|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$35.97 |
$35.97 |
$35.97 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$36.96 |
$36.96 |
$36.96 |
$76.32
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$36.96 |
$36.96 |
$36.96 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$29.04 |
$29.04 |
$29.04 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$36.96 |
$36.96 |
$36.96 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$78.87 |
$78.87 |
$78.87 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$112.20 |
$112.20 |
$112.20 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$37.29 |
$37.29 |
$37.29 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$110.55 |
$110.55 |
$110.55 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$116.82 |
$116.82 |
$116.82 |
$139.68
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$114.18 |
$114.18 |
$114.18 |
$167.00
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$594.00 |
$594.00 |
$594.00 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$49.17 |
$49.17 |
$49.17 |
$179.92
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$110.55 |
$110.55 |
$110.55 |
$147.55
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$77.88 |
$77.88 |
$77.88 |
$217.85
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$116.82 |
$116.82 |
$116.82 |
$136.03
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$118.47 |
$118.47 |
$118.47 |
$103.20
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$32.67 |
$32.67 |
$32.67 |
$92.50
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$162.03 |
$162.03 |
$162.03 |
$211.00
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$177.21 |
$177.21 |
$177.21 |
$185.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$191.40 |
$191.40 |
$191.40 |
$423.53
|
|
Infectious agent nucleic acid quantification bk virus
|
$229.68 |
$229.68 |
$229.68 |
$279.40
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$69.63 |
$69.63 |
$69.63 |
$239.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$49.50 |
$49.50 |
$49.50 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$67.98 |
$67.98 |
$67.98 |
$374.00
|
|
Infliximab 100 mg intravenous solution
|
$1,313.37 |
$1,313.37 |
$1,313.37 |
$2,080.86
|
|
Infliximab-axxq 100 mg intravenous solution
|
$562.32 |
$562.32 |
$562.32 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,064.23 |
$1,064.23 |
$1,064.23 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$110.88 |
$110.88 |
$110.88 |
$293.25
|
|
Initiation & management bipap/cpap initial day
|
$285.78 |
$285.78 |
$285.78 |
$576.00
|
|
Inj, abilify maintena, 1 mg
|
$3,266.45 |
$3,266.45 |
$3,266.45 |
$5,355.30
|
|
Inj, adalimumab, 1 mg
|
$1,370.68 |
$1,370.68 |
$1,370.68 |
$12,098.05
|
|
Inj, adstiladrin, per tx dos
|
$66,207.56 |
$66,207.56 |
$66,207.56 |
$63,354.77
|
|
Inj allopurinol sodium 1 mg
|
$4,484.00 |
$4,484.00 |
$4,484.00 |
$6,968.99
|
|
Inj alymsys 10 mg
|
$3,232.67 |
$3,232.67 |
$3,232.67 |
$1,280.74
|
|
Inj, artesunate, 1mg
|
$5,600.71 |
$5,600.71 |
$5,600.71 |
$14,460.21
|
|
Inj beta interferon sq 1 mcg
|
$362.61 |
$362.61 |
$362.61 |
$2,856.95
|
|
Inj, bezlotoxumab, 10 mg
|
$4,273.63 |
$4,273.63 |
$4,273.63 |
$7,612.43
|
|
Inj calcitriol per 0.1 mcg
|
$18.07 |
$18.07 |
$18.07 |
$23.28
|
|
Inj, cefiderocol, 10 mg
|
$261.86 |
$261.86 |
$261.86 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$196.09 |
$196.09 |
$196.09 |
$380.80
|
|
Inj cntr knee arthro incl ct/mri
|
$252.78 |
$252.78 |
$252.78 |
$436.80
|
|
Inj., copanlisib, 1 mg
|
$23,169.38 |
$23,169.38 |
$23,169.38 |
$9,204.29
|
|
Inj cyclophosphamd (ingenus)
|
$1,318.08 |
$1,318.08 |
$1,318.08 |
$742.72
|
|
Inj. denosumab-bbdz, 1 mg
|
$3,608.13 |
$3,608.13 |
$3,608.13 |
$4,615.43
|
|
Inj, durolane 1 mg
|
$441.54 |
$441.54 |
$441.54 |
$1,950.93
|
|
Inj dx for sinogram
|
$55.44 |
$55.44 |
$55.44 |
$422.59
|
|
Inject for sacroiliac joint
|
$73.59 |
$73.59 |
$73.59 |
$1,025.77
|
|
Injection arthrography hip without anesthesia (both sides)
|
$264.33 |
$264.33 |
$264.33 |
$495.84
|
|
Injection, belinostat, 10mg
|
$2,424.31 |
$2,424.31 |
$2,424.31 |
$4,446.10
|
|
Injection, caplacizumab-yhdp
|
$9,640.06 |
$9,640.06 |
$9,640.06 |
$16,375.33
|
|
Injection, daratumumab 10 mg
|
$3,307.90 |
$3,307.90 |
$3,307.90 |
$5,239.24
|
|
Injection, doxercalciferol
|
$16.09 |
$16.09 |
$16.09 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$130.02 |
$130.02 |
$130.02 |
$952.66
|
|
Injection epidural blood patch or clot
|
$357.06 |
$357.06 |
$357.06 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$274.23 |
$274.23 |
$274.23 |
$428.40
|
|
Injection for bladder x-ray
|
$89.43 |
$89.43 |
$89.43 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$264.33 |
$264.33 |
$264.33 |
$494.65
|
|
Injection for ureter x-ray
|
$621.39 |
$621.39 |
$621.39 |
$515.21
|
|
Injection, fulvestrant
|
$1,090.37 |
$1,090.37 |
$1,090.37 |
$1,817.65
|
|
Injection glatiramer acetate
|
$202.08 |
$202.08 |
$202.08 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$4,034.91 |
$4,034.91 |
$4,034.91 |
$6,679.35
|
|
Injection, isavuconazonium
|
$410.11 |
$410.11 |
$410.11 |
$787.67
|
|
Injection jugular
|
$165.99 |
$165.99 |
$165.99 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$1,464.28 |
$1,464.28 |
$1,464.28 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$269.94 |
$269.94 |
$269.94 |
$670.64
|
|
Injection, renflexis
|
$847.29 |
$847.29 |
$847.29 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$714.12 |
$714.12 |
$714.12 |
$1,582.12
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$447.15 |
$447.15 |
$447.15 |
$1,952.40
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$409.20 |
$409.20 |
$409.20 |
$1,681.24
|
|
Injection, siltuximab
|
$7,387.63 |
$7,387.63 |
$7,387.63 |
$10,680.75
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$407.22 |
$407.22 |
$407.22 |
$472.76
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$24.75 |
$24.75 |
$24.75 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$24.75 |
$24.75 |
$24.75 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$107.58 |
$107.58 |
$107.58 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$36.30 |
$36.30 |
$36.30 |
$135.60
|
|
Inject sacroiliac joint
|
$714.12 |
$714.12 |
$714.12 |
$1,028.95
|
|
Inj, eculizumab-aagh, 2 mg
|
$5,135.11 |
$5,135.11 |
$5,135.11 |
$7,980.52
|
|
Inj., eravacycline, 1 mg
|
$128.57 |
$128.57 |
$128.57 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$232.18 |
$232.18 |
$232.18 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$3,651.44 |
$3,651.44 |
$3,651.44 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$368.12 |
$368.12 |
$368.12 |
$39.54
|
|
Inj for ext venography
|
$331.32 |
$331.32 |
$331.32 |
$649.95
|
|
Inj fosnetupitant, palonoset
|
$629.80 |
$629.80 |
$629.80 |
$1,110.99
|
|
Inj glofitamab gxbm, 2.5 mg
|
$11,492.67 |
$11,492.67 |
$11,492.67 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$7.63 |
$7.63 |
$7.63 |
$11.23
|
|
Inj. herceptin hylecta, 10mg
|
$5,257.96 |
$5,257.96 |
$5,257.96 |
$7,690.59
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$130.02 |
$130.02 |
$130.02 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$134.64 |
$134.64 |
$134.64 |
$1,827.74
|
|
Inj hrt cath w/s&i sel left vent
|
$180.84 |
$180.84 |
$180.84 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$130.02 |
$130.02 |
$130.02 |
$965.33
|
|
Inj hydroxocobalamin IV 25mg
|
$1,178.62 |
$1,178.62 |
$1,178.62 |
$2,452.32
|
|
Inj. inebilizumab-cdon, 1 mg
|
$52,576.36 |
$52,576.36 |
$52,576.36 |
$70,014.65
|
|
Inj ivig privigen 500 mg
|
$14,434.60 |
$14,434.60 |
$14,434.60 |
$6,967.29
|
|
Inj, kovaltry, 1 i.u
|
$5.57 |
$5.57 |
$5.57 |
$5.07
|
|
Inj, lanreotide, (cipla) 1mg
|
$10,001.04 |
$10,001.04 |
$10,001.04 |
$11,648.70
|
|
Inj, levothyroxine, freskabi
|
$34.00 |
$34.00 |
$34.00 |
$303.45
|
|
Inj melpha hydroch nos 50 mg
|
$1,847.89 |
$1,847.89 |
$1,847.89 |
$1,791.90
|
|
Inj meropenem (wg crit care)
|
$63.06 |
$63.06 |
$63.06 |
$77.97
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$4,767.78 |
$4,767.78 |
$4,767.78 |
$8,304.04
|