|
Debridement subcutaneous tissue <= 20 sq cm
|
$294.00 |
$294.00 |
$294.00 |
$810.50
|
|
Debride nail1-5 11720
|
$122.85 |
$122.85 |
$122.85 |
$173.25
|
|
Debride nail6 or more 11721
|
$122.85 |
$122.85 |
$122.85 |
$195.20
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$597.80 |
$597.80 |
$597.80 |
$1,265.16
|
|
Debride skin bone at fx site
|
$2,276.05 |
$2,276.05 |
$2,276.05 |
$3,278.34
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$122.85 |
$122.85 |
$122.85 |
$663.30
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$597.80 |
$597.80 |
$597.80 |
$1,129.45
|
|
Debr inf skin add-on 11001
|
$109.55 |
$109.55 |
$109.55 |
$113.05
|
|
Debr musc/fascia 20sq cm/< 11043
|
$304.85 |
$304.85 |
$304.85 |
$1,193.40
|
|
Decitabine 50 mg intravenous solution
|
$6,204.08 |
$6,204.08 |
$6,204.08 |
$1,157.57
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$311.85 |
$311.85 |
$311.85 |
$545.90
|
|
Decompress fasciotomyhand 26037
|
$3,930.50 |
$3,930.50 |
$3,930.50 |
$3,594.44
|
|
Decompression of lower leg
|
$2,426.55 |
$2,426.55 |
$2,426.55 |
$3,839.54
|
|
Decompression of thigh/knee
|
$2,426.55 |
$2,426.55 |
$2,426.55 |
$3,839.54
|
|
Deep muscle biopsy 20205
|
$2,276.05 |
$2,276.05 |
$2,276.05 |
$3,370.52
|
|
Deferoxamine 500 mg solution for injection
|
$110.42 |
$110.42 |
$110.42 |
$96.41
|
|
Delivery of placenta 59414
|
$1,246.00 |
$1,246.00 |
$1,246.00 |
$3,271.20
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$316.40 |
$316.40 |
$316.40 |
$196.26
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$12,397.98 |
$12,397.98 |
$12,397.98 |
$6,359.20
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$156.80 |
$156.80 |
$156.80 |
$460.50
|
|
Derma-fat-fascia graft 15770
|
$4,402.30 |
$4,402.30 |
$4,402.30 |
$4,326.42
|
|
Dermagraft
|
$21.00 |
$21.00 |
$21.00 |
$1,432.59
|
|
Design mlc device for imrt
|
$2,340.10 |
$2,340.10 |
$2,340.10 |
$1,669.85
|
|
Desmopressin 4 mcg/ml injection solution
|
$34.40 |
$34.40 |
$34.40 |
$116.22
|
|
Destroy premlg lesns;1st lesn 17000
|
$140.00 |
$140.00 |
$140.00 |
$220.12
|
|
Destruct cut vasl lesions <10cm 17106
|
$332.15 |
$332.15 |
$332.15 |
$658.40
|
|
Destruction anal lesion(s) smpl chem 46900
|
$296.45 |
$296.45 |
$296.45 |
$535.46
|
|
Destruction benign lesions < 14 lesions
|
$171.15 |
$171.15 |
$171.15 |
$250.60
|
|
Destruction vag lesions simple 57061
|
$5,107.55 |
$5,107.55 |
$5,107.55 |
$3,762.53
|
|
Devel tst phys/qhp 1st hr
|
$463.05 |
$463.05 |
$463.05 |
$339.30
|
|
Device ablt adv novasure
|
$4,494.00 |
$4,494.00 |
$4,494.00 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$3,762.50 |
$3,762.50 |
$3,762.50 |
$4,298.87
|
|
Device sut capio slim opn
|
$1,114.58 |
$1,114.58 |
$1,114.58 |
$1,936.74
|
|
Device tiss remov myosure reach
|
$8,085.00 |
$8,085.00 |
$8,085.00 |
$2,541.00
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$232.40 |
$232.40 |
$232.40 |
$196.30
|
|
Dexamethasone 4 mg tablet
|
$8.93 |
$8.93 |
$8.93 |
$5.98
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$32.82 |
$32.82 |
$32.82 |
$27.00
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$68.93 |
$68.93 |
$68.93 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$68.93 |
$68.93 |
$68.93 |
$51.80
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$68.93 |
$68.93 |
$68.93 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$68.93 |
$68.93 |
$68.93 |
$48.58
|
|
Diabetes (HbA1c) Test
|
$125.30 |
$125.30 |
$125.30 |
$78.03
|
|
Diab manage trn ind/group
|
$59.15 |
$59.15 |
$59.15 |
$59.36
|
|
Diagnostic anoscopy
|
$139.65 |
$139.65 |
$139.65 |
$441.68
|
|
Diagnostic anoscopy spx 46600
|
$121.80 |
$121.80 |
$121.80 |
$245.35
|
|
Diagnostic laryngoscopy 31505
|
$121.80 |
$121.80 |
$121.80 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$242.20 |
$242.20 |
$242.20 |
$385.20
|
|
Diagnostic Mammogram (both breasts)
|
$502.60 |
$502.60 |
$502.60 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$366.10 |
$366.10 |
$366.10 |
$301.55
|
|
Dialysis circuit perm vascular embolization 36909
|
$1,865.85 |
$1,865.85 |
$1,865.85 |
$7,145.00
|
|
Dialysis one evaluation
|
$2,347.45 |
$2,347.45 |
$2,347.45 |
$842.10
|
|
Diatrizoate meglumine 18 % urethral solution
|
$31.50 |
$31.50 |
$31.50 |
$103.50
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$55.40 |
$55.40 |
$55.40 |
$73.22
|
|
Dicyclomine injection
|
$302.03 |
$302.03 |
$302.03 |
$203.85
|
|
Diffusing capacity
|
$160.30 |
$160.30 |
$160.30 |
$360.10
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$494.87 |
$494.87 |
$494.87 |
$71.09
|
|
Digoxin immune fab 40 mg intravenous solution
|
$17,877.79 |
$17,877.79 |
$17,877.79 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$521.85 |
$521.85 |
$521.85 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$472.05 |
$472.05 |
$472.05 |
$309.20
|
|
Dilate biliary duct/ampulla
|
$3,073.70 |
$3,073.70 |
$3,073.70 |
$2,304.60
|
|
Dilate urethra stricture
|
$173.25 |
$173.25 |
$173.25 |
$514.79
|
|
Dilation/female urethra/initial 53660
|
$169.75 |
$169.75 |
$169.75 |
$207.39
|
|
Dilation/urethral strict/male/ini 53620
|
$708.75 |
$708.75 |
$708.75 |
$1,550.25
|
|
Dilator fascial 10fx20cm
|
$263.55 |
$263.55 |
$263.55 |
$305.68
|
|
Dilat xst trc ndurlgc px
|
$5,649.00 |
$5,649.00 |
$5,649.00 |
$4,081.37
|
|
Dilat xst trc new access rcs
|
$3,685.50 |
$3,685.50 |
$3,685.50 |
$5,020.00
|
|
Dimethyl sulfoxide 50% 50 ml
|
$2,622.87 |
$2,622.87 |
$2,622.87 |
$1,182.00
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$33.60 |
$33.60 |
$33.60 |
$25.12
|
|
Disability dlco
|
$95.55 |
$95.55 |
$95.55 |
$307.58
|
|
Discography cerv/thor spine
|
$929.25 |
$929.25 |
$929.25 |
$2,404.00
|
|
Dissolve clot heart vessel
|
$2,822.40 |
$2,822.40 |
$2,822.40 |
$1,396.47
|
|
Dlyd plmt xtn prosth ea addl
|
$1,205.75 |
$1,205.75 |
$1,205.75 |
$2,001.55
|
|
Dna antibody native/double stranded
|
$26.95 |
$26.95 |
$26.95 |
$102.60
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$107.59 |
$107.59 |
$107.59 |
$99.10
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$7,768.98 |
$7,768.98 |
$7,768.98 |
$797.62
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$87.41 |
$87.41 |
$87.41 |
$76.20
|
|
Doppler echo complete
|
$524.65 |
$524.65 |
$524.65 |
$608.25
|
|
Doppler intravascular pressure flow initial vessel
|
$915.60 |
$915.60 |
$915.60 |
$3,006.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$533.40 |
$533.40 |
$533.40 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$393.40 |
$393.40 |
$393.40 |
$482.03
|
|
Dornase alfa non-comp unit
|
$77.25 |
$77.25 |
$77.25 |
$350.67
|
|
Dornhoffer fixed part w/window
|
$20,701.45 |
$20,701.45 |
$20,701.45 |
$33,604.20
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$223.09 |
$223.09 |
$223.09 |
$404.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$4,228.65 |
$4,228.65 |
$4,228.65 |
$2,278.13
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$59.90 |
$59.90 |
$59.90 |
$84.80
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$387.80 |
$387.80 |
$387.80 |
$820.50
|
|
Drainage ext aud canal abscess 69020
|
$597.80 |
$597.80 |
$597.80 |
$900.80
|
|
Drainage external ear complex 69005
|
$1,351.00 |
$1,351.00 |
$1,351.00 |
$2,967.58
|
|
Drainage external ear simple 69000
|
$597.80 |
$597.80 |
$597.80 |
$809.25
|
|
Drainage lymph node lesion 38300
|
$2,031.75 |
$2,031.75 |
$2,031.75 |
$3,170.64
|
|
Drainage mouth roof lesion
|
$203.35 |
$203.35 |
$203.35 |
$474.39
|
|
Drainage of arm bursa 23931
|
$2,585.80 |
$2,585.80 |
$2,585.80 |
$2,419.30
|
|
Drainage of eye
|
$1,185.80 |
$1,185.80 |
$1,185.80 |
$2,503.62
|
|
Drainage of kidney lesion
|
$480.20 |
$480.20 |
$480.20 |
$1,706.65
|
|
Drainage of mouth lesion
|
$169.75 |
$169.75 |
$169.75 |
$455.56
|
|
Drainage of mouth lesion
|
$1,159.20 |
$1,159.20 |
$1,159.20 |
$2,320.03
|
|
Drainage of mouth lesion
|
$1,470.70 |
$1,470.70 |
$1,470.70 |
$3,986.00
|
|
Drainage of mouth lesion
|
$387.80 |
$387.80 |
$387.80 |
$799.40
|
|
Drainage of mouth lesion
|
$1,470.70 |
$1,470.70 |
$1,470.70 |
$3,837.72
|
|
Drainage of nose lesion int 30000
|
$156.80 |
$156.80 |
$156.80 |
$548.00
|