|
Incisn windpipe
|
$7,040.40 |
$7,040.40 |
$7,040.40 |
$3,810.50
|
|
Induced abortion d&c
|
$13,515.91 |
$13,515.91 |
$13,515.91 |
$3,762.53
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$210.60 |
$210.60 |
$210.60 |
$137.15
|
|
Infect ag genotype na cytomegalovirus
|
$772.20 |
$772.20 |
$772.20 |
$661.80
|
|
Infect ag genotype na dna hepatitis b
|
$772.20 |
$772.20 |
$772.20 |
$405.30
|
|
Infect ag genotype na hiv-1 other region
|
$386.40 |
$386.40 |
$386.40 |
$386.40
|
|
Infect ag ia optc obs influenza
|
$95.40 |
$95.40 |
$95.40 |
$72.93
|
|
Infect ag if influenza a
|
$49.80 |
$49.80 |
$49.80 |
$41.30
|
|
Infect ag if influenza b
|
$48.60 |
$48.60 |
$48.60 |
$40.08
|
|
Infect ag if legionella pneumophila
|
$86.40 |
$86.40 |
$86.40 |
$72.58
|
|
Infect ag if nos ea
|
$57.00 |
$57.00 |
$57.00 |
$74.88
|
|
Infect ag if pneumocystis carinii
|
$120.60 |
$120.60 |
$120.60 |
$66.00
|
|
Infect ag if varicella zoster
|
$40.80 |
$40.80 |
$40.80 |
$70.70
|
|
Infect ag na herpes simplex quant
|
$245.40 |
$245.40 |
$245.40 |
$169.65
|
|
Infect ag na hpv high-risk types
|
$105.00 |
$105.00 |
$105.00 |
$139.75
|
|
Infect ag na influenza r/amp 1st 2 types
|
$307.80 |
$307.80 |
$307.80 |
$219.70
|
|
Infect ag na influenza revr/amp ea type
|
$198.00 |
$198.00 |
$198.00 |
$158.06
|
|
Infect ag na orthopoxvirus amp prb each
|
$73.20 |
$73.20 |
$73.20 |
$99.36
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$90.60 |
$90.60 |
$90.60 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$60.60 |
$60.60 |
$60.60 |
$72.80
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$41.40 |
$41.40 |
$41.40 |
$76.32
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$61.20 |
$61.20 |
$96.00 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$115.80 |
$115.80 |
$115.80 |
$100.02
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$189.60 |
$189.60 |
$189.60 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$152.40 |
$152.40 |
$152.40 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$101.40 |
$101.40 |
$101.40 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$64.80 |
$64.80 |
$64.80 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$73.20 |
$73.20 |
$73.20 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$538.20 |
$538.20 |
$538.20 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$100.20 |
$100.20 |
$152.40 |
$139.68
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$136.80 |
$136.80 |
$136.80 |
$167.00
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,375.80 |
$1,375.80 |
$1,375.80 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$165.60 |
$165.60 |
$165.60 |
$179.92
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$169.20 |
$169.20 |
$422.40 |
$147.55
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$49.80 |
$49.80 |
$152.40 |
$136.03
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$96.00 |
$96.00 |
$102.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$427.80 |
$427.80 |
$427.80 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$148.80 |
$148.80 |
$148.80 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$111.00 |
$111.00 |
$111.00 |
$92.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$55.80 |
$55.80 |
$55.80 |
$108.75
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$230.40 |
$230.40 |
$230.40 |
$185.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$384.60 |
$384.60 |
$384.60 |
$286.06
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$789.00 |
$789.00 |
$789.00 |
$423.53
|
|
Infectious agent nucleic acid quantification bk virus
|
$460.20 |
$460.20 |
$460.20 |
$279.40
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$369.00 |
$369.00 |
$369.00 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$340.80 |
$340.80 |
$340.80 |
$374.00
|
|
Infliximab 100 mg intravenous solution
|
$4,904.84 |
$4,904.84 |
$5,605.54 |
$2,080.86
|
|
Infliximab-axxq 100 mg intravenous solution
|
$2,100.00 |
$2,100.00 |
$2,400.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,974.38 |
$3,974.38 |
$4,542.14 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$366.60 |
$366.60 |
$366.60 |
$293.25
|
|
Initiation & management bipap/cpap initial day
|
$906.60 |
$906.60 |
$906.60 |
$576.00
|
|
Inj, adstiladrin, per tx dos
|
$63,945.00 |
$63,945.00 |
$73,080.00 |
$63,354.77
|
|
Inj, aspara, rylaze, 0.1 mg
|
$26,443.80 |
$26,443.80 |
$30,267.00 |
$10,458.00
|
|
Inj, bortezomib, hospira
|
$0.01 |
$0.01 |
$0.01 |
$175.35
|
|
Inj cefazolin sodium, hikma
|
$72.92 |
$72.92 |
$81.61 |
$28.08
|
|
Inj cefazolin (wg crit care)
|
$91.41 |
$91.41 |
$102.30 |
$18.05
|
|
Inj ceftolozane tazobactam
|
$1,448.93 |
$1,448.93 |
$1,621.55 |
$380.80
|
|
Inj, clindamycin (baxter)
|
$108.45 |
$108.45 |
$121.37 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$357.00 |
$357.00 |
$357.00 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$2,914.72 |
$2,914.72 |
$3,336.12 |
$2,584.85
|
|
Inj dx for sinogram
|
$783.00 |
$783.00 |
$783.00 |
$422.59
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,662.00 |
$1,662.00 |
$1,662.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$459.00 |
$459.00 |
$459.00 |
$495.84
|
|
Injection, belinostat, 10mg
|
$12,600.80 |
$12,600.80 |
$14,422.60 |
$4,446.10
|
|
Injection carpal tunnel therapeutic (both sides)
|
$12,958.33 |
$12,958.33 |
$12,958.33 |
$450.72
|
|
Injection, doxercalciferol
|
$45.00 |
$45.00 |
$45.00 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$879.00 |
$879.00 |
$879.00 |
$952.66
|
|
Injection epidural blood patch or clot
|
$1,149.00 |
$1,149.00 |
$1,149.00 |
$1,156.80
|
|
Injection eye drug
|
$9,807.23 |
$9,807.23 |
$9,807.23 |
$644.50
|
|
Injection for arthrography wrist (both sides)
|
$249.00 |
$249.00 |
$249.00 |
$428.40
|
|
Injection for bladder x-ray
|
$13,061.36 |
$13,061.36 |
$13,061.36 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$391.20 |
$391.20 |
$391.20 |
$494.65
|
|
Injection for ureter x-ray
|
$529.80 |
$529.80 |
$529.80 |
$515.21
|
|
Injection, fulvestrant
|
$4,828.24 |
$4,828.24 |
$5,526.29 |
$1,817.65
|
|
Injection, glucarpidase
|
$359,266.23 |
$359,266.23 |
$402,066.90 |
$74,113.20
|
|
Injection into brain canal
|
$677.40 |
$677.40 |
$677.40 |
$836.40
|
|
Injection,onabotulinumtoxina
|
$2,734.20 |
$2,734.20 |
$3,124.80 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$27,903.59 |
$27,903.59 |
$29,128.58 |
$670.64
|
|
Injection, renflexis
|
$3,164.24 |
$3,164.24 |
$3,616.27 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,459.20 |
$1,459.20 |
$1,459.20 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$833.40 |
$833.40 |
$1,296.00 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$6,789.49 |
$6,789.49 |
$6,789.49 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,142.40 |
$1,142.40 |
$1,142.40 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,888.80 |
$1,888.80 |
$1,888.80 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,768.20 |
$1,768.20 |
$1,768.20 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$4,759.80 |
$4,759.80 |
$4,759.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,007.60 |
$2,007.60 |
$2,007.60 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$91,005.71 |
$91,005.71 |
$91,005.71 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$529.80 |
$529.80 |
$556.80 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$672.60 |
$672.60 |
$672.60 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$171.00 |
$171.00 |
$171.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$152.40 |
$152.40 |
$152.40 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$234.60 |
$234.60 |
$234.60 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$136.20 |
$136.20 |
$136.20 |
$135.60
|
|
Inject sacroiliac joint
|
$833.40 |
$833.40 |
$833.40 |
$1,028.95
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$105,495.20 |
$105,495.20 |
$118,063.22 |
$54,322.53
|
|
Inj epidural sgl lumb-sacral without img
|
$1,977.00 |
$1,977.00 |
$1,977.00 |
$1,415.50
|
|
Inj for ext venography
|
$741.00 |
$741.00 |
$741.00 |
$649.95
|
|
Inj for mammo ductogram
|
$1,197.60 |
$1,197.60 |
$1,197.60 |
$399.60
|
