|
Implant cartilage 10mm synthetic
|
$3,863.00 |
$3,863.00 |
$3,863.00 |
$8,332.51
|
|
Implant cochlear osia osi300
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
$16,195.55
|
|
Implant ureth bulk agent
|
$1,150.00 |
$1,150.00 |
$1,150.00 |
$2,168.00
|
|
In-111 autol wbc diag per dose
|
$3,169.95 |
$3,169.95 |
$3,169.95 |
$3,493.75
|
|
In-111 oxyquinolin per 0.5 mci
|
$3,109.35 |
$3,109.35 |
$3,109.35 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$3,037.40 |
$3,037.40 |
$3,037.40 |
$2,598.17
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$3,521.65 |
$3,521.65 |
$3,521.65 |
$2,086.70
|
|
Infect ag drug suscept pheno predict
|
$1,372.70 |
$1,372.70 |
$1,372.70 |
$325.00
|
|
Infect ag genotype na cytomegalovirus
|
$643.65 |
$643.65 |
$643.65 |
$665.40
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$855.25 |
$855.25 |
$855.25 |
$603.83
|
|
Infect ag ia optc obs influenza
|
$38.00 |
$38.00 |
$38.00 |
$72.93
|
|
Infect ag if legionella pneumophila
|
$46.20 |
$46.20 |
$46.20 |
$73.45
|
|
Infect ag na hpv high-risk types
|
$227.70 |
$227.70 |
$227.70 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$286.45 |
$286.45 |
$286.45 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$228.80 |
$228.80 |
$228.80 |
$100.00
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$89.00 |
$89.00 |
$89.00 |
$53.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$33.30 |
$33.30 |
$33.30 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$156.10 |
$156.10 |
$156.10 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$161.05 |
$161.05 |
$161.05 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$83.50 |
$83.50 |
$83.50 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$60.30 |
$60.30 |
$60.30 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$98.40 |
$98.40 |
$98.40 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$96.95 |
$96.95 |
$96.95 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$328.15 |
$328.15 |
$328.15 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$45.05 |
$45.05 |
$45.05 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$153.50 |
$153.50 |
$153.50 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$339.90 |
$339.90 |
$339.90 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$174.55 |
$174.55 |
$174.55 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$142.60 |
$142.60 |
$142.60 |
$167.05
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$71.70 |
$71.70 |
$71.70 |
$181.35
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$430.85 |
$430.85 |
$430.85 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$174.55 |
$174.55 |
$174.55 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$84.45 |
$84.45 |
$84.45 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$166.60 |
$166.60 |
$166.60 |
$206.00
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$79.00 |
$79.00 |
$79.00 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$112.15 |
$112.15 |
$112.15 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$191.95 |
$191.95 |
$191.95 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$356.25 |
$356.25 |
$356.25 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$730.30 |
$730.30 |
$730.30 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$134.15 |
$134.15 |
$134.15 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$237.70 |
$237.70 |
$237.70 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$226.35 |
$226.35 |
$226.35 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$169.80 |
$169.80 |
$169.80 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$370.85 |
$370.85 |
$370.85 |
$304.20
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,710.75 |
$1,710.75 |
$1,710.75 |
$1,062.00
|
|
Inf lwr xtr fscl pln blk uni w/wo image
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$762.00
|
|
Inf thrc fascial pln blk bi w/wo image
|
$1,241.30 |
$1,241.30 |
$1,241.30 |
$523.25
|
|
Inf thrc fascial pln blk uni w/wo image
|
$1,241.30 |
$1,241.30 |
$1,241.30 |
$770.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$576.65 |
$576.65 |
$576.65 |
$296.00
|
|
Initial nursing facility care/day 35 minutes
|
$357.35 |
$357.35 |
$357.35 |
$188.50
|
|
Initial nursing facility care/day 45 minutes
|
$456.70 |
$456.70 |
$456.70 |
$236.80
|
|
Initial nursing facility care/day low severity 99304
|
$249.80 |
$249.80 |
$249.80 |
$128.00
|
|
Inj, bortezomib, hospira
|
$788.36 |
$788.36 |
$788.36 |
$175.35
|
|
Inj, bupivacaine liposome
|
$1,364.08 |
$1,364.08 |
$1,364.08 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$44.20 |
$44.20 |
$44.20 |
$27.38
|
|
Inj cntr knee arthro incl ct/mri
|
$523.85 |
$523.85 |
$523.85 |
$436.80
|
|
Inj disk cerv-thor ea lev
|
$869.80 |
$869.80 |
$869.80 |
$875.28
|
|
Inj dx for sinogram
|
$222.15 |
$222.15 |
$222.15 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,998.85 |
$1,998.85 |
$1,998.85 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$185.35 |
$185.35 |
$185.35 |
$503.50
|
|
Injection during cath supravalvular aortography
|
$264.30 |
$264.30 |
$264.30 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,947.60 |
$1,947.60 |
$1,947.60 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$175.95 |
$175.95 |
$175.95 |
$436.00
|
|
Injection for bladder x-ray
|
$343.05 |
$343.05 |
$343.05 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$206.10 |
$206.10 |
$206.10 |
$497.76
|
|
Injection for ureter x-ray
|
$218.40 |
$218.40 |
$218.40 |
$415.80
|
|
Injection for ureter x-ray
|
$334.55 |
$334.55 |
$334.55 |
$515.21
|
|
Injection into brain canal
|
$1,765.25 |
$1,765.25 |
$1,765.25 |
$844.50
|
|
Injection,onabotulinumtoxina
|
$2,210.29 |
$2,210.29 |
$2,210.29 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$218.40 |
$218.40 |
$218.40 |
$685.44
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,990.35 |
$1,990.35 |
$1,990.35 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,603.45 |
$2,603.45 |
$2,603.45 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1.00 |
$1.00 |
$1.00 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,369.65 |
$3,369.65 |
$3,369.65 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1.00 |
$1.00 |
$1.00 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,257.30 |
$2,257.30 |
$2,257.30 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$791.95 |
$791.95 |
$791.95 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,160.35 |
$1,160.35 |
$1,160.35 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$821.70 |
$821.70 |
$821.70 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$134.25 |
$134.25 |
$134.25 |
$145.60
|
|
Inject sacroiliac joint
|
$2,037.90 |
$2,037.90 |
$2,037.90 |
$1,029.04
|
|
Inj epidural sgl cerv-thor without img
|
$1,950.85 |
$1,950.85 |
$1,950.85 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,950.85 |
$1,950.85 |
$1,950.85 |
$1,450.84
|
|
Inj for ext venography
|
$458.10 |
$458.10 |
$458.10 |
$628.80
|
|
Inj for mammo ductogram
|
$592.40 |
$592.40 |
$592.40 |
$397.80
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,909.00 |
$2,909.00 |
$2,909.00 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,628.25 |
$3,628.25 |
$3,628.25 |
$1,818.15
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,927.65 |
$1,927.65 |
$1,927.65 |
$1,938.00
|
|
Inj ivig privigen 500 mg
|
$10,736.48 |
$10,736.48 |
$10,736.48 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$70.52 |
$70.52 |
$70.52 |
$41.79
|
|
Inj levocarnitine per 1 gm
|
$195.82 |
$195.82 |
$195.82 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$303.45 |
$303.45 |
$303.45 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$58.99 |
$58.99 |
$58.99 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$794.70
|
|
Inj, moxifloxacin 100 mg
|
$43.07 |
$43.07 |
$43.07 |
$101.31
|
|
Inj. mycophenolate mofetil
|
$248.06 |
$248.06 |
$248.06 |
$252.66
|
|
Inj naloxone hydrochloride
|
$166.23 |
$166.23 |
$166.23 |
$83.16
|