|
Injection, fulvestrant
|
$2,550.36 |
$2,550.36 |
$2,550.36 |
$2,618.94
|
|
Injection glatiramer acetate
|
$358.05 |
$358.05 |
$358.05 |
$418.45
|
|
Injection, inclisiran, 1 mg
|
$4,940.02 |
$4,940.02 |
$4,940.02 |
$9,094.90
|
|
Injection, isavuconazonium
|
$482.37 |
$482.37 |
$482.37 |
$674.71
|
|
Injection,onabotulinumtoxina
|
$1,691.35 |
$1,691.35 |
$1,691.35 |
$2,154.07
|
|
Injection, peramivir
|
$1,418.92 |
$1,418.92 |
$1,418.92 |
$1,257.68
|
|
Injection radioactive tracer sentinel node (both sides)
|
$477.75 |
$477.75 |
$477.75 |
$717.20
|
|
Injection, renflexis
|
$1,205.90 |
$1,205.90 |
$1,205.90 |
$1,445.21
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,160.20 |
$2,160.20 |
$2,160.20 |
$1,242.00
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$570.15 |
$570.15 |
$570.15 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$516.25 |
$516.25 |
$516.25 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$936.25 |
$936.25 |
$936.25 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,030.05 |
$1,030.05 |
$1,030.05 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$936.25 |
$936.25 |
$936.25 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$256.20 |
$256.20 |
$256.20 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$449.05 |
$449.05 |
$449.05 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,877.75 |
$1,877.75 |
$1,877.75 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$158.55 |
$158.55 |
$158.55 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$355.95 |
$355.95 |
$355.95 |
$552.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$306.60 |
$306.60 |
$306.60 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$93.45 |
$93.45 |
$93.45 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$306.60 |
$306.60 |
$306.60 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$306.60 |
$306.60 |
$306.60 |
$141.60
|
|
Inject/treat eye socket
|
$262.15 |
$262.15 |
$262.15 |
$365.40
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$38,221.73 |
$38,221.73 |
$38,221.73 |
$15,669.18
|
|
Inj for ext venography
|
$649.95 |
$649.95 |
$649.95 |
$737.55
|
|
Inj for mammo ductogram
|
$87.50 |
$87.50 |
$87.50 |
$433.50
|
|
Inj, fosaprepitant (teva)
|
$115.36 |
$115.36 |
$115.36 |
$2.04
|
|
Inj heparin, pfizer, 1000u
|
$24.28 |
$24.28 |
$24.28 |
$24.28
|
|
Inj. herceptin hylecta, 10mg
|
$12,149.65 |
$12,149.65 |
$12,149.65 |
$108.76
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,691.90 |
$1,691.90 |
$1,691.90 |
$1,482.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,883.00 |
$1,883.00 |
$1,883.00 |
$1,837.17
|
|
Inj hrt cath w/s&i sel hrt art
|
$2,005.85 |
$2,005.85 |
$2,005.85 |
$1,192.50
|
|
Inj hrt cath w/s&i sel left vent
|
$982.45 |
$982.45 |
$982.45 |
$1,214.40
|
|
Inj hrt cath w/s&i sel right vent
|
$941.50 |
$941.50 |
$941.50 |
$947.65
|
|
Inj human fibrinogen con nos
|
$126.10 |
$126.10 |
$126.10 |
$1.52
|
|
Inj imip 4 cilas 4 releb 2mg
|
$457.80 |
$457.80 |
$457.80 |
$1,004.42
|
|
Inj, immphentiv, 20 mcg
|
$24.52 |
$24.52 |
$24.52 |
$32.83
|
|
Inj. inebilizumab-cdon, 1 mg
|
$115,324.19 |
$115,324.19 |
$115,324.19 |
$494.43
|
|
Inj intralesional <= 7 lsn(s)
|
$157.15 |
$157.15 |
$157.15 |
$241.74
|
|
Inj ivig privigen 500 mg
|
$10,879.50 |
$10,879.50 |
$10,879.50 |
$7,298.71
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,729.21 |
$1,729.21 |
$1,729.21 |
$1,462.42
|
|
Inj levocarnitine per 1 gm
|
$51.76 |
$51.76 |
$51.76 |
$138.96
|
|
Inj, levothyroxine, freskabi
|
$115.33 |
$115.33 |
$115.33 |
$302.07
|
|
Inj luxturna 1 billion vec g
|
$159,939.86 |
$159,939.86 |
$159,939.86 |
$3,084.46
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$390.60 |
$390.60 |
$390.60 |
$625.00
|
|
Inj melpha hydroch nos 50 mg
|
$3,856.04 |
$3,856.04 |
$3,856.04 |
$1,518.68
|
|
Inj mepivacaine hcl/10 ml
|
$1,485.81 |
$1,485.81 |
$1,485.81 |
$30.00
|
|
Inj., meropenem, vaborbactam
|
$281.22 |
$281.22 |
$281.22 |
$633.75
|
|
Inj meropenem (wg crit care)
|
$24.84 |
$24.84 |
$24.84 |
$104.29
|
|
Inj, moxifloxacin 100 mg
|
$54.12 |
$54.12 |
$54.12 |
$120.04
|
|
Inj multihance
|
$64.28 |
$64.28 |
$64.28 |
$119.25
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$751.45 |
$751.45 |
$751.45 |
$1,522.56
|
|
Inj ogivri 10 mg
|
$3,968.67 |
$3,968.67 |
$3,968.67 |
$3,968.67
|
|
Inj pantoprazole(hikma) 40mg
|
$22.50 |
$22.50 |
$22.50 |
$36.04
|
|
Inj., patisiran, 0.1 mg
|
$24,790.29 |
$24,790.29 |
$24,790.29 |
$11,742.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$7,258.20 |
$7,258.20 |
$7,258.20 |
$6,614.40
|
|
Inj proc ankle arthr
|
$86.80 |
$86.80 |
$86.80 |
$405.31
|
|
Inj proc elbow arthro
|
$137.55 |
$137.55 |
$137.55 |
$453.60
|
|
Inj proc for lymphang
|
$113.40 |
$113.40 |
$113.40 |
$1,372.00
|
|
Inj proc lumbr disk ea lvl
|
$1,165.15 |
$1,165.15 |
$1,165.15 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$914.55 |
$914.55 |
$914.55 |
$922.80
|
|
Inj proc sialogram
|
$68.60 |
$68.60 |
$68.60 |
$380.80
|
|
Inj progesterone per 50 mg
|
$19.32 |
$19.32 |
$19.32 |
$38.79
|
|
Inj, releuko 1 mcg
|
$326.52 |
$326.52 |
$326.52 |
$557.11
|
|
Inj retacrit esrd on dialysi
|
$505.94 |
$505.94 |
$505.94 |
$305.00
|
|
Inj retro urethrocysto
|
$104.30 |
$104.30 |
$104.30 |
$551.29
|
|
Inj, rimabotulinumtoxinb
|
$855.67 |
$855.67 |
$855.67 |
$17.73
|
|
Inj secretin synthetic human
|
$28.80 |
$28.80 |
$28.80 |
$809.36
|
|
Inj, sutimlimab-jome, 10 mg
|
$28,688.40 |
$28,688.40 |
$28,688.40 |
$18.13
|
|
Inj teclistamab cqyv 0.5 mg
|
$24,482.56 |
$24,482.56 |
$24,482.56 |
$15,797.25
|
|
Inj. teprotumumab-trbw 10 mg
|
$43,022.95 |
$43,022.95 |
$43,022.95 |
$47,971.67
|
|
Inj testosterone cypionate
|
$25.67 |
$25.67 |
$25.67 |
$78.79
|
|
Inj thiotepa nos 1 mg
|
$896.27 |
$896.27 |
$896.27 |
$2,298.83
|
|
Inj thrc fascial pln blk bi w/wo image
|
$520.80 |
$520.80 |
$520.80 |
$1,483.20
|
|
Inj thrc fascial pln blk uni w/wo image
|
$390.60 |
$390.60 |
$390.60 |
$1,252.02
|
|
Inj, tofidence, 1 mg
|
$5,719.74 |
$5,719.74 |
$5,719.74 |
$922.66
|
|
Inj, vancomycin hcl (mylan)
|
$44.28 |
$44.28 |
$44.28 |
$65.21
|
|
Inj w/fluor eval cv device
|
$170.45 |
$170.45 |
$170.45 |
$588.90
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$57,283.51 |
$57,283.51 |
$57,283.51 |
$17,281.68
|
|
Ins cath ren art 1st bi
|
$6,549.90 |
$6,549.90 |
$6,549.90 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$4,712.05 |
$4,712.05 |
$4,712.05 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$7,680.75 |
$7,680.75 |
$7,680.75 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$6,549.90 |
$6,549.90 |
$6,549.90 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$263.20 |
$263.20 |
$263.20 |
$544.00
|
|
Insert cath pleura with image
|
$2,241.75 |
$2,241.75 |
$2,241.75 |
$2,239.02
|
|
Insert cath pleura without image
|
$1,479.80 |
$1,479.80 |
$1,479.80 |
$2,212.00
|
|
Insert drug delivery implant
|
$105.35 |
$105.35 |
$105.35 |
$285.80
|
|
Insert hepatic shunt (tips)
|
$4,767.70 |
$4,767.70 |
$4,767.70 |
$9,754.48
|
|
Insert intrauterine device iud
|
$224.35 |
$224.35 |
$224.35 |
$378.83
|
|
Insertion catheter bladder non indwelling
|
$248.50 |
$248.50 |
$248.50 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$315.35 |
$315.35 |
$315.35 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,351.70 |
$1,351.70 |
$1,351.70 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,643.60 |
$1,643.60 |
$1,643.60 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$6,832.00 |
$6,832.00 |
$6,832.00 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,965.55 |
$2,965.55 |
$2,965.55 |
$2,618.40
|
|
Insertion of catheter vein
|
$594.30 |
$594.30 |
$594.30 |
$1,749.80
|
|
Insertion of catheter vein
|
$496.65 |
$496.65 |
$496.65 |
$858.05
|
|
Insertion of heart electrode 33211
|
$3,040.45 |
$3,040.45 |
$3,040.45 |
$9,090.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$10,759.35 |
$10,759.35 |
$10,759.35 |
$14,158.20
|