|
Cystoscopy & ureter catheter
|
$2,835.20 |
$2,835.20 |
$2,835.20 |
$3,728.50
|
|
Cytarabine 20 mg/ml injection solution
|
$70.80 |
$70.80 |
$70.80 |
$90.00
|
|
Cytogenetics 25-99
|
$412.00 |
$412.00 |
$412.00 |
$189.80
|
|
Cytomegalovirus (cmv) antibody igg
|
$176.80 |
$176.80 |
$176.80 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$176.80 |
$176.80 |
$176.80 |
$100.00
|
|
Cyto/molecular report
|
$326.40 |
$326.40 |
$326.40 |
$144.75
|
|
Cytopath c/v auto in fluid
|
$334.40 |
$334.40 |
$334.40 |
$56.00
|
|
Cytopath fl nongyn filter
|
$169.60 |
$169.60 |
$169.60 |
$96.48
|
|
Cytopathology cellular enhancement technique non-gyn
|
$172.00 |
$172.00 |
$172.00 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$104.00 |
$104.00 |
$104.00 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$81.60 |
$81.60 |
$81.60 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$62.20 |
$62.20 |
$62.20 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$280.80 |
$280.80 |
$280.80 |
$127.50
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$85.60 |
$85.60 |
$85.60 |
$191.66
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$450.40 |
$450.40 |
$450.40 |
$213.85
|
|
Cytopath smear other source
|
$66.40 |
$66.40 |
$66.40 |
$92.50
|
|
Cytopath smear oth prep screen & interp
|
$120.80 |
$120.80 |
$120.80 |
$96.20
|
|
Dacarbazine 100 mg intravenous solution
|
$76.80 |
$76.80 |
$76.80 |
$62.41
|
|
Dactinomycin 0.5 mg intravenous solution
|
$2,879.40 |
$2,879.40 |
$2,879.40 |
$3,264.26
|
|
Dalbavancin 500 mg intravenous solution
|
$7,113.00 |
$7,113.00 |
$7,113.00 |
$3,493.11
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$2,063.40 |
$2,063.40 |
$2,063.40 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$104.40 |
$104.40 |
$104.40 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$17,923.80 |
$17,923.80 |
$17,923.80 |
$6,281.29
|
|
Darbepoetin alfa, esrd use
|
$2,151.00 |
$2,151.00 |
$2,151.00 |
$7.20
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$483.00 |
$483.00 |
$483.00 |
$20,196.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$622.20 |
$622.20 |
$622.20 |
$259.58
|
|
Dch glucoscan
|
$14.40 |
$14.40 |
$14.40 |
$29.16
|
|
Dch pulmonary stress test
|
$188.80 |
$188.80 |
$188.80 |
$963.30
|
|
Dch validity tests
|
$62.20 |
$62.20 |
$62.20 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$80.40 |
$80.40 |
$80.40 |
$43.35
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$1,592.00 |
$1,592.00 |
$1,592.00 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$312.80 |
$312.80 |
$312.80 |
$284.00
|
|
Debridement bone <= 20 sq cm
|
$2,103.20 |
$2,103.20 |
$2,103.20 |
$2,320.80
|
|
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
|
$206.40 |
$206.40 |
$206.40 |
$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
|
$1,778.40 |
$1,778.40 |
$1,778.40 |
$1,149.50
|
|
Debr musc/fascia 20sq cm/< 11043
|
$728.40 |
$728.40 |
$728.40 |
$1,165.50
|
|
Decalcification
|
$469.60 |
$469.60 |
$469.60 |
$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
|
$790.40 |
$790.40 |
$790.40 |
$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
|
$78.60 |
$78.60 |
$78.60 |
$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
|
$712.80 |
$712.80 |
$712.80 |
$401.60
|
|
Dermagraft
|
$2,778.40 |
$2,778.40 |
$2,778.40 |
$85.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$2,755.80 |
$2,755.80 |
$2,755.80 |
$91.84
|
|
Desoxycorticosterone
|
$481.60 |
$481.60 |
$481.60 |
$109.28
|
|
Dest mal lesion tal <0.5 17260
|
$1,172.00 |
$1,172.00 |
$1,172.00 |
$238.40
|
|
Dest mal lesion tal 0.6-1.0cm 17261
|
$1,489.60 |
$1,489.60 |
$1,489.60 |
$274.80
|
|
Destroy premlg lesns;1st lesn 17000
|
$847.20 |
$847.20 |
$847.20 |
$202.40
|
|
Destruct ben lesion 15/> 17111
|
$147.00 |
$147.00 |
$147.00 |
$235.13
|
|
Destruction 2-14 lesions 17003
|
$118.20 |
$118.20 |
$118.20 |
$78.61
|
|
Destruction benign lesions < 14 lesions
|
$847.20 |
$847.20 |
$847.20 |
$240.24
|
|
Developmental screen/score/document 96110
|
$20.40 |
$20.40 |
$20.40 |
$142.38
|
|
Device ablt adv novasure
|
$7,153.60 |
$7,153.60 |
$7,153.60 |
$6,237.48
|
|
Device intraute mirena
|
$4,133.60 |
$4,133.60 |
$4,133.60 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,632.80 |
$1,632.80 |
$1,632.80 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$3,273.60 |
$3,273.60 |
$3,273.60 |
$2,515.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$161.60 |
$161.60 |
$161.60 |
$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)
|
$222.40 |
$222.40 |
$222.40 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$200.00 |
$200.00 |
$200.00 |
$79.30
|
|
Diagnostic anoscopy spx 46600
|
$3,052.80 |
$3,052.80 |
$3,052.80 |
$195.50
|
|
Diagnostic laryngoscopy 31505
|
$338.40 |
$338.40 |
$338.40 |
$242.14
|
|
Diagnostic Mammogram (both breasts)
|
$584.00 |
$584.00 |
$584.00 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$383.20 |
$383.20 |
$383.20 |
$314.00
|
|
Dialysis one evaluation
|
$1,536.00 |
$1,536.00 |
$1,536.00 |
$936.00
|
|
Dialysis repeated eval
|
$1,405.60 |
$1,405.60 |
$1,405.60 |
$1,332.80
|
|
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
|
$498.40 |
$498.40 |
$498.40 |
$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
|
$152.00 |
$152.00 |
$152.00 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$924.80 |
$924.80 |
$924.80 |
$297.86
|
|
Dilate esophagus 1/mult pass
|
$4,264.00 |
$4,264.00 |
$4,264.00 |
$1,548.00
|
|
Dilation of cervical canal 57800
|
$4,291.20 |
$4,291.20 |
$4,291.20 |
$4,446.00
|
|
Dilation of rectal stricture 45910
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,491.80
|
|
Dilator fascial 10fx20cm
|
$1,022.40 |
$1,022.40 |
$1,022.40 |
$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)
|
$25.80 |
$25.80 |
$25.80 |
$98.15
|
|
Disability dlco
|
$282.40 |
$282.40 |
$282.40 |
$293.76
|
|
Disaccharidases
|
$107.20 |
$107.20 |
$107.20 |
$230.40
|
|
Discography cerv/thor spine
|
$2,404.00 |
$2,404.00 |
$2,404.00 |
$2,565.00
|
|
Dna antibody native/double stranded
|
$301.60 |
$301.60 |
$301.60 |
$100.00
|
|
Dna gardnerella
|
$267.20 |
$267.20 |
$267.20 |
$61.83
|
