|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$150.80 |
$150.80 |
$150.80 |
$135.00
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$282.10 |
$282.10 |
$282.10 |
$296.71
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$143.00 |
$143.00 |
$143.00 |
$248.18
|
|
Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets
|
$483.60 |
$483.60 |
$483.60 |
$1,069.61
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$676.00 |
$676.00 |
$676.00 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$512.85 |
$512.85 |
$512.85 |
$300.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$295.10 |
$295.10 |
$295.10 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$369.20 |
$369.20 |
$369.20 |
$280.20
|
|
Infectious agent nucleic acid quantification hiv-1
|
$198.25 |
$198.25 |
$198.25 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$287.95 |
$287.95 |
$287.95 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$4,301.80 |
$4,301.80 |
$4,301.80 |
$178.95
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,862.25 |
$1,862.25 |
$1,862.25 |
$89.49
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,492.51 |
$3,492.51 |
$3,492.51 |
$157.14
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$523.90 |
$523.90 |
$523.90 |
$344.50
|
|
Initiation & management bipap/cpap initial day
|
$1,044.55 |
$1,044.55 |
$1,044.55 |
$608.40
|
|
Inj, abilify maintena, 1 mg
|
$9,742.05 |
$9,742.05 |
$9,742.05 |
$3,138.28
|
|
Inj, adzynma, 10 iu
|
$5,340.66 |
$5,340.66 |
$5,340.66 |
$35.59
|
|
Inj allopurinol sodium 1 mg
|
$12,983.87 |
$12,983.87 |
$12,983.87 |
$5,937.23
|
|
Inj alymsys 10 mg
|
$2,660.80 |
$2,660.80 |
$2,660.80 |
$42.60
|
|
Inj anifrolumab-fnia 1mg
|
$20,208.53 |
$20,208.53 |
$20,208.53 |
$1,038.87
|
|
Inj., benralizumab, 1 mg
|
$22,035.84 |
$22,035.84 |
$22,035.84 |
$12,417.10
|
|
Inj, bezlotoxumab, 10 mg
|
$13,917.15 |
$13,917.15 |
$13,917.15 |
$39.83
|
|
Inj, bupivacaine liposome
|
$886.63 |
$886.63 |
$886.63 |
$3.22
|
|
Inj calcitriol per 0.1 mcg
|
$28.63 |
$28.63 |
$28.63 |
$11.21
|
|
Inj cefazolin sodium, hikma
|
$38.39 |
$38.39 |
$38.39 |
$66.38
|
|
Inj, cefiderocol, 10 mg
|
$1,079.68 |
$1,079.68 |
$1,079.68 |
$79.20
|
|
Inj ceftolozane tazobactam
|
$838.29 |
$838.29 |
$838.29 |
$248.93
|
|
Inj. cetirizine hcl 0.5mg
|
$424.35 |
$424.35 |
$424.35 |
$16.40
|
|
Inj, clevidipine butyrate
|
$793.97 |
$793.97 |
$793.97 |
$4.86
|
|
Inj cntr knee arthro incl ct/mri
|
$352.30 |
$352.30 |
$352.30 |
$505.20
|
|
Inj crotalidae im f(ab')2 eq
|
$4,298.58 |
$4,298.58 |
$4,298.58 |
$2,388.06
|
|
Inj cyclophosphamd (ingenus)
|
$2,711.57 |
$2,711.57 |
$2,711.57 |
$1.16
|
|
Inj. denosumab-bbdz, 1 mg
|
$11,755.53 |
$11,755.53 |
$11,755.53 |
$6,618.42
|
|
Inj, donanemab-azbt, 2 mg
|
$2,633.18 |
$2,633.18 |
$2,633.18 |
$6.20
|
|
Inj dx for sinogram
|
$308.75 |
$308.75 |
$308.75 |
$484.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,729.35 |
$2,729.35 |
$2,729.35 |
$1,165.32
|
|
Injection arthrography hip without anesthesia (both sides)
|
$344.50 |
$344.50 |
$344.50 |
$609.20
|
|
Injection, daratumumab 10 mg
|
$12,083.13 |
$12,083.13 |
$12,083.13 |
$85.20
|
|
Injection, doxercalciferol
|
$30.43 |
$30.43 |
$30.43 |
$30.35
|
|
Injection during cath supravalvular aortography
|
$1,248.65 |
$1,248.65 |
$1,248.65 |
$1,604.20
|
|
Injection epidural blood patch or clot
|
$1,090.86 |
$1,090.86 |
$1,090.86 |
$1,470.60
|
|
Injection eye drug
|
$3,779.10 |
$3,779.10 |
$3,779.10 |
$709.80
|
|
Injection for arthrography wrist (both sides)
|
$356.20 |
$356.20 |
$356.20 |
$521.18
|
|
Injection for bladder x-ray
|
$2,679.43 |
$2,679.43 |
$2,679.43 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$280.15 |
$280.15 |
$280.15 |
$514.36
|
|
Injection for ureter x-ray
|
$1,873.95 |
$1,873.95 |
$1,873.95 |
$349.55
|
|
Injection for ureter x-ray
|
$7,201.20 |
$7,201.20 |
$7,201.20 |
$544.50
|
|
Injection, fulvestrant
|
$583.70 |
$583.70 |
$583.70 |
$166.25
|
|
Injection glatiramer acetate
|
$1,037.34 |
$1,037.34 |
$1,037.34 |
$458.43
|
|
Injection, inclisiran, 1 mg
|
$12,150.78 |
$12,150.78 |
$12,150.78 |
$12.72
|
|
Injection into brain canal
|
$4,909.39 |
$4,909.39 |
$4,909.39 |
$961.20
|
|
Injection, isavuconazonium
|
$1,776.97 |
$1,776.97 |
$1,776.97 |
$634.28
|
|
Injection,onabotulinumtoxina
|
$2,119.98 |
$2,119.98 |
$2,119.98 |
$12.88
|
|
Injection radioactive tracer sentinel node (both sides)
|
$2,594.15 |
$2,594.15 |
$2,594.15 |
$787.50
|
|
Injection, renflexis
|
$2,787.89 |
$2,787.89 |
$2,787.89 |
$632.98
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,405.65 |
$2,405.65 |
$2,405.65 |
$1,066.24
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$19,231.76 |
$19,231.76 |
$19,231.76 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$13,907.74 |
$13,907.74 |
$13,907.74 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,960.36 |
$2,960.36 |
$2,960.36 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$4,272.29 |
$4,272.29 |
$4,272.29 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$4,272.29 |
$4,272.29 |
$4,272.29 |
$1,985.61
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$3,682.67 |
$3,682.67 |
$3,682.67 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$3,671.69 |
$3,671.69 |
$3,671.69 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,559.72 |
$2,559.72 |
$2,559.72 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,264.95 |
$2,264.95 |
$2,264.95 |
$1,758.12
|
|
Injection, siltuximab
|
$24,631.77 |
$24,631.77 |
$24,631.77 |
$23,535.37
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$5,395.65 |
$5,395.65 |
$5,395.65 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$295.75 |
$295.75 |
$295.75 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$453.70 |
$453.70 |
$453.70 |
$654.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$252.20 |
$252.20 |
$252.20 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$146.25 |
$146.25 |
$146.25 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$369.20 |
$369.20 |
$369.20 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$107.90 |
$107.90 |
$107.90 |
$130.19
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$59,982.32 |
$59,982.32 |
$59,982.32 |
$33.74
|
|
Inj epidural sgl lumb-sacral without img
|
$9,225.45 |
$9,225.45 |
$9,225.45 |
$1,260.60
|
|
Inj, evinacumab-dgnb, 5mg
|
$163,496.87 |
$163,496.87 |
$163,496.87 |
$189.75
|
|
Inj. fe derisomaltose 10 mg
|
$16,615.53 |
$16,615.53 |
$16,615.53 |
$21.05
|
|
Inj for ext venography
|
$6,711.34 |
$6,711.34 |
$6,711.34 |
$946.64
|
|
Inj for mammo ductogram
|
$312.65 |
$312.65 |
$312.65 |
$469.16
|
|
Inj. herceptin hylecta, 10mg
|
$17,114.40 |
$17,114.40 |
$17,114.40 |
$63.79
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,580.80 |
$1,580.80 |
$1,580.80 |
$1,646.97
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,786.90 |
$3,786.90 |
$3,786.90 |
$2,471.00
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,176.50 |
$1,176.50 |
$1,176.50 |
$1,192.50
|
|
Inj hrt cath w/s&i sel left vent
|
$1,916.20 |
$1,916.20 |
$1,916.20 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$1,204.45 |
$1,204.45 |
$1,204.45 |
$1,352.65
|
|
Inj hydroxocobalamin IV 25mg
|
$4,584.48 |
$4,584.48 |
$4,584.48 |
$1,593.19
|
|
Inj hydroxyprogst capoat nos
|
$97.69 |
$97.69 |
$97.69 |
$1,495.98
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$4,106.02 |
$4,106.02 |
$4,106.02 |
$1,673.66
|
|
Inj, invega hafyera/trinza
|
$23,804.37 |
$23,804.37 |
$23,804.37 |
$12.96
|
|
Inj ivig privigen 500 mg
|
$25,741.98 |
$25,741.98 |
$25,741.98 |
$6,144.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$32,520.64 |
$32,520.64 |
$32,520.64 |
$12,160.05
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,009.20 |
$1,009.20 |
$1,009.20 |
$1.33
|
|
Inj levocarnitine per 1 gm
|
$156.04 |
$156.04 |
$156.04 |
$87.51
|
|
Inj, levothyroxine, freskabi
|
$193.99 |
$193.99 |
$193.99 |
$244.63
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$21,986.26 |
$21,986.26 |
$21,986.26 |
$625.00
|
|
Inj mepivacaine hcl/10 ml
|
$75.33 |
$75.33 |
$75.33 |
$28.41
|
|
Inj meropenem (wg crit care)
|
$131.23 |
$131.23 |
$131.23 |
$20.78
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$35,079.78 |
$35,079.78 |
$35,079.78 |
$48.27
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$17,855.23 |
$17,855.23 |
$17,855.23 |
$540.60
|
|
Inj multihance
|
$129.69 |
$129.69 |
$129.69 |
$86.40
|
