|
Icd cobalt xt dr MRI is1 df1
|
$166,489.63 |
$166,489.63 |
$166,489.63 |
$35,816.55
|
|
Icd crtd cobalt hf MRI is1 df1
|
$33,787.59 |
$33,787.59 |
$33,787.59 |
$32,098.95
|
|
Icd crtp serena MRI
|
$15,750.00 |
$15,750.00 |
$15,750.00 |
$12,663.00
|
|
Icd reliance df4 ib 64cm
|
$10,831.70 |
$10,831.70 |
$10,831.70 |
$7,292.40
|
|
Ifosfamide 1 gram intravenous solution
|
$5,071.62 |
$5,071.62 |
$5,071.62 |
$289.34
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$416.31 |
$416.31 |
$416.31 |
$339.73
|
|
Ihc/icc per specimen initial single antibody stain
|
$262.03 |
$262.03 |
$262.03 |
$266.76
|
|
Iliac/fem angio cath insert
|
$1,367.10 |
$1,367.10 |
$1,367.10 |
$1,601.66
|
|
Iliac revasc add-on 37222
|
$2,622.20 |
$2,622.20 |
$2,622.20 |
$6,513.10
|
|
Immob elbow child sm
|
$48.51 |
$48.51 |
$48.51 |
$83.26
|
|
Immune complex assay
|
$81.59 |
$81.59 |
$81.59 |
$88.80
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$12,807.66 |
$12,807.66 |
$12,807.66 |
$5,617.36
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$101.15 |
$101.15 |
$101.15 |
$2,568.72
|
|
Immunoassay tumor antigen quantitative ca 125
|
$101.85 |
$101.85 |
$1,292.11 |
$123.50
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$90.04 |
$90.04 |
$1,030.62 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$49.77 |
$49.77 |
$49.77 |
$53.95
|
|
Immunodiffusion nes
|
$63.00 |
$63.00 |
$63.00 |
$53.76
|
|
Immunofixation electrophoresis serum
|
$93.79 |
$93.79 |
$970.63 |
$133.38
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$1,847.43 |
$1,847.43 |
$1,847.43 |
$156.00
|
|
Immunofluorescence per specimen initial single antibody stain
|
$120.65 |
$120.65 |
$120.65 |
$250.00
|
|
Immunoglobulin assay
|
$49.77 |
$49.77 |
$49.77 |
$74.00
|
|
Immunology procedure
|
$27.09 |
$27.09 |
$27.09 |
$281.45
|
|
Implant cartilage 10mm synthetic
|
$5,895.81 |
$5,895.81 |
$5,895.81 |
$9,261.00
|
|
Implant ureth bulk agent
|
$565.95 |
$565.95 |
$565.95 |
$1,930.57
|
|
In-111 autol wbc diag per dose
|
$3,927.05 |
$3,927.05 |
$8,225.86 |
$3,704.00
|
|
In-111 capromab pendet
|
$81,843.23 |
$81,843.23 |
$81,843.23 |
$3,941.34
|
|
In-111 oxyquinolin per 0.5 mci
|
$15,961.38 |
$15,961.38 |
$15,961.38 |
$2,808.00
|
|
In-111 pentetate dtpa / 0.5 mci
|
$1,541.61 |
$1,541.61 |
$8,225.86 |
$2,135.29
|
|
In-111 pentetreotide
|
$5,771.75 |
$5,771.75 |
$8,225.86 |
$6,617.05
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$927.36 |
$927.36 |
$6,036.68 |
$2,261.20
|
|
Incision of burn scab initi
|
$97.34 |
$97.34 |
$97.34 |
$501.00
|
|
Incisn of toe tndn
|
$749.39 |
$749.39 |
$749.39 |
$2,298.99
|
|
Incisn windpipe
|
$2,687.30 |
$2,687.30 |
$2,687.30 |
$3,837.72
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$1,039.27 |
$1,039.27 |
$1,039.27 |
$1,099.05
|
|
Infect ag drug suscept pheno predict
|
$223.97 |
$223.97 |
$223.97 |
$325.00
|
|
Infect ag eia influenza a or b ea
|
$128.10 |
$128.10 |
$128.10 |
$69.03
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$167.90 |
$167.90 |
$167.90 |
$574.60
|
|
Infect ag ia optc obs influenza
|
$40.95 |
$40.95 |
$40.95 |
$66.72
|
|
Infect ag if hep delta agent
|
$83.79 |
$83.79 |
$83.79 |
$125.97
|
|
Infect ag if influenza b
|
$33.71 |
$33.71 |
$33.71 |
$34.67
|
|
Infect ag if legionella pneumophila
|
$44.42 |
$44.42 |
$44.42 |
$75.79
|
|
Infect ag if nos ea
|
$90.41 |
$90.41 |
$90.41 |
$60.40
|
|
Infect ag if pneumocystis carinii
|
$78.25 |
$78.25 |
$78.25 |
$62.29
|
|
Infect ag if varicella zoster
|
$34.97 |
$34.97 |
$34.97 |
$66.00
|
|
Infect ag na hep b amp
|
$73.08 |
$73.08 |
$73.08 |
$108.44
|
|
Infect ag na influenza r/amp 1st 2 types
|
$104.90 |
$104.90 |
$104.90 |
$227.96
|
|
Infect ag na orthopoxvirus amp prb each
|
$217.33 |
$217.33 |
$217.33 |
$102.00
|
|
Infect ag na resp virus 12-25 targets
|
$268.38 |
$268.38 |
$6,854.38 |
$859.44
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$125.69 |
$125.69 |
$125.69 |
$47.50
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$51.45 |
$51.45 |
$51.45 |
$81.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$33.71 |
$33.71 |
$590.68 |
$63.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$30.62 |
$30.62 |
$30.62 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$590.68 |
$590.68 |
$590.68 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$34.34 |
$34.34 |
$284.58 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$101.80 |
$101.80 |
$1,016.78 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$573.76 |
$573.76 |
$573.76 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$48.65 |
$48.65 |
$2,010.47 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$61.43 |
$61.43 |
$1,173.68 |
$97.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$45.36 |
$45.36 |
$45.36 |
$60.00
|
|
Infectious agent nucleic acid amplified probe
|
$117.94 |
$117.94 |
$117.94 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$146.27 |
$146.27 |
$612.21 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$64.84 |
$64.84 |
$64.84 |
$174.06
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$133.00 |
$133.00 |
$4,747.00 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$75.60 |
$75.60 |
$990.63 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$61.74 |
$61.74 |
$61.74 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$148.11 |
$148.11 |
$612.21 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$71.02 |
$71.02 |
$82.85 |
$103.20
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$626.07 |
$626.07 |
$626.07 |
$98.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$446.09 |
$446.09 |
$446.09 |
$112.45
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$203.81 |
$203.81 |
$203.81 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$313.74 |
$313.74 |
$4,485.51 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$163.49 |
$163.49 |
$875.25 |
$381.55
|
|
Infuse radioactive materials
|
$11,622.05 |
$11,622.05 |
$11,622.05 |
$600.89
|
|
Initiation & management bipap/cpap initial day
|
$1,476.30 |
$1,476.30 |
$1,476.30 |
$645.79
|
|
Inj allopurinol sodium 1 mg
|
$2,226.51 |
$2,226.51 |
$2,226.51 |
$5,948.29
|
|
Inj, bupivacaine liposome
|
$3,415.55 |
$3,415.55 |
$3,415.55 |
$816.31
|
|
Inj ceftolozane tazobactam
|
$877.71 |
$877.71 |
$877.71 |
$447.36
|
|
Inj cntr knee arthro incl ct/mri
|
$54.18 |
$54.18 |
$54.18 |
$464.28
|
|
Inj crotalidae im f(ab')2 eq
|
$2,759.76 |
$2,759.76 |
$2,759.76 |
$2,836.95
|
|
Inj dx for sinogram
|
$238.77 |
$238.77 |
$238.77 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$65.52 |
$65.52 |
$65.52 |
$507.10
|
|
Injection during cath supravalvular aortography
|
$961.07 |
$961.07 |
$961.07 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$835.07 |
$835.07 |
$835.07 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$151.52 |
$151.52 |
$151.52 |
$441.12
|
|
Injection for bladder x-ray
|
$263.97 |
$263.97 |
$263.97 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$288.12 |
$288.12 |
$288.12 |
$504.00
|
|
Injection for ureter x-ray
|
$39.38 |
$39.38 |
$39.38 |
$444.95
|
|
Injection for ureter x-ray
|
$54.50 |
$54.50 |
$54.50 |
$515.21
|
|
Injection, fulvestrant
|
$22,753.58 |
$22,753.58 |
$22,753.58 |
$2,756.47
|
|
Injection of sinus tract
|
$330.75 |
$330.75 |
$330.75 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$21,990.19 |
$21,990.19 |
$21,990.19 |
$2,154.07
|
|
Injection, peramivir
|
$3,146.12 |
$3,146.12 |
$3,146.12 |
$1,257.68
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,000.57 |
$2,000.57 |
$2,000.57 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$205.38 |
$205.38 |
$205.38 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$624.33 |
$624.33 |
$624.33 |
$2,251.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,127.30 |
$2,127.30 |
$2,127.30 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$168.84 |
$168.84 |
$168.84 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$375.20 |
$375.20 |
$375.20 |
$552.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$306.25 |
$306.25 |
$306.25 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$129.50 |
$129.50 |
$129.50 |
$154.05
|