|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$115.80 |
$115.80 |
$115.80 |
$127.80
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$76.80 |
$76.80 |
$76.80 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$22.80 |
$22.80 |
$22.80 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$246.00 |
$246.00 |
$246.00 |
$267.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$202.80 |
$202.80 |
$202.80 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$408.60 |
$408.60 |
$408.60 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$2,393.40 |
$2,393.40 |
$2,393.40 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$75.60 |
$75.60 |
$75.60 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$232.20 |
$232.20 |
$232.20 |
$151.25
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$121.20 |
$121.20 |
$121.20 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$154.20 |
$154.20 |
$154.20 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$106.20 |
$106.20 |
$106.20 |
$100.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$222.60 |
$222.60 |
$222.60 |
$217.70
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$225.00 |
$225.00 |
$225.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$90.60 |
$90.60 |
$90.60 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$70.80 |
$70.80 |
$70.80 |
$105.00
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$184.80 |
$184.80 |
$184.80 |
$184.80
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$831.60 |
$831.60 |
$831.60 |
$711.93
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$406.20 |
$406.20 |
$406.20 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$484.20 |
$484.20 |
$484.20 |
$429.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$244.80 |
$244.80 |
$244.80 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$87.00 |
$87.00 |
$87.00 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$163.20 |
$163.20 |
$163.20 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$269.40 |
$269.40 |
$269.40 |
$374.50
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$348.60 |
$348.60 |
$348.60 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$2,052.00 |
$2,052.00 |
$2,052.00 |
$2,080.86
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$4,087.98 |
$4,087.98 |
$4,087.98 |
$1,617.43
|
|
Influenza dna amp prob addl
|
$51.00 |
$51.00 |
$51.00 |
$64.26
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$203.40 |
$203.40 |
$203.40 |
$293.04
|
|
Initiation & management bipap/cpap initial day
|
$239.40 |
$239.40 |
$239.40 |
$576.00
|
|
Inj., benralizumab, 1 mg
|
$25,259.28 |
$25,259.28 |
$25,259.28 |
$11,604.71
|
|
Inj beta interferon sq 1 mcg
|
$3,955.80 |
$3,955.80 |
$3,955.80 |
$2,856.95
|
|
Inj, bezlotoxumab, 10 mg
|
$16,416.00 |
$16,416.00 |
$16,416.00 |
$7,612.43
|
|
Inj, bupivacaine liposome
|
$388.26 |
$388.26 |
$388.26 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$39.60 |
$39.60 |
$39.60 |
$29.10
|
|
Inj, cefepime hcl (b braun)
|
$134.70 |
$134.70 |
$134.70 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$1,050.60 |
$1,050.60 |
$1,050.60 |
$544.85
|
|
Inj, clindamycin (baxter)
|
$58.92 |
$58.92 |
$58.92 |
$48.39
|
|
Inj cntr knee arthro incl ct/mri
|
$342.60 |
$342.60 |
$342.60 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$2,985.00 |
$2,985.00 |
$2,985.00 |
$2,584.85
|
|
Inj dx for sinogram
|
$141.00 |
$141.00 |
$141.00 |
$413.82
|
|
Injection arthrography hip without anesthesia (both sides)
|
$414.00 |
$414.00 |
$414.00 |
$500.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$571.80 |
$571.80 |
$571.80 |
$504.90
|
|
Injection epidural blood patch or clot
|
$1,484.40 |
$1,484.40 |
$1,484.40 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$177.00 |
$177.00 |
$177.00 |
$441.12
|
|
Injection for bladder x-ray
|
$225.00 |
$225.00 |
$225.00 |
$459.20
|
|
Injection for hip x-ray
|
$476.40 |
$476.40 |
$476.40 |
$669.24
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$520.20 |
$520.20 |
$520.20 |
$494.65
|
|
Injection for ureter x-ray
|
$273.60 |
$273.60 |
$273.60 |
$415.80
|
|
Injection for ureter x-ray
|
$235.20 |
$235.20 |
$235.20 |
$515.21
|
|
Injection, inclisiran, 1 mg
|
$15,499.02 |
$15,499.02 |
$15,499.02 |
$6,679.35
|
|
Injection into brain canal
|
$524.40 |
$524.40 |
$524.40 |
$836.40
|
|
Injection jaw joint x-ray
|
$141.00 |
$141.00 |
$141.00 |
$307.80
|
|
Injection,onabotulinumtoxina
|
$2,812.32 |
$2,812.32 |
$2,812.32 |
$2,241.61
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,058.40 |
$1,058.40 |
$1,058.40 |
$683.28
|
|
Injection, renflexis
|
$3,254.70 |
$3,254.70 |
$3,254.70 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,596.60 |
$1,596.60 |
$1,596.60 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,522.40 |
$2,522.40 |
$2,522.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,870.20 |
$1,870.20 |
$1,870.20 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,017.60 |
$1,017.60 |
$1,017.60 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$7,441.20 |
$7,441.20 |
$7,441.20 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,024.00 |
$3,024.00 |
$3,024.00 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$3,400.80 |
$3,400.80 |
$3,400.80 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,590.00 |
$4,590.00 |
$4,590.00 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,250.00 |
$2,250.00 |
$2,250.00 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,362.80 |
$2,362.80 |
$2,362.80 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$985.80 |
$985.80 |
$985.80 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,233.60 |
$1,233.60 |
$1,233.60 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,233.60 |
$1,233.60 |
$1,233.60 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$251.40 |
$251.40 |
$251.40 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$117.00 |
$117.00 |
$117.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$224.40 |
$224.40 |
$224.40 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$306.00 |
$306.00 |
$306.00 |
$135.20
|
|
Inject/treat eye socket
|
$2,624.40 |
$2,624.40 |
$2,624.40 |
$381.13
|
|
Inj. fe derisomaltose 10 mg
|
$7,888.74 |
$7,888.74 |
$7,888.74 |
$3,540.79
|
|
Inj for ext venography
|
$414.60 |
$414.60 |
$414.60 |
$654.00
|
|
Inj for mammo ductogram
|
$294.60 |
$294.60 |
$294.60 |
$433.50
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$865.80 |
$865.80 |
$865.80 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$408.00 |
$408.00 |
$408.00 |
$235.13
|
|
Inj, lenacapavir, 1 mg
|
$84,240.00 |
$84,240.00 |
$84,240.00 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$175.44 |
$175.44 |
$175.44 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$1,086.18 |
$1,086.18 |
$1,086.18 |
$363.97
|
|
Inj, lidocaine w epinephrine
|
$25.32 |
$25.32 |
$25.32 |
$44.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$2,190.00 |
$2,190.00 |
$2,190.00 |
$783.50
|
|
Inj melpha hydroch nos 50 mg
|
$512.40 |
$512.40 |
$512.40 |
$2,375.23
|
|
Inj, meropenem (b. braun)
|
$135.00 |
$135.00 |
$135.00 |
$71.14
|
|
Inj multihance
|
$61.50 |
$61.50 |
$61.50 |
$79.42
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,496.40 |
$1,496.40 |
$1,496.40 |
$1,414.40
|
|
Inj ogivri 10 mg
|
$13,387.80 |
$13,387.80 |
$13,387.80 |
$4,492.28
|
|
Inj pemetrexed, hospira 10mg
|
$2,539.02 |
$2,539.02 |
$2,539.02 |
$64.35
|
|
Inj peritoneal venous shunt
|
$406.80 |
$406.80 |
$406.80 |
$406.80
|
|
Inj proc ankle arthr
|
$136.80 |
$136.80 |
$136.80 |
$405.31
|
|
Inj proc elbow arthro
|
$166.80 |
$166.80 |
$166.80 |
$432.00
|
|
Inj proc for lymphang
|
$2,300.40 |
$2,300.40 |
$2,300.40 |
$805.80
|
|
Inj proc lumbr disk ea lvl
|
$585.00 |
$585.00 |
$585.00 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$1,265.40 |
$1,265.40 |
$1,265.40 |
$856.00
|
|
Inj proc sialogram
|
$154.20 |
$154.20 |
$154.20 |
$373.00
|
|
Inj progesterone per 50 mg
|
$6.00 |
$6.00 |
$6.00 |
$14.93
|
|
Inj, releuko 1 mcg
|
$1,099.02 |
$1,099.02 |
$1,099.02 |
$461.20
|
|
Inj retro urethrocysto
|
$225.00 |
$225.00 |
$225.00 |
$450.00
|
