|
Daptomycin 500 mg/10 ml intravenous solution
|
$491.59 |
$491.59 |
$491.59 |
$362.16
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$855.06 |
$855.06 |
$855.06 |
$5,500.25
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$148.22 |
$148.22 |
$148.22 |
$300.73
|
|
Dch validity tests
|
$7.59 |
$7.59 |
$7.59 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$9.43 |
$9.43 |
$9.43 |
$44.16
|
|
Debridement (>20 cm) charge pt
|
$138.17 |
$138.17 |
$138.17 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$2,329.01 |
$2,329.01 |
$2,329.01 |
$2,553.60
|
|
Debridement/bone/20 sq cm or less 11046
|
$545.51 |
$545.51 |
$545.51 |
$688.80
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$962.27 |
$962.27 |
$962.27 |
$1,283.44
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$612.95 |
$612.95 |
$612.95 |
$810.50
|
|
Debride nail1-5 11720
|
$33.62 |
$33.62 |
$33.62 |
$173.25
|
|
Debride nail6 or more 11721
|
$56.79 |
$56.79 |
$56.79 |
$195.20
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$263.63 |
$263.63 |
$263.63 |
$663.30
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,556.77 |
$1,556.77 |
$1,556.77 |
$1,193.40
|
|
Decalcification
|
$8.41 |
$8.41 |
$8.41 |
$73.60
|
|
Decitabine 50 mg intravenous solution
|
$920.45 |
$920.45 |
$920.45 |
$1,350.27
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$592.04 |
$592.04 |
$592.04 |
$545.90
|
|
Deferoxamine 500 mg solution for injection
|
$34.24 |
$34.24 |
$34.24 |
$96.41
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$61.71 |
$61.71 |
$61.71 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$931.93 |
$931.93 |
$931.93 |
$6,508.51
|
|
Dermagraft
|
$1,356.08 |
$1,356.08 |
$1,356.08 |
$252.49
|
|
Desmopressin 4 mcg/ml injection solution
|
$74.01 |
$74.01 |
$74.01 |
$116.22
|
|
Desoxycorticosterone
|
$29.52 |
$29.52 |
$29.52 |
$109.28
|
|
Destroy cervthor facet jnt 64633
|
$645.96 |
$645.96 |
$645.96 |
$3,164.80
|
|
Destroy cth facet jnt addl 64634
|
$376.18 |
$376.18 |
$376.18 |
$1,441.44
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$376.18 |
$376.18 |
$376.18 |
$1,879.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$645.96 |
$645.96 |
$645.96 |
$3,375.00
|
|
Developmental screen/score/document 96110
|
$78.93 |
$78.93 |
$78.93 |
$139.10
|
|
Devel tst phys/qhp 1st hr
|
$163.18 |
$163.18 |
$163.18 |
$339.30
|
|
Device ablt adv novasure
|
$5,040.54 |
$5,040.54 |
$5,040.54 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$1,763.41 |
$1,763.41 |
$1,763.41 |
$4,298.87
|
|
Device sut capio slim opn
|
$890.52 |
$890.52 |
$890.52 |
$1,946.41
|
|
Device tiss remov myosure reach
|
$1,356.08 |
$1,356.08 |
$1,356.08 |
$2,541.00
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$56.99 |
$56.99 |
$56.99 |
$196.30
|
|
Dexamethasone 4 mg tablet
|
$5.13 |
$5.13 |
$5.13 |
$5.17
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$5.33 |
$5.33 |
$5.33 |
$27.00
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$506.56 |
$506.56 |
$506.56 |
$641.76
|
|
Dextran 40 infusion
|
$36.90 |
$36.90 |
$36.90 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$11.07 |
$11.07 |
$11.07 |
$43.65
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$11.07 |
$11.07 |
$11.07 |
$47.22
|
|
Dextrose 5 % IV bolus
|
$11.07 |
$11.07 |
$11.07 |
$48.58
|
|
Dhea-s (dehydroepiand sulfate)
|
$17.02 |
$17.02 |
$17.02 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$106.19 |
$106.19 |
$106.19 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$246.21 |
$246.21 |
$246.21 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$123.00 |
$123.00 |
$123.00 |
$301.55
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,454.87 |
$3,454.87 |
$3,454.87 |
$7,145.00
|
|
Dialysis one evaluation
|
$742.31 |
$742.31 |
$742.31 |
$842.10
|
|
Diatrizoate meglumine 18 % urethral solution
|
$60.07 |
$60.07 |
$60.07 |
$122.25
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$12.30 |
$12.30 |
$12.30 |
$73.22
|
|
Dicyclomine injection
|
$92.87 |
$92.87 |
$92.87 |
$202.91
|
|
Diffusing capacity
|
$179.99 |
$179.99 |
$179.99 |
$360.10
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$145.14 |
$145.14 |
$145.14 |
$78.40
|
|
Digoxin immune fab 40 mg intravenous solution
|
$947.72 |
$947.72 |
$947.72 |
$10,388.97
|
|
Digoxin total therapeutic drug level
|
$198.24 |
$198.24 |
$198.24 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$86.31 |
$86.31 |
$86.31 |
$309.20
|
|
Dilate ic vasospasm init
|
$1,973.33 |
$1,973.33 |
$1,973.33 |
$6,280.95
|
|
Dilate urethra stricture
|
$220.58 |
$220.58 |
$220.58 |
$514.79
|
|
Dilator fascial 10fx20cm
|
$213.82 |
$213.82 |
$213.82 |
$335.13
|
|
Dilat xst trc ndurlgc px
|
$1,204.99 |
$1,204.99 |
$1,204.99 |
$4,081.37
|
|
Dilat xst trc new access rcs
|
$1,204.99 |
$1,204.99 |
$1,204.99 |
$5,020.00
|
|
Dimecaprol injection
|
$91.02 |
$91.02 |
$91.02 |
$390.78
|
|
Dimenhydrinate injection
|
$6.36 |
$6.36 |
$6.36 |
$17.32
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$5.33 |
$5.33 |
$5.33 |
$24.70
|
|
Disability dlco
|
$120.34 |
$120.34 |
$120.34 |
$307.58
|
|
Disaccharidases
|
$204.80 |
$204.80 |
$204.80 |
$223.80
|
|
Discography cerv/thor spine
|
$983.39 |
$983.39 |
$983.39 |
$2,404.00
|
|
Dlyd plmt xtn prosth ea addl
|
$353.83 |
$353.83 |
$353.83 |
$2,001.55
|
|
Dmd dup/delet analysis
|
$292.74 |
$292.74 |
$292.74 |
$385.02
|
|
Dmpk gene detc abnor allele
|
$162.98 |
$162.98 |
$162.98 |
$318.75
|
|
Dna antibody native/double stranded
|
$25.42 |
$25.42 |
$25.42 |
$102.60
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$28.91 |
$28.91 |
$28.91 |
$101.04
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$308.53 |
$308.53 |
$308.53 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$16.20 |
$16.20 |
$16.20 |
$76.20
|
|
Doppler echo complete
|
$461.46 |
$461.46 |
$461.46 |
$608.25
|
|
Doppler intravascular pressure flow initial vessel
|
$2,308.51 |
$2,308.51 |
$2,308.51 |
$3,006.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$473.96 |
$473.96 |
$473.96 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$303.40 |
$303.40 |
$303.40 |
$482.03
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$269.37 |
$269.37 |
$269.37 |
$409.84
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$920.45 |
$920.45 |
$920.45 |
$2,242.17
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$26.86 |
$26.86 |
$26.86 |
$88.05
|
|
Drainage of bladder abscess
|
$1,004.30 |
$1,004.30 |
$1,004.30 |
$3,167.89
|
|
Drainage of kidney lesion
|
$562.93 |
$562.93 |
$562.93 |
$1,706.65
|
|
Drainage of pelvis lesion 26990
|
$1,078.51 |
$1,078.51 |
$1,078.51 |
$3,969.00
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$418.82 |
$418.82 |
$418.82 |
$2,614.66
|
|
Drain cath image guided visceral pq
|
$716.89 |
$716.89 |
$716.89 |
$3,073.90
|
|
Drain cerebro spinal fluid 62272
|
$627.30 |
$627.30 |
$627.30 |
$1,113.06
|
|
Drain lower leg lesion 27603
|
$1,004.30 |
$1,004.30 |
$1,004.30 |
$3,631.18
|
|
Drain neck/chest lesion 21501
|
$1,004.30 |
$1,004.30 |
$1,004.30 |
$3,386.84
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$138.58 |
$138.58 |
$138.58 |
$420.00
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$85.08 |
$85.08 |
$85.08 |
$365.60
|
|
Dress/debrid prtl-thick burn l 16030
|
$247.23 |
$247.23 |
$247.23 |
$554.40
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$6,553.44 |
$6,553.44 |
$6,553.44 |
$6,026.40
|
|
Drill hole implt ventricular cath/device 61107
|
$592.45 |
$592.45 |
$592.45 |
$1,594.26
|
|
Droperidol 2.5 mg/ml injection solution
|
$5.54 |
$5.54 |
$5.54 |
$34.85
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$614.59 |
$614.59 |
$614.59 |
$1,818.32
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$614.59 |
$614.59 |
$614.59 |
$171.12
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$614.59 |
$614.59 |
$614.59 |
$127.14
|
|
Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm
|
$1,356.08 |
$1,356.08 |
$1,356.08 |
$127.14
|
|
Drsg wnd hyalomatrix 10x10cm -cost per sq cm
|
$1,763.41 |
$1,763.41 |
$1,763.41 |
$7,156.03
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$10,112.86 |
$10,112.86 |
$10,112.86 |
$10,534.20
|