|
Drm agrft t/a/l ea addl
|
$3,808.00 |
$3,808.00 |
$3,808.00 |
$1,793.59
|
|
Drng hand tendon sheath 26020
|
$7,694.40 |
$7,694.40 |
$7,694.40 |
$3,839.54
|
|
Drng of eyelid abscess 67700
|
$1,702.40 |
$1,702.40 |
$1,702.40 |
$655.72
|
|
Drng of finger abscess comp 26011
|
$6,395.20 |
$6,395.20 |
$6,395.20 |
$2,029.60
|
|
Drng of hydrocele 55000
|
$3,298.40 |
$3,298.40 |
$3,298.40 |
$832.60
|
|
Drng of mouth lesion 40801
|
$3,382.40 |
$3,382.40 |
$3,382.40 |
$1,350.97
|
|
Drng of ovarian cyst(s) 58800
|
$8,002.40 |
$8,002.40 |
$8,002.40 |
$3,474.84
|
|
Drng of palm multi bursas 26030
|
$6,412.00 |
$6,412.00 |
$6,412.00 |
$3,839.54
|
|
Drng of palm single bursa 26025
|
$6,412.00 |
$6,412.00 |
$6,412.00 |
$3,839.54
|
|
Drng of pelvic abscess transrectal 45000
|
$6,434.40 |
$6,434.40 |
$6,434.40 |
$2,111.46
|
|
Drng of salivary cyst 42409
|
$8,820.00 |
$8,820.00 |
$8,820.00 |
$3,819.23
|
|
Drng of scrotum abscess 55100
|
$6,305.60 |
$6,305.60 |
$6,305.60 |
$1,997.89
|
|
Drng peritoneal abscess open 49020
|
$4,138.40 |
$4,138.40 |
$4,138.40 |
$2,520.00
|
|
Drng salivary gland simple 42300
|
$4,788.00 |
$4,788.00 |
$4,788.00 |
$2,039.50
|
|
Drng salivary gland submax/subling 42310
|
$2,559.20 |
$2,559.20 |
$2,559.20 |
$741.60
|
|
Dronabinol 2.5mg oral
|
$3.92 |
$3.92 |
$3.92 |
$13.36
|
|
Droperidol 2.5 mg/ml injection solution
|
$5.84 |
$5.84 |
$5.84 |
$31.26
|
|
Drop lock knee
|
$114.80 |
$114.80 |
$114.80 |
$204.95
|
|
Drop lock retainer each
|
$44.80 |
$44.80 |
$44.80 |
$63.89
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$48,300.00 |
$48,300.00 |
$48,300.00 |
$1,818.32
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$14.00 |
$14.00 |
$14.00 |
$1,575.70
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$16,459.80 |
$16,459.80 |
$16,459.80 |
$58.20
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$3,396.98 |
$3,396.98 |
$3,396.98 |
$289.05
|
|
Drsg sht 5.625x4.625in std
|
$616.00 |
$616.00 |
$616.00 |
$123.24
|
|
Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm
|
$44.80 |
$44.80 |
$44.80 |
$122.50
|
|
Drsg wnd hyalomatrix 10x10cm -cost per sq cm
|
$146.16 |
$146.16 |
$146.16 |
$135.72
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$8,040.27 |
$8,040.27 |
$8,040.27 |
$8,040.27
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$44.80 |
$44.80 |
$44.80 |
$400.98
|
|
Drug admin & hemodynmic meas
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$578.59
|
|
Drug assay caffeine
|
$187.60 |
$187.60 |
$187.60 |
$81.61
|
|
Drug assay posaconazole
|
$46.48 |
$46.48 |
$46.48 |
$96.75
|
|
Drug assay rufinamide
|
$63.84 |
$63.84 |
$63.84 |
$85.80
|
|
Drug assay vedolizumab
|
$136.08 |
$136.08 |
$136.08 |
$157.00
|
|
Drug assay voriconazole
|
$46.48 |
$46.48 |
$46.48 |
$96.75
|
|
Drug asy hydroxychloroquine
|
$43.68 |
$43.68 |
$43.68 |
$66.43
|
|
Drug of abuse screen urine
|
$85.68 |
$85.68 |
$85.68 |
$64.50
|
|
Drug screening tapentadol
|
$80.08 |
$80.08 |
$80.08 |
$44.25
|
|
Drug screen quant tiagabine
|
$219.52 |
$219.52 |
$219.52 |
$107.59
|
|
Drug/substance nos 4-6
|
$80.08 |
$80.08 |
$80.08 |
$72.14
|
|
Drug test def 15-21 classes
|
$1,383.20 |
$1,383.20 |
$1,383.20 |
$316.00
|
|
Drug test def 1-7 classes
|
$364.00 |
$364.00 |
$364.00 |
$263.25
|
|
Drug test def 22+ classes
|
$1,780.80 |
$1,780.80 |
$1,780.80 |
$423.00
|
|
Drug test def 8-14 classes
|
$403.20 |
$403.20 |
$403.20 |
$289.80
|
|
Drug test prsmv instrmnt
|
$481.60 |
$481.60 |
$481.60 |
$83.20
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$515.20 |
$515.20 |
$515.20 |
$280.95
|
|
Drvvt confirm - quest
|
$109.20 |
$109.20 |
$109.20 |
$109.20
|
|
Dry needling (97799)
|
$20.72 |
$20.72 |
$20.72 |
$114.27
|
|
Dstrj extensive retinopathy
|
$4,877.60 |
$4,877.60 |
$4,877.60 |
$4,462.45
|
|
Dstrj nulyt agt gnclr nrv
|
$6,227.20 |
$6,227.20 |
$6,227.20 |
$2,967.48
|
|
Dstr mal les s/n/h/f/g >4.0
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$664.50
|
|
Dstr mal ls f/e/e/n/l/m2.1-3
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$603.20
|
|
Dstr mal ls f/e/e/n/l/m3.1-4
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$724.37
|
|
Dstr mal ls f/e/e/n/l/m>4.0
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$886.40
|
|
Dstry eye lesn,fdr vssl tech
|
$2,682.40 |
$2,682.40 |
$2,682.40 |
$756.27
|
|
Ductogram sgl duct
|
$716.80 |
$716.80 |
$716.80 |
$469.44
|
|
Duodenal motility study
|
$2,503.20 |
$2,503.20 |
$2,503.20 |
$1,143.10
|
|
Duplex scan bilateral study 93985
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$692.40
|
|
Duplex scan unilateral study 93986
|
$907.20 |
$907.20 |
$907.20 |
$375.60
|
|
Dup scan/hemodialysis access 93990
|
$1,596.00 |
$1,596.00 |
$1,596.00 |
$486.02
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$1,288.00 |
$1,288.00 |
$1,288.00 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,920.80 |
$1,920.80 |
$1,920.80 |
$903.50
|
|
Duragen 1x1 5ea/bx
|
$5,017.60 |
$5,017.60 |
$5,017.60 |
$10,564.87
|
|
Durvalumab 50 mg/ml intravenous solution
|
$1,826.08 |
$1,826.08 |
$1,826.08 |
$7,973.90
|
|
Dxa bone density axl vrt fx
|
$683.20 |
$683.20 |
$683.20 |
$410.25
|
|
Dx aly aud oi snd prcsr 1st
|
$386.40 |
$386.40 |
$386.40 |
$186.40
|
|
Dx aly aud oi snd prcsr each
|
$51.52 |
$51.52 |
$51.52 |
$51.52
|
|
Dx bronchoscope/brush 31623
|
$3,231.20 |
$3,231.20 |
$3,231.20 |
$2,040.67
|
|
Dx bronchoscope/lavage 31624
|
$5,639.20 |
$5,639.20 |
$5,639.20 |
$2,400.95
|
|
Dx bronchoscope/wash 31622
|
$4,877.60 |
$4,877.60 |
$4,877.60 |
$2,322.60
|
|
Dx dark adaptation exam i&r
|
$492.80 |
$492.80 |
$492.80 |
$472.21
|
|
Dx duod intub w/asp spec 43756
|
$1,075.20 |
$1,075.20 |
$1,075.20 |
$1,075.20
|
|
Dx duod intub w/asp specs
|
$2,408.00 |
$2,408.00 |
$2,408.00 |
$1,406.58
|
|
Dx gastr intub w/asp spec
|
$660.80 |
$660.80 |
$660.80 |
$441.60
|
|
Dx gastr intub w/asp specs
|
$666.40 |
$666.40 |
$666.40 |
$308.70
|
|
Dx intraop epcar Ultrasound chd i&r
|
$49.84 |
$49.84 |
$49.84 |
$261.15
|
|
Dx intraop epicar car Ultrasound chd
|
$49.84 |
$49.84 |
$49.84 |
$351.20
|
|
Dx intraop thoracic aorta Ultrasound
|
$50.96 |
$50.96 |
$50.96 |
$558.11
|
|
Dx laryngoscopy newborn
|
$1,226.40 |
$1,226.40 |
$1,226.40 |
$658.00
|
|
Dx laryngoscopy w/oper scope
|
$5,448.80 |
$5,448.80 |
$5,448.80 |
$2,755.53
|
|
Dx ntrop epcr Ultrasound chd img acq
|
$49.84 |
$49.84 |
$49.84 |
$558.11
|
|
Dynamic cavernosometry
|
$6,115.20 |
$6,115.20 |
$6,115.20 |
$3,442.40
|
|
Dynamic surface emg
|
$767.20 |
$767.20 |
$767.20 |
$368.50
|
|
Ear and throat examination
|
$1,450.40 |
$1,450.40 |
$1,450.40 |
$602.63
|
|
Ear canal biopsy 69105
|
$5,633.60 |
$5,633.60 |
$5,633.60 |
$1,889.50
|
|
Ear cartilage graft
|
$11,883.20 |
$11,883.20 |
$11,883.20 |
$6,311.00
|
|
Ear irrigation 69209
|
$177.52 |
$177.52 |
$177.52 |
$150.00
|
|
Ear protector evaluation
|
$112.56 |
$112.56 |
$112.56 |
$112.56
|
|
Ecallantide injection
|
$9,973.33 |
$9,973.33 |
$9,973.33 |
$13,353.39
|
|
Ecg 12 lead tracing only
|
$380.80 |
$380.80 |
$380.80 |
$226.50
|
|
Ecg/1-3 leads/tracing only 93041
|
$144.48 |
$144.48 |
$144.48 |
$132.08
|
|
Ecg < 30 days transmission & analysis
|
$1,030.40 |
$1,030.40 |
$1,030.40 |
$466.20
|
|
Ecg external < 48 hours recording
|
$621.60 |
$621.60 |
$621.60 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$873.60 |
$873.60 |
$873.60 |
$541.20
|
|
Ecg external > 48 hours up to 7 days recording
|
$147.28 |
$147.28 |
$147.28 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$241.92 |
$241.92 |
$241.92 |
$161.85
|
|
Echocardiogram (Heart Ultrasound)
|
$3,824.80 |
$3,824.80 |
$3,824.80 |
$1,977.50
|
|
Echocardiography doppler color flow mapping
|
$940.80 |
$940.80 |
$940.80 |
$499.20
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$3,634.40 |
$3,634.40 |
$3,634.40 |
$1,935.00
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,909.60 |
$1,909.60 |
$1,909.60 |
$711.00
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$2,749.60 |
$2,749.60 |
$2,749.60 |
$851.50
|
