|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$162.00 |
$162.00 |
$162.00 |
$130.19
|
|
Inj for mammo ductogram
|
$610.80 |
$610.80 |
$610.80 |
$469.16
|
|
Inj intralesional <= 7 lsn(s)
|
$247.20 |
$247.20 |
$247.20 |
$238.77
|
|
Inj ivig privigen 500 mg
|
$5,204.56 |
$5,204.56 |
$5,204.56 |
$6,144.00
|
|
Inj proc myelogram lumbar
|
$1,621.80 |
$1,621.80 |
$1,621.80 |
$1,026.35
|
|
Insertion catheter bladder non indwelling
|
$357.60 |
$357.60 |
$357.60 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$429.60 |
$429.60 |
$429.60 |
$245.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,263.00 |
$1,263.00 |
$1,263.00 |
$2,457.24
|
|
Insert swan-ganz cath
|
$3,082.20 |
$3,082.20 |
$3,082.20 |
$2,269.00
|
|
Insitu hybridization manual
|
$644.40 |
$644.40 |
$644.40 |
$407.11
|
|
In situ hybridization per specimen each additional single probe stain
|
$192.00 |
$192.00 |
$192.00 |
$291.00
|
|
In situ hybridization per specimen initial single probe stain
|
$1,198.20 |
$1,198.20 |
$1,198.20 |
$364.00
|
|
Insulin total
|
$147.00 |
$147.00 |
$147.00 |
$72.15
|
|
Intracranial complete study
|
$1,174.20 |
$1,174.20 |
$1,174.20 |
$903.50
|
|
Intracranial limited study
|
$863.40 |
$863.40 |
$863.40 |
$398.34
|
|
Intrinsic factor antibody
|
$140.40 |
$140.40 |
$140.40 |
$76.77
|
|
Intro long gi tube
|
$1,009.20 |
$1,009.20 |
$1,009.20 |
$880.75
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$0.63 |
$0.63 |
$0.63 |
$4.59
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$0.67 |
$0.67 |
$0.67 |
$145.52
|
|
Ioxaglate 39.3%-19.6% inj 200 ml
|
$16.79 |
$16.79 |
$16.79 |
$16.79
|
|
Iron
|
$79.80 |
$79.80 |
$79.80 |
$67.50
|
|
Iron binding capacity
|
$51.60 |
$51.60 |
$51.60 |
$55.00
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$276.11 |
$276.11 |
$276.11 |
$211.09
|
|
Irrigation implantable venous access device for drug delivery systems
|
$112.80 |
$112.80 |
$112.80 |
$149.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$130.80 |
$130.80 |
$130.80 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$105.60 |
$105.60 |
$105.60 |
$170.94
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$130.80 |
$130.80 |
$130.80 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$523.20 |
$523.20 |
$523.20 |
$476.50
|
|
Ivp w/wo kub w/wo tomography
|
$613.20 |
$613.20 |
$613.20 |
$687.80
|
|
Jak2 targeted sequence analysis
|
$333.60 |
$333.60 |
$333.60 |
$465.74
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$105.60 |
$105.60 |
$105.60 |
$52.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$39.01 |
$39.01 |
$39.01 |
$17.11
|
|
Kidney imaging morphology
|
$1,243.20 |
$1,243.20 |
$1,243.20 |
$693.60
|
|
Kidney imag w/bld flow multi
|
$2,377.20 |
$2,377.20 |
$2,377.20 |
$1,319.61
|
|
Kidney img w/bldflw sgl without rx
|
$1,961.40 |
$1,961.40 |
$1,961.40 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$553.20 |
$553.20 |
$553.20 |
$618.54
|
|
Knee MRI (with and without contrast)
|
$5,092.80 |
$5,092.80 |
$5,092.80 |
$2,703.85
|
|
Knee MRI (with contrast)
|
$4,244.40 |
$4,244.40 |
$4,244.40 |
$2,315.95
|
|
Knee MRI (without contrast)
|
$3,396.00 |
$3,396.00 |
$3,396.00 |
$2,120.00
|
|
Knee X-ray
|
$746.40 |
$746.40 |
$746.40 |
$387.20
|
|
Kras gene addl variants
|
$303.00 |
$303.00 |
$303.00 |
$366.56
|
|
Kras gene variants exon 2
|
$661.80 |
$661.80 |
$661.80 |
$495.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$44.90 |
$44.90 |
$44.90 |
$13.00
|
|
Lactate dehydrogenase (ldh)
|
$48.00 |
$48.00 |
$48.00 |
$50.55
|
|
Lactated ringers intravenous solution
|
$78.66 |
$78.66 |
$78.66 |
$46.35
|
|
Lactic acid
|
$123.60 |
$123.60 |
$123.60 |
$85.20
|
|
Lactoferrin fecal quant
|
$217.20 |
$217.20 |
$217.20 |
$106.10
|
|
Lead capillary
|
$138.60 |
$138.60 |
$138.60 |
$66.32
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,554.60 |
$1,554.60 |
$1,554.60 |
$1,053.00
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$43.18 |
$43.18 |
$43.18 |
$115.27
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$1,094.81 |
$1,094.81 |
$1,094.81 |
$5,001.00
|
|
Levalbuterol non-comp unit
|
$20.15 |
$20.15 |
$20.15 |
$20.15
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$40.91 |
$40.91 |
$40.91 |
$45.50
|
|
Levetiracetam therapeutic drug level
|
$118.80 |
$118.80 |
$118.80 |
$99.45
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$64.88 |
$64.88 |
$64.88 |
$43.61
|
|
Lidocaine therapeutic drug level
|
$219.60 |
$219.60 |
$219.60 |
$82.50
|
|
Lipase
|
$130.80 |
$130.80 |
$130.80 |
$67.68
|
|
Lipoprotein blood high res frac & quant
|
$50.40 |
$50.40 |
$50.40 |
$90.60
|
|
Lipoprotein blood quant
|
$219.60 |
$219.60 |
$219.60 |
$106.43
|
|
Lipoprotein direct measurement hdl
|
$91.20 |
$91.20 |
$91.20 |
$54.60
|
|
Lipoprotein direct measurement ldl
|
$118.20 |
$118.20 |
$118.20 |
$61.60
|
|
Lithium therapeutic drug level
|
$86.40 |
$86.40 |
$86.40 |
$62.40
|
|
Liver Function Test
|
$176.40 |
$176.40 |
$176.40 |
$92.85
|
|
Liver imaging
|
$595.20 |
$595.20 |
$595.20 |
$827.28
|
|
Liver imag w/vasclr flow
|
$1,222.80 |
$1,222.80 |
$1,222.80 |
$913.25
|
|
Liver/spleen imag static only
|
$1,601.40 |
$1,601.40 |
$1,601.40 |
$1,135.20
|
|
Liver/spleen imag w/vasclr flow
|
$1,735.80 |
$1,735.80 |
$1,735.80 |
$727.35
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$38.73 |
$38.73 |
$38.73 |
$37.37
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,626.00 |
$1,626.00 |
$1,626.00 |
$1,731.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,355.40 |
$1,355.40 |
$1,355.40 |
$1,705.08
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,084.80 |
$1,084.80 |
$1,084.80 |
$1,450.15
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$2,410.20 |
$2,410.20 |
$2,410.20 |
$2,631.85
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$2,008.20 |
$2,008.20 |
$2,008.20 |
$2,181.58
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,606.80 |
$1,606.80 |
$1,606.80 |
$1,791.60
|
|
Lower Back (Lumbar Spine) X-ray
|
$285.60 |
$285.60 |
$285.60 |
$328.23
|
|
Lung Function Test (Spirometry)
|
$396.60 |
$396.60 |
$396.60 |
$290.89
|
|
Lung perfusion imaging
|
$1,438.80 |
$1,438.80 |
$1,438.80 |
$919.75
|
|
Lymphatics/lymph node imaging
|
$1,933.20 |
$1,933.20 |
$1,933.20 |
$1,330.00
|
|
Lymphocytotoxicity assay
|
$922.20 |
$922.20 |
$922.20 |
$379.20
|
|
Macroscopic exam arthropod
|
$58.80 |
$58.80 |
$58.80 |
$38.50
|
|
Magnesium
|
$97.20 |
$97.20 |
$97.20 |
$64.80
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$64.61 |
$64.61 |
$64.61 |
$39.81
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$228.00 |
$228.00 |
$228.00 |
$129.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$304.20 |
$304.20 |
$304.20 |
$147.72
|
|
Marker biop eviva buckle ss
|
$300.00 |
$300.00 |
$300.00 |
$1,126.34
|
|
Mastoids complete
|
$637.20 |
$637.20 |
$637.20 |
$271.95
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$236.40 |
$236.40 |
$236.40 |
$76.70
|
|
Mayo aathr protein s free
|
$231.00 |
$231.00 |
$231.00 |
$139.23
|
|
Mayo activated protein c resistance assay
|
$224.40 |
$224.40 |
$224.40 |
$100.26
|
|
Mayo alkaline phosphatase isoenzyme
|
$264.60 |
$264.60 |
$264.60 |
$83.85
|
|
Mayo alpha 1 antitrypsin
|
$136.20 |
$136.20 |
$136.20 |
$91.80
|
|
Mayo analysis gene calr common variants exon 9
|
$219.00 |
$219.00 |
$219.00 |
$517.60
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$573.60 |
$573.60 |
$573.60 |
$343.20
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$1,791.60 |
$1,791.60 |
$1,791.60 |
$1,922.13
|
|
Mayo androstenedione
|
$151.20 |
$151.20 |
$151.20 |
$131.30
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$195.60 |
$195.60 |
$195.60 |
$86.40
|
|
Mayo antithrombin iii antigen
|
$345.60 |
$345.60 |
$345.60 |
$75.00
|
|
Mayo aspergillus fumigatus antibody
|
$31.80 |
$31.80 |
$31.80 |
$72.60
|
|
Mayo avwpr vw factor activity
|
$55.80 |
$55.80 |
$55.80 |
$159.66
|
|
Mayo bart bartonella henselae antibody igg
|
$62.40 |
$62.40 |
$62.40 |
$52.00
|