|
Dicyclomine injection
|
$759.00 |
$759.00 |
$759.00 |
$210.00
|
|
Diffusing capacity
|
$1,935.00 |
$1,935.00 |
$1,935.00 |
$357.50
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$128.00 |
$128.00 |
$128.00 |
$53.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$33,840.00 |
$33,840.00 |
$33,840.00 |
$9,684.65
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,502.00 |
$1,502.00 |
$1,502.00 |
$308.90
|
|
Dimenhydrinate injection
|
$128.00 |
$128.00 |
$128.00 |
$24.68
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$2.00 |
$2.00 |
$2.00 |
$1.62
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$128.00 |
$128.00 |
$128.00 |
$22.58
|
|
Disability dlco
|
$1,107.00 |
$1,107.00 |
$1,107.00 |
$302.40
|
|
Doppler echo complete
|
$4,354.00 |
$4,354.00 |
$4,354.00 |
$644.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$1,637.00 |
$1,637.00 |
$1,637.00 |
$490.82
|
|
Dornase alfa non-comp unit
|
$1,265.00 |
$1,265.00 |
$1,265.00 |
$500.29
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$535.00 |
$535.00 |
$535.00 |
$89.34
|
|
Droperidol 2.5 mg/ml injection solution
|
$207.00 |
$207.00 |
$207.00 |
$33.99
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$789.00 |
$789.00 |
$789.00 |
$189.68
|
|
Duplex scan bilateral study 93985
|
$3,174.00 |
$3,174.00 |
$3,174.00 |
$690.95
|
|
Duplex scan unilateral study 93986
|
$1,588.00 |
$1,588.00 |
$1,588.00 |
$392.15
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$3,837.00 |
$3,837.00 |
$3,837.00 |
$750.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,444.00 |
$2,444.00 |
$2,444.00 |
$885.60
|
|
Echocardiogram (Heart Ultrasound)
|
$11,959.00 |
$11,959.00 |
$11,959.00 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$2,008.00 |
$2,008.00 |
$2,008.00 |
$461.61
|
|
Echocardiography transthoracic 2d followup/limited
|
$4,300.00 |
$4,300.00 |
$4,300.00 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$2,209.00 |
$2,209.00 |
$2,209.00 |
$354.90
|
|
Echo exam uterus 76831-
|
$3,554.00 |
$3,554.00 |
$3,554.00 |
$547.23
|
|
Echo guidance radiotherapy
|
$4,054.00 |
$4,054.00 |
$4,054.00 |
$769.18
|
|
Echo guide for amniocentesis
|
$3,094.00 |
$3,094.00 |
$3,094.00 |
$377.11
|
|
Echo guide for artery repair
|
$934.00 |
$934.00 |
$934.00 |
$676.80
|
|
Echo stress
|
$8,593.00 |
$8,593.00 |
$8,593.00 |
$1,607.45
|
|
Echo transesophageal intraop
|
$15,316.00 |
$15,316.00 |
$15,316.00 |
$1,571.70
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$8,593.00 |
$8,593.00 |
$8,593.00 |
$1,020.09
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$4,808.00 |
$4,808.00 |
$4,808.00 |
$1,048.30
|
|
Eeg over 1 hour 95813 - 26
|
$5,559.00 |
$5,559.00 |
$5,559.00 |
$1,100.40
|
|
Eeg/record in coma or sleep only 95822
|
$3,512.00 |
$3,512.00 |
$3,512.00 |
$911.00
|
|
Eeg recording awake and asleep
|
$4,217.00 |
$4,217.00 |
$4,217.00 |
$1,030.27
|
|
Electron microscopy diagnostic
|
$6,064.00 |
$6,064.00 |
$6,064.00 |
$1,006.20
|
|
Electrophysiology evaluation
|
$11,616.00 |
$11,616.00 |
$11,616.00 |
$2,630.40
|
|
Embolization s&i
|
$9,542.00 |
$9,542.00 |
$9,542.00 |
$2,745.08
|
|
Emg 2 ext w-w/o paraspinal area 95861
|
$1,224.00 |
$1,224.00 |
$1,224.00 |
$436.64
|
|
Emg 3 ext w-w/o paraspinal area 95863
|
$2,851.00 |
$2,851.00 |
$2,851.00 |
$512.85
|
|
Emg needle test 1-extremity
|
$1,224.00 |
$1,224.00 |
$1,224.00 |
$340.80
|
|
Encephalitis, california igg/igm
|
$107.00 |
$107.00 |
$107.00 |
$48.57
|
|
Endoscopy swallow (fees) vid
|
$1,860.00 |
$1,860.00 |
$1,860.00 |
$420.00
|
|
Enzyme histochemistry
|
$213.00 |
$213.00 |
$213.00 |
$460.32
|
|
Epirubicin 200 mg/100 ml intravenous solution
|
$816.00 |
$816.00 |
$816.00 |
$195.23
|
|
Epoetin alfa, 100 units esrd
|
$14.00 |
$14.00 |
$14.00 |
$41.32
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,088.00 |
$1,088.00 |
$1,088.00 |
$364.08
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$673.00 |
$673.00 |
$673.00 |
$232.84
|
|
Esophageal dilat s&i
|
$2,771.00 |
$2,771.00 |
$2,771.00 |
$525.00
|
|
Esophagus motility study
|
$2,252.00 |
$2,252.00 |
$2,252.00 |
$1,274.00
|
|
Estradiol total
|
$118.00 |
$118.00 |
$118.00 |
$147.79
|
|
Estrogens total-sendout
|
$157.00 |
$157.00 |
$157.00 |
$89.25
|
|
Etanercept injection
|
$2,537.00 |
$2,537.00 |
$2,537.00 |
$1,521.15
|
|
Ethanolamine oleate 100 mg
|
$539.00 |
$539.00 |
$539.00 |
$933.59
|
|
Etoposide 20 mg/ml intravenous solution
|
$85.00 |
$85.00 |
$85.00 |
$213.17
|
|
Etoposide 50 mg cap
|
$40.00 |
$40.00 |
$40.00 |
$196.27
|
|
Euglobulin lysis
|
$143.00 |
$143.00 |
$143.00 |
$37.70
|
|
Evaluation of speech fluency 92521
|
$1,517.00 |
$1,517.00 |
$1,517.00 |
$347.75
|
|
Evaluation psychiatric diagnostic
|
$531.00 |
$531.00 |
$531.00 |
$324.00
|
|
F-18 fdg pet diag
|
$7,164.00 |
$7,164.00 |
$7,164.00 |
$609.85
|
|
Factor ix
|
$640.00 |
$640.00 |
$640.00 |
$139.75
|
|
Factor viii recombinant nos
|
$14.00 |
$14.00 |
$14.00 |
$4.68
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$180.00 |
$180.00 |
$180.00 |
$22.20
|
|
Fat/lipids feces qualitative
|
$92.00 |
$92.00 |
$92.00 |
$37.40
|
|
Felbamate (felbatol(r)) - sendout
|
$380.00 |
$380.00 |
$380.00 |
$66.43
|
|
Fetal hemoglobin (kleihauer betke)
|
$252.00 |
$252.00 |
$252.00 |
$85.00
|
|
Fetal hemoglobin rosette
|
$242.00 |
$242.00 |
$242.00 |
$74.25
|
|
Fetal non stress test
|
$1,025.00 |
$1,025.00 |
$1,025.00 |
$500.57
|
|
Fibrin degradation products
|
$718.00 |
$718.00 |
$718.00 |
$63.90
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$157.00 |
$157.00 |
$157.00 |
$59.89
|
|
Flecainide (tambocor)-sendout
|
$78.00 |
$78.00 |
$78.00 |
$66.43
|
|
Flow cytometry marker each additional
|
$150.00 |
$150.00 |
$150.00 |
$102.00
|
|
Fludarabine 50 mg intravenous solution
|
$2,412.00 |
$2,412.00 |
$2,412.00 |
$592.00
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$113.00 |
$113.00 |
$113.00 |
$97.74
|
|
Folic acid 5 mg/ml injection solution
|
$521.00 |
$521.00 |
$521.00 |
$48.78
|
|
Follow-up angiography
|
$3,431.00 |
$3,431.00 |
$3,431.00 |
$1,875.00
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$3,753.00 |
$3,753.00 |
$3,753.00 |
$462.82
|
|
Foscarnet sodium injection
|
$55.00 |
$55.00 |
$55.00 |
$714.25
|
|
Fresh frozen plasma thawing ea un
|
$254.00 |
$254.00 |
$254.00 |
$130.00
|
|
Fructosamine glycated protein
|
$109.00 |
$109.00 |
$109.00 |
$64.20
|
|
Ga-67 gallium 0.1 mci
|
$216.00 |
$216.00 |
$216.00 |
$163.80
|
|
Galactokinase - sendout
|
$692.00 |
$692.00 |
$692.00 |
$175.00
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$957.00 |
$957.00 |
$957.00 |
$211.20
|
|
Gastric analy w/ph ea spec
|
$207.00 |
$207.00 |
$207.00 |
$23.01
|
|
Gastroesophageal reflux study
|
$3,144.00 |
$3,144.00 |
$3,144.00 |
$911.04
|
|
Gastroesophageal reflux test
|
$7,102.00 |
$7,102.00 |
$7,102.00 |
$1,115.40
|
|
G-esoph reflx tst w/electrod
|
$7,508.00 |
$7,508.00 |
$7,508.00 |
$1,352.03
|
|
Ghs acetylcholinesterase, rbc
|
$84.00 |
$84.00 |
$84.00 |
$39.60
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$52.00 |
$52.00 |
$52.00 |
$103.14
|
|
Ghs bleeding time (ivy)
|
$602.00 |
$602.00 |
$602.00 |
$55.90
|
|
Ghs fish cytogen
|
$59.00 |
$59.00 |
$59.00 |
$176.93
|
|
Ghs fish hybrid in situ 100-300
|
$158.00 |
$158.00 |
$158.00 |
$229.45
|
|
Ghs flow volume loop
|
$1,482.00 |
$1,482.00 |
$1,482.00 |
$308.69
|
|
Ghs hepatitis c virus (hcv riba)
|
$646.00 |
$646.00 |
$646.00 |
$105.00
|
|
Ghs histoplasma antigen
|
$2,012.00 |
$2,012.00 |
$2,012.00 |
$144.50
|
|
Ghs leukocyte alkaline phos (mayo)
|
$39.00 |
$39.00 |
$39.00 |
$59.40
|
|
Ghs mbp
|
$127.00 |
$127.00 |
$127.00 |
$77.35
|
|
Ghs myocardial strain img spckl track
|
$1,197.00 |
$1,197.00 |
$1,197.00 |
$500.00
|
|
Ghs o2 uptake rest & indirect
|
$204.00 |
$204.00 |
$204.00 |
$195.00
|
|
Ghs ob unlisted IV or art inj or infusion
|
$170.00 |
$170.00 |
$170.00 |
$95.16
|
|
Ghs ot sensory integrative tech/15min
|
$454.00 |
$454.00 |
$454.00 |
$101.50
|
