|
Injection for arthrography wrist (both sides)
|
$132.00 |
$132.00 |
$132.00 |
$441.12
|
|
Injection for bladder x-ray
|
$121.20 |
$121.20 |
$121.20 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$109.92 |
$109.92 |
$109.92 |
$494.65
|
|
Injection, fulvestrant
|
$1,151.80 |
$1,151.80 |
$1,151.80 |
$1,719.16
|
|
Injection glatiramer acetate
|
$108.24 |
$108.24 |
$108.24 |
$830.51
|
|
Injection radioactive tracer sentinel node (both sides)
|
$182.64 |
$182.64 |
$182.64 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$451.44 |
$451.44 |
$451.44 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$204.96 |
$204.96 |
$204.96 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$506.16 |
$506.16 |
$506.16 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$425.28 |
$425.28 |
$425.28 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$425.28 |
$425.28 |
$425.28 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$453.84 |
$453.84 |
$453.84 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$169.92 |
$169.92 |
$169.92 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$142.56 |
$142.56 |
$142.56 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$193.44 |
$193.44 |
$193.44 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$92.88 |
$92.88 |
$92.88 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$92.88 |
$92.88 |
$92.88 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$192.00 |
$192.00 |
$192.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$80.88 |
$80.88 |
$80.88 |
$135.20
|
|
Inj epidural sgl lumb-sacral without img
|
$199.68 |
$199.68 |
$199.68 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$1,462.95 |
$1,462.95 |
$1,462.95 |
$6.24
|
|
Inj, fosaprepitant (teva)
|
$47.54 |
$47.54 |
$47.54 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$610.57 |
$610.57 |
$610.57 |
$1,065.08
|
|
Inj gemcitabine hcl (accord)
|
$69.68 |
$69.68 |
$69.68 |
$113.90
|
|
Inj glycopyrrolate fres kabi
|
$14.62 |
$14.62 |
$14.62 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$10.37 |
$10.37 |
$10.37 |
$24.28
|
|
Inj, idacio, 1 mg
|
$598.80 |
$598.80 |
$598.80 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$133.68 |
$133.68 |
$133.68 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$5.25 |
$5.25 |
$5.25 |
$40.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$4,063.04 |
$4,063.04 |
$4,063.04 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$114.70 |
$114.70 |
$114.70 |
$103.60
|
|
Inj, linezolid (hospira)
|
$108.00 |
$108.00 |
$108.00 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$689.45 |
$689.45 |
$689.45 |
$2,375.23
|
|
Inj, meropenem (b. braun)
|
$49.81 |
$49.81 |
$49.81 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$52.05 |
$52.05 |
$52.05 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$65.00 |
$65.00 |
$65.00 |
$89.40
|
|
Inj, moxifloxacin 100 mg
|
$73.35 |
$73.35 |
$73.35 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$120.72 |
$120.72 |
$120.72 |
$252.66
|
|
Inj naloxone hydrochloride
|
$66.44 |
$66.44 |
$66.44 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$219.84 |
$219.84 |
$219.84 |
$1,414.40
|
|
Inj pantoprazole(hikma) 40mg
|
$21.90 |
$21.90 |
$21.90 |
$34.61
|
|
Inj pemetrexed (accord) 10mg
|
$695.72 |
$695.72 |
$695.72 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$33.05 |
$33.05 |
$33.05 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$1,057.33 |
$1,057.33 |
$1,057.33 |
$200.85
|
|
Inj proc ankle arthr
|
$108.48 |
$108.48 |
$108.48 |
$405.31
|
|
Inj proc elbow arthro
|
$108.48 |
$108.48 |
$108.48 |
$432.00
|
|
Inj proc myelogram lumbar
|
$251.04 |
$251.04 |
$251.04 |
$856.00
|
|
Inj progesterone per 50 mg
|
$52.87 |
$52.87 |
$52.87 |
$14.93
|
|
Inj retro urethrocysto
|
$121.20 |
$121.20 |
$121.20 |
$450.00
|
|
Inj romidepsin non-lyo 0.1mg
|
$5,300.68 |
$5,300.68 |
$5,300.68 |
$9,892.69
|
|
Inj testostero enanthate 1mg
|
$196.95 |
$196.95 |
$196.95 |
$157.81
|
|
Inj testosterone cypionate
|
$260.52 |
$260.52 |
$260.52 |
$62.80
|
|
Inj. tigecycline (accord)
|
$208.53 |
$208.53 |
$208.53 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$70.54 |
$70.54 |
$70.54 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$24.48 |
$24.48 |
$24.48 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$41.61 |
$41.61 |
$41.61 |
$40.24
|
|
Inj w/fluor eval cv device
|
$168.72 |
$168.72 |
$168.72 |
$463.40
|
|
Ins cerv dilator (sep proc)
|
$204.72 |
$204.72 |
$204.72 |
$488.35
|
|
Insert cath pleura with image
|
$470.16 |
$470.16 |
$470.16 |
$2,194.40
|
|
Insert cath pleura without image
|
$484.56 |
$484.56 |
$484.56 |
$2,019.00
|
|
Insertion catheter bladder non indwelling
|
$54.00 |
$54.00 |
$54.00 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$54.00 |
$54.00 |
$54.00 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$4,731.80
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$1,903.20 |
$1,903.20 |
$1,903.20 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,626.72 |
$1,626.72 |
$1,626.72 |
$2,511.00
|
|
Insertion of heart electrode 33211
|
$4,355.76 |
$4,355.76 |
$4,355.76 |
$7,392.84
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$413.52 |
$413.52 |
$413.52 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$525.12 |
$525.12 |
$525.12 |
$2,414.10
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$4,732.32 |
$4,732.32 |
$4,732.32 |
$7,513.67
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$6,224.64 |
$6,224.64 |
$6,224.64 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$4,610.16 |
$4,610.16 |
$4,610.16 |
$5,236.80
|
|
Insert swan-ganz cath
|
$1,186.80 |
$1,186.80 |
$1,186.80 |
$2,210.50
|
|
Insitu hybridization auto
|
$198.72 |
$198.72 |
$198.72 |
$371.00
|
|
Insitu hybridization manual
|
$119.76 |
$119.76 |
$119.76 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$83.28 |
$83.28 |
$83.28 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$386.64 |
$386.64 |
$386.64 |
$326.04
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$591.12 |
$591.12 |
$591.12 |
$1,609.25
|
|
Ins pq tunnld ip cath w/img
|
$1,886.88 |
$1,886.88 |
$1,886.88 |
$5,377.00
|
|
Instillation anticarcinogenic agent bladder
|
$192.24 |
$192.24 |
$192.24 |
$621.40
|
|
Ins tun cv cath wo subq prt/pm
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$4,202.70
|
|
Insulin total
|
$44.88 |
$44.88 |
$44.88 |
$66.64
|
|
Interrog evl pm/ldls pm ip
|
$32.64 |
$32.64 |
$32.64 |
$124.80
|
|
Intrinsic factor antibody
|
$160.08 |
$160.08 |
$160.08 |
$66.60
|
|
Intro long gi tube w/mult fluo
|
$108.96 |
$108.96 |
$108.96 |
$449.40
|
|
Intubation endotracheal emergency procedure
|
$284.64 |
$284.64 |
$284.64 |
$589.60
|
|
Iodine i-123 sod iodide mil
|
$336.71 |
$336.71 |
$336.71 |
$350.74
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$67.50 |
$67.50 |
$67.50 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$251.37 |
$251.37 |
$251.37 |
$279.10
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$76.59 |
$76.59 |
$76.59 |
$163.87
|
|
Iron
|
$281.76 |
$281.76 |
$281.76 |
$74.40
|
|
Iron binding capacity
|
$48.00 |
$48.00 |
$48.00 |
$63.79
|
|
Irrigation implantable venous access device for drug delivery systems
|
$45.84 |
$45.84 |
$45.84 |
$142.20
|
|
Ivc venogram s&i
|
$1,363.20 |
$1,363.20 |
$1,363.20 |
$3,316.95
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$100.32 |
$100.32 |
$100.32 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$62.88 |
$62.88 |
$62.88 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$66.48 |
$66.48 |
$66.48 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$302.40 |
$302.40 |
$302.40 |
$439.56
|
|
Ivp w/nephrotomography
|
$433.44 |
$433.44 |
$433.44 |
$790.08
|
|
Ivp w/wo kub w/wo tomography
|
$433.44 |
$433.44 |
$433.44 |
$692.18
|
|
Jak2 targeted sequence analysis
|
$149.76 |
$149.76 |
$149.76 |
$379.87
|
