|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$2,172.60 |
$2,172.60 |
$2,172.60 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$319.80 |
$319.80 |
$319.80 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$197.40 |
$197.40 |
$197.40 |
$151.25
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$355.80 |
$355.80 |
$355.80 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$183.60 |
$183.60 |
$183.60 |
$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
|
$171.00 |
$171.00 |
$171.00 |
$217.70
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$23.40 |
$23.40 |
$23.40 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$47.40 |
$47.40 |
$47.40 |
$105.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,386.60 |
$1,386.60 |
$1,386.60 |
$711.93
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$362.40 |
$362.40 |
$362.40 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$639.60 |
$639.60 |
$639.60 |
$429.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$298.20 |
$298.20 |
$298.20 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$216.00 |
$216.00 |
$216.00 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$589.20 |
$589.20 |
$589.20 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$558.00 |
$558.00 |
$558.00 |
$374.50
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$221.40 |
$221.40 |
$221.40 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$4,484.46 |
$4,484.46 |
$4,484.46 |
$2,080.86
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,633.72 |
$3,633.72 |
$3,633.72 |
$1,617.43
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$960.00 |
$960.00 |
$960.00 |
$293.04
|
|
Initiation & management bipap/cpap initial day
|
$432.00 |
$432.00 |
$432.00 |
$576.00
|
|
Inj, abilify maintena, 1 mg
|
$0.06 |
$0.06 |
$0.06 |
$5,355.30
|
|
Inj., aristada initio, 1 mg
|
$0.06 |
$0.06 |
$0.06 |
$4,052.45
|
|
Inj, bezlotoxumab, 10 mg
|
$14,592.00 |
$14,592.00 |
$14,592.00 |
$7,612.43
|
|
Inj, bupivacaine liposome
|
$472.44 |
$472.44 |
$472.44 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$41.64 |
$41.64 |
$41.64 |
$29.10
|
|
Inj cefazolin (wg crit care)
|
$7.62 |
$7.62 |
$7.62 |
$18.30
|
|
Inj, cefiderocol, 10 mg
|
$1,103.70 |
$1,103.70 |
$1,103.70 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$826.50 |
$826.50 |
$826.50 |
$408.00
|
|
Inj, clindamycin (baxter)
|
$61.86 |
$61.86 |
$61.86 |
$48.39
|
|
Inj cntr knee arthro incl ct/mri
|
$418.80 |
$418.80 |
$418.80 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$1,850.70 |
$1,850.70 |
$1,850.70 |
$2,584.85
|
|
Inj disk cerv-thor ea lev
|
$1,386.60 |
$1,386.60 |
$1,386.60 |
$945.00
|
|
Inj dx for sinogram
|
$593.40 |
$593.40 |
$593.40 |
$413.82
|
|
Injection arthrography hip without anesthesia (both sides)
|
$418.80 |
$418.80 |
$418.80 |
$500.50
|
|
Injection, cangrelor
|
$4,745.70 |
$4,745.70 |
$4,745.70 |
$1,889.78
|
|
Injection, daratumumab 10 mg
|
$12,229.98 |
$12,229.98 |
$12,229.98 |
$5,164.24
|
|
Injection, doxercalciferol
|
$7.50 |
$7.50 |
$7.50 |
$23.12
|
|
Injection epidural blood patch or clot
|
$2,527.20 |
$2,527.20 |
$2,527.20 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$445.80 |
$445.80 |
$445.80 |
$441.12
|
|
Injection for bladder x-ray
|
$593.40 |
$593.40 |
$593.40 |
$459.20
|
|
Injection for hip x-ray
|
$583.80 |
$583.80 |
$583.80 |
$669.24
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$445.80 |
$445.80 |
$445.80 |
$494.65
|
|
Injection for ureter x-ray
|
$317.40 |
$317.40 |
$317.40 |
$415.80
|
|
Injection for ureter x-ray
|
$351.00 |
$351.00 |
$351.00 |
$515.21
|
|
Injection, fulvestrant
|
$3,821.88 |
$3,821.88 |
$3,821.88 |
$1,719.16
|
|
Injection glatiramer acetate
|
$910.62 |
$910.62 |
$910.62 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$13,776.90 |
$13,776.90 |
$13,776.90 |
$6,679.35
|
|
Injection into brain canal
|
$789.60 |
$789.60 |
$789.60 |
$836.40
|
|
Injection jugular
|
$327.00 |
$327.00 |
$327.00 |
$790.00
|
|
Injection of sinus tract
|
$1,705.80 |
$1,705.80 |
$1,705.80 |
$1,627.60
|
|
Injection,onabotulinumtoxina
|
$2,499.84 |
$2,499.84 |
$2,499.84 |
$2,241.61
|
|
Injection radioactive tracer sentinel node (both sides)
|
$765.00 |
$765.00 |
$765.00 |
$683.28
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$6,975.12 |
$6,975.12 |
$6,975.12 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,319.00 |
$2,319.00 |
$2,319.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$7,437.30 |
$7,437.30 |
$7,437.30 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$2,221.80 |
$2,221.80 |
$2,221.80 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,172.00 |
$2,172.00 |
$2,172.00 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$4,411.50 |
$4,411.50 |
$4,411.50 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,411.50 |
$4,411.50 |
$4,411.50 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,779.28 |
$3,779.28 |
$3,779.28 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$4,987.20 |
$4,987.20 |
$4,987.20 |
$1,704.78
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$530.40 |
$530.40 |
$530.40 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$530.40 |
$530.40 |
$530.40 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$317.40 |
$317.40 |
$317.40 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$256.80 |
$256.80 |
$256.80 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$317.40 |
$317.40 |
$317.40 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$277.20 |
$277.20 |
$277.20 |
$135.20
|
|
Inject sacroiliac joint
|
$2,499.00 |
$2,499.00 |
$2,499.00 |
$963.00
|
|
Inject/treat eye socket
|
$2,080.80 |
$2,080.80 |
$2,080.80 |
$381.13
|
|
Inj., eravacycline, 1 mg
|
$318.00 |
$318.00 |
$318.00 |
$206.64
|
|
Inj for ext venography
|
$392.40 |
$392.40 |
$392.40 |
$654.00
|
|
Inj for mammo ductogram
|
$456.60 |
$456.60 |
$456.60 |
$433.50
|
|
Inj gemcitabine hcl (accord)
|
$104.10 |
$104.10 |
$104.10 |
$113.90
|
|
Inj., guselkumab, 1 mg
|
$69,044.94 |
$69,044.94 |
$69,044.94 |
$29,130.83
|
|
Inj hydroxocobalamin IV 25mg
|
$4,024.32 |
$4,024.32 |
$4,024.32 |
$2,452.32
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,498.56 |
$1,498.56 |
$1,498.56 |
$662.97
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$2,448.00 |
$2,448.00 |
$2,448.00 |
$1,928.00
|
|
Inj labetalol hcl hikma, 5mg
|
$14.28 |
$14.28 |
$14.28 |
$40.00
|
|
Inj levocarnitine per 1 gm
|
$184.32 |
$184.32 |
$184.32 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$570.54 |
$570.54 |
$570.54 |
$363.97
|
|
Inj, lidocaine w epinephrine
|
$111.06 |
$111.06 |
$111.06 |
$44.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$869.40 |
$869.40 |
$869.40 |
$783.50
|
|
Inj mepivacaine hcl/10 ml
|
$7.50 |
$7.50 |
$7.50 |
$33.86
|
|
Inj multihance
|
$131.82 |
$131.82 |
$131.82 |
$79.42
|
|
Inj. mycophenolate mofetil
|
$511.86 |
$511.86 |
$511.86 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,810.40 |
$2,810.40 |
$2,810.40 |
$1,414.40
|
|
Inj, nithiodote, 3mg / 125mg
|
$1,564.20 |
$1,564.20 |
$1,564.20 |
$452.89
|
|
Inj ogivri 10 mg
|
$10,347.96 |
$10,347.96 |
$10,347.96 |
$4,492.28
|
|
Inj, pedmark, 100 mg
|
$8.82 |
$8.82 |
$8.82 |
$123.00
|
|
Inj peritoneal venous shunt
|
$843.00 |
$843.00 |
$843.00 |
$406.80
|
|
Inj proc ankle arthr
|
$418.80 |
$418.80 |
$418.80 |
$405.31
|
|
Inj proc elbow arthro
|
$324.60 |
$324.60 |
$324.60 |
$432.00
|
|
Inj proc for lymphang
|
$777.60 |
$777.60 |
$777.60 |
$805.80
|
|
Inj proc lumbr disk ea lvl
|
$1,386.60 |
$1,386.60 |
$1,386.60 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$1,403.40 |
$1,403.40 |
$1,403.40 |
$856.00
|
|
Inj proc sialogram
|
$556.80 |
$556.80 |
$556.80 |
$373.00
|
|
Inj progesterone per 50 mg
|
$7.50 |
$7.50 |
$7.50 |
$14.93
|
|
Inj recombin esperoct per iu
|
$30,758.40 |
$30,758.40 |
$30,758.40 |
$6.63
|
