|
Hydroxyzine pamoate 25 mg capsule
|
$1.00 |
$1.00 |
$1.00 |
$1.28
|
|
Hzv zoster vacc recombinant adjuvanted im inj
|
$169.00 |
$169.00 |
$169.00 |
$352.24
|
|
I-123 iobenguane diag
|
$24,445.60 |
$24,445.60 |
$24,445.60 |
$5,170.70
|
|
I-123 ioflupane diag
|
$12,340.00 |
$12,340.00 |
$12,340.00 |
$4,158.00
|
|
I-123 sod iodide diag per 100 uci
|
$412.50 |
$412.50 |
$412.50 |
$147.46
|
|
I-131 iobenguane sulf diag mibg
|
$6,709.35 |
$6,709.35 |
$6,709.35 |
$3,638.48
|
|
I-131 sod iodide sol diag per mci
|
$417.75 |
$417.75 |
$417.75 |
$114.60
|
|
Ibandronate 3 mg/3 ml intravenous syringe
|
$1,149.75 |
$1,149.75 |
$1,149.75 |
$684.45
|
|
Icd cobalt xt dr MRI is1 df1
|
$20,112.30 |
$20,112.30 |
$20,112.30 |
$34,093.09
|
|
Icd crtd cobalt hf MRI is1 df1
|
$27,933.75 |
$27,933.75 |
$27,933.75 |
$39,070.50
|
|
Icd crtp serena MRI
|
$9,235.69 |
$9,235.69 |
$9,235.69 |
$14,360.25
|
|
Icd reliance df4 ib 64cm
|
$4,621.95 |
$4,621.95 |
$4,621.95 |
$9,264.83
|
|
Ifosfamide 1 gram intravenous solution
|
$494.70 |
$494.70 |
$494.70 |
$246.95
|
|
Imetelstat 188 mg intravenous solution
|
$31,931.40 |
$31,931.40 |
$31,931.40 |
$20,373.55
|
|
Immob elbow child sm
|
$29.02 |
$29.02 |
$29.02 |
$85.39
|
|
Immobilizer lwr extrem nylon 20in reinforc 21-35in
|
$525.01 |
$525.01 |
$525.01 |
$259.20
|
|
Immobilizer shldr cntor adlt
|
$171.43 |
$171.43 |
$171.43 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$136.42 |
$136.42 |
$136.42 |
$118.43
|
|
Immobilizer shldr sling med
|
$34.03 |
$34.03 |
$34.03 |
$126.00
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$10,106.10 |
$10,106.10 |
$10,106.10 |
$6,106.32
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$4,576.15 |
$4,576.15 |
$4,576.15 |
$2,900.11
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$6,381.00 |
$6,381.00 |
$6,381.00 |
$3,846.15
|
|
Immunoassay tumor antigen quantitative ca 125
|
$131.95 |
$131.95 |
$131.95 |
$132.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$104.65 |
$104.65 |
$104.65 |
$116.40
|
|
Immunofixation electrophoresis serum
|
$155.35 |
$155.35 |
$155.35 |
$142.50
|
|
Impl ahmed 6x25x9.6mm glaucoma vlv w/sil ped ster
|
$5,473.00 |
$5,473.00 |
$5,473.00 |
$2,946.00
|
|
Implant 11 volt lithium-ion backup battery for controller pocket
|
$913.25 |
$913.25 |
$913.25 |
$1,754.00
|
|
Implant cartilage 10mm synthetic
|
$4,241.57 |
$4,241.57 |
$4,241.57 |
$8,332.51
|
|
Implant cochlear osia osi300
|
$6,357.14 |
$6,357.14 |
$6,357.14 |
$16,195.55
|
|
Implant power module patient cable cable 14 volt
|
$2,283.12 |
$2,283.12 |
$2,283.12 |
$3,695.42
|
|
Implant pulse generator remede el
|
$12,314.25 |
$12,314.25 |
$12,314.25 |
$43,752.80
|
|
Implant ureth bulk agent
|
$2,100.47 |
$2,100.47 |
$2,100.47 |
$2,168.00
|
|
Impl ear abutment ba300 9mm
|
$3,704.37 |
$3,704.37 |
$3,704.37 |
$3,974.88
|
|
Impl eye bio-eye 16mm
|
$1,657.55 |
$1,657.55 |
$1,657.55 |
$3,917.20
|
|
In-111 autologous plt stdy dx
|
$1,494.95 |
$1,494.95 |
$1,494.95 |
$6,139.64
|
|
In-111 autol wbc diag per dose
|
$10,776.60 |
$10,776.60 |
$10,776.60 |
$3,493.75
|
|
In-111 capromab pendet
|
$7,024.00 |
$7,024.00 |
$7,024.00 |
$3,141.45
|
|
In-111 ibritumomab tiux dx
|
$7,246.75 |
$7,246.75 |
$7,246.75 |
$4,748.02
|
|
In-111 oxyquinolin per 0.5 mci
|
$10,776.60 |
$10,776.60 |
$10,776.60 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$11,163.95 |
$11,163.95 |
$11,163.95 |
$2,598.17
|
|
In-111 pentetreotide
|
$15,327.00 |
$15,327.00 |
$15,327.00 |
$5,294.90
|
|
In-111 satumomab pend
|
$3,524.25 |
$3,524.25 |
$3,524.25 |
$3,113.04
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$364.00 |
$364.00 |
$364.00 |
$2,086.70
|
|
Incision tendon sheath
|
$666.90 |
$666.90 |
$666.90 |
$3,073.20
|
|
Infect ag eia influenza a or b ea
|
$466.00 |
$466.00 |
$466.00 |
$71.20
|
|
Infect ag na resp virus 12-25 targets
|
$812.50 |
$812.50 |
$812.50 |
$854.70
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$68.25 |
$68.25 |
$68.25 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$103.35 |
$103.35 |
$103.35 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$100.10 |
$100.10 |
$100.10 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$210.60 |
$210.60 |
$210.60 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$94.25 |
$94.25 |
$94.25 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$123.50 |
$123.50 |
$123.50 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$53.30 |
$53.30 |
$53.30 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$63.70 |
$63.70 |
$63.70 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$213.85 |
$213.85 |
$213.85 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$200.85 |
$200.85 |
$200.85 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$126.10 |
$126.10 |
$126.10 |
$167.05
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$193.70 |
$193.70 |
$193.70 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$181.35 |
$181.35 |
$181.35 |
$149.13
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$193.05 |
$193.05 |
$193.05 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$807.00 |
$807.00 |
$807.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$361.40 |
$361.40 |
$361.40 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$298.35 |
$298.35 |
$298.35 |
$236.08
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$202.15 |
$202.15 |
$202.15 |
$112.45
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$137.15 |
$137.15 |
$137.15 |
$217.60
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$209.95 |
$209.95 |
$209.95 |
$195.60
|
|
Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets
|
$1,325.35 |
$1,325.35 |
$1,325.35 |
$1,143.75
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$579.80 |
$579.80 |
$579.80 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$313.95 |
$313.95 |
$313.95 |
$289.91
|
|
Infectious agent nucleic acid quantification bk virus
|
$231.40 |
$231.40 |
$231.40 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$308.10 |
$308.10 |
$308.10 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$219.05 |
$219.05 |
$219.05 |
$375.00
|
|
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
|
|
Initial nursing facility care/day 35 minutes
|
$224.25 |
$224.25 |
$224.25 |
$188.50
|
|
Initial nursing facility care/day low severity 99304
|
$216.00 |
$216.00 |
$216.00 |
$128.00
|
|
Injection, renflexis
|
$1,933.40 |
$1,933.40 |
$1,933.40 |
$1,341.52
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$156.00 |
$156.00 |
$156.00 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$145.60 |
$145.60 |
$145.60 |
$145.60
|
|
Inj hydroxocobalamin IV 25mg
|
$4,819.80 |
$4,819.80 |
$4,819.80 |
$2,452.32
|
|
Inj, nithiodote, 3mg / 125mg
|
$984.90 |
$984.90 |
$984.90 |
$468.10
|
|
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
|
|
Insertion catheter bladder non indwelling
|
$250.90 |
$250.90 |
$250.90 |
$208.01
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,022.15 |
$2,022.15 |
$2,022.15 |
$2,103.75
|
|
Insole orthotic freedom sz6 6816
|
$44.30 |
$44.30 |
$44.30 |
$84.00
|
|
Insulin total
|
$85.80 |
$85.80 |
$85.80 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$2,333.79 |
$2,333.79 |
$2,333.79 |
$8,617.32
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$146.76 |
$146.76 |
$146.76 |
$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
|
$122.20 |
$122.20 |
$122.20 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$450.00 |
$450.00 |
$450.00 |
$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
|
|
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
|
$53.30 |
$53.30 |
$53.30 |
$75.00
|
|
Iron binding capacity
|
$63.05 |
$63.05 |
$63.05 |
$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
|