|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$399.00 |
$399.00 |
$399.00 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,021.44 |
$1,021.44 |
$1,021.44 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,387.68 |
$1,387.68 |
$1,387.68 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$427.56 |
$427.56 |
$427.56 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$819.00 |
$819.00 |
$819.00 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$752.64 |
$752.64 |
$752.64 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,447.32 |
$1,447.32 |
$1,447.32 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,513.68 |
$1,513.68 |
$1,513.68 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,513.68 |
$1,513.68 |
$1,513.68 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$246.12 |
$246.12 |
$246.12 |
$468.98
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$239.40 |
$239.40 |
$239.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$351.96 |
$351.96 |
$351.96 |
$629.99
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$118.44 |
$118.44 |
$118.44 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$121.80 |
$121.80 |
$121.80 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$118.44 |
$118.44 |
$118.44 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$187.32 |
$187.32 |
$187.32 |
$135.60
|
|
Inject sacroiliac joint
|
$435.12 |
$435.12 |
$435.12 |
$1,028.95
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$66,246.60 |
$66,246.60 |
$66,246.60 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$1,150.80 |
$1,150.80 |
$1,150.80 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$1,044.96 |
$1,044.96 |
$1,044.96 |
$1,415.50
|
|
Inj, etelcalcetide, 0.1 mg
|
$686.70 |
$686.70 |
$686.70 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$12,661.58 |
$12,661.58 |
$12,661.58 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$421.39 |
$421.39 |
$421.39 |
$39.54
|
|
Inj for ext venography
|
$220.92 |
$220.92 |
$220.92 |
$649.95
|
|
Inj, fulvestrant (fresenius)
|
$345.73 |
$345.73 |
$345.73 |
$1,017.61
|
|
Inj gemcitabine hcl (accord)
|
$401.86 |
$401.86 |
$401.86 |
$130.65
|
|
Inj glofitamab gxbm, 2.5 mg
|
$42,919.72 |
$42,919.72 |
$42,919.72 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$83.58 |
$83.58 |
$83.58 |
$11.23
|
|
Inj, granisetron, xr, 0.1 mg
|
$2,794.35 |
$2,794.35 |
$2,794.35 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$59,037.77 |
$59,037.77 |
$59,037.77 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$83.58 |
$83.58 |
$83.58 |
$26.26
|
|
Inj hydroxyprogst capoat nos
|
$431.18 |
$431.18 |
$431.18 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,214.01 |
$1,214.01 |
$1,214.01 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$183,399.72 |
$183,399.72 |
$183,399.72 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$112.56 |
$112.56 |
$112.56 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$110.88 |
$110.88 |
$110.88 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$12,230.40 |
$12,230.40 |
$12,230.40 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$83.58 |
$83.58 |
$83.58 |
$38.94
|
|
Inj, lanreotide, (cipla) 1mg
|
$28,617.84 |
$28,617.84 |
$28,617.84 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$2,675.49 |
$2,675.49 |
$2,675.49 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$149.34 |
$149.34 |
$149.34 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$322.98 |
$322.98 |
$322.98 |
$303.45
|
|
Inj, levothyroxine, hikma
|
$217.02 |
$217.02 |
$217.02 |
$38.01
|
|
Inj, lidocaine w epinephrine
|
$83.58 |
$83.58 |
$83.58 |
$46.52
|
|
Inj melpha hydroch nos 50 mg
|
$787.84 |
$787.84 |
$787.84 |
$1,847.89
|
|
Inj mepivacaine hcl/10 ml
|
$83.58 |
$83.58 |
$83.58 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$173.67 |
$173.67 |
$173.67 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$747.09 |
$747.09 |
$747.09 |
$558.08
|
|
Inj, micafungin (par pharm)
|
$92.19 |
$92.19 |
$92.19 |
$89.40
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$40,291.53 |
$40,291.53 |
$40,291.53 |
$1,496.55
|
|
Inj, moxifloxacin 100 mg
|
$173.67 |
$173.67 |
$173.67 |
$107.25
|
|
Inj multihance
|
$128.61 |
$128.61 |
$128.61 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$280.09 |
$280.09 |
$280.09 |
$252.66
|
|
Inj, nithiodote, 3mg / 125mg
|
$827.32 |
$827.32 |
$827.32 |
$452.89
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$173,384.06 |
$173,384.06 |
$173,384.06 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$6,267.50 |
$6,267.50 |
$6,267.50 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$83.58 |
$83.58 |
$83.58 |
$34.67
|
|
Inj., patisiran, 0.1 mg
|
$39,900.00 |
$39,900.00 |
$39,900.00 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$83.58 |
$83.58 |
$83.58 |
$123.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$12,539.36 |
$12,539.36 |
$12,539.36 |
$6,371.38
|
|
Inj. pemetrexed, 10 mg
|
$15,393.17 |
$15,393.17 |
$15,393.17 |
$104.72
|
|
Inj pemetrexed (sandoz) 10mg
|
$190.52 |
$190.52 |
$190.52 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$2,695.01 |
$2,695.01 |
$2,695.01 |
$1,235.55
|
|
Inj progesterone per 50 mg
|
$83.58 |
$83.58 |
$83.58 |
$14.93
|
|
Inj, releuko 1 mcg
|
$599.43 |
$599.43 |
$599.43 |
$473.25
|
|
Inj retacrit esrd on dialysi
|
$1,476.18 |
$1,476.18 |
$1,476.18 |
$349.45
|
|
Inj retro urethrocysto
|
$173.88 |
$173.88 |
$173.88 |
$443.50
|
|
Inj scleros sol sgl vein
|
$97.44 |
$97.44 |
$97.44 |
$558.97
|
|
Inj secretin synthetic human
|
$2,776.20 |
$2,776.20 |
$2,776.20 |
$1,275.00
|
|
Inj secukinumab intrav 1mg
|
$8,971.83 |
$8,971.83 |
$8,971.83 |
$4,413.21
|
|
Inj, spesolimab-sbzo, 1 mg
|
$107,379.32 |
$107,379.32 |
$107,379.32 |
$90,007.62
|
|
Inj teplizumab mzwv 5 mcg
|
$45,491.59 |
$45,491.59 |
$45,491.59 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$64,980.72 |
$64,980.72 |
$64,980.72 |
$35,034.78
|
|
Inj testosterone cypionate
|
$146.33 |
$146.33 |
$146.33 |
$64.80
|
|
Inj., tildrakizumab, 1 mg
|
$55,934.76 |
$55,934.76 |
$55,934.76 |
$26,635.60
|
|
Inj, tofidence, 1 mg
|
$9,324.00 |
$9,324.00 |
$9,324.00 |
$86.87
|
|
Inj triamcinolone ace X-ray 1mg
|
$2,513.70 |
$2,513.70 |
$2,513.70 |
$1,090.75
|
|
Inj, tyenne, 1 mg
|
$7,536.48 |
$7,536.48 |
$7,536.48 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$23,458.73 |
$23,458.73 |
$23,458.73 |
$11,475.96
|
|
Inj, vancomycin hcl (xellia)
|
$173.67 |
$173.67 |
$173.67 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$83.58 |
$83.58 |
$83.58 |
$41.79
|
|
Inj w/fluor eval cv device
|
$189.84 |
$189.84 |
$189.84 |
$503.92
|
|
Inpatient consultation
|
$89.04 |
$89.04 |
$89.04 |
$73.80
|
|
Insert cath pleura with image
|
$1,632.12 |
$1,632.12 |
$1,632.12 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,823.64 |
$1,823.64 |
$1,823.64 |
$2,073.18
|
|
Insert drug delivery implant
|
$71.40 |
$71.40 |
$71.40 |
$280.00
|
|
Insert intrauterine device iud
|
$252.84 |
$252.84 |
$252.84 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$219.24 |
$219.24 |
$219.24 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$215.04 |
$215.04 |
$215.04 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,950.48 |
$1,950.48 |
$1,950.48 |
$4,782.00
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,183.16 |
$2,183.16 |
$2,183.16 |
$2,505.60
|
|
Insertion of catheter vein
|
$1,494.36 |
$1,494.36 |
$1,494.36 |
$1,490.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,735.04 |
$2,735.04 |
$2,735.04 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,446.48 |
$1,446.48 |
$1,446.48 |
$2,419.65
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$5,060.16 |
$5,060.16 |
$5,060.16 |
$7,200.05
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$2,417.52 |
$2,417.52 |
$2,417.52 |
$5,223.20
|
|
Insert pessary/other device
|
$126.00 |
$126.00 |
$126.00 |
$278.50
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$1,993.32 |
$1,993.32 |
$1,993.32 |
$4,803.00
|
|
Insert tunneled cv cath
|
$3,020.64 |
$3,020.64 |
$3,020.64 |
$4,520.00
|
|
Insert tunneled cv cath
|
$2,728.32 |
$2,728.32 |
$2,728.32 |
$5,983.35
|
