|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$20.10 |
$20.10 |
$20.10 |
$69.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$20.10 |
$20.10 |
$20.10 |
$76.50
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$21.00 |
$21.00 |
$21.00 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$25.20 |
$25.20 |
$25.20 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$17.40 |
$17.40 |
$17.40 |
$81.06
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$17.40 |
$17.40 |
$17.40 |
$57.60
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$42.15 |
$42.15 |
$42.15 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$20.10 |
$20.10 |
$20.10 |
$127.80
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$20.10 |
$20.10 |
$20.10 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$20.10 |
$20.10 |
$20.10 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$61.50 |
$61.50 |
$61.50 |
$267.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$61.50 |
$61.50 |
$61.50 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$61.50 |
$61.50 |
$61.50 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$733.80 |
$733.80 |
$733.80 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$61.50 |
$61.50 |
$61.50 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$61.50 |
$61.50 |
$61.50 |
$151.25
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$61.50 |
$61.50 |
$61.50 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$61.50 |
$61.50 |
$61.50 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$15.00 |
$15.00 |
$15.00 |
$100.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$47.10 |
$47.10 |
$47.10 |
$217.70
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$61.50 |
$61.50 |
$61.50 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$61.50 |
$61.50 |
$61.50 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$30.90 |
$30.90 |
$30.90 |
$105.00
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$34.80 |
$34.80 |
$34.80 |
$184.80
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$402.60 |
$402.60 |
$402.60 |
$711.93
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$224.10 |
$224.10 |
$224.10 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$372.75 |
$372.75 |
$372.75 |
$429.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$75.15 |
$75.15 |
$75.15 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$75.15 |
$75.15 |
$75.15 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$75.15 |
$75.15 |
$75.15 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$148.95 |
$148.95 |
$148.95 |
$374.50
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$124.20 |
$124.20 |
$124.20 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$1,297.97 |
$1,297.97 |
$1,297.97 |
$2,080.86
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,052.69 |
$1,052.69 |
$1,052.69 |
$1,617.43
|
|
Influenza dna amp prob addl
|
$36.45 |
$36.45 |
$36.45 |
$64.26
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$53.55 |
$53.55 |
$53.55 |
$293.04
|
|
Initiation & management bipap/cpap initial day
|
$234.75 |
$234.75 |
$234.75 |
$576.00
|
|
Inj acetaminophen -fresenius
|
$51.35 |
$51.35 |
$51.35 |
$38.87
|
|
Inj., benralizumab, 1 mg
|
$5,924.23 |
$5,924.23 |
$5,924.23 |
$11,604.71
|
|
Inj calcitriol per 0.1 mcg
|
$24.33 |
$24.33 |
$24.33 |
$22.69
|
|
Inj, cefiderocol, 10 mg
|
$287.35 |
$287.35 |
$287.35 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$189.44 |
$189.44 |
$189.44 |
$408.00
|
|
Inj cntr knee arthro incl ct/mri
|
$169.05 |
$169.05 |
$169.05 |
$436.80
|
|
Inj, daptomycin (baxter)
|
$161.40 |
$161.40 |
$161.40 |
$1.83
|
|
Inj dx for sinogram
|
$202.65 |
$202.65 |
$202.65 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$312.90 |
$312.90 |
$312.90 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$169.05 |
$169.05 |
$169.05 |
$500.50
|
|
Injection, cangrelor
|
$922.96 |
$922.96 |
$922.96 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$165.90 |
$165.90 |
$165.90 |
$504.90
|
|
Injection, daratumumab 10 mg
|
$3,268.71 |
$3,268.71 |
$3,268.71 |
$5,164.24
|
|
Injection, doxercalciferol
|
$7.34 |
$7.34 |
$7.34 |
$23.12
|
|
Injection during cath supravalvular aortography
|
$67.35 |
$67.35 |
$67.35 |
$904.17
|
|
Injection epidural blood patch or clot
|
$352.95 |
$352.95 |
$352.95 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$60.75 |
$60.75 |
$60.75 |
$441.12
|
|
Injection for bladder x-ray
|
$66.90 |
$66.90 |
$66.90 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$197.40 |
$197.40 |
$197.40 |
$494.65
|
|
Injection for ureter x-ray
|
$264.30 |
$264.30 |
$264.30 |
$515.21
|
|
Injection, fulvestrant
|
$1,293.80 |
$1,293.80 |
$1,293.80 |
$1,719.16
|
|
Injection, glucarpidase
|
$40,574.83 |
$40,574.83 |
$40,574.83 |
$74,113.20
|
|
Injection, isavuconazonium
|
$496.16 |
$496.16 |
$496.16 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$701.93 |
$701.93 |
$1,403.87 |
$2,241.61
|
|
Injection radioactive tracer sentinel node (both sides)
|
$482.85 |
$482.85 |
$482.85 |
$683.28
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$471.15 |
$471.15 |
$471.15 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$293.70 |
$293.70 |
$293.70 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$352.80 |
$352.80 |
$352.80 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$787.50 |
$787.50 |
$787.50 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$828.90 |
$828.90 |
$828.90 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$129.90 |
$129.90 |
$129.90 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$552.30 |
$552.30 |
$552.30 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$152.25 |
$152.25 |
$152.25 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$447.90 |
$447.90 |
$447.90 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$235.35 |
$235.35 |
$235.35 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$245.85 |
$245.85 |
$245.85 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$235.35 |
$235.35 |
$235.35 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$27.75 |
$27.75 |
$27.75 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$43.65 |
$43.65 |
$43.65 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$59.70 |
$59.70 |
$59.70 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$31.95 |
$31.95 |
$31.95 |
$135.20
|
|
Inject sacroiliac joint
|
$342.15 |
$342.15 |
$342.15 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$138.45 |
$138.45 |
$138.45 |
$1,329.00
|
|
Inj for ext venography
|
$552.45 |
$552.45 |
$552.45 |
$654.00
|
|
Inj for mammo ductogram
|
$242.10 |
$242.10 |
$242.10 |
$433.50
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,237.50
|
|
Inj intralesional <= 7 lsn(s)
|
$83.55 |
$83.55 |
$83.55 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$6,506.50 |
$6,506.50 |
$13,007.99 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$87.23 |
$87.23 |
$87.23 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$18.05 |
$18.05 |
$18.05 |
$44.96
|
|
Inj mepivacaine hcl/10 ml
|
$18.19 |
$18.19 |
$18.19 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$296.63 |
$296.63 |
$296.63 |
$536.27
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$702.45 |
$702.45 |
$702.45 |
$1,414.40
|
|
Inj peritoneal venous shunt
|
$54.90 |
$54.90 |
$54.90 |
$406.80
|
|
Inj proc elbow arthro
|
$61.65 |
$61.65 |
$61.65 |
$432.00
|
|
Inj proc for lymphang
|
$661.50 |
$661.50 |
$661.50 |
$805.80
|
|
Inj proc myelogram lumbar
|
$368.55 |
$368.55 |
$368.55 |
$856.00
|
|
Inj, releuko 1 mcg
|
$366.91 |
$366.91 |
$366.91 |
$461.20
|
|
Inj retro urethrocysto
|
$66.90 |
$66.90 |
$66.90 |
$450.00
|
|
Inj scleros sol sgl vein
|
$267.00 |
$267.00 |
$267.00 |
$534.40
|
|
Inj sulf hexa lipid microsph
|
$86.15 |
$86.15 |
$86.15 |
$256.14
|
|
Inj testosterone cypionate
|
$51.35 |
$51.35 |
$51.35 |
$62.80
|
|
Inj w/fluor eval cv device
|
$241.50 |
$241.50 |
$241.50 |
$463.40
|