|
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 screening tapentadol
|
$24.70 |
$24.70 |
$24.70 |
$47.03
|
|
Drug screen quant tiagabine
|
$121.55 |
$121.55 |
$121.55 |
$107.59
|
|
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 |
$209.95 |
$114.27
|
|
Dstrj extensive retinopathy
|
$910.00 |
$910.00 |
$910.00 |
$4,462.45
|
|
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
|
$779.35 |
$779.35 |
$779.35 |
$603.20
|
|
Dstr mal ls f/e/e/n/l/m3.1-4
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$724.37
|
|
Dstr mal ls f/e/e/n/l/m>4.0
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$886.40
|
|
Ductogram sgl duct
|
$1,084.20 |
$1,084.20 |
$1,177.80 |
$469.80
|
|
Duodenal exclusion
|
$7,898.80 |
$7,898.80 |
$7,898.80 |
$4,393.60
|
|
Duodenal motility study
|
$1,961.05 |
$1,961.05 |
$1,961.05 |
$1,143.10
|
|
Duplex scan bilateral study 93985
|
$903.50 |
$903.50 |
$1,111.50 |
$691.08
|
|
Duplex scan unilateral study 93986
|
$397.15 |
$397.15 |
$527.15 |
$369.20
|
|
Dup scan/hemodialysis access 93990
|
$397.15 |
$397.15 |
$527.15 |
$489.72
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$585.00 |
$585.00 |
$715.00 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$903.50 |
$903.50 |
$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 |
$562.90 |
$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 duod intub w/asp specs
|
$2,803.45 |
$2,803.45 |
$2,803.45 |
$1,406.58
|
|
Dx gastr intub w/asp spec
|
$117.00 |
$117.00 |
$117.00 |
$441.60
|
|
Dx gastr intub w/asp specs
|
$244.40 |
$244.40 |
$244.40 |
$308.70
|
|
Dx laryngoscopy newborn
|
$665.60 |
$665.60 |
$665.60 |
$658.00
|
|
Dx laryngoscopy w/oper scope
|
$5,156.45 |
$5,156.45 |
$5,156.45 |
$2,755.53
|
|
Dynamic cavernosometry
|
$583.70 |
$583.70 |
$583.70 |
$3,442.40
|
|
Dynamic surface emg
|
$1,396.85 |
$1,396.85 |
$1,396.85 |
$368.50
|
|
Ear and throat examination
|
$392.60 |
$392.60 |
$392.60 |
$602.63
|
|
Ear canal biopsy 69105
|
$3,851.25 |
$3,851.25 |
$3,851.25 |
$1,889.50
|
|
Ear cartilage graft
|
$17,687.80 |
$17,687.80 |
$17,687.80 |
$6,385.40
|
|
Ear irrigation 69209
|
$154.70 |
$154.70 |
$167.70 |
$154.70
|
|
Ear protector evaluation
|
$78.65 |
$78.65 |
$78.65 |
$112.56
|
|
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
|
$222.30 |
$222.30 |
$487.50 |
$541.20
|
|
Ecg external > 48 hours up to 7 days recording
|
$146.90 |
$146.90 |
$213.20 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$146.90 |
$146.90 |
$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)
|
$2,049.45 |
$2,049.45 |
$2,466.75 |
$2,024.64
|
|
Echocardiogram (Limited Follow-Up Heart Ultrasound)
|
$903.50 |
$903.50 |
$1,054.95 |
$720.60
|
|
Echocardiography doppler color flow mapping
|
$692.90 |
$692.90 |
$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
|
$390.00 |
$390.00 |
$432.90 |
$371.25
|
|
Echo exam of eye
|
$591.50 |
$591.50 |
$591.50 |
$143.75
|
|
Echo exam of eye
|
$617.50 |
$617.50 |
$617.50 |
$172.00
|
|
Echo exam of eye
|
$543.40 |
$543.40 |
$543.40 |
$169.62
|
|
Echo exam of eye thickness
|
$109.85 |
$109.85 |
$150.15 |
$40.30
|
|
Echo exam of fetal heart
|
$2,458.95 |
$2,458.95 |
$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
|
$477.10 |
$477.10 |
$627.90 |
$431.41
|
|
Echo exam of fetal heart
|
$622.70 |
$622.70 |
$622.70 |
$318.34
|
|
Echo exam uterus 76831-
|
$1,084.20 |
$1,084.20 |
$1,271.40 |
$561.00
|
|
Echograp trans r pros study
|
$477.10 |
$477.10 |
$920.40 |
$468.00
|
|
Echo guidance radiotherapy
|
$774.80 |
$774.80 |
$1,123.20 |
$812.00
|
|
Echo guide for amniocentesis
|
$237.90 |
$237.90 |
$336.70 |
$455.57
|
|
Echo guide for artery repair
|
$1,396.85 |
$1,396.85 |
$1,914.25 |
$696.30
|
|
Echo guide for transfusion
|
$819.00 |
$819.00 |
$819.00 |
$332.39
|
|
Echo guide ova aspiration
|
$308.75 |
$308.75 |
$308.75 |
$174.20
|
|
Echo guide villus sampling
|
$329.55 |
$329.55 |
$329.55 |
$362.88
|
|
Echo stress
|
$2,049.45 |
$2,049.45 |
$2,466.75 |
$1,609.44
|
|
Echo tee cngntl wo ctrst probe plcmnt
|
$171.60 |
$171.60 |
$171.60 |
$751.34
|
|
Echo tee guidance
|
$2,631.20 |
$2,631.20 |
$2,631.20 |
$1,878.84
|
|
Echo tee probe placement image acquisition interpretation & report
|
$2,049.45 |
$2,049.45 |
$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 |
$1,983.15 |
$602.00
|
|
Echo transesophageal
|
$2,049.45 |
$2,049.45 |
$2,819.05 |
$1,650.00
|
|
Echo transesophageal
|
$526.50 |
$526.50 |
$526.50 |
$603.20
|
|
Echo transesophageal intraop
|
$2,049.45 |
$2,049.45 |
$2,664.35 |
$1,578.00
|
|
Echo transthoracic
|
$2,049.45 |
$2,049.45 |
$2,421.25 |
$1,361.75
|
|
Echo transthoracic
|
$2,049.45 |
$2,049.45 |
$2,263.95 |
$1,052.40
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$903.50 |
$903.50 |
$1,166.75 |
$1,033.00
|
|
Ecmo/ecls daily mgmt artery 33949
|
$1,243.45 |
$1,243.45 |
$1,243.45 |
$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
|
$1,792.05 |
$1,792.05 |
$1,896.05 |
$3,950.10
|
|
Ecmo/ecls initiation venous 33946
|
$1,621.75 |
$1,621.75 |
$1,716.00 |
$4,084.29
|
|
Ecmo/ecls insj cent cannula 0-5yrs 33955
|
$4,160.00 |
$4,160.00 |
$4,160.00 |
$1,948.20
|
|
Ecmo/ecls insj cent cannula 6yrs&older 33956
|
$4,160.00 |
$4,160.00 |
$4,160.00 |
$2,055.20
|
|
Ecmo/ecls insj prph cannula 0-5yrs opn 33953
|
$2,368.60 |
$2,368.60 |
$2,368.60 |
$1,083.00
|
|
Ecmo/ecls insj prph cannula 0-5yrs perq 33951
|
$2,119.00 |
$2,119.00 |
$2,119.00 |
$970.80
|
|
Ecmo/ecls insj prph cannula 6yrs&older opn 33954
|
$2,368.60 |
$2,368.60 |
$2,368.60 |
$1,313.68
|
