|
Injection radioactive tracer sentinel node (both sides)
|
$740.80 |
$740.80 |
$740.80 |
$670.64
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,253.60 |
$2,253.60 |
$2,253.60 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,187.20 |
$3,187.20 |
$3,187.20 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,510.40 |
$1,510.40 |
$1,510.40 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,729.60 |
$1,729.60 |
$1,729.60 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,700.00 |
$1,700.00 |
$1,700.00 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,512.80 |
$1,512.80 |
$1,512.80 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,404.80 |
$2,404.80 |
$2,404.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,320.00 |
$2,320.00 |
$2,320.00 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$422.40 |
$422.40 |
$422.40 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$548.80 |
$548.80 |
$548.80 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$548.80 |
$548.80 |
$548.80 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$389.60 |
$389.60 |
$389.60 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$389.60 |
$389.60 |
$389.60 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$190.40 |
$190.40 |
$190.40 |
$135.60
|
|
Inject sacroiliac joint
|
$2,447.20 |
$2,447.20 |
$2,447.20 |
$1,028.95
|
|
Inj fluphenazine hcl 1.25 mg
|
$876.20 |
$876.20 |
$876.20 |
$39.54
|
|
Inj for ext venography
|
$443.20 |
$443.20 |
$443.20 |
$649.95
|
|
Inj hydroxocobalamin IV 25mg
|
$3,902.60 |
$3,902.60 |
$3,902.60 |
$2,452.32
|
|
Inj, lidocaine w epinephrine
|
$95.00 |
$95.00 |
$95.00 |
$47.52
|
|
Inj mepivacaine hcl/10 ml
|
$109.00 |
$109.00 |
$109.00 |
$33.86
|
|
Inj multihance
|
$4.00 |
$4.00 |
$4.00 |
$73.49
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,644.80 |
$2,644.80 |
$2,644.80 |
$1,413.35
|
|
Inj proc elbow arthro
|
$944.00 |
$944.00 |
$944.00 |
$419.60
|
|
Inj proc myelogram lumbar
|
$3,385.60 |
$3,385.60 |
$3,385.60 |
$830.50
|
|
Inj retro urethrocysto
|
$285.60 |
$285.60 |
$285.60 |
$443.50
|
|
Inj testosterone cypionate
|
$121.00 |
$121.00 |
$121.00 |
$64.80
|
|
Inj w/fluor eval cv device
|
$595.20 |
$595.20 |
$595.20 |
$503.92
|
|
Insert cath pleura with image
|
$1,232.00 |
$1,232.00 |
$1,232.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$3,650.40 |
$3,650.40 |
$3,650.40 |
$2,073.18
|
|
Insert drug delivery implant
|
$192.80 |
$192.80 |
$192.80 |
$280.00
|
|
Insertion catheter bladder non indwelling
|
$213.60 |
$213.60 |
$213.60 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$231.20 |
$231.20 |
$231.20 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$9,328.00 |
$9,328.00 |
$9,328.00 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,572.00 |
$1,572.00 |
$1,572.00 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$8,252.80 |
$8,252.80 |
$8,252.80 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,099.20 |
$2,099.20 |
$2,099.20 |
$2,505.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$18,232.80 |
$18,232.80 |
$18,232.80 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$18,232.80 |
$18,232.80 |
$18,232.80 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$14,454.40 |
$14,454.40 |
$14,454.40 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,008.00 |
$2,008.00 |
$2,008.00 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,962.40 |
$1,962.40 |
$1,962.40 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$59,126.40 |
$59,126.40 |
$59,126.40 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$13,698.40 |
$13,698.40 |
$13,698.40 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$12,016.00 |
$12,016.00 |
$12,016.00 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$10,404.80 |
$10,404.80 |
$10,404.80 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$5,223.20 |
$5,223.20 |
$5,223.20 |
$5,223.20
|
|
Insert/repl sq defib w/eltrd
|
$72,809.60 |
$72,809.60 |
$72,809.60 |
$32,800.04
|
|
Insert vad art access left hrt arterial access
|
$29,700.80 |
$29,700.80 |
$29,700.80 |
$4,270.75
|
|
Insitu hybridization auto
|
$173.60 |
$173.60 |
$173.60 |
$377.37
|
|
In situ hybridization per specimen each additional single probe stain
|
$235.20 |
$235.20 |
$235.20 |
$241.15
|
|
In situ hybridization per specimen initial single probe stain
|
$381.60 |
$381.60 |
$381.60 |
$331.69
|
|
Ins mark abd/pel for right perq
|
$2,096.00 |
$2,096.00 |
$2,096.00 |
$2,414.36
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$1,317.60 |
$1,317.60 |
$1,317.60 |
$1,690.00
|
|
Ins pq tunnld ip cath w/img
|
$2,670.40 |
$2,670.40 |
$2,670.40 |
$5,377.00
|
|
Ins/rpl ldless pm right vent w img & eval
|
$5,923.20 |
$5,923.20 |
$5,923.20 |
$24,135.54
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$58,797.60 |
$58,797.60 |
$58,797.60 |
$25,694.00
|
|
Inst fibrinolysis agent ini day
|
$840.80 |
$840.80 |
$840.80 |
$1,036.05
|
|
Ins tun cv cath wo subq prt/pm
|
$2,836.00 |
$2,836.00 |
$2,836.00 |
$4,202.70
|
|
Insulin total
|
$47.20 |
$47.20 |
$47.20 |
$66.64
|
|
Interdiscal perq aspir dx
|
$1,187.20 |
$1,187.20 |
$1,187.20 |
$1,222.26
|
|
Interfyl, 1 mg
|
$2,996.40 |
$2,996.40 |
$2,996.40 |
$4,656.80
|
|
Interrogate subq defib
|
$765.60 |
$765.60 |
$765.60 |
$119.60
|
|
Interrog dev eval scrms ip
|
$159.20 |
$159.20 |
$159.20 |
$124.80
|
|
Interrog evl pm/ldls pm ip
|
$285.60 |
$285.60 |
$285.60 |
$124.80
|
|
Intrapul surf admin endo tube
|
$720.00 |
$720.00 |
$720.00 |
$220.80
|
|
Intrinsic factor antibody
|
$62.40 |
$62.40 |
$62.40 |
$63.15
|
|
Intro cath dialysis circuit
|
$1,716.00 |
$1,716.00 |
$1,716.00 |
$2,036.94
|
|
Intro cath dialysis circuit w/pta
|
$10,528.00 |
$10,528.00 |
$10,528.00 |
$8,690.50
|
|
Intro catheter aorta
|
$5,244.00 |
$5,244.00 |
$5,244.00 |
$1,654.05
|
|
Intro cath svc/ivc
|
$1,604.80 |
$1,604.80 |
$1,604.80 |
$1,323.27
|
|
Intro long gi tube
|
$1,575.20 |
$1,575.20 |
$1,575.20 |
$957.18
|
|
Intubation endotracheal emergency procedure
|
$1,163.20 |
$1,163.20 |
$1,163.20 |
$598.80
|
|
Iodine i-123 sod iodide mil
|
$704.80 |
$704.80 |
$704.80 |
$371.18
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$1.60 |
$1.60 |
$1.60 |
$170.06
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$1.60 |
$1.60 |
$1.60 |
$288.11
|
|
Iron
|
$20.00 |
$20.00 |
$20.00 |
$72.29
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$211.40 |
$211.40 |
$211.40 |
$187.06
|
|
Irrigation implantable venous access device for drug delivery systems
|
$100.00 |
$100.00 |
$100.00 |
$144.62
|
|
Ivc venogram s&i
|
$8,673.60 |
$8,673.60 |
$8,673.60 |
$3,316.95
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$679.20 |
$679.20 |
$679.20 |
$190.56
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$330.40 |
$330.40 |
$330.40 |
$159.00
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$679.20 |
$679.20 |
$679.20 |
$153.60
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$1,350.40 |
$1,350.40 |
$1,350.40 |
$437.45
|
|
IV inj ra drug dx study
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$552.60
|
|
Jak2 targeted sequence analysis
|
$605.60 |
$605.60 |
$605.60 |
$393.43
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$34.40 |
$34.40 |
$34.40 |
$58.50
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$27.60 |
$27.60 |
$27.60 |
$23.77
|
|
Kidney function study
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$968.50
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$1,365.60 |
$1,365.60 |
$1,365.60 |
$673.36
|
|
Knee MRI (with and without contrast)
|
$712.50 |
$712.50 |
$712.50 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$645.00 |
$645.00 |
$645.00 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$462.00 |
$462.00 |
$462.00 |
$2,110.76
|
|
Knee X-ray
|
$483.20 |
$483.20 |
$483.20 |
$425.55
|
|
Kyleena, 19.5 mg
|
$4,771.20 |
$4,771.20 |
$4,771.20 |
$2,125.00
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$36.40 |
$36.40 |
$36.40 |
$33.60
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$436.80 |
$436.80 |
$436.80 |
$175.92
|
|
Lactate dehydrogenase (ldh)
|
$25.00 |
$25.00 |
$25.00 |
$55.50
|
|
Lactated ringers intravenous solution
|
$28.80 |
$28.80 |
$28.80 |
$44.91
|
|
Lactic acid
|
$75.20 |
$75.20 |
$75.20 |
$107.00
|
