|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$684.60 |
$684.60 |
$684.60 |
$514.36
|
|
Injection for spleen x-ray
|
$1,550.40 |
$1,550.40 |
$1,550.40 |
$341.60
|
|
Injection for tear sac x-ray
|
$622.80 |
$622.80 |
$622.80 |
$386.00
|
|
Injection for ureter x-ray
|
$2,236.80 |
$2,236.80 |
$2,236.80 |
$349.55
|
|
Injection for ureter x-ray
|
$2,074.20 |
$2,074.20 |
$2,074.20 |
$544.50
|
|
Injection, fulvestrant
|
$1,660.11 |
$1,660.11 |
$1,660.11 |
$166.25
|
|
Injection glatiramer acetate
|
$418.45 |
$418.45 |
$418.45 |
$458.43
|
|
Injection, inclisiran, 1 mg
|
$5,431.58 |
$5,431.58 |
$5,431.58 |
$12.72
|
|
Injection into brain canal
|
$836.40 |
$836.40 |
$836.40 |
$961.20
|
|
Injection, isavuconazonium
|
$634.28 |
$634.28 |
$634.28 |
$634.28
|
|
Injection jugular
|
$1,607.40 |
$1,607.40 |
$1,607.40 |
$1,134.12
|
|
Injection, necitumumab, 1 mg
|
$8.12 |
$8.12 |
$8.12 |
$5.73
|
|
Injection of sinus tract
|
$1,271.40 |
$1,271.40 |
$1,271.40 |
$1,639.57
|
|
Injection,onabotulinumtoxina
|
$1,290.32 |
$1,290.32 |
$1,461.60 |
$12.88
|
|
Injection, peramivir
|
$857.20 |
$857.20 |
$857.20 |
$857.20
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,740.00 |
$1,740.00 |
$1,740.00 |
$787.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,596.00 |
$4,596.00 |
$4,596.00 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$3,252.60 |
$3,252.60 |
$3,252.60 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$8,260.80 |
$8,260.80 |
$8,260.80 |
$1,985.61
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,124.60 |
$2,124.60 |
$2,124.60 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$5,310.00 |
$5,310.00 |
$5,310.00 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,942.40 |
$2,942.40 |
$2,942.40 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$534.60 |
$534.60 |
$534.60 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$604.20 |
$604.20 |
$604.20 |
$517.24
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$216.00 |
$216.00 |
$216.00 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$155.40 |
$155.40 |
$155.40 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$306.60 |
$306.60 |
$306.60 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$157.20 |
$157.20 |
$157.20 |
$130.19
|
|
Injection torsemide 10 mg/ml
|
$40.94 |
$40.94 |
$40.94 |
$40.67
|
|
Inject sacroiliac joint
|
$4,227.00 |
$4,227.00 |
$4,227.00 |
$1,028.95
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$181.35 |
$181.35 |
$181.35 |
$39,043.20
|
|
Inj, factor x, (human), 1iu
|
$12.54 |
$12.54 |
$12.54 |
$12.54
|
|
Inj fluphenazine hcl 1.25 mg
|
$266.49 |
$266.49 |
$266.49 |
$29.65
|
|
Inj for ext venography
|
$1,202.40 |
$1,202.40 |
$1,202.40 |
$946.64
|
|
Inj for mammo ductogram
|
$606.60 |
$606.60 |
$606.60 |
$469.16
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,358.80 |
$3,358.80 |
$3,358.80 |
$1,646.97
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,209.40 |
$3,209.40 |
$3,209.40 |
$2,471.00
|
|
Inj hrt cath w/s&i sel hrt art
|
$4,933.80 |
$4,933.80 |
$4,933.80 |
$1,192.50
|
|
Inj hrt cath w/s&i sel left vent
|
$2,796.00 |
$2,796.00 |
$2,796.00 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$2,898.60 |
$2,898.60 |
$2,898.60 |
$1,352.65
|
|
Inj human fibrinogen con nos
|
$3.16 |
$3.16 |
$3.16 |
$2.41
|
|
Inj hydroxocobalamin IV 25mg
|
$1,593.19 |
$1,593.19 |
$1,593.19 |
$1,593.19
|
|
Inj hydroxyprogst capoat nos
|
$1,293.56 |
$1,293.56 |
$1,293.56 |
$1,495.98
|
|
Inj intralesional <= 7 lsn(s)
|
$520.80 |
$520.80 |
$520.80 |
$238.77
|
|
Inj intralesional > 7 lsns
|
$520.80 |
$520.80 |
$520.80 |
$222.75
|
|
Inj ivig privigen 500 mg
|
$7,298.71 |
$7,298.71 |
$7,298.71 |
$6,144.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$12,160.05 |
$12,160.05 |
$12,160.05 |
$12,160.05
|
|
Inj levocarnitine per 1 gm
|
$53.36 |
$53.36 |
$53.36 |
$87.51
|
|
Inj melpha hydroch nos 50 mg
|
$2,513.20 |
$2,513.20 |
$2,513.20 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$41.81 |
$41.81 |
$41.81 |
$28.41
|
|
Inj., meropenem, vaborbactam
|
$426.85 |
$426.85 |
$426.85 |
$426.85
|
|
Inj, moxifloxacin 100 mg
|
$262.28 |
$262.28 |
$262.28 |
$100.44
|
|
Inj. mycophenolate mofetil
|
$425.22 |
$442.90 |
$643.72 |
$387.27
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,632.80 |
$2,632.80 |
$2,632.80 |
$1,522.56
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$990.60 |
$990.60 |
$990.60 |
$2,154.21
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,518.00 |
$1,518.00 |
$1,518.00 |
$2,058.43
|
|
Inj., patisiran, 0.1 mg
|
$146.78 |
$146.78 |
$146.78 |
$36,180.04
|
|
Inj peritoneal venous shunt
|
$681.00 |
$681.00 |
$681.00 |
$329.49
|
|
Inj proc ankle arthr
|
$482.40 |
$482.40 |
$482.40 |
$405.60
|
|
Inj proc elbow arthro
|
$534.60 |
$534.60 |
$534.60 |
$483.15
|
|
Inj proc for lymphang
|
$3,809.40 |
$3,809.40 |
$7,618.80 |
$1,718.73
|
|
Inj proc lumbr disk ea lvl
|
$4,177.80 |
$4,177.80 |
$4,177.80 |
$1,218.51
|
|
Inj proc myelogram lumbar
|
$1,544.40 |
$1,544.40 |
$1,544.40 |
$1,026.35
|
|
Inj proc sialogram
|
$1,032.60 |
$1,032.60 |
$1,032.60 |
$419.34
|
|
Inj progesterone per 50 mg
|
$120.00 |
$120.00 |
$120.00 |
$35.00
|
|
Inj prohance multipack
|
$4.82 |
$4.82 |
$4.82 |
$110.40
|
|
Inj retacrit esrd on dialysi
|
$307.40 |
$307.40 |
$307.40 |
$307.40
|
|
Inj retro urethrocysto
|
$640.80 |
$640.80 |
$640.80 |
$569.60
|
|
Inj scleros sol mult veins
|
$460.80 |
$460.80 |
$460.80 |
$614.00
|
|
Inj scleros sol sgl vein
|
$987.60 |
$987.60 |
$987.60 |
$534.40
|
|
Inj sebelipase alfa 1 mg
|
$804.04 |
$804.04 |
$804.04 |
$539.69
|
|
Inj secretin synthetic human
|
$1,234.65 |
$1,234.65 |
$1,234.65 |
$610.89
|
|
Inj testostero enanthate 1mg
|
$197.08 |
$197.08 |
$197.08 |
$55.89
|
|
Inj testosterone cypionate
|
$122.55 |
$122.55 |
$122.55 |
$78.79
|
|
Inj., tildrakizumab, 1 mg
|
$24,563.40 |
$24,563.40 |
$24,563.40 |
$126.24
|
|
Inj w/fluor eval cv device
|
$872.40 |
$872.40 |
$872.40 |
$573.00
|
|
Ins cath ren art 1st bi
|
$17,988.00 |
$17,988.00 |
$17,988.00 |
$6,012.50
|
|
Ins cath ren art 1st uni
|
$9,374.40 |
$9,374.40 |
$9,758.40 |
$4,628.00
|
|
Ins cath ren art 2nd+ bi
|
$18,786.60 |
$18,786.60 |
$18,786.60 |
$5,251.20
|
|
Ins cath ren art 2nd+ uni
|
$10,158.60 |
$10,158.60 |
$10,158.60 |
$5,528.94
|
|
Insert abdomen-venous drain
|
$8,817.00 |
$8,817.00 |
$8,817.00 |
$2,875.81
|
|
Insert cath pleura with image
|
$3,266.40 |
$3,266.40 |
$3,266.40 |
$2,239.02
|
|
Insert cath pleura without image
|
$1,911.00 |
$1,911.00 |
$1,911.00 |
$2,157.58
|
|
Insert hepatic shunt (tips)
|
$9,354.60 |
$9,354.60 |
$9,354.60 |
$9,754.48
|
|
Insertion catheter bladder non indwelling
|
$343.80 |
$343.80 |
$343.80 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$315.00 |
$315.00 |
$366.60 |
$245.00
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$726.00 |
$726.00 |
$726.00 |
$4,923.19
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,859.20 |
$3,859.20 |
$3,859.20 |
$2,346.00
|
|
Insertion intra-aortic circulation dev 33970
|
$4,191.60 |
$4,191.60 |
$4,191.60 |
$866.40
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$11,380.80 |
$11,380.80 |
$11,380.80 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,024.60 |
$3,024.60 |
$5,048.40 |
$2,457.24
|
|
Insertion of catheter vein
|
$1,907.40 |
$1,907.40 |
$1,907.40 |
$2,214.00
|
|
Insertion of catheter vein
|
$2,487.60 |
$2,487.60 |
$2,487.60 |
$1,079.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$12,064.20 |
$12,064.20 |
$14,158.20 |
$14,777.24
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$12,064.20 |
$12,064.20 |
$12,669.00 |
$13,806.24
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$14,976.60 |
$14,976.60 |
$14,976.60 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$4,831.80 |
$4,831.80 |
$4,831.80 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$5,228.40 |
$5,228.40 |
$5,228.40 |
$2,367.00
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$26,412.00 |
$26,412.00 |
$27,734.40 |
$32,608.80
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$1,944.00 |
$1,944.00 |
$3,201.60 |
$7,513.67
|
