|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$750.75 |
$750.75 |
$750.75 |
$1,165.32
|
|
Injection carpal tunnel therapeutic (both sides)
|
$44.20 |
$44.20 |
$44.20 |
$441.60
|
|
Injection, daratumumab 10 mg
|
$2,161.54 |
$2,161.54 |
$2,161.54 |
$85.20
|
|
Injection epidural blood patch or clot
|
$600.60 |
$600.60 |
$600.60 |
$1,470.60
|
|
Injection, fulvestrant
|
$268.45 |
$268.45 |
$268.45 |
$166.25
|
|
Injection, inclisiran, 1 mg
|
$9,094.90 |
$9,094.90 |
$9,094.90 |
$12.72
|
|
Injection, renflexis
|
$1,975.76 |
$1,975.76 |
$1,975.76 |
$632.98
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$16,806.73 |
$16,806.73 |
$16,806.73 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$728.00 |
$728.00 |
$728.00 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,548.95 |
$1,548.95 |
$1,548.95 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,973.16 |
$1,973.16 |
$1,973.16 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,973.16 |
$1,973.16 |
$1,973.16 |
$1,985.61
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,277.91 |
$2,277.91 |
$2,277.91 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,277.36 |
$2,277.36 |
$2,277.36 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,730.32 |
$2,730.32 |
$2,730.32 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,212.27 |
$2,212.27 |
$2,212.27 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$183.95 |
$183.95 |
$183.95 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$365.30 |
$365.30 |
$365.30 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$314.60 |
$314.60 |
$314.60 |
$654.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$150.15 |
$150.15 |
$150.15 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$150.15 |
$150.15 |
$150.15 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$92.95 |
$92.95 |
$92.95 |
$130.19
|
|
Inj epidural sgl lumb-sacral without img
|
$14,348.33 |
$14,348.33 |
$14,348.33 |
$1,260.60
|
|
Inj., guselkumab, 1 mg
|
$39,972.36 |
$39,972.36 |
$39,972.36 |
$74.86
|
|
Inj herzuma 10 mg
|
$7,987.52 |
$7,987.52 |
$7,987.52 |
$77.49
|
|
Inj intralesional <= 7 lsn(s)
|
$23.40 |
$23.40 |
$23.40 |
$238.77
|
|
Inj intralesional > 7 lsns
|
$180.05 |
$180.05 |
$180.05 |
$222.75
|
|
Inj, invega hafyera/trinza
|
$26,725.80 |
$26,725.80 |
$26,725.80 |
$12.96
|
|
Inj ivig privigen 500 mg
|
$2,408.50 |
$2,408.50 |
$2,408.50 |
$6,144.00
|
|
Inj, lecanemab-irmb, 1 mg
|
$703.46 |
$703.46 |
$703.46 |
$1.33
|
|
Inj multihance
|
$94.51 |
$94.51 |
$94.51 |
$86.40
|
|
Inj ogivri 10 mg
|
$2,464.71 |
$2,464.71 |
$2,464.71 |
$91.01
|
|
Inj ontruzant 10 mg
|
$3,468.49 |
$3,468.49 |
$3,468.49 |
$34.96
|
|
Inj., patisiran, 0.1 mg
|
$25,575.35 |
$25,575.35 |
$25,575.35 |
$36,180.04
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$9,568.48 |
$9,568.48 |
$9,568.48 |
$1,695.87
|
|
Inj, releuko 1 mcg
|
$826.80 |
$826.80 |
$826.80 |
$775.12
|
|
Inj teclistamab cqyv 0.5 mg
|
$28,316.68 |
$28,316.68 |
$28,316.68 |
$33.27
|
|
Inj. teprotumumab-trbw 10 mg
|
$48,926.93 |
$48,926.93 |
$48,926.93 |
$359.09
|
|
Inj, tofidence, 1 mg
|
$1,167.32 |
$1,167.32 |
$1,167.32 |
$1,167.32
|
|
Inj, tyenne, 1 mg
|
$1,030.61 |
$1,030.61 |
$1,030.61 |
$12.60
|
|
Inj, vegzelma, 10 mg
|
$1,777.20 |
$1,777.20 |
$1,777.20 |
$43.62
|
|
Insertion catheter bladder non indwelling
|
$217.75 |
$217.75 |
$217.75 |
$230.40
|
|
Insertion catheter bladder temporary simple
|
$17,849.01 |
$17,849.01 |
$17,849.01 |
$245.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$641.55 |
$641.55 |
$641.55 |
$2,457.24
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
$2,079.43
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$793.65 |
$793.65 |
$793.65 |
$7,513.67
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$7,315.66 |
$7,315.66 |
$7,315.66 |
$5,423.04
|
|
Insert pessary/other device
|
$156.65 |
$156.65 |
$156.65 |
$277.99
|
|
Insitu hybridization auto
|
$319.80 |
$319.80 |
$319.80 |
$328.79
|
|
Insitu hybridization manual
|
$414.05 |
$414.05 |
$414.05 |
$407.11
|
|
In situ hybridization per specimen each additional single probe stain
|
$269.75 |
$269.75 |
$269.75 |
$291.00
|
|
In situ hybridization per specimen initial single probe stain
|
$289.25 |
$289.25 |
$289.25 |
$364.00
|
|
Ins tun cv cath wo subq prt/pm
|
$1,554.15 |
$1,554.15 |
$1,554.15 |
$5,324.80
|
|
Ins tun cv cath wo subq prt/pm
|
$1,372.80 |
$1,372.80 |
$1,372.80 |
$4,314.75
|
|
Insulin total
|
$92.95 |
$92.95 |
$92.95 |
$72.15
|
|
Intranasal biopsy 30100
|
$53.30 |
$53.30 |
$53.30 |
$1,618.86
|
|
Intrauterine transfusion ftl
|
$1,004.25 |
$1,004.25 |
$1,004.25 |
$1,004.25
|
|
Intrinsic factor antibody
|
$97.50 |
$97.50 |
$97.50 |
$76.77
|
|
Intubation endotracheal emergency procedure
|
$700.05 |
$700.05 |
$700.05 |
$565.00
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$210.01 |
$210.01 |
$210.01 |
$4.59
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$279.10 |
$279.10 |
$279.10 |
$145.52
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$96,539.94 |
$96,539.94 |
$96,539.94 |
$261.10
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$304.21 |
$304.21 |
$304.21 |
$254.59
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$7,984.64 |
$7,984.64 |
$7,984.64 |
$111.98
|
|
Iron
|
$83.20 |
$83.20 |
$83.20 |
$67.50
|
|
Iron binding capacity
|
$83.20 |
$83.20 |
$83.20 |
$55.00
|
|
Iron dextran 50 mg/ml injection solution
|
$31.81 |
$31.81 |
$31.81 |
$38.16
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$211.09 |
$211.09 |
$211.09 |
$211.09
|
|
Irradiation of blood product each unit reference
|
$85.80 |
$85.80 |
$85.80 |
$127.49
|
|
Irrigation implantable venous access device for drug delivery systems
|
$140.40 |
$140.40 |
$140.40 |
$149.00
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$2,427.96 |
$2,427.96 |
$2,427.96 |
$82.86
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$185.90 |
$185.90 |
$185.90 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$185.90 |
$185.90 |
$185.90 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$185.90 |
$185.90 |
$185.90 |
$476.50
|
|
Ivp w/wo kub w/wo tomography
|
$685.75 |
$685.75 |
$685.75 |
$687.80
|
|
John cunningham antibody
|
$1,164.15 |
$1,164.15 |
$1,164.15 |
$39.65
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$72.15 |
$72.15 |
$72.15 |
$52.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$21.22 |
$21.22 |
$21.22 |
$17.11
|
|
Kidney img w/bldflw sgl without rx
|
$1,195.35 |
$1,195.35 |
$1,195.35 |
$1,425.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$750.75 |
$750.75 |
$750.75 |
$618.54
|
|
Knee arthroscopy/surgery
|
$10,888.27 |
$10,888.27 |
$10,888.27 |
$3,594.44
|
|
Knee arthroscopy/surgery
|
$10,888.27 |
$10,888.27 |
$10,888.27 |
$3,743.15
|
|
Knee MRI (with and without contrast)
|
$4,221.75 |
$4,221.75 |
$4,221.75 |
$2,703.85
|
|
Knee MRI (with contrast)
|
$2,406.30 |
$2,406.30 |
$2,406.30 |
$2,315.95
|
|
Knee MRI (without contrast)
|
$3,703.05 |
$3,703.05 |
$3,703.05 |
$2,120.00
|
|
Knee X-ray
|
$669.50 |
$669.50 |
$669.50 |
$387.20
|
|
Kras gene addl variants
|
$328.25 |
$328.25 |
$328.25 |
$366.56
|
|
Kras gene variants exon 2
|
$684.45 |
$684.45 |
$684.45 |
$495.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$13.00 |
$13.00 |
$13.00 |
$13.00
|
|
Lactate dehydrogenase (ldh)
|
$73.45 |
$73.45 |
$73.45 |
$50.55
|
|
Lactated ringers intravenous solution
|
$40.30 |
$40.30 |
$40.30 |
$46.35
|
|
Lactic acid
|
$193.70 |
$193.70 |
$193.70 |
$85.20
|
|
Lactoferrin fecal qualitative
|
$107.90 |
$107.90 |
$107.90 |
$88.40
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$25,990.82 |
$25,990.82 |
$25,990.82 |
$21,470.76
|
|
Laparoscopy excise lesions
|
$7,920.91 |
$7,920.91 |
$7,920.91 |
$5,747.73
|
|
Laparoscopy remove adnexa
|
$10,071.76 |
$10,071.76 |
$10,071.76 |
$6,672.53
|
|
Lap ing hernia repair init
|
$14,531.57 |
$14,531.57 |
$14,531.57 |
$6,457.82
|
|
Lap ing hernia repair recur
|
$14,069.81 |
$14,069.81 |
$14,069.81 |
$6,376.26
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$768.30 |
$768.30 |
$768.30 |
$2,480.71
|
|
Laryngoscopy telescopic
|
$677.30 |
$677.30 |
$677.30 |
$685.43
|
