|
Inj., benralizumab, 1 mg
|
$27,634.95 |
$27,634.95 |
$27,634.95 |
$11,239.97
|
|
Inj, bezlotoxumab, 10 mg
|
$18,159.75 |
$18,159.75 |
$18,159.75 |
$7,612.43
|
|
Inj calcitriol per 0.1 mcg
|
$28.70 |
$28.70 |
$28.70 |
$23.28
|
|
Inj cefazolin sodium, baxter
|
$44.45 |
$44.45 |
$44.45 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$21.17 |
$21.17 |
$21.17 |
$28.08
|
|
Inj ceftolozane tazobactam
|
$763.70 |
$763.70 |
$763.70 |
$380.80
|
|
Inj, clindamycin (baxter)
|
$24.15 |
$24.15 |
$24.15 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$459.90 |
$459.90 |
$459.90 |
$436.80
|
|
Inj cyclophosphamd auromedic
|
$1,226.40 |
$1,226.40 |
$1,226.40 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$2,309.65 |
$2,309.65 |
$2,309.65 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$155.57 |
$155.57 |
$155.57 |
$113.35
|
|
Inj. denosumab-bbdz, 1 mg
|
$14,499.27 |
$14,499.27 |
$14,499.27 |
$4,615.43
|
|
Inj, donanemab-azbt, 2 mg
|
$3,329.20 |
$3,329.20 |
$3,329.20 |
$1,233.44
|
|
Inj dx for sinogram
|
$730.80 |
$730.80 |
$730.80 |
$422.59
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,617.70 |
$1,617.70 |
$1,617.70 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$745.50 |
$745.50 |
$745.50 |
$495.84
|
|
Injection, cangrelor
|
$4,375.87 |
$4,375.87 |
$4,375.87 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$423.50 |
$423.50 |
$423.50 |
$450.72
|
|
Injection, daratumumab 10 mg
|
$14,663.25 |
$14,663.25 |
$14,663.25 |
$5,239.24
|
|
Injection during cath supravalvular aortography
|
$2,097.90 |
$2,097.90 |
$2,097.90 |
$952.66
|
|
Injection epidural blood patch or clot
|
$5,457.20 |
$5,457.20 |
$5,457.20 |
$1,156.80
|
|
Injection eye drug
|
$3,068.80 |
$3,068.80 |
$3,068.80 |
$644.50
|
|
Injection for arthrography wrist (both sides)
|
$610.40 |
$610.40 |
$610.40 |
$428.40
|
|
Injection for bladder x-ray
|
$1,939.70 |
$1,939.70 |
$1,939.70 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$677.60 |
$677.60 |
$677.60 |
$494.65
|
|
Injection for spleen x-ray
|
$2,619.40 |
$2,619.40 |
$2,619.40 |
$529.57
|
|
Injection for ureter x-ray
|
$1,450.40 |
$1,450.40 |
$1,450.40 |
$427.70
|
|
Injection for ureter x-ray
|
$1,509.20 |
$1,509.20 |
$1,509.20 |
$515.21
|
|
Injection, fulvestrant
|
$8,942.15 |
$8,942.15 |
$8,942.15 |
$1,817.65
|
|
Injection, glucarpidase
|
$204,331.56 |
$204,331.56 |
$204,331.56 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$16,956.80 |
$16,956.80 |
$16,956.80 |
$6,679.35
|
|
Injection into brain canal
|
$1,261.40 |
$1,261.40 |
$1,261.40 |
$1,289.60
|
|
Injection jugular
|
$4,524.10 |
$4,524.10 |
$4,524.10 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$3,111.15 |
$3,111.15 |
$3,111.15 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$3,868.90 |
$3,868.90 |
$3,868.90 |
$670.64
|
|
Injection, renflexis
|
$3,231.20 |
$3,231.20 |
$3,231.20 |
$1,341.52
|
|
Injection, ruconest
|
$38,164.87 |
$38,164.87 |
$38,164.87 |
$14,111.44
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,939.30 |
$2,939.30 |
$2,939.30 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$60,378.84 |
$60,378.84 |
$60,378.84 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$52,052.98 |
$52,052.98 |
$52,052.98 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,570.22 |
$2,570.22 |
$2,570.22 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$4,564.87 |
$4,564.87 |
$4,564.87 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$4,562.25 |
$4,562.25 |
$4,562.25 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$6,232.80 |
$6,232.80 |
$6,232.80 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$6,232.80 |
$6,232.80 |
$6,232.80 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,272.20 |
$2,272.20 |
$2,272.20 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,339.05 |
$2,339.05 |
$2,339.05 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$835.10 |
$835.10 |
$835.10 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$726.60 |
$726.60 |
$726.60 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$763.00 |
$763.00 |
$763.00 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$301.70 |
$301.70 |
$301.70 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$301.70 |
$301.70 |
$301.70 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$301.70 |
$301.70 |
$301.70 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$148.40 |
$148.40 |
$148.40 |
$135.60
|
|
Injection treatment of eye
|
$4,273.50 |
$4,273.50 |
$4,273.50 |
$2,665.60
|
|
Injection treatment of nerve
|
$4,208.40 |
$4,208.40 |
$4,208.40 |
$4,350.00
|
|
Inject sacroiliac joint
|
$1,448.30 |
$1,448.30 |
$1,448.30 |
$1,028.95
|
|
Inj, eculizumab-aagh, 2 mg
|
$21,580.30 |
$21,580.30 |
$21,580.30 |
$7,980.52
|
|
Inj, eculizumab-aeeb, 2 mg
|
$27,746.77 |
$27,746.77 |
$27,746.77 |
$610.56
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$78,422.05 |
$78,422.05 |
$78,422.05 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$2,876.30 |
$2,876.30 |
$2,876.30 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$47,582.70 |
$47,582.70 |
$47,582.70 |
$1,415.50
|
|
Inj, factor x, (human), 1iu
|
$7,726.25 |
$7,726.25 |
$7,726.25 |
$26.74
|
|
Inj., fibryga, 1 mg
|
$4,368.00 |
$4,368.00 |
$4,368.00 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$417.90 |
$417.90 |
$417.90 |
$39.54
|
|
Inj for ext venography
|
$6,848.80 |
$6,848.80 |
$6,848.80 |
$649.95
|
|
Inj, fulvestrant (fresenius)
|
$4,379.37 |
$4,379.37 |
$4,379.37 |
$1,043.05
|
|
Inj., guselkumab, 1 mg
|
$68,810.87 |
$68,810.87 |
$68,810.87 |
$29,130.83
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,875.20 |
$3,875.20 |
$3,875.20 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,314.50 |
$3,314.50 |
$3,314.50 |
$1,827.74
|
|
Inj hrt cath w/s&i sel left vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$965.33
|
|
Inj hydroxocobalamin IV 25mg
|
$4,589.72 |
$4,589.72 |
$4,589.72 |
$2,452.32
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,384.60 |
$1,384.60 |
$1,384.60 |
$739.77
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$5,803.00 |
$5,803.00 |
$5,803.00 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$371.00 |
$371.00 |
$371.00 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$13,512.97 |
$13,512.97 |
$13,512.97 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$22,240.92 |
$22,240.92 |
$22,240.92 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$16.10 |
$16.10 |
$16.10 |
$38.94
|
|
Inj, lecanemab-irmb, 1 mg
|
$3,117.62 |
$3,117.62 |
$3,117.62 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$156.27 |
$156.27 |
$156.27 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$808.67 |
$808.67 |
$808.67 |
$109.92
|
|
Inj, levothyroxine, freskabi
|
$78.22 |
$78.22 |
$78.22 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$42.17 |
$42.17 |
$42.17 |
$47.52
|
|
Inj mepivacaine hcl/10 ml
|
$29.92 |
$29.92 |
$29.92 |
$33.86
|
|
Inj meropenem (wg crit care)
|
$119.17 |
$119.17 |
$119.17 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$105.17 |
$105.17 |
$105.17 |
$89.40
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$45,340.40 |
$45,340.40 |
$45,340.40 |
$1,496.55
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$13,195.41 |
$13,195.41 |
$13,195.41 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$941.50 |
$941.50 |
$941.50 |
$462.04
|
|
Inj nivolumab 2 mg hyaluron
|
$37,769.02 |
$37,769.02 |
$37,769.02 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,686.90 |
$3,686.90 |
$3,686.90 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$195,110.12 |
$195,110.12 |
$195,110.12 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$8,181.07 |
$8,181.07 |
$8,181.07 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$12.42 |
$12.42 |
$12.42 |
$34.67
|
|
Inj peritoneal venous shunt
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$413.70
|
|
Inj proc ankle arthr
|
$128.80 |
$128.80 |
$128.80 |
$405.31
|
|
Inj proc elbow arthro
|
$273.70 |
$273.70 |
$273.70 |
$419.60
|
|
Inj proc for lymphang
|
$4,806.90 |
$4,806.90 |
$4,806.90 |
$682.00
|
|
Inj proc sialogram
|
$1,299.20 |
$1,299.20 |
$1,299.20 |
$373.00
|
