|
Incision of burn scab initi
|
$63.15 |
$63.15 |
$63.15 |
$494.40
|
|
Incision of tongue fold
|
$670.95 |
$670.95 |
$670.95 |
$1,792.50
|
|
Incisn of toe tndn
|
$753.60 |
$753.60 |
$753.60 |
$2,627.96
|
|
Incisn windpipe
|
$1,298.70 |
$1,298.70 |
$1,298.70 |
$3,810.50
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$30.15 |
$30.15 |
$30.15 |
$137.15
|
|
Infect ag drug suscept pheno predict
|
$228.15 |
$228.15 |
$228.15 |
$323.20
|
|
Infect ag eia influenza a or b ea
|
$20.10 |
$20.10 |
$20.10 |
$71.50
|
|
Infect ag genotype na cytomegalovirus
|
$388.80 |
$388.80 |
$388.80 |
$661.80
|
|
Infect ag genotype na dna hepatitis b
|
$388.80 |
$388.80 |
$388.80 |
$405.30
|
|
Infect ag genotype na hiv-1 other region
|
$178.05 |
$178.05 |
$178.05 |
$386.40
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$388.35 |
$388.35 |
$388.35 |
$603.75
|
|
Infect ag ia optc obs influenza
|
$20.10 |
$20.10 |
$20.10 |
$72.93
|
|
Infect ag if hep delta agent
|
$28.80 |
$28.80 |
$28.80 |
$125.97
|
|
Infect ag if legionella pneumophila
|
$20.10 |
$20.10 |
$20.10 |
$72.58
|
|
Infect ag if nos ea
|
$20.10 |
$20.10 |
$20.10 |
$74.88
|
|
Infect ag if varicella zoster
|
$20.10 |
$20.10 |
$20.10 |
$70.70
|
|
Infect ag na hpv high-risk types
|
$30.75 |
$30.75 |
$30.75 |
$139.75
|
|
Infect ag na influenza r/amp 1st 2 types
|
$148.95 |
$148.95 |
$148.95 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$15.00 |
$15.00 |
$15.00 |
$99.36
|
|
Infect ag na resp virus 12-25 targets
|
$374.85 |
$374.85 |
$374.85 |
$835.80
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$12.15 |
$12.15 |
$12.15 |
$53.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$20.10 |
$20.10 |
$20.10 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$20.10 |
$20.10 |
$20.10 |
$72.80
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$20.10 |
$20.10 |
$20.10 |
$76.32
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$21.00 |
$21.00 |
$21.00 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$25.20 |
$25.20 |
$25.20 |
$100.02
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$17.40 |
$17.40 |
$17.40 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$17.40 |
$17.40 |
$17.40 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$42.15 |
$42.15 |
$42.15 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$20.10 |
$20.10 |
$20.10 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$20.10 |
$20.10 |
$20.10 |
$98.02
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$20.10 |
$20.10 |
$20.10 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$61.50 |
$61.50 |
$61.50 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$61.50 |
$61.50 |
$61.50 |
$139.68
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$61.50 |
$61.50 |
$61.50 |
$167.00
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$733.80 |
$733.80 |
$733.80 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$61.50 |
$61.50 |
$61.50 |
$179.92
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$61.50 |
$61.50 |
$61.50 |
$147.55
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$61.50 |
$61.50 |
$61.50 |
$217.85
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$61.50 |
$61.50 |
$61.50 |
$136.03
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$15.00 |
$15.00 |
$15.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$47.10 |
$47.10 |
$47.10 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$61.50 |
$61.50 |
$61.50 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$61.50 |
$61.50 |
$61.50 |
$92.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$30.90 |
$30.90 |
$30.90 |
$108.75
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$34.80 |
$34.80 |
$34.80 |
$185.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$402.60 |
$402.60 |
$402.60 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$224.10 |
$224.10 |
$224.10 |
$286.06
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$372.75 |
$372.75 |
$372.75 |
$423.53
|
|
Infectious agent nucleic acid quantification bk virus
|
$75.15 |
$75.15 |
$75.15 |
$279.40
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$75.15 |
$75.15 |
$75.15 |
$239.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$75.15 |
$75.15 |
$75.15 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$148.95 |
$148.95 |
$148.95 |
$374.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$124.20 |
$124.20 |
$124.20 |
$303.59
|
|
Influenza dna amp prob addl
|
$36.45 |
$36.45 |
$36.45 |
$64.26
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$53.55 |
$53.55 |
$53.55 |
$293.25
|
|
Initiation & management bipap/cpap initial day
|
$234.75 |
$234.75 |
$234.75 |
$576.00
|
|
Inj., aristada initio, 1 mg
|
$0.15 |
$0.15 |
$0.15 |
$4,052.45
|
|
Inj ceftolozane tazobactam
|
$189.44 |
$189.44 |
$189.44 |
$380.80
|
|
Inj cntr knee arthro incl ct/mri
|
$169.05 |
$169.05 |
$169.05 |
$436.80
|
|
Inj dx for sinogram
|
$202.65 |
$202.65 |
$202.65 |
$422.59
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$312.90 |
$312.90 |
$312.90 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$169.05 |
$169.05 |
$169.05 |
$495.84
|
|
Injection, cangrelor
|
$922.96 |
$922.96 |
$922.96 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$165.90 |
$165.90 |
$165.90 |
$450.72
|
|
Injection during cath supravalvular aortography
|
$67.35 |
$67.35 |
$67.35 |
$952.66
|
|
Injection epidural blood patch or clot
|
$352.95 |
$352.95 |
$352.95 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$60.75 |
$60.75 |
$60.75 |
$428.40
|
|
Injection for bladder x-ray
|
$66.90 |
$66.90 |
$66.90 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$197.40 |
$197.40 |
$197.40 |
$494.65
|
|
Injection for ureter x-ray
|
$264.30 |
$264.30 |
$264.30 |
$515.21
|
|
Injection,onabotulinumtoxina
|
$701.93 |
$701.93 |
$701.93 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$482.85 |
$482.85 |
$482.85 |
$670.64
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$471.15 |
$471.15 |
$471.15 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$293.70 |
$293.70 |
$293.70 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$352.80 |
$352.80 |
$352.80 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$787.50 |
$787.50 |
$787.50 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$828.90 |
$828.90 |
$828.90 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$129.90 |
$129.90 |
$129.90 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$552.30 |
$552.30 |
$552.30 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$152.25 |
$152.25 |
$152.25 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$447.90 |
$447.90 |
$447.90 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$235.35 |
$235.35 |
$235.35 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$245.85 |
$245.85 |
$245.85 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$235.35 |
$235.35 |
$235.35 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$27.75 |
$27.75 |
$27.75 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$43.65 |
$43.65 |
$43.65 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$59.70 |
$59.70 |
$59.70 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$31.95 |
$31.95 |
$31.95 |
$135.60
|
|
Inject sacroiliac joint
|
$342.15 |
$342.15 |
$342.15 |
$1,028.95
|
|
Inj epidural sgl cerv-thor without img
|
$138.45 |
$138.45 |
$138.45 |
$1,318.80
|
|
Inj for ext venography
|
$552.45 |
$552.45 |
$552.45 |
$649.95
|
|
Inj for mammo ductogram
|
$242.10 |
$242.10 |
$242.10 |
$399.60
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,439.90
|
|
Inj intralesional <= 7 lsn(s)
|
$83.55 |
$83.55 |
$83.55 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$6,506.50 |
$6,506.50 |
$6,506.50 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$83.27 |
$83.27 |
$83.27 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$2.93 |
$2.93 |
$2.93 |
$47.52
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$702.45 |
$702.45 |
$702.45 |
$1,413.35
|
|
Inj peritoneal venous shunt
|
$54.90 |
$54.90 |
$54.90 |
$413.70
|
