|
CT limited or localized follow-up study
|
$516.22 |
$516.22 |
$516.22 |
$625.63
|
|
CT lower extremity w/contrast (both sides)
|
$867.61 |
$867.61 |
$867.61 |
$1,693.20
|
|
CT lower extremity without contrast (both sides)
|
$841.64 |
$841.64 |
$841.64 |
$1,398.82
|
|
CT lwr extremity w/o&w/dye
|
$1,007.53 |
$1,007.53 |
$1,007.53 |
$1,817.40
|
|
CT neck soft tissue w/contrast
|
$850.12 |
$850.12 |
$850.12 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$841.64 |
$841.64 |
$841.64 |
$1,332.50
|
|
CT neck soft tissue without & w/contrast
|
$876.09 |
$876.09 |
$876.09 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$876.62 |
$876.62 |
$876.62 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$867.61 |
$867.61 |
$867.61 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$858.60 |
$858.60 |
$858.60 |
$1,351.20
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,274.65 |
$1,274.65 |
$1,274.65 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,274.65 |
$1,274.65 |
$1,274.65 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,212.11 |
$1,212.11 |
$1,212.11 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$894.64 |
$894.64 |
$894.64 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$841.64 |
$841.64 |
$841.64 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$595.72 |
$595.72 |
$595.72 |
$400.20
|
|
CT t-spine w /wo contrast
|
$947.64 |
$947.64 |
$947.64 |
$2,030.60
|
|
CT upper extremity w/contrast (both sides)
|
$867.61 |
$867.61 |
$867.61 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$850.12 |
$850.12 |
$850.12 |
$1,468.83
|
|
CT uppr extremity w/o&w/dye
|
$885.10 |
$885.10 |
$885.10 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$30.74 |
$30.74 |
$30.74 |
$63.75
|
|
Culture afb any source
|
$67.84 |
$67.84 |
$67.84 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$38.69 |
$38.69 |
$38.69 |
$77.31
|
|
Culture anaerobic except blood
|
$62.54 |
$62.54 |
$62.54 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$36.04 |
$36.04 |
$36.04 |
$52.80
|
|
Culture body fluid
|
$54.06 |
$54.06 |
$54.06 |
$130.50
|
|
Culture fungi definitive id mold
|
$38.16 |
$38.16 |
$38.16 |
$70.00
|
|
Culture fungi definitive id yeast
|
$39.22 |
$39.22 |
$39.22 |
$80.60
|
|
Culture fungi other (except blood)
|
$64.66 |
$64.66 |
$64.66 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$47.70 |
$47.70 |
$47.70 |
$77.40
|
|
Culture mycobacteria definitive id each isolate
|
$79.50 |
$79.50 |
$79.50 |
$84.75
|
|
Culture mycoplasma any source
|
$81.62 |
$81.62 |
$81.62 |
$90.37
|
|
Culture quantitative aerobic other source
|
$46.64 |
$46.64 |
$46.64 |
$87.02
|
|
Culture screening strep group a
|
$36.04 |
$36.04 |
$36.04 |
$81.60
|
|
Culture typing immunologic
|
$20.67 |
$20.67 |
$20.67 |
$41.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$130.38 |
$130.38 |
$130.38 |
$124.40
|
|
Culture urine each isolate
|
$36.57 |
$36.57 |
$36.57 |
$46.20
|
|
Cv line/pic reposition
|
$1,228.54 |
$1,228.54 |
$1,228.54 |
$1,829.42
|
|
Cyanocobalamin unsat binding capacity
|
$46.64 |
$46.64 |
$46.64 |
$60.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$4.75 |
$4.75 |
$4.75 |
$33.37
|
|
Cyclic citrullinated peptide antibody
|
$56.18 |
$56.18 |
$56.18 |
$80.05
|
|
Cyclosporine 2 hour
|
$89.04 |
$89.04 |
$89.04 |
$121.80
|
|
Cystatin c
|
$73.67 |
$73.67 |
$73.67 |
$82.26
|
|
Cystic fibrosis cftr
|
$3,576.44 |
$3,576.44 |
$3,576.44 |
$1,041.95
|
|
Cystine urine quantitative
|
$100.70 |
$100.70 |
$100.70 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$194.51 |
$194.51 |
$194.51 |
$539.55
|
|
Cystoscopy removal of clots
|
$5,945.54 |
$5,945.54 |
$5,945.54 |
$3,970.98
|
|
Cytogenetics 25-99
|
$119.25 |
$119.25 |
$119.25 |
$180.32
|
|
Cytomegalovirus (cmv) antibody igg
|
$49.82 |
$49.82 |
$49.82 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$51.94 |
$51.94 |
$51.94 |
$96.80
|
|
Cytomegalovirus dfa
|
$108.12 |
$108.12 |
$108.12 |
$59.59
|
|
Cytopath c/v index add-on
|
$43.46 |
$43.46 |
$43.46 |
$29.60
|
|
Cytopathology cellular enhancement technique non-gyn
|
$91.16 |
$91.16 |
$91.16 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$93.81 |
$93.81 |
$93.81 |
$90.75
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$80.03 |
$80.03 |
$80.03 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$74.73 |
$74.73 |
$74.73 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$97.52 |
$97.52 |
$97.52 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$127.73 |
$127.73 |
$127.73 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$90.63 |
$90.63 |
$90.63 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$115.01 |
$115.01 |
$115.01 |
$205.00
|
|
Cytopath smear other source
|
$58.30 |
$58.30 |
$58.30 |
$85.80
|
|
Cytopath smear other source
|
$171.72 |
$171.72 |
$171.72 |
$122.19
|
|
Cytopath smear oth prep screen & interp
|
$66.78 |
$66.78 |
$66.78 |
$95.89
|
|
Cytopath tbs c/v manual
|
$81.09 |
$81.09 |
$81.09 |
$57.94
|
|
Cytp urine 3-5 probes cmptr
|
$484.95 |
$484.95 |
$484.95 |
$690.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.52 |
$0.52 |
$0.52 |
$315.32
|
|
Dch validity tests
|
$13.78 |
$13.78 |
$13.78 |
$25.20
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$3,863.17 |
$3,863.17 |
$3,863.17 |
$4,021.68
|
|
Deamidated gliadin antibody iga
|
$7.42 |
$7.42 |
$7.42 |
$44.16
|
|
Decalcification
|
$33.39 |
$33.39 |
$33.39 |
$73.60
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$227.37 |
$227.37 |
$227.37 |
$545.90
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$3,263.74 |
$3,263.74 |
$3,263.74 |
$7,763.47
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$111.30 |
$111.30 |
$111.30 |
$196.26
|
|
Descend thora aorta rpr/lt sub art 33880
|
$4,539.98 |
$4,539.98 |
$4,539.98 |
$5,702.04
|
|
Desmopressin 4 mcg/ml injection solution
|
$26.36 |
$26.36 |
$26.36 |
$102.32
|
|
Des thora aorta rpr without left sub art 33881
|
$31,412.57 |
$31,412.57 |
$31,412.57 |
$5,698.68
|
|
Destroy cervthor facet jnt 64633
|
$1,696.00 |
$1,696.00 |
$1,696.00 |
$3,164.80
|
|
Destroy cth facet jnt addl 64634
|
$848.00 |
$848.00 |
$848.00 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$920.61 |
$920.61 |
$920.61 |
$1,879.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,841.22 |
$1,841.22 |
$1,841.22 |
$3,375.00
|
|
Detect agnt mult dna direc
|
$102.82 |
$102.82 |
$102.82 |
$109.60
|
|
Dexamethasone 4 mg tablet
|
$0.04 |
$0.04 |
$0.04 |
$6.01
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$1.43 |
$1.43 |
$1.43 |
$30.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$72.61 |
$72.61 |
$72.61 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$38.16 |
$38.16 |
$38.16 |
$78.03
|
|
Diagnostic radio unlisted proc
|
$123.49 |
$123.49 |
$123.49 |
$239.25
|
|
Dialysis circuit perm vascular embolization 36909
|
$4,560.65 |
$4,560.65 |
$4,560.65 |
$7,145.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$26.35 |
$26.35 |
$26.35 |
$72.34
|
|
Diffusing capacity
|
$214.12 |
$214.12 |
$214.12 |
$360.10
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$105.19 |
$105.19 |
$105.19 |
$69.79
|
|
Digoxin total therapeutic drug level
|
$56.18 |
$56.18 |
$56.18 |
$102.00
|
|
Dilate biliary duct/ampulla
|
$1,276.77 |
$1,276.77 |
$1,276.77 |
$2,304.60
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$1,340.37 |
$1,340.37 |
$1,340.37 |
$4,322.56
|
|
Dilate ic vasospasm ea add vsl same territory
|
$696.95 |
$696.95 |
$696.95 |
$2,299.05
|
|
Dilate ic vasospasm init
|
$1,394.43 |
$1,394.43 |
$1,394.43 |
$6,280.95
|
|
Dilation of salivary duct
|
$333.37 |
$333.37 |
$333.37 |
$599.72
|
|
Dilat xst trc ndurlgc px
|
$3,632.62 |
$3,632.62 |
$3,632.62 |
$4,081.37
|
|
Dilat xst trc new access rcs
|
$6,110.90 |
$6,110.90 |
$6,110.90 |
$5,020.00
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$1.63 |
$1.63 |
$1.63 |
$26.87
|
|
Disability dlco
|
$292.03 |
$292.03 |
$292.03 |
$307.58
|