|
Insert uteri tandem/ovoids
|
$1,750.00 |
$1,750.00 |
$1,750.00 |
$3,986.00
|
|
Insert vad art access left hrt arterial access
|
$2,000.00 |
$2,000.00 |
$2,000.00 |
$5,062.80
|
|
Ins icd gen exist mlt leads
|
$10,000.00 |
$10,000.00 |
$10,000.00 |
$31,286.77
|
|
Ins icd gen exist sgl lead
|
$9,150.00 |
$9,150.00 |
$9,150.00 |
$24,159.72
|
|
In situ hybridization per specimen each additional single probe stain
|
$81.25 |
$81.25 |
$81.25 |
$251.55
|
|
In situ hybridization per specimen initial single probe stain
|
$81.25 |
$81.25 |
$81.25 |
$338.40
|
|
Ins picad w subq port 5yr>
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$4,341.66
|
|
Ins pm gen w/exist mlt leads
|
$5,775.00 |
$5,775.00 |
$5,775.00 |
$15,600.75
|
|
Ins pq tunnld ip cath w/img
|
$1,750.00 |
$1,750.00 |
$1,750.00 |
$5,593.60
|
|
Ins/rpl ldless pm right vent w img & eval
|
$8,750.00 |
$8,750.00 |
$8,750.00 |
$24,135.54
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$7,500.00 |
$7,500.00 |
$7,500.00 |
$25,106.90
|
|
Inst fibrinolysis agent ini day
|
$375.00 |
$375.00 |
$375.00 |
$1,095.00
|
|
Insti hexaminolevulinate hcl
|
$927.68 |
$927.68 |
$927.68 |
$2,359.80
|
|
Instillation anticarcinogenic agent bladder
|
$400.00 |
$400.00 |
$400.00 |
$721.50
|
|
Instill, bupivac and meloxic
|
$46.67 |
$46.67 |
$46.67 |
$786.78
|
|
Ins tun cv cath wo subq prt/pm
|
$2,737.50 |
$2,737.50 |
$2,737.50 |
$5,888.85
|
|
Ins tun cv cath wo subq prt/pm
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$4,748.00
|
|
Ins tun intraperit dia cath
|
$1,750.00 |
$1,750.00 |
$1,750.00 |
$4,657.46
|
|
Insulin total
|
$35.00 |
$35.00 |
$35.00 |
$67.60
|
|
Interdiscal perq aspir dx
|
$557.50 |
$557.50 |
$557.50 |
$1,222.26
|
|
Interferon alfa-2b inj
|
$443.30 |
$443.30 |
$443.30 |
$559.83
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$3,853.81 |
$3,853.81 |
$3,853.81 |
$6,283.01
|
|
Intracard echo interv w/s&i
|
$1,450.00 |
$1,450.00 |
$1,450.00 |
$3,982.59
|
|
Intrinsic factor antibody
|
$26.25 |
$26.25 |
$26.25 |
$59.95
|
|
Intro cath dialysis circuit
|
$625.00 |
$625.00 |
$625.00 |
$2,317.80
|
|
Intro cath dialysis circuit w/pta
|
$3,000.00 |
$3,000.00 |
$3,000.00 |
$8,761.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$3,750.00 |
$3,750.00 |
$3,750.00 |
$15,625.00
|
|
Intro catheter aorta
|
$200.00 |
$200.00 |
$200.00 |
$1,861.61
|
|
Intro cath svc/ivc
|
$200.00 |
$200.00 |
$200.00 |
$1,350.75
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$875.00 |
$875.00 |
$875.00 |
$3,510.75
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$375.00 |
$375.00 |
$375.00 |
$1,825.16
|
|
Intubation endotracheal emergency procedure
|
$130.00 |
$130.00 |
$130.00 |
$617.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$185.00 |
$185.00 |
$185.00 |
$153.03
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$1,021.08 |
$1,021.08 |
$1,021.08 |
$153.98
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$142,745.06 |
$142,745.06 |
$142,745.06 |
$55,747.24
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$58.25 |
$58.25 |
$58.25 |
$198.22
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$11,682.12 |
$11,682.12 |
$11,682.12 |
$5,626.93
|
|
Iron
|
$31.25 |
$31.25 |
$31.25 |
$70.72
|
|
Iron binding capacity
|
$40.00 |
$40.00 |
$40.00 |
$63.00
|
|
Iron dextran 50 mg/ml injection solution
|
$40.12 |
$40.12 |
$40.12 |
$73.22
|
|
Iron stain peripheral blood
|
$6.00 |
$6.00 |
$6.00 |
$17.60
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$253.51 |
$253.51 |
$253.51 |
$162.68
|
|
Irradiation of blood product each unit reference
|
$27.50 |
$27.50 |
$27.50 |
$124.24
|
|
Irrigation implantable venous access device for drug delivery systems
|
$50.00 |
$50.00 |
$50.00 |
$154.50
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$3,388.62 |
$3,388.62 |
$3,388.62 |
$8,273.35
|
|
Ivc venogram s&i
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$3,332.55
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$62.50 |
$62.50 |
$62.50 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$43.75 |
$43.75 |
$43.75 |
$174.40
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$93.75 |
$93.75 |
$93.75 |
$155.00
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$190.00 |
$190.00 |
$190.00 |
$460.85
|
|
Ixabepilone 15 mg intravenous solution
|
$4,460.19 |
$4,460.19 |
$4,460.19 |
$10,695.32
|
|
Jak2 targeted sequence analysis
|
$100.00 |
$100.00 |
$100.00 |
$378.30
|
|
John cunningham antibody
|
$20.00 |
$20.00 |
$20.00 |
$48.57
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$25.00 |
$25.00 |
$25.00 |
$56.61
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$25.09 |
$25.09 |
$25.09 |
$29.52
|
|
Kidney imag w/bld flow multi
|
$575.00 |
$575.00 |
$575.00 |
$1,566.50
|
|
Kidney img w/bldflw sgl without rx
|
$575.00 |
$575.00 |
$575.00 |
$1,468.04
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$350.00 |
$350.00 |
$350.00 |
$668.25
|
|
Kit cast tcc 3in w/2reg boots total contact cast
|
$100.00 |
$100.00 |
$100.00 |
$103.20
|
|
Kit sound processor cochlear osia 2
|
$4,210.75 |
$4,210.75 |
$4,210.75 |
$10,472.03
|
|
Knee MRI (with and without contrast)
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$2,950.00
|
|
Knee MRI (with contrast)
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$950.00 |
$950.00 |
$950.00 |
$2,181.10
|
|
Knee X-ray
|
$162.50 |
$162.50 |
$162.50 |
$443.90
|
|
Kyleena, 19.5 mg
|
$4,518.43 |
$4,518.43 |
$4,518.43 |
$2,211.85
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$25.05 |
$25.05 |
$25.05 |
$172.80
|
|
Lactate dehydrogenase (ldh)
|
$31.25 |
$31.25 |
$31.25 |
$53.30
|
|
Lactated ringers intravenous solution
|
$2.38 |
$2.38 |
$2.38 |
$48.00
|
|
Lactic acid
|
$56.25 |
$56.25 |
$56.25 |
$102.90
|
|
Lactoferrin fecal qualitative
|
$25.00 |
$25.00 |
$25.00 |
$88.40
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$20,471.45 |
$20,471.45 |
$20,471.45 |
$20,471.45
|
|
Laronidase injection
|
$131.01 |
$131.01 |
$131.01 |
$749.39
|
|
Lead acuity x4 spiral l 86cm
|
$2,668.29 |
$2,668.29 |
$2,668.29 |
$5,831.00
|
|
Lead capillary
|
$35.00 |
$35.00 |
$35.00 |
$62.40
|
|
Lead ingevity 45cm pfret MRI
|
$529.32 |
$529.32 |
$529.32 |
$3,854.16
|
|
Lead tachy durata sj4 58cm
|
$3,703.86 |
$3,703.86 |
$3,703.86 |
$6,656.44
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$500.00 |
$500.00 |
$500.00 |
$1,100.74
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$234.69 |
$234.69 |
$234.69 |
$1,654.19
|
|
Lens iol ant bicnvx 24.0 multi
|
$213.75 |
$213.75 |
$213.75 |
$1,136.25
|
|
Lens iol ant chamb 10.5
|
$170.68 |
$170.68 |
$170.68 |
$213.82
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$346.49 |
$346.49 |
$346.49 |
$164.09
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$47,906.12 |
$47,906.12 |
$47,906.12 |
$4,196.00
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$104,501.51 |
$104,501.51 |
$104,501.51 |
$6,972.00
|
|
Leuprolide depot cipla 7.5mg
|
$1,390.72 |
$1,390.72 |
$1,390.72 |
$257.70
|
|
Levalbuterol non-comp unit
|
$11.90 |
$11.90 |
$11.90 |
$8.71
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$5.45 |
$5.45 |
$5.45 |
$80.94
|
|
Levetiracetam therapeutic drug level
|
$35.00 |
$35.00 |
$35.00 |
$71.40
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$11.76 |
$11.76 |
$11.76 |
$62.72
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$160.00 |
$160.00 |
$160.00 |
$420.60
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$115.80 |
$115.80 |
$115.80 |
$38.00
|
|
Lidocaine therapeutic drug level
|
$35.00 |
$35.00 |
$35.00 |
$83.85
|
|
Liletta, 52 mg
|
$3,466.04 |
$3,466.04 |
$3,466.04 |
$1,790.04
|
|
Lincomycin injection
|
$34.57 |
$34.57 |
$34.57 |
$13.41
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$5.60 |
$5.60 |
$5.60 |
$159.12
|
|
Lipase
|
$40.00 |
$40.00 |
$40.00 |
$83.20
|
|
Lipoprotein blood quant
|
$43.75 |
$43.75 |
$43.75 |
$103.00
|
|
Lipoprotein direct measurement hdl
|
$18.75 |
$18.75 |
$18.75 |
$55.90
|
|
Lipoprotein direct measurement ldl
|
$31.25 |
$31.25 |
$31.25 |
$60.00
|
|
Lisocabtagene mara car pos t
|
$1,965,000.00 |
$1,965,000.00 |
$1,965,000.00 |
$1,578,304.84
|
|
Lithium therapeutic drug level
|
$31.25 |
$31.25 |
$31.25 |
$67.60
|
