|
Drain thigh/knee lesion 27301
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,620.47
|
|
Drain thyroid/tongue cyst
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,744.44
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$420.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$365.60
|
|
Dress/debrid prtl-thick burn l 16030
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$554.40
|
|
Dressing change not for burn w/anes 15852
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$790.56
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$403.95 |
$403.95 |
$403.95 |
$9,390.80
|
|
Drng hand tendon sheath 26020
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,981.06
|
|
Drng of eyelid abscess 67700
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$747.00
|
|
Drng of finger abscess comp 26011
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,048.00
|
|
Drng of hydrocele 55000
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$832.60
|
|
Drng of mouth lesion 40801
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,145.97
|
|
Drng of ovarian cyst(s) 58800
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,474.84
|
|
Drng of palm multi bursas 26030
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,591.33
|
|
Drng of palm single bursa 26025
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,545.97
|
|
Drng of pelvic abscess transrectal 45000
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,614.45
|
|
Drng of salivary cyst 42409
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,575.45
|
|
Drng of scrotum abscess 55100
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,069.60
|
|
Drng salivary gland simple 42300
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,133.48
|
|
Drng salivary gland submax/subling 42310
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$602.63
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$234.72 |
$234.72 |
$234.72 |
$468.29
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$8.47 |
$8.47 |
$8.47 |
$318.13
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$2,367.86 |
$2,367.86 |
$2,367.86 |
$18,384.03
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$41.67 |
$41.67 |
$41.67 |
$448.16
|
|
Drug admin & hemodynmic meas
|
$63.10 |
$63.10 |
$63.10 |
$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
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,173.97
|
|
Dstrj nulyt agt gnclr nrv
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,390.00
|
|
Dstr mal les s/n/h/f/g >4.0
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$670.00
|
|
Dstr mal ls f/e/e/n/l/m2.1-3
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$603.20
|
|
Dstr mal ls f/e/e/n/l/m3.1-4
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$724.37
|
|
Dstr mal ls f/e/e/n/l/m>4.0
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$886.40
|
|
Duplex scan bilateral study 93985
|
$292.39 |
$292.39 |
$292.39 |
$673.00
|
|
Dup scan/hemodialysis access 93990
|
$125.21 |
$125.21 |
$125.21 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$276.99 |
$276.99 |
$276.99 |
$757.57
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$327.30 |
$327.30 |
$327.30 |
$903.00
|
|
Dxa bone density axl vrt fx
|
$145.37 |
$145.37 |
$145.37 |
$374.00
|
|
Dx bronchoscope/brush 31623
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,168.40
|
|
Dx bronchoscope/lavage 31624
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,780.40
|
|
Dx bronchoscope/wash 31622
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,587.60
|
|
Dx duod intub w/asp spec 43756
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,037.75
|
|
Dx duod intub w/asp specs
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,104.13
|
|
Dx gastr intub w/asp spec
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$368.50
|
|
Dx gastr intub w/asp specs
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$204.96
|
|
Dx laryngoscopy newborn
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$619.08
|
|
Dx laryngoscopy w/oper scope
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,040.67
|
|
Dynamic cavernosometry
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$343.55
|
|
Ear canal biopsy 69105
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,768.50
|
|
Ear cartilage graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
Ear irrigation 69209
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$165.42
|
|
Ecg 12 lead tracing only
|
$58.84 |
$58.84 |
$58.84 |
$245.00
|
|
Echocardiogram (Heart Ultrasound)
|
$813.10 |
$813.10 |
$813.10 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$242.57 |
$242.57 |
$242.57 |
$469.95
|
|
Echocardiography transthoracic 2d followup/limited
|
$225.36 |
$225.36 |
$225.36 |
$724.20
|
|
Echocardiograpy doppler follow up/limited study
|
$52.77 |
$52.77 |
$52.77 |
$353.46
|
|
Echo exam uterus 76831-
|
$153.08 |
$153.08 |
$153.08 |
$547.20
|
|
Echograp trans r pros study
|
$131.93 |
$131.93 |
$131.93 |
$459.40
|
|
Echo stress
|
$442.20 |
$442.20 |
$442.20 |
$1,582.75
|
|
Echo tee probe placement image acquisition interpretation & report
|
$980.12 |
$980.12 |
$980.12 |
$1,871.10
|
|
Echo transesophageal
|
$632.65 |
$632.65 |
$632.65 |
$1,734.10
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$339.27 |
$339.27 |
$339.27 |
$1,014.01
|
|
E coli 0157 ag ia
|
$13.93 |
$13.93 |
$13.93 |
$32.00
|
|
Ecp ciliary body destruction
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,526.64
|
|
Eeg 41-60 minutes 95812-26
|
$299.93 |
$299.93 |
$299.93 |
$956.45
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$198.81 |
$198.81 |
$198.81 |
$1,049.59
|
|
Eeg monitor/record/awake/drowsy 95816
|
$302.23 |
$302.23 |
$302.23 |
$861.12
|
|
Eeg over 1 hour 95813 - 26
|
$341.07 |
$341.07 |
$341.07 |
$1,119.54
|
|
Eeg/record in coma or sleep only 95822
|
$221.26 |
$221.26 |
$221.26 |
$936.00
|
|
Eeg recording awake and asleep
|
$276.49 |
$276.49 |
$276.49 |
$1,030.27
|
|
Eeg without vid 2-12hr cont mntr
|
$359.92 |
$359.92 |
$359.92 |
$704.79
|
|
Eeg without vid 2-12 hr unmntr
|
$206.67 |
$206.67 |
$206.67 |
$586.20
|
|
Eeg without vid ea 12-26hr cont
|
$490.88 |
$490.88 |
$490.88 |
$1,353.60
|
|
Eeg without vid ea 12-26hr intmt
|
$467.27 |
$467.27 |
$467.27 |
$1,278.57
|
|
Eeg wo vid 2-12hr intmt mntr
|
$323.86 |
$323.86 |
$323.86 |
$639.00
|
|
Eeg wo vid ea 12-26hr unmntr
|
$504.32 |
$504.32 |
$504.32 |
$1,251.52
|
|
E equine encephalitis igg
|
$14.51 |
$14.51 |
$14.51 |
$48.73
|
|
Egd balloon dil esoph30 mm/>
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,244.82
|
|
Egd control bleeding any
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,553.75
|
|
Egd dilate stricture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,638.57
|
|
Egd endo mucosal resection
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,433.60
|
|
Egd endoscopic stent place
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,379.25
|
|
Egd esophagogastrc fndoplsty
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$9,562.50
|
|
Egd flx trnsorl dplmnt balo
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,244.82
|
|
Egd flx trnsorl rmvl balo
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,104.13
|
|
Egd guide wire insertion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,250.00
|
|
Egd injection varices
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,244.82
|