|
Injection, isavuconazonium
|
$787.67 |
$787.67 |
$787.67 |
$787.67
|
|
Injection, necitumumab, 1 mg
|
$8,572.91 |
$8,572.91 |
$8,572.91 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$2,510.64 |
$2,510.64 |
$2,510.64 |
$2,241.61
|
|
Injection, peramivir
|
$684.00 |
$684.00 |
$684.00 |
$775.82
|
|
Injection radioactive tracer sentinel node (both sides)
|
$731.25 |
$731.25 |
$731.25 |
$683.28
|
|
Injection, renflexis
|
$1,491.72 |
$1,491.72 |
$1,491.72 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,255.55 |
$2,255.55 |
$2,255.55 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$741.45 |
$741.45 |
$741.45 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$741.45 |
$741.45 |
$741.45 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,438.95 |
$1,438.95 |
$1,438.95 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,001.25 |
$1,001.25 |
$1,001.25 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$441.30 |
$441.30 |
$441.30 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$146.85 |
$146.85 |
$146.85 |
$135.20
|
|
Injection treatment of nerve
|
$2,346.60 |
$2,346.60 |
$2,346.60 |
$3,219.20
|
|
Inject sacroiliac joint
|
$2,255.55 |
$2,255.55 |
$2,255.55 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,001.25 |
$1,001.25 |
$1,001.25 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$237.60 |
$237.60 |
$237.60 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$212.36 |
$212.36 |
$212.36 |
$343.35
|
|
Inj for ext venography
|
$518.10 |
$518.10 |
$518.10 |
$654.00
|
|
Inj herzuma 10 mg
|
$7,775.46 |
$7,775.46 |
$7,775.46 |
$7,775.46
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,045.80 |
$1,045.80 |
$1,045.80 |
$1,045.80
|
|
Inj hrt cath w/s&i sel right vent
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$947.05
|
|
Inj human fibrinogen con nos
|
$3.95 |
$3.95 |
$3.95 |
$3.95
|
|
Inj hydroxyprogst capoat nos
|
$1,589.94 |
$1,589.94 |
$1,589.94 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$662.97 |
$662.97 |
$662.97 |
$662.97
|
|
Inj ivig privigen 500 mg
|
$6,967.29 |
$6,967.29 |
$6,967.29 |
$6,967.29
|
|
Inj levoleucovorin nos 0.5mg
|
$117.00 |
$117.00 |
$117.00 |
$103.60
|
|
Inj, levothyroxine, freskabi
|
$59.87 |
$59.87 |
$59.87 |
$363.97
|
|
Inj. meloxicam 1 mg
|
$203.04 |
$203.04 |
$203.04 |
$167.04
|
|
Inj melpha hydroch nos 50 mg
|
$4,962.63 |
$4,962.63 |
$4,962.63 |
$2,375.23
|
|
Inj mepivacaine hcl/10 ml
|
$33.86 |
$33.86 |
$33.86 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$466.56 |
$466.56 |
$466.56 |
$536.27
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$8,922.99 |
$8,922.99 |
$8,922.99 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$107.25 |
$107.25 |
$107.25 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$466.47 |
$466.47 |
$466.47 |
$252.66
|
|
Inj naloxone hydrochloride
|
$83.16 |
$83.16 |
$83.16 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,657.05 |
$1,657.05 |
$1,657.05 |
$1,414.40
|
|
Inj octafluoropropane mic,ml
|
$421.20 |
$421.20 |
$421.20 |
$211.40
|
|
Inj ogivri 10 mg
|
$5,197.61 |
$5,197.61 |
$5,197.61 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$865.34 |
$865.34 |
$865.34 |
$865.34
|
|
Inj ontruzant 10 mg
|
$7,343.90 |
$7,343.90 |
$7,343.90 |
$6,706.27
|
|
Inj proc ankle arthr
|
$469.05 |
$469.05 |
$469.05 |
$405.31
|
|
Inj proc elbow arthro
|
$497.55 |
$497.55 |
$497.55 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$401.10 |
$401.10 |
$401.10 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$651.90 |
$651.90 |
$651.90 |
$856.00
|
|
Inj progesterone per 50 mg
|
$6.00 |
$6.00 |
$6.00 |
$14.93
|
|
Inj retro urethrocysto
|
$384.60 |
$384.60 |
$384.60 |
$450.00
|
|
Inj, rimabotulinumtoxinb
|
$672.44 |
$672.44 |
$672.44 |
$714.24
|
|
Inj, sezaby, 1 mg
|
$288.11 |
$288.11 |
$288.11 |
$235.85
|
|
Inj tedizolid phosphate
|
$664.72 |
$664.72 |
$664.72 |
$664.72
|
|
Inj testostero enanthate 1mg
|
$8.29 |
$8.29 |
$8.29 |
$157.81
|
|
Inj testosterone cypionate
|
$54.70 |
$54.70 |
$54.70 |
$62.80
|
|
Inj, vancomycin hcl (xellia)
|
$70.56 |
$70.56 |
$70.56 |
$85.20
|
|
Inj w/fluor eval cv device
|
$198.60 |
$198.60 |
$198.60 |
$463.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$44,026.28 |
$44,026.28 |
$44,026.28 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$261.15 |
$261.15 |
$261.15 |
$488.35
|
|
Insert cath pleura with image
|
$2,414.10 |
$2,414.10 |
$2,414.10 |
$2,194.40
|
|
Insertion catheter bladder non indwelling
|
$205.20 |
$205.20 |
$205.20 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$188.70 |
$188.70 |
$188.70 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,035.45 |
$4,035.45 |
$4,035.45 |
$4,731.80
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,803.15 |
$1,803.15 |
$1,803.15 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$8,028.15 |
$8,028.15 |
$8,028.15 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,899.95 |
$2,899.95 |
$2,899.95 |
$2,511.00
|
|
Insertion of catheter vein
|
$1,241.85 |
$1,241.85 |
$1,241.85 |
$836.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$18,985.80 |
$18,985.80 |
$18,985.80 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$16,493.55 |
$16,493.55 |
$16,493.55 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$33,423.45 |
$33,423.45 |
$33,423.45 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,510.55 |
$2,510.55 |
$2,510.55 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,414.10 |
$2,414.10 |
$2,414.10 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$51,832.80 |
$51,832.80 |
$51,832.80 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$9,426.60 |
$9,426.60 |
$9,426.60 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$9,426.60 |
$9,426.60 |
$9,426.60 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$9,277.20 |
$9,277.20 |
$9,277.20 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,648.15 |
$3,648.15 |
$3,648.15 |
$5,236.80
|
|
Insert pm/icd lead dual
|
$9,134.25 |
$9,134.25 |
$9,134.25 |
$7,388.80
|
|
Insert/repl sq defib w/eltrd
|
$32,052.60 |
$32,052.60 |
$32,052.60 |
$33,297.72
|
|
Insert sq defib electrode
|
$8,937.30 |
$8,937.30 |
$8,937.30 |
$8,167.68
|
|
Insert swan-ganz cath
|
$3,286.50 |
$3,286.50 |
$3,286.50 |
$2,210.50
|
|
Insert vad art access left hrt arterial access
|
$1,712.10 |
$1,712.10 |
$1,712.10 |
$4,221.97
|
|
Insitu hybridization manual
|
$318.00 |
$318.00 |
$318.00 |
$388.20
|
|
Ins lv lead exist pm/icd
|
$33,423.45 |
$33,423.45 |
$33,423.45 |
$12,087.24
|
|
Ins picad w subq port 5yr>
|
$3,167.85 |
$3,167.85 |
$3,167.85 |
$3,912.93
|
|
Ins pm gen exist dual lead
|
$42,952.50 |
$42,952.50 |
$42,952.50 |
$24,696.00
|
|
Ins pm gen w/exist mlt leads
|
$15,107.85 |
$15,107.85 |
$15,107.85 |
$14,804.40
|
|
Ins pq tunnld ip cath w/img
|
$5,882.10 |
$5,882.10 |
$5,882.10 |
$5,377.00
|
