|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$236.40 |
$236.40 |
$236.40 |
$190.56
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$248.40 |
$248.40 |
$248.40 |
$159.00
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$85.80 |
$85.80 |
$85.80 |
$153.60
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$394.20 |
$394.20 |
$394.20 |
$437.45
|
|
IV inj ra drug dx study
|
$552.60 |
$552.60 |
$552.60 |
$549.70
|
|
Ivp w/wo kub w/wo tomography
|
$713.40 |
$713.40 |
$713.40 |
$692.18
|
|
Jejunstmy tube plcmt
|
$1,153.20 |
$1,153.20 |
$1,153.20 |
$2,174.40
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$91.20 |
$91.20 |
$91.20 |
$58.50
|
|
Kidney imaging morphology
|
$872.40 |
$872.40 |
$872.40 |
$785.00
|
|
Kidney imag w/bld flow multi
|
$1,916.40 |
$1,916.40 |
$1,916.40 |
$1,556.10
|
|
Kidney img w/bldflw sgl without rx
|
$1,881.00 |
$1,881.00 |
$1,881.00 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$729.00 |
$729.00 |
$729.00 |
$673.36
|
|
Kit gene analys d816 variant
|
$1,456.80 |
$1,456.80 |
$1,456.80 |
$366.03
|
|
Knee MRI (with and without contrast)
|
$5,408.40 |
$5,408.40 |
$5,408.40 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$4,664.40 |
$4,664.40 |
$4,664.40 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$4,307.40 |
$4,307.40 |
$4,307.40 |
$2,110.76
|
|
Knee X-ray
|
$344.40 |
$344.40 |
$344.40 |
$425.55
|
|
Kras gene addl variants
|
$927.00 |
$927.00 |
$927.00 |
$384.80
|
|
Kras gene variants exon 2
|
$1,128.60 |
$1,128.60 |
$1,128.60 |
$509.00
|
|
Lactate dehydrogenase (ldh)
|
$100.80 |
$100.80 |
$100.80 |
$55.50
|
|
Lactic acid
|
$252.60 |
$252.60 |
$252.60 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$73.80 |
$73.80 |
$73.80 |
$80.60
|
|
Laps abltj uterine fibroids
|
$2,297.40 |
$2,297.40 |
$2,297.40 |
$12,320.22
|
|
Largsc w/laser dstrj les
|
$5,511.00 |
$5,511.00 |
$5,511.00 |
$4,881.00
|
|
Largsc w/njx augmentation
|
$2,877.60 |
$2,877.60 |
$2,877.60 |
$3,297.97
|
|
Largsc w/rmvl foreign bdy(s)
|
$276.00 |
$276.00 |
$276.00 |
$765.97
|
|
Largsc w/ther injection
|
$2,877.60 |
$2,877.60 |
$2,877.60 |
$2,286.46
|
|
Laryngoscop w/vc inj + scope
|
$7,411.20 |
$7,411.20 |
$7,411.20 |
$4,362.99
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$6,243.60 |
$6,243.60 |
$6,243.60 |
$2,480.71
|
|
Laryngoscopy telescopic
|
$1,115.40 |
$1,115.40 |
$1,115.40 |
$852.80
|
|
Laryngoscopy w/exc of tumor
|
$5,484.00 |
$5,484.00 |
$5,484.00 |
$5,126.62
|
|
Laryngoscopy with biopsy
|
$5,103.60 |
$5,103.60 |
$5,103.60 |
$3,297.83
|
|
Laryngoscopy w/w/o tracheoscopy aspiration
|
$5,380.80 |
$5,380.80 |
$5,380.80 |
$800.25
|
|
Larynscop w/tumr exc + scope
|
$5,104.80 |
$5,104.80 |
$5,104.80 |
$5,104.80
|
|
Lead capillary
|
$151.80 |
$151.80 |
$151.80 |
$55.25
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,278.60 |
$1,278.60 |
$1,278.60 |
$1,091.30
|
|
Levetiracetam therapeutic drug level
|
$235.80 |
$235.80 |
$235.80 |
$88.92
|
|
L hrt cath chd nm/abn nt cnj
|
$7,195.80 |
$7,195.80 |
$7,195.80 |
$6,095.95
|
|
Lidocaine therapeutic drug level
|
$163.20 |
$163.20 |
$163.20 |
$87.45
|
|
Ligation common iliac vein
|
$975.00 |
$975.00 |
$975.00 |
$3,349.39
|
|
Ligation of shunt
|
$2,491.20 |
$2,491.20 |
$2,491.20 |
$1,786.20
|
|
Lig/band angioaccess av fistula
|
$3,485.40 |
$3,485.40 |
$3,485.40 |
$4,676.50
|
|
Lipase
|
$240.60 |
$240.60 |
$240.60 |
$91.65
|
|
Lipoprotein blood high res frac & quant
|
$133.20 |
$133.20 |
$133.20 |
$86.42
|
|
Lipoprotein blood quant
|
$198.00 |
$198.00 |
$198.00 |
$97.53
|
|
Lipoprotein direct measurement hdl
|
$165.00 |
$165.00 |
$165.00 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$79.20 |
$79.20 |
$79.20 |
$61.60
|
|
Lithium therapeutic drug level
|
$133.20 |
$133.20 |
$133.20 |
$69.42
|
|
Lithotripsy transluminal coronary percutaneous
|
$3,879.00 |
$3,879.00 |
$3,879.00 |
$4,113.20
|
|
Liver abs/cyst dr opn 1-2 stge
|
$1,011.60 |
$1,011.60 |
$1,011.60 |
$1,714.14
|
|
Liver ds alys 3 bmrk srm alg
|
$612.00 |
$612.00 |
$612.00 |
$365.28
|
|
Liver Function Test
|
$204.60 |
$204.60 |
$204.60 |
$115.44
|
|
Liver imag w/vasclr flow
|
$1,888.80 |
$1,888.80 |
$1,888.80 |
$1,227.60
|
|
Liver/spleen imag static only
|
$975.60 |
$975.60 |
$975.60 |
$1,123.00
|
|
Locm 100-199mg/ml iodine,1ml
|
$6.00 |
$6.00 |
$6.00 |
$49.70
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,717.40 |
$2,717.40 |
$2,717.40 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,515.20 |
$2,515.20 |
$2,515.20 |
$1,798.55
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,157.60 |
$2,157.60 |
$2,157.60 |
$1,470.00
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$3,879.00 |
$3,879.00 |
$3,879.00 |
$3,054.10
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,496.80 |
$3,496.80 |
$3,496.80 |
$2,429.00
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$2,871.00 |
$2,871.00 |
$2,871.00 |
$2,065.69
|
|
Lower Back (Lumbar Spine) X-ray
|
$415.80 |
$415.80 |
$415.80 |
$355.85
|
|
Low frequency non-thermal Ultrasound
|
$278.40 |
$278.40 |
$278.40 |
$364.00
|
|
Lumbar diskogram s&i
|
$2,133.00 |
$2,133.00 |
$2,133.00 |
$2,358.23
|
|
Lung function test (mbc/mvv)
|
$164.40 |
$164.40 |
$164.40 |
$180.16
|
|
Lung Function Test (Spirometry)
|
$160.20 |
$160.20 |
$160.20 |
$295.35
|
|
Lung perfusion imaging
|
$1,610.40 |
$1,610.40 |
$1,610.40 |
$1,057.60
|
|
Lymphatics/lymph node imaging
|
$339.00 |
$339.00 |
$339.00 |
$1,463.22
|
|
Lymphocyte transformation mitogen
|
$1,710.00 |
$1,710.00 |
$1,710.00 |
$267.30
|
|
Lymph vessel x-ray trunk
|
$4,714.20 |
$4,714.20 |
$4,714.20 |
$3,380.00
|
|
Macroscopic exam arthropod
|
$43.80 |
$43.80 |
$43.80 |
$38.58
|
|
Macroscopic exam parasite
|
$129.60 |
$129.60 |
$129.60 |
$36.55
|
|
Magnesium
|
$200.40 |
$200.40 |
$200.40 |
$72.50
|
|
Magnetic image bone marrow
|
$4,609.80 |
$4,609.80 |
$4,609.80 |
$1,302.80
|
|
Malaria antibody
|
$115.80 |
$115.80 |
$115.80 |
$94.80
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$102.00 |
$102.00 |
$102.00 |
$131.04
|
|
Manipulation chest wall initial demonstration/evaluation
|
$102.00 |
$102.00 |
$102.00 |
$160.80
|
|
Mapping functional cort/subcort ea add'l hr
|
$2,044.80 |
$2,044.80 |
$2,044.80 |
$626.34
|
|
Map tachycard site(s)
|
$4,495.20 |
$4,495.20 |
$4,495.20 |
$4,082.82
|
|
Mastoids complete
|
$583.80 |
$583.80 |
$583.80 |
$299.50
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$155.40 |
$155.40 |
$155.40 |
$65.00
|
|
Mayo aathr protein s free
|
$265.20 |
$265.20 |
$265.20 |
$130.00
|
|
Mayo activated protein c resistance assay
|
$244.80 |
$244.80 |
$244.80 |
$97.50
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$610.80 |
$610.80 |
$610.80 |
$172.90
|
|
Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation
|
$205.20 |
$205.20 |
$205.20 |
$100.00
|
|
Mayo alcohol definitive assay volatile screen
|
$303.00 |
$303.00 |
$303.00 |
$122.45
|
|
Mayo alkaline phosphatase isoenzyme
|
$76.80 |
$76.80 |
$76.80 |
$66.30
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$124.80 |
$124.80 |
$124.80 |
$111.69
|
|
Mayo alpha 1 antitrypsin
|
$183.00 |
$183.00 |
$183.00 |
$87.00
|
|
Mayo amikacin trough therapeutic drug level
|
$180.60 |
$180.60 |
$180.60 |
$81.81
|
|
Mayo amphu amphetamines definitive assay 3 or 4 urine
|
$48.60 |
$48.60 |
$48.60 |
$72.14
|
|
Mayo amphu methylenedioxyamphetamines definitive assay urine
|
$156.00 |
$156.00 |
$156.00 |
$75.90
|
|
Mayo analysis gene calr common variants exon 9
|
$1,412.40 |
$1,412.40 |
$1,412.40 |
$467.61
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$1,251.00 |
$1,251.00 |
$1,251.00 |
$369.00
|
|
Mayo analysis gene smn1 dosage/deletion
|
$1,614.60 |
$1,614.60 |
$1,614.60 |
$368.25
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$4,998.00 |
$4,998.00 |
$4,998.00 |
$1,860.00
|
|
Mayo androstenedione
|
$195.00 |
$195.00 |
$195.00 |
$109.90
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$223.80 |
$223.80 |
$223.80 |
$73.08
|
|
Mayo antithrombin iii antigen
|
$166.20 |
$166.20 |
$166.20 |
$73.50
|
|
Mayo aspergillus fumigatus antibody
|
$206.40 |
$206.40 |
$206.40 |
$65.70
|
