|
Implant cartilage 10mm synthetic
|
$7,622.40 |
$7,622.40 |
$7,622.40 |
$8,332.51
|
|
In-111 oxyquinolin per 0.5 mci
|
$1,980.60 |
$1,980.60 |
$1,980.60 |
$2,753.23
|
|
In-111 pentetreotide
|
$265.20 |
$265.20 |
$265.20 |
$5,294.90
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,378.20 |
$1,378.20 |
$1,378.20 |
$2,086.70
|
|
Incision of breast lesion
|
$2,899.80 |
$2,899.80 |
$2,899.80 |
$2,577.85
|
|
Incisn of toe tndn
|
$1,663.20 |
$1,663.20 |
$1,663.20 |
$2,667.00
|
|
Infect ag drug suscept pheno predict
|
$1,122.00 |
$1,122.00 |
$1,122.00 |
$325.00
|
|
Infect ag genotype na hiv-1 other region
|
$951.00 |
$951.00 |
$951.00 |
$361.65
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$1,214.40 |
$1,214.40 |
$1,214.40 |
$603.83
|
|
Infect ag if hep delta agent
|
$133.20 |
$133.20 |
$133.20 |
$125.97
|
|
Infect ag if influenza a
|
$117.00 |
$117.00 |
$117.00 |
$41.30
|
|
Infect ag if influenza b
|
$117.00 |
$117.00 |
$117.00 |
$37.95
|
|
Infect ag na herpes simplex quant
|
$250.80 |
$250.80 |
$250.80 |
$178.86
|
|
Infect ag na hpv high-risk types
|
$133.20 |
$133.20 |
$133.20 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$513.60 |
$513.60 |
$513.60 |
$219.70
|
|
Infect ag na resp virus 12-25 targets
|
$2,801.40 |
$2,801.40 |
$2,801.40 |
$854.70
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$100.20 |
$100.20 |
$100.20 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$60.00 |
$60.00 |
$60.00 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$76.20 |
$76.20 |
$76.20 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$62.40 |
$62.40 |
$62.40 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$60.00 |
$60.00 |
$60.00 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$63.60 |
$63.60 |
$63.60 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$63.60 |
$63.60 |
$63.60 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$42.00 |
$42.00 |
$42.00 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$74.40 |
$74.40 |
$74.40 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$40.80 |
$40.80 |
$40.80 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$99.00 |
$99.00 |
$99.00 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$115.20 |
$115.20 |
$115.20 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,402.80 |
$1,402.80 |
$1,402.80 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$114.60 |
$114.60 |
$114.60 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$487.20 |
$487.20 |
$487.20 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$371.40 |
$371.40 |
$371.40 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$128.40 |
$128.40 |
$128.40 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$75.00 |
$75.00 |
$75.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$210.00 |
$210.00 |
$210.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$697.20 |
$697.20 |
$697.20 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$139.20 |
$139.20 |
$139.20 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$147.00 |
$147.00 |
$147.00 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$454.20 |
$454.20 |
$454.20 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$759.00 |
$759.00 |
$759.00 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$321.00 |
$321.00 |
$321.00 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$163.80 |
$163.80 |
$163.80 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$156.60 |
$156.60 |
$156.60 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$406.80 |
$406.80 |
$406.80 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$543.60 |
$543.60 |
$543.60 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$385.60 |
$385.60 |
$385.60 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,062.00 |
$1,062.00 |
$1,062.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$203.20 |
$203.20 |
$203.20 |
$1,537.84
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$40.00 |
$40.00 |
$40.00 |
$111.51
|
|
Inf lwr xtr fscl pln blk uni w/wo image
|
$135.00 |
$135.00 |
$135.00 |
$762.00
|
|
Inf thrc fascial pln blk bi w/wo image
|
$147.00 |
$147.00 |
$147.00 |
$523.25
|
|
Inf thrc fascial pln blk uni w/wo image
|
$139.80 |
$139.80 |
$139.80 |
$770.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$289.20 |
$289.20 |
$289.20 |
$296.00
|
|
Inj, adalimumab, 1 mg
|
$117.60 |
$117.60 |
$117.60 |
$12,098.05
|
|
Inj andexxa, 10 mg
|
$14,184.00 |
$14,184.00 |
$14,184.00 |
$4,370.80
|
|
Inj, aponvie, 1 mg
|
$3.00 |
$3.00 |
$3.00 |
$3.36
|
|
Inj., benralizumab, 1 mg
|
$577.60 |
$577.60 |
$577.60 |
$11,310.00
|
|
Inj, bezlotoxumab, 10 mg
|
$11,010.60 |
$11,010.60 |
$11,010.60 |
$7,612.43
|
|
Inj., brexanolone, 1 mg
|
$180.60 |
$180.60 |
$180.60 |
$13,019.44
|
|
Inj, brixadi, 7 days or less
|
$814.80 |
$814.80 |
$814.80 |
$748.85
|
|
Inj, cefepime hcl (b braun)
|
$24.80 |
$24.80 |
$24.80 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$6.40 |
$6.40 |
$6.40 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$285.60 |
$285.60 |
$285.60 |
$364.86
|
|
Inj cntr knee arthro incl ct/mri
|
$133.80 |
$133.80 |
$133.80 |
$436.80
|
|
Inj dx for sinogram
|
$360.60 |
$360.60 |
$360.60 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$520.20 |
$520.20 |
$520.20 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$360.60 |
$360.60 |
$360.60 |
$503.50
|
|
Injection, cangrelor
|
$4,273.80 |
$4,273.80 |
$4,273.80 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$19,956.00 |
$19,956.00 |
$19,956.00 |
$16,319.16
|
|
Injection during cath supravalvular aortography
|
$474.60 |
$474.60 |
$474.60 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,201.80 |
$1,201.80 |
$1,201.80 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$580.80 |
$580.80 |
$580.80 |
$436.00
|
|
Injection for bladder x-ray
|
$1,296.60 |
$1,296.60 |
$1,296.60 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$216.00 |
$216.00 |
$216.00 |
$497.76
|
|
Injection glatiramer acetate
|
$509.40 |
$509.40 |
$509.40 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$37.80 |
$37.80 |
$37.80 |
$6,679.35
|
|
Injection, isavuconazonium
|
$5.00 |
$5.00 |
$5.00 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$672.00 |
$672.00 |
$672.00 |
$685.44
|
|
Injection, renflexis
|
$228.80 |
$228.80 |
$228.80 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,912.40 |
$2,912.40 |
$2,912.40 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$652.20 |
$652.20 |
$652.20 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$764.40 |
$764.40 |
$764.40 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,674.80 |
$2,674.80 |
$2,674.80 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,897.80 |
$1,897.80 |
$1,897.80 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,897.80 |
$1,897.80 |
$1,897.80 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,897.80 |
$1,897.80 |
$1,897.80 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,897.80 |
$1,897.80 |
$1,897.80 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,085.60 |
$2,085.60 |
$2,085.60 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,493.40 |
$1,493.40 |
$1,493.40 |
$1,685.00
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$571.20 |
$571.20 |
$571.20 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$725.40 |
$725.40 |
$725.40 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$126.60 |
$126.60 |
$126.60 |
$145.60
|
|
Inj epidural sgl cerv-thor without img
|
$1,429.80 |
$1,429.80 |
$1,429.80 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,956.60 |
$1,956.60 |
$1,956.60 |
$1,450.84
|
|
Inj, epinephrine (belcher)
|
$1.20 |
$1.20 |
$1.20 |
$6.55
|
|
Inj for mammo ductogram
|
$146.40 |
$146.40 |
$146.40 |
$397.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$6.00 |
$6.00 |
$1,322.20
|
|
Inj hrt cath w/s&i sel left vent
|
$1,350.60 |
$1,350.60 |
$1,350.60 |
$1,250.34
|
|
Inj imip 4 cilas 4 releb 2mg
|
$5.40 |
$5.40 |
$5.40 |
$739.77
|
