|
Diagnostic Mammogram (both breasts)
|
$233.10 |
$233.10 |
$504.00 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$178.65 |
$178.65 |
$375.20 |
$312.72
|
|
Diagnostic radio unlisted proc
|
$101.40 |
$101.40 |
$498.40 |
$243.60
|
|
Dialysis circuit perm vascular embolization 36909
|
$8,540.00 |
$8,540.00 |
$8,540.00 |
$5,663.50
|
|
Dialysis one evaluation
|
$477.90 |
$477.90 |
$1,103.20 |
$936.00
|
|
Dialysis repeated eval
|
$50.10 |
$50.10 |
$1,332.80 |
$1,332.80
|
|
Dialysis training incompl
|
$2,676.80 |
$2,676.80 |
$2,676.80 |
$391.67
|
|
Diathermy eg microwave
|
$29.68 |
$29.68 |
$29.68 |
$29.68
|
|
Diatrizoate meglumine 18 % urethral solution
|
$114.18 |
$114.18 |
$114.18 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$47.60 |
$47.60 |
$79.71 |
$77.25
|
|
Dicyclomine injection
|
$87.53 |
$87.53 |
$87.53 |
$150.91
|
|
Difelikefalin, esrd on dialy
|
$264.88 |
$264.88 |
$264.88 |
$264.88
|
|
Diffusing capacity
|
$299.85 |
$299.85 |
$554.40 |
$335.20
|
|
Digital analysis of eeg
|
$728.00 |
$728.00 |
$728.00 |
$551.20
|
|
Digit nerve surgery add-on
|
$2,335.20 |
$2,335.20 |
$2,335.20 |
$1,832.59
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$243.44 |
$243.44 |
$243.44 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$8,693.37 |
$8,693.37 |
$8,693.37 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$63.90 |
$63.90 |
$183.68 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$106.91 |
$106.91 |
$186.26 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$1,696.80 |
$1,696.80 |
$1,696.80 |
$1,729.70
|
|
Dilate esophagus
|
$5,163.20 |
$5,163.20 |
$5,163.20 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$45.30 |
$45.30 |
$2,878.40 |
$1,490.36
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$828.80 |
$828.80 |
$828.80 |
$3,026.10
|
|
Dilate ic vasospasm ea add vsl same territory
|
$414.40 |
$414.40 |
$414.40 |
$1,895.00
|
|
Dilate ic vasospasm init
|
$1,181.60 |
$1,181.60 |
$1,181.60 |
$4,627.52
|
|
Dilate tear duct opening
|
$968.80 |
$968.80 |
$968.80 |
$454.40
|
|
Dilate urethra stricture
|
$35.10 |
$35.10 |
$1,556.80 |
$496.00
|
|
Dilate urethra stricture
|
$666.40 |
$666.40 |
$666.40 |
$200.80
|
|
Dilate urethra stricture
|
$6,109.60 |
$6,109.60 |
$6,109.60 |
$3,863.60
|
|
Dilate urethra stricture
|
$1,276.80 |
$1,276.80 |
$1,276.80 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$890.40 |
$890.40 |
$890.40 |
$235.61
|
|
Dilation of anal sphincter
|
$5,527.20 |
$5,527.20 |
$5,527.20 |
$1,995.20
|
|
Dilation of cervical canal 57800
|
$10,001.60 |
$10,001.60 |
$10,001.60 |
$4,376.00
|
|
Dilation of rectal stricture 45910
|
$6,423.20 |
$6,423.20 |
$6,423.20 |
$2,263.80
|
|
Dilation of salivary duct
|
$1,450.40 |
$1,450.40 |
$1,450.40 |
$750.00
|
|
Dilation of urethra
|
$666.40 |
$666.40 |
$666.40 |
$172.00
|
|
Dilation of urethra
|
$1,696.80 |
$1,696.80 |
$1,696.80 |
$2,424.12
|
|
Dilation of vagina
|
$6,143.20 |
$6,143.20 |
$6,143.20 |
$3,986.00
|
|
Dilation salivary duct 42650
|
$5,633.60 |
$5,633.60 |
$5,633.60 |
$2,675.71
|
|
Dilation/urethral strict/male/ini 53620
|
$4,144.00 |
$4,144.00 |
$4,144.00 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$476.70 |
$476.70 |
$48,300.00 |
$402.10
|
|
Dilat xst trc ndurlgc px
|
$7,554.40 |
$7,554.40 |
$7,554.40 |
$3,883.16
|
|
Dilat xst trc new access rcs
|
$7,554.40 |
$7,554.40 |
$7,554.40 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$17.54 |
$17.54 |
$55.05 |
$46.56
|
|
Dimecaprol injection
|
$283.12 |
$283.12 |
$283.12 |
$293.38
|
|
Dimenhydrinate injection
|
$32.82 |
$32.82 |
$32.82 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,277.82 |
$1,277.82 |
$1,277.82 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$5.48 |
$5.48 |
$8.25 |
$18.35
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$28.56 |
$28.56 |
$28.56 |
$98.56
|
|
Dipyridamole injection
|
$48.04 |
$48.04 |
$48.04 |
$48.04
|
|
Dir nsl mucous membrane test
|
$145.60 |
$145.60 |
$145.60 |
$76.80
|
|
Disability dlco
|
$498.40 |
$498.40 |
$498.40 |
$292.03
|
|
Disaccharidases
|
$50.52 |
$50.52 |
$185.36 |
$224.31
|
|
Disarticulation sho sec clsr
|
$5,605.60 |
$5,605.60 |
$5,605.60 |
$2,300.80
|
|
Discography cerv/thor spine
|
$1,678.80 |
$1,678.80 |
$5,342.40 |
$2,481.50
|
|
Disconnect insert locking wr
|
$75.60 |
$75.60 |
$75.60 |
$75.60
|
|
Disconnect locking wrist uni
|
$207.20 |
$207.20 |
$207.20 |
$207.20
|
|
Dise eval slp do brth flx dx
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$1,120.00
|
|
Dist revas ligation hemo
|
$15,383.20 |
$15,383.20 |
$15,383.20 |
$6,396.89
|
|
Diverticulectomy/hypophar/esoph 43130
|
$14,319.20 |
$14,319.20 |
$14,319.20 |
$6,547.81
|
|
#d/lmeth-l-methamphetamine
|
$80.08 |
$80.08 |
$80.08 |
$72.14
|
|
Dlyd plmt xtn prosth ea addl
|
$571.20 |
$571.20 |
$571.20 |
$1,875.00
|
|
Dmd dup/delet analysis
|
$41.85 |
$41.85 |
$638.40 |
$418.50
|
|
Dmpk gene charac alleles
|
$627.20 |
$627.20 |
$627.20 |
$367.20
|
|
Dmpk gene detc abnor allele
|
$16.44 |
$16.44 |
$313.60 |
$313.60
|
|
Dna antibody native/double stranded
|
$19.65 |
$19.65 |
$71.12 |
$100.00
|
|
Dna gardnerella
|
$35.10 |
$35.10 |
$55.44 |
$61.80
|
|
Dna probe chlamydia
|
$14.72 |
$14.72 |
$63.28 |
$82.20
|
|
Dna probe gc
|
$14.72 |
$14.72 |
$71.68 |
$84.80
|
|
Dna trichomonas
|
$20.40 |
$20.40 |
$55.44 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$34.19 |
$34.19 |
$94.19 |
$98.29
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$9.21 |
$9.21 |
$904.81 |
$949.39
|
|
Dolasetron mesylate oral
|
$156.80 |
$156.80 |
$156.80 |
$156.80
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$16.62 |
$16.62 |
$55.16 |
$67.28
|
|
Doppler echo complete
|
$333.60 |
$333.60 |
$1,120.00 |
$558.00
|
|
Doppler intravascular pressure flow initial vessel
|
$2,690.85 |
$2,690.85 |
$2,777.60 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$743.55 |
$743.55 |
$1,831.20 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$339.60 |
$339.60 |
$716.80 |
$473.76
|
|
Dornhoffer fixed part w/window
|
$22,176.00 |
$22,176.00 |
$22,176.00 |
$34,278.00
|
|
Dorsi & plantar flex ass/res
|
$5,320.00 |
$5,320.00 |
$5,320.00 |
$163.50
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$19,427.62 |
$19,427.62 |
$19,427.62 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$5.39 |
$5.39 |
$484.77 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$1,718.24 |
$1,718.24 |
$1,718.24 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$37.40 |
$37.40 |
$62.96 |
$84.80
|
|
Dpyd gene common variants
|
$26.22 |
$26.22 |
$1,209.60 |
$423.60
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$1,993.60 |
$1,993.60 |
$1,993.60 |
$794.82
|
|
Drainage ext aud canal abscess 69020
|
$1,965.60 |
$1,965.60 |
$1,965.60 |
$914.34
|
|
Drainage external ear complex 69005
|
$4,664.80 |
$4,664.80 |
$4,664.80 |
$2,888.03
|
|
Drainage external ear simple 69000
|
$1,993.60 |
$1,993.60 |
$1,993.60 |
$779.45
|
|
Drainage lymph node lesion 38300
|
$5,891.20 |
$5,891.20 |
$5,891.20 |
$3,088.80
|
|
Drainage lymph node lesion 38305
|
$5,157.60 |
$5,157.60 |
$5,157.60 |
$3,170.64
|
|
Drainage mouth roof lesion
|
$1,646.40 |
$1,646.40 |
$1,646.40 |
$405.60
|
|
Drainage of arm bursa 23931
|
$403.50 |
$403.50 |
$6,395.20 |
$2,271.01
|
|
Drainage of bladder abscess
|
$5,723.20 |
$5,723.20 |
$5,723.20 |
$3,127.88
|
|
Drainage of bone lesion
|
$377.85 |
$377.85 |
$377.85 |
$3,153.60
|
|
Drainage of eye
|
$2,301.60 |
$2,301.60 |
$2,301.60 |
$2,415.65
|
|
Drainage of eye
|
$7,184.80 |
$7,184.80 |
$7,184.80 |
$3,170.00
|
|
Drainage of eye
|
$3,494.40 |
$3,494.40 |
$3,494.40 |
$3,222.78
|
|
Drainage of forearm bursa
|
$5,247.20 |
$5,247.20 |
$5,247.20 |
$2,170.50
|
|
Drainage of kidney lesion
|
$974.40 |
$974.40 |
$3,063.20 |
$1,506.00
|
