|
Initial hosp neonate 28 d/less than not critically ill 99477
|
$705.00 |
$705.00 |
$705.00 |
$629.60
|
|
Initial nursing facility care/day 35 minutes
|
$253.20 |
$253.20 |
$253.20 |
$188.50
|
|
Initial nursing facility care/day 45 minutes
|
$322.20 |
$322.20 |
$322.20 |
$236.80
|
|
Initial nursing facility care/day low severity 99304
|
$178.80 |
$178.80 |
$178.80 |
$128.00
|
|
Initial observation care
|
$196.20 |
$196.20 |
$196.20 |
$156.00
|
|
Initial observation care
|
$268.20 |
$268.20 |
$268.20 |
$268.20
|
|
Initial observation care
|
$369.00 |
$369.00 |
$369.00 |
$369.00
|
|
Init pm e/m new pat 65+ yrs
|
$270.00 |
$270.00 |
$270.00 |
$189.15
|
|
Inj, abilify maintena, 1 mg
|
$5,156.77 |
$5,156.77 |
$5,156.77 |
$5,355.30
|
|
Inj, adalimumab, 1 mg
|
$6,143.09 |
$6,143.09 |
$6,143.09 |
$12,098.05
|
|
Inj anifrolumab-fnia 1mg
|
$9,648.88 |
$9,648.88 |
$9,648.88 |
$10,052.58
|
|
Inj., aristada initio, 1 mg
|
$4,325.66 |
$4,325.66 |
$4,325.66 |
$4,052.45
|
|
Inj aval alfa-nqpt 4mg
|
$3,478.84 |
$3,478.84 |
$3,478.84 |
$3,907.30
|
|
Inj., benralizumab, 1 mg
|
$10,067.08 |
$10,067.08 |
$10,067.08 |
$11,310.00
|
|
Inj, bezlotoxumab, 10 mg
|
$6,760.17 |
$6,760.17 |
$6,760.17 |
$7,612.43
|
|
Inj calcitriol per 0.1 mcg
|
$22.69 |
$22.69 |
$22.69 |
$22.69
|
|
Inj, cefepime hcl (b braun)
|
$64.46 |
$64.46 |
$64.46 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$442.01 |
$442.01 |
$442.01 |
$544.85
|
|
Inj cntr knee arthro incl ct/mri
|
$166.80 |
$166.80 |
$166.80 |
$436.80
|
|
Inj cyclophosphamd (ingenus)
|
$1,338.80 |
$1,338.80 |
$1,338.80 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$152.35 |
$152.35 |
$152.35 |
$128.08
|
|
Inj. denosumab-bbdz, 1 mg
|
$5,694.89 |
$5,694.89 |
$5,694.89 |
$4,615.43
|
|
Inj, donanemab-azbt, 2 mg
|
$1,277.15 |
$1,277.15 |
$1,277.15 |
$1,233.44
|
|
Inj, durolane 1 mg
|
$1,987.31 |
$1,987.31 |
$1,987.31 |
$1,950.93
|
|
Inj dx for sinogram
|
$409.20 |
$409.20 |
$409.20 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$414.00 |
$414.00 |
$414.00 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$249.60 |
$249.60 |
$249.60 |
$503.50
|
|
Injection, cangrelor
|
$1,356.24 |
$1,356.24 |
$1,356.24 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$142.80 |
$142.80 |
$142.80 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$5,239.24 |
$5,239.24 |
$5,239.24 |
$5,324.34
|
|
Injection, doxercalciferol
|
$58.44 |
$58.44 |
$58.44 |
$23.86
|
|
Injection epidural blood patch or clot
|
$928.20 |
$928.20 |
$928.20 |
$1,182.33
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$582.60 |
$582.60 |
$582.60 |
$497.76
|
|
Injection, fulvestrant
|
$3,446.87 |
$3,446.87 |
$3,446.87 |
$1,719.16
|
|
Injection glatiramer acetate
|
$3,493.72 |
$3,493.72 |
$3,493.72 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$5,987.41 |
$5,987.41 |
$5,987.41 |
$6,679.35
|
|
Injection, isavuconazonium
|
$674.71 |
$674.71 |
$674.71 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$2,318.52 |
$2,318.52 |
$2,318.52 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$78.60 |
$78.60 |
$78.60 |
$685.44
|
|
Injection, renflexis
|
$1,346.83 |
$1,346.83 |
$1,346.83 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$241.20 |
$241.20 |
$241.20 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$481.80 |
$481.80 |
$481.80 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,848.00 |
$1,848.00 |
$1,848.00 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$988.20 |
$988.20 |
$988.20 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,632.60 |
$1,632.60 |
$1,632.60 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,048.20 |
$1,048.20 |
$1,048.20 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,632.60 |
$1,632.60 |
$1,632.60 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$610.80 |
$610.80 |
$610.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$639.60 |
$639.60 |
$639.60 |
$1,685.00
|
|
Injection, siltuximab
|
$9,427.67 |
$9,427.67 |
$9,427.67 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$348.00 |
$348.00 |
$348.00 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$363.60 |
$363.60 |
$363.60 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$436.20 |
$436.20 |
$436.20 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$106.80 |
$106.80 |
$106.80 |
$145.60
|
|
Injection torsemide 10 mg/ml
|
$26.06 |
$26.06 |
$26.06 |
$16.02
|
|
Inject sacroiliac joint
|
$778.20 |
$778.20 |
$778.20 |
$1,029.04
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$28,508.30 |
$28,508.30 |
$28,508.30 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$190.80 |
$190.80 |
$190.80 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$164.40 |
$164.40 |
$164.40 |
$1,450.84
|
|
Inj for ext venography
|
$660.00 |
$660.00 |
$660.00 |
$628.80
|
|
Inj heparin, pfizer, 1000u
|
$18.40 |
$18.40 |
$18.40 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$8,322.19 |
$8,322.19 |
$8,322.19 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$271.20 |
$271.20 |
$271.20 |
$1,492.00
|
|
Inj hydroxocobalamin IV 25mg
|
$1,797.27 |
$1,797.27 |
$1,797.27 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$1,271.73 |
$1,271.73 |
$1,271.73 |
$1,228.59
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$561.60 |
$561.60 |
$561.60 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$107.40 |
$107.40 |
$107.40 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$134.40 |
$134.40 |
$134.40 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$13,368.87 |
$13,368.87 |
$13,368.87 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$15,763.10 |
$15,763.10 |
$15,763.10 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,174.88 |
$1,174.88 |
$1,174.88 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$65.56 |
$65.56 |
$65.56 |
$136.62
|
|
Inj melpha hydroch nos 50 mg
|
$2,951.66 |
$2,951.66 |
$2,951.66 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$30.04 |
$30.04 |
$30.04 |
$34.34
|
|
Inj, moxifloxacin 100 mg
|
$120.04 |
$120.04 |
$120.04 |
$101.31
|
|
Inj multihance
|
$64.93 |
$64.93 |
$64.93 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$220.86 |
$220.86 |
$220.86 |
$252.66
|
|
Inj nivolumab 2 mg hyaluron
|
$14,110.18 |
$14,110.18 |
$14,110.18 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$233.40 |
$233.40 |
$233.40 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$180.00 |
$180.00 |
$180.00 |
$2,726.90
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$73,159.94 |
$73,159.94 |
$73,159.94 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$6,589.99 |
$6,589.99 |
$6,589.99 |
$4,492.28
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$6,965.32 |
$6,965.32 |
$6,965.32 |
$6,614.40
|
|
Inj peritoneal venous shunt
|
$586.20 |
$586.20 |
$586.20 |
$406.80
|
|
Inj., perseris, 0.5 mg
|
$5,146.85 |
$5,146.85 |
$5,146.85 |
$5,146.85
|
|
Inj proc for lymphang
|
$805.80 |
$805.80 |
$805.80 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$666.00 |
$666.00 |
$666.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$382.20 |
$382.20 |
$382.20 |
$838.30
|
|
Inj progesterone per 50 mg
|
$14.93 |
$14.93 |
$14.93 |
$13.76
|
|
Inj retro urethrocysto
|
$213.60 |
$213.60 |
$213.60 |
$447.74
|
|
Inj, rimabotulinumtoxinb
|
$594.44 |
$594.44 |
$594.44 |
$714.24
|
|
Inj scleros sol mult veins
|
$337.80 |
$337.80 |
$337.80 |
$692.90
|
|
Inj scleros sol sgl vein
|
$286.20 |
$286.20 |
$286.20 |
$561.88
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$112.20 |
$112.20 |
$112.20 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$281.30 |
$281.30 |
$281.30 |
$256.14
|
|
Inj teclistamab cqyv 0.5 mg
|
$17,249.16 |
$17,249.16 |
$17,249.16 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$685.81 |
$685.81 |
$685.81 |
$664.72
|
|
Inj testostero enanthate 1mg
|
$157.81 |
$157.81 |
$157.81 |
$123.09
|
|
Inj testosterone cypionate
|
$257.14 |
$257.14 |
$257.14 |
$64.96
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,230.10 |
$1,230.10 |
$1,230.10 |
$1,090.75
|