|
Drng of mouth lesion 40801
|
$683.80 |
$683.80 |
$683.80 |
$1,350.97
|
|
Drng of ovarian cyst(s) 58800
|
$1,201.20 |
$1,201.20 |
$1,201.20 |
$3,474.84
|
|
Drng of palm multi bursas 26030
|
$1,625.00 |
$1,625.00 |
$1,625.00 |
$3,839.54
|
|
Drng of palm single bursa 26025
|
$1,320.80 |
$1,320.80 |
$1,320.80 |
$3,839.54
|
|
Drng of pelvic abscess transrectal 45000
|
$1,638.00 |
$1,638.00 |
$1,638.00 |
$2,295.30
|
|
Drng of scrotum abscess 55100
|
$4,844.45 |
$4,844.45 |
$4,844.45 |
$1,997.89
|
|
Drng open retroperitoneal abscess 49060
|
$4,817.80 |
$4,817.80 |
$4,817.80 |
$1,924.00
|
|
Drng peritoneal abscess open 49020
|
$6,934.20 |
$6,934.20 |
$6,934.20 |
$2,520.00
|
|
Drng salivary gland simple 42300
|
$514.80 |
$514.80 |
$514.80 |
$2,039.50
|
|
Droperidol 2.5 mg/ml injection solution
|
$12.44 |
$12.44 |
$12.44 |
$31.25
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$17.55 |
$17.55 |
$17.55 |
$53.60
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$82.69 |
$82.69 |
$82.69 |
$193.15
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$4,519.45 |
$4,519.45 |
$4,519.45 |
$7,465.97
|
|
Drug admin & hemodynmic meas
|
$2,944.50 |
$2,944.50 |
$2,944.50 |
$569.75
|
|
Drug assay caffeine
|
$172.90 |
$172.90 |
$172.90 |
$80.00
|
|
Drug assay rufinamide
|
$121.55 |
$121.55 |
$121.55 |
$87.10
|
|
Drug assay vedolizumab
|
$172.90 |
$172.90 |
$172.90 |
$154.00
|
|
Drug assay voriconazole
|
$121.55 |
$121.55 |
$121.55 |
$96.75
|
|
Drug asy hydroxychloroquine
|
$83.85 |
$83.85 |
$83.85 |
$66.43
|
|
Drug of abuse screen urine
|
$56.55 |
$56.55 |
$56.55 |
$67.89
|
|
Drug screening tapentadol
|
$24.70 |
$24.70 |
$24.70 |
$47.03
|
|
Drug test def 15-21 classes
|
$837.20 |
$837.20 |
$837.20 |
$322.50
|
|
Drug test def 1-7 classes
|
$482.30 |
$482.30 |
$482.30 |
$263.25
|
|
Drug test def 22+ classes
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$426.24
|
|
Drug test def 8-14 classes
|
$659.75 |
$659.75 |
$659.75 |
$289.80
|
|
Drug test prsmv instrmnt
|
$76.70 |
$76.70 |
$76.70 |
$83.20
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$278.85 |
$278.85 |
$278.85 |
$278.85
|
|
Drvvt confirm - quest
|
$80.60 |
$80.60 |
$80.60 |
$109.20
|
|
Dry needling (97799)
|
$65.00 |
$65.00 |
$65.00 |
$114.27
|
|
Dstrj nulyt agt gnclr nrv
|
$8,758.10 |
$8,758.10 |
$8,758.10 |
$2,980.00
|
|
Dstr mal les s/n/h/f/g >4.0
|
$845.00 |
$845.00 |
$845.00 |
$664.50
|
|
Dstr mal ls f/e/e/n/l/m2.1-3
|
$699.40 |
$699.40 |
$699.40 |
$603.20
|
|
Dstr mal ls f/e/e/n/l/m3.1-4
|
$832.00 |
$832.00 |
$832.00 |
$724.37
|
|
Dstr mal ls f/e/e/n/l/m>4.0
|
$1,164.80 |
$1,164.80 |
$1,164.80 |
$886.40
|
|
Ductogram sgl duct
|
$1,084.20 |
$1,084.20 |
$1,084.20 |
$469.80
|
|
Duodenal exclusion
|
$7,898.80 |
$7,898.80 |
$7,898.80 |
$4,393.60
|
|
Duplex scan bilateral study 93985
|
$1,111.50 |
$1,111.50 |
$1,111.50 |
$691.08
|
|
Duplex scan unilateral study 93986
|
$527.15 |
$527.15 |
$527.15 |
$369.20
|
|
Dup scan/hemodialysis access 93990
|
$527.15 |
$527.15 |
$527.15 |
$489.72
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$715.00 |
$715.00 |
$715.00 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,111.50 |
$1,111.50 |
$1,111.50 |
$904.78
|
|
Durvalumab 50 mg/ml intravenous solution
|
$1,339.94 |
$1,339.94 |
$1,339.94 |
$8,445.90
|
|
Dxa bone density axl vrt fx
|
$477.10 |
$477.10 |
$477.10 |
$401.20
|
|
Dx aly aud oi snd prcsr 1st
|
$406.90 |
$406.90 |
$406.90 |
$186.40
|
|
Dx aly aud oi snd prcsr each
|
$101.40 |
$101.40 |
$101.40 |
$51.52
|
|
Dx bronchoscope/brush 31623
|
$5,156.45 |
$5,156.45 |
$5,156.45 |
$2,120.32
|
|
Dx bronchoscope/lavage 31624
|
$5,156.45 |
$5,156.45 |
$5,156.45 |
$2,446.60
|
|
Dx bronchoscope/wash 31622
|
$5,156.45 |
$5,156.45 |
$5,156.45 |
$2,410.50
|
|
Dx dark adaptation exam i&r
|
$1,259.70 |
$1,259.70 |
$1,259.70 |
$472.21
|
|
Dx laryngoscopy newborn
|
$665.60 |
$665.60 |
$665.60 |
$658.00
|
|
Dx laryngoscopy w/oper scope
|
$668.20 |
$668.20 |
$668.20 |
$2,755.53
|
|
Ear and throat examination
|
$392.60 |
$392.60 |
$392.60 |
$602.63
|
|
Ear cartilage graft
|
$1,950.00 |
$1,950.00 |
$1,950.00 |
$6,385.40
|
|
Ear irrigation 69209
|
$167.70 |
$167.70 |
$167.70 |
$154.70
|
|
Ecallantide injection
|
$13,353.39 |
$13,353.39 |
$13,353.39 |
$13,357.14
|
|
Ecg/1-3 leads/interp & report only 93042
|
$42.90 |
$42.90 |
$42.90 |
$16.00
|
|
Ecg/1-3 leads/tracing only 93041
|
$222.30 |
$222.30 |
$222.30 |
$132.08
|
|
Ecg < 30 days transmission & analysis
|
$343.20 |
$343.20 |
$343.20 |
$412.88
|
|
Ecg external < 48 hours recording
|
$481.65 |
$481.65 |
$481.65 |
$467.40
|
|
Ecg external < 48 hours scanning analysis w/report
|
$487.50 |
$487.50 |
$487.50 |
$541.20
|
|
Ecg external > 48 hours up to 7 days recording
|
$213.20 |
$213.20 |
$213.20 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$213.20 |
$213.20 |
$213.20 |
$173.40
|
|
Ecg record/review
|
$135.20 |
$135.20 |
$135.20 |
$371.28
|
|
Ecg/review interpret only
|
$135.20 |
$135.20 |
$135.20 |
$57.60
|
|
Echocardiogram (Heart Ultrasound)
|
$2,466.75 |
$2,466.75 |
$2,466.75 |
$2,024.64
|
|
Echocardiogram (Limited Follow-Up Heart Ultrasound)
|
$1,054.95 |
$1,054.95 |
$1,054.95 |
$720.60
|
|
Echocardiography doppler color flow mapping
|
$713.05 |
$713.05 |
$713.05 |
$511.55
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$2,952.95 |
$2,952.95 |
$2,952.95 |
$1,944.80
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$1,334.45 |
$1,334.45 |
$1,334.45 |
$866.87
|
|
Echocardiograpy doppler follow up/limited study
|
$432.90 |
$432.90 |
$432.90 |
$371.25
|
|
Echo exam of eye
|
$148.20 |
$148.20 |
$148.20 |
$169.62
|
|
Echo exam of eye thickness
|
$150.15 |
$150.15 |
$150.15 |
$40.30
|
|
Echo exam of fetal heart
|
$2,893.15 |
$2,893.15 |
$2,893.15 |
$904.80
|
|
Echo exam of fetal heart
|
$1,321.45 |
$1,321.45 |
$1,321.45 |
$538.27
|
|
Echo exam of fetal heart
|
$627.90 |
$627.90 |
$627.90 |
$431.41
|
|
Echo exam of fetal heart
|
$622.70 |
$622.70 |
$622.70 |
$318.34
|
|
Echo exam uterus 76831-
|
$1,271.40 |
$1,271.40 |
$1,271.40 |
$561.00
|
|
Echograp trans r pros study
|
$920.40 |
$920.40 |
$920.40 |
$468.00
|
|
Echo guidance radiotherapy
|
$1,123.20 |
$1,123.20 |
$1,123.20 |
$812.00
|
|
Echo guide for amniocentesis
|
$336.70 |
$336.70 |
$336.70 |
$455.57
|
|
Echo guide for artery repair
|
$1,914.25 |
$1,914.25 |
$1,914.25 |
$696.30
|
|
Echo guide for transfusion
|
$819.00 |
$819.00 |
$819.00 |
$332.39
|
|
Echo guide villus sampling
|
$329.55 |
$329.55 |
$329.55 |
$362.88
|
|
Echo stress
|
$2,466.75 |
$2,466.75 |
$2,466.75 |
$1,609.44
|
|
Echo tee guidance
|
$2,631.20 |
$2,631.20 |
$2,631.20 |
$1,878.84
|
|
Echo tee probe placement image acquisition interpretation & report
|
$2,707.25 |
$2,707.25 |
$2,707.25 |
$1,913.60
|
|
Echo transesophageal
|
$74.10 |
$74.10 |
$74.10 |
$1,075.20
|
|
Echo transesophageal
|
$1,454.05 |
$1,454.05 |
$1,454.05 |
$602.00
|
|
Echo transesophageal
|
$2,049.45 |
$2,049.45 |
$2,049.45 |
$1,650.00
|
|
Echo transesophageal
|
$526.50 |
$526.50 |
$526.50 |
$603.20
|
|
Echo transesophageal intraop
|
$2,664.35 |
$2,664.35 |
$2,664.35 |
$1,578.00
|
|
Echo transthoracic
|
$2,049.45 |
$2,049.45 |
$2,049.45 |
$1,361.75
|
|
Echo transthoracic
|
$2,049.45 |
$2,049.45 |
$2,049.45 |
$1,052.40
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$1,166.75 |
$1,166.75 |
$1,166.75 |
$1,033.00
|
|
Ecmo/ecls daily mgmt artery 33949
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$2,867.22
|
|
Ecmo/ecls daily mgmt-venous 33948
|
$1,352.65 |
$1,352.65 |
$1,352.65 |
$3,099.00
|
|
Ecmo/ecls initiation artery 33947
|
$1,896.05 |
$1,896.05 |
$1,896.05 |
$3,950.10
|
|
Ecmo/ecls initiation venous 33946
|
$1,716.00 |
$1,716.00 |
$1,716.00 |
$4,084.29
|
|
Ecmo/ecls insj prph cannula 6yrs&older perq 33952
|
$2,119.00 |
$2,119.00 |
$2,119.00 |
$2,660.16
|
|
Ecmo/ecls remove prph cannula 6yrs&older perq 33966
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$1,660.50
|
