|
Infect ag phenotype na hiv-1 ea addl drg
|
$113.75 |
$113.75 |
$113.75 |
$77.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$146.25 |
$146.25 |
$146.25 |
$81.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$100.10 |
$100.10 |
$100.10 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$102.05 |
$102.05 |
$102.05 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$130.65 |
$130.65 |
$130.65 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$26.00 |
$26.00 |
$26.00 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$98.80 |
$98.80 |
$98.80 |
$55.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$78.00 |
$78.00 |
$78.00 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$236.60 |
$236.60 |
$236.60 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$76.70 |
$76.70 |
$76.70 |
$97.50
|
|
Infectious agent nucleic acid amplified probe
|
$391.30 |
$391.30 |
$391.30 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$74.75 |
$74.75 |
$74.75 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$1,120.60 |
$1,120.60 |
$1,120.60 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,156.35 |
$1,156.35 |
$1,156.35 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$96.20 |
$96.20 |
$96.20 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$305.50 |
$305.50 |
$305.50 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$414.70 |
$414.70 |
$414.70 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$74.75 |
$74.75 |
$74.75 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$194.35 |
$194.35 |
$194.35 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$314.60 |
$314.60 |
$314.60 |
$222.60
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$310.70 |
$310.70 |
$310.70 |
$248.15
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$162.50 |
$162.50 |
$162.50 |
$98.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$110.50 |
$110.50 |
$110.50 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$391.30 |
$391.30 |
$391.30 |
$200.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,008.15 |
$1,008.15 |
$1,008.15 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$174.20 |
$174.20 |
$174.20 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$1,008.15 |
$1,008.15 |
$1,008.15 |
$489.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$707.20 |
$707.20 |
$707.20 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$187.20 |
$187.20 |
$187.20 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$768.30 |
$768.30 |
$768.30 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$852.15 |
$852.15 |
$852.15 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$637.65 |
$637.65 |
$637.65 |
$298.35
|
|
Infliximab 100 mg intravenous solution
|
$1,452.46 |
$1,452.46 |
$1,452.46 |
$2,791.24
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,574.50 |
$1,574.50 |
$1,574.50 |
$1,144.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,869.27 |
$1,869.27 |
$1,869.27 |
$1,654.83
|
|
Influenza dna amp prob addl
|
$76.70 |
$76.70 |
$76.70 |
$69.60
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$1,080.30 |
$1,080.30 |
$1,080.30 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$310.70 |
$310.70 |
$310.70 |
$645.79
|
|
Inj andexxa, 10 mg
|
$6,794.00 |
$6,794.00 |
$6,794.00 |
$6,794.00
|
|
Inj anifrolumab-fnia 1mg
|
$17,666.71 |
$17,666.71 |
$17,666.71 |
$9,878.82
|
|
Inj., benralizumab, 1 mg
|
$18,984.78 |
$18,984.78 |
$18,984.78 |
$16,865.48
|
|
Inj, bezlotoxumab, 10 mg
|
$10,299.15 |
$10,299.15 |
$10,299.15 |
$9,702.65
|
|
Inj, bupivacaine liposome
|
$638.07 |
$638.07 |
$638.07 |
$816.31
|
|
Inj cefazolin sodium, hikma
|
$37.21 |
$37.21 |
$37.21 |
$56.70
|
|
Inj, cefepime hcl (b braun)
|
$81.41 |
$81.41 |
$81.41 |
$81.41
|
|
Inj cntr knee arthro incl ct/mri
|
$2,739.75 |
$2,739.75 |
$2,739.75 |
$464.28
|
|
Inj cyclophosphamd (ingenus)
|
$614.70 |
$614.70 |
$614.70 |
$1,040.94
|
|
Inj disk cerv-thor ea lev
|
$2,696.85 |
$2,696.85 |
$2,696.85 |
$869.80
|
|
Inj, donanemab-azbt, 2 mg
|
$2,305.81 |
$2,305.81 |
$2,305.81 |
$121.74
|
|
Inj, durolane 1 mg
|
$3,382.31 |
$3,382.31 |
$3,382.31 |
$3,382.31
|
|
Inj dx for sinogram
|
$2,885.35 |
$2,885.35 |
$2,885.35 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$5,428.80 |
$5,428.80 |
$5,428.80 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$2,476.50 |
$2,476.50 |
$2,476.50 |
$507.10
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,086.80 |
$1,086.80 |
$1,086.80 |
$536.00
|
|
Injection, daratumumab 10 mg
|
$8,376.65 |
$8,376.65 |
$8,376.65 |
$7,107.73
|
|
Injection during cath supravalvular aortography
|
$1,985.10 |
$1,985.10 |
$1,985.10 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$2,941.25 |
$2,941.25 |
$2,941.25 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$1,631.50 |
$1,631.50 |
$1,631.50 |
$441.12
|
|
Injection for bladder x-ray
|
$1,756.95 |
$1,756.95 |
$1,756.95 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$1,667.90 |
$1,667.90 |
$1,667.90 |
$504.00
|
|
Injection for spleen x-ray
|
$178.10 |
$178.10 |
$178.10 |
$686.40
|
|
Injection for ureter x-ray
|
$2,148.90 |
$2,148.90 |
$2,148.90 |
$444.95
|
|
Injection for ureter x-ray
|
$1,988.35 |
$1,988.35 |
$1,988.35 |
$515.21
|
|
Injection, fulvestrant
|
$142.32 |
$142.32 |
$142.32 |
$2,756.47
|
|
Injection, inclisiran, 1 mg
|
$11,657.30 |
$11,657.30 |
$11,657.30 |
$10,366.61
|
|
Injection into brain canal
|
$109.85 |
$109.85 |
$109.85 |
$933.60
|
|
Injection jugular
|
$289.90 |
$289.90 |
$289.90 |
$1,048.20
|
|
Injection of sinus tract
|
$1,420.25 |
$1,420.25 |
$1,420.25 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$4,286.75 |
$4,286.75 |
$4,286.75 |
$2,154.07
|
|
Injection radioactive tracer sentinel node (both sides)
|
$2,096.90 |
$2,096.90 |
$2,096.90 |
$717.20
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$4,443.40 |
$4,443.40 |
$4,443.40 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,256.50 |
$3,256.50 |
$3,256.50 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,151.80 |
$1,151.80 |
$1,151.80 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,338.40 |
$3,338.40 |
$3,338.40 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,589.25 |
$1,589.25 |
$1,589.25 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$6,463.60 |
$6,463.60 |
$6,463.60 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,509.30 |
$1,509.30 |
$1,509.30 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$6,471.40 |
$6,471.40 |
$6,471.40 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$4,642.30 |
$4,642.30 |
$4,642.30 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$4,173.65 |
$4,173.65 |
$4,173.65 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$2,853.50 |
$2,853.50 |
$2,853.50 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,287.65 |
$1,287.65 |
$1,287.65 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$209.95 |
$209.95 |
$209.95 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$156.65 |
$156.65 |
$156.65 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$228.15 |
$228.15 |
$228.15 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$184.60 |
$184.60 |
$184.60 |
$141.60
|
|
Injection treatment of nerve
|
$5,038.80 |
$5,038.80 |
$5,038.80 |
$3,016.15
|
|
Injection treatment of nerve
|
$3,140.80 |
$3,140.80 |
$3,140.80 |
$2,037.10
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$53,243.74 |
$53,243.74 |
$53,243.74 |
$66,229.74
|
|
Inj epidural sgl cerv-thor without img
|
$3,816.80 |
$3,816.80 |
$3,816.80 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$3,231.80 |
$3,231.80 |
$3,231.80 |
$1,450.84
|
|
Inj, evinacumab-dgnb, 5mg
|
$34,403.59 |
$34,403.59 |
$34,403.59 |
$186.31
|
|
Inj fluphenazine hcl 1.25 mg
|
$37.93 |
$37.93 |
$37.93 |
$37.93
|
|
Inj for ext venography
|
$2,675.40 |
$2,675.40 |
$2,675.40 |
$737.55
|
|
Inj for mammo ductogram
|
$3,094.00 |
$3,094.00 |
$3,094.00 |
$433.50
|
|
Inj., guselkumab, 1 mg
|
$39,308.75 |
$39,308.75 |
$39,308.75 |
$74.86
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,172.30 |
$2,172.30 |
$2,172.30 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$740.35 |
$740.35 |
$740.35 |
$947.65
|
|
Inj hydroxocobalamin IV 25mg
|
$3,180.35 |
$3,180.35 |
$3,180.35 |
$3,180.35
|