|
Incobotulinumtoxin a
|
$1,044.89 |
$1,044.89 |
$1,044.89 |
$1,359.43
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$696.96 |
$696.96 |
$696.96 |
$785.83
|
|
Infect ag drug suscept pheno predict
|
$29.70 |
$29.70 |
$29.70 |
$323.20
|
|
Infect ag if ea plyvlnt antsrm
|
$17.40 |
$17.40 |
$17.40 |
$68.40
|
|
Infect ag if influenza a
|
$34.50 |
$34.50 |
$34.50 |
$42.35
|
|
Infect ag if influenza b
|
$34.50 |
$34.50 |
$34.50 |
$41.22
|
|
Infect ag if legionella pneumophila
|
$30.30 |
$30.30 |
$30.30 |
$73.45
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$32.70 |
$32.70 |
$32.70 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$33.60 |
$33.60 |
$33.60 |
$76.50
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$33.60 |
$33.60 |
$33.60 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$26.40 |
$26.40 |
$26.40 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$26.40 |
$26.40 |
$26.40 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$71.70 |
$71.70 |
$71.70 |
$101.43
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$102.00 |
$102.00 |
$102.00 |
$129.68
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$33.90 |
$33.90 |
$33.90 |
$56.70
|
|
Infectious agent nucleic acid amplified probe
|
$100.50 |
$100.50 |
$100.50 |
$268.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$106.20 |
$106.20 |
$106.20 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$103.80 |
$103.80 |
$103.80 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$540.00 |
$540.00 |
$540.00 |
$860.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$44.70 |
$44.70 |
$44.70 |
$184.80
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$100.50 |
$100.50 |
$100.50 |
$153.00
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$70.80 |
$70.80 |
$70.80 |
$208.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$106.20 |
$106.20 |
$106.20 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$107.70 |
$107.70 |
$107.70 |
$102.57
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$29.70 |
$29.70 |
$29.70 |
$94.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$26.10 |
$26.10 |
$26.10 |
$108.21
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$147.30 |
$147.30 |
$147.30 |
$254.50
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$161.10 |
$161.10 |
$161.10 |
$184.80
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$174.00 |
$174.00 |
$174.00 |
$440.26
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$63.30 |
$63.30 |
$63.30 |
$239.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$45.00 |
$45.00 |
$45.00 |
$258.05
|
|
Infectious agent nucleic acid quantification hiv-1
|
$61.80 |
$61.80 |
$61.80 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$85.50 |
$85.50 |
$85.50 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$1,193.98 |
$1,193.98 |
$1,193.98 |
$2,069.44
|
|
Infliximab-axxq 100 mg intravenous solution
|
$511.20 |
$511.20 |
$511.20 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$967.48 |
$967.48 |
$967.48 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$100.80 |
$100.80 |
$100.80 |
$302.94
|
|
Initiation & management bipap/cpap initial day
|
$259.80 |
$259.80 |
$259.80 |
$576.00
|
|
Inj, abilify maintena, 1 mg
|
$2,969.50 |
$2,969.50 |
$2,969.50 |
$5,355.30
|
|
Inj, adalimumab, 1 mg
|
$1,246.07 |
$1,246.07 |
$1,246.07 |
$12,098.05
|
|
Inj, adstiladrin, per tx dos
|
$60,188.69 |
$60,188.69 |
$60,188.69 |
$63,354.77
|
|
Inj allopurinol sodium 1 mg
|
$4,076.37 |
$4,076.37 |
$4,076.37 |
$6,968.99
|
|
Inj alymsys 10 mg
|
$2,938.79 |
$2,938.79 |
$2,938.79 |
$1,280.74
|
|
Inj, artesunate, 1mg
|
$5,091.55 |
$5,091.55 |
$5,091.55 |
$14,460.21
|
|
Inj beta interferon sq 1 mcg
|
$329.65 |
$329.65 |
$329.65 |
$2,856.95
|
|
Inj, bezlotoxumab, 10 mg
|
$3,885.12 |
$3,885.12 |
$3,885.12 |
$7,612.43
|
|
Inj calcitriol per 0.1 mcg
|
$16.43 |
$16.43 |
$16.43 |
$23.28
|
|
Inj, cefiderocol, 10 mg
|
$238.06 |
$238.06 |
$238.06 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$178.27 |
$178.27 |
$178.27 |
$390.44
|
|
Inj cntr knee arthro incl ct/mri
|
$115.20 |
$115.20 |
$115.20 |
$436.80
|
|
Inj., copanlisib, 1 mg
|
$21,063.08 |
$21,063.08 |
$21,063.08 |
$9,204.29
|
|
Inj cyclophosphamd (ingenus)
|
$1,198.25 |
$1,198.25 |
$1,198.25 |
$741.63
|
|
Inj. denosumab-bbdz, 1 mg
|
$3,280.12 |
$3,280.12 |
$3,280.12 |
$4,416.07
|
|
Inj, durolane 1 mg
|
$401.40 |
$401.40 |
$401.40 |
$1,950.93
|
|
Inj dx for sinogram
|
$50.40 |
$50.40 |
$50.40 |
$420.00
|
|
Inject for sacroiliac joint
|
$66.90 |
$66.90 |
$66.90 |
$1,025.77
|
|
Injection arthrography hip without anesthesia (both sides)
|
$240.30 |
$240.30 |
$240.30 |
$504.00
|
|
Injection, belinostat, 10mg
|
$2,203.92 |
$2,203.92 |
$2,203.92 |
$4,446.10
|
|
Injection, caplacizumab-yhdp
|
$8,763.69 |
$8,763.69 |
$8,763.69 |
$16,642.50
|
|
Injection, daratumumab 10 mg
|
$3,007.19 |
$3,007.19 |
$3,007.19 |
$5,239.24
|
|
Injection, doxercalciferol
|
$14.63 |
$14.63 |
$14.63 |
$23.83
|
|
Injection during cath supravalvular aortography
|
$118.20 |
$118.20 |
$118.20 |
$990.03
|
|
Injection epidural blood patch or clot
|
$324.60 |
$324.60 |
$324.60 |
$1,170.45
|
|
Injection for arthrography wrist (both sides)
|
$124.50 |
$124.50 |
$124.50 |
$448.20
|
|
Injection for bladder x-ray
|
$81.30 |
$81.30 |
$81.30 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$119.70 |
$119.70 |
$119.70 |
$494.65
|
|
Injection for ureter x-ray
|
$564.90 |
$564.90 |
$564.90 |
$527.70
|
|
Injection, fulvestrant
|
$991.24 |
$991.24 |
$991.24 |
$1,719.16
|
|
Injection glatiramer acetate
|
$183.71 |
$183.71 |
$183.71 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$3,668.10 |
$3,668.10 |
$3,668.10 |
$6,679.35
|
|
Injection, isavuconazonium
|
$372.83 |
$372.83 |
$372.83 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$1,331.17 |
$1,331.17 |
$1,331.17 |
$2,241.61
|
|
Injection radioactive tracer sentinel node (both sides)
|
$245.40 |
$245.40 |
$245.40 |
$704.50
|
|
Injection, renflexis
|
$770.27 |
$770.27 |
$770.27 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$649.20 |
$649.20 |
$649.20 |
$1,582.12
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$621.00 |
$621.00 |
$621.00 |
$1,048.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$813.30 |
$813.30 |
$813.30 |
$1,984.32
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$372.00 |
$372.00 |
$372.00 |
$1,696.20
|
|
Injection, siltuximab
|
$6,716.03 |
$6,716.03 |
$6,716.03 |
$11,502.35
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$141.00 |
$141.00 |
$141.00 |
$538.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$22.50 |
$22.50 |
$22.50 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$22.50 |
$22.50 |
$22.50 |
$147.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$97.80 |
$97.80 |
$97.80 |
$259.49
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$33.00 |
$33.00 |
$33.00 |
$136.20
|
|
Inject sacroiliac joint
|
$649.20 |
$649.20 |
$649.20 |
$984.39
|
|
Inj, eculizumab-aagh, 2 mg
|
$4,668.28 |
$4,668.28 |
$4,668.28 |
$7,410.48
|
|
Inj., eravacycline, 1 mg
|
$116.89 |
$116.89 |
$116.89 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$211.08 |
$211.08 |
$211.08 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$3,319.49 |
$3,319.49 |
$3,319.49 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$334.66 |
$334.66 |
$334.66 |
$37.93
|
|
Inj for ext venography
|
$150.90 |
$150.90 |
$150.90 |
$654.00
|
|
Inj for mammo ductogram
|
$129.60 |
$129.60 |
$129.60 |
$400.80
|
|
Inj fosnetupitant, palonoset
|
$572.54 |
$572.54 |
$572.54 |
$1,110.99
|
|
Inj glofitamab gxbm, 2.5 mg
|
$10,447.88 |
$10,447.88 |
$10,447.88 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$6.94 |
$6.94 |
$6.94 |
$11.23
|
|
Inj. herceptin hylecta, 10mg
|
$4,779.97 |
$4,779.97 |
$4,779.97 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$118.20 |
$118.20 |
$118.20 |
$1,323.50
|
|
Inj hrt cath w/s&i sel right vent
|
$118.20 |
$118.20 |
$118.20 |
$941.50
|
|
Inj hydroxocobalamin IV 25mg
|
$1,071.47 |
$1,071.47 |
$1,071.47 |
$2,452.32
|
|
Inj. inebilizumab-cdon, 1 mg
|
$47,796.69 |
$47,796.69 |
$47,796.69 |
$70,014.65
|