|
Inj. inebilizumab-cdon, 1 mg
|
$10,939.38 |
$10,939.38 |
$10,939.38 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$666.25 |
$666.25 |
$666.25 |
$1,938.00
|
|
Inj intralesional <= 7 lsn(s)
|
$387.40 |
$387.40 |
$387.40 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$228.80 |
$228.80 |
$228.80 |
$234.00
|
|
Inj, invega hafyera/trinza
|
$10,022.18 |
$10,022.18 |
$10,022.18 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$46.23 |
$46.23 |
$46.23 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$2.48 |
$2.48 |
$2.48 |
$41.79
|
|
Inj, lanreotide, (cipla) 1mg
|
$41,617.64 |
$41,617.64 |
$41,617.64 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$308.70 |
$308.70 |
$308.70 |
$1,174.88
|
|
Inj, lenacapavir, 1 mg
|
$15,210.00 |
$15,210.00 |
$15,210.00 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$18.19 |
$18.19 |
$18.19 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$103.76 |
$103.76 |
$103.76 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$3.04 |
$3.04 |
$3.04 |
$45.60
|
|
Inj, lovotibeglogene autotem
|
$9,672,000.00 |
$9,672,000.00 |
$9,672,000.00 |
$4,488,461.15
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$489.45 |
$489.45 |
$489.45 |
$794.70
|
|
Inj melpha hydroch nos 50 mg
|
$3,583.63 |
$3,583.63 |
$3,583.63 |
$1,713.99
|
|
Inj melphalan (hepzato) 1 mg
|
$117,998.40 |
$117,998.40 |
$117,998.40 |
$787.79
|
|
Inj mepivacaine hcl/10 ml
|
$1.44 |
$1.44 |
$1.44 |
$34.34
|
|
Inj, meropenem (b. braun)
|
$69.99 |
$69.99 |
$69.99 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$536.27 |
$536.27 |
$536.27 |
$556.87
|
|
Inj meropenem (wg crit care)
|
$76.99 |
$76.99 |
$76.99 |
$82.42
|
|
Inj, micafungin (par pharm)
|
$350.06 |
$350.06 |
$350.06 |
$79.08
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$1,496.55 |
$1,496.55 |
$1,496.55 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$2,984.20 |
$2,984.20 |
$2,984.20 |
$8,304.04
|
|
Inj, motixafortide, 0.25 mg
|
$13,806.00 |
$13,806.00 |
$13,806.00 |
$25.22
|
|
Inj, moxifloxacin 100 mg
|
$0.43 |
$0.43 |
$0.43 |
$101.31
|
|
Inj moxifloxacin (fres kabi)
|
$0.43 |
$0.43 |
$0.43 |
$95.62
|
|
Inj multihance
|
$14.30 |
$14.30 |
$14.30 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$252.66 |
$252.66 |
$252.66 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$8,132.57 |
$8,132.57 |
$8,132.57 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$1,995.50 |
$1,995.50 |
$1,995.50 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$7.64 |
$7.64 |
$7.64 |
$468.10
|
|
Inj, nogapendekin pmln, 1mcg
|
$209,430.00 |
$209,430.00 |
$209,430.00 |
$94.12
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$6,836.70 |
$6,836.70 |
$6,836.70 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$6,836.70 |
$6,836.70 |
$6,836.70 |
$2,726.90
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$4,199.99 |
$4,199.99 |
$4,199.99 |
$66,582.27
|
|
Inj octafluoropropane mic,ml
|
$100.39 |
$100.39 |
$100.39 |
$211.40
|
|
Inj ogivri 10 mg
|
$8,190.16 |
$8,190.16 |
$8,190.16 |
$4,492.28
|
|
Inj olipudase alfa-rpcp 1mg
|
$18,260.23 |
$18,260.23 |
$18,260.23 |
$13,239.99
|
|
Inj., omadacycline, 1 mg
|
$1,151.01 |
$1,151.01 |
$1,151.01 |
$865.34
|
|
Inj onase abepar-xioi treat
|
$4,972,500.00 |
$4,972,500.00 |
$4,972,500.00 |
$3,572,794.09
|
|
Inj ontruzant 10 mg
|
$11,572.21 |
$11,572.21 |
$11,572.21 |
$6,706.27
|
|
Inj, pafolacianine, 0.1 mg
|
$6,215.63 |
$6,215.63 |
$6,215.63 |
$6,897.80
|
|
Inj pantoprazole(hikma) 40mg
|
$11.88 |
$11.88 |
$11.88 |
$34.67
|
|
Inj, pasireotide long acting
|
$50,915.83 |
$50,915.83 |
$50,915.83 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$4,579.38 |
$4,579.38 |
$4,579.38 |
$17,613.00
|
|
Inj, pegcetacoplan, 1mg
|
$54,905.53 |
$54,905.53 |
$54,905.53 |
$3,662.96
|
|
Inj pemetrexed (accord) 10mg
|
$12,614.16 |
$12,614.16 |
$12,614.16 |
$579.77
|
|
Inj pemetrexed, hospira 10mg
|
$64.35 |
$64.35 |
$64.35 |
$64.35
|
|
Inj, pemivibart, 4500 mg
|
$412.76 |
$412.76 |
$412.76 |
$1,235.55
|
|
Inj peritoneal venous shunt
|
$254.80 |
$254.80 |
$254.80 |
$406.80
|
|
Inj., perseris, 0.5 mg
|
$6,783.29 |
$6,783.29 |
$6,783.29 |
$5,146.85
|
|
Inj proc ankle arthr
|
$423.15 |
$423.15 |
$423.15 |
$405.31
|
|
Inj proc elbow arthro
|
$287.30 |
$287.30 |
$287.30 |
$432.00
|
|
Inj proc for lymphang
|
$2,442.05 |
$2,442.05 |
$2,442.05 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$1,366.95 |
$1,366.95 |
$1,366.95 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,026.35 |
$1,026.35 |
$1,026.35 |
$838.30
|
|
Inj progesterone per 50 mg
|
$7.57 |
$7.57 |
$7.57 |
$13.76
|
|
Inj prohance multipack
|
$21.45 |
$21.45 |
$21.45 |
$10.40
|
|
Inj recombin esperoct per iu
|
$6.63 |
$6.63 |
$6.63 |
$6.63
|
|
Inj retro urethrocysto
|
$867.75 |
$867.75 |
$867.75 |
$447.74
|
|
Inj, rimabotulinumtoxinb
|
$1,486.10 |
$1,486.10 |
$1,486.10 |
$714.24
|
|
Inj romidepsin non-lyo 0.1mg
|
$4,740.40 |
$4,740.40 |
$4,740.40 |
$9,892.69
|
|
Inj scleros sol mult veins
|
$1,493.05 |
$1,493.05 |
$1,493.05 |
$692.90
|
|
Inj scleros sol sgl vein
|
$1,493.05 |
$1,493.05 |
$1,493.05 |
$561.88
|
|
Inj secretin synthetic human
|
$1,546.74 |
$1,546.74 |
$1,546.74 |
$1,253.09
|
|
Inj secukinumab intrav 1mg
|
$1,029.91 |
$1,029.91 |
$1,029.91 |
$4,413.21
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$1,493.05 |
$1,493.05 |
$1,493.05 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$339.30 |
$339.30 |
$339.30 |
$256.14
|
|
Inj, susvimo 0.1 mg
|
$187,200.00 |
$187,200.00 |
$187,200.00 |
$2,598.44
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$105,320.75 |
$105,320.75 |
$105,320.75 |
$67,538.30
|
|
Inj, taliglucerace alfa 10 u
|
$2,208.47 |
$2,208.47 |
$2,208.47 |
$1,573.27
|
|
Inj teclistamab cqyv 0.5 mg
|
$19,174.32 |
$19,174.32 |
$19,174.32 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$866.93 |
$866.93 |
$866.93 |
$664.72
|
|
Inj. teprotumumab-trbw 10 mg
|
$42,164.34 |
$42,164.34 |
$42,164.34 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$33.13 |
$33.13 |
$33.13 |
$123.09
|
|
Inj testosterone cypionate
|
$55.67 |
$55.67 |
$55.67 |
$64.96
|
|
Inj thiotepa nos 1 mg
|
$5,616.00 |
$5,616.00 |
$5,616.00 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$2,818.40 |
$2,818.40 |
$2,818.40 |
$1,049.50
|
|
Inj thrc fascial pln blk uni w/wo image
|
$2,818.40 |
$2,818.40 |
$2,818.40 |
$818.00
|
|
Inj. tigecycline (accord)
|
$365.04 |
$365.04 |
$365.04 |
$188.03
|
|
Inj., tildrakizumab, 1 mg
|
$42,029.77 |
$42,029.77 |
$42,029.77 |
$26,635.60
|
|
Inj tofersen intrathec 1 mg
|
$2,355.07 |
$2,355.07 |
$2,355.07 |
$293.34
|
|
Inj, tofidence, 1 mg
|
$346.32 |
$346.32 |
$346.32 |
$86.87
|
|
Inj triamcinolone ace X-ray 1mg
|
$47.45 |
$47.45 |
$47.45 |
$1,090.75
|
|
Inj, tyenne, 1 mg
|
$2,647.24 |
$2,647.24 |
$2,647.24 |
$3,525.12
|
|
Inj ustekinumab-aekn, 1 mg
|
$126.01 |
$126.01 |
$126.01 |
$47.80
|
|
Inj ustekinumab-kfce, 1 mg
|
$7,019.96 |
$7,019.96 |
$7,019.96 |
$5,244.37
|
|
Inj ustekinumab-stba, 1 mg
|
$27.34 |
$27.34 |
$27.34 |
$16.36
|
|
Inj, uzedy, 1 mg
|
$21,951.72 |
$21,951.72 |
$21,951.72 |
$11,475.96
|
|
Inj, vancomycin hcl (mylan)
|
$211.20 |
$211.20 |
$211.20 |
$72.33
|
|
Inj, vancomycin hcl (xellia)
|
$497.25 |
$497.25 |
$497.25 |
$85.20
|
|
Inj, vegzelma, 10 mg
|
$528.37 |
$528.37 |
$528.37 |
$1,186.35
|
|
Inj velmanase alfa-tycv 1 mg
|
$10,578.36 |
$10,578.36 |
$10,578.36 |
$7,123.31
|
|
Inj w/fluor eval cv device
|
$787.15 |
$787.15 |
$787.15 |
$504.40
|
|
Inj xipere 1 mg
|
$4,290.00 |
$4,290.00 |
$4,290.00 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$14,458.60 |
$14,458.60 |
$14,458.60 |
$14,458.60
|
|
Inj zanidatamab-hrii, 2 mg
|
$11,091.60 |
$11,091.60 |
$11,091.60 |
$8,532.00
|
|
Inj zenocutuzumab-zbco 1 mg
|
$1,993.78 |
$1,993.78 |
$1,993.78 |
$19,177.20
|
|
Inner skull vessel surgery
|
$15,610.40 |
$15,610.40 |
$15,610.40 |
$15,610.40
|
