|
Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution
|
$6,142.50 |
$6,142.50 |
$6,142.50 |
$3.39
|
|
Hydration IV infusion each additional hour
|
$455.00 |
$455.00 |
$455.00 |
$125.45
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$235.30 |
$235.30 |
$235.30 |
$388.70
|
|
Hydrxycorticsterds 17- (17-ohcs)
|
$201.50 |
$201.50 |
$201.50 |
$86.45
|
|
Icatibant injection
|
$2,730.01 |
$2,730.01 |
$2,730.01 |
$2,196.00
|
|
Igh@ var region somatic mutation analy
|
$456.95 |
$456.95 |
$456.95 |
$685.75
|
|
Ihc/icc per specimen each additional single antibody stain
|
$7,351.64 |
$7,351.64 |
$7,351.64 |
$187.20
|
|
Ihc/icc per specimen initial single antibody stain
|
$8,028.40 |
$8,028.40 |
$8,028.40 |
$274.86
|
|
Immunoassay tumor antigen quantitative ca 125
|
$169.00 |
$169.00 |
$169.00 |
$122.50
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$150.80 |
$150.80 |
$150.80 |
$117.00
|
|
Immunofixation electrophoresis serum
|
$165.10 |
$165.10 |
$165.10 |
$133.38
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$113.75 |
$113.75 |
$113.75 |
$154.40
|
|
Infect ag drug suscept pheno predict
|
$508.95 |
$508.95 |
$508.95 |
$382.20
|
|
Infect ag genotype na hiv-1 other region
|
$213.85 |
$213.85 |
$213.85 |
$390.00
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$169.00 |
$169.00 |
$169.00 |
$619.11
|
|
Infect ag ia direct hiv-1 antgn
|
$39.65 |
$39.65 |
$39.65 |
$95.55
|
|
Infect ag ia optc obs influenza
|
$102.70 |
$102.70 |
$102.70 |
$65.58
|
|
Infect ag na hpv high-risk types
|
$81.90 |
$81.90 |
$81.90 |
$147.00
|
|
Infect ag na influenza r/amp 1st 2 types
|
$252.85 |
$252.85 |
$252.85 |
$248.80
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$215.80 |
$215.80 |
$215.80 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$50.70 |
$50.70 |
$50.70 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$110.50 |
$110.50 |
$110.50 |
$73.45
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$210.60 |
$210.60 |
$210.60 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$116.35 |
$116.35 |
$116.35 |
$75.27
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$55.25 |
$55.25 |
$55.25 |
$107.90
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$154.05 |
$154.05 |
$154.05 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$188.50 |
$188.50 |
$188.50 |
$98.40
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$22.10 |
$22.10 |
$22.10 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$460.85 |
$460.85 |
$460.85 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$91.00 |
$91.00 |
$91.00 |
$144.00
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$206.70 |
$206.70 |
$206.70 |
$174.06
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$315.25 |
$315.25 |
$315.25 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$129.35 |
$129.35 |
$129.35 |
$148.80
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$91.00 |
$91.00 |
$91.00 |
$134.55
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$131.95 |
$131.95 |
$131.95 |
$109.18
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$68.25 |
$68.25 |
$68.25 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$80.60 |
$80.60 |
$80.60 |
$135.00
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$91.00 |
$91.00 |
$91.00 |
$296.71
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,292.20 |
$1,292.20 |
$1,292.20 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$525.85 |
$525.85 |
$525.85 |
$300.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$120.25 |
$120.25 |
$120.25 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$280.80 |
$280.80 |
$280.80 |
$280.20
|
|
Infectious agent nucleic acid quantification hiv-1
|
$254.80 |
$254.80 |
$254.80 |
$381.55
|
|
Infliximab 100 mg intravenous solution
|
$1,165.61 |
$1,165.61 |
$1,165.61 |
$178.95
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,314.36 |
$2,314.36 |
$2,314.36 |
$157.14
|
|
Initiation & management bipap/cpap initial day
|
$664.95 |
$664.95 |
$664.95 |
$608.40
|
|
Inj crotalidae im f(ab')2 eq
|
$2,574.00 |
$2,574.00 |
$2,574.00 |
$2,388.06
|
|
Inj. denosumab-bbdz, 1 mg
|
$7,827.94 |
$7,827.94 |
$7,827.94 |
$6,618.42
|
|
Injection, daratumumab 10 mg
|
$8,046.53 |
$8,046.53 |
$8,046.53 |
$85.20
|
|
Injection, fulvestrant
|
$251.55 |
$251.55 |
$251.55 |
$166.25
|
|
Injection, renflexis
|
$1,844.19 |
$1,844.19 |
$1,844.19 |
$632.98
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$92.30 |
$92.30 |
$92.30 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$106.60 |
$106.60 |
$106.60 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$62.40 |
$62.40 |
$62.40 |
$130.19
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$40,007.73 |
$40,007.73 |
$40,007.73 |
$33.74
|
|
Inj hydroxocobalamin IV 25mg
|
$2,213.90 |
$2,213.90 |
$2,213.90 |
$1,593.19
|
|
Inj ivig privigen 500 mg
|
$15,414.36 |
$15,414.36 |
$15,414.36 |
$6,144.00
|
|
Inj meropenem (wg crit care)
|
$69.50 |
$69.50 |
$69.50 |
$20.78
|
|
Inj pemetrexed (teva) 10mg
|
$2,423.22 |
$2,423.22 |
$2,423.22 |
$3.79
|
|
Inj secukinumab intrav 1mg
|
$5,479.19 |
$5,479.19 |
$5,479.19 |
$31.80
|
|
Inj, tyenne, 1 mg
|
$4,781.40 |
$4,781.40 |
$4,781.40 |
$12.60
|
|
Inj, uzedy, 1 mg
|
$6,658.53 |
$6,658.53 |
$6,658.53 |
$2,836.80
|
|
Insertion catheter bladder non indwelling
|
$148.20 |
$148.20 |
$148.20 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$237.90 |
$237.90 |
$237.90 |
$245.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,125.85 |
$3,125.85 |
$3,125.85 |
$2,079.43
|
|
In situ hybridization per specimen each additional single probe stain
|
$7,351.64 |
$7,351.64 |
$7,351.64 |
$291.00
|
|
In situ hybridization per specimen initial single probe stain
|
$7,351.64 |
$7,351.64 |
$7,351.64 |
$364.00
|
|
Insulin total
|
$82.55 |
$82.55 |
$82.55 |
$72.15
|
|
Intrinsic factor antibody
|
$73.45 |
$73.45 |
$73.45 |
$76.77
|
|
Intubation endotracheal emergency procedure
|
$252.85 |
$252.85 |
$252.85 |
$565.00
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$22,520.14 |
$22,520.14 |
$22,520.14 |
$261.10
|
|
Iron
|
$72.15 |
$72.15 |
$72.15 |
$67.50
|
|
Iron binding capacity
|
$72.15 |
$72.15 |
$72.15 |
$55.00
|
|
Iron dextran 50 mg/ml injection solution
|
$20.68 |
$20.68 |
$20.68 |
$38.16
|
|
Irrigation implantable venous access device for drug delivery systems
|
$117.00 |
$117.00 |
$117.00 |
$149.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$184.60 |
$184.60 |
$184.60 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$57.20 |
$57.20 |
$57.20 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$361.40 |
$361.40 |
$361.40 |
$476.50
|
|
Jak2 targeted sequence analysis
|
$312.65 |
$312.65 |
$312.65 |
$465.74
|
|
John cunningham antibody
|
$1,181.70 |
$1,181.70 |
$1,181.70 |
$39.65
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$13.80 |
$13.80 |
$13.80 |
$17.11
|
|
Kidney function study
|
$2,848.95 |
$2,848.95 |
$2,848.95 |
$549.70
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$474.50 |
$474.50 |
$474.50 |
$618.54
|
|
Knee MRI (with and without contrast)
|
$2,528.50 |
$2,528.50 |
$2,528.50 |
$2,703.85
|
|
Knee MRI (without contrast)
|
$2,274.35 |
$2,274.35 |
$2,274.35 |
$2,120.00
|
|
Knee X-ray
|
$410.80 |
$410.80 |
$410.80 |
$387.20
|
|
Lactate dehydrogenase (ldh)
|
$53.30 |
$53.30 |
$53.30 |
$50.55
|
|
Lactic acid
|
$156.00 |
$156.00 |
$156.00 |
$85.20
|
|
Lead capillary
|
$83.20 |
$83.20 |
$83.20 |
$66.32
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$999.05 |
$999.05 |
$999.05 |
$1,053.00
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$3,310.79 |
$3,310.79 |
$3,310.79 |
$5,001.00
|
|
Levetiracetam therapeutic drug level
|
$157.30 |
$157.30 |
$157.30 |
$99.45
|
|
Lipase
|
$85.80 |
$85.80 |
$85.80 |
$67.68
|
|
Lipoprotein blood quant
|
$159.25 |
$159.25 |
$159.25 |
$106.43
|
|
Lipoprotein direct measurement hdl
|
$48.75 |
$48.75 |
$48.75 |
$54.60
|
|
Lipoprotein direct measurement ldl
|
$48.75 |
$48.75 |
$48.75 |
$61.60
|
|
Lithium therapeutic drug level
|
$83.85 |
$83.85 |
$83.85 |
$62.40
|
|
Liver Function Test
|
$170.30 |
$170.30 |
$170.30 |
$92.85
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,361.10 |
$1,361.10 |
$1,361.10 |
$1,731.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,329.90 |
$1,329.90 |
$1,329.90 |
$1,705.08
|