|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$88.50 |
$88.50 |
$302.40 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$86.55 |
$86.55 |
$278.88 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$171.00 |
$171.00 |
$520.80 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$64.65 |
$64.65 |
$236.88 |
$135.60
|
|
Injection treatment of eye
|
$2,822.40 |
$2,822.40 |
$2,822.40 |
$2,698.92
|
|
Injection treatment of eye
|
$2,665.60 |
$2,665.60 |
$2,665.60 |
$2,665.60
|
|
Injection treatment of nerve
|
$5,924.80 |
$5,924.80 |
$5,924.80 |
$3,219.20
|
|
Injection treatment of nerve
|
$5,924.80 |
$5,924.80 |
$5,924.80 |
$4,350.00
|
|
Injection treatment of nerve
|
$3,337.60 |
$3,337.60 |
$3,337.60 |
$2,025.45
|
|
Injection treatment of nose
|
$2,643.20 |
$2,643.20 |
$2,643.20 |
$859.59
|
|
Inject sacroiliac joint
|
$76.35 |
$76.35 |
$414.40 |
$1,028.95
|
|
Inject/treat eye socket
|
$840.00 |
$840.00 |
$840.00 |
$381.13
|
|
Inject/treat eye socket
|
$1,741.60 |
$1,741.60 |
$1,741.60 |
$750.70
|
|
Inject/treat eye socket
|
$946.40 |
$946.40 |
$946.40 |
$670.02
|
|
Inj, eculizumab-aagh, 2 mg
|
$7,980.52 |
$7,980.52 |
$7,980.52 |
$7,980.52
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$26,469.22 |
$26,469.22 |
$26,469.22 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$6,347.93 |
$6,347.93 |
$6,347.93 |
$3,712.74
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$58,501.18 |
$58,501.18 |
$58,501.18 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$3,808.00 |
$3,808.00 |
$3,808.00 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$2,402.40 |
$2,402.40 |
$2,402.40 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$206.64 |
$206.64 |
$206.64 |
$206.64
|
|
Inj, erzofri, 1 mg
|
$10,213.70 |
$10,213.70 |
$10,213.70 |
$10,213.70
|
|
Inj, etelcalcetide, 0.1 mg
|
$363.53 |
$363.53 |
$363.53 |
$343.35
|
|
Inj, eteplirsen, 10 mg
|
$2,798.32 |
$2,798.32 |
$2,798.32 |
$2,598.44
|
|
Inj, evinacumab-dgnb, 5mg
|
$20,751.13 |
$20,751.13 |
$20,751.13 |
$20,751.13
|
|
Inj, factor x, (human), 1iu
|
$28.80 |
$28.80 |
$28.80 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$4,103.29 |
$4,103.29 |
$4,103.29 |
$4,103.29
|
|
Inj fe-based mr contrast,1ml
|
$56.56 |
$56.56 |
$179.10 |
$56.56
|
|
Inj fensolvi 0.25 mg
|
$44,262.98 |
$44,262.98 |
$44,262.98 |
$44,262.98
|
|
Inj., fibryga, 1 mg
|
$5.31 |
$5.31 |
$5.31 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$24.74 |
$24.74 |
$24.74 |
$39.54
|
|
Inj, focinvez, 1mg
|
$826.10 |
$826.10 |
$826.10 |
$3.63
|
|
Inj follitropin alfa 75 iu
|
$176.40 |
$176.40 |
$176.40 |
$176.40
|
|
Inj follitropin beta 75 iu
|
$207.20 |
$207.20 |
$207.20 |
$207.20
|
|
Inj for ext venography
|
$198.60 |
$198.60 |
$2,038.40 |
$649.95
|
|
Inj for mammo ductogram
|
$100.95 |
$100.95 |
$487.20 |
$399.60
|
|
Inj fosnetupitant, palonoset
|
$1,196.45 |
$1,196.45 |
$1,196.45 |
$1,110.99
|
|
Inj., fremanezumab-vfrm 1 mg
|
$1,322.20 |
$1,322.20 |
$1,322.20 |
$1,322.20
|
|
Inj, gadopiclenol, 1 ml
|
$1.50 |
$1.50 |
$5.60 |
$37.63
|
|
Inj ganirelix acetat 250 mcg
|
$196.00 |
$196.00 |
$196.00 |
$196.00
|
|
Inj gemcitabine hcl (accord)
|
$113.90 |
$113.90 |
$113.90 |
$130.65
|
|
Inj givosiran 0.5 mg
|
$70,795.04 |
$70,795.04 |
$70,795.04 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$4,760.67 |
$4,760.67 |
$4,760.67 |
$4,760.67
|
|
Inj glycopyrrolate fres kabi
|
$10.77 |
$10.77 |
$10.77 |
$12.18
|
|
Inj golodirsen 10 mg
|
$2,798.32 |
$2,798.32 |
$2,798.32 |
$2,798.32
|
|
Inj., guselkumab, 1 mg
|
$23,495.56 |
$23,495.56 |
$23,495.56 |
$29,130.83
|
|
Inj., haegarda 10 units
|
$6,346.38 |
$6,346.38 |
$6,346.38 |
$6,346.38
|
|
Inj, hemgenix, per tx dose
|
$4,704,002.80 |
$4,704,002.80 |
$4,704,002.80 |
$4,368,002.60
|
|
Inj. herceptin hylecta, 10mg
|
$8,193.78 |
$8,193.78 |
$8,193.78 |
$7,690.59
|
|
Inj, hercessi, 10 mg
|
$6,497.53 |
$6,497.53 |
$6,497.53 |
$6,033.42
|
|
Inj herzuma 10 mg
|
$16.80 |
$16.80 |
$16.80 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$17.70 |
$17.70 |
$369.60 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$148.40 |
$148.40 |
$473.25 |
$1,827.74
|
|
Inj hrt cath w/s&i sel hrt art
|
$20.85 |
$20.85 |
$138.32 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$110.88 |
$110.88 |
$965.25 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$9.90 |
$9.90 |
$907.20 |
$965.33
|
|
Inj human fibrinogen con nos
|
$6.27 |
$6.27 |
$6.27 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$952.50 |
$952.50 |
$1,833.87 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$675.67 |
$675.67 |
$675.67 |
$1,228.59
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$10,657.23 |
$10,657.23 |
$10,657.23 |
$3,542.09
|
|
Inj, idacio, 1 mg
|
$24.64 |
$24.64 |
$24.64 |
$14.63
|
|
Inj imip 4 cilas 4 releb 2mg
|
$555.16 |
$555.16 |
$555.16 |
$739.77
|
|
Inj, imm glob bivigam, 500mg
|
$1,355.28 |
$1,355.28 |
$1,355.28 |
$1,258.47
|
|
Inj, immphentiv, 20 mcg
|
$5.08 |
$5.08 |
$5.08 |
$18.44
|
|
Inj. inebilizumab-cdon, 1 mg
|
$75,400.39 |
$75,400.39 |
$75,400.39 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$4,575.20 |
$4,575.20 |
$4,575.20 |
$1,928.00
|
|
Inj. infugem, 100 mg
|
$1,485.86 |
$1,485.86 |
$1,485.86 |
$1,485.86
|
|
Inj. insulin (fiasp)
|
$190.61 |
$190.61 |
$190.61 |
$177.00
|
|
Inj intralesional <= 7 lsn(s)
|
$470.40 |
$470.40 |
$470.40 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$459.20 |
$459.20 |
$459.20 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$34,540.75 |
$34,540.75 |
$34,540.75 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$3,355.15 |
$3,355.15 |
$6,707.10 |
$6,967.29
|
|
Inj, ixinity, 1 i.u
|
$7.53 |
$7.53 |
$7.53 |
$6.99
|
|
Inj labetalol hcl hikma, 5mg
|
$87.47 |
$87.47 |
$87.47 |
$38.94
|
|
Inj., lanadelumab-flyo, 1 mg
|
$42,504.48 |
$42,504.48 |
$42,504.48 |
$42,504.48
|
|
Inj, lecanemab-irmb, 1 mg
|
$463.78 |
$463.78 |
$463.78 |
$1,174.88
|
|
Inj lefamulin 1 mg
|
$181.89 |
$181.89 |
$181.89 |
$181.89
|
|
Inj, lenacapavir, 1 mg
|
$31,452.40 |
$31,452.40 |
$31,452.40 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$146.62 |
$146.62 |
$146.62 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$103.60 |
$103.60 |
$103.60 |
$109.92
|
|
Inj, levothyroxine, freskabi
|
$925.16 |
$925.16 |
$925.16 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$23.81 |
$23.81 |
$56.49 |
$47.52
|
|
Inj, linezolid (hospira)
|
$165.09 |
$165.09 |
$165.09 |
$153.30
|
|
Inj. lumasiran, 0.5 mg
|
$96,930.47 |
$96,930.47 |
$96,930.47 |
$96,930.47
|
|
Inj., lumoxiti, 0.01 mg
|
$3,881.27 |
$3,881.27 |
$3,881.27 |
$3,881.27
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$397.60 |
$397.60 |
$397.60 |
$784.00
|
|
Inj. meloxicam 1 mg
|
$167.04 |
$167.04 |
$167.04 |
$167.04
|
|
Inj melpha hydroch nos 50 mg
|
$4,404.34 |
$4,404.34 |
$4,404.34 |
$1,791.90
|
|
Inj menotropins 75 iu
|
$137.20 |
$137.20 |
$137.20 |
$137.20
|
|
Inj mepivacaine hcl/10 ml
|
$23.39 |
$23.39 |
$39.45 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$45.15 |
$45.15 |
$71.14 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$391.55 |
$391.55 |
$391.55 |
$558.08
|
|
Inj meropenem (wg crit care)
|
$77.97 |
$77.97 |
$77.97 |
$77.97
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$17,547.97 |
$17,547.97 |
$17,547.97 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$8,358.59 |
$8,358.59 |
$8,358.59 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$95.20 |
$95.20 |
$95.20 |
$107.25
|
|
Inj moxifloxacin (fres kabi)
|
$95.62 |
$95.62 |
$95.62 |
$95.62
|
|
Inj multihance
|
$0.90 |
$0.90 |
$70.54 |
$73.49
|
|
Inj multihance multipack
|
$2.80 |
$2.80 |
$2.80 |
$2.80
|
