|
Destroy cervthor facet jnt 64633
|
$2,555.60 |
$2,555.60 |
$2,555.60 |
$3,018.00
|
|
Destroy cth facet jnt addl 64634
|
$1,303.60 |
$1,303.60 |
$1,303.60 |
$1,441.44
|
|
Destroy premlg lesns;1st lesn 17000
|
$147.61 |
$147.61 |
$147.61 |
$202.40
|
|
Destruct ben lesion 15/> 17111
|
$158.78 |
$158.78 |
$158.78 |
$235.13
|
|
Destruction benign lesions < 14 lesions
|
$147.61 |
$296.00 |
$296.00 |
$235.13
|
|
Destruction by injection tx of nerve 64630
|
$2,679.60 |
$2,679.60 |
$2,679.60 |
$1,626.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,754.80 |
$1,754.80 |
$1,754.80 |
$1,618.65
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,825.20 |
$3,825.20 |
$3,825.20 |
$3,295.50
|
|
Destruction vag lesions complex 57065
|
$6,279.60 |
$6,279.60 |
$6,279.60 |
$3,762.53
|
|
Destruction vag lesions simple 57061
|
$6,279.60 |
$6,279.60 |
$6,279.60 |
$3,815.20
|
|
Detect agent nos dna dir
|
$54.40 |
$54.40 |
$54.40 |
$145.80
|
|
Detect agnt mult dna direc
|
$93.20 |
$93.20 |
$93.20 |
$166.77
|
|
Developmental screen/score/document 96110
|
$218.80 |
$218.80 |
$218.80 |
$143.13
|
|
Devel tst phys/qhp 1st hr
|
$350.40 |
$350.40 |
$350.40 |
$350.40
|
|
Device ablt adv novasure
|
$7,895.13 |
$9,923.60 |
$9,923.60 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$3,912.00 |
$4,767.84 |
$5,280.00 |
$4,200.00
|
|
Device intraute mirena
|
$1,192.22 |
$1,396.02 |
$1,816.51 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,297.43 |
$1,816.80 |
$1,816.80 |
$1,894.50
|
|
Device tiss remov myosure reach
|
$644.49 |
$2,035.60 |
$2,035.60 |
$2,466.14
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$169.71 |
$169.71 |
$169.71 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$2.78 |
$9.50 |
$258.47 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$30.40 |
$35.64 |
$768.25 |
$21.20
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$102.40 |
$309.42 |
$1,510.83 |
$884.80
|
|
Dextran 40 infusion
|
$135.30 |
$135.30 |
$135.30 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$20.00 |
$21.63 |
$23.60 |
$36.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$20.00 |
$20.00 |
$23.60 |
$42.50
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$23.60 |
$32.30 |
$216.28 |
$46.12
|
|
Dextrose 5 % IV bolus
|
$20.00 |
$20.00 |
$23.60 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$51.20 |
$51.20 |
$157.70 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$24.00 |
$24.00 |
$52.36 |
$79.20
|
|
Diab manage trn ind/group
|
$32.40 |
$32.40 |
$51.20 |
$54.99
|
|
Diag bronchoscope/catheter
|
$1,735.20 |
$1,735.20 |
$1,735.20 |
$2,360.15
|
|
Diagnostic anoscopy spx 46600
|
$176.37 |
$344.40 |
$344.40 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$87.60 |
$87.60 |
$87.60 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$68.40 |
$68.40 |
$68.40 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$129.59 |
$129.59 |
$129.59 |
$235.00
|
|
Diagnostic laryngoscopy 31575
|
$308.68 |
$469.60 |
$469.60 |
$334.95
|
|
Diagnostic Mammogram (both breasts)
|
$381.79 |
$384.40 |
$384.40 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$299.60 |
$299.60 |
$299.60 |
$312.72
|
|
Diagnostic radio unlisted proc
|
$37.20 |
$37.20 |
$37.20 |
$243.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$2,101.20 |
$2,101.20 |
$3,597.93 |
$5,663.50
|
|
Dialysis one evaluation
|
$540.80 |
$540.80 |
$2,167.57 |
$936.00
|
|
Dialysis repeated eval
|
$1,583.60 |
$1,583.60 |
$1,583.60 |
$1,332.80
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.40 |
$0.40 |
$148.55 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$50.05 |
$59.00 |
$216.09 |
$77.25
|
|
Dicyclomine injection
|
$86.42 |
$86.42 |
$173.40 |
$150.91
|
|
Diffusing capacity
|
$232.40 |
$232.40 |
$233.93 |
$335.20
|
|
Digital analysis of eeg
|
$205.55 |
$396.40 |
$396.40 |
$551.20
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$34.82 |
$34.82 |
$135.76 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$5,360.12 |
$5,360.12 |
$5,360.12 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$32.40 |
$32.40 |
$65.38 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$167.08 |
$167.08 |
$167.08 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$1,073.60 |
$1,073.60 |
$1,381.65 |
$1,729.70
|
|
Dilate esophagus
|
$710.05 |
$710.05 |
$710.05 |
$2,142.40
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$624.00 |
$624.00 |
$624.00 |
$3,026.10
|
|
Dilate ic vasospasm ea add vsl same territory
|
$286.80 |
$286.80 |
$286.80 |
$1,895.00
|
|
Dilate ic vasospasm init
|
$817.60 |
$817.60 |
$3,163.48 |
$4,627.52
|
|
Dilation/female urethra/initial 53660
|
$95.39 |
$95.39 |
$95.39 |
$235.61
|
|
Dilation of anal sphincter
|
$1,995.20 |
$1,995.20 |
$1,995.20 |
$1,995.20
|
|
Dilation/urethral strict/male/ini 53620
|
$844.81 |
$844.81 |
$844.81 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$197.72 |
$544.40 |
$638.00 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$1,510.80 |
$1,510.80 |
$2,159.91 |
$3,883.16
|
|
Dilat xst trc new access rcs
|
$2,159.91 |
$2,520.40 |
$2,520.40 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$3.05 |
$3.05 |
$86.94 |
$46.56
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,278.16 |
$1,278.16 |
$1,278.16 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$36.46 |
$37.46 |
$45.74 |
$18.35
|
|
Dipyridamole injection
|
$266.59 |
$266.59 |
$266.59 |
$48.04
|
|
Disability dlco
|
$236.18 |
$289.20 |
$289.20 |
$292.03
|
|
Disaccharidases
|
$46.00 |
$46.00 |
$86.30 |
$224.31
|
|
Discography cerv/thor spine
|
$2,311.95 |
$5,070.40 |
$5,070.40 |
$2,481.50
|
|
Disconnect insert locking wr
|
$48.80 |
$48.80 |
$48.80 |
$75.60
|
|
Disconnect locking wrist uni
|
$133.20 |
$133.20 |
$133.20 |
$207.20
|
|
Dissolve clot heart vessel
|
$635.84 |
$635.84 |
$635.84 |
$1,560.00
|
|
Dist revas ligation hemo
|
$3,373.81 |
$3,373.81 |
$3,373.81 |
$6,396.89
|
|
#d/lmeth-l-methamphetamine
|
$41.60 |
$41.60 |
$41.60 |
$72.14
|
|
Dmd dup/delet analysis
|
$228.00 |
$228.00 |
$228.00 |
$418.50
|
|
Dmpk gene charac alleles
|
$367.20 |
$367.20 |
$367.20 |
$367.20
|
|
Dmpk gene detc abnor allele
|
$143.60 |
$143.60 |
$143.60 |
$313.60
|
|
Dna antibody native/double stranded
|
$34.00 |
$34.00 |
$149.43 |
$100.00
|
|
Dna gardnerella
|
$50.40 |
$50.40 |
$184.13 |
$61.80
|
|
Dna probe chlamydia
|
$50.40 |
$50.40 |
$50.40 |
$82.20
|
|
Dna probe gc
|
$54.00 |
$54.00 |
$54.00 |
$84.80
|
|
Dna trichomonas
|
$34.59 |
$40.00 |
$40.00 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$44.40 |
$53.72 |
$129.25 |
$98.29
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$7.21 |
$7.21 |
$5,191.53 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$4.68 |
$35.91 |
$179.02 |
$67.28
|
|
Doppler echo complete
|
$471.09 |
$560.40 |
$560.40 |
$558.00
|
|
Doppler intravascular pressure flow initial vessel
|
$1,756.20 |
$2,158.80 |
$2,158.80 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$379.65 |
$455.60 |
$455.60 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$311.86 |
$340.00 |
$340.00 |
$473.76
|
|
Doripenem 50 mg/ml inj 10 ml
|
$80.27 |
$80.27 |
$80.27 |
$73.80
|
|
Dornase alfa non-comp unit
|
$51.78 |
$51.78 |
$54.66 |
$386.42
|
|
Dornhoffer fixed part w/window
|
$39,920.08 |
$39,920.08 |
$39,920.08 |
$34,278.00
|
|
Dorsi & plantar flex ass/res
|
$56.80 |
$56.80 |
$56.80 |
$163.50
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$456.25 |
$456.25 |
$22,963.91 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$265.94 |
$604.74 |
$856.81 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$609.35 |
$609.35 |
$7,530.72 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$0.81 |
$1.12 |
$240.80 |
$84.80
|
|
Dpyd gene common variants
|
$210.40 |
$210.40 |
$539.11 |
$423.60
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$296.78 |
$296.78 |
$296.78 |
$794.82
|
