|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$464.82 |
$464.82 |
$464.82 |
$254.52
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$215.94 |
$215.94 |
$215.94 |
$135.60
|
|
Inject sacroiliac joint
|
$982.71 |
$982.71 |
$982.71 |
$990.00
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$1,718.14 |
$1,718.14 |
$1,718.14 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$1,557.33 |
$1,557.33 |
$1,557.33 |
$1,311.74
|
|
Inj epidural sgl lumb-sacral without img
|
$1,848.30 |
$1,848.30 |
$1,848.30 |
$1,415.50
|
|
Inj, etelcalcetide, 0.1 mg
|
$99.74 |
$99.74 |
$99.74 |
$343.35
|
|
Inj. fe derisomaltose 10 mg
|
$183.90 |
$183.90 |
$183.90 |
$3,221.52
|
|
Inj fluphenazine hcl 1.25 mg
|
$6.13 |
$6.13 |
$6.13 |
$39.54
|
|
Inj for ext venography
|
$710.65 |
$710.65 |
$710.65 |
$654.00
|
|
Inj for mammo ductogram
|
$239.12 |
$239.12 |
$239.12 |
$397.00
|
|
Inj gemcitabine hcl (accord)
|
$7.09 |
$7.09 |
$7.09 |
$130.65
|
|
Inj glofitamab gxbm, 2.5 mg
|
$623.36 |
$623.36 |
$623.36 |
$4,752.60
|
|
Inj glycopyrrolate, glyrx-pf
|
$1.13 |
$1.13 |
$1.13 |
$11.23
|
|
Inj, granisetron, xr, 0.1 mg
|
$1,014.62 |
$1,014.62 |
$1,014.62 |
$5.71
|
|
Inj., guselkumab, 1 mg
|
$8,574.54 |
$8,574.54 |
$8,574.54 |
$29,130.83
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,970.70 |
$2,970.70 |
$2,970.70 |
$1,323.50
|
|
Inj hrt cath w/s&i sel right vent
|
$1,941.02 |
$1,941.02 |
$1,941.02 |
$947.05
|
|
Inj imip 4 cilas 4 releb 2mg
|
$176.32 |
$176.32 |
$176.32 |
$662.97
|
|
Inj ivig privigen 500 mg
|
$4.45 |
$4.45 |
$4.45 |
$6,967.29
|
|
Inj, lecanemab-irmb, 1 mg
|
$77.72 |
$77.72 |
$77.72 |
$923.69
|
|
Inj levocarnitine per 1 gm
|
$4.34 |
$4.34 |
$4.34 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$46.91 |
$46.91 |
$46.91 |
$363.97
|
|
Inj, levothyroxine, hikma
|
$31.52 |
$31.52 |
$31.52 |
$38.01
|
|
Inj, lidocaine w epinephrine
|
$0.58 |
$0.58 |
$0.58 |
$46.52
|
|
Inj melpha hydroch nos 50 mg
|
$114.43 |
$114.43 |
$114.43 |
$1,791.90
|
|
Inj mepivacaine hcl/10 ml
|
$0.19 |
$0.19 |
$0.19 |
$34.20
|
|
Inj, meropenem (b. braun)
|
$11.44 |
$11.44 |
$11.44 |
$71.14
|
|
Inj., meropenem, vaborbactam
|
$108.51 |
$108.51 |
$108.51 |
$536.27
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$390.13 |
$390.13 |
$390.13 |
$331.93
|
|
Inj, moxifloxacin 100 mg
|
$0.10 |
$0.10 |
$0.10 |
$107.25
|
|
Inj multihance
|
$0.96 |
$0.96 |
$0.96 |
$73.49
|
|
Inj. mycophenolate mofetil
|
$40.68 |
$40.68 |
$40.68 |
$252.66
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$658.19 |
$658.19 |
$658.19 |
$1,413.35
|
|
Inj, nithiodote, 3mg / 125mg
|
$2.01 |
$2.01 |
$2.01 |
$472.76
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,662.86 |
$1,662.86 |
$1,662.86 |
$2,484.00
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,662.86 |
$1,662.86 |
$1,662.86 |
$2,373.55
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$1,094.87 |
$1,094.87 |
$1,094.87 |
$66,582.27
|
|
Inj ogivri 10 mg
|
$910.28 |
$910.28 |
$910.28 |
$4,492.28
|
|
Inj., patisiran, 0.1 mg
|
$1,159.00 |
$1,159.00 |
$1,159.00 |
$17,613.00
|
|
Inj. pemetrexed, 10 mg
|
$111.79 |
$111.79 |
$111.79 |
$104.72
|
|
Inj pemetrexed (sandoz) 10mg
|
$1.39 |
$1.39 |
$1.39 |
$95.26
|
|
Inj, pemivibart, 4500 mg
|
$97.86 |
$97.86 |
$97.86 |
$1,235.55
|
|
Inj peritoneal venous shunt
|
$276.94 |
$276.94 |
$276.94 |
$413.70
|
|
Inj proc elbow arthro
|
$269.01 |
$269.01 |
$269.01 |
$438.00
|
|
Inj proc for lymphang
|
$519.72 |
$519.72 |
$519.72 |
$805.80
|
|
Inj proc lumbr disk ea lvl
|
$692.96 |
$692.96 |
$692.96 |
$1,139.40
|
|
Inj proc myelogram lumbar
|
$972.34 |
$972.34 |
$972.34 |
$859.98
|
|
Inj proc sialogram
|
$297.07 |
$297.07 |
$297.07 |
$380.80
|
|
Inj progesterone per 50 mg
|
$1.69 |
$1.69 |
$1.69 |
$14.93
|
|
Inj, releuko 1 mcg
|
$108.83 |
$108.83 |
$108.83 |
$461.20
|
|
Inj retacrit esrd on dialysi
|
$214.40 |
$214.40 |
$214.40 |
$352.22
|
|
Inj retro urethrocysto
|
$447.74 |
$447.74 |
$447.74 |
$450.00
|
|
Inj scleros sol mult veins
|
$204.96 |
$204.96 |
$204.96 |
$641.24
|
|
Inj secretin synthetic human
|
$403.21 |
$403.21 |
$403.21 |
$1,285.20
|
|
Inj secukinumab intrav 1mg
|
$2,246.07 |
$2,246.07 |
$2,246.07 |
$4,351.48
|
|
Inj, spesolimab-sbzo, 1 mg
|
$2,079.41 |
$2,079.41 |
$2,079.41 |
$83,709.85
|
|
Inj teplizumab mzwv 5 mcg
|
$3,303.56 |
$3,303.56 |
$3,303.56 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$9,437.68 |
$9,437.68 |
$9,437.68 |
$35,034.78
|
|
Inj testosterone cypionate
|
$12.24 |
$12.24 |
$12.24 |
$64.80
|
|
Inj., tildrakizumab, 1 mg
|
$8,123.86 |
$8,123.86 |
$8,123.86 |
$26,635.60
|
|
Inj, tofidence, 1 mg
|
$67.71 |
$67.71 |
$67.71 |
$86.87
|
|
Inj, tyenne, 1 mg
|
$54.74 |
$54.74 |
$54.74 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$4,867.39 |
$4,867.39 |
$4,867.39 |
$11,475.96
|
|
Inj, vancomycin hcl (xellia)
|
$0.04 |
$0.04 |
$0.04 |
$85.20
|
|
Inj w/fluor eval cv device
|
$449.57 |
$449.57 |
$449.57 |
$504.40
|
|
Ins cath ren art 1st bi
|
$4,139.46 |
$4,139.46 |
$4,139.46 |
$5,855.00
|
|
Ins cath ren art 1st uni
|
$3,464.19 |
$3,464.19 |
$3,464.19 |
$4,667.63
|
|
Ins cath ren art 2nd+ bi
|
$5,049.58 |
$5,049.58 |
$5,049.58 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$7,862.29 |
$7,862.29 |
$7,862.29 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$283.65 |
$283.65 |
$283.65 |
$464.75
|
|
Insert cath pleura with image
|
$1,709.22 |
$1,709.22 |
$1,709.22 |
$2,164.52
|
|
Insert cath pleura without image
|
$514.23 |
$514.23 |
$514.23 |
$2,019.81
|
|
Insert hepatic shunt (tips)
|
$2,011.78 |
$2,011.78 |
$2,011.78 |
$8,018.40
|
|
Insert intrauterine device iud
|
$183.61 |
$183.61 |
$183.61 |
$378.83
|
|
Insertion catheter bladder non indwelling
|
$163.48 |
$163.48 |
$163.48 |
$207.00
|
|
Insertion catheter bladder temporary simple
|
$181.17 |
$181.17 |
$181.17 |
$234.40
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,194.57 |
$3,194.57 |
$3,194.57 |
$4,747.60
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,502.01 |
$3,502.01 |
$3,502.01 |
$2,585.00
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$9,269.56 |
$9,269.56 |
$9,269.56 |
$7,082.35
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,045.33 |
$2,045.33 |
$2,045.33 |
$2,549.95
|
|
Insertion of catheter vein
|
$1,240.13 |
$1,240.13 |
$1,240.13 |
$1,657.32
|
|
Insertion of catheter vein
|
$403.21 |
$403.21 |
$403.21 |
$856.80
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$12,435.46 |
$12,435.46 |
$12,435.46 |
$12,843.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$9,556.87 |
$9,556.87 |
$9,556.87 |
$12,384.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,025.81 |
$2,025.81 |
$2,025.81 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,440.61 |
$2,440.61 |
$2,440.61 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$21,052.93 |
$21,052.93 |
$21,052.93 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$5,957.87 |
$5,957.87 |
$5,957.87 |
$7,394.45
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$5,709.60 |
$5,709.60 |
$5,709.60 |
$7,447.01
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$6,365.35 |
$6,365.35 |
$6,365.35 |
$9,390.55
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$5,475.36 |
$5,475.36 |
$5,475.36 |
$5,236.80
|
|
Insert pm/icd lead dual
|
$4,068.09 |
$4,068.09 |
$4,068.09 |
$7,378.28
|
|
Insert swan-ganz cath
|
$1,917.23 |
$1,917.23 |
$1,917.23 |
$2,271.60
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$4,046.74 |
$4,046.74 |
$4,046.74 |
$5,018.25
|
|
Insert vad art access left hrt arterial access
|
$5,200.25 |
$5,200.25 |
$5,200.25 |
$4,504.50
|
|
Insitu hybridization manual
|
$326.96 |
$326.96 |
$326.96 |
$393.13
|
|
In situ hybridization per specimen each additional single probe stain
|
$129.93 |
$129.93 |
$129.93 |
$243.00
|
|
In situ hybridization per specimen initial single probe stain
|
$147.62 |
$147.62 |
$147.62 |
$335.00
|
|
Ins lv lead exist pm/icd
|
$7,488.97 |
$7,488.97 |
$7,488.97 |
$12,384.25
|