|
Injection, fulvestrant
|
$2,609.44 |
$2,609.44 |
$2,609.44 |
$1,817.65
|
|
Injection glatiramer acetate
|
$633.14 |
$633.14 |
$633.14 |
$830.51
|
|
Injection, glucarpidase
|
$44,106.16 |
$44,106.16 |
$44,106.16 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$3,667.99 |
$3,667.99 |
$3,667.99 |
$6,679.35
|
|
Injection into hemorrhoid(s)
|
$2,485.40 |
$2,485.40 |
$2,485.40 |
$1,432.81
|
|
Injection, isavuconazonium
|
$971.33 |
$971.33 |
$971.33 |
$787.67
|
|
Injection jugular
|
$920.55 |
$920.55 |
$920.55 |
$790.00
|
|
Injection, khapzory, 0.5 mg
|
$1,269.47 |
$1,269.47 |
$1,269.47 |
$2,162.76
|
|
Injection, necitumumab, 1 mg
|
$4,424.85 |
$4,424.85 |
$4,424.85 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$3,457.16 |
$3,457.16 |
$3,457.16 |
$2,277.65
|
|
Injection, peramivir
|
$323.00 |
$323.00 |
$323.00 |
$744.75
|
|
Injection radioactive tracer sentinel node (both sides)
|
$1,012.35 |
$1,012.35 |
$1,012.35 |
$670.64
|
|
Injection, renflexis
|
$776.96 |
$776.96 |
$776.96 |
$1,341.52
|
|
Injection, ruconest
|
$8,245.00 |
$8,245.00 |
$8,245.00 |
$14,111.44
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,023.50
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,681.24
|
|
Injection, siltuximab
|
$6,708.77 |
$6,708.77 |
$6,708.77 |
$10,680.75
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$828.75 |
$828.75 |
$828.75 |
$468.98
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$828.75 |
$828.75 |
$828.75 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$828.75 |
$828.75 |
$828.75 |
$629.99
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$158.95 |
$158.95 |
$158.95 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$122.40 |
$122.40 |
$122.40 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$297.50 |
$297.50 |
$297.50 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$143.65 |
$143.65 |
$143.65 |
$135.60
|
|
Injection treatment of eye
|
$5,715.40 |
$5,715.40 |
$5,715.40 |
$2,665.60
|
|
Inject sacroiliac joint
|
$490.45 |
$490.45 |
$490.45 |
$1,028.95
|
|
Inj, eculizumab-aagh, 2 mg
|
$12,147.29 |
$12,147.29 |
$12,147.29 |
$7,980.52
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$16,746.94 |
$16,746.94 |
$16,746.94 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$3,712.74 |
$3,712.74 |
$3,712.74 |
$3,712.74
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$37,005.25 |
$37,005.25 |
$37,005.25 |
$54,322.53
|
|
Inj epidural sgl cerv-thor without img
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$2,552.55 |
$2,552.55 |
$2,552.55 |
$1,415.50
|
|
Inj., eravacycline, 1 mg
|
$127.50 |
$127.50 |
$127.50 |
$206.64
|
|
Inj, erzofri, 1 mg
|
$5,969.54 |
$5,969.54 |
$5,969.54 |
$10,213.70
|
|
Inj, etelcalcetide, 0.1 mg
|
$551.79 |
$551.79 |
$551.79 |
$343.35
|
|
Inj, eteplirsen, 10 mg
|
$1,640.50 |
$1,640.50 |
$1,640.50 |
$2,598.44
|
|
Inj, evinacumab-dgnb, 5mg
|
$34,155.67 |
$34,155.67 |
$34,155.67 |
$20,751.13
|
|
Inj, factor x, (human), 1iu
|
$26.92 |
$26.92 |
$26.92 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$2,402.33 |
$2,402.33 |
$2,402.33 |
$4,103.29
|
|
Inj fensolvi 0.25 mg
|
$28,000.43 |
$28,000.43 |
$28,000.43 |
$44,262.98
|
|
Inj., fibryga, 1 mg
|
$4.10 |
$4.10 |
$4.10 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$31.05 |
$31.05 |
$31.05 |
$39.54
|
|
Inj, focinvez, 1mg
|
$495.94 |
$495.94 |
$495.94 |
$3.63
|
|
Inj for ext venography
|
$947.75 |
$947.75 |
$947.75 |
$649.95
|
|
Inj for mammo ductogram
|
$533.80 |
$533.80 |
$533.80 |
$399.60
|
|
Inj fosnetupitant, palonoset
|
$705.35 |
$705.35 |
$705.35 |
$1,110.99
|
|
Inj., fremanezumab-vfrm 1 mg
|
$778.76 |
$778.76 |
$778.76 |
$1,322.20
|
|
Inj gemcitabine hcl (accord)
|
$172.89 |
$172.89 |
$172.89 |
$130.65
|
|
Inj givosiran 0.5 mg
|
$116,445.14 |
$116,445.14 |
$116,445.14 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$7,226.02 |
$7,226.02 |
$7,226.02 |
$4,760.67
|
|
Inj glycopyrrolate fres kabi
|
$18.87 |
$18.87 |
$18.87 |
$12.18
|
|
Inj golodirsen 10 mg
|
$1,640.50 |
$1,640.50 |
$1,640.50 |
$2,798.32
|
|
Inj., guselkumab, 1 mg
|
$38,668.43 |
$38,668.43 |
$38,668.43 |
$29,130.83
|
|
Inj., haegarda 10 units
|
$9,632.90 |
$9,632.90 |
$9,632.90 |
$6,346.38
|
|
Inj, hemgenix, per tx dose
|
$3,570,008.50 |
$3,570,008.50 |
$3,570,008.50 |
$4,368,002.60
|
|
Inj. herceptin hylecta, 10mg
|
$4,777.25 |
$4,777.25 |
$4,777.25 |
$7,690.59
|
|
Inj, hercessi, 10 mg
|
$9,862.33 |
$9,862.33 |
$9,862.33 |
$6,033.42
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$626.45 |
$626.45 |
$626.45 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$730.15 |
$730.15 |
$730.15 |
$1,827.74
|
|
Inj hrt cath w/s&i sel right vent
|
$354.45 |
$354.45 |
$354.45 |
$965.33
|
|
Inj human fibrinogen con nos
|
$9.52 |
$9.52 |
$9.52 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$2,783.55 |
$2,783.55 |
$2,783.55 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$1,025.58 |
$1,025.58 |
$1,025.58 |
$1,228.59
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$6,228.46 |
$6,228.46 |
$6,228.46 |
$3,542.09
|
|
Inj imip 4 cilas 4 releb 2mg
|
$330.97 |
$330.97 |
$330.97 |
$739.77
|
|
Inj, imm glob bivigam, 500mg
|
$810.82 |
$810.82 |
$810.82 |
$1,258.47
|
|
Inj, immphentiv, 20 mcg
|
$4.00 |
$4.00 |
$4.00 |
$18.44
|
|
Inj. inebilizumab-cdon, 1 mg
|
$47,692.99 |
$47,692.99 |
$47,692.99 |
$70,014.65
|
|
Inj. infugem, 100 mg
|
$858.67 |
$858.67 |
$858.67 |
$1,485.86
|
|
Inj. insulin (fiasp)
|
$116.45 |
$116.45 |
$116.45 |
$177.00
|
|
Inj intralesional <= 7 lsn(s)
|
$491.30 |
$491.30 |
$491.30 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$21,851.70 |
$21,851.70 |
$21,851.70 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$10,180.42 |
$10,180.42 |
$10,180.42 |
$6,967.29
|
|
Inj, ixinity, 1 i.u
|
$5.94 |
$5.94 |
$5.94 |
$6.99
|
|
Inj labetalol hcl hikma, 5mg
|
$44.54 |
$44.54 |
$44.54 |
$38.94
|
|
Inj., lanadelumab-flyo, 1 mg
|
$26,888.29 |
$26,888.29 |
$26,888.29 |
$42,504.48
|
|
Inj, lecanemab-irmb, 1 mg
|
$703.96 |
$703.96 |
$703.96 |
$1,174.88
|
|
Inj lefamulin 1 mg
|
$119.85 |
$119.85 |
$119.85 |
$181.89
|
|
Inj, lenacapavir, 1 mg
|
$19,898.50 |
$19,898.50 |
$19,898.50 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$139.07 |
$139.07 |
$139.07 |
$136.62
|
|
Inj levoleucovorin nos 0.5mg
|
$59.50 |
$59.50 |
$59.50 |
$103.60
|
|
Inj, levothyroxine, freskabi
|
$1,404.27 |
$1,404.27 |
$1,404.27 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$92.54 |
$92.54 |
$92.54 |
$46.52
|
|
Inj, linezolid (hospira)
|
$83.81 |
$83.81 |
$83.81 |
$153.30
|
|
Inj. lumasiran, 0.5 mg
|
$61,309.48 |
$61,309.48 |
$61,309.48 |
$96,930.47
|
|
Inj., lumoxiti, 0.01 mg
|
$5,891.22 |
$5,891.22 |
$5,891.22 |
$3,881.27
|
|
Inj. meloxicam 1 mg
|
$104.38 |
$104.38 |
$104.38 |
$167.04
|
|
Inj melpha hydroch nos 50 mg
|
$2,565.01 |
$2,565.01 |
$2,565.01 |
$1,847.89
|
|
Inj mepivacaine hcl/10 ml
|
$59.89 |
$59.89 |
$59.89 |
$33.86
|
|
Inj, meropenem (b. braun)
|
$42.16 |
$42.16 |
$42.16 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$594.32 |
$594.32 |
$594.32 |
$558.08
|
|
Inj meropenem (wg crit care)
|
$39.51 |
$39.51 |
$39.51 |
$77.97
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$25,479.49 |
$25,479.49 |
$25,479.49 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$4,886.54 |
$4,886.54 |
$4,886.54 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$144.50 |
$144.50 |
$144.50 |
$107.25
|
|
Inj moxifloxacin (fres kabi)
|
$48.67 |
$48.67 |
$48.67 |
$95.62
|
|
Inj multihance
|
$107.07 |
$107.07 |
$107.07 |
$73.49
|
