|
Infliximab-axxq 100 mg intravenous solution
|
$1,193.90 |
$1,193.90 |
$1,193.90 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,259.53 |
$2,259.53 |
$2,259.53 |
$1,537.84
|
|
Inf lwr xtr fscl pln blk uni w/wo image
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$762.00
|
|
Inf thrc fascial pln blk bi w/wo image
|
$1,241.30 |
$1,241.30 |
$1,241.30 |
$523.25
|
|
Inf thrc fascial pln blk uni w/wo image
|
$1,241.30 |
$1,241.30 |
$1,241.30 |
$770.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$576.65 |
$576.65 |
$576.65 |
$296.00
|
|
Initial nursing facility care/day 35 minutes
|
$298.25 |
$298.25 |
$298.25 |
$188.50
|
|
Initial nursing facility care/day 45 minutes
|
$381.95 |
$381.95 |
$381.95 |
$236.80
|
|
Initial nursing facility care/day low severity 99304
|
$207.90 |
$207.90 |
$207.90 |
$128.00
|
|
Inj, abilify maintena, 1 mg
|
$6,935.22 |
$6,935.22 |
$6,935.22 |
$5,355.30
|
|
Inj acetaminophen -fresenius
|
$111.39 |
$111.39 |
$111.39 |
$36.60
|
|
Inj., benralizumab, 1 mg
|
$13,961.59 |
$13,961.59 |
$13,961.59 |
$11,310.00
|
|
Inj, bupivacaine liposome
|
$1,762.02 |
$1,762.02 |
$1,762.02 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$101.82 |
$101.82 |
$101.82 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$291.33 |
$291.33 |
$291.33 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$82.38 |
$82.38 |
$82.38 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$1,189.15 |
$1,189.15 |
$1,189.15 |
$436.80
|
|
Inj, cyclophosphamd, sandoz
|
$1,338.03 |
$1,338.03 |
$1,338.03 |
$735.20
|
|
Inj, decitabine (sun pharma)
|
$975.98 |
$975.98 |
$975.98 |
$310.09
|
|
Inj disk cerv-thor ea lev
|
$869.80 |
$869.80 |
$869.80 |
$875.28
|
|
Inj dx for sinogram
|
$943.45 |
$943.45 |
$943.45 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,998.85 |
$1,998.85 |
$1,998.85 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$1,189.15 |
$1,189.15 |
$1,189.15 |
$503.50
|
|
Injection, daratumumab 10 mg
|
$1,852.05 |
$1,852.05 |
$1,852.05 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$264.30 |
$264.30 |
$264.30 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,947.60 |
$1,947.60 |
$1,947.60 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$1,189.15 |
$1,189.15 |
$1,189.15 |
$436.00
|
|
Injection for bladder x-ray
|
$462.90 |
$462.90 |
$462.90 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$1,189.15 |
$1,189.15 |
$1,189.15 |
$497.76
|
|
Injection for ureter x-ray
|
$943.45 |
$943.45 |
$943.45 |
$415.80
|
|
Injection for ureter x-ray
|
$527.70 |
$527.70 |
$527.70 |
$515.21
|
|
Injection, fulvestrant
|
$1,585.97 |
$1,585.97 |
$1,585.97 |
$1,719.16
|
|
Injection glatiramer acetate
|
$487.99 |
$487.99 |
$487.99 |
$830.51
|
|
Injection into brain canal
|
$1,765.25 |
$1,765.25 |
$1,765.25 |
$844.50
|
|
Injection,onabotulinumtoxina
|
$1,542.52 |
$1,542.52 |
$1,542.52 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$1,628.81 |
$1,628.81 |
$1,628.81 |
$383.03
|
|
Injection radioactive tracer sentinel node (both sides)
|
$218.40 |
$218.40 |
$218.40 |
$685.44
|
|
Injection, renflexis
|
$1,798.95 |
$1,798.95 |
$1,798.95 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,990.35 |
$1,990.35 |
$1,990.35 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,603.45 |
$2,603.45 |
$2,603.45 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$2,450.80 |
$2,450.80 |
$2,450.80 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,369.65 |
$3,369.65 |
$3,369.65 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$943.45 |
$943.45 |
$943.45 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,257.30 |
$2,257.30 |
$2,257.30 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$791.95 |
$791.95 |
$791.95 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,160.35 |
$1,160.35 |
$1,160.35 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$821.70 |
$821.70 |
$821.70 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$134.25 |
$134.25 |
$134.25 |
$145.60
|
|
Inject sacroiliac joint
|
$2,037.90 |
$2,037.90 |
$2,037.90 |
$1,029.04
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$38,416.02 |
$38,416.02 |
$38,416.02 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$1,950.85 |
$1,950.85 |
$1,950.85 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,950.85 |
$1,950.85 |
$1,950.85 |
$1,450.84
|
|
Inj. fe derisomaltose 10 mg
|
$8,385.26 |
$8,385.26 |
$8,385.26 |
$3,221.52
|
|
Inj for ext venography
|
$458.10 |
$458.10 |
$458.10 |
$628.80
|
|
Inj for mammo ductogram
|
$592.40 |
$592.40 |
$592.40 |
$397.80
|
|
Inj herzuma 10 mg
|
$9,376.89 |
$9,376.89 |
$9,376.89 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,909.00 |
$2,909.00 |
$2,909.00 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,628.25 |
$3,628.25 |
$3,628.25 |
$1,818.15
|
|
Inj hydroxocobalamin IV 25mg
|
$2,383.03 |
$2,383.03 |
$2,383.03 |
$2,452.32
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,927.65 |
$1,927.65 |
$1,927.65 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$353.60 |
$353.60 |
$353.60 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$51,134.50 |
$51,134.50 |
$51,134.50 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$17,983.00 |
$17,983.00 |
$17,983.00 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$379.41 |
$379.41 |
$379.41 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$1,757.86 |
$1,757.86 |
$1,757.86 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$118.00 |
$118.00 |
$118.00 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,826.80 |
$1,826.80 |
$1,826.80 |
$794.70
|
|
Inj mepivacaine hcl/10 ml
|
$175.44 |
$175.44 |
$175.44 |
$34.34
|
|
Inj, meropenem (b. braun)
|
$291.92 |
$291.92 |
$291.92 |
$71.14
|
|
Inj. mycophenolate mofetil
|
$1,053.84 |
$1,053.84 |
$1,053.84 |
$252.66
|
|
Inj naloxone hydrochloride
|
$322.07 |
$322.07 |
$322.07 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,726.75 |
$1,726.75 |
$1,726.75 |
$1,413.35
|
|
Inj ontruzant 10 mg
|
$8,856.45 |
$8,856.45 |
$8,856.45 |
$6,706.27
|
|
Inj, pemivibart, 4500 mg
|
$1,684.73 |
$1,684.73 |
$1,684.73 |
$1,235.55
|
|
Inj proc ankle arthr
|
$723.50 |
$723.50 |
$723.50 |
$405.31
|
|
Inj proc elbow arthro
|
$674.85 |
$674.85 |
$674.85 |
$432.00
|
|
Inj proc for lymphang
|
$281.60 |
$281.60 |
$281.60 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$912.00 |
$912.00 |
$912.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$3,364.80 |
$3,364.80 |
$3,364.80 |
$838.30
|
|
Inj proc sialogram
|
$259.10 |
$259.10 |
$259.10 |
$373.00
|
|
Inj retro urethrocysto
|
$943.45 |
$943.45 |
$943.45 |
$447.74
|
|
Inj scleros sol mult veins
|
$357.85 |
$357.85 |
$357.85 |
$692.90
|
|
Inj scleros sol sgl vein
|
$357.85 |
$357.85 |
$357.85 |
$561.88
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,241.30 |
$1,241.30 |
$1,241.30 |
$1,049.50
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,241.30 |
$1,241.30 |
$1,241.30 |
$818.00
|
|
Inj, vancomycin hcl (mylan)
|
$279.86 |
$279.86 |
$279.86 |
$72.33
|
|
Inj vocal cord bulking agent
|
$735.00 |
$735.00 |
$735.00 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$898.90 |
$898.90 |
$898.90 |
$504.40
|
|
Ins cath ren art 1st bi
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$9,572.35 |
$9,572.35 |
$9,572.35 |
$5,395.20
|
|
Insert cath pleura with image
|
$4,177.90 |
$4,177.90 |
$4,177.90 |
$2,194.40
|
|
Insert cath pleura without image
|
$3,050.30 |
$3,050.30 |
$3,050.30 |
$2,099.70
|
|
Insert intrauterine device iud
|
$925.90 |
$925.90 |
$925.90 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$144.40 |
$144.40 |
$144.40 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,911.15 |
$1,911.15 |
$1,911.15 |
$4,897.20
|