|
Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution
|
$10.89 |
$10.89 |
$10.89 |
$5,836.20
|
|
Hydralazine 20 mg/ml injection solution
|
$48.38 |
$48.38 |
$48.38 |
$46.74
|
|
Hydration IV infusion each additional hour
|
$64.08 |
$64.08 |
$64.08 |
$131.20
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$385.20 |
$385.20 |
$385.20 |
$383.00
|
|
Hydrocolld drg <=16 without bdr
|
$30.96 |
$30.96 |
$30.96 |
$7.92
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$3.24 |
$3.24 |
$3.24 |
$131.47
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$55.75 |
$55.75 |
$55.75 |
$72.65
|
|
Hydrxycorticsterds 17- (17-ohcs)
|
$56.88 |
$56.88 |
$56.88 |
$76.13
|
|
Hymenotomy
|
$4,245.12 |
$4,245.12 |
$4,245.12 |
$4,446.00
|
|
Hysterosalpingography s&i
|
$694.08 |
$694.08 |
$694.08 |
$651.85
|
|
Iadna legionella pneumophila amplified probe tq
|
$94.32 |
$94.32 |
$94.32 |
$109.80
|
|
I&d abscss rtrphryngl/paraphryngl intraorl apprch
|
$7,931.52 |
$7,931.52 |
$7,931.52 |
$3,771.20
|
|
Igh gene rearrange amp meth
|
$1,239.84 |
$1,239.84 |
$1,239.84 |
$456.54
|
|
Igk rearrangeabn clonal pop
|
$1,230.48 |
$1,230.48 |
$1,230.48 |
$396.00
|
|
Ihc/icc per specimen each additional single antibody stain
|
$216.72 |
$216.72 |
$216.72 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$614.88 |
$614.88 |
$614.88 |
$328.79
|
|
Ihc/icc per specimen initial single antibody stain
|
$233.28 |
$233.28 |
$233.28 |
$274.86
|
|
Immune complex assay
|
$46.08 |
$46.08 |
$46.08 |
$109.20
|
|
Immunoassay tumor antigen quantitative ca 125
|
$48.24 |
$48.24 |
$48.24 |
$130.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$152.64 |
$152.64 |
$152.64 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$35.28 |
$35.28 |
$35.28 |
$48.50
|
|
Immunodiffusion nes
|
$82.80 |
$82.80 |
$82.80 |
$53.76
|
|
Immunofixation electrophoresis serum
|
$126.72 |
$126.72 |
$126.72 |
$138.60
|
|
Immunoglobulin assay
|
$110.16 |
$110.16 |
$110.16 |
$74.15
|
|
Implant cartilage 10mm synthetic
|
$2,376.00 |
$2,376.00 |
$2,376.00 |
$10,050.00
|
|
Impl neurostim electr perc
|
$7,087.68 |
$7,087.68 |
$7,087.68 |
$7,546.20
|
|
Incision of breast lesion
|
$3,443.76 |
$3,443.76 |
$3,443.76 |
$2,577.85
|
|
Incision of tongue fold
|
$5,457.60 |
$5,457.60 |
$5,457.60 |
$1,792.50
|
|
Infect ag ia optc obs influenza
|
$193.68 |
$193.68 |
$193.68 |
$72.93
|
|
Infect ag if nos ea
|
$73.44 |
$73.44 |
$73.44 |
$74.10
|
|
Infect ag if varicella zoster
|
$28.08 |
$28.08 |
$28.08 |
$72.00
|
|
Infect ag na herpes simplex quant
|
$332.64 |
$332.64 |
$332.64 |
$169.65
|
|
Infect ag na hpv high-risk types
|
$249.12 |
$249.12 |
$249.12 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$501.84 |
$501.84 |
$501.84 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$99.36 |
$99.36 |
$99.36 |
$99.36
|
|
Infect ag na resp virus 12-25 targets
|
$1,321.20 |
$1,321.20 |
$1,321.20 |
$859.44
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$109.44 |
$109.44 |
$109.44 |
$51.31
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$36.72 |
$36.72 |
$36.72 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$126.00 |
$126.00 |
$126.00 |
$69.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$122.40 |
$122.40 |
$122.40 |
$76.50
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$88.56 |
$88.56 |
$88.56 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$289.44 |
$289.44 |
$289.44 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$198.72 |
$198.72 |
$198.72 |
$81.06
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$186.48 |
$186.48 |
$186.48 |
$57.60
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$203.04 |
$203.04 |
$203.04 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$360.72 |
$360.72 |
$360.72 |
$127.80
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$325.44 |
$325.44 |
$325.44 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$153.36 |
$153.36 |
$153.36 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$513.36 |
$513.36 |
$513.36 |
$267.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$264.24 |
$264.24 |
$264.24 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$235.44 |
$235.44 |
$235.44 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$653.76 |
$653.76 |
$653.76 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$617.76 |
$617.76 |
$617.76 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$217.44 |
$217.44 |
$217.44 |
$151.25
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$220.32 |
$220.32 |
$220.32 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$331.92 |
$331.92 |
$331.92 |
$100.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$346.32 |
$346.32 |
$346.32 |
$217.70
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$396.00 |
$396.00 |
$396.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$200.88 |
$200.88 |
$200.88 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$221.04 |
$221.04 |
$221.04 |
$105.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$710.64 |
$710.64 |
$710.64 |
$711.93
|
|
Infectious agent nucleic acid quantification bk virus
|
$410.40 |
$410.40 |
$410.40 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$357.84 |
$357.84 |
$357.84 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$639.36 |
$639.36 |
$639.36 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$333.36 |
$333.36 |
$333.36 |
$374.50
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$464.40 |
$464.40 |
$464.40 |
$303.59
|
|
Initiation & management bipap/cpap initial day
|
$324.72 |
$324.72 |
$324.72 |
$576.00
|
|
Inj, biorphen, 20 micrograms
|
$0.86 |
$0.86 |
$0.86 |
$17.12
|
|
Inj cntr knee arthro incl ct/mri
|
$202.32 |
$202.32 |
$202.32 |
$436.80
|
|
Injection arthrography hip without anesthesia (both sides)
|
$291.60 |
$291.60 |
$291.60 |
$500.50
|
|
Injection epidural blood patch or clot
|
$982.08 |
$982.08 |
$982.08 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$215.28 |
$215.28 |
$215.28 |
$441.12
|
|
Injection for bladder x-ray
|
$802.08 |
$802.08 |
$802.08 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$216.72 |
$216.72 |
$216.72 |
$494.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$822.96 |
$822.96 |
$822.96 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,492.00 |
$3,492.00 |
$3,492.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,086.56 |
$2,086.56 |
$2,086.56 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,523.68 |
$3,523.68 |
$3,523.68 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$2,054.16 |
$2,054.16 |
$2,054.16 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,349.36 |
$2,349.36 |
$2,349.36 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,034.72 |
$2,034.72 |
$2,034.72 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,698.72 |
$4,698.72 |
$4,698.72 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,808.64 |
$1,808.64 |
$1,808.64 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,808.64 |
$1,808.64 |
$1,808.64 |
$1,704.78
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$756.00 |
$756.00 |
$756.00 |
$517.24
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$100.08 |
$100.08 |
$100.08 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$100.08 |
$100.08 |
$100.08 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$198.00 |
$198.00 |
$198.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$66.96 |
$66.96 |
$66.96 |
$135.20
|
|
Inj epidural sgl cerv-thor without img
|
$1,740.96 |
$1,740.96 |
$1,740.96 |
$1,329.00
|
|
Inj for mammo ductogram
|
$401.76 |
$401.76 |
$401.76 |
$433.50
|
|
Inj labetalol hcl hikma, 5mg
|
$1.62 |
$1.62 |
$1.62 |
$40.00
|
|
Inj, lidocaine w epinephrine
|
$0.20 |
$0.20 |
$0.20 |
$44.96
|
|
Inj proc ankle arthr
|
$176.40 |
$176.40 |
$176.40 |
$405.31
|
|
Inj proc elbow arthro
|
$200.16 |
$200.16 |
$200.16 |
$432.00
|
|
Inj w/fluor eval cv device
|
$406.80 |
$406.80 |
$406.80 |
$463.40
|
|
Insertion catheter bladder non indwelling
|
$226.80 |
$226.80 |
$226.80 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$215.28 |
$215.28 |
$215.28 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,399.12 |
$3,399.12 |
$3,399.12 |
$2,511.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,194.56 |
$2,194.56 |
$2,194.56 |
$2,079.43
|