|
Inj, biorphen, 20 micrograms
|
$7.32 |
$7.32 |
$7.32 |
$17.12
|
|
Inj cefazolin sodium, hikma
|
$24.44 |
$24.44 |
$24.44 |
$27.38
|
|
Inj ceftolozane tazobactam
|
$19.70 |
$19.70 |
$19.70 |
$358.56
|
|
Inj, clindamycin (baxter)
|
$43.56 |
$43.56 |
$43.56 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$769.60 |
$769.60 |
$769.60 |
$441.88
|
|
Inj cyclophosphamd (ingenus)
|
$6.70 |
$6.70 |
$6.70 |
$742.72
|
|
Inj daptomycin (xellia)
|
$0.55 |
$0.55 |
$0.55 |
$56.04
|
|
Inj disk cerv-thor ea lev
|
$828.00 |
$828.00 |
$828.00 |
$875.28
|
|
Inj, donanemab-azbt, 2 mg
|
$6.56 |
$6.56 |
$6.56 |
$1,233.44
|
|
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
|
$344.68 |
$344.68 |
$344.68 |
$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)
|
$1,044.80 |
$1,044.80 |
$1,044.80 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$1,072.00 |
$1,072.00 |
$1,072.00 |
$504.00
|
|
Injection carpal tunnel therapeutic (both sides)
|
$385.60 |
$385.60 |
$385.60 |
$458.15
|
|
Injection during cath supravalvular aortography
|
$553.68 |
$553.68 |
$553.68 |
$1,028.00
|
|
Injection epidural blood patch or clot
|
$695.93 |
$695.93 |
$695.93 |
$1,192.80
|
|
Injection estrone per 1 mg
|
$0.80 |
$0.80 |
$0.80 |
$0.80
|
|
Injection eye drug
|
$616.09 |
$616.09 |
$616.09 |
$648.96
|
|
Injection, famotidine, 20 mg
|
$71.44 |
$71.44 |
$71.44 |
$24.14
|
|
Injection for arthrography wrist (both sides)
|
$910.40 |
$910.40 |
$910.40 |
$438.00
|
|
Injection for bladder x-ray
|
$625.64 |
$625.64 |
$625.64 |
$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)
|
$752.00 |
$752.00 |
$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 |
$576.00 |
$415.80
|
|
Injection for ureter x-ray
|
$410.28 |
$410.28 |
$410.28 |
$527.70
|
|
Injection, fosphenytoin sodi
|
$146.00 |
$146.00 |
$146.00 |
$165.20
|
|
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
|
$682.29 |
$682.29 |
$682.29 |
$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
|
$9.60 |
$9.60 |
$9.60 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$226.32 |
$226.32 |
$226.32 |
$321.94
|
|
Injection px peyronie ds
|
$275.20 |
$275.20 |
$275.20 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$408.00 |
$408.00 |
$408.00 |
$694.20
|
|
Injection, renflexis
|
$121.95 |
$121.95 |
$121.95 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,713.48 |
$2,713.48 |
$2,713.48 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,286.31 |
$1,286.31 |
$1,286.31 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$420.78 |
$420.78 |
$420.78 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,164.80 |
$1,164.80 |
$1,164.80 |
$2,071.80
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$475.20 |
$475.20 |
$475.20 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,415.32 |
$1,415.32 |
$1,415.32 |
$1,888.80
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,065.11 |
$1,065.11 |
$1,065.11 |
$1,048.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,845.22 |
$2,845.22 |
$2,845.22 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$637.60 |
$637.60 |
$637.60 |
$1,826.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$629.60 |
$629.60 |
$629.60 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$393.99 |
$393.99 |
$393.99 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$513.56 |
$513.56 |
$513.56 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$158.40 |
$158.40 |
$158.40 |
$638.95
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$115.72 |
$115.72 |
$115.72 |
$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 |
$406.40 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$461.96 |
$461.96 |
$461.96 |
$1,450.84
|
|
Inj, epinephrine (belcher)
|
$10.76 |
$10.76 |
$10.76 |
$6.55
|
|
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
|
$27.14 |
$27.14 |
$27.14 |
$37.63
|
|
Inj., guselkumab, 1 mg
|
$116.88 |
$116.88 |
$116.88 |
$29,130.83
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$771.14 |
$771.14 |
$771.14 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,509.56 |
$1,509.56 |
$1,509.56 |
$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
|
$771.14 |
$771.14 |
$771.14 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$771.14 |
$771.14 |
$771.14 |
$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)
|
$438.62 |
$438.62 |
$438.62 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$171.20 |
$171.20 |
$171.20 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$168.68 |
$168.68 |
$168.68 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$18.07 |
$18.07 |
$18.07 |
$41.79
|
|
Inj levocarnitine per 1 gm
|
$70.87 |
$70.87 |
$70.87 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$23.56 |
$23.56 |
$23.56 |
$320.80
|
|
Inj, lidocaine w epinephrine
|
$7.03 |
$7.03 |
$7.03 |
$45.14
|
|
Inj. lumasiran, 0.5 mg
|
$508.36 |
$508.36 |
$508.36 |
$96,930.47
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$422.40 |
$422.40 |
$422.40 |
$794.70
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$51.24 |
$51.24 |
$51.24 |
$1,496.55
|
|
Inj multihance
|
$14.16 |
$14.16 |
$14.16 |
$70.54
|
|
Inj naloxone hydrochloride
|
$96.40 |
$96.40 |
$96.40 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,267.20 |
$1,267.20 |
$1,267.20 |
$1,413.35
|
