|
Disability dlco
|
$62.40 |
$62.40 |
$62.40 |
|
|
Disaccharidases
|
$64.80 |
$64.80 |
$64.80 |
|
|
Discography cerv/thor spine
|
$0.60 |
$0.60 |
$0.60 |
|
|
Dissolve clot heart vessel
|
$0.60 |
$0.60 |
$0.60 |
|
|
Dna antibody native/double stranded
|
$49.80 |
$49.80 |
$49.80 |
|
|
Dna gardnerella
|
$194.40 |
$194.40 |
$194.40 |
|
|
Dna probe chlamydia
|
$72.60 |
$72.60 |
$72.60 |
|
|
Dna probe gc
|
$72.60 |
$72.60 |
$72.60 |
|
|
Dna trichomonas
|
$72.60 |
$72.60 |
$72.60 |
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$31.20 |
$31.20 |
$31.20 |
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$0.60 |
$0.60 |
$0.60 |
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$2.40 |
$2.40 |
$2.40 |
|
|
Doppler echo complete
|
$66.00 |
$66.00 |
$66.00 |
|
|
Doppler intravascular pressure flow initial vessel
|
$0.60 |
$0.60 |
$0.60 |
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$571.80 |
$571.80 |
$571.80 |
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$375.00 |
$375.00 |
$375.00 |
|
|
Doripenem 50 mg/ml inj 10 ml
|
$43.20 |
$43.20 |
$43.20 |
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$279.00 |
$279.00 |
$279.00 |
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$232.80 |
$232.80 |
$232.80 |
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$642.60 |
$642.60 |
$642.60 |
|
|
Drainage of kidney lesion
|
$0.60 |
$0.60 |
$0.60 |
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$0.60 |
$0.60 |
$0.60 |
|
|
Drain cath image guided visceral pq
|
$0.60 |
$0.60 |
$0.60 |
|
|
Droperidol 2.5 mg/ml injection solution
|
$7.80 |
$7.80 |
$7.80 |
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$573.00 |
$573.00 |
$573.00 |
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$237.60 |
$237.60 |
$237.60 |
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$423.60 |
$423.60 |
$423.60 |
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$10,534.20 |
$10,534.20 |
$10,534.20 |
|
|
Drug admin & hemodynmic meas
|
$0.60 |
$0.60 |
$0.60 |
|
|
Drug assay caffeine
|
$24.00 |
$24.00 |
$24.00 |
|
|
Drug of abuse screen urine
|
$16.20 |
$16.20 |
$16.20 |
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$103.80 |
$103.80 |
$103.80 |
|
|
Drvvt confirm - quest
|
$81.00 |
$81.00 |
$81.00 |
|
|
Ductogram sgl duct
|
$196.20 |
$196.20 |
$196.20 |
|
|
Duplex scan bilateral study 93985
|
$1,144.20 |
$1,144.20 |
$1,144.20 |
|
|
Duplex scan unilateral study 93986
|
$643.20 |
$643.20 |
$643.20 |
|
|
Dup scan/hemodialysis access 93990
|
$679.20 |
$679.20 |
$679.20 |
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$732.60 |
$732.60 |
$732.60 |
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$840.00 |
$840.00 |
$840.00 |
|
|
Durvalumab 50 mg/ml intravenous solution
|
$1,036.80 |
$1,036.80 |
$1,036.80 |
|
|
Ecg/1-3 leads/tracing only 93041
|
$33.00 |
$33.00 |
$33.00 |
|
|
Ecg external < 48 hours recording
|
$66.00 |
$66.00 |
$66.00 |
|
|
Ecg external < 48 hours scanning analysis w/report
|
$331.80 |
$331.80 |
$331.80 |
|
|
Ecg external > 48 hours up to 7 days recording
|
$66.00 |
$66.00 |
$66.00 |
|
|
Ecg external >7 days up to 15 days recording
|
$66.00 |
$66.00 |
$66.00 |
|
|
Echocardiogram (Heart Ultrasound)
|
$405.00 |
$405.00 |
$405.00 |
|
|
Echocardiogram (Limited Follow-Up Heart Ultrasound)
|
$139.20 |
$139.20 |
$139.20 |
|
|
Echocardiography doppler color flow mapping
|
$33.00 |
$33.00 |
$33.00 |
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$405.00 |
$405.00 |
$405.00 |
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$139.20 |
$139.20 |
$139.20 |
|
|
Echo guide for artery repair
|
$0.60 |
$0.60 |
$0.60 |
|
|
Echo stress
|
$398.40 |
$398.40 |
$398.40 |
|
|
Echo tee probe placement image acquisition interpretation & report
|
$398.40 |
$398.40 |
$398.40 |
|
|
Echo transthoracic
|
$298.80 |
$298.80 |
$298.80 |
|
|
Echo transthoracic
|
$132.60 |
$132.60 |
$132.60 |
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$298.80 |
$298.80 |
$298.80 |
|
|
Ecmo/ecls remove perph cannula 0-5yrs perq 33965
|
$0.60 |
$0.60 |
$0.60 |
|
|
Ecmo/ecls remove prph cannula 6yrs&older perq 33966
|
$0.60 |
$0.60 |
$0.60 |
|
|
Eeg monitor/record/awake/drowsy 95816
|
$421.80 |
$421.80 |
$421.80 |
|
|
Eeg recording awake and asleep
|
$501.00 |
$501.00 |
$501.00 |
|
|
Egfr gene com variants
|
$909.60 |
$909.60 |
$909.60 |
|
|
EKG (Tracing Only)
|
$79.20 |
$79.20 |
$79.20 |
|
|
Elbow X-ray (2 views, both sides)
|
$89.40 |
$89.40 |
$89.40 |
|
|
Elbow X-ray (3 or more views, both sides)
|
$106.80 |
$106.80 |
$106.80 |
|
|
Electrd sq emblem s-icd
|
$6,672.00 |
$6,672.00 |
$6,672.00 |
|
|
Electrical Stimulation Therapy (each 15 minutes)
|
$22.80 |
$22.80 |
$22.80 |
|
|
Electrolyte panel
|
$12.60 |
$12.60 |
$12.60 |
|
|
Electron microscopy diagnostic
|
$649.20 |
$649.20 |
$649.20 |
|
|
Electrophysiology evaluation
|
$0.60 |
$0.60 |
$0.60 |
|
|
Electrophysiology evaluation
|
$0.60 |
$0.60 |
$0.60 |
|
|
Electrophysiology evaluation
|
$0.60 |
$0.60 |
$0.60 |
|
|
Electrophysiology evaluation
|
$0.60 |
$0.60 |
$0.60 |
|
|
Electrophysiology evaluation
|
$0.60 |
$0.60 |
$0.60 |
|
|
Electrophysiology evaluation
|
$0.60 |
$0.60 |
$0.60 |
|
|
Electrophysiology evaluation
|
$0.60 |
$0.60 |
$0.60 |
|
|
Elotuzumab 300 mg intravenous solution
|
$3,061.20 |
$3,061.20 |
$3,061.20 |
|
|
Embolization s&i
|
$0.60 |
$0.60 |
$0.60 |
|
|
Embo or occlude vascular arterial s&i
|
$0.60 |
$0.60 |
$0.60 |
|
|
Embo or occlude vascular hemorrhage s&i
|
$0.60 |
$0.60 |
$0.60 |
|
|
Embo or occlude vascular tumor/organ/infarct s&i
|
$0.60 |
$0.60 |
$0.60 |
|
|
Embo or occlude vascular venous s&i
|
$0.60 |
$0.60 |
$0.60 |
|
|
Emg 3 ext w-w/o paraspinal area 95863
|
$163.80 |
$163.80 |
$163.80 |
|
|
Endoluminal bx biliary tree
|
$0.60 |
$0.60 |
$0.60 |
|
|
Endoluminl ivus oct c 1st
|
$0.60 |
$0.60 |
$0.60 |
|
|
Endoluminl ivus oct c ea
|
$0.60 |
$0.60 |
$0.60 |
|
|
Endovasc visc aorta 2 graft
|
$0.60 |
$0.60 |
$0.60 |
|
|
Endovas iliac a device addon
|
$0.60 |
$0.60 |
$0.60 |
|
|
Enfortumab vedotin-ejfv 20 mg intravenous solution
|
$36.60 |
$36.60 |
$36.60 |
|
|
Enoxaparin 30 mg/0.3 ml subcutaneous syringe
|
$35.40 |
$35.40 |
$35.40 |
|
|
Entamoeba histolytica ag eia - sendout
|
$64.80 |
$64.80 |
$64.80 |
|
|
Enzyme histochemistry
|
$81.00 |
$81.00 |
$81.00 |
|
|
Ep & ablate supravent arrhyt
|
$0.60 |
$0.60 |
$0.60 |
|
|
Ep & ablate ventric tachy
|
$0.60 |
$0.60 |
$0.60 |
|
|
Epirubicin 200 mg/100 ml intravenous solution
|
$33.00 |
$33.00 |
$33.00 |
|
|
Epoetin alfa, 100 units esrd
|
$164.40 |
$164.40 |
$164.40 |
|
|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$667.20 |
$667.20 |
$667.20 |
|
|
Epstein barr early antigen antibody
|
$53.40 |
$53.40 |
$53.40 |
|
|
Epstein barr nuclear antigen antibody
|
$53.40 |
$53.40 |
$53.40 |
|
|
Epstein barr viral capsid antigen antibody igm
|
$76.20 |
$76.20 |
$76.20 |
|
|
Eptifibatide 0.75 mg/ml intravenous solution
|
$62.40 |
$62.40 |
$62.40 |
|