|
Irradiation of blood product each unit reference
|
$24.80 |
$24.80 |
$24.80 |
|
|
Irrigation implantable venous access device for drug delivery systems
|
$68.00 |
$72.80 |
$84.80 |
|
|
Ivc venogram s&i
|
$1,653.60 |
$1,653.60 |
$1,653.60 |
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$102.40 |
$208.40 |
$225.55 |
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$115.60 |
$156.00 |
$225.55 |
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$68.00 |
$114.80 |
$225.55 |
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$179.60 |
$256.80 |
$259.35 |
|
|
Ivp w/nephrotomography
|
$681.20 |
$681.20 |
$681.20 |
|
|
Ivp w/wo kub w/wo tomography
|
$636.80 |
$636.80 |
$636.80 |
|
|
John cunningham antibody
|
$867.20 |
$867.20 |
$867.20 |
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$30.80 |
$84.80 |
$256.10 |
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$21.09 |
$21.09 |
$21.09 |
|
|
Kidney imaging morphology
|
$740.00 |
$740.00 |
$740.00 |
|
|
Kidney imag w/bld flow multi
|
$1,024.00 |
$1,024.00 |
$1,024.00 |
|
|
Kidney img w/bldflw sgl without rx
|
$982.40 |
$982.40 |
$982.40 |
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$553.80 |
$593.20 |
$676.40 |
|
|
Kit gene analys d816 variant
|
$320.00 |
$320.00 |
$320.00 |
|
|
Knee Arthroscopy (Cartilage Repair)
|
$11,762.18 |
$11,762.18 |
$11,762.18 |
|
|
Knee arthroscopy dx
|
$11,745.71 |
$11,745.71 |
$11,745.71 |
|
|
Knee Arthroscopy (Meniscus Repair)
|
$12,372.13 |
$12,372.13 |
$12,372.13 |
|
|
Knee arthroscopy/surgery
|
$12,226.08 |
$12,226.08 |
$12,226.08 |
|
|
Knee arthroscopy/surgery
|
$11,238.40 |
$11,238.40 |
$11,238.40 |
|
|
Knee arthroscopy/surgery
|
$12,345.39 |
$12,345.39 |
$12,345.39 |
|
|
Knee arthroscopy/surgery
|
$12,183.14 |
$12,183.14 |
$12,183.14 |
|
|
Knee arthroscopy/surgery
|
$12,226.08 |
$12,226.08 |
$12,226.08 |
|
|
Knee arthroscopy/surgery
|
$15,200.30 |
$15,200.30 |
$15,200.30 |
|
|
Knee arthroscopy/surgery
|
$15,705.07 |
$15,705.07 |
$15,705.07 |
|
|
Knee arthroscopy/surgery
|
$40,032.32 |
$40,032.32 |
$40,032.32 |
|
|
Knee MRI (with and without contrast)
|
$1,247.60 |
$2,475.20 |
$3,641.30 |
|
|
Knee MRI (with contrast)
|
$1,382.00 |
$2,490.80 |
$3,443.70 |
|
|
Knee MRI (without contrast)
|
$1,610.80 |
$2,303.60 |
$4,353.05 |
|
|
Knee X-ray
|
$183.20 |
$336.80 |
$493.35 |
|
|
Kyleena, 19.5 mg
|
$5,789.60 |
$5,789.60 |
$5,789.60 |
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$16.90 |
$16.90 |
$16.90 |
|
|
Lactate dehydrogenase (ldh)
|
$28.80 |
$28.80 |
$53.30 |
|
|
Lactated ringers intravenous solution
|
$25.35 |
$25.35 |
$25.35 |
|
|
Lactic acid
|
$30.00 |
$42.40 |
$104.00 |
|
|
Lactoferrin fecal qualitative
|
$76.00 |
$76.00 |
$76.00 |
|
|
Laparo cholecystectomy/graph
|
$16,498.25 |
$16,498.25 |
$16,498.25 |
|
|
Laparoscopy excise lesions
|
$15,121.47 |
$15,121.47 |
$15,121.47 |
|
|
Laparoscopy lysis
|
$12,207.33 |
$12,207.33 |
$12,207.33 |
|
|
Laparoscopy remove adnexa
|
$15,849.00 |
$15,849.00 |
$15,849.00 |
|
|
Laparo-vag hyst incl t/o
|
$24,602.70 |
$24,602.70 |
$24,602.70 |
|
|
Lap enterolysis
|
$24,330.83 |
$24,330.83 |
$24,330.83 |
|
|
Lap ing hernia repair init
|
$20,893.36 |
$20,893.36 |
$20,893.36 |
|
|
Lap ing hernia repair recur
|
$19,431.87 |
$19,431.87 |
$19,431.87 |
|
|
Lap insert tunnel ip cath
|
$14,067.35 |
$14,067.35 |
$14,067.35 |
|
|
Lap revision perm ip cath
|
$13,278.97 |
$13,278.97 |
$13,278.97 |
|
|
Larynscop w/tumr exc + scope
|
$10,015.00 |
$10,015.00 |
$10,015.00 |
|
|
Laser surgery of prostate
|
$14,864.62 |
$14,864.62 |
$14,864.62 |
|
|
Lead capillary
|
$32.40 |
$40.80 |
$61.10 |
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$274.00 |
$485.20 |
$535.60 |
|
|
Leucovorin calcium 100 mg solution for injection (1 mg rounding)
|
$499.61 |
$499.61 |
$499.61 |
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$4,852.16 |
$4,852.16 |
$4,852.16 |
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$126.75 |
$126.75 |
$126.75 |
|
|
Levetiracetam therapeutic drug level
|
$130.00 |
$130.00 |
$138.80 |
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$20.70 |
$20.70 |
$20.70 |
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$387.90 |
$387.90 |
$387.90 |
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$29.57 |
$29.57 |
$29.57 |
|
|
Ligation/major artery/extremity 37618
|
$431.60 |
$431.60 |
$431.60 |
|
|
Liletta, 52 mg
|
$4,451.36 |
$4,451.36 |
$4,451.36 |
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$59.57 |
$59.57 |
$59.57 |
|
|
Lipase
|
$67.60 |
$75.20 |
$124.15 |
|
|
Lipoprotein blood high res frac & quant
|
$48.80 |
$48.80 |
$48.80 |
|
|
Lipoprotein blood quant
|
$32.40 |
$32.40 |
$136.50 |
|
|
Lipoprotein direct measurement hdl
|
$46.80 |
$46.80 |
$73.20 |
|
|
Lipoprotein direct measurement ldl
|
$44.00 |
$47.20 |
$81.25 |
|
|
Listeria monocytogenes
|
$100.40 |
$100.40 |
$100.40 |
|
|
Lithium therapeutic drug level
|
$49.60 |
$59.15 |
$66.00 |
|
|
Liver Function Test
|
$66.40 |
$105.60 |
$176.15 |
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$14.04 |
$14.04 |
$14.04 |
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,342.40 |
$1,342.40 |
$1,892.15 |
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,321.20 |
$1,362.00 |
$1,627.60 |
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,204.40 |
$1,206.00 |
$1,436.50 |
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$1,806.40 |
$2,849.20 |
$3,177.20 |
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,606.00 |
$2,117.60 |
$2,905.50 |
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,431.60 |
$1,694.40 |
$2,811.25 |
|
|
Lower Back (Lumbar Spine) X-ray
|
$271.20 |
$317.20 |
$440.05 |
|
|
L/s ratio fetal lung
|
$90.40 |
$90.40 |
$90.40 |
|
|
Lumbar diskogram s&i
|
$1,578.00 |
$1,578.00 |
$1,578.00 |
|
|
Lung Function Test (Spirometry)
|
$131.20 |
$131.20 |
$213.20 |
|
|
Lung perfusion imaging
|
$623.20 |
$623.20 |
$1,392.95 |
|
|
Lymphatics/lymph node imaging
|
$964.80 |
$964.80 |
$22,314.68 |
|
|
Macroscopic exam arthropod
|
$60.00 |
$60.00 |
$80.60 |
|
|
Macroscopic exam parasite
|
$60.00 |
$60.00 |
$60.00 |
|
|
Magnesium
|
$40.00 |
$48.80 |
$83.20 |
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$65.49 |
$65.49 |
$65.49 |
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$68.40 |
$68.40 |
$98.15 |
|
|
Manipulation chest wall initial demonstration/evaluation
|
$158.60 |
$158.60 |
$231.60 |
|
|
Mapping io sentinel lymph node
|
$22,314.68 |
$22,314.68 |
$22,314.68 |
|
|
Mastoids complete
|
$57.20 |
$57.20 |
$57.20 |
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$69.20 |
$69.20 |
$77.60 |
|
|
Mayo aathr protein s free
|
$92.40 |
$95.20 |
$176.80 |
|
|
Mayo activated protein c resistance assay
|
$182.00 |
$182.00 |
$228.80 |
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$190.40 |
$190.40 |
$190.40 |
|
|
Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation
|
$71.20 |
$71.20 |
$71.20 |
|
|
Mayo alcohol definitive assay volatile screen
|
$102.40 |
$120.00 |
$185.90 |
|
|
Mayo alkaline phosphatase isoenzyme
|
$44.00 |
$44.00 |
$68.40 |
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$42.40 |
$48.00 |
$141.70 |
|
|
Mayo alpha 1 antitrypsin
|
$78.00 |
$81.60 |
$121.55 |
|
