|
Inj. naxitamab-gqgk, 1 mg
|
$56,336.10 |
$56,336.10 |
$56,336.10 |
$42,064.28
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$670.50 |
$670.50 |
$670.50 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$462.04 |
$462.04 |
$462.04 |
$462.04
|
|
Inj nivolumab 2 mg hyaluron
|
$18,620.56 |
$18,620.56 |
$18,620.56 |
$15,599.68
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$89,172.69 |
$89,172.69 |
$89,172.69 |
$66,582.27
|
|
Inj octafluoropropane mic,ml
|
$304.91 |
$304.91 |
$304.91 |
$211.40
|
|
Inj ogivri 10 mg
|
$6,176.37 |
$6,176.37 |
$6,176.37 |
$4,492.28
|
|
Inj olipudase alfa-rpcp 1mg
|
$17,732.13 |
$17,732.13 |
$17,732.13 |
$13,239.99
|
|
Inj, omacetaxine mep, 0.01mg
|
$3,148.06 |
$3,148.06 |
$3,148.06 |
$2,686.80
|
|
Inj., omadacycline, 1 mg
|
$1,121.25 |
$1,121.25 |
$1,121.25 |
$865.34
|
|
Inj, pafolacianine, 0.1 mg
|
$9,948.75 |
$9,948.75 |
$9,948.75 |
$6,897.80
|
|
Inj, panzyga, 500 mg
|
$10,769.70 |
$10,769.70 |
$10,769.70 |
$8,041.38
|
|
Inj, pasireotide long acting
|
$45,195.32 |
$45,195.32 |
$45,195.32 |
$33,745.84
|
|
Inj., patisiran, 0.1 mg
|
$21,139.35 |
$21,139.35 |
$21,139.35 |
$17,613.00
|
|
Inj, pedmark, 100 mg
|
$25,897.65 |
$25,897.65 |
$25,897.65 |
$132.57
|
|
Inj, pegcetacoplan, 1mg
|
$5,283.12 |
$5,283.12 |
$5,283.12 |
$3,662.96
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$9,189.49 |
$9,189.49 |
$9,189.49 |
$6,403.59
|
|
Inj. pemetrexed, 10 mg
|
$10,452.64 |
$10,452.64 |
$10,452.64 |
$104.72
|
|
Inj pemetrexed ditromethamin
|
$1,198.70 |
$1,198.70 |
$1,198.70 |
$895.03
|
|
Inj pemetrexed (sandoz) 10mg
|
$8,246.10 |
$8,246.10 |
$8,246.10 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$1,654.76 |
$1,654.76 |
$1,654.76 |
$1,235.55
|
|
Inj., perseris, 0.5 mg
|
$6,787.04 |
$6,787.04 |
$6,787.04 |
$5,146.85
|
|
Inj plasminogen tvmh 1mg
|
$6,428.08 |
$6,428.08 |
$6,428.08 |
$4,456.80
|
|
Inj., plazomicin, 5 mg
|
$813.16 |
$813.16 |
$813.16 |
$607.16
|
|
Inj proc lumbr disk ea lvl
|
$893.25 |
$893.25 |
$893.25 |
$1,106.93
|
|
Inj progesterone per 50 mg
|
$4.74 |
$4.74 |
$4.74 |
$15.00
|
|
Inj retro urethrocysto
|
$321.75 |
$321.75 |
$321.75 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$746.79 |
$746.79 |
$746.79 |
$746.79
|
|
Inj roctavian ml 2x10^13vc g
|
$187,598.85 |
$187,598.85 |
$187,598.85 |
$130,068.54
|
|
Inj romidepsin non-lyo 0.1mg
|
$18,083.74 |
$18,083.74 |
$18,083.74 |
$9,892.69
|
|
Inj scleros sol sgl vein
|
$592.50 |
$592.50 |
$592.50 |
$558.97
|
|
Inj secretin synthetic human
|
$1,027.50 |
$1,027.50 |
$1,027.50 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$5,153.29 |
$5,153.29 |
$5,153.29 |
$4,413.21
|
|
Inj, sezaby, 1 mg
|
$315.87 |
$315.87 |
$315.87 |
$235.85
|
|
Inj, spesolimab-sbzo, 1 mg
|
$120,545.93 |
$120,545.93 |
$120,545.93 |
$90,007.62
|
|
Inj sulf hexa lipid microsph
|
$343.05 |
$343.05 |
$343.05 |
$256.14
|
|
Inj, susvimo 0.1 mg
|
$3,747.75 |
$3,747.75 |
$3,747.75 |
$2,598.44
|
|
Inj, sutimlimab-jome, 10 mg
|
$4,625.54 |
$4,625.54 |
$4,625.54 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$72,948.12 |
$72,948.12 |
$72,948.12 |
$67,538.30
|
|
Inj, taliglucerace alfa 10 u
|
$2,107.06 |
$2,107.06 |
$2,107.06 |
$1,573.27
|
|
Inj teclistamab cqyv 0.5 mg
|
$22,600.46 |
$22,600.46 |
$22,600.46 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$870.68 |
$870.68 |
$870.68 |
$664.72
|
|
Inj teplizumab mzwv 5 mcg
|
$29,919.75 |
$29,919.75 |
$29,919.75 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$38,924.69 |
$38,924.69 |
$38,924.69 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$379.98 |
$379.98 |
$379.98 |
$123.24
|
|
Inj testosterone cypionate
|
$33.31 |
$33.31 |
$33.31 |
$64.80
|
|
Inj theophylline per 40 mg
|
$46.02 |
$46.02 |
$46.02 |
$31.90
|
|
Inj thiotepa nos 1 mg
|
$4,245.75 |
$4,245.75 |
$4,245.75 |
$3,170.16
|
|
Inj, tislelizumab-jsgr
|
$13,076.91 |
$13,076.91 |
$13,076.91 |
$9,764.09
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,460.82 |
$1,460.82 |
$1,460.82 |
$1,090.75
|
|
Inj., triptorelin X-ray 3.75 mg
|
$48,196.72 |
$48,196.72 |
$48,196.72 |
$34,503.95
|
|
Inj, tyenne, 1 mg
|
$4,586.41 |
$4,586.41 |
$4,586.41 |
$3,525.12
|
|
Inj ustekinumab-kfce, 1 mg
|
$7,023.71 |
$7,023.71 |
$7,023.71 |
$5,244.37
|
|
Inj, uzedy, 1 mg
|
$15,369.60 |
$15,369.60 |
$15,369.60 |
$11,475.96
|
|
Inj vancomycin (xellia) 10mg
|
$89.43 |
$89.43 |
$89.43 |
$76.59
|
|
Inj, vasopressin (baxter)
|
$354.75 |
$354.75 |
$354.75 |
$228.24
|
|
Inj, vegzelma, 10 mg
|
$1,588.87 |
$1,588.87 |
$1,588.87 |
$1,291.28
|
|
Inj velmanase alfa-tycv 1 mg
|
$10,274.01 |
$10,274.01 |
$10,274.01 |
$7,123.31
|
|
Inj. viltolarsen
|
$3,303.15 |
$3,303.15 |
$3,303.15 |
$2,466.35
|
|
Inj vocal cord bulking agent
|
$472.50 |
$472.50 |
$472.50 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$687.00 |
$687.00 |
$687.00 |
$503.92
|
|
Inj. xembify, 100 mg
|
$4,622.91 |
$4,622.91 |
$4,622.91 |
$3,451.77
|
|
Inj xipere 1 mg
|
$432.75 |
$432.75 |
$432.75 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$19,726.35 |
$19,726.35 |
$19,726.35 |
$14,458.60
|
|
Inj zanidatamab-hrii, 2 mg
|
$8,352.45 |
$8,352.45 |
$8,352.45 |
$11,091.60
|
|
Inj zenocutuzumab-zbco 1 mg
|
$25,683.75 |
$25,683.75 |
$25,683.75 |
$19,177.20
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$51,692.21 |
$51,692.21 |
$51,692.21 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$4,020.00 |
$4,020.00 |
$4,020.00 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$3,752.25 |
$3,752.25 |
$3,752.25 |
$4,660.00
|
|
Ins cath ren art 2nd+ uni
|
$6,027.00 |
$6,027.00 |
$6,027.00 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$964.50 |
$964.50 |
$964.50 |
$480.28
|
|
Insert cannula vein-to-vein hemodialysis
|
$7,014.75 |
$7,014.75 |
$7,014.75 |
$7,279.50
|
|
Insert cath pleura with image
|
$3,461.25 |
$3,461.25 |
$3,461.25 |
$2,194.40
|
|
Insert cath pleura without image
|
$3,177.75 |
$3,177.75 |
$3,177.75 |
$2,073.18
|
|
Insert drug delivery implant
|
$279.75 |
$279.75 |
$279.75 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$2,934.75 |
$2,934.75 |
$2,934.75 |
$7,571.20
|
|
Insert intrauterine device iud
|
$225.00 |
$225.00 |
$225.00 |
$347.10
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$5,613.75 |
$5,613.75 |
$5,613.75 |
$3,706.68
|
|
Insertion catheter bladder non indwelling
|
$114.00 |
$114.00 |
$114.00 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$166.50 |
$166.50 |
$166.50 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$6,976.50 |
$6,976.50 |
$6,976.50 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$824.25 |
$824.25 |
$824.25 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$7,585.50 |
$7,585.50 |
$7,585.50 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,864.00 |
$3,864.00 |
$3,864.00 |
$2,505.60
|
|
Insertion of catheter vein
|
$5,335.50 |
$5,335.50 |
$5,335.50 |
$1,477.00
|
|
Insertion of catheter vein
|
$471.00 |
$471.00 |
$471.00 |
$836.25
|
|
Insertion of heart electrode 33211
|
$9,716.25 |
$9,716.25 |
$9,716.25 |
$6,903.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$8,202.00 |
$8,202.00 |
$8,202.00 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$11,747.25 |
$11,747.25 |
$11,747.25 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$3,698.25 |
$3,698.25 |
$3,698.25 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,054.75 |
$3,054.75 |
$3,054.75 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,084.00 |
$3,084.00 |
$3,084.00 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$25,472.25 |
$25,472.25 |
$25,472.25 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$9,716.25 |
$9,716.25 |
$9,716.25 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$9,716.25 |
$9,716.25 |
$9,716.25 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$15,150.00 |
$15,150.00 |
$15,150.00 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$5,140.50 |
$5,140.50 |
$5,140.50 |
$5,223.20
|
|
Insert pm/icd lead dual
|
$9,716.25 |
$9,716.25 |
$9,716.25 |
$7,115.20
|
|
Insert/repl sq defib w/eltrd
|
$37,100.25 |
$37,100.25 |
$37,100.25 |
$32,800.04
|
|
Insert sq defib electrode
|
$9,716.25 |
$9,716.25 |
$9,716.25 |
$8,167.68
|
