|
Homovanillic acid (hva)
|
$393.25 |
$393.25 |
$393.25 |
$56.00
|
|
Hpv types 16 & 18 only
|
$127.05 |
$127.05 |
$127.05 |
$93.60
|
|
H pylori (c-13) breath
|
$127.05 |
$127.05 |
$127.05 |
$219.05
|
|
Human epididymis protein 4 (he4)
|
$239.25 |
$239.25 |
$239.25 |
$131.84
|
|
Hydration IV infusion each additional hour
|
$158.40 |
$158.40 |
$158.40 |
$134.53
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$201.30 |
$201.30 |
$201.30 |
$394.40
|
|
Hysterosalpingography s&i
|
$380.05 |
$380.05 |
$380.05 |
$629.46
|
|
I-123 sod iodide diag per 100 uci
|
$147.46 |
$147.46 |
$147.46 |
$158.05
|
|
I131 iodide cap, rx
|
$333.19 |
$333.19 |
$333.19 |
$91.83
|
|
Icd cobalt xt dr MRI is1 df1
|
$8,336.62 |
$8,336.62 |
$8,336.62 |
$35,816.55
|
|
Icd crtd cobalt hf MRI is1 df1
|
$12,103.02 |
$12,103.02 |
$12,103.02 |
$32,098.95
|
|
Icd crtp serena MRI
|
$4,463.94 |
$4,463.94 |
$4,463.94 |
$12,663.00
|
|
Icut allergy test drug/bug
|
$10.45 |
$10.45 |
$10.45 |
$69.95
|
|
Igh gene rearrange amp meth
|
$437.80 |
$437.80 |
$437.80 |
$464.25
|
|
Igk rearrangeabn clonal pop
|
$489.50 |
$489.50 |
$489.50 |
$373.16
|
|
Ihc/icc per specimen each additional single antibody stain
|
$184.40 |
$184.40 |
$184.40 |
$191.75
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$63.80 |
$63.80 |
$63.80 |
$339.73
|
|
Ihc/icc per specimen initial single antibody stain
|
$382.25 |
$382.25 |
$382.25 |
$266.76
|
|
Iliac/fem angio cath insert
|
$2,136.20 |
$2,136.20 |
$2,136.20 |
$1,601.66
|
|
Iliac revasc add-on 37222
|
$4,214.10 |
$4,214.10 |
$4,214.10 |
$6,513.10
|
|
Immune complex assay
|
$204.60 |
$204.60 |
$204.60 |
$88.80
|
|
Immunoassay tumor antigen quantitative ca 125
|
$150.70 |
$150.70 |
$150.70 |
$123.50
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$118.80 |
$118.80 |
$118.80 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$138.60 |
$138.60 |
$138.60 |
$53.95
|
|
Immunofixation electrophoresis serum
|
$215.60 |
$215.60 |
$215.60 |
$133.38
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$422.95 |
$422.95 |
$422.95 |
$156.00
|
|
Immunofluorescence per specimen initial single antibody stain
|
$248.60 |
$248.60 |
$248.60 |
$250.00
|
|
Immunoglobulin assay
|
$101.20 |
$101.20 |
$101.20 |
$74.00
|
|
Implant cartilage 10mm synthetic
|
$766.90 |
$766.90 |
$766.90 |
$9,261.00
|
|
Implant neuroelectrodes
|
$9,997.35 |
$9,997.35 |
$9,997.35 |
$7,266.73
|
|
In-111 autol wbc diag per dose
|
$6,106.95 |
$6,106.95 |
$6,106.95 |
$3,704.00
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$2,085.60 |
$2,085.60 |
$2,085.60 |
$2,261.20
|
|
Incision of breast lesion
|
$1,403.05 |
$1,403.05 |
$1,403.05 |
$3,029.60
|
|
Infect ag drug suscept pheno predict
|
$404.25 |
$404.25 |
$404.25 |
$325.00
|
|
Infect ag eia influenza a or b ea
|
$72.60 |
$72.60 |
$72.60 |
$69.03
|
|
Infect ag genotype na cytomegalovirus
|
$806.85 |
$806.85 |
$806.85 |
$603.41
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$866.25 |
$866.25 |
$866.25 |
$574.60
|
|
Infect ag if legionella pneumophila
|
$69.30 |
$69.30 |
$69.30 |
$75.79
|
|
Infect ag if pneumocystis carinii
|
$84.15 |
$84.15 |
$84.15 |
$62.29
|
|
Infect ag if varicella zoster
|
$83.60 |
$83.60 |
$83.60 |
$66.00
|
|
Infect ag na hpv high-risk types
|
$276.10 |
$276.10 |
$276.10 |
$139.75
|
|
Infect ag na influenza r/amp 1st 2 types
|
$156.20 |
$156.20 |
$156.20 |
$227.96
|
|
Infect ag na orthopoxvirus amp prb each
|
$160.60 |
$160.60 |
$160.60 |
$102.00
|
|
Infect ag na resp virus 12-25 targets
|
$773.30 |
$773.30 |
$773.30 |
$859.44
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$1,405.80 |
$1,405.80 |
$1,405.80 |
$714.67
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$78.10 |
$78.10 |
$78.10 |
$77.00
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$76.45 |
$76.45 |
$76.45 |
$81.44
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$76.45 |
$76.45 |
$76.45 |
$63.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$76.45 |
$76.45 |
$76.45 |
$80.05
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$76.45 |
$76.45 |
$76.45 |
$77.28
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$40.15 |
$40.15 |
$40.15 |
$83.50
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$76.45 |
$76.45 |
$76.45 |
$77.72
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$118.80 |
$118.80 |
$118.80 |
$55.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$81.95 |
$81.95 |
$81.95 |
$101.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$156.20 |
$156.20 |
$156.20 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$72.60 |
$72.60 |
$72.60 |
$97.50
|
|
Infectious agent nucleic acid amplified probe
|
$487.85 |
$487.85 |
$487.85 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$185.35 |
$185.35 |
$185.35 |
$141.48
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$156.20 |
$156.20 |
$156.20 |
$174.06
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$572.00 |
$572.00 |
$572.00 |
$855.45
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$261.80 |
$261.80 |
$261.80 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$185.35 |
$185.35 |
$185.35 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$185.35 |
$185.35 |
$185.35 |
$210.00
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$179.85 |
$179.85 |
$179.85 |
$136.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$130.35 |
$130.35 |
$130.35 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$229.35 |
$229.35 |
$229.35 |
$222.60
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$264.00 |
$264.00 |
$264.00 |
$248.15
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$78.10 |
$78.10 |
$78.10 |
$112.45
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$200.20 |
$200.20 |
$200.20 |
$200.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$1,506.18 |
$1,506.18 |
$1,506.18 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$392.70 |
$392.70 |
$392.70 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$459.80 |
$459.80 |
$459.80 |
$489.50
|
|
Infectious agent nucleic acid quantification bk virus
|
$553.30 |
$553.30 |
$553.30 |
$285.66
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$237.05 |
$237.05 |
$237.05 |
$226.35
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$167.20 |
$167.20 |
$167.20 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$475.75 |
$475.75 |
$475.75 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$354.20 |
$354.20 |
$354.20 |
$298.35
|
|
Influenza dna amp prob addl
|
$62.15 |
$62.15 |
$62.15 |
$69.60
|
|
Initiation & management bipap/cpap initial day
|
$381.70 |
$381.70 |
$381.70 |
$645.79
|
|
Inj cntr knee arthro incl ct/mri
|
$303.05 |
$303.05 |
$303.05 |
$464.28
|
|
Inj dx for sinogram
|
$235.40 |
$235.40 |
$235.40 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$930.60 |
$930.60 |
$930.60 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$507.10 |
$507.10 |
$507.10 |
$507.10
|
|
Injection during cath supravalvular aortography
|
$8,831.35 |
$8,831.35 |
$8,831.35 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$960.30 |
$960.30 |
$960.30 |
$1,473.12
|
|
Injection eye drug
|
$350.35 |
$350.35 |
$350.35 |
$648.90
|
|
Injection for arthrography wrist (both sides)
|
$413.60 |
$413.60 |
$413.60 |
$441.12
|
|
Injection for bladder x-ray
|
$820.60 |
$820.60 |
$820.60 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$331.65 |
$331.65 |
$331.65 |
$504.00
|
|
Injection for ureter x-ray
|
$410.85 |
$410.85 |
$410.85 |
$444.95
|
|
Injection for ureter x-ray
|
$535.70 |
$535.70 |
$535.70 |
$515.21
|
|
Injection radioactive tracer sentinel node (both sides)
|
$316.80 |
$316.80 |
$316.80 |
$717.20
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,773.20 |
$1,773.20 |
$1,773.20 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,141.25 |
$1,141.25 |
$1,141.25 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,906.20 |
$2,906.20 |
$2,906.20 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$680.35 |
$680.35 |
$680.35 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,019.15 |
$1,019.15 |
$1,019.15 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,220.45 |
$1,220.45 |
$1,220.45 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,298.45 |
$2,298.45 |
$2,298.45 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$989.45 |
$989.45 |
$989.45 |
$1,829.28
|
