|
Inj. mycophenolate mofetil
|
$191.46 |
$191.46 |
$191.46 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$42,064.28 |
$42,064.28 |
$42,064.28 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$847.80 |
$847.80 |
$3,623.20 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$344.99 |
$344.99 |
$344.99 |
$462.04
|
|
Inj nivolumab 2 mg hyaluron
|
$3,699.49 |
$3,699.49 |
$13,903.35 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$5,415.20 |
$5,415.20 |
$5,415.20 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$5,415.20 |
$5,415.20 |
$5,415.20 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$66,582.27 |
$66,582.27 |
$66,582.27 |
$66,582.27
|
|
Inj octafluoropropane mic,ml
|
$227.66 |
$227.66 |
$227.66 |
$211.40
|
|
Inj ogivri 10 mg
|
$4,611.69 |
$4,611.69 |
$4,611.69 |
$4,492.28
|
|
Inj olipudase alfa-rpcp 1mg
|
$13,239.99 |
$13,239.99 |
$13,239.99 |
$13,239.99
|
|
Inj, omacetaxine mep, 0.01mg
|
$2,350.55 |
$2,350.55 |
$2,350.55 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$837.19 |
$837.19 |
$837.19 |
$865.34
|
|
Inj ontruzant 10 mg
|
$16.80 |
$16.80 |
$16.80 |
$6,706.27
|
|
Inj, pafolacianine, 0.1 mg
|
$7,428.40 |
$7,428.40 |
$7,428.40 |
$6,897.80
|
|
Inj, panzyga, 500 mg
|
$8,041.38 |
$8,041.38 |
$8,041.38 |
$8,041.38
|
|
Inj, pasireotide long acting
|
$33,745.84 |
$33,745.84 |
$33,745.84 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$15,784.05 |
$15,784.05 |
$15,784.05 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$19,336.91 |
$19,336.91 |
$19,336.91 |
$132.57
|
|
Inj, pegcetacoplan, 1mg
|
$3,944.73 |
$3,944.73 |
$3,944.73 |
$3,662.96
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$6,861.48 |
$6,861.48 |
$6,861.48 |
$6,403.59
|
|
Inj, pegulicianine, 1 mg
|
$63.28 |
$63.28 |
$63.28 |
$51.76
|
|
Inj. pemetrexed, 10 mg
|
$7,804.64 |
$7,804.64 |
$7,804.64 |
$104.72
|
|
Inj pemetrexed ditromethamin
|
$895.03 |
$895.03 |
$895.03 |
$895.03
|
|
Inj pemetrexed (sandoz) 10mg
|
$6,157.09 |
$6,157.09 |
$6,157.09 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$1,235.55 |
$1,235.55 |
$4,677.75 |
$1,235.55
|
|
Inj perflexane lip micros,ml
|
$2.80 |
$2.80 |
$2.80 |
$2.80
|
|
Inj peritoneal venous shunt
|
$119.28 |
$119.28 |
$119.28 |
$413.70
|
|
Inj., perseris, 0.5 mg
|
$5,067.65 |
$5,067.65 |
$5,067.65 |
$5,146.85
|
|
Inj plasminogen tvmh 1mg
|
$4,799.63 |
$4,799.63 |
$4,799.63 |
$4,456.80
|
|
Inj., plazomicin, 5 mg
|
$607.16 |
$607.16 |
$607.16 |
$607.16
|
|
Inj proc elbow arthro
|
$188.10 |
$188.10 |
$476.00 |
$419.60
|
|
Inj proc for lymphang
|
$53.55 |
$53.55 |
$224.56 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$289.80 |
$289.80 |
$991.20 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,422.40 |
$1,422.40 |
$1,422.40 |
$830.50
|
|
Inj proc sialogram
|
$65.55 |
$65.55 |
$431.20 |
$373.00
|
|
Inj progesterone per 50 mg
|
$3.54 |
$3.54 |
$3.54 |
$15.00
|
|
Inj prohance multipack
|
$2.24 |
$2.24 |
$2.24 |
$9.59
|
|
Inj retro urethrocysto
|
$202.35 |
$202.35 |
$638.40 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$557.60 |
$557.60 |
$557.60 |
$746.79
|
|
Inj roctavian ml 2x10^13vc g
|
$140,073.81 |
$140,073.81 |
$140,073.81 |
$130,068.54
|
|
Inj romidepsin non-lyo 0.1mg
|
$13,502.52 |
$13,502.52 |
$13,502.52 |
$9,892.69
|
|
Inj scleros sol mult veins
|
$521.55 |
$521.55 |
$1,092.00 |
$675.00
|
|
Inj scleros sol sgl vein
|
$340.80 |
$340.80 |
$1,092.00 |
$558.97
|
|
Inj secretin synthetic human
|
$767.20 |
$767.20 |
$767.20 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$3,847.79 |
$3,847.79 |
$3,847.79 |
$4,413.21
|
|
Inj, sezaby, 1 mg
|
$235.85 |
$235.85 |
$235.85 |
$235.85
|
|
Inj, spesolimab-sbzo, 1 mg
|
$90,007.62 |
$90,007.62 |
$90,007.62 |
$90,007.62
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$436.80 |
$436.80 |
$436.80 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$256.14 |
$256.14 |
$256.14 |
$256.14
|
|
Inj, susvimo 0.1 mg
|
$2,798.32 |
$2,798.32 |
$2,798.32 |
$2,598.44
|
|
Inj, sutimlimab-jome, 10 mg
|
$3,453.73 |
$3,453.73 |
$3,453.73 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$54,467.92 |
$54,467.92 |
$54,467.92 |
$67,538.30
|
|
Inj, taliglucerace alfa 10 u
|
$1,573.27 |
$1,573.27 |
$1,573.27 |
$1,573.27
|
|
Inj teclistamab cqyv 0.5 mg
|
$16,875.01 |
$16,875.01 |
$16,875.01 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$650.10 |
$650.10 |
$650.10 |
$664.72
|
|
Inj teplizumab mzwv 5 mcg
|
$22,340.08 |
$22,340.08 |
$22,340.08 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$29,063.76 |
$29,063.76 |
$29,063.76 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$283.72 |
$283.72 |
$283.72 |
$123.24
|
|
Inj testosterone cypionate
|
$24.87 |
$24.87 |
$24.87 |
$64.80
|
|
Inj theophylline per 40 mg
|
$34.36 |
$34.36 |
$34.36 |
$31.90
|
|
Inj thiotepa nos 1 mg
|
$3,170.16 |
$3,170.16 |
$3,170.16 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$397.60 |
$397.60 |
$397.60 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$397.60 |
$397.60 |
$397.60 |
$837.50
|
|
Inj, tislelizumab-jsgr
|
$9,764.09 |
$9,764.09 |
$9,764.09 |
$9,764.09
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,090.75 |
$1,090.75 |
$1,090.75 |
$1,090.75
|
|
Inj., triptorelin X-ray 3.75 mg
|
$35,986.88 |
$35,986.88 |
$35,986.88 |
$34,503.95
|
|
Inj, tyenne, 1 mg
|
$3,424.52 |
$3,424.52 |
$3,424.52 |
$3,525.12
|
|
Inj ustekinumab-aekn, 1 mg
|
$44.80 |
$44.80 |
$44.80 |
$47.80
|
|
Inj ustekinumab-kfce, 1 mg
|
$5,244.37 |
$5,244.37 |
$5,244.37 |
$5,244.37
|
|
Inj, uzedy, 1 mg
|
$11,475.96 |
$11,475.96 |
$11,475.96 |
$11,475.96
|
|
Inj vancomycin (xellia) 10mg
|
$66.77 |
$66.77 |
$66.77 |
$76.59
|
|
Inj, vasopressin (baxter)
|
$264.88 |
$264.88 |
$264.88 |
$228.24
|
|
Inj, vegzelma, 10 mg
|
$1,186.35 |
$1,186.35 |
$1,186.35 |
$1,291.28
|
|
Inj velmanase alfa-tycv 1 mg
|
$7,671.26 |
$7,671.26 |
$7,671.26 |
$7,123.31
|
|
Inj. viltolarsen
|
$2,466.35 |
$2,466.35 |
$2,466.35 |
$2,466.35
|
|
Inj vocal cord bulking agent
|
$705.60 |
$705.60 |
$705.60 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$222.00 |
$222.00 |
$1,002.40 |
$503.92
|
|
Inj. xembify, 100 mg
|
$3,451.77 |
$3,451.77 |
$3,451.77 |
$3,451.77
|
|
Inj xipere 1 mg
|
$323.12 |
$323.12 |
$323.12 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$14,729.01 |
$14,729.01 |
$14,729.01 |
$14,458.60
|
|
Inj zanidatamab-hrii, 2 mg
|
$6,236.50 |
$6,236.50 |
$6,236.50 |
$11,091.60
|
|
Inj zenocutuzumab-zbco 1 mg
|
$19,177.20 |
$19,177.20 |
$19,177.20 |
$19,177.20
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$38,596.85 |
$38,596.85 |
$38,596.85 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$4,716.45 |
$4,716.45 |
$9,340.80 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$4,818.30 |
$4,818.30 |
$7,778.40 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$9,340.80 |
$9,340.80 |
$10,034.70 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$4,456.20 |
$4,456.20 |
$10,091.20 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$63.00 |
$63.00 |
$1,394.40 |
$480.28
|
|
Ins device for right guide open
|
$487.20 |
$487.20 |
$487.20 |
$487.20
|
|
Insemination of oocytes
|
$632.80 |
$632.80 |
$632.80 |
$314.40
|
|
Insert abdomen-venous drain
|
$432.90 |
$432.90 |
$432.90 |
$3,147.06
|
|
Insert and remove bone pin
|
$5,482.40 |
$5,482.40 |
$5,482.40 |
$4,410.60
|
|
Insert ant drainage device
|
$10,035.20 |
$10,035.20 |
$10,035.20 |
$4,881.00
|
|
Insert brain-fluid device 61215
|
$11,922.40 |
$11,922.40 |
$11,922.40 |
$7,181.20
|
|
Insert cannula hemo oth 36815
|
$5,964.00 |
$5,964.00 |
$5,964.00 |
$5,983.35
|
|
Insert cannula vein-to-vein hemodialysis
|
$11,524.80 |
$11,524.80 |
$11,524.80 |
$7,279.50
|
|
Insert cath pleura with image
|
$2,617.20 |
$2,617.20 |
$3,606.40 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,183.95 |
$1,183.95 |
$1,836.80 |
$2,073.18
|
|
Insert drug del implant, >=4
|
$0.01 |
$0.01 |
$0.01 |
$472.21
|
