|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$200.30 |
$200.30 |
$200.30 |
$298.35
|
|
Infliximab 100 mg intravenous solution
|
$1,536.05 |
$1,536.05 |
$1,536.05 |
$2,102.08
|
|
Infliximab-axxq 100 mg intravenous solution
|
$657.60 |
$657.60 |
$657.60 |
$1,096.55
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,244.79 |
$1,244.79 |
$1,244.79 |
$1,432.80
|
|
Initiation & management bipap/cpap initial day
|
$1,209.17 |
$1,209.17 |
$1,209.17 |
$645.79
|
|
Inj, abilify maintena, 1 mg
|
$2,991.81 |
$2,991.81 |
$2,991.81 |
$6,796.39
|
|
Inj alymsys 10 mg
|
$3,780.66 |
$3,780.66 |
$3,780.66 |
$676.74
|
|
Inj anifrolumab-fnia 1mg
|
$6,325.84 |
$6,325.84 |
$6,325.84 |
$9,648.88
|
|
Inj., aristada initio, 1 mg
|
$3,018.94 |
$3,018.94 |
$3,018.94 |
$3,854.61
|
|
Inj., benralizumab, 1 mg
|
$6,343.93 |
$6,343.93 |
$6,343.93 |
$13,682.10
|
|
Inj, bezlotoxumab, 10 mg
|
$4,997.76 |
$4,997.76 |
$4,997.76 |
$8,698.20
|
|
Inj calcitriol per 0.1 mcg
|
$13.70 |
$13.70 |
$13.70 |
$31.69
|
|
Inj cefazolin sodium, hikma
|
$14.25 |
$14.25 |
$14.25 |
$34.59
|
|
Inj, cefiderocol, 10 mg
|
$249.62 |
$249.62 |
$249.62 |
$596.08
|
|
Inj ceftolozane tazobactam
|
$129.88 |
$129.88 |
$129.88 |
$431.36
|
|
Inj cntr knee arthro incl ct/mri
|
$89.88 |
$89.88 |
$89.88 |
$464.28
|
|
Inj crotalidae im f(ab')2 eq
|
$1,736.07 |
$1,736.07 |
$1,736.07 |
$2,735.85
|
|
Inj cyclophosphamd (ingenus)
|
$8.50 |
$8.50 |
$8.50 |
$493.23
|
|
Inj dx for sinogram
|
$214.27 |
$214.27 |
$214.27 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$678.43 |
$678.43 |
$678.43 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$107.41 |
$107.41 |
$107.41 |
$507.10
|
|
Injection, daratumumab 10 mg
|
$2,786.86 |
$2,786.86 |
$2,786.86 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$882.56 |
$882.56 |
$882.56 |
$1,148.80
|
|
Injection, edaravone, 1 mg
|
$728.57 |
$728.57 |
$728.57 |
$18.84
|
|
Injection epidural blood patch or clot
|
$1,019.83 |
$1,019.83 |
$1,019.83 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$93.99 |
$93.99 |
$93.99 |
$441.12
|
|
Injection for bladder x-ray
|
$144.40 |
$144.40 |
$144.40 |
$585.00
|
|
Injection for hip x-ray
|
$161.39 |
$161.39 |
$161.39 |
$567.45
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$204.13 |
$204.13 |
$204.13 |
$504.00
|
|
Injection for ureter x-ray
|
$79.19 |
$79.19 |
$79.19 |
$444.95
|
|
Injection for ureter x-ray
|
$107.41 |
$107.41 |
$107.41 |
$515.21
|
|
Injection, fulvestrant
|
$2,295.03 |
$2,295.03 |
$2,295.03 |
$1,817.65
|
|
Injection glatiramer acetate
|
$6,344.47 |
$6,344.47 |
$6,344.47 |
$646.72
|
|
Injection,onabotulinumtoxina
|
$1,380.96 |
$1,380.96 |
$1,380.96 |
$2,154.07
|
|
Injection radioactive tracer sentinel node (both sides)
|
$202.49 |
$202.49 |
$202.49 |
$717.20
|
|
Injection, renflexis
|
$991.06 |
$991.06 |
$991.06 |
$1,356.10
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$883.93 |
$883.93 |
$883.93 |
$1,501.60
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$289.07 |
$289.07 |
$289.07 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,317.94 |
$1,317.94 |
$1,317.94 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$647.47 |
$647.47 |
$647.47 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,011.89 |
$1,011.89 |
$1,011.89 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,011.89 |
$1,011.89 |
$1,011.89 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,517.69 |
$1,517.69 |
$1,517.69 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,056.00 |
$1,056.00 |
$1,056.00 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,056.00 |
$1,056.00 |
$1,056.00 |
$1,758.12
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$275.37 |
$275.37 |
$275.37 |
$552.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$219.20 |
$219.20 |
$219.20 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$199.20 |
$199.20 |
$199.20 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$199.48 |
$199.48 |
$199.48 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$140.29 |
$140.29 |
$140.29 |
$141.60
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$20,744.82 |
$20,744.82 |
$20,744.82 |
$32,176.93
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$19,570.73 |
$19,570.73 |
$19,570.73 |
$42,437.44
|
|
Inj fluphenazine hcl 1.25 mg
|
$13.70 |
$13.70 |
$13.70 |
$44.95
|
|
Inj for ext venography
|
$545.54 |
$545.54 |
$545.54 |
$737.55
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$882.56 |
$882.56 |
$882.56 |
$1,482.00
|
|
Inj hrt cath w/s&i sel left vent
|
$3,671.33 |
$3,671.33 |
$3,671.33 |
$1,214.40
|
|
Inj hrt cath w/s&i sel right vent
|
$4,033.28 |
$4,033.28 |
$4,033.28 |
$947.65
|
|
Inj ivig privigen 500 mg
|
$2,919.75 |
$2,919.75 |
$2,919.75 |
$7,173.90
|
|
Inj, moxifloxacin 100 mg
|
$60.56 |
$60.56 |
$60.56 |
$153.27
|
|
Inj multihance
|
$76.72 |
$76.72 |
$76.72 |
$119.25
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$651.03 |
$651.03 |
$651.03 |
$1,522.56
|
|
Inj, nithiodote, 3mg / 125mg
|
$249.89 |
$249.89 |
$249.89 |
$228.00
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,853.61 |
$1,853.61 |
$1,853.61 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,853.61 |
$1,853.61 |
$1,853.61 |
$2,164.64
|
|
Inj ogivri 10 mg
|
$1,742.37 |
$1,742.37 |
$1,742.37 |
$4,096.71
|
|
Inj., patisiran, 0.1 mg
|
$12,494.40 |
$12,494.40 |
$12,494.40 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$5,162.99 |
$5,162.99 |
$5,162.99 |
$6,244.73
|
|
Inj proc myelogram lumbar
|
$983.12 |
$983.12 |
$983.12 |
$922.80
|
|
Inj prohance multipack
|
$13.70 |
$13.70 |
$13.70 |
$51.48
|
|
Inj, releuko 1 mcg
|
$334.83 |
$334.83 |
$334.83 |
$519.53
|
|
Inj retacrit esrd on dialysi
|
$145.22 |
$145.22 |
$145.22 |
$343.53
|
|
Inj retro urethrocysto
|
$79.19 |
$79.19 |
$79.19 |
$551.29
|
|
Inj scleros sol mult veins
|
$260.03 |
$260.03 |
$260.03 |
$687.96
|
|
Inj scleros sol sgl vein
|
$260.03 |
$260.03 |
$260.03 |
$534.40
|
|
Inj secukinumab intrav 1mg
|
$2,781.65 |
$2,781.65 |
$2,781.65 |
$5,994.20
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$309.08 |
$309.08 |
$309.08 |
$436.64
|
|
Inj teclistamab cqyv 0.5 mg
|
$11,872.42 |
$11,872.42 |
$11,872.42 |
$17,517.56
|
|
Inj. teprotumumab-trbw 10 mg
|
$19,596.48 |
$19,596.48 |
$19,596.48 |
$42,164.34
|
|
Inj testosterone cypionate
|
$31.51 |
$31.51 |
$31.51 |
$82.58
|
|
Inj, vancomycin hcl (mylan)
|
$548.00 |
$548.00 |
$548.00 |
$89.83
|
|
Inj w/fluor eval cv device
|
$1,023.67 |
$1,023.67 |
$1,023.67 |
$588.90
|
|
Ins cath ren art 1st bi
|
$4,326.74 |
$4,326.74 |
$4,326.74 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$3,090.45 |
$3,090.45 |
$3,090.45 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,006.53 |
$5,006.53 |
$5,006.53 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$4,203.16 |
$4,203.16 |
$4,203.16 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$275.92 |
$275.92 |
$275.92 |
$544.00
|
|
Insert cath pleura with image
|
$673.50 |
$673.50 |
$673.50 |
$2,239.02
|
|
Insert cath pleura without image
|
$2,168.17 |
$2,168.17 |
$2,168.17 |
$2,212.00
|
|
Insert hepatic shunt (tips)
|
$2,933.72 |
$2,933.72 |
$2,933.72 |
$9,754.48
|
|
Insertion catheter bladder non indwelling
|
$175.09 |
$175.09 |
$175.09 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$175.09 |
$175.09 |
$175.09 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,332.94 |
$3,332.94 |
$3,332.94 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,893.72 |
$2,893.72 |
$2,893.72 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$9,465.61 |
$9,465.61 |
$9,465.61 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,809.05 |
$2,809.05 |
$2,809.05 |
$2,618.40
|
|
Insertion of catheter vein
|
$1,727.30 |
$1,727.30 |
$1,727.30 |
$1,749.80
|
|
Insertion of catheter vein
|
$1,078.47 |
$1,078.47 |
$1,078.47 |
$858.05
|
|
Insertion of heart electrode 33211
|
$5,933.47 |
$5,933.47 |
$5,933.47 |
$9,090.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$4,761.58 |
$4,761.58 |
$4,761.58 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$4,856.65 |
$4,856.65 |
$4,856.65 |
$12,813.28
|