|
In-111 oxyquinolin per 0.5 mci
|
$734.58 |
$734.58 |
$734.58 |
|
|
In-111 pentetate dtpa / 0.5 mci
|
$783.30 |
$783.30 |
$863.75 |
|
|
In-111 pentetreotide
|
$5,206.74 |
$5,206.74 |
$5,206.74 |
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$290.51 |
$332.25 |
$987.84 |
|
|
Infect ag drug suscept pheno predict
|
$164.64 |
$164.64 |
$164.64 |
|
|
Infect ag eia influenza a or b ea
|
$18.06 |
$27.05 |
$30.19 |
|
|
Infect ag genotype na cytomegalovirus
|
$324.66 |
$486.22 |
$547.28 |
|
|
Infect ag genotype na dna hepatitis b
|
$547.28 |
$547.28 |
$547.28 |
|
|
Infect ag genotype na hiv-1 other region
|
$162.54 |
$243.42 |
$274.00 |
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$324.66 |
$486.22 |
$547.28 |
|
|
Infect ag ia optc obs influenza
|
$21.00 |
$31.45 |
$35.40 |
|
|
Infect ag if ea plyvlnt antsrm
|
$25.20 |
$37.74 |
$42.48 |
|
|
Infect ag if hep delta agent
|
$73.50 |
$73.50 |
$73.50 |
|
|
Infect ag if influenza a
|
$25.20 |
$37.74 |
$42.48 |
|
|
Infect ag if influenza b
|
$25.20 |
$37.74 |
$42.48 |
|
|
Infect ag if pneumocystis carinii
|
$31.92 |
$47.80 |
$53.81 |
|
|
Infect ag if varicella zoster
|
$25.20 |
$37.74 |
$42.48 |
|
|
Infect ag na hep b amp
|
$56.70 |
$84.92 |
$95.58 |
|
|
Infect ag na herpes simplex quant
|
$54.18 |
$54.18 |
$54.18 |
|
|
Infect ag na hpv high-risk types
|
$44.52 |
$66.67 |
$75.05 |
|
|
Infect ag na influenza r/amp 1st 2 types
|
$120.96 |
$181.15 |
$203.90 |
|
|
Infect ag na orthopoxvirus amp prb each
|
$64.68 |
$96.87 |
$109.03 |
|
|
Infect ag na resp virus 12-25 targets
|
$525.42 |
$786.88 |
$885.71 |
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$615.72 |
$615.72 |
$615.72 |
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$38.22 |
$38.22 |
$38.22 |
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$25.20 |
$37.74 |
$42.48 |
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$26.42 |
$29.48 |
$31.08 |
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$27.72 |
$41.51 |
$46.73 |
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$31.50 |
$47.17 |
$53.10 |
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$97.02 |
$145.30 |
$163.55 |
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$24.36 |
$53.47 |
$60.18 |
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$36.54 |
$54.72 |
$61.60 |
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$65.94 |
$98.75 |
$111.16 |
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$15.12 |
$22.64 |
$25.49 |
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$26.88 |
$40.26 |
$45.31 |
|
|
Infectious agent nucleic acid amplified probe
|
$295.54 |
$312.48 |
$355.42 |
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$48.30 |
$72.33 |
$81.42 |
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$47.04 |
$70.45 |
$79.30 |
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$525.42 |
$786.88 |
$885.71 |
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$44.52 |
$66.67 |
$75.05 |
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$44.52 |
$66.67 |
$75.05 |
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$52.92 |
$79.25 |
$89.21 |
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$44.52 |
$66.67 |
$75.05 |
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$64.68 |
$96.87 |
$109.03 |
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$60.38 |
$67.39 |
$179.76 |
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$44.52 |
$66.67 |
$75.05 |
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$46.62 |
$69.82 |
$78.59 |
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$525.42 |
$786.88 |
$885.71 |
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$161.70 |
$242.16 |
$272.58 |
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$331.38 |
$496.28 |
$558.61 |
|
|
Infectious agent nucleic acid quantification bk virus
|
$115.50 |
$172.98 |
$194.70 |
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$54.18 |
$81.14 |
$91.33 |
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$61.74 |
$92.46 |
$104.08 |
|
|
Infectious agent nucleic acid quantification hiv-1
|
$107.52 |
$161.02 |
$181.25 |
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$179.76 |
$269.21 |
$303.02 |
|
|
Influenza dna amp prob addl
|
$36.96 |
$36.96 |
$36.96 |
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$172.62 |
$172.62 |
$231.15 |
|
|
Inj., benralizumab, 1 mg
|
$256.98 |
$256.98 |
$256.98 |
|
|
Inj, bortezomib, hospira
|
$10.87 |
$10.87 |
$10.87 |
|
|
Inj cntr knee arthro incl ct/mri
|
$166.05 |
$166.05 |
$182.53 |
|
|
Inj disk cerv-thor ea lev
|
$703.92 |
$703.92 |
$703.92 |
|
|
Inj dx for sinogram
|
$169.34 |
$169.34 |
$169.34 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,534.56 |
$2,534.56 |
$2,534.56 |
|
|
Injection arthrography hip without anesthesia (both sides)
|
$253.13 |
$260.25 |
$352.80 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$425.91 |
$425.91 |
$425.91 |
|
|
Injection during cath supravalvular aortography
|
$691.74 |
$691.74 |
$691.74 |
|
|
Injection epidural blood patch or clot
|
$488.46 |
$650.03 |
$714.55 |
|
|
Injection for arthrography wrist (both sides)
|
$327.38 |
$327.38 |
$327.38 |
|
|
Injection for bladder x-ray
|
$252.62 |
$270.09 |
$333.48 |
|
|
Injection for hip x-ray
|
$287.15 |
$287.15 |
$287.15 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$243.18 |
$392.18 |
$431.10 |
|
|
Injection for ureter x-ray
|
$328.44 |
$328.44 |
$328.44 |
|
|
Injection for ureter x-ray
|
$752.64 |
$752.64 |
$752.64 |
|
|
Injection jugular
|
$435.12 |
$435.12 |
$435.12 |
|
|
Injection,onabotulinumtoxina
|
$13.10 |
$13.10 |
$13.10 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$674.48 |
$674.48 |
$706.44 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$220.46 |
$284.34 |
$966.00 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$177.58 |
$653.52 |
$976.60 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,142.82 |
$2,577.15 |
$2,832.96 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$687.96 |
$1,198.96 |
$1,445.18 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,228.08 |
$2,138.08 |
$2,577.15 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$787.50 |
$1,504.72 |
$1,864.78 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,865.64 |
$2,630.88 |
$3,260.41 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,375.36 |
$1,650.60 |
$1,704.46 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$951.44 |
$1,146.83 |
$1,254.96 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$290.64 |
$400.96 |
$468.98 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$94.87 |
$108.50 |
$344.40 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$217.98 |
$387.70 |
$486.75 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$71.82 |
$98.40 |
$110.37 |
|
|
Inject sacroiliac joint
|
$1,142.40 |
$1,156.96 |
$1,433.80 |
|
|
Inj epidural sgl cerv-thor without img
|
$962.64 |
$1,125.94 |
$1,160.33 |
|
|
Inj epidural sgl lumb-sacral without img
|
$749.28 |
$867.72 |
$903.15 |
|
|
Inj for ext venography
|
$489.72 |
$489.72 |
$515.69 |
|
|
Inj for mammo ductogram
|
$241.89 |
$241.89 |
$241.89 |
|
|
Inj, fulvestrant (fresenius)
|
$25.80 |
$25.80 |
$25.80 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$576.66 |
$576.66 |
$576.66 |
|
|
Inj hrt cath w/s&i sel right vent
|
$450.66 |
$450.66 |
$450.66 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$928.57 |
$928.57 |
$928.57 |
|
|
Inj ivig privigen 500 mg
|
$17.55 |
$17.55 |
$17.55 |
|
|
Inj mepivacaine hcl/10 ml
|
$3.96 |
$3.96 |
$3.96 |
|