|
Inj anifrolumab-fnia 1mg
|
$7,363.28 |
$7,363.28 |
$7,363.28 |
$10,052.58
|
|
Inj, artesunate, 1mg
|
$7,508.47 |
$7,508.47 |
$7,508.47 |
$14,460.21
|
|
Inj, aspara, rylaze, 0.1 mg
|
$6,953.76 |
$6,953.76 |
$6,953.76 |
$10,458.00
|
|
Inj., benralizumab, 1 mg
|
$7,077.30 |
$7,077.30 |
$7,077.30 |
$11,310.00
|
|
Inj beta interferon sq 1 mcg
|
$1,529.84 |
$1,529.84 |
$1,529.84 |
$2,397.11
|
|
Inj, bortezomib, dr. reddy's
|
$2,511.36 |
$2,511.36 |
$2,511.36 |
$48.55
|
|
Inj, bortezomib, hospira
|
$183.83 |
$183.83 |
$183.83 |
$175.35
|
|
Inj, bupivacaine liposome
|
$390.03 |
$390.03 |
$390.03 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$27.74 |
$27.74 |
$27.74 |
$22.69
|
|
Inj cefazolin sodium, hikma
|
$30.01 |
$30.01 |
$30.01 |
$27.38
|
|
Inj cefazolin (wg crit care)
|
$29.77 |
$29.77 |
$29.77 |
$18.43
|
|
Inj, cefiderocol, 10 mg
|
$402.33 |
$402.33 |
$402.33 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$324.46 |
$324.46 |
$324.46 |
$364.86
|
|
Inj, clindamycin (baxter)
|
$66.53 |
$66.53 |
$66.53 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$370.99 |
$370.99 |
$370.99 |
$436.80
|
|
Inj, cyclophosphamd, sandoz
|
$171.15 |
$171.15 |
$171.15 |
$735.20
|
|
Inj. denosumab-bbdz, 1 mg
|
$4,615.43 |
$4,615.43 |
$4,615.43 |
$4,615.43
|
|
Inj disk cerv-thor ea lev
|
$487.58 |
$487.58 |
$487.58 |
$875.28
|
|
Inj dx for sinogram
|
$422.59 |
$422.59 |
$422.59 |
$436.00
|
|
Inject for sacroiliac joint
|
$340.18 |
$340.18 |
$340.18 |
$1,025.77
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$647.09 |
$647.09 |
$647.09 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$370.99 |
$370.99 |
$370.99 |
$503.50
|
|
Injection, cangrelor
|
$1,522.98 |
$1,522.98 |
$1,522.98 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$11,556.86 |
$11,556.86 |
$11,556.86 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,583.86 |
$1,583.86 |
$1,583.86 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$4,447.64 |
$4,447.64 |
$4,447.64 |
$5,324.34
|
|
Injection, doxercalciferol
|
$42.37 |
$42.37 |
$42.37 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$1,028.88 |
$1,028.88 |
$1,028.88 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$922.22 |
$922.22 |
$922.22 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$491.71 |
$491.71 |
$491.71 |
$436.00
|
|
Injection for bladder x-ray
|
$919.97 |
$919.97 |
$919.97 |
$459.20
|
|
Injection for hip x-ray
|
$370.99 |
$370.99 |
$370.99 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$370.99 |
$370.99 |
$370.99 |
$497.76
|
|
Injection for spleen x-ray
|
$952.99 |
$952.99 |
$952.99 |
$686.40
|
|
Injection for tear sac x-ray
|
$159.26 |
$159.26 |
$159.26 |
$225.20
|
|
Injection for ureter x-ray
|
$657.65 |
$657.65 |
$657.65 |
$415.80
|
|
Injection for ureter x-ray
|
$389.28 |
$389.28 |
$389.28 |
$515.21
|
|
Injection, fulvestrant
|
$3,017.73 |
$3,017.73 |
$3,017.73 |
$1,719.16
|
|
Injection glatiramer acetate
|
$918.42 |
$918.42 |
$918.42 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$5,471.96 |
$5,471.96 |
$5,471.96 |
$6,679.35
|
|
Injection into brain canal
|
$469.78 |
$469.78 |
$469.78 |
$844.50
|
|
Injection, isavuconazonium
|
$683.43 |
$683.43 |
$683.43 |
$787.67
|
|
Injection jaw joint x-ray
|
$441.02 |
$441.02 |
$441.02 |
$307.80
|
|
Injection of sinus tract
|
$459.55 |
$459.55 |
$459.55 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$2,146.46 |
$2,146.46 |
$2,146.46 |
$2,277.65
|
|
Injection radioactive tracer sentinel node (both sides)
|
$328.94 |
$328.94 |
$328.94 |
$685.44
|
|
Injection, renflexis
|
$784.79 |
$784.79 |
$784.79 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,486.85 |
$1,486.85 |
$1,486.85 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,313.42 |
$1,313.42 |
$1,313.42 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,313.42 |
$1,313.42 |
$1,313.42 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,939.97 |
$1,939.97 |
$1,939.97 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$884.21 |
$884.21 |
$884.21 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,939.97 |
$1,939.97 |
$1,939.97 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$984.48 |
$984.48 |
$984.48 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,921.20 |
$1,921.20 |
$1,921.20 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,269.79 |
$1,269.79 |
$1,269.79 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,126.22 |
$1,126.22 |
$1,126.22 |
$1,685.00
|
|
Injection, siltuximab
|
$8,443.92 |
$8,443.92 |
$8,443.92 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$948.82 |
$948.82 |
$948.82 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$925.44 |
$925.44 |
$925.44 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$947.18 |
$947.18 |
$947.18 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$132.48 |
$132.48 |
$132.48 |
$145.60
|
|
Injection treatment of nerve
|
$2,792.16 |
$2,792.16 |
$2,792.16 |
$2,054.00
|
|
Inject/treat eye socket
|
$751.39 |
$751.39 |
$751.39 |
$381.13
|
|
Inj epidural sgl cerv-thor without img
|
$862.70 |
$862.70 |
$862.70 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$738.82 |
$738.82 |
$738.82 |
$1,450.84
|
|
Inj, etelcalcetide, 0.1 mg
|
$342.86 |
$342.86 |
$342.86 |
$343.35
|
|
Inj, evinacumab-dgnb, 5mg
|
$58,801.90 |
$58,801.90 |
$58,801.90 |
$20,751.13
|
|
Inj. fe derisomaltose 10 mg
|
$4,921.01 |
$4,921.01 |
$4,921.01 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$39.54 |
$39.54 |
$39.54 |
$40.33
|
|
Inj for ext venography
|
$514.90 |
$514.90 |
$514.90 |
$628.80
|
|
Inj for mammo ductogram
|
$336.10 |
$336.10 |
$336.10 |
$397.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$4,378.43 |
$4,378.43 |
$4,378.43 |
$4,760.67
|
|
Inj heparin, pfizer, 1000u
|
$56.23 |
$56.23 |
$56.23 |
$25.30
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$6,396.86 |
$6,396.86 |
$6,396.86 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,827.74 |
$1,827.74 |
$1,827.74 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$913.82 |
$913.82 |
$913.82 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$913.82 |
$913.82 |
$913.82 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$1,675.39 |
$1,675.39 |
$1,675.39 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$1,576.14 |
$1,576.14 |
$1,576.14 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$579.41 |
$579.41 |
$579.41 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$538.54 |
$538.54 |
$538.54 |
$739.77
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$813.79 |
$813.79 |
$813.79 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$524.64 |
$524.64 |
$524.64 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$977.47 |
$977.47 |
$977.47 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$13,469.96 |
$13,469.96 |
$13,469.96 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$6,072.29 |
$6,072.29 |
$6,072.29 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$6,657.00 |
$6,657.00 |
$6,657.00 |
$11,648.70
|
|
Inj levocarnitine per 1 gm
|
$85.16 |
$85.16 |
$85.16 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$110.40 |
$110.40 |
$110.40 |
$110.40
|
|
Inj, levothyroxine, freskabi
|
$667.39 |
$667.39 |
$667.39 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$53.60 |
$53.60 |
$53.60 |
$45.60
|
|
Inj, linezolid (hospira)
|
$98.32 |
$98.32 |
$98.32 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$2,669.02 |
$2,669.02 |
$2,669.02 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$35.54 |
$35.54 |
$35.54 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$349.04 |
$349.04 |
$349.04 |
$556.87
|
|
Inj meropenem (wg crit care)
|
$66.55 |
$66.55 |
$66.55 |
$82.42
|
|
Inj, moxifloxacin 100 mg
|
$123.28 |
$123.28 |
$123.28 |
$101.31
|
|
Inj moxifloxacin (fres kabi)
|
$93.97 |
$93.97 |
$93.97 |
$95.62
|
|
Inj. mycophenolate mofetil
|
$134.60 |
$134.60 |
$134.60 |
$252.66
|
