|
Inj, biorphen, 20 micrograms
|
$13.68 |
$13.68 |
$13.68 |
$17.12
|
|
Inj calcitriol per 0.1 mcg
|
$8.20 |
$8.20 |
$8.20 |
$22.69
|
|
Inj cefazolin sodium, hikma
|
$24.01 |
$24.01 |
$24.01 |
$29.10
|
|
Inj, cefiderocol, 10 mg
|
$474.47 |
$474.47 |
$474.47 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$342.69 |
$342.69 |
$342.69 |
$408.00
|
|
Inj, clindamycin (baxter)
|
$35.69 |
$35.69 |
$35.69 |
$48.39
|
|
Inj crotalidae im f(ab')2 eq
|
$2,613.60 |
$2,613.60 |
$2,613.60 |
$2,613.60
|
|
Inj dx for sinogram
|
$460.50 |
$460.50 |
$460.50 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,141.35 |
$1,141.35 |
$1,141.35 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$724.65 |
$724.65 |
$724.65 |
$500.50
|
|
Injection, cangrelor
|
$1,889.78 |
$1,889.78 |
$1,889.78 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$16,319.16 |
$16,319.16 |
$16,319.16 |
$16,642.50
|
|
Injection, daratumumab 10 mg
|
$1,408.08 |
$1,408.08 |
$1,408.08 |
$5,164.24
|
|
Injection, doxercalciferol
|
$9.52 |
$9.52 |
$9.52 |
$23.12
|
|
Injection during cath supravalvular aortography
|
$1,087.65 |
$1,087.65 |
$1,087.65 |
$904.17
|
|
Injection epidural blood patch or clot
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,156.80
|
|
Injection for arthrography wrist (both sides)
|
$487.95 |
$487.95 |
$487.95 |
$441.12
|
|
Injection for bladder x-ray
|
$445.95 |
$445.95 |
$445.95 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$591.75 |
$591.75 |
$591.75 |
$494.65
|
|
Injection for ureter x-ray
|
$415.80 |
$415.80 |
$415.80 |
$415.80
|
|
Injection for ureter x-ray
|
$708.75 |
$708.75 |
$708.75 |
$515.21
|
|
Injection, fulvestrant
|
$1,919.66 |
$1,919.66 |
$1,919.66 |
$1,719.16
|
|
Injection glatiramer acetate
|
$865.10 |
$865.10 |
$865.10 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$6,679.35 |
$6,679.35 |
$6,679.35 |
$6,679.35
|
|
Injection into brain canal
|
$746.85 |
$746.85 |
$746.85 |
$836.40
|
|
Injection, isavuconazonium
|
$787.67 |
$787.67 |
$787.67 |
$787.67
|
|
Injection jugular
|
$191.85 |
$191.85 |
$191.85 |
$790.00
|
|
Injection, necitumumab, 1 mg
|
$8,572.91 |
$8,572.91 |
$8,572.91 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$2,510.64 |
$2,510.64 |
$2,510.64 |
$2,241.61
|
|
Injection, peramivir
|
$684.00 |
$684.00 |
$684.00 |
$775.82
|
|
Injection radioactive tracer sentinel node (both sides)
|
$731.25 |
$731.25 |
$731.25 |
$683.28
|
|
Injection, renflexis
|
$1,491.72 |
$1,491.72 |
$1,491.72 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$741.45 |
$741.45 |
$741.45 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$741.45 |
$741.45 |
$741.45 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,438.95 |
$1,438.95 |
$1,438.95 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,001.25 |
$1,001.25 |
$1,001.25 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$441.30 |
$441.30 |
$441.30 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$146.85 |
$146.85 |
$146.85 |
$135.20
|
|
Inject sacroiliac joint
|
$2,255.55 |
$2,255.55 |
$2,255.55 |
$963.00
|
|
Inj epidural sgl cerv-thor without img
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,001.25 |
$1,001.25 |
$1,001.25 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$237.60 |
$237.60 |
$237.60 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$212.36 |
$212.36 |
$212.36 |
$343.35
|
|
Inj for ext venography
|
$518.10 |
$518.10 |
$518.10 |
$654.00
|
|
Inj herzuma 10 mg
|
$7,775.46 |
$7,775.46 |
$7,775.46 |
$7,775.46
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,045.80 |
$1,045.80 |
$1,045.80 |
$1,045.80
|
|
Inj hrt cath w/s&i sel right vent
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$947.05
|
|
Inj human fibrinogen con nos
|
$3.95 |
$3.95 |
$3.95 |
$3.95
|
|
Inj hydroxyprogst capoat nos
|
$1,589.94 |
$1,589.94 |
$1,589.94 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$662.97 |
$662.97 |
$662.97 |
$662.97
|
|
Inj ivig privigen 500 mg
|
$6,967.29 |
$6,967.29 |
$6,967.29 |
$6,967.29
|
|
Inj levoleucovorin nos 0.5mg
|
$117.00 |
$117.00 |
$117.00 |
$103.60
|
|
Inj, levothyroxine, freskabi
|
$59.87 |
$59.87 |
$59.87 |
$363.97
|
|
Inj. meloxicam 1 mg
|
$203.04 |
$203.04 |
$203.04 |
$167.04
|
|
Inj melpha hydroch nos 50 mg
|
$4,962.63 |
$4,962.63 |
$4,962.63 |
$2,375.23
|
|
Inj mepivacaine hcl/10 ml
|
$33.86 |
$33.86 |
$33.86 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$466.56 |
$466.56 |
$466.56 |
$536.27
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$8,922.99 |
$8,922.99 |
$8,922.99 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$107.25 |
$107.25 |
$107.25 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$466.47 |
$466.47 |
$466.47 |
$252.66
|
|
Inj naloxone hydrochloride
|
$83.16 |
$83.16 |
$83.16 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,657.05 |
$1,657.05 |
$1,657.05 |
$1,414.40
|
|
Inj octafluoropropane mic,ml
|
$421.20 |
$421.20 |
$421.20 |
$211.40
|
|
Inj ogivri 10 mg
|
$5,197.61 |
$5,197.61 |
$5,197.61 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$865.34 |
$865.34 |
$865.34 |
$865.34
|
|
Inj ontruzant 10 mg
|
$7,343.90 |
$7,343.90 |
$7,343.90 |
$6,706.27
|
|
Inj proc ankle arthr
|
$469.05 |
$469.05 |
$469.05 |
$405.31
|
|
Inj proc elbow arthro
|
$497.55 |
$497.55 |
$497.55 |
$432.00
|
|
Inj proc for lymphang
|
$445.95 |
$445.95 |
$445.95 |
$805.80
|
|
Inj proc myelogram lumbar
|
$651.90 |
$651.90 |
$651.90 |
$856.00
|
|
Inj progesterone per 50 mg
|
$6.00 |
$6.00 |
$6.00 |
$14.93
|
|
Inj retro urethrocysto
|
$384.60 |
$384.60 |
$384.60 |
$450.00
|
|
Inj, rimabotulinumtoxinb
|
$672.44 |
$672.44 |
$672.44 |
$714.24
|
|
Inj scleros sol mult veins
|
$237.15 |
$237.15 |
$237.15 |
$602.50
|
|
Inj scleros sol sgl vein
|
$244.80 |
$244.80 |
$244.80 |
$534.40
|
|
Inj, sezaby, 1 mg
|
$288.11 |
$288.11 |
$288.11 |
$235.85
|
|
Inj tedizolid phosphate
|
$664.72 |
$664.72 |
$664.72 |
$664.72
|
|
Inj testostero enanthate 1mg
|
$8.29 |
$8.29 |
$8.29 |
$157.81
|
|
Inj testosterone cypionate
|
$54.70 |
$54.70 |
$54.70 |
$62.80
|
|
Inj, vancomycin hcl (xellia)
|
$70.56 |
$70.56 |
$70.56 |
$85.20
|
|
Inj w/fluor eval cv device
|
$198.60 |
$198.60 |
$198.60 |
$463.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$44,026.28 |
$44,026.28 |
$44,026.28 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$261.15 |
$261.15 |
$261.15 |
$488.35
|
|
Insert cath pleura with image
|
$2,414.10 |
$2,414.10 |
$2,414.10 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,825.70 |
$2,825.70 |
$2,825.70 |
$2,019.00
|
|
Insert hepatic shunt (tips)
|
$4,419.15 |
$4,419.15 |
$4,419.15 |
$8,367.70
|
