|
In-111 ibritumomab tiux dx
|
$5,699.00 |
$5,699.00 |
$5,699.00 |
|
|
In-111 oxyquinolin per 0.5 mci
|
$701.00 |
$2,005.00 |
$2,255.50 |
|
|
In-111 pentetate dtpa / 0.5 mci
|
$1,969.50 |
$2,635.00 |
$4,950.50 |
|
|
In-111 pentetreotide
|
$2,769.50 |
$4,159.00 |
$5,482.50 |
|
|
Inactivated je vacc im
|
$354.50 |
$354.50 |
$850.40 |
|
|
Incise/drain eyelid lining
|
$103.00 |
$103.00 |
$1,301.50 |
|
|
Incise flexor carpi radialis
|
$4,690.50 |
$4,690.50 |
$4,690.50 |
|
|
Incise inner ear
|
$239.00 |
$1,783.50 |
$2,790.00 |
|
|
Incise inner eye adhesions
|
$632.50 |
$697.00 |
$1,003.00 |
|
|
Incise inner eye adhesions
|
$1,899.33 |
$1,899.33 |
$1,899.33 |
|
|
Incise inner eye adhesions
|
$8,413.00 |
$8,413.00 |
$8,413.00 |
|
|
Incise inner eye adhesions
|
$1,945.17 |
$1,945.17 |
$16,563.00 |
|
|
Incise perq finger tendon 26060
|
$266.00 |
$1,793.00 |
$2,711.50 |
|
|
Incise spine nrv half segmnt
|
$6,091.34 |
$6,091.34 |
$6,091.34 |
|
|
Incise tear duct opening 68440
|
$97.00 |
$347.50 |
$1,504.83 |
|
|
Incise thigh tendon & fascia
|
$4,575.00 |
$4,575.00 |
$4,811.00 |
|
|
Incise wrist/forearm tendon
|
$2,921.67 |
$2,921.67 |
$2,921.67 |
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,582.00 |
$2,531.20 |
$26,651.00 |
|
|
Incision & drainage open of deep abscess (subfascial) pos
|
$12,214.00 |
$12,214.00 |
$12,214.00 |
|
|
Incision of achilles tendon
|
$1,848.50 |
$1,883.00 |
$4,661.00 |
|
|
Incision of achilles tendon
|
$3,761.00 |
$3,907.50 |
$9,541.50 |
|
|
Incision of anal sphincter
|
$168.00 |
$275.20 |
$4,390.00 |
|
|
Incision of bile duct
|
$1,469.50 |
$1,512.00 |
$2,419.20 |
|
|
Incision of bile duct 47420
|
$1,433.50 |
$1,456.00 |
$11,395.75 |
|
|
Incision of breast lesion
|
$328.50 |
$1,898.50 |
$8,980.50 |
|
|
Incision of burn scab initi
|
$466.50 |
$467.00 |
$467.50 |
|
|
Incision of eardrum
|
$109.50 |
$272.50 |
$1,666.17 |
|
|
Incision of eardrum
|
$972.00 |
$3,811.00 |
$5,378.00 |
|
|
Incision of eye
|
$3,738.34 |
$3,738.34 |
$3,738.34 |
|
|
Incision of eye
|
$3,458.50 |
$3,458.50 |
$3,458.50 |
|
|
Incision of eyelid
|
$93.50 |
$97.00 |
$2,621.00 |
|
|
Incision of facial nerve
|
$3,230.76 |
$3,230.76 |
$3,230.76 |
|
|
Incision of fibula
|
$424.50 |
$433.00 |
$8,394.50 |
|
|
Incision of finger tendon
|
$1,848.50 |
$1,883.00 |
$3,290.13 |
|
|
Incision of foot fascia
|
$306.00 |
$490.40 |
$12,413.00 |
|
|
Incision of foot tendon 28234
|
$1,312.72 |
$1,540.00 |
$2,464.00 |
|
|
Incision of gallbladder 47480
|
$937.50 |
$966.00 |
$1,545.60 |
|
|
Incision of heel bone
|
$685.50 |
$713.50 |
$17,494.34 |
|
|
Incision of hip bone
|
$13,874.34 |
$13,874.34 |
$13,874.34 |
|
|
Incision of hip tendon
|
$2,053.50 |
$2,053.50 |
$2,053.50 |
|
|
Incision of hip tendon
|
$915.00 |
$915.00 |
$9,079.50 |
|
|
Incision of iris
|
$2,564.50 |
$2,564.50 |
$2,564.50 |
|
|
Incision of metatarsal
|
$425.00 |
$431.00 |
$10,759.83 |
|
|
Incision of metatarsal
|
$547.00 |
$555.50 |
$888.80 |
|
|
Incision of metatarsal
|
$403.00 |
$658.40 |
$14,447.00 |
|
|
Incision of midfoot bones
|
$1,766.13 |
$3,605.50 |
$15,078.00 |
|
|
Incision of rectal abscess
|
$509.00 |
$546.00 |
$5,922.50 |
|
|
Incision of spinal nerve 64772
|
$583.00 |
$587.00 |
$25,165.50 |
|
|
Incision of tendon & muscle
|
$646.50 |
$646.50 |
$1,034.40 |
|
|
Incision of tendon sheath
|
$370.50 |
$1,867.50 |
$6,056.50 |
|
|
Incision of thigh
|
$1,058.00 |
$1,111.50 |
$12,027.51 |
|
|
Incision of thigh tendon
|
$468.50 |
$478.00 |
$749.60 |
|
|
Incision of tibia
|
$784.00 |
$784.50 |
$43,949.00 |
|
|
Incision of tibia & fibula
|
$22,893.00 |
$22,893.00 |
$22,893.00 |
|
|
Incision of toe tendons 28011
|
$293.00 |
$1,848.50 |
$3,575.00 |
|
|
Incision of tongue fold
|
$111.00 |
$1,140.00 |
$3,663.00 |
|
|
Incision of urethra
|
$309.50 |
$314.00 |
$8,038.75 |
|
|
Incision of urethra
|
$99.00 |
$2,002.00 |
$2,799.13 |
|
|
Incision of windpipe
|
$1,137.00 |
$1,137.00 |
$1,137.00 |
|
|
Incision of wrist capsule
|
$1,998.75 |
$1,998.75 |
$1,998.75 |
|
|
Incision secondary cataract
|
$2,774.17 |
$2,774.17 |
$2,774.17 |
|
|
Incision tendon sheath
|
$314.00 |
$2,412.80 |
$8,036.50 |
|
|
Incisn of toe tndn
|
$215.50 |
$1,867.00 |
$7,327.00 |
|
|
Incisn windpipe
|
$709.80 |
$3,810.50 |
$5,080.80 |
|
|
Incobotulinumtoxin a
|
$5.50 |
$8.50 |
$2,530.00 |
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$702.81 |
$702.81 |
$702.81 |
|
|
Induced ab 1+ vag sup w/dlv fetus
|
$1,773.00 |
$1,773.00 |
$1,773.00 |
|
|
Induced abortion d&c
|
$3,711.50 |
$3,721.00 |
$5,344.50 |
|
|
Induced abortion dilat&evac
|
$3,302.00 |
$3,302.00 |
$3,302.00 |
|
|
Infect ag drug suscept pheno predict
|
$63.50 |
$63.50 |
$715.50 |
|
|
Infect ag eia influenza a or b ea
|
$23.00 |
$31.00 |
$83.50 |
|
|
Infect ag genotype na cytomegalovirus
|
$715.50 |
$715.50 |
$715.50 |
|
|
Infect ag genotype na dna hepatitis b
|
$230.00 |
$230.00 |
$1,112.40 |
|
|
Infect ag genotype na hiv-1 other region
|
$62.50 |
$185.00 |
$943.20 |
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$125.00 |
$284.00 |
$954.60 |
|
|
Infect ag ia direct hiv-1 antgn
|
$100.00 |
$100.00 |
$102.00 |
|
|
Infect ag ia optc obs influenza
|
$28.50 |
$123.00 |
$262.50 |
|
|
Infect ag if hep delta agent
|
$140.50 |
$140.50 |
$140.50 |
|
|
Infect ag if influenza a
|
$76.50 |
$76.50 |
$76.50 |
|
|
Infect ag if influenza b
|
$22.00 |
$22.00 |
$22.00 |
|
|
Infect ag if legionella pneumophila
|
$59.00 |
$59.00 |
$230.50 |
|
|
Infect ag if nos ea
|
$83.50 |
$83.50 |
$83.50 |
|
|
Infect ag if pneumocystis carinii
|
$45.60 |
$66.00 |
$71.00 |
|
|
Infect ag if varicella zoster
|
$58.50 |
$77.00 |
$123.20 |
|
|
Infect ag na hep b amp
|
$225.00 |
$225.00 |
$225.00 |
|
|
Infect ag na herpes simplex quant
|
$69.50 |
$81.50 |
$93.50 |
|
|
Infect ag na hpv high-risk types
|
$44.40 |
$410.00 |
$554.00 |
|
|
Infect ag na influenza r/amp 1st 2 types
|
$84.80 |
$155.50 |
$293.50 |
|
|
Infect ag na influenza revr/amp ea type
|
$255.50 |
$255.50 |
$255.50 |
|
|
Infect ag na orthopoxvirus amp prb each
|
$90.00 |
$90.00 |
$144.00 |
|
|
Infect ag na resp virus 12-25 targets
|
$526.00 |
$895.50 |
$1,451.50 |
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$113.75 |
$284.00 |
$606.00 |
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$93.50 |
$140.00 |
$1,368.75 |
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$67.00 |
$67.00 |
$107.20 |
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$19.00 |
$98.50 |
$128.80 |
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$79.00 |
$79.00 |
$85.00 |
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$17.40 |
$44.50 |
$196.00 |
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$19.50 |
$62.00 |
$171.00 |
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$32.50 |
$32.50 |
$208.80 |
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$13.50 |
$61.00 |
$247.80 |
|