|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,320.00 |
$2,320.00 |
$2,320.00 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$18,770.50 |
$18,770.50 |
$18,770.50 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,752.00 |
$2,752.00 |
$2,752.00 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,837.00 |
$3,837.00 |
$3,837.00 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$5,784.00 |
$5,784.00 |
$5,784.00 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$12,920.00 |
$12,920.00 |
$12,920.00 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$5,784.00 |
$5,784.00 |
$5,784.00 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$12,920.00 |
$12,920.00 |
$12,920.00 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,990.50 |
$2,990.50 |
$2,990.50 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,980.00 |
$1,980.00 |
$1,980.00 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$4,121.25 |
$4,121.25 |
$4,121.25 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,247.50 |
$1,247.50 |
$1,247.50 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,292.00 |
$1,292.00 |
$1,292.00 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$342.00 |
$342.00 |
$342.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$610.00 |
$610.00 |
$610.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$443.00 |
$443.00 |
$443.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$259.00 |
$259.00 |
$259.00 |
$135.60
|
|
Inject sacroiliac joint
|
$2,320.00 |
$2,320.00 |
$2,320.00 |
$1,028.95
|
|
Inject/treat eye socket
|
$688.00 |
$688.00 |
$688.00 |
$381.13
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$73.50 |
$73.50 |
$73.50 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$534.00 |
$534.00 |
$534.00 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$973.50 |
$973.50 |
$973.50 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$3.50 |
$3.50 |
$3.50 |
$206.64
|
|
Inj, faricimab-svoa, 0.1mg
|
$88.50 |
$88.50 |
$88.50 |
$4,103.29
|
|
Inj for ext venography
|
$1,071.00 |
$1,071.00 |
$1,071.00 |
$649.95
|
|
Inj for mammo ductogram
|
$355.50 |
$355.50 |
$355.50 |
$399.60
|
|
Inj, fulvestrant (fresenius)
|
$371.95 |
$371.95 |
$371.95 |
$1,043.05
|
|
Inj., guselkumab, 1 mg
|
$27,745.60 |
$27,745.60 |
$27,745.60 |
$29,130.83
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,688.50 |
$1,688.50 |
$1,688.50 |
$1,439.90
|
|
Inj hrt cath w/s&i sel right vent
|
$1,688.50 |
$1,688.50 |
$1,688.50 |
$965.33
|
|
Inj. inebilizumab-cdon, 1 mg
|
$140,248.50 |
$140,248.50 |
$140,248.50 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$229.00 |
$229.00 |
$229.00 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$229.00 |
$229.00 |
$229.00 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$28.50 |
$28.50 |
$28.50 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$6,570.00 |
$6,570.00 |
$6,570.00 |
$6,967.29
|
|
Inj, lecanemab-irmb, 1 mg
|
$3,181.92 |
$3,181.92 |
$3,181.92 |
$1,174.88
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$949.50 |
$949.50 |
$949.50 |
$784.00
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$118.50 |
$118.50 |
$118.50 |
$1,496.55
|
|
Inj multihance
|
$6.00 |
$6.00 |
$6.00 |
$73.49
|
|
Inj multihance multipack
|
$69.17 |
$69.17 |
$69.17 |
$2.80
|
|
Inj naloxone hydrochloride
|
$9.43 |
$9.43 |
$9.43 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$807.50 |
$807.50 |
$807.50 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$3,403.50 |
$3,403.50 |
$3,403.50 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,403.50 |
$3,403.50 |
$3,403.50 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$101.00 |
$101.00 |
$101.00 |
$66,582.27
|
|
Inj., patisiran, 0.1 mg
|
$25,049.60 |
$25,049.60 |
$25,049.60 |
$17,613.00
|
|
Inj, pegcetacoplan, 1mg
|
$338.50 |
$338.50 |
$338.50 |
$3,662.96
|
|
Inj., perseris, 0.5 mg
|
$25.00 |
$25.00 |
$25.00 |
$5,146.85
|
|
Inj proc elbow arthro
|
$197.00 |
$197.00 |
$197.00 |
$419.60
|
|
Inj proc lumbr disk ea lvl
|
$390.50 |
$390.50 |
$390.50 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$234.50 |
$234.50 |
$234.50 |
$830.50
|
|
Inj retacrit esrd on dialysi
|
$2.50 |
$2.50 |
$2.50 |
$349.45
|
|
Inj retro urethrocysto
|
$223.00 |
$223.00 |
$223.00 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$622.62 |
$622.62 |
$622.62 |
$746.79
|
|
Inj scleros sol mult veins
|
$690.50 |
$690.50 |
$690.50 |
$675.00
|
|
Inj scleros sol sgl vein
|
$690.50 |
$690.50 |
$690.50 |
$558.97
|
|
Inj secukinumab intrav 1mg
|
$9,902.97 |
$9,902.97 |
$9,902.97 |
$4,413.21
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$725.00 |
$725.00 |
$725.00 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$70.37 |
$70.37 |
$70.37 |
$256.14
|
|
Inj, susvimo 0.1 mg
|
$180.00 |
$180.00 |
$180.00 |
$2,598.44
|
|
Inj. teprotumumab-trbw 10 mg
|
$85,731.89 |
$85,731.89 |
$85,731.89 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$0.50 |
$0.50 |
$0.50 |
$123.24
|
|
Inj testosterone cypionate
|
$450.00 |
$450.00 |
$450.00 |
$64.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$976.00 |
$976.00 |
$976.00 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$837.50 |
$837.50 |
$837.50 |
$837.50
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,546.86 |
$1,546.86 |
$1,546.86 |
$1,090.75
|
|
Inj., triptorelin X-ray 3.75 mg
|
$44,595.34 |
$44,595.34 |
$44,595.34 |
$34,503.95
|
|
Inj, trivisc 1 mg
|
$37.50 |
$37.50 |
$37.50 |
$6.67
|
|
Inj, uzedy, 1 mg
|
$50.50 |
$50.50 |
$50.50 |
$11,475.96
|
|
Inj w/fluor eval cv device
|
$395.50 |
$395.50 |
$395.50 |
$503.92
|
|
Inj xipere 1 mg
|
$93.00 |
$93.00 |
$93.00 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$1,158.50 |
$1,158.50 |
$1,158.50 |
$14,458.60
|
|
Ins cath ren art 1st bi
|
$5,783.00 |
$5,783.00 |
$5,783.00 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$5,783.00 |
$5,783.00 |
$5,783.00 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$2,870.00 |
$2,870.00 |
$2,870.00 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$5,039.50 |
$5,039.50 |
$5,039.50 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$632.50 |
$632.50 |
$632.50 |
$480.28
|
|
Insert ant drainage device
|
$1,799.83 |
$1,799.83 |
$1,799.83 |
$4,881.00
|
|
Insert cath pleura with image
|
$1,188.00 |
$1,188.00 |
$1,188.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,222.50 |
$2,222.50 |
$2,222.50 |
$2,073.18
|
|
Insert drug delivery implant
|
$287.50 |
$287.50 |
$287.50 |
$280.00
|
|
Insert epicardial lead open 33202
|
$10,524.50 |
$10,524.50 |
$10,524.50 |
$3,775.20
|
|
Insert intervert bimech device 22854
|
$4,007.50 |
$4,007.50 |
$4,007.50 |
$1,573.00
|
|
Insert intrauterine device iud
|
$1,247.83 |
$1,247.83 |
$1,247.83 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$318.50 |
$318.50 |
$318.50 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$253.00 |
$253.00 |
$253.00 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,135.00 |
$3,135.00 |
$3,135.00 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,803.50 |
$1,803.50 |
$1,803.50 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$5,039.50 |
$5,039.50 |
$5,039.50 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$5,187.00 |
$5,187.00 |
$5,187.00 |
$2,505.60
|
|
Insertion of heart electrode 33211
|
$5,915.00 |
$5,915.00 |
$5,915.00 |
$6,903.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$8,365.00 |
$8,365.00 |
$8,365.00 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$5,362.50 |
$5,362.50 |
$5,362.50 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$7,737.50 |
$7,737.50 |
$7,737.50 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,309.50 |
$3,309.50 |
$3,309.50 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,151.50 |
$3,151.50 |
$3,151.50 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$11,267.50 |
$11,267.50 |
$11,267.50 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$5,915.00 |
$5,915.00 |
$5,915.00 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$5,915.00 |
$5,915.00 |
$5,915.00 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$16,155.00 |
$16,155.00 |
$16,155.00 |
$9,332.50
|
