|
Inj ceftolozane tazobactam
|
$302.76 |
$302.76 |
$302.76 |
$364.86
|
|
Inj, clevidipine butyrate
|
$191.40 |
$191.40 |
$191.40 |
$4.86
|
|
Inj cntr knee arthro incl ct/mri
|
$869.60 |
$869.60 |
$869.60 |
$436.80
|
|
Inj, daptomycin (hospira)
|
$99.88 |
$99.88 |
$99.88 |
$128.08
|
|
Inj daptomycin (xellia)
|
$42.64 |
$42.64 |
$42.64 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$1,008.70 |
$1,008.70 |
$1,008.70 |
$310.09
|
|
Inj dx for sinogram
|
$549.60 |
$549.60 |
$549.60 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$2,392.80 |
$2,392.80 |
$2,392.80 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$794.40 |
$794.40 |
$794.40 |
$503.50
|
|
Injection, burosumab-twza 1m
|
$30,192.00 |
$30,192.00 |
$30,192.00 |
$20,002.09
|
|
Injection, caplacizumab-yhdp
|
$13,188.18 |
$13,188.18 |
$13,188.18 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$441.60 |
$441.60 |
$441.60 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$3,262.96 |
$3,262.96 |
$3,262.96 |
$5,324.34
|
|
Injection, doxercalciferol
|
$40.68 |
$40.68 |
$40.68 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$2,606.40 |
$2,606.40 |
$2,606.40 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,760.00 |
$1,760.00 |
$1,760.00 |
$1,182.33
|
|
Injection eye drug
|
$592.80 |
$592.80 |
$592.80 |
$654.00
|
|
Injection for arthrography wrist (both sides)
|
$587.20 |
$587.20 |
$587.20 |
$436.00
|
|
Injection for bladder x-ray
|
$692.00 |
$692.00 |
$692.00 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$652.00 |
$652.00 |
$652.00 |
$497.76
|
|
Injection for spleen x-ray
|
$77.60 |
$77.60 |
$77.60 |
$686.40
|
|
Injection for ureter x-ray
|
$393.60 |
$393.60 |
$393.60 |
$415.80
|
|
Injection for ureter x-ray
|
$576.00 |
$576.00 |
$576.00 |
$515.21
|
|
Injection, fulvestrant
|
$2,155.27 |
$2,155.27 |
$2,155.27 |
$1,719.16
|
|
Injection glatiramer acetate
|
$642.41 |
$642.41 |
$642.41 |
$830.51
|
|
Injection, glucarpidase
|
$46,172.12 |
$46,172.12 |
$46,172.12 |
$74,113.20
|
|
Injection into brain canal
|
$1,289.60 |
$1,289.60 |
$1,289.60 |
$1,289.60
|
|
Injection into brain canal
|
$1,681.60 |
$1,681.60 |
$1,681.60 |
$844.50
|
|
Injection, isavuconazonium
|
$1,175.47 |
$1,175.47 |
$1,175.47 |
$787.67
|
|
Injection jaw joint x-ray
|
$245.60 |
$245.60 |
$245.60 |
$307.80
|
|
Injection jugular
|
$1,965.60 |
$1,965.60 |
$1,965.60 |
$790.00
|
|
Injection of sinus tract
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$1,046.81 |
$1,046.81 |
$1,046.81 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$312.33 |
$312.33 |
$312.33 |
$383.03
|
|
Injection radioactive tracer sentinel node (both sides)
|
$744.80 |
$744.80 |
$744.80 |
$685.44
|
|
Injection, renflexis
|
$645.40 |
$645.40 |
$645.40 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,545.60 |
$1,545.60 |
$1,545.60 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,300.80 |
$1,300.80 |
$1,300.80 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,902.40 |
$1,902.40 |
$1,902.40 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,229.60 |
$1,229.60 |
$1,229.60 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,082.40 |
$2,082.40 |
$2,082.40 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,317.60 |
$1,317.60 |
$1,317.60 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,031.20 |
$2,031.20 |
$2,031.20 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,420.80 |
$2,420.80 |
$2,420.80 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,304.80 |
$2,304.80 |
$2,304.80 |
$1,685.00
|
|
Injection, siltuximab
|
$9,867.30 |
$9,867.30 |
$9,867.30 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,073.60 |
$1,073.60 |
$1,073.60 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,042.40 |
$1,042.40 |
$1,042.40 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,042.40 |
$1,042.40 |
$1,042.40 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$202.40 |
$202.40 |
$202.40 |
$145.60
|
|
Injection treatment of eye
|
$3,223.20 |
$3,223.20 |
$3,223.20 |
$2,685.92
|
|
Injection treatment of nerve
|
$5,391.20 |
$5,391.20 |
$5,391.20 |
$4,446.30
|
|
Injection treatment of nerve
|
$1,301.60 |
$1,301.60 |
$1,301.60 |
$2,054.00
|
|
Inject sacroiliac joint
|
$912.00 |
$912.00 |
$912.00 |
$1,029.04
|
|
Inj epidural sgl cerv-thor without img
|
$1,891.20 |
$1,891.20 |
$1,891.20 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,868.00 |
$1,868.00 |
$1,868.00 |
$1,450.84
|
|
Inj, etelcalcetide, 0.1 mg
|
$796.58 |
$796.58 |
$796.58 |
$343.35
|
|
Inj for ext venography
|
$764.00 |
$764.00 |
$764.00 |
$628.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$17,336.98 |
$17,336.98 |
$17,336.98 |
$4,760.67
|
|
Inj heparin, pfizer, 1000u
|
$16.80 |
$16.80 |
$16.80 |
$25.30
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,481.60 |
$2,481.60 |
$2,481.60 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$2,784.00 |
$2,784.00 |
$2,784.00 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$2,409.60 |
$2,409.60 |
$2,409.60 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$1,800.80 |
$1,800.80 |
$1,800.80 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$1,853.60 |
$1,853.60 |
$1,853.60 |
$999.96
|
|
Inj hydroxocobalamin IV 25mg
|
$2,738.45 |
$2,738.45 |
$2,738.45 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$943.41 |
$943.41 |
$943.41 |
$1,228.59
|
|
Inj intralesional <= 7 lsn(s)
|
$850.40 |
$850.40 |
$850.40 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$9,892.95 |
$9,892.95 |
$9,892.95 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$4,184.02 |
$4,184.02 |
$4,184.02 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$351.28 |
$351.28 |
$351.28 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$117.63 |
$117.63 |
$117.63 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$19.49 |
$19.49 |
$19.49 |
$45.60
|
|
Inj melpha hydroch nos 50 mg
|
$562.32 |
$562.32 |
$562.32 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$21.58 |
$21.58 |
$21.58 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$574.72 |
$574.72 |
$574.72 |
$556.87
|
|
Inj, micafungin (par pharm)
|
$79.16 |
$79.16 |
$79.16 |
$79.08
|
|
Inj. mycophenolate mofetil
|
$351.31 |
$351.31 |
$351.31 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$35,277.71 |
$35,277.71 |
$35,277.71 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,481.60 |
$1,481.60 |
$1,481.60 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$3,564.00 |
$3,564.00 |
$3,564.00 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,686.40 |
$3,686.40 |
$3,686.40 |
$2,726.90
|
|
Inj octafluoropropane mic,ml
|
$285.33 |
$285.33 |
$285.33 |
$211.40
|
|
Inj onase abepar-xioi treat
|
$2,163,400.00 |
$2,163,400.00 |
$2,163,400.00 |
$3,572,794.09
|
|
Inj ontruzant 10 mg
|
$9,526.64 |
$9,526.64 |
$9,526.64 |
$6,706.27
|
|
Inj, pafolacianine, 0.1 mg
|
$6,834.00 |
$6,834.00 |
$6,834.00 |
$6,897.80
|
|
Inj pantoprazole(hikma) 40mg
|
$16.80 |
$16.80 |
$16.80 |
$34.67
|
|
Inj, pasireotide long acting
|
$38,652.87 |
$38,652.87 |
$38,652.87 |
$33,745.84
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$3,261.87 |
$3,261.87 |
$3,261.87 |
$6,614.40
|
|
Inj peritoneal venous shunt
|
$584.00 |
$584.00 |
$584.00 |
$406.80
|
|
Inj proc ankle arthr
|
$601.60 |
$601.60 |
$601.60 |
$405.31
|
|
Inj proc elbow arthro
|
$570.40 |
$570.40 |
$570.40 |
$432.00
|
|
Inj proc lumbr disk ea lvl
|
$1,732.00 |
$1,732.00 |
$1,732.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,576.80 |
$1,576.80 |
$1,576.80 |
$838.30
|
|
Inj, releuko 1 mcg
|
$159.74 |
$159.74 |
$159.74 |
$475.36
|
|
Inj retacrit esrd on dialysi
|
$532.80 |
$532.80 |
$532.80 |
$349.45
|
|
Inj retro urethrocysto
|
$569.60 |
$569.60 |
$569.60 |
$447.74
|
|
Inj scleros sol mult veins
|
$557.60 |
$557.60 |
$557.60 |
$692.90
|
|
Inj scleros sol sgl vein
|
$638.40 |
$638.40 |
$638.40 |
$561.88
|
|
Inj secretin synthetic human
|
$1,444.23 |
$1,444.23 |
$1,444.23 |
$1,253.09
|