|
Cta lower extremity without & w/contrast (both sides)
|
$3,210.00 |
$3,210.00 |
$3,210.00 |
$2,002.44
|
|
Cta neck without &/or w/contrast
|
$2,883.00 |
$2,883.00 |
$2,883.00 |
$1,899.75
|
|
CT Angiogram of Abdomen and Pelvis
|
$4,607.50 |
$4,607.50 |
$4,607.50 |
$2,842.40
|
|
CT Angiogram of the Chest (for blood clot)
|
$2,835.50 |
$2,835.50 |
$2,835.50 |
$1,912.50
|
|
CT Angiogram of the Head
|
$2,824.50 |
$2,824.50 |
$2,824.50 |
$1,946.10
|
|
CT angio hrt w/3d image
|
$1,130.00 |
$1,130.00 |
$1,130.00 |
$1,424.40
|
|
CT angio pelvis
|
$2,808.50 |
$2,808.50 |
$2,808.50 |
$1,795.97
|
|
Cta upper extremity w &/or without contrast left
|
$3,730.50 |
$3,730.50 |
$3,730.50 |
$1,681.50
|
|
CT cerebral perf w cont & prcssng
|
$1,783.00 |
$1,783.00 |
$1,783.00 |
$1,040.00
|
|
CT heart w/evaluation of calcium without contrast
|
$129.00 |
$129.00 |
$129.00 |
$156.00
|
|
CT hrt c+ strux cgen hrt ds
|
$1,130.00 |
$1,130.00 |
$1,130.00 |
$1,371.50
|
|
CT hrt w/3d image
|
$1,130.00 |
$1,130.00 |
$1,130.00 |
$1,350.03
|
|
CT limited or localized follow-up study
|
$1,422.50 |
$1,422.50 |
$1,422.50 |
$633.60
|
|
CT lower extremity w/contrast (both sides)
|
$2,092.50 |
$2,092.50 |
$2,092.50 |
$1,585.18
|
|
CT lower extremity without contrast (both sides)
|
$1,819.50 |
$1,819.50 |
$1,819.50 |
$1,398.82
|
|
CT lwr extremity w/o&w/dye
|
$2,365.00 |
$2,365.00 |
$2,365.00 |
$1,818.96
|
|
CT neck soft tissue w/contrast
|
$2,257.00 |
$2,257.00 |
$2,257.00 |
$1,603.55
|
|
CT neck soft tissue without contrast
|
$1,962.50 |
$1,962.50 |
$1,962.50 |
$1,312.00
|
|
CT neck soft tissue without & w/contrast
|
$2,552.00 |
$2,552.00 |
$2,552.00 |
$1,940.00
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,316.50 |
$2,316.50 |
$2,316.50 |
$1,705.20
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,049.50 |
$2,049.50 |
$2,049.50 |
$1,543.00
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,782.00 |
$1,782.00 |
$1,782.00 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,006.00 |
$5,006.00 |
$5,006.00 |
$3,408.50
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,335.00 |
$4,335.00 |
$4,335.00 |
$2,871.05
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,769.50 |
$3,769.50 |
$3,769.50 |
$2,295.00
|
|
CT thoracic spine w/contrast
|
$2,577.00 |
$2,577.00 |
$2,577.00 |
$1,655.85
|
|
CT thoracic spine without contrast
|
$2,240.50 |
$2,240.50 |
$2,240.50 |
$1,430.20
|
|
CT thorax low dose for lung screening without contrast
|
$170.50 |
$170.50 |
$170.50 |
$332.00
|
|
CT t-spine w /wo contrast
|
$2,912.50 |
$2,912.50 |
$2,912.50 |
$1,968.47
|
|
CT upper extremity w/contrast (both sides)
|
$1,925.50 |
$1,925.50 |
$1,925.50 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$1,675.00 |
$1,675.00 |
$1,675.00 |
$1,404.36
|
|
CT uppr extremity w/o&w/dye
|
$2,177.00 |
$2,177.00 |
$2,177.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$188.00 |
$188.00 |
$188.00 |
$71.40
|
|
Culture afb any source
|
$33.50 |
$33.50 |
$33.50 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$188.00 |
$188.00 |
$188.00 |
$84.76
|
|
Culture anaerobic except blood
|
$333.50 |
$333.50 |
$333.50 |
$120.54
|
|
Culture bact stool aero addl path ea
|
$101.00 |
$101.00 |
$101.00 |
$52.50
|
|
Culture body fluid
|
$195.50 |
$195.50 |
$195.50 |
$126.00
|
|
Culture fungi definitive id mold
|
$195.50 |
$195.50 |
$195.50 |
$80.00
|
|
Culture fungi definitive id yeast
|
$188.00 |
$188.00 |
$188.00 |
$79.50
|
|
Culture fungi other (except blood)
|
$186.00 |
$186.00 |
$186.00 |
$109.20
|
|
Culture fungi skin/hair/nail
|
$186.00 |
$186.00 |
$186.00 |
$74.40
|
|
Culture mycoplasma any source
|
$18.00 |
$18.00 |
$18.00 |
$81.62
|
|
Culture quantitative aerobic other source
|
$201.00 |
$201.00 |
$201.00 |
$90.35
|
|
Culture screening strep group a
|
$101.00 |
$101.00 |
$101.00 |
$83.16
|
|
Culture typing added method
|
$54.00 |
$54.00 |
$54.00 |
$38.70
|
|
Culture typing immunologic
|
$195.50 |
$195.50 |
$195.50 |
$43.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$165.00 |
$165.00 |
$165.00 |
$138.40
|
|
Culture urine each isolate
|
$43.00 |
$43.00 |
$43.00 |
$54.78
|
|
Cyclic citrullinated peptide antibody
|
$12.00 |
$12.00 |
$12.00 |
$72.15
|
|
Cyclosporine 2 hour
|
$711.00 |
$711.00 |
$711.00 |
$129.48
|
|
Cygnus matrix, per sq cm
|
$60.94 |
$60.94 |
$60.94 |
$295.20
|
|
Cyp2c19 gene com variants
|
$169.00 |
$169.00 |
$169.00 |
$502.45
|
|
Cyp2c9 gene com variants
|
$60.00 |
$60.00 |
$60.00 |
$266.50
|
|
Cyp3a4 gene common variants
|
$240.00 |
$240.00 |
$240.00 |
$241.24
|
|
Cystatin c
|
$55.50 |
$55.50 |
$55.50 |
$76.48
|
|
Cystic fibrosis cftr
|
$900.00 |
$900.00 |
$900.00 |
$1,104.40
|
|
Cystine urine quantitative
|
$12.50 |
$12.50 |
$12.50 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$536.00 |
$536.00 |
$536.00 |
$564.85
|
|
Cystometrogram w/up 51727
|
$774.00 |
$774.00 |
$774.00 |
$908.59
|
|
Cytogenetics 25-99
|
$78.00 |
$78.00 |
$78.00 |
$189.80
|
|
Cytogenomic neo microra alys
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$2,156.05
|
|
Cytogenom microarray copy nmbr var
|
$971.50 |
$971.50 |
$971.50 |
$1,564.68
|
|
Cytomegalovirus (cmv) antibody igg
|
$103.00 |
$103.00 |
$103.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$84.50 |
$84.50 |
$84.50 |
$100.00
|
|
Cyto/molecular report
|
$346.00 |
$346.00 |
$346.00 |
$144.75
|
|
Cytopath c/v auto in fluid
|
$24.50 |
$24.50 |
$24.50 |
$56.00
|
|
Cytopath c/v thin layer redo
|
$32.50 |
$32.50 |
$32.50 |
$50.40
|
|
Cytopathology cellular enhancement technique non-gyn
|
$99.00 |
$99.00 |
$99.00 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$66.00 |
$66.00 |
$66.00 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$32.50 |
$32.50 |
$32.50 |
$86.86
|
|
Cytopathology concentration technique smears & interpretation
|
$247.50 |
$247.50 |
$247.50 |
$131.36
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$117.50 |
$117.50 |
$117.50 |
$124.00
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$447.50 |
$447.50 |
$447.50 |
$68.51
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$447.50 |
$447.50 |
$447.50 |
$189.67
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$406.00 |
$406.00 |
$406.00 |
$209.92
|
|
Cytopath smear oth prep screen & interp
|
$124.00 |
$124.00 |
$124.00 |
$96.20
|
|
Cytopath tbs c/v manual
|
$9.50 |
$9.50 |
$9.50 |
$59.28
|
|
Cytotoxic antibody screening
|
$166.50 |
$166.50 |
$166.50 |
$193.80
|
|
Cytp urine 3-5 probes cmptr
|
$345.00 |
$345.00 |
$345.00 |
$664.80
|
|
Dch pulmonary stress test
|
$984.50 |
$984.50 |
$984.50 |
$963.30
|
|
Dch validity tests
|
$43.00 |
$43.00 |
$43.00 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$10.50 |
$10.50 |
$10.50 |
$42.75
|
|
Decalcification
|
$292.00 |
$292.00 |
$292.00 |
$68.90
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$148.50 |
$148.50 |
$148.50 |
$182.40
|
|
Dermapure 1 square cm
|
$185.62 |
$185.62 |
$185.62 |
$3,822.00
|
|
Design mlc device for imrt
|
$3,679.50 |
$3,679.50 |
$3,679.50 |
$1,739.10
|
|
Desoxycorticosterone
|
$80.00 |
$80.00 |
$80.00 |
$98.80
|
|
Detect agent nos dna dir
|
$153.00 |
$153.00 |
$153.00 |
$145.80
|
|
Devel tst phys/qhp 1st hr
|
$432.50 |
$432.50 |
$432.50 |
$350.40
|
|
Dhea-s (dehydroepiand sulfate)
|
$16.50 |
$16.50 |
$16.50 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$79.00 |
$79.00 |
$79.00 |
$79.20
|
|
Diab manage trn ind/group
|
$87.50 |
$87.50 |
$87.50 |
$54.99
|
|
Diagnostic digital breast tomosynthesis bil
|
$135.00 |
$135.00 |
$135.00 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$74.00 |
$74.00 |
$74.00 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$580.00 |
$580.00 |
$580.00 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$469.00 |
$469.00 |
$469.00 |
$312.72
|
|
Dialysis one evaluation
|
$3,632.50 |
$3,632.50 |
$3,632.50 |
$936.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$6,267.25 |
$6,267.25 |
$6,267.25 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$292.00 |
$292.00 |
$292.00 |
$102.07
|
