|
Inj dx for sinogram
|
$917.80 |
$917.80 |
$917.80 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$1,066.65 |
$1,066.65 |
$1,066.65 |
$503.50
|
|
Injection, belinostat, 10mg
|
$226.20 |
$226.20 |
$226.20 |
$4,446.10
|
|
Injection, burosumab-twza 1m
|
$1,075.10 |
$1,075.10 |
$1,075.10 |
$20,002.09
|
|
Injection, cangrelor
|
$136.50 |
$136.50 |
$136.50 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$2,076.10 |
$2,076.10 |
$2,076.10 |
$16,319.16
|
|
Injection, daratumumab 10 mg
|
$334.75 |
$334.75 |
$334.75 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$713.70 |
$713.70 |
$713.70 |
$1,027.26
|
|
Injection for bladder x-ray
|
$1,782.95 |
$1,782.95 |
$1,782.95 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$1,066.65 |
$1,066.65 |
$1,066.65 |
$497.76
|
|
Injection for spleen x-ray
|
$4,331.60 |
$4,331.60 |
$4,331.60 |
$686.40
|
|
Injection for ureter x-ray
|
$776.10 |
$776.10 |
$776.10 |
$415.80
|
|
Injection for ureter x-ray
|
$393.25 |
$393.25 |
$393.25 |
$515.21
|
|
Injection, fulvestrant
|
$333.45 |
$333.45 |
$333.45 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,790.75 |
$1,790.75 |
$1,790.75 |
$830.51
|
|
Injection, glucarpidase
|
$1,066.00 |
$1,066.00 |
$1,066.00 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$56.55 |
$56.55 |
$56.55 |
$6,679.35
|
|
Injection into brain canal
|
$1,253.20 |
$1,253.20 |
$1,253.20 |
$844.50
|
|
Injection, isavuconazonium
|
$3,050.45 |
$3,050.45 |
$3,050.45 |
$787.67
|
|
Injection jugular
|
$1,201.20 |
$1,201.20 |
$1,201.20 |
$790.00
|
|
Injection, necitumumab, 1 mg
|
$53.30 |
$53.30 |
$53.30 |
$8,572.91
|
|
Injection of sinus tract
|
$1,159.60 |
$1,159.60 |
$1,159.60 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$45.50 |
$45.50 |
$45.50 |
$2,277.65
|
|
Injection, peramivir
|
$48.75 |
$48.75 |
$48.75 |
$744.75
|
|
Injection, renflexis
|
$380.90 |
$380.90 |
$380.90 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$5,597.15 |
$5,597.15 |
$5,597.15 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,373.85 |
$4,373.85 |
$4,373.85 |
$2,040.36
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,463.85 |
$3,463.85 |
$3,463.85 |
$1,685.00
|
|
Injection, siltuximab
|
$683.15 |
$683.15 |
$683.15 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$856.70 |
$856.70 |
$856.70 |
$475.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$154.05 |
$154.05 |
$154.05 |
$145.60
|
|
Injection treatment of nerve
|
$3,280.55 |
$3,280.55 |
$3,280.55 |
$2,054.00
|
|
Inject sacroiliac joint
|
$4,093.05 |
$4,093.05 |
$4,093.05 |
$1,029.04
|
|
Inj, eculizumab-aagh, 2 mg
|
$130.65 |
$130.65 |
$130.65 |
$7,980.52
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$124.15 |
$124.15 |
$124.15 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$2,893.15 |
$2,893.15 |
$2,893.15 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$507.00 |
$507.00 |
$507.00 |
$54,322.53
|
|
Inj epidural sgl lumb-sacral without img
|
$2,198.30 |
$2,198.30 |
$2,198.30 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$13.00 |
$13.00 |
$13.00 |
$206.64
|
|
Inj., evomela, 1 mg
|
$150.80 |
$150.80 |
$150.80 |
$17.37
|
|
Inj fe-based mr contrast,1ml
|
$1.30 |
$1.30 |
$1.30 |
$56.56
|
|
Inj. fe derisomaltose 10 mg
|
$159.90 |
$159.90 |
$159.90 |
$3,221.52
|
|
Inj., fibryga, 1 mg
|
$11.70 |
$11.70 |
$11.70 |
$4.93
|
|
Inj for ext venography
|
$584.35 |
$584.35 |
$584.35 |
$628.80
|
|
Inj, fulvestrant (fresenius)
|
$363.35 |
$363.35 |
$363.35 |
$905.30
|
|
Inj, gadopiclenol, 1 ml
|
$50.70 |
$50.70 |
$50.70 |
$37.63
|
|
Inj gemcitabine hcl (accord)
|
$94.25 |
$94.25 |
$94.25 |
$131.21
|
|
Inj glofitamab gxbm, 2.5 mg
|
$11,300.90 |
$11,300.90 |
$11,300.90 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$620.75 |
$620.75 |
$620.75 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$393.90 |
$393.90 |
$393.90 |
$8,193.78
|
|
Inj, hercessi, 10 mg
|
$537.55 |
$537.55 |
$537.55 |
$6,033.42
|
|
Inj herzuma 10 mg
|
$472.55 |
$472.55 |
$472.55 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$544.05 |
$544.05 |
$544.05 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$171.60 |
$171.60 |
$171.60 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$189.80 |
$189.80 |
$189.80 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$206.05 |
$206.05 |
$206.05 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$206.05 |
$206.05 |
$206.05 |
$999.96
|
|
Inj human fibrinogen con nos
|
$7.80 |
$7.80 |
$7.80 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$6,913.40 |
$6,913.40 |
$6,913.40 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$686.40 |
$686.40 |
$686.40 |
$1,228.59
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$358.80 |
$358.80 |
$358.80 |
$3,542.09
|
|
Inj imip 4 cilas 4 releb 2mg
|
$2,445.30 |
$2,445.30 |
$2,445.30 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$3,723.85 |
$3,723.85 |
$3,723.85 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,901.25 |
$1,901.25 |
$1,901.25 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$246.35 |
$246.35 |
$246.35 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$268.45 |
$268.45 |
$268.45 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$414.05 |
$414.05 |
$414.05 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$349.05 |
$349.05 |
$349.05 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$9.10 |
$9.10 |
$9.10 |
$1,174.88
|
|
Inj levoleucovorin nos 0.5mg
|
$3.25 |
$3.25 |
$3.25 |
$110.40
|
|
Inj., lumoxiti, 0.01 mg
|
$209.30 |
$209.30 |
$209.30 |
$3,881.27
|
|
Inj melpha hydroch nos 50 mg
|
$3,636.75 |
$3,636.75 |
$3,636.75 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$127.40 |
$127.40 |
$127.40 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$16.90 |
$16.90 |
$16.90 |
$556.87
|
|
Inj, micafungin (par pharm)
|
$1,191.45 |
$1,191.45 |
$1,191.45 |
$79.08
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$289.90 |
$289.90 |
$289.90 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$876.85 |
$876.85 |
$876.85 |
$8,304.04
|
|
Inj, motixafortide, 0.25 mg
|
$225.55 |
$225.55 |
$225.55 |
$25.22
|
|
Inj, moxifloxacin 100 mg
|
$430.95 |
$430.95 |
$430.95 |
$101.31
|
|
Inj multihance
|
$5.20 |
$5.20 |
$5.20 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$577.85 |
$577.85 |
$577.85 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$2,263.30 |
$2,263.30 |
$2,263.30 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$4,278.95 |
$4,278.95 |
$4,278.95 |
$1,413.35
|
|
Inj nivolumab 2 mg hyaluron
|
$106.60 |
$106.60 |
$106.60 |
$15,599.68
|
|
Inj, nogapendekin pmln, 1mcg
|
$384.15 |
$384.15 |
$384.15 |
$94.12
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$11,835.85 |
$11,835.85 |
$11,835.85 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$11,835.85 |
$11,835.85 |
$11,835.85 |
$2,726.90
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$388.70 |
$388.70 |
$388.70 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$533.65 |
$533.65 |
$533.65 |
$4,492.28
|
|
Inj, olaratumab, 10 mg
|
$443.95 |
$443.95 |
$443.95 |
$4,127.04
|
|
Inj, omacetaxine mep, 0.01mg
|
$35.75 |
$35.75 |
$35.75 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$11.05 |
$11.05 |
$11.05 |
$865.34
|
|
Inj ontruzant 10 mg
|
$752.70 |
$752.70 |
$752.70 |
$6,706.27
|
|
Inj, pafolacianine, 0.1 mg
|
$440.70 |
$440.70 |
$440.70 |
$6,897.80
|
|
Inj, pasireotide long acting
|
$2,029.30 |
$2,029.30 |
$2,029.30 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$420.55 |
$420.55 |
$420.55 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,518.40 |
$1,518.40 |
$1,518.40 |
$6,614.40
|
|
Inj. pemetrexed, 10 mg
|
$395.85 |
$395.85 |
$395.85 |
$104.72
|
|
Inj pemetrexed (accord) 10mg
|
$80.60 |
$80.60 |
$80.60 |
$579.77
|
|
Inj, pemetrexed (avyxa) 10mg
|
$673.40 |
$673.40 |
$673.40 |
$112.10
|
