|
Inj levocarnitine per 1 gm
|
$1,083.90 |
$1,083.90 |
$1,083.90 |
$122.28
|
|
Inj mepivacaine hcl/10 ml
|
$161.51 |
$161.51 |
$161.51 |
$22.52
|
|
Inj., meropenem, vaborbactam
|
$1,981.22 |
$1,981.22 |
$1,981.22 |
$618.43
|
|
Inj meropenem (wg crit care)
|
$245.43 |
$245.43 |
$245.43 |
$104.12
|
|
Inj. mycophenolate mofetil
|
$178.26 |
$178.26 |
$178.26 |
$374.72
|
|
Inj, nithiodote, 3mg / 125mg
|
$772.32 |
$772.32 |
$772.32 |
$653.00
|
|
Inj testosterone cypionate
|
$26.07 |
$26.07 |
$26.07 |
$81.39
|
|
Inj w/fluor eval cv device
|
$1,460.90 |
$1,460.90 |
$1,460.90 |
$593.60
|
|
Ins cath ren art 1st bi
|
$8,999.00 |
$8,999.00 |
$8,999.00 |
$6,033.75
|
|
Ins cath ren art 2nd+ bi
|
$6,630.00 |
$6,630.00 |
$6,630.00 |
$5,349.00
|
|
Insert cath pleura with image
|
$16,757.81 |
$16,757.81 |
$16,757.81 |
$2,239.02
|
|
Insert cv cath inf & sup app
|
$34,342.72 |
$34,342.72 |
$34,342.72 |
$9,763.31
|
|
Insert hepatic shunt (tips)
|
$38,400.88 |
$38,400.88 |
$38,400.88 |
$9,754.48
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$11,121.23 |
$11,121.23 |
$11,121.23 |
$4,782.00
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$25,017.35 |
$25,017.35 |
$25,017.35 |
$6,832.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$7,711.90 |
$7,711.90 |
$7,711.90 |
$2,505.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$23,251.00 |
$23,251.00 |
$23,251.00 |
$13,588.90
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$60,596.60 |
$60,596.60 |
$60,596.60 |
$12,384.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$4,393.91 |
$4,393.91 |
$4,393.91 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$23,654.94 |
$23,654.94 |
$23,654.94 |
$2,368.45
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$40,686.58 |
$40,686.58 |
$40,686.58 |
$29,997.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$40,686.58 |
$40,686.58 |
$40,686.58 |
$7,216.00
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$40,686.58 |
$40,686.58 |
$40,686.58 |
$7,504.00
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$46,633.72 |
$46,633.72 |
$46,633.72 |
$9,793.46
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$25,503.20 |
$25,503.20 |
$25,503.20 |
$5,423.04
|
|
Insert pm/icd lead dual
|
$32,727.25 |
$32,727.25 |
$32,727.25 |
$7,562.63
|
|
Insert/repl sq defib w/eltrd
|
$128,811.60 |
$128,811.60 |
$128,811.60 |
$33,948.20
|
|
Insert swan-ganz cath
|
$3,981.05 |
$3,981.05 |
$3,981.05 |
$2,164.52
|
|
Insert vad art access left hrt arterial access
|
$30,597.17 |
$30,597.17 |
$30,597.17 |
$5,135.65
|
|
Ins icd gen exist sgl lead
|
$4,266.64 |
$4,266.64 |
$4,266.64 |
$24,844.79
|
|
Insitu hybridization auto
|
$296.53 |
$296.53 |
$296.53 |
$398.51
|
|
Insitu hybridization (fish)
|
$309.11 |
$309.11 |
$309.11 |
$481.60
|
|
Insitu hybridization manual
|
$1,620.46 |
$1,620.46 |
$1,620.46 |
$411.33
|
|
In situ hybridization per specimen each additional single probe stain
|
$677.00 |
$677.00 |
$677.00 |
$264.00
|
|
In situ hybridization per specimen initial single probe stain
|
$1,341.11 |
$1,341.11 |
$1,341.11 |
$341.90
|
|
Insj perq vad r hrt venous
|
$26,713.67 |
$26,713.67 |
$26,713.67 |
$5,334.45
|
|
Ins lv lead exist pm/icd
|
$151,994.08 |
$151,994.08 |
$151,994.08 |
$12,384.25
|
|
Ins pm gen exist dual lead
|
$68,742.60 |
$68,742.60 |
$68,742.60 |
$24,696.00
|
|
Ins pm gen w/exist mlt leads
|
$41,670.03 |
$41,670.03 |
$41,670.03 |
$15,600.75
|
|
Ins pq tunnld ip cath w/img
|
$13,371.00 |
$13,371.00 |
$13,371.00 |
$5,508.65
|
|
Ins/rpl ldless pm right vent w img & eval
|
$55,360.72 |
$55,360.72 |
$55,360.72 |
$24,135.54
|
|
Ins/rpl pm gen exist dual lead
|
$38,130.06 |
$38,130.06 |
$38,130.06 |
$11,583.66
|
|
Ins/rpl pm gen exist sgl lead
|
$20,520.41 |
$20,520.41 |
$20,520.41 |
$9,793.46
|
|
Ins/rpl pm w/tv ld atrl
|
$71,188.58 |
$71,188.58 |
$71,188.58 |
$12,384.25
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$79,990.73 |
$79,990.73 |
$79,990.73 |
$25,106.90
|
|
Inst fibrinolysis agent ini day
|
$1,185.41 |
$1,185.41 |
$1,185.41 |
$1,008.15
|
|
Insti hexaminolevulinate hcl
|
$6,250.50 |
$6,250.50 |
$6,250.50 |
$2,359.80
|
|
Ins tun cv cath wo subq prt/pm
|
$42,371.21 |
$42,371.21 |
$42,371.21 |
$4,341.66
|
|
Insulin total
|
$379.95 |
$379.95 |
$379.95 |
$67.50
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$10,746.00 |
$10,746.00 |
$10,746.00 |
$9,736.00
|
|
Integra meshed bil wound mat
|
$2,190.00 |
$2,190.00 |
$2,190.00 |
$8,521.10
|
|
Interdiscal perq aspir dx
|
$21,441.05 |
$21,441.05 |
$21,441.05 |
$1,222.26
|
|
Intra-atrial pacing
|
$12,694.10 |
$12,694.10 |
$12,694.10 |
$5,155.51
|
|
Intra-atrial recording
|
$14,606.57 |
$14,606.57 |
$14,606.57 |
$5,593.09
|
|
Intracard echo interv w/s&i
|
$15,687.60 |
$15,687.60 |
$15,687.60 |
$4,013.16
|
|
Intracran angioplsty w/stent
|
$39,785.00 |
$39,785.00 |
$39,785.00 |
$10,669.75
|
|
Intracranial angioplasty
|
$24,145.81 |
$24,145.81 |
$24,145.81 |
$6,006.33
|
|
Intracranial complete study
|
$4,120.91 |
$4,120.91 |
$4,120.91 |
$873.82
|
|
Intracranial limited study
|
$3,091.33 |
$3,091.33 |
$3,091.33 |
$418.44
|
|
Intraop epicard/endocard/pace/map/ 93631
|
$15,214.46 |
$15,214.46 |
$15,214.46 |
$3,690.00
|
|
Intrapul surf admin endo tube
|
$845.45 |
$845.45 |
$845.45 |
$240.68
|
|
Intraventricular pacing
|
$11,893.51 |
$11,893.51 |
$11,893.51 |
$5,644.35
|
|
Intrinsic factor antibody
|
$526.46 |
$526.46 |
$526.46 |
$59.95
|
|
Intro cath dialysis circuit
|
$2,804.94 |
$2,804.94 |
$2,804.94 |
$2,317.80
|
|
Intro cath dialysis circuit w/pta
|
$15,807.81 |
$15,807.81 |
$15,807.81 |
$8,717.80
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$30,542.06 |
$30,542.06 |
$30,542.06 |
$15,873.70
|
|
Iodine i-125 sodium iodide
|
$29,677.49 |
$29,677.49 |
$29,677.49 |
$246.83
|
|
Ipratropium bromide non-comp
|
$54.19 |
$54.19 |
$54.19 |
$11.59
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$2,154.08 |
$2,154.08 |
$2,154.08 |
$236.99
|
|
Iron
|
$822.70 |
$822.70 |
$822.70 |
$72.15
|
|
Iron binding capacity
|
$1,015.89 |
$1,015.89 |
$1,015.89 |
$61.47
|
|
Irradiation of blood product each unit reference
|
$265.64 |
$265.64 |
$265.64 |
$124.24
|
|
Irrigation implantable venous access device for drug delivery systems
|
$663.83 |
$663.83 |
$663.83 |
$153.75
|
|
IV inj ra drug dx study
|
$1,955.87 |
$1,955.87 |
$1,955.87 |
$544.45
|
|
Ivp w/wo kub w/wo tomography
|
$1,579.53 |
$1,579.53 |
$1,579.53 |
$692.18
|
|
Jak2 targeted sequence analysis
|
$250.96 |
$250.96 |
$250.96 |
$379.87
|
|
Jejunstmy tube plcmt
|
$5,259.47 |
$5,259.47 |
$5,259.47 |
$2,244.82
|
|
John cunningham antibody
|
$8,307.50 |
$8,307.50 |
$8,307.50 |
$43.90
|
|
Kidney imag w/bld flow multi
|
$20,601.94 |
$20,601.94 |
$20,601.94 |
$1,574.40
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$1,865.00 |
$1,865.00 |
$1,865.00 |
$150.60
|
|
Kras gene addl variants
|
$261.87 |
$261.87 |
$261.87 |
$346.45
|
|
Kras gene variants exon 2
|
$2,575.98 |
$2,575.98 |
$2,575.98 |
$496.60
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$1,031.76 |
$1,031.76 |
$1,031.76 |
$207.29
|
|
Lactoferrin fecal qualitative
|
$335.16 |
$335.16 |
$335.16 |
$88.40
|
|
Lactoferrin fecal quant
|
$482.99 |
$482.99 |
$482.99 |
$106.10
|
|
Laryngoscopic sensory vid
|
$1,226.88 |
$1,226.88 |
$1,226.88 |
$323.20
|
|
Leishmania antibody
|
$648.79 |
$648.79 |
$648.79 |
$58.50
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$104.89 |
$104.89 |
$104.89 |
$122.95
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$15,852.39 |
$15,852.39 |
$15,852.39 |
$4,313.88
|
|
Levetiracetam therapeutic drug level
|
$611.80 |
$611.80 |
$611.80 |
$74.92
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$546.36 |
$546.36 |
$546.36 |
$274.85
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$240.38 |
$240.38 |
$240.38 |
$38.02
|
|
Lidocaine therapeutic drug level
|
$391.23 |
$391.23 |
$391.23 |
$87.45
|
|
Lipase
|
$898.38 |
$898.38 |
$898.38 |
$81.25
|
|
Lipoprotein blood quant
|
$1,059.36 |
$1,059.36 |
$1,059.36 |
$103.90
|
|
Lipoprotein direct measurement hdl
|
$1,149.52 |
$1,149.52 |
$1,149.52 |
$54.60
|
|
Lithium therapeutic drug level
|
$851.67 |
$851.67 |
$851.67 |
$66.43
|
|
Liver Function Test
|
$2,282.00 |
$2,282.00 |
$2,282.00 |
$111.13
|
|
Liver imaging
|
$4,624.01 |
$4,624.01 |
$4,624.01 |
$1,241.25
|
|
Liver/spleen imag static only
|
$7,843.15 |
$7,843.15 |
$7,843.15 |
$1,140.78
|