|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,024.00 |
$3,024.00 |
$3,024.00 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$3,400.80 |
$3,400.80 |
$3,400.80 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,590.00 |
$4,590.00 |
$4,590.00 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,250.00 |
$2,250.00 |
$3,505.50 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,362.80 |
$2,362.80 |
$3,498.90 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$985.80 |
$985.80 |
$7,342.14 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,174.80 |
$1,233.60 |
$1,233.60 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,174.80 |
$1,233.60 |
$1,233.60 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$251.40 |
$251.40 |
$251.40 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$117.00 |
$117.00 |
$117.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$224.40 |
$224.40 |
$224.40 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$306.00 |
$306.00 |
$31,382.37 |
$135.20
|
|
Inject sacroiliac joint
|
$751.20 |
$751.20 |
$1,159.80 |
$963.00
|
|
Inject/treat eye socket
|
$2,624.40 |
$2,624.40 |
$2,624.40 |
$381.13
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$69,502.20 |
$69,502.20 |
$69,502.20 |
$32,176.93
|
|
Inj epidural sgl lumb-sacral without img
|
$1,666.20 |
$1,666.20 |
$1,666.20 |
$1,415.50
|
|
Inj for ext venography
|
$414.60 |
$414.60 |
$414.60 |
$654.00
|
|
Inj for mammo ductogram
|
$294.60 |
$618.60 |
$618.60 |
$433.50
|
|
Inj herzuma 10 mg
|
$15,575.94 |
$15,575.94 |
$15,575.94 |
$7,775.46
|
|
Inj hydroxocobalamin IV 25mg
|
$3,835.68 |
$3,835.68 |
$3,835.68 |
$2,452.32
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$865.80 |
$865.80 |
$865.80 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$408.00 |
$408.00 |
$408.00 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$8,288.40 |
$8,288.40 |
$8,288.40 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$163.32 |
$163.32 |
$175.44 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$56.04 |
$1,086.18 |
$2,217.24 |
$363.97
|
|
Inj, lidocaine w epinephrine
|
$38.46 |
$106.08 |
$106.08 |
$44.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$2,190.00 |
$2,190.00 |
$2,190.00 |
$783.50
|
|
Inj melpha hydroch nos 50 mg
|
$2,316.84 |
$2,316.84 |
$2,316.84 |
$2,375.23
|
|
Inj mepivacaine hcl/10 ml
|
$6.00 |
$6.00 |
$6.00 |
$33.86
|
|
Inj meropenem (wg crit care)
|
$138.18 |
$138.18 |
$138.18 |
$77.97
|
|
Inj multihance
|
$108.00 |
$108.00 |
$108.00 |
$79.42
|
|
Inj. mycophenolate mofetil
|
$453.54 |
$453.54 |
$487.20 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,496.40 |
$1,496.40 |
$1,496.40 |
$1,414.40
|
|
Inj, nithiodote, 3mg / 125mg
|
$1,488.96 |
$1,488.96 |
$1,488.96 |
$452.89
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,881.20 |
$2,881.20 |
$2,881.20 |
$2,485.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,881.20 |
$2,881.20 |
$2,881.20 |
$2,431.74
|
|
Inj octafluoropropane mic,ml
|
$122.40 |
$122.40 |
$122.40 |
$211.40
|
|
Inj ogivri 10 mg
|
$13,387.80 |
$13,387.80 |
$13,545.30 |
$4,492.28
|
|
Inj peritoneal venous shunt
|
$406.80 |
$406.80 |
$406.80 |
$406.80
|
|
Inj proc ankle arthr
|
$136.80 |
$286.80 |
$286.80 |
$405.31
|
|
Inj proc elbow arthro
|
$166.80 |
$350.40 |
$350.40 |
$432.00
|
|
Inj proc for lymphang
|
$2,300.40 |
$2,300.40 |
$2,300.40 |
$805.80
|
|
Inj proc lumbr disk ea lvl
|
$585.00 |
$1,228.80 |
$1,228.80 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$603.00 |
$1,265.40 |
$1,265.40 |
$856.00
|
|
Inj proc sialogram
|
$154.20 |
$324.00 |
$324.00 |
$373.00
|
|
Inj progesterone per 50 mg
|
$6.00 |
$6.00 |
$6.00 |
$14.93
|
|
Inj prohance multipack
|
$150.00 |
$150.00 |
$150.00 |
$9.60
|
|
Inj, releuko 1 mcg
|
$1,099.02 |
$1,099.02 |
$1,099.02 |
$461.20
|
|
Inj retro urethrocysto
|
$225.00 |
$225.00 |
$225.00 |
$450.00
|
|
Inj scleros sol mult veins
|
$1,475.40 |
$1,475.40 |
$1,475.40 |
$602.50
|
|
Inj scleros sol sgl vein
|
$1,167.60 |
$1,167.60 |
$1,167.60 |
$534.40
|
|
Inj sebelipase alfa 1 mg
|
$39,819.00 |
$39,819.00 |
$39,819.00 |
$539.69
|
|
Inj secretin synthetic human
|
$2,419.26 |
$2,419.26 |
$2,855.52 |
$1,285.20
|
|
Inj sulf hexa lipid microsph
|
$324.00 |
$380.28 |
$388.74 |
$256.14
|
|
Inj, taliglucerace alfa 10 u
|
$3,505.56 |
$3,505.56 |
$3,505.56 |
$1,573.27
|
|
Inj testosterone cypionate
|
$19.50 |
$19.50 |
$26.88 |
$62.80
|
|
Inj thiotepa nos 1 mg
|
$11,680.50 |
$11,680.50 |
$11,680.50 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$2,190.00 |
$2,190.00 |
$2,190.00 |
$1,025.00
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,095.60 |
$1,095.60 |
$1,095.60 |
$818.00
|
|
Inj. tigecycline (accord)
|
$88.14 |
$88.14 |
$100.62 |
$182.46
|
|
Inj, tyenne, 1 mg
|
$7,167.78 |
$8,460.30 |
$8,460.30 |
$3,525.12
|
|
Inj vancomycin (xellia) 10mg
|
$126.36 |
$126.36 |
$126.36 |
$79.21
|
|
Inj vocal cord bulking agent
|
$1,928.80 |
$1,928.80 |
$1,928.80 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$595.20 |
$595.20 |
$595.20 |
$463.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$123,406.32 |
$123,406.32 |
$123,406.32 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$6,178.80 |
$6,487.80 |
$6,487.80 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$5,941.20 |
$5,941.20 |
$5,941.20 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$7,073.40 |
$7,426.80 |
$7,426.80 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$7,426.80 |
$7,426.80 |
$7,426.80 |
$5,419.00
|
|
Insert and remove bone pin
|
$6,061.80 |
$6,061.80 |
$6,061.80 |
$4,421.00
|
|
Insert cath pleura with image
|
$4,102.80 |
$4,102.80 |
$4,102.80 |
$2,194.40
|
|
Insert cath pleura without image
|
$3,753.00 |
$3,753.00 |
$3,753.00 |
$2,019.00
|
|
Insert hepatic shunt (tips)
|
$17,757.60 |
$17,757.60 |
$17,757.60 |
$8,367.70
|
|
Insert intrauterine device iud
|
$12,736.30 |
$12,736.30 |
$21,143.04 |
$366.65
|
|
Insertion catheter bladder temporary simple
|
$216.60 |
$216.60 |
$216.60 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,197.60 |
$4,197.60 |
$4,197.60 |
$4,731.80
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$10,500.00 |
$10,500.00 |
$10,500.00 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$4,954.80 |
$4,954.80 |
$4,954.80 |
$2,511.00
|
|
Insertion of catheter vein
|
$1,371.00 |
$1,371.00 |
$1,371.00 |
$1,657.32
|
|
Insertion of catheter vein
|
$542.40 |
$542.40 |
$542.40 |
$836.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$9,278.40 |
$9,278.40 |
$9,278.40 |
$12,508.08
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$10,309.20 |
$10,309.20 |
$10,309.20 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,109.00 |
$2,109.00 |
$2,869.75 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,481.20 |
$3,481.20 |
$3,481.20 |
$2,414.10
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$6,076.80 |
$6,076.80 |
$6,076.80 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$6,076.80 |
$6,076.80 |
$6,076.80 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$8,203.80 |
$8,203.80 |
$20,862.39 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$12,858.47 |
$16,132.01 |
$19,810.71 |
$5,236.80
|
|
Insert multi-comp penis pros
|
$69,392.75 |
$69,392.75 |
$69,392.75 |
$9,495.20
|
|
Insert sq defib electrode
|
$12,890.40 |
$12,890.40 |
$12,890.40 |
$8,167.68
|
|
Insert swan-ganz cath
|
$2,580.60 |
$2,580.60 |
$2,580.60 |
$2,210.50
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$6,494.40 |
$6,494.40 |
$6,494.40 |
$5,018.25
|
|
Insert tunneled cv cath
|
$4,783.80 |
$4,783.80 |
$4,783.80 |
$4,580.61
|
|
Insert tunneled cv cath
|
$9,057.00 |
$9,057.00 |
$9,057.00 |
$6,075.30
|
|
Insert uro/ves nck sphincter
|
$80,608.25 |
$80,608.25 |
$80,608.25 |
$21,998.10
|
|
Insert vad art access left hrt arterial access
|
$3,677.40 |
$3,677.40 |
$3,677.40 |
$4,221.97
|
|
Insert vad art access left hrt art & vein access
|
$3,677.40 |
$3,677.40 |
$3,677.40 |
$2,889.60
|
|
Insitu hybridization (fish)
|
$568.80 |
$568.80 |
$568.80 |
$481.60
|
|
Insitu hybridization manual
|
$187.20 |
$187.20 |
$187.20 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$117.00 |
$117.00 |
$117.00 |
$243.60
|
