|
Dest mal lesion snhfg 0.6-1cm 17271
|
$193.00 |
$267.00 |
$267.00 |
|
|
Dest mal lesion snhfg 1.1-2cm 17272
|
$212.50 |
$293.50 |
$293.50 |
|
|
Dest mal lesion tal <0.5 17260
|
$121.00 |
$167.50 |
$167.50 |
|
|
Dest mal lesion tal 0.6-1.0cm 17261
|
$136.00 |
$187.50 |
$187.50 |
|
|
Dest mal lesion tal 1.1-2.0cm 17262
|
$151.00 |
$209.00 |
$209.00 |
|
|
Dest mal lesion tal 2.1-3.0cm 17263
|
$188.00 |
$260.50 |
$260.50 |
|
|
Destroy cervthor facet jnt 64633
|
$1,081.50 |
$1,468.00 |
$4,686.60 |
|
|
Destroy cth facet jnt addl 64634
|
$324.50 |
$441.00 |
$630.50 |
|
|
Destroy internal hemorrhoids destroy 46930
|
$758.50 |
$1,030.00 |
$1,030.00 |
|
|
Destroy premlg lesns;1st lesn 17000
|
$111.50 |
$154.00 |
$154.00 |
|
|
Destroy vulva lesion simple 56501
|
$1,443.00 |
$1,995.50 |
$1,995.50 |
|
|
Destruct ben lesion 15/> 17111
|
$223.00 |
$308.50 |
$308.50 |
|
|
Destruct cut vasl lesions 10-50cm 17107
|
$298.00 |
$412.00 |
$412.00 |
|
|
Destruct cut vasl lesions <10cm 17106
|
$216.00 |
$298.50 |
$298.50 |
|
|
Destruct cut vasl lesions >50cm 17108
|
$948.50 |
$1,311.50 |
$1,311.50 |
|
|
Destruction 2-14 lesions 17003
|
$50.50 |
$69.50 |
$69.50 |
|
|
Destruction benign lesions < 14 lesions
|
$201.50 |
$279.00 |
$8,988.72 |
|
|
Destruction by injection tx of nerve 64630
|
$823.50 |
$1,138.50 |
$1,138.50 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$927.50 |
$1,259.00 |
$57,648.12 |
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,592.00 |
$2,162.00 |
$57,648.12 |
|
|
Destruction les conjunctiva
|
$819.00 |
$1,213.50 |
$1,213.50 |
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$233.50 |
$323.00 |
$323.00 |
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$376.00 |
$519.50 |
$519.50 |
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$349.00 |
$482.00 |
$482.00 |
|
|
Destruction mal lsn t/a/l >4cm
|
$430.00 |
$594.00 |
$594.00 |
|
|
Destruction penis lesion(s) chem 54050
|
$196.00 |
$270.50 |
$270.50 |
|
|
Destruction penis lesion(s) exten 54065
|
$2,293.00 |
$3,170.00 |
$3,170.00 |
|
|
Destruction premal lesions 15/> 17004
|
$216.00 |
$298.50 |
$298.50 |
|
|
Destruction vag lesions simple 57061
|
$1,843.00 |
$2,548.50 |
$2,548.50 |
|
|
Detect agnt mult dna direc
|
$133.00 |
$133.00 |
$175.50 |
|
|
Determine refractive state
|
$21.50 |
$30.00 |
$30.00 |
|
|
Device ablt adv novasure
|
$357.50 |
$4,842.50 |
$30,409.50 |
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$15,675.00 |
$15,675.00 |
$15,675.00 |
|
|
Device intraute mirena
|
$3,815.00 |
$3,815.00 |
$3,815.00 |
|
|
Device sut capio slim opn
|
$1,127.50 |
$1,315.00 |
$7,172.88 |
|
|
Device tiss remov myosure reach
|
$3,868.50 |
$4,655.00 |
$10,966.00 |
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$50.50 |
$61.00 |
$1,189.00 |
|
|
Dexamethasone 4 mg tablet
|
$19.17 |
$27.00 |
$27.00 |
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$27.82 |
$45.00 |
$45.00 |
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$967.22 |
$967.22 |
$1,105.39 |
|
|
Dextran 40 infusion
|
$552.62 |
$552.62 |
$618.45 |
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$111.60 |
$111.60 |
$129.60 |
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$105.00 |
$108.00 |
$375.00 |
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$105.00 |
$118.80 |
$121.55 |
|
|
Dextrose 5 % IV bolus
|
$111.60 |
$129.60 |
$306.00 |
|
|
Dhea-s (dehydroepiand sulfate)
|
$70.50 |
$235.00 |
$944.50 |
|
|
Diabetes (HbA1c) Test
|
$55.50 |
$126.00 |
$408.00 |
|
|
Diab manage trn ind/group
|
$28.50 |
$42.00 |
$42.00 |
|
|
Diag laparo separate proc 49320
|
$13,044.19 |
$13,044.19 |
$21,217.89 |
|
|
Diagnostic anoscopy
|
$104.00 |
$173.00 |
$173.00 |
|
|
Diagnostic anoscopy spx 46600
|
$100.20 |
$104.00 |
$215.50 |
|
|
Diagnostic digital breast tomosynthesis bil
|
$468.50 |
$468.50 |
$468.50 |
|
|
Diagnostic digital breast tomosynthesis unil
|
$413.50 |
$413.50 |
$414.00 |
|
|
Diagnostic laryngoscopy 31575
|
$162.00 |
$269.00 |
$10,872.00 |
|
|
Diagnostic Mammogram (both breasts)
|
$257.40 |
$413.50 |
$414.00 |
|
|
Diagnostic Mammogram (one breast)
|
$237.00 |
$358.00 |
$358.50 |
|
|
Diagnostic radio unlisted proc
|
$67.00 |
$574.50 |
$1,577.00 |
|
|
Dialysis circuit perm vascular embolization 36909
|
$4,640.00 |
$5,728.50 |
$27,763.00 |
|
|
Dialysis one evaluation
|
$335.00 |
$335.00 |
$4,805.00 |
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$51.15 |
$57.25 |
$269.00 |
|
|
Dicyclomine injection
|
$133.57 |
$308.00 |
$308.00 |
|
|
Diffusing capacity
|
$155.50 |
$227.00 |
$1,209.00 |
|
|
Digital analysis of eeg
|
$660.00 |
$1,058.50 |
$1,234.00 |
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$45.00 |
$45.00 |
$45.00 |
|
|
Digoxin immune fab 40 mg intravenous solution
|
$13,715.00 |
$13,715.00 |
$23,875.20 |
|
|
Digoxin total therapeutic drug level
|
$64.00 |
$104.40 |
$408.00 |
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$599.00 |
$599.00 |
$599.00 |
|
|
Dilate biliary duct/ampulla
|
$1,028.00 |
$1,163.00 |
$3,230.00 |
|
|
Dilate esophagus
|
$12,042.65 |
$12,042.65 |
$12,042.65 |
|
|
Dilate esophagus 1/mult pass
|
$568.00 |
$853.50 |
$7,234.26 |
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$1,809.00 |
$2,455.50 |
$2,455.50 |
|
|
Dilate ic vasospasm ea add vsl same territory
|
$736.20 |
$1,651.00 |
$2,241.00 |
|
|
Dilate ic vasospasm init
|
$2,887.50 |
$3,681.00 |
$3,920.00 |
|
|
Dilate tear duct opening
|
$180.00 |
$266.50 |
$266.50 |
|
|
Dilate urethra stricture
|
$244.00 |
$377.50 |
$377.50 |
|
|
Dilate urethra stricture
|
$142.00 |
$196.50 |
$196.50 |
|
|
Dilate urethra stricture
|
$169.50 |
$234.50 |
$234.50 |
|
|
Dilation/female urethra/initial 53660
|
$185.50 |
$256.50 |
$256.50 |
|
|
Dilation of anal sphincter
|
$3,755.00 |
$4,268.00 |
$5,901.50 |
|
|
Dilation of cervical canal 57800
|
$1,444.00 |
$1,997.00 |
$1,997.00 |
|
|
Dilation of rectal stricture 45910
|
$2,854.50 |
$3,947.00 |
$3,947.00 |
|
|
Dilation of salivary duct
|
$370.00 |
$511.50 |
$511.50 |
|
|
Dilation of urethra
|
$176.00 |
$243.00 |
$243.00 |
|
|
Dilation salivary duct 42650
|
$10,072.95 |
$10,072.95 |
$10,072.95 |
|
|
Dilation/urethral strict/male/ini 53620
|
$2,290.00 |
$2,750.40 |
$3,166.00 |
|
|
Dilator fascial 10fx20cm
|
$221.00 |
$237.50 |
$4,055.50 |
|
|
Dilat xst trc ndurlgc px
|
$1,462.50 |
$1,985.00 |
$53,974.03 |
|
|
Dilat xst trc new access rcs
|
$2,459.50 |
$3,339.00 |
$6,728.50 |
|
|
Diltiazem 5 mg/ml intravenous solution
|
$27.82 |
$94.83 |
$106.13 |
|
|
Dimecaprol injection
|
$437.00 |
$437.00 |
$437.00 |
|
|
Dimenhydrinate injection
|
$219.00 |
$219.00 |
$219.00 |
|
|
Dimethyl sulfoxide 50% 50 ml
|
$6,064.22 |
$6,064.22 |
$6,786.68 |
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$27.82 |
$45.00 |
$247.00 |
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$247.00 |
$247.00 |
$247.00 |
|
|
Dipyridamole injection
|
$220.00 |
$220.00 |
$220.00 |
|
|
Disability dlco
|
$155.40 |
$213.00 |
$1,244.00 |
|
|
Disaccharidases
|
$122.00 |
$158.50 |
$247.50 |
|
|
Discography cerv/thor spine
|
$1,244.50 |
$1,244.50 |
$2,869.00 |
|
|
Dise eval slp do brth flx dx
|
$1,600.50 |
$1,600.50 |
$2,022.00 |
|
|
Dissolve clot heart vessel
|
$1,263.50 |
$1,560.00 |
$2,711.00 |
|
