|
CT upper extremity without contrast (both sides)
|
$299.00 |
$299.00 |
$299.00 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$533.50 |
$533.50 |
$533.50 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$36.50 |
$36.50 |
$36.50 |
$68.64
|
|
Culture afb any source
|
$195.00 |
$195.00 |
$195.00 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$57.50 |
$57.50 |
$57.50 |
$79.00
|
|
Culture anaerobic except blood
|
$57.50 |
$57.50 |
$57.50 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$51.00 |
$51.00 |
$51.00 |
$51.45
|
|
Culture body fluid
|
$34.00 |
$34.00 |
$34.00 |
$126.75
|
|
Culture fungi definitive id mold
|
$48.00 |
$48.00 |
$48.00 |
$77.28
|
|
Culture fungi definitive id yeast
|
$50.00 |
$50.00 |
$50.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$34.00 |
$34.00 |
$34.00 |
$108.00
|
|
Culture mycobacteria definitive id each isolate
|
$140.00 |
$140.00 |
$140.00 |
$89.70
|
|
Culture screening strep group a
|
$18.00 |
$18.00 |
$18.00 |
$81.00
|
|
Culture typing immunologic
|
$52.50 |
$52.50 |
$52.50 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$363.00 |
$363.00 |
$363.00 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$202.00 |
$202.00 |
$202.00 |
$133.90
|
|
Curette/treat cornea
|
$66.00 |
$66.00 |
$66.00 |
$1,345.80
|
|
Curette/treat cornea
|
$348.00 |
$348.00 |
$348.00 |
$2,818.14
|
|
Cv line/pic reposition
|
$61.00 |
$61.00 |
$61.00 |
$1,720.93
|
|
Cv stress test i&r only 93018
|
$15.50 |
$15.50 |
$15.50 |
$40.20
|
|
Cv stress test/supervision only 93016
|
$23.00 |
$23.00 |
$23.00 |
$51.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$3.00 |
$3.00 |
$3.00 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$30.50 |
$30.50 |
$30.50 |
$70.72
|
|
Cyclosporine 2 hour
|
$39.50 |
$39.50 |
$39.50 |
$129.48
|
|
Cygnus matrix, per sq cm
|
$221.50 |
$221.50 |
$221.50 |
$295.20
|
|
Cyp2c19 gene com variants
|
$1,175.00 |
$1,175.00 |
$1,175.00 |
$504.00
|
|
Cystatin c
|
$31.00 |
$31.00 |
$31.00 |
$77.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$17.00 |
$17.00 |
$17.00 |
$542.10
|
|
Cysto, litho, vacuum kidney
|
$399.00 |
$399.00 |
$399.00 |
$10,942.71
|
|
Cystometrogram w/up 51727
|
$345.50 |
$345.50 |
$345.50 |
$908.59
|
|
Cystorrhaphy wound comp 51865
|
$930.50 |
$930.50 |
$930.50 |
$1,756.80
|
|
Cystorrhaphy wound simple 51860
|
$783.00 |
$783.00 |
$783.00 |
$5,855.00
|
|
Cysto rx balo cath urtl strx
|
$169.00 |
$169.00 |
$169.00 |
$6,015.75
|
|
Cystoscopy and biopsy
|
$170.50 |
$170.50 |
$170.50 |
$4,081.37
|
|
Cystoscopy and treatment
|
$177.50 |
$177.50 |
$177.50 |
$4,081.37
|
|
Cystoscopy and treatment
|
$205.00 |
$205.00 |
$205.00 |
$4,160.10
|
|
Cystoscopy and treatment
|
$250.50 |
$250.50 |
$250.50 |
$5,162.50
|
|
Cystoscopy and treatment
|
$294.50 |
$294.50 |
$294.50 |
$5,995.60
|
|
Cystoscopy and treatment
|
$399.00 |
$399.00 |
$399.00 |
$6,475.26
|
|
Cystoscopy and treatment
|
$215.00 |
$215.00 |
$215.00 |
$3,213.14
|
|
Cystoscopy and treatment
|
$167.00 |
$167.00 |
$167.00 |
$2,424.12
|
|
Cystoscopy and treatment
|
$270.00 |
$270.00 |
$270.00 |
$4,045.60
|
|
Cystoscopy and treatment
|
$295.50 |
$295.50 |
$295.50 |
$4,081.37
|
|
Cystoscopy and treatment
|
$155.50 |
$155.50 |
$155.50 |
$2,874.36
|
|
Cystoscopy and treatment
|
$281.00 |
$281.00 |
$281.00 |
$3,203.50
|
|
Cystoscopy and treatment
|
$250.50 |
$250.50 |
$250.50 |
$4,061.71
|
|
Cystoscopy and treatment
|
$268.00 |
$268.00 |
$268.00 |
$3,820.84
|
|
Cystoscopy (Bladder Scope)
|
$571.00 |
$571.00 |
$571.00 |
$1,493.80
|
|
Cystoscopy chemodenervation
|
$173.00 |
$173.00 |
$173.00 |
$2,704.80
|
|
Cystoscopy implant stent
|
$345.00 |
$345.00 |
$345.00 |
$4,627.00
|
|
Cystoscopy removal of clots
|
$2,881.00 |
$2,881.00 |
$2,881.00 |
$4,081.37
|
|
Cystoscopy & revise urethra
|
$253.50 |
$253.50 |
$253.50 |
$2,874.36
|
|
Cystoscopy stone removal
|
$327.00 |
$327.00 |
$327.00 |
$5,741.00
|
|
Cystoscopy & ureter catheter
|
$137.00 |
$137.00 |
$137.00 |
$3,786.00
|
|
Cystostomy cystotomy w/drainage 51040
|
$305.50 |
$305.50 |
$305.50 |
$3,863.60
|
|
Cystouretero & or pyeloscope
|
$308.50 |
$308.50 |
$308.50 |
$4,315.98
|
|
Cysto/uretero stricture tx
|
$376.50 |
$376.50 |
$376.50 |
$4,846.99
|
|
Cystouretero w/biopsy
|
$425.50 |
$425.50 |
$425.50 |
$5,986.78
|
|
Cystouretero w/excise tumor
|
$476.00 |
$476.00 |
$476.00 |
$5,584.80
|
|
Cysto/uretero w/lithotripsy
|
$424.00 |
$424.00 |
$424.00 |
$9,002.88
|
|
Cystouretero w/lithotripsy
|
$399.00 |
$399.00 |
$399.00 |
$7,061.60
|
|
Cystouretero w/renal strict
|
$454.50 |
$454.50 |
$454.50 |
$5,741.00
|
|
Cystouretero w/stone remove
|
$361.50 |
$361.50 |
$361.50 |
$5,110.00
|
|
Cystourethroscop/calib/dilat stric 52281
|
$157.00 |
$157.00 |
$157.00 |
$3,065.15
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$146.50 |
$146.50 |
$146.50 |
$4,045.60
|
|
Cystourethro w/addl implant 52442
|
$51.50 |
$51.50 |
$51.50 |
$2,161.60
|
|
Cystourethro w/implant
|
$213.00 |
$213.00 |
$213.00 |
$2,298.40
|
|
Cysto w/renal stricture tx
|
$350.50 |
$350.50 |
$350.50 |
$4,045.60
|
|
Cysto w/ureter stricture tx
|
$289.50 |
$289.50 |
$289.50 |
$4,081.37
|
|
Cytomegalovirus (cmv) antibody igg
|
$58.00 |
$58.00 |
$58.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$10.00 |
$10.00 |
$10.00 |
$97.50
|
|
Cyto/molecular report
|
$36.00 |
$36.00 |
$36.00 |
$133.20
|
|
Cytopath fl nongyn filter
|
$19.50 |
$19.50 |
$19.50 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$29.00 |
$29.00 |
$29.00 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$89.00 |
$89.00 |
$89.00 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$90.00 |
$90.00 |
$90.00 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$23.50 |
$23.50 |
$23.50 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$29.50 |
$29.50 |
$29.50 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$22.50 |
$22.50 |
$22.50 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$72.50 |
$72.50 |
$72.50 |
$209.23
|
|
Cytopath smear other source
|
$40.50 |
$40.50 |
$40.50 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$26.50 |
$26.50 |
$26.50 |
$96.20
|
|
Dalbavancin 500 mg intravenous solution
|
$13.50 |
$13.50 |
$13.50 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.50 |
$0.50 |
$0.50 |
$168.53
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$11.50 |
$11.50 |
$11.50 |
$6,072.48
|
|
Darbepoetin alfa, esrd use
|
$11.50 |
$11.50 |
$11.50 |
$4.48
|
|
D&c after delivery 59160
|
$199.00 |
$199.00 |
$199.00 |
$3,827.25
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$240.50 |
$240.50 |
$240.50 |
$3,774.81
|
|
Dch validity tests
|
$19.50 |
$19.50 |
$19.50 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$61.50 |
$61.50 |
$61.50 |
$43.60
|
|
Debr g/per/abd wall 11006
|
$745.00 |
$745.00 |
$745.00 |
$1,357.80
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$28.00 |
$28.00 |
$28.00 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$25.50 |
$25.50 |
$25.50 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$234.00 |
$234.00 |
$234.00 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$56.50 |
$56.50 |
$56.50 |
$663.00
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$101.00 |
$101.00 |
$101.00 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$389.50 |
$389.50 |
$389.50 |
$810.50
|
|
Debride nail1-5 11720
|
$57.00 |
$57.00 |
$57.00 |
$148.80
|
|
Debride nail6 or more 11721
|
$92.00 |
$92.00 |
$92.00 |
$169.60
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$307.50 |
$307.50 |
$307.50 |
$1,012.80
|
