|
Ihc/icc per specimen each multiplex antibody stain
|
$366.40 |
$366.40 |
$366.40 |
$331.20
|
|
Ihc/icc per specimen initial single antibody stain
|
$188.80 |
$188.80 |
$188.80 |
$277.90
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$2,876.00 |
$2,876.00 |
$2,876.00 |
$6,106.32
|
|
Immunoassay tumor antigen quantitative ca 125
|
$101.60 |
$101.60 |
$101.60 |
$132.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$101.60 |
$101.60 |
$101.60 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$90.40 |
$90.40 |
$90.40 |
$48.57
|
|
Immunofixation electrophoresis serum
|
$119.20 |
$119.20 |
$119.20 |
$142.50
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$2,106.40 |
$2,106.40 |
$2,106.40 |
$2,086.70
|
|
Incision tendon sheath
|
$1,963.20 |
$1,963.20 |
$1,963.20 |
$3,073.20
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$120.80 |
$120.80 |
$120.80 |
$140.80
|
|
Infect ag ia optc obs influenza
|
$55.20 |
$55.20 |
$55.20 |
$72.93
|
|
Infect ag na hep b amp
|
$87.20 |
$87.20 |
$87.20 |
$120.50
|
|
Infect ag na hpv high-risk types
|
$120.80 |
$120.80 |
$120.80 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$248.80 |
$248.80 |
$248.80 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$152.80 |
$152.80 |
$152.80 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$97.60 |
$97.60 |
$97.60 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$53.60 |
$53.60 |
$53.60 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$48.00 |
$48.00 |
$48.00 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$162.40 |
$162.40 |
$162.40 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$51.20 |
$51.20 |
$51.20 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$67.20 |
$67.20 |
$67.20 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$80.00 |
$80.00 |
$80.00 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$164.00 |
$164.00 |
$164.00 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$51.20 |
$51.20 |
$51.20 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$52.00 |
$52.00 |
$52.00 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$127.20 |
$127.20 |
$127.20 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$172.80 |
$172.80 |
$172.80 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$121.60 |
$121.60 |
$121.60 |
$167.05
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$121.60 |
$121.60 |
$121.60 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$101.60 |
$101.60 |
$101.60 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$252.00 |
$252.00 |
$252.00 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$136.00 |
$136.00 |
$136.00 |
$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
|
$117.60 |
$117.60 |
$117.60 |
$112.45
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$266.40 |
$266.40 |
$266.40 |
$217.60
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$117.60 |
$117.60 |
$117.60 |
$195.60
|
|
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 3-5 targets
|
$312.80 |
$312.80 |
$312.80 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$739.20 |
$739.20 |
$739.20 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$189.60 |
$189.60 |
$189.60 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$100.00 |
$100.00 |
$100.00 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$119.20 |
$119.20 |
$119.20 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$377.60 |
$377.60 |
$377.60 |
$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
|
$1,333.11 |
$1,333.11 |
$1,333.11 |
$2,047.13
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$664.63 |
$664.63 |
$664.63 |
$1,537.84
|
|
Inj, abilify maintena, 1 mg
|
$3,357.01 |
$3,357.01 |
$3,357.01 |
$5,355.30
|
|
Inj, alfentanil hcl, 500mcg
|
$29.11 |
$29.11 |
$29.11 |
$35.94
|
|
Inj, cefepime hcl (b braun)
|
$95.10 |
$95.10 |
$95.10 |
$69.85
|
|
Inj, daptomycin (hospira)
|
$60.00 |
$60.00 |
$60.00 |
$128.08
|
|
Injection, renflexis
|
$585.64 |
$585.64 |
$585.64 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,020.80 |
$1,020.80 |
$1,020.80 |
$1,043.72
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$416.00 |
$416.00 |
$416.00 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$626.40 |
$626.40 |
$626.40 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$131.20 |
$131.20 |
$131.20 |
$145.60
|
|
Inj. fe derisomaltose 10 mg
|
$2,788.45 |
$2,788.45 |
$2,788.45 |
$3,221.52
|
|
Inj ivig privigen 500 mg
|
$4,960.00 |
$4,960.00 |
$4,960.00 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$7,799.96 |
$7,799.96 |
$7,799.96 |
$11,648.70
|
|
Inj, lidocaine w epinephrine
|
$24.68 |
$24.68 |
$24.68 |
$45.60
|
|
Inj, meropenem (b. braun)
|
$94.05 |
$94.05 |
$94.05 |
$71.14
|
|
Inj pantoprazole(hikma) 40mg
|
$26.44 |
$26.44 |
$26.44 |
$34.67
|
|
Inj, releuko 1 mcg
|
$175.81 |
$175.81 |
$175.81 |
$475.36
|
|
Inj testosterone cypionate
|
$57.85 |
$57.85 |
$57.85 |
$64.96
|
|
Insertion catheter bladder non indwelling
|
$188.80 |
$188.80 |
$188.80 |
$208.01
|
|
In situ hybridization per specimen each additional single probe stain
|
$328.80 |
$328.80 |
$328.80 |
$243.50
|
|
In situ hybridization per specimen initial single probe stain
|
$341.60 |
$341.60 |
$341.60 |
$338.40
|
|
Insulin total
|
$117.60 |
$117.60 |
$117.60 |
$66.64
|
|
Intrinsic factor antibody
|
$56.80 |
$56.80 |
$56.80 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$466.40 |
$466.40 |
$466.40 |
$601.28
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$24.00 |
$24.00 |
$24.00 |
$279.10
|
|
Ipratropium bromide non-comp
|
$2.40 |
$2.40 |
$2.40 |
$4.06
|
|
Iron
|
$60.80 |
$60.80 |
$60.80 |
$75.00
|
|
Iron binding capacity
|
$72.00 |
$72.00 |
$72.00 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$64.36 |
$64.36 |
$64.36 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$30.72 |
$30.72 |
$30.72 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$120.80 |
$120.80 |
$120.80 |
$146.11
|
|
IV Fluids (each additional hour)
|
$141.60 |
$141.60 |
$141.60 |
$133.90
|
|
IV Fluids (first hour)
|
$382.40 |
$382.40 |
$382.40 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$174.40 |
$174.40 |
$174.40 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$208.00 |
$208.00 |
$208.00 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$144.00 |
$144.00 |
$144.00 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$432.80 |
$432.80 |
$432.80 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$129.60 |
$129.60 |
$129.60 |
$167.50
|
|
IV Push Injection (first drug)
|
$178.40 |
$178.40 |
$178.40 |
$252.76
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$440.00 |
$440.00 |
$440.00 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$481.60 |
$481.60 |
$481.60 |
$362.05
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$28.00 |
$28.00 |
$28.00 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$25.22 |
$25.22 |
$25.22 |
$23.52
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$779.20 |
$779.20 |
$779.20 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$613.60 |
$613.60 |
$613.60 |
$490.75
|
|
Knee MRI (with and without contrast)
|
$3,506.40 |
$3,506.40 |
$3,506.40 |
$3,022.20
|
|
Knee MRI (without contrast)
|
$2,514.40 |
$2,514.40 |
$2,514.40 |
$2,130.88
|
|
Knee X-ray
|
$489.60 |
$489.60 |
$489.60 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$290.40 |
$290.40 |
$290.40 |
$290.40
|
|
Knee X-ray (3 views, both knees)
|
$272.00 |
$272.00 |
$272.00 |
$363.60
|
|
Knee X-ray (standing, both knees)
|
$291.20 |
$291.20 |
$291.20 |
$251.20
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$24.90 |
$24.90 |
$24.90 |
$33.60
|
