|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$10,947.95 |
$10,947.95 |
$10,947.95 |
$3,296.80
|
|
Destruction ciliary body
|
$1,235.00 |
$1,235.00 |
$1,235.00 |
$3,228.83
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$742.95 |
$742.95 |
$742.95 |
$375.87
|
|
Destruction laser surgery anal lesions 46917
|
$496.60 |
$496.60 |
$496.60 |
$3,640.00
|
|
Destruction les conjunctiva
|
$491.40 |
$491.40 |
$491.40 |
$2,760.73
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$974.35 |
$974.35 |
$974.35 |
$513.60
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$686.40 |
$686.40 |
$686.40 |
$558.97
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$974.35 |
$974.35 |
$974.35 |
$482.00
|
|
Destruction mal lsn t/a/l >4cm
|
$683.80 |
$683.80 |
$683.80 |
$569.80
|
|
Destruction penis lesion(s) exten 54065
|
$642.20 |
$642.20 |
$642.20 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$974.35 |
$974.35 |
$974.35 |
$442.61
|
|
Destruction rectal tumor 45190
|
$2,709.20 |
$2,709.20 |
$2,709.20 |
$3,245.23
|
|
Destruction vag lesions complex 57065
|
$760.50 |
$760.50 |
$760.50 |
$3,986.00
|
|
Destruction vag lesions simple 57061
|
$11,883.95 |
$11,883.95 |
$11,883.95 |
$4,006.38
|
|
Destruct penis les/smp/electrodesi 54055
|
$6,836.70 |
$6,836.70 |
$6,836.70 |
$2,837.09
|
|
Determination venous press
|
$45.50 |
$45.50 |
$45.50 |
$166.56
|
|
Determine refractive state
|
$42.25 |
$42.25 |
$42.25 |
$21.50
|
|
Developmental screen/score/document 96110
|
$256.75 |
$256.75 |
$256.75 |
$142.38
|
|
Devel tst phys/qhp 1st hr
|
$877.50 |
$877.50 |
$877.50 |
$350.40
|
|
Device ablt adv novasure
|
$2,259.40 |
$2,259.40 |
$2,259.40 |
$6,237.48
|
|
Device intraute mirena
|
$1,894.83 |
$1,894.83 |
$1,894.83 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,381.90 |
$1,381.90 |
$1,381.90 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$876.85 |
$876.85 |
$876.85 |
$2,515.00
|
|
Dev interrog remote 1/2/mlt
|
$211.90 |
$211.90 |
$211.90 |
$115.20
|
|
Devise bowel pouch
|
$6,133.40 |
$6,133.40 |
$6,133.40 |
$3,464.00
|
|
Devlopment test interpt&rep
|
$345.15 |
$345.15 |
$345.15 |
$109.46
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$301.60 |
$301.60 |
$301.60 |
$199.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$551.20 |
$551.20 |
$551.20 |
$227.25
|
|
Dexametha opth insert 0.1 mg
|
$998.40 |
$998.40 |
$998.40 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$24.05 |
$24.05 |
$24.05 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$17.55 |
$17.55 |
$17.55 |
$20.76
|
|
Dexamethasone intra implant
|
$3,119.22 |
$3,119.22 |
$3,119.22 |
$2,356.90
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$641.76 |
$641.76 |
$641.76 |
$884.80
|
|
Dextran 40 infusion
|
$1.54 |
$1.54 |
$1.54 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$27.95 |
$27.95 |
$27.95 |
$36.05
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$26.65 |
$26.65 |
$26.65 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$33.15 |
$33.15 |
$33.15 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$25.35 |
$25.35 |
$25.35 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$69.55 |
$69.55 |
$69.55 |
$79.30
|
|
Diabetes training group per 30 min g0109
|
$51.35 |
$51.35 |
$51.35 |
$35.43
|
|
Diab manage trn ind/group
|
$71.50 |
$71.50 |
$71.50 |
$54.99
|
|
Diag bronchoscope/catheter
|
$907.40 |
$907.40 |
$907.40 |
$2,360.15
|
|
Diag laparo separate proc 49320
|
$1,470.30 |
$1,470.30 |
$1,470.30 |
$7,104.72
|
|
Diagnostic anoscopy
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$392.70
|
|
Diagnostic anoscopy & biopsy
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$2,288.00
|
|
Diagnostic anoscopy spx 46600
|
$481.65 |
$481.65 |
$481.65 |
$195.50
|
|
Diagnostic digital breast tomosynthesis bil
|
$159.90 |
$159.90 |
$159.90 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$129.35 |
$129.35 |
$129.35 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$725.40 |
$725.40 |
$725.40 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$725.40 |
$725.40 |
$725.40 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$833.95 |
$833.95 |
$833.95 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$668.20 |
$668.20 |
$668.20 |
$314.00
|
|
Diagnostic radio unlisted proc
|
$17,667.00 |
$17,667.00 |
$17,667.00 |
$259.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$18,500.95 |
$18,500.95 |
$18,500.95 |
$5,741.00
|
|
Dialysis one evaluation
|
$2,387.45 |
$2,387.45 |
$2,387.45 |
$936.00
|
|
Dialysis repeated eval
|
$655.20 |
$655.20 |
$655.20 |
$1,332.80
|
|
Dialysis training complete
|
$1,632.80 |
$1,632.80 |
$1,632.80 |
$783.36
|
|
Dialysis training incompl
|
$347.10 |
$347.10 |
$347.10 |
$391.67
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.72 |
$0.72 |
$0.72 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$46.80 |
$46.80 |
$46.80 |
$79.71
|
|
Dicyclomine injection
|
$45.63 |
$45.63 |
$45.63 |
$154.33
|
|
Diffusing capacity
|
$540.80 |
$540.80 |
$540.80 |
$336.80
|
|
Digital analysis of eeg
|
$739.70 |
$739.70 |
$739.70 |
$593.40
|
|
Digit nerve surgery add-on
|
$808.60 |
$808.60 |
$808.60 |
$1,832.59
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$335.15 |
$335.15 |
$335.15 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$11,639.16 |
$11,639.16 |
$11,639.16 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$92.95 |
$92.95 |
$92.95 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$245.70 |
$245.70 |
$245.70 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$3,354.65 |
$3,354.65 |
$3,354.65 |
$1,866.73
|
|
Dilate esophagus
|
$366.60 |
$366.60 |
$366.60 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$365.95 |
$365.95 |
$365.95 |
$1,548.00
|
|
Dilate tear duct opening
|
$213.20 |
$213.20 |
$213.20 |
$454.40
|
|
Dilate urethra stricture
|
$909.35 |
$909.35 |
$909.35 |
$513.00
|
|
Dilate urethra stricture
|
$481.65 |
$481.65 |
$481.65 |
$200.80
|
|
Dilate urethra stricture
|
$332.80 |
$332.80 |
$332.80 |
$3,863.60
|
|
Dilate urethra stricture
|
$909.35 |
$909.35 |
$909.35 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$585.00 |
$585.00 |
$585.00 |
$235.61
|
|
Dilation of anal sphincter
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$2,166.04
|
|
Dilation of cervical canal 57800
|
$200.20 |
$200.20 |
$200.20 |
$4,446.00
|
|
Dilation of rectal stricture 45910
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$2,491.80
|
|
Dilation of salivary duct
|
$293.80 |
$293.80 |
$293.80 |
$790.00
|
|
Dilation of urethra
|
$481.65 |
$481.65 |
$481.65 |
$172.00
|
|
Dilation of urethra
|
$197.60 |
$197.60 |
$197.60 |
$2,424.12
|
|
Dilation of vagina
|
$590.20 |
$590.20 |
$590.20 |
$4,446.00
|
|
Dilation salivary duct 42650
|
$5,536.70 |
$5,536.70 |
$5,536.70 |
$2,675.71
|
|
Dilation/urethral strict/male/ini 53620
|
$2,494.70 |
$2,494.70 |
$2,494.70 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$857.35 |
$857.35 |
$857.35 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$12,890.15 |
$12,890.15 |
$12,890.15 |
$3,900.60
|
|
Dilat xst trc new access rcs
|
$12,890.15 |
$12,890.15 |
$12,890.15 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$26.70 |
$26.70 |
$26.70 |
$45.60
|
|
Dimenhydrinate injection
|
$30.75 |
$30.75 |
$30.75 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$102.05 |
$102.05 |
$102.05 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$9.75 |
$9.75 |
$9.75 |
$18.32
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$287.88 |
$287.88 |
$287.88 |
$98.15
|
|
Dipyridamole injection
|
$4.64 |
$4.64 |
$4.64 |
$48.04
|
|
Disability dlco
|
$659.10 |
$659.10 |
$659.10 |
$293.76
|
|
Disaccharidases
|
$921.05 |
$921.05 |
$921.05 |
$230.40
|
|
Disarticulation shoulder
|
$4,219.80 |
$4,219.80 |
$4,219.80 |
$13,116.76
|
|
Discectomy ant dcmprn cord thoracic 1 ntrspc 63077
|
$5,948.80 |
$5,948.80 |
$5,948.80 |
$3,636.00
|
|
Discectomy ant dcmprn cord thoracic ea ntrsp 63078
|
$852.80 |
$852.80 |
$852.80 |
$370.20
|
