|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$757.45 |
$757.45 |
$757.45 |
$227.15
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$10,504.59 |
$10,504.59 |
$10,504.59 |
$858.00
|
|
Dextran 40 infusion
|
$882.80 |
$882.80 |
$882.80 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$199.97 |
$199.97 |
$199.97 |
$38.08
|
|
Dextrose 5 % IV bolus
|
$271.97 |
$271.97 |
$271.97 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$1,259.02 |
$1,259.02 |
$1,259.02 |
$112.00
|
|
Diab manage trn ind/group
|
$249.05 |
$249.05 |
$249.05 |
$56.55
|
|
Diagnostic Mammogram (both breasts)
|
$1,216.18 |
$1,216.18 |
$1,216.18 |
$399.30
|
|
Diathermy eg microwave
|
$273.14 |
$273.14 |
$273.14 |
$29.68
|
|
Dicyclomine injection
|
$817.94 |
$817.94 |
$817.94 |
$153.29
|
|
Diffusing capacity
|
$2,296.76 |
$2,296.76 |
$2,296.76 |
$332.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$26,282.47 |
$26,282.47 |
$26,282.47 |
$10,079.82
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,860.94 |
$1,860.94 |
$1,860.94 |
$297.86
|
|
Dimenhydrinate injection
|
$186.97 |
$186.97 |
$186.97 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$4,311.18 |
$4,311.18 |
$4,311.18 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$35.19 |
$35.19 |
$35.19 |
$17.75
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$854.39 |
$854.39 |
$854.39 |
$91.53
|
|
Disability dlco
|
$2,188.59 |
$2,188.59 |
$2,188.59 |
$282.40
|
|
Dna antibody native/double stranded
|
$1,789.32 |
$1,789.32 |
$1,789.32 |
$97.50
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$569.20 |
$569.20 |
$569.20 |
$904.81
|
|
Doppler echo complete
|
$3,904.66 |
$3,904.66 |
$3,904.66 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$4,955.27 |
$4,955.27 |
$4,955.27 |
$662.35
|
|
Dornase alfa non-comp unit
|
$1,508.84 |
$1,508.84 |
$1,508.84 |
$446.75
|
|
Dorsi & plantar flex ass/res
|
$390.00 |
$390.00 |
$390.00 |
$163.50
|
|
Drain ostomy pouch w/flange
|
$27.00 |
$27.00 |
$27.00 |
$8.80
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$2,946.00 |
$2,946.00 |
$2,946.00 |
$8,131.20
|
|
Dronabinol 2.5mg oral
|
$309.56 |
$309.56 |
$309.56 |
$10.17
|
|
Drop lock knee
|
$622.00 |
$622.00 |
$622.00 |
$204.95
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$1,145.00 |
$1,145.00 |
$1,145.00 |
$8,040.27
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$2,579.00 |
$2,579.00 |
$2,579.00 |
$400.98
|
|
Drug of abuse screen urine
|
$2,177.85 |
$2,177.85 |
$2,177.85 |
$63.75
|
|
Drug screen quant tiagabine
|
$1,028.90 |
$1,028.90 |
$1,028.90 |
$114.62
|
|
Drug test def 1-7 classes
|
$1,457.97 |
$1,457.97 |
$1,457.97 |
$250.52
|
|
Drug test prsmv instrmnt
|
$2,177.85 |
$2,177.85 |
$2,177.85 |
$90.75
|
|
Duplex scan bilateral study 93985
|
$3,245.37 |
$3,245.37 |
$3,245.37 |
$690.95
|
|
Dup scan/hemodialysis access 93990
|
$4,004.83 |
$4,004.83 |
$4,004.83 |
$489.72
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$5,351.73 |
$5,351.73 |
$5,351.73 |
$745.00
|
|
Dxa bone density axl vrt fx
|
$423.20 |
$423.20 |
$423.20 |
$392.60
|
|
Ecg/1-3 leads/tracing only 93041
|
$601.34 |
$601.34 |
$601.34 |
$135.80
|
|
Ecg external < 48 hours recording
|
$4,171.44 |
$4,171.44 |
$4,171.44 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$1,421.32 |
$1,421.32 |
$1,421.32 |
$541.20
|
|
Echocardiogram (Heart Ultrasound)
|
$13,365.37 |
$13,365.37 |
$13,365.37 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$4,025.38 |
$4,025.38 |
$4,025.38 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$13,385.47 |
$13,385.47 |
$13,385.47 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$5,745.49 |
$5,745.49 |
$5,745.49 |
$703.25
|
|
Echocardiograpy doppler follow up/limited study
|
$3,346.38 |
$3,346.38 |
$3,346.38 |
$362.50
|
|
Echo exam of fetal heart
|
$4,908.16 |
$4,908.16 |
$4,908.16 |
$939.00
|
|
Echo exam of fetal heart
|
$3,236.84 |
$3,236.84 |
$3,236.84 |
$524.55
|
|
Echo exam of fetal heart
|
$624.75 |
$624.75 |
$624.75 |
$431.41
|
|
Echo exam of fetal heart
|
$624.75 |
$624.75 |
$624.75 |
$323.40
|
|
Echo exam uterus 76831-
|
$2,310.58 |
$2,310.58 |
$2,310.58 |
$523.71
|
|
Echo guidance radiotherapy
|
$3,476.01 |
$3,476.01 |
$3,476.01 |
$812.00
|
|
Echo guide for amniocentesis
|
$3,871.74 |
$3,871.74 |
$3,871.74 |
$456.30
|
|
Echo guide for artery repair
|
$2,059.82 |
$2,059.82 |
$2,059.82 |
$664.00
|
|
Echo guide villus sampling
|
$1,039.33 |
$1,039.33 |
$1,039.33 |
$362.88
|
|
Echo stress
|
$12,627.68 |
$12,627.68 |
$12,627.68 |
$1,592.05
|
|
Echo tee guidance
|
$18,574.36 |
$18,574.36 |
$18,574.36 |
$1,821.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$18,574.36 |
$18,574.36 |
$18,574.36 |
$1,849.50
|
|
Echo transesophageal
|
$12,960.00 |
$12,960.00 |
$12,960.00 |
$1,087.90
|
|
Echo transthoracic
|
$13,385.47 |
$13,385.47 |
$13,385.47 |
$1,361.75
|
|
Echo transthoracic
|
$7,807.63 |
$7,807.63 |
$7,807.63 |
$953.10
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$12,776.90 |
$12,776.90 |
$12,776.90 |
$985.15
|
|
Eculizumab injection
|
$32,904.92 |
$32,904.92 |
$32,904.92 |
$17,032.68
|
|
Eeg 41-60 minutes 95812-26
|
$2,040.86 |
$2,040.86 |
$2,040.86 |
$920.00
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$3,742.52 |
$3,742.52 |
$3,742.52 |
$1,000.42
|
|
Eeg monitor/record/awake/drowsy 95816
|
$3,221.10 |
$3,221.10 |
$3,221.10 |
$835.00
|
|
Eeg over 1 hour 95813 - 26
|
$9,202.12 |
$9,202.12 |
$9,202.12 |
$1,102.05
|
|
Eeg recording awake and asleep
|
$4,060.70 |
$4,060.70 |
$4,060.70 |
$931.20
|
|
Eeg without vid 2-12hr cont mntr
|
$4,360.66 |
$4,360.66 |
$4,360.66 |
$783.60
|
|
Eeg without vid 2-12 hr unmntr
|
$2,663.22 |
$2,663.22 |
$2,663.22 |
$601.30
|
|
Eeg without vid ea 12-26hr cont
|
$5,547.90 |
$5,547.90 |
$5,547.90 |
$1,460.20
|
|
Eeg without vid ea 12-26hr intmt
|
$4,716.71 |
$4,716.71 |
$4,716.71 |
$1,379.30
|
|
Eeg wo vid 2-12hr intmt mntr
|
$5,120.38 |
$5,120.38 |
$5,120.38 |
$671.00
|
|
Eeg wo vid ea 12-26hr unmntr
|
$6,095.95 |
$6,095.95 |
$6,095.95 |
$1,502.40
|
|
E equine encephalitis igg
|
$648.67 |
$648.67 |
$648.67 |
$49.92
|
|
Egd balloon dil esoph30 mm/>
|
$3,899.52 |
$3,899.52 |
$3,899.52 |
$2,244.82
|
|
Egfr gene com variants
|
$5,969.89 |
$5,969.89 |
$5,969.89 |
$657.00
|
|
Ehrlicha chaffeensis amp prb
|
$2,876.56 |
$2,876.56 |
$2,876.56 |
$93.00
|
|
Electron microscopy diagnostic
|
$24,334.86 |
$24,334.86 |
$24,334.86 |
$983.41
|
|
Electrophysiologic study
|
$17,277.42 |
$17,277.42 |
$17,277.42 |
$6,758.40
|
|
Electrophysiology evaluation
|
$25,914.84 |
$25,914.84 |
$25,914.84 |
$8,979.45
|
|
Electrophysiology evaluation
|
$25,914.84 |
$25,914.84 |
$25,914.84 |
$10,233.60
|
|
Electrophysiology evaluation
|
$8,827.32 |
$8,827.32 |
$8,827.32 |
$6,760.00
|
|
Electrophysiology evaluation
|
$8,827.32 |
$8,827.32 |
$8,827.32 |
$5,854.80
|
|
Electrophysiology evaluation
|
$12,017.43 |
$12,017.43 |
$12,017.43 |
$2,451.90
|
|
Electrophysiology evaluation
|
$2,728.73 |
$2,728.73 |
$2,728.73 |
$1,869.13
|
|
Electrophys map 3d add-on
|
$18,198.64 |
$18,198.64 |
$18,198.64 |
$5,881.00
|
|
Embolization s&i
|
$8,727.50 |
$8,727.50 |
$8,727.50 |
$3,199.00
|
|
Encephalitis, california igg/igm
|
$648.67 |
$648.67 |
$648.67 |
$53.55
|
|
Encephalitis, st louis igg/igm
|
$330.18 |
$330.18 |
$330.18 |
$48.57
|
|
Encephalitis, western equine igg/igm
|
$648.67 |
$648.67 |
$648.67 |
$53.10
|
|
Endoscopy swallow (fees) vid
|
$720.77 |
$720.77 |
$720.77 |
$402.35
|
|
Entamoeba histolytica ag eia - sendout
|
$1,033.88 |
$1,033.88 |
$1,033.88 |
$56.89
|
|
Enzyme histochemistry
|
$240.13 |
$240.13 |
$240.13 |
$471.60
|
|
Ep & ablate supravent arrhyt
|
$92,602.13 |
$92,602.13 |
$92,602.13 |
$27,075.00
|
|
Ep & ablate ventric tachy
|
$92,602.13 |
$92,602.13 |
$92,602.13 |
$28,199.40
|
|
Ep induct arrhy by elect pacing
|
$4,299.47 |
$4,299.47 |
$4,299.47 |
$2,635.75
|
|
Epirubicin 200 mg/100 ml intravenous solution
|
$15,486.33 |
$15,486.33 |
$15,486.33 |
$248.81
|
|
Epoetin alfa, 100 units esrd
|
$83.15 |
$83.15 |
$83.15 |
$4.82
|
|
Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr
|
$511.02 |
$511.02 |
$511.02 |
$129.30
|
