|
Inj cntr knee arthro incl ct/mri
|
$1,789.45 |
$1,789.45 |
$1,789.45 |
$464.28
|
|
Inj cyclophosphamd auromedic
|
$1.87 |
$361.01 |
$361.01 |
$1.16
|
|
Inj cyclophosphamd (ingenus)
|
$4.15 |
$339.04 |
$1,168.47 |
$1,040.94
|
|
Inj, daptomycin (hospira)
|
$0.27 |
$0.27 |
$0.27 |
$167.85
|
|
Inj. denosumab-bbdz, 1 mg
|
$4,026.62 |
$4,026.62 |
$4,026.62 |
$6,636.36
|
|
Inj disk cerv-thor ea lev
|
$3,405.35 |
$3,405.35 |
$3,405.35 |
$869.80
|
|
Inj dx for sinogram
|
$3,766.75 |
$3,766.75 |
$3,766.75 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$4,925.70 |
$4,925.70 |
$4,925.70 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$3,018.60 |
$3,018.60 |
$3,018.60 |
$507.10
|
|
Injection, belinostat, 10mg
|
$0.42 |
$0.42 |
$6,875.67 |
$5,341.40
|
|
Injection, cangrelor
|
$3,033.22 |
$3,033.22 |
$3,033.22 |
$2,546.20
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,807.00 |
$1,807.00 |
$1,807.00 |
$536.00
|
|
Injection, daratumumab 10 mg
|
$192.40 |
$192.40 |
$192.40 |
$7,107.73
|
|
Injection during cath supravalvular aortography
|
$2,117.70 |
$2,117.70 |
$2,117.70 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$3,841.50 |
$3,841.50 |
$3,841.50 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$1,575.60 |
$1,575.60 |
$1,575.60 |
$441.12
|
|
Injection for bladder x-ray
|
$2,481.70 |
$2,481.70 |
$2,481.70 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$1,851.20 |
$1,851.20 |
$1,851.20 |
$504.00
|
|
Injection for spleen x-ray
|
$804.70 |
$804.70 |
$804.70 |
$686.40
|
|
Injection for ureter x-ray
|
$2,714.40 |
$2,714.40 |
$2,714.40 |
$444.95
|
|
Injection for ureter x-ray
|
$2,510.95 |
$2,510.95 |
$2,510.95 |
$515.21
|
|
Injection, fulvestrant
|
$142.32 |
$445.61 |
$445.61 |
$2,756.47
|
|
Injection glatiramer acetate
|
$168.54 |
$773.01 |
$1,638.81 |
$405.93
|
|
Injection, inclisiran, 1 mg
|
$39.47 |
$11,657.30 |
$11,657.30 |
$10,366.61
|
|
Injection into brain canal
|
$139.75 |
$139.75 |
$139.75 |
$933.60
|
|
Injection, isavuconazonium
|
$3.30 |
$3.30 |
$1,208.64 |
$646.20
|
|
Injection jugular
|
$309.40 |
$309.40 |
$309.40 |
$1,048.20
|
|
Injection of sinus tract
|
$1,855.10 |
$1,855.10 |
$1,855.10 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$2,154.07 |
$2,154.07 |
$2,154.07 |
$2,154.07
|
|
Injection, peramivir
|
$1,019.46 |
$1,019.46 |
$1,019.46 |
$1,257.68
|
|
Injection radioactive tracer sentinel node (both sides)
|
$2,646.80 |
$2,646.80 |
$2,646.80 |
$717.20
|
|
Injection, renflexis
|
$1,035.22 |
$1,035.22 |
$1,035.22 |
$1,457.42
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$6,043.70 |
$6,043.70 |
$6,043.70 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,346.20 |
$3,346.20 |
$3,346.20 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,570.10 |
$2,570.10 |
$2,570.10 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,355.00 |
$4,355.00 |
$4,355.00 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,729.65 |
$1,729.65 |
$1,729.65 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$5,860.40 |
$5,860.40 |
$5,860.40 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,369.55 |
$1,369.55 |
$1,369.55 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$7,400.90 |
$7,400.90 |
$7,400.90 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$5,265.00 |
$5,265.00 |
$5,265.00 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$4,732.65 |
$4,732.65 |
$4,732.65 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,820.00 |
$1,820.00 |
$1,820.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,095.90 |
$1,095.90 |
$1,095.90 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,461.20 |
$1,461.20 |
$1,461.20 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$207.35 |
$207.35 |
$207.35 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$154.05 |
$154.05 |
$154.05 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$226.85 |
$226.85 |
$226.85 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$182.65 |
$182.65 |
$182.65 |
$141.60
|
|
Injection treatment of nerve
|
$6,858.80 |
$6,858.80 |
$6,858.80 |
$3,016.15
|
|
Injection treatment of nerve
|
$5,215.60 |
$5,215.60 |
$5,215.60 |
$2,037.10
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$105.61 |
$53,243.74 |
$53,243.74 |
$66,229.74
|
|
Inj epidural sgl cerv-thor without img
|
$5,069.35 |
$5,069.35 |
$5,069.35 |
$1,366.20
|
|
Inj epidural sgl lumb-sacral without img
|
$4,290.65 |
$4,290.65 |
$4,290.65 |
$1,450.84
|
|
Inj, evinacumab-dgnb, 5mg
|
$365.92 |
$365.92 |
$119,532.46 |
$186.31
|
|
Inj. fe derisomaltose 10 mg
|
$9,849.87 |
$9,849.87 |
$9,849.87 |
$21.05
|
|
Inj fluphenazine hcl 1.25 mg
|
$37.93 |
$37.93 |
$37.93 |
$37.93
|
|
Inj for ext venography
|
$3,802.50 |
$3,802.50 |
$3,802.50 |
$737.55
|
|
Inj for mammo ductogram
|
$4,110.60 |
$4,110.60 |
$4,110.60 |
$433.50
|
|
Inj givosiran 0.5 mg
|
$106,269.83 |
$106,269.83 |
$106,269.83 |
$112.14
|
|
Inj glofitamab gxbm, 2.5 mg
|
$29,284.42 |
$29,284.42 |
$29,284.42 |
$2,770.57
|
|
Inj., guselkumab, 1 mg
|
$39,308.75 |
$39,308.75 |
$39,308.75 |
$74.86
|
|
Inj heparin, pfizer, 1000u
|
$2.60 |
$2.60 |
$2.60 |
$24.28
|
|
Inj. herceptin hylecta, 10mg
|
$217.32 |
$217.32 |
$12,659.04 |
$63.79
|
|
Inj herzuma 10 mg
|
$257.69 |
$257.69 |
$2,065.67 |
$60.44
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,315.95 |
$2,315.95 |
$2,315.95 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$789.10 |
$789.10 |
$789.10 |
$947.65
|
|
Inj human fibrinogen con nos
|
$3,288.87 |
$3,288.87 |
$3,288.87 |
$1.52
|
|
Inj hydroxocobalamin IV 25mg
|
$3,180.35 |
$3,180.35 |
$3,180.35 |
$3,180.35
|
|
Inj. inebilizumab-cdon, 1 mg
|
$1,133.55 |
$378,200.52 |
$378,200.52 |
$494.43
|
|
Inj intralesional <= 7 lsn(s)
|
$589.55 |
$589.55 |
$589.55 |
$241.74
|
|
Inj, invega hafyera/trinza
|
$39.57 |
$39.57 |
$22,194.48 |
$12.66
|
|
Inj ivig privigen 500 mg
|
$1,979.51 |
$7,803.44 |
$7,803.44 |
$7,298.71
|
|
Inj, kovaltry, 1 i.u
|
$9,330.82 |
$9,330.82 |
$9,330.82 |
$1.48
|
|
Inj, lanreotide, (cipla) 1mg
|
$4,264.42 |
$4,264.42 |
$4,264.42 |
$12,160.05
|
|
Inj, lecanemab-irmb, 1 mg
|
$4.33 |
$4.33 |
$2,160.70 |
$1,729.21
|
|
Inj levocarnitine per 1 gm
|
$124.79 |
$138.58 |
$138.58 |
$138.96
|
|
Inj, levothyroxine, freskabi
|
$236.50 |
$236.50 |
$236.50 |
$302.07
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$7,151.30 |
$7,151.30 |
$7,151.30 |
$625.00
|
|
Inj melpha hydroch nos 50 mg
|
$251.08 |
$374.11 |
$554.52 |
$1,518.68
|
|
Inj mepivacaine hcl/10 ml
|
$23.77 |
$23.77 |
$39.88 |
$28.41
|
|
Inj., meropenem, vaborbactam
|
$740.32 |
$740.32 |
$740.32 |
$618.43
|
|
Inj meropenem (wg crit care)
|
$6.03 |
$104.29 |
$104.29 |
$104.29
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$578.70 |
$12,822.81 |
$12,822.81 |
$788.73
|
|
Inj, motixafortide, 0.25 mg
|
$20,113.28 |
$20,113.28 |
$20,113.28 |
$25.22
|
|
Inj, moxifloxacin 100 mg
|
$153.27 |
$153.27 |
$153.27 |
$190.81
|
|
Inj multihance
|
$20.28 |
$20.28 |
$20.28 |
$119.25
|
|
Inj. mycophenolate mofetil
|
$1.41 |
$1.41 |
$76.02 |
$344.84
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$8,728.20 |
$8,728.20 |
$8,728.20 |
$1,522.56
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,913.30 |
$2,913.30 |
$2,913.30 |
$2,371.50
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,942.20 |
$1,942.20 |
$1,942.20 |
$2,164.64
|
|
Inj ogivri 10 mg
|
$5,334.88 |
$5,334.88 |
$5,334.88 |
$3,968.67
|
|
Inj ontruzant 10 mg
|
$105.88 |
$1,661.08 |
$1,661.08 |
$34.17
|
|
Inj pantoprazole(hikma) 40mg
|
$30.71 |
$30.71 |
$30.71 |
$36.04
|
|
Inj., patisiran, 0.1 mg
|
$239.76 |
$239.76 |
$26,702.78 |
$11,742.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,013.31 |
$1,013.31 |
$12,463.52 |
$6,403.59
|
|
Inj pemetrexed (accord) 10mg
|
$11.34 |
$11.34 |
$11.34 |
$9.74
|
|
Inj pemetrexed ditromethamin
|
$4.10 |
$4.10 |
$4.10 |
$10.55
|
|
Inj pemetrexed, hospira 10mg
|
$213.59 |
$213.59 |
$213.59 |
$0.62
|
|
Inj peritoneal venous shunt
|
$3,643.90 |
$3,643.90 |
$3,643.90 |
$386.88
|