|
Initial nursing facility care/day low severity 99304
|
$102.24 |
$102.24 |
$102.24 |
$128.00
|
|
Initiation & management bipap/cpap initial day
|
$386.40 |
$386.40 |
$386.40 |
$570.50
|
|
Init pm e/m new pat 65+ yrs
|
$206.88 |
$206.88 |
$206.88 |
$182.00
|
|
Inj., benralizumab, 1 mg
|
$14,036.76 |
$14,036.76 |
$14,036.76 |
$11,239.97
|
|
Inj, bezlotoxumab, 10 mg
|
$8,438.40 |
$8,438.40 |
$8,438.40 |
$7,612.43
|
|
Inj cefazolin sodium, baxter
|
$41.09 |
$41.09 |
$41.09 |
$27.38
|
|
Inj cntr knee arthro incl ct/mri
|
$225.40 |
$225.40 |
$225.40 |
$436.80
|
|
Inj, decitabine (sun pharma)
|
$240.00 |
$240.00 |
$240.00 |
$310.09
|
|
Inj dupuytren cord w/enzyme
|
$134.40 |
$134.40 |
$134.40 |
$416.00
|
|
Inj dx for sinogram
|
$158.24 |
$158.24 |
$158.24 |
$413.82
|
|
Injection arthrography hip without anesthesia (both sides)
|
$351.36 |
$351.36 |
$351.36 |
$503.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$126.24 |
$126.24 |
$126.24 |
$484.90
|
|
Injection, daratumumab 10 mg
|
$5,695.30 |
$5,695.30 |
$5,695.30 |
$5,188.91
|
|
Injection epidural blood patch or clot
|
$1,129.92 |
$1,129.92 |
$1,129.92 |
$1,161.14
|
|
Injection for arthrography wrist (both sides)
|
$297.60 |
$297.60 |
$297.60 |
$438.00
|
|
Injection for bladder x-ray
|
$320.16 |
$320.16 |
$320.16 |
$459.20
|
|
Injection for hip x-ray
|
$466.08 |
$466.08 |
$466.08 |
$662.40
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$247.20 |
$247.20 |
$247.20 |
$494.65
|
|
Injection for ureter x-ray
|
$194.40 |
$194.40 |
$194.40 |
$415.80
|
|
Injection for ureter x-ray
|
$1,093.92 |
$1,093.92 |
$1,093.92 |
$515.21
|
|
Injection, fulvestrant
|
$2,330.70 |
$2,330.70 |
$2,330.70 |
$1,719.16
|
|
Injection,onabotulinumtoxina
|
$3,104.64 |
$3,104.64 |
$3,104.64 |
$2,277.65
|
|
Injection, peramivir
|
$747.19 |
$747.19 |
$747.19 |
$775.82
|
|
Injection px peyronie ds
|
$180.00 |
$180.00 |
$180.00 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$273.12 |
$273.12 |
$273.12 |
$699.68
|
|
Injection, renflexis
|
$1,711.49 |
$1,711.49 |
$1,711.49 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,228.32 |
$1,228.32 |
$1,228.32 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,111.20 |
$1,111.20 |
$1,111.20 |
$1,045.65
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$321.12 |
$321.12 |
$321.12 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$315.84 |
$315.84 |
$315.84 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$513.60 |
$513.60 |
$513.60 |
$637.35
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$166.38 |
$166.38 |
$166.38 |
$163.83
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$173.50 |
$173.50 |
$173.50 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$154.17 |
$154.17 |
$154.17 |
$261.25
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$95.65 |
$95.65 |
$95.65 |
$136.00
|
|
Inject sacroiliac joint
|
$251.04 |
$251.04 |
$251.04 |
$1,029.04
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$35,571.32 |
$35,571.32 |
$35,571.32 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$250.56 |
$250.56 |
$250.56 |
$1,311.74
|
|
Inj. fe derisomaltose 10 mg
|
$7,503.62 |
$7,503.62 |
$7,503.62 |
$3,221.52
|
|
Inj for ext venography
|
$380.64 |
$380.64 |
$380.64 |
$654.00
|
|
Inj for mammo ductogram
|
$56.48 |
$56.48 |
$56.48 |
$397.80
|
|
Inj fosnetupitant, palonoset
|
$1,556.46 |
$1,556.46 |
$1,556.46 |
$1,110.99
|
|
Inj hydroxocobalamin IV 25mg
|
$1,861.48 |
$1,861.48 |
$1,861.48 |
$2,452.32
|
|
Inj intralesional <= 7 lsn(s)
|
$88.32 |
$88.32 |
$88.32 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$107.52 |
$107.52 |
$107.52 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$16,676.89 |
$16,676.89 |
$16,676.89 |
$6,967.29
|
|
Inj, levothyroxine, hikma
|
$213.45 |
$213.45 |
$213.45 |
$38.01
|
|
Inj, lidocaine w epinephrine
|
$53.33 |
$53.33 |
$53.33 |
$45.60
|
|
Inj. mycophenolate mofetil
|
$208.08 |
$208.08 |
$208.08 |
$252.66
|
|
Inj naloxone hydrochloride
|
$83.04 |
$83.04 |
$83.04 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,129.44 |
$1,129.44 |
$1,129.44 |
$1,413.35
|
|
Inj octafluoropropane mic,ml
|
$374.50 |
$374.50 |
$374.50 |
$211.40
|
|
Inj ogivri 10 mg
|
$5,088.10 |
$5,088.10 |
$5,088.10 |
$4,492.28
|
|
Inj proc ankle arthr
|
$322.08 |
$322.08 |
$322.08 |
$405.31
|
|
Inj proc myelogram lumbar
|
$393.12 |
$393.12 |
$393.12 |
$854.00
|
|
Inj proc sialogram
|
$121.09 |
$121.09 |
$121.09 |
$380.80
|
|
Inj, releuko 1 mcg
|
$609.72 |
$609.72 |
$609.72 |
$461.20
|
|
Inj retro urethrocysto
|
$31.55 |
$31.55 |
$31.55 |
$450.00
|
|
Inj scleros sol mult veins
|
$304.80 |
$304.80 |
$304.80 |
$687.96
|
|
Inj scleros sol sgl vein
|
$176.16 |
$176.16 |
$176.16 |
$561.88
|
|
Inj. teprotumumab-trbw 10 mg
|
$38,712.58 |
$38,712.58 |
$38,712.58 |
$35,034.78
|
|
Inj testosterone cypionate
|
$72.93 |
$72.93 |
$72.93 |
$64.80
|
|
Inj., tildrakizumab, 1 mg
|
$41,373.77 |
$41,373.77 |
$41,373.77 |
$26,635.60
|
|
Inj, vancomycin hcl (xellia)
|
$76.80 |
$76.80 |
$76.80 |
$85.20
|
|
Inj w/fluor eval cv device
|
$344.64 |
$344.64 |
$344.64 |
$504.40
|
|
Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
|
$54.24 |
$54.24 |
$54.24 |
$54.24
|
|
Inpt/ed teleconsult30
|
$117.60 |
$117.60 |
$117.60 |
$164.40
|
|
Inpt/ed teleconsult50
|
$166.56 |
$166.56 |
$166.56 |
$223.80
|
|
Inpt/ed teleconsult70
|
$235.20 |
$235.20 |
$235.20 |
$330.60
|
|
Inpt/tele follow up 15
|
$52.80 |
$52.80 |
$52.80 |
$64.80
|
|
Inpt/tele follow up 25
|
$91.68 |
$91.68 |
$91.68 |
$118.80
|
|
Inpt/tele follow up 35
|
$133.44 |
$133.44 |
$133.44 |
$171.60
|
|
Ins cerv dilator (sep proc)
|
$160.80 |
$160.80 |
$160.80 |
$484.90
|
|
Insert cath pleura without image
|
$1,124.64 |
$1,124.64 |
$1,124.64 |
$2,073.18
|
|
Insert drug delivery implant
|
$214.27 |
$214.27 |
$214.27 |
$284.91
|
|
Insert intrauterine device iud
|
$168.48 |
$168.48 |
$168.48 |
$366.65
|
|
Insertion catheter bladder non indwelling
|
$136.36 |
$136.36 |
$136.36 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$214.71 |
$214.71 |
$214.71 |
$235.20
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,172.64 |
$1,172.64 |
$1,172.64 |
$4,782.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,073.60 |
$2,073.60 |
$2,073.60 |
$2,515.80
|
|
Insertion of heart electrode 33211
|
$251.52 |
$251.52 |
$251.52 |
$7,048.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$776.16 |
$776.16 |
$776.16 |
$12,824.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$717.12 |
$717.12 |
$717.12 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$687.84 |
$687.84 |
$687.84 |
$10,285.70
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,008.80 |
$2,008.80 |
$2,008.80 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,235.36 |
$2,235.36 |
$2,235.36 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$1,366.56 |
$1,366.56 |
$1,366.56 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$15,065.28 |
$15,065.28 |
$15,065.28 |
$7,216.00
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$558.72 |
$558.72 |
$558.72 |
$7,388.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$9,303.84 |
$9,303.84 |
$9,303.84 |
$9,390.55
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,462.56 |
$1,462.56 |
$1,462.56 |
$5,236.80
|
|
Insert multi-comp penis pros
|
$1,227.36 |
$1,227.36 |
$1,227.36 |
$16,482.71
|
|
Insert nasal septal button
|
$466.08 |
$466.08 |
$466.08 |
$1,783.50
|
|
Insert pessary/other device
|
$114.24 |
$114.24 |
$114.24 |
$278.90
|
|
Insert picvad cath
|
$5,399.04 |
$5,399.04 |
$5,399.04 |
$4,201.80
|
|
Insert pm/icd lead dual
|
$554.88 |
$554.88 |
$554.88 |
$7,264.40
|
|
Insert/repl sq defib w/eltrd
|
$839.52 |
$839.52 |
$839.52 |
$32,052.60
|
|
Insert self-contd prosthesis
|
$1,018.56 |
$1,018.56 |
$1,018.56 |
$21,998.10
|
|
Insert semi-rigid prosthesis
|
$812.16 |
$812.16 |
$812.16 |
$14,380.79
|
|
Insert spine infusion device 62360
|
$479.04 |
$479.04 |
$479.04 |
$15,920.80
|
