|
Drug screen quant tiagabine
|
$148.80 |
$148.80 |
$188.40 |
|
|
Drug test def 15-21 classes
|
$436.80 |
$436.80 |
$449.50 |
|
|
Drug test def 1-7 classes
|
$108.60 |
$332.80 |
$610.80 |
|
|
Drug test def 22+ classes
|
$423.00 |
$634.20 |
$835.20 |
|
|
Drug test def 8-14 classes
|
$90.00 |
$345.00 |
$610.80 |
|
|
Drug test prsmv instrmnt
|
$44.40 |
$44.40 |
$100.80 |
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$53.40 |
$258.40 |
$610.80 |
|
|
Drvvt confirm - quest
|
$52.50 |
$136.00 |
$3,389.40 |
|
|
Dry needling (97799)
|
$58.80 |
$58.80 |
$58.80 |
|
|
Dstrj nulyt agt gnclr nrv
|
$219.60 |
$2,244.50 |
$6,627.80 |
|
|
Dstr mal ls f/e/e/n/l/m2.1-3
|
$2,925.00 |
$2,925.00 |
$2,925.00 |
|
|
Ductogram sgl duct
|
$409.20 |
$547.80 |
$1,043.20 |
|
|
Duplex scan bilateral study 93985
|
$456.50 |
$811.20 |
$1,762.20 |
|
|
Duplex scan unilateral study 93986
|
$215.50 |
$493.80 |
$1,207.20 |
|
|
Dup scan/hemodialysis access 93990
|
$209.00 |
$480.00 |
$1,112.60 |
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$241.20 |
$797.40 |
$1,488.80 |
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$459.60 |
$885.60 |
$2,229.80 |
|
|
Duragen 1x1 5ea/bx
|
$411.00 |
$425.40 |
$514.40 |
|
|
Durvalumab 50 mg/ml intravenous solution
|
$200.40 |
$241.20 |
$25,767.96 |
|
|
Dxa bone density axl vrt fx
|
$151.80 |
$501.60 |
$813.60 |
|
|
Dx bronchoscope/brush 31623
|
$851.75 |
$2,168.40 |
$6,982.20 |
|
|
Dx bronchoscope/lavage 31624
|
$851.75 |
$2,926.80 |
$6,400.80 |
|
|
Dx bronchoscope/wash 31622
|
$1,023.20 |
$2,197.80 |
$6,220.80 |
|
|
Dx gastr intub w/asp spec
|
$861.60 |
$861.60 |
$861.60 |
|
|
Dx laryngoscopy newborn
|
$437.00 |
$437.00 |
$437.00 |
|
|
Dx laryngoscopy w/oper scope
|
$2,374.00 |
$2,374.00 |
$2,374.00 |
|
|
Ear and throat examination
|
$107.00 |
$107.00 |
$107.00 |
|
|
Ear canal biopsy 69105
|
$94.80 |
$1,211.40 |
$1,795.20 |
|
|
Ear cartilage graft
|
$5,724.92 |
$5,724.92 |
$9,009.00 |
|
|
Ear irrigation 69209
|
$17.40 |
$168.00 |
$277.60 |
|
|
Ecallantide injection
|
$14,223.60 |
$14,223.60 |
$14,223.60 |
|
|
Ecg/1-3 leads/tracing only 93041
|
$19.20 |
$76.20 |
$243.00 |
|
|
Ecg < 30 days transmission & analysis
|
$239.00 |
$1,472.40 |
$2,946.00 |
|
|
Ecg external < 48 hours recording
|
$122.00 |
$551.40 |
$873.40 |
|
|
Ecg external < 48 hours scanning analysis w/report
|
$216.00 |
$539.40 |
$1,035.60 |
|
|
Ecg external > 48 hours up to 7 days recording
|
$58.80 |
$72.00 |
$546.40 |
|
|
Ecg external >7 days up to 15 days recording
|
$58.20 |
$72.00 |
$546.40 |
|
|
Ecg/review interpret only
|
$45.60 |
$52.80 |
$58.20 |
|
|
Echocardiogram (Heart Ultrasound)
|
$837.00 |
$2,265.00 |
$3,730.40 |
|
|
Echocardiogram (Limited Follow-Up Heart Ultrasound)
|
$295.20 |
$841.20 |
$2,907.00 |
|
|
Echocardiography doppler color flow mapping
|
$105.60 |
$480.00 |
$1,435.80 |
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$1,483.80 |
$2,457.00 |
$3,415.80 |
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$364.20 |
$1,000.00 |
$3,569.40 |
|
|
Echocardiograpy doppler follow up/limited study
|
$67.20 |
$333.00 |
$922.40 |
|
|
Echo exam of eye
|
$197.40 |
$197.40 |
$722.40 |
|
|
Echo exam of fetal heart
|
$627.60 |
$1,223.40 |
$1,823.40 |
|
|
Echo exam of fetal heart
|
$480.60 |
$875.40 |
$1,026.40 |
|
|
Echo exam of fetal heart
|
$424.80 |
$424.80 |
$853.60 |
|
|
Echo exam of fetal heart
|
$424.80 |
$424.80 |
$501.60 |
|
|
Echo exam uterus 76831-
|
$330.00 |
$819.60 |
$840.80 |
|
|
Echograp trans r pros study
|
$251.40 |
$507.60 |
$1,909.20 |
|
|
Echo guidance radiotherapy
|
$421.80 |
$2,718.00 |
$3,656.40 |
|
|
Echo guide cardiocentesis
|
$448.80 |
$448.80 |
$448.80 |
|
|
Echo guide for amniocentesis
|
$274.50 |
$295.80 |
$603.20 |
|
|
Echo guide for artery repair
|
$378.50 |
$676.80 |
$1,748.40 |
|
|
Echo guide for heart biopsy
|
$381.00 |
$381.00 |
$381.00 |
|
|
Echo guide for transfusion
|
$434.40 |
$434.40 |
$790.20 |
|
|
Echo guide villus sampling
|
$355.80 |
$355.80 |
$469.80 |
|
|
Echo stress
|
$561.60 |
$1,737.60 |
$5,167.80 |
|
|
Echo tee guidance
|
$559.80 |
$981.00 |
$4,141.20 |
|
|
Echo tee probe placement image acquisition interpretation & report
|
$834.60 |
$1,737.60 |
$4,258.80 |
|
|
Echo transesophageal
|
$58.80 |
$58.80 |
$125.40 |
|
|
Echo transesophageal
|
$391.20 |
$391.20 |
$472.80 |
|
|
Echo transesophageal
|
$1,018.80 |
$1,737.60 |
$1,737.60 |
|
|
Echo transesophageal intraop
|
$1,737.60 |
$2,142.60 |
$3,743.20 |
|
|
Echo transthoracic
|
$511.20 |
$1,737.60 |
$2,946.00 |
|
|
Echo transthoracic
|
$351.60 |
$1,244.00 |
$2,016.00 |
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$562.20 |
$900.00 |
$3,546.60 |
|
|
Ecmo/ecls initiation artery 33947
|
$985.20 |
$1,218.60 |
$1,809.00 |
|
|
Ecmo/ecls initiation venous 33946
|
$1,189.80 |
$1,189.80 |
$1,189.80 |
|
|
Ecmo/ecls insj prph cannula 6yrs&older perq 33952
|
$1,245.00 |
$1,538.40 |
$2,248.80 |
|
|
Ecog impltd brn npgt <30 d
|
$403.20 |
$403.20 |
$403.20 |
|
|
Ecp ciliary body destruction
|
$2,652.50 |
$2,652.50 |
$2,652.50 |
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$130.20 |
$268.80 |
$16,242.00 |
|
|
Eculizumab injection
|
$507.60 |
$38,703.60 |
$62,315.40 |
|
|
Edetate disodium per 150 mg
|
$28.80 |
$28.80 |
$28.80 |
|
|
Ed svc ckd grp per session
|
$39.00 |
$39.00 |
$39.00 |
|
|
Ed svc ckd ind per session
|
$161.40 |
$161.40 |
$161.40 |
|
|
Edu/train/pt/nonmd/in person/30 min98960
|
$71.00 |
$549.60 |
$764.40 |
|
|
Eeg 41-60 minutes 95812-26
|
$274.80 |
$790.80 |
$2,166.60 |
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$122.40 |
$1,177.80 |
$2,775.60 |
|
|
Eeg during surgery
|
$363.60 |
$619.20 |
$1,827.60 |
|
|
Eeg monitor/record/awake/drowsy 95816
|
$245.40 |
$855.60 |
$1,439.20 |
|
|
Eeg over 1 hour 95813 - 26
|
$441.00 |
$871.20 |
$2,782.80 |
|
|
Eeg phy/qhp>36<60 hr without vid
|
$1,662.60 |
$1,761.60 |
$1,762.20 |
|
|
Eeg phy/qhp>36<60 hr w/veeg
|
$1,662.60 |
$1,662.60 |
$1,761.60 |
|
|
Eeg phy/qhp>60<84 hr without vid
|
$2,216.40 |
$2,216.40 |
$2,216.40 |
|
|
Eeg phy/qhp>60<84 hr w/veeg
|
$2,216.40 |
$2,216.40 |
$2,219.40 |
|
|
Eeg phy/qhp>84 hr without vid
|
$2,850.60 |
$2,850.60 |
$3,021.60 |
|
|
Eeg phy/qhp>84 hr w/veeg
|
$2,850.60 |
$3,021.60 |
$3,915.00 |
|
|
Eeg phy/qhp ea incr w/veeg
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
|
|
Eeg phys/qhp 2-12 hr without vid
|
$345.00 |
$345.00 |
$602.40 |
|
|
Eeg phys/qhp 2-12 hr w/veeg
|
$553.80 |
$602.40 |
$783.60 |
|
|
Eeg phys/qhp ea incr without vid
|
$700.00 |
$1,108.80 |
$1,566.60 |
|
|
Eeg/record in coma or sleep only 95822
|
$245.40 |
$548.40 |
$1,439.20 |
|
|
Eeg recording awake and asleep
|
$306.60 |
$951.60 |
$2,146.80 |
|
|
Eeg without vid 2-12hr cont mntr
|
$553.80 |
$586.80 |
$783.60 |
|
|
Eeg without vid 2-12 hr unmntr
|
$214.00 |
$586.80 |
$2,904.00 |
|
|
Eeg without vid ea 12-26hr cont
|
$1,062.60 |
$1,126.20 |
$1,502.40 |
|
|
Eeg without vid ea 12-26hr intmt
|
$1,062.60 |
$1,126.20 |
$1,502.40 |
|
