|
Injection for arthrography wrist (both sides)
|
$361.20 |
$361.20 |
$361.20 |
$428.40
|
|
Injection for bladder x-ray
|
$2,467.67 |
$2,467.67 |
$2,467.67 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$372.40 |
$372.40 |
$372.40 |
$494.65
|
|
Injection for spleen x-ray
|
$2,619.40 |
$2,619.40 |
$2,619.40 |
$529.57
|
|
Injection for ureter x-ray
|
$1,450.40 |
$1,450.40 |
$1,450.40 |
$427.70
|
|
Injection for ureter x-ray
|
$406.70 |
$406.70 |
$406.70 |
$515.21
|
|
Injection, fulvestrant
|
$7,806.22 |
$7,806.22 |
$7,806.22 |
$1,817.65
|
|
Injection, glucarpidase
|
$178,372.42 |
$178,372.42 |
$178,372.42 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$14,802.55 |
$14,802.55 |
$14,802.55 |
$6,679.35
|
|
Injection into brain canal
|
$1,261.40 |
$1,261.40 |
$1,261.40 |
$1,289.60
|
|
Injection into hemorrhoid(s)
|
$12,401.00 |
$12,401.00 |
$12,401.00 |
$1,432.81
|
|
Injection jugular
|
$4,524.10 |
$4,524.10 |
$4,524.10 |
$790.00
|
|
Injection of sinus tract
|
$1,732.50 |
$1,732.50 |
$1,732.50 |
$1,627.60
|
|
Injection,onabotulinumtoxina
|
$2,715.82 |
$2,715.82 |
$2,715.82 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$51,629.23 |
$51,629.23 |
$51,629.23 |
$670.64
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,727.20 |
$2,727.20 |
$2,727.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$57,876.72 |
$57,876.72 |
$57,876.72 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$48,709.41 |
$48,709.41 |
$48,709.41 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,017.70 |
$3,017.70 |
$3,017.70 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$6,386.27 |
$6,386.27 |
$6,386.27 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$6,386.27 |
$6,386.27 |
$6,386.27 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,053.40 |
$3,053.40 |
$3,053.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,940.40 |
$1,940.40 |
$1,940.40 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$954.80 |
$954.80 |
$954.80 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$991.20 |
$991.20 |
$991.20 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,004.50 |
$1,004.50 |
$1,004.50 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$157.50 |
$157.50 |
$157.50 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$140.70 |
$140.70 |
$140.70 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$157.50 |
$157.50 |
$157.50 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$163.10 |
$163.10 |
$163.10 |
$135.60
|
|
Injection treatment of eye
|
$4,273.50 |
$4,273.50 |
$4,273.50 |
$2,665.60
|
|
Injection treatment of nerve
|
$4,208.40 |
$4,208.40 |
$4,208.40 |
$4,350.00
|
|
Inject sacroiliac joint
|
$957.60 |
$957.60 |
$957.60 |
$1,028.95
|
|
Inj, eculizumab-aagh, 2 mg
|
$18,838.75 |
$18,838.75 |
$18,838.75 |
$7,980.52
|
|
Inj, eculizumab-aeeb, 2 mg
|
$24,221.75 |
$24,221.75 |
$24,221.75 |
$610.56
|
|
Inj epidural sgl cerv-thor without img
|
$2,876.30 |
$2,876.30 |
$2,876.30 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$3,347.40 |
$3,347.40 |
$3,347.40 |
$1,415.50
|
|
Inj, faricimab-svoa, 0.1mg
|
$9,790.72 |
$9,790.72 |
$9,790.72 |
$4,103.29
|
|
Inj., fibryga, 1 mg
|
$3,813.07 |
$3,813.07 |
$3,813.07 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$364.70 |
$364.70 |
$364.70 |
$39.54
|
|
Inj for ext venography
|
$5,654.33 |
$5,654.33 |
$5,654.33 |
$649.95
|
|
Inj., guselkumab, 1 mg
|
$60,068.92 |
$60,068.92 |
$60,068.92 |
$29,130.83
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,875.20 |
$3,875.20 |
$3,875.20 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,314.50 |
$3,314.50 |
$3,314.50 |
$1,827.74
|
|
Inj hrt cath w/s&i sel left vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$965.33
|
|
Inj hydroxocobalamin IV 25mg
|
$4,006.62 |
$4,006.62 |
$4,006.62 |
$2,452.32
|
|
Inj. inebilizumab-cdon, 1 mg
|
$186,355.22 |
$186,355.22 |
$186,355.22 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$5,803.00 |
$5,803.00 |
$5,803.00 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$371.00 |
$371.00 |
$371.00 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$9,537.50 |
$9,537.50 |
$9,537.50 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$14.17 |
$14.17 |
$14.17 |
$38.94
|
|
Inj, levothyroxine, freskabi
|
$71.75 |
$71.75 |
$71.75 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$36.75 |
$36.75 |
$36.75 |
$47.52
|
|
Inj mepivacaine hcl/10 ml
|
$26.07 |
$26.07 |
$26.07 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$914.72 |
$914.72 |
$914.72 |
$558.08
|
|
Inj meropenem (wg crit care)
|
$104.12 |
$104.12 |
$104.12 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$91.87 |
$91.87 |
$91.87 |
$89.40
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$39,580.10 |
$39,580.10 |
$39,580.10 |
$1,496.55
|
|
Inj, moxifloxacin 100 mg
|
$99.22 |
$99.22 |
$99.22 |
$107.25
|
|
Inj multihance
|
$113.40 |
$113.40 |
$113.40 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$434.70 |
$434.70 |
$434.70 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$3,247.12 |
$3,247.12 |
$3,247.12 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$4,634.70 |
$4,634.70 |
$4,634.70 |
$2,609.38
|
|
Inj pantoprazole(hikma) 40mg
|
$10.85 |
$10.85 |
$10.85 |
$34.67
|
|
Inj peritoneal venous shunt
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$413.70
|
|
Inj proc ankle arthr
|
$128.80 |
$128.80 |
$128.80 |
$405.31
|
|
Inj proc elbow arthro
|
$269.50 |
$269.50 |
$269.50 |
$419.60
|
|
Inj proc sialogram
|
$1,299.20 |
$1,299.20 |
$1,299.20 |
$373.00
|
|
Inj progesterone per 50 mg
|
$119.00 |
$119.00 |
$119.00 |
$15.00
|
|
Inj retro urethrocysto
|
$2,371.42 |
$2,371.42 |
$2,371.42 |
$443.50
|
|
Inj scleros sol mult veins
|
$645.40 |
$645.40 |
$645.40 |
$675.00
|
|
Inj scleros sol sgl vein
|
$465.50 |
$465.50 |
$465.50 |
$558.97
|
|
Inj secretin synthetic human
|
$2,757.65 |
$2,757.65 |
$2,757.65 |
$1,285.20
|
|
Inj teclistamab cqyv 0.5 mg
|
$43,104.95 |
$43,104.95 |
$43,104.95 |
$17,517.56
|
|
Inj testostero enanthate 1mg
|
$0.01 |
$0.01 |
$0.01 |
$123.24
|
|
Inj testosterone cypionate
|
$7.70 |
$7.70 |
$7.70 |
$64.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$3,438.40 |
$3,438.40 |
$3,438.40 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$76,937.33 |
$76,937.33 |
$76,937.33 |
$837.50
|
|
Inj. tigecycline (accord)
|
$129.85 |
$129.85 |
$129.85 |
$188.03
|
|
Inj tofersen intrathec 1 mg
|
$59,363.85 |
$59,363.85 |
$59,363.85 |
$422.10
|
|
Inj, tyenne, 1 mg
|
$7,726.42 |
$7,726.42 |
$7,726.42 |
$3,525.12
|
|
Inj vancomycin (xellia) 10mg
|
$40.07 |
$40.07 |
$40.07 |
$76.59
|
|
Inj vasopressin (am reg) 1 u
|
$152.95 |
$152.95 |
$152.95 |
$41.79
|
|
Inj, vasopressin (baxter)
|
$163.97 |
$163.97 |
$163.97 |
$228.24
|
|
Inj w/fluor eval cv device
|
$484.78 |
$484.78 |
$484.78 |
$503.92
|
|
Ins cath ren art 1st bi
|
$22,822.30 |
$22,822.30 |
$22,822.30 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$4,536.00 |
$4,536.00 |
$4,536.00 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$6,309.80 |
$6,309.80 |
$6,309.80 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$22,832.77 |
$22,832.77 |
$22,832.77 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$669.20 |
$669.20 |
$669.20 |
$480.28
|
|
Insert cath pleura with image
|
$6,751.67 |
$6,751.67 |
$6,751.67 |
$2,194.40
|
|
Insert cath pleura without image
|
$32,758.33 |
$32,758.33 |
$32,758.33 |
$2,073.18
|
|
Insert hepatic shunt (tips)
|
$34,949.73 |
$34,949.73 |
$34,949.73 |
$7,571.20
|
|
Insert intrauterine device iud
|
$21,245.10 |
$21,245.10 |
$21,245.10 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$3,599.40 |
$3,599.40 |
$3,599.40 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$80,050.97 |
$80,050.97 |
$80,050.97 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$9,606.70 |
$9,606.70 |
$9,606.70 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$86,645.21 |
$86,645.21 |
$86,645.21 |
$2,529.45
|
|
Insertion intra-aortic circulation dev 33970
|
$2,826.60 |
$2,826.60 |
$2,826.60 |
$1,752.40
|
