|
Cryptosporidium antigen
|
$122.40 |
$122.40 |
$122.40 |
$52.08
|
|
Crystal identification light microscopy
|
$116.40 |
$116.40 |
$116.40 |
$66.43
|
|
Csf leakage imaging
|
$1,144.80 |
$1,144.80 |
$1,144.80 |
$1,564.11
|
|
Csf ventriculography
|
$575.40 |
$575.40 |
$575.40 |
$877.00
|
|
Cta lower extremity without & w/contrast (both sides)
|
$3,502.20 |
$3,502.20 |
$3,502.20 |
$1,986.77
|
|
CT Angiogram of Abdomen and Pelvis
|
$1,030.20 |
$1,030.20 |
$1,030.20 |
$2,839.85
|
|
CT Angiogram of the Abdomen
|
$1,871.40 |
$1,871.40 |
$1,871.40 |
$1,994.52
|
|
CT Angiogram of the Abdomen and Both Legs
|
$957.00 |
$957.00 |
$957.00 |
$1,909.90
|
|
CT Angiogram of the Chest (for blood clot)
|
$1,893.60 |
$1,893.60 |
$1,893.60 |
$1,915.30
|
|
CT Angiogram of the Head
|
$1,920.00 |
$1,920.00 |
$1,920.00 |
$1,940.00
|
|
CT Angiogram of the Neck
|
$1,924.20 |
$1,924.20 |
$1,924.20 |
$1,881.75
|
|
CT angio hrt w/3d image
|
$2,457.60 |
$2,457.60 |
$2,457.60 |
$1,428.68
|
|
CT angio pelvis
|
$1,840.20 |
$1,840.20 |
$1,840.20 |
$1,806.60
|
|
Cta upper extremity w &/or without contrast left
|
$1,698.00 |
$1,698.00 |
$1,698.00 |
$1,691.30
|
|
CT colonography dx
|
$848.40 |
$848.40 |
$848.40 |
$811.41
|
|
CT colonography dx w/dye
|
$778.20 |
$778.20 |
$778.20 |
$1,069.25
|
|
CT colonography screening
|
$1,710.60 |
$1,710.60 |
$1,710.60 |
$1,084.20
|
|
CT guidance for needle placement
|
$694.20 |
$694.20 |
$694.20 |
$1,494.00
|
|
CT heart w/evaluation of calcium without contrast
|
$124.80 |
$124.80 |
$124.80 |
$150.00
|
|
CT hrt w/3d image
|
$1,096.80 |
$1,096.80 |
$1,096.80 |
$1,350.03
|
|
CT lwr extremity w/o&w/dye
|
$1,296.00 |
$1,296.00 |
$1,296.00 |
$1,818.96
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$822.60 |
$822.60 |
$822.60 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$738.60 |
$738.60 |
$738.60 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$477.00 |
$477.00 |
$477.00 |
$2,272.00
|
|
CT t-spine w /wo contrast
|
$1,443.60 |
$1,443.60 |
$1,443.60 |
$1,975.00
|
|
CT uppr extremity w/o&w/dye
|
$1,293.00 |
$1,293.00 |
$1,293.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$35.40 |
$35.40 |
$35.40 |
$72.00
|
|
Culture afb any source
|
$58.80 |
$58.80 |
$58.80 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$133.20 |
$133.20 |
$133.20 |
$84.76
|
|
Culture anaerobic except blood
|
$51.60 |
$51.60 |
$51.60 |
$121.22
|
|
Culture bact stool aero addl path ea
|
$51.60 |
$51.60 |
$51.60 |
$52.50
|
|
Culture body fluid
|
$94.20 |
$94.20 |
$94.20 |
$126.75
|
|
Culture fungi definitive id mold
|
$145.20 |
$145.20 |
$145.20 |
$80.00
|
|
Culture fungi definitive id yeast
|
$151.20 |
$151.20 |
$151.20 |
$80.00
|
|
Culture fungi other (except blood)
|
$45.60 |
$45.60 |
$45.60 |
$111.10
|
|
Culture fungi skin/hair/nail
|
$81.60 |
$81.60 |
$81.60 |
$74.75
|
|
Culture mycobacteria definitive id each isolate
|
$60.00 |
$60.00 |
$60.00 |
$100.00
|
|
Culture mycoplasma any source
|
$255.60 |
$255.60 |
$255.60 |
$83.21
|
|
Culture screening strep group a
|
$126.60 |
$126.60 |
$126.60 |
$84.60
|
|
Culture typing added method
|
$100.80 |
$100.80 |
$100.80 |
$42.60
|
|
Culture typing glc/hplc
|
$152.40 |
$152.40 |
$152.40 |
$53.75
|
|
Culture typing immunologic
|
$28.20 |
$28.20 |
$28.20 |
$44.00
|
|
Culture urine each isolate
|
$132.00 |
$132.00 |
$132.00 |
$55.50
|
|
Curette/treat cornea
|
$899.40 |
$899.40 |
$899.40 |
$1,365.60
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$22.80 |
$22.80 |
$22.80 |
$25.32
|
|
Cyclic citrullinated peptide antibody
|
$244.80 |
$244.80 |
$244.80 |
$72.36
|
|
Cyclosporine 2 hour
|
$98.40 |
$98.40 |
$98.40 |
$130.40
|
|
Cystatin c
|
$63.60 |
$63.60 |
$63.60 |
$77.60
|
|
Cystine urine quantitative
|
$361.20 |
$361.20 |
$361.20 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$235.20 |
$235.20 |
$235.20 |
$586.95
|
|
Cystoscopy and treatment
|
$3,071.40 |
$3,071.40 |
$3,071.40 |
$5,304.00
|
|
Cystoscopy and treatment
|
$3,071.40 |
$3,071.40 |
$3,071.40 |
$5,995.60
|
|
Cystoscopy (Bladder Scope)
|
$1,731.00 |
$1,731.00 |
$1,731.00 |
$1,493.80
|
|
Cystouretero w/lithotripsy
|
$4,305.00 |
$4,305.00 |
$4,305.00 |
$7,372.68
|
|
Cystourethroscop/calib/dilat stric 52281
|
$1,752.00 |
$1,752.00 |
$1,752.00 |
$3,245.90
|
|
Cytomegalovirus (cmv) antibody igg
|
$186.00 |
$186.00 |
$186.00 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$200.40 |
$200.40 |
$200.40 |
$100.00
|
|
Cytomegalovirus dfa
|
$61.20 |
$61.20 |
$61.20 |
$77.40
|
|
Cyto/molecular report
|
$273.00 |
$273.00 |
$273.00 |
$144.75
|
|
Cytopath c/v manual
|
$82.20 |
$82.20 |
$82.20 |
$36.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$97.20 |
$97.20 |
$97.20 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$124.20 |
$124.20 |
$124.20 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$124.20 |
$124.20 |
$124.20 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$233.40 |
$233.40 |
$233.40 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$197.40 |
$197.40 |
$197.40 |
$127.50
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$129.60 |
$129.60 |
$129.60 |
$191.66
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$176.40 |
$176.40 |
$176.40 |
$213.85
|
|
Cytopath smear other source
|
$163.80 |
$163.80 |
$163.80 |
$92.50
|
|
Cytopath smear other source
|
$252.00 |
$252.00 |
$252.00 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$219.60 |
$219.60 |
$219.60 |
$96.20
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$170.40 |
$170.40 |
$170.40 |
$171.19
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$5,572.80 |
$5,572.80 |
$5,572.80 |
$6,281.29
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$51.60 |
$51.60 |
$51.60 |
$668.55
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$481.80 |
$481.80 |
$481.80 |
$835.20
|
|
Debride nail1-5 11720
|
$127.80 |
$127.80 |
$127.80 |
$149.60
|
|
Decalcification
|
$128.40 |
$128.40 |
$128.40 |
$68.34
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$309.00 |
$309.00 |
$309.00 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$27.60 |
$27.60 |
$27.60 |
$95.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$154.20 |
$154.20 |
$154.20 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,565.20 |
$3,565.20 |
$3,565.20 |
$6,324.98
|
|
Desmopressin 4 mcg/ml injection solution
|
$126.60 |
$126.60 |
$126.60 |
$91.84
|
|
Desoxycorticosterone
|
$274.80 |
$274.80 |
$274.80 |
$109.28
|
|
Dest mal lesion feenlm <0.5cm 17280
|
$363.60 |
$363.60 |
$363.60 |
$275.88
|
|
Destroy cervthor facet jnt 64633
|
$1,947.60 |
$1,947.60 |
$1,947.60 |
$3,138.15
|
|
Destroy cth facet jnt addl 64634
|
$257.40 |
$257.40 |
$257.40 |
$1,441.44
|
|
Destroy premlg lesns;1st lesn 17000
|
$249.60 |
$249.60 |
$249.60 |
$202.40
|
|
Destruct ben lesion 15/> 17111
|
$391.20 |
$391.20 |
$391.20 |
$235.13
|
|
Destruction 2-14 lesions 17003
|
$46.80 |
$46.80 |
$46.80 |
$78.61
|
|
Destruction benign lesions < 14 lesions
|
$127.20 |
$127.20 |
$127.20 |
$240.24
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$236.40 |
$236.40 |
$236.40 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,947.60 |
$1,947.60 |
$1,947.60 |
$3,296.80
|
|
Detect agent nos dna dir
|
$138.00 |
$138.00 |
$138.00 |
$138.00
|
|
Detect agnt mult dna direc
|
$207.60 |
$207.60 |
$207.60 |
$166.77
|
|
Device intraute mirena
|
$2,059.20 |
$2,059.20 |
$2,059.20 |
$2,125.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$139.80 |
$139.80 |
$139.80 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$1.80 |
$1.80 |
$1.80 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$9.00 |
$9.00 |
$9.00 |
$20.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$8.40 |
$8.40 |
$8.40 |
$36.05
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$9.60 |
$9.60 |
$9.60 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$8.40 |
$8.40 |
$8.40 |
$48.00
|
