|
Injection for arthrography wrist (both sides)
|
$340.00 |
$340.00 |
$340.00 |
$428.40
|
|
Injection for bladder x-ray
|
$958.40 |
$958.40 |
$958.40 |
$459.20
|
|
Injection for hip x-ray
|
$763.60 |
$763.60 |
$763.60 |
$710.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$598.40 |
$598.40 |
$598.40 |
$494.65
|
|
Injection for tear sac x-ray
|
$267.60 |
$267.60 |
$267.60 |
$225.20
|
|
Injection for ureter x-ray
|
$1,143.20 |
$1,143.20 |
$1,143.20 |
$427.70
|
|
Injection for ureter x-ray
|
$780.40 |
$780.40 |
$780.40 |
$515.21
|
|
Injection radioactive tracer sentinel node (both sides)
|
$152.80 |
$152.80 |
$152.80 |
$670.64
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,403.60 |
$1,403.60 |
$1,403.60 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$822.80 |
$822.80 |
$822.80 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,034.00 |
$1,034.00 |
$1,034.00 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,524.40 |
$1,524.40 |
$1,524.40 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,042.80 |
$3,042.80 |
$3,042.80 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,544.80 |
$1,544.80 |
$1,544.80 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$3,085.60 |
$3,085.60 |
$3,085.60 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,020.00 |
$2,020.00 |
$2,020.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,580.80 |
$1,580.80 |
$1,580.80 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,115.60 |
$1,115.60 |
$1,115.60 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$938.80 |
$938.80 |
$938.80 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,119.20 |
$1,119.20 |
$1,119.20 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$140.80 |
$140.80 |
$140.80 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$140.80 |
$140.80 |
$140.80 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$140.80 |
$140.80 |
$140.80 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$123.60 |
$123.60 |
$123.60 |
$135.60
|
|
Injection treatment of eye
|
$2,284.80 |
$2,284.80 |
$2,284.80 |
$2,665.60
|
|
Injection treatment of nerve
|
$7,559.60 |
$7,559.60 |
$7,559.60 |
$4,350.00
|
|
Inject sacroiliac joint
|
$75.60 |
$75.60 |
$75.60 |
$1,028.95
|
|
Inject/treat eye socket
|
$303.60 |
$303.60 |
$303.60 |
$381.13
|
|
Inject/treat eye socket
|
$303.60 |
$303.60 |
$303.60 |
$670.02
|
|
Inj epidural sgl cerv-thor without img
|
$2,148.00 |
$2,148.00 |
$2,148.00 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$1,532.00 |
$1,532.00 |
$1,532.00 |
$1,415.50
|
|
Inj for ext venography
|
$432.00 |
$432.00 |
$432.00 |
$649.95
|
|
Inj for mammo ductogram
|
$729.60 |
$729.60 |
$729.60 |
$399.60
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,492.00 |
$1,492.00 |
$1,492.00 |
$1,439.90
|
|
Inj hrt cath w/s&i sel right vent
|
$982.40 |
$982.40 |
$982.40 |
$965.33
|
|
Inj intralesional <= 7 lsn(s)
|
$232.80 |
$232.80 |
$232.80 |
$235.13
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,192.40 |
$1,192.40 |
$1,192.40 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$6,474.00 |
$6,474.00 |
$6,474.00 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$6,474.00 |
$6,474.00 |
$6,474.00 |
$2,609.38
|
|
Inj peritoneal venous shunt
|
$648.80 |
$648.80 |
$648.80 |
$413.70
|
|
Inj proc ankle arthr
|
$399.60 |
$399.60 |
$399.60 |
$405.31
|
|
Inj proc elbow arthro
|
$419.60 |
$419.60 |
$419.60 |
$419.60
|
|
Inj proc lumbr disk ea lvl
|
$666.00 |
$666.00 |
$666.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$532.40 |
$532.40 |
$532.40 |
$830.50
|
|
Inj proc sialogram
|
$322.80 |
$322.80 |
$322.80 |
$373.00
|
|
Inj retro urethrocysto
|
$312.80 |
$312.80 |
$312.80 |
$443.50
|
|
Inj w/fluor eval cv device
|
$95.20 |
$95.20 |
$95.20 |
$503.92
|
|
Ins cath ren art 1st bi
|
$3,318.80 |
$3,318.80 |
$3,318.80 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$3,242.00 |
$3,242.00 |
$3,242.00 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$3,318.80 |
$3,318.80 |
$3,318.80 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$3,242.00 |
$3,242.00 |
$3,242.00 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$710.80 |
$710.80 |
$710.80 |
$480.28
|
|
Insert cath pleura with image
|
$4,806.00 |
$4,806.00 |
$4,806.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$3,383.20 |
$3,383.20 |
$3,383.20 |
$2,073.18
|
|
Insert drug delivery implant
|
$149.60 |
$149.60 |
$149.60 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$7,164.00 |
$7,164.00 |
$7,164.00 |
$7,571.20
|
|
Insert intrauterine device iud
|
$180.80 |
$180.80 |
$180.80 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$319.20 |
$319.20 |
$319.20 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$319.20 |
$319.20 |
$319.20 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$6,519.20 |
$6,519.20 |
$6,519.20 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,741.60 |
$3,741.60 |
$3,741.60 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$5,536.40 |
$5,536.40 |
$5,536.40 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,257.60 |
$3,257.60 |
$3,257.60 |
$2,505.60
|
|
Insertion of catheter vein
|
$1,435.60 |
$1,435.60 |
$1,435.60 |
$1,477.00
|
|
Insertion of catheter vein
|
$346.00 |
$346.00 |
$346.00 |
$836.25
|
|
Insertion of heart electrode 33211
|
$3,424.40 |
$3,424.40 |
$3,424.40 |
$6,903.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$8,327.60 |
$8,327.60 |
$8,327.60 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$6,196.00 |
$6,196.00 |
$6,196.00 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$5,524.40 |
$5,524.40 |
$5,524.40 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$4,108.00 |
$4,108.00 |
$4,108.00 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$4,572.00 |
$4,572.00 |
$4,572.00 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$29,412.40 |
$29,412.40 |
$29,412.40 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$3,424.40 |
$3,424.40 |
$3,424.40 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$4,213.60 |
$4,213.60 |
$4,213.60 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$4,213.60 |
$4,213.60 |
$4,213.60 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$4,755.20 |
$4,755.20 |
$4,755.20 |
$5,223.20
|
|
Insert pm/icd lead dual
|
$3,424.40 |
$3,424.40 |
$3,424.40 |
$7,115.20
|
|
Insert/repl sq defib w/eltrd
|
$46,634.00 |
$46,634.00 |
$46,634.00 |
$32,800.04
|
|
Insert spine infusion device 62360
|
$35,842.40 |
$35,842.40 |
$35,842.40 |
$17,262.84
|
|
Insert sq defib electrode
|
$12,539.20 |
$12,539.20 |
$12,539.20 |
$8,167.68
|
|
Insert swan-ganz cath
|
$760.00 |
$760.00 |
$760.00 |
$2,210.50
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$4,686.00 |
$4,686.00 |
$4,686.00 |
$4,803.00
|
|
Insert uteri tandem/ovoids
|
$1,852.00 |
$1,852.00 |
$1,852.00 |
$3,905.20
|
|
Insert vad art access left hrt arterial access
|
$905.20 |
$905.20 |
$905.20 |
$4,270.75
|
|
Insert vad art access left hrt art & vein access
|
$905.20 |
$905.20 |
$905.20 |
$3,677.40
|
|
Ins icd gen exist mlt leads
|
$26,782.40 |
$26,782.40 |
$26,782.40 |
$31,286.77
|
|
Ins icd gen exist sgl lead
|
$25,633.20 |
$25,633.20 |
$25,633.20 |
$23,230.50
|
|
Insitu hybridization manual
|
$838.00 |
$838.00 |
$838.00 |
$401.28
|
|
In situ hybridization per specimen each additional single probe stain
|
$1,565.20 |
$1,565.20 |
$1,565.20 |
$241.15
|
|
In situ hybridization per specimen initial single probe stain
|
$294.40 |
$294.40 |
$294.40 |
$331.69
|
|
Insj perq vad r hrt venous
|
$905.20 |
$905.20 |
$905.20 |
$3,796.00
|
|
Insj stablj dev without dcmprn
|
$20,836.00 |
$20,836.00 |
$20,836.00 |
$15,226.08
|
|
Insj stablj dev without dcmprn
|
$10,418.40 |
$10,418.40 |
$10,418.40 |
$10,418.40
|
|
Ins lv lead exist pm/icd
|
$5,524.40 |
$5,524.40 |
$5,524.40 |
$12,384.25
|
|
Ins mark abd/pel for right perq
|
$3,081.20 |
$3,081.20 |
$3,081.20 |
$2,414.36
|
|
Ins picad w subq port 5yr>
|
$5,192.00 |
$5,192.00 |
$5,192.00 |
$3,985.20
|
|
Ins pm gen exist dual lead
|
$26,208.00 |
$26,208.00 |
$26,208.00 |
$23,665.85
|
|
Ins pm gen w/exist mlt leads
|
$7,725.60 |
$7,725.60 |
$7,725.60 |
$14,804.40
|
|
Ins pq tunnld ip cath w/img
|
$13,094.40 |
$13,094.40 |
$13,094.40 |
$5,377.00
|
|
Ins/rplcm prq eltrd ra pn ea
|
$22,747.60 |
$22,747.60 |
$22,747.60 |
$2,681.11
|
