|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$268.20 |
$268.20 |
$268.20 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$259.20 |
$259.20 |
$259.20 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$143.40 |
$143.40 |
$143.40 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$207.00 |
$207.00 |
$207.00 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$726.60 |
$726.60 |
$726.60 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$274.80 |
$274.80 |
$274.80 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$293.40 |
$293.40 |
$293.40 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,920.60 |
$1,920.60 |
$1,920.60 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$607.20 |
$607.20 |
$607.20 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$575.40 |
$575.40 |
$575.40 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$423.60 |
$423.60 |
$423.60 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$191.40 |
$191.40 |
$191.40 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$75.00 |
$75.00 |
$75.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$210.00 |
$210.00 |
$210.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$501.60 |
$501.60 |
$501.60 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$203.40 |
$203.40 |
$203.40 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$147.00 |
$147.00 |
$147.00 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$462.00 |
$462.00 |
$462.00 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$1,088.40 |
$1,088.40 |
$1,088.40 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$719.40 |
$719.40 |
$719.40 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$390.60 |
$390.60 |
$390.60 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$958.80 |
$958.80 |
$958.80 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$582.60 |
$582.60 |
$582.60 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$838.20 |
$838.20 |
$838.20 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$489.60 |
$489.60 |
$489.60 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,095.60 |
$1,095.60 |
$1,095.60 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,619.40 |
$1,619.40 |
$1,619.40 |
$1,537.84
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$40.00 |
$40.00 |
$40.00 |
$111.51
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$1,113.00 |
$1,113.00 |
$1,113.00 |
$296.00
|
|
Inj, abilify maintena, 1 mg
|
$17.00 |
$17.00 |
$17.00 |
$5,355.30
|
|
Inj, aducanumab-avwa, 2 mg
|
$25.80 |
$25.80 |
$25.80 |
$5.98
|
|
Inj andexxa, 10 mg
|
$246.00 |
$246.00 |
$246.00 |
$4,370.80
|
|
Inj anifrolumab-fnia 1mg
|
$10,723.20 |
$10,723.20 |
$10,723.20 |
$10,052.58
|
|
Inj, aponvie, 1 mg
|
$3.00 |
$3.00 |
$3.00 |
$3.36
|
|
Inj, aspara, rylaze, 0.1 mg
|
$102.00 |
$102.00 |
$102.00 |
$10,458.00
|
|
Inj atezolizumb 5mg hya-tqjs
|
$54.60 |
$54.60 |
$54.60 |
$18,716.52
|
|
Inj aval alfa-nqpt 4mg
|
$5,329.60 |
$5,329.60 |
$5,329.60 |
$3,907.30
|
|
Inj., benralizumab, 1 mg
|
$14,607.00 |
$14,607.00 |
$14,607.00 |
$11,310.00
|
|
Inj, bezlotoxumab, 10 mg
|
$12,381.00 |
$12,381.00 |
$12,381.00 |
$7,612.43
|
|
Inj., brexanolone, 1 mg
|
$187.80 |
$187.80 |
$187.80 |
$13,019.44
|
|
Inj, brixadi, 7 days or less
|
$814.80 |
$814.80 |
$814.80 |
$748.85
|
|
Inj brixadi, more than 7 day
|
$4,344.80 |
$4,344.80 |
$4,344.80 |
$2,858.76
|
|
Inj, bupivacaine liposome
|
$2.40 |
$2.40 |
$2.40 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$27.80 |
$27.80 |
$27.80 |
$22.69
|
|
Inj cefazolin sodium, baxter
|
$8.60 |
$8.60 |
$8.60 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$139.20 |
$139.20 |
$139.20 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$6.40 |
$6.40 |
$6.40 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$277.80 |
$277.80 |
$277.80 |
$364.86
|
|
Inj, cimerli, 0.1 mg
|
$519.00 |
$519.00 |
$519.00 |
$201.01
|
|
Inj, clindamycin (baxter)
|
$7.20 |
$7.20 |
$7.20 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$487.80 |
$487.80 |
$487.80 |
$436.80
|
|
Inj cyclophosphamd (ingenus)
|
$2.40 |
$2.40 |
$2.40 |
$742.72
|
|
Inj dx for sinogram
|
$562.20 |
$562.20 |
$562.20 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$562.20 |
$562.20 |
$562.20 |
$503.50
|
|
Injection, burosumab-twza 1m
|
$665.40 |
$665.40 |
$665.40 |
$20,002.09
|
|
Injection, cangrelor
|
$1,969.80 |
$1,969.80 |
$1,969.80 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$20,647.20 |
$20,647.20 |
$20,647.20 |
$16,319.16
|
|
Injection, daratumumab 10 mg
|
$6,643.20 |
$6,643.20 |
$6,643.20 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$2,024.40 |
$2,024.40 |
$2,024.40 |
$1,027.26
|
|
Injection, edaravone, 1 mg
|
$1,699.80 |
$1,699.80 |
$1,699.80 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$2,334.00 |
$2,334.00 |
$2,334.00 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$566.40 |
$566.40 |
$566.40 |
$436.00
|
|
Injection for bladder x-ray
|
$2,310.60 |
$2,310.60 |
$2,310.60 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$566.40 |
$566.40 |
$566.40 |
$497.76
|
|
Injection for ureter x-ray
|
$3,021.60 |
$3,021.60 |
$3,021.60 |
$515.21
|
|
Injection, fulvestrant
|
$584.00 |
$584.00 |
$584.00 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,550.40 |
$1,550.40 |
$1,550.40 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$35.00 |
$35.00 |
$35.00 |
$6,679.35
|
|
Injection,onabotulinumtoxina
|
$1,920.60 |
$1,920.60 |
$1,920.60 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$1,286.40 |
$1,286.40 |
$1,286.40 |
$383.03
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,941.00 |
$1,941.00 |
$1,941.00 |
$685.44
|
|
Injection, renflexis
|
$240.00 |
$240.00 |
$240.00 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$775.20 |
$775.20 |
$775.20 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$879.00 |
$879.00 |
$879.00 |
$1,043.72
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,842.00 |
$1,842.00 |
$1,842.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,868.60 |
$2,868.60 |
$2,868.60 |
$1,685.00
|
|
Injection, siltuximab
|
$310.20 |
$310.20 |
$310.20 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,162.20 |
$1,162.20 |
$1,162.20 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$532.80 |
$532.80 |
$532.80 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$158.40 |
$158.40 |
$158.40 |
$145.60
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$84.80 |
$84.80 |
$84.80 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$3,181.80 |
$3,181.80 |
$3,181.80 |
$3,181.80
|
|
Inj epidural sgl lumb-sacral without img
|
$1,980.00 |
$1,980.00 |
$1,980.00 |
$1,450.84
|
|
Inj, factor x, (human), 1iu
|
$33.60 |
$33.60 |
$33.60 |
$26.74
|
|
Inj. fe derisomaltose 10 mg
|
$60.00 |
$60.00 |
$60.00 |
$3,221.52
|
|
Inj for ext venography
|
$672.00 |
$672.00 |
$672.00 |
$628.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$6.00 |
$6.00 |
$1,322.20
|
|
Inj givosiran 0.5 mg
|
$257.40 |
$257.40 |
$257.40 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$4,752.60 |
$4,752.60 |
$4,752.60 |
$4,760.67
|
|
Inj herzuma 10 mg
|
$189.60 |
$189.60 |
$189.60 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,024.40 |
$2,024.40 |
$2,024.40 |
$1,492.00
|
|
Inj hydroxyprogst capoat nos
|
$6,426.00 |
$6,426.00 |
$6,426.00 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$5.40 |
$5.40 |
$5.40 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$871.80 |
$871.80 |
$871.80 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$321.00 |
$321.00 |
$321.00 |
$235.13
|
|
Inj levocarnitine per 1 gm
|
$607.20 |
$607.20 |
$607.20 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$0.60 |
$0.60 |
$0.60 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$108.00 |
$108.00 |
$108.00 |
$794.70
|
|
Inj mepivacaine hcl/10 ml
|
$14.40 |
$14.40 |
$14.40 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$2,895.00 |
$2,895.00 |
$2,895.00 |
$556.87
|
