|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$291.72 |
$291.72 |
$530.40 |
$7,216.00
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$3,601.62 |
$3,601.62 |
$6,548.40 |
$7,429.39
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$3,601.62 |
$3,601.62 |
$6,548.40 |
$9,390.55
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,354.10 |
$1,354.10 |
$2,462.00 |
$5,236.80
|
|
Insert pm/icd lead dual
|
$2,832.28 |
$2,832.28 |
$5,149.60 |
$7,264.40
|
|
Insert swan-ganz cath
|
$702.24 |
$702.24 |
$1,276.80 |
$2,337.00
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$793.10 |
$793.10 |
$1,442.00 |
$5,018.25
|
|
Insert vad art access left hrt arterial access
|
$810.70 |
$810.70 |
$1,474.00 |
$4,386.00
|
|
In situ hybridization per specimen each additional single probe stain
|
$30.36 |
$30.36 |
$55.20 |
$241.80
|
|
In situ hybridization per specimen initial single probe stain
|
$58.74 |
$58.74 |
$106.80 |
$337.20
|
|
Ins picad w subq port 5yr>
|
$1,354.10 |
$1,354.10 |
$2,462.00 |
$3,957.62
|
|
Ins pq tunnld ip cath w/img
|
$2,883.98 |
$2,883.98 |
$5,243.60 |
$5,377.00
|
|
Ins/rpl ldless pm right vent w img & eval
|
$7,631.14 |
$7,631.14 |
$13,874.80 |
$24,135.54
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$16,084.64 |
$16,084.64 |
$29,244.80 |
$25,106.90
|
|
Instillation anticarcinogenic agent bladder
|
$483.12 |
$483.12 |
$878.40 |
$653.25
|
|
Ins tun cv cath wo subq prt/pm
|
$1,354.10 |
$1,354.10 |
$2,462.00 |
$4,202.70
|
|
Ins tun intraperit dia cath
|
$842.60 |
$842.60 |
$1,532.00 |
$4,652.70
|
|
Insulin total
|
$17.38 |
$17.38 |
$31.60 |
$66.64
|
|
Intra-atrial pacing
|
$266.42 |
$266.42 |
$484.40 |
$4,865.25
|
|
Intrinsic factor antibody
|
$12.54 |
$12.54 |
$22.80 |
$64.20
|
|
Intro cath dialysis circuit
|
$447.26 |
$447.26 |
$813.20 |
$2,036.94
|
|
Intro cath dialysis circuit w/pta
|
$2,490.84 |
$2,490.84 |
$4,528.80 |
$8,690.50
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$5,034.48 |
$5,034.48 |
$9,153.60 |
$15,620.00
|
|
Intro catheter aorta
|
$801.46 |
$801.46 |
$1,457.20 |
$1,678.05
|
|
Intro cath svc/ivc
|
$801.46 |
$801.46 |
$1,457.20 |
$1,329.90
|
|
Intro long gi tube w/mult fluo
|
$98.12 |
$98.12 |
$178.40 |
$465.50
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$801.46 |
$801.46 |
$1,457.20 |
$3,471.05
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$386.76 |
$386.76 |
$703.20 |
$1,801.10
|
|
Intubation endotracheal emergency procedure
|
$116.60 |
$116.60 |
$212.00 |
$598.80
|
|
Iodine i-123 sod iodide mil
|
$308.65 |
$308.65 |
$561.18 |
$370.50
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$61.87 |
$61.87 |
$112.50 |
$170.06
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$230.42 |
$230.42 |
$418.95 |
$279.10
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$140.42 |
$140.42 |
$255.30 |
$173.40
|
|
Iron
|
$5.94 |
$5.94 |
$10.80 |
$74.40
|
|
Iron binding capacity
|
$20.02 |
$20.02 |
$36.40 |
$63.84
|
|
Irradiation of blood product each unit reference
|
$14.52 |
$14.52 |
$26.40 |
$117.60
|
|
Irrigation implantable venous access device for drug delivery systems
|
$43.12 |
$43.12 |
$78.40 |
$143.76
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$135.74 |
$135.74 |
$246.80 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$14.08 |
$14.08 |
$25.60 |
$158.40
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$26.40 |
$26.40 |
$48.00 |
$154.00
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$129.80 |
$129.80 |
$236.00 |
$444.49
|
|
Ivp w/nephrotomography
|
$231.44 |
$231.44 |
$420.80 |
$764.40
|
|
Ivp w/wo kub w/wo tomography
|
$167.20 |
$167.20 |
$304.00 |
$692.18
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$3.30 |
$3.30 |
$6.00 |
$60.32
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$27.88 |
$27.88 |
$50.70 |
$23.77
|
|
Kidney imag w/bld flow multi
|
$618.42 |
$618.42 |
$1,124.40 |
$1,570.65
|
|
Kidney img w/bldflw sgl without rx
|
$328.46 |
$328.46 |
$597.20 |
$1,435.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$90.64 |
$90.64 |
$164.80 |
$666.00
|
|
Kit gene analys d816 variant
|
$85.14 |
$85.14 |
$154.80 |
$374.61
|
|
Knee MRI (with and without contrast)
|
$444.18 |
$444.18 |
$807.60 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$444.18 |
$444.18 |
$807.60 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$322.96 |
$322.96 |
$587.20 |
$2,139.80
|
|
Knee X-ray
|
$79.20 |
$79.20 |
$144.00 |
$425.55
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$67.19 |
$67.19 |
$122.16 |
$33.14
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$1,679.04 |
$1,679.04 |
$3,052.80 |
$175.92
|
|
Lactate dehydrogenase (ldh)
|
$6.82 |
$6.82 |
$12.40 |
$55.50
|
|
Lactated ringers intravenous solution
|
$700.04 |
$700.04 |
$1,272.80 |
$44.91
|
|
Lactic acid
|
$38.72 |
$38.72 |
$70.40 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$13.86 |
$13.86 |
$25.20 |
$81.25
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$8,173.52 |
$8,173.52 |
$14,860.94 |
$19,124.00
|
|
Laryngeal function studies
|
$172.04 |
$172.04 |
$312.80 |
$335.40
|
|
Lead capillary
|
$5.06 |
$5.06 |
$9.20 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$224.84 |
$224.84 |
$408.80 |
$1,090.23
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$105.24 |
$105.24 |
$191.35 |
$163.80
|
|
Leuprolide acetate injeciton
|
$2,178.15 |
$2,178.15 |
$3,960.26 |
$1,322.50
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$72.93 |
$72.93 |
$132.60 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$73.70 |
$73.70 |
$134.00 |
$82.65
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$65.04 |
$65.04 |
$118.26 |
$55.60
|
|
Lincomycin injection
|
$290.07 |
$290.07 |
$527.40 |
$64.31
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$76.23 |
$76.23 |
$138.60 |
$123.78
|
|
Lipase
|
$38.72 |
$38.72 |
$70.40 |
$93.58
|
|
Lipoprotein blood high res frac & quant
|
$75.24 |
$75.24 |
$136.80 |
$86.42
|
|
Lipoprotein blood quant
|
$38.50 |
$38.50 |
$70.00 |
$99.60
|
|
Lipoprotein direct measurement hdl
|
$35.86 |
$35.86 |
$65.20 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$23.76 |
$23.76 |
$43.20 |
$61.60
|
|
Lithium therapeutic drug level
|
$26.40 |
$26.40 |
$48.00 |
$69.42
|
|
Lithotripsy transluminal coronary percutaneous
|
$1,668.48 |
$1,668.48 |
$3,033.60 |
$4,113.20
|
|
Liver Function Test
|
$9.90 |
$9.90 |
$18.00 |
$115.44
|
|
Liver imaging
|
$181.94 |
$181.94 |
$330.80 |
$1,093.50
|
|
Liver/spleen imag static only
|
$219.34 |
$219.34 |
$398.80 |
$1,140.78
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$66.27 |
$66.27 |
$120.50 |
$37.44
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$286.88 |
$286.88 |
$521.60 |
$1,926.60
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$239.14 |
$239.14 |
$434.80 |
$1,824.55
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$207.68 |
$207.68 |
$377.60 |
$1,472.25
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$358.82 |
$358.82 |
$652.40 |
$3,054.10
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$310.86 |
$310.86 |
$565.20 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$263.12 |
$263.12 |
$478.40 |
$2,065.69
|
|
Lower Back (Lumbar Spine) X-ray
|
$77.88 |
$77.88 |
$141.60 |
$356.16
|
|
Lung Function Test (Spirometry)
|
$73.70 |
$73.70 |
$134.00 |
$296.91
|
|
Lung perfusion imaging
|
$240.46 |
$240.46 |
$437.20 |
$1,075.25
|
|
Lymphatics/lymph node imaging
|
$253.00 |
$253.00 |
$460.00 |
$1,479.60
|
|
Magnesium
|
$4.84 |
$4.84 |
$8.80 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$107.74 |
$107.74 |
$195.90 |
$59.88
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$22.44 |
$22.44 |
$40.80 |
$129.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$22.44 |
$22.44 |
$40.80 |
$158.98
|
|
Mannitol 12.5 gm/50 ml inj
|
$22.00 |
$22.00 |
$40.00 |
$27.81
|
|
Mastoids complete
|
$68.86 |
$68.86 |
$125.20 |
$299.50
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$23.32 |
$23.32 |
$42.40 |
$65.00
|
|
Mayo aathr protein s free
|
$45.54 |
$45.54 |
$82.80 |
$130.18
|
|
Mayo activated protein c resistance assay
|
$58.30 |
$58.30 |
$106.00 |
$96.50
|