|
Incision of foot fascia
|
$8,828.36 |
$8,828.36 |
$8,828.36 |
$4,570.33
|
|
Incision of heel bone
|
$29,329.40 |
$29,329.40 |
$29,329.40 |
$5,110.00
|
|
Incision of metatarsal
|
$167,698.43 |
$167,698.43 |
$167,698.43 |
$3,591.33
|
|
Incision of spinal nerve 64772
|
$29,594.09 |
$29,594.09 |
$29,594.09 |
$2,310.83
|
|
Incision of toe tendons 28011
|
$8,828.36 |
$8,828.36 |
$8,828.36 |
$2,119.12
|
|
Incision tendon sheath
|
$15,700.46 |
$15,700.46 |
$15,700.46 |
$3,073.20
|
|
Incisn of toe tndn
|
$8,828.36 |
$8,828.36 |
$8,828.36 |
$2,627.96
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$221.40 |
$221.40 |
$221.40 |
$137.15
|
|
Infect ag drug suscept pheno predict
|
$393.60 |
$393.60 |
$393.60 |
$323.20
|
|
Infect ag genotype na cytomegalovirus
|
$810.60 |
$810.60 |
$810.60 |
$643.65
|
|
Infect ag genotype na dna hepatitis b
|
$810.60 |
$810.60 |
$810.60 |
$409.27
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$1,521.60 |
$1,521.60 |
$1,521.60 |
$601.00
|
|
Infect ag ia optc obs influenza
|
$142.80 |
$142.80 |
$142.80 |
$72.93
|
|
Infect ag if legionella pneumophila
|
$162.00 |
$162.00 |
$162.00 |
$71.50
|
|
Infect ag if pneumocystis carinii
|
$72.00 |
$72.00 |
$72.00 |
$68.40
|
|
Infect ag if varicella zoster
|
$69.60 |
$69.60 |
$69.60 |
$72.80
|
|
Infect ag na hpv high-risk types
|
$121.80 |
$121.80 |
$121.80 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$430.80 |
$430.80 |
$430.80 |
$217.88
|
|
Infect ag na orthopoxvirus amp prb each
|
$80.40 |
$80.40 |
$80.40 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$331.20 |
$331.20 |
$331.20 |
$82.08
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$134.40 |
$134.40 |
$134.40 |
$72.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$116.40 |
$116.40 |
$116.40 |
$76.32
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$104.40 |
$104.40 |
$104.40 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$170.40 |
$170.40 |
$170.40 |
$95.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$148.20 |
$148.20 |
$148.20 |
$81.06
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$156.60 |
$156.60 |
$156.60 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$306.60 |
$306.60 |
$306.60 |
$130.90
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$190.80 |
$190.80 |
$190.80 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$114.00 |
$114.00 |
$114.00 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$490.20 |
$490.20 |
$490.20 |
$270.80
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$187.80 |
$187.80 |
$187.80 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$224.40 |
$224.40 |
$224.40 |
$167.05
|
|
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
|
$568.20 |
$568.20 |
$568.20 |
$183.41
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$115.80 |
$115.80 |
$115.80 |
$151.25
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$189.00 |
$189.00 |
$189.00 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$190.20 |
$190.20 |
$190.20 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$130.20 |
$130.20 |
$130.20 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$300.60 |
$300.60 |
$300.60 |
$217.80
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$122.40 |
$122.40 |
$122.40 |
$92.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$183.00 |
$183.00 |
$183.00 |
$109.20
|
|
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 12-25 targets
|
$280.80 |
$280.80 |
$280.80 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$403.80 |
$403.80 |
$403.80 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$2,000.40 |
$2,000.40 |
$2,000.40 |
$429.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$433.80 |
$433.80 |
$433.80 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$501.00 |
$501.00 |
$501.00 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$480.00 |
$480.00 |
$480.00 |
$375.00
|
|
Infliximab 100 mg intravenous solution
|
$6,376.30 |
$6,376.30 |
$6,376.30 |
$2,069.44
|
|
Infliximab-axxq 100 mg intravenous solution
|
$2,730.00 |
$2,730.00 |
$2,730.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$5,166.69 |
$5,166.69 |
$5,166.69 |
$1,537.84
|
|
Initiation & management bipap/cpap initial day
|
$1,385.40 |
$1,385.40 |
$1,385.40 |
$576.00
|
|
Inj anifrolumab-fnia 1mg
|
$29,705.90 |
$29,705.90 |
$29,705.90 |
$9,648.88
|
|
Inj., benralizumab, 1 mg
|
$31,924.90 |
$31,924.90 |
$31,924.90 |
$11,239.97
|
|
Inj, biorphen, 20 micrograms
|
$48.00 |
$48.00 |
$48.00 |
$17.12
|
|
Inj, bupivacaine liposome
|
$994.19 |
$994.19 |
$994.19 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$61.43 |
$61.43 |
$61.43 |
$28.52
|
|
Inj, cefiderocol, 10 mg
|
$2,444.82 |
$2,444.82 |
$2,444.82 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$1,830.78 |
$1,830.78 |
$1,830.78 |
$381.60
|
|
Inj, clindamycin (baxter)
|
$74.55 |
$74.55 |
$74.55 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$801.00 |
$801.00 |
$801.00 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$708.62 |
$708.62 |
$708.62 |
$2,584.85
|
|
Inj cyclophosphamd auromedic
|
$2,850.00 |
$2,850.00 |
$2,850.00 |
$249.68
|
|
Inj dx for sinogram
|
$656.40 |
$656.40 |
$656.40 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,343.40 |
$1,343.40 |
$1,343.40 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$1,068.60 |
$1,068.60 |
$1,068.60 |
$504.00
|
|
Injection, cangrelor
|
$10,512.60 |
$10,512.60 |
$10,512.60 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$17,635.63 |
$17,635.63 |
$17,635.63 |
$516.38
|
|
Injection, doxercalciferol
|
$48.00 |
$48.00 |
$48.00 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$1,968.00 |
$1,968.00 |
$1,968.00 |
$1,030.00
|
|
Injection epidural blood patch or clot
|
$2,190.00 |
$2,190.00 |
$2,190.00 |
$1,149.13
|
|
Injection for bladder x-ray
|
$2,662.20 |
$2,662.20 |
$2,662.20 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$1,279.20 |
$1,279.20 |
$1,279.20 |
$494.65
|
|
Injection, fulvestrant
|
$5,526.29 |
$5,526.29 |
$5,526.29 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,294.75 |
$1,294.75 |
$1,294.75 |
$830.51
|
|
Injection,onabotulinumtoxina
|
$3,554.46 |
$3,554.46 |
$3,554.46 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$112,030.28 |
$112,030.28 |
$112,030.28 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,115.00 |
$2,115.00 |
$2,115.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,428.60 |
$1,428.60 |
$1,428.60 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,544.60 |
$2,544.60 |
$2,544.60 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$307.20 |
$307.20 |
$307.20 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$967.20 |
$967.20 |
$967.20 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,809.60 |
$1,809.60 |
$1,809.60 |
$1,004.00
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,809.60 |
$1,809.60 |
$1,809.60 |
$1,927.64
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,284.40 |
$3,284.40 |
$3,284.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,530.40 |
$3,530.40 |
$3,530.40 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$9,314.04 |
$9,314.04 |
$9,314.04 |
$478.20
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$528.00 |
$528.00 |
$528.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$567.00 |
$567.00 |
$567.00 |
$637.35
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$259.20 |
$259.20 |
$259.20 |
$166.52
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$168.00 |
$168.00 |
$168.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$396.00 |
$396.00 |
$396.00 |
$258.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$148.20 |
$148.20 |
$148.20 |
$136.00
|
|
Inj for ext venography
|
$3,445.20 |
$3,445.20 |
$3,445.20 |
$654.00
|
|
Inj glycopyrrolate, glyrx-pf
|
$48.00 |
$48.00 |
$48.00 |
$11.23
|
|
Inj herzuma 10 mg
|
$17,408.37 |
$17,408.37 |
$17,408.37 |
$7,775.46
|
|
Inj hrt cath w/s&i sel hrt art
|
$973.80 |
$973.80 |
$973.80 |
$1,045.80
|
|
Inj hydroxocobalamin IV 25mg
|
$5,722.08 |
$5,722.08 |
$5,722.08 |
$2,452.32
|
|
Inj intralesional <= 7 lsn(s)
|
$376.20 |
$376.20 |
$376.20 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$20,951.11 |
$20,951.11 |
$20,951.11 |
$6,967.29
|