|
Infect ag if legionella pneumophila
|
$17.16 |
$17.16 |
$17.16 |
$75.79
|
|
Infect ag if nos ea
|
$17.71 |
$17.71 |
$17.71 |
$60.40
|
|
Infect ag if pneumocystis carinii
|
$13.18 |
$13.18 |
$13.18 |
$62.29
|
|
Infect ag if varicella zoster
|
$14.76 |
$14.76 |
$14.76 |
$66.00
|
|
Infect ag na chlamydia trachomatis qnt
|
$58.82 |
$58.82 |
$58.82 |
$58.82
|
|
Infect ag na hep b amp
|
$38.60 |
$38.60 |
$38.60 |
$108.44
|
|
Infect ag na herpes simplex quant
|
$47.12 |
$47.12 |
$47.12 |
$145.20
|
|
Infect ag na hpv high-risk types
|
$38.60 |
$38.60 |
$38.60 |
$139.75
|
|
Infect ag na influenza r/amp 1st 2 types
|
$105.38 |
$105.38 |
$105.38 |
$227.96
|
|
Infect ag na influenza revr/amp ea type
|
$56.44 |
$56.44 |
$56.44 |
$124.80
|
|
Infect ag na resp virus 12-25 targets
|
$458.46 |
$458.46 |
$458.46 |
$859.44
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$537.53 |
$537.53 |
$537.53 |
$714.67
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$28.68 |
$28.68 |
$28.68 |
$77.00
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$45.52 |
$45.52 |
$45.52 |
$47.50
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$13.18 |
$13.18 |
$13.18 |
$81.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$14.76 |
$14.76 |
$14.76 |
$63.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$15.20 |
$15.20 |
$15.20 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$13.18 |
$13.18 |
$13.18 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$15.82 |
$15.82 |
$15.82 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$11.36 |
$11.36 |
$11.36 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$11.36 |
$11.36 |
$11.36 |
$55.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$26.49 |
$26.49 |
$26.49 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$13.18 |
$13.18 |
$13.18 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$13.18 |
$13.18 |
$13.18 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$13.18 |
$13.18 |
$13.18 |
$60.00
|
|
Infectious agent nucleic acid amplified probe
|
$38.60 |
$38.60 |
$38.60 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$38.60 |
$38.60 |
$38.60 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$41.00 |
$41.00 |
$41.00 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$458.46 |
$458.46 |
$458.46 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$38.60 |
$38.60 |
$38.60 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$38.60 |
$38.60 |
$38.60 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$45.85 |
$45.85 |
$45.85 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$38.60 |
$38.60 |
$38.60 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$56.44 |
$56.44 |
$56.44 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$156.89 |
$156.89 |
$156.89 |
$222.60
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$156.89 |
$156.89 |
$156.89 |
$248.15
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$38.60 |
$38.60 |
$38.60 |
$98.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$38.60 |
$38.60 |
$38.60 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$35.07 |
$35.07 |
$35.07 |
$200.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$458.46 |
$458.46 |
$458.46 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$141.12 |
$141.12 |
$141.12 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$289.29 |
$289.29 |
$289.29 |
$489.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$47.12 |
$47.12 |
$47.12 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$47.12 |
$47.12 |
$47.12 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$47.12 |
$47.12 |
$47.12 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$93.61 |
$93.61 |
$93.61 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$156.89 |
$156.89 |
$156.89 |
$298.35
|
|
Influenza dna amp prob addl
|
$32.14 |
$32.14 |
$32.14 |
$69.60
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$29.54 |
$29.54 |
$29.54 |
$76.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$51.30 |
$51.30 |
$51.30 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$159.80 |
$159.80 |
$159.80 |
$645.79
|
|
Inj dupuytren cord w/enzyme
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$416.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,214.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$536.00
|
|
Injection during cath supravalvular aortography
|
$64.74 |
$64.74 |
$64.74 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,473.12
|
|
Injection eye drug
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$648.90
|
|
Injection for bladder x-ray
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$585.00
|
|
Injection for ureter x-ray
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$515.21
|
|
Injection into brain canal
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$970.61
|
|
Injection into brain canal
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$933.60
|
|
Injection into hemorrhoid(s)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,278.72
|
|
Injection into spinal artery
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,468.18
|
|
Injection into vocal cord
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$457.30
|
|
Injection of sinus tract
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,651.20
|
|
Injection px peyronie ds
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$343.55
|
|
Injection radioactive tracer sentinel node (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$717.20
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$95.88 |
$95.88 |
$95.88 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$54.57 |
$54.57 |
$54.57 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$123.41 |
$123.41 |
$123.41 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$76.04 |
$76.04 |
$76.04 |
$141.60
|
|
Injection treatment of eye
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,698.27
|
|
Injection treatment of eye
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,698.92
|
|
Injection treatment of nerve
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,016.15
|
|
Injection treatment of nerve
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,986.00
|
|
Injection treatment of nerve
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,037.10
|
|
Injection treatment of nose
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$602.63
|
|
Inject/treat eye socket
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$365.40
|
|
Inject/treat eye socket
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$414.40
|
|
Inject/treat eye socket
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$670.02
|
|
Inj epidural sgl cerv-thor without img
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,450.84
|
|
Inj for ext venography
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$737.55
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$49.98 |
$49.98 |
$49.98 |
$1,482.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$60.64 |
$60.64 |
$60.64 |
$1,837.17
|
|
Inj hrt cath w/s&i sel left vent
|
$48.51 |
$48.51 |
$48.51 |
$1,214.40
|
|
Inj hrt cath w/s&i sel right vent
|
$48.18 |
$48.18 |
$48.18 |
$947.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,901.25
|
|
Inj intralesional <= 7 lsn(s)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$241.74
|
|
Inj intralesional > 7 lsns
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$234.00
|
