|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,092.00 |
$2,092.00 |
$2,092.00 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,107.20 |
$1,107.20 |
$1,107.20 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,107.20 |
$1,107.20 |
$1,107.20 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$504.00 |
$504.00 |
$504.00 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$558.40 |
$558.40 |
$558.40 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$773.60 |
$773.60 |
$773.60 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$232.80 |
$232.80 |
$232.80 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$224.00 |
$224.00 |
$224.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$262.40 |
$262.40 |
$262.40 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$160.00 |
$160.00 |
$160.00 |
$135.20
|
|
Injection treatment of nerve
|
$1,393.60 |
$1,393.60 |
$1,393.60 |
$2,054.00
|
|
Inject sacroiliac joint
|
$2,571.20 |
$2,571.20 |
$2,571.20 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$1,107.20 |
$1,107.20 |
$1,107.20 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,107.20 |
$1,107.20 |
$1,107.20 |
$1,415.50
|
|
Inj for mammo ductogram
|
$801.60 |
$801.60 |
$801.60 |
$433.50
|
|
Inj multihance
|
$18.40 |
$18.40 |
$18.40 |
$79.42
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,648.80 |
$1,648.80 |
$1,648.80 |
$2,485.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,648.80 |
$1,648.80 |
$1,648.80 |
$2,431.74
|
|
Inj proc ankle arthr
|
$582.40 |
$582.40 |
$582.40 |
$405.31
|
|
Inj proc elbow arthro
|
$729.60 |
$729.60 |
$729.60 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$2,565.60 |
$2,565.60 |
$2,565.60 |
$1,139.40
|
|
Inj proc sialogram
|
$380.00 |
$380.00 |
$380.00 |
$373.00
|
|
Inj prohance multipack
|
$9.60 |
$9.60 |
$9.60 |
$9.60
|
|
Inj retro urethrocysto
|
$380.00 |
$380.00 |
$380.00 |
$450.00
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$1,506.40 |
$1,506.40 |
$1,506.40 |
$436.80
|
|
Inj w/fluor eval cv device
|
$869.60 |
$869.60 |
$869.60 |
$463.40
|
|
Insertion catheter bladder non indwelling
|
$108.00 |
$108.00 |
$108.00 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$108.00 |
$108.00 |
$108.00 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,696.00 |
$2,696.00 |
$2,696.00 |
$2,511.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$9,350.40 |
$9,350.40 |
$9,350.40 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$9,350.40 |
$9,350.40 |
$9,350.40 |
$12,384.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,532.00 |
$2,532.00 |
$2,532.00 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,285.60 |
$2,285.60 |
$2,285.60 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$29,036.80 |
$29,036.80 |
$29,036.80 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$7,388.80 |
$7,388.80 |
$7,388.80 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$7,388.80 |
$7,388.80 |
$7,388.80 |
$7,342.20
|
|
Insert pm/icd lead dual
|
$7,388.80 |
$7,388.80 |
$7,388.80 |
$7,388.80
|
|
Ins icd gen exist sgl lead
|
$20,785.60 |
$20,785.60 |
$20,785.60 |
$23,742.75
|
|
In situ hybridization per specimen initial single probe stain
|
$676.00 |
$676.00 |
$676.00 |
$326.04
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$2,622.40 |
$2,622.40 |
$2,622.40 |
$1,609.25
|
|
Instillation anticarcinogenic agent bladder
|
$577.60 |
$577.60 |
$577.60 |
$621.40
|
|
Ins tun cv cath wo subq prt/pm
|
$990.40 |
$990.40 |
$990.40 |
$4,202.70
|
|
Insulin total
|
$163.20 |
$163.20 |
$163.20 |
$66.64
|
|
Intrinsic factor antibody
|
$276.00 |
$276.00 |
$276.00 |
$66.60
|
|
Intro catheter aorta
|
$389.60 |
$389.60 |
$389.60 |
$1,654.05
|
|
Intubation endotracheal emergency procedure
|
$679.20 |
$679.20 |
$679.20 |
$589.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$4.80 |
$4.80 |
$4.80 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$7.20 |
$7.20 |
$7.20 |
$279.10
|
|
Ip/obs cnsltj new/est low 45
|
$607.20 |
$607.20 |
$607.20 |
$174.20
|
|
Ip/obs cnsltj new/est mod 60
|
$749.60 |
$749.60 |
$749.60 |
$284.45
|
|
Ip/obs consltj new/est hi 80
|
$900.00 |
$900.00 |
$900.00 |
$332.80
|
|
Ip/obs consltj new/est sf 35
|
$457.60 |
$457.60 |
$457.60 |
$134.46
|
|
Iron
|
$140.00 |
$140.00 |
$140.00 |
$74.40
|
|
Iron binding capacity
|
$156.80 |
$156.80 |
$156.80 |
$63.79
|
|
Irradiation of blood product each unit reference
|
$114.40 |
$114.40 |
$114.40 |
$119.83
|
|
Irrigation implantable venous access device for drug delivery systems
|
$194.40 |
$194.40 |
$194.40 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$240.80 |
$240.80 |
$240.80 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$224.00 |
$224.00 |
$224.00 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$222.40 |
$222.40 |
$222.40 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$528.80 |
$528.80 |
$528.80 |
$439.56
|
|
Ivp w/wo kub w/wo tomography
|
$1,185.60 |
$1,185.60 |
$1,185.60 |
$692.18
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$91.20 |
$91.20 |
$91.20 |
$60.20
|
|
Kidney imag w/bld flow multi
|
$1,728.00 |
$1,728.00 |
$1,728.00 |
$1,570.65
|
|
Kidney img w/bldflw sgl without rx
|
$1,521.60 |
$1,521.60 |
$1,521.60 |
$1,427.40
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$666.00
|
|
Kit cast tcc 3in w/2reg boots total contact cast
|
$780.80 |
$780.80 |
$780.80 |
$104.52
|
|
Kit gene analys d816 variant
|
$1,738.40 |
$1,738.40 |
$1,738.40 |
$374.61
|
|
Knee MRI (with and without contrast)
|
$5,664.80 |
$5,664.80 |
$5,664.80 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$4,945.60 |
$4,945.60 |
$4,945.60 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$4,629.60 |
$4,629.60 |
$4,629.60 |
$2,169.60
|
|
Knee orth pos locking joint
|
$780.80 |
$780.80 |
$780.80 |
$585.60
|
|
Knee X-ray
|
$878.40 |
$878.40 |
$878.40 |
$425.55
|
|
Kras gene addl variants
|
$962.40 |
$962.40 |
$962.40 |
$384.80
|
|
Kras gene variants exon 2
|
$962.40 |
$962.40 |
$962.40 |
$486.45
|
|
Lactate dehydrogenase (ldh)
|
$128.00 |
$128.00 |
$128.00 |
$55.50
|
|
Lactic acid
|
$408.00 |
$408.00 |
$408.00 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$156.00 |
$156.00 |
$156.00 |
$80.40
|
|
Largsc w/rmvl foreign bdy(s)
|
$1,424.80 |
$1,424.80 |
$1,424.80 |
$765.97
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$1,448.80 |
$1,448.80 |
$1,448.80 |
$2,480.71
|
|
Lead capillary
|
$245.60 |
$245.60 |
$245.60 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$917.60 |
$917.60 |
$917.60 |
$1,088.26
|
|
Levetiracetam therapeutic drug level
|
$278.40 |
$278.40 |
$278.40 |
$88.92
|
|
Lidocaine therapeutic drug level
|
$136.00 |
$136.00 |
$136.00 |
$89.70
|
|
Lift heel adj small gl60404sm
|
$113.60 |
$113.60 |
$113.60 |
$148.39
|
|
Limited ankle motion ea jnt
|
$780.80 |
$780.80 |
$780.80 |
$123.05
|
|
Lipase
|
$308.80 |
$308.80 |
$308.80 |
$93.58
|
|
Lipoprotein blood high res frac & quant
|
$56.00 |
$56.00 |
$56.00 |
$90.35
|
|
Lipoprotein blood quant
|
$189.60 |
$189.60 |
$189.60 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$155.20 |
$155.20 |
$155.20 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$117.60 |
$117.60 |
$117.60 |
$61.60
|
|
Lithium therapeutic drug level
|
$111.20 |
$111.20 |
$111.20 |
$69.42
|
|
Liver ds alys 3 bmrk srm alg
|
$816.00 |
$816.00 |
$816.00 |
$340.00
|
|
Liver Function Test
|
$228.00 |
$228.00 |
$228.00 |
$115.44
|
|
Liver imag w/vasclr flow
|
$1,504.00 |
$1,504.00 |
$1,504.00 |
$1,238.65
|
|
Liver/spleen imag static only
|
$1,503.20 |
$1,503.20 |
$1,503.20 |
$1,123.50
|
|
Lo sag rig pnl stays pre cst
|
$113.60 |
$113.60 |
$113.60 |
$167.74
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,411.20 |
$2,411.20 |
$2,411.20 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,363.20 |
$2,363.20 |
$2,363.20 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,306.40 |
$2,306.40 |
$2,306.40 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,840.00 |
$4,840.00 |
$4,840.00 |
$3,111.17
|