|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$62.40 |
$62.40 |
$62.40 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$73.45 |
$73.45 |
$73.45 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$63.05 |
$63.05 |
$63.05 |
$97.50
|
|
Infectious agent nucleic acid amplified probe
|
$132.60 |
$132.60 |
$132.60 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$92.95 |
$92.95 |
$92.95 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$1,120.60 |
$1,120.60 |
$1,120.60 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$645.45 |
$645.45 |
$645.45 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$173.55 |
$173.55 |
$173.55 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$147.55 |
$147.55 |
$147.55 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$148.85 |
$148.85 |
$148.85 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$92.95 |
$92.95 |
$92.95 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$111.80 |
$111.80 |
$111.80 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$278.85 |
$278.85 |
$278.85 |
$222.60
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$230.75 |
$230.75 |
$230.75 |
$248.15
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$113.75 |
$113.75 |
$113.75 |
$98.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$92.95 |
$92.95 |
$92.95 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$188.50 |
$188.50 |
$188.50 |
$200.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$581.10 |
$581.10 |
$581.10 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$96.20 |
$96.20 |
$96.20 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$562.90 |
$562.90 |
$562.90 |
$489.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$328.90 |
$328.90 |
$328.90 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$276.25 |
$276.25 |
$276.25 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$341.90 |
$341.90 |
$341.90 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$241.80 |
$241.80 |
$241.80 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$158.60 |
$158.60 |
$158.60 |
$298.35
|
|
Infliximab 100 mg intravenous solution
|
$3,721.02 |
$3,721.02 |
$3,721.02 |
$2,791.24
|
|
Influenza dna amp prob addl
|
$41.60 |
$41.60 |
$41.60 |
$69.60
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$817.70 |
$817.70 |
$817.70 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$306.80 |
$306.80 |
$306.80 |
$645.79
|
|
Inj, bupivacaine liposome
|
$1,040.36 |
$1,040.36 |
$1,040.36 |
$816.31
|
|
Inj, cefepime hcl (b braun)
|
$107.78 |
$107.78 |
$107.78 |
$81.41
|
|
Inj cntr knee arthro incl ct/mri
|
$1,292.20 |
$1,292.20 |
$1,292.20 |
$464.28
|
|
Inj cyclophosphamd (ingenus)
|
$1,165.97 |
$1,165.97 |
$1,165.97 |
$1,040.94
|
|
Inj disk cerv-thor ea lev
|
$463.45 |
$463.45 |
$463.45 |
$869.80
|
|
Inj, durolane 1 mg
|
$3,382.31 |
$3,382.31 |
$3,382.31 |
$3,382.31
|
|
Inj dx for sinogram
|
$2,180.75 |
$2,180.75 |
$2,180.75 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,004.60 |
$2,004.60 |
$2,004.60 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$3,040.70 |
$3,040.70 |
$3,040.70 |
$507.10
|
|
Injection carpal tunnel therapeutic (both sides)
|
$825.50 |
$825.50 |
$825.50 |
$536.00
|
|
Injection during cath supravalvular aortography
|
$1,666.60 |
$1,666.60 |
$1,666.60 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$1,002.30 |
$1,002.30 |
$1,002.30 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$4,321.20 |
$4,321.20 |
$4,321.20 |
$441.12
|
|
Injection for bladder x-ray
|
$1,407.90 |
$1,407.90 |
$1,407.90 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$3,005.60 |
$3,005.60 |
$3,005.60 |
$504.00
|
|
Injection for spleen x-ray
|
$208.00 |
$208.00 |
$208.00 |
$686.40
|
|
Injection for ureter x-ray
|
$1,637.35 |
$1,637.35 |
$1,637.35 |
$444.95
|
|
Injection for ureter x-ray
|
$1,514.50 |
$1,514.50 |
$1,514.50 |
$515.21
|
|
Injection, fulvestrant
|
$179.85 |
$179.85 |
$179.85 |
$2,756.47
|
|
Injection, inclisiran, 1 mg
|
$11,657.30 |
$11,657.30 |
$11,657.30 |
$10,366.61
|
|
Injection into brain canal
|
$139.75 |
$139.75 |
$139.75 |
$933.60
|
|
Injection jugular
|
$236.60 |
$236.60 |
$236.60 |
$1,048.20
|
|
Injection of sinus tract
|
$1,075.75 |
$1,075.75 |
$1,075.75 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$2,154.07 |
$2,154.07 |
$2,154.07 |
$2,154.07
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,597.70 |
$1,597.70 |
$1,597.70 |
$717.20
|
|
Injection, renflexis
|
$1,035.22 |
$1,035.22 |
$1,035.22 |
$1,457.42
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,710.50 |
$2,710.50 |
$2,710.50 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,006.90 |
$3,006.90 |
$3,006.90 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$3,006.90 |
$3,006.90 |
$3,006.90 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,598.70 |
$2,598.70 |
$2,598.70 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$334.10 |
$334.10 |
$334.10 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,598.70 |
$2,598.70 |
$2,598.70 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$334.10 |
$334.10 |
$334.10 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,598.70 |
$2,598.70 |
$2,598.70 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,392.30 |
$1,392.30 |
$1,392.30 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,392.30 |
$1,392.30 |
$1,392.30 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$646.10 |
$646.10 |
$646.10 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$412.10 |
$412.10 |
$412.10 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$412.75 |
$412.75 |
$412.75 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$127.40 |
$127.40 |
$127.40 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$105.95 |
$105.95 |
$105.95 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$234.00 |
$234.00 |
$234.00 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$107.90 |
$107.90 |
$107.90 |
$141.60
|
|
Injection treatment of nerve
|
$2,171.00 |
$2,171.00 |
$2,171.00 |
$3,016.15
|
|
Injection treatment of nerve
|
$1,600.95 |
$1,600.95 |
$1,600.95 |
$2,037.10
|
|
Inj epidural sgl cerv-thor without img
|
$1,002.30 |
$1,002.30 |
$1,002.30 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$1,299.35 |
$1,299.35 |
$1,299.35 |
$1,450.84
|
|
Inj for mammo ductogram
|
$2,338.70 |
$2,338.70 |
$2,338.70 |
$433.50
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,762.80 |
$1,762.80 |
$1,762.80 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$947.05 |
$947.05 |
$947.05 |
$947.65
|
|
Inj hydroxocobalamin IV 25mg
|
$3,180.35 |
$3,180.35 |
$3,180.35 |
$3,180.35
|
|
Inj intralesional <= 7 lsn(s)
|
$340.60 |
$340.60 |
$340.60 |
$241.74
|
|
Inj ivig privigen 500 mg
|
$3,920.83 |
$3,920.83 |
$3,920.83 |
$7,298.71
|
|
Inj levocarnitine per 1 gm
|
$349.34 |
$349.34 |
$349.34 |
$138.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$7,151.30 |
$7,151.30 |
$7,151.30 |
$625.00
|
|
Inj mepivacaine hcl/10 ml
|
$41.92 |
$41.92 |
$41.92 |
$28.41
|
|
Inj meropenem (wg crit care)
|
$104.29 |
$104.29 |
$104.29 |
$104.29
|
|
Inj multihance
|
$20.28 |
$20.28 |
$20.28 |
$119.25
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,176.20 |
$2,176.20 |
$2,176.20 |
$1,522.56
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,124.50 |
$1,124.50 |
$1,124.50 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,124.50 |
$1,124.50 |
$1,124.50 |
$2,164.64
|
|
Inj ontruzant 10 mg
|
$4,554.03 |
$4,554.03 |
$4,554.03 |
$34.17
|
|
Inj peritoneal venous shunt
|
$1,699.75 |
$1,699.75 |
$1,699.75 |
$386.88
|
|
Inj proc ankle arthr
|
$1,445.60 |
$1,445.60 |
$1,445.60 |
$405.31
|
|
Inj proc elbow arthro
|
$2,314.65 |
$2,314.65 |
$2,314.65 |
$453.60
|
|
Inj proc for lymphang
|
$2,003.95 |
$2,003.95 |
$2,003.95 |
$1,372.00
|
|
Inj proc lumbr disk ea lvl
|
$463.45 |
$463.45 |
$463.45 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$1,851.85 |
$1,851.85 |
$1,851.85 |
$922.80
|
|
Inj proc sialogram
|
$1,514.50 |
$1,514.50 |
$1,514.50 |
$380.80
|
|
Inj retro urethrocysto
|
$1,340.30 |
$1,340.30 |
$1,340.30 |
$551.29
|
|
Inj scleros sol mult veins
|
$393.90 |
$393.90 |
$393.90 |
$687.96
|