|
CT neck soft tissue without & w/contrast
|
$1,750.10 |
$1,750.10 |
$1,750.10 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,750.10 |
$1,750.10 |
$1,750.10 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,516.35 |
$1,516.35 |
$1,516.35 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,392.60 |
$1,392.60 |
$1,392.60 |
$1,351.20
|
|
CT scan for therapy guide
|
$253.00 |
$253.00 |
$253.00 |
$729.40
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,869.15 |
$4,869.15 |
$4,869.15 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,467.75 |
$3,467.75 |
$3,467.75 |
$2,847.65
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,693.35 |
$2,693.35 |
$2,693.35 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$2,765.40 |
$2,765.40 |
$2,765.40 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$2,429.90 |
$2,429.90 |
$2,429.90 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$244.20 |
$244.20 |
$244.20 |
$400.20
|
|
CT t-spine w /wo contrast
|
$2,919.40 |
$2,919.40 |
$2,919.40 |
$2,030.60
|
|
CT upper extremity w/contrast (both sides)
|
$1,536.15 |
$1,536.15 |
$1,536.15 |
$1,700.00
|
|
CT upper extremity without contrast (both sides)
|
$1,447.05 |
$1,447.05 |
$1,447.05 |
$1,468.83
|
|
Culture aerobic additional method definitive id each
|
$167.20 |
$167.20 |
$167.20 |
$63.75
|
|
Culture afb any source
|
$92.40 |
$92.40 |
$92.40 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$70.40 |
$70.40 |
$70.40 |
$77.31
|
|
Culture anaerobic except blood
|
$70.40 |
$70.40 |
$70.40 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$65.45 |
$65.45 |
$65.45 |
$52.80
|
|
Culture body fluid
|
$62.70 |
$62.70 |
$62.70 |
$130.50
|
|
Culture fungi definitive id mold
|
$139.15 |
$139.15 |
$139.15 |
$70.00
|
|
Culture fungi definitive id yeast
|
$129.25 |
$129.25 |
$129.25 |
$80.60
|
|
Culture fungi other (except blood)
|
$61.05 |
$61.05 |
$61.05 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$57.20 |
$57.20 |
$57.20 |
$77.40
|
|
Culture mycoplasma any source
|
$128.15 |
$128.15 |
$128.15 |
$90.37
|
|
Culture screening strep group a
|
$57.20 |
$57.20 |
$57.20 |
$81.60
|
|
Culture typing added method
|
$103.40 |
$103.40 |
$103.40 |
$34.45
|
|
Culture typing immunologic
|
$96.80 |
$96.80 |
$96.80 |
$41.60
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$388.85 |
$388.85 |
$388.85 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$92.40 |
$92.40 |
$92.40 |
$124.40
|
|
Culture urine each isolate
|
$9.90 |
$9.90 |
$9.90 |
$46.20
|
|
Cutter lead
|
$428.20 |
$428.20 |
$428.20 |
$5,538.98
|
|
Cv line/pic reposition
|
$1,604.90 |
$1,604.90 |
$1,604.90 |
$1,829.42
|
|
Cyclic citrullinated peptide antibody
|
$182.60 |
$182.60 |
$182.60 |
$80.05
|
|
Cyclosporine 2 hour
|
$103.95 |
$103.95 |
$103.95 |
$121.80
|
|
Cylinder pump set 20cm titan zero angl
|
$6,607.69 |
$6,607.69 |
$6,607.69 |
$22,594.80
|
|
Cyp2c19 gene com variants
|
$822.25 |
$822.25 |
$822.25 |
$567.75
|
|
Cystatin c
|
$49.50 |
$49.50 |
$49.50 |
$82.26
|
|
Cystine urine quantitative
|
$284.90 |
$284.90 |
$284.90 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$543.40 |
$543.40 |
$543.40 |
$539.55
|
|
Cystoscopy and treatment
|
$2,906.75 |
$2,906.75 |
$2,906.75 |
$3,174.25
|
|
Cystoscopy (Bladder Scope)
|
$234.85 |
$234.85 |
$234.85 |
$1,610.20
|
|
Cystoscopy chemodenervation
|
$564.30 |
$564.30 |
$564.30 |
$2,412.45
|
|
Cystoscopy & ureter catheter
|
$3,109.15 |
$3,109.15 |
$3,109.15 |
$3,416.48
|
|
Cystouretero & or pyeloscope
|
$1,405.80 |
$1,405.80 |
$1,405.80 |
$4,315.98
|
|
Cytomegalovirus (cmv) antibody igg
|
$117.15 |
$117.15 |
$117.15 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$122.10 |
$122.10 |
$122.10 |
$96.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$381.70 |
$381.70 |
$381.70 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$72.05 |
$72.05 |
$72.05 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$152.90 |
$152.90 |
$152.90 |
$142.94
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$82.50 |
$82.50 |
$82.50 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$114.95 |
$114.95 |
$114.95 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$402.60 |
$402.60 |
$402.60 |
$205.00
|
|
Cytopath smear other source
|
$226.05 |
$226.05 |
$226.05 |
$85.80
|
|
Cytopath smear oth prep screen & interp
|
$226.05 |
$226.05 |
$226.05 |
$95.89
|
|
Cytopath tbs c/v manual
|
$70.40 |
$70.40 |
$70.40 |
$57.94
|
|
Dch glucoscan
|
$24.20 |
$24.20 |
$24.20 |
$24.85
|
|
Dch validity tests
|
$19.80 |
$19.80 |
$19.80 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$18.70 |
$18.70 |
$18.70 |
$44.16
|
|
Debridement (>20 cm) charge pt
|
$183.15 |
$183.15 |
$183.15 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$1,632.40 |
$1,632.40 |
$1,632.40 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$244.20 |
$244.20 |
$244.20 |
$688.80
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$509.85 |
$509.85 |
$509.85 |
$810.50
|
|
Debride nail1-5 11720
|
$81.95 |
$81.95 |
$81.95 |
$173.25
|
|
Debride nail6 or more 11721
|
$476.30 |
$476.30 |
$476.30 |
$195.20
|
|
Debride skin bone at fx site
|
$425.15 |
$425.15 |
$425.15 |
$3,278.34
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$158.95 |
$158.95 |
$158.95 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$763.40 |
$763.40 |
$763.40 |
$1,193.40
|
|
Decalcification
|
$90.75 |
$90.75 |
$90.75 |
$73.60
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$466.95 |
$466.95 |
$466.95 |
$545.90
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$118.80 |
$118.80 |
$118.80 |
$460.50
|
|
Desoxycorticosterone
|
$96.80 |
$96.80 |
$96.80 |
$109.28
|
|
Destroy cervthor facet jnt 64633
|
$2,378.75 |
$2,378.75 |
$2,378.75 |
$3,164.80
|
|
Destroy cth facet jnt addl 64634
|
$1,658.25 |
$1,658.25 |
$1,658.25 |
$1,441.44
|
|
Destroy premlg lesns;1st lesn 17000
|
$96.80 |
$96.80 |
$96.80 |
$220.12
|
|
Destruction 2-14 lesions 17003
|
$209.00 |
$209.00 |
$209.00 |
$72.60
|
|
Destruction benign lesions < 14 lesions
|
$130.90 |
$130.90 |
$130.90 |
$250.60
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,896.95 |
$1,896.95 |
$1,896.95 |
$1,879.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$4,203.65 |
$4,203.65 |
$4,203.65 |
$3,375.00
|
|
Device tiss remov myosure reach
|
$741.28 |
$741.28 |
$741.28 |
$2,440.98
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$162.52 |
$162.52 |
$162.52 |
$220.43
|
|
Dhea-s (dehydroepiand sulfate)
|
$8.52 |
$8.52 |
$8.52 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$61.05 |
$61.05 |
$61.05 |
$78.03
|
|
Diagnostic anoscopy spx 46600
|
$50.60 |
$50.60 |
$50.60 |
$245.35
|
|
Diagnostic digital breast tomosynthesis bil
|
$323.40 |
$323.40 |
$323.40 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$123.75 |
$123.75 |
$123.75 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$642.40 |
$642.40 |
$642.40 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$684.75 |
$684.75 |
$684.75 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$342.10 |
$342.10 |
$342.10 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$634.15 |
$634.15 |
$634.15 |
$239.25
|
|
Dialysis circuit perm vascular embolization 36909
|
$4,957.70 |
$4,957.70 |
$4,957.70 |
$7,145.00
|
|
Diffusing capacity
|
$326.15 |
$326.15 |
$326.15 |
$360.10
|
|
Digoxin total therapeutic drug level
|
$143.55 |
$143.55 |
$143.55 |
$102.00
|
|
Dilator fascial 10fx20cm
|
$290.93 |
$290.93 |
$290.93 |
$305.68
|
|
Dilat xst trc ndurlgc px
|
$2,719.20 |
$2,719.20 |
$2,719.20 |
$4,081.37
|
|
Dilat xst trc new access rcs
|
$4,574.35 |
$4,574.35 |
$4,574.35 |
$5,020.00
|
|
Disaccharidases
|
$453.20 |
$453.20 |
$453.20 |
$223.80
|
|
Dissolve clot heart vessel
|
$943.25 |
$943.25 |
$943.25 |
$1,396.47
|
|
Dna antibody native/double stranded
|
$264.00 |
$264.00 |
$264.00 |
$102.60
|
|
Doppler echo complete
|
$374.00 |
$374.00 |
$374.00 |
$608.25
|
