|
Hysterosalpingography s&i
|
$1,033.60 |
$1,033.60 |
$1,033.60 |
$669.12
|
|
Hzv zoster vacc recombinant adjuvanted im inj
|
$1,381.84 |
$1,381.84 |
$1,381.84 |
$352.24
|
|
I-123 sod iodide diag per 100 uci
|
$224.80 |
$224.80 |
$224.80 |
$147.46
|
|
I131 iodide cap, rx
|
$140.00 |
$140.00 |
$140.00 |
$71.70
|
|
Icd cobalt xt dr MRI is1 df1
|
$53,242.24 |
$53,242.24 |
$53,242.24 |
$34,093.09
|
|
Icd crtd cobalt hf MRI is1 df1
|
$65,757.92 |
$65,757.92 |
$65,757.92 |
$39,070.50
|
|
Icd crtp serena MRI
|
$29,062.80 |
$29,062.80 |
$29,062.80 |
$14,360.25
|
|
Icd reliance df4 ib 64cm
|
$13,314.24 |
$13,314.24 |
$13,314.24 |
$9,264.83
|
|
Ihc/icc per specimen each additional single antibody stain
|
$187.20 |
$187.20 |
$187.20 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$558.40 |
$558.40 |
$558.40 |
$331.20
|
|
Ihc/icc per specimen initial single antibody stain
|
$265.60 |
$265.60 |
$265.60 |
$277.90
|
|
Iliac/fem angio cath insert
|
$2,992.00 |
$2,992.00 |
$2,992.00 |
$1,856.01
|
|
Immob elbow child sm
|
$162.19 |
$162.19 |
$162.19 |
$85.39
|
|
Immobilizer shldr cntor adlt
|
$166.97 |
$166.97 |
$166.97 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$125.40 |
$125.40 |
$125.40 |
$118.43
|
|
Immobilizer shldr sling med
|
$160.94 |
$160.94 |
$160.94 |
$126.00
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$2,156.91 |
$2,156.91 |
$2,156.91 |
$6,106.32
|
|
Immunofluorescence per specimen initial single antibody stain
|
$288.00 |
$288.00 |
$288.00 |
$234.27
|
|
Implant cartilage 10mm synthetic
|
$5,317.60 |
$5,317.60 |
$5,317.60 |
$8,332.51
|
|
Implant cochlear osia osi300
|
$13,627.04 |
$13,627.04 |
$13,627.04 |
$16,195.55
|
|
Implant ureth bulk agent
|
$2,438.00 |
$2,438.00 |
$2,438.00 |
$2,168.00
|
|
Impl neurostim electr perc
|
$8,555.20 |
$8,555.20 |
$8,555.20 |
$7,672.50
|
|
Incise tear duct opening 68440
|
$1,439.20 |
$1,439.20 |
$1,439.20 |
$841.43
|
|
Incise tendon(s) & muscle(s)
|
$8,528.80 |
$8,528.80 |
$8,528.80 |
$7,968.80
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,894.40 |
$1,894.40 |
$1,894.40 |
$2,086.70
|
|
Incision of achilles tendon
|
$4,276.00 |
$4,276.00 |
$4,276.00 |
$3,318.90
|
|
Incision of breast lesion
|
$4,999.20 |
$4,999.20 |
$4,999.20 |
$2,577.85
|
|
Incision of burn scab initi
|
$1,541.60 |
$1,541.60 |
$1,541.60 |
$494.40
|
|
Incision of foot tendon 28234
|
$3,852.80 |
$3,852.80 |
$3,852.80 |
$2,211.05
|
|
Incision of hip tendons
|
$5,143.20 |
$5,143.20 |
$5,143.20 |
$3,865.95
|
|
Incision of spinal nerve 64772
|
$3,431.20 |
$3,431.20 |
$3,431.20 |
$2,685.07
|
|
Incision of tendon & muscle
|
$5,784.00 |
$5,784.00 |
$5,784.00 |
$5,855.00
|
|
Incision of tendon sheath
|
$2,345.60 |
$2,345.60 |
$2,345.60 |
$2,263.68
|
|
Incision of toe tendons 28011
|
$2,620.00 |
$2,620.00 |
$2,620.00 |
$2,119.12
|
|
Incision tendon sheath
|
$2,747.20 |
$2,747.20 |
$2,747.20 |
$3,073.20
|
|
Incisn of toe tndn
|
$2,482.40 |
$2,482.40 |
$2,482.40 |
$2,667.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$288.80 |
$288.80 |
$288.80 |
$296.00
|
|
Inj, abilify maintena, 1 mg
|
$2,108.40 |
$2,108.40 |
$2,108.40 |
$5,355.30
|
|
Inj, acetaminophen (b braun)
|
$50.51 |
$50.51 |
$50.51 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$51.40 |
$51.40 |
$51.40 |
$36.60
|
|
Inj, adalimumab, 1 mg
|
$2,498.37 |
$2,498.37 |
$2,498.37 |
$12,098.05
|
|
Inj, aflibercept hd, 1 mg
|
$2,692.93 |
$2,692.93 |
$2,692.93 |
$2,794.18
|
|
Inj alymsys 10 mg
|
$624.80 |
$624.80 |
$624.80 |
$1,280.74
|
|
Inj., benralizumab, 1 mg
|
$4,901.00 |
$4,901.00 |
$4,901.00 |
$11,310.00
|
|
Inj calcitriol per 0.1 mcg
|
$50.80 |
$50.80 |
$50.80 |
$22.69
|
|
Inj cefazolin sodium, hikma
|
$48.88 |
$48.88 |
$48.88 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$54.60 |
$54.60 |
$54.60 |
$69.85
|
|
Inj ceftolozane tazobactam
|
$161.00 |
$161.00 |
$161.00 |
$364.86
|
|
Inj, clevidipine butyrate
|
$104.85 |
$104.85 |
$104.85 |
$4.86
|
|
Inj, clindamycin (baxter)
|
$49.40 |
$49.40 |
$49.40 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$599.20 |
$599.20 |
$599.20 |
$436.80
|
|
Inj disk cerv-thor ea lev
|
$1,896.80 |
$1,896.80 |
$1,896.80 |
$875.28
|
|
Inj dx for sinogram
|
$662.40 |
$662.40 |
$662.40 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,712.00 |
$2,712.00 |
$2,712.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$680.00 |
$680.00 |
$680.00 |
$503.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$463.20 |
$463.20 |
$463.20 |
$458.15
|
|
Injection, doxercalciferol
|
$50.47 |
$50.47 |
$50.47 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$2,331.20 |
$2,331.20 |
$2,331.20 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,546.40 |
$1,546.40 |
$1,546.40 |
$1,182.33
|
|
Injection eye drug
|
$1,040.80 |
$1,040.80 |
$1,040.80 |
$654.00
|
|
Injection for arthrography wrist (both sides)
|
$592.00 |
$592.00 |
$592.00 |
$436.00
|
|
Injection for bladder x-ray
|
$703.20 |
$703.20 |
$703.20 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$646.40 |
$646.40 |
$646.40 |
$497.76
|
|
Injection for ureter x-ray
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$515.21
|
|
Injection into hemorrhoid(s)
|
$2,020.80 |
$2,020.80 |
$2,020.80 |
$1,433.00
|
|
Injection of sinus tract
|
$1,651.20 |
$1,651.20 |
$1,651.20 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$1,372.00 |
$1,372.00 |
$1,372.00 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,218.40 |
$1,218.40 |
$1,218.40 |
$685.44
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,776.00 |
$1,776.00 |
$1,776.00 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,110.40 |
$1,110.40 |
$1,110.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,337.60 |
$1,337.60 |
$1,337.60 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,311.20 |
$2,311.20 |
$2,311.20 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,181.60 |
$1,181.60 |
$1,181.60 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,275.20 |
$2,275.20 |
$2,275.20 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,197.60 |
$1,197.60 |
$1,197.60 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,364.80 |
$2,364.80 |
$2,364.80 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,208.00 |
$2,208.00 |
$2,208.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,133.60 |
$2,133.60 |
$2,133.60 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$543.20 |
$543.20 |
$543.20 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$706.40 |
$706.40 |
$706.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$620.00 |
$620.00 |
$620.00 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$215.20 |
$215.20 |
$215.20 |
$145.60
|
|
Injection treatment of eye
|
$3,524.00 |
$3,524.00 |
$3,524.00 |
$2,685.92
|
|
Inject sacroiliac joint
|
$1,224.80 |
$1,224.80 |
$1,224.80 |
$1,029.04
|
|
Inj, faricimab-svoa, 0.1mg
|
$2,280.19 |
$2,280.19 |
$2,280.19 |
$4,103.29
|
|
Inj for ext venography
|
$1,247.20 |
$1,247.20 |
$1,247.20 |
$628.80
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,258.40 |
$2,258.40 |
$2,258.40 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt art
|
$2,844.00 |
$2,844.00 |
$2,844.00 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$2,159.20 |
$2,159.20 |
$2,159.20 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$2,099.20 |
$2,099.20 |
$2,099.20 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$978.95 |
$978.95 |
$978.95 |
$2,452.32
|
|
Inj, invega hafyera/trinza
|
$4,668.04 |
$4,668.04 |
$4,668.04 |
$32,073.55
|
|
Inj, levothyroxine, freskabi
|
$84.86 |
$84.86 |
$84.86 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$44.79 |
$44.79 |
$44.79 |
$45.60
|
|
Inj mepivacaine hcl/10 ml
|
$51.68 |
$51.68 |
$51.68 |
$34.34
|
|
Inj, meropenem (b. braun)
|
$64.60 |
$64.60 |
$64.60 |
$71.14
|
|
Inj multihance
|
$12.00 |
$12.00 |
$12.00 |
$70.54
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,993.60 |
$1,993.60 |
$1,993.60 |
$1,413.35
|
|
Inj pantoprazole(hikma) 40mg
|
$51.04 |
$51.04 |
$51.04 |
$34.67
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$2,108.52 |
$2,108.52 |
$2,108.52 |
$6,614.40
|
