|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,428.60 |
$1,428.60 |
$1,428.60 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,066.49 |
$4,066.49 |
$4,066.49 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$2,804.60 |
$2,804.60 |
$2,804.60 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,804.60 |
$2,804.60 |
$2,804.60 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$3,925.85 |
$3,925.85 |
$3,925.85 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$3,925.85 |
$3,925.85 |
$3,925.85 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,284.40 |
$3,284.40 |
$3,284.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,752.74 |
$3,752.74 |
$3,752.74 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$947.40 |
$947.40 |
$947.40 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$528.00 |
$528.00 |
$528.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$226.80 |
$226.80 |
$226.80 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$259.20 |
$259.20 |
$259.20 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$168.00 |
$168.00 |
$168.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$396.00 |
$396.00 |
$396.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$148.20 |
$148.20 |
$148.20 |
$135.60
|
|
Inject sacroiliac joint
|
$789.00 |
$789.00 |
$789.00 |
$1,028.95
|
|
Inj., eravacycline, 1 mg
|
$463.05 |
$463.05 |
$463.05 |
$206.64
|
|
Inj for ext venography
|
$3,445.20 |
$3,445.20 |
$3,445.20 |
$649.95
|
|
Inj glycopyrrolate, glyrx-pf
|
$48.00 |
$48.00 |
$48.00 |
$11.23
|
|
Inj. herceptin hylecta, 10mg
|
$27,209.90 |
$27,209.90 |
$27,209.90 |
$7,690.59
|
|
Inj, immphentiv, 20 mcg
|
$48.00 |
$48.00 |
$48.00 |
$18.44
|
|
Inj ivig privigen 500 mg
|
$44,204.54 |
$44,204.54 |
$44,204.54 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$48.00 |
$48.00 |
$48.00 |
$38.94
|
|
Inj levocarnitine per 1 gm
|
$367.37 |
$367.37 |
$367.37 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$1,137.40 |
$1,137.40 |
$1,137.40 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$221.32 |
$221.32 |
$221.32 |
$47.52
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,407.60 |
$1,407.60 |
$1,407.60 |
$784.00
|
|
Inj mepivacaine hcl/10 ml
|
$48.00 |
$48.00 |
$48.00 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$2,102.63 |
$2,102.63 |
$2,102.63 |
$558.08
|
|
Inj multihance
|
$165.31 |
$165.31 |
$165.31 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$1,020.40 |
$1,020.40 |
$1,020.40 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$5,178.00 |
$5,178.00 |
$5,178.00 |
$1,413.35
|
|
Inj octafluoropropane mic,ml
|
$168.48 |
$168.48 |
$168.48 |
$211.40
|
|
Inj, releuko 1 mcg
|
$1,465.34 |
$1,465.34 |
$1,465.34 |
$473.25
|
|
Inj, rimabotulinumtoxinb
|
$3,658.06 |
$3,658.06 |
$3,658.06 |
$746.79
|
|
Inj sulf hexa lipid microsph
|
$1,023.12 |
$1,023.12 |
$1,023.12 |
$256.14
|
|
Inj. teprotumumab-trbw 10 mg
|
$54,056.85 |
$54,056.85 |
$54,056.85 |
$35,034.78
|
|
Inj testosterone cypionate
|
$56.21 |
$56.21 |
$56.21 |
$64.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,407.60 |
$1,407.60 |
$1,407.60 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$756.00 |
$756.00 |
$756.00 |
$837.50
|
|
Inj. tigecycline (accord)
|
$226.39 |
$226.39 |
$226.39 |
$188.03
|
|
Inj, tyenne, 1 mg
|
$11,280.38 |
$11,280.38 |
$11,280.38 |
$3,525.12
|
|
Inj vocal cord bulking agent
|
$3,821.27 |
$3,821.27 |
$3,821.27 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$597.00 |
$597.00 |
$597.00 |
$503.92
|
|
Ins cath ren art 1st bi
|
$45,092.87 |
$45,092.87 |
$45,092.87 |
$5,753.10
|
|
Ins cath ren art 2nd+ uni
|
$7,228.20 |
$7,228.20 |
$7,228.20 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$600.60 |
$600.60 |
$600.60 |
$480.28
|
|
Insert and remove bone pin
|
$2,481.60 |
$2,481.60 |
$2,481.60 |
$4,410.60
|
|
Insert ant drainage device
|
$28,700.57 |
$28,700.57 |
$28,700.57 |
$4,881.00
|
|
Insert cath pleura with image
|
$1,557.00 |
$1,557.00 |
$1,557.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,452.00 |
$1,452.00 |
$1,452.00 |
$2,073.18
|
|
Insert drug delivery implant
|
$23,930.31 |
$23,930.31 |
$23,930.31 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$12,355.20 |
$12,355.20 |
$12,355.20 |
$7,571.20
|
|
Insert intrauterine device iud
|
$14,894.51 |
$14,894.51 |
$14,894.51 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$118.20 |
$118.20 |
$118.20 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$133.80 |
$133.80 |
$133.80 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$10,320.60 |
$10,320.60 |
$10,320.60 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$9,093.00 |
$9,093.00 |
$9,093.00 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$8,932.80 |
$8,932.80 |
$8,932.80 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,607.60 |
$2,607.60 |
$2,607.60 |
$2,505.60
|
|
Insertion of catheter vein
|
$1,956.60 |
$1,956.60 |
$1,956.60 |
$1,477.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$49,731.93 |
$49,731.93 |
$49,731.93 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$23,722.20 |
$23,722.20 |
$23,722.20 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$87,845.56 |
$87,845.56 |
$87,845.56 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$6,373.80 |
$6,373.80 |
$6,373.80 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$5,815.20 |
$5,815.20 |
$5,815.20 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$173,081.24 |
$173,081.24 |
$173,081.24 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$8,140.20 |
$8,140.20 |
$8,140.20 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$11,513.40 |
$11,513.40 |
$11,513.40 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$11,830.80 |
$11,830.80 |
$11,830.80 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$11,606.62 |
$11,606.62 |
$11,606.62 |
$5,223.20
|
|
Insert/repl sq defib w/eltrd
|
$65,328.00 |
$65,328.00 |
$65,328.00 |
$32,800.04
|
|
Insert vad art access left hrt arterial access
|
$10,623.60 |
$10,623.60 |
$10,623.60 |
$4,270.75
|
|
Ins icd gen exist mlt leads
|
$66,838.20 |
$66,838.20 |
$66,838.20 |
$31,286.77
|
|
Insitu hybridization manual
|
$540.00 |
$540.00 |
$540.00 |
$401.28
|
|
In situ hybridization per specimen each additional single probe stain
|
$301.80 |
$301.80 |
$301.80 |
$241.15
|
|
In situ hybridization per specimen initial single probe stain
|
$552.00 |
$552.00 |
$552.00 |
$331.69
|
|
Insj biomechanical device 22853
|
$66,967.48 |
$66,967.48 |
$66,967.48 |
$622.40
|
|
Ins lv lead exist pm/icd
|
$9,433.80 |
$9,433.80 |
$9,433.80 |
$12,384.25
|
|
Ins mark abd/pel for right perq
|
$2,620.20 |
$2,620.20 |
$2,620.20 |
$2,414.36
|
|
Insole orthotic freedom sz6 6816
|
$345.73 |
$345.73 |
$345.73 |
$84.00
|
|
Ins pq tunnld ip cath w/img
|
$7,071.60 |
$7,071.60 |
$7,071.60 |
$5,377.00
|
|
Ins/rplc spi npg/rcvr pocket
|
$153,823.48 |
$153,823.48 |
$153,823.48 |
$24,061.80
|
|
Ins/rpl ldless pm right vent w img & eval
|
$42,183.00 |
$42,183.00 |
$42,183.00 |
$24,135.54
|
|
Ins/rpl pm w/tv ld atrl
|
$12,371.40 |
$12,371.40 |
$12,371.40 |
$11,583.66
|
|
Ins/rpl prph sac/gstr npg/r
|
$95,752.73 |
$95,752.73 |
$95,752.73 |
$21,857.50
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$6,736.80 |
$6,736.80 |
$6,736.80 |
$25,694.00
|
|
Insrt/redo neurostim 1 array
|
$210,230.85 |
$210,230.85 |
$210,230.85 |
$21,817.60
|
|
Inst fibrinolysis agent ini day
|
$1,090.80 |
$1,090.80 |
$1,090.80 |
$1,036.05
|
|
Instillation anticarcinogenic agent bladder
|
$13,909.75 |
$13,909.75 |
$13,909.75 |
$621.40
|
|
Ins tun cv cath wo subq prt/pm
|
$7,405.22 |
$7,405.22 |
$7,405.22 |
$4,202.70
|
|
Insulin total
|
$87.60 |
$87.60 |
$87.60 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$24,018.70 |
$24,018.70 |
$24,018.70 |
$8,629.72
|
|
Integra meshed bil wound mat
|
$78,781.80 |
$78,781.80 |
$78,781.80 |
$9,924.16
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$18,118.52 |
$18,118.52 |
$18,118.52 |
$3,803.11
|
|
Intens behave ther cardio dx
|
$20.40 |
$20.40 |
$20.40 |
$47.60
|
|
Interdental fixation
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$2,133.48
|
|
Interdiscal perq aspir dx
|
$1,542.60 |
$1,542.60 |
$1,542.60 |
$1,222.26
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$50,272.00 |
$50,272.00 |
$50,272.00 |
$10,427.90
|
|
Interfyl, 1 mg
|
$10,398.00 |
$10,398.00 |
$10,398.00 |
$4,656.80
|
