|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$196.80 |
$196.80 |
$196.80 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$267.00 |
$267.00 |
$267.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$96.00 |
$96.00 |
$96.00 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$129.00 |
$129.00 |
$129.00 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,050.60 |
$1,050.60 |
$1,050.60 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$300.00 |
$300.00 |
$300.00 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$190.20 |
$190.20 |
$190.20 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$472.20 |
$472.20 |
$472.20 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$310.80 |
$310.80 |
$310.80 |
$375.00
|
|
Infliximab 100 mg intravenous solution
|
$2,080.86 |
$2,080.86 |
$2,080.86 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$898.02 |
$898.02 |
$898.02 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,688.48 |
$1,688.48 |
$1,688.48 |
$1,537.84
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$73.99 |
$73.99 |
$73.99 |
$111.51
|
|
Influenza virus vaccine, live trivalent intranasal
|
$63.28 |
$63.28 |
$63.28 |
$36.50
|
|
Initial foot exam pt lops
|
$127.20 |
$127.20 |
$127.20 |
$155.50
|
|
Initial hosp neonate 28 d/less than not critically ill 99477
|
$705.00 |
$705.00 |
$705.00 |
$629.60
|
|
Initial nursing facility care/day 35 minutes
|
$253.20 |
$253.20 |
$253.20 |
$188.50
|
|
Initial nursing facility care/day 45 minutes
|
$322.20 |
$322.20 |
$322.20 |
$236.80
|
|
Initial nursing facility care/day low severity 99304
|
$178.80 |
$178.80 |
$178.80 |
$128.00
|
|
Initial observation care
|
$196.20 |
$196.20 |
$196.20 |
$156.00
|
|
Initial observation care
|
$268.20 |
$268.20 |
$268.20 |
$268.20
|
|
Initial observation care
|
$369.00 |
$369.00 |
$369.00 |
$369.00
|
|
Init pm e/m new pat 65+ yrs
|
$270.00 |
$270.00 |
$270.00 |
$189.15
|
|
Inj, abilify maintena, 1 mg
|
$5,156.77 |
$5,156.77 |
$5,156.77 |
$5,355.30
|
|
Inj, adalimumab, 1 mg
|
$6,143.09 |
$6,143.09 |
$6,143.09 |
$12,098.05
|
|
Inj anifrolumab-fnia 1mg
|
$9,648.88 |
$9,648.88 |
$9,648.88 |
$10,052.58
|
|
Inj., aristada initio, 1 mg
|
$4,325.66 |
$4,325.66 |
$4,325.66 |
$4,052.45
|
|
Inj aval alfa-nqpt 4mg
|
$3,478.84 |
$3,478.84 |
$3,478.84 |
$3,907.30
|
|
Inj., benralizumab, 1 mg
|
$10,067.08 |
$10,067.08 |
$10,067.08 |
$11,310.00
|
|
Inj, bezlotoxumab, 10 mg
|
$6,760.17 |
$6,760.17 |
$6,760.17 |
$7,612.43
|
|
Inj calcitriol per 0.1 mcg
|
$22.69 |
$22.69 |
$22.69 |
$22.69
|
|
Inj, cefepime hcl (b braun)
|
$64.46 |
$64.46 |
$64.46 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$442.01 |
$442.01 |
$442.01 |
$544.85
|
|
Inj cntr knee arthro incl ct/mri
|
$166.80 |
$166.80 |
$166.80 |
$436.80
|
|
Inj cyclophosphamd (ingenus)
|
$1,338.80 |
$1,338.80 |
$1,338.80 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$152.35 |
$152.35 |
$152.35 |
$128.08
|
|
Inj. denosumab-bbdz, 1 mg
|
$5,694.89 |
$5,694.89 |
$5,694.89 |
$4,615.43
|
|
Inj disk cerv-thor ea lev
|
$396.60 |
$396.60 |
$396.60 |
$875.28
|
|
Inj, donanemab-azbt, 2 mg
|
$1,277.15 |
$1,277.15 |
$1,277.15 |
$1,233.44
|
|
Inj, durolane 1 mg
|
$1,987.31 |
$1,987.31 |
$1,987.31 |
$1,950.93
|
|
Inj dx for sinogram
|
$409.20 |
$409.20 |
$409.20 |
$436.00
|
|
Inject for sacroiliac joint
|
$258.60 |
$258.60 |
$258.60 |
$1,025.77
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$414.00 |
$414.00 |
$414.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$249.60 |
$249.60 |
$249.60 |
$503.50
|
|
Injection, cangrelor
|
$1,356.24 |
$1,356.24 |
$1,356.24 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$142.80 |
$142.80 |
$142.80 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$5,239.24 |
$5,239.24 |
$5,239.24 |
$5,324.34
|
|
Injection, doxercalciferol
|
$58.44 |
$58.44 |
$58.44 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$171.00 |
$171.00 |
$171.00 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$928.20 |
$928.20 |
$928.20 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$270.60 |
$270.60 |
$270.60 |
$436.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$582.60 |
$582.60 |
$582.60 |
$497.76
|
|
Injection, fulvestrant
|
$3,446.87 |
$3,446.87 |
$3,446.87 |
$1,719.16
|
|
Injection glatiramer acetate
|
$3,493.72 |
$3,493.72 |
$3,493.72 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$5,987.41 |
$5,987.41 |
$5,987.41 |
$6,679.35
|
|
Injection, isavuconazonium
|
$674.71 |
$674.71 |
$674.71 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$2,318.52 |
$2,318.52 |
$2,318.52 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$78.60 |
$78.60 |
$78.60 |
$685.44
|
|
Injection, renflexis
|
$1,346.83 |
$1,346.83 |
$1,346.83 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$778.20 |
$778.20 |
$778.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$241.20 |
$241.20 |
$241.20 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$481.80 |
$481.80 |
$481.80 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,848.00 |
$1,848.00 |
$1,848.00 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$988.20 |
$988.20 |
$988.20 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,632.60 |
$1,632.60 |
$1,632.60 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,048.20 |
$1,048.20 |
$1,048.20 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,632.60 |
$1,632.60 |
$1,632.60 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$610.80 |
$610.80 |
$610.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$639.60 |
$639.60 |
$639.60 |
$1,685.00
|
|
Injection, siltuximab
|
$9,427.67 |
$9,427.67 |
$9,427.67 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$348.00 |
$348.00 |
$348.00 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$363.60 |
$363.60 |
$363.60 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$436.20 |
$436.20 |
$436.20 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$106.80 |
$106.80 |
$106.80 |
$145.60
|
|
Injection torsemide 10 mg/ml
|
$26.06 |
$26.06 |
$26.06 |
$16.02
|
|
Inject sacroiliac joint
|
$1,168.20 |
$1,168.20 |
$1,168.20 |
$1,029.04
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$28,508.30 |
$28,508.30 |
$28,508.30 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$190.80 |
$190.80 |
$190.80 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$164.40 |
$164.40 |
$164.40 |
$1,450.84
|
|
Inj for ext venography
|
$660.00 |
$660.00 |
$660.00 |
$628.80
|
|
Inj for mammo ductogram
|
$462.00 |
$462.00 |
$462.00 |
$397.80
|
|
Inj heparin, pfizer, 1000u
|
$18.40 |
$18.40 |
$18.40 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$8,322.19 |
$8,322.19 |
$8,322.19 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,183.60 |
$3,183.60 |
$3,183.60 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$658.80 |
$658.80 |
$658.80 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$664.20 |
$664.20 |
$664.20 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$823.80 |
$823.80 |
$823.80 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$184.80 |
$184.80 |
$184.80 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$1,797.27 |
$1,797.27 |
$1,797.27 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$1,271.73 |
$1,271.73 |
$1,271.73 |
$1,228.59
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$561.60 |
$561.60 |
$561.60 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$154.80 |
$154.80 |
$154.80 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$134.40 |
$134.40 |
$134.40 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$13,368.87 |
$13,368.87 |
$13,368.87 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$15,763.10 |
$15,763.10 |
$15,763.10 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,174.88 |
$1,174.88 |
$1,174.88 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$65.56 |
$65.56 |
$65.56 |
$136.62
|
|
Inj melpha hydroch nos 50 mg
|
$2,951.66 |
$2,951.66 |
$2,951.66 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$30.04 |
$30.04 |
$30.04 |
$34.34
|
|
Inj, moxifloxacin 100 mg
|
$120.04 |
$120.04 |
$120.04 |
$101.31
|