|
Inj, adstiladrin, per tx dos
|
$80,745.00 |
$80,745.00 |
$80,745.00 |
|
|
Inj, aducanumab-avwa, 2 mg
|
$24.60 |
$25.80 |
$25.80 |
|
|
Inj, aflibercept-ayyh, 1 mg
|
$549.24 |
$549.24 |
$620.88 |
|
|
Inj, aflibercept hd, 1 mg
|
$768.50 |
$768.50 |
$768.50 |
|
|
Inj allopurinol sodium 1 mg
|
$155.40 |
$155.40 |
$155.40 |
|
|
Inj, amisulpride, 1 mg
|
$182.32 |
$182.32 |
$182.32 |
|
|
Inj andexxa, 10 mg
|
$246.00 |
$13,381.20 |
$20,052.60 |
|
|
Inj anifrolumab-fnia 1mg
|
$34.80 |
$1,522.80 |
$32,563.20 |
|
|
Inj, aponvie, 1 mg
|
$3.00 |
$3.00 |
$4.20 |
|
|
Inj, artesunate, 1mg
|
$109.80 |
$109.80 |
$109.80 |
|
|
Inj, aspara, rylaze, 0.1 mg
|
$96.60 |
$99.60 |
$102.00 |
|
|
Inj atezolizumb 5mg hya-tqjs
|
$21.39 |
$54.60 |
$54.60 |
|
|
Inj avacincaptad pegol 0.1mg
|
$236.50 |
$236.50 |
$236.50 |
|
|
Inj aval alfa-nqpt 4mg
|
$157.20 |
$5,052.80 |
$5,329.60 |
|
|
Inj belantamab mafodot blmf
|
$99.00 |
$5,295.60 |
$33,801.60 |
|
|
Inj., benralizumab, 1 mg
|
$439.00 |
$3,405.60 |
$16,340.40 |
|
|
Inj beta interferon sq 1 mcg
|
$33.40 |
$43.40 |
$1,488.00 |
|
|
Inj, bezlotoxumab, 10 mg
|
$103.00 |
$11,010.60 |
$17,599.20 |
|
|
Inj bimatoprost itc imp1mcg
|
$456.00 |
$456.00 |
$456.00 |
|
|
Inj., brexanolone, 1 mg
|
$171.00 |
$187.80 |
$22,798.80 |
|
|
Inj, brixadi, 7 days or less
|
$533.40 |
$814.80 |
$1,086.40 |
|
|
Inj brixadi, more than 7 day
|
$2,846.40 |
$4,344.80 |
$4,345.20 |
|
|
Inj, bupivacaine liposome
|
$2.40 |
$7.60 |
$2,421.60 |
|
|
Inj calcitriol per 0.1 mcg
|
$1.20 |
$9.60 |
$443.40 |
|
|
Inj cefazolin sodium, baxter
|
$8.60 |
$19.65 |
$19.80 |
|
|
Inj cefazolin sodium, hikma
|
$1.61 |
$4.80 |
$149.80 |
|
|
Inj cefazolin (wg crit care)
|
$3.00 |
$3.00 |
$76.80 |
|
|
Inj, cefepime hcl (b braun)
|
$17.40 |
$39.40 |
$139.20 |
|
|
Inj, cefiderocol, 10 mg
|
$5.80 |
$131.40 |
$1,675.80 |
|
|
Inj ceftolozane tazobactam
|
$19.00 |
$285.60 |
$1,255.00 |
|
|
Inj, cimerli, 0.1 mg
|
$514.20 |
$519.00 |
$691.80 |
|
|
Inj, cipaglucosidase, 5 mg
|
$229.20 |
$229.20 |
$229.20 |
|
|
Inj, clevidipine butyrate
|
$8.40 |
$483.60 |
$839.40 |
|
|
Inj, clindamycin (baxter)
|
$7.20 |
$8.70 |
$8.70 |
|
|
Inj cntr knee arthro incl ct/mri
|
$98.40 |
$345.60 |
$1,513.80 |
|
|
Inj., copanlisib, 1 mg
|
$178.80 |
$3,151.80 |
$21,182.40 |
|
|
Inj crotalidae im f(ab')2 eq
|
$792.00 |
$792.00 |
$3,968.40 |
|
|
Inj cyclophosphamd (ingenus)
|
$1.20 |
$4.60 |
$87.60 |
|
|
Inj, cyclophosphamd, sandoz
|
$254.97 |
$254.97 |
$2,408.40 |
|
|
Inj daptomycin (xellia)
|
$48.30 |
$48.30 |
$54.60 |
|
|
Inj, decitabine (sun pharma)
|
$4,596.00 |
$4,596.00 |
$4,596.00 |
|
|
Inj delandistrogene mox rokl
|
$2,056,320.00 |
$2,056,320.00 |
$2,056,320.00 |
|
|
Inj. denosumab-bbdz, 1 mg
|
$3,223.11 |
$4,741.40 |
$8,856.80 |
|
|
Inj disk cerv-thor ea lev
|
$332.00 |
$1,878.60 |
$5,575.20 |
|
|
Inj, donanemab-azbt, 2 mg
|
$7.20 |
$7.20 |
$6,339.24 |
|
|
Inj dupuytren cord w/enzyme
|
$42.55 |
$48.10 |
$353.00 |
|
|
Inj, durolane 1 mg
|
$15.60 |
$22.80 |
$2,168.58 |
|
|
Inj dx for sinogram
|
$124.00 |
$640.20 |
$3,250.94 |
|
|
Inject for sacroiliac joint
|
$1,044.00 |
$2,995.20 |
$3,029.40 |
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$60.06 |
$1,209.60 |
$2,397.80 |
|
|
Injection arthrography hip without anesthesia (both sides)
|
$164.80 |
$543.60 |
$1,348.20 |
|
|
Injection, belinostat, 10mg
|
$95.40 |
$95.40 |
$95.40 |
|
|
Injection, burosumab-twza 1m
|
$102.00 |
$665.40 |
$1,120.20 |
|
|
Injection, cangrelor
|
$58.60 |
$1,969.80 |
$41,627.40 |
|
|
Injection, caplacizumab-yhdp
|
$2,329.60 |
$19,956.00 |
$26,607.60 |
|
|
Injection carpal tunnel therapeutic (both sides)
|
$36.57 |
$596.40 |
$840.60 |
|
|
Injection, casimersen, 10 mg
|
$271.50 |
$271.50 |
$271.50 |
|
|
Injection, daratumumab 10 mg
|
$85.20 |
$198.60 |
$9,445.80 |
|
|
Injection, doxercalciferol
|
$3.62 |
$98.40 |
$395.40 |
|
|
Injection during cath supravalvular aortography
|
$160.00 |
$1,728.00 |
$7,058.59 |
|
|
Injection, edaravone, 1 mg
|
$1,401.00 |
$1,485.00 |
$2,098.80 |
|
|
Injection epidural blood patch or clot
|
$500.80 |
$1,470.60 |
$3,776.40 |
|
|
Injection eye drug
|
$58.65 |
$494.50 |
$2,608.20 |
|
|
Injection, famotidine, 20 mg
|
$75.60 |
$75.60 |
$339.60 |
|
|
Injection for arthrography wrist (both sides)
|
$164.80 |
$566.40 |
$1,188.60 |
|
|
Injection for bladder x-ray
|
$85.80 |
$1,651.80 |
$4,087.20 |
|
|
Injection for hip x-ray
|
$52.44 |
$59.28 |
$725.40 |
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$164.80 |
$543.60 |
$1,300.53 |
|
|
Injection for spleen x-ray
|
$83.03 |
$788.40 |
$788.40 |
|
|
Injection for tear sac x-ray
|
$32.89 |
$37.18 |
$990.00 |
|
|
Injection for ureter x-ray
|
$36.66 |
$1,540.80 |
$3,368.40 |
|
|
Injection for ureter x-ray
|
$140.00 |
$1,540.80 |
$4,470.00 |
|
|
Injection, fosphenytoin sodi
|
$90.00 |
$90.00 |
$90.00 |
|
|
Injection, fulvestrant
|
$115.80 |
$921.60 |
$9,219.60 |
|
|
Injection glatiramer acetate
|
$318.40 |
$811.20 |
$1,550.40 |
|
|
Injection, glucarpidase
|
$18,885.60 |
$23,088.00 |
$37,862.40 |
|
|
Injection, inclisiran, 1 mg
|
$22.80 |
$43.60 |
$1,348.80 |
|
|
Injection into brain canal
|
$73.14 |
$73.14 |
$82.68 |
|
|
Injection into brain canal
|
$267.00 |
$961.20 |
$2,740.80 |
|
|
Injection into hemorrhoid(s)
|
$117.99 |
$133.38 |
$742.80 |
|
|
Injection into spinal artery
|
$625.83 |
$707.46 |
$1,852.80 |
|
|
Injection into vocal cord
|
$84.41 |
$95.42 |
$6,130.20 |
|
|
Injection intraop add-on
|
$68.54 |
$68.54 |
$77.48 |
|
|
Injection, isavuconazonium
|
$2.60 |
$229.20 |
$1,378.20 |
|
|
Injection jaw joint x-ray
|
$67.80 |
$67.80 |
$1,172.00 |
|
|
Injection jugular
|
$187.50 |
$187.50 |
$187.50 |
|
|
Injection, necitumumab, 1 mg
|
$15.60 |
$15.60 |
$16.20 |
|
|
Injection of sinus tract
|
$58.42 |
$2,046.00 |
$4,165.46 |
|
|
Injection,onabotulinumtoxina
|
$41.55 |
$1,965.60 |
$6,946.80 |
|
|
Injection, pentamidine iseth
|
$134.35 |
$508.80 |
$1,286.40 |
|
|
Injection, peramivir
|
$6.75 |
$7.40 |
$8.40 |
|
|
Injection px peyronie ds
|
$57.04 |
$64.48 |
$287.00 |
|
|
Injection radioactive tracer sentinel node (both sides)
|
$80.40 |
$837.60 |
$1,941.00 |
|
|
Injection, renflexis
|
$216.80 |
$451.80 |
$2,293.80 |
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$78.66 |
$2,647.20 |
$4,453.20 |
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$134.40 |
$880.80 |
$5,391.33 |
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$454.20 |
$948.00 |
$3,434.40 |
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$280.20 |
$2,647.20 |
$3,272.00 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$80.40 |
$1,318.80 |
$3,157.80 |
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$351.60 |
$1,656.60 |
$3,596.80 |
|
