|
Inj, cefiderocol, 10 mg
|
$544.85 |
$544.85 |
$544.85 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$408.00 |
$408.00 |
$408.00 |
$364.86
|
|
Inj, cimerli, 0.1 mg
|
$63,648.00 |
$63,648.00 |
$63,648.00 |
$201.01
|
|
Inj, cipaglucosidase, 5 mg
|
$4,584.06 |
$4,584.06 |
$4,584.06 |
$3,278.80
|
|
Inj, clindamycin (baxter)
|
$0.60 |
$0.60 |
$0.60 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$508.30 |
$508.30 |
$508.30 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$4,570.80 |
$4,570.80 |
$4,570.80 |
$2,584.85
|
|
Inj cyclophosphamd (ingenus)
|
$342.81 |
$342.81 |
$342.81 |
$742.72
|
|
Inj, daptomycin (baxter)
|
$1.83 |
$1.83 |
$1.83 |
$1.83
|
|
Inj, daptomycin (hospira)
|
$40.37 |
$40.37 |
$40.37 |
$128.08
|
|
Inj daptomycin (xellia)
|
$56.04 |
$56.04 |
$56.04 |
$56.04
|
|
Inj daxibotulinumtoxina-lanm
|
$982.80 |
$982.80 |
$982.80 |
$736.62
|
|
Inj, decitabine (sun pharma)
|
$312.00 |
$312.00 |
$312.00 |
$310.09
|
|
Inj. denosumab-bbdz, 1 mg
|
$4,416.07 |
$4,416.07 |
$4,416.07 |
$4,615.43
|
|
Inj disk cerv-thor ea lev
|
$993.20 |
$993.20 |
$993.20 |
$875.28
|
|
Inj, donanemab-azbt, 2 mg
|
$82.41 |
$82.41 |
$82.41 |
$1,233.44
|
|
Inj dupuytren cord w/enzyme
|
$882.70 |
$882.70 |
$882.70 |
$416.00
|
|
Inj, durolane 1 mg
|
$869.70 |
$869.70 |
$869.70 |
$1,950.93
|
|
Inj dx for sinogram
|
$700.70 |
$700.70 |
$700.70 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$473.20 |
$473.20 |
$473.20 |
$503.50
|
|
Injection, belinostat, 10mg
|
$8,012.89 |
$8,012.89 |
$8,012.89 |
$4,446.10
|
|
Injection, cangrelor
|
$2,457.60 |
$2,457.60 |
$2,457.60 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$20,860.05 |
$20,860.05 |
$20,860.05 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$882.70 |
$882.70 |
$882.70 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$483.99 |
$483.99 |
$483.99 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$2,980.90 |
$2,980.90 |
$2,980.90 |
$1,027.26
|
|
Injection, edaravone, 1 mg
|
$15.19 |
$15.19 |
$15.19 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,182.33
|
|
Injection eye drug
|
$991.90 |
$991.90 |
$991.90 |
$654.00
|
|
Injection for arthrography wrist (both sides)
|
$414.05 |
$414.05 |
$414.05 |
$436.00
|
|
Injection for bladder x-ray
|
$681.20 |
$681.20 |
$681.20 |
$459.20
|
|
Injection for hip x-ray
|
$567.45 |
$567.45 |
$567.45 |
$763.60
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$494.65 |
$494.65 |
$494.65 |
$497.76
|
|
Injection for ureter x-ray
|
$341.90 |
$341.90 |
$341.90 |
$415.80
|
|
Injection for ureter x-ray
|
$6,436.95 |
$6,436.95 |
$6,436.95 |
$515.21
|
|
Injection glatiramer acetate
|
$1,194.10 |
$1,194.10 |
$1,194.10 |
$830.51
|
|
Injection, glucarpidase
|
$101,165.22 |
$101,165.22 |
$101,165.22 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$5,596.85 |
$5,596.85 |
$5,596.85 |
$6,679.35
|
|
Injection into brain canal
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,289.60
|
|
Injection into brain canal
|
$1,324.05 |
$1,324.05 |
$1,324.05 |
$844.50
|
|
Injection into hemorrhoid(s)
|
$452.40 |
$452.40 |
$452.40 |
$1,433.00
|
|
Injection jugular
|
$1,450.80 |
$1,450.80 |
$1,450.80 |
$790.00
|
|
Injection of sinus tract
|
$4,429.10 |
$4,429.10 |
$4,429.10 |
$1,640.99
|
|
Injection,onabotulinumtoxina
|
$3,046.68 |
$3,046.68 |
$3,046.68 |
$2,277.65
|
|
Injection, peramivir
|
$37.05 |
$37.05 |
$37.05 |
$744.75
|
|
Injection px peyronie ds
|
$727.35 |
$727.35 |
$727.35 |
$409.34
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,044.55 |
$1,044.55 |
$1,044.55 |
$685.44
|
|
Injection, renflexis
|
$1,762.94 |
$1,762.94 |
$1,762.94 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,285.05 |
$1,285.05 |
$1,285.05 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,992.95 |
$3,992.95 |
$3,992.95 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$426.40 |
$426.40 |
$426.40 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$3,992.95 |
$3,992.95 |
$3,992.95 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$1,129.05 |
$1,129.05 |
$1,129.05 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$3,992.95 |
$3,992.95 |
$3,992.95 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,685.00
|
|
Injection, siltuximab
|
$20,494.92 |
$20,494.92 |
$20,494.92 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$882.70 |
$882.70 |
$882.70 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$882.70 |
$882.70 |
$882.70 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$882.70 |
$882.70 |
$882.70 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$317.20 |
$317.20 |
$317.20 |
$145.60
|
|
Injection treatment of nerve
|
$1,469.00 |
$1,469.00 |
$1,469.00 |
$3,219.20
|
|
Injection treatment of nerve
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$4,446.30
|
|
Injection treatment of nerve
|
$982.80 |
$982.80 |
$982.80 |
$2,054.00
|
|
Inject sacroiliac joint
|
$1,253.20 |
$1,253.20 |
$1,253.20 |
$1,029.04
|
|
Inj, eculizumab-aagh, 2 mg
|
$474.86 |
$474.86 |
$474.86 |
$7,980.52
|
|
Inj, eculizumab-aeeb, 2 mg
|
$610.56 |
$610.56 |
$610.56 |
$610.56
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$6,857.14 |
$6,857.14 |
$6,857.14 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$4,341.87 |
$4,341.87 |
$4,341.87 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$42,437.44 |
$42,437.44 |
$42,437.44 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$3,992.95 |
$3,992.95 |
$3,992.95 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$170.63 |
$170.63 |
$170.63 |
$206.64
|
|
Inj, eteplirsen, 10 mg
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$2,598.44
|
|
Inj, exagamglogene autotem
|
$6,864,000.00 |
$6,864,000.00 |
$6,864,000.00 |
$3,218,160.00
|
|
Inj, factor x, (human), 1iu
|
$26.64 |
$26.64 |
$26.64 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$109,834.45 |
$109,834.45 |
$109,834.45 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$854.61 |
$854.61 |
$854.61 |
$3,221.52
|
|
Inj fensolvi 0.25 mg
|
$67,427.61 |
$67,427.61 |
$67,427.61 |
$44,262.98
|
|
Inj fluphenazine hcl 1.25 mg
|
$44.95 |
$44.95 |
$44.95 |
$40.33
|
|
Inj, focinvez, 1mg
|
$22.05 |
$22.05 |
$22.05 |
$3.63
|
|
Inj for ext venography
|
$1,433.90 |
$1,433.90 |
$1,433.90 |
$628.80
|
|
Inj for mammo ductogram
|
$315.90 |
$315.90 |
$315.90 |
$397.80
|
|
Inj, fosaprepitant (teva)
|
$152.10 |
$152.10 |
$152.10 |
$152.10
|
|
Inj., fremanezumab-vfrm 1 mg
|
$1,178.03 |
$1,178.03 |
$1,178.03 |
$1,322.20
|
|
Inj, fulvestrant (fresenius)
|
$604.99 |
$604.99 |
$604.99 |
$905.30
|
|
Inj, gadopiclenol, 1 ml
|
$25.84 |
$25.84 |
$25.84 |
$37.63
|
|
Inj givosiran 0.5 mg
|
$102,711.96 |
$102,711.96 |
$102,711.96 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$3,382.50 |
$3,382.50 |
$3,382.50 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$34,085.47 |
$34,085.47 |
$34,085.47 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$12.17 |
$12.17 |
$12.17 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$2,917.36 |
$2,917.36 |
$2,917.36 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$9,528.79 |
$9,528.79 |
$9,528.79 |
$7,775.46
|
|
Inj human fibrinogen con nos
|
$3.55 |
$3.55 |
$3.55 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$2,452.32 |
$2,452.32 |
$2,452.32 |
$2,452.32
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$2,682.21 |
$2,682.21 |
$2,682.21 |
$3,542.09
|
|
Inj imip 4 cilas 4 releb 2mg
|
$739.77 |
$739.77 |
$739.77 |
$739.77
|
