|
Injection epidural blood patch or clot
|
$1,000.00 |
$1,000.00 |
$1,000.00 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$460.00 |
$460.00 |
$460.00 |
$441.12
|
|
Injection for bladder x-ray
|
$380.00 |
$380.00 |
$380.00 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$460.00 |
$460.00 |
$460.00 |
$494.65
|
|
Injection for ureter x-ray
|
$1,615.00 |
$1,615.00 |
$1,615.00 |
$415.80
|
|
Injection for ureter x-ray
|
$640.00 |
$640.00 |
$640.00 |
$515.21
|
|
Injection, fulvestrant
|
$259.05 |
$259.05 |
$259.05 |
$1,719.16
|
|
Injection jaw joint x-ray
|
$460.00 |
$460.00 |
$460.00 |
$307.80
|
|
Injection radioactive tracer sentinel node (both sides)
|
$257.50 |
$257.50 |
$257.50 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,195.00 |
$1,195.00 |
$1,195.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$515.00 |
$515.00 |
$515.00 |
$1,045.65
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$580.00 |
$580.00 |
$580.00 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$895.00 |
$895.00 |
$895.00 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$142.50 |
$142.50 |
$142.50 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$142.50 |
$142.50 |
$142.50 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$142.50 |
$142.50 |
$142.50 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$55.00 |
$55.00 |
$55.00 |
$135.20
|
|
Inject sacroiliac joint
|
$2,250.00 |
$2,250.00 |
$2,250.00 |
$963.00
|
|
Inj for ext venography
|
$610.00 |
$610.00 |
$610.00 |
$654.00
|
|
Inj for mammo ductogram
|
$172.50 |
$172.50 |
$172.50 |
$433.50
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$650.00 |
$650.00 |
$650.00 |
$783.50
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$925.00 |
$925.00 |
$925.00 |
$1,414.40
|
|
Inj pemetrexed (sandoz) 10mg
|
$684.75 |
$684.75 |
$684.75 |
$95.26
|
|
Inj peritoneal venous shunt
|
$485.00 |
$485.00 |
$485.00 |
$406.80
|
|
Inj proc ankle arthr
|
$460.00 |
$460.00 |
$460.00 |
$405.31
|
|
Inj proc elbow arthro
|
$460.00 |
$460.00 |
$460.00 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$580.00 |
$580.00 |
$580.00 |
$856.00
|
|
Inj proc sialogram
|
$175.00 |
$175.00 |
$175.00 |
$373.00
|
|
Inj retro urethrocysto
|
$450.00 |
$450.00 |
$450.00 |
$450.00
|
|
Inj scleros sol mult veins
|
$425.00 |
$425.00 |
$425.00 |
$602.50
|
|
Inj thrc fascial pln blk bi w/wo image
|
$775.00 |
$775.00 |
$775.00 |
$1,025.00
|
|
Inj thrc fascial pln blk uni w/wo image
|
$650.00 |
$650.00 |
$650.00 |
$818.00
|
|
Inj w/fluor eval cv device
|
$377.50 |
$377.50 |
$377.50 |
$463.40
|
|
Ins cath ren art 1st bi
|
$4,280.00 |
$4,280.00 |
$4,280.00 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$3,425.00 |
$3,425.00 |
$3,425.00 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$4,280.00 |
$4,280.00 |
$4,280.00 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$3,425.00 |
$3,425.00 |
$3,425.00 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$382.50 |
$382.50 |
$382.50 |
$488.35
|
|
Insert cath pleura with image
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$2,019.00
|
|
Insert hepatic shunt (tips)
|
$11,055.00 |
$11,055.00 |
$11,055.00 |
$8,367.70
|
|
Insert intrauterine device iud
|
$570.00 |
$570.00 |
$570.00 |
$366.65
|
|
Insertion catheter bladder non indwelling
|
$117.50 |
$117.50 |
$117.50 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$195.00 |
$195.00 |
$195.00 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,125.00 |
$3,125.00 |
$3,125.00 |
$4,731.80
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$4,295.00 |
$4,295.00 |
$4,295.00 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$2,511.00
|
|
Insertion of catheter vein
|
$880.00 |
$880.00 |
$880.00 |
$1,657.32
|
|
Insertion of catheter vein
|
$760.00 |
$760.00 |
$760.00 |
$836.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,015.00 |
$2,015.00 |
$2,015.00 |
$2,414.10
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$5,320.00 |
$5,320.00 |
$5,320.00 |
$5,236.80
|
|
Insert pessary/other device
|
$157.50 |
$157.50 |
$157.50 |
$273.54
|
|
Insert tunneled cv cath
|
$5,320.00 |
$5,320.00 |
$5,320.00 |
$6,075.30
|
|
Insert uteri tandem/ovoids
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
$3,905.20
|
|
Insitu hybridization manual
|
$357.50 |
$357.50 |
$357.50 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$257.50 |
$257.50 |
$257.50 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$322.50 |
$322.50 |
$322.50 |
$326.04
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$1,855.00 |
$1,855.00 |
$1,855.00 |
$1,609.25
|
|
Ins pq tunnld ip cath w/img
|
$3,490.00 |
$3,490.00 |
$3,490.00 |
$5,377.00
|
|
Ins tun cv cath wo subq prt/pm
|
$4,405.00 |
$4,405.00 |
$4,405.00 |
$5,324.80
|
|
Ins tun cv cath wo subq prt/pm
|
$4,405.00 |
$4,405.00 |
$4,405.00 |
$4,202.70
|
|
Ins tun intraperit dia cath
|
$3,130.00 |
$3,130.00 |
$3,130.00 |
$4,657.46
|
|
Insulin total
|
$65.00 |
$65.00 |
$65.00 |
$66.64
|
|
Ins vag brachytx device
|
$1,125.00 |
$1,125.00 |
$1,125.00 |
$897.75
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$3,825.00
|
|
Interdiscal perq aspir dx
|
$710.00 |
$710.00 |
$710.00 |
$1,180.84
|
|
Interrog evl pm/ldls pm ip
|
$310.00 |
$310.00 |
$310.00 |
$124.80
|
|
Interstitial brachy inter
|
$1,275.00 |
$1,275.00 |
$1,275.00 |
$1,129.00
|
|
Intrinsic factor antibody
|
$95.00 |
$95.00 |
$95.00 |
$66.60
|
|
Intro cath dialysis circuit
|
$1,145.00 |
$1,145.00 |
$1,145.00 |
$2,035.00
|
|
Intro cath dialysis circuit w/pta
|
$9,450.00 |
$9,450.00 |
$9,450.00 |
$8,761.00
|
|
Intro catheter aorta
|
$1,060.00 |
$1,060.00 |
$1,060.00 |
$1,654.05
|
|
Intro cath svc/ivc
|
$880.00 |
$880.00 |
$880.00 |
$1,329.90
|
|
Intro long gi tube
|
$457.50 |
$457.50 |
$457.50 |
$990.00
|
|
Intro long gi tube w/mult fluo
|
$317.50 |
$317.50 |
$317.50 |
$449.40
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$4,420.00 |
$4,420.00 |
$4,420.00 |
$3,303.76
|
|
Intubation endotracheal emergency procedure
|
$302.50 |
$302.50 |
$302.50 |
$589.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$8.88 |
$8.88 |
$8.88 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$4.65 |
$4.65 |
$4.65 |
$279.10
|
|
Io rad tx delivery by x-ray
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
$9,046.18
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$373.96 |
$373.96 |
$373.96 |
$62,692.46
|
|
Iron
|
$82.50 |
$82.50 |
$82.50 |
$74.40
|
|
Iron binding capacity
|
$72.50 |
$72.50 |
$72.50 |
$63.79
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$2.02 |
$2.02 |
$2.02 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$65.00 |
$65.00 |
$65.00 |
$119.83
|
|
Irrigation implantable venous access device for drug delivery systems
|
$112.50 |
$112.50 |
$112.50 |
$142.20
|
|
Ivc venogram s&i
|
$2,095.00 |
$2,095.00 |
$2,095.00 |
$3,316.95
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$97.50 |
$97.50 |
$97.50 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$97.50 |
$97.50 |
$97.50 |
$157.50
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$100.00 |
$100.00 |
$100.00 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$235.00 |
$235.00 |
$235.00 |
$439.56
|
|
Ivp w/wo kub w/wo tomography
|
$670.00 |
$670.00 |
$670.00 |
$692.18
|
|
Jak2 targeted sequence analysis
|
$475.00 |
$475.00 |
$475.00 |
$379.87
|
|
John cunningham antibody
|
$65.00 |
$65.00 |
$65.00 |
$72.60
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$47.50 |
$47.50 |
$47.50 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$12.60 |
$12.60 |
$12.60 |
$23.50
|
|
Kidney endoscopy
|
$1,665.00 |
$1,665.00 |
$1,665.00 |
$5,728.00
|
