|
Diagnostic laryngoscopy 31575
|
$1,574.40 |
$1,574.40 |
$1,574.40 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$378.00 |
$378.00 |
$378.00 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$276.60 |
$276.60 |
$276.60 |
$276.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$11,506.80 |
$11,506.80 |
$11,506.80 |
$9,395.77
|
|
Dialysis one evaluation
|
$1,136.40 |
$1,136.40 |
$1,136.40 |
$920.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.22 |
$0.22 |
$0.22 |
$58.24
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$80.83 |
$80.83 |
$80.83 |
$42.12
|
|
Dicyclomine injection
|
$193.54 |
$193.54 |
$193.54 |
$153.53
|
|
Diffusing capacity
|
$339.60 |
$339.60 |
$339.60 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$41.63 |
$41.63 |
$41.63 |
$29.85
|
|
Digoxin immune fab 40 mg intravenous solution
|
$6,815.78 |
$6,815.78 |
$6,815.78 |
$6,815.78
|
|
Digoxin total therapeutic drug level
|
$231.00 |
$231.00 |
$231.00 |
$92.95
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$308.90 |
$308.90 |
$308.90 |
$297.86
|
|
Dimecaprol injection
|
$248.83 |
$248.83 |
$248.83 |
$147.91
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,001.55 |
$1,001.55 |
$1,001.55 |
$1,001.55
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$38.75 |
$38.75 |
$38.75 |
$9.29
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$43.03 |
$43.03 |
$43.03 |
$67.32
|
|
Disability dlco
|
$383.40 |
$383.40 |
$383.40 |
$289.08
|
|
Disaccharidases
|
$306.60 |
$306.60 |
$306.60 |
$224.58
|
|
Dna antibody native/double stranded
|
$246.60 |
$246.60 |
$246.60 |
$101.40
|
|
Dna gardnerella
|
$65.40 |
$65.40 |
$65.40 |
$67.68
|
|
Dna trichomonas
|
$106.20 |
$106.20 |
$106.20 |
$69.60
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$101.04 |
$101.04 |
$101.04 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$850.09 |
$850.09 |
$850.09 |
$131.40
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$104.59 |
$104.59 |
$104.59 |
$60.21
|
|
Doppler echo complete
|
$923.40 |
$923.40 |
$923.40 |
$517.94
|
|
Doppler intravascular pressure flow initial vessel
|
$4,755.60 |
$4,755.60 |
$4,755.60 |
$3,026.62
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,099.20 |
$1,099.20 |
$1,099.20 |
$642.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$692.40 |
$692.40 |
$692.40 |
$463.20
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$17,344.68 |
$17,344.68 |
$17,344.68 |
$326.36
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$1,988.63 |
$1,988.63 |
$1,988.63 |
$97.83
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$99.43 |
$99.43 |
$99.43 |
$715.22
|
|
Drainage of kidney lesion
|
$2,145.60 |
$2,145.60 |
$2,145.60 |
$1,578.89
|
|
Drain cath image guided visceral pq
|
$4,220.40 |
$4,220.40 |
$4,220.40 |
$2,999.34
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$619.20 |
$619.20 |
$619.20 |
$387.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$510.60 |
$510.60 |
$510.60 |
$353.60
|
|
Droperidol 2.5 mg/ml injection solution
|
$40.32 |
$40.32 |
$40.32 |
$32.82
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$901.80 |
$901.80 |
$901.80 |
$57.00
|
|
Drug assay caffeine
|
$280.80 |
$280.80 |
$280.80 |
$89.17
|
|
Drug of abuse screen urine
|
$293.40 |
$293.40 |
$293.40 |
$58.50
|
|
Drug test def 1-7 classes
|
$396.60 |
$396.60 |
$396.60 |
$316.80
|
|
Drug test def 8-14 classes
|
$396.60 |
$396.60 |
$396.60 |
$249.10
|
|
Drug test prsmv instrmnt
|
$293.40 |
$293.40 |
$293.40 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$293.40 |
$293.40 |
$293.40 |
$278.85
|
|
Drvvt confirm - quest
|
$195.00 |
$195.00 |
$195.00 |
$108.55
|
|
Ductogram sgl duct
|
$258.00 |
$258.00 |
$258.00 |
$346.42
|
|
Duplex scan bilateral study 93985
|
$1,201.20 |
$1,201.20 |
$1,201.20 |
$692.40
|
|
Duplex scan unilateral study 93986
|
$600.60 |
$600.60 |
$600.60 |
$357.60
|
|
Dup scan/hemodialysis access 93990
|
$812.40 |
$812.40 |
$812.40 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$1,099.80 |
$1,099.80 |
$1,099.80 |
$740.80
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,578.00 |
$1,578.00 |
$1,578.00 |
$852.57
|
|
Dxa bone density axl vrt fx
|
$466.80 |
$466.80 |
$466.80 |
$365.14
|
|
Ear irrigation 69209
|
$184.80 |
$184.80 |
$184.80 |
$152.50
|
|
Ecg 12 lead tracing only
|
$337.20 |
$337.20 |
$337.20 |
$222.30
|
|
Ecg/1-3 leads/tracing only 93041
|
$239.40 |
$239.40 |
$239.40 |
$129.83
|
|
Ecg < 30 days transmission & analysis
|
$1,131.00 |
$1,131.00 |
$1,131.00 |
$404.21
|
|
Ecg external < 48 hours recording
|
$943.20 |
$943.20 |
$943.20 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$541.73
|
|
Ecg external > 48 hours up to 7 days recording
|
$442.20 |
$442.20 |
$442.20 |
$180.00
|
|
Ecg external >7 days up to 15 days recording
|
$883.80 |
$883.80 |
$883.80 |
$213.20
|
|
Echocardiogram (Heart Ultrasound)
|
$2,880.00 |
$2,880.00 |
$2,880.00 |
$2,021.12
|
|
Echocardiography doppler color flow mapping
|
$800.40 |
$800.40 |
$800.40 |
$450.40
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,072.20 |
$1,072.20 |
$1,072.20 |
$720.60
|
|
Echocardiograpy doppler follow up/limited study
|
$591.00 |
$591.00 |
$591.00 |
$348.80
|
|
Echo guidance radiotherapy
|
$1,751.40 |
$1,751.40 |
$1,751.40 |
$655.00
|
|
Echo guide for amniocentesis
|
$257.40 |
$257.40 |
$257.40 |
$355.17
|
|
Echo guide for artery repair
|
$324.60 |
$324.60 |
$324.60 |
$687.35
|
|
Echo tee guidance
|
$2,514.00 |
$2,514.00 |
$2,514.00 |
$2,007.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$2,238.00 |
$2,238.00 |
$2,238.00 |
$1,946.10
|
|
Echo transthoracic
|
$2,002.20 |
$2,002.20 |
$2,002.20 |
$1,361.75
|
|
Echo transthoracic
|
$1,297.80 |
$1,297.80 |
$1,297.80 |
$765.00
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$1,745.40 |
$1,745.40 |
$1,745.40 |
$997.40
|
|
Eeg 41-60 minutes 95812-26
|
$1,355.40 |
$1,355.40 |
$1,355.40 |
$934.05
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$1,210.80 |
$1,210.80 |
$1,210.80 |
$970.07
|
|
Eeg during surgery
|
$1,640.40 |
$1,640.40 |
$1,640.40 |
$775.45
|
|
Eeg monitor/record/awake/drowsy 95816
|
$923.40 |
$923.40 |
$923.40 |
$835.00
|
|
Eeg over 1 hour 95813 - 26
|
$1,782.00 |
$1,782.00 |
$1,782.00 |
$1,072.93
|
|
Eeg recording awake and asleep
|
$1,311.00 |
$1,311.00 |
$1,311.00 |
$937.95
|
|
Egfr gene com variants
|
$376.20 |
$376.20 |
$376.20 |
$619.04
|
|
Electrical stimulation/unattended 97014
|
$56.40 |
$56.40 |
$56.40 |
$79.20
|
|
Electric stim/w chemodenervation 95873
|
$93.00 |
$93.00 |
$93.00 |
$128.40
|
|
Electroconvulsive therapy 90870
|
$1,569.00 |
$1,569.00 |
$1,569.00 |
$1,052.70
|
|
Electrode stimulation brain
|
$958.80 |
$958.80 |
$958.80 |
$1,127.09
|
|
Electrolyte panel
|
$180.00 |
$180.00 |
$180.00 |
$68.56
|
|
Electron microscopy diagnostic
|
$1,746.60 |
$1,746.60 |
$1,746.60 |
$1,107.84
|
|
Elotuzumab 300 mg intravenous solution
|
$12.05 |
$12.05 |
$12.05 |
$7,188.13
|
|
Embo or occlude vascular arterial s&i
|
$11,506.80 |
$11,506.80 |
$11,506.80 |
$16,060.54
|
|
Embo or occlude vascular hemorrhage s&i
|
$11,506.80 |
$11,506.80 |
$11,506.80 |
$15,266.94
|
|
Embo or occlude vascular tumor/organ/infarct s&i
|
$16,860.00 |
$16,860.00 |
$16,860.00 |
$16,381.78
|
|
Embo or occlude vascular venous s&i
|
$11,506.80 |
$11,506.80 |
$11,506.80 |
$15,873.70
|
|
Emg 2 ext w-w/o paraspinal area 95861
|
$1,207.20 |
$1,207.20 |
$1,207.20 |
$447.50
|
|
Emg 3 ext w-w/o paraspinal area 95863
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$482.30
|
|
Emg cranial nerve bilateral
|
$447.60 |
$447.60 |
$447.60 |
$494.13
|
|
Emg needle test 1-extremity
|
$967.20 |
$967.20 |
$967.20 |
$362.25
|
|
Emg needle test 4-extremities
|
$1,690.20 |
$1,690.20 |
$1,690.20 |
$547.00
|
|
Emg thor paraspinal without t1/t2
|
$399.60 |
$399.60 |
$399.60 |
$309.83
|
|
Endo abl/incom vein/ext/laser/#1 36478
|
$8,628.60 |
$8,628.60 |
$8,628.60 |
$5,206.19
|
|
Endo cath bile duct s&i
|
$258.00 |
$258.00 |
$258.00 |
$525.00
|
|
Endo cath panc duct s&i
|
$258.00 |
$258.00 |
$258.00 |
$634.40
|
|
Endoscopy swallow (fees) vid
|
$236.40 |
$236.40 |
$236.40 |
$457.50
|
