|
Inj calcitriol per 0.1 mcg
|
$22.25 |
$22.25 |
$22.25 |
$33.36
|
|
Inj cefazolin sodium, hikma
|
$21.90 |
$21.90 |
$21.90 |
$44.24
|
|
Inj cefazolin (wg crit care)
|
$18.05 |
$18.05 |
$18.05 |
$25.00
|
|
Inj ceftolozane tazobactam
|
$197.07 |
$197.07 |
$197.07 |
$431.36
|
|
Inj cntr knee arthro incl ct/mri
|
$297.19 |
$297.19 |
$297.19 |
$464.28
|
|
Inj crotalidae im f(ab')2 eq
|
$1,462.82 |
$1,462.82 |
$1,462.82 |
$2,735.85
|
|
Inj, cyclophosphamd, sandoz
|
$358.29 |
$358.29 |
$358.29 |
$423.66
|
|
Inj disk cerv-thor ea lev
|
$733.20 |
$733.20 |
$733.20 |
$869.80
|
|
Inj, donanemab-azbt, 2 mg
|
$883.06 |
$883.06 |
$883.06 |
$1,261.94
|
|
Inj dx for sinogram
|
$42.04 |
$42.04 |
$42.04 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$279.72 |
$279.72 |
$279.72 |
$507.10
|
|
Injection, cangrelor
|
$1,102.15 |
$1,102.15 |
$1,102.15 |
$2,048.01
|
|
Injection, daratumumab 10 mg
|
$5,536.46 |
$5,536.46 |
$5,536.46 |
$5,536.46
|
|
Injection during cath supravalvular aortography
|
$69.86 |
$69.86 |
$69.86 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$812.52 |
$812.52 |
$812.52 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$226.74 |
$226.74 |
$226.74 |
$441.12
|
|
Injection for bladder x-ray
|
$90.58 |
$90.58 |
$90.58 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$273.21 |
$273.21 |
$273.21 |
$504.00
|
|
Injection for ureter x-ray
|
$60.98 |
$60.98 |
$60.98 |
$444.95
|
|
Injection for ureter x-ray
|
$132.02 |
$132.02 |
$132.02 |
$515.21
|
|
Injection, fulvestrant
|
$2,156.88 |
$2,156.88 |
$2,156.88 |
$2,550.36
|
|
Injection, inclisiran, 1 mg
|
$4,177.84 |
$4,177.84 |
$4,177.84 |
$7,889.98
|
|
Injection into brain canal
|
$692.64 |
$692.64 |
$692.64 |
$970.61
|
|
Injection, isavuconazonium
|
$452.19 |
$452.19 |
$452.19 |
$832.85
|
|
Injection of sinus tract
|
$290.38 |
$290.38 |
$290.38 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$1,430.40 |
$1,430.40 |
$1,430.40 |
$2,085.72
|
|
Injection, peramivir
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$1,019.46
|
|
Injection radioactive tracer sentinel node (both sides)
|
$290.97 |
$290.97 |
$290.97 |
$717.20
|
|
Injection, renflexis
|
$1,019.85 |
$1,019.85 |
$1,019.85 |
$1,356.10
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$633.74 |
$633.74 |
$633.74 |
$1,441.04
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$750.36 |
$750.36 |
$750.36 |
$1,471.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$634.92 |
$634.92 |
$634.92 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$468.87 |
$468.87 |
$468.87 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$413.22 |
$413.22 |
$413.22 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$652.09 |
$652.09 |
$652.09 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$500.24 |
$500.24 |
$500.24 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,226.92 |
$1,226.92 |
$1,226.92 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$392.80 |
$392.80 |
$392.80 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$302.52 |
$302.52 |
$302.52 |
$472.76
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$94.43 |
$94.43 |
$94.43 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$45.00 |
$45.00 |
$45.00 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$147.41 |
$147.41 |
$147.41 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$91.47 |
$91.47 |
$91.47 |
$141.60
|
|
Inj for ext venography
|
$584.90 |
$584.90 |
$584.90 |
$737.55
|
|
Inj heparin, pfizer, 1000u
|
$20.54 |
$20.54 |
$20.54 |
$29.35
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$69.86 |
$69.86 |
$69.86 |
$1,482.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$64.83 |
$64.83 |
$64.83 |
$1,837.17
|
|
Inj hrt cath w/s&i sel left vent
|
$31.97 |
$31.97 |
$31.97 |
$1,214.40
|
|
Inj hrt cath w/s&i sel right vent
|
$39.67 |
$39.67 |
$39.67 |
$947.65
|
|
Inj imip 4 cilas 4 releb 2mg
|
$387.18 |
$387.18 |
$387.18 |
$840.28
|
|
Inj. inebilizumab-cdon, 1 mg
|
$97,531.31 |
$97,531.31 |
$97,531.31 |
$522.50
|
|
Inj intralesional <= 7 lsn(s)
|
$216.68 |
$216.68 |
$216.68 |
$241.74
|
|
Inj intralesional > 7 lsns
|
$216.68 |
$216.68 |
$216.68 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$7,624.60 |
$7,624.60 |
$7,624.60 |
$7,173.90
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,462.42 |
$1,462.42 |
$1,462.42 |
$1,292.93
|
|
Inj levocarnitine per 1 gm
|
$43.77 |
$43.77 |
$43.77 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$99.17 |
$99.17 |
$99.17 |
$331.00
|
|
Inj mepivacaine hcl/10 ml
|
$23.93 |
$23.93 |
$23.93 |
$31.28
|
|
Inj., meropenem, vaborbactam
|
$237.84 |
$237.84 |
$237.84 |
$586.20
|
|
Inj meropenem (wg crit care)
|
$19.35 |
$19.35 |
$19.35 |
$104.12
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$20,556.64 |
$20,556.64 |
$20,556.64 |
$39.54
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$535.76 |
$535.76 |
$535.76 |
$1,522.56
|
|
Inj, nithiodote, 3mg / 125mg
|
$228.00 |
$228.00 |
$228.00 |
$519.39
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,883.64 |
$2,883.64 |
$2,883.64 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,883.64 |
$2,883.64 |
$2,883.64 |
$2,164.64
|
|
Inj ogivri 10 mg
|
$3,330.34 |
$3,330.34 |
$3,330.34 |
$3,968.67
|
|
Inj pantoprazole(hikma) 40mg
|
$19.03 |
$19.03 |
$19.03 |
$36.04
|
|
Inj peritoneal venous shunt
|
$386.88 |
$386.88 |
$386.88 |
$386.88
|
|
Inj proc elbow arthro
|
$196.84 |
$196.84 |
$196.84 |
$453.60
|
|
Inj proc lumbr disk ea lvl
|
$999.89 |
$999.89 |
$999.89 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$259.60 |
$259.60 |
$259.60 |
$922.80
|
|
Inj retacrit esrd on dialysi
|
$427.89 |
$427.89 |
$427.89 |
$252.88
|
|
Inj retro urethrocysto
|
$355.50 |
$355.50 |
$355.50 |
$551.29
|
|
Inj scleros sol mult veins
|
$557.08 |
$557.08 |
$557.08 |
$687.96
|
|
Inj scleros sol sgl vein
|
$371.48 |
$371.48 |
$371.48 |
$534.40
|
|
Inj secretin synthetic human
|
$670.39 |
$670.39 |
$670.39 |
$1,091.50
|
|
Inj secukinumab intrav 1mg
|
$2,678.09 |
$2,678.09 |
$2,678.09 |
$8,235.53
|
|
Inj, spesolimab-sbzo, 1 mg
|
$55,701.08 |
$55,701.08 |
$55,701.08 |
$218,949.63
|
|
Inj teplizumab mzwv 5 mcg
|
$0.08 |
$0.08 |
$0.08 |
$36.90
|
|
Inj. teprotumumab-trbw 10 mg
|
$36,385.12 |
$36,385.12 |
$36,385.12 |
$43,022.95
|
|
Inj, tofidence, 1 mg
|
$4,837.26 |
$4,837.26 |
$4,837.26 |
$1,167.32
|
|
Inj w/fluor eval cv device
|
$412.04 |
$412.04 |
$412.04 |
$588.90
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$48,445.48 |
$48,445.48 |
$48,445.48 |
$18,932.40
|
|
Ins cath ren art 1st bi
|
$1,726.87 |
$1,726.87 |
$1,726.87 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$1,398.60 |
$1,398.60 |
$1,398.60 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$1,882.27 |
$1,882.27 |
$1,882.27 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$1,398.60 |
$1,398.60 |
$1,398.60 |
$5,528.94
|
|
Insert cath pleura with image
|
$1,384.99 |
$1,384.99 |
$1,384.99 |
$2,239.02
|
|
Insert cath pleura without image
|
$1,731.01 |
$1,731.01 |
$1,731.01 |
$2,212.00
|
|
Insert hepatic shunt (tips)
|
$3,233.51 |
$3,233.51 |
$3,233.51 |
$9,754.48
|
|
Insertion catheter bladder non indwelling
|
$131.43 |
$131.43 |
$131.43 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$74.60 |
$74.60 |
$74.60 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,402.82 |
$3,402.82 |
$3,402.82 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,447.63 |
$2,447.63 |
$2,447.63 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$1,671.22 |
$1,671.22 |
$1,671.22 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$868.17 |
$868.17 |
$868.17 |
$2,618.40
|
|
Insertion of catheter vein
|
$1,009.36 |
$1,009.36 |
$1,009.36 |
$1,749.80
|
|
Insertion of catheter vein
|
$627.82 |
$627.82 |
$627.82 |
$858.05
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$10,656.00 |
$10,656.00 |
$10,656.00 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$10,656.00 |
$10,656.00 |
$10,656.00 |
$12,813.28
|