|
Ip/obs cnsltj new/est low 45
|
$102.50 |
$102.50 |
$102.50 |
$174.20
|
|
Ip/obs cnsltj new/est mod 60
|
$141.50 |
$141.50 |
$141.50 |
$284.45
|
|
Ip/obs consltj new/est hi 80
|
$191.00 |
$191.00 |
$191.00 |
$332.80
|
|
Ip/obs consltj new/est sf 35
|
$72.50 |
$72.50 |
$72.50 |
$134.46
|
|
Ipratropium bromide non-comp
|
$1.50 |
$1.50 |
$1.50 |
$3.75
|
|
Iron
|
$33.00 |
$33.00 |
$33.00 |
$72.29
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$140.20 |
$140.20 |
$140.20 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$107.50 |
$107.50 |
$107.50 |
$144.62
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$394.50 |
$394.50 |
$394.50 |
$190.56
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$137.50 |
$137.50 |
$137.50 |
$159.00
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$420.00 |
$420.00 |
$420.00 |
$153.60
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$405.00 |
$405.00 |
$405.00 |
$437.45
|
|
Jak2 targeted sequence analysis
|
$140.00 |
$140.00 |
$140.00 |
$393.43
|
|
John cunningham antibody
|
$584.00 |
$584.00 |
$584.00 |
$66.31
|
|
Keratoprosthesis
|
$1,404.50 |
$1,404.50 |
$1,404.50 |
$13,812.84
|
|
Ketamine and metabolite screen - quest
|
$5.00 |
$5.00 |
$5.00 |
$72.14
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$169.00 |
$169.00 |
$169.00 |
$58.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$4.14 |
$4.14 |
$4.14 |
$23.77
|
|
Kidney img w/bldflw sgl without rx
|
$819.50 |
$819.50 |
$819.50 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$472.50 |
$472.50 |
$472.50 |
$673.36
|
|
Kit gene analys d816 variant
|
$1,068.00 |
$1,068.00 |
$1,068.00 |
$366.03
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$923.90
|
|
Knee Arthroscopy (Cartilage Repair)
|
$656.00 |
$656.00 |
$656.00 |
$4,499.12
|
|
Knee arthroscopy/drainage
|
$2,366.00 |
$2,366.00 |
$2,366.00 |
$3,839.54
|
|
Knee arthroscopy dx
|
$436.50 |
$436.50 |
$436.50 |
$3,980.03
|
|
Knee Arthroscopy (Meniscus Repair)
|
$8,700.00 |
$8,700.00 |
$8,700.00 |
$5,148.00
|
|
Knee arthroscopy/surgery
|
$563.50 |
$563.50 |
$563.50 |
$4,198.40
|
|
Knee arthroscopy/surgery
|
$13,050.00 |
$13,050.00 |
$13,050.00 |
$3,839.54
|
|
Knee arthroscopy/surgery
|
$8,410.00 |
$8,410.00 |
$8,410.00 |
$3,839.54
|
|
Knee arthroscopy/surgery
|
$8,410.00 |
$8,410.00 |
$8,410.00 |
$4,623.79
|
|
Knee arthroscopy/surgery
|
$728.00 |
$728.00 |
$728.00 |
$3,839.54
|
|
Knee arthroscopy/surgery
|
$886.50 |
$886.50 |
$886.50 |
$4,137.60
|
|
Knee arthroscopy/surgery
|
$654.50 |
$654.50 |
$654.50 |
$3,839.54
|
|
Knee arthroscopy/surgery
|
$798.00 |
$798.00 |
$798.00 |
$5,855.00
|
|
Knee arthroscopy/surgery
|
$7,744.00 |
$7,744.00 |
$7,744.00 |
$8,979.74
|
|
Knee arthroscopy/surgery
|
$1,294.50 |
$1,294.50 |
$1,294.50 |
$6,411.60
|
|
Knee MRI (with and without contrast)
|
$1,690.50 |
$1,690.50 |
$1,690.50 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$1,398.00 |
$1,398.00 |
$1,398.00 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$1,040.50 |
$1,040.50 |
$1,040.50 |
$2,110.76
|
|
Knee X-ray
|
$324.00 |
$324.00 |
$324.00 |
$425.55
|
|
Kras gene addl variants
|
$98.00 |
$98.00 |
$98.00 |
$386.75
|
|
Kras gene variants exon 2
|
$98.00 |
$98.00 |
$98.00 |
$509.00
|
|
Kyleena, 19.5 mg
|
$1,822.00 |
$1,822.00 |
$1,822.00 |
$2,125.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$22.74 |
$22.74 |
$22.74 |
$33.60
|
|
Lactate dehydrogenase (ldh)
|
$29.00 |
$29.00 |
$29.00 |
$55.50
|
|
Lactated ringers intravenous solution
|
$7.00 |
$7.00 |
$7.00 |
$44.91
|
|
Lactic acid
|
$35.00 |
$35.00 |
$35.00 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$91.50 |
$91.50 |
$91.50 |
$81.00
|
|
Lam facetec & foramot crv
|
$1,409.00 |
$1,409.00 |
$1,409.00 |
$7,549.13
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$14,343.00 |
$14,343.00 |
$14,343.00 |
$19,124.00
|
|
Laparo ablate renal cyst
|
$958.50 |
$958.50 |
$958.50 |
$9,367.23
|
|
Laparo-asst vag hysterectomy
|
$931.50 |
$931.50 |
$931.50 |
$6,839.00
|
|
Laparo cholecystectomy/explr
|
$1,205.00 |
$1,205.00 |
$1,205.00 |
$6,637.99
|
|
Laparo cholecystectomy/graph
|
$775.00 |
$775.00 |
$775.00 |
$8,346.00
|
|
Laparo partial colectomy 44204
|
$18,415.00 |
$18,415.00 |
$18,415.00 |
$2,917.80
|
|
Laparo proc abdm/per/oment 49329
|
$482.00 |
$482.00 |
$482.00 |
$6,622.75
|
|
Laparoscopic myomectomy
|
$953.00 |
$953.00 |
$953.00 |
$6,461.32
|
|
Laparoscopic proc
|
$1,188.50 |
$1,188.50 |
$1,188.50 |
$2,215.20
|
|
Laparoscopic salpingostomy 58673
|
$838.00 |
$838.00 |
$838.00 |
$5,214.15
|
|
Laparoscopy aspiration
|
$420.50 |
$420.50 |
$420.50 |
$6,839.00
|
|
Laparoscopy biopsy
|
$368.00 |
$368.00 |
$368.00 |
$6,376.26
|
|
Laparoscopye procstom 43659
|
$962.00 |
$962.00 |
$962.00 |
$6,448.00
|
|
Laparoscopy excise lesions
|
$753.50 |
$753.50 |
$753.50 |
$6,904.15
|
|
Laparoscopy fundoplasty
|
$1,161.50 |
$1,161.50 |
$1,161.50 |
$11,424.40
|
|
Laparoscopy lymphadenectomy
|
$694.00 |
$694.00 |
$694.00 |
$12,320.22
|
|
Laparoscopy lymphadenectomy
|
$944.50 |
$944.50 |
$944.50 |
$8,932.00
|
|
Laparoscopy lymph node biop
|
$545.00 |
$545.00 |
$545.00 |
$6,904.15
|
|
Laparoscopy lysis
|
$729.50 |
$729.50 |
$729.50 |
$5,419.00
|
|
Laparoscopy remove adnexa
|
$690.00 |
$690.00 |
$690.00 |
$8,607.55
|
|
Laparoscopy splenectomy
|
$1,139.00 |
$1,139.00 |
$1,139.00 |
$10,488.40
|
|
Laparoscopy surg colpopexy
|
$1,024.00 |
$1,024.00 |
$1,024.00 |
$10,897.60
|
|
Laparoscopy tubal block 58671
|
$390.50 |
$390.50 |
$390.50 |
$5,166.25
|
|
Laparo sling operation 51992
|
$880.00 |
$880.00 |
$880.00 |
$5,353.60
|
|
Laparo urethral suspension
|
$778.50 |
$778.50 |
$778.50 |
$5,353.60
|
|
Laparo-vag hyst incl t/o
|
$1,036.50 |
$1,036.50 |
$1,036.50 |
$12,100.40
|
|
Laparo-vag hyst w/t/o compl
|
$1,378.00 |
$1,378.00 |
$1,378.00 |
$8,917.26
|
|
Lap close enterostomy with resect 44227
|
$1,763.00 |
$1,763.00 |
$1,763.00 |
$3,582.00
|
|
Lap colectomy/coloproctostomy 44207
|
$1,917.00 |
$1,917.00 |
$1,917.00 |
$4,491.20
|
|
Lap colectomy/coloproctostomy w/clst 44208
|
$2,078.50 |
$2,078.50 |
$2,078.50 |
$4,896.80
|
|
Lap colectomy part w/ileum 44205
|
$1,417.00 |
$1,417.00 |
$1,417.00 |
$2,938.32
|
|
Lap colostomy 44188
|
$1,282.50 |
$1,282.50 |
$1,282.50 |
$3,008.00
|
|
Lap enterectomy 44202
|
$1,558.00 |
$1,558.00 |
$1,558.00 |
$2,142.00
|
|
Lap enterolysis
|
$1,036.50 |
$1,036.50 |
$1,036.50 |
$6,376.26
|
|
Lap ing hernia repair init
|
$19,575.00 |
$19,575.00 |
$19,575.00 |
$8,312.83
|
|
Lap ing hernia repair recur
|
$607.50 |
$607.50 |
$607.50 |
$6,463.42
|
|
Lap insert tunnel ip cath
|
$415.50 |
$415.50 |
$415.50 |
$6,895.20
|
|
Lap mobil splenic fl add-on 44213
|
$198.50 |
$198.50 |
$198.50 |
$622.40
|
|
Lap paraesophag hern repair
|
$1,655.50 |
$1,655.50 |
$1,655.50 |
$12,260.88
|
|
Lap part colectomy w/stoma 44206
|
$1,848.00 |
$1,848.00 |
$1,848.00 |
$4,307.20
|
|
Lap rmvl gastr adj all parts
|
$1,038.00 |
$1,038.00 |
$1,038.00 |
$4,502.13
|
|
Lap sleeve gastrectomy
|
$1,202.00 |
$1,202.00 |
$1,202.00 |
$2,733.60
|
|
Laps pelvic lymphadec
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$7,285.60
|
|
Lap w/omentopexy add-on 49326
|
$203.50 |
$203.50 |
$203.50 |
$463.20
|
|
Largsc w/rmvl foreign bdy(s)
|
$139.50 |
$139.50 |
$139.50 |
$765.97
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$167.00 |
$167.00 |
$167.00 |
$2,480.71
|
|
Laryngoscopy w/fb removal
|
$208.00 |
$208.00 |
$208.00 |
$2,854.09
|
|
Laser surgery eye strands
|
$351.50 |
$351.50 |
$351.50 |
$1,513.20
|
|
Laser surgery of prostate
|
$723.50 |
$723.50 |
$723.50 |
$6,822.11
|
|
Laser surg penis lesion(s)
|
$99.50 |
$99.50 |
$99.50 |
$3,562.00
|
|
Lat retinacular release open
|
$480.50 |
$480.50 |
$480.50 |
$3,839.54
|
