|
Implant cochlear osia osi300
|
$20,655.00 |
$20,655.00 |
$20,655.00 |
$16,195.55
|
|
Implant neuroelectrodes
|
$10,672.50 |
$10,672.50 |
$10,672.50 |
$13,628.55
|
|
Implant neuroelectrodes
|
$1,830.00 |
$1,830.00 |
$1,830.00 |
$8,836.80
|
|
Implant power module patient cable cable 14 volt
|
$2,812.50 |
$2,812.50 |
$2,812.50 |
$3,695.42
|
|
Implant pulse generator remede el
|
$57,375.00 |
$57,375.00 |
$57,375.00 |
$43,752.80
|
|
Implant ureth bulk agent
|
$2,587.50 |
$2,587.50 |
$2,587.50 |
$2,168.00
|
|
Impl neurostim electr perc
|
$1,736.25 |
$1,736.25 |
$1,736.25 |
$7,672.50
|
|
Implnt spinl canal catheter 62350
|
$7,425.75 |
$7,425.75 |
$7,425.75 |
$5,095.20
|
|
In-111 oxyquinolin per 0.5 mci
|
$2,808.00 |
$2,808.00 |
$2,808.00 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$2,156.25 |
$2,156.25 |
$2,156.25 |
$2,598.17
|
|
In-111 pentetreotide
|
$47,542.46 |
$47,542.46 |
$47,542.46 |
$5,294.90
|
|
Inactivated je vacc im
|
$2,069.33 |
$2,069.33 |
$2,069.33 |
$481.34
|
|
Incise/drain eyelid lining
|
$1,020.75 |
$1,020.75 |
$1,020.75 |
$1,271.00
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$3,438.00 |
$3,438.00 |
$3,438.00 |
$2,086.70
|
|
Incision of breast lesion
|
$1,461.75 |
$1,461.75 |
$1,461.75 |
$2,577.85
|
|
Incision of hip tendons
|
$3,006.75 |
$3,006.75 |
$3,006.75 |
$3,865.95
|
|
Incisn of toe tndn
|
$2,176.50 |
$2,176.50 |
$2,176.50 |
$2,667.00
|
|
Incobotulinumtoxin a
|
$1,889.43 |
$1,889.43 |
$1,889.43 |
$1,339.57
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$586.73 |
$586.73 |
$586.73 |
$766.66
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$215.25 |
$215.25 |
$215.25 |
$140.80
|
|
Infect ag drug suscept pheno predict
|
$485.25 |
$485.25 |
$485.25 |
$325.00
|
|
Infect ag genotype na cytomegalovirus
|
$2,392.50 |
$2,392.50 |
$2,392.50 |
$665.40
|
|
Infect ag genotype na hiv-1 other region
|
$279.00 |
$279.00 |
$279.00 |
$361.65
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$558.00 |
$558.00 |
$558.00 |
$603.83
|
|
Infect ag ia optc obs influenza
|
$102.00 |
$102.00 |
$102.00 |
$72.93
|
|
Infect ag if hep delta agent
|
$201.00 |
$201.00 |
$201.00 |
$125.97
|
|
Infect ag if legionella pneumophila
|
$91.50 |
$91.50 |
$91.50 |
$73.45
|
|
Infect ag na herpes simplex quant
|
$375.00 |
$375.00 |
$375.00 |
$178.86
|
|
Infect ag na hpv high-risk types
|
$314.25 |
$314.25 |
$314.25 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$179.25 |
$179.25 |
$179.25 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$166.50 |
$166.50 |
$166.50 |
$100.00
|
|
Infect ag na resp virus 12-25 targets
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$854.70
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$108.00 |
$108.00 |
$108.00 |
$954.00
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$1,288.50 |
$1,288.50 |
$1,288.50 |
$75.63
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$117.00 |
$117.00 |
$117.00 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$58.50 |
$58.50 |
$58.50 |
$72.80
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$84.75 |
$84.75 |
$84.75 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$98.25 |
$98.25 |
$98.25 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$66.00 |
$66.00 |
$66.00 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$87.00 |
$87.00 |
$87.00 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$388.50 |
$388.50 |
$388.50 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$160.50 |
$160.50 |
$160.50 |
$98.58
|
|
Infectious agent nucleic acid amplified probe
|
$722.25 |
$722.25 |
$722.25 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$174.00 |
$174.00 |
$174.00 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$156.75 |
$156.75 |
$156.75 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$933.00 |
$933.00 |
$933.00 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$353.25 |
$353.25 |
$353.25 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$119.25 |
$119.25 |
$119.25 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$620.25 |
$620.25 |
$620.25 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$174.00 |
$174.00 |
$174.00 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$141.00 |
$141.00 |
$141.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$276.75 |
$276.75 |
$276.75 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$276.75 |
$276.75 |
$276.75 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$97.50 |
$97.50 |
$97.50 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$112.50 |
$112.50 |
$112.50 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$357.75 |
$357.75 |
$357.75 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$946.50 |
$946.50 |
$946.50 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$420.00 |
$420.00 |
$420.00 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$327.00 |
$327.00 |
$327.00 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$1,682.25 |
$1,682.25 |
$1,682.25 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$345.75 |
$345.75 |
$345.75 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$1,197.75 |
$1,197.75 |
$1,197.75 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$783.00 |
$783.00 |
$783.00 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$248.25 |
$248.25 |
$248.25 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$1,702.78 |
$1,702.78 |
$1,702.78 |
$2,047.13
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,713.99 |
$1,713.99 |
$1,713.99 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$311.25 |
$311.25 |
$311.25 |
$296.00
|
|
Inj, abilify maintena, 1 mg
|
$9,281.66 |
$9,281.66 |
$9,281.66 |
$5,355.30
|
|
Inj, acetaminophen (b braun)
|
$20.71 |
$20.71 |
$20.71 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$14.79 |
$14.79 |
$14.79 |
$36.60
|
|
Inj, adalimumab, 1 mg
|
$24,828.50 |
$24,828.50 |
$24,828.50 |
$12,098.05
|
|
Inj allopurinol sodium 1 mg
|
$5,937.23 |
$5,937.23 |
$5,937.23 |
$6,968.99
|
|
Inj anifrolumab-fnia 1mg
|
$20,116.77 |
$20,116.77 |
$20,116.77 |
$10,052.58
|
|
Inj, artesunate, 1mg
|
$39,774.01 |
$39,774.01 |
$39,774.01 |
$14,460.21
|
|
Inj., benralizumab, 1 mg
|
$19,707.27 |
$19,707.27 |
$19,707.27 |
$11,310.00
|
|
Inj bimatoprost itc imp1mcg
|
$7,487.44 |
$7,487.44 |
$7,487.44 |
$3,287.96
|
|
Inj., brexanolone, 1 mg
|
$33,055.65 |
$33,055.65 |
$33,055.65 |
$13,019.44
|
|
Inj, bupivacaine liposome
|
$1,326.75 |
$1,326.75 |
$1,326.75 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$22.16 |
$22.16 |
$22.16 |
$22.69
|
|
Inj cefazolin sodium, baxter
|
$48.81 |
$48.81 |
$48.81 |
$27.38
|
|
Inj. cefepime hcl (baxter)
|
$54.36 |
$54.36 |
$54.36 |
$86.84
|
|
Inj, cefiderocol, 10 mg
|
$846.06 |
$846.06 |
$846.06 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$597.69 |
$597.69 |
$597.69 |
$364.86
|
|
Inj, clindamycin (baxter)
|
$15.35 |
$15.35 |
$15.35 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$314.25 |
$314.25 |
$314.25 |
$436.80
|
|
Inj., copanlisib, 1 mg
|
$19,661.50 |
$19,661.50 |
$19,661.50 |
$9,204.29
|
|
Inj, decitabine (sun pharma)
|
$369.75 |
$369.75 |
$369.75 |
$310.09
|
|
Inj disk cerv-thor ea lev
|
$2,577.00 |
$2,577.00 |
$2,577.00 |
$875.28
|
|
Inj dupuytren cord w/enzyme
|
$373.50 |
$373.50 |
$373.50 |
$416.00
|
|
Inj, durolane 1 mg
|
$4,122.72 |
$4,122.72 |
$4,122.72 |
$1,950.93
|
|
Inj dx for sinogram
|
$1,007.25 |
$1,007.25 |
$1,007.25 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$627.75 |
$627.75 |
$627.75 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$450.75 |
$450.75 |
$450.75 |
$503.50
|
|
Injection, belinostat, 10mg
|
$9,355.72 |
$9,355.72 |
$9,355.72 |
$4,446.10
|
|
Injection, cangrelor
|
$3,425.21 |
$3,425.21 |
$3,425.21 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$31,693.80 |
$31,693.80 |
$31,693.80 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$789.00 |
$789.00 |
$789.00 |
$458.15
|
|
Injection, doxercalciferol
|
$23.86 |
$23.86 |
$23.86 |
$23.86
|
|
Injection epidural blood patch or clot
|
$1,499.25 |
$1,499.25 |
$1,499.25 |
$1,182.33
|
|
Injection eye drug
|
$322.50 |
$322.50 |
$322.50 |
$654.00
|
