|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,984.32 |
$1,984.32 |
$1,984.32 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,067.84 |
$2,067.84 |
$2,067.84 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,615.76 |
$2,615.76 |
$2,615.76 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$318.96 |
$318.96 |
$318.96 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$318.96 |
$318.96 |
$318.96 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$576.00 |
$576.00 |
$576.00 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$162.00 |
$162.00 |
$162.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$162.00 |
$162.00 |
$162.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$318.24 |
$318.24 |
$318.24 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$176.40 |
$176.40 |
$176.40 |
$135.20
|
|
Inject sacroiliac joint
|
$517.68 |
$517.68 |
$517.68 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$1,347.12 |
$1,347.12 |
$1,347.12 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,895.04 |
$1,895.04 |
$1,895.04 |
$1,415.50
|
|
Inj for mammo ductogram
|
$154.08 |
$154.08 |
$154.08 |
$433.50
|
|
Inj labetalol hcl hikma, 5mg
|
$3.24 |
$3.24 |
$3.24 |
$40.00
|
|
Inj, lidocaine w epinephrine
|
$0.13 |
$0.13 |
$0.13 |
$44.96
|
|
Inj multihance
|
$15.63 |
$15.63 |
$15.63 |
$79.42
|
|
Inj proc elbow arthro
|
$228.96 |
$228.96 |
$228.96 |
$432.00
|
|
Inj proc sialogram
|
$263.52 |
$263.52 |
$263.52 |
$373.00
|
|
Inj testosterone cypionate
|
$0.33 |
$0.33 |
$0.33 |
$62.80
|
|
Inj w/fluor eval cv device
|
$526.32 |
$526.32 |
$526.32 |
$463.40
|
|
Insertion catheter bladder non indwelling
|
$149.76 |
$149.76 |
$149.76 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$123.84 |
$123.84 |
$123.84 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,021.84 |
$3,021.84 |
$3,021.84 |
$2,511.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,491.12 |
$1,491.12 |
$1,491.12 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,340.08 |
$3,340.08 |
$3,340.08 |
$2,414.10
|
|
In situ hybridization per specimen initial single probe stain
|
$722.16 |
$722.16 |
$722.16 |
$326.04
|
|
Insulin total
|
$107.28 |
$107.28 |
$107.28 |
$66.64
|
|
Intens cardiac rehab no exer
|
$288.00 |
$288.00 |
$288.00 |
$238.40
|
|
Intens cardiac rehab w/exerc
|
$288.00 |
$288.00 |
$288.00 |
$238.40
|
|
Intrinsic factor antibody
|
$139.68 |
$139.68 |
$139.68 |
$66.60
|
|
Intro long gi tube w/mult fluo
|
$349.20 |
$349.20 |
$349.20 |
$449.40
|
|
Intubation endotracheal emergency procedure
|
$660.96 |
$660.96 |
$660.96 |
$589.60
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$2.69 |
$2.69 |
$2.69 |
$279.10
|
|
Iron
|
$91.44 |
$91.44 |
$91.44 |
$74.40
|
|
Iron binding capacity
|
$108.72 |
$108.72 |
$108.72 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$2.03 |
$2.03 |
$2.03 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$59.04 |
$59.04 |
$59.04 |
$119.83
|
|
Irrigation implantable venous access device for drug delivery systems
|
$192.24 |
$192.24 |
$192.24 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$212.40 |
$212.40 |
$212.40 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$203.04 |
$203.04 |
$203.04 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$198.72 |
$198.72 |
$198.72 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$551.52 |
$551.52 |
$551.52 |
$439.56
|
|
Ivp w/wo kub w/wo tomography
|
$505.44 |
$505.44 |
$505.44 |
$692.18
|
|
Jak2 targeted sequence analysis
|
$563.76 |
$563.76 |
$563.76 |
$379.87
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$46.80 |
$46.80 |
$46.80 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$12.96 |
$12.96 |
$12.96 |
$23.50
|
|
Kidney imaging morphology
|
$1,141.92 |
$1,141.92 |
$1,141.92 |
$785.00
|
|
Kidney imag w/bld flow multi
|
$3,733.20 |
$3,733.20 |
$3,733.20 |
$1,570.65
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$361.44 |
$361.44 |
$361.44 |
$666.00
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$187.20 |
$187.20 |
$187.20 |
$740.00
|
|
Knee MRI (with and without contrast)
|
$4,088.88 |
$4,088.88 |
$4,088.88 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$3,556.08 |
$3,556.08 |
$3,556.08 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$2,946.24 |
$2,946.24 |
$2,946.24 |
$2,169.60
|
|
Knee X-ray
|
$591.12 |
$591.12 |
$591.12 |
$425.55
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$12.96 |
$12.96 |
$12.96 |
$32.34
|
|
Lactate dehydrogenase (ldh)
|
$101.52 |
$101.52 |
$101.52 |
$55.50
|
|
Lactated ringers intravenous solution
|
$32.40 |
$32.40 |
$32.40 |
$45.56
|
|
Lactic acid
|
$157.68 |
$157.68 |
$157.68 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$120.96 |
$120.96 |
$120.96 |
$80.40
|
|
Largsc w/rmvl foreign bdy(s)
|
$818.64 |
$818.64 |
$818.64 |
$765.97
|
|
Laryngoscopy telescopic
|
$419.04 |
$419.04 |
$419.04 |
$832.00
|
|
Lead capillary
|
$86.40 |
$86.40 |
$86.40 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,998.00 |
$1,998.00 |
$1,998.00 |
$1,088.26
|
|
Lens, intraocular (new tech)
|
$2,376.00 |
$2,376.00 |
$2,376.00 |
$589.05
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$266.40 |
$266.40 |
$266.40 |
$1,050.40
|
|
Lens iol ant bicnvx 24.0 multi
|
$2,376.00 |
$2,376.00 |
$2,376.00 |
$1,065.00
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$0.27 |
$0.27 |
$0.27 |
$95.68
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$65.52 |
$65.52 |
$65.52 |
$55.60
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$2.59 |
$2.59 |
$2.59 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$0.04 |
$0.04 |
$0.04 |
$39.37
|
|
Lidocaine therapeutic drug level
|
$79.20 |
$79.20 |
$79.20 |
$89.70
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$21.84 |
$21.84 |
$21.84 |
$125.66
|
|
Lipase
|
$135.36 |
$135.36 |
$135.36 |
$93.58
|
|
Lipoprotein blood quant
|
$101.52 |
$101.52 |
$101.52 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$69.84 |
$69.84 |
$69.84 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$85.68 |
$85.68 |
$85.68 |
$61.60
|
|
Lithium therapeutic drug level
|
$92.88 |
$92.88 |
$92.88 |
$69.42
|
|
Liver Function Test
|
$288.00 |
$288.00 |
$288.00 |
$115.44
|
|
Liver/spleen imag static only
|
$1,574.64 |
$1,574.64 |
$1,574.64 |
$1,123.50
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$120.96 |
$120.96 |
$120.96 |
$37.20
|
|
Low cost skin substitute app
|
$678.24 |
$678.24 |
$678.24 |
$909.35
|
|
Low cost skin substitute app
|
$1,975.68 |
$1,975.68 |
$1,975.68 |
$2,164.64
|
|
Low cost skin substitute app
|
$678.24 |
$678.24 |
$678.24 |
$933.60
|
|
Low cost skin substitute app
|
$1,034.64 |
$1,034.64 |
$1,034.64 |
$1,016.16
|
|
Low cost skin substitute app
|
$248.40 |
$248.40 |
$248.40 |
$429.50
|
|
Low cost skin substitute app
|
$678.24 |
$678.24 |
$678.24 |
$659.75
|
|
Low cost skin substitute app
|
$248.40 |
$248.40 |
$248.40 |
$349.44
|
|
Low cost skin substitute app
|
$678.24 |
$678.24 |
$678.24 |
$515.00
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,782.80 |
$2,782.80 |
$2,782.80 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,624.40 |
$2,624.40 |
$2,624.40 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,537.28 |
$2,537.28 |
$2,537.28 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,680.72 |
$4,680.72 |
$4,680.72 |
$3,111.17
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,556.08 |
$3,556.08 |
$3,556.08 |
$2,445.30
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,208.32 |
$3,208.32 |
$3,208.32 |
$2,096.84
|
|
Lower Back (Lumbar Spine) X-ray
|
$618.48 |
$618.48 |
$618.48 |
$352.32
|
|
Lung Function Test (Spirometry)
|
$392.40 |
$392.40 |
$392.40 |
$295.35
|
|
Lung perfusion imaging
|
$2,073.60 |
$2,073.60 |
$2,073.60 |
$1,075.25
|
|
Lymphatics/lymph node imaging
|
$1,208.16 |
$1,208.16 |
$1,208.16 |
$1,448.00
|
|
Macroscopic exam parasite
|
$37.44 |
$37.44 |
$37.44 |
$36.40
|