|
In-111 pentetate dtpa / 0.5 mci
|
$4,729.50 |
$4,729.50 |
$23,553.42 |
$2,135.29
|
|
In-111 pentetreotide
|
$22,948.25 |
$22,948.25 |
$31,470.00 |
$6,617.05
|
|
Incise tendon(s) & muscle(s)
|
$20,180.27 |
$20,180.27 |
$20,180.27 |
$7,855.87
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$5,534.27 |
$5,534.27 |
$5,534.27 |
$2,261.20
|
|
Incision of achilles tendon
|
$5,916.21 |
$5,916.21 |
$5,916.21 |
$3,306.48
|
|
Incision of ankle bone
|
$8,675.77 |
$8,675.77 |
$8,675.77 |
$5,886.74
|
|
Incision of breast lesion
|
$4,705.79 |
$4,705.79 |
$4,705.79 |
$3,029.60
|
|
Incision of burn scab initi
|
$1,087.35 |
$1,087.35 |
$1,087.35 |
$501.00
|
|
Incision of foot fascia
|
$7,546.32 |
$7,546.32 |
$7,546.32 |
$4,499.12
|
|
Incision of foot tendon 28234
|
$9,949.50 |
$9,949.50 |
$9,949.50 |
$2,116.27
|
|
Incision of heel bone
|
$19,279.01 |
$19,279.01 |
$19,279.01 |
$6,004.47
|
|
Incision of hip tendon
|
$5,905.07 |
$5,905.07 |
$5,905.07 |
$3,885.29
|
|
Incision of metatarsal
|
$8,675.77 |
$8,675.77 |
$8,675.77 |
$3,594.44
|
|
Incision of midfoot bones
|
$19,279.01 |
$19,279.01 |
$19,279.01 |
$6,004.47
|
|
Incision of tendon & muscle
|
$17,061.57 |
$17,061.57 |
$17,061.57 |
$8,293.50
|
|
Incision of tendon sheath
|
$4,181.05 |
$4,181.05 |
$4,181.05 |
$2,263.68
|
|
Incision of thigh tendon
|
$8,017.78 |
$8,017.78 |
$8,017.78 |
$4,499.12
|
|
Incision of thigh tendons
|
$7,546.32 |
$7,546.32 |
$7,546.32 |
$4,627.00
|
|
Incision of tibia
|
$19,279.01 |
$19,279.01 |
$19,279.01 |
$5,886.74
|
|
Incision of toe tendons 28011
|
$5,639.31 |
$5,639.31 |
$5,639.31 |
$2,068.30
|
|
Incision of tongue fold
|
$4,045.88 |
$4,045.88 |
$4,045.88 |
$1,865.58
|
|
Incision tendon sheath
|
$4,181.05 |
$4,181.05 |
$4,181.05 |
$2,309.40
|
|
Incisn of toe tndn
|
$4,207.84 |
$4,207.84 |
$4,207.84 |
$2,298.99
|
|
Incobotulinumtoxin a
|
$3,390.67 |
$3,390.67 |
$3,390.67 |
$1,339.57
|
|
Infect ag drug suscept pheno predict
|
$3,510.06 |
$3,510.06 |
$3,510.06 |
$325.00
|
|
Infect ag eia influenza a or b ea
|
$312.88 |
$312.88 |
$312.88 |
$69.03
|
|
Infect ag genotype na cytomegalovirus
|
$75.63 |
$1,507.80 |
$2,688.25 |
$603.41
|
|
Infect ag genotype na dna hepatitis b
|
$409.27 |
$409.27 |
$409.27 |
$500.40
|
|
Infect ag genotype na hiv-1 other region
|
$75.63 |
$336.50 |
$2,462.00 |
$301.50
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$3,495.00 |
$3,510.06 |
$4,072.75 |
$574.60
|
|
Infect ag ia optc obs influenza
|
$179.47 |
$179.47 |
$179.47 |
$66.72
|
|
Infect ag if ea plyvlnt antsrm
|
$1,591.75 |
$1,591.75 |
$1,591.75 |
$37.74
|
|
Infect ag if hep delta agent
|
$1,813.00 |
$1,813.00 |
$1,813.00 |
$125.97
|
|
Infect ag if influenza a
|
$190.79 |
$190.79 |
$190.79 |
$40.61
|
|
Infect ag if influenza b
|
$190.79 |
$190.79 |
$190.79 |
$34.67
|
|
Infect ag if legionella pneumophila
|
$265.47 |
$337.50 |
$1,640.50 |
$75.79
|
|
Infect ag if nos ea
|
$185.28 |
$185.28 |
$282.45 |
$60.40
|
|
Infect ag if pneumocystis carinii
|
$190.79 |
$1,784.00 |
$2,271.50 |
$62.29
|
|
Infect ag if varicella zoster
|
$190.79 |
$190.79 |
$190.79 |
$66.00
|
|
Infect ag na hep b amp
|
$569.18 |
$674.14 |
$1,962.00 |
$108.44
|
|
Infect ag na herpes simplex quant
|
$86.41 |
$165.00 |
$430.00 |
$145.20
|
|
Infect ag na hpv high-risk types
|
$505.57 |
$505.57 |
$505.57 |
$139.75
|
|
Infect ag na influenza r/amp 1st 2 types
|
$126.50 |
$158.25 |
$1,270.98 |
$227.96
|
|
Infect ag na influenza revr/amp ea type
|
$419.00 |
$1,039.01 |
$2,391.00 |
$124.80
|
|
Infect ag na orthopoxvirus amp prb each
|
$82.50 |
$99.00 |
$311.69 |
$102.00
|
|
Infect ag na resp virus 12-25 targets
|
$1,855.07 |
$2,815.08 |
$4,846.50 |
$859.44
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$75.63 |
$75.63 |
$15,495.00 |
$714.67
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$75.63 |
$75.63 |
$391.00 |
$77.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$283.38 |
$283.38 |
$355.12 |
$81.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$277.23 |
$390.47 |
$1,231.00 |
$63.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$106.43 |
$195.25 |
$1,175.00 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$195.25 |
$199.86 |
$1,068.00 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$75.00 |
$122.25 |
$1,245.00 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$159.49 |
$220.72 |
$1,192.00 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$164.28 |
$922.00 |
$1,326.75 |
$55.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$347.57 |
$588.00 |
$1,140.25 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$382.60 |
$382.60 |
$382.60 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$271.18 |
$310.98 |
$1,108.00 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$180.88 |
$648.00 |
$1,476.25 |
$60.00
|
|
Infectious agent nucleic acid amplified probe
|
$569.30 |
$569.30 |
$569.30 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$525.00 |
$562.15 |
$764.25 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$283.38 |
$550.27 |
$922.00 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,007.83 |
$1,561.50 |
$1,759.00 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$150.25 |
$378.81 |
$458.91 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$562.15 |
$652.75 |
$718.00 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$528.24 |
$1,098.78 |
$1,779.00 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$322.15 |
$518.00 |
$764.25 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$147.43 |
$147.43 |
$147.43 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$139.15 |
$152.00 |
$639.36 |
$222.60
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$126.50 |
$152.00 |
$639.36 |
$248.15
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$297.82 |
$297.82 |
$297.82 |
$98.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$135.00 |
$135.00 |
$509.17 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$762.15 |
$959.89 |
$3,024.00 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$222.14 |
$222.14 |
$222.14 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$222.14 |
$222.14 |
$222.14 |
$489.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$694.54 |
$694.54 |
$694.54 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$412.50 |
$679.50 |
$1,254.00 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$264.00 |
$264.00 |
$278.78 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$823.28 |
$1,168.00 |
$1,379.76 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$297.01 |
$297.01 |
$2,662.00 |
$298.35
|
|
Infliximab 100 mg intravenous solution
|
$3,993.32 |
$3,993.32 |
$3,993.32 |
$2,102.08
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,530.00 |
$2,530.00 |
$2,662.00 |
$1,432.80
|
|
Influenza dna amp prob addl
|
$700.00 |
$1,039.01 |
$1,594.00 |
$69.60
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$158.00 |
$158.00 |
$183.75 |
$76.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$1,481.00 |
$2,774.43 |
$4,860.50 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$551.88 |
$3,885.19 |
$6,000.00 |
$645.79
|
|
Inj allopurinol sodium 1 mg
|
$2,924.75 |
$4,036.00 |
$34,902.00 |
$7,176.71
|
|
Inj, aspara, rylaze, 0.1 mg
|
$71,236.50 |
$71,236.50 |
$71,236.50 |
$81.97
|
|
Inj., benralizumab, 1 mg
|
$20,495.24 |
$20,495.24 |
$35,151.25 |
$13,682.10
|
|
Inj, bezlotoxumab, 10 mg
|
$4,606.88 |
$25,323.25 |
$34,941.00 |
$8,698.20
|
|
Inj cefazolin sodium, hikma
|
$221.96 |
$221.96 |
$221.96 |
$34.59
|
|
Inj, cefiderocol, 10 mg
|
$10.00 |
$10.00 |
$10.00 |
$596.08
|
|
Inj ceftolozane tazobactam
|
$554.41 |
$554.41 |
$855.00 |
$431.36
|
|
Inj cntr knee arthro incl ct/mri
|
$2,911.23 |
$2,911.23 |
$2,911.23 |
$464.28
|
|
Inj crotalidae im f(ab')2 eq
|
$7,407.50 |
$7,407.50 |
$32,390.00 |
$2,735.85
|
|
Inj disk cerv-thor ea lev
|
$2,102.43 |
$2,102.43 |
$2,102.43 |
$869.80
|
|
Inj dupuytren cord w/enzyme
|
$792.45 |
$792.45 |
$792.45 |
$416.00
|
|
Inj, durolane 1 mg
|
$2,181.77 |
$2,181.77 |
$2,181.77 |
$2,181.77
|
|
Inj dx for sinogram
|
$1,281.62 |
$1,281.62 |
$1,281.62 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$4,236.87 |
$4,236.87 |
$4,236.87 |
$1,214.78
|