|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$2,617.06 |
$3,979.88 |
$5,451.99 |
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$348.00 |
$365.60 |
$507.20 |
|
|
Depo-estradiol cypionate inj
|
$90.27 |
$90.27 |
$336.68 |
|
|
Descend thora aorta rpr/lt sub art 33880
|
$10,212.80 |
$10,212.80 |
$10,212.80 |
|
|
Design mlc device for imrt
|
$3,862.40 |
$3,862.40 |
$3,862.40 |
|
|
Desmopressin 4 mcg/ml injection solution
|
$324.47 |
$324.47 |
$324.47 |
|
|
Des thora aorta rpr without left sub art 33881
|
$10,212.80 |
$10,212.80 |
$10,212.80 |
|
|
Destroy cervthor facet jnt 64633
|
$2,798.40 |
$2,798.40 |
$3,476.80 |
|
|
Destroy cth facet jnt addl 64634
|
$1,062.40 |
$1,062.40 |
$1,319.20 |
|
|
Destroy premlg lesns;1st lesn 17000
|
$220.80 |
$220.80 |
$220.80 |
|
|
Destroy vulva lesion simple 56501
|
$4,597.60 |
$4,597.60 |
$4,597.60 |
|
|
Destruct ben lesion 15/> 17111
|
$240.00 |
$240.00 |
$240.00 |
|
|
Destruction 2-14 lesions 17003
|
$197.60 |
$197.60 |
$197.60 |
|
|
Destruction anal lesion(s)
|
$3,416.00 |
$3,416.00 |
$3,416.00 |
|
|
Destruction benign lesions < 14 lesions
|
$170.40 |
$170.40 |
$220.00 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,292.00 |
$1,292.00 |
$1,648.00 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,458.40 |
$2,458.40 |
$3,059.20 |
|
|
Developmental screen/score/document 96110
|
$98.40 |
$98.40 |
$251.20 |
|
|
Devel tst phys/qhp 1st hr
|
$412.80 |
$412.80 |
$412.80 |
|
|
Device ablt adv novasure
|
$13,500.00 |
$13,500.00 |
$13,500.00 |
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$5,000.00 |
$5,000.00 |
$9,000.00 |
|
|
Device intraute mirena
|
$366.21 |
$366.21 |
$1,244.00 |
|
|
Device sut capio slim opn
|
$2,086.40 |
$2,086.40 |
$3,244.80 |
|
|
Device tiss remov myosure reach
|
$2,060.80 |
$2,060.80 |
$5,382.40 |
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$208.00 |
$208.00 |
$208.00 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$254.40 |
$339.20 |
$369.60 |
|
|
Dexamethasone 4 mg tablet
|
$1.20 |
$5.50 |
$62.08 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$60.76 |
$62.08 |
$316.32 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$280.64 |
$280.64 |
$904.56 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$40.00 |
$86.40 |
$148.40 |
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$40.00 |
$80.00 |
$125.44 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$48.00 |
$133.60 |
$600.00 |
|
|
Dextrose 5 % IV bolus
|
$40.00 |
$80.00 |
$148.40 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$108.00 |
$145.60 |
$203.20 |
|
|
Diabetes (HbA1c) Test
|
$45.60 |
$62.40 |
$91.20 |
|
|
Diab manage trn ind/group
|
$36.80 |
$44.80 |
$68.80 |
|
|
Diagnostic anoscopy spx 46600
|
$304.00 |
$304.00 |
$304.00 |
|
|
Diagnostic laryngoscopy 31505
|
$280.80 |
$291.20 |
$306.40 |
|
|
Diagnostic laryngoscopy 31575
|
$445.60 |
$445.60 |
$558.40 |
|
|
Diagnostic Mammogram (both breasts)
|
$573.60 |
$573.60 |
$618.40 |
|
|
Diagnostic Mammogram (one breast)
|
$470.40 |
$470.40 |
$503.20 |
|
|
Diagnostic radio unlisted proc
|
$808.80 |
$951.20 |
$960.00 |
|
|
Dialysis circuit perm vascular embolization 36909
|
$14,717.60 |
$14,717.60 |
$15,456.00 |
|
|
Dialysis one evaluation
|
$1,328.00 |
$1,328.00 |
$1,328.00 |
|
|
Diathermy eg microwave
|
$69.60 |
$69.60 |
$69.60 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$68.03 |
$68.84 |
$313.77 |
|
|
Dicyclomine injection
|
$89.14 |
$89.14 |
$324.76 |
|
|
Difelikefalin, esrd on dialy
|
$540.00 |
$540.00 |
$540.00 |
|
|
Diffusing capacity
|
$228.00 |
$240.00 |
$408.80 |
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$60.53 |
$62.46 |
$416.32 |
|
|
Digoxin immune fab 40 mg intravenous solution
|
$4,438.71 |
$4,438.71 |
$12,067.47 |
|
|
Digoxin total therapeutic drug level
|
$64.80 |
$95.20 |
$139.20 |
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$123.04 |
$123.04 |
$374.24 |
|
|
Dilate biliary duct/ampulla
|
$4,858.40 |
$4,858.40 |
$4,858.40 |
|
|
Dilate esophagus
|
$2,903.20 |
$3,038.40 |
$3,715.20 |
|
|
Dilate esophagus 1/mult pass
|
$2,649.60 |
$2,649.60 |
$2,684.00 |
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$2,149.60 |
$2,149.60 |
$2,932.80 |
|
|
Dilate ic vasospasm ea add vsl same territory
|
$3,552.80 |
$3,552.80 |
$4,609.60 |
|
|
Dilate ic vasospasm init
|
$6,934.40 |
$6,934.40 |
$10,529.60 |
|
|
Dilate urethra stricture
|
$564.80 |
$564.80 |
$564.80 |
|
|
Dilation of anal sphincter
|
$2,344.80 |
$2,344.80 |
$2,344.80 |
|
|
Dilation of cervical canal 57800
|
$3,953.60 |
$3,953.60 |
$3,953.60 |
|
|
Dilation/urethral strict/male/ini 53620
|
$1,536.00 |
$1,536.00 |
$2,191.20 |
|
|
Dilator fascial 10fx20cm
|
$1,353.60 |
$1,353.60 |
$1,353.60 |
|
|
Dilat xst trc ndurlgc px
|
$3,725.60 |
$3,725.60 |
$3,725.60 |
|
|
Dilat xst trc new access rcs
|
$6,207.20 |
$6,207.20 |
$6,207.20 |
|
|
Diltiazem 5 mg/ml intravenous solution
|
$60.62 |
$61.19 |
$319.28 |
|
|
Dimenhydrinate injection
|
$313.77 |
$313.77 |
$313.77 |
|
|
Dimethyl sulfoxide 50% 50 ml
|
$381.48 |
$381.48 |
$381.48 |
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$0.82 |
$1.20 |
$1.20 |
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$60.44 |
$60.58 |
$313.24 |
|
|
Dipyridamole injection
|
$324.90 |
$324.90 |
$324.90 |
|
|
Disability dlco
|
$129.60 |
$129.60 |
$272.80 |
|
|
Discography cerv/thor spine
|
$2,628.00 |
$2,628.00 |
$3,407.20 |
|
|
Dlyd plmt xtn prosth ea addl
|
$1,532.80 |
$1,532.80 |
$5,290.40 |
|
|
Dna antibody native/double stranded
|
$78.40 |
$81.60 |
$124.80 |
|
|
Dna gardnerella
|
$90.40 |
$90.40 |
$100.80 |
|
|
Dna probe chlamydia
|
$78.40 |
$84.00 |
$122.40 |
|
|
Dna probe gc
|
$80.80 |
$80.80 |
$84.80 |
|
|
Dna trichomonas
|
$90.40 |
$90.40 |
$100.80 |
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$111.66 |
$139.76 |
$319.00 |
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$277.12 |
$880.44 |
$4,023.68 |
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$99.24 |
$132.83 |
$325.60 |
|
|
Doppler echo complete
|
$691.20 |
$743.20 |
$760.80 |
|
|
Doppler intravascular pressure flow initial vessel
|
$2,136.00 |
$2,136.00 |
$3,712.80 |
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$836.00 |
$996.80 |
$1,106.40 |
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$450.40 |
$627.20 |
$771.20 |
|
|
Dornase alfa non-comp unit
|
$86.83 |
$86.83 |
$146.09 |
|
|
Dornhoffer fixed part w/window
|
$50,876.00 |
$50,876.00 |
$50,876.00 |
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$670.60 |
$670.60 |
$670.60 |
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$1,921.33 |
$1,921.33 |
$5,470.37 |
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$72.25 |
$73.84 |
$326.19 |
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$574.40 |
$632.00 |
$842.40 |
|
|
Drainage ext aud canal abscess 69020
|
$450.40 |
$729.60 |
$865.60 |
|
|
Drainage external ear complex 69005
|
$2,293.60 |
$2,293.60 |
$2,640.80 |
|
|
Drainage external ear simple 69000
|
$499.20 |
$809.60 |
$842.40 |
|
|
Drainage mouth roof lesion
|
$439.20 |
$439.20 |
$439.20 |
|
|
Drainage of kidney lesion
|
$1,640.80 |
$1,640.80 |
$1,878.40 |
|
|
Drainage of nose lesion sept 30020
|
$1,488.00 |
$1,488.00 |
$1,488.00 |
|
|
Drainage of rectal abscess
|
$2,912.80 |
$2,912.80 |
$2,912.80 |
|
