|
Inj, cyclophos (baxter) 5mg
|
$15.84 |
$15.84 |
$3,516.00 |
|
|
Inj, cyclophosphamd, sandoz
|
$358.29 |
$358.29 |
$358.29 |
|
|
Inj, daptomycin (hospira)
|
$0.62 |
$0.62 |
$212.10 |
|
|
Inj daptomycin (xellia)
|
$0.64 |
$0.64 |
$168.00 |
|
|
Inj daxibotulinumtoxina-lanm
|
$10.63 |
$10.63 |
$10.63 |
|
|
Inj disk cerv-thor ea lev
|
$733.20 |
$2,201.00 |
$2,201.00 |
|
|
Inj, donanemab-azbt, 2 mg
|
$9.83 |
$9.83 |
$883.06 |
|
|
Inj, durolane 1 mg
|
$7,365.38 |
$7,365.38 |
$8,532.40 |
|
|
Inj dx for sinogram
|
$42.04 |
$697.71 |
$1,492.82 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,807.65 |
$1,807.65 |
$4,631.00 |
|
|
Injection arthrography hip without anesthesia (both sides)
|
$279.72 |
$764.40 |
$4,371.06 |
|
|
Injection, belinostat, 10mg
|
$118.75 |
$118.75 |
$6,072.68 |
|
|
Injection, cangrelor
|
$47.22 |
$47.22 |
$3,539.03 |
|
|
Injection, caplacizumab-yhdp
|
$1,852.20 |
$1,852.20 |
$20,572.04 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$1,832.61 |
$1,832.61 |
$4,862.00 |
|
|
Injection, daratumumab 10 mg
|
$181.59 |
$181.59 |
$11,035.45 |
|
|
Injection during cath supravalvular aortography
|
$69.86 |
$1,783.08 |
$2,858.00 |
|
|
Injection epidural blood patch or clot
|
$812.52 |
$1,987.44 |
$6,376.75 |
|
|
Injection eye drug
|
$709.80 |
$709.80 |
$3,920.00 |
|
|
Injection, famotidine, 20 mg
|
$4.12 |
$4.12 |
$4.12 |
|
|
Injection for arthrography wrist (both sides)
|
$226.74 |
$588.12 |
$5,026.42 |
|
|
Injection for bladder x-ray
|
$90.58 |
$890.37 |
$7,627.23 |
|
|
Injection for hip x-ray
|
$1,529.58 |
$1,529.58 |
$4,377.00 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$273.21 |
$591.63 |
$5,593.29 |
|
|
Injection for spleen x-ray
|
$1,960.00 |
$1,960.00 |
$1,960.00 |
|
|
Injection for tear sac x-ray
|
$504.27 |
$504.27 |
$504.27 |
|
|
Injection for ureter x-ray
|
$60.98 |
$219.18 |
$2,477.22 |
|
|
Injection for ureter x-ray
|
$132.02 |
$742.17 |
$742.17 |
|
|
Injection, fulvestrant
|
$239.68 |
$239.68 |
$6,158.08 |
|
|
Injection glatiramer acetate
|
$1,048.60 |
$1,048.60 |
$1,048.60 |
|
|
Injection, glucarpidase
|
$87,885.43 |
$92,352.00 |
$92,352.00 |
|
|
Injection, inclisiran, 1 mg
|
$29.41 |
$29.41 |
$57,085.56 |
|
|
Injection into brain canal
|
$692.64 |
$692.64 |
$692.64 |
|
|
Injection into brain canal
|
$1,266.72 |
$1,266.72 |
$4,661.00 |
|
|
Injection into hemorrhoid(s)
|
$4,377.00 |
$4,377.00 |
$4,377.00 |
|
|
Injection, isavuconazonium
|
$4.45 |
$4.45 |
$1,656.41 |
|
|
Injection jaw joint x-ray
|
$451.23 |
$451.23 |
$451.23 |
|
|
Injection jugular
|
$434.00 |
$1,134.12 |
$1,134.12 |
|
|
Injection of sinus tract
|
$290.38 |
$2,436.33 |
$4,299.00 |
|
|
Injection,onabotulinumtoxina
|
$17.24 |
$131.04 |
$2,350.87 |
|
|
Injection, peramivir
|
$6.85 |
$6.85 |
$1,330.00 |
|
|
Injection px peyronie ds
|
$471.51 |
$471.51 |
$471.51 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$290.97 |
$1,164.93 |
$1,275.00 |
|
|
Injection, renflexis
|
$24.86 |
$24.86 |
$2,793.58 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$633.74 |
$1,895.01 |
$6,376.75 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$750.36 |
$2,867.67 |
$6,376.75 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,831.40 |
$2,049.06 |
$6,376.75 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$634.92 |
$4,175.73 |
$9,504.85 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$468.87 |
$1,346.28 |
$4,862.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$413.22 |
$2,719.08 |
$11,393.78 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$652.09 |
$1,346.28 |
$4,862.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$500.24 |
$3,041.22 |
$11,384.35 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,226.92 |
$4,862.00 |
$6,020.82 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$392.80 |
$1,758.12 |
$7,702.56 |
|
|
Injection, siltuximab
|
$361.39 |
$361.39 |
$15,276.50 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$302.52 |
$1,396.20 |
$4,862.00 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,092.00 |
$1,210.56 |
$4,862.00 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,248.00 |
$1,248.00 |
$4,862.00 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$45.00 |
$343.00 |
$521.67 |
|
|
Injection treatment of eye
|
$2,601.69 |
$2,601.69 |
$6,732.00 |
|
|
Injection treatment of eye
|
$1,022.19 |
$1,022.19 |
$3,920.00 |
|
|
Injection treatment of nerve
|
$4,535.70 |
$4,535.70 |
$4,535.70 |
|
|
Injection treatment of nerve
|
$4,535.70 |
$4,535.70 |
$5,197.00 |
|
|
Injection treatment of nerve
|
$3,667.00 |
$3,667.00 |
$3,667.00 |
|
|
Inject sacroiliac joint
|
$2,015.33 |
$4,377.00 |
$4,377.00 |
|
|
Inject/treat eye socket
|
$282.36 |
$282.36 |
$3,920.00 |
|
|
Inject/treat eye socket
|
$670.02 |
$670.02 |
$3,920.00 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$74.90 |
$74.90 |
$260,947.90 |
|
|
Inj., emapalumab-lzsg, 1 mg
|
$834.80 |
$834.80 |
$87,158.40 |
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$138.37 |
$138.37 |
$87,051.16 |
|
|
Inj epidural sgl cerv-thor without img
|
$1,895.01 |
$1,895.01 |
$3,125.00 |
|
|
Inj epidural sgl lumb-sacral without img
|
$1,740.18 |
$1,740.18 |
$6,376.75 |
|
|
Inj., eravacycline, 1 mg
|
$6.74 |
$6.74 |
$281.75 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$765.52 |
$765.52 |
$765.52 |
|
|
Inj, evinacumab-dgnb, 5mg
|
$333.17 |
$333.17 |
$30,270.10 |
|
|
Inj., evomela, 1 mg
|
$3,837.60 |
$3,837.60 |
$3,837.60 |
|
|
Inj, exagamglogene autotem
|
$9,064,000.00 |
$9,064,000.00 |
$9,064,000.00 |
|
|
Inj., fibryga, 1 mg
|
$4.62 |
$4.62 |
$4.62 |
|
|
Inj fluphenazine hcl 1.25 mg
|
$40.33 |
$40.33 |
$40.33 |
|
|
Inj for ext venography
|
$362.00 |
$394.29 |
$1,231.65 |
|
|
Inj for mammo ductogram
|
$328.00 |
$1,127.49 |
$1,127.49 |
|
|
Inj, fulvestrant (fresenius)
|
$123.60 |
$123.60 |
$1,317.39 |
|
|
Inj, gadopiclenol, 1 ml
|
$29.66 |
$79.56 |
$309.04 |
|
|
Inj gemcitabine hcl (accord)
|
$435.07 |
$447.05 |
$464.40 |
|
|
Inj givosiran 0.5 mg
|
$270.71 |
$270.71 |
$105,345.60 |
|
|
Inj glofitamab gxbm, 2.5 mg
|
$5,601.18 |
$5,601.18 |
$26,019.16 |
|
|
Inj glycopyrrolate fres kabi
|
$139.79 |
$139.79 |
$140.09 |
|
|
Inj, granisetron, xr, 0.1 mg
|
$2,483.33 |
$2,483.33 |
$2,483.33 |
|
|
Inj, hemgenix, per tx dose
|
$7,210,000.00 |
$7,210,000.00 |
$8,400,000.00 |
|
|
Inj heparin, pfizer, 1000u
|
$14.42 |
$14.42 |
$59.50 |
|
|
Inj. herceptin hylecta, 10mg
|
$192.62 |
$192.62 |
$11,220.58 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$69.86 |
$1,646.97 |
$2,813.00 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$64.83 |
$2,920.32 |
$2,920.32 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$2,311.53 |
$2,311.53 |
$2,999.00 |
|
|
Inj hrt cath w/s&i sel left vent
|
$31.97 |
$1,250.34 |
$4,124.79 |
|
|
Inj hrt cath w/s&i sel right vent
|
$39.67 |
$1,377.87 |
$1,863.00 |
|
|
Inj hydroxocobalamin IV 25mg
|
$2,625.91 |
$2,625.91 |
$2,625.91 |
|
|
Inj imip 4 cilas 4 releb 2mg
|
$4.29 |
$4.29 |
$29,306.18 |
|
|
Inj. inebilizumab-cdon, 1 mg
|
$97,531.31 |
$97,531.31 |
$97,531.31 |
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$2,028.39 |
$2,028.39 |
$2,383.00 |
|
