|
Infectious agent nucleic acid quantification hepatitis c
|
$197.00 |
$197.00 |
$197.00 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$391.00 |
$391.00 |
$391.00 |
$375.00
|
|
Infliximab 100 mg intravenous solution
|
$4,330.26 |
$4,330.26 |
$4,330.26 |
$2,047.13
|
|
Infliximab-axxq 100 mg intravenous solution
|
$1,854.00 |
$1,854.00 |
$1,854.00 |
$1,062.00
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$3,508.82 |
$3,508.82 |
$3,508.82 |
$1,537.84
|
|
Inj, abilify maintena, 1 mg
|
$10,082.92 |
$10,082.92 |
$10,082.92 |
$5,355.30
|
|
Inj, acetaminophen (b braun)
|
$33.95 |
$33.95 |
$33.95 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$40.25 |
$40.25 |
$40.25 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$44.50 |
$44.50 |
$44.50 |
$56.70
|
|
Inj, adalimumab, 1 mg
|
$8,307.14 |
$8,307.14 |
$8,307.14 |
$12,098.05
|
|
Inj, adstiladrin, per tx dos
|
$36,000.00 |
$36,000.00 |
$36,000.00 |
$63,354.77
|
|
Inj andexxa, 10 mg
|
$6,000.00 |
$6,000.00 |
$6,000.00 |
$4,370.80
|
|
Inj anifrolumab-fnia 1mg
|
$18,825.73 |
$18,825.73 |
$18,825.73 |
$10,052.58
|
|
Inj, aponvie, 1 mg
|
$466.71 |
$466.71 |
$466.71 |
$3.36
|
|
Inj, artesunate, 1mg
|
$12,908.40 |
$12,908.40 |
$12,908.40 |
$14,460.21
|
|
Inj, aspara, rylaze, 0.1 mg
|
$12,560.00 |
$12,560.00 |
$12,560.00 |
$10,458.00
|
|
Inj aval alfa-nqpt 4mg
|
$4,673.76 |
$4,673.76 |
$4,673.76 |
$3,907.30
|
|
Inj belantamab mafodot blmf
|
$1.00 |
$1.00 |
$1.00 |
$21,726.12
|
|
Inj, bortezomib freseniuskab
|
$3,847.16 |
$3,847.16 |
$3,847.16 |
$2,624.08
|
|
Inj, bortezomib, hospira
|
$711.97 |
$711.97 |
$711.97 |
$175.35
|
|
Inj, bupivacaine liposome
|
$1,674.47 |
$1,674.47 |
$1,674.47 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$46.41 |
$46.41 |
$46.41 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$125.37 |
$125.37 |
$125.37 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$977.94 |
$977.94 |
$977.94 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$732.31 |
$732.31 |
$732.31 |
$364.86
|
|
Inj, cipaglucosidase, 5 mg
|
$4,442.40 |
$4,442.40 |
$4,442.40 |
$3,278.80
|
|
Inj, clevidipine butyrate
|
$653.57 |
$653.57 |
$653.57 |
$4.86
|
|
Inj cntr knee arthro incl ct/mri
|
$681.00 |
$681.00 |
$681.00 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$3,516.00 |
$3,516.00 |
$3,516.00 |
$2,584.85
|
|
Inj, daptomycin (hospira)
|
$212.10 |
$212.10 |
$212.10 |
$128.08
|
|
Inj daptomycin (xellia)
|
$168.00 |
$168.00 |
$168.00 |
$56.04
|
|
Injection arthrography hip without anesthesia (both sides)
|
$618.00 |
$618.00 |
$618.00 |
$503.50
|
|
Injection, belinostat, 10mg
|
$6,072.68 |
$6,072.68 |
$6,072.68 |
$4,446.10
|
|
Injection, cangrelor
|
$3,539.03 |
$3,539.03 |
$3,539.03 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$20,572.04 |
$20,572.04 |
$20,572.04 |
$16,319.16
|
|
Injection, daratumumab 10 mg
|
$9,922.58 |
$9,922.58 |
$9,922.58 |
$5,324.34
|
|
Injection during cath supravalvular aortography
|
$300.00 |
$300.00 |
$300.00 |
$1,027.26
|
|
Injection epidural blood patch or clot
|
$2,615.00 |
$2,615.00 |
$2,615.00 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$618.00 |
$618.00 |
$618.00 |
$436.00
|
|
Injection for bladder x-ray
|
$1,884.00 |
$1,884.00 |
$1,884.00 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$927.00 |
$927.00 |
$927.00 |
$497.76
|
|
Injection, fulvestrant
|
$3,595.00 |
$3,595.00 |
$3,595.00 |
$1,719.16
|
|
Injection glatiramer acetate
|
$1,048.60 |
$1,048.60 |
$1,048.60 |
$830.51
|
|
Injection, glucarpidase
|
$92,352.00 |
$92,352.00 |
$92,352.00 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$12,508.60 |
$12,508.60 |
$12,508.60 |
$6,679.35
|
|
Injection, isavuconazonium
|
$1,656.41 |
$1,656.41 |
$1,656.41 |
$787.67
|
|
Injection,onabotulinumtoxina
|
$2,350.87 |
$2,350.87 |
$2,350.87 |
$2,277.65
|
|
Injection, peramivir
|
$1,330.00 |
$1,330.00 |
$1,330.00 |
$744.75
|
|
Injection, renflexis
|
$2,793.58 |
$2,793.58 |
$2,793.58 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,589.00 |
$2,589.00 |
$2,589.00 |
$1,043.72
|
|
Injection, siltuximab
|
$15,276.50 |
$15,276.50 |
$15,276.50 |
$11,502.35
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$348.00 |
$348.00 |
$348.00 |
$145.60
|
|
Inj., emapalumab-lzsg, 1 mg
|
$87,158.40 |
$87,158.40 |
$87,158.40 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$87,051.16 |
$87,051.16 |
$87,051.16 |
$54,322.53
|
|
Inj., eravacycline, 1 mg
|
$281.75 |
$281.75 |
$281.75 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$765.52 |
$765.52 |
$765.52 |
$343.35
|
|
Inj, evinacumab-dgnb, 5mg
|
$30,270.10 |
$30,270.10 |
$30,270.10 |
$20,751.13
|
|
Inj., evomela, 1 mg
|
$3,837.60 |
$3,837.60 |
$3,837.60 |
$17.37
|
|
Inj., fibryga, 1 mg
|
$4.62 |
$4.62 |
$4.62 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$40.33 |
$40.33 |
$40.33 |
$40.33
|
|
Inj for mammo ductogram
|
$328.00 |
$328.00 |
$328.00 |
$397.80
|
|
Inj, fulvestrant (fresenius)
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$905.30
|
|
Inj, gadopiclenol, 1 ml
|
$41.90 |
$41.90 |
$41.90 |
$37.63
|
|
Inj gemcitabine hcl (accord)
|
$435.07 |
$435.07 |
$435.07 |
$131.21
|
|
Inj givosiran 0.5 mg
|
$105,345.60 |
$105,345.60 |
$105,345.60 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$26,019.16 |
$26,019.16 |
$26,019.16 |
$4,760.67
|
|
Inj, granisetron, xr, 0.1 mg
|
$2,483.33 |
$2,483.33 |
$2,483.33 |
$163.28
|
|
Inj, hemgenix, per tx dose
|
$8,400,000.00 |
$8,400,000.00 |
$8,400,000.00 |
$4,704,002.80
|
|
Inj heparin, pfizer, 1000u
|
$59.50 |
$59.50 |
$59.50 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$11,220.58 |
$11,220.58 |
$11,220.58 |
$8,193.78
|
|
Inj hydroxocobalamin IV 25mg
|
$2,625.91 |
$2,625.91 |
$2,625.91 |
$2,452.32
|
|
Inj imip 4 cilas 4 releb 2mg
|
$29,306.18 |
$29,306.18 |
$29,306.18 |
$739.77
|
|
Inj, invega hafyera/trinza
|
$39,703.22 |
$39,703.22 |
$39,703.22 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$2,111.30 |
$2,111.30 |
$2,111.30 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$22.27 |
$22.27 |
$22.27 |
$41.79
|
|
Inj, lanreotide, (cipla) 1mg
|
$21,342.38 |
$21,342.38 |
$21,342.38 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$1,097.18 |
$1,097.18 |
$1,097.18 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$163.28 |
$163.28 |
$163.28 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$2,055.38 |
$2,055.38 |
$2,055.38 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$98.70 |
$98.70 |
$98.70 |
$45.60
|
|
Inj melpha hydroch nos 50 mg
|
$840.00 |
$840.00 |
$840.00 |
$1,713.99
|
|
Inj melphalan (hepzato) 1 mg
|
$438,000.00 |
$438,000.00 |
$438,000.00 |
$787.79
|
|
Inj mepivacaine hcl/10 ml
|
$51.94 |
$51.94 |
$51.94 |
$34.34
|
|
Inj, meropenem (b. braun)
|
$86.10 |
$86.10 |
$86.10 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$934.50 |
$934.50 |
$934.50 |
$556.87
|
|
Inj meropenem (wg crit care)
|
$138.18 |
$138.18 |
$138.18 |
$82.42
|
|
Inj, micafungin (par pharm)
|
$628.32 |
$628.32 |
$628.32 |
$79.08
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$11,477.74 |
$11,477.74 |
$11,477.74 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$192.50 |
$192.50 |
$192.50 |
$101.31
|
|
Inj multihance
|
$244.30 |
$244.30 |
$244.30 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$1,075.32 |
$1,075.32 |
$1,075.32 |
$252.66
|
|
Inj, ocriplasmin, 0.125 mg
|
$1,030.50 |
$1,030.50 |
$1,030.50 |
$17.67
|
|
Inj octafluoropropane mic,ml
|
$589.68 |
$589.68 |
$589.68 |
$211.40
|
|
Inj ogivri 10 mg
|
$9,733.69 |
$9,733.69 |
$9,733.69 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$1,146.14 |
$1,146.14 |
$1,146.14 |
$865.34
|
|
Inj., patisiran, 0.1 mg
|
$23,484.00 |
$23,484.00 |
$23,484.00 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$14,555.88 |
$14,555.88 |
$14,555.88 |
$6,614.40
|
|
Inj proc ankle arthr
|
$618.00 |
$618.00 |
$618.00 |
$405.31
|
