|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$819.00 |
$819.00 |
$819.00 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,023.75 |
$1,023.75 |
$1,023.75 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,341.00 |
$1,341.00 |
$1,341.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$178.50 |
$178.50 |
$178.50 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,353.75 |
$1,353.75 |
$1,353.75 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$495.00 |
$495.00 |
$495.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,835.25 |
$1,835.25 |
$1,835.25 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,023.75 |
$1,023.75 |
$1,023.75 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$540.16 |
$540.16 |
$1,023.75 |
|
|
Injection, siltuximab
|
$4,380.67 |
$4,380.67 |
$15,404.94 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$168.00 |
$168.00 |
$346.50 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$168.00 |
$168.00 |
$614.25 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$168.00 |
$168.00 |
$879.75 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$78.08 |
$78.08 |
$108.00 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$77.12 |
$77.12 |
$130.50 |
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$156.48 |
$156.48 |
$217.50 |
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$63.04 |
$63.04 |
$151.50 |
|
|
Inject sacroiliac joint
|
$403.20 |
$403.20 |
$541.50 |
|
|
Inj, eculizumab-aagh, 2 mg
|
$10,688.19 |
$10,688.19 |
$10,688.19 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$35,449.85 |
$35,449.85 |
$35,449.85 |
|
|
Inj., emapalumab-lzsg, 1 mg
|
$8,501.70 |
$8,501.70 |
$8,501.70 |
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$78,349.80 |
$78,349.80 |
$78,349.80 |
|
|
Inj epidural sgl cerv-thor without img
|
$855.75 |
$855.75 |
$855.75 |
|
|
Inj epidural sgl lumb-sacral without img
|
$1,082.25 |
$1,082.25 |
$1,082.25 |
|
|
Inj., eravacycline, 1 mg
|
$276.75 |
$276.75 |
$276.75 |
|
|
Inj, erzofri, 1 mg
|
$13,679.07 |
$13,679.07 |
$13,679.07 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$486.87 |
$486.87 |
$486.87 |
|
|
Inj, eteplirsen, 10 mg
|
$3,747.75 |
$3,747.75 |
$3,747.75 |
|
|
Inj, evinacumab-dgnb, 5mg
|
$27,791.70 |
$27,791.70 |
$27,791.70 |
|
|
Inj, factor x, (human), 1iu
|
$38.58 |
$38.58 |
$38.58 |
|
|
Inj, faricimab-svoa, 0.1mg
|
$5,495.48 |
$5,495.48 |
$5,495.48 |
|
|
Inj. fe derisomaltose 10 mg
|
$2,680.53 |
$2,680.53 |
$2,680.53 |
|
|
Inj fensolvi 0.25 mg
|
$59,280.78 |
$59,280.78 |
$59,280.78 |
|
|
Inj., fibryga, 1 mg
|
$7.12 |
$7.12 |
$7.12 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$33.14 |
$33.14 |
$33.14 |
|
|
Inj, focinvez, 1mg
|
$1,106.38 |
$1,106.38 |
$1,106.38 |
|
|
Inj for ext venography
|
$407.04 |
$407.04 |
$1,151.25 |
|
|
Inj for mammo ductogram
|
$188.16 |
$188.16 |
$188.16 |
|
|
Inj fosnetupitant, palonoset
|
$1,602.39 |
$1,602.39 |
$1,602.39 |
|
|
Inj., fremanezumab-vfrm 1 mg
|
$1,770.81 |
$1,770.81 |
$1,770.81 |
|
|
Inj, gadopiclenol, 1 ml
|
$3.51 |
$3.51 |
$3.51 |
|
|
Inj gemcitabine hcl (accord)
|
$152.55 |
$152.55 |
$152.55 |
|
|
Inj givosiran 0.5 mg
|
$94,814.79 |
$94,814.79 |
$94,814.79 |
|
|
Inj glofitamab gxbm, 2.5 mg
|
$6,375.90 |
$6,375.90 |
$6,375.90 |
|
|
Inj glycopyrrolate fres kabi
|
$14.43 |
$14.43 |
$14.43 |
|
|
Inj golodirsen 10 mg
|
$3,747.75 |
$3,747.75 |
$3,747.75 |
|
|
Inj., guselkumab, 1 mg
|
$9,229.30 |
$9,229.30 |
$31,467.27 |
|
|
Inj., haegarda 10 units
|
$8,499.62 |
$8,499.62 |
$8,499.62 |
|
|
Inj, hemgenix, per tx dose
|
$6,300,003.75 |
$6,300,003.75 |
$6,300,003.75 |
|
|
Inj. herceptin hylecta, 10mg
|
$10,973.82 |
$10,973.82 |
$10,973.82 |
|
|
Inj, hercessi, 10 mg
|
$8,702.05 |
$8,702.05 |
$8,702.05 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$125.44 |
$125.44 |
$395.25 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$257.25 |
$257.25 |
$474.88 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$267.75 |
$267.75 |
$271.36 |
|
|
Inj hrt cath w/s&i sel left vent
|
$199.50 |
$199.50 |
$203.52 |
|
|
Inj hrt cath w/s&i sel right vent
|
$203.52 |
$203.52 |
$825.00 |
|
|
Inj human fibrinogen con nos
|
$8.40 |
$8.40 |
$8.40 |
|
|
Inj hydroxocobalamin IV 25mg
|
$2,456.07 |
$2,456.07 |
$2,456.07 |
|
|
Inj hydroxyprogst capoat nos
|
$904.92 |
$904.92 |
$904.92 |
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$14,273.07 |
$14,273.07 |
$14,273.07 |
|
|
Inj imip 4 cilas 4 releb 2mg
|
$743.52 |
$743.52 |
$743.52 |
|
|
Inj, imm glob bivigam, 500mg
|
$1,815.11 |
$1,815.11 |
$1,815.11 |
|
|
Inj, immphentiv, 20 mcg
|
$6.81 |
$6.81 |
$6.81 |
|
|
Inj. inebilizumab-cdon, 1 mg
|
$28,722.89 |
$28,722.89 |
$100,982.67 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$2,421.00 |
$2,421.00 |
$2,421.00 |
|
|
Inj. infugem, 100 mg
|
$1,989.99 |
$1,989.99 |
$1,989.99 |
|
|
Inj. insulin (fiasp)
|
$255.29 |
$255.29 |
$255.29 |
|
|
Inj intralesional <= 7 lsn(s)
|
$23.68 |
$23.68 |
$23.68 |
|
|
Inj, invega hafyera/trinza
|
$46,259.94 |
$46,259.94 |
$46,259.94 |
|
|
Inj ivig privigen 500 mg
|
$6,362.36 |
$6,362.36 |
$8,982.72 |
|
|
Inj, ixinity, 1 i.u
|
$10.09 |
$10.09 |
$10.09 |
|
|
Inj labetalol hcl hikma, 5mg
|
$117.15 |
$117.15 |
$117.15 |
|
|
Inj., lanadelumab-flyo, 1 mg
|
$56,925.65 |
$56,925.65 |
$56,925.65 |
|
|
Inj, lecanemab-irmb, 1 mg
|
$621.14 |
$621.14 |
$621.14 |
|
|
Inj lefamulin 1 mg
|
$243.60 |
$243.60 |
$243.60 |
|
|
Inj, lenacapavir, 1 mg
|
$42,123.75 |
$42,123.75 |
$42,123.75 |
|
|
Inj levocarnitine per 1 gm
|
$196.38 |
$196.38 |
$196.38 |
|
|
Inj levoleucovorin nos 0.5mg
|
$138.75 |
$138.75 |
$138.75 |
|
|
Inj, levothyroxine, freskabi
|
$1,239.06 |
$1,239.06 |
$1,239.06 |
|
|
Inj, lidocaine w epinephrine
|
$29.28 |
$29.28 |
$75.66 |
|
|
Inj, linezolid (hospira)
|
$221.10 |
$221.10 |
$221.10 |
|
|
Inj. lumasiran, 0.5 mg
|
$129,817.59 |
$129,817.59 |
$129,817.59 |
|
|
Inj., lumoxiti, 0.01 mg
|
$5,198.13 |
$5,198.13 |
$5,198.13 |
|
|
Inj. meloxicam 1 mg
|
$223.71 |
$223.71 |
$223.71 |
|
|
Inj melpha hydroch nos 50 mg
|
$5,898.67 |
$5,898.67 |
$5,898.67 |
|
|
Inj mepivacaine hcl/10 ml
|
$21.47 |
$21.47 |
$52.84 |
|
|
Inj, meropenem (b. braun)
|
$95.28 |
$95.28 |
$95.28 |
|
|
Inj., meropenem, vaborbactam
|
$524.40 |
$524.40 |
$524.40 |
|
|
Inj meropenem (wg crit care)
|
$104.43 |
$104.43 |
$104.43 |
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$23,501.75 |
$23,501.75 |
$23,501.75 |
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$11,194.55 |
$11,194.55 |
$11,194.55 |
|
|
Inj, moxifloxacin 100 mg
|
$127.50 |
$127.50 |
$127.50 |
|
|
Inj moxifloxacin (fres kabi)
|
$128.07 |
$128.07 |
$128.07 |
|
|
Inj multihance
|
$1.47 |
$1.47 |
$94.47 |
|
|
Inj. mycophenolate mofetil
|
$103.01 |
$103.01 |
$256.42 |
|
|
Inj. naxitamab-gqgk, 1 mg
|
$56,336.10 |
$56,336.10 |
$56,336.10 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$670.50 |
$670.50 |
$670.50 |
|
|
Inj, nithiodote, 3mg / 125mg
|
$462.04 |
$462.04 |
$462.04 |
|
|
Inj nivolumab 2 mg hyaluron
|
$4,880.23 |
$4,880.23 |
$18,620.56 |
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$89,172.69 |
$89,172.69 |
$89,172.69 |
|
