|
In situ hybridization per specimen each additional single probe stain
|
$105.90 |
$212.00 |
$1,100.90 |
|
|
In situ hybridization per specimen initial single probe stain
|
$105.90 |
$424.00 |
$1,100.90 |
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$1,609.25 |
$1,609.25 |
$1,609.25 |
|
|
Ins pq tunnld ip cath w/img
|
$5,975.80 |
$5,975.80 |
$6,400.20 |
|
|
Ins/rpl pm gen exist dual lead
|
$36,341.60 |
$36,341.60 |
$36,341.60 |
|
|
Ins/rpl pm gen exist sgl lead
|
$34,525.55 |
$34,525.55 |
$34,525.55 |
|
|
Ins/rpl pm w/tv ld atrl
|
$37,630.20 |
$37,630.20 |
$37,630.20 |
|
|
Inst fibrinolysis agent sbsq d
|
$714.65 |
$714.65 |
$714.65 |
|
|
Insti hexaminolevulinate hcl
|
$3,357.71 |
$3,357.71 |
$3,357.71 |
|
|
Instillation anticarcinogenic agent bladder
|
$364.00 |
$807.50 |
$807.50 |
|
|
Ins tun cvad 2 cath w/subq port(s)
|
$13,865.35 |
$13,865.35 |
$13,865.35 |
|
|
Ins tun cv cath wo subq prt/pm
|
$1,698.00 |
$4,521.45 |
$9,803.80 |
|
|
Insulin for insulin pump use
|
$658.77 |
$658.77 |
$658.77 |
|
|
Insulin total
|
$28.65 |
$128.15 |
$200.75 |
|
|
Interdiscal perq aspir dx
|
$1,380.60 |
$1,380.60 |
$1,652.05 |
|
|
Interrog dev eval scrms ip
|
$32.00 |
$32.00 |
$32.00 |
|
|
Interrog device eval heart
|
$137.50 |
$137.50 |
$141.75 |
|
|
Interrog evl pm/ldls pm ip
|
$40.00 |
$50.70 |
$107.45 |
|
|
Intranasal biopsy 30100
|
$228.10 |
$2,199.10 |
$4,155.40 |
|
|
Intraoral i+d tongue/floor lingual 41000
|
$211.25 |
$273.00 |
$982.55 |
|
|
Intrinsic factor antibody
|
$63.15 |
$146.15 |
$389.00 |
|
|
Intro catheter aorta
|
$3,399.05 |
$3,399.05 |
$3,399.05 |
|
|
Intro cath svc/ivc
|
$769.80 |
$769.80 |
$769.80 |
|
|
Intro long gi tube
|
$689.90 |
$689.90 |
$689.90 |
|
|
Intro long gi tube w/mult fluo
|
$443.10 |
$481.85 |
$3,743.50 |
|
|
Intubation endotracheal emergency procedure
|
$257.80 |
$466.40 |
$1,334.85 |
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$25.00 |
$217.70 |
$1,893.99 |
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$83.28 |
$165.01 |
$921.33 |
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$23,366.57 |
$26,999.12 |
$92,780.74 |
|
|
Ip/obs cnsltj new/est low 45
|
$223.50 |
$286.10 |
$473.75 |
|
|
Ip/obs cnsltj new/est mod 60
|
$284.45 |
$381.75 |
$662.70 |
|
|
Ip/obs consltj new/est hi 80
|
$422.45 |
$523.30 |
$922.05 |
|
|
Ip/obs consltj new/est sf 35
|
$173.45 |
$209.15 |
$487.25 |
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$84.59 |
$109.44 |
$696.83 |
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$7,113.26 |
$7,113.26 |
$7,113.26 |
|
|
Iron
|
$49.95 |
$71.50 |
$141.00 |
|
|
Iron binding capacity
|
$53.65 |
$97.05 |
$183.60 |
|
|
Iron dextran 50 mg/ml injection solution
|
$301.49 |
$301.49 |
$363.89 |
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$365.39 |
$575.61 |
$1,231.39 |
|
|
Irradiation of blood product each unit reference
|
$103.90 |
$119.75 |
$156.55 |
|
|
Irrigation implantable venous access device for drug delivery systems
|
$197.80 |
$202.45 |
$374.40 |
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$10,063.92 |
$10,063.92 |
$13,460.15 |
|
|
Ivc venogram s&i
|
$144.00 |
$2,859.80 |
$6,074.90 |
|
|
IV Fluids (each additional hour)
|
$122.75 |
$129.75 |
$532.50 |
|
|
IV Fluids (first hour)
|
$328.00 |
$533.10 |
$757.55 |
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$64.15 |
$153.85 |
$404.35 |
|
|
IV inj ra drug dx study
|
$214.60 |
$214.60 |
$214.60 |
|
|
IV Medicine Infusion (additional drug)
|
$129.75 |
$134.25 |
$444.80 |
|
|
IV Medicine Infusion (each additional hour)
|
$81.80 |
$129.75 |
$465.15 |
|
|
IV Medicine Infusion (first hour)
|
$328.00 |
$461.60 |
$565.60 |
|
|
IV njx tst vasc flo flap/grf
|
$555.60 |
$634.45 |
$1,158.65 |
|
|
IV Push Injection (each additional drug)
|
$81.80 |
$129.65 |
$464.20 |
|
|
IV Push Injection (first drug)
|
$120.05 |
$271.65 |
$565.60 |
|
|
Ivp w/nephrotomography
|
$1,064.90 |
$1,477.95 |
$2,395.65 |
|
|
Ivp w/wo kub w/wo tomography
|
$1,015.10 |
$1,342.75 |
$2,395.65 |
|
|
Ixabepilone 15 mg intravenous solution
|
$15,791.54 |
$15,791.54 |
$15,791.54 |
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$416.55 |
$526.45 |
$867.90 |
|
|
Jaw (Mandible) X-ray (complete)
|
$320.90 |
$645.15 |
$801.10 |
|
|
John cunningham antibody
|
$27.90 |
$43.90 |
$106.65 |
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$33.30 |
$73.70 |
$226.15 |
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$8.82 |
$49.88 |
$109.38 |
|
|
Kidney imaging morphology
|
$2,322.65 |
$2,322.65 |
$2,411.90 |
|
|
Kidney imag w/bld flow multi
|
$733.15 |
$2,389.00 |
$3,037.85 |
|
|
Kidney img w/bldflw sgl without rx
|
$1,375.00 |
$1,703.20 |
$2,532.05 |
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$683.50 |
$858.35 |
$1,165.75 |
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$595.85 |
$758.60 |
$915.30 |
|
|
Kit cast tcc 3in w/2reg boots total contact cast
|
$185.30 |
$185.30 |
$386.00 |
|
|
Kit gene analys d816 variant
|
$738.25 |
$890.40 |
$1,457.80 |
|
|
Kit lead specify 5-6-5
|
$2,300.00 |
$3,351.00 |
$3,555.00 |
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$265.00 |
$265.00 |
$315.00 |
|
|
Knee MRI (with and without contrast)
|
$2,703.85 |
$3,301.70 |
$3,955.10 |
|
|
Knee MRI (with contrast)
|
$2,197.30 |
$2,376.80 |
$3,136.80 |
|
|
Knee MRI (without contrast)
|
$1,366.70 |
$2,139.80 |
$2,554.55 |
|
|
Knee X-ray
|
$311.20 |
$514.30 |
$645.15 |
|
|
Knee X-ray (1 to 2 views, both knees)
|
$223.50 |
$332.00 |
$473.75 |
|
|
Knee X-ray (3 views, both knees)
|
$266.20 |
$472.40 |
$507.45 |
|
|
Knee X-ray (standing, both knees)
|
$253.35 |
$384.60 |
$473.75 |
|
|
Kras gene addl variants
|
$308.70 |
$365.20 |
$1,153.95 |
|
|
Kras gene variants exon 2
|
$365.20 |
$960.30 |
$1,378.60 |
|
|
Kyleena, 19.5 mg
|
$1,846.97 |
$2,900.29 |
$5,289.60 |
|
|
Lab draw <3 yrs scalp vein 36405
|
$30.80 |
$30.80 |
$30.80 |
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$45.74 |
$52.21 |
$93.42 |
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$224.18 |
$574.10 |
$967.00 |
|
|
Lactate dehydrogenase (ldh)
|
$33.75 |
$108.30 |
$191.00 |
|
|
Lactated ringers intravenous solution
|
$12.92 |
$12.92 |
$34.84 |
|
|
Lactation class
|
$33.75 |
$68.10 |
$124.20 |
|
|
Lactic acid
|
$118.65 |
$145.80 |
$444.90 |
|
|
Lactoferrin fecal qualitative
|
$113.80 |
$113.80 |
$113.80 |
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$22,832.14 |
$22,832.14 |
$29,081.87 |
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$99.70 |
$589.85 |
$1,189.15 |
|
|
Largsc w/rmvl foreign bdy(s)
|
$610.05 |
$635.25 |
$1,596.70 |
|
|
Laryngeal function studies
|
$178.15 |
$178.15 |
$178.15 |
|
|
Laryngoscopic sensory vid
|
$685.45 |
$685.45 |
$685.45 |
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$4,109.80 |
$4,109.80 |
$4,109.80 |
|
|
Laryngoscopy telescopic
|
$873.25 |
$873.25 |
$873.25 |
|
|
Laryngoscopy w/fb removal
|
$446.75 |
$446.75 |
$2,828.95 |
|
|
Laryngoscopy w/w/o tracheoscopy aspiration
|
$141.65 |
$642.50 |
$801.70 |
|
|
Lead capillary
|
$48.90 |
$55.60 |
$123.65 |
|
|
Lead ingevity 45cm pfret MRI
|
$350.00 |
$350.00 |
$400.00 |
|
|
Leg Artery Ultrasound (complete, both legs)
|
$636.75 |
$1,288.85 |
$1,453.60 |
|