|
Injection epidural blood patch or clot
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,182.33
|
|
Injection eye drug
|
$1,240.20 |
$1,240.20 |
$1,240.20 |
$654.00
|
|
Injection, famotidine, 20 mg
|
$4.55 |
$4.55 |
$4.55 |
$24.14
|
|
Injection for arthrography wrist (both sides)
|
$517.40 |
$517.40 |
$517.40 |
$436.00
|
|
Injection for bladder x-ray
|
$851.50 |
$851.50 |
$851.50 |
$459.20
|
|
Injection for hip x-ray
|
$390.00 |
$390.00 |
$390.00 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$618.15 |
$618.15 |
$618.15 |
$497.76
|
|
Injection for ureter x-ray
|
$427.70 |
$427.70 |
$427.70 |
$415.80
|
|
Injection for ureter x-ray
|
$811.85 |
$811.85 |
$811.85 |
$515.21
|
|
Injection, fulvestrant
|
$477.10 |
$477.10 |
$9,053.00 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,194.10 |
$1,194.10 |
$1,194.10 |
$830.51
|
|
Injection, glucarpidase
|
$101,165.22 |
$101,165.22 |
$101,165.22 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$5,596.85 |
$5,596.85 |
$5,596.85 |
$6,679.35
|
|
Injection into brain canal
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,289.60
|
|
Injection into brain canal
|
$1,654.90 |
$1,654.90 |
$1,654.90 |
$844.50
|
|
Injection into hemorrhoid(s)
|
$3,407.95 |
$3,407.95 |
$3,407.95 |
$1,433.00
|
|
Injection jugular
|
$1,880.45 |
$1,880.45 |
$1,880.45 |
$790.00
|
|
Injection of sinus tract
|
$332.80 |
$332.80 |
$332.80 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$3,046.68 |
$3,046.68 |
$3,046.68 |
$2,277.65
|
|
Injection, peramivir
|
$37.05 |
$37.05 |
$37.05 |
$744.75
|
|
Injection px peyronie ds
|
$909.35 |
$909.35 |
$909.35 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,305.85 |
$1,305.85 |
$1,305.85 |
$685.44
|
|
Injection, renflexis
|
$1,762.94 |
$1,762.94 |
$7,823.00 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$2,250.95 |
$2,250.95 |
$2,250.95 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$533.00 |
$533.00 |
$533.00 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,411.15 |
$1,411.15 |
$1,411.15 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,685.00
|
|
Injection, siltuximab
|
$20,494.92 |
$20,494.92 |
$20,494.92 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,103.70 |
$1,103.70 |
$1,103.70 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,103.70 |
$1,103.70 |
$1,103.70 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,103.70 |
$1,103.70 |
$1,103.70 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$396.50 |
$396.50 |
$396.50 |
$145.60
|
|
Injection treatment of eye
|
$8,524.10 |
$8,524.10 |
$8,524.10 |
$2,698.92
|
|
Injection treatment of eye
|
$8,524.10 |
$8,524.10 |
$8,524.10 |
$2,685.92
|
|
Injection treatment of nerve
|
$1,469.00 |
$1,469.00 |
$1,469.00 |
$3,219.20
|
|
Injection treatment of nerve
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$4,446.30
|
|
Injection treatment of nerve
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$2,054.00
|
|
Inject sacroiliac joint
|
$1,566.50 |
$1,566.50 |
$1,566.50 |
$1,029.04
|
|
Inject/treat eye socket
|
$1,117.35 |
$1,117.35 |
$1,117.35 |
$381.13
|
|
Inject/treat eye socket
|
$1,117.35 |
$1,117.35 |
$1,117.35 |
$670.02
|
|
Inj, eculizumab-aagh, 2 mg
|
$474.86 |
$474.86 |
$474.86 |
$7,980.52
|
|
Inj, eculizumab-aeeb, 2 mg
|
$610.56 |
$610.56 |
$610.56 |
$610.56
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$6,857.14 |
$6,857.14 |
$6,857.14 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$4,341.87 |
$4,341.87 |
$4,341.87 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$42,437.44 |
$42,437.44 |
$42,437.44 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$170.63 |
$170.63 |
$170.63 |
$206.64
|
|
Inj, eteplirsen, 10 mg
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$2,598.44
|
|
Inj, exagamglogene autotem
|
$6,864,000.00 |
$6,864,000.00 |
$6,864,000.00 |
$3,218,160.00
|
|
Inj, factor x, (human), 1iu
|
$26.64 |
$26.64 |
$26.64 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$109,834.45 |
$109,834.45 |
$109,834.45 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$854.61 |
$854.61 |
$854.61 |
$3,221.52
|
|
Inj fensolvi 0.25 mg
|
$67,427.61 |
$67,427.61 |
$67,427.61 |
$44,262.98
|
|
Inj fluphenazine hcl 1.25 mg
|
$44.95 |
$44.95 |
$44.95 |
$40.33
|
|
Inj, focinvez, 1mg
|
$22.05 |
$22.05 |
$22.05 |
$3.63
|
|
Inj for ext venography
|
$1,792.70 |
$1,792.70 |
$1,792.70 |
$628.80
|
|
Inj for mammo ductogram
|
$395.20 |
$395.20 |
$395.20 |
$397.80
|
|
Inj, fosaprepitant (teva)
|
$152.10 |
$152.10 |
$152.10 |
$152.10
|
|
Inj., fremanezumab-vfrm 1 mg
|
$1,178.03 |
$1,178.03 |
$1,178.03 |
$1,322.20
|
|
Inj, fulvestrant (fresenius)
|
$604.99 |
$604.99 |
$905.30 |
$905.30
|
|
Inj, fulvestrant (teva)
|
$905.30 |
$905.30 |
$905.30 |
$136.50
|
|
Inj, gadopiclenol, 1 ml
|
$25.84 |
$25.84 |
$25.84 |
$37.63
|
|
Inj, ganciclovir (exela)
|
$1,113.00 |
$1,113.00 |
$1,113.00 |
$354.00
|
|
Inj givosiran 0.5 mg
|
$102,711.96 |
$102,711.96 |
$102,711.96 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$3,382.50 |
$3,382.50 |
$3,382.50 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$34,085.47 |
$34,085.47 |
$34,085.47 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$12.17 |
$12.17 |
$31.00 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$2,917.36 |
$2,917.36 |
$2,917.36 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$9,528.79 |
$9,528.79 |
$9,528.79 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,688.10 |
$3,688.10 |
$3,688.10 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$260.00 |
$260.00 |
$260.00 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$267.80 |
$267.80 |
$267.80 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$143.00 |
$143.00 |
$143.00 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$3,272.75 |
$3,272.75 |
$3,272.75 |
$999.96
|
|
Inj human fibrinogen con nos
|
$3.55 |
$3.55 |
$3.55 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$2,452.32 |
$2,452.32 |
$2,452.32 |
$2,452.32
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$2,682.21 |
$2,682.21 |
$2,682.21 |
$3,542.09
|
|
Inj imip 4 cilas 4 releb 2mg
|
$739.77 |
$739.77 |
$2,599.00 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$10,939.38 |
$10,939.38 |
$10,939.38 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$666.25 |
$666.25 |
$666.25 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$484.25 |
$484.25 |
$484.25 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$484.25 |
$484.25 |
$484.25 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$10,022.18 |
$10,022.18 |
$10,022.18 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$46.23 |
$46.23 |
$46.23 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$2.48 |
$2.48 |
$2.48 |
$41.79
|
|
Inj, lanreotide, (cipla) 1mg
|
$41,617.64 |
$41,617.64 |
$41,617.64 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$308.70 |
$308.70 |
$308.70 |
$1,174.88
|
|
Inj, lenacapavir, 1 mg
|
$15,210.00 |
$15,210.00 |
$15,210.00 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$18.19 |
$18.19 |
$1,233.00 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$103.76 |
$103.76 |
$103.76 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$3.04 |
$3.04 |
$168.17 |
$45.60
|
|
Inj, linezolid (hospira)
|
$477.00 |
$477.00 |
$477.00 |
$153.30
|
|
Inj, lovotibeglogene autotem
|
$9,672,000.00 |
$9,672,000.00 |
$9,672,000.00 |
$4,488,461.15
|
