|
Inj, acetaminophen (b braun)
|
$97.88 |
$97.88 |
$97.88 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$95.88 |
$95.88 |
$95.88 |
$36.60
|
|
Inj alymsys 10 mg
|
$2,078.72 |
$2,078.72 |
$2,078.72 |
$1,280.74
|
|
Inj., benralizumab, 1 mg
|
$8,081.14 |
$8,081.14 |
$8,081.14 |
$11,310.00
|
|
Inj, cefepime hcl (b braun)
|
$129.07 |
$129.07 |
$129.07 |
$69.85
|
|
Inj, daptomycin (baxter)
|
$180.24 |
$180.24 |
$180.24 |
$1.83
|
|
Inj disk cerv-thor ea lev
|
$2,373.60 |
$2,373.60 |
$2,373.60 |
$875.28
|
|
Injection, daratumumab 10 mg
|
$2,485.45 |
$2,485.45 |
$2,485.45 |
$5,324.34
|
|
Injection for bladder x-ray
|
$771.20 |
$771.20 |
$771.20 |
$459.20
|
|
Injection, fulvestrant
|
$1,486.30 |
$1,486.30 |
$1,486.30 |
$1,719.16
|
|
Injection, inclisiran, 1 mg
|
$5,260.16 |
$5,260.16 |
$5,260.16 |
$6,679.35
|
|
Injection,onabotulinumtoxina
|
$1,983.20 |
$1,983.20 |
$1,983.20 |
$2,277.65
|
|
Injection, renflexis
|
$895.69 |
$895.69 |
$895.69 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,168.80 |
$1,168.80 |
$1,168.80 |
$1,043.72
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$667.20 |
$667.20 |
$667.20 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$608.80 |
$608.80 |
$608.80 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$183.20 |
$183.20 |
$183.20 |
$145.60
|
|
Inj. fe derisomaltose 10 mg
|
$5,048.82 |
$5,048.82 |
$5,048.82 |
$3,221.52
|
|
Inj hydroxocobalamin IV 25mg
|
$1,541.19 |
$1,541.19 |
$1,541.19 |
$2,452.32
|
|
Inj intralesional <= 7 lsn(s)
|
$272.00 |
$272.00 |
$272.00 |
$235.13
|
|
Inj, levothyroxine, freskabi
|
$86.52 |
$86.52 |
$86.52 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$21.55 |
$21.55 |
$21.55 |
$45.60
|
|
Inj, micafungin (par pharm)
|
$70.02 |
$70.02 |
$70.02 |
$79.08
|
|
Inj octafluoropropane mic,ml
|
$191.20 |
$191.20 |
$191.20 |
$211.40
|
|
Inj ogivri 10 mg
|
$1,501.52 |
$1,501.52 |
$1,501.52 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$62.07 |
$62.07 |
$62.07 |
$34.67
|
|
Inj proc lumbr disk ea lvl
|
$2,721.60 |
$2,721.60 |
$2,721.60 |
$1,106.93
|
|
Inj, releuko 1 mcg
|
$118.76 |
$118.76 |
$118.76 |
$475.36
|
|
Inj retacrit esrd on dialysi
|
$335.69 |
$335.69 |
$335.69 |
$349.45
|
|
Inj testosterone cypionate
|
$62.80 |
$62.80 |
$62.80 |
$64.96
|
|
Inj, uzedy, 1 mg
|
$3,683.20 |
$3,683.20 |
$3,683.20 |
$11,475.96
|
|
Inj vasopressin (am reg) 1 u
|
$62.36 |
$62.36 |
$62.36 |
$41.79
|
|
Insertion catheter bladder non indwelling
|
$183.20 |
$183.20 |
$183.20 |
$208.01
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,937.60 |
$1,937.60 |
$1,937.60 |
$2,585.25
|
|
In situ hybridization per specimen initial single probe stain
|
$394.40 |
$394.40 |
$394.40 |
$338.40
|
|
Ins tun cv cath wo subq prt/pm
|
$6,042.40 |
$6,042.40 |
$6,042.40 |
$4,218.00
|
|
Insulin total
|
$132.80 |
$132.80 |
$132.80 |
$66.64
|
|
Intracranial complete study
|
$1,917.60 |
$1,917.60 |
$1,917.60 |
$881.50
|
|
Intrinsic factor antibody
|
$56.80 |
$56.80 |
$56.80 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$617.60 |
$617.60 |
$617.60 |
$601.28
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$20.00 |
$20.00 |
$20.00 |
$165.67
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$100.00 |
$100.00 |
$100.00 |
$279.10
|
|
Ipratropium bromide non-comp
|
$5.19 |
$5.19 |
$5.19 |
$4.06
|
|
Iron
|
$74.40 |
$74.40 |
$74.40 |
$75.00
|
|
Iron binding capacity
|
$74.40 |
$74.40 |
$74.40 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$87.64 |
$87.64 |
$87.64 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$66.59 |
$66.59 |
$66.59 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$237.60 |
$237.60 |
$237.60 |
$146.11
|
|
IV Fluids (each additional hour)
|
$179.20 |
$179.20 |
$179.20 |
$133.90
|
|
IV Fluids (first hour)
|
$596.80 |
$596.80 |
$596.80 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$191.20 |
$191.20 |
$191.20 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$384.00 |
$384.00 |
$384.00 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$244.00 |
$244.00 |
$244.00 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$551.20 |
$551.20 |
$551.20 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$240.80 |
$240.80 |
$240.80 |
$167.50
|
|
IV Push Injection (first drug)
|
$374.40 |
$374.40 |
$374.40 |
$252.76
|
|
Ivp w/wo kub w/wo tomography
|
$1,248.80 |
$1,248.80 |
$1,248.80 |
$713.40
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$486.40 |
$486.40 |
$486.40 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$540.00 |
$540.00 |
$540.00 |
$362.05
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$97.60 |
$97.60 |
$97.60 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$61.19 |
$61.19 |
$61.19 |
$23.52
|
|
Kidney function study
|
$1,944.80 |
$1,944.80 |
$1,944.80 |
$935.22
|
|
Kidney imag w/bld flow multi
|
$2,884.80 |
$2,884.80 |
$2,884.80 |
$1,566.50
|
|
Kidney img w/bldflw sgl without rx
|
$2,041.60 |
$2,041.60 |
$2,041.60 |
$1,433.22
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$996.80 |
$996.80 |
$996.80 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$728.80 |
$728.80 |
$728.80 |
$490.75
|
|
Knee MRI (with and without contrast)
|
$4,088.00 |
$4,088.00 |
$4,088.00 |
$3,022.20
|
|
Knee MRI (with contrast)
|
$3,437.60 |
$3,437.60 |
$3,437.60 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$2,818.40 |
$2,818.40 |
$2,818.40 |
$2,130.88
|
|
Knee X-ray
|
$540.00 |
$540.00 |
$540.00 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$372.80 |
$372.80 |
$372.80 |
$290.40
|
|
Knee X-ray (3 views, both knees)
|
$415.20 |
$415.20 |
$415.20 |
$363.60
|
|
Knee X-ray (standing, both knees)
|
$407.20 |
$407.20 |
$407.20 |
$251.20
|
|
Ko elastic w/joints pre ots
|
$84.80 |
$84.80 |
$84.80 |
$137.05
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$65.16 |
$65.16 |
$65.16 |
$33.60
|
|
Lactate dehydrogenase (ldh)
|
$82.40 |
$82.40 |
$82.40 |
$55.50
|
|
Lactated ringers intravenous solution
|
$80.00 |
$80.00 |
$80.00 |
$43.74
|
|
Lactic acid
|
$128.80 |
$128.80 |
$128.80 |
$107.10
|
|
Lactoferrin fecal qualitative
|
$197.60 |
$197.60 |
$197.60 |
$82.16
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$812.00 |
$812.00 |
$812.00 |
$740.40
|
|
Lead capillary
|
$128.80 |
$128.80 |
$128.80 |
$57.50
|
|
Leg Artery Ultrasound (complete, both legs)
|
$1,357.60 |
$1,357.60 |
$1,357.60 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$2,652.80 |
$2,652.80 |
$2,652.80 |
$1,585.20
|
|
Leg CT Scan (without contrast, both legs)
|
$2,307.20 |
$2,307.20 |
$2,307.20 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,336.80 |
$1,336.80 |
$1,336.80 |
$1,092.58
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$1,635.80 |
$1,635.80 |
$1,635.80 |
$6,360.76
|
|
Levalbuterol non-comp unit
|
$6.38 |
$6.38 |
$6.38 |
$6.48
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$60.98 |
$60.98 |
$60.98 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$160.00 |
$160.00 |
$160.00 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$70.23 |
$70.23 |
$70.23 |
$55.69
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$65.41 |
$65.41 |
$65.41 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$72.35 |
$72.35 |
$72.35 |
$39.75
|
|
Ligate leg veins radical 37760
|
$6,402.40 |
$6,402.40 |
$6,402.40 |
$3,439.84
|
|
Ligation/divis of long saph vein 37700
|
$6,522.40 |
$6,522.40 |
$6,522.40 |
$4,255.00
|
|
Ligation vericose vein cluster(s) 1 leg
|
$5,698.40 |
$5,698.40 |
$5,698.40 |
$3,724.63
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$153.12 |
$153.12 |
$153.12 |
$121.00
|
|
Lipase
|
$208.00 |
$208.00 |
$208.00 |
$93.58
|
|
Lipoprotein direct measurement hdl
|
$85.60 |
$85.60 |
$85.60 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$112.00 |
$112.00 |
$112.00 |
$61.60
|
|
Lithium therapeutic drug level
|
$84.80 |
$84.80 |
$84.80 |
$69.75
|