|
Infectious agent nucleic acid quantification hepatitis c
|
$633.10 |
$633.10 |
$633.10 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$560.95 |
$560.95 |
$560.95 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$412.10 |
$412.10 |
$412.10 |
$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
|
$49.40 |
$49.40 |
$49.40 |
$69.60
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$728.00 |
$728.00 |
$728.00 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$417.95 |
$417.95 |
$417.95 |
$645.79
|
|
Inj, abilify maintena, 1 mg
|
$6,324.82 |
$6,324.82 |
$6,324.82 |
$6,324.82
|
|
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., aristada initio, 1 mg
|
$7,361.74 |
$7,361.74 |
$7,361.74 |
$1,052.01
|
|
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
|
$1,040.36 |
$1,040.36 |
$1,040.36 |
$816.31
|
|
Inj, cefepime hcl (b braun)
|
$81.41 |
$81.41 |
$81.41 |
$81.41
|
|
Inj, cefiderocol, 10 mg
|
$723.26 |
$723.26 |
$723.26 |
$718.84
|
|
Inj ceftolozane tazobactam
|
$546.94 |
$546.94 |
$546.94 |
$447.36
|
|
Inj cntr knee arthro incl ct/mri
|
$1,602.90 |
$1,602.90 |
$1,602.90 |
$464.28
|
|
Inj cyclophosphamd auromedic
|
$2.03 |
$2.03 |
$2.03 |
$1.16
|
|
Inj cyclophosphamd (ingenus)
|
$3.33 |
$3.33 |
$3.33 |
$1,040.94
|
|
Inj disk cerv-thor ea lev
|
$2,780.70 |
$2,780.70 |
$2,780.70 |
$869.80
|
|
Inj dx for sinogram
|
$1,687.40 |
$1,687.40 |
$1,687.40 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$3,023.80 |
$3,023.80 |
$3,023.80 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$2,106.00 |
$2,106.00 |
$2,106.00 |
$507.10
|
|
Injection, cangrelor
|
$3,033.22 |
$3,033.22 |
$3,033.22 |
$2,546.20
|
|
Injection carpal tunnel therapeutic (both sides)
|
$661.70 |
$661.70 |
$661.70 |
$536.00
|
|
Injection during cath supravalvular aortography
|
$2,346.50 |
$2,346.50 |
$2,346.50 |
$1,148.80
|
|
Injection, edaravone, 1 mg
|
$2,084.94 |
$2,084.94 |
$2,084.94 |
$2,345.85
|
|
Injection epidural blood patch or clot
|
$1,720.55 |
$1,720.55 |
$1,720.55 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$1,318.20 |
$1,318.20 |
$1,318.20 |
$441.12
|
|
Injection for bladder x-ray
|
$1,734.85 |
$1,734.85 |
$1,734.85 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$1,241.50 |
$1,241.50 |
$1,241.50 |
$504.00
|
|
Injection for spleen x-ray
|
$183.95 |
$183.95 |
$183.95 |
$686.40
|
|
Injection for ureter x-ray
|
$2,237.30 |
$2,237.30 |
$2,237.30 |
$444.95
|
|
Injection for ureter x-ray
|
$2,067.00 |
$2,067.00 |
$2,067.00 |
$515.21
|
|
Injection, fulvestrant
|
$285.16 |
$285.16 |
$285.16 |
$2,756.47
|
|
Injection glatiramer acetate
|
$119.18 |
$119.18 |
$119.18 |
$405.93
|
|
Injection, inclisiran, 1 mg
|
$11,657.30 |
$11,657.30 |
$11,657.30 |
$10,366.61
|
|
Injection into brain canal
|
$208.00 |
$208.00 |
$208.00 |
$933.60
|
|
Injection jugular
|
$333.45 |
$333.45 |
$333.45 |
$1,048.20
|
|
Injection of sinus tract
|
$1,059.50 |
$1,059.50 |
$1,059.50 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$2,154.07 |
$2,154.07 |
$2,154.07 |
$2,154.07
|
|
Injection radioactive tracer sentinel node (both sides)
|
$2,223.00 |
$2,223.00 |
$2,223.00 |
$717.20
|
|
Injection, renflexis
|
$105.60 |
$105.60 |
$105.60 |
$1,457.42
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$3,190.20 |
$3,190.20 |
$3,190.20 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,208.70 |
$2,208.70 |
$2,208.70 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$982.80 |
$982.80 |
$982.80 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,862.90 |
$1,862.90 |
$1,862.90 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,859.00 |
$1,859.00 |
$1,859.00 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,777.80 |
$3,777.80 |
$3,777.80 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$845.00 |
$845.00 |
$845.00 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$3,620.50 |
$3,620.50 |
$3,620.50 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,307.20 |
$3,307.20 |
$3,307.20 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,973.75 |
$2,973.75 |
$2,973.75 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$2,163.20 |
$2,163.20 |
$2,163.20 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$923.65 |
$923.65 |
$923.65 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$923.65 |
$923.65 |
$923.65 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$147.55 |
$147.55 |
$147.55 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$110.50 |
$110.50 |
$110.50 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$160.55 |
$160.55 |
$160.55 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$131.30 |
$131.30 |
$131.30 |
$141.60
|
|
Injection treatment of nerve
|
$3,507.40 |
$3,507.40 |
$3,507.40 |
$3,016.15
|
|
Injection treatment of nerve
|
$2,253.55 |
$2,253.55 |
$2,253.55 |
$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
|
$2,174.25 |
$2,174.25 |
$2,174.25 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$1,854.45 |
$1,854.45 |
$1,854.45 |
$1,450.84
|
|
Inj fluphenazine hcl 1.25 mg
|
$37.93 |
$37.93 |
$37.93 |
$37.93
|
|
Inj for ext venography
|
$4,214.60 |
$4,214.60 |
$4,214.60 |
$737.55
|
|
Inj for mammo ductogram
|
$1,774.50 |
$1,774.50 |
$1,774.50 |
$433.50
|
|
Inj glofitamab gxbm, 2.5 mg
|
$29,284.42 |
$29,284.42 |
$29,284.42 |
$2,770.57
|
|
Inj herzuma 10 mg
|
$0.42 |
$0.42 |
$0.42 |
$60.44
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,521.35 |
$2,521.35 |
$2,521.35 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$671.45 |
$671.45 |
$671.45 |
$947.65
|
|
Inj human fibrinogen con nos
|
$3,288.87 |
$3,288.87 |
$3,288.87 |
$1.52
|
|
Inj hydroxocobalamin IV 25mg
|
$2,930.52 |
$2,930.52 |
$2,930.52 |
$3,180.35
|
|
Inj. inebilizumab-cdon, 1 mg
|
$378,200.52 |
$378,200.52 |
$378,200.52 |
$494.43
|
|
Inj intralesional <= 7 lsn(s)
|
$251.55 |
$251.55 |
$251.55 |
$241.74
|
|
Inj, invega hafyera/trinza
|
$33,280.23 |
$33,280.23 |
$33,280.23 |
$12.66
|
|
Inj ivig privigen 500 mg
|
$1,979.51 |
$1,979.51 |
$1,979.51 |
$7,298.71
|
|
Inj, lanreotide, (cipla) 1mg
|
$4,264.42 |
$4,264.42 |
$4,264.42 |
$12,160.05
|
|
Inj, levothyroxine, freskabi
|
$236.50 |
$236.50 |
$236.50 |
$302.07
|
|
Inj mepivacaine hcl/10 ml
|
$22.52 |
$22.52 |
$22.52 |
$28.41
|
|
Inj meropenem (wg crit care)
|
$104.29 |
$104.29 |
$104.29 |
$104.29
|
|
Inj. mycophenolate mofetil
|
$76.02 |
$76.02 |
$76.02 |
$344.84
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$7,979.40 |
$7,979.40 |
$7,979.40 |
$1,522.56
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,316.25 |
$1,316.25 |
$1,316.25 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,316.25 |
$1,316.25 |
$1,316.25 |
$2,164.64
|
|
Inj ontruzant 10 mg
|
$1,661.08 |
$1,661.08 |
$1,661.08 |
$34.17
|
|
Inj pantoprazole(hikma) 40mg
|
$33.86 |
$33.86 |
$33.86 |
$36.04
|
|
Inj., patisiran, 0.1 mg
|
$0.42 |
$0.42 |
$0.42 |
$11,742.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$879.58 |
$879.58 |
$879.58 |
$6,403.59
|
|
Inj peritoneal venous shunt
|
$1,802.45 |
$1,802.45 |
$1,802.45 |
$386.88
|
|
Inj proc ankle arthr
|
$1,288.30 |
$1,288.30 |
$1,288.30 |
$405.31
|
|
Inj proc elbow arthro
|
$2,059.20 |
$2,059.20 |
$2,059.20 |
$453.60
|
|
Inj proc for lymphang
|
$2,182.70 |
$2,182.70 |
$2,182.70 |
$1,372.00
|
|
Inj proc lumbr disk ea lvl
|
$2,801.50 |
$2,801.50 |
$2,801.50 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$882.70 |
$882.70 |
$882.70 |
$922.80
|
|
Inj proc sialogram
|
$2,067.00 |
$2,067.00 |
$2,067.00 |
$380.80
|
