|
Inj, bezlotoxumab, 10 mg
|
$7,524.00 |
$7,524.00 |
$7,524.00 |
$7,612.43
|
|
Inj, biorphen, 20 micrograms
|
$13.68 |
$13.68 |
$13.68 |
$17.12
|
|
Inj calcitriol per 0.1 mcg
|
$8.20 |
$8.20 |
$8.20 |
$23.28
|
|
Inj cefazolin sodium, hikma
|
$24.01 |
$24.01 |
$24.01 |
$28.51
|
|
Inj, cefiderocol, 10 mg
|
$474.47 |
$474.47 |
$474.47 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$342.69 |
$342.69 |
$342.69 |
$381.60
|
|
Inj, clindamycin (baxter)
|
$35.69 |
$35.69 |
$35.69 |
$48.96
|
|
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 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 |
$16,319.16
|
|
Injection, daratumumab 10 mg
|
$1,408.08 |
$1,408.08 |
$1,408.08 |
$5,188.91
|
|
Injection, doxercalciferol
|
$9.52 |
$9.52 |
$9.52 |
$23.83
|
|
Injection epidural blood patch or clot
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,153.03
|
|
Injection for arthrography wrist (both sides)
|
$487.95 |
$487.95 |
$487.95 |
$438.00
|
|
Injection for bladder x-ray
|
$445.95 |
$445.95 |
$445.95 |
$459.20
|
|
Injection for hip x-ray
|
$1,327.50 |
$1,327.50 |
$1,327.50 |
$662.40
|
|
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, 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 |
$844.50
|
|
Injection, isavuconazonium
|
$787.67 |
$787.67 |
$787.67 |
$787.67
|
|
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 |
$2,277.65
|
|
Injection, peramivir
|
$684.00 |
$684.00 |
$684.00 |
$775.82
|
|
Injection radioactive tracer sentinel node (both sides)
|
$731.25 |
$731.25 |
$731.25 |
$699.68
|
|
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) tendon sheath/ligament aponeurosis single (both sides)
|
$441.30 |
$441.30 |
$441.30 |
$478.20
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$546.40
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$634.40
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$163.83
|
|
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 |
$136.00
|
|
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 herzuma 10 mg
|
$7,775.46 |
$7,775.46 |
$7,775.46 |
$7,775.46
|
|
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 |
$693.72
|
|
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 |
$320.80
|
|
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 |
$1,791.90
|
|
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 |
$1,413.35
|
|
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 |
$405.60
|
|
Inj proc elbow arthro
|
$497.55 |
$497.55 |
$497.55 |
$434.00
|
|
Inj proc myelogram lumbar
|
$651.90 |
$651.90 |
$651.90 |
$843.84
|
|
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 |
$746.79
|
|
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 |
$64.80
|
|
Inj, vancomycin hcl (xellia)
|
$70.56 |
$70.56 |
$70.56 |
$85.20
|
|
Inj w/fluor eval cv device
|
$198.60 |
$198.60 |
$198.60 |
$504.40
|
|
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 |
$5,855.00
|
|
Ins cath ren art 1st uni
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,475.60
|
|
Ins cath ren art 2nd+ uni
|
$5,395.20 |
$5,395.20 |
$5,395.20 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$261.15 |
$261.15 |
$261.15 |
$484.90
|
|
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 |
$2,056.00
|
|
Insertion catheter bladder non indwelling
|
$205.20 |
$205.20 |
$205.20 |
$205.80
|
|
Insertion catheter bladder temporary simple
|
$188.70 |
$188.70 |
$188.70 |
$235.20
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,035.45 |
$4,035.45 |
$4,035.45 |
$4,782.00
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$8,028.15 |
$8,028.15 |
$8,028.15 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,899.95 |
$2,899.95 |
$2,899.95 |
$2,511.00
|
|
Insertion of catheter vein
|
$1,953.90 |
$1,953.90 |
$1,953.90 |
$1,657.32
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,510.55 |
$2,510.55 |
$2,510.55 |
$2,079.43
|
|
Insert pessary/other device
|
$234.30 |
$234.30 |
$234.30 |
$278.90
|
|
Insert swan-ganz cath
|
$3,286.50 |
$3,286.50 |
$3,286.50 |
$2,346.51
|
|
In situ hybridization per specimen each additional single probe stain
|
$416.40 |
$416.40 |
$416.40 |
$241.80
|
|
In situ hybridization per specimen initial single probe stain
|
$353.40 |
$353.40 |
$353.40 |
$337.20
|
|
Instill, bupivac and meloxic
|
$637.01 |
$637.01 |
$637.01 |
$687.60
|
|
Ins tun cv cath wo subq prt/pm
|
$3,045.90 |
$3,045.90 |
$3,045.90 |
$4,218.00
|
|
Insulin total
|
$22.14 |
$22.14 |
$22.14 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$5,124.80 |
$5,124.80 |
$5,124.80 |
$8,683.20
|
|
Integra meshed bil wound mat
|
$486.69 |
$486.69 |
$486.69 |
$9,924.16
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$4,440.00 |
$4,440.00 |
$4,440.00 |
$3,803.11
|
|
Interferon alfa-2b inj
|
$1,409.92 |
$1,409.92 |
$1,409.92 |
$1,409.92
|
|
Interferon alfa-n3 inj
|
$59.64 |
$59.64 |
$59.64 |
$59.64
|
