|
H pylori (c-13) breath
|
$214.40 |
$214.40 |
$214.40 |
$213.00
|
|
Hrdtry cardmypy gene panel
|
$5,668.00 |
$5,668.00 |
$5,668.00 |
$1,276.00
|
|
Hrdtry perph neurphy panel
|
$8,949.60 |
$8,949.60 |
$8,949.60 |
$1,951.80
|
|
Hydration IV infusion each additional hour
|
$143.20 |
$143.20 |
$143.20 |
$131.20
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$401.60 |
$401.60 |
$401.60 |
$383.00
|
|
Hysterosalpingography s&i
|
$1,167.20 |
$1,167.20 |
$1,167.20 |
$651.85
|
|
Idh1 common variants
|
$750.40 |
$750.40 |
$750.40 |
$406.90
|
|
Idh2 common variants
|
$1,148.80 |
$1,148.80 |
$1,148.80 |
$486.00
|
|
Ihc/icc per specimen each additional single antibody stain
|
$228.80 |
$228.80 |
$228.80 |
$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
|
$244.80 |
$244.80 |
$244.80 |
$274.86
|
|
Immunoassay tumor antigen quantitative ca 125
|
$200.80 |
$200.80 |
$200.80 |
$130.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$293.60 |
$293.60 |
$293.60 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$1,052.80 |
$1,052.80 |
$1,052.80 |
$48.50
|
|
Immunofixation electrophoresis serum
|
$175.20 |
$175.20 |
$175.20 |
$138.60
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$247.20 |
$247.20 |
$247.20 |
$156.00
|
|
Immunofluorescence per specimen initial single antibody stain
|
$276.00 |
$276.00 |
$276.00 |
$232.05
|
|
Immunoglobulin assay
|
$151.20 |
$151.20 |
$151.20 |
$74.15
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$3,032.00 |
$3,032.00 |
$3,032.00 |
$2,080.80
|
|
Infect ag drug suscept pheno predict
|
$518.40 |
$518.40 |
$518.40 |
$320.00
|
|
Infect ag genotype na hiv-1 other region
|
$448.00 |
$448.00 |
$448.00 |
$326.20
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$448.00 |
$448.00 |
$448.00 |
$603.75
|
|
Infect ag ia optc obs influenza
|
$88.00 |
$88.00 |
$88.00 |
$72.93
|
|
Infect ag na hpv high-risk types
|
$186.40 |
$186.40 |
$186.40 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$168.80 |
$168.80 |
$168.80 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$268.80 |
$268.80 |
$268.80 |
$99.36
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$88.00 |
$88.00 |
$88.00 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$103.20 |
$103.20 |
$103.20 |
$76.50
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$207.20 |
$207.20 |
$207.20 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$165.60 |
$165.60 |
$165.60 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$128.00 |
$128.00 |
$128.00 |
$81.06
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$227.20 |
$227.20 |
$227.20 |
$57.60
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$241.60 |
$241.60 |
$241.60 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$465.60 |
$465.60 |
$465.60 |
$127.80
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$225.60 |
$225.60 |
$225.60 |
$97.50
|
|
Infectious agent nucleic acid amplified probe
|
$508.80 |
$508.80 |
$508.80 |
$267.50
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$169.60 |
$169.60 |
$169.60 |
$137.67
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$195.20 |
$195.20 |
$195.20 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,527.20 |
$1,527.20 |
$1,527.20 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$301.60 |
$301.60 |
$301.60 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$202.40 |
$202.40 |
$202.40 |
$151.25
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$178.40 |
$178.40 |
$178.40 |
$135.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$64.00 |
$64.00 |
$64.00 |
$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
|
$125.60 |
$125.60 |
$125.60 |
$94.53
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$192.80 |
$192.80 |
$192.80 |
$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 multiplex amplified probe gi pathogen 12-25 targets
|
$1,450.40 |
$1,450.40 |
$1,450.40 |
$711.93
|
|
Infectious agent nucleic acid quantification bk virus
|
$1,101.60 |
$1,101.60 |
$1,101.60 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$440.80 |
$440.80 |
$440.80 |
$238.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$280.00 |
$280.00 |
$280.00 |
$252.60
|
|
Infectious agent nucleic acid quantification hiv-1
|
$252.80 |
$252.80 |
$252.80 |
$374.50
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$112.80 |
$112.80 |
$112.80 |
$293.04
|
|
Initiation & management bipap/cpap initial day
|
$412.80 |
$412.80 |
$412.80 |
$576.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$955.20 |
$955.20 |
$955.20 |
$500.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$726.40 |
$726.40 |
$726.40 |
$504.90
|
|
Injection epidural blood patch or clot
|
$1,557.60 |
$1,557.60 |
$1,557.60 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$437.60 |
$437.60 |
$437.60 |
$441.12
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$490.40 |
$490.40 |
$490.40 |
$494.65
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,557.60 |
$1,557.60 |
$1,557.60 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,557.60 |
$1,557.60 |
$1,557.60 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$726.40 |
$726.40 |
$726.40 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$726.40 |
$726.40 |
$726.40 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$773.60 |
$773.60 |
$773.60 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$200.00 |
$200.00 |
$200.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$200.00 |
$200.00 |
$200.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$244.00 |
$244.00 |
$244.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$120.00 |
$120.00 |
$120.00 |
$135.20
|
|
Inject sacroiliac joint
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$963.00
|
|
Inj multihance
|
$9.60 |
$9.60 |
$9.60 |
$79.42
|
|
Inj proc ankle arthr
|
$464.00 |
$464.00 |
$464.00 |
$405.31
|
|
Inj proc elbow arthro
|
$476.80 |
$476.80 |
$476.80 |
$432.00
|
|
Inj prohance multipack
|
$9.60 |
$9.60 |
$9.60 |
$9.60
|
|
Insertion catheter bladder temporary simple
|
$176.00 |
$176.00 |
$176.00 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,480.00 |
$2,480.00 |
$2,480.00 |
$2,511.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$8,544.00 |
$8,544.00 |
$8,544.00 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$8,544.00 |
$8,544.00 |
$8,544.00 |
$12,384.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,092.00 |
$2,092.00 |
$2,092.00 |
$2,079.43
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$27,199.20 |
$27,199.20 |
$27,199.20 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$12,586.40 |
$12,586.40 |
$12,586.40 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$6,752.00 |
$6,752.00 |
$6,752.00 |
$7,342.20
|
|
Insert pm/icd lead dual
|
$6,752.00 |
$6,752.00 |
$6,752.00 |
$7,388.80
|
|
Ins icd gen exist sgl lead
|
$18,993.60 |
$18,993.60 |
$18,993.60 |
$23,742.75
|
|
Insitu hybridization auto
|
$454.40 |
$454.40 |
$454.40 |
$371.00
|
|
Insitu hybridization manual
|
$727.20 |
$727.20 |
$727.20 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$416.80 |
$416.80 |
$416.80 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$517.60 |
$517.60 |
$517.60 |
$326.04
|
|
Instillation anticarcinogenic agent bladder
|
$553.60 |
$553.60 |
$553.60 |
$621.40
|
|
Insulin total
|
$206.40 |
$206.40 |
$206.40 |
$66.64
|
|
Interdental fixation
|
$2,000.80 |
$2,000.80 |
$2,000.80 |
$2,162.05
|
|
Intrinsic factor antibody
|
$30.40 |
$30.40 |
$30.40 |
$66.60
|
|
Intubation endotracheal emergency procedure
|
$704.00 |
$704.00 |
$704.00 |
$589.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$4.80 |
$4.80 |
$4.80 |
$172.98
|
