|
Dilation of cervical canal 57800
|
$3,712.00 |
$3,712.00 |
$3,712.00 |
$4,376.00
|
|
Dilation of rectal stricture 45910
|
$211.50 |
$211.50 |
$211.50 |
$1,645.43
|
|
Dilation of urethra
|
$41.00 |
$41.00 |
$41.00 |
$172.00
|
|
Dilation/urethral strict/male/ini 53620
|
$668.00 |
$668.00 |
$668.00 |
$1,372.80
|
|
Diltiazem 5 mg/ml intravenous solution
|
$5.34 |
$5.34 |
$5.34 |
$42.04
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,005.50 |
$1,005.50 |
$1,005.50 |
$1,258.20
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$1.00 |
$1.00 |
$1.00 |
$1.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$1.50 |
$1.50 |
$1.50 |
$19.01
|
|
Disability dlco
|
$207.00 |
$207.00 |
$207.00 |
$293.76
|
|
Disaccharidases
|
$415.00 |
$415.00 |
$415.00 |
$223.80
|
|
Dis site tele svcs rhc/fqhc
|
$106.50 |
$106.50 |
$106.50 |
$94.80
|
|
Dist revas ligation hemo
|
$1,247.00 |
$1,247.00 |
$1,247.00 |
$6,396.89
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$11.25 |
$11.25 |
$11.25 |
$95.38
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$147.35 |
$147.35 |
$147.35 |
$944.35
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$16.13 |
$16.13 |
$16.13 |
$65.40
|
|
Doppler echo complete
|
$841.75 |
$841.75 |
$841.75 |
$548.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$256.50 |
$256.50 |
$256.50 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$769.00 |
$769.00 |
$769.00 |
$481.65
|
|
Double transfer toe-hand
|
$3,942.50 |
$3,942.50 |
$3,942.50 |
$7,413.38
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$25.80 |
$25.80 |
$25.80 |
$423.95
|
|
Dpyd gene common variants
|
$800.00 |
$800.00 |
$800.00 |
$386.12
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$125.00 |
$125.00 |
$125.00 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$144.00 |
$144.00 |
$144.00 |
$901.80
|
|
Drainage external ear simple 69000
|
$1,408.00 |
$1,408.00 |
$1,408.00 |
$779.45
|
|
Drainage lymph node lesion 38300
|
$239.50 |
$239.50 |
$239.50 |
$3,088.80
|
|
Drainage mouth roof lesion
|
$109.00 |
$109.00 |
$109.00 |
$401.50
|
|
Drainage of arm bursa 23931
|
$1,556.50 |
$1,556.50 |
$1,556.50 |
$2,209.90
|
|
Drainage of eye
|
$81.00 |
$81.00 |
$81.00 |
$2,360.00
|
|
Drainage of eye
|
$448.50 |
$448.50 |
$448.50 |
$3,222.78
|
|
Drainage of forearm bursa
|
$402.00 |
$402.00 |
$402.00 |
$2,054.00
|
|
Drainage of mouth lesion
|
$227.00 |
$227.00 |
$227.00 |
$489.00
|
|
Drainage of mouth lesion
|
$352.00 |
$352.00 |
$352.00 |
$3,544.29
|
|
Drainage of nose lesion int 30000
|
$432.50 |
$432.50 |
$432.50 |
$548.00
|
|
Drainage of pelvis lesion 26990
|
$732.50 |
$732.50 |
$732.50 |
$3,863.70
|
|
Drainage of rectal abscess
|
$194.00 |
$194.00 |
$194.00 |
$2,111.46
|
|
Drain blood from under nail 11740
|
$183.00 |
$183.00 |
$183.00 |
$173.21
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$211.00 |
$211.00 |
$211.00 |
$2,540.00
|
|
Drain cath image guided visceral pq
|
$194.50 |
$194.50 |
$194.50 |
$2,869.76
|
|
Drain cerebro spinal fluid 62272
|
$1,428.50 |
$1,428.50 |
$1,428.50 |
$1,044.00
|
|
Drain finger abscess;simple 26010
|
$286.50 |
$286.50 |
$286.50 |
$428.40
|
|
Drain lower leg lesion 27603
|
$415.00 |
$415.00 |
$415.00 |
$3,986.00
|
|
Drain neck/chest lesion 21501
|
$4,136.00 |
$4,136.00 |
$4,136.00 |
$3,338.50
|
|
Drain ovary abscess open
|
$342.50 |
$342.50 |
$342.50 |
$3,762.53
|
|
Drain shoulder lesion
|
$275.00 |
$275.00 |
$275.00 |
$3,638.88
|
|
Drain thigh/knee lesion 27301
|
$2,740.50 |
$2,740.50 |
$2,740.50 |
$3,638.88
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$259.00 |
$259.00 |
$259.00 |
$393.60
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$242.50 |
$242.50 |
$242.50 |
$349.50
|
|
Dress/debrid prtl-thick burn l 16030
|
$141.50 |
$141.50 |
$141.50 |
$524.04
|
|
Dressing change not for burn w/anes 15852
|
$1,016.00 |
$1,016.00 |
$1,016.00 |
$755.08
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$6,501.85
|
|
Drill hole implt ventricular cath/device 61107
|
$916.50 |
$916.50 |
$916.50 |
$1,503.60
|
|
Drng hand tendon sheath 26020
|
$591.50 |
$591.50 |
$591.50 |
$3,839.54
|
|
Drng of eyelid abscess 67700
|
$631.50 |
$631.50 |
$631.50 |
$655.72
|
|
Drng of finger abscess comp 26011
|
$2,904.00 |
$2,904.00 |
$2,904.00 |
$1,994.16
|
|
Drng of hydrocele 55000
|
$87.50 |
$87.50 |
$87.50 |
$854.50
|
|
Drng of mouth lesion 40801
|
$208.50 |
$208.50 |
$208.50 |
$1,350.97
|
|
Drng of scrotum abscess 55100
|
$183.50 |
$183.50 |
$183.50 |
$1,956.40
|
|
Drng open retroperitoneal abscess 49060
|
$1,202.50 |
$1,202.50 |
$1,202.50 |
$1,924.00
|
|
Drng peritoneal abscess open 49020
|
$1,791.50 |
$1,791.50 |
$1,791.50 |
$2,520.00
|
|
Dronabinol 2.5mg oral
|
$12.62 |
$12.62 |
$12.62 |
$11.40
|
|
Droperidol 2.5 mg/ml injection solution
|
$5.46 |
$5.46 |
$5.46 |
$31.25
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,575.70
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$127.14
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$289.05
|
|
Drug assay rufinamide
|
$51.00 |
$51.00 |
$51.00 |
$80.64
|
|
Drug assay vedolizumab
|
$455.00 |
$455.00 |
$455.00 |
$157.00
|
|
Drug assay voriconazole
|
$119.50 |
$119.50 |
$119.50 |
$96.75
|
|
Drug screen quant tiagabine
|
$50.00 |
$50.00 |
$50.00 |
$114.62
|
|
Drug test def 15-21 classes
|
$165.00 |
$165.00 |
$165.00 |
$274.26
|
|
Drug test def 1-7 classes
|
$163.00 |
$163.00 |
$163.00 |
$263.25
|
|
Drug test def 22+ classes
|
$41.00 |
$41.00 |
$41.00 |
$426.24
|
|
Drug test def 8-14 classes
|
$165.50 |
$165.50 |
$165.50 |
$282.00
|
|
Drug test prsmv instrmnt
|
$32.00 |
$32.00 |
$32.00 |
$89.05
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$375.50 |
$375.50 |
$375.50 |
$278.85
|
|
Dstrj nulyt agt gnclr nrv
|
$2,788.50 |
$2,788.50 |
$2,788.50 |
$2,967.48
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$204.00 |
$204.00 |
$204.00 |
$890.55
|
|
Durvalumab 50 mg/ml intravenous solution
|
$19,325.97 |
$19,325.97 |
$19,325.97 |
$7,973.90
|
|
Dx bronchoscope/brush 31623
|
$136.50 |
$136.50 |
$136.50 |
$2,040.67
|
|
Dx bronchoscope/lavage 31624
|
$138.50 |
$138.50 |
$138.50 |
$2,333.10
|
|
Dx bronchoscope/wash 31622
|
$138.50 |
$138.50 |
$138.50 |
$2,293.80
|
|
Dx gastr intub w/asp spec
|
$402.00 |
$402.00 |
$402.00 |
$441.60
|
|
Dx laryngoscopy newborn
|
$391.50 |
$391.50 |
$391.50 |
$707.25
|
|
Ear irrigation 69209
|
$105.00 |
$105.00 |
$105.00 |
$150.00
|
|
Ecg 12 lead tracing only
|
$537.50 |
$537.50 |
$537.50 |
$226.50
|
|
Ecg/1-3 leads/interp & report only 93042
|
$8.00 |
$8.00 |
$8.00 |
$16.00
|
|
Ecg external > 48 hours up to 7 days recording
|
$55.00 |
$55.00 |
$55.00 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$89.00 |
$89.00 |
$89.00 |
$161.85
|
|
Ecg/review interpret only
|
$26.50 |
$26.50 |
$26.50 |
$57.60
|
|
Echocardiogram (Heart Ultrasound)
|
$1,852.00 |
$1,852.00 |
$1,852.00 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$591.50 |
$591.50 |
$591.50 |
$485.25
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$1,852.00 |
$1,852.00 |
$1,852.00 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$689.50 |
$689.50 |
$689.50 |
$711.00
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$685.50 |
$685.50 |
$685.50 |
$851.50
|
|
Echocardiograpy doppler follow up/limited study
|
$587.50 |
$587.50 |
$587.50 |
$362.50
|
|
Echo exam of eye
|
$72.00 |
$72.00 |
$72.00 |
$172.00
|
|
Echo exam of eye
|
$90.00 |
$90.00 |
$90.00 |
$168.00
|
|
Echo exam of eye thickness
|
$13.00 |
$13.00 |
$13.00 |
$50.91
|
|
Echo exam uterus 76831-
|
$516.00 |
$516.00 |
$516.00 |
$552.03
|
|
Echo stress
|
$69.50 |
$69.50 |
$69.50 |
$1,607.45
|
|
Echo tee probe placement image acquisition interpretation & report
|
$2,730.00 |
$2,730.00 |
$2,730.00 |
$1,889.20
|
