|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1.00 |
$230.85 |
$2,450.80 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$475.10 |
$2,527.50 |
$3,369.65 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1.00 |
$545.55 |
$943.45 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,257.30 |
$2,257.30 |
$2,615.05 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$514.30 |
$855.90 |
$2,114.10 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$504.75 |
$855.90 |
$2,114.10 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$73.55 |
$114.65 |
$791.95 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$111.00 |
$186.20 |
$1,160.35 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$133.65 |
$412.50 |
$821.70 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$64.15 |
$134.25 |
$179.50 |
|
|
Inject sacroiliac joint
|
$1,375.60 |
$1,619.65 |
$2,037.90 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$38,416.02 |
$38,416.02 |
$42,037.54 |
|
|
Inj epidural sgl cerv-thor without img
|
$319.05 |
$855.90 |
$2,114.10 |
|
|
Inj epidural sgl lumb-sacral without img
|
$325.25 |
$855.90 |
$2,114.10 |
|
|
Inj. fe derisomaltose 10 mg
|
$8,385.26 |
$8,385.26 |
$8,385.26 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$66.92 |
$66.92 |
$1,481.44 |
|
|
Inj for ext venography
|
$172.50 |
$458.10 |
$458.10 |
|
|
Inj for mammo ductogram
|
$119.00 |
$392.80 |
$592.40 |
|
|
Inj herzuma 10 mg
|
$4,815.69 |
$10,336.65 |
$13,681.28 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,909.00 |
$2,909.00 |
$2,909.00 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,628.25 |
$3,628.25 |
$3,628.25 |
|
|
Inj hydroxocobalamin IV 25mg
|
$2,383.03 |
$2,383.03 |
$2,383.03 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,927.65 |
$1,927.65 |
$1,927.65 |
|
|
Inj intralesional <= 7 lsn(s)
|
$114.40 |
$134.95 |
$618.10 |
|
|
Inj, invega hafyera/trinza
|
$18,652.11 |
$21,710.95 |
$51,134.50 |
|
|
Inj ivig privigen 500 mg
|
$9,235.52 |
$11,452.70 |
$19,823.63 |
|
|
Inj labetalol hcl hikma, 5mg
|
$70.52 |
$70.52 |
$70.52 |
|
|
Inj, lanreotide, (cipla) 1mg
|
$15,907.34 |
$15,907.34 |
$23,407.26 |
|
|
Inj levocarnitine per 1 gm
|
$195.82 |
$225.26 |
$379.41 |
|
|
Inj, levothyroxine, freskabi
|
$303.45 |
$1,677.32 |
$1,757.86 |
|
|
Inj, levothyroxine, hikma
|
$379.83 |
$379.83 |
$379.83 |
|
|
Inj, lidocaine w epinephrine
|
$1.73 |
$64.83 |
$227.62 |
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$855.90 |
$1,120.50 |
$2,068.70 |
|
|
Inj mepivacaine hcl/10 ml
|
$19.70 |
$135.22 |
$175.44 |
|
|
Inj, meropenem (b. braun)
|
$166.78 |
$173.31 |
$291.92 |
|
|
Inj meropenem (wg crit care)
|
$190.64 |
$190.64 |
$399.70 |
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$14,259.97 |
$14,259.97 |
$14,259.97 |
|
|
Inj, moxifloxacin 100 mg
|
$43.07 |
$60.19 |
$103.88 |
|
|
Inj multihance
|
$119.77 |
$119.77 |
$136.63 |
|
|
Inj. mycophenolate mofetil
|
$248.06 |
$248.06 |
$1,053.84 |
|
|
Inj naloxone hydrochloride
|
$77.13 |
$191.22 |
$400.92 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,726.75 |
$1,726.75 |
$2,012.55 |
|
|
Inj, nithiodote, 3mg / 125mg
|
$559.79 |
$581.59 |
$1,184.41 |
|
|
Inj ogivri 10 mg
|
$6,909.66 |
$6,909.66 |
$6,909.66 |
|
|
Inj ontruzant 10 mg
|
$4,548.40 |
$9,762.94 |
$12,921.93 |
|
|
Inj, pemivibart, 4500 mg
|
$1,684.73 |
$2,500.07 |
$3,277.45 |
|
|
Inj proc ankle arthr
|
$175.95 |
$680.20 |
$723.50 |
|
|
Inj proc elbow arthro
|
$113.20 |
$324.90 |
$674.85 |
|
|
Inj proc for lymphang
|
$281.60 |
$281.60 |
$281.60 |
|
|
Inj proc lumbr disk ea lvl
|
$912.00 |
$912.00 |
$912.00 |
|
|
Inj proc myelogram lumbar
|
$785.90 |
$785.90 |
$3,364.80 |
|
|
Inj proc sialogram
|
$259.10 |
$259.10 |
$259.10 |
|
|
Inj retro urethrocysto
|
$232.15 |
$558.05 |
$1,085.40 |
|
|
Inj, rimabotulinumtoxinb
|
$2,172.93 |
$2,172.93 |
$2,172.93 |
|
|
Inj scleros sol mult veins
|
$357.85 |
$357.85 |
$357.85 |
|
|
Inj scleros sol sgl vein
|
$357.85 |
$357.85 |
$357.85 |
|
|
Inj secukinumab intrav 1mg
|
$5,679.00 |
$5,679.00 |
$8,769.42 |
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$128.00 |
$128.00 |
$328.00 |
|
|
Inj. teprotumumab-trbw 10 mg
|
$48,500.13 |
$48,500.13 |
$48,500.13 |
|
|
Inj testostero enanthate 1mg
|
$33.19 |
$33.19 |
$33.19 |
|
|
Inj testosterone cypionate
|
$10.64 |
$16.40 |
$40.49 |
|
|
Inj thrc fascial pln blk bi w/wo image
|
$268.15 |
$1,241.30 |
$3,063.86 |
|
|
Inj thrc fascial pln blk uni w/wo image
|
$268.15 |
$1,241.30 |
$3,063.86 |
|
|
Inj, vancomycin hcl (mylan)
|
$68.21 |
$203.93 |
$279.86 |
|
|
Inj, vegzelma, 10 mg
|
$8,240.98 |
$8,240.98 |
$8,240.98 |
|
|
Inj vocal cord bulking agent
|
$715.00 |
$715.00 |
$735.00 |
|
|
Inj w/fluor eval cv device
|
$428.70 |
$683.35 |
$1,271.35 |
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$59,856.32 |
$59,856.32 |
$59,856.32 |
|
|
Inpt/ed teleconsult30
|
$184.85 |
$184.85 |
$184.85 |
|
|
Inpt/ed teleconsult50
|
$249.70 |
$249.70 |
$249.70 |
|
|
Inpt/ed teleconsult70
|
$372.55 |
$372.55 |
$372.55 |
|
|
Ins cath ren art 1st bi
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
|
|
Ins cath ren art 1st uni
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
|
|
Ins cath ren art 2nd+ bi
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
|
|
Ins cath ren art 2nd+ uni
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
|
|
Ins cerv dilator (sep proc)
|
$288.80 |
$288.80 |
$288.80 |
|
|
Insert and remove bone pin
|
$396.80 |
$396.80 |
$396.80 |
|
|
Insert cath pleura with image
|
$3,583.40 |
$4,177.90 |
$4,177.90 |
|
|
Insert cath pleura without image
|
$1,482.00 |
$3,050.30 |
$5,272.35 |
|
|
Insert intrauterine device iud
|
$925.90 |
$925.90 |
$925.90 |
|
|
Insertion catheter bladder non indwelling
|
$58.00 |
$144.40 |
$233.25 |
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$530.90 |
$904.95 |
$1,911.15 |
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,667.10 |
$1,667.10 |
$1,667.10 |
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$14,190.05 |
$14,190.05 |
$14,190.05 |
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$301.50 |
$1,485.95 |
$6,890.25 |
|
|
Insertion of catheter vein
|
$2,231.20 |
$2,231.20 |
$2,231.20 |
|
|
Insertion of catheter vein
|
$1,513.00 |
$1,513.00 |
$1,513.00 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$41,076.90 |
$41,076.90 |
$41,076.90 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$37,630.20 |
$37,630.20 |
$37,630.20 |
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$832.80 |
$2,088.10 |
$3,537.50 |
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$637.05 |
$2,553.20 |
$5,215.60 |
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$252.70 |
$1,090.20 |
$17,353.10 |
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$15,928.10 |
$15,928.10 |
$15,928.10 |
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$25,571.85 |
$25,571.85 |
$25,571.85 |
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$15,376.55 |
$15,376.55 |
$15,376.55 |
|
|
Insert lens prosthesis
|
$1,159.80 |
$1,159.80 |
$1,159.80 |
|
|
Insert pessary/other device
|
$144.30 |
$287.90 |
$567.15 |
|
|
Insert pm/icd lead dual
|
$15,928.10 |
$15,928.10 |
$15,928.10 |
|
|
Insert swan-ganz cath
|
$173.85 |
$898.10 |
$2,100.05 |
|
|
Insert tunneled cv cath
|
$15,376.55 |
$15,376.55 |
$15,376.55 |
|
