|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$438.60 |
$438.60 |
$438.60 |
$62,692.46
|
|
Ipratropium bromide non-comp
|
$0.20 |
$0.20 |
$0.20 |
$4.06
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$1,122.40 |
$1,122.40 |
$1,122.40 |
$173.98
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$118.80 |
$118.80 |
$118.80 |
$5,517.12
|
|
Iron
|
$30.60 |
$30.60 |
$30.60 |
$75.00
|
|
Iron binding capacity
|
$21.00 |
$21.00 |
$21.00 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$100.80 |
$100.80 |
$100.80 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$138.60 |
$138.60 |
$138.60 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$277.80 |
$277.80 |
$277.80 |
$115.20
|
|
Irrigation implantable venous access device for drug delivery systems
|
$71.40 |
$71.40 |
$71.40 |
$146.11
|
|
IV Fluids (each additional hour)
|
$144.00 |
$144.00 |
$144.00 |
$133.90
|
|
IV Fluids (first hour)
|
$144.00 |
$144.00 |
$144.00 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$29.40 |
$29.40 |
$29.40 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$144.00 |
$144.00 |
$144.00 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$144.00 |
$144.00 |
$144.00 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$153.00 |
$153.00 |
$153.00 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$60.00 |
$60.00 |
$60.00 |
$167.50
|
|
IV Push Injection (first drug)
|
$108.60 |
$108.60 |
$108.60 |
$252.76
|
|
Ivp w/wo kub w/wo tomography
|
$274.80 |
$274.80 |
$274.80 |
$713.40
|
|
Ixabepilone 15 mg intravenous solution
|
$139.20 |
$139.20 |
$139.20 |
$10,695.32
|
|
Jak2 targeted sequence analysis
|
$1,227.60 |
$1,227.60 |
$1,227.60 |
$405.00
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$155.40 |
$155.40 |
$155.40 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$149.40 |
$149.40 |
$149.40 |
$362.05
|
|
John cunningham antibody
|
$53.40 |
$53.40 |
$53.40 |
$78.00
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$19.80 |
$19.80 |
$19.80 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$23.40 |
$23.40 |
$23.40 |
$23.52
|
|
Kidney img w/bldflw sgl without rx
|
$1,260.60 |
$1,260.60 |
$1,260.60 |
$1,433.22
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$150.00 |
$150.00 |
$150.00 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$181.80 |
$181.80 |
$181.80 |
$490.75
|
|
Kit case 4.2mm spinejack
|
$2,731.20 |
$2,731.20 |
$2,731.20 |
$7,177.60
|
|
Kit gene analys d816 variant
|
$1,122.00 |
$1,122.00 |
$1,122.00 |
$374.61
|
|
Kit lead specify 5-6-5
|
$8,386.80 |
$8,386.80 |
$8,386.80 |
$16,672.10
|
|
Knee MRI (with and without contrast)
|
$979.20 |
$979.20 |
$979.20 |
$3,022.20
|
|
Knee MRI (with contrast)
|
$739.80 |
$739.80 |
$739.80 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$685.80 |
$685.80 |
$685.80 |
$2,130.88
|
|
Knee X-ray
|
$155.40 |
$155.40 |
$155.40 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$122.40 |
$122.40 |
$122.40 |
$290.40
|
|
Knee X-ray (3 views, both knees)
|
$130.80 |
$130.80 |
$130.80 |
$363.60
|
|
Knee X-ray (standing, both knees)
|
$146.40 |
$146.40 |
$146.40 |
$251.20
|
|
Kras gene variants exon 2
|
$691.20 |
$691.20 |
$691.20 |
$536.20
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$229.20 |
$229.20 |
$229.20 |
$175.92
|
|
Lactate dehydrogenase (ldh)
|
$14.40 |
$14.40 |
$14.40 |
$55.50
|
|
Lactated ringers intravenous solution
|
$9.60 |
$9.60 |
$9.60 |
$43.74
|
|
Lactic acid
|
$90.60 |
$90.60 |
$90.60 |
$107.10
|
|
Lactoferrin fecal qualitative
|
$103.20 |
$103.20 |
$103.20 |
$82.16
|
|
Lactoferrin fecal quant
|
$156.00 |
$156.00 |
$156.00 |
$108.93
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$286.40 |
$286.40 |
$286.40 |
$19,124.00
|
|
Laparoscopy remove adnexa
|
$6,385.20 |
$6,385.20 |
$6,385.20 |
$8,782.80
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$168.60 |
$168.60 |
$168.60 |
$740.40
|
|
Laryngoscopy w/w/o tracheoscopy aspiration
|
$3,049.20 |
$3,049.20 |
$3,049.20 |
$981.40
|
|
Lavage cannulation maxillary sinus
|
$690.00 |
$690.00 |
$690.00 |
$728.00
|
|
Lead capillary
|
$29.40 |
$29.40 |
$29.40 |
$57.50
|
|
Lead ingevity 45cm pfret MRI
|
$2,043.60 |
$2,043.60 |
$2,043.60 |
$2,928.00
|
|
Left compres band >=5"/yd
|
$3.60 |
$3.60 |
$3.60 |
$6.73
|
|
Leg Artery Ultrasound (complete, both legs)
|
$436.20 |
$436.20 |
$436.20 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$663.60 |
$663.60 |
$663.60 |
$1,585.20
|
|
Leg CT Scan (without contrast, both legs)
|
$507.60 |
$507.60 |
$507.60 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$436.20 |
$436.20 |
$436.20 |
$1,092.58
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$270.00 |
$270.00 |
$270.00 |
$955.30
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$22.20 |
$22.20 |
$22.20 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$3,944.00 |
$3,944.00 |
$3,944.00 |
$6,360.76
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$1,721.40 |
$1,721.40 |
$1,721.40 |
$8,348.12
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$282.00 |
$282.00 |
$282.00 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$32.40 |
$32.40 |
$32.40 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$18.00 |
$18.00 |
$18.00 |
$55.69
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$23.40 |
$23.40 |
$23.40 |
$420.60
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$0.40 |
$0.40 |
$0.40 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$0.60 |
$0.60 |
$0.60 |
$39.75
|
|
Lifileucel til/dose 7.5b-72b snij
|
$2.40 |
$2.40 |
$2.40 |
$30,744.64
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$80.80 |
$80.80 |
$80.80 |
$121.00
|
|
Lipase
|
$16.80 |
$16.80 |
$16.80 |
$93.58
|
|
Lipoprotein blood high res frac & quant
|
$361.80 |
$361.80 |
$361.80 |
$87.00
|
|
Lipoprotein blood quant
|
$202.80 |
$202.80 |
$202.80 |
$97.53
|
|
Lipoprotein direct measurement hdl
|
$19.80 |
$19.80 |
$19.80 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$23.40 |
$23.40 |
$23.40 |
$61.60
|
|
Lip surgery procedure
|
$97.80 |
$97.80 |
$97.80 |
$334.50
|
|
Lithium therapeutic drug level
|
$16.20 |
$16.20 |
$16.20 |
$69.75
|
|
Liver ds alys 3 bmrk srm alg
|
$972.60 |
$972.60 |
$972.60 |
$365.28
|
|
Liver Function Test
|
$48.00 |
$48.00 |
$48.00 |
$115.44
|
|
Liver/spleen imag static only
|
$516.60 |
$516.60 |
$516.60 |
$1,138.55
|
|
Locm 100-199mg/ml iodine,1ml
|
$0.60 |
$0.60 |
$0.60 |
$49.70
|
|
Loncastuximab tesirine-lpyl 10 mg intravenous solution
|
$388.20 |
$388.20 |
$388.20 |
$62,704.30
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$11.00 |
$11.00 |
$11.00 |
$37.20
|
|
Low-Dose Lung Cancer Screening CT Scan
|
$600.60 |
$600.60 |
$600.60 |
$331.50
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$794.40 |
$794.40 |
$794.40 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$669.60 |
$669.60 |
$669.60 |
$1,815.45
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$507.00 |
$507.00 |
$507.00 |
$1,468.80
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$975.00 |
$975.00 |
$975.00 |
$3,097.92
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$736.20 |
$736.20 |
$736.20 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$682.20 |
$682.20 |
$682.20 |
$2,080.00
|
|
Lower Back (Lumbar Spine) X-ray
|
$158.40 |
$158.40 |
$158.40 |
$359.20
|
|
Lower Back (Lumbar Spine) X-ray (4 or more views)
|
$240.00 |
$240.00 |
$240.00 |
$505.83
|
|
Lower Back (Lumbar Spine) X-ray (with bending views)
|
$242.40 |
$242.40 |
$242.40 |
$540.60
|
|
Lower Leg (Shin) X-ray (both sides)
|
$122.40 |
$122.40 |
$122.40 |
$338.40
|
|
Lung Function Test Before and After an Inhaler
|
$300.00 |
$300.00 |
$300.00 |
$549.83
|
|
Lung function test (mbc/mvv)
|
$67.20 |
$67.20 |
$67.20 |
$182.91
|
|
Lung Function Test (Spirometry)
|
$150.60 |
$150.60 |
$150.60 |
$296.91
|
|
Lung perfusion imaging
|
$516.60 |
$516.60 |
$516.60 |
$1,069.25
|
|
Lurbinectedin 4 mg intravenous solution
|
$377.40 |
$377.40 |
$377.40 |
$19,182.33
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$87.60 |
$87.60 |
$87.60 |
$22,771.63
|
