|
Instillation anticarcinogenic agent bladder
|
$664.20 |
$664.20 |
$664.20 |
$621.40
|
|
Insulin total
|
$136.20 |
$136.20 |
$136.20 |
$66.64
|
|
Intrinsic factor antibody
|
$252.60 |
$252.60 |
$252.60 |
$66.60
|
|
Intubation endotracheal emergency procedure
|
$759.60 |
$759.60 |
$759.60 |
$589.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$318.00 |
$318.00 |
$318.00 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$696.00 |
$696.00 |
$696.00 |
$279.10
|
|
Ip/obs cnsltj new/est low 45
|
$110.40 |
$110.40 |
$110.40 |
$174.20
|
|
Ip/obs consltj new/est sf 35
|
$88.20 |
$88.20 |
$88.20 |
$134.46
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$184.20 |
$184.20 |
$184.20 |
$163.87
|
|
Iron
|
$135.00 |
$135.00 |
$135.00 |
$74.40
|
|
Iron binding capacity
|
$115.80 |
$115.80 |
$115.80 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$321.00 |
$321.00 |
$321.00 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$90.60 |
$90.60 |
$90.60 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$289.20 |
$289.20 |
$289.20 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$289.20 |
$289.20 |
$289.20 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$88.20 |
$88.20 |
$88.20 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$318.60 |
$318.60 |
$318.60 |
$439.56
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$219.00 |
$219.00 |
$219.00 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$18.00 |
$18.00 |
$18.00 |
$23.50
|
|
Kidney img w/bldflw sgl without rx
|
$1,330.20 |
$1,330.20 |
$1,330.20 |
$1,427.40
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$454.20 |
$454.20 |
$454.20 |
$666.00
|
|
Kit lead specify 5-6-5
|
$70.56 |
$70.56 |
$70.56 |
$15,639.00
|
|
Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm
|
$923.90 |
$923.90 |
$923.90 |
$740.00
|
|
Knee MRI (with and without contrast)
|
$3,022.20 |
$3,022.20 |
$3,022.20 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$3,022.20 |
$3,022.20 |
$3,022.20 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$6,044.40 |
$6,044.40 |
$6,044.40 |
$2,169.60
|
|
Knee X-ray
|
$567.00 |
$567.00 |
$567.00 |
$425.55
|
|
Kyleena, 19.5 mg
|
$3,031.20 |
$3,031.20 |
$3,031.20 |
$2,125.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$33.60 |
$33.60 |
$33.60 |
$32.34
|
|
Lactate dehydrogenase (ldh)
|
$78.00 |
$78.00 |
$78.00 |
$55.50
|
|
Lactated ringers intravenous solution
|
$21.00 |
$21.00 |
$21.00 |
$45.56
|
|
Lactic acid
|
$114.00 |
$114.00 |
$114.00 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$276.60 |
$276.60 |
$276.60 |
$80.40
|
|
Lactoferrin fecal quant
|
$82.80 |
$82.80 |
$82.80 |
$106.10
|
|
Lead capillary
|
$156.60 |
$156.60 |
$156.60 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$806.40 |
$806.40 |
$806.40 |
$1,088.26
|
|
Lens iol ant bicnvx 24.0 multi
|
$1,499.40 |
$1,499.40 |
$1,499.40 |
$1,065.00
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$274.80 |
$274.80 |
$274.80 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$13,044.00 |
$13,044.00 |
$13,044.00 |
$7,052.00
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$4,551.00 |
$4,551.00 |
$4,551.00 |
$9,107.80
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$27.00 |
$27.00 |
$27.00 |
$95.68
|
|
Levetiracetam therapeutic drug level
|
$159.00 |
$159.00 |
$159.00 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$39.00 |
$39.00 |
$39.00 |
$55.60
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$13.80 |
$13.80 |
$13.80 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$27.30 |
$27.30 |
$27.30 |
$39.37
|
|
Ligation major artery neck
|
$925.20 |
$925.20 |
$925.20 |
$3,703.00
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$135.60 |
$135.60 |
$135.60 |
$125.66
|
|
Lipase
|
$164.40 |
$164.40 |
$164.40 |
$93.58
|
|
Lipoprotein direct measurement hdl
|
$90.60 |
$90.60 |
$90.60 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$102.00 |
$102.00 |
$102.00 |
$61.60
|
|
Lithium therapeutic drug level
|
$102.60 |
$102.60 |
$102.60 |
$69.42
|
|
Liver Function Test
|
$164.40 |
$164.40 |
$164.40 |
$115.44
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$4.20 |
$4.20 |
$4.20 |
$37.20
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,360.80 |
$1,360.80 |
$1,360.80 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,884.00 |
$1,884.00 |
$1,884.00 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$3,774.00 |
$3,774.00 |
$3,774.00 |
$3,111.17
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,151.80 |
$3,151.80 |
$3,151.80 |
$2,445.30
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,066.60 |
$3,066.60 |
$3,066.60 |
$2,096.84
|
|
Lower Back (Lumbar Spine) X-ray
|
$267.60 |
$267.60 |
$267.60 |
$352.32
|
|
Lung Function Test (Spirometry)
|
$214.20 |
$214.20 |
$214.20 |
$295.35
|
|
Lung perfusion imaging
|
$690.60 |
$690.60 |
$690.60 |
$1,075.25
|
|
Lurbinectedin 4 mg intravenous solution
|
$23,212.20 |
$23,212.20 |
$23,212.20 |
$20,101.00
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$36,126.00 |
$36,126.00 |
$36,126.00 |
$21,867.91
|
|
Lymphatics/lymph node imaging
|
$801.60 |
$801.60 |
$801.60 |
$1,448.00
|
|
Magnesium
|
$180.00 |
$180.00 |
$180.00 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$28.20 |
$28.20 |
$28.20 |
$58.70
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$100.20 |
$100.20 |
$100.20 |
$128.40
|
|
Manipulation chest wall initial demonstration/evaluation
|
$103.20 |
$103.20 |
$103.20 |
$152.54
|
|
Marker biop eviva buckle ss
|
$132.26 |
$132.26 |
$132.26 |
$1,152.48
|
|
Mastectomy partial
|
$1,122.60 |
$1,122.60 |
$1,122.60 |
$4,531.42
|
|
Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm
|
$82.79 |
$82.79 |
$82.79 |
$5,065.63
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$25.20 |
$25.20 |
$25.20 |
$66.36
|
|
Mayo aathr protein s free
|
$181.20 |
$181.20 |
$181.20 |
$130.08
|
|
Mayo activated protein c resistance assay
|
$240.60 |
$240.60 |
$240.60 |
$97.50
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$1,021.20 |
$1,021.20 |
$1,021.20 |
$172.90
|
|
Mayo alkaline phosphatase isoenzyme
|
$160.20 |
$160.20 |
$160.20 |
$66.30
|
|
Mayo alpha 1 antitrypsin
|
$323.40 |
$323.40 |
$323.40 |
$89.05
|
|
Mayo amikacin trough therapeutic drug level
|
$92.40 |
$92.40 |
$92.40 |
$82.80
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$277.20 |
$277.20 |
$277.20 |
$359.00
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$2,297.40 |
$2,297.40 |
$2,297.40 |
$1,860.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$158.40 |
$158.40 |
$158.40 |
$73.08
|
|
Mayo antithrombin iii antigen
|
$118.20 |
$118.20 |
$118.20 |
$72.35
|
|
Mayo bart bartonella henselae antibody igg
|
$82.20 |
$82.20 |
$82.20 |
$45.50
|
|
Mayo bordetella pertussis antibody igg
|
$156.00 |
$156.00 |
$156.00 |
$69.00
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$37.20 |
$37.20 |
$37.20 |
$82.68
|
|
Mayo cd20b mononuclear cell antigen nos quantitative each
|
$414.00 |
$414.00 |
$414.00 |
$113.50
|
|
Mayo ceruloplasmin
|
$181.20 |
$181.20 |
$181.20 |
$69.60
|
|
Mayo chemiluminescent parathyroid related peptide
|
$256.80 |
$256.80 |
$256.80 |
$113.88
|
|
Mayo chikv chikungunya antibodies igg
|
$112.80 |
$112.80 |
$112.80 |
$109.20
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$64.20 |
$64.20 |
$64.20 |
$53.30
|
|
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte
|
$1,322.40 |
$1,322.40 |
$1,322.40 |
$346.32
|
|
Mayo chromium
|
$215.40 |
$215.40 |
$215.40 |
$70.85
|
|
Mayo cocou cortisone urine
|
$874.20 |
$874.20 |
$874.20 |
$207.26
|
|
Mayo cortisol free
|
$73.80 |
$73.80 |
$73.80 |
$94.95
|
|
Mayo covid-19 antibody nucleocapsid total
|
$96.00 |
$96.00 |
$96.00 |
$70.20
|
|
Mayo coxiella brunetii (q fever) igg antibody
|
$175.20 |
$175.20 |
$175.20 |
$61.80
|
|
Mayo deoxyribonuclease antibody titer
|
$24.60 |
$24.60 |
$24.60 |
$56.80
|
|
Mayo dhea (dehydroepiandrosterone)
|
$185.40 |
$185.40 |
$185.40 |
$113.10
|
|
Mayo dihydrotestosterone
|
$49.80 |
$49.80 |
$49.80 |
$78.00
|
