|
Injection, ruconest
|
$26,687.50 |
$26,687.50 |
$26,687.50 |
$36.74
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$1,471.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$2,832.00 |
$2,832.00 |
$2,832.00 |
$1,017.28
|
|
Injection, siltuximab
|
$21,587.44 |
$21,587.44 |
$21,587.44 |
$9,427.67
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$1,402.00 |
$1,402.00 |
$1,402.00 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$1,715.00 |
$1,715.00 |
$1,715.00 |
$552.60
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$3,049.00 |
$3,049.00 |
$3,049.00 |
$670.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$375.00 |
$375.00 |
$375.00 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$296.00 |
$296.00 |
$296.00 |
$154.05
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$968.00 |
$968.00 |
$968.00 |
$271.65
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$288.00 |
$288.00 |
$288.00 |
$141.60
|
|
Inj eflapegrastim-xnst 0.1mg
|
$25,593.75 |
$25,593.75 |
$25,593.75 |
$22.75
|
|
Inj., emapalumab-lzsg, 1 mg
|
$11,689.65 |
$11,689.65 |
$11,689.65 |
$1,771.28
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$11,457.18 |
$11,457.18 |
$11,457.18 |
$42,437.44
|
|
Inj epidural sgl lumb-sacral without img
|
$2,905.00 |
$2,905.00 |
$2,905.00 |
$1,450.84
|
|
Inj., eravacycline, 1 mg
|
$215.24 |
$215.24 |
$215.24 |
$205.80
|
|
Inj., evomela, 1 mg
|
$3,924.38 |
$3,924.38 |
$3,924.38 |
$17.37
|
|
Inj, factor x, (human), 1iu
|
$25.03 |
$25.03 |
$25.03 |
$26.64
|
|
Inj, faricimab-svoa, 0.1mg
|
$154,802.20 |
$154,802.20 |
$154,802.20 |
$4,591.80
|
|
Inj. fe derisomaltose 10 mg
|
$695.13 |
$695.13 |
$695.13 |
$854.61
|
|
Inj fensolvi 0.25 mg
|
$91,476.91 |
$91,476.91 |
$91,476.91 |
$140.62
|
|
Inj., fibryga, 1 mg
|
$3,831.80 |
$3,831.80 |
$3,831.80 |
$1.21
|
|
Inj fluphenazine hcl 1.25 mg
|
$35.90 |
$35.90 |
$35.90 |
$44.95
|
|
Inj, fosaprepitant (teva)
|
$171.12 |
$171.12 |
$171.12 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$341.25 |
$341.25 |
$341.25 |
$1,242.20
|
|
Inj, fulvestrant (teva)
|
$136.50 |
$136.50 |
$136.50 |
$57.40
|
|
Inj, gadopiclenol, 1 ml
|
$11.96 |
$11.96 |
$11.96 |
$70.20
|
|
Inj gemcitabine hcl (accord)
|
$347.20 |
$347.20 |
$347.20 |
$374.24
|
|
Inj glofitamab gxbm, 2.5 mg
|
$3,683.93 |
$3,683.93 |
$3,683.93 |
$3,683.93
|
|
Inj glycopyrrolate, glyrx-pf
|
$7.51 |
$7.51 |
$7.51 |
$11.23
|
|
Inj heparin, pfizer, 1000u
|
$7.91 |
$7.91 |
$7.91 |
$26.85
|
|
Inj. herceptin hylecta, 10mg
|
$3,272.67 |
$3,272.67 |
$3,272.67 |
$3,272.67
|
|
Inj hydroxocobalamin IV 25mg
|
$3,265.96 |
$3,265.96 |
$3,265.96 |
$2,452.32
|
|
Inj hydroxyprogst capoat nos
|
$1,121.12 |
$1,121.12 |
$1,121.12 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$1,004.42 |
$1,004.42 |
$1,004.42 |
$743.18
|
|
Inj. inebilizumab-cdon, 1 mg
|
$15,994.45 |
$15,994.45 |
$15,994.45 |
$871.80
|
|
Inj. insulin (fiasp)
|
$94.69 |
$94.69 |
$94.69 |
$16.80
|
|
Inj intralesional <= 7 lsn(s)
|
$169.00 |
$169.00 |
$169.00 |
$241.74
|
|
Inj ivig privigen 500 mg
|
$38.94 |
$38.94 |
$38.94 |
$7,173.90
|
|
Inj, ixinity, 1 i.u
|
$5.60 |
$5.60 |
$5.60 |
$1.91
|
|
Inj, kovaltry, 1 i.u
|
$5.12 |
$5.12 |
$5.12 |
$5.12
|
|
Inj, lanreotide, (cipla) 1mg
|
$34,534.64 |
$34,534.64 |
$34,534.64 |
$12,160.05
|
|
Inj, lecanemab-irmb, 1 mg
|
$445.92 |
$445.92 |
$445.92 |
$1,174.88
|
|
Inj, lenacapavir, 1 mg
|
$22,750.00 |
$22,750.00 |
$22,750.00 |
$19,512.50
|
|
Inj levocarnitine per 1 gm
|
$15.84 |
$15.84 |
$15.84 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$533.89 |
$533.89 |
$533.89 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$2.22 |
$2.22 |
$2.22 |
$43.73
|
|
Inj, linezolid (hospira)
|
$0.66 |
$0.66 |
$0.66 |
$152.75
|
|
Inj., lumoxiti, 0.01 mg
|
$7,724.50 |
$7,724.50 |
$7,724.50 |
$23.39
|
|
Inj melpha hydroch nos 50 mg
|
$674.14 |
$674.14 |
$674.14 |
$1,713.99
|
|
Inj, melphalan flufenami 1mg
|
$33,250.00 |
$33,250.00 |
$33,250.00 |
$5,700.00
|
|
Inj mepivacaine hcl/10 ml
|
$1.10 |
$1.10 |
$1.10 |
$31.28
|
|
Inj, meropenem (b. braun)
|
$46.13 |
$46.13 |
$46.13 |
$77.28
|
|
Inj, micafungin (par pharm)
|
$78.54 |
$78.54 |
$78.54 |
$93.73
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$2,238.42 |
$2,238.42 |
$2,238.42 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$3,002.65 |
$3,002.65 |
$3,002.65 |
$2,984.20
|
|
Inj, motixafortide, 0.25 mg
|
$20,650.00 |
$20,650.00 |
$20,650.00 |
$25.22
|
|
Inj multihance multipack
|
$5.59 |
$5.59 |
$5.59 |
$803.75
|
|
Inj. mycophenolate mofetil
|
$237.25 |
$237.25 |
$237.25 |
$291.54
|
|
Inj naloxone hydrochloride
|
$21.32 |
$21.32 |
$21.32 |
$95.36
|
|
Inj. naxitamab-gqgk, 1 mg
|
$8,526.23 |
$8,526.23 |
$8,526.23 |
$2,263.30
|
|
Inj, ocriplasmin, 0.125 mg
|
$41,482.00 |
$41,482.00 |
$41,482.00 |
$41,482.00
|
|
Inj octafluoropropane mic,ml
|
$92.17 |
$92.17 |
$92.17 |
$169.22
|
|
Inj ogivri 10 mg
|
$8,241.21 |
$8,241.21 |
$8,241.21 |
$4,096.71
|
|
Inj, olaratumab, 10 mg
|
$171.92 |
$171.92 |
$171.92 |
$443.95
|
|
Inj olipudase alfa-rpcp 1mg
|
$5,099.40 |
$5,099.40 |
$5,099.40 |
$5,099.40
|
|
Inj, omacetaxine mep, 0.01mg
|
$4,541.71 |
$4,541.71 |
$4,541.71 |
$4,541.71
|
|
Inj., omadacycline, 1 mg
|
$1,449.48 |
$1,449.48 |
$1,449.48 |
$1,151.01
|
|
Inj, pafolacianine, 0.1 mg
|
$9,296.88 |
$9,296.88 |
$9,296.88 |
$6,215.63
|
|
Inj., patisiran, 0.1 mg
|
$5,096.88 |
$5,096.88 |
$5,096.88 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$5.79 |
$5.79 |
$5.79 |
$96.08
|
|
Inj, pegcetacoplan, 1mg
|
$76,650.00 |
$76,650.00 |
$76,650.00 |
$4,436.30
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$14,288.93 |
$14,288.93 |
$14,288.93 |
$6,244.73
|
|
Inj. pemetrexed, 10 mg
|
$683.74 |
$683.74 |
$683.74 |
$104.72
|
|
Inj pemetrexed (accord) 10mg
|
$33.79 |
$33.79 |
$33.79 |
$11.34
|
|
Inj pemetrexed, hospira 10mg
|
$10.91 |
$10.91 |
$10.91 |
$64.35
|
|
Inj pemetrexed (sandoz) 10mg
|
$20.15 |
$20.15 |
$20.15 |
$97.50
|
|
Inj pemetrexed (teva) 10mg
|
$65.87 |
$65.87 |
$65.87 |
$5.52
|
|
Inj, pemivibart, 4500 mg
|
$561.46 |
$561.46 |
$561.46 |
$1,295.85
|
|
Inj., perseris, 0.5 mg
|
$9,486.47 |
$9,486.47 |
$9,486.47 |
$5,372.48
|
|
Inj progesterone per 50 mg
|
$10.15 |
$10.15 |
$10.15 |
$19.53
|
|
Inj prohance multipack
|
$4.52 |
$4.52 |
$4.52 |
$51.48
|
|
Inj recombin esperoct per iu
|
$7.67 |
$7.67 |
$7.67 |
$6.63
|
|
Inj, releuko 1 mcg
|
$461.20 |
$461.20 |
$461.20 |
$519.53
|
|
Inj, rimabotulinumtoxinb
|
$2,179.17 |
$2,179.17 |
$2,179.17 |
$1,486.10
|
|
Inj secretin synthetic human
|
$2,249.10 |
$2,249.10 |
$2,249.10 |
$1,459.08
|
|
Inj, sezaby, 1 mg
|
$402.22 |
$402.22 |
$402.22 |
$292.85
|
|
Inj, spesolimab-sbzo, 1 mg
|
$12,169.65 |
$12,169.65 |
$12,169.65 |
$178,150.09
|
|
Inj sulf hexa lipid microsph
|
$283.47 |
$283.47 |
$283.47 |
$281.30
|
|
Inj, susvimo 0.1 mg
|
$280,000.00 |
$280,000.00 |
$280,000.00 |
$79.08
|
|
Inj, sutimlimab-jome, 10 mg
|
$305.07 |
$305.07 |
$305.07 |
$34.80
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$112,522.17 |
$112,522.17 |
$112,522.17 |
$105,320.75
|
|
Inj, taliglucerace alfa 10 u
|
$3,054.35 |
$3,054.35 |
$3,054.35 |
$42.58
|
|
Inj teclistamab cqyv 0.5 mg
|
$14,653.61 |
$14,653.61 |
$14,653.61 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$1,001.48 |
$1,001.48 |
$1,001.48 |
$866.93
|
|
Inj teplizumab mzwv 5 mcg
|
$24,969.47 |
$24,969.47 |
$24,969.47 |
$37.65
|
|
Inj. teprotumumab-trbw 10 mg
|
$59,561.67 |
$59,561.67 |
$59,561.67 |
$42,164.34
|
|
Inj testostero enanthate 1mg
|
$1,021.67 |
$1,021.67 |
$1,021.67 |
$35.40
|
|
Inj testosterone cypionate
|
$77.70 |
$77.70 |
$77.70 |
$82.58
|
|
Inj theophylline per 40 mg
|
$0.03 |
$0.03 |
$0.03 |
$14.40
|
