|
Injection, daratumumab 10 mg
|
$682.80 |
$682.80 |
$682.80 |
$5,324.34
|
|
Injection, edaravone, 1 mg
|
$1,485.00 |
$1,485.00 |
$1,485.00 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$450.00 |
$450.00 |
$450.00 |
$436.00
|
|
Injection for bladder x-ray
|
$2,055.60 |
$2,055.60 |
$2,055.60 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$450.00 |
$450.00 |
$450.00 |
$497.76
|
|
Injection, fulvestrant
|
$6,048.60 |
$6,048.60 |
$6,048.60 |
$1,719.16
|
|
Injection, inclisiran, 1 mg
|
$22.80 |
$22.80 |
$22.80 |
$6,679.35
|
|
Injection, isavuconazonium
|
$3.20 |
$3.20 |
$3.20 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$3,445.20 |
$3,445.20 |
$3,445.20 |
$2,277.65
|
|
Injection, peramivir
|
$7.40 |
$7.40 |
$7.40 |
$744.75
|
|
Injection, renflexis
|
$228.80 |
$228.80 |
$228.80 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,521.20 |
$2,521.20 |
$2,521.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$880.80 |
$880.80 |
$880.80 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$611.40 |
$611.40 |
$611.40 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,674.80 |
$2,674.80 |
$2,674.80 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,071.60 |
$1,071.60 |
$1,071.60 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,110.80 |
$2,110.80 |
$2,110.80 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$974.40 |
$974.40 |
$974.40 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,885.20 |
$1,885.20 |
$1,885.20 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$4,189.80 |
$4,189.80 |
$4,189.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,253.20 |
$3,253.20 |
$3,253.20 |
$1,685.00
|
|
Injection, siltuximab
|
$410.40 |
$410.40 |
$410.40 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,294.20 |
$1,294.20 |
$1,294.20 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$571.20 |
$571.20 |
$571.20 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$647.40 |
$647.40 |
$647.40 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$136.20 |
$136.20 |
$136.20 |
$145.60
|
|
Inj epidural sgl cerv-thor without img
|
$3,711.60 |
$3,711.60 |
$3,711.60 |
$1,329.00
|
|
Inj, factor x, (human), 1iu
|
$34.20 |
$34.20 |
$34.20 |
$26.74
|
|
Inj, focinvez, 1mg
|
$5.40 |
$5.40 |
$5.40 |
$3.63
|
|
Inj for ext venography
|
$306.60 |
$306.60 |
$306.60 |
$628.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$6.00 |
$6.00 |
$1,322.20
|
|
Inj., guselkumab, 1 mg
|
$695.20 |
$695.20 |
$695.20 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$189.60 |
$189.60 |
$189.60 |
$8,193.78
|
|
Inj imip 4 cilas 4 releb 2mg
|
$5.40 |
$5.40 |
$5.40 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$871.80 |
$871.80 |
$871.80 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$350.40 |
$350.40 |
$350.40 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$81.00 |
$81.00 |
$81.00 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$494.40 |
$494.40 |
$494.40 |
$136.62
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$108.00 |
$108.00 |
$108.00 |
$794.70
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$691.20 |
$691.20 |
$691.20 |
$8,304.04
|
|
Inj multihance
|
$31.80 |
$31.80 |
$31.80 |
$70.54
|
|
Inj naloxone hydrochloride
|
$71.40 |
$71.40 |
$71.40 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,092.80 |
$2,092.80 |
$2,092.80 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$3.60 |
$3.60 |
$3.60 |
$468.10
|
|
Inj nivolumab 2 mg hyaluron
|
$48.60 |
$48.60 |
$48.60 |
$15,599.68
|
|
Inj ogivri 10 mg
|
$242.40 |
$242.40 |
$242.40 |
$4,492.28
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,313.40 |
$1,313.40 |
$1,313.40 |
$6,614.40
|
|
Inj. pemetrexed, 10 mg
|
$156.60 |
$156.60 |
$156.60 |
$104.72
|
|
Inj., plazomicin, 5 mg
|
$85.80 |
$85.80 |
$85.80 |
$607.16
|
|
Inj proc ankle arthr
|
$409.20 |
$409.20 |
$409.20 |
$405.31
|
|
Inj proc elbow arthro
|
$450.00 |
$450.00 |
$450.00 |
$432.00
|
|
Inj prohance multipack
|
$10.80 |
$10.80 |
$10.80 |
$10.40
|
|
Inj retro urethrocysto
|
$3,582.00 |
$3,582.00 |
$3,582.00 |
$447.74
|
|
Inj., rolapitant, 0.5 mg
|
$1.80 |
$1.80 |
$1.80 |
$1.80
|
|
Inj secukinumab intrav 1mg
|
$42.80 |
$42.80 |
$42.80 |
$4,413.21
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$544.80 |
$544.80 |
$544.80 |
$67,538.30
|
|
Inj. teprotumumab-trbw 10 mg
|
$768.00 |
$768.00 |
$768.00 |
$35,034.78
|
|
Inj testosterone cypionate
|
$72.60 |
$72.60 |
$72.60 |
$64.96
|
|
Inj., tildrakizumab, 1 mg
|
$432.80 |
$432.80 |
$432.80 |
$26,635.60
|
|
Inj, tislelizumab-jsgr
|
$103.20 |
$103.20 |
$103.20 |
$9,764.09
|
|
Inj, tyenne, 1 mg
|
$12.80 |
$12.80 |
$12.80 |
$3,525.12
|
|
Inj w/fluor eval cv device
|
$551.40 |
$551.40 |
$551.40 |
$504.40
|
|
Inj zanidatamab-hrii, 2 mg
|
$44.40 |
$44.40 |
$44.40 |
$8,532.00
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$6,358.40 |
$6,358.40 |
$6,358.40 |
$41,083.73
|
|
Ins cath ren art 1st bi
|
$12,124.80 |
$12,124.80 |
$12,124.80 |
$5,974.80
|
|
Insert cath pleura with image
|
$2,320.80 |
$2,320.80 |
$2,320.80 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,829.00 |
$2,829.00 |
$2,829.00 |
$2,099.70
|
|
Insert drug delivery implant
|
$1,447.80 |
$1,447.80 |
$1,447.80 |
$280.00
|
|
Insert intrauterine device iud
|
$607.20 |
$607.20 |
$607.20 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$297.00 |
$297.00 |
$297.00 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$8,501.40 |
$8,501.40 |
$8,501.40 |
$4,897.20
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$1,806.60 |
$1,806.60 |
$1,806.60 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,239.00 |
$1,239.00 |
$1,239.00 |
$2,585.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,239.00 |
$1,239.00 |
$1,239.00 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,239.00 |
$1,239.00 |
$1,239.00 |
$2,453.83
|
|
Insert vad art access left hrt arterial access
|
$2,458.80 |
$2,458.80 |
$2,458.80 |
$4,276.00
|
|
Insitu hybridization auto
|
$1,438.20 |
$1,438.20 |
$1,438.20 |
$377.37
|
|
Insitu hybridization manual
|
$646.80 |
$646.80 |
$646.80 |
$401.28
|
|
In situ hybridization per specimen initial single probe stain
|
$141.00 |
$141.00 |
$141.00 |
$338.40
|
|
Ins pq tunnld ip cath w/img
|
$8,416.80 |
$8,416.80 |
$8,416.80 |
$5,486.00
|
|
Instillation anticarcinogenic agent bladder
|
$1,062.60 |
$1,062.60 |
$1,062.60 |
$638.40
|
|
Ins tun cvad 2 cath w/subq port(s)
|
$5,882.40 |
$5,882.40 |
$5,882.40 |
$7,826.00
|
|
Ins tun cv cath wo subq prt/pm
|
$2,386.20 |
$2,386.20 |
$2,386.20 |
$4,218.00
|
|
Insulin total
|
$57.00 |
$57.00 |
$57.00 |
$66.64
|
|
Interdiscal perq aspir dx
|
$2,792.40 |
$2,792.40 |
$2,792.40 |
$1,222.26
|
|
Interferon alfa-2b inj
|
$108.00 |
$108.00 |
$108.00 |
$1,409.92
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$3,403.20 |
$3,403.20 |
$3,403.20 |
$10,427.90
|
|
Interferon beta-1a inj
|
$4,373.40 |
$4,373.40 |
$4,373.40 |
$1,851.20
|
|
Intrinsic factor antibody
|
$96.00 |
$96.00 |
$96.00 |
$65.00
|
|
Intro cath dialysis circuit
|
$3,175.20 |
$3,175.20 |
$3,175.20 |
$2,036.94
|
|
Intro cath dialysis circuit w/pta
|
$8,154.60 |
$8,154.60 |
$8,154.60 |
$8,690.50
|
|
Intro catheter aorta
|
$3,157.20 |
$3,157.20 |
$3,157.20 |
$1,678.05
|
|
Intubation endotracheal emergency procedure
|
$1,051.80 |
$1,051.80 |
$1,051.80 |
$601.28
|
|
Ionm in operatng room 15 min
|
$191.40 |
$191.40 |
$191.40 |
$200.78
|
|
Ionm remote/>1 pt or per hr
|
$1,587.60 |
$1,587.60 |
$1,587.60 |
$622.70
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$5.40 |
$5.40 |
$5.40 |
$165.67
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$16.40 |
$16.40 |
$16.40 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$495.00 |
$495.00 |
$495.00 |
$62,692.46
|
|
Ipratropium bromide non-comp
|
$24.20 |
$24.20 |
$24.20 |
$4.06
|
