|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$3,562.00 |
$3,562.00 |
$3,562.00 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,302.00 |
$3,302.00 |
$3,302.00 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$61,826.39 |
$61,826.39 |
$61,826.39 |
$66,582.27
|
|
Inj octafluoropropane mic,ml
|
$211.40 |
$211.40 |
$211.40 |
$211.40
|
|
Inj ogivri 10 mg
|
$4,282.28 |
$4,282.28 |
$4,282.28 |
$4,492.28
|
|
Inj olipudase alfa-rpcp 1mg
|
$12,294.28 |
$12,294.28 |
$12,294.28 |
$13,239.99
|
|
Inj, omacetaxine mep, 0.01mg
|
$2,182.65 |
$2,182.65 |
$2,182.65 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$777.39 |
$777.39 |
$777.39 |
$865.34
|
|
Inj, pafolacianine, 0.1 mg
|
$6,897.80 |
$6,897.80 |
$6,897.80 |
$6,897.80
|
|
Inj, panzyga, 500 mg
|
$7,466.99 |
$7,466.99 |
$7,466.99 |
$8,041.38
|
|
Inj, pasireotide long acting
|
$31,335.42 |
$31,335.42 |
$31,335.42 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$14,656.62 |
$14,656.62 |
$14,656.62 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$17,955.70 |
$17,955.70 |
$17,955.70 |
$132.57
|
|
Inj, pegcetacoplan, 1mg
|
$3,662.96 |
$3,662.96 |
$3,662.96 |
$3,662.96
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$6,371.38 |
$6,371.38 |
$6,371.38 |
$6,403.59
|
|
Inj. pemetrexed, 10 mg
|
$7,247.16 |
$7,247.16 |
$7,247.16 |
$104.72
|
|
Inj pemetrexed ditromethamin
|
$831.10 |
$831.10 |
$831.10 |
$895.03
|
|
Inj pemetrexed (sandoz) 10mg
|
$5,717.30 |
$5,717.30 |
$5,717.30 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$1,147.30 |
$1,147.30 |
$1,147.30 |
$1,235.55
|
|
Inj peritoneal venous shunt
|
$613.60 |
$613.60 |
$613.60 |
$413.70
|
|
Inj., perseris, 0.5 mg
|
$4,705.68 |
$4,705.68 |
$4,705.68 |
$5,146.85
|
|
Inj plasminogen tvmh 1mg
|
$4,456.80 |
$4,456.80 |
$4,456.80 |
$4,456.80
|
|
Inj., plazomicin, 5 mg
|
$563.79 |
$563.79 |
$563.79 |
$607.16
|
|
Inj proc ankle arthr
|
$551.20 |
$551.20 |
$551.20 |
$405.31
|
|
Inj proc elbow arthro
|
$462.80 |
$462.80 |
$462.80 |
$419.60
|
|
Inj proc for lymphang
|
$1,440.40 |
$1,440.40 |
$1,440.40 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$2,152.80 |
$2,152.80 |
$2,152.80 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,211.60 |
$1,211.60 |
$1,211.60 |
$830.50
|
|
Inj progesterone per 50 mg
|
$3.29 |
$3.29 |
$3.29 |
$15.00
|
|
Inj prohance multipack
|
$1.56 |
$1.56 |
$1.56 |
$9.59
|
|
Inj retro urethrocysto
|
$930.80 |
$930.80 |
$930.80 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$517.77 |
$517.77 |
$517.77 |
$746.79
|
|
Inj roctavian ml 2x10^13vc g
|
$130,068.54 |
$130,068.54 |
$130,068.54 |
$130,068.54
|
|
Inj romidepsin non-lyo 0.1mg
|
$12,538.06 |
$12,538.06 |
$12,538.06 |
$9,892.69
|
|
Inj scleros sol mult veins
|
$722.80 |
$722.80 |
$722.80 |
$675.00
|
|
Inj scleros sol sgl vein
|
$972.40 |
$972.40 |
$972.40 |
$558.97
|
|
Inj secretin synthetic human
|
$712.40 |
$712.40 |
$712.40 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$3,572.95 |
$3,572.95 |
$3,572.95 |
$4,413.21
|
|
Inj, sezaby, 1 mg
|
$219.00 |
$219.00 |
$219.00 |
$235.85
|
|
Inj, spesolimab-sbzo, 1 mg
|
$83,578.51 |
$83,578.51 |
$83,578.51 |
$90,007.62
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$587.60 |
$587.60 |
$587.60 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$237.85 |
$237.85 |
$237.85 |
$256.14
|
|
Inj, susvimo 0.1 mg
|
$2,598.44 |
$2,598.44 |
$2,598.44 |
$2,598.44
|
|
Inj, sutimlimab-jome, 10 mg
|
$3,207.04 |
$3,207.04 |
$3,207.04 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$50,577.36 |
$50,577.36 |
$50,577.36 |
$67,538.30
|
|
Inj, taliglucerace alfa 10 u
|
$1,460.89 |
$1,460.89 |
$1,460.89 |
$1,573.27
|
|
Inj teclistamab cqyv 0.5 mg
|
$15,669.65 |
$15,669.65 |
$15,669.65 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$603.67 |
$603.67 |
$603.67 |
$664.72
|
|
Inj teplizumab mzwv 5 mcg
|
$20,744.36 |
$20,744.36 |
$20,744.36 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$26,987.78 |
$26,987.78 |
$26,987.78 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$263.45 |
$263.45 |
$263.45 |
$123.24
|
|
Inj testosterone cypionate
|
$23.09 |
$23.09 |
$23.09 |
$64.80
|
|
Inj theophylline per 40 mg
|
$31.90 |
$31.90 |
$31.90 |
$31.90
|
|
Inj thiotepa nos 1 mg
|
$2,943.72 |
$2,943.72 |
$2,943.72 |
$3,170.16
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,560.00 |
$1,560.00 |
$1,560.00 |
$837.50
|
|
Inj, tislelizumab-jsgr
|
$9,066.66 |
$9,066.66 |
$9,066.66 |
$9,764.09
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,012.84 |
$1,012.84 |
$1,012.84 |
$1,090.75
|
|
Inj., triptorelin X-ray 3.75 mg
|
$33,416.39 |
$33,416.39 |
$33,416.39 |
$34,503.95
|
|
Inj, tyenne, 1 mg
|
$3,179.91 |
$3,179.91 |
$3,179.91 |
$3,525.12
|
|
Inj ustekinumab-kfce, 1 mg
|
$4,869.77 |
$4,869.77 |
$4,869.77 |
$5,244.37
|
|
Inj, uzedy, 1 mg
|
$10,656.25 |
$10,656.25 |
$10,656.25 |
$11,475.96
|
|
Inj vancomycin (xellia) 10mg
|
$62.00 |
$62.00 |
$62.00 |
$76.59
|
|
Inj, vasopressin (baxter)
|
$245.96 |
$245.96 |
$245.96 |
$228.24
|
|
Inj, vegzelma, 10 mg
|
$1,101.61 |
$1,101.61 |
$1,101.61 |
$1,291.28
|
|
Inj velmanase alfa-tycv 1 mg
|
$7,123.31 |
$7,123.31 |
$7,123.31 |
$7,123.31
|
|
Inj. viltolarsen
|
$2,290.18 |
$2,290.18 |
$2,290.18 |
$2,466.35
|
|
Inj vocal cord bulking agent
|
$655.20 |
$655.20 |
$655.20 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$504.40 |
$504.40 |
$504.40 |
$503.92
|
|
Inj. xembify, 100 mg
|
$3,205.22 |
$3,205.22 |
$3,205.22 |
$3,451.77
|
|
Inj xipere 1 mg
|
$300.04 |
$300.04 |
$300.04 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$13,676.94 |
$13,676.94 |
$13,676.94 |
$14,458.60
|
|
Inj zanidatamab-hrii, 2 mg
|
$5,791.03 |
$5,791.03 |
$5,791.03 |
$11,091.60
|
|
Inj zenocutuzumab-zbco 1 mg
|
$17,807.40 |
$17,807.40 |
$17,807.40 |
$19,177.20
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$35,839.93 |
$35,839.93 |
$35,839.93 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$5,974.80 |
$5,974.80 |
$5,974.80 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$5,044.00 |
$5,044.00 |
$5,044.00 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$5,917.60 |
$5,917.60 |
$5,917.60 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$5,657.60 |
$5,657.60 |
$5,657.60 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$587.60 |
$587.60 |
$587.60 |
$480.28
|
|
Insert and remove bone pin
|
$4,836.00 |
$4,836.00 |
$4,836.00 |
$4,410.60
|
|
Insert ant drainage device
|
$2,038.40 |
$2,038.40 |
$2,038.40 |
$4,881.00
|
|
Insert brain-fluid device 61215
|
$7,181.20 |
$7,181.20 |
$7,181.20 |
$7,181.20
|
|
Insert cannula hemo oth 36815
|
$7,534.80 |
$7,534.80 |
$7,534.80 |
$5,983.35
|
|
Insert cannula vein-to-vein hemodialysis
|
$7,534.80 |
$7,534.80 |
$7,534.80 |
$7,279.50
|
|
Insert cath pleura with image
|
$2,194.40 |
$2,194.40 |
$2,194.40 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,960.40 |
$1,960.40 |
$1,960.40 |
$2,073.18
|
|
Insert drug delivery implant
|
$364.00 |
$364.00 |
$364.00 |
$280.00
|
|
Insert epicardial lead open 33202
|
$2,293.20 |
$2,293.20 |
$2,293.20 |
$3,775.20
|
|
Insert hepatic shunt (tips)
|
$7,571.20 |
$7,571.20 |
$7,571.20 |
$7,571.20
|
|
Insert intrauterine device iud
|
$587.60 |
$587.60 |
$587.60 |
$347.10
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$2,293.20 |
$2,293.20 |
$2,293.20 |
$3,706.68
|
|
Insertion catheter bladder non indwelling
|
$171.60 |
$171.60 |
$171.60 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$275.60 |
$275.60 |
$275.60 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$5,371.60 |
$5,371.60 |
$5,371.60 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,629.60 |
$3,629.60 |
$3,629.60 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$6,500.00 |
$6,500.00 |
$6,500.00 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,194.40 |
$2,194.40 |
$2,194.40 |
$2,505.60
|
|
Insertion of cannula
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$4,341.66
|
|
Insertion of catheter vein
|
$2,605.20 |
$2,605.20 |
$2,605.20 |
$1,477.00
|
|
Insertion of catheter vein
|
$1,861.60 |
$1,861.60 |
$1,861.60 |
$836.25
|
