|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$100.00 |
$100.00 |
$100.00 |
$283.20
|
|
Infectious agent nucleic acid quantification bk virus
|
$43.75 |
$43.75 |
$43.75 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$43.75 |
$43.75 |
$43.75 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$43.75 |
$43.75 |
$43.75 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$57.50 |
$57.50 |
$57.50 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$107.00 |
$107.00 |
$107.00 |
$298.35
|
|
Infliximab 100 mg intravenous solution
|
$4,694.64 |
$4,694.64 |
$4,694.64 |
$2,102.08
|
|
Infliximab-axxq 100 mg intravenous solution
|
$2,010.00 |
$2,010.00 |
$2,010.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,804.05 |
$3,804.05 |
$3,804.05 |
$1,617.43
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$102.83 |
$102.83 |
$102.83 |
$76.00
|
|
Influenza virus vaccine, live trivalent intranasal
|
$16.67 |
$16.67 |
$16.67 |
$40.89
|
|
Ingest challenge ea addl 60 min
|
$87.50 |
$87.50 |
$87.50 |
$274.50
|
|
Ingest challenge ini 120 min
|
$175.00 |
$175.00 |
$175.00 |
$627.89
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$50.00 |
$50.00 |
$50.00 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$310.00 |
$310.00 |
$310.00 |
$645.79
|
|
Inj, abilify maintena, 1 mg
|
$11,675.85 |
$11,675.85 |
$11,675.85 |
$5,156.77
|
|
Inj, adstiladrin, per tx dos
|
$40,500.00 |
$40,500.00 |
$40,500.00 |
$63,354.77
|
|
Inj, adzynma, 10 iu
|
$4,305.40 |
$4,305.40 |
$4,305.40 |
$34.60
|
|
Inj, aflibercept hd, 1 mg
|
$10,763.55 |
$10,763.55 |
$10,763.55 |
$333.70
|
|
Inj alymsys 10 mg
|
$11,555.09 |
$11,555.09 |
$11,555.09 |
$676.74
|
|
Inj andexxa, 10 mg
|
$10,050.00 |
$10,050.00 |
$10,050.00 |
$6,794.00
|
|
Inj anifrolumab-fnia 1mg
|
$21,442.52 |
$21,442.52 |
$21,442.52 |
$9,648.88
|
|
Inj., aristada initio, 1 mg
|
$9,789.55 |
$9,789.55 |
$9,789.55 |
$4,052.45
|
|
Inj, artesunate, 1mg
|
$13,446.00 |
$13,446.00 |
$13,446.00 |
$19,423.99
|
|
Inj, aspara, rylaze, 0.1 mg
|
$21,037.99 |
$21,037.99 |
$21,037.99 |
$79.98
|
|
Inj avacincaptad pegol 0.1mg
|
$8,442.00 |
$8,442.00 |
$8,442.00 |
$109.53
|
|
Inj aval alfa-nqpt 4mg
|
$5,257.98 |
$5,257.98 |
$5,257.98 |
$3,907.30
|
|
Inj., benralizumab, 1 mg
|
$23,505.14 |
$23,505.14 |
$23,505.14 |
$14,405.42
|
|
Inj, bezlotoxumab, 10 mg
|
$15,276.00 |
$15,276.00 |
$15,276.00 |
$8,651.50
|
|
Inj, bortezomib, dr. reddy's
|
$277.06 |
$277.06 |
$277.06 |
$48.55
|
|
Inj, bortezomib freseniuskab
|
$1,559.27 |
$1,559.27 |
$1,559.27 |
$16.50
|
|
Inj. byooviz, 0.1 mg
|
$4,678.88 |
$4,678.88 |
$4,678.88 |
$170.80
|
|
Inj calcitriol per 0.1 mcg
|
$40.00 |
$40.00 |
$40.00 |
$33.39
|
|
Inj cefazolin sodium, hikma
|
$35.40 |
$35.40 |
$35.40 |
$42.12
|
|
Inj cefazolin (wg crit care)
|
$26.14 |
$26.14 |
$26.14 |
$24.24
|
|
Inj, cefepime hcl (b braun)
|
$45.62 |
$45.62 |
$45.62 |
$81.41
|
|
Inj, cefiderocol, 10 mg
|
$1,872.04 |
$1,872.04 |
$1,872.04 |
$596.08
|
|
Inj ceftolozane tazobactam
|
$700.93 |
$700.93 |
$700.93 |
$431.36
|
|
Inj, cimerli, 0.1 mg
|
$5,467.20 |
$5,467.20 |
$5,467.20 |
$201.01
|
|
Inj, clevidipine butyrate
|
$13.88 |
$13.88 |
$13.88 |
$4.86
|
|
Inj cntr knee arthro incl ct/mri
|
$100.00 |
$100.00 |
$100.00 |
$464.28
|
|
Inj crotalidae im f(ab')2 eq
|
$847.76 |
$847.76 |
$847.76 |
$2,706.67
|
|
Inj cyclophosphamd (ingenus)
|
$123.18 |
$123.18 |
$123.18 |
$768.17
|
|
Inj, cyclophosphamd, sandoz
|
$4,505.34 |
$4,505.34 |
$4,505.34 |
$423.66
|
|
Inj, daptomycin (hospira)
|
$80.91 |
$80.91 |
$80.91 |
$154.59
|
|
Inj, donanemab-azbt, 2 mg
|
$2,796.56 |
$2,796.56 |
$2,796.56 |
$1,261.94
|
|
Inj, durolane 1 mg
|
$4,482.31 |
$4,482.31 |
$4,482.31 |
$2,181.77
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$435.00 |
$435.00 |
$435.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$100.00 |
$100.00 |
$100.00 |
$507.10
|
|
Injection, belinostat, 10mg
|
$9,971.33 |
$9,971.33 |
$9,971.33 |
$3,631.78
|
|
Injection, cangrelor
|
$4,024.82 |
$4,024.82 |
$4,024.82 |
$1,847.53
|
|
Injection carpal tunnel therapeutic (both sides)
|
$175.00 |
$175.00 |
$175.00 |
$536.00
|
|
Injection, daratumumab 10 mg
|
$2,094.20 |
$2,094.20 |
$2,094.20 |
$5,324.34
|
|
Injection, doxercalciferol
|
$23.83 |
$23.83 |
$23.83 |
$30.77
|
|
Injection during cath supravalvular aortography
|
$162.50 |
$162.50 |
$162.50 |
$1,148.80
|
|
Injection, edaravone, 1 mg
|
$4,275.26 |
$4,275.26 |
$4,275.26 |
$2,788.85
|
|
Injection epidural blood patch or clot
|
$435.00 |
$435.00 |
$435.00 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$100.00 |
$100.00 |
$100.00 |
$441.12
|
|
Injection for bladder x-ray
|
$100.00 |
$100.00 |
$100.00 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$100.00 |
$100.00 |
$100.00 |
$504.00
|
|
Injection for ureter x-ray
|
$100.00 |
$100.00 |
$100.00 |
$444.95
|
|
Injection, fulvestrant
|
$321.42 |
$321.42 |
$321.42 |
$2,550.36
|
|
Injection glatiramer acetate
|
$135.23 |
$135.23 |
$135.23 |
$458.43
|
|
Injection, inclisiran, 1 mg
|
$13,867.96 |
$13,867.96 |
$13,867.96 |
$7,300.18
|
|
Injection, isavuconazonium
|
$219.25 |
$219.25 |
$219.25 |
$862.16
|
|
Injection, necitumumab, 1 mg
|
$215.84 |
$215.84 |
$215.84 |
$5.73
|
|
Injection,onabotulinumtoxina
|
$2,637.12 |
$2,637.12 |
$2,637.12 |
$1,983.20
|
|
Injection, peramivir
|
$38.82 |
$38.82 |
$38.82 |
$911.87
|
|
Injection, renflexis
|
$435.93 |
$435.93 |
$435.93 |
$1,356.10
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$435.00 |
$435.00 |
$435.00 |
$1,491.47
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$435.00 |
$435.00 |
$435.00 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$435.00 |
$435.00 |
$435.00 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$446.25 |
$446.25 |
$446.25 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$200.00 |
$200.00 |
$200.00 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$446.25 |
$446.25 |
$446.25 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$200.00 |
$200.00 |
$200.00 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$446.25 |
$446.25 |
$446.25 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$615.00 |
$615.00 |
$615.00 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$615.00 |
$615.00 |
$615.00 |
$1,758.12
|
|
Injection, siltuximab
|
$6,198.68 |
$6,198.68 |
$6,198.68 |
$8,477.45
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$175.00 |
$175.00 |
$175.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$175.00 |
$175.00 |
$175.00 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$231.25 |
$231.25 |
$231.25 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$76.25 |
$76.25 |
$76.25 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$68.75 |
$68.75 |
$68.75 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$101.25 |
$101.25 |
$101.25 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$68.75 |
$68.75 |
$68.75 |
$141.60
|
|
Inject sacroiliac joint
|
$100.00 |
$100.00 |
$100.00 |
$1,090.00
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$2,135.96 |
$2,135.96 |
$2,135.96 |
$53,243.74
|
|
Inj., emapalumab-lzsg, 1 mg
|
$91,179.27 |
$91,179.27 |
$91,179.27 |
$506.87
|
|
Inj epidural sgl lumb-sacral without img
|
$446.25 |
$446.25 |
$446.25 |
$1,450.84
|
|
Inj., evomela, 1 mg
|
$1,475.98 |
$1,475.98 |
$1,475.98 |
$3,630.00
|
|
Inj. fe derisomaltose 10 mg
|
$13,574.09 |
$13,574.09 |
$13,574.09 |
$207.71
|
|
Inj., fibryga, 1 mg
|
$820.74 |
$820.74 |
$820.74 |
$1.11
|
|
Inj for ext venography
|
$100.00 |
$100.00 |
$100.00 |
$737.55
|
|
Inj fosnetupitant, palonoset
|
$2,686.41 |
$2,686.41 |
$2,686.41 |
$679.51
|
|
Inj, fulvestrant (fresenius)
|
$75.05 |
$75.05 |
$75.05 |
$1,688.69
|
|
Inj, fulvestrant (teva)
|
$57.40 |
$57.40 |
$57.40 |
$46.21
|
|
Inj givosiran 0.5 mg
|
$143,189.76 |
$143,189.76 |
$143,189.76 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$28,418.99 |
$28,418.99 |
$28,418.99 |
$3,683.93
|
