|
Inj dx for sinogram
|
$389.76 |
$389.76 |
$389.76 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,280.64 |
$1,280.64 |
$1,280.64 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$286.56 |
$286.56 |
$286.56 |
$507.10
|
|
Injection, cangrelor
|
$2,638.56 |
$2,638.56 |
$2,638.56 |
$1,943.40
|
|
Injection carpal tunnel therapeutic (both sides)
|
$740.16 |
$740.16 |
$740.16 |
$536.00
|
|
Injection, daratumumab 10 mg
|
$4,425.02 |
$4,425.02 |
$4,425.02 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$266.40 |
$266.40 |
$266.40 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$1,473.12 |
$1,473.12 |
$1,473.12 |
$1,473.12
|
|
Injection eye drug
|
$214.08 |
$214.08 |
$214.08 |
$648.90
|
|
Injection for arthrography wrist (both sides)
|
$293.76 |
$293.76 |
$293.76 |
$441.12
|
|
Injection for bladder x-ray
|
$497.28 |
$497.28 |
$497.28 |
$585.00
|
|
Injection for hip x-ray
|
$268.32 |
$268.32 |
$268.32 |
$567.45
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$217.92 |
$217.92 |
$217.92 |
$504.00
|
|
Injection for spleen x-ray
|
$296.64 |
$296.64 |
$296.64 |
$686.40
|
|
Injection for ureter x-ray
|
$625.44 |
$625.44 |
$625.44 |
$444.95
|
|
Injection for ureter x-ray
|
$512.16 |
$512.16 |
$512.16 |
$515.21
|
|
Injection glatiramer acetate
|
$179.13 |
$179.13 |
$179.13 |
$646.72
|
|
Injection into brain canal
|
$414.72 |
$414.72 |
$414.72 |
$970.61
|
|
Injection into brain canal
|
$1,988.64 |
$1,988.64 |
$1,988.64 |
$933.60
|
|
Injection into hemorrhoid(s)
|
$2,364.96 |
$2,364.96 |
$2,364.96 |
$1,278.72
|
|
Injection, isavuconazonium
|
$1,213.46 |
$1,213.46 |
$1,213.46 |
$863.93
|
|
Injection jugular
|
$1,048.80 |
$1,048.80 |
$1,048.80 |
$1,048.20
|
|
Injection of sinus tract
|
$1,249.92 |
$1,249.92 |
$1,249.92 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$1,860.48 |
$1,860.48 |
$1,860.48 |
$2,154.07
|
|
Injection radioactive tracer sentinel node (both sides)
|
$624.00 |
$624.00 |
$624.00 |
$717.20
|
|
Injection, renflexis
|
$1,479.34 |
$1,479.34 |
$1,479.34 |
$1,356.10
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,472.64 |
$1,472.64 |
$1,472.64 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,472.64 |
$1,472.64 |
$1,472.64 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,315.20 |
$1,315.20 |
$1,315.20 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$3,504.48 |
$3,504.48 |
$3,504.48 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,504.48 |
$3,504.48 |
$3,504.48 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$3,115.68 |
$3,115.68 |
$3,115.68 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$3,115.68 |
$3,115.68 |
$3,115.68 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,509.92 |
$2,509.92 |
$2,509.92 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,509.92 |
$2,509.92 |
$2,509.92 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$934.56 |
$934.56 |
$934.56 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$834.72 |
$834.72 |
$834.72 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$849.60 |
$849.60 |
$849.60 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$130.08 |
$130.08 |
$130.08 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$98.88 |
$98.88 |
$98.88 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$176.64 |
$176.64 |
$176.64 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$95.52 |
$95.52 |
$95.52 |
$141.60
|
|
Injection treatment of eye
|
$5,063.04 |
$5,063.04 |
$5,063.04 |
$2,698.92
|
|
Inject sacroiliac joint
|
$906.24 |
$906.24 |
$906.24 |
$1,090.00
|
|
Inj epidural sgl cerv-thor without img
|
$1,280.64 |
$1,280.64 |
$1,280.64 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$1,472.64 |
$1,472.64 |
$1,472.64 |
$1,450.84
|
|
Inj for ext venography
|
$637.44 |
$637.44 |
$637.44 |
$737.55
|
|
Inj for mammo ductogram
|
$919.68 |
$919.68 |
$919.68 |
$433.50
|
|
Inj hrt cath w/s&i sel right vent
|
$266.40 |
$266.40 |
$266.40 |
$947.65
|
|
Inj, immphentiv, 20 mcg
|
$44.76 |
$44.76 |
$44.76 |
$38.40
|
|
Inj intralesional <= 7 lsn(s)
|
$918.72 |
$918.72 |
$918.72 |
$241.74
|
|
Inj ivig privigen 500 mg
|
$5,429.76 |
$5,429.76 |
$5,429.76 |
$7,173.90
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,890.17 |
$1,890.17 |
$1,890.17 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$145.37 |
$145.37 |
$145.37 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$258.92 |
$258.92 |
$258.92 |
$303.45
|
|
Inj mepivacaine hcl/10 ml
|
$44.76 |
$44.76 |
$44.76 |
$31.28
|
|
Inj, moxifloxacin 100 mg
|
$112.75 |
$112.75 |
$112.75 |
$153.27
|
|
Inj. mycophenolate mofetil
|
$228.12 |
$228.12 |
$228.12 |
$291.54
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$986.40 |
$986.40 |
$986.40 |
$1,522.56
|
|
Inj pantoprazole(hikma) 40mg
|
$44.76 |
$44.76 |
$44.76 |
$33.52
|
|
Inj., perseris, 0.5 mg
|
$2,318.34 |
$2,318.34 |
$2,318.34 |
$5,372.48
|
|
Inj proc ankle arthr
|
$331.20 |
$331.20 |
$331.20 |
$405.31
|
|
Inj proc elbow arthro
|
$268.32 |
$268.32 |
$268.32 |
$453.60
|
|
Inj proc for lymphang
|
$354.72 |
$354.72 |
$354.72 |
$1,372.00
|
|
Inj proc lumbr disk ea lvl
|
$633.12 |
$633.12 |
$633.12 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$1,949.76 |
$1,949.76 |
$1,949.76 |
$922.80
|
|
Inj progesterone per 50 mg
|
$44.76 |
$44.76 |
$44.76 |
$19.53
|
|
Inj, releuko 1 mcg
|
$503.56 |
$503.56 |
$503.56 |
$519.53
|
|
Inj retro urethrocysto
|
$396.48 |
$396.48 |
$396.48 |
$551.29
|
|
Inj scleros sol sgl vein
|
$1,180.32 |
$1,180.32 |
$1,180.32 |
$534.40
|
|
Inj testosterone cypionate
|
$60.00 |
$60.00 |
$60.00 |
$82.58
|
|
Inj w/fluor eval cv device
|
$1,558.08 |
$1,558.08 |
$1,558.08 |
$588.90
|
|
Ins cath ren art 1st bi
|
$5,545.44 |
$5,545.44 |
$5,545.44 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$2,301.12 |
$2,301.12 |
$2,301.12 |
$4,667.63
|
|
Ins cath ren art 2nd+ uni
|
$5,365.92 |
$5,365.92 |
$5,365.92 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$446.40 |
$446.40 |
$446.40 |
$544.00
|
|
Insert abdomen-venous drain
|
$24,799.68 |
$24,799.68 |
$24,799.68 |
$4,391.00
|
|
Insert and remove bone pin
|
$4,885.44 |
$4,885.44 |
$4,885.44 |
$4,335.60
|
|
Insert cath pleura with image
|
$2,950.08 |
$2,950.08 |
$2,950.08 |
$2,239.02
|
|
Insert cath pleura without image
|
$1,659.36 |
$1,659.36 |
$1,659.36 |
$2,212.00
|
|
Insert hepatic shunt (tips)
|
$9,475.68 |
$9,475.68 |
$9,475.68 |
$9,754.48
|
|
Insert intrauterine device iud
|
$140.64 |
$140.64 |
$140.64 |
$378.83
|
|
Insertion catheter bladder non indwelling
|
$221.28 |
$221.28 |
$221.28 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$390.24 |
$390.24 |
$390.24 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$2,880.48 |
$2,880.48 |
$2,880.48 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,313.76 |
$1,313.76 |
$1,313.76 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$3,354.72 |
$3,354.72 |
$3,354.72 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,754.24 |
$2,754.24 |
$2,754.24 |
$2,618.40
|
|
Insertion of catheter vein
|
$233.76 |
$233.76 |
$233.76 |
$1,749.80
|
|
Insertion of catheter vein
|
$586.08 |
$586.08 |
$586.08 |
$858.05
|
|
Insertion of heart electrode 33211
|
$4,340.64 |
$4,340.64 |
$4,340.64 |
$9,090.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$5,612.16 |
$5,612.16 |
$5,612.16 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$3,962.40 |
$3,962.40 |
$3,962.40 |
$12,813.28
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$11,028.00 |
$11,028.00 |
$11,028.00 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,751.36 |
$2,751.36 |
$2,751.36 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$4,047.36 |
$4,047.36 |
$4,047.36 |
$2,527.91
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$13,990.08 |
$13,990.08 |
$13,990.08 |
$29,997.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$4,668.48 |
$4,668.48 |
$4,668.48 |
$7,572.47
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$3,242.88 |
$3,242.88 |
$3,242.88 |
$7,673.12
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$3,470.40 |
$3,470.40 |
$3,470.40 |
$9,793.46
|