|
Influenza dna amp prob addl
|
$57.40 |
$57.40 |
$57.40 |
$69.60
|
|
Influenza virus vaccine, live trivalent intranasal
|
$8.70 |
$8.70 |
$8.70 |
$40.89
|
|
Inf lwr xtr fscl pln blk uni w/wo image
|
$390.60 |
$390.60 |
$390.60 |
$780.00
|
|
Inf thrc fascial pln blk bi w/wo image
|
$520.80 |
$520.80 |
$520.80 |
$624.00
|
|
Inf thrc fascial pln blk uni w/wo image
|
$390.60 |
$390.60 |
$390.60 |
$820.80
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$396.90 |
$396.90 |
$396.90 |
$359.64
|
|
Initiation & management bipap/cpap initial day
|
$754.60 |
$754.60 |
$754.60 |
$645.79
|
|
Inj, adstiladrin, per tx dos
|
$141,923.56 |
$141,923.56 |
$141,923.56 |
$63,354.77
|
|
Inj alymsys 10 mg
|
$1,860.13 |
$1,860.13 |
$1,860.13 |
$928.80
|
|
Inj anifrolumab-fnia 1mg
|
$7,499.98 |
$7,499.98 |
$7,499.98 |
$9,878.82
|
|
Inj, bezlotoxumab, 10 mg
|
$9,702.65 |
$9,702.65 |
$9,702.65 |
$9,702.65
|
|
Inj, bortezomib freseniuskab
|
$2,099.22 |
$2,099.22 |
$2,099.22 |
$16.50
|
|
Inj calcitriol per 0.1 mcg
|
$31.69 |
$31.69 |
$31.69 |
$33.36
|
|
Inj cefazolin sodium, hikma
|
$26.21 |
$26.21 |
$61.60 |
$56.70
|
|
Inj cefazolin (wg crit care)
|
$33.94 |
$33.94 |
$113.48 |
$32.05
|
|
Inj, cefepime hcl (b braun)
|
$268.25 |
$268.25 |
$268.25 |
$81.41
|
|
Inj, cefiderocol, 10 mg
|
$315.28 |
$315.28 |
$1,181.16 |
$718.84
|
|
Inj ceftolozane tazobactam
|
$233.01 |
$233.01 |
$233.01 |
$447.36
|
|
Inj cntr knee arthro incl ct/mri
|
$55.30 |
$55.30 |
$55.30 |
$464.28
|
|
Inj crotalidae im f(ab')2 eq
|
$3,421.96 |
$3,421.96 |
$17,124.69 |
$2,836.95
|
|
Inj, cyclophosphamd, sandoz
|
$423.66 |
$423.66 |
$423.66 |
$4.34
|
|
Inj, daptomycin (hospira)
|
$205.21 |
$205.21 |
$292.84 |
$167.85
|
|
Inj, donanemab-azbt, 2 mg
|
$1,044.16 |
$1,044.16 |
$1,044.16 |
$121.74
|
|
Inj dx for sinogram
|
$295.05 |
$295.05 |
$295.05 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$386.05 |
$386.05 |
$386.05 |
$507.10
|
|
Injection, belinostat, 10mg
|
$5,276.22 |
$5,276.22 |
$5,276.22 |
$5,341.40
|
|
Injection, cangrelor
|
$1,303.21 |
$1,303.21 |
$1,303.21 |
$2,546.20
|
|
Injection, daratumumab 10 mg
|
$1,907.11 |
$1,907.11 |
$1,907.11 |
$7,107.73
|
|
Injection, doxercalciferol
|
$30.62 |
$30.62 |
$30.62 |
$30.35
|
|
Injection during cath supravalvular aortography
|
$1,364.30 |
$1,364.30 |
$1,364.30 |
$1,148.80
|
|
Injection epidural blood patch or clot
|
$862.05 |
$862.05 |
$862.05 |
$1,473.12
|
|
Injection for arthrography wrist (both sides)
|
$158.90 |
$158.90 |
$158.90 |
$441.12
|
|
Injection for bladder x-ray
|
$471.80 |
$471.80 |
$471.80 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$503.30 |
$503.30 |
$503.30 |
$504.00
|
|
Injection for ureter x-ray
|
$51.10 |
$51.10 |
$51.10 |
$515.21
|
|
Injection, fulvestrant
|
$2,550.36 |
$2,550.36 |
$2,550.36 |
$2,756.47
|
|
Injection glatiramer acetate
|
$358.05 |
$358.05 |
$358.05 |
$405.93
|
|
Injection, inclisiran, 1 mg
|
$4,940.02 |
$4,940.02 |
$4,940.02 |
$10,366.61
|
|
Injection, isavuconazonium
|
$482.37 |
$482.37 |
$482.37 |
$646.20
|
|
Injection,onabotulinumtoxina
|
$1,691.35 |
$1,691.35 |
$1,691.35 |
$2,154.07
|
|
Injection, peramivir
|
$1,418.92 |
$1,418.92 |
$1,418.92 |
$1,257.68
|
|
Injection radioactive tracer sentinel node (both sides)
|
$477.75 |
$477.75 |
$477.75 |
$717.20
|
|
Injection, renflexis
|
$1,205.90 |
$1,205.90 |
$1,205.90 |
$1,457.42
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,160.20 |
$2,160.20 |
$2,160.20 |
$1,160.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$570.15 |
$570.15 |
$570.15 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$516.25 |
$516.25 |
$516.25 |
$1,017.28
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$936.25 |
$936.25 |
$936.25 |
$2,251.00
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,030.05 |
$1,030.05 |
$1,030.05 |
$1,131.41
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$936.25 |
$936.25 |
$936.25 |
$1,961.05
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$256.20 |
$256.20 |
$256.20 |
$1,119.88
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$449.05 |
$449.05 |
$449.05 |
$2,154.68
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,877.75 |
$1,877.75 |
$3,123.53 |
$1,758.12
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$158.55 |
$158.55 |
$158.55 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$355.95 |
$355.95 |
$355.95 |
$552.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$306.60 |
$306.60 |
$306.60 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$93.45 |
$93.45 |
$93.45 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$306.60 |
$306.60 |
$306.60 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$306.60 |
$306.60 |
$306.60 |
$141.60
|
|
Inject/treat eye socket
|
$262.15 |
$262.15 |
$262.15 |
$365.40
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$38,221.73 |
$38,221.73 |
$38,221.73 |
$15,669.18
|
|
Inj for ext venography
|
$649.95 |
$649.95 |
$649.95 |
$737.55
|
|
Inj for mammo ductogram
|
$87.50 |
$87.50 |
$87.50 |
$433.50
|
|
Inj, fosaprepitant (teva)
|
$115.36 |
$115.36 |
$115.36 |
$2.04
|
|
Inj heparin, pfizer, 1000u
|
$12.15 |
$12.15 |
$24.28 |
$24.28
|
|
Inj. herceptin hylecta, 10mg
|
$12,149.65 |
$12,149.65 |
$12,149.65 |
$63.79
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,691.90 |
$1,691.90 |
$1,691.90 |
$1,482.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,883.00 |
$1,883.00 |
$1,883.00 |
$1,837.17
|
|
Inj hrt cath w/s&i sel hrt art
|
$2,005.85 |
$2,005.85 |
$2,005.85 |
$1,192.50
|
|
Inj hrt cath w/s&i sel left vent
|
$982.45 |
$982.45 |
$982.45 |
$1,214.40
|
|
Inj hrt cath w/s&i sel right vent
|
$941.50 |
$941.50 |
$941.50 |
$947.65
|
|
Inj human fibrinogen con nos
|
$126.10 |
$126.10 |
$126.10 |
$1.52
|
|
Inj hydroxocobalamin IV 25mg
|
$3,654.20 |
$3,654.20 |
$3,654.20 |
$3,180.35
|
|
Inj imip 4 cilas 4 releb 2mg
|
$457.80 |
$457.80 |
$457.80 |
$1,004.42
|
|
Inj, immphentiv, 20 mcg
|
$24.52 |
$24.52 |
$37.12 |
$32.83
|
|
Inj. inebilizumab-cdon, 1 mg
|
$115,324.19 |
$115,324.19 |
$115,324.19 |
$494.43
|
|
Inj intralesional <= 7 lsn(s)
|
$157.15 |
$157.15 |
$157.15 |
$241.74
|
|
Inj ivig privigen 500 mg
|
$10,879.50 |
$10,879.50 |
$10,879.50 |
$7,298.71
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,729.21 |
$1,729.21 |
$1,729.21 |
$1,729.21
|
|
Inj levocarnitine per 1 gm
|
$51.76 |
$51.76 |
$485.49 |
$138.96
|
|
Inj, levothyroxine, freskabi
|
$115.33 |
$115.33 |
$115.33 |
$302.07
|
|
Inj luxturna 1 billion vec g
|
$159,939.86 |
$159,939.86 |
$159,939.86 |
$3,084.46
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$390.60 |
$390.60 |
$390.60 |
$625.00
|
|
Inj melpha hydroch nos 50 mg
|
$3,856.04 |
$3,856.04 |
$3,856.04 |
$1,518.68
|
|
Inj mepivacaine hcl/10 ml
|
$1,485.81 |
$1,485.81 |
$1,485.81 |
$28.41
|
|
Inj., meropenem, vaborbactam
|
$281.22 |
$281.22 |
$281.22 |
$618.43
|
|
Inj meropenem (wg crit care)
|
$24.84 |
$24.84 |
$219.13 |
$104.29
|
|
Inj, moxifloxacin 100 mg
|
$54.12 |
$54.12 |
$54.12 |
$190.81
|
|
Inj multihance
|
$64.28 |
$64.28 |
$64.28 |
$119.25
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$751.45 |
$751.45 |
$751.45 |
$1,522.56
|
|
Inj, nithiodote, 3mg / 125mg
|
$1,063.12 |
$1,063.12 |
$1,063.12 |
$389.50
|
|
Inj ogivri 10 mg
|
$3,968.67 |
$3,968.67 |
$3,968.67 |
$3,968.67
|
|
Inj pantoprazole(hikma) 40mg
|
$22.50 |
$22.50 |
$22.50 |
$36.04
|
|
Inj., patisiran, 0.1 mg
|
$24,790.29 |
$24,790.29 |
$24,790.29 |
$11,742.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$7,258.20 |
$7,258.20 |
$7,258.20 |
$6,403.59
|
|
Inj proc ankle arthr
|
$86.80 |
$86.80 |
$86.80 |
$405.31
|
|
Inj proc elbow arthro
|
$137.55 |
$137.55 |
$137.55 |
$453.60
|
|
Inj proc for lymphang
|
$113.40 |
$113.40 |
$113.40 |
$1,372.00
|
|
Inj proc lumbr disk ea lvl
|
$1,165.15 |
$1,165.15 |
$1,165.15 |
$1,224.30
|
|
Inj proc myelogram lumbar
|
$914.55 |
$914.55 |
$914.55 |
$922.80
|
|
Inj proc sialogram
|
$68.60 |
$68.60 |
$68.60 |
$380.80
|
