|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$326.76 |
$326.76 |
$326.76 |
$2,079.43
|
|
Insitu hybridization auto
|
$68.60 |
$68.60 |
$68.60 |
$371.00
|
|
Insitu hybridization (fish)
|
$182.84 |
$182.84 |
$182.84 |
$481.60
|
|
Insitu hybridization manual
|
$92.40 |
$92.40 |
$92.40 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$109.20 |
$109.20 |
$109.20 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$117.04 |
$117.04 |
$117.04 |
$326.04
|
|
Insulin total
|
$7.00 |
$7.00 |
$7.00 |
$66.64
|
|
Intens cardiac rehab no exer
|
$74.20 |
$74.20 |
$74.20 |
$238.40
|
|
Intens cardiac rehab w/exerc
|
$74.20 |
$74.20 |
$74.20 |
$238.40
|
|
Intrinsic factor antibody
|
$26.60 |
$26.60 |
$26.60 |
$66.60
|
|
Intro long gi tube
|
$393.68 |
$393.68 |
$393.68 |
$990.00
|
|
Intro long gi tube w/mult fluo
|
$95.20 |
$95.20 |
$95.20 |
$449.40
|
|
Intubation endotracheal emergency procedure
|
$101.64 |
$101.64 |
$101.64 |
$589.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$0.30 |
$0.30 |
$0.30 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$35.00 |
$35.00 |
$35.00 |
$279.10
|
|
Iron
|
$13.16 |
$13.16 |
$13.16 |
$74.40
|
|
Iron binding capacity
|
$17.64 |
$17.64 |
$17.64 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$0.28 |
$0.28 |
$0.28 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$7.56 |
$7.56 |
$7.56 |
$119.83
|
|
Irrigation implantable venous access device for drug delivery systems
|
$25.20 |
$25.20 |
$25.20 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$30.80 |
$30.80 |
$30.80 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$10.36 |
$10.36 |
$10.36 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$20.16 |
$20.16 |
$20.16 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$91.28 |
$91.28 |
$91.28 |
$439.56
|
|
Ivp w/wo kub w/wo tomography
|
$177.80 |
$177.80 |
$177.80 |
$692.18
|
|
Jak2 targeted sequence analysis
|
$173.60 |
$173.60 |
$173.60 |
$379.87
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$4.20 |
$4.20 |
$4.20 |
$23.50
|
|
Kidney imag w/bld flow multi
|
$232.96 |
$232.96 |
$232.96 |
$1,570.65
|
|
Kidney img w/bldflw sgl without rx
|
$279.16 |
$279.16 |
$279.16 |
$1,427.40
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$81.20 |
$81.20 |
$81.20 |
$666.00
|
|
Knee MRI (with and without contrast)
|
$1,520.40 |
$1,520.40 |
$1,520.40 |
$3,034.80
|
|
Knee MRI (with contrast)
|
$995.12 |
$995.12 |
$995.12 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$868.28 |
$868.28 |
$868.28 |
$2,169.60
|
|
Knee X-ray
|
$117.88 |
$117.88 |
$117.88 |
$425.55
|
|
Lactate dehydrogenase (ldh)
|
$12.04 |
$12.04 |
$12.04 |
$55.50
|
|
Lactic acid
|
$21.56 |
$21.56 |
$21.56 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$49.28 |
$49.28 |
$49.28 |
$80.40
|
|
Lead capillary
|
$9.80 |
$9.80 |
$9.80 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$211.68 |
$211.68 |
$211.68 |
$1,088.26
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$481.04 |
$481.04 |
$481.04 |
$7,052.00
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$240.52 |
$240.52 |
$240.52 |
$9,107.80
|
|
Levetiracetam 500 mg/5 ml intravenous solution
|
$0.70 |
$0.70 |
$0.70 |
$95.68
|
|
Levetiracetam therapeutic drug level
|
$35.28 |
$35.28 |
$35.28 |
$88.92
|
|
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback
|
$16.24 |
$16.24 |
$16.24 |
$55.60
|
|
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution
|
$0.01 |
$0.01 |
$0.01 |
$39.37
|
|
Lincomycin injection
|
$11.48 |
$11.48 |
$11.48 |
$64.31
|
|
Lipase
|
$14.00 |
$14.00 |
$14.00 |
$93.58
|
|
Lipoprotein blood high res frac & quant
|
$7.84 |
$7.84 |
$7.84 |
$90.35
|
|
Lipoprotein direct measurement hdl
|
$16.52 |
$16.52 |
$16.52 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$5.32 |
$5.32 |
$5.32 |
$61.60
|
|
Lithium therapeutic drug level
|
$4.48 |
$4.48 |
$4.48 |
$69.42
|
|
Liver Function Test
|
$30.52 |
$30.52 |
$30.52 |
$115.44
|
|
Liver/spleen imag static only
|
$216.16 |
$216.16 |
$216.16 |
$1,123.50
|
|
Liver/spleen imag w/vasclr flow
|
$171.64 |
$171.64 |
$171.64 |
$1,067.48
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$5.60 |
$5.60 |
$5.60 |
$37.20
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$761.88 |
$761.88 |
$761.88 |
$1,958.19
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$507.92 |
$507.92 |
$507.92 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$507.92 |
$507.92 |
$507.92 |
$1,504.05
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$809.20 |
$809.20 |
$809.20 |
$3,111.17
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$658.00 |
$658.00 |
$658.00 |
$2,445.30
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$658.00 |
$658.00 |
$658.00 |
$2,096.84
|
|
Lower Back (Lumbar Spine) X-ray
|
$70.28 |
$70.28 |
$70.28 |
$352.32
|
|
Lung Function Test (Spirometry)
|
$92.68 |
$92.68 |
$92.68 |
$295.35
|
|
Lung perfusion imaging
|
$200.20 |
$200.20 |
$200.20 |
$1,075.25
|
|
Lymphatics/lymph node imaging
|
$241.92 |
$241.92 |
$241.92 |
$1,448.00
|
|
Magnesium
|
$13.44 |
$13.44 |
$13.44 |
$73.00
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$57.12 |
$57.12 |
$57.12 |
$128.40
|
|
Manipulation chest wall initial demonstration/evaluation
|
$57.12 |
$57.12 |
$57.12 |
$152.54
|
|
Marker biop eviva buckle ss
|
$200.59 |
$200.59 |
$200.59 |
$1,152.48
|
|
Mastoids complete
|
$97.16 |
$97.16 |
$97.16 |
$299.50
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$17.08 |
$17.08 |
$17.08 |
$66.36
|
|
Mayo activated protein c resistance assay
|
$51.52 |
$51.52 |
$51.52 |
$97.50
|
|
Mayo alkaline phosphatase isoenzyme
|
$24.92 |
$24.92 |
$24.92 |
$66.30
|
|
Mayo alpha 1 antitrypsin
|
$25.76 |
$25.76 |
$25.76 |
$89.05
|
|
Mayo amikacin trough therapeutic drug level
|
$10.08 |
$10.08 |
$10.08 |
$82.80
|
|
Mayo analysis gene calr common variants exon 9
|
$173.60 |
$173.60 |
$173.60 |
$467.61
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$123.20 |
$123.20 |
$123.20 |
$359.00
|
|
Mayo androstenedione
|
$19.32 |
$19.32 |
$19.32 |
$110.00
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$13.16 |
$13.16 |
$13.16 |
$73.08
|
|
Mayo antithrombin iii antigen
|
$11.48 |
$11.48 |
$11.48 |
$72.35
|
|
Mayo aspergillus fumigatus antibody
|
$14.84 |
$14.84 |
$14.84 |
$67.60
|
|
Mayo bart bartonella henselae antibody igg
|
$25.76 |
$25.76 |
$25.76 |
$45.50
|
|
Mayo blastomyces antibody immunodiffusion
|
$19.04 |
$19.04 |
$19.04 |
$57.85
|
|
Mayo bordetella pertussis antibody igg
|
$23.24 |
$23.24 |
$23.24 |
$69.00
|
|
Mayo brcmg brucella antibody igm
|
$39.76 |
$39.76 |
$39.76 |
$44.14
|
|
Mayo c1 esterase inhibitor
|
$7.84 |
$7.84 |
$7.84 |
$85.00
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$30.80 |
$30.80 |
$30.80 |
$82.68
|
|
Mayo ceruloplasmin
|
$6.16 |
$6.16 |
$6.16 |
$69.60
|
|
Mayo chemiluminescent parathyroid related peptide
|
$36.40 |
$36.40 |
$36.40 |
$113.88
|
|
Mayo chikv chikungunya antibodies igg
|
$36.40 |
$36.40 |
$36.40 |
$109.20
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$27.72 |
$27.72 |
$27.72 |
$53.30
|
|
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte
|
$169.12 |
$169.12 |
$169.12 |
$346.32
|
|
Mayo chromium
|
$32.76 |
$32.76 |
$32.76 |
$70.85
|
|
Mayo coccidioides antibody
|
$19.04 |
$19.04 |
$19.04 |
$55.20
|
|
Mayo cocou cortisone urine
|
$72.52 |
$72.52 |
$72.52 |
$207.26
|
|
Mayo cortisol free
|
$52.64 |
$52.64 |
$52.64 |
$94.95
|
|
Mayo covid-19 antibody nucleocapsid total
|
$45.64 |
$45.64 |
$45.64 |
$70.20
|
|
Mayo coxiella brunetii (q fever) igg antibody
|
$21.84 |
$21.84 |
$21.84 |
$61.80
|
|
Mayo cyanide
|
$13.16 |
$13.16 |
$13.16 |
$90.00
|
|
Mayo deoxyribonuclease antibody titer
|
$8.82 |
$8.82 |
$8.82 |
$56.80
|
