|
Injection into hemorrhoid(s)
|
$742.80 |
$742.80 |
$742.80 |
$1,433.00
|
|
Injection into vocal cord
|
$6,130.20 |
$6,130.20 |
$6,130.20 |
$459.51
|
|
Injection, isavuconazonium
|
$2.60 |
$2.85 |
$1,041.60 |
$787.67
|
|
Injection, necitumumab, 1 mg
|
$15.60 |
$15.60 |
$16.20 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$41.55 |
$2,307.60 |
$6,946.80 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$508.80 |
$1,222.20 |
$1,222.20 |
$321.94
|
|
Injection, peramivir
|
$6.75 |
$6.75 |
$7.40 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$898.80 |
$898.80 |
$1,666.20 |
$694.20
|
|
Injection, renflexis
|
$228.80 |
$229.20 |
$2,293.80 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,656.60 |
$3,000.60 |
$4,453.20 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$605.40 |
$831.00 |
$1,914.60 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$576.00 |
$615.00 |
$1,647.60 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,656.60 |
$2,703.60 |
$3,192.60 |
$2,071.80
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,320.00 |
$1,620.00 |
$3,157.80 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,322.40 |
$1,656.60 |
$3,157.80 |
$1,888.80
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,320.00 |
$1,620.00 |
$2,703.60 |
$1,048.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,320.00 |
$1,656.60 |
$2,703.60 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,939.20 |
$2,903.40 |
$3,899.40 |
$1,826.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,779.00 |
$2,088.00 |
$3,595.20 |
$1,685.00
|
|
Injection, siltuximab
|
$404.40 |
$471.00 |
$15,318.00 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$703.20 |
$1,018.80 |
$1,172.40 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$403.20 |
$580.20 |
$595.80 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$286.80 |
$547.20 |
$672.00 |
$638.95
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$154.80 |
$238.80 |
$438.00 |
$145.60
|
|
Injection torsemide 10 mg/ml
|
$69.60 |
$69.60 |
$69.60 |
$16.02
|
|
Injection treatment of eye
|
$2,851.20 |
$2,851.20 |
$4,132.80 |
$2,685.92
|
|
Inject sacroiliac joint
|
$3,000.60 |
$3,000.60 |
$3,000.60 |
$1,029.04
|
|
Inject/treat eye socket
|
$571.80 |
$571.80 |
$784.20 |
$381.13
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$79.80 |
$79.80 |
$79.80 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$1,929.00 |
$1,929.00 |
$4,497.60 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$98.40 |
$98.40 |
$39,043.20 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$1,318.80 |
$1,656.60 |
$3,469.80 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,366.20 |
$1,549.80 |
$3,088.20 |
$1,450.84
|
|
Inj, epinephrine (belcher)
|
$1.80 |
$3.00 |
$24.00 |
$6.55
|
|
Inj, etelcalcetide, 0.1 mg
|
$418.20 |
$418.20 |
$628.20 |
$343.35
|
|
Inj., evomela, 1 mg
|
$97.80 |
$97.80 |
$97.80 |
$17.37
|
|
Inj, factor x, (human), 1iu
|
$17.60 |
$20.85 |
$41.40 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$100.00 |
$100.00 |
$106.40 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$181.20 |
$181.20 |
$181.20 |
$3,221.52
|
|
Inj., fibryga, 1 mg
|
$5.40 |
$5.40 |
$5.40 |
$4.93
|
|
Inj, focinvez, 1mg
|
$5.40 |
$5.40 |
$5.40 |
$3.63
|
|
Inj for ext venography
|
$403.20 |
$440.40 |
$602.40 |
$631.80
|
|
Inj for mammo ductogram
|
$525.00 |
$525.00 |
$525.00 |
$397.80
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$7.80 |
$1,404.00 |
$1,322.20
|
|
Inj givosiran 0.5 mg
|
$235.20 |
$249.60 |
$119,349.60 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$6,717.00 |
$6,717.00 |
$6,717.00 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$675.00 |
$675.00 |
$675.00 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$433.20 |
$433.20 |
$433.20 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$543.60 |
$543.60 |
$543.60 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$1,530.60 |
$1,530.60 |
$2,085.60 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,480.00 |
$3,480.00 |
$3,480.00 |
$1,818.15
|
|
Inj hrt cath w/s&i sel right vent
|
$2,085.00 |
$2,085.00 |
$2,085.00 |
$999.96
|
|
Inj human fibrinogen con nos
|
$7.20 |
$7.20 |
$9.00 |
$3.95
|
|
Inj hydroxyprogst capoat nos
|
$6,398.40 |
$6,398.40 |
$6,398.40 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$5.40 |
$7.35 |
$7.40 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$871.80 |
$871.80 |
$871.80 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$2,487.00 |
$2,487.00 |
$2,487.00 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$271.20 |
$281.40 |
$303.00 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$303.00 |
$457.20 |
$626.40 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$32.40 |
$32.40 |
$32.40 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$199.80 |
$4,345.80 |
$6,144.00 |
$6,967.29
|
|
Inj., lanadelumab-flyo, 1 mg
|
$112.20 |
$112.20 |
$112.20 |
$42,504.48
|
|
Inj, lanreotide, (cipla) 1mg
|
$96.60 |
$96.60 |
$96.60 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$2.40 |
$2.40 |
$2.40 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$220.00 |
$1,039.80 |
$1,039.80 |
$136.62
|
|
Inj. lumasiran, 0.5 mg
|
$763.20 |
$763.20 |
$763.20 |
$96,930.47
|
|
Inj., lumoxiti, 0.01 mg
|
$52.80 |
$52.80 |
$56.40 |
$3,881.27
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$108.00 |
$108.00 |
$144.00 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$6,460.20 |
$6,460.20 |
$6,460.20 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$13.80 |
$33.30 |
$105.00 |
$34.00
|
|
Inj., meropenem, vaborbactam
|
$36.20 |
$2,281.20 |
$3,622.20 |
$556.87
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$138.60 |
$138.60 |
$138.60 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$691.20 |
$691.20 |
$13,813.20 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$85.80 |
$225.00 |
$442.20 |
$101.31
|
|
Inj multihance
|
$31.80 |
$86.40 |
$160.80 |
$70.54
|
|
Inj naloxone hydrochloride
|
$25.80 |
$58.80 |
$76.20 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$2,092.80 |
$2,092.80 |
$3,574.20 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$3.60 |
$3.60 |
$4.80 |
$472.76
|
|
Inj nivolumab 2 mg hyaluron
|
$48.60 |
$48.60 |
$48.60 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$4,791.00 |
$4,791.00 |
$4,791.00 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$4,581.60 |
$4,581.60 |
$5,749.20 |
$2,726.90
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$85.80 |
$85.80 |
$85.80 |
$1,058.98
|
|
Inj octafluoropropane mic,ml
|
$963.60 |
$963.60 |
$2,890.20 |
$211.40
|
|
Inj ogivri 10 mg
|
$242.40 |
$10,183.20 |
$10,183.20 |
$4,492.28
|
|
Inj, olaratumab, 10 mg
|
$128.40 |
$128.40 |
$129.00 |
$4,127.04
|
|
Inj., omadacycline, 1 mg
|
$21.60 |
$21.60 |
$21.60 |
$865.34
|
|
Inj ontruzant 10 mg
|
$6,316.80 |
$6,316.80 |
$7,279.20 |
$6,706.27
|
|
Inj, pafolacianine, 0.1 mg
|
$253.20 |
$253.20 |
$337.80 |
$6,897.80
|
|
Inj., patisiran, 0.1 mg
|
$256.80 |
$256.80 |
$256.80 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$123.00 |
$123.00 |
$123.00 |
$96.08
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,168.80 |
$6,614.40 |
$6,614.40 |
$6,614.40
|
|
Inj. pemetrexed, 10 mg
|
$156.60 |
$156.60 |
$156.60 |
$104.72
|
|
Inj, pemivibart, 4500 mg
|
$11,019.00 |
$11,019.00 |
$11,019.00 |
$1,235.55
|
|
Inj peritoneal venous shunt
|
$358.80 |
$358.80 |
$3,279.60 |
$406.80
|
|
Inj., plazomicin, 5 mg
|
$85.80 |
$85.80 |
$115.20 |
$607.16
|
|
Inj proc ankle arthr
|
$543.00 |
$780.60 |
$1,020.60 |
$405.31
|
|
Inj proc elbow arthro
|
$381.60 |
$666.60 |
$1,070.40 |
$433.00
|
|
Inj proc for lymphang
|
$2,552.40 |
$3,368.40 |
$3,449.40 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$6,966.00 |
$6,966.00 |
$6,966.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,000.80 |
$1,068.00 |
$2,289.60 |
$840.00
|
