|
Debridement/bone/20 sq cm or less 11046
|
$406.08 |
$406.08 |
$406.08 |
$717.92
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,229.52 |
$1,229.52 |
$1,229.52 |
$1,738.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$820.15 |
$820.15 |
$820.15 |
$779.35
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$406.08 |
$406.08 |
$406.08 |
$728.40
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,558.05 |
$1,558.05 |
$1,558.05 |
$1,101.10
|
|
Decalcification
|
$44.65 |
$44.65 |
$44.65 |
$72.15
|
|
Deferoxamine 500 mg solution for injection
|
$18.66 |
$18.66 |
$18.66 |
$47.62
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$28.67 |
$28.67 |
$28.67 |
$165.60
|
|
Design mlc device for imrt
|
$614.29 |
$614.29 |
$614.29 |
$1,677.86
|
|
Desmopressin 4 mcg/ml injection solution
|
$11.12 |
$11.12 |
$11.12 |
$37.26
|
|
Detect agent nos dna dir
|
$14.10 |
$14.10 |
$14.10 |
$186.00
|
|
Device ablt adv novasure
|
$3,572.00 |
$3,572.00 |
$3,572.00 |
$7,153.60
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$103.87 |
$103.87 |
$103.87 |
$220.43
|
|
Dexamethasone 4 mg tablet
|
$4.52 |
$4.52 |
$4.52 |
$4.87
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$3.82 |
$3.82 |
$3.82 |
$8.23
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$21.71 |
$21.71 |
$21.71 |
$37.50
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$21.58 |
$21.58 |
$21.58 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$24.29 |
$24.29 |
$24.29 |
$48.56
|
|
Dextrose 5 % IV bolus
|
$13.99 |
$13.99 |
$13.99 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$30.55 |
$30.55 |
$30.55 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$10.34 |
$10.34 |
$10.34 |
$70.00
|
|
Diagnostic Mammogram (both breasts)
|
$204.45 |
$204.45 |
$204.45 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$146.64 |
$146.64 |
$146.64 |
$276.60
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.54 |
$0.54 |
$0.54 |
$58.24
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$16.93 |
$16.93 |
$16.93 |
$42.12
|
|
Dicyclomine injection
|
$63.89 |
$63.89 |
$63.89 |
$153.53
|
|
Diffusing capacity
|
$83.66 |
$83.66 |
$83.66 |
$336.80
|
|
Digital analysis of eeg
|
$576.69 |
$576.69 |
$576.69 |
$649.63
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.56 |
$19.56 |
$19.56 |
$29.85
|
|
Digoxin total therapeutic drug level
|
$27.73 |
$27.73 |
$27.73 |
$92.95
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$103.46 |
$103.46 |
$103.46 |
$297.86
|
|
Dilat xst trc ndurlgc px
|
$3,704.54 |
$3,704.54 |
$3,704.54 |
$4,031.47
|
|
Dilat xst trc new access rcs
|
$3,704.54 |
$3,704.54 |
$3,704.54 |
$5,842.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$5.95 |
$5.95 |
$5.95 |
$9.29
|
|
Disability dlco
|
$66.27 |
$66.27 |
$66.27 |
$289.08
|
|
Disaccharidases
|
$137.24 |
$137.24 |
$137.24 |
$224.58
|
|
Discography cerv/thor spine
|
$576.22 |
$576.22 |
$576.22 |
$2,161.44
|
|
Dmd dup/delet analysis
|
$131.13 |
$131.13 |
$131.13 |
$418.50
|
|
Dna antibody native/double stranded
|
$10.34 |
$10.34 |
$10.34 |
$101.40
|
|
Dna gardnerella
|
$15.04 |
$15.04 |
$15.04 |
$67.68
|
|
Dna probe gc
|
$12.69 |
$12.69 |
$12.69 |
$88.67
|
|
Dna trichomonas
|
$15.04 |
$15.04 |
$15.04 |
$69.60
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$18.84 |
$18.84 |
$18.84 |
$95.06
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$11.24 |
$11.24 |
$11.24 |
$60.21
|
|
Doppler echo complete
|
$517.94 |
$517.94 |
$517.94 |
$517.94
|
|
Doppler intravascular pressure flow initial vessel
|
$6,883.62 |
$6,883.62 |
$6,883.62 |
$3,026.62
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$295.16 |
$295.16 |
$295.16 |
$642.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$210.56 |
$210.56 |
$210.56 |
$463.20
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$10.36 |
$10.36 |
$10.36 |
$97.83
|
|
Dpyd gene common variants
|
$82.25 |
$82.25 |
$82.25 |
$380.50
|
|
Drainage of kidney lesion
|
$415.95 |
$415.95 |
$415.95 |
$1,578.89
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$428.17 |
$428.17 |
$428.17 |
$353.60
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$180.95 |
$180.95 |
$180.95 |
$5,715.36
|
|
Dronabinol 2.5mg oral
|
$7.81 |
$7.81 |
$7.81 |
$3.39
|
|
Droperidol 2.5 mg/ml injection solution
|
$22.40 |
$22.40 |
$22.40 |
$32.82
|
|
Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm
|
$31.96 |
$31.96 |
$31.96 |
$1,459.20
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$24.44 |
$24.44 |
$24.44 |
$57.00
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$57.34 |
$57.34 |
$57.34 |
$12,735.45
|
|
Drug admin & hemodynmic meas
|
$654.71 |
$654.71 |
$654.71 |
$612.15
|
|
Drug assay caffeine
|
$18.33 |
$18.33 |
$18.33 |
$89.17
|
|
Drug of abuse screen urine
|
$6.11 |
$6.11 |
$6.11 |
$58.50
|
|
Drug screen quant tiagabine
|
$12.69 |
$12.69 |
$12.69 |
$91.80
|
|
Drug test def 1-7 classes
|
$124.08 |
$124.08 |
$124.08 |
$316.80
|
|
Drug test prsmv instrmnt
|
$7.99 |
$7.99 |
$7.99 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$70.50 |
$70.50 |
$70.50 |
$278.85
|
|
Drvvt confirm - quest
|
$18.80 |
$18.80 |
$18.80 |
$108.55
|
|
Dup scan/hemodialysis access 93990
|
$298.45 |
$298.45 |
$298.45 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$147.11 |
$147.11 |
$147.11 |
$740.80
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$320.54 |
$320.54 |
$320.54 |
$852.57
|
|
Ecg 12 lead tracing only
|
$80.37 |
$80.37 |
$80.37 |
$222.30
|
|
Ecg external < 48 hours recording
|
$116.56 |
$116.56 |
$116.56 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$139.59 |
$139.59 |
$139.59 |
$541.73
|
|
Echocardiogram (Heart Ultrasound)
|
$1,009.56 |
$1,009.56 |
$1,009.56 |
$2,021.12
|
|
Echocardiography doppler color flow mapping
|
$317.25 |
$317.25 |
$317.25 |
$450.40
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$1,009.56 |
$1,009.56 |
$1,009.56 |
$1,899.00
|
|
Echocardiography transthoracic 2d followup/limited
|
$538.15 |
$538.15 |
$538.15 |
$720.60
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$538.15 |
$538.15 |
$538.15 |
$840.00
|
|
Echocardiograpy doppler follow up/limited study
|
$306.91 |
$306.91 |
$306.91 |
$348.80
|
|
Echo exam of fetal heart
|
$561.18 |
$561.18 |
$561.18 |
$855.38
|
|
Echo exam of fetal heart
|
$435.22 |
$435.22 |
$435.22 |
$481.55
|
|
Echo exam of fetal heart
|
$132.07 |
$132.07 |
$132.07 |
$429.87
|
|
Echo exam of fetal heart
|
$132.07 |
$132.07 |
$132.07 |
$318.34
|
|
Echo exam uterus 76831-
|
$152.75 |
$152.75 |
$152.75 |
$497.93
|
|
Echo guide for amniocentesis
|
$152.75 |
$152.75 |
$152.75 |
$355.17
|
|
Echo guide villus sampling
|
$105.28 |
$105.28 |
$105.28 |
$316.00
|
|
Echo stress
|
$924.02 |
$924.02 |
$924.02 |
$1,401.00
|
|
Echo tee guidance
|
$1,217.30 |
$1,217.30 |
$1,217.30 |
$2,007.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$908.98 |
$908.98 |
$908.98 |
$1,946.10
|
|
Echo transesophageal
|
$574.81 |
$574.81 |
$574.81 |
$637.97
|
|
Echo transesophageal
|
$825.79 |
$825.79 |
$825.79 |
$1,737.60
|
|
Echo transthoracic
|
$880.78 |
$880.78 |
$880.78 |
$1,361.75
|
|
Echo transthoracic
|
$648.13 |
$648.13 |
$648.13 |
$765.00
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$874.67 |
$874.67 |
$874.67 |
$997.40
|
|
Ecmo/ecls initiation artery 33947
|
$12,263.71 |
$12,263.71 |
$12,263.71 |
$3,151.20
|
|
Ecmo/ecls initiation venous 33946
|
$1,310.83 |
$1,310.83 |
$1,310.83 |
$4,324.50
|
|
Ecmo/ecls insj prph cannula 6yrs&older perq 33952
|
$1,819.84 |
$1,819.84 |
$1,819.84 |
$3,321.00
|
|
Eeg without vid 2-12 hr unmntr
|
$389.16 |
$389.16 |
$389.16 |
$602.40
|
|
Egfr gene com variants
|
$152.75 |
$152.75 |
$152.75 |
$619.04
|
|
Electrolyte panel
|
$59.22 |
$59.22 |
$59.22 |
$68.56
|
|
Electrophysiology evaluation
|
$4,085.71 |
$4,085.71 |
$4,085.71 |
$8,605.71
|