|
Infect ag genotype na hiv-1 revr trn/prt
|
$1,431.00 |
$1,431.00 |
$1,431.00 |
$603.83
|
|
Infect ag ia direct hiv-1 antgn
|
$182.40 |
$182.40 |
$182.40 |
$95.55
|
|
Infect ag if nos ea
|
$90.60 |
$90.60 |
$90.60 |
$74.88
|
|
Infect ag if varicella zoster
|
$75.00 |
$75.00 |
$75.00 |
$72.00
|
|
Infect ag na hep b amp
|
$126.60 |
$126.60 |
$126.60 |
$120.50
|
|
Infect ag na herpes simplex quant
|
$102.60 |
$102.60 |
$102.60 |
$178.86
|
|
Infect ag na hpv high-risk types
|
$195.60 |
$195.60 |
$195.60 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$532.80 |
$532.80 |
$532.80 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$195.60 |
$195.60 |
$195.60 |
$100.00
|
|
Infect ag na resp virus 12-25 targets
|
$2,317.80 |
$2,317.80 |
$2,317.80 |
$854.70
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$43.80 |
$43.80 |
$43.80 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$66.60 |
$66.60 |
$66.60 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$80.40 |
$80.40 |
$80.40 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$57.00 |
$57.00 |
$57.00 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$57.00 |
$57.00 |
$57.00 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$135.00 |
$135.00 |
$135.00 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$66.60 |
$66.60 |
$66.60 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$66.60 |
$66.60 |
$66.60 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$66.60 |
$66.60 |
$66.60 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$195.60 |
$195.60 |
$195.60 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$195.60 |
$195.60 |
$195.60 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$207.60 |
$207.60 |
$207.60 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$3,829.20 |
$3,829.20 |
$3,829.20 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$195.60 |
$195.60 |
$195.60 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$195.60 |
$195.60 |
$195.60 |
$149.13
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$195.60 |
$195.60 |
$195.60 |
$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
|
$84.60 |
$84.60 |
$84.60 |
$206.00
|
|
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
|
$195.60 |
$195.60 |
$195.60 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$195.60 |
$195.60 |
$195.60 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$876.60 |
$876.60 |
$876.60 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$553.20 |
$553.20 |
$553.20 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$238.80 |
$238.80 |
$238.80 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$238.80 |
$238.80 |
$238.80 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$238.80 |
$238.80 |
$238.80 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$474.60 |
$474.60 |
$474.60 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$793.80 |
$793.80 |
$793.80 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$700.20 |
$700.20 |
$700.20 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$300.00 |
$300.00 |
$300.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$567.60 |
$567.60 |
$567.60 |
$1,537.84
|
|
Influenza dna amp prob addl
|
$105.00 |
$105.00 |
$105.00 |
$64.26
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$93.60 |
$93.60 |
$93.60 |
$111.51
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$165.60 |
$165.60 |
$165.60 |
$296.00
|
|
Inj anifrolumab-fnia 1mg
|
$1,522.80 |
$1,522.80 |
$1,522.80 |
$10,052.58
|
|
Inj belantamab mafodot blmf
|
$5,295.60 |
$5,295.60 |
$5,295.60 |
$21,726.12
|
|
Inj., benralizumab, 1 mg
|
$3,405.60 |
$3,405.60 |
$3,405.60 |
$11,310.00
|
|
Inj, brixadi, 7 days or less
|
$533.40 |
$533.40 |
$533.40 |
$748.85
|
|
Inj brixadi, more than 7 day
|
$2,846.40 |
$2,846.40 |
$2,846.40 |
$2,858.76
|
|
Inj, bupivacaine liposome
|
$13.20 |
$13.20 |
$13.20 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$5.40 |
$5.40 |
$5.40 |
$22.69
|
|
Inj cefazolin sodium, hikma
|
$4.80 |
$4.80 |
$4.80 |
$27.38
|
|
Inj cefazolin (wg crit care)
|
$3.00 |
$3.00 |
$3.00 |
$18.43
|
|
Inj, cefepime hcl (b braun)
|
$17.40 |
$17.40 |
$17.40 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$131.40 |
$131.40 |
$131.40 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$94.80 |
$94.80 |
$94.80 |
$364.86
|
|
Inj cntr knee arthro incl ct/mri
|
$186.60 |
$186.60 |
$186.60 |
$436.80
|
|
Inj., copanlisib, 1 mg
|
$3,151.80 |
$3,151.80 |
$3,151.80 |
$9,204.29
|
|
Inj crotalidae im f(ab')2 eq
|
$792.00 |
$792.00 |
$792.00 |
$2,613.60
|
|
Inj cyclophosphamd (ingenus)
|
$87.60 |
$87.60 |
$87.60 |
$742.72
|
|
Inj disk cerv-thor ea lev
|
$1,878.60 |
$1,878.60 |
$1,878.60 |
$875.28
|
|
Inj dx for sinogram
|
$2,304.60 |
$2,304.60 |
$2,304.60 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,420.80 |
$1,420.80 |
$1,420.80 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$461.40 |
$461.40 |
$461.40 |
$503.50
|
|
Injection, cangrelor
|
$572.40 |
$572.40 |
$572.40 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$596.40 |
$596.40 |
$596.40 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$85.20 |
$85.20 |
$85.20 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$1,728.00 |
$1,728.00 |
$1,728.00 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,192.80 |
$1,192.80 |
$1,192.80 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$471.00 |
$471.00 |
$471.00 |
$436.00
|
|
Injection for bladder x-ray
|
$585.00 |
$585.00 |
$585.00 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$461.40 |
$461.40 |
$461.40 |
$497.76
|
|
Injection for spleen x-ray
|
$788.40 |
$788.40 |
$788.40 |
$686.40
|
|
Injection for ureter x-ray
|
$1,540.80 |
$1,540.80 |
$1,540.80 |
$415.80
|
|
Injection for ureter x-ray
|
$1,540.80 |
$1,540.80 |
$1,540.80 |
$515.21
|
|
Injection, fulvestrant
|
$115.80 |
$115.80 |
$115.80 |
$1,719.16
|
|
Injection, glucarpidase
|
$23,088.00 |
$23,088.00 |
$23,088.00 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$1,348.80 |
$1,348.80 |
$1,348.80 |
$6,679.35
|
|
Injection into brain canal
|
$961.20 |
$961.20 |
$961.20 |
$844.50
|
|
Injection, isavuconazonium
|
$229.20 |
$229.20 |
$229.20 |
$787.67
|
|
Injection jaw joint x-ray
|
$67.80 |
$67.80 |
$67.80 |
$307.80
|
|
Injection of sinus tract
|
$2,046.00 |
$2,046.00 |
$2,046.00 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$380.40 |
$380.40 |
$380.40 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$837.60 |
$837.60 |
$837.60 |
$685.44
|
|
Injection, renflexis
|
$451.80 |
$451.80 |
$451.80 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,647.20 |
$2,647.20 |
$2,647.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,346.60 |
$2,346.60 |
$2,346.60 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$948.00 |
$948.00 |
$948.00 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,647.20 |
$2,647.20 |
$2,647.20 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,318.80 |
$1,318.80 |
$1,318.80 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,456.20 |
$1,456.20 |
$1,456.20 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,318.80 |
$1,318.80 |
$1,318.80 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,318.80 |
$1,318.80 |
$1,318.80 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,048.40 |
$2,048.40 |
$2,048.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,048.40 |
$2,048.40 |
$2,048.40 |
$1,685.00
|
|
Injection, siltuximab
|
$3,603.00 |
$3,603.00 |
$3,603.00 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$894.60 |
$894.60 |
$894.60 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$396.60 |
$396.60 |
$396.60 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$766.20 |
$766.20 |
$766.20 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$108.00 |
$108.00 |
$108.00 |
$145.60
|
