|
Debridement/bone/20 sq cm or less 11046
|
$440.10 |
$440.10 |
$576.50 |
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$1,168.18 |
$1,168.18 |
$1,782.50 |
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$416.18 |
$416.18 |
$966.00 |
|
|
Debride nail1-5 11720
|
$88.63 |
$88.63 |
$268.00 |
|
|
Debride nail6 or more 11721
|
$107.85 |
$107.85 |
$452.00 |
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$930.00 |
$930.00 |
$930.00 |
|
|
Debride skin bone at fx site
|
$479.48 |
$479.48 |
$1,453.50 |
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$416.18 |
$416.18 |
$1,063.00 |
|
|
Debrid mastoidectomy cavity simple 69220
|
$214.00 |
$214.00 |
$214.00 |
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$930.00 |
$1,129.45 |
$1,129.45 |
|
|
Debr inf skin add-on 11001
|
$168.50 |
$168.50 |
$168.50 |
|
|
Debr musc/fascia 20sq cm/< 11043
|
$440.10 |
$440.10 |
$1,130.00 |
|
|
Decalcification
|
$22.05 |
$75.38 |
$266.00 |
|
|
Decitabine 50 mg intravenous solution
|
$3,364.08 |
$3,364.08 |
$3,364.08 |
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$457.50 |
$482.35 |
$826.00 |
|
|
Decomp fasct leg ant+/lat+pst cmprt 27602
|
$6,100.33 |
$6,100.33 |
$6,100.33 |
|
|
Decompression of leg
|
$6,100.33 |
$6,100.33 |
$6,100.33 |
|
|
Deferoxamine 500 mg solution for injection
|
$96.30 |
$96.30 |
$648.02 |
|
|
Degarelix 120 mg subcutaneous solution
|
$1,856.85 |
$1,856.85 |
$1,856.85 |
|
|
Delay flap trunk 15600
|
$4,118.00 |
$4,118.00 |
$4,118.00 |
|
|
Delivery of placenta 59414
|
$1,420.00 |
$2,362.38 |
$2,916.00 |
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$20,544.05 |
$20,544.05 |
$20,544.05 |
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$62.75 |
$62.75 |
$268.00 |
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$6,704.35 |
$6,704.35 |
$16,291.72 |
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$217.00 |
$414.78 |
$1,186.00 |
|
|
Depo-estradiol cypionate inj
|
$496.73 |
$496.73 |
$496.73 |
|
|
Dermagraft
|
$67.80 |
$70.60 |
$70.60 |
|
|
Descend thora aorta rpr/lt sub art 33880
|
$3,868.75 |
$3,868.75 |
$3,868.75 |
|
|
Design mlc device for imrt
|
$1,487.50 |
$4,645.35 |
$4,645.35 |
|
|
Desmopressin 4 mcg/ml injection solution
|
$708.63 |
$1,177.20 |
$1,177.20 |
|
|
Des thora aorta/ea add prox prosth 33884
|
$3,273.55 |
$3,273.55 |
$3,273.55 |
|
|
Des thora aorta rpr without left sub art 33881
|
$3,273.55 |
$3,273.55 |
$3,273.55 |
|
|
Des thor aorta/prox ext prosth/ini 33883
|
$3,273.55 |
$3,273.55 |
$3,273.55 |
|
|
Dest mal lesion feenlm <0.5cm 17280
|
$317.00 |
$317.00 |
$317.00 |
|
|
Dest mal lesion feenlm 0.6-1cm 17281
|
$362.58 |
$362.58 |
$576.50 |
|
|
Dest mal lesion feenlm 1.1 - 2.0 cm 17282
|
$408.50 |
$408.50 |
$576.50 |
|
|
Dest mal lesion snhfg 0.6-1cm 17271
|
$317.00 |
$317.00 |
$317.00 |
|
|
Dest mal lesion snhfg 1.1-2cm 17272
|
$184.50 |
$184.50 |
$317.00 |
|
|
Dest mal lesion tal <0.5 17260
|
$218.03 |
$218.03 |
$238.00 |
|
|
Dest mal lesion tal 0.6-1.0cm 17261
|
$241.93 |
$241.93 |
$1,505.00 |
|
|
Dest mal lesion tal 1.1-2.0cm 17262
|
$267.85 |
$267.85 |
$317.00 |
|
|
Dest mal lesion tal 2.1-3.0cm 17263
|
$259.55 |
$259.55 |
$317.00 |
|
|
Destroy cervthor facet jnt 64633
|
$1,806.00 |
$4,370.03 |
$12,290.00 |
|
|
Destroy cth facet jnt addl 64634
|
$1,191.50 |
$3,188.60 |
$3,188.60 |
|
|
Destroy internal hemorrhoids destroy 46930
|
$1,139.00 |
$1,139.00 |
$1,139.00 |
|
|
Destroy premlg lesns;1st lesn 17000
|
$140.50 |
$241.00 |
$373.00 |
|
|
Destroy vulva lesion simple 56501
|
$283.88 |
$283.88 |
$2,817.00 |
|
|
Destruct ben lesion 15/> 17111
|
$194.50 |
$197.13 |
$197.13 |
|
|
Destruction 2-14 lesions 17003
|
$56.00 |
$101.13 |
$101.13 |
|
|
Destruction benign lesions < 14 lesions
|
$156.23 |
$156.23 |
$524.00 |
|
|
Destruction by injection tx of nerve 64630
|
$1,589.38 |
$1,589.38 |
$1,589.38 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,806.00 |
$2,868.55 |
$3,126.00 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,606.00 |
$4,666.75 |
$7,833.00 |
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$317.00 |
$318.18 |
$318.18 |
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$576.50 |
$576.50 |
$576.50 |
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$317.00 |
$416.55 |
$416.55 |
|
|
Destruction mal lsn t/a/l >4cm
|
$317.00 |
$454.00 |
$454.00 |
|
|
Destruction penis lesion(s) chem 54050
|
$303.00 |
$303.00 |
$303.00 |
|
|
Destruction premal lesions 15/> 17004
|
$319.25 |
$319.25 |
$2,659.00 |
|
|
Destruction vag lesions simple 57061
|
$234.60 |
$234.60 |
$234.60 |
|
|
Destruct penis les/smp/electrodesi 54055
|
$2,825.00 |
$2,825.00 |
$2,825.00 |
|
|
Developmental screen/score/document 96110
|
$5.95 |
$5.95 |
$5.95 |
|
|
Devel tst phys/qhp 1st hr
|
$228.00 |
$364.48 |
$364.48 |
|
|
Device ablt adv novasure
|
$2,324.10 |
$2,773.00 |
$2,773.00 |
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$2,375.00 |
$2,375.00 |
$2,375.00 |
|
|
Device intraute mirena
|
$2,429.28 |
$2,429.28 |
$2,429.28 |
|
|
Device tiss remov myosure reach
|
$503.50 |
$503.50 |
$3,039.05 |
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$114.50 |
$114.50 |
$114.50 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$227.25 |
$227.25 |
$1,088.00 |
|
|
Dexametha opth insert 0.1 mg
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
|
|
Dexamethasone 4 mg tablet
|
$374.75 |
$374.75 |
$374.75 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$26.80 |
$28.50 |
$28.50 |
|
|
Dexamethasone intra implant
|
$2,758.50 |
$2,758.50 |
$2,758.50 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$618.85 |
$618.85 |
$618.85 |
|
|
Dextroamphetamine
|
$143.40 |
$143.40 |
$143.40 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$96.76 |
$96.76 |
$96.76 |
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$96.76 |
$96.76 |
$96.76 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$30.99 |
$30.99 |
$30.99 |
|
|
Dextrose 5 % IV bolus
|
$96.76 |
$96.76 |
$96.76 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$97.00 |
$191.45 |
$191.45 |
|
|
Diabetes (HbA1c) Test
|
$73.50 |
$136.70 |
$184.00 |
|
|
Diabetes training group per 30 min g0109
|
$35.00 |
$35.00 |
$35.00 |
|
|
Diab manage trn ind/group
|
$30.00 |
$73.38 |
$73.38 |
|
|
Diagnostic anoscopy & biopsy
|
$1,745.00 |
$1,745.00 |
$1,745.00 |
|
|
Diagnostic anoscopy spx 46600
|
$169.16 |
$245.35 |
$2,124.00 |
|
|
Diagnostic digital breast tomosynthesis bil
|
$68.00 |
$107.20 |
$242.00 |
|
|
Diagnostic digital breast tomosynthesis unil
|
$34.00 |
$53.65 |
$168.00 |
|
|
Diagnostic laryngoscopy 31505
|
$93.65 |
$93.65 |
$94.00 |
|
|
Diagnostic laryngoscopy 31575
|
$194.08 |
$194.08 |
$367.19 |
|
|
Diagnostic Mammogram (both breasts)
|
$377.50 |
$442.60 |
$829.00 |
|
|
Diagnostic Mammogram (one breast)
|
$221.33 |
$221.33 |
$712.00 |
|
|
Diagnostic radio unlisted proc
|
$326.43 |
$326.43 |
$326.43 |
|
|
Dialysis circuit perm vascular embolization 36909
|
$3,725.00 |
$8,891.30 |
$8,891.30 |
|
|
Dialysis one evaluation
|
$447.00 |
$564.68 |
$564.68 |
|
|
Dialysis repeated eval
|
$564.68 |
$564.68 |
$564.68 |
|
|
Dialysis training complete
|
$390.68 |
$390.68 |
$390.68 |
|
|
Dialysis training incompl
|
$195.53 |
$195.53 |
$195.53 |
|
|
Diathermy eg microwave
|
$85.00 |
$85.00 |
$85.00 |
|
|
Diatrizoate meglumine 18 % urethral solution
|
$127.50 |
$127.50 |
$501.26 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$44.72 |
$126.60 |
$126.60 |
|
