|
Inj cefazolin sodium, hikma
|
$26.94 |
$26.94 |
$26.94 |
$27.38
|
|
Inj cefazolin (wg crit care)
|
$26.89 |
$26.89 |
$26.89 |
$18.43
|
|
Inj, cefepime hcl (b braun)
|
$88.45 |
$88.45 |
$88.45 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$232.23 |
$232.23 |
$232.23 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$165.60 |
$165.60 |
$165.60 |
$364.86
|
|
Inj, clevidipine butyrate
|
$120.68 |
$120.68 |
$120.68 |
$4.86
|
|
Inj, clindamycin (baxter)
|
$50.44 |
$50.44 |
$50.44 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$524.80 |
$524.80 |
$524.80 |
$436.80
|
|
Inj., copanlisib, 1 mg
|
$5,506.39 |
$5,506.39 |
$5,506.39 |
$9,204.29
|
|
Inj crotalidae im f(ab')2 eq
|
$1,933.04 |
$1,933.04 |
$1,933.04 |
$2,613.60
|
|
Inj, daptomycin (hospira)
|
$60.72 |
$60.72 |
$60.72 |
$128.08
|
|
Inj daptomycin (xellia)
|
$71.92 |
$71.92 |
$71.92 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$359.05 |
$359.05 |
$359.05 |
$310.09
|
|
Inj disk cerv-thor ea lev
|
$831.20 |
$831.20 |
$831.20 |
$875.28
|
|
Inj dx for sinogram
|
$511.20 |
$511.20 |
$511.20 |
$436.00
|
|
Inject for sacroiliac joint
|
$581.60 |
$581.60 |
$581.60 |
$1,025.77
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,648.80 |
$2,648.80 |
$2,648.80 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$660.00 |
$660.00 |
$660.00 |
$503.50
|
|
Injection, belinostat, 10mg
|
$2,791.55 |
$2,791.55 |
$2,791.55 |
$4,446.10
|
|
Injection, cangrelor
|
$1,280.55 |
$1,280.55 |
$1,280.55 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$505.60 |
$505.60 |
$505.60 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$3,129.56 |
$3,129.56 |
$3,129.56 |
$5,324.34
|
|
Injection, doxercalciferol
|
$30.00 |
$30.00 |
$30.00 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$1,492.80 |
$1,492.80 |
$1,492.80 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,787.20 |
$1,787.20 |
$1,787.20 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$508.00 |
$508.00 |
$508.00 |
$436.00
|
|
Injection for bladder x-ray
|
$690.40 |
$690.40 |
$690.40 |
$459.20
|
|
Injection for hip x-ray
|
$662.40 |
$662.40 |
$662.40 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$586.40 |
$586.40 |
$586.40 |
$497.76
|
|
Injection for spleen x-ray
|
$84.00 |
$84.00 |
$84.00 |
$686.40
|
|
Injection for tear sac x-ray
|
$24.00 |
$24.00 |
$24.00 |
$225.20
|
|
Injection for ureter x-ray
|
$456.00 |
$456.00 |
$456.00 |
$415.80
|
|
Injection for ureter x-ray
|
$191.20 |
$191.20 |
$191.20 |
$515.21
|
|
Injection, fulvestrant
|
$1,346.83 |
$1,346.83 |
$1,346.83 |
$1,719.16
|
|
Injection glatiramer acetate
|
$294.72 |
$294.72 |
$294.72 |
$830.51
|
|
Injection, glucarpidase
|
$42,174.00 |
$42,174.00 |
$42,174.00 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$4,250.10 |
$4,250.10 |
$4,250.10 |
$6,679.35
|
|
Injection into brain canal
|
$1,504.80 |
$1,504.80 |
$1,504.80 |
$1,289.60
|
|
Injection into brain canal
|
$1,607.20 |
$1,607.20 |
$1,607.20 |
$844.50
|
|
Injection jaw joint x-ray
|
$380.80 |
$380.80 |
$380.80 |
$307.80
|
|
Injection jugular
|
$222.40 |
$222.40 |
$222.40 |
$790.00
|
|
Injection of sinus tract
|
$1,814.40 |
$1,814.40 |
$1,814.40 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$2,068.00 |
$2,068.00 |
$2,068.00 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$179.96 |
$179.96 |
$179.96 |
$383.03
|
|
Injection, peramivir
|
$732.51 |
$732.51 |
$732.51 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$944.00 |
$944.00 |
$944.00 |
$685.44
|
|
Injection, renflexis
|
$1,283.13 |
$1,283.13 |
$1,283.13 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,531.20 |
$1,531.20 |
$1,531.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,476.00 |
$1,476.00 |
$1,476.00 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,173.60 |
$1,173.60 |
$1,173.60 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,708.00 |
$1,708.00 |
$1,708.00 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$628.00 |
$628.00 |
$628.00 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,814.40 |
$1,814.40 |
$1,814.40 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$592.00 |
$592.00 |
$592.00 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,897.60 |
$1,897.60 |
$1,897.60 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,536.80 |
$1,536.80 |
$1,536.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,618.40 |
$1,618.40 |
$1,618.40 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$536.80 |
$536.80 |
$536.80 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$604.00 |
$604.00 |
$604.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$634.40 |
$634.40 |
$634.40 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$194.40 |
$194.40 |
$194.40 |
$145.60
|
|
Inject sacroiliac joint
|
$1,129.60 |
$1,129.60 |
$1,129.60 |
$1,029.04
|
|
Inject/treat eye socket
|
$683.20 |
$683.20 |
$683.20 |
$381.13
|
|
Inj epidural sgl cerv-thor without img
|
$1,476.80 |
$1,476.80 |
$1,476.80 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,618.40 |
$1,618.40 |
$1,618.40 |
$1,450.84
|
|
Inj, etelcalcetide, 0.1 mg
|
$290.80 |
$290.80 |
$290.80 |
$343.35
|
|
Inj, factor x, (human), 1iu
|
$30.98 |
$30.98 |
$30.98 |
$26.74
|
|
Inj. fe derisomaltose 10 mg
|
$2,976.00 |
$2,976.00 |
$2,976.00 |
$3,221.52
|
|
Inj for ext venography
|
$1,183.20 |
$1,183.20 |
$1,183.20 |
$628.80
|
|
Inj for mammo ductogram
|
$400.80 |
$400.80 |
$400.80 |
$397.80
|
|
Inj, fosaprepitant (teva)
|
$120.36 |
$120.36 |
$120.36 |
$152.10
|
|
Inj fosnetupitant, palonoset
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$1,110.99
|
|
Inj, fulvestrant (fresenius)
|
$337.51 |
$337.51 |
$337.51 |
$905.30
|
|
Inj, fulvestrant (teva)
|
$739.03 |
$739.03 |
$739.03 |
$136.50
|
|
Inj., guselkumab, 1 mg
|
$15,484.91 |
$15,484.91 |
$15,484.91 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$26.26 |
$26.26 |
$26.26 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$5,155.20 |
$5,155.20 |
$5,155.20 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,708.00 |
$1,708.00 |
$1,708.00 |
$1,492.00
|
|
Inj hrt cath w/s&i sel right vent
|
$9,492.80 |
$9,492.80 |
$9,492.80 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$1,457.28 |
$1,457.28 |
$1,457.28 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$718.72 |
$718.72 |
$718.72 |
$1,228.59
|
|
Inj, immphentiv, 20 mcg
|
$26.58 |
$26.58 |
$26.58 |
$21.00
|
|
Inj intralesional <= 7 lsn(s)
|
$260.00 |
$260.00 |
$260.00 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$244.80 |
$244.80 |
$244.80 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$3,615.60 |
$3,615.60 |
$3,615.60 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$60.42 |
$60.42 |
$60.42 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$88.69 |
$88.69 |
$88.69 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$27.60 |
$27.60 |
$27.60 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$988.80 |
$988.80 |
$988.80 |
$794.70
|
|
Inj mepivacaine hcl/10 ml
|
$30.89 |
$30.89 |
$30.89 |
$34.34
|
|
Inj, meropenem (b. braun)
|
$104.72 |
$104.72 |
$104.72 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$167.51 |
$167.51 |
$167.51 |
$556.87
|
|
Inj, micafungin (par pharm)
|
$68.61 |
$68.61 |
$68.61 |
$79.08
|
|
Inj, moxifloxacin 100 mg
|
$112.71 |
$112.71 |
$112.71 |
$101.31
|
|
Inj. mycophenolate mofetil
|
$170.05 |
$170.05 |
$170.05 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,274.40 |
$1,274.40 |
$1,274.40 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$222.24 |
$222.24 |
$222.24 |
$468.10
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$3,632.00 |
$3,632.00 |
$3,632.00 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,220.80 |
$3,220.80 |
$3,220.80 |
$2,726.90
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$40,227.91 |
$40,227.91 |
$40,227.91 |
$66,582.27
|
