|
Inj glycopyrrolate fres kabi
|
$19.31 |
$19.31 |
$19.31 |
$77.09
|
|
Inj, granisetron, xr, 0.1 mg
|
$1,184.36 |
$1,184.36 |
$1,184.36 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$54,187.16 |
$54,187.16 |
$54,187.16 |
$675.00
|
|
Inj heparin, pfizer, 1000u
|
$13.31 |
$13.31 |
$13.31 |
$31.87
|
|
Inj. herceptin hylecta, 10mg
|
$18,794.47 |
$18,794.47 |
$18,794.47 |
$924.71
|
|
Inj herzuma 10 mg
|
$15,786.54 |
$15,786.54 |
$15,786.54 |
$2,554.50
|
|
Inj hrt cath w/s&i sel hrt ang
|
$162.50 |
$162.50 |
$162.50 |
$1,837.17
|
|
Inj hrt cath w/s&i sel left vent
|
$162.50 |
$162.50 |
$162.50 |
$1,214.40
|
|
Inj hydroxocobalamin IV 25mg
|
$701.60 |
$701.60 |
$701.60 |
$2,452.32
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$6,128.50 |
$6,128.50 |
$6,128.50 |
$2,682.21
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,270.88 |
$1,270.88 |
$1,270.88 |
$743.18
|
|
Inj, immphentiv, 20 mcg
|
$10.43 |
$10.43 |
$10.43 |
$38.40
|
|
Inj. inebilizumab-cdon, 1 mg
|
$126,223.65 |
$126,223.65 |
$126,223.65 |
$864.00
|
|
Inj, invega hafyera/trinza
|
$42,962.12 |
$42,962.12 |
$42,962.12 |
$10,022.18
|
|
Inj ivig privigen 500 mg
|
$56.29 |
$56.29 |
$56.29 |
$6,908.00
|
|
Inj, kovaltry, 1 i.u
|
$226.40 |
$226.40 |
$226.40 |
$5.12
|
|
Inj, lanreotide, (cipla) 1mg
|
$8,532.66 |
$8,532.66 |
$8,532.66 |
$12,160.05
|
|
Inj, lecanemab-irmb, 1 mg
|
$2,573.65 |
$2,573.65 |
$2,573.65 |
$1,174.88
|
|
Inj, lenacapavir, 1 mg
|
$78,390.00 |
$78,390.00 |
$78,390.00 |
$15,210.00
|
|
Inj levocarnitine per 1 gm
|
$26.77 |
$26.77 |
$26.77 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$967.70 |
$967.70 |
$967.70 |
$304.77
|
|
Inj, levothyroxine, hikma
|
$123.22 |
$123.22 |
$123.22 |
$5.14
|
|
Inj melpha hydroch nos 50 mg
|
$2,375.23 |
$2,375.23 |
$2,375.23 |
$1,657.46
|
|
Inj mepivacaine hcl/10 ml
|
$7.55 |
$7.55 |
$7.55 |
$30.04
|
|
Inj., meropenem, vaborbactam
|
$894.45 |
$894.45 |
$894.45 |
$574.72
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$38,564.75 |
$38,564.75 |
$38,564.75 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$18,848.26 |
$18,848.26 |
$18,848.26 |
$6,949.35
|
|
Inj, motixafortide, 0.25 mg
|
$23,718.00 |
$23,718.00 |
$23,718.00 |
$25.22
|
|
Inj, moxifloxacin 100 mg
|
$3.65 |
$3.65 |
$3.65 |
$119.60
|
|
Inj multihance
|
$9.39 |
$9.39 |
$9.39 |
$119.25
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$400.00 |
$400.00 |
$400.00 |
$1,522.56
|
|
Inj, nithiodote, 3mg / 125mg
|
$763.88 |
$763.88 |
$763.88 |
$476.75
|
|
Inj ogivri 10 mg
|
$10,552.70 |
$10,552.70 |
$10,552.70 |
$4,096.71
|
|
Inj., omadacycline, 1 mg
|
$1,863.88 |
$1,863.88 |
$1,863.88 |
$1,151.01
|
|
Inj ontruzant 10 mg
|
$1,563.84 |
$1,563.84 |
$1,563.84 |
$5,309.54
|
|
Inj., patisiran, 0.1 mg
|
$26,419.50 |
$26,419.50 |
$26,419.50 |
$17,613.00
|
|
Inj, pegcetacoplan, 1mg
|
$8,891.84 |
$8,891.84 |
$8,891.84 |
$4,436.30
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$2,394.47 |
$2,394.47 |
$2,394.47 |
$6,244.73
|
|
Inj pemetrexed (accord) 10mg
|
$416.04 |
$416.04 |
$416.04 |
$11.34
|
|
Inj pemetrexed, hospira 10mg
|
$2,001.32 |
$2,001.32 |
$2,001.32 |
$64.35
|
|
Inj plasminogen tvmh 1mg
|
$1,292.93 |
$1,292.93 |
$1,292.93 |
$32.55
|
|
Inj progesterone per 50 mg
|
$18.77 |
$18.77 |
$18.77 |
$21.71
|
|
Inj, releuko 1 mcg
|
$1,022.69 |
$1,022.69 |
$1,022.69 |
$503.56
|
|
Inj, rimabotulinumtoxinb
|
$479.10 |
$479.10 |
$479.10 |
$101.68
|
|
Inj scleros sol mult veins
|
$300.00 |
$300.00 |
$300.00 |
$687.96
|
|
Inj scleros sol sgl vein
|
$187.50 |
$187.50 |
$187.50 |
$534.40
|
|
Inj secretin synthetic human
|
$493.41 |
$493.41 |
$493.41 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$8,673.19 |
$8,673.19 |
$8,673.19 |
$7,064.91
|
|
Inj, sezaby, 1 mg
|
$536.19 |
$536.19 |
$536.19 |
$12.85
|
|
Inj, spesolimab-sbzo, 1 mg
|
$76,343.37 |
$76,343.37 |
$76,343.37 |
$179,184.73
|
|
Inj sulf hexa lipid microsph
|
$315.78 |
$315.78 |
$315.78 |
$281.30
|
|
Inj, sutimlimab-jome, 10 mg
|
$195.26 |
$195.26 |
$195.26 |
$34.80
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$91,142.96 |
$91,142.96 |
$91,142.96 |
$105,320.75
|
|
Inj, taliglucerace alfa 10 u
|
$612.45 |
$612.45 |
$612.45 |
$56.50
|
|
Inj teclistamab cqyv 0.5 mg
|
$40,500.62 |
$40,500.62 |
$40,500.62 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$246.90 |
$246.90 |
$246.90 |
$866.93
|
|
Inj teplizumab mzwv 5 mcg
|
$38,909.57 |
$38,909.57 |
$38,909.57 |
$36.90
|
|
Inj. teprotumumab-trbw 10 mg
|
$47,280.05 |
$47,280.05 |
$47,280.05 |
$42,164.34
|
|
Inj testostero enanthate 1mg
|
$35.40 |
$35.40 |
$35.40 |
$33.13
|
|
Inj testosterone cypionate
|
$43.92 |
$43.92 |
$43.92 |
$77.70
|
|
Inj., tildrakizumab, 1 mg
|
$46,541.17 |
$46,541.17 |
$46,541.17 |
$26,635.60
|
|
Inj, tislelizumab-jsgr
|
$723.94 |
$723.94 |
$723.94 |
$45,250.97
|
|
Inj, tofidence, 1 mg
|
$8,924.40 |
$8,924.40 |
$8,924.40 |
$346.32
|
|
Inj triamcinolone ace X-ray 1mg
|
$503.26 |
$503.26 |
$503.26 |
$21.60
|
|
Inj., triptorelin X-ray 3.75 mg
|
$89,636.63 |
$89,636.63 |
$89,636.63 |
$5,195.68
|
|
Inj, tyenne, 1 mg
|
$7,872.77 |
$7,872.77 |
$7,872.77 |
$2,647.24
|
|
Inj, vancomycin hcl (mylan)
|
$185.44 |
$185.44 |
$185.44 |
$89.83
|
|
Inj, vegzelma, 10 mg
|
$10,892.59 |
$10,892.59 |
$10,892.59 |
$7,932.08
|
|
Inj w/fluor eval cv device
|
$125.00 |
$125.00 |
$125.00 |
$588.90
|
|
Inj xipere 1 mg
|
$1,405.30 |
$1,405.30 |
$1,405.30 |
$3,312.50
|
|
Inj., yutiq, 0.01 mg
|
$36,706.62 |
$36,706.62 |
$36,706.62 |
$14,458.60
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$92,090.16 |
$92,090.16 |
$92,090.16 |
$45,841.00
|
|
Ins cath ren art 1st bi
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$1,537.50 |
$1,537.50 |
$1,537.50 |
$4,667.63
|
|
Ins cath ren art 2nd+ uni
|
$2,737.50 |
$2,737.50 |
$2,737.50 |
$5,528.94
|
|
Ins cerv dilator (sep proc)
|
$162.50 |
$162.50 |
$162.50 |
$544.00
|
|
Insert cath pleura with image
|
$625.00 |
$625.00 |
$625.00 |
$2,239.02
|
|
Insert cath pleura without image
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$2,212.00
|
|
Insert hepatic shunt (tips)
|
$2,000.00 |
$2,000.00 |
$2,000.00 |
$9,754.48
|
|
Insertion catheter bladder non indwelling
|
$62.50 |
$62.50 |
$62.50 |
$237.13
|
|
Insertion catheter bladder temporary simple
|
$62.50 |
$62.50 |
$62.50 |
$273.60
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,750.00 |
$1,750.00 |
$1,750.00 |
$4,943.21
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,000.00 |
$1,000.00 |
$1,000.00 |
$2,549.95
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,737.50 |
$2,737.50 |
$2,737.50 |
$7,088.54
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$2,618.40
|
|
Insertion of catheter vein
|
$198.75 |
$198.75 |
$198.75 |
$1,749.80
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$5,750.00 |
$5,750.00 |
$5,750.00 |
$14,158.20
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$5,750.00 |
$5,750.00 |
$5,750.00 |
$12,813.28
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$5,500.00 |
$5,500.00 |
$5,500.00 |
$9,855.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$625.00 |
$625.00 |
$625.00 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$625.00 |
$625.00 |
$625.00 |
$2,527.91
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$11,875.00 |
$11,875.00 |
$11,875.00 |
$29,997.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$3,250.00 |
$3,250.00 |
$3,250.00 |
$7,572.47
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$4,000.00 |
$4,000.00 |
$4,000.00 |
$9,793.46
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$5,470.54
|
|
Insert pm/icd lead dual
|
$3,250.00 |
$3,250.00 |
$3,250.00 |
$7,562.63
|
|
Insert/repl sq defib w/eltrd
|
$11,875.00 |
$11,875.00 |
$11,875.00 |
$33,948.20
|
|
Insert swan-ganz cath
|
$625.00 |
$625.00 |
$625.00 |
$2,164.52
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$4,705.13
|
|
Insert tunneled cv cath
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$4,520.00
|