|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$83.40 |
$1,318.80 |
$2,703.60 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$522.60 |
$1,512.80 |
$4,737.20 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$78.00 |
$2,048.40 |
$4,834.00 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$165.60 |
$2,048.40 |
$3,595.20 |
|
|
Injection, siltuximab
|
$310.20 |
$627.60 |
$15,318.00 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$199.80 |
$894.60 |
$1,294.20 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$183.00 |
$548.80 |
$1,605.20 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$30.16 |
$654.00 |
$1,605.20 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$108.00 |
$147.00 |
$438.00 |
|
|
Injection torsemide 10 mg/ml
|
$69.60 |
$69.60 |
$69.60 |
|
|
Injection treatment of eye
|
$83.26 |
$83.26 |
$94.12 |
|
|
Injection treatment of eye
|
$70.38 |
$2,652.50 |
$4,132.80 |
|
|
Injection treatment of nerve
|
$276.46 |
$312.52 |
$2,244.50 |
|
|
Injection treatment of nerve
|
$311.65 |
$311.65 |
$352.30 |
|
|
Injection treatment of nerve
|
$142.60 |
$161.20 |
$2,692.80 |
|
|
Injection treatment of nose
|
$38.87 |
$38.87 |
$43.94 |
|
|
Inject sacroiliac joint
|
$318.00 |
$2,364.80 |
$3,000.60 |
|
|
Inject/treat eye socket
|
$41.63 |
$365.00 |
$784.20 |
|
|
Inject/treat eye socket
|
$45.77 |
$45.77 |
$51.74 |
|
|
Inject/treat eye socket
|
$29.67 |
$33.54 |
$365.00 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$73.50 |
$84.80 |
$1,723.20 |
|
|
Inj., emapalumab-lzsg, 1 mg
|
$1,790.40 |
$1,929.00 |
$4,497.60 |
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$98.40 |
$98.40 |
$39,043.20 |
|
|
Inj epidural sgl cerv-thor without img
|
$1,025.40 |
$1,920.60 |
$3,711.60 |
|
|
Inj epidural sgl lumb-sacral without img
|
$1,127.50 |
$1,549.80 |
$3,088.20 |
|
|
Inj, epinephrine (belcher)
|
$1.20 |
$3.00 |
$36.18 |
|
|
Inj., eravacycline, 1 mg
|
$3.50 |
$36.60 |
$36.60 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$418.20 |
$418.20 |
$628.20 |
|
|
Inj., evomela, 1 mg
|
$97.80 |
$105.60 |
$106.80 |
|
|
Inj, factor x, (human), 1iu
|
$6.60 |
$32.40 |
$52.80 |
|
|
Inj, faricimab-svoa, 0.1mg
|
$88.50 |
$100.00 |
$106.40 |
|
|
Inj. fe derisomaltose 10 mg
|
$60.00 |
$181.20 |
$236.00 |
|
|
Inj., fibryga, 1 mg
|
$4.20 |
$4.20 |
$5.40 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$876.20 |
$876.20 |
$1,112.80 |
|
|
Inj, focinvez, 1mg
|
$5.40 |
$5.40 |
$5.40 |
|
|
Inj for ext venography
|
$189.60 |
$443.20 |
$1,152.60 |
|
|
Inj for mammo ductogram
|
$54.86 |
$306.60 |
$774.62 |
|
|
Inj., fremanezumab-vfrm 1 mg
|
$6.00 |
$6.00 |
$1,404.00 |
|
|
Inj, gadopiclenol, 1 ml
|
$6.60 |
$6.60 |
$82.97 |
|
|
Inj givosiran 0.5 mg
|
$235.20 |
$249.60 |
$119,349.60 |
|
|
Inj glofitamab gxbm, 2.5 mg
|
$612.60 |
$612.60 |
$6,717.00 |
|
|
Inj., guselkumab, 1 mg
|
$367.20 |
$675.00 |
$695.20 |
|
|
Inj heparin, pfizer, 1000u
|
$3.00 |
$3.00 |
$4.86 |
|
|
Inj. herceptin hylecta, 10mg
|
$37.20 |
$561.00 |
$10,519.29 |
|
|
Inj herzuma 10 mg
|
$189.60 |
$841.20 |
$841.20 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$139.00 |
$1,230.00 |
$7,058.59 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$32.66 |
$943.20 |
$6,783.58 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$34.96 |
$34.96 |
$6,783.58 |
|
|
Inj hrt cath w/s&i sel left vent
|
$22.08 |
$1,214.40 |
$6,783.58 |
|
|
Inj hrt cath w/s&i sel right vent
|
$22.77 |
$2,010.00 |
$6,783.58 |
|
|
Inj human fibrinogen con nos
|
$7.20 |
$7.20 |
$9.00 |
|
|
Inj hydroxocobalamin IV 25mg
|
$843.64 |
$953.68 |
$3,902.60 |
|
|
Inj hydroxyprogst capoat nos
|
$6,398.40 |
$6,398.40 |
$6,426.00 |
|
|
Inj imip 4 cilas 4 releb 2mg
|
$5.40 |
$7.35 |
$652.80 |
|
|
Inj. inebilizumab-cdon, 1 mg
|
$864.00 |
$871.80 |
$871.80 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$91.31 |
$103.22 |
$2,487.00 |
|
|
Inj. insulin (fiasp)
|
$16.80 |
$16.80 |
$16.80 |
|
|
Inj intralesional <= 7 lsn(s)
|
$44.40 |
$303.00 |
$581.35 |
|
|
Inj intralesional > 7 lsns
|
$28.98 |
$303.00 |
$626.40 |
|
|
Inj, invega hafyera/trinza
|
$28.50 |
$28.50 |
$32.40 |
|
|
Inj ivig privigen 500 mg
|
$81.00 |
$4,345.80 |
$7,636.80 |
|
|
Inj., lanadelumab-flyo, 1 mg
|
$112.20 |
$112.20 |
$112.20 |
|
|
Inj, lanreotide, (cipla) 1mg
|
$96.60 |
$10,671.00 |
$10,671.00 |
|
|
Inj, lecanemab-irmb, 1 mg
|
$2.40 |
$2.40 |
$1,322.49 |
|
|
Inj levocarnitine per 1 gm
|
$4.20 |
$205.60 |
$1,039.80 |
|
|
Inj, levothyroxine, freskabi
|
$10.20 |
$10.20 |
$10.20 |
|
|
Inj, lidocaine w epinephrine
|
$0.04 |
$12.39 |
$99.40 |
|
|
Inj, linezolid (hospira)
|
$100.20 |
$100.20 |
$100.20 |
|
|
Inj. lumasiran, 0.5 mg
|
$763.20 |
$763.20 |
$763.20 |
|
|
Inj., lumoxiti, 0.01 mg
|
$52.80 |
$52.80 |
$56.40 |
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$88.80 |
$108.00 |
$2,026.64 |
|
|
Inj melpha hydroch nos 50 mg
|
$5,335.80 |
$6,460.20 |
$6,460.20 |
|
|
Inj, melphalan flufenami 1mg
|
$5,700.00 |
$5,700.00 |
$5,700.00 |
|
|
Inj mepivacaine hcl/10 ml
|
$3.51 |
$14.40 |
$114.60 |
|
|
Inj, meropenem (b. braun)
|
$12.00 |
$12.00 |
$12.00 |
|
|
Inj., meropenem, vaborbactam
|
$36.20 |
$991.20 |
$3,622.20 |
|
|
Inj, micafungin (par pharm)
|
$89.40 |
$89.40 |
$89.40 |
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$118.50 |
$118.50 |
$138.60 |
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$540.60 |
$691.20 |
$13,813.20 |
|
|
Inj, moxifloxacin 100 mg
|
$85.80 |
$225.00 |
$442.20 |
|
|
Inj multihance
|
$3.00 |
$31.80 |
$612.60 |
|
|
Inj multihance multipack
|
$69.17 |
$69.17 |
$69.17 |
|
|
Inj. mycophenolate mofetil
|
$64.20 |
$64.20 |
$64.20 |
|
|
Inj naloxone hydrochloride
|
$9.00 |
$57.00 |
$144.00 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$845.40 |
$1,877.38 |
$3,574.20 |
|
|
Inj, nithiodote, 3mg / 125mg
|
$3.60 |
$3.60 |
$4.80 |
|
|
Inj nivolumab 2 mg hyaluron
|
$48.00 |
$48.60 |
$19,390.20 |
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$96.60 |
$109.20 |
$4,791.00 |
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$76.36 |
$3,260.00 |
$5,749.20 |
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$31.28 |
$85.20 |
$101.00 |
|
|
Inj octafluoropropane mic,ml
|
$428.40 |
$963.60 |
$2,890.20 |
|
|
Inj ogivri 10 mg
|
$234.00 |
$564.00 |
$10,341.00 |
|
|
Inj, olaratumab, 10 mg
|
$128.40 |
$128.40 |
$129.00 |
|
|
Inj., omadacycline, 1 mg
|
$21.60 |
$21.60 |
$21.60 |
|
|
Inj ontruzant 10 mg
|
$4,939.20 |
$6,316.80 |
$7,279.20 |
|
|
Inj, pafolacianine, 0.1 mg
|
$253.20 |
$253.20 |
$337.80 |
|
|
Inj., patisiran, 0.1 mg
|
$244.80 |
$256.80 |
$22,800.00 |
|
|
Inj, pedmark, 100 mg
|
$123.00 |
$193.20 |
$218.40 |
|
|
Inj, pegcetacoplan, 1mg
|
$338.50 |
$338.50 |
$338.50 |
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,168.80 |
$3,925.20 |
$9,774.60 |
|
