|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$2,071.80
|
|
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 |
$1,888.80
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,411.15 |
$1,411.15 |
$1,411.15 |
$1,048.20
|
|
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 |
$1,826.80
|
|
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 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,103.70 |
$1,103.70 |
$1,103.70 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,103.70 |
$1,103.70 |
$1,103.70 |
$638.95
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$396.50 |
$396.50 |
$396.50 |
$145.60
|
|
Injection treatment of eye
|
$426.40 |
$426.40 |
$426.40 |
$2,698.92
|
|
Injection treatment of eye
|
$338.00 |
$338.00 |
$338.00 |
$2,685.92
|
|
Injection treatment of nerve
|
$1,469.00 |
$1,469.00 |
$1,469.00 |
$3,219.20
|
|
Injection treatment of nerve
|
$10,947.95 |
$10,947.95 |
$10,947.95 |
$4,446.30
|
|
Injection treatment of nerve
|
$982.80 |
$982.80 |
$982.80 |
$2,050.30
|
|
Injection treatment of nose
|
$1,903.85 |
$1,903.85 |
$1,903.85 |
$859.59
|
|
Inject sacroiliac joint
|
$1,566.50 |
$1,566.50 |
$1,566.50 |
$1,029.04
|
|
Inject/treat eye socket
|
$306.80 |
$306.80 |
$306.80 |
$381.13
|
|
Inject/treat eye socket
|
$306.80 |
$306.80 |
$306.80 |
$750.70
|
|
Inject/treat eye socket
|
$214.50 |
$214.50 |
$214.50 |
$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 |
$631.80
|
|
Inj for mammo ductogram
|
$397.80 |
$397.80 |
$397.80 |
$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 |
$604.99 |
$905.30
|
|
Inj, gadopiclenol, 1 ml
|
$25.84 |
$25.84 |
$25.84 |
$37.63
|
|
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 |
$12.17 |
$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
|
$4,339.40 |
$4,339.40 |
$4,339.40 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$4,543.50 |
$4,543.50 |
$4,543.50 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$3,433.95 |
$3,433.95 |
$3,433.95 |
$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 |
$739.77 |
$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 |
$1,928.00
|
|
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 |
$18.19 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$103.76 |
$103.76 |
$103.76 |
$320.80
|
|
Inj, lidocaine w epinephrine
|
$3.04 |
$3.04 |
$3.04 |
$45.14
|
|
Inj, lovotibeglogene autotem
|
$9,672,000.00 |
$9,672,000.00 |
$9,672,000.00 |
$4,488,461.15
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$383.50 |
$383.50 |
$383.50 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$5,288.40 |
$5,288.40 |
$5,288.40 |
$1,713.99
|
|
Inj melphalan (hepzato) 1 mg
|
$117,998.40 |
$117,998.40 |
$117,998.40 |
$787.79
|
|
Inj mepivacaine hcl/10 ml
|
$1.44 |
$1.44 |
$1.44 |
$34.00
|
|
Inj, meropenem (b. braun)
|
$69.99 |
$69.99 |
$69.99 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$536.27 |
$536.27 |
$536.27 |
$556.87
|
|
Inj meropenem (wg crit care)
|
$76.99 |
$76.99 |
$76.99 |
$83.19
|
|
Inj, micafungin (par pharm)
|
$350.06 |
$350.06 |
$350.06 |
$79.08
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$1,496.55 |
$1,496.55 |
$1,496.55 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$2,984.20 |
$2,984.20 |
$2,984.20 |
$8,304.04
|
|
Inj, motixafortide, 0.25 mg
|
$13,806.00 |
$13,806.00 |
$13,806.00 |
$25.22
|
|
Inj, moxifloxacin 100 mg
|
$8.45 |
$8.45 |
$8.45 |
$101.31
|
|
Inj moxifloxacin (fres kabi)
|
$0.43 |
$0.43 |
$0.43 |
$95.62
|
|
Inj multihance
|
$24.05 |
$24.05 |
$24.05 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$252.66 |
$252.66 |
$252.66 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$8,132.57 |
$8,132.57 |
$8,132.57 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,494.70 |
$2,494.70 |
$2,494.70 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$7.64 |
$7.64 |
$7.64 |
$472.76
|
|
Inj, nogapendekin pmln, 1mcg
|
$209,430.00 |
$209,430.00 |
$209,430.00 |
$94.12
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$780.00 |
$780.00 |
$780.00 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$611.00 |
$611.00 |
$611.00 |
$2,726.90
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$4,199.99 |
$4,199.99 |
$4,199.99 |
$1,058.98
|
|
Inj octafluoropropane mic,ml
|
$100.39 |
$100.39 |
$100.39 |
$211.40
|
|
Inj ogivri 10 mg
|
$8,190.16 |
$8,190.16 |
$8,190.16 |
$4,492.28
|
|
Inj olipudase alfa-rpcp 1mg
|
$18,260.23 |
$18,260.23 |
$18,260.23 |
$13,239.99
|
|
Inj., omadacycline, 1 mg
|
$1,151.01 |
$1,151.01 |
$1,151.01 |
$865.34
|
|
Inj onase abepar-xioi treat
|
$4,972,500.00 |
$4,972,500.00 |
$4,972,500.00 |
$3,572,794.09
|
