|
Cystoscopy (Bladder Scope)
|
$1,995.50 |
$1,995.50 |
$1,995.50 |
$1,493.80
|
|
Cystoscopy removal of clots
|
$10,312.25 |
$10,312.25 |
$10,312.25 |
$4,081.37
|
|
Cystourethroscop/calib/dilat stric 52281
|
$6,124.95 |
$6,124.95 |
$6,124.95 |
$3,245.90
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$6,124.95 |
$6,124.95 |
$6,124.95 |
$4,057.50
|
|
Cytarabine 20 mg/ml injection solution
|
$4.11 |
$4.11 |
$4.11 |
$90.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$64.35 |
$64.35 |
$64.35 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$75.40 |
$75.40 |
$75.40 |
$100.00
|
|
Cytomegalovirus imm IV /vial
|
$84.69 |
$84.69 |
$84.69 |
$3,072.34
|
|
Cytopathology cellular enhancement technique non-gyn
|
$239.85 |
$239.85 |
$239.85 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$119.60 |
$119.60 |
$119.60 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$91.00 |
$91.00 |
$91.00 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$176.15 |
$176.15 |
$176.15 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$176.15 |
$176.15 |
$176.15 |
$127.50
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$95.55 |
$95.55 |
$95.55 |
$68.06
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$168.35 |
$168.35 |
$168.35 |
$191.66
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$239.85 |
$239.85 |
$239.85 |
$213.85
|
|
Cytopath smear other source
|
$109.85 |
$109.85 |
$109.85 |
$92.50
|
|
Cytopath smear oth prep screen & interp
|
$109.85 |
$109.85 |
$109.85 |
$96.20
|
|
Dacarbazine 100 mg intravenous solution
|
$38.66 |
$38.66 |
$38.66 |
$62.41
|
|
Dactinomycin 0.5 mg intravenous solution
|
$1,725.75 |
$1,725.75 |
$1,725.75 |
$3,264.26
|
|
Dalbavancin 500 mg intravenous solution
|
$4,162.86 |
$4,162.86 |
$4,162.86 |
$3,493.11
|
|
Dalteparin sodium
|
$1,847.31 |
$1,847.31 |
$1,847.31 |
$469.55
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$1,649.21 |
$1,649.21 |
$1,649.21 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$9,055.80 |
$9,055.80 |
$9,055.80 |
$6,281.29
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$34,257.60 |
$34,257.60 |
$34,257.60 |
$20,196.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$104.62 |
$104.62 |
$104.62 |
$259.58
|
|
Dch validity tests
|
$15.60 |
$15.60 |
$15.60 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$53.95 |
$53.95 |
$53.95 |
$43.35
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,593.80 |
$1,593.80 |
$1,593.80 |
$702.28
|
|
Decalcification
|
$68.90 |
$68.90 |
$68.90 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
$1,073.52
|
|
Deferoxamine 500 mg solution for injection
|
$96.41 |
$96.41 |
$96.41 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$2,377.73 |
$2,377.73 |
$2,377.73 |
$1,856.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$608.40 |
$608.40 |
$608.40 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$4,748.46 |
$4,748.46 |
$4,748.46 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$385.45 |
$385.45 |
$385.45 |
$401.60
|
|
Depo-estradiol cypionate inj
|
$120.72 |
$120.72 |
$120.72 |
$71.51
|
|
Dermapure 1 square cm
|
$1,751.75 |
$1,751.75 |
$1,751.75 |
$3,300.73
|
|
Desmopressin 4 mcg/ml injection solution
|
$185.38 |
$185.38 |
$185.38 |
$91.84
|
|
Desoxycorticosterone
|
$139.10 |
$139.10 |
$139.10 |
$109.28
|
|
Determine refractive state
|
$9.75 |
$9.75 |
$9.75 |
$21.50
|
|
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
|
$0.02 |
$0.02 |
$0.02 |
$36.05
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$0.27 |
$0.27 |
$0.27 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$0.88 |
$0.88 |
$0.88 |
$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
|
|
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 Mammogram (both breasts)
|
$458.90 |
$458.90 |
$458.90 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$365.95 |
$365.95 |
$365.95 |
$314.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.72 |
$0.72 |
$0.72 |
$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 urethra stricture
|
$727.35 |
$727.35 |
$727.35 |
$513.00
|
|
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
|
|
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
|
$0.90 |
$0.90 |
$0.90 |
$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 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
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$2,104.05 |
$2,104.05 |
$2,104.05 |
$800.00
|
|
Drainage external ear simple 69000
|
$1,829.10 |
$1,829.10 |
$1,829.10 |
$790.40
|
|
Drain blood from under nail 11740
|
$251.55 |
$251.55 |
$251.55 |
$182.40
|
|
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 thigh/knee lesion 27301
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,986.00
|
|
Drain thyroid/tongue cyst
|
$3,851.25 |
$3,851.25 |
$3,851.25 |
$1,752.89
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$387.40 |
$387.40 |
$387.40 |
$397.65
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$387.40 |
$387.40 |
$387.40 |
$349.50
|