|
Injection, cangrelor
|
$678.39 |
$678.39 |
$678.39 |
$2,546.20
|
|
Injection carpal tunnel therapeutic (both sides)
|
$175.00 |
$175.00 |
$175.00 |
$536.00
|
|
Injection, daratumumab 10 mg
|
$250.67 |
$250.67 |
$250.67 |
$7,107.73
|
|
Injection, doxercalciferol
|
$23.83 |
$23.83 |
$23.83 |
$30.35
|
|
Injection during cath supravalvular aortography
|
$162.50 |
$162.50 |
$162.50 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$435.00 |
$435.00 |
$435.00 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$100.00 |
$100.00 |
$100.00 |
$441.12
|
|
Injection for bladder x-ray
|
$100.00 |
$100.00 |
$100.00 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$100.00 |
$100.00 |
$100.00 |
$504.00
|
|
Injection for ureter x-ray
|
$100.00 |
$100.00 |
$100.00 |
$444.95
|
|
Injection, fulvestrant
|
$321.42 |
$321.42 |
$321.42 |
$2,756.47
|
|
Injection glatiramer acetate
|
$135.23 |
$135.23 |
$135.23 |
$405.93
|
|
Injection, inclisiran, 1 mg
|
$1,727.33 |
$1,727.33 |
$1,727.33 |
$10,366.61
|
|
Injection, isavuconazonium
|
$219.25 |
$219.25 |
$219.25 |
$646.20
|
|
Injection, necitumumab, 1 mg
|
$215.84 |
$215.84 |
$215.84 |
$5.73
|
|
Injection,onabotulinumtoxina
|
$989.21 |
$989.21 |
$989.21 |
$2,154.07
|
|
Injection, peramivir
|
$38.82 |
$38.82 |
$38.82 |
$1,257.68
|
|
Injection, renflexis
|
$435.93 |
$435.93 |
$435.93 |
$1,457.42
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$435.00 |
$435.00 |
$435.00 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$435.00 |
$435.00 |
$435.00 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$435.00 |
$435.00 |
$435.00 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$446.25 |
$446.25 |
$446.25 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$200.00 |
$200.00 |
$200.00 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$446.25 |
$446.25 |
$446.25 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$200.00 |
$200.00 |
$200.00 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$446.25 |
$446.25 |
$446.25 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$615.00 |
$615.00 |
$615.00 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$615.00 |
$615.00 |
$615.00 |
$1,758.12
|
|
Injection, siltuximab
|
$4,551.21 |
$4,551.21 |
$4,551.21 |
$18,164.96
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$175.00 |
$175.00 |
$175.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$175.00 |
$175.00 |
$175.00 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$231.25 |
$231.25 |
$231.25 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$76.25 |
$76.25 |
$76.25 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$68.75 |
$68.75 |
$68.75 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$101.25 |
$101.25 |
$101.25 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$68.75 |
$68.75 |
$68.75 |
$141.60
|
|
Inject sacroiliac joint
|
$100.00 |
$100.00 |
$100.00 |
$1,090.00
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$2,135.96 |
$2,135.96 |
$2,135.96 |
$66,229.74
|
|
Inj., emapalumab-lzsg, 1 mg
|
$2,557.82 |
$2,557.82 |
$2,557.82 |
$381.64
|
|
Inj epidural sgl lumb-sacral without img
|
$446.25 |
$446.25 |
$446.25 |
$1,450.84
|
|
Inj., evomela, 1 mg
|
$1,475.98 |
$1,475.98 |
$1,475.98 |
$17.35
|
|
Inj. fe derisomaltose 10 mg
|
$207.71 |
$207.71 |
$207.71 |
$21.05
|
|
Inj., fibryga, 1 mg
|
$820.74 |
$820.74 |
$820.74 |
$1.11
|
|
Inj for ext venography
|
$100.00 |
$100.00 |
$100.00 |
$737.55
|
|
Inj, fulvestrant (fresenius)
|
$75.05 |
$75.05 |
$75.05 |
$1,713.99
|
|
Inj, fulvestrant (teva)
|
$57.40 |
$57.40 |
$57.40 |
$26.57
|
|
Inj glycopyrrolate fres kabi
|
$19.31 |
$19.31 |
$19.31 |
$96.70
|
|
Inj, granisetron, xr, 0.1 mg
|
$1,184.36 |
$1,184.36 |
$1,184.36 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$527.87 |
$527.87 |
$527.87 |
$74.86
|
|
Inj heparin, pfizer, 1000u
|
$13.31 |
$13.31 |
$13.31 |
$24.28
|
|
Inj. herceptin hylecta, 10mg
|
$924.71 |
$924.71 |
$924.71 |
$63.79
|
|
Inj herzuma 10 mg
|
$2,925.85 |
$2,925.85 |
$2,925.85 |
$60.44
|
|
Inj hrt cath w/s&i sel hrt ang
|
$162.50 |
$162.50 |
$162.50 |
$1,837.17
|
|
Inj hrt cath w/s&i sel left vent
|
$162.50 |
$162.50 |
$162.50 |
$1,214.40
|
|
Inj hydroxocobalamin IV 25mg
|
$701.60 |
$701.60 |
$701.60 |
$3,180.35
|
|
Inj imip 4 cilas 4 releb 2mg
|
$131.93 |
$131.93 |
$131.93 |
$1,004.42
|
|
Inj, immphentiv, 20 mcg
|
$10.43 |
$10.43 |
$10.43 |
$32.83
|
|
Inj, invega hafyera/trinza
|
$2,947.77 |
$2,947.77 |
$2,947.77 |
$12.66
|
|
Inj ivig privigen 500 mg
|
$56.29 |
$56.29 |
$56.29 |
$7,298.71
|
|
Inj, kovaltry, 1 i.u
|
$226.40 |
$226.40 |
$226.40 |
$1.48
|
|
Inj, lanreotide, (cipla) 1mg
|
$8,532.66 |
$8,532.66 |
$8,532.66 |
$12,160.05
|
|
Inj, lecanemab-irmb, 1 mg
|
$99.29 |
$99.29 |
$99.29 |
$1,729.21
|
|
Inj levocarnitine per 1 gm
|
$26.77 |
$26.77 |
$26.77 |
$138.96
|
|
Inj, levothyroxine, freskabi
|
$468.29 |
$468.29 |
$468.29 |
$302.07
|
|
Inj, levothyroxine, hikma
|
$123.22 |
$123.22 |
$123.22 |
$5.14
|
|
Inj melpha hydroch nos 50 mg
|
$2,375.23 |
$2,375.23 |
$2,375.23 |
$1,518.68
|
|
Inj mepivacaine hcl/10 ml
|
$7.55 |
$7.55 |
$7.55 |
$28.41
|
|
Inj., meropenem, vaborbactam
|
$108.12 |
$108.12 |
$108.12 |
$618.43
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$788.73 |
$788.73 |
$788.73 |
$788.73
|
|
Inj, moxifloxacin 100 mg
|
$3.65 |
$3.65 |
$3.65 |
$190.81
|
|
Inj multihance
|
$9.39 |
$9.39 |
$9.39 |
$119.25
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$400.00 |
$400.00 |
$400.00 |
$1,522.56
|
|
Inj, nithiodote, 3mg / 125mg
|
$27.97 |
$27.97 |
$27.97 |
$389.50
|
|
Inj ogivri 10 mg
|
$1,800.40 |
$1,800.40 |
$1,800.40 |
$3,968.67
|
|
Inj., omadacycline, 1 mg
|
$333.79 |
$333.79 |
$333.79 |
$3.80
|
|
Inj ontruzant 10 mg
|
$1,563.84 |
$1,563.84 |
$1,563.84 |
$34.17
|
|
Inj., patisiran, 0.1 mg
|
$1,120.54 |
$1,120.54 |
$1,120.54 |
$11,742.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$2,394.47 |
$2,394.47 |
$2,394.47 |
$6,403.59
|
|
Inj pemetrexed (accord) 10mg
|
$416.04 |
$416.04 |
$416.04 |
$9.74
|
|
Inj pemetrexed, hospira 10mg
|
$47.53 |
$47.53 |
$47.53 |
$0.62
|
|
Inj plasminogen tvmh 1mg
|
$1,292.93 |
$1,292.93 |
$1,292.93 |
$32.55
|
|
Inj progesterone per 50 mg
|
$18.77 |
$18.77 |
$18.77 |
$48.51
|
|
Inj, releuko 1 mcg
|
$202.57 |
$202.57 |
$202.57 |
$557.11
|
|
Inj, rimabotulinumtoxinb
|
$479.10 |
$479.10 |
$479.10 |
$16.56
|
|
Inj scleros sol mult veins
|
$300.00 |
$300.00 |
$300.00 |
$687.96
|
|
Inj scleros sol sgl vein
|
$187.50 |
$187.50 |
$187.50 |
$534.40
|
|
Inj secretin synthetic human
|
$493.41 |
$493.41 |
$493.41 |
$741.75
|
|
Inj, sezaby, 1 mg
|
$13.46 |
$13.46 |
$13.46 |
$1.41
|
|
Inj, spesolimab-sbzo, 1 mg
|
$2,636.14 |
$2,636.14 |
$2,636.14 |
$253,022.14
|
|
Inj sulf hexa lipid microsph
|
$315.78 |
$315.78 |
$315.78 |
$315.78
|
|
Inj, sutimlimab-jome, 10 mg
|
$195.26 |
$195.26 |
$195.26 |
$18.13
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$24,871.24 |
$24,871.24 |
$24,871.24 |
$92,981.70
|
|
Inj, taliglucerace alfa 10 u
|
$612.45 |
$612.45 |
$612.45 |
$42.58
|
|
Inj teclistamab cqyv 0.5 mg
|
$3,436.01 |
$3,436.01 |
$3,436.01 |
$14,653.61
|
|
Inj tedizolid phosphate
|
$246.90 |
$246.90 |
$246.90 |
$1,001.48
|
|
Inj. teprotumumab-trbw 10 mg
|
$12,409.71 |
$12,409.71 |
$12,409.71 |
$47,971.67
|
|
Inj testosterone cypionate
|
$43.92 |
$43.92 |
$43.92 |
$77.15
|
|
Inj., tildrakizumab, 1 mg
|
$10,143.64 |
$10,143.64 |
$10,143.64 |
$24,563.40
|
|
Inj, tislelizumab-jsgr
|
$723.94 |
$723.94 |
$723.94 |
$45,250.97
|
|
Inj, tofidence, 1 mg
|
$86.87 |
$86.87 |
$86.87 |
$5.72
|
