|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,610.00 |
$4,610.00 |
$4,610.00 |
$3,575.60
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,140.00 |
$3,140.00 |
$3,140.00 |
$2,985.60
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,940.00 |
$2,940.00 |
$2,940.00 |
$2,418.75
|
|
CT thoracic spine w/contrast
|
$1,570.00 |
$1,570.00 |
$1,570.00 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,468.80
|
|
CT thorax low dose for lung screening without contrast
|
$445.00 |
$445.00 |
$445.00 |
$359.90
|
|
CT t-spine w /wo contrast
|
$2,305.00 |
$2,305.00 |
$2,305.00 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$1,570.00 |
$1,570.00 |
$1,570.00 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$2,305.00 |
$2,305.00 |
$2,305.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$80.00 |
$80.00 |
$80.00 |
$68.64
|
|
Culture afb any source
|
$80.00 |
$80.00 |
$80.00 |
$107.92
|
|
Culture anaerobic additional method definitive id each
|
$47.50 |
$47.50 |
$47.50 |
$77.31
|
|
Culture anaerobic except blood
|
$80.00 |
$80.00 |
$80.00 |
$119.20
|
|
Culture bact stool aero addl path ea
|
$80.00 |
$80.00 |
$80.00 |
$52.50
|
|
Culture body fluid
|
$80.00 |
$80.00 |
$80.00 |
$126.75
|
|
Culture fungi definitive id mold
|
$80.00 |
$80.00 |
$80.00 |
$74.83
|
|
Culture fungi definitive id yeast
|
$80.00 |
$80.00 |
$80.00 |
$79.00
|
|
Culture fungi other (except blood)
|
$80.00 |
$80.00 |
$80.00 |
$108.80
|
|
Culture fungi skin/hair/nail
|
$80.00 |
$80.00 |
$80.00 |
$77.37
|
|
Culture mycobacteria definitive id each isolate
|
$80.00 |
$80.00 |
$80.00 |
$88.14
|
|
Culture quantitative aerobic other source
|
$80.00 |
$80.00 |
$80.00 |
$89.40
|
|
Culture screening strep group a
|
$142.50 |
$142.50 |
$142.50 |
$85.80
|
|
Culture type pulse field gel
|
$120.00 |
$120.00 |
$120.00 |
$38.58
|
|
Culture typing immunologic
|
$22.50 |
$22.50 |
$22.50 |
$40.86
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$392.50 |
$392.50 |
$392.50 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$235.00 |
$235.00 |
$235.00 |
$123.76
|
|
Culture urine each isolate
|
$80.00 |
$80.00 |
$80.00 |
$51.35
|
|
Cutter lead
|
$1,151.49 |
$1,151.49 |
$1,151.49 |
$6,092.06
|
|
Cv line/pic reposition
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$1,752.40
|
|
Cyanocobalamin unsat binding capacity
|
$100.00 |
$100.00 |
$100.00 |
$64.28
|
|
Cyclic citrullinated peptide antibody
|
$80.00 |
$80.00 |
$80.00 |
$70.98
|
|
Cyclosporine 2 hour
|
$150.00 |
$150.00 |
$150.00 |
$126.10
|
|
Cystatin c
|
$90.00 |
$90.00 |
$90.00 |
$78.75
|
|
Cystic fibrosis cftr
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$1,060.00
|
|
Cystine urine quantitative
|
$112.50 |
$112.50 |
$112.50 |
$101.60
|
|
Cystogram >= 3 views supervision & interpretation
|
$510.00 |
$510.00 |
$510.00 |
$564.85
|
|
Cystoscopy and treatment
|
$2,400.00 |
$2,400.00 |
$2,400.00 |
$2,896.40
|
|
Cytogenetics 25-99
|
$265.00 |
$265.00 |
$265.00 |
$189.80
|
|
Cytogenetics 3-5
|
$915.00 |
$915.00 |
$915.00 |
$147.36
|
|
Cytomegalovirus (cmv) antibody igg
|
$95.00 |
$95.00 |
$95.00 |
$95.45
|
|
Cytomegalovirus (cmv) antibody igm
|
$100.00 |
$100.00 |
$100.00 |
$95.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$80.00 |
$80.00 |
$80.00 |
$162.50
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$95.00 |
$95.00 |
$95.00 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$87.50 |
$87.50 |
$87.50 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$152.50 |
$152.50 |
$152.50 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$100.00 |
$100.00 |
$100.00 |
$132.60
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$42.50 |
$42.50 |
$42.50 |
$70.00
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$120.00 |
$120.00 |
$120.00 |
$186.08
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$207.50 |
$207.50 |
$207.50 |
$207.50
|
|
Cytopath smear other source
|
$92.50 |
$92.50 |
$92.50 |
$88.13
|
|
Cytopath smear oth prep screen & interp
|
$85.00 |
$85.00 |
$85.00 |
$100.20
|
|
Cytp urine 3-5 probes cmptr
|
$760.00 |
$760.00 |
$760.00 |
$745.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.20 |
$0.20 |
$0.20 |
$267.00
|
|
Dch validity tests
|
$15.00 |
$15.00 |
$15.00 |
$25.00
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$3,500.00 |
$3,500.00 |
$3,500.00 |
$4,478.50
|
|
Deamidated gliadin antibody iga
|
$85.00 |
$85.00 |
$85.00 |
$44.20
|
|
Debridement (>20 cm) charge pt
|
$227.50 |
$227.50 |
$227.50 |
$274.56
|
|
Decalcification
|
$75.00 |
$75.00 |
$75.00 |
$70.40
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$272.50 |
$272.50 |
$272.50 |
$540.00
|
|
Delivery of placenta 59414
|
$635.00 |
$635.00 |
$635.00 |
$3,073.67
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$3,975.00 |
$3,975.00 |
$3,975.00 |
$7,178.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$70.00 |
$70.00 |
$70.00 |
$193.05
|
|
Dermagraft
|
$85.00 |
$85.00 |
$85.00 |
$85.00
|
|
Device ablt adv novasure
|
$925.00 |
$925.00 |
$925.00 |
$6,148.80
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$270.00 |
$270.00 |
$270.00 |
$227.25
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$5.29 |
$5.29 |
$5.29 |
$23.56
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$31.83 |
$31.83 |
$31.83 |
$37.20
|
|
Dextrose 5 % IV bolus
|
$65.55 |
$65.55 |
$65.55 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$137.50 |
$137.50 |
$137.50 |
$109.00
|
|
Diabetes (HbA1c) Test
|
$82.50 |
$82.50 |
$82.50 |
$79.52
|
|
Diab manage trn ind/group
|
$45.00 |
$45.00 |
$45.00 |
$57.75
|
|
Diagnostic anoscopy spx 46600
|
$160.00 |
$160.00 |
$160.00 |
$200.43
|
|
Diagnostic Mammogram (both breasts)
|
$475.00 |
$475.00 |
$475.00 |
$405.00
|
|
Diagnostic Mammogram (one breast)
|
$412.50 |
$412.50 |
$412.50 |
$313.29
|
|
Diagnostic radio unlisted proc
|
$590.00 |
$590.00 |
$590.00 |
$239.25
|
|
Dialysis circuit perm vascular embolization 36909
|
$17,110.00 |
$17,110.00 |
$17,110.00 |
$6,185.00
|
|
Dialysis one evaluation
|
$650.00 |
$650.00 |
$650.00 |
$845.00
|
|
Diathermy eg microwave
|
$47.50 |
$47.50 |
$47.50 |
$29.68
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$60.28 |
$60.28 |
$60.28 |
$74.17
|
|
Diffusing capacity
|
$285.00 |
$285.00 |
$285.00 |
$339.60
|
|
Digoxin total therapeutic drug level
|
$77.50 |
$77.50 |
$77.50 |
$100.20
|
|
Dilate biliary duct/ampulla
|
$4,815.00 |
$4,815.00 |
$4,815.00 |
$2,074.08
|
|
Dilat xst trc ndurlgc px
|
$2,075.00 |
$2,075.00 |
$2,075.00 |
$4,061.71
|
|
Dilat xst trc new access rcs
|
$3,110.00 |
$3,110.00 |
$3,110.00 |
$4,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$31.24 |
$31.24 |
$31.24 |
$17.75
|
|
Disability dlco
|
$240.00 |
$240.00 |
$240.00 |
$289.08
|
|
Disaccharidases
|
$357.50 |
$357.50 |
$357.50 |
$214.40
|
|
Dlyd plmt xtn prosth ea addl
|
$730.00 |
$730.00 |
$730.00 |
$1,864.35
|
|
Dna antibody native/double stranded
|
$100.00 |
$100.00 |
$100.00 |
$100.00
|
|
Dna gardnerella
|
$62.50 |
$62.50 |
$62.50 |
$62.50
|
|
Dna trichomonas
|
$62.50 |
$62.50 |
$62.50 |
$64.80
|
|
Doppler echo complete
|
$710.00 |
$710.00 |
$710.00 |
$586.75
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$540.00 |
$540.00 |
$540.00 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$362.50 |
$362.50 |
$362.50 |
$481.65
|
|
Dpyd gene common variants
|
$175.00 |
$175.00 |
$175.00 |
$362.05
|
|
Drainage of kidney lesion
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$1,578.89
|
|
Drain blood from under nail 11740
|
$75.00 |
$75.00 |
$75.00 |
$182.95
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$2,540.00 |
$2,540.00 |
$2,540.00 |
$2,684.50
|
|
Drain cath image guided visceral pq
|
$2,785.00 |
$2,785.00 |
$2,785.00 |
$2,903.44
|
