|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,067.40 |
$1,067.40 |
$3,422.30 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,866.60 |
$1,866.60 |
$1,866.60 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$2,478.00 |
$2,478.00 |
$2,478.00 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,478.00 |
$2,478.00 |
$2,478.00 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$2,478.00 |
$2,478.00 |
$2,478.00 |
$1,017.90
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,478.00 |
$2,478.00 |
$2,478.00 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,692.00 |
$1,692.00 |
$1,692.00 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,692.00 |
$1,692.00 |
$1,692.00 |
$1,681.24
|
|
Injection, siltuximab
|
$48,713.66 |
$48,713.66 |
$48,713.66 |
$10,680.75
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$909.00 |
$909.00 |
$2,850.77 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$856.20 |
$856.20 |
$1,405.87 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,222.80 |
$1,222.80 |
$1,507.37 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$309.00 |
$309.00 |
$343.64 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$276.00 |
$276.00 |
$342.42 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$309.00 |
$309.00 |
$410.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$202.20 |
$202.20 |
$326.80 |
$135.60
|
|
Inject sacroiliac joint
|
$1,960.20 |
$1,960.20 |
$1,960.20 |
$1,028.95
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$335.69 |
$335.69 |
$335.69 |
$32,176.93
|
|
Inj epidural sgl lumb-sacral without img
|
$1,436.40 |
$1,436.40 |
$1,436.40 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$756.84 |
$756.84 |
$756.84 |
$206.64
|
|
Inj. fe derisomaltose 10 mg
|
$287.33 |
$287.33 |
$287.33 |
$3,221.52
|
|
Inj for ext venography
|
$128,568.97 |
$128,568.97 |
$128,568.97 |
$649.95
|
|
Inj, fulvestrant (fresenius)
|
$1,587.00 |
$1,587.00 |
$1,587.00 |
$1,043.05
|
|
Inj, gadopiclenol, 1 ml
|
$37.63 |
$37.63 |
$37.63 |
$37.63
|
|
Inj gemcitabine hcl (accord)
|
$561.04 |
$561.04 |
$561.04 |
$130.65
|
|
Inj givosiran 0.5 mg
|
$879.47 |
$879.47 |
$879.47 |
$76,708.80
|
|
Inj glycopyrrolate, glyrx-pf
|
$38.14 |
$38.14 |
$38.14 |
$11.23
|
|
Inj., guselkumab, 1 mg
|
$757.42 |
$757.42 |
$71,666.94 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$808.82 |
$808.82 |
$808.82 |
$7,690.59
|
|
Inj herzuma 10 mg
|
$9,693.72 |
$9,693.72 |
$9,693.72 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,181.40 |
$1,181.40 |
$3,779.48 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$1,181.40 |
$1,181.40 |
$1,346.84 |
$1,827.74
|
|
Inj hrt cath w/s&i sel hrt art
|
$919.52 |
$919.52 |
$919.52 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$3,256.04 |
$3,256.04 |
$3,256.04 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$1,181.40 |
$1,181.40 |
$1,816.97 |
$965.33
|
|
Inj hydroxocobalamin IV 25mg
|
$8,530.28 |
$8,530.28 |
$8,530.28 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$8,335.14 |
$8,335.14 |
$8,335.14 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$3,160.31 |
$3,160.31 |
$3,160.31 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$4,905.98 |
$4,905.98 |
$4,905.98 |
$70,014.65
|
|
Inj, invega hafyera/trinza
|
$69,524.92 |
$69,524.92 |
$69,524.92 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$49,757.57 |
$49,757.57 |
$49,757.57 |
$6,967.29
|
|
Inj, ixinity, 1 i.u
|
$28,062.85 |
$28,062.85 |
$28,062.85 |
$6.99
|
|
Inj, lanreotide, (cipla) 1mg
|
$444.82 |
$444.82 |
$444.82 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$10.78 |
$10.78 |
$1,920.06 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$208.62 |
$208.62 |
$225.14 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$528.08 |
$528.08 |
$528.08 |
$109.92
|
|
Inj, levothyroxine, freskabi
|
$173.14 |
$173.14 |
$434.34 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$1.14 |
$1.14 |
$115.62 |
$47.52
|
|
Inj, linezolid (hospira)
|
$153.62 |
$153.62 |
$153.62 |
$153.30
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,345.80 |
$1,345.80 |
$1,345.80 |
$784.00
|
|
Inj melpha hydroch nos 50 mg
|
$720.06 |
$720.06 |
$720.06 |
$1,791.90
|
|
Inj mepivacaine hcl/10 ml
|
$84.60 |
$84.60 |
$84.60 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$147.18 |
$147.18 |
$147.18 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$1,094.70 |
$1,094.70 |
$2,259.90 |
$558.08
|
|
Inj meropenem (wg crit care)
|
$12.97 |
$12.97 |
$12.97 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$3.87 |
$3.87 |
$3.87 |
$89.40
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$331.93 |
$331.93 |
$331.93 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$2,233.42 |
$2,233.42 |
$15,179.34 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$490.46 |
$490.46 |
$490.46 |
$107.25
|
|
Inj multihance
|
$24.16 |
$24.16 |
$87.96 |
$73.49
|
|
Inj multihance multipack
|
$16.21 |
$16.21 |
$16.21 |
$2.80
|
|
Inj. mycophenolate mofetil
|
$5.37 |
$5.37 |
$531.30 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$1,623.60 |
$1,623.60 |
$2,044.65 |
$462.04
|
|
Inj nivolumab 2 mg hyaluron
|
$278.07 |
$278.07 |
$25,211.34 |
$15,599.68
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$459.34 |
$459.34 |
$121,368.84 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$582.27 |
$582.27 |
$8,331.96 |
$4,492.28
|
|
Inj, omacetaxine mep, 0.01mg
|
$13,469.40 |
$13,469.40 |
$13,469.40 |
$2,686.80
|
|
Inj ontruzant 10 mg
|
$505.36 |
$505.36 |
$505.36 |
$6,706.27
|
|
Inj., patisiran, 0.1 mg
|
$28,767.90 |
$28,767.90 |
$28,767.90 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$9.12 |
$9.12 |
$9.12 |
$132.57
|
|
Inj pemetrexed ditromethamin
|
$4,604.99 |
$4,604.99 |
$4,604.99 |
$895.03
|
|
Inj peritoneal venous shunt
|
$1,422.04 |
$1,422.04 |
$1,561.20 |
$413.70
|
|
Inj., plazomicin, 5 mg
|
$1,701.84 |
$1,701.84 |
$1,701.84 |
$607.16
|
|
Inj proc myelogram lumbar
|
$1,014.60 |
$1,014.60 |
$3,172.46 |
$830.50
|
|
Inj progesterone per 50 mg
|
$9.86 |
$9.86 |
$9.86 |
$15.00
|
|
Inj, releuko 1 mcg
|
$1.50 |
$1.50 |
$747.96 |
$473.25
|
|
Inj, rimabotulinumtoxinb
|
$3,296.06 |
$3,296.06 |
$3,734.28 |
$746.79
|
|
Inj secretin synthetic human
|
$7,266.00 |
$7,266.00 |
$7,266.00 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$144.86 |
$144.86 |
$22,435.86 |
$4,413.21
|
|
Inj sulf hexa lipid microsph
|
$162.14 |
$162.14 |
$305.04 |
$256.14
|
|
Inj, sutimlimab-jome, 10 mg
|
$191.31 |
$191.31 |
$191.31 |
$3,453.73
|
|
Inj teclistamab cqyv 0.5 mg
|
$250.10 |
$250.10 |
$33,160.56 |
$17,517.56
|
|
Inj. teprotumumab-trbw 10 mg
|
$3,762.84 |
$3,762.84 |
$52,975.74 |
$35,034.78
|
|
Inj testosterone cypionate
|
$29.28 |
$29.28 |
$1,434.31 |
$64.80
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,345.80 |
$1,345.80 |
$1,345.80 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$768.60 |
$768.60 |
$768.60 |
$837.50
|
|
Inj. tigecycline (accord)
|
$117.90 |
$117.90 |
$117.90 |
$188.03
|
|
Inj., tildrakizumab, 1 mg
|
$1,296.41 |
$1,296.41 |
$1,296.41 |
$26,635.60
|
|
Inj, tislelizumab-jsgr
|
$17,691.90 |
$17,691.90 |
$17,691.90 |
$9,764.09
|
|
Inj, tofidence, 1 mg
|
$42.13 |
$42.13 |
$42.13 |
$92.13
|
|
Inj triamcinolone ace X-ray 1mg
|
$194.14 |
$194.14 |
$2,021.28 |
$1,090.75
|
|
Inj, tyenne, 1 mg
|
$5,757.72 |
$5,757.72 |
$5,757.72 |
$3,525.12
|
|
Inj ustekinumab-aekn, 1 mg
|
$107.90 |
$107.90 |
$107.90 |
$47.80
|
|
Inj vancomycin (xellia) 10mg
|
$1.29 |
$1.29 |
$1.29 |
$76.59
|
|
Inj, vasopressin (baxter)
|
$20.81 |
$20.81 |
$20.81 |
$228.24
|
|
Inj, vegzelma, 10 mg
|
$537.68 |
$537.68 |
$537.68 |
$1,291.28
|
|
Inj vocal cord bulking agent
|
$2,330.24 |
$2,330.24 |
$2,330.24 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$627.00 |
$627.00 |
$2,904.21 |
$503.92
|
|
Inj zanidatamab-hrii, 2 mg
|
$253.28 |
$253.28 |
$253.28 |
$11,091.60
|
