|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$158.60 |
$158.60 |
$158.60 |
$654.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$120.90 |
$120.90 |
$120.90 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$120.90 |
$120.90 |
$120.90 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$120.90 |
$120.90 |
$120.90 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$94.90 |
$94.90 |
$94.90 |
$130.19
|
|
Inj, levothyroxine, freskabi
|
$1,629.93 |
$1,629.93 |
$1,629.93 |
$244.63
|
|
Inj testosterone cypionate
|
$13.00 |
$13.00 |
$13.00 |
$78.79
|
|
Insertion catheter bladder non indwelling
|
$90.35 |
$90.35 |
$90.35 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$165.75 |
$165.75 |
$165.75 |
$245.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$439.40 |
$439.40 |
$439.40 |
$2,457.24
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,309.75 |
$1,309.75 |
$1,309.75 |
$2,079.43
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,654.90 |
$1,654.90 |
$1,654.90 |
$5,423.04
|
|
Insitu hybridization manual
|
$319.80 |
$319.80 |
$319.80 |
$407.11
|
|
In situ hybridization per specimen each additional single probe stain
|
$241.15 |
$241.15 |
$241.15 |
$291.00
|
|
In situ hybridization per specimen initial single probe stain
|
$260.65 |
$260.65 |
$260.65 |
$364.00
|
|
Insulin total
|
$58.50 |
$58.50 |
$58.50 |
$72.15
|
|
Intrauterine transfusion ftl
|
$963.95 |
$963.95 |
$963.95 |
$1,004.25
|
|
Intrinsic factor antibody
|
$61.10 |
$61.10 |
$61.10 |
$76.77
|
|
Intubation endotracheal emergency procedure
|
$453.70 |
$453.70 |
$453.70 |
$565.00
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$146.66 |
$146.66 |
$146.66 |
$145.52
|
|
Iron
|
$40.30 |
$40.30 |
$40.30 |
$67.50
|
|
Iron binding capacity
|
$56.55 |
$56.55 |
$56.55 |
$55.00
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$200.51 |
$200.51 |
$200.51 |
$211.09
|
|
Irradiation of blood product each unit reference
|
$116.35 |
$116.35 |
$116.35 |
$127.49
|
|
Irrigation implantable venous access device for drug delivery systems
|
$93.60 |
$93.60 |
$93.60 |
$149.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$153.40 |
$153.40 |
$153.40 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$153.40 |
$153.40 |
$153.40 |
$170.94
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$153.40 |
$153.40 |
$153.40 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$153.40 |
$153.40 |
$153.40 |
$476.50
|
|
Ivp w/wo kub w/wo tomography
|
$756.60 |
$756.60 |
$756.60 |
$687.80
|
|
John cunningham antibody
|
$1,005.55 |
$1,005.55 |
$1,005.55 |
$39.65
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$77.35 |
$77.35 |
$77.35 |
$52.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$11.58 |
$11.58 |
$11.58 |
$17.11
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$475.15 |
$475.15 |
$475.15 |
$618.54
|
|
Knee X-ray
|
$482.30 |
$482.30 |
$482.30 |
$387.20
|
|
Kras gene addl variants
|
$346.45 |
$346.45 |
$346.45 |
$366.56
|
|
Kras gene variants exon 2
|
$552.50 |
$552.50 |
$552.50 |
$495.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$7.15 |
$7.15 |
$7.15 |
$13.00
|
|
Lactate dehydrogenase (ldh)
|
$61.75 |
$61.75 |
$61.75 |
$50.55
|
|
Lactated ringers intravenous solution
|
$37.50 |
$37.50 |
$37.50 |
$46.35
|
|
Lactic acid
|
$195.65 |
$195.65 |
$195.65 |
$85.20
|
|
Lactoferrin fecal qualitative
|
$82.55 |
$82.55 |
$82.55 |
$88.40
|
|
Laparo cholecystectomy/explr
|
$1,981.85 |
$1,981.85 |
$1,981.85 |
$6,637.99
|
|
Laparo cholecystectomy/graph
|
$1,539.20 |
$1,539.20 |
$1,539.20 |
$6,870.89
|
|
Laparo partial colectomy 44204
|
$2,386.15 |
$2,386.15 |
$2,386.15 |
$3,790.40
|
|
Laparoscopy fundoplasty
|
$2,086.50 |
$2,086.50 |
$2,086.50 |
$11,191.12
|
|
Lap enterolysis
|
$2,005.25 |
$2,005.25 |
$2,005.25 |
$5,868.27
|
|
Lap ing hernia repair init
|
$6,323.13 |
$6,323.13 |
$6,323.13 |
$6,457.82
|
|
Lap ing hernia repair recur
|
$1,406.60 |
$1,406.60 |
$1,406.60 |
$6,376.26
|
|
Lead capillary
|
$61.75 |
$61.75 |
$61.75 |
$66.32
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$878.15 |
$878.15 |
$878.15 |
$1,053.00
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$12.01 |
$12.01 |
$12.01 |
$45.50
|
|
Levetiracetam therapeutic drug level
|
$63.05 |
$63.05 |
$63.05 |
$99.45
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$19.45 |
$19.45 |
$19.45 |
$43.61
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$21.61 |
$21.61 |
$21.61 |
$25.89
|
|
Lidocaine therapeutic drug level
|
$78.65 |
$78.65 |
$78.65 |
$82.50
|
|
Ligation/biopsy of temporal artery 37609
|
$553.80 |
$553.80 |
$553.80 |
$3,679.25
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$192.66 |
$192.66 |
$192.66 |
$84.28
|
|
Lipase
|
$68.90 |
$68.90 |
$68.90 |
$67.68
|
|
Lipoprotein blood high res frac & quant
|
$90.35 |
$90.35 |
$90.35 |
$90.60
|
|
Lipoprotein blood quant
|
$102.05 |
$102.05 |
$102.05 |
$106.43
|
|
Lipoprotein direct measurement hdl
|
$42.90 |
$42.90 |
$42.90 |
$54.60
|
|
Lipoprotein direct measurement ldl
|
$42.90 |
$42.90 |
$42.90 |
$61.60
|
|
Lithium therapeutic drug level
|
$62.40 |
$62.40 |
$62.40 |
$62.40
|
|
Liver Function Test
|
$89.05 |
$89.05 |
$89.05 |
$92.85
|
|
Liver hem/re-expl wnd/remove pack 47362
|
$2,028.65 |
$2,028.65 |
$2,028.65 |
$2,586.00
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$13.00 |
$13.00 |
$13.00 |
$37.37
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,754.35 |
$1,754.35 |
$1,754.35 |
$1,731.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,674.40 |
$1,674.40 |
$1,674.40 |
$1,705.08
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,450.80 |
$1,450.80 |
$1,450.80 |
$1,450.15
|
|
Lower Back (Lumbar Spine) X-ray
|
$232.70 |
$232.70 |
$232.70 |
$328.23
|
|
L/s ratio fetal lung
|
$173.55 |
$173.55 |
$173.55 |
$173.55
|
|
Lung Function Test (Spirometry)
|
$233.35 |
$233.35 |
$233.35 |
$290.89
|
|
Macro exam dissect molec study ea
|
$76.70 |
$76.70 |
$76.70 |
$76.70
|
|
Macroscopic exam arthropod
|
$14.95 |
$14.95 |
$14.95 |
$38.50
|
|
Macroscopic exam parasite
|
$35.10 |
$35.10 |
$35.10 |
$35.98
|
|
Magnesium
|
$96.20 |
$96.20 |
$96.20 |
$64.80
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$38.90 |
$38.90 |
$38.90 |
$39.81
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$70.85 |
$70.85 |
$70.85 |
$129.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$83.85 |
$83.85 |
$83.85 |
$147.72
|
|
Mastectomy partial
|
$1,245.40 |
$1,245.40 |
$1,245.40 |
$4,306.52
|
|
Mastoids complete
|
$219.05 |
$219.05 |
$219.05 |
$271.95
|
|
M.avium-intra dna dir prob
|
$70.85 |
$70.85 |
$70.85 |
$58.40
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$100.10 |
$100.10 |
$100.10 |
$76.70
|
|
Mayo aathr protein s free
|
$174.20 |
$174.20 |
$174.20 |
$139.23
|
|
Mayo activated protein c resistance assay
|
$100.10 |
$100.10 |
$100.10 |
$100.26
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$209.30 |
$209.30 |
$209.30 |
$172.80
|
|
Mayo alcohol definitive assay volatile screen
|
$93.60 |
$93.60 |
$93.60 |
$118.40
|
|
Mayo alkaline phosphatase isoenzyme
|
$118.30 |
$118.30 |
$118.30 |
$83.85
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$89.05 |
$89.05 |
$89.05 |
$96.10
|
|
Mayo alpha 1 antitrypsin
|
$102.70 |
$102.70 |
$102.70 |
$91.80
|
|
Mayo amikacin trough therapeutic drug level
|
$58.50 |
$58.50 |
$58.50 |
$112.89
|
|
Mayo amphu amphetamines definitive assay 3 or 4 urine
|
$110.50 |
$110.50 |
$110.50 |
$94.50
|
|
Mayo amphu methylenedioxyamphetamines definitive assay urine
|
$108.55 |
$108.55 |
$108.55 |
$73.60
|
|
Mayo analysis gene calr common variants exon 9
|
$657.80 |
$657.80 |
$657.80 |
$517.60
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$284.05 |
$284.05 |
$284.05 |
$343.20
|
|
Mayo analysis gene smn1 dosage/deletion
|
$472.55 |
$472.55 |
$472.55 |
$368.25
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$1,524.25 |
$1,524.25 |
$1,524.25 |
$1,922.13
|
|
Mayo androstenedione
|
$115.05 |
$115.05 |
$115.05 |
$131.30
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$119.60 |
$119.60 |
$119.60 |
$86.40
|