|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$54,890.00 |
$54,890.00 |
$54,890.00 |
$8,629.72
|
|
Intracard echo interv w/s&i
|
$1,170.91 |
$1,170.91 |
$1,170.91 |
$3,429.40
|
|
Intrapul surf admin endo tube
|
$883.40 |
$883.40 |
$883.40 |
$220.80
|
|
Intrinsic factor antibody
|
$918.95 |
$918.95 |
$918.95 |
$66.60
|
|
Intro long gi tube w/mult fluo
|
$2,198.87 |
$2,198.87 |
$2,198.87 |
$449.40
|
|
Ipratropium bromide non-comp
|
$38.69 |
$38.69 |
$38.69 |
$3.75
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$14,906.54 |
$14,906.54 |
$14,906.54 |
$163.87
|
|
Iron
|
$707.28 |
$707.28 |
$707.28 |
$74.40
|
|
Iron binding capacity
|
$533.41 |
$533.41 |
$533.41 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$1,174.24 |
$1,174.24 |
$1,174.24 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$492.37 |
$492.37 |
$492.37 |
$119.83
|
|
Ivc venogram s&i
|
$15,845.01 |
$15,845.01 |
$15,845.01 |
$3,316.95
|
|
IV inj ra drug dx study
|
$2,598.93 |
$2,598.93 |
$2,598.93 |
$549.70
|
|
Ivp w/wo kub w/wo tomography
|
$3,027.56 |
$3,027.56 |
$3,027.56 |
$692.18
|
|
Kafo fem fx cast molded to p
|
$16,729.00 |
$16,729.00 |
$16,729.00 |
$3,130.66
|
|
Kafo fem fx cast thermoplas
|
$17,807.00 |
$17,807.00 |
$17,807.00 |
$2,710.45
|
|
Kafo femoral fx cast rigid
|
$10,686.00 |
$10,686.00 |
$10,686.00 |
$2,138.81
|
|
Kidney imaging morphology
|
$3,329.03 |
$3,329.03 |
$3,329.03 |
$785.00
|
|
Kidney img w/bldflw sgl without rx
|
$6,006.52 |
$6,006.52 |
$6,006.52 |
$1,427.40
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$3,603.34 |
$3,603.34 |
$3,603.34 |
$666.00
|
|
Knee disc/dial lock/adj flex
|
$3,007.00 |
$3,007.00 |
$3,007.00 |
$288.41
|
|
Knee joint cam lock each joi
|
$1,084.00 |
$1,084.00 |
$1,084.00 |
$287.46
|
|
Ko swedish type pre ots
|
$2,760.00 |
$2,760.00 |
$2,760.00 |
$604.50
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$665.32 |
$665.32 |
$665.32 |
$32.34
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$981.04 |
$981.04 |
$981.04 |
$175.92
|
|
Lactoferrin fecal qualitative
|
$464.25 |
$464.25 |
$464.25 |
$80.40
|
|
Lactoferrin fecal quant
|
$224.68 |
$224.68 |
$224.68 |
$106.10
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$5,172.57 |
$5,172.57 |
$5,172.57 |
$1,088.26
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$531.76 |
$531.76 |
$531.76 |
$163.62
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$10,842.42 |
$10,842.42 |
$10,842.42 |
$7,052.00
|
|
Lev 1 hosp type b ed visit
|
$1,119.13 |
$1,119.13 |
$1,119.13 |
$186.98
|
|
Lev 2 hosp type b ed visit
|
$1,677.68 |
$1,677.68 |
$1,677.68 |
$359.65
|
|
Lev 3 hosp type b ed visit
|
$2,235.82 |
$2,235.82 |
$2,235.82 |
$598.15
|
|
Levetiracetam therapeutic drug level
|
$712.23 |
$712.23 |
$712.23 |
$88.92
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$942.46 |
$942.46 |
$942.46 |
$385.62
|
|
Lidocaine injection
|
$682.87 |
$682.87 |
$682.87 |
$44.76
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$1.62 |
$1.62 |
$1.62 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$30.59 |
$30.59 |
$30.59 |
$39.37
|
|
Lidocaine therapeutic drug level
|
$630.10 |
$630.10 |
$630.10 |
$89.70
|
|
Limited ankle motion ea jnt
|
$701.00 |
$701.00 |
$701.00 |
$123.05
|
|
Limited autopsy
|
$2,503.53 |
$2,503.53 |
$2,503.53 |
$352.80
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$3,145.59 |
$3,145.59 |
$3,145.59 |
$125.66
|
|
Lipoprotein blood quant
|
$434.82 |
$434.82 |
$434.82 |
$102.05
|
|
Lipoprotein direct measurement hdl
|
$623.59 |
$623.59 |
$623.59 |
$57.50
|
|
Lithium therapeutic drug level
|
$708.80 |
$708.80 |
$708.80 |
$69.42
|
|
Liver Function Test
|
$1,604.83 |
$1,604.83 |
$1,604.83 |
$115.44
|
|
Liver imag w/vasclr flow
|
$4,646.34 |
$4,646.34 |
$4,646.34 |
$1,238.65
|
|
Liver/spleen imag static only
|
$3,856.24 |
$3,856.24 |
$3,856.24 |
$1,123.50
|
|
Liver/spleen imag w/vasclr flow
|
$4,579.20 |
$4,579.20 |
$4,579.20 |
$1,067.48
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$120.55 |
$120.55 |
$120.55 |
$37.20
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$5,994.28 |
$5,994.28 |
$5,994.28 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$5,838.58 |
$5,838.58 |
$5,838.58 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$5,838.58 |
$5,838.58 |
$5,838.58 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$11,540.14 |
$11,540.14 |
$11,540.14 |
$3,111.17
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$11,171.52 |
$11,171.52 |
$11,171.52 |
$2,445.30
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$9,537.01 |
$9,537.01 |
$9,537.01 |
$2,096.84
|
|
Lower Back (Lumbar Spine) X-ray
|
$1,948.84 |
$1,948.84 |
$1,948.84 |
$352.32
|
|
Low frequency non-thermal Ultrasound
|
$163.66 |
$163.66 |
$163.66 |
$364.00
|
|
Lso full corset
|
$1,598.00 |
$1,598.00 |
$1,598.00 |
$320.92
|
|
Lso sagittal rigid panel cus
|
$5,508.00 |
$5,508.00 |
$5,508.00 |
$3,092.00
|
|
Lso s/c shell/panel prefab
|
$20,187.00 |
$20,187.00 |
$20,187.00 |
$1,332.80
|
|
L/s ratio fetal lung
|
$3,292.19 |
$3,292.19 |
$3,292.19 |
$176.15
|
|
Lumbar diskogram s&i
|
$12,354.53 |
$12,354.53 |
$12,354.53 |
$2,358.23
|
|
Lung Function Test (Spirometry)
|
$780.58 |
$780.58 |
$780.58 |
$295.35
|
|
Lung perfusion imaging
|
$3,158.99 |
$3,158.99 |
$3,158.99 |
$1,075.25
|
|
Lymphatics/lymph node imaging
|
$9,648.46 |
$9,648.46 |
$9,648.46 |
$1,448.00
|
|
Lymphocyte transformation mitogen
|
$1,422.57 |
$1,422.57 |
$1,422.57 |
$266.20
|
|
Mannitol 12.5 gm/50 ml inj
|
$107.02 |
$107.02 |
$107.02 |
$27.81
|
|
Map tachycard site(s)
|
$1,897.78 |
$1,897.78 |
$1,897.78 |
$3,875.95
|
|
Mastoids complete
|
$1,998.83 |
$1,998.83 |
$1,998.83 |
$299.50
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$529.98 |
$529.98 |
$529.98 |
$66.36
|
|
Mayo activated protein c resistance assay
|
$1,054.99 |
$1,054.99 |
$1,054.99 |
$97.50
|
|
Mayo alcohol definitive assay volatile screen
|
$913.99 |
$913.99 |
$913.99 |
$112.85
|
|
Mayo alpha 1 antitrypsin
|
$749.69 |
$749.69 |
$749.69 |
$89.05
|
|
Mayo analysis gene calr common variants exon 9
|
$946.85 |
$946.85 |
$946.85 |
$467.61
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$1,615.52 |
$1,615.52 |
$1,615.52 |
$359.00
|
|
Mayo androstenedione
|
$1,470.33 |
$1,470.33 |
$1,470.33 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$792.48 |
$792.48 |
$792.48 |
$73.08
|
|
Mayo antithrombin iii antigen
|
$984.68 |
$984.68 |
$984.68 |
$72.35
|
|
Mayo c1 esterase inhibitor
|
$608.69 |
$608.69 |
$608.69 |
$85.00
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$964.81 |
$964.81 |
$964.81 |
$82.68
|
|
Mayo ceruloplasmin
|
$779.49 |
$779.49 |
$779.49 |
$69.60
|
|
Mayo chlap chlamydia pneumoniae antibody igm
|
$475.71 |
$475.71 |
$475.71 |
$50.88
|
|
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte
|
$851.71 |
$851.71 |
$851.71 |
$346.32
|
|
Mayo chromium
|
$675.93 |
$675.93 |
$675.93 |
$70.85
|
|
Mayo coccidioides antibody
|
$470.75 |
$470.75 |
$470.75 |
$55.20
|
|
Mayo covid-19 antibody nucleocapsid total
|
$66.94 |
$66.94 |
$66.94 |
$70.20
|
|
Mayo cyanide
|
$758.08 |
$758.08 |
$758.08 |
$90.00
|
|
Mayo deoxyribonuclease antibody titer
|
$713.76 |
$713.76 |
$713.76 |
$56.80
|
|
Mayo dhea (dehydroepiandrosterone)
|
$1,524.20 |
$1,524.20 |
$1,524.20 |
$113.10
|
|
Mayo efpo chloride stool
|
$414.97 |
$414.97 |
$414.97 |
$44.20
|
|
Mayo estriol
|
$831.83 |
$831.83 |
$831.83 |
$92.30
|
|
Mayo estrone
|
$877.69 |
$877.69 |
$877.69 |
$84.60
|
|
Mayo everolimus therapeutic drug level
|
$361.09 |
$361.09 |
$361.09 |
$91.99
|
|
Mayo factor ii
|
$1,200.95 |
$1,200.95 |
$1,200.95 |
$96.76
|
|
Mayo factor v
|
$1,120.70 |
$1,120.70 |
$1,120.70 |
$125.58
|
|
Mayo factor vii
|
$1,124.14 |
$1,124.14 |
$1,124.14 |
$155.00
|
|
Mayo factor viii vw factor antigen
|
$1,058.42 |
$1,058.42 |
$1,058.42 |
$112.75
|
|
Mayo factor viii vw factor multimetric analysis
|
$1,271.63 |
$1,271.63 |
$1,271.63 |
$127.92
|
|
Mayo factor viii vw factor ristocetin cofactor
|
$1,171.54 |
$1,171.54 |
$1,171.54 |
$140.40
|
