|
Dextrose 5 % IV bolus
|
$178.45 |
$178.45 |
$178.45 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$1,149.11 |
$1,149.11 |
$1,149.11 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$602.93 |
$602.93 |
$602.93 |
$79.20
|
|
Diagnostic radio unlisted proc
|
$436.21 |
$436.21 |
$436.21 |
$214.08
|
|
Dicyclomine injection
|
$425.40 |
$425.40 |
$425.40 |
$153.29
|
|
Diffusing capacity
|
$2,089.09 |
$2,089.09 |
$2,089.09 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$218.05 |
$218.05 |
$218.05 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$24,632.92 |
$24,632.92 |
$24,632.92 |
$10,079.82
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,651.29 |
$1,651.29 |
$1,651.29 |
$297.86
|
|
Dimecaprol injection
|
$1,470.49 |
$1,470.49 |
$1,470.49 |
$293.38
|
|
Dimethyl sulfoxide 50% 50 ml
|
$5,189.44 |
$5,189.44 |
$5,189.44 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$73.15 |
$73.15 |
$73.15 |
$17.75
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$297.53 |
$297.53 |
$297.53 |
$91.53
|
|
Discography cerv/thor spine
|
$2,809.71 |
$2,809.71 |
$2,809.71 |
$2,565.00
|
|
Dna antibody native/double stranded
|
$806.98 |
$806.98 |
$806.98 |
$97.50
|
|
Dna probe chlamydia
|
$389.68 |
$389.68 |
$389.68 |
$79.38
|
|
Dna probe gc
|
$389.68 |
$389.68 |
$389.68 |
$80.80
|
|
Doppler echo complete
|
$2,563.69 |
$2,563.69 |
$2,563.69 |
$540.00
|
|
Dornase alfa non-comp unit
|
$1,072.42 |
$1,072.42 |
$1,072.42 |
$446.75
|
|
Dorsi & plantar flex ass/res
|
$579.00 |
$579.00 |
$579.00 |
$163.50
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$95.01 |
$95.01 |
$95.01 |
$423.95
|
|
Droperidol 2.5 mg/ml injection solution
|
$147.00 |
$147.00 |
$147.00 |
$31.07
|
|
Drop lock knee
|
$1,119.00 |
$1,119.00 |
$1,119.00 |
$204.95
|
|
Drug assay posaconazole
|
$328.32 |
$328.32 |
$328.32 |
$96.75
|
|
Drug assay voriconazole
|
$136.55 |
$136.55 |
$136.55 |
$96.75
|
|
Drug test def 15-21 classes
|
$3,582.26 |
$3,582.26 |
$3,582.26 |
$263.25
|
|
Drug test def 1-7 classes
|
$240.88 |
$240.88 |
$240.88 |
$250.52
|
|
Drug test def 22+ classes
|
$5,251.43 |
$5,251.43 |
$5,251.43 |
$423.00
|
|
Drug test def 8-14 classes
|
$1,911.57 |
$1,911.57 |
$1,911.57 |
$282.00
|
|
Ductogram sgl duct
|
$397.44 |
$397.44 |
$397.44 |
$463.10
|
|
Duplex scan bilateral study 93985
|
$1,045.33 |
$1,045.33 |
$1,045.33 |
$690.95
|
|
Dup scan/hemodialysis access 93990
|
$3,082.21 |
$3,082.21 |
$3,082.21 |
$489.72
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$4,143.98 |
$4,143.98 |
$4,143.98 |
$745.00
|
|
Dx intraop epcar Ultrasound chd i&r
|
$2,661.12 |
$2,661.12 |
$2,661.12 |
$261.15
|
|
Dx intraop epicar car Ultrasound chd
|
$2,661.12 |
$2,661.12 |
$2,661.12 |
$351.20
|
|
Dx intraop thoracic aorta Ultrasound
|
$2,518.56 |
$2,518.56 |
$2,518.56 |
$558.11
|
|
Dx ntrop epcr Ultrasound chd img acq
|
$2,661.12 |
$2,661.12 |
$2,661.12 |
$558.11
|
|
Ecg/1-3 leads/tracing only 93041
|
$477.93 |
$477.93 |
$477.93 |
$135.80
|
|
Ecg external < 48 hours recording
|
$2,637.76 |
$2,637.76 |
$2,637.76 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$2,026.67 |
$2,026.67 |
$2,026.67 |
$541.20
|
|
Echocardiogram (Heart Ultrasound)
|
$10,359.08 |
$10,359.08 |
$10,359.08 |
$2,001.17
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$12,652.51 |
$12,652.51 |
$12,652.51 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$3,154.82 |
$3,154.82 |
$3,154.82 |
$703.25
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$3,641.65 |
$3,641.65 |
$3,641.65 |
$851.50
|
|
Echocardiograpy doppler follow up/limited study
|
$2,374.02 |
$2,374.02 |
$2,374.02 |
$362.50
|
|
Echo guide for amniocentesis
|
$868.71 |
$868.71 |
$868.71 |
$456.30
|
|
Echo tee guidance
|
$18,310.96 |
$18,310.96 |
$18,310.96 |
$1,821.00
|
|
Echo transesophageal
|
$10,341.71 |
$10,341.71 |
$10,341.71 |
$664.39
|
|
Echo transesophageal intraop
|
$3,940.04 |
$3,940.04 |
$3,940.04 |
$1,571.70
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$4,381.35 |
$4,381.35 |
$4,381.35 |
$985.15
|
|
Ecmo/ecls repos perph cnula 6yrs&older perq 33958
|
$10,640.00 |
$10,640.00 |
$10,640.00 |
$1,057.76
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$84,423.78 |
$84,423.78 |
$84,423.78 |
$18,199.20
|
|
Edetate calcium disodium inj
|
$49,651.51 |
$49,651.51 |
$49,651.51 |
$8,569.35
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$3,721.16 |
$3,721.16 |
$3,721.16 |
$1,000.42
|
|
Eeg monitoring/function test
|
$38,402.88 |
$38,402.88 |
$38,402.88 |
$1,548.52
|
|
Eeg over 1 hour 95813 - 26
|
$4,818.59 |
$4,818.59 |
$4,818.59 |
$1,102.05
|
|
Eeg recording awake and asleep
|
$2,978.33 |
$2,978.33 |
$2,978.33 |
$931.20
|
|
Electrophysiology evaluation
|
$39,216.30 |
$39,216.30 |
$39,216.30 |
$8,979.45
|
|
Electrophysiology evaluation
|
$31,001.39 |
$31,001.39 |
$31,001.39 |
$10,233.60
|
|
Electrophysiology evaluation
|
$8,799.06 |
$8,799.06 |
$8,799.06 |
$6,760.00
|
|
Electrophysiology evaluation
|
$8,799.06 |
$8,799.06 |
$8,799.06 |
$5,854.80
|
|
Electrophysiology evaluation
|
$4,569.44 |
$4,569.44 |
$4,569.44 |
$2,451.90
|
|
Electrophysiology evaluation
|
$5,177.96 |
$5,177.96 |
$5,177.96 |
$2,821.00
|
|
Electrophys map 3d add-on
|
$15,554.44 |
$15,554.44 |
$15,554.44 |
$5,881.00
|
|
Encephalitis, st louis igg/igm
|
$868.32 |
$868.32 |
$868.32 |
$48.57
|
|
Endo cath bile duct s&i
|
$1,688.02 |
$1,688.02 |
$1,688.02 |
$694.06
|
|
Endo cath panc duct s&i
|
$1,688.02 |
$1,688.02 |
$1,688.02 |
$672.43
|
|
Entamoeba histolytica ag eia - sendout
|
$217.86 |
$217.86 |
$217.86 |
$56.89
|
|
Enzyme histochemistry
|
$345.18 |
$345.18 |
$345.18 |
$471.60
|
|
Ep induct arrhy by elect pacing
|
$4,876.08 |
$4,876.08 |
$4,876.08 |
$2,635.75
|
|
Epirubicin 200 mg/100 ml intravenous solution
|
$14,016.73 |
$14,016.73 |
$14,016.73 |
$248.81
|
|
Epoetin alfa-epbx 40,000 unit/ml injection solution
|
$636.17 |
$636.17 |
$636.17 |
$809.08
|
|
Epstein barr early antigen antibody
|
$828.45 |
$828.45 |
$828.45 |
$60.48
|
|
Ercp biliary & pancreas
|
$2,955.08 |
$2,955.08 |
$2,955.08 |
$967.04
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$763.57 |
$763.57 |
$763.57 |
$222.98
|
|
Erwinaze injection
|
$47,689.43 |
$47,689.43 |
$47,689.43 |
$6,423.46
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$518.23 |
$518.23 |
$518.23 |
$223.99
|
|
Esophageal dilat s&i
|
$3,635.01 |
$3,635.01 |
$3,635.01 |
$581.10
|
|
Esophagus motility study
|
$3,652.68 |
$3,652.68 |
$3,652.68 |
$1,289.20
|
|
Estradiol total
|
$989.53 |
$989.53 |
$989.53 |
$146.50
|
|
Estrogens total-sendout
|
$1,172.09 |
$1,172.09 |
$1,172.09 |
$96.20
|
|
Etanercept injection
|
$4,693.37 |
$4,693.37 |
$4,693.37 |
$3,172.86
|
|
Ethanolamine oleate 100 mg
|
$2,589.06 |
$2,589.06 |
$2,589.06 |
$751.36
|
|
Etoposide 50 mg cap
|
$945.78 |
$945.78 |
$945.78 |
$135.02
|
|
Euglobulin lysis
|
$582.98 |
$582.98 |
$582.98 |
$56.70
|
|
Evaluation heart device
|
$4,027.31 |
$4,027.31 |
$4,027.31 |
$2,368.17
|
|
Evoked potential visual not glaucoma
|
$2,683.51 |
$2,683.51 |
$2,683.51 |
$814.61
|
|
Exemestane, 25 mg
|
$293.53 |
$293.53 |
$293.53 |
$35.75
|
|
External chromosome analysis 20-25 cells
|
$267.46 |
$267.46 |
$267.46 |
$384.15
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$41.43 |
$41.43 |
$41.43 |
$61.10
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$498.60 |
$498.60 |
$498.60 |
$454.20
|
|
Factor ix
|
$1,322.44 |
$1,322.44 |
$1,322.44 |
$156.13
|
|
Factor ix non-recombinant
|
$5.12 |
$5.12 |
$5.12 |
$4.63
|
|
Factor ix recombinant nos
|
$7.82 |
$7.82 |
$7.82 |
$4.65
|
|
Factor viii
|
$1,322.44 |
$1,322.44 |
$1,322.44 |
$133.81
|
|
Factor viii recombinant nos
|
$8.36 |
$8.36 |
$8.36 |
$6.56
|
|
Factor viii recomb novoeight
|
$7.21 |
$7.21 |
$7.21 |
$7.39
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$121.58 |
$121.58 |
$121.58 |
$22.20
|
|
Fat/lipids feces qualitative
|
$382.01 |
$382.01 |
$382.01 |
$38.35
|
|
#fecal-sodium
|
$530.82 |
$530.82 |
$530.82 |
$37.50
|
