|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$398.80 |
$398.80 |
$398.80 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$302.40 |
$302.40 |
$302.40 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$287.60 |
$287.60 |
$287.60 |
$654.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$110.80 |
$110.80 |
$110.80 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$86.40 |
$86.40 |
$86.40 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$152.00 |
$152.00 |
$152.00 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$76.40 |
$76.40 |
$76.40 |
$130.19
|
|
Inject sacroiliac joint
|
$722.40 |
$722.40 |
$722.40 |
$1,028.95
|
|
Inj epidural sgl cerv-thor without img
|
$750.40 |
$750.40 |
$750.40 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$750.40 |
$750.40 |
$750.40 |
$1,260.60
|
|
Inj proc lumbr disk ea lvl
|
$1,197.60 |
$1,197.60 |
$1,197.60 |
$1,218.51
|
|
Insert hepatic shunt (tips)
|
$5,304.40 |
$5,304.40 |
$5,304.40 |
$9,754.48
|
|
Insertion catheter bladder non indwelling
|
$116.00 |
$116.00 |
$116.00 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$73.20 |
$73.20 |
$73.20 |
$245.00
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$7,940.00 |
$7,940.00 |
$7,940.00 |
$9,855.00
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,357.60 |
$1,357.60 |
$1,357.60 |
$2,367.00
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$6,947.60 |
$6,947.60 |
$6,947.60 |
$9,824.59
|
|
Insitu hybridization auto
|
$158.40 |
$158.40 |
$158.40 |
$328.79
|
|
Insitu hybridization manual
|
$160.80 |
$160.80 |
$160.80 |
$407.11
|
|
Ins/rpl ldless pm right vent w img & eval
|
$3,372.80 |
$3,372.80 |
$3,372.80 |
$24,705.20
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$3,174.80 |
$3,174.80 |
$3,174.80 |
$28,931.50
|
|
Instillation anticarcinogenic agent bladder
|
$549.60 |
$549.60 |
$549.60 |
$721.50
|
|
Ins tun cv cath wo subq prt/pm
|
$2,289.60 |
$2,289.60 |
$2,289.60 |
$4,314.75
|
|
Insulin total
|
$78.00 |
$78.00 |
$78.00 |
$72.15
|
|
Interdiscal perq aspir dx
|
$498.00 |
$498.00 |
$498.00 |
$1,222.26
|
|
Iron
|
$20.80 |
$20.80 |
$20.80 |
$67.50
|
|
Iron binding capacity
|
$32.40 |
$32.40 |
$32.40 |
$55.00
|
|
Irradiation of blood product each unit reference
|
$24.80 |
$24.80 |
$24.80 |
$127.49
|
|
Irrigation implantable venous access device for drug delivery systems
|
$84.80 |
$84.80 |
$84.80 |
$149.00
|
|
Ivc venogram s&i
|
$1,653.60 |
$1,653.60 |
$1,653.60 |
$2,975.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$208.40 |
$208.40 |
$208.40 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$156.00 |
$156.00 |
$156.00 |
$170.94
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$114.80 |
$114.80 |
$114.80 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$256.80 |
$256.80 |
$256.80 |
$476.50
|
|
Ivp w/wo kub w/wo tomography
|
$636.80 |
$636.80 |
$636.80 |
$687.80
|
|
John cunningham antibody
|
$867.20 |
$867.20 |
$867.20 |
$39.65
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$84.80 |
$84.80 |
$84.80 |
$52.50
|
|
Kidney imaging morphology
|
$740.00 |
$740.00 |
$740.00 |
$693.60
|
|
Kidney imag w/bld flow multi
|
$1,024.00 |
$1,024.00 |
$1,024.00 |
$1,319.61
|
|
Kidney img w/bldflw sgl without rx
|
$982.40 |
$982.40 |
$982.40 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$676.40 |
$676.40 |
$676.40 |
$618.54
|
|
Knee MRI (with and without contrast)
|
$1,247.60 |
$1,247.60 |
$1,247.60 |
$2,703.85
|
|
Knee MRI (with contrast)
|
$2,490.80 |
$2,490.80 |
$2,490.80 |
$2,315.95
|
|
Knee MRI (without contrast)
|
$2,303.60 |
$2,303.60 |
$2,303.60 |
$2,120.00
|
|
Knee X-ray
|
$336.80 |
$336.80 |
$336.80 |
$387.20
|
|
Lactate dehydrogenase (ldh)
|
$28.80 |
$28.80 |
$28.80 |
$50.55
|
|
Lactic acid
|
$30.00 |
$30.00 |
$30.00 |
$85.20
|
|
Lead capillary
|
$40.80 |
$40.80 |
$40.80 |
$66.32
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$485.20 |
$485.20 |
$485.20 |
$1,053.00
|
|
Levetiracetam therapeutic drug level
|
$138.80 |
$138.80 |
$138.80 |
$99.45
|
|
Ligation/major artery/extremity 37618
|
$431.60 |
$431.60 |
$431.60 |
$1,497.00
|
|
Lipase
|
$67.60 |
$67.60 |
$67.60 |
$67.68
|
|
Lipoprotein direct measurement hdl
|
$73.20 |
$73.20 |
$73.20 |
$54.60
|
|
Lipoprotein direct measurement ldl
|
$47.20 |
$47.20 |
$47.20 |
$61.60
|
|
Listeria monocytogenes
|
$100.40 |
$100.40 |
$100.40 |
$60.84
|
|
Lithium therapeutic drug level
|
$49.60 |
$49.60 |
$49.60 |
$62.40
|
|
Liver Function Test
|
$66.40 |
$66.40 |
$66.40 |
$92.85
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,342.40 |
$1,342.40 |
$1,342.40 |
$1,731.00
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,362.00 |
$1,362.00 |
$1,362.00 |
$1,705.08
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,206.00 |
$1,206.00 |
$1,206.00 |
$1,450.15
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$1,806.40 |
$1,806.40 |
$1,806.40 |
$2,631.85
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,606.00 |
$1,606.00 |
$1,606.00 |
$2,181.58
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,431.60 |
$1,431.60 |
$1,431.60 |
$1,791.60
|
|
Lower Back (Lumbar Spine) X-ray
|
$317.20 |
$317.20 |
$317.20 |
$328.23
|
|
L/s ratio fetal lung
|
$90.40 |
$90.40 |
$90.40 |
$173.55
|
|
Lumbar diskogram s&i
|
$1,578.00 |
$1,578.00 |
$1,578.00 |
$2,358.23
|
|
Lung Function Test (Spirometry)
|
$131.20 |
$131.20 |
$131.20 |
$290.89
|
|
Lung perfusion imaging
|
$623.20 |
$623.20 |
$623.20 |
$919.75
|
|
Lymphatics/lymph node imaging
|
$964.80 |
$964.80 |
$964.80 |
$1,330.00
|
|
Magnesium
|
$40.00 |
$40.00 |
$40.00 |
$64.80
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$68.40 |
$68.40 |
$68.40 |
$129.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$231.60 |
$231.60 |
$231.60 |
$147.72
|
|
Mastoids complete
|
$57.20 |
$57.20 |
$57.20 |
$271.95
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$69.20 |
$69.20 |
$69.20 |
$76.70
|
|
Mayo aathr protein s free
|
$92.40 |
$92.40 |
$92.40 |
$139.23
|
|
Mayo activated protein c resistance assay
|
$182.00 |
$182.00 |
$182.00 |
$100.26
|
|
Mayo alcohol definitive assay volatile screen
|
$120.00 |
$120.00 |
$120.00 |
$118.40
|
|
Mayo alkaline phosphatase isoenzyme
|
$44.00 |
$44.00 |
$44.00 |
$83.85
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$48.00 |
$48.00 |
$48.00 |
$96.10
|
|
Mayo alpha 1 antitrypsin
|
$78.00 |
$78.00 |
$78.00 |
$91.80
|
|
Mayo amikacin trough therapeutic drug level
|
$92.40 |
$92.40 |
$92.40 |
$112.89
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$264.40 |
$264.40 |
$264.40 |
$343.20
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$48.00 |
$48.00 |
$48.00 |
$86.40
|
|
Mayo aspergillus fumigatus antibody
|
$62.40 |
$62.40 |
$62.40 |
$72.60
|
|
Mayo avwpr vw factor activity
|
$117.20 |
$117.20 |
$117.20 |
$159.66
|
|
Mayo bart bartonella henselae antibody igg
|
$30.80 |
$30.80 |
$30.80 |
$52.00
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$94.80 |
$94.80 |
$94.80 |
$364.90
|
|
Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative
|
$141.60 |
$141.60 |
$141.60 |
$381.55
|
|
Mayo blastomyces antibody immunodiffusion
|
$36.00 |
$36.00 |
$36.00 |
$67.60
|
|
Mayo bordetella pertussis antibody igg
|
$72.80 |
$72.80 |
$72.80 |
$59.15
|
|
Mayo brcmg brucella antibody igm
|
$40.80 |
$40.80 |
$40.80 |
$56.80
|
|
Mayo c1 esterase inhibitor
|
$58.80 |
$58.80 |
$58.80 |
$124.80
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$137.60 |
$137.60 |
$137.60 |
$104.55
|
|
Mayo ceruloplasmin
|
$102.40 |
$102.40 |
$102.40 |
$70.85
|
|
Mayo chemiluminescent parathyroid related peptide
|
$124.00 |
$124.00 |
$124.00 |
$125.50
|
|
Mayo chikv chikungunya antibodies igg
|
$49.20 |
$49.20 |
$49.20 |
$122.00
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$49.20 |
$49.20 |
$49.20 |
$59.11
|
|
Mayo chlap chlamydia pneumoniae antibody igm
|
$49.20 |
$49.20 |
$49.20 |
$54.40
|
|
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte
|
$327.20 |
$327.20 |
$327.20 |
$380.40
|
|
Mayo chromium
|
$32.40 |
$32.40 |
$32.40 |
$89.25
|