|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
CPT 87449
|
$82.00
|
$82.00
|
$22.50 – $82.00
|
42 |
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
CPT 87425
|
$182.00
|
$182.00
|
$11.74 – $182.00
|
42 |
|
Infectious agent nucleic acid amplified probe
CPT 87798
|
$329.00
|
$329.00
|
$90.28 – $329.00
|
42 |
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
CPT 87491
|
$309.00
|
$309.00
|
$84.79 – $309.00
|
42 |
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
CPT 87493
|
$194.00
|
$194.00
|
$53.23 – $194.00
|
42 |
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
CPT 87483
|
$1,764.00
|
$1,764.00
|
$408.44 – $1,764.00
|
42 |
|
Infectious agent nucleic acid amplified probe hsv-1
CPT 87529
|
$298.00
|
$298.00
|
$81.77 – $298.00
|
42 |
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
CPT 87641
|
$279.00
|
$279.00
|
$35.09 – $279.00
|
42 |
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
CPT 87556
|
$168.00
|
$168.00
|
$46.10 – $168.00
|
42 |
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
CPT 87591
|
$297.00
|
$297.00
|
$81.50 – $297.00
|
42 |
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
CPT 87635
|
$288.00
|
$288.00
|
$51.31 – $288.00
|
42 |
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
CPT 87636
|
$556.00
|
$556.00
|
$152.57 – $556.00
|
42 |
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
CPT 87637
|
$459.00
|
$459.00
|
$125.95 – $459.00
|
42 |
|
Infectious agent nucleic acid amplified probe streptococcus group a
CPT 87651
|
$154.00
|
$154.00
|
$42.26 – $154.00
|
42 |
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
CPT 87661
|
$182.00
|
$182.00
|
$49.94 – $182.00
|
42 |
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
CPT 87494
|
$211.00
|
$211.00
|
$57.90 – $211.00
|
42 |
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
CPT 87564
|
$323.00
|
$323.00
|
$88.63 – $323.00
|
42 |
|
Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets
CPT 87627
|
$2,039.00
|
$2,039.00
|
$559.50 – $2,039.00
|
42 |
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
CPT 87507
|
$892.00
|
$892.00
|
$244.76 – $892.00
|
42 |
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
CPT 87505
|
$483.00
|
$483.00
|
$132.54 – $483.00
|
42 |
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
CPT 87506
|
$637.00
|
$637.00
|
$174.79 – $637.00
|
42 |
|
Infectious agent nucleic acid quantification bk virus
CPT 87799
|
$1,958.00
|
$356.00
|
$9.09 – $356.00
|
42 |
|
Infectious agent nucleic acid quantification hepatitis b
CPT 87517
|
$478.00
|
$478.00
|
$131.16 – $478.00
|
42 |
|
Infectious agent nucleic acid quantification hepatitis c
CPT 87522
|
$474.00
|
$474.00
|
$130.07 – $474.00
|
42 |
|
Infectious agent nucleic acid quantification hiv-1
CPT 87536
|
$337.00
|
$337.00
|
$85.10 – $337.00
|
42 |
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
CPT 87631
|
$442.00
|
$442.00
|
$121.28 – $442.00
|
42 |
|
Infliximab 100 mg intravenous solution
HCPCS J1745
|
$3,222.55
|
$3,222.55
|
$311.80 – $3,222.55
|
108 |
|
Infliximab-axxq 100 mg intravenous solution
HCPCS Q5121
|
$1,379.70
|
$1,379.70
|
$358.80 – $1,379.70
|
108 |
|
Infliximab-dyyb 100 mg intravenous solution
HCPCS Q5103
|
$2,739.55
|
$2,739.55
|
$405.00 – $2,739.55
|
108 |
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
CPT 94642
|
$378.00
|
$378.00
|
$103.72 – $378.00
|
42 |
|
Initial nursing facility care/day 35 minutes
CPT 99305
|
$310.00
|
$310.00
|
$57.41 – $310.00
|
769 |
|
Initial nursing facility care/day 45 minutes
CPT 99306
|
$403.92
|
$399.00
|
$57.41 – $399.00
|
767 |
|
Initial nursing facility care/day low severity 99304
CPT 99304
|
$216.00
|
$216.00
|
$48.80 – $216.00
|
767 |
|
Inj, durolane 1 mg
HCPCS J7318
|
$1,709.30
|
$1,709.30
|
$5.79 – $1,452.82
|
766 |
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
CPT 64454
|
$2,595.00
|
$2,595.00
|
$79.21 – $691.00
|
42 |
|
Injection arthrography hip without anesthesia (both sides)
CPT 27093
|
$824.00
|
$824.00
|
$150.65 – $549.00
|
42 |
|
Injection carpal tunnel therapeutic (both sides)
CPT 20526
|
$1,199.00
|
$1,199.00
|
$219.25 – $799.00
|
42 |
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
CPT 23350
|
$7,275.90
|
$824.00
|
$0.12 – $536.00
|
108 |
|
Injection,onabotulinumtoxina
HCPCS J0585
|
$3,255.00
|
$3,255.00
|
$893.17 – $3,255.00
|
42 |
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
HCPCS G0260
|
$1,733.00
|
$1,733.00
|
$316.93 – $1,155.00
|
42 |
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
CPT 64447
|
$770.00
|
$770.00
|
$19.23 – $513.00
|
782 |
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
CPT 64450
|
$2,870.23
|
$1,485.00
|
$1.20 – $294.00
|
781 |
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
CPT 64483
|
$9,846.00
|
$9,846.00
|
$25.81 – $895.00
|
780 |
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
CPT 64491
|
$6,095.39
|
$3,200.00
|
$0.25 – $304.00
|
780 |
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
CPT 64490
|
$4,473.00
|
$4,473.00
|
$30.04 – $597.00
|
780 |
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
CPT 64494
|
$7,747.78
|
$3,879.00
|
$0.25 – $225.00
|
780 |
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
CPT 64493
|
$5,973.85
|
$3,861.00
|
$0.25 – $510.00
|
780 |
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
CPT 62321
|
$2,358.35
|
$1,549.00
|
$1.20 – $736.00
|
780 |
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
CPT 62323
|
$2,392.75
|
$1,549.00
|
$9.60 – $736.00
|
780 |
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
CPT 20550
|
$1,199.00
|
$1,199.00
|
$9.16 – $149.10
|
781 |
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
CPT 20552
|
$232.00
|
$232.00
|
$11.40 – $184.00
|
781 |
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
CPT 20553
|
$332.00
|
$332.00
|
$43.67 – $332.00
|
42 |
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
CPT 96376
|
$6,655.00
|
$224.00
|
$0.90 – $224.00
|
108 |
|
Inject sacroiliac joint
CPT 27096
|
$2,118.53
|
$1,350.00
|
$9.60 – $900.00
|
780 |
|
Inj epidural sgl lumb-sacral without img
CPT 62322
|
$2,671.00
|
$2,671.00
|
$732.92 – $2,671.00
|
42 |
|
Inj levocarnitine per 1 gm
HCPCS J1955
|
$178.80
|
$178.80
|
$49.06 – $178.80
|
42 |
|
Inj multihance
HCPCS A9577
|
$391.45
|
$391.45
|
$107.41 – $391.45
|
42 |
|
Inj, nithiodote, 3mg / 125mg
HCPCS J0211
|
$984.90
|
$984.90
|
$157.00 – $984.90
|
108 |
|
Inj pantoprazole(hikma) 40mg
HCPCS J2471
|
$16.80
|
$16.80
|
$4.61 – $16.80
|
108 |
|
Inj testosterone cypionate
HCPCS J1071
|
$74.40
|
$74.40
|
$6.00 – $74.40
|
108 |
|
Inj., tildrakizumab, 1 mg
HCPCS J3245
|
$53,884.35
|
$53,884.35
|
$14,785.87 – $53,884.35
|
42 |
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
HCPCS J9229
|
$73,182.85
|
$73,182.85
|
$20,081.37 – $73,182.85
|
108 |
|
Inpt/tele follow up 25
HCPCS G0407
|
$212.00
|
$212.00
|
$40.68 – $156.62
|
768 |
|
Insert drug delivery implant
CPT 11981
|
$524.00
|
$330.00
|
$2.79 – $21.60
|
768 |
|
Insertion catheter bladder non indwelling
CPT 51701
|
$48,123.28
|
$386.00
|
$6.00 – $386.00
|
108 |
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
CPT 36569
|
$11,602.20
|
$3,111.00
|
$3.00 – $364.00
|
780 |
|
Insertion picc without port or pump with imaging guidance=>5y
CPT 36573
|
$4,212.00
|
$4,212.00
|
$23.01 – $4,212.00
|
781 |
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
CPT 36561
|
$6,851.00
|
$6,500.00
|
$9.09 – $4,333.00
|
42 |
|
Insitu hybridization auto
CPT 88367
|
$1,079.00
|
$1,079.00
|
$98.18 – $1,079.00
|
42 |
|
In situ hybridization per specimen each additional single probe stain
CPT 88364
|
$244.00
|
$244.00
|
$66.95 – $244.00
|
42 |
|
In situ hybridization per specimen initial single probe stain
CPT 88365
|
$431.00
|
$431.00
|
$117.24 – $431.00
|
42 |
|
Insole orthotic freedom sz6 6816
HCPCS L3060
|
$68.15
|
$68.15
|
$18.70 – $68.15
|
42 |
|
Instillation anticarcinogenic agent bladder
CPT 51720
|
$1,011.00
|
$1,011.00
|
$277.42 – $1,011.00
|
42 |
|
Insulin total
CPT 83525
|
$132.00
|
$132.00
|
$36.22 – $132.00
|
42 |
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
HCPCS Q4114
|
$3,590.44
|
$3,590.44
|
$985.22 – $3,590.44
|
42 |
|
Integra os putty 2.5cc - cost per 0.5cc
HCPCS C9359
|
$225.79
|
$225.79
|
$61.96 – $225.79
|
42 |
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
HCPCS Q3027
|
$10,427.90
|
$10,427.90
|
$2,159.40 – $10,427.90
|
108 |
|
Intrinsic factor antibody
CPT 86340
|
$188.00
|
$188.00
|
$14.78 – $188.00
|
42 |
|
Intubation endotracheal emergency procedure
CPT 31500
|
$2,448.00
|
$2,448.00
|
$123.48 – $450.00
|
42 |
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
HCPCS Q9967
|
$227.50
|
$227.50
|
$17.11 – $62.35
|
42 |
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
HCPCS J9228
|
$110,829.85
|
$110,829.85
|
$7,602.94 – $27,707.50
|
108 |
|
Ipratropium bromide non-comp
HCPCS J7644
|
$1.02
|
$1.00
|
$0.20 – $1.00
|
766 |
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
HCPCS J9206
|
$522.90
|
$522.90
|
$17.55 – $63.95
|
42 |
|
Irinotecan liposomal 4.3 mg/ml intravenous
HCPCS J9205
|
$9,268.95
|
$9,268.95
|
$2,543.40 – $9,268.95
|
108 |
|
Iron
CPT 83540
|
$82.00
|
$82.00
|
$22.50 – $82.00
|
42 |
|
Iron binding capacity
CPT 83550
|
$1,155.00
|
$97.00
|
$9.09 – $97.00
|
42 |
|
Iron dextran 50 mg/ml injection solution
HCPCS J1750
|
$185.90
|
$185.90
|
$51.01 – $185.90
|
42 |
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
HCPCS J1756
|
$158.45
|
$158.45
|
$22.00 – $158.45
|
108 |
|
Irradiation of blood product each unit reference
CPT 86945
|
$311.00
|
$311.00
|
$85.34 – $311.00
|
42 |
|
Irrigation implantable venous access device for drug delivery systems
CPT 96523
|
$251.00
|
$251.00
|
$68.87 – $251.00
|
42 |
|
Isatuximab-irfc 20 mg/ml intravenous solution
HCPCS J9227
|
$2,779.35
|
$2,779.35
|
$762.65 – $2,779.35
|
108 |
|
IV Fluids (each additional hour)
CPT 96361
|
$1,242.00
|
$152.00
|
$2.28 – $152.00
|
108 |
|
IV Fluids (first hour)
CPT 96360
|
$561.00
|
$369.00
|
$4.56 – $369.00
|
108 |
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
CPT 96368
|
$7,892.05
|
$174.00
|
$2.28 – $1,244.52
|
108 |
|
IV Medicine Infusion (additional drug)
CPT 96367
|
$294.00
|
$294.00
|
$80.67 – $294.00
|
42 |
|
IV Medicine Infusion (each additional hour)
CPT 96366
|
$8,353.05
|
$149.00
|
$40.89 – $951.90
|
108 |
|
IV Medicine Infusion (first hour)
CPT 96365
|
$1,915.95
|
$445.00
|
$0.90 – $445.00
|
780 |
|
IV Push Injection (each additional drug)
CPT 96375
|
$6,655.00
|
$192.00
|
$0.90 – $192.00
|
108 |
|
IV Push Injection (first drug)
CPT 96374
|
$1,137.00
|
$310.00
|
$9.09 – $310.00
|
108 |
|
Ixabepilone 15 mg intravenous solution
HCPCS J9207
|
$18,131.05
|
$18,131.05
|
$1,658.39 – $6,043.70
|
108 |