|
Interrog dev eval icpms ip
|
$23.00 |
$23.00 |
$23.00 |
$104.00
|
|
Interrog dev eval scrms ip
|
$26.00 |
$26.00 |
$26.00 |
$124.80
|
|
Interrog device eval heart
|
$47.50 |
$47.50 |
$47.50 |
$168.30
|
|
Interrog evl pm/ldls pm ip
|
$36.50 |
$36.50 |
$36.50 |
$124.80
|
|
Intrinsic factor antibody
|
$114.00 |
$114.00 |
$114.00 |
$64.41
|
|
Intro cath dialysis circuit
|
$4,081.50 |
$4,081.50 |
$4,081.50 |
$2,073.03
|
|
Intro cath dialysis circuit w/pta
|
$12,536.50 |
$12,536.50 |
$12,536.50 |
$8,761.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$13,358.00 |
$13,358.00 |
$13,358.00 |
$15,671.00
|
|
Intro catheter aorta
|
$588.00 |
$588.00 |
$588.00 |
$1,678.05
|
|
Intro cath svc/ivc
|
$581.50 |
$581.50 |
$581.50 |
$1,346.13
|
|
Intro long gi tube w/mult fluo
|
$1,510.50 |
$1,510.50 |
$1,510.50 |
$457.60
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$1,688.00 |
$1,688.00 |
$1,688.00 |
$3,472.95
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$450.50 |
$450.50 |
$450.50 |
$1,764.10
|
|
Intubation endotracheal emergency procedure
|
$513.00 |
$513.00 |
$513.00 |
$600.60
|
|
Iodine i-123 sod iodide mil
|
$370.50 |
$370.50 |
$370.50 |
$370.50
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$621.68 |
$621.68 |
$621.68 |
$173.40
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$621.68 |
$621.68 |
$621.68 |
$288.11
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$42.12 |
$42.12 |
$42.12 |
$171.37
|
|
Iron
|
$43.50 |
$43.50 |
$43.50 |
$75.40
|
|
Iron binding capacity
|
$55.50 |
$55.50 |
$55.50 |
$63.91
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$210.33 |
$210.33 |
$210.33 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$138.00 |
$138.00 |
$138.00 |
$142.56
|
|
Ivc venogram s&i
|
$7,104.50 |
$7,104.50 |
$7,104.50 |
$3,316.95
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$202.00 |
$202.00 |
$202.00 |
$192.40
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$124.00 |
$124.00 |
$124.00 |
$160.05
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$610.00 |
$610.00 |
$610.00 |
$154.00
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$517.00 |
$517.00 |
$517.00 |
$443.20
|
|
Jak2 targeted sequence analysis
|
$553.00 |
$553.00 |
$553.00 |
$399.76
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$51.50 |
$51.50 |
$51.50 |
$61.00
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$2.96 |
$2.96 |
$2.96 |
$23.52
|
|
Kidney img w/bldflw sgl without rx
|
$1,130.00 |
$1,130.00 |
$1,130.00 |
$1,456.50
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$303.50 |
$303.50 |
$303.50 |
$668.25
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$5,009.00 |
$5,009.00 |
$5,009.00 |
$9,482.25
|
|
Kit gene analys d816 variant
|
$1,068.00 |
$1,068.00 |
$1,068.00 |
$374.61
|
|
Kit lead specify 5-6-5
|
$3,753.00 |
$3,753.00 |
$3,753.00 |
$15,889.84
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$923.90
|
|
Knee Arthroscopy (Meniscus Repair)
|
$11,662.00 |
$11,662.00 |
$11,662.00 |
$5,148.00
|
|
Knee arthroscopy/surgery
|
$9,062.50 |
$9,062.50 |
$9,062.50 |
$4,499.12
|
|
Knee MRI (with and without contrast)
|
$2,783.50 |
$2,783.50 |
$2,783.50 |
$3,022.20
|
|
Knee MRI (with contrast)
|
$1,128.00 |
$1,128.00 |
$1,128.00 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$1,466.00 |
$1,466.00 |
$1,466.00 |
$2,159.09
|
|
Knee X-ray
|
$528.00 |
$528.00 |
$528.00 |
$433.50
|
|
Kyleena, 19.5 mg
|
$2,733.00 |
$2,733.00 |
$2,733.00 |
$2,152.80
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$17.74 |
$17.74 |
$17.74 |
$33.60
|
|
Lactate dehydrogenase (ldh)
|
$44.00 |
$44.00 |
$44.00 |
$55.50
|
|
Lactated ringers intravenous solution
|
$120.00 |
$120.00 |
$120.00 |
$45.90
|
|
Lactic acid
|
$54.00 |
$54.00 |
$54.00 |
$107.40
|
|
Lactoferrin fecal qualitative
|
$137.50 |
$137.50 |
$137.50 |
$82.16
|
|
Lactoferrin fecal quant
|
$229.50 |
$229.50 |
$229.50 |
$108.93
|
|
Laparo proc abdm/per/oment 49329
|
$12,432.00 |
$12,432.00 |
$12,432.00 |
$6,622.75
|
|
Laparoscopic nephrectomy
|
$29,108.00 |
$29,108.00 |
$29,108.00 |
$5,686.20
|
|
Laparoscopy fundoplasty
|
$36,410.50 |
$36,410.50 |
$36,410.50 |
$11,378.21
|
|
Laparoscopy remove adnexa
|
$46,487.00 |
$46,487.00 |
$46,487.00 |
$8,312.83
|
|
Laparo-vag hyst incl t/o
|
$26,265.50 |
$26,265.50 |
$26,265.50 |
$12,100.40
|
|
Lap enterolysis
|
$14,021.50 |
$14,021.50 |
$14,021.50 |
$6,161.68
|
|
Lap ing hernia repair init
|
$23,306.50 |
$23,306.50 |
$23,306.50 |
$6,904.15
|
|
Laryngoscopy with biopsy
|
$1,940.00 |
$1,940.00 |
$1,940.00 |
$3,297.83
|
|
Laser surgery of prostate
|
$10,268.00 |
$10,268.00 |
$10,268.00 |
$6,015.75
|
|
Lead acuity x4 spiral l 86cm
|
$2,419.00 |
$2,419.00 |
$2,419.00 |
$5,617.19
|
|
Lead capillary
|
$85.00 |
$85.00 |
$85.00 |
$57.50
|
|
Lead ingevity 45cm pfret MRI
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$3,387.41
|
|
Lead tachy durata sj4 58cm
|
$3,484.50 |
$3,484.50 |
$3,484.50 |
$8,202.66
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$558.00 |
$558.00 |
$558.00 |
$1,092.58
|
|
Lens iol ant bicnvx 24.0 multi
|
$75.00 |
$75.00 |
$75.00 |
$1,044.75
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$71.96 |
$71.96 |
$71.96 |
$163.80
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$1,085.63 |
$1,085.63 |
$1,085.63 |
$6,172.05
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$3,911.00 |
$3,911.00 |
$3,911.00 |
$9,107.80
|
|
Lev 1 hosp type b ed visit
|
$197.50 |
$197.50 |
$197.50 |
$186.98
|
|
Lev 2 hosp type b ed visit
|
$359.00 |
$359.00 |
$359.00 |
$359.65
|
|
Lev 3 hosp type b ed visit
|
$627.50 |
$627.50 |
$627.50 |
$598.15
|
|
Lev 4 hosp type b ed visit
|
$901.50 |
$901.50 |
$901.50 |
$915.40
|
|
Lev 5 hosp type b ed visit
|
$1,068.50 |
$1,068.50 |
$1,068.50 |
$1,542.68
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$5.56 |
$5.56 |
$5.56 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$101.00 |
$101.00 |
$101.00 |
$85.14
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$5.63 |
$5.63 |
$5.63 |
$55.60
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$9.92 |
$9.92 |
$9.92 |
$46.02
|
|
Lig/band angioaccess av fistula
|
$3,661.00 |
$3,661.00 |
$3,661.00 |
$4,341.66
|
|
Liletta, 52 mg
|
$2,096.50 |
$2,096.50 |
$2,096.50 |
$1,453.50
|
|
Limited visual field xm
|
$8.00 |
$8.00 |
$8.00 |
$79.20
|
|
Lincomycin injection
|
$34.50 |
$34.50 |
$34.50 |
$64.31
|
|
Lipase
|
$45.00 |
$45.00 |
$45.00 |
$93.58
|
|
Lipoprotein blood quant
|
$157.00 |
$157.00 |
$157.00 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$37.00 |
$37.00 |
$37.00 |
$58.10
|
|
Lipoprotein direct measurement ldl
|
$58.50 |
$58.50 |
$58.50 |
$61.60
|
|
Lithium therapeutic drug level
|
$38.00 |
$38.00 |
$38.00 |
$69.42
|
|
Lithotripsy transluminal coronary percutaneous
|
$7,087.50 |
$7,087.50 |
$7,087.50 |
$4,128.00
|
|
Liver ds alys 3 bmrk srm alg
|
$365.50 |
$365.50 |
$365.50 |
$340.00
|
|
Liver Function Test
|
$59.00 |
$59.00 |
$59.00 |
$115.44
|
|
Liver/spleen imag w/vasclr flow
|
$871.00 |
$871.00 |
$871.00 |
$1,069.20
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$5.25 |
$5.25 |
$5.25 |
$37.37
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$572.50 |
$572.50 |
$572.50 |
$1,955.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,129.50 |
$1,129.50 |
$1,129.50 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$296.00 |
$296.00 |
$296.00 |
$1,495.45
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$1,849.00 |
$1,849.00 |
$1,849.00 |
$3,070.20
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,522.00 |
$1,522.00 |
$1,522.00 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,443.50 |
$1,443.50 |
$1,443.50 |
$2,065.69
|
|
Lower Back (Lumbar Spine) X-ray
|
$303.50 |
$303.50 |
$303.50 |
$355.00
|
|
Lung function test (mbc/mvv)
|
$232.00 |
$232.00 |
$232.00 |
$180.50
|
|
Lung Function Test (Spirometry)
|
$346.50 |
$346.50 |
$346.50 |
$296.91
|
|
Lung perfusion imaging
|
$936.50 |
$936.50 |
$936.50 |
$1,082.75
|
