|
Diagnostic Mammogram (both breasts)
|
$413.50 |
$413.50 |
$413.50 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$358.00 |
$358.00 |
$358.00 |
$312.72
|
|
Dialysis circuit perm vascular embolization 36909
|
$27,763.00 |
$27,763.00 |
$27,763.00 |
$5,663.50
|
|
Dialysis one evaluation
|
$335.00 |
$335.00 |
$335.00 |
$936.00
|
|
Diffusing capacity
|
$627.00 |
$627.00 |
$627.00 |
$335.20
|
|
Digital analysis of eeg
|
$1,234.00 |
$1,234.00 |
$1,234.00 |
$551.20
|
|
Digoxin total therapeutic drug level
|
$119.50 |
$119.50 |
$119.50 |
$102.07
|
|
Dilator fascial 10fx20cm
|
$237.50 |
$237.50 |
$237.50 |
$402.10
|
|
Dilat xst trc new access rcs
|
$4,054.00 |
$4,054.00 |
$4,054.00 |
$4,258.20
|
|
Disability dlco
|
$850.50 |
$850.50 |
$850.50 |
$292.03
|
|
Disaccharidases
|
$158.50 |
$158.50 |
$158.50 |
$224.31
|
|
Dise eval slp do brth flx dx
|
$1,600.50 |
$1,600.50 |
$1,600.50 |
$1,120.00
|
|
Dissolve clot heart vessel
|
$2,617.50 |
$2,617.50 |
$2,617.50 |
$1,560.00
|
|
Dna antibody native/double stranded
|
$497.00 |
$497.00 |
$497.00 |
$100.00
|
|
Dna gardnerella
|
$68.00 |
$68.00 |
$68.00 |
$61.80
|
|
Dna trichomonas
|
$68.00 |
$68.00 |
$68.00 |
$63.00
|
|
Doppler echo complete
|
$376.00 |
$376.00 |
$376.00 |
$558.00
|
|
Doppler intravascular pressure flow initial vessel
|
$4,650.00 |
$4,650.00 |
$4,650.00 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$583.00 |
$583.00 |
$583.00 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$328.00 |
$328.00 |
$328.00 |
$473.76
|
|
Dornhoffer fixed part w/window
|
$22,758.00 |
$22,758.00 |
$22,758.00 |
$34,278.00
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$193.00 |
$193.00 |
$193.00 |
$794.82
|
|
Drainage external ear simple 69000
|
$710.00 |
$710.00 |
$710.00 |
$779.45
|
|
Drainage of kidney lesion
|
$4,224.00 |
$4,224.00 |
$4,224.00 |
$1,506.00
|
|
Drain blood from under nail 11740
|
$143.00 |
$143.00 |
$143.00 |
$177.04
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$4,525.00 |
$4,525.00 |
$4,525.00 |
$2,540.00
|
|
Drain cath image guided visceral pq
|
$6,788.00 |
$6,788.00 |
$6,788.00 |
$2,885.30
|
|
Drain chst dry seal exp thorastat
|
$100.00 |
$100.00 |
$100.00 |
$119.43
|
|
Drain finger abscess;simple 26010
|
$428.50 |
$428.50 |
$428.50 |
$428.40
|
|
Drain lower leg lesion 27603
|
$2,566.00 |
$2,566.00 |
$2,566.00 |
$3,858.40
|
|
Drain neck/chest lesion 21501
|
$5,395.50 |
$5,395.50 |
$5,395.50 |
$3,301.20
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$963.50 |
$963.50 |
$963.50 |
$394.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$496.00 |
$496.00 |
$496.00 |
$352.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$963.50 |
$963.50 |
$963.50 |
$540.80
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$3,878.50 |
$3,878.50 |
$3,878.50 |
$5,857.52
|
|
Drng of finger abscess comp 26011
|
$3,324.00 |
$3,324.00 |
$3,324.00 |
$2,029.60
|
|
Drng of scrotum abscess 55100
|
$2,616.50 |
$2,616.50 |
$2,616.50 |
$1,997.89
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$7,875.50 |
$7,875.50 |
$7,875.50 |
$1,818.32
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$76.50 |
$76.50 |
$76.50 |
$1,575.70
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$25.50 |
$25.50 |
$25.50 |
$58.20
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$27.00 |
$27.00 |
$27.00 |
$289.05
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$185.00 |
$185.00 |
$185.00 |
$8,040.27
|
|
Drsg wound/burn 18x10cm suprathel resorb cost per sq cm
|
$2.00 |
$2.00 |
$2.00 |
$3.11
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$376.50 |
$376.50 |
$376.50 |
$400.98
|
|
Drug assay caffeine
|
$47.50 |
$47.50 |
$47.50 |
$81.61
|
|
Drug asy hydroxychloroquine
|
$75.00 |
$75.00 |
$75.00 |
$66.43
|
|
Drug of abuse screen urine
|
$31.00 |
$31.00 |
$31.00 |
$64.50
|
|
Drug test prsmv instrmnt
|
$41.00 |
$41.00 |
$41.00 |
$83.20
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$719.00 |
$719.00 |
$719.00 |
$280.95
|
|
Drvvt confirm - quest
|
$94.00 |
$94.00 |
$94.00 |
$109.20
|
|
Ductogram sgl duct
|
$248.00 |
$248.00 |
$248.00 |
$469.44
|
|
Duodenal motility study
|
$2,506.50 |
$2,506.50 |
$2,506.50 |
$1,143.10
|
|
Dup scan/hemodialysis access 93990
|
$203.50 |
$203.50 |
$203.50 |
$486.02
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$903.50
|
|
Dura-guard dura repair patch 10x16cm -q4432-cost per sq cm-160sq cm
|
$2,004.50 |
$2,004.50 |
$2,004.50 |
$23,482.80
|
|
Dx gastr intub w/asp spec
|
$664.50 |
$664.50 |
$664.50 |
$441.60
|
|
Ear irrigation 69209
|
$103.00 |
$103.00 |
$103.00 |
$150.00
|
|
Ecg 12 lead tracing only
|
$431.50 |
$431.50 |
$431.50 |
$226.50
|
|
Ecg/1-3 leads/tracing only 93041
|
$84.50 |
$84.50 |
$84.50 |
$132.08
|
|
Ecg external < 48 hours recording
|
$689.50 |
$689.50 |
$689.50 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$1,030.00 |
$1,030.00 |
$1,030.00 |
$541.20
|
|
Ecg external > 48 hours up to 7 days recording
|
$29.00 |
$29.00 |
$29.00 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$64.00 |
$64.00 |
$64.00 |
$161.85
|
|
Echocardiogram (Heart Ultrasound)
|
$1,225.50 |
$1,225.50 |
$1,225.50 |
$1,977.50
|
|
Echocardiography doppler color flow mapping
|
$408.50 |
$408.50 |
$408.50 |
$499.20
|
|
Echocardiography transthoracic 2d followup/limited
|
$628.50 |
$628.50 |
$628.50 |
$711.00
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$628.50 |
$628.50 |
$628.50 |
$851.50
|
|
Echocardiograpy doppler follow up/limited study
|
$199.50 |
$199.50 |
$199.50 |
$371.25
|
|
Echo exam of fetal heart
|
$847.50 |
$847.50 |
$847.50 |
$904.80
|
|
Echo exam of fetal heart
|
$847.50 |
$847.50 |
$847.50 |
$538.27
|
|
Echo exam of fetal heart
|
$156.00 |
$156.00 |
$156.00 |
$431.41
|
|
Echo exam of fetal heart
|
$156.00 |
$156.00 |
$156.00 |
$319.00
|
|
Echo exam uterus 76831-
|
$683.00 |
$683.00 |
$683.00 |
$552.50
|
|
Echo guide for amniocentesis
|
$308.50 |
$308.50 |
$308.50 |
$446.60
|
|
Echo guide for artery repair
|
$1,005.00 |
$1,005.00 |
$1,005.00 |
$687.35
|
|
Echo stress
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$1,606.44
|
|
Echo tee probe placement image acquisition interpretation & report
|
$2,057.50 |
$2,057.50 |
$2,057.50 |
$1,889.20
|
|
Echo transesophageal
|
$2,057.50 |
$2,057.50 |
$2,057.50 |
$1,599.50
|
|
Echo transesophageal intraop
|
$2,057.50 |
$2,057.50 |
$2,057.50 |
$1,578.00
|
|
Echo transthoracic
|
$2,222.50 |
$2,222.50 |
$2,222.50 |
$1,361.75
|
|
Echo transthoracic
|
$1,507.00 |
$1,507.00 |
$1,507.00 |
$1,010.10
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$1,022.30
|
|
Ecmo/ecls insj prph cannula 6yrs&older perq 33952
|
$2,612.00 |
$2,612.00 |
$2,612.00 |
$2,825.34
|
|
Eeg 41-60 minutes 95812-26
|
$803.00 |
$803.00 |
$803.00 |
$923.88
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$748.00 |
$748.00 |
$748.00 |
$970.07
|
|
Eeg during surgery
|
$1,309.00 |
$1,309.00 |
$1,309.00 |
$775.45
|
|
Eeg monitor/record/awake/drowsy 95816
|
$857.50 |
$857.50 |
$857.50 |
$831.00
|
|
Eeg over 1 hour 95813 - 26
|
$803.00 |
$803.00 |
$803.00 |
$1,100.40
|
|
Eeg/record in coma or sleep only 95822
|
$593.00 |
$593.00 |
$593.00 |
$865.00
|
|
Eeg recording awake and asleep
|
$900.00 |
$900.00 |
$900.00 |
$929.00
|
|
Eeg without vid 2-12hr cont mntr
|
$210.50 |
$210.50 |
$210.50 |
$826.15
|
|
Eeg without vid 2-12 hr unmntr
|
$210.50 |
$210.50 |
$210.50 |
$681.02
|
|
Eeg without vid ea 12-26hr cont
|
$404.00 |
$404.00 |
$404.00 |
$1,584.70
|
|
Eeg without vid ea 12-26hr intmt
|
$404.00 |
$404.00 |
$404.00 |
$1,402.50
|
|
Eeg wo vid 2-12hr intmt mntr
|
$210.50 |
$210.50 |
$210.50 |
$704.79
|
|
Eeg wo vid ea 12-26hr unmntr
|
$404.00 |
$404.00 |
$404.00 |
$1,591.10
|
|
E equine encephalitis igg
|
$36.50 |
$36.50 |
$36.50 |
$50.88
|
|
Egd remove foreign body
|
$2,485.50 |
$2,485.50 |
$2,485.50 |
$1,548.00
|
|
Egfr gene com variants
|
$378.00 |
$378.00 |
$378.00 |
$657.00
|
