|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$335.40 |
$335.40 |
$335.40 |
$494.65
|
|
Injection for ureter x-ray
|
$287.40 |
$287.40 |
$287.40 |
$427.70
|
|
Injection for ureter x-ray
|
$880.80 |
$880.80 |
$880.80 |
$515.21
|
|
Injection, fulvestrant
|
$8,260.38 |
$8,260.38 |
$8,260.38 |
$1,817.65
|
|
Injection glatiramer acetate
|
$3,798.90 |
$3,798.90 |
$3,798.90 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$31,643.82 |
$31,643.82 |
$31,643.82 |
$6,679.35
|
|
Injection into brain canal
|
$1,675.20 |
$1,675.20 |
$1,675.20 |
$836.40
|
|
Injection into spinal artery
|
$839.40 |
$839.40 |
$839.40 |
$1,710.80
|
|
Injection, isavuconazonium
|
$7,169.88 |
$7,169.88 |
$7,169.88 |
$787.67
|
|
Injection jaw joint x-ray
|
$251.40 |
$251.40 |
$251.40 |
$307.80
|
|
Injection jugular
|
$240.60 |
$240.60 |
$240.60 |
$790.00
|
|
Injection of sinus tract
|
$3,827.40 |
$3,827.40 |
$3,827.40 |
$1,627.60
|
|
Injection,onabotulinumtoxina
|
$10,468.08 |
$10,468.08 |
$10,468.08 |
$2,277.65
|
|
Injection, peramivir
|
$570.00 |
$570.00 |
$570.00 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$388.20 |
$388.20 |
$388.20 |
$670.64
|
|
Injection, renflexis
|
$12,114.54 |
$12,114.54 |
$12,114.54 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,513.20 |
$1,513.20 |
$1,513.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,066.00 |
$3,066.00 |
$3,066.00 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$147,548.20 |
$147,548.20 |
$147,548.20 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,476.00 |
$4,476.00 |
$4,476.00 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$2,084.40 |
$2,084.40 |
$2,084.40 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,084.40 |
$2,084.40 |
$2,084.40 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,084.40 |
$2,084.40 |
$2,084.40 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,084.40 |
$2,084.40 |
$2,084.40 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$6,815.40 |
$6,815.40 |
$6,815.40 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$859.86 |
$859.86 |
$859.86 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$704.40 |
$704.40 |
$704.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$19,238.52 |
$19,238.52 |
$19,238.52 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$470.40 |
$470.40 |
$470.40 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$159.00 |
$159.00 |
$159.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$470.40 |
$470.40 |
$470.40 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$234.60 |
$234.60 |
$234.60 |
$135.60
|
|
Injection treatment of nerve
|
$22,687.18 |
$22,687.18 |
$22,687.18 |
$4,350.00
|
|
Inject sacroiliac joint
|
$2,124.00 |
$2,124.00 |
$2,124.00 |
$1,028.95
|
|
Inject/treat eye socket
|
$1,396.80 |
$1,396.80 |
$1,396.80 |
$381.13
|
|
Inj., eravacycline, 1 mg
|
$1,295.04 |
$1,295.04 |
$1,295.04 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$2,291.64 |
$2,291.64 |
$2,291.64 |
$343.35
|
|
Inj for ext venography
|
$2,800.80 |
$2,800.80 |
$2,800.80 |
$649.95
|
|
Inj for mammo ductogram
|
$1,679.40 |
$1,679.40 |
$1,679.40 |
$399.60
|
|
Inj., guselkumab, 1 mg
|
$211,504.74 |
$211,504.74 |
$211,504.74 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$39,833.10 |
$39,833.10 |
$39,833.10 |
$7,690.59
|
|
Inj herzuma 10 mg
|
$21,073.32 |
$21,073.32 |
$21,073.32 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,054.80 |
$1,054.80 |
$1,054.80 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,179.00 |
$1,179.00 |
$1,179.00 |
$1,827.74
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,179.00 |
$1,179.00 |
$1,179.00 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$52.80 |
$52.80 |
$52.80 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$66.00 |
$66.00 |
$66.00 |
$965.33
|
|
Inj. inebilizumab-cdon, 1 mg
|
$140,248.50 |
$140,248.50 |
$140,248.50 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,824.60 |
$1,824.60 |
$1,824.60 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$241.20 |
$241.20 |
$241.20 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$62,474.04 |
$62,474.04 |
$62,474.04 |
$6,967.29
|
|
Inj, kovaltry, 1 i.u
|
$21,256.20 |
$21,256.20 |
$21,256.20 |
$5.07
|
|
Inj, lanreotide, (cipla) 1mg
|
$78,433.32 |
$78,433.32 |
$78,433.32 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$13,424.16 |
$13,424.16 |
$13,424.16 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$706.80 |
$706.80 |
$706.80 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$9,597.42 |
$9,597.42 |
$9,597.42 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$425.82 |
$425.82 |
$425.82 |
$47.52
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$2,626.20 |
$2,626.20 |
$2,626.20 |
$784.00
|
|
Inj mepivacaine hcl/10 ml
|
$13.50 |
$13.50 |
$13.50 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$3,230.70 |
$3,230.70 |
$3,230.70 |
$558.08
|
|
Inj, moxifloxacin 100 mg
|
$488.40 |
$488.40 |
$488.40 |
$107.25
|
|
Inj moxifloxacin (fres kabi)
|
$510.60 |
$510.60 |
$510.60 |
$95.62
|
|
Inj. mycophenolate mofetil
|
$1,318.08 |
$1,318.08 |
$1,318.08 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,200.20 |
$2,200.20 |
$2,200.20 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$5,999.40 |
$5,999.40 |
$5,999.40 |
$462.04
|
|
Inj, nogapendekin pmln, 1mcg
|
$107,400.00 |
$107,400.00 |
$107,400.00 |
$94.12
|
|
Inj ogivri 10 mg
|
$22,365.48 |
$22,365.48 |
$22,365.48 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$72.18 |
$72.18 |
$72.18 |
$34.67
|
|
Inj peritoneal venous shunt
|
$208.20 |
$208.20 |
$208.20 |
$413.70
|
|
Inj., perseris, 0.5 mg
|
$0.06 |
$0.06 |
$0.06 |
$5,146.85
|
|
Inj proc ankle arthr
|
$3,165.60 |
$3,165.60 |
$3,165.60 |
$405.31
|
|
Inj proc elbow arthro
|
$5,394.60 |
$5,394.60 |
$5,394.60 |
$419.60
|
|
Inj proc for lymphang
|
$468.00 |
$468.00 |
$468.00 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$4,629.60 |
$4,629.60 |
$4,629.60 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$508.20 |
$508.20 |
$508.20 |
$830.50
|
|
Inj proc sialogram
|
$6,529.80 |
$6,529.80 |
$6,529.80 |
$373.00
|
|
Inj progesterone per 50 mg
|
$7.50 |
$7.50 |
$7.50 |
$15.00
|
|
Inj prohance multipack
|
$730.80 |
$730.80 |
$730.80 |
$9.59
|
|
Inj, releuko 1 mcg
|
$4,075.50 |
$4,075.50 |
$4,075.50 |
$473.25
|
|
Inj retro urethrocysto
|
$16,172.46 |
$16,172.46 |
$16,172.46 |
$443.50
|
|
Inj scleros sol mult veins
|
$34,377.25 |
$34,377.25 |
$34,377.25 |
$675.00
|
|
Inj scleros sol sgl vein
|
$628.80 |
$628.80 |
$628.80 |
$558.97
|
|
Inj secretin synthetic human
|
$5,830.02 |
$5,830.02 |
$5,830.02 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$61,355.10 |
$61,355.10 |
$61,355.10 |
$4,413.21
|
|
Inj, spesolimab-sbzo, 1 mg
|
$164,071.44 |
$164,071.44 |
$164,071.44 |
$90,007.62
|
|
Inj sulf hexa lipid microsph
|
$2,472.54 |
$2,472.54 |
$2,472.54 |
$256.14
|
|
Inj testosterone cypionate
|
$79.86 |
$79.86 |
$79.86 |
$64.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$2,744.40 |
$2,744.40 |
$2,744.40 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$2,084.40 |
$2,084.40 |
$2,084.40 |
$837.50
|
|
Inj. tigecycline (accord)
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$188.03
|
|
Inj, tyenne, 1 mg
|
$31,491.12 |
$31,491.12 |
$31,491.12 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$0.06 |
$0.06 |
$0.06 |
$11,475.96
|
|
Inj vancomycin (xellia) 10mg
|
$210.90 |
$210.90 |
$210.90 |
$76.59
|
|
Inj vocal cord bulking agent
|
$2,219.51 |
$2,219.51 |
$2,219.51 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$274.20 |
$274.20 |
$274.20 |
$503.92
|
|
Ins cath ren art 1st bi
|
$9,421.80 |
$9,421.80 |
$9,421.80 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$201,409.49 |
$201,409.49 |
$201,409.49 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$8,245.80 |
$8,245.80 |
$8,245.80 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$8,924.40 |
$8,924.40 |
$8,924.40 |
$5,395.20
|
