|
Dextrose 5 % and lactated ringers intravenous solution
|
$183.20 |
$183.20 |
$183.20 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$121.60 |
$121.60 |
$121.60 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$153.60 |
$153.60 |
$153.60 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$334.20 |
$334.20 |
$334.20 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$158.40 |
$158.40 |
$158.40 |
$79.30
|
|
Diab manage trn ind/group
|
$93.00 |
$93.00 |
$93.00 |
$54.99
|
|
Diagnostic anoscopy spx 46600
|
$389.40 |
$389.40 |
$389.40 |
$195.50
|
|
Diagnostic laryngoscopy 31575
|
$856.80 |
$856.80 |
$856.80 |
$338.00
|
|
Diagnostic Mammogram (one breast)
|
$336.60 |
$336.60 |
$336.60 |
$314.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$5,287.20 |
$5,287.20 |
$5,287.20 |
$5,741.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$1.40 |
$1.40 |
$1.40 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$17.40 |
$17.40 |
$17.40 |
$79.71
|
|
Dicyclomine injection
|
$20.20 |
$20.20 |
$20.20 |
$154.33
|
|
Diffusing capacity
|
$360.00 |
$360.00 |
$360.00 |
$336.80
|
|
Digital analysis of eeg
|
$642.00 |
$642.00 |
$642.00 |
$593.40
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.00 |
$19.00 |
$19.00 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$11,176.80 |
$11,176.80 |
$11,176.80 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$198.60 |
$198.60 |
$198.60 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$518.40 |
$518.40 |
$518.40 |
$297.86
|
|
Dilate esophagus 1/mult pass
|
$2,281.20 |
$2,281.20 |
$2,281.20 |
$1,548.00
|
|
Dilate urethra stricture
|
$840.60 |
$840.60 |
$840.60 |
$513.00
|
|
Dilation/urethral strict/male/ini 53620
|
$1,288.80 |
$1,288.80 |
$1,288.80 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$680.40 |
$680.40 |
$680.40 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$2,332.20 |
$2,332.20 |
$2,332.20 |
$3,900.60
|
|
Dimenhydrinate injection
|
$14.40 |
$14.40 |
$14.40 |
$30.48
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$14.40 |
$14.40 |
$14.40 |
$18.32
|
|
Disability dlco
|
$225.00 |
$225.00 |
$225.00 |
$293.76
|
|
Disaccharidases
|
$370.80 |
$370.80 |
$370.80 |
$230.40
|
|
Dna antibody native/double stranded
|
$204.00 |
$204.00 |
$204.00 |
$100.00
|
|
Dna gardnerella
|
$203.40 |
$203.40 |
$203.40 |
$61.83
|
|
Dna probe chlamydia
|
$281.40 |
$281.40 |
$281.40 |
$82.20
|
|
Dna trichomonas
|
$213.60 |
$213.60 |
$213.60 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$303.00 |
$303.00 |
$303.00 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$70.40 |
$70.40 |
$70.40 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$22.80 |
$22.80 |
$22.80 |
$65.40
|
|
Doppler echo complete
|
$551.40 |
$551.40 |
$551.40 |
$558.00
|
|
Doppler intravascular pressure flow initial vessel
|
$981.60 |
$981.60 |
$981.60 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$551.40 |
$551.40 |
$551.40 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$391.80 |
$391.80 |
$391.80 |
$481.65
|
|
Dornase alfa non-comp unit
|
$231.20 |
$231.20 |
$231.20 |
$356.00
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$503.20 |
$503.20 |
$503.20 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$1,848.60 |
$1,848.60 |
$1,848.60 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$0.18 |
$0.18 |
$0.18 |
$89.34
|
|
Dpyd gene common variants
|
$2,524.20 |
$2,524.20 |
$2,524.20 |
$423.60
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$543.60 |
$543.60 |
$543.60 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$2,815.20 |
$2,815.20 |
$2,815.20 |
$964.00
|
|
Drainage external ear simple 69000
|
$856.80 |
$856.80 |
$856.80 |
$790.40
|
|
Drainage mouth roof lesion
|
$2,565.00 |
$2,565.00 |
$2,565.00 |
$405.60
|
|
Drainage of kidney lesion
|
$2,790.00 |
$2,790.00 |
$2,790.00 |
$1,506.00
|
|
Drainage of mouth lesion
|
$2,815.20 |
$2,815.20 |
$2,815.20 |
$3,837.72
|
|
Drainage of mouth lesion
|
$2,710.80 |
$2,710.80 |
$2,710.80 |
$3,459.00
|
|
Drainage of nose lesion int 30000
|
$9,009.00 |
$9,009.00 |
$9,009.00 |
$548.00
|
|
Drainage of nose lesion sept 30020
|
$8,550.60 |
$8,550.60 |
$8,550.60 |
$781.44
|
|
Drainage of prostate abscess
|
$3,097.80 |
$3,097.80 |
$3,097.80 |
$3,863.60
|
|
Drainage of rectal abscess
|
$3,055.20 |
$3,055.20 |
$3,055.20 |
$2,135.10
|
|
Drainage of rectal abscess 45020
|
$3,324.00 |
$3,324.00 |
$3,324.00 |
$3,816.64
|
|
Drain blood from under nail 11740
|
$388.80 |
$388.80 |
$388.80 |
$182.40
|
|
Drain cath image guided visceral pq
|
$7,281.60 |
$7,281.60 |
$7,281.60 |
$2,903.44
|
|
Drain finger abscess;simple 26010
|
$272.40 |
$272.40 |
$272.40 |
$428.40
|
|
Drain thigh/knee lesion 27301
|
$4,321.20 |
$4,321.20 |
$4,321.20 |
$3,986.00
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$471.00 |
$471.00 |
$471.00 |
$397.65
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$388.80 |
$388.80 |
$388.80 |
$349.50
|
|
Drng of eyelid abscess 67700
|
$5,161.80 |
$5,161.80 |
$5,161.80 |
$655.72
|
|
Drng of finger abscess comp 26011
|
$2,281.20 |
$2,281.20 |
$2,281.20 |
$2,079.50
|
|
Drng of scrotum abscess 55100
|
$3,329.40 |
$3,329.40 |
$3,329.40 |
$1,997.89
|
|
Droperidol 2.5 mg/ml injection solution
|
$20.20 |
$20.20 |
$20.20 |
$31.25
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$2,118.60 |
$2,118.60 |
$2,118.60 |
$1,818.32
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$22,306.80 |
$22,306.80 |
$22,306.80 |
$7,465.97
|
|
Drug assay vedolizumab
|
$203.40 |
$203.40 |
$203.40 |
$154.00
|
|
Drug of abuse screen urine
|
$425.40 |
$425.40 |
$425.40 |
$67.89
|
|
Drug test def 1-7 classes
|
$496.80 |
$496.80 |
$496.80 |
$263.25
|
|
Drug test def 8-14 classes
|
$425.40 |
$425.40 |
$425.40 |
$289.80
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$292.80 |
$292.80 |
$292.80 |
$278.85
|
|
Drvvt confirm - quest
|
$370.80 |
$370.80 |
$370.80 |
$109.20
|
|
Dstrj nulyt agt gnclr nrv
|
$3,961.20 |
$3,961.20 |
$3,961.20 |
$2,980.00
|
|
Duplex scan bilateral study 93985
|
$791.40 |
$791.40 |
$791.40 |
$691.08
|
|
Duplex scan unilateral study 93986
|
$395.40 |
$395.40 |
$395.40 |
$369.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$885.60 |
$885.60 |
$885.60 |
$904.78
|
|
Dx bronchoscope/lavage 31624
|
$3,761.40 |
$3,761.40 |
$3,761.40 |
$2,446.60
|
|
Dx bronchoscope/wash 31622
|
$2,281.20 |
$2,281.20 |
$2,281.20 |
$2,410.50
|
|
Ear irrigation 69209
|
$76.80 |
$76.80 |
$76.80 |
$154.70
|
|
Ecg/1-3 leads/tracing only 93041
|
$47.40 |
$47.40 |
$47.40 |
$132.08
|
|
Ecg < 30 days transmission & analysis
|
$2,124.60 |
$2,124.60 |
$2,124.60 |
$412.88
|
|
Ecg external < 48 hours recording
|
$430.80 |
$430.80 |
$430.80 |
$467.40
|
|
Ecg external < 48 hours scanning analysis w/report
|
$761.40 |
$761.40 |
$761.40 |
$541.20
|
|
Ecg external > 48 hours up to 7 days recording
|
$71.40 |
$71.40 |
$71.40 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$70.80 |
$70.80 |
$70.80 |
$173.40
|
|
Echocardiogram (Heart Ultrasound)
|
$1,759.20 |
$1,759.20 |
$1,759.20 |
$2,024.64
|
|
Echocardiogram (Limited Follow-Up Heart Ultrasound)
|
$487.20 |
$487.20 |
$487.20 |
$720.60
|
|
Echocardiography doppler color flow mapping
|
$596.40 |
$596.40 |
$596.40 |
$511.55
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$2,521.80 |
$2,521.80 |
$2,521.80 |
$1,944.80
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$487.20 |
$487.20 |
$487.20 |
$866.87
|
|
Echo tee probe placement image acquisition interpretation & report
|
$1,324.20 |
$1,324.20 |
$1,324.20 |
$1,913.60
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$900.00 |
$900.00 |
$900.00 |
$1,033.00
|
|
Ecmo/ecls initiation artery 33947
|
$1,218.60 |
$1,218.60 |
$1,218.60 |
$3,950.10
|
|
Ecmo/ecls insj prph cannula 6yrs&older perq 33952
|
$1,538.40 |
$1,538.40 |
$1,538.40 |
$2,660.16
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$553.60 |
$553.60 |
$553.60 |
$19,540.29
|
|
Eculizumab injection
|
$62,315.40 |
$62,315.40 |
$62,315.40 |
$16,330.48
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$326.40 |
$326.40 |
$326.40 |
$994.15
|
|
Eeg during surgery
|
$619.20 |
$619.20 |
$619.20 |
$775.45
|
