|
Inj mogamulizumab-kpkc, 1 mg
|
$876.85 |
$876.85 |
$876.85 |
$8,304.04
|
|
Inj, motixafortide, 0.25 mg
|
$225.55 |
$225.55 |
$225.55 |
$25.22
|
|
Inj, moxifloxacin 100 mg
|
$430.95 |
$430.95 |
$430.95 |
$101.31
|
|
Inj multihance
|
$5.20 |
$5.20 |
$5.20 |
$70.54
|
|
Inj. mycophenolate mofetil
|
$577.85 |
$577.85 |
$577.85 |
$252.66
|
|
Inj. naxitamab-gqgk, 1 mg
|
$2,263.30 |
$2,263.30 |
$2,263.30 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$4,278.95 |
$4,278.95 |
$4,278.95 |
$1,413.35
|
|
Inj nivolumab 2 mg hyaluron
|
$106.60 |
$106.60 |
$106.60 |
$15,599.68
|
|
Inj, nogapendekin pmln, 1mcg
|
$384.15 |
$384.15 |
$384.15 |
$94.12
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$11,835.85 |
$11,835.85 |
$11,835.85 |
$2,881.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$11,835.85 |
$11,835.85 |
$11,835.85 |
$2,726.90
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$388.70 |
$388.70 |
$388.70 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$533.65 |
$533.65 |
$533.65 |
$4,492.28
|
|
Inj, olaratumab, 10 mg
|
$443.95 |
$443.95 |
$443.95 |
$4,127.04
|
|
Inj, omacetaxine mep, 0.01mg
|
$35.75 |
$35.75 |
$35.75 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$11.05 |
$11.05 |
$11.05 |
$865.34
|
|
Inj ontruzant 10 mg
|
$752.70 |
$752.70 |
$752.70 |
$6,706.27
|
|
Inj, pafolacianine, 0.1 mg
|
$440.70 |
$440.70 |
$440.70 |
$6,897.80
|
|
Inj, pasireotide long acting
|
$2,029.30 |
$2,029.30 |
$2,029.30 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$420.55 |
$420.55 |
$420.55 |
$17,613.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$1,518.40 |
$1,518.40 |
$1,518.40 |
$6,614.40
|
|
Inj. pemetrexed, 10 mg
|
$395.85 |
$395.85 |
$395.85 |
$104.72
|
|
Inj pemetrexed (accord) 10mg
|
$80.60 |
$80.60 |
$80.60 |
$579.77
|
|
Inj, pemetrexed (avyxa) 10mg
|
$673.40 |
$673.40 |
$673.40 |
$112.10
|
|
Inj pemetrexed, hospira 10mg
|
$66.95 |
$66.95 |
$66.95 |
$64.35
|
|
Inj pemetrexed (sandoz) 10mg
|
$90.35 |
$90.35 |
$90.35 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$185.25 |
$185.25 |
$185.25 |
$200.85
|
|
Inj, pemrydi rtu, 10 mg
|
$680.55 |
$680.55 |
$680.55 |
$82.30
|
|
Inj peritoneal venous shunt
|
$610.35 |
$610.35 |
$610.35 |
$406.80
|
|
Inj proc for lymphang
|
$2,416.70 |
$2,416.70 |
$2,416.70 |
$742.40
|
|
Inj proc lumbr disk ea lvl
|
$2,221.05 |
$2,221.05 |
$2,221.05 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$419.90 |
$419.90 |
$419.90 |
$838.30
|
|
Inj progesterone per 50 mg
|
$20.15 |
$20.15 |
$20.15 |
$13.76
|
|
Inj, releuko 1 mcg
|
$5.20 |
$5.20 |
$5.20 |
$475.36
|
|
Inj retro urethrocysto
|
$806.00 |
$806.00 |
$806.00 |
$447.74
|
|
Inj scleros sol mult veins
|
$3,510.00 |
$3,510.00 |
$3,510.00 |
$692.90
|
|
Inj scleros sol sgl vein
|
$2,861.95 |
$2,861.95 |
$2,861.95 |
$561.88
|
|
Inj secretin synthetic human
|
$234.00 |
$234.00 |
$234.00 |
$1,253.09
|
|
Inj, spesolimab-sbzo, 1 mg
|
$528.45 |
$528.45 |
$528.45 |
$90,007.62
|
|
Inj sulf hexa lipid microsph
|
$91.00 |
$91.00 |
$91.00 |
$256.14
|
|
Inj, sutimlimab-jome, 10 mg
|
$74.75 |
$74.75 |
$74.75 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$2,345.20 |
$2,345.20 |
$2,345.20 |
$67,538.30
|
|
Inj teclistamab cqyv 0.5 mg
|
$145.60 |
$145.60 |
$145.60 |
$17,517.56
|
|
Inj teplizumab mzwv 5 mcg
|
$148.85 |
$148.85 |
$148.85 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$841.10 |
$841.10 |
$841.10 |
$35,034.78
|
|
Inj testosterone cypionate
|
$196.30 |
$196.30 |
$196.30 |
$64.96
|
|
Inj theophylline per 40 mg
|
$39.65 |
$39.65 |
$39.65 |
$31.90
|
|
Inj thiotepa nos 1 mg
|
$178.10 |
$178.10 |
$178.10 |
$3,170.16
|
|
Inj, tislelizumab-jsgr
|
$234.67 |
$234.67 |
$234.67 |
$9,764.09
|
|
Inj, tofidence, 1 mg
|
$50.05 |
$50.05 |
$50.05 |
$86.87
|
|
Inj travoprost intra impl
|
$43,524.00 |
$43,524.00 |
$43,524.00 |
$197.16
|
|
Inj, tyenne, 1 mg
|
$50.05 |
$50.05 |
$50.05 |
$3,525.12
|
|
Inj vasopressin (am reg) 1 u
|
$20.80 |
$20.80 |
$20.80 |
$41.79
|
|
Inj, vegzelma, 10 mg
|
$577.20 |
$577.20 |
$577.20 |
$1,186.35
|
|
Inj vocal cord bulking agent
|
$4,306.25 |
$4,306.25 |
$4,306.25 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$2,401.75 |
$2,401.75 |
$2,401.75 |
$504.40
|
|
Inj zanidatamab-hrii, 2 mg
|
$102.05 |
$102.05 |
$102.05 |
$8,532.00
|
|
Inj zenocutuzumab-zbco 1 mg
|
$135.85 |
$135.85 |
$135.85 |
$19,177.20
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$10,931.70 |
$10,931.70 |
$10,931.70 |
$41,083.73
|
|
Ins cath ren art 1st bi
|
$6,012.50 |
$6,012.50 |
$6,012.50 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$6,012.50 |
$6,012.50 |
$6,012.50 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,408.65 |
$5,408.65 |
$5,408.65 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$6,012.50 |
$6,012.50 |
$6,012.50 |
$5,395.20
|
|
Insert abdomen-venous drain
|
$36,865.40 |
$36,865.40 |
$36,865.40 |
$4,039.47
|
|
Insert cannula hemo oth 36815
|
$10,476.70 |
$10,476.70 |
$10,476.70 |
$5,983.35
|
|
Insert cannula vein-to-vein hemodialysis
|
$10,476.70 |
$10,476.70 |
$10,476.70 |
$7,279.50
|
|
Insert cath pleura with image
|
$9,275.50 |
$9,275.50 |
$9,275.50 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,681.90 |
$2,681.90 |
$2,681.90 |
$2,099.70
|
|
Insert drug delivery implant
|
$335.40 |
$335.40 |
$335.40 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$36,865.40 |
$36,865.40 |
$36,865.40 |
$7,571.20
|
|
Insertion catheter bladder non indwelling
|
$322.40 |
$322.40 |
$322.40 |
$208.01
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$10,601.50 |
$10,601.50 |
$10,601.50 |
$4,897.20
|
|
Insertion intra aortic balloon assist device percutaneous
|
$11,616.80 |
$11,616.80 |
$11,616.80 |
$2,447.63
|
|
Insertion intra-aortic circulation dev 33970
|
$12,658.75 |
$12,658.75 |
$12,658.75 |
$1,752.40
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$8,944.00 |
$8,944.00 |
$8,944.00 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,595.45 |
$2,595.45 |
$2,595.45 |
$2,585.25
|
|
Insertion of cannula
|
$10,476.70 |
$10,476.70 |
$10,476.70 |
$4,341.66
|
|
Insertion of catheter vein
|
$1,387.10 |
$1,387.10 |
$1,387.10 |
$1,525.80
|
|
Insertion of catheter vein
|
$1,387.10 |
$1,387.10 |
$1,387.10 |
$870.59
|
|
Insertion of heart electrode 33211
|
$15,759.25 |
$15,759.25 |
$15,759.25 |
$6,820.50
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$18,983.90 |
$18,983.90 |
$18,983.90 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$20,861.10 |
$20,861.10 |
$20,861.10 |
$12,324.60
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$17,997.85 |
$17,997.85 |
$17,997.85 |
$9,884.16
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,983.15 |
$1,983.15 |
$1,983.15 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,776.80 |
$2,776.80 |
$2,776.80 |
$2,453.83
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$29,779.75 |
$29,779.75 |
$29,779.75 |
$29,180.00
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$17,499.30 |
$17,499.30 |
$17,499.30 |
$7,183.68
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$12,075.70 |
$12,075.70 |
$12,075.70 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$9,390.55 |
$9,390.55 |
$9,390.55 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$8,350.55 |
$8,350.55 |
$8,350.55 |
$5,236.80
|
|
Insert picvad cath
|
$4,899.05 |
$4,899.05 |
$4,899.05 |
$4,195.00
|
|
Insert pm/icd lead dual
|
$9,201.40 |
$9,201.40 |
$9,201.40 |
$7,115.90
|
|
Insert/repl sq defib w/eltrd
|
$29,779.75 |
$29,779.75 |
$29,779.75 |
$33,593.55
|
|
Insert sq defib electrode
|
$8,366.80 |
$8,366.80 |
$8,366.80 |
$8,167.68
|
|
Insert swan-ganz cath
|
$5,100.55 |
$5,100.55 |
$5,100.55 |
$2,164.52
|
|
Insert tissue expander(s)
|
$5,164.25 |
$5,164.25 |
$5,164.25 |
$4,332.25
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$6,144.45 |
$6,144.45 |
$6,144.45 |
$4,997.60
|
|
Insert tunneled cv cath
|
$8,271.90 |
$8,271.90 |
$8,271.90 |
$4,520.00
|
|
Insert tunneled cv cath
|
$15,077.40 |
$15,077.40 |
$15,077.40 |
$6,028.07
|
|
Insert vad art access left hrt arterial access
|
$66,951.30 |
$66,951.30 |
$66,951.30 |
$4,276.00
|
