|
Inj, durolane 1 mg
|
$7.70 |
$2,181.77 |
$2,181.77 |
|
|
Inj dx for sinogram
|
$103.94 |
$1,281.62 |
$1,281.62 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$985.19 |
$4,236.87 |
$4,236.87 |
|
|
Injection arthrography hip without anesthesia (both sides)
|
$159.75 |
$2,473.45 |
$2,473.45 |
|
|
Injection, cangrelor
|
$3,432.56 |
$5,355.26 |
$34,716.05 |
|
|
Injection, caplacizumab-yhdp
|
$35,701.12 |
$35,701.12 |
$46,094.00 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$277.77 |
$1,655.85 |
$1,655.85 |
|
|
Injection, daratumumab 10 mg
|
$448.22 |
$35,666.83 |
$35,666.83 |
|
|
Injection, doxercalciferol
|
$348.00 |
$1,513.12 |
$1,513.12 |
|
|
Injection during cath supravalvular aortography
|
$254.55 |
$1,450.35 |
$1,450.35 |
|
|
Injection epidural blood patch or clot
|
$490.17 |
$1,853.05 |
$1,853.05 |
|
|
Injection for arthrography wrist (both sides)
|
$206.61 |
$2,945.99 |
$2,945.99 |
|
|
Injection for bladder x-ray
|
$150.90 |
$2,087.40 |
$2,087.40 |
|
|
Injection for hip x-ray
|
$274.38 |
$3,350.36 |
$3,350.36 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$194.64 |
$2,693.08 |
$2,693.08 |
|
|
Injection for ureter x-ray
|
$284.57 |
$2,581.59 |
$2,581.59 |
|
|
Injection for ureter x-ray
|
$706.05 |
$957.35 |
$957.35 |
|
|
Injection, fulvestrant
|
$7,077.00 |
$29,849.42 |
$29,849.42 |
|
|
Injection glatiramer acetate
|
$537.21 |
$1,854.00 |
$2,193.00 |
|
|
Injection, glucarpidase
|
$222,988.28 |
$222,988.28 |
$229,617.00 |
|
|
Injection, inclisiran, 1 mg
|
$14,501.66 |
$14,501.66 |
$16,216.00 |
|
|
Injection into brain canal
|
$792.45 |
$792.45 |
$792.45 |
|
|
Injection, isavuconazonium
|
$1,125.92 |
$1,468.88 |
$14,372.00 |
|
|
Injection jaw joint x-ray
|
$71.14 |
$100.86 |
$114.43 |
|
|
Injection jugular
|
$6,755.78 |
$6,755.78 |
$6,755.78 |
|
|
Injection of sinus tract
|
$866.80 |
$8,878.85 |
$8,878.85 |
|
|
Injection,onabotulinumtoxina
|
$2,667.27 |
$10,757.17 |
$24,765.00 |
|
|
Injection, peramivir
|
$1,372.00 |
$1,372.00 |
$2,715.80 |
|
|
Injection px peyronie ds
|
$626.26 |
$626.26 |
$626.26 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$358.93 |
$1,384.73 |
$1,384.73 |
|
|
Injection, renflexis
|
$3,313.88 |
$4,473.48 |
$7,105.99 |
|
|
Injection, ruconest
|
$211.25 |
$211.25 |
$303.45 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,219.79 |
$2,219.79 |
$2,219.79 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$213.89 |
$2,066.83 |
$2,066.83 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$172.28 |
$2,928.19 |
$2,928.19 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$889.65 |
$2,914.65 |
$2,914.65 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$618.19 |
$3,970.83 |
$3,970.83 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,152.06 |
$4,963.52 |
$4,963.52 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$591.00 |
$3,701.29 |
$3,701.29 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,296.26 |
$3,175.40 |
$3,330.88 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$990.12 |
$2,920.91 |
$2,920.91 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$723.77 |
$3,017.89 |
$3,017.89 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$135.81 |
$1,230.35 |
$1,230.35 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$103.72 |
$1,870.48 |
$1,870.48 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$100.10 |
$2,244.56 |
$2,244.56 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$28.34 |
$893.15 |
$893.15 |
|
|
Injection treatment of nerve
|
$5,989.98 |
$5,989.98 |
$5,989.98 |
|
|
Injection treatment of nerve
|
$7,187.99 |
$7,187.99 |
$7,187.99 |
|
|
Injection treatment of nerve
|
$1,343.98 |
$1,343.98 |
$1,744.19 |
|
|
Inject sacroiliac joint
|
$880.12 |
$2,296.10 |
$2,296.10 |
|
|
Inj, eculizumab-aagh, 2 mg
|
$17,898.75 |
$17,898.75 |
$17,898.75 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$66,229.74 |
$66,229.74 |
$66,229.74 |
|
|
Inj., emapalumab-lzsg, 1 mg
|
$1,771.28 |
$1,771.28 |
$1,771.28 |
|
|
Inj epidural sgl cerv-thor without img
|
$768.39 |
$2,434.09 |
$2,434.09 |
|
|
Inj epidural sgl lumb-sacral without img
|
$226.20 |
$2,132.48 |
$2,132.48 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$229.69 |
$260.72 |
$850.08 |
|
|
Inj for ext venography
|
$296.07 |
$1,367.03 |
$1,367.03 |
|
|
Inj for mammo ductogram
|
$138.88 |
$1,065.79 |
$1,065.79 |
|
|
Inj, fulvestrant (fresenius)
|
$2,357.04 |
$5,212.73 |
$5,212.73 |
|
|
Inj, gadopiclenol, 1 ml
|
$308.96 |
$308.96 |
$308.96 |
|
|
Inj gemcitabine hcl (accord)
|
$1,079.39 |
$1,079.39 |
$1,079.39 |
|
|
Inj glycopyrrolate fres kabi
|
$135.15 |
$135.15 |
$135.15 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$440.73 |
$3,665.81 |
$3,665.81 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$434.63 |
$4,251.38 |
$4,251.38 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,414.28 |
$1,414.28 |
$1,414.28 |
|
|
Inj hrt cath w/s&i sel left vent
|
$3,665.81 |
$3,665.81 |
$3,665.81 |
|
|
Inj hrt cath w/s&i sel right vent
|
$344.43 |
$1,462.25 |
$1,462.25 |
|
|
Inj human fibrinogen con nos
|
$8.79 |
$8.79 |
$8.79 |
|
|
Inj hydroxocobalamin IV 25mg
|
$4,084.40 |
$5,031.98 |
$11,280.00 |
|
|
Inj hydroxyprogst capoat nos
|
$1,962.78 |
$6,517.50 |
$7,738.72 |
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,347.42 |
$1,669.75 |
$4,954.32 |
|
|
Inj, immphentiv, 20 mcg
|
$25.55 |
$25.55 |
$25.55 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$633.55 |
$3,746.46 |
$3,746.46 |
|
|
Inj intralesional <= 7 lsn(s)
|
$526.32 |
$526.32 |
$526.32 |
|
|
Inj intralesional > 7 lsns
|
$944.00 |
$944.00 |
$944.00 |
|
|
Inj ivig privigen 500 mg
|
$3,465.37 |
$12,796.97 |
$12,796.97 |
|
|
Inj labetalol hcl hikma, 5mg
|
$257.01 |
$257.01 |
$257.01 |
|
|
Inj, lanreotide, (cipla) 1mg
|
$40,428.71 |
$40,428.71 |
$40,428.71 |
|
|
Inj levocarnitine per 1 gm
|
$326.96 |
$908.12 |
$1,981.00 |
|
|
Inj levoleucovorin nos 0.5mg
|
$1,549.36 |
$1,549.36 |
$2,455.25 |
|
|
Inj, levothyroxine, freskabi
|
$11.00 |
$11.00 |
$1,096.82 |
|
|
Inj, lidocaine w epinephrine
|
$3.91 |
$1,108.08 |
$1,108.08 |
|
|
Inj., lumoxiti, 0.01 mg
|
$18,037.69 |
$18,037.69 |
$18,037.69 |
|
|
Inj melpha hydroch nos 50 mg
|
$14,220.00 |
$15,692.88 |
$22,001.02 |
|
|
Inj mepivacaine hcl/10 ml
|
$35.34 |
$35.34 |
$37.00 |
|
|
Inj., meropenem, vaborbactam
|
$531.46 |
$940.00 |
$1,959.00 |
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$26,020.00 |
$26,020.00 |
$26,020.00 |
|
|
Inj, moxifloxacin 100 mg
|
$302.50 |
$302.50 |
$1,006.75 |
|
|
Inj moxifloxacin (fres kabi)
|
$133.41 |
$133.41 |
$133.41 |
|
|
Inj multihance
|
$16.00 |
$412.67 |
$412.67 |
|
|
Inj. mycophenolate mofetil
|
$365.20 |
$997.77 |
$2,560.88 |
|
|
Inj naloxone hydrochloride
|
$0.36 |
$526.57 |
$526.57 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$600.66 |
$3,875.34 |
$3,875.34 |
|
|
Inj, nithiodote, 3mg / 125mg
|
$1,604.00 |
$1,604.00 |
$1,604.00 |
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$5,077.35 |
$5,077.35 |
$5,077.35 |
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$5,077.35 |
$5,077.35 |
$5,077.35 |
|
|
Inj octafluoropropane mic,ml
|
$169.22 |
$169.22 |
$2,931.04 |
|
|
Inj., patisiran, 0.1 mg
|
$61,664.96 |
$61,664.96 |
$61,664.96 |
|
|
Inj, pedmark, 100 mg
|
$237.56 |
$265.53 |
$534.04 |
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$15,113.32 |
$15,113.32 |
$15,113.32 |
|
