|
Inj allopurinol sodium 1 mg
|
$5,673.85 |
$5,673.85 |
$5,673.85 |
|
|
Inj alymsys 10 mg
|
$1,884.86 |
$1,884.86 |
$1,884.86 |
|
|
Inj anifrolumab-fnia 1mg
|
$11,386.40 |
$11,386.40 |
$12,032.50 |
|
|
Inj., aristada initio, 1 mg
|
$6,291.97 |
$6,291.97 |
$6,291.97 |
|
|
Inj., benralizumab, 1 mg
|
$12,417.10 |
$13,121.73 |
$15,743.86 |
|
|
Inj, bezlotoxumab, 10 mg
|
$8,282.30 |
$8,282.30 |
$9,936.55 |
|
|
Inj, bupivacaine liposome
|
$506.12 |
$506.12 |
$658.74 |
|
|
Inj calcitriol per 0.1 mcg
|
$16.17 |
$16.17 |
$16.17 |
|
|
Inj cefazolin sodium, hikma
|
$17.69 |
$26.53 |
$37.08 |
|
|
Inj cefazolin (wg crit care)
|
$7.15 |
$7.15 |
$33.25 |
|
|
Inj, cefiderocol, 10 mg
|
$802.13 |
$802.13 |
$802.13 |
|
|
Inj ceftolozane tazobactam
|
$579.20 |
$622.80 |
$809.64 |
|
|
Inj cntr knee arthro incl ct/mri
|
$605.15 |
$605.15 |
$605.15 |
|
|
Inj crotalidae im f(ab')2 eq
|
$2,574.00 |
$2,582.58 |
$3,217.50 |
|
|
Inj cyclophosphamd (ingenus)
|
$1,283.81 |
$1,538.37 |
$1,912.30 |
|
|
Inj daxibotulinumtoxina-lanm
|
$1,774.50 |
$1,774.50 |
$1,774.50 |
|
|
Inj. denosumab-bbdz, 1 mg
|
$6,618.42 |
$6,993.79 |
$8,390.34 |
|
|
Inj disk cerv-thor ea lev
|
$2,792.40 |
$2,792.40 |
$2,792.40 |
|
|
Inj, donanemab-azbt, 2 mg
|
$1,472.90 |
$1,556.09 |
$1,865.10 |
|
|
Inj, durolane 1 mg
|
$4,710.88 |
$4,710.88 |
$4,710.88 |
|
|
Inj dx for sinogram
|
$270.40 |
$270.40 |
$270.40 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$750.75 |
$20,107.14 |
$25,543.39 |
|
|
Injection arthrography hip without anesthesia (both sides)
|
$619.45 |
$619.45 |
$619.45 |
|
|
Injection, belinostat, 10mg
|
$4,181.18 |
$4,181.18 |
$4,181.18 |
|
|
Injection, cangrelor
|
$2,048.01 |
$2,048.01 |
$2,048.01 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$44.20 |
$86.25 |
$1,035.45 |
|
|
Injection, daratumumab 10 mg
|
$2,161.54 |
$5,366.95 |
$8,046.53 |
|
|
Injection during cath supravalvular aortography
|
$1,604.20 |
$1,604.20 |
$1,604.20 |
|
|
Injection, edaravone, 1 mg
|
$1,269.57 |
$1,269.57 |
$1,269.57 |
|
|
Injection epidural blood patch or clot
|
$600.60 |
$625.30 |
$1,544.56 |
|
|
Injection eye drug
|
$1,313.13 |
$1,313.13 |
$1,313.13 |
|
|
Injection for arthrography wrist (both sides)
|
$422.50 |
$422.50 |
$422.50 |
|
|
Injection for bladder x-ray
|
$1,574.95 |
$1,574.95 |
$2,071.98 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$523.25 |
$523.25 |
$523.25 |
|
|
Injection for ureter x-ray
|
$2,055.65 |
$2,055.65 |
$13,008.97 |
|
|
Injection, fulvestrant
|
$225.55 |
$251.55 |
$332.80 |
|
|
Injection glatiramer acetate
|
$716.74 |
$716.74 |
$716.74 |
|
|
Injection, inclisiran, 1 mg
|
$7,275.92 |
$7,300.18 |
$9,094.90 |
|
|
Injection into brain canal
|
$4,060.87 |
$4,060.87 |
$4,060.87 |
|
|
Injection jugular
|
$4,919.20 |
$4,919.20 |
$4,919.20 |
|
|
Injection of sinus tract
|
$1,152.45 |
$1,152.45 |
$1,152.45 |
|
|
Injection,onabotulinumtoxina
|
$1,136.18 |
$1,269.45 |
$2,547.36 |
|
|
Injection px peyronie ds
|
$14,820.86 |
$14,820.86 |
$14,820.86 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$13,148.12 |
$13,148.12 |
$13,148.12 |
|
|
Injection, renflexis
|
$1,232.06 |
$1,648.31 |
$1,975.76 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,160.25 |
$1,160.25 |
$2,914.60 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$16,806.73 |
$20,107.14 |
$48,298.04 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$243.00 |
$728.00 |
$51,110.27 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$294.75 |
$2,040.36 |
$3,811.20 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,973.16 |
$3,172.89 |
$4,000.67 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,973.16 |
$2,194.64 |
$4,000.67 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$66.75 |
$3,122.19 |
$4,266.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$133.50 |
$3,122.19 |
$4,265.05 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,840.16 |
$2,651.36 |
$2,909.32 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$906.39 |
$2,212.27 |
$2,769.90 |
|
|
Injection, siltuximab
|
$14,669.13 |
$14,669.13 |
$14,669.13 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$31.20 |
$147.55 |
$556.40 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$29.25 |
$128.05 |
$436.80 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$33.15 |
$204.75 |
$638.95 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$92.30 |
$150.15 |
$229.45 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$128.05 |
$154.05 |
$198.90 |
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$106.60 |
$150.15 |
$329.55 |
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$18.75 |
$92.95 |
$174.20 |
|
|
Injection treatment of eye
|
$6,527.95 |
$6,527.95 |
$6,527.95 |
|
|
Injection treatment of eye
|
$10,635.43 |
$10,635.43 |
$10,635.43 |
|
|
Injection treatment of nerve
|
$15,410.85 |
$15,410.85 |
$15,410.85 |
|
|
Injection treatment of nerve
|
$6,115.20 |
$6,115.20 |
$6,115.20 |
|
|
Injection treatment of nerve
|
$753.35 |
$753.35 |
$3,300.92 |
|
|
Inject sacroiliac joint
|
$249.00 |
$447.20 |
$739.05 |
|
|
Inject/treat eye socket
|
$5,833.72 |
$5,833.72 |
$5,833.72 |
|
|
Inject/treat eye socket
|
$682.06 |
$682.06 |
$682.06 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$35,741.08 |
$35,741.08 |
$40,007.73 |
|
|
Inj epidural sgl cerv-thor without img
|
$1,007.50 |
$1,007.50 |
$2,276.30 |
|
|
Inj epidural sgl lumb-sacral without img
|
$790.40 |
$14,348.33 |
$15,082.08 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$29.03 |
$29.03 |
$29.03 |
|
|
Inj for ext venography
|
$32,397.18 |
$32,397.18 |
$32,397.18 |
|
|
Inj for mammo ductogram
|
$325.00 |
$325.00 |
$325.00 |
|
|
Inj., guselkumab, 1 mg
|
$31,522.65 |
$31,522.65 |
$39,972.36 |
|
|
Inj heparin, pfizer, 1000u
|
$19.47 |
$19.47 |
$19.47 |
|
|
Inj herzuma 10 mg
|
$7,987.52 |
$7,987.52 |
$7,987.52 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$5,046.60 |
$5,046.60 |
$5,046.60 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$5,323.50 |
$5,323.50 |
$5,323.50 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,294.15 |
$1,294.15 |
$1,294.15 |
|
|
Inj hrt cath w/s&i sel left vent
|
$3,575.00 |
$3,575.00 |
$3,575.00 |
|
|
Inj hrt cath w/s&i sel right vent
|
$3,420.30 |
$3,420.30 |
$3,420.30 |
|
|
Inj hydroxocobalamin IV 25mg
|
$2,213.90 |
$2,213.90 |
$3,406.00 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$867.75 |
$867.75 |
$3,244.15 |
|
|
Inj intralesional <= 7 lsn(s)
|
$23.40 |
$66.00 |
$195.65 |
|
|
Inj intralesional > 7 lsns
|
$180.05 |
$180.05 |
$180.05 |
|
|
Inj, invega hafyera/trinza
|
$21,451.91 |
$21,451.91 |
$26,725.80 |
|
|
Inj ivig privigen 500 mg
|
$2,408.50 |
$15,414.36 |
$15,465.74 |
|
|
Inj, lanreotide, (cipla) 1mg
|
$14,458.37 |
$14,458.37 |
$14,458.37 |
|
|
Inj, lecanemab-irmb, 1 mg
|
$703.46 |
$703.46 |
$1,380.53 |
|
|
Inj levocarnitine per 1 gm
|
$115.93 |
$115.93 |
$117.50 |
|
|
Inj, levothyroxine, freskabi
|
$286.91 |
$508.52 |
$638.23 |
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$21,612.27 |
$35,410.84 |
$47,928.89 |
|
|
Inj mepivacaine hcl/10 ml
|
$42.62 |
$42.62 |
$59.57 |
|
|
Inj meropenem (wg crit care)
|
$69.50 |
$69.50 |
$90.67 |
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$19,774.63 |
$19,774.63 |
$19,774.63 |
|
|
Inj multihance
|
$85.75 |
$89.60 |
$94.51 |
|
