|
Infectious agent nucleic acid quantification hepatitis b
|
$151.20 |
$151.20 |
$151.20 |
$237.70
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$411.00 |
$411.00 |
$411.00 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$396.00 |
$396.00 |
$396.00 |
$373.60
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$565.80 |
$565.80 |
$565.80 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$5,990.94 |
$5,990.94 |
$6,096.06 |
$2,043.22
|
|
Infliximab-axxq 100 mg intravenous solution
|
$2,610.00 |
$2,610.00 |
$2,610.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$4,854.42 |
$4,854.42 |
$4,939.62 |
$1,537.84
|
|
Influenza dna amp prob addl
|
$30.00 |
$30.00 |
$30.00 |
$64.26
|
|
Inj, abilify maintena, 1 mg
|
$0.06 |
$0.06 |
$0.06 |
$5,355.30
|
|
Inj, adalimumab, 1 mg
|
$16,614.30 |
$16,614.30 |
$16,614.30 |
$12,098.05
|
|
Inj anifrolumab-fnia 1mg
|
$27,910.50 |
$27,910.50 |
$28,400.16 |
$9,878.82
|
|
Inj., aristada initio, 1 mg
|
$0.06 |
$0.06 |
$0.06 |
$4,052.45
|
|
Inj., benralizumab, 1 mg
|
$29,995.38 |
$29,995.38 |
$30,521.64 |
$11,239.97
|
|
Inj beta interferon sq 1 mcg
|
$4,395.36 |
$4,395.36 |
$4,697.52 |
$2,397.11
|
|
Inj, bezlotoxumab, 10 mg
|
$19,494.00 |
$19,494.00 |
$19,836.00 |
$7,612.43
|
|
Inj cefazolin sodium, hikma
|
$47.40 |
$47.40 |
$49.50 |
$28.51
|
|
Inj cefazolin (wg crit care)
|
$27.54 |
$27.54 |
$27.54 |
$17.00
|
|
Inj, cefiderocol, 10 mg
|
$1,257.36 |
$1,257.36 |
$1,313.22 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$941.58 |
$941.58 |
$983.40 |
$381.60
|
|
Inj, clindamycin (baxter)
|
$57.78 |
$57.78 |
$60.36 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$252.00 |
$252.00 |
$252.00 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$2,197.20 |
$2,197.20 |
$2,394.36 |
$2,584.85
|
|
Inj cyclophosphamd auromedic
|
$2,340.00 |
$2,340.00 |
$2,340.00 |
$249.68
|
|
Inj daptomycin (xellia)
|
$313.20 |
$313.20 |
$313.20 |
$56.04
|
|
Inj, durolane 1 mg
|
$5,719.98 |
$5,719.98 |
$5,719.98 |
$1,950.93
|
|
Inj dx for sinogram
|
$244.80 |
$244.80 |
$244.80 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$3,794.40 |
$3,794.40 |
$3,794.40 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$253.80 |
$253.80 |
$4,881.96 |
$500.50
|
|
Injection, cangrelor
|
$5,406.48 |
$5,406.48 |
$5,646.78 |
$1,889.78
|
|
Injection, daratumumab 10 mg
|
$15,822.66 |
$15,822.66 |
$15,822.66 |
$5,188.91
|
|
Injection epidural blood patch or clot
|
$1,773.00 |
$1,773.00 |
$1,773.00 |
$1,153.03
|
|
Injection for arthrography wrist (both sides)
|
$247.80 |
$247.80 |
$247.80 |
$438.00
|
|
Injection for bladder x-ray
|
$224.40 |
$224.40 |
$224.40 |
$459.20
|
|
Injection for hip x-ray
|
$5,148.30 |
$5,148.30 |
$5,148.30 |
$662.40
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$274.20 |
$274.20 |
$274.20 |
$494.65
|
|
Injection for ureter x-ray
|
$126.60 |
$126.60 |
$126.60 |
$515.21
|
|
Injection, fulvestrant
|
$253.98 |
$253.98 |
$276.78 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,216.50 |
$1,216.50 |
$1,237.86 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$18,405.06 |
$18,405.06 |
$18,727.98 |
$6,679.35
|
|
Injection, isavuconazonium
|
$2,224.32 |
$2,224.32 |
$2,224.32 |
$787.67
|
|
Injection, necitumumab, 1 mg
|
$20,782.80 |
$20,782.80 |
$20,782.80 |
$8,572.91
|
|
Injection of sinus tract
|
$1,330.80 |
$1,330.80 |
$1,330.80 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$3,339.66 |
$3,339.66 |
$3,398.22 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$426.60 |
$426.60 |
$37,358.69 |
$699.68
|
|
Injection, renflexis
|
$3,932.70 |
$3,932.70 |
$3,932.70 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$4,909.80 |
$4,909.80 |
$4,909.80 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,341.80 |
$2,341.80 |
$2,341.80 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,107.00 |
$1,107.00 |
$68,955.00 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,956.12 |
$4,956.12 |
$4,956.12 |
$2,031.18
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,831.20 |
$1,831.20 |
$4,909.08 |
$1,008.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,831.20 |
$1,831.20 |
$5,075.22 |
$1,781.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,831.20 |
$1,831.20 |
$3,531.72 |
$1,002.76
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,831.20 |
$1,831.20 |
$4,757.34 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$4,939.56 |
$4,939.56 |
$4,939.56 |
$1,783.60
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,738.20 |
$1,738.20 |
$3,633.12 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$317.40 |
$317.40 |
$317.40 |
$478.20
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$534.60 |
$534.60 |
$2,591.40 |
$546.40
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$435.00 |
$435.00 |
$435.00 |
$163.83
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$435.00 |
$435.00 |
$435.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$435.00 |
$435.00 |
$435.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$114.60 |
$114.60 |
$114.60 |
$136.00
|
|
Inject sacroiliac joint
|
$1,155.00 |
$1,155.00 |
$2,557.98 |
$1,028.95
|
|
Inject/treat eye socket
|
$1,146.60 |
$1,146.60 |
$1,146.60 |
$381.13
|
|
Inj epidural sgl lumb-sacral without img
|
$1,738.20 |
$1,738.20 |
$1,738.20 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$378.36 |
$378.36 |
$630.06 |
$206.64
|
|
Inj, erzofri, 1 mg
|
$3,331.02 |
$3,331.02 |
$3,331.02 |
$10,213.70
|
|
Inj. fe derisomaltose 10 mg
|
$9,367.86 |
$9,367.86 |
$9,532.20 |
$3,221.52
|
|
Inj for mammo ductogram
|
$481.80 |
$481.80 |
$481.80 |
$397.80
|
|
Inj., guselkumab, 1 mg
|
$69,918.96 |
$69,918.96 |
$69,918.96 |
$29,130.83
|
|
Inj herzuma 10 mg
|
$14,293.20 |
$14,293.20 |
$14,293.20 |
$7,775.46
|
|
Inj hydroxocobalamin IV 25mg
|
$5,376.24 |
$5,376.24 |
$5,376.24 |
$2,452.32
|
|
Inj ivig privigen 500 mg
|
$9,842.46 |
$9,842.46 |
$10,015.14 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$209.94 |
$209.94 |
$219.30 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$678.84 |
$678.84 |
$1,299.90 |
$320.80
|
|
Inj, lidocaine w epinephrine
|
$19,278.22 |
$19,278.22 |
$21,708.46 |
$45.14
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,639.80 |
$1,639.80 |
$1,639.80 |
$788.40
|
|
Inj melpha hydroch nos 50 mg
|
$492.60 |
$492.60 |
$492.60 |
$1,791.90
|
|
Inj., meropenem, vaborbactam
|
$1,201.50 |
$1,201.50 |
$1,254.90 |
$536.27
|
|
Inj meropenem (wg crit care)
|
$185.58 |
$185.58 |
$185.58 |
$77.97
|
|
Inj multihance
|
$72.00 |
$72.00 |
$72.00 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$391.50 |
$391.50 |
$408.90 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,407.80 |
$2,407.80 |
$2,407.80 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$1,861.20 |
$1,861.20 |
$1,861.20 |
$472.76
|
|
Inj octafluoropropane mic,ml
|
$77.94 |
$77.94 |
$94.80 |
$211.40
|
|
Inj ogivri 10 mg
|
$12,285.24 |
$12,285.24 |
$13,387.80 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$36.66 |
$36.66 |
$36.66 |
$34.70
|
|
Inj pemetrexed, hospira 10mg
|
$1,955.16 |
$1,955.16 |
$2,539.02 |
$64.35
|
|
Inj pemetrexed (sandoz) 10mg
|
$2,129.40 |
$2,129.40 |
$2,129.40 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$8,811.36 |
$8,811.36 |
$9,602.10 |
$200.85
|
|
Inj., perseris, 0.5 mg
|
$16,349.46 |
$16,349.46 |
$16,349.46 |
$5,146.85
|
|
Inj proc ankle arthr
|
$149.40 |
$149.40 |
$149.40 |
$405.60
|
|
Inj proc elbow arthro
|
$247.80 |
$247.80 |
$247.80 |
$434.00
|
|
Inj proc myelogram lumbar
|
$607.20 |
$607.20 |
$607.20 |
$843.84
|
|
Inj, releuko 1 mcg
|
$1,305.12 |
$1,305.12 |
$1,327.98 |
$461.20
|
|
Inj secretin synthetic human
|
$3,390.96 |
$3,390.96 |
$3,450.42 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$20,714.22 |
$20,714.22 |
$20,714.22 |
$4,485.92
|
|
Inj sulf hexa lipid microsph
|
$483.72 |
$483.72 |
$588.30 |
$256.14
|
|
Inj teclistamab cqyv 0.5 mg
|
$53,282.52 |
$53,282.52 |
$53,282.52 |
$17,517.56
|
|
Inj testosterone cypionate
|
$24.66 |
$24.66 |
$33.60 |
$64.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,639.80 |
$1,639.80 |
$1,639.80 |
$1,025.00
|
