|
Immunodiff gel qual ea antigen/ab
|
$50.78 |
$50.78 |
$50.78 |
$58.25
|
|
Immunofixation electrophoresis serum
|
$77.70 |
$77.70 |
$77.70 |
$133.38
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$90.56 |
$90.56 |
$90.56 |
$185.00
|
|
Immunofluorescence per specimen initial single antibody stain
|
$126.73 |
$126.73 |
$126.73 |
$288.00
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,272.52 |
$1,272.52 |
$1,272.52 |
$2,056.93
|
|
Incision of breast lesion
|
$3,863.36 |
$3,863.36 |
$3,863.36 |
$2,715.60
|
|
Infect ag drug suscept pheno predict
|
$158.55 |
$158.55 |
$158.55 |
$382.20
|
|
Infect ag genotype na cytomegalovirus
|
$358.99 |
$358.99 |
$358.99 |
$577.60
|
|
Infect ag genotype na dna hepatitis b
|
$202.30 |
$202.30 |
$202.30 |
$533.91
|
|
Infect ag genotype na hiv-1 other region
|
$310.41 |
$310.41 |
$310.41 |
$390.00
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$367.32 |
$367.32 |
$367.32 |
$619.11
|
|
Infect ag ia optc obs influenza
|
$65.58 |
$65.58 |
$65.58 |
$65.58
|
|
Infect ag if ea plyvlnt antsrm
|
$18.78 |
$18.78 |
$18.78 |
$47.70
|
|
Infect ag if hep delta agent
|
$78.26 |
$78.26 |
$78.26 |
$125.97
|
|
Infect ag if influenza a
|
$40.61 |
$40.61 |
$40.61 |
$51.20
|
|
Infect ag if influenza b
|
$43.38 |
$43.38 |
$43.38 |
$45.50
|
|
Infect ag if legionella pneumophila
|
$64.75 |
$64.75 |
$64.75 |
$85.15
|
|
Infect ag if nos ea
|
$60.40 |
$60.40 |
$60.40 |
$66.40
|
|
Infect ag if pneumocystis carinii
|
$56.15 |
$56.15 |
$56.15 |
$53.81
|
|
Infect ag na herpes simplex quant
|
$190.46 |
$190.46 |
$190.46 |
$145.20
|
|
Infect ag na hpv high-risk types
|
$136.25 |
$136.25 |
$136.25 |
$147.00
|
|
Infect ag na influenza r/amp 1st 2 types
|
$294.06 |
$294.06 |
$294.06 |
$248.80
|
|
Infect ag na influenza revr/amp ea type
|
$121.55 |
$121.55 |
$121.55 |
$151.80
|
|
Infect ag na resp virus 12-25 targets
|
$336.15 |
$336.15 |
$336.15 |
$878.20
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$40.70 |
$40.70 |
$40.70 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$51.15 |
$51.15 |
$51.15 |
$74.10
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$43.38 |
$43.38 |
$43.38 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$44.77 |
$44.77 |
$44.77 |
$73.45
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$112.85 |
$112.85 |
$112.85 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$35.80 |
$35.80 |
$35.80 |
$75.27
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$21.46 |
$21.46 |
$21.46 |
$60.95
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$32.28 |
$32.28 |
$32.28 |
$107.90
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$98.51 |
$98.51 |
$98.51 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$71.41 |
$71.41 |
$71.41 |
$98.40
|
|
Infectious agent nucleic acid amplified probe
|
$386.17 |
$386.17 |
$386.17 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$92.04 |
$92.04 |
$92.04 |
$144.00
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$77.42 |
$77.42 |
$77.42 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$372.96 |
$372.96 |
$372.96 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$157.62 |
$157.62 |
$157.62 |
$181.35
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$165.58 |
$165.58 |
$165.58 |
$217.10
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$92.04 |
$92.04 |
$92.04 |
$134.55
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$37.46 |
$37.46 |
$37.46 |
$109.18
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$58.74 |
$58.74 |
$58.74 |
$135.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$462.63 |
$462.63 |
$462.63 |
$727.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$197.40 |
$197.40 |
$197.40 |
$300.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$203.50 |
$203.50 |
$203.50 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$222.28 |
$222.28 |
$222.28 |
$280.20
|
|
Infectious agent nucleic acid quantification hiv-1
|
$200.08 |
$200.08 |
$200.08 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$443.35 |
$443.35 |
$443.35 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$178.95 |
$178.95 |
$178.95 |
$178.95
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$96.50 |
$96.50 |
$96.50 |
$157.14
|
|
Influenza dna amp prob addl
|
$75.80 |
$75.80 |
$75.80 |
$75.80
|
|
Initial foot exam pt lops
|
$142.17 |
$142.17 |
$142.17 |
$142.64
|
|
Initiation & management bipap/cpap initial day
|
$103.69 |
$103.69 |
$103.69 |
$608.40
|
|
Inj, abilify maintena, 1 mg
|
$2,488.27 |
$2,488.27 |
$2,488.27 |
$3,138.28
|
|
Inj, bezlotoxumab, 10 mg
|
$46.58 |
$46.58 |
$46.58 |
$39.83
|
|
Inj calcitriol per 0.1 mcg
|
$11.21 |
$11.21 |
$11.21 |
$11.21
|
|
Inj ceftolozane tazobactam
|
$164.93 |
$164.93 |
$164.93 |
$248.93
|
|
Inj, clevidipine butyrate
|
$17.45 |
$17.45 |
$17.45 |
$4.86
|
|
Inj dx for sinogram
|
$139.12 |
$139.12 |
$139.12 |
$484.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$212.66 |
$212.66 |
$212.66 |
$609.20
|
|
Injection, cangrelor
|
$19.75 |
$19.75 |
$19.75 |
$1,305.72
|
|
Injection carpal tunnel therapeutic (both sides)
|
$424.02 |
$424.02 |
$424.02 |
$441.60
|
|
Injection epidural blood patch or clot
|
$402.84 |
$402.84 |
$402.84 |
$1,470.60
|
|
Injection for arthrography wrist (both sides)
|
$175.29 |
$175.29 |
$175.29 |
$521.18
|
|
Injection for bladder x-ray
|
$128.95 |
$128.95 |
$128.95 |
$585.00
|
|
Injection for hip x-ray
|
$202.48 |
$202.48 |
$202.48 |
$1,189.34
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$141.06 |
$141.06 |
$141.06 |
$514.36
|
|
Injection for ureter x-ray
|
$99.81 |
$99.81 |
$99.81 |
$544.50
|
|
Injection, fulvestrant
|
$163.24 |
$163.24 |
$163.24 |
$166.25
|
|
Injection glatiramer acetate
|
$272.52 |
$272.52 |
$272.52 |
$458.43
|
|
Injection into brain canal
|
$459.45 |
$459.45 |
$459.45 |
$791.62
|
|
Injection into brain canal
|
$421.43 |
$421.43 |
$421.43 |
$961.20
|
|
Injection into hemorrhoid(s)
|
$193.05 |
$193.05 |
$193.05 |
$1,133.20
|
|
Injection, isavuconazonium
|
$389.92 |
$389.92 |
$389.92 |
$634.28
|
|
Injection,onabotulinumtoxina
|
$17.91 |
$17.91 |
$17.91 |
$12.88
|
|
Injection, peramivir
|
$9.71 |
$9.71 |
$9.71 |
$857.20
|
|
Injection, renflexis
|
$592.94 |
$592.94 |
$592.94 |
$632.98
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$543.53 |
$543.53 |
$543.53 |
$1,066.24
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,110.37 |
$1,110.37 |
$1,110.37 |
$1,017.28
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,985.61 |
$1,985.61 |
$1,985.61 |
$1,985.61
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$349.28 |
$349.28 |
$349.28 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$992.80 |
$992.80 |
$992.80 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$660.73 |
$660.73 |
$660.73 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$660.73 |
$660.73 |
$660.73 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$416.07 |
$416.07 |
$416.07 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$263.90 |
$263.90 |
$263.90 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$319.77 |
$319.77 |
$319.77 |
$654.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$75.11 |
$75.11 |
$75.11 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$75.48 |
$75.48 |
$75.48 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$84.55 |
$84.55 |
$84.55 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$61.14 |
$61.14 |
$61.14 |
$130.19
|
|
Injection torsemide 10 mg/ml
|
$16.02 |
$16.02 |
$16.02 |
$40.67
|
|
Injection treatment of eye
|
$2,911.53 |
$2,911.53 |
$2,911.53 |
$2,370.28
|
|
Inject sacroiliac joint
|
$170.57 |
$170.57 |
$170.57 |
$1,028.95
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$20,238.04 |
$20,238.04 |
$20,238.04 |
$39,043.20
|
|
Inj for mammo ductogram
|
$469.16 |
$469.16 |
$469.16 |
$469.16
|
|
Inj intralesional <= 7 lsn(s)
|
$159.19 |
$159.19 |
$159.19 |
$238.77
|
|
Inj ivig privigen 500 mg
|
$520.15 |
$520.15 |
$520.15 |
$6,144.00
|
|
Inj levocarnitine per 1 gm
|
$65.60 |
$65.60 |
$65.60 |
$87.51
|
