|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,792.00 |
$1,792.00 |
$1,792.00 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,683.20 |
$1,683.20 |
$1,683.20 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,732.80 |
$1,732.80 |
$1,732.80 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$668.80 |
$668.80 |
$668.80 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$628.80 |
$628.80 |
$628.80 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$114.40 |
$114.40 |
$114.40 |
$145.60
|
|
Inject sacroiliac joint
|
$1,116.80 |
$1,116.80 |
$1,116.80 |
$1,029.04
|
|
Inj epidural sgl cerv-thor without img
|
$1,161.60 |
$1,161.60 |
$1,161.60 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,109.60 |
$1,109.60 |
$1,109.60 |
$1,450.84
|
|
Inj. fe derisomaltose 10 mg
|
$3,859.35 |
$3,859.35 |
$3,859.35 |
$3,221.52
|
|
Inj heparin, pfizer, 1000u
|
$35.43 |
$35.43 |
$35.43 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$5,334.44 |
$5,334.44 |
$5,334.44 |
$8,193.78
|
|
Inj ivig privigen 500 mg
|
$4,863.63 |
$4,863.63 |
$4,863.63 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$9,913.66 |
$9,913.66 |
$9,913.66 |
$11,648.70
|
|
Inj, lidocaine w epinephrine
|
$36.40 |
$36.40 |
$36.40 |
$45.60
|
|
Inj melpha hydroch nos 50 mg
|
$2,635.40 |
$2,635.40 |
$2,635.40 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$40.71 |
$40.71 |
$40.71 |
$34.34
|
|
Inj, moxifloxacin 100 mg
|
$119.60 |
$119.60 |
$119.60 |
$101.31
|
|
Inj. mycophenolate mofetil
|
$195.01 |
$195.01 |
$195.01 |
$252.66
|
|
Inj octafluoropropane mic,ml
|
$367.01 |
$367.01 |
$367.01 |
$211.40
|
|
Inj ogivri 10 mg
|
$1,475.30 |
$1,475.30 |
$1,475.30 |
$4,492.28
|
|
Inj ontruzant 10 mg
|
$3,877.70 |
$3,877.70 |
$3,877.70 |
$6,706.27
|
|
Inj pantoprazole(hikma) 40mg
|
$37.00 |
$37.00 |
$37.00 |
$34.67
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$3,810.15 |
$3,810.15 |
$3,810.15 |
$6,614.40
|
|
Inj. pemetrexed, 10 mg
|
$4,238.42 |
$4,238.42 |
$4,238.42 |
$104.72
|
|
Inj pemetrexed, hospira 10mg
|
$467.62 |
$467.62 |
$467.62 |
$64.35
|
|
Inj proc elbow arthro
|
$491.20 |
$491.20 |
$491.20 |
$432.00
|
|
Inj, releuko 1 mcg
|
$191.96 |
$191.96 |
$191.96 |
$475.36
|
|
Inj retro urethrocysto
|
$744.80 |
$744.80 |
$744.80 |
$447.74
|
|
Inj testosterone cypionate
|
$39.76 |
$39.76 |
$39.76 |
$64.96
|
|
Inj, tyenne, 1 mg
|
$2,016.58 |
$2,016.58 |
$2,016.58 |
$3,525.12
|
|
Inj w/fluor eval cv device
|
$708.80 |
$708.80 |
$708.80 |
$504.40
|
|
Ins cerv dilator (sep proc)
|
$892.00 |
$892.00 |
$892.00 |
$490.73
|
|
Insert cath pleura without image
|
$1,979.20 |
$1,979.20 |
$1,979.20 |
$2,099.70
|
|
Insertion catheter bladder non indwelling
|
$204.00 |
$204.00 |
$204.00 |
$208.01
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,964.80 |
$1,964.80 |
$1,964.80 |
$2,585.25
|
|
Insertion of cannula(s)
|
$1,684.00 |
$1,684.00 |
$1,684.00 |
$1,989.39
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,471.20 |
$2,471.20 |
$2,471.20 |
$2,103.75
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$8,560.00 |
$8,560.00 |
$8,560.00 |
$7,183.68
|
|
Insitu hybridization manual
|
$493.60 |
$493.60 |
$493.60 |
$401.28
|
|
In situ hybridization per specimen each additional single probe stain
|
$251.20 |
$251.20 |
$251.20 |
$243.50
|
|
In situ hybridization per specimen initial single probe stain
|
$979.20 |
$979.20 |
$979.20 |
$338.40
|
|
Instillation anticarcinogenic agent bladder
|
$399.20 |
$399.20 |
$399.20 |
$638.40
|
|
Instill, bupivac and meloxic
|
$946.51 |
$946.51 |
$946.51 |
$687.60
|
|
Ins tun cv cath wo subq prt/pm
|
$3,978.40 |
$3,978.40 |
$3,978.40 |
$4,218.00
|
|
Insulin total
|
$123.20 |
$123.20 |
$123.20 |
$66.64
|
|
Intrinsic factor antibody
|
$56.80 |
$56.80 |
$56.80 |
$65.00
|
|
Intro long gi tube
|
$1,128.00 |
$1,128.00 |
$1,128.00 |
$974.17
|
|
Intro long gi tube w/mult fluo
|
$678.40 |
$678.40 |
$678.40 |
$469.00
|
|
Intubation endotracheal emergency procedure
|
$592.80 |
$592.80 |
$592.80 |
$601.28
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$105.00 |
$105.00 |
$105.00 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$35,986.88 |
$35,986.88 |
$35,986.88 |
$62,692.46
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$338.66 |
$338.66 |
$338.66 |
$173.98
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$965.44 |
$965.44 |
$965.44 |
$5,517.12
|
|
Iron
|
$92.80 |
$92.80 |
$92.80 |
$75.00
|
|
Iron binding capacity
|
$42.40 |
$42.40 |
$42.40 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$72.64 |
$72.64 |
$72.64 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$41.25 |
$41.25 |
$41.25 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$164.00 |
$164.00 |
$164.00 |
$115.20
|
|
Irrigation implantable venous access device for drug delivery systems
|
$180.80 |
$180.80 |
$180.80 |
$146.11
|
|
IV Fluids (each additional hour)
|
$132.80 |
$132.80 |
$132.80 |
$133.90
|
|
IV Fluids (first hour)
|
$342.40 |
$342.40 |
$342.40 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$107.20 |
$107.20 |
$107.20 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$238.40 |
$238.40 |
$238.40 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$182.40 |
$182.40 |
$182.40 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$497.60 |
$497.60 |
$497.60 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$120.00 |
$120.00 |
$120.00 |
$167.50
|
|
IV Push Injection (first drug)
|
$261.60 |
$261.60 |
$261.60 |
$252.76
|
|
Ivp w/wo kub w/wo tomography
|
$929.60 |
$929.60 |
$929.60 |
$713.40
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$442.40 |
$442.40 |
$442.40 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$328.80 |
$328.80 |
$328.80 |
$362.05
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$31.20 |
$31.20 |
$31.20 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$38.74 |
$38.74 |
$38.74 |
$23.52
|
|
Kidney img w/bldflw sgl without rx
|
$1,880.00 |
$1,880.00 |
$1,880.00 |
$1,433.22
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$776.80 |
$776.80 |
$776.80 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$629.60 |
$629.60 |
$629.60 |
$490.75
|
|
Kit gene analys d816 variant
|
$526.40 |
$526.40 |
$526.40 |
$374.61
|
|
Kit lead specify 5-6-5
|
$2,800.00 |
$2,800.00 |
$2,800.00 |
$16,672.10
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$1,028.80 |
$1,028.80 |
$1,028.80 |
$1,635.87
|
|
Knee MRI (with and without contrast)
|
$3,605.60 |
$3,605.60 |
$3,605.60 |
$3,022.20
|
|
Knee MRI (with contrast)
|
$3,146.40 |
$3,146.40 |
$3,146.40 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$2,560.00 |
$2,560.00 |
$2,560.00 |
$2,130.88
|
|
Knee X-ray
|
$487.20 |
$487.20 |
$487.20 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$323.20 |
$323.20 |
$323.20 |
$290.40
|
|
Knee X-ray (3 views, both knees)
|
$391.20 |
$391.20 |
$391.20 |
$363.60
|
|
Knee X-ray (standing, both knees)
|
$220.00 |
$220.00 |
$220.00 |
$251.20
|
|
Kyleena, 19.5 mg
|
$1,201.60 |
$1,201.60 |
$1,201.60 |
$2,125.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$39.72 |
$39.72 |
$39.72 |
$33.60
|
|
Lactate dehydrogenase (ldh)
|
$59.20 |
$59.20 |
$59.20 |
$55.50
|
|
Lactic acid
|
$84.80 |
$84.80 |
$84.80 |
$107.10
|
|
Lactoferrin fecal qualitative
|
$98.40 |
$98.40 |
$98.40 |
$82.16
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$12,988.06 |
$12,988.06 |
$12,988.06 |
$19,124.00
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$600.80 |
$600.80 |
$600.80 |
$740.40
|
|
Lead capillary
|
$78.40 |
$78.40 |
$78.40 |
$57.50
|
|
Leg Artery Ultrasound (complete, both legs)
|
$1,032.80 |
$1,032.80 |
$1,032.80 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$2,092.00 |
$2,092.00 |
$2,092.00 |
$1,585.20
|
|
Leg CT Scan (without contrast, both legs)
|
$1,724.80 |
$1,724.80 |
$1,724.80 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$912.00 |
$912.00 |
$912.00 |
$1,092.58
|
|
Lens iol ant bicnvx 24.0 multi
|
$264.00 |
$264.00 |
$264.00 |
$1,065.00
|
|
Lens iol ant chamb 10.5
|
$240.00 |
$240.00 |
$240.00 |
$377.71
|