|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,318.80 |
$1,318.80 |
$1,318.80 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,318.80 |
$1,318.80 |
$1,318.80 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,048.40 |
$2,048.40 |
$2,048.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,048.40 |
$2,048.40 |
$2,048.40 |
$1,685.00
|
|
Injection, siltuximab
|
$3,603.00 |
$3,603.00 |
$3,603.00 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$894.60 |
$894.60 |
$894.60 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$396.60 |
$396.60 |
$396.60 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$766.20 |
$766.20 |
$766.20 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$108.00 |
$108.00 |
$108.00 |
$145.60
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$1,723.20 |
$1,723.20 |
$1,723.20 |
$32,176.93
|
|
Inj., eravacycline, 1 mg
|
$36.60 |
$36.60 |
$36.60 |
$206.64
|
|
Inj, factor x, (human), 1iu
|
$6.60 |
$6.60 |
$6.60 |
$26.74
|
|
Inj. fe derisomaltose 10 mg
|
$194.40 |
$194.40 |
$194.40 |
$3,221.52
|
|
Inj for ext venography
|
$1,152.60 |
$1,152.60 |
$1,152.60 |
$628.80
|
|
Inj for mammo ductogram
|
$306.60 |
$306.60 |
$306.60 |
$397.80
|
|
Inj, gadopiclenol, 1 ml
|
$6.60 |
$6.60 |
$6.60 |
$37.63
|
|
Inj glofitamab gxbm, 2.5 mg
|
$612.60 |
$612.60 |
$612.60 |
$4,760.67
|
|
Inj heparin, pfizer, 1000u
|
$3.00 |
$3.00 |
$3.00 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$561.00 |
$561.00 |
$561.00 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$841.20 |
$841.20 |
$841.20 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$1,492.00
|
|
Inj imip 4 cilas 4 releb 2mg
|
$183.60 |
$183.60 |
$183.60 |
$739.77
|
|
Inj. insulin (fiasp)
|
$16.80 |
$16.80 |
$16.80 |
$177.00
|
|
Inj ivig privigen 500 mg
|
$5,274.00 |
$5,274.00 |
$5,274.00 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$10,671.00 |
$10,671.00 |
$10,671.00 |
$11,648.70
|
|
Inj levocarnitine per 1 gm
|
$4.20 |
$4.20 |
$4.20 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$10.20 |
$10.20 |
$10.20 |
$308.21
|
|
Inj, melphalan flufenami 1mg
|
$5,700.00 |
$5,700.00 |
$5,700.00 |
$5,700.00
|
|
Inj, meropenem (b. braun)
|
$12.00 |
$12.00 |
$12.00 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$129.60 |
$129.60 |
$129.60 |
$556.87
|
|
Inj, micafungin (par pharm)
|
$89.40 |
$89.40 |
$89.40 |
$79.08
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$540.60 |
$540.60 |
$540.60 |
$8,304.04
|
|
Inj multihance
|
$3.00 |
$3.00 |
$3.00 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$64.20 |
$64.20 |
$64.20 |
$252.66
|
|
Inj naloxone hydrochloride
|
$9.00 |
$9.00 |
$9.00 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$1,413.35
|
|
Inj nivolumab 2 mg hyaluron
|
$4,611.60 |
$4,611.60 |
$4,611.60 |
$15,599.68
|
|
Inj ogivri 10 mg
|
$564.00 |
$564.00 |
$564.00 |
$4,492.28
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$3,925.20 |
$3,925.20 |
$3,925.20 |
$6,614.40
|
|
Inj, pemivibart, 4500 mg
|
$96.00 |
$96.00 |
$96.00 |
$1,235.55
|
|
Inj peritoneal venous shunt
|
$1,665.60 |
$1,665.60 |
$1,665.60 |
$406.80
|
|
Inj proc ankle arthr
|
$405.60 |
$405.60 |
$405.60 |
$405.31
|
|
Inj proc elbow arthro
|
$461.40 |
$461.40 |
$461.40 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$3,214.20 |
$3,214.20 |
$3,214.20 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$518.40 |
$518.40 |
$518.40 |
$838.30
|
|
Inj proc sialogram
|
$612.60 |
$612.60 |
$612.60 |
$373.00
|
|
Inj progesterone per 50 mg
|
$1.80 |
$1.80 |
$1.80 |
$13.76
|
|
Inj, releuko 1 mcg
|
$190.80 |
$190.80 |
$190.80 |
$475.36
|
|
Inj retro urethrocysto
|
$504.00 |
$504.00 |
$504.00 |
$447.74
|
|
Inj secukinumab intrav 1mg
|
$253.80 |
$253.80 |
$253.80 |
$4,413.21
|
|
Inj, sezaby, 1 mg
|
$79.80 |
$79.80 |
$79.80 |
$235.85
|
|
Inj, sutimlimab-jome, 10 mg
|
$52.20 |
$52.20 |
$52.20 |
$3,453.73
|
|
Inj teclistamab cqyv 0.5 mg
|
$3,345.00 |
$3,345.00 |
$3,345.00 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$184.20 |
$184.20 |
$184.20 |
$664.72
|
|
Inj. teprotumumab-trbw 10 mg
|
$9,829.20 |
$9,829.20 |
$9,829.20 |
$35,034.78
|
|
Inj testosterone cypionate
|
$12.60 |
$12.60 |
$12.60 |
$64.96
|
|
Inj thiotepa nos 1 mg
|
$450.00 |
$450.00 |
$450.00 |
$3,170.16
|
|
Inj., tildrakizumab, 1 mg
|
$10,342.20 |
$10,342.20 |
$10,342.20 |
$26,635.60
|
|
Inj, tyenne, 1 mg
|
$58.20 |
$58.20 |
$58.20 |
$3,525.12
|
|
Inj vasopressin (am reg) 1 u
|
$30.00 |
$30.00 |
$30.00 |
$41.79
|
|
Inj w/fluor eval cv device
|
$417.00 |
$417.00 |
$417.00 |
$504.40
|
|
Ins cath ren art 1st bi
|
$6,300.60 |
$6,300.60 |
$6,300.60 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$6,300.60 |
$6,300.60 |
$6,300.60 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$6,300.60 |
$6,300.60 |
$6,300.60 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$10,450.20 |
$10,450.20 |
$10,450.20 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$678.00 |
$678.00 |
$678.00 |
$490.73
|
|
Insert cannula vein-to-vein hemodialysis
|
$6,966.60 |
$6,966.60 |
$6,966.60 |
$7,279.50
|
|
Insert cath pleura with image
|
$10,384.20 |
$10,384.20 |
$10,384.20 |
$2,194.40
|
|
Insert drug delivery implant
|
$254.40 |
$254.40 |
$254.40 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$11,241.60 |
$11,241.60 |
$11,241.60 |
$7,571.20
|
|
Insert intrauterine device iud
|
$254.40 |
$254.40 |
$254.40 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$558.60 |
$558.60 |
$558.60 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$8,638.80 |
$8,638.80 |
$8,638.80 |
$4,897.20
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$2,447.63
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$9,498.60 |
$9,498.60 |
$9,498.60 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,472.00 |
$2,472.00 |
$2,472.00 |
$2,585.25
|
|
Insertion of catheter vein
|
$3,023.40 |
$3,023.40 |
$3,023.40 |
$1,525.80
|
|
Insertion of catheter vein
|
$4,608.60 |
$4,608.60 |
$4,608.60 |
$870.59
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$25,401.60 |
$25,401.60 |
$25,401.60 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$24,630.00 |
$24,630.00 |
$24,630.00 |
$12,324.60
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$5,751.00 |
$5,751.00 |
$5,751.00 |
$9,884.16
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,472.00 |
$2,472.00 |
$2,472.00 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,925.80 |
$3,925.80 |
$3,925.80 |
$2,453.83
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$48,933.60 |
$48,933.60 |
$48,933.60 |
$29,180.00
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$11,583.60 |
$11,583.60 |
$11,583.60 |
$7,183.68
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$11,583.60 |
$11,583.60 |
$11,583.60 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$17,281.80 |
$17,281.80 |
$17,281.80 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$8,004.00 |
$8,004.00 |
$8,004.00 |
$5,236.80
|
|
Insert picvad cath
|
$4,201.80 |
$4,201.80 |
$4,201.80 |
$4,195.00
|
|
Insert pm/icd lead dual
|
$11,583.60 |
$11,583.60 |
$11,583.60 |
$7,115.90
|
|
Insert/repl sq defib w/eltrd
|
$48,933.60 |
$48,933.60 |
$48,933.60 |
$33,593.55
|
|
Insert sq defib electrode
|
$12,994.80 |
$12,994.80 |
$12,994.80 |
$8,167.68
|
|
Insert swan-ganz cath
|
$2,472.00 |
$2,472.00 |
$2,472.00 |
$2,164.52
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$8,004.00 |
$8,004.00 |
$8,004.00 |
$4,997.60
|
|
Insert tunneled cv cath
|
$8,004.00 |
$8,004.00 |
$8,004.00 |
$4,520.00
|
|
Insert tunneled cv cath
|
$8,004.00 |
$8,004.00 |
$8,004.00 |
$6,028.07
|
|
Insert vad art access left hrt arterial access
|
$2,497.20 |
$2,497.20 |
$2,497.20 |
$4,276.00
|
|
Ins icd gen exist sgl lead
|
$34,428.60 |
$34,428.60 |
$34,428.60 |
$23,230.50
|
|
Insitu hybridization auto
|
$664.80 |
$664.80 |
$664.80 |
$377.37
|
|
Insitu hybridization manual
|
$664.80 |
$664.80 |
$664.80 |
$401.28
|
