|
Incision of toe tendons 28011
|
$4,353.00 |
$4,353.00 |
$4,353.00 |
$2,119.12
|
|
Incisn of toe tndn
|
$4,222.80 |
$4,222.80 |
$4,222.80 |
$2,667.00
|
|
Incisn windpipe
|
$2,040.00 |
$2,040.00 |
$2,040.00 |
$3,819.23
|
|
Incobotulinumtoxin a
|
$10.72 |
$10.72 |
$10.72 |
$1,339.57
|
|
Infect ag genotype na cytomegalovirus
|
$367.80 |
$367.80 |
$367.80 |
$665.40
|
|
Infect ag genotype na hiv-1 other region
|
$671.40 |
$671.40 |
$671.40 |
$361.65
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$1,026.60 |
$1,026.60 |
$1,026.60 |
$603.83
|
|
Infect ag ia direct hiv-1 antgn
|
$133.20 |
$133.20 |
$133.20 |
$95.55
|
|
Infect ag ia optc obs influenza
|
$105.60 |
$105.60 |
$105.60 |
$72.93
|
|
Infect ag if ea plyvlnt antsrm
|
$80.40 |
$80.40 |
$80.40 |
$68.40
|
|
Infect ag if legionella pneumophila
|
$67.80 |
$67.80 |
$67.80 |
$73.45
|
|
Infect ag if nos ea
|
$102.00 |
$102.00 |
$102.00 |
$74.88
|
|
Infect ag if pneumocystis carinii
|
$42.00 |
$42.00 |
$42.00 |
$66.06
|
|
Infect ag na hep b amp
|
$229.20 |
$229.20 |
$229.20 |
$120.50
|
|
Infect ag na herpes simplex quant
|
$77.40 |
$77.40 |
$77.40 |
$178.86
|
|
Infect ag na hpv high-risk types
|
$147.00 |
$147.00 |
$147.00 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$286.80 |
$286.80 |
$286.80 |
$219.70
|
|
Infect ag na influenza revr/amp ea type
|
$139.80 |
$139.80 |
$139.80 |
$156.60
|
|
Infect ag na resp virus 12-25 targets
|
$1,454.40 |
$1,454.40 |
$1,454.40 |
$854.70
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$816.00 |
$816.00 |
$816.00 |
$954.00
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$51.60 |
$51.60 |
$51.60 |
$75.63
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$120.00 |
$120.00 |
$120.00 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$68.40 |
$68.40 |
$68.40 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$67.80 |
$67.80 |
$67.80 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$175.20 |
$175.20 |
$175.20 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$152.40 |
$152.40 |
$152.40 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$44.40 |
$44.40 |
$44.40 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$145.80 |
$145.80 |
$145.80 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$110.40 |
$110.40 |
$110.40 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$109.80 |
$109.80 |
$109.80 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$67.80 |
$67.80 |
$67.80 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$189.60 |
$189.60 |
$189.60 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$161.40 |
$161.40 |
$161.40 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$194.40 |
$194.40 |
$194.40 |
$167.05
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$213.60 |
$213.60 |
$213.60 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$148.80 |
$148.80 |
$148.80 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$261.00 |
$261.00 |
$261.00 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$141.00 |
$141.00 |
$141.00 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$319.20 |
$319.20 |
$319.20 |
$103.20
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$309.60 |
$309.60 |
$309.60 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$766.80 |
$766.80 |
$766.80 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$279.00 |
$279.00 |
$279.00 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$179.40 |
$179.40 |
$179.40 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$485.40 |
$485.40 |
$485.40 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$417.00 |
$417.00 |
$417.00 |
$375.00
|
|
Infliximab 100 mg intravenous solution
|
$23.58 |
$23.58 |
$23.58 |
$2,047.13
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$20.66 |
$20.66 |
$20.66 |
$1,537.84
|
|
Influenza dna amp prob addl
|
$69.60 |
$69.60 |
$69.60 |
$64.26
|
|
Ingest challenge ea addl 60 min
|
$166.20 |
$166.20 |
$166.20 |
$289.64
|
|
Ingest challenge ini 120 min
|
$368.40 |
$368.40 |
$368.40 |
$764.78
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$493.80 |
$493.80 |
$493.80 |
$296.00
|
|
Inj, alfentanil hcl, 500mcg
|
$73.85 |
$73.85 |
$73.85 |
$35.94
|
|
Inj allopurinol sodium 1 mg
|
$5,992.97 |
$5,992.97 |
$5,992.97 |
$6,968.99
|
|
Inj., benralizumab, 1 mg
|
$8,674.10 |
$8,674.10 |
$8,674.10 |
$11,310.00
|
|
Inj bimatoprost itc imp1mcg
|
$11,754.76 |
$11,754.76 |
$11,754.76 |
$3,287.96
|
|
Inj calcitriol per 0.1 mcg
|
$40.17 |
$40.17 |
$40.17 |
$22.69
|
|
Inj cefazolin sodium, hikma
|
$66.38 |
$66.38 |
$66.38 |
$27.38
|
|
Inj ceftolozane tazobactam
|
$248.93 |
$248.93 |
$248.93 |
$364.86
|
|
Inj, clindamycin (baxter)
|
$45.64 |
$45.64 |
$45.64 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$506.40 |
$506.40 |
$506.40 |
$436.80
|
|
Inj., copanlisib, 1 mg
|
$6,936.60 |
$6,936.60 |
$6,936.60 |
$9,204.29
|
|
Injection arthrography hip without anesthesia (both sides)
|
$763.20 |
$763.20 |
$763.20 |
$503.50
|
|
Injection, caplacizumab-yhdp
|
$1,156.01 |
$1,156.01 |
$1,156.01 |
$16,319.16
|
|
Injection, doxercalciferol
|
$45.89 |
$45.89 |
$45.89 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$2,679.60 |
$2,679.60 |
$2,679.60 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,963.80 |
$1,963.80 |
$1,963.80 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$556.80 |
$556.80 |
$556.80 |
$436.00
|
|
Injection for bladder x-ray
|
$217.80 |
$217.80 |
$217.80 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$625.20 |
$625.20 |
$625.20 |
$497.76
|
|
Injection for ureter x-ray
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$415.80
|
|
Injection for ureter x-ray
|
$1,405.80 |
$1,405.80 |
$1,405.80 |
$515.21
|
|
Injection, fulvestrant
|
$1,995.00 |
$1,995.00 |
$1,995.00 |
$1,719.16
|
|
Injection glatiramer acetate
|
$332.78 |
$332.78 |
$332.78 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$5,431.58 |
$5,431.58 |
$5,431.58 |
$6,679.35
|
|
Injection, isavuconazonium
|
$634.28 |
$634.28 |
$634.28 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$1,290.32 |
$1,290.32 |
$1,290.32 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,027.20 |
$1,027.20 |
$1,027.20 |
$685.44
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,448.00 |
$2,448.00 |
$2,448.00 |
$1,685.00
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$587.40 |
$587.40 |
$587.40 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$174.60 |
$174.60 |
$174.60 |
$145.60
|
|
Inject sacroiliac joint
|
$2,323.80 |
$2,323.80 |
$2,323.80 |
$1,029.04
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$23.68 |
$23.68 |
$23.68 |
$32,176.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$266.49 |
$266.49 |
$266.49 |
$40.33
|
|
Inj for ext venography
|
$1,028.40 |
$1,028.40 |
$1,028.40 |
$628.80
|
|
Inj gemcitabine hcl (accord)
|
$305.94 |
$305.94 |
$305.94 |
$131.21
|
|
Inj., guselkumab, 1 mg
|
$18,777.83 |
$18,777.83 |
$18,777.83 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$6,935.72 |
$6,935.72 |
$6,935.72 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,218.40 |
$3,218.40 |
$3,218.40 |
$1,492.00
|
|
Inj hydroxyprogst capoat nos
|
$1,293.56 |
$1,293.56 |
$1,293.56 |
$1,228.59
|
|
Inj ivig privigen 500 mg
|
$7,298.71 |
$7,298.71 |
$7,298.71 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$12,160.05 |
$12,160.05 |
$12,160.05 |
$11,648.70
|
|
Inj levocarnitine per 1 gm
|
$53.36 |
$53.36 |
$53.36 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$42.79 |
$42.79 |
$42.79 |
$45.60
|
|
Inj melpha hydroch nos 50 mg
|
$2,513.20 |
$2,513.20 |
$2,513.20 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$41.30 |
$41.30 |
$41.30 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$426.85 |
$426.85 |
$426.85 |
$556.87
|
|
Inj, micafungin (par pharm)
|
$167.62 |
$167.62 |
$167.62 |
$79.08
|
|
Inj, moxifloxacin 100 mg
|
$262.28 |
$262.28 |
$262.28 |
$101.31
|
|
Inj. mycophenolate mofetil
|
$188.11 |
$188.11 |
$188.11 |
$252.66
|
|
Inj naloxone hydrochloride
|
$85.34 |
$85.34 |
$85.34 |
$83.16
|