|
Inj, pemrydi rtu, 10 mg
|
$82.30 |
$82.30 |
$82.30 |
$82.30
|
|
Inj., perseris, 0.5 mg
|
$12.19 |
$12.19 |
$12.19 |
$5,146.85
|
|
Inj plasminogen tvmh 1mg
|
$32.55 |
$32.55 |
$32.55 |
$4,456.80
|
|
Inj., plazomicin, 5 mg
|
$3.59 |
$3.59 |
$3.59 |
$607.16
|
|
Inj recombin esperoct per iu
|
$2.17 |
$2.17 |
$2.17 |
$6.63
|
|
Inj, releuko 1 mcg
|
$0.47 |
$0.47 |
$0.47 |
$475.36
|
|
Inj retacrit esrd on dialysi
|
$0.76 |
$0.76 |
$0.76 |
$307.40
|
|
Inj, rimabotulinumtoxinb
|
$12.99 |
$12.99 |
$12.99 |
$714.24
|
|
Inj roctavian ml 2x10^13vc g
|
$12,007.81 |
$12,007.81 |
$12,007.81 |
$130,068.54
|
|
Inj romidepsin non-lyo 0.1mg
|
$33.91 |
$33.91 |
$33.91 |
$9,892.69
|
|
Inj, rykindo, 0.5 mg
|
$13.03 |
$13.03 |
$13.03 |
$13.03
|
|
Inj scleros sol mult veins
|
$472.79 |
$472.79 |
$472.79 |
$707.85
|
|
Inj scleros sol sgl vein
|
$472.79 |
$472.79 |
$472.79 |
$561.88
|
|
Inj, sculptra, 0.5mg
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Inj sebelipase alfa 1 mg
|
$539.42 |
$539.42 |
$539.42 |
$539.69
|
|
Inj secretin synthetic human
|
$42.57 |
$42.57 |
$42.57 |
$1,234.65
|
|
Inj secukinumab intrav 1mg
|
$17.54 |
$17.54 |
$17.54 |
$4,413.21
|
|
Inj, sezaby, 1 mg
|
$1.41 |
$1.41 |
$1.41 |
$235.85
|
|
Inj, spesolimab-sbzo, 1 mg
|
$61.43 |
$61.43 |
$61.43 |
$90,007.62
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$472.79 |
$472.79 |
$472.79 |
$436.80
|
|
Inj, susvimo 0.1 mg
|
$79.08 |
$79.08 |
$79.08 |
$2,598.44
|
|
Inj, sutimlimab-jome, 10 mg
|
$18.13 |
$18.13 |
$18.13 |
$3,453.73
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$339.03 |
$339.03 |
$339.03 |
$67,538.30
|
|
Inj, taliglucerace alfa 10 u
|
$42.58 |
$42.58 |
$42.58 |
$1,573.27
|
|
Inj teclistamab cqyv 0.5 mg
|
$31.98 |
$31.98 |
$31.98 |
$17,517.56
|
|
Inj tedizolid phosphate
|
$1.81 |
$1.81 |
$1.81 |
$664.72
|
|
Inj teplizumab mzwv 5 mcg
|
$36.90 |
$36.90 |
$36.90 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$343.89 |
$343.89 |
$343.89 |
$35,034.78
|
|
Inj., tildrakizumab, 1 mg
|
$135.92 |
$135.92 |
$135.92 |
$26,635.60
|
|
Inj, tislelizumab-jsgr
|
$551.62 |
$551.62 |
$551.62 |
$9,764.09
|
|
Inj tofersen intrathec 1 mg
|
$153.66 |
$153.66 |
$153.66 |
$293.34
|
|
Inj, tofidence, 1 mg
|
$5.72 |
$5.72 |
$5.72 |
$86.87
|
|
Inj travoprost intra impl
|
$197.16 |
$197.16 |
$197.16 |
$197.16
|
|
Inj triamcinolone ace X-ray 1mg
|
$17.75 |
$17.75 |
$17.75 |
$1,090.75
|
|
Inj., triluron, 1 mg
|
$10.36 |
$10.36 |
$10.36 |
$10.36
|
|
Inj., triptorelin X-ray 3.75 mg
|
$3,418.49 |
$3,418.49 |
$3,418.49 |
$33,416.39
|
|
Inj, trivisc 1 mg
|
$6.67 |
$6.67 |
$6.67 |
$6.67
|
|
Inj, tyenne, 1 mg
|
$5.04 |
$5.04 |
$5.04 |
$3,525.12
|
|
Inj, uzedy, 1 mg
|
$24.77 |
$24.77 |
$24.77 |
$11,475.96
|
|
Inj, vasopressin (baxter)
|
$3.77 |
$3.77 |
$3.77 |
$202.50
|
|
Inj, vegzelma, 10 mg
|
$56.82 |
$56.82 |
$56.82 |
$1,186.35
|
|
Inj velmanase alfa-tycv 1 mg
|
$442.00 |
$442.00 |
$442.00 |
$7,123.31
|
|
Inj w/fluor eval cv device
|
$249.32 |
$249.32 |
$249.32 |
$504.40
|
|
Inj. xembify, 100 mg
|
$14.30 |
$14.30 |
$14.30 |
$3,451.77
|
|
Inj xipere 1 mg
|
$48.40 |
$48.40 |
$48.40 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$527.97 |
$527.97 |
$527.97 |
$14,458.60
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$2,618.85 |
$2,618.85 |
$2,618.85 |
$41,083.73
|
|
Ins cath ren art 1st bi
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$5,974.80
|
|
Ins cath ren art 1st uni
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$5,663.98
|
|
Ins cath ren art 2nd+ uni
|
$6,396.89 |
$6,396.89 |
$6,396.89 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$359.97 |
$359.97 |
$359.97 |
$488.35
|
|
Insemination of oocytes
|
$202.78 |
$202.78 |
$202.78 |
$314.40
|
|
Insert and remove bone pin
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$4,433.36
|
|
Insert ant drainage device
|
$4,760.49 |
$4,760.49 |
$4,760.49 |
$5,108.80
|
|
Insert brain-fluid device 61215
|
$8,965.93 |
$8,965.93 |
$8,965.93 |
$7,181.20
|
|
Insert cannula hemo oth 36815
|
$6,396.89 |
$6,396.89 |
$6,396.89 |
$5,983.35
|
|
Insert cannula vein-to-vein hemodialysis
|
$6,396.89 |
$6,396.89 |
$6,396.89 |
$7,279.50
|
|
Insert cath pleura with image
|
$1,838.28 |
$1,838.28 |
$1,838.28 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,244.82 |
$2,244.82 |
$2,244.82 |
$2,101.52
|
|
Insert cv cath inf & sup app
|
$9,763.31 |
$9,763.31 |
$9,763.31 |
$9,763.31
|
|
Insert drug del implant, >=4
|
$472.21 |
$472.21 |
$472.21 |
$472.21
|
|
Insert drug delivery implant
|
$152.54 |
$152.54 |
$152.54 |
$280.00
|
|
Insert eye socket implant
|
$4,462.45 |
$4,462.45 |
$4,462.45 |
$5,067.20
|
|
Insert hepatic shunt (tips)
|
$18,728.69 |
$18,728.69 |
$18,728.69 |
$7,571.20
|
|
Insert heyman uteri capsule
|
$5,841.60 |
$5,841.60 |
$5,841.60 |
$5,813.46
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$3,594.47
|
|
Insertion catheter bladder non indwelling
|
$152.54 |
$152.54 |
$152.54 |
$209.30
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,176.15 |
$4,176.15 |
$4,176.15 |
$4,923.19
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$6,396.89 |
$6,396.89 |
$6,396.89 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$2,595.45
|
|
Insertion of cannula
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$4,322.40
|
|
Insertion of heart electrode 33211
|
$9,793.46 |
$9,793.46 |
$9,793.46 |
$6,839.00
|
|
Insertion of infusion pump
|
$6,396.89 |
$6,396.89 |
$6,396.89 |
$5,855.00
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$12,384.25 |
$12,384.25 |
$12,384.25 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$12,384.25 |
$12,384.25 |
$12,384.25 |
$12,324.60
|
|
Insertion palate prosthesis
|
$7,000.36 |
$7,000.36 |
$7,000.36 |
$6,547.81
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,838.28 |
$1,838.28 |
$1,838.28 |
$2,109.00
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,838.28 |
$1,838.28 |
$1,838.28 |
$2,463.50
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$37,940.39 |
$37,940.39 |
$37,940.39 |
$29,180.00
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$9,793.46 |
$9,793.46 |
$9,793.46 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$9,793.46 |
$9,793.46 |
$9,793.46 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$9,793.46 |
$9,793.46 |
$9,793.46 |
$9,390.55
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$5,236.80
|
|
Insertion ureth cath
|
$2,424.12 |
$2,424.12 |
$2,424.12 |
$2,365.38
|
|
Insert lens prosthesis
|
$2,698.92 |
$2,698.92 |
$2,698.92 |
$3,173.34
|
|
Insert multi-comp penis pros
|
$23,819.33 |
$23,819.33 |
$23,819.33 |
$9,495.20
|
|
Insert nasal septal button
|
$1,752.89 |
$1,752.89 |
$1,752.89 |
$1,783.50
|
|
Insert ocular implant
|
$4,462.45 |
$4,462.45 |
$4,462.45 |
$4,462.45
|
|
Insert ocular implant
|
$4,462.45 |
$4,462.45 |
$4,462.45 |
$4,462.45
|
|
Insert palate implants
|
$1,752.89 |
$1,752.89 |
$1,752.89 |
$1,752.89
|
|
Insert pessary/other device
|
$238.06 |
$238.06 |
$238.06 |
$278.90
|
|
Insert picvad cath
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$4,195.00
|
|
Insert pm/icd lead dual
|
$9,793.46 |
$9,793.46 |
$9,793.46 |
$7,115.90
|
|
Insert prost urethral stent
|
$2,424.12 |
$2,424.12 |
$2,424.12 |
$2,467.08
|
|
Insert/repl sq defib w/eltrd
|
$37,940.39 |
$37,940.39 |
$37,940.39 |
$33,593.55
|
|
Insert self-contd prosthesis
|
$23,819.33 |
$23,819.33 |
$23,819.33 |
$22,279.50
|
|
Insert semi-rigid prosthesis
|
$15,374.71 |
$15,374.71 |
$15,374.71 |
$14,199.16
|
|
Insert spine infusion device 62360
|
$20,914.85 |
$20,914.85 |
$20,914.85 |
$17,262.84
|
|
Insert sq defib electrode
|
$9,793.46 |
$9,793.46 |
$9,793.46 |
$8,167.68
|
