|
Infliximab 100 mg intravenous solution
|
$15,266.88 |
$15,266.88 |
$15,266.88 |
$2,080.86
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$562.29 |
$562.29 |
$562.29 |
$102.83
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$1,075.56 |
$1,075.56 |
$1,075.56 |
$293.04
|
|
Inj allopurinol sodium 1 mg
|
$26.00 |
$26.00 |
$26.00 |
$6,968.99
|
|
Inj calcitriol per 0.1 mcg
|
$196.72 |
$196.72 |
$196.72 |
$22.69
|
|
Inj ceftolozane tazobactam
|
$873.67 |
$873.67 |
$873.67 |
$408.00
|
|
Inj crotalidae im f(ab')2 eq
|
$4,795.80 |
$4,795.80 |
$4,795.80 |
$2,613.60
|
|
Injection, daratumumab 10 mg
|
$16,401.78 |
$16,401.78 |
$16,401.78 |
$5,164.24
|
|
Injection, fulvestrant
|
$20,104.36 |
$20,104.36 |
$20,104.36 |
$1,719.16
|
|
Injection,onabotulinumtoxina
|
$10,649.23 |
$10,649.23 |
$10,649.23 |
$2,241.61
|
|
Injection, pentamidine iseth
|
$2,172.38 |
$2,172.38 |
$2,172.38 |
$464.32
|
|
Injection, renflexis
|
$3,638.11 |
$3,638.11 |
$3,638.11 |
$1,341.52
|
|
Inj ivig privigen 500 mg
|
$33,465.28 |
$33,465.28 |
$33,465.28 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$1,036.26 |
$1,036.26 |
$1,036.26 |
$136.62
|
|
Inj melpha hydroch nos 50 mg
|
$27,410.93 |
$27,410.93 |
$27,410.93 |
$2,375.23
|
|
Inj. mycophenolate mofetil
|
$1,471.24 |
$1,471.24 |
$1,471.24 |
$252.66
|
|
Inj, pedmark, 100 mg
|
$549.64 |
$549.64 |
$549.64 |
$123.00
|
|
Inj progesterone per 50 mg
|
$1,045.69 |
$1,045.69 |
$1,045.69 |
$14.93
|
|
Inj testosterone cypionate
|
$324.60 |
$324.60 |
$324.60 |
$62.80
|
|
Inj thiotepa nos 1 mg
|
$6,448.57 |
$6,448.57 |
$6,448.57 |
$3,170.16
|
|
Insert cath pleura with image
|
$3,166.10 |
$3,166.10 |
$3,166.10 |
$2,194.40
|
|
Insitu hybridization manual
|
$637.01 |
$637.01 |
$637.01 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$3,071.50 |
$3,071.50 |
$3,071.50 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$1,345.73 |
$1,345.73 |
$1,345.73 |
$326.04
|
|
Insulin total
|
$800.44 |
$800.44 |
$800.44 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$37,982.00 |
$37,982.00 |
$37,982.00 |
$8,629.72
|
|
Interfyl, 1 mg
|
$568.00 |
$568.00 |
$568.00 |
$5,118.52
|
|
Interrog evl pm/ldls pm ip
|
$637.10 |
$637.10 |
$637.10 |
$124.80
|
|
Interstitial brachy inter
|
$5.68 |
$5.68 |
$5.68 |
$1,129.00
|
|
Intra-atrial pacing
|
$25,914.84 |
$25,914.84 |
$25,914.84 |
$4,683.25
|
|
Intra-atrial recording
|
$25,914.84 |
$25,914.84 |
$25,914.84 |
$5,252.30
|
|
Intracard echo interv w/s&i
|
$5,414.93 |
$5,414.93 |
$5,414.93 |
$3,429.40
|
|
Intrapul surf admin endo tube
|
$601.83 |
$601.83 |
$601.83 |
$220.80
|
|
Intraventricular pacing
|
$25,914.84 |
$25,914.84 |
$25,914.84 |
$5,609.50
|
|
Intrinsic factor antibody
|
$1,444.12 |
$1,444.12 |
$1,444.12 |
$66.60
|
|
Intro long gi tube w/mult fluo
|
$3,342.57 |
$3,342.57 |
$3,342.57 |
$449.40
|
|
Iodine i-123 sod iodide mil
|
$2,061.64 |
$2,061.64 |
$2,061.64 |
$350.74
|
|
Ipratropium bromide non-comp
|
$40.69 |
$40.69 |
$40.69 |
$3.75
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$16,330.87 |
$16,330.87 |
$16,330.87 |
$163.87
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$17,820.73 |
$17,820.73 |
$17,820.73 |
$5,476.68
|
|
Iron binding capacity
|
$395.20 |
$395.20 |
$395.20 |
$63.79
|
|
Iron dextran 50 mg/ml injection solution
|
$1,071.62 |
$1,071.62 |
$1,071.62 |
$80.95
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$1,186.96 |
$1,186.96 |
$1,186.96 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$1,879.58 |
$1,879.58 |
$1,879.58 |
$142.20
|
|
IV inj ra drug dx study
|
$2,665.36 |
$2,665.36 |
$2,665.36 |
$549.70
|
|
Ivp w/nephrotomography
|
$2,643.39 |
$2,643.39 |
$2,643.39 |
$790.08
|
|
Kafo fem fx cast molded to p
|
$5,744.00 |
$5,744.00 |
$5,744.00 |
$3,130.66
|
|
Kafo fem fx cast thermoplas
|
$6,115.00 |
$6,115.00 |
$6,115.00 |
$2,710.45
|
|
Kafo femoral fx cast rigid
|
$3,670.00 |
$3,670.00 |
$3,670.00 |
$2,138.81
|
|
Ketogenic steroids fract
|
$1,153.97 |
$1,153.97 |
$1,153.97 |
$82.74
|
|
Kidney imag w/bld flow multi
|
$16,431.99 |
$16,431.99 |
$16,431.99 |
$1,570.65
|
|
Kidney img w/bldflw sgl without rx
|
$7,377.47 |
$7,377.47 |
$7,377.47 |
$1,427.40
|
|
Knee disc/dial lock/adj flex
|
$1,136.00 |
$1,136.00 |
$1,136.00 |
$288.41
|
|
Knee joint cam lock each joi
|
$451.00 |
$451.00 |
$451.00 |
$287.46
|
|
Ko rigid without joints pre ots
|
$169.00 |
$169.00 |
$169.00 |
$214.97
|
|
Ko swedish type pre ots
|
$1,043.00 |
$1,043.00 |
$1,043.00 |
$604.50
|
|
Kras gene variants exon 2
|
$3,980.49 |
$3,980.49 |
$3,980.49 |
$486.45
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$549.20 |
$549.20 |
$549.20 |
$175.92
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$64.98 |
$64.98 |
$64.98 |
$163.62
|
|
Leukocyte phagocytosis
|
$1,440.77 |
$1,440.77 |
$1,440.77 |
$71.76
|
|
Lev 1 hosp type b ed visit
|
$669.06 |
$669.06 |
$669.06 |
$186.98
|
|
Lev 2 hosp type b ed visit
|
$1,147.48 |
$1,147.48 |
$1,147.48 |
$359.65
|
|
Lev 3 hosp type b ed visit
|
$1,749.99 |
$1,749.99 |
$1,749.99 |
$598.15
|
|
Levetiracetam therapeutic drug level
|
$1,085.58 |
$1,085.58 |
$1,085.58 |
$88.92
|
|
Lidocaine injection
|
$440.76 |
$440.76 |
$440.76 |
$44.76
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$440.76 |
$440.76 |
$440.76 |
$39.37
|
|
Lidocaine therapeutic drug level
|
$917.17 |
$917.17 |
$917.17 |
$89.70
|
|
Limited ankle motion ea jnt
|
$265.00 |
$265.00 |
$265.00 |
$123.05
|
|
Lipoprotein blood quant
|
$328.52 |
$328.52 |
$328.52 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$695.38 |
$695.38 |
$695.38 |
$57.50
|
|
Listeria monocytogenes
|
$1,562.52 |
$1,562.52 |
$1,562.52 |
$117.52
|
|
Liver imaging
|
$5,853.97 |
$5,853.97 |
$5,853.97 |
$1,093.50
|
|
Liver imag w/vasclr flow
|
$5,141.43 |
$5,141.43 |
$5,141.43 |
$1,238.65
|
|
Liver/spleen imag w/vasclr flow
|
$7,116.59 |
$7,116.59 |
$7,116.59 |
$1,067.48
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$52.40 |
$52.40 |
$52.40 |
$37.20
|
|
Lso flex no ri stays pre ots
|
$1,322.00 |
$1,322.00 |
$1,322.00 |
$195.00
|
|
Lso full corset
|
$604.00 |
$604.00 |
$604.00 |
$320.92
|
|
Lso sagittal rigid panel cus
|
$1,892.00 |
$1,892.00 |
$1,892.00 |
$3,092.00
|
|
Lso s/c shell/panel prefab
|
$6,932.00 |
$6,932.00 |
$6,932.00 |
$1,332.80
|
|
L/s ratio fetal lung
|
$4,457.42 |
$4,457.42 |
$4,457.42 |
$176.15
|
|
Lung function test (mbc/mvv)
|
$795.72 |
$795.72 |
$795.72 |
$180.16
|
|
Lung Function Test (Spirometry)
|
$1,917.44 |
$1,917.44 |
$1,917.44 |
$295.35
|
|
Lung perfusion imaging
|
$4,920.44 |
$4,920.44 |
$4,920.44 |
$1,075.25
|
|
Lymphatics/lymph node imaging
|
$6,815.48 |
$6,815.48 |
$6,815.48 |
$1,448.00
|
|
Makena, 10 mg
|
$8,763.70 |
$8,763.70 |
$8,763.70 |
$1,405.80
|
|
Mannitol 12.5 gm/50 ml inj
|
$39.10 |
$39.10 |
$39.10 |
$27.81
|
|
Map tachycard site(s)
|
$11,960.50 |
$11,960.50 |
$11,960.50 |
$3,875.95
|
|
Matrion 1 sq cm
|
$3,009.00 |
$3,009.00 |
$3,009.00 |
$361.00
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$1,055.56 |
$1,055.56 |
$1,055.56 |
$66.36
|
|
Mayo aathr protein s free
|
$1,632.55 |
$1,632.55 |
$1,632.55 |
$130.08
|
|
Mayo activated protein c resistance assay
|
$1,178.97 |
$1,178.97 |
$1,178.97 |
$97.50
|
|
Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation
|
$1,619.23 |
$1,619.23 |
$1,619.23 |
$102.96
|
|
Mayo alkaline phosphatase isoenzyme
|
$1,239.02 |
$1,239.02 |
$1,239.02 |
$66.30
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$942.18 |
$942.18 |
$942.18 |
$105.11
|
|
Mayo alpha 1 antitrypsin
|
$937.17 |
$937.17 |
$937.17 |
$89.05
|
|
Mayo amikacin trough therapeutic drug level
|
$550.30 |
$550.30 |
$550.30 |
$82.80
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$3,543.60 |
$3,543.60 |
$3,543.60 |
$1,860.00
|
|
Mayo androstenedione
|
$2,411.32 |
$2,411.32 |
$2,411.32 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$968.86 |
$968.86 |
$968.86 |
$73.08
|
|
Mayo antithrombin iii antigen
|
$1,242.33 |
$1,242.33 |
$1,242.33 |
$72.35
|
