|
Destruction penis lesion(s) chem 54050
|
$229.20 |
$229.20 |
$229.20 |
|
|
Destruction penis lesion(s) exten 54065
|
$598.33 |
$598.33 |
$598.33 |
|
|
Destruction premal lesions 15/> 17004
|
$175.20 |
$532.80 |
$2,739.60 |
|
|
Destruction rectal tumor 45190
|
$4,170.00 |
$4,170.00 |
$4,170.00 |
|
|
Destruction vag lesions simple 57061
|
$5,142.60 |
$5,142.60 |
$5,142.60 |
|
|
Detect agent nos dna dir
|
$138.00 |
$138.00 |
$198.00 |
|
|
Detect agnt mult dna direc
|
$186.00 |
$207.60 |
$501.00 |
|
|
Determine refractive state
|
$23.50 |
$23.50 |
$23.50 |
|
|
Developmental screen/score/document 96110
|
$13.00 |
$13.00 |
$20.40 |
|
|
Devel tst phys/qhp 1st hr
|
$276.00 |
$276.00 |
$276.00 |
|
|
Device ablt adv novasure
|
$2,597.50 |
$5,392.80 |
$14,299.20 |
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$396.21 |
$396.21 |
$396.21 |
|
|
Device intraute mirena
|
$693.60 |
$2,869.50 |
$7,201.60 |
|
|
Device sut capio slim opn
|
$898.20 |
$1,450.20 |
$2,653.20 |
|
|
Device tiss remov myosure reach
|
$1,221.00 |
$2,842.20 |
$3,790.20 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$94.00 |
$188.40 |
$469.60 |
|
|
Dexametha opth insert 0.1 mg
|
$354.00 |
$505.60 |
$2,022.60 |
|
|
Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr
|
$1,639.80 |
$1,665.00 |
$1,738.20 |
|
|
Dexamethasone 4 mg tablet
|
$0.60 |
$5.40 |
$256.80 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$1.80 |
$8.20 |
$215.40 |
|
|
Dexamethasone intra implant
|
$441.50 |
$521.40 |
$3,437.40 |
|
|
Dexamethasone panel
|
$646.80 |
$646.80 |
$747.60 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$307.20 |
$1,192.20 |
$5,923.80 |
|
|
Dextran 40 infusion
|
$327.00 |
$645.60 |
$680.80 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$6.60 |
$58.60 |
$159.00 |
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$6.60 |
$74.40 |
$183.20 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$4.40 |
$60.00 |
$136.80 |
|
|
Dextrose 5 % IV bolus
|
$6.00 |
$60.60 |
$153.60 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$31.00 |
$113.40 |
$496.20 |
|
|
Diabetes (HbA1c) Test
|
$25.00 |
$66.60 |
$416.40 |
|
|
Diab manage trn ind/group
|
$16.80 |
$93.00 |
$679.20 |
|
|
Diag laparo separate proc 49320
|
$625.80 |
$853.80 |
$1,868.67 |
|
|
Diagnostic anoscopy
|
$513.50 |
$534.60 |
$1,349.40 |
|
|
Diagnostic anoscopy & biopsy
|
$209.40 |
$209.40 |
$3,235.80 |
|
|
Diagnostic anoscopy spx 46600
|
$42.00 |
$432.60 |
$3,052.80 |
|
|
Diagnostic digital breast tomosynthesis bil
|
$88.80 |
$126.00 |
$847.20 |
|
|
Diagnostic digital breast tomosynthesis unil
|
$59.20 |
$104.80 |
$691.80 |
|
|
Diagnostic laryngoscopy 31505
|
$229.50 |
$432.60 |
$609.00 |
|
|
Diagnostic laryngoscopy 31575
|
$105.60 |
$749.40 |
$1,651.80 |
|
|
Diagnostic Mammogram (both breasts)
|
$208.00 |
$310.20 |
$612.00 |
|
|
Diagnostic Mammogram (one breast)
|
$175.80 |
$316.80 |
$543.00 |
|
|
Diagnostic radio unlisted proc
|
$94.00 |
$170.40 |
$2,070.60 |
|
|
Dialysis circuit perm vascular embolization 36909
|
$2,160.60 |
$3,309.60 |
$29,771.20 |
|
|
Dialysis one evaluation
|
$464.80 |
$970.80 |
$2,373.00 |
|
|
Dialysis repeated eval
|
$1,405.60 |
$1,405.60 |
$1,419.50 |
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.24 |
$0.80 |
$441.00 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$9.60 |
$32.40 |
$333.00 |
|
|
Dicyclomine injection
|
$16.54 |
$150.40 |
$691.20 |
|
|
Difelikefalin, esrd on dialy
|
$1.20 |
$1.20 |
$1.20 |
|
|
Diffusing capacity
|
$34.50 |
$477.60 |
$1,176.60 |
|
|
Digital analysis of eeg
|
$555.60 |
$642.00 |
$760.80 |
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$6.47 |
$34.00 |
$85.80 |
|
|
Digoxin immune fab 40 mg intravenous solution
|
$2,869.80 |
$11,176.20 |
$19,087.80 |
|
|
Digoxin total therapeutic drug level
|
$37.50 |
$96.00 |
$355.80 |
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$89.40 |
$437.80 |
$1,475.40 |
|
|
Dilate biliary duct/ampulla
|
$2,304.60 |
$2,304.60 |
$24,785.40 |
|
|
Dilate esophagus
|
$2,734.20 |
$2,734.20 |
$2,734.20 |
|
|
Dilate esophagus 1/mult pass
|
$1,372.20 |
$1,872.60 |
$4,264.00 |
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$1,269.00 |
$1,269.00 |
$9,783.00 |
|
|
Dilate ic vasospasm ea add vsl same territory
|
$1,257.00 |
$1,269.00 |
$9,783.00 |
|
|
Dilate ic vasospasm init
|
$1,948.20 |
$3,575.40 |
$9,783.00 |
|
|
Dilate urethra stricture
|
$320.00 |
$534.00 |
$1,246.20 |
|
|
Dilate urethra stricture
|
$153.00 |
$153.00 |
$153.00 |
|
|
Dilate urethra stricture
|
$2,194.33 |
$2,194.33 |
$2,194.33 |
|
|
Dilate urethra stricture
|
$287.00 |
$287.00 |
$287.00 |
|
|
Dilation/female urethra/initial 53660
|
$148.00 |
$148.00 |
$158.40 |
|
|
Dilation of anal sphincter
|
$298.20 |
$298.20 |
$298.20 |
|
|
Dilation of cervical canal 57800
|
$681.00 |
$3,720.50 |
$4,291.20 |
|
|
Dilation of rectal stricture 45910
|
$2,491.80 |
$3,435.60 |
$8,947.80 |
|
|
Dilation of urethra
|
$153.00 |
$153.00 |
$1,020.60 |
|
|
Dilation salivary duct 42650
|
$80.40 |
$80.40 |
$80.40 |
|
|
Dilation/urethral strict/male/ini 53620
|
$583.20 |
$801.50 |
$2,997.00 |
|
|
Dilator fascial 10fx20cm
|
$7.20 |
$680.40 |
$2,022.60 |
|
|
Dilat xst trc ndurlgc px
|
$1,995.60 |
$4,140.00 |
$9,487.80 |
|
|
Dilat xst trc new access rcs
|
$2,344.20 |
$11,311.20 |
$11,311.20 |
|
|
Diltiazem 5 mg/ml intravenous solution
|
$0.60 |
$12.60 |
$130.00 |
|
|
Dimenhydrinate injection
|
$6.60 |
$13.20 |
$33.90 |
|
|
Dimethyl sulfoxide 50% 50 ml
|
$7.80 |
$7.80 |
$3,160.80 |
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$0.60 |
$9.60 |
$10.20 |
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$1.80 |
$13.80 |
$84.80 |
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$24.60 |
$24.60 |
$40.80 |
|
|
Direct advanced life support
|
$888.00 |
$888.00 |
$911.40 |
|
|
Dir nsl mucous membrane test
|
$33.00 |
$33.00 |
$33.00 |
|
|
Disability dlco
|
$90.00 |
$234.00 |
$886.80 |
|
|
Disaccharidases
|
$66.60 |
$159.00 |
$1,345.20 |
|
|
Discography cerv/thor spine
|
$1,987.80 |
$4,030.20 |
$10,866.00 |
|
|
Dise eval slp do brth flx dx
|
$661.00 |
$661.00 |
$661.00 |
|
|
Dis site tele svcs rhc/fqhc
|
$71.40 |
$71.40 |
$71.40 |
|
|
Dissolve clot heart vessel
|
$1,274.40 |
$1,274.40 |
$1,274.40 |
|
|
Dist revas ligation hemo
|
$9,842.40 |
$9,842.40 |
$18,247.20 |
|
|
Dlyd plmt xtn prosth ea addl
|
$874.20 |
$1,597.80 |
$1,991.40 |
|
|
Dmd dup/delet analysis
|
$402.60 |
$402.60 |
$3,223.20 |
|
|
Dmpk gene detc abnor allele
|
$1,539.00 |
$1,539.00 |
$1,539.00 |
|
|
Dna antibody native/double stranded
|
$42.00 |
$76.80 |
$416.40 |
|
|
Dna gardnerella
|
$60.00 |
$175.80 |
$370.20 |
|
|
Dna probe chlamydia
|
$82.20 |
$82.20 |
$861.60 |
|
|
Dna probe gc
|
$97.20 |
$97.20 |
$180.60 |
|
|
Dna trichomonas
|
$64.80 |
$194.40 |
$385.20 |
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$2.40 |
$138.60 |
$556.80 |
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$18.00 |
$86.40 |
$7,117.20 |
|
