|
Ingest challenge ea addl 60 min
|
$140.50 |
$140.50 |
$140.50 |
$289.64
|
|
Ingest challenge ini 120 min
|
$623.50 |
$623.50 |
$623.50 |
$764.78
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$252.00 |
$252.00 |
$252.00 |
$293.25
|
|
Initiation & management bipap/cpap initial day
|
$172.00 |
$172.00 |
$172.00 |
$576.00
|
|
Init pm e/m new pat 65+ yrs
|
$107.00 |
$107.00 |
$107.00 |
$185.90
|
|
Init/sub psych care m 1st 30
|
$100.00 |
$100.00 |
$100.00 |
$94.34
|
|
Inj, abilify asimtufii, 1 mg
|
$12.50 |
$12.50 |
$12.50 |
$9,426.91
|
|
Inj, abilify maintena, 1 mg
|
$5,800.00 |
$5,800.00 |
$5,800.00 |
$5,355.30
|
|
Inj, acetaminophen (b braun)
|
$21.60 |
$21.60 |
$21.60 |
$33.31
|
|
Inj acetaminophen -fresenius
|
$8.78 |
$8.78 |
$8.78 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$24.30 |
$24.30 |
$24.30 |
$58.50
|
|
Inj, adstiladrin, per tx dos
|
$80,745.00 |
$80,745.00 |
$80,745.00 |
$63,354.77
|
|
Inj, aflibercept hd, 1 mg
|
$768.50 |
$768.50 |
$768.50 |
$2,794.18
|
|
Inj anifrolumab-fnia 1mg
|
$41.00 |
$41.00 |
$41.00 |
$9,878.82
|
|
Inj atezolizumb 5mg hya-tqjs
|
$22,503.63 |
$22,503.63 |
$22,503.63 |
$18,716.52
|
|
Inj avacincaptad pegol 0.1mg
|
$236.50 |
$236.50 |
$236.50 |
$3,409.64
|
|
Inj., benralizumab, 1 mg
|
$10,349.28 |
$10,349.28 |
$10,349.28 |
$11,239.97
|
|
Inj, bezlotoxumab, 10 mg
|
$103.00 |
$103.00 |
$103.00 |
$7,612.43
|
|
Inj bimatoprost itc imp1mcg
|
$456.00 |
$456.00 |
$456.00 |
$3,287.96
|
|
Inj, bupivacaine liposome
|
$755.91 |
$755.91 |
$755.91 |
$699.38
|
|
Inj cefazolin sodium, baxter
|
$20.93 |
$20.93 |
$20.93 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$10.64 |
$10.64 |
$10.64 |
$28.08
|
|
Inj cefazolin (wg crit care)
|
$9.31 |
$9.31 |
$9.31 |
$18.05
|
|
Inj. cefepime hcl (baxter)
|
$139.95 |
$139.95 |
$139.95 |
$86.84
|
|
Inj ceftolozane tazobactam
|
$720.66 |
$720.66 |
$720.66 |
$380.80
|
|
Inj, clindamycin (baxter)
|
$22.05 |
$22.05 |
$22.05 |
$48.96
|
|
Inj, daptomycin (hospira)
|
$88.05 |
$88.05 |
$88.05 |
$113.35
|
|
Inj disk cerv-thor ea lev
|
$329.00 |
$329.00 |
$329.00 |
$875.28
|
|
Inj, donanemab-azbt, 2 mg
|
$1,565.24 |
$1,565.24 |
$1,565.24 |
$1,233.44
|
|
Inj, durolane 1 mg
|
$4,608.50 |
$4,608.50 |
$4,608.50 |
$1,950.93
|
|
Inj dx for sinogram
|
$763.00 |
$763.00 |
$763.00 |
$422.59
|
|
Inject for sacroiliac joint
|
$1,155.00 |
$1,155.00 |
$1,155.00 |
$1,025.77
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,865.50 |
$1,865.50 |
$1,865.50 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$1,339.00 |
$1,339.00 |
$1,339.00 |
$495.84
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,069.00 |
$1,069.00 |
$1,069.00 |
$450.72
|
|
Injection, casimersen, 10 mg
|
$271.50 |
$271.50 |
$271.50 |
$2,598.44
|
|
Injection during cath supravalvular aortography
|
$327.00 |
$327.00 |
$327.00 |
$952.66
|
|
Injection epidural blood patch or clot
|
$1,369.00 |
$1,369.00 |
$1,369.00 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$1,620.50 |
$1,620.50 |
$1,620.50 |
$428.40
|
|
Injection for bladder x-ray
|
$913.50 |
$913.50 |
$913.50 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$1,118.50 |
$1,118.50 |
$1,118.50 |
$494.65
|
|
Injection for ureter x-ray
|
$1,204.50 |
$1,204.50 |
$1,204.50 |
$515.21
|
|
Injection, fulvestrant
|
$423.18 |
$423.18 |
$423.18 |
$1,817.65
|
|
Injection, inclisiran, 1 mg
|
$7,608.20 |
$7,608.20 |
$7,608.20 |
$6,679.35
|
|
Injection jugular
|
$240.50 |
$240.50 |
$240.50 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$1,302.00 |
$1,302.00 |
$1,302.00 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$813.00 |
$813.00 |
$813.00 |
$670.64
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,634.00 |
$1,634.00 |
$1,634.00 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,324.00 |
$2,324.00 |
$2,324.00 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$3,498.00 |
$3,498.00 |
$3,498.00 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,930.00 |
$2,930.00 |
$2,930.00 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$451.17 |
$451.17 |
$451.17 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,731.50 |
$1,731.50 |
$1,731.50 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,004.00 |
$1,004.00 |
$1,004.00 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,822.00 |
$4,822.00 |
$4,822.00 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,369.00 |
$1,369.00 |
$1,369.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,584.17 |
$1,584.17 |
$1,584.17 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$4,745.00 |
$4,745.00 |
$4,745.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,355.50 |
$1,355.50 |
$1,355.50 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$706.00 |
$706.00 |
$706.00 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$350.00 |
$350.00 |
$350.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$609.00 |
$609.00 |
$609.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$417.00 |
$417.00 |
$417.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$290.00 |
$290.00 |
$290.00 |
$135.60
|
|
Inject sacroiliac joint
|
$2,066.00 |
$2,066.00 |
$2,066.00 |
$1,028.95
|
|
Inject/treat eye socket
|
$365.00 |
$365.00 |
$365.00 |
$381.13
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$73.50 |
$73.50 |
$73.50 |
$32,176.93
|
|
Inj epidural sgl lumb-sacral without img
|
$1,169.50 |
$1,169.50 |
$1,169.50 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$3.50 |
$3.50 |
$3.50 |
$206.64
|
|
Inj, faricimab-svoa, 0.1mg
|
$88.50 |
$88.50 |
$88.50 |
$4,103.29
|
|
Inj for ext venography
|
$1,062.00 |
$1,062.00 |
$1,062.00 |
$649.95
|
|
Inj for mammo ductogram
|
$313.00 |
$313.00 |
$313.00 |
$399.60
|
|
Inj. herceptin hylecta, 10mg
|
$10,519.29 |
$10,519.29 |
$10,519.29 |
$7,690.59
|
|
Inj, invega hafyera/trinza
|
$28.50 |
$28.50 |
$28.50 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$8,971.88 |
$8,971.88 |
$8,971.88 |
$6,967.29
|
|
Inj, lecanemab-irmb, 1 mg
|
$2,579.93 |
$2,579.93 |
$2,579.93 |
$1,174.88
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$875.00 |
$875.00 |
$875.00 |
$784.00
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$118.50 |
$118.50 |
$118.50 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$40,018.61 |
$40,018.61 |
$40,018.61 |
$8,304.04
|
|
Inj naloxone hydrochloride
|
$31.75 |
$31.75 |
$31.75 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$4,331.00 |
$4,331.00 |
$4,331.00 |
$1,413.35
|
|
Inj nivolumab 2 mg hyaluron
|
$31,772.32 |
$31,772.32 |
$31,772.32 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$72,243.36 |
$72,243.36 |
$72,243.36 |
$66,582.27
|
|
Inj, pegcetacoplan, 1mg
|
$338.50 |
$338.50 |
$338.50 |
$3,662.96
|
|
Inj., perseris, 0.5 mg
|
$25.00 |
$25.00 |
$25.00 |
$5,146.85
|
|
Inj proc myelogram lumbar
|
$1,719.00 |
$1,719.00 |
$1,719.00 |
$830.50
|
|
Inj prohance multipack
|
$255.15 |
$255.15 |
$255.15 |
$9.59
|
|
Inj retacrit esrd on dialysi
|
$169.55 |
$169.55 |
$169.55 |
$349.45
|
|
Inj retro urethrocysto
|
$1,172.50 |
$1,172.50 |
$1,172.50 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$13.00 |
$13.00 |
$13.00 |
$746.79
|
|
Inj scleros sol mult veins
|
$1,524.50 |
$1,524.50 |
$1,524.50 |
$675.00
|
|
Inj scleros sol sgl vein
|
$1,609.00 |
$1,609.00 |
$1,609.00 |
$558.97
|
|
Inj secukinumab intrav 1mg
|
$5,767.61 |
$5,767.61 |
$5,767.61 |
$4,413.21
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$467.50 |
$467.50 |
$467.50 |
$436.80
|
|
Inj, susvimo 0.1 mg
|
$180.00 |
$180.00 |
$180.00 |
$2,598.44
|
|
Inj. teprotumumab-trbw 10 mg
|
$42,027.89 |
$42,027.89 |
$42,027.89 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$0.50 |
$0.50 |
$0.50 |
$123.24
|
|
Inj testosterone cypionate
|
$9.00 |
$9.00 |
$9.00 |
$64.80
|
