|
Initiation & management bipap/cpap initial day
|
$297.23 |
$297.23 |
$297.23 |
$570.00
|
|
Inj, abilify asimtufii, 1 mg
|
$12,633.78 |
$12,633.78 |
$12,633.78 |
$9,426.91
|
|
Inj, abilify maintena, 1 mg
|
$4,761.56 |
$4,761.56 |
$4,761.56 |
$5,168.00
|
|
Inj, acetaminophen (hikma)
|
$81.30 |
$81.30 |
$81.30 |
$56.70
|
|
Inj. acthar gel to 40 units
|
$0.01 |
$0.01 |
$0.01 |
$7,918.32
|
|
Inj allopurinol sodium 1 mg
|
$3,419.02 |
$3,419.02 |
$3,419.02 |
$6,968.99
|
|
Inj alymsys 10 mg
|
$5,026.08 |
$5,026.08 |
$5,026.08 |
$1,280.74
|
|
Inj andexxa, 10 mg
|
$3,875.00 |
$3,875.00 |
$3,875.00 |
$4,370.80
|
|
Inj anifrolumab-fnia 1mg
|
$13,099.42 |
$13,099.42 |
$13,099.42 |
$9,878.82
|
|
Inj., aristada initio, 1 mg
|
$5,530.00 |
$5,530.00 |
$5,530.00 |
$4,052.45
|
|
Inj, aspara, rylaze, 0.1 mg
|
$12,851.00 |
$12,851.00 |
$12,851.00 |
$10,458.00
|
|
Inj., benralizumab, 1 mg
|
$14,217.88 |
$14,217.88 |
$14,217.88 |
$11,239.97
|
|
Inj beta interferon sq 1 mcg
|
$2,016.70 |
$2,016.70 |
$2,016.70 |
$2,397.11
|
|
Inj, bezlotoxumab, 10 mg
|
$9,526.00 |
$9,526.00 |
$9,526.00 |
$7,612.43
|
|
Inj, biorphen, 20 micrograms
|
$134.16 |
$134.16 |
$134.16 |
$17.12
|
|
Inj cefazolin sodium, baxter
|
$50.82 |
$50.82 |
$50.82 |
$27.18
|
|
Inj, cefiderocol, 10 mg
|
$953.96 |
$953.96 |
$953.96 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$698.14 |
$698.14 |
$698.14 |
$381.60
|
|
Inj, clevidipine butyrate
|
$437.20 |
$437.20 |
$437.20 |
$4.86
|
|
Inj, clindamycin (baxter)
|
$52.42 |
$52.42 |
$52.42 |
$48.96
|
|
Inj., copanlisib, 1 mg
|
$13,160.00 |
$13,160.00 |
$13,160.00 |
$9,204.29
|
|
Inj cyclophosphamd (ingenus)
|
$742.72 |
$742.72 |
$742.72 |
$683.35
|
|
Inj, durolane 1 mg
|
$2,526.95 |
$2,526.95 |
$2,526.95 |
$1,950.93
|
|
Inj dx for sinogram
|
$110.50 |
$110.50 |
$110.50 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$1,254.78 |
$1,254.78 |
$1,254.78 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$293.06 |
$293.06 |
$293.06 |
$498.50
|
|
Injection, belinostat, 10mg
|
$6,030.58 |
$6,030.58 |
$6,030.58 |
$4,446.10
|
|
Injection, burosumab-twza 1m
|
$33,411.90 |
$33,411.90 |
$33,411.90 |
$20,002.09
|
|
Injection, caplacizumab-yhdp
|
$22,279.40 |
$22,279.40 |
$22,279.40 |
$16,319.16
|
|
Injection, daratumumab 10 mg
|
$6,251.15 |
$6,251.15 |
$6,251.15 |
$5,188.91
|
|
Injection, edaravone, 1 mg
|
$1,588.37 |
$1,588.37 |
$1,588.37 |
$1,136.59
|
|
Injection for arthrography wrist (both sides)
|
$110.50 |
$110.50 |
$110.50 |
$438.00
|
|
Injection for bladder x-ray
|
$209.75 |
$209.75 |
$209.75 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$458.25 |
$458.25 |
$458.25 |
$494.65
|
|
Injection, fulvestrant
|
$202.44 |
$202.44 |
$202.44 |
$1,719.16
|
|
Injection glatiramer acetate
|
$190.63 |
$190.63 |
$190.63 |
$830.51
|
|
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)
|
$662.25 |
$662.25 |
$662.25 |
$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 |
$1,045.65
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,254.78 |
$1,254.78 |
$1,254.78 |
$478.20
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,254.78 |
$1,254.78 |
$1,254.78 |
$546.40
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$1,254.78 |
$1,254.78 |
$1,254.78 |
$634.40
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$105.50 |
$105.50 |
$105.50 |
$163.83
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$102.50 |
$102.50 |
$102.50 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$274.50 |
$274.50 |
$274.50 |
$259.49
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$117.38 |
$117.38 |
$117.38 |
$136.00
|
|
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 |
$6.55
|
|
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, gadopiclenol, 1 ml
|
$134.64 |
$134.64 |
$134.64 |
$37.63
|
|
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, 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 |
$45.14
|
|
Inj mepivacaine hcl/10 ml
|
$66.20 |
$66.20 |
$66.20 |
$33.86
|
|
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 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$117.28 |
$117.28 |
$117.28 |
$252.66
|
|
Inj naloxone hydrochloride
|
$99.22 |
$99.22 |
$99.22 |
$83.16
|
|
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
|
$110.50 |
$110.50 |
$110.50 |
$405.60
|
|
Inj proc elbow arthro
|
$110.50 |
$110.50 |
$110.50 |
$434.00
|
|
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, rimabotulinumtoxinb
|
$2,328.70 |
$2,328.70 |
$2,328.70 |
$746.79
|
|
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
|
