|
Debridement bone <= 20 sq cm
|
$2,327.92 |
$2,327.92 |
$2,327.92 |
$2,481.05
|
|
Debridement/bone/20 sq cm or less 11046
|
$1,060.08 |
$1,060.08 |
$1,060.08 |
$717.92
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$2,327.92 |
$2,327.92 |
$2,327.92 |
$1,738.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$559.44 |
$559.44 |
$559.44 |
$779.35
|
|
Debride nail1-5 11720
|
$226.24 |
$226.24 |
$226.24 |
$186.88
|
|
Debride nail6 or more 11721
|
$238.00 |
$238.00 |
$238.00 |
$200.21
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$559.44 |
$559.44 |
$559.44 |
$728.40
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,060.08 |
$1,060.08 |
$1,060.08 |
$1,101.10
|
|
Decalcification
|
$14.00 |
$14.00 |
$14.00 |
$72.15
|
|
Decitabine 50 mg intravenous solution
|
$21.45 |
$21.45 |
$21.45 |
$225.55
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$376.32 |
$376.32 |
$376.32 |
$482.35
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$151.76 |
$151.76 |
$151.76 |
$165.60
|
|
Dermagraft
|
$55.44 |
$55.44 |
$55.44 |
$100.50
|
|
Design mlc device for imrt
|
$626.08 |
$626.08 |
$626.08 |
$1,677.86
|
|
Desmopressin 4 mcg/ml injection solution
|
$12.92 |
$12.92 |
$12.92 |
$37.26
|
|
Desoxycorticosterone
|
$96.44 |
$96.44 |
$96.44 |
$109.28
|
|
Developmental screen/score/document 96110
|
$136.64 |
$136.64 |
$136.64 |
$126.75
|
|
Devel tst phys/qhp 1st hr
|
$155.12 |
$155.12 |
$155.12 |
$364.48
|
|
Device ablt adv novasure
|
$2,963.52 |
$2,963.52 |
$2,963.52 |
$7,153.60
|
|
Device sut capio slim opn
|
$576.24 |
$576.24 |
$576.24 |
$1,454.07
|
|
Device tiss remov myosure reach
|
$787.36 |
$787.36 |
$787.36 |
$1,070.85
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$77.84 |
$77.84 |
$77.84 |
$203.19
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$322.00 |
$322.00 |
$322.00 |
$220.43
|
|
Dexamethasone 4 mg tablet
|
$1.02 |
$1.02 |
$1.02 |
$4.87
|
|
Dhea-s (dehydroepiand sulfate)
|
$65.52 |
$65.52 |
$65.52 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$56.00 |
$56.00 |
$56.00 |
$70.00
|
|
Diab manage trn ind/group
|
$21.84 |
$21.84 |
$21.84 |
$56.55
|
|
Diagnostic Mammogram (both breasts)
|
$442.96 |
$442.96 |
$442.96 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$329.28 |
$329.28 |
$329.28 |
$276.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$15,771.84 |
$15,771.84 |
$15,771.84 |
$9,395.77
|
|
Diffusing capacity
|
$101.92 |
$101.92 |
$101.92 |
$336.80
|
|
Digital analysis of eeg
|
$288.40 |
$288.40 |
$288.40 |
$649.63
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$175.62 |
$175.62 |
$175.62 |
$29.85
|
|
Digoxin immune fab 40 mg intravenous solution
|
$1,730.52 |
$1,730.52 |
$1,730.52 |
$6,815.78
|
|
Digoxin total therapeutic drug level
|
$45.36 |
$45.36 |
$45.36 |
$92.95
|
|
Dilator fascial 10fx20cm
|
$120.96 |
$120.96 |
$120.96 |
$291.87
|
|
Dimethyl sulfoxide 50% 50 ml
|
$309.24 |
$309.24 |
$309.24 |
$1,001.55
|
|
Disability dlco
|
$84.56 |
$84.56 |
$84.56 |
$289.08
|
|
Disaccharidases
|
$231.67 |
$231.67 |
$231.67 |
$224.58
|
|
Dmd dup/delet analysis
|
$359.52 |
$359.52 |
$359.52 |
$418.50
|
|
Dna antibody native/double stranded
|
$34.10 |
$34.10 |
$34.10 |
$101.40
|
|
Dna gardnerella
|
$74.48 |
$74.48 |
$74.48 |
$67.68
|
|
Dna probe chlamydia
|
$122.64 |
$122.64 |
$122.64 |
$98.40
|
|
Dna probe gc
|
$36.96 |
$36.96 |
$36.96 |
$88.67
|
|
Dna trichomonas
|
$74.48 |
$74.48 |
$74.48 |
$69.60
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$45.87 |
$45.87 |
$45.87 |
$131.40
|
|
Doppler echo complete
|
$408.24 |
$408.24 |
$408.24 |
$517.94
|
|
Doppler intravascular pressure flow initial vessel
|
$3,227.28 |
$3,227.28 |
$3,227.28 |
$3,026.62
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$425.04 |
$425.04 |
$425.04 |
$642.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$194.32 |
$194.32 |
$194.32 |
$463.20
|
|
Dornhoffer fixed part w/window
|
$19,600.00 |
$19,600.00 |
$19,600.00 |
$53,356.20
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$15.09 |
$15.09 |
$15.09 |
$97.83
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$327.31 |
$327.31 |
$327.31 |
$715.22
|
|
Drainage of bladder abscess
|
$3,409.84 |
$3,409.84 |
$3,409.84 |
$2,902.06
|
|
Drainage of kidney lesion
|
$1,296.96 |
$1,296.96 |
$1,296.96 |
$1,578.89
|
|
Drain blood from under nail 11740
|
$74.48 |
$74.48 |
$74.48 |
$173.21
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$5,867.12 |
$5,867.12 |
$5,867.12 |
$2,595.00
|
|
Drain cath image guided visceral pq
|
$6,111.28 |
$6,111.28 |
$6,111.28 |
$2,999.34
|
|
Drain chst dry seal exp thorastat
|
$45.36 |
$45.36 |
$45.36 |
$85.57
|
|
Drain lower leg lesion 27603
|
$3,494.96 |
$3,494.96 |
$3,494.96 |
$3,631.18
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$164.64 |
$164.64 |
$164.64 |
$387.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$152.88 |
$152.88 |
$152.88 |
$353.60
|
|
Dress/debrid prtl-thick burn l 16030
|
$182.56 |
$182.56 |
$182.56 |
$515.00
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$585.76 |
$585.76 |
$585.76 |
$5,715.36
|
|
Drng of finger abscess comp 26011
|
$1,245.44 |
$1,245.44 |
$1,245.44 |
$1,908.09
|
|
Dronabinol 2.5mg oral
|
$4.51 |
$4.51 |
$4.51 |
$3.39
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$364.00 |
$364.00 |
$364.00 |
$1,956.48
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$17.36 |
$17.36 |
$17.36 |
$57.00
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$21.84 |
$21.84 |
$21.84 |
$983.03
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$1,853.60 |
$1,853.60 |
$1,853.60 |
$12,735.45
|
|
Drug admin & hemodynmic meas
|
$436.80 |
$436.80 |
$436.80 |
$612.15
|
|
Drug assay caffeine
|
$16.67 |
$16.67 |
$16.67 |
$89.17
|
|
Drug of abuse screen urine
|
$36.96 |
$36.96 |
$36.96 |
$58.50
|
|
Drug test def 1-7 classes
|
$196.00 |
$196.00 |
$196.00 |
$316.80
|
|
Drug test def 22+ classes
|
$318.08 |
$318.08 |
$318.08 |
$291.76
|
|
Drug test def 8-14 classes
|
$205.52 |
$205.52 |
$205.52 |
$249.10
|
|
Drug test prsmv instrmnt
|
$16.80 |
$16.80 |
$16.80 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$80.08 |
$80.08 |
$80.08 |
$278.85
|
|
Drvvt confirm - quest
|
$25.76 |
$25.76 |
$25.76 |
$108.55
|
|
Ductogram sgl duct
|
$157.92 |
$157.92 |
$157.92 |
$346.42
|
|
Dup scan/hemodialysis access 93990
|
$498.40 |
$498.40 |
$498.40 |
$499.38
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$441.28 |
$441.28 |
$441.28 |
$852.57
|
|
Ecg 12 lead tracing only
|
$71.68 |
$71.68 |
$71.68 |
$222.30
|
|
Ecg < 30 days transmission & analysis
|
$191.52 |
$191.52 |
$191.52 |
$404.21
|
|
Ecg external < 48 hours recording
|
$339.36 |
$339.36 |
$339.36 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$356.16 |
$356.16 |
$356.16 |
$541.73
|
|
Echocardiogram (Heart Ultrasound)
|
$1,691.76 |
$1,691.76 |
$1,691.76 |
$2,021.12
|
|
Echocardiography doppler color flow mapping
|
$546.00 |
$546.00 |
$546.00 |
$450.40
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$1,691.76 |
$1,691.76 |
$1,691.76 |
$1,899.00
|
|
Echocardiography transthoracic 2d followup/limited
|
$459.76 |
$459.76 |
$459.76 |
$720.60
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$840.00 |
$840.00 |
$840.00 |
$840.00
|
|
Echograp trans r pros study
|
$298.48 |
$298.48 |
$298.48 |
$406.33
|
|
Echo guidance radiotherapy
|
$558.88 |
$558.88 |
$558.88 |
$655.00
|
|
Echo guide for artery repair
|
$453.60 |
$453.60 |
$453.60 |
$687.35
|
|
Echo tee guidance
|
$1,364.16 |
$1,364.16 |
$1,364.16 |
$2,007.00
|
|
Echo tee probe placement image acquisition interpretation & report
|
$776.16 |
$776.16 |
$776.16 |
$1,946.10
|
|
Echo transesophageal
|
$776.16 |
$776.16 |
$776.16 |
$637.97
|
|
Echo transesophageal intraop
|
$841.12 |
$841.12 |
$841.12 |
$1,571.70
|
|
Echo transthoracic
|
$815.36 |
$815.36 |
$815.36 |
$1,361.75
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$743.12 |
$743.12 |
$743.12 |
$997.40
|
