|
CT Angiogram of the Chest (for blood clot)
|
$531.50 |
$531.50 |
$531.50 |
$1,912.50
|
|
CT Angiogram of the Head
|
$538.00 |
$538.00 |
$538.00 |
$1,946.10
|
|
CT angio hrt w/3d image
|
$407.00 |
$407.00 |
$407.00 |
$1,424.40
|
|
CT angio pelvis
|
$534.00 |
$534.00 |
$534.00 |
$1,795.97
|
|
CT heart w/evaluation of calcium without contrast
|
$85.50 |
$85.50 |
$85.50 |
$156.00
|
|
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 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
|
$379.00 |
$379.00 |
$379.00 |
$71.40
|
|
Culture afb any source
|
$392.20 |
$392.20 |
$392.20 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$161.20 |
$161.20 |
$161.20 |
$84.76
|
|
Culture anaerobic except blood
|
$315.60 |
$315.60 |
$315.60 |
$120.54
|
|
Culture bact stool aero addl path ea
|
$171.60 |
$171.60 |
$171.60 |
$52.50
|
|
Culture body fluid
|
$378.80 |
$378.80 |
$378.80 |
$126.00
|
|
Culture fungi definitive id yeast
|
$166.60 |
$166.60 |
$166.60 |
$79.50
|
|
Culture fungi other (except blood)
|
$35.20 |
$35.20 |
$35.20 |
$109.20
|
|
Culture fungi skin/hair/nail
|
$100.00 |
$100.00 |
$100.00 |
$74.40
|
|
Culture mycoplasma any source
|
$588.00 |
$588.00 |
$588.00 |
$81.62
|
|
Culture quantitative aerobic other source
|
$379.00 |
$379.00 |
$379.00 |
$90.35
|
|
Culture typing immunologic
|
$153.40 |
$153.40 |
$153.40 |
$43.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$872.00 |
$872.00 |
$872.00 |
$408.37
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$178.20 |
$178.20 |
$178.20 |
$138.40
|
|
Culture urine each isolate
|
$400.40 |
$400.40 |
$400.40 |
$54.78
|
|
Cyclic citrullinated peptide antibody
|
$270.40 |
$270.40 |
$270.40 |
$72.15
|
|
Cyclosporine modified 25 mg capsule
|
$2.00 |
$2.00 |
$2.00 |
$7.48
|
|
Cystatin c
|
$451.40 |
$451.40 |
$451.40 |
$76.48
|
|
Cytomegalovirus (cmv) antibody igg
|
$384.20 |
$384.20 |
$384.20 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$148.60 |
$148.60 |
$148.60 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$146.40 |
$146.40 |
$146.40 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$367.80 |
$367.80 |
$367.80 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$367.80 |
$367.80 |
$367.80 |
$86.86
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$50.60 |
$50.60 |
$50.60 |
$68.51
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$232.40 |
$232.40 |
$232.40 |
$189.67
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$382.20 |
$382.20 |
$382.20 |
$209.92
|
|
Debridement (>20 cm) charge pt
|
$1,387.00 |
$1,387.00 |
$1,387.00 |
$278.50
|
|
Debridement bone <= 20 sq cm
|
$7,413.80 |
$7,413.80 |
$7,413.80 |
$2,293.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,640.00 |
$1,640.00 |
$1,640.00 |
$687.35
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$2,409.00 |
$2,409.00 |
$2,409.00 |
$820.15
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$1,607.20 |
$1,607.20 |
$1,607.20 |
$641.52
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,847.00 |
$1,847.00 |
$1,847.00 |
$1,160.00
|
|
Decalcification
|
$398.20 |
$398.20 |
$398.20 |
$68.90
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$111.00 |
$111.00 |
$111.00 |
$182.40
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$761.40 |
$761.40 |
$761.40 |
$399.93
|
|
Destroy cervthor facet jnt 64633
|
$5,453.60 |
$5,453.60 |
$5,453.60 |
$3,018.00
|
|
Destroy cth facet jnt addl 64634
|
$1,545.20 |
$1,545.20 |
$1,545.20 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,412.80 |
$1,412.80 |
$1,412.80 |
$1,618.65
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$5,453.60 |
$5,453.60 |
$5,453.60 |
$3,295.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$469.60 |
$469.60 |
$469.60 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$4.20 |
$4.20 |
$4.20 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$8.00 |
$8.00 |
$8.00 |
$21.20
|
|
Dhea-s (dehydroepiand sulfate)
|
$229.80 |
$229.80 |
$229.80 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$25.00 |
$25.00 |
$25.00 |
$79.20
|
|
Diagnostic anoscopy spx 46600
|
$1,174.80 |
$1,174.80 |
$1,174.80 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$103.20 |
$103.20 |
$103.20 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$103.00 |
$103.00 |
$103.00 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$208.00 |
$208.00 |
$208.00 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$222.00 |
$222.00 |
$222.00 |
$312.72
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.80 |
$0.80 |
$0.80 |
$115.15
|
|
Diffusing capacity
|
$471.40 |
$471.40 |
$471.40 |
$335.20
|
|
Digoxin total therapeutic drug level
|
$280.20 |
$280.20 |
$280.20 |
$102.07
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$3.40 |
$3.40 |
$3.40 |
$18.35
|
|
Dna antibody native/double stranded
|
$252.60 |
$252.60 |
$252.60 |
$100.00
|
|
Dna gardnerella
|
$83.20 |
$83.20 |
$83.20 |
$61.80
|
|
Doppler echo complete
|
$1,071.40 |
$1,071.40 |
$1,071.40 |
$558.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$869.20 |
$869.20 |
$869.20 |
$473.76
|
|
Drain finger abscess;simple 26010
|
$581.60 |
$581.60 |
$581.60 |
$428.40
|
|
Drng of finger abscess comp 26011
|
$5,927.60 |
$5,927.60 |
$5,927.60 |
$2,029.60
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$344.65 |
$344.65 |
$344.65 |
$280.95
|
|
Drvvt confirm - quest
|
$81.60 |
$81.60 |
$81.60 |
$109.20
|
|
Dstrj nulyt agt gnclr nrv
|
$6,627.80 |
$6,627.80 |
$6,627.80 |
$2,967.48
|
|
Duplex scan bilateral study 93985
|
$811.20 |
$811.20 |
$811.20 |
$692.40
|
|
Dup scan/hemodialysis access 93990
|
$1,112.60 |
$1,112.60 |
$1,112.60 |
$486.02
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,229.80 |
$2,229.80 |
$2,229.80 |
$903.50
|
|
Dxa bone density axl vrt fx
|
$799.40 |
$799.40 |
$799.40 |
$410.25
|
|
Dx bronchoscope/lavage 31624
|
$4,929.80 |
$4,929.80 |
$4,929.80 |
$2,400.95
|
|
Ear irrigation 69209
|
$210.20 |
$210.20 |
$210.20 |
$150.00
|
|
Ecg 12 lead tracing only
|
$378.20 |
$378.20 |
$378.20 |
$226.50
|
|
Ecg external < 48 hours recording
|
$873.40 |
$873.40 |
$873.40 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$983.40 |
$983.40 |
$983.40 |
$541.20
|
|
Ecg external >7 days up to 15 days recording
|
$206.40 |
$206.40 |
$206.40 |
$161.85
|
|
Echocardiogram (Heart Ultrasound)
|
$2,898.80 |
$2,898.80 |
$2,898.80 |
$1,977.50
|
|
Echocardiography doppler color flow mapping
|
$617.60 |
$617.60 |
$617.60 |
$499.20
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,895.40 |
$1,895.40 |
$1,895.40 |
$711.00
|
|
Echocardiograpy doppler follow up/limited study
|
$456.80 |
$456.80 |
$456.80 |
$371.25
|
|
Echo stress
|
$2,475.60 |
$2,475.60 |
$2,475.60 |
$1,606.44
|
|
Echo tee probe placement image acquisition interpretation & report
|
$1,001.40 |
$1,001.40 |
$1,001.40 |
$1,889.20
|
