|
Debridement (>20 cm) charge pt
|
$475.30 |
$475.30 |
$475.30 |
$278.50
|
|
Debridement bone <= 20 sq cm
|
$2,844.10 |
$2,844.10 |
$2,844.10 |
$2,293.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,191.40 |
$1,191.40 |
$1,191.40 |
$687.35
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$998.90 |
$998.90 |
$998.90 |
$1,373.46
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$1,381.80 |
$1,381.80 |
$1,381.80 |
$820.15
|
|
Debride nail1-5 11720
|
$160.30 |
$160.30 |
$160.30 |
$149.04
|
|
Debride nail6 or more 11721
|
$260.40 |
$260.40 |
$260.40 |
$167.63
|
|
Debride skin bone at fx site
|
$1,523.20 |
$1,523.20 |
$1,523.20 |
$2,921.60
|
|
Debride skn/sq t/m/f necro infctj abdl wall 11005
|
$1,899.80 |
$1,899.80 |
$1,899.80 |
$1,899.80
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$1,082.20 |
$1,082.20 |
$1,082.20 |
$641.52
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$1,985.90 |
$1,985.90 |
$1,985.90 |
$1,129.45
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,799.00 |
$1,799.00 |
$1,799.00 |
$1,160.00
|
|
Decalcification
|
$77,910.33 |
$77,910.33 |
$77,910.33 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$593.60 |
$593.60 |
$593.60 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$35,840.00 |
$35,840.00 |
$35,840.00 |
$546.84
|
|
Decompression of leg
|
$7,102.90 |
$7,102.90 |
$7,102.90 |
$4,094.02
|
|
Decompression of lower leg
|
$7,102.90 |
$7,102.90 |
$7,102.90 |
$3,839.54
|
|
Deferoxamine 500 mg solution for injection
|
$570.85 |
$570.85 |
$570.85 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$3,794.35 |
$3,794.35 |
$3,794.35 |
$1,855.50
|
|
Delivery of placenta 59414
|
$2,444.40 |
$2,444.40 |
$2,444.40 |
$2,822.68
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$172.90 |
$172.90 |
$172.90 |
$182.40
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$21,074.37 |
$21,074.37 |
$21,074.37 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$750.40 |
$750.40 |
$750.40 |
$399.93
|
|
Derma-gide, 1 sq cm
|
$707.00 |
$707.00 |
$707.00 |
$16.80
|
|
Design mlc device for imrt
|
$54,317.90 |
$54,317.90 |
$54,317.90 |
$1,739.10
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,277.32 |
$1,277.32 |
$1,277.32 |
$93.84
|
|
Desoxycorticosterone
|
$70.00 |
$70.00 |
$70.00 |
$98.80
|
|
Des thora aorta rpr without left sub art 33881
|
$4,153.80 |
$4,153.80 |
$4,153.80 |
$4,937.50
|
|
Dest mal lesion tal 2.1-3.0cm 17263
|
$425.60 |
$425.60 |
$425.60 |
$364.50
|
|
Destroy cervthor facet jnt 64633
|
$8,300.60 |
$8,300.60 |
$8,300.60 |
$3,018.00
|
|
Destroy cth facet jnt addl 64634
|
$8,300.60 |
$8,300.60 |
$8,300.60 |
$1,441.44
|
|
Destroy vulva lesion extensive 56515
|
$22,914.56 |
$22,914.56 |
$22,914.56 |
$2,837.09
|
|
Destroy vulva lesion simple 56501
|
$22,686.24 |
$22,686.24 |
$22,686.24 |
$3,556.00
|
|
Destruction anal lesion(s)
|
$17,351.83 |
$17,351.83 |
$17,351.83 |
$3,711.00
|
|
Destruction anal lesion(s) smpl chem 46900
|
$678.30 |
$678.30 |
$678.30 |
$557.90
|
|
Destruction benign lesions < 14 lesions
|
$154.70 |
$154.70 |
$154.70 |
$235.13
|
|
Destruction by injection tx of nerve 64630
|
$10,433.13 |
$10,433.13 |
$10,433.13 |
$1,626.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$8,554.00 |
$8,554.00 |
$8,554.00 |
$1,618.65
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$8,554.00 |
$8,554.00 |
$8,554.00 |
$3,295.50
|
|
Destruction vag lesions complex 57065
|
$16,526.92 |
$16,526.92 |
$16,526.92 |
$3,762.53
|
|
Destruction vag lesions simple 57061
|
$12,488.99 |
$12,488.99 |
$12,488.99 |
$3,815.20
|
|
Detect agent nos dna dir
|
$105.00 |
$105.00 |
$105.00 |
$145.80
|
|
Detect agnt mult dna direc
|
$209.30 |
$209.30 |
$209.30 |
$166.77
|
|
Devel tst phys/qhp 1st hr
|
$399.00 |
$399.00 |
$399.00 |
$350.40
|
|
Device ablt adv novasure
|
$40,298.24 |
$40,298.24 |
$40,298.24 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$10,783.90 |
$10,783.90 |
$10,783.90 |
$4,200.00
|
|
Device intraute mirena
|
$7,690.02 |
$7,690.02 |
$7,690.02 |
$2,125.00
|
|
Device sut capio slim opn
|
$3,631.58 |
$3,631.58 |
$3,631.58 |
$1,894.50
|
|
Device tiss remov myosure reach
|
$4,864.24 |
$4,864.24 |
$4,864.24 |
$2,466.14
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$199.50 |
$199.50 |
$199.50 |
$199.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$368.20 |
$368.20 |
$368.20 |
$227.15
|
|
Dexametha opth insert 0.1 mg
|
$3,506.12 |
$3,506.12 |
$3,506.12 |
$888.47
|
|
Dexamethasone 4 mg tablet
|
$36.75 |
$36.75 |
$36.75 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$288.22 |
$288.22 |
$288.22 |
$21.20
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,481.55 |
$1,481.55 |
$1,481.55 |
$884.80
|
|
Dextran 40 infusion
|
$1,310.05 |
$1,310.05 |
$1,310.05 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$194.07 |
$194.07 |
$194.07 |
$36.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$1,090.95 |
$1,090.95 |
$1,090.95 |
$42.50
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$161.87 |
$161.87 |
$161.87 |
$46.12
|
|
Dextrose 5 % IV bolus
|
$129.50 |
$129.50 |
$129.50 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$303.80 |
$303.80 |
$303.80 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$116.90 |
$116.90 |
$116.90 |
$79.20
|
|
Diag laparo separate proc 49320
|
$31,699.56 |
$31,699.56 |
$31,699.56 |
$6,904.15
|
|
Diagnostic anoscopy
|
$15,536.98 |
$15,536.98 |
$15,536.98 |
$392.70
|
|
Diagnostic anoscopy & biopsy
|
$18,300.23 |
$18,300.23 |
$18,300.23 |
$2,288.00
|
|
Diagnostic anoscopy spx 46600
|
$13,235.60 |
$13,235.60 |
$13,235.60 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$112.70 |
$112.70 |
$112.70 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$102.20 |
$102.20 |
$102.20 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$1,633.80 |
$1,633.80 |
$1,633.80 |
$235.00
|
|
Diagnostic laryngoscopy 31575
|
$16,495.64 |
$16,495.64 |
$16,495.64 |
$334.95
|
|
Diagnostic Mammogram (both breasts)
|
$513.80 |
$513.80 |
$513.80 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$464.80 |
$464.80 |
$464.80 |
$312.72
|
|
Diagnostic radio unlisted proc
|
$5,055.40 |
$5,055.40 |
$5,055.40 |
$243.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,066.70 |
$3,066.70 |
$3,066.70 |
$5,663.50
|
|
Dialysis one evaluation
|
$3,222.10 |
$3,222.10 |
$3,222.10 |
$936.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$868.35 |
$868.35 |
$868.35 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$1,802.85 |
$1,802.85 |
$1,802.85 |
$77.25
|
|
Dicyclomine injection
|
$111.47 |
$111.47 |
$111.47 |
$150.91
|
|
Diffusing capacity
|
$300.30 |
$300.30 |
$300.30 |
$335.20
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$868.00 |
$868.00 |
$868.00 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$28,858.37 |
$28,858.37 |
$28,858.37 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$252.70 |
$252.70 |
$252.70 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$627.72 |
$627.72 |
$627.72 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$26,132.94 |
$26,132.94 |
$26,132.94 |
$1,729.70
|
|
Dilate esophagus
|
$8,030.57 |
$8,030.57 |
$8,030.57 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$4,187.40 |
$4,187.40 |
$4,187.40 |
$1,490.36
|
|
Dilate tear duct opening
|
$16,530.02 |
$16,530.02 |
$16,530.02 |
$454.40
|
|
Dilate urethra stricture
|
$16,357.26 |
$16,357.26 |
$16,357.26 |
$496.00
|
|
Dilate urethra stricture
|
$11,455.55 |
$11,455.55 |
$11,455.55 |
$3,863.60
|
|
Dilation of cervical canal 57800
|
$4,780.30 |
$4,780.30 |
$4,780.30 |
$4,376.00
|
|
Dilation of rectal stricture 45910
|
$3,345.30 |
$3,345.30 |
$3,345.30 |
$2,263.80
|
|
Dilation of salivary duct
|
$6,040.30 |
$6,040.30 |
$6,040.30 |
$750.00
|
|
Dilation of urethra
|
$14,117.74 |
$14,117.74 |
$14,117.74 |
$2,424.12
|
|
Dilation salivary duct 42650
|
$22,409.14 |
$22,409.14 |
$22,409.14 |
$2,675.71
|
|
Dilator fascial 10fx20cm
|
$2,013.28 |
$2,013.28 |
$2,013.28 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$90,727.17 |
$90,727.17 |
$90,727.17 |
$3,883.16
|
|
Dilat xst trc new access rcs
|
$7,464.80 |
$7,464.80 |
$7,464.80 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$243.42 |
$243.42 |
$243.42 |
$46.56
|
|
Dimethyl sulfoxide 50% 50 ml
|
$5,789.52 |
$5,789.52 |
$5,789.52 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$8.05 |
$8.05 |
$8.05 |
$18.35
|