|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$582.40 |
$582.40 |
$582.40 |
$364.50
|
|
Destruction laser surgery anal lesions 46917
|
$4,552.80 |
$4,552.80 |
$4,552.80 |
$3,640.00
|
|
Destruction les conjunctiva
|
$4,810.40 |
$4,810.40 |
$4,810.40 |
$2,760.73
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$513.60
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$558.97
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$482.00
|
|
Destruction mal lsn t/a/l >4cm
|
$1,209.60 |
$1,209.60 |
$1,209.60 |
$569.80
|
|
Destruction penis lesion(s) chem 54050
|
$358.40 |
$358.40 |
$358.40 |
$332.00
|
|
Destruction penis lesion(s) exten 54065
|
$5,504.80 |
$5,504.80 |
$5,504.80 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$1,052.80 |
$1,052.80 |
$1,052.80 |
$442.61
|
|
Destruction rectal tumor 45190
|
$8,909.60 |
$8,909.60 |
$8,909.60 |
$3,245.23
|
|
Destruction vag lesions complex 57065
|
$8,573.60 |
$8,573.60 |
$8,573.60 |
$3,762.53
|
|
Destruction vag lesions simple 57061
|
$9,312.80 |
$9,312.80 |
$9,312.80 |
$3,815.20
|
|
Destruct penis les/smp/electrodesi 54055
|
$6,725.60 |
$6,725.60 |
$6,725.60 |
$2,837.09
|
|
Detect agent nos dna dir
|
$80.08 |
$80.08 |
$80.08 |
$145.80
|
|
Detect agnt mult dna direc
|
$487.20 |
$487.20 |
$487.20 |
$166.77
|
|
Determination venous press
|
$31.36 |
$31.36 |
$31.36 |
$166.56
|
|
Developmental screen/score/document 96110
|
$397.60 |
$397.60 |
$397.60 |
$143.13
|
|
Devel tst phys/qhp 1st hr
|
$845.60 |
$845.60 |
$845.60 |
$350.40
|
|
Device ablt adv novasure
|
$5,285.00 |
$5,285.00 |
$5,285.00 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$4,200.00 |
$4,200.00 |
$4,200.00 |
$4,200.00
|
|
Device intraute mirena
|
$2,125.00 |
$2,125.00 |
$2,125.00 |
$2,125.00
|
|
Device sut capio slim opn
|
$48,300.00 |
$48,300.00 |
$48,300.00 |
$1,894.50
|
|
Device tiss remov myosure reach
|
$4,788.00 |
$4,788.00 |
$4,788.00 |
$2,466.14
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$543.20 |
$543.20 |
$543.20 |
$199.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$276.64 |
$276.64 |
$276.64 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$108.23 |
$108.23 |
$108.23 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$17.91 |
$17.91 |
$17.91 |
$21.20
|
|
Dexamethasone intra implant
|
$2,538.20 |
$2,538.20 |
$2,538.20 |
$2,356.90
|
|
Dexamethasone panel
|
$694.40 |
$694.40 |
$694.40 |
$223.39
|
|
Dexmedetomidine film, 1 mcg
|
$184.58 |
$184.58 |
$184.58 |
$171.39
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$961.16 |
$961.16 |
$961.16 |
$884.80
|
|
Dextran 40 infusion
|
$159.88 |
$159.88 |
$159.88 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$21.73 |
$21.73 |
$21.73 |
$36.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$32.93 |
$32.93 |
$32.93 |
$42.50
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$74.56 |
$74.56 |
$74.56 |
$46.12
|
|
Dhea-s (dehydroepiand sulfate)
|
$132.72 |
$132.72 |
$132.72 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$79.52 |
$79.52 |
$79.52 |
$79.20
|
|
Diabetic custom molded shoe
|
$269.36 |
$269.36 |
$269.36 |
$269.36
|
|
Diab manage trn ind/group
|
$128.24 |
$128.24 |
$128.24 |
$54.99
|
|
Diag bronchoscope/catheter
|
$3,808.00 |
$3,808.00 |
$3,808.00 |
$2,360.15
|
|
Diag laparo separate proc 49320
|
$12,174.40 |
$12,174.40 |
$12,174.40 |
$6,904.15
|
|
Diagnostic anoscopy
|
$250.32 |
$250.32 |
$250.32 |
$392.70
|
|
Diagnostic anoscopy & biopsy
|
$3,483.20 |
$3,483.20 |
$3,483.20 |
$2,288.00
|
|
Diagnostic anoscopy spx 46600
|
$806.40 |
$806.40 |
$806.40 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$509.60 |
$509.60 |
$509.60 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$336.00 |
$336.00 |
$336.00 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$767.20 |
$767.20 |
$767.20 |
$235.00
|
|
Diagnostic laryngoscopy 31575
|
$627.20 |
$627.20 |
$627.20 |
$334.95
|
|
Diagnostic Mammogram (both breasts)
|
$504.00 |
$504.00 |
$504.00 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$375.20 |
$375.20 |
$375.20 |
$312.72
|
|
Diagnostic radio unlisted proc
|
$498.40 |
$498.40 |
$498.40 |
$243.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$8,540.00 |
$8,540.00 |
$8,540.00 |
$5,663.50
|
|
Dialysis one evaluation
|
$1,103.20 |
$1,103.20 |
$1,103.20 |
$936.00
|
|
Dialysis repeated eval
|
$1,332.80 |
$1,332.80 |
$1,332.80 |
$1,332.80
|
|
Dialysis training incompl
|
$2,676.80 |
$2,676.80 |
$2,676.80 |
$391.67
|
|
Diathermy eg microwave
|
$29.68 |
$29.68 |
$29.68 |
$29.68
|
|
Diatrizoate meglumine 18 % urethral solution
|
$114.18 |
$114.18 |
$114.18 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$79.71 |
$79.71 |
$79.71 |
$77.25
|
|
Dicyclomine injection
|
$87.53 |
$87.53 |
$87.53 |
$150.91
|
|
Difelikefalin, esrd on dialy
|
$264.88 |
$264.88 |
$264.88 |
$264.88
|
|
Diffusing capacity
|
$554.40 |
$554.40 |
$554.40 |
$335.20
|
|
Digital analysis of eeg
|
$728.00 |
$728.00 |
$728.00 |
$551.20
|
|
Digit nerve surgery add-on
|
$2,335.20 |
$2,335.20 |
$2,335.20 |
$1,832.59
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$243.44 |
$243.44 |
$243.44 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$8,693.37 |
$8,693.37 |
$8,693.37 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$183.68 |
$183.68 |
$183.68 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$186.26 |
$186.26 |
$186.26 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$1,696.80 |
$1,696.80 |
$1,696.80 |
$1,729.70
|
|
Dilate esophagus
|
$5,163.20 |
$5,163.20 |
$5,163.20 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$2,878.40 |
$2,878.40 |
$2,878.40 |
$1,490.36
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$828.80 |
$828.80 |
$828.80 |
$3,026.10
|
|
Dilate ic vasospasm ea add vsl same territory
|
$414.40 |
$414.40 |
$414.40 |
$1,895.00
|
|
Dilate ic vasospasm init
|
$1,181.60 |
$1,181.60 |
$1,181.60 |
$4,627.52
|
|
Dilate tear duct opening
|
$968.80 |
$968.80 |
$968.80 |
$454.40
|
|
Dilate urethra stricture
|
$1,556.80 |
$1,556.80 |
$1,556.80 |
$496.00
|
|
Dilate urethra stricture
|
$666.40 |
$666.40 |
$666.40 |
$200.80
|
|
Dilate urethra stricture
|
$6,109.60 |
$6,109.60 |
$6,109.60 |
$3,863.60
|
|
Dilate urethra stricture
|
$1,276.80 |
$1,276.80 |
$1,276.80 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$890.40 |
$890.40 |
$890.40 |
$235.61
|
|
Dilation of anal sphincter
|
$5,527.20 |
$5,527.20 |
$5,527.20 |
$1,995.20
|
|
Dilation of cervical canal 57800
|
$10,001.60 |
$10,001.60 |
$10,001.60 |
$4,376.00
|
|
Dilation of rectal stricture 45910
|
$6,423.20 |
$6,423.20 |
$6,423.20 |
$2,263.80
|
|
Dilation of salivary duct
|
$1,450.40 |
$1,450.40 |
$1,450.40 |
$750.00
|
|
Dilation of urethra
|
$666.40 |
$666.40 |
$666.40 |
$172.00
|
|
Dilation of urethra
|
$1,696.80 |
$1,696.80 |
$1,696.80 |
$2,424.12
|
|
Dilation of vagina
|
$6,143.20 |
$6,143.20 |
$6,143.20 |
$3,986.00
|
|
Dilation salivary duct 42650
|
$5,633.60 |
$5,633.60 |
$5,633.60 |
$2,675.71
|
|
Dilation/urethral strict/male/ini 53620
|
$4,144.00 |
$4,144.00 |
$4,144.00 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$48,300.00 |
$48,300.00 |
$48,300.00 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$7,554.40 |
$7,554.40 |
$7,554.40 |
$3,883.16
|
|
Dilat xst trc new access rcs
|
$7,554.40 |
$7,554.40 |
$7,554.40 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$55.05 |
$55.05 |
$55.05 |
$46.56
|
|
Dimecaprol injection
|
$283.12 |
$283.12 |
$283.12 |
$293.38
|
|
Dimenhydrinate injection
|
$32.82 |
$32.82 |
$32.82 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,277.82 |
$1,277.82 |
$1,277.82 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$5.48 |
$5.48 |
$5.48 |
$18.35
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$28.56 |
$28.56 |
$28.56 |
$98.56
|
|
Dipyridamole injection
|
$48.04 |
$48.04 |
$48.04 |
$48.04
|
|
Dir nsl mucous membrane test
|
$145.60 |
$145.60 |
$145.60 |
$76.80
|
