|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,054.40 |
$1,054.40 |
$1,054.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,778.40 |
$1,778.40 |
$1,778.40 |
$1,043.72
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$616.20 |
$616.20 |
$616.20 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$998.40 |
$998.40 |
$998.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$791.20 |
$791.20 |
$791.20 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$168.80 |
$168.80 |
$168.80 |
$145.60
|
|
Inj., emapalumab-lzsg, 1 mg
|
$1,790.40 |
$1,790.40 |
$1,790.40 |
$3,181.80
|
|
Inj epidural sgl lumb-sacral without img
|
$1,524.80 |
$1,524.80 |
$1,524.80 |
$1,450.84
|
|
Inj, epinephrine (belcher)
|
$6.60 |
$6.60 |
$6.60 |
$6.55
|
|
Inj. fe derisomaltose 10 mg
|
$141.60 |
$141.60 |
$141.60 |
$3,221.52
|
|
Inj for ext venography
|
$1,056.80 |
$1,056.80 |
$1,056.80 |
$628.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$1,327.20 |
$1,327.20 |
$1,327.20 |
$1,322.20
|
|
Inj givosiran 0.5 mg
|
$237.60 |
$237.60 |
$237.60 |
$76,708.80
|
|
Inj. herceptin hylecta, 10mg
|
$37.20 |
$37.20 |
$37.20 |
$8,193.78
|
|
Inj imip 4 cilas 4 releb 2mg
|
$652.80 |
$652.80 |
$652.80 |
$739.77
|
|
Inj levocarnitine per 1 gm
|
$205.60 |
$205.60 |
$205.60 |
$136.62
|
|
Inj., lumoxiti, 0.01 mg
|
$52.80 |
$52.80 |
$52.80 |
$3,881.27
|
|
Inj mepivacaine hcl/10 ml
|
$31.80 |
$31.80 |
$31.80 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$991.20 |
$991.20 |
$991.20 |
$556.87
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$558.40 |
$558.40 |
$558.40 |
$8,304.04
|
|
Inj multihance
|
$612.60 |
$612.60 |
$612.60 |
$70.54
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,264.80 |
$1,264.80 |
$1,264.80 |
$6,614.40
|
|
Inj. pemetrexed, 10 mg
|
$152.40 |
$152.40 |
$152.40 |
$104.72
|
|
Inj proc ankle arthr
|
$1,172.00 |
$1,172.00 |
$1,172.00 |
$405.31
|
|
Inj proc elbow arthro
|
$1,172.00 |
$1,172.00 |
$1,172.00 |
$432.00
|
|
Inj proc for lymphang
|
$574.40 |
$574.40 |
$574.40 |
$742.40
|
|
Inj proc myelogram lumbar
|
$1,323.20 |
$1,323.20 |
$1,323.20 |
$838.30
|
|
Inj proc sialogram
|
$1,172.00 |
$1,172.00 |
$1,172.00 |
$373.00
|
|
Inj prohance multipack
|
$46.20 |
$46.20 |
$46.20 |
$10.40
|
|
Inj retro urethrocysto
|
$4,464.00 |
$4,464.00 |
$4,464.00 |
$447.74
|
|
Inj tedizolid phosphate
|
$1,282.20 |
$1,282.20 |
$1,282.20 |
$664.72
|
|
Inj. teprotumumab-trbw 10 mg
|
$36,300.60 |
$36,300.60 |
$36,300.60 |
$35,034.78
|
|
Inj testosterone cypionate
|
$40.80 |
$40.80 |
$40.80 |
$64.96
|
|
Inj., tildrakizumab, 1 mg
|
$424.00 |
$424.00 |
$424.00 |
$26,635.60
|
|
Inj, tyenne, 1 mg
|
$12.60 |
$12.60 |
$12.60 |
$3,525.12
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$3.00 |
$3.00 |
$3.00 |
$41,083.73
|
|
Insert cath pleura with image
|
$2,467.20 |
$2,467.20 |
$2,467.20 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$2,099.70
|
|
Insert drug delivery implant
|
$1,437.00 |
$1,437.00 |
$1,437.00 |
$280.00
|
|
Insert intrauterine device iud
|
$733.60 |
$733.60 |
$733.60 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$298.40 |
$298.40 |
$298.40 |
$208.01
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,349.80 |
$3,349.80 |
$3,349.80 |
$2,585.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,204.80 |
$3,204.80 |
$3,204.80 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,532.00 |
$1,532.00 |
$1,532.00 |
$2,453.83
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$4,508.00 |
$4,508.00 |
$4,508.00 |
$5,236.80
|
|
Insert pessary/other device
|
$907.20 |
$907.20 |
$907.20 |
$278.90
|
|
Insitu hybridization manual
|
$412.80 |
$412.80 |
$412.80 |
$401.28
|
|
In situ hybridization per specimen initial single probe stain
|
$619.20 |
$619.20 |
$619.20 |
$338.40
|
|
Ins mark abd/pel for right perq
|
$4,976.80 |
$4,976.80 |
$4,976.80 |
$2,477.24
|
|
Ins picad w subq port 5yr>
|
$2,063.20 |
$2,063.20 |
$2,063.20 |
$4,078.00
|
|
Inst fibrinolysis agent ini day
|
$1,327.20 |
$1,327.20 |
$1,327.20 |
$1,043.35
|
|
Ins tun cvad 2 cath w/subq port(s)
|
$5,640.60 |
$5,640.60 |
$5,640.60 |
$7,826.00
|
|
Ins tun cv cath wo subq prt/pm
|
$5,788.20 |
$5,788.20 |
$5,788.20 |
$4,218.00
|
|
Insulin total
|
$200.00 |
$200.00 |
$200.00 |
$66.64
|
|
Interferon alfa-2b inj
|
$1,111.20 |
$1,111.20 |
$1,111.20 |
$1,409.92
|
|
Interfyl, 1 mg
|
$6,389.60 |
$6,389.60 |
$6,389.60 |
$4,656.80
|
|
Int hrhc lig 1 hroid without img
|
$4,520.00 |
$4,520.00 |
$4,520.00 |
$3,491.25
|
|
Intraoral i+d tongue/floor lingual 41000
|
$1,291.20 |
$1,291.20 |
$1,291.20 |
$1,331.45
|
|
Intrapul surf admin endo tube
|
$73.60 |
$73.60 |
$73.60 |
$220.80
|
|
Intrinsic factor antibody
|
$246.40 |
$246.40 |
$246.40 |
$65.00
|
|
Intro long gi tube
|
$3,526.20 |
$3,526.20 |
$3,526.20 |
$974.17
|
|
Intro long gi tube w/mult fluo
|
$464.80 |
$464.80 |
$464.80 |
$469.00
|
|
Intubation endotracheal emergency procedure
|
$868.80 |
$868.80 |
$868.80 |
$601.28
|
|
Iodine i-123 sod iodide mil
|
$1,979.20 |
$1,979.20 |
$1,979.20 |
$386.37
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$41.40 |
$41.40 |
$41.40 |
$165.67
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$78.60 |
$78.60 |
$78.60 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$33,224.40 |
$33,224.40 |
$33,224.40 |
$62,692.46
|
|
Ipratropium bromide non-comp
|
$7.20 |
$7.20 |
$7.20 |
$4.06
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$1,091.20 |
$1,091.20 |
$1,091.20 |
$173.98
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$210.60 |
$210.60 |
$210.60 |
$5,517.12
|
|
Iron
|
$58.20 |
$58.20 |
$58.20 |
$75.00
|
|
Iron binding capacity
|
$121.60 |
$121.60 |
$121.60 |
$63.91
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$555.60 |
$555.60 |
$555.60 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$98.40 |
$98.40 |
$98.40 |
$115.20
|
|
Irrigation implantable venous access device for drug delivery systems
|
$201.60 |
$201.60 |
$201.60 |
$146.11
|
|
Irrigation vagina and/or appl medicament tx disease
|
$891.20 |
$891.20 |
$891.20 |
$132.00
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$149.40 |
$149.40 |
$149.40 |
$8,273.35
|
|
IV Fluids (each additional hour)
|
$389.60 |
$389.60 |
$389.60 |
$133.90
|
|
IV Fluids (first hour)
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$390.00
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$344.80 |
$344.80 |
$344.80 |
$162.68
|
|
IV Medicine Infusion (additional drug)
|
$285.60 |
$285.60 |
$285.60 |
$191.75
|
|
IV Medicine Infusion (each additional hour)
|
$344.80 |
$344.80 |
$344.80 |
$154.00
|
|
IV Medicine Infusion (first hour)
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$439.56
|
|
IV Push Injection (each additional drug)
|
$177.60 |
$177.60 |
$177.60 |
$167.50
|
|
IV Push Injection (first drug)
|
$200.00 |
$200.00 |
$200.00 |
$252.76
|
|
Ivp w/wo kub w/wo tomography
|
$1,552.00 |
$1,552.00 |
$1,552.00 |
$713.40
|
|
Ixabepilone 15 mg intravenous solution
|
$16,246.20 |
$16,246.20 |
$16,246.20 |
$10,695.32
|
|
Jak2 targeted sequence analysis
|
$1,223.20 |
$1,223.20 |
$1,223.20 |
$405.00
|
|
Jaw Joint (TMJ) X-ray (both sides, open and closed)
|
$816.80 |
$816.80 |
$816.80 |
$330.05
|
|
Jaw (Mandible) X-ray (complete)
|
$499.20 |
$499.20 |
$499.20 |
$362.05
|
|
Jejunstmy tube plcmt
|
$4,128.80 |
$4,128.80 |
$4,128.80 |
$2,174.40
|
|
John cunningham antibody
|
$3,827.20 |
$3,827.20 |
$3,827.20 |
$78.00
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$211.20 |
$211.20 |
$211.20 |
$58.56
|
|
Ketorolac (Toradol) Pain Shot, 15 mg
|
$24.60 |
$24.60 |
$24.60 |
$23.52
|
|
Kidney function study
|
$1,426.40 |
$1,426.40 |
$1,426.40 |
$935.22
|
|
Kidney imaging morphology
|
$2,058.40 |
$2,058.40 |
$2,058.40 |
$785.00
|
|
Kidney imag w/bld flow multi
|
$1,404.00 |
$1,404.00 |
$1,404.00 |
$1,566.50
|
|
Kidney img w/bldflw sgl without rx
|
$1,877.60 |
$1,877.60 |
$1,877.60 |
$1,433.22
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$886.40 |
$886.40 |
$886.40 |
$673.36
|
|
Kidney (Retroperitoneal) Ultrasound (limited)
|
$844.00 |
$844.00 |
$844.00 |
$490.75
|
