|
Inj, abilify maintena, 1 mg
|
$8.00 |
$8.00 |
$8.00 |
$5,355.30
|
|
Inj acetaminophen -fresenius
|
$0.86 |
$0.86 |
$0.86 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$0.90 |
$0.90 |
$0.90 |
$56.70
|
|
Inj alymsys 10 mg
|
$113.68 |
$113.68 |
$113.68 |
$1,280.74
|
|
Inj andexxa, 10 mg
|
$201.60 |
$201.60 |
$201.60 |
$4,370.80
|
|
Inj., benralizumab, 1 mg
|
$199.20 |
$199.20 |
$199.20 |
$11,310.00
|
|
Inj cefazolin sodium, baxter
|
$38.72 |
$38.72 |
$38.72 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$14.01 |
$14.01 |
$14.01 |
$27.38
|
|
Inj cefazolin (wg crit care)
|
$31.32 |
$31.32 |
$31.32 |
$18.43
|
|
Inj ceftolozane tazobactam
|
$881.35 |
$881.35 |
$881.35 |
$358.56
|
|
Inj, clindamycin (baxter)
|
$81.36 |
$81.36 |
$81.36 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$769.60 |
$769.60 |
$769.60 |
$441.88
|
|
Inj daptomycin (xellia)
|
$0.20 |
$0.20 |
$0.20 |
$56.04
|
|
Inj disk cerv-thor ea lev
|
$828.00 |
$828.00 |
$828.00 |
$875.28
|
|
Inj dupuytren cord w/enzyme
|
$416.00 |
$416.00 |
$416.00 |
$416.00
|
|
Inj, durolane 1 mg
|
$16.00 |
$16.00 |
$16.00 |
$1,950.93
|
|
Inj dx for sinogram
|
$336.80 |
$336.80 |
$403.65 |
$447.50
|
|
Inject for sacroiliac joint
|
$1,323.20 |
$1,323.20 |
$1,323.20 |
$1,025.77
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,301.50 |
$1,301.50 |
$1,301.50 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$760.50 |
$760.50 |
$1,072.00 |
$504.00
|
|
Injection carpal tunnel therapeutic (both sides)
|
$385.60 |
$385.60 |
$385.60 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$116.59 |
$116.59 |
$116.59 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$488.15 |
$488.15 |
$551.05 |
$1,028.00
|
|
Injection epidural blood patch or clot
|
$1,153.03 |
$1,153.03 |
$1,591.85 |
$1,192.80
|
|
Injection estrone per 1 mg
|
$0.80 |
$0.80 |
$0.80 |
$0.80
|
|
Injection eye drug
|
$504.00 |
$504.00 |
$504.00 |
$648.96
|
|
Injection, famotidine, 20 mg
|
$71.44 |
$71.44 |
$71.44 |
$24.14
|
|
Injection for arthrography wrist (both sides)
|
$794.30 |
$794.30 |
$910.40 |
$438.00
|
|
Injection for bladder x-ray
|
$447.20 |
$447.20 |
$619.26 |
$460.00
|
|
Injection for hip x-ray
|
$1,432.00 |
$1,432.00 |
$1,432.00 |
$750.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$722.15 |
$722.15 |
$752.00 |
$503.30
|
|
Injection for spleen x-ray
|
$341.60 |
$341.60 |
$341.60 |
$595.50
|
|
Injection for tear sac x-ray
|
$392.00 |
$392.00 |
$392.00 |
$212.55
|
|
Injection for ureter x-ray
|
$576.00 |
$576.00 |
$622.05 |
$415.80
|
|
Injection for ureter x-ray
|
$589.99 |
$589.99 |
$589.99 |
$527.70
|
|
Injection, fulvestrant
|
$119.20 |
$119.20 |
$119.20 |
$1,719.16
|
|
Injection, inclisiran, 1 mg
|
$19.52 |
$19.52 |
$19.52 |
$6,679.35
|
|
Injection into brain canal
|
$261.60 |
$261.60 |
$261.60 |
$1,261.40
|
|
Injection into brain canal
|
$304.00 |
$304.00 |
$304.00 |
$844.50
|
|
Injection into hemorrhoid(s)
|
$731.20 |
$731.20 |
$731.20 |
$1,433.00
|
|
Injection into spinal artery
|
$2,231.20 |
$2,231.20 |
$2,231.20 |
$1,710.80
|
|
Injection into vocal cord
|
$323.20 |
$323.20 |
$323.20 |
$459.51
|
|
Injection jaw joint x-ray
|
$964.80 |
$964.80 |
$964.80 |
$340.00
|
|
Injection of HIV prep drug
|
$33.60 |
$33.60 |
$33.60 |
$78.84
|
|
Injection of sinus tract
|
$282.40 |
$282.40 |
$282.40 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$10.67 |
$10.67 |
$3,255.00 |
$2,277.65
|
|
Injection px peyronie ds
|
$275.20 |
$275.20 |
$275.20 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$796.58 |
$796.58 |
$1,662.05 |
$694.20
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$3,519.11 |
$3,519.11 |
$3,519.11 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,576.40 |
$2,576.40 |
$39,983.80 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$707.47 |
$707.47 |
$27,915.58 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,326.32 |
$3,326.32 |
$3,326.32 |
$2,071.80
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,001.46 |
$1,001.46 |
$1,001.46 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,623.98 |
$1,623.98 |
$1,623.98 |
$1,888.80
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,048.20 |
$1,048.20 |
$1,048.20 |
$1,048.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,423.58 |
$1,423.58 |
$1,423.58 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,210.32 |
$1,210.32 |
$1,210.32 |
$1,826.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,210.32 |
$1,210.32 |
$1,210.32 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$522.87 |
$522.87 |
$522.87 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$495.59 |
$495.59 |
$495.59 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$457.40 |
$457.40 |
$457.40 |
$638.95
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$82.47 |
$82.47 |
$15,828.86 |
$145.60
|
|
Injection torsemide 10 mg/ml
|
$4.00 |
$4.00 |
$4.00 |
$16.02
|
|
Injection treatment of eye
|
$955.20 |
$955.20 |
$955.20 |
$2,698.92
|
|
Injection treatment of eye
|
$852.80 |
$852.80 |
$852.80 |
$2,685.92
|
|
Injection treatment of nerve
|
$3,219.20 |
$3,219.20 |
$3,219.20 |
$3,219.20
|
|
Injection treatment of nerve
|
$3,731.20 |
$3,731.20 |
$3,731.20 |
$4,446.30
|
|
Injection treatment of nerve
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$2,050.30
|
|
Injection treatment of nose
|
$273.60 |
$273.60 |
$273.60 |
$859.59
|
|
Inject sacroiliac joint
|
$801.60 |
$801.60 |
$801.60 |
$1,029.04
|
|
Inject/treat eye socket
|
$366.40 |
$366.40 |
$366.40 |
$381.13
|
|
Inject/treat eye socket
|
$414.40 |
$414.40 |
$414.40 |
$750.70
|
|
Inject/treat eye socket
|
$342.40 |
$342.40 |
$342.40 |
$670.02
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$51.22 |
$51.22 |
$51.22 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$406.40 |
$406.40 |
$1,287.00 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,210.32 |
$1,210.32 |
$1,210.32 |
$1,450.84
|
|
Inj, epinephrine (belcher)
|
$8.76 |
$8.76 |
$8.76 |
$6.55
|
|
Inj fluphenazine hcl 1.25 mg
|
$21.95 |
$21.95 |
$21.95 |
$40.33
|
|
Inj follitropin beta 75 iu
|
$307.20 |
$307.20 |
$307.20 |
$207.20
|
|
Inj for ext venography
|
$1,444.80 |
$1,444.80 |
$1,444.80 |
$631.80
|
|
Inj for mammo ductogram
|
$833.60 |
$833.60 |
$833.60 |
$397.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$3.20 |
$3.20 |
$3.20 |
$1,322.20
|
|
Inj, gadopiclenol, 1 ml
|
$4.57 |
$4.57 |
$4.57 |
$37.63
|
|
Inj glycopyrrolate fres kabi
|
$36.80 |
$36.80 |
$36.80 |
$12.18
|
|
Inj. herceptin hylecta, 10mg
|
$125.84 |
$125.84 |
$125.84 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$288.00 |
$288.00 |
$288.00 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$127.20 |
$127.20 |
$127.20 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$132.00 |
$132.00 |
$132.00 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$98.40 |
$98.40 |
$98.40 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$313.60 |
$313.60 |
$313.60 |
$999.96
|
|
Inj hydroxyprogst capoat nos
|
$17.60 |
$17.60 |
$17.60 |
$1,228.59
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$757.60 |
$757.60 |
$757.60 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$136.00 |
$136.00 |
$136.00 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$171.20 |
$171.20 |
$171.20 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$69.60 |
$69.60 |
$69.60 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$39.13 |
$39.13 |
$39.13 |
$41.79
|
|
Inj, lanreotide, (cipla) 1mg
|
$89.84 |
$89.84 |
$89.84 |
$11,648.70
|
|
Inj levocarnitine per 1 gm
|
$101.24 |
$101.24 |
$178.80 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$1.38 |
$1.38 |
$1.38 |
$45.14
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$422.40 |
$422.40 |
$43,706.59 |
$794.70
|
