|
Injection for arthrography wrist (both sides)
|
$376.50 |
$376.50 |
$376.50 |
$436.00
|
|
Injection for bladder x-ray
|
$391.50 |
$391.50 |
$391.50 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$369.00 |
$369.00 |
$369.00 |
$497.76
|
|
Injection for ureter x-ray
|
$783.00 |
$783.00 |
$783.00 |
$515.21
|
|
Injection, fulvestrant
|
$3,584.82 |
$3,584.82 |
$3,584.82 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,749.29 |
$1,749.29 |
$1,749.29 |
$830.51
|
|
Injection, glucarpidase
|
$159,854.02 |
$159,854.02 |
$159,854.02 |
$74,113.20
|
|
Injection, isavuconazonium
|
$1,350.22 |
$1,350.22 |
$1,350.22 |
$787.67
|
|
Injection jaw joint x-ray
|
$732.75 |
$732.75 |
$732.75 |
$307.80
|
|
Injection jugular
|
$1,423.50 |
$1,423.50 |
$1,423.50 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$4,814.15 |
$4,814.15 |
$4,814.15 |
$2,277.65
|
|
Injection, peramivir
|
$1,257.68 |
$1,257.68 |
$1,257.68 |
$744.75
|
|
Injection px peyronie ds
|
$239.25 |
$239.25 |
$239.25 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$539.25 |
$539.25 |
$539.25 |
$685.44
|
|
Injection, renflexis
|
$2,582.56 |
$2,582.56 |
$2,582.56 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,027.25 |
$2,027.25 |
$2,027.25 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$911.25 |
$911.25 |
$911.25 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,671.75 |
$1,671.75 |
$1,671.75 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,666.50 |
$1,666.50 |
$1,666.50 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,285.50 |
$1,285.50 |
$1,285.50 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,713.00 |
$1,713.00 |
$1,713.00 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,871.25 |
$1,871.25 |
$1,871.25 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,871.25 |
$1,871.25 |
$1,871.25 |
$1,685.00
|
|
Injection, siltuximab
|
$23,535.37 |
$23,535.37 |
$23,535.37 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$235.50 |
$235.50 |
$235.50 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,125.00 |
$1,125.00 |
$1,125.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$546.00 |
$546.00 |
$546.00 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$465.00 |
$465.00 |
$465.00 |
$145.60
|
|
Injection treatment of nerve
|
$1,794.00 |
$1,794.00 |
$1,794.00 |
$3,219.20
|
|
Inject sacroiliac joint
|
$336.00 |
$336.00 |
$336.00 |
$1,029.04
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$58,842.17 |
$58,842.17 |
$58,842.17 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$1,436.25 |
$1,436.25 |
$1,436.25 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,249.50 |
$1,249.50 |
$1,249.50 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$248.03 |
$248.03 |
$248.03 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$1,404.58 |
$1,404.58 |
$1,404.58 |
$343.35
|
|
Inj, factor x, (human), 1iu
|
$33.28 |
$33.28 |
$33.28 |
$26.74
|
|
Inj for ext venography
|
$1,326.00 |
$1,326.00 |
$1,326.00 |
$628.80
|
|
Inj for mammo ductogram
|
$433.50 |
$433.50 |
$433.50 |
$397.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$2,588.63 |
$2,588.63 |
$2,588.63 |
$1,322.20
|
|
Inj, fulvestrant (fresenius)
|
$1,713.99 |
$1,713.99 |
$1,713.99 |
$905.30
|
|
Inj givosiran 0.5 mg
|
$162,298.07 |
$162,298.07 |
$162,298.07 |
$76,708.80
|
|
Inj glycopyrrolate, glyrx-pf
|
$8.22 |
$8.22 |
$8.22 |
$11.23
|
|
Inj. herceptin hylecta, 10mg
|
$17,286.71 |
$17,286.71 |
$17,286.71 |
$8,193.78
|
|
Inj human fibrinogen con nos
|
$4,326.08 |
$4,326.08 |
$4,326.08 |
$3.95
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,083.72 |
$1,083.72 |
$1,083.72 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$172,856.28 |
$172,856.28 |
$172,856.28 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$2,064.75 |
$2,064.75 |
$2,064.75 |
$1,938.00
|
|
Inj ivig privigen 500 mg
|
$4,194.45 |
$4,194.45 |
$4,194.45 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$122.28 |
$122.28 |
$122.28 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$76.51 |
$76.51 |
$76.51 |
$110.40
|
|
Inj, levothyroxine, freskabi
|
$244.63 |
$244.63 |
$244.63 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$37.17 |
$37.17 |
$37.17 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$1,713.99 |
$1,713.99 |
$1,713.99 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$28.41 |
$28.41 |
$28.41 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$759.87 |
$759.87 |
$759.87 |
$556.87
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$17,682.90 |
$17,682.90 |
$17,682.90 |
$8,304.04
|
|
Inj multihance
|
$166.47 |
$166.47 |
$166.47 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$387.27 |
$387.27 |
$387.27 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$96,378.67 |
$96,378.67 |
$96,378.67 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$303.75 |
$303.75 |
$303.75 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,976.25 |
$1,976.25 |
$1,976.25 |
$2,881.20
|
|
Inj octafluoropropane mic,ml
|
$340.18 |
$340.18 |
$340.18 |
$211.40
|
|
Inj ogivri 10 mg
|
$8,661.59 |
$8,661.59 |
$8,661.59 |
$4,492.28
|
|
Inj, omacetaxine mep, 0.01mg
|
$4,831.38 |
$4,831.38 |
$4,831.38 |
$2,686.80
|
|
Inj., patisiran, 0.1 mg
|
$36,180.04 |
$36,180.04 |
$36,180.04 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$12,400.57 |
$12,400.57 |
$12,400.57 |
$6,614.40
|
|
Inj proc ankle arthr
|
$150.75 |
$150.75 |
$150.75 |
$405.31
|
|
Inj proc elbow arthro
|
$145.50 |
$145.50 |
$145.50 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$2,577.00 |
$2,577.00 |
$2,577.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,036.50 |
$1,036.50 |
$1,036.50 |
$838.30
|
|
Inj progesterone per 50 mg
|
$123.09 |
$123.09 |
$123.09 |
$13.76
|
|
Inj retro urethrocysto
|
$391.50 |
$391.50 |
$391.50 |
$447.74
|
|
Inj, rimabotulinumtoxinb
|
$2,348.22 |
$2,348.22 |
$2,348.22 |
$714.24
|
|
Inj scleros sol mult veins
|
$200.25 |
$200.25 |
$200.25 |
$692.90
|
|
Inj scleros sol sgl vein
|
$650.25 |
$650.25 |
$650.25 |
$561.88
|
|
Inj secretin synthetic human
|
$2,444.05 |
$2,444.05 |
$2,444.05 |
$1,253.09
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$389.25 |
$389.25 |
$389.25 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$336.56 |
$336.56 |
$336.56 |
$256.14
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$124,816.51 |
$124,816.51 |
$124,816.51 |
$67,538.30
|
|
Inj. teprotumumab-trbw 10 mg
|
$66,625.08 |
$66,625.08 |
$66,625.08 |
$35,034.78
|
|
Inj testosterone cypionate
|
$473.66 |
$473.66 |
$473.66 |
$64.96
|
|
Inj thiotepa nos 1 mg
|
$8,689.13 |
$8,689.13 |
$8,689.13 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$2,207.25 |
$2,207.25 |
$2,207.25 |
$1,049.50
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$818.00
|
|
Inj vancomycin (xellia) 10mg
|
$93.18 |
$93.18 |
$93.18 |
$76.59
|
|
Inj vocal cord bulking agent
|
$1,653.75 |
$1,653.75 |
$1,653.75 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$954.00 |
$954.00 |
$954.00 |
$504.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$88,429.23 |
$88,429.23 |
$88,429.23 |
$41,083.73
|
|
Ins cath ren art 1st uni
|
$4,692.00 |
$4,692.00 |
$4,692.00 |
$4,667.63
|
|
Insert cath pleura with image
|
$1,703.25 |
$1,703.25 |
$1,703.25 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,379.25 |
$1,379.25 |
$1,379.25 |
$2,099.70
|
|
Insert hepatic shunt (tips)
|
$9,741.00 |
$9,741.00 |
$9,741.00 |
$7,571.20
|
|
Insert intrauterine device iud
|
$669.00 |
$669.00 |
$669.00 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$364.50 |
$364.50 |
$364.50 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,697.25 |
$4,697.25 |
$4,697.25 |
$4,897.20
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$8,907.00 |
$8,907.00 |
$8,907.00 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,923.00 |
$1,923.00 |
$1,923.00 |
$2,585.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,103.75 |
$2,103.75 |
$2,103.75 |
$2,103.75
|
