|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$893.90 |
$893.90 |
$893.90 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,004.50 |
$1,004.50 |
$1,004.50 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$275.10 |
$275.10 |
$275.10 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$275.10 |
$275.10 |
$275.10 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$275.10 |
$275.10 |
$275.10 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$93.10 |
$93.10 |
$93.10 |
$135.60
|
|
Injection treatment of eye
|
$4,273.50 |
$4,273.50 |
$4,273.50 |
$2,665.60
|
|
Injection treatment of nerve
|
$4,208.40 |
$4,208.40 |
$4,208.40 |
$4,350.00
|
|
Inject sacroiliac joint
|
$2,881.20 |
$2,881.20 |
$2,881.20 |
$1,028.95
|
|
Inj, eculizumab-aagh, 2 mg
|
$15,870.57 |
$15,870.57 |
$15,870.57 |
$7,980.52
|
|
Inj, eculizumab-aeeb, 2 mg
|
$20,405.52 |
$20,405.52 |
$20,405.52 |
$610.56
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$57,673.35 |
$57,673.35 |
$57,673.35 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$2,876.30 |
$2,876.30 |
$2,876.30 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$8,372.52 |
$8,372.52 |
$8,372.52 |
$1,415.50
|
|
Inj for ext venography
|
$3,529.30 |
$3,529.30 |
$3,529.30 |
$649.95
|
|
Inj glofitamab gxbm, 2.5 mg
|
$29,872.15 |
$29,872.15 |
$29,872.15 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$80,557.05 |
$80,557.05 |
$80,557.05 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$43.75 |
$43.75 |
$43.75 |
$26.26
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,314.50 |
$3,314.50 |
$3,314.50 |
$1,827.74
|
|
Inj hrt cath w/s&i sel left vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$965.33
|
|
Inj hydroxocobalamin IV 25mg
|
$5,373.02 |
$5,373.02 |
$5,373.02 |
$2,452.32
|
|
Inj imip 4 cilas 4 releb 2mg
|
$2,627.62 |
$2,627.62 |
$2,627.62 |
$739.77
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$5,803.00 |
$5,803.00 |
$5,803.00 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$371.00 |
$371.00 |
$371.00 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$9,403.80 |
$9,403.80 |
$9,403.80 |
$32,073.55
|
|
Inj labetalol hcl hikma, 5mg
|
$58.45 |
$58.45 |
$58.45 |
$38.94
|
|
Inj, lecanemab-irmb, 1 mg
|
$4,389.52 |
$4,389.52 |
$4,389.52 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$169.40 |
$169.40 |
$169.40 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$151.90 |
$151.90 |
$151.90 |
$47.52
|
|
Inj melpha hydroch nos 50 mg
|
$2,566.02 |
$2,566.02 |
$2,566.02 |
$1,791.90
|
|
Inj mepivacaine hcl/10 ml
|
$132.47 |
$132.47 |
$132.47 |
$33.86
|
|
Inj meropenem (wg crit care)
|
$419.47 |
$419.47 |
$419.47 |
$77.97
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$53,080.12 |
$53,080.12 |
$53,080.12 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$26,231.10 |
$26,231.10 |
$26,231.10 |
$8,304.04
|
|
Inj multihance
|
$216.47 |
$216.47 |
$216.47 |
$73.49
|
|
Inj multihance multipack
|
$4,312.17 |
$4,312.17 |
$4,312.17 |
$2.80
|
|
Inj. mycophenolate mofetil
|
$1,752.80 |
$1,752.80 |
$1,752.80 |
$252.66
|
|
Inj naloxone hydrochloride
|
$113.57 |
$113.57 |
$113.57 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$5,192.17 |
$5,192.17 |
$5,192.17 |
$1,413.35
|
|
Inj nivolumab 2 mg hyaluron
|
$27,776.17 |
$27,776.17 |
$27,776.17 |
$15,599.68
|
|
Inj ogivri 10 mg
|
$4,769.62 |
$4,769.62 |
$4,769.62 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$20.82 |
$20.82 |
$20.82 |
$34.67
|
|
Inj peritoneal venous shunt
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$413.70
|
|
Inj proc ankle arthr
|
$128.80 |
$128.80 |
$128.80 |
$405.31
|
|
Inj proc elbow arthro
|
$666.40 |
$666.40 |
$666.40 |
$419.60
|
|
Inj proc for lymphang
|
$1,718.50 |
$1,718.50 |
$1,718.50 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$3,110.10 |
$3,110.10 |
$3,110.10 |
$1,106.93
|
|
Inj proc sialogram
|
$1,299.20 |
$1,299.20 |
$1,299.20 |
$373.00
|
|
Inj progesterone per 50 mg
|
$3.15 |
$3.15 |
$3.15 |
$15.00
|
|
Inj retro urethrocysto
|
$2,568.30 |
$2,568.30 |
$2,568.30 |
$443.50
|
|
Inj scleros sol sgl vein
|
$465.50 |
$465.50 |
$465.50 |
$558.97
|
|
Inj secretin synthetic human
|
$3,707.37 |
$3,707.37 |
$3,707.37 |
$1,285.20
|
|
Inj sulf hexa lipid microsph
|
$1,335.42 |
$1,335.42 |
$1,335.42 |
$256.14
|
|
Inj teclistamab cqyv 0.5 mg
|
$28,787.15 |
$28,787.15 |
$28,787.15 |
$17,517.56
|
|
Inj teplizumab mzwv 5 mcg
|
$82,987.10 |
$82,987.10 |
$82,987.10 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$62,630.57 |
$62,630.57 |
$62,630.57 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$0.01 |
$0.01 |
$0.01 |
$123.24
|
|
Inj testosterone cypionate
|
$227.85 |
$227.85 |
$227.85 |
$64.80
|
|
Inj thiotepa nos 1 mg
|
$848.05 |
$848.05 |
$848.05 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$3,438.40 |
$3,438.40 |
$3,438.40 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$5,999.70 |
$5,999.70 |
$5,999.70 |
$837.50
|
|
Inj. tigecycline (accord)
|
$523.25 |
$523.25 |
$523.25 |
$188.03
|
|
Inj, tyenne, 1 mg
|
$6,509.12 |
$6,509.12 |
$6,509.12 |
$3,525.12
|
|
Inj w/fluor eval cv device
|
$2,120.73 |
$2,120.73 |
$2,120.73 |
$503.92
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$83,127.45 |
$83,127.45 |
$83,127.45 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$5,484.50 |
$5,484.50 |
$5,484.50 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$5,484.50 |
$5,484.50 |
$5,484.50 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$6,309.80 |
$6,309.80 |
$6,309.80 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$51,838.04 |
$51,838.04 |
$51,838.04 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$652.40 |
$652.40 |
$652.40 |
$480.28
|
|
Insert cath pleura with image
|
$5,573.40 |
$5,573.40 |
$5,573.40 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,088.80 |
$2,088.80 |
$2,088.80 |
$2,073.18
|
|
Insert drug delivery implant
|
$2,567.60 |
$2,567.60 |
$2,567.60 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$15,928.50 |
$15,928.50 |
$15,928.50 |
$7,571.20
|
|
Insert intrauterine device iud
|
$24,719.55 |
$24,719.55 |
$24,719.55 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$8,143.45 |
$8,143.45 |
$8,143.45 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$467.60 |
$467.60 |
$467.60 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$44,680.36 |
$44,680.36 |
$44,680.36 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,743.00 |
$1,743.00 |
$1,743.00 |
$2,529.45
|
|
Insertion intra-aortic circulation dev 33970
|
$2,826.60 |
$2,826.60 |
$2,826.60 |
$1,752.40
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$17,092.91 |
$17,092.91 |
$17,092.91 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,788.40 |
$3,788.40 |
$3,788.40 |
$2,505.60
|
|
Insertion of catheter vein
|
$4,123.70 |
$4,123.70 |
$4,123.70 |
$1,477.00
|
|
Insertion of catheter vein
|
$30,801.84 |
$30,801.84 |
$30,801.84 |
$836.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$60,586.98 |
$60,586.98 |
$60,586.98 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$69,877.31 |
$69,877.31 |
$69,877.31 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$228,237.94 |
$228,237.94 |
$228,237.94 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,150.00 |
$3,150.00 |
$3,150.00 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$10,378.05 |
$10,378.05 |
$10,378.05 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$170,409.40 |
$170,409.40 |
$170,409.40 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$9,056.60 |
$9,056.60 |
$9,056.60 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$32,749.26 |
$32,749.26 |
$32,749.26 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$42,437.38 |
$42,437.38 |
$42,437.38 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$17,872.67 |
$17,872.67 |
$17,872.67 |
$5,223.20
|
|
Insert multi-comp penis pros
|
$85,410.18 |
$85,410.18 |
$85,410.18 |
$21,998.10
|
|
Insert pessary/other device
|
$343.00 |
$343.00 |
$343.00 |
$278.50
|
|
Insert pm/icd lead dual
|
$16,692.20 |
$16,692.20 |
$16,692.20 |
$7,115.20
|
|
Insert/repl sq defib w/eltrd
|
$200,211.64 |
$200,211.64 |
$200,211.64 |
$32,800.04
|
|
Insert semi-rigid prosthesis
|
$75,455.69 |
$75,455.69 |
$75,455.69 |
$14,393.26
|
