|
Infect ag if pneumocystis carinii
|
$227.40 |
$227.40 |
$227.40 |
$53.81
|
|
Infect ag na hep b amp
|
$277.80 |
$277.80 |
$277.80 |
$108.44
|
|
Infect ag na herpes simplex quant
|
$77.40 |
$77.40 |
$77.40 |
$145.20
|
|
Infect ag na hpv high-risk types
|
$295.20 |
$295.20 |
$295.20 |
$147.00
|
|
Infect ag na influenza r/amp 1st 2 types
|
$375.60 |
$375.60 |
$375.60 |
$248.80
|
|
Infect ag na influenza revr/amp ea type
|
$158.40 |
$158.40 |
$158.40 |
$151.80
|
|
Infect ag na resp virus 12-25 targets
|
$1,505.40 |
$1,505.40 |
$1,505.40 |
$878.20
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$877.20 |
$877.20 |
$877.20 |
$843.26
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$58.80 |
$58.80 |
$58.80 |
$117.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$324.60 |
$324.60 |
$324.60 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$129.00 |
$129.00 |
$129.00 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$136.80 |
$136.80 |
$136.80 |
$73.45
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$203.40 |
$203.40 |
$203.40 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$208.80 |
$208.80 |
$208.80 |
$75.27
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$129.60 |
$129.60 |
$129.60 |
$60.95
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$190.20 |
$190.20 |
$190.20 |
$107.90
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$238.20 |
$238.20 |
$238.20 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$250.80 |
$250.80 |
$250.80 |
$98.40
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$81.00 |
$81.00 |
$81.00 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$404.40 |
$404.40 |
$404.40 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$253.20 |
$253.20 |
$253.20 |
$144.00
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$228.00 |
$228.00 |
$228.00 |
$174.06
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$198.00 |
$198.00 |
$259.80 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$375.60 |
$375.60 |
$375.60 |
$148.80
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$504.60 |
$504.60 |
$504.60 |
$217.10
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$253.20 |
$253.20 |
$253.20 |
$134.55
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$406.20 |
$406.20 |
$406.20 |
$109.18
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$124.80 |
$124.80 |
$124.80 |
$194.40
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$154.20 |
$154.20 |
$154.20 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$404.40 |
$404.40 |
$404.40 |
$135.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,041.00 |
$1,041.00 |
$1,041.00 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$608.40 |
$608.40 |
$608.40 |
$300.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$907.20 |
$907.20 |
$907.20 |
$280.20
|
|
Infectious agent nucleic acid quantification hiv-1
|
$655.20 |
$655.20 |
$655.20 |
$381.55
|
|
Infliximab 100 mg intravenous solution
|
$23.58 |
$23.58 |
$23.58 |
$178.95
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$20.66 |
$20.66 |
$20.66 |
$157.14
|
|
Influenza dna amp prob addl
|
$78.00 |
$78.00 |
$78.00 |
$75.80
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$513.00 |
$513.00 |
$513.00 |
$344.50
|
|
Initiation & management bipap/cpap initial day
|
$685.20 |
$685.20 |
$685.20 |
$608.40
|
|
Inj allopurinol sodium 1 mg
|
$5,992.97 |
$5,992.97 |
$5,992.97 |
$5,937.23
|
|
Inj, amisulpride, 1 mg
|
$313.65 |
$313.65 |
$313.65 |
$9.66
|
|
Inj, aspara, rylaze, 0.1 mg
|
$790.20 |
$790.20 |
$790.20 |
$99.60
|
|
Inj., benralizumab, 1 mg
|
$8,674.10 |
$8,674.10 |
$8,674.10 |
$12,417.10
|
|
Inj calcitriol per 0.1 mcg
|
$40.17 |
$40.17 |
$40.17 |
$11.21
|
|
Inj cefazolin sodium, hikma
|
$104.18 |
$104.18 |
$104.18 |
$66.38
|
|
Inj, cefiderocol, 10 mg
|
$3.83 |
$3.83 |
$3.83 |
$79.20
|
|
Inj ceftolozane tazobactam
|
$239.31 |
$239.31 |
$248.93 |
$248.93
|
|
Inj cntr knee arthro incl ct/mri
|
$505.20 |
$505.20 |
$505.20 |
$505.20
|
|
Inj disk cerv-thor ea lev
|
$1,923.60 |
$1,923.60 |
$1,923.60 |
$828.00
|
|
Inj dx for sinogram
|
$734.40 |
$734.40 |
$734.40 |
$484.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$853.80 |
$853.80 |
$853.80 |
$609.20
|
|
Injection, burosumab-twza 1m
|
$590.52 |
$590.52 |
$590.52 |
$481.57
|
|
Injection, doxercalciferol
|
$45.89 |
$45.89 |
$45.89 |
$30.35
|
|
Injection during cath supravalvular aortography
|
$2,796.00 |
$2,796.00 |
$2,796.00 |
$1,604.20
|
|
Injection, edaravone, 1 mg
|
$1,721.40 |
$1,721.40 |
$1,721.40 |
$1,721.40
|
|
Injection epidural blood patch or clot
|
$1,537.20 |
$1,537.20 |
$1,537.20 |
$1,470.60
|
|
Injection for arthrography wrist (both sides)
|
$618.00 |
$618.00 |
$618.00 |
$521.18
|
|
Injection for bladder x-ray
|
$560.40 |
$560.40 |
$560.40 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$684.60 |
$684.60 |
$684.60 |
$514.36
|
|
Injection for spleen x-ray
|
$1,550.40 |
$1,550.40 |
$1,550.40 |
$341.60
|
|
Injection for tear sac x-ray
|
$622.80 |
$622.80 |
$622.80 |
$386.00
|
|
Injection for ureter x-ray
|
$2,236.80 |
$2,236.80 |
$2,236.80 |
$349.55
|
|
Injection for ureter x-ray
|
$2,074.20 |
$2,074.20 |
$2,074.20 |
$544.50
|
|
Injection, fulvestrant
|
$1,660.11 |
$1,660.11 |
$1,660.11 |
$166.25
|
|
Injection glatiramer acetate
|
$418.45 |
$418.45 |
$418.45 |
$458.43
|
|
Injection, inclisiran, 1 mg
|
$5,431.58 |
$5,431.58 |
$5,431.58 |
$12.72
|
|
Injection into brain canal
|
$836.40 |
$836.40 |
$836.40 |
$961.20
|
|
Injection, isavuconazonium
|
$634.28 |
$634.28 |
$634.28 |
$634.28
|
|
Injection jugular
|
$1,607.40 |
$1,607.40 |
$1,607.40 |
$1,134.12
|
|
Injection, necitumumab, 1 mg
|
$8.12 |
$8.12 |
$8.12 |
$5.73
|
|
Injection of sinus tract
|
$1,271.40 |
$1,271.40 |
$1,271.40 |
$1,639.57
|
|
Injection,onabotulinumtoxina
|
$1,461.60 |
$1,461.60 |
$1,461.60 |
$12.88
|
|
Injection, peramivir
|
$857.20 |
$857.20 |
$857.20 |
$857.20
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,740.00 |
$1,740.00 |
$1,740.00 |
$787.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,596.00 |
$4,596.00 |
$4,596.00 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$3,252.60 |
$3,252.60 |
$3,252.60 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$8,260.80 |
$8,260.80 |
$8,260.80 |
$1,985.61
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,124.60 |
$2,124.60 |
$2,124.60 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$5,310.00 |
$5,310.00 |
$5,310.00 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,942.40 |
$2,942.40 |
$2,942.40 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$534.60 |
$534.60 |
$534.60 |
$460.94
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$216.00 |
$216.00 |
$216.00 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$155.40 |
$155.40 |
$155.40 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$306.60 |
$306.60 |
$306.60 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$157.20 |
$157.20 |
$157.20 |
$130.19
|
|
Injection torsemide 10 mg/ml
|
$40.94 |
$40.94 |
$40.94 |
$40.67
|
|
Inject sacroiliac joint
|
$2,218.80 |
$2,218.80 |
$4,227.00 |
$1,028.95
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$181.35 |
$181.35 |
$181.35 |
$39,043.20
|
|
Inj, factor x, (human), 1iu
|
$12.54 |
$12.54 |
$12.54 |
$12.54
|
|
Inj fluphenazine hcl 1.25 mg
|
$266.49 |
$266.49 |
$266.49 |
$29.65
|
|
Inj for ext venography
|
$1,202.40 |
$1,202.40 |
$1,202.40 |
$946.64
|
|
Inj for mammo ductogram
|
$606.60 |
$606.60 |
$606.60 |
$469.16
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,358.80 |
$3,358.80 |
$3,358.80 |
$1,646.97
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,209.40 |
$3,209.40 |
$3,209.40 |
$2,471.00
|
|
Inj hrt cath w/s&i sel hrt art
|
$4,933.80 |
$4,933.80 |
$4,933.80 |
$1,192.50
|
|
Inj hrt cath w/s&i sel left vent
|
$2,796.00 |
$2,796.00 |
$2,796.00 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$2,898.60 |
$2,898.60 |
$2,898.60 |
$1,352.65
|
|
Inj human fibrinogen con nos
|
$3.16 |
$3.16 |
$3.16 |
$2.41
|
|
Inj hydroxocobalamin IV 25mg
|
$1,593.19 |
$1,593.19 |
$1,593.19 |
$1,593.19
|
