|
Dextrose 5 % and lactated ringers intravenous solution
|
$2.34 |
$2.34 |
$2.34 |
$68.93
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$3.13 |
$3.13 |
$3.13 |
$49.75
|
|
Dextrose 5 % IV bolus
|
$2.81 |
$2.81 |
$2.81 |
$68.93
|
|
Dhea-s (dehydroepiand sulfate)
|
$32.50 |
$32.50 |
$32.50 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$59.75 |
$59.75 |
$59.75 |
$78.03
|
|
Diagnostic digital breast tomosynthesis bil
|
$70.00 |
$70.00 |
$70.00 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$50.00 |
$50.00 |
$50.00 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$125.00 |
$125.00 |
$125.00 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$68.75 |
$68.75 |
$68.75 |
$301.55
|
|
Dialysis one evaluation
|
$405.00 |
$405.00 |
$405.00 |
$842.10
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.77 |
$0.77 |
$0.77 |
$100.03
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$45.64 |
$45.64 |
$45.64 |
$72.34
|
|
Dicyclomine injection
|
$90.06 |
$90.06 |
$90.06 |
$211.81
|
|
Diffusing capacity
|
$112.50 |
$112.50 |
$112.50 |
$360.10
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$145.78 |
$145.78 |
$145.78 |
$69.79
|
|
Digoxin immune fab 40 mg intravenous solution
|
$3,340.91 |
$3,340.91 |
$3,340.91 |
$10,945.58
|
|
Digoxin total therapeutic drug level
|
$35.00 |
$35.00 |
$35.00 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$182.72 |
$182.72 |
$182.72 |
$334.68
|
|
Dimecaprol injection
|
$107.90 |
$107.90 |
$107.90 |
$199.46
|
|
Dimenhydrinate injection
|
$24.68 |
$24.68 |
$24.68 |
$24.68
|
|
Dimethyl sulfoxide 50% 50 ml
|
$105.39 |
$105.39 |
$105.39 |
$1,155.52
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$19.27 |
$19.27 |
$19.27 |
$26.87
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$91.33 |
$91.33 |
$91.33 |
$106.59
|
|
Disability dlco
|
$101.25 |
$101.25 |
$101.25 |
$307.58
|
|
Disaccharidases
|
$50.00 |
$50.00 |
$50.00 |
$223.80
|
|
Dlyd plmt xtn prosth ea addl
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$2,001.55
|
|
Dna antibody native/double stranded
|
$35.00 |
$35.00 |
$35.00 |
$102.60
|
|
Dna gardnerella
|
$17.50 |
$17.50 |
$17.50 |
$67.68
|
|
Dna trichomonas
|
$17.50 |
$17.50 |
$17.50 |
$68.75
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$6.47 |
$6.47 |
$6.47 |
$101.04
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$712.02 |
$712.02 |
$712.02 |
$712.02
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$7.71 |
$7.71 |
$7.71 |
$84.30
|
|
Doppler echo complete
|
$375.00 |
$375.00 |
$375.00 |
$608.25
|
|
Doppler intravascular pressure flow initial vessel
|
$750.00 |
$750.00 |
$750.00 |
$3,006.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$231.25 |
$231.25 |
$231.25 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$187.50 |
$187.50 |
$187.50 |
$482.03
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$1,517.70 |
$1,517.70 |
$1,517.70 |
$32,490.15
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$409.84 |
$409.84 |
$409.84 |
$299.52
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$178.92 |
$178.92 |
$178.92 |
$2,417.38
|
|
Dpyd gene common variants
|
$100.00 |
$100.00 |
$100.00 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$557.50 |
$557.50 |
$557.50 |
$820.50
|
|
Drainage ext aud canal abscess 69020
|
$557.50 |
$557.50 |
$557.50 |
$900.80
|
|
Drainage external ear complex 69005
|
$600.00 |
$600.00 |
$600.00 |
$2,967.58
|
|
Drainage external ear simple 69000
|
$557.50 |
$557.50 |
$557.50 |
$809.25
|
|
Drainage mouth roof lesion
|
$130.00 |
$130.00 |
$130.00 |
$474.39
|
|
Drainage of arm bursa 23931
|
$600.00 |
$600.00 |
$600.00 |
$2,419.30
|
|
Drainage of nose lesion int 30000
|
$130.00 |
$130.00 |
$130.00 |
$548.00
|
|
Drain blood from under nail 11740
|
$43.75 |
$43.75 |
$43.75 |
$190.33
|
|
Drain cath image guided visceral pq
|
$600.00 |
$600.00 |
$600.00 |
$3,073.90
|
|
Drain finger abscess;simple 26010
|
$105.00 |
$105.00 |
$105.00 |
$492.81
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$105.00 |
$105.00 |
$105.00 |
$365.60
|
|
Drng of finger abscess comp 26011
|
$600.00 |
$600.00 |
$600.00 |
$2,048.00
|
|
Drng of scrotum abscess 55100
|
$600.00 |
$600.00 |
$600.00 |
$2,069.60
|
|
Dronabinol 2.5mg oral
|
$2.46 |
$2.46 |
$2.46 |
$10.17
|
|
Droperidol 2.5 mg/ml injection solution
|
$30.78 |
$30.78 |
$30.78 |
$39.60
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$5.89 |
$5.89 |
$5.89 |
$3,374.24
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$40.04 |
$40.04 |
$40.04 |
$468.29
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$13.48 |
$13.48 |
$13.48 |
$318.13
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$38.81 |
$38.81 |
$38.81 |
$18,384.03
|
|
Drug assay posaconazole
|
$37.50 |
$37.50 |
$37.50 |
$96.39
|
|
Drug of abuse screen urine
|
$35.00 |
$35.00 |
$35.00 |
$63.75
|
|
Drug screen quant tiagabine
|
$37.50 |
$37.50 |
$37.50 |
$91.80
|
|
Drug test prsmv instrmnt
|
$31.25 |
$31.25 |
$31.25 |
$83.20
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$53.75 |
$53.75 |
$53.75 |
$278.85
|
|
Drvvt confirm - quest
|
$25.00 |
$25.00 |
$25.00 |
$101.66
|
|
Dstrj nulyt agt gnclr nrv
|
$1,125.00 |
$1,125.00 |
$1,125.00 |
$3,390.00
|
|
Duplex scan unilateral study 93986
|
$325.00 |
$325.00 |
$325.00 |
$394.00
|
|
Dup scan/hemodialysis access 93990
|
$325.00 |
$325.00 |
$325.00 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$231.25 |
$231.25 |
$231.25 |
$757.57
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$500.00 |
$500.00 |
$500.00 |
$903.00
|
|
Durvalumab 50 mg/ml intravenous solution
|
$710.30 |
$710.30 |
$710.30 |
$10,021.12
|
|
Dxa bone density axl vrt fx
|
$92.50 |
$92.50 |
$92.50 |
$374.00
|
|
Ear irrigation 69209
|
$30.00 |
$30.00 |
$30.00 |
$165.42
|
|
Ecallantide injection
|
$4,014.63 |
$4,014.63 |
$4,014.63 |
$6,132.60
|
|
Ecg 12 lead tracing only
|
$112.50 |
$112.50 |
$112.50 |
$245.00
|
|
Ecg < 30 days transmission & analysis
|
$250.00 |
$250.00 |
$250.00 |
$429.00
|
|
Ecg external < 48 hours recording
|
$217.50 |
$217.50 |
$217.50 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$250.00 |
$250.00 |
$250.00 |
$567.00
|
|
Ecg external > 48 hours up to 7 days recording
|
$32.50 |
$32.50 |
$32.50 |
$162.78
|
|
Ecg external >7 days up to 15 days recording
|
$107.50 |
$107.50 |
$107.50 |
$200.00
|
|
Echocardiogram (Heart Ultrasound)
|
$800.00 |
$800.00 |
$800.00 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$237.50 |
$237.50 |
$237.50 |
$469.95
|
|
Echocardiography transthoracic 2d followup/limited
|
$225.00 |
$225.00 |
$225.00 |
$724.20
|
|
Echocardiograpy doppler follow up/limited study
|
$200.00 |
$200.00 |
$200.00 |
$353.46
|
|
Echo exam of fetal heart
|
$375.00 |
$375.00 |
$375.00 |
$855.38
|
|
Echo exam of fetal heart
|
$193.75 |
$193.75 |
$193.75 |
$503.80
|
|
Echo exam uterus 76831-
|
$225.00 |
$225.00 |
$225.00 |
$547.20
|
|
Echo guide for amniocentesis
|
$300.00 |
$300.00 |
$300.00 |
$384.65
|
|
Echo stress
|
$800.00 |
$800.00 |
$800.00 |
$1,582.75
|
|
Echo tee guidance
|
$1,125.00 |
$1,125.00 |
$1,125.00 |
$2,007.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$800.00 |
$800.00 |
$800.00 |
$1,871.10
|
|
Echo transesophageal intraop
|
$800.00 |
$800.00 |
$800.00 |
$1,571.70
|
|
Echo transthoracic
|
$375.00 |
$375.00 |
$375.00 |
$1,492.50
|
|
Echo transthoracic
|
$325.00 |
$325.00 |
$325.00 |
$953.10
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$300.00 |
$300.00 |
$300.00 |
$1,014.01
|
|
Eeg 41-60 minutes 95812-26
|
$221.25 |
$221.25 |
$221.25 |
$956.45
|
|
Eeg monitor/record/awake/drowsy 95816
|
$237.50 |
$237.50 |
$237.50 |
$861.12
|
|
Eeg over 1 hour 95813 - 26
|
$262.50 |
$262.50 |
$262.50 |
$1,119.54
|
|
Eeg/record in coma or sleep only 95822
|
$804.50 |
$804.50 |
$804.50 |
$936.00
|
|
Eeg recording awake and asleep
|
$367.50 |
$367.50 |
$367.50 |
$1,030.27
|
