|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,355.00 |
$4,355.00 |
$4,355.00 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,729.65 |
$1,729.65 |
$1,729.65 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$5,860.40 |
$5,860.40 |
$5,860.40 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,369.55 |
$1,369.55 |
$1,369.55 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$7,400.90 |
$7,400.90 |
$7,400.90 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$5,265.00 |
$5,265.00 |
$5,265.00 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$4,732.65 |
$4,732.65 |
$4,732.65 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,820.00 |
$1,820.00 |
$1,820.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,095.90 |
$1,095.90 |
$1,095.90 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,461.20 |
$1,461.20 |
$1,461.20 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$207.35 |
$207.35 |
$207.35 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$154.05 |
$154.05 |
$154.05 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$226.85 |
$226.85 |
$226.85 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$182.65 |
$182.65 |
$182.65 |
$141.60
|
|
Injection treatment of nerve
|
$6,858.80 |
$6,858.80 |
$6,858.80 |
$3,016.15
|
|
Injection treatment of nerve
|
$5,215.60 |
$5,215.60 |
$5,215.60 |
$2,037.10
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$105.61 |
$105.61 |
$105.61 |
$66,229.74
|
|
Inj epidural sgl cerv-thor without img
|
$5,069.35 |
$5,069.35 |
$5,069.35 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$4,290.65 |
$4,290.65 |
$4,290.65 |
$1,450.84
|
|
Inj, evinacumab-dgnb, 5mg
|
$365.92 |
$365.92 |
$365.92 |
$186.31
|
|
Inj fluphenazine hcl 1.25 mg
|
$28.44 |
$28.44 |
$28.44 |
$37.93
|
|
Inj for ext venography
|
$3,802.50 |
$3,802.50 |
$3,802.50 |
$737.55
|
|
Inj for mammo ductogram
|
$4,110.60 |
$4,110.60 |
$4,110.60 |
$433.50
|
|
Inj heparin, pfizer, 1000u
|
$2.60 |
$2.60 |
$2.60 |
$24.28
|
|
Inj. herceptin hylecta, 10mg
|
$217.32 |
$217.32 |
$217.32 |
$63.79
|
|
Inj herzuma 10 mg
|
$257.69 |
$257.69 |
$257.69 |
$60.44
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,315.95 |
$2,315.95 |
$2,315.95 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$789.10 |
$789.10 |
$789.10 |
$947.65
|
|
Inj human fibrinogen con nos
|
$3,288.87 |
$3,288.87 |
$3,288.87 |
$1.52
|
|
Inj hydroxocobalamin IV 25mg
|
$3,124.58 |
$3,124.58 |
$3,124.58 |
$3,180.35
|
|
Inj. inebilizumab-cdon, 1 mg
|
$1,133.55 |
$1,133.55 |
$1,133.55 |
$494.43
|
|
Inj intralesional <= 7 lsn(s)
|
$589.55 |
$589.55 |
$589.55 |
$241.74
|
|
Inj, invega hafyera/trinza
|
$39.57 |
$39.57 |
$39.57 |
$12.66
|
|
Inj ivig privigen 500 mg
|
$1,008.86 |
$1,008.86 |
$1,008.86 |
$7,298.71
|
|
Inj, lecanemab-irmb, 1 mg
|
$4.33 |
$4.33 |
$4.33 |
$1,729.21
|
|
Inj levocarnitine per 1 gm
|
$138.58 |
$138.58 |
$138.58 |
$138.96
|
|
Inj, levothyroxine, freskabi
|
$236.50 |
$236.50 |
$236.50 |
$302.07
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$7,151.30 |
$7,151.30 |
$7,151.30 |
$625.00
|
|
Inj melpha hydroch nos 50 mg
|
$251.08 |
$251.08 |
$251.08 |
$1,518.68
|
|
Inj mepivacaine hcl/10 ml
|
$23.77 |
$23.77 |
$23.77 |
$28.41
|
|
Inj., meropenem, vaborbactam
|
$740.32 |
$740.32 |
$740.32 |
$618.43
|
|
Inj meropenem (wg crit care)
|
$104.29 |
$104.29 |
$104.29 |
$104.29
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$578.70 |
$578.70 |
$578.70 |
$788.73
|
|
Inj multihance
|
$20.28 |
$20.28 |
$20.28 |
$119.25
|
|
Inj. mycophenolate mofetil
|
$102.02 |
$102.02 |
$102.02 |
$344.84
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$8,728.20 |
$8,728.20 |
$8,728.20 |
$1,522.56
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,913.30 |
$2,913.30 |
$2,913.30 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,942.20 |
$1,942.20 |
$1,942.20 |
$2,164.64
|
|
Inj ontruzant 10 mg
|
$4,554.03 |
$4,554.03 |
$4,554.03 |
$34.17
|
|
Inj pantoprazole(hikma) 40mg
|
$30.71 |
$30.71 |
$30.71 |
$36.04
|
|
Inj., patisiran, 0.1 mg
|
$239.76 |
$239.76 |
$239.76 |
$11,742.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,013.31 |
$1,013.31 |
$1,013.31 |
$6,403.59
|
|
Inj pemetrexed (accord) 10mg
|
$11.34 |
$11.34 |
$11.34 |
$9.74
|
|
Inj pemetrexed ditromethamin
|
$4.10 |
$4.10 |
$4.10 |
$10.55
|
|
Inj pemetrexed, hospira 10mg
|
$4.39 |
$4.39 |
$4.39 |
$0.62
|
|
Inj peritoneal venous shunt
|
$3,643.90 |
$3,643.90 |
$3,643.90 |
$386.88
|
|
Inj proc ankle arthr
|
$1,563.90 |
$1,563.90 |
$1,563.90 |
$405.31
|
|
Inj proc elbow arthro
|
$2,503.80 |
$2,503.80 |
$2,503.80 |
$453.60
|
|
Inj proc for lymphang
|
$2,646.80 |
$2,646.80 |
$2,646.80 |
$1,372.00
|
|
Inj proc lumbr disk ea lvl
|
$3,405.35 |
$3,405.35 |
$3,405.35 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$1,051.05 |
$1,051.05 |
$1,051.05 |
$922.80
|
|
Inj proc sialogram
|
$2,510.95 |
$2,510.95 |
$2,510.95 |
$380.80
|
|
Inj progesterone per 50 mg
|
$21.71 |
$21.71 |
$21.71 |
$48.51
|
|
Inj retacrit esrd on dialysi
|
$3.54 |
$3.54 |
$3.54 |
$307.40
|
|
Inj retro urethrocysto
|
$2,223.00 |
$2,223.00 |
$2,223.00 |
$551.29
|
|
Inj scleros sol mult veins
|
$925.60 |
$925.60 |
$925.60 |
$687.96
|
|
Inj scleros sol sgl vein
|
$925.60 |
$925.60 |
$925.60 |
$534.40
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$418.60 |
$418.60 |
$418.60 |
$436.64
|
|
Inj. teprotumumab-trbw 10 mg
|
$905.45 |
$905.45 |
$905.45 |
$47,971.67
|
|
Inj testosterone cypionate
|
$27.33 |
$27.33 |
$27.33 |
$77.15
|
|
Inj thrc fascial pln blk bi w/wo image
|
$7,151.30 |
$7,151.30 |
$7,151.30 |
$1,483.20
|
|
Inj thrc fascial pln blk uni w/wo image
|
$3,575.65 |
$3,575.65 |
$3,575.65 |
$1,252.02
|
|
Inj, vancomycin hcl (mylan)
|
$28.18 |
$28.18 |
$28.18 |
$63.82
|
|
Inj, vasopressin (baxter)
|
$137.70 |
$137.70 |
$137.70 |
$32.40
|
|
Inj w/fluor eval cv device
|
$4,491.50 |
$4,491.50 |
$4,491.50 |
$588.90
|
|
Ins cath ren art 1st bi
|
$12,677.60 |
$12,677.60 |
$12,677.60 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$10,729.55 |
$10,729.55 |
$10,729.55 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$9,808.50 |
$9,808.50 |
$9,808.50 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$7,090.85 |
$7,090.85 |
$7,090.85 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$1,169.35 |
$1,169.35 |
$1,169.35 |
$544.00
|
|
Insert abdomen-venous drain
|
$4,992.65 |
$4,992.65 |
$4,992.65 |
$4,391.00
|
|
Insert cath pleura with image
|
$10,571.60 |
$10,571.60 |
$10,571.60 |
$2,239.02
|
|
Insert cath pleura without image
|
$7,047.30 |
$7,047.30 |
$7,047.30 |
$2,212.00
|
|
Insert drug delivery implant
|
$759.20 |
$759.20 |
$759.20 |
$285.80
|
|
Insert hepatic shunt (tips)
|
$24,617.45 |
$24,617.45 |
$24,617.45 |
$9,754.48
|
|
Insert intrauterine device iud
|
$2,288.00 |
$2,288.00 |
$2,288.00 |
$378.83
|
|
Insertion catheter bladder non indwelling
|
$484.25 |
$484.25 |
$484.25 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$592.80 |
$592.80 |
$592.80 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$7,711.60 |
$7,711.60 |
$7,711.60 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,407.60 |
$2,407.60 |
$2,407.60 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$12,535.90 |
$12,535.90 |
$12,535.90 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,202.85 |
$2,202.85 |
$2,202.85 |
$2,618.40
|
|
Insertion of catheter vein
|
$488.80 |
$488.80 |
$488.80 |
$1,749.80
|
|
Insertion of catheter vein
|
$328.90 |
$328.90 |
$328.90 |
$858.05
|
|
Insertion of heart electrode 33211
|
$7,048.60 |
$7,048.60 |
$7,048.60 |
$9,090.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$17,323.80 |
$17,323.80 |
$17,323.80 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$14,487.20 |
$14,487.20 |
$14,487.20 |
$12,813.28
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$13,338.00 |
$13,338.00 |
$13,338.00 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,202.85 |
$2,202.85 |
$2,202.85 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,772.60 |
$3,772.60 |
$3,772.60 |
$2,527.91
|