|
In-111 oxyquinolin per 0.5 mci
|
$4,940.80 |
$4,940.80 |
$4,940.80 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$5,174.40 |
$5,174.40 |
$5,174.40 |
$2,598.17
|
|
In-111 pentetreotide
|
$8,008.00 |
$8,008.00 |
$8,008.00 |
$5,294.90
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$3,730.40 |
$3,730.40 |
$3,730.40 |
$2,086.70
|
|
Incision of achilles tendon
|
$4,111.20 |
$4,111.20 |
$4,111.20 |
$3,318.90
|
|
Incision of breast lesion
|
$3,426.40 |
$3,426.40 |
$3,426.40 |
$2,577.85
|
|
Incision of eardrum
|
$610.40 |
$610.40 |
$610.40 |
$552.75
|
|
Incision of foot fascia
|
$4,407.20 |
$4,407.20 |
$4,407.20 |
$4,599.40
|
|
Incision of hip tendons
|
$5,496.00 |
$5,496.00 |
$5,496.00 |
$3,865.95
|
|
Incision of spinal nerve 64772
|
$4,342.40 |
$4,342.40 |
$4,342.40 |
$2,685.07
|
|
Incision of tendon sheath
|
$4,433.60 |
$4,433.60 |
$4,433.60 |
$2,263.68
|
|
Incision of toe tendons 28011
|
$2,971.20 |
$2,971.20 |
$2,971.20 |
$2,119.12
|
|
Incision of tongue fold
|
$1,182.40 |
$1,182.40 |
$1,182.40 |
$1,792.50
|
|
Incision of wrist capsule
|
$3,868.80 |
$3,868.80 |
$3,868.80 |
$3,839.54
|
|
Incision tendon sheath
|
$3,634.40 |
$3,634.40 |
$3,634.40 |
$3,073.20
|
|
Incisn of toe tndn
|
$3,640.00 |
$3,640.00 |
$3,640.00 |
$2,667.00
|
|
Incobotulinumtoxin a
|
$2,819.20 |
$2,819.20 |
$2,819.20 |
$1,339.57
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$608.40 |
$608.40 |
$608.40 |
$766.66
|
|
Infliximab 100 mg intravenous solution
|
$3,306.57 |
$3,306.57 |
$3,306.57 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,350.69 |
$1,350.69 |
$1,350.69 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,599.74 |
$2,599.74 |
$2,599.74 |
$1,537.84
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$57.58 |
$57.58 |
$57.58 |
$111.51
|
|
Inf thrc fascial pln blk bi w/wo image
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
$523.25
|
|
Inf thrc fascial pln blk uni w/wo image
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
$770.00
|
|
Ingest challenge ea addl 60 min
|
$277.60 |
$277.60 |
$277.60 |
$289.64
|
|
Ingest challenge ini 120 min
|
$640.00 |
$640.00 |
$640.00 |
$764.78
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$351.20 |
$351.20 |
$351.20 |
$296.00
|
|
Inj, acetaminophen (b braun)
|
$316.40 |
$316.40 |
$316.40 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$317.12 |
$317.12 |
$317.12 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$326.96 |
$326.96 |
$326.96 |
$56.70
|
|
Inj, adalimumab, 1 mg
|
$14,245.32 |
$14,245.32 |
$14,245.32 |
$12,098.05
|
|
Inj allopurinol sodium 1 mg
|
$9,092.21 |
$9,092.21 |
$9,092.21 |
$6,968.99
|
|
Inj anifrolumab-fnia 1mg
|
$13,001.40 |
$13,001.40 |
$13,001.40 |
$10,052.58
|
|
Inj, artesunate, 1mg
|
$13,999.86 |
$13,999.86 |
$13,999.86 |
$14,460.21
|
|
Inj, aspara, rylaze, 0.1 mg
|
$14,410.75 |
$14,410.75 |
$14,410.75 |
$10,458.00
|
|
Inj aval alfa-nqpt 4mg
|
$4,921.72 |
$4,921.72 |
$4,921.72 |
$3,907.30
|
|
Inj., benralizumab, 1 mg
|
$14,666.09 |
$14,666.09 |
$14,666.09 |
$11,310.00
|
|
Inj, bezlotoxumab, 10 mg
|
$10,759.89 |
$10,759.89 |
$10,759.89 |
$7,612.43
|
|
Inj, bortezomib freseniuskab
|
$3,665.96 |
$3,665.96 |
$3,665.96 |
$2,624.08
|
|
Inj, bupivacaine liposome
|
$120.00 |
$120.00 |
$120.00 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$316.03 |
$316.03 |
$316.03 |
$22.69
|
|
Inj, cefepime hcl (b braun)
|
$319.48 |
$319.48 |
$319.48 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$724.36 |
$724.36 |
$724.36 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$380.80 |
$380.80 |
$380.80 |
$364.86
|
|
Inj, clevidipine butyrate
|
$408.64 |
$408.64 |
$408.64 |
$4.86
|
|
Inj cntr knee arthro incl ct/mri
|
$640.80 |
$640.80 |
$640.80 |
$436.80
|
|
Inj crotalidae im f(ab')2 eq
|
$3,292.52 |
$3,292.52 |
$3,292.52 |
$2,613.60
|
|
Inj cyclophosphamd (ingenus)
|
$1,148.28 |
$1,148.28 |
$1,148.28 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$330.24 |
$330.24 |
$330.24 |
$128.08
|
|
Inj daptomycin (xellia)
|
$345.92 |
$345.92 |
$345.92 |
$56.04
|
|
Inj disk cerv-thor ea lev
|
$2,775.20 |
$2,775.20 |
$2,775.20 |
$875.28
|
|
Inj dupuytren cord w/enzyme
|
$395.20 |
$395.20 |
$395.20 |
$416.00
|
|
Inj dx for sinogram
|
$638.40 |
$638.40 |
$638.40 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,743.20 |
$1,743.20 |
$1,743.20 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$766.40 |
$766.40 |
$766.40 |
$503.50
|
|
Injection, cangrelor
|
$2,075.24 |
$2,075.24 |
$2,075.24 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$20,560.00 |
$20,560.00 |
$20,560.00 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$444.80 |
$444.80 |
$444.80 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$8,083.01 |
$8,083.01 |
$8,083.01 |
$5,324.34
|
|
Injection, doxercalciferol
|
$320.31 |
$320.31 |
$320.31 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$1,648.80 |
$1,648.80 |
$1,648.80 |
$1,027.26
|
|
Injection, edaravone, 1 mg
|
$10,458.72 |
$10,458.72 |
$10,458.72 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$1,887.20 |
$1,887.20 |
$1,887.20 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$1,208.00 |
$1,208.00 |
$1,208.00 |
$436.00
|
|
Injection for bladder x-ray
|
$1,305.60 |
$1,305.60 |
$1,305.60 |
$459.20
|
|
Injection for hip x-ray
|
$266.40 |
$266.40 |
$266.40 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$929.60 |
$929.60 |
$929.60 |
$497.76
|
|
Injection for ureter x-ray
|
$941.60 |
$941.60 |
$941.60 |
$515.21
|
|
Injection, fulvestrant
|
$2,656.81 |
$2,656.81 |
$2,656.81 |
$1,719.16
|
|
Injection glatiramer acetate
|
$695.12 |
$695.12 |
$695.12 |
$830.51
|
|
Injection, glucarpidase
|
$42,003.60 |
$42,003.60 |
$42,003.60 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$9,220.28 |
$9,220.28 |
$9,220.28 |
$6,679.35
|
|
Injection into brain canal
|
$450.40 |
$450.40 |
$450.40 |
$844.50
|
|
Injection, isavuconazonium
|
$1,112.65 |
$1,112.65 |
$1,112.65 |
$787.67
|
|
Injection jaw joint x-ray
|
$340.00 |
$340.00 |
$340.00 |
$307.80
|
|
Injection jugular
|
$1,745.60 |
$1,745.60 |
$1,745.60 |
$790.00
|
|
Injection of sinus tract
|
$1,494.40 |
$1,494.40 |
$1,494.40 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$960.00 |
$960.00 |
$960.00 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$383.03 |
$383.03 |
$383.03 |
$383.03
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,232.80 |
$1,232.80 |
$1,232.80 |
$685.44
|
|
Injection, renflexis
|
$1,211.11 |
$1,211.11 |
$1,211.11 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,789.60 |
$1,789.60 |
$1,789.60 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,665.60 |
$1,665.60 |
$1,665.60 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,312.80 |
$1,312.80 |
$1,312.80 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,200.80 |
$2,200.80 |
$2,200.80 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,270.40 |
$1,270.40 |
$1,270.40 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,243.20 |
$2,243.20 |
$2,243.20 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,178.40 |
$1,178.40 |
$1,178.40 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,035.20 |
$2,035.20 |
$2,035.20 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,174.40 |
$2,174.40 |
$2,174.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,091.20 |
$2,091.20 |
$2,091.20 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$633.60 |
$633.60 |
$633.60 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$674.40 |
$674.40 |
$674.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$680.80 |
$680.80 |
$680.80 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$371.20 |
$371.20 |
$371.20 |
$145.60
|
|
Injection treatment of nose
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$859.59
|
|
Inject sacroiliac joint
|
$1,096.80 |
$1,096.80 |
$1,096.80 |
$1,029.04
|
|
Inj., emapalumab-lzsg, 1 mg
|
$40,644.12 |
$40,644.12 |
$40,644.12 |
$3,181.80
|
|
Inj epidural sgl cerv-thor without img
|
$2,098.40 |
$2,098.40 |
$2,098.40 |
$1,329.00
|
|
Inj, etelcalcetide, 0.1 mg
|
$371.96 |
$371.96 |
$371.96 |
$343.35
|
