|
Injection, glucarpidase
|
$57,673.60 |
$57,673.60 |
$57,673.60 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$6,343.82 |
$6,343.82 |
$6,343.82 |
$6,679.35
|
|
Injection, isavuconazonium
|
$1,636.26 |
$1,636.26 |
$1,636.26 |
$787.67
|
|
Injection, necitumumab, 1 mg
|
$10,850.38 |
$10,850.38 |
$10,850.38 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$2,002.60 |
$2,002.60 |
$2,002.60 |
$2,277.65
|
|
Injection, peramivir
|
$1,457.97 |
$1,457.97 |
$1,457.97 |
$775.82
|
|
Injection px peyronie ds
|
$62.65 |
$62.65 |
$62.65 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$739.00 |
$739.00 |
$739.00 |
$699.68
|
|
Injection, renflexis
|
$1,058.12 |
$1,058.12 |
$1,058.12 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$106.22 |
$106.22 |
$106.22 |
$1,043.72
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$34.30 |
$34.30 |
$34.30 |
$539.55
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$39.72 |
$39.72 |
$39.72 |
$638.95
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$110.00 |
$110.00 |
$110.00 |
$168.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$110.00 |
$110.00 |
$110.00 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$285.50 |
$285.50 |
$285.50 |
$254.52
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$145.00 |
$145.00 |
$145.00 |
$135.60
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$39,458.50 |
$39,458.50 |
$39,458.50 |
$32,176.93
|
|
Inj, epinephrine (belcher)
|
$286.41 |
$286.41 |
$286.41 |
$6.24
|
|
Inj., eravacycline, 1 mg
|
$348.93 |
$348.93 |
$348.93 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$917.80 |
$917.80 |
$917.80 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$5,851.60 |
$5,851.60 |
$5,851.60 |
$3,221.52
|
|
Inj., fibryga, 1 mg
|
$1,283.28 |
$1,283.28 |
$1,283.28 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$492.90 |
$492.90 |
$492.90 |
$39.54
|
|
Inj for ext venography
|
$566.50 |
$566.50 |
$566.50 |
$654.00
|
|
Inj, gadopiclenol, 1 ml
|
$134.64 |
$134.64 |
$134.64 |
$50.70
|
|
Inj givosiran 0.5 mg
|
$57,955.00 |
$57,955.00 |
$57,955.00 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$26,339.85 |
$26,339.85 |
$26,339.85 |
$4,752.60
|
|
Inj, granisetron, xr, 0.1 mg
|
$1,954.92 |
$1,954.92 |
$1,954.92 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$32,336.22 |
$32,336.22 |
$32,336.22 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$11,861.38 |
$11,861.38 |
$11,861.38 |
$7,690.59
|
|
Inj herzuma 10 mg
|
$9,647.15 |
$9,647.15 |
$9,647.15 |
$7,775.46
|
|
Inj human fibrinogen con nos
|
$1,798.04 |
$1,798.04 |
$1,798.04 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$3,292.44 |
$3,292.44 |
$3,292.44 |
$2,452.32
|
|
Inj intralesional <= 7 lsn(s)
|
$22.75 |
$22.75 |
$22.75 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$24,696.58 |
$24,696.58 |
$24,696.58 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$3,563.50 |
$3,563.50 |
$3,563.50 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$10,396.32 |
$10,396.32 |
$10,396.32 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,618.56 |
$1,618.56 |
$1,618.56 |
$923.69
|
|
Inj, lenacapavir, 1 mg
|
$24,398.00 |
$24,398.00 |
$24,398.00 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$129.48 |
$129.48 |
$129.48 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$132.40 |
$132.40 |
$132.40 |
$46.52
|
|
Inj mepivacaine hcl/10 ml
|
$66.20 |
$66.20 |
$66.20 |
$34.20
|
|
Inj., meropenem, vaborbactam
|
$1,005.00 |
$1,005.00 |
$1,005.00 |
$536.27
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$24,009.05 |
$24,009.05 |
$24,009.05 |
$331.93
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$9,643.12 |
$9,643.12 |
$9,643.12 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$249.58 |
$249.58 |
$249.58 |
$107.25
|
|
Inj multihance
|
$126.98 |
$126.98 |
$126.98 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$117.28 |
$117.28 |
$117.28 |
$252.66
|
|
Inj naloxone hydrochloride
|
$99.22 |
$99.22 |
$99.22 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,483.00 |
$1,483.00 |
$1,483.00 |
$1,413.35
|
|
Inj ogivri 10 mg
|
$4,371.95 |
$4,371.95 |
$4,371.95 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$1,487.48 |
$1,487.48 |
$1,487.48 |
$865.34
|
|
Inj ontruzant 10 mg
|
$8,113.58 |
$8,113.58 |
$8,113.58 |
$6,706.27
|
|
Inj, panzyga, 500 mg
|
$11,237.00 |
$11,237.00 |
$11,237.00 |
$8,041.38
|
|
Inj., patisiran, 0.1 mg
|
$23,776.00 |
$23,776.00 |
$23,776.00 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$9,640.55 |
$9,640.55 |
$9,640.55 |
$6,371.38
|
|
Inj, pemivibart, 4500 mg
|
$1,527.92 |
$1,527.92 |
$1,527.92 |
$1,235.55
|
|
Inj., perseris, 0.5 mg
|
$6,775.10 |
$6,775.10 |
$6,775.10 |
$5,146.85
|
|
Inj., plazomicin, 5 mg
|
$1,589.55 |
$1,589.55 |
$1,589.55 |
$607.16
|
|
Inj proc ankle arthr
|
$421.50 |
$421.50 |
$421.50 |
$407.50
|
|
Inj proc elbow arthro
|
$446.50 |
$446.50 |
$446.50 |
$438.00
|
|
Inj proc myelogram lumbar
|
$856.00 |
$856.00 |
$856.00 |
$859.98
|
|
Inj progesterone per 50 mg
|
$66.30 |
$66.30 |
$66.30 |
$14.93
|
|
Inj, releuko 1 mcg
|
$435.98 |
$435.98 |
$435.98 |
$461.20
|
|
Inj retro urethrocysto
|
$458.50 |
$458.50 |
$458.50 |
$450.00
|
|
Inj, rimabotulinumtoxinb
|
$2,328.70 |
$2,328.70 |
$2,328.70 |
$746.79
|
|
Inj scleros sol sgl vein
|
$1,677.00 |
$1,677.00 |
$1,677.00 |
$558.97
|
|
Inj secretin synthetic human
|
$3,773.82 |
$3,773.82 |
$3,773.82 |
$1,285.20
|
|
Inj, spesolimab-sbzo, 1 mg
|
$36,539.13 |
$36,539.13 |
$36,539.13 |
$83,709.85
|
|
Inj, sutimlimab-jome, 10 mg
|
$4,820.02 |
$4,820.02 |
$4,820.02 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$80,398.50 |
$80,398.50 |
$80,398.50 |
$67,538.30
|
|
Inj teclistamab cqyv 0.5 mg
|
$17,678.92 |
$17,678.92 |
$17,678.92 |
$17,517.56
|
|
Inj teplizumab mzwv 5 mcg
|
$19,420.00 |
$19,420.00 |
$19,420.00 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$42,570.05 |
$42,570.05 |
$42,570.05 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$227.37 |
$227.37 |
$227.37 |
$157.81
|
|
Inj testosterone cypionate
|
$60.05 |
$60.05 |
$60.05 |
$64.80
|
|
Inj., tildrakizumab, 1 mg
|
$24,162.46 |
$24,162.46 |
$24,162.46 |
$26,635.60
|
|
Inj tofersen intrathec 1 mg
|
$19,952.01 |
$19,952.01 |
$19,952.01 |
$422.10
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,878.22 |
$1,878.22 |
$1,878.22 |
$1,090.75
|
|
Inj, vancomycin hcl (mylan)
|
$70.84 |
$70.84 |
$70.84 |
$76.59
|
|
Inj, vegzelma, 10 mg
|
$5,170.88 |
$5,170.88 |
$5,170.88 |
$1,430.67
|
|
Inj vocal cord bulking agent
|
$1,480.00 |
$1,480.00 |
$1,480.00 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$427.50 |
$427.50 |
$427.50 |
$504.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$62,655.04 |
$62,655.04 |
$62,655.04 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$5,245.00 |
$5,245.00 |
$5,245.00 |
$5,855.00
|
|
Ins cath ren art 1st uni
|
$3,443.00 |
$3,443.00 |
$3,443.00 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,644.50 |
$5,644.50 |
$5,644.50 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$3,443.00 |
$3,443.00 |
$3,443.00 |
$5,395.20
|
|
Insert drug delivery implant
|
$1,975.50 |
$1,975.50 |
$1,975.50 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$37,347.00 |
$37,347.00 |
$37,347.00 |
$8,018.40
|
|
Insert intrauterine device iud
|
$63.18 |
$63.18 |
$63.18 |
$378.83
|
|
Insertion catheter bladder non indwelling
|
$37.45 |
$37.45 |
$37.45 |
$207.00
|
|
Insertion catheter bladder temporary simple
|
$423.50 |
$423.50 |
$423.50 |
$234.40
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$5,950.50 |
$5,950.50 |
$5,950.50 |
$4,747.60
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$6,933.50 |
$6,933.50 |
$6,933.50 |
$7,082.35
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,040.00 |
$2,040.00 |
$2,040.00 |
$2,549.95
|
|
Insertion of catheter vein
|
$2,337.50 |
$2,337.50 |
$2,337.50 |
$1,657.32
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$11,599.50 |
$11,599.50 |
$11,599.50 |
$12,843.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$14,657.00 |
$14,657.00 |
$14,657.00 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$12,295.50 |
$12,295.50 |
$12,295.50 |
$10,309.20
|
