|
Injection px peyronie ds
|
$343.55 |
$343.55 |
$343.55 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$549.70 |
$1,240.00 |
$4,431.20 |
|
|
Injection, renflexis
|
$38.30 |
$38.30 |
$51.35 |
|
|
Injection, ruconest
|
$50.75 |
$50.75 |
$50.75 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$868.09 |
$970.61 |
$1,066.24 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$638.96 |
$970.61 |
$2,585.00 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$372.96 |
$1,198.00 |
$2,585.00 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$934.83 |
$2,853.00 |
$5,192.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$73.08 |
$1,029.45 |
$3,062.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,216.18 |
$3,358.54 |
$6,536.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$62.51 |
$1,271.20 |
$2,824.80 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,216.18 |
$2,602.00 |
$5,971.20 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$825.32 |
$970.61 |
$3,953.60 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$825.32 |
$1,431.00 |
$3,438.40 |
|
|
Injection, siltuximab
|
$232.78 |
$232.78 |
$232.78 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$276.00 |
$527.00 |
$1,084.00 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$409.00 |
$422.07 |
$1,216.00 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$422.07 |
$670.00 |
$1,084.00 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$23.00 |
$227.00 |
$432.00 |
|
|
Injection treatment of eye
|
$3,173.34 |
$7,609.00 |
$7,609.00 |
|
|
Injection treatment of eye
|
$3,173.34 |
$3,173.34 |
$3,173.34 |
|
|
Injection treatment of nerve
|
$2,685.07 |
$2,685.07 |
$2,685.07 |
|
|
Injection treatment of nerve
|
$2,685.07 |
$2,685.07 |
$2,685.07 |
|
|
Injection treatment of nerve
|
$1,216.18 |
$1,472.00 |
$1,636.00 |
|
|
Injection treatment of nose
|
$741.60 |
$741.60 |
$741.60 |
|
|
Inject sacroiliac joint
|
$105.28 |
$2,307.00 |
$9,660.00 |
|
|
Inject/treat eye socket
|
$436.44 |
$436.44 |
$436.44 |
|
|
Inject/treat eye socket
|
$436.44 |
$436.44 |
$436.44 |
|
|
Inject/treat eye socket
|
$436.44 |
$1,018.00 |
$1,018.00 |
|
|
Inj, eculizumab-aagh, 2 mg
|
$43.71 |
$43.71 |
$43.71 |
|
|
Inj, eculizumab-aeeb, 2 mg
|
$58.44 |
$58.44 |
$58.44 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$47.08 |
$47.08 |
$47.08 |
|
|
Inj eflapegrastim-xnst 0.1mg
|
$32.50 |
$32.50 |
$32.50 |
|
|
Inj., emapalumab-lzsg, 1 mg
|
$530.10 |
$530.10 |
$530.10 |
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$77.92 |
$77.92 |
$77.92 |
|
|
Inj epidural sgl cerv-thor without img
|
$970.61 |
$970.61 |
$2,732.80 |
|
|
Inj epidural sgl lumb-sacral without img
|
$1,012.00 |
$1,216.18 |
$2,183.00 |
|
|
Inj., eravacycline, 1 mg
|
$1.78 |
$1.78 |
$1.78 |
|
|
Inj, erzofri, 1 mg
|
$21.12 |
$21.12 |
$21.12 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$3.17 |
$3.17 |
$3.17 |
|
|
Inj, eteplirsen, 10 mg
|
$230.96 |
$230.96 |
$230.96 |
|
|
Inj, evinacumab-dgnb, 5mg
|
$272.09 |
$272.09 |
$272.09 |
|
|
Inj., evomela, 1 mg
|
$25.71 |
$25.71 |
$25.71 |
|
|
Inj, exagamglogene autotem
|
$3,218,160.00 |
$3,218,160.00 |
$3,218,160.00 |
|
|
Inj, factor x, (human), 1iu
|
$13.69 |
$13.69 |
$13.69 |
|
|
Inj, faricimab-svoa, 0.1mg
|
$45.40 |
$45.40 |
$45.40 |
|
|
Inj. fe derisomaltose 10 mg
|
$31.50 |
$31.50 |
$31.50 |
|
|
Inj fensolvi 0.25 mg
|
$193.03 |
$193.03 |
$193.03 |
|
|
Inj., fibryga, 1 mg
|
$1.69 |
$1.69 |
$1.69 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$10.20 |
$10.20 |
$10.20 |
|
|
Inj, focinvez, 1mg
|
$3.63 |
$3.63 |
$3.63 |
|
|
Inj for ext venography
|
$62.42 |
$654.00 |
$3,975.00 |
|
|
Inj for mammo ductogram
|
$92.79 |
$790.72 |
$1,972.00 |
|
|
Inj, fosaprepitant (teva)
|
$0.88 |
$0.88 |
$0.88 |
|
|
Inj fosnetupitant, palonoset
|
$754.77 |
$754.77 |
$754.77 |
|
|
Inj, fulvestrant (fresenius)
|
$37.41 |
$37.41 |
$37.41 |
|
|
Inj, fulvestrant (teva)
|
$57.50 |
$57.50 |
$57.50 |
|
|
Inj, gadopiclenol, 1 ml
|
$4.55 |
$4.55 |
$4.55 |
|
|
Inj gemcitabine hcl (accord)
|
$7.30 |
$7.30 |
$7.30 |
|
|
Inj givosiran 0.5 mg
|
$166.55 |
$166.55 |
$166.55 |
|
|
Inj glofitamab gxbm, 2.5 mg
|
$3,924.15 |
$3,924.15 |
$3,924.15 |
|
|
Inj glycopyrrolate fres kabi
|
$1.85 |
$1.85 |
$1.85 |
|
|
Inj glycopyrrolate, glyrx-pf
|
$1.76 |
$1.76 |
$1.76 |
|
|
Inj, granisetron, xr, 0.1 mg
|
$5.93 |
$5.93 |
$5.93 |
|
|
Inj., guselkumab, 1 mg
|
$100.65 |
$100.65 |
$100.65 |
|
|
Inj, hemgenix, per tx dose
|
$5,085,668.00 |
$5,085,668.00 |
$5,085,668.00 |
|
|
Inj heparin, pfizer, 1000u
|
$2.90 |
$2.90 |
$2.90 |
|
|
Inj. herceptin hylecta, 10mg
|
$84.27 |
$84.27 |
$84.27 |
|
|
Inj, hercessi, 10 mg
|
$51.27 |
$51.27 |
$51.27 |
|
|
Inj herzuma 10 mg
|
$76.49 |
$76.49 |
$76.49 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$61.19 |
$765.00 |
$2,461.76 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$66.06 |
$654.00 |
$727.00 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$72.42 |
$72.42 |
$72.42 |
|
|
Inj hrt cath w/s&i sel left vent
|
$35.91 |
$494.00 |
$549.00 |
|
|
Inj hrt cath w/s&i sel right vent
|
$33.24 |
$729.00 |
$1,942.08 |
|
|
Inj human fibrinogen con nos
|
$2.10 |
$2.10 |
$2.10 |
|
|
Inj hydroxocobalamin IV 25mg
|
$7.51 |
$7.51 |
$7.51 |
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$107.00 |
$107.00 |
$107.00 |
|
|
Inj imip 4 cilas 4 releb 2mg
|
$3.59 |
$3.59 |
$3.59 |
|
|
Inj, imm glob bivigam, 500mg
|
$109.91 |
$109.91 |
$109.91 |
|
|
Inj, immphentiv, 20 mcg
|
$0.19 |
$0.19 |
$0.19 |
|
|
Inj. inebilizumab-cdon, 1 mg
|
$683.85 |
$683.85 |
$683.85 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,216.18 |
$1,928.00 |
$1,938.00 |
|
|
Inj intralesional <= 7 lsn(s)
|
$209.00 |
$275.88 |
$724.03 |
|
|
Inj intralesional > 7 lsns
|
$275.88 |
$833.00 |
$833.00 |
|
|
Inj, invega hafyera/trinza
|
$17.93 |
$17.93 |
$17.93 |
|
|
Inj ivig privigen 500 mg
|
$57.52 |
$69.39 |
$74.71 |
|
|
Inj, ixinity, 1 i.u
|
$2.85 |
$2.85 |
$2.85 |
|
|
Inj. jivi 1 iu
|
$3.66 |
$3.66 |
$3.66 |
|
|
Inj, kovaltry, 1 i.u
|
$2.17 |
$2.17 |
$2.17 |
|
|
Inj labetalol hcl hikma, 5mg
|
$1.50 |
$1.50 |
$1.50 |
|
|
Inj., lanadelumab-flyo, 1 mg
|
$120.32 |
$120.32 |
$120.32 |
|
|
Inj, lanreotide, (cipla) 1mg
|
$52.74 |
$52.74 |
$52.74 |
|
|
Inj, lecanemab-irmb, 1 mg
|
$1.84 |
$1.84 |
$1.84 |
|
|
Inj, lenacapavir, 1 mg
|
$30.77 |
$30.77 |
$30.77 |
|
|
Inj levocarnitine per 1 gm
|
$32.11 |
$32.11 |
$32.11 |
|
|
Inj levoleucovorin nos 0.5mg
|
$0.07 |
$0.07 |
$0.07 |
|
|
Inj, levothyroxine, freskabi
|
$9.57 |
$9.57 |
$9.57 |
|
|
Inj, levothyroxine, hikma
|
$10.61 |
$10.61 |
$10.61 |
|
|
Inj, linezolid (hospira)
|
$29.85 |
$29.85 |
$29.85 |
|