|
Diag laparo separate proc 49320
|
$1,470.30 |
$1,470.30 |
$1,470.30 |
$7,104.72
|
|
Diagnostic anoscopy
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$392.70
|
|
Diagnostic anoscopy & biopsy
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$2,288.00
|
|
Diagnostic anoscopy spx 46600
|
$481.65 |
$481.65 |
$481.65 |
$195.50
|
|
Diagnostic digital breast tomosynthesis bil
|
$159.90 |
$159.90 |
$159.90 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$90.35 |
$90.35 |
$90.35 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$725.40 |
$725.40 |
$725.40 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$725.40 |
$725.40 |
$725.40 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$833.95 |
$833.95 |
$1,001.00 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$457.60 |
$457.60 |
$457.60 |
$314.00
|
|
Diagnostic radio unlisted proc
|
$17,667.00 |
$17,667.00 |
$17,667.00 |
$259.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$18,500.95 |
$18,500.95 |
$18,500.95 |
$5,741.00
|
|
Dialysis one evaluation
|
$923.00 |
$923.00 |
$2,387.45 |
$936.00
|
|
Dialysis repeated eval
|
$655.20 |
$655.20 |
$655.20 |
$1,332.80
|
|
Dialysis training complete
|
$1,632.80 |
$1,632.80 |
$1,632.80 |
$783.36
|
|
Diatrizoate meglumine 18 % urethral solution
|
$1.87 |
$1.87 |
$1.87 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$58.50 |
$58.50 |
$259.00 |
$79.71
|
|
Dicyclomine injection
|
$45.63 |
$45.63 |
$627.00 |
$154.33
|
|
Diffusing capacity
|
$540.80 |
$540.80 |
$1,483.00 |
$336.80
|
|
Digital analysis of eeg
|
$514.80 |
$514.80 |
$6,638.00 |
$593.40
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$110.00 |
$110.00 |
$335.15 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$11,639.16 |
$11,639.16 |
$27,942.00 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$92.30 |
$92.30 |
$92.30 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$245.70 |
$245.70 |
$1,241.00 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$3,354.65 |
$3,354.65 |
$3,354.65 |
$1,866.73
|
|
Dilate esophagus
|
$366.60 |
$366.60 |
$366.60 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$365.95 |
$365.95 |
$365.95 |
$1,548.00
|
|
Dilate ic vasospasm ea add vsl diff territory
|
$13,873.60 |
$13,873.60 |
$13,873.60 |
$3,169.00
|
|
Dilate ic vasospasm ea add vsl same territory
|
$6,786.00 |
$6,786.00 |
$6,786.00 |
$1,931.80
|
|
Dilate ic vasospasm init
|
$21,388.25 |
$21,388.25 |
$21,388.25 |
$5,151.95
|
|
Dilate tear duct opening
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$454.40
|
|
Dilate urethra stricture
|
$909.35 |
$909.35 |
$909.35 |
$513.00
|
|
Dilate urethra stricture
|
$481.65 |
$481.65 |
$481.65 |
$200.80
|
|
Dilate urethra stricture
|
$332.80 |
$332.80 |
$332.80 |
$3,863.60
|
|
Dilate urethra stricture
|
$351.00 |
$351.00 |
$351.00 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$585.00 |
$585.00 |
$585.00 |
$235.61
|
|
Dilation of anal sphincter
|
$611.00 |
$611.00 |
$611.00 |
$2,166.04
|
|
Dilation of cervical canal 57800
|
$11,883.95 |
$11,883.95 |
$11,883.95 |
$4,446.00
|
|
Dilation of rectal stricture 45910
|
$741.00 |
$741.00 |
$741.00 |
$2,491.80
|
|
Dilation of salivary duct
|
$293.80 |
$293.80 |
$293.80 |
$790.00
|
|
Dilation of urethra
|
$481.65 |
$481.65 |
$481.65 |
$172.00
|
|
Dilation salivary duct 42650
|
$5,536.70 |
$5,536.70 |
$5,536.70 |
$2,675.71
|
|
Dilation/urethral strict/male/ini 53620
|
$2,494.70 |
$2,494.70 |
$2,494.70 |
$1,372.80
|
|
Dilat xst trc ndurlgc px
|
$722.80 |
$722.80 |
$722.80 |
$3,900.60
|
|
Dilat xst trc new access rcs
|
$12,890.15 |
$12,890.15 |
$12,890.15 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$26.70 |
$26.70 |
$26.70 |
$45.60
|
|
Dimenhydrinate injection
|
$30.75 |
$30.75 |
$30.75 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,209.00 |
$1,209.00 |
$1,331.04 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$35.10 |
$35.10 |
$110.00 |
$18.32
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$287.88 |
$287.88 |
$287.88 |
$98.15
|
|
Dipyridamole injection
|
$4.64 |
$4.64 |
$1,016.00 |
$48.04
|
|
Dir nsl mucous membrane test
|
$81.90 |
$81.90 |
$81.90 |
$76.80
|
|
Disability dlco
|
$659.10 |
$659.10 |
$3,059.00 |
$293.76
|
|
Disaccharidases
|
$61.00 |
$61.00 |
$921.05 |
$230.40
|
|
Discectomy ant dcmprn cord thoracic 1 ntrspc 63077
|
$5,948.80 |
$5,948.80 |
$5,948.80 |
$3,636.00
|
|
Discectomy ant dcmprn cord thoracic ea ntrsp 63078
|
$852.80 |
$852.80 |
$852.80 |
$370.20
|
|
Discography cerv/thor spine
|
$301.60 |
$301.60 |
$301.60 |
$2,565.00
|
|
Dise eval slp do brth flx dx
|
$451.75 |
$451.75 |
$451.75 |
$1,120.00
|
|
Dissect brain w/scope
|
$5,519.80 |
$5,519.80 |
$5,519.80 |
$5,519.80
|
|
Dist revas ligation hemo
|
$25,255.10 |
$25,255.10 |
$25,255.10 |
$6,396.89
|
|
Diverticulectomy/hypophar/esoph 43130
|
$3,583.45 |
$3,583.45 |
$3,583.45 |
$6,547.81
|
|
Division of fallopian tube 58605
|
$1,372.80 |
$1,372.80 |
$1,372.80 |
$976.50
|
|
Dlyd plmt xtn prosth ea addl
|
$8,338.20 |
$8,338.20 |
$8,338.20 |
$1,810.80
|
|
Dmpk gene detc abnor allele
|
$336.05 |
$336.05 |
$336.05 |
$313.60
|
|
Dna antibody native/double stranded
|
$395.85 |
$395.85 |
$395.85 |
$100.00
|
|
Dna gardnerella
|
$17.55 |
$17.55 |
$17.55 |
$61.83
|
|
Dna probe chlamydia
|
$20.80 |
$20.80 |
$20.80 |
$82.20
|
|
Dna probe gc
|
$24.05 |
$24.05 |
$24.05 |
$79.38
|
|
Dna trichomonas
|
$17.55 |
$17.55 |
$17.55 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$109.85 |
$109.85 |
$109.85 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$949.39 |
$949.39 |
$3,054.00 |
$949.39
|
|
Docetaxel (docivyx), 1 mg
|
$108.86 |
$108.86 |
$108.86 |
$108.86
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$2.07 |
$2.07 |
$2.07 |
$65.40
|
|
Doppler echo complete
|
$1,191.45 |
$1,191.45 |
$3,978.00 |
$558.00
|
|
Doppler intravascular pressure flow initial vessel
|
$3,757.65 |
$3,757.65 |
$3,757.65 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$859.95 |
$859.95 |
$859.95 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$673.40 |
$673.40 |
$673.40 |
$481.65
|
|
Dornase alfa non-comp unit
|
$1,247.00 |
$1,247.00 |
$1,247.00 |
$356.00
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$2,871.39 |
$2,871.39 |
$2,871.39 |
$23,613.78
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$820.66 |
$820.66 |
$1,224.00 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$1,691.30 |
$1,691.30 |
$1,691.30 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$61.62 |
$61.62 |
$1,010.00 |
$89.34
|
|
Dpyd gene common variants
|
$517.40 |
$517.40 |
$517.40 |
$423.60
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$2,629.90 |
$2,629.90 |
$2,629.90 |
$800.00
|
|
Drainage ext aud canal abscess 69020
|
$2,286.70 |
$2,286.70 |
$2,286.70 |
$964.00
|
|
Drainage external ear complex 69005
|
$5,265.65 |
$5,265.65 |
$5,265.65 |
$2,888.03
|
|
Drainage external ear simple 69000
|
$2,286.70 |
$2,286.70 |
$2,286.70 |
$790.40
|
|
Drainage lymph node lesion 38300
|
$613.60 |
$613.60 |
$613.60 |
$3,088.80
|
|
Drainage lymph node lesion 38305
|
$1,736.80 |
$1,736.80 |
$1,736.80 |
$3,170.64
|
|
Drainage mouth roof lesion
|
$867.75 |
$867.75 |
$867.75 |
$405.60
|
|
Drainage of arm bursa 23931
|
$6,055.40 |
$6,055.40 |
$6,055.40 |
$2,271.01
|
|
Drainage of eye
|
$8,524.10 |
$8,524.10 |
$8,524.10 |
$2,415.65
|
|
Drainage of eye
|
$8,524.10 |
$8,524.10 |
$8,524.10 |
$3,494.40
|
|
Drainage of kidney lesion
|
$2,629.90 |
$2,629.90 |
$2,629.90 |
$1,506.00
|
|
Drainage of mouth lesion
|
$867.75 |
$867.75 |
$867.75 |
$535.20
|
|
Drainage of mouth lesion
|
$5,536.70 |
$5,536.70 |
$5,536.70 |
$2,320.03
|
|
Drainage of mouth lesion
|
$12,121.20 |
$12,121.20 |
$12,121.20 |
$3,837.72
|
|
Drainage of mouth lesion
|
$1,903.85 |
$1,903.85 |
$1,903.85 |
$905.30
|
|
Drainage of mouth lesion
|
$22,109.75 |
$22,109.75 |
$22,109.75 |
$6,781.90
|
|
Drainage of mouth lesion
|
$12,121.20 |
$12,121.20 |
$12,121.20 |
$3,459.00
|
