|
Destruct ben lesion 15/> 17111
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$238.20
|
|
Destruct cut vasl lesions 10-50cm 17107
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,016.25
|
|
Destruct cut vasl lesions <10cm 17106
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$664.05
|
|
Destruct cut vasl lesions >50cm 17108
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,999.13
|
|
Destruction anal lesion(s)
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,772.60
|
|
Destruction anal lesion(s)
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,229.60
|
|
Destruction anal lesion(s) smpl chem 46900
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$535.46
|
|
Destruction benign lesions < 14 lesions
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$235.13
|
|
Destruction by injection tx of nerve 64630
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,589.38
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,375.00
|
|
Destruction ciliary body
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,694.88
|
|
Destruction ciliary body
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,760.73
|
|
Destruction ciliary body
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,584.50
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$328.95
|
|
Destruction laser surgery anal lesions 46917
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,229.60
|
|
Destruction les conjunctiva
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,747.43
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$513.60
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$558.97
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$472.79
|
|
Destruction mal lsn t/a/l >4cm
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$578.40
|
|
Destruction penis lesion(s) chem 54050
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$332.00
|
|
Destruction penis lesion(s) exten 54065
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$461.12
|
|
Destruction rectal tumor 45190
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,035.44
|
|
Destruction vag lesions complex 57065
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,519.29
|
|
Destruction vag lesions simple 57061
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,519.29
|
|
Destruct penis les/smp/electrodesi 54055
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,236.85
|
|
Detect agent nos dna dir
|
$33.03 |
$33.03 |
$33.03 |
$67.15
|
|
Detect agnt mult dna direc
|
$48.04 |
$48.04 |
$48.04 |
$109.60
|
|
Device intraute mirena
|
$496.58 |
$496.58 |
$496.58 |
$2,289.60
|
|
Dhea-s (dehydroepiand sulfate)
|
$24.45 |
$24.45 |
$24.45 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$10.68 |
$10.68 |
$10.68 |
$78.41
|
|
Diab manage trn ind/group
|
$41.66 |
$41.66 |
$41.66 |
$49.50
|
|
Diag bronchoscope/catheter
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,040.67
|
|
Diag laparo separate proc 49320
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,649.52
|
|
Diagnostic anoscopy
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$472.21
|
|
Diagnostic anoscopy & biopsy
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,395.28
|
|
Diagnostic anoscopy spx 46600
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$245.35
|
|
Diagnostic laryngoscopy 31505
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$231.71
|
|
Diagnostic laryngoscopy 31575
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$381.00
|
|
Diagnostic Mammogram (both breasts)
|
$163.09 |
$163.09 |
$163.09 |
$407.04
|
|
Dialysis circuit perm vascular embolization 36909
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$7,822.05
|
|
Dialysis one evaluation
|
$472.84 |
$472.84 |
$472.84 |
$827.97
|
|
Diffusing capacity
|
$182.88 |
$182.88 |
$182.88 |
$357.50
|
|
Digoxin total therapeutic drug level
|
$14.61 |
$14.61 |
$14.61 |
$99.35
|
|
Dilate biliary duct/ampulla
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,304.60
|
|
Dilate esophagus
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,003.04
|
|
Dilate esophagus 1/mult pass
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,484.17
|
|
Dilate tear duct opening
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$454.40
|
|
Dilate urethra stricture
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$514.79
|
|
Dilate urethra stricture
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$185.58
|
|
Dilate urethra stricture
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,745.07
|
|
Dilate urethra stricture
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$204.60
|
|
Dilation of anal sphincter
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,395.28
|
|
Dilation of cervical canal 57800
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,096.04
|
|
Dilation of rectal stricture 45910
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,375.50
|
|
Dilation of salivary duct
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$599.72
|
|
Dilation of urethra
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$172.00
|
|
Dilation of urethra
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,507.31
|
|
Dilation of vagina
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,519.29
|
|
Dilation salivary duct 42650
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,744.44
|
|
Dilation/urethral strict/male/ini 53620
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,995.50
|
|
Dilat xst trc ndurlgc px
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,061.71
|
|
Dilat xst trc new access rcs
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,952.80
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$29.36 |
$29.36 |
$29.36 |
$100.80
|
|
Disability dlco
|
$144.76 |
$144.76 |
$144.76 |
$302.90
|
|
Disaccharidases
|
$24.39 |
$24.39 |
$24.39 |
$230.40
|
|
Disarticulation sho sec clsr
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,300.80
|
|
Dise eval slp do brth flx dx
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$288.80
|
|
Dissolve clot heart vessel
|
$1,250.84 |
$1,250.84 |
$1,250.84 |
$1,274.40
|
|
Dist revas ligation hemo
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,988.54
|
|
Diverticulectomy/hypophar/esoph 43130
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,817.32
|
|
Dmd dup/delet analysis
|
$306.90 |
$306.90 |
$306.90 |
$402.60
|
|
Dmpk gene detc abnor allele
|
$150.70 |
$150.70 |
$150.70 |
$239.85
|
|
Dna antibody native/double stranded
|
$15.11 |
$15.11 |
$15.11 |
$102.60
|
|
Dna gardnerella
|
$22.06 |
$22.06 |
$22.06 |
$67.60
|
|
Dna probe chlamydia
|
$25.03 |
$25.03 |
$25.03 |
$82.20
|
|
Dna probe gc
|
$29.57 |
$29.57 |
$29.57 |
$88.67
|
|
Dna trichomonas
|
$22.06 |
$22.06 |
$22.06 |
$68.75
|
|
Doppler echo complete
|
$495.12 |
$495.12 |
$495.12 |
$644.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$373.48 |
$373.48 |
$373.48 |
$686.60
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$239.96 |
$239.96 |
$239.96 |
$495.00
|
|
Dornhoffer fixed part w/window
|
$10,184.40 |
$10,184.40 |
$10,184.40 |
$32,112.76
|
|
Dpyd gene common variants
|
$192.29 |
$192.29 |
$192.29 |
$380.50
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$820.50
|
|
Drainage ext aud canal abscess 69020
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$832.60
|
|
Drainage external ear complex 69005
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,996.52
|
|
Drainage external ear simple 69000
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$812.80
|
|
Drainage lymph node lesion 38300
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,986.75
|
|
Drainage lymph node lesion 38305
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,167.89
|
|
Drainage mouth roof lesion
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$481.80
|
|
Drainage of arm bursa 23931
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,347.56
|
|
Drainage of bladder abscess
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,127.88
|
|
Drainage of eye
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,360.00
|
|
Drainage of eye
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,702.25
|
|
Drainage of eye
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,172.80
|
|
Drainage of forearm bursa
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,893.86
|
|
Drainage of kidney lesion
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,619.40
|
|
Drainage of mouth lesion
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$535.20
|
