|
CT upper extremity without contrast (both sides)
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$1,470.00
|
|
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 |
$127.40
|
|
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 |
$108.80
|
|
Culture fungi skin/hair/nail
|
$80.00 |
$80.00 |
$80.00 |
$77.37
|
|
Culture quantitative aerobic other source
|
$80.00 |
$80.00 |
$80.00 |
$89.10
|
|
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
|
|
Cyclic citrullinated peptide antibody
|
$80.00 |
$80.00 |
$80.00 |
$71.00
|
|
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 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$510.00 |
$510.00 |
$510.00 |
$564.85
|
|
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 |
$95.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$80.00 |
$80.00 |
$80.00 |
$159.90
|
|
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 |
$141.25
|
|
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 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$207.50 |
$207.50 |
$207.50 |
$207.50
|
|
Cytopath smear oth prep screen & interp
|
$85.00 |
$85.00 |
$85.00 |
$98.45
|
|
Dalbavancin 500 mg intravenous solution
|
$25.48 |
$25.48 |
$25.48 |
$3,410.61
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.15 |
$0.15 |
$0.15 |
$267.00
|
|
Dch validity tests
|
$15.00 |
$15.00 |
$15.00 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$85.00 |
$85.00 |
$85.00 |
$46.05
|
|
Debridement (>20 cm) charge pt
|
$227.50 |
$227.50 |
$227.50 |
$272.39
|
|
Debride nail6 or more 11721
|
$90.00 |
$90.00 |
$90.00 |
$172.20
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$470.00 |
$470.00 |
$470.00 |
$1,149.50
|
|
Decalcification
|
$75.00 |
$75.00 |
$75.00 |
$72.15
|
|
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 |
$3,086.10
|
|
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
|
|
Design mlc device for imrt
|
$1,785.00 |
$1,785.00 |
$1,785.00 |
$1,677.86
|
|
Developmental screen/score/document 96110
|
$87.50 |
$87.50 |
$87.50 |
$139.10
|
|
Device ablt adv novasure
|
$2,408.49 |
$2,408.49 |
$2,408.49 |
$6,148.80
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$4.46 |
$4.46 |
$4.46 |
$23.56
|
|
Dextrose 5 % IV bolus
|
$44.84 |
$44.84 |
$44.84 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$137.50 |
$137.50 |
$137.50 |
$109.20
|
|
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 |
$201.25
|
|
Diagnostic Mammogram (one breast)
|
$220.00 |
$220.00 |
$220.00 |
$314.72
|
|
Dialysis one evaluation
|
$650.00 |
$650.00 |
$650.00 |
$845.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$17.38 |
$17.38 |
$17.38 |
$74.17
|
|
Diffusing capacity
|
$285.00 |
$285.00 |
$285.00 |
$343.80
|
|
Digoxin total therapeutic drug level
|
$77.50 |
$77.50 |
$77.50 |
$102.00
|
|
Dilate esophagus 1/mult pass
|
$1,605.00 |
$1,605.00 |
$1,605.00 |
$1,490.36
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$19.64 |
$19.64 |
$19.64 |
$18.00
|
|
Disability dlco
|
$240.00 |
$240.00 |
$240.00 |
$289.08
|
|
Disaccharidases
|
$357.50 |
$357.50 |
$357.50 |
$209.43
|
|
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
|
$335.00 |
$335.00 |
$335.00 |
$605.50
|
|
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 |
$380.50
|
|
Drain blood from under nail 11740
|
$75.00 |
$75.00 |
$75.00 |
$182.95
|
|
Drain cerebro spinal fluid 62272
|
$910.00 |
$910.00 |
$910.00 |
$1,045.65
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$207.50 |
$207.50 |
$207.50 |
$403.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$157.50 |
$157.50 |
$157.50 |
$365.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$252.50 |
$252.50 |
$252.50 |
$547.20
|
|
Drug assay caffeine
|
$80.00 |
$80.00 |
$80.00 |
$81.61
|
|
Drug assay posaconazole
|
$100.00 |
$100.00 |
$100.00 |
$91.77
|
|
Drug assay rufinamide
|
$135.00 |
$135.00 |
$135.00 |
$87.75
|
|
Drug assay vedolizumab
|
$272.50 |
$272.50 |
$272.50 |
$136.08
|
|
Drug assay voriconazole
|
$137.50 |
$137.50 |
$137.50 |
$96.75
|
|
Drug asy hydroxychloroquine
|
$345.00 |
$345.00 |
$345.00 |
$66.43
|
|
Drug screen quant tiagabine
|
$115.00 |
$115.00 |
$115.00 |
$114.40
|
|
Drug test def 15-21 classes
|
$322.50 |
$322.50 |
$322.50 |
$274.26
|
|
Drug test def 22+ classes
|
$140.00 |
$140.00 |
$140.00 |
$276.30
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$352.50 |
$352.50 |
$352.50 |
$278.85
|
|
Duplex scan bilateral study 93985
|
$1,090.00 |
$1,090.00 |
$1,090.00 |
$690.95
|
|
Duplex scan unilateral study 93986
|
$730.00 |
$730.00 |
$730.00 |
$397.15
|
|
Dup scan/hemodialysis access 93990
|
$600.00 |
$600.00 |
$600.00 |
$499.72
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$745.00 |
$745.00 |
$745.00 |
$750.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$710.00 |
$710.00 |
$710.00 |
$903.50
|
|
Ear irrigation 69209
|
$30.00 |
$30.00 |
$30.00 |
$154.70
|
|
Ecg 12 lead tracing only
|
$140.00 |
$140.00 |
$140.00 |
$228.82
|
|
Ecg/1-3 leads/tracing only 93041
|
$155.00 |
$155.00 |
$155.00 |
$140.40
|
|
Ecg < 30 days transmission & analysis
|
$395.00 |
$395.00 |
$395.00 |
$466.20
|
|
Ecg external < 48 hours recording
|
$440.00 |
$440.00 |
$440.00 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$535.00 |
$535.00 |
$535.00 |
$536.50
|
|
Echocardiogram (Heart Ultrasound)
|
$1,480.00 |
$1,480.00 |
$1,480.00 |
$2,049.45
|
