|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,685.00
|
|
Injection, siltuximab
|
$361.39 |
$361.39 |
$361.39 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$343.00 |
$343.00 |
$343.00 |
$145.60
|
|
Injection treatment of eye
|
$6,732.00 |
$6,732.00 |
$6,732.00 |
$2,698.92
|
|
Injection treatment of eye
|
$3,920.00 |
$3,920.00 |
$3,920.00 |
$2,685.92
|
|
Injection treatment of nerve
|
$5,197.00 |
$5,197.00 |
$5,197.00 |
$4,446.30
|
|
Injection treatment of nerve
|
$3,667.00 |
$3,667.00 |
$3,667.00 |
$2,054.00
|
|
Inject sacroiliac joint
|
$4,377.00 |
$4,377.00 |
$4,377.00 |
$1,029.04
|
|
Inject/treat eye socket
|
$3,920.00 |
$3,920.00 |
$3,920.00 |
$381.13
|
|
Inject/treat eye socket
|
$3,920.00 |
$3,920.00 |
$3,920.00 |
$670.02
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$74.90 |
$74.90 |
$74.90 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$834.80 |
$834.80 |
$834.80 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$138.37 |
$138.37 |
$138.37 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$3,125.00 |
$3,125.00 |
$3,125.00 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$4,609.00 |
$4,609.00 |
$4,609.00 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$6.74 |
$6.74 |
$6.74 |
$206.64
|
|
Inj, evinacumab-dgnb, 5mg
|
$333.17 |
$333.17 |
$333.17 |
$20,751.13
|
|
Inj, exagamglogene autotem
|
$9,064,000.00 |
$9,064,000.00 |
$9,064,000.00 |
$3,218,160.00
|
|
Inj for ext venography
|
$362.00 |
$362.00 |
$362.00 |
$628.80
|
|
Inj, fulvestrant (fresenius)
|
$123.60 |
$123.60 |
$123.60 |
$905.30
|
|
Inj givosiran 0.5 mg
|
$270.71 |
$270.71 |
$270.71 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$5,601.18 |
$5,601.18 |
$5,601.18 |
$4,760.67
|
|
Inj, hemgenix, per tx dose
|
$7,210,000.00 |
$7,210,000.00 |
$7,210,000.00 |
$4,704,002.80
|
|
Inj heparin, pfizer, 1000u
|
$14.42 |
$14.42 |
$14.42 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$192.62 |
$192.62 |
$192.62 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,813.00 |
$2,813.00 |
$2,813.00 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$273.00 |
$273.00 |
$273.00 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$2,999.00 |
$2,999.00 |
$2,999.00 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$1,917.00 |
$1,917.00 |
$1,917.00 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$1,863.00 |
$1,863.00 |
$1,863.00 |
$999.96
|
|
Inj imip 4 cilas 4 releb 2mg
|
$4.29 |
$4.29 |
$4.29 |
$739.77
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$2,383.00 |
$2,383.00 |
$2,383.00 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$8,661.00 |
$8,661.00 |
$8,661.00 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$217.48 |
$217.48 |
$217.48 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$250.82 |
$250.82 |
$250.82 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$3.41 |
$3.41 |
$3.41 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$164.19 |
$164.19 |
$164.19 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$3.69 |
$3.69 |
$3.69 |
$45.60
|
|
Inj, lovotibeglogene autotem
|
$12,772,000.00 |
$12,772,000.00 |
$12,772,000.00 |
$4,488,461.15
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$594.95 |
$594.95 |
$594.95 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$47.38 |
$47.38 |
$47.38 |
$34.34
|
|
Inj., meropenem, vaborbactam
|
$31.96 |
$31.96 |
$31.96 |
$556.87
|
|
Inj, micafungin (par pharm)
|
$6.48 |
$6.48 |
$6.48 |
$79.08
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$568.15 |
$568.15 |
$568.15 |
$8,304.04
|
|
Inj, motixafortide, 0.25 mg
|
$235.24 |
$235.24 |
$235.24 |
$25.22
|
|
Inj, moxifloxacin 100 mg
|
$49.57 |
$49.57 |
$49.57 |
$101.31
|
|
Inj multihance
|
$30.64 |
$30.64 |
$30.64 |
$70.54
|
|
Inj multihance multipack
|
$19.57 |
$19.57 |
$19.57 |
$4.08
|
|
Inj naloxone hydrochloride
|
$128.43 |
$128.43 |
$128.43 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$4,169.00 |
$4,169.00 |
$4,169.00 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$5,054.00 |
$5,054.00 |
$5,054.00 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$5,054.00 |
$5,054.00 |
$5,054.00 |
$2,726.90
|
|
Inj, ocriplasmin, 0.125 mg
|
$17.67 |
$17.67 |
$17.67 |
$17.67
|
|
Inj octafluoropropane mic,ml
|
$570.99 |
$570.99 |
$570.99 |
$211.40
|
|
Inj ogivri 10 mg
|
$226.00 |
$226.00 |
$226.00 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$11.46 |
$11.46 |
$11.46 |
$865.34
|
|
Inj., patisiran, 0.1 mg
|
$242.14 |
$242.14 |
$242.14 |
$17,613.00
|
|
Inj peritoneal venous shunt
|
$365.00 |
$365.00 |
$365.00 |
$406.80
|
|
Inj proc ankle arthr
|
$669.00 |
$669.00 |
$669.00 |
$405.31
|
|
Inj proc elbow arthro
|
$733.00 |
$733.00 |
$733.00 |
$432.00
|
|
Inj proc for lymphang
|
$1,390.00 |
$1,390.00 |
$1,390.00 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$4,377.00 |
$4,377.00 |
$4,377.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,707.00 |
$1,707.00 |
$1,707.00 |
$838.30
|
|
Inj progesterone per 50 mg
|
$8.76 |
$8.76 |
$8.76 |
$13.76
|
|
Inj prohance multipack
|
$20.57 |
$20.57 |
$20.57 |
$10.40
|
|
Inj retacrit esrd on dialysi
|
$7.17 |
$7.17 |
$7.17 |
$349.45
|
|
Inj retro urethrocysto
|
$588.00 |
$588.00 |
$588.00 |
$447.74
|
|
Inj, rimabotulinumtoxinb
|
$45.56 |
$45.56 |
$45.56 |
$714.24
|
|
Inj scleros sol mult veins
|
$1,294.00 |
$1,294.00 |
$1,294.00 |
$692.90
|
|
Inj scleros sol sgl vein
|
$1,206.00 |
$1,206.00 |
$1,206.00 |
$561.88
|
|
Inj sebelipase alfa 1 mg
|
$1,261.96 |
$1,261.96 |
$1,261.96 |
$539.69
|
|
Inj secretin synthetic human
|
$97.34 |
$97.34 |
$97.34 |
$1,253.09
|
|
Inj secukinumab intrav 1mg
|
$42.24 |
$42.24 |
$42.24 |
$4,413.21
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$1,105.00 |
$1,105.00 |
$1,105.00 |
$436.80
|
|
Inj teclistamab cqyv 0.5 mg
|
$85.65 |
$85.65 |
$85.65 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$7.64 |
$7.64 |
$7.64 |
$664.72
|
|
Inj testosterone cypionate
|
$0.88 |
$0.88 |
$0.88 |
$64.96
|
|
Inj thrc fascial pln blk bi w/wo image
|
$246.00 |
$246.00 |
$246.00 |
$1,049.50
|
|
Inj thrc fascial pln blk uni w/wo image
|
$222.00 |
$222.00 |
$222.00 |
$818.00
|
|
Inj., tildrakizumab, 1 mg
|
$361.18 |
$361.18 |
$361.18 |
$26,635.60
|
|
Inj tofersen intrathec 1 mg
|
$293.34 |
$293.34 |
$293.34 |
$293.34
|
|
Inj., triptorelin X-ray 3.75 mg
|
$2,131.07 |
$2,131.07 |
$2,131.07 |
$33,416.39
|
|
Inj, uzedy, 1 mg
|
$56.56 |
$56.56 |
$56.56 |
$11,475.96
|
|
Inj, vancomycin hcl (mylan)
|
$42.88 |
$42.88 |
$42.88 |
$72.33
|
|
Inj, vasopressin (baxter)
|
$16.22 |
$16.22 |
$16.22 |
$202.50
|
|
Inj w/fluor eval cv device
|
$4,377.00 |
$4,377.00 |
$4,377.00 |
$504.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$6,041.32 |
$6,041.32 |
$6,041.32 |
$41,083.73
|
|
Ins cath ren art 1st bi
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$11,368.00 |
$11,368.00 |
$11,368.00 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$11,129.00 |
$11,129.00 |
$11,129.00 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$1,439.00 |
$1,439.00 |
$1,439.00 |
$490.73
|
|
Insert abdomen-venous drain
|
$5,510.00 |
$5,510.00 |
$5,510.00 |
$4,039.47
|
|
Insert and remove bone pin
|
$8,971.00 |
$8,971.00 |
$8,971.00 |
$4,433.36
|
