|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$251.40 |
$251.40 |
$251.40 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$240.60 |
$240.60 |
$240.60 |
$159.00
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$116.40 |
$116.40 |
$116.40 |
$153.60
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$319.80 |
$319.80 |
$319.80 |
$443.20
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$224.40 |
$224.40 |
$224.40 |
$58.56
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$18.00 |
$18.00 |
$18.00 |
$23.77
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$508.20 |
$508.20 |
$508.20 |
$664.20
|
|
Knee MRI (with and without contrast)
|
$3,325.20 |
$3,325.20 |
$3,325.20 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$3,325.20 |
$3,325.20 |
$3,325.20 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$6,651.00 |
$6,651.00 |
$6,651.00 |
$2,110.76
|
|
Knee X-ray
|
$584.40 |
$584.40 |
$584.40 |
$425.55
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$33.60 |
$33.60 |
$33.60 |
$33.14
|
|
Lactate dehydrogenase (ldh)
|
$80.40 |
$80.40 |
$80.40 |
$55.25
|
|
Lactated ringers intravenous solution
|
$21.00 |
$21.00 |
$21.00 |
$44.91
|
|
Lactic acid
|
$49.80 |
$49.80 |
$49.80 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$287.40 |
$287.40 |
$287.40 |
$81.25
|
|
Lactoferrin fecal quant
|
$82.80 |
$82.80 |
$82.80 |
$106.10
|
|
Laparo cholecystectomy/graph
|
$2,020.20 |
$2,020.20 |
$2,020.20 |
$8,346.00
|
|
Laparo partial colectomy 44204
|
$2,259.60 |
$2,259.60 |
$2,259.60 |
$2,917.80
|
|
Laparoscopy aspiration
|
$1,257.60 |
$1,257.60 |
$1,257.60 |
$6,457.82
|
|
Laparoscopy biopsy
|
$1,147.20 |
$1,147.20 |
$1,147.20 |
$5,954.23
|
|
Lap colostomy 44188
|
$2,095.80 |
$2,095.80 |
$2,095.80 |
$3,008.00
|
|
Lap enterolysis
|
$1,644.00 |
$1,644.00 |
$1,644.00 |
$6,161.68
|
|
Lap ing hernia repair recur
|
$1,205.40 |
$1,205.40 |
$1,205.40 |
$6,376.26
|
|
Lead capillary
|
$25.20 |
$25.20 |
$25.20 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$903.60 |
$903.60 |
$903.60 |
$1,088.26
|
|
Lens iol ant bicnvx 24.0 multi
|
$1,014.30 |
$1,014.30 |
$1,014.30 |
$1,041.25
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$27.00 |
$27.00 |
$27.00 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$166.20 |
$166.20 |
$166.20 |
$82.50
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$39.00 |
$39.00 |
$39.00 |
$55.60
|
|
Levothyroxine 100 mcg intravenous powder for solution
|
$421.50 |
$421.50 |
$421.50 |
$420.60
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$12.90 |
$12.90 |
$12.90 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$27.30 |
$27.30 |
$27.30 |
$40.54
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$135.60 |
$135.60 |
$135.60 |
$123.78
|
|
Lipase
|
$108.00 |
$108.00 |
$108.00 |
$91.80
|
|
Lipoprotein blood quant
|
$88.20 |
$88.20 |
$88.20 |
$101.14
|
|
Lipoprotein direct measurement hdl
|
$95.40 |
$95.40 |
$95.40 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$105.00 |
$105.00 |
$105.00 |
$61.60
|
|
Lithium therapeutic drug level
|
$105.60 |
$105.60 |
$105.60 |
$69.42
|
|
Liver ds alys 3 bmrk srm alg
|
$145.80 |
$145.80 |
$145.80 |
$365.28
|
|
Liver Function Test
|
$171.00 |
$171.00 |
$171.00 |
$115.44
|
|
Locm 100-199mg/ml iodine,1ml
|
$163.20 |
$163.20 |
$163.20 |
$44.10
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$4.20 |
$4.20 |
$4.20 |
$37.44
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,428.20 |
$2,428.20 |
$2,428.20 |
$1,815.45
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,992.60 |
$1,992.60 |
$1,992.60 |
$1,470.00
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,153.80 |
$4,153.80 |
$4,153.80 |
$3,053.40
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,469.20 |
$3,469.20 |
$3,469.20 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,377.40 |
$3,377.40 |
$3,377.40 |
$2,060.27
|
|
Lower Back (Lumbar Spine) X-ray
|
$274.20 |
$274.20 |
$274.20 |
$355.32
|
|
Lung Function Test (Spirometry)
|
$197.40 |
$197.40 |
$197.40 |
$296.91
|
|
Lung perfusion imaging
|
$697.20 |
$697.20 |
$697.20 |
$1,069.25
|
|
Macroscopic exam arthropod
|
$100.80 |
$100.80 |
$100.80 |
$38.58
|
|
Macroscopic exam parasite
|
$29.40 |
$29.40 |
$29.40 |
$37.05
|
|
Magnesium
|
$39.00 |
$39.00 |
$39.00 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$28.20 |
$28.20 |
$28.20 |
$58.70
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$91.20 |
$91.20 |
$91.20 |
$130.81
|
|
Manipulation chest wall initial demonstration/evaluation
|
$133.80 |
$133.80 |
$133.80 |
$159.05
|
|
Mastectomy partial
|
$1,122.60 |
$1,122.60 |
$1,122.60 |
$4,531.42
|
|
Mast mod rad
|
$2,418.00 |
$2,418.00 |
$2,418.00 |
$7,127.17
|
|
Mast simple complete
|
$1,903.20 |
$1,903.20 |
$1,903.20 |
$6,052.48
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$27.00 |
$27.00 |
$27.00 |
$65.00
|
|
Mayo aathr protein s free
|
$187.80 |
$187.80 |
$187.80 |
$130.08
|
|
Mayo activated protein c resistance assay
|
$224.40 |
$224.40 |
$224.40 |
$96.50
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$1,093.80 |
$1,093.80 |
$1,093.80 |
$172.90
|
|
Mayo alkaline phosphatase isoenzyme
|
$166.80 |
$166.80 |
$166.80 |
$66.30
|
|
Mayo alpha 1 antitrypsin
|
$323.40 |
$323.40 |
$323.40 |
$88.80
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$277.20 |
$277.20 |
$277.20 |
$369.00
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$2,297.40 |
$2,297.40 |
$2,297.40 |
$1,860.00
|
|
Mayo androstenedione
|
$348.60 |
$348.60 |
$348.60 |
$106.40
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$165.60 |
$165.60 |
$165.60 |
$73.08
|
|
Mayo antithrombin iii antigen
|
$123.00 |
$123.00 |
$123.00 |
$71.20
|
|
Mayo aspergillus fumigatus antibody
|
$54.60 |
$54.60 |
$54.60 |
$66.50
|
|
Mayo avwpr vw factor activity
|
$291.00 |
$291.00 |
$291.00 |
$170.00
|
|
Mayo bart bartonella henselae antibody igg
|
$41.40 |
$41.40 |
$41.40 |
$45.50
|
|
Mayo blastomyces antibody immunodiffusion
|
$91.20 |
$91.20 |
$91.20 |
$57.00
|
|
Mayo bordetella pertussis antibody igg
|
$158.40 |
$158.40 |
$158.40 |
$69.00
|
|
Mayo c1 esterase inhibitor
|
$134.40 |
$134.40 |
$134.40 |
$85.00
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$37.20 |
$37.20 |
$37.20 |
$79.20
|
|
Mayo ceruloplasmin
|
$187.80 |
$187.80 |
$187.80 |
$69.60
|
|
Mayo chemiluminescent parathyroid related peptide
|
$694.80 |
$694.80 |
$694.80 |
$117.00
|
|
Mayo chikv chikungunya antibodies igg
|
$171.00 |
$171.00 |
$171.00 |
$109.20
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$25.20 |
$25.20 |
$25.20 |
$52.80
|
|
Mayo coccidioides antibody
|
$58.80 |
$58.80 |
$58.80 |
$55.20
|
|
Mayo cortisol free
|
$77.40 |
$77.40 |
$77.40 |
$92.80
|
|
Mayo covid-19 antibody nucleocapsid total
|
$96.00 |
$96.00 |
$96.00 |
$71.50
|
|
Mayo coxiella brunetii (q fever) igg antibody
|
$61.20 |
$61.20 |
$61.20 |
$61.02
|
|
Mayo csmpu benzodiazepines definitive assay >=13 urine
|
$101.40 |
$101.40 |
$101.40 |
$92.50
|
|
Mayo deoxyribonuclease antibody titer
|
$26.40 |
$26.40 |
$26.40 |
$56.11
|
|
Mayo dhea (dehydroepiandrosterone)
|
$190.20 |
$190.20 |
$190.20 |
$108.90
|
|
Mayo estriol
|
$80.40 |
$80.40 |
$80.40 |
$90.34
|
|
Mayo estrone
|
$486.00 |
$486.00 |
$486.00 |
$85.00
|
|
Mayo ethosuximide therapeutic drug level
|
$187.80 |
$187.80 |
$187.80 |
$69.55
|
|
Mayo everolimus therapeutic drug level
|
$589.80 |
$589.80 |
$589.80 |
$88.20
|
|
Mayo factor ii
|
$133.80 |
$133.80 |
$133.80 |
$96.76
|
|
Mayo factor v
|
$570.00 |
$570.00 |
$570.00 |
$125.58
|
|
Mayo factor vii
|
$570.00 |
$570.00 |
$570.00 |
$155.00
|
|
Mayo factor viii vw factor antigen
|
$150.60 |
$150.60 |
$150.60 |
$116.40
|
|
Mayo factor viii vw factor ristocetin cofactor
|
$288.00 |
$288.00 |
$288.00 |
$138.00
|
|
Mayo ffspg allergen clam igg
|
$40.80 |
$40.80 |
$40.80 |
$37.00
|
|
Mayo gabapentin bld/srm/plasma therapeutic drug level
|
$174.60 |
$174.60 |
$174.60 |
$66.43
|
