|
Htt gene detc abnor alleles
|
$1,285.60 |
$1,285.60 |
$1,285.60 |
$250.50
|
|
Human epididymis protein 4 (he4)
|
$465.60 |
$465.60 |
$465.60 |
$157.32
|
|
Hydration IV infusion each additional hour
|
$272.80 |
$272.80 |
$272.80 |
$131.20
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$572.80 |
$572.80 |
$572.80 |
$383.00
|
|
Hysterosalpingography s&i
|
$1,052.80 |
$1,052.80 |
$1,052.80 |
$651.85
|
|
Idh1 common variants
|
$842.40 |
$842.40 |
$842.40 |
$406.90
|
|
Idh2 common variants
|
$1,288.80 |
$1,288.80 |
$1,288.80 |
$486.00
|
|
Ifnl3 gene
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$143.40
|
|
Igh gene rearrange amp meth
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$456.54
|
|
Igk rearrangeabn clonal pop
|
$784.00 |
$784.00 |
$784.00 |
$396.00
|
|
Ihc/icc per specimen each additional single antibody stain
|
$170.40 |
$170.40 |
$170.40 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$302.40 |
$302.40 |
$302.40 |
$328.79
|
|
Ihc/icc per specimen initial single antibody stain
|
$156.80 |
$156.80 |
$156.80 |
$274.86
|
|
Immobilizer lwr extrem nylon 20in reinforc 21-35in
|
$410.40 |
$410.40 |
$410.40 |
$336.17
|
|
Immobilizer shldr cntor adlt
|
$780.80 |
$780.80 |
$780.80 |
$171.43
|
|
Immobilizer shldr dlx str 24-36in med
|
$225.60 |
$225.60 |
$225.60 |
$102.00
|
|
Immobilizer shldr sling med
|
$410.40 |
$410.40 |
$410.40 |
$99.45
|
|
Immunoassay tumor antigen quantitative ca 125
|
$257.60 |
$257.60 |
$257.60 |
$130.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$220.80 |
$220.80 |
$220.80 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$1,056.80 |
$1,056.80 |
$1,056.80 |
$48.50
|
|
Immunofixation electrophoresis serum
|
$479.20 |
$479.20 |
$479.20 |
$138.60
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$693.60 |
$693.60 |
$693.60 |
$156.00
|
|
Immunofluorescence per specimen initial single antibody stain
|
$894.40 |
$894.40 |
$894.40 |
$232.05
|
|
Immunoglobulin assay
|
$268.00 |
$268.00 |
$268.00 |
$74.15
|
|
Implant 11 volt lithium-ion backup battery for controller pocket
|
$8,607.20 |
$8,607.20 |
$8,607.20 |
$1,670.40
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$2,188.80 |
$2,188.80 |
$2,188.80 |
$2,080.80
|
|
Infect ag drug suscept pheno predict
|
$949.60 |
$949.60 |
$949.60 |
$320.00
|
|
Infect ag eia influenza a or b ea
|
$83.20 |
$83.20 |
$83.20 |
$69.03
|
|
Infect ag genotype na hiv-1 other region
|
$1,722.40 |
$1,722.40 |
$1,722.40 |
$326.20
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$1,945.60 |
$1,945.60 |
$1,945.60 |
$603.75
|
|
Infect ag ia optc obs influenza
|
$248.80 |
$248.80 |
$248.80 |
$72.93
|
|
Infect ag if hep delta agent
|
$422.40 |
$422.40 |
$422.40 |
$125.97
|
|
Infect ag if varicella zoster
|
$222.40 |
$222.40 |
$222.40 |
$72.00
|
|
Infect ag na influenza r/amp 1st 2 types
|
$506.40 |
$506.40 |
$506.40 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$289.60 |
$289.60 |
$289.60 |
$99.36
|
|
Infect ag na resp virus 12-25 targets
|
$992.80 |
$992.80 |
$992.80 |
$859.44
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$386.40 |
$386.40 |
$386.40 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$229.60 |
$229.60 |
$229.60 |
$76.50
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$133.60 |
$133.60 |
$133.60 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$392.00 |
$392.00 |
$392.00 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$196.00 |
$196.00 |
$196.00 |
$81.06
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$273.60 |
$273.60 |
$273.60 |
$57.60
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$613.60 |
$613.60 |
$613.60 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$692.80 |
$692.80 |
$692.80 |
$127.80
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$324.80 |
$324.80 |
$324.80 |
$97.50
|
|
Infectious agent nucleic acid amplified probe
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
$267.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$1,249.60 |
$1,249.60 |
$1,249.60 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$610.40 |
$610.40 |
$610.40 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,545.60 |
$1,545.60 |
$1,545.60 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$514.40 |
$514.40 |
$514.40 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$356.80 |
$356.80 |
$356.80 |
$151.25
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$708.00 |
$708.00 |
$708.00 |
$201.60
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$310.40 |
$310.40 |
$310.40 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$68.00 |
$68.00 |
$68.00 |
$100.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$350.40 |
$350.40 |
$350.40 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$199.20 |
$199.20 |
$199.20 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$208.00 |
$208.00 |
$208.00 |
$105.00
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$96.80 |
$96.80 |
$96.80 |
$250.50
|
|
Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets
|
$2,289.60 |
$2,289.60 |
$2,289.60 |
$1,325.35
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,628.00 |
$1,628.00 |
$1,628.00 |
$711.93
|
|
Infectious agent nucleic acid quantification bk virus
|
$1,236.80 |
$1,236.80 |
$1,236.80 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$755.20 |
$755.20 |
$755.20 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$932.00 |
$932.00 |
$932.00 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$859.20 |
$859.20 |
$859.20 |
$374.50
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$388.80 |
$388.80 |
$388.80 |
$303.59
|
|
Initiation & management bipap/cpap initial day
|
$516.80 |
$516.80 |
$516.80 |
$576.00
|
|
Inj cntr knee arthro incl ct/mri
|
$1,188.80 |
$1,188.80 |
$1,188.80 |
$436.80
|
|
Inj dx for sinogram
|
$1,258.40 |
$1,258.40 |
$1,258.40 |
$413.82
|
|
Injection carpal tunnel therapeutic (both sides)
|
$412.00 |
$412.00 |
$412.00 |
$504.90
|
|
Injection epidural blood patch or clot
|
$2,645.60 |
$2,645.60 |
$2,645.60 |
$1,156.80
|
|
Injection for bladder x-ray
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$459.20
|
|
Injection for hip x-ray
|
$1,017.60 |
$1,017.60 |
$1,017.60 |
$669.24
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$715.20 |
$715.20 |
$715.20 |
$494.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$2,802.40 |
$2,802.40 |
$2,802.40 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,269.60 |
$2,269.60 |
$2,269.60 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,111.20 |
$2,111.20 |
$2,111.20 |
$1,045.65
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$1,704.78
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$422.40 |
$422.40 |
$422.40 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,552.80 |
$1,552.80 |
$1,552.80 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$294.40 |
$294.40 |
$294.40 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$283.20 |
$283.20 |
$283.20 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$329.60 |
$329.60 |
$329.60 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$201.60 |
$201.60 |
$201.60 |
$135.20
|
|
Inj for mammo ductogram
|
$1,791.20 |
$1,791.20 |
$1,791.20 |
$433.50
|
|
Inj multihance
|
$17.60 |
$17.60 |
$17.60 |
$79.42
|
|
Inj multihance multipack
|
$9.60 |
$9.60 |
$9.60 |
$2.80
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,625.60 |
$1,625.60 |
$1,625.60 |
$2,485.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,625.60 |
$1,625.60 |
$1,625.60 |
$2,431.74
|
|
Inj proc ankle arthr
|
$779.20 |
$779.20 |
$779.20 |
$405.31
|
|
Inj proc elbow arthro
|
$764.80 |
$764.80 |
$764.80 |
$432.00
|
|
Inj proc myelogram lumbar
|
$1,452.00 |
$1,452.00 |
$1,452.00 |
$856.00
|
|
Inj prohance multipack
|
$17.60 |
$17.60 |
$17.60 |
$9.60
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$725.60 |
$725.60 |
$725.60 |
$436.80
|
|
Inj w/fluor eval cv device
|
$198.40 |
$198.40 |
$198.40 |
$463.40
|
|
Insertion catheter bladder non indwelling
|
$234.40 |
$234.40 |
$234.40 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$234.40 |
$234.40 |
$234.40 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,668.80 |
$2,668.80 |
$2,668.80 |
$2,511.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$9,252.00 |
$9,252.00 |
$9,252.00 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$9,252.00 |
$9,252.00 |
$9,252.00 |
$12,384.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,804.00 |
$2,804.00 |
$2,804.00 |
$2,079.43
|
