|
Inj, bupivacaine liposome
|
$7.20 |
$7.20 |
$7.20 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$26.80 |
$26.80 |
$26.80 |
$22.69
|
|
Inj cefazolin sodium, baxter
|
$16.40 |
$16.40 |
$16.40 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$32.20 |
$32.20 |
$32.20 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$5.80 |
$5.80 |
$5.80 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$285.60 |
$285.60 |
$285.60 |
$364.86
|
|
Inj, cimerli, 0.1 mg
|
$519.00 |
$519.00 |
$519.00 |
$201.01
|
|
Inj, clevidipine butyrate
|
$483.60 |
$483.60 |
$483.60 |
$4.86
|
|
Inj cntr knee arthro incl ct/mri
|
$235.20 |
$235.20 |
$235.20 |
$436.80
|
|
Inj cyclophosphamd (ingenus)
|
$4.60 |
$4.60 |
$4.60 |
$742.72
|
|
Inj dx for sinogram
|
$543.60 |
$543.60 |
$543.60 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,439.40 |
$1,439.40 |
$1,439.40 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$543.60 |
$543.60 |
$543.60 |
$503.50
|
|
Injection, cangrelor
|
$58.60 |
$58.60 |
$58.60 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$19,956.00 |
$19,956.00 |
$19,956.00 |
$16,319.16
|
|
Injection, doxercalciferol
|
$285.60 |
$285.60 |
$285.60 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$1,305.00 |
$1,305.00 |
$1,305.00 |
$1,027.26
|
|
Injection, edaravone, 1 mg
|
$1,485.00 |
$1,485.00 |
$1,485.00 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$2,281.20 |
$2,281.20 |
$2,281.20 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$666.00 |
$666.00 |
$666.00 |
$436.00
|
|
Injection for bladder x-ray
|
$2,281.20 |
$2,281.20 |
$2,281.20 |
$459.20
|
|
Injection for hip x-ray
|
$725.40 |
$725.40 |
$725.40 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$543.60 |
$543.60 |
$543.60 |
$497.76
|
|
Injection glatiramer acetate
|
$1,206.60 |
$1,206.60 |
$1,206.60 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$46.80 |
$46.80 |
$46.80 |
$6,679.35
|
|
Injection, isavuconazonium
|
$782.40 |
$782.40 |
$782.40 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$6,946.80 |
$6,946.80 |
$6,946.80 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$508.80 |
$508.80 |
$508.80 |
$383.03
|
|
Injection, peramivir
|
$7.40 |
$7.40 |
$7.40 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$389.40 |
$389.40 |
$389.40 |
$685.44
|
|
Injection, renflexis
|
$1,719.60 |
$1,719.60 |
$1,719.60 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,353.60 |
$1,353.60 |
$1,353.60 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$584.40 |
$584.40 |
$584.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$856.80 |
$856.80 |
$856.80 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,935.00 |
$1,935.00 |
$1,935.00 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$845.40 |
$845.40 |
$845.40 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,664.40 |
$1,664.40 |
$1,664.40 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$766.20 |
$766.20 |
$766.20 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,462.80 |
$1,462.80 |
$1,462.80 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,861.20 |
$1,861.20 |
$1,861.20 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,771.20 |
$1,771.20 |
$1,771.20 |
$1,685.00
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$401.40 |
$401.40 |
$401.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$603.00 |
$603.00 |
$603.00 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$236.40 |
$236.40 |
$236.40 |
$145.60
|
|
Inj epidural sgl lumb-sacral without img
|
$1,278.00 |
$1,278.00 |
$1,278.00 |
$1,450.84
|
|
Inj, epinephrine (belcher)
|
$3.00 |
$3.00 |
$3.00 |
$6.55
|
|
Inj for ext venography
|
$388.80 |
$388.80 |
$388.80 |
$628.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$6.00 |
$6.00 |
$1,322.20
|
|
Inj., guselkumab, 1 mg
|
$695.20 |
$695.20 |
$695.20 |
$29,130.83
|
|
Inj imip 4 cilas 4 releb 2mg
|
$5.40 |
$5.40 |
$5.40 |
$739.77
|
|
Inj ivig privigen 500 mg
|
$2,574.60 |
$2,574.60 |
$2,574.60 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$598.40 |
$598.40 |
$598.40 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$0.08 |
$0.08 |
$0.08 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$108.00 |
$108.00 |
$108.00 |
$794.70
|
|
Inj mepivacaine hcl/10 ml
|
$14.40 |
$14.40 |
$14.40 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$2,418.00 |
$2,418.00 |
$2,418.00 |
$556.87
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$691.20 |
$691.20 |
$691.20 |
$8,304.04
|
|
Inj multihance
|
$31.80 |
$31.80 |
$31.80 |
$70.54
|
|
Inj naloxone hydrochloride
|
$67.20 |
$67.20 |
$67.20 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,092.80 |
$2,092.80 |
$2,092.80 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$3.60 |
$3.60 |
$3.60 |
$468.10
|
|
Inj octafluoropropane mic,ml
|
$428.40 |
$428.40 |
$428.40 |
$211.40
|
|
Inj., plazomicin, 5 mg
|
$85.80 |
$85.80 |
$85.80 |
$607.16
|
|
Inj proc ankle arthr
|
$543.60 |
$543.60 |
$543.60 |
$405.31
|
|
Inj proc elbow arthro
|
$543.60 |
$543.60 |
$543.60 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$5,860.20 |
$5,860.20 |
$5,860.20 |
$1,106.93
|
|
Inj progesterone per 50 mg
|
$12.60 |
$12.60 |
$12.60 |
$13.76
|
|
Inj., rolapitant, 0.5 mg
|
$1.80 |
$1.80 |
$1.80 |
$1.80
|
|
Inj scleros sol mult veins
|
$1,129.80 |
$1,129.80 |
$1,129.80 |
$692.90
|
|
Inj scleros sol sgl vein
|
$1,416.60 |
$1,416.60 |
$1,416.60 |
$561.88
|
|
Inj secukinumab intrav 1mg
|
$42.80 |
$42.80 |
$42.80 |
$4,413.21
|
|
Inj sulf hexa lipid microsph
|
$397.80 |
$397.80 |
$397.80 |
$256.14
|
|
Inj tedizolid phosphate
|
$3.60 |
$3.60 |
$3.60 |
$664.72
|
|
Inj. teprotumumab-trbw 10 mg
|
$38,425.20 |
$38,425.20 |
$38,425.20 |
$35,034.78
|
|
Inj testosterone cypionate
|
$61.20 |
$61.20 |
$61.20 |
$64.96
|
|
Inj, tyenne, 1 mg
|
$12.80 |
$12.80 |
$12.80 |
$3,525.12
|
|
Inj, vancomycin hcl (xellia)
|
$24.00 |
$24.00 |
$24.00 |
$85.20
|
|
Inj w/fluor eval cv device
|
$935.40 |
$935.40 |
$935.40 |
$504.40
|
|
Ins cath ren art 1st bi
|
$11,313.00 |
$11,313.00 |
$11,313.00 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$7,671.00 |
$7,671.00 |
$7,671.00 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$15,274.80 |
$15,274.80 |
$15,274.80 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$7,236.60 |
$7,236.60 |
$7,236.60 |
$5,395.20
|
|
Insert cath pleura with image
|
$2,764.80 |
$2,764.80 |
$2,764.80 |
$2,194.40
|
|
Insert cath pleura without image
|
$832.80 |
$832.80 |
$832.80 |
$2,099.70
|
|
Insertion catheter bladder non indwelling
|
$585.00 |
$585.00 |
$585.00 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$7,321.80 |
$7,321.80 |
$7,321.80 |
$4,897.20
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,115.60 |
$2,115.60 |
$2,115.60 |
$2,447.63
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,328.00 |
$2,328.00 |
$2,328.00 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,449.20 |
$2,449.20 |
$2,449.20 |
$2,585.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$3,822.60 |
$3,822.60 |
$3,822.60 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$3,774.00 |
$3,774.00 |
$3,774.00 |
$12,324.60
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$24,882.60 |
$24,882.60 |
$24,882.60 |
$9,884.16
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,449.20 |
$2,449.20 |
$2,449.20 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,017.40 |
$3,017.40 |
$3,017.40 |
$2,453.83
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$73,004.40 |
$73,004.40 |
$73,004.40 |
$29,180.00
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$1,355.40 |
$1,355.40 |
$1,355.40 |
$7,183.68
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$2,794.80 |
$2,794.80 |
$2,794.80 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$2,371.80 |
$2,371.80 |
$2,371.80 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,746.40 |
$3,746.40 |
$3,746.40 |
$5,236.80
|
|
Insert pessary/other device
|
$690.00 |
$690.00 |
$690.00 |
$278.90
|
