|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$572.40 |
$572.40 |
$572.40 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$111.60 |
$111.60 |
$111.60 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$122.40 |
$122.40 |
$122.40 |
$100.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$191.40 |
$191.40 |
$191.40 |
$217.70
|
|
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
|
$91.80 |
$91.80 |
$91.80 |
$105.00
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$184.20 |
$184.20 |
$184.20 |
$184.80
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$603.60 |
$603.60 |
$603.60 |
$711.93
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$261.00 |
$261.00 |
$261.00 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$272.40 |
$272.40 |
$272.40 |
$429.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$655.80 |
$655.80 |
$655.80 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$278.40 |
$278.40 |
$278.40 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$398.40 |
$398.40 |
$398.40 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$310.20 |
$310.20 |
$310.20 |
$374.50
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$243.60 |
$243.60 |
$243.60 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$4,519.50 |
$4,519.50 |
$4,519.50 |
$2,080.86
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,935.00 |
$1,935.00 |
$1,935.00 |
$1,095.60
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,662.16 |
$3,662.16 |
$3,662.16 |
$1,617.43
|
|
Inj, abilify maintena, 1 mg
|
$0.06 |
$0.06 |
$0.06 |
$5,355.30
|
|
Inj anifrolumab-fnia 1mg
|
$21,055.32 |
$21,055.32 |
$21,055.32 |
$10,052.58
|
|
Inj atezolizumb 5mg hya-tqjs
|
$46,241.58 |
$46,241.58 |
$46,241.58 |
$18,716.52
|
|
Inj, bezlotoxumab, 10 mg
|
$14,706.00 |
$14,706.00 |
$14,706.00 |
$7,612.43
|
|
Inj, bortezomib, hospira
|
$323.88 |
$323.88 |
$323.88 |
$175.35
|
|
Inj cefazolin sodium, baxter
|
$61.44 |
$61.44 |
$61.44 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$68.46 |
$68.46 |
$68.46 |
$29.10
|
|
Inj, cefiderocol, 10 mg
|
$2,724.24 |
$2,724.24 |
$2,724.24 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$2,040.06 |
$2,040.06 |
$2,040.06 |
$408.00
|
|
Inj, clindamycin (baxter)
|
$83.10 |
$83.10 |
$83.10 |
$48.39
|
|
Inj cntr knee arthro incl ct/mri
|
$381.00 |
$381.00 |
$381.00 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$496.08 |
$496.08 |
$496.08 |
$2,584.85
|
|
Inj, cyclophosphamd, sandoz
|
$480.42 |
$480.42 |
$480.42 |
$735.20
|
|
Inj daptomycin (xellia)
|
$232.20 |
$232.20 |
$232.20 |
$56.04
|
|
Inj. denosumab-bbdz, 1 mg
|
$12,415.98 |
$12,415.98 |
$12,415.98 |
$4,416.07
|
|
Inj dx for sinogram
|
$468.60 |
$468.60 |
$468.60 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$8,125.44 |
$8,125.44 |
$8,125.44 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$848.40 |
$848.40 |
$848.40 |
$500.50
|
|
Injection, cangrelor
|
$11,714.04 |
$11,714.04 |
$11,714.04 |
$1,889.78
|
|
Injection, doxercalciferol
|
$9.00 |
$9.00 |
$9.00 |
$23.12
|
|
Injection for arthrography wrist (both sides)
|
$407.40 |
$407.40 |
$407.40 |
$441.12
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$468.60 |
$468.60 |
$468.60 |
$494.65
|
|
Injection, inclisiran, 1 mg
|
$13,884.54 |
$13,884.54 |
$13,884.54 |
$6,679.35
|
|
Injection jaw joint x-ray
|
$153.60 |
$153.60 |
$153.60 |
$307.80
|
|
Injection jugular
|
$319.80 |
$319.80 |
$319.80 |
$790.00
|
|
Injection of sinus tract
|
$1,747.80 |
$1,747.80 |
$1,747.80 |
$1,627.60
|
|
Injection,onabotulinumtoxina
|
$2,519.40 |
$2,519.40 |
$2,519.40 |
$2,241.61
|
|
Injection, peramivir
|
$441.78 |
$441.78 |
$441.78 |
$775.82
|
|
Injection radioactive tracer sentinel node (both sides)
|
$31,345.87 |
$31,345.87 |
$31,345.87 |
$683.28
|
|
Injection, renflexis
|
$2,915.64 |
$2,915.64 |
$2,915.64 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$8,033.46 |
$8,033.46 |
$8,033.46 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,774.20 |
$1,774.20 |
$1,774.20 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$8,125.92 |
$8,125.92 |
$8,125.92 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$8,232.78 |
$8,232.78 |
$8,232.78 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$10,936.74 |
$10,936.74 |
$10,936.74 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$10,037.10 |
$10,037.10 |
$10,037.10 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$10,065.54 |
$10,065.54 |
$10,065.54 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$10,020.66 |
$10,020.66 |
$10,020.66 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$8,209.50 |
$8,209.50 |
$8,209.50 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$9,037.92 |
$9,037.92 |
$9,037.92 |
$1,704.78
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$741.60 |
$741.60 |
$741.60 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$741.60 |
$741.60 |
$741.60 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$105.00 |
$105.00 |
$105.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$150.00 |
$150.00 |
$150.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$136.20 |
$136.20 |
$136.20 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$84.00 |
$84.00 |
$84.00 |
$135.20
|
|
Inject sacroiliac joint
|
$2,218.20 |
$2,218.20 |
$2,218.20 |
$963.00
|
|
Inject/treat eye socket
|
$662.40 |
$662.40 |
$662.40 |
$381.13
|
|
Inj, eculizumab-aagh, 2 mg
|
$17,670.42 |
$17,670.42 |
$17,670.42 |
$7,410.48
|
|
Inj eflapegrastim-xnst 0.1mg
|
$52,650.00 |
$52,650.00 |
$52,650.00 |
$22.75
|
|
Inj for ext venography
|
$570.00 |
$570.00 |
$570.00 |
$654.00
|
|
Inj for mammo ductogram
|
$240.60 |
$240.60 |
$240.60 |
$433.50
|
|
Inj, fulvestrant (fresenius)
|
$1,995.00 |
$1,995.00 |
$1,995.00 |
$1,065.08
|
|
Inj. herceptin hylecta, 10mg
|
$18,654.24 |
$18,654.24 |
$18,654.24 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$12,185.88 |
$12,185.88 |
$12,185.88 |
$7,775.46
|
|
Inj hydroxocobalamin IV 25mg
|
$4,055.76 |
$4,055.76 |
$4,055.76 |
$2,452.32
|
|
Inj ivig privigen 500 mg
|
$29,699.94 |
$29,699.94 |
$29,699.94 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$35.16 |
$35.16 |
$35.16 |
$40.00
|
|
Inj levocarnitine per 1 gm
|
$454.86 |
$454.86 |
$454.86 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$1,408.26 |
$1,408.26 |
$1,408.26 |
$363.97
|
|
Inj, lidocaine w epinephrine
|
$274.02 |
$274.02 |
$274.02 |
$44.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,629.60 |
$1,629.60 |
$1,629.60 |
$783.50
|
|
Inj mepivacaine hcl/10 ml
|
$9.00 |
$9.00 |
$9.00 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$2,603.28 |
$2,603.28 |
$2,603.28 |
$536.27
|
|
Inj. mycophenolate mofetil
|
$1,263.36 |
$1,263.36 |
$1,263.36 |
$252.66
|
|
Inj, nithiodote, 3mg / 125mg
|
$3,861.00 |
$3,861.00 |
$3,861.00 |
$452.89
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,189.60 |
$3,189.60 |
$3,189.60 |
$2,431.74
|
|
Inj ogivri 10 mg
|
$10,473.96 |
$10,473.96 |
$10,473.96 |
$4,492.28
|
|
Inj peritoneal venous shunt
|
$769.20 |
$769.20 |
$769.20 |
$406.80
|
|
Inj., perseris, 0.5 mg
|
$25,783.08 |
$25,783.08 |
$25,783.08 |
$5,372.48
|
|
Inj., plazomicin, 5 mg
|
$4,047.06 |
$4,047.06 |
$4,047.06 |
$607.16
|
|
Inj proc ankle arthr
|
$375.00 |
$375.00 |
$375.00 |
$405.31
|
|
Inj proc elbow arthro
|
$96.00 |
$96.00 |
$96.00 |
$432.00
|
|
Inj proc sialogram
|
$222.00 |
$222.00 |
$222.00 |
$373.00
|
|
Inj, releuko 1 mcg
|
$984.54 |
$984.54 |
$984.54 |
$461.20
|
|
Inj scleros sol mult veins
|
$553.80 |
$553.80 |
$553.80 |
$602.50
|
|
Inj scleros sol sgl vein
|
$643.80 |
$643.80 |
$643.80 |
$534.40
|
|
Inj secretin synthetic human
|
$2,558.10 |
$2,558.10 |
$2,558.10 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$8,516.58 |
$8,516.58 |
$8,516.58 |
$4,485.92
|
|
Inj sulf hexa lipid microsph
|
$255.78 |
$255.78 |
$255.78 |
$256.14
|
|
Inj testosterone cypionate
|
$69.60 |
$69.60 |
$69.60 |
$62.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,629.60 |
$1,629.60 |
$1,629.60 |
$1,025.00
|
