|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$994.70 |
$994.70 |
$2,989.87 |
$3,296.80
|
|
Destruction ciliary body
|
$3,293.41 |
$3,293.41 |
$3,293.41 |
$3,228.83
|
|
Destruction ciliary body
|
$2,188.86 |
$2,188.86 |
$2,188.86 |
$2,760.73
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$328.95 |
$328.95 |
$328.95 |
$375.87
|
|
Destruction laser surgery anal lesions 46917
|
$2,770.80 |
$2,770.80 |
$2,770.80 |
$3,640.00
|
|
Destruction les conjunctiva
|
$1,569.81 |
$1,569.81 |
$1,569.81 |
$2,760.73
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$661.99 |
$661.99 |
$661.99 |
$513.60
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$461.84 |
$461.84 |
$461.84 |
$558.97
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$527.99 |
$527.99 |
$527.99 |
$482.00
|
|
Destruction mal lsn t/a/l >4cm
|
$767.22 |
$767.22 |
$767.22 |
$569.80
|
|
Destruction penis lesion(s) chem 54050
|
$62.65 |
$62.65 |
$221.39 |
$332.00
|
|
Destruction penis lesion(s) exten 54065
|
$3,556.35 |
$3,556.35 |
$3,556.35 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$40.25 |
$40.25 |
$657.25 |
$442.61
|
|
Destruction rectal tumor 45190
|
$2,998.42 |
$2,998.42 |
$2,998.42 |
$3,245.23
|
|
Destruction vag lesions complex 57065
|
$3,302.03 |
$3,302.03 |
$3,302.03 |
$3,986.00
|
|
Destruction vag lesions simple 57061
|
$1,102.33 |
$1,102.33 |
$3,299.39 |
$4,006.38
|
|
Destruct penis les/smp/electrodesi 54055
|
$2,236.85 |
$2,236.85 |
$2,236.85 |
$2,837.09
|
|
Detect agent nos dna dir
|
$186.00 |
$186.00 |
$186.00 |
$138.00
|
|
Detect agnt mult dna direc
|
$175.12 |
$175.12 |
$175.12 |
$166.77
|
|
Determination venous press
|
$167.73 |
$167.73 |
$167.73 |
$166.56
|
|
Determine refractive state
|
$6.09 |
$6.09 |
$6.09 |
$21.50
|
|
Devel tst phys/qhp 1st hr
|
$105.91 |
$105.91 |
$105.91 |
$350.40
|
|
Device ablt adv novasure
|
$9,177.30 |
$9,177.30 |
$9,177.30 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$5,098.50 |
$5,098.50 |
$5,098.50 |
$4,200.00
|
|
Device intraute mirena
|
$2,082.22 |
$2,082.22 |
$2,082.22 |
$2,125.00
|
|
Device sut capio slim opn
|
$725.20 |
$725.20 |
$725.20 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$971.78 |
$971.78 |
$2,541.00 |
$2,515.00
|
|
Dev interrog remote 1/2/mlt
|
$272.69 |
$272.69 |
$272.69 |
$115.20
|
|
Devlopment test interpt&rep
|
$112.13 |
$112.13 |
$112.13 |
$109.46
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$223.51 |
$223.51 |
$223.51 |
$199.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$372.51 |
$372.51 |
$372.51 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$3.39 |
$3.39 |
$85.86 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$0.70 |
$0.70 |
$27.00 |
$20.76
|
|
Dexamethasone intra implant
|
$233.28 |
$233.28 |
$233.28 |
$2,356.90
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$62.35 |
$62.35 |
$1,268.38 |
$884.80
|
|
Dextran 40 infusion
|
$3.51 |
$3.51 |
$151.20 |
$151.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$0.36 |
$0.36 |
$28.80 |
$36.05
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$28.80 |
$28.80 |
$28.80 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$0.34 |
$0.34 |
$31.32 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$0.61 |
$0.61 |
$35.74 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$32.90 |
$32.90 |
$153.80 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$30.45 |
$30.45 |
$92.09 |
$79.30
|
|
Diabetes training group per 30 min g0109
|
$35.43 |
$35.43 |
$35.43 |
$35.43
|
|
Diab manage trn ind/group
|
$3.68 |
$3.68 |
$63.45 |
$54.99
|
|
Diag laparo separate proc 49320
|
$7,144.88 |
$7,144.88 |
$7,144.88 |
$7,104.72
|
|
Diagnostic anoscopy spx 46600
|
$34.13 |
$34.13 |
$134.55 |
$195.50
|
|
Diagnostic digital breast tomosynthesis bil
|
$117.94 |
$117.94 |
$117.94 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$75.93 |
$75.93 |
$75.93 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$69.13 |
$69.13 |
$242.14 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$81.20 |
$81.20 |
$374.65 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$100.98 |
$100.98 |
$340.20 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$272.16 |
$272.16 |
$272.16 |
$314.00
|
|
Diagnostic radio unlisted proc
|
$35.00 |
$35.00 |
$6,139.57 |
$259.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$1,234.80 |
$1,234.80 |
$2,978.93 |
$5,741.00
|
|
Dialysis one evaluation
|
$297.85 |
$297.85 |
$1,775.84 |
$936.00
|
|
Dialysis repeated eval
|
$1,523.40 |
$1,523.40 |
$1,523.40 |
$1,332.80
|
|
Dialysis training complete
|
$783.36 |
$783.36 |
$783.36 |
$783.36
|
|
Dialysis training incompl
|
$391.67 |
$391.67 |
$391.67 |
$391.67
|
|
Diatrizoate meglumine 18 % urethral solution
|
$149.04 |
$149.04 |
$149.04 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$2.50 |
$2.50 |
$135.30 |
$79.71
|
|
Dicyclomine injection
|
$229.36 |
$229.36 |
$229.36 |
$154.33
|
|
Diffusing capacity
|
$179.20 |
$179.20 |
$434.72 |
$336.80
|
|
Digital analysis of eeg
|
$92.75 |
$92.75 |
$641.56 |
$593.40
|
|
Digit nerve surgery add-on
|
$1,832.59 |
$1,832.59 |
$1,832.59 |
$1,832.59
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$20.24 |
$20.24 |
$371.87 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$590.92 |
$590.92 |
$8,613.00 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$48.13 |
$48.13 |
$102.07 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$11.43 |
$11.43 |
$357.05 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$578.55 |
$578.55 |
$2,316.61 |
$1,866.73
|
|
Dilate esophagus
|
$1,053.98 |
$1,053.98 |
$1,053.98 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$280.53 |
$280.53 |
$1,349.05 |
$1,548.00
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$1,139.60 |
$1,139.60 |
$2,932.13 |
$3,169.00
|
|
Dilate ic vasospasm ea add vsl same territory
|
$657.13 |
$657.13 |
$1,190.10 |
$1,931.80
|
|
Dilate ic vasospasm init
|
$2,170.70 |
$2,170.70 |
$4,627.52 |
$5,151.95
|
|
Dilate tear duct opening
|
$351.48 |
$351.48 |
$351.48 |
$454.40
|
|
Dilate urethra stricture
|
$127.75 |
$127.75 |
$910.83 |
$513.00
|
|
Dilate urethra stricture
|
$18.20 |
$18.20 |
$208.22 |
$200.80
|
|
Dilate urethra stricture
|
$3,424.84 |
$3,424.84 |
$3,424.84 |
$3,863.60
|
|
Dilate urethra stricture
|
$24.50 |
$24.50 |
$450.25 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$17.68 |
$17.68 |
$277.58 |
$235.61
|
|
Dilation of anal sphincter
|
$2,166.04 |
$2,166.04 |
$2,166.04 |
$2,166.04
|
|
Dilation of cervical canal 57800
|
$4,096.04 |
$4,096.04 |
$4,096.04 |
$4,446.00
|
|
Dilation of rectal stricture 45910
|
$2,263.80 |
$2,263.80 |
$2,263.80 |
$2,491.80
|
|
Dilation of salivary duct
|
$97.65 |
$97.65 |
$551.84 |
$790.00
|
|
Dilation of urethra
|
$17.50 |
$17.50 |
$275.49 |
$172.00
|
|
Dilation of urethra
|
$3,636.97 |
$3,636.97 |
$3,636.97 |
$2,424.12
|
|
Dilation of vagina
|
$2,643.08 |
$2,643.08 |
$2,643.08 |
$4,446.00
|
|
Dilation salivary duct 42650
|
$18.73 |
$18.73 |
$2,498.32 |
$2,675.71
|
|
Dilation/urethral strict/male/ini 53620
|
$495.78 |
$495.78 |
$2,796.96 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$283.68 |
$283.68 |
$1,277.43 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$657.13 |
$657.13 |
$7,914.70 |
$3,900.60
|
|
Dilat xst trc new access rcs
|
$1,189.13 |
$1,189.13 |
$8,147.48 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$138.24 |
$138.24 |
$138.24 |
$45.60
|
|
Dimecaprol injection
|
$22.46 |
$22.46 |
$457.03 |
$314.63
|
|
Dimethyl sulfoxide 50% 50 ml
|
$12.02 |
$12.02 |
$1,258.20 |
$1,258.20
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$0.42 |
$0.42 |
$0.42 |
$1.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$1.93 |
$1.93 |
$10.84 |
$18.32
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$2.84 |
$2.84 |
$2.84 |
$98.15
|
|
Dipyridamole injection
|
$24.50 |
$24.50 |
$24.50 |
$48.04
|
|
Disability dlco
|
$44.98 |
$44.98 |
$356.06 |
$293.76
|
