|
Diabetes (HbA1c) Test
|
$70.80 |
$70.80 |
$70.80 |
$79.20
|
|
Diab manage trn ind/group
|
$16.80 |
$16.80 |
$16.80 |
$56.55
|
|
Diagnostic Mammogram (both breasts)
|
$578.40 |
$578.40 |
$578.40 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$289.20 |
$289.20 |
$289.20 |
$301.55
|
|
Dialysis one evaluation
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$919.55
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$91.80 |
$91.80 |
$91.80 |
$74.76
|
|
Dicyclomine injection
|
$268.20 |
$268.20 |
$268.20 |
$153.29
|
|
Diffusing capacity
|
$192.00 |
$192.00 |
$192.00 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.20 |
$19.20 |
$19.20 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$12,133.20 |
$12,133.20 |
$12,133.20 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$175.20 |
$175.20 |
$175.20 |
$102.00
|
|
Diltiazem 5 mg/ml intravenous solution
|
$22.20 |
$22.20 |
$22.20 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$17.75
|
|
Dna antibody native/double stranded
|
$279.60 |
$279.60 |
$279.60 |
$97.50
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$42.60 |
$42.60 |
$42.60 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$65.40 |
$65.40 |
$65.40 |
$65.40
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$205.20 |
$205.20 |
$205.20 |
$662.35
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$96.60 |
$96.60 |
$96.60 |
$84.80
|
|
Drainage ext aud canal abscess 69020
|
$258.60 |
$258.60 |
$258.60 |
$914.34
|
|
Drain blood from under nail 11740
|
$145.20 |
$145.20 |
$145.20 |
$170.50
|
|
Drain finger abscess;simple 26010
|
$307.80 |
$307.80 |
$307.80 |
$419.00
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$246.60 |
$246.60 |
$246.60 |
$392.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$195.60 |
$195.60 |
$195.60 |
$344.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$438.00 |
$438.00 |
$438.00 |
$523.00
|
|
Drng of scrotum abscess 55100
|
$1,526.40 |
$1,526.40 |
$1,526.40 |
$1,917.33
|
|
Droperidol 2.5 mg/ml injection solution
|
$9.00 |
$9.00 |
$9.00 |
$31.07
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$193.15 |
$193.15 |
$193.15 |
$289.05
|
|
Drug of abuse screen urine
|
$120.60 |
$120.60 |
$120.60 |
$63.75
|
|
Drug test def 1-7 classes
|
$203.40 |
$203.40 |
$203.40 |
$250.52
|
|
Drug test def 8-14 classes
|
$156.60 |
$156.60 |
$156.60 |
$282.00
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$220.80 |
$220.80 |
$220.80 |
$278.85
|
|
Drvvt confirm - quest
|
$518.40 |
$518.40 |
$518.40 |
$109.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$819.60 |
$819.60 |
$819.60 |
$887.25
|
|
Dxa bone density axl vrt fx
|
$279.60 |
$279.60 |
$279.60 |
$392.60
|
|
Ear irrigation 69209
|
$108.60 |
$108.60 |
$108.60 |
$149.76
|
|
Ecg 12 lead tracing only
|
$234.60 |
$234.60 |
$234.60 |
$226.50
|
|
Ecg/1-3 leads/tracing only 93041
|
$105.00 |
$105.00 |
$105.00 |
$135.80
|
|
Ecg external < 48 hours recording
|
$127.20 |
$127.20 |
$127.20 |
$462.00
|
|
Ecg external > 48 hours up to 7 days recording
|
$51.60 |
$51.60 |
$51.60 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$82.20 |
$82.20 |
$82.20 |
$161.85
|
|
Echocardiogram (Heart Ultrasound)
|
$2,035.80 |
$2,035.80 |
$2,035.80 |
$2,001.17
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$2,053.20 |
$2,053.20 |
$2,053.20 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$540.60 |
$540.60 |
$540.60 |
$703.25
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$802.20 |
$802.20 |
$802.20 |
$851.50
|
|
Eeg recording awake and asleep
|
$463.20 |
$463.20 |
$463.20 |
$931.20
|
|
EKG (Electrocardiogram)
|
$136.80 |
$136.80 |
$136.80 |
$89.60
|
|
Electrical stimulation/unattended 97014
|
$209.40 |
$209.40 |
$209.40 |
$79.20
|
|
Electrolyte panel
|
$115.20 |
$115.20 |
$115.20 |
$84.24
|
|
Emg 2 ext w-w/o paraspinal area 95861
|
$62.40 |
$62.40 |
$62.40 |
$375.20
|
|
Enoxaparin 30 mg/0.3 ml subcutaneous syringe
|
$373.20 |
$373.20 |
$373.20 |
$109.71
|
|
Epinephrine 0.1 mg/ml injection syringe
|
$54.90 |
$54.90 |
$54.90 |
$37.86
|
|
Epinephrine 1 mg/ml im kit - pediatric
|
$897.90 |
$897.90 |
$897.90 |
$393.15
|
|
Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution
|
$45.00 |
$45.00 |
$45.00 |
$34.13
|
|
Epoetin alfa-epbx 40,000 unit/ml injection solution
|
$368.40 |
$368.40 |
$368.40 |
$809.08
|
|
Epstein barr early antigen antibody
|
$40.20 |
$40.20 |
$40.20 |
$60.48
|
|
Epstein barr nuclear antigen antibody
|
$28.20 |
$28.20 |
$28.20 |
$78.65
|
|
Epstein barr viral capsid antigen antibody igm
|
$57.60 |
$57.60 |
$57.60 |
$91.00
|
|
Eptinezumab-jjmr 100 mg/ml intravenous solution
|
$6,681.60 |
$6,681.60 |
$6,681.60 |
$3,838.45
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$429.60 |
$429.60 |
$429.60 |
$222.98
|
|
ER Visit (level 1, minor)
|
$66.60 |
$66.60 |
$66.60 |
$246.24
|
|
ER Visit (level 2)
|
$152.40 |
$152.40 |
$152.40 |
$452.20
|
|
ER Visit (level 3)
|
$292.80 |
$292.80 |
$292.80 |
$770.04
|
|
ER Visit (level 4)
|
$1,847.40 |
$1,847.40 |
$1,847.40 |
$1,273.68
|
|
ER Visit (level 5, high severity)
|
$3,148.80 |
$3,148.80 |
$3,148.80 |
$1,820.02
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$1,298.40 |
$1,298.40 |
$1,298.40 |
$553.88
|
|
Established Patient Office Visit (level 1)
|
$271.80 |
$271.80 |
$271.80 |
$120.25
|
|
Established Patient Office Visit (level 2)
|
$387.60 |
$387.60 |
$387.60 |
$132.72
|
|
Established Patient Office Visit (level 3)
|
$514.20 |
$514.20 |
$514.20 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$662.40 |
$662.40 |
$662.40 |
$231.75
|
|
Established Patient Office Visit (level 5)
|
$872.40 |
$872.40 |
$872.40 |
$280.33
|
|
Estradiol total
|
$192.00 |
$192.00 |
$192.00 |
$146.50
|
|
Estrogens total-sendout
|
$275.40 |
$275.40 |
$275.40 |
$96.20
|
|
Euflexxa inj per dose
|
$178.20 |
$178.20 |
$178.20 |
$587.51
|
|
Evaluation psychiatric diagnostic
|
$113.40 |
$113.40 |
$113.40 |
$312.00
|
|
Event monitor
|
$175.20 |
$175.20 |
$175.20 |
$242.65
|
|
Excision olecranon bursa
|
$644.40 |
$644.40 |
$644.40 |
$2,889.60
|
|
Exc sq tum/vasc malform/hand/fngr 26111
|
$498.60 |
$498.60 |
$498.60 |
$1,898.50
|
|
Exc tendon sheath or cap lesion 26160
|
$236.40 |
$236.40 |
$236.40 |
$2,650.53
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$198.00 |
$198.00 |
$198.00 |
$108.60
|
|
Facial bones <3
|
$302.40 |
$302.40 |
$302.40 |
$252.60
|
|
Factor viii
|
$550.20 |
$550.20 |
$550.20 |
$133.81
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$4.20 |
$4.20 |
$4.20 |
$22.20
|
|
Fasciotomy hip/thigh any typ
|
$1,204.20 |
$1,204.20 |
$1,204.20 |
$3,342.87
|
|
Fat/lipids feces qualitative
|
$40.80 |
$40.80 |
$40.80 |
$38.35
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$8.40 |
$8.40 |
$8.40 |
$101.40
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$3,310.20 |
$3,310.20 |
$3,310.20 |
$2,590.25
|
|
Ferritin
|
$229.80 |
$229.80 |
$229.80 |
$100.94
|
|
Fibrin degrade semiquant
|
$69.60 |
$69.60 |
$69.60 |
$78.09
|
|
Fibrinogen activity
|
$133.80 |
$133.80 |
$133.80 |
$83.50
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$1,464.60 |
$1,464.60 |
$1,464.60 |
$869.18
|
|
Fixation of knee joint
|
$367.20 |
$367.20 |
$367.20 |
$1,893.86
|
|
Fl exam g/colon tube w contrast
|
$319.80 |
$319.80 |
$319.80 |
$511.92
|
|
Flow cytometry marker each additional
|
$24.00 |
$24.00 |
$24.00 |
$97.50
|
|
Flow cytometry one marker technical component
|
$559.80 |
$559.80 |
$559.80 |
$284.40
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$32.40 |
$32.40 |
$32.40 |
$64.22
|
|
Fluoroguide needle placement
|
$667.20 |
$667.20 |
$667.20 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$489.60 |
$489.60 |
$489.60 |
$492.00
|
|
Folic acid
|
$255.60 |
$255.60 |
$255.60 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$139.80 |
$139.80 |
$139.80 |
$54.75
|
|
Fomepizole 1 gram/ml intravenous solution
|
$3,584.40 |
$3,584.40 |
$3,584.40 |
$2,581.14
|
