|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$52.80 |
$52.80 |
$52.80 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$52.80 |
$52.80 |
$52.80 |
$98.02
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$30.40 |
$30.40 |
$30.40 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$155.20 |
$155.20 |
$155.20 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$155.20 |
$155.20 |
$155.20 |
$139.68
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$155.20 |
$155.20 |
$155.20 |
$167.00
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,195.20 |
$1,195.20 |
$1,195.20 |
$861.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$155.20 |
$155.20 |
$155.20 |
$179.92
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$155.20 |
$155.20 |
$155.20 |
$147.55
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$155.20 |
$155.20 |
$155.20 |
$217.85
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$155.20 |
$155.20 |
$155.20 |
$136.03
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$112.40 |
$112.40 |
$112.40 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$137.20 |
$137.20 |
$137.20 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$200.00 |
$200.00 |
$200.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$22.80 |
$22.80 |
$22.80 |
$92.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$161.60 |
$161.60 |
$161.60 |
$108.75
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$310.40 |
$310.40 |
$310.40 |
$211.00
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$227.60 |
$227.60 |
$227.60 |
$185.00
|
|
Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets
|
$752.80 |
$752.80 |
$752.80 |
$1,143.75
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$812.00 |
$812.00 |
$812.00 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$212.80 |
$212.80 |
$212.80 |
$286.06
|
|
Infectious agent nucleic acid quantification bk virus
|
$189.20 |
$189.20 |
$189.20 |
$279.40
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$189.20 |
$189.20 |
$189.20 |
$239.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$189.20 |
$189.20 |
$189.20 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$376.00 |
$376.00 |
$376.00 |
$374.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$100.80 |
$100.80 |
$100.80 |
$303.59
|
|
Influenza dna amp prob addl
|
$104.80 |
$104.80 |
$104.80 |
$64.26
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$400.00 |
$400.00 |
$400.00 |
$293.25
|
|
Initial custom socket insert
|
$806.00 |
$806.00 |
$806.00 |
$1,453.20
|
|
Initiation & management bipap/cpap initial day
|
$412.40 |
$412.40 |
$412.40 |
$576.00
|
|
Inj acetaminophen -fresenius
|
$3.12 |
$3.12 |
$3.12 |
$36.60
|
|
Inj, aponvie, 1 mg
|
$5.09 |
$5.09 |
$5.09 |
$3.00
|
|
Inj, bupivacaine liposome
|
$8.25 |
$8.25 |
$8.25 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$13.66 |
$13.66 |
$13.66 |
$28.08
|
|
Inj cntr knee arthro incl ct/mri
|
$233.20 |
$233.20 |
$233.20 |
$436.80
|
|
Inj dx for sinogram
|
$157.20 |
$157.20 |
$157.20 |
$422.59
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$539.60 |
$539.60 |
$539.60 |
$495.84
|
|
Injection during cath supravalvular aortography
|
$95.20 |
$95.20 |
$95.20 |
$952.66
|
|
Injection epidural blood patch or clot
|
$1,011.60 |
$1,011.60 |
$1,011.60 |
$1,156.80
|
|
Injection eye drug
|
$1,411.60 |
$1,411.60 |
$1,411.60 |
$644.50
|
|
Injection for arthrography wrist (both sides)
|
$245.60 |
$245.60 |
$245.60 |
$428.40
|
|
Injection for bladder x-ray
|
$377.60 |
$377.60 |
$377.60 |
$459.20
|
|
Injection for hip x-ray
|
$550.40 |
$550.40 |
$550.40 |
$710.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$252.40 |
$252.40 |
$252.40 |
$494.65
|
|
Injection for ureter x-ray
|
$769.20 |
$769.20 |
$769.20 |
$427.70
|
|
Injection for ureter x-ray
|
$192.00 |
$192.00 |
$192.00 |
$515.21
|
|
Injection into brain canal
|
$558.00 |
$558.00 |
$558.00 |
$836.40
|
|
Injection of sinus tract
|
$2,097.60 |
$2,097.60 |
$2,097.60 |
$1,627.60
|
|
Injection,onabotulinumtoxina
|
$13.78 |
$13.78 |
$13.78 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,365.20 |
$1,365.20 |
$1,365.20 |
$670.64
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$991.60 |
$991.60 |
$991.60 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,446.40 |
$1,446.40 |
$1,446.40 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$647.20 |
$647.20 |
$647.20 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,446.40 |
$1,446.40 |
$1,446.40 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$315.20 |
$315.20 |
$315.20 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,446.40 |
$1,446.40 |
$1,446.40 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$446.80 |
$446.80 |
$446.80 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$446.80 |
$446.80 |
$446.80 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$446.80 |
$446.80 |
$446.80 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$78.00 |
$78.00 |
$78.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$75.20 |
$75.20 |
$75.20 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$470.00 |
$470.00 |
$470.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$110.00 |
$110.00 |
$110.00 |
$135.60
|
|
Inject sacroiliac joint
|
$542.00 |
$542.00 |
$542.00 |
$1,028.95
|
|
Inj, epinephrine (belcher)
|
$6.55 |
$6.55 |
$6.55 |
$6.55
|
|
Inj for ext venography
|
$300.80 |
$300.80 |
$300.80 |
$649.95
|
|
Inj glycopyrrolate, glyrx-pf
|
$48.54 |
$48.54 |
$48.54 |
$11.23
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$92.00 |
$92.00 |
$92.00 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$144.80 |
$144.80 |
$144.80 |
$1,827.74
|
|
Inj hrt cath w/s&i sel hrt art
|
$144.80 |
$144.80 |
$144.80 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$107.60 |
$107.60 |
$107.60 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$75.20 |
$75.20 |
$75.20 |
$965.33
|
|
Inj levocarnitine per 1 gm
|
$111.20 |
$111.20 |
$111.20 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$27.44 |
$27.44 |
$27.44 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$4.87 |
$4.87 |
$4.87 |
$47.52
|
|
Inj mepivacaine hcl/10 ml
|
$48.36 |
$48.36 |
$48.36 |
$33.86
|
|
Inj, micafungin (par pharm)
|
$1.14 |
$1.14 |
$1.14 |
$89.40
|
|
Inj multihance
|
$11.29 |
$11.29 |
$11.29 |
$73.49
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,290.80 |
$1,290.80 |
$1,290.80 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,696.40 |
$2,696.40 |
$2,696.40 |
$2,609.38
|
|
Inj peritoneal venous shunt
|
$227.20 |
$227.20 |
$227.20 |
$413.70
|
|
Inj proc ankle arthr
|
$444.80 |
$444.80 |
$444.80 |
$405.31
|
|
Inj proc elbow arthro
|
$682.00 |
$682.00 |
$682.00 |
$419.60
|
|
Inj proc for lymphang
|
$682.00 |
$682.00 |
$682.00 |
$682.00
|
|
Inj proc myelogram lumbar
|
$403.60 |
$403.60 |
$403.60 |
$830.50
|
|
Inj, releuko 1 mcg
|
$12.68 |
$12.68 |
$12.68 |
$473.25
|
|
Inj retacrit esrd on dialysi
|
$5.39 |
$5.39 |
$5.39 |
$349.45
|
|
Inj retro urethrocysto
|
$244.40 |
$244.40 |
$244.40 |
$443.50
|
|
Inj scleros sol mult veins
|
$442.40 |
$442.40 |
$442.40 |
$675.00
|
|
Inj scleros sol sgl vein
|
$567.60 |
$567.60 |
$567.60 |
$558.97
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$245.20 |
$245.20 |
$245.20 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$56.24 |
$56.24 |
$56.24 |
$256.14
|
|
Inj testosterone cypionate
|
$0.72 |
$0.72 |
$0.72 |
$64.80
|
|
Inj vocal cord bulking agent
|
$1,902.80 |
$1,902.80 |
$1,902.80 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$435.60 |
$435.60 |
$435.60 |
$503.92
|
|
Ins cath ren art 1st bi
|
$5,101.20 |
$5,101.20 |
$5,101.20 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$5,101.20 |
$5,101.20 |
$5,101.20 |
$4,660.00
|