|
Developmental screen/score/document 96110
|
$268.45 |
$268.45 |
$268.45 |
|
|
Devel tst phys/qhp 1st hr
|
$247.00 |
$247.00 |
$247.00 |
|
|
Device intraute mirena
|
$5,789.60 |
$5,789.60 |
$5,789.60 |
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$247.00 |
$247.00 |
$247.00 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$127.60 |
$127.60 |
$127.60 |
|
|
Dexamethasone 4 mg tablet
|
$108.52 |
$108.52 |
$108.52 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$7.34 |
$7.34 |
$7.34 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,158.75 |
$1,158.75 |
$1,158.75 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$23.40 |
$23.40 |
$23.40 |
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$25.35 |
$25.35 |
$25.35 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$23.40 |
$23.40 |
$23.40 |
|
|
Dextrose 5 % IV bolus
|
$25.35 |
$25.35 |
$25.35 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$79.20 |
$126.00 |
$165.75 |
|
|
Diabetes (HbA1c) Test
|
$58.00 |
$70.40 |
$84.50 |
|
|
Diag laparo separate proc 49320
|
$14,704.38 |
$14,704.38 |
$14,704.38 |
|
|
Diagnostic digital breast tomosynthesis bil
|
$174.00 |
$174.00 |
$183.20 |
|
|
Diagnostic digital breast tomosynthesis unil
|
$64.00 |
$64.00 |
$143.60 |
|
|
Diagnostic Mammogram (both breasts)
|
$179.60 |
$228.80 |
$267.15 |
|
|
Diagnostic Mammogram (one breast)
|
$140.80 |
$181.60 |
$260.00 |
|
|
Dialysis one evaluation
|
$716.40 |
$716.40 |
$716.40 |
|
|
Diatrizoate meglumine 18 % urethral solution
|
$38.87 |
$38.87 |
$38.87 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$117.00 |
$117.00 |
$117.00 |
|
|
Dicyclomine injection
|
$51.21 |
$51.21 |
$51.21 |
|
|
Diffusing capacity
|
$167.60 |
$167.60 |
$215.80 |
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$7.15 |
$7.15 |
$7.15 |
|
|
Digoxin total therapeutic drug level
|
$52.80 |
$88.80 |
$105.95 |
|
|
Dilate biliary duct/ampulla
|
$270.00 |
$270.00 |
$270.00 |
|
|
Dilat xst trc ndurlgc px
|
$2,158.80 |
$2,158.80 |
$2,158.80 |
|
|
Dilat xst trc new access rcs
|
$3,632.00 |
$3,632.00 |
$3,632.00 |
|
|
Diltiazem 5 mg/ml intravenous solution
|
$122.00 |
$122.00 |
$122.00 |
|
|
Dimethyl sulfoxide 50% 50 ml
|
$3,083.20 |
$3,083.20 |
$3,083.20 |
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$7.15 |
$7.15 |
$7.15 |
|
|
Disability dlco
|
$299.00 |
$299.00 |
$299.00 |
|
|
Disaccharidases
|
$83.20 |
$83.20 |
$83.20 |
|
|
Dna antibody native/double stranded
|
$72.80 |
$84.40 |
$165.10 |
|
|
Dna gardnerella
|
$43.20 |
$43.20 |
$92.30 |
|
|
Dna trichomonas
|
$43.20 |
$43.20 |
$89.70 |
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$92.95 |
$92.95 |
$92.95 |
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$495.81 |
$495.81 |
$495.81 |
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$60.21 |
$60.21 |
$60.21 |
|
|
Doppler echo complete
|
$399.20 |
$399.20 |
$510.25 |
|
|
Doppler intravascular pressure flow initial vessel
|
$1,521.00 |
$1,521.00 |
$1,844.00 |
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$382.85 |
$382.85 |
$382.85 |
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$266.00 |
$266.00 |
$374.40 |
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$21,942.00 |
$21,942.00 |
$21,942.00 |
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$477.97 |
$477.97 |
$477.97 |
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$2,242.17 |
$2,242.17 |
$2,242.17 |
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$106.05 |
$106.05 |
$106.05 |
|
|
Drain blood from under nail 11740
|
$63.60 |
$63.60 |
$200.40 |
|
|
Drain cath image guided visceral pq
|
$1,499.60 |
$1,499.60 |
$1,499.60 |
|
|
Drain finger abscess;simple 26010
|
$55.60 |
$55.60 |
$55.60 |
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$280.80 |
$280.80 |
$444.00 |
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$172.80 |
$172.80 |
$232.40 |
|
|
Dress/debrid prtl-thick burn l 16030
|
$539.20 |
$539.20 |
$743.60 |
|
|
Droperidol 2.5 mg/ml injection solution
|
$44.91 |
$44.91 |
$44.91 |
|
|
Drug admin & hemodynmic meas
|
$1,653.60 |
$1,653.60 |
$1,653.60 |
|
|
Drug of abuse screen urine
|
$70.40 |
$70.40 |
$78.00 |
|
|
Drug test prsmv instrmnt
|
$39.20 |
$39.20 |
$65.00 |
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$90.80 |
$128.40 |
$378.30 |
|
|
Drvvt confirm - quest
|
$119.60 |
$119.60 |
$119.60 |
|
|
Ductogram sgl duct
|
$304.40 |
$304.40 |
$304.40 |
|
|
Duplex scan bilateral study 93985
|
$730.00 |
$730.00 |
$730.00 |
|
|
Dup scan/hemodialysis access 93990
|
$209.60 |
$209.60 |
$209.60 |
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$419.90 |
$419.90 |
$502.80 |
|
|
Durvalumab 50 mg/ml intravenous solution
|
$7,876.43 |
$7,876.43 |
$7,876.43 |
|
|
Ecg 12 lead tracing only
|
$72.40 |
$152.00 |
$236.60 |
|
|
Ecg/1-3 leads/tracing only 93041
|
$32.40 |
$65.20 |
$121.55 |
|
|
Ecg < 30 days transmission & analysis
|
$254.40 |
$254.40 |
$254.40 |
|
|
Ecg external < 48 hours recording
|
$239.60 |
$307.45 |
$323.60 |
|
|
Ecg external < 48 hours scanning analysis w/report
|
$307.45 |
$307.45 |
$372.80 |
|
|
Ecg external > 48 hours up to 7 days recording
|
$182.00 |
$182.00 |
$182.00 |
|
|
Ecg external >7 days up to 15 days recording
|
$182.00 |
$182.00 |
$182.00 |
|
|
Echocardiogram (Heart Ultrasound)
|
$908.80 |
$1,342.80 |
$1,443.00 |
|
|
Echocardiography doppler color flow mapping
|
$354.00 |
$354.00 |
$391.95 |
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$1,212.25 |
$1,212.25 |
$1,212.25 |
|
|
Echocardiography transthoracic 2d followup/limited
|
$250.80 |
$320.80 |
$449.15 |
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$1,112.15 |
$1,112.15 |
$1,112.15 |
|
|
Echocardiograpy doppler follow up/limited study
|
$209.60 |
$209.60 |
$376.35 |
|
|
Echo exam uterus 76831-
|
$300.00 |
$300.00 |
$300.00 |
|
|
Echograp trans r pros study
|
$381.55 |
$381.55 |
$381.55 |
|
|
Echo stress
|
$486.80 |
$486.80 |
$836.80 |
|
|
Echo tee probe placement image acquisition interpretation & report
|
$1,222.65 |
$1,222.65 |
$1,288.40 |
|
|
Echo transesophageal
|
$827.60 |
$827.60 |
$827.60 |
|
|
Echo transthoracic
|
$713.05 |
$713.05 |
$900.40 |
|
|
Echo transthoracic
|
$304.00 |
$304.00 |
$304.00 |
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$674.40 |
$674.40 |
$674.40 |
|
|
E coli 0157 ag ia
|
$83.20 |
$83.20 |
$83.20 |
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$11,667.65 |
$11,667.65 |
$11,667.65 |
|
|
Edu/train/pt/nonmd/in person/30 min98960
|
$17.60 |
$17.60 |
$31.85 |
|
|
Eeg monitor/record/awake/drowsy 95816
|
$405.20 |
$405.20 |
$405.20 |
|
|
Eeg over 1 hour 95813 - 26
|
$726.00 |
$726.00 |
$726.00 |
|
|
Egd control bleeding any
|
$7,042.40 |
$7,042.40 |
$7,042.40 |
|
|
Egd dilate stricture
|
$4,624.50 |
$4,624.50 |
$4,624.50 |
|
|
Egd remove lesion snare
|
$858.40 |
$858.40 |
$7,411.99 |
|
|
Egd/remov tum/polyp/hot bx forcep 43250
|
$7,352.12 |
$7,352.12 |
$7,352.12 |
|
|
Egfr gene com variants
|
$262.80 |
$262.80 |
$262.80 |
|
|
Ehrlicha chaffeensis amp prb
|
$88.00 |
$88.00 |
$227.50 |
|
|
Electrical stimulation/unattended 97014
|
$38.35 |
$50.40 |
$85.20 |
|
|
Electric stim/w chemodenervation 95873
|
$32.80 |
$32.80 |
$112.00 |
|
|
Electrolyte panel
|
$55.60 |
$64.40 |
$78.65 |
|
