|
Implant cochlear osia osi300
|
$6,764.49 |
$10,783.53 |
$16,195.55 |
$15,318.47
|
|
Implant tcat pulm vlv perq
|
$79,737.53 |
$79,737.53 |
$79,737.53 |
$18,494.40
|
|
Imuglucerase injection
|
$82.80 |
$82.80 |
$161.00 |
$343.20
|
|
In-111 pentetate dtpa / 0.5 mci
|
$826.56 |
$826.56 |
$1,553.83 |
$2,135.29
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$2,224.62 |
$2,224.62 |
$2,224.62 |
$2,261.20
|
|
Incobotulinumtoxin a
|
$4.38 |
$4.38 |
$4.38 |
$1,339.57
|
|
Infect ag drug suscept pheno predict
|
$192.15 |
$192.15 |
$373.63 |
$325.00
|
|
Infect ag eia influenza a or b ea
|
$69.03 |
$69.03 |
$501.55 |
$69.03
|
|
Infect ag genotype na cytomegalovirus
|
$380.52 |
$380.52 |
$739.90 |
$603.41
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$557.19 |
$619.11 |
$1,083.43 |
$574.60
|
|
Infect ag ia direct hiv-1 antgn
|
$186.84 |
$186.84 |
$363.30 |
$95.55
|
|
Infect ag ia optc obs influenza
|
$77.04 |
$77.04 |
$223.30 |
$66.72
|
|
Infect ag if ea plyvlnt antsrm
|
$118.80 |
$118.80 |
$231.00 |
$37.74
|
|
Infect ag if influenza a
|
$150.30 |
$150.30 |
$292.25 |
$40.61
|
|
Infect ag if influenza b
|
$149.13 |
$149.13 |
$289.98 |
$34.67
|
|
Infect ag if legionella pneumophila
|
$88.38 |
$98.19 |
$171.85 |
$75.79
|
|
Infect ag if nos ea
|
$136.80 |
$136.80 |
$266.00 |
$60.40
|
|
Infect ag if pneumocystis carinii
|
$66.06 |
$66.06 |
$274.40 |
$62.29
|
|
Infect ag if varicella zoster
|
$74.61 |
$74.61 |
$201.78 |
$66.00
|
|
Infect ag na hep b amp
|
$825.83 |
$825.83 |
$825.83 |
$108.44
|
|
Infect ag na influenza r/amp 1st 2 types
|
$639.90 |
$639.90 |
$1,244.25 |
$227.96
|
|
Infect ag na orthopoxvirus amp prb each
|
$49.77 |
$49.77 |
$96.78 |
$102.00
|
|
Infect ag na resp virus 12-25 targets
|
$273.15 |
$273.15 |
$531.13 |
$859.44
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$387.99 |
$387.99 |
$1,232.53 |
$714.67
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$21.78 |
$24.12 |
$56.88 |
$77.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$201.51 |
$201.51 |
$391.83 |
$81.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$154.80 |
$172.08 |
$301.00 |
$63.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$62.64 |
$69.66 |
$206.85 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$82.26 |
$91.44 |
$366.45 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$39.78 |
$44.28 |
$386.05 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$115.56 |
$115.56 |
$224.70 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$62.28 |
$62.28 |
$121.10 |
$55.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$112.23 |
$112.23 |
$218.23 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$102.78 |
$114.03 |
$362.25 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$121.77 |
$121.77 |
$236.78 |
$97.50
|
|
Infectious agent nucleic acid amplified probe
|
$289.17 |
$289.17 |
$562.28 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$127.53 |
$141.48 |
$453.78 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$174.06 |
$174.06 |
$338.45 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$551.34 |
$551.34 |
$1,072.05 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$179.55 |
$199.35 |
$349.13 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$149.13 |
$149.13 |
$289.98 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$263.61 |
$293.04 |
$512.58 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$86.31 |
$86.31 |
$454.83 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$40.68 |
$40.68 |
$79.10 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$152.19 |
$152.19 |
$295.93 |
$248.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$76.14 |
$76.14 |
$148.05 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$3,232.35 |
$3,232.35 |
$6,285.13 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$285.66 |
$285.66 |
$555.45 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$172.98 |
$192.15 |
$610.75 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$267.03 |
$296.64 |
$707.70 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$294.39 |
$327.24 |
$572.43 |
$381.55
|
|
Infliximab 100 mg intravenous solution
|
$205.20 |
$205.20 |
$399.00 |
$2,791.24
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,654.83 |
$1,654.83 |
$3,217.73 |
$1,654.83
|
|
Initial foot exam pt lops
|
$172.98 |
$244.30 |
$258.12 |
$152.50
|
|
Initiation & management bipap/cpap initial day
|
$696.33 |
$1,353.98 |
$4,410.45 |
$645.79
|
|
Inj, abilify asimtufii, 1 mg
|
$784.17 |
$784.17 |
$1,524.78 |
$5.95
|
|
Inj, abilify maintena, 1 mg
|
$1,613.97 |
$1,613.97 |
$3,138.28 |
$6,324.82
|
|
Inj anifrolumab-fnia 1mg
|
$1,038.87 |
$1,038.87 |
$2,020.03 |
$9,878.82
|
|
Inj., aristada initio, 1 mg
|
$1,052.01 |
$1,052.01 |
$2,045.58 |
$1,052.01
|
|
Inj, aspara, rylaze, 0.1 mg
|
$1,896.48 |
$1,896.48 |
$3,687.60 |
$81.97
|
|
Inj calcitriol per 0.1 mcg
|
$3.42 |
$3.42 |
$24.12 |
$33.36
|
|
Inj, cefiderocol, 10 mg
|
$79.20 |
$79.20 |
$154.00 |
$718.84
|
|
Inj ceftolozane tazobactam
|
$148.77 |
$148.77 |
$318.15 |
$447.36
|
|
Inj, clevidipine butyrate
|
$4.86 |
$4.86 |
$9.45 |
$3.39
|
|
Inj crotalidae im f(ab')2 eq
|
$2,388.06 |
$2,388.06 |
$4,643.45 |
$2,836.95
|
|
Inj disk cerv-thor ea lev
|
$349.20 |
$349.20 |
$349.20 |
$869.80
|
|
Inj dx for sinogram
|
$300.42 |
$300.42 |
$536.03 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$203.49 |
$203.49 |
$884.10 |
$507.10
|
|
Injection, belinostat, 10mg
|
$2,863.53 |
$2,863.53 |
$5,567.98 |
$5,341.40
|
|
Injection, cangrelor
|
$1,305.72 |
$1,305.72 |
$2,538.90 |
$2,546.20
|
|
Injection, daratumumab 10 mg
|
$3,147.75 |
$3,147.75 |
$6,120.63 |
$7,107.73
|
|
Injection, doxercalciferol
|
$58.41 |
$58.41 |
$113.58 |
$30.35
|
|
Injection during cath supravalvular aortography
|
$4,439.34 |
$4,439.34 |
$14,376.60 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$1,655.01 |
$1,655.01 |
$3,766.35 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$165.06 |
$165.06 |
$320.95 |
$441.12
|
|
Injection for bladder x-ray
|
$104.30 |
$183.60 |
$183.60 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$482.85 |
$482.85 |
$759.85 |
$504.00
|
|
Injection for spleen x-ray
|
$232.02 |
$232.02 |
$404.25 |
$686.40
|
|
Injection for ureter x-ray
|
$129.69 |
$129.69 |
$161.70 |
$444.95
|
|
Injection, fulvestrant
|
$107.55 |
$107.55 |
$209.13 |
$2,756.47
|
|
Injection glatiramer acetate
|
$1,210.77 |
$1,210.77 |
$2,354.28 |
$405.93
|
|
Injection, inclisiran, 1 mg
|
$5.22 |
$5.22 |
$10.15 |
$10,366.61
|
|
Injection into brain canal
|
$1,365.88 |
$1,365.88 |
$1,365.88 |
$970.61
|
|
Injection into brain canal
|
$726.39 |
$914.04 |
$1,307.95 |
$933.60
|
|
Injection, isavuconazonium
|
$477.45 |
$477.45 |
$928.38 |
$646.20
|
|
Injection,onabotulinumtoxina
|
$16.56 |
$16.56 |
$32.20 |
$2,154.07
|
|
Injection, peramivir
|
$553.86 |
$553.86 |
$1,076.95 |
$1,257.68
|
|
Injection radioactive tracer sentinel node (both sides)
|
$240.39 |
$240.39 |
$467.60 |
$717.20
|
|
Injection, renflexis
|
$325.53 |
$325.53 |
$632.98 |
$1,457.42
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,170.81 |
$1,170.81 |
$2,163.88 |
$1,160.25
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$578.88 |
$578.88 |
$1,325.63 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,037.05 |
$1,141.02 |
$1,141.02 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$654.30 |
$654.30 |
$1,325.63 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,841.85 |
$1,841.85 |
$2,635.15 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,446.12 |
$1,446.12 |
$2,069.03 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,946.07 |
$1,946.07 |
$2,420.95 |
$1,758.12
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$180.00 |
$180.00 |
$350.00 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$169.20 |
$169.20 |
$329.00 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$309.60 |
$309.60 |
$602.00 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$182.79 |
$182.79 |
$322.88 |
$141.60
|
