|
Inj cntr knee arthro incl ct/mri
|
$169.05 |
$169.05 |
$169.05 |
$436.80
|
|
Inj dupuytren cord w/enzyme
|
$126.15 |
$126.15 |
$126.15 |
$416.00
|
|
Inj dx for sinogram
|
$202.65 |
$202.65 |
$202.65 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$312.90 |
$312.90 |
$312.90 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$169.05 |
$169.05 |
$169.05 |
$500.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$165.90 |
$165.90 |
$165.90 |
$504.90
|
|
Injection during cath supravalvular aortography
|
$67.35 |
$67.35 |
$67.35 |
$904.17
|
|
Injection epidural blood patch or clot
|
$352.95 |
$352.95 |
$352.95 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$60.75 |
$60.75 |
$60.75 |
$441.12
|
|
Injection for bladder x-ray
|
$66.90 |
$66.90 |
$66.90 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$197.40 |
$197.40 |
$197.40 |
$494.65
|
|
Injection for spleen x-ray
|
$91.20 |
$91.20 |
$91.20 |
$423.41
|
|
Injection for ureter x-ray
|
$264.30 |
$264.30 |
$264.30 |
$515.21
|
|
Injection, fulvestrant
|
$1,293.80 |
$1,293.80 |
$1,293.80 |
$1,719.16
|
|
Injection into brain canal
|
$320.10 |
$320.10 |
$320.10 |
$836.40
|
|
Injection of sinus tract
|
$265.95 |
$265.95 |
$265.95 |
$1,627.60
|
|
Injection radioactive tracer sentinel node (both sides)
|
$482.85 |
$482.85 |
$482.85 |
$683.28
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$471.15 |
$471.15 |
$471.15 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$187.95 |
$187.95 |
$187.95 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$293.70 |
$293.70 |
$293.70 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$352.80 |
$352.80 |
$352.80 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$787.50 |
$787.50 |
$787.50 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$828.90 |
$828.90 |
$828.90 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$129.90 |
$129.90 |
$129.90 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$552.30 |
$552.30 |
$552.30 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$152.25 |
$152.25 |
$152.25 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$447.90 |
$447.90 |
$447.90 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$235.35 |
$235.35 |
$235.35 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$245.85 |
$245.85 |
$245.85 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$235.35 |
$235.35 |
$235.35 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$27.75 |
$27.75 |
$27.75 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$43.65 |
$43.65 |
$43.65 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$59.70 |
$59.70 |
$59.70 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$31.95 |
$31.95 |
$31.95 |
$135.20
|
|
Inject sacroiliac joint
|
$342.15 |
$342.15 |
$342.15 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$138.45 |
$138.45 |
$138.45 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$323.40 |
$323.40 |
$323.40 |
$1,415.50
|
|
Inj for ext venography
|
$552.45 |
$552.45 |
$552.45 |
$654.00
|
|
Inj for mammo ductogram
|
$242.10 |
$242.10 |
$242.10 |
$433.50
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,237.50
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,757.00
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$1,071.00
|
|
Inj hrt cath w/s&i sel right vent
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$947.05
|
|
Inj intralesional <= 7 lsn(s)
|
$83.55 |
$83.55 |
$83.55 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$83.55 |
$83.55 |
$83.55 |
$235.13
|
|
Inj, lidocaine w epinephrine
|
$2.93 |
$2.93 |
$2.93 |
$44.96
|
|
Inj mepivacaine hcl/10 ml
|
$7.51 |
$7.51 |
$7.51 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$296.63 |
$296.63 |
$296.63 |
$536.27
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$702.45 |
$702.45 |
$702.45 |
$1,414.40
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$4,346.15 |
$4,346.15 |
$4,346.15 |
$6,371.38
|
|
Inj peritoneal venous shunt
|
$54.90 |
$54.90 |
$54.90 |
$406.80
|
|
Inj proc ankle arthr
|
$155.25 |
$155.25 |
$155.25 |
$405.31
|
|
Inj proc elbow arthro
|
$61.65 |
$61.65 |
$61.65 |
$432.00
|
|
Inj proc for lymphang
|
$661.50 |
$661.50 |
$661.50 |
$805.80
|
|
Inj proc lumbr disk ea lvl
|
$298.20 |
$298.20 |
$298.20 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$368.55 |
$368.55 |
$368.55 |
$856.00
|
|
Inj proc sialogram
|
$109.80 |
$109.80 |
$109.80 |
$373.00
|
|
Inj, releuko 1 mcg
|
$366.91 |
$366.91 |
$366.91 |
$461.20
|
|
Inj retro urethrocysto
|
$66.90 |
$66.90 |
$66.90 |
$450.00
|
|
Inj scleros sol mult veins
|
$158.55 |
$158.55 |
$158.55 |
$602.50
|
|
Inj scleros sol sgl vein
|
$267.00 |
$267.00 |
$267.00 |
$534.40
|
|
Inj sulf hexa lipid microsph
|
$86.15 |
$86.15 |
$86.15 |
$256.14
|
|
Inj testosterone cypionate
|
$48.91 |
$48.91 |
$48.91 |
$62.80
|
|
Inj w/fluor eval cv device
|
$241.50 |
$241.50 |
$241.50 |
$463.40
|
|
Ins cath ren art 1st bi
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$1,559.10 |
$1,559.10 |
$1,559.10 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$1,594.50 |
$1,594.50 |
$1,594.50 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$311.70 |
$311.70 |
$311.70 |
$488.35
|
|
Insert and remove bone pin
|
$506.70 |
$506.70 |
$506.70 |
$4,421.00
|
|
Insert cath pleura with image
|
$517.35 |
$517.35 |
$517.35 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,059.30 |
$1,059.30 |
$1,059.30 |
$2,019.00
|
|
Insert drug delivery implant
|
$55.35 |
$55.35 |
$55.35 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$3,418.65 |
$3,418.65 |
$3,418.65 |
$8,367.70
|
|
Insert intrauterine device iud
|
$223.65 |
$223.65 |
$223.65 |
$366.65
|
|
Insertion catheter bladder non indwelling
|
$34.95 |
$34.95 |
$34.95 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$43.20 |
$43.20 |
$43.20 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,377.90 |
$1,377.90 |
$1,377.90 |
$4,731.80
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,593.50 |
$2,593.50 |
$2,593.50 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$1,952.70 |
$1,952.70 |
$1,952.70 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$539.10 |
$539.10 |
$539.10 |
$2,511.00
|
|
Insertion of catheter vein
|
$546.75 |
$546.75 |
$546.75 |
$1,657.32
|
|
Insertion of heart electrode 33211
|
$1,898.55 |
$1,898.55 |
$1,898.55 |
$7,392.84
|
|
Insertion of infusion pump
|
$2,145.00 |
$2,145.00 |
$2,145.00 |
$5,907.78
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$4,345.65 |
$4,345.65 |
$4,345.65 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$3,981.15 |
$3,981.15 |
$3,981.15 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$2,714.40 |
$2,714.40 |
$2,714.40 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$514.50 |
$514.50 |
$514.50 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,046.85 |
$1,046.85 |
$1,046.85 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$15,687.75 |
$15,687.75 |
$15,687.75 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$1,898.55 |
$1,898.55 |
$1,898.55 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$1,898.55 |
$1,898.55 |
$1,898.55 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$4,215.15 |
$4,215.15 |
$4,215.15 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,087.95 |
$1,087.95 |
$1,087.95 |
$5,236.80
|
|
Insert pessary/other device
|
$37.20 |
$37.20 |
$37.20 |
$273.54
|
|
Insert pm/icd lead dual
|
$1,898.55 |
$1,898.55 |
$1,898.55 |
$7,388.80
|
|
Insert/repl sq defib w/eltrd
|
$14,695.35 |
$14,695.35 |
$14,695.35 |
$33,297.72
|
|
Insert sq defib electrode
|
$3,993.30 |
$3,993.30 |
$3,993.30 |
$8,167.68
|
|
Insert swan-ganz cath
|
$1,818.15 |
$1,818.15 |
$1,818.15 |
$2,210.50
|
