|
Inj acetaminophen -fresenius
|
$0.23 |
$0.23 |
$0.23 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$0.86 |
$0.86 |
$0.86 |
$56.70
|
|
Inj. acthar gel to 40 units
|
$21,202.27 |
$21,202.27 |
$21,202.27 |
$7,918.32
|
|
Inj, adalimumab, 1 mg
|
$19,998.76 |
$19,998.76 |
$19,998.76 |
$12,098.05
|
|
Inj, adstiladrin, per tx dos
|
$47,502.00 |
$47,502.00 |
$47,502.00 |
$63,354.77
|
|
Inj, adzynma, 10 iu
|
$7.92 |
$7.92 |
$7.92 |
$34.60
|
|
Inj, aflibercept hd, 1 mg
|
$91,295.10 |
$91,295.10 |
$91,295.10 |
$2,794.18
|
|
Inj alymsys 10 mg
|
$420.38 |
$420.38 |
$420.38 |
$1,280.74
|
|
Inj anifrolumab-fnia 1mg
|
$6,365.54 |
$6,365.54 |
$6,365.54 |
$10,052.58
|
|
Inj., aristada initio, 1 mg
|
$2,374.34 |
$2,374.34 |
$2,374.34 |
$4,052.45
|
|
Inj, artesunate, 1mg
|
$10,488.08 |
$10,488.08 |
$10,488.08 |
$14,460.21
|
|
Inj, aspara, rylaze, 0.1 mg
|
$33,134.40 |
$33,134.40 |
$33,134.40 |
$10,458.00
|
|
Inj avacincaptad pegol 0.1mg
|
$49,140.00 |
$49,140.00 |
$49,140.00 |
$3,409.64
|
|
Inj aval alfa-nqpt 4mg
|
$4,741.91 |
$4,741.91 |
$4,741.91 |
$3,907.30
|
|
Inj., benralizumab, 1 mg
|
$13,682.10 |
$13,682.10 |
$13,682.10 |
$11,310.00
|
|
Inj beta interferon sq 1 mcg
|
$4,285.44 |
$4,285.44 |
$4,285.44 |
$2,397.11
|
|
Inj, betibeglogene autotemce
|
$8,736,000.00 |
$8,736,000.00 |
$8,736,000.00 |
$4,057,157.07
|
|
Inj bimatoprost itc imp1mcg
|
$4,738.50 |
$4,738.50 |
$4,738.50 |
$3,287.96
|
|
Inj, brixadi, 7 days or less
|
$6,244.88 |
$6,244.88 |
$6,244.88 |
$748.85
|
|
Inj brixadi, more than 7 day
|
$22,204.01 |
$22,204.01 |
$22,204.01 |
$2,858.76
|
|
Inj, brolucizumab-dbll, 1 mg
|
$97,502.65 |
$97,502.65 |
$97,502.65 |
$3,382.69
|
|
Inj, bupivacaine liposome
|
$59.28 |
$59.28 |
$59.28 |
$699.38
|
|
Inj. byooviz, 0.1 mg
|
$54,470.52 |
$54,470.52 |
$54,470.52 |
$1,135.59
|
|
Inj calcitriol per 0.1 mcg
|
$23.28 |
$23.28 |
$23.28 |
$22.69
|
|
Inj cefazolin sodium, baxter
|
$0.21 |
$0.21 |
$0.21 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$25.86 |
$25.86 |
$25.86 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$69.85 |
$69.85 |
$69.85 |
$69.85
|
|
Inj, cefiderocol, 10 mg
|
$544.85 |
$544.85 |
$544.85 |
$544.85
|
|
Inj ceftolozane tazobactam
|
$408.00 |
$408.00 |
$408.00 |
$364.86
|
|
Inj, cimerli, 0.1 mg
|
$63,648.00 |
$63,648.00 |
$63,648.00 |
$201.01
|
|
Inj, cipaglucosidase, 5 mg
|
$4,584.06 |
$4,584.06 |
$4,584.06 |
$3,278.80
|
|
Inj, clindamycin (baxter)
|
$0.60 |
$0.60 |
$0.60 |
$48.30
|
|
Inj, cyclophos (baxter) 5mg
|
$4,570.80 |
$4,570.80 |
$4,570.80 |
$2,584.85
|
|
Inj cyclophosphamd (ingenus)
|
$342.81 |
$342.81 |
$342.81 |
$742.72
|
|
Inj, daptomycin (baxter)
|
$1.83 |
$1.83 |
$1.83 |
$1.83
|
|
Inj, daptomycin (hospira)
|
$40.37 |
$40.37 |
$40.37 |
$128.08
|
|
Inj daptomycin (xellia)
|
$56.04 |
$56.04 |
$56.04 |
$56.04
|
|
Inj daxibotulinumtoxina-lanm
|
$982.80 |
$982.80 |
$982.80 |
$736.62
|
|
Inj, decitabine (sun pharma)
|
$312.00 |
$312.00 |
$312.00 |
$310.09
|
|
Inj. denosumab-bbdz, 1 mg
|
$4,416.07 |
$4,416.07 |
$4,416.07 |
$4,615.43
|
|
Inj, donanemab-azbt, 2 mg
|
$82.41 |
$82.41 |
$82.41 |
$1,233.44
|
|
Inj, durolane 1 mg
|
$869.70 |
$869.70 |
$869.70 |
$1,950.93
|
|
Injection, belinostat, 10mg
|
$8,012.89 |
$8,012.89 |
$8,012.89 |
$4,446.10
|
|
Injection, cangrelor
|
$2,457.60 |
$2,457.60 |
$2,457.60 |
$1,889.78
|
|
Injection, caplacizumab-yhdp
|
$20,860.05 |
$20,860.05 |
$20,860.05 |
$16,319.16
|
|
Injection carpal tunnel therapeutic (both sides)
|
$882.70 |
$882.70 |
$882.70 |
$458.15
|
|
Injection, daratumumab 10 mg
|
$483.99 |
$483.99 |
$483.99 |
$5,324.34
|
|
Injection, edaravone, 1 mg
|
$15.19 |
$15.19 |
$15.19 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,182.33
|
|
Injection for bladder x-ray
|
$681.20 |
$681.20 |
$681.20 |
$459.20
|
|
Injection glatiramer acetate
|
$1,194.10 |
$1,194.10 |
$1,194.10 |
$830.51
|
|
Injection, glucarpidase
|
$101,165.22 |
$101,165.22 |
$101,165.22 |
$74,113.20
|
|
Injection, inclisiran, 1 mg
|
$5,596.85 |
$5,596.85 |
$5,596.85 |
$6,679.35
|
|
Injection into brain canal
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,289.60
|
|
Injection,onabotulinumtoxina
|
$3,046.68 |
$3,046.68 |
$3,046.68 |
$2,277.65
|
|
Injection, peramivir
|
$37.05 |
$37.05 |
$37.05 |
$744.75
|
|
Injection, renflexis
|
$1,762.94 |
$1,762.94 |
$1,762.94 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$3,992.95 |
$3,992.95 |
$3,992.95 |
$2,040.36
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,685.00
|
|
Injection, siltuximab
|
$20,494.92 |
$20,494.92 |
$20,494.92 |
$11,502.35
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$882.70 |
$882.70 |
$882.70 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$882.70 |
$882.70 |
$882.70 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$317.20 |
$317.20 |
$317.20 |
$145.60
|
|
Inj, eculizumab-aagh, 2 mg
|
$474.86 |
$474.86 |
$474.86 |
$7,980.52
|
|
Inj, eculizumab-aeeb, 2 mg
|
$610.56 |
$610.56 |
$610.56 |
$610.56
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$6,857.14 |
$6,857.14 |
$6,857.14 |
$32,176.93
|
|
Inj., emapalumab-lzsg, 1 mg
|
$4,341.87 |
$4,341.87 |
$4,341.87 |
$3,181.80
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$42,437.44 |
$42,437.44 |
$42,437.44 |
$54,322.53
|
|
Inj., eravacycline, 1 mg
|
$170.63 |
$170.63 |
$170.63 |
$206.64
|
|
Inj, eteplirsen, 10 mg
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$2,598.44
|
|
Inj, exagamglogene autotem
|
$6,864,000.00 |
$6,864,000.00 |
$6,864,000.00 |
$3,218,160.00
|
|
Inj, factor x, (human), 1iu
|
$26.64 |
$26.64 |
$26.64 |
$26.74
|
|
Inj, faricimab-svoa, 0.1mg
|
$109,834.45 |
$109,834.45 |
$109,834.45 |
$4,103.29
|
|
Inj. fe derisomaltose 10 mg
|
$854.61 |
$854.61 |
$854.61 |
$3,221.52
|
|
Inj fensolvi 0.25 mg
|
$67,427.61 |
$67,427.61 |
$67,427.61 |
$44,262.98
|
|
Inj fluphenazine hcl 1.25 mg
|
$44.95 |
$44.95 |
$44.95 |
$40.33
|
|
Inj, focinvez, 1mg
|
$22.05 |
$22.05 |
$22.05 |
$3.63
|
|
Inj, fosaprepitant (teva)
|
$152.10 |
$152.10 |
$152.10 |
$152.10
|
|
Inj., fremanezumab-vfrm 1 mg
|
$1,178.03 |
$1,178.03 |
$1,178.03 |
$1,322.20
|
|
Inj, fulvestrant (fresenius)
|
$604.99 |
$604.99 |
$604.99 |
$905.30
|
|
Inj, gadopiclenol, 1 ml
|
$25.84 |
$25.84 |
$25.84 |
$37.63
|
|
Inj givosiran 0.5 mg
|
$102,711.96 |
$102,711.96 |
$102,711.96 |
$76,708.80
|
|
Inj glofitamab gxbm, 2.5 mg
|
$3,382.50 |
$3,382.50 |
$3,382.50 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$34,085.47 |
$34,085.47 |
$34,085.47 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$12.17 |
$12.17 |
$12.17 |
$25.30
|
|
Inj. herceptin hylecta, 10mg
|
$2,917.36 |
$2,917.36 |
$2,917.36 |
$8,193.78
|
|
Inj herzuma 10 mg
|
$9,528.79 |
$9,528.79 |
$9,528.79 |
$7,775.46
|
|
Inj human fibrinogen con nos
|
$3.55 |
$3.55 |
$3.55 |
$3.95
|
|
Inj hydroxocobalamin IV 25mg
|
$2,452.32 |
$2,452.32 |
$2,452.32 |
$2,452.32
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$2,682.21 |
$2,682.21 |
$2,682.21 |
$3,542.09
|
|
Inj imip 4 cilas 4 releb 2mg
|
$739.77 |
$739.77 |
$739.77 |
$739.77
|
|
Inj. inebilizumab-cdon, 1 mg
|
$10,939.38 |
$10,939.38 |
$10,939.38 |
$70,014.65
|
|
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
|
