|
Destruction penis lesion(s) exten 54065
|
$5,469.10 |
$5,469.10 |
$5,469.10 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$779.35 |
$779.35 |
$779.35 |
$442.61
|
|
Destruct penis les/smp/electrodesi 54055
|
$5,469.10 |
$5,469.10 |
$5,469.10 |
$2,837.09
|
|
Developmental screen/score/document 96110
|
$205.40 |
$205.40 |
$205.40 |
$142.38
|
|
Devel tst phys/qhp 1st hr
|
$702.00 |
$702.00 |
$702.00 |
$350.40
|
|
Device intraute mirena
|
$1,894.83 |
$1,894.83 |
$1,894.83 |
$2,125.00
|
|
Devlopment test interpt&rep
|
$276.25 |
$276.25 |
$276.25 |
$109.46
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$196.30 |
$196.30 |
$196.30 |
$199.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$395.20 |
$395.20 |
$395.20 |
$227.25
|
|
Dexametha opth insert 0.1 mg
|
$998.40 |
$998.40 |
$998.40 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$2.47 |
$2.47 |
$2.47 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$17.55 |
$17.55 |
$17.55 |
$20.76
|
|
Dexamethasone intra implant
|
$3,119.22 |
$3,119.22 |
$3,119.22 |
$2,356.90
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$641.76 |
$641.76 |
$641.76 |
$884.80
|
|
Dextran 40 infusion
|
$1.54 |
$1.54 |
$1.54 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$1.37 |
$1.37 |
$1.37 |
$36.05
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$4.88 |
$4.88 |
$4.88 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$17.55 |
$17.55 |
$17.55 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$99.45 |
$99.45 |
$99.45 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$43.55 |
$43.55 |
$43.55 |
$79.30
|
|
Diabetic custom molded shoe
|
$192.40 |
$192.40 |
$192.40 |
$269.36
|
|
Diab manage trn ind/group
|
$78.65 |
$78.65 |
$78.65 |
$54.99
|
|
Diagnostic anoscopy
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$392.70
|
|
Diagnostic anoscopy & biopsy
|
$3,525.60 |
$3,525.60 |
$3,525.60 |
$2,288.00
|
|
Diagnostic anoscopy spx 46600
|
$385.45 |
$385.45 |
$385.45 |
$195.50
|
|
Diagnostic digital breast tomosynthesis bil
|
$87.10 |
$87.10 |
$87.10 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$72.15 |
$72.15 |
$72.15 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$490.75 |
$490.75 |
$490.75 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$580.45 |
$580.45 |
$580.45 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$458.90 |
$458.90 |
$458.90 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$365.95 |
$365.95 |
$365.95 |
$314.00
|
|
Diagnostic radio unlisted proc
|
$14,116.70 |
$14,116.70 |
$14,116.70 |
$259.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$14,800.50 |
$14,800.50 |
$14,800.50 |
$5,741.00
|
|
Dialysis one evaluation
|
$1,909.70 |
$1,909.70 |
$1,909.70 |
$936.00
|
|
Dialysis repeated eval
|
$3,416.40 |
$3,416.40 |
$3,416.40 |
$1,332.80
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.98 |
$0.98 |
$0.98 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$46.80 |
$46.80 |
$46.80 |
$79.71
|
|
Dicyclomine injection
|
$45.63 |
$45.63 |
$45.63 |
$154.33
|
|
Diffusing capacity
|
$393.25 |
$393.25 |
$393.25 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$335.15 |
$335.15 |
$335.15 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$11,639.16 |
$11,639.16 |
$11,639.16 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$59.80 |
$59.80 |
$59.80 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$245.70 |
$245.70 |
$245.70 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$2,683.85 |
$2,683.85 |
$2,683.85 |
$1,866.73
|
|
Dilate esophagus 1/mult pass
|
$2,803.45 |
$2,803.45 |
$2,803.45 |
$1,548.00
|
|
Dilate urethra stricture
|
$727.35 |
$727.35 |
$727.35 |
$513.00
|
|
Dilate urethra stricture
|
$385.45 |
$385.45 |
$385.45 |
$200.80
|
|
Dilation/female urethra/initial 53660
|
$468.00 |
$468.00 |
$468.00 |
$235.61
|
|
Dilation of cervical canal 57800
|
$9,506.90 |
$9,506.90 |
$9,506.90 |
$4,446.00
|
|
Dilation of urethra
|
$385.45 |
$385.45 |
$385.45 |
$172.00
|
|
Dilation/urethral strict/male/ini 53620
|
$1,995.50 |
$1,995.50 |
$1,995.50 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$65.00 |
$65.00 |
$65.00 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$10,312.25 |
$10,312.25 |
$10,312.25 |
$3,900.60
|
|
Dilat xst trc new access rcs
|
$10,312.25 |
$10,312.25 |
$10,312.25 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$26.70 |
$26.70 |
$26.70 |
$45.60
|
|
Dimenhydrinate injection
|
$30.75 |
$30.75 |
$30.75 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$34.14 |
$34.14 |
$34.14 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$7.04 |
$7.04 |
$7.04 |
$18.32
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$287.88 |
$287.88 |
$287.88 |
$98.15
|
|
Dipyridamole injection
|
$4.64 |
$4.64 |
$4.64 |
$48.04
|
|
Disability dlco
|
$468.00 |
$468.00 |
$468.00 |
$293.76
|
|
Disaccharidases
|
$99.45 |
$99.45 |
$99.45 |
$230.40
|
|
Dlyd plmt xtn prosth ea addl
|
$6,670.30 |
$6,670.30 |
$6,670.30 |
$1,810.80
|
|
Dna antibody native/double stranded
|
$61.75 |
$61.75 |
$61.75 |
$100.00
|
|
Dna gardnerella
|
$89.70 |
$89.70 |
$89.70 |
$61.83
|
|
Dna trichomonas
|
$89.70 |
$89.70 |
$89.70 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$18.85 |
$18.85 |
$18.85 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$949.39 |
$949.39 |
$949.39 |
$949.39
|
|
Docetaxel (docivyx), 1 mg
|
$108.86 |
$108.86 |
$108.86 |
$108.86
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$2.07 |
$2.07 |
$2.07 |
$65.40
|
|
Doppler echo complete
|
$866.45 |
$866.45 |
$866.45 |
$558.00
|
|
Doppler intravascular pressure flow initial vessel
|
$3,006.25 |
$3,006.25 |
$3,006.25 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$585.00 |
$585.00 |
$585.00 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$481.65 |
$481.65 |
$481.65 |
$481.65
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$2,871.39 |
$2,871.39 |
$2,871.39 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$820.66 |
$820.66 |
$820.66 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$210.16 |
$210.16 |
$210.16 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$61.62 |
$61.62 |
$61.62 |
$89.34
|
|
Dpyd gene common variants
|
$783.90 |
$783.90 |
$783.90 |
$423.60
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$2,104.05 |
$2,104.05 |
$2,104.05 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$1,829.10 |
$1,829.10 |
$1,829.10 |
$964.00
|
|
Drainage external ear complex 69005
|
$4,212.65 |
$4,212.65 |
$4,212.65 |
$2,888.03
|
|
Drainage external ear simple 69000
|
$1,829.10 |
$1,829.10 |
$1,829.10 |
$790.40
|
|
Drainage mouth roof lesion
|
$694.20 |
$694.20 |
$694.20 |
$405.60
|
|
Drainage of arm bursa 23931
|
$4,844.45 |
$4,844.45 |
$4,844.45 |
$2,271.01
|
|
Drainage of kidney lesion
|
$2,104.05 |
$2,104.05 |
$2,104.05 |
$1,506.00
|
|
Drainage of mouth lesion
|
$694.20 |
$694.20 |
$694.20 |
$535.20
|
|
Drainage of mouth lesion
|
$9,696.70 |
$9,696.70 |
$9,696.70 |
$3,837.72
|
|
Drainage of nose lesion int 30000
|
$694.20 |
$694.20 |
$694.20 |
$548.00
|
|
Drainage of nose lesion sept 30020
|
$1,522.95 |
$1,522.95 |
$1,522.95 |
$781.44
|
|
Drainage of urethra abscess 53060
|
$627.25 |
$627.25 |
$627.25 |
$2,424.12
|
|
Drain blood from under nail 11740
|
$251.55 |
$251.55 |
$251.55 |
$182.40
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$4,844.45 |
$4,844.45 |
$4,844.45 |
$2,540.00
|
|
Drain cath image guided visceral pq
|
$4,844.45 |
$4,844.45 |
$4,844.45 |
$2,903.44
|
|
Drain cerebro spinal fluid 62272
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,044.00
|
|
Drain finger abscess;simple 26010
|
$594.10 |
$594.10 |
$594.10 |
$428.40
|
|
Drain lower leg lesion 27603
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,994.09
|
|
Drain neck/chest lesion 21501
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,339.00
|
|
Drain shoulder lesion
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,904.61
|
|
Drain thigh/knee lesion 27301
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,986.00
|