|
Inj. mycophenolate mofetil
|
$290.61 |
$290.61 |
$290.61 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$26,595.72 |
$26,595.72 |
$26,595.72 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,484.95 |
$1,484.95 |
$1,484.95 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$204.87 |
$204.87 |
$204.87 |
$462.04
|
|
Inj nivolumab 2 mg hyaluron
|
$8,110.45 |
$8,110.45 |
$8,110.45 |
$15,599.68
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$42,116.06 |
$42,116.06 |
$42,116.06 |
$66,582.27
|
|
Inj octafluoropropane mic,ml
|
$345.56 |
$345.56 |
$345.56 |
$211.40
|
|
Inj ogivri 10 mg
|
$6,999.89 |
$6,999.89 |
$6,999.89 |
$4,492.28
|
|
Inj olipudase alfa-rpcp 1mg
|
$20,096.42 |
$20,096.42 |
$20,096.42 |
$13,239.99
|
|
Inj, omacetaxine mep, 0.01mg
|
$3,567.80 |
$3,567.80 |
$3,567.80 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$495.61 |
$495.61 |
$495.61 |
$865.34
|
|
Inj, pafolacianine, 0.1 mg
|
$4,343.50 |
$4,343.50 |
$4,343.50 |
$6,897.80
|
|
Inj, panzyga, 500 mg
|
$4,697.10 |
$4,697.10 |
$4,697.10 |
$8,041.38
|
|
Inj, pasireotide long acting
|
$21,348.96 |
$21,348.96 |
$21,348.96 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$25,954.07 |
$25,954.07 |
$25,954.07 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$12,236.18 |
$12,236.18 |
$12,236.18 |
$132.57
|
|
Inj, pegcetacoplan, 1mg
|
$2,309.77 |
$2,309.77 |
$2,309.77 |
$3,662.96
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$4,012.55 |
$4,012.55 |
$4,012.55 |
$6,403.59
|
|
Inj. pemetrexed, 10 mg
|
$4,550.07 |
$4,550.07 |
$4,550.07 |
$104.72
|
|
Inj pemetrexed ditromethamin
|
$516.30 |
$516.30 |
$516.30 |
$895.03
|
|
Inj pemetrexed (sandoz) 10mg
|
$3,588.25 |
$3,588.25 |
$3,588.25 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$728.17 |
$728.17 |
$728.17 |
$1,235.55
|
|
Inj., perseris, 0.5 mg
|
$2,965.32 |
$2,965.32 |
$2,965.32 |
$5,146.85
|
|
Inj plasminogen tvmh 1mg
|
$2,808.86 |
$2,808.86 |
$2,808.86 |
$4,456.80
|
|
Inj., plazomicin, 5 mg
|
$921.58 |
$921.58 |
$921.58 |
$607.16
|
|
Inj proc ankle arthr
|
$956.25 |
$956.25 |
$956.25 |
$405.31
|
|
Inj proc elbow arthro
|
$738.65 |
$738.65 |
$738.65 |
$419.60
|
|
Inj proc myelogram lumbar
|
$624.75 |
$624.75 |
$624.75 |
$830.50
|
|
Inj progesterone per 50 mg
|
$116.24 |
$116.24 |
$116.24 |
$15.00
|
|
Inj, rimabotulinumtoxinb
|
$846.37 |
$846.37 |
$846.37 |
$746.79
|
|
Inj roctavian ml 2x10^13vc g
|
$96,648.40 |
$96,648.40 |
$96,648.40 |
$130,068.54
|
|
Inj romidepsin non-lyo 0.1mg
|
$8,532.11 |
$8,532.11 |
$8,532.11 |
$9,892.69
|
|
Inj scleros sol sgl vein
|
$1,116.90 |
$1,116.90 |
$1,116.90 |
$558.97
|
|
Inj secretin synthetic human
|
$1,164.50 |
$1,164.50 |
$1,164.50 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$5,874.40 |
$5,874.40 |
$5,874.40 |
$4,413.21
|
|
Inj, sezaby, 1 mg
|
$144.56 |
$144.56 |
$144.56 |
$235.85
|
|
Inj, spesolimab-sbzo, 1 mg
|
$148,011.76 |
$148,011.76 |
$148,011.76 |
$90,007.62
|
|
Inj sulf hexa lipid microsph
|
$388.79 |
$388.79 |
$388.79 |
$256.14
|
|
Inj, susvimo 0.1 mg
|
$1,640.50 |
$1,640.50 |
$1,640.50 |
$2,598.44
|
|
Inj, sutimlimab-jome, 10 mg
|
$5,276.28 |
$5,276.28 |
$5,276.28 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$34,440.29 |
$34,440.29 |
$34,440.29 |
$67,538.30
|
|
Inj, taliglucerace alfa 10 u
|
$2,422.00 |
$2,422.00 |
$2,422.00 |
$1,573.27
|
|
Inj teclistamab cqyv 0.5 mg
|
$27,711.16 |
$27,711.16 |
$27,711.16 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$986.77 |
$986.77 |
$986.77 |
$664.72
|
|
Inj teplizumab mzwv 5 mcg
|
$36,734.45 |
$36,734.45 |
$36,734.45 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$18,387.83 |
$18,387.83 |
$18,387.83 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$172.50 |
$172.50 |
$172.50 |
$123.24
|
|
Inj testosterone cypionate
|
$37.75 |
$37.75 |
$37.75 |
$64.80
|
|
Inj theophylline per 40 mg
|
$8.29 |
$8.29 |
$8.29 |
$31.90
|
|
Inj thiotepa nos 1 mg
|
$2,027.25 |
$2,027.25 |
$2,027.25 |
$3,170.16
|
|
Inj, tislelizumab-jsgr
|
$5,693.98 |
$5,693.98 |
$5,693.98 |
$9,764.09
|
|
Inj triamcinolone ace X-ray 1mg
|
$643.64 |
$643.64 |
$643.64 |
$1,090.75
|
|
Inj., triptorelin X-ray 3.75 mg
|
$22,752.12 |
$22,752.12 |
$22,752.12 |
$34,503.95
|
|
Inj, tyenne, 1 mg
|
$2,006.07 |
$2,006.07 |
$2,006.07 |
$3,525.12
|
|
Inj ustekinumab-kfce, 1 mg
|
$3,068.49 |
$3,068.49 |
$3,068.49 |
$5,244.37
|
|
Inj, uzedy, 1 mg
|
$6,706.44 |
$6,706.44 |
$6,706.44 |
$11,475.96
|
|
Inj vancomycin (xellia) 10mg
|
$30.26 |
$30.26 |
$30.26 |
$76.59
|
|
Inj, vasopressin (baxter)
|
$155.98 |
$155.98 |
$155.98 |
$228.24
|
|
Inj, vegzelma, 10 mg
|
$1,834.72 |
$1,834.72 |
$1,834.72 |
$1,291.28
|
|
Inj velmanase alfa-tycv 1 mg
|
$4,485.28 |
$4,485.28 |
$4,485.28 |
$7,123.31
|
|
Inj. viltolarsen
|
$1,446.70 |
$1,446.70 |
$1,446.70 |
$2,466.35
|
|
Inj w/fluor eval cv device
|
$600.95 |
$600.95 |
$600.95 |
$503.92
|
|
Inj. xembify, 100 mg
|
$2,021.13 |
$2,021.13 |
$2,021.13 |
$3,451.77
|
|
Inj xipere 1 mg
|
$195.50 |
$195.50 |
$195.50 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$24,219.22 |
$24,219.22 |
$24,219.22 |
$14,458.60
|
|
Inj zanidatamab-hrii, 2 mg
|
$3,634.60 |
$3,634.60 |
$3,634.60 |
$11,091.60
|
|
Inj zenocutuzumab-zbco 1 mg
|
$31,530.75 |
$31,530.75 |
$31,530.75 |
$19,177.20
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$63,463.35 |
$63,463.35 |
$63,463.35 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$6,930.05 |
$6,930.05 |
$6,930.05 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$7,817.45 |
$7,817.45 |
$7,817.45 |
$4,660.00
|
|
Ins cath ren art 2nd+ uni
|
$13,477.60 |
$13,477.60 |
$13,477.60 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$898.45 |
$898.45 |
$898.45 |
$480.28
|
|
Insert balloon device
|
$8,806.85 |
$8,806.85 |
$8,806.85 |
$2,535.00
|
|
Insert cannula hemo oth 36815
|
$13,477.60 |
$13,477.60 |
$13,477.60 |
$5,983.35
|
|
Insert cannula vein-to-vein hemodialysis
|
$13,477.60 |
$13,477.60 |
$13,477.60 |
$7,279.50
|
|
Insert cath pleura with image
|
$3,928.70 |
$3,928.70 |
$3,928.70 |
$2,194.40
|
|
Insert cath pleura without image
|
$4,667.35 |
$4,667.35 |
$4,667.35 |
$2,073.18
|
|
Insert drug delivery implant
|
$313.65 |
$313.65 |
$313.65 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$16,597.10 |
$16,597.10 |
$16,597.10 |
$7,571.20
|
|
Insert intracorporeal device
|
$35,090.55 |
$35,090.55 |
$35,090.55 |
$6,261.00
|
|
Insert intrauterine device iud
|
$697.85 |
$697.85 |
$697.85 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$313.65 |
$313.65 |
$313.65 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$313.65 |
$313.65 |
$313.65 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$8,485.55 |
$8,485.55 |
$8,485.55 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$5,487.60 |
$5,487.60 |
$5,487.60 |
$2,529.45
|
|
Insertion intra-aortic circulation dev 33970
|
$6,944.50 |
$6,944.50 |
$6,944.50 |
$1,752.40
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$13,477.60 |
$13,477.60 |
$13,477.60 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$7,817.45 |
$7,817.45 |
$7,817.45 |
$2,505.60
|
|
Insertion of cannula
|
$7,817.45 |
$7,817.45 |
$7,817.45 |
$4,341.66
|
|
Insertion of catheter vein
|
$6,774.50 |
$6,774.50 |
$6,774.50 |
$1,477.00
|
|
Insertion of catheter vein
|
$3,896.40 |
$3,896.40 |
$3,896.40 |
$836.25
|
|
Insertion of heart electrode 33211
|
$20,836.90 |
$20,836.90 |
$20,836.90 |
$6,903.60
|
|
Insertion of infusion pump
|
$13,477.60 |
$13,477.60 |
$13,477.60 |
$5,907.78
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$26,189.35 |
$26,189.35 |
$26,189.35 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$26,189.35 |
$26,189.35 |
$26,189.35 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$11,144.35 |
$11,144.35 |
$11,144.35 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,928.70 |
$3,928.70 |
$3,928.70 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,928.70 |
$3,928.70 |
$3,928.70 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$80,687.95 |
$80,687.95 |
$80,687.95 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$20,836.90 |
$20,836.90 |
$20,836.90 |
$7,200.05
|
