|
Debride nail1-5 11720
|
$68.10 |
$195.75 |
$375.25 |
|
|
Debride nail6 or more 11721
|
$34.50 |
$110.50 |
$239.30 |
|
|
Debride skin bone at fx site
|
$1,010.95 |
$1,164.70 |
$4,968.20 |
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$91.75 |
$744.75 |
$971.15 |
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$262.10 |
$981.10 |
$983.95 |
|
|
Debr inf skin add-on 11001
|
$51.10 |
$51.10 |
$51.10 |
|
|
Debr musc/fascia 20sq cm/< 11043
|
$584.45 |
$841.25 |
$1,669.25 |
|
|
Decalcification
|
$55.35 |
$92.40 |
$272.65 |
|
|
Decitabine 50 mg intravenous solution
|
$701.60 |
$892.33 |
$1,824.84 |
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$202.45 |
$427.85 |
$589.85 |
|
|
Decomp forearm 2 spaces w/debrid 25025
|
$2,838.60 |
$2,838.60 |
$2,838.60 |
|
|
Decompress forearm 2 spaces
|
$1,800.65 |
$1,800.65 |
$1,800.65 |
|
|
Deferoxamine 500 mg solution for injection
|
$82.31 |
$471.20 |
$627.25 |
|
|
Degarelix 120 mg subcutaneous solution
|
$2,066.58 |
$2,201.30 |
$2,836.24 |
|
|
Delivery of placenta 59414
|
$1,301.10 |
$1,301.10 |
$1,301.10 |
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$54.80 |
$90.40 |
$492.30 |
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$2,851.78 |
$8,237.29 |
$12,018.56 |
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$93.60 |
$583.10 |
$629.55 |
|
|
Dermagraft
|
$1,250.00 |
$1,250.00 |
$1,250.00 |
|
|
Desmopressin 4 mcg/ml injection solution
|
$208.33 |
$475.42 |
$2,036.48 |
|
|
Desoxycorticosterone
|
$72.20 |
$72.20 |
$72.20 |
|
|
Destroy cervthor facet jnt 64633
|
$5,408.25 |
$5,408.25 |
$5,515.95 |
|
|
Destroy cth facet jnt addl 64634
|
$1.00 |
$545.55 |
$946.80 |
|
|
Destruct cut vasl lesions <10cm 17106
|
$660.00 |
$664.05 |
$677.85 |
|
|
Destruction anal lesion(s) smpl chem 46900
|
$770.75 |
$770.75 |
$770.75 |
|
|
Destruction benign lesions < 14 lesions
|
$194.40 |
$213.25 |
$607.35 |
|
|
Destruction by injection tx of nerve 64630
|
$2,596.95 |
$2,596.95 |
$2,596.95 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,690.20 |
$2,410.15 |
$2,410.15 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$5,515.95 |
$6,597.10 |
$6,597.10 |
|
|
Developmental screen/score/document 96110
|
$79.90 |
$277.75 |
$510.15 |
|
|
Devel tst phys/qhp 1st hr
|
$307.55 |
$456.70 |
$859.40 |
|
|
Device ablt adv novasure
|
$205.20 |
$386.10 |
$2,488.00 |
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$1,200.00 |
$1,465.00 |
$9,038.64 |
|
|
Device intraute mirena
|
$1,489.51 |
$2,900.29 |
$5,289.60 |
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$228.35 |
$291.05 |
$616.80 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$133.65 |
$188.95 |
$400.85 |
|
|
Dexametha opth insert 0.1 mg
|
$2,267.78 |
$2,267.78 |
$2,267.78 |
|
|
Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr
|
$6,264.64 |
$6,264.64 |
$6,264.64 |
|
|
Dexamethasone 4 mg tablet
|
$1.03 |
$3.44 |
$7.74 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$8.70 |
$20.28 |
$87.02 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,413.82 |
$1,413.82 |
$2,002.78 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$25.19 |
$34.84 |
$157.14 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$12.92 |
$28.96 |
$157.14 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$21.90 |
$34.95 |
$212.00 |
|
|
Diabetes (HbA1c) Test
|
$30.25 |
$77.70 |
$165.00 |
|
|
Diab manage trn ind/group
|
$26.95 |
$30.80 |
$124.20 |
|
|
Diagnostic anoscopy spx 46600
|
$70.60 |
$266.90 |
$329.30 |
|
|
Diagnostic digital breast tomosynthesis bil
|
$84.75 |
$121.45 |
$377.45 |
|
|
Diagnostic digital breast tomosynthesis unil
|
$84.75 |
$121.45 |
$337.05 |
|
|
Diagnostic laryngoscopy 31505
|
$180.85 |
$199.80 |
$781.50 |
|
|
Diagnostic laryngoscopy 31575
|
$117.30 |
$430.50 |
$873.25 |
|
|
Diagnostic Mammogram (both breasts)
|
$380.60 |
$397.95 |
$855.70 |
|
|
Diagnostic Mammogram (one breast)
|
$214.25 |
$322.60 |
$692.45 |
|
|
Dialysis one evaluation
|
$278.05 |
$278.05 |
$278.05 |
|
|
Diatrizoate meglumine 18 % urethral solution
|
$55.20 |
$97.20 |
$480.24 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$22.29 |
$170.64 |
$408.96 |
|
|
Dicyclomine injection
|
$157.69 |
$157.69 |
$157.69 |
|
|
Diffusing capacity
|
$268.75 |
$368.05 |
$410.95 |
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$6.93 |
$18.17 |
$74.29 |
|
|
Digoxin immune fab 40 mg intravenous solution
|
$6,099.62 |
$11,876.92 |
$15,884.97 |
|
|
Digoxin total therapeutic drug level
|
$140.35 |
$168.75 |
$237.95 |
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$255.76 |
$255.76 |
$255.76 |
|
|
Dilate esophagus 1/mult pass
|
$484.55 |
$484.55 |
$510.15 |
|
|
Dilate urethra stricture
|
$684.25 |
$684.25 |
$684.25 |
|
|
Dilation of cervical canal 57800
|
$146.80 |
$4,340.80 |
$8,572.80 |
|
|
Dilation/urethral strict/male/ini 53620
|
$77.60 |
$77.60 |
$77.60 |
|
|
Dilator fascial 10fx20cm
|
$67.95 |
$67.95 |
$96.78 |
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,742.50 |
$2,219.47 |
$3,389.84 |
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$0.04 |
$4.05 |
$14.97 |
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$5.89 |
$9.03 |
$41.64 |
|
|
Disability dlco
|
$86.05 |
$248.10 |
$464.85 |
|
|
Disaccharidases
|
$123.70 |
$233.25 |
$738.60 |
|
|
Dna antibody native/double stranded
|
$71.70 |
$95.80 |
$172.70 |
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$83.35 |
$201.49 |
$390.39 |
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$150.55 |
$1,114.87 |
$1,840.70 |
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$71.78 |
$100.39 |
$173.13 |
|
|
Doppler echo complete
|
$444.90 |
$924.50 |
$1,199.85 |
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$52.95 |
$611.85 |
$675.40 |
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$29.10 |
$388.70 |
$641.85 |
|
|
Dornase alfa non-comp unit
|
$457.71 |
$932.10 |
$1,305.62 |
|
|
Dornhoffer fixed part w/window
|
$395.00 |
$395.00 |
$395.00 |
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$31,045.17 |
$31,045.17 |
$31,045.17 |
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$157.94 |
$157.94 |
$325.25 |
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$1,594.53 |
$1,859.05 |
$2,028.02 |
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$96.61 |
$121.70 |
$256.98 |
|
|
Dpyd gene common variants
|
$437.00 |
$1,076.30 |
$1,076.30 |
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$227.05 |
$472.40 |
$2,174.80 |
|
|
Drainage ext aud canal abscess 69020
|
$252.30 |
$435.95 |
$2,174.80 |
|
|
Drainage external ear complex 69005
|
$164.40 |
$429.25 |
$6,850.70 |
|
|
Drainage external ear simple 69000
|
$211.90 |
$407.60 |
$674.85 |
|
|
Drainage lymph node lesion 38300
|
$554.70 |
$3,920.40 |
$7,742.45 |
|
|
Drainage mouth roof lesion
|
$257.80 |
$329.05 |
$738.30 |
|
|
Drainage of arm bursa 23931
|
$275.00 |
$2,377.90 |
$4,684.45 |
|
|
Drainage of kidney lesion
|
$1,020.40 |
$1,429.85 |
$3,105.10 |
|
|
Drainage of mouth lesion
|
$230.90 |
$381.95 |
$640.00 |
|
|
Drainage of mouth lesion
|
$757.15 |
$757.15 |
$757.15 |
|
|
Drainage of mouth lesion
|
$743.70 |
$743.70 |
$743.70 |
|
|
Drainage of mouth lesion
|
$366.40 |
$811.15 |
$7,986.85 |
|
|
Drainage of mouth lesion
|
$661.35 |
$865.05 |
$1,562.65 |
|
|
Drainage of mouth lesion
|
$762.75 |
$7,732.15 |
$15,342.35 |
|