|
Interrog evl pm/ldls pm ip
|
$98.40 |
$98.40 |
$98.40 |
$130.00
|
|
Interstitial brachy inter
|
$1,348.20 |
$1,348.20 |
$1,348.20 |
$1,348.20
|
|
Intra-atrial pacing
|
$3,400.20 |
$3,400.20 |
$3,400.20 |
$4,614.35
|
|
Intra-atrial recording
|
$3,994.20 |
$3,994.20 |
$3,994.20 |
$5,252.30
|
|
Intracard echo interv w/s&i
|
$4,879.80 |
$4,879.80 |
$4,879.80 |
$4,328.45
|
|
Intracran angioplsty w/stent
|
$14,095.20 |
$14,095.20 |
$14,095.20 |
$9,045.05
|
|
Intracranial angioplasty
|
$9,654.60 |
$9,654.60 |
$9,654.60 |
$7,578.00
|
|
Intracranial complete study
|
$1,014.60 |
$1,014.60 |
$1,014.60 |
$903.50
|
|
Intracranial limited study
|
$608.40 |
$608.40 |
$608.40 |
$398.34
|
|
Intrapul surf admin endo tube
|
$112.80 |
$112.80 |
$112.80 |
$220.80
|
|
Intraventricular pacing
|
$4,806.60 |
$4,806.60 |
$4,806.60 |
$5,625.00
|
|
Intrinsic factor antibody
|
$183.60 |
$183.60 |
$183.60 |
$76.77
|
|
Intro cath dialysis circuit
|
$11,572.80 |
$11,572.80 |
$11,572.80 |
$2,161.90
|
|
Intro cath dialysis circuit w/pta
|
$23,532.00 |
$23,532.00 |
$23,532.00 |
$8,761.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$40,361.40 |
$40,361.40 |
$40,361.40 |
$18,260.50
|
|
Intro catheter aorta
|
$1,770.00 |
$1,770.00 |
$1,770.00 |
$1,963.80
|
|
Intro cath svc/ivc
|
$4,279.80 |
$4,279.80 |
$4,279.80 |
$1,942.50
|
|
Intro long gi tube
|
$697.80 |
$697.80 |
$697.80 |
$880.75
|
|
Intro long gi tube w/mult fluo
|
$258.00 |
$258.00 |
$258.00 |
$469.00
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$3,719.40 |
$3,719.40 |
$3,719.40 |
$3,510.75
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$3,719.40 |
$3,719.40 |
$3,719.40 |
$1,633.03
|
|
Intubation endotracheal emergency procedure
|
$1,146.60 |
$1,146.60 |
$1,146.60 |
$565.00
|
|
Iodine i-123 sod iodide mil
|
$553.80 |
$553.80 |
$553.80 |
$650.00
|
|
Ionm in operatng room 15 min
|
$451.20 |
$451.20 |
$451.20 |
$238.00
|
|
Ionm remote/>1 pt or per hr
|
$300.60 |
$300.60 |
$300.60 |
$622.70
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$66.50 |
$66.50 |
$66.50 |
$4.59
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$41.22 |
$41.22 |
$145.52 |
$145.52
|
|
Io rad tx deliver by elctrns
|
$11,796.00 |
$11,796.00 |
$11,796.00 |
$9,332.31
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$261.10 |
$261.10 |
$261.10 |
$261.10
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$181.38 |
$181.38 |
$188.06 |
$254.59
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$111.98 |
$111.98 |
$111.98 |
$111.98
|
|
Iron
|
$136.80 |
$136.80 |
$136.80 |
$67.50
|
|
Iron binding capacity
|
$63.60 |
$63.60 |
$63.60 |
$55.00
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$122.33 |
$122.33 |
$660.70 |
$211.09
|
|
Irradiation of blood product each unit reference
|
$286.80 |
$286.80 |
$286.80 |
$127.49
|
|
Irrigation implantable venous access device for drug delivery systems
|
$302.40 |
$302.40 |
$302.40 |
$149.00
|
|
Ivc venogram s&i
|
$1,770.00 |
$1,770.00 |
$1,770.00 |
$2,975.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$221.40 |
$221.40 |
$221.40 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$221.40 |
$221.40 |
$221.40 |
$170.94
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$129.00 |
$129.00 |
$129.00 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$517.20 |
$517.20 |
$517.20 |
$476.50
|
|
IV inj ra drug dx study
|
$231.60 |
$231.60 |
$231.60 |
$473.22
|
|
Ivp w/wo kub w/wo tomography
|
$540.00 |
$540.00 |
$540.00 |
$687.80
|
|
Ixabepilone 15 mg intravenous solution
|
$197.51 |
$197.51 |
$197.51 |
$189.96
|
|
Jak2 targeted sequence analysis
|
$333.60 |
$333.60 |
$333.60 |
$465.74
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$217.80 |
$217.80 |
$217.80 |
$52.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$39.01 |
$39.01 |
$165.89 |
$17.11
|
|
Kidney imag w/bld flow multi
|
$2,606.40 |
$2,606.40 |
$2,606.40 |
$1,319.61
|
|
Kidney img w/bldflw sgl without rx
|
$2,014.20 |
$2,014.20 |
$2,014.20 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$319.20 |
$319.20 |
$319.20 |
$618.54
|
|
Kit gene analys d816 variant
|
$622.80 |
$622.80 |
$622.80 |
$276.38
|
|
Kit sound processor cochlear osia 2
|
$26,452.80 |
$26,452.80 |
$26,452.80 |
$22,008.58
|
|
Knee MRI (with and without contrast)
|
$1,165.20 |
$1,165.20 |
$1,165.20 |
$2,703.85
|
|
Knee MRI (with contrast)
|
$1,165.20 |
$1,165.20 |
$1,165.20 |
$2,315.95
|
|
Knee MRI (without contrast)
|
$1,165.20 |
$1,165.20 |
$1,165.20 |
$2,120.00
|
|
Knee X-ray
|
$523.20 |
$523.20 |
$523.20 |
$387.20
|
|
Kras gene addl variants
|
$415.80 |
$415.80 |
$415.80 |
$366.56
|
|
Kras gene variants exon 2
|
$411.60 |
$411.60 |
$411.60 |
$495.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$44.90 |
$44.90 |
$50.65 |
$13.00
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$130.51 |
$130.51 |
$196.60 |
$171.00
|
|
Lactate dehydrogenase (ldh)
|
$101.40 |
$101.40 |
$101.40 |
$50.55
|
|
Lactated ringers intravenous solution
|
$78.68 |
$78.68 |
$78.68 |
$46.35
|
|
Lactic acid
|
$217.20 |
$217.20 |
$217.20 |
$85.20
|
|
Lactoferrin fecal qualitative
|
$214.20 |
$214.20 |
$214.20 |
$88.40
|
|
Lactoferrin fecal quant
|
$228.00 |
$228.00 |
$228.00 |
$106.10
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$14,343.00 |
$14,343.00 |
$14,343.00 |
$21,470.76
|
|
Laryngeal function studies
|
$342.60 |
$342.60 |
$342.60 |
$335.40
|
|
Laryngoscopy telescopic
|
$2,383.20 |
$2,383.20 |
$2,383.20 |
$685.43
|
|
Lead capillary
|
$198.60 |
$198.60 |
$198.60 |
$66.32
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,751.40 |
$1,751.40 |
$1,751.40 |
$1,053.00
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$609.00 |
$609.00 |
$609.00 |
$609.00
|
|
Lens iol ant bicnvx 24.0 multi
|
$612.60 |
$612.60 |
$612.60 |
$1,136.25
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$43.18 |
$43.18 |
$164.09 |
$115.27
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$9,320.28 |
$9,320.28 |
$9,320.28 |
$5,001.00
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$7,821.38 |
$7,821.38 |
$7,821.38 |
$4,308.91
|
|
Levalbuterol non-comp unit
|
$20.15 |
$20.15 |
$20.15 |
$20.15
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$40.91 |
$40.91 |
$124.96 |
$45.50
|
|
Levetiracetam therapeutic drug level
|
$346.80 |
$346.80 |
$346.80 |
$99.45
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$64.88 |
$64.88 |
$64.88 |
$43.61
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$665.44 |
$665.44 |
$665.44 |
$343.13
|
|
L hrt cath chd nm/abn nt cnj
|
$6,415.80 |
$6,415.80 |
$6,415.80 |
$6,242.85
|
|
Lidocaine therapeutic drug level
|
$204.00 |
$204.00 |
$204.00 |
$82.50
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$130.49 |
$130.49 |
$206.92 |
$84.28
|
|
Lipase
|
$174.60 |
$174.60 |
$174.60 |
$67.68
|
|
Lipoprotein blood high res frac & quant
|
$119.40 |
$119.40 |
$119.40 |
$90.60
|
|
Lipoprotein blood quant
|
$303.60 |
$303.60 |
$303.60 |
$106.43
|
|
Lipoprotein direct measurement hdl
|
$195.00 |
$195.00 |
$195.00 |
$54.60
|
|
Lipoprotein direct measurement ldl
|
$170.40 |
$170.40 |
$170.40 |
$61.60
|
|
Lithium therapeutic drug level
|
$189.60 |
$189.60 |
$189.60 |
$62.40
|
|
Lithotripsy transluminal coronary percutaneous
|
$11,460.60 |
$11,460.60 |
$11,460.60 |
$3,650.25
|
|
Liver Function Test
|
$241.20 |
$241.20 |
$241.20 |
$92.85
|
|
Liver imaging
|
$1,031.40 |
$1,031.40 |
$1,031.40 |
$827.28
|
|
Liver/spleen imag static only
|
$1,635.00 |
$1,635.00 |
$1,635.00 |
$1,135.20
|
|
Locm 100-199mg/ml iodine,1ml
|
$2.57 |
$2.57 |
$2.57 |
$2.57
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$75.74 |
$75.74 |
$261.04 |
$37.37
|
|
Low cost skin substitute app
|
$1,380.00 |
$1,380.00 |
$1,380.00 |
$879.60
|
|
Low cost skin substitute app
|
$6,739.20 |
$6,739.20 |
$6,739.20 |
$2,147.57
|
|
Low cost skin substitute app
|
$1,380.00 |
$1,380.00 |
$1,380.00 |
$879.60
|
|
Low cost skin substitute app
|
$4,450.20 |
$4,450.20 |
$4,450.20 |
$1,214.40
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$542.40 |
$542.40 |
$542.40 |
$1,731.00
|
