|
In-111 autol wbc diag per dose
|
$2,072.50 |
$2,072.50 |
$2,072.50 |
$3,523.65
|
|
In-111 pentetate dtpa / 0.5 mci
|
$1,306.50 |
$1,306.50 |
$1,306.50 |
$2,598.17
|
|
In-111 pentetreotide
|
$2,028.50 |
$2,028.50 |
$2,028.50 |
$5,201.00
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$2,135.00 |
$2,135.00 |
$2,135.00 |
$2,056.93
|
|
Incision of breast lesion
|
$2,826.50 |
$2,826.50 |
$2,826.50 |
$2,560.80
|
|
Incision of burn scab initi
|
$475.50 |
$475.50 |
$475.50 |
$494.40
|
|
Incision of foot tendon 28234
|
$1,997.50 |
$1,997.50 |
$1,997.50 |
$2,116.27
|
|
Incision of tongue fold
|
$1,911.50 |
$1,911.50 |
$1,911.50 |
$1,792.50
|
|
Incision tendon sheath
|
$4,137.50 |
$4,137.50 |
$4,137.50 |
$3,073.20
|
|
Incisn of toe tndn
|
$3,884.00 |
$3,884.00 |
$3,884.00 |
$2,627.96
|
|
Induced ab 1+ vag sup w/dlv fetus
|
$1,840.00 |
$1,840.00 |
$1,840.00 |
$1,881.75
|
|
Infec agen detec ampli probe
|
$12.50 |
$12.50 |
$12.50 |
$26.00
|
|
Infect ag drug suscept pheno predict
|
$405.50 |
$405.50 |
$405.50 |
$323.20
|
|
Infect ag genotype na hiv-1 other region
|
$392.00 |
$392.00 |
$392.00 |
$386.40
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$752.50 |
$752.50 |
$752.50 |
$603.75
|
|
Infect ag ia direct hiv-1 antgn
|
$146.00 |
$146.00 |
$146.00 |
$91.70
|
|
Infect ag ia optc obs influenza
|
$204.50 |
$204.50 |
$204.50 |
$72.93
|
|
Infect ag if ea plyvlnt antsrm
|
$52.00 |
$52.00 |
$52.00 |
$62.80
|
|
Infect ag if legionella pneumophila
|
$80.50 |
$80.50 |
$80.50 |
$72.58
|
|
Infect ag na hep b amp
|
$120.50 |
$120.50 |
$120.50 |
$120.50
|
|
Infect ag na herpes simplex quant
|
$233.00 |
$233.00 |
$233.00 |
$169.65
|
|
Infect ag na hpv high-risk types
|
$53.00 |
$53.00 |
$53.00 |
$139.75
|
|
Infect ag na influenza r/amp 1st 2 types
|
$127.00 |
$127.00 |
$127.00 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$38.50 |
$38.50 |
$38.50 |
$99.36
|
|
Infect ag na resp virus 12-25 targets
|
$258.00 |
$258.00 |
$258.00 |
$835.80
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$1,501.00 |
$1,501.00 |
$1,501.00 |
$943.80
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$94.50 |
$94.50 |
$94.50 |
$75.63
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$12.00 |
$12.00 |
$12.00 |
$82.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$54.50 |
$54.50 |
$54.50 |
$72.80
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$106.00 |
$106.00 |
$106.00 |
$76.32
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$286.00 |
$286.00 |
$286.00 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$203.50 |
$203.50 |
$203.50 |
$100.02
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$161.50 |
$161.50 |
$161.50 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$83.00 |
$83.00 |
$83.00 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$104.50 |
$104.50 |
$104.50 |
$98.02
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$76.00 |
$76.00 |
$76.00 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$743.50 |
$743.50 |
$743.50 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$233.00 |
$233.00 |
$233.00 |
$139.68
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$40.00 |
$40.00 |
$40.00 |
$167.00
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$639.50 |
$639.50 |
$639.50 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$233.00 |
$233.00 |
$233.00 |
$179.92
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$158.50 |
$158.50 |
$158.50 |
$147.55
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$251.00 |
$251.00 |
$251.00 |
$217.85
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$246.50 |
$246.50 |
$246.50 |
$136.03
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$54.00 |
$54.00 |
$54.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$125.00 |
$125.00 |
$125.00 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$150.00 |
$150.00 |
$150.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$62.50 |
$62.50 |
$62.50 |
$92.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$229.00 |
$229.00 |
$229.00 |
$108.75
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$569.50 |
$569.50 |
$569.50 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$116.50 |
$116.50 |
$116.50 |
$423.53
|
|
Infectious agent nucleic acid quantification bk virus
|
$854.00 |
$854.00 |
$854.00 |
$279.40
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$476.00 |
$476.00 |
$476.00 |
$239.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$398.50 |
$398.50 |
$398.50 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$453.00 |
$453.00 |
$453.00 |
$374.00
|
|
Infuse radioactive materials
|
$931.00 |
$931.00 |
$931.00 |
$640.50
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$273.50 |
$273.50 |
$273.50 |
$293.25
|
|
Initial foot exam pt lops
|
$177.00 |
$177.00 |
$177.00 |
$155.50
|
|
Initiation & management bipap/cpap initial day
|
$406.00 |
$406.00 |
$406.00 |
$576.00
|
|
Inj bulking agent anal canal
|
$851.29 |
$851.29 |
$851.29 |
$9,525.70
|
|
Inj cntr knee arthro incl ct/mri
|
$116.00 |
$116.00 |
$116.00 |
$436.80
|
|
Inj disk cerv-thor ea lev
|
$2,270.50 |
$2,270.50 |
$2,270.50 |
$875.28
|
|
Inj dupuytren cord w/enzyme
|
$609.50 |
$609.50 |
$609.50 |
$416.00
|
|
Inj dx for sinogram
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$422.59
|
|
Inject for sacroiliac joint
|
$597.50 |
$597.50 |
$597.50 |
$1,025.77
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,515.00 |
$1,515.00 |
$1,515.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$479.00 |
$479.00 |
$479.00 |
$495.84
|
|
Injection carpal tunnel therapeutic (both sides)
|
$394.00 |
$394.00 |
$394.00 |
$450.72
|
|
Injection during cath supravalvular aortography
|
$5,291.00 |
$5,291.00 |
$5,291.00 |
$952.66
|
|
Injection epidural blood patch or clot
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$1,156.80
|
|
Injection eye drug
|
$644.50 |
$644.50 |
$644.50 |
$644.50
|
|
Injection for arthrography wrist (both sides)
|
$479.00 |
$479.00 |
$479.00 |
$428.40
|
|
Injection for bladder x-ray
|
$118.00 |
$118.00 |
$118.00 |
$459.20
|
|
Injection for hip x-ray
|
$267.00 |
$267.00 |
$267.00 |
$710.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$190.00 |
$190.00 |
$190.00 |
$494.65
|
|
Injection for spleen x-ray
|
$3,029.50 |
$3,029.50 |
$3,029.50 |
$529.57
|
|
Injection for tear sac x-ray
|
$1,254.50 |
$1,254.50 |
$1,254.50 |
$225.20
|
|
Injection for ureter x-ray
|
$2,298.00 |
$2,298.00 |
$2,298.00 |
$427.70
|
|
Injection for ureter x-ray
|
$1,694.50 |
$1,694.50 |
$1,694.50 |
$515.21
|
|
Injection into brain canal
|
$2,199.00 |
$2,199.00 |
$2,199.00 |
$836.40
|
|
Injection into hemorrhoid(s)
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$1,432.81
|
|
Injection of sinus tract
|
$1,576.50 |
$1,576.50 |
$1,576.50 |
$1,627.60
|
|
Injection radioactive tracer sentinel node (both sides)
|
$652.00 |
$652.00 |
$652.00 |
$670.64
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$999.50 |
$999.50 |
$999.50 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,073.00 |
$1,073.00 |
$1,073.00 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,511.50 |
$1,511.50 |
$1,511.50 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,189.50 |
$2,189.50 |
$2,189.50 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,994.00 |
$1,994.00 |
$1,994.00 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,571.50 |
$2,571.50 |
$2,571.50 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,567.00 |
$2,567.00 |
$2,567.00 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,973.00 |
$1,973.00 |
$1,973.00 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,532.50 |
$2,532.50 |
$2,532.50 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,636.00 |
$1,636.00 |
$1,636.00 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$460.00 |
$460.00 |
$460.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$622.00 |
$622.00 |
$622.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$489.50 |
$489.50 |
$489.50 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$113.50 |
$113.50 |
$113.50 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$104.00 |
$104.00 |
$104.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$178.00 |
$178.00 |
$178.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$67.50 |
$67.50 |
$67.50 |
$135.60
|
