|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$90.00 |
$90.00 |
$90.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$90.00 |
$90.00 |
$90.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$90.00 |
$90.00 |
$90.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$55.00 |
$55.00 |
$55.00 |
$135.20
|
|
Inject sacroiliac joint
|
$2,250.00 |
$2,250.00 |
$2,250.00 |
$963.00
|
|
Inj, epinephrine (belcher)
|
$2.88 |
$2.88 |
$2.88 |
$6.24
|
|
Inj for ext venography
|
$610.00 |
$610.00 |
$610.00 |
$654.00
|
|
Inj for mammo ductogram
|
$172.50 |
$172.50 |
$172.50 |
$433.50
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$650.00 |
$650.00 |
$650.00 |
$783.50
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$925.00 |
$925.00 |
$925.00 |
$1,414.40
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$975.00 |
$975.00 |
$975.00 |
$2,485.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$885.00 |
$885.00 |
$885.00 |
$2,431.74
|
|
Inj pantoprazole(hikma) 40mg
|
$32.88 |
$32.88 |
$32.88 |
$34.61
|
|
Inj proc ankle arthr
|
$460.00 |
$460.00 |
$460.00 |
$405.31
|
|
Inj proc elbow arthro
|
$460.00 |
$460.00 |
$460.00 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$580.00 |
$580.00 |
$580.00 |
$856.00
|
|
Inj retro urethrocysto
|
$450.00 |
$450.00 |
$450.00 |
$450.00
|
|
Inj scleros sol mult veins
|
$425.00 |
$425.00 |
$425.00 |
$602.50
|
|
Inj scleros sol sgl vein
|
$142.50 |
$142.50 |
$142.50 |
$534.40
|
|
Inj thrc fascial pln blk bi w/wo image
|
$775.00 |
$775.00 |
$775.00 |
$1,025.00
|
|
Inj thrc fascial pln blk uni w/wo image
|
$650.00 |
$650.00 |
$650.00 |
$818.00
|
|
Inj w/fluor eval cv device
|
$377.50 |
$377.50 |
$377.50 |
$463.40
|
|
Ins cath ren art 1st bi
|
$3,745.00 |
$3,745.00 |
$3,745.00 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$3,000.00 |
$3,000.00 |
$3,000.00 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$3,745.00 |
$3,745.00 |
$3,745.00 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$3,000.00 |
$3,000.00 |
$3,000.00 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$382.50 |
$382.50 |
$382.50 |
$488.35
|
|
Insert cath pleura with image
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$2,019.00
|
|
Insert drug delivery implant
|
$305.00 |
$305.00 |
$305.00 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$11,055.00 |
$11,055.00 |
$11,055.00 |
$8,367.70
|
|
Insert intrauterine device iud
|
$570.00 |
$570.00 |
$570.00 |
$366.65
|
|
Insertion catheter bladder non indwelling
|
$117.50 |
$117.50 |
$117.50 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$195.00 |
$195.00 |
$195.00 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,125.00 |
$3,125.00 |
$3,125.00 |
$4,731.80
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$3,900.00 |
$3,900.00 |
$3,900.00 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$2,511.00
|
|
Insertion of catheter vein
|
$880.00 |
$880.00 |
$880.00 |
$1,657.32
|
|
Insertion of catheter vein
|
$760.00 |
$760.00 |
$760.00 |
$836.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,015.00 |
$2,015.00 |
$2,015.00 |
$2,414.10
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,820.00 |
$1,820.00 |
$1,820.00 |
$5,236.80
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$2,995.00 |
$2,995.00 |
$2,995.00 |
$5,018.25
|
|
Insitu hybridization auto
|
$295.00 |
$295.00 |
$295.00 |
$371.00
|
|
Insitu hybridization (fish)
|
$322.50 |
$322.50 |
$322.50 |
$481.60
|
|
Insitu hybridization manual
|
$357.50 |
$357.50 |
$357.50 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$257.50 |
$257.50 |
$257.50 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$322.50 |
$322.50 |
$322.50 |
$326.04
|
|
Ins mark abd/pel for right perq
|
$3,390.00 |
$3,390.00 |
$3,390.00 |
$2,376.00
|
|
Ins pq tunnld ip cath w/img
|
$3,490.00 |
$3,490.00 |
$3,490.00 |
$5,377.00
|
|
Inst fibrinolysis agent ini day
|
$905.00 |
$905.00 |
$905.00 |
$1,090.80
|
|
Inst fibrinolysis agent sbsq d
|
$675.00 |
$675.00 |
$675.00 |
$1,018.47
|
|
Ins tun cv cath wo subq prt/pm
|
$1,740.00 |
$1,740.00 |
$1,740.00 |
$4,202.70
|
|
Ins tun intraperit dia cath
|
$3,130.00 |
$3,130.00 |
$3,130.00 |
$4,657.46
|
|
Insulin total
|
$65.00 |
$65.00 |
$65.00 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$1,775.00 |
$1,775.00 |
$1,775.00 |
$8,629.72
|
|
Interdiscal perq aspir dx
|
$710.00 |
$710.00 |
$710.00 |
$1,180.84
|
|
Intrinsic factor antibody
|
$95.00 |
$95.00 |
$95.00 |
$66.60
|
|
Intro cath dialysis circuit
|
$1,145.00 |
$1,145.00 |
$1,145.00 |
$2,035.00
|
|
Intro cath dialysis circuit w/pta
|
$6,930.00 |
$6,930.00 |
$6,930.00 |
$8,761.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$16,900.00 |
$16,900.00 |
$16,900.00 |
$15,805.00
|
|
Intro catheter aorta
|
$1,060.00 |
$1,060.00 |
$1,060.00 |
$1,654.05
|
|
Intro cath svc/ivc
|
$880.00 |
$880.00 |
$880.00 |
$1,329.90
|
|
Intro long gi tube
|
$457.50 |
$457.50 |
$457.50 |
$990.00
|
|
Intro long gi tube w/mult fluo
|
$317.50 |
$317.50 |
$317.50 |
$449.40
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$1,810.00 |
$1,810.00 |
$1,810.00 |
$3,303.76
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$1,530.00 |
$1,530.00 |
$1,530.00 |
$1,633.03
|
|
Intubation endotracheal emergency procedure
|
$302.50 |
$302.50 |
$302.50 |
$589.60
|
|
Iodine i-123 sod iodide mil
|
$307.50 |
$307.50 |
$307.50 |
$350.74
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$6.60 |
$6.60 |
$6.60 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$1.52 |
$1.52 |
$1.52 |
$279.10
|
|
Iron
|
$82.50 |
$82.50 |
$82.50 |
$74.40
|
|
Iron binding capacity
|
$72.50 |
$72.50 |
$72.50 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$1.16 |
$1.16 |
$1.16 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$65.00 |
$65.00 |
$65.00 |
$119.83
|
|
Irrigation implantable venous access device for drug delivery systems
|
$112.50 |
$112.50 |
$112.50 |
$142.20
|
|
Ivc venogram s&i
|
$2,095.00 |
$2,095.00 |
$2,095.00 |
$3,316.95
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$150.00 |
$150.00 |
$150.00 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$150.00 |
$150.00 |
$150.00 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$150.00 |
$150.00 |
$150.00 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$350.00 |
$350.00 |
$350.00 |
$439.56
|
|
Ivp w/wo kub w/wo tomography
|
$670.00 |
$670.00 |
$670.00 |
$692.18
|
|
Jak2 targeted sequence analysis
|
$475.00 |
$475.00 |
$475.00 |
$379.87
|
|
John cunningham antibody
|
$65.00 |
$65.00 |
$65.00 |
$72.60
|
|
Ketamine and metabolite screen - quest
|
$225.00 |
$225.00 |
$225.00 |
$72.14
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$47.50 |
$47.50 |
$47.50 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$29.73 |
$29.73 |
$29.73 |
$23.50
|
|
Kidney function study
|
$1,595.00 |
$1,595.00 |
$1,595.00 |
$783.86
|
|
Kidney img w/bldflw sgl without rx
|
$1,595.00 |
$1,595.00 |
$1,595.00 |
$1,427.40
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$515.00 |
$515.00 |
$515.00 |
$666.00
|
|
Kit gene analys d816 variant
|
$382.50 |
$382.50 |
$382.50 |
$374.61
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$1,176.18 |
$1,176.18 |
$1,176.18 |
$1,543.50
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$47.50 |
$47.50 |
$47.50 |
$740.00
|
|
Knee MRI (with and without contrast)
|
$3,265.00 |
$3,265.00 |
$3,265.00 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$2,210.00 |
$2,210.00 |
$2,210.00 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$2,110.00 |
$2,110.00 |
$2,110.00 |
$2,169.60
|
|
Knee X-ray
|
$585.00 |
$585.00 |
$585.00 |
$425.55
|
|
Kras gene addl variants
|
$875.00 |
$875.00 |
$875.00 |
$384.80
|
