|
Implant ureth bulk agent
|
$2,564.10 |
$2,564.10 |
$2,564.10 |
$2,168.00
|
|
Implnt spinl canal catheter 62350
|
$3,287.76 |
$3,287.76 |
$3,287.76 |
$5,095.20
|
|
In-111 autol wbc diag per dose
|
$1,935.78 |
$1,935.78 |
$1,935.78 |
$3,493.75
|
|
In-111 oxyquinolin per 0.5 mci
|
$734.58 |
$734.58 |
$734.58 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$783.30 |
$783.30 |
$783.30 |
$2,598.17
|
|
In-111 pentetreotide
|
$5,206.74 |
$5,206.74 |
$5,206.74 |
$5,294.90
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$987.84 |
$987.84 |
$987.84 |
$2,086.70
|
|
Infect ag drug suscept pheno predict
|
$164.64 |
$164.64 |
$164.64 |
$325.00
|
|
Infect ag eia influenza a or b ea
|
$18.06 |
$18.06 |
$18.06 |
$71.20
|
|
Infect ag genotype na cytomegalovirus
|
$324.66 |
$324.66 |
$324.66 |
$665.40
|
|
Infect ag genotype na hiv-1 other region
|
$162.54 |
$162.54 |
$162.54 |
$361.65
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$324.66 |
$324.66 |
$324.66 |
$603.83
|
|
Infect ag ia optc obs influenza
|
$21.00 |
$21.00 |
$21.00 |
$72.93
|
|
Infect ag if ea plyvlnt antsrm
|
$25.20 |
$25.20 |
$25.20 |
$68.40
|
|
Infect ag if hep delta agent
|
$73.50 |
$73.50 |
$73.50 |
$125.97
|
|
Infect ag if influenza a
|
$25.20 |
$25.20 |
$25.20 |
$41.30
|
|
Infect ag if influenza b
|
$25.20 |
$25.20 |
$25.20 |
$37.95
|
|
Infect ag if pneumocystis carinii
|
$31.92 |
$31.92 |
$31.92 |
$66.06
|
|
Infect ag if varicella zoster
|
$25.20 |
$25.20 |
$25.20 |
$72.00
|
|
Infect ag na hep b amp
|
$56.70 |
$56.70 |
$56.70 |
$120.50
|
|
Infect ag na herpes simplex quant
|
$54.18 |
$54.18 |
$54.18 |
$178.86
|
|
Infect ag na hpv high-risk types
|
$44.52 |
$44.52 |
$44.52 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$120.96 |
$120.96 |
$120.96 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$64.68 |
$64.68 |
$64.68 |
$100.00
|
|
Infect ag na resp virus 12-25 targets
|
$525.42 |
$525.42 |
$525.42 |
$854.70
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$615.72 |
$615.72 |
$615.72 |
$954.00
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$38.22 |
$38.22 |
$38.22 |
$75.63
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$25.20 |
$25.20 |
$25.20 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$31.08 |
$31.08 |
$31.08 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$27.72 |
$27.72 |
$27.72 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$31.50 |
$31.50 |
$31.50 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$97.02 |
$97.02 |
$97.02 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$24.36 |
$24.36 |
$24.36 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$36.54 |
$36.54 |
$36.54 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$65.94 |
$65.94 |
$65.94 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$15.12 |
$15.12 |
$15.12 |
$98.58
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$26.88 |
$26.88 |
$26.88 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$312.48 |
$312.48 |
$312.48 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$48.30 |
$48.30 |
$48.30 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$47.04 |
$47.04 |
$47.04 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$525.42 |
$525.42 |
$525.42 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$44.52 |
$44.52 |
$44.52 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$44.52 |
$44.52 |
$44.52 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$52.92 |
$52.92 |
$52.92 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$44.52 |
$44.52 |
$44.52 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$64.68 |
$64.68 |
$64.68 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$179.76 |
$179.76 |
$179.76 |
$206.00
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$44.52 |
$44.52 |
$44.52 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$46.62 |
$46.62 |
$46.62 |
$112.45
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$525.42 |
$525.42 |
$525.42 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$161.70 |
$161.70 |
$161.70 |
$289.91
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$331.38 |
$331.38 |
$331.38 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$115.50 |
$115.50 |
$115.50 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$54.18 |
$54.18 |
$54.18 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$61.74 |
$61.74 |
$61.74 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$107.52 |
$107.52 |
$107.52 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$179.76 |
$179.76 |
$179.76 |
$304.20
|
|
Influenza dna amp prob addl
|
$36.96 |
$36.96 |
$36.96 |
$64.26
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$172.62 |
$172.62 |
$172.62 |
$296.00
|
|
Inj disk cerv-thor ea lev
|
$703.92 |
$703.92 |
$703.92 |
$875.28
|
|
Injection arthrography hip without anesthesia (both sides)
|
$352.80 |
$352.80 |
$352.80 |
$503.50
|
|
Injection during cath supravalvular aortography
|
$691.74 |
$691.74 |
$691.74 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$488.46 |
$488.46 |
$488.46 |
$1,182.33
|
|
Injection for bladder x-ray
|
$333.48 |
$333.48 |
$333.48 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$243.18 |
$243.18 |
$243.18 |
$497.76
|
|
Injection for ureter x-ray
|
$328.44 |
$328.44 |
$328.44 |
$415.80
|
|
Injection for ureter x-ray
|
$752.64 |
$752.64 |
$752.64 |
$515.21
|
|
Injection jugular
|
$435.12 |
$435.12 |
$435.12 |
$790.00
|
|
Injection radioactive tracer sentinel node (both sides)
|
$706.44 |
$706.44 |
$706.44 |
$685.44
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$966.00 |
$966.00 |
$966.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$653.52 |
$653.52 |
$653.52 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,142.82 |
$1,142.82 |
$1,142.82 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$687.96 |
$687.96 |
$687.96 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,228.08 |
$1,228.08 |
$1,228.08 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$787.50 |
$787.50 |
$787.50 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,865.64 |
$1,865.64 |
$1,865.64 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,650.60 |
$1,650.60 |
$1,650.60 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,254.96 |
$1,254.96 |
$1,254.96 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$290.64 |
$290.64 |
$290.64 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$188.16 |
$188.16 |
$188.16 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$217.98 |
$217.98 |
$217.98 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$71.82 |
$71.82 |
$71.82 |
$145.60
|
|
Inject sacroiliac joint
|
$1,142.40 |
$1,142.40 |
$1,142.40 |
$1,029.04
|
|
Inj epidural sgl lumb-sacral without img
|
$867.72 |
$867.72 |
$867.72 |
$1,450.84
|
|
Inj for ext venography
|
$489.72 |
$489.72 |
$489.72 |
$628.80
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$576.66 |
$576.66 |
$576.66 |
$1,492.00
|
|
Inj hrt cath w/s&i sel right vent
|
$450.66 |
$450.66 |
$450.66 |
$999.96
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$835.38 |
$835.38 |
$835.38 |
$1,413.35
|
|
Inj proc lumbr disk ea lvl
|
$725.34 |
$725.34 |
$725.34 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$619.08 |
$619.08 |
$619.08 |
$838.30
|
|
Inj retacrit esrd on dialysi
|
$2.44 |
$2.44 |
$2.44 |
$349.45
|
|
Inj retro urethrocysto
|
$123.90 |
$123.90 |
$123.90 |
$447.74
|
|
Inj scleros sol mult veins
|
$769.44 |
$769.44 |
$769.44 |
$692.90
|
|
Inj scleros sol sgl vein
|
$386.82 |
$386.82 |
$386.82 |
$561.88
|
|
Inj w/fluor eval cv device
|
$315.84 |
$315.84 |
$315.84 |
$504.40
|
|
Ins cath ren art 1st bi
|
$4,236.54 |
$4,236.54 |
$4,236.54 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$2,529.66 |
$2,529.66 |
$2,529.66 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$6,112.68 |
$6,112.68 |
$6,112.68 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$3,513.30 |
$3,513.30 |
$3,513.30 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$191.94 |
$191.94 |
$191.94 |
$490.73
|