|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$583.68 |
$583.68 |
$583.68 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$792.96 |
$792.96 |
$792.96 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$244.32 |
$244.32 |
$244.32 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$468.00 |
$468.00 |
$468.00 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$430.08 |
$430.08 |
$430.08 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$827.04 |
$827.04 |
$827.04 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$864.96 |
$864.96 |
$864.96 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$864.96 |
$864.96 |
$864.96 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$140.64 |
$140.64 |
$140.64 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$136.80 |
$136.80 |
$136.80 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$201.12 |
$201.12 |
$201.12 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$67.68 |
$67.68 |
$67.68 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$69.60 |
$69.60 |
$69.60 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$67.68 |
$67.68 |
$67.68 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$107.04 |
$107.04 |
$107.04 |
$135.60
|
|
Inject sacroiliac joint
|
$248.64 |
$248.64 |
$248.64 |
$1,028.95
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$37,855.20 |
$37,855.20 |
$37,855.20 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$657.60 |
$657.60 |
$657.60 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$597.12 |
$597.12 |
$597.12 |
$1,415.50
|
|
Inj, etelcalcetide, 0.1 mg
|
$392.40 |
$392.40 |
$392.40 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$7,235.19 |
$7,235.19 |
$7,235.19 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$240.80 |
$240.80 |
$240.80 |
$39.54
|
|
Inj for ext venography
|
$126.24 |
$126.24 |
$126.24 |
$649.95
|
|
Inj, fulvestrant (fresenius)
|
$197.56 |
$197.56 |
$197.56 |
$1,043.05
|
|
Inj gemcitabine hcl (accord)
|
$229.64 |
$229.64 |
$229.64 |
$130.65
|
|
Inj glofitamab gxbm, 2.5 mg
|
$24,525.56 |
$24,525.56 |
$24,525.56 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$47.76 |
$47.76 |
$47.76 |
$11.23
|
|
Inj, granisetron, xr, 0.1 mg
|
$1,596.77 |
$1,596.77 |
$1,596.77 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$33,735.87 |
$33,735.87 |
$33,735.87 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$47.76 |
$47.76 |
$47.76 |
$26.26
|
|
Inj hydroxyprogst capoat nos
|
$246.39 |
$246.39 |
$246.39 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$693.72 |
$693.72 |
$693.72 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$104,799.84 |
$104,799.84 |
$104,799.84 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$64.32 |
$64.32 |
$64.32 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$63.36 |
$63.36 |
$63.36 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$6,988.80 |
$6,988.80 |
$6,988.80 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$47.76 |
$47.76 |
$47.76 |
$38.94
|
|
Inj, lanreotide, (cipla) 1mg
|
$16,353.05 |
$16,353.05 |
$16,353.05 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,528.85 |
$1,528.85 |
$1,528.85 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$85.34 |
$85.34 |
$85.34 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$184.56 |
$184.56 |
$184.56 |
$303.45
|
|
Inj, levothyroxine, hikma
|
$124.01 |
$124.01 |
$124.01 |
$42.89
|
|
Inj, lidocaine w epinephrine
|
$47.76 |
$47.76 |
$47.76 |
$47.52
|
|
Inj melpha hydroch nos 50 mg
|
$450.20 |
$450.20 |
$450.20 |
$1,791.90
|
|
Inj mepivacaine hcl/10 ml
|
$47.76 |
$47.76 |
$47.76 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$99.24 |
$99.24 |
$99.24 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$426.91 |
$426.91 |
$426.91 |
$558.08
|
|
Inj, micafungin (par pharm)
|
$52.68 |
$52.68 |
$52.68 |
$89.40
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$23,023.73 |
$23,023.73 |
$23,023.73 |
$1,496.55
|
|
Inj, moxifloxacin 100 mg
|
$99.24 |
$99.24 |
$99.24 |
$107.25
|
|
Inj multihance
|
$73.49 |
$73.49 |
$73.49 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$160.06 |
$160.06 |
$160.06 |
$252.66
|
|
Inj, nithiodote, 3mg / 125mg
|
$472.76 |
$472.76 |
$472.76 |
$462.04
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$99,076.61 |
$99,076.61 |
$99,076.61 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$3,581.43 |
$3,581.43 |
$3,581.43 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$47.76 |
$47.76 |
$47.76 |
$34.67
|
|
Inj., patisiran, 0.1 mg
|
$22,800.00 |
$22,800.00 |
$22,800.00 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$47.76 |
$47.76 |
$47.76 |
$132.57
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$7,165.35 |
$7,165.35 |
$7,165.35 |
$6,403.59
|
|
Inj. pemetrexed, 10 mg
|
$8,796.10 |
$8,796.10 |
$8,796.10 |
$104.72
|
|
Inj pemetrexed (sandoz) 10mg
|
$108.87 |
$108.87 |
$108.87 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$1,540.01 |
$1,540.01 |
$1,540.01 |
$1,235.55
|
|
Inj progesterone per 50 mg
|
$47.76 |
$47.76 |
$47.76 |
$15.00
|
|
Inj, releuko 1 mcg
|
$342.53 |
$342.53 |
$342.53 |
$473.25
|
|
Inj retacrit esrd on dialysi
|
$843.53 |
$843.53 |
$843.53 |
$349.45
|
|
Inj retro urethrocysto
|
$99.36 |
$99.36 |
$99.36 |
$443.50
|
|
Inj scleros sol sgl vein
|
$55.68 |
$55.68 |
$55.68 |
$558.97
|
|
Inj secretin synthetic human
|
$1,586.40 |
$1,586.40 |
$1,586.40 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$5,126.76 |
$5,126.76 |
$5,126.76 |
$4,413.21
|
|
Inj, spesolimab-sbzo, 1 mg
|
$61,359.61 |
$61,359.61 |
$61,359.61 |
$90,007.62
|
|
Inj teplizumab mzwv 5 mcg
|
$25,995.20 |
$25,995.20 |
$25,995.20 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$37,131.84 |
$37,131.84 |
$37,131.84 |
$35,034.78
|
|
Inj testosterone cypionate
|
$83.62 |
$83.62 |
$83.62 |
$64.80
|
|
Inj., tildrakizumab, 1 mg
|
$31,962.72 |
$31,962.72 |
$31,962.72 |
$26,635.60
|
|
Inj, tofidence, 1 mg
|
$5,328.00 |
$5,328.00 |
$5,328.00 |
$92.13
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,436.40 |
$1,436.40 |
$1,436.40 |
$1,090.75
|
|
Inj, tyenne, 1 mg
|
$4,306.56 |
$4,306.56 |
$4,306.56 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$13,404.99 |
$13,404.99 |
$13,404.99 |
$11,475.96
|
|
Inj, vancomycin hcl (xellia)
|
$99.24 |
$99.24 |
$99.24 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$47.76 |
$47.76 |
$47.76 |
$41.79
|
|
Inj w/fluor eval cv device
|
$108.48 |
$108.48 |
$108.48 |
$503.92
|
|
Inpatient consultation
|
$50.88 |
$50.88 |
$50.88 |
$73.80
|
|
Insert cath pleura with image
|
$932.64 |
$932.64 |
$932.64 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,042.08 |
$1,042.08 |
$1,042.08 |
$2,073.18
|
|
Insert drug delivery implant
|
$40.80 |
$40.80 |
$40.80 |
$280.00
|
|
Insert intrauterine device iud
|
$144.48 |
$144.48 |
$144.48 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$125.28 |
$125.28 |
$125.28 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$122.88 |
$122.88 |
$122.88 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,114.56 |
$1,114.56 |
$1,114.56 |
$4,782.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,247.52 |
$1,247.52 |
$1,247.52 |
$2,505.60
|
|
Insertion of catheter vein
|
$853.92 |
$853.92 |
$853.92 |
$1,477.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,562.88 |
$1,562.88 |
$1,562.88 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$826.56 |
$826.56 |
$826.56 |
$2,419.65
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$2,891.52 |
$2,891.52 |
$2,891.52 |
$7,200.05
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,381.44 |
$1,381.44 |
$1,381.44 |
$5,223.20
|
|
Insert pessary/other device
|
$72.00 |
$72.00 |
$72.00 |
$278.50
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$1,139.04 |
$1,139.04 |
$1,139.04 |
$4,803.00
|
|
Insert tunneled cv cath
|
$1,726.08 |
$1,726.08 |
$1,726.08 |
$4,520.00
|
|
Insert tunneled cv cath
|
$1,559.04 |
$1,559.04 |
$1,559.04 |
$5,983.35
|
|
Insitu hybridization manual
|
$364.32 |
$364.32 |
$364.32 |
$401.28
|
