|
Electrical stimulation/unattended 97014
|
$197.40 |
$197.40 |
$197.40 |
$79.20
|
|
Enoxaparin 30 mg/0.3 ml subcutaneous syringe
|
$249.00 |
$249.00 |
$249.00 |
$109.71
|
|
Epinephrine 0.1 mg/ml injection syringe
|
$54.90 |
$54.90 |
$54.90 |
$37.86
|
|
Epinephrine 1 mg/ml im kit - pediatric
|
$897.90 |
$897.90 |
$897.90 |
$393.15
|
|
Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution
|
$45.00 |
$45.00 |
$45.00 |
$34.13
|
|
Epoetin alfa-epbx 40,000 unit/ml injection solution
|
$368.40 |
$368.40 |
$368.40 |
$809.08
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$429.60 |
$429.60 |
$429.60 |
$222.98
|
|
ER Visit (level 1, minor)
|
$141.60 |
$141.60 |
$141.60 |
$246.24
|
|
ER Visit (level 2)
|
$279.00 |
$279.00 |
$279.00 |
$452.20
|
|
ER Visit (level 3)
|
$378.00 |
$378.00 |
$378.00 |
$770.04
|
|
Factor viii recombinant nos
|
$5.40 |
$5.40 |
$5.40 |
$6.56
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$4.20 |
$4.20 |
$4.20 |
$22.20
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$8.40 |
$8.40 |
$8.40 |
$101.40
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$21.00 |
$21.00 |
$21.00 |
$64.22
|
|
Folic acid 5 mg/ml injection solution
|
$139.80 |
$139.80 |
$139.80 |
$54.75
|
|
Fructosamine glycated protein
|
$171.60 |
$171.60 |
$171.60 |
$60.75
|
|
Furosemide 10 mg/ml injection solution
|
$11.40 |
$11.40 |
$11.40 |
$19.00
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$363.00 |
$363.00 |
$363.00 |
$177.52
|
|
Gamma glutamyltransferase
|
$135.60 |
$135.60 |
$135.60 |
$57.54
|
|
Glucagon 1 mg solution for injection
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$601.79
|
|
Glucose 1 hr post dose
|
$141.00 |
$141.00 |
$141.00 |
$47.20
|
|
Glucose blood quantitative
|
$130.80 |
$130.80 |
$130.80 |
$40.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$208.20 |
$208.20 |
$208.20 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$135.00 |
$135.00 |
$135.00 |
$35.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$316.20 |
$316.20 |
$316.20 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$316.20 |
$316.20 |
$316.20 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$5,087.40 |
$5,087.40 |
$5,087.40 |
$672.50
|
|
Graft axiofill 1000mg
|
$133.20 |
$133.20 |
$133.20 |
$5,125.68
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$70.67 |
$70.67 |
$70.67 |
$24,469.57
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$94.08 |
$94.08 |
$94.08 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$22,192.80 |
$22,192.80 |
$22,192.80 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$10,595.70 |
$10,595.70 |
$10,595.70 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$526.26 |
$526.26 |
$526.26 |
$373.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$517.44 |
$517.44 |
$517.44 |
$1,132.47
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$4.80 |
$4.80 |
$4.80 |
$23.06
|
|
Hcg qualitative
|
$132.60 |
$132.60 |
$132.60 |
$89.70
|
|
Head CT scan (with and without contrast)
|
$2,240.40 |
$2,240.40 |
$2,240.40 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,577.40 |
$1,577.40 |
$1,577.40 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,806.60 |
$1,806.60 |
$1,806.60 |
$1,268.90
|
|
Hematocrit
|
$61.20 |
$61.20 |
$61.20 |
$33.57
|
|
Hemoglobin
|
$67.20 |
$67.20 |
$67.20 |
$31.80
|
|
Heparin bolus from bag
|
$32.40 |
$32.40 |
$32.40 |
$66.47
|
|
Hepatitis c antibody
|
$164.40 |
$164.40 |
$164.40 |
$108.00
|
|
Heterophile antibodies screening
|
$111.60 |
$111.60 |
$111.60 |
$74.00
|
|
Hocm 350-399mg/ml iodine,1ml
|
$296.40 |
$296.40 |
$296.40 |
$79.78
|
|
Hydralazine 20 mg/ml injection solution
|
$42.60 |
$42.60 |
$42.60 |
$46.74
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$17.40 |
$17.40 |
$17.40 |
$131.47
|
|
Infect ag ia optc obs influenza
|
$57.60 |
$57.60 |
$57.60 |
$72.93
|
|
Infect ag na influenza r/amp 1st 2 types
|
$154.80 |
$154.80 |
$154.80 |
$219.70
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$208.80 |
$208.80 |
$208.80 |
$96.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$286.20 |
$286.20 |
$286.20 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$215.40 |
$215.40 |
$215.40 |
$127.80
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$146.40 |
$146.40 |
$146.40 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$63.00 |
$63.00 |
$63.00 |
$94.53
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$262.80 |
$262.80 |
$262.80 |
$303.59
|
|
Inj, acetaminophen (b braun)
|
$29.40 |
$29.40 |
$29.40 |
$32.79
|
|
Inj daptomycin (xellia)
|
$154.80 |
$154.80 |
$154.80 |
$56.04
|
|
Inj, lidocaine w epinephrine
|
$19.80 |
$19.80 |
$19.80 |
$44.96
|
|
Inj vancomycin (xellia) 10mg
|
$458.40 |
$458.40 |
$458.40 |
$79.21
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$368.40 |
$368.40 |
$368.40 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$576.00 |
$576.00 |
$576.00 |
$279.10
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$321.00 |
$321.00 |
$321.00 |
$187.06
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$277.80 |
$277.80 |
$277.80 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$18.00 |
$18.00 |
$18.00 |
$23.50
|
|
Knee MRI (without contrast)
|
$3,205.20 |
$3,205.20 |
$3,205.20 |
$2,169.60
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$33.60 |
$33.60 |
$33.60 |
$32.34
|
|
Lactated ringers intravenous solution
|
$21.00 |
$21.00 |
$21.00 |
$45.56
|
|
Lactic acid
|
$208.20 |
$208.20 |
$208.20 |
$107.00
|
|
Lead capillary
|
$181.20 |
$181.20 |
$181.20 |
$57.50
|
|
Leuprolide acetate implant
|
$137.40 |
$137.40 |
$137.40 |
$4,516.13
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$27.00 |
$27.00 |
$27.00 |
$95.68
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$39.00 |
$39.00 |
$39.00 |
$55.60
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$135.60 |
$135.60 |
$135.60 |
$125.66
|
|
Lipoprotein direct measurement ldl
|
$132.60 |
$132.60 |
$132.60 |
$61.60
|
|
Lithium therapeutic drug level
|
$133.20 |
$133.20 |
$133.20 |
$69.42
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$4.20 |
$4.20 |
$4.20 |
$37.20
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,088.60 |
$2,088.60 |
$2,088.60 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,053.40 |
$3,053.40 |
$3,053.40 |
$2,096.84
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$28.20 |
$28.20 |
$28.20 |
$58.70
|
|
Mayo covid-19 antibody nucleocapsid total
|
$96.00 |
$96.00 |
$96.00 |
$70.20
|
|
Mayo estrone
|
$598.80 |
$598.80 |
$598.80 |
$84.60
|
|
Mayo immunoassay c1 esterase inhibitor antibody quantitative
|
$291.60 |
$291.60 |
$291.60 |
$204.48
|
|
Mayo infectious agent antigen immunoassay direct optical observation cryptococcus
|
$445.20 |
$445.20 |
$445.20 |
$81.04
|
|
Membrane affinity fresh amniotic 2.5x2.5cm -cost per sq cm
|
$5,087.40 |
$5,087.40 |
$5,087.40 |
$1,660.50
|
|
Meropenem 1 gram intravenous solution
|
$119.70 |
$119.70 |
$119.70 |
$59.84
|
|
Metabolic Blood Panel (Basic)
|
$148.80 |
$148.80 |
$148.80 |
$117.50
|
|
Metabolic Blood Panel (Comprehensive)
|
$172.80 |
$172.80 |
$172.80 |
$157.50
|
|
Metabolic panel ionized ca
|
$151.20 |
$151.20 |
$151.20 |
$144.95
|
|
Methylprednisolone acetate 40 mg/ml suspension for injection
|
$66.00 |
$66.00 |
$66.00 |
$59.60
|
|
Methylprednisolone sodium succinate 1,000 mg intravenous solution
|
$259.20 |
$259.20 |
$259.20 |
$193.00
|
|
Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr
|
$11.40 |
$11.40 |
$11.40 |
$14.85
|
|
Metoprolol tartrate 5 mg/5 ml intravenous (wrapper)
|
$5.40 |
$5.40 |
$5.40 |
$7.59
|
|
Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback
|
$9.60 |
$9.60 |
$9.60 |
$22.10
|
|
Micafungin 100 mg intravenous solution
|
$301.20 |
$301.20 |
$301.20 |
$324.36
|
|
Midazolam 1 mg/ml injection solution
|
$27.00 |
$27.00 |
$27.00 |
$64.34
|
|
Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper)
|
$116.40 |
$116.40 |
$116.40 |
$104.50
|
|
Morphine 4 mg/ml injection (wrapper)
|
$10.20 |
$10.20 |
$10.20 |
$72.07
|
|
Morphine 4 mg/ml injection (wrapper)|discarded drug not administered
|
$9.60 |
$9.60 |
$9.60 |
$22.12
|
|
MRI lower extremity other than joint without contrast (both sides)
|
$2,166.60 |
$2,166.60 |
$2,166.60 |
$2,110.00
|
|
MRI orbit/face/neck without contrast
|
$3,052.20 |
$3,052.20 |
$3,052.20 |
$1,902.00
|