|
IV njx tst vasc flo flap/grf
|
$584.55 |
$584.55 |
$584.55 |
$476.00
|
|
IV Push Injection (each additional drug)
|
$211.95 |
$211.95 |
$211.95 |
$166.80
|
|
IV Push Injection (first drug)
|
$394.65 |
$394.65 |
$394.65 |
$254.52
|
|
Ivp w/nephrotomography
|
$1,396.95 |
$1,396.95 |
$1,396.95 |
$729.00
|
|
Ivp w/wo kub w/wo tomography
|
$1,396.95 |
$1,396.95 |
$1,396.95 |
$713.40
|
|
Ixabepilone 15 mg intravenous solution
|
$21,687.75 |
$21,687.75 |
$21,687.75 |
$10,695.32
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$1,054.10 |
$1,054.10 |
$1,054.10 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$594.10 |
$594.10 |
$594.10 |
$362.05
|
|
Jejunstmy tube plcmt
|
$2,965.70 |
$2,965.70 |
$2,965.70 |
$2,174.40
|
|
John cunningham antibody
|
$37.00 |
$37.00 |
$37.00 |
$78.60
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$226.75 |
$226.75 |
$226.75 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$17.82 |
$17.82 |
$17.82 |
$23.50
|
|
Kidney endoscopy
|
$3,441.30 |
$3,441.30 |
$3,441.30 |
$5,728.00
|
|
Kidney function study
|
$765.60 |
$765.60 |
$765.60 |
$935.22
|
|
Kidney imag w/bld flow multi
|
$2,931.95 |
$2,931.95 |
$2,931.95 |
$1,566.50
|
|
Kidney img w/bldflw sgl without rx
|
$2,093.35 |
$2,093.35 |
$2,093.35 |
$1,427.40
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$1,040.15 |
$1,040.15 |
$1,040.15 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$783.00 |
$783.00 |
$783.00 |
$492.25
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$4,700.00 |
$4,700.00 |
$4,700.00 |
$9,423.50
|
|
Kit gene analys d816 variant
|
$1,096.05 |
$1,096.05 |
$1,096.05 |
$374.40
|
|
Kit hfx iq ipg bundle
|
$22,500.00 |
$22,500.00 |
$22,500.00 |
$33,859.00
|
|
Kit lead specify 5-6-5
|
$7,500.00 |
$7,500.00 |
$7,500.00 |
$16,672.10
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$12,750.00 |
$12,750.00 |
$12,750.00 |
$360.12
|
|
Knee MRI (with and without contrast)
|
$6,736.70 |
$6,736.70 |
$6,736.70 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$3,945.95 |
$3,945.95 |
$3,945.95 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$3,614.95 |
$3,614.95 |
$3,614.95 |
$2,122.12
|
|
Knee X-ray
|
$534.95 |
$534.95 |
$534.95 |
$428.12
|
|
Knee X-ray (1 to 2 views, both knees)
|
$393.95 |
$393.95 |
$393.95 |
$291.20
|
|
Knee X-ray (3 views, both knees)
|
$503.65 |
$503.65 |
$503.65 |
$363.60
|
|
Knee X-ray (standing, both knees)
|
$460.70 |
$460.70 |
$460.70 |
$252.50
|
|
Ko elastic w/joints pre ots
|
$262.60 |
$262.60 |
$262.60 |
$137.05
|
|
Kras gene addl variants
|
$524.70 |
$524.70 |
$524.70 |
$387.20
|
|
Kras gene variants exon 2
|
$524.70 |
$524.70 |
$524.70 |
$536.20
|
|
Kyleena, 19.5 mg
|
$4,919.91 |
$4,919.91 |
$4,919.91 |
$2,125.00
|
|
Lab draw < 3 yrs fem/jugular 36400
|
$264.85 |
$264.85 |
$264.85 |
$109.20
|
|
Lab draw <3 yrs scalp vein 36405
|
$261.90 |
$261.90 |
$261.90 |
$70.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$48.87 |
$48.87 |
$48.87 |
$33.60
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$1,008.58 |
$1,008.58 |
$1,008.58 |
$175.92
|
|
Lactate dehydrogenase (ldh)
|
$110.15 |
$110.15 |
$110.15 |
$55.50
|
|
Lactated ringers intravenous solution
|
$174.77 |
$174.77 |
$174.77 |
$43.74
|
|
Lactation class
|
$60.20 |
$60.20 |
$60.20 |
$104.96
|
|
Lactic acid
|
$218.90 |
$218.90 |
$218.90 |
$107.00
|
|
Lap gastric bypass/roux-en-y
|
$5,686.85 |
$5,686.85 |
$5,686.85 |
$3,805.56
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$734.10 |
$734.10 |
$734.10 |
$740.40
|
|
Largsc w/rmvl foreign bdy(s)
|
$837.00 |
$837.00 |
$837.00 |
$765.97
|
|
Laryngeal function studies
|
$207.40 |
$207.40 |
$207.40 |
$335.40
|
|
Laryngoscopic sensory vid
|
$685.45 |
$685.45 |
$685.45 |
$323.20
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$3,757.50 |
$3,757.50 |
$3,757.50 |
$2,514.60
|
|
Laryngoscopy w/fb removal
|
$3,259.50 |
$3,259.50 |
$3,259.50 |
$2,854.09
|
|
Lead acuity x4 spiral l 86cm
|
$2,200.00 |
$2,200.00 |
$2,200.00 |
$5,460.00
|
|
Lead capillary
|
$134.80 |
$134.80 |
$134.80 |
$57.50
|
|
Lead ingevity 45cm pfret MRI
|
$475.00 |
$475.00 |
$475.00 |
$2,887.50
|
|
Lead tachy durata sj4 58cm
|
$3,880.00 |
$3,880.00 |
$3,880.00 |
$8,202.66
|
|
Leg Artery Ultrasound (complete, both legs)
|
$2,312.95 |
$2,312.95 |
$2,312.95 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$2,716.15 |
$2,716.15 |
$2,716.15 |
$1,612.00
|
|
Leg CT Scan (without contrast, both legs)
|
$2,599.70 |
$2,599.70 |
$2,599.70 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,963.00 |
$1,963.00 |
$1,963.00 |
$1,092.58
|
|
Leishmania antibody
|
$25.60 |
$25.60 |
$25.60 |
$58.50
|
|
Lens, intraocular (new tech)
|
$175.00 |
$175.00 |
$175.00 |
$589.05
|
|
Lens iol ant bicnvx 24.0 multi
|
$709.67 |
$709.67 |
$709.67 |
$1,044.75
|
|
Lens iol ant chamb 10.5
|
$150.00 |
$150.00 |
$150.00 |
$377.71
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$431.28 |
$431.28 |
$431.28 |
$162.76
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$16,963.50 |
$16,963.50 |
$16,963.50 |
$6,360.76
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$19,390.00 |
$19,390.00 |
$19,390.00 |
$8,348.12
|
|
Lev 1 hosp type b ed visit
|
$193.65 |
$193.65 |
$193.65 |
$186.98
|
|
Lev 2 hosp type b ed visit
|
$172.10 |
$172.10 |
$172.10 |
$359.65
|
|
Lev 3 hosp type b ed visit
|
$284.15 |
$284.15 |
$284.15 |
$598.15
|
|
Lev 4 hosp type b ed visit
|
$405.85 |
$405.85 |
$405.85 |
$915.40
|
|
Lev 5 hosp type b ed visit
|
$836.00 |
$836.00 |
$836.00 |
$1,542.68
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$407.18 |
$407.18 |
$407.18 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$369.65 |
$369.65 |
$369.65 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$50.10 |
$50.10 |
$50.10 |
$55.60
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$506.75 |
$506.75 |
$506.75 |
$420.60
|
|
L hrt cath chd nm/abn nt cnj
|
$5,505.20 |
$5,505.20 |
$5,505.20 |
$6,104.00
|
|
Liberta rc ipg
|
$33,895.00 |
$33,895.00 |
$33,895.00 |
$39,189.70
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$139.67 |
$139.67 |
$139.67 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$197.20 |
$197.20 |
$197.20 |
$39.75
|
|
Lifileucel til/dose 7.5b-72b snij
|
$0.07 |
$0.07 |
$0.07 |
$30,744.64
|
|
Ligation/major artery/extremity 37618
|
$8,224.45 |
$8,224.45 |
$8,224.45 |
$1,581.82
|
|
Ligation of shunt
|
$4,076.90 |
$4,076.90 |
$4,076.90 |
$2,258.50
|
|
Liletta, 52 mg
|
$4,627.79 |
$4,627.79 |
$4,627.79 |
$1,514.24
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$335.93 |
$335.93 |
$335.93 |
$119.81
|
|
Lipase
|
$142.75 |
$142.75 |
$142.75 |
$92.88
|
|
Lipoprotein blood high res frac & quant
|
$168.90 |
$168.90 |
$168.90 |
$87.00
|
|
Lipoprotein blood quant
|
$288.05 |
$288.05 |
$288.05 |
$97.53
|
|
Lipoprotein direct measurement hdl
|
$171.25 |
$171.25 |
$171.25 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$183.25 |
$183.25 |
$183.25 |
$61.60
|
|
Lip surgery procedure
|
$408.20 |
$408.20 |
$408.20 |
$334.50
|
|
Lithium therapeutic drug level
|
$197.15 |
$197.15 |
$197.15 |
$69.42
|
|
Lithotripsy transluminal coronary percutaneous
|
$4,844.30 |
$4,844.30 |
$4,844.30 |
$4,371.12
|
|
Liver Function Test
|
$260.40 |
$260.40 |
$260.40 |
$115.44
|
|
Liver imaging
|
$654.25 |
$654.25 |
$654.25 |
$1,109.00
|
|
Liver imag w/vasclr flow
|
$971.80 |
$971.80 |
$971.80 |
$1,227.60
|
|
Liver/spleen imag static only
|
$804.85 |
$804.85 |
$804.85 |
$1,135.20
|
|
Liver/spleen imag w/vasclr flow
|
$1,656.45 |
$1,656.45 |
$1,656.45 |
$1,069.20
|
|
Lngth/shrt tendon leg/ankle 1 tendon
|
$1,043.85 |
$1,043.85 |
$1,043.85 |
$3,839.54
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$14.48 |
$14.48 |
$14.48 |
$37.20
|
|
Low cost skin substitute app
|
$1,762.50 |
$1,762.50 |
$1,762.50 |
$933.60
|
|
Low cost skin substitute app
|
$2,999.55 |
$2,999.55 |
$2,999.55 |
$2,164.64
|
|
Low cost skin substitute app
|
$1,762.50 |
$1,762.50 |
$1,762.50 |
$1,018.50
|
