|
H pylori (c-13) breath
|
$146.30 |
$146.30 |
$146.30 |
$213.00
|
|
Hydration IV infusion each additional hour
|
$278.30 |
$278.30 |
$278.30 |
$133.90
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$1,057.65 |
$1,057.65 |
$1,057.65 |
$390.00
|
|
Hysterosalpingography s&i
|
$1,854.69 |
$1,854.69 |
$1,854.69 |
$576.89
|
|
I-123 iobenguane diag
|
$24,446.40 |
$24,446.40 |
$24,446.40 |
$5,730.40
|
|
I-123 sod iodide diag per 100 uci
|
$417.27 |
$417.27 |
$417.27 |
$157.80
|
|
I131 iodide cap, rx
|
$1,059.27 |
$1,059.27 |
$1,059.27 |
$106.20
|
|
Iaadi respiratory synctial virus
|
$81.40 |
$81.40 |
$81.40 |
$46.02
|
|
Iadna legionella pneumophila amplified probe tq
|
$356.95 |
$356.95 |
$356.95 |
$119.60
|
|
Icd cobalt xt dr MRI is1 df1
|
$59,009.89 |
$59,009.89 |
$59,009.89 |
$32,319.18
|
|
Icd crtd cobalt hf MRI is1 df1
|
$71,785.11 |
$71,785.11 |
$71,785.11 |
$37,490.48
|
|
Icd crtp serena MRI
|
$34,525.69 |
$34,525.69 |
$34,525.69 |
$15,738.14
|
|
Icd reliance df4 ib 64cm
|
$14,220.44 |
$14,220.44 |
$14,220.44 |
$8,597.15
|
|
I&d upper arm/elbow deep abscess/hematoma
|
$2,936.37 |
$2,936.37 |
$2,936.37 |
$3,345.60
|
|
Igh@ var region somatic mutation analy
|
$544.50 |
$544.50 |
$544.50 |
$660.80
|
|
Ihc/icc per specimen each additional single antibody stain
|
$277.34 |
$277.34 |
$277.34 |
$191.10
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$348.15 |
$348.15 |
$348.15 |
$339.64
|
|
Ihc/icc per specimen initial single antibody stain
|
$1,201.20 |
$1,201.20 |
$1,201.20 |
$265.60
|
|
Iliac/fem angio cath insert
|
$1,509.56 |
$1,509.56 |
$1,509.56 |
$1,571.50
|
|
Iliac revasc add-on 37222
|
$3,564.69 |
$3,564.69 |
$3,564.69 |
$6,513.10
|
|
Img rta detc/mntr ds poc aly
|
$52.80 |
$52.80 |
$52.80 |
$70.29
|
|
Immobilizer shldr dlx str 24-36in med
|
$103.56 |
$103.56 |
$103.56 |
$67.77
|
|
Immune complex assay
|
$35.20 |
$35.20 |
$35.20 |
$89.25
|
|
Immunoassay tumor antigen quantitative ca 125
|
$352.82 |
$352.82 |
$352.82 |
$122.50
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$176.41 |
$176.41 |
$176.41 |
$116.40
|
|
Immunofixation electrophoresis serum
|
$210.10 |
$210.10 |
$210.10 |
$133.38
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$252.45 |
$252.45 |
$252.45 |
$161.85
|
|
Immunofluorescence per specimen initial single antibody stain
|
$665.50 |
$665.50 |
$665.50 |
$250.00
|
|
Immunoglobulin assay
|
$154.00 |
$154.00 |
$154.00 |
$74.15
|
|
In-111 pentetate dtpa / 0.5 mci
|
$15,734.95 |
$15,734.95 |
$15,734.95 |
$2,135.29
|
|
In-111 pentetreotide
|
$32,495.65 |
$32,495.65 |
$32,495.65 |
$6,617.05
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$2,565.17 |
$2,565.17 |
$2,565.17 |
$2,111.40
|
|
Incision of breast lesion
|
$3,048.57 |
$3,048.57 |
$3,048.57 |
$2,851.86
|
|
Infect ag drug suscept pheno predict
|
$214.50 |
$214.50 |
$214.50 |
$374.40
|
|
Infect ag eia influenza a or b ea
|
$135.85 |
$135.85 |
$135.85 |
$69.03
|
|
Infect ag genotype na hiv-1 other region
|
$212.85 |
$212.85 |
$212.85 |
$310.41
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$2,181.71 |
$2,181.71 |
$2,181.71 |
$603.75
|
|
Infect ag ia optc obs influenza
|
$257.95 |
$257.95 |
$257.95 |
$65.60
|
|
Infect ag if influenza a
|
$81.40 |
$81.40 |
$81.40 |
$42.12
|
|
Infect ag if pneumocystis carinii
|
$34.65 |
$34.65 |
$34.65 |
$56.15
|
|
Infect ag na hpv high-risk types
|
$199.65 |
$199.65 |
$199.65 |
$143.37
|
|
Infect ag na influenza r/amp 1st 2 types
|
$312.26 |
$312.26 |
$312.26 |
$228.68
|
|
Infect ag na orthopoxvirus amp prb each
|
$374.00 |
$374.00 |
$374.00 |
$105.00
|
|
Infect ag na resp virus 12-25 targets
|
$1,766.05 |
$1,766.05 |
$1,766.05 |
$858.92
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$103.95 |
$103.95 |
$103.95 |
$81.90
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$203.22 |
$203.22 |
$203.22 |
$76.45
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$243.79 |
$243.79 |
$243.79 |
$88.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$175.04 |
$175.04 |
$175.04 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$53.90 |
$53.90 |
$53.90 |
$57.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$204.05 |
$204.05 |
$204.05 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$202.88 |
$202.88 |
$202.88 |
$138.05
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$203.22 |
$203.22 |
$203.22 |
$93.60
|
|
Infectious agent nucleic acid amplified probe
|
$594.82 |
$594.82 |
$594.82 |
$278.95
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$297.41 |
$297.41 |
$297.41 |
$144.00
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$297.41 |
$297.41 |
$297.41 |
$171.60
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,024.65 |
$1,024.65 |
$1,024.65 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$297.41 |
$297.41 |
$297.41 |
$175.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$213.40 |
$213.40 |
$213.40 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$529.51 |
$529.51 |
$529.51 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$398.06 |
$398.06 |
$398.06 |
$137.04
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$68.80 |
$68.80 |
$68.80 |
$102.57
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$549.45 |
$549.45 |
$549.45 |
$248.15
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$63.36 |
$63.36 |
$63.36 |
$98.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$297.41 |
$297.41 |
$297.41 |
$112.50
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$200.20 |
$200.20 |
$200.20 |
$200.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$180.95 |
$180.95 |
$180.95 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$363.00 |
$363.00 |
$363.00 |
$300.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$726.00 |
$726.00 |
$726.00 |
$234.21
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$726.00 |
$726.00 |
$726.00 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$721.19 |
$721.19 |
$721.19 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$235.95 |
$235.95 |
$235.95 |
$300.46
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$213.65 |
$213.65 |
$213.65 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$604.01 |
$604.01 |
$604.01 |
$627.00
|
|
Inj cntr knee arthro incl ct/mri
|
$110.80 |
$110.80 |
$110.80 |
$461.25
|
|
Injection arthrography hip without anesthesia (both sides)
|
$1,021.02 |
$1,021.02 |
$1,021.02 |
$562.20
|
|
Injection during cath supravalvular aortography
|
$1,524.05 |
$1,524.05 |
$1,524.05 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$886.38 |
$886.38 |
$886.38 |
$1,457.85
|
|
Injection for arthrography wrist (both sides)
|
$116.64 |
$116.64 |
$116.64 |
$471.00
|
|
Injection for bladder x-ray
|
$302.24 |
$302.24 |
$302.24 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$116.64 |
$116.64 |
$116.64 |
$504.55
|
|
Injection into brain canal
|
$788.67 |
$788.67 |
$788.67 |
$933.60
|
|
Injection jugular
|
$997.18 |
$997.18 |
$997.18 |
$1,048.20
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,484.78 |
$1,484.78 |
$1,484.78 |
$787.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,431.48 |
$1,431.48 |
$1,431.48 |
$1,017.28
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,505.80 |
$2,505.80 |
$2,505.80 |
$2,035.20
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$48.31 |
$48.31 |
$48.31 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$769.97 |
$769.97 |
$769.97 |
$552.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$231.55 |
$231.55 |
$231.55 |
$175.35
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$277.20 |
$277.20 |
$277.20 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$292.05 |
$292.05 |
$292.05 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$327.25 |
$327.25 |
$327.25 |
$140.34
|
|
Inj for ext venography
|
$512.85 |
$512.85 |
$512.85 |
$699.06
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,515.17 |
$1,515.17 |
$1,515.17 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$287.04 |
$287.04 |
$287.04 |
$861.49
|
|
Inj proc ankle arthr
|
$116.64 |
$116.64 |
$116.64 |
$405.31
|
|
Inj proc elbow arthro
|
$116.64 |
$116.64 |
$116.64 |
$456.17
|
|
Inj w/fluor eval cv device
|
$1,178.10 |
$1,178.10 |
$1,178.10 |
$593.60
|
|
Ins cath ren art 1st bi
|
$3,701.66 |
$3,701.66 |
$3,701.66 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$1,850.83 |
$1,850.83 |
$1,850.83 |
$4,628.00
|
|
Ins cath ren art 2nd+ bi
|
$3,701.66 |
$3,701.66 |
$3,701.66 |
$5,408.65
|
