|
Inject for sacroiliac joint
|
$340.18 |
$340.18 |
$340.18 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$348.82 |
$348.82 |
$2,712.00 |
|
|
Injection arthrography hip without anesthesia (both sides)
|
$370.99 |
$574.28 |
$784.80 |
|
|
Injection, belinostat, 10mg
|
$4,692.36 |
$4,692.36 |
$4,692.36 |
|
|
Injection, cangrelor
|
$1,522.98 |
$1,522.98 |
$1,522.98 |
|
|
Injection, caplacizumab-yhdp
|
$11,556.86 |
$11,556.86 |
$11,556.86 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$422.97 |
$422.97 |
$1,583.86 |
|
|
Injection, daratumumab 10 mg
|
$2,485.45 |
$4,447.64 |
$6,918.40 |
|
|
Injection, doxercalciferol
|
$42.37 |
$42.37 |
$69.36 |
|
|
Injection during cath supravalvular aortography
|
$1,028.88 |
$1,028.88 |
$2,331.20 |
|
|
Injection epidural blood patch or clot
|
$374.36 |
$922.22 |
$1,593.60 |
|
|
Injection eye drug
|
$1,040.80 |
$1,040.80 |
$1,040.80 |
|
|
Injection for arthrography wrist (both sides)
|
$300.05 |
$491.71 |
$592.00 |
|
|
Injection for bladder x-ray
|
$460.00 |
$771.20 |
$1,808.30 |
|
|
Injection for hip x-ray
|
$370.99 |
$582.12 |
$582.12 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$370.99 |
$581.84 |
$678.10 |
|
|
Injection for spleen x-ray
|
$952.99 |
$952.99 |
$952.99 |
|
|
Injection for tear sac x-ray
|
$67.31 |
$67.31 |
$159.26 |
|
|
Injection for ureter x-ray
|
$314.27 |
$314.27 |
$657.65 |
|
|
Injection for ureter x-ray
|
$317.91 |
$317.91 |
$1,008.00 |
|
|
Injection, fulvestrant
|
$249.68 |
$3,017.73 |
$3,518.45 |
|
|
Injection glatiramer acetate
|
$388.64 |
$918.42 |
$918.42 |
|
|
Injection, inclisiran, 1 mg
|
$5,260.16 |
$5,549.16 |
$6,383.95 |
|
|
Injection into brain canal
|
$237.66 |
$237.66 |
$469.78 |
|
|
Injection into hemorrhoid(s)
|
$2,020.80 |
$2,020.80 |
$2,020.80 |
|
|
Injection, isavuconazonium
|
$683.43 |
$683.43 |
$683.43 |
|
|
Injection jaw joint x-ray
|
$441.02 |
$441.02 |
$441.02 |
|
|
Injection, necitumumab, 1 mg
|
$7,055.36 |
$7,055.36 |
$7,055.36 |
|
|
Injection of sinus tract
|
$459.55 |
$459.55 |
$1,651.20 |
|
|
Injection,onabotulinumtoxina
|
$1,074.40 |
$2,146.46 |
$2,504.21 |
|
|
Injection, pentamidine iseth
|
$105.46 |
$105.46 |
$105.46 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$145.04 |
$328.94 |
$1,218.40 |
|
|
Injection, renflexis
|
$585.64 |
$880.05 |
$1,076.56 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,008.90 |
$1,776.00 |
$1,846.10 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$993.44 |
$1,004.25 |
$1,313.42 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$914.40 |
$1,168.80 |
$1,337.60 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,520.51 |
$1,521.07 |
$2,311.20 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$140.17 |
$141.62 |
$1,181.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,520.51 |
$1,521.07 |
$2,275.20 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$164.70 |
$781.60 |
$1,197.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,520.51 |
$1,521.07 |
$2,364.80 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$893.26 |
$989.52 |
$2,208.00 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$855.74 |
$949.48 |
$2,133.60 |
|
|
Injection, siltuximab
|
$8,443.92 |
$8,443.92 |
$8,443.92 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$416.00 |
$732.59 |
$948.82 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$434.17 |
$626.40 |
$925.44 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$620.00 |
$947.18 |
$947.18 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$97.44 |
$132.48 |
$215.20 |
|
|
Injection treatment of eye
|
$3,524.00 |
$3,524.00 |
$3,524.00 |
|
|
Injection treatment of nerve
|
$2,792.16 |
$2,792.16 |
$2,792.16 |
|
|
Inject sacroiliac joint
|
$1,116.80 |
$1,116.80 |
$1,224.80 |
|
|
Inject/treat eye socket
|
$751.39 |
$751.39 |
$751.39 |
|
|
Inj epidural sgl cerv-thor without img
|
$594.16 |
$764.46 |
$1,161.60 |
|
|
Inj epidural sgl lumb-sacral without img
|
$610.57 |
$658.50 |
$1,109.60 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$342.86 |
$342.86 |
$347.96 |
|
|
Inj, evinacumab-dgnb, 5mg
|
$58,801.90 |
$58,801.90 |
$58,801.90 |
|
|
Inj, faricimab-svoa, 0.1mg
|
$2,280.19 |
$2,280.19 |
$2,280.19 |
|
|
Inj. fe derisomaltose 10 mg
|
$2,788.45 |
$3,859.35 |
$5,048.82 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$39.54 |
$234.45 |
$234.45 |
|
|
Inj for ext venography
|
$514.90 |
$514.90 |
$1,247.20 |
|
|
Inj for mammo ductogram
|
$193.03 |
$193.03 |
$336.10 |
|
|
Inj, fosaprepitant (teva)
|
$108.36 |
$108.36 |
$108.36 |
|
|
Inj, fulvestrant (fresenius)
|
$462.67 |
$462.67 |
$462.67 |
|
|
Inj, fulvestrant (teva)
|
$882.69 |
$882.69 |
$882.69 |
|
|
Inj glofitamab gxbm, 2.5 mg
|
$4,378.43 |
$4,378.43 |
$4,378.43 |
|
|
Inj glycopyrrolate, glyrx-pf
|
$60.76 |
$60.76 |
$60.76 |
|
|
Inj., guselkumab, 1 mg
|
$22,143.30 |
$22,143.30 |
$22,143.30 |
|
|
Inj heparin, pfizer, 1000u
|
$35.43 |
$53.17 |
$61.04 |
|
|
Inj. herceptin hylecta, 10mg
|
$5,334.44 |
$7,690.59 |
$7,690.59 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,258.40 |
$6,396.86 |
$6,396.86 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,827.74 |
$1,827.74 |
$1,827.74 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$913.82 |
$913.82 |
$2,844.00 |
|
|
Inj hrt cath w/s&i sel left vent
|
$913.82 |
$913.82 |
$2,159.20 |
|
|
Inj hrt cath w/s&i sel right vent
|
$1,675.39 |
$1,675.39 |
$2,099.20 |
|
|
Inj hydroxocobalamin IV 25mg
|
$978.95 |
$1,576.14 |
$1,838.83 |
|
|
Inj hydroxyprogst capoat nos
|
$579.41 |
$579.41 |
$579.41 |
|
|
Inj imip 4 cilas 4 releb 2mg
|
$538.54 |
$538.54 |
$538.54 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$374.42 |
$374.42 |
$813.79 |
|
|
Inj intralesional <= 7 lsn(s)
|
$272.00 |
$524.64 |
$524.64 |
|
|
Inj intralesional > 7 lsns
|
$977.47 |
$977.47 |
$977.47 |
|
|
Inj, invega hafyera/trinza
|
$4,668.04 |
$13,469.96 |
$15,908.48 |
|
|
Inj ivig privigen 500 mg
|
$2,277.60 |
$6,072.29 |
$7,084.34 |
|
|
Inj labetalol hcl hikma, 5mg
|
$25.86 |
$25.86 |
$25.86 |
|
|
Inj, lanreotide, (cipla) 1mg
|
$6,657.00 |
$7,766.50 |
$9,913.66 |
|
|
Inj levocarnitine per 1 gm
|
$64.23 |
$76.00 |
$85.16 |
|
|
Inj levoleucovorin nos 0.5mg
|
$110.40 |
$110.40 |
$122.64 |
|
|
Inj, levothyroxine, freskabi
|
$84.86 |
$667.39 |
$778.62 |
|
|
Inj, lidocaine w epinephrine
|
$0.87 |
$49.63 |
$62.62 |
|
|
Inj, linezolid (hospira)
|
$98.32 |
$98.32 |
$98.32 |
|
|
Inj melpha hydroch nos 50 mg
|
$512.25 |
$512.25 |
$2,669.02 |
|
|
Inj mepivacaine hcl/10 ml
|
$34.34 |
$51.68 |
$196.76 |
|
|
Inj, meropenem (b. braun)
|
$64.60 |
$94.05 |
$164.72 |
|
|
Inj., meropenem, vaborbactam
|
$349.04 |
$349.04 |
$349.04 |
|
|
Inj meropenem (wg crit care)
|
$66.55 |
$66.55 |
$72.87 |
|
|
Inj, micafungin (par pharm)
|
$70.02 |
$70.02 |
$70.02 |
|
|
Inj, moxifloxacin 100 mg
|
$29.46 |
$29.46 |
$123.28 |
|
|
Inj moxifloxacin (fres kabi)
|
$93.97 |
$93.97 |
$93.97 |
|
|
Inj multihance
|
$12.00 |
$120.00 |
$204.00 |
|
|
Inj. mycophenolate mofetil
|
$134.60 |
$134.60 |
$195.01 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$446.32 |
$446.32 |
$1,993.60 |
|