|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$40.20 |
$40.20 |
$40.20 |
$98.58
|
|
Infectious agent nucleic acid amplified probe
|
$194.40 |
$194.40 |
$194.40 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$72.60 |
$72.60 |
$72.60 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$194.40 |
$194.40 |
$194.40 |
$167.05
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$194.40 |
$194.40 |
$194.40 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$194.40 |
$194.40 |
$194.40 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$194.40 |
$194.40 |
$194.40 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$72.60 |
$72.60 |
$72.60 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$194.40 |
$194.40 |
$194.40 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$194.40 |
$194.40 |
$194.40 |
$206.00
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$194.40 |
$194.40 |
$194.40 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$72.60 |
$72.60 |
$72.60 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$292.20 |
$292.20 |
$292.20 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$97.20 |
$97.20 |
$97.20 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$194.40 |
$194.40 |
$194.40 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$259.80 |
$259.80 |
$259.80 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$259.80 |
$259.80 |
$259.80 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$259.80 |
$259.80 |
$259.80 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$259.80 |
$259.80 |
$259.80 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$97.20 |
$97.20 |
$97.20 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$540.60 |
$540.60 |
$540.60 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$55.80 |
$55.80 |
$55.80 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$37.80 |
$37.80 |
$37.80 |
$1,537.84
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$75.60 |
$75.60 |
$75.60 |
$111.51
|
|
Infuse radioactive materials
|
$186.60 |
$186.60 |
$186.60 |
$739.50
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$95.40 |
$95.40 |
$95.40 |
$296.00
|
|
Inj., benralizumab, 1 mg
|
$5,853.00 |
$5,853.00 |
$5,853.00 |
$11,310.00
|
|
Inj, cefepime hcl (b braun)
|
$20.40 |
$20.40 |
$20.40 |
$69.85
|
|
Inj ceftolozane tazobactam
|
$164.40 |
$164.40 |
$164.40 |
$364.86
|
|
Inj, clevidipine butyrate
|
$94.20 |
$94.20 |
$94.20 |
$4.86
|
|
Inj cntr knee arthro incl ct/mri
|
$0.60 |
$0.60 |
$0.60 |
$436.80
|
|
Inj crotalidae im f(ab')2 eq
|
$1,134.60 |
$1,134.60 |
$1,134.60 |
$2,613.60
|
|
Inj dx for sinogram
|
$0.60 |
$0.60 |
$0.60 |
$436.00
|
|
Injection, cangrelor
|
$1,013.40 |
$1,013.40 |
$1,013.40 |
$1,889.78
|
|
Injection, daratumumab 10 mg
|
$3,195.00 |
$3,195.00 |
$3,195.00 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$0.60 |
$0.60 |
$0.60 |
$1,027.26
|
|
Injection for bladder x-ray
|
$0.60 |
$0.60 |
$0.60 |
$459.20
|
|
Injection for ureter x-ray
|
$0.60 |
$0.60 |
$0.60 |
$515.21
|
|
Injection, fulvestrant
|
$71.40 |
$71.40 |
$71.40 |
$1,719.16
|
|
Injection into brain canal
|
$117.00 |
$117.00 |
$117.00 |
$1,289.60
|
|
Injection,onabotulinumtoxina
|
$721.20 |
$721.20 |
$721.20 |
$2,277.65
|
|
Injection, renflexis
|
$798.00 |
$798.00 |
$798.00 |
$1,341.52
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$0.60 |
$0.60 |
$0.60 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$0.60 |
$0.60 |
$0.60 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$0.60 |
$0.60 |
$0.60 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$0.60 |
$0.60 |
$0.60 |
$2,006.79
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$0.60 |
$0.60 |
$0.60 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$28.80 |
$28.80 |
$28.80 |
$145.60
|
|
Inj for ext venography
|
$0.60 |
$0.60 |
$0.60 |
$628.80
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$0.60 |
$0.60 |
$0.60 |
$1,492.00
|
|
Inj hrt cath w/s&i sel left vent
|
$0.60 |
$0.60 |
$0.60 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$0.60 |
$0.60 |
$0.60 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$2,452.32
|
|
Inj ivig privigen 500 mg
|
$4,935.60 |
$4,935.60 |
$4,935.60 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$8,487.60 |
$8,487.60 |
$8,487.60 |
$11,648.70
|
|
Inj levocarnitine per 1 gm
|
$16.20 |
$16.20 |
$16.20 |
$136.62
|
|
Inj., lumoxiti, 0.01 mg
|
$31.20 |
$31.20 |
$31.20 |
$3,881.27
|
|
Inj melpha hydroch nos 50 mg
|
$1,156.20 |
$1,156.20 |
$1,156.20 |
$1,713.99
|
|
Inj., meropenem, vaborbactam
|
$198.00 |
$198.00 |
$198.00 |
$556.87
|
|
Inj meropenem (wg crit care)
|
$34.20 |
$34.20 |
$34.20 |
$82.42
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$0.60 |
$0.60 |
$0.60 |
$1,413.35
|
|
Inj ogivri 10 mg
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$4,492.28
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$5,157.00 |
$5,157.00 |
$5,157.00 |
$6,614.40
|
|
Inj peritoneal venous shunt
|
$0.60 |
$0.60 |
$0.60 |
$406.80
|
|
Inj retro urethrocysto
|
$0.60 |
$0.60 |
$0.60 |
$447.74
|
|
Inj secretin synthetic human
|
$630.00 |
$630.00 |
$630.00 |
$1,253.09
|
|
Inj, sutimlimab-jome, 10 mg
|
$2,256.00 |
$2,256.00 |
$2,256.00 |
$3,453.73
|
|
Inj, tislelizumab-jsgr
|
$64.20 |
$64.20 |
$64.20 |
$9,764.09
|
|
Inj w/fluor eval cv device
|
$0.60 |
$0.60 |
$0.60 |
$504.40
|
|
Ins cath ren art 1st bi
|
$0.60 |
$0.60 |
$0.60 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$0.60 |
$0.60 |
$0.60 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$0.60 |
$0.60 |
$0.60 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$0.60 |
$0.60 |
$0.60 |
$5,395.20
|
|
Insert abdomen-venous drain
|
$0.60 |
$0.60 |
$0.60 |
$4,039.47
|
|
Insert hepatic shunt (tips)
|
$0.60 |
$0.60 |
$0.60 |
$7,571.20
|
|
Insertion catheter bladder non indwelling
|
$117.00 |
$117.00 |
$117.00 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$0.60 |
$0.60 |
$0.60 |
$4,897.20
|
|
Insertion intra aortic balloon assist device percutaneous
|
$0.60 |
$0.60 |
$0.60 |
$2,447.63
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$0.60 |
$0.60 |
$0.60 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$0.60 |
$0.60 |
$0.60 |
$2,585.25
|
|
Insertion of catheter vein
|
$0.60 |
$0.60 |
$0.60 |
$1,525.80
|
|
Insertion of catheter vein
|
$0.60 |
$0.60 |
$0.60 |
$870.59
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$0.60 |
$0.60 |
$0.60 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$0.60 |
$0.60 |
$0.60 |
$12,324.60
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$0.60 |
$0.60 |
$0.60 |
$9,884.16
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$0.60 |
$0.60 |
$0.60 |
$2,103.75
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$0.60 |
$0.60 |
$0.60 |
$29,180.00
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$0.60 |
$0.60 |
$0.60 |
$7,183.68
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$0.60 |
$0.60 |
$0.60 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$0.60 |
$0.60 |
$0.60 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$0.60 |
$0.60 |
$0.60 |
$5,236.80
|
|
Insert picvad cath
|
$0.60 |
$0.60 |
$0.60 |
$4,195.00
|
|
Insert pm/icd lead dual
|
$0.60 |
$0.60 |
$0.60 |
$7,115.90
|
|
Insert/repl sq defib w/eltrd
|
$0.60 |
$0.60 |
$0.60 |
$33,593.55
|
|
Insert sq defib electrode
|
$0.60 |
$0.60 |
$0.60 |
$8,167.68
|
|
Insert swan-ganz cath
|
$0.60 |
$0.60 |
$0.60 |
$2,164.52
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$0.60 |
$0.60 |
$0.60 |
$4,997.60
|
|
Insert tunneled cv cath
|
$0.60 |
$0.60 |
$0.60 |
$4,520.00
|
|
Insert tunneled cv cath
|
$0.60 |
$0.60 |
$0.60 |
$6,028.07
|
|
Insert vad art access left hrt arterial access
|
$0.60 |
$0.60 |
$0.60 |
$4,276.00
|