|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$126.60 |
$126.60 |
$126.60 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$146.40 |
$146.40 |
$146.40 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$105.00 |
$105.00 |
$105.00 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$168.60 |
$168.60 |
$168.60 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$129.60 |
$129.60 |
$129.60 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$153.00 |
$153.00 |
$153.00 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$116.40 |
$116.40 |
$116.40 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$928.80 |
$928.80 |
$928.80 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$402.00 |
$402.00 |
$402.00 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$345.00 |
$345.00 |
$345.00 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,408.20 |
$1,408.20 |
$1,408.20 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$457.20 |
$457.20 |
$457.20 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$397.80 |
$397.80 |
$397.80 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$363.60 |
$363.60 |
$363.60 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$436.20 |
$436.20 |
$436.20 |
$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 trichomonas vaginalis
|
$142.20 |
$142.20 |
$142.20 |
$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
|
$454.20 |
$454.20 |
$454.20 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$791.40 |
$791.40 |
$791.40 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$508.20 |
$508.20 |
$508.20 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$799.20 |
$799.20 |
$799.20 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$585.00 |
$585.00 |
$585.00 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$1,144.80 |
$1,144.80 |
$1,144.80 |
$375.00
|
|
Infliximab 100 mg intravenous solution
|
$539.20 |
$539.20 |
$539.20 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,062.00 |
$1,062.00 |
$1,062.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$203.20 |
$203.20 |
$203.20 |
$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
|
$832.80 |
$832.80 |
$832.80 |
$296.00
|
|
Inj, abilify maintena, 1 mg
|
$8,046.00 |
$8,046.00 |
$8,046.00 |
$5,355.30
|
|
Inj, adalimumab, 1 mg
|
$117.60 |
$117.60 |
$117.60 |
$12,098.05
|
|
Inj andexxa, 10 mg
|
$14,184.00 |
$14,184.00 |
$14,184.00 |
$4,370.80
|
|
Inj, aponvie, 1 mg
|
$3.00 |
$3.00 |
$3.00 |
$3.36
|
|
Inj atezolizumb 5mg hya-tqjs
|
$54.60 |
$54.60 |
$54.60 |
$18,716.52
|
|
Inj, bezlotoxumab, 10 mg
|
$11,671.20 |
$11,671.20 |
$11,671.20 |
$7,612.43
|
|
Inj., brexanolone, 1 mg
|
$17,099.40 |
$17,099.40 |
$17,099.40 |
$13,019.44
|
|
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
|
$9.20 |
$9.20 |
$9.20 |
$22.69
|
|
Inj, cefepime hcl (b braun)
|
$75.00 |
$75.00 |
$75.00 |
$69.85
|
|
Inj ceftolozane tazobactam
|
$19.00 |
$19.00 |
$19.00 |
$364.86
|
|
Inj, cimerli, 0.1 mg
|
$519.00 |
$519.00 |
$519.00 |
$201.01
|
|
Inj cntr knee arthro incl ct/mri
|
$241.20 |
$241.20 |
$241.20 |
$436.80
|
|
Inj cyclophosphamd (ingenus)
|
$1.20 |
$1.20 |
$1.20 |
$742.72
|
|
Inj, donanemab-azbt, 2 mg
|
$7.20 |
$7.20 |
$7.20 |
$1,233.44
|
|
Inj, durolane 1 mg
|
$15.60 |
$15.60 |
$15.60 |
$1,950.93
|
|
Injection arthrography hip without anesthesia (both sides)
|
$583.80 |
$583.80 |
$583.80 |
$503.50
|
|
Injection, caplacizumab-yhdp
|
$19,956.00 |
$19,956.00 |
$19,956.00 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$703.80 |
$703.80 |
$703.80 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$131.40 |
$131.40 |
$131.40 |
$5,324.34
|
|
Injection, doxercalciferol
|
$105.00 |
$105.00 |
$105.00 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$1,909.20 |
$1,909.20 |
$1,909.20 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,877.40 |
$1,877.40 |
$1,877.40 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$606.60 |
$606.60 |
$606.60 |
$436.00
|
|
Injection for bladder x-ray
|
$1,845.00 |
$1,845.00 |
$1,845.00 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$561.00 |
$561.00 |
$561.00 |
$497.76
|
|
Injection, fulvestrant
|
$6,970.20 |
$6,970.20 |
$6,970.20 |
$1,719.16
|
|
Injection glatiramer acetate
|
$805.60 |
$805.60 |
$805.60 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$22.80 |
$22.80 |
$22.80 |
$6,679.35
|
|
Injection,onabotulinumtoxina
|
$3,987.00 |
$3,987.00 |
$3,987.00 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$508.80 |
$508.80 |
$508.80 |
$383.03
|
|
Injection, renflexis
|
$228.80 |
$228.80 |
$228.80 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,595.60 |
$2,595.60 |
$2,595.60 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,154.40 |
$1,154.40 |
$1,154.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$933.00 |
$933.00 |
$933.00 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,844.60 |
$2,844.60 |
$2,844.60 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$795.00 |
$795.00 |
$795.00 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,564.80 |
$1,564.80 |
$1,564.80 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$721.80 |
$721.80 |
$721.80 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,397.40 |
$1,397.40 |
$1,397.40 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,327.60 |
$3,327.60 |
$3,327.60 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,564.60 |
$3,564.60 |
$3,564.60 |
$1,685.00
|
|
Injection, siltuximab
|
$627.60 |
$627.60 |
$627.60 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$815.40 |
$815.40 |
$815.40 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$457.20 |
$457.20 |
$457.20 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$484.20 |
$484.20 |
$484.20 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$222.00 |
$222.00 |
$222.00 |
$145.60
|
|
Inj, epinephrine (belcher)
|
$1.20 |
$1.20 |
$1.20 |
$6.55
|
|
Inj., evomela, 1 mg
|
$106.80 |
$106.80 |
$106.80 |
$17.37
|
|
Inj, factor x, (human), 1iu
|
$52.80 |
$52.80 |
$52.80 |
$26.74
|
|
Inj. fe derisomaltose 10 mg
|
$236.00 |
$236.00 |
$236.00 |
$3,221.52
|
|
Inj for ext venography
|
$393.00 |
$393.00 |
$393.00 |
$628.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$6.00 |
$6.00 |
$1,322.20
|
|
Inj glofitamab gxbm, 2.5 mg
|
$4,752.60 |
$4,752.60 |
$4,752.60 |
$4,760.67
|
|
Inj. herceptin hylecta, 10mg
|
$178.80 |
$178.80 |
$178.80 |
$8,193.78
|
|
Inj hrt cath w/s&i sel left vent
|
$1,214.40 |
$1,214.40 |
$1,214.40 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$2,010.00 |
$2,010.00 |
$2,010.00 |
$999.96
|
|
Inj imip 4 cilas 4 releb 2mg
|
$7.40 |
$7.40 |
$7.40 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$871.80 |
$871.80 |
$871.80 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$303.00 |
$303.00 |
$303.00 |
$235.13
|
|
Inj levocarnitine per 1 gm
|
$598.40 |
$598.40 |
$598.40 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$0.05 |
$0.05 |
$0.05 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$108.00 |
$108.00 |
$108.00 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$5,335.80 |
$5,335.80 |
$5,335.80 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$13.80 |
$13.80 |
$13.80 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$36.20 |
$36.20 |
$36.20 |
$556.87
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$691.20 |
$691.20 |
$691.20 |
$8,304.04
|
|
Inj multihance
|
$160.80 |
$160.80 |
$160.80 |
$70.54
|
|
Inj naloxone hydrochloride
|
$57.00 |
$57.00 |
$57.00 |
$83.16
|
