|
Injection for arthrography wrist (both sides)
|
$120.32 |
$120.32 |
$120.32 |
$441.12
|
|
Injection for bladder x-ray
|
$228.64 |
$228.64 |
$228.64 |
$459.20
|
|
Injection for hip x-ray
|
$498.72 |
$498.72 |
$498.72 |
$669.24
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$300.00 |
$300.00 |
$300.00 |
$494.65
|
|
Injection for spleen x-ray
|
$277.12 |
$277.12 |
$277.12 |
$423.41
|
|
Injection for ureter x-ray
|
$224.80 |
$224.80 |
$224.80 |
$415.80
|
|
Injection into brain canal
|
$310.72 |
$310.72 |
$310.72 |
$836.40
|
|
Injection jugular
|
$374.40 |
$374.40 |
$374.40 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$693.71 |
$693.71 |
$693.71 |
$2,241.61
|
|
Injection radioactive tracer sentinel node (both sides)
|
$236.16 |
$236.16 |
$236.16 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$841.92 |
$841.92 |
$841.92 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$602.24 |
$602.24 |
$602.24 |
$1,045.65
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$672.96 |
$672.96 |
$672.96 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$481.60 |
$481.60 |
$481.60 |
$1,704.78
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$59.20 |
$59.20 |
$59.20 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$52.96 |
$52.96 |
$52.96 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$112.48 |
$112.48 |
$112.48 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$52.96 |
$52.96 |
$52.96 |
$135.20
|
|
Inj for ext venography
|
$383.04 |
$383.04 |
$383.04 |
$654.00
|
|
Inj for mammo ductogram
|
$200.48 |
$200.48 |
$200.48 |
$433.50
|
|
Inj hrt cath w/s&i sel left vent
|
$394.08 |
$394.08 |
$394.08 |
$1,071.00
|
|
Inj hrt cath w/s&i sel right vent
|
$669.76 |
$669.76 |
$669.76 |
$947.05
|
|
Inj ivig privigen 500 mg
|
$2,168.99 |
$2,168.99 |
$2,168.99 |
$6,967.29
|
|
Inj, lidocaine w epinephrine
|
$29.68 |
$29.68 |
$29.68 |
$44.96
|
|
Inj multihance
|
$1.40 |
$1.40 |
$1.40 |
$79.42
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$640.64 |
$640.64 |
$640.64 |
$1,414.40
|
|
Inj proc ankle arthr
|
$92.64 |
$92.64 |
$92.64 |
$405.31
|
|
Inj proc elbow arthro
|
$260.64 |
$260.64 |
$260.64 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$269.60 |
$269.60 |
$269.60 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$398.24 |
$398.24 |
$398.24 |
$856.00
|
|
Inj proc sialogram
|
$38.56 |
$38.56 |
$38.56 |
$373.00
|
|
Inj, releuko 1 mcg
|
$271.09 |
$271.09 |
$271.09 |
$461.20
|
|
Inj retro urethrocysto
|
$233.60 |
$233.60 |
$233.60 |
$450.00
|
|
Inj w/fluor eval cv device
|
$155.20 |
$155.20 |
$155.20 |
$463.40
|
|
Ins cath ren art 1st bi
|
$2,998.40 |
$2,998.40 |
$2,998.40 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$1,850.40 |
$1,850.40 |
$1,850.40 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$3,301.44 |
$3,301.44 |
$3,301.44 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$1,725.44 |
$1,725.44 |
$1,725.44 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$82.24 |
$82.24 |
$82.24 |
$488.35
|
|
Insert cath pleura with image
|
$752.80 |
$752.80 |
$752.80 |
$2,194.40
|
|
Insert hepatic shunt (tips)
|
$3,313.60 |
$3,313.60 |
$3,313.60 |
$8,367.70
|
|
Insertion catheter bladder non indwelling
|
$54.08 |
$54.08 |
$54.08 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$116.16 |
$116.16 |
$116.16 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,911.68 |
$1,911.68 |
$1,911.68 |
$4,731.80
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,702.24 |
$1,702.24 |
$1,702.24 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,912.64 |
$2,912.64 |
$2,912.64 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,019.84 |
$1,019.84 |
$1,019.84 |
$2,511.00
|
|
Insertion of catheter vein
|
$361.09 |
$361.09 |
$361.09 |
$1,657.32
|
|
Insertion of catheter vein
|
$319.36 |
$319.36 |
$319.36 |
$836.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$6,303.20 |
$6,303.20 |
$6,303.20 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$4,536.48 |
$4,536.48 |
$4,536.48 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$5,217.60 |
$5,217.60 |
$5,217.60 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$717.28 |
$717.28 |
$717.28 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$558.88 |
$558.88 |
$558.88 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$12,619.84 |
$12,619.84 |
$12,619.84 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$4,578.40 |
$4,578.40 |
$4,578.40 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$4,374.88 |
$4,374.88 |
$4,374.88 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$4,272.16 |
$4,272.16 |
$4,272.16 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$2,200.48 |
$2,200.48 |
$2,200.48 |
$5,236.80
|
|
Insert picvad cath
|
$1,340.32 |
$1,340.32 |
$1,340.32 |
$4,341.66
|
|
Insert pm/icd lead dual
|
$3,611.84 |
$3,611.84 |
$3,611.84 |
$7,388.80
|
|
Insert/repl sq defib w/eltrd
|
$20,725.28 |
$20,725.28 |
$20,725.28 |
$33,297.72
|
|
Insert swan-ganz cath
|
$702.08 |
$702.08 |
$702.08 |
$2,210.50
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$1,687.20 |
$1,687.20 |
$1,687.20 |
$5,018.25
|
|
Insert vad art access left hrt arterial access
|
$3,480.64 |
$3,480.64 |
$3,480.64 |
$4,221.97
|
|
Ins icd gen exist mlt leads
|
$7,573.92 |
$7,573.92 |
$7,573.92 |
$31,286.77
|
|
Ins icd gen exist sgl lead
|
$10,083.36 |
$10,083.36 |
$10,083.36 |
$23,742.75
|
|
Insitu hybridization (fish)
|
$79.20 |
$79.20 |
$79.20 |
$481.60
|
|
Insitu hybridization manual
|
$78.40 |
$78.40 |
$78.40 |
$388.20
|
|
In situ hybridization per specimen initial single probe stain
|
$63.20 |
$63.20 |
$63.20 |
$326.04
|
|
Ins lv lead exist pm/icd
|
$6,457.12 |
$6,457.12 |
$6,457.12 |
$12,087.24
|
|
Ins picad w subq port 5yr>
|
$1,340.32 |
$1,340.32 |
$1,340.32 |
$3,912.93
|
|
Ins pm gen exist dual lead
|
$7,814.88 |
$7,814.88 |
$7,814.88 |
$24,696.00
|
|
Ins pm gen w/exist mlt leads
|
$4,846.40 |
$4,846.40 |
$4,846.40 |
$14,804.40
|
|
Ins pq tunnld ip cath w/img
|
$2,160.00 |
$2,160.00 |
$2,160.00 |
$5,377.00
|
|
Ins/rplc spi npg/rcvr pocket
|
$8,968.64 |
$8,968.64 |
$8,968.64 |
$23,746.69
|
|
Ins/rpl ldless pm right vent w img & eval
|
$10,953.44 |
$10,953.44 |
$10,953.44 |
$23,369.00
|
|
Ins/rpl pm gen exist dual lead
|
$3,463.20 |
$3,463.20 |
$3,463.20 |
$11,408.40
|
|
Ins/rpl pm gen exist sgl lead
|
$3,151.20 |
$3,151.20 |
$3,151.20 |
$9,558.78
|
|
Ins/rpl pm w/tv ld atrl
|
$5,927.04 |
$5,927.04 |
$5,927.04 |
$12,371.40
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$21,844.14 |
$21,844.14 |
$21,844.14 |
$25,807.00
|
|
Ins tun cv cath wo subq prt/pm
|
$1,373.76 |
$1,373.76 |
$1,373.76 |
$5,324.80
|
|
Ins tun cv cath wo subq prt/pm
|
$1,199.36 |
$1,199.36 |
$1,199.36 |
$4,202.70
|
|
Ins tun intraperit dia cath
|
$2,011.68 |
$2,011.68 |
$2,011.68 |
$4,657.46
|
|
Insulin total
|
$32.32 |
$32.32 |
$32.32 |
$66.64
|
|
Integra meshed bil wound mat
|
$3,245.44 |
$3,245.44 |
$3,245.44 |
$9,924.00
|
|
Interdiscal perq aspir dx
|
$273.44 |
$273.44 |
$273.44 |
$1,180.84
|
|
Intra-atrial pacing
|
$2,530.72 |
$2,530.72 |
$2,530.72 |
$4,683.25
|
|
Intra-atrial recording
|
$2,530.72 |
$2,530.72 |
$2,530.72 |
$5,252.30
|
|
Intracard echo interv w/s&i
|
$1,645.60 |
$1,645.60 |
$1,645.60 |
$3,429.40
|
|
Intracranial complete study
|
$321.44 |
$321.44 |
$321.44 |
$900.50
|
|
Intrauterine transfusion ftl
|
$482.72 |
$482.72 |
$482.72 |
$1,074.75
|
|
Intraventricular pacing
|
$1,928.32 |
$1,928.32 |
$1,928.32 |
$5,609.50
|
|
Intrinsic factor antibody
|
$2.14 |
$2.14 |
$2.14 |
$66.60
|
|
Intro cath dialysis circuit
|
$1,043.52 |
$1,043.52 |
$1,043.52 |
$2,035.00
|
|
Intro cath dialysis circuit w/pta
|
$3,619.04 |
$3,619.04 |
$3,619.04 |
$8,761.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$4,907.52 |
$4,907.52 |
$4,907.52 |
$15,805.00
|
|
Intro catheter aorta
|
$175.84 |
$175.84 |
$175.84 |
$1,654.05
|
|
Intro cath svc/ivc
|
$88.32 |
$88.32 |
$88.32 |
$1,329.90
|
|
Intro long gi tube
|
$203.52 |
$203.52 |
$203.52 |
$990.00
|