|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$311.17 |
$311.17 |
$311.17 |
$552.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$165.26 |
$165.26 |
$208.21 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$165.26 |
$165.26 |
$208.21 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$165.26 |
$165.26 |
$208.21 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$81.04 |
$81.04 |
$102.11 |
$141.60
|
|
Injection torsemide 10 mg/ml
|
$11.58 |
$11.58 |
$11.58 |
$16.02
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$6,452.03 |
$6,452.03 |
$6,452.03 |
$19,570.73
|
|
Inj, factor x, (human), 1iu
|
$9.99 |
$9.99 |
$9.99 |
$26.64
|
|
Inj fluphenazine hcl 1.25 mg
|
$11.81 |
$11.81 |
$11.81 |
$44.95
|
|
Inj for ext venography
|
$721.41 |
$721.41 |
$721.41 |
$737.55
|
|
Inj hydroxocobalamin IV 25mg
|
$1,019.23 |
$1,019.23 |
$1,284.14 |
$2,452.32
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$243.35 |
$243.35 |
$243.35 |
$625.00
|
|
Inj mepivacaine hcl/10 ml
|
$9.31 |
$9.31 |
$9.31 |
$30.04
|
|
Inj., meropenem, vaborbactam
|
$218.15 |
$218.15 |
$218.15 |
$566.68
|
|
Inj, moxifloxacin 100 mg
|
$56.30 |
$56.30 |
$56.30 |
$120.04
|
|
Inj multihance
|
$128.71 |
$128.71 |
$162.17 |
$119.25
|
|
Inj. mycophenolate mofetil
|
$132.12 |
$132.12 |
$132.12 |
$271.10
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$670.11 |
$670.11 |
$844.28 |
$1,522.56
|
|
Inj ogivri 10 mg
|
$108.74 |
$108.74 |
$108.74 |
$3,968.67
|
|
Inj proc myelogram lumbar
|
$324.39 |
$324.39 |
$408.70 |
$922.80
|
|
Inj proc sialogram
|
$181.04 |
$181.04 |
$181.04 |
$380.80
|
|
Inj progesterone per 50 mg
|
$36.78 |
$36.78 |
$36.78 |
$20.15
|
|
Inj, releuko 1 mcg
|
$311.22 |
$311.22 |
$392.11 |
$461.20
|
|
Inj retacrit esrd on dialysi
|
$135.07 |
$135.07 |
$170.17 |
$266.26
|
|
Inj secretin synthetic human
|
$42.45 |
$42.45 |
$42.45 |
$1,285.20
|
|
Inj testosterone cypionate
|
$90.12 |
$90.12 |
$90.12 |
$77.15
|
|
Inj, vancomycin hcl (mylan)
|
$9.99 |
$9.99 |
$37.18 |
$89.83
|
|
Inj w/fluor eval cv device
|
$543.67 |
$543.67 |
$543.67 |
$588.90
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$7,870.09 |
$7,870.09 |
$7,870.09 |
$45,841.00
|
|
Ins cath ren art 1st bi
|
$3,718.26 |
$3,718.26 |
$3,718.26 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$2,807.54 |
$2,807.54 |
$2,807.54 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$4,363.17 |
$4,363.17 |
$4,363.17 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$3,794.08 |
$3,794.08 |
$3,794.08 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$236.54 |
$236.54 |
$236.54 |
$544.00
|
|
Insert cath pleura with image
|
$359.79 |
$359.79 |
$1,558.13 |
$2,239.02
|
|
Insert cath pleura without image
|
$554.11 |
$554.11 |
$554.11 |
$2,212.00
|
|
Insertion catheter bladder non indwelling
|
$165.49 |
$165.49 |
$165.49 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$249.70 |
$249.70 |
$249.70 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$2,558.75 |
$2,558.75 |
$2,558.75 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,004.71 |
$1,004.71 |
$1,004.71 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$4,219.93 |
$4,219.93 |
$4,219.93 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,429.20 |
$1,429.20 |
$1,429.20 |
$2,618.40
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$11,445.80 |
$11,445.80 |
$11,445.80 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$10,530.08 |
$10,530.08 |
$10,530.08 |
$12,813.28
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$18,372.02 |
$18,372.02 |
$18,372.02 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,531.57 |
$1,531.57 |
$1,929.65 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,583.78 |
$1,583.78 |
$1,583.78 |
$2,527.91
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$21,578.17 |
$21,578.17 |
$21,578.17 |
$29,997.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$6,434.09 |
$6,434.09 |
$6,434.09 |
$7,572.47
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$6,151.93 |
$6,151.93 |
$6,151.93 |
$7,673.12
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$6,799.56 |
$6,799.56 |
$6,799.56 |
$9,793.46
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,056.56 |
$3,056.56 |
$3,056.56 |
$5,470.54
|
|
Insert picvad cath
|
$4,728.87 |
$4,728.87 |
$4,728.87 |
$4,490.00
|
|
Insert pm/icd lead dual
|
$6,028.67 |
$6,028.67 |
$6,028.67 |
$7,562.63
|
|
Insert/repl sq defib w/eltrd
|
$17,227.72 |
$17,227.72 |
$17,227.72 |
$33,948.20
|
|
Insert swan-ganz cath
|
$1,391.51 |
$1,391.51 |
$1,391.51 |
$2,164.52
|
|
Insert vad art access left hrt arterial access
|
$13,380.97 |
$13,380.97 |
$13,380.97 |
$5,062.80
|
|
Insitu hybridization manual
|
$107.60 |
$107.60 |
$135.57 |
$407.11
|
|
In situ hybridization per specimen each additional single probe stain
|
$106.69 |
$106.69 |
$134.42 |
$251.55
|
|
In situ hybridization per specimen initial single probe stain
|
$106.69 |
$106.69 |
$134.42 |
$338.40
|
|
Ins lv lead exist pm/icd
|
$9,147.42 |
$9,147.42 |
$9,147.42 |
$12,384.25
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$1,598.31 |
$1,598.31 |
$1,598.31 |
$1,483.95
|
|
Ins pm gen w/exist mlt leads
|
$7,961.12 |
$7,961.12 |
$7,961.12 |
$15,600.75
|
|
Ins pq tunnld ip cath w/img
|
$2,623.90 |
$2,623.90 |
$2,623.90 |
$5,593.60
|
|
Ins/rpl ldless pm right vent w img & eval
|
$10,755.49 |
$10,755.49 |
$10,755.49 |
$24,135.54
|
|
Ins/rpl pm gen exist dual lead
|
$7,637.87 |
$7,637.87 |
$7,637.87 |
$11,593.70
|
|
Ins/rpl pm w/tv ld atrl
|
$9,957.81 |
$9,957.81 |
$9,957.81 |
$12,384.25
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$25,056.72 |
$25,056.72 |
$25,056.72 |
$25,106.90
|
|
Ins tun cv cath wo subq prt/pm
|
$2,407.34 |
$2,407.34 |
$2,407.34 |
$4,748.00
|
|
Ins tun intraperit dia cath
|
$2,655.90 |
$2,655.90 |
$2,655.90 |
$4,657.46
|
|
Insulin total
|
$23.61 |
$23.61 |
$29.75 |
$67.60
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$4,293.26 |
$4,293.26 |
$4,293.26 |
$9,970.16
|
|
Integra meshed bil wound mat
|
$4,293.26 |
$4,293.26 |
$4,293.26 |
$24,354.93
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$1,501.61 |
$1,501.61 |
$1,501.61 |
$3,057.60
|
|
Interdiscal perq aspir dx
|
$703.70 |
$703.70 |
$703.70 |
$1,222.26
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$1,019.23 |
$1,019.23 |
$1,019.23 |
$5,318.40
|
|
Interrog dev eval icpms ip
|
$60.39 |
$60.39 |
$60.39 |
$106.80
|
|
Interrog device eval heart
|
$87.85 |
$87.85 |
$87.85 |
$150.00
|
|
Intracard echo interv w/s&i
|
$1,580.15 |
$1,580.15 |
$1,990.85 |
$3,982.59
|
|
Intracran angioplsty w/stent
|
$3,153.03 |
$3,153.03 |
$3,153.03 |
$11,364.78
|
|
Intracranial angioplasty
|
$1,074.62 |
$1,074.62 |
$1,074.62 |
$7,149.60
|
|
Intracranial complete study
|
$244.26 |
$244.26 |
$307.74 |
$883.30
|
|
Intracranial limited study
|
$160.16 |
$160.16 |
$160.16 |
$423.52
|
|
Intrapul surf admin endo tube
|
$190.00 |
$190.00 |
$190.00 |
$239.52
|
|
Intraventricular pacing
|
$5,710.87 |
$5,710.87 |
$5,710.87 |
$5,775.22
|
|
Intrinsic factor antibody
|
$16.12 |
$16.12 |
$20.31 |
$59.95
|
|
Intro cath dialysis circuit
|
$496.45 |
$496.45 |
$496.45 |
$2,317.80
|
|
Intro cath dialysis circuit w/pta
|
$3,475.60 |
$3,475.60 |
$3,475.60 |
$8,761.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$7,092.85 |
$7,092.85 |
$7,092.85 |
$15,625.00
|
|
Intro catheter aorta
|
$1,047.16 |
$1,047.16 |
$1,047.16 |
$1,861.61
|
|
Intro cath svc/ivc
|
$407.24 |
$407.24 |
$407.24 |
$1,350.75
|
|
Intro long gi tube
|
$508.71 |
$508.71 |
$640.93 |
$1,036.00
|
|
Intro long gi tube w/mult fluo
|
$228.37 |
$228.37 |
$287.72 |
$477.85
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$1,285.96 |
$1,285.96 |
$1,285.96 |
$3,510.75
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$1,102.09 |
$1,102.09 |
$1,102.09 |
$1,825.16
|
|
Intubation endotracheal emergency procedure
|
$431.53 |
$431.53 |
$570.86 |
$617.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$152.32 |
$152.32 |
$191.91 |
$147.60
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$325.52 |
$325.52 |
$410.13 |
$148.28
|
|
Ioxaglate 39.3%-19.6% inj 200 ml
|
$805.40 |
$805.40 |
$1,014.73 |
$1,014.73
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$12,258.00 |
$12,258.00 |
$12,258.00 |
$52,277.70
|