|
CT neck soft tissue without contrast
|
$1,316.71 |
$1,316.71 |
$1,316.71 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$1,706.77 |
$1,706.77 |
$1,706.77 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,074.48 |
$2,074.48 |
$2,074.48 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,898.00 |
$1,898.00 |
$1,898.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,721.53 |
$1,721.53 |
$1,721.53 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$2,559.96 |
$2,559.96 |
$2,559.96 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,267.46 |
$2,267.46 |
$2,267.46 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,974.96 |
$1,974.96 |
$1,974.96 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$1,604.85 |
$1,604.85 |
$1,604.85 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,409.85 |
$1,409.85 |
$1,409.85 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$822.06 |
$822.06 |
$822.06 |
$420.60
|
|
CT t-spine w /wo contrast
|
$2,171.20 |
$2,171.20 |
$2,171.20 |
$2,030.60
|
|
CT upper extremity w/contrast (both sides)
|
$1,529.39 |
$1,529.39 |
$1,529.39 |
$1,697.85
|
|
CT upper extremity without contrast (both sides)
|
$1,473.36 |
$1,473.36 |
$1,473.36 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$1,640.99 |
$1,640.99 |
$1,640.99 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$69.10 |
$69.10 |
$69.10 |
$62.65
|
|
Culture afb any source
|
$175.24 |
$175.24 |
$175.24 |
$107.50
|
|
Culture anaerobic except blood
|
$145.73 |
$145.73 |
$145.73 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$52.85 |
$52.85 |
$52.85 |
$52.50
|
|
Culture body fluid
|
$145.73 |
$145.73 |
$145.73 |
$129.21
|
|
Culture fungi definitive id yeast
|
$40.69 |
$40.69 |
$40.69 |
$79.00
|
|
Culture fungi other (except blood)
|
$145.73 |
$145.73 |
$145.73 |
$94.90
|
|
Culture fungi skin/hair/nail
|
$145.73 |
$145.73 |
$145.73 |
$76.05
|
|
Culture screening strep group a
|
$44.27 |
$44.27 |
$44.27 |
$78.47
|
|
Culture typing immunologic
|
$72.35 |
$72.35 |
$72.35 |
$41.19
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$253.50 |
$253.50 |
$253.50 |
$101.45
|
|
Culture urine each isolate
|
$61.56 |
$61.56 |
$61.56 |
$46.20
|
|
Cyanocobalamin unsat binding capacity
|
$142.09 |
$142.09 |
$142.09 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$4.05 |
$4.05 |
$4.05 |
$26.73
|
|
Cyclic citrullinated peptide antibody
|
$77.55 |
$77.55 |
$77.55 |
$85.03
|
|
Cyclosporine 2 hour
|
$216.91 |
$216.91 |
$216.91 |
$119.40
|
|
Cyp2c19 gene com variants
|
$2,173.28 |
$2,173.28 |
$2,173.28 |
$553.00
|
|
Cyp2d6 gene com variants
|
$2,687.62 |
$2,687.62 |
$2,687.62 |
$525.95
|
|
Cystatin c
|
$44.66 |
$44.66 |
$44.66 |
$82.50
|
|
Cystic fibrosis cftr
|
$687.31 |
$687.31 |
$687.31 |
$1,041.95
|
|
Cystine urine quantitative
|
$124.87 |
$124.87 |
$124.87 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$588.77 |
$588.77 |
$588.77 |
$527.50
|
|
Cystoscopy and treatment
|
$446.55 |
$446.55 |
$446.55 |
$2,874.36
|
|
Cystoscopy (Bladder Scope)
|
$371.15 |
$371.15 |
$371.15 |
$1,619.67
|
|
Cytomegalovirus (cmv) antibody igg
|
$135.59 |
$135.59 |
$135.59 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$158.73 |
$158.73 |
$158.73 |
$101.94
|
|
Cyto/molecular report
|
$72.35 |
$72.35 |
$72.35 |
$150.30
|
|
Cytopathology cellular enhancement technique non-gyn
|
$163.09 |
$163.09 |
$163.09 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$137.54 |
$137.54 |
$137.54 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$70.66 |
$70.66 |
$70.66 |
$122.40
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$79.82 |
$79.82 |
$79.82 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$260.59 |
$260.59 |
$260.59 |
$203.08
|
|
Cytopath smear other source
|
$49.21 |
$49.21 |
$49.21 |
$85.80
|
|
Cytopath smear oth prep screen & interp
|
$265.92 |
$265.92 |
$265.92 |
$95.00
|
|
Cytopath tbs c/v manual
|
$146.90 |
$146.90 |
$146.90 |
$57.94
|
|
Cytotoxic antibody screening
|
$53.76 |
$53.76 |
$53.76 |
$157.60
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$42.30 |
$42.30 |
$42.30 |
$544.35
|
|
Dch glucoscan
|
$29.84 |
$29.84 |
$29.84 |
$23.25
|
|
Deamidated gliadin antibody iga
|
$27.04 |
$27.04 |
$27.04 |
$44.20
|
|
Decalcification
|
$73.71 |
$73.71 |
$73.71 |
$75.38
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$575.77 |
$575.77 |
$575.77 |
$497.14
|
|
Delivery of placenta 59414
|
$1,769.95 |
$1,769.95 |
$1,769.95 |
$3,135.14
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$100.23 |
$100.23 |
$100.23 |
$182.40
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,203.34 |
$3,203.34 |
$3,203.34 |
$7,737.00
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$376.16 |
$376.16 |
$376.16 |
$448.50
|
|
Desmopressin 4 mcg/ml injection solution
|
$72.23 |
$72.23 |
$72.23 |
$172.46
|
|
Detect agnt mult dna direc
|
$112.52 |
$112.52 |
$112.52 |
$109.60
|
|
Device intraute mirena
|
$1,127.87 |
$1,127.87 |
$1,127.87 |
$2,289.60
|
|
Device sut capio slim opn
|
$1,016.86 |
$1,016.86 |
$1,016.86 |
$1,350.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$126.23 |
$126.23 |
$126.23 |
$222.30
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$22.75 |
$22.75 |
$22.75 |
$43.65
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$22.75 |
$22.75 |
$22.75 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$209.50 |
$209.50 |
$209.50 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$53.76 |
$53.76 |
$53.76 |
$78.03
|
|
Diab manage trn ind/group
|
$35.49 |
$35.49 |
$35.49 |
$49.50
|
|
Diagnostic anoscopy spx 46600
|
$123.57 |
$123.57 |
$123.57 |
$245.35
|
|
Diagnostic Mammogram (both breasts)
|
$276.51 |
$276.51 |
$276.51 |
$403.32
|
|
Diagnostic Mammogram (one breast)
|
$210.02 |
$210.02 |
$210.02 |
$282.50
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$55.99 |
$55.99 |
$55.99 |
$67.89
|
|
Dicyclomine injection
|
$88.73 |
$88.73 |
$88.73 |
$210.00
|
|
Diffusing capacity
|
$198.97 |
$198.97 |
$198.97 |
$357.50
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$17.02 |
$17.02 |
$17.02 |
$53.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$4,663.43 |
$4,663.43 |
$4,663.43 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$125.06 |
$125.06 |
$125.06 |
$99.35
|
|
Dilate urethra stricture
|
$187.33 |
$187.33 |
$187.33 |
$514.79
|
|
Dilate urethra stricture
|
$187.33 |
$187.33 |
$187.33 |
$185.58
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$2.67 |
$2.67 |
$2.67 |
$22.58
|
|
Disability dlco
|
$163.22 |
$163.22 |
$163.22 |
$302.40
|
|
Disaccharidases
|
$209.43 |
$209.43 |
$209.43 |
$224.58
|
|
Discography cerv/thor spine
|
$796.38 |
$796.38 |
$796.38 |
$2,360.70
|
|
Dna antibody native/double stranded
|
$58.24 |
$58.24 |
$58.24 |
$101.40
|
|
Dna gardnerella
|
$60.06 |
$60.06 |
$60.06 |
$66.05
|
|
Dna trichomonas
|
$60.06 |
$60.06 |
$60.06 |
$68.50
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$90.89 |
$90.89 |
$90.89 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$31.40 |
$31.40 |
$31.40 |
$64.77
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$623.48 |
$623.48 |
$623.48 |
$490.82
|
|
Drainage external ear simple 69000
|
$200.92 |
$200.92 |
$200.92 |
$812.80
|
|
Drng of scrotum abscess 55100
|
$401.38 |
$401.38 |
$401.38 |
$1,997.89
|
|
Drug assay rufinamide
|
$72.35 |
$72.35 |
$72.35 |
$94.25
|
|
Drug assay voriconazole
|
$155.03 |
$155.03 |
$155.03 |
$96.75
|
|
Drug test def 1-7 classes
|
$197.15 |
$197.15 |
$197.15 |
$263.86
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$159.90 |
$159.90 |
$159.90 |
$278.85
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$1,068.67 |
$1,068.67 |
$1,068.67 |
$750.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$715.26 |
$715.26 |
$715.26 |
$885.60
|
|
Ear irrigation 69209
|
$96.79 |
$96.79 |
$96.79 |
$154.70
|