|
Implant ureth bulk agent
|
$2,447.55 |
$2,447.55 |
$2,447.55 |
$2,072.07
|
|
In-111 oxyquinolin per 0.5 mci
|
$4,605.30 |
$4,605.30 |
$4,605.30 |
$2,808.00
|
|
In-111 pentetreotide
|
$4,340.25 |
$4,340.25 |
$4,340.25 |
$6,617.05
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,605.15 |
$1,605.15 |
$1,605.15 |
$2,261.20
|
|
Incision of windpipe
|
$9,150.30 |
$9,150.30 |
$9,150.30 |
$5,564.16
|
|
Incision of windpipe
|
$9,151.20 |
$9,151.20 |
$9,151.20 |
$5,293.68
|
|
Incisn windpipe
|
$4,876.20 |
$4,876.20 |
$4,876.20 |
$3,837.72
|
|
Incobotulinumtoxin a
|
$2,142.72 |
$2,142.72 |
$2,142.72 |
$1,304.79
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$1,728.00 |
$1,728.00 |
$1,728.00 |
$1,080.00
|
|
Infect ag drug suscept pheno predict
|
$63.00 |
$63.00 |
$63.00 |
$325.00
|
|
Infect ag genotype na hiv-1 other region
|
$63.00 |
$63.00 |
$63.00 |
$301.50
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$63.00 |
$63.00 |
$63.00 |
$574.60
|
|
Infect ag if hep delta agent
|
$56.25 |
$56.25 |
$56.25 |
$125.97
|
|
Infect ag if legionella pneumophila
|
$13.50 |
$13.50 |
$13.50 |
$75.79
|
|
Infect ag if pneumocystis carinii
|
$6.75 |
$6.75 |
$6.75 |
$62.29
|
|
Infect ag na orthopoxvirus amp prb each
|
$38.25 |
$38.25 |
$38.25 |
$102.00
|
|
Infect ag na resp virus 12-25 targets
|
$600.75 |
$600.75 |
$600.75 |
$859.44
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$51.93 |
$51.93 |
$51.93 |
$714.67
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$51.93 |
$51.93 |
$51.93 |
$77.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$123.30 |
$123.30 |
$123.30 |
$81.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$9.90 |
$9.90 |
$9.90 |
$63.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$6.75 |
$6.75 |
$6.75 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$5.40 |
$5.40 |
$5.40 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$83.70 |
$83.70 |
$83.70 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$398.25 |
$398.25 |
$398.25 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$13.82 |
$13.82 |
$13.82 |
$55.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$104.40 |
$104.40 |
$104.40 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$31.50 |
$31.50 |
$31.50 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$5.69 |
$5.69 |
$5.69 |
$97.50
|
|
Infectious agent nucleic acid amplified probe
|
$222.75 |
$222.75 |
$222.75 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$39.60 |
$39.60 |
$39.60 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$151.65 |
$151.65 |
$151.65 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$128.70 |
$128.70 |
$128.70 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$22.50 |
$22.50 |
$22.50 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$58.95 |
$58.95 |
$58.95 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$93.60 |
$93.60 |
$93.60 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$39.60 |
$39.60 |
$39.60 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$33.66 |
$33.66 |
$33.66 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$160.65 |
$160.65 |
$160.65 |
$248.15
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$111.15 |
$111.15 |
$111.15 |
$98.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$40.95 |
$40.95 |
$40.95 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$56.25 |
$56.25 |
$56.25 |
$200.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$189.90 |
$189.90 |
$189.90 |
$489.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$53.78 |
$53.78 |
$53.78 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$22.50 |
$22.50 |
$22.50 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$17.41 |
$17.41 |
$17.41 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$27.00 |
$27.00 |
$27.00 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$67.50 |
$67.50 |
$67.50 |
$298.35
|
|
Infliximab 100 mg intravenous solution
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$2,102.08
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,096.90 |
$3,096.90 |
$3,096.90 |
$1,617.43
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$202.05 |
$202.05 |
$202.05 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$4,891.50 |
$4,891.50 |
$4,891.50 |
$645.79
|
|
Inj, abilify maintena, 1 mg
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$5,156.77
|
|
Inj andexxa, 10 mg
|
$1,188.00 |
$1,188.00 |
$1,188.00 |
$6,794.00
|
|
Inj anifrolumab-fnia 1mg
|
$6,493.05 |
$6,493.05 |
$6,493.05 |
$9,648.88
|
|
Inj., benralizumab, 1 mg
|
$6,808.50 |
$6,808.50 |
$6,808.50 |
$14,405.42
|
|
Inj, bezlotoxumab, 10 mg
|
$5,130.00 |
$5,130.00 |
$5,130.00 |
$8,651.50
|
|
Inj, bupivacaine liposome
|
$1,360.79 |
$1,360.79 |
$1,360.79 |
$558.36
|
|
Inj, cefiderocol, 10 mg
|
$792.00 |
$792.00 |
$792.00 |
$596.08
|
|
Inj ceftolozane tazobactam
|
$358.56 |
$358.56 |
$358.56 |
$431.36
|
|
Inj cntr knee arthro incl ct/mri
|
$298.35 |
$298.35 |
$298.35 |
$464.28
|
|
Inj crotalidae im f(ab')2 eq
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$2,706.67
|
|
Inj, cyclophosphamd, sandoz
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$423.66
|
|
Inj dx for sinogram
|
$259.65 |
$259.65 |
$259.65 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$247.50 |
$247.50 |
$247.50 |
$507.10
|
|
Injection, burosumab-twza 1m
|
$18,569.24 |
$18,569.24 |
$18,569.24 |
$481.57
|
|
Injection, daratumumab 10 mg
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$2,735.10 |
$2,735.10 |
$2,735.10 |
$1,148.80
|
|
Injection, edaravone, 1 mg
|
$2,345.85 |
$2,345.85 |
$2,345.85 |
$2,788.85
|
|
Injection epidural blood patch or clot
|
$814.50 |
$814.50 |
$814.50 |
$1,473.12
|
|
Injection for bladder x-ray
|
$727.65 |
$727.65 |
$727.65 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$330.30 |
$330.30 |
$330.30 |
$504.00
|
|
Injection for ureter x-ray
|
$159.30 |
$159.30 |
$159.30 |
$444.95
|
|
Injection for ureter x-ray
|
$229.50 |
$229.50 |
$229.50 |
$515.21
|
|
Injection, fulvestrant
|
$432.00 |
$432.00 |
$432.00 |
$2,550.36
|
|
Injection, inclisiran, 1 mg
|
$4,387.50 |
$4,387.50 |
$4,387.50 |
$7,300.18
|
|
Injection, isavuconazonium
|
$1,030.32 |
$1,030.32 |
$1,030.32 |
$862.16
|
|
Injection jugular
|
$1,525.95 |
$1,525.95 |
$1,525.95 |
$1,048.20
|
|
Injection of sinus tract
|
$1,821.60 |
$1,821.60 |
$1,821.60 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$1,965.60
|
|
Injection, peramivir
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$911.87
|
|
Injection radioactive tracer sentinel node (both sides)
|
$575.10 |
$575.10 |
$575.10 |
$717.20
|
|
Injection, renflexis
|
$3,254.66 |
$3,254.66 |
$3,254.66 |
$1,356.10
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,109.25 |
$1,109.25 |
$1,109.25 |
$1,491.47
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$987.30 |
$987.30 |
$987.30 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,021.50 |
$1,021.50 |
$1,021.50 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,143.90 |
$1,143.90 |
$1,143.90 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$987.30 |
$987.30 |
$987.30 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$473.85 |
$473.85 |
$473.85 |
$472.76
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$190.80 |
$190.80 |
$190.80 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$174.15 |
$174.15 |
$174.15 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$190.80 |
$190.80 |
$190.80 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$150.75 |
$150.75 |
$150.75 |
$141.60
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$21,293.55 |
$21,293.55 |
$21,293.55 |
$53,243.74
|
|
Inj epidural sgl lumb-sacral without img
|
$1,045.35 |
$1,045.35 |
$1,045.35 |
$1,450.84
|
|
Inj fluphenazine hcl 1.25 mg
|
$41.49 |
$41.49 |
$41.49 |
$37.93
|
|
Inj for ext venography
|
$322.65 |
$322.65 |
$322.65 |
$737.55
|
|
Inj fosnetupitant, palonoset
|
$2,887.20 |
$2,887.20 |
$2,887.20 |
$679.51
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,735.10 |
$2,735.10 |
$2,735.10 |
$1,482.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$2,953.80 |
$2,953.80 |
$2,953.80 |
$1,837.17
|