|
CT t-spine w /wo contrast
|
$715.30 |
$715.30 |
$715.30 |
$1,817.25
|
|
CT upper extremity w/contrast (both sides)
|
$1,771.19 |
$1,771.19 |
$1,771.19 |
$1,651.65
|
|
CT upper extremity without contrast (both sides)
|
$1,587.30 |
$1,587.30 |
$1,587.30 |
$1,408.54
|
|
CT uppr extremity w/o&w/dye
|
$1,476.49 |
$1,476.49 |
$1,476.49 |
$1,688.20
|
|
Culture aerobic additional method definitive id each
|
$27.38 |
$27.38 |
$27.38 |
$61.03
|
|
Culture afb any source
|
$51.34 |
$51.34 |
$51.34 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$35.34 |
$35.34 |
$35.34 |
$73.00
|
|
Culture anaerobic except blood
|
$65.49 |
$65.49 |
$65.49 |
$110.00
|
|
Culture bact stool aero addl path ea
|
$19.43 |
$19.43 |
$19.43 |
$49.40
|
|
Culture body fluid
|
$60.22 |
$60.22 |
$60.22 |
$111.15
|
|
Culture fungi definitive id mold
|
$27.10 |
$27.10 |
$27.10 |
$70.00
|
|
Culture fungi definitive id yeast
|
$41.90 |
$41.90 |
$41.90 |
$68.00
|
|
Culture fungi other (except blood)
|
$45.51 |
$45.51 |
$45.51 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$36.45 |
$36.45 |
$36.45 |
$74.75
|
|
Culture mycoplasma any source
|
$90.37 |
$90.37 |
$90.37 |
$94.00
|
|
Culture screening strep group a
|
$43.29 |
$43.29 |
$43.29 |
$76.00
|
|
Culture typing immunologic
|
$29.32 |
$29.32 |
$29.32 |
$38.58
|
|
Culture urine each isolate
|
$17.48 |
$17.48 |
$17.48 |
$44.80
|
|
Curette/treat cornea
|
$1,317.39 |
$1,317.39 |
$1,317.39 |
$1,175.85
|
|
Cyclic citrullinated peptide antibody
|
$65.68 |
$65.68 |
$65.68 |
$91.20
|
|
Cyclosporine 2 hour
|
$87.88 |
$87.88 |
$87.88 |
$126.10
|
|
Cyp2c19 gene com variants
|
$657.12 |
$657.12 |
$657.12 |
$583.20
|
|
Cyp2c9 gene com variants
|
$318.85 |
$318.85 |
$318.85 |
$287.82
|
|
Cystatin c
|
$71.23 |
$71.23 |
$71.23 |
$83.20
|
|
Cystine urine quantitative
|
$94.26 |
$94.26 |
$94.26 |
$112.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$265.85 |
$265.85 |
$265.85 |
$487.04
|
|
Cystoscopy (Bladder Scope)
|
$605.78 |
$605.78 |
$605.78 |
$1,633.60
|
|
Cystoscopy removal of clots
|
$1,528.84 |
$1,528.84 |
$1,528.84 |
$3,970.98
|
|
Cystoscopy & ureter catheter
|
$1,757.59 |
$1,757.59 |
$1,757.59 |
$3,416.48
|
|
Cystostomy cystotomy w/drainage 51040
|
$976.15 |
$976.15 |
$976.15 |
$3,276.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$999.19 |
$999.19 |
$999.19 |
$2,874.36
|
|
Cysto w/ureter stricture tx
|
$2,708.31 |
$2,708.31 |
$2,708.31 |
$4,074.86
|
|
Cytogenom microarray copy nmbr var
|
$629.65 |
$629.65 |
$629.65 |
$1,433.77
|
|
Cytomegalovirus (cmv) antibody igg
|
$49.03 |
$49.03 |
$49.03 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$49.40 |
$49.40 |
$49.40 |
$95.00
|
|
Cyto/molecular report
|
$235.90 |
$235.90 |
$235.90 |
$91.65
|
|
Cytopathology cellular enhancement technique non-gyn
|
$47.64 |
$47.64 |
$47.64 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$48.56 |
$48.56 |
$48.56 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$40.70 |
$40.70 |
$40.70 |
$129.90
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$27.29 |
$27.29 |
$27.29 |
$71.25
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$26.92 |
$26.92 |
$26.92 |
$179.44
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$73.26 |
$73.26 |
$73.26 |
$205.00
|
|
Cytopath smear other source
|
$41.07 |
$41.07 |
$41.07 |
$88.13
|
|
Cytopath smear other source
|
$55.50 |
$55.50 |
$55.50 |
$145.31
|
|
Cytopath smear oth prep screen & interp
|
$32.75 |
$32.75 |
$32.75 |
$95.00
|
|
Cytotoxic antibody screening
|
$184.63 |
$184.63 |
$184.63 |
$184.63
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$130.13 |
$130.13 |
$130.13 |
$130.13
|
|
Dch pulmonary stress test
|
$246.61 |
$246.61 |
$246.61 |
$964.41
|
|
Dch validity tests
|
$18.59 |
$18.59 |
$18.59 |
$25.00
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$555.65 |
$555.65 |
$555.65 |
$677.54
|
|
Debridement bone <= 20 sq cm
|
$1,036.00 |
$1,036.00 |
$1,036.00 |
$2,481.05
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$406.35 |
$406.35 |
$406.35 |
$779.35
|
|
Debride nail1-5 11720
|
$110.35 |
$110.35 |
$110.35 |
$186.88
|
|
Debride nail6 or more 11721
|
$64.84 |
$64.84 |
$64.84 |
$200.21
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$567.77 |
$567.77 |
$567.77 |
$1,206.20
|
|
Debride skin bone at fx site
|
$2,379.93 |
$2,379.93 |
$2,379.93 |
$3,127.88
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$847.49 |
$847.49 |
$847.49 |
$1,146.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$381.66 |
$381.66 |
$381.66 |
$1,101.10
|
|
Decalcification
|
$7.31 |
$7.31 |
$7.31 |
$72.15
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$165.58 |
$165.58 |
$165.58 |
$482.35
|
|
Delivery of placenta 59414
|
$1,017.13 |
$1,017.13 |
$1,017.13 |
$3,135.14
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$85.56 |
$85.56 |
$85.56 |
$165.60
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$105.64 |
$105.64 |
$105.64 |
$460.50
|
|
Destroy cervthor facet jnt 64633
|
$2,998.30 |
$2,998.30 |
$2,998.30 |
$2,963.07
|
|
Destroy internal hemorrhoids destroy 46930
|
$693.94 |
$693.94 |
$693.94 |
$900.53
|
|
Destroy premlg lesns;1st lesn 17000
|
$79.64 |
$79.64 |
$79.64 |
$199.50
|
|
Destruction benign lesions < 14 lesions
|
$104.90 |
$104.90 |
$104.90 |
$231.52
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,998.30 |
$2,998.30 |
$2,998.30 |
$3,101.88
|
|
Developmental screen/score/document 96110
|
$76.59 |
$76.59 |
$76.59 |
$126.75
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$80.11 |
$80.11 |
$80.11 |
$220.43
|
|
Dhea-s (dehydroepiand sulfate)
|
$75.48 |
$75.48 |
$75.48 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$137.09 |
$137.09 |
$137.09 |
$70.00
|
|
Diagnostic anoscopy spx 46600
|
$93.89 |
$93.89 |
$93.89 |
$252.00
|
|
Diagnostic laryngoscopy 31505
|
$95.83 |
$95.83 |
$95.83 |
$229.07
|
|
Diagnostic laryngoscopy 31575
|
$229.40 |
$229.40 |
$229.40 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$208.87 |
$208.87 |
$208.87 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$161.69 |
$161.69 |
$161.69 |
$276.60
|
|
Diffusing capacity
|
$71.04 |
$71.04 |
$71.04 |
$336.80
|
|
Digoxin total therapeutic drug level
|
$57.72 |
$57.72 |
$57.72 |
$92.95
|
|
Dilate tear duct opening
|
$547.97 |
$547.97 |
$547.97 |
$454.40
|
|
Dilate urethra stricture
|
$254.65 |
$254.65 |
$254.65 |
$514.79
|
|
Dilate urethra stricture
|
$269.73 |
$269.73 |
$269.73 |
$344.80
|
|
Dilation/female urethra/initial 53660
|
$207.39 |
$207.39 |
$207.39 |
$207.39
|
|
Dilation/urethral strict/male/ini 53620
|
$1,310.45 |
$1,310.45 |
$1,310.45 |
$1,606.15
|
|
Disability dlco
|
$89.45 |
$89.45 |
$89.45 |
$289.08
|
|
Disaccharidases
|
$174.09 |
$174.09 |
$174.09 |
$224.58
|
|
Dna antibody native/double stranded
|
$65.77 |
$65.77 |
$65.77 |
$101.40
|
|
Dna gardnerella
|
$66.05 |
$66.05 |
$66.05 |
$67.68
|
|
Dna trichomonas
|
$66.05 |
$66.05 |
$66.05 |
$69.60
|
|
Doppler echo complete
|
$265.66 |
$265.66 |
$265.66 |
$517.94
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$280.46 |
$280.46 |
$280.46 |
$642.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$194.71 |
$194.71 |
$194.71 |
$463.20
|
|
Dornhoffer fixed part w/window
|
$32,112.76 |
$32,112.76 |
$32,112.76 |
$53,356.20
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$579.70 |
$579.70 |
$579.70 |
$800.00
|
|
Drainage external ear simple 69000
|
$579.70 |
$579.70 |
$579.70 |
$800.00
|
|
Drainage lymph node lesion 38300
|
$1,062.27 |
$1,062.27 |
$1,062.27 |
$1,779.65
|
|
Drainage mouth roof lesion
|
$315.33 |
$315.33 |
$315.33 |
$408.80
|
|
Drainage of eye
|
$1,095.20 |
$1,095.20 |
$1,095.20 |
$1,824.02
|
|
Drainage of eye
|
$3,667.81 |
$3,667.81 |
$3,667.81 |
$2,702.25
|
|
Drainage of kidney lesion
|
$685.43 |
$685.43 |
$685.43 |
$1,578.89
|
