|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$61.50 |
$61.50 |
$61.50 |
$160.05
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$59.70 |
$59.70 |
$59.70 |
$154.00
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$449.55 |
$449.55 |
$449.55 |
$441.75
|
|
Ivp w/wo kub w/wo tomography
|
$622.35 |
$622.35 |
$622.35 |
$692.18
|
|
Ixabepilone 15 mg intravenous solution
|
$11,501.78 |
$11,501.78 |
$11,501.78 |
$10,695.32
|
|
Kafo dbl solid stirrup band/
|
$2,185.15 |
$2,185.15 |
$2,185.15 |
$2,185.15
|
|
Kafo fem fx cast molded to p
|
$3,130.66 |
$3,130.66 |
$3,130.66 |
$3,130.66
|
|
Kafo fem fx cast semi-rigid
|
$2,130.02 |
$2,130.02 |
$2,130.02 |
$2,130.02
|
|
Kafo femoral fx cast rigid
|
$2,445.29 |
$2,445.29 |
$2,445.29 |
$2,162.01
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$71.10 |
$71.10 |
$71.10 |
$61.00
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$19.68 |
$19.68 |
$19.68 |
$23.52
|
|
Kidney img w/bldflw sgl without rx
|
$1,320.15 |
$1,320.15 |
$1,320.15 |
$1,456.50
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$742.20 |
$742.20 |
$742.20 |
$668.25
|
|
Kit case 4.2mm spinejack
|
$9,996.00 |
$9,996.00 |
$9,996.00 |
$7,751.14
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$11,280.00 |
$11,280.00 |
$11,280.00 |
$9,482.25
|
|
Kit hfx iq ipg bundle
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$30,880.20
|
|
Kit ipg optimizer smart
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$49,011.18
|
|
Kit lead specify 5-6-5
|
$25,500.00 |
$25,500.00 |
$25,500.00 |
$15,925.64
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$1,783.50 |
$1,783.50 |
$1,783.50 |
$1,543.50
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$142.68 |
$142.68 |
$142.68 |
$923.90
|
|
Kit tissue closure sealant adhesive air leak progel 4 ml pleura
|
$2,908.80 |
$2,908.80 |
$2,908.80 |
$2,218.45
|
|
Kit trach suct cls 30.5cm
|
$39.81 |
$39.81 |
$39.81 |
$35.26
|
|
Knee control condylar pad
|
$12,003.00 |
$12,003.00 |
$12,003.00 |
$176.57
|
|
Knee disc/dial lock/adj flex
|
$288.41 |
$288.41 |
$288.41 |
$288.41
|
|
Knee joint drop lock ea jnt
|
$175.45 |
$175.45 |
$175.45 |
$175.68
|
|
Knee MRI (with and without contrast)
|
$3,700.05 |
$3,700.05 |
$3,700.05 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$3,482.70 |
$3,482.70 |
$3,482.70 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$2,159.09
|
|
Knee X-ray
|
$425.55 |
$425.55 |
$425.55 |
$434.50
|
|
Ko w adj flex/ext rotat mold
|
$4,285.97 |
$4,285.97 |
$4,285.97 |
$2,459.35
|
|
Kyleena, 19.5 mg
|
$2,345.64 |
$2,345.64 |
$2,345.64 |
$2,152.80
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$28.37 |
$28.37 |
$28.37 |
$33.60
|
|
Lacer molded to patient mode
|
$775.69 |
$775.69 |
$775.69 |
$775.69
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$52.20 |
$52.20 |
$52.20 |
$175.92
|
|
Lactate dehydrogenase (ldh)
|
$201.00 |
$201.00 |
$201.00 |
$55.50
|
|
Lactated ringers intravenous solution
|
$30.00 |
$30.00 |
$30.00 |
$46.30
|
|
Lactic acid
|
$193.65 |
$193.65 |
$193.65 |
$107.40
|
|
Lactoferrin fecal qualitative
|
$118.35 |
$118.35 |
$118.35 |
$82.16
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$3,720.15 |
$3,720.15 |
$3,720.15 |
$2,480.71
|
|
Lead acuity x4 spiral l 86cm
|
$5,292.00 |
$5,292.00 |
$5,292.00 |
$5,617.19
|
|
Lead capillary
|
$17.40 |
$17.40 |
$17.40 |
$57.50
|
|
Lead ingevity 45cm pfret MRI
|
$1,476.00 |
$1,476.00 |
$1,476.00 |
$3,324.10
|
|
Lead tachy durata sj4 58cm
|
$10,944.00 |
$10,944.00 |
$10,944.00 |
$8,202.66
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,212.45 |
$1,212.45 |
$1,212.45 |
$1,092.58
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$2,616.00 |
$2,616.00 |
$2,616.00 |
$1,050.40
|
|
Lens iol ant bicnvx 24.0 multi
|
$479.70 |
$479.70 |
$479.70 |
$1,044.75
|
|
Lens iol ant chamb 10.5
|
$725.70 |
$725.70 |
$725.70 |
$377.71
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$100.80 |
$100.80 |
$100.80 |
$164.09
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$16,189.23 |
$16,189.23 |
$16,189.23 |
$6,209.40
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$10,189.22 |
$10,189.22 |
$10,189.22 |
$9,107.80
|
|
Leuprolide acetate injeciton
|
$52.51 |
$52.51 |
$52.51 |
$1,322.50
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$105.30 |
$105.30 |
$105.30 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$146.70 |
$146.70 |
$146.70 |
$85.40
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$46.98 |
$46.98 |
$46.98 |
$55.60
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$627.16 |
$627.16 |
$627.16 |
$420.60
|
|
Liberta rc ipg
|
$31,524.00 |
$31,524.00 |
$31,524.00 |
$37,575.00
|
|
Lidocaine injection
|
$44.76 |
$44.76 |
$44.76 |
$44.76
|
|
Lidocaine therapeutic drug level
|
$243.60 |
$243.60 |
$243.60 |
$91.20
|
|
Lift heel adj small gl60404sm
|
$148.39 |
$148.39 |
$148.39 |
$148.39
|
|
Ligate oviduct(s) add-on 58611
|
$1,743.00 |
$1,743.00 |
$1,743.00 |
$800.00
|
|
Liletta, 52 mg
|
$1,100.85 |
$1,100.85 |
$1,100.85 |
$1,453.50
|
|
Limited ankle motion ea jnt
|
$123.05 |
$123.05 |
$123.05 |
$123.05
|
|
Limited motion knee joint
|
$278.92 |
$278.92 |
$278.92 |
$274.07
|
|
Lincomycin injection
|
$64.31 |
$64.31 |
$64.31 |
$64.31
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$83.16 |
$83.16 |
$83.16 |
$125.66
|
|
Lipase
|
$160.50 |
$160.50 |
$160.50 |
$93.58
|
|
Lipoprotein direct measurement hdl
|
$221.10 |
$221.10 |
$221.10 |
$58.10
|
|
Lipoprotein direct measurement ldl
|
$99.45 |
$99.45 |
$99.45 |
$61.60
|
|
Liver Function Test
|
$316.20 |
$316.20 |
$316.20 |
$115.44
|
|
Liver imag w/vasclr flow
|
$820.20 |
$820.20 |
$820.20 |
$1,238.65
|
|
Liver/spleen imag static only
|
$1,069.20 |
$1,069.20 |
$1,069.20 |
$1,138.55
|
|
Liver/spleen imag w/vasclr flow
|
$1,069.20 |
$1,069.20 |
$1,069.20 |
$1,069.20
|
|
Locm 100-199mg/ml iodine,1ml
|
$211.50 |
$211.50 |
$211.50 |
$45.35
|
|
Long tongue stirrup
|
$293.85 |
$293.85 |
$293.85 |
$247.25
|
|
Loop ostmy bridg ster
|
$27.60 |
$27.60 |
$27.60 |
$45.43
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$39.61 |
$39.61 |
$39.61 |
$37.20
|
|
Lo sag rig pnl stays pre cst
|
$156.86 |
$156.86 |
$156.86 |
$167.74
|
|
Low cost skin substitute app
|
$933.60 |
$933.60 |
$933.60 |
$880.50
|
|
Low cost skin substitute app
|
$2,710.80 |
$2,710.80 |
$2,710.80 |
$2,154.21
|
|
Low cost skin substitute app
|
$933.60 |
$933.60 |
$933.60 |
$933.60
|
|
Low cost skin substitute app
|
$2,710.80 |
$2,710.80 |
$2,710.80 |
$923.50
|
|
Low cost skin substitute app
|
$466.80 |
$466.80 |
$466.80 |
$383.48
|
|
Low cost skin substitute app
|
$1,355.40 |
$1,355.40 |
$1,355.40 |
$699.72
|
|
Low cost skin substitute app
|
$466.80 |
$466.80 |
$466.80 |
$349.44
|
|
Low cost skin substitute app
|
$1,355.40 |
$1,355.40 |
$1,355.40 |
$515.00
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$1,955.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,612.85 |
$2,612.85 |
$2,612.85 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,394.15 |
$2,394.15 |
$2,394.15 |
$1,495.45
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$3,075.80
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$2,612.85 |
$2,612.85 |
$2,612.85 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$2,394.15 |
$2,394.15 |
$2,394.15 |
$2,065.69
|
|
Lower Back (Lumbar Spine) X-ray
|
$524.40 |
$524.40 |
$524.40 |
$355.32
|
|
Lso flex no ri stays pre ots
|
$135.35 |
$135.35 |
$135.35 |
$164.80
|
|
Lso r post pnl sj-t9 pre cst
|
$326.82 |
$326.82 |
$326.82 |
$326.82
|
|
Lso sagit rigid panel prefab
|
$1,990.83 |
$1,990.83 |
$1,990.83 |
$1,990.83
|
|
Lso sc r pos/lat pnl pre cst
|
$577.00 |
$577.00 |
$577.00 |
$577.00
|
|
Lso sc r pos/lat pnl pre ots
|
$598.52 |
$598.52 |
$598.52 |
$678.49
|
|
Lso s/c shell/panel custom
|
$2,320.59 |
$2,320.59 |
$2,320.59 |
$2,252.16
|
|
Lumizyme injection
|
$1,909.58 |
$1,909.58 |
$1,909.58 |
$1,738.40
|
|
Lung function test (mbc/mvv)
|
$241.80 |
$241.80 |
$241.80 |
$180.50
|