|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$60.00 |
$60.00 |
$60.00 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$7,358.40 |
$7,358.40 |
$7,358.40 |
$6,360.76
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$3,087.60 |
$3,087.60 |
$3,087.60 |
$8,348.12
|
|
Leuprolide acetate injeciton
|
$427.20 |
$427.20 |
$427.20 |
$1,322.50
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$7.80 |
$7.80 |
$7.80 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$33.60 |
$33.60 |
$33.60 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$1.20 |
$1.20 |
$1.20 |
$55.69
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$4.20 |
$4.20 |
$4.20 |
$39.75
|
|
Lidocaine therapeutic drug level
|
$104.40 |
$104.40 |
$104.40 |
$87.45
|
|
Ligate oviduct(s) add-on 58611
|
$3,814.20 |
$3,814.20 |
$3,814.20 |
$584.00
|
|
Ligation/biopsy of temporal artery 37609
|
$4,489.80 |
$4,489.80 |
$4,489.80 |
$3,322.80
|
|
Ligation/major artery/extremity 37618
|
$1,497.00 |
$1,497.00 |
$1,497.00 |
$1,567.80
|
|
Lig/band angioaccess av fistula
|
$12,573.60 |
$12,573.60 |
$12,573.60 |
$4,676.50
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$0.60 |
$0.60 |
$0.60 |
$121.00
|
|
Lipase
|
$34.20 |
$34.20 |
$34.20 |
$93.58
|
|
Lipoprotein blood quant
|
$172.20 |
$172.20 |
$172.20 |
$97.53
|
|
Lipoprotein direct measurement hdl
|
$42.00 |
$42.00 |
$42.00 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$54.00 |
$54.00 |
$54.00 |
$61.60
|
|
Lithium therapeutic drug level
|
$46.80 |
$46.80 |
$46.80 |
$69.75
|
|
Lithotripsy transluminal coronary percutaneous
|
$5,071.20 |
$5,071.20 |
$5,071.20 |
$4,371.12
|
|
Liver ds alys 3 bmrk srm alg
|
$68.40 |
$68.40 |
$68.40 |
$365.28
|
|
Liver Function Test
|
$54.00 |
$54.00 |
$54.00 |
$115.44
|
|
Liver imaging
|
$4,242.60 |
$4,242.60 |
$4,242.60 |
$1,109.00
|
|
Liver imag w/vasclr flow
|
$1,800.00 |
$1,800.00 |
$1,800.00 |
$1,227.60
|
|
Liver/spleen imag static only
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$1,138.55
|
|
Liver/spleen imag w/vasclr flow
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$1,069.20
|
|
Loncastuximab tesirine-lpyl 10 mg intravenous solution
|
$15,780.00 |
$15,780.00 |
$15,780.00 |
$62,704.30
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$1.80 |
$1.80 |
$1.80 |
$37.20
|
|
Low cost skin substitute app
|
$1,325.40 |
$1,325.40 |
$1,325.40 |
$933.60
|
|
Low cost skin substitute app
|
$4,443.00 |
$4,443.00 |
$4,443.00 |
$2,164.64
|
|
Low cost skin substitute app
|
$1,325.40 |
$1,325.40 |
$1,325.40 |
$1,012.00
|
|
Low cost skin substitute app
|
$1,325.40 |
$1,325.40 |
$1,325.40 |
$1,016.16
|
|
Low-Dose Lung Cancer Screening CT Scan
|
$190.20 |
$190.20 |
$190.20 |
$331.50
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,815.45
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$876.00 |
$876.00 |
$876.00 |
$1,468.80
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$3,097.92
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$2,080.00
|
|
Lower Back (Lumbar Spine) X-ray
|
$262.80 |
$262.80 |
$262.80 |
$359.20
|
|
Lower Back (Lumbar Spine) X-ray (4 or more views)
|
$262.80 |
$262.80 |
$262.80 |
$505.83
|
|
Lower Back (Lumbar Spine) X-ray (with bending views)
|
$262.80 |
$262.80 |
$262.80 |
$540.60
|
|
Lower Leg (Shin) X-ray (both sides)
|
$188.40 |
$188.40 |
$188.40 |
$338.40
|
|
Lso flex no ri stays pre ots
|
$294.60 |
$294.60 |
$294.60 |
$164.80
|
|
L/s ratio fetal lung
|
$79.80 |
$79.80 |
$79.80 |
$176.15
|
|
Lumbar diskogram s&i
|
$4,030.20 |
$4,030.20 |
$4,030.20 |
$2,358.23
|
|
Lung Function Test Before and After an Inhaler
|
$650.40 |
$650.40 |
$650.40 |
$549.83
|
|
Lung function test (mbc/mvv)
|
$145.20 |
$145.20 |
$145.20 |
$182.91
|
|
Lung Function Test (Spirometry)
|
$346.20 |
$346.20 |
$346.20 |
$296.91
|
|
Lung perfusion imaging
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$1,069.25
|
|
Lurbinectedin 4 mg intravenous solution
|
$4,770.00 |
$4,770.00 |
$4,770.00 |
$19,182.33
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$6,976.20 |
$6,976.20 |
$6,976.20 |
$22,771.63
|
|
Lutetium lu 177 dotatat ther
|
$616.20 |
$616.20 |
$616.20 |
$347.50
|
|
Lutetium lu 177 vipivotide
|
$27,310.20 |
$27,310.20 |
$27,310.20 |
$357.85
|
|
Lymphatics/lymph node imaging
|
$1,574.40 |
$1,574.40 |
$1,574.40 |
$1,491.70
|
|
Lymphocyte transformation mitogen
|
$272.40 |
$272.40 |
$272.40 |
$271.88
|
|
Lymphocytotoxicity assay
|
$1,055.40 |
$1,055.40 |
$1,055.40 |
$370.20
|
|
Macroscopic exam arthropod
|
$24.00 |
$24.00 |
$24.00 |
$38.58
|
|
Macroscopic exam parasite
|
$24.00 |
$24.00 |
$24.00 |
$37.05
|
|
Magnesium
|
$33.60 |
$33.60 |
$33.60 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$1.80 |
$1.80 |
$1.80 |
$58.70
|
|
Magnetic image bone marrow
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$1,329.39
|
|
Manual diff wbc count b-coat
|
$19.20 |
$19.20 |
$19.20 |
$25.74
|
|
Mapping functional cort/subcort ea add'l hr
|
$744.00 |
$744.00 |
$744.00 |
$584.80
|
|
Map tachycard site(s)
|
$3,363.00 |
$3,363.00 |
$3,363.00 |
$4,082.82
|
|
Margetuximab-cmkb 25 mg/ml intravenous solution
|
$138.00 |
$138.00 |
$138.00 |
$5,930.92
|
|
Marker biop eviva buckle ss
|
$1,213.20 |
$1,213.20 |
$1,213.20 |
$1,451.30
|
|
Mastoids complete
|
$262.80 |
$262.80 |
$262.80 |
$299.50
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$73.80 |
$73.80 |
$73.80 |
$65.28
|
|
Mayo aathr protein s free
|
$77.40 |
$77.40 |
$77.40 |
$130.00
|
|
Mayo activated protein c resistance assay
|
$77.40 |
$77.40 |
$77.40 |
$97.50
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$85.80 |
$85.80 |
$85.80 |
$172.90
|
|
Mayo alcohol definitive assay volatile screen
|
$40.80 |
$40.80 |
$40.80 |
$126.36
|
|
Mayo alpha 1 antitrypsin
|
$67.80 |
$67.80 |
$67.80 |
$89.05
|
|
Mayo amikacin trough therapeutic drug level
|
$109.20 |
$109.20 |
$109.20 |
$81.81
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$529.80 |
$529.80 |
$529.80 |
$374.73
|
|
Mayo analysis gene smn1 dosage/deletion
|
$792.60 |
$792.60 |
$792.60 |
$368.25
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$6,701.40 |
$6,701.40 |
$6,701.40 |
$1,860.00
|
|
Mayo androstenedione
|
$148.20 |
$148.20 |
$148.20 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$74.40 |
$74.40 |
$74.40 |
$74.00
|
|
Mayo antithrombin iii antigen
|
$55.20 |
$55.20 |
$55.20 |
$74.74
|
|
Mayo aspergillus fumigatus antibody
|
$83.40 |
$83.40 |
$83.40 |
$67.20
|
|
Mayo avwpr vw factor activity
|
$156.00 |
$156.00 |
$156.00 |
$171.50
|
|
Mayo babpb infectious agent nucleic acid amplified probe babesia microti
|
$70.80 |
$70.80 |
$70.80 |
$96.73
|
|
Mayo bart bartonella henselae antibody igg
|
$56.40 |
$56.40 |
$56.40 |
$45.50
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$837.60 |
$837.60 |
$837.60 |
$333.60
|
|
Mayo blastomyces antibody immunodiffusion
|
$72.00 |
$72.00 |
$72.00 |
$56.00
|
|
Mayo bordetella pertussis antibody igg
|
$73.80 |
$73.80 |
$73.80 |
$69.20
|
|
Mayo brcmg brucella antibody igm
|
$49.80 |
$49.80 |
$49.80 |
$44.10
|
|
Mayo c1 esterase inhibitor
|
$124.80 |
$124.80 |
$124.80 |
$86.73
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$85.80 |
$85.80 |
$85.80 |
$81.00
|
|
Mayo cdcom hla class ii typing low resolution one locus each
|
$706.80 |
$706.80 |
$706.80 |
$283.40
|
|
Mayo ceruloplasmin
|
$54.60 |
$54.60 |
$54.60 |
$69.60
|
|
Mayo chemiluminescent parathyroid related peptide
|
$72.00 |
$72.00 |
$72.00 |
$122.20
|
|
Mayo chikv chikungunya antibodies igg
|
$72.00 |
$72.00 |
$72.00 |
$109.54
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$66.00 |
$66.00 |
$66.00 |
$53.30
|
|
Mayo chlap chlamydia pneumoniae antibody igm
|
$71.40 |
$71.40 |
$71.40 |
$50.88
|
|
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte
|
$833.40 |
$833.40 |
$833.40 |
$366.94
|
|
Mayo chromium
|
$102.60 |
$102.60 |
$102.60 |
$75.60
|
|
Mayo coccidioides antibody
|
$64.20 |
$64.20 |
$64.20 |
$54.00
|
