|
Inj, moxifloxacin 100 mg
|
$451.69 |
$451.69 |
$451.69 |
$190.81
|
|
Inj, nithiodote, 3mg / 125mg
|
$5,004.01 |
$5,004.01 |
$5,004.01 |
$389.50
|
|
Inj., omadacycline, 1 mg
|
$1,507.76 |
$1,507.76 |
$1,507.76 |
$3.80
|
|
Inj, pedmark, 100 mg
|
$819.56 |
$819.56 |
$819.56 |
$96.08
|
|
Inj progesterone per 50 mg
|
$29.84 |
$29.84 |
$29.84 |
$48.51
|
|
Inj testostero enanthate 1mg
|
$391.57 |
$391.57 |
$391.57 |
$50.85
|
|
Inj testosterone cypionate
|
$503.88 |
$503.88 |
$503.88 |
$77.15
|
|
Insitu hybridization manual
|
$58.57 |
$58.57 |
$58.57 |
$407.11
|
|
In situ hybridization per specimen initial single probe stain
|
$43.97 |
$43.97 |
$43.97 |
$338.40
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$14,223.57 |
$14,223.57 |
$14,223.57 |
$10,179.63
|
|
Interferon beta-1a inj
|
$4,514.12 |
$4,514.12 |
$4,514.12 |
$2,203.14
|
|
Intra-atrial pacing
|
$15,124.74 |
$15,124.74 |
$15,124.74 |
$5,155.51
|
|
Intra-atrial recording
|
$21,990.02 |
$21,990.02 |
$21,990.02 |
$5,707.00
|
|
Intracranial complete study
|
$4,356.37 |
$4,356.37 |
$4,356.37 |
$883.30
|
|
Intracranial limited study
|
$1,707.28 |
$1,707.28 |
$1,707.28 |
$423.52
|
|
Intraventricular pacing
|
$7,323.70 |
$7,323.70 |
$7,323.70 |
$5,775.22
|
|
Intrinsic factor antibody
|
$7.00 |
$7.00 |
$7.00 |
$59.95
|
|
Intro long gi tube w/mult fluo
|
$653.08 |
$653.08 |
$653.08 |
$477.85
|
|
Ionm in operatng room 15 min
|
$693.59 |
$693.59 |
$693.59 |
$200.78
|
|
Ionm remote/>1 pt or per hr
|
$2,581.17 |
$2,581.17 |
$2,581.17 |
$622.70
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$3.84 |
$3.84 |
$3.84 |
$153.98
|
|
Iron dextran 50 mg/ml injection solution
|
$232.30 |
$232.30 |
$232.30 |
$62.70
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$1,114.88 |
$1,114.88 |
$1,114.88 |
$198.01
|
|
Irradiation of blood product each unit reference
|
$885.92 |
$885.92 |
$885.92 |
$124.24
|
|
Irrigation implantable venous access device for drug delivery systems
|
$515.00 |
$515.00 |
$515.00 |
$154.50
|
|
Ivc venogram s&i
|
$1,393.16 |
$1,393.16 |
$1,393.16 |
$3,332.55
|
|
IV inj ra drug dx study
|
$8,733.82 |
$8,733.82 |
$8,733.82 |
$560.00
|
|
Ivp w/wo kub w/wo tomography
|
$3,879.60 |
$3,879.60 |
$3,879.60 |
$713.05
|
|
Ketogenic steroids fract
|
$12.13 |
$12.13 |
$12.13 |
$79.54
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$174.59 |
$174.59 |
$174.59 |
$56.61
|
|
Kidney imag w/bld flow multi
|
$10,574.56 |
$10,574.56 |
$10,574.56 |
$1,566.50
|
|
Kidney img w/bldflw sgl without rx
|
$6,651.12 |
$6,651.12 |
$6,651.12 |
$1,468.04
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$4,911.38 |
$4,911.38 |
$4,911.38 |
$668.25
|
|
Knee MRI (with and without contrast)
|
$8,619.62 |
$8,619.62 |
$8,619.62 |
$2,950.00
|
|
Knee X-ray
|
$655.84 |
$655.84 |
$655.84 |
$443.90
|
|
Lactated ringers intravenous solution
|
$120.56 |
$120.56 |
$120.56 |
$54.11
|
|
Lactoferrin fecal qualitative
|
$580.55 |
$580.55 |
$580.55 |
$88.40
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$3,035.46 |
$3,035.46 |
$3,035.46 |
$1,100.74
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$468.82 |
$468.82 |
$468.82 |
$146.32
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$6,287.74 |
$6,287.74 |
$6,287.74 |
$6,208.50
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$479.03 |
$479.03 |
$479.03 |
$89.14
|
|
Levetiracetam therapeutic drug level
|
$10.59 |
$10.59 |
$10.59 |
$71.40
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$209.29 |
$209.29 |
$209.29 |
$49.11
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$1,240.02 |
$1,240.02 |
$1,240.02 |
$177.90
|
|
Lipoprotein direct measurement hdl
|
$1,044.75 |
$1,044.75 |
$1,044.75 |
$55.90
|
|
Lipoprotein direct measurement ldl
|
$5.52 |
$5.52 |
$5.52 |
$60.00
|
|
Lithium therapeutic drug level
|
$197.77 |
$197.77 |
$197.77 |
$67.60
|
|
Liver elastography 91200
|
$240.00 |
$240.00 |
$240.00 |
$291.74
|
|
Liver imaging
|
$11,553.75 |
$11,553.75 |
$11,553.75 |
$1,241.25
|
|
Liver imag w/vasclr flow
|
$5,496.74 |
$5,496.74 |
$5,496.74 |
$1,255.15
|
|
Liver/spleen imag static only
|
$10,472.89 |
$10,472.89 |
$10,472.89 |
$1,140.78
|
|
Liver/spleen imag w/vasclr flow
|
$6,389.57 |
$6,389.57 |
$6,389.57 |
$949.00
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$13,560.68 |
$13,560.68 |
$13,560.68 |
$1,921.40
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$10,277.66 |
$10,277.66 |
$10,277.66 |
$1,844.70
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$9,148.55 |
$9,148.55 |
$9,148.55 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$25,822.15 |
$25,822.15 |
$25,822.15 |
$2,995.20
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$18,206.98 |
$18,206.98 |
$18,206.98 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$15,710.54 |
$15,710.54 |
$15,710.54 |
$2,060.27
|
|
Lower Back (Lumbar Spine) X-ray
|
$1,606.12 |
$1,606.12 |
$1,606.12 |
$344.00
|
|
L/s ratio fetal lung
|
$150.30 |
$150.30 |
$150.30 |
$168.00
|
|
Lung function test (mbc/mvv)
|
$678.49 |
$678.49 |
$678.49 |
$182.91
|
|
Lung perfusion imaging
|
$9,614.21 |
$9,614.21 |
$9,614.21 |
$1,100.39
|
|
Lvad shower bag heartmate
|
$1,148.81 |
$1,148.81 |
$1,148.81 |
$1,090.58
|
|
Lymphatics/lymph node imaging
|
$8,733.82 |
$8,733.82 |
$8,733.82 |
$1,543.75
|
|
Lymph vessel x-ray trunk
|
$4,352.72 |
$4,352.72 |
$4,352.72 |
$3,380.00
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$318.98 |
$318.98 |
$318.98 |
$144.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$318.98 |
$318.98 |
$318.98 |
$178.75
|
|
Mannitol 12.5 gm/50 ml inj
|
$58.12 |
$58.12 |
$58.12 |
$40.12
|
|
Map tachycard site(s)
|
$17,968.54 |
$17,968.54 |
$17,968.54 |
$3,960.00
|
|
M.avium-intra dna dir prob
|
$284.22 |
$284.22 |
$284.22 |
$58.25
|
|
Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation
|
$100.00 |
$100.00 |
$100.00 |
$101.44
|
|
Mayo alkaline phosphatase isoenzyme
|
$5.00 |
$5.00 |
$5.00 |
$66.30
|
|
Mayo analysis gene smn1 dosage/deletion
|
$135.00 |
$135.00 |
$135.00 |
$328.80
|
|
Mayo androstenedione
|
$36.80 |
$36.80 |
$36.80 |
$105.30
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$4.50 |
$4.50 |
$4.50 |
$72.46
|
|
Mayo antithrombin iii antigen
|
$28.45 |
$28.45 |
$28.45 |
$68.90
|
|
Mayo avwpr vw factor activity
|
$125.00 |
$125.00 |
$125.00 |
$157.95
|
|
Mayo barbiturates definitive assay confirmation urine
|
$73.31 |
$73.31 |
$73.31 |
$91.65
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$81.45 |
$81.45 |
$81.45 |
$353.60
|
|
Mayo blastomyces antibody immunodiffusion
|
$12.22 |
$12.22 |
$12.22 |
$57.85
|
|
Mayo bordetella pertussis antibody igg
|
$18.40 |
$18.40 |
$18.40 |
$59.15
|
|
Mayo brcmg brucella antibody igm
|
$3.16 |
$3.16 |
$3.16 |
$48.57
|
|
Mayo c1 esterase inhibitor
|
$19.53 |
$19.53 |
$19.53 |
$88.35
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$23.89 |
$23.89 |
$23.89 |
$83.97
|
|
Mayo ceruloplasmin
|
$5.00 |
$5.00 |
$5.00 |
$65.08
|
|
Mayo chemiluminescent parathyroid related peptide
|
$42.00 |
$42.00 |
$42.00 |
$123.73
|
|
Mayo chlap chlamydia pneumoniae antibody igm
|
$16.83 |
$16.83 |
$16.83 |
$50.88
|
|
Mayo coccidioides antibody
|
$16.04 |
$16.04 |
$16.04 |
$58.37
|
|
Mayo cocou cortisone urine
|
$90.00 |
$90.00 |
$90.00 |
$207.26
|
|
Mayo covid-19 antibody nucleocapsid total
|
$46.34 |
$46.34 |
$46.34 |
$72.60
|
|
Mayo cyanide
|
$65.00 |
$65.00 |
$65.00 |
$87.10
|
|
Mayo dhea (dehydroepiandrosterone)
|
$6.00 |
$6.00 |
$6.00 |
$88.45
|
|
Mayo efpo chloride stool
|
$471.34 |
$471.34 |
$471.34 |
$44.20
|
|
Mayo estriol
|
$14.33 |
$14.33 |
$14.33 |
$98.70
|
|
Mayo estrone
|
$30.53 |
$30.53 |
$30.53 |
$84.70
|
|
Mayo ethosuximide therapeutic drug level
|
$11.23 |
$11.23 |
$11.23 |
$70.40
|
|
Mayo everolimus therapeutic drug level
|
$100.00 |
$100.00 |
$100.00 |
$80.50
|
|
Mayo factor ii
|
$177.12 |
$177.12 |
$177.12 |
$93.00
|
|
Mayo factor viii vw factor antigen
|
$70.00 |
$70.00 |
$70.00 |
$110.50
|
|
Mayo factor viii vw factor multimetric analysis
|
$60.27 |
$60.27 |
$60.27 |
$125.00
|
