|
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
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,173.97
|
|
Dstrj nulyt agt gnclr nrv
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,390.00
|
|
Dstr mal les s/n/h/f/g >4.0
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$670.00
|
|
Dstr mal ls f/e/e/n/l/m2.1-3
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$603.20
|
|
Dstr mal ls f/e/e/n/l/m3.1-4
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$724.37
|
|
Dstr mal ls f/e/e/n/l/m>4.0
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$886.40
|
|
Duplex scan bilateral study 93985
|
$509.36 |
$509.36 |
$509.36 |
$673.00
|
|
Dup scan/hemodialysis access 93990
|
$329.33 |
$329.33 |
$329.33 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$425.10 |
$425.10 |
$425.10 |
$757.57
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$551.38 |
$551.38 |
$551.38 |
$903.00
|
|
Dxa bone density axl vrt fx
|
$223.32 |
$223.32 |
$223.32 |
$374.00
|
|
Dx aly aud oi snd prcsr 1st
|
$76.57 |
$76.57 |
$76.57 |
$185.15
|
|
Dx bronchoscope/brush 31623
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,168.40
|
|
Dx bronchoscope/lavage 31624
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,780.40
|
|
Dx bronchoscope/wash 31622
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,587.60
|
|
Dx duod intub w/asp spec 43756
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,037.75
|
|
Dx duod intub w/asp specs
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,104.13
|
|
Dx gastr intub w/asp spec
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$368.50
|
|
Dx gastr intub w/asp specs
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$204.96
|
|
Dx laryngoscopy newborn
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$619.08
|
|
Dx laryngoscopy w/oper scope
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,040.67
|
|
Dynamic cavernosometry
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$343.55
|
|
Ear canal biopsy 69105
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,768.50
|
|
Ear cartilage graft
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$5,741.00
|
|
Ear irrigation 69209
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$165.42
|
|
Ecg 12 lead tracing only
|
$76.57 |
$76.57 |
$76.57 |
$245.00
|
|
Ecg < 30 days transmission & analysis
|
$286.88 |
$286.88 |
$286.88 |
$429.00
|
|
Ecg external < 48 hours recording
|
$387.13 |
$387.13 |
$387.13 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$475.23 |
$475.23 |
$475.23 |
$567.00
|
|
Ecg external > 48 hours up to 7 days recording
|
$249.34 |
$249.34 |
$249.34 |
$162.78
|
|
Ecg external >7 days up to 15 days recording
|
$174.47 |
$174.47 |
$174.47 |
$200.00
|
|
Echocardiogram (Heart Ultrasound)
|
$1,041.54 |
$1,041.54 |
$1,041.54 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$463.50 |
$463.50 |
$463.50 |
$469.95
|
|
Echocardiography transthoracic 2d followup/limited
|
$321.01 |
$321.01 |
$321.01 |
$724.20
|
|
Echocardiograpy doppler follow up/limited study
|
$169.78 |
$169.78 |
$169.78 |
$353.46
|
|
Echo exam of fetal heart
|
$289.23 |
$289.23 |
$289.23 |
$855.38
|
|
Echo exam of fetal heart
|
$240.17 |
$240.17 |
$240.17 |
$503.80
|
|
Echo exam of fetal heart
|
$261.29 |
$261.29 |
$261.29 |
$431.41
|
|
Echo exam of fetal heart
|
$107.07 |
$107.07 |
$107.07 |
$323.40
|
|
Echo exam uterus 76831-
|
$169.36 |
$169.36 |
$169.36 |
$547.20
|
|
Echograp trans r pros study
|
$129.68 |
$129.68 |
$129.68 |
$459.40
|
|
Echo guidance radiotherapy
|
$308.00 |
$308.00 |
$308.00 |
$774.80
|
|
Echo guide for amniocentesis
|
$314.40 |
$314.40 |
$314.40 |
$384.65
|
|
Echo guide for artery repair
|
$310.99 |
$310.99 |
$310.99 |
$680.28
|
|
Echo guide for heart biopsy
|
$103.02 |
$103.02 |
$103.02 |
$455.26
|
|
Echo guide villus sampling
|
$157.62 |
$157.62 |
$157.62 |
$355.80
|
|
Echo stress
|
$543.27 |
$543.27 |
$543.27 |
$1,582.75
|
|
Echo tee guidance
|
$983.95 |
$983.95 |
$983.95 |
$2,007.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$1,177.62 |
$1,177.62 |
$1,177.62 |
$1,871.10
|
|
Echo transesophageal
|
$642.67 |
$642.67 |
$642.67 |
$1,734.10
|
|
Echo transesophageal intraop
|
$786.22 |
$786.22 |
$786.22 |
$1,571.70
|
|
Echo transthoracic
|
$589.77 |
$589.77 |
$589.77 |
$1,492.50
|
|
Echo transthoracic
|
$209.67 |
$209.67 |
$209.67 |
$953.10
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$443.66 |
$443.66 |
$443.66 |
$1,014.01
|
|
Ecog impltd brn npgt <30 d
|
$65.69 |
$65.69 |
$65.69 |
$146.00
|
|
E coli 0157 ag ia
|
$13.93 |
$13.93 |
$13.93 |
$32.00
|
|
Ecp ciliary body destruction
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,526.64
|
|
Eeg 41-60 minutes 95812-26
|
$470.75 |
$470.75 |
$470.75 |
$956.45
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$226.95 |
$226.95 |
$226.95 |
$1,049.59
|
|
Eeg monitoring/function test
|
$397.37 |
$397.37 |
$397.37 |
$1,373.60
|
|
Eeg monitor/record/awake/drowsy 95816
|
$240.60 |
$240.60 |
$240.60 |
$861.12
|
|
Eeg over 1 hour 95813 - 26
|
$377.11 |
$377.11 |
$377.11 |
$1,119.54
|
|
Eeg recording awake and asleep
|
$273.45 |
$273.45 |
$273.45 |
$1,030.27
|
|
Eeg without vid 2-12hr cont mntr
|
$354.93 |
$354.93 |
$354.93 |
$704.79
|
|
Eeg without vid 2-12 hr unmntr
|
$318.45 |
$318.45 |
$318.45 |
$586.20
|
|
Eeg without vid ea 12-26hr cont
|
$937.02 |
$937.02 |
$937.02 |
$1,353.60
|
|
Eeg without vid ea 12-26hr intmt
|
$890.95 |
$890.95 |
$890.95 |
$1,278.57
|
|
Eeg wo vid 2-12hr intmt mntr
|
$338.08 |
$338.08 |
$338.08 |
$639.00
|
|
Eeg wo vid ea 12-26hr unmntr
|
$721.59 |
$721.59 |
$721.59 |
$1,251.52
|
|
E equine encephalitis igg
|
$14.51 |
$14.51 |
$14.51 |
$48.73
|
|
Egd balloon dil esoph30 mm/>
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,244.82
|
|
Egd control bleeding any
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,553.75
|
|
Egd dilate stricture
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,638.57
|
|
Egd endo mucosal resection
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,433.60
|
|
Egd endoscopic stent place
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,379.25
|
|
Egd esophagogastrc fndoplsty
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$9,562.50
|
|
Egd flx trnsorl dplmnt balo
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,244.82
|
|
Egd flx trnsorl rmvl balo
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,104.13
|
|
Egd guide wire insertion
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,250.00
|
|
Egd injection varices
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,244.82
|
|
Egd/insert intraluminal tube/cath 43241
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,244.82
|
|
Egd lesion ablation
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,805.40
|
|
Egd optical endomicroscopy
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,234.01
|
|
Egd remove foreign body
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,588.55
|
|
Egd remove lesion snare
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,506.40
|
|
Egd/remov tum/polyp/hot bx forcep 43250
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,244.82
|
|
Egd Ultrasound exam duodenum/jejunum
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,527.97
|
|
Egd Ultrasound fine needle bx/aspir
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,638.57
|
|
Egd Ultrasound fine needle bx/aspir
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,664.75
|
|
Egd Ultrasound transmural injxn/mark
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,638.57
|