|
Injection for hip x-ray
|
$662.40 |
$662.40 |
$662.40 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$586.40 |
$586.40 |
$652.00 |
|
|
Injection for spleen x-ray
|
$77.60 |
$77.60 |
$84.00 |
|
|
Injection for tear sac x-ray
|
$24.00 |
$24.00 |
$24.00 |
|
|
Injection for ureter x-ray
|
$393.60 |
$393.60 |
$456.00 |
|
|
Injection for ureter x-ray
|
$191.20 |
$191.20 |
$576.00 |
|
|
Injection, fulvestrant
|
$1,346.83 |
$1,346.83 |
$2,155.27 |
|
|
Injection glatiramer acetate
|
$294.72 |
$294.72 |
$642.41 |
|
|
Injection, glucarpidase
|
$42,174.00 |
$42,174.00 |
$46,172.12 |
|
|
Injection, inclisiran, 1 mg
|
$4,250.10 |
$4,250.10 |
$4,250.10 |
|
|
Injection into brain canal
|
$1,289.60 |
$1,289.60 |
$1,504.80 |
|
|
Injection into brain canal
|
$1,607.20 |
$1,607.20 |
$1,681.60 |
|
|
Injection, isavuconazonium
|
$1,175.47 |
$1,175.47 |
$1,175.47 |
|
|
Injection jaw joint x-ray
|
$245.60 |
$245.60 |
$380.80 |
|
|
Injection jugular
|
$222.40 |
$222.40 |
$1,965.60 |
|
|
Injection of sinus tract
|
$1,656.00 |
$1,656.00 |
$1,814.40 |
|
|
Injection,onabotulinumtoxina
|
$1,046.81 |
$1,046.81 |
$2,068.00 |
|
|
Injection, pentamidine iseth
|
$179.96 |
$179.96 |
$312.33 |
|
|
Injection, peramivir
|
$732.51 |
$732.51 |
$732.51 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$744.80 |
$744.80 |
$944.00 |
|
|
Injection, renflexis
|
$539.71 |
$645.40 |
$1,283.13 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,531.20 |
$1,531.20 |
$1,531.20 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,476.00 |
$1,476.00 |
$1,545.60 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$992.80 |
$992.80 |
$1,300.80 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,708.00 |
$1,708.00 |
$1,902.40 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$628.00 |
$628.00 |
$1,229.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,814.40 |
$1,814.40 |
$2,082.40 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$592.00 |
$592.00 |
$1,317.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,897.60 |
$1,897.60 |
$2,031.20 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,536.80 |
$1,536.80 |
$2,420.80 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,618.40 |
$1,618.40 |
$2,304.80 |
|
|
Injection, siltuximab
|
$9,867.30 |
$9,867.30 |
$9,867.30 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$536.80 |
$536.80 |
$1,073.60 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$604.00 |
$609.60 |
$1,042.40 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$634.40 |
$634.40 |
$1,042.40 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$112.00 |
$112.00 |
$202.40 |
|
|
Injection treatment of eye
|
$3,223.20 |
$3,223.20 |
$3,223.20 |
|
|
Injection treatment of nerve
|
$5,391.20 |
$5,391.20 |
$5,391.20 |
|
|
Injection treatment of nerve
|
$1,301.60 |
$1,301.60 |
$1,301.60 |
|
|
Inject sacroiliac joint
|
$912.00 |
$912.00 |
$1,129.60 |
|
|
Inject/treat eye socket
|
$683.20 |
$683.20 |
$683.20 |
|
|
Inj epidural sgl cerv-thor without img
|
$1,476.80 |
$1,476.80 |
$1,891.20 |
|
|
Inj epidural sgl lumb-sacral without img
|
$1,618.40 |
$1,618.40 |
$1,868.00 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$290.80 |
$290.80 |
$796.58 |
|
|
Inj, factor x, (human), 1iu
|
$30.98 |
$30.98 |
$30.98 |
|
|
Inj. fe derisomaltose 10 mg
|
$2,444.76 |
$2,448.42 |
$2,976.00 |
|
|
Inj for ext venography
|
$764.00 |
$764.00 |
$1,183.20 |
|
|
Inj for mammo ductogram
|
$400.80 |
$400.80 |
$400.80 |
|
|
Inj, fosaprepitant (teva)
|
$120.36 |
$120.36 |
$120.36 |
|
|
Inj fosnetupitant, palonoset
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
|
|
Inj, fulvestrant (fresenius)
|
$337.51 |
$337.51 |
$337.51 |
|
|
Inj, fulvestrant (teva)
|
$739.03 |
$739.03 |
$739.03 |
|
|
Inj glofitamab gxbm, 2.5 mg
|
$17,336.98 |
$17,336.98 |
$17,336.98 |
|
|
Inj., guselkumab, 1 mg
|
$15,484.91 |
$15,484.91 |
$15,484.91 |
|
|
Inj heparin, pfizer, 1000u
|
$16.80 |
$16.80 |
$26.26 |
|
|
Inj. herceptin hylecta, 10mg
|
$5,155.20 |
$5,155.20 |
$5,155.20 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,708.00 |
$1,708.00 |
$2,481.60 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$2,784.00 |
$2,784.00 |
$2,784.00 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$2,409.60 |
$2,409.60 |
$2,409.60 |
|
|
Inj hrt cath w/s&i sel left vent
|
$1,800.80 |
$1,800.80 |
$1,800.80 |
|
|
Inj hrt cath w/s&i sel right vent
|
$1,853.60 |
$1,853.60 |
$9,492.80 |
|
|
Inj hydroxocobalamin IV 25mg
|
$1,457.28 |
$1,457.28 |
$2,738.45 |
|
|
Inj hydroxyprogst capoat nos
|
$718.72 |
$718.72 |
$943.41 |
|
|
Inj, immphentiv, 20 mcg
|
$26.58 |
$26.58 |
$26.58 |
|
|
Inj intralesional <= 7 lsn(s)
|
$260.00 |
$260.00 |
$850.40 |
|
|
Inj intralesional > 7 lsns
|
$244.80 |
$244.80 |
$244.80 |
|
|
Inj, invega hafyera/trinza
|
$9,892.95 |
$9,892.95 |
$9,892.95 |
|
|
Inj ivig privigen 500 mg
|
$1,732.16 |
$3,615.60 |
$4,184.02 |
|
|
Inj levocarnitine per 1 gm
|
$60.42 |
$60.42 |
$351.28 |
|
|
Inj, levothyroxine, freskabi
|
$88.69 |
$88.69 |
$117.63 |
|
|
Inj, lidocaine w epinephrine
|
$19.49 |
$27.60 |
$28.49 |
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$988.80 |
$988.80 |
$988.80 |
|
|
Inj melpha hydroch nos 50 mg
|
$562.32 |
$562.32 |
$562.32 |
|
|
Inj mepivacaine hcl/10 ml
|
$21.58 |
$21.58 |
$30.89 |
|
|
Inj, meropenem (b. braun)
|
$104.72 |
$119.25 |
$119.25 |
|
|
Inj., meropenem, vaborbactam
|
$167.51 |
$167.51 |
$574.72 |
|
|
Inj, micafungin (par pharm)
|
$68.61 |
$68.61 |
$79.16 |
|
|
Inj, moxifloxacin 100 mg
|
$112.71 |
$112.71 |
$112.71 |
|
|
Inj. mycophenolate mofetil
|
$170.05 |
$170.05 |
$351.31 |
|
|
Inj. naxitamab-gqgk, 1 mg
|
$35,277.71 |
$35,277.71 |
$35,277.71 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,274.40 |
$1,274.40 |
$1,481.60 |
|
|
Inj, nithiodote, 3mg / 125mg
|
$222.24 |
$222.24 |
$222.24 |
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$3,564.00 |
$3,564.00 |
$3,632.00 |
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,220.80 |
$3,220.80 |
$3,686.40 |
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$40,227.91 |
$40,227.91 |
$40,227.91 |
|
|
Inj octafluoropropane mic,ml
|
$285.33 |
$285.33 |
$285.33 |
|
|
Inj ogivri 10 mg
|
$1,296.20 |
$1,296.20 |
$1,296.20 |
|
|
Inj onase abepar-xioi treat
|
$2,163,400.00 |
$2,163,400.00 |
$2,163,400.00 |
|
|
Inj ontruzant 10 mg
|
$4,096.20 |
$4,096.20 |
$9,526.64 |
|
|
Inj, pafolacianine, 0.1 mg
|
$6,834.00 |
$6,834.00 |
$6,834.00 |
|
|
Inj pantoprazole(hikma) 40mg
|
$16.80 |
$26.64 |
$28.37 |
|
|
Inj, pasireotide long acting
|
$38,652.87 |
$38,652.87 |
$38,652.87 |
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$2,486.82 |
$2,486.82 |
$3,261.87 |
|
|
Inj peritoneal venous shunt
|
$584.00 |
$584.00 |
$584.00 |
|
|
Inj proc ankle arthr
|
$559.20 |
$559.20 |
$601.60 |
|
|
Inj proc elbow arthro
|
$467.20 |
$467.20 |
$570.40 |
|
|
Inj proc for lymphang
|
$1,591.20 |
$1,591.20 |
$1,591.20 |
|
|
Inj proc lumbr disk ea lvl
|
$1,004.80 |
$1,004.80 |
$1,732.00 |
|
|
Inj proc myelogram lumbar
|
$708.00 |
$708.00 |
$1,576.80 |
|
|
Inj proc sialogram
|
$362.40 |
$362.40 |
$362.40 |
|
