|
Inj, cefiderocol, 10 mg
|
$2.28 |
$2.28 |
$2.28 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$8.23 |
$8.23 |
$8.23 |
$358.56
|
|
Inj. cetirizine hcl 0.5mg
|
$14.87 |
$14.87 |
$14.87 |
$159.98
|
|
Inj, cimerli, 0.1 mg
|
$201.01 |
$201.01 |
$201.01 |
$201.01
|
|
Inj, cipaglucosidase, 5 mg
|
$88.06 |
$88.06 |
$88.06 |
$3,278.80
|
|
Inj, clevidipine butyrate
|
$2.83 |
$2.83 |
$2.83 |
$4.86
|
|
Inj., copanlisib, 1 mg
|
$92.81 |
$92.81 |
$92.81 |
$9,204.29
|
|
Inj crotalidae im f(ab')2 eq
|
$1,040.11 |
$1,040.11 |
$1,040.11 |
$2,613.60
|
|
Inj, crovalimab-akkz, 10 mg
|
$535.90 |
$535.90 |
$535.90 |
$535.90
|
|
Inj cuvitru, 100 mg
|
$16.82 |
$16.82 |
$16.82 |
$4,163.61
|
|
Inj cyclophosphamd auromedic
|
$1.16 |
$1.16 |
$1.16 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$0.93 |
$0.93 |
$0.93 |
$742.72
|
|
Inj, cyclophosphamd, sandoz
|
$4.34 |
$4.34 |
$4.34 |
$735.20
|
|
Inj daptomycin (xellia)
|
$0.04 |
$0.04 |
$0.04 |
$56.04
|
|
Inj daxibotulinumtoxina-lanm
|
$3.12 |
$3.12 |
$3.12 |
$736.62
|
|
Inj delandistrogene mox rokl
|
$3,325,454.76 |
$3,325,454.76 |
$3,325,454.76 |
$3,325,454.76
|
|
Inj, donanemab-azbt, 2 mg
|
$4.09 |
$4.09 |
$4.09 |
$1,233.44
|
|
Inj dupuytren cord w/enzyme
|
$349.32 |
$349.32 |
$349.32 |
$416.00
|
|
Inj, durolane 1 mg
|
$7.00 |
$7.00 |
$7.00 |
$1,950.93
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$819.50 |
$819.50 |
$819.50 |
$1,214.78
|
|
Injection, belinostat, 10mg
|
$50.09 |
$50.09 |
$50.09 |
$4,446.10
|
|
Injection, burosumab-twza 1m
|
$469.58 |
$469.58 |
$469.58 |
$20,002.09
|
|
Injection, cangrelor
|
$18.82 |
$18.82 |
$18.82 |
$1,889.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$349.32 |
$349.32 |
$349.32 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$65.12 |
$65.12 |
$65.12 |
$5,324.34
|
|
Injection, edaravone, 1 mg
|
$22.14 |
$22.14 |
$22.14 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$819.50 |
$819.50 |
$819.50 |
$1,192.80
|
|
Injection eye drug
|
$392.51 |
$392.51 |
$392.51 |
$648.96
|
|
Injection, fulvestrant
|
$7.51 |
$7.51 |
$7.51 |
$1,719.16
|
|
Injection glatiramer acetate
|
$172.88 |
$172.88 |
$172.88 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$12.19 |
$12.19 |
$12.19 |
$6,679.35
|
|
Injection into brain canal
|
$819.50 |
$819.50 |
$819.50 |
$1,261.40
|
|
Injection into brain canal
|
$349.32 |
$349.32 |
$349.32 |
$844.50
|
|
Injection into hemorrhoid(s)
|
$1,078.88 |
$1,078.88 |
$1,078.88 |
$1,433.00
|
|
Injection into spinal artery
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$1,710.80
|
|
Injection into vocal cord
|
$459.51 |
$459.51 |
$459.51 |
$459.51
|
|
Injection, isavuconazonium
|
$0.98 |
$0.98 |
$0.98 |
$787.67
|
|
Injection, necitumumab, 1 mg
|
$5.73 |
$5.73 |
$5.73 |
$8,572.91
|
|
Injection of HIV prep drug
|
$84.22 |
$84.22 |
$84.22 |
$78.84
|
|
Injection of sinus tract
|
$1,752.89 |
$1,752.89 |
$1,752.89 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$6.41 |
$6.41 |
$6.41 |
$2,277.65
|
|
Injection, peramivir
|
$1.68 |
$1.68 |
$1.68 |
$744.75
|
|
Injection px peyronie ds
|
$287.81 |
$287.81 |
$287.81 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$475.51 |
$475.51 |
$475.51 |
$694.20
|
|
Injection, renflexis
|
$27.18 |
$27.18 |
$27.18 |
$1,341.52
|
|
Injection, ruconest
|
$34.72 |
$34.72 |
$34.72 |
$14,111.44
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$819.50 |
$819.50 |
$819.50 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$819.50 |
$819.50 |
$819.50 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$819.50 |
$819.50 |
$819.50 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$2,071.80
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$1,888.80
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$819.50 |
$819.50 |
$819.50 |
$1,826.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$819.50 |
$819.50 |
$819.50 |
$1,685.00
|
|
Injection, siltuximab
|
$157.07 |
$157.07 |
$157.07 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$349.32 |
$349.32 |
$349.32 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$349.32 |
$349.32 |
$349.32 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$349.32 |
$349.32 |
$349.32 |
$638.95
|
|
Injection treatment of eye
|
$2,698.92 |
$2,698.92 |
$2,698.92 |
$2,698.92
|
|
Injection treatment of eye
|
$2,698.92 |
$2,698.92 |
$2,698.92 |
$2,685.92
|
|
Injection treatment of nerve
|
$2,310.83 |
$2,310.83 |
$2,310.83 |
$3,219.20
|
|
Injection treatment of nerve
|
$2,310.83 |
$2,310.83 |
$2,310.83 |
$4,446.30
|
|
Injection treatment of nerve
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$2,050.30
|
|
Injection treatment of nose
|
$602.63 |
$602.63 |
$602.63 |
$859.59
|
|
Inject/treat eye socket
|
$353.74 |
$353.74 |
$353.74 |
$381.13
|
|
Inject/treat eye socket
|
$353.74 |
$353.74 |
$353.74 |
$750.70
|
|
Inject/treat eye socket
|
$353.74 |
$353.74 |
$353.74 |
$670.02
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$33.13 |
$33.13 |
$33.13 |
$32,176.93
|
|
Inj eflapegrastim-xnst 0.1mg
|
$22.75 |
$22.75 |
$22.75 |
$22.75
|
|
Inj., emapalumab-lzsg, 1 mg
|
$378.03 |
$378.03 |
$378.03 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$52.82 |
$52.82 |
$52.82 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$819.50 |
$819.50 |
$819.50 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,053.53 |
$1,053.53 |
$1,053.53 |
$1,450.84
|
|
Inj, evinacumab-dgnb, 5mg
|
$186.31 |
$186.31 |
$186.31 |
$20,751.13
|
|
Inj., evomela, 1 mg
|
$17.35 |
$17.35 |
$17.35 |
$17.37
|
|
Inj, exagamglogene autotem
|
$2,332,000.00 |
$2,332,000.00 |
$2,332,000.00 |
$3,218,160.00
|
|
Inj, factor x, (human), 1iu
|
$9.11 |
$9.11 |
$9.11 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$34.25 |
$34.25 |
$34.25 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$21.05 |
$21.05 |
$21.05 |
$3,221.52
|
|
Inj fensolvi 0.25 mg
|
$140.62 |
$140.62 |
$140.62 |
$44,262.98
|
|
Inj., fibryga, 1 mg
|
$1.11 |
$1.11 |
$1.11 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$7.35 |
$7.35 |
$7.35 |
$40.33
|
|
Inj, focinvez, 1mg
|
$3.14 |
$3.14 |
$3.14 |
$3.63
|
|
Inj, fosaprepitant (teva)
|
$2.04 |
$2.04 |
$2.04 |
$152.10
|
|
Inj fosnetupitant, palonoset
|
$679.51 |
$679.51 |
$679.51 |
$1,110.99
|
|
Inj, fulvestrant (fresenius)
|
$53.00 |
$53.00 |
$53.00 |
$905.30
|
|
Inj, fulvestrant (teva)
|
$21.20 |
$21.20 |
$21.20 |
$136.50
|
|
Inj givosiran 0.5 mg
|
$112.14 |
$112.14 |
$112.14 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$2,701.04 |
$2,701.04 |
$2,701.04 |
$4,760.67
|
|
Inj glycopyrrolate fres kabi
|
$1.80 |
$1.80 |
$1.80 |
$12.18
|
|
Inj, granisetron, xr, 0.1 mg
|
$5.71 |
$5.71 |
$5.71 |
$163.28
|
|
Inj., guselkumab, 1 mg
|
$74.47 |
$74.47 |
$74.47 |
$29,130.83
|
|
Inj, hemgenix, per tx dose
|
$3,672,900.00 |
$3,672,900.00 |
$3,672,900.00 |
$4,704,002.80
|
|
Inj. herceptin hylecta, 10mg
|
$63.79 |
$63.79 |
$63.79 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$60.44 |
$60.44 |
$60.44 |
$7,775.46
|
|
Inj human fibrinogen con nos
|
$1.45 |
$1.45 |
$1.45 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$5.03 |
$5.03 |
$5.03 |
$2,452.32
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$77.06 |
$77.06 |
$77.06 |
$3,542.09
|
|
Inj, idacio, 1 mg
|
$14.63 |
$14.63 |
$14.63 |
$14.63
|
|
Inj imip 4 cilas 4 releb 2mg
|
$2.51 |
$2.51 |
$2.51 |
$739.77
|
