|
CT orbit/sella/fossa w/wo contrast
|
$2,949.11 |
$2,949.11 |
$2,949.11 |
$1,681.95
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,949.11 |
$2,949.11 |
$2,949.11 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$2,424.81 |
$2,424.81 |
$2,424.81 |
$1,369.73
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$9,006.80 |
$9,006.80 |
$9,006.80 |
$3,472.30
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$7,625.20 |
$7,625.20 |
$7,625.20 |
$2,979.85
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$6,299.70 |
$6,299.70 |
$6,299.70 |
$2,412.75
|
|
CT thoracic spine w/contrast
|
$3,816.45 |
$3,816.45 |
$3,816.45 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$3,768.05 |
$3,768.05 |
$3,768.05 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,421.20 |
$1,421.20 |
$1,421.20 |
$427.70
|
|
CT t-spine w /wo contrast
|
$4,461.05 |
$4,461.05 |
$4,461.05 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$4,263.05 |
$4,263.05 |
$4,263.05 |
$1,706.10
|
|
CT upper extremity without contrast (both sides)
|
$4,054.05 |
$4,054.05 |
$4,054.05 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$4,855.40 |
$4,855.40 |
$4,855.40 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$319.13 |
$319.13 |
$319.13 |
$63.75
|
|
Culture afb any source
|
$183.15 |
$183.15 |
$183.15 |
$110.00
|
|
Culture anaerobic additional method definitive id each
|
$147.95 |
$147.95 |
$147.95 |
$77.31
|
|
Culture anaerobic except blood
|
$362.54 |
$362.54 |
$362.54 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$90.20 |
$90.20 |
$90.20 |
$52.65
|
|
Culture body fluid
|
$463.43 |
$463.43 |
$463.43 |
$130.50
|
|
Culture fungi definitive id mold
|
$117.70 |
$117.70 |
$117.70 |
$70.00
|
|
Culture fungi definitive id yeast
|
$132.00 |
$132.00 |
$132.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$142.45 |
$142.45 |
$142.45 |
$99.88
|
|
Culture fungi skin/hair/nail
|
$65.31 |
$65.31 |
$65.31 |
$77.37
|
|
Culture screening strep group a
|
$182.57 |
$182.57 |
$182.57 |
$80.60
|
|
Culture typing immunologic
|
$87.72 |
$87.72 |
$87.72 |
$42.12
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$599.50 |
$599.50 |
$599.50 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$184.25 |
$184.25 |
$184.25 |
$124.02
|
|
Culture urine each isolate
|
$159.50 |
$159.50 |
$159.50 |
$47.45
|
|
Cutter lead
|
$2,903.86 |
$2,903.86 |
$2,903.86 |
$2,205.00
|
|
Cv line/pic reposition
|
$1,727.41 |
$1,727.41 |
$1,727.41 |
$1,752.40
|
|
Cyanocobalamin unsat binding capacity
|
$60.64 |
$60.64 |
$60.64 |
$64.28
|
|
Cyclic citrullinated peptide antibody
|
$109.72 |
$109.72 |
$109.72 |
$88.51
|
|
Cyclosporine 2 hour
|
$275.00 |
$275.00 |
$275.00 |
$120.20
|
|
Cystatin c
|
$159.64 |
$159.64 |
$159.64 |
$82.50
|
|
Cystine urine quantitative
|
$25.30 |
$25.30 |
$25.30 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$2,064.36 |
$2,064.36 |
$2,064.36 |
$527.50
|
|
Cytogenetics 25-99
|
$206.52 |
$206.52 |
$206.52 |
$185.35
|
|
Cytomegalovirus (cmv) antibody igg
|
$243.92 |
$243.92 |
$243.92 |
$102.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$142.72 |
$142.72 |
$142.72 |
$105.23
|
|
Cytopathology cellular enhancement technique non-gyn
|
$477.95 |
$477.95 |
$477.95 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$108.90 |
$108.90 |
$108.90 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$98.45 |
$98.45 |
$98.45 |
$142.94
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$138.05 |
$138.05 |
$138.05 |
$205.00
|
|
Cytopath smear oth prep screen & interp
|
$98.45 |
$98.45 |
$98.45 |
$96.20
|
|
Dch validity tests
|
$95.70 |
$95.70 |
$95.70 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$75.90 |
$75.90 |
$75.90 |
$45.31
|
|
Debridement (>20 cm) charge pt
|
$363.72 |
$363.72 |
$363.72 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$2,138.34 |
$2,138.34 |
$2,138.34 |
$2,578.95
|
|
Debridement/bone/20 sq cm or less 11046
|
$347.35 |
$347.35 |
$347.35 |
$681.60
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,079.92 |
$1,079.92 |
$1,079.92 |
$1,407.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,620.82 |
$1,620.82 |
$1,620.82 |
$810.50
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$389.43 |
$389.43 |
$389.43 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$2,112.16 |
$2,112.16 |
$2,112.16 |
$1,193.40
|
|
Decalcification
|
$125.95 |
$125.95 |
$125.95 |
$75.38
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$637.67 |
$637.67 |
$637.67 |
$510.95
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$361.38 |
$361.38 |
$361.38 |
$180.00
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$642.34 |
$642.34 |
$642.34 |
$460.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,729.10 |
$2,729.10 |
$2,729.10 |
$3,375.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$519.75 |
$519.75 |
$519.75 |
$227.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$376.89 |
$376.89 |
$376.89 |
$108.00
|
|
Diabetes (HbA1c) Test
|
$266.34 |
$266.34 |
$266.34 |
$79.30
|
|
Diagnostic digital breast tomosynthesis bil
|
$94.98 |
$94.98 |
$94.98 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$47.49 |
$47.49 |
$47.49 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$837.38 |
$837.38 |
$837.38 |
$421.20
|
|
Diagnostic Mammogram (one breast)
|
$418.69 |
$418.69 |
$418.69 |
$289.85
|
|
Diagnostic radio unlisted proc
|
$211.31 |
$211.31 |
$211.31 |
$259.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,629.20 |
$3,629.20 |
$3,629.20 |
$7,822.05
|
|
Dialysis one evaluation
|
$1,826.52 |
$1,826.52 |
$1,826.52 |
$827.97
|
|
Diffusing capacity
|
$1,333.20 |
$1,333.20 |
$1,333.20 |
$357.50
|
|
Digoxin total therapeutic drug level
|
$224.95 |
$224.95 |
$224.95 |
$99.35
|
|
Disability dlco
|
$741.18 |
$741.18 |
$741.18 |
$304.99
|
|
Dissolve clot heart vessel
|
$5,732.48 |
$5,732.48 |
$5,732.48 |
$1,274.40
|
|
Dna antibody native/double stranded
|
$232.92 |
$232.92 |
$232.92 |
$103.20
|
|
Dna gardnerella
|
$112.75 |
$112.75 |
$112.75 |
$68.25
|
|
Dna trichomonas
|
$112.75 |
$112.75 |
$112.75 |
$71.50
|
|
Doppler echo complete
|
$606.82 |
$606.82 |
$606.82 |
$644.00
|
|
Doppler intravascular pressure flow initial vessel
|
$3,176.20 |
$3,176.20 |
$3,176.20 |
$3,006.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$493.02 |
$493.02 |
$493.02 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$1,332.54 |
$1,332.54 |
$1,332.54 |
$495.30
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$770.44 |
$770.44 |
$770.44 |
$813.63
|
|
Drainage ext aud canal abscess 69020
|
$898.54 |
$898.54 |
$898.54 |
$865.60
|
|
Drainage external ear complex 69005
|
$1,390.34 |
$1,390.34 |
$1,390.34 |
$3,016.11
|
|
Drainage external ear simple 69000
|
$770.44 |
$770.44 |
$770.44 |
$800.00
|
|
Drainage mouth roof lesion
|
$355.30 |
$355.30 |
$355.30 |
$528.80
|
|
Drainage of arm bursa 23931
|
$2,158.20 |
$2,158.20 |
$2,158.20 |
$2,419.30
|
|
Drainage of nose lesion int 30000
|
$103.32 |
$103.32 |
$103.32 |
$615.20
|
|
Drainage of nose lesion sept 30020
|
$1,057.95 |
$1,057.95 |
$1,057.95 |
$755.95
|
|
Drainage of rectal abscess
|
$1,285.16 |
$1,285.16 |
$1,285.16 |
$2,299.90
|
|
Drain blood from under nail 11740
|
$138.85 |
$138.85 |
$138.85 |
$190.10
|
|
Drain cath image guided visceral pq
|
$2,186.25 |
$2,186.25 |
$2,186.25 |
$3,025.20
|
|
Drain cerebro spinal fluid 62272
|
$1,039.72 |
$1,039.72 |
$1,039.72 |
$1,113.06
|
|
Drain finger abscess;simple 26010
|
$562.40 |
$562.40 |
$562.40 |
$492.81
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$407.19 |
$407.19 |
$407.19 |
$403.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$387.56 |
$387.56 |
$387.56 |
$359.45
|
|
Dress/debrid prtl-thick burn l 16030
|
$429.16 |
$429.16 |
$429.16 |
$523.00
|
|
Drng of eyelid abscess 67700
|
$323.98 |
$323.98 |
$323.98 |
$747.00
|
|
Drng of finger abscess comp 26011
|
$2,246.80 |
$2,246.80 |
$2,246.80 |
$1,894.80
|
|
Drng of scrotum abscess 55100
|
$1,743.31 |
$1,743.31 |
$1,743.31 |
$1,997.89
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$1,690.64 |
$1,690.64 |
$1,690.64 |
$843.34
|
|
Drug admin & hemodynmic meas
|
$1,947.14 |
$1,947.14 |
$1,947.14 |
$542.23
|
