|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,175.00 |
$2,175.00 |
$2,175.00 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$934.80 |
$934.80 |
$934.80 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$934.80 |
$934.80 |
$934.80 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$67.80 |
$67.80 |
$67.80 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$370.80 |
$370.80 |
$370.80 |
$517.24
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$91.80 |
$91.80 |
$91.80 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$91.80 |
$91.80 |
$91.80 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$258.60 |
$258.60 |
$258.60 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$95.40 |
$95.40 |
$95.40 |
$135.20
|
|
Inject sacroiliac joint
|
$963.00 |
$963.00 |
$963.00 |
$963.00
|
|
Inj., eravacycline, 1 mg
|
$146.40 |
$146.40 |
$146.40 |
$206.64
|
|
Inj. fe derisomaltose 10 mg
|
$12,084.00 |
$12,084.00 |
$12,084.00 |
$3,540.79
|
|
Inj fluphenazine hcl 1.25 mg
|
$772.20 |
$772.20 |
$772.20 |
$37.93
|
|
Inj for ext venography
|
$1,891.80 |
$1,891.80 |
$1,891.80 |
$654.00
|
|
Inj gemcitabine hcl (accord)
|
$18.60 |
$18.60 |
$18.60 |
$113.90
|
|
Inj. herceptin hylecta, 10mg
|
$17,165.40 |
$17,165.40 |
$17,165.40 |
$8,193.78
|
|
Inj intralesional <= 7 lsn(s)
|
$43.20 |
$43.20 |
$43.20 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$36.00 |
$36.00 |
$36.00 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$18,537.60 |
$18,537.60 |
$18,537.60 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$151.50 |
$151.50 |
$151.50 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$41.10 |
$41.10 |
$41.10 |
$44.96
|
|
Inj., meropenem, vaborbactam
|
$575.40 |
$575.40 |
$575.40 |
$536.27
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$38,559.60 |
$38,559.60 |
$38,559.60 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$17,366.40 |
$17,366.40 |
$17,366.40 |
$8,304.04
|
|
Inj multihance
|
$426.60 |
$426.60 |
$426.60 |
$79.42
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,012.20 |
$1,012.20 |
$1,012.20 |
$1,414.40
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,484.00 |
$2,484.00 |
$2,484.00 |
$2,485.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,484.00 |
$2,484.00 |
$2,484.00 |
$2,431.74
|
|
Inj octafluoropropane mic,ml
|
$541.80 |
$541.80 |
$541.80 |
$211.40
|
|
Inj., omadacycline, 1 mg
|
$1,498.20 |
$1,498.20 |
$1,498.20 |
$865.34
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$14,412.00 |
$14,412.00 |
$14,412.00 |
$6,371.38
|
|
Inj., perseris, 0.5 mg
|
$10,179.60 |
$10,179.60 |
$10,179.60 |
$5,372.48
|
|
Inj scleros sol sgl vein
|
$466.20 |
$466.20 |
$466.20 |
$534.40
|
|
Inj secukinumab intrav 1mg
|
$8,523.30 |
$8,523.30 |
$8,523.30 |
$4,485.92
|
|
Inj, tislelizumab-jsgr
|
$21,801.60 |
$21,801.60 |
$21,801.60 |
$9,764.09
|
|
Inj, uzedy, 1 mg
|
$20,449.20 |
$20,449.20 |
$20,449.20 |
$11,475.96
|
|
Inj vancomycin (xellia) 10mg
|
$458.40 |
$458.40 |
$458.40 |
$79.21
|
|
Inj w/fluor eval cv device
|
$178.80 |
$178.80 |
$178.80 |
$463.40
|
|
Ins cath ren art 1st bi
|
$2,517.00 |
$2,517.00 |
$2,517.00 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$5,231.40 |
$5,231.40 |
$5,231.40 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$5,231.40 |
$5,231.40 |
$5,231.40 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$5,231.40 |
$5,231.40 |
$5,231.40 |
$5,419.00
|
|
Insert cath pleura with image
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,974.00 |
$1,974.00 |
$1,974.00 |
$2,019.00
|
|
Insert drug delivery implant
|
$135.00 |
$135.00 |
$135.00 |
$280.00
|
|
Insert intrauterine device iud
|
$110.40 |
$110.40 |
$110.40 |
$366.65
|
|
Insertion catheter bladder non indwelling
|
$223.20 |
$223.20 |
$223.20 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$223.20 |
$223.20 |
$223.20 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$5,028.00 |
$5,028.00 |
$5,028.00 |
$4,731.80
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,247.00 |
$2,247.00 |
$2,247.00 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$7,782.60 |
$7,782.60 |
$7,782.60 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,616.40 |
$1,616.40 |
$1,616.40 |
$2,511.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$24,754.20 |
$24,754.20 |
$24,754.20 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$11,742.60 |
$11,742.60 |
$11,742.60 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$14,416.20 |
$14,416.20 |
$14,416.20 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,759.20 |
$1,759.20 |
$1,759.20 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,497.80 |
$2,497.80 |
$2,497.80 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$56,131.20 |
$56,131.20 |
$56,131.20 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$11,891.40 |
$11,891.40 |
$11,891.40 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$11,027.40 |
$11,027.40 |
$11,027.40 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$13,599.00 |
$13,599.00 |
$13,599.00 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$4,174.80 |
$4,174.80 |
$4,174.80 |
$5,236.80
|
|
Insert pessary/other device
|
$71.40 |
$71.40 |
$71.40 |
$273.54
|
|
Insert pm/icd lead dual
|
$11,027.40 |
$11,027.40 |
$11,027.40 |
$7,388.80
|
|
Insert vad art access left hrt arterial access
|
$924.60 |
$924.60 |
$924.60 |
$4,221.97
|
|
Ins icd gen exist mlt leads
|
$38,658.60 |
$38,658.60 |
$38,658.60 |
$31,286.77
|
|
In situ hybridization per specimen initial single probe stain
|
$165.60 |
$165.60 |
$165.60 |
$326.04
|
|
Ins pm gen w/exist mlt leads
|
$18,183.00 |
$18,183.00 |
$18,183.00 |
$14,804.40
|
|
Ins/rpl pm w/tv ld atrl
|
$11,742.60 |
$11,742.60 |
$11,742.60 |
$12,371.40
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$34,404.60 |
$34,404.60 |
$34,404.60 |
$25,807.00
|
|
Instillation anticarcinogenic agent bladder
|
$664.20 |
$664.20 |
$664.20 |
$621.40
|
|
Insulin total
|
$151.20 |
$151.20 |
$151.20 |
$66.64
|
|
Interrog device eval heart
|
$128.40 |
$128.40 |
$128.40 |
$162.40
|
|
Interrog evl pm/ldls pm ip
|
$45.60 |
$45.60 |
$45.60 |
$124.80
|
|
Intra-atrial pacing
|
$8,866.20 |
$8,866.20 |
$8,866.20 |
$4,683.25
|
|
Intra-atrial recording
|
$8,866.20 |
$8,866.20 |
$8,866.20 |
$5,252.30
|
|
Intracard echo interv w/s&i
|
$3,454.20 |
$3,454.20 |
$3,454.20 |
$3,429.40
|
|
Intrinsic factor antibody
|
$288.60 |
$288.60 |
$288.60 |
$66.60
|
|
Intro cath dialysis circuit
|
$1,214.40 |
$1,214.40 |
$1,214.40 |
$2,035.00
|
|
Intro catheter aorta
|
$863.40 |
$863.40 |
$863.40 |
$1,654.05
|
|
Intro cath svc/ivc
|
$961.20 |
$961.20 |
$961.20 |
$1,329.90
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$3,772.80 |
$3,772.80 |
$3,772.80 |
$3,303.76
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$3,772.80 |
$3,772.80 |
$3,772.80 |
$1,633.03
|
|
Intubation endotracheal emergency procedure
|
$869.40 |
$869.40 |
$869.40 |
$589.60
|
|
Iodine i-123 sod iodide mil
|
$1,972.80 |
$1,972.80 |
$1,972.80 |
$350.74
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$368.40 |
$368.40 |
$368.40 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$537.00 |
$537.00 |
$537.00 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$116,523.60 |
$116,523.60 |
$116,523.60 |
$62,692.46
|
|
Ip/obs cnsltj new/est low 45
|
$110.40 |
$110.40 |
$110.40 |
$174.20
|
|
Ip/obs cnsltj new/est mod 60
|
$180.60 |
$180.60 |
$180.60 |
$284.45
|
|
Ip/obs consltj new/est hi 80
|
$238.80 |
$238.80 |
$238.80 |
$332.80
|
|
Ip/obs consltj new/est sf 35
|
$88.20 |
$88.20 |
$88.20 |
$134.46
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$184.20 |
$184.20 |
$184.20 |
$163.87
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$6,528.60 |
$6,528.60 |
$6,528.60 |
$5,476.68
|
|
Iron
|
$150.00 |
$150.00 |
$150.00 |
$74.40
|
|
Iron binding capacity
|
$133.80 |
$133.80 |
$133.80 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$321.00 |
$321.00 |
$321.00 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$90.60 |
$90.60 |
$90.60 |
$142.20
|
|
Ivc venogram s&i
|
$4,980.00 |
$4,980.00 |
$4,980.00 |
$3,316.95
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$289.20 |
$289.20 |
$289.20 |
$191.75
|
