|
Inj, bupivacaine liposome
|
$842.91 |
$842.91 |
$3,650.03 |
|
|
Inj calcitriol per 0.1 mcg
|
$40.17 |
$40.17 |
$67.23 |
|
|
Inj cefazolin sodium, baxter
|
$15.45 |
$50.82 |
$50.82 |
|
|
Inj cefazolin sodium, hikma
|
$7.71 |
$104.18 |
$104.18 |
|
|
Inj cefazolin (wg crit care)
|
$7.61 |
$7.61 |
$7.61 |
|
|
Inj, cefiderocol, 10 mg
|
$3.83 |
$953.96 |
$953.96 |
|
|
Inj ceftolozane tazobactam
|
$97.31 |
$248.93 |
$698.14 |
|
|
Inj, clevidipine butyrate
|
$437.20 |
$437.20 |
$437.20 |
|
|
Inj, clindamycin (baxter)
|
$30.64 |
$45.64 |
$52.42 |
|
|
Inj cntr knee arthro incl ct/mri
|
$474.00 |
$696.00 |
$1,276.20 |
|
|
Inj., copanlisib, 1 mg
|
$6,936.60 |
$13,160.00 |
$54,532.37 |
|
|
Inj crotalidae im f(ab')2 eq
|
$13,667.35 |
$13,667.35 |
$13,667.35 |
|
|
Inj cyclophosphamd auromedic
|
$8.92 |
$8.92 |
$8.92 |
|
|
Inj cyclophosphamd (ingenus)
|
$10.99 |
$742.72 |
$742.72 |
|
|
Inj. denosumab-bbdz, 1 mg
|
$238.88 |
$238.88 |
$238.88 |
|
|
Inj disk cerv-thor ea lev
|
$1,923.60 |
$1,923.60 |
$1,923.60 |
|
|
Inj, donanemab-azbt, 2 mg
|
$41.65 |
$41.65 |
$41.65 |
|
|
Inj, durolane 1 mg
|
$184.22 |
$2,526.95 |
$2,526.95 |
|
|
Inj dx for sinogram
|
$110.50 |
$669.50 |
$734.40 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,254.78 |
$1,254.78 |
$1,254.78 |
|
|
Injection arthrography hip without anesthesia (both sides)
|
$293.06 |
$763.20 |
$1,218.00 |
|
|
Injection, belinostat, 10mg
|
$6,030.58 |
$6,030.58 |
$6,030.58 |
|
|
Injection, burosumab-twza 1m
|
$590.52 |
$33,411.90 |
$33,411.90 |
|
|
Injection, cangrelor
|
$198.71 |
$198.71 |
$198.71 |
|
|
Injection, caplacizumab-yhdp
|
$1,156.01 |
$22,279.40 |
$22,279.40 |
|
|
Injection, daratumumab 10 mg
|
$6,251.15 |
$6,251.15 |
$30,530.69 |
|
|
Injection, doxercalciferol
|
$30.35 |
$45.89 |
$68.96 |
|
|
Injection during cath supravalvular aortography
|
$2,238.00 |
$2,796.00 |
$3,318.00 |
|
|
Injection, edaravone, 1 mg
|
$1,588.37 |
$1,588.37 |
$12,202.73 |
|
|
Injection epidural blood patch or clot
|
$1,537.20 |
$1,894.80 |
$2,435.00 |
|
|
Injection for arthrography wrist (both sides)
|
$110.50 |
$568.50 |
$787.80 |
|
|
Injection for bladder x-ray
|
$209.75 |
$528.50 |
$775.80 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$458.25 |
$756.60 |
$994.80 |
|
|
Injection for spleen x-ray
|
$1,550.40 |
$1,550.40 |
$1,550.40 |
|
|
Injection for tear sac x-ray
|
$622.80 |
$622.80 |
$622.80 |
|
|
Injection for ureter x-ray
|
$1,138.20 |
$2,236.80 |
$2,236.80 |
|
|
Injection for ureter x-ray
|
$441.50 |
$2,074.20 |
$2,074.20 |
|
|
Injection, fulvestrant
|
$202.44 |
$1,660.11 |
$4,115.67 |
|
|
Injection glatiramer acetate
|
$190.63 |
$190.63 |
$5,649.96 |
|
|
Injection, glucarpidase
|
$57,673.60 |
$57,673.60 |
$57,673.60 |
|
|
Injection, inclisiran, 1 mg
|
$126.26 |
$5,431.58 |
$6,343.82 |
|
|
Injection into brain canal
|
$836.40 |
$836.40 |
$3,140.46 |
|
|
Injection, isavuconazonium
|
$634.28 |
$1,636.26 |
$3,197.15 |
|
|
Injection jaw joint x-ray
|
$611.40 |
$611.40 |
$784.20 |
|
|
Injection jugular
|
$1,265.87 |
$1,607.40 |
$1,607.40 |
|
|
Injection, necitumumab, 1 mg
|
$8.12 |
$10,850.38 |
$45,140.55 |
|
|
Injection of sinus tract
|
$1,271.40 |
$1,271.40 |
$1,271.40 |
|
|
Injection,onabotulinumtoxina
|
$12.88 |
$1,290.32 |
$2,002.60 |
|
|
Injection, peramivir
|
$857.20 |
$1,457.97 |
$1,457.97 |
|
|
Injection px peyronie ds
|
$62.65 |
$62.65 |
$62.65 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$662.25 |
$739.00 |
$2,011.63 |
|
|
Injection, renflexis
|
$1,058.12 |
$1,058.12 |
$3,963.19 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$106.22 |
$238.00 |
$3,422.30 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,596.00 |
$4,596.00 |
$4,596.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$826.20 |
$3,252.60 |
$3,252.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,295.60 |
$8,260.80 |
$8,260.80 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$826.20 |
$2,124.60 |
$2,124.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,295.60 |
$5,310.00 |
$5,310.00 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,448.00 |
$2,942.40 |
$2,942.40 |
|
|
Injection, siltuximab
|
$48,713.66 |
$48,713.66 |
$48,713.66 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$534.60 |
$645.60 |
$2,850.77 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$34.30 |
$635.40 |
$1,405.87 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$39.72 |
$723.60 |
$1,507.37 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$102.50 |
$155.40 |
$342.42 |
|
|
Injection torsemide 10 mg/ml
|
$40.67 |
$40.94 |
$40.94 |
|
|
Inject sacroiliac joint
|
$2,218.80 |
$2,589.00 |
$5,196.00 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$23.68 |
$39,458.50 |
$39,458.50 |
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$181.35 |
$181.35 |
$181.35 |
|
|
Inj, epinephrine (belcher)
|
$286.41 |
$286.41 |
$286.41 |
|
|
Inj., eravacycline, 1 mg
|
$205.80 |
$348.93 |
$756.84 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$917.80 |
$917.80 |
$917.80 |
|
|
Inj, factor x, (human), 1iu
|
$12.54 |
$12.54 |
$12.54 |
|
|
Inj. fe derisomaltose 10 mg
|
$287.33 |
$5,851.60 |
$5,851.60 |
|
|
Inj., fibryga, 1 mg
|
$1,283.28 |
$1,283.28 |
$1,283.28 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$266.49 |
$492.90 |
$492.90 |
|
|
Inj for ext venography
|
$566.50 |
$1,202.40 |
$2,190.00 |
|
|
Inj for mammo ductogram
|
$606.60 |
$606.60 |
$610.80 |
|
|
Inj, gadopiclenol, 1 ml
|
$37.63 |
$134.64 |
$134.64 |
|
|
Inj gemcitabine hcl (accord)
|
$305.94 |
$305.94 |
$561.04 |
|
|
Inj givosiran 0.5 mg
|
$879.47 |
$57,955.00 |
$57,955.00 |
|
|
Inj glofitamab gxbm, 2.5 mg
|
$26,339.85 |
$26,339.85 |
$26,339.85 |
|
|
Inj glycopyrrolate, glyrx-pf
|
$38.14 |
$38.14 |
$38.14 |
|
|
Inj, granisetron, xr, 0.1 mg
|
$1,954.92 |
$1,954.92 |
$1,954.92 |
|
|
Inj., guselkumab, 1 mg
|
$757.42 |
$32,336.22 |
$32,336.22 |
|
|
Inj. herceptin hylecta, 10mg
|
$808.82 |
$11,861.38 |
$11,861.38 |
|
|
Inj herzuma 10 mg
|
$9,647.15 |
$9,647.15 |
$9,647.15 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,218.40 |
$3,358.80 |
$3,779.48 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,346.84 |
$3,209.40 |
$3,209.40 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$919.52 |
$4,933.80 |
$4,933.80 |
|
|
Inj hrt cath w/s&i sel left vent
|
$2,796.00 |
$2,796.00 |
$3,256.04 |
|
|
Inj hrt cath w/s&i sel right vent
|
$1,816.97 |
$2,898.60 |
$3,042.60 |
|
|
Inj human fibrinogen con nos
|
$3.16 |
$1,798.04 |
$1,798.04 |
|
|
Inj hydroxocobalamin IV 25mg
|
$1,593.19 |
$3,292.44 |
$8,530.28 |
|
|
Inj hydroxyprogst capoat nos
|
$1,293.56 |
$1,293.56 |
$8,335.14 |
|
|
Inj imip 4 cilas 4 releb 2mg
|
$3,160.31 |
$3,160.31 |
$3,160.31 |
|
|
Inj. inebilizumab-cdon, 1 mg
|
$4,905.98 |
$4,905.98 |
$4,905.98 |
|
|
Inj intralesional <= 7 lsn(s)
|
$22.75 |
$247.20 |
$520.80 |
|
|
Inj intralesional > 7 lsns
|
$520.80 |
$520.80 |
$520.80 |
|
|
Inj, invega hafyera/trinza
|
$24,696.58 |
$24,696.58 |
$69,524.92 |
|
|
Inj ivig privigen 500 mg
|
$3,563.50 |
$5,204.56 |
$49,757.57 |
|
