|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,331.00 |
$2,331.00 |
$2,331.00 |
$3,202.98
|
|
Destruction premal lesions 15/> 17004
|
$357.84 |
$357.84 |
$357.84 |
$436.64
|
|
Destruction vag lesions simple 57061
|
$2,268.00 |
$2,268.00 |
$2,268.00 |
$3,815.20
|
|
Detect agent nos dna dir
|
$104.16 |
$104.16 |
$104.16 |
$115.20
|
|
Detect agnt mult dna direc
|
$155.40 |
$155.40 |
$155.40 |
$162.00
|
|
Device ablt adv novasure
|
$10,643.73 |
$10,643.73 |
$10,643.73 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$3,832.92 |
$3,832.92 |
$3,832.92 |
$4,200.00
|
|
Device intraute mirena
|
$3,673.06 |
$3,673.06 |
$3,673.06 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,247.81 |
$1,247.81 |
$1,247.81 |
$1,894.50
|
|
Device tiss remov myosure reach
|
$2,089.50 |
$2,089.50 |
$2,089.50 |
$2,541.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$252.00 |
$252.00 |
$252.00 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$456.96 |
$456.96 |
$456.96 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$130.41 |
$130.41 |
$130.41 |
$21.17
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$2,107.02 |
$2,107.02 |
$2,107.02 |
$858.00
|
|
Dextran 40 infusion
|
$173.67 |
$173.67 |
$173.67 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$173.67 |
$173.67 |
$173.67 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$173.67 |
$173.67 |
$173.67 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$173.67 |
$173.67 |
$173.67 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$173.67 |
$173.67 |
$173.67 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$207.48 |
$207.48 |
$207.48 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$115.92 |
$115.92 |
$115.92 |
$79.20
|
|
Diab manage trn ind/group
|
$27.72 |
$27.72 |
$27.72 |
$56.55
|
|
Diag bronchoscope/catheter
|
$1,612.80 |
$1,612.80 |
$1,612.80 |
$2,766.40
|
|
Diag laparo separate proc 49320
|
$747.60 |
$747.60 |
$747.60 |
$6,904.15
|
|
Diagnostic anoscopy spx 46600
|
$288.96 |
$288.96 |
$288.96 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$330.96 |
$330.96 |
$330.96 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$258.72 |
$258.72 |
$258.72 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$215.88 |
$215.88 |
$215.88 |
$236.60
|
|
Diagnostic laryngoscopy 31575
|
$305.76 |
$305.76 |
$305.76 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$258.72 |
$258.72 |
$258.72 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$258.72 |
$258.72 |
$258.72 |
$301.55
|
|
Dialysis one evaluation
|
$3,291.12 |
$3,291.12 |
$3,291.12 |
$919.55
|
|
Diatrizoate meglumine 18 % urethral solution
|
$83.58 |
$83.58 |
$83.58 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$153.51 |
$153.51 |
$153.51 |
$74.76
|
|
Dicyclomine injection
|
$322.90 |
$322.90 |
$322.90 |
$153.29
|
|
Diffusing capacity
|
$535.08 |
$535.08 |
$535.08 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$530.98 |
$530.98 |
$530.98 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$20,159.63 |
$20,159.63 |
$20,159.63 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$134.40 |
$134.40 |
$134.40 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$4,703.66 |
$4,703.66 |
$4,703.66 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$1,706.88 |
$1,706.88 |
$1,706.88 |
$1,866.73
|
|
Dilate esophagus
|
$678.72 |
$678.72 |
$678.72 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$1,092.84 |
$1,092.84 |
$1,092.84 |
$1,484.17
|
|
Dilate urethra stricture
|
$363.72 |
$363.72 |
$363.72 |
$490.00
|
|
Dilate urethra stricture
|
$277.20 |
$277.20 |
$277.20 |
$200.80
|
|
Dilation/female urethra/initial 53660
|
$231.84 |
$231.84 |
$231.84 |
$235.61
|
|
Dilation/urethral strict/male/ini 53620
|
$2,298.24 |
$2,298.24 |
$2,298.24 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$816.48 |
$816.48 |
$816.48 |
$402.10
|
|
Dimethyl sulfoxide 50% 50 ml
|
$2,242.47 |
$2,242.47 |
$2,242.47 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$83.58 |
$83.58 |
$83.58 |
$17.75
|
|
Disability dlco
|
$635.88 |
$635.88 |
$635.88 |
$282.40
|
|
Disaccharidases
|
$787.08 |
$787.08 |
$787.08 |
$216.00
|
|
Dna antibody native/double stranded
|
$312.48 |
$312.48 |
$312.48 |
$97.50
|
|
Dna gardnerella
|
$87.36 |
$87.36 |
$87.36 |
$62.50
|
|
Dna probe chlamydia
|
$122.64 |
$122.64 |
$122.64 |
$79.38
|
|
Dna probe gc
|
$98.28 |
$98.28 |
$98.28 |
$80.80
|
|
Dna trichomonas
|
$206.64 |
$206.64 |
$206.64 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$173.67 |
$173.67 |
$173.67 |
$98.43
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$2,145.50 |
$2,145.50 |
$2,145.50 |
$904.81
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$173.67 |
$173.67 |
$173.67 |
$65.40
|
|
Doppler echo complete
|
$311.64 |
$311.64 |
$311.64 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$713.16 |
$713.16 |
$713.16 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$750.96 |
$750.96 |
$750.96 |
$471.17
|
|
Dornhoffer fixed part w/window
|
$23,058.11 |
$23,058.11 |
$23,058.11 |
$34,278.00
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$47,612.84 |
$47,612.84 |
$47,612.84 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$814.89 |
$814.89 |
$814.89 |
$423.95
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$6,365.52 |
$6,365.52 |
$6,365.52 |
$1,718.24
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$486.36 |
$486.36 |
$486.36 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$560.28 |
$560.28 |
$560.28 |
$914.34
|
|
Drainage external ear simple 69000
|
$441.84 |
$441.84 |
$441.84 |
$789.60
|
|
Drainage mouth roof lesion
|
$381.36 |
$381.36 |
$381.36 |
$390.39
|
|
Drainage of arm bursa 23931
|
$719.88 |
$719.88 |
$719.88 |
$2,197.48
|
|
Drainage of nose lesion sept 30020
|
$649.32 |
$649.32 |
$649.32 |
$781.44
|
|
Drainage of rectal abscess
|
$812.28 |
$812.28 |
$812.28 |
$2,111.46
|
|
Drain blood from under nail 11740
|
$135.24 |
$135.24 |
$135.24 |
$170.50
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$3,122.28 |
$3,122.28 |
$3,122.28 |
$2,540.00
|
|
Drain cath image guided visceral pq
|
$1,656.48 |
$1,656.48 |
$1,656.48 |
$2,850.35
|
|
Drain chst dry seal exp thorastat
|
$184.74 |
$184.74 |
$184.74 |
$119.43
|
|
Drain finger abscess;simple 26010
|
$832.44 |
$832.44 |
$832.44 |
$419.00
|
|
Drain lower leg lesion 27603
|
$3,026.52 |
$3,026.52 |
$3,026.52 |
$3,858.40
|
|
Drain neck/chest lesion 21501
|
$2,972.76 |
$2,972.76 |
$2,972.76 |
$3,339.00
|
|
Drain thigh/knee lesion 27301
|
$2,026.92 |
$2,026.92 |
$2,026.92 |
$3,620.47
|
|
Drain thyroid/tongue cyst
|
$837.48 |
$837.48 |
$837.48 |
$1,752.89
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$379.68 |
$379.68 |
$379.68 |
$392.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$261.24 |
$261.24 |
$261.24 |
$344.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$570.36 |
$570.36 |
$570.36 |
$523.00
|
|
Dressing change not for burn w/anes 15852
|
$614.04 |
$614.04 |
$614.04 |
$755.08
|
|
Drng appendix abscess open 44900
|
$1,774.08 |
$1,774.08 |
$1,774.08 |
$1,453.80
|
|
Drng of eyelid abscess 67700
|
$683.76 |
$683.76 |
$683.76 |
$648.00
|
|
Drng of hydrocele 55000
|
$247.80 |
$247.80 |
$247.80 |
$832.60
|
|
Drng of scrotum abscess 55100
|
$1,214.64 |
$1,214.64 |
$1,214.64 |
$1,917.33
|
|
Dronabinol 2.5mg oral
|
$1,360.13 |
$1,360.13 |
$1,360.13 |
$10.17
|
|
Droperidol 2.5 mg/ml injection solution
|
$83.58 |
$83.58 |
$83.58 |
$31.07
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$1,004.85 |
$1,004.85 |
$1,004.85 |
$1,956.48
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$3,903.80 |
$3,903.80 |
$3,903.80 |
$127.14
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$3,080.84 |
$3,080.84 |
$3,080.84 |
$289.05
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$12,789.79 |
$12,789.79 |
$12,789.79 |
$8,040.27
|
|
Drug assay caffeine
|
$82.32 |
$82.32 |
$82.32 |
$83.40
|
|
Drug assay voriconazole
|
$189.84 |
$189.84 |
$189.84 |
$96.75
|
|
Drug of abuse screen urine
|
$202.44 |
$202.44 |
$202.44 |
$63.75
|
