|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$5.31 |
$5.31 |
$5.77 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$43.70 |
$43.70 |
$126.50 |
$144.62
|
|
Ivc venogram s&i
|
$836.74 |
$836.74 |
$1,850.00 |
$3,316.95
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$77.00 |
$77.00 |
$192.74 |
$190.56
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$36.34 |
$36.34 |
$69.50 |
$159.00
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$44.62 |
$44.62 |
$74.50 |
$153.60
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$224.94 |
$224.94 |
$256.50 |
$437.45
|
|
Ivp w/nephrotomography
|
$842.00 |
$842.00 |
$842.00 |
$748.15
|
|
Ivp w/wo kub w/wo tomography
|
$561.50 |
$561.50 |
$561.50 |
$692.18
|
|
Ixabepilone 15 mg intravenous solution
|
$2,672.14 |
$2,672.14 |
$2,904.49 |
$10,695.32
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$15.18 |
$15.18 |
$111.00 |
$58.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$2.18 |
$2.18 |
$2.36 |
$23.77
|
|
Kidney function study
|
$434.50 |
$434.50 |
$434.50 |
$968.50
|
|
Kidney imaging morphology
|
$602.00 |
$602.00 |
$602.00 |
$785.00
|
|
Kidney imag w/bld flow multi
|
$383.64 |
$383.64 |
$1,320.00 |
$1,557.41
|
|
Kidney img w/bldflw sgl without rx
|
$383.64 |
$383.64 |
$982.00 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$197.34 |
$197.34 |
$247.50 |
$673.36
|
|
Kit case 4.2mm spinejack
|
$3,879.70 |
$3,879.70 |
$4,217.07 |
$7,751.14
|
|
Kit cath f 8f w/glv + wipe ster
|
$11.62 |
$11.62 |
$12.63 |
$9.49
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$4,864.50 |
$4,864.50 |
$5,287.50 |
$9,482.25
|
|
Kit lead specify 5-6-5
|
$31,272.87 |
$31,272.87 |
$33,992.25 |
$16,965.41
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$500.03 |
$500.03 |
$543.51 |
$1,667.50
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$1,071.23 |
$1,071.23 |
$1,164.38 |
$923.90
|
|
Kit sound processor cochlear osia 2
|
$3,278.88 |
$3,278.88 |
$3,564.00 |
$8,425.00
|
|
Knee MRI (with and without contrast)
|
$2,074.00 |
$2,074.00 |
$2,074.00 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$1,947.00 |
$1,947.00 |
$1,947.00 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$1,583.00 |
$1,583.00 |
$1,583.00 |
$2,110.76
|
|
Knee X-ray
|
$162.84 |
$162.84 |
$319.00 |
$425.55
|
|
Lab draw < 3 yrs fem/jugular 36400
|
$34.00 |
$34.00 |
$34.00 |
$109.20
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$2.99 |
$2.99 |
$3.25 |
$33.60
|
|
Lab pathology consultation
|
$69.00 |
$69.00 |
$69.00 |
$48.44
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$2.09 |
$2.09 |
$2.27 |
$175.92
|
|
Lactate dehydrogenase (ldh)
|
$18.40 |
$18.40 |
$58.50 |
$55.50
|
|
Lactated ringers intravenous solution
|
$0.01 |
$0.01 |
$0.01 |
$44.91
|
|
Lactic acid
|
$59.34 |
$59.34 |
$126.50 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$53.36 |
$53.36 |
$57.00 |
$81.00
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$8,418.00 |
$8,418.00 |
$9,150.00 |
$19,124.00
|
|
Largsc w/rmvl foreign bdy(s)
|
$769.50 |
$769.50 |
$769.50 |
$765.97
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$1,167.50 |
$1,167.50 |
$1,167.50 |
$2,480.71
|
|
Laryngoscopy w/w/o tracheoscopy aspiration
|
$288.42 |
$288.42 |
$301.50 |
$800.25
|
|
Lead acuity x4 spiral l 86cm
|
$3,375.00 |
$3,375.00 |
$4,719.60 |
$5,534.00
|
|
Lead capillary
|
$47.38 |
$47.38 |
$73.50 |
$55.25
|
|
Lead ingevity 45cm pfret MRI
|
$2,693.76 |
$2,693.76 |
$2,928.00 |
$3,047.96
|
|
Lead tachy durata sj4 58cm
|
$6,229.32 |
$6,229.32 |
$6,771.00 |
$8,204.74
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$601.68 |
$601.68 |
$1,077.50 |
$1,092.58
|
|
Lens, intraocular (new tech)
|
$545.10 |
$545.10 |
$592.50 |
$589.05
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$227.70 |
$227.70 |
$247.50 |
$1,050.40
|
|
Lens iol ant bicnvx 24.0 multi
|
$1,144.25 |
$1,144.25 |
$1,243.75 |
$1,044.75
|
|
Lens iol ant chamb 10.5
|
$401.74 |
$401.74 |
$436.67 |
$377.71
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$36.27 |
$36.27 |
$39.42 |
$164.09
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$446.99 |
$446.99 |
$485.85 |
$6,236.52
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$2,273.29 |
$2,273.29 |
$2,470.96 |
$9,107.80
|
|
Leuprolide depot cipla 7.5mg
|
$573.91 |
$573.91 |
$623.81 |
$623.81
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$4.84 |
$4.84 |
$5.26 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$72.68 |
$72.68 |
$106.50 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$0.06 |
$0.06 |
$0.06 |
$55.60
|
|
Liberta rc ipg
|
$31,500.16 |
$31,500.16 |
$34,239.30 |
$39,406.68
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$0.62 |
$0.62 |
$0.67 |
$46.02
|
|
Lidocaine therapeutic drug level
|
$97.00 |
$97.00 |
$128.34 |
$87.45
|
|
Lifileucel til/dose 7.5b-72b snij
|
$1,953.87 |
$1,953.87 |
$2,123.77 |
$30,744.64
|
|
Ligation/biopsy of temporal artery 37609
|
$2,943.08 |
$2,943.08 |
$2,943.08 |
$3,322.80
|
|
Liletta, 52 mg
|
$274.31 |
$274.31 |
$298.16 |
$1,514.24
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$0.05 |
$0.05 |
$0.05 |
$121.00
|
|
Lipase
|
$30.36 |
$30.36 |
$110.00 |
$91.65
|
|
Lipoprotein blood quant
|
$23.50 |
$23.50 |
$107.64 |
$97.53
|
|
Lipoprotein direct measurement hdl
|
$16.10 |
$16.10 |
$36.50 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$31.28 |
$31.28 |
$94.00 |
$61.60
|
|
Lithium therapeutic drug level
|
$44.16 |
$44.16 |
$126.00 |
$69.42
|
|
Lithotripsy transluminal coronary percutaneous
|
$3,525.44 |
$3,525.44 |
$3,525.44 |
$4,113.20
|
|
Liver Function Test
|
$34.50 |
$34.50 |
$153.50 |
$115.44
|
|
Liver imaging
|
$445.50 |
$445.50 |
$445.50 |
$1,143.00
|
|
Liver imag w/vasclr flow
|
$343.16 |
$343.16 |
$343.16 |
$1,227.60
|
|
Liver/spleen imag static only
|
$343.16 |
$343.16 |
$551.50 |
$1,123.50
|
|
Liver/spleen imag w/vasclr flow
|
$343.16 |
$343.16 |
$343.16 |
$1,069.20
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$1.16 |
$1.16 |
$1.26 |
$37.37
|
|
Low cost skin substitute app
|
$432.00 |
$432.00 |
$432.00 |
$933.60
|
|
Low cost skin substitute app
|
$508.50 |
$508.50 |
$508.50 |
$2,147.57
|
|
Low cost skin substitute app
|
$432.00 |
$432.00 |
$432.00 |
$1,012.00
|
|
Low cost skin substitute app
|
$648.00 |
$648.00 |
$648.00 |
$1,009.49
|
|
Low cost skin substitute app
|
$139.00 |
$139.00 |
$139.00 |
$428.35
|
|
Low cost skin substitute app
|
$335.50 |
$335.50 |
$335.50 |
$727.77
|
|
Low cost skin substitute app
|
$146.50 |
$146.50 |
$146.50 |
$408.04
|
|
Low cost skin substitute app
|
$373.00 |
$373.00 |
$373.00 |
$515.00
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,332.62 |
$1,332.62 |
$1,448.50 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,198.30 |
$1,198.30 |
$1,389.50 |
$1,804.80
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$714.84 |
$714.84 |
$1,177.50 |
$1,470.00
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$1,312.38 |
$1,312.38 |
$2,185.00 |
$3,070.20
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,884.00 |
$1,884.00 |
$1,884.00 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,583.00 |
$1,583.00 |
$1,583.00 |
$2,065.69
|
|
Lower Back (Lumbar Spine) X-ray
|
$149.50 |
$149.50 |
$341.50 |
$356.16
|
|
Lso flex no ri stays pre ots
|
$284.96 |
$284.96 |
$309.74 |
$164.80
|
|
Lumbar diskogram s&i
|
$1,723.00 |
$1,723.00 |
$1,723.00 |
$2,358.23
|
|
Lung function test (mbc/mvv)
|
$63.94 |
$63.94 |
$180.50 |
$180.16
|
|
Lung Function Test (Spirometry)
|
$198.72 |
$198.72 |
$208.00 |
$295.35
|
|
Lung perfusion imaging
|
$256.22 |
$256.22 |
$879.00 |
$1,059.97
|
|
Lurbinectedin 4 mg intravenous solution
|
$3,173.23 |
$3,173.23 |
$3,449.16 |
$19,182.33
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$5,455.71 |
$5,455.71 |
$5,930.11 |
$22,210.87
|
|
Lutetium lu 177 dotatat ther
|
$21,850.00 |
$21,850.00 |
$23,750.00 |
$333.50
|
|
Lymphatics/lymph node imaging
|
$1,098.50 |
$1,098.50 |
$1,098.50 |
$1,463.22
|
|
Macroscopic exam parasite
|
$22.00 |
$22.00 |
$22.00 |
$36.55
|
