|
Immunoassay tumor antigen quantitative ca 19-9
|
$81.60 |
$81.60 |
$81.60 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$45.00 |
$45.00 |
$45.00 |
$48.50
|
|
Immunofixation electrophoresis serum
|
$48.00 |
$48.00 |
$48.00 |
$138.60
|
|
Immunofluorescence per specimen initial single antibody stain
|
$908.40 |
$908.40 |
$908.40 |
$232.05
|
|
Immunology procedure
|
$106.20 |
$106.20 |
$106.20 |
$118.25
|
|
Impl ahmed 6x25x9.6mm glaucoma vlv w/sil ped ster
|
$10,100.56 |
$10,100.56 |
$10,100.56 |
$3,840.76
|
|
Implant cartilage 10mm synthetic
|
$7,350.77 |
$7,350.77 |
$7,350.77 |
$10,050.00
|
|
Implant cochlear osia osi300
|
$49,473.75 |
$49,473.75 |
$49,473.75 |
$17,423.06
|
|
Implant ureth bulk agent
|
$8,113.70 |
$8,113.70 |
$8,113.70 |
$2,139.62
|
|
Impl ear abutment ba300 9mm
|
$14,657.57 |
$14,657.57 |
$14,657.57 |
$3,974.88
|
|
In-111 oxyquinolin per 0.5 mci
|
$10,103.90 |
$10,103.90 |
$10,103.90 |
$2,568.98
|
|
In-111 pentetate dtpa / 0.5 mci
|
$6,375.62 |
$6,375.62 |
$6,375.62 |
$2,550.60
|
|
In-111 pentetreotide
|
$2,862.00 |
$2,862.00 |
$2,862.00 |
$4,944.55
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$2,080.80
|
|
Incision of breast lesion
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$2,577.85
|
|
Incision of burn scab initi
|
$268.80 |
$268.80 |
$268.80 |
$494.40
|
|
Incision tendon sheath
|
$3,562.21 |
$3,562.21 |
$3,562.21 |
$3,073.20
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$210.60 |
$210.60 |
$210.60 |
$131.20
|
|
Infect ag drug suscept pheno predict
|
$480.60 |
$480.60 |
$480.60 |
$320.00
|
|
Infect ag genotype na cytomegalovirus
|
$772.20 |
$772.20 |
$772.20 |
$636.35
|
|
Infect ag genotype na dna hepatitis b
|
$772.20 |
$772.20 |
$772.20 |
$427.43
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$947.40 |
$947.40 |
$947.40 |
$603.75
|
|
Infect ag ia optc obs influenza
|
$46.80 |
$46.80 |
$46.80 |
$72.93
|
|
Infect ag if legionella pneumophila
|
$52.20 |
$52.20 |
$52.20 |
$73.46
|
|
Infect ag if pneumocystis carinii
|
$45.00 |
$45.00 |
$45.00 |
$67.46
|
|
Infect ag if varicella zoster
|
$45.60 |
$45.60 |
$45.60 |
$72.00
|
|
Infect ag na hpv high-risk types
|
$110.40 |
$110.40 |
$110.40 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$287.40 |
$287.40 |
$287.40 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$69.60 |
$69.60 |
$69.60 |
$99.36
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$90.00 |
$90.00 |
$90.00 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$46.80 |
$46.80 |
$46.80 |
$69.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$46.80 |
$46.80 |
$46.80 |
$76.50
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$48.60 |
$48.60 |
$48.60 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$53.40 |
$53.40 |
$53.40 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$103.20 |
$103.20 |
$103.20 |
$81.06
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$99.00 |
$99.00 |
$99.00 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$46.80 |
$46.80 |
$46.80 |
$127.80
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$46.80 |
$46.80 |
$46.80 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$45.00 |
$45.00 |
$45.00 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$466.80 |
$466.80 |
$466.80 |
$267.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$106.80 |
$106.80 |
$106.80 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$136.20 |
$136.20 |
$136.20 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,310.40 |
$1,310.40 |
$1,310.40 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$129.00 |
$129.00 |
$129.00 |
$181.35
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$138.60 |
$138.60 |
$138.60 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$106.20 |
$106.20 |
$106.20 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$224.40 |
$224.40 |
$224.40 |
$217.70
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$105.60 |
$105.60 |
$105.60 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$111.00 |
$111.00 |
$111.00 |
$105.00
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$230.40 |
$230.40 |
$230.40 |
$184.80
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$384.60 |
$384.60 |
$384.60 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$870.60 |
$870.60 |
$870.60 |
$429.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$250.20 |
$250.20 |
$250.20 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$129.00 |
$129.00 |
$129.00 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$457.20 |
$457.20 |
$457.20 |
$374.50
|
|
Infliximab 100 mg intravenous solution
|
$1,891.87 |
$1,891.87 |
$1,891.87 |
$2,080.86
|
|
Infliximab-axxq 100 mg intravenous solution
|
$810.00 |
$810.00 |
$810.00 |
$1,095.60
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,532.98 |
$1,532.98 |
$1,532.98 |
$1,617.43
|
|
Initiation & management bipap/cpap initial day
|
$130.20 |
$130.20 |
$130.20 |
$576.00
|
|
Inj, abilify maintena, 1 mg
|
$0.01 |
$0.01 |
$0.01 |
$5,355.30
|
|
Inj., aristada initio, 1 mg
|
$0.01 |
$0.01 |
$0.01 |
$4,052.45
|
|
Inj., benralizumab, 1 mg
|
$9,472.22 |
$9,472.22 |
$9,472.22 |
$11,604.71
|
|
Inj, bezlotoxumab, 10 mg
|
$6,156.00 |
$6,156.00 |
$6,156.00 |
$7,612.43
|
|
Inj, bupivacaine liposome
|
$351.08 |
$351.08 |
$351.08 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$8.17 |
$8.17 |
$8.17 |
$29.10
|
|
Inj, cefepime hcl (b braun)
|
$80.30 |
$80.30 |
$80.30 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$53.24 |
$53.24 |
$53.24 |
$48.39
|
|
Inj, cyclophos (baxter) 5mg
|
$1,053.52 |
$1,053.52 |
$1,053.52 |
$2,584.85
|
|
Inj, donanemab-azbt, 2 mg
|
$2,282.13 |
$2,282.13 |
$2,282.13 |
$1,233.44
|
|
Injection, belinostat, 10mg
|
$4,554.50 |
$4,554.50 |
$4,554.50 |
$4,446.10
|
|
Injection, edaravone, 1 mg
|
$2,102.44 |
$2,102.44 |
$2,102.44 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$525.00 |
$525.00 |
$525.00 |
$1,156.80
|
|
Injection, fulvestrant
|
$1,745.15 |
$1,745.15 |
$1,745.15 |
$1,719.16
|
|
Injection, inclisiran, 1 mg
|
$5,812.13 |
$5,812.13 |
$5,812.13 |
$6,679.35
|
|
Injection, renflexis
|
$1,220.50 |
$1,220.50 |
$1,220.50 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$585.60 |
$585.60 |
$585.60 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$738.00 |
$738.00 |
$738.00 |
$1,045.65
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$265.80 |
$265.80 |
$265.80 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,533.60 |
$1,533.60 |
$1,533.60 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,104.60 |
$1,104.60 |
$1,104.60 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,533.60 |
$1,533.60 |
$1,533.60 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,159.80 |
$1,159.80 |
$1,159.80 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,159.80 |
$1,159.80 |
$1,159.80 |
$1,704.78
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$196.20 |
$196.20 |
$196.20 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$196.20 |
$196.20 |
$196.20 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$91.80 |
$91.80 |
$91.80 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$103.20 |
$103.20 |
$103.20 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$189.00 |
$189.00 |
$189.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$91.80 |
$91.80 |
$91.80 |
$135.20
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$26,063.30 |
$26,063.30 |
$26,063.30 |
$32,176.93
|
|
Inj. fe derisomaltose 10 mg
|
$2,958.27 |
$2,958.27 |
$2,958.27 |
$3,540.79
|
|
Inj herzuma 10 mg
|
$5,497.38 |
$5,497.38 |
$5,497.38 |
$7,775.46
|
|
Inj hydroxocobalamin IV 25mg
|
$1,697.76 |
$1,697.76 |
$1,697.76 |
$2,452.32
|
|
Inj, immphentiv, 20 mcg
|
$4.80 |
$4.80 |
$4.80 |
$18.44
|
|
Inj, invega hafyera/trinza
|
$17,346.07 |
$17,346.07 |
$17,346.07 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$6,216.26 |
$6,216.26 |
$6,216.26 |
$6,967.29
|
|
Inj, lidocaine w epinephrine
|
$95.88 |
$95.88 |
$95.88 |
$44.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,216.20 |
$1,216.20 |
$1,216.20 |
$783.50
|
|
Inj multihance
|
$123.69 |
$123.69 |
$123.69 |
$79.42
|
|
Inj ogivri 10 mg
|
$4,725.09 |
$4,725.09 |
$4,725.09 |
$4,492.28
|
