|
Cta upper extremity w &/or without contrast left
|
$535.50 |
$535.50 |
$535.50 |
$1,681.50
|
|
CT guidance for needle placement
|
$1,810.40 |
$1,810.40 |
$1,810.40 |
$1,498.20
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,862.40 |
$1,862.40 |
$1,862.40 |
$1,178.52
|
|
CT heart w/evaluation of calcium without contrast
|
$85.50 |
$85.50 |
$85.50 |
$156.00
|
|
CT hrt w/3d image
|
$445.50 |
$445.50 |
$445.50 |
$1,350.03
|
|
CT lower extremity w/contrast (both sides)
|
$475.50 |
$475.50 |
$475.50 |
$1,585.18
|
|
CT lower extremity without contrast (both sides)
|
$285.50 |
$285.50 |
$285.50 |
$1,398.82
|
|
CT lwr extremity w/o&w/dye
|
$572.00 |
$572.00 |
$572.00 |
$1,818.96
|
|
CT neck soft tissue w/contrast
|
$461.50 |
$461.50 |
$461.50 |
$1,603.55
|
|
CT neck soft tissue without contrast
|
$268.00 |
$268.00 |
$268.00 |
$1,312.00
|
|
CT neck soft tissue without & w/contrast
|
$557.50 |
$557.50 |
$557.50 |
$1,940.00
|
|
CT orbit/sella/fossa w/wo contrast
|
$557.50 |
$557.50 |
$557.50 |
$1,705.20
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$461.50 |
$461.50 |
$461.50 |
$1,543.00
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$268.00 |
$268.00 |
$268.00 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$525.00 |
$525.00 |
$525.00 |
$3,408.50
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$437.50 |
$437.50 |
$437.50 |
$2,871.05
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$242.50 |
$242.50 |
$242.50 |
$2,295.00
|
|
CT thoracic spine w/contrast
|
$472.00 |
$472.00 |
$472.00 |
$1,655.85
|
|
CT thoracic spine without contrast
|
$286.50 |
$286.50 |
$286.50 |
$1,430.20
|
|
CT thorax low dose for lung screening without contrast
|
$266.00 |
$266.00 |
$266.00 |
$332.00
|
|
CT t-spine w /wo contrast
|
$568.50 |
$568.50 |
$568.50 |
$1,968.47
|
|
CT upper extremity w/contrast (both sides)
|
$475.50 |
$475.50 |
$475.50 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$285.50 |
$285.50 |
$285.50 |
$1,404.36
|
|
Culture aerobic additional method definitive id each
|
$33.60 |
$33.60 |
$33.60 |
$71.40
|
|
Culture afb any source
|
$44.80 |
$44.80 |
$44.80 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$33.60 |
$33.60 |
$33.60 |
$84.76
|
|
Culture anaerobic except blood
|
$39.20 |
$39.20 |
$39.20 |
$120.54
|
|
Culture bact stool aero addl path ea
|
$39.20 |
$39.20 |
$39.20 |
$52.50
|
|
Culture body fluid
|
$36.00 |
$36.00 |
$36.00 |
$126.00
|
|
Culture fungi definitive id mold
|
$43.20 |
$43.20 |
$43.20 |
$80.00
|
|
Culture fungi definitive id yeast
|
$43.20 |
$43.20 |
$43.20 |
$79.50
|
|
Culture fungi other (except blood)
|
$35.20 |
$35.20 |
$35.20 |
$109.20
|
|
Culture fungi skin/hair/nail
|
$32.80 |
$32.80 |
$32.80 |
$74.40
|
|
Culture mycobacteria definitive id each isolate
|
$60.80 |
$60.80 |
$60.80 |
$100.00
|
|
Culture mycoplasma any source
|
$64.00 |
$64.00 |
$64.00 |
$81.62
|
|
Culture quantitative aerobic other source
|
$40.80 |
$40.80 |
$40.80 |
$90.35
|
|
Culture typing immunologic
|
$21.60 |
$21.60 |
$21.60 |
$43.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$145.60 |
$145.60 |
$145.60 |
$138.40
|
|
Cv line/pic reposition
|
$2,060.80 |
$2,060.80 |
$2,060.80 |
$1,608.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$19.00 |
$19.00 |
$19.00 |
$25.16
|
|
Cyclic citrullinated peptide antibody
|
$54.40 |
$54.40 |
$54.40 |
$72.15
|
|
Cyclosporine 2 hour
|
$75.20 |
$75.20 |
$75.20 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$7.40 |
$7.40 |
$7.40 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$11.60 |
$11.60 |
$11.60 |
$35.57
|
|
Cystatin c
|
$77.60 |
$77.60 |
$77.60 |
$76.48
|
|
Cystine urine quantitative
|
$96.00 |
$96.00 |
$96.00 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$531.20 |
$531.20 |
$531.20 |
$564.85
|
|
Cystometrogram w/up 51727
|
$1,421.60 |
$1,421.60 |
$1,421.60 |
$908.59
|
|
Cystoscopy chemodenervation
|
$1,615.20 |
$1,615.20 |
$1,615.20 |
$2,831.92
|
|
Cytogenetics 25-99
|
$185.60 |
$185.60 |
$185.60 |
$189.80
|
|
Cytomegalovirus (cmv) antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$69.60 |
$69.60 |
$69.60 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$208.80 |
$208.80 |
$208.80 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$112.00 |
$112.00 |
$112.00 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$84.00 |
$84.00 |
$84.00 |
$86.86
|
|
Cytopathology concentration technique smears & interpretation
|
$141.60 |
$141.60 |
$141.60 |
$131.36
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$141.60 |
$141.60 |
$141.60 |
$124.00
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$29.60 |
$29.60 |
$29.60 |
$68.51
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$193.60 |
$193.60 |
$193.60 |
$189.67
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$208.80 |
$208.80 |
$208.80 |
$209.92
|
|
Cytopath smear other source
|
$104.00 |
$104.00 |
$104.00 |
$91.20
|
|
Cytp urine 3-5 probes cmptr
|
$272.00 |
$272.00 |
$272.00 |
$664.80
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$109.60 |
$109.60 |
$109.60 |
$171.19
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,416.20 |
$2,416.20 |
$2,416.20 |
$6,273.69
|
|
Dch pulmonary stress test
|
$2,496.00 |
$2,496.00 |
$2,496.00 |
$963.30
|
|
Deamidated gliadin antibody iga
|
$49.60 |
$49.60 |
$49.60 |
$42.75
|
|
Debridement (>20 cm) charge pt
|
$472.00 |
$472.00 |
$472.00 |
$278.50
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,103.20 |
$1,103.20 |
$1,103.20 |
$820.15
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$370.40 |
$370.40 |
$370.40 |
$641.52
|
|
Debr musc/fascia 20sq cm/< 11043
|
$996.00 |
$996.00 |
$996.00 |
$1,160.00
|
|
Decalcification
|
$91.20 |
$91.20 |
$91.20 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$1,002.40 |
$1,002.40 |
$1,002.40 |
$546.84
|
|
Delivery of placenta 59414
|
$3,380.00 |
$3,380.00 |
$3,380.00 |
$2,822.68
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$294.40 |
$294.40 |
$294.40 |
$182.40
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$679.20 |
$679.20 |
$679.20 |
$399.93
|
|
Design mlc device for imrt
|
$4,720.00 |
$4,720.00 |
$4,720.00 |
$1,739.10
|
|
Desmopressin 4 mcg/ml injection solution
|
$389.80 |
$389.80 |
$389.80 |
$93.84
|
|
Destroy cervthor facet jnt 64633
|
$3,845.60 |
$3,845.60 |
$3,845.60 |
$3,018.00
|
|
Destroy cth facet jnt addl 64634
|
$2,220.00 |
$2,220.00 |
$2,220.00 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$892.00 |
$892.00 |
$892.00 |
$1,618.65
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,952.00 |
$2,952.00 |
$2,952.00 |
$3,295.50
|
|
Device intraute mirena
|
$5,896.40 |
$5,896.40 |
$5,896.40 |
$2,125.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$323.20 |
$323.20 |
$323.20 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$10.80 |
$10.80 |
$10.80 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$18.80 |
$18.80 |
$18.80 |
$21.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$49.00 |
$49.00 |
$49.00 |
$36.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$28.80 |
$28.80 |
$28.80 |
$42.50
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$31.60 |
$31.60 |
$31.60 |
$46.12
|
|
Dhea-s (dehydroepiand sulfate)
|
$92.00 |
$92.00 |
$92.00 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$25.00 |
$25.00 |
$25.00 |
$79.20
|
|
Diab manage trn ind/group
|
$28.00 |
$28.00 |
$28.00 |
$54.99
|
|
Diagnostic digital breast tomosynthesis bil
|
$93.60 |
$93.60 |
$93.60 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$60.80 |
$60.80 |
$60.80 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$388.00 |
$388.00 |
$388.00 |
$334.95
|
|
Diagnostic Mammogram (both breasts)
|
$208.00 |
$208.00 |
$208.00 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$222.00 |
$222.00 |
$222.00 |
$312.72
|
|
Diagnostic radio unlisted proc
|
$552.80 |
$552.80 |
$552.80 |
$243.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$29,771.20 |
$29,771.20 |
$29,771.20 |
$5,663.50
|
|
Dialysis one evaluation
|
$960.00 |
$960.00 |
$960.00 |
$936.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$1.60 |
$1.60 |
$1.60 |
$115.15
|
