|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$108.00 |
$108.00 |
$108.00 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$94.40 |
$94.40 |
$94.40 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$97.60 |
$97.60 |
$97.60 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$170.40 |
$170.40 |
$170.40 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$70.40 |
$70.40 |
$70.40 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$101.60 |
$101.60 |
$101.60 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$31.20 |
$31.20 |
$31.20 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$129.60 |
$129.60 |
$129.60 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$92.00 |
$92.00 |
$92.00 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$177.60 |
$177.60 |
$177.60 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$184.00 |
$184.00 |
$184.00 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$210.40 |
$210.40 |
$210.40 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,355.20 |
$1,355.20 |
$1,355.20 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$263.20 |
$263.20 |
$263.20 |
$181.35
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$182.40 |
$182.40 |
$182.40 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$124.80 |
$124.80 |
$124.80 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$349.60 |
$349.60 |
$349.60 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$460.80 |
$460.80 |
$460.80 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$105.60 |
$105.60 |
$105.60 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$114.40 |
$114.40 |
$114.40 |
$112.45
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$366.40 |
$366.40 |
$366.40 |
$217.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,227.20 |
$1,227.20 |
$1,227.20 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$757.60 |
$757.60 |
$757.60 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$103.20 |
$103.20 |
$103.20 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$100.00 |
$100.00 |
$100.00 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$461.60 |
$461.60 |
$461.60 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$443.20 |
$443.20 |
$443.20 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$348.00 |
$348.00 |
$348.00 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$1,587.80 |
$1,587.80 |
$1,587.80 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$753.01 |
$753.01 |
$753.01 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$801.01 |
$801.01 |
$801.01 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$320.00 |
$320.00 |
$320.00 |
$296.00
|
|
Inj, acetaminophen (b braun)
|
$76.83 |
$76.83 |
$76.83 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$97.51 |
$97.51 |
$97.51 |
$36.60
|
|
Inj alymsys 10 mg
|
$2,472.50 |
$2,472.50 |
$2,472.50 |
$1,280.74
|
|
Inj., benralizumab, 1 mg
|
$8,621.41 |
$8,621.41 |
$8,621.41 |
$11,310.00
|
|
Inj, bupivacaine liposome
|
$60.00 |
$60.00 |
$60.00 |
$699.38
|
|
Inj, cefepime hcl (b braun)
|
$124.31 |
$124.31 |
$124.31 |
$69.85
|
|
Inj, daptomycin (hospira)
|
$86.38 |
$86.38 |
$86.38 |
$128.08
|
|
Inj dx for sinogram
|
$728.00 |
$728.00 |
$728.00 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$753.60 |
$753.60 |
$753.60 |
$503.50
|
|
Injection epidural blood patch or clot
|
$1,869.60 |
$1,869.60 |
$1,869.60 |
$1,182.33
|
|
Injection for bladder x-ray
|
$747.20 |
$747.20 |
$747.20 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$641.60 |
$641.60 |
$641.60 |
$497.76
|
|
Injection, fulvestrant
|
$1,350.36 |
$1,350.36 |
$1,350.36 |
$1,719.16
|
|
Injection glatiramer acetate
|
$684.93 |
$684.93 |
$684.93 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$5,260.16 |
$5,260.16 |
$5,260.16 |
$6,679.35
|
|
Injection,onabotulinumtoxina
|
$916.80 |
$916.80 |
$916.80 |
$2,277.65
|
|
Injection, renflexis
|
$781.63 |
$781.63 |
$781.63 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$994.40 |
$994.40 |
$994.40 |
$1,043.72
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,328.80 |
$2,328.80 |
$2,328.80 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,048.00 |
$2,048.00 |
$2,048.00 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$473.60 |
$473.60 |
$473.60 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$546.40 |
$546.40 |
$546.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$652.00 |
$652.00 |
$652.00 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$174.40 |
$174.40 |
$174.40 |
$145.60
|
|
Inject sacroiliac joint
|
$1,198.40 |
$1,198.40 |
$1,198.40 |
$1,029.04
|
|
Inj. fe derisomaltose 10 mg
|
$3,221.52 |
$3,221.52 |
$3,221.52 |
$3,221.52
|
|
Inj heparin, pfizer, 1000u
|
$61.86 |
$61.86 |
$61.86 |
$25.30
|
|
Inj hydroxocobalamin IV 25mg
|
$1,614.40 |
$1,614.40 |
$1,614.40 |
$2,452.32
|
|
Inj ivig privigen 500 mg
|
$7,183.84 |
$7,183.84 |
$7,183.84 |
$6,967.29
|
|
Inj, lidocaine w epinephrine
|
$21.96 |
$21.96 |
$21.96 |
$45.60
|
|
Inj, meropenem (b. braun)
|
$125.58 |
$125.58 |
$125.58 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$83.19 |
$83.19 |
$83.19 |
$82.42
|
|
Inj octafluoropropane mic,ml
|
$229.60 |
$229.60 |
$229.60 |
$211.40
|
|
Inj pantoprazole(hikma) 40mg
|
$62.44 |
$62.44 |
$62.44 |
$34.67
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$3,121.92 |
$3,121.92 |
$3,121.92 |
$6,614.40
|
|
Inj, releuko 1 mcg
|
$216.71 |
$216.71 |
$216.71 |
$475.36
|
|
Inj sulf hexa lipid microsph
|
$251.81 |
$251.81 |
$251.81 |
$256.14
|
|
Inj testosterone cypionate
|
$64.72 |
$64.72 |
$64.72 |
$64.96
|
|
Ins cerv dilator (sep proc)
|
$587.20 |
$587.20 |
$587.20 |
$490.73
|
|
Insert drug delivery implant
|
$470.40 |
$470.40 |
$470.40 |
$280.00
|
|
Insertion catheter bladder non indwelling
|
$180.80 |
$180.80 |
$180.80 |
$208.01
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,795.20 |
$1,795.20 |
$1,795.20 |
$2,585.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,940.00 |
$1,940.00 |
$1,940.00 |
$2,103.75
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$6,962.40 |
$6,962.40 |
$6,962.40 |
$7,183.68
|
|
Insert pessary/other device
|
$256.80 |
$256.80 |
$256.80 |
$278.90
|
|
In situ hybridization per specimen each additional single probe stain
|
$502.40 |
$502.40 |
$502.40 |
$243.50
|
|
In situ hybridization per specimen initial single probe stain
|
$712.00 |
$712.00 |
$712.00 |
$338.40
|
|
Instillation anticarcinogenic agent bladder
|
$1,044.00 |
$1,044.00 |
$1,044.00 |
$638.40
|
|
Ins tun cv cath wo subq prt/pm
|
$5,350.40 |
$5,350.40 |
$5,350.40 |
$4,218.00
|
|
Insulin total
|
$90.40 |
$90.40 |
$90.40 |
$66.64
|
|
Intrinsic factor antibody
|
$56.80 |
$56.80 |
$56.80 |
$65.00
|
|
Intro long gi tube
|
$1,061.60 |
$1,061.60 |
$1,061.60 |
$974.17
|
|
Intro long gi tube w/mult fluo
|
$845.60 |
$845.60 |
$845.60 |
$469.00
|
|
Intubation endotracheal emergency procedure
|
$572.00 |
$572.00 |
$572.00 |
$601.28
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$100.00 |
$100.00 |
$100.00 |
$279.10
|
|
Ipratropium bromide non-comp
|
$4.80 |
$4.80 |
$4.80 |
$4.06
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$239.30 |
$239.30 |
$239.30 |
$173.98
|
|
Iron
|
$55.20 |
$55.20 |
$55.20 |
$75.00
|
|
Iron binding capacity
|
$68.00 |
$68.00 |
$68.00 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$80.67 |
$80.67 |
$80.67 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$66.61 |
$66.61 |
$66.61 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$180.00 |
$180.00 |
$180.00 |
$146.11
|
|
IV Fluids (each additional hour)
|
$168.80 |
$168.80 |
$168.80 |
$133.90
|
|
IV Fluids (first hour)
|
$512.80 |
$512.80 |
$512.80 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$190.40 |
$190.40 |
$190.40 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$328.80 |
$328.80 |
$328.80 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$222.40 |
$222.40 |
$222.40 |
$154.00
|
