|
Head CT scan (with contrast)
|
$3,904.47 |
$3,904.47 |
$3,904.47 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$3,122.52 |
$3,122.52 |
$3,122.52 |
$1,268.90
|
|
Hematocrit
|
$93.54 |
$93.54 |
$93.54 |
$33.57
|
|
Hemoglobin
|
$93.54 |
$93.54 |
$93.54 |
$31.75
|
|
Hemoglobin fetal qualitative
|
$211.39 |
$211.39 |
$211.39 |
$51.75
|
|
Hemoglobin methemoglobin quantitative
|
$735.18 |
$735.18 |
$735.18 |
$49.40
|
|
Heparin assay
|
$603.09 |
$603.09 |
$603.09 |
$130.20
|
|
Hepatitis a antibody igm
|
$771.03 |
$771.03 |
$771.03 |
$85.15
|
|
Hepatitis b core antibody igm
|
$625.55 |
$625.55 |
$625.55 |
$87.98
|
|
Hepatitis b core antibody total
|
$625.55 |
$625.55 |
$625.55 |
$83.29
|
|
Hepatitis b surface antibody
|
$698.13 |
$698.13 |
$698.13 |
$83.79
|
|
Hepatitis c antibody
|
$868.37 |
$868.37 |
$868.37 |
$108.00
|
|
Hepatobiliary system imaging
|
$3,134.88 |
$3,134.88 |
$3,134.88 |
$1,521.10
|
|
Herpes simplex type 1 antibody igg
|
$210.11 |
$210.11 |
$210.11 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$237.66 |
$237.66 |
$237.66 |
$87.10
|
|
Herpes simplex virus isolation
|
$566.00 |
$566.00 |
$566.00 |
$93.32
|
|
Heterophile antibodies screening
|
$429.88 |
$429.88 |
$429.88 |
$73.60
|
|
Hla i low res one antigen equiv ea
|
$1,021.56 |
$1,021.56 |
$1,021.56 |
$164.00
|
|
Hla i typing low res one locus ea
|
$895.32 |
$895.32 |
$895.32 |
$340.00
|
|
Homocysteine
|
$1,481.94 |
$1,481.94 |
$1,481.94 |
$113.10
|
|
Homogenization tissue
|
$89.42 |
$89.42 |
$89.42 |
$39.00
|
|
Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution
|
$5,823.84 |
$5,823.84 |
$5,823.84 |
$4,190.44
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$1,815.10 |
$1,815.10 |
$1,815.10 |
$176.15
|
|
Hydroxyurea 500 mg
|
$44.12 |
$44.12 |
$44.12 |
$12.00
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$61.17 |
$61.17 |
$61.17 |
$80.11
|
|
Hysterosalpingography s&i
|
$2,524.28 |
$2,524.28 |
$2,524.28 |
$629.46
|
|
I-123 iobenguane diag
|
$12,376.76 |
$12,376.76 |
$12,376.76 |
$5,730.40
|
|
I-123 sod iodide diag per 100 uci
|
$590.19 |
$590.19 |
$590.19 |
$158.05
|
|
I-131 iobenguane sulf diag mibg
|
$5,429.52 |
$5,429.52 |
$5,429.52 |
$5,062.20
|
|
I131 iodide cap, rx
|
$213.44 |
$213.44 |
$213.44 |
$91.83
|
|
Ihc/icc per specimen each additional single antibody stain
|
$410.81 |
$410.81 |
$410.81 |
$191.75
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$1,213.98 |
$1,213.98 |
$1,213.98 |
$339.73
|
|
Ihc/icc per specimen initial single antibody stain
|
$1,193.88 |
$1,193.88 |
$1,193.88 |
$266.76
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$5,495.02 |
$5,495.02 |
$5,495.02 |
$5,089.25
|
|
Immunoassay tumor antigen quantitative ca 125
|
$890.08 |
$890.08 |
$890.08 |
$123.50
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$804.03 |
$804.03 |
$804.03 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$190.44 |
$190.44 |
$190.44 |
$53.95
|
|
Immunofixation electrophoresis serum
|
$2,073.84 |
$2,073.84 |
$2,073.84 |
$133.38
|
|
Implant ureth bulk agent
|
$3,596.00 |
$3,596.00 |
$3,596.00 |
$2,003.82
|
|
In-111 oxyquinolin per 0.5 mci
|
$6,081.38 |
$6,081.38 |
$6,081.38 |
$2,808.00
|
|
In-111 pentetate dtpa / 0.5 mci
|
$2,243.69 |
$2,243.69 |
$2,243.69 |
$2,135.29
|
|
In-111 pentetreotide
|
$16,037.92 |
$16,037.92 |
$16,037.92 |
$6,617.05
|
|
In-111 satumomab pend
|
$16,472.51 |
$16,472.51 |
$16,472.51 |
$3,524.25
|
|
Infect ag ia direct hiv-1 antgn
|
$1,068.12 |
$1,068.12 |
$1,068.12 |
$95.55
|
|
Infect ag if legionella pneumophila
|
$804.03 |
$804.03 |
$804.03 |
$75.79
|
|
Infect ag na resp virus 12-25 targets
|
$3,804.59 |
$3,804.59 |
$3,804.59 |
$859.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$181.83 |
$181.83 |
$181.83 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$689.16 |
$689.16 |
$689.16 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$735.18 |
$735.18 |
$735.18 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$563.44 |
$563.44 |
$563.44 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$259.29 |
$259.29 |
$259.29 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$339.71 |
$339.71 |
$339.71 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$265.68 |
$265.68 |
$265.68 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$771.10 |
$771.10 |
$771.10 |
$60.00
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$724.32 |
$724.32 |
$724.32 |
$141.48
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$890.98 |
$890.98 |
$890.98 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$945.82 |
$945.82 |
$945.82 |
$178.00
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$2,562.83 |
$2,562.83 |
$2,562.83 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$402.57 |
$402.57 |
$402.57 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$84.55 |
$84.55 |
$84.55 |
$103.20
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$935.22 |
$935.22 |
$935.22 |
$98.15
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$1,083.13 |
$1,083.13 |
$1,083.13 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$367.79 |
$367.79 |
$367.79 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$966.60 |
$966.60 |
$966.60 |
$381.55
|
|
Initiation & management bipap/cpap initial day
|
$827.46 |
$827.46 |
$827.46 |
$645.79
|
|
Inj, bupivacaine liposome
|
$1,735.56 |
$1,735.56 |
$1,735.56 |
$638.07
|
|
Inj calcitriol per 0.1 mcg
|
$117.16 |
$117.16 |
$117.16 |
$31.69
|
|
Inj cefazolin sodium, hikma
|
$101.79 |
$101.79 |
$101.79 |
$34.59
|
|
Inj crotalidae im f(ab')2 eq
|
$5,397.52 |
$5,397.52 |
$5,397.52 |
$2,735.85
|
|
Injection, pentamidine iseth
|
$3,122.32 |
$3,122.32 |
$3,122.32 |
$508.80
|
|
Inj fluphenazine hcl 1.25 mg
|
$268.77 |
$268.77 |
$268.77 |
$44.95
|
|
Inj levocarnitine per 1 gm
|
$199.47 |
$199.47 |
$199.47 |
$136.62
|
|
Inj, nithiodote, 3mg / 125mg
|
$745.91 |
$745.91 |
$745.91 |
$228.00
|
|
Inj progesterone per 50 mg
|
$59.32 |
$59.32 |
$59.32 |
$19.53
|
|
Insitu hybridization auto
|
$1,400.00 |
$1,400.00 |
$1,400.00 |
$398.16
|
|
Insitu hybridization manual
|
$1,637.96 |
$1,637.96 |
$1,637.96 |
$407.11
|
|
In situ hybridization per specimen each additional single probe stain
|
$1,046.53 |
$1,046.53 |
$1,046.53 |
$251.55
|
|
In situ hybridization per specimen initial single probe stain
|
$1,046.83 |
$1,046.83 |
$1,046.83 |
$338.40
|
|
Insulin total
|
$523.04 |
$523.04 |
$523.04 |
$67.60
|
|
Integra meshed bil wound mat
|
$359.00 |
$359.00 |
$359.00 |
$13,812.34
|
|
Interrog device eval heart
|
$386.72 |
$386.72 |
$386.72 |
$150.00
|
|
Intro long gi tube w/mult fluo
|
$1,796.22 |
$1,796.22 |
$1,796.22 |
$477.85
|
|
Ipratropium bromide non-comp
|
$11.91 |
$11.91 |
$11.91 |
$4.77
|
|
Iron
|
$484.14 |
$484.14 |
$484.14 |
$70.72
|
|
Iron binding capacity
|
$642.39 |
$642.39 |
$642.39 |
$63.00
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$745.18 |
$745.18 |
$745.18 |
$169.30
|
|
Irradiation of blood product each unit reference
|
$1,029.25 |
$1,029.25 |
$1,029.25 |
$124.24
|
|
Kidney img w/bldflw sgl without rx
|
$3,257.71 |
$3,257.71 |
$3,257.71 |
$1,468.04
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$2,199.24 |
$2,199.24 |
$2,199.24 |
$668.25
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$471.57 |
$471.57 |
$471.57 |
$188.92
|
|
Lactic acid
|
$545.49 |
$545.49 |
$545.49 |
$102.90
|
|
Lactoferrin fecal qualitative
|
$658.85 |
$658.85 |
$658.85 |
$88.40
|
|
Lead capillary
|
$323.25 |
$323.25 |
$323.25 |
$62.40
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$3,448.30 |
$3,448.30 |
$3,448.30 |
$1,100.74
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$170.90 |
$170.90 |
$170.90 |
$164.09
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$3,842.28 |
$3,842.28 |
$3,842.28 |
$5,001.00
|
|
Levetiracetam therapeutic drug level
|
$855.65 |
$855.65 |
$855.65 |
$71.40
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$798.20 |
$798.20 |
$798.20 |
$420.60
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$78.30 |
$78.30 |
$78.30 |
$39.75
|
|
Liletta, 52 mg
|
$3,080.46 |
$3,080.46 |
$3,080.46 |
$1,790.04
|