|
Ins/rpl pm gen exist sgl lead
|
$12,240.36 |
$12,240.36 |
$12,240.36 |
$9,558.78
|
|
Ins/rpl pm w/tv ld atrl
|
$26,138.91 |
$26,138.91 |
$26,138.91 |
$12,371.40
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$212,142.76 |
$212,142.76 |
$212,142.76 |
$25,807.00
|
|
Ins tun intraperit dia cath
|
$10,396.69 |
$10,396.69 |
$10,396.69 |
$4,657.46
|
|
Insulin total
|
$610.72 |
$610.72 |
$610.72 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$69,411.00 |
$69,411.00 |
$69,411.00 |
$8,629.72
|
|
Intens cardiac rehab no exer
|
$712.04 |
$712.04 |
$712.04 |
$238.40
|
|
Intens cardiac rehab w/exerc
|
$712.04 |
$712.04 |
$712.04 |
$238.40
|
|
Interrog dev eval icpms ip
|
$273.78 |
$273.78 |
$273.78 |
$104.00
|
|
Intra-atrial pacing
|
$2,554.32 |
$2,554.32 |
$2,554.32 |
$4,683.25
|
|
Intra-atrial recording
|
$5,103.00 |
$5,103.00 |
$5,103.00 |
$5,252.30
|
|
Intracard echo interv w/s&i
|
$2,303.12 |
$2,303.12 |
$2,303.12 |
$3,429.40
|
|
Intraop epicard/endocard/pace/map/ 93631
|
$21,147.24 |
$21,147.24 |
$21,147.24 |
$3,500.60
|
|
Intraventricular pacing
|
$5,736.64 |
$5,736.64 |
$5,736.64 |
$5,609.50
|
|
Intrinsic factor antibody
|
$1,184.52 |
$1,184.52 |
$1,184.52 |
$66.60
|
|
Intro cath dialysis circuit
|
$3,182.22 |
$3,182.22 |
$3,182.22 |
$2,035.00
|
|
Intro cath dialysis circuit w/pta
|
$7,611.39 |
$7,611.39 |
$7,611.39 |
$8,761.00
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$11,915.13 |
$11,915.13 |
$11,915.13 |
$3,303.76
|
|
Ipratropium bromide non-comp
|
$61.77 |
$61.77 |
$61.77 |
$3.75
|
|
Iron
|
$629.19 |
$629.19 |
$629.19 |
$74.40
|
|
Iron binding capacity
|
$308.20 |
$308.20 |
$308.20 |
$63.79
|
|
Iron dextran 50 mg/ml injection solution
|
$344.48 |
$344.48 |
$344.48 |
$80.95
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$131.44 |
$131.44 |
$131.44 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$765.47 |
$765.47 |
$765.47 |
$119.83
|
|
Irrigation implantable venous access device for drug delivery systems
|
$573.34 |
$573.34 |
$573.34 |
$142.20
|
|
Ivc venogram s&i
|
$9,341.43 |
$9,341.43 |
$9,341.43 |
$3,316.95
|
|
IV inj ra drug dx study
|
$1,093.64 |
$1,093.64 |
$1,093.64 |
$549.70
|
|
Ivp w/nephrotomography
|
$2,538.11 |
$2,538.11 |
$2,538.11 |
$790.08
|
|
Ivp w/wo kub w/wo tomography
|
$2,365.66 |
$2,365.66 |
$2,365.66 |
$692.18
|
|
Jak2 targeted sequence analysis
|
$575.97 |
$575.97 |
$575.97 |
$379.87
|
|
Kafo fem fx cast molded to p
|
$7,453.00 |
$7,453.00 |
$7,453.00 |
$3,130.66
|
|
Kafo fem fx cast thermoplas
|
$7,934.00 |
$7,934.00 |
$7,934.00 |
$2,710.45
|
|
Kafo femoral fx cast rigid
|
$4,761.00 |
$4,761.00 |
$4,761.00 |
$2,138.81
|
|
Ketogenic steroids fract
|
$471.54 |
$471.54 |
$471.54 |
$82.74
|
|
Kidney img w/bldflw sgl without rx
|
$7,818.74 |
$7,818.74 |
$7,818.74 |
$1,427.40
|
|
Knee joint cam lock each joi
|
$659.00 |
$659.00 |
$659.00 |
$287.46
|
|
Knee orth pos locking joint
|
$2,382.00 |
$2,382.00 |
$2,382.00 |
$585.60
|
|
Ko swedish type pre ots
|
$1,379.00 |
$1,379.00 |
$1,379.00 |
$604.50
|
|
Kras gene variants exon 2
|
$2,209.97 |
$2,209.97 |
$2,209.97 |
$486.45
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$1,174.76 |
$1,174.76 |
$1,174.76 |
$175.92
|
|
Lactated ringers intravenous solution
|
$5,723.07 |
$5,723.07 |
$5,723.07 |
$45.56
|
|
Lactic acid
|
$801.04 |
$801.04 |
$801.04 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$539.71 |
$539.71 |
$539.71 |
$80.40
|
|
Lead capillary
|
$1,201.56 |
$1,201.56 |
$1,201.56 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$2,436.27 |
$2,436.27 |
$2,436.27 |
$1,088.26
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$34.51 |
$34.51 |
$34.51 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$1,222.80 |
$1,222.80 |
$1,222.80 |
$7,052.00
|
|
Lev 1 hosp type b ed visit
|
$926.62 |
$926.62 |
$926.62 |
$186.98
|
|
Lev 2 hosp type b ed visit
|
$1,699.21 |
$1,699.21 |
$1,699.21 |
$359.65
|
|
Lev 3 hosp type b ed visit
|
$2,811.64 |
$2,811.64 |
$2,811.64 |
$598.15
|
|
Levalbuterol non-comp con
|
$69.99 |
$69.99 |
$69.99 |
$21.60
|
|
Levalbuterol non-comp unit
|
$115.28 |
$115.28 |
$115.28 |
$6.00
|
|
Levetiracetam therapeutic drug level
|
$1,053.85 |
$1,053.85 |
$1,053.85 |
$88.92
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$434.49 |
$434.49 |
$434.49 |
$385.62
|
|
Lidocaine injection
|
$56.27 |
$56.27 |
$56.27 |
$44.76
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$30.38 |
$30.38 |
$30.38 |
$39.37
|
|
Lidocaine therapeutic drug level
|
$399.10 |
$399.10 |
$399.10 |
$89.70
|
|
Limited ankle motion ea jnt
|
$1,538.00 |
$1,538.00 |
$1,538.00 |
$123.05
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$62.81 |
$62.81 |
$62.81 |
$125.66
|
|
Lipase
|
$684.58 |
$684.58 |
$684.58 |
$93.58
|
|
Lipoprotein blood quant
|
$1,191.62 |
$1,191.62 |
$1,191.62 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$705.88 |
$705.88 |
$705.88 |
$57.50
|
|
Listeria monocytogenes
|
$1,666.00 |
$1,666.00 |
$1,666.00 |
$117.52
|
|
Lithium therapeutic drug level
|
$653.34 |
$653.34 |
$653.34 |
$69.42
|
|
Liver Function Test
|
$947.33 |
$947.33 |
$947.33 |
$115.44
|
|
Liver imag w/vasclr flow
|
$3,957.95 |
$3,957.95 |
$3,957.95 |
$1,238.65
|
|
Liver/spleen imag static only
|
$5,764.69 |
$5,764.69 |
$5,764.69 |
$1,123.50
|
|
Liver/spleen imag w/vasclr flow
|
$4,135.84 |
$4,135.84 |
$4,135.84 |
$1,067.48
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$9,681.01 |
$9,681.01 |
$9,681.01 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$8,418.17 |
$8,418.17 |
$8,418.17 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$7,917.56 |
$7,917.56 |
$7,917.56 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$14,722.15 |
$14,722.15 |
$14,722.15 |
$3,111.17
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$12,478.94 |
$12,478.94 |
$12,478.94 |
$2,445.30
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$10,962.95 |
$10,962.95 |
$10,962.95 |
$2,096.84
|
|
Lower Back (Lumbar Spine) X-ray
|
$1,119.52 |
$1,119.52 |
$1,119.52 |
$352.32
|
|
Low frequency non-thermal Ultrasound
|
$507.04 |
$507.04 |
$507.04 |
$364.00
|
|
Lso full corset
|
$971.00 |
$971.00 |
$971.00 |
$320.92
|
|
Lso sagit rigid panel prefab
|
$7,420.00 |
$7,420.00 |
$7,420.00 |
$1,990.83
|
|
Lso sagittal rigid panel cus
|
$2,454.00 |
$2,454.00 |
$2,454.00 |
$3,092.00
|
|
Lso s/c shell/panel prefab
|
$8,994.00 |
$8,994.00 |
$8,994.00 |
$1,332.80
|
|
L/s ratio fetal lung
|
$2,670.14 |
$2,670.14 |
$2,670.14 |
$176.15
|
|
Lung function test (mbc/mvv)
|
$275.18 |
$275.18 |
$275.18 |
$180.16
|
|
Lung Function Test (Spirometry)
|
$1,735.81 |
$1,735.81 |
$1,735.81 |
$295.35
|
|
Lung perfusion imaging
|
$5,723.06 |
$5,723.06 |
$5,723.06 |
$1,075.25
|
|
Lymphatics/lymph node imaging
|
$5,489.64 |
$5,489.64 |
$5,489.64 |
$1,448.00
|
|
Macro exam dissect molec study ea
|
$188.90 |
$188.90 |
$188.90 |
$72.85
|
|
Macroscopic exam parasite
|
$21.55 |
$21.55 |
$21.55 |
$36.40
|
|
Mannitol 12.5 gm/50 ml inj
|
$204.48 |
$204.48 |
$204.48 |
$27.81
|
|
Map tachycard site(s)
|
$5,736.64 |
$5,736.64 |
$5,736.64 |
$3,875.95
|
|
Mastoids complete
|
$1,285.22 |
$1,285.22 |
$1,285.22 |
$299.50
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$1,475.68 |
$1,475.68 |
$1,475.68 |
$66.36
|
|
Mayo aathr protein s free
|
$494.21 |
$494.21 |
$494.21 |
$130.08
|
|
Mayo alcohol definitive assay volatile screen
|
$1,184.52 |
$1,184.52 |
$1,184.52 |
$112.85
|
|
Mayo alkaline phosphatase isoenzyme
|
$548.24 |
$548.24 |
$548.24 |
$66.30
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$593.69 |
$593.69 |
$593.69 |
$105.11
|
|
Mayo amikacin trough therapeutic drug level
|
$463.02 |
$463.02 |
$463.02 |
$82.80
|
|
Mayo analysis gene calr common variants exon 9
|
$1,886.14 |
$1,886.14 |
$1,886.14 |
$467.61
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$1,069.24 |
$1,069.24 |
$1,069.24 |
$359.00
|
|
Mayo androstenedione
|
$2,164.53 |
$2,164.53 |
$2,164.53 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$1,120.61 |
$1,120.61 |
$1,120.61 |
$73.08
|
