|
Acyclovir 400 mg tablet
|
$291.55 |
$291.55 |
$291.55 |
$54.77
|
|
Atropine 0.1 mg/ml injection syringe
|
$444.15 |
$444.15 |
$444.15 |
$53.24
|
|
Bendamustine 25 mg/ml intravenous solution (bendeka)
|
$11,897.55 |
$11,897.55 |
$11,897.55 |
$4,898.13
|
|
Bilateral n block inj occipital 64405
|
$3,657.85 |
$3,657.85 |
$3,657.85 |
$808.17
|
|
Blood draw capillary 36416
|
$137.20 |
$137.20 |
$137.20 |
$20.00
|
|
Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection
|
$3,276.87 |
$3,276.87 |
$3,276.87 |
$2,880.64
|
|
Bundled special stain group 1 microorganisms
|
$11,142.93 |
$11,142.93 |
$11,142.93 |
$154.70
|
|
Bundled special stain group 2
|
$12,294.46 |
$12,294.46 |
$12,294.46 |
$170.65
|
|
Cabazitaxel 10 mg/ml (first dilution) intravenous solution
|
$326,524.44 |
$326,524.44 |
$326,524.44 |
$26,328.21
|
|
Carboplatin 10 mg/ml desensitization
|
$1,359.57 |
$1,359.57 |
$1,359.57 |
$197.57
|
|
Carfilzomib 10 mg intravenous solution
|
$19,812.27 |
$19,812.27 |
$19,812.27 |
$6,306.47
|
|
Chemodenerv musc migraine 64615
|
$3,159.62 |
$3,159.62 |
$3,159.62 |
$540.80
|
|
Chemodenerv musc neck dyston 64616
|
$3,549.35 |
$3,549.35 |
$3,549.35 |
$698.60
|
|
Collection blood specimen from completely implantable venous access device
|
$870.10 |
$870.10 |
$870.10 |
$160.00
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$768.60 |
$768.60 |
$768.60 |
$155.40
|
|
Collection of venous blood by venipuncture
|
$675.50 |
$675.50 |
$675.50 |
$21.00
|
|
Colonoscopy (diagnostic)
|
$4,292.57 |
$4,292.57 |
$4,292.57 |
$1,899.00
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$10,156.52 |
$10,156.52 |
$10,156.52 |
$2,004.81
|
|
Colonoscopy submucous njx
|
$11,448.50 |
$11,448.50 |
$11,448.50 |
$2,080.00
|
|
Colonoscopy w/ablation
|
$15,808.76 |
$15,808.76 |
$15,808.76 |
$2,708.80
|
|
Colonoscopy w/balloon dilat
|
$20,123.08 |
$20,123.08 |
$20,123.08 |
$1,645.43
|
|
Colonoscopy w/band ligation
|
$10,976.27 |
$10,976.27 |
$10,976.27 |
$2,030.00
|
|
Colonoscopy w/control bleed
|
$9,385.79 |
$9,385.79 |
$9,385.79 |
$2,030.25
|
|
Colonoscopy (with biopsy)
|
$12,261.91 |
$12,261.91 |
$12,261.91 |
$2,080.00
|
|
Colonoscopy (with polyp removal)
|
$8,121.99 |
$8,121.99 |
$8,121.99 |
$2,288.00
|
|
Consultation/report referred material w/preparation of slides
|
$17,098.33 |
$17,098.33 |
$17,098.33 |
$224.80
|
|
#creutz-prot.,western blot
|
$154.70 |
$154.70 |
$154.70 |
$163.50
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,359.05 |
$1,359.05 |
$1,359.05 |
$1,305.02
|
|
Decalcification
|
$9,891.80 |
$9,891.80 |
$9,891.80 |
$68.90
|
|
Decitabine 50 mg intravenous solution
|
$276.32 |
$276.32 |
$276.32 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$2,195.72 |
$2,195.72 |
$2,195.72 |
$546.84
|
|
Dilate esophagus 1/mult pass
|
$7,590.56 |
$7,590.56 |
$7,590.56 |
$1,490.36
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$73,737.12 |
$73,737.12 |
$73,737.12 |
$19,540.29
|
|
Egd control bleeding any
|
$11,411.99 |
$11,411.99 |
$11,411.99 |
$2,553.75
|
|
Egd lesion ablation
|
$15,224.52 |
$15,224.52 |
$15,224.52 |
$2,244.82
|
|
Egd remove foreign body
|
$8,605.83 |
$8,605.83 |
$8,605.83 |
$1,548.00
|
|
Egd remove lesion snare
|
$14,426.89 |
$14,426.89 |
$14,426.89 |
$2,597.25
|
|
Egd/remov tum/polyp/hot bx forcep 43250
|
$12,889.18 |
$12,889.18 |
$12,889.18 |
$2,244.82
|
|
Egd varices ligation
|
$4,797.30 |
$4,797.30 |
$4,797.30 |
$2,244.82
|
|
Elect anlys sp inf pmp w/reprg&fill 62369
|
$7,629.12 |
$7,629.12 |
$7,629.12 |
$618.80
|
|
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution
|
$7,897.57 |
$7,897.57 |
$7,897.57 |
$2,488.75
|
|
ER Visit (level 3)
|
$1,781.15 |
$1,781.15 |
$1,781.15 |
$793.20
|
|
ER Visit (level 4)
|
$4,134.37 |
$4,134.37 |
$4,134.37 |
$1,277.65
|
|
ER Visit (level 5, high severity)
|
$10,081.05 |
$10,081.05 |
$10,081.05 |
$1,844.80
|
|
Esophagoscopy flex biopsy
|
$9,375.11 |
$9,375.11 |
$9,375.11 |
$2,132.00
|
|
Esoph egd dilation <30 mm
|
$10,082.25 |
$10,082.25 |
$10,082.25 |
$2,638.57
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$29.75 |
$29.75 |
$29.75 |
$22.23
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$17,287.72 |
$17,287.72 |
$17,287.72 |
$5,894.50
|
|
Flexible Sigmoidoscopy
|
$8,821.94 |
$8,821.94 |
$8,821.94 |
$1,284.13
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$1,892.62 |
$1,892.62 |
$1,892.62 |
$107.00
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$2,053.45 |
$2,053.45 |
$2,053.45 |
$490.67
|
|
Ghs nerve block brachial plexus
|
$64,809.28 |
$64,809.28 |
$64,809.28 |
$1,695.24
|
|
Gw stiffened micro access kit
|
$2,449.81 |
$2,449.81 |
$2,449.81 |
$6,600.00
|
|
Hopd covid-19 spec collect
|
$31.50 |
$31.50 |
$31.50 |
$30.41
|
|
Ihc/icc per specimen each additional single antibody stain
|
$11,240.80 |
$11,240.80 |
$11,240.80 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$15,763.10 |
$15,763.10 |
$15,763.10 |
$328.79
|
|
Ihc/icc per specimen initial single antibody stain
|
$11,784.83 |
$11,784.83 |
$11,784.83 |
$272.30
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$4,431.70 |
$4,431.70 |
$4,431.70 |
$154.05
|
|
Immunofluorescence per specimen initial single antibody stain
|
$4,431.70 |
$4,431.70 |
$4,431.70 |
$231.40
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$46,923.68 |
$46,923.68 |
$46,923.68 |
$1,348.56
|
|
Inj ogivri 10 mg
|
$3,538.50 |
$3,538.50 |
$3,538.50 |
$4,492.28
|
|
Insitu hybridization (fish)
|
$1,936.90 |
$1,936.90 |
$1,936.90 |
$481.60
|
|
Instillation anticarcinogenic agent bladder
|
$4,131.22 |
$4,131.22 |
$4,131.22 |
$621.40
|
|
Intubation endotracheal emergency procedure
|
$14,097.11 |
$14,097.11 |
$14,097.11 |
$598.80
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$299.25 |
$299.25 |
$299.25 |
$174.47
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$264.60 |
$264.60 |
$264.60 |
$190.56
|
|
Lifileucel til/dose 7.5b-72b snij
|
$25.37 |
$25.37 |
$25.37 |
$30,744.64
|
|
Measurement post void urine by ultrasound
|
$16,476.09 |
$16,476.09 |
$16,476.09 |
$162.58
|
|
Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain
|
$17,426.50 |
$17,426.50 |
$17,426.50 |
$402.00
|
|
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted
|
$17,426.50 |
$17,426.50 |
$17,426.50 |
$328.79
|
|
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual
|
$12,727.57 |
$12,727.57 |
$12,727.57 |
$318.43
|
|
M/phmtrc alys ishquant/semiq
|
$12,727.57 |
$12,727.57 |
$12,727.57 |
$487.50
|
|
Nivolumab 10 mg/ml intravenous solution (wrapper)
|
$44,490.07 |
$44,490.07 |
$44,490.07 |
$14,820.18
|
|
Obinutuzumab 1,000 mg/40 ml intravenous solution
|
$59,610.77 |
$59,610.77 |
$59,610.77 |
$14,865.31
|
|
Oxaliplatin 5 mg/ml desensitization
|
$1,646.22 |
$1,646.22 |
$1,646.22 |
$370.75
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$745.32 |
$745.32 |
$745.32 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$3,151.75 |
$3,151.75 |
$3,151.75 |
$3,435.42
|
|
Palonosetron hcl
|
$323.22 |
$323.22 |
$323.22 |
$170.48
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$39,600.22 |
$39,600.22 |
$39,600.22 |
$13,051.61
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$33,694.50 |
$33,694.50 |
$33,694.50 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$8,064.17 |
$8,064.17 |
$8,064.17 |
$7,089.13
|
|
Pertuzumab 30 mg/ml desensitization
|
$45,173.62 |
$45,173.62 |
$45,173.62 |
$13,666.00
|
|
Pertuzu, trastuzu, 10 mg
|
$92,171.97 |
$92,171.97 |
$92,171.97 |
$27,833.07
|
|
Pr egd flexible transoral w/placement percutaneous gastrostomy tube
|
$12,808.77 |
$12,808.77 |
$12,808.77 |
$2,246.75
|
|
Prochlorperazine maleate 5 mg tablet
|
$16.80 |
$16.80 |
$16.80 |
$1.50
|
|
Pt application of modality >=1 area hot/cold packs
|
$70.00 |
$70.00 |
$70.00 |
$35.00
|
|
Puncture arterial withdrawal blood for diagnosis
|
$2,034.20 |
$2,034.20 |
$2,034.20 |
$127.50
|
|
Romiplostim 125 mcg subcutaneous solution
|
$5,627.82 |
$5,627.82 |
$5,627.82 |
$8,950.11
|
|
Sgmdsc w/band ligation
|
$4,965.65 |
$4,965.65 |
$4,965.65 |
$2,146.95
|
|
Sigmoidoscopy and biopsy
|
$4,149.26 |
$4,149.26 |
$4,149.26 |
$1,351.63
|
|
Sigmoidoscopy for bleeding
|
$5,653.97 |
$5,653.97 |
$5,653.97 |
$1,890.00
|
|
Sigmoidoscopy w/ablation
|
$6,384.64 |
$6,384.64 |
$6,384.64 |
$2,604.00
|
|
Sigmoidoscopy w/tumr remove
|
$10,196.33 |
$10,196.33 |
$10,196.33 |
$1,558.80
|
|
Sig w/tndsc balloon dilation
|
$6,956.90 |
$6,956.90 |
$6,956.90 |
$1,901.90
|
|
Small bowel endoscopy
|
$14,834.80 |
$14,834.80 |
$14,834.80 |
$2,638.57
|
|
Small bowel endoscopy
|
$10,424.41 |
$10,424.41 |
$10,424.41 |
$1,620.78
|
|
Small bowel endoscopy/biopsy
|
$8,437.13 |
$8,437.13 |
$8,437.13 |
$2,413.20
|
|
Surgical pathology level 1 gross examination only
|
$21,477.83 |
$21,477.83 |
$21,477.83 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$17,987.56 |
$17,987.56 |
$17,987.56 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$11,240.80 |
$11,240.80 |
$11,240.80 |
$181.00
|
