|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$7,225.68 |
$7,225.68 |
$7,225.68 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$7,225.68 |
$7,225.68 |
$7,225.68 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$2,180.76 |
$2,180.76 |
$2,180.76 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$2,070.60 |
$2,070.60 |
$2,070.60 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$2,499.51 |
$2,499.51 |
$2,499.51 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$126.99 |
$126.99 |
$126.99 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$143.31 |
$143.31 |
$143.31 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$240.21 |
$240.21 |
$240.21 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$208.08 |
$208.08 |
$208.08 |
$141.60
|
|
Injection treatment of eye
|
$3,294.60 |
$3,294.60 |
$3,294.60 |
$2,698.92
|
|
Inject sacroiliac joint
|
$7,206.30 |
$7,206.30 |
$7,206.30 |
$1,090.00
|
|
Inj epidural sgl cerv-thor without img
|
$5,235.15 |
$5,235.15 |
$5,235.15 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$6,445.89 |
$6,445.89 |
$6,445.89 |
$1,450.84
|
|
Inj for ext venography
|
$6,501.99 |
$6,501.99 |
$6,501.99 |
$737.55
|
|
Inj, fosaprepitant (teva)
|
$137.43 |
$137.43 |
$137.43 |
$120.36
|
|
Inj heparin, pfizer, 1000u
|
$84.15 |
$84.15 |
$84.15 |
$26.85
|
|
Inj intralesional <= 7 lsn(s)
|
$409.53 |
$409.53 |
$409.53 |
$241.74
|
|
Inj, lanreotide, (cipla) 1mg
|
$11,541.76 |
$11,541.76 |
$11,541.76 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,799.09 |
$1,799.09 |
$1,799.09 |
$444.36
|
|
Inj levocarnitine per 1 gm
|
$182.65 |
$182.65 |
$182.65 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$287.45 |
$287.45 |
$287.45 |
$287.45
|
|
Inj mepivacaine hcl/10 ml
|
$84.15 |
$84.15 |
$84.15 |
$30.04
|
|
Inj., meropenem, vaborbactam
|
$712.24 |
$712.24 |
$712.24 |
$566.68
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$11,383.97 |
$11,383.97 |
$11,383.97 |
$2,984.20
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$4,250.34 |
$4,250.34 |
$4,250.34 |
$1,522.56
|
|
Inj ogivri 10 mg
|
$3,990.07 |
$3,990.07 |
$3,990.07 |
$3,968.67
|
|
Inj pantoprazole(hikma) 40mg
|
$84.15 |
$84.15 |
$84.15 |
$33.52
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$10,815.07 |
$10,815.07 |
$10,815.07 |
$6,244.73
|
|
Inj pemetrexed, hospira 10mg
|
$565.97 |
$565.97 |
$565.97 |
$64.35
|
|
Inj., perseris, 0.5 mg
|
$2,262.24 |
$2,262.24 |
$2,262.24 |
$5,372.48
|
|
Inj proc ankle arthr
|
$6,478.02 |
$6,478.02 |
$6,478.02 |
$405.31
|
|
Inj proc elbow arthro
|
$5,889.48 |
$5,889.48 |
$5,889.48 |
$453.60
|
|
Inj proc myelogram lumbar
|
$5,301.45 |
$5,301.45 |
$5,301.45 |
$922.80
|
|
Inj, releuko 1 mcg
|
$519.53 |
$519.53 |
$519.53 |
$461.20
|
|
Inj retro urethrocysto
|
$6,772.80 |
$6,772.80 |
$6,772.80 |
$551.29
|
|
Inj testosterone cypionate
|
$85.68 |
$85.68 |
$85.68 |
$77.15
|
|
Inj, vegzelma, 10 mg
|
$5,635.73 |
$5,635.73 |
$5,635.73 |
$3,889.63
|
|
Inj w/fluor eval cv device
|
$1,560.09 |
$1,560.09 |
$1,560.09 |
$588.90
|
|
Ins cath ren art 1st bi
|
$4,443.12 |
$4,443.12 |
$4,443.12 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$4,443.12 |
$4,443.12 |
$4,443.12 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,500.86 |
$5,500.86 |
$5,500.86 |
$5,408.65
|
|
Ins cerv dilator (sep proc)
|
$661.98 |
$661.98 |
$661.98 |
$544.00
|
|
Insert and remove bone pin
|
$6,740.16 |
$6,740.16 |
$6,740.16 |
$4,335.60
|
|
Insert cath pleura with image
|
$5,978.73 |
$5,978.73 |
$5,978.73 |
$2,239.02
|
|
Insert cath pleura without image
|
$5,978.73 |
$5,978.73 |
$5,978.73 |
$2,212.00
|
|
Insert intrauterine device iud
|
$7,910.10 |
$7,910.10 |
$7,910.10 |
$378.83
|
|
Insertion catheter bladder non indwelling
|
$258.57 |
$258.57 |
$258.57 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$640.05 |
$640.05 |
$640.05 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$11,772.33 |
$11,772.33 |
$11,772.33 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,170.05 |
$2,170.05 |
$2,170.05 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$5,786.46 |
$5,786.46 |
$5,786.46 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$4,796.04 |
$4,796.04 |
$4,796.04 |
$2,618.40
|
|
Insertion of catheter vein
|
$5,621.22 |
$5,621.22 |
$5,621.22 |
$1,749.80
|
|
Insertion of catheter vein
|
$795.60 |
$795.60 |
$795.60 |
$858.05
|
|
Insertion of heart electrode 33211
|
$13,974.00 |
$13,974.00 |
$13,974.00 |
$9,090.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$11,737.14 |
$11,737.14 |
$11,737.14 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$11,737.14 |
$11,737.14 |
$11,737.14 |
$12,813.28
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$12,456.24 |
$12,456.24 |
$12,456.24 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$5,381.01 |
$5,381.01 |
$5,381.01 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$7,455.18 |
$7,455.18 |
$7,455.18 |
$2,527.91
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$37,077.00 |
$37,077.00 |
$37,077.00 |
$29,997.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$12,452.16 |
$12,452.16 |
$12,452.16 |
$7,572.47
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$9,209.58 |
$9,209.58 |
$9,209.58 |
$7,673.12
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$9,209.58 |
$9,209.58 |
$9,209.58 |
$9,793.46
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$6,745.26 |
$6,745.26 |
$6,745.26 |
$5,470.54
|
|
Insertion ureth cath
|
$3,650.58 |
$3,650.58 |
$3,650.58 |
$2,424.12
|
|
Insert pessary/other device
|
$403.92 |
$403.92 |
$403.92 |
$278.90
|
|
Insert pm/icd lead dual
|
$20,155.71 |
$20,155.71 |
$20,155.71 |
$7,562.63
|
|
Insert prost urethral stent
|
$4,200.87 |
$4,200.87 |
$4,200.87 |
$2,424.12
|
|
Insert swan-ganz cath
|
$1,763.58 |
$1,763.58 |
$1,763.58 |
$2,164.52
|
|
Insert vad art access left hrt arterial access
|
$8,592.48 |
$8,592.48 |
$8,592.48 |
$5,062.80
|
|
Insitu hybridization auto
|
$441.15 |
$441.15 |
$441.15 |
$398.16
|
|
Insitu hybridization manual
|
$446.76 |
$446.76 |
$446.76 |
$407.11
|
|
In situ hybridization per specimen each additional single probe stain
|
$109.14 |
$109.14 |
$109.14 |
$251.55
|
|
In situ hybridization per specimen initial single probe stain
|
$228.99 |
$228.99 |
$228.99 |
$338.40
|
|
Ins mark abd/pel for right perq
|
$2,338.86 |
$2,338.86 |
$2,338.86 |
$2,070.00
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$1,486.14 |
$1,486.14 |
$1,486.14 |
$1,483.95
|
|
Ins pq tunnld ip cath w/img
|
$5,330.52 |
$5,330.52 |
$5,330.52 |
$5,593.60
|
|
Ins/rpl ldless pm right vent w img & eval
|
$27,480.84 |
$27,480.84 |
$27,480.84 |
$24,135.54
|
|
Ins/rpl pm w/tv ld atrl
|
$11,737.14 |
$11,737.14 |
$11,737.14 |
$12,384.25
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$36,843.93 |
$36,843.93 |
$36,843.93 |
$25,106.90
|
|
Inst fibrinolysis agent ini day
|
$779.79 |
$779.79 |
$779.79 |
$1,095.00
|
|
Inst fibrinolysis agent sbsq d
|
$779.79 |
$779.79 |
$779.79 |
$898.12
|
|
Instillation anticarcinogenic agent bladder
|
$637.50 |
$637.50 |
$637.50 |
$721.50
|
|
Ins tun cv cath wo subq prt/pm
|
$11,638.20 |
$11,638.20 |
$11,638.20 |
$5,888.85
|
|
Ins tun cv cath wo subq prt/pm
|
$6,745.26 |
$6,745.26 |
$6,745.26 |
$4,748.00
|
|
Ins tun intraperit dia cath
|
$6,970.68 |
$6,970.68 |
$6,970.68 |
$4,657.46
|
|
Inst via cath agent pleurds
|
$1,509.60 |
$1,509.60 |
$1,509.60 |
$1,074.68
|
|
Insulin total
|
$13.80 |
$13.80 |
$13.80 |
$67.60
|
|
Ins vag brachytx device
|
$277.95 |
$277.95 |
$277.95 |
$909.35
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$7,264.92 |
$7,264.92 |
$7,264.92 |
$9,970.16
|
|
Integra meshed bil wound mat
|
$20,463.61 |
$20,463.61 |
$20,463.61 |
$24,354.93
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$3,198.72 |
$3,198.72 |
$3,198.72 |
$3,057.60
|
|
Interdental fixation
|
$3,142.62 |
$3,142.62 |
$3,142.62 |
$2,133.48
|
