|
Inj., benralizumab, 1 mg
|
$12,419.14 |
$12,419.14 |
$12,419.14 |
$11,239.97
|
|
Inj, bezlotoxumab, 10 mg
|
$109.60 |
$109.60 |
$109.60 |
$7,612.43
|
|
Inj bimatoprost itc imp1mcg
|
$486.40 |
$486.40 |
$486.40 |
$3,287.96
|
|
Inj, bupivacaine liposome
|
$806.30 |
$806.30 |
$806.30 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$11.35 |
$11.35 |
$11.35 |
$28.08
|
|
Inj cefazolin (wg crit care)
|
$9.93 |
$9.93 |
$9.93 |
$18.05
|
|
Inj ceftolozane tazobactam
|
$20.00 |
$20.00 |
$20.00 |
$380.80
|
|
Inj cntr knee arthro incl ct/mri
|
$92.80 |
$92.80 |
$92.80 |
$436.80
|
|
Inj. denosumab-bbdz, 1 mg
|
$3,437.98 |
$3,437.98 |
$3,437.98 |
$4,615.43
|
|
Inj disk cerv-thor ea lev
|
$244.00 |
$244.00 |
$244.00 |
$875.28
|
|
Inj dupuytren cord w/enzyme
|
$107.20 |
$107.20 |
$107.20 |
$416.00
|
|
Inj, durolane 1 mg
|
$44.80 |
$44.80 |
$44.80 |
$1,950.93
|
|
Inj dx for sinogram
|
$57.60 |
$57.60 |
$57.60 |
$422.59
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,412.53 |
$2,412.53 |
$2,412.53 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$143.20 |
$143.20 |
$143.20 |
$495.84
|
|
Injection carpal tunnel therapeutic (both sides)
|
$790.40 |
$790.40 |
$790.40 |
$450.72
|
|
Injection, casimersen, 10 mg
|
$289.60 |
$289.60 |
$289.60 |
$2,598.44
|
|
Injection epidural blood patch or clot
|
$1,081.60 |
$1,081.60 |
$1,081.60 |
$1,156.80
|
|
Injection eye drug
|
$135.20 |
$135.20 |
$135.20 |
$644.50
|
|
Injection for bladder x-ray
|
$69.60 |
$69.60 |
$69.60 |
$459.20
|
|
Injection for hip x-ray
|
$130.40 |
$130.40 |
$130.40 |
$710.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$104.80 |
$104.80 |
$104.80 |
$494.65
|
|
Injection, inclisiran, 1 mg
|
$8,115.41 |
$8,115.41 |
$8,115.41 |
$6,679.35
|
|
Injection into hemorrhoid(s)
|
$332.80 |
$332.80 |
$332.80 |
$1,432.81
|
|
Injection,onabotulinumtoxina
|
$3,100.80 |
$3,100.80 |
$3,100.80 |
$2,277.65
|
|
Injection px peyronie ds
|
$146.40 |
$146.40 |
$146.40 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$51.20 |
$51.20 |
$51.20 |
$670.64
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,835.20 |
$2,835.20 |
$2,835.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,374.13 |
$2,374.13 |
$2,374.13 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,552.00 |
$2,552.00 |
$2,552.00 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,436.80 |
$1,436.80 |
$1,436.80 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$93.60 |
$93.60 |
$93.60 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$169.60 |
$169.60 |
$169.60 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$80.00 |
$80.00 |
$80.00 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$146.40 |
$146.40 |
$146.40 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,522.40 |
$1,522.40 |
$1,522.40 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,488.80 |
$1,488.80 |
$1,488.80 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$846.40 |
$846.40 |
$846.40 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$846.40 |
$846.40 |
$846.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$470.40 |
$470.40 |
$470.40 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$316.80 |
$316.80 |
$316.80 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$76.80 |
$76.80 |
$76.80 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$455.20 |
$455.20 |
$455.20 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$524.00 |
$524.00 |
$524.00 |
$135.60
|
|
Inject sacroiliac joint
|
$176.80 |
$176.80 |
$176.80 |
$1,028.95
|
|
Inject/treat eye socket
|
$100.00 |
$100.00 |
$100.00 |
$381.13
|
|
Inject/treat eye socket
|
$487.20 |
$487.20 |
$487.20 |
$670.02
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$78.40 |
$78.40 |
$78.40 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$160.80 |
$160.80 |
$160.80 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$8,371.20 |
$8,371.20 |
$8,371.20 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$5.79 |
$5.79 |
$5.79 |
$6.55
|
|
Inj., eravacycline, 1 mg
|
$4.00 |
$4.00 |
$4.00 |
$206.64
|
|
Inj, evinacumab-dgnb, 5mg
|
$90,000.00 |
$90,000.00 |
$90,000.00 |
$20,751.13
|
|
Inj, faricimab-svoa, 0.1mg
|
$57.60 |
$57.60 |
$57.60 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$7,573.15 |
$7,573.15 |
$7,573.15 |
$3,221.52
|
|
Inj for ext venography
|
$79.20 |
$79.20 |
$79.20 |
$649.95
|
|
Inj, gadopiclenol, 1 ml
|
$71.02 |
$71.02 |
$71.02 |
$37.63
|
|
Inj intralesional <= 7 lsn(s)
|
$572.80 |
$572.80 |
$572.80 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$30.40 |
$30.40 |
$30.40 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$23,652.00 |
$23,652.00 |
$23,652.00 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$13,474.03 |
$13,474.03 |
$13,474.03 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$2,018.08 |
$2,018.08 |
$2,018.08 |
$1,174.88
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,224.80 |
$1,224.80 |
$1,224.80 |
$784.00
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$126.40 |
$126.40 |
$126.40 |
$1,496.55
|
|
Inj naloxone hydrochloride
|
$22.56 |
$22.56 |
$22.56 |
$83.16
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$256.00 |
$256.00 |
$256.00 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$203.20 |
$203.20 |
$203.20 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$108.00 |
$108.00 |
$108.00 |
$66,582.27
|
|
Inj, pegcetacoplan, 1mg
|
$361.60 |
$361.60 |
$361.60 |
$3,662.96
|
|
Inj., perseris, 0.5 mg
|
$27.20 |
$27.20 |
$27.20 |
$5,146.85
|
|
Inj proc for lymphang
|
$137.60 |
$137.60 |
$137.60 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$259.20 |
$259.20 |
$259.20 |
$1,106.93
|
|
Inj prohance multipack
|
$60.82 |
$60.82 |
$60.82 |
$9.59
|
|
Inj retacrit esrd on dialysi
|
$2.40 |
$2.40 |
$2.40 |
$349.45
|
|
Inj retro urethrocysto
|
$104.00 |
$104.00 |
$104.00 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$31.20 |
$31.20 |
$31.20 |
$746.79
|
|
Inj scleros sol mult veins
|
$128.00 |
$128.00 |
$128.00 |
$675.00
|
|
Inj scleros sol sgl vein
|
$64.80 |
$64.80 |
$64.80 |
$558.97
|
|
Inj secukinumab intrav 1mg
|
$8,612.96 |
$8,612.96 |
$8,612.96 |
$4,413.21
|
|
Inj, susvimo 0.1 mg
|
$137.60 |
$137.60 |
$137.60 |
$2,598.44
|
|
Inj. teprotumumab-trbw 10 mg
|
$865.60 |
$865.60 |
$865.60 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$0.80 |
$0.80 |
$0.80 |
$123.24
|
|
Inj testosterone cypionate
|
$0.80 |
$0.80 |
$0.80 |
$64.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$126.40 |
$126.40 |
$126.40 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,142.40 |
$1,142.40 |
$1,142.40 |
$837.50
|
|
Inj., tildrakizumab, 1 mg
|
$43,107.46 |
$43,107.46 |
$43,107.46 |
$26,635.60
|
|
Inj triamcinolone ace X-ray 1mg
|
$52.00 |
$52.00 |
$52.00 |
$1,090.75
|
|
Inj, trivisc 1 mg
|
$40.00 |
$40.00 |
$40.00 |
$6.67
|
|
Inj, uzedy, 1 mg
|
$54.40 |
$54.40 |
$54.40 |
$11,475.96
|
|
Inj, vancomycin hcl (mylan)
|
$43.00 |
$43.00 |
$43.00 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$48.72 |
$48.72 |
$48.72 |
$85.20
|
|
Inj vancomycin (xellia) 10mg
|
$59.52 |
$59.52 |
$59.52 |
$76.59
|
|
Inj w/fluor eval cv device
|
$56.80 |
$56.80 |
$56.80 |
$503.92
|
|
Inj xipere 1 mg
|
$99.20 |
$99.20 |
$99.20 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$1,236.00 |
$1,236.00 |
$1,236.00 |
$14,458.60
|
|
Inpatient consultation
|
$116.80 |
$116.80 |
$116.80 |
$73.80
|
|
Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
|
$72.80 |
$72.80 |
$72.80 |
$54.24
|
|
Inpt/ed teleconsult30
|
$156.00 |
$156.00 |
$156.00 |
$164.40
|
|
Inpt/ed teleconsult50
|
$215.20 |
$215.20 |
$215.20 |
$223.80
|
|
Inpt/ed teleconsult70
|
$308.80 |
$308.80 |
$308.80 |
$330.60
|
