|
Decitabine 50 mg intravenous solution
|
$2,191.00 |
$2,191.00 |
$3,901.08 |
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$553.60 |
$553.60 |
$672.80 |
|
|
Decompress fasciotomyhand 26037
|
$3,498.40 |
$3,498.40 |
$3,498.40 |
|
|
Decompression unspecified nerve 64722
|
$2,944.00 |
$2,944.00 |
$2,944.00 |
|
|
Decompress small bowel
|
$969.60 |
$969.60 |
$969.60 |
|
|
Deep muscle biopsy 20205
|
$4,823.20 |
$4,823.20 |
$4,823.20 |
|
|
Deferoxamine 500 mg solution for injection
|
$33.73 |
$63.46 |
$133.18 |
|
|
Degarelix 120 mg subcutaneous solution
|
$1,050.66 |
$1,050.66 |
$1,533.16 |
|
|
Delivery of placenta 59414
|
$1,064.80 |
$1,064.80 |
$3,271.20 |
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$12,841.60 |
$12,841.60 |
$13,281.60 |
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$158.40 |
$208.80 |
$248.80 |
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$2,714.98 |
$2,735.52 |
$7,899.65 |
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$380.80 |
$401.60 |
$572.80 |
|
|
Depo-estradiol cypionate inj
|
$88.06 |
$88.06 |
$88.06 |
|
|
Descend thora aorta rpr/lt sub art 33880
|
$8,108.80 |
$8,108.80 |
$10,796.00 |
|
|
Design mlc device for imrt
|
$815.20 |
$815.20 |
$1,980.80 |
|
|
Desmopressin 4 mcg/ml injection solution
|
$27.37 |
$60.29 |
$85.94 |
|
|
Des thora aorta rpr without left sub art 33881
|
$8,108.80 |
$8,108.80 |
$10,796.00 |
|
|
Des thor aorta/prox ext prosth/ini 33883
|
$1,998.40 |
$1,998.40 |
$5,459.20 |
|
|
Destroy cervthor facet jnt 64633
|
$3,164.80 |
$3,164.80 |
$3,404.80 |
|
|
Destroy cth facet jnt addl 64634
|
$629.60 |
$629.60 |
$1,268.80 |
|
|
Destruct cut vasl lesions 10-50cm 17107
|
$656.00 |
$656.00 |
$656.00 |
|
|
Destruction anal lesion(s)
|
$3,071.20 |
$3,071.20 |
$3,071.20 |
|
|
Destruction benign lesions < 14 lesions
|
$262.40 |
$262.40 |
$262.40 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,612.80 |
$1,612.80 |
$1,659.20 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,221.60 |
$3,221.60 |
$3,500.80 |
|
|
Developmental screen/score/document 96110
|
$128.80 |
$128.80 |
$128.80 |
|
|
Devel tst phys/qhp 1st hr
|
$572.00 |
$572.00 |
$572.00 |
|
|
Device ablt adv novasure
|
$11,880.00 |
$11,880.00 |
$12,960.00 |
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$4,400.00 |
$4,400.00 |
$5,600.00 |
|
|
Device intraute mirena
|
$692.26 |
$692.26 |
$850.52 |
|
|
Device sut capio slim opn
|
$1,668.91 |
$1,668.91 |
$1,668.91 |
|
|
Device tiss remov myosure reach
|
$2,631.20 |
$2,631.20 |
$2,631.20 |
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$286.40 |
$286.40 |
$286.40 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$95.20 |
$138.40 |
$291.20 |
|
|
Dexamethasone 4 mg tablet
|
$3.52 |
$24.00 |
$92.28 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$26.95 |
$35.19 |
$48.65 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,154.43 |
$1,154.43 |
$1,642.66 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$16.80 |
$40.00 |
$60.00 |
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$40.00 |
$40.00 |
$40.00 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$60.00 |
$60.00 |
$100.00 |
|
|
Dextrose 5 % IV bolus
|
$40.00 |
$40.00 |
$60.00 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$128.00 |
$128.00 |
$128.00 |
|
|
Diabetes (HbA1c) Test
|
$55.20 |
$55.20 |
$55.20 |
|
|
Diab manage trn ind/group
|
$64.00 |
$64.00 |
$64.00 |
|
|
Diag bronchoscope/catheter
|
$2,948.00 |
$2,948.00 |
$2,948.00 |
|
|
Diagnostic anoscopy spx 46600
|
$264.80 |
$264.80 |
$531.20 |
|
|
Diagnostic digital breast tomosynthesis bil
|
$332.80 |
$332.80 |
$454.40 |
|
|
Diagnostic digital breast tomosynthesis unil
|
$270.40 |
$270.40 |
$433.60 |
|
|
Diagnostic laryngoscopy 31505
|
$304.80 |
$304.80 |
$569.60 |
|
|
Diagnostic laryngoscopy 31575
|
$475.20 |
$475.20 |
$789.60 |
|
|
Diagnostic Mammogram (both breasts)
|
$465.60 |
$474.40 |
$494.40 |
|
|
Diagnostic Mammogram (one breast)
|
$389.60 |
$389.60 |
$419.20 |
|
|
Diagnostic radio unlisted proc
|
$317.60 |
$317.60 |
$766.40 |
|
|
Dialysis circuit perm vascular embolization 36909
|
$14,204.00 |
$14,204.00 |
$18,169.60 |
|
|
Dialysis one evaluation
|
$920.00 |
$920.00 |
$920.00 |
|
|
Diatrizoate meglumine 18 % urethral solution
|
$18.00 |
$18.00 |
$60.00 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$29.63 |
$33.60 |
$41.45 |
|
|
Dicyclomine injection
|
$70.08 |
$70.08 |
$298.17 |
|
|
Difelikefalin, esrd on dialy
|
$444.00 |
$444.00 |
$444.00 |
|
|
Diffusing capacity
|
$360.80 |
$360.80 |
$402.40 |
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$28.30 |
$28.68 |
$371.64 |
|
|
Digoxin immune fab 40 mg intravenous solution
|
$5,266.96 |
$5,266.96 |
$6,604.30 |
|
|
Digoxin total therapeutic drug level
|
$73.60 |
$73.60 |
$73.60 |
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$97.56 |
$361.34 |
$925.51 |
|
|
Dilate biliary duct/ampulla
|
$4,451.20 |
$4,451.20 |
$4,924.00 |
|
|
Dilate esophagus
|
$2,228.80 |
$2,228.80 |
$2,228.80 |
|
|
Dilate esophagus 1/mult pass
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$1,523.20 |
$1,523.20 |
$1,523.20 |
|
|
Dilate ic vasospasm ea add vsl same territory
|
$2,529.60 |
$2,529.60 |
$2,529.60 |
|
|
Dilate ic vasospasm init
|
$5,250.40 |
$5,250.40 |
$5,250.40 |
|
|
Dilate urethra stricture
|
$618.40 |
$618.40 |
$622.40 |
|
|
Dilate urethra stricture
|
$201.60 |
$201.60 |
$201.60 |
|
|
Dilate urethra stricture
|
$2,410.40 |
$2,410.40 |
$4,020.80 |
|
|
Dilate urethra stricture
|
$479.20 |
$479.20 |
$479.20 |
|
|
Dilation/female urethra/initial 53660
|
$222.40 |
$222.40 |
$222.40 |
|
|
Dilation of anal sphincter
|
$2,541.60 |
$2,541.60 |
$2,541.60 |
|
|
Dilation of cervical canal 57800
|
$3,652.00 |
$3,652.00 |
$3,652.00 |
|
|
Dilation of rectal stricture 45910
|
$3,159.20 |
$3,159.20 |
$3,159.20 |
|
|
Dilation of urethra
|
$2,871.20 |
$2,871.20 |
$2,871.20 |
|
|
Dilation/urethral strict/male/ini 53620
|
$2,622.40 |
$2,622.40 |
$3,261.60 |
|
|
Dilator fascial 10fx20cm
|
$597.00 |
$597.00 |
$716.40 |
|
|
Dilat xst trc ndurlgc px
|
$4,952.80 |
$4,952.80 |
$7,204.00 |
|
|
Dilat xst trc new access rcs
|
$4,952.80 |
$4,952.80 |
$8,915.20 |
|
|
Diltiazem 5 mg/ml intravenous solution
|
$10.84 |
$16.80 |
$35.60 |
|
|
Dimenhydrinate injection
|
$27.81 |
$27.81 |
$27.81 |
|
|
Dimethyl sulfoxide 50% 50 ml
|
$491.85 |
$491.85 |
$976.00 |
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$1.20 |
$2.40 |
$3.40 |
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$16.80 |
$26.42 |
$27.96 |
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$91.53 |
$133.60 |
$133.60 |
|
|
Dipyridamole injection
|
$16.80 |
$16.80 |
$16.80 |
|
|
Disability dlco
|
$404.00 |
$404.00 |
$404.00 |
|
|
Discography cerv/thor spine
|
$3,023.20 |
$3,023.20 |
$3,023.20 |
|
|
Dise eval slp do brth flx dx
|
$2,142.40 |
$2,142.40 |
$2,142.40 |
|
|
Dist revas ligation hemo
|
$6,732.80 |
$6,732.80 |
$6,732.80 |
|
|
Dlyd plmt xtn prosth ea addl
|
$4,280.00 |
$4,280.00 |
$8,000.00 |
|
|
Dna antibody native/double stranded
|
$80.00 |
$80.00 |
$80.00 |
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$69.20 |
$85.27 |
$146.88 |
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$848.95 |
$848.95 |
$1,279.00 |
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$54.81 |
$91.20 |
$111.88 |
|
