|
Injection, renflexis
|
$1,183.43 |
$1,183.43 |
$1,183.43 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$460.70 |
$460.70 |
$460.70 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$938.40 |
$938.40 |
$938.40 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,899.07 |
$1,899.07 |
$1,899.07 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$689.86 |
$689.86 |
$689.86 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,406.58 |
$1,406.58 |
$1,406.58 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$689.86 |
$689.86 |
$689.86 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,541.05 |
$1,541.05 |
$1,541.05 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$991.27 |
$991.27 |
$991.27 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$991.27 |
$991.27 |
$991.27 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$144.33 |
$144.33 |
$144.33 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$194.82 |
$194.82 |
$194.82 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$121.72 |
$121.72 |
$121.72 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$55.93 |
$55.93 |
$55.93 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$41.48 |
$41.48 |
$41.48 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$65.79 |
$65.79 |
$65.79 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$73.78 |
$73.78 |
$73.78 |
$135.60
|
|
Injection treatment of eye
|
$66.81 |
$66.81 |
$66.81 |
$2,665.60
|
|
Injection treatment of nerve
|
$531.93 |
$531.93 |
$531.93 |
$3,219.20
|
|
Injection treatment of nerve
|
$447.27 |
$447.27 |
$447.27 |
$4,350.00
|
|
Injection treatment of nerve
|
$275.06 |
$275.06 |
$275.06 |
$2,025.45
|
|
Injection treatment of nose
|
$111.86 |
$111.86 |
$111.86 |
$859.59
|
|
Inject sacroiliac joint
|
$451.69 |
$451.69 |
$451.69 |
$1,028.95
|
|
Inject/treat eye socket
|
$27.54 |
$27.54 |
$27.54 |
$670.02
|
|
Inj epidural sgl cerv-thor without img
|
$56.95 |
$56.95 |
$56.95 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$45.22 |
$45.22 |
$45.22 |
$1,415.50
|
|
Inj for ext venography
|
$784.04 |
$784.04 |
$784.04 |
$649.95
|
|
Inj for mammo ductogram
|
$73.95 |
$73.95 |
$73.95 |
$399.60
|
|
Inj, gadopiclenol, 1 ml
|
$1.84 |
$1.84 |
$1.84 |
$37.63
|
|
Inj herzuma 10 mg
|
$119.62 |
$119.62 |
$119.62 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$353.77 |
$353.77 |
$353.77 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$20.40 |
$20.40 |
$20.40 |
$1,827.74
|
|
Inj hrt cath w/s&i sel hrt art
|
$21.59 |
$21.59 |
$21.59 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$447.27 |
$447.27 |
$447.27 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$447.27 |
$447.27 |
$447.27 |
$965.33
|
|
Inj, immphentiv, 20 mcg
|
$25.39 |
$25.39 |
$25.39 |
$18.44
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$736.10 |
$736.10 |
$736.10 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$35.19 |
$35.19 |
$35.19 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$42.16 |
$42.16 |
$42.16 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$16,285.47 |
$16,285.47 |
$16,285.47 |
$6,967.29
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,170.85 |
$1,170.85 |
$1,170.85 |
$1,174.88
|
|
Inj, lidocaine w epinephrine
|
$49.37 |
$49.37 |
$49.37 |
$47.52
|
|
Inj mepivacaine hcl/10 ml
|
$5.78 |
$5.78 |
$5.78 |
$33.86
|
|
Inj multihance
|
$9.01 |
$9.01 |
$9.01 |
$73.49
|
|
Inj naloxone hydrochloride
|
$4.76 |
$4.76 |
$4.76 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$394.57 |
$394.57 |
$394.57 |
$1,413.35
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$45,476.16 |
$45,476.16 |
$45,476.16 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$102.82 |
$102.82 |
$102.82 |
$4,492.28
|
|
Inj proc ankle arthr
|
$76.84 |
$76.84 |
$76.84 |
$405.31
|
|
Inj proc elbow arthro
|
$101.83 |
$101.83 |
$101.83 |
$419.60
|
|
Inj proc for lymphang
|
$47.94 |
$47.94 |
$47.94 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$676.94 |
$676.94 |
$676.94 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$345.44 |
$345.44 |
$345.44 |
$830.50
|
|
Inj proc sialogram
|
$65.79 |
$65.79 |
$65.79 |
$373.00
|
|
Inj progesterone per 50 mg
|
$4.08 |
$4.08 |
$4.08 |
$15.00
|
|
Inj, releuko 1 mcg
|
$506.00 |
$506.00 |
$506.00 |
$473.25
|
|
Inj retro urethrocysto
|
$38.08 |
$38.08 |
$38.08 |
$443.50
|
|
Inj scleros sol mult veins
|
$119.51 |
$119.51 |
$119.51 |
$675.00
|
|
Inj scleros sol sgl vein
|
$52.87 |
$52.87 |
$52.87 |
$558.97
|
|
Inj secukinumab intrav 1mg
|
$3,322.24 |
$3,322.24 |
$3,322.24 |
$4,413.21
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$37.23 |
$37.23 |
$37.23 |
$436.80
|
|
Inj thrc fascial pln blk uni w/wo image
|
$573.75 |
$573.75 |
$573.75 |
$837.50
|
|
Inj triamcinolone ace X-ray 1mg
|
$630.36 |
$630.36 |
$630.36 |
$1,090.75
|
|
Inj, vegzelma, 10 mg
|
$4,422.07 |
$4,422.07 |
$4,422.07 |
$1,291.28
|
|
Inj w/fluor eval cv device
|
$76.16 |
$76.16 |
$76.16 |
$503.92
|
|
Inpt/ed teleconsult30
|
$37.91 |
$37.91 |
$37.91 |
$164.40
|
|
Inpt/ed teleconsult50
|
$54.06 |
$54.06 |
$54.06 |
$223.80
|
|
Inpt/ed teleconsult70
|
$76.84 |
$76.84 |
$76.84 |
$330.60
|
|
Inpt/tele follow up 15
|
$17.00 |
$17.00 |
$17.00 |
$64.80
|
|
Inpt/tele follow up 25
|
$29.92 |
$29.92 |
$29.92 |
$118.80
|
|
Inpt/tele follow up 35
|
$43.52 |
$43.52 |
$43.52 |
$171.60
|
|
Ins cath ren art 1st bi
|
$2,881.84 |
$2,881.84 |
$2,881.84 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$900.66 |
$900.66 |
$900.66 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$1,351.50 |
$1,351.50 |
$1,351.50 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$1,250.18 |
$1,250.18 |
$1,250.18 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$274.21 |
$274.21 |
$274.21 |
$480.28
|
|
Insert and remove bone pin
|
$100.81 |
$100.81 |
$100.81 |
$4,410.60
|
|
Insert cannula vein-to-vein hemodialysis
|
$68.34 |
$68.34 |
$68.34 |
$7,279.50
|
|
Insert cath pleura with image
|
$916.13 |
$916.13 |
$916.13 |
$2,194.40
|
|
Insert cath pleura without image
|
$307.53 |
$307.53 |
$307.53 |
$2,073.18
|
|
Insert drug delivery implant
|
$59.84 |
$59.84 |
$59.84 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$457.30 |
$457.30 |
$457.30 |
$7,571.20
|
|
Insert intervert bimech device 22854
|
$185.13 |
$185.13 |
$185.13 |
$1,573.00
|
|
Insert intrauterine device iud
|
$48.96 |
$48.96 |
$48.96 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$39.44 |
$39.44 |
$39.44 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$39.27 |
$39.27 |
$39.27 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,799.79 |
$1,799.79 |
$1,799.79 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$811.92 |
$811.92 |
$811.92 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$1,687.76 |
$1,687.76 |
$1,687.76 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$766.53 |
$766.53 |
$766.53 |
$2,505.60
|
|
Insertion of catheter vein
|
$480.59 |
$480.59 |
$480.59 |
$836.25
|
|
Insertion of heart electrode 33211
|
$91.97 |
$91.97 |
$91.97 |
$6,903.60
|
|
Insertion of infusion pump
|
$377.74 |
$377.74 |
$377.74 |
$5,907.78
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$4,913.51 |
$4,913.51 |
$4,913.51 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$4,214.47 |
$4,214.47 |
$4,214.47 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$2,392.24 |
$2,392.24 |
$2,392.24 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$825.18 |
$825.18 |
$825.18 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$913.07 |
$913.07 |
$913.07 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$18,623.33 |
$18,623.33 |
$18,623.33 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$1,566.55 |
$1,566.55 |
$1,566.55 |
$7,200.05
|
