|
Implant ureth bulk agent
|
$8,849.85 |
$8,849.85 |
$8,849.85 |
$2,168.00
|
|
Impl ear abutment ba300 9mm
|
$15,987.45 |
$15,987.45 |
$15,987.45 |
$3,974.88
|
|
Impl neurostim electr perc
|
$24,705.61 |
$24,705.61 |
$24,705.61 |
$7,672.50
|
|
Implnt bio implnt for soft tiss reinforcement 15777
|
$142,272.32 |
$142,272.32 |
$142,272.32 |
$1,072.00
|
|
Implnt spinl canal catheter 62350
|
$78,531.02 |
$78,531.02 |
$78,531.02 |
$5,095.20
|
|
In-111 oxyquinolin per 0.5 mci
|
$1,107.60 |
$1,107.60 |
$1,107.60 |
$2,581.82
|
|
In-111 pentetate dtpa / 0.5 mci
|
$1,339.20 |
$1,339.20 |
$1,339.20 |
$2,598.17
|
|
In-111 pentetreotide
|
$3,015.00 |
$3,015.00 |
$3,015.00 |
$5,201.00
|
|
Incise thigh tendon & fascia
|
$51,327.68 |
$51,327.68 |
$51,327.68 |
$3,839.54
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$13,224.76 |
$13,224.76 |
$13,224.76 |
$2,056.93
|
|
Incision of breast lesion
|
$12,503.26 |
$12,503.26 |
$12,503.26 |
$2,560.80
|
|
Incision of burn scab initi
|
$518.40 |
$518.40 |
$518.40 |
$494.40
|
|
Incision of foot fascia
|
$17,094.43 |
$17,094.43 |
$17,094.43 |
$4,570.33
|
|
Incision of heel bone
|
$68,356.81 |
$68,356.81 |
$68,356.81 |
$5,339.00
|
|
Incision of metatarsal
|
$90,768.49 |
$90,768.49 |
$90,768.49 |
$3,591.33
|
|
Incision of prostate
|
$13,153.58 |
$13,153.58 |
$13,153.58 |
$4,081.37
|
|
Incision tendon sheath
|
$14,755.35 |
$14,755.35 |
$14,755.35 |
$3,073.20
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$2,568.00 |
$2,568.00 |
$2,568.00 |
$766.66
|
|
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
|
$743.40 |
$743.40 |
$743.40 |
$323.20
|
|
Infect ag genotype na cytomegalovirus
|
$810.60 |
$810.60 |
$810.60 |
$661.80
|
|
Infect ag genotype na dna hepatitis b
|
$1,273.80 |
$1,273.80 |
$1,273.80 |
$405.30
|
|
Infect ag genotype na hiv-1 other region
|
$405.60 |
$405.60 |
$405.60 |
$386.40
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$1,296.00 |
$1,296.00 |
$1,296.00 |
$603.75
|
|
Infect ag ia optc obs influenza
|
$68.40 |
$68.40 |
$68.40 |
$72.93
|
|
Infect ag if legionella pneumophila
|
$147.60 |
$147.60 |
$147.60 |
$72.58
|
|
Infect ag if pneumocystis carinii
|
$68.40 |
$68.40 |
$68.40 |
$66.00
|
|
Infect ag if varicella zoster
|
$89.40 |
$89.40 |
$89.40 |
$70.70
|
|
Infect ag na hpv high-risk types
|
$304.20 |
$304.20 |
$304.20 |
$139.75
|
|
Infect ag na influenza r/amp 1st 2 types
|
$63.00 |
$63.00 |
$63.00 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$51.00 |
$51.00 |
$51.00 |
$99.36
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$128.40 |
$128.40 |
$128.40 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$81.00 |
$81.00 |
$81.00 |
$72.80
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$102.00 |
$102.00 |
$102.00 |
$76.32
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$159.00 |
$159.00 |
$159.00 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$124.20 |
$124.20 |
$124.20 |
$100.02
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$228.00 |
$228.00 |
$228.00 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$73.20 |
$73.20 |
$73.20 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$140.40 |
$140.40 |
$140.40 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$366.60 |
$366.60 |
$366.60 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$84.60 |
$84.60 |
$84.60 |
$98.02
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$100.80 |
$100.80 |
$100.80 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$490.20 |
$490.20 |
$490.20 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$196.20 |
$196.20 |
$196.20 |
$139.68
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$192.00 |
$192.00 |
$192.00 |
$167.00
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,862.40 |
$1,862.40 |
$1,862.40 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$195.60 |
$195.60 |
$195.60 |
$179.92
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$192.00 |
$192.00 |
$192.00 |
$147.55
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$232.20 |
$232.20 |
$232.20 |
$217.85
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$196.20 |
$196.20 |
$196.20 |
$136.03
|
|
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
|
$218.40 |
$218.40 |
$218.40 |
$206.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$190.20 |
$190.20 |
$190.20 |
$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 12-25 targets
|
$1,847.40 |
$1,847.40 |
$1,847.40 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$403.80 |
$403.80 |
$403.80 |
$286.06
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$1,058.40 |
$1,058.40 |
$1,058.40 |
$423.53
|
|
Infectious agent nucleic acid quantification bk virus
|
$435.60 |
$435.60 |
$435.60 |
$279.40
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$292.80 |
$292.80 |
$292.80 |
$239.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$360.60 |
$360.60 |
$360.60 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$436.80 |
$436.80 |
$436.80 |
$374.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$495.00 |
$495.00 |
$495.00 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$4,379.33 |
$4,379.33 |
$4,379.33 |
$2,080.86
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,548.55 |
$3,548.55 |
$3,548.55 |
$1,537.84
|
|
Initiation & management bipap/cpap initial day
|
$1,119.00 |
$1,119.00 |
$1,119.00 |
$576.00
|
|
Inj, abilify asimtufii, 1 mg
|
$21,783.26 |
$21,783.26 |
$21,783.26 |
$9,426.91
|
|
Inj, abilify maintena, 1 mg
|
$10,891.65 |
$10,891.65 |
$10,891.65 |
$5,355.30
|
|
Inj allopurinol sodium 1 mg
|
$25,596.93 |
$25,596.93 |
$25,596.93 |
$6,968.99
|
|
Inj alymsys 10 mg
|
$11,296.39 |
$11,296.39 |
$11,296.39 |
$1,280.74
|
|
Inj anifrolumab-fnia 1mg
|
$20,402.40 |
$20,402.40 |
$20,402.40 |
$9,878.82
|
|
Inj., aristada initio, 1 mg
|
$0.01 |
$0.01 |
$0.01 |
$4,052.45
|
|
Inj., benralizumab, 1 mg
|
$21,926.44 |
$21,926.44 |
$21,926.44 |
$11,239.97
|
|
Inj, bupivacaine liposome
|
$639.88 |
$639.88 |
$639.88 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$24.00 |
$24.00 |
$24.00 |
$28.08
|
|
Inj ceftolozane tazobactam
|
$1,119.40 |
$1,119.40 |
$1,119.40 |
$380.80
|
|
Inj, clindamycin (baxter)
|
$83.78 |
$83.78 |
$83.78 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$282.00 |
$282.00 |
$282.00 |
$436.80
|
|
Inj, cyclophosphamd, sandoz
|
$1,830.35 |
$1,830.35 |
$1,830.35 |
$735.20
|
|
Inj dx for sinogram
|
$739.80 |
$739.80 |
$739.80 |
$422.59
|
|
Injection arthrography hip without anesthesia (both sides)
|
$1,601.40 |
$1,601.40 |
$1,601.40 |
$495.84
|
|
Injection, cangrelor
|
$6,427.70 |
$6,427.70 |
$6,427.70 |
$1,889.78
|
|
Injection, doxercalciferol
|
$24.00 |
$24.00 |
$24.00 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$1,180.80 |
$1,180.80 |
$1,180.80 |
$952.66
|
|
Injection epidural blood patch or clot
|
$1,697.40 |
$1,697.40 |
$1,697.40 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$1,263.60 |
$1,263.60 |
$1,263.60 |
$428.40
|
|
Injection for bladder x-ray
|
$1,883.33 |
$1,883.33 |
$1,883.33 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$7,093.20 |
$7,093.20 |
$7,093.20 |
$494.65
|
|
Injection, fulvestrant
|
$196.50 |
$196.50 |
$196.50 |
$1,817.65
|
|
Injection glatiramer acetate
|
$889.25 |
$889.25 |
$889.25 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$13,453.99 |
$13,453.99 |
$13,453.99 |
$6,679.35
|
|
Injection,onabotulinumtoxina
|
$4,882.50 |
$4,882.50 |
$4,882.50 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$664.20 |
$664.20 |
$664.20 |
$670.64
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,897.80 |
$1,897.80 |
$1,897.80 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,523.00 |
$2,523.00 |
$2,523.00 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,776.00 |
$1,776.00 |
$1,776.00 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,502.00 |
$2,502.00 |
$2,502.00 |
$1,017.90
|
