|
Injection for arthrography wrist (both sides)
|
$487.95 |
$521.18 |
$521.18 |
$436.00
|
|
Injection for bladder x-ray
|
$445.95 |
$780.00 |
$780.00 |
$459.20
|
|
Injection for hip x-ray
|
$1,210.53 |
$1,210.53 |
$1,210.53 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$514.36 |
$514.36 |
$591.75 |
$497.76
|
|
Injection for spleen x-ray
|
$982.72 |
$982.72 |
$982.72 |
$686.40
|
|
Injection for ureter x-ray
|
$415.80 |
$841.49 |
$841.49 |
$415.80
|
|
Injection for ureter x-ray
|
$515.21 |
$515.21 |
$515.21 |
$515.21
|
|
Injection, fulvestrant
|
$356.67 |
$1,919.66 |
$3,520.29 |
$1,719.16
|
|
Injection glatiramer acetate
|
$865.10 |
$865.10 |
$865.10 |
$830.51
|
|
Injection, glucarpidase
|
$74,113.20 |
$74,113.20 |
$74,113.20 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$6,679.35 |
$6,679.35 |
$6,679.35 |
$6,679.35
|
|
Injection into brain canal
|
$746.85 |
$1,090.69 |
$1,090.69 |
$844.50
|
|
Injection into hemorrhoid(s)
|
$2,926.20 |
$2,926.20 |
$2,926.20 |
$1,433.00
|
|
Injection, isavuconazonium
|
$787.67 |
$987.58 |
$2,218.05 |
$787.67
|
|
Injection jaw joint x-ray
|
$229.06 |
$229.06 |
$229.06 |
$307.80
|
|
Injection jugular
|
$191.85 |
$1,048.20 |
$1,048.20 |
$790.00
|
|
Injection, necitumumab, 1 mg
|
$8,572.91 |
$8,572.91 |
$8,572.91 |
$8,572.91
|
|
Injection of sinus tract
|
$1,006.81 |
$1,006.81 |
$1,006.81 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$1,162.80 |
$1,162.80 |
$2,510.64 |
$2,277.65
|
|
Injection, peramivir
|
$684.00 |
$857.98 |
$857.98 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$731.25 |
$1,481.87 |
$1,481.87 |
$685.44
|
|
Injection, renflexis
|
$1,356.10 |
$1,356.10 |
$3,291.58 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,582.12 |
$1,582.12 |
$2,255.55 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,045.65 |
$2,618.36 |
$2,618.36 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,045.65 |
$1,139.12 |
$1,787.72 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,482.45 |
$2,251.00 |
$2,251.00 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$741.45 |
$1,131.41 |
$1,131.41 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,482.45 |
$2,195.95 |
$2,195.95 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$741.45 |
$966.32 |
$966.32 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,482.45 |
$2,165.84 |
$2,165.84 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,438.95 |
$2,033.74 |
$2,033.74 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,001.25 |
$1,882.52 |
$1,882.52 |
$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)
|
$441.30 |
$460.94 |
$460.94 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$441.30 |
$624.56 |
$1,137.05 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$441.30 |
$684.48 |
$684.48 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$192.15 |
$216.67 |
$216.67 |
$145.60
|
|
Injection treatment of nerve
|
$2,792.73 |
$2,792.73 |
$2,792.73 |
$3,219.20
|
|
Inject sacroiliac joint
|
$950.29 |
$950.29 |
$2,255.55 |
$1,029.04
|
|
Inj, eculizumab-aagh, 2 mg
|
$20,341.00 |
$20,341.00 |
$20,341.00 |
$7,980.52
|
|
Inj epidural sgl cerv-thor without img
|
$1,045.65 |
$1,311.74 |
$1,311.74 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,001.25 |
$1,450.84 |
$1,450.84 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$237.60 |
$300.00 |
$300.00 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$212.36 |
$212.36 |
$212.36 |
$343.35
|
|
Inj., evomela, 1 mg
|
$3,630.00 |
$3,630.00 |
$3,630.00 |
$17.37
|
|
Inj for ext venography
|
$518.10 |
$1,858.36 |
$1,858.36 |
$628.80
|
|
Inj for mammo ductogram
|
$621.62 |
$621.62 |
$621.62 |
$397.80
|
|
Inj, gadopiclenol, 1 ml
|
$904.21 |
$904.21 |
$904.21 |
$37.63
|
|
Inj givosiran 0.5 mg
|
$76,708.80 |
$76,708.80 |
$76,708.80 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$12,379.37 |
$12,379.37 |
$12,379.37 |
$4,760.67
|
|
Inj heparin, pfizer, 1000u
|
$36.60 |
$36.60 |
$36.60 |
$25.30
|
|
Inj herzuma 10 mg
|
$2,554.50 |
$2,554.50 |
$7,775.46 |
$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
|
$2,874.61 |
$2,874.61 |
$2,874.61 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,045.80 |
$1,960.03 |
$1,960.03 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$2,226.93 |
$2,226.93 |
$2,226.93 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$1,045.65 |
$1,887.60 |
$1,887.60 |
$999.96
|
|
Inj human fibrinogen con nos
|
$3.95 |
$3.95 |
$3.95 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$1,478.38 |
$1,478.38 |
$4,622.00 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$1,228.59 |
$1,228.59 |
$1,589.94 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$662.97 |
$662.97 |
$1,477.56 |
$739.77
|
|
Inj, immphentiv, 20 mcg
|
$38.40 |
$38.40 |
$38.40 |
$21.00
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,673.66 |
$1,673.66 |
$1,673.66 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$238.77 |
$238.77 |
$238.77 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$6,967.29 |
$6,967.29 |
$9,934.68 |
$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 |
$216.38 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$117.00 |
$117.00 |
$117.00 |
$110.40
|
|
Inj, levothyroxine, freskabi
|
$39.24 |
$59.87 |
$570.13 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$48.60 |
$48.60 |
$48.60 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$794.70 |
$794.70 |
$794.70 |
$794.70
|
|
Inj. meloxicam 1 mg
|
$203.04 |
$203.04 |
$203.04 |
$167.04
|
|
Inj melpha hydroch nos 50 mg
|
$1,380.00 |
$1,380.00 |
$4,962.63 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$33.86 |
$35.21 |
$49.07 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$466.56 |
$586.20 |
$892.99 |
$556.87
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$8,304.04 |
$8,304.04 |
$8,922.99 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$107.25 |
$165.60 |
$165.60 |
$101.31
|
|
Inj multihance
|
$283.77 |
$283.77 |
$283.77 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$109.74 |
$291.54 |
$466.47 |
$252.66
|
|
Inj naloxone hydrochloride
|
$83.16 |
$83.16 |
$83.16 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,569.23 |
$1,569.23 |
$1,657.05 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,058.43 |
$2,058.43 |
$2,058.43 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,058.43 |
$2,058.43 |
$2,058.43 |
$2,726.90
|
|
Inj octafluoropropane mic,ml
|
$379.08 |
$379.08 |
$421.20 |
$211.40
|
|
Inj ogivri 10 mg
|
$5,197.61 |
$5,197.61 |
$5,197.61 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$865.34 |
$865.34 |
$2,099.93 |
$865.34
|
|
Inj ontruzant 10 mg
|
$6,706.27 |
$6,706.27 |
$7,343.90 |
$6,706.27
|
|
Inj., patisiran, 0.1 mg
|
$17,613.00 |
$17,613.00 |
$17,613.00 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$7,082.75 |
$7,082.75 |
$7,082.75 |
$6,614.40
|
|
Inj peritoneal venous shunt
|
$329.49 |
$329.49 |
$329.49 |
$406.80
|
|
Inj proc ankle arthr
|
$405.31 |
$405.31 |
$405.31 |
$405.31
|
|
Inj proc elbow arthro
|
$497.55 |
$768.85 |
$768.85 |
$432.00
|
|
Inj proc for lymphang
|
$1,848.76 |
$1,848.76 |
$1,848.76 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$2,015.55 |
$2,015.55 |
$2,015.55 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$651.90 |
$1,267.73 |
$1,267.73 |
$838.30
|
|
Inj proc sialogram
|
$419.34 |
$419.34 |
$419.34 |
$373.00
|
|
Inj progesterone per 50 mg
|
$6.00 |
$10.76 |
$1,307.64 |
$13.76
|
|
Inj prohance multipack
|
$283.77 |
$283.77 |
$283.77 |
$10.40
|
|
Inj retacrit esrd on dialysi
|
$602.99 |
$602.99 |
$602.99 |
$349.45
|
|
Inj retro urethrocysto
|
$384.60 |
$605.02 |
$605.02 |
$447.74
|
