|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$434.93 |
$434.93 |
$434.93 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$162.84 |
$162.84 |
$162.84 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$175.03 |
$175.03 |
$175.03 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$186.53 |
$186.53 |
$186.53 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$89.01 |
$89.01 |
$89.01 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$89.01 |
$89.01 |
$89.01 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$89.01 |
$89.01 |
$89.01 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$33.12 |
$33.12 |
$33.12 |
$135.20
|
|
Inject sacroiliac joint
|
$342.93 |
$342.93 |
$342.93 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$191.36 |
$191.36 |
$191.36 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$215.05 |
$215.05 |
$215.05 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$1,401.99 |
$1,401.99 |
$1,401.99 |
$6.24
|
|
Inj for ext venography
|
$221.72 |
$221.72 |
$221.72 |
$654.00
|
|
Inj, fosaprepitant (teva)
|
$45.56 |
$45.56 |
$45.56 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$585.13 |
$585.13 |
$585.13 |
$1,065.08
|
|
Inj gemcitabine hcl (accord)
|
$66.78 |
$66.78 |
$66.78 |
$113.90
|
|
Inj glycopyrrolate fres kabi
|
$14.01 |
$14.01 |
$14.01 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$9.94 |
$9.94 |
$9.94 |
$24.28
|
|
Inj, idacio, 1 mg
|
$573.85 |
$573.85 |
$573.85 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$128.11 |
$128.11 |
$128.11 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$5.03 |
$5.03 |
$5.03 |
$40.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$3,893.75 |
$3,893.75 |
$3,893.75 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$109.92 |
$109.92 |
$109.92 |
$103.60
|
|
Inj, linezolid (hospira)
|
$103.50 |
$103.50 |
$103.50 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$660.73 |
$660.73 |
$660.73 |
$2,375.23
|
|
Inj, meropenem (b. braun)
|
$47.73 |
$47.73 |
$47.73 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$49.88 |
$49.88 |
$49.88 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$62.29 |
$62.29 |
$62.29 |
$89.40
|
|
Inj, moxifloxacin 100 mg
|
$70.29 |
$70.29 |
$70.29 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$115.69 |
$115.69 |
$115.69 |
$252.66
|
|
Inj naloxone hydrochloride
|
$63.67 |
$63.67 |
$63.67 |
$83.16
|
|
Inj pantoprazole(hikma) 40mg
|
$20.99 |
$20.99 |
$20.99 |
$34.61
|
|
Inj pemetrexed (accord) 10mg
|
$666.73 |
$666.73 |
$666.73 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$31.67 |
$31.67 |
$31.67 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$1,013.28 |
$1,013.28 |
$1,013.28 |
$200.85
|
|
Inj progesterone per 50 mg
|
$50.66 |
$50.66 |
$50.66 |
$14.93
|
|
Inj romidepsin non-lyo 0.1mg
|
$5,079.82 |
$5,079.82 |
$5,079.82 |
$9,892.69
|
|
Inj testostero enanthate 1mg
|
$188.74 |
$188.74 |
$188.74 |
$157.81
|
|
Inj testosterone cypionate
|
$249.66 |
$249.66 |
$249.66 |
$62.80
|
|
Inj. tigecycline (accord)
|
$199.84 |
$199.84 |
$199.84 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$67.60 |
$67.60 |
$67.60 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$23.46 |
$23.46 |
$23.46 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$39.88 |
$39.88 |
$39.88 |
$40.24
|
|
Inj w/fluor eval cv device
|
$155.48 |
$155.48 |
$155.48 |
$463.40
|
|
Ins cath ren art 1st bi
|
$2,327.83 |
$2,327.83 |
$2,327.83 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$2,245.72 |
$2,245.72 |
$2,245.72 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$2,387.63 |
$2,387.63 |
$2,387.63 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$2,387.63 |
$2,387.63 |
$2,387.63 |
$5,419.00
|
|
Insert cath pleura without image
|
$464.60 |
$464.60 |
$464.60 |
$2,019.00
|
|
Insertion catheter bladder non indwelling
|
$52.67 |
$52.67 |
$52.67 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$44.39 |
$44.39 |
$44.39 |
$229.32
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,354.09 |
$3,354.09 |
$3,354.09 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,265.27 |
$2,265.27 |
$2,265.27 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$499.10 |
$499.10 |
$499.10 |
$2,511.00
|
|
Insertion of heart electrode 33211
|
$4,535.14 |
$4,535.14 |
$4,535.14 |
$7,392.84
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$10,849.79 |
$10,849.79 |
$10,849.79 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$10,849.79 |
$10,849.79 |
$10,849.79 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$11,998.18 |
$11,998.18 |
$11,998.18 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$396.29 |
$396.29 |
$396.29 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$503.24 |
$503.24 |
$503.24 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$18,862.76 |
$18,862.76 |
$18,862.76 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$4,535.14 |
$4,535.14 |
$4,535.14 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$4,013.73 |
$4,013.73 |
$4,013.73 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$5,735.74 |
$5,735.74 |
$5,735.74 |
$9,397.50
|
|
Insert pm/icd lead dual
|
$4,174.27 |
$4,174.27 |
$4,174.27 |
$7,388.80
|
|
Insert/repl sq defib w/eltrd
|
$18,160.34 |
$18,160.34 |
$18,160.34 |
$33,297.72
|
|
Insert sq defib electrode
|
$3,856.64 |
$3,856.64 |
$3,856.64 |
$8,167.68
|
|
Insert swan-ganz cath
|
$1,137.35 |
$1,137.35 |
$1,137.35 |
$2,210.50
|
|
Ins icd gen exist mlt leads
|
$17,494.72 |
$17,494.72 |
$17,494.72 |
$31,286.77
|
|
Ins icd gen exist sgl lead
|
$16,055.84 |
$16,055.84 |
$16,055.84 |
$23,742.75
|
|
Insitu hybridization auto
|
$115.23 |
$115.23 |
$115.23 |
$371.00
|
|
Insitu hybridization manual
|
$115.23 |
$115.23 |
$115.23 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$79.81 |
$79.81 |
$79.81 |
$243.60
|
|
Ins lv lead exist pm/icd
|
$12,478.19 |
$12,478.19 |
$12,478.19 |
$12,087.24
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$566.49 |
$566.49 |
$566.49 |
$1,609.25
|
|
Ins pm gen exist dual lead
|
$16,055.84 |
$16,055.84 |
$16,055.84 |
$24,696.00
|
|
Ins pm gen w/exist mlt leads
|
$10,849.79 |
$10,849.79 |
$10,849.79 |
$14,804.40
|
|
Ins/rpl ldless pm right vent w img & eval
|
$8,633.28 |
$8,633.28 |
$8,633.28 |
$23,369.00
|
|
Ins/rpl pm gen exist dual lead
|
$8,529.78 |
$8,529.78 |
$8,529.78 |
$11,408.40
|
|
Ins/rpl pm gen exist sgl lead
|
$8,529.78 |
$8,529.78 |
$8,529.78 |
$9,558.78
|
|
Ins/rpl pm w/tv ld atrl
|
$11,283.80 |
$11,283.80 |
$11,283.80 |
$12,371.40
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$22,729.29 |
$22,729.29 |
$22,729.29 |
$25,807.00
|
|
Instillation anticarcinogenic agent bladder
|
$242.88 |
$242.88 |
$242.88 |
$621.40
|
|
Ins tun cv cath wo subq prt/pm
|
$1,345.27 |
$1,345.27 |
$1,345.27 |
$4,202.70
|
|
Insulin total
|
$50.14 |
$50.14 |
$50.14 |
$66.64
|
|
Intens cardiac rehab no exer
|
$93.38 |
$93.38 |
$93.38 |
$238.40
|
|
Intens cardiac rehab w/exerc
|
$93.38 |
$93.38 |
$93.38 |
$238.40
|
|
Intro cath dialysis circuit
|
$321.08 |
$321.08 |
$321.08 |
$2,035.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$4,756.40 |
$4,756.40 |
$4,756.40 |
$15,805.00
|
|
Intro catheter aorta
|
$408.48 |
$408.48 |
$408.48 |
$1,654.05
|
|
Intro cath svc/ivc
|
$501.63 |
$501.63 |
$501.63 |
$1,329.90
|
|
Intro long gi tube
|
$379.04 |
$379.04 |
$379.04 |
$990.00
|
|
Intro long gi tube w/mult fluo
|
$104.42 |
$104.42 |
$104.42 |
$449.40
|
|
Intubation endotracheal emergency procedure
|
$278.99 |
$278.99 |
$278.99 |
$589.60
|
|
Iodine i-123 sod iodide mil
|
$322.68 |
$322.68 |
$322.68 |
$350.74
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$64.69 |
$64.69 |
$64.69 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$240.90 |
$240.90 |
$240.90 |
$279.10
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$73.40 |
$73.40 |
$73.40 |
$163.87
|
|
Iron
|
$36.34 |
$36.34 |
$36.34 |
$74.40
|
|
Iron binding capacity
|
$43.93 |
$43.93 |
$43.93 |
$63.79
|