|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$10.76 |
$10.76 |
$51.17 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$12.06 |
$12.06 |
$33.46 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$37.65 |
$37.65 |
$71.34 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$10.17 |
$10.17 |
$13.86 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$14.18 |
$14.18 |
$104.55 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$25.59 |
$25.59 |
$117.10 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$5.87 |
$5.87 |
$59.04 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$10.43 |
$10.43 |
$41.09 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$68.62 |
$68.62 |
$255.84 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$18.75 |
$18.75 |
$62.98 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$18.26 |
$18.26 |
$109.97 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$203.91 |
$203.91 |
$410.12 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$17.28 |
$17.28 |
$181.80 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$17.28 |
$17.28 |
$17.28 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$20.54 |
$20.54 |
$195.33 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$17.28 |
$17.28 |
$62.49 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$25.10 |
$25.10 |
$73.61 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$15.65 |
$15.65 |
$146.13 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$166.55 |
$166.55 |
$166.55 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$17.28 |
$17.28 |
$17.28 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$18.09 |
$18.09 |
$45.51 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$75.55 |
$75.55 |
$75.55 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$203.91 |
$203.91 |
$536.78 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$126.24 |
$126.24 |
$126.24 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$128.61 |
$128.61 |
$128.61 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$48.90 |
$48.90 |
$200.74 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$21.03 |
$21.03 |
$42.16 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$23.96 |
$23.96 |
$42.16 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$41.73 |
$41.73 |
$83.74 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$69.76 |
$69.76 |
$140.35 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$2,930.36 |
$2,930.36 |
$2,930.36 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$50.37 |
$50.37 |
$50.37 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,374.64 |
$2,374.64 |
$2,374.64 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$55.35 |
$55.35 |
$55.35 |
$296.00
|
|
Inj., benralizumab, 1 mg
|
$4,983.72 |
$4,983.72 |
$4,983.72 |
$11,310.00
|
|
Inj, bezlotoxumab, 10 mg
|
$3,926.16 |
$3,926.16 |
$3,926.16 |
$7,612.43
|
|
Inj, bupivacaine liposome
|
$752.76 |
$752.76 |
$752.76 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$25.10 |
$25.10 |
$25.10 |
$22.69
|
|
Inj, cefiderocol, 10 mg
|
$476.26 |
$476.26 |
$476.26 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$247.97 |
$247.97 |
$247.97 |
$364.86
|
|
Inj, clindamycin (baxter)
|
$32.97 |
$32.97 |
$32.97 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$142.76 |
$142.76 |
$286.59 |
$436.80
|
|
Inj crotalidae im f(ab')2 eq
|
$3,312.15 |
$3,312.15 |
$3,312.15 |
$2,613.60
|
|
Inj disk cerv-thor ea lev
|
$275.99 |
$275.99 |
$275.99 |
$875.28
|
|
Inj dx for sinogram
|
$83.81 |
$83.81 |
$83.81 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$196.17 |
$196.17 |
$332.60 |
$503.50
|
|
Injection during cath supravalvular aortography
|
$3,375.86 |
$3,375.86 |
$3,375.86 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$443.66 |
$443.66 |
$467.90 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$220.12 |
$220.12 |
$220.12 |
$436.00
|
|
Injection for bladder x-ray
|
$156.57 |
$156.57 |
$156.57 |
$459.20
|
|
Injection for hip x-ray
|
$237.31 |
$237.31 |
$237.31 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$213.67 |
$213.67 |
$346.86 |
$497.76
|
|
Injection for spleen x-ray
|
$165.78 |
$165.78 |
$165.78 |
$686.40
|
|
Injection for tear sac x-ray
|
$78.28 |
$78.28 |
$78.28 |
$225.20
|
|
Injection for ureter x-ray
|
$98.24 |
$98.24 |
$98.24 |
$415.80
|
|
Injection for ureter x-ray
|
$71.84 |
$71.84 |
$71.84 |
$515.21
|
|
Injection into brain canal
|
$310.38 |
$310.38 |
$310.38 |
$844.50
|
|
Injection jaw joint x-ray
|
$55.87 |
$55.87 |
$55.87 |
$307.80
|
|
Injection jugular
|
$136.92 |
$136.92 |
$136.92 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$1,320.78 |
$1,320.78 |
$1,320.78 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$456.51 |
$456.51 |
$856.58 |
$685.44
|
|
Injection, renflexis
|
$1,890.51 |
$1,890.51 |
$1,890.51 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$857.31 |
$857.31 |
$857.31 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$322.76 |
$322.76 |
$322.76 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$472.47 |
$472.47 |
$848.70 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$840.87 |
$840.87 |
$896.67 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$284.59 |
$284.59 |
$284.59 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$324.19 |
$324.19 |
$324.19 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$670.49 |
$670.49 |
$670.49 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,364.62 |
$1,364.62 |
$1,364.62 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$881.70 |
$881.70 |
$881.70 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$881.70 |
$881.70 |
$881.70 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$202.62 |
$202.62 |
$202.62 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$135.08 |
$135.08 |
$135.08 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$153.50 |
$153.50 |
$153.50 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$85.80 |
$85.80 |
$253.88 |
$145.60
|
|
Inject sacroiliac joint
|
$413.22 |
$413.22 |
$413.22 |
$1,029.04
|
|
Inj epidural sgl cerv-thor without img
|
$617.38 |
$617.38 |
$617.38 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$617.38 |
$617.38 |
$617.38 |
$1,450.84
|
|
Inj for ext venography
|
$223.50 |
$223.50 |
$378.84 |
$628.80
|
|
Inj for mammo ductogram
|
$588.52 |
$588.52 |
$588.52 |
$397.80
|
|
Inj, gadopiclenol, 1 ml
|
$470.60 |
$470.60 |
$470.60 |
$37.63
|
|
Inj hydroxocobalamin IV 25mg
|
$2,504.28 |
$2,504.28 |
$2,504.28 |
$2,452.32
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$450.06 |
$450.06 |
$450.06 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$64.16 |
$64.16 |
$64.16 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$91.49 |
$91.49 |
$91.49 |
$234.00
|
|
Inj, kovaltry, 1 i.u
|
$4.68 |
$4.68 |
$4.68 |
$5.07
|
|
Inj, lidocaine w epinephrine
|
$33.95 |
$33.95 |
$33.95 |
$45.60
|
|
Inj mepivacaine hcl/10 ml
|
$19.19 |
$19.19 |
$19.19 |
$34.34
|
|
Inj, moxifloxacin 100 mg
|
$0.84 |
$0.84 |
$0.84 |
$101.31
|
|
Inj. mycophenolate mofetil
|
$271.10 |
$271.10 |
$271.10 |
$252.66
|
|
Inj naloxone hydrochloride
|
$298.16 |
$298.16 |
$298.16 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$605.10 |
$605.10 |
$933.57 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$476.75 |
$476.75 |
$476.75 |
$468.10
|
|
Inj ogivri 10 mg
|
$3,323.96 |
$3,323.96 |
$3,323.96 |
$4,492.28
|
|
Inj peritoneal venous shunt
|
$88.11 |
$88.11 |
$88.11 |
$406.80
|
|
Inj proc ankle arthr
|
$256.96 |
$256.96 |
$256.96 |
$405.31
|
|
Inj proc elbow arthro
|
$238.54 |
$238.54 |
$238.54 |
$432.00
|
|
Inj proc for lymphang
|
$304.85 |
$304.85 |
$304.85 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$289.81 |
$289.81 |
$289.81 |
$1,106.93
|