|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$153.60 |
$153.60 |
$153.60 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$10,683.36 |
$10,683.36 |
$10,683.36 |
$7,052.00
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$21,300.12 |
$21,300.12 |
$21,300.12 |
$9,107.80
|
|
Levalbuterol non-comp con
|
$21.72 |
$21.72 |
$21.72 |
$21.60
|
|
Levetiracetam therapeutic drug level
|
$50.40 |
$50.40 |
$50.40 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$28.02 |
$28.02 |
$28.02 |
$55.60
|
|
Liberta rc ipg
|
$81,180.25 |
$81,180.25 |
$81,180.25 |
$36,300.00
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$35.10 |
$35.10 |
$35.10 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$28.44 |
$28.44 |
$28.44 |
$39.37
|
|
Lidocaine therapeutic drug level
|
$118.20 |
$118.20 |
$118.20 |
$89.70
|
|
Lift heel adj small gl60404sm
|
$174.51 |
$174.51 |
$174.51 |
$148.39
|
|
Lift heel adjustable med
|
$90.22 |
$90.22 |
$90.22 |
$57.90
|
|
Lifts elevation metal extens
|
$1,339.06 |
$1,339.06 |
$1,339.06 |
$959.80
|
|
Ligation/biopsy of temporal artery 37609
|
$6,560.70 |
$6,560.70 |
$6,560.70 |
$3,322.80
|
|
Limited ankle motion ea jnt
|
$351.65 |
$351.65 |
$351.65 |
$123.05
|
|
Limited motion knee joint
|
$274.07 |
$274.07 |
$274.07 |
$278.92
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$118.08 |
$118.08 |
$118.08 |
$125.66
|
|
Lipase
|
$96.00 |
$96.00 |
$96.00 |
$93.58
|
|
Lipoprotein blood high res frac & quant
|
$111.00 |
$111.00 |
$111.00 |
$90.35
|
|
Lipoprotein blood quant
|
$111.00 |
$111.00 |
$111.00 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$102.60 |
$102.60 |
$102.60 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$42.60 |
$42.60 |
$42.60 |
$61.60
|
|
Listeria monocytogenes
|
$133.20 |
$133.20 |
$133.20 |
$117.52
|
|
Lithium therapeutic drug level
|
$66.00 |
$66.00 |
$66.00 |
$69.42
|
|
Liver elastography 91200
|
$520.20 |
$520.20 |
$520.20 |
$285.18
|
|
Liver Function Test
|
$96.60 |
$96.60 |
$96.60 |
$115.44
|
|
Liver imaging
|
$801.60 |
$801.60 |
$801.60 |
$1,093.50
|
|
Liver/spleen imag static only
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$1,123.50
|
|
Liver/spleen imag w/vasclr flow
|
$703.20 |
$703.20 |
$703.20 |
$1,067.48
|
|
Locm 100-199mg/ml iodine,1ml
|
$146.64 |
$146.64 |
$146.64 |
$45.90
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$7.50 |
$7.50 |
$7.50 |
$37.20
|
|
Lo rig pos pnl l1-l5 pre ots
|
$408.17 |
$408.17 |
$408.17 |
$414.13
|
|
Lo sag rig pnl stays pre cst
|
$167.74 |
$167.74 |
$167.74 |
$167.74
|
|
Low back disk surgery
|
$26,569.81 |
$26,569.81 |
$26,569.81 |
$7,913.97
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,926.60 |
$1,926.60 |
$1,926.60 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,777.80 |
$1,777.80 |
$1,777.80 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,579.80 |
$1,579.80 |
$1,579.80 |
$1,504.05
|
|
Lower Back (Lumbar Spine) X-ray
|
$526.20 |
$526.20 |
$526.20 |
$352.32
|
|
Lsh w/t/o ut 250 g or less
|
$66,691.70 |
$66,691.70 |
$66,691.70 |
$6,839.00
|
|
Lso corset front
|
$249.04 |
$249.04 |
$249.04 |
$172.04
|
|
Lso flex no ri stays pre ots
|
$269.09 |
$269.09 |
$269.09 |
$195.00
|
|
Lso full corset
|
$353.77 |
$353.77 |
$353.77 |
$320.92
|
|
Lso r post pnl sj-t9 pre cst
|
$401.51 |
$401.51 |
$401.51 |
$326.82
|
|
Lso sag-coronal panel custom
|
$3,970.45 |
$3,970.45 |
$3,970.45 |
$2,440.98
|
|
Lso sag-co shell pnl pre ots
|
$3,065.30 |
$3,065.30 |
$3,065.30 |
$3,065.30
|
|
Lso sag ctr rigi pos pre ots
|
$383.24 |
$383.24 |
$383.24 |
$388.83
|
|
Lso sagit rigid panel prefab
|
$2,364.26 |
$2,364.26 |
$2,364.26 |
$1,990.83
|
|
Lso sagittal rigid panel cus
|
$3,207.92 |
$3,207.92 |
$3,207.92 |
$3,092.00
|
|
Lso sc r pos/lat pnl pre cst
|
$617.19 |
$617.19 |
$617.19 |
$577.00
|
|
Lso sc r pos/lat pnl pre ots
|
$678.49 |
$678.49 |
$678.49 |
$678.49
|
|
Lso s/c shell/panel custom
|
$2,252.16 |
$2,252.16 |
$2,252.16 |
$2,252.16
|
|
L/s ratio fetal lung
|
$153.00 |
$153.00 |
$153.00 |
$176.15
|
|
Lumbar bolster pad
|
$185.27 |
$185.27 |
$185.27 |
$185.27
|
|
Lumbar derotation pad
|
$215.18 |
$215.18 |
$215.18 |
$215.18
|
|
Lumbar diskogram s&i
|
$2,595.00 |
$2,595.00 |
$2,595.00 |
$2,358.23
|
|
Lumbar or lumbar rib pad
|
$209.78 |
$209.78 |
$209.78 |
$209.78
|
|
Lumbar sling
|
$238.10 |
$238.10 |
$238.10 |
$238.10
|
|
Lung perfusion imaging
|
$1,149.00 |
$1,149.00 |
$1,149.00 |
$1,075.25
|
|
Lurbinectedin 4 mg intravenous solution
|
$32,521.50 |
$32,521.50 |
$32,521.50 |
$20,101.00
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$48,641.82 |
$48,641.82 |
$48,641.82 |
$21,867.91
|
|
Lvad shower bag heartmate
|
$787.27 |
$787.27 |
$787.27 |
$887.68
|
|
Lymphatics/lymph node imaging
|
$1,308.00 |
$1,308.00 |
$1,308.00 |
$1,448.00
|
|
Lymphocyte culture mixed
|
$60.00 |
$60.00 |
$60.00 |
$92.00
|
|
Lymphocyte transformation mitogen
|
$228.00 |
$228.00 |
$228.00 |
$266.20
|
|
Macroscopic exam arthropod
|
$58.20 |
$58.20 |
$58.20 |
$38.50
|
|
Macroscopic exam parasite
|
$43.20 |
$43.20 |
$43.20 |
$36.40
|
|
Magnesium
|
$77.40 |
$77.40 |
$77.40 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$43.14 |
$43.14 |
$43.14 |
$58.70
|
|
Malaria antibody
|
$94.80 |
$94.80 |
$94.80 |
$94.80
|
|
Mammosite ced
|
$7,938.26 |
$7,938.26 |
$7,938.26 |
$5,152.06
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$449.40 |
$449.40 |
$449.40 |
$128.40
|
|
Manipulation chest wall initial demonstration/evaluation
|
$489.00 |
$489.00 |
$489.00 |
$152.54
|
|
Man's shoe oxford brace
|
$174.64 |
$174.64 |
$174.64 |
$175.11
|
|
Mapping io sentinel lymph node
|
$57,841.62 |
$57,841.62 |
$57,841.62 |
$650.00
|
|
Marker biop eviva buckle ss
|
$14,826.85 |
$14,826.85 |
$14,826.85 |
$1,152.48
|
|
Mastectomy partial
|
$23,036.98 |
$23,036.98 |
$23,036.98 |
$4,531.42
|
|
Mastoids complete
|
$250.20 |
$250.20 |
$250.20 |
$299.50
|
|
Mastopexy
|
$20,950.86 |
$20,950.86 |
$20,950.86 |
$6,311.00
|
|
Mast simple complete
|
$56,791.92 |
$56,791.92 |
$56,791.92 |
$6,052.48
|
|
Matrion 1 sq cm
|
$20,298.34 |
$20,298.34 |
$20,298.34 |
$361.00
|
|
Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm
|
$85,260.91 |
$85,260.91 |
$85,260.91 |
$5,065.63
|
|
M.avium-intra dna amp prob
|
$103.80 |
$103.80 |
$103.80 |
$132.00
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$40.80 |
$40.80 |
$40.80 |
$66.36
|
|
Mayo aathr protein s free
|
$162.60 |
$162.60 |
$162.60 |
$130.08
|
|
Mayo activated protein c resistance assay
|
$109.80 |
$109.80 |
$109.80 |
$97.50
|
|
Mayo alkaline phosphatase isoenzyme
|
$121.80 |
$121.80 |
$121.80 |
$66.30
|
|
Mayo alpha 1 antitrypsin
|
$93.00 |
$93.00 |
$93.00 |
$89.05
|
|
Mayo amikacin trough therapeutic drug level
|
$78.00 |
$78.00 |
$78.00 |
$82.80
|
|
Mayo analysis gene calr common variants exon 9
|
$376.20 |
$376.20 |
$376.20 |
$467.61
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$306.00 |
$306.00 |
$306.00 |
$359.00
|
|
Mayo analysis gene smn1 dosage/deletion
|
$226.20 |
$226.20 |
$226.20 |
$361.50
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$3,223.20 |
$3,223.20 |
$3,223.20 |
$1,860.00
|
|
Mayo androstenedione
|
$286.20 |
$286.20 |
$286.20 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$158.40 |
$158.40 |
$158.40 |
$73.08
|
|
Mayo antithrombin iii antigen
|
$109.20 |
$109.20 |
$109.20 |
$72.35
|
|
Mayo aspergillus fumigatus antibody
|
$149.40 |
$149.40 |
$149.40 |
$67.60
|
|
Mayo avwpr vw factor activity
|
$47.40 |
$47.40 |
$47.40 |
$165.78
|
|
Mayo bart bartonella henselae antibody igg
|
$74.40 |
$74.40 |
$74.40 |
$45.50
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$393.00 |
$393.00 |
$393.00 |
$325.60
|
|
Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative
|
$310.20 |
$310.20 |
$310.20 |
$347.00
|
