|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$303.84 |
$303.84 |
$303.84 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$1,371.84 |
$1,371.84 |
$1,371.84 |
$645.79
|
|
Inj, artesunate, 1mg
|
$10,275.09 |
$10,275.09 |
$10,275.09 |
$18,824.75
|
|
Inj, bupivacaine liposome
|
$77.26 |
$77.26 |
$77.26 |
$638.07
|
|
Inj cefazolin sodium, hikma
|
$44.76 |
$44.76 |
$44.76 |
$34.59
|
|
Inj cefazolin (wg crit care)
|
$44.76 |
$44.76 |
$44.76 |
$25.00
|
|
Inj, cefiderocol, 10 mg
|
$717.33 |
$717.33 |
$717.33 |
$596.08
|
|
Inj ceftolozane tazobactam
|
$445.07 |
$445.07 |
$445.07 |
$431.36
|
|
Inj cntr knee arthro incl ct/mri
|
$113.28 |
$113.28 |
$113.28 |
$464.28
|
|
Inj cyclophosphamd auromedic
|
$398.58 |
$398.58 |
$398.58 |
$231.57
|
|
Inj cyclophosphamd (ingenus)
|
$805.62 |
$805.62 |
$805.62 |
$493.23
|
|
Inj, daptomycin (hospira)
|
$132.80 |
$132.80 |
$132.80 |
$152.35
|
|
Inj dx for sinogram
|
$245.76 |
$245.76 |
$245.76 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,352.64 |
$1,352.64 |
$1,352.64 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$331.68 |
$331.68 |
$331.68 |
$507.10
|
|
Injection, cangrelor
|
$2,638.56 |
$2,638.56 |
$2,638.56 |
$1,943.40
|
|
Injection carpal tunnel therapeutic (both sides)
|
$706.56 |
$706.56 |
$706.56 |
$536.00
|
|
Injection, daratumumab 10 mg
|
$4,425.02 |
$4,425.02 |
$4,425.02 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$1,800.96 |
$1,800.96 |
$1,800.96 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$1,065.12 |
$1,065.12 |
$1,065.12 |
$1,473.12
|
|
Injection eye drug
|
$720.48 |
$720.48 |
$720.48 |
$648.90
|
|
Injection for arthrography wrist (both sides)
|
$485.76 |
$485.76 |
$485.76 |
$441.12
|
|
Injection for bladder x-ray
|
$501.12 |
$501.12 |
$501.12 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$267.84 |
$267.84 |
$267.84 |
$504.00
|
|
Injection for ureter x-ray
|
$271.20 |
$271.20 |
$271.20 |
$444.95
|
|
Injection for ureter x-ray
|
$326.88 |
$326.88 |
$326.88 |
$515.21
|
|
Injection, fulvestrant
|
$501.58 |
$501.58 |
$501.58 |
$1,817.65
|
|
Injection into brain canal
|
$779.52 |
$779.52 |
$779.52 |
$933.60
|
|
Injection into hemorrhoid(s)
|
$1,381.92 |
$1,381.92 |
$1,381.92 |
$1,278.72
|
|
Injection, isavuconazonium
|
$1,213.46 |
$1,213.46 |
$1,213.46 |
$863.93
|
|
Injection,onabotulinumtoxina
|
$2,884.80 |
$2,884.80 |
$2,884.80 |
$2,154.07
|
|
Injection radioactive tracer sentinel node (both sides)
|
$710.88 |
$710.88 |
$710.88 |
$717.20
|
|
Injection, renflexis
|
$1,189.94 |
$1,189.94 |
$1,189.94 |
$1,356.10
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,036.80 |
$1,036.80 |
$1,036.80 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$574.08 |
$574.08 |
$574.08 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,046.40 |
$1,046.40 |
$1,046.40 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$812.16 |
$812.16 |
$812.16 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,810.08 |
$1,810.08 |
$1,810.08 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$812.16 |
$812.16 |
$812.16 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,810.08 |
$1,810.08 |
$1,810.08 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,555.20 |
$1,555.20 |
$1,555.20 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,555.20 |
$1,555.20 |
$1,555.20 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$377.28 |
$377.28 |
$377.28 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$377.28 |
$377.28 |
$377.28 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$412.80 |
$412.80 |
$412.80 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$72.96 |
$72.96 |
$72.96 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$83.52 |
$83.52 |
$83.52 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$162.24 |
$162.24 |
$162.24 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$84.00 |
$84.00 |
$84.00 |
$141.60
|
|
Injection treatment of eye
|
$3,639.84 |
$3,639.84 |
$3,639.84 |
$2,698.92
|
|
Inject sacroiliac joint
|
$1,380.48 |
$1,380.48 |
$1,380.48 |
$1,090.00
|
|
Inj epidural sgl cerv-thor without img
|
$1,352.64 |
$1,352.64 |
$1,352.64 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$1,399.20 |
$1,399.20 |
$1,399.20 |
$1,450.84
|
|
Inj for ext venography
|
$48.48 |
$48.48 |
$48.48 |
$737.55
|
|
Inj for mammo ductogram
|
$192.00 |
$192.00 |
$192.00 |
$433.50
|
|
Inj, fosaprepitant (teva)
|
$98.69 |
$98.69 |
$98.69 |
$152.10
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$202.08 |
$202.08 |
$202.08 |
$1,482.00
|
|
Inj, immphentiv, 20 mcg
|
$44.76 |
$44.76 |
$44.76 |
$38.40
|
|
Inj intralesional <= 7 lsn(s)
|
$331.68 |
$331.68 |
$331.68 |
$241.74
|
|
Inj ivig privigen 500 mg
|
$5,425.44 |
$5,425.44 |
$5,425.44 |
$7,173.90
|
|
Inj. jivi 1 iu
|
$5,766.60 |
$5,766.60 |
$5,766.60 |
$2.65
|
|
Inj, kovaltry, 1 i.u
|
$10,142.47 |
$10,142.47 |
$10,142.47 |
$5.12
|
|
Inj, lanreotide, (cipla) 1mg
|
$11,393.14 |
$11,393.14 |
$11,393.14 |
$12,160.05
|
|
Inj levocarnitine per 1 gm
|
$145.37 |
$145.37 |
$145.37 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$258.92 |
$258.92 |
$258.92 |
$303.45
|
|
Inj mepivacaine hcl/10 ml
|
$44.76 |
$44.76 |
$44.76 |
$31.28
|
|
Inj. mycophenolate mofetil
|
$228.12 |
$228.12 |
$228.12 |
$291.54
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,692.00 |
$1,692.00 |
$1,692.00 |
$1,522.56
|
|
Inj pantoprazole(hikma) 40mg
|
$44.76 |
$44.76 |
$44.76 |
$33.52
|
|
Inj peritoneal venous shunt
|
$223.20 |
$223.20 |
$223.20 |
$386.88
|
|
Inj., perseris, 0.5 mg
|
$2,640.33 |
$2,640.33 |
$2,640.33 |
$5,372.48
|
|
Inj proc ankle arthr
|
$302.88 |
$302.88 |
$302.88 |
$405.31
|
|
Inj proc elbow arthro
|
$302.88 |
$302.88 |
$302.88 |
$453.60
|
|
Inj proc for lymphang
|
$1,169.28 |
$1,169.28 |
$1,169.28 |
$1,372.00
|
|
Inj proc lumbr disk ea lvl
|
$3,167.04 |
$3,167.04 |
$3,167.04 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
$922.80
|
|
Inj, releuko 1 mcg
|
$503.56 |
$503.56 |
$503.56 |
$519.53
|
|
Inj retro urethrocysto
|
$1,011.84 |
$1,011.84 |
$1,011.84 |
$551.29
|
|
Inj scleros sol sgl vein
|
$371.04 |
$371.04 |
$371.04 |
$534.40
|
|
Inj teclistamab cqyv 0.5 mg
|
$10,832.40 |
$10,832.40 |
$10,832.40 |
$17,517.56
|
|
Inj testosterone cypionate
|
$60.00 |
$60.00 |
$60.00 |
$82.58
|
|
Inj w/fluor eval cv device
|
$267.84 |
$267.84 |
$267.84 |
$588.90
|
|
Ins cath ren art 1st bi
|
$6,252.96 |
$6,252.96 |
$6,252.96 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$6,252.96 |
$6,252.96 |
$6,252.96 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$6,366.24 |
$6,366.24 |
$6,366.24 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$10,896.48 |
$10,896.48 |
$10,896.48 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$543.84 |
$543.84 |
$543.84 |
$544.00
|
|
Insert abdomen-venous drain
|
$34,919.04 |
$34,919.04 |
$34,919.04 |
$4,391.00
|
|
Insert and remove bone pin
|
$4,307.52 |
$4,307.52 |
$4,307.52 |
$4,335.60
|
|
Insert cath pleura with image
|
$1,419.84 |
$1,419.84 |
$1,419.84 |
$2,239.02
|
|
Insert cath pleura without image
|
$1,761.12 |
$1,761.12 |
$1,761.12 |
$2,212.00
|
|
Insert hepatic shunt (tips)
|
$1,720.80 |
$1,720.80 |
$1,720.80 |
$9,754.48
|
|
Insert intrauterine device iud
|
$133.44 |
$133.44 |
$133.44 |
$378.83
|
|
Insertion catheter bladder non indwelling
|
$151.20 |
$151.20 |
$151.20 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$179.52 |
$179.52 |
$179.52 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,509.60 |
$4,509.60 |
$4,509.60 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,210.08 |
$1,210.08 |
$1,210.08 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$16,605.60 |
$16,605.60 |
$16,605.60 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,075.84 |
$3,075.84 |
$3,075.84 |
$2,618.40
|
|
Insertion of catheter vein
|
$516.00 |
$516.00 |
$516.00 |
$1,749.80
|
