|
Infliximab-dyyb 100 mg intravenous solution
|
$665.05 |
$665.05 |
$665.05 |
$1,654.83
|
|
Initiation & management bipap/cpap initial day
|
$185.98 |
$185.98 |
$185.98 |
$645.79
|
|
Inj, abilify maintena, 1 mg
|
$3,181.89 |
$3,181.89 |
$3,181.89 |
$6,324.82
|
|
Inj., benralizumab, 1 mg
|
$7,805.95 |
$7,805.95 |
$7,805.95 |
$16,865.48
|
|
Inj, bezlotoxumab, 10 mg
|
$5,847.52 |
$5,847.52 |
$5,847.52 |
$9,702.65
|
|
Inj, bupivacaine liposome
|
$488.50 |
$488.50 |
$488.50 |
$816.31
|
|
Inj calcitriol per 0.1 mcg
|
$18.35 |
$18.35 |
$18.35 |
$33.36
|
|
Inj cefazolin sodium, hikma
|
$8.25 |
$8.25 |
$8.25 |
$56.70
|
|
Inj cefazolin (wg crit care)
|
$15.87 |
$15.87 |
$15.87 |
$32.05
|
|
Inj ceftolozane tazobactam
|
$172.09 |
$172.09 |
$172.09 |
$447.36
|
|
Inj, clevidipine butyrate
|
$191.43 |
$191.43 |
$191.43 |
$3.39
|
|
Inj cntr knee arthro incl ct/mri
|
$109.61 |
$109.61 |
$109.61 |
$464.28
|
|
Inj cyclophosphamd (ingenus)
|
$580.74 |
$580.74 |
$580.74 |
$1,040.94
|
|
Inj disk cerv-thor ea lev
|
$135.89 |
$135.89 |
$135.89 |
$869.80
|
|
Inj dx for sinogram
|
$397.25 |
$397.25 |
$397.25 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$189.95 |
$189.95 |
$189.95 |
$507.10
|
|
Injection, belinostat, 10mg
|
$47.61 |
$47.61 |
$47.61 |
$5,341.40
|
|
Injection, cangrelor
|
$1,434.20 |
$1,434.20 |
$1,434.20 |
$2,546.20
|
|
Injection, daratumumab 10 mg
|
$3,172.97 |
$3,172.97 |
$3,172.97 |
$7,107.73
|
|
Injection, doxercalciferol
|
$12.90 |
$12.90 |
$12.90 |
$30.35
|
|
Injection during cath supravalvular aortography
|
$665.05 |
$665.05 |
$665.05 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$1,024.60 |
$1,024.60 |
$1,024.60 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$121.51 |
$121.51 |
$121.51 |
$441.12
|
|
Injection for bladder x-ray
|
$49.60 |
$49.60 |
$49.60 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$189.95 |
$189.95 |
$189.95 |
$504.00
|
|
Injection for tear sac x-ray
|
$66.96 |
$66.96 |
$66.96 |
$386.00
|
|
Injection for ureter x-ray
|
$55.05 |
$55.05 |
$55.05 |
$515.21
|
|
Injection, fulvestrant
|
$1,350.92 |
$1,350.92 |
$1,350.92 |
$2,756.47
|
|
Injection, inclisiran, 1 mg
|
$4,978.96 |
$4,978.96 |
$4,978.96 |
$10,366.61
|
|
Injection jugular
|
$48.11 |
$48.11 |
$48.11 |
$1,048.20
|
|
Injection, necitumumab, 1 mg
|
$11.91 |
$11.91 |
$11.91 |
$5.73
|
|
Injection of sinus tract
|
$558.92 |
$558.92 |
$558.92 |
$1,651.20
|
|
Injection,onabotulinumtoxina
|
$1,814.61 |
$1,814.61 |
$1,814.61 |
$2,154.07
|
|
Injection radioactive tracer sentinel node (both sides)
|
$895.16 |
$895.16 |
$895.16 |
$717.20
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$80.35 |
$80.35 |
$80.35 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$277.73 |
$277.73 |
$277.73 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$530.15 |
$530.15 |
$530.15 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$548.50 |
$548.50 |
$548.50 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$617.44 |
$617.44 |
$617.44 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$617.44 |
$617.44 |
$617.44 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$588.18 |
$588.18 |
$588.18 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$588.18 |
$588.18 |
$588.18 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$522.22 |
$522.22 |
$522.22 |
$1,829.28
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$407.16 |
$407.16 |
$407.16 |
$1,758.12
|
|
Injection, siltuximab
|
$161.18 |
$161.18 |
$161.18 |
$18,164.96
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$230.12 |
$230.12 |
$230.12 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$332.28 |
$332.28 |
$332.28 |
$552.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$132.42 |
$132.42 |
$132.42 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$131.92 |
$131.92 |
$131.92 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$379.89 |
$379.89 |
$379.89 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$132.42 |
$132.42 |
$132.42 |
$141.60
|
|
Inj epidural sgl lumb-sacral without img
|
$522.22 |
$522.22 |
$522.22 |
$1,450.84
|
|
Inj for ext venography
|
$91.26 |
$91.26 |
$91.26 |
$737.55
|
|
Inj for mammo ductogram
|
$55.55 |
$55.55 |
$55.55 |
$433.50
|
|
Inj glycopyrrolate fres kabi
|
$11.41 |
$11.41 |
$11.41 |
$96.70
|
|
Inj. herceptin hylecta, 10mg
|
$117.04 |
$117.04 |
$117.04 |
$63.79
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$598.59 |
$598.59 |
$598.59 |
$1,482.00
|
|
Inj hrt cath w/s&i sel right vent
|
$578.76 |
$578.76 |
$578.76 |
$947.65
|
|
Inj ivig privigen 500 mg
|
$2,904.97 |
$2,904.97 |
$2,904.97 |
$7,298.71
|
|
Inj mepivacaine hcl/10 ml
|
$11.41 |
$11.41 |
$11.41 |
$28.41
|
|
Inj meropenem (wg crit care)
|
$49.44 |
$49.44 |
$49.44 |
$104.29
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$342.20 |
$342.20 |
$342.20 |
$788.73
|
|
Inj multihance
|
$47.12 |
$47.12 |
$47.12 |
$119.25
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$419.56 |
$419.56 |
$419.56 |
$1,522.56
|
|
Inj ogivri 10 mg
|
$3.23 |
$3.23 |
$3.23 |
$3,968.67
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,812.86 |
$1,812.86 |
$1,812.86 |
$6,403.59
|
|
Inj. pemetrexed, 10 mg
|
$507.25 |
$507.25 |
$507.25 |
$50.83
|
|
Inj., perseris, 0.5 mg
|
$3,629.01 |
$3,629.01 |
$3,629.01 |
$12.19
|
|
Inj proc ankle arthr
|
$109.61 |
$109.61 |
$109.61 |
$405.31
|
|
Inj proc elbow arthro
|
$105.64 |
$105.64 |
$105.64 |
$453.60
|
|
Inj proc lumbr disk ea lvl
|
$135.89 |
$135.89 |
$135.89 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$231.60 |
$231.60 |
$231.60 |
$922.80
|
|
Inj proc sialogram
|
$68.44 |
$68.44 |
$68.44 |
$380.80
|
|
Inj progesterone per 50 mg
|
$7.94 |
$7.94 |
$7.94 |
$48.51
|
|
Inj, releuko 1 mcg
|
$2.48 |
$2.48 |
$2.48 |
$557.11
|
|
Inj retacrit esrd on dialysi
|
$303.77 |
$303.77 |
$303.77 |
$307.40
|
|
Inj retro urethrocysto
|
$68.44 |
$68.44 |
$68.44 |
$551.29
|
|
Inj, rimabotulinumtoxinb
|
$320.87 |
$320.87 |
$320.87 |
$16.56
|
|
Inj secretin synthetic human
|
$809.36 |
$809.36 |
$809.36 |
$741.75
|
|
Inj testostero enanthate 1mg
|
$32.74 |
$32.74 |
$32.74 |
$50.85
|
|
Inj testosterone cypionate
|
$23.81 |
$23.81 |
$23.81 |
$77.15
|
|
Inj w/fluor eval cv device
|
$345.17 |
$345.17 |
$345.17 |
$588.90
|
|
Inj xipere 1 mg
|
$2,479.41 |
$2,479.41 |
$2,479.41 |
$48.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$3,362.41 |
$3,362.41 |
$3,362.41 |
$3,429.94
|
|
Ins cath ren art 1st bi
|
$3,198.26 |
$3,198.26 |
$3,198.26 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$1,968.85 |
$1,968.85 |
$1,968.85 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$1,890.49 |
$1,890.49 |
$1,890.49 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$3,139.24 |
$3,139.24 |
$3,139.24 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$1,031.54 |
$1,031.54 |
$1,031.54 |
$544.00
|
|
Insert cath pleura with image
|
$780.60 |
$780.60 |
$780.60 |
$2,239.02
|
|
Insert cath pleura without image
|
$647.69 |
$647.69 |
$647.69 |
$2,212.00
|
|
Insertion catheter bladder non indwelling
|
$99.69 |
$99.69 |
$99.69 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$157.21 |
$157.21 |
$157.21 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$2,270.87 |
$2,270.87 |
$2,270.87 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,925.21 |
$1,925.21 |
$1,925.21 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$3,815.69 |
$3,815.69 |
$3,815.69 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,917.77 |
$1,917.77 |
$1,917.77 |
$2,618.40
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$5,708.16 |
$5,708.16 |
$5,708.16 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,451.59 |
$1,451.59 |
$1,451.59 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,451.59 |
$1,451.59 |
$1,451.59 |
$2,527.91
|
