|
Destruction mal lsn t/a/l 3.1-4cm
|
$122.25 |
$122.25 |
$122.25 |
$472.79
|
|
Destruction mal lsn t/a/l >4cm
|
$134.55 |
$134.55 |
$134.55 |
$569.80
|
|
Destruction penis lesion(s) chem 54050
|
$159.90 |
$159.90 |
$159.90 |
$332.00
|
|
Destruction penis lesion(s) exten 54065
|
$780.45 |
$780.45 |
$780.45 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$159.90 |
$159.90 |
$159.90 |
$436.64
|
|
Destruction vag lesions complex 57065
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$3,762.53
|
|
Destruction vag lesions simple 57061
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$3,815.20
|
|
Destruct penis les/smp/electrodesi 54055
|
$1,345.50 |
$1,345.50 |
$1,345.50 |
$2,837.09
|
|
Detect agnt mult dna direc
|
$70.20 |
$70.20 |
$70.20 |
$162.00
|
|
Developmental screen/score/document 96110
|
$40.65 |
$40.65 |
$40.65 |
$130.65
|
|
Devel tst phys/qhp 1st hr
|
$67.20 |
$67.20 |
$67.20 |
$337.50
|
|
Device ablt adv novasure
|
$6,885.23 |
$6,885.23 |
$6,885.23 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$3,578.00 |
$3,578.00 |
$3,578.00 |
$4,200.00
|
|
Device tiss remov myosure reach
|
$1,223.52 |
$1,223.52 |
$1,223.52 |
$2,541.00
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$33.75 |
$33.75 |
$33.75 |
$200.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$69.30 |
$69.30 |
$69.30 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$0.20 |
$0.20 |
$8.56 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$15.43 |
$15.43 |
$23.77 |
$21.17
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$614.51 |
$614.51 |
$614.51 |
$858.00
|
|
Dextran 40 infusion
|
$18.06 |
$18.06 |
$18.06 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$7.26 |
$7.26 |
$7.26 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$7.26 |
$7.26 |
$7.26 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$7.26 |
$7.26 |
$12.95 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$7.26 |
$7.26 |
$7.26 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$38.85 |
$38.85 |
$38.85 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$16.95 |
$16.95 |
$16.95 |
$79.20
|
|
Diab manage trn ind/group
|
$11.85 |
$11.85 |
$100.20 |
$56.55
|
|
Diagnostic anoscopy spx 46600
|
$138.30 |
$138.30 |
$138.30 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$156.15 |
$156.15 |
$156.15 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$103.95 |
$103.95 |
$103.95 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$51.30 |
$51.30 |
$51.30 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$85.50 |
$85.50 |
$85.50 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$74.10 |
$74.10 |
$74.10 |
$301.55
|
|
Diagnostic radio unlisted proc
|
$63.90 |
$63.90 |
$63.90 |
$214.08
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,533.70 |
$3,533.70 |
$3,533.70 |
$5,419.00
|
|
Dialysis one evaluation
|
$194.55 |
$194.55 |
$194.55 |
$919.55
|
|
Diatrizoate meglumine 18 % urethral solution
|
$22.41 |
$22.41 |
$22.41 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$68.03 |
$68.03 |
$99.06 |
$74.76
|
|
Dicyclomine injection
|
$95.37 |
$95.37 |
$177.39 |
$153.29
|
|
Diffusing capacity
|
$100.35 |
$100.35 |
$100.35 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$3.36 |
$3.36 |
$189.51 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$4,895.82 |
$4,895.82 |
$4,895.82 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$23.25 |
$23.25 |
$23.25 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$189.44 |
$189.44 |
$215.62 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$841.05 |
$841.05 |
$841.05 |
$1,866.73
|
|
Dilate esophagus 1/mult pass
|
$384.60 |
$384.60 |
$384.60 |
$1,484.17
|
|
Dilate urethra stricture
|
$212.25 |
$212.25 |
$212.25 |
$490.00
|
|
Dilate urethra stricture
|
$54.75 |
$54.75 |
$54.75 |
$200.80
|
|
Dilation of cervical canal 57800
|
$1,346.40 |
$1,346.40 |
$1,346.40 |
$4,376.00
|
|
Dilation of urethra
|
$54.75 |
$54.75 |
$54.75 |
$172.00
|
|
Dilator fascial 10fx20cm
|
$388.60 |
$388.60 |
$388.60 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$912.60 |
$912.60 |
$912.60 |
$4,061.71
|
|
Dilat xst trc new access rcs
|
$1,535.25 |
$1,535.25 |
$1,535.25 |
$4,213.20
|
|
Dimecaprol injection
|
$357.22 |
$357.22 |
$357.22 |
$293.38
|
|
Dimenhydrinate injection
|
$24.53 |
$24.53 |
$24.53 |
$30.48
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$2.93 |
$2.93 |
$6.72 |
$17.75
|
|
Disability dlco
|
$47.55 |
$47.55 |
$47.55 |
$282.40
|
|
Disaccharidases
|
$31.65 |
$31.65 |
$31.65 |
$216.00
|
|
Discography cerv/thor spine
|
$1,040.40 |
$1,040.40 |
$1,040.40 |
$2,565.00
|
|
Dissolve clot heart vessel
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,579.93
|
|
#d/lmeth-l-methamphetamine
|
$7.05 |
$7.05 |
$7.05 |
$72.14
|
|
Dlyd plmt xtn prosth ea addl
|
$414.00 |
$414.00 |
$414.00 |
$1,582.68
|
|
Dmd dup/delet analysis
|
$219.15 |
$219.15 |
$219.15 |
$404.03
|
|
Dmpk gene detc abnor allele
|
$175.80 |
$175.80 |
$175.80 |
$313.60
|
|
Dna antibody native/double stranded
|
$24.00 |
$24.00 |
$24.00 |
$97.50
|
|
Dna gardnerella
|
$35.10 |
$35.10 |
$35.10 |
$62.50
|
|
Dna probe chlamydia
|
$35.10 |
$35.10 |
$35.10 |
$79.38
|
|
Dna probe gc
|
$35.10 |
$35.10 |
$35.10 |
$80.80
|
|
Dna trichomonas
|
$35.10 |
$35.10 |
$35.10 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$24.08 |
$24.08 |
$24.08 |
$98.43
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$438.59 |
$438.59 |
$438.59 |
$904.81
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$8.58 |
$8.58 |
$14.31 |
$65.40
|
|
Doppler echo complete
|
$224.25 |
$224.25 |
$224.25 |
$540.00
|
|
Doppler intravascular pressure flow initial vessel
|
$513.90 |
$513.90 |
$513.90 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$252.45 |
$252.45 |
$252.45 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$229.50 |
$229.50 |
$229.50 |
$471.17
|
|
Dornase alfa non-comp unit
|
$24.33 |
$24.33 |
$24.33 |
$446.75
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$354.66 |
$354.66 |
$354.66 |
$423.95
|
|
Dpyd gene common variants
|
$224.40 |
$224.40 |
$224.40 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$66.45 |
$66.45 |
$66.45 |
$800.00
|
|
Drainage external ear complex 69005
|
$676.05 |
$676.05 |
$676.05 |
$2,726.90
|
|
Drainage external ear simple 69000
|
$56.70 |
$56.70 |
$56.70 |
$789.60
|
|
Drainage lymph node lesion 38300
|
$900.45 |
$900.45 |
$900.45 |
$3,088.80
|
|
Drainage mouth roof lesion
|
$147.45 |
$147.45 |
$147.45 |
$390.39
|
|
Drainage of arm bursa 23931
|
$676.05 |
$676.05 |
$676.05 |
$2,197.48
|
|
Drainage of forearm bursa
|
$723.45 |
$723.45 |
$723.45 |
$2,054.00
|
|
Drainage of kidney lesion
|
$369.45 |
$369.45 |
$369.45 |
$1,506.00
|
|
Drainage of pelvis lesion 26990
|
$444.30 |
$444.30 |
$444.30 |
$3,958.50
|
|
Drainage of urethra abscess 53060
|
$877.35 |
$877.35 |
$877.35 |
$2,424.12
|
|
Drain blood from under nail 11740
|
$40.95 |
$40.95 |
$40.95 |
$170.50
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$430.50 |
$430.50 |
$430.50 |
$2,540.00
|
|
Drain cath image guided visceral pq
|
$1,161.30 |
$1,161.30 |
$1,161.30 |
$2,850.35
|
|
Drain cerebro spinal fluid 62272
|
$363.60 |
$363.60 |
$363.60 |
$1,044.00
|
|
Drain finger abscess;simple 26010
|
$130.95 |
$130.95 |
$130.95 |
$419.00
|
|
Drain neck/chest lesion 21501
|
$1,309.95 |
$1,309.95 |
$1,309.95 |
$3,339.00
|
|
Drain shoulder lesion
|
$1,309.95 |
$1,309.95 |
$1,309.95 |
$3,904.61
|
|
Drain thigh/knee lesion 27301
|
$1,309.95 |
$1,309.95 |
$1,309.95 |
$3,620.47
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$228.60 |
$228.60 |
$228.60 |
$392.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$75.90 |
$75.90 |
$75.90 |
$344.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$102.00 |
$102.00 |
$102.00 |
$523.00
|
