|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$59.80 |
$59.80 |
$59.80 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$117.52 |
$117.52 |
$117.52 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$257.14 |
$257.14 |
$257.14 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$202.54 |
$202.54 |
$202.54 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$92.04 |
$92.04 |
$92.04 |
$151.25
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$88.14 |
$88.14 |
$88.14 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$59.80 |
$59.80 |
$59.80 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$65.00 |
$65.00 |
$65.00 |
$100.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$155.74 |
$155.74 |
$155.74 |
$217.70
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$155.74 |
$155.74 |
$155.74 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$146.12 |
$146.12 |
$146.12 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$138.84 |
$138.84 |
$138.84 |
$105.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,369.16 |
$1,369.16 |
$1,369.16 |
$711.93
|
|
Infectious agent nucleic acid quantification bk virus
|
$323.44 |
$323.44 |
$323.44 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$93.60 |
$93.60 |
$93.60 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$129.22 |
$129.22 |
$129.22 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$194.48 |
$194.48 |
$194.48 |
$374.50
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$222.82 |
$222.82 |
$222.82 |
$293.04
|
|
Initiation & management bipap/cpap initial day
|
$837.46 |
$837.46 |
$837.46 |
$576.00
|
|
Init pm e/m new pat 65+ yrs
|
$102.25 |
$102.25 |
$102.25 |
$180.77
|
|
Inj, abilify maintena, 1 mg
|
$8,028.81 |
$8,028.81 |
$8,028.81 |
$5,355.30
|
|
Inj, acetaminophen (b braun)
|
$44.69 |
$44.69 |
$44.69 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$52.98 |
$52.98 |
$52.98 |
$38.87
|
|
Inj alymsys 10 mg
|
$31,783.05 |
$31,783.05 |
$31,783.05 |
$1,483.29
|
|
Inj, amisulpride, 1 mg
|
$263.72 |
$263.72 |
$263.72 |
$98.96
|
|
Inj, aponvie, 1 mg
|
$168.46 |
$168.46 |
$168.46 |
$3.00
|
|
Inj, bortezomib, dr. reddy's
|
$533.12 |
$533.12 |
$533.12 |
$48.55
|
|
Inj, cefiderocol, 10 mg
|
$1,287.30 |
$1,287.30 |
$1,287.30 |
$544.85
|
|
Inj, clindamycin (baxter)
|
$58.97 |
$58.97 |
$58.97 |
$48.39
|
|
Inj cyclophosphamd (ingenus)
|
$2,551.33 |
$2,551.33 |
$2,551.33 |
$742.72
|
|
Injection arthrography hip without anesthesia (both sides)
|
$128.44 |
$128.44 |
$128.44 |
$500.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,302.60 |
$1,302.60 |
$1,302.60 |
$504.90
|
|
Injection during cath supravalvular aortography
|
$478.40 |
$478.40 |
$478.40 |
$904.17
|
|
Injection epidural blood patch or clot
|
$1,456.26 |
$1,456.26 |
$1,456.26 |
$1,156.80
|
|
Injection, famotidine, 20 mg
|
$10.87 |
$10.87 |
$10.87 |
$28.74
|
|
Injection for arthrography wrist (both sides)
|
$152.62 |
$152.62 |
$152.62 |
$441.12
|
|
Injection for bladder x-ray
|
$145.34 |
$145.34 |
$145.34 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$131.30 |
$131.30 |
$131.30 |
$494.65
|
|
Injection jugular
|
$806.26 |
$806.26 |
$806.26 |
$790.00
|
|
Injection radioactive tracer sentinel node (both sides)
|
$589.94 |
$589.94 |
$589.94 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$478.66 |
$478.66 |
$478.66 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$720.72 |
$720.72 |
$720.72 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,137.72 |
$2,137.72 |
$2,137.72 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,215.24 |
$1,215.24 |
$1,215.24 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$988.52 |
$988.52 |
$988.52 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$825.76 |
$825.76 |
$825.76 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,310.14 |
$1,310.14 |
$1,310.14 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,473.42 |
$1,473.42 |
$1,473.42 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,473.42 |
$1,473.42 |
$1,473.42 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$368.94 |
$368.94 |
$368.94 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$368.94 |
$368.94 |
$368.94 |
$517.24
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$57.20 |
$57.20 |
$57.20 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$40.30 |
$40.30 |
$40.30 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$147.42 |
$147.42 |
$147.42 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$56.42 |
$56.42 |
$56.42 |
$135.20
|
|
Injection treatment of nerve
|
$1,824.16 |
$1,824.16 |
$1,824.16 |
$2,054.00
|
|
Inj epidural sgl cerv-thor without img
|
$755.04 |
$755.04 |
$755.04 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$653.38 |
$653.38 |
$653.38 |
$1,415.50
|
|
Inj for ext venography
|
$2,106.00 |
$2,106.00 |
$2,106.00 |
$654.00
|
|
Inj, fulvestrant (fresenius)
|
$2,764.32 |
$2,764.32 |
$2,764.32 |
$1,065.08
|
|
Inj, gadopiclenol, 1 ml
|
$309.97 |
$309.97 |
$309.97 |
$66.94
|
|
Inj heparin, pfizer, 1000u
|
$5,873.84 |
$5,873.84 |
$5,873.84 |
$24.28
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$693.16 |
$693.16 |
$693.16 |
$1,237.50
|
|
Inj hrt cath w/s&i sel right vent
|
$575.38 |
$575.38 |
$575.38 |
$947.05
|
|
Inj ivig privigen 500 mg
|
$34,473.26 |
$34,473.26 |
$34,473.26 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$20.36 |
$20.36 |
$20.36 |
$40.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$24,582.16 |
$24,582.16 |
$24,582.16 |
$11,648.70
|
|
Inj levocarnitine per 1 gm
|
$13.43 |
$13.43 |
$13.43 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$55.89 |
$55.89 |
$55.89 |
$44.96
|
|
Inj meropenem (wg crit care)
|
$90.95 |
$90.95 |
$90.95 |
$77.97
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$347.36 |
$347.36 |
$347.36 |
$1,414.40
|
|
Inj ogivri 10 mg
|
$10,366.61 |
$10,366.61 |
$10,366.61 |
$4,492.28
|
|
Inj proc elbow arthro
|
$225.16 |
$225.16 |
$225.16 |
$432.00
|
|
Inj proc myelogram lumbar
|
$642.98 |
$642.98 |
$642.98 |
$856.00
|
|
Inj retacrit esrd on dialysi
|
$1,219.62 |
$1,219.62 |
$1,219.62 |
$352.22
|
|
Inj scleros sol sgl vein
|
$137.80 |
$137.80 |
$137.80 |
$534.40
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$145.60 |
$145.60 |
$145.60 |
$436.80
|
|
Inj vancomycin (xellia) 10mg
|
$130.84 |
$130.84 |
$130.84 |
$79.21
|
|
Inj, vasopressin (baxter)
|
$258.80 |
$258.80 |
$258.80 |
$245.96
|
|
Inj, vegzelma, 10 mg
|
$22,470.61 |
$22,470.61 |
$22,470.61 |
$1,291.28
|
|
Inj w/fluor eval cv device
|
$140.40 |
$140.40 |
$140.40 |
$463.40
|
|
Ins cath ren art 1st bi
|
$1,246.18 |
$1,246.18 |
$1,246.18 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$1,050.14 |
$1,050.14 |
$1,050.14 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$2,914.60 |
$2,914.60 |
$2,914.60 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$2,211.56 |
$2,211.56 |
$2,211.56 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$1,160.90 |
$1,160.90 |
$1,160.90 |
$488.35
|
|
Insert cath pleura with image
|
$1,320.54 |
$1,320.54 |
$1,320.54 |
$2,194.40
|
|
Insert hepatic shunt (tips)
|
$9,614.28 |
$9,614.28 |
$9,614.28 |
$8,367.70
|
|
Insertion catheter bladder non indwelling
|
$197.86 |
$197.86 |
$197.86 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$145.86 |
$145.86 |
$145.86 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,042.52 |
$3,042.52 |
$3,042.52 |
$4,731.80
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,877.98 |
$1,877.98 |
$1,877.98 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$3,267.94 |
$3,267.94 |
$3,267.94 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,743.30 |
$1,743.30 |
$1,743.30 |
$2,511.00
|
|
Insertion of heart electrode 33211
|
$1,960.40 |
$1,960.40 |
$1,960.40 |
$7,392.84
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$2,691.26 |
$2,691.26 |
$2,691.26 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$2,827.76 |
$2,827.76 |
$2,827.76 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$3,416.40 |
$3,416.40 |
$3,416.40 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,493.96 |
$1,493.96 |
$1,493.96 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$874.64 |
$874.64 |
$874.64 |
$2,414.10
|
