|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$82.00 |
$82.00 |
$82.00 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$182.00 |
$182.00 |
$182.00 |
$98.58
|
|
Infectious agent nucleic acid amplified probe
|
$329.00 |
$329.00 |
$329.00 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$309.00 |
$309.00 |
$309.00 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$194.00 |
$194.00 |
$194.00 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,764.00 |
$1,764.00 |
$1,764.00 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$298.00 |
$298.00 |
$298.00 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$279.00 |
$279.00 |
$279.00 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$168.00 |
$168.00 |
$168.00 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$297.00 |
$297.00 |
$297.00 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$288.00 |
$288.00 |
$288.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$556.00 |
$556.00 |
$556.00 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$459.00 |
$459.00 |
$459.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$154.00 |
$154.00 |
$154.00 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$182.00 |
$182.00 |
$182.00 |
$112.45
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$211.00 |
$211.00 |
$211.00 |
$217.60
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$323.00 |
$323.00 |
$323.00 |
$195.60
|
|
Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets
|
$2,039.00 |
$2,039.00 |
$2,039.00 |
$1,143.75
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$892.00 |
$892.00 |
$892.00 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$483.00 |
$483.00 |
$483.00 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$637.00 |
$637.00 |
$637.00 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$1,958.00 |
$1,958.00 |
$1,958.00 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$478.00 |
$478.00 |
$478.00 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$474.00 |
$474.00 |
$474.00 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$337.00 |
$337.00 |
$337.00 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$442.00 |
$442.00 |
$442.00 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$3,222.55 |
$3,222.55 |
$3,222.55 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,379.70 |
$1,379.70 |
$1,379.70 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,739.55 |
$2,739.55 |
$2,739.55 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$378.00 |
$378.00 |
$378.00 |
$296.00
|
|
Initial nursing facility care/day 35 minutes
|
$310.00 |
$310.00 |
$310.00 |
$188.50
|
|
Initial nursing facility care/day 45 minutes
|
$403.92 |
$403.92 |
$403.92 |
$236.80
|
|
Initial nursing facility care/day low severity 99304
|
$216.00 |
$216.00 |
$216.00 |
$128.00
|
|
Inj, durolane 1 mg
|
$1,709.30 |
$1,709.30 |
$1,709.30 |
$1,950.93
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,595.00 |
$2,595.00 |
$2,595.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$824.00 |
$824.00 |
$824.00 |
$503.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,199.00 |
$1,199.00 |
$1,199.00 |
$458.15
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$7,275.90 |
$7,275.90 |
$7,275.90 |
$497.76
|
|
Injection,onabotulinumtoxina
|
$3,255.00 |
$3,255.00 |
$3,255.00 |
$2,277.65
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,733.00 |
$1,733.00 |
$1,733.00 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$770.00 |
$770.00 |
$770.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,870.23 |
$2,870.23 |
$2,870.23 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$9,846.00 |
$9,846.00 |
$9,846.00 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$6,095.39 |
$6,095.39 |
$6,095.39 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$4,473.00 |
$4,473.00 |
$4,473.00 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$7,747.78 |
$7,747.78 |
$7,747.78 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$5,973.85 |
$5,973.85 |
$5,973.85 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,358.35 |
$2,358.35 |
$2,358.35 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,392.75 |
$2,392.75 |
$2,392.75 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,199.00 |
$1,199.00 |
$1,199.00 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$232.00 |
$232.00 |
$232.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$332.00 |
$332.00 |
$332.00 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$6,655.00 |
$6,655.00 |
$6,655.00 |
$145.60
|
|
Inject sacroiliac joint
|
$2,118.53 |
$2,118.53 |
$2,118.53 |
$1,029.04
|
|
Inj epidural sgl lumb-sacral without img
|
$2,671.00 |
$2,671.00 |
$2,671.00 |
$1,450.84
|
|
Inj levocarnitine per 1 gm
|
$178.80 |
$178.80 |
$178.80 |
$136.62
|
|
Inj multihance
|
$391.45 |
$391.45 |
$391.45 |
$70.54
|
|
Inj, nithiodote, 3mg / 125mg
|
$984.90 |
$984.90 |
$984.90 |
$468.10
|
|
Inj pantoprazole(hikma) 40mg
|
$16.80 |
$16.80 |
$16.80 |
$34.67
|
|
Inj testosterone cypionate
|
$74.40 |
$74.40 |
$74.40 |
$64.96
|
|
Inj., tildrakizumab, 1 mg
|
$53,884.35 |
$53,884.35 |
$53,884.35 |
$26,635.60
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$73,182.85 |
$73,182.85 |
$73,182.85 |
$41,083.73
|
|
Inpt/tele follow up 25
|
$212.00 |
$212.00 |
$212.00 |
$118.80
|
|
Insert drug delivery implant
|
$524.00 |
$524.00 |
$524.00 |
$280.00
|
|
Insertion catheter bladder non indwelling
|
$48,123.28 |
$48,123.28 |
$48,123.28 |
$208.01
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$11,602.20 |
$11,602.20 |
$11,602.20 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$4,212.00 |
$4,212.00 |
$4,212.00 |
$2,453.83
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$6,851.00 |
$6,851.00 |
$6,851.00 |
$5,236.80
|
|
Insitu hybridization auto
|
$1,079.00 |
$1,079.00 |
$1,079.00 |
$377.37
|
|
In situ hybridization per specimen each additional single probe stain
|
$244.00 |
$244.00 |
$244.00 |
$243.50
|
|
In situ hybridization per specimen initial single probe stain
|
$431.00 |
$431.00 |
$431.00 |
$338.40
|
|
Insole orthotic freedom sz6 6816
|
$68.15 |
$68.15 |
$68.15 |
$84.00
|
|
Instillation anticarcinogenic agent bladder
|
$1,011.00 |
$1,011.00 |
$1,011.00 |
$638.40
|
|
Insulin total
|
$132.00 |
$132.00 |
$132.00 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$3,590.44 |
$3,590.44 |
$3,590.44 |
$8,617.32
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$225.79 |
$225.79 |
$225.79 |
$3,803.11
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$10,427.90 |
$10,427.90 |
$10,427.90 |
$10,427.90
|
|
Intrinsic factor antibody
|
$188.00 |
$188.00 |
$188.00 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$2,448.00 |
$2,448.00 |
$2,448.00 |
$601.28
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$227.50 |
$227.50 |
$227.50 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$110,829.85 |
$110,829.85 |
$110,829.85 |
$62,692.46
|
|
Ipratropium bromide non-comp
|
$1.02 |
$1.02 |
$1.02 |
$4.06
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$522.90 |
$522.90 |
$522.90 |
$173.98
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$9,268.95 |
$9,268.95 |
$9,268.95 |
$5,517.12
|
|
Iron
|
$82.00 |
$82.00 |
$82.00 |
$75.00
|
|
Iron binding capacity
|
$1,155.00 |
$1,155.00 |
$1,155.00 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$185.90 |
$185.90 |
$185.90 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$158.45 |
$158.45 |
$158.45 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$311.00 |
$311.00 |
$311.00 |
$115.20
|
|
Irrigation implantable venous access device for drug delivery systems
|
$251.00 |
$251.00 |
$251.00 |
$146.11
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$2,779.35 |
$2,779.35 |
$2,779.35 |
$8,273.35
|
|
IV Fluids (each additional hour)
|
$1,242.00 |
$1,242.00 |
$1,242.00 |
$133.90
|
|
IV Fluids (first hour)
|
$561.00 |
$561.00 |
$561.00 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$7,892.05 |
$7,892.05 |
$7,892.05 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$294.00 |
$294.00 |
$294.00 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$8,353.05 |
$8,353.05 |
$8,353.05 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$1,915.95 |
$1,915.95 |
$1,915.95 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$6,655.00 |
$6,655.00 |
$6,655.00 |
$167.50
|
|
IV Push Injection (first drug)
|
$1,137.00 |
$1,137.00 |
$1,137.00 |
$252.76
|
|
Ixabepilone 15 mg intravenous solution
|
$18,131.05 |
$18,131.05 |
$18,131.05 |
$10,695.32
|
