|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,734.40 |
$1,734.40 |
$1,734.40 |
$2,585.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,348.00 |
$1,348.00 |
$1,348.00 |
$2,103.75
|
|
In situ hybridization per specimen initial single probe stain
|
$352.80 |
$352.80 |
$352.80 |
$338.40
|
|
Ins picad w subq port 5yr>
|
$4,635.20 |
$4,635.20 |
$4,635.20 |
$4,078.00
|
|
Insulin total
|
$119.20 |
$119.20 |
$119.20 |
$66.64
|
|
Intrinsic factor antibody
|
$56.80 |
$56.80 |
$56.80 |
$65.00
|
|
Intubation endotracheal emergency procedure
|
$552.80 |
$552.80 |
$552.80 |
$601.28
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$140.00 |
$140.00 |
$140.00 |
$279.10
|
|
Ipratropium bromide non-comp
|
$4.80 |
$4.80 |
$4.80 |
$4.06
|
|
Iron
|
$65.60 |
$65.60 |
$65.60 |
$75.00
|
|
Iron binding capacity
|
$46.40 |
$46.40 |
$46.40 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$87.64 |
$87.64 |
$87.64 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$67.08 |
$67.08 |
$67.08 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$125.60 |
$125.60 |
$125.60 |
$146.11
|
|
IV Fluids (each additional hour)
|
$131.20 |
$131.20 |
$131.20 |
$133.90
|
|
IV Fluids (first hour)
|
$372.00 |
$372.00 |
$372.00 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$179.20 |
$179.20 |
$179.20 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$240.00 |
$240.00 |
$240.00 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$180.80 |
$180.80 |
$180.80 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$504.80 |
$504.80 |
$504.80 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$130.40 |
$130.40 |
$130.40 |
$167.50
|
|
IV Push Injection (first drug)
|
$280.80 |
$280.80 |
$280.80 |
$252.76
|
|
Ivp w/wo kub w/wo tomography
|
$1,091.20 |
$1,091.20 |
$1,091.20 |
$713.40
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$498.40 |
$498.40 |
$498.40 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$536.00 |
$536.00 |
$536.00 |
$362.05
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$65.60 |
$65.60 |
$65.60 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$61.20 |
$61.20 |
$61.20 |
$23.52
|
|
Kidney img w/bldflw sgl without rx
|
$2,049.60 |
$2,049.60 |
$2,049.60 |
$1,433.22
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$830.40 |
$830.40 |
$830.40 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$700.00 |
$700.00 |
$700.00 |
$490.75
|
|
Knee MRI (with and without contrast)
|
$4,273.60 |
$4,273.60 |
$4,273.60 |
$3,022.20
|
|
Knee MRI (with contrast)
|
$3,372.80 |
$3,372.80 |
$3,372.80 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$2,919.20 |
$2,919.20 |
$2,919.20 |
$2,130.88
|
|
Knee X-ray
|
$477.60 |
$477.60 |
$477.60 |
$432.18
|
|
Knee X-ray (1 to 2 views, both knees)
|
$308.80 |
$308.80 |
$308.80 |
$290.40
|
|
Knee X-ray (3 views, both knees)
|
$407.20 |
$407.20 |
$407.20 |
$363.60
|
|
Knee X-ray (standing, both knees)
|
$295.20 |
$295.20 |
$295.20 |
$251.20
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$60.39 |
$60.39 |
$60.39 |
$33.60
|
|
Lactate dehydrogenase (ldh)
|
$58.40 |
$58.40 |
$58.40 |
$55.50
|
|
Lactated ringers intravenous solution
|
$40.00 |
$40.00 |
$40.00 |
$43.74
|
|
Lactic acid
|
$65.60 |
$65.60 |
$65.60 |
$107.10
|
|
Large Joint Injection or Fluid Draw (both sides)
|
$727.20 |
$727.20 |
$727.20 |
$740.40
|
|
Lead capillary
|
$116.00 |
$116.00 |
$116.00 |
$57.50
|
|
Leg Artery Ultrasound (complete, both legs)
|
$1,187.20 |
$1,187.20 |
$1,187.20 |
$990.00
|
|
Leg CT Scan (with contrast, both legs)
|
$2,538.40 |
$2,538.40 |
$2,538.40 |
$1,585.20
|
|
Leg CT Scan (without contrast, both legs)
|
$2,029.60 |
$2,029.60 |
$2,029.60 |
$1,372.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,168.80 |
$1,168.80 |
$1,168.80 |
$1,092.58
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$630.40 |
$630.40 |
$630.40 |
$955.30
|
|
Lens iol ant bicnvx 24.0 multi
|
$676.80 |
$676.80 |
$676.80 |
$1,065.00
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$969.25 |
$969.25 |
$969.25 |
$6,360.76
|
|
Levalbuterol non-comp unit
|
$6.00 |
$6.00 |
$6.00 |
$6.48
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$60.97 |
$60.97 |
$60.97 |
$97.62
|
|
Levetiracetam therapeutic drug level
|
$175.20 |
$175.20 |
$175.20 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$75.68 |
$75.68 |
$75.68 |
$55.69
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$65.41 |
$65.41 |
$65.41 |
$46.02
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$55.83 |
$55.83 |
$55.83 |
$39.75
|
|
Ligation vericose vein cluster(s) 1 leg
|
$5,520.00 |
$5,520.00 |
$5,520.00 |
$3,724.63
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$97.20 |
$97.20 |
$97.20 |
$121.00
|
|
Lipase
|
$88.00 |
$88.00 |
$88.00 |
$93.58
|
|
Lipoprotein direct measurement hdl
|
$79.20 |
$79.20 |
$79.20 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$57.60 |
$57.60 |
$57.60 |
$61.60
|
|
Lithium therapeutic drug level
|
$60.00 |
$60.00 |
$60.00 |
$69.75
|
|
Liver Function Test
|
$108.00 |
$108.00 |
$108.00 |
$115.44
|
|
Liver imaging
|
$1,848.80 |
$1,848.80 |
$1,848.80 |
$1,109.00
|
|
Liver imag w/vasclr flow
|
$1,690.40 |
$1,690.40 |
$1,690.40 |
$1,227.60
|
|
Liver/spleen imag static only
|
$1,672.80 |
$1,672.80 |
$1,672.80 |
$1,138.55
|
|
Liver/spleen imag w/vasclr flow
|
$2,071.20 |
$2,071.20 |
$2,071.20 |
$1,069.20
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$61.89 |
$61.89 |
$61.89 |
$37.20
|
|
Low-Dose Lung Cancer Screening CT Scan
|
$1,708.00 |
$1,708.00 |
$1,708.00 |
$331.50
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,968.00 |
$2,968.00 |
$2,968.00 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,680.00 |
$2,680.00 |
$2,680.00 |
$1,815.45
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,376.00 |
$2,376.00 |
$2,376.00 |
$1,468.80
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,319.20 |
$4,319.20 |
$4,319.20 |
$3,097.92
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,616.00 |
$3,616.00 |
$3,616.00 |
$2,441.25
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,180.80 |
$3,180.80 |
$3,180.80 |
$2,080.00
|
|
Lower Back (Lumbar Spine) X-ray
|
$444.00 |
$444.00 |
$444.00 |
$359.20
|
|
Lower Back (Lumbar Spine) X-ray (4 or more views)
|
$616.00 |
$616.00 |
$616.00 |
$505.83
|
|
Lower Leg (Shin) X-ray (both sides)
|
$308.80 |
$308.80 |
$308.80 |
$338.40
|
|
Lung Function Test Before and After an Inhaler
|
$520.80 |
$520.80 |
$520.80 |
$549.83
|
|
Lung Function Test (Spirometry)
|
$379.20 |
$379.20 |
$379.20 |
$296.91
|
|
Lung perfusion imaging
|
$1,503.20 |
$1,503.20 |
$1,503.20 |
$1,069.25
|
|
Macroscopic exam arthropod
|
$52.80 |
$52.80 |
$52.80 |
$38.58
|
|
Magnesium
|
$79.20 |
$79.20 |
$79.20 |
$73.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$63.44 |
$63.44 |
$63.44 |
$58.70
|
|
Mastoids complete
|
$428.00 |
$428.00 |
$428.00 |
$299.50
|
|
Mayo aathr protein s free
|
$139.20 |
$139.20 |
$139.20 |
$130.00
|
|
Mayo activated protein c resistance assay
|
$211.20 |
$211.20 |
$211.20 |
$97.50
|
|
Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation
|
$132.00 |
$132.00 |
$132.00 |
$101.07
|
|
Mayo alcohol definitive assay volatile screen
|
$156.80 |
$156.80 |
$156.80 |
$126.36
|
|
Mayo alkaline phosphatase isoenzyme
|
$50.40 |
$50.40 |
$50.40 |
$66.60
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$88.80 |
$88.80 |
$88.80 |
$112.77
|
|
Mayo alpha 1 antitrypsin
|
$98.40 |
$98.40 |
$98.40 |
$89.05
|
|
Mayo amphu methylenedioxyamphetamines definitive assay urine
|
$195.20 |
$195.20 |
$195.20 |
$78.10
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$250.40 |
$250.40 |
$250.40 |
$374.73
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$460.00 |
$460.00 |
$460.00 |
$1,860.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$148.00 |
$148.00 |
$148.00 |
$74.00
|
|
Mayo antithrombin iii antigen
|
$350.40 |
$350.40 |
$350.40 |
$74.74
|
|
Mayo aspergillus fumigatus antibody
|
$64.80 |
$64.80 |
$64.80 |
$67.20
|
|
Mayo barbiturates definitive assay confirmation urine
|
$88.80 |
$88.80 |
$88.80 |
$93.60
|
|
Mayo bart bartonella henselae antibody igg
|
$284.80 |
$284.80 |
$284.80 |
$45.50
|