|
Injection of sinus tract
|
$1,081.52 |
$1,081.52 |
$1,081.52 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$965.32 |
$965.32 |
$2,452.59 |
$2,277.65
|
|
Injection px peyronie ds
|
$435.48 |
$435.48 |
$435.48 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$532.35 |
$575.47 |
$598.22 |
$685.44
|
|
Injection, renflexis
|
$1,209.03 |
$1,209.03 |
$1,209.03 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$990.15 |
$990.15 |
$990.15 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$856.07 |
$856.07 |
$856.07 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$550.96 |
$595.59 |
$597.83 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$763.24 |
$980.56 |
$1,059.99 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$331.87 |
$358.75 |
$1,071.13 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$378.05 |
$408.67 |
$1,071.13 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$781.87 |
$845.21 |
$1,285.43 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,285.43 |
$1,591.31 |
$1,720.22 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,028.18 |
$1,111.46 |
$1,565.06 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,028.18 |
$1,111.46 |
$1,272.45 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$236.28 |
$236.28 |
$255.42 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$170.28 |
$227.92 |
$448.47 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$179.00 |
$179.00 |
$193.50 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$68.75 |
$81.67 |
$129.88 |
$145.60
|
|
Injection treatment of nerve
|
$1,196.08 |
$1,196.08 |
$1,196.08 |
$2,054.00
|
|
Inject sacroiliac joint
|
$481.87 |
$481.87 |
$520.90 |
$1,029.04
|
|
Inj epidural sgl cerv-thor without img
|
$719.94 |
$778.26 |
$1,183.44 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$719.94 |
$719.94 |
$778.26 |
$1,450.84
|
|
Inj for ext venography
|
$260.62 |
$281.74 |
$699.06 |
$628.80
|
|
Inj for mammo ductogram
|
$50.43 |
$686.29 |
$741.88 |
$397.80
|
|
Inj, fosaprepitant (teva)
|
$483.23 |
$483.23 |
$483.23 |
$152.10
|
|
Inj, gadopiclenol, 1 ml
|
$19.10 |
$19.10 |
$19.10 |
$37.63
|
|
Inj glofitamab gxbm, 2.5 mg
|
$18,737.87 |
$18,737.87 |
$18,737.87 |
$4,760.67
|
|
Inj. herceptin hylecta, 10mg
|
$8,572.85 |
$8,572.85 |
$8,572.85 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$310.72 |
$435.66 |
$707.85 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$582.47 |
$582.47 |
$582.47 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$614.27 |
$614.27 |
$614.27 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$240.79 |
$337.61 |
$699.83 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$258.93 |
$363.05 |
$699.83 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$1,830.17 |
$1,830.17 |
$1,830.17 |
$2,452.32
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$524.83 |
$524.83 |
$567.34 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$108.26 |
$108.26 |
$108.26 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$154.36 |
$154.36 |
$154.36 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$4,070.60 |
$4,070.60 |
$4,070.60 |
$6,967.29
|
|
Inj, lidocaine w epinephrine
|
$12.37 |
$12.37 |
$24.83 |
$45.60
|
|
Inj melpha hydroch nos 50 mg
|
$4,595.85 |
$4,595.85 |
$4,595.85 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$19.49 |
$19.49 |
$19.49 |
$34.34
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$6,949.35 |
$6,949.35 |
$6,949.35 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$84.43 |
$84.43 |
$84.43 |
$101.31
|
|
Inj multihance
|
$44.70 |
$44.70 |
$44.70 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$198.26 |
$198.26 |
$198.26 |
$252.66
|
|
Inj naloxone hydrochloride
|
$217.74 |
$217.74 |
$277.55 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$705.62 |
$762.78 |
$1,034.46 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$348.39 |
$348.39 |
$348.39 |
$468.10
|
|
Inj ogivri 10 mg
|
$2,429.14 |
$2,429.14 |
$2,429.14 |
$4,492.28
|
|
Inj, olaratumab, 10 mg
|
$4,327.30 |
$4,327.30 |
$4,327.30 |
$4,127.04
|
|
Inj, omacetaxine mep, 0.01mg
|
$2,440.60 |
$2,440.60 |
$2,440.60 |
$2,686.80
|
|
Inj peritoneal venous shunt
|
$102.75 |
$111.07 |
$809.46 |
$406.80
|
|
Inj proc ankle arthr
|
$299.65 |
$299.65 |
$323.92 |
$405.31
|
|
Inj proc elbow arthro
|
$278.17 |
$278.17 |
$300.70 |
$432.00
|
|
Inj proc for lymphang
|
$355.49 |
$384.29 |
$581.79 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$337.95 |
$337.95 |
$365.33 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$363.37 |
$392.80 |
$472.16 |
$838.30
|
|
Inj proc sialogram
|
$170.41 |
$170.41 |
$184.21 |
$373.00
|
|
Inj prohance multipack
|
$27.48 |
$27.48 |
$45.84 |
$10.40
|
|
Inj, releuko 1 mcg
|
$466.81 |
$466.81 |
$466.81 |
$475.36
|
|
Inj retacrit esrd on dialysi
|
$0.50 |
$1.61 |
$809.08 |
$349.45
|
|
Inj retro urethrocysto
|
$92.72 |
$100.23 |
$171.14 |
$447.74
|
|
Inj scleros sol mult veins
|
$182.58 |
$182.58 |
$182.58 |
$692.90
|
|
Inj scleros sol sgl vein
|
$91.29 |
$91.29 |
$91.29 |
$561.88
|
|
Inj secretin synthetic human
|
$496.60 |
$496.60 |
$496.60 |
$1,253.09
|
|
Inj sulf hexa lipid microsph
|
$161.21 |
$161.21 |
$161.21 |
$256.14
|
|
Inj testosterone cypionate
|
$43.93 |
$43.93 |
$43.93 |
$64.96
|
|
Inj tofersen intrathec 1 mg
|
$26,092.13 |
$26,092.13 |
$26,092.13 |
$293.34
|
|
Inj, vancomycin hcl (mylan)
|
$44.32 |
$44.32 |
$56.57 |
$72.33
|
|
Inj w/fluor eval cv device
|
$248.45 |
$268.58 |
$415.62 |
$504.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$34,288.32 |
$34,288.32 |
$34,288.32 |
$41,083.73
|
|
Ins cath ren art 1st bi
|
$2,829.63 |
$3,058.85 |
$4,826.57 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$2,179.50 |
$2,356.06 |
$6,660.56 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$3,642.29 |
$3,937.34 |
$4,826.57 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$2,791.68 |
$3,017.83 |
$6,660.56 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$663.92 |
$1,183.25 |
$1,338.62 |
$490.73
|
|
Insert abdomen-venous drain
|
$2,875.81 |
$2,875.81 |
$2,875.81 |
$4,039.47
|
|
Insert cath pleura with image
|
$1,106.22 |
$1,195.83 |
$4,265.80 |
$2,194.40
|
|
Insert cath pleura without image
|
$926.50 |
$926.50 |
$3,007.49 |
$2,099.70
|
|
Insert hepatic shunt (tips)
|
$2,997.18 |
$3,239.96 |
$4,089.31 |
$7,571.20
|
|
Insertion catheter bladder non indwelling
|
$73.53 |
$98.42 |
$194.44 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,646.80 |
$1,780.20 |
$5,928.64 |
$4,897.20
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,283.52 |
$2,213.51 |
$2,392.82 |
$2,447.63
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,467.69 |
$2,667.59 |
$6,479.49 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,409.80 |
$1,524.01 |
$5,016.81 |
$2,585.25
|
|
Insertion of catheter vein
|
$492.02 |
$610.03 |
$659.45 |
$1,525.80
|
|
Insertion of catheter vein
|
$381.27 |
$412.16 |
$534.04 |
$870.59
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$7,519.79 |
$8,128.94 |
$13,119.41 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$5,188.85 |
$5,609.18 |
$12,201.08 |
$12,324.60
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$5,575.49 |
$6,027.14 |
$10,668.88 |
$9,884.16
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$980.56 |
$1,059.99 |
$2,565.52 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,022.09 |
$1,104.88 |
$2,565.52 |
$2,453.83
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$7,872.78 |
$8,510.52 |
$56,493.98 |
$29,180.00
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$2,564.71 |
$2,772.47 |
$6,263.66 |
$7,183.68
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$2,856.12 |
$3,087.49 |
$5,528.31 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$3,993.49 |
$4,316.98 |
$8,049.89 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$4,501.66 |
$4,995.04 |
$5,014.03 |
$5,236.80
|
|
Insert picvad cath
|
$3,602.20 |
$3,602.20 |
$3,893.99 |
$4,195.00
|
|
Insert pm/icd lead dual
|
$3,292.88 |
$3,559.63 |
$5,528.31 |
$7,115.90
|