|
Injection, peramivir
|
$804.15 |
$804.15 |
$804.15 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$348.70 |
$348.70 |
$348.70 |
$694.20
|
|
Injection, renflexis
|
$1,371.78 |
$1,371.78 |
$1,371.78 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$916.80 |
$916.80 |
$916.80 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,391.40 |
$1,391.40 |
$1,391.40 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$632.78 |
$632.78 |
$632.78 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$2,207.48 |
$2,207.48 |
$2,207.48 |
$2,071.80
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,611.33 |
$1,611.33 |
$1,611.33 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$2,546.65 |
$2,546.65 |
$2,546.65 |
$1,888.80
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,119.88 |
$1,119.88 |
$1,119.88 |
$1,048.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$2,226.90 |
$2,226.90 |
$2,226.90 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,788.70 |
$2,788.70 |
$2,788.70 |
$1,826.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$2,207.98 |
$2,207.98 |
$2,207.98 |
$1,685.00
|
|
Injection, siltuximab
|
$12,360.70 |
$12,360.70 |
$12,360.70 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$445.18 |
$445.18 |
$445.18 |
$485.28
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$794.45 |
$794.45 |
$794.45 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$794.45 |
$794.45 |
$794.45 |
$638.95
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$24.88 |
$24.88 |
$24.88 |
$145.60
|
|
Injection treatment of nerve
|
$5,543.00 |
$5,543.00 |
$5,543.00 |
$3,219.20
|
|
Injection treatment of nerve
|
$4,786.43 |
$4,786.43 |
$4,786.43 |
$4,446.30
|
|
Injection treatment of nerve
|
$2,900.28 |
$2,900.28 |
$2,900.28 |
$2,050.30
|
|
Inject sacroiliac joint
|
$916.80 |
$916.80 |
$916.80 |
$1,029.04
|
|
Inject/treat eye socket
|
$381.13 |
$381.13 |
$381.13 |
$381.13
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$32,176.93 |
$32,176.93 |
$32,176.93 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$67,552.70 |
$67,552.70 |
$67,552.70 |
$3,181.80
|
|
Inj epidural sgl cerv-thor without img
|
$1,625.93 |
$1,625.93 |
$1,625.93 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$1,177.23 |
$1,177.23 |
$1,177.23 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$180.20 |
$180.20 |
$180.20 |
$206.64
|
|
Inj, evinacumab-dgnb, 5mg
|
$84,377.30 |
$84,377.30 |
$84,377.30 |
$20,751.13
|
|
Inj, factor x, (human), 1iu
|
$37.65 |
$37.65 |
$37.65 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$4,591.80 |
$4,591.80 |
$4,591.80 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$6,041.83 |
$6,041.83 |
$6,041.83 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$220.48 |
$220.48 |
$220.48 |
$40.33
|
|
Inj for ext venography
|
$1,521.48 |
$1,521.48 |
$1,521.48 |
$631.80
|
|
Inj, fosaprepitant (teva)
|
$735.30 |
$735.30 |
$735.30 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$1,065.08 |
$1,065.08 |
$1,065.08 |
$905.30
|
|
Inj, fulvestrant (teva)
|
$475.00 |
$475.00 |
$475.00 |
$136.50
|
|
Inj, gadopiclenol, 1 ml
|
$516.00 |
$516.00 |
$516.00 |
$37.63
|
|
Inj givosiran 0.5 mg
|
$85,244.50 |
$85,244.50 |
$85,244.50 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$31,576.65 |
$31,576.65 |
$31,576.65 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$11.23 |
$11.23 |
$11.23 |
$11.23
|
|
Inj., guselkumab, 1 mg
|
$29,130.83 |
$29,130.83 |
$29,130.83 |
$29,130.83
|
|
Inj, hemgenix, per tx dose
|
$8,750,000.00 |
$8,750,000.00 |
$8,750,000.00 |
$4,704,002.80
|
|
Inj heparin, pfizer, 1000u
|
$35.85 |
$35.85 |
$35.85 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$9,375.50 |
$9,375.50 |
$9,375.50 |
$8,193.78
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,926.30 |
$2,926.30 |
$2,926.30 |
$1,492.00
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,895.28 |
$3,895.28 |
$3,895.28 |
$1,818.15
|
|
Inj hrt cath w/s&i sel hrt art
|
$3,940.45 |
$3,940.45 |
$3,940.45 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$2,582.80 |
$2,582.80 |
$2,582.80 |
$1,250.34
|
|
Inj hrt cath w/s&i sel right vent
|
$2,618.60 |
$2,618.60 |
$2,618.60 |
$999.96
|
|
Inj human fibrinogen con nos
|
$22.50 |
$22.50 |
$22.50 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$1,857.80 |
$1,857.80 |
$1,857.80 |
$2,452.32
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$2,960.00 |
$2,960.00 |
$2,960.00 |
$3,542.09
|
|
Inj imip 4 cilas 4 releb 2mg
|
$743.18 |
$743.18 |
$743.18 |
$739.77
|
|
Inj intralesional <= 7 lsn(s)
|
$110.95 |
$110.95 |
$110.95 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$158.50 |
$158.50 |
$158.50 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$40,714.00 |
$40,714.00 |
$40,714.00 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$8,003.70 |
$8,003.70 |
$8,003.70 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$23.28 |
$23.28 |
$23.28 |
$41.79
|
|
Inj, lanreotide, (cipla) 1mg
|
$11,648.70 |
$11,648.70 |
$11,648.70 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,292.93 |
$1,292.93 |
$1,292.93 |
$1,174.88
|
|
Inj, lenacapavir, 1 mg
|
$19,512.50 |
$19,512.50 |
$19,512.50 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$88.83 |
$88.83 |
$88.83 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$468.50 |
$468.50 |
$468.50 |
$110.40
|
|
Inj, levothyroxine, freskabi
|
$912.83 |
$912.83 |
$912.83 |
$320.80
|
|
Inj, levothyroxine, hikma
|
$127.13 |
$127.13 |
$127.13 |
$42.89
|
|
Inj, lidocaine w epinephrine
|
$35.60 |
$35.60 |
$35.60 |
$45.14
|
|
Inj, linezolid (hospira)
|
$152.75 |
$152.75 |
$152.75 |
$153.30
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,523.38 |
$1,523.38 |
$1,523.38 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$3,311.20 |
$3,311.20 |
$3,311.20 |
$1,713.99
|
|
Inj mepivacaine hcl/10 ml
|
$24.45 |
$24.45 |
$24.45 |
$34.00
|
|
Inj, meropenem (b. braun)
|
$91.53 |
$91.53 |
$91.53 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$566.68 |
$566.68 |
$566.68 |
$556.87
|
|
Inj meropenem (wg crit care)
|
$99.20 |
$99.20 |
$99.20 |
$83.19
|
|
Inj, micafungin (par pharm)
|
$79.08 |
$79.08 |
$79.08 |
$79.08
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$19,198.95 |
$19,198.95 |
$19,198.95 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$9,402.25 |
$9,402.25 |
$9,402.25 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$84.50 |
$84.50 |
$84.50 |
$101.31
|
|
Inj moxifloxacin (fres kabi)
|
$105.50 |
$105.50 |
$105.50 |
$95.62
|
|
Inj multihance
|
$160.75 |
$160.75 |
$160.75 |
$70.54
|
|
Inj multihance multipack
|
$803.75 |
$803.75 |
$803.75 |
$4.08
|
|
Inj. mycophenolate mofetil
|
$180.10 |
$180.10 |
$180.10 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$52,144.30 |
$52,144.30 |
$52,144.30 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,413.35 |
$1,413.35 |
$1,413.35 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$492.45 |
$492.45 |
$492.45 |
$472.76
|
|
Inj nivolumab 2 mg hyaluron
|
$15,599.68 |
$15,599.68 |
$15,599.68 |
$15,599.68
|
|
Inj octafluoropropane mic,ml
|
$351.00 |
$351.00 |
$351.00 |
$211.40
|
|
Inj ogivri 10 mg
|
$4,492.28 |
$4,492.28 |
$4,492.28 |
$4,492.28
|
|
Inj olipudase alfa-rpcp 1mg
|
$15,164.98 |
$15,164.98 |
$15,164.98 |
$13,239.99
|
|
Inj, omacetaxine mep, 0.01mg
|
$2,686.80 |
$2,686.80 |
$2,686.80 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$1,159.15 |
$1,159.15 |
$1,159.15 |
$865.34
|
|
Inj onase abepar-xioi treat
|
$5,805,110.90 |
$5,805,110.90 |
$5,805,110.90 |
$3,572,794.09
|
|
Inj pantoprazole(hikma) 40mg
|
$30.55 |
$30.55 |
$30.55 |
$34.67
|
|
Inj., patisiran, 0.1 mg
|
$19,582.50 |
$19,582.50 |
$19,582.50 |
$17,613.00
|
|
Inj, pegcetacoplan, 1mg
|
$4,436.30 |
$4,436.30 |
$4,436.30 |
$3,662.96
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$6,244.73 |
$6,244.73 |
$6,244.73 |
$6,614.40
|
|
Inj pemetrexed, hospira 10mg
|
$1,007.63 |
$1,007.63 |
$1,007.63 |
$64.35
|
|
Inj pemetrexed (sandoz) 10mg
|
$225.00 |
$225.00 |
$225.00 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$1,295.85 |
$1,295.85 |
$1,295.85 |
$1,235.55
|
|
Inj., perseris, 0.5 mg
|
$5,372.48 |
$5,372.48 |
$5,372.48 |
$5,146.85
|
