|
Initiation & management bipap/cpap initial day
|
$566.64 |
$566.64 |
$566.64 |
$576.00
|
|
Inj, biorphen, 20 micrograms
|
$0.69 |
$0.69 |
$0.69 |
$17.12
|
|
Inj cefazolin sodium, hikma
|
$5.06 |
$5.06 |
$5.06 |
$29.10
|
|
Inj cefazolin (wg crit care)
|
$3.41 |
$3.41 |
$3.41 |
$18.30
|
|
Inj ceftolozane tazobactam
|
$27.42 |
$27.42 |
$27.42 |
$408.00
|
|
Inj, clindamycin (baxter)
|
$65.52 |
$65.52 |
$65.52 |
$48.39
|
|
Inj cntr knee arthro incl ct/mri
|
$342.72 |
$342.72 |
$342.72 |
$436.80
|
|
Inj, cyclophosphamd, sandoz
|
$10.74 |
$10.74 |
$10.74 |
$735.20
|
|
Injection arthrography hip without anesthesia (both sides)
|
$182.16 |
$182.16 |
$182.16 |
$500.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$554.40 |
$554.40 |
$554.40 |
$504.90
|
|
Injection epidural blood patch or clot
|
$1,496.16 |
$1,496.16 |
$1,496.16 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$150.48 |
$150.48 |
$150.48 |
$441.12
|
|
Injection for bladder x-ray
|
$150.48 |
$150.48 |
$150.48 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$167.76 |
$167.76 |
$167.76 |
$494.65
|
|
Injection, fulvestrant
|
$335.07 |
$335.07 |
$335.07 |
$1,719.16
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,916.64 |
$1,916.64 |
$1,916.64 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,624.32 |
$1,624.32 |
$1,624.32 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,777.68 |
$1,777.68 |
$1,777.68 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,923.12 |
$1,923.12 |
$1,923.12 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$531.36 |
$531.36 |
$531.36 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,923.12 |
$1,923.12 |
$1,923.12 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$498.24 |
$498.24 |
$498.24 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,923.12 |
$1,923.12 |
$1,923.12 |
$1,961.05
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$662.40 |
$662.40 |
$662.40 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$554.40 |
$554.40 |
$554.40 |
$517.24
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$189.36 |
$189.36 |
$189.36 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$186.48 |
$186.48 |
$186.48 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$396.00 |
$396.00 |
$396.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$178.56 |
$178.56 |
$178.56 |
$135.20
|
|
Inj for mammo ductogram
|
$1,041.12 |
$1,041.12 |
$1,041.12 |
$433.50
|
|
Inj intralesional <= 7 lsn(s)
|
$429.12 |
$429.12 |
$429.12 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$331.53 |
$331.53 |
$331.53 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$1.21 |
$1.21 |
$1.21 |
$40.00
|
|
Inj, lidocaine w epinephrine
|
$0.32 |
$0.32 |
$0.32 |
$44.96
|
|
Inj meropenem (wg crit care)
|
$5.69 |
$5.69 |
$5.69 |
$77.97
|
|
Inj multihance
|
$15.93 |
$15.93 |
$15.93 |
$79.42
|
|
Inj nivolumab 2 mg hyaluron
|
$45.87 |
$45.87 |
$45.87 |
$14,110.18
|
|
Inj ogivri 10 mg
|
$194.41 |
$194.41 |
$194.41 |
$4,492.28
|
|
Inj retro urethrocysto
|
$98.64 |
$98.64 |
$98.64 |
$450.00
|
|
Inj w/fluor eval cv device
|
$455.04 |
$455.04 |
$455.04 |
$463.40
|
|
Ins cerv dilator (sep proc)
|
$656.64 |
$656.64 |
$656.64 |
$488.35
|
|
Insertion catheter bladder non indwelling
|
$370.80 |
$370.80 |
$370.80 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$444.96 |
$444.96 |
$444.96 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$5,911.92 |
$5,911.92 |
$5,911.92 |
$2,511.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,355.20 |
$3,355.20 |
$3,355.20 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$4,011.84 |
$4,011.84 |
$4,011.84 |
$2,414.10
|
|
In situ hybridization per specimen initial single probe stain
|
$650.16 |
$650.16 |
$650.16 |
$326.04
|
|
Instillation anticarcinogenic agent bladder
|
$1,253.52 |
$1,253.52 |
$1,253.52 |
$621.40
|
|
Insulin total
|
$115.92 |
$115.92 |
$115.92 |
$66.64
|
|
Intens cardiac rehab no exer
|
$274.32 |
$274.32 |
$274.32 |
$238.40
|
|
Intens cardiac rehab w/exerc
|
$274.32 |
$274.32 |
$274.32 |
$238.40
|
|
Intrinsic factor antibody
|
$43.92 |
$43.92 |
$43.92 |
$66.60
|
|
Intubation endotracheal emergency procedure
|
$690.48 |
$690.48 |
$690.48 |
$589.60
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$1.37 |
$1.37 |
$1.37 |
$279.10
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$24.77 |
$24.77 |
$24.77 |
$163.87
|
|
Iron
|
$120.96 |
$120.96 |
$120.96 |
$74.40
|
|
Iron binding capacity
|
$244.08 |
$244.08 |
$244.08 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$2.18 |
$2.18 |
$2.18 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$95.04 |
$95.04 |
$95.04 |
$119.83
|
|
Irrigation implantable venous access device for drug delivery systems
|
$206.64 |
$206.64 |
$206.64 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$223.92 |
$223.92 |
$223.92 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$223.92 |
$223.92 |
$223.92 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$223.92 |
$223.92 |
$223.92 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$405.36 |
$405.36 |
$405.36 |
$439.56
|
|
Jak2 targeted sequence analysis
|
$566.64 |
$566.64 |
$566.64 |
$379.87
|
|
John cunningham antibody
|
$1,989.36 |
$1,989.36 |
$1,989.36 |
$72.60
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$48.96 |
$48.96 |
$48.96 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$12.96 |
$12.96 |
$12.96 |
$23.50
|
|
Kidney imaging morphology
|
$962.64 |
$962.64 |
$962.64 |
$785.00
|
|
Kidney imag w/bld flow multi
|
$1,848.96 |
$1,848.96 |
$1,848.96 |
$1,570.65
|
|
Kidney img w/bldflw sgl without rx
|
$1,329.12 |
$1,329.12 |
$1,329.12 |
$1,427.40
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$1,145.52 |
$1,145.52 |
$1,145.52 |
$666.00
|
|
Kit gene analys d816 variant
|
$635.04 |
$635.04 |
$635.04 |
$374.61
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$187.20 |
$187.20 |
$187.20 |
$740.00
|
|
Knee Arthroscopy (Meniscus Repair)
|
$7,008.48 |
$7,008.48 |
$7,008.48 |
$5,148.00
|
|
Knee arthroscopy/surgery
|
$7,008.48 |
$7,008.48 |
$7,008.48 |
$4,183.50
|
|
Knee arthroscopy/surgery
|
$7,008.48 |
$7,008.48 |
$7,008.48 |
$4,499.12
|
|
Knee arthroscopy/surgery
|
$15,430.32 |
$15,430.32 |
$15,430.32 |
$8,453.60
|
|
Knee MRI (with and without contrast)
|
$3,672.00 |
$3,672.00 |
$3,672.00 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$3,111.84 |
$3,111.84 |
$3,111.84 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$3,006.00 |
$3,006.00 |
$3,006.00 |
$2,169.60
|
|
Knee X-ray
|
$601.20 |
$601.20 |
$601.20 |
$425.55
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$12.96 |
$12.96 |
$12.96 |
$32.34
|
|
Lactate dehydrogenase (ldh)
|
$120.96 |
$120.96 |
$120.96 |
$55.50
|
|
Lactated ringers intravenous solution
|
$32.40 |
$32.40 |
$32.40 |
$45.56
|
|
Lactation class
|
$254.16 |
$254.16 |
$254.16 |
$93.71
|
|
Lactic acid
|
$179.28 |
$179.28 |
$179.28 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$123.84 |
$123.84 |
$123.84 |
$80.40
|
|
Lactoferrin fecal quant
|
$205.20 |
$205.20 |
$205.20 |
$106.10
|
|
Largsc w/rmvl foreign bdy(s)
|
$838.80 |
$838.80 |
$838.80 |
$765.97
|
|
Lead capillary
|
$22.32 |
$22.32 |
$22.32 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,432.80 |
$1,432.80 |
$1,432.80 |
$1,088.26
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$44.85 |
$44.85 |
$44.85 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$1,561.05 |
$1,561.05 |
$1,561.05 |
$7,052.00
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$6,224.65 |
$6,224.65 |
$6,224.65 |
$9,107.80
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$0.27 |
$0.27 |
$0.27 |
$95.68
|
|
Levetiracetam therapeutic drug level
|
$73.44 |
$73.44 |
$73.44 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$32.76 |
$32.76 |
$32.76 |
$55.60
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$36.49 |
$36.49 |
$36.49 |
$385.62
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$2.59 |
$2.59 |
$2.59 |
$46.02
|