|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,204.00 |
$2,204.00 |
$2,204.00 |
$1,524.90
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,410.00 |
$1,410.00 |
$1,410.00 |
$1,301.36
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,075.00 |
$5,075.00 |
$5,075.00 |
$3,133.65
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,153.00 |
$4,153.00 |
$4,153.00 |
$2,737.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,507.00 |
$3,507.00 |
$3,507.00 |
$2,245.00
|
|
CT thoracic spine w/contrast
|
$3,236.00 |
$3,236.00 |
$3,236.00 |
$1,623.05
|
|
CT thoracic spine without contrast
|
$2,793.00 |
$2,793.00 |
$2,793.00 |
$1,382.10
|
|
CT upper extremity w/contrast (both sides)
|
$3,852.00 |
$3,852.00 |
$3,852.00 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$3,842.00 |
$3,842.00 |
$3,842.00 |
$1,408.54
|
|
CT uppr extremity w/o&w/dye
|
$3,758.00 |
$3,758.00 |
$3,758.00 |
$1,707.60
|
|
Culture aerobic additional method definitive id each
|
$29.00 |
$29.00 |
$41.00 |
$61.03
|
|
Culture afb any source
|
$189.00 |
$189.00 |
$189.00 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$155.00 |
$155.00 |
$155.00 |
$73.50
|
|
Culture anaerobic except blood
|
$110.00 |
$110.00 |
$190.00 |
$112.45
|
|
Culture bact stool aero addl path ea
|
$47.00 |
$47.00 |
$52.00 |
$50.67
|
|
Culture body fluid
|
$48.00 |
$48.00 |
$193.00 |
$116.35
|
|
Culture fungi definitive id mold
|
$134.00 |
$134.00 |
$134.00 |
$70.00
|
|
Culture fungi definitive id yeast
|
$134.00 |
$134.00 |
$134.00 |
$70.50
|
|
Culture fungi other (except blood)
|
$77.00 |
$77.00 |
$163.00 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$130.00 |
$130.00 |
$130.00 |
$76.80
|
|
Culture mycobacteria definitive id each isolate
|
$116.00 |
$116.00 |
$116.00 |
$79.00
|
|
Culture mycoplasma any source
|
$265.00 |
$265.00 |
$265.00 |
$95.00
|
|
Culture quantitative aerobic other source
|
$112.00 |
$112.00 |
$112.00 |
$63.45
|
|
Culture screening strep group a
|
$60.00 |
$60.00 |
$135.00 |
$76.00
|
|
Culture typing added method
|
$88.00 |
$88.00 |
$88.00 |
$31.00
|
|
Culture typing immunologic
|
$38.00 |
$38.00 |
$64.00 |
$38.58
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$1,161.00 |
$1,161.00 |
$1,161.00 |
$392.40
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$48.00 |
$48.00 |
$48.00 |
$97.50
|
|
Culture urine each isolate
|
$41.00 |
$41.00 |
$102.00 |
$45.60
|
|
Cv stress test/supervision only 93016
|
$126.00 |
$126.00 |
$126.00 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$11.00 |
$11.00 |
$11.00 |
$19.39
|
|
Cyclic citrullinated peptide antibody
|
$71.00 |
$71.00 |
$79.00 |
$93.00
|
|
Cyclosporine 2 hour
|
$278.00 |
$278.00 |
$278.00 |
$130.40
|
|
Cystatin c
|
$56.00 |
$56.00 |
$56.00 |
$83.20
|
|
Cystic fibrosis cftr
|
$1,832.00 |
$1,832.00 |
$1,832.00 |
$1,041.95
|
|
Cystine urine quantitative
|
$93.00 |
$93.00 |
$93.00 |
$112.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$792.00 |
$792.00 |
$792.00 |
$497.66
|
|
Cytogenetics 25-99
|
$161.00 |
$161.00 |
$161.00 |
$188.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$79.00 |
$79.00 |
$79.00 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$93.00 |
$93.00 |
$93.00 |
$95.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$260.00 |
$260.00 |
$260.00 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$58.00 |
$58.00 |
$90.00 |
$98.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$112.00 |
$112.00 |
$112.00 |
$90.88
|
|
Cytopathology concentration technique smears & interpretation
|
$218.00 |
$218.00 |
$218.00 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$204.00 |
$204.00 |
$204.00 |
$132.50
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$67.00 |
$67.00 |
$67.00 |
$70.00
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$95.00 |
$95.00 |
$95.00 |
$180.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$230.00 |
$230.00 |
$230.00 |
$213.85
|
|
Cytopath smear oth prep screen & interp
|
$135.00 |
$135.00 |
$135.00 |
$95.00
|
|
Cytopath tbs c/v manual
|
$76.00 |
$76.00 |
$76.00 |
$57.94
|
|
D&c after delivery 59160
|
$184.00 |
$184.00 |
$184.00 |
$3,441.98
|
|
Dch glucoscan
|
$3.00 |
$3.00 |
$3.00 |
$28.10
|
|
Dch validity tests
|
$34.00 |
$34.00 |
$34.00 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$63.00 |
$63.00 |
$63.00 |
$53.95
|
|
Debridement (>20 cm) charge pt
|
$440.00 |
$440.00 |
$440.00 |
$315.59
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,694.00 |
$1,694.00 |
$1,694.00 |
$1,101.10
|
|
Decalcification
|
$113.00 |
$113.00 |
$113.00 |
$72.80
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$498.00 |
$498.00 |
$498.00 |
$482.35
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$227.00 |
$227.00 |
$227.00 |
$166.08
|
|
Dexamethasone 4 mg tablet
|
$7.50 |
$7.50 |
$7.50 |
$4.87
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$11.00 |
$11.00 |
$17.00 |
$9.26
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$65.00 |
$65.00 |
$65.00 |
$48.56
|
|
Dhea-s (dehydroepiand sulfate)
|
$122.00 |
$122.00 |
$122.00 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$65.00 |
$65.00 |
$130.00 |
$70.00
|
|
Diab manage trn ind/group
|
$75.00 |
$75.00 |
$75.00 |
$57.75
|
|
Dialysis one evaluation
|
$1,108.00 |
$1,108.00 |
$1,108.00 |
$934.16
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$23.14 |
$23.14 |
$23.14 |
$50.35
|
|
Digital analysis of eeg
|
$666.00 |
$666.00 |
$666.00 |
$642.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$11.22 |
$11.22 |
$11.22 |
$29.85
|
|
Digoxin total therapeutic drug level
|
$67.00 |
$67.00 |
$73.00 |
$95.00
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$22.58 |
$22.58 |
$38.00 |
$9.56
|
|
Disaccharidases
|
$450.00 |
$450.00 |
$450.00 |
$230.40
|
|
Dna antibody native/double stranded
|
$48.00 |
$48.00 |
$57.00 |
$101.40
|
|
Dna gardnerella
|
$109.00 |
$109.00 |
$109.00 |
$68.25
|
|
Dna probe gc
|
$137.00 |
$137.00 |
$137.00 |
$88.67
|
|
Dna trichomonas
|
$116.00 |
$116.00 |
$116.00 |
$69.60
|
|
Doppler echo complete
|
$786.00 |
$786.00 |
$786.00 |
$510.25
|
|
Doppler intravascular pressure flow initial vessel
|
$4,071.00 |
$4,071.00 |
$4,071.00 |
$3,026.62
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$967.00 |
$967.00 |
$967.00 |
$642.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$503.00 |
$503.00 |
$503.00 |
$464.04
|
|
Drain blood from under nail 11740
|
$146.00 |
$146.00 |
$146.00 |
$173.21
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$235.00 |
$235.00 |
$235.00 |
$352.94
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$57.00 |
$57.00 |
$57.00 |
$112.05
|
|
Drug assay caffeine
|
$170.00 |
$170.00 |
$170.00 |
$89.17
|
|
Drug assay posaconazole
|
$221.00 |
$221.00 |
$221.00 |
$96.75
|
|
Drug assay voriconazole
|
$158.00 |
$158.00 |
$158.00 |
$96.75
|
|
Drug of abuse screen urine
|
$26.00 |
$26.00 |
$90.00 |
$58.40
|
|
Drug test prsmv instrmnt
|
$150.00 |
$150.00 |
$152.00 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$364.00 |
$364.00 |
$364.00 |
$276.58
|
|
Drvvt confirm - quest
|
$172.00 |
$172.00 |
$172.00 |
$111.80
|
|
Ductogram sgl duct
|
$64.00 |
$64.00 |
$64.00 |
$376.56
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$699.00 |
$699.00 |
$699.00 |
$740.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$838.98
|
|
Ear irrigation 69209
|
$95.00 |
$95.00 |
$95.00 |
$152.50
|
|
Ecg 12 lead tracing only
|
$100.00 |
$100.00 |
$348.00 |
$222.30
|
|
Ecg/1-3 leads/tracing only 93041
|
$194.00 |
$194.00 |
$194.00 |
$128.40
|
|
Ecg external < 48 hours recording
|
$798.00 |
$798.00 |
$798.00 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$1,043.00 |
$1,043.00 |
$1,043.00 |
$539.40
|
|
Echocardiogram (Heart Ultrasound)
|
$2,371.00 |
$2,371.00 |
$2,371.00 |
$2,000.60
|
|
Echocardiography doppler color flow mapping
|
$992.00 |
$992.00 |
$992.00 |
$452.40
|
