|
Injection, caplacizumab-yhdp
|
$2,730.22 |
$2,730.22 |
$2,730.22 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$208.05 |
$536.00 |
$815.00 |
|
|
Injection, daratumumab 10 mg
|
$76.92 |
$163.49 |
$8,710.36 |
|
|
Injection, doxercalciferol
|
$1.88 |
$3.76 |
$7.29 |
|
|
Injection during cath supravalvular aortography
|
$266.20 |
$696.96 |
$8,831.35 |
|
|
Injection epidural blood patch or clot
|
$756.31 |
$1,000.00 |
$3,670.24 |
|
|
Injection eye drug
|
$350.35 |
$555.00 |
$646.07 |
|
|
Injection, famotidine, 20 mg
|
$71.20 |
$71.20 |
$71.20 |
|
|
Injection for arthrography wrist (both sides)
|
$129.80 |
$460.00 |
$766.40 |
|
|
Injection for bladder x-ray
|
$152.90 |
$456.33 |
$1,989.76 |
|
|
Injection for hip x-ray
|
$611.16 |
$611.16 |
$1,314.40 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$152.90 |
$460.00 |
$1,300.09 |
|
|
Injection for spleen x-ray
|
$245.00 |
$245.00 |
$245.00 |
|
|
Injection for tear sac x-ray
|
$275.00 |
$275.00 |
$609.18 |
|
|
Injection for ureter x-ray
|
$410.85 |
$757.46 |
$1,615.00 |
|
|
Injection for ureter x-ray
|
$126.67 |
$640.00 |
$1,110.13 |
|
|
Injection, fulvestrant
|
$14.27 |
$39.39 |
$5,784.83 |
|
|
Injection glatiramer acetate
|
$112.56 |
$112.56 |
$224.05 |
|
|
Injection, glucarpidase
|
$838.89 |
$838.89 |
$838.89 |
|
|
Injection, inclisiran, 1 mg
|
$12.72 |
$19.45 |
$6,948.48 |
|
|
Injection into brain canal
|
$695.00 |
$695.00 |
$695.00 |
|
|
Injection into brain canal
|
$657.20 |
$880.00 |
$5,199.56 |
|
|
Injection into hemorrhoid(s)
|
$217.83 |
$217.83 |
$217.83 |
|
|
Injection into vocal cord
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
|
|
Injection, isavuconazonium
|
$1.71 |
$3.32 |
$600.68 |
|
|
Injection jaw joint x-ray
|
$460.00 |
$460.00 |
$541.20 |
|
|
Injection jugular
|
$98.45 |
$790.00 |
$790.00 |
|
|
Injection of HIV prep drug
|
$53.60 |
$53.60 |
$53.60 |
|
|
Injection of sinus tract
|
$500.00 |
$741.60 |
$1,602.15 |
|
|
Injection,onabotulinumtoxina
|
$10.02 |
$16.14 |
$25.63 |
|
|
Injection, peramivir
|
$5.27 |
$5.27 |
$5.27 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$257.50 |
$365.17 |
$1,942.40 |
|
|
Injection, renflexis
|
$92.74 |
$125.38 |
$147.66 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,679.70 |
$2,901.25 |
$6,291.28 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$168.01 |
$1,195.00 |
$3,544.28 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$76.85 |
$655.08 |
$3,544.28 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$836.76 |
$1,779.36 |
$6,167.70 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$84.80 |
$739.86 |
$3,955.05 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,019.15 |
$2,010.96 |
$6,508.15 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$454.74 |
$1,002.76 |
$3,955.05 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,340.07 |
$2,281.62 |
$5,979.52 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$287.26 |
$1,696.75 |
$2,258.07 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$925.10 |
$1,704.78 |
$2,258.07 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$46.64 |
$580.00 |
$1,003.19 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$222.20 |
$717.75 |
$1,263.38 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$67.84 |
$1,003.19 |
$1,120.00 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$58.85 |
$117.66 |
$213.40 |
|
|
Injection treatment of nerve
|
$4,666.37 |
$4,666.37 |
$4,666.37 |
|
|
Injection treatment of nerve
|
$2,035.00 |
$2,035.00 |
$7,530.60 |
|
|
Injection treatment of nerve
|
$1,198.40 |
$1,290.00 |
$1,290.00 |
|
|
Injection treatment of nose
|
$121.37 |
$121.37 |
$976.00 |
|
|
Inject sacroiliac joint
|
$984.39 |
$1,721.50 |
$2,250.00 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$26.85 |
$70.66 |
$31,714.52 |
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$190.48 |
$190.48 |
$190.48 |
|
|
Inj epidural sgl cerv-thor without img
|
$134.09 |
$1,097.80 |
$2,258.07 |
|
|
Inj epidural sgl lumb-sacral without img
|
$139.92 |
$1,072.50 |
$2,258.07 |
|
|
Inj, epinephrine (belcher)
|
$2.88 |
$2.88 |
$4.60 |
|
|
Inj. fe derisomaltose 10 mg
|
$80.29 |
$80.29 |
$80.29 |
|
|
Inj for ext venography
|
$116.05 |
$610.00 |
$1,852.50 |
|
|
Inj for mammo ductogram
|
$172.50 |
$231.00 |
$1,312.81 |
|
|
Inj, fosaprepitant (teva)
|
$0.96 |
$0.96 |
$0.96 |
|
|
Inj, fulvestrant (fresenius)
|
$1,185.24 |
$1,185.24 |
$1,185.24 |
|
|
Inj, gadopiclenol, 1 ml
|
$18.80 |
$19.25 |
$303.51 |
|
|
Inj gemcitabine hcl (accord)
|
$54.68 |
$54.68 |
$420.01 |
|
|
Inj glycopyrrolate fres kabi
|
$36.93 |
$36.93 |
$36.93 |
|
|
Inj., guselkumab, 1 mg
|
$67.42 |
$91.93 |
$483.07 |
|
|
Inj heparin, pfizer, 1000u
|
$3.23 |
$3.23 |
$3.23 |
|
|
Inj. herceptin hylecta, 10mg
|
$129.68 |
$147.25 |
$173.38 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$446.88 |
$1,028.94 |
$3,306.05 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$307.23 |
$307.23 |
$7,695.60 |
|
|
Inj hrt cath w/s&i sel left vent
|
$536.80 |
$793.32 |
$1,927.17 |
|
|
Inj hrt cath w/s&i sel right vent
|
$510.39 |
$856.68 |
$3,024.71 |
|
|
Inj hydroxocobalamin IV 25mg
|
$15.03 |
$15.03 |
$16.28 |
|
|
Inj hydroxyprogst capoat nos
|
$11.13 |
$11.13 |
$14.25 |
|
|
Inj. inebilizumab-cdon, 1 mg
|
$907.13 |
$907.13 |
$1,617.95 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$444.14 |
$444.14 |
$444.14 |
|
|
Inj intralesional <= 7 lsn(s)
|
$69.96 |
$380.60 |
$1,390.00 |
|
|
Inj intralesional > 7 lsns
|
$47.17 |
$406.45 |
$406.45 |
|
|
Inj, invega hafyera/trinza
|
$12.00 |
$12.00 |
$24.16 |
|
|
Inj ivig privigen 500 mg
|
$57.00 |
$135.29 |
$6,340.13 |
|
|
Inj, kovaltry, 1 i.u
|
$4.87 |
$4.87 |
$5.23 |
|
|
Inj labetalol hcl hikma, 5mg
|
$1.70 |
$7.53 |
$45.82 |
|
|
Inj, lanreotide, (cipla) 1mg
|
$146.88 |
$146.88 |
$146.88 |
|
|
Inj, lecanemab-irmb, 1 mg
|
$2.86 |
$3.52 |
$82.58 |
|
|
Inj levocarnitine per 1 gm
|
$75.97 |
$76.17 |
$81.19 |
|
|
Inj, levothyroxine, freskabi
|
$18.73 |
$25.96 |
$26.34 |
|
|
Inj, levothyroxine, hikma
|
$36.50 |
$36.50 |
$36.50 |
|
|
Inj, lidocaine w epinephrine
|
$0.24 |
$1.80 |
$194.99 |
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$622.40 |
$650.00 |
$3,866.50 |
|
|
Inj mepivacaine hcl/10 ml
|
$3.64 |
$30.13 |
$75.80 |
|
|
Inj., meropenem, vaborbactam
|
$3.77 |
$3.77 |
$749.26 |
|
|
Inj meropenem (wg crit care)
|
$8.01 |
$8.01 |
$8.01 |
|
|
Inj, moxifloxacin 100 mg
|
$10.60 |
$35.11 |
$53.05 |
|
|
Inj moxifloxacin (fres kabi)
|
$61.17 |
$61.17 |
$61.17 |
|
|
Inj multihance
|
$10.10 |
$10.10 |
$410.96 |
|
|
Inj naloxone hydrochloride
|
$18.24 |
$38.48 |
$87.60 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$688.60 |
$925.00 |
$4,003.40 |
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$975.00 |
$975.00 |
$7,442.40 |
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$885.00 |
$885.00 |
$7,087.20 |
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$68.65 |
$68.65 |
$68.65 |
|
