|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$22,682.00 |
$22,682.00 |
$22,682.00 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$4,662.00 |
$4,662.00 |
$4,662.00 |
$5,500.25
|
|
Darbepoetin alfa, esrd use
|
$4,662.00 |
$4,662.00 |
$4,662.00 |
$3.04
|
|
Dch validity tests
|
$470.00 |
$470.00 |
$470.00 |
$25.00
|
|
Deferoxamine 500 mg solution for injection
|
$343.00 |
$343.00 |
$343.00 |
$112.87
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$424.00 |
$424.00 |
$424.00 |
$182.40
|
|
Devel tst phys/qhp 1st hr
|
$671.00 |
$671.00 |
$671.00 |
$343.20
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$9,428.00 |
$9,428.00 |
$9,428.00 |
$196.30
|
|
Dextrose 5 % IV bolus
|
$505.00 |
$505.00 |
$505.00 |
$68.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$192.00 |
$192.00 |
$192.00 |
$107.50
|
|
Diagnostic Mammogram (both breasts)
|
$1,180.00 |
$1,180.00 |
$1,180.00 |
$403.32
|
|
Diagnostic radio unlisted proc
|
$1,396.00 |
$1,396.00 |
$1,396.00 |
$236.93
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$201.00 |
$201.00 |
$201.00 |
$67.89
|
|
Dicyclomine injection
|
$765.00 |
$765.00 |
$765.00 |
$210.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$34,120.00 |
$34,120.00 |
$34,120.00 |
$9,684.65
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$482.00 |
$482.00 |
$482.00 |
$308.90
|
|
Dimenhydrinate injection
|
$160.00 |
$160.00 |
$160.00 |
$24.68
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$1.00 |
$1.00 |
$1.00 |
$1.62
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$160.00 |
$160.00 |
$160.00 |
$22.58
|
|
Disaccharidases
|
$293.00 |
$293.00 |
$293.00 |
$224.58
|
|
Discography cerv/thor spine
|
$12,013.00 |
$12,013.00 |
$12,013.00 |
$2,360.70
|
|
Dna probe chlamydia
|
$113.00 |
$113.00 |
$113.00 |
$82.20
|
|
Dna probe gc
|
$113.00 |
$113.00 |
$113.00 |
$88.67
|
|
Doppler echo complete
|
$2,782.00 |
$2,782.00 |
$2,782.00 |
$644.00
|
|
Dornase alfa non-comp unit
|
$694.00 |
$694.00 |
$694.00 |
$500.29
|
|
Dornhoffer fixed part w/window
|
$40,200.00 |
$40,200.00 |
$40,200.00 |
$32,112.76
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$97,464.35 |
$97,464.35 |
$97,464.35 |
$33,342.33
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$2,594.40 |
$2,594.40 |
$2,594.40 |
$2,469.31
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$69.41 |
$69.41 |
$69.41 |
$89.34
|
|
Dronabinol 2.5mg oral
|
$113.00 |
$113.00 |
$113.00 |
$10.17
|
|
Droperidol 2.5 mg/ml injection solution
|
$160.00 |
$160.00 |
$160.00 |
$33.99
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$5,706.00 |
$5,706.00 |
$5,706.00 |
$327.39
|
|
Drug assay voriconazole
|
$122.00 |
$122.00 |
$122.00 |
$96.75
|
|
Drug of abuse screen urine
|
$87.00 |
$87.00 |
$87.00 |
$63.75
|
|
Duplex scan bilateral study 93985
|
$833.00 |
$833.00 |
$833.00 |
$690.95
|
|
Duplex scan unilateral study 93986
|
$394.00 |
$394.00 |
$394.00 |
$392.15
|
|
Durvalumab 50 mg/ml intravenous solution
|
$4,046.95 |
$4,046.95 |
$4,046.95 |
$6,529.68
|
|
Ecg 12 lead tracing only
|
$1,715.00 |
$1,715.00 |
$1,715.00 |
$243.61
|
|
Ecg/1-3 leads/tracing only 93041
|
$539.00 |
$539.00 |
$539.00 |
$129.83
|
|
Ecg external < 48 hours recording
|
$7,435.00 |
$7,435.00 |
$7,435.00 |
$461.76
|
|
Echocardiogram (Heart Ultrasound)
|
$14,826.00 |
$14,826.00 |
$14,826.00 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$1,147.00 |
$1,147.00 |
$1,147.00 |
$461.61
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,063.00 |
$1,063.00 |
$1,063.00 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$1,925.00 |
$1,925.00 |
$1,925.00 |
$354.90
|
|
Echo exam of fetal heart
|
$768.00 |
$768.00 |
$768.00 |
$855.38
|
|
Echo exam of fetal heart
|
$617.00 |
$617.00 |
$617.00 |
$481.55
|
|
Echo exam of fetal heart
|
$768.00 |
$768.00 |
$768.00 |
$431.41
|
|
Echo exam of fetal heart
|
$617.00 |
$617.00 |
$617.00 |
$323.40
|
|
Echo exam uterus 76831-
|
$626.00 |
$626.00 |
$626.00 |
$547.23
|
|
Echograp trans r pros study
|
$654.00 |
$654.00 |
$654.00 |
$445.25
|
|
Echo guide for amniocentesis
|
$1,126.00 |
$1,126.00 |
$1,126.00 |
$377.11
|
|
Echo guide for artery repair
|
$1,385.00 |
$1,385.00 |
$1,385.00 |
$676.80
|
|
Echo stress
|
$3,450.00 |
$3,450.00 |
$3,450.00 |
$1,607.45
|
|
Echo tee guidance
|
$670.00 |
$670.00 |
$670.00 |
$2,007.00
|
|
Echo transesophageal
|
$2,763.00 |
$2,763.00 |
$2,763.00 |
$577.22
|
|
Echo transthoracic
|
$8,968.00 |
$8,968.00 |
$8,968.00 |
$1,475.25
|
|
Echo transthoracic
|
$7,176.00 |
$7,176.00 |
$7,176.00 |
$944.14
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$10,898.00 |
$10,898.00 |
$10,898.00 |
$1,020.09
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$59,815.00 |
$59,815.00 |
$59,815.00 |
$17,641.10
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$3,777.00 |
$3,777.00 |
$3,777.00 |
$1,048.30
|
|
Eeg during surgery
|
$3,469.00 |
$3,469.00 |
$3,469.00 |
$775.45
|
|
Eeg monitor/record/awake/drowsy 95816
|
$3,050.00 |
$3,050.00 |
$3,050.00 |
$861.12
|
|
Eeg over 1 hour 95813 - 26
|
$1,201.00 |
$1,201.00 |
$1,201.00 |
$1,100.40
|
|
Eeg/record in coma or sleep only 95822
|
$583.00 |
$583.00 |
$583.00 |
$911.00
|
|
Eeg recording awake and asleep
|
$3,210.00 |
$3,210.00 |
$3,210.00 |
$1,030.27
|
|
E equine encephalitis igg
|
$133.00 |
$133.00 |
$133.00 |
$48.73
|
|
Electroconvulsive therapy 90870
|
$1,448.00 |
$1,448.00 |
$1,448.00 |
$1,130.00
|
|
Electrolyte panel
|
$626.00 |
$626.00 |
$626.00 |
$86.33
|
|
Electron microscopy diagnostic
|
$1,147.00 |
$1,147.00 |
$1,147.00 |
$1,006.20
|
|
Electrophysiologic study
|
$45,892.00 |
$45,892.00 |
$45,892.00 |
$6,758.40
|
|
Electrophysiology evaluation
|
$50,675.00 |
$50,675.00 |
$50,675.00 |
$8,979.45
|
|
Electrophysiology evaluation
|
$50,675.00 |
$50,675.00 |
$50,675.00 |
$11,542.01
|
|
Electrophysiology evaluation
|
$50,675.00 |
$50,675.00 |
$50,675.00 |
$8,393.40
|
|
Electrophysiology evaluation
|
$48,288.00 |
$48,288.00 |
$48,288.00 |
$6,516.00
|
|
Electrophysiology evaluation
|
$6,010.00 |
$6,010.00 |
$6,010.00 |
$2,845.10
|
|
Electrophysiology evaluation
|
$6,010.00 |
$6,010.00 |
$6,010.00 |
$2,630.40
|
|
Electrophys map 3d add-on
|
$45,892.00 |
$45,892.00 |
$45,892.00 |
$6,534.00
|
|
Encephalitis, california igg/igm
|
$113.00 |
$113.00 |
$113.00 |
$48.57
|
|
Encephalitis, st louis igg/igm
|
$190.00 |
$190.00 |
$190.00 |
$48.57
|
|
Encephalitis, western equine igg/igm
|
$133.00 |
$133.00 |
$133.00 |
$50.35
|
|
Endo cath bile duct s&i
|
$1,828.00 |
$1,828.00 |
$1,828.00 |
$545.37
|
|
Endo cath panc duct s&i
|
$1,828.00 |
$1,828.00 |
$1,828.00 |
$637.65
|
|
Endoscopy swallow (fees) vid
|
$764.00 |
$764.00 |
$764.00 |
$420.00
|
|
Enzyme histochemistry
|
$256.00 |
$256.00 |
$256.00 |
$460.32
|
|
Ep & ablate supravent arrhyt
|
$99,623.00 |
$99,623.00 |
$99,623.00 |
$29,766.10
|
|
Ep & ablate ventric tachy
|
$106,718.00 |
$106,718.00 |
$106,718.00 |
$30,975.00
|
|
Ep induct arrhy by elect pacing
|
$45,892.00 |
$45,892.00 |
$45,892.00 |
$2,753.40
|
|
Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr
|
$638.00 |
$638.00 |
$638.00 |
$135.20
|
|
Ercp biliary & pancreas
|
$1,828.00 |
$1,828.00 |
$1,828.00 |
$922.35
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,098.00 |
$1,098.00 |
$1,098.00 |
$364.08
|
|
Esophgl motil w/stim/perfus
|
$1,662.00 |
$1,662.00 |
$1,662.00 |
$1,075.06
|
|
Estradiol total
|
$231.00 |
$231.00 |
$231.00 |
$147.79
|
|
Estradiol valerate 10 mg inj
|
$140.49 |
$140.49 |
$140.49 |
$51.40
|
|
Estrogens total-sendout
|
$185.00 |
$185.00 |
$185.00 |
$89.25
|
|
Ethanolamine oleate 100 mg
|
$5,218.00 |
$5,218.00 |
$5,218.00 |
$933.59
|
|
Ethylene glycol -sendout
|
$122.00 |
$122.00 |
$122.00 |
$78.00
|
|
Etoposide 50 mg cap
|
$411.00 |
$411.00 |
$411.00 |
$196.27
|
|
Eval/fit voice prosthesis iii, st
|
$622.00 |
$622.00 |
$622.00 |
$375.20
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$675.00 |
$675.00 |
$675.00 |
$219.60
|
|
Evaluation heart device
|
$6,010.00 |
$6,010.00 |
$6,010.00 |
$2,384.20
|
