|
Inj peritoneal venous shunt
|
$47.55 |
$47.55 |
$47.55 |
$329.49
|
|
Inj proc ankle arthr
|
$316.54 |
$316.54 |
$316.54 |
$405.60
|
|
Inj proc elbow arthro
|
$302.66 |
$302.66 |
$302.66 |
$483.15
|
|
Inj proc myelogram lumbar
|
$446.68 |
$446.68 |
$446.68 |
$1,026.35
|
|
Inj proc sialogram
|
$130.24 |
$130.24 |
$130.24 |
$419.34
|
|
Inj retro urethrocysto
|
$111.28 |
$111.28 |
$111.28 |
$569.60
|
|
Inj scleros sol sgl vein
|
$213.86 |
$213.86 |
$213.86 |
$534.40
|
|
Inj secretin synthetic human
|
$610.89 |
$610.89 |
$610.89 |
$610.89
|
|
Insert cannula vein-to-vein hemodialysis
|
$2,016.78 |
$2,016.78 |
$2,016.78 |
$7,279.50
|
|
Insert cath pleura with image
|
$1,600.99 |
$1,600.99 |
$1,600.99 |
$2,239.02
|
|
Insert cath pleura without image
|
$4,113.48 |
$4,113.48 |
$4,113.48 |
$2,157.58
|
|
Insertion catheter bladder non indwelling
|
$103.14 |
$103.14 |
$103.14 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$113.78 |
$113.78 |
$113.78 |
$245.00
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,662.23 |
$1,662.23 |
$1,662.23 |
$4,923.19
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,018.15 |
$1,018.15 |
$1,018.15 |
$2,457.24
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,159.86 |
$1,159.86 |
$1,159.86 |
$2,079.43
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$2,494.54 |
$2,494.54 |
$2,494.54 |
$7,513.67
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,720.69 |
$1,720.69 |
$1,720.69 |
$5,423.04
|
|
Insert pessary/other device
|
$177.42 |
$177.42 |
$177.42 |
$277.99
|
|
Insert swan-ganz cath
|
$1,373.35 |
$1,373.35 |
$1,373.35 |
$2,269.00
|
|
Insitu hybridization (fish)
|
$254.01 |
$254.01 |
$254.01 |
$481.60
|
|
In situ hybridization per specimen each additional single probe stain
|
$181.69 |
$181.69 |
$181.69 |
$291.00
|
|
In situ hybridization per specimen initial single probe stain
|
$240.83 |
$240.83 |
$240.83 |
$364.00
|
|
Ins mark abd/pel for right perq
|
$1,549.19 |
$1,549.19 |
$1,549.19 |
$2,000.78
|
|
Ins mark thor for right perq
|
$833.70 |
$833.70 |
$833.70 |
$2,477.45
|
|
Ins picad w subq port 5yr>
|
$1,161.15 |
$1,161.15 |
$1,161.15 |
$4,312.97
|
|
Instillation anticarcinogenic agent bladder
|
$481.56 |
$481.56 |
$481.56 |
$721.50
|
|
Inst via cath agent pleurds
|
$524.57 |
$524.57 |
$524.57 |
$970.40
|
|
Insulin total
|
$48.66 |
$48.66 |
$48.66 |
$72.15
|
|
Interdental wirg oth/thn fx
|
$810.12 |
$810.12 |
$810.12 |
$1,809.68
|
|
Interdiscal perq aspir dx
|
$633.07 |
$633.07 |
$633.07 |
$1,222.26
|
|
Interferon alfa-2b inj
|
$473.03 |
$473.03 |
$473.03 |
$51.21
|
|
Intracard echo interv w/s&i
|
$857.66 |
$857.66 |
$857.66 |
$4,328.45
|
|
Intracranial complete study
|
$336.61 |
$336.61 |
$336.61 |
$903.50
|
|
Intracranial limited study
|
$238.37 |
$238.37 |
$238.37 |
$398.34
|
|
Intrapul surf admin endo tube
|
$100.64 |
$100.64 |
$100.64 |
$220.80
|
|
Intrinsic factor antibody
|
$59.66 |
$59.66 |
$59.66 |
$76.77
|
|
Intro long gi tube
|
$481.00 |
$481.00 |
$481.00 |
$880.75
|
|
Intubation endotracheal emergency procedure
|
$263.53 |
$263.53 |
$263.53 |
$565.00
|
|
Ionm in operatng room 15 min
|
$82.79 |
$82.79 |
$82.79 |
$238.00
|
|
Iron
|
$70.67 |
$70.67 |
$70.67 |
$67.50
|
|
Iron binding capacity
|
$24.14 |
$24.14 |
$24.14 |
$55.00
|
|
Irradiation of blood product each unit reference
|
$71.04 |
$71.04 |
$71.04 |
$127.49
|
|
Irrigation implantable venous access device for drug delivery systems
|
$100.36 |
$100.36 |
$100.36 |
$149.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$75.94 |
$75.94 |
$75.94 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$71.87 |
$71.87 |
$71.87 |
$170.94
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$67.62 |
$67.62 |
$67.62 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$229.40 |
$229.40 |
$229.40 |
$476.50
|
|
IV inj ra drug dx study
|
$145.60 |
$145.60 |
$145.60 |
$473.22
|
|
Ivp w/nephrotomography
|
$322.92 |
$322.92 |
$322.92 |
$673.90
|
|
Ivp w/wo kub w/wo tomography
|
$330.32 |
$330.32 |
$330.32 |
$687.80
|
|
Jak2 targeted sequence analysis
|
$215.62 |
$215.62 |
$215.62 |
$465.74
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$64.10 |
$64.10 |
$64.10 |
$52.50
|
|
Kidney imaging morphology
|
$769.51 |
$769.51 |
$769.51 |
$693.60
|
|
Kidney imag w/bld flow multi
|
$1,257.54 |
$1,257.54 |
$1,257.54 |
$1,319.61
|
|
Kidney img w/bldflw sgl without rx
|
$782.83 |
$782.83 |
$782.83 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$400.16 |
$400.16 |
$400.16 |
$618.54
|
|
Kit gene analys d816 variant
|
$269.27 |
$269.27 |
$269.27 |
$276.38
|
|
Kit sound processor cochlear osia 2
|
$22,008.58 |
$22,008.58 |
$22,008.58 |
$22,008.58
|
|
Knee MRI (with and without contrast)
|
$1,070.87 |
$1,070.87 |
$1,070.87 |
$2,703.85
|
|
Knee MRI (with contrast)
|
$1,113.05 |
$1,113.05 |
$1,113.05 |
$2,315.95
|
|
Knee MRI (without contrast)
|
$1,953.60 |
$1,953.60 |
$1,953.60 |
$2,120.00
|
|
Knee X-ray
|
$303.22 |
$303.22 |
$303.22 |
$387.20
|
|
Kras gene addl variants
|
$128.52 |
$128.52 |
$128.52 |
$366.56
|
|
Kras gene variants exon 2
|
$128.52 |
$128.52 |
$128.52 |
$495.00
|
|
Lab draw < 3 yrs fem/jugular 36400
|
$77.89 |
$77.89 |
$77.89 |
$102.70
|
|
Lactate dehydrogenase (ldh)
|
$27.84 |
$27.84 |
$27.84 |
$50.55
|
|
Lactic acid
|
$163.91 |
$163.91 |
$163.91 |
$85.20
|
|
Largsc w/rmvl foreign bdy(s)
|
$447.15 |
$447.15 |
$447.15 |
$765.97
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$2,256.91 |
$2,256.91 |
$2,256.91 |
$2,480.71
|
|
Laryngoscopy w/fb removal
|
$2,423.50 |
$2,423.50 |
$2,423.50 |
$3,505.20
|
|
Lead capillary
|
$41.16 |
$41.16 |
$41.16 |
$66.32
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$407.46 |
$407.46 |
$407.46 |
$1,053.00
|
|
Lens iol ant bicnvx 24.0 multi
|
$2,026.49 |
$2,026.49 |
$2,026.49 |
$1,136.25
|
|
Lens iol ant chamb 10.5
|
$269.71 |
$269.71 |
$269.71 |
$191.25
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$8,124.05 |
$8,124.05 |
$8,124.05 |
$5,001.00
|
|
Levetiracetam therapeutic drug level
|
$70.39 |
$70.39 |
$70.39 |
$99.45
|
|
Lidocaine therapeutic drug level
|
$59.29 |
$59.29 |
$59.29 |
$82.50
|
|
Ligation/biopsy of temporal artery 37609
|
$1,044.33 |
$1,044.33 |
$1,044.33 |
$3,679.25
|
|
Ligation/major artery/extremity 37618
|
$1,044.42 |
$1,044.42 |
$1,044.42 |
$1,497.00
|
|
Ligation vericose vein cluster(s) 1 leg
|
$3,071.93 |
$3,071.93 |
$3,071.93 |
$3,182.01
|
|
Lipase
|
$44.68 |
$44.68 |
$44.68 |
$67.68
|
|
Lipoprotein blood quant
|
$40.05 |
$40.05 |
$40.05 |
$106.43
|
|
Lipoprotein direct measurement hdl
|
$36.72 |
$36.72 |
$36.72 |
$54.60
|
|
Lipoprotein direct measurement ldl
|
$29.79 |
$29.79 |
$29.79 |
$61.60
|
|
Lithium therapeutic drug level
|
$45.51 |
$45.51 |
$45.51 |
$62.40
|
|
Liver Function Test
|
$44.31 |
$44.31 |
$44.31 |
$92.85
|
|
Liver imaging
|
$321.62 |
$321.62 |
$321.62 |
$827.28
|
|
Liver/spleen imag static only
|
$406.08 |
$406.08 |
$406.08 |
$1,135.20
|
|
Liver/spleen imag w/vasclr flow
|
$429.48 |
$429.48 |
$429.48 |
$727.35
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$715.30 |
$715.30 |
$715.30 |
$1,731.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$902.80 |
$902.80 |
$902.80 |
$1,705.08
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$843.69 |
$843.69 |
$843.69 |
$1,450.15
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$1,396.84 |
$1,396.84 |
$1,396.84 |
$2,631.85
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,054.87 |
$1,054.87 |
$1,054.87 |
$2,181.58
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$924.82 |
$924.82 |
$924.82 |
$1,791.60
|
|
Lower Back (Lumbar Spine) X-ray
|
$148.46 |
$148.46 |
$148.46 |
$328.23
|
|
Lung function test (mbc/mvv)
|
$69.75 |
$69.75 |
$69.75 |
$166.95
|
|
Lung Function Test (Spirometry)
|
$99.16 |
$99.16 |
$99.16 |
$290.89
|
|
Lung perfusion imaging
|
$394.33 |
$394.33 |
$394.33 |
$919.75
|