|
Injection during cath supravalvular aortography
|
$118.20 |
$118.20 |
$130.02 |
$952.66
|
|
Injection epidural blood patch or clot
|
$324.60 |
$324.60 |
$357.06 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$249.30 |
$249.30 |
$274.23 |
$428.40
|
|
Injection for bladder x-ray
|
$81.30 |
$81.30 |
$89.43 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$240.30 |
$240.30 |
$264.33 |
$494.65
|
|
Injection for ureter x-ray
|
$564.90 |
$564.90 |
$621.39 |
$515.21
|
|
Injection, fulvestrant
|
$991.24 |
$991.24 |
$1,090.37 |
$1,817.65
|
|
Injection glatiramer acetate
|
$183.71 |
$183.71 |
$202.08 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$3,668.10 |
$3,668.10 |
$4,034.91 |
$6,679.35
|
|
Injection, isavuconazonium
|
$372.83 |
$372.83 |
$410.11 |
$787.67
|
|
Injection jugular
|
$150.90 |
$150.90 |
$165.99 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$1,331.17 |
$1,331.17 |
$1,464.28 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$245.40 |
$245.40 |
$269.94 |
$670.64
|
|
Injection, renflexis
|
$770.27 |
$770.27 |
$847.29 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$649.20 |
$649.20 |
$714.12 |
$1,582.12
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$406.50 |
$406.50 |
$894.63 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$447.15 |
$447.15 |
$447.15 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$310.50 |
$310.50 |
$683.10 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$406.50 |
$406.50 |
$894.63 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$372.00 |
$372.00 |
$409.20 |
$1,681.24
|
|
Injection, siltuximab
|
$6,716.03 |
$6,716.03 |
$7,387.63 |
$10,680.75
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$370.20 |
$370.20 |
$407.22 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$141.00 |
$141.00 |
$155.10 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$22.50 |
$22.50 |
$24.75 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$22.50 |
$22.50 |
$24.75 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$97.80 |
$97.80 |
$107.58 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$36.30 |
$36.30 |
$55.44 |
$135.60
|
|
Inject sacroiliac joint
|
$649.20 |
$649.20 |
$714.12 |
$1,028.95
|
|
Inj, eculizumab-aagh, 2 mg
|
$4,668.28 |
$4,668.28 |
$5,135.11 |
$7,980.52
|
|
Inj., eravacycline, 1 mg
|
$116.89 |
$116.89 |
$128.57 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$211.08 |
$211.08 |
$232.18 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$3,319.49 |
$3,319.49 |
$3,651.44 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$334.66 |
$334.66 |
$368.12 |
$39.54
|
|
Inj for ext venography
|
$301.20 |
$301.20 |
$331.32 |
$649.95
|
|
Inj for mammo ductogram
|
$129.60 |
$129.60 |
$129.60 |
$399.60
|
|
Inj fosnetupitant, palonoset
|
$572.54 |
$572.54 |
$629.80 |
$1,110.99
|
|
Inj glofitamab gxbm, 2.5 mg
|
$10,447.88 |
$10,447.88 |
$11,492.67 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$6.94 |
$6.94 |
$7.63 |
$11.23
|
|
Inj. herceptin hylecta, 10mg
|
$4,779.97 |
$4,779.97 |
$5,257.96 |
$7,690.59
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$118.20 |
$118.20 |
$130.02 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$122.40 |
$122.40 |
$134.64 |
$1,827.74
|
|
Inj hrt cath w/s&i sel left vent
|
$180.84 |
$180.84 |
$180.84 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$118.20 |
$118.20 |
$130.02 |
$965.33
|
|
Inj hydroxocobalamin IV 25mg
|
$1,071.47 |
$1,071.47 |
$1,178.62 |
$2,452.32
|
|
Inj. inebilizumab-cdon, 1 mg
|
$47,796.69 |
$47,796.69 |
$52,576.36 |
$70,014.65
|
|
Inj intralesional <= 7 lsn(s)
|
$101.31 |
$101.31 |
$101.31 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$13,122.36 |
$13,122.36 |
$14,434.60 |
$6,967.29
|
|
Inj, kovaltry, 1 i.u
|
$5.07 |
$5.07 |
$5.57 |
$5.07
|
|
Inj, lanreotide, (cipla) 1mg
|
$9,091.85 |
$9,091.85 |
$10,001.04 |
$11,648.70
|
|
Inj, levothyroxine, freskabi
|
$30.91 |
$30.91 |
$34.00 |
$303.45
|
|
Inj melpha hydroch nos 50 mg
|
$1,679.90 |
$1,679.90 |
$1,847.89 |
$1,791.90
|
|
Inj meropenem (wg crit care)
|
$57.32 |
$57.32 |
$63.06 |
$77.97
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$4,334.34 |
$4,334.34 |
$4,767.78 |
$8,304.04
|
|
Inj multihance
|
$220.98 |
$220.98 |
$243.07 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$110.40 |
$110.40 |
$121.44 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$641.10 |
$641.10 |
$705.21 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$411.72 |
$411.72 |
$452.89 |
$462.04
|
|
Inj, nyposi 1 mcg
|
$307.06 |
$307.06 |
$337.77 |
$0.55
|
|
Inj octafluoropropane mic,ml
|
$244.63 |
$244.63 |
$269.10 |
$211.40
|
|
Inj ogivri 10 mg
|
$3,780.08 |
$3,780.08 |
$4,158.09 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$488.26 |
$488.26 |
$537.08 |
$865.34
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$4,013.47 |
$4,013.47 |
$4,414.81 |
$6,403.59
|
|
Inj peritoneal venous shunt
|
$119.70 |
$119.70 |
$131.67 |
$413.70
|
|
Inj proc ankle arthr
|
$239.40 |
$239.40 |
$263.34 |
$405.31
|
|
Inj proc elbow arthro
|
$240.30 |
$240.30 |
$264.33 |
$419.60
|
|
Inj proc for lymphang
|
$295.20 |
$295.20 |
$324.72 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$130.80 |
$130.80 |
$143.88 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$240.24 |
$240.24 |
$240.24 |
$830.50
|
|
Inj proc sialogram
|
$149.70 |
$149.70 |
$164.67 |
$373.00
|
|
Inj progesterone per 50 mg
|
$42.05 |
$42.05 |
$46.25 |
$15.00
|
|
Inj, releuko 1 mcg
|
$260.10 |
$260.10 |
$286.11 |
$473.25
|
|
Inj retro urethrocysto
|
$71.10 |
$71.10 |
$78.21 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$649.31 |
$649.31 |
$714.24 |
$746.79
|
|
Inj romidepsin non-lyo 0.1mg
|
$8,993.36 |
$8,993.36 |
$9,892.69 |
$9,892.69
|
|
Inj secretin synthetic human
|
$675.81 |
$675.81 |
$743.39 |
$1,285.20
|
|
Inj, spesolimab-sbzo, 1 mg
|
$28,528.31 |
$28,528.31 |
$31,381.15 |
$90,007.62
|
|
Inj teclistamab cqyv 0.5 mg
|
$10,681.58 |
$10,681.58 |
$11,749.73 |
$17,517.56
|
|
Inj testosterone cypionate
|
$16.58 |
$16.58 |
$18.23 |
$64.80
|
|
Inj thiotepa nos 1 mg
|
$2,402.64 |
$2,402.64 |
$2,642.90 |
$3,170.16
|
|
Inj, tislelizumab-jsgr
|
$5,698.18 |
$5,698.18 |
$6,267.99 |
$9,764.09
|
|
Inj triamcinolone ace X-ray 1mg
|
$702.89 |
$702.89 |
$773.18 |
$1,090.75
|
|
Inj, tyenne, 1 mg
|
$2,002.27 |
$2,002.27 |
$2,202.50 |
$3,525.12
|
|
Inj, vegzelma, 10 mg
|
$2,770.30 |
$2,770.30 |
$3,047.33 |
$1,291.28
|
|
Inj w/fluor eval cv device
|
$307.20 |
$307.20 |
$337.92 |
$503.92
|
|
Inpt/ed teleconsult30
|
$141.75 |
$141.75 |
$141.75 |
$164.40
|
|
Inpt/ed teleconsult50
|
$157.50 |
$157.50 |
$157.50 |
$223.80
|
|
Inpt/ed teleconsult70
|
$173.25 |
$173.25 |
$173.25 |
$330.60
|
|
Ins cath ren art 1st bi
|
$1,451.70 |
$1,451.70 |
$1,596.87 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$1,451.70 |
$1,451.70 |
$1,596.87 |
$4,660.00
|
|
Ins cath ren art 2nd+ uni
|
$2,558.40 |
$2,558.40 |
$2,814.24 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$140.10 |
$140.10 |
$154.11 |
$480.28
|
|
Insert abdomen-venous drain
|
$550.20 |
$550.20 |
$550.20 |
$3,147.06
|
|
Insert cath pleura with image
|
$885.60 |
$885.60 |
$974.16 |
$2,194.40
|
|
Insert cath pleura without image
|
$393.60 |
$393.60 |
$432.96 |
$2,073.18
|
|
Insert hepatic shunt (tips)
|
$3,180.00 |
$3,180.00 |
$3,498.00 |
$7,571.20
|
|
Insertion catheter bladder temporary simple
|
$61.20 |
$61.20 |
$67.32 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$2,149.20 |
$2,149.20 |
$2,364.12 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,024.80 |
$1,024.80 |
$1,127.28 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$1,338.30 |
$1,338.30 |
$1,472.13 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$350.10 |
$350.10 |
$385.11 |
$2,505.60
|
