|
Injection, caplacizumab-yhdp
|
$4,675.75 |
$4,675.75 |
$4,675.75 |
$16,375.33
|
|
Injection, daratumumab 10 mg
|
$90.75 |
$90.75 |
$90.75 |
$5,239.24
|
|
Injection, doxercalciferol
|
$1.88 |
$1.88 |
$1.88 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$843.11 |
$843.11 |
$843.11 |
$952.66
|
|
Injection, edaravone, 1 mg
|
$3.40 |
$3.40 |
$3.40 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$851.96 |
$851.96 |
$851.96 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$150.45 |
$150.45 |
$150.45 |
$428.40
|
|
Injection for bladder x-ray
|
$487.34 |
$487.34 |
$487.34 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$481.44 |
$481.44 |
$481.44 |
$494.65
|
|
Injection for ureter x-ray
|
$1,054.33 |
$1,054.33 |
$1,054.33 |
$515.21
|
|
Injection, fulvestrant
|
$104.64 |
$104.64 |
$104.64 |
$1,817.65
|
|
Injection, glucarpidase
|
$24,292.66 |
$24,292.66 |
$24,292.66 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$1,330.03 |
$1,330.03 |
$1,330.03 |
$6,679.35
|
|
Injection, isavuconazonium
|
$212.55 |
$212.55 |
$212.55 |
$787.67
|
|
Injection jaw joint x-ray
|
$517.43 |
$517.43 |
$517.43 |
$307.80
|
|
Injection, necitumumab, 1 mg
|
$51.10 |
$51.10 |
$51.10 |
$8,572.91
|
|
Injection of sinus tract
|
$650.18 |
$650.18 |
$650.18 |
$1,627.60
|
|
Injection,onabotulinumtoxina
|
$762.28 |
$762.28 |
$762.28 |
$2,277.65
|
|
Injection, peramivir
|
$9.35 |
$9.35 |
$9.35 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$603.57 |
$603.57 |
$603.57 |
$670.64
|
|
Injection, renflexis
|
$206.88 |
$206.88 |
$206.88 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,539.31 |
$1,539.31 |
$1,539.31 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$853.73 |
$853.73 |
$853.73 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,420.72 |
$1,420.72 |
$1,420.72 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$585.28 |
$585.28 |
$585.28 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,581.79 |
$1,581.79 |
$1,581.79 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,748.76 |
$1,748.76 |
$1,748.76 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,748.76 |
$1,748.76 |
$1,748.76 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$880.87 |
$880.87 |
$880.87 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$880.87 |
$880.87 |
$880.87 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$215.94 |
$215.94 |
$215.94 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$252.52 |
$252.52 |
$252.52 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$321.55 |
$321.55 |
$321.55 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$177.00 |
$177.00 |
$177.00 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$140.42 |
$140.42 |
$140.42 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$454.30 |
$454.30 |
$454.30 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$208.86 |
$208.86 |
$208.86 |
$135.60
|
|
Injection treatment of nerve
|
$1,180.00 |
$1,180.00 |
$1,180.00 |
$2,025.45
|
|
Inject sacroiliac joint
|
$950.49 |
$950.49 |
$950.49 |
$1,028.95
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$1,661.80 |
$1,661.80 |
$1,661.80 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$880.87 |
$880.87 |
$880.87 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$880.87 |
$880.87 |
$880.87 |
$1,415.50
|
|
Inj, etelcalcetide, 0.1 mg
|
$96.47 |
$96.47 |
$96.47 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$177.87 |
$177.87 |
$177.87 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$5.92 |
$5.92 |
$5.92 |
$39.54
|
|
Inj for ext venography
|
$687.35 |
$687.35 |
$687.35 |
$649.95
|
|
Inj gemcitabine hcl (accord)
|
$6.86 |
$6.86 |
$6.86 |
$130.65
|
|
Inj glofitamab gxbm, 2.5 mg
|
$602.92 |
$602.92 |
$602.92 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$1.09 |
$1.09 |
$1.09 |
$11.23
|
|
Inj, granisetron, xr, 0.1 mg
|
$981.35 |
$981.35 |
$981.35 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$8,293.40 |
$8,293.40 |
$8,293.40 |
$29,130.83
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,761.79 |
$2,761.79 |
$2,761.79 |
$1,439.90
|
|
Inj hrt cath w/s&i sel right vent
|
$1,657.31 |
$1,657.31 |
$1,657.31 |
$965.33
|
|
Inj imip 4 cilas 4 releb 2mg
|
$170.54 |
$170.54 |
$170.54 |
$739.77
|
|
Inj ivig privigen 500 mg
|
$4.30 |
$4.30 |
$4.30 |
$6,967.29
|
|
Inj, lecanemab-irmb, 1 mg
|
$75.17 |
$75.17 |
$75.17 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$4.20 |
$4.20 |
$4.20 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$7.71 |
$7.71 |
$7.71 |
$303.45
|
|
Inj, levothyroxine, hikma
|
$30.49 |
$30.49 |
$30.49 |
$42.89
|
|
Inj, lidocaine w epinephrine
|
$0.56 |
$0.56 |
$0.56 |
$47.52
|
|
Inj melpha hydroch nos 50 mg
|
$110.68 |
$110.68 |
$110.68 |
$1,791.90
|
|
Inj mepivacaine hcl/10 ml
|
$0.19 |
$0.19 |
$0.19 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$11.07 |
$11.07 |
$11.07 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$104.95 |
$104.95 |
$104.95 |
$558.08
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$377.34 |
$377.34 |
$377.34 |
$1,496.55
|
|
Inj, moxifloxacin 100 mg
|
$0.10 |
$0.10 |
$0.10 |
$107.25
|
|
Inj multihance
|
$0.93 |
$0.93 |
$0.93 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$39.35 |
$39.35 |
$39.35 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$849.01 |
$849.01 |
$849.01 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$1.94 |
$1.94 |
$1.94 |
$462.04
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$1,058.98 |
$1,058.98 |
$1,058.98 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$880.44 |
$880.44 |
$880.44 |
$4,492.28
|
|
Inj., patisiran, 0.1 mg
|
$1,121.00 |
$1,121.00 |
$1,121.00 |
$17,613.00
|
|
Inj. pemetrexed, 10 mg
|
$108.12 |
$108.12 |
$108.12 |
$104.72
|
|
Inj pemetrexed (sandoz) 10mg
|
$1.34 |
$1.34 |
$1.34 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$94.65 |
$94.65 |
$94.65 |
$1,235.55
|
|
Inj proc ankle arthr
|
$512.12 |
$512.12 |
$512.12 |
$405.31
|
|
Inj proc elbow arthro
|
$260.19 |
$260.19 |
$260.19 |
$419.60
|
|
Inj proc myelogram lumbar
|
$995.92 |
$995.92 |
$995.92 |
$830.50
|
|
Inj progesterone per 50 mg
|
$1.64 |
$1.64 |
$1.64 |
$15.00
|
|
Inj, releuko 1 mcg
|
$105.26 |
$105.26 |
$105.26 |
$473.25
|
|
Inj retacrit esrd on dialysi
|
$207.37 |
$207.37 |
$207.37 |
$349.45
|
|
Inj retro urethrocysto
|
$433.06 |
$433.06 |
$433.06 |
$443.50
|
|
Inj secretin synthetic human
|
$389.99 |
$389.99 |
$389.99 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$2,172.43 |
$2,172.43 |
$2,172.43 |
$4,413.21
|
|
Inj, spesolimab-sbzo, 1 mg
|
$2,011.24 |
$2,011.24 |
$2,011.24 |
$90,007.62
|
|
Inj teplizumab mzwv 5 mcg
|
$3,195.25 |
$3,195.25 |
$3,195.25 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$9,128.25 |
$9,128.25 |
$9,128.25 |
$35,034.78
|
|
Inj testosterone cypionate
|
$11.84 |
$11.84 |
$11.84 |
$64.80
|
|
Inj., tildrakizumab, 1 mg
|
$7,857.51 |
$7,857.51 |
$7,857.51 |
$26,635.60
|
|
Inj, tofidence, 1 mg
|
$65.49 |
$65.49 |
$65.49 |
$92.13
|
|
Inj, tyenne, 1 mg
|
$52.95 |
$52.95 |
$52.95 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$4,707.80 |
$4,707.80 |
$4,707.80 |
$11,475.96
|
|
Inj w/fluor eval cv device
|
$348.10 |
$348.10 |
$348.10 |
$503.92
|
|
Ins cath ren art 1st bi
|
$3,407.25 |
$3,407.25 |
$3,407.25 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$2,839.67 |
$2,839.67 |
$2,839.67 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$4,174.25 |
$4,174.25 |
$4,174.25 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$7,604.51 |
$7,604.51 |
$7,604.51 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$271.99 |
$271.99 |
$271.99 |
$480.28
|
|
Insert cath pleura with image
|
$1,777.08 |
$1,777.08 |
$1,777.08 |
$2,194.40
|
