|
Infliximab 100 mg intravenous solution
|
$1,571.30 |
$1,571.30 |
$1,571.30 |
$178.95
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$2,068.33 |
$2,068.33 |
$2,068.33 |
$157.14
|
|
Inf lwr xtr fscl pln blk uni w/wo image
|
$1,788.15 |
$1,788.15 |
$1,788.15 |
$811.20
|
|
Inf thrc fascial pln blk bi w/wo image
|
$3,344.25 |
$3,344.25 |
$3,344.25 |
$624.00
|
|
Inf thrc fascial pln blk uni w/wo image
|
$1,966.90 |
$1,966.90 |
$1,966.90 |
$1,153.60
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$293.15 |
$293.15 |
$293.15 |
$344.50
|
|
Initiation & management bipap/cpap initial day
|
$1,214.85 |
$1,214.85 |
$1,214.85 |
$608.40
|
|
Inj, abilify maintena, 1 mg
|
$5,682.54 |
$5,682.54 |
$5,682.54 |
$3,138.28
|
|
Inj allopurinol sodium 1 mg
|
$5,673.85 |
$5,673.85 |
$5,673.85 |
$5,937.23
|
|
Inj anifrolumab-fnia 1mg
|
$12,032.50 |
$12,032.50 |
$12,032.50 |
$1,038.87
|
|
Inj., benralizumab, 1 mg
|
$13,121.73 |
$13,121.73 |
$13,121.73 |
$12,417.10
|
|
Inj, bezlotoxumab, 10 mg
|
$8,282.30 |
$8,282.30 |
$8,282.30 |
$39.83
|
|
Inj, bupivacaine liposome
|
$506.12 |
$506.12 |
$506.12 |
$3.22
|
|
Inj cefazolin sodium, hikma
|
$17.69 |
$17.69 |
$17.69 |
$66.38
|
|
Inj cefazolin (wg crit care)
|
$33.25 |
$33.25 |
$33.25 |
$1.00
|
|
Inj ceftolozane tazobactam
|
$579.20 |
$579.20 |
$579.20 |
$248.93
|
|
Inj cntr knee arthro incl ct/mri
|
$605.15 |
$605.15 |
$605.15 |
$505.20
|
|
Inj crotalidae im f(ab')2 eq
|
$2,582.58 |
$2,582.58 |
$2,582.58 |
$2,388.06
|
|
Inj cyclophosphamd (ingenus)
|
$1,283.81 |
$1,283.81 |
$1,283.81 |
$1.16
|
|
Inj. denosumab-bbdz, 1 mg
|
$6,993.79 |
$6,993.79 |
$6,993.79 |
$6,618.42
|
|
Inj disk cerv-thor ea lev
|
$2,792.40 |
$2,792.40 |
$2,792.40 |
$828.00
|
|
Inj, donanemab-azbt, 2 mg
|
$1,556.09 |
$1,556.09 |
$1,556.09 |
$6.20
|
|
Inj dx for sinogram
|
$270.40 |
$270.40 |
$270.40 |
$484.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$25,543.39 |
$25,543.39 |
$25,543.39 |
$1,165.32
|
|
Injection arthrography hip without anesthesia (both sides)
|
$619.45 |
$619.45 |
$619.45 |
$609.20
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,035.45 |
$1,035.45 |
$1,035.45 |
$441.60
|
|
Injection during cath supravalvular aortography
|
$1,604.20 |
$1,604.20 |
$1,604.20 |
$1,604.20
|
|
Injection, edaravone, 1 mg
|
$1,269.57 |
$1,269.57 |
$1,269.57 |
$1,721.40
|
|
Injection epidural blood patch or clot
|
$1,323.40 |
$1,323.40 |
$1,323.40 |
$1,470.60
|
|
Injection eye drug
|
$1,313.13 |
$1,313.13 |
$1,313.13 |
$709.80
|
|
Injection for arthrography wrist (both sides)
|
$422.50 |
$422.50 |
$422.50 |
$521.18
|
|
Injection for bladder x-ray
|
$2,071.98 |
$2,071.98 |
$2,071.98 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$523.25 |
$523.25 |
$523.25 |
$514.36
|
|
Injection for ureter x-ray
|
$2,055.65 |
$2,055.65 |
$2,055.65 |
$544.50
|
|
Injection, fulvestrant
|
$225.55 |
$225.55 |
$225.55 |
$166.25
|
|
Injection glatiramer acetate
|
$716.74 |
$716.74 |
$716.74 |
$458.43
|
|
Injection, inclisiran, 1 mg
|
$7,300.18 |
$7,300.18 |
$7,300.18 |
$12.72
|
|
Injection into brain canal
|
$4,060.87 |
$4,060.87 |
$4,060.87 |
$961.20
|
|
Injection jugular
|
$4,919.20 |
$4,919.20 |
$4,919.20 |
$1,134.12
|
|
Injection of sinus tract
|
$1,152.45 |
$1,152.45 |
$1,152.45 |
$1,639.57
|
|
Injection,onabotulinumtoxina
|
$2,547.36 |
$2,547.36 |
$2,547.36 |
$12.88
|
|
Injection px peyronie ds
|
$14,820.86 |
$14,820.86 |
$14,820.86 |
$343.55
|
|
Injection radioactive tracer sentinel node (both sides)
|
$13,148.12 |
$13,148.12 |
$13,148.12 |
$787.50
|
|
Injection, renflexis
|
$1,648.31 |
$1,648.31 |
$1,648.31 |
$632.98
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,914.60 |
$2,914.60 |
$2,914.60 |
$1,066.24
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$25,708.12 |
$25,708.12 |
$25,708.12 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$25,762.85 |
$25,762.85 |
$25,762.85 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,811.20 |
$3,811.20 |
$3,811.20 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$3,853.20 |
$3,853.20 |
$3,853.20 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,853.20 |
$3,853.20 |
$3,853.20 |
$1,985.61
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$4,266.60 |
$4,266.60 |
$4,266.60 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,265.05 |
$4,265.05 |
$4,265.05 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,651.36 |
$2,651.36 |
$2,651.36 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,769.90 |
$2,769.90 |
$2,769.90 |
$1,758.12
|
|
Injection, siltuximab
|
$14,669.13 |
$14,669.13 |
$14,669.13 |
$23,535.37
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$556.40 |
$556.40 |
$556.40 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$436.80 |
$436.80 |
$436.80 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$638.95 |
$638.95 |
$638.95 |
$654.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$219.05 |
$219.05 |
$219.05 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$198.90 |
$198.90 |
$198.90 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$232.05 |
$232.05 |
$232.05 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$148.20 |
$148.20 |
$148.20 |
$130.19
|
|
Injection treatment of eye
|
$6,527.95 |
$6,527.95 |
$6,527.95 |
$2,601.69
|
|
Injection treatment of eye
|
$10,635.43 |
$10,635.43 |
$10,635.43 |
$2,370.28
|
|
Injection treatment of nerve
|
$15,410.85 |
$15,410.85 |
$15,410.85 |
$2,792.73
|
|
Injection treatment of nerve
|
$6,115.20 |
$6,115.20 |
$6,115.20 |
$4,446.30
|
|
Injection treatment of nerve
|
$3,300.92 |
$3,300.92 |
$3,300.92 |
$1,636.00
|
|
Inject/treat eye socket
|
$5,833.72 |
$5,833.72 |
$5,833.72 |
$414.40
|
|
Inject/treat eye socket
|
$682.06 |
$682.06 |
$682.06 |
$436.44
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$35,741.08 |
$35,741.08 |
$35,741.08 |
$33.74
|
|
Inj epidural sgl cerv-thor without img
|
$2,276.30 |
$2,276.30 |
$2,276.30 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$15,082.08 |
$15,082.08 |
$15,082.08 |
$1,260.60
|
|
Inj fluphenazine hcl 1.25 mg
|
$29.03 |
$29.03 |
$29.03 |
$29.65
|
|
Inj for ext venography
|
$32,397.18 |
$32,397.18 |
$32,397.18 |
$946.64
|
|
Inj for mammo ductogram
|
$325.00 |
$325.00 |
$325.00 |
$469.16
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$5,046.60 |
$5,046.60 |
$5,046.60 |
$1,646.97
|
|
Inj hrt cath w/s&i sel hrt ang
|
$5,323.50 |
$5,323.50 |
$5,323.50 |
$2,471.00
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,294.15 |
$1,294.15 |
$1,294.15 |
$1,192.50
|
|
Inj hrt cath w/s&i sel left vent
|
$3,575.00 |
$3,575.00 |
$3,575.00 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$3,420.30 |
$3,420.30 |
$3,420.30 |
$1,352.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$3,244.15 |
$3,244.15 |
$3,244.15 |
$1,673.66
|
|
Inj intralesional <= 7 lsn(s)
|
$195.65 |
$195.65 |
$195.65 |
$238.77
|
|
Inj, invega hafyera/trinza
|
$21,451.91 |
$21,451.91 |
$21,451.91 |
$12.96
|
|
Inj ivig privigen 500 mg
|
$15,465.74 |
$15,465.74 |
$15,465.74 |
$6,144.00
|
|
Inj levocarnitine per 1 gm
|
$117.50 |
$117.50 |
$117.50 |
$87.51
|
|
Inj, levothyroxine, freskabi
|
$638.23 |
$638.23 |
$638.23 |
$244.63
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$35,410.84 |
$35,410.84 |
$35,410.84 |
$625.00
|
|
Inj mepivacaine hcl/10 ml
|
$42.62 |
$42.62 |
$42.62 |
$28.41
|
|
Inj multihance
|
$89.60 |
$89.60 |
$89.60 |
$86.40
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,932.80 |
$2,932.80 |
$2,932.80 |
$1,522.56
|
|
Inj ogivri 10 mg
|
$5,723.85 |
$5,723.85 |
$5,723.85 |
$91.01
|
|
Inj pemetrexed (accord) 10mg
|
$227.82 |
$227.82 |
$227.82 |
$9.74
|
|
Inj proc ankle arthr
|
$226.85 |
$226.85 |
$226.85 |
$405.60
|
|
Inj proc elbow arthro
|
$478.40 |
$478.40 |
$478.40 |
$483.15
|
|
Inj proc lumbr disk ea lvl
|
$3,998.15 |
$3,998.15 |
$3,998.15 |
$1,218.51
|
|
Inj proc myelogram lumbar
|
$625.95 |
$625.95 |
$625.95 |
$1,026.35
|
|
Inj proc sialogram
|
$501.15 |
$501.15 |
$501.15 |
$419.34
|
|
Inj progesterone per 50 mg
|
$9.07 |
$9.07 |
$9.07 |
$35.00
|
|
Inj retro urethrocysto
|
$1,316.28 |
$1,316.28 |
$1,316.28 |
$569.60
|
|
Inj scleros sol mult veins
|
$707.85 |
$707.85 |
$707.85 |
$614.00
|