|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$265.00 |
$265.00 |
$265.00 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$794.50 |
$794.50 |
$794.50 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$329.50 |
$329.50 |
$329.50 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$329.50 |
$329.50 |
$329.50 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$329.50 |
$329.50 |
$329.50 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$67.00 |
$67.00 |
$67.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$80.00 |
$80.00 |
$80.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$338.00 |
$338.00 |
$338.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$110.50 |
$110.50 |
$110.50 |
$135.20
|
|
Inject sacroiliac joint
|
$1,119.50 |
$1,119.50 |
$1,119.50 |
$963.00
|
|
Inj, epinephrine (belcher)
|
$96.92 |
$96.92 |
$96.92 |
$6.24
|
|
Inj., eravacycline, 1 mg
|
$116.84 |
$116.84 |
$116.84 |
$206.64
|
|
Inj. fe derisomaltose 10 mg
|
$3,030.88 |
$3,030.88 |
$3,030.88 |
$3,540.79
|
|
Inj., fibryga, 1 mg
|
$1,200.48 |
$1,200.48 |
$1,200.48 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$178.85 |
$178.85 |
$178.85 |
$37.93
|
|
Inj for ext venography
|
$1,003.50 |
$1,003.50 |
$1,003.50 |
$654.00
|
|
Inj, gadopiclenol, 1 ml
|
$66.94 |
$66.94 |
$66.94 |
$66.94
|
|
Inj givosiran 0.5 mg
|
$53,787.50 |
$53,787.50 |
$53,787.50 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$13,683.20 |
$13,683.20 |
$13,683.20 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$16,802.88 |
$16,802.88 |
$16,802.88 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$6,154.40 |
$6,154.40 |
$6,154.40 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$5,003.00 |
$5,003.00 |
$5,003.00 |
$7,775.46
|
|
Inj human fibrinogen con nos
|
$1,508.04 |
$1,508.04 |
$1,508.04 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$1,348.27 |
$1,348.27 |
$1,348.27 |
$2,452.32
|
|
Inj ivig privigen 500 mg
|
$1,839.50 |
$1,839.50 |
$1,839.50 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$5,394.13 |
$5,394.13 |
$5,394.13 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$923.69 |
$923.69 |
$923.69 |
$923.69
|
|
Inj, lenacapavir, 1 mg
|
$12,675.00 |
$12,675.00 |
$12,675.00 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$40.18 |
$40.18 |
$40.18 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$41.28 |
$41.28 |
$41.28 |
$44.96
|
|
Inj mepivacaine hcl/10 ml
|
$16.30 |
$16.30 |
$16.30 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$351.00 |
$351.00 |
$351.00 |
$536.27
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$5,000.90 |
$5,000.90 |
$5,000.90 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$83.36 |
$83.36 |
$83.36 |
$107.25
|
|
Inj multihance
|
$62.56 |
$62.56 |
$62.56 |
$79.42
|
|
Inj. mycophenolate mofetil
|
$32.76 |
$32.76 |
$32.76 |
$252.66
|
|
Inj naloxone hydrochloride
|
$28.76 |
$28.76 |
$28.76 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,307.50 |
$1,307.50 |
$1,307.50 |
$1,414.40
|
|
Inj ogivri 10 mg
|
$2,259.90 |
$2,259.90 |
$2,259.90 |
$4,492.28
|
|
Inj ontruzant 10 mg
|
$4,205.54 |
$4,205.54 |
$4,205.54 |
$6,706.27
|
|
Inj, panzyga, 500 mg
|
$5,829.72 |
$5,829.72 |
$5,829.72 |
$8,041.38
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$5,001.13 |
$5,001.13 |
$5,001.13 |
$6,371.38
|
|
Inj, pemivibart, 4500 mg
|
$930.42 |
$930.42 |
$930.42 |
$1,235.55
|
|
Inj proc elbow arthro
|
$375.00 |
$375.00 |
$375.00 |
$432.00
|
|
Inj progesterone per 50 mg
|
$16.34 |
$16.34 |
$16.34 |
$14.93
|
|
Inj, releuko 1 mcg
|
$309.77 |
$309.77 |
$309.77 |
$461.20
|
|
Inj, rimabotulinumtoxinb
|
$1,618.82 |
$1,618.82 |
$1,618.82 |
$714.24
|
|
Inj secretin synthetic human
|
$1,253.09 |
$1,253.09 |
$1,253.09 |
$1,285.20
|
|
Inj, spesolimab-sbzo, 1 mg
|
$33,901.34 |
$33,901.34 |
$33,901.34 |
$83,709.85
|
|
Inj, sutimlimab-jome, 10 mg
|
$2,492.90 |
$2,492.90 |
$2,492.90 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$41,793.70 |
$41,793.70 |
$41,793.70 |
$67,538.30
|
|
Inj teclistamab cqyv 0.5 mg
|
$9,179.52 |
$9,179.52 |
$9,179.52 |
$17,517.56
|
|
Inj teplizumab mzwv 5 mcg
|
$18,005.00 |
$18,005.00 |
$18,005.00 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$22,122.91 |
$22,122.91 |
$22,122.91 |
$36,385.12
|
|
Inj testostero enanthate 1mg
|
$75.20 |
$75.20 |
$75.20 |
$157.81
|
|
Inj testosterone cypionate
|
$16.60 |
$16.60 |
$16.60 |
$62.80
|
|
Inj tofersen intrathec 1 mg
|
$18,499.01 |
$18,499.01 |
$18,499.01 |
$422.10
|
|
Inj triamcinolone ace X-ray 1mg
|
$762.02 |
$762.02 |
$762.02 |
$1,132.35
|
|
Inj, vegzelma, 10 mg
|
$2,675.34 |
$2,675.34 |
$2,675.34 |
$1,291.28
|
|
Inj vocal cord bulking agent
|
$1,480.00 |
$1,480.00 |
$1,480.00 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$455.50 |
$455.50 |
$455.50 |
$463.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$32,567.10 |
$32,567.10 |
$32,567.10 |
$44,026.28
|
|
Insertion catheter bladder temporary simple
|
$148.50 |
$148.50 |
$148.50 |
$229.32
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$4,803.50 |
$4,803.50 |
$4,803.50 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,483.50 |
$1,483.50 |
$1,483.50 |
$2,511.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$16,845.00 |
$16,845.00 |
$16,845.00 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$16,845.00 |
$16,845.00 |
$16,845.00 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$18,538.00 |
$18,538.00 |
$18,538.00 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,752.00 |
$1,752.00 |
$1,752.00 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,035.50 |
$2,035.50 |
$2,035.50 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$53,010.50 |
$53,010.50 |
$53,010.50 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$12,561.00 |
$12,561.00 |
$12,561.00 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$12,561.00 |
$12,561.00 |
$12,561.00 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$12,561.00 |
$12,561.00 |
$12,561.00 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$5,697.00 |
$5,697.00 |
$5,697.00 |
$5,236.80
|
|
Insert pm/icd lead dual
|
$12,561.00 |
$12,561.00 |
$12,561.00 |
$7,388.80
|
|
Insitu hybridization manual
|
$605.00 |
$605.00 |
$605.00 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$207.00 |
$207.00 |
$207.00 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$353.00 |
$353.00 |
$353.00 |
$326.04
|
|
Ins pq tunnld ip cath w/img
|
$6,046.50 |
$6,046.50 |
$6,046.50 |
$5,377.00
|
|
Ins/rplc spi npg/rcvr pocket
|
$40,347.00 |
$40,347.00 |
$40,347.00 |
$23,746.69
|
|
Insulin total
|
$51.50 |
$51.50 |
$51.50 |
$66.64
|
|
Integra meshed bil wound mat
|
$9,924.16 |
$9,924.16 |
$9,924.16 |
$9,924.00
|
|
Interferon alfa-n3 inj
|
$244.23 |
$244.23 |
$244.23 |
$59.64
|
|
Interferon beta-1b / .25 mg
|
$974.76 |
$974.76 |
$974.76 |
$1,662.71
|
|
Intrinsic factor antibody
|
$76.50 |
$76.50 |
$76.50 |
$66.60
|
|
Intro catheter aorta
|
$632.00 |
$632.00 |
$632.00 |
$1,654.05
|
|
Intro cath svc/ivc
|
$385.50 |
$385.50 |
$385.50 |
$1,329.90
|
|
Intubation endotracheal emergency procedure
|
$350.50 |
$350.50 |
$350.50 |
$589.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$111.30 |
$111.30 |
$111.30 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$373.62 |
$373.62 |
$373.62 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$45,256.22 |
$45,256.22 |
$45,256.22 |
$62,692.46
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$65.20 |
$65.20 |
$65.20 |
$163.87
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$3,685.50 |
$3,685.50 |
$3,685.50 |
$5,476.68
|
|
Iron
|
$34.00 |
$34.00 |
$34.00 |
$74.40
|
|
Iron binding capacity
|
$43.50 |
$43.50 |
$43.50 |
$63.79
|
|
Iron dextran 50 mg/ml injection solution
|
$64.48 |
$64.48 |
$64.48 |
$80.95
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$177.62 |
$177.62 |
$177.62 |
$187.06
|
