|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$60.83 |
$60.83 |
$60.83 |
$112.66
|
|
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge
|
$154.80 |
$154.80 |
$154.80 |
$294.92
|
|
Hysterosalpingography s&i
|
$877.60 |
$877.60 |
$877.60 |
$669.12
|
|
I-123 iobenguane diag
|
$5,632.80 |
$5,632.80 |
$5,632.80 |
$5,170.70
|
|
I-123 sod iodide diag per 100 uci
|
$224.80 |
$224.80 |
$224.80 |
$147.46
|
|
Ihc/icc per specimen each additional single antibody stain
|
$209.60 |
$209.60 |
$209.60 |
$191.52
|
|
Ihc/icc per specimen initial single antibody stain
|
$157.60 |
$157.60 |
$157.60 |
$277.90
|
|
Immobilizer shldr cntor adlt
|
$38.40 |
$38.40 |
$38.40 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$84.80 |
$84.80 |
$84.80 |
$118.43
|
|
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
|
$46.40 |
$46.40 |
$46.40 |
$48.57
|
|
Immunofixation electrophoresis serum
|
$119.20 |
$119.20 |
$119.20 |
$142.50
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$136.00 |
$136.00 |
$136.00 |
$140.80
|
|
Infect ag eia influenza a or b ea
|
$64.80 |
$64.80 |
$64.80 |
$71.20
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$880.80 |
$880.80 |
$880.80 |
$603.83
|
|
Infect ag ia optc obs influenza
|
$48.80 |
$48.80 |
$48.80 |
$72.93
|
|
Infect ag if influenza a
|
$51.20 |
$51.20 |
$51.20 |
$41.30
|
|
Infect ag if influenza b
|
$48.80 |
$48.80 |
$48.80 |
$37.95
|
|
Infect ag if nos ea
|
$66.40 |
$66.40 |
$66.40 |
$74.88
|
|
Infect ag if varicella zoster
|
$106.40 |
$106.40 |
$106.40 |
$72.00
|
|
Infect ag na hpv high-risk types
|
$136.00 |
$136.00 |
$136.00 |
$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
|
$143.20 |
$143.20 |
$143.20 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$85.60 |
$85.60 |
$85.60 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$80.00 |
$80.00 |
$80.00 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$52.80 |
$52.80 |
$52.80 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$99.20 |
$99.20 |
$99.20 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$57.60 |
$57.60 |
$57.60 |
$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
|
$66.40 |
$66.40 |
$66.40 |
$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
|
$66.40 |
$66.40 |
$66.40 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$60.80 |
$60.80 |
$60.80 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$135.20 |
$135.20 |
$135.20 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$162.40 |
$162.40 |
$162.40 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$113.60 |
$113.60 |
$113.60 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,310.40 |
$1,310.40 |
$1,310.40 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$148.80 |
$148.80 |
$148.80 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$91.20 |
$91.20 |
$91.20 |
$149.13
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$133.60 |
$133.60 |
$133.60 |
$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
|
$110.40 |
$110.40 |
$110.40 |
$112.45
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$296.00 |
$296.00 |
$296.00 |
$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 3-5 targets
|
$312.80 |
$312.80 |
$312.80 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$592.00 |
$592.00 |
$592.00 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$233.60 |
$233.60 |
$233.60 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$84.80 |
$84.80 |
$84.80 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$101.60 |
$101.60 |
$101.60 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$354.40 |
$354.40 |
$354.40 |
$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
|
$763.25 |
$763.25 |
$763.25 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$801.01 |
$801.01 |
$801.01 |
$1,537.84
|
|
Influenza virus vaccine, live trivalent intranasal
|
$29.52 |
$29.52 |
$29.52 |
$36.50
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$333.60 |
$333.60 |
$333.60 |
$296.00
|
|
Inj, acetaminophen (b braun)
|
$363.89 |
$363.89 |
$363.89 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$188.52 |
$188.52 |
$188.52 |
$36.60
|
|
Inj alymsys 10 mg
|
$1,142.79 |
$1,142.79 |
$1,142.79 |
$1,280.74
|
|
Inj., benralizumab, 1 mg
|
$7,893.17 |
$7,893.17 |
$7,893.17 |
$11,310.00
|
|
Inj, cefepime hcl (b braun)
|
$228.47 |
$228.47 |
$228.47 |
$69.85
|
|
Inj, daptomycin (baxter)
|
$280.06 |
$280.06 |
$280.06 |
$1.83
|
|
Injection epidural blood patch or clot
|
$2,073.60 |
$2,073.60 |
$2,073.60 |
$1,182.33
|
|
Injection for bladder x-ray
|
$1,456.80 |
$1,456.80 |
$1,456.80 |
$459.20
|
|
Injection, renflexis
|
$676.21 |
$676.21 |
$676.21 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,265.60 |
$1,265.60 |
$1,265.60 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,080.80 |
$1,080.80 |
$1,080.80 |
$2,040.36
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$680.80 |
$680.80 |
$680.80 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$602.40 |
$602.40 |
$602.40 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$191.20 |
$191.20 |
$191.20 |
$145.60
|
|
Inject sacroiliac joint
|
$1,258.40 |
$1,258.40 |
$1,258.40 |
$1,029.04
|
|
Inj epidural sgl lumb-sacral without img
|
$1,123.20 |
$1,123.20 |
$1,123.20 |
$1,450.84
|
|
Inj. fe derisomaltose 10 mg
|
$3,221.52 |
$3,221.52 |
$3,221.52 |
$3,221.52
|
|
Inj hydroxocobalamin IV 25mg
|
$1,498.47 |
$1,498.47 |
$1,498.47 |
$2,452.32
|
|
Inj multihance
|
$264.00 |
$264.00 |
$264.00 |
$70.54
|
|
Inj ogivri 10 mg
|
$1,427.66 |
$1,427.66 |
$1,427.66 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$62.44 |
$62.44 |
$62.44 |
$34.67
|
|
Inj, releuko 1 mcg
|
$393.32 |
$393.32 |
$393.32 |
$475.36
|
|
Inj scleros sol mult veins
|
$798.40 |
$798.40 |
$798.40 |
$692.90
|
|
Inj scleros sol sgl vein
|
$677.60 |
$677.60 |
$677.60 |
$561.88
|
|
Inj., tildrakizumab, 1 mg
|
$21,259.81 |
$21,259.81 |
$21,259.81 |
$26,635.60
|
|
Ins cerv dilator (sep proc)
|
$574.40 |
$574.40 |
$574.40 |
$490.73
|
|
Insertion catheter bladder non indwelling
|
$211.20 |
$211.20 |
$211.20 |
$208.01
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,530.40 |
$2,530.40 |
$2,530.40 |
$2,103.75
|
|
In situ hybridization per specimen initial single probe stain
|
$430.40 |
$430.40 |
$430.40 |
$338.40
|
|
Insulin total
|
$53.60 |
$53.60 |
$53.60 |
$66.64
|
|
Intrinsic factor antibody
|
$56.80 |
$56.80 |
$56.80 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$944.00 |
$944.00 |
$944.00 |
$601.28
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$750.00 |
$750.00 |
$750.00 |
$279.10
|
|
Ipratropium bromide non-comp
|
$3.40 |
$3.40 |
$3.40 |
$4.06
|
|
Iron
|
$56.80 |
$56.80 |
$56.80 |
$75.00
|
|
Iron binding capacity
|
$48.00 |
$48.00 |
$48.00 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$85.09 |
$85.09 |
$85.09 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$66.61 |
$66.61 |
$66.61 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$171.20 |
$171.20 |
$171.20 |
$115.20
|
|
Irrigation implantable venous access device for drug delivery systems
|
$172.80 |
$172.80 |
$172.80 |
$146.11
|