|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$189.00 |
$189.00 |
$189.00 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$101.10 |
$101.10 |
$101.10 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$96.90 |
$96.90 |
$96.90 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$101.10 |
$101.10 |
$101.10 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$45.90 |
$45.90 |
$45.90 |
$135.20
|
|
Inj, levothyroxine, freskabi
|
$582.65 |
$582.65 |
$582.65 |
$363.97
|
|
Inj, lidocaine w epinephrine
|
$72.86 |
$72.86 |
$72.86 |
$44.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$738.90 |
$738.90 |
$738.90 |
$783.50
|
|
Inj mepivacaine hcl/10 ml
|
$9.00 |
$9.00 |
$9.00 |
$33.86
|
|
Inj, nithiodote, 3mg / 125mg
|
$2,178.00 |
$2,178.00 |
$2,178.00 |
$452.89
|
|
Inj proc elbow arthro
|
$405.00 |
$405.00 |
$405.00 |
$432.00
|
|
Inj, releuko 1 mcg
|
$1,274.54 |
$1,274.54 |
$1,274.54 |
$461.20
|
|
Inj sulf hexa lipid microsph
|
$950.65 |
$950.65 |
$950.65 |
$256.14
|
|
Inj thrc fascial pln blk bi w/wo image
|
$738.90 |
$738.90 |
$738.90 |
$1,025.00
|
|
Inj thrc fascial pln blk uni w/wo image
|
$369.90 |
$369.90 |
$369.90 |
$818.00
|
|
Inj vancomycin (xellia) 10mg
|
$184.80 |
$184.80 |
$184.80 |
$79.21
|
|
Inj vocal cord bulking agent
|
$1,216.06 |
$1,216.06 |
$1,216.06 |
$1,480.00
|
|
Insert and remove bone pin
|
$2,067.90 |
$2,067.90 |
$2,067.90 |
$4,421.00
|
|
Insert cath pleura without image
|
$1,209.90 |
$1,209.90 |
$1,209.90 |
$2,019.00
|
|
Insert intrauterine device iud
|
$580.80 |
$580.80 |
$580.80 |
$366.65
|
|
Insertion catheter bladder non indwelling
|
$28,001.85 |
$28,001.85 |
$28,001.85 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$138.60 |
$138.60 |
$138.60 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$2,511.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,083.60 |
$1,083.60 |
$1,083.60 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,967.40 |
$1,967.40 |
$1,967.40 |
$2,414.10
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$5,669.70 |
$5,669.70 |
$5,669.70 |
$7,513.67
|
|
Insole orthotic freedom sz6 6816
|
$110.02 |
$110.02 |
$110.02 |
$84.00
|
|
Insulin total
|
$110.40 |
$110.40 |
$110.40 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$7,643.57 |
$7,643.57 |
$7,643.57 |
$8,629.72
|
|
Integra meshed bil wound mat
|
$25,071.07 |
$25,071.07 |
$25,071.07 |
$9,924.00
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$5,765.93 |
$5,765.93 |
$5,765.93 |
$3,825.00
|
|
Interdental fixation
|
$964.50 |
$964.50 |
$964.50 |
$2,162.05
|
|
Interfyl, 1 mg
|
$3,309.00 |
$3,309.00 |
$3,309.00 |
$5,118.52
|
|
Intrinsic factor antibody
|
$132.90 |
$132.90 |
$132.90 |
$66.60
|
|
Intubation endotracheal emergency procedure
|
$459.00 |
$459.00 |
$459.00 |
$589.60
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$675.02 |
$675.02 |
$675.02 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$108,656.64 |
$108,656.64 |
$108,656.64 |
$62,692.46
|
|
Ipratropium bromide non-comp
|
$9.00 |
$9.00 |
$9.00 |
$3.75
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$11,260.62 |
$11,260.62 |
$11,260.62 |
$5,476.68
|
|
Iron
|
$78.90 |
$78.90 |
$78.90 |
$74.40
|
|
Iron binding capacity
|
$27.60 |
$27.60 |
$27.60 |
$63.79
|
|
Irrigation implantable venous access device for drug delivery systems
|
$39.90 |
$39.90 |
$39.90 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$79.50 |
$79.50 |
$79.50 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$237.60 |
$237.60 |
$237.60 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$79.50 |
$79.50 |
$79.50 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$237.60 |
$237.60 |
$237.60 |
$439.56
|
|
Jak2 targeted sequence analysis
|
$234.30 |
$234.30 |
$234.30 |
$379.87
|
|
Kafo dbl solid stirrup band/
|
$1,643.93 |
$1,643.93 |
$1,643.93 |
$2,185.15
|
|
Kafo dbl solid stirrup without j
|
$1,615.85 |
$1,615.85 |
$1,615.85 |
$2,562.92
|
|
Kafo fem fx cast molded to p
|
$2,419.85 |
$2,419.85 |
$2,419.85 |
$3,130.66
|
|
Kafo fem fx cast semi-rigid
|
$1,719.09 |
$1,719.09 |
$1,719.09 |
$2,130.02
|
|
Kafo fem fx cast thermoplas
|
$1,708.87 |
$1,708.87 |
$1,708.87 |
$2,710.45
|
|
Kafo femoral fx cast rigid
|
$1,881.30 |
$1,881.30 |
$1,881.30 |
$2,138.81
|
|
Kafo pla sin up w/wo k/a cus
|
$3,030.46 |
$3,030.46 |
$3,030.46 |
$4,806.65
|
|
Kafo plas sing free knee mol
|
$2,473.84 |
$2,473.84 |
$2,473.84 |
$3,923.78
|
|
Kafo plastic pediatric size
|
$258.43 |
$258.43 |
$258.43 |
$409.90
|
|
Kafo sing fre stirr thi/calf
|
$1,668.79 |
$1,668.79 |
$1,668.79 |
$2,646.89
|
|
Kafo sng/dbl mechanical act
|
$6,112.81 |
$6,112.81 |
$6,112.81 |
$9,695.60
|
|
Kafo sng solid stirrup without j
|
$1,301.65 |
$1,301.65 |
$1,301.65 |
$2,064.55
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$24.60 |
$24.60 |
$24.60 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$54.12 |
$54.12 |
$54.12 |
$23.50
|
|
Kidney imag w/bld flow multi
|
$404.10 |
$404.10 |
$404.10 |
$1,570.65
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$422.70 |
$422.70 |
$422.70 |
$666.00
|
|
Kit case 4.2mm spinejack
|
$6,890.99 |
$6,890.99 |
$6,890.99 |
$7,751.14
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$7,776.15 |
$7,776.15 |
$7,776.15 |
$9,482.25
|
|
Kit hfx iq ipg bundle
|
$43,678.80 |
$43,678.80 |
$43,678.80 |
$30,006.00
|
|
Kit ipg optimizer smart
|
$43,017.00 |
$43,017.00 |
$43,017.00 |
$49,011.18
|
|
Kit lead specify 5-6-5
|
$18,199.50 |
$18,199.50 |
$18,199.50 |
$15,639.00
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$1,216.06 |
$1,216.06 |
$1,216.06 |
$1,543.50
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$22,463.13 |
$22,463.13 |
$22,463.13 |
$740.00
|
|
Kit sound processor cochlear osia 2
|
$19,766.31 |
$19,766.31 |
$19,766.31 |
$10,164.00
|
|
Kit tissue closure sealant adhesive air leak progel 4 ml pleura
|
$1,296.58 |
$1,296.58 |
$1,296.58 |
$2,089.15
|
|
Knee Arthroscopy (Meniscus Repair)
|
$7,709.45 |
$7,709.45 |
$7,709.45 |
$5,148.00
|
|
Knee arthroscopy/surgery
|
$8,921.24 |
$8,921.24 |
$8,921.24 |
$4,535.82
|
|
Knee arthroscopy/surgery
|
$22,666.67 |
$22,666.67 |
$22,666.67 |
$3,839.54
|
|
Knee arthroscopy/surgery
|
$22,666.67 |
$22,666.67 |
$22,666.67 |
$8,453.60
|
|
Knee control condylar pad
|
$121.84 |
$121.84 |
$121.84 |
$193.25
|
|
Knee control full kneecap
|
$122.33 |
$122.33 |
$122.33 |
$192.00
|
|
Knee disc/dial lock/adj flex
|
$213.84 |
$213.84 |
$213.84 |
$288.41
|
|
Knee jnt ratchet lock ea jnt
|
$213.84 |
$213.84 |
$213.84 |
$289.44
|
|
Knee joint cam lock each joi
|
$181.23 |
$181.23 |
$181.23 |
$287.46
|
|
Knee joint drop lock ea jnt
|
$118.31 |
$118.31 |
$118.31 |
$175.45
|
|
Knee lift loop drop lock rin
|
$174.96 |
$174.96 |
$174.96 |
$242.92
|
|
Knee MRI (with and without contrast)
|
$1,699.80 |
$1,699.80 |
$1,699.80 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$2,542.20 |
$2,542.20 |
$2,542.20 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$730.80 |
$730.80 |
$730.80 |
$2,169.60
|
|
Knee orth pos locking joint
|
$439.04 |
$439.04 |
$439.04 |
$585.60
|
|
Knee X-ray
|
$257.40 |
$257.40 |
$257.40 |
$425.55
|
|
Ko dbl upright w/air pre cst
|
$858.02 |
$858.02 |
$858.02 |
$1,360.92
|
|
Ko dbl upright w/air pre ots
|
$858.02 |
$858.02 |
$858.02 |
$1,371.41
|
|
Ko derot ant cruciate custom
|
$1,402.87 |
$1,402.87 |
$1,402.87 |
$2,225.10
|
|
Ko elastic w/joints pre ots
|
$120.30 |
$120.30 |
$120.30 |
$147.59
|
|
Ko rigid without joints pre ots
|
$199.02 |
$199.02 |
$199.02 |
$214.97
|
|
Ko single upright prefab ots
|
$1,338.51 |
$1,338.51 |
$1,338.51 |
$928.28
|
|
Ko supracondylar socket mold
|
$1,860.19 |
$1,860.19 |
$1,860.19 |
$2,950.46
|
|
Ko swedish type pre ots
|
$424.99 |
$424.99 |
$424.99 |
$604.50
|
|
Ko w/0 joint rigid molded to
|
$1,192.90 |
$1,192.90 |
$1,192.90 |
$1,230.99
|
|
Ko w adj flex/ext rotat mold
|
$1,745.41 |
$1,745.41 |
$1,745.41 |
$2,768.42
|
|
Kyphosis pad
|
$160.75 |
$160.75 |
$160.75 |
$254.97
|
|
Kyphosis pad floating
|
$231.93 |
$231.93 |
$231.93 |
$367.87
|