|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,570.80 |
$2,570.80 |
$2,570.80 |
$5,546.48
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$1,271.85 |
$1,271.85 |
$1,271.85 |
$3,774.81
|
|
Dch glucoscan
|
$5.70 |
$5.70 |
$5.70 |
$27.50
|
|
Dch pulmonary stress test
|
$247.50 |
$247.50 |
$247.50 |
$930.80
|
|
Dch validity tests
|
$4.35 |
$4.35 |
$4.35 |
$24.11
|
|
Deamidated gliadin antibody iga
|
$74.55 |
$74.55 |
$74.55 |
$44.16
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$156.75 |
$156.75 |
$156.75 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$76.95 |
$76.95 |
$76.95 |
$262.60
|
|
Debridement bone <= 20 sq cm
|
$306.75 |
$306.75 |
$306.75 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$27.45 |
$27.45 |
$27.45 |
$654.75
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$294.90 |
$294.90 |
$294.90 |
$1,313.25
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$304.65 |
$304.65 |
$304.65 |
$810.50
|
|
Debride nail1-5 11720
|
$16.50 |
$16.50 |
$16.50 |
$144.95
|
|
Debride nail6 or more 11721
|
$24.90 |
$24.90 |
$24.90 |
$167.00
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$294.75 |
$294.75 |
$294.75 |
$973.71
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$113.40 |
$113.40 |
$113.40 |
$639.60
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$345.30 |
$345.30 |
$345.30 |
$1,110.20
|
|
Debr inf skin add-on 11001
|
$31.20 |
$31.20 |
$31.20 |
$106.86
|
|
Debr musc/fascia 20sq cm/< 11043
|
$290.10 |
$290.10 |
$290.10 |
$1,160.00
|
|
Decalcification
|
$9.00 |
$9.00 |
$9.00 |
$70.21
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$261.75 |
$261.75 |
$261.75 |
$540.00
|
|
Deep muscle biopsy 20205
|
$1,124.85 |
$1,124.85 |
$1,124.85 |
$3,170.64
|
|
Deferoxamine 500 mg solution for injection
|
$31.67 |
$31.67 |
$31.67 |
$95.85
|
|
Delivery of placenta 59414
|
$863.40 |
$863.40 |
$863.40 |
$2,778.27
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$34.80 |
$34.80 |
$34.80 |
$185.40
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,013.31 |
$3,013.31 |
$3,013.31 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$205.50 |
$205.50 |
$205.50 |
$404.25
|
|
Dermagraft
|
$23.40 |
$23.40 |
$23.40 |
$87.60
|
|
Dermapure 1 square cm
|
$140.32 |
$140.32 |
$140.32 |
$2,319.00
|
|
Design mlc device for imrt
|
$391.95 |
$391.95 |
$391.95 |
$1,677.86
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,256.08 |
$1,256.08 |
$1,256.08 |
$70.80
|
|
Desoxycorticosterone
|
$33.15 |
$33.15 |
$33.15 |
$109.28
|
|
Destroy cervthor facet jnt 64633
|
$1,285.95 |
$1,285.95 |
$1,285.95 |
$2,998.30
|
|
Destroy cth facet jnt addl 64634
|
$761.70 |
$761.70 |
$761.70 |
$1,441.44
|
|
Destroy premlg lesns;1st lesn 17000
|
$99.60 |
$99.60 |
$99.60 |
$199.50
|
|
Destruction 2-14 lesions 17003
|
$27.60 |
$27.60 |
$27.60 |
$72.24
|
|
Destruction benign lesions < 14 lesions
|
$39.15 |
$39.15 |
$39.15 |
$235.13
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$168.60 |
$168.60 |
$168.60 |
$1,612.80
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$421.20 |
$421.20 |
$421.20 |
$3,138.15
|
|
Destruction premal lesions 15/> 17004
|
$159.90 |
$159.90 |
$159.90 |
$436.64
|
|
Destruction vag lesions simple 57061
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$3,762.53
|
|
Destruct penis les/smp/electrodesi 54055
|
$1,345.50 |
$1,345.50 |
$1,345.50 |
$2,507.31
|
|
Developmental screen/score/document 96110
|
$40.65 |
$40.65 |
$40.65 |
$111.00
|
|
Devel tst phys/qhp 1st hr
|
$67.20 |
$67.20 |
$67.20 |
$307.20
|
|
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 |
$2,440.98
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$33.75 |
$33.75 |
$33.75 |
$196.30
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$69.30 |
$69.30 |
$69.30 |
$222.50
|
|
Dexamethasone 4 mg tablet
|
$0.20 |
$0.20 |
$0.20 |
$5.98
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$23.77 |
$23.77 |
$23.77 |
$22.05
|
|
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 |
$45.80
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$7.26 |
$7.26 |
$7.26 |
$46.12
|
|
Dextrose 5 % IV bolus
|
$7.26 |
$7.26 |
$7.26 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$38.85 |
$38.85 |
$38.85 |
$109.20
|
|
Diabetes (HbA1c) Test
|
$16.95 |
$16.95 |
$16.95 |
$79.52
|
|
Diab manage trn ind/group
|
$11.85 |
$11.85 |
$11.85 |
$57.75
|
|
Diagnostic anoscopy spx 46600
|
$138.30 |
$138.30 |
$138.30 |
$186.00
|
|
Diagnostic laryngoscopy 31575
|
$51.30 |
$51.30 |
$51.30 |
$330.20
|
|
Diagnostic Mammogram (both breasts)
|
$85.50 |
$85.50 |
$85.50 |
$388.22
|
|
Diagnostic Mammogram (one breast)
|
$74.10 |
$74.10 |
$74.10 |
$295.10
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,533.70 |
$3,533.70 |
$3,533.70 |
$5,382.00
|
|
Dialysis one evaluation
|
$194.55 |
$194.55 |
$194.55 |
$845.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$22.41 |
$22.41 |
$22.41 |
$114.18
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$68.03 |
$68.03 |
$68.03 |
$74.02
|
|
Dicyclomine injection
|
$177.39 |
$177.39 |
$177.39 |
$157.69
|
|
Diffusing capacity
|
$100.35 |
$100.35 |
$100.35 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$13.45 |
$13.45 |
$13.45 |
$68.22
|
|
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 |
$99.35
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$215.62 |
$215.62 |
$215.62 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$841.05 |
$841.05 |
$841.05 |
$1,866.73
|
|
Dilate urethra stricture
|
$212.25 |
$212.25 |
$212.25 |
$474.50
|
|
Dilation of cervical canal 57800
|
$1,346.40 |
$1,346.40 |
$1,346.40 |
$4,340.80
|
|
Dilator fascial 10fx20cm
|
$388.60 |
$388.60 |
$388.60 |
$408.24
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$2.93 |
$2.93 |
$2.93 |
$17.75
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$90.88 |
$90.88 |
$90.88 |
$106.59
|
|
Disability dlco
|
$47.55 |
$47.55 |
$47.55 |
$279.73
|
|
Disaccharidases
|
$31.65 |
$31.65 |
$31.65 |
$222.63
|
|
Dissolve clot heart vessel
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,579.93
|
|
Dmd dup/delet analysis
|
$219.15 |
$219.15 |
$219.15 |
$385.02
|
|
Dna antibody native/double stranded
|
$24.00 |
$24.00 |
$24.00 |
$100.00
|
|
Dna gardnerella
|
$35.10 |
$35.10 |
$35.10 |
$62.50
|
|
Dna trichomonas
|
$35.10 |
$35.10 |
$35.10 |
$67.20
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$24.08 |
$24.08 |
$24.08 |
$99.10
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$8.58 |
$8.58 |
$8.58 |
$69.47
|
|
Doppler echo complete
|
$224.25 |
$224.25 |
$224.25 |
$551.40
|
|
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 |
$653.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$229.50 |
$229.50 |
$229.50 |
$461.20
|
|
Dornase alfa non-comp unit
|
$24.33 |
$24.33 |
$24.33 |
$429.81
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$282.92 |
$282.92 |
$282.92 |
$417.48
|
|
Dpyd gene common variants
|
$224.40 |
$224.40 |
$224.40 |
$377.47
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$66.45 |
$66.45 |
$66.45 |
$800.00
|
|
Drainage external ear simple 69000
|
$56.70 |
$56.70 |
$56.70 |
$779.45
|
|
Drainage lymph node lesion 38300
|
$900.45 |
$900.45 |
$900.45 |
$3,088.80
|
|
Drainage mouth roof lesion
|
$147.45 |
$147.45 |
$147.45 |
$381.36
|
|
Drainage of kidney lesion
|
$369.45 |
$369.45 |
$369.45 |
$1,506.00
|
