|
Debridement (>20 cm) charge pt
|
$1,300.20 |
$1,300.20 |
$1,300.20 |
$262.60
|
|
Decalcification
|
$452.55 |
$452.55 |
$452.55 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$3,571.25 |
$3,571.25 |
$3,571.25 |
$1,026.60
|
|
Deferoxamine 500 mg solution for injection
|
$68.00 |
$68.00 |
$68.00 |
$112.87
|
|
Desmopressin 4 mcg/ml injection solution
|
$47.75 |
$47.75 |
$47.75 |
$172.46
|
|
Dextran 40 infusion
|
$191.75 |
$191.75 |
$191.75 |
$173.97
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$10.75 |
$10.75 |
$10.75 |
$43.65
|
|
Dextrose 5 % IV bolus
|
$12.00 |
$12.00 |
$12.00 |
$68.25
|
|
Diabetes (HbA1c) Test
|
$552.95 |
$552.95 |
$552.95 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$3,234.30 |
$3,234.30 |
$3,234.30 |
$403.32
|
|
Dialysis one evaluation
|
$407.60 |
$407.60 |
$407.60 |
$827.97
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$64.75 |
$64.75 |
$64.75 |
$67.89
|
|
Dicyclomine injection
|
$83.00 |
$83.00 |
$83.00 |
$210.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$42.00 |
$42.00 |
$42.00 |
$53.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$1,463.75 |
$1,463.75 |
$1,463.75 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$839.05 |
$839.05 |
$839.05 |
$99.35
|
|
Dimenhydrinate injection
|
$70.50 |
$70.50 |
$70.50 |
$24.68
|
|
Dimethyl sulfoxide 50% 50 ml
|
$327.25 |
$327.25 |
$327.25 |
$1,001.55
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$37.25 |
$37.25 |
$37.25 |
$22.58
|
|
Disability dlco
|
$1,659.55 |
$1,659.55 |
$1,659.55 |
$302.40
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$1,966.50 |
$1,966.50 |
$1,966.50 |
$712.02
|
|
Dolasetron mesylate
|
$125.50 |
$125.50 |
$125.50 |
$76.59
|
|
Dolasetron mesylate oral
|
$21.50 |
$21.50 |
$21.50 |
$910.67
|
|
Doppler echo complete
|
$4,498.35 |
$4,498.35 |
$4,498.35 |
$644.00
|
|
Dornase alfa non-comp unit
|
$660.70 |
$660.70 |
$660.70 |
$500.29
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$5,307.40 |
$5,307.40 |
$5,307.40 |
$2,458.05
|
|
Dronabinol 2.5mg oral
|
$39.00 |
$39.00 |
$39.00 |
$10.17
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$52.13 |
$52.13 |
$52.13 |
$751.17
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$650.12 |
$650.12 |
$650.12 |
$189.68
|
|
Drug assay rufinamide
|
$141.45 |
$141.45 |
$141.45 |
$94.25
|
|
Drug of abuse screen urine
|
$118.10 |
$118.10 |
$118.10 |
$63.75
|
|
Drug test def 1-7 classes
|
$2,431.50 |
$2,431.50 |
$2,431.50 |
$263.86
|
|
Drvvt confirm - quest
|
$198.00 |
$198.00 |
$198.00 |
$102.30
|
|
Duplex scan bilateral study 93985
|
$756.45 |
$756.45 |
$756.45 |
$690.95
|
|
Duplex scan unilateral study 93986
|
$339.40 |
$339.40 |
$339.40 |
$392.15
|
|
Ecg/1-3 leads/tracing only 93041
|
$1,182.85 |
$1,182.85 |
$1,182.85 |
$129.83
|
|
Ecg external < 48 hours recording
|
$7,892.15 |
$7,892.15 |
$7,892.15 |
$461.76
|
|
Echocardiogram (Heart Ultrasound)
|
$12,330.65 |
$12,330.65 |
$12,330.65 |
$2,049.45
|
|
Echocardiography transthoracic 2d followup/limited
|
$4,842.30 |
$4,842.30 |
$4,842.30 |
$773.30
|
|
Echo exam uterus 76831-
|
$958.65 |
$958.65 |
$958.65 |
$547.23
|
|
Echo stress
|
$11,923.00 |
$11,923.00 |
$11,923.00 |
$1,607.45
|
|
Echo tee probe placement image acquisition interpretation & report
|
$11,714.85 |
$11,714.85 |
$11,714.85 |
$1,938.95
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$3,339.80 |
$3,339.80 |
$3,339.80 |
$1,020.09
|
|
Eeg 41-60 minutes 95812-26
|
$1,659.85 |
$1,659.85 |
$1,659.85 |
$934.05
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$2,971.55 |
$2,971.55 |
$2,971.55 |
$1,048.30
|
|
Eeg during surgery
|
$16,693.35 |
$16,693.35 |
$16,693.35 |
$775.45
|
|
Eeg over 1 hour 95813 - 26
|
$1,659.85 |
$1,659.85 |
$1,659.85 |
$1,100.40
|
|
Eeg recording awake and asleep
|
$5,544.20 |
$5,544.20 |
$5,544.20 |
$1,030.27
|
|
Egfr gene com variants
|
$1,553.70 |
$1,553.70 |
$1,553.70 |
$646.75
|
|
Electrocorticography durng sx
|
$6,235.40 |
$6,235.40 |
$6,235.40 |
$1,660.52
|
|
Electrolyte panel
|
$2,022.50 |
$2,022.50 |
$2,022.50 |
$86.33
|
|
Electrophysiologic study
|
$14,149.00 |
$14,149.00 |
$14,149.00 |
$6,758.40
|
|
Electrophysiology evaluation
|
$28,210.00 |
$28,210.00 |
$28,210.00 |
$11,542.01
|
|
Electrophysiology evaluation
|
$50,339.30 |
$50,339.30 |
$50,339.30 |
$8,393.40
|
|
Electrophysiology evaluation
|
$21,478.15 |
$21,478.15 |
$21,478.15 |
$6,516.00
|
|
Electrophysiology evaluation
|
$11,071.60 |
$11,071.60 |
$11,071.60 |
$2,845.10
|
|
Electrophysiology evaluation
|
$7,565.85 |
$7,565.85 |
$7,565.85 |
$2,630.40
|
|
Embolization s&i
|
$15,899.85 |
$15,899.85 |
$15,899.85 |
$2,745.08
|
|
Emg needle test 1-extremity
|
$2,378.55 |
$2,378.55 |
$2,378.55 |
$340.80
|
|
Encephalitis, california igg/igm
|
$13.50 |
$13.50 |
$13.50 |
$48.57
|
|
Encephalitis, st louis igg/igm
|
$13.50 |
$13.50 |
$13.50 |
$48.57
|
|
Encephalitis, western equine igg/igm
|
$13.50 |
$13.50 |
$13.50 |
$50.35
|
|
Ep induct arrhy by elect pacing
|
$8,048.70 |
$8,048.70 |
$8,048.70 |
$2,753.40
|
|
Epinephrine 0.1 mg/ml injection syringe
|
$82.00 |
$82.00 |
$82.00 |
$59.36
|
|
Epirubicin 200 mg/100 ml intravenous solution
|
$2,569.25 |
$2,569.25 |
$2,569.25 |
$195.23
|
|
Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr
|
$391.00 |
$391.00 |
$391.00 |
$135.20
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$369.75 |
$369.75 |
$369.75 |
$364.08
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$160.25 |
$160.25 |
$160.25 |
$232.84
|
|
Estrogens total-sendout
|
$8.05 |
$8.05 |
$8.05 |
$89.25
|
|
Ethylene glycol -sendout
|
$17.50 |
$17.50 |
$17.50 |
$78.00
|
|
Etoposide 50 mg cap
|
$66.25 |
$66.25 |
$66.25 |
$196.27
|
|
Eval/fit voice prosthesis iii, st
|
$1,293.05 |
$1,293.05 |
$1,293.05 |
$375.20
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$175.65 |
$175.65 |
$175.65 |
$219.60
|
|
Evaluation heart device
|
$16,755.80 |
$16,755.80 |
$16,755.80 |
$2,384.20
|
|
Evaluation of speech fluency 92521
|
$806.85 |
$806.85 |
$806.85 |
$347.75
|
|
Evoked potentials upper limbs
|
$4,909.05 |
$4,909.05 |
$4,909.05 |
$908.54
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$178.00 |
$178.00 |
$178.00 |
$466.15
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$6.50 |
$6.50 |
$6.50 |
$22.20
|
|
Fat/lipids feces qualitative
|
$14.10 |
$14.10 |
$14.10 |
$37.40
|
|
Fern test
|
$385.70 |
$385.70 |
$385.70 |
$17.72
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$1,473.05 |
$1,473.05 |
$1,473.05 |
$2,232.93
|
|
Ferumoxytol, esrd use
|
$1,473.05 |
$1,473.05 |
$1,473.05 |
$0.34
|
|
Fetal fibronectin
|
$3,329.70 |
$3,329.70 |
$3,329.70 |
$342.47
|
|
Fetal hemoglobin (kleihauer betke)
|
$39.60 |
$39.60 |
$39.60 |
$85.00
|
|
Fetal hemoglobin rosette
|
$129.45 |
$129.45 |
$129.45 |
$74.25
|
|
Fetal lung maturity assess lam body dnst
|
$17.00 |
$17.00 |
$17.00 |
$64.28
|
|
Fibrin degrade semiquant
|
$934.90 |
$934.90 |
$934.90 |
$90.35
|
|
Fibrinogen activity
|
$1,514.95 |
$1,514.95 |
$1,514.95 |
$80.83
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$1,495.25 |
$1,495.25 |
$1,495.25 |
$1,295.37
|
|
Flow cytometry one marker technical component
|
$558.70 |
$558.70 |
$558.70 |
$298.04
|
|
Fludarabine 50 mg intravenous solution
|
$592.00 |
$592.00 |
$592.00 |
$592.00
|
|
Fluoro polarize fetal lung
|
$92.80 |
$92.80 |
$92.80 |
$62.81
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$19.50 |
$19.50 |
$19.50 |
$97.74
|
|
Follow-up angiography
|
$14,230.10 |
$14,230.10 |
$14,230.10 |
$1,875.00
|
|
Fomepizole 1 gram/ml intravenous solution
|
$4,000.50 |
$4,000.50 |
$4,000.50 |
$3,035.46
|
|
Foscarnet sodium injection
|
$3,132.75 |
$3,132.75 |
$3,132.75 |
$714.25
|
|
Fresh frozen plasma thawing ea un
|
$73.00 |
$73.00 |
$73.00 |
$130.00
|
|
Ga-67 gallium 0.1 mci
|
$3,885.95 |
$3,885.95 |
$3,885.95 |
$163.80
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$848.50 |
$848.50 |
$848.50 |
$210.50
|
|
Galac-1-phosphate uridyltran - sendout
|
$155.60 |
$155.60 |
$155.60 |
$82.50
|
