|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$200.00 |
$200.00 |
$200.00 |
$3,202.98
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$185.80 |
$185.80 |
$185.80 |
$364.50
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$149.40 |
$149.40 |
$149.40 |
$513.60
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$174.20 |
$174.20 |
$174.20 |
$558.97
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$148.00 |
$148.00 |
$148.00 |
$472.79
|
|
Destruction mal lsn t/a/l >4cm
|
$168.00 |
$168.00 |
$168.00 |
$569.80
|
|
Destruction penis lesion(s) chem 54050
|
$104.40 |
$104.40 |
$104.40 |
$332.00
|
|
Destruction penis lesion(s) exten 54065
|
$160.20 |
$160.20 |
$160.20 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$119.60 |
$119.60 |
$119.60 |
$436.64
|
|
Destruction rectal tumor 45190
|
$484.60 |
$484.60 |
$484.60 |
$3,245.23
|
|
Destruction vag lesions complex 57065
|
$172.40 |
$172.40 |
$172.40 |
$3,762.53
|
|
Destruction vag lesions simple 57061
|
$118.60 |
$118.60 |
$118.60 |
$3,815.20
|
|
Destruct penis les/smp/electrodesi 54055
|
$547.60 |
$547.60 |
$547.60 |
$2,837.09
|
|
Determine refractive state
|
$13.20 |
$13.20 |
$13.20 |
$19.80
|
|
Developmental screen/score/document 96110
|
$110.60 |
$110.60 |
$110.60 |
$130.65
|
|
Devel tst phys/qhp 1st hr
|
$59.40 |
$59.40 |
$59.40 |
$337.50
|
|
Device intraute mirena
|
$814.47 |
$814.47 |
$814.47 |
$2,125.00
|
|
Device sut capio slim opn
|
$875.40 |
$875.40 |
$875.40 |
$1,894.50
|
|
Dev interrog remote 1/2/mlt
|
$30.00 |
$30.00 |
$30.00 |
$115.20
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$105.80 |
$105.80 |
$105.80 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$2.80 |
$2.80 |
$2.80 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$17.37 |
$17.37 |
$17.37 |
$21.17
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$11.99 |
$11.99 |
$11.99 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$12.30 |
$12.30 |
$12.30 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$9.45 |
$9.45 |
$9.45 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$11.42 |
$11.42 |
$11.42 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$82.20 |
$82.20 |
$82.20 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$36.20 |
$36.20 |
$36.20 |
$79.20
|
|
Diabetes training group per 30 min g0109
|
$9.80 |
$9.80 |
$9.80 |
$35.25
|
|
Diab manage trn ind/group
|
$8.00 |
$8.00 |
$8.00 |
$56.55
|
|
Diag laparo separate proc 49320
|
$224.20 |
$224.20 |
$224.20 |
$6,904.15
|
|
Diagnostic anoscopy
|
$64.20 |
$64.20 |
$64.20 |
$391.20
|
|
Diagnostic anoscopy & biopsy
|
$84.40 |
$84.40 |
$84.40 |
$1,905.00
|
|
Diagnostic anoscopy spx 46600
|
$83.00 |
$83.00 |
$83.00 |
$190.68
|
|
Diagnostic laryngoscopy 31505
|
$63.40 |
$63.40 |
$63.40 |
$236.60
|
|
Diagnostic laryngoscopy 31575
|
$91.20 |
$91.20 |
$91.20 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$216.20 |
$216.20 |
$216.20 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$168.00 |
$168.00 |
$168.00 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$10.00 |
$10.00 |
$10.00 |
$214.08
|
|
Dialysis circuit perm vascular embolization 36909
|
$129.60 |
$129.60 |
$129.60 |
$5,419.00
|
|
Dialysis one evaluation
|
$292.20 |
$292.20 |
$292.20 |
$919.55
|
|
Dialysis repeated eval
|
$78.80 |
$78.80 |
$78.80 |
$1,267.50
|
|
Diathermy eg microwave
|
$19.80 |
$19.80 |
$19.80 |
$29.68
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$54.68 |
$54.68 |
$54.68 |
$74.76
|
|
Dicyclomine injection
|
$42.80 |
$42.80 |
$42.80 |
$153.29
|
|
Diffusing capacity
|
$118.40 |
$118.40 |
$118.40 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$12.74 |
$12.74 |
$12.74 |
$69.03
|
|
Digoxin total therapeutic drug level
|
$58.00 |
$58.00 |
$58.00 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$24.20 |
$24.20 |
$24.20 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$89.40 |
$89.40 |
$89.40 |
$1,866.73
|
|
Dilate esophagus
|
$59.40 |
$59.40 |
$59.40 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$134.40 |
$134.40 |
$134.40 |
$1,484.17
|
|
Dilate tear duct opening
|
$109.80 |
$109.80 |
$109.80 |
$472.21
|
|
Dilate urethra stricture
|
$72.80 |
$72.80 |
$72.80 |
$490.00
|
|
Dilate urethra stricture
|
$60.80 |
$60.80 |
$60.80 |
$200.80
|
|
Dilate urethra stricture
|
$42.80 |
$42.80 |
$42.80 |
$3,863.60
|
|
Dilate urethra stricture
|
$114.40 |
$114.40 |
$114.40 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$54.00 |
$54.00 |
$54.00 |
$235.61
|
|
Dilation of anal sphincter
|
$118.80 |
$118.80 |
$118.80 |
$1,969.12
|
|
Dilation of cervical canal 57800
|
$54.40 |
$54.40 |
$54.40 |
$4,376.00
|
|
Dilation of rectal stricture 45910
|
$134.20 |
$134.20 |
$134.20 |
$1,395.28
|
|
Dilation of urethra
|
$53.20 |
$53.20 |
$53.20 |
$172.00
|
|
Dilation of vagina
|
$88.20 |
$88.20 |
$88.20 |
$3,786.00
|
|
Dilation salivary duct 42650
|
$52.80 |
$52.80 |
$52.80 |
$2,498.32
|
|
Dilation/urethral strict/male/ini 53620
|
$199.80 |
$199.80 |
$199.80 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$635.60 |
$635.60 |
$635.60 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$1,470.80 |
$1,470.80 |
$1,470.80 |
$4,061.71
|
|
Diltiazem 5 mg/ml intravenous solution
|
$8.00 |
$8.00 |
$8.00 |
$47.94
|
|
Dimethyl sulfoxide 50% 50 ml
|
$32.80 |
$32.80 |
$32.80 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$7.85 |
$7.85 |
$7.85 |
$17.75
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$22.40 |
$22.40 |
$22.40 |
$91.53
|
|
Disability dlco
|
$131.00 |
$131.00 |
$131.00 |
$282.40
|
|
Disaccharidases
|
$67.36 |
$67.36 |
$67.36 |
$216.00
|
|
Discography cerv/thor spine
|
$44.00 |
$44.00 |
$44.00 |
$2,565.00
|
|
Dise eval slp do brth flx dx
|
$66.80 |
$66.80 |
$66.80 |
$1,120.00
|
|
Diverticulectomy/hypophar/esoph 43130
|
$543.20 |
$543.20 |
$543.20 |
$6,465.11
|
|
Division of fallopian tube 58605
|
$231.60 |
$231.60 |
$231.60 |
$832.00
|
|
Dna antibody native/double stranded
|
$1.60 |
$1.60 |
$1.60 |
$97.50
|
|
Dna gardnerella
|
$49.60 |
$49.60 |
$49.60 |
$62.50
|
|
Dna trichomonas
|
$90.60 |
$90.60 |
$90.60 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$30.51 |
$30.51 |
$30.51 |
$98.43
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$7.80 |
$7.80 |
$7.80 |
$904.81
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$14.83 |
$14.83 |
$14.83 |
$65.40
|
|
Doppler echo complete
|
$319.60 |
$319.60 |
$319.60 |
$540.00
|
|
Doppler intravascular pressure flow initial vessel
|
$33.40 |
$33.40 |
$33.40 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$690.40 |
$690.40 |
$690.40 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$208.20 |
$208.20 |
$208.20 |
$471.17
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$3,989.11 |
$3,989.11 |
$3,989.11 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$31.46 |
$31.46 |
$31.46 |
$423.95
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$31.95 |
$31.95 |
$31.95 |
$84.80
|
|
Dpyd gene common variants
|
$34.96 |
$34.96 |
$34.96 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$86.60 |
$86.60 |
$86.60 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$194.00 |
$194.00 |
$194.00 |
$914.34
|
|
Drainage external ear complex 69005
|
$485.00 |
$485.00 |
$485.00 |
$2,726.90
|
|
Drainage external ear simple 69000
|
$131.60 |
$131.60 |
$131.60 |
$789.60
|
|
Drainage lymph node lesion 38305
|
$341.60 |
$341.60 |
$341.60 |
$3,170.64
|
|
Drainage mouth roof lesion
|
$77.80 |
$77.80 |
$77.80 |
$390.39
|
|
Drainage of arm bursa 23931
|
$215.40 |
$215.40 |
$215.40 |
$2,197.48
|
|
Drainage of bone lesion
|
$698.80 |
$698.80 |
$698.80 |
$2,854.40
|
|
Drainage of bone lesion
|
$451.00 |
$451.00 |
$451.00 |
$3,153.60
|
