|
Inj. byooviz, 0.1 mg
|
$62.15 |
$62.15 |
$170.80 |
|
|
Inj, carmustine (accord)
|
$259.70 |
$259.70 |
$259.70 |
|
|
Inj cefazolin sodium, hikma
|
$0.91 |
$0.91 |
$0.98 |
|
|
Inj cefazolin (wg crit care)
|
$1.00 |
$1.00 |
$1.04 |
|
|
Inj, cefiderocol, 10 mg
|
$2.28 |
$2.40 |
$2.40 |
|
|
Inj ceftolozane tazobactam
|
$8.23 |
$9.13 |
$9.13 |
|
|
Inj. cetirizine hcl 0.5mg
|
$14.87 |
$16.40 |
$16.40 |
|
|
Inj, cimerli, 0.1 mg
|
$86.51 |
$86.51 |
$201.01 |
|
|
Inj, cipaglucosidase, 5 mg
|
$88.06 |
$89.80 |
$89.80 |
|
|
Inj, clevidipine butyrate
|
$2.83 |
$2.88 |
$2.88 |
|
|
Inj., copanlisib, 1 mg
|
$92.81 |
$92.81 |
$92.81 |
|
|
Inj crotalidae im f(ab')2 eq
|
$1,040.11 |
$1,044.14 |
$1,044.14 |
|
|
Inj, crovalimab-akkz, 10 mg
|
$535.90 |
$551.51 |
$551.51 |
|
|
Inj cuvitru, 100 mg
|
$16.82 |
$17.59 |
$17.59 |
|
|
Inj cyclophos dr.reddy's 5mg
|
$9.00 |
$9.00 |
$9.00 |
|
|
Inj cyclophosphamd auromedic
|
$0.78 |
$0.78 |
$1.16 |
|
|
Inj cyclophosphamd (ingenus)
|
$0.93 |
$1.16 |
$1.16 |
|
|
Inj, cyclophosphamd, sandoz
|
$4.21 |
$4.21 |
$4.34 |
|
|
Inj daptomycin (xellia)
|
$0.04 |
$0.04 |
$0.04 |
|
|
Inj daxibotulinumtoxina-lanm
|
$3.11 |
$3.11 |
$3.12 |
|
|
Inj delandistrogene mox rokl
|
$3,324,571.90 |
$3,324,571.90 |
$3,325,454.76 |
|
|
Inj. denosumab-bbdz, 1 mg
|
$27.54 |
$27.54 |
$27.54 |
|
|
Inj disk cerv-thor ea lev
|
$4,627.00 |
$5,419.00 |
$6,311.00 |
|
|
Inj, docetaxel (beizray) 1mg
|
$52.47 |
$52.47 |
$52.47 |
|
|
Inj, donanemab-azbt, 2 mg
|
$4.09 |
$4.14 |
$4.14 |
|
|
Inj dupuytren cord w/enzyme
|
$322.61 |
$3,986.00 |
$6,839.00 |
|
|
Inj, durolane 1 mg
|
$6.68 |
$6.68 |
$7.00 |
|
|
Inj dx for sinogram
|
$4,881.00 |
$5,741.00 |
$6,311.00 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Injection, belinostat, 10mg
|
$50.09 |
$52.04 |
$52.04 |
|
|
Injection, burosumab-twza 1m
|
$469.58 |
$481.57 |
$481.57 |
|
|
Injection, cangrelor
|
$18.82 |
$19.81 |
$19.81 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$322.61 |
$3,986.00 |
$6,839.00 |
|
|
Injection, daratumumab 10 mg
|
$65.12 |
$69.84 |
$69.84 |
|
|
Injection during cath supravalvular aortography
|
$50.95 |
$146.63 |
$159.76 |
|
|
Injection, edaravone, 1 mg
|
$18.84 |
$18.84 |
$22.14 |
|
|
Injection epidural blood patch or clot
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Injection eye drug
|
$362.50 |
$3,986.00 |
$6,839.00 |
|
|
Injection for bladder x-ray
|
$3,786.00 |
$5,110.00 |
$6,839.00 |
|
|
Injection for tear sac x-ray
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
|
|
Injection for ureter x-ray
|
$4,881.00 |
$5,419.00 |
$6,311.00 |
|
|
Injection for ureter x-ray
|
$3,786.00 |
$4,881.00 |
$6,311.00 |
|
|
Injection, fulvestrant
|
$6.98 |
$6.98 |
$7.51 |
|
|
Injection glatiramer acetate
|
$160.39 |
$160.39 |
$172.88 |
|
|
Injection, inclisiran, 1 mg
|
$12.19 |
$12.35 |
$12.35 |
|
|
Injection into brain canal
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Injection into brain canal
|
$322.61 |
$3,986.00 |
$6,839.00 |
|
|
Injection into hemorrhoid(s)
|
$996.39 |
$3,986.00 |
$6,839.00 |
|
|
Injection into spinal artery
|
$972.98 |
$3,986.00 |
$6,839.00 |
|
|
Injection into vocal cord
|
$424.38 |
$3,986.00 |
$6,839.00 |
|
|
Injection, isavuconazonium
|
$0.98 |
$1.01 |
$1.01 |
|
|
Injection, necitumumab, 1 mg
|
$5.73 |
$5.73 |
$5.73 |
|
|
Injection of HIV prep drug
|
$77.78 |
$78.78 |
$83.81 |
|
|
Injection of sinus tract
|
$1,618.86 |
$3,986.00 |
$6,839.00 |
|
|
Injection,onabotulinumtoxina
|
$6.41 |
$6.50 |
$6.50 |
|
|
Injection, peramivir
|
$1.68 |
$1.68 |
$1.68 |
|
|
Injection px peyronie ds
|
$265.80 |
$3,986.00 |
$6,839.00 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$439.15 |
$3,986.00 |
$6,839.00 |
|
|
Injection, renflexis
|
$25.05 |
$25.05 |
$27.18 |
|
|
Injection, ruconest
|
$34.72 |
$36.74 |
$36.74 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$756.84 |
$766.52 |
$815.55 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$972.98 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$3,786.00 |
$4,350.00 |
$5,419.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$972.98 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$3,786.00 |
$4,350.00 |
$5,419.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$972.98 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Injection, siltuximab
|
$157.07 |
$161.96 |
$161.96 |
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$322.61 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$322.61 |
$3,986.00 |
$6,839.00 |
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$322.61 |
$3,986.00 |
$6,839.00 |
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$49.92 |
$63.37 |
$72.67 |
|
|
Injection treatment of eye
|
$2,492.56 |
$3,986.00 |
$6,839.00 |
|
|
Injection treatment of eye
|
$2,492.56 |
$3,986.00 |
$6,839.00 |
|
|
Injection treatment of nerve
|
$2,134.14 |
$3,986.00 |
$6,839.00 |
|
|
Injection treatment of nerve
|
$2,134.14 |
$3,986.00 |
$6,839.00 |
|
|
Injection treatment of nerve
|
$972.98 |
$3,986.00 |
$6,839.00 |
|
|
Injection treatment of nose
|
$556.55 |
$3,986.00 |
$6,839.00 |
|
|
Inject/treat eye socket
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Inject/treat eye socket
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Inject/treat eye socket
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Inj, eculizumab-aagh, 2 mg
|
$31.35 |
$31.35 |
$31.35 |
|
|
Inj, eculizumab-aeeb, 2 mg
|
$41.49 |
$41.49 |
$41.49 |
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$33.13 |
$33.74 |
$33.74 |
|
|
Inj eflapegrastim-xnst 0.1mg
|
$21.12 |
$21.12 |
$22.75 |
|
|
Inj., emapalumab-lzsg, 1 mg
|
$378.03 |
$381.64 |
$381.64 |
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$52.82 |
$57.43 |
$57.43 |
|
|
Inj epidural sgl cerv-thor without img
|
$756.84 |
$3,986.00 |
$6,839.00 |
|
|
Inj epidural sgl lumb-sacral without img
|
$972.98 |
$3,986.00 |
$6,839.00 |
|
|
Inj, erzofri, 1 mg
|
$17.15 |
$17.15 |
$17.15 |
|
|
Inj, evinacumab-dgnb, 5mg
|
$186.31 |
$189.75 |
$189.75 |
|
|
Inj., evomela, 1 mg
|
$17.35 |
$17.37 |
$17.37 |
|
|
Inj, exagamglogene autotem
|
$2,332,000.00 |
$2,332,000.00 |
$2,332,000.00 |
|
|
Inj, factor x, (human), 1iu
|
$9.11 |
$9.91 |
$9.91 |
|
|
Inj, faricimab-svoa, 0.1mg
|
$34.25 |
$34.48 |
$34.48 |
|
|
Inj. fe derisomaltose 10 mg
|
$18.95 |
$18.95 |
$21.05 |
|
|
Inj fensolvi 0.25 mg
|
$140.43 |
$140.43 |
$140.62 |
|
