|
Injection, isavuconazonium
|
$783.60 |
$783.60 |
$783.60 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$2,987.40 |
$2,987.40 |
$2,987.40 |
$2,277.65
|
|
Injection, renflexis
|
$216.00 |
$216.00 |
$216.00 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$472.20 |
$472.20 |
$472.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,544.40 |
$1,544.40 |
$1,544.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$291.00 |
$291.00 |
$291.00 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$480.60 |
$480.60 |
$480.60 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$165.60 |
$165.60 |
$165.60 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$465.60 |
$465.60 |
$465.60 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$165.60 |
$165.60 |
$165.60 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$465.60 |
$465.60 |
$465.60 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,967.40 |
$1,967.40 |
$1,967.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,408.80 |
$1,408.80 |
$1,408.80 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$171.60 |
$171.60 |
$171.60 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$171.60 |
$171.60 |
$171.60 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$596.40 |
$596.40 |
$596.40 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$60.00 |
$60.00 |
$60.00 |
$145.60
|
|
Inj epidural sgl cerv-thor without img
|
$1,515.60 |
$1,515.60 |
$1,515.60 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,845.60 |
$1,845.60 |
$1,845.60 |
$1,450.84
|
|
Inj, factor x, (human), 1iu
|
$30.60 |
$30.60 |
$30.60 |
$26.74
|
|
Inj, focinvez, 1mg
|
$5.40 |
$5.40 |
$5.40 |
$3.63
|
|
Inj for ext venography
|
$201.00 |
$201.00 |
$201.00 |
$628.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$6.00 |
$6.00 |
$1,322.20
|
|
Inj imip 4 cilas 4 releb 2mg
|
$4.80 |
$4.80 |
$4.80 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$822.60 |
$822.60 |
$822.60 |
$70,014.65
|
|
Inj ivig privigen 500 mg
|
$266.40 |
$266.40 |
$266.40 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$199.20 |
$199.20 |
$199.20 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$0.07 |
$0.07 |
$0.07 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$102.00 |
$102.00 |
$102.00 |
$794.70
|
|
Inj mepivacaine hcl/10 ml
|
$11.40 |
$11.40 |
$11.40 |
$34.34
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$579.20 |
$579.20 |
$579.20 |
$8,304.04
|
|
Inj multihance
|
$31.80 |
$31.80 |
$31.80 |
$70.54
|
|
Inj naloxone hydrochloride
|
$78.60 |
$78.60 |
$78.60 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,092.80 |
$2,092.80 |
$2,092.80 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$3.60 |
$3.60 |
$3.60 |
$468.10
|
|
Inj nivolumab 2 mg hyaluron
|
$45.60 |
$45.60 |
$45.60 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$5,322.00 |
$5,322.00 |
$5,322.00 |
$2,881.20
|
|
Inj ogivri 10 mg
|
$242.40 |
$242.40 |
$242.40 |
$4,492.28
|
|
Inj. pemetrexed, 10 mg
|
$147.60 |
$147.60 |
$147.60 |
$104.72
|
|
Inj., plazomicin, 5 mg
|
$81.00 |
$81.00 |
$81.00 |
$607.16
|
|
Inj proc elbow arthro
|
$201.00 |
$201.00 |
$201.00 |
$432.00
|
|
Inj proc myelogram lumbar
|
$1,733.40 |
$1,733.40 |
$1,733.40 |
$838.30
|
|
Inj retro urethrocysto
|
$201.00 |
$201.00 |
$201.00 |
$447.74
|
|
Inj scleros sol mult veins
|
$1,074.60 |
$1,074.60 |
$1,074.60 |
$692.90
|
|
Inj scleros sol sgl vein
|
$1,348.20 |
$1,348.20 |
$1,348.20 |
$561.88
|
|
Inj secukinumab intrav 1mg
|
$31.80 |
$31.80 |
$31.80 |
$4,413.21
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$12.00 |
$12.00 |
$12.00 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$263.40 |
$263.40 |
$263.40 |
$256.14
|
|
Inj. teprotumumab-trbw 10 mg
|
$724.80 |
$724.80 |
$724.80 |
$35,034.78
|
|
Inj testosterone cypionate
|
$0.80 |
$0.80 |
$0.80 |
$64.96
|
|
Inj thrc fascial pln blk bi w/wo image
|
$127.20 |
$127.20 |
$127.20 |
$1,049.50
|
|
Inj thrc fascial pln blk uni w/wo image
|
$113.40 |
$113.40 |
$113.40 |
$818.00
|
|
Inj., tildrakizumab, 1 mg
|
$408.00 |
$408.00 |
$408.00 |
$26,635.60
|
|
Inj, tislelizumab-jsgr
|
$97.20 |
$97.20 |
$97.20 |
$9,764.09
|
|
Inj, tyenne, 1 mg
|
$12.00 |
$12.00 |
$12.00 |
$3,525.12
|
|
Inj, vancomycin hcl (mylan)
|
$19.80 |
$19.80 |
$19.80 |
$72.33
|
|
Inj w/fluor eval cv device
|
$43.20 |
$43.20 |
$43.20 |
$504.40
|
|
Ins cath ren art 1st bi
|
$3,860.40 |
$3,860.40 |
$3,860.40 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$3,860.40 |
$3,860.40 |
$3,860.40 |
$4,667.63
|
|
Ins cath ren art 2nd+ uni
|
$3,860.40 |
$3,860.40 |
$3,860.40 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$2,661.00 |
$2,661.00 |
$2,661.00 |
$490.73
|
|
Insert and remove bone pin
|
$4,335.60 |
$4,335.60 |
$4,335.60 |
$4,433.36
|
|
Insert cath pleura with image
|
$349.80 |
$349.80 |
$349.80 |
$2,194.40
|
|
Insert cath pleura without image
|
$360.60 |
$360.60 |
$360.60 |
$2,099.70
|
|
Insert drug delivery implant
|
$1,182.60 |
$1,182.60 |
$1,182.60 |
$280.00
|
|
Insert intrauterine device iud
|
$148.20 |
$148.20 |
$148.20 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$42.00 |
$42.00 |
$42.00 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$6,456.00 |
$6,456.00 |
$6,456.00 |
$4,897.20
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$3,302.40 |
$3,302.40 |
$3,302.40 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$712.20 |
$712.20 |
$712.20 |
$2,585.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$11,075.40 |
$11,075.40 |
$11,075.40 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$9,196.20 |
$9,196.20 |
$9,196.20 |
$12,324.60
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$712.20 |
$712.20 |
$712.20 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,984.80 |
$1,984.80 |
$1,984.80 |
$2,453.83
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$28,629.60 |
$28,629.60 |
$28,629.60 |
$29,180.00
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$4,527.00 |
$4,527.00 |
$4,527.00 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$5,261.40 |
$5,261.40 |
$5,261.40 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$2,197.80 |
$2,197.80 |
$2,197.80 |
$5,236.80
|
|
Insert swan-ganz cath
|
$1,025.40 |
$1,025.40 |
$1,025.40 |
$2,164.52
|
|
In situ hybridization per specimen each additional single probe stain
|
$270.60 |
$270.60 |
$270.60 |
$243.50
|
|
In situ hybridization per specimen initial single probe stain
|
$211.80 |
$211.80 |
$211.80 |
$338.40
|
|
Ins mark abd/pel for right perq
|
$4,664.40 |
$4,664.40 |
$4,664.40 |
$2,477.24
|
|
Ins picad w subq port 5yr>
|
$1,719.60 |
$1,719.60 |
$1,719.60 |
$4,078.00
|
|
Ins pq tunnld ip cath w/img
|
$1,980.00 |
$1,980.00 |
$1,980.00 |
$5,486.00
|
|
Ins/rpl pm w/tv ld atrl
|
$9,196.20 |
$9,196.20 |
$9,196.20 |
$11,583.66
|
|
Ins tun cvad 2 cath w/subq port(s)
|
$4,723.80 |
$4,723.80 |
$4,723.80 |
$7,826.00
|
|
Ins tun cv cath wo subq prt/pm
|
$1,719.60 |
$1,719.60 |
$1,719.60 |
$4,218.00
|
|
Ins tun intraperit dia cath
|
$2,823.60 |
$2,823.60 |
$2,823.60 |
$4,570.00
|
|
Insulin total
|
$27.60 |
$27.60 |
$27.60 |
$66.64
|
|
Interdiscal perq aspir dx
|
$408.60 |
$408.60 |
$408.60 |
$1,222.26
|
|
Interferon alfa-2b inj
|
$44.40 |
$44.40 |
$44.40 |
$1,409.92
|
|
Interrog evl pm/ldls pm ip
|
$86.40 |
$86.40 |
$86.40 |
$127.20
|
|
Intraoral i+d tongue/floor lingual 41000
|
$2,865.00 |
$2,865.00 |
$2,865.00 |
$1,331.45
|
|
Intrinsic factor antibody
|
$36.60 |
$36.60 |
$36.60 |
$65.00
|
|
Intro cath dialysis circuit
|
$925.20 |
$925.20 |
$925.20 |
$2,036.94
|
|
Intro cath dialysis circuit w/pta
|
$6,529.20 |
$6,529.20 |
$6,529.20 |
$8,690.50
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$13,197.00 |
$13,197.00 |
$13,197.00 |
$16,262.40
|
|
Intubation endotracheal emergency procedure
|
$152.40 |
$152.40 |
$152.40 |
$601.28
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$3.60 |
$3.60 |
$3.60 |
$165.67
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$24.00 |
$24.00 |
$24.00 |
$279.10
|
