|
IV Fluids (each additional hour)
|
$180.80 |
$180.80 |
$180.80 |
$133.90
|
|
IV Fluids (first hour)
|
$425.60 |
$425.60 |
$425.60 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$225.60 |
$225.60 |
$225.60 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$260.80 |
$260.80 |
$260.80 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$216.80 |
$216.80 |
$216.80 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$524.80 |
$524.80 |
$524.80 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$225.60 |
$225.60 |
$225.60 |
$167.50
|
|
IV Push Injection (first drug)
|
$388.00 |
$388.00 |
$388.00 |
$252.76
|
|
Ivp w/wo kub w/wo tomography
|
$967.20 |
$967.20 |
$967.20 |
$713.40
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$428.00 |
$428.00 |
$428.00 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$431.20 |
$431.20 |
$431.20 |
$362.05
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$47.20 |
$47.20 |
$47.20 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$61.10 |
$61.10 |
$61.10 |
$23.52
|
|
Kidney img w/bldflw sgl without rx
|
$1,616.80 |
$1,616.80 |
$1,616.80 |
$1,433.22
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$778.40 |
$778.40 |
$778.40 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$567.20 |
$567.20 |
$567.20 |
$490.75
|
|
Knee MRI (with and without contrast)
|
$3,893.60 |
$3,893.60 |
$3,893.60 |
$3,022.20
|
|
Knee MRI (without contrast)
|
$3,292.00 |
$3,292.00 |
$3,292.00 |
$2,130.88
|
|
Knee X-ray
|
$336.80 |
$336.80 |
$336.80 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$277.60 |
$277.60 |
$277.60 |
$290.40
|
|
Knee X-ray (3 views, both knees)
|
$296.00 |
$296.00 |
$296.00 |
$363.60
|
|
Knee X-ray (standing, both knees)
|
$299.20 |
$299.20 |
$299.20 |
$251.20
|
|
Kyleena, 19.5 mg
|
$769.48 |
$769.48 |
$769.48 |
$2,125.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$61.65 |
$61.65 |
$61.65 |
$33.60
|
|
Lactate dehydrogenase (ldh)
|
$39.20 |
$39.20 |
$39.20 |
$55.50
|
|
Lactated ringers intravenous solution
|
$148.40 |
$148.40 |
$148.40 |
$43.74
|
|
Lactic acid
|
$70.40 |
$70.40 |
$70.40 |
$107.10
|
|
Lactoferrin fecal qualitative
|
$106.40 |
$106.40 |
$106.40 |
$82.16
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$498.40 |
$498.40 |
$498.40 |
$740.40
|
|
Lead capillary
|
$67.20 |
$67.20 |
$67.20 |
$57.50
|
|
Leg Artery Ultrasound (complete, both legs)
|
$1,158.40 |
$1,158.40 |
$1,158.40 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$2,270.40 |
$2,270.40 |
$2,270.40 |
$1,585.20
|
|
Leg CT Scan (without contrast, both legs)
|
$1,756.80 |
$1,756.80 |
$1,756.80 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,186.40 |
$1,186.40 |
$1,186.40 |
$1,092.58
|
|
Leishmania antibody
|
$232.80 |
$232.80 |
$232.80 |
$58.50
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$64.83 |
$64.83 |
$64.83 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$896.05 |
$896.05 |
$896.05 |
$6,360.76
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$7,335.48 |
$7,335.48 |
$7,335.48 |
$8,348.12
|
|
Levalbuterol non-comp unit
|
$4.48 |
$4.48 |
$4.48 |
$6.48
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$61.52 |
$61.52 |
$61.52 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$75.20 |
$75.20 |
$75.20 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$181.03 |
$181.03 |
$181.03 |
$55.69
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$109.69 |
$109.69 |
$109.69 |
$420.60
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$63.95 |
$63.95 |
$63.95 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$278.86 |
$278.86 |
$278.86 |
$39.75
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$246.10 |
$246.10 |
$246.10 |
$121.00
|
|
Lipase
|
$60.80 |
$60.80 |
$60.80 |
$93.58
|
|
Lipoprotein direct measurement hdl
|
$34.40 |
$34.40 |
$34.40 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$54.40 |
$54.40 |
$54.40 |
$61.60
|
|
Lithium therapeutic drug level
|
$50.40 |
$50.40 |
$50.40 |
$69.75
|
|
Liver Function Test
|
$82.40 |
$82.40 |
$82.40 |
$115.44
|
|
Liver imaging
|
$1,802.40 |
$1,802.40 |
$1,802.40 |
$1,109.00
|
|
Liver imag w/vasclr flow
|
$1,507.20 |
$1,507.20 |
$1,507.20 |
$1,227.60
|
|
Liver/spleen imag static only
|
$1,557.60 |
$1,557.60 |
$1,557.60 |
$1,138.55
|
|
Liver/spleen imag w/vasclr flow
|
$1,864.80 |
$1,864.80 |
$1,864.80 |
$1,069.20
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$61.41 |
$61.41 |
$61.41 |
$37.20
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$3,000.00 |
$3,000.00 |
$3,000.00 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,474.40 |
$2,474.40 |
$2,474.40 |
$1,815.45
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,018.40 |
$2,018.40 |
$2,018.40 |
$1,468.80
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,184.80 |
$4,184.80 |
$4,184.80 |
$3,097.92
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,169.60 |
$3,169.60 |
$3,169.60 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,374.40 |
$3,374.40 |
$3,374.40 |
$2,080.00
|
|
Lower Back (Lumbar Spine) X-ray
|
$344.00 |
$344.00 |
$344.00 |
$359.20
|
|
Lower Back (Lumbar Spine) X-ray (4 or more views)
|
$419.20 |
$419.20 |
$419.20 |
$505.83
|
|
Lower Back (Lumbar Spine) X-ray (with bending views)
|
$583.20 |
$583.20 |
$583.20 |
$540.60
|
|
Lower Leg (Shin) X-ray (both sides)
|
$278.40 |
$278.40 |
$278.40 |
$338.40
|
|
Lung Function Test Before and After an Inhaler
|
$650.40 |
$650.40 |
$650.40 |
$549.83
|
|
Lung Function Test (Spirometry)
|
$307.20 |
$307.20 |
$307.20 |
$296.91
|
|
Lung perfusion imaging
|
$1,388.00 |
$1,388.00 |
$1,388.00 |
$1,069.25
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$18,578.64 |
$18,578.64 |
$18,578.64 |
$22,771.63
|
|
Macroscopic exam arthropod
|
$44.80 |
$44.80 |
$44.80 |
$38.58
|
|
Macroscopic exam parasite
|
$25.60 |
$25.60 |
$25.60 |
$37.05
|
|
Magnesium
|
$48.00 |
$48.00 |
$48.00 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$188.52 |
$188.52 |
$188.52 |
$58.70
|
|
Mannitol 12.5 gm/50 ml inj
|
$61.40 |
$61.40 |
$61.40 |
$26.29
|
|
Mastoids complete
|
$385.60 |
$385.60 |
$385.60 |
$299.50
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$61.60 |
$61.60 |
$61.60 |
$65.28
|
|
Mayo aathr protein s free
|
$120.00 |
$120.00 |
$120.00 |
$130.00
|
|
Mayo activated protein c resistance assay
|
$79.20 |
$79.20 |
$79.20 |
$97.50
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$203.20 |
$203.20 |
$203.20 |
$172.90
|
|
Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation
|
$104.00 |
$104.00 |
$104.00 |
$101.07
|
|
Mayo alcohol definitive assay volatile screen
|
$77.60 |
$77.60 |
$77.60 |
$126.36
|
|
Mayo alkaline phosphatase isoenzyme
|
$43.20 |
$43.20 |
$43.20 |
$66.60
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$88.80 |
$88.80 |
$88.80 |
$112.77
|
|
Mayo alpha 1 antitrypsin
|
$92.00 |
$92.00 |
$92.00 |
$89.05
|
|
Mayo amphu amphetamines definitive assay 3 or 4 urine
|
$58.40 |
$58.40 |
$58.40 |
$72.14
|
|
Mayo amphu methylenedioxyamphetamines definitive assay urine
|
$73.60 |
$73.60 |
$73.60 |
$78.10
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$250.40 |
$250.40 |
$250.40 |
$374.73
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$3,087.20 |
$3,087.20 |
$3,087.20 |
$1,860.00
|
|
Mayo androstenedione
|
$58.40 |
$58.40 |
$58.40 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$97.60 |
$97.60 |
$97.60 |
$74.00
|
|
Mayo antithrombin iii antigen
|
$138.40 |
$138.40 |
$138.40 |
$74.74
|
|
Mayo aspergillus fumigatus antibody
|
$57.60 |
$57.60 |
$57.60 |
$67.20
|
|
Mayo avwpr vw factor activity
|
$150.40 |
$150.40 |
$150.40 |
$171.50
|
|
Mayo barbiturates definitive assay confirmation urine
|
$68.80 |
$68.80 |
$68.80 |
$93.60
|
|
Mayo bart bartonella henselae antibody igg
|
$76.80 |
$76.80 |
$76.80 |
$45.50
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$353.60 |
$353.60 |
$353.60 |
$333.60
|
|
Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative
|
$524.00 |
$524.00 |
$524.00 |
$310.20
|
|
Mayo blastomyces antibody immunodiffusion
|
$69.60 |
$69.60 |
$69.60 |
$56.00
|
|
Mayo bnzu sedative hypnotics definitive urine
|
$73.60 |
$73.60 |
$73.60 |
$62.79
|