|
In-111 autol wbc diag per dose
|
$562.30 |
$562.30 |
$562.30 |
$3,493.75
|
|
In-111 oxyquinolin per 0.5 mci
|
$316.66 |
$316.66 |
$316.66 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$201.85 |
$201.85 |
$201.85 |
$2,598.17
|
|
In-111 pentetreotide
|
$1,250.63 |
$1,250.63 |
$1,250.63 |
$5,294.90
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$741.68 |
$741.68 |
$741.68 |
$2,086.70
|
|
Infect ag drug suscept pheno predict
|
$78.79 |
$78.79 |
$78.79 |
$325.00
|
|
Infect ag genotype na cytomegalovirus
|
$155.37 |
$155.37 |
$155.37 |
$665.40
|
|
Infect ag genotype na dna hepatitis b
|
$155.37 |
$155.37 |
$155.37 |
$409.27
|
|
Infect ag genotype na hiv-1 other region
|
$77.79 |
$77.79 |
$77.79 |
$361.65
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$155.37 |
$155.37 |
$155.37 |
$603.83
|
|
Infect ag ia optc obs influenza
|
$10.05 |
$10.05 |
$10.05 |
$72.93
|
|
Infect ag if ea plyvlnt antsrm
|
$12.06 |
$12.06 |
$12.06 |
$68.40
|
|
Infect ag if influenza a
|
$12.06 |
$12.06 |
$12.06 |
$41.30
|
|
Infect ag if influenza b
|
$12.06 |
$12.06 |
$12.06 |
$37.95
|
|
Infect ag if legionella pneumophila
|
$9.45 |
$9.45 |
$9.45 |
$73.45
|
|
Infect ag if pneumocystis carinii
|
$15.28 |
$15.28 |
$15.28 |
$66.06
|
|
Infect ag if varicella zoster
|
$12.06 |
$12.06 |
$12.06 |
$72.00
|
|
Infect ag na hep b amp
|
$27.14 |
$27.14 |
$27.14 |
$120.50
|
|
Infect ag na herpes simplex quant
|
$25.93 |
$25.93 |
$25.93 |
$178.86
|
|
Infect ag na hpv high-risk types
|
$21.31 |
$21.31 |
$21.31 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$57.89 |
$57.89 |
$57.89 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$60.10 |
$60.10 |
$60.10 |
$100.00
|
|
Infect ag na resp virus 12-25 targets
|
$251.45 |
$251.45 |
$251.45 |
$854.70
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$12.06 |
$12.06 |
$12.06 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$13.27 |
$13.27 |
$13.27 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$14.87 |
$14.87 |
$14.87 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$46.43 |
$46.43 |
$46.43 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$17.09 |
$17.09 |
$17.09 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$17.49 |
$17.49 |
$17.49 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$31.56 |
$31.56 |
$31.56 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$7.24 |
$7.24 |
$7.24 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$12.86 |
$12.86 |
$12.86 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$84.62 |
$84.62 |
$84.62 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$23.12 |
$23.12 |
$23.12 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$22.51 |
$22.51 |
$22.51 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$251.45 |
$251.45 |
$251.45 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$21.31 |
$21.31 |
$21.31 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$21.31 |
$21.31 |
$21.31 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$25.33 |
$25.33 |
$25.33 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$21.31 |
$21.31 |
$21.31 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$30.95 |
$30.95 |
$30.95 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$19.30 |
$19.30 |
$19.30 |
$206.00
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$21.31 |
$21.31 |
$21.31 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$22.31 |
$22.31 |
$22.31 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$251.45 |
$251.45 |
$251.45 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$55.28 |
$55.28 |
$55.28 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$25.93 |
$25.93 |
$25.93 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$29.55 |
$29.55 |
$29.55 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$51.46 |
$51.46 |
$51.46 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$86.03 |
$86.03 |
$86.03 |
$304.20
|
|
Inj cntr knee arthro incl ct/mri
|
$148.34 |
$148.34 |
$148.34 |
$436.80
|
|
Inj dx for sinogram
|
$87.09 |
$87.09 |
$87.09 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$203.84 |
$203.84 |
$203.84 |
$503.50
|
|
Injection during cath supravalvular aortography
|
$274.32 |
$274.32 |
$274.32 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$453.62 |
$453.62 |
$453.62 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$228.72 |
$228.72 |
$228.72 |
$436.00
|
|
Injection for bladder x-ray
|
$162.69 |
$162.69 |
$162.69 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$222.02 |
$222.02 |
$222.02 |
$497.76
|
|
Injection for ureter x-ray
|
$74.65 |
$74.65 |
$74.65 |
$515.21
|
|
Injection into brain canal
|
$327.29 |
$327.29 |
$327.29 |
$1,289.60
|
|
Injection jugular
|
$467.97 |
$467.97 |
$467.97 |
$790.00
|
|
Injection radioactive tracer sentinel node (both sides)
|
$474.35 |
$474.35 |
$474.35 |
$685.44
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$295.71 |
$295.71 |
$295.71 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$336.86 |
$336.86 |
$336.86 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$696.70 |
$696.70 |
$696.70 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,417.95 |
$1,417.95 |
$1,417.95 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$916.17 |
$916.17 |
$916.17 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$916.17 |
$916.17 |
$916.17 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$210.54 |
$210.54 |
$210.54 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$140.36 |
$140.36 |
$140.36 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$159.50 |
$159.50 |
$159.50 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$66.83 |
$66.83 |
$66.83 |
$145.60
|
|
Inject sacroiliac joint
|
$429.37 |
$429.37 |
$429.37 |
$1,029.04
|
|
Inj for ext venography
|
$232.23 |
$232.23 |
$232.23 |
$628.80
|
|
Inj for mammo ductogram
|
$611.52 |
$611.52 |
$611.52 |
$397.80
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$300.85 |
$300.85 |
$300.85 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$402.23 |
$402.23 |
$402.23 |
$1,818.15
|
|
Inj hrt cath w/s&i sel right vent
|
$250.71 |
$250.71 |
$250.71 |
$999.96
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$628.75 |
$628.75 |
$628.75 |
$1,413.35
|
|
Inj proc ankle arthr
|
$267.00 |
$267.00 |
$267.00 |
$405.31
|
|
Inj proc elbow arthro
|
$247.86 |
$247.86 |
$247.86 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$301.14 |
$301.14 |
$301.14 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$323.79 |
$323.79 |
$323.79 |
$838.30
|
|
Inj retacrit esrd on dialysi
|
$0.69 |
$0.69 |
$0.69 |
$349.45
|
|
Inj retro urethrocysto
|
$82.62 |
$82.62 |
$82.62 |
$447.74
|
|
Inj w/fluor eval cv device
|
$221.39 |
$221.39 |
$221.39 |
$504.40
|
|
Ins cath ren art 1st bi
|
$2,521.38 |
$2,521.38 |
$2,521.38 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$1,942.07 |
$1,942.07 |
$1,942.07 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$3,245.51 |
$3,245.51 |
$3,245.51 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$2,487.56 |
$2,487.56 |
$2,487.56 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$1,464.78 |
$1,464.78 |
$1,464.78 |
$490.73
|
|
Insert cath pleura with image
|
$985.71 |
$985.71 |
$985.71 |
$2,194.40
|
|
Insert hepatic shunt (tips)
|
$2,670.67 |
$2,670.67 |
$2,670.67 |
$7,571.20
|
|
Insertion catheter bladder non indwelling
|
$60.61 |
$60.61 |
$60.61 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,467.40 |
$1,467.40 |
$1,467.40 |
$4,897.20
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,972.38 |
$1,972.38 |
$1,972.38 |
$2,447.63
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,198.87 |
$2,198.87 |
$2,198.87 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,256.22 |
$1,256.22 |
$1,256.22 |
$2,585.25
|
|
Insertion of catheter vein
|
$543.58 |
$543.58 |
$543.58 |
$1,525.80
|
|
Insertion of catheter vein
|
$339.74 |
$339.74 |
$339.74 |
$870.59
|