|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$720.60 |
$720.60 |
$720.60 |
$514.36
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$144.00 |
$144.00 |
$144.00 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$148.80 |
$148.80 |
$148.80 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$160.80 |
$160.80 |
$160.80 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$125.40 |
$125.40 |
$125.40 |
$130.19
|
|
Inj for mammo ductogram
|
$610.80 |
$610.80 |
$610.80 |
$469.16
|
|
Inj, moxifloxacin 100 mg
|
$262.28 |
$262.28 |
$262.28 |
$100.44
|
|
Inj, pedmark, 100 mg
|
$64.75 |
$64.75 |
$64.75 |
$95.14
|
|
Insertion catheter bladder non indwelling
|
$298.20 |
$298.20 |
$298.20 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$342.60 |
$342.60 |
$342.60 |
$245.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,334.20 |
$3,334.20 |
$3,334.20 |
$2,457.24
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,139.00 |
$2,139.00 |
$2,139.00 |
$2,079.43
|
|
Insitu hybridization manual
|
$387.60 |
$387.60 |
$387.60 |
$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
|
$738.00 |
$738.00 |
$738.00 |
$364.00
|
|
Instillation anticarcinogenic agent bladder
|
$844.80 |
$844.80 |
$844.80 |
$721.50
|
|
Insulin total
|
$115.20 |
$115.20 |
$115.20 |
$72.15
|
|
Interferon alfa-2b inj
|
$51.21 |
$51.21 |
$51.21 |
$51.21
|
|
Intrinsic factor antibody
|
$210.00 |
$210.00 |
$210.00 |
$76.77
|
|
Intro long gi tube
|
$1,007.40 |
$1,007.40 |
$1,007.40 |
$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
|
|
Iron
|
$96.00 |
$96.00 |
$96.00 |
$67.50
|
|
Iron binding capacity
|
$75.60 |
$75.60 |
$75.60 |
$55.00
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$660.70 |
$660.70 |
$660.70 |
$211.09
|
|
Irrigation implantable venous access device for drug delivery systems
|
$171.60 |
$171.60 |
$171.60 |
$149.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$160.80 |
$160.80 |
$160.80 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$281.40 |
$281.40 |
$281.40 |
$170.94
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$107.40 |
$107.40 |
$107.40 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$627.60 |
$627.60 |
$627.60 |
$476.50
|
|
Ivp w/wo kub w/wo tomography
|
$673.20 |
$673.20 |
$673.20 |
$687.80
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$171.60 |
$171.60 |
$171.60 |
$52.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$39.01 |
$39.01 |
$39.01 |
$17.11
|
|
Kidney img w/bldflw sgl without rx
|
$1,961.40 |
$1,961.40 |
$1,961.40 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$614.40 |
$614.40 |
$614.40 |
$618.54
|
|
Knee MRI (with and without contrast)
|
$4,604.40 |
$4,604.40 |
$4,604.40 |
$2,703.85
|
|
Knee MRI (with contrast)
|
$4,411.20 |
$4,411.20 |
$4,411.20 |
$2,315.95
|
|
Knee MRI (without contrast)
|
$3,898.80 |
$3,898.80 |
$3,898.80 |
$2,120.00
|
|
Knee X-ray
|
$765.60 |
$765.60 |
$765.60 |
$387.20
|
|
Kras gene addl variants
|
$279.00 |
$279.00 |
$279.00 |
$366.56
|
|
Kras gene variants exon 2
|
$234.60 |
$234.60 |
$234.60 |
$495.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$50.65 |
$50.65 |
$50.65 |
$13.00
|
|
Lactate dehydrogenase (ldh)
|
$61.80 |
$61.80 |
$61.80 |
$50.55
|
|
Lactated ringers intravenous solution
|
$78.68 |
$78.68 |
$78.68 |
$46.35
|
|
Lactic acid
|
$114.00 |
$114.00 |
$114.00 |
$85.20
|
|
Lactoferrin fecal qualitative
|
$90.60 |
$90.60 |
$90.60 |
$88.40
|
|
Lactoferrin fecal quant
|
$206.40 |
$206.40 |
$206.40 |
$106.10
|
|
Lead capillary
|
$184.80 |
$184.80 |
$184.80 |
$66.32
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,554.60 |
$1,554.60 |
$1,554.60 |
$1,053.00
|
|
Lens iol ant bicnvx 24.0 multi
|
$587.40 |
$587.40 |
$587.40 |
$1,136.25
|
|
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
|
$225.00 |
$225.00 |
$225.00 |
$99.45
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$64.88 |
$64.88 |
$64.88 |
$43.61
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$690.62 |
$690.62 |
$690.62 |
$343.13
|
|
Lidocaine therapeutic drug level
|
$214.20 |
$214.20 |
$214.20 |
$82.50
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$130.49 |
$130.49 |
$130.49 |
$84.28
|
|
Lipase
|
$170.40 |
$170.40 |
$170.40 |
$67.68
|
|
Lipoprotein blood quant
|
$265.80 |
$265.80 |
$265.80 |
$106.43
|
|
Lipoprotein direct measurement hdl
|
$90.60 |
$90.60 |
$90.60 |
$54.60
|
|
Lipoprotein direct measurement ldl
|
$100.80 |
$100.80 |
$100.80 |
$61.60
|
|
Lithium therapeutic drug level
|
$127.80 |
$127.80 |
$127.80 |
$62.40
|
|
Liver Function Test
|
$231.00 |
$231.00 |
$231.00 |
$92.85
|
|
Liver/spleen imag static only
|
$1,250.40 |
$1,250.40 |
$1,250.40 |
$1,135.20
|
|
Locm 100-199mg/ml iodine,1ml
|
$2.57 |
$2.57 |
$2.57 |
$2.57
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$38.73 |
$38.73 |
$38.73 |
$37.37
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,731.00 |
$1,731.00 |
$1,731.00 |
$1,731.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$939.60 |
$939.60 |
$939.60 |
$1,705.08
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,245.00 |
$1,245.00 |
$1,245.00 |
$1,450.15
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$2,501.40 |
$2,501.40 |
$2,501.40 |
$2,631.85
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$2,767.20 |
$2,767.20 |
$2,767.20 |
$2,181.58
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,845.60 |
$1,845.60 |
$1,845.60 |
$1,791.60
|
|
Lower Back (Lumbar Spine) X-ray
|
$302.40 |
$302.40 |
$302.40 |
$328.23
|
|
L/s ratio fetal lung
|
$76.80 |
$76.80 |
$76.80 |
$173.55
|
|
Lung perfusion imaging
|
$1,153.80 |
$1,153.80 |
$1,153.80 |
$919.75
|
|
Macroscopic exam arthropod
|
$88.80 |
$88.80 |
$88.80 |
$38.50
|
|
Macroscopic exam parasite
|
$48.00 |
$48.00 |
$48.00 |
$35.98
|
|
Magnesium
|
$126.60 |
$126.60 |
$126.60 |
$64.80
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$64.61 |
$64.61 |
$64.61 |
$39.81
|
|
Mannitol 12.5 gm/50 ml inj
|
$40.12 |
$40.12 |
$40.12 |
$33.24
|
|
Manual diff wbc count b-coat
|
$79.80 |
$79.80 |
$79.80 |
$22.75
|
|
Mastoids complete
|
$637.20 |
$637.20 |
$637.20 |
$271.95
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$205.20 |
$205.20 |
$205.20 |
$76.70
|
|
Mayo aathr protein s free
|
$291.00 |
$291.00 |
$291.00 |
$139.23
|
|
Mayo activated protein c resistance assay
|
$253.20 |
$253.20 |
$253.20 |
$100.26
|
|
Mayo alkaline phosphatase isoenzyme
|
$52.20 |
$52.20 |
$52.20 |
$83.85
|
|
Mayo alpha 1 antitrypsin
|
$151.20 |
$151.20 |
$151.20 |
$91.80
|
|
Mayo amikacin trough therapeutic drug level
|
$199.80 |
$199.80 |
$199.80 |
$112.89
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$657.60 |
$657.60 |
$657.60 |
$343.20
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$2,158.20 |
$2,158.20 |
$2,158.20 |
$1,922.13
|
|
Mayo androstenedione
|
$277.20 |
$277.20 |
$277.20 |
$131.30
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$213.00 |
$213.00 |
$213.00 |
$86.40
|
|
Mayo antithrombin iii antigen
|
$259.20 |
$259.20 |
$259.20 |
$75.00
|
|
Mayo aspergillus fumigatus antibody
|
$36.00 |
$36.00 |
$36.00 |
$72.60
|
|
Mayo avwpr vw factor activity
|
$55.80 |
$55.80 |
$55.80 |
$159.66
|
|
Mayo bart bartonella henselae antibody igg
|
$110.40 |
$110.40 |
$110.40 |
$52.00
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$428.40 |
$428.40 |
$428.40 |
$364.90
|
|
Mayo blastomyces antibody immunodiffusion
|
$148.80 |
$148.80 |
$148.80 |
$67.60
|
|
Mayo bordetella pertussis antibody igg
|
$36.00 |
$36.00 |
$36.00 |
$59.15
|
|
Mayo brcmg brucella antibody igm
|
$30.60 |
$30.60 |
$30.60 |
$56.80
|