|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$5,071.14 |
$5,071.14 |
$5,071.14 |
$3,375.00
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$526.32 |
$526.32 |
$526.32 |
$331.20
|
|
Destruction laser surgery anal lesions 46917
|
$7,488.98 |
$7,488.98 |
$7,488.98 |
$3,038.07
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$472.99 |
$472.99 |
$472.99 |
$513.60
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$567.59 |
$567.59 |
$567.59 |
$558.97
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$3,062.36 |
$3,062.36 |
$3,062.36 |
$481.50
|
|
Destruction mal lsn t/a/l >4cm
|
$3,587.12 |
$3,587.12 |
$3,587.12 |
$578.40
|
|
Destruction premal lesions 15/> 17004
|
$510.36 |
$510.36 |
$510.36 |
$470.51
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$1,283.97 |
$1,283.97 |
$1,283.97 |
$220.43
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$95.54 |
$95.54 |
$95.54 |
$30.00
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$192.72 |
$192.72 |
$192.72 |
$60.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$192.72 |
$192.72 |
$192.72 |
$68.93
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$61.55 |
$61.55 |
$61.55 |
$49.75
|
|
Dextrose 5 % IV bolus
|
$192.72 |
$192.72 |
$192.72 |
$68.93
|
|
Dhea-s (dehydroepiand sulfate)
|
$624.56 |
$624.56 |
$624.56 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$155.43 |
$155.43 |
$155.43 |
$78.03
|
|
Diab manage trn ind/group
|
$67.77 |
$67.77 |
$67.77 |
$49.50
|
|
Diagnostic anoscopy spx 46600
|
$1,504.69 |
$1,504.69 |
$1,504.69 |
$245.35
|
|
Diagnostic digital breast tomosynthesis bil
|
$269.66 |
$269.66 |
$269.66 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$192.39 |
$192.39 |
$192.39 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$427.17 |
$427.17 |
$427.17 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$1,827.51 |
$1,827.51 |
$1,827.51 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$970.67 |
$970.67 |
$970.67 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$391.23 |
$391.23 |
$391.23 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$99.00 |
$99.00 |
$99.00 |
$239.25
|
|
Dialysis circuit perm vascular embolization 36909
|
$34,442.20 |
$34,442.20 |
$34,442.20 |
$7,145.00
|
|
Dialysis one evaluation
|
$2,714.13 |
$2,714.13 |
$2,714.13 |
$842.10
|
|
Diatrizoate meglumine 18 % urethral solution
|
$509.22 |
$509.22 |
$509.22 |
$100.03
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$225.84 |
$225.84 |
$225.84 |
$72.34
|
|
Dicyclomine injection
|
$912.29 |
$912.29 |
$912.29 |
$211.81
|
|
Diffusing capacity
|
$2,645.96 |
$2,645.96 |
$2,645.96 |
$360.10
|
|
Digital analysis of eeg
|
$2,270.28 |
$2,270.28 |
$2,270.28 |
$641.56
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$93.18 |
$93.18 |
$93.18 |
$69.79
|
|
Digoxin total therapeutic drug level
|
$249.45 |
$249.45 |
$249.45 |
$102.00
|
|
Dilate biliary duct/ampulla
|
$8,324.68 |
$8,324.68 |
$8,324.68 |
$2,304.60
|
|
Dilate esophagus 1/mult pass
|
$2,406.03 |
$2,406.03 |
$2,406.03 |
$1,484.17
|
|
Dilat xst trc ndurlgc px
|
$7,688.57 |
$7,688.57 |
$7,688.57 |
$4,081.37
|
|
Dilat xst trc new access rcs
|
$14,777.39 |
$14,777.39 |
$14,777.39 |
$5,020.00
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$73.56 |
$73.56 |
$73.56 |
$26.87
|
|
Disability dlco
|
$2,411.37 |
$2,411.37 |
$2,411.37 |
$307.58
|
|
Disaccharidases
|
$413.25 |
$413.25 |
$413.25 |
$223.80
|
|
Discography cerv/thor spine
|
$7,308.79 |
$7,308.79 |
$7,308.79 |
$2,404.00
|
|
Dissolve clot heart vessel
|
$672.68 |
$672.68 |
$672.68 |
$1,396.47
|
|
Dlyd plmt xtn prosth ea addl
|
$9,561.95 |
$9,561.95 |
$9,561.95 |
$2,001.55
|
|
Dna antibody native/double stranded
|
$220.03 |
$220.03 |
$220.03 |
$102.60
|
|
Dna gardnerella
|
$299.13 |
$299.13 |
$299.13 |
$67.68
|
|
Dna trichomonas
|
$299.13 |
$299.13 |
$299.13 |
$68.75
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$803.28 |
$803.28 |
$803.28 |
$101.04
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$1,734.29 |
$1,734.29 |
$1,734.29 |
$712.02
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$296.60 |
$296.60 |
$296.60 |
$84.30
|
|
Doppler echo complete
|
$774.10 |
$774.10 |
$774.10 |
$608.25
|
|
Doppler intravascular pressure flow initial vessel
|
$7,741.09 |
$7,741.09 |
$7,741.09 |
$3,006.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$3,885.73 |
$3,885.73 |
$3,885.73 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$732.78 |
$732.78 |
$732.78 |
$482.03
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$48,320.30 |
$48,320.30 |
$48,320.30 |
$32,490.15
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$411.34 |
$411.34 |
$411.34 |
$299.52
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$31,780.45 |
$31,780.45 |
$31,780.45 |
$2,417.38
|
|
Dpyd gene common variants
|
$1,031.38 |
$1,031.38 |
$1,031.38 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$1,635.15 |
$1,635.15 |
$1,635.15 |
$820.50
|
|
Drainage ext aud canal abscess 69020
|
$1,891.49 |
$1,891.49 |
$1,891.49 |
$900.80
|
|
Drainage external ear complex 69005
|
$1,635.15 |
$1,635.15 |
$1,635.15 |
$2,967.58
|
|
Drainage external ear simple 69000
|
$1,635.15 |
$1,635.15 |
$1,635.15 |
$809.25
|
|
Drainage mouth roof lesion
|
$605.74 |
$605.74 |
$605.74 |
$474.39
|
|
Drainage of arm bursa 23931
|
$7,463.75 |
$7,463.75 |
$7,463.75 |
$2,419.30
|
|
Drainage of forearm bursa
|
$4,181.05 |
$4,181.05 |
$4,181.05 |
$1,893.86
|
|
Drainage of kidney lesion
|
$5,177.76 |
$5,177.76 |
$5,177.76 |
$1,706.65
|
|
Drainage of mouth lesion
|
$1,331.45 |
$1,331.45 |
$1,331.45 |
$455.56
|
|
Drainage of mouth lesion
|
$4,045.88 |
$4,045.88 |
$4,045.88 |
$2,320.03
|
|
Drainage of mouth lesion
|
$8,292.12 |
$8,292.12 |
$8,292.12 |
$3,986.00
|
|
Drainage of mouth lesion
|
$1,331.45 |
$1,331.45 |
$1,331.45 |
$1,022.40
|
|
Drainage of nose lesion sept 30020
|
$3,115.67 |
$3,115.67 |
$3,115.67 |
$755.95
|
|
Drainage of pelvis lesion 26990
|
$8,675.77 |
$8,675.77 |
$8,675.77 |
$3,969.00
|
|
Drainage of rectal abscess
|
$3,156.25 |
$3,156.25 |
$3,156.25 |
$2,299.90
|
|
Drainage of rectal abscess 45020
|
$4,096.00 |
$4,096.00 |
$4,096.00 |
$3,245.23
|
|
Drain bladder by trocar/cath
|
$1,402.98 |
$1,402.98 |
$1,402.98 |
$1,126.11
|
|
Drain blood from under nail 11740
|
$1,340.43 |
$1,340.43 |
$1,340.43 |
$190.33
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$5,005.31 |
$5,005.31 |
$5,005.31 |
$2,614.66
|
|
Drain cath image guided visceral pq
|
$10,622.95 |
$10,622.95 |
$10,622.95 |
$3,073.90
|
|
Drain cerebro spinal fluid 62272
|
$2,107.87 |
$2,107.87 |
$2,107.87 |
$1,113.06
|
|
Drain finger abscess;simple 26010
|
$1,551.82 |
$1,551.82 |
$1,551.82 |
$492.81
|
|
Drain lower leg lesion 27603
|
$7,529.14 |
$7,529.14 |
$7,529.14 |
$3,631.18
|
|
Drain neck/chest lesion 21501
|
$7,529.14 |
$7,529.14 |
$7,529.14 |
$3,386.84
|
|
Drain shoulder lesion
|
$7,529.14 |
$7,529.14 |
$7,529.14 |
$3,571.53
|
|
Drain thigh/knee lesion 27301
|
$1,241.93 |
$1,241.93 |
$1,241.93 |
$3,620.47
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$1,049.26 |
$1,049.26 |
$1,049.26 |
$420.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$874.38 |
$874.38 |
$874.38 |
$365.60
|
|
Dress/debrid prtl-thick burn l 16030
|
$1,259.11 |
$1,259.11 |
$1,259.11 |
$554.40
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$289.82 |
$289.82 |
$289.82 |
$9,390.80
|
|
Drng of eyelid abscess 67700
|
$1,138.95 |
$1,138.95 |
$1,138.95 |
$747.00
|
|
Drng of finger abscess comp 26011
|
$4,370.59 |
$4,370.59 |
$4,370.59 |
$2,048.00
|
|
Drng of hydrocele 55000
|
$2,756.59 |
$2,756.59 |
$2,756.59 |
$832.60
|
|
Drng of mouth lesion 40801
|
$1,817.61 |
$1,817.61 |
$1,817.61 |
$1,145.97
|
|
Drng of ovarian cyst(s) 58800
|
$8,240.86 |
$8,240.86 |
$8,240.86 |
$3,474.84
|
|
Drng of scrotum abscess 55100
|
$3,922.28 |
$3,922.28 |
$3,922.28 |
$2,069.60
|
|
Droperidol 2.5 mg/ml injection solution
|
$108.52 |
$108.52 |
$108.52 |
$39.60
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$189.68 |
$189.68 |
$189.68 |
$468.29
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$189.68 |
$189.68 |
$189.68 |
$318.13
|
|
Drsg wnd hyalomatrix 10x10cm -cost per sq cm
|
$97.50 |
$97.50 |
$97.50 |
$6,581.45
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$126.18 |
$126.18 |
$126.18 |
$18,384.03
|
|
Drug admin & hemodynmic meas
|
$8,355.00 |
$8,355.00 |
$8,355.00 |
$528.50
|