto rx balo cath urtl strx
|
$179.00 |
$179.00 |
$179.00 |
$6,015.75
|
|
Cystoscopy and biopsy
|
$181.00 |
$181.00 |
$181.00 |
$4,081.37
|
|
Cystoscopy and treatment
|
$187.50 |
$187.50 |
$187.50 |
$4,081.37
|
|
Cystoscopy and treatment
|
$217.00 |
$217.00 |
$217.00 |
$4,160.10
|
|
Cystoscopy and treatment
|
$266.00 |
$266.00 |
$266.00 |
$5,162.50
|
|
Cystoscopy and treatment
|
$312.50 |
$312.50 |
$312.50 |
$5,995.60
|
|
Cystoscopy and treatment
|
$423.00 |
$423.00 |
$423.00 |
$6,475.26
|
|
Cystoscopy and treatment
|
$228.00 |
$228.00 |
$228.00 |
$3,213.14
|
|
Cystoscopy and treatment
|
$177.00 |
$177.00 |
$177.00 |
$2,424.12
|
|
Cystoscopy and treatment
|
$286.50 |
$286.50 |
$286.50 |
$4,045.60
|
|
Cystoscopy and treatment
|
$313.50 |
$313.50 |
$313.50 |
$4,081.37
|
|
Cystoscopy and treatment
|
$165.00 |
$165.00 |
$165.00 |
$2,874.36
|
|
Cystoscopy and treatment
|
$298.00 |
$298.00 |
$298.00 |
$3,203.50
|
|
Cystoscopy and treatment
|
$266.00 |
$266.00 |
$266.00 |
$4,061.71
|
|
Cystoscopy and treatment
|
$284.00 |
$284.00 |
$284.00 |
$3,820.84
|
|
Cystoscopy (Bladder Scope)
|
$571.00 |
$571.00 |
$571.00 |
$1,493.80
|
|
Cystoscopy chemodenervation
|
$183.00 |
$183.00 |
$183.00 |
$2,704.80
|
|
Cystoscopy implant stent
|
$365.00 |
$365.00 |
$365.00 |
$4,627.00
|
|
Cystoscopy removal of clots
|
$2,881.00 |
$2,881.00 |
$2,881.00 |
$4,081.37
|
|
Cystoscopy & revise urethra
|
$269.00 |
$269.00 |
$269.00 |
$2,874.36
|
|
Cystoscopy stone removal
|
$346.00 |
$346.00 |
$346.00 |
$5,741.00
|
|
Cystoscopy & ureter catheter
|
$146.00 |
$146.00 |
$146.00 |
$3,786.00
|
|
Cystostomy cystotomy w/drainage 51040
|
$329.50 |
$329.50 |
$329.50 |
$3,863.60
|
|
Cystouretero & or pyeloscope
|
$327.50 |
$327.50 |
$327.50 |
$4,315.98
|
|
Cysto/uretero stricture tx
|
$399.00 |
$399.00 |
$399.00 |
$4,846.99
|
|
Cystouretero w/biopsy
|
$450.50 |
$450.50 |
$450.50 |
$5,986.78
|
|
Cystouretero w/excise tumor
|
$504.00 |
$504.00 |
$504.00 |
$5,584.80
|
|
Cysto/uretero w/lithotripsy
|
$449.00 |
$449.00 |
$449.00 |
$9,002.88
|
|
Cystouretero w/lithotripsy
|
$423.00 |
$423.00 |
$423.00 |
$7,061.60
|
|
Cystouretero w/renal strict
|
$481.50 |
$481.50 |
$481.50 |
$5,741.00
|
|
Cystouretero w/stone remove
|
$383.00 |
$383.00 |
$383.00 |
$5,110.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$167.00 |
$167.00 |
$167.00 |
$3,065.15
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$155.50 |
$155.50 |
$155.50 |
$4,045.60
|
|
Cystourethro w/addl implant 52442
|
$54.50 |
$54.50 |
$54.50 |
$2,161.60
|
|
Cystourethro w/implant
|
$226.00 |
$226.00 |
$226.00 |
$2,298.40
|
|
Cysto w/renal stricture tx
|
$372.00 |
$372.00 |
$372.00 |
$4,045.60
|
|
Cysto w/ureter stricture tx
|
$307.50 |
$307.50 |
$307.50 |
$4,081.37
|
|
Cytomegalovirus (cmv) antibody igg
|
$55.50 |
$55.50 |
$55.50 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$56.50 |
$56.50 |
$56.50 |
$97.50
|
|
Cyto/molecular report
|
$39.50 |
$39.50 |
$39.50 |
$133.20
|
|
Cytopath fl nongyn filter
|
$21.50 |
$21.50 |
$21.50 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$158.50 |
$158.50 |
$158.50 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$95.00 |
$95.00 |
$95.00 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$50.00 |
$50.00 |
$50.00 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$138.00 |
$138.00 |
$138.00 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$32.50 |
$32.50 |
$32.50 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$25.00 |
$25.00 |
$25.00 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$79.50 |
$79.50 |
$79.50 |
$209.23
|
|
Cytopath smear other source
|
$44.50 |
$44.50 |
$44.50 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$29.50 |
$29.50 |
$29.50 |
$96.20
|
|
Dalbavancin 500 mg intravenous solution
|
$13.50 |
$13.50 |
$13.50 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$24.80 |
$24.80 |
$24.80 |
$168.53
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$11.50 |
$11.50 |
$11.50 |
$6,072.48
|
|
Darbepoetin alfa, esrd use
|
$11.50 |
$11.50 |
$11.50 |
$4.48
|
