|
CT lower extremity without contrast (both sides)
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,398.82
|
|
CT lwr extremity w/o&w/dye
|
$2,305.00 |
$2,305.00 |
$2,305.00 |
$1,851.60
|
|
CT neck soft tissue w/contrast
|
$1,570.00 |
$1,570.00 |
$1,570.00 |
$1,630.23
|
|
CT neck soft tissue without contrast
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,318.20
|
|
CT neck soft tissue without & w/contrast
|
$2,305.00 |
$2,305.00 |
$2,305.00 |
$1,940.00
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,305.00 |
$2,305.00 |
$2,305.00 |
$1,705.20
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,570.00 |
$1,570.00 |
$1,570.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,351.20
|
|
CT scan for localization
|
$845.00 |
$845.00 |
$845.00 |
$1,202.37
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,610.00 |
$4,610.00 |
$4,610.00 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,140.00 |
$3,140.00 |
$3,140.00 |
$2,855.63
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,940.00 |
$2,940.00 |
$2,940.00 |
$2,295.00
|
|
CT thoracic spine w/contrast
|
$1,570.00 |
$1,570.00 |
$1,570.00 |
$1,688.40
|
|
CT thoracic spine without contrast
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$445.00 |
$445.00 |
$445.00 |
$331.50
|
|
CT t-spine w /wo contrast
|
$2,305.00 |
$2,305.00 |
$2,305.00 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$1,570.00 |
$1,570.00 |
$1,570.00 |
$1,687.88
|
|
CT upper extremity without contrast (both sides)
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,421.20
|
|
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 |
$68.80
|
|
Culture afb any source
|
$80.00 |
$80.00 |
$80.00 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$47.50 |
$47.50 |
$47.50 |
$78.60
|
|
Culture anaerobic except blood
|
$80.00 |
$80.00 |
$80.00 |
$117.45
|
|
Culture bact stool aero addl path ea
|
$80.00 |
$80.00 |
$80.00 |
$51.60
|
|
Culture body fluid
|
$80.00 |
$80.00 |
$80.00 |
$121.80
|
|
Culture fungi definitive id mold
|
$80.00 |
$80.00 |
$80.00 |
$74.83
|
|
Culture fungi definitive id yeast
|
$80.00 |
$80.00 |
$80.00 |
$79.10
|
|
Culture fungi other (except blood)
|
$80.00 |
$80.00 |
$80.00 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$80.00 |
$80.00 |
$80.00 |
$75.40
|
|
Culture mycobacteria definitive id each isolate
|
$80.00 |
$80.00 |
$80.00 |
$88.40
|
|
Culture quantitative aerobic other source
|
$80.00 |
$80.00 |
$80.00 |
$89.10
|
|
Culture screening strep group a
|
$142.50 |
$142.50 |
$142.50 |
$81.25
|
|
Culture type pulse field gel
|
$120.00 |
$120.00 |
$120.00 |
$38.58
|
|
Culture typing immunologic
|
$22.50 |
$22.50 |
$22.50 |
$41.60
|
|
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 |
$130.38
|
|
Culture urine each isolate
|
$80.00 |
$80.00 |
$80.00 |
$52.65
|
|
Cutter lead
|
$836.48 |
$836.48 |
$836.48 |
$5,906.56
|
|
Cv line/pic reposition
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$1,719.44
|
|
Cyanocobalamin unsat binding capacity
|
$100.00 |
$100.00 |
$100.00 |
$64.28
|
|
Cyclic citrullinated peptide antibody
|
$80.00 |
$80.00 |
$80.00 |
$72.00
|
|
Cyclosporine 2 hour
|
$150.00 |
$150.00 |
$150.00 |
$126.10
|
|
Cystatin c
|
$90.00 |
$90.00 |
$90.00 |
$76.41
|
|
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 |
$539.55
|
|
Cystoscopy and treatment
|
$2,400.00 |
$2,400.00 |
$2,400.00 |
$2,874.36
|
|
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 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$100.00 |
$100.00 |
$100.00 |
$95.55
|
|
Cytopathology cellular enhancement technique non-gyn
|
$80.00 |
$80.00 |
$80.00 |
$159.45
|
|
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 |
$87.29
|
|
Cytopathology concentration technique smears & interpretation
|
$152.50 |
$152.50 |
$152.50 |
$134.70
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$100.00 |
$100.00 |
$100.00 |
$129.90
|
|
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 |
$185.00
|
|
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 |
$96.20
|
|
Dalbavancin 500 mg intravenous solution
|
$48.64 |
$48.64 |
$48.64 |
$3,493.11
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.26 |
$0.26 |
$0.26 |
$176.24
|
|
Dch validity tests
|
$15.00 |
$15.00 |
$15.00 |
$24.05
|
|
Deamidated gliadin antibody iga
|
$85.00 |
$85.00 |
$85.00 |
$44.16
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$237.50 |
$237.50 |
$237.50 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$227.50 |
$227.50 |
$227.50 |
$262.60
|
|
Debride nail1-5 11720
|
$67.50 |
$67.50 |
$67.50 |
$148.80
|
|
Debride nail6 or more 11721
|
$90.00 |
$90.00 |
$90.00 |
$166.40
|
|
Decalcification
|
$75.00 |
$75.00 |
$75.00 |
$68.90
|
|
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 |
$2,917.60
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$70.00 |
$70.00 |
$70.00 |
$185.40
|
|
Dermagraft
|
$85.00 |
$85.00 |
$85.00 |
$85.00
|
|
Device ablt adv novasure
|
$609.45 |
$609.45 |
$609.45 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$4,611.75 |
$4,611.75 |
$4,611.75 |
$4,265.58
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$7.15 |
$7.15 |
$7.15 |
$21.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$30.85 |
$30.85 |
$30.85 |
$37.80
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$67.62 |
$67.62 |
$67.62 |
$43.65
|
|
Dhea-s (dehydroepiand sulfate)
|
$137.50 |
$137.50 |
$137.50 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$82.50 |
$82.50 |
$82.50 |
$79.30
|
|
Diagnostic anoscopy spx 46600
|
$160.00 |
$160.00 |
$160.00 |
$182.95
|
|
Diagnostic radio unlisted proc
|
$590.00 |
$590.00 |
$590.00 |
$239.25
|
|
Dialysis circuit perm vascular embolization 36909
|
$12,865.00 |
$12,865.00 |
$12,865.00 |
$5,663.50
|
|
Dialysis one evaluation
|
$650.00 |
$650.00 |
$650.00 |
$845.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$80.01 |
$80.01 |
$80.01 |
$73.22
|
|
Diffusing capacity
|
$285.00 |
$285.00 |
$285.00 |
$331.76
|
|
Digoxin total therapeutic drug level
|
$77.50 |
$77.50 |
$77.50 |
$99.35
|
|
Dilate biliary duct/ampulla
|
$4,815.00 |
$4,815.00 |
$4,815.00 |
$1,866.73
|
|
Dilat xst trc new access rcs
|
$3,110.00 |
$3,110.00 |
$3,110.00 |
$4,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$52.11 |
$52.11 |
$52.11 |
$16.80
|
|
Disability dlco
|
$240.00 |
$240.00 |
$240.00 |
$282.40
|
|
Disaccharidases
|
$357.50 |
$357.50 |
$357.50 |
$216.00
|
|
Discography cerv/thor spine
|
$1,940.00 |
$1,940.00 |
$1,940.00 |
$2,404.00
|
|
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 |
$66.05
|
|
Doppler echo complete
|
$407.50 |
$407.50 |
$407.50 |
$558.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$540.00 |
$540.00 |
$540.00 |
$657.41
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$362.50 |
$362.50 |
$362.50 |
$467.27
|
