|
Inj anifrolumab-fnia 1mg
|
$5,347.06 |
$5,347.06 |
$5,347.06 |
$9,878.82
|
|
Inj, bupivacaine liposome
|
$170.69 |
$170.69 |
$170.69 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$12.93 |
$12.93 |
$12.93 |
$23.28
|
|
Inj cefazolin sodium, baxter
|
$15.70 |
$15.70 |
$15.70 |
$27.38
|
|
Inj. cefepime hcl (baxter)
|
$21.64 |
$21.64 |
$21.64 |
$86.84
|
|
Inj, cefepime hcl (b braun)
|
$14.06 |
$14.06 |
$14.06 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$383.39 |
$383.39 |
$383.39 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$98.70 |
$98.70 |
$98.70 |
$380.80
|
|
Inj, clindamycin (baxter)
|
$32.04 |
$32.04 |
$32.04 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$509.04 |
$509.04 |
$509.04 |
$436.80
|
|
Inj crotalidae im f(ab')2 eq
|
$267.12 |
$267.12 |
$267.12 |
$2,613.60
|
|
Inj dupuytren cord w/enzyme
|
$43.56 |
$43.56 |
$43.56 |
$416.00
|
|
Inj dx for sinogram
|
$538.92 |
$538.92 |
$538.92 |
$422.59
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$53.82 |
$53.82 |
$53.82 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$255.24 |
$255.24 |
$255.24 |
$495.84
|
|
Injection, cangrelor
|
$319.50 |
$319.50 |
$319.50 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$159.12 |
$159.12 |
$159.12 |
$450.72
|
|
Injection, cimetidine hydroc
|
$16.07 |
$16.07 |
$16.07 |
$14.00
|
|
Injection during cath supravalvular aortography
|
$194.94 |
$194.94 |
$194.94 |
$952.66
|
|
Injection epidural blood patch or clot
|
$430.20 |
$430.20 |
$430.20 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$399.06 |
$399.06 |
$399.06 |
$428.40
|
|
Injection for bladder x-ray
|
$189.36 |
$189.36 |
$189.36 |
$459.20
|
|
Injection for hip x-ray
|
$52.38 |
$52.38 |
$52.38 |
$710.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$430.92 |
$430.92 |
$430.92 |
$494.65
|
|
Injection for spleen x-ray
|
$351.18 |
$351.18 |
$351.18 |
$529.57
|
|
Injection for ureter x-ray
|
$572.40 |
$572.40 |
$572.40 |
$427.70
|
|
Injection for ureter x-ray
|
$79.74 |
$79.74 |
$79.74 |
$515.21
|
|
Injection, fulvestrant
|
$607.65 |
$607.65 |
$607.65 |
$1,817.65
|
|
Injection jugular
|
$666.90 |
$666.90 |
$666.90 |
$790.00
|
|
Injection of sinus tract
|
$1,600.02 |
$1,600.02 |
$1,600.02 |
$1,627.60
|
|
Injection, piperacillin sodi
|
$39.43 |
$39.43 |
$39.43 |
$14.00
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$40.68 |
$40.68 |
$40.68 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$316.80 |
$316.80 |
$316.80 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$110.16 |
$110.16 |
$110.16 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$57.60 |
$57.60 |
$57.60 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$104.22 |
$104.22 |
$104.22 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$49.32 |
$49.32 |
$49.32 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$90.18 |
$90.18 |
$90.18 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$70.20 |
$70.20 |
$70.20 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,093.32 |
$1,093.32 |
$1,093.32 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$231.66 |
$231.66 |
$231.66 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$193.68 |
$193.68 |
$193.68 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$172.80 |
$172.80 |
$172.80 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$113.76 |
$113.76 |
$113.76 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$107.64 |
$107.64 |
$107.64 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$180.00 |
$180.00 |
$180.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$78.30 |
$78.30 |
$78.30 |
$135.60
|
|
Injection torsemide 10 mg/ml
|
$15.73 |
$15.73 |
$15.73 |
$16.02
|
|
Inject sacroiliac joint
|
$702.54 |
$702.54 |
$702.54 |
$1,028.95
|
|
Inj fe-based mr contrast,1ml
|
$190.98 |
$190.98 |
$190.98 |
$56.56
|
|
Inj fluphenazine hcl 1.25 mg
|
$71.64 |
$71.64 |
$71.64 |
$39.54
|
|
Inj for ext venography
|
$1,058.22 |
$1,058.22 |
$1,058.22 |
$649.95
|
|
Inj, gadopiclenol, 1 ml
|
$1.94 |
$1.94 |
$1.94 |
$37.63
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$658.62 |
$658.62 |
$658.62 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$59.58 |
$59.58 |
$59.58 |
$1,827.74
|
|
Inj hrt cath w/s&i sel hrt art
|
$59.58 |
$59.58 |
$59.58 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$68.58 |
$68.58 |
$68.58 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$129.96 |
$129.96 |
$129.96 |
$965.33
|
|
Inj intralesional <= 7 lsn(s)
|
$94.32 |
$94.32 |
$94.32 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$145.62 |
$145.62 |
$145.62 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$4,229.52 |
$4,229.52 |
$4,229.52 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$15.33 |
$15.33 |
$15.33 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$19.26 |
$19.26 |
$19.26 |
$47.52
|
|
Inj mepivacaine hcl/10 ml
|
$15.78 |
$15.78 |
$15.78 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$12.46 |
$12.46 |
$12.46 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$82.08 |
$82.08 |
$82.08 |
$77.97
|
|
Inj metaraminol bitartrate
|
$18.72 |
$18.72 |
$18.72 |
$18.72
|
|
Inj, moxifloxacin 100 mg
|
$39.09 |
$39.09 |
$39.09 |
$107.25
|
|
Inj multihance
|
$3.96 |
$3.96 |
$3.96 |
$73.49
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$768.24 |
$768.24 |
$768.24 |
$1,413.35
|
|
Inj progesterone per 50 mg
|
$33.37 |
$33.37 |
$33.37 |
$15.00
|
|
Inj, releuko 1 mcg
|
$420.37 |
$420.37 |
$420.37 |
$473.25
|
|
Inj retro urethrocysto
|
$651.78 |
$651.78 |
$651.78 |
$443.50
|
|
Inj scleros sol mult veins
|
$159.48 |
$159.48 |
$159.48 |
$675.00
|
|
Inj scleros sol sgl vein
|
$110.52 |
$110.52 |
$110.52 |
$558.97
|
|
Inj testostero enanthate 1mg
|
$20.77 |
$20.77 |
$20.77 |
$123.24
|
|
Inj testosterone cypionate
|
$42.43 |
$42.43 |
$42.43 |
$64.80
|
|
Inj thiotepa nos 1 mg
|
$100.83 |
$100.83 |
$100.83 |
$3,170.16
|
|
Inj, trivisc 1 mg
|
$74.02 |
$74.02 |
$74.02 |
$6.67
|
|
Inj w/fluor eval cv device
|
$327.78 |
$327.78 |
$327.78 |
$503.92
|
|
Ins cath ren art 1st bi
|
$6,164.10 |
$6,164.10 |
$6,164.10 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$3,231.54 |
$3,231.54 |
$3,231.54 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$2,596.86 |
$2,596.86 |
$2,596.86 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$2,409.48 |
$2,409.48 |
$2,409.48 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$190.98 |
$190.98 |
$190.98 |
$480.28
|
|
Insert cath pleura with image
|
$919.44 |
$919.44 |
$919.44 |
$2,194.40
|
|
Insert cath pleura without image
|
$440.82 |
$440.82 |
$440.82 |
$2,073.18
|
|
Insert drug delivery implant
|
$40.32 |
$40.32 |
$40.32 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$5,010.66 |
$5,010.66 |
$5,010.66 |
$7,571.20
|
|
Insert intervert bimech device 22854
|
$209.70 |
$209.70 |
$209.70 |
$1,573.00
|
|
Insertion catheter bladder non indwelling
|
$114.30 |
$114.30 |
$114.30 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$117.54 |
$117.54 |
$117.54 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,106.08 |
$3,106.08 |
$3,106.08 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$457.74 |
$457.74 |
$457.74 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$7,296.30 |
$7,296.30 |
$7,296.30 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,118.96 |
$2,118.96 |
$2,118.96 |
$2,505.60
|
|
Insertion of catheter vein
|
$1,773.72 |
$1,773.72 |
$1,773.72 |
$1,477.00
|
|
Insertion of catheter vein
|
$759.96 |
$759.96 |
$759.96 |
$836.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$17,226.00 |
$17,226.00 |
$17,226.00 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$13,780.80 |
$13,780.80 |
$13,780.80 |
$12,384.25
|