|
Diabetic custom molded shoe
|
$375.08 |
$375.08 |
$375.08 |
$269.36
|
|
Diabetic shoe with wedge
|
$63.19 |
$63.19 |
$63.19 |
$63.19
|
|
Diabetic shoe w/off set heel
|
$63.19 |
$63.19 |
$63.19 |
$63.19
|
|
Diabetic shoe w/roller/rockr
|
$63.19 |
$63.19 |
$63.19 |
$63.19
|
|
Diab manage trn ind/group
|
$22.08 |
$22.08 |
$22.08 |
$54.99
|
|
Diab shoe for density insert
|
$125.07 |
$125.07 |
$125.07 |
$147.56
|
|
Diab shoe w/metatarsal bar
|
$63.19 |
$63.19 |
$63.19 |
$63.19
|
|
Diag bronchoscope/catheter
|
$2,447.43 |
$2,447.43 |
$2,447.43 |
$2,360.15
|
|
Diag laparo separate proc 49320
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
$7,104.72
|
|
Diagnostic anoscopy
|
$614.27 |
$614.27 |
$614.27 |
$392.70
|
|
Diagnostic anoscopy & biopsy
|
$1,645.43 |
$1,645.43 |
$1,645.43 |
$2,288.00
|
|
Diagnostic anoscopy spx 46600
|
$182.95 |
$182.95 |
$182.95 |
$195.50
|
|
Diagnostic laryngoscopy 31505
|
$274.47 |
$274.47 |
$274.47 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$274.47 |
$274.47 |
$274.47 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$147.89 |
$147.89 |
$147.89 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$115.09 |
$115.09 |
$115.09 |
$314.00
|
|
Diagnostic radio unlisted proc
|
$119.66 |
$119.66 |
$119.66 |
$259.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$262.71 |
$262.71 |
$262.71 |
$5,741.00
|
|
Dialysis one evaluation
|
$573.75 |
$573.75 |
$573.75 |
$936.00
|
|
Dialysis repeated eval
|
$151.07 |
$151.07 |
$151.07 |
$1,332.80
|
|
Diathermy eg microwave
|
$10.21 |
$10.21 |
$10.21 |
$29.68
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.10 |
$0.10 |
$0.10 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$9.23 |
$9.23 |
$9.23 |
$79.71
|
|
Dicyclomine injection
|
$15.63 |
$15.63 |
$15.63 |
$154.33
|
|
Diffusing capacity
|
$72.39 |
$72.39 |
$72.39 |
$336.80
|
|
Digital analysis of eeg
|
$278.88 |
$278.88 |
$278.88 |
$593.40
|
|
Digit nerve surgery add-on
|
$232.54 |
$232.54 |
$232.54 |
$1,832.59
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$13.21 |
$13.21 |
$13.21 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$7,130.45 |
$7,130.45 |
$7,130.45 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$18.33 |
$18.33 |
$18.33 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$78.77 |
$78.77 |
$78.77 |
$297.86
|
|
Dilate biliary duct/ampulla
|
$171.58 |
$171.58 |
$171.58 |
$1,866.73
|
|
Dilate esophagus
|
$2,638.57 |
$2,638.57 |
$2,638.57 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
$1,548.00
|
|
Dilate tear duct opening
|
$614.27 |
$614.27 |
$614.27 |
$454.40
|
|
Dilate urethra stricture
|
$343.55 |
$343.55 |
$343.55 |
$513.00
|
|
Dilate urethra stricture
|
$182.95 |
$182.95 |
$182.95 |
$200.80
|
|
Dilate urethra stricture
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
$3,863.60
|
|
Dilate urethra stricture
|
$343.55 |
$343.55 |
$343.55 |
$343.55
|
|
Dilation/female urethra/initial 53660
|
$176.93 |
$176.93 |
$176.93 |
$235.61
|
|
Dilation of anal sphincter
|
$1,645.43 |
$1,645.43 |
$1,645.43 |
$2,166.04
|
|
Dilation of cervical canal 57800
|
$4,451.18 |
$4,451.18 |
$4,451.18 |
$4,446.00
|
|
Dilation of rectal stricture 45910
|
$1,645.43 |
$1,645.43 |
$1,645.43 |
$2,491.80
|
|
Dilation of salivary duct
|
$741.60 |
$741.60 |
$741.60 |
$790.00
|
|
Dilation of urethra
|
$182.95 |
$182.95 |
$182.95 |
$172.00
|
|
Dilation of urethra
|
$2,874.36 |
$2,874.36 |
$2,874.36 |
$2,424.12
|
|
Dilation of vagina
|
$4,451.18 |
$4,451.18 |
$4,451.18 |
$4,446.00
|
|
Dilation salivary duct 42650
|
$2,133.48 |
$2,133.48 |
$2,133.48 |
$2,675.71
|
|
Dilation/urethral strict/male/ini 53620
|
$958.81 |
$958.81 |
$958.81 |
$1,372.80
|
|
Dilat xst trc ndurlgc px
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
$3,900.60
|
|
Dilat xst trc new access rcs
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
$4,258.20
|
|
Diltiazem 5 mg/ml intravenous solution
|
$0.04 |
$0.04 |
$0.04 |
$45.60
|
|
Dimenhydrinate injection
|
$1.26 |
$1.26 |
$1.26 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,033.94 |
$1,033.94 |
$1,033.94 |
$1,258.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$0.98 |
$0.98 |
$0.98 |
$18.32
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$45.00 |
$45.00 |
$45.00 |
$98.15
|
|
Dipyridamole injection
|
$11.61 |
$11.61 |
$11.61 |
$48.04
|
|
Dir nsl mucous membrane test
|
$51.36 |
$51.36 |
$51.36 |
$76.80
|
|
Disability dlco
|
$296.91 |
$296.91 |
$296.91 |
$293.76
|
|
Disaccharidases
|
$30.59 |
$30.59 |
$30.59 |
$230.40
|
|
Disarticulation sho sec clsr
|
$2,837.09 |
$2,837.09 |
$2,837.09 |
$2,300.80
|
|
Disarticulation shoulder
|
$17,653.66 |
$17,653.66 |
$17,653.66 |
$13,116.76
|
|
Discectomy ant dcmprn cord thoracic 1 ntrspc 63077
|
$1,940.58 |
$1,940.58 |
$1,940.58 |
$3,636.00
|
|
Discectomy ant dcmprn cord thoracic ea ntrsp 63078
|
$300.67 |
$300.67 |
$300.67 |
$370.20
|
|
Discography cerv/thor spine
|
$2,685.07 |
$2,685.07 |
$2,685.07 |
$2,565.00
|
|
Disconnect insert locking wr
|
$109.59 |
$109.59 |
$109.59 |
$75.60
|
|
Disconnect locking wrist uni
|
$364.04 |
$364.04 |
$364.04 |
$207.20
|
|
Dise eval slp do brth flx dx
|
$2,447.43 |
$2,447.43 |
$2,447.43 |
$1,120.00
|
|
Dissect brain w/scope
|
$2,321.68 |
$2,321.68 |
$2,321.68 |
$5,519.80
|
|
Dist revas ligation hemo
|
$7,651.38 |
$7,651.38 |
$7,651.38 |
$6,396.89
|
|
Div aberrant vsl w/reanast
|
$1,644.05 |
$1,644.05 |
$1,644.05 |
$1,644.05
|
|
Diverticulectomy/hypophar/esoph 43130
|
$8,139.99 |
$8,139.99 |
$8,139.99 |
$6,547.81
|
|
Division of fallopian tube 58605
|
$441.09 |
$441.09 |
$441.09 |
$976.50
|
|
Dlyd plmt xtn prosth ea addl
|
$409.79 |
$409.79 |
$409.79 |
$1,810.80
|
|
Dmd dup/delet analysis
|
$385.02 |
$385.02 |
$385.02 |
$418.50
|
|
Dmpk gene charac alleles
|
$379.27 |
$379.27 |
$379.27 |
$367.20
|
|
Dmpk gene detc abnor allele
|
$189.06 |
$189.06 |
$189.06 |
$313.60
|
|
Dna antibody native/double stranded
|
$18.96 |
$18.96 |
$18.96 |
$100.00
|
|
Dna gardnerella
|
$27.67 |
$27.67 |
$27.67 |
$61.83
|
|
Dna probe chlamydia
|
$31.40 |
$31.40 |
$31.40 |
$82.20
|
|
Dna probe gc
|
$37.09 |
$37.09 |
$37.09 |
$79.38
|
|
Dna trichomonas
|
$27.67 |
$27.67 |
$27.67 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$11.07 |
$11.07 |
$11.07 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$0.90 |
$0.90 |
$0.90 |
$949.39
|
|
Docetaxel (docivyx), 1 mg
|
$68.66 |
$68.66 |
$68.66 |
$108.86
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$1.11 |
$1.11 |
$1.11 |
$65.40
|
|
Doppler echo complete
|
$45.71 |
$45.71 |
$45.71 |
$558.00
|
|
Doppler intravascular pressure flow initial vessel
|
$138.46 |
$138.46 |
$138.46 |
$2,777.60
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$296.91 |
$296.91 |
$296.91 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$182.95 |
$182.95 |
$182.95 |
$481.65
|
|
Dornase alfa non-comp unit
|
$76.12 |
$76.12 |
$76.12 |
$356.00
|
|
Dornhoffer fixed part w/window
|
$33,271.54 |
$33,271.54 |
$33,271.54 |
$34,278.00
|
|
Dorsi & plantar flex ass/res
|
$137.21 |
$137.21 |
$137.21 |
$163.44
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$341.46 |
$341.46 |
$341.46 |
$23,613.78
|
|
Double transfer toe-hand
|
$9,977.57 |
$9,977.57 |
$9,977.57 |
$7,413.38
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$3.84 |
$3.84 |
$3.84 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$143.53 |
$143.53 |
$143.53 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$0.14 |
$0.14 |
$0.14 |
$89.34
|
|
Dpyd gene common variants
|
$241.24 |
$241.24 |
$241.24 |
$423.60
|
|
Drainable plastic pch w fcpl
|
$33.77 |
$33.77 |
$33.77 |
$33.77
|
