|
Dornase alfa non-comp unit
|
$503.00 |
$503.00 |
$503.00 |
$498.89
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$182.71 |
$182.71 |
$182.71 |
$93.12
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$13,748.82 |
$13,748.82 |
$13,748.82 |
$3,555.40
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$853.47 |
$853.47 |
$853.47 |
$213.07
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$6,179.60 |
$6,179.60 |
$6,179.60 |
$327.39
|
|
Drug assay caffeine
|
$12.36 |
$12.36 |
$12.36 |
$88.83
|
|
Drug of abuse screen urine
|
$117.00 |
$117.00 |
$117.00 |
$63.75
|
|
Drug test def 1-7 classes
|
$73.28 |
$73.28 |
$73.28 |
$263.86
|
|
Drvvt confirm - quest
|
$561.76 |
$561.76 |
$561.76 |
$101.66
|
|
Ecg/1-3 leads/tracing only 93041
|
$347.96 |
$347.96 |
$347.96 |
$129.83
|
|
Ecg < 30 days transmission & analysis
|
$2,469.75 |
$2,469.75 |
$2,469.75 |
$441.40
|
|
Echocardiography doppler color flow mapping
|
$4,106.30 |
$4,106.30 |
$4,106.30 |
$463.45
|
|
Echocardiography transthoracic 2d followup/limited
|
$2,296.23 |
$2,296.23 |
$2,296.23 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$1,417.50 |
$1,417.50 |
$1,417.50 |
$356.40
|
|
Echo exam of fetal heart
|
$2,147.17 |
$2,147.17 |
$2,147.17 |
$855.38
|
|
Echo exam of fetal heart
|
$3,165.62 |
$3,165.62 |
$3,165.62 |
$431.41
|
|
Echograp trans r pros study
|
$4,790.97 |
$4,790.97 |
$4,790.97 |
$458.25
|
|
Echo guidance radiotherapy
|
$3,334.80 |
$3,334.80 |
$3,334.80 |
$774.80
|
|
Echo stress
|
$4,848.47 |
$4,848.47 |
$4,848.47 |
$1,607.45
|
|
Echo tee cngntl wo ctrst probe plcmnt
|
$5,073.86 |
$5,073.86 |
$5,073.86 |
$648.84
|
|
Echo transesophageal
|
$6,087.76 |
$6,087.76 |
$6,087.76 |
$1,734.10
|
|
Echo transesophageal intraop
|
$5,073.86 |
$5,073.86 |
$5,073.86 |
$1,571.70
|
|
Echo transthoracic
|
$6,184.52 |
$6,184.52 |
$6,184.52 |
$1,510.84
|
|
Echo transthoracic
|
$3,082.51 |
$3,082.51 |
$3,082.51 |
$944.14
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$19,569.00 |
$19,569.00 |
$19,569.00 |
$17,641.10
|
|
Eeg 41-60 minutes 95812-26
|
$1,779.17 |
$1,779.17 |
$1,779.17 |
$934.05
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$6,894.58 |
$6,894.58 |
$6,894.58 |
$1,048.30
|
|
Eeg monitoring/giving drugs
|
$3,922.11 |
$3,922.11 |
$3,922.11 |
$797.51
|
|
Eeg monitor/record/awake/drowsy 95816
|
$5,854.43 |
$5,854.43 |
$5,854.43 |
$861.12
|
|
Eeg over 1 hour 95813 - 26
|
$1,779.17 |
$1,779.17 |
$1,779.17 |
$1,086.80
|
|
Eeg/record in coma or sleep only 95822
|
$2,144.00 |
$2,144.00 |
$2,144.00 |
$924.30
|
|
Eeg recording awake and asleep
|
$5,230.42 |
$5,230.42 |
$5,230.42 |
$1,030.27
|
|
Elec stim unattend for press
|
$282.55 |
$282.55 |
$282.55 |
$43.59
|
|
Electrolyte panel
|
$1,678.86 |
$1,678.86 |
$1,678.86 |
$88.20
|
|
Electrophysiology evaluation
|
$5,863.77 |
$5,863.77 |
$5,863.77 |
$2,845.10
|
|
Electrophysiology evaluation
|
$4,687.10 |
$4,687.10 |
$4,687.10 |
$2,630.40
|
|
Emg 2 ext w-w/o paraspinal area 95861
|
$682.03 |
$682.03 |
$682.03 |
$434.00
|
|
Emg 3 ext w-w/o paraspinal area 95863
|
$682.03 |
$682.03 |
$682.03 |
$512.85
|
|
Emg needle test 1-extremity
|
$678.68 |
$678.68 |
$678.68 |
$340.80
|
|
Emg needle test 4-extremities
|
$682.03 |
$682.03 |
$682.03 |
$547.00
|
|
Endo cath bile duct s&i
|
$7,748.16 |
$7,748.16 |
$7,748.16 |
$569.40
|
|
Endo cath panc duct s&i
|
$7,748.16 |
$7,748.16 |
$7,748.16 |
$637.65
|
|
Entamoeba histolytica ag eia - sendout
|
$20.00 |
$20.00 |
$20.00 |
$66.60
|
|
Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr
|
$1,242.00 |
$1,242.00 |
$1,242.00 |
$130.76
|
|
Ercp biliary & pancreas
|
$15,610.61 |
$15,610.61 |
$15,610.61 |
$929.40
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,226.00 |
$1,226.00 |
$1,226.00 |
$323.00
|
|
ER Visit (level 1, minor)
|
$1,893.00 |
$1,893.00 |
$1,893.00 |
$276.25
|
|
ER Visit (level 2)
|
$5,081.75 |
$5,081.75 |
$5,081.75 |
$482.40
|
|
ER Visit (level 3)
|
$9,940.07 |
$9,940.07 |
$9,940.07 |
$850.50
|
|
ER Visit (level 4)
|
$12,811.59 |
$12,811.59 |
$12,811.59 |
$1,351.35
|
|
ER Visit (level 5, high severity)
|
$22,071.02 |
$22,071.02 |
$22,071.02 |
$1,957.38
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$386.00 |
$386.00 |
$386.00 |
$240.87
|
|
Esophageal dilat s&i
|
$2,298.29 |
$2,298.29 |
$2,298.29 |
$525.00
|
|
Esoph balloon distension tst
|
$3,492.50 |
$3,492.50 |
$3,492.50 |
$780.00
|
|
Ethanolamine oleate 100 mg
|
$2,494.49 |
$2,494.49 |
$2,494.49 |
$1,011.00
|
|
Etoposide 20 mg/ml intravenous solution
|
$119.73 |
$119.73 |
$119.73 |
$213.17
|
|
Etoposide 50 mg cap
|
$687.00 |
$687.00 |
$687.00 |
$203.41
|
|
Euglobulin lysis
|
$47.96 |
$47.96 |
$47.96 |
$38.35
|
|
Eval/fit voice prosthesis iii, st
|
$336.74 |
$336.74 |
$336.74 |
$375.70
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$619.34 |
$619.34 |
$619.34 |
$221.00
|
|
Evaluation heart device
|
$5,863.77 |
$5,863.77 |
$5,863.77 |
$2,523.52
|
|
Evaluation of speech fluency 92521
|
$828.55 |
$828.55 |
$828.55 |
$350.00
|
|
Evoked potentials upper limbs
|
$5,130.48 |
$5,130.48 |
$5,130.48 |
$908.54
|
|
Evoked potential visual not glaucoma
|
$3,428.39 |
$3,428.39 |
$3,428.39 |
$852.80
|
|
External chromosome analysis 20-25 cells
|
$124.17 |
$124.17 |
$124.17 |
$389.35
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$125.83 |
$125.83 |
$125.83 |
$466.15
|
|
F-18 fdg pet diag
|
$2,398.58 |
$2,398.58 |
$2,398.58 |
$609.85
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$9.35 |
$9.35 |
$9.35 |
$22.23
|
|
#fecal-sodium
|
$28.45 |
$28.45 |
$28.45 |
$37.50
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$2,982.36 |
$2,982.36 |
$2,982.36 |
$2,175.15
|
|
Fetal biophys profile w/nst 76818
|
$3,533.48 |
$3,533.48 |
$3,533.48 |
$541.74
|
|
Fetal contract stress test 59020 - 26
|
$3,218.37 |
$3,218.37 |
$3,218.37 |
$559.32
|
|
Fetal fibronectin
|
$250.00 |
$250.00 |
$250.00 |
$346.45
|
|
Fetal hemoglobin (kleihauer betke)
|
$1,770.70 |
$1,770.70 |
$1,770.70 |
$85.00
|
|
Fetal non stress test
|
$1,176.87 |
$1,176.87 |
$1,176.87 |
$507.90
|
|
Fibrin degradation d dimer quantitative
|
$2,529.88 |
$2,529.88 |
$2,529.88 |
$111.68
|
|
Fibrin degrade semiquant
|
$1,963.65 |
$1,963.65 |
$1,963.65 |
$90.35
|
|
Fibrinogen activity
|
$1,302.37 |
$1,302.37 |
$1,302.37 |
$82.38
|
|
Fibrinolytic antiplasmin
|
$40.73 |
$40.73 |
$40.73 |
$58.25
|
|
Fibrinolytic plasminogen
|
$23.98 |
$23.98 |
$23.98 |
$112.02
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$55.70 |
$55.70 |
$55.70 |
$59.89
|
|
Floxuridine injection
|
$4,139.00 |
$4,139.00 |
$4,139.00 |
$774.69
|
|
Fludarabine 50 mg intravenous solution
|
$1,940.00 |
$1,940.00 |
$1,940.00 |
$592.00
|
|
Fluoro polarize fetal lung
|
$212.00 |
$212.00 |
$212.00 |
$62.81
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$77.00 |
$77.00 |
$77.00 |
$97.74
|
|
Folic acid 5 mg/ml injection solution
|
$1,027.00 |
$1,027.00 |
$1,027.00 |
$50.70
|
|
Fomepizole 1 gram/ml intravenous solution
|
$9,155.00 |
$9,155.00 |
$9,155.00 |
$2,993.41
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$215.89 |
$215.89 |
$215.89 |
$462.82
|
|
Foscarnet sodium injection
|
$714.25 |
$714.25 |
$714.25 |
$714.25
|
|
Fracture assessment via dxa
|
$3,914.71 |
$3,914.71 |
$3,914.71 |
$136.07
|
|
Fresh frozen plasma thawing ea un
|
$275.51 |
$275.51 |
$275.51 |
$131.25
|
|
Ga-67 gallium 0.1 mci
|
$496.80 |
$496.80 |
$496.80 |
$163.80
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$157.00 |
$157.00 |
$157.00 |
$177.43
|
|
Gamma glutamyltransferase
|
$1,408.14 |
$1,408.14 |
$1,408.14 |
$55.28
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$649.00 |
$649.00 |
$649.00 |
$211.20
|
|
Gastroesophageal reflux study
|
$7,251.98 |
$7,251.98 |
$7,251.98 |
$917.28
|
|
G-esoph reflx tst w/electrod
|
$20,892.75 |
$20,892.75 |
$20,892.75 |
$1,352.03
|
|
Ghs acetylcholinesterase, rbc
|
$12.20 |
$12.20 |
$12.20 |
$39.60
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$25.86 |
$25.86 |
$25.86 |
$103.14
|
|
Ghs alpha thalasemia, 7 deletions
|
$47.00 |
$47.00 |
$47.00 |
$433.00
|
