|
Inj glofitamab gxbm, 2.5 mg
|
$21,113.85 |
$21,113.85 |
$21,113.85 |
$4,760.67
|
|
Inj glycopyrrolate, glyrx-pf
|
$31.46 |
$31.46 |
$35.90 |
$11.23
|
|
Inj., guselkumab, 1 mg
|
$28,661.84 |
$28,661.84 |
$28,661.84 |
$29,130.83
|
|
Inj heparin, pfizer, 1000u
|
$25.64 |
$25.64 |
$25.64 |
$26.26
|
|
Inj. herceptin hylecta, 10mg
|
$156.93 |
$156.93 |
$156.93 |
$7,690.59
|
|
Inj, hercessi, 10 mg
|
$195.10 |
$195.10 |
$195.10 |
$6,033.42
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$293.83 |
$2,232.40 |
$2,232.40 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$2,035.09 |
$3,643.60 |
$3,643.60 |
$1,827.74
|
|
Inj hrt cath w/s&i sel hrt art
|
$506.80 |
$2,247.20 |
$2,247.20 |
$1,045.80
|
|
Inj hrt cath w/s&i sel left vent
|
$1,376.45 |
$1,752.80 |
$1,752.80 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$222.84 |
$1,752.80 |
$1,752.80 |
$965.33
|
|
Inj hydroxocobalamin IV 25mg
|
$7.88 |
$7.88 |
$1,328.29 |
$2,452.32
|
|
Inj imip 4 cilas 4 releb 2mg
|
$4.94 |
$4.94 |
$4.94 |
$739.77
|
|
Inj, imm glob bivigam, 500mg
|
$163.56 |
$163.56 |
$163.56 |
$1,258.47
|
|
Inj. inebilizumab-cdon, 1 mg
|
$863.34 |
$863.34 |
$863.34 |
$70,014.65
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$965.34 |
$2,526.00 |
$2,526.00 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$87.73 |
$526.40 |
$526.40 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$29,890.45 |
$29,890.45 |
$29,890.45 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$440.66 |
$440.66 |
$440.66 |
$38.94
|
|
Inj, lanreotide, (cipla) 1mg
|
$64.08 |
$64.08 |
$64.08 |
$11,648.70
|
|
Inj, lecanemab-irmb, 1 mg
|
$2,506.64 |
$2,506.64 |
$2,506.64 |
$1,174.88
|
|
Inj levocarnitine per 1 gm
|
$196.12 |
$196.12 |
$196.12 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$16.56 |
$48.29 |
$288.88 |
$303.45
|
|
Inj, lidocaine w epinephrine
|
$2.38 |
$10.06 |
$79.28 |
$47.52
|
|
Inj, melphalan (apotex) 1 mg
|
$39,366.67 |
$39,366.67 |
$39,366.67 |
$64.78
|
|
Inj mepivacaine hcl/10 ml
|
$9.61 |
$9.61 |
$34.00 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$892.91 |
$892.91 |
$892.91 |
$558.08
|
|
Inj, micafungin (par pharm)
|
$0.81 |
$0.81 |
$61.04 |
$89.40
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$46,112.63 |
$46,112.63 |
$46,112.63 |
$8,304.04
|
|
Inj multihance
|
$8.00 |
$10.18 |
$167.77 |
$73.49
|
|
Inj multihance multipack
|
$8.00 |
$8.00 |
$8.00 |
$2.80
|
|
Inj. mycophenolate mofetil
|
$322.03 |
$322.03 |
$322.03 |
$252.66
|
|
Inj naloxone hydrochloride
|
$38.24 |
$38.24 |
$38.24 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$374.40 |
$374.40 |
$594.36 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$351.27 |
$351.27 |
$351.27 |
$462.04
|
|
Inj nivolumab 2 mg hyaluron
|
$51.71 |
$51.71 |
$32,179.15 |
$15,599.68
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$75.56 |
$75.56 |
$75.56 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$174.08 |
$174.08 |
$174.08 |
$4,492.28
|
|
Inj, olaratumab, 10 mg
|
$9,294.17 |
$9,294.17 |
$9,294.17 |
$4,127.04
|
|
Inj onase abepar-xioi treat
|
$761,919.27 |
$761,919.27 |
$761,919.27 |
$3,572,794.09
|
|
Inj pantoprazole(hikma) 40mg
|
$34.70 |
$34.70 |
$34.70 |
$34.67
|
|
Inj., patisiran, 0.1 mg
|
$46,716.89 |
$46,716.89 |
$46,716.89 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$8,111.03 |
$8,111.03 |
$8,111.03 |
$6,403.59
|
|
Inj pemetrexed (accord) 10mg
|
$5,349.04 |
$5,349.04 |
$5,349.04 |
$579.77
|
|
Inj, pemivibart, 4500 mg
|
$10,190.02 |
$10,190.02 |
$10,190.02 |
$1,235.55
|
|
Inj peritoneal venous shunt
|
$242.97 |
$242.97 |
$242.97 |
$413.70
|
|
Inj proc ankle arthr
|
$224.40 |
$224.40 |
$224.40 |
$405.31
|
|
Inj proc elbow arthro
|
$442.80 |
$442.80 |
$442.80 |
$419.60
|
|
Inj proc for lymphang
|
$254.80 |
$254.80 |
$336.02 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$533.70 |
$832.40 |
$832.40 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$315.82 |
$548.40 |
$548.40 |
$830.50
|
|
Inj proc sialogram
|
$258.00 |
$258.00 |
$365.86 |
$373.00
|
|
Inj progesterone per 50 mg
|
$14.93 |
$14.93 |
$14.93 |
$15.00
|
|
Inj, releuko 1 mcg
|
$0.94 |
$0.94 |
$1,044.45 |
$473.25
|
|
Inj retacrit esrd on dialysi
|
$8.93 |
$8.93 |
$8.93 |
$349.45
|
|
Inj retro urethrocysto
|
$231.62 |
$500.40 |
$500.40 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$1.60 |
$1.60 |
$1.60 |
$746.79
|
|
Inj scleros sol mult veins
|
$1,014.40 |
$1,014.40 |
$1,014.40 |
$675.00
|
|
Inj scleros sol sgl vein
|
$325.51 |
$1,064.00 |
$1,064.00 |
$558.97
|
|
Inj sebelipase alfa 1 mg
|
$156.62 |
$156.62 |
$156.62 |
$539.69
|
|
Inj secretin synthetic human
|
$905.12 |
$905.12 |
$905.12 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$29.09 |
$29.09 |
$4,413.21 |
$4,413.21
|
|
Inj, spesolimab-sbzo, 1 mg
|
$107,765.05 |
$107,765.05 |
$107,765.05 |
$90,007.62
|
|
Inj sulf hexa lipid microsph
|
$54.73 |
$54.73 |
$54.73 |
$256.14
|
|
Inj teclistamab cqyv 0.5 mg
|
$97.58 |
$97.58 |
$19,428.80 |
$17,517.56
|
|
Inj. teprotumumab-trbw 10 mg
|
$577.21 |
$577.21 |
$30,786.47 |
$35,034.78
|
|
Inj testosterone cypionate
|
$0.84 |
$2.36 |
$78.60 |
$64.80
|
|
Inj thiotepa nos 1 mg
|
$25,236.81 |
$25,236.81 |
$25,236.81 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,324.80 |
$1,324.80 |
$1,324.80 |
$1,152.97
|
|
Inj. tigecycline (accord)
|
$323.35 |
$323.35 |
$323.35 |
$188.03
|
|
Inj., tildrakizumab, 1 mg
|
$204.23 |
$204.23 |
$204.23 |
$26,635.60
|
|
Inj, tislelizumab-jsgr
|
$105.34 |
$105.34 |
$105.34 |
$9,764.09
|
|
Inj, tofidence, 1 mg
|
$8.07 |
$8.07 |
$4,583.78 |
$92.13
|
|
Inj, tyenne, 1 mg
|
$41.86 |
$41.86 |
$41.86 |
$3,525.12
|
|
Inj ustekinumab-kfce, 1 mg
|
$4.87 |
$4.87 |
$5.96 |
$5,244.37
|
|
Inj ustekinumab-stba, 1 mg
|
$3.49 |
$3.49 |
$4.34 |
$16.36
|
|
Inj, vegzelma, 10 mg
|
$177.48 |
$177.48 |
$177.48 |
$1,291.28
|
|
Inj vocal cord bulking agent
|
$1,902.80 |
$1,902.80 |
$1,902.80 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$362.11 |
$628.40 |
$628.40 |
$503.92
|
|
Inj zanidatamab-hrii, 2 mg
|
$46,626.59 |
$46,626.59 |
$46,626.59 |
$11,091.60
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$41,083.73 |
$41,083.73 |
$41,083.73 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$5,092.80 |
$5,092.80 |
$6,071.61 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$3,894.40 |
$3,894.40 |
$3,894.40 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$5,092.80 |
$5,092.80 |
$9,593.14 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$2,821.60 |
$2,821.60 |
$2,821.60 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$314.82 |
$518.40 |
$518.40 |
$480.28
|
|
Insert cath pleura with image
|
$1,324.52 |
$3,362.80 |
$3,362.80 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,072.87 |
$3,161.20 |
$3,161.20 |
$2,073.18
|
|
Insert drug delivery implant
|
$106.00 |
$1,396.80 |
$1,396.80 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$3,622.11 |
$3,996.80 |
$3,996.80 |
$7,571.20
|
|
Insert intrauterine device iud
|
$104.90 |
$122.40 |
$122.40 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$165.56 |
$202.00 |
$202.00 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$205.88 |
$210.00 |
$210.00 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$2,495.23 |
$6,514.40 |
$6,514.40 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$915.20 |
$915.20 |
$1,689.18 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$7,111.41 |
$7,585.60 |
$7,585.60 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,606.86 |
$1,939.20 |
$1,939.20 |
$2,505.60
|
|
Insertion of catheter vein
|
$566.33 |
$1,692.00 |
$1,692.00 |
$1,477.00
|
|
Insertion of catheter vein
|
$578.40 |
$578.40 |
$578.40 |
$836.25
|
|
Insertion of heart electrode 33211
|
$3,676.34 |
$3,676.34 |
$3,676.34 |
$6,903.60
|
