|
CT angio pelvis
|
$1,479.60 |
$1,479.60 |
$1,479.60 |
$1,837.80
|
|
Cta upper extremity w &/or without contrast left
|
$1,479.60 |
$1,479.60 |
$1,479.60 |
$1,698.00
|
|
CT guidance for needle placement
|
$2,460.60 |
$2,460.60 |
$2,460.60 |
$1,494.00
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,650.60 |
$1,650.60 |
$1,650.60 |
$1,178.52
|
|
CT heart w/evaluation of calcium without contrast
|
$1,301.00 |
$1,301.00 |
$1,301.00 |
$171.60
|
|
CT limited or localized follow-up study
|
$1,046.10 |
$1,046.10 |
$1,046.10 |
$642.75
|
|
CT lower extremity w/contrast (both sides)
|
$3,680.40 |
$3,680.40 |
$3,680.40 |
$1,652.00
|
|
CT lower extremity without contrast (both sides)
|
$2,373.60 |
$2,373.60 |
$2,373.60 |
$1,421.85
|
|
Ctlso a-p-l control molded
|
$4,779.03 |
$4,779.03 |
$4,779.03 |
$3,746.69
|
|
Ctlso a-p-l control with inter
|
$5,253.46 |
$5,253.46 |
$5,253.46 |
$4,186.78
|
|
Ctlso axilla sling
|
$200.86 |
$200.86 |
$200.86 |
$197.97
|
|
Ctlso milwauke initial model
|
$4,867.90 |
$4,867.90 |
$4,867.90 |
$4,797.91
|
|
CT lwr extremity w/o&w/dye
|
$4,014.90 |
$4,014.90 |
$4,014.90 |
$1,854.05
|
|
CT neck soft tissue w/contrast
|
$3,889.20 |
$3,889.20 |
$3,889.20 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$3,889.20 |
$3,889.20 |
$3,889.20 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$2,112.30 |
$2,112.30 |
$2,112.30 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$3,287.10 |
$3,287.10 |
$3,287.10 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$489.00 |
$489.00 |
$489.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$2,032.80 |
$2,032.80 |
$2,032.80 |
$1,360.00
|
|
Ctrl nosebld postir subsq 30906
|
$87.00 |
$87.00 |
$87.00 |
$437.04
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,098.90 |
$4,098.90 |
$4,098.90 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,614.10 |
$3,614.10 |
$3,614.10 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,698.50 |
$2,698.50 |
$2,698.50 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$2,722.20 |
$2,722.20 |
$2,722.20 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,671.20 |
$2,671.20 |
$2,671.20 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,899.00 |
$1,899.00 |
$1,899.00 |
$331.50
|
|
CT t-spine w /wo contrast
|
$595.50 |
$595.50 |
$595.50 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$2,987.40 |
$2,987.40 |
$2,987.40 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$2,120.40 |
$2,120.40 |
$2,120.40 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$3,258.90 |
$3,258.90 |
$3,258.90 |
$1,845.36
|
|
Cuffs adj lock with active con
|
$2,347.50 |
$2,347.50 |
$2,347.50 |
$1,472.80
|
|
Culture aerobic additional method definitive id each
|
$132.00 |
$132.00 |
$132.00 |
$68.64
|
|
Culture afb any source
|
$98.70 |
$98.70 |
$98.70 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$140.10 |
$140.10 |
$140.10 |
$79.00
|
|
Culture anaerobic except blood
|
$200.70 |
$200.70 |
$200.70 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$11.40 |
$11.40 |
$11.40 |
$51.45
|
|
Culture body fluid
|
$71.40 |
$71.40 |
$71.40 |
$126.75
|
|
Culture fungi definitive id mold
|
$137.10 |
$137.10 |
$137.10 |
$77.28
|
|
Culture fungi definitive id yeast
|
$140.10 |
$140.10 |
$140.10 |
$79.10
|
|
Culture fungi other (except blood)
|
$106.80 |
$106.80 |
$106.80 |
$108.00
|
|
Culture mycobacteria definitive id each isolate
|
$140.10 |
$140.10 |
$140.10 |
$89.70
|
|
Culture mycoplasma any source
|
$30.30 |
$30.30 |
$30.30 |
$85.26
|
|
Culture screening strep group a
|
$13.50 |
$13.50 |
$13.50 |
$81.00
|
|
Culture typing added method
|
$137.10 |
$137.10 |
$137.10 |
$38.58
|
|
Culture typing immunologic
|
$70.20 |
$70.20 |
$70.20 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$378.60 |
$378.60 |
$378.60 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$166.50 |
$166.50 |
$166.50 |
$133.90
|
|
Culture urine each isolate
|
$47.40 |
$47.40 |
$47.40 |
$57.00
|
|
Cutter lead
|
$9,505.12 |
$9,505.12 |
$9,505.12 |
$6,092.06
|
|
Cv line/pic reposition
|
$1,550.10 |
$1,550.10 |
$1,550.10 |
$1,720.93
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$48.00 |
$48.00 |
$48.00 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$188.10 |
$188.10 |
$188.10 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$651.36 |
$651.36 |
$651.36 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$69.20 |
$69.20 |
$69.20 |
$19.49
|
|
Cyclosporine modified 25 mg capsule
|
$44.26 |
$44.26 |
$44.26 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$152.89 |
$152.89 |
$152.89 |
$34.88
|
|
Cygnus, per sq cm
|
$11,981.25 |
$11,981.25 |
$11,981.25 |
$356.54
|
|
Cylinder pump set 20cm titan zero angl
|
$38,795.42 |
$38,795.42 |
$38,795.42 |
$22,803.38
|
|
Cyp2c9 gene com variants
|
$275.40 |
$275.40 |
$275.40 |
$275.10
|
|
Cyp3a4 gene common variants
|
$262.20 |
$262.20 |
$262.20 |
$245.31
|
|
Cyp3a5 gene common variants
|
$262.20 |
$262.20 |
$262.20 |
$245.31
|
|
Cystogram >= 3 views supervision & interpretation
|
$519.30 |
$519.30 |
$519.30 |
$542.10
|
|
Cysto impl 4 or more
|
$35,758.27 |
$35,758.27 |
$35,758.27 |
$6,860.21
|
|
Cystoscopy and treatment
|
$10,319.15 |
$10,319.15 |
$10,319.15 |
$4,081.37
|
|
Cystoscopy and treatment
|
$10,452.42 |
$10,452.42 |
$10,452.42 |
$4,160.10
|
|
Cystoscopy and treatment
|
$18,942.46 |
$18,942.46 |
$18,942.46 |
$5,162.50
|
|
Cystoscopy and treatment
|
$13,871.70 |
$13,871.70 |
$13,871.70 |
$5,995.60
|
|
Cystoscopy and treatment
|
$18,632.41 |
$18,632.41 |
$18,632.41 |
$6,475.26
|
|
Cystoscopy and treatment
|
$9,090.64 |
$9,090.64 |
$9,090.64 |
$3,213.14
|
|
Cystoscopy and treatment
|
$18,972.92 |
$18,972.92 |
$18,972.92 |
$4,045.60
|
|
Cystoscopy and treatment
|
$9,564.12 |
$9,564.12 |
$9,564.12 |
$2,874.36
|
|
Cystoscopy and treatment
|
$773.10 |
$773.10 |
$773.10 |
$3,203.50
|
|
Cystoscopy (Bladder Scope)
|
$8,212.54 |
$8,212.54 |
$8,212.54 |
$1,493.80
|
|
Cystoscopy chemodenervation
|
$14,979.64 |
$14,979.64 |
$14,979.64 |
$2,704.80
|
|
Cystoscopy removal of clots
|
$16,542.16 |
$16,542.16 |
$16,542.16 |
$4,081.37
|
|
Cystoscopy & revise urethra
|
$13,780.72 |
$13,780.72 |
$13,780.72 |
$2,874.36
|
|
Cystoscopy & ureter catheter
|
$18,632.41 |
$18,632.41 |
$18,632.41 |
$3,786.00
|
|
Cystostomy cystotomy w/drainage 51040
|
$16,121.68 |
$16,121.68 |
$16,121.68 |
$3,863.60
|
|
Cystouretero & or pyeloscope
|
$15,301.09 |
$15,301.09 |
$15,301.09 |
$4,315.98
|
|
Cysto/uretero stricture tx
|
$23,500.16 |
$23,500.16 |
$23,500.16 |
$4,846.99
|
|
Cystouretero w/biopsy
|
$14,228.31 |
$14,228.31 |
$14,228.31 |
$5,986.78
|
|
Cysto/uretero w/lithotripsy
|
$25,379.37 |
$25,379.37 |
$25,379.37 |
$9,002.88
|
|
Cystouretero w/lithotripsy
|
$15,766.66 |
$15,766.66 |
$15,766.66 |
$7,061.60
|
|
Cystouretero w/stone remove
|
$18,686.08 |
$18,686.08 |
$18,686.08 |
$5,110.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$9,213.41 |
$9,213.41 |
$9,213.41 |
$3,065.15
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$11,643.45 |
$11,643.45 |
$11,643.45 |
$4,045.60
|
|
Cystourethro w/addl implant 52442
|
$29,886.55 |
$29,886.55 |
$29,886.55 |
$2,161.60
|
|
Cystourethro w/implant
|
$29,886.55 |
$29,886.55 |
$29,886.55 |
$2,298.40
|
|
Cytarabine 20 mg/ml injection solution
|
$112.17 |
$112.17 |
$112.17 |
$89.94
|
|
Cytomegalovirus (cmv) antibody igg
|
$172.50 |
$172.50 |
$172.50 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$128.40 |
$128.40 |
$128.40 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$87.00 |
$87.00 |
$87.00 |
$159.45
|
|
Cytopathology concentration technique smears & interpretation
|
$73.80 |
$73.80 |
$73.80 |
$129.60
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$22.20 |
$22.20 |
$22.20 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$164.10 |
$164.10 |
$164.10 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$52.20 |
$52.20 |
$52.20 |
$209.23
|
|
Dacarbazine 100 mg intravenous solution
|
$90.00 |
$90.00 |
$90.00 |
$58.22
|
|
Dalbavancin 500 mg intravenous solution
|
$8,059.46 |
$8,059.46 |
$8,059.46 |
$3,480.35
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,103.73 |
$2,103.73 |
$2,103.73 |
$6,072.48
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$10,512.90 |
$10,512.90 |
$10,512.90 |
$3,774.81
|