|
Inj, donanemab-azbt, 2 mg
|
$1,904.80 |
$1,904.80 |
$1,904.80 |
$1,261.94
|
|
Inj dx for sinogram
|
$407.63 |
$407.63 |
$407.63 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$885.73 |
$885.73 |
$885.73 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$471.51 |
$471.51 |
$471.51 |
$507.10
|
|
Injection, belinostat, 10mg
|
$2,281.50 |
$2,281.50 |
$2,281.50 |
$4,985.88
|
|
Injection, cangrelor
|
$2,161.85 |
$2,161.85 |
$2,161.85 |
$2,048.01
|
|
Injection carpal tunnel therapeutic (both sides)
|
$577.48 |
$577.48 |
$577.48 |
$536.00
|
|
Injection, daratumumab 10 mg
|
$2,281.50 |
$2,281.50 |
$2,281.50 |
$5,536.46
|
|
Injection during cath supravalvular aortography
|
$4,014.94 |
$4,014.94 |
$4,014.94 |
$1,148.80
|
|
Injection, edaravone, 1 mg
|
$1,516.44 |
$1,516.44 |
$1,516.44 |
$2,345.85
|
|
Injection epidural blood patch or clot
|
$1,182.33 |
$1,182.33 |
$1,182.33 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$432.48 |
$432.48 |
$432.48 |
$441.12
|
|
Injection for bladder x-ray
|
$561.76 |
$561.76 |
$561.76 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$432.48 |
$432.48 |
$432.48 |
$504.00
|
|
Injection, fulvestrant
|
$2,281.50 |
$2,281.50 |
$2,281.50 |
$2,550.36
|
|
Injection, inclisiran, 1 mg
|
$2,965.95 |
$2,965.95 |
$2,965.95 |
$7,889.98
|
|
Injection, isavuconazonium
|
$863.93 |
$863.93 |
$863.93 |
$832.85
|
|
Injection,onabotulinumtoxina
|
$906.52 |
$906.52 |
$906.52 |
$2,085.72
|
|
Injection radioactive tracer sentinel node (both sides)
|
$473.04 |
$473.04 |
$473.04 |
$717.20
|
|
Injection, renflexis
|
$2,062.99 |
$2,062.99 |
$2,062.99 |
$1,356.10
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$885.73 |
$885.73 |
$885.73 |
$1,441.04
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,029.72 |
$1,029.72 |
$1,029.72 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$999.81 |
$999.81 |
$999.81 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,148.36 |
$1,148.36 |
$1,148.36 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$297.61 |
$297.61 |
$297.61 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$566.83 |
$566.83 |
$566.83 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$708.79 |
$708.79 |
$708.79 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,417.58 |
$1,417.58 |
$1,417.58 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,094.11 |
$1,094.11 |
$1,094.11 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$451.74 |
$451.74 |
$451.74 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$451.74 |
$451.74 |
$451.74 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$68.45 |
$68.45 |
$68.45 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$293.56 |
$293.56 |
$293.56 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$293.56 |
$293.56 |
$293.56 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$293.56 |
$293.56 |
$293.56 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$293.56 |
$293.56 |
$293.56 |
$141.60
|
|
Inj epidural sgl lumb-sacral without img
|
$737.18 |
$737.18 |
$737.18 |
$1,450.84
|
|
Inj for ext venography
|
$622.60 |
$622.60 |
$622.60 |
$737.55
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,613.39 |
$3,613.39 |
$3,613.39 |
$1,482.00
|
|
Inj hydroxocobalamin IV 25mg
|
$2,281.50 |
$2,281.50 |
$2,281.50 |
$2,930.52
|
|
Inj ivig privigen 500 mg
|
$4,051.95 |
$4,051.95 |
$4,051.95 |
$7,173.90
|
|
Inj mepivacaine hcl/10 ml
|
$21.81 |
$21.81 |
$21.81 |
$31.28
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$3,458.76 |
$3,458.76 |
$3,458.76 |
$6,949.35
|
|
Inj multihance
|
$287.98 |
$287.98 |
$287.98 |
$119.25
|
|
Inj. mycophenolate mofetil
|
$296.09 |
$296.09 |
$296.09 |
$291.54
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,808.78 |
$2,808.78 |
$2,808.78 |
$1,522.56
|
|
Inj, nithiodote, 3mg / 125mg
|
$520.19 |
$520.19 |
$520.19 |
$519.39
|
|
Inj ogivri 10 mg
|
$243.36 |
$243.36 |
$243.36 |
$3,968.67
|
|
Inj., patisiran, 0.1 mg
|
$8,669.70 |
$8,669.70 |
$8,669.70 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$3,582.47 |
$3,582.47 |
$3,582.47 |
$6,965.32
|
|
Inj proc ankle arthr
|
$432.48 |
$432.48 |
$432.48 |
$405.31
|
|
Inj proc elbow arthro
|
$369.61 |
$369.61 |
$369.61 |
$453.60
|
|
Inj, releuko 1 mcg
|
$696.62 |
$696.62 |
$696.62 |
$519.53
|
|
Inj retacrit esrd on dialysi
|
$60.84 |
$60.84 |
$60.84 |
$252.88
|
|
Inj retro urethrocysto
|
$139.94 |
$139.94 |
$139.94 |
$551.29
|
|
Inj romidepsin non-lyo 0.1mg
|
$8,027.84 |
$8,027.84 |
$8,027.84 |
$33.91
|
|
Inj secretin synthetic human
|
$741.75 |
$741.75 |
$741.75 |
$1,091.50
|
|
Inj sulf hexa lipid microsph
|
$398.00 |
$398.00 |
$398.00 |
$201.03
|
|
Inj teclistamab cqyv 0.5 mg
|
$8,238.25 |
$8,238.25 |
$8,238.25 |
$17,517.56
|
|
Inj. teprotumumab-trbw 10 mg
|
$13,597.74 |
$13,597.74 |
$13,597.74 |
$43,022.95
|
|
Inj testosterone cypionate
|
$65.41 |
$65.41 |
$65.41 |
$81.11
|
|
Inj triamcinolone ace X-ray 1mg
|
$38.03 |
$38.03 |
$38.03 |
$21.60
|
|
Inj, vancomycin hcl (mylan)
|
$1,140.75 |
$1,140.75 |
$1,140.75 |
$70.39
|
|
Inj w/fluor eval cv device
|
$297.61 |
$297.61 |
$297.61 |
$588.90
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$18,932.40 |
$18,932.40 |
$18,932.40 |
$18,932.40
|
|
Ins cath ren art 1st bi
|
$4,740.96 |
$4,740.96 |
$4,740.96 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$3,555.60 |
$3,555.60 |
$3,555.60 |
$4,667.63
|
|
Ins cath ren art 2nd+ uni
|
$4,835.77 |
$4,835.77 |
$4,835.77 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$208.89 |
$208.89 |
$208.89 |
$544.00
|
|
Insert cath pleura with image
|
$1,146.84 |
$1,146.84 |
$1,146.84 |
$2,239.02
|
|
Insert cath pleura without image
|
$768.62 |
$768.62 |
$768.62 |
$2,212.00
|
|
Insert hepatic shunt (tips)
|
$26,170.84 |
$26,170.84 |
$26,170.84 |
$9,754.48
|
|
Insertion catheter bladder non indwelling
|
$272.26 |
$272.26 |
$272.26 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$212.94 |
$212.94 |
$212.94 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,074.26 |
$4,074.26 |
$4,074.26 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,541.91 |
$3,541.91 |
$3,541.91 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$5,979.56 |
$5,979.56 |
$5,979.56 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,556.49 |
$1,556.49 |
$1,556.49 |
$2,618.40
|
|
Insertion of catheter vein
|
$781.80 |
$781.80 |
$781.80 |
$858.05
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$14,293.35 |
$14,293.35 |
$14,293.35 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$13,149.56 |
$13,149.56 |
$13,149.56 |
$12,813.28
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$14,869.30 |
$14,869.30 |
$14,869.30 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,022.43 |
$2,022.43 |
$2,022.43 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,527.91 |
$2,527.91 |
$2,527.91 |
$2,527.91
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$52,758.42 |
$52,758.42 |
$52,758.42 |
$29,997.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$6,688.86 |
$6,688.86 |
$6,688.86 |
$7,572.47
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$7,898.56 |
$7,898.56 |
$7,898.56 |
$7,673.12
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$8,832.45 |
$8,832.45 |
$8,832.45 |
$9,793.46
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,017.16 |
$3,017.16 |
$3,017.16 |
$5,470.54
|
|
Insert pm/icd lead dual
|
$9,908.31 |
$9,908.31 |
$9,908.31 |
$7,562.63
|
|
Insert swan-ganz cath
|
$2,385.44 |
$2,385.44 |
$2,385.44 |
$2,164.52
|
|
Insert tunneled cv cath
|
$3,228.58 |
$3,228.58 |
$3,228.58 |
$6,028.07
|
|
Insert vad art access left hrt arterial access
|
$3,718.85 |
$3,718.85 |
$3,718.85 |
$5,062.80
|
|
Insitu hybridization auto
|
$65.91 |
$65.91 |
$65.91 |
$398.16
|
|
Insitu hybridization manual
|
$155.15 |
$155.15 |
$155.15 |
$407.11
|
|
In situ hybridization per specimen each additional single probe stain
|
$55.77 |
$55.77 |
$55.77 |
$251.55
|
|
In situ hybridization per specimen initial single probe stain
|
$147.03 |
$147.03 |
$147.03 |
$338.40
|
|
Ins lv lead exist pm/icd
|
$17,299.86 |
$17,299.86 |
$17,299.86 |
$12,384.25
|
|
Ins picad w subq port 5yr>
|
$5,333.64 |
$5,333.64 |
$5,333.64 |
$4,341.66
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$1,516.44 |
$1,516.44 |
$1,516.44 |
$1,483.95
|
