|
Inj bimatoprost itc imp1mcg
|
$7,487.44 |
$7,487.44 |
$7,487.44 |
$3,287.96
|
|
Inj., brexanolone, 1 mg
|
$33,055.65 |
$33,055.65 |
$33,055.65 |
$13,019.44
|
|
Inj, bupivacaine liposome
|
$1,326.75 |
$1,326.75 |
$1,326.75 |
$699.38
|
|
Inj calcitriol per 0.1 mcg
|
$22.16 |
$22.16 |
$22.16 |
$22.69
|
|
Inj cefazolin sodium, baxter
|
$48.81 |
$48.81 |
$48.81 |
$27.38
|
|
Inj. cefepime hcl (baxter)
|
$54.36 |
$54.36 |
$54.36 |
$86.84
|
|
Inj, cefiderocol, 10 mg
|
$846.06 |
$846.06 |
$846.06 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$597.69 |
$597.69 |
$597.69 |
$364.86
|
|
Inj, clindamycin (baxter)
|
$15.35 |
$15.35 |
$15.35 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$459.75 |
$459.75 |
$459.75 |
$436.80
|
|
Inj., copanlisib, 1 mg
|
$19,661.50 |
$19,661.50 |
$19,661.50 |
$9,204.29
|
|
Inj, decitabine (sun pharma)
|
$369.75 |
$369.75 |
$369.75 |
$310.09
|
|
Inj disk cerv-thor ea lev
|
$2,326.50 |
$2,326.50 |
$2,326.50 |
$875.28
|
|
Inj, durolane 1 mg
|
$4,122.72 |
$4,122.72 |
$4,122.72 |
$1,950.93
|
|
Inj dx for sinogram
|
$1,089.00 |
$1,089.00 |
$1,089.00 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$678.75 |
$678.75 |
$678.75 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$217.50 |
$217.50 |
$217.50 |
$503.50
|
|
Injection, belinostat, 10mg
|
$9,355.72 |
$9,355.72 |
$9,355.72 |
$4,446.10
|
|
Injection, cangrelor
|
$3,425.21 |
$3,425.21 |
$3,425.21 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$31,693.80 |
$31,693.80 |
$31,693.80 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$593.25 |
$593.25 |
$593.25 |
$458.15
|
|
Injection, doxercalciferol
|
$23.86 |
$23.86 |
$23.86 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$353.25 |
$353.25 |
$353.25 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$1,115.25 |
$1,115.25 |
$1,115.25 |
$1,182.33
|
|
Injection eye drug
|
$322.50 |
$322.50 |
$322.50 |
$654.00
|
|
Injection for arthrography wrist (both sides)
|
$281.25 |
$281.25 |
$281.25 |
$436.00
|
|
Injection for bladder x-ray
|
$357.75 |
$357.75 |
$357.75 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$405.00 |
$405.00 |
$405.00 |
$497.76
|
|
Injection for ureter x-ray
|
$545.25 |
$545.25 |
$545.25 |
$515.21
|
|
Injection, fulvestrant
|
$3,584.82 |
$3,584.82 |
$3,584.82 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,749.29 |
$1,749.29 |
$1,749.29 |
$830.51
|
|
Injection, glucarpidase
|
$159,854.02 |
$159,854.02 |
$159,854.02 |
$74,113.20
|
|
Injection, isavuconazonium
|
$1,350.22 |
$1,350.22 |
$1,350.22 |
$787.67
|
|
Injection jaw joint x-ray
|
$151.50 |
$151.50 |
$151.50 |
$307.80
|
|
Injection jugular
|
$1,539.75 |
$1,539.75 |
$1,539.75 |
$790.00
|
|
Injection,onabotulinumtoxina
|
$4,814.15 |
$4,814.15 |
$4,814.15 |
$2,277.65
|
|
Injection, peramivir
|
$1,257.68 |
$1,257.68 |
$1,257.68 |
$744.75
|
|
Injection px peyronie ds
|
$239.25 |
$239.25 |
$239.25 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$269.25 |
$269.25 |
$269.25 |
$685.44
|
|
Injection, renflexis
|
$2,582.56 |
$2,582.56 |
$2,582.56 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,021.50 |
$1,021.50 |
$1,021.50 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$710.25 |
$710.25 |
$710.25 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,513.50 |
$1,513.50 |
$1,513.50 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,791.00 |
$1,791.00 |
$1,791.00 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,791.00 |
$1,791.00 |
$1,791.00 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,791.00 |
$1,791.00 |
$1,791.00 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,289.00 |
$2,289.00 |
$2,289.00 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,250.00 |
$2,250.00 |
$2,250.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,959.00 |
$1,959.00 |
$1,959.00 |
$1,685.00
|
|
Injection, siltuximab
|
$23,535.37 |
$23,535.37 |
$23,535.37 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$216.75 |
$216.75 |
$216.75 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$699.00 |
$699.00 |
$699.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$856.50 |
$856.50 |
$856.50 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$132.00 |
$132.00 |
$132.00 |
$145.60
|
|
Injection treatment of nerve
|
$1,866.00 |
$1,866.00 |
$1,866.00 |
$3,219.20
|
|
Injection treatment of nerve
|
$2,706.75 |
$2,706.75 |
$2,706.75 |
$2,054.00
|
|
Inject sacroiliac joint
|
$250.50 |
$250.50 |
$250.50 |
$1,029.04
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$58,842.17 |
$58,842.17 |
$58,842.17 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$2,184.75 |
$2,184.75 |
$2,184.75 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,623.75 |
$1,623.75 |
$1,623.75 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$248.03 |
$248.03 |
$248.03 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$1,404.58 |
$1,404.58 |
$1,404.58 |
$343.35
|
|
Inj, factor x, (human), 1iu
|
$33.28 |
$33.28 |
$33.28 |
$26.74
|
|
Inj for ext venography
|
$1,731.75 |
$1,731.75 |
$1,731.75 |
$628.80
|
|
Inj for mammo ductogram
|
$633.00 |
$633.00 |
$633.00 |
$397.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$2,588.63 |
$2,588.63 |
$2,588.63 |
$1,322.20
|
|
Inj, fulvestrant (fresenius)
|
$1,713.99 |
$1,713.99 |
$1,713.99 |
$905.30
|
|
Inj givosiran 0.5 mg
|
$162,298.07 |
$162,298.07 |
$162,298.07 |
$76,708.80
|
|
Inj glycopyrrolate, glyrx-pf
|
$8.22 |
$8.22 |
$8.22 |
$11.23
|
|
Inj. herceptin hylecta, 10mg
|
$17,286.71 |
$17,286.71 |
$17,286.71 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$930.75 |
$930.75 |
$930.75 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,038.00 |
$1,038.00 |
$1,038.00 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$666.75 |
$666.75 |
$666.75 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$693.75 |
$693.75 |
$693.75 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$648.00 |
$648.00 |
$648.00 |
$999.96
|
|
Inj human fibrinogen con nos
|
$4,326.08 |
$4,326.08 |
$4,326.08 |
$3.95
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,083.72 |
$1,083.72 |
$1,083.72 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$172,856.28 |
$172,856.28 |
$172,856.28 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$2,231.25 |
$2,231.25 |
$2,231.25 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$427.50 |
$427.50 |
$427.50 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$222.75 |
$222.75 |
$222.75 |
$234.00
|
|
Inj ivig privigen 500 mg
|
$4,194.45 |
$4,194.45 |
$4,194.45 |
$6,967.29
|
|
Inj levocarnitine per 1 gm
|
$122.28 |
$122.28 |
$122.28 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$76.51 |
$76.51 |
$76.51 |
$110.40
|
|
Inj, levothyroxine, freskabi
|
$244.63 |
$244.63 |
$244.63 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$37.17 |
$37.17 |
$37.17 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$1,713.99 |
$1,713.99 |
$1,713.99 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$28.41 |
$28.41 |
$28.41 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$759.87 |
$759.87 |
$759.87 |
$556.87
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$17,682.90 |
$17,682.90 |
$17,682.90 |
$8,304.04
|
|
Inj multihance
|
$166.47 |
$166.47 |
$166.47 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$387.27 |
$387.27 |
$387.27 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$96,378.67 |
$96,378.67 |
$96,378.67 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$441.00 |
$441.00 |
$441.00 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,976.25 |
$1,976.25 |
$1,976.25 |
$2,881.20
|
|
Inj octafluoropropane mic,ml
|
$340.18 |
$340.18 |
$340.18 |
$211.40
|
|
Inj ogivri 10 mg
|
$8,661.59 |
$8,661.59 |
$8,661.59 |
$4,492.28
|
|
Inj, omacetaxine mep, 0.01mg
|
$4,831.38 |
$4,831.38 |
$4,831.38 |
$2,686.80
|
|
Inj., patisiran, 0.1 mg
|
$36,180.04 |
$36,180.04 |
$36,180.04 |
$17,613.00
|
