|
Impreg gauze no h20/sal/yard
|
$22.58 |
$22.58 |
$22.58 |
$11.90
|
|
Imuglucerase injection
|
$3,399.59 |
$3,399.59 |
$3,399.59 |
$3,399.59
|
|
In-111 pentetate dtpa / 0.5 mci
|
$2,926.65 |
$2,926.65 |
$2,926.65 |
$2,550.60
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,946.55 |
$1,946.55 |
$1,946.55 |
$2,080.80
|
|
Incision of breast lesion
|
$1,611.00 |
$1,611.00 |
$1,611.00 |
$2,577.85
|
|
Incobotulinumtoxin a
|
$1,011.78 |
$1,011.78 |
$1,011.78 |
$1,359.43
|
|
Induced abortion d&c
|
$1,907.85 |
$1,907.85 |
$1,907.85 |
$3,762.53
|
|
Infect ag drug suscept pheno predict
|
$295.95 |
$295.95 |
$295.95 |
$320.00
|
|
Infect ag eia influenza a or b ea
|
$192.45 |
$192.45 |
$192.45 |
$69.03
|
|
Infect ag genotype na hiv-1 other region
|
$552.00 |
$552.00 |
$552.00 |
$326.20
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$823.20 |
$823.20 |
$823.20 |
$603.75
|
|
Infect ag ia optc obs influenza
|
$225.45 |
$225.45 |
$225.45 |
$72.93
|
|
Infect ag if influenza a
|
$18.00 |
$18.00 |
$18.00 |
$40.61
|
|
Infect ag if influenza b
|
$18.00 |
$18.00 |
$18.00 |
$37.95
|
|
Infect ag if nos ea
|
$158.40 |
$158.40 |
$158.40 |
$74.10
|
|
Infect ag if pneumocystis carinii
|
$71.40 |
$71.40 |
$71.40 |
$67.46
|
|
Infect ag na hpv high-risk types
|
$186.00 |
$186.00 |
$186.00 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$309.30 |
$309.30 |
$309.30 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$209.10 |
$209.10 |
$209.10 |
$99.36
|
|
Infect ag na resp virus 12-25 targets
|
$1,340.70 |
$1,340.70 |
$1,340.70 |
$859.44
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$1,291.65 |
$1,291.65 |
$1,291.65 |
$855.60
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$67.80 |
$67.80 |
$67.80 |
$77.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$347.10 |
$347.10 |
$347.10 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$105.00 |
$105.00 |
$105.00 |
$76.50
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$97.05 |
$97.05 |
$97.05 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$121.80 |
$121.80 |
$121.80 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$169.50 |
$169.50 |
$169.50 |
$81.06
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$192.45 |
$192.45 |
$192.45 |
$57.60
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$174.90 |
$174.90 |
$174.90 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$405.90 |
$405.90 |
$405.90 |
$127.80
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$199.20 |
$199.20 |
$199.20 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$89.10 |
$89.10 |
$89.10 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$796.80 |
$796.80 |
$796.80 |
$267.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$230.40 |
$230.40 |
$230.40 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$233.25 |
$233.25 |
$233.25 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,568.70 |
$1,568.70 |
$1,568.70 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$405.90 |
$405.90 |
$405.90 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$344.55 |
$344.55 |
$344.55 |
$151.25
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$512.55 |
$512.55 |
$512.55 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$183.30 |
$183.30 |
$183.30 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$140.00 |
$140.00 |
$140.00 |
$100.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$285.00 |
$285.00 |
$285.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$137.10 |
$137.10 |
$137.10 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$87.45 |
$87.45 |
$87.45 |
$105.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$930.00 |
$930.00 |
$930.00 |
$711.93
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$362.25 |
$362.25 |
$362.25 |
$429.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$730.05 |
$730.05 |
$730.05 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$278.70 |
$278.70 |
$278.70 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$334.20 |
$334.20 |
$334.20 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$307.95 |
$307.95 |
$307.95 |
$374.50
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$418.50 |
$418.50 |
$418.50 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$2,312.29 |
$2,312.29 |
$2,312.29 |
$2,080.86
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,873.64 |
$1,873.64 |
$1,873.64 |
$1,617.43
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$271.35 |
$271.35 |
$271.35 |
$293.04
|
|
Initiation & management bipap/cpap initial day
|
$1,305.00 |
$1,305.00 |
$1,305.00 |
$576.00
|
|
Inj, abilify maintena, 1 mg
|
$5,583.29 |
$5,583.29 |
$5,583.29 |
$5,355.30
|
|
Inj allopurinol sodium 1 mg
|
$7,722.00 |
$7,722.00 |
$7,722.00 |
$6,968.99
|
|
Inj alymsys 10 mg
|
$5,691.32 |
$5,691.32 |
$5,691.32 |
$1,483.29
|
|
Inj anifrolumab-fnia 1mg
|
$10,052.58 |
$10,052.58 |
$10,052.58 |
$10,052.58
|
|
Inj, aponvie, 1 mg
|
$848.15 |
$848.15 |
$848.15 |
$3.00
|
|
Inj., benralizumab, 1 mg
|
$11,239.97 |
$11,239.97 |
$11,239.97 |
$11,604.71
|
|
Inj, bezlotoxumab, 10 mg
|
$7,524.00 |
$7,524.00 |
$7,524.00 |
$7,612.43
|
|
Inj, biorphen, 20 micrograms
|
$13.68 |
$13.68 |
$13.68 |
$17.12
|
|
Inj calcitriol per 0.1 mcg
|
$8.20 |
$8.20 |
$8.20 |
$22.69
|
|
Inj cefazolin sodium, hikma
|
$24.01 |
$24.01 |
$24.01 |
$29.10
|
|
Inj, cefiderocol, 10 mg
|
$474.47 |
$474.47 |
$474.47 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$342.69 |
$342.69 |
$342.69 |
$408.00
|
|
Inj, clindamycin (baxter)
|
$35.69 |
$35.69 |
$35.69 |
$48.39
|
|
Inj crotalidae im f(ab')2 eq
|
$2,613.60 |
$2,613.60 |
$2,613.60 |
$2,613.60
|
|
Inj dx for sinogram
|
$460.50 |
$460.50 |
$460.50 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,141.35 |
$1,141.35 |
$1,141.35 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$724.65 |
$724.65 |
$724.65 |
$500.50
|
|
Injection, cangrelor
|
$1,889.78 |
$1,889.78 |
$1,889.78 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$16,319.16 |
$16,319.16 |
$16,319.16 |
$16,642.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$417.15 |
$417.15 |
$417.15 |
$504.90
|
|
Injection, daratumumab 10 mg
|
$1,408.08 |
$1,408.08 |
$1,408.08 |
$5,164.24
|
|
Injection, doxercalciferol
|
$9.52 |
$9.52 |
$9.52 |
$23.12
|
|
Injection epidural blood patch or clot
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$487.95 |
$487.95 |
$487.95 |
$441.12
|
|
Injection for bladder x-ray
|
$445.95 |
$445.95 |
$445.95 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$591.75 |
$591.75 |
$591.75 |
$494.65
|
|
Injection, fulvestrant
|
$1,919.66 |
$1,919.66 |
$1,919.66 |
$1,719.16
|
|
Injection glatiramer acetate
|
$865.10 |
$865.10 |
$865.10 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$6,679.35 |
$6,679.35 |
$6,679.35 |
$6,679.35
|
|
Injection, isavuconazonium
|
$787.67 |
$787.67 |
$787.67 |
$787.67
|
|
Injection, necitumumab, 1 mg
|
$8,572.91 |
$8,572.91 |
$8,572.91 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$2,510.64 |
$2,510.64 |
$2,510.64 |
$2,241.61
|
|
Injection, peramivir
|
$684.00 |
$684.00 |
$684.00 |
$775.82
|
|
Injection, renflexis
|
$1,491.72 |
$1,491.72 |
$1,491.72 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$741.45 |
$741.45 |
$741.45 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$741.45 |
$741.45 |
$741.45 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,438.95 |
$1,438.95 |
$1,438.95 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,001.25 |
$1,001.25 |
$1,001.25 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$441.30 |
$441.30 |
$441.30 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$517.24
|
