|
Dest mal lesion tal 0.6-1.0cm 17261
|
$222.30 |
$222.30 |
$222.30 |
|
|
Dest mal lesion tal 1.1-2.0cm 17262
|
$171.60 |
$171.60 |
$171.60 |
|
|
Dest mal lesion tal 2.1-3.0cm 17263
|
$222.30 |
$222.30 |
$222.30 |
|
|
Destroy cervthor facet jnt 64633
|
$3,982.40 |
$4,326.27 |
$10,780.00 |
|
|
Destroy cth facet jnt addl 64634
|
$1,441.44 |
$1,441.44 |
$5,778.00 |
|
|
Destroy internal hemorrhoids destroy 46930
|
$9,290.00 |
$9,290.00 |
$9,290.00 |
|
|
Destroy premlg lesns;1st lesn 17000
|
$89.70 |
$89.70 |
$4,609.00 |
|
|
Destroy vulva lesion extensive 56515
|
$6,653.00 |
$6,653.00 |
$6,653.00 |
|
|
Destroy vulva lesion simple 56501
|
$4,077.84 |
$4,077.84 |
$4,862.00 |
|
|
Destruct ben lesion 15/> 17111
|
$173.16 |
$173.16 |
$173.16 |
|
|
Destruct cut vasl lesions 10-50cm 17107
|
$789.75 |
$789.75 |
$789.75 |
|
|
Destruct cut vasl lesions <10cm 17106
|
$355.29 |
$355.29 |
$1,079.00 |
|
|
Destruct cut vasl lesions >50cm 17108
|
$737.10 |
$737.10 |
$737.10 |
|
|
Destruction 2-14 lesions 17003
|
$1,122.03 |
$1,122.03 |
$1,122.03 |
|
|
Destruction anal lesion(s)
|
$5,810.00 |
$5,810.00 |
$5,810.00 |
|
|
Destruction anal lesion(s)
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
|
|
Destruction anal lesion(s) smpl chem 46900
|
$340.86 |
$340.86 |
$340.86 |
|
|
Destruction benign lesions < 14 lesions
|
$726.00 |
$2,690.22 |
$4,609.00 |
|
|
Destruction by injection tx of nerve 64630
|
$2,143.44 |
$2,143.44 |
$5,507.00 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,441.44 |
$1,441.44 |
$11,148.00 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$4,326.27 |
$4,326.27 |
$24,351.18 |
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$355.29 |
$355.29 |
$604.00 |
|
|
Destruction les conjunctiva
|
$3,920.00 |
$3,920.00 |
$3,920.00 |
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$252.72 |
$252.72 |
$252.72 |
|
|
Destruction penis lesion(s) chem 54050
|
$132.21 |
$132.21 |
$132.21 |
|
|
Destruction penis lesion(s) exten 54065
|
$2,507.31 |
$2,507.31 |
$2,507.31 |
|
|
Destruction premal lesions 15/> 17004
|
$370.89 |
$370.89 |
$370.89 |
|
|
Destruction rectal tumor 45190
|
$15,686.00 |
$15,686.00 |
$15,686.00 |
|
|
Destruction vag lesions complex 57065
|
$4,609.00 |
$4,609.00 |
$4,609.00 |
|
|
Destruction vag lesions simple 57061
|
$4,609.00 |
$6,276.66 |
$6,276.66 |
|
|
Destruct penis les/smp/electrodesi 54055
|
$2,507.31 |
$2,507.31 |
$2,507.31 |
|
|
Detect agnt mult dna direc
|
$201.00 |
$201.00 |
$201.00 |
|
|
Devel tst phys/qhp 1st hr
|
$393.12 |
$393.12 |
$393.12 |
|
|
Device ablt adv novasure
|
$11,951.50 |
$16,765.60 |
$16,765.60 |
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$3,850.00 |
$4,298.87 |
$4,298.87 |
|
|
Device intraute mirena
|
$2,915.12 |
$3,053.60 |
$3,053.60 |
|
|
Device sut capio slim opn
|
$1,137.40 |
$1,461.67 |
$1,461.67 |
|
|
Device tiss remov myosure reach
|
$591.75 |
$591.75 |
$2,623.50 |
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$339.30 |
$339.30 |
$339.30 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$84.96 |
$332.67 |
$1,162.81 |
|
|
Dexamethasone 4 mg tablet
|
$2.45 |
$2.45 |
$223.14 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$3.36 |
$3.36 |
$194.88 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$187.21 |
$770.96 |
$1,675.80 |
|
|
Dextran 40 infusion
|
$41.92 |
$174.02 |
$292.25 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$6.22 |
$36.05 |
$449.28 |
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$4.67 |
$32.44 |
$449.28 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$22.16 |
$60.32 |
$113.87 |
|
|
Dextrose 5 % IV bolus
|
$7.77 |
$36.05 |
$449.28 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$35.82 |
$296.79 |
$1,191.43 |
|
|
Diabetes (HbA1c) Test
|
$24.57 |
$122.46 |
$660.26 |
|
|
Diabetes training group per 30 min g0109
|
$66.00 |
$66.00 |
$66.00 |
|
|
Diab manage trn ind/group
|
$14.80 |
$54.99 |
$379.00 |
|
|
Diag bronchoscope/catheter
|
$1,647.84 |
$1,647.84 |
$1,647.84 |
|
|
Diag laparo separate proc 49320
|
$5,630.22 |
$8,661.00 |
$8,661.00 |
|
|
Diagnostic anoscopy
|
$8,264.00 |
$8,264.00 |
$8,264.00 |
|
|
Diagnostic anoscopy & biopsy
|
$4,894.00 |
$4,894.00 |
$4,894.00 |
|
|
Diagnostic anoscopy spx 46600
|
$423.00 |
$1,365.00 |
$8,718.00 |
|
|
Diagnostic digital breast tomosynthesis bil
|
$304.42 |
$304.42 |
$310.42 |
|
|
Diagnostic digital breast tomosynthesis unil
|
$44.46 |
$44.46 |
$268.00 |
|
|
Diagnostic laryngoscopy 31505
|
$166.95 |
$205.14 |
$478.00 |
|
|
Diagnostic laryngoscopy 31575
|
$668.00 |
$2,006.94 |
$2,006.94 |
|
|
Diagnostic Mammogram (both breasts)
|
$126.99 |
$402.33 |
$612.00 |
|
|
Diagnostic Mammogram (one breast)
|
$97.68 |
$349.05 |
$550.00 |
|
|
Diagnostic radio unlisted proc
|
$146.25 |
$146.25 |
$1,481.00 |
|
|
Dialysis circuit perm vascular embolization 36909
|
$4,064.38 |
$9,279.66 |
$9,279.66 |
|
|
Dialysis one evaluation
|
$570.99 |
$827.97 |
$5,189.35 |
|
|
Dialysis repeated eval
|
$222.00 |
$222.00 |
$222.00 |
|
|
Diathermy eg microwave
|
$50.31 |
$50.31 |
$50.31 |
|
|
Diatrizoate meglumine 18 % urethral solution
|
$1.33 |
$321.75 |
$520.29 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$55.63 |
$110.23 |
$243.08 |
|
|
Dicyclomine injection
|
$112.02 |
$312.30 |
$858.23 |
|
|
Diffusing capacity
|
$208.68 |
$541.71 |
$1,719.00 |
|
|
Digital analysis of eeg
|
$549.00 |
$2,811.00 |
$2,811.00 |
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$14.36 |
$14.36 |
$578.47 |
|
|
Digoxin immune fab 40 mg intravenous solution
|
$9,075.78 |
$11,823.58 |
$17,053.09 |
|
|
Digoxin total therapeutic drug level
|
$61.00 |
$124.80 |
$499.09 |
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$137.09 |
$646.73 |
$646.73 |
|
|
Dilate biliary duct/ampulla
|
$185.30 |
$1,156.74 |
$5,258.00 |
|
|
Dilate esophagus
|
$2,003.04 |
$2,003.04 |
$6,234.00 |
|
|
Dilate esophagus 1/mult pass
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$5,382.39 |
$5,382.39 |
$8,507.00 |
|
|
Dilate ic vasospasm ea add vsl same territory
|
$3,589.17 |
$3,589.17 |
$7,291.00 |
|
|
Dilate ic vasospasm init
|
$3,012.10 |
$6,280.95 |
$9,720.00 |
|
|
Dilate tear duct opening
|
$80.73 |
$80.73 |
$80.73 |
|
|
Dilate urethra stricture
|
$946.00 |
$1,503.84 |
$4,609.00 |
|
|
Dilate urethra stricture
|
$1,368.12 |
$1,368.12 |
$1,368.12 |
|
|
Dilation/female urethra/initial 53660
|
$714.87 |
$714.87 |
$714.87 |
|
|
Dilation of anal sphincter
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
|
|
Dilation of cervical canal 57800
|
$4,609.00 |
$4,609.00 |
$4,609.00 |
|
|
Dilation of rectal stricture 45910
|
$4,609.00 |
$4,609.00 |
$4,609.00 |
|
|
Dilation of salivary duct
|
$1,525.00 |
$1,525.00 |
$1,525.00 |
|
|
Dilation of urethra
|
$2,507.31 |
$2,507.31 |
$2,507.31 |
|
|
Dilation of vagina
|
$5,507.00 |
$5,507.00 |
$5,507.00 |
|
|
Dilation/urethral strict/male/ini 53620
|
$2,507.31 |
$2,507.31 |
$2,507.31 |
|
|
Dilator fascial 10fx20cm
|
$104.50 |
$286.59 |
$286.59 |
|
|
Dilat xst trc ndurlgc px
|
$4,820.40 |
$4,820.40 |
$7,301.00 |
|
|
Dilat xst trc new access rcs
|
$8,110.83 |
$8,110.83 |
$8,110.83 |
|
|
Diltiazem 5 mg/ml intravenous solution
|
$33.74 |
$33.74 |
$33.74 |
|
|
Dimethyl sulfoxide 50% 50 ml
|
$808.59 |
$1,751.40 |
$1,751.40 |
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$1.13 |
$106.09 |
$2,420.18 |
|
