|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,407.00 |
$2,407.00 |
$2,407.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$225.23 |
$225.23 |
$1,017.28 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$530.78 |
$530.78 |
$2,284.54 |
$2,071.80
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$637.53 |
$637.53 |
$659.12 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$579.43 |
$579.43 |
$1,626.73 |
$1,888.80
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$423.15 |
$423.15 |
$856.48 |
$1,048.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$742.35 |
$742.35 |
$1,778.98 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$448.53 |
$448.53 |
$1,140.93 |
$1,826.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$756.18 |
$756.18 |
$2,070.82 |
$1,685.00
|
|
Injection, siltuximab
|
$8,477.45 |
$8,477.45 |
$8,477.45 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$205.63 |
$205.63 |
$398.06 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$191.63 |
$191.63 |
$684.07 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$217.70 |
$217.70 |
$703.22 |
$638.95
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$71.23 |
$71.23 |
$211.78 |
$145.60
|
|
Injection treatment of eye
|
$2,698.27 |
$2,698.27 |
$2,698.27 |
$2,698.92
|
|
Injection treatment of eye
|
$2,370.28 |
$2,370.28 |
$2,370.28 |
$2,685.92
|
|
Injection treatment of nerve
|
$3,016.15 |
$3,016.15 |
$3,016.15 |
$3,219.20
|
|
Injection treatment of nerve
|
$707.18 |
$707.18 |
$4,446.30 |
$4,446.30
|
|
Injection treatment of nerve
|
$2,380.77 |
$2,380.77 |
$2,380.77 |
$2,050.30
|
|
Injection treatment of nose
|
$859.59 |
$859.59 |
$859.59 |
$859.59
|
|
Inject sacroiliac joint
|
$368.90 |
$368.90 |
$1,029.04 |
$1,029.04
|
|
Inject/treat eye socket
|
$398.06 |
$398.06 |
$398.06 |
$381.13
|
|
Inject/treat eye socket
|
$631.90 |
$631.90 |
$631.90 |
$750.70
|
|
Inject/treat eye socket
|
$901.85 |
$901.85 |
$901.85 |
$670.02
|
|
Inj epidural sgl cerv-thor without img
|
$345.63 |
$345.63 |
$1,358.86 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$314.13 |
$314.13 |
$1,616.30 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$300.00 |
$300.00 |
$300.00 |
$206.64
|
|
Inj., evomela, 1 mg
|
$3,630.00 |
$3,630.00 |
$3,630.00 |
$17.37
|
|
Inj for ext venography
|
$525.88 |
$525.88 |
$983.75 |
$631.80
|
|
Inj for mammo ductogram
|
$219.68 |
$219.68 |
$219.68 |
$397.80
|
|
Inj, gadopiclenol, 1 ml
|
$6.43 |
$6.43 |
$904.21 |
$37.63
|
|
Inj givosiran 0.5 mg
|
$76,708.80 |
$76,708.80 |
$76,708.80 |
$76,708.80
|
|
Inj heparin, pfizer, 1000u
|
$0.24 |
$0.24 |
$36.60 |
$25.30
|
|
Inj herzuma 10 mg
|
$2,554.50 |
$2,554.50 |
$2,554.50 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,613.24 |
$2,613.24 |
$2,613.24 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$148.51 |
$148.51 |
$148.51 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$145.45 |
$145.45 |
$145.45 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$110.75 |
$110.75 |
$110.75 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$354.52 |
$354.52 |
$375.03 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$1,478.38 |
$1,478.38 |
$1,478.38 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$60.87 |
$60.87 |
$1,228.59 |
$1,228.59
|
|
Inj, immphentiv, 20 mcg
|
$38.40 |
$38.40 |
$38.40 |
$21.00
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,565.46 |
$1,565.46 |
$1,565.46 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$40.25 |
$40.25 |
$255.02 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$251.02 |
$251.02 |
$251.02 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$562.38 |
$562.38 |
$562.38 |
$6,967.29
|
|
Inj, kovaltry, 1 i.u
|
$24.72 |
$24.72 |
$24.72 |
$5.07
|
|
Inj levocarnitine per 1 gm
|
$136.62 |
$136.62 |
$136.62 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$570.13 |
$570.13 |
$570.13 |
$320.80
|
|
Inj, lidocaine w epinephrine
|
$48.60 |
$48.60 |
$48.60 |
$45.14
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$820.87 |
$820.87 |
$820.87 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$1,380.00 |
$1,380.00 |
$1,380.00 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$35.21 |
$35.21 |
$35.21 |
$34.00
|
|
Inj., meropenem, vaborbactam
|
$26.14 |
$26.14 |
$586.20 |
$556.87
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$1,678.82 |
$1,678.82 |
$1,678.82 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$8,304.04 |
$8,304.04 |
$8,304.04 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$165.60 |
$165.60 |
$165.60 |
$101.31
|
|
Inj multihance
|
$5.44 |
$5.44 |
$283.77 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$291.54 |
$291.54 |
$291.54 |
$252.66
|
|
Inj naloxone hydrochloride
|
$1.65 |
$1.65 |
$40.39 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$370.13 |
$370.13 |
$2,177.23 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,377.49 |
$2,377.49 |
$2,377.49 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,567.69 |
$2,567.69 |
$2,567.69 |
$2,726.90
|
|
Inj octafluoropropane mic,ml
|
$379.08 |
$379.08 |
$379.08 |
$211.40
|
|
Inj ogivri 10 mg
|
$261.15 |
$261.15 |
$261.15 |
$4,492.28
|
|
Inj ontruzant 10 mg
|
$6,706.27 |
$6,706.27 |
$6,706.27 |
$6,706.27
|
|
Inj., patisiran, 0.1 mg
|
$17,613.00 |
$17,613.00 |
$17,613.00 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$14.18 |
$14.18 |
$14.18 |
$96.08
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$7,082.75 |
$7,082.75 |
$7,082.75 |
$6,614.40
|
|
Inj peritoneal venous shunt
|
$69.39 |
$69.39 |
$69.39 |
$406.80
|
|
Inj proc ankle arthr
|
$232.66 |
$232.66 |
$232.66 |
$405.31
|
|
Inj proc elbow arthro
|
$118.83 |
$118.83 |
$331.58 |
$433.00
|
|
Inj proc for lymphang
|
$1,526.96 |
$1,526.96 |
$1,526.96 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$547.14 |
$547.14 |
$797.65 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$266.48 |
$266.48 |
$548.98 |
$840.00
|
|
Inj proc sialogram
|
$85.93 |
$85.93 |
$146.27 |
$369.45
|
|
Inj progesterone per 50 mg
|
$10.76 |
$10.76 |
$10.76 |
$13.76
|
|
Inj prohance multipack
|
$283.77 |
$283.77 |
$283.77 |
$10.40
|
|
Inj retacrit esrd on dialysi
|
$24.42 |
$24.42 |
$24.42 |
$307.40
|
|
Inj retro urethrocysto
|
$75.95 |
$75.95 |
$125.71 |
$447.74
|
|
Inj, rimabotulinumtoxinb
|
$101.68 |
$101.68 |
$101.68 |
$714.24
|
|
Inj scleros sol mult veins
|
$517.41 |
$517.41 |
$517.41 |
$707.85
|
|
Inj scleros sol sgl vein
|
$561.88 |
$561.88 |
$561.88 |
$561.88
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$392.39 |
$392.39 |
$392.39 |
$436.80
|
|
Inj teclistamab cqyv 0.5 mg
|
$17,517.56 |
$17,517.56 |
$17,517.56 |
$17,517.56
|
|
Inj testostero enanthate 1mg
|
$0.01 |
$0.01 |
$0.01 |
$123.09
|
|
Inj testosterone cypionate
|
$2.98 |
$2.98 |
$85.64 |
$64.96
|
|
Inj theophylline per 40 mg
|
$14.40 |
$14.40 |
$14.40 |
$31.90
|
|
Inj thrc fascial pln blk bi w/wo image
|
$2,774.06 |
$2,774.06 |
$2,774.06 |
$1,059.00
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,677.65 |
$1,677.65 |
$1,677.65 |
$837.50
|
|
Inj, tyenne, 1 mg
|
$3,525.12 |
$3,525.12 |
$3,525.12 |
$3,525.12
|
|
Inj, vancomycin hcl (mylan)
|
$0.39 |
$0.39 |
$89.83 |
$70.84
|
|
Inj, vancomycin hcl (xellia)
|
$1.38 |
$1.38 |
$1.38 |
$85.20
|
|
Inj vancomycin (xellia) 10mg
|
$13.80 |
$13.80 |
$13.80 |
$76.59
|
|
Inj, vasopressin (baxter)
|
$202.50 |
$202.50 |
$202.50 |
$202.50
|
|
Inj vocal cord bulking agent
|
$1,313.90 |
$1,313.90 |
$1,313.90 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$237.48 |
$237.48 |
$624.49 |
$504.40
|
|
Ins cath ren art 1st bi
|
$2,889.25 |
$2,889.25 |
$6,815.98 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$2,080.40 |
$2,080.40 |
$4,667.63 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$3,380.48 |
$3,380.48 |
$5,663.98 |
$5,663.98
|