|
Inj epidural sgl lumb-sacral without img
|
$23,212.63 |
$23,212.63 |
$23,212.63 |
$1,415.50
|
|
Inj fensolvi 0.25 mg
|
$173,744.90 |
$173,744.90 |
$173,744.90 |
$44,262.98
|
|
Inj., fibryga, 1 mg
|
$7,912.62 |
$7,912.62 |
$7,912.62 |
$4.93
|
|
Inj fluphenazine hcl 1.25 mg
|
$1,497.12 |
$1,497.12 |
$1,497.12 |
$39.54
|
|
Inj for ext venography
|
$7,356.97 |
$7,356.97 |
$7,356.97 |
$649.95
|
|
Inj gemcitabine hcl (accord)
|
$1,657.95 |
$1,657.95 |
$1,657.95 |
$130.65
|
|
Inj glofitamab gxbm, 2.5 mg
|
$67,882.67 |
$67,882.67 |
$67,882.67 |
$4,760.67
|
|
Inj., guselkumab, 1 mg
|
$135,612.40 |
$135,612.40 |
$135,612.40 |
$29,130.83
|
|
Inj. herceptin hylecta, 10mg
|
$29,274.00 |
$29,274.00 |
$29,274.00 |
$7,690.59
|
|
Inj herzuma 10 mg
|
$13,535.20 |
$13,535.20 |
$13,535.20 |
$7,775.46
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$3,875.20 |
$3,875.20 |
$3,875.20 |
$1,439.90
|
|
Inj hrt cath w/s&i sel hrt ang
|
$3,314.50 |
$3,314.50 |
$3,314.50 |
$1,827.74
|
|
Inj hrt cath w/s&i sel left vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$1,239.00
|
|
Inj hrt cath w/s&i sel right vent
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$965.33
|
|
Inj human fibrinogen con nos
|
$7.52 |
$7.52 |
$7.52 |
$3.95
|
|
Inj imip 4 cilas 4 releb 2mg
|
$2,728.60 |
$2,728.60 |
$2,728.60 |
$739.77
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$5,803.00 |
$5,803.00 |
$5,803.00 |
$1,928.00
|
|
Inj intralesional <= 7 lsn(s)
|
$371.00 |
$371.00 |
$371.00 |
$235.13
|
|
Inj ivig privigen 500 mg
|
$14,474.25 |
$14,474.25 |
$14,474.25 |
$6,967.29
|
|
Inj labetalol hcl hikma, 5mg
|
$49.87 |
$49.87 |
$49.87 |
$38.94
|
|
Inj, lecanemab-irmb, 1 mg
|
$6,144.07 |
$6,144.07 |
$6,144.07 |
$1,174.88
|
|
Inj, lenacapavir, 1 mg
|
$122,098.55 |
$122,098.55 |
$122,098.55 |
$24,398.00
|
|
Inj levocarnitine per 1 gm
|
$559.82 |
$559.82 |
$559.82 |
$136.62
|
|
Inj, lidocaine w epinephrine
|
$282.80 |
$282.80 |
$282.80 |
$47.52
|
|
Inj mepivacaine hcl/10 ml
|
$201.95 |
$201.95 |
$201.95 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$2,064.82 |
$2,064.82 |
$2,064.82 |
$558.08
|
|
Inj meropenem (wg crit care)
|
$447.12 |
$447.12 |
$447.12 |
$77.97
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$89,356.75 |
$89,356.75 |
$89,356.75 |
$1,496.55
|
|
Inj multihance
|
$465.32 |
$465.32 |
$465.32 |
$73.49
|
|
Inj multihance multipack
|
$10,364.72 |
$10,364.72 |
$10,364.72 |
$2.80
|
|
Inj. mycophenolate mofetil
|
$981.40 |
$981.40 |
$981.40 |
$252.66
|
|
Inj naloxone hydrochloride
|
$244.12 |
$244.12 |
$244.12 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$8,842.46 |
$8,842.46 |
$8,842.46 |
$1,413.35
|
|
Inj nivolumab 2 mg hyaluron
|
$50,037.05 |
$50,037.05 |
$50,037.05 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,686.90 |
$3,686.90 |
$3,686.90 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$258,485.16 |
$258,485.16 |
$258,485.16 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$10,838.45 |
$10,838.45 |
$10,838.45 |
$4,492.28
|
|
Inj pantoprazole(hikma) 40mg
|
$50.22 |
$50.22 |
$50.22 |
$34.67
|
|
Inj peritoneal venous shunt
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$413.70
|
|
Inj proc ankle arthr
|
$128.80 |
$128.80 |
$128.80 |
$405.31
|
|
Inj proc elbow arthro
|
$666.40 |
$666.40 |
$666.40 |
$419.60
|
|
Inj proc for lymphang
|
$1,718.50 |
$1,718.50 |
$1,718.50 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$23,646.15 |
$23,646.15 |
$23,646.15 |
$1,106.93
|
|
Inj proc sialogram
|
$1,299.20 |
$1,299.20 |
$1,299.20 |
$373.00
|
|
Inj progesterone per 50 mg
|
$488.42 |
$488.42 |
$488.42 |
$15.00
|
|
Inj retro urethrocysto
|
$2,422.00 |
$2,422.00 |
$2,422.00 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$2,990.75 |
$2,990.75 |
$2,990.75 |
$746.79
|
|
Inj scleros sol mult veins
|
$984.20 |
$984.20 |
$984.20 |
$675.00
|
|
Inj scleros sol sgl vein
|
$465.50 |
$465.50 |
$465.50 |
$558.97
|
|
Inj secretin synthetic human
|
$5,722.50 |
$5,722.50 |
$5,722.50 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$20,498.27 |
$20,498.27 |
$20,498.27 |
$4,413.21
|
|
Inj, spesolimab-sbzo, 1 mg
|
$174,715.27 |
$174,715.27 |
$174,715.27 |
$90,007.62
|
|
Inj sulf hexa lipid microsph
|
$1,423.97 |
$1,423.97 |
$1,423.97 |
$256.14
|
|
Inj teclistamab cqyv 0.5 mg
|
$65,417.10 |
$65,417.10 |
$65,417.10 |
$17,517.56
|
|
Inj teplizumab mzwv 5 mcg
|
$139,703.02 |
$139,703.02 |
$139,703.02 |
$22,340.08
|
|
Inj testostero enanthate 1mg
|
$34.30 |
$34.30 |
$34.30 |
$123.24
|
|
Inj thiotepa nos 1 mg
|
$1,817.20 |
$1,817.20 |
$1,817.20 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$3,438.40 |
$3,438.40 |
$3,438.40 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$5,999.70 |
$5,999.70 |
$5,999.70 |
$837.50
|
|
Inj., triptorelin X-ray 3.75 mg
|
$139,616.05 |
$139,616.05 |
$139,616.05 |
$34,503.95
|
|
Inj, tyenne, 1 mg
|
$11,725.70 |
$11,725.70 |
$11,725.70 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$7,936.95 |
$7,936.95 |
$7,936.95 |
$11,475.96
|
|
Inj w/fluor eval cv device
|
$3,191.17 |
$3,191.17 |
$3,191.17 |
$503.92
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$149,748.90 |
$149,748.90 |
$149,748.90 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$47,100.49 |
$47,100.49 |
$47,100.49 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$38,918.05 |
$38,918.05 |
$38,918.05 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$6,309.80 |
$6,309.80 |
$6,309.80 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$30,771.10 |
$30,771.10 |
$30,771.10 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$1,901.55 |
$1,901.55 |
$1,901.55 |
$480.28
|
|
Insert brain-fluid device 61215
|
$48,567.83 |
$48,567.83 |
$48,567.83 |
$7,181.20
|
|
Insert cath pleura with image
|
$10,552.16 |
$10,552.16 |
$10,552.16 |
$2,194.40
|
|
Insert cath pleura without image
|
$8,964.37 |
$8,964.37 |
$8,964.37 |
$2,073.18
|
|
Insert drug delivery implant
|
$2,567.60 |
$2,567.60 |
$2,567.60 |
$280.00
|
|
Insert hepatic shunt (tips)
|
$102,912.52 |
$102,912.52 |
$102,912.52 |
$7,571.20
|
|
Insert intrauterine device iud
|
$27,174.10 |
$27,174.10 |
$27,174.10 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$107,066.38 |
$107,066.38 |
$107,066.38 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$5,126.80 |
$5,126.80 |
$5,126.80 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$27,467.45 |
$27,467.45 |
$27,467.45 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,743.00 |
$1,743.00 |
$1,743.00 |
$2,529.45
|
|
Insertion intra-aortic circulation dev 33970
|
$2,826.60 |
$2,826.60 |
$2,826.60 |
$1,752.40
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$19,866.00 |
$19,866.00 |
$19,866.00 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$43,264.54 |
$43,264.54 |
$43,264.54 |
$2,505.60
|
|
Insertion of catheter vein
|
$25,959.13 |
$25,959.13 |
$25,959.13 |
$1,477.00
|
|
Insertion of catheter vein
|
$33,208.01 |
$33,208.01 |
$33,208.01 |
$836.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$73,164.80 |
$73,164.80 |
$73,164.80 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$78,417.92 |
$78,417.92 |
$78,417.92 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$256,529.14 |
$256,529.14 |
$256,529.14 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$3,150.00 |
$3,150.00 |
$3,150.00 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$9,099.12 |
$9,099.12 |
$9,099.12 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$214,614.19 |
$214,614.19 |
$214,614.19 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$9,056.60 |
$9,056.60 |
$9,056.60 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$40,199.01 |
$40,199.01 |
$40,199.01 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$49,832.95 |
$49,832.95 |
$49,832.95 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$18,030.96 |
$18,030.96 |
$18,030.96 |
$5,223.20
|
|
Insert lens prosthesis
|
$23,637.45 |
$23,637.45 |
$23,637.45 |
$3,173.34
|
|
Insert multi-comp penis pros
|
$96,213.10 |
$96,213.10 |
$96,213.10 |
$21,998.10
|
|
Insert pessary/other device
|
$343.00 |
$343.00 |
$343.00 |
$278.50
|
|
Insert pm/icd lead dual
|
$16,692.20 |
$16,692.20 |
$16,692.20 |
$7,115.20
|
|
Insert/repl sq defib w/eltrd
|
$283,472.40 |
$283,472.40 |
$283,472.40 |
$32,800.04
|
|
Insert semi-rigid prosthesis
|
$92,542.16 |
$92,542.16 |
$92,542.16 |
$14,393.26
|
