|
Infectious agent nucleic acid quantification hepatitis c
|
$47.12 |
$47.12 |
$47.12 |
$278.78
|
|
Infectious agent nucleic acid quantification hiv-1
|
$93.61 |
$93.61 |
$93.61 |
$381.55
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$156.89 |
$156.89 |
$156.89 |
$298.35
|
|
Influenza dna amp prob addl
|
$32.14 |
$32.14 |
$32.14 |
$69.60
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$28.17 |
$28.17 |
$28.17 |
$76.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$88.83 |
$88.83 |
$88.83 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$210.26 |
$210.26 |
$210.26 |
$645.79
|
|
Inj disk cerv-thor ea lev
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$869.80
|
|
Inj dupuytren cord w/enzyme
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$416.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,214.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$536.00
|
|
Injection during cath supravalvular aortography
|
$154.69 |
$154.69 |
$154.69 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,473.12
|
|
Injection eye drug
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$648.90
|
|
Injection for bladder x-ray
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$585.00
|
|
Injection for tear sac x-ray
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$386.00
|
|
Injection for ureter x-ray
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$444.95
|
|
Injection for ureter x-ray
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$515.21
|
|
Injection into brain canal
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$970.61
|
|
Injection into brain canal
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$933.60
|
|
Injection into hemorrhoid(s)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,278.72
|
|
Injection into spinal artery
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,468.18
|
|
Injection into vocal cord
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$457.30
|
|
Injection of sinus tract
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,651.20
|
|
Injection px peyronie ds
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$343.55
|
|
Injection radioactive tracer sentinel node (both sides)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$717.20
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$113.77 |
$113.77 |
$113.77 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$66.73 |
$66.73 |
$66.73 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$122.96 |
$122.96 |
$122.96 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$71.76 |
$71.76 |
$71.76 |
$141.60
|
|
Injection treatment of eye
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,698.27
|
|
Injection treatment of eye
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,698.92
|
|
Injection treatment of nerve
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,016.15
|
|
Injection treatment of nerve
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,986.00
|
|
Injection treatment of nerve
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,037.10
|
|
Injection treatment of nose
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$602.63
|
|
Inject/treat eye socket
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$365.40
|
|
Inject/treat eye socket
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$414.40
|
|
Inject/treat eye socket
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$670.02
|
|
Inj epidural sgl cerv-thor without img
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,450.84
|
|
Inj for ext venography
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$737.55
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$113.33 |
$113.33 |
$113.33 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$113.99 |
$113.99 |
$113.99 |
$947.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,901.25
|
|
Inj intralesional <= 7 lsn(s)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$241.74
|
|
Inj intralesional > 7 lsns
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$234.00
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,522.56
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,164.64
|
|
Inj peritoneal venous shunt
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$386.88
|
|
Inj proc lumbr disk ea lvl
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$922.80
|
|
Inj retro urethrocysto
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$551.29
|
|
Inj scleros sol mult veins
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$687.96
|
|
Inj scleros sol sgl vein
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$534.40
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$436.64
|
|
Inj w/fluor eval cv device
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$588.90
|
|
Ins cath ren art 1st bi
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$544.00
|
|
Insert abdomen-venous drain
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,391.00
|
|
Insert and remove bone pin
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,335.60
|
|
Insert ant drainage device
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,760.49
|
|
Insert brain-fluid device 61215
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,311.00
|
|
Insert cannula hemo oth 36815
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,983.35
|
|
Insert cannula vein-to-vein hemodialysis
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,642.90
|
|
Insert cath pleura with image
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,239.02
|
|
Insert cath pleura without image
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,212.00
|
|
Insert drug delivery implant
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$285.80
|
|
Insert eye socket implant
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,713.51
|
|
Insert hepatic shunt (tips)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$9,754.48
|
|
Insert heyman uteri capsule
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,463.96
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,706.68
|
|
Insertion catheter bladder non indwelling
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,943.21
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,618.40
|
|
Insertion of cannula
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,724.63
|
|
Insertion of catheter vein
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,749.80
|
|
Insertion of catheter vein
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$858.05
|
|
Insertion of heart electrode 33211
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$9,090.00
|
|
Insertion of infusion pump
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,907.78
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$12,813.28
|
