|
Influenza dna amp prob addl
|
$131.30 |
$131.30 |
$131.30 |
$64.26
|
|
Influenza virus vaccine, inact hemagglutinin tiv pf inj
|
$184.99 |
$184.99 |
$184.99 |
$111.51
|
|
Influenza virus vaccine, live trivalent intranasal
|
$40.89 |
$40.89 |
$40.89 |
$36.50
|
|
Inf lwr xtr fscl pln blk uni w/wo image
|
$477.75 |
$477.75 |
$477.75 |
$762.00
|
|
Infratemporal approach/skull
|
$13,447.85 |
$13,447.85 |
$13,447.85 |
$4,149.01
|
|
Infratemporal approach/skull
|
$13,453.70 |
$13,453.70 |
$13,453.70 |
$3,928.68
|
|
Inf thrc fascial pln blk bi w/wo image
|
$523.25 |
$523.25 |
$523.25 |
$523.25
|
|
Inf thrc fascial pln blk uni w/wo image
|
$497.90 |
$497.90 |
$497.90 |
$780.00
|
|
Infuse radioactive materials
|
$2,479.75 |
$2,479.75 |
$2,479.75 |
$672.42
|
|
Ingest challenge ea addl 60 min
|
$179.40 |
$179.40 |
$394.55 |
$289.64
|
|
Ingest challenge ini 120 min
|
$1,034.80 |
$1,034.80 |
$1,034.80 |
$764.78
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$608.40 |
$608.40 |
$608.40 |
$299.65
|
|
Initial foot exam pt lops
|
$334.75 |
$334.75 |
$334.75 |
$152.50
|
|
Initial hosp neonate 28 d/less than not critically ill 99477
|
$2,002.00 |
$2,002.00 |
$2,002.00 |
$540.80
|
|
Initial nursing facility care/day 35 minutes
|
$650.00 |
$650.00 |
$650.00 |
$184.80
|
|
Initial nursing facility care/day 45 minutes
|
$910.00 |
$910.00 |
$910.00 |
$231.84
|
|
Initial nursing facility care/day low severity 99304
|
$390.00 |
$390.00 |
$390.00 |
$127.63
|
|
Init nb em per day non-fac
|
$327.60 |
$327.60 |
$327.60 |
$97.68
|
|
Init pm e/m new pat 65+ yrs
|
$189.15 |
$189.15 |
$650.00 |
$189.15
|
|
Inj, abilify asimtufii, 1 mg
|
$4,247.74 |
$4,247.74 |
$4,247.74 |
$9,426.91
|
|
Inj, abilify maintena, 1 mg
|
$6,796.39 |
$6,796.39 |
$6,796.39 |
$5,355.30
|
|
Inj, acetaminophen (b braun)
|
$0.29 |
$0.29 |
$0.29 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$0.23 |
$0.23 |
$0.23 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$0.86 |
$0.86 |
$0.86 |
$56.70
|
|
Inj. acthar gel to 40 units
|
$21,202.27 |
$21,202.27 |
$21,202.27 |
$7,918.32
|
|
Inj, adalimumab, 1 mg
|
$19,998.76 |
$19,998.76 |
$19,998.76 |
$12,098.05
|
|
Inj, adstiladrin, per tx dos
|
$47,502.00 |
$47,502.00 |
$47,502.00 |
$63,354.77
|
|
Inj, adzynma, 10 iu
|
$7.92 |
$7.92 |
$7.92 |
$34.60
|
|
Inj, aflibercept hd, 1 mg
|
$91,295.10 |
$91,295.10 |
$91,295.10 |
$2,794.18
|
|
Inj alymsys 10 mg
|
$420.38 |
$420.38 |
$420.38 |
$1,280.74
|
|
Inj anifrolumab-fnia 1mg
|
$6,365.54 |
$6,365.54 |
$6,365.54 |
$10,052.58
|
|
Inj., aristada initio, 1 mg
|
$2,374.34 |
$2,374.34 |
$2,374.34 |
$4,052.45
|
|
Inj, artesunate, 1mg
|
$10,488.08 |
$10,488.08 |
$10,488.08 |
$14,460.21
|
|
Inj, aspara, rylaze, 0.1 mg
|
$33,134.40 |
$33,134.40 |
$33,134.40 |
$10,458.00
|
|
Inj avacincaptad pegol 0.1mg
|
$49,140.00 |
$49,140.00 |
$49,140.00 |
$3,409.64
|
|
Inj aval alfa-nqpt 4mg
|
$4,741.91 |
$4,741.91 |
$4,741.91 |
$3,907.30
|
|
Inj., benralizumab, 1 mg
|
$13,682.10 |
$13,682.10 |
$13,682.10 |
$11,310.00
|
|
Inj beta interferon sq 1 mcg
|
$4,285.44 |
$4,285.44 |
$4,285.44 |
$2,397.11
|
|
Inj, betibeglogene autotemce
|
$8,736,000.00 |
$8,736,000.00 |
$8,736,000.00 |
$4,057,157.07
|
|
Inj bimatoprost itc imp1mcg
|
$456.37 |
$4,738.50 |
$4,738.50 |
$3,287.96
|
|
Inj, brixadi, 7 days or less
|
$6,244.88 |
$6,244.88 |
$6,244.88 |
$748.85
|
|
Inj brixadi, more than 7 day
|
$22,204.01 |
$22,204.01 |
$22,204.01 |
$2,858.76
|
|
Inj, brolucizumab-dbll, 1 mg
|
$721.61 |
$97,502.65 |
$97,502.65 |
$3,382.69
|
|
Inj bulking agent anal canal
|
$715.00 |
$715.00 |
$715.00 |
$9,525.70
|
|
Inj, bupivacaine liposome
|
$59.28 |
$59.28 |
$59.28 |
$699.38
|
|
Inj. byooviz, 0.1 mg
|
$54,470.52 |
$54,470.52 |
$54,470.52 |
$1,135.59
|
|
Inj calcitriol per 0.1 mcg
|
$23.28 |
$23.28 |
$23.28 |
$22.69
|
|
Inj cefazolin sodium, baxter
|
$0.21 |
$0.21 |
$0.21 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$25.86 |
$25.86 |
$25.86 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$69.85 |
$69.85 |
$69.85 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$544.85 |
$544.85 |
$544.85 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$408.00 |
$408.00 |
$408.00 |
$358.56
|
|
Inj, cimerli, 0.1 mg
|
$63,648.00 |
$63,648.00 |
$63,648.00 |
$201.01
|
|
Inj, cipaglucosidase, 5 mg
|
$4,584.06 |
$4,584.06 |
$4,584.06 |
$3,278.80
|
|
Inj, clindamycin (baxter)
|
$0.60 |
$0.60 |
$0.60 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$508.30 |
$508.30 |
$508.30 |
$441.88
|
|
Inj, cyclophos (baxter) 5mg
|
$4,570.80 |
$4,570.80 |
$4,570.80 |
$2,584.85
|
|
Inj cyclophosphamd (ingenus)
|
$342.81 |
$342.81 |
$342.81 |
$742.72
|
|
Inj, cyclophosphamd, sandoz
|
$10.27 |
$10.27 |
$10.27 |
$735.20
|
|
Inj, daptomycin (baxter)
|
$1.83 |
$1.83 |
$1.83 |
$1.83
|
|
Inj, daptomycin (hospira)
|
$40.37 |
$40.37 |
$40.37 |
$128.08
|
|
Inj daptomycin (xellia)
|
$56.04 |
$56.04 |
$56.04 |
$56.04
|
|
Inj daxibotulinumtoxina-lanm
|
$982.80 |
$982.80 |
$982.80 |
$736.62
|
|
Inj, decitabine (sun pharma)
|
$312.00 |
$312.00 |
$312.00 |
$310.09
|
|
Inj. denosumab-bbdz, 1 mg
|
$4,416.07 |
$4,416.07 |
$4,416.07 |
$4,615.43
|
|
Inj disk cerv-thor ea lev
|
$993.20 |
$993.20 |
$993.20 |
$875.28
|
|
Inj, donanemab-azbt, 2 mg
|
$82.41 |
$82.41 |
$82.41 |
$1,233.44
|
|
Inj dupuytren cord w/enzyme
|
$882.70 |
$882.70 |
$882.70 |
$416.00
|
|
Inj, durolane 1 mg
|
$38.04 |
$869.70 |
$869.70 |
$1,950.93
|
|
Inj dx for sinogram
|
$700.70 |
$700.70 |
$700.70 |
$447.50
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$473.20 |
$473.20 |
$473.20 |
$504.00
|
|
Injection, belinostat, 10mg
|
$8,012.89 |
$8,012.89 |
$8,012.89 |
$4,446.10
|
|
Injection, cangrelor
|
$2,457.60 |
$2,457.60 |
$2,457.60 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$20,860.05 |
$20,860.05 |
$20,860.05 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$882.70 |
$882.70 |
$882.70 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$483.99 |
$483.99 |
$483.99 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$2,980.90 |
$2,980.90 |
$2,980.90 |
$1,028.00
|
|
Injection, edaravone, 1 mg
|
$15.19 |
$15.19 |
$15.19 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,192.80
|
|
Injection eye drug
|
$991.90 |
$991.90 |
$991.90 |
$648.96
|
|
Injection, famotidine, 20 mg
|
$7.80 |
$7.80 |
$7.80 |
$24.14
|
|
Injection for arthrography wrist (both sides)
|
$414.05 |
$414.05 |
$414.05 |
$438.00
|
|
Injection for bladder x-ray
|
$681.20 |
$681.20 |
$681.20 |
$460.00
|
|
Injection for hip x-ray
|
$567.45 |
$567.45 |
$567.45 |
$750.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$494.65 |
$494.65 |
$494.65 |
$503.30
|
|
Injection for spleen x-ray
|
$2,229.50 |
$2,229.50 |
$2,229.50 |
$595.50
|
|
Injection for ureter x-ray
|
$341.90 |
$341.90 |
$341.90 |
$415.80
|
|
Injection for ureter x-ray
|
$649.35 |
$649.35 |
$649.35 |
$527.70
|
|
Injection, fulvestrant
|
$259.00 |
$259.00 |
$259.00 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,194.10 |
$1,194.10 |
$1,194.10 |
$830.51
|
|
Injection, glucarpidase
|
$101,165.22 |
$101,165.22 |
$101,165.22 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$5,596.85 |
$5,596.85 |
$5,596.85 |
$6,679.35
|
|
Injection into brain canal
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,261.40
|
|
Injection into brain canal
|
$1,324.05 |
$1,324.05 |
$1,324.05 |
$844.50
|
|
Injection into hemorrhoid(s)
|
$2,726.10 |
$2,726.10 |
$2,726.10 |
$1,433.00
|
|
Injection jaw joint x-ray
|
$210.60 |
$210.60 |
$210.60 |
$340.00
|
|
Injection jugular
|
$1,327.95 |
$1,327.95 |
$1,450.80 |
$790.00
|
|
Injection of sinus tract
|
$4,429.10 |
$4,429.10 |
$4,429.10 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$13.55 |
$3,046.68 |
$3,046.68 |
$2,277.65
|
