|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$289.20 |
$289.20 |
$289.20 |
$160.05
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$93.60 |
$93.60 |
$93.60 |
$154.00
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$362.40 |
$362.40 |
$362.40 |
$441.75
|
|
Jak2 targeted sequence analysis
|
$478.20 |
$478.20 |
$478.20 |
$399.76
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$248.40 |
$248.40 |
$248.40 |
$61.00
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$18.00 |
$18.00 |
$18.00 |
$23.52
|
|
Kidney img w/bldflw sgl without rx
|
$1,314.00 |
$1,314.00 |
$1,314.00 |
$1,456.50
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$495.00 |
$495.00 |
$495.00 |
$668.25
|
|
Kit cath ivl 2.5x40mm 135cm shockwave s4
|
$8,290.80 |
$8,290.80 |
$8,290.80 |
$9,482.25
|
|
Kit lead specify 5-6-5
|
$70.56 |
$70.56 |
$70.56 |
$15,925.64
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$923.90 |
$923.90 |
$923.90 |
$923.90
|
|
Knee MRI (with and without contrast)
|
$6,487.20 |
$6,487.20 |
$6,487.20 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$6,122.40 |
$6,122.40 |
$6,122.40 |
$2,159.09
|
|
Knee X-ray
|
$598.80 |
$598.80 |
$598.80 |
$434.50
|
|
Kyleena, 19.5 mg
|
$2,624.22 |
$2,624.22 |
$2,624.22 |
$2,152.80
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$33.60 |
$33.60 |
$33.60 |
$33.60
|
|
Lactate dehydrogenase (ldh)
|
$88.20 |
$88.20 |
$88.20 |
$55.50
|
|
Lactated ringers intravenous solution
|
$21.00 |
$21.00 |
$21.00 |
$46.30
|
|
Lactic acid
|
$185.40 |
$185.40 |
$185.40 |
$107.40
|
|
Lactoferrin fecal qualitative
|
$315.00 |
$315.00 |
$315.00 |
$82.16
|
|
Lactoferrin fecal quant
|
$82.80 |
$82.80 |
$82.80 |
$108.93
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$24,168.60 |
$24,168.60 |
$24,168.60 |
$19,124.00
|
|
Lanthanum carbonate oral 5mg
|
$22.20 |
$22.20 |
$22.20 |
$14.53
|
|
Lead acuity x4 spiral l 86cm
|
$8,820.00 |
$8,820.00 |
$8,820.00 |
$5,617.19
|
|
Lead capillary
|
$170.40 |
$170.40 |
$170.40 |
$57.50
|
|
Lead ingevity 45cm pfret MRI
|
$4,939.20 |
$4,939.20 |
$4,939.20 |
$3,324.10
|
|
Lead tachy durata sj4 58cm
|
$7,056.00 |
$7,056.00 |
$7,056.00 |
$8,202.66
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$880.80 |
$880.80 |
$880.80 |
$1,092.58
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$1,552.32 |
$1,552.32 |
$1,552.32 |
$1,050.40
|
|
Lens iol ant bicnvx 24.0 multi
|
$1,120.14 |
$1,120.14 |
$1,120.14 |
$1,044.75
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$70.80 |
$70.80 |
$70.80 |
$164.09
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$32,536.80 |
$32,536.80 |
$32,536.80 |
$6,209.40
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$12,801.00 |
$12,801.00 |
$12,801.00 |
$9,107.80
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$68.40 |
$68.40 |
$68.40 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$183.00 |
$183.00 |
$183.00 |
$85.40
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$39.00 |
$39.00 |
$39.00 |
$55.60
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$421.50 |
$421.50 |
$421.50 |
$420.60
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$19.20 |
$19.20 |
$19.20 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$27.30 |
$27.30 |
$27.30 |
$40.54
|
|
Limited autopsy
|
$222.60 |
$222.60 |
$222.60 |
$352.80
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$135.60 |
$135.60 |
$135.60 |
$125.66
|
|
Lipase
|
$186.00 |
$186.00 |
$186.00 |
$93.58
|
|
Lipoprotein blood quant
|
$96.60 |
$96.60 |
$96.60 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$102.60 |
$102.60 |
$102.60 |
$58.10
|
|
Lipoprotein direct measurement ldl
|
$118.20 |
$118.20 |
$118.20 |
$61.60
|
|
Lithium therapeutic drug level
|
$120.00 |
$120.00 |
$120.00 |
$69.42
|
|
Lithotripsy transluminal coronary percutaneous
|
$289.20 |
$289.20 |
$289.20 |
$4,204.55
|
|
Liver elastography 91200
|
$280.20 |
$280.20 |
$280.20 |
$288.00
|
|
Liver Function Test
|
$186.00 |
$186.00 |
$186.00 |
$115.44
|
|
Liver/spleen imag static only
|
$1,314.00 |
$1,314.00 |
$1,314.00 |
$1,138.55
|
|
Liver/spleen imag w/vasclr flow
|
$1,377.00 |
$1,377.00 |
$1,377.00 |
$1,069.20
|
|
Locm 100-199mg/ml iodine,1ml
|
$182.40 |
$182.40 |
$182.40 |
$45.35
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$37.20
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,918.40 |
$2,918.40 |
$2,918.40 |
$1,955.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,464.20 |
$2,464.20 |
$2,464.20 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,789.80 |
$1,789.80 |
$1,789.80 |
$1,495.45
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,051.80 |
$4,051.80 |
$4,051.80 |
$3,075.80
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,384.60 |
$3,384.60 |
$3,384.60 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,295.20 |
$3,295.20 |
$3,295.20 |
$2,065.69
|
|
Lower Back (Lumbar Spine) X-ray
|
$280.20 |
$280.20 |
$280.20 |
$355.32
|
|
Lung Function Test (Spirometry)
|
$188.40 |
$188.40 |
$188.40 |
$296.91
|
|
Lung perfusion imaging
|
$684.60 |
$684.60 |
$684.60 |
$1,082.75
|
|
Lurbinectedin 4 mg intravenous solution
|
$23,212.20 |
$23,212.20 |
$23,212.20 |
$17,393.41
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$36,126.00 |
$36,126.00 |
$36,126.00 |
$21,365.20
|
|
Lymphatics/lymph node imaging
|
$792.60 |
$792.60 |
$792.60 |
$1,487.90
|
|
Macroscopic exam parasite
|
$34.20 |
$34.20 |
$34.20 |
$38.50
|
|
Magnesium
|
$205.20 |
$205.20 |
$205.20 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$28.20 |
$28.20 |
$28.20 |
$60.00
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$88.80 |
$88.80 |
$88.80 |
$129.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$133.80 |
$133.80 |
$133.80 |
$157.44
|
|
Map tachycard site(s)
|
$3,166.80 |
$3,166.80 |
$3,166.80 |
$4,082.82
|
|
Mastoids complete
|
$630.00 |
$630.00 |
$630.00 |
$299.52
|
|
Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm
|
$82.79 |
$82.79 |
$82.79 |
$4,784.00
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$28.80 |
$28.80 |
$28.80 |
$65.30
|
|
Mayo aathr protein s free
|
$208.20 |
$208.20 |
$208.20 |
$133.20
|
|
Mayo activated protein c resistance assay
|
$273.00 |
$273.00 |
$273.00 |
$97.50
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$1,053.00 |
$1,053.00 |
$1,053.00 |
$172.90
|
|
Mayo alkaline phosphatase isoenzyme
|
$183.60 |
$183.60 |
$183.60 |
$66.30
|
|
Mayo alpha 1 antitrypsin
|
$349.80 |
$349.80 |
$349.80 |
$91.44
|
|
Mayo analysis gene calr common variants exon 9
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$492.00
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$277.20 |
$277.20 |
$277.20 |
$369.00
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$2,297.40 |
$2,297.40 |
$2,297.40 |
$1,860.00
|
|
Mayo androstenedione
|
$383.40 |
$383.40 |
$383.40 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$302.40 |
$302.40 |
$302.40 |
$74.00
|
|
Mayo antithrombin iii antigen
|
$135.00 |
$135.00 |
$135.00 |
$71.50
|
|
Mayo aspergillus fumigatus antibody
|
$118.20 |
$118.20 |
$118.20 |
$67.60
|
|
Mayo avwpr vw factor activity
|
$545.40 |
$545.40 |
$545.40 |
$170.25
|
|
Mayo bart bartonella henselae antibody igg
|
$91.20 |
$91.20 |
$91.20 |
$45.50
|
|
Mayo blastomyces antibody immunodiffusion
|
$101.40 |
$101.40 |
$101.40 |
$57.77
|
|
Mayo bordetella pertussis antibody igg
|
$172.80 |
$172.80 |
$172.80 |
$69.00
|
|
Mayo brcmg brucella antibody igm
|
$13.80 |
$13.80 |
$13.80 |
$44.86
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$37.20 |
$37.20 |
$37.20 |
$80.16
|
|
Mayo ceruloplasmin
|
$208.20 |
$208.20 |
$208.20 |
$70.20
|
|
Mayo chemiluminescent parathyroid related peptide
|
$275.40 |
$275.40 |
$275.40 |
$121.60
|
|
Mayo chikv chikungunya antibodies igg
|
$112.80 |
$112.80 |
$112.80 |
$109.20
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$42.60 |
$42.60 |
$42.60 |
$53.30
|
|
Mayo chromium
|
$240.60 |
$240.60 |
$240.60 |
$73.30
|
|
Mayo coccidioides antibody
|
$82.80 |
$82.80 |
$82.80 |
$56.50
|
|
Mayo cocou cortisone urine
|
$927.60 |
$927.60 |
$927.60 |
$210.00
|
