|
Dextrose 5 % IV bolus
|
$13.80 |
$13.80 |
$13.80 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$64.00 |
$64.00 |
$64.00 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$244.00 |
$244.00 |
$244.00 |
$79.20
|
|
Diagnostic Mammogram (both breasts)
|
$109.40 |
$109.40 |
$109.40 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$84.40 |
$84.40 |
$84.40 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$51.20 |
$51.20 |
$51.20 |
$214.08
|
|
Dialysis one evaluation
|
$221.40 |
$221.40 |
$221.40 |
$919.55
|
|
Diathermy eg microwave
|
$16.40 |
$16.40 |
$16.40 |
$29.68
|
|
Diatrizoate meglumine 18 % urethral solution
|
$51.40 |
$51.40 |
$51.40 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$31.49 |
$31.49 |
$31.49 |
$74.76
|
|
Dicyclomine injection
|
$33.22 |
$33.22 |
$33.22 |
$153.29
|
|
Digital analysis of eeg
|
$155.00 |
$155.00 |
$155.00 |
$605.60
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$6.93 |
$6.93 |
$6.93 |
$69.03
|
|
Digoxin total therapeutic drug level
|
$144.40 |
$144.40 |
$144.40 |
$102.00
|
|
Dilator fascial 10fx20cm
|
$43.20 |
$43.20 |
$43.20 |
$402.10
|
|
Diltiazem 5 mg/ml intravenous solution
|
$5.40 |
$5.40 |
$5.40 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$5.39 |
$5.39 |
$5.39 |
$17.75
|
|
Disaccharidases
|
$67.36 |
$67.36 |
$67.36 |
$216.00
|
|
Discography cerv/thor spine
|
$497.00 |
$497.00 |
$497.00 |
$2,565.00
|
|
Dmd dup/delet analysis
|
$55.80 |
$55.80 |
$55.80 |
$404.03
|
|
Dmpk gene detc abnor allele
|
$21.92 |
$21.92 |
$21.92 |
$313.60
|
|
Dna antibody native/double stranded
|
$3.80 |
$3.80 |
$3.80 |
$97.50
|
|
Dna trichomonas
|
$3.57 |
$3.57 |
$3.57 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$21.21 |
$21.21 |
$21.21 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$12.80 |
$12.80 |
$12.80 |
$65.40
|
|
Doppler echo complete
|
$214.40 |
$214.40 |
$214.40 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$747.00 |
$747.00 |
$747.00 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$301.20 |
$301.20 |
$301.20 |
$471.17
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$21.21 |
$21.21 |
$21.21 |
$84.80
|
|
Dpyd gene common variants
|
$34.96 |
$34.96 |
$34.96 |
$380.50
|
|
Drainage of kidney lesion
|
$1,362.80 |
$1,362.80 |
$1,362.80 |
$1,506.00
|
|
Drainage of pelvis lesion 26990
|
$1,030.60 |
$1,030.60 |
$1,030.60 |
$3,958.50
|
|
Drain blood from under nail 11740
|
$95.60 |
$95.60 |
$95.60 |
$170.50
|
|
Drain cath image guided visceral pq
|
$2,792.40 |
$2,792.40 |
$2,792.40 |
$2,850.35
|
|
Drain cerebro spinal fluid 62272
|
$220.00 |
$220.00 |
$220.00 |
$1,044.00
|
|
Drain lower leg bursa
|
$1,030.60 |
$1,030.60 |
$1,030.60 |
$3,958.50
|
|
Drain lower leg lesion 27603
|
$731.40 |
$731.40 |
$731.40 |
$3,858.40
|
|
Drain neck/chest lesion 21501
|
$909.20 |
$909.20 |
$909.20 |
$3,339.00
|
|
Drain thigh/knee lesion 27301
|
$731.40 |
$731.40 |
$731.40 |
$3,620.47
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$143.60 |
$143.60 |
$143.60 |
$392.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$124.80 |
$124.80 |
$124.80 |
$344.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$228.40 |
$228.40 |
$228.40 |
$523.00
|
|
Drng of finger abscess comp 26011
|
$514.60 |
$514.60 |
$514.60 |
$1,943.50
|
|
Drng of scrotum abscess 55100
|
$417.20 |
$417.20 |
$417.20 |
$1,917.33
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$691.60 |
$691.60 |
$691.60 |
$1,956.48
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$7.00 |
$7.00 |
$7.00 |
$1,575.70
|
|
Drug assay caffeine
|
$8.05 |
$8.05 |
$8.05 |
$83.40
|
|
Drug assay posaconazole
|
$4.34 |
$4.34 |
$4.34 |
$96.75
|
|
Drug assay rufinamide
|
$3.03 |
$3.03 |
$3.03 |
$85.80
|
|
Drug assay vedolizumab
|
$40.00 |
$40.00 |
$40.00 |
$152.79
|
|
Drug assay voriconazole
|
$4.34 |
$4.34 |
$4.34 |
$96.75
|
|
Drug of abuse screen urine
|
$14.20 |
$14.20 |
$14.20 |
$63.75
|
|
Drug screening tapentadol
|
$4.30 |
$4.30 |
$4.30 |
$36.00
|
|
Drug screen quant tiagabine
|
$17.40 |
$17.40 |
$17.40 |
$114.62
|
|
Drug test prsmv instrmnt
|
$122.80 |
$122.80 |
$122.80 |
$90.75
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$33.00 |
$33.00 |
$33.00 |
$278.85
|
|
Drvvt confirm - quest
|
$3.20 |
$3.20 |
$3.20 |
$109.20
|
|
Dstrj nulyt agt gnclr nrv
|
$620.20 |
$620.20 |
$620.20 |
$3,020.80
|
|
Ductogram sgl duct
|
$145.20 |
$145.20 |
$145.20 |
$463.10
|
|
Duplex scan bilateral study 93985
|
$961.00 |
$961.00 |
$961.00 |
$690.95
|
|
Dup scan/hemodialysis access 93990
|
$523.80 |
$523.80 |
$523.80 |
$489.72
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$106.80 |
$106.80 |
$106.80 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,020.80 |
$1,020.80 |
$1,020.80 |
$887.25
|
|
Ear irrigation 69209
|
$55.80 |
$55.80 |
$55.80 |
$149.76
|
|
Ecg 12 lead tracing only
|
$56.00 |
$56.00 |
$56.00 |
$226.50
|
|
Ecg/1-3 leads/tracing only 93041
|
$31.40 |
$31.40 |
$31.40 |
$135.80
|
|
Echocardiogram (Heart Ultrasound)
|
$549.00 |
$549.00 |
$549.00 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$81.40 |
$81.40 |
$81.40 |
$469.95
|
|
Echocardiography transthoracic 2d followup/limited
|
$251.40 |
$251.40 |
$251.40 |
$703.25
|
|
Echocardiograpy doppler follow up/limited study
|
$114.00 |
$114.00 |
$114.00 |
$362.50
|
|
Echo exam of fetal heart
|
$142.00 |
$142.00 |
$142.00 |
$939.00
|
|
Echo exam of fetal heart
|
$63.40 |
$63.40 |
$63.40 |
$431.41
|
|
Echo exam uterus 76831-
|
$73.60 |
$73.60 |
$73.60 |
$523.71
|
|
Echograp trans r pros study
|
$95.40 |
$95.40 |
$95.40 |
$459.40
|
|
Echo guide for amniocentesis
|
$116.80 |
$116.80 |
$116.80 |
$456.30
|
|
Echo guide for transfusion
|
$190.16 |
$190.16 |
$190.16 |
$324.60
|
|
Echo stress
|
$322.20 |
$322.20 |
$322.20 |
$1,592.05
|
|
Echo tee probe placement image acquisition interpretation & report
|
$333.40 |
$333.40 |
$333.40 |
$1,849.50
|
|
Echo transthoracic
|
$305.20 |
$305.20 |
$305.20 |
$1,361.75
|
|
Echo transthoracic
|
$320.40 |
$320.40 |
$320.40 |
$953.10
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$223.00 |
$223.00 |
$223.00 |
$985.15
|
|
Eeg 41-60 minutes 95812-26
|
$270.60 |
$270.60 |
$270.60 |
$920.00
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$318.40 |
$318.40 |
$318.40 |
$1,000.42
|
|
Eeg monitor/record/awake/drowsy 95816
|
$217.20 |
$217.20 |
$217.20 |
$835.00
|
|
Eeg over 1 hour 95813 - 26
|
$207.40 |
$207.40 |
$207.40 |
$1,102.05
|
|
Eeg/record in coma or sleep only 95822
|
$219.40 |
$219.40 |
$219.40 |
$907.80
|
|
Eeg recording awake and asleep
|
$216.40 |
$216.40 |
$216.40 |
$931.20
|
|
Eeg without vid 2-12hr cont mntr
|
$187.00 |
$187.00 |
$187.00 |
$783.60
|
|
Eeg without vid 2-12 hr unmntr
|
$202.39 |
$202.39 |
$202.39 |
$601.30
|
|
Eeg without vid ea 12-26hr cont
|
$318.40 |
$318.40 |
$318.40 |
$1,460.20
|
|
Eeg without vid ea 12-26hr intmt
|
$318.40 |
$318.40 |
$318.40 |
$1,379.30
|
|
Eeg wo vid 2-12hr intmt mntr
|
$202.39 |
$202.39 |
$202.39 |
$671.00
|
|
Eeg wo vid ea 12-26hr unmntr
|
$318.40 |
$318.40 |
$318.40 |
$1,502.40
|
|
E equine encephalitis igg
|
$3.95 |
$3.95 |
$3.95 |
$49.92
|
|
Egd endoscopic stent place
|
$12,070.20 |
$12,070.20 |
$12,070.20 |
$3,774.00
|
|
Egfr gene com variants
|
$103.00 |
$103.00 |
$103.00 |
$657.00
|
|
Ehrlicha chaffeensis amp prb
|
$6.03 |
$6.03 |
$6.03 |
$93.00
|
|
EKG (Electrocardiogram)
|
$20.00 |
$20.00 |
$20.00 |
$89.60
|
|
Electrical stimulation/unattended 97014
|
$15.40 |
$15.40 |
$15.40 |
$79.20
|
|
Electrolyte panel
|
$168.60 |
$168.60 |
$168.60 |
$84.24
|
