|
Ileostomy/jejunostomy non-tube 44310
|
$2,178.63 |
$2,178.63 |
$2,178.63 |
$1,976.40
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$5,204.77 |
$5,204.77 |
$5,204.77 |
$6,106.32
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$69.12 |
$69.12 |
$69.12 |
$3,846.15
|
|
Implant cartilage 10mm synthetic
|
$2,549.34 |
$2,549.34 |
$2,549.34 |
$10,050.00
|
|
Implant hormone pellet(s) 11980
|
$197.10 |
$197.10 |
$197.10 |
$315.75
|
|
Inactivated je vacc im
|
$184.68 |
$184.68 |
$184.68 |
$481.34
|
|
Inc dp opn b1 crtx hum/elbw
|
$1,095.66 |
$1,095.66 |
$1,095.66 |
$3,821.05
|
|
Incise inner ear
|
$506.52 |
$506.52 |
$506.52 |
$2,186.08
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$355.86 |
$355.86 |
$355.86 |
$2,080.80
|
|
Incision of anal sphincter
|
$501.66 |
$501.66 |
$501.66 |
$3,245.23
|
|
Incision of breast lesion
|
$923.13 |
$923.13 |
$923.13 |
$2,577.85
|
|
Incision of eardrum
|
$399.60 |
$399.60 |
$399.60 |
$553.02
|
|
Incision of eardrum
|
$883.44 |
$883.44 |
$883.44 |
$3,827.50
|
|
Incision of finger tendon
|
$976.86 |
$976.86 |
$976.86 |
$1,893.86
|
|
Incision of foot fascia
|
$629.64 |
$629.64 |
$629.64 |
$4,570.33
|
|
Incision of foot tendon 28234
|
$581.04 |
$581.04 |
$581.04 |
$2,116.27
|
|
Incision of metatarsal
|
$1,405.08 |
$1,405.08 |
$1,405.08 |
$4,176.43
|
|
Incision of metatarsal
|
$827.82 |
$827.82 |
$827.82 |
$3,591.33
|
|
Incision of palm tendon
|
$983.88 |
$983.88 |
$983.88 |
$3,821.05
|
|
Incision of rectal abscess
|
$1,028.16 |
$1,028.16 |
$1,028.16 |
$3,245.23
|
|
Incision of spinal nerve 64772
|
$1,172.88 |
$1,172.88 |
$1,172.88 |
$2,310.83
|
|
Incision of tendon & muscle
|
$1,299.24 |
$1,299.24 |
$1,299.24 |
$5,376.00
|
|
Incision of tendon sheath
|
$749.52 |
$749.52 |
$749.52 |
$2,176.80
|
|
Incision of toe tendons 28011
|
$676.08 |
$676.08 |
$676.08 |
$2,068.30
|
|
Incision of tongue fold
|
$446.04 |
$446.04 |
$446.04 |
$1,792.50
|
|
Incision of urethra
|
$200.88 |
$200.88 |
$200.88 |
$2,899.60
|
|
Incision tendon sheath
|
$1,231.74 |
$1,231.74 |
$1,231.74 |
$3,073.20
|
|
Incisn of toe tndn
|
$501.12 |
$501.12 |
$501.12 |
$2,493.15
|
|
Infliximab 100 mg intravenous solution
|
$1,327.08 |
$1,327.08 |
$1,327.08 |
$2,080.86
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,195.72 |
$1,195.72 |
$1,195.72 |
$1,617.43
|
|
Influenza virus vaccine, live trivalent intranasal
|
$23.22 |
$23.22 |
$23.22 |
$37.80
|
|
Inf lwr xtr fscl pln blk uni w/wo image
|
$182.79 |
$182.79 |
$182.79 |
$780.00
|
|
Inf thrc fascial pln blk bi w/wo image
|
$200.34 |
$200.34 |
$200.34 |
$523.25
|
|
Inf thrc fascial pln blk uni w/wo image
|
$190.35 |
$190.35 |
$190.35 |
$780.00
|
|
Initial nursing facility care/day low severity 99304
|
$118.53 |
$118.53 |
$118.53 |
$128.00
|
|
Init pm e/m new pat 65+ yrs
|
$212.76 |
$212.76 |
$212.76 |
$180.77
|
|
Inj, abilify maintena, 1 mg
|
$2.86 |
$2.86 |
$2.86 |
$5,355.30
|
|
Inj alymsys 10 mg
|
$3,725.22 |
$3,725.22 |
$3,725.22 |
$1,483.29
|
|
Inj, brixadi, 7 days or less
|
$760.91 |
$760.91 |
$760.91 |
$748.85
|
|
Inj brixadi, more than 7 day
|
$3,043.66 |
$3,043.66 |
$3,043.66 |
$2,846.40
|
|
Inj, bupivacaine liposome
|
$697.54 |
$697.54 |
$697.54 |
$699.38
|
|
Inj cntr knee arthro incl ct/mri
|
$136.62 |
$136.62 |
$136.62 |
$436.80
|
|
Inj disk cerv-thor ea lev
|
$357.21 |
$357.21 |
$357.21 |
$945.00
|
|
Inj dx for sinogram
|
$116.64 |
$116.64 |
$116.64 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$172.26 |
$172.26 |
$172.26 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$184.95 |
$184.95 |
$184.95 |
$500.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$173.34 |
$173.34 |
$173.34 |
$504.90
|
|
Injection, daratumumab 10 mg
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$5,164.24
|
|
Injection epidural blood patch or clot
|
$354.78 |
$354.78 |
$354.78 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$229.50 |
$229.50 |
$229.50 |
$441.12
|
|
Injection for bladder x-ray
|
$146.07 |
$146.07 |
$146.07 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$119.07 |
$119.07 |
$119.07 |
$494.65
|
|
Injection, fulvestrant
|
$1,177.98 |
$1,177.98 |
$1,177.98 |
$1,719.16
|
|
Injection, inclisiran, 1 mg
|
$5,464.92 |
$5,464.92 |
$5,464.92 |
$6,679.35
|
|
Injection, necitumumab, 1 mg
|
$2.86 |
$2.86 |
$2.86 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$8.64 |
$8.64 |
$8.64 |
$2,241.61
|
|
Injection, renflexis
|
$951.99 |
$951.99 |
$951.99 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$191.43 |
$191.43 |
$191.43 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$156.06 |
$156.06 |
$156.06 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$349.92 |
$349.92 |
$349.92 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$185.22 |
$185.22 |
$185.22 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$451.98 |
$451.98 |
$451.98 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$158.76 |
$158.76 |
$158.76 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$376.65 |
$376.65 |
$376.65 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$335.88 |
$335.88 |
$335.88 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$311.04 |
$311.04 |
$311.04 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$122.04 |
$122.04 |
$122.04 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$109.62 |
$109.62 |
$109.62 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$126.36 |
$126.36 |
$126.36 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$33.21 |
$33.21 |
$33.21 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$83.43 |
$83.43 |
$83.43 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$27.00 |
$27.00 |
$27.00 |
$135.20
|
|
Inject sacroiliac joint
|
$396.90 |
$396.90 |
$396.90 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$331.56 |
$331.56 |
$331.56 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$176.31 |
$176.31 |
$176.31 |
$1,415.50
|
|
Inj., guselkumab, 1 mg
|
$15,102.48 |
$15,102.48 |
$15,102.48 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$10.80 |
$10.80 |
$10.80 |
$24.28
|
|
Inj hydroxyprogst capoat nos
|
$18.36 |
$18.36 |
$18.36 |
$1,228.59
|
|
Inj intralesional <= 7 lsn(s)
|
$120.96 |
$120.96 |
$120.96 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$147.42 |
$147.42 |
$147.42 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$5,856.26 |
$5,856.26 |
$5,856.26 |
$6,967.29
|
|
Inj levoleucovorin nos 0.5mg
|
$3.83 |
$3.83 |
$3.83 |
$103.60
|
|
Inj, lidocaine w epinephrine
|
$26.94 |
$26.94 |
$26.94 |
$44.96
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$146.88 |
$146.88 |
$146.88 |
$783.50
|
|
Inj mepivacaine hcl/10 ml
|
$28.43 |
$28.43 |
$28.43 |
$33.86
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$137.70 |
$137.70 |
$137.70 |
$1,414.40
|
|
Inj nivolumab 2 mg hyaluron
|
$8,235.38 |
$8,235.38 |
$8,235.38 |
$14,110.18
|
|
Inj ogivri 10 mg
|
$1,218.90 |
$1,218.90 |
$1,218.90 |
$4,492.28
|
|
Inj proc ankle arthr
|
$159.30 |
$159.30 |
$159.30 |
$405.31
|
|
Inj proc elbow arthro
|
$186.57 |
$186.57 |
$186.57 |
$432.00
|
|
Inj proc myelogram lumbar
|
$264.06 |
$264.06 |
$264.06 |
$856.00
|
|
Inj retro urethrocysto
|
$170.10 |
$170.10 |
$170.10 |
$450.00
|
|
Inj secretin synthetic human
|
$18.90 |
$18.90 |
$18.90 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$2,672.51 |
$2,672.51 |
$2,672.51 |
$4,485.92
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$204.12 |
$204.12 |
$204.12 |
$436.80
|
|
Inj testosterone cypionate
|
$53.35 |
$53.35 |
$53.35 |
$62.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$182.79 |
$182.79 |
$182.79 |
$1,025.00
|
|
Inj thrc fascial pln blk uni w/wo image
|
$164.16 |
$164.16 |
$164.16 |
$818.00
|
|
Inj, tyenne, 1 mg
|
$2,474.64 |
$2,474.64 |
$2,474.64 |
$3,525.12
|
|
Inj, vegzelma, 10 mg
|
$3,511.64 |
$3,511.64 |
$3,511.64 |
$1,291.28
|