|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$595.84 |
$595.84 |
$595.84 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$809.48 |
$809.48 |
$809.48 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$249.41 |
$249.41 |
$249.41 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$477.75 |
$477.75 |
$477.75 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$439.04 |
$439.04 |
$439.04 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$844.27 |
$844.27 |
$844.27 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$882.98 |
$882.98 |
$882.98 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$882.98 |
$882.98 |
$882.98 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$143.57 |
$143.57 |
$143.57 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$139.65 |
$139.65 |
$139.65 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$205.31 |
$205.31 |
$205.31 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$69.09 |
$69.09 |
$69.09 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$71.05 |
$71.05 |
$71.05 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$69.09 |
$69.09 |
$69.09 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$109.27 |
$109.27 |
$109.27 |
$135.60
|
|
Inject sacroiliac joint
|
$253.82 |
$253.82 |
$253.82 |
$1,028.95
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$38,643.85 |
$38,643.85 |
$38,643.85 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$671.30 |
$671.30 |
$671.30 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$609.56 |
$609.56 |
$609.56 |
$1,415.50
|
|
Inj, etelcalcetide, 0.1 mg
|
$400.58 |
$400.58 |
$400.58 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$7,385.92 |
$7,385.92 |
$7,385.92 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$245.81 |
$245.81 |
$245.81 |
$39.54
|
|
Inj for ext venography
|
$128.87 |
$128.87 |
$128.87 |
$649.95
|
|
Inj, fulvestrant (fresenius)
|
$201.68 |
$201.68 |
$201.68 |
$1,043.05
|
|
Inj gemcitabine hcl (accord)
|
$234.42 |
$234.42 |
$234.42 |
$130.65
|
|
Inj glofitamab gxbm, 2.5 mg
|
$25,036.51 |
$25,036.51 |
$25,036.51 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$48.76 |
$48.76 |
$48.76 |
$11.23
|
|
Inj, granisetron, xr, 0.1 mg
|
$1,630.04 |
$1,630.04 |
$1,630.04 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$34,438.70 |
$34,438.70 |
$34,438.70 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$48.76 |
$48.76 |
$48.76 |
$26.26
|
|
Inj hydroxyprogst capoat nos
|
$251.52 |
$251.52 |
$251.52 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$708.17 |
$708.17 |
$708.17 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$106,983.17 |
$106,983.17 |
$106,983.17 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$65.66 |
$65.66 |
$65.66 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$64.68 |
$64.68 |
$64.68 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$7,134.40 |
$7,134.40 |
$7,134.40 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$48.76 |
$48.76 |
$48.76 |
$38.94
|
|
Inj, lanreotide, (cipla) 1mg
|
$16,693.74 |
$16,693.74 |
$16,693.74 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,560.70 |
$1,560.70 |
$1,560.70 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$87.12 |
$87.12 |
$87.12 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$188.41 |
$188.41 |
$188.41 |
$303.45
|
|
Inj, levothyroxine, hikma
|
$126.60 |
$126.60 |
$126.60 |
$42.89
|
|
Inj, lidocaine w epinephrine
|
$48.76 |
$48.76 |
$48.76 |
$47.52
|
|
Inj melpha hydroch nos 50 mg
|
$459.58 |
$459.58 |
$459.58 |
$1,791.90
|
|
Inj mepivacaine hcl/10 ml
|
$48.76 |
$48.76 |
$48.76 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$101.31 |
$101.31 |
$101.31 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$435.81 |
$435.81 |
$435.81 |
$558.08
|
|
Inj, micafungin (par pharm)
|
$53.78 |
$53.78 |
$53.78 |
$89.40
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$23,503.39 |
$23,503.39 |
$23,503.39 |
$1,496.55
|
|
Inj, moxifloxacin 100 mg
|
$101.31 |
$101.31 |
$101.31 |
$107.25
|
|
Inj multihance
|
$75.02 |
$75.02 |
$75.02 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$163.39 |
$163.39 |
$163.39 |
$252.66
|
|
Inj, nithiodote, 3mg / 125mg
|
$482.61 |
$482.61 |
$482.61 |
$462.04
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$101,140.70 |
$101,140.70 |
$101,140.70 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$3,656.04 |
$3,656.04 |
$3,656.04 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$48.76 |
$48.76 |
$48.76 |
$34.67
|
|
Inj., patisiran, 0.1 mg
|
$23,275.00 |
$23,275.00 |
$23,275.00 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$48.76 |
$48.76 |
$48.76 |
$132.57
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$7,314.63 |
$7,314.63 |
$7,314.63 |
$6,403.59
|
|
Inj. pemetrexed, 10 mg
|
$8,979.35 |
$8,979.35 |
$8,979.35 |
$104.72
|
|
Inj pemetrexed (sandoz) 10mg
|
$111.14 |
$111.14 |
$111.14 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$1,572.09 |
$1,572.09 |
$1,572.09 |
$1,235.55
|
|
Inj progesterone per 50 mg
|
$48.76 |
$48.76 |
$48.76 |
$15.00
|
|
Inj, releuko 1 mcg
|
$349.67 |
$349.67 |
$349.67 |
$473.25
|
|
Inj retacrit esrd on dialysi
|
$861.11 |
$861.11 |
$861.11 |
$349.45
|
|
Inj retro urethrocysto
|
$101.43 |
$101.43 |
$101.43 |
$443.50
|
|
Inj scleros sol sgl vein
|
$56.84 |
$56.84 |
$56.84 |
$558.97
|
|
Inj secretin synthetic human
|
$1,619.45 |
$1,619.45 |
$1,619.45 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$5,233.57 |
$5,233.57 |
$5,233.57 |
$4,413.21
|
|
Inj, spesolimab-sbzo, 1 mg
|
$62,637.94 |
$62,637.94 |
$62,637.94 |
$90,007.62
|
|
Inj teplizumab mzwv 5 mcg
|
$26,536.76 |
$26,536.76 |
$26,536.76 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$37,905.42 |
$37,905.42 |
$37,905.42 |
$35,034.78
|
|
Inj testosterone cypionate
|
$85.36 |
$85.36 |
$85.36 |
$64.80
|
|
Inj., tildrakizumab, 1 mg
|
$32,628.61 |
$32,628.61 |
$32,628.61 |
$26,635.60
|
|
Inj, tofidence, 1 mg
|
$5,439.00 |
$5,439.00 |
$5,439.00 |
$92.13
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,466.33 |
$1,466.33 |
$1,466.33 |
$1,090.75
|
|
Inj, tyenne, 1 mg
|
$4,396.28 |
$4,396.28 |
$4,396.28 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$13,684.26 |
$13,684.26 |
$13,684.26 |
$11,475.96
|
|
Inj, vancomycin hcl (xellia)
|
$101.31 |
$101.31 |
$101.31 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$48.76 |
$48.76 |
$48.76 |
$41.79
|
|
Inj w/fluor eval cv device
|
$110.74 |
$110.74 |
$110.74 |
$503.92
|
|
Inpatient consultation
|
$51.94 |
$51.94 |
$51.94 |
$73.80
|
|
Insert cath pleura with image
|
$952.07 |
$952.07 |
$952.07 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,063.79 |
$1,063.79 |
$1,063.79 |
$2,073.18
|
|
Insert drug delivery implant
|
$41.65 |
$41.65 |
$41.65 |
$280.00
|
|
Insert intrauterine device iud
|
$147.49 |
$147.49 |
$147.49 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$127.89 |
$127.89 |
$127.89 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$125.44 |
$125.44 |
$125.44 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,137.78 |
$1,137.78 |
$1,137.78 |
$4,782.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,273.51 |
$1,273.51 |
$1,273.51 |
$2,505.60
|
|
Insertion of catheter vein
|
$871.71 |
$871.71 |
$871.71 |
$1,477.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,595.44 |
$1,595.44 |
$1,595.44 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$843.78 |
$843.78 |
$843.78 |
$2,419.65
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$2,951.76 |
$2,951.76 |
$2,951.76 |
$7,200.05
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,410.22 |
$1,410.22 |
$1,410.22 |
$5,223.20
|
|
Insert pessary/other device
|
$73.50 |
$73.50 |
$73.50 |
$278.50
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$1,162.77 |
$1,162.77 |
$1,162.77 |
$4,803.00
|
|
Insert tunneled cv cath
|
$1,762.04 |
$1,762.04 |
$1,762.04 |
$4,520.00
|
|
Insert tunneled cv cath
|
$1,591.52 |
$1,591.52 |
$1,591.52 |
$5,983.35
|
|
Insitu hybridization manual
|
$371.91 |
$371.91 |
$371.91 |
$401.28
|