|
Initial nursing facility care/day low severity 99304
|
$137.80 |
$137.80 |
$137.80 |
$128.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,686.75 |
$1,686.75 |
$1,686.75 |
$1,214.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$779.35 |
$779.35 |
$779.35 |
$458.15
|
|
Injection,onabotulinumtoxina
|
$3,255.00 |
$3,255.00 |
$3,255.00 |
$2,277.65
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,126.45 |
$1,126.45 |
$1,126.45 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$21,780.02 |
$21,780.02 |
$21,780.02 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,767.50 |
$1,767.50 |
$1,767.50 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$6,399.90 |
$6,399.90 |
$6,399.90 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$5,964.15 |
$5,964.15 |
$5,964.15 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$5,856.90 |
$5,856.90 |
$5,856.90 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$6,848.28 |
$6,848.28 |
$6,848.28 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,058.23 |
$4,058.23 |
$4,058.23 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,781.55 |
$1,781.55 |
$1,781.55 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,006.85 |
$1,006.85 |
$1,006.85 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$779.35 |
$779.35 |
$779.35 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,142.05 |
$1,142.05 |
$1,142.05 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$742.30 |
$742.30 |
$742.30 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$8,725.63 |
$8,725.63 |
$8,725.63 |
$145.60
|
|
Inject sacroiliac joint
|
$877.50 |
$877.50 |
$877.50 |
$1,029.04
|
|
Inj epidural sgl cerv-thor without img
|
$227.50 |
$227.50 |
$227.50 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,736.15 |
$1,736.15 |
$1,736.15 |
$1,450.84
|
|
Inj labetalol hcl hikma, 5mg
|
$15.00 |
$15.00 |
$15.00 |
$41.79
|
|
Inj testosterone cypionate
|
$200.00 |
$200.00 |
$200.00 |
$64.96
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$73,182.85 |
$73,182.85 |
$73,182.85 |
$41,083.73
|
|
Insert drug delivery implant
|
$571.70 |
$571.70 |
$571.70 |
$280.00
|
|
Insert intrauterine device iud
|
$380.00 |
$380.00 |
$380.00 |
$347.10
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$602.55 |
$602.55 |
$602.55 |
$4,897.20
|
|
Insole orthotic freedom sz6 6816
|
$35.44 |
$35.44 |
$35.44 |
$84.00
|
|
Insulin total
|
$85.80 |
$85.80 |
$85.80 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$2,217.37 |
$2,217.37 |
$2,217.37 |
$8,617.32
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$152.42 |
$152.42 |
$152.42 |
$3,803.11
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$10,427.90 |
$10,427.90 |
$10,427.90 |
$10,427.90
|
|
Intrinsic factor antibody
|
$122.20 |
$122.20 |
$122.20 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$450.00 |
$450.00 |
$450.00 |
$601.28
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$1,773.82 |
$1,773.82 |
$1,773.82 |
$165.67
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$220.25 |
$220.25 |
$220.25 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$110,829.85 |
$110,829.85 |
$110,829.85 |
$62,692.46
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$522.90 |
$522.90 |
$522.90 |
$173.98
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$9,268.95 |
$9,268.95 |
$9,268.95 |
$5,517.12
|
|
Iron
|
$53.30 |
$53.30 |
$53.30 |
$75.00
|
|
Iron binding capacity
|
$63.05 |
$63.05 |
$63.05 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$185.90 |
$185.90 |
$185.90 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$82.80 |
$82.80 |
$82.80 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$163.15 |
$163.15 |
$163.15 |
$146.11
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$2,779.35 |
$2,779.35 |
$2,779.35 |
$8,273.35
|
|
IV Fluids (each additional hour)
|
$846.30 |
$846.30 |
$846.30 |
$133.90
|
|
IV Fluids (first hour)
|
$505.70 |
$505.70 |
$505.70 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$113.10 |
$113.10 |
$113.10 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$191.10 |
$191.10 |
$191.10 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$3,726.64 |
$3,726.64 |
$3,726.64 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$1,434.35 |
$1,434.35 |
$1,434.35 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$11,543.25 |
$11,543.25 |
$11,543.25 |
$167.50
|
|
IV Push Injection (first drug)
|
$1,308.77 |
$1,308.77 |
$1,308.77 |
$252.76
|
|
Ixabepilone 15 mg intravenous solution
|
$18,131.05 |
$18,131.05 |
$18,131.05 |
$10,695.32
|
|
Jkt lso inter
|
$48.98 |
$48.98 |
$48.98 |
$41.27
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$72.80 |
$72.80 |
$72.80 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$17.25 |
$17.25 |
$17.25 |
$23.52
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$603.85 |
$603.85 |
$603.85 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$261.09 |
$261.09 |
$261.09 |
$490.75
|
|
Kit case 4.2mm spinejack
|
$5,641.23 |
$5,641.23 |
$5,641.23 |
$7,177.60
|
|
Kit cast tcc 3in w/2reg boots total contact cast
|
$267.13 |
$267.13 |
$267.13 |
$174.00
|
|
Kit cath f 8f w/glv + wipe ster
|
$5.25 |
$5.25 |
$5.25 |
$9.49
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$6,110.00 |
$6,110.00 |
$6,110.00 |
$9,423.50
|
|
Kit hfx iq ipg bundle
|
$30,880.20 |
$30,880.20 |
$30,880.20 |
$33,859.00
|
|
Kit ipg optimizer smart
|
$33,800.00 |
$33,800.00 |
$33,800.00 |
$49,011.18
|
|
Kit irrigator stoma cone 7721
|
$8.22 |
$8.22 |
$8.22 |
$7.20
|
|
Kit lead specify 5-6-5
|
$12,783.33 |
$12,783.33 |
$12,783.33 |
$16,672.10
|
|
Kit monitr cath camino icp w/integratd licox bolt fitting
|
$1,168.83 |
$1,168.83 |
$1,168.83 |
$1,313.77
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$1,238.25 |
$1,238.25 |
$1,238.25 |
$1,635.87
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$243.11 |
$243.11 |
$243.11 |
$360.12
|
|
Kit sound processor cochlear osia 2
|
$5,801.69 |
$5,801.69 |
$5,801.69 |
$8,425.00
|
|
Kit trach suct cls 30.5cm
|
$2,983.50 |
$2,983.50 |
$2,983.50 |
$35.26
|
|
Knee Arthroscopy (Meniscus Trimming)
|
$9,979.22 |
$9,979.22 |
$9,979.22 |
$5,339.00
|
|
Knee MRI (with and without contrast)
|
$4,938.70 |
$4,938.70 |
$4,938.70 |
$3,022.20
|
|
Knee MRI (without contrast)
|
$3,903.25 |
$3,903.25 |
$3,903.25 |
$2,130.88
|
|
Knee X-ray
|
$483.60 |
$483.60 |
$483.60 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$266.50 |
$266.50 |
$266.50 |
$290.40
|
|
Knee X-ray (3 views, both knees)
|
$319.15 |
$319.15 |
$319.15 |
$363.60
|
|
Lactate dehydrogenase (ldh)
|
$48.75 |
$48.75 |
$48.75 |
$55.50
|
|
Lactated ringers intravenous solution
|
$20.00 |
$20.00 |
$20.00 |
$43.74
|
|
Lactic acid
|
$1,172.60 |
$1,172.60 |
$1,172.60 |
$107.10
|
|
Lactoferrin fecal qualitative
|
$126.75 |
$126.75 |
$126.75 |
$82.16
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$29,832.00 |
$29,832.00 |
$29,832.00 |
$19,124.00
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$1,397.50 |
$1,397.50 |
$1,397.50 |
$740.40
|
|
Lead acuity x4 spiral l 86cm
|
$2,730.00 |
$2,730.00 |
$2,730.00 |
$5,460.00
|
|
Lead capillary
|
$90.35 |
$90.35 |
$90.35 |
$57.50
|
|
Lead ingevity 45cm pfret MRI
|
$3,952.26 |
$3,952.26 |
$3,952.26 |
$2,928.00
|
|
Lead tachy durata sj4 58cm
|
$7,793.50 |
$7,793.50 |
$7,793.50 |
$8,202.66
|
|
Leg Artery Ultrasound (complete, both legs)
|
$880.75 |
$880.75 |
$880.75 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$2,269.15 |
$2,269.15 |
$2,269.15 |
$1,585.20
|
|
Leg CT Scan (without contrast, both legs)
|
$2,120.95 |
$2,120.95 |
$2,120.95 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$987.35 |
$987.35 |
$987.35 |
$1,092.58
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$419.25 |
$419.25 |
$419.25 |
$955.30
|
|
Lens iol ant bicnvx 24.0 multi
|
$692.25 |
$692.25 |
$692.25 |
$1,065.00
|
|
Lens iol ant chamb 10.5
|
$487.50 |
$487.50 |
$487.50 |
$377.71
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$396.40 |
$396.40 |
$396.40 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$37,312.35 |
$37,312.35 |
$37,312.35 |
$6,360.76
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$5,218.50 |
$5,218.50 |
$5,218.50 |
$8,348.12
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$48.30 |
$48.30 |
$48.30 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$130.00 |
$130.00 |
$130.00 |
$88.92
|