|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$97.60 |
$97.60 |
$97.60 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$57.24 |
$57.24 |
$57.24 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$105.48 |
$105.48 |
$105.48 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$61.56 |
$61.56 |
$61.56 |
$141.60
|
|
Injection treatment of eye
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,698.27
|
|
Injection treatment of eye
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,698.92
|
|
Injection treatment of nerve
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,016.15
|
|
Injection treatment of nerve
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,986.00
|
|
Injection treatment of nerve
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,037.10
|
|
Injection treatment of nose
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$602.63
|
|
Inject/treat eye socket
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$365.40
|
|
Inject/treat eye socket
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$414.40
|
|
Inject/treat eye socket
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$670.02
|
|
Inj epidural sgl cerv-thor without img
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,450.84
|
|
Inj for ext venography
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$737.55
|
|
Inj for mammo ductogram
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$433.50
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$97.22 |
$97.22 |
$97.22 |
$1,482.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$422.32 |
$422.32 |
$422.32 |
$1,837.17
|
|
Inj hrt cath w/s&i sel hrt art
|
$142.27 |
$142.27 |
$142.27 |
$1,192.50
|
|
Inj hrt cath w/s&i sel left vent
|
$98.35 |
$98.35 |
$98.35 |
$1,214.40
|
|
Inj hrt cath w/s&i sel right vent
|
$97.79 |
$97.79 |
$97.79 |
$947.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,901.25
|
|
Inj intralesional <= 7 lsn(s)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$241.74
|
|
Inj intralesional > 7 lsns
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$234.00
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,522.56
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,164.64
|
|
Inj proc myelogram lumbar
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$922.80
|
|
Inj proc sialogram
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$380.80
|
|
Inj scleros sol mult veins
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$687.96
|
|
Inj scleros sol sgl vein
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$534.40
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$436.64
|
|
Inj w/fluor eval cv device
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$588.90
|
|
Ins cath ren art 1st bi
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$544.00
|
|
Insert and remove bone pin
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,335.60
|
|
Insert ant drainage device
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,760.49
|
|
Insert brain-fluid device 61215
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,311.00
|
|
Insert cannula hemo oth 36815
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,983.35
|
|
Insert cannula vein-to-vein hemodialysis
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,642.90
|
|
Insert cath pleura with image
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,239.02
|
|
Insert cath pleura without image
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,212.00
|
|
Insert drug delivery implant
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$285.80
|
|
Insert eye socket implant
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,713.51
|
|
Insert hepatic shunt (tips)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$9,754.48
|
|
Insert heyman uteri capsule
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,463.96
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,706.68
|
|
Insertion catheter bladder non indwelling
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,943.21
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,618.40
|
|
Insertion of cannula
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,724.63
|
|
Insertion of catheter vein
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$858.05
|
|
Insertion of heart electrode 33211
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$9,090.00
|
|
Insertion of infusion pump
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,907.78
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$12,813.28
|
|
Insertion palate prosthesis
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,311.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,527.91
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$29,997.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,572.47
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,673.12
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$9,793.46
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,470.54
|
|
Insertion ureth cath
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,424.12
|
|
Insert lens prosthesis
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,333.13
|
|
Insert multi-comp penis pros
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$16,482.71
|
|
Insert nasal septal button
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,752.89
|
|
Insert ocular implant
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,173.97
|
|
Insert ocular implant
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,177.59
|
|
Insert pessary/other device
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$278.90
|
|
Insert picvad cath
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,490.00
|
|
Insert pm/icd lead dual
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,562.63
|
|
Insert prost urethral stent
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,424.12
|
|
Insert/repl sq defib w/eltrd
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$33,948.20
|
|
Insert self-contd prosthesis
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$9,754.56
|
|
Insert semi-rigid prosthesis
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$10,037.15
|
|
Insert spine infusion device 62360
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,531.84
|
|
Insert sq defib electrode
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$8,167.68
|
|
Insert swan-ganz cath
|
$897.01 |
$897.01 |
$897.01 |
$2,164.52
|
|
Insert tandem cuff
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$9,445.19
|
|
Insert tissue expander(s)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,052.18
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,705.13
|
|
Insert tunneled cv cath
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,520.00
|
|
Insert tunneled cv cath
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,028.07
|
|
Insert uro/ves nck sphincter
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$9,417.14
|
|
Insert uteri tandem/ovoids
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,986.00
|
|
Ins icd gen exist mlt leads
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$31,286.77
|
|
Ins icd gen exist sgl lead
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$24,159.72
|
|
Insj phrnc nrv stim sys
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$53,251.79
|
|
Insj rx elut implt lac canal
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,582.26
|
|
Insj stablj dev w/dcmprn
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$16,139.55
|
|
Insj stablj dev without dcmprn
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$15,226.08
|
