|
Drain cerebro spinal fluid 62272
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,113.06
|
|
Drain chest lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,594.44
|
|
Drain finger abscess;simple 26010
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$492.81
|
|
Drain lower leg bursa
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,839.54
|
|
Drain lower leg lesion 27603
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,631.18
|
|
Drain neck/chest lesion 21501
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,386.84
|
|
Drain ovarn cyst abd
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,762.53
|
|
Drain ovary abscess open
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,762.53
|
|
Drain penis lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,005.32
|
|
Drain shoulder bone lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,206.33
|
|
Drain shoulder bursa 23031
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,719.83
|
|
Drain shoulder lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,571.53
|
|
Drain thigh/knee lesion 27301
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,620.47
|
|
Drain thyroid/tongue cyst
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,744.44
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$420.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$365.60
|
|
Dress/debrid prtl-thick burn l 16030
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$554.40
|
|
Dressing change not for burn w/anes 15852
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$790.56
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$462.61 |
$462.61 |
$462.61 |
$9,390.80
|
|
Drng hand tendon sheath 26020
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,981.06
|
|
Drng of eyelid abscess 67700
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$747.00
|
|
Drng of finger abscess comp 26011
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,048.00
|
|
Drng of hydrocele 55000
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$832.60
|
|
Drng of mouth lesion 40801
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,145.97
|
|
Drng of ovarian cyst(s) 58800
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,474.84
|
|
Drng of palm multi bursas 26030
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,591.33
|
|
Drng of palm single bursa 26025
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,545.97
|
|
Drng of pelvic abscess transrectal 45000
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,614.45
|
|
Drng of salivary cyst 42409
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,575.45
|
|
Drng of scrotum abscess 55100
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,069.60
|
|
Drng salivary gland simple 42300
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,133.48
|
|
Drng salivary gland submax/subling 42310
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$602.63
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$268.80 |
$268.80 |
$268.80 |
$468.29
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$9.70 |
$9.70 |
$9.70 |
$318.13
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$2,711.70 |
$2,711.70 |
$2,711.70 |
$18,384.03
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$47.73 |
$47.73 |
$47.73 |
$448.16
|
|
Drug admin & hemodynmic meas
|
$116.93 |
$116.93 |
$116.93 |
$528.50
|
|
Drug assay caffeine
|
$42.43 |
$42.43 |
$42.43 |
$81.61
|
|
Drug assay posaconazole
|
$29.82 |
$29.82 |
$29.82 |
$96.39
|
|
Drug assay rufinamide
|
$29.82 |
$29.82 |
$29.82 |
$93.60
|
|
Drug assay vedolizumab
|
$42.43 |
$42.43 |
$42.43 |
$164.16
|
|
Drug assay voriconazole
|
$29.82 |
$29.82 |
$29.82 |
$96.75
|
|
Drug asy hydroxychloroquine
|
$20.50 |
$20.50 |
$20.50 |
$83.85
|
|
Drug of abuse screen urine
|
$13.86 |
$13.86 |
$13.86 |
$63.75
|
|
Drug screen quant tiagabine
|
$29.82 |
$29.82 |
$29.82 |
$91.80
|
|
Drug test def 15-21 classes
|
$218.61 |
$218.61 |
$218.61 |
$144.42
|
|
Drug test def 1-7 classes
|
$125.87 |
$125.87 |
$125.87 |
$250.52
|
|
Drug test def 22+ classes
|
$271.61 |
$271.61 |
$271.61 |
$246.92
|
|
Drug test def 8-14 classes
|
$172.25 |
$172.25 |
$172.25 |
$172.25
|
|
Drug test prsmv instrmnt
|
$18.85 |
$18.85 |
$18.85 |
$83.20
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$68.35 |
$68.35 |
$68.35 |
$278.85
|
|
Drvvt confirm - quest
|
$19.78 |
$19.78 |
$19.78 |
$101.66
|
|
Dstrj extensive retinopathy
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,173.97
|
|
Dstrj nulyt agt gnclr nrv
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,390.00
|
|
Dstr mal les s/n/h/f/g >4.0
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$670.00
|
|
Dstr mal ls f/e/e/n/l/m2.1-3
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$603.20
|
|
Dstr mal ls f/e/e/n/l/m3.1-4
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$724.37
|
|
Dstr mal ls f/e/e/n/l/m>4.0
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$886.40
|
|
Duplex scan bilateral study 93985
|
$481.82 |
$481.82 |
$481.82 |
$673.00
|
|
Dup scan/hemodialysis access 93990
|
$283.61 |
$283.61 |
$283.61 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$374.08 |
$374.08 |
$374.08 |
$757.57
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$479.57 |
$479.57 |
$479.57 |
$903.00
|
|
Dxa bone density axl vrt fx
|
$217.16 |
$217.16 |
$217.16 |
$374.00
|
|
Dx bronchoscope/brush 31623
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,168.40
|
|
Dx bronchoscope/lavage 31624
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,780.40
|
|
Dx bronchoscope/wash 31622
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,587.60
|
|
Dx duod intub w/asp spec 43756
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,037.75
|
|
Dx duod intub w/asp specs
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,104.13
|
|
Dx gastr intub w/asp spec
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$368.50
|
|
Dx gastr intub w/asp specs
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$204.96
|
|
Dx laryngoscopy newborn
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$619.08
|
|
Dx laryngoscopy w/oper scope
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,040.67
|
|
Dynamic cavernosometry
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$343.55
|
|
Ear canal biopsy 69105
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,768.50
|
|
Ear cartilage graft
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,741.00
|
|
Ear irrigation 69209
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$165.42
|
|
Ecg 12 lead tracing only
|
$67.38 |
$67.38 |
$67.38 |
$245.00
|
|
Ecg < 30 days transmission & analysis
|
$214.91 |
$214.91 |
$214.91 |
$429.00
|
|
Ecg external < 48 hours recording
|
$340.67 |
$340.67 |
$340.67 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$418.19 |
$418.19 |
$418.19 |
$567.00
|
|
Echocardiogram (Heart Ultrasound)
|
$772.94 |
$772.94 |
$772.94 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$214.72 |
$214.72 |
$214.72 |
$469.95
|
|
Echocardiography transthoracic 2d followup/limited
|
$312.52 |
$312.52 |
$312.52 |
$724.20
|
|
Echocardiograpy doppler follow up/limited study
|
$149.40 |
$149.40 |
$149.40 |
$353.46
|
|
Echo exam of fetal heart
|
$360.38 |
$360.38 |
$360.38 |
$855.38
|
|
Echo exam of fetal heart
|
$317.02 |
$317.02 |
$317.02 |
$503.80
|
|
Echo exam of fetal heart
|
$133.07 |
$133.07 |
$133.07 |
$431.41
|
|
Echo exam of fetal heart
|
$94.22 |
$94.22 |
$94.22 |
$323.40
|
|
Echo exam uterus 76831-
|
$161.60 |
$161.60 |
$161.60 |
$547.20
|
|
Echograp trans r pros study
|
$74.70 |
$74.70 |
$74.70 |
$459.40
|
|
Echo guidance radiotherapy
|
$271.03 |
$271.03 |
$271.03 |
$774.80
|
|
Echo guide for amniocentesis
|
$336.17 |
$336.17 |
$336.17 |
$384.65
|
|
Echo guide for artery repair
|
$330.16 |
$330.16 |
$330.16 |
$680.28
|
|
Echo guide for heart biopsy
|
$61.75 |
$61.75 |
$61.75 |
$455.26
|
|
Echo guide for transfusion
|
$106.42 |
$106.42 |
$106.42 |
$324.60
|
|
Echo guide villus sampling
|
$138.71 |
$138.71 |
$138.71 |
$355.80
|
|
Echo stress
|
$478.07 |
$478.07 |
$478.07 |
$1,582.75
|
|
Echo tee probe placement image acquisition interpretation & report
|
$1,036.10 |
$1,036.10 |
$1,036.10 |
$1,871.10
|
|
Echo transesophageal intraop
|
$864.92 |
$864.92 |
$864.92 |
$1,571.70
|
|
Echo transthoracic
|
$347.99 |
$347.99 |
$347.99 |
$1,492.50
|