|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$273.47 |
$273.47 |
$273.47 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$207.46 |
$207.46 |
$207.46 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$336.61 |
$336.61 |
$336.61 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$59.04 |
$59.04 |
$59.04 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$88.15 |
$88.15 |
$88.15 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$59.04 |
$59.04 |
$59.04 |
$135.20
|
|
Inject sacroiliac joint
|
$376.38 |
$376.38 |
$376.38 |
$963.00
|
|
Inj, epinephrine (belcher)
|
$2,499.21 |
$2,499.21 |
$2,499.21 |
$6.24
|
|
Inj, fosaprepitant (teva)
|
$81.22 |
$81.22 |
$81.22 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$1,043.05 |
$1,043.05 |
$1,043.05 |
$1,065.08
|
|
Inj gemcitabine hcl (accord)
|
$119.04 |
$119.04 |
$119.04 |
$113.90
|
|
Inj glycopyrrolate fres kabi
|
$24.97 |
$24.97 |
$24.97 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$17.71 |
$17.71 |
$17.71 |
$24.28
|
|
Inj, idacio, 1 mg
|
$1,022.94 |
$1,022.94 |
$1,022.94 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$243.95 |
$243.95 |
$243.95 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$8.96 |
$8.96 |
$8.96 |
$40.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$6,941.03 |
$6,941.03 |
$6,941.03 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$195.94 |
$195.94 |
$195.94 |
$103.60
|
|
Inj, linezolid (hospira)
|
$184.50 |
$184.50 |
$184.50 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$1,177.82 |
$1,177.82 |
$1,177.82 |
$2,375.23
|
|
Inj, meropenem (b. braun)
|
$85.09 |
$85.09 |
$85.09 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$88.92 |
$88.92 |
$88.92 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$111.05 |
$111.05 |
$111.05 |
$89.40
|
|
Inj. mycophenolate mofetil
|
$206.23 |
$206.23 |
$206.23 |
$252.66
|
|
Inj pantoprazole(hikma) 40mg
|
$37.41 |
$37.41 |
$37.41 |
$34.61
|
|
Inj pemetrexed (accord) 10mg
|
$1,188.52 |
$1,188.52 |
$1,188.52 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$56.46 |
$56.46 |
$56.46 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$1,806.28 |
$1,806.28 |
$1,806.28 |
$200.85
|
|
Inj romidepsin non-lyo 0.1mg
|
$9,055.33 |
$9,055.33 |
$9,055.33 |
$9,892.69
|
|
Inj. tigecycline (accord)
|
$356.23 |
$356.23 |
$356.23 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$120.51 |
$120.51 |
$120.51 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$41.82 |
$41.82 |
$41.82 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$71.09 |
$71.09 |
$71.09 |
$40.24
|
|
Insert cath pleura without image
|
$874.12 |
$874.12 |
$874.12 |
$2,019.00
|
|
Insertion catheter bladder non indwelling
|
$115.62 |
$115.62 |
$115.62 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$131.20 |
$131.20 |
$131.20 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,703.14 |
$1,703.14 |
$1,703.14 |
$2,511.00
|
|
Insertion of heart electrode 33211
|
$7,441.09 |
$7,441.09 |
$7,441.09 |
$7,392.84
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,703.14 |
$1,703.14 |
$1,703.14 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,921.26 |
$1,921.26 |
$1,921.26 |
$2,414.10
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$8,084.38 |
$8,084.38 |
$8,084.38 |
$7,513.67
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,330.43 |
$3,330.43 |
$3,330.43 |
$5,236.80
|
|
Ins/rplc spi npg/rcvr pocket
|
$23,205.59 |
$23,205.59 |
$23,205.59 |
$23,746.69
|
|
Instillation anticarcinogenic agent bladder
|
$416.15 |
$416.15 |
$416.15 |
$621.40
|
|
Insulin total
|
$51.66 |
$51.66 |
$51.66 |
$66.64
|
|
Intrinsic factor antibody
|
$25.01 |
$25.01 |
$25.01 |
$66.60
|
|
Intubation endotracheal emergency procedure
|
$339.89 |
$339.89 |
$339.89 |
$589.60
|
|
Iron
|
$85.28 |
$85.28 |
$85.28 |
$74.40
|
|
Iron binding capacity
|
$45.92 |
$45.92 |
$45.92 |
$63.79
|
|
Irrigation implantable venous access device for drug delivery systems
|
$107.01 |
$107.01 |
$107.01 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$59.04 |
$59.04 |
$59.04 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$22.14 |
$22.14 |
$22.14 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$219.35 |
$219.35 |
$219.35 |
$439.56
|
|
John cunningham antibody
|
$23.78 |
$23.78 |
$23.78 |
$72.60
|
|
Ketamine and metabolite screen - quest
|
$152.11 |
$152.11 |
$152.11 |
$72.14
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$41.82 |
$41.82 |
$41.82 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$25.98 |
$25.98 |
$25.98 |
$23.50
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$341.53 |
$341.53 |
$341.53 |
$666.00
|
|
Kit gene analys d816 variant
|
$63.96 |
$63.96 |
$63.96 |
$374.61
|
|
Knee MRI (with and without contrast)
|
$1,942.17 |
$1,942.17 |
$1,942.17 |
$3,034.80
|
|
Knee MRI (without contrast)
|
$998.76 |
$998.76 |
$998.76 |
$2,169.60
|
|
Knee X-ray
|
$118.90 |
$118.90 |
$118.90 |
$425.55
|
|
Kras gene variants exon 2
|
$160.31 |
$160.31 |
$160.31 |
$486.45
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$62.61 |
$62.61 |
$62.61 |
$32.34
|
|
Lactate dehydrogenase (ldh)
|
$29.52 |
$29.52 |
$29.52 |
$55.50
|
|
Lactic acid
|
$42.64 |
$42.64 |
$42.64 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$22.14 |
$22.14 |
$22.14 |
$80.40
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$7,616.23 |
$7,616.23 |
$7,616.23 |
$19,124.00
|
|
Lead capillary
|
$74.62 |
$74.62 |
$74.62 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$310.37 |
$310.37 |
$310.37 |
$1,088.26
|
|
Leishmania antibody
|
$16.40 |
$16.40 |
$16.40 |
$68.25
|
|
Leuprolide acetate injeciton
|
$2,029.64 |
$2,029.64 |
$2,029.64 |
$1,322.50
|
|
Levetiracetam therapeutic drug level
|
$137.35 |
$137.35 |
$137.35 |
$88.92
|
|
Lidocaine therapeutic drug level
|
$18.04 |
$18.04 |
$18.04 |
$89.70
|
|
Lipase
|
$39.77 |
$39.77 |
$39.77 |
$93.58
|
|
Lipoprotein direct measurement hdl
|
$66.83 |
$66.83 |
$66.83 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$44.28 |
$44.28 |
$44.28 |
$61.60
|
|
Lip surgery procedure
|
$123.00 |
$123.00 |
$123.00 |
$334.50
|
|
Lithium therapeutic drug level
|
$43.46 |
$43.46 |
$43.46 |
$69.42
|
|
Liver ds alys 3 bmrk srm alg
|
$643.70 |
$643.70 |
$643.70 |
$340.00
|
|
Liver Function Test
|
$65.60 |
$65.60 |
$65.60 |
$115.44
|
|
Liver/spleen imag static only
|
$469.86 |
$469.86 |
$469.86 |
$1,123.50
|
|
Low cost skin substitute app
|
$607.62 |
$607.62 |
$607.62 |
$909.35
|
|
Low cost skin substitute app
|
$801.96 |
$801.96 |
$801.96 |
$2,164.64
|
|
Low cost skin substitute app
|
$526.85 |
$526.85 |
$526.85 |
$933.60
|
|
Low cost skin substitute app
|
$728.98 |
$728.98 |
$728.98 |
$1,016.16
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$786.38 |
$786.38 |
$786.38 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,398.92 |
$1,398.92 |
$1,398.92 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$755.63 |
$755.63 |
$755.63 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$1,942.17 |
$1,942.17 |
$1,942.17 |
$3,111.17
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,214.42 |
$1,214.42 |
$1,214.42 |
$2,445.30
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,106.18 |
$1,106.18 |
$1,106.18 |
$2,096.84
|
|
Lower Back (Lumbar Spine) X-ray
|
$139.81 |
$139.81 |
$139.81 |
$352.32
|
|
Lung Function Test (Spirometry)
|
$112.75 |
$112.75 |
$112.75 |
$295.35
|
|
Lung perfusion imaging
|
$431.32 |
$431.32 |
$431.32 |
$1,075.25
|
|
Macroscopic exam parasite
|
$4.92 |
$4.92 |
$4.92 |
$36.40
|
|
Magnesium
|
$37.72 |
$37.72 |
$37.72 |
$73.00
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$33.62 |
$33.62 |
$33.62 |
$128.40
|
|
Manipulation chest wall initial demonstration/evaluation
|
$38.13 |
$38.13 |
$38.13 |
$152.54
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$25.42 |
$25.42 |
$25.42 |
$66.36
|