|
Debridement subcutaneous tissue <= 20 sq cm
|
$825.60 |
$825.60 |
$825.60 |
$835.20
|
|
Debride nail1-5 11720
|
$471.00 |
$471.00 |
$471.00 |
$149.60
|
|
Debride nail6 or more 11721
|
$202.20 |
$202.20 |
$202.20 |
$169.80
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$728.40 |
$728.40 |
$728.40 |
$663.30
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,470.60 |
$1,470.60 |
$1,470.60 |
$1,149.50
|
|
Decalcification
|
$388.20 |
$388.20 |
$388.20 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$5,326.20 |
$5,326.20 |
$5,326.20 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$653.40 |
$653.40 |
$653.40 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$43.20 |
$43.20 |
$43.20 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$2,262.60 |
$2,262.60 |
$2,262.60 |
$1,856.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$64.80 |
$64.80 |
$64.80 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$10,269.00 |
$10,269.00 |
$10,269.00 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$589.80 |
$589.80 |
$589.80 |
$401.60
|
|
Desmopressin 4 mcg/ml injection solution
|
$2,755.80 |
$2,755.80 |
$2,755.80 |
$91.84
|
|
Device ablt adv novasure
|
$9,649.20 |
$9,649.20 |
$9,649.20 |
$6,237.48
|
|
Device intraute mirena
|
$4,133.60 |
$4,133.60 |
$4,133.60 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$2,707.20 |
$2,707.20 |
$2,707.20 |
$2,515.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$127.20 |
$127.20 |
$127.20 |
$227.25
|
|
Dexametha opth insert 0.1 mg
|
$1,432.80 |
$1,432.80 |
$1,432.80 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$5.40 |
$5.40 |
$5.40 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$6.60 |
$6.60 |
$6.60 |
$20.76
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,196.40 |
$1,196.40 |
$1,196.40 |
$884.80
|
|
Dextran 40 infusion
|
$645.60 |
$645.60 |
$645.60 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$32.40 |
$32.40 |
$32.40 |
$36.05
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$29.00 |
$29.00 |
$29.00 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$60.40 |
$60.40 |
$60.40 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$26.80 |
$26.80 |
$26.80 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$184.20 |
$184.20 |
$184.20 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$165.60 |
$165.60 |
$165.60 |
$79.30
|
|
Diagnostic anoscopy spx 46600
|
$2,524.20 |
$2,524.20 |
$2,524.20 |
$195.50
|
|
Diagnostic laryngoscopy 31505
|
$279.60 |
$279.60 |
$279.60 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$256.80 |
$256.80 |
$256.80 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$483.00 |
$483.00 |
$483.00 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$316.80 |
$316.80 |
$316.80 |
$314.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$79.20 |
$79.20 |
$79.20 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$127.20 |
$127.20 |
$127.20 |
$79.71
|
|
Dicyclomine injection
|
$494.40 |
$494.40 |
$494.40 |
$154.33
|
|
Diffusing capacity
|
$412.20 |
$412.20 |
$412.20 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$34.00 |
$34.00 |
$34.00 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$16,441.80 |
$16,441.80 |
$16,441.80 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$126.00 |
$126.00 |
$126.00 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$924.80 |
$924.80 |
$924.80 |
$297.86
|
|
Dilate esophagus 1/mult pass
|
$1,372.80 |
$1,372.80 |
$1,372.80 |
$1,548.00
|
|
Dilator fascial 10fx20cm
|
$845.40 |
$845.40 |
$845.40 |
$402.10
|
|
Dimenhydrinate injection
|
$13.20 |
$13.20 |
$13.20 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$3,160.80 |
$3,160.80 |
$3,160.80 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$16.80 |
$16.80 |
$16.80 |
$18.32
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$24.60 |
$24.60 |
$24.60 |
$98.15
|
|
Disability dlco
|
$234.00 |
$234.00 |
$234.00 |
$293.76
|
|
Disaccharidases
|
$88.80 |
$88.80 |
$88.80 |
$230.40
|
|
Discography cerv/thor spine
|
$1,987.80 |
$1,987.80 |
$1,987.80 |
$2,565.00
|
|
Dna antibody native/double stranded
|
$249.60 |
$249.60 |
$249.60 |
$100.00
|
|
Dna gardnerella
|
$255.60 |
$255.60 |
$255.60 |
$61.83
|
|
Dna trichomonas
|
$266.40 |
$266.40 |
$266.40 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$162.00 |
$162.00 |
$162.00 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$7,030.80 |
$7,030.80 |
$7,030.80 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$89.40 |
$89.40 |
$89.40 |
$65.40
|
|
Doppler echo complete
|
$959.40 |
$959.40 |
$959.40 |
$558.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,081.80 |
$1,081.80 |
$1,081.80 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$759.60 |
$759.60 |
$759.60 |
$481.65
|
|
Doripenem 50 mg/ml inj 10 ml
|
$8.40 |
$8.40 |
$8.40 |
$73.80
|
|
Dornase alfa non-comp unit
|
$236.00 |
$236.00 |
$236.00 |
$356.00
|
|
Dornhoffer fixed part w/window
|
$36,517.20 |
$36,517.20 |
$36,517.20 |
$34,278.00
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$162.60 |
$162.60 |
$162.60 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$4,487.40 |
$4,487.40 |
$4,487.40 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$1.20 |
$1.20 |
$1.20 |
$89.34
|
|
Dpyd gene common variants
|
$2,358.60 |
$2,358.60 |
$2,358.60 |
$423.60
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$1,440.00 |
$1,440.00 |
$1,440.00 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$1,440.00 |
$1,440.00 |
$1,440.00 |
$964.00
|
|
Drainage external ear complex 69005
|
$7,126.80 |
$7,126.80 |
$7,126.80 |
$2,888.03
|
|
Drainage external ear simple 69000
|
$589.80 |
$589.80 |
$589.80 |
$790.40
|
|
Drainage of arm bursa 23931
|
$2,883.60 |
$2,883.60 |
$2,883.60 |
$2,271.01
|
|
Drainage of kidney lesion
|
$1,119.00 |
$1,119.00 |
$1,119.00 |
$1,506.00
|
|
Drainage of mouth lesion
|
$3,435.60 |
$3,435.60 |
$3,435.60 |
$3,837.72
|
|
Drainage of nose lesion int 30000
|
$3,592.20 |
$3,592.20 |
$3,592.20 |
$548.00
|
|
Drainage of rectal abscess 45020
|
$5,376.00 |
$5,376.00 |
$5,376.00 |
$3,816.64
|
|
Drain blood from under nail 11740
|
$247.20 |
$247.20 |
$247.20 |
$182.40
|
|
Drain cath image guided visceral pq
|
$4,627.80 |
$4,627.80 |
$4,627.80 |
$2,903.44
|
|
Drain cerebro spinal fluid 62272
|
$1,260.60 |
$1,260.60 |
$1,260.60 |
$1,044.00
|
|
Drain finger abscess;simple 26010
|
$589.80 |
$589.80 |
$589.80 |
$428.40
|
|
Drain thigh/knee lesion 27301
|
$5,397.60 |
$5,397.60 |
$5,397.60 |
$3,986.00
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$825.60 |
$825.60 |
$825.60 |
$397.65
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$589.80 |
$589.80 |
$589.80 |
$349.50
|
|
Dress/debrid prtl-thick burn l 16030
|
$825.60 |
$825.60 |
$825.60 |
$541.00
|
|
Drng of eyelid abscess 67700
|
$7,126.80 |
$7,126.80 |
$7,126.80 |
$655.72
|
|
Drng of finger abscess comp 26011
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$2,079.50
|
|
Drng of scrotum abscess 55100
|
$2,892.60 |
$2,892.60 |
$2,892.60 |
$1,997.89
|
|
Droperidol 2.5 mg/ml injection solution
|
$39.60 |
$39.60 |
$39.60 |
$31.25
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$1,778.40 |
$1,778.40 |
$1,778.40 |
$1,818.32
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$696.00 |
$696.00 |
$696.00 |
$193.15
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$29,534.40 |
$29,534.40 |
$29,534.40 |
$7,465.97
|
|
Drug assay vedolizumab
|
$431.40 |
$431.40 |
$431.40 |
$154.00
|
|
Drug test def 1-7 classes
|
$316.80 |
$316.80 |
$316.80 |
$263.25
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$53.40 |
$53.40 |
$53.40 |
$278.85
|
|
Drvvt confirm - quest
|
$174.60 |
$174.60 |
$174.60 |
$109.20
|
|
Ductogram sgl duct
|
$862.20 |
$862.20 |
$862.20 |
$469.80
|
|
Duplex scan bilateral study 93985
|
$1,429.20 |
$1,429.20 |
$1,429.20 |
$691.08
|
|
Duplex scan unilateral study 93986
|
$714.60 |
$714.60 |
$714.60 |
$369.20
|
|
Dup scan/hemodialysis access 93990
|
$878.40 |
$878.40 |
$878.40 |
$489.72
|
