|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$819.50 |
$819.50 |
$819.50 |
$1,685.00
|
|
Injection, siltuximab
|
$157.07 |
$157.07 |
$157.07 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$349.32 |
$349.32 |
$349.32 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$349.32 |
$349.32 |
$349.32 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$349.32 |
$349.32 |
$349.32 |
$638.95
|
|
Injection treatment of eye
|
$2,698.92 |
$2,698.92 |
$2,698.92 |
$2,698.92
|
|
Injection treatment of eye
|
$2,698.92 |
$2,698.92 |
$2,698.92 |
$2,685.92
|
|
Injection treatment of nerve
|
$2,310.83 |
$2,310.83 |
$2,310.83 |
$3,219.20
|
|
Injection treatment of nerve
|
$2,310.83 |
$2,310.83 |
$2,310.83 |
$4,446.30
|
|
Injection treatment of nerve
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$2,050.30
|
|
Injection treatment of nose
|
$602.63 |
$602.63 |
$602.63 |
$859.59
|
|
Inject/treat eye socket
|
$353.74 |
$353.74 |
$353.74 |
$381.13
|
|
Inject/treat eye socket
|
$353.74 |
$353.74 |
$353.74 |
$750.70
|
|
Inject/treat eye socket
|
$353.74 |
$353.74 |
$353.74 |
$670.02
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$33.13 |
$33.13 |
$33.13 |
$32,176.93
|
|
Inj eflapegrastim-xnst 0.1mg
|
$22.75 |
$22.75 |
$22.75 |
$22.75
|
|
Inj., emapalumab-lzsg, 1 mg
|
$378.03 |
$378.03 |
$378.03 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$52.82 |
$52.82 |
$52.82 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$819.50 |
$819.50 |
$819.50 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$1,450.84
|
|
Inj, evinacumab-dgnb, 5mg
|
$186.31 |
$186.31 |
$186.31 |
$20,751.13
|
|
Inj., evomela, 1 mg
|
$17.35 |
$17.35 |
$17.35 |
$17.37
|
|
Inj, exagamglogene autotem
|
$2,332,000.00 |
$2,332,000.00 |
$2,332,000.00 |
$3,218,160.00
|
|
Inj, factor x, (human), 1iu
|
$9.11 |
$9.11 |
$9.11 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$34.25 |
$34.25 |
$34.25 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$21.05 |
$21.05 |
$21.05 |
$3,221.52
|
|
Inj fensolvi 0.25 mg
|
$140.62 |
$140.62 |
$140.62 |
$44,262.98
|
|
Inj., fibryga, 1 mg
|
$1.11 |
$1.11 |
$1.11 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$7.35 |
$7.35 |
$7.35 |
$40.33
|
|
Inj, focinvez, 1mg
|
$3.14 |
$3.14 |
$3.14 |
$3.63
|
|
Inj, fosaprepitant (teva)
|
$2.04 |
$2.04 |
$2.04 |
$152.10
|
|
Inj fosnetupitant, palonoset
|
$679.51 |
$679.51 |
$679.51 |
$1,110.99
|
|
Inj, fulvestrant (fresenius)
|
$53.00 |
$53.00 |
$53.00 |
$905.30
|
|
Inj, fulvestrant (teva)
|
$21.20 |
$21.20 |
$21.20 |
$136.50
|
|
Inj givosiran 0.5 mg
|
$112.14 |
$112.14 |
$112.14 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$2,701.04 |
$2,701.04 |
$2,701.04 |
$4,760.67
|
|
Inj glycopyrrolate fres kabi
|
$1.80 |
$1.80 |
$1.80 |
$12.18
|
|
Inj, granisetron, xr, 0.1 mg
|
$5.71 |
$5.71 |
$5.71 |
$163.28
|
|
Inj., guselkumab, 1 mg
|
$74.47 |
$74.47 |
$74.47 |
$29,130.83
|
|
Inj, hemgenix, per tx dose
|
$3,672,900.00 |
$3,672,900.00 |
$3,672,900.00 |
$4,704,002.80
|
|
Inj. herceptin hylecta, 10mg
|
$63.79 |
$63.79 |
$63.79 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$60.44 |
$60.44 |
$60.44 |
$7,775.46
|
|
Inj human fibrinogen con nos
|
$1.45 |
$1.45 |
$1.45 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$5.03 |
$5.03 |
$5.03 |
$2,452.32
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$77.06 |
$77.06 |
$77.06 |
$3,542.09
|
|
Inj, idacio, 1 mg
|
$14.63 |
$14.63 |
$14.63 |
$14.63
|
|
Inj imip 4 cilas 4 releb 2mg
|
$2.51 |
$2.51 |
$2.51 |
$739.77
|
|
Inj, immphentiv, 20 mcg
|
$0.15 |
$0.15 |
$0.15 |
$21.00
|
|
Inj. inebilizumab-cdon, 1 mg
|
$484.40 |
$484.40 |
$484.40 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$1,928.00
|
|
Inj. infugem, 100 mg
|
$40.28 |
$40.28 |
$40.28 |
$1,485.86
|
|
Inj intralesional <= 7 lsn(s)
|
$235.13 |
$235.13 |
$235.13 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$235.13 |
$235.13 |
$235.13 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$12.66 |
$12.66 |
$12.66 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$48.58 |
$48.58 |
$48.58 |
$6,967.29
|
|
Inj, ixinity, 1 i.u
|
$1.81 |
$1.81 |
$1.81 |
$6.99
|
|
Inj. jivi 1 iu
|
$2.44 |
$2.44 |
$2.44 |
$2.65
|
|
Inj, kovaltry, 1 i.u
|
$1.48 |
$1.48 |
$1.48 |
$5.07
|
|
Inj, lanreotide, (cipla) 1mg
|
$36.80 |
$36.80 |
$36.80 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1.34 |
$1.34 |
$1.34 |
$1,174.88
|
|
Inj, lenacapavir, 1 mg
|
$21.99 |
$21.99 |
$21.99 |
$24,398.00
|
|
Inj, levothyroxine, freskabi
|
$3.75 |
$3.75 |
$3.75 |
$320.80
|
|
Inj, levothyroxine, hikma
|
$5.14 |
$5.14 |
$5.14 |
$42.89
|
|
Inj, lovotibeglogene autotem
|
$3,286,000.00 |
$3,286,000.00 |
$3,286,000.00 |
$4,488,461.15
|
|
Inj. lumasiran, 0.5 mg
|
$317.88 |
$317.88 |
$317.88 |
$96,930.47
|
|
Inj., lumoxiti, 0.01 mg
|
$23.39 |
$23.39 |
$23.39 |
$3,881.27
|
|
Inj luxturna 1 billion vec g
|
$3,084.46 |
$3,084.46 |
$3,084.46 |
$3,084.46
|
|
Inj melpha hydroch nos 50 mg
|
$153.54 |
$153.54 |
$153.54 |
$1,713.99
|
|
Inj melphalan (hepzato) 1 mg
|
$773.80 |
$773.80 |
$773.80 |
$787.79
|
|
Inj., meropenem, vaborbactam
|
$2.09 |
$2.09 |
$2.09 |
$556.87
|
|
Inj meropenem (wg crit care)
|
$1.62 |
$1.62 |
$1.62 |
$83.19
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$39.54 |
$39.54 |
$39.54 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$238.85 |
$238.85 |
$238.85 |
$8,304.04
|
|
Inj, motixafortide, 0.25 mg
|
$25.22 |
$25.22 |
$25.22 |
$25.22
|
|
Inj. naxitamab-gqgk, 1 mg
|
$642.15 |
$642.15 |
$642.15 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$789.86 |
$789.86 |
$789.86 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$2.17 |
$2.17 |
$2.17 |
$472.76
|
|
Inj, nogapendekin pmln, 1mcg
|
$92.19 |
$92.19 |
$92.19 |
$94.12
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,164.64 |
$2,164.64 |
$2,164.64 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,164.64 |
$2,164.64 |
$2,164.64 |
$2,726.90
|
|
Inj ogivri 10 mg
|
$54.16 |
$54.16 |
$54.16 |
$4,492.28
|
|
Inj, oliceridine 0.1 mg
|
$1.23 |
$1.23 |
$1.23 |
$1.23
|
|
Inj olipudase alfa-rpcp 1mg
|
$382.56 |
$382.56 |
$382.56 |
$13,239.99
|
|
Inj, omacetaxine mep, 0.01mg
|
$4.03 |
$4.03 |
$4.03 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$3.80 |
$3.80 |
$3.80 |
$865.34
|
|
Inj onase abepar-xioi treat
|
$2,388,614.23 |
$2,388,614.23 |
$2,388,614.23 |
$3,572,794.09
|
|
Inj ontruzant 10 mg
|
$34.17 |
$34.17 |
$34.17 |
$6,706.27
|
|
Inj, palonosetron (posfrea)
|
$59.74 |
$59.74 |
$59.74 |
$59.74
|
|
Inj, panzyga, 500 mg
|
$67.46 |
$67.46 |
$67.46 |
$8,041.38
|
|
Inj, pasireotide long acting
|
$479.84 |
$479.84 |
$479.84 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$98.88 |
$98.88 |
$98.88 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$96.08 |
$96.08 |
$96.08 |
$96.08
|
|
Inj, pegcetacoplan, 1mg
|
$147.36 |
$147.36 |
$147.36 |
$3,662.96
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$346.76 |
$346.76 |
$346.76 |
$6,614.40
|
|
Inj, pegulicianine, 1 mg
|
$37.51 |
$37.51 |
$37.51 |
$51.76
|
|
Inj. pemetrexed, 10 mg
|
$50.83 |
$50.83 |
$50.83 |
$104.72
|
|
Inj pemetrexed (accord) 10mg
|
$9.66 |
$9.66 |
$9.66 |
$579.77
|
|
Inj pemetrexed ditromethamin
|
$10.55 |
$10.55 |
$10.55 |
$895.03
|
|
Inj pemetrexed, hospira 10mg
|
$0.62 |
$0.62 |
$0.62 |
$64.35
|
|
Inj pemetrexed (teva) 10mg
|
$5.52 |
$5.52 |
$5.52 |
$200.85
|
