|
Ivc venogram s&i
|
$2,587.20 |
$2,587.20 |
$2,587.20 |
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$108.80 |
$108.80 |
$131.20 |
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$158.40 |
$158.40 |
$174.40 |
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$80.00 |
$80.00 |
$94.40 |
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$443.20 |
$443.20 |
$516.80 |
|
|
IV inj ra drug dx study
|
$786.40 |
$786.40 |
$786.40 |
|
|
Jak2 targeted sequence analysis
|
$435.20 |
$435.20 |
$435.20 |
|
|
John cunningham antibody
|
$47.20 |
$47.20 |
$47.20 |
|
|
J-tube placement
|
$208.80 |
$208.80 |
$208.80 |
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$84.80 |
$84.80 |
$84.80 |
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$70.04 |
$70.04 |
$75.07 |
|
|
Kidney endoscopy
|
$1,047.20 |
$1,047.20 |
$1,047.20 |
|
|
Kidney img w/bldflw sgl without rx
|
$1,282.40 |
$1,282.40 |
$1,282.40 |
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$591.20 |
$591.20 |
$626.40 |
|
|
Kit cast tcc 3in w/2reg boots total contact cast
|
$62.40 |
$62.40 |
$237.60 |
|
|
Kit cath f 8f w/glv + wipe ster
|
$7.77 |
$7.77 |
$7.77 |
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$6,467.20 |
$6,467.20 |
$6,467.20 |
|
|
Kit gene analys d816 variant
|
$382.40 |
$382.40 |
$382.40 |
|
|
Kit hfx iq ipg bundle
|
$18,600.00 |
$18,600.00 |
$18,600.00 |
|
|
Kit ipg optimizer smart
|
$30,160.00 |
$30,160.00 |
$30,160.00 |
|
|
Kit lead specify 5-6-5
|
$23,250.00 |
$23,250.00 |
$23,250.00 |
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$1,411.20 |
$1,411.20 |
$1,411.20 |
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$3,866.30 |
$3,866.30 |
$3,866.30 |
|
|
Kit sound processor cochlear osia 2
|
$7,686.72 |
$7,686.72 |
$7,686.72 |
|
|
Kit tissue closure sealant adhesive air leak progel 4 ml pleura
|
$1,876.99 |
$1,876.99 |
$1,876.99 |
|
|
Knee Arthroscopy (Cartilage Repair)
|
$917.60 |
$917.60 |
$917.60 |
|
|
Knee arthroscopy/drainage
|
$787.20 |
$787.20 |
$787.20 |
|
|
Knee arthroscopy dx
|
$841.60 |
$841.60 |
$841.60 |
|
|
Knee Arthroscopy (Meniscus Repair)
|
$960.00 |
$960.00 |
$960.00 |
|
|
Knee arthroscopy/surgery
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
|
|
Knee arthroscopy/surgery
|
$795.20 |
$795.20 |
$795.20 |
|
|
Knee arthroscopy/surgery
|
$792.00 |
$792.00 |
$792.00 |
|
|
Knee arthroscopy/surgery
|
$733.60 |
$733.60 |
$733.60 |
|
|
Knee arthroscopy/surgery
|
$964.00 |
$964.00 |
$964.00 |
|
|
Knee arthroscopy/surgery
|
$976.00 |
$976.00 |
$976.00 |
|
|
Knee arthroscopy/surgery
|
$830.40 |
$830.40 |
$830.40 |
|
|
Knee arthroscopy/surgery
|
$1,016.00 |
$1,016.00 |
$1,016.00 |
|
|
Knee arthroscopy/surgery
|
$972.80 |
$972.80 |
$972.80 |
|
|
Knee arthroscopy/surgery
|
$1,438.40 |
$1,438.40 |
$1,438.40 |
|
|
Knee MRI (with and without contrast)
|
$2,171.20 |
$2,171.20 |
$2,905.60 |
|
|
Knee MRI (with contrast)
|
$1,732.80 |
$1,732.80 |
$2,183.20 |
|
|
Knee MRI (without contrast)
|
$1,331.20 |
$1,331.20 |
$1,724.00 |
|
|
Knee X-ray
|
$256.00 |
$256.00 |
$260.80 |
|
|
Kras gene variants exon 2
|
$603.20 |
$603.20 |
$603.20 |
|
|
Kyleena, 19.5 mg
|
$1,008.00 |
$1,008.00 |
$3,741.30 |
|
|
Lab draw < 3 yrs fem/jugular 36400
|
$49.60 |
$49.60 |
$239.20 |
|
|
Lab draw <3 yrs scalp vein 36405
|
$120.00 |
$120.00 |
$120.00 |
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$75.96 |
$75.96 |
$76.99 |
|
|
Labioplasty 56800
|
$373.60 |
$373.60 |
$373.60 |
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$142.25 |
$142.25 |
$142.25 |
|
|
Lactate dehydrogenase (ldh)
|
$45.60 |
$45.60 |
$52.80 |
|
|
Lactated ringers intravenous solution
|
$36.28 |
$36.28 |
$36.28 |
|
|
Lactic acid
|
$87.20 |
$87.20 |
$118.40 |
|
|
Lactoferrin fecal qualitative
|
$83.20 |
$83.20 |
$83.20 |
|
|
Laparo-asst vag hysterectomy
|
$1,300.80 |
$1,300.80 |
$1,300.80 |
|
|
Laparo cholecystectomy/explr
|
$1,655.20 |
$1,655.20 |
$1,655.20 |
|
|
Laparo cholecystectomy/graph
|
$1,066.40 |
$1,066.40 |
$7,512.80 |
|
|
Laparo partial colectomy 44204
|
$2,260.00 |
$2,260.00 |
$2,260.00 |
|
|
Laparo proc abdm/per/oment 49329
|
$1,266.40 |
$1,266.40 |
$1,266.40 |
|
|
Laparoscopic myomectomy
|
$1,329.60 |
$1,329.60 |
$1,329.60 |
|
|
Laparoscopic salpingostomy 58673
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
|
|
Laparoscopy aspiration
|
$555.20 |
$555.20 |
$555.20 |
|
|
Laparoscopy biopsy
|
$509.60 |
$509.60 |
$509.60 |
|
|
Laparoscopy excise lesions
|
$1,049.60 |
$1,049.60 |
$1,049.60 |
|
|
Laparoscopy lymph node biop
|
$773.60 |
$773.60 |
$773.60 |
|
|
Laparoscopy lysis
|
$1,007.20 |
$1,007.20 |
$1,007.20 |
|
|
Laparoscopy remove adnexa
|
$961.60 |
$961.60 |
$961.60 |
|
|
Laparoscopy tubal block 58671
|
$549.60 |
$549.60 |
$549.60 |
|
|
Laparo sling operation 51992
|
$1,223.20 |
$1,223.20 |
$1,223.20 |
|
|
Laparo-vag hyst incl t/o
|
$1,445.60 |
$1,445.60 |
$1,445.60 |
|
|
Laparo-vag hyst w/t/o compl
|
$1,922.40 |
$1,922.40 |
$1,922.40 |
|
|
Lap enterectomy 44202
|
$2,046.40 |
$2,046.40 |
$2,046.40 |
|
|
Lap enterolysis
|
$1,360.80 |
$1,360.80 |
$1,360.80 |
|
|
Lap ing hernia repair init
|
$642.40 |
$642.40 |
$642.40 |
|
|
Lap jejunostomy 44186
|
$966.40 |
$966.40 |
$966.40 |
|
|
Lap paraesophag hern repair
|
$2,272.80 |
$2,272.80 |
$2,272.80 |
|
|
Lap resect s/intestine addl 44203
|
$355.20 |
$355.20 |
$355.20 |
|
|
Lap rmvl gastr adj all parts
|
$1,424.80 |
$1,424.80 |
$1,424.80 |
|
|
Largsc w/removal lesion
|
$4,091.20 |
$4,091.20 |
$4,091.20 |
|
|
Largsc w/rmvl foreign bdy(s)
|
$463.20 |
$463.20 |
$463.20 |
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$2,148.00 |
$2,148.00 |
$2,596.80 |
|
|
Laryngoscopy telescopic
|
$293.60 |
$293.60 |
$293.60 |
|
|
Laryngoscopy w/fb removal
|
$1,961.60 |
$1,961.60 |
$1,961.60 |
|
|
Laryngoscopy with biopsy
|
$397.60 |
$397.60 |
$1,961.60 |
|
|
Laryngoscopy w/w/o tracheoscopy aspiration
|
$463.20 |
$463.20 |
$463.20 |
|
|
Lateral canthopexy
|
$4,101.60 |
$4,101.60 |
$4,101.60 |
|
|
Lat retinacular release open
|
$672.80 |
$672.80 |
$672.80 |
|
|
Lavage cannulation maxillary sinus
|
$276.00 |
$276.00 |
$276.00 |
|
|
Lb with mastopexy 15839
|
$1,313.60 |
$1,313.60 |
$3,723.20 |
|
|
Lead acuity x4 spiral l 86cm
|
$5,488.00 |
$5,488.00 |
$5,488.00 |
|
|
Lead capillary
|
$112.80 |
$112.80 |
$112.80 |
|
|
Lead ingevity 45cm pfret MRI
|
$4,320.00 |
$4,320.00 |
$4,320.00 |
|
|
Lead tachy durata sj4 58cm
|
$4,716.00 |
$4,716.00 |
$4,716.00 |
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$932.00 |
$932.00 |
$1,153.60 |
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$1,870.60 |
$1,870.60 |
$1,870.60 |
|
|
Lens iol ant bicnvx 24.0 multi
|
$1,870.60 |
$1,870.60 |
$1,870.60 |
|
|
Lens iol ant chamb 10.5
|
$268.00 |
$268.00 |
$268.00 |
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$161.66 |
$161.66 |
$161.66 |
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$2,000.21 |
$2,000.21 |
$2,000.21 |
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$10,680.33 |
$10,680.33 |
$10,680.33 |
|