|
Incision of eardrum
|
$2,039.60 |
$2,039.60 |
$2,039.60 |
|
|
Incision of prostate
|
$4,092.79 |
$4,092.79 |
$4,092.79 |
|
|
Incision of spinal nerve 64772
|
$3,313.67 |
$3,313.67 |
$3,313.67 |
|
|
Incision of tongue fold
|
$429.00 |
$429.00 |
$2,339.32 |
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$77.19 |
$77.19 |
$77.19 |
|
|
Infect ag drug suscept pheno predict
|
$369.85 |
$382.85 |
$382.85 |
|
|
Infect ag eia influenza a or b ea
|
$43.55 |
$43.55 |
$98.80 |
|
|
Infect ag genotype na hiv-1 other region
|
$506.35 |
$506.35 |
$523.25 |
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$629.20 |
$689.65 |
$689.65 |
|
|
Infect ag ia direct hiv-1 antgn
|
$90.35 |
$91.65 |
$105.95 |
|
|
Infect ag ia optc obs influenza
|
$63.05 |
$63.05 |
$74.75 |
|
|
Infect ag if influenza a
|
$57.20 |
$63.05 |
$63.05 |
|
|
Infect ag if influenza b
|
$57.20 |
$85.80 |
$85.80 |
|
|
Infect ag if nos ea
|
$58.50 |
$58.50 |
$68.90 |
|
|
Infect ag if varicella zoster
|
$68.25 |
$68.25 |
$80.60 |
|
|
Infect ag na herpes simplex quant
|
$210.60 |
$210.60 |
$248.30 |
|
|
Infect ag na hpv high-risk types
|
$104.65 |
$104.65 |
$124.15 |
|
|
Infect ag na influenza r/amp 1st 2 types
|
$210.60 |
$219.70 |
$219.70 |
|
|
Infect ag na orthopoxvirus amp prb each
|
$139.10 |
$139.10 |
$161.20 |
|
|
Infect ag na resp virus 12-25 targets
|
$615.55 |
$629.20 |
$742.30 |
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$85.15 |
$85.15 |
$100.75 |
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$49.40 |
$78.65 |
$78.65 |
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$42.90 |
$79.30 |
$79.30 |
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$42.90 |
$63.70 |
$98.15 |
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$70.85 |
$71.50 |
$74.10 |
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$37.05 |
$53.95 |
$106.60 |
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$73.45 |
$76.05 |
$76.05 |
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$48.75 |
$83.85 |
$83.85 |
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$128.05 |
$152.10 |
$237.90 |
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$90.35 |
$93.60 |
$112.45 |
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$35.75 |
$35.75 |
$41.60 |
|
|
Infectious agent nucleic acid amplified probe
|
$276.90 |
$276.90 |
$366.60 |
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$98.80 |
$98.80 |
$221.00 |
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$100.75 |
$145.60 |
$171.60 |
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$679.25 |
$725.40 |
$856.70 |
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$100.75 |
$181.35 |
$193.70 |
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$100.75 |
$124.15 |
$124.15 |
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$226.20 |
$246.35 |
$246.35 |
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$97.50 |
$97.50 |
$122.85 |
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$130.00 |
$139.10 |
$139.10 |
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$178.75 |
$264.55 |
$264.55 |
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$256.75 |
$362.05 |
$362.05 |
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$65.00 |
$97.50 |
$97.50 |
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$128.05 |
$130.00 |
$153.40 |
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$167.70 |
$167.70 |
$186.55 |
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$143.00 |
$143.00 |
$143.00 |
|
|
Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets
|
$358.80 |
$358.80 |
$358.80 |
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$579.80 |
$609.05 |
$718.25 |
|
|
Infectious agent nucleic acid quantification bk virus
|
$403.00 |
$404.95 |
$478.40 |
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$123.50 |
$127.40 |
$183.95 |
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$131.30 |
$131.30 |
$321.75 |
|
|
Infectious agent nucleic acid quantification hiv-1
|
$224.90 |
$232.70 |
$258.05 |
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$304.85 |
$338.65 |
$399.75 |
|
|
Infliximab 100 mg intravenous solution
|
$2,550.73 |
$2,550.73 |
$2,663.29 |
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,096.55 |
$1,096.55 |
$1,144.00 |
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,068.33 |
$2,068.33 |
$2,159.29 |
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$204.10 |
$204.10 |
$204.10 |
|
|
Initial nursing facility care/day 35 minutes
|
$169.65 |
$169.65 |
$169.65 |
|
|
Initial nursing facility care/day 45 minutes
|
$222.30 |
$222.30 |
$222.30 |
|
|
Initial nursing facility care/day low severity 99304
|
$128.70 |
$128.70 |
$128.70 |
|
|
Initiation & management bipap/cpap initial day
|
$649.35 |
$795.60 |
$817.05 |
|
|
Inj allopurinol sodium 1 mg
|
$8,033.93 |
$8,033.93 |
$8,033.93 |
|
|
Inj anifrolumab-fnia 1mg
|
$12,569.62 |
$12,569.62 |
$12,569.62 |
|
|
Inj, aspara, rylaze, 0.1 mg
|
$12,678.25 |
$12,678.25 |
$12,678.25 |
|
|
Inj., benralizumab, 1 mg
|
$13,707.62 |
$13,707.62 |
$13,707.62 |
|
|
Inj, bezlotoxumab, 10 mg
|
$8,651.50 |
$8,651.50 |
$8,651.50 |
|
|
Inj brixadi, more than 7 day
|
$3,578.65 |
$3,578.65 |
$3,578.65 |
|
|
Inj calcitriol per 0.1 mcg
|
$9.25 |
$9.25 |
$9.25 |
|
|
Inj cefazolin sodium, hikma
|
$26.53 |
$27.10 |
$27.10 |
|
|
Inj cefazolin (wg crit care)
|
$7.15 |
$7.15 |
$7.15 |
|
|
Inj, cefiderocol, 10 mg
|
$762.03 |
$762.03 |
$762.03 |
|
|
Inj ceftolozane tazobactam
|
$591.66 |
$591.66 |
$591.66 |
|
|
Inj crotalidae im f(ab')2 eq
|
$2,659.80 |
$2,659.80 |
$2,659.80 |
|
|
Inj cyclophosphamd (ingenus)
|
$2,672.80 |
$2,672.80 |
$2,672.80 |
|
|
Inj. denosumab-bbdz, 1 mg
|
$3,655.90 |
$3,655.90 |
$7,305.30 |
|
|
Inj, donanemab-azbt, 2 mg
|
$1,556.09 |
$1,556.09 |
$1,556.09 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,175.12 |
$1,175.12 |
$1,175.12 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$187.20 |
$187.20 |
$187.20 |
|
|
Injection during cath supravalvular aortography
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
|
|
Injection, edaravone, 1 mg
|
$1,307.53 |
$1,307.53 |
$1,307.53 |
|
|
Injection epidural blood patch or clot
|
$575.90 |
$575.90 |
$1,748.58 |
|
|
Injection for bladder x-ray
|
$1,855.75 |
$1,855.75 |
$1,855.75 |
|
|
Injection for ureter x-ray
|
$434.20 |
$434.20 |
$434.20 |
|
|
Injection, fulvestrant
|
$461.50 |
$461.50 |
$461.50 |
|
|
Injection glatiramer acetate
|
$732.15 |
$732.15 |
$732.15 |
|
|
Injection, inclisiran, 1 mg
|
$7,300.18 |
$7,300.18 |
$7,518.45 |
|
|
Injection,onabotulinumtoxina
|
$1,311.76 |
$1,311.76 |
$1,311.76 |
|
|
Injection, renflexis
|
$1,648.31 |
$1,648.31 |
$1,648.31 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$6,840.03 |
$6,840.03 |
$16,567.29 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$245.70 |
$245.70 |
$9,161.06 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,447.44 |
$1,447.44 |
$1,447.44 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,185.83 |
$1,185.83 |
$1,185.83 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,185.83 |
$1,185.83 |
$1,185.83 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,197.24 |
$1,197.24 |
$1,197.24 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,197.24 |
$1,197.24 |
$1,197.24 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,459.13 |
$1,459.13 |
$1,459.13 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,476.03 |
$1,476.03 |
$1,476.03 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$37.05 |
$37.05 |
$137.15 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$140.40 |
$150.80 |
$150.80 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$158.60 |
$158.60 |
$178.10 |
|