|
Injection arthrography hip without anesthesia (both sides)
|
$567.00 |
$567.00 |
$567.00 |
$503.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$471.60 |
$471.60 |
$471.60 |
$458.15
|
|
Injection for arthrography wrist (both sides)
|
$316.80 |
$316.80 |
$316.80 |
$436.00
|
|
Injection for bladder x-ray
|
$85.80 |
$85.80 |
$85.80 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$403.20 |
$403.20 |
$403.20 |
$497.76
|
|
Injection, fulvestrant
|
$1,031.40 |
$1,031.40 |
$1,031.40 |
$1,719.16
|
|
Injection into brain canal
|
$267.00 |
$267.00 |
$267.00 |
$844.50
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$625.20 |
$625.20 |
$625.20 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$743.40 |
$743.40 |
$743.40 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$844.20 |
$844.20 |
$844.20 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$80.40 |
$80.40 |
$80.40 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$844.20 |
$844.20 |
$844.20 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$83.40 |
$83.40 |
$83.40 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$843.60 |
$843.60 |
$843.60 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,044.00 |
$1,044.00 |
$1,044.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,044.60 |
$1,044.60 |
$1,044.60 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$199.80 |
$199.80 |
$199.80 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$200.40 |
$200.40 |
$200.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$228.60 |
$228.60 |
$228.60 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$138.60 |
$138.60 |
$138.60 |
$145.60
|
|
Inject sacroiliac joint
|
$719.40 |
$719.40 |
$719.40 |
$1,029.04
|
|
Inj epidural sgl cerv-thor without img
|
$1,025.40 |
$1,025.40 |
$1,025.40 |
$1,329.00
|
|
Inj for ext venography
|
$189.60 |
$189.60 |
$189.60 |
$628.80
|
|
Inj for mammo ductogram
|
$381.00 |
$381.00 |
$381.00 |
$397.80
|
|
Inj naloxone hydrochloride
|
$98.40 |
$98.40 |
$98.40 |
$83.16
|
|
Inj proc ankle arthr
|
$388.80 |
$388.80 |
$388.80 |
$405.31
|
|
Inj proc elbow arthro
|
$478.80 |
$478.80 |
$478.80 |
$432.00
|
|
Inj proc myelogram lumbar
|
$307.20 |
$307.20 |
$307.20 |
$838.30
|
|
Inj proc sialogram
|
$117.00 |
$117.00 |
$117.00 |
$373.00
|
|
Insert cath pleura with image
|
$642.60 |
$642.60 |
$642.60 |
$2,194.40
|
|
Insert drug delivery implant
|
$206.40 |
$206.40 |
$206.40 |
$280.00
|
|
Insertion catheter bladder non indwelling
|
$177.60 |
$177.60 |
$177.60 |
$208.01
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,070.40 |
$1,070.40 |
$1,070.40 |
$2,103.75
|
|
Insert pessary/other device
|
$274.80 |
$274.80 |
$274.80 |
$278.90
|
|
Insitu hybridization manual
|
$322.20 |
$322.20 |
$322.20 |
$401.28
|
|
In situ hybridization per specimen initial single probe stain
|
$760.80 |
$760.80 |
$760.80 |
$338.40
|
|
Instillation anticarcinogenic agent bladder
|
$693.00 |
$693.00 |
$693.00 |
$638.40
|
|
Insulin total
|
$62.40 |
$62.40 |
$62.40 |
$66.64
|
|
Intrinsic factor antibody
|
$283.80 |
$283.80 |
$283.80 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$822.00 |
$822.00 |
$822.00 |
$601.28
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$207.60 |
$207.60 |
$207.60 |
$165.67
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$153.60 |
$153.60 |
$153.60 |
$279.10
|
|
Iron
|
$46.20 |
$46.20 |
$46.20 |
$75.00
|
|
Iron binding capacity
|
$46.20 |
$46.20 |
$46.20 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$87.00 |
$87.00 |
$87.00 |
$80.67
|
|
Iron stain peripheral blood
|
$147.00 |
$147.00 |
$147.00 |
$30.55
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$43.20 |
$43.20 |
$43.20 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$154.80 |
$154.80 |
$154.80 |
$146.11
|
|
Irrigation syringe
|
$1.80 |
$1.80 |
$1.80 |
$3.60
|
|
IV Fluids (each additional hour)
|
$85.80 |
$85.80 |
$85.80 |
$133.90
|
|
IV Fluids (first hour)
|
$368.40 |
$368.40 |
$368.40 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$69.00 |
$69.00 |
$69.00 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$112.20 |
$112.20 |
$112.20 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$85.80 |
$85.80 |
$85.80 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$368.40 |
$368.40 |
$368.40 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$85.80 |
$85.80 |
$85.80 |
$167.50
|
|
IV Push Injection (first drug)
|
$368.40 |
$368.40 |
$368.40 |
$252.76
|
|
Ivp w/nephrotomography
|
$75.60 |
$75.60 |
$75.60 |
$748.15
|
|
Ivp w/wo kub w/wo tomography
|
$358.80 |
$358.80 |
$358.80 |
$713.40
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$163.20 |
$163.20 |
$163.20 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$138.00 |
$138.00 |
$138.00 |
$362.05
|
|
John cunningham antibody
|
$56.40 |
$56.40 |
$56.40 |
$78.00
|
|
Ketogenic steroids fract
|
$262.80 |
$262.80 |
$262.80 |
$82.80
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$121.20 |
$121.20 |
$121.20 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$4.20 |
$4.20 |
$4.20 |
$23.52
|
|
Kidney function study
|
$266.40 |
$266.40 |
$266.40 |
$935.22
|
|
Kidney imaging morphology
|
$465.60 |
$465.60 |
$465.60 |
$785.00
|
|
Kidney img w/bldflw sgl without rx
|
$642.00 |
$642.00 |
$642.00 |
$1,433.22
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$528.00 |
$528.00 |
$528.00 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$301.80 |
$301.80 |
$301.80 |
$490.75
|
|
Kit lead specify 5-6-5
|
$2,910.60 |
$2,910.60 |
$2,910.60 |
$16,672.10
|
|
Kit trach suct cls 30.5cm
|
$2.40 |
$2.40 |
$2.40 |
$35.26
|
|
Knee MRI (with and without contrast)
|
$8,550.60 |
$8,550.60 |
$8,550.60 |
$3,022.20
|
|
Knee MRI (with contrast)
|
$5,051.40 |
$5,051.40 |
$5,051.40 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$4,363.20 |
$4,363.20 |
$4,363.20 |
$2,130.88
|
|
Knee X-ray
|
$278.40 |
$278.40 |
$278.40 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$227.40 |
$227.40 |
$227.40 |
$290.40
|
|
Knee X-ray (standing, both knees)
|
$130.20 |
$130.20 |
$130.20 |
$251.20
|
|
Kyleena, 19.5 mg
|
$1,372.80 |
$1,372.80 |
$1,372.80 |
$2,125.00
|
|
Lactate dehydrogenase (ldh)
|
$87.00 |
$87.00 |
$87.00 |
$55.50
|
|
Lactated ringers intravenous solution
|
$13.80 |
$13.80 |
$13.80 |
$43.74
|
|
Lactic acid
|
$58.20 |
$58.20 |
$58.20 |
$107.10
|
|
Lactoferrin fecal qualitative
|
$88.80 |
$88.80 |
$88.80 |
$82.16
|
|
Laparo cholecystectomy/graph
|
$3,965.40 |
$3,965.40 |
$3,965.40 |
$8,346.00
|
|
Laparo proc abdm/per/oment 49329
|
$3,979.80 |
$3,979.80 |
$3,979.80 |
$6,622.75
|
|
Lap ing hernia repair recur
|
$3,965.40 |
$3,965.40 |
$3,965.40 |
$6,870.89
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$418.80 |
$418.80 |
$418.80 |
$740.40
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$2,110.20 |
$2,110.20 |
$2,110.20 |
$2,514.60
|
|
Laser surgery of prostate
|
$5,498.40 |
$5,498.40 |
$5,498.40 |
$6,822.11
|
|
Lead capillary
|
$66.00 |
$66.00 |
$66.00 |
$57.50
|
|
Left compres band >=3" <5"/yd
|
$3.00 |
$3.00 |
$3.00 |
$5.20
|
|
Left compres band <3"/yd
|
$1.80 |
$1.80 |
$1.80 |
$3.64
|
|
Left compres band >=5"/yd
|
$4.20 |
$4.20 |
$4.20 |
$6.73
|
|
Leg Artery Ultrasound (complete, both legs)
|
$1,306.80 |
$1,306.80 |
$1,306.80 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$1,585.20
|
|
Leg CT Scan (without contrast, both legs)
|
$833.40 |
$833.40 |
$833.40 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,357.20 |
$1,357.20 |
$1,357.20 |
$1,092.58
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$9.00 |
$9.00 |
$9.00 |
$97.62
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$21.60 |
$21.60 |
$21.60 |
$55.69
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$18.00 |
$18.00 |
$18.00 |
$39.75
|
