|
Inj epidural sgl lumb-sacral without img
|
$917.60 |
$1,123.20 |
$1,299.20 |
|
|
Inj, etelcalcetide, 0.1 mg
|
$371.96 |
$371.96 |
$371.96 |
|
|
Inj. fe derisomaltose 10 mg
|
$3,160.69 |
$3,221.52 |
$5,652.67 |
|
|
Inj for ext venography
|
$836.00 |
$836.00 |
$1,214.40 |
|
|
Inj, fosaprepitant (teva)
|
$359.56 |
$359.56 |
$359.56 |
|
|
Inj glycopyrrolate, glyrx-pf
|
$32.05 |
$32.05 |
$32.05 |
|
|
Inj., guselkumab, 1 mg
|
$33,244.95 |
$33,244.95 |
$33,244.95 |
|
|
Inj heparin, pfizer, 1000u
|
$61.02 |
$61.02 |
$313.52 |
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$2,092.80 |
$2,092.80 |
$2,222.40 |
|
|
Inj hrt cath w/s&i sel hrt ang
|
$2,308.80 |
$2,308.80 |
$2,626.40 |
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,772.80 |
$1,772.80 |
$2,309.60 |
|
|
Inj hrt cath w/s&i sel left vent
|
$1,772.00 |
$1,772.00 |
$2,012.80 |
|
|
Inj hrt cath w/s&i sel right vent
|
$1,610.40 |
$1,610.40 |
$2,061.60 |
|
|
Inj hydroxocobalamin IV 25mg
|
$1,498.47 |
$1,498.47 |
$2,636.76 |
|
|
Inj. inebilizumab-cdon, 1 mg
|
$131,120.01 |
$131,120.01 |
$131,120.01 |
|
|
Inj intralesional > 7 lsns
|
$244.00 |
$244.00 |
$244.00 |
|
|
Inj ivig privigen 500 mg
|
$2,293.60 |
$4,520.16 |
$9,628.80 |
|
|
Inj levocarnitine per 1 gm
|
$77.04 |
$77.04 |
$399.29 |
|
|
Inj, levothyroxine, freskabi
|
$188.51 |
$188.51 |
$188.51 |
|
|
Inj, lidocaine w epinephrine
|
$13.01 |
$14.04 |
$311.62 |
|
|
Inj melpha hydroch nos 50 mg
|
$731.92 |
$731.92 |
$731.92 |
|
|
Inj mepivacaine hcl/10 ml
|
$63.40 |
$63.40 |
$317.30 |
|
|
Inj, meropenem (b. braun)
|
$175.96 |
$175.96 |
$326.89 |
|
|
Inj., meropenem, vaborbactam
|
$558.08 |
$558.08 |
$558.08 |
|
|
Inj, micafungin (par pharm)
|
$321.22 |
$321.22 |
$321.22 |
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$26,844.02 |
$26,844.02 |
$26,844.02 |
|
|
Inj moxifloxacin (fres kabi)
|
$336.00 |
$336.00 |
$336.00 |
|
|
Inj multihance
|
$72.00 |
$72.00 |
$264.00 |
|
|
Inj. mycophenolate mofetil
|
$362.50 |
$362.50 |
$362.50 |
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$987.20 |
$987.20 |
$1,900.00 |
|
|
Inj, nithiodote, 3mg / 125mg
|
$233.99 |
$233.99 |
$233.99 |
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$3,841.60 |
$3,841.60 |
$3,841.60 |
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$49,385.84 |
$49,385.84 |
$49,385.84 |
|
|
Inj octafluoropropane mic,ml
|
$196.00 |
$205.60 |
$374.80 |
|
|
Inj ogivri 10 mg
|
$1,427.66 |
$1,427.66 |
$2,484.97 |
|
|
Inj onase abepar-xioi treat
|
$2,104,701.01 |
$2,104,701.01 |
$2,104,701.01 |
|
|
Inj ontruzant 10 mg
|
$2,534.28 |
$2,534.28 |
$5,742.49 |
|
|
Inj pantoprazole(hikma) 40mg
|
$62.07 |
$62.44 |
$313.23 |
|
|
Inj., patisiran, 0.1 mg
|
$26,720.00 |
$26,720.00 |
$26,720.00 |
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$3,121.92 |
$3,305.64 |
$5,799.86 |
|
|
Inj proc elbow arthro
|
$878.40 |
$878.40 |
$997.60 |
|
|
Inj proc for lymphang
|
$1,372.00 |
$1,372.00 |
$1,581.60 |
|
|
Inj proc lumbr disk ea lvl
|
$2,474.40 |
$2,474.40 |
$3,672.80 |
|
|
Inj proc myelogram lumbar
|
$1,808.00 |
$1,808.00 |
$2,159.20 |
|
|
Inj proc sialogram
|
$546.40 |
$546.40 |
$584.00 |
|
|
Inj, releuko 1 mcg
|
$216.71 |
$393.32 |
$805.44 |
|
|
Inj retro urethrocysto
|
$860.80 |
$860.80 |
$862.40 |
|
|
Inj scleros sol mult veins
|
$625.60 |
$676.00 |
$798.40 |
|
|
Inj scleros sol sgl vein
|
$447.20 |
$580.00 |
$677.60 |
|
|
Inj secretin synthetic human
|
$1,590.03 |
$1,590.03 |
$1,590.03 |
|
|
Inj, sezaby, 1 mg
|
$439.24 |
$439.24 |
$439.24 |
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$773.60 |
$773.60 |
$773.60 |
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$58,832.00 |
$58,832.00 |
$58,832.00 |
|
|
Inj teclistamab cqyv 0.5 mg
|
$19,245.07 |
$19,245.07 |
$19,245.07 |
|
|
Inj teplizumab mzwv 5 mcg
|
$33,360.00 |
$33,360.00 |
$33,360.00 |
|
|
Inj testosterone cypionate
|
$62.80 |
$65.28 |
$160.32 |
|
|
Inj thiotepa nos 1 mg
|
$517.47 |
$517.47 |
$517.47 |
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
|
|
Inj. tigecycline (accord)
|
$87.24 |
$87.24 |
$87.24 |
|
|
Inj., tildrakizumab, 1 mg
|
$21,259.81 |
$21,323.40 |
$31,164.94 |
|
|
Inj triamcinolone ace X-ray 1mg
|
$1,716.05 |
$1,716.05 |
$1,716.05 |
|
|
Inj, tyenne, 1 mg
|
$2,091.32 |
$2,091.32 |
$2,091.32 |
|
|
Inj vasopressin (am reg) 1 u
|
$49.04 |
$49.04 |
$49.04 |
|
|
Inj w/fluor eval cv device
|
$903.20 |
$903.20 |
$1,106.40 |
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$51,482.67 |
$51,482.67 |
$51,482.67 |
|
|
Ins cath ren art 1st bi
|
$8,612.80 |
$8,612.80 |
$8,614.40 |
|
|
Ins cath ren art 1st uni
|
$4,404.00 |
$4,404.00 |
$6,712.00 |
|
|
Ins cath ren art 2nd+ bi
|
$8,673.60 |
$8,673.60 |
$8,673.60 |
|
|
Ins cath ren art 2nd+ uni
|
$7,094.40 |
$7,094.40 |
$8,564.00 |
|
|
Ins cerv dilator (sep proc)
|
$276.80 |
$481.60 |
$574.40 |
|
|
Insert cath pleura with image
|
$2,668.80 |
$2,668.80 |
$2,674.40 |
|
|
Insert cath pleura without image
|
$1,418.40 |
$2,207.20 |
$2,212.00 |
|
|
Insert drug delivery implant
|
$452.80 |
$452.80 |
$595.20 |
|
|
Insert hepatic shunt (tips)
|
$11,761.60 |
$11,761.60 |
$15,450.40 |
|
|
Insert intrauterine device iud
|
$462.40 |
$462.40 |
$1,358.40 |
|
|
Insertion catheter bladder non indwelling
|
$164.00 |
$173.60 |
$242.40 |
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$4,706.40 |
$4,706.40 |
$5,136.80 |
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,292.00 |
$2,292.00 |
$2,440.00 |
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$9,819.20 |
$9,819.20 |
$9,837.60 |
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,734.40 |
$1,800.00 |
$2,740.00 |
|
|
Insertion of catheter vein
|
$2,976.00 |
$2,976.00 |
$3,037.60 |
|
|
Insertion of catheter vein
|
$1,676.80 |
$1,676.80 |
$2,197.60 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$10,281.60 |
$10,281.60 |
$20,249.60 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$5,110.40 |
$5,110.40 |
$18,748.00 |
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$11,797.60 |
$11,797.60 |
$11,797.60 |
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,348.00 |
$2,128.00 |
$2,640.80 |
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$3,212.80 |
$3,212.80 |
$3,229.60 |
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$55,776.80 |
$55,776.80 |
$55,776.80 |
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$6,986.40 |
$6,986.40 |
$12,250.40 |
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$4,276.80 |
$4,276.80 |
$11,024.80 |
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$15,163.20 |
$15,163.20 |
$15,163.20 |
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$6,286.40 |
$6,675.20 |
$6,914.40 |
|
|
Insert pm/icd lead dual
|
$2,492.80 |
$2,492.80 |
$11,952.00 |
|
|
Insert/repl sq defib w/eltrd
|
$53,226.40 |
$53,226.40 |
$53,226.40 |
|
|
Insert sq defib electrode
|
$12,536.80 |
$12,536.80 |
$12,536.80 |
|
|
Insert swan-ganz cath
|
$3,176.80 |
$3,176.80 |
$3,276.00 |
|
|
Insert uteri tandem/ovoids
|
$4,703.20 |
$4,703.20 |
$4,703.20 |
|
|
Insert vad art access left hrt arterial access
|
$2,104.80 |
$2,104.80 |
$2,104.80 |
|
|
Ins icd gen exist mlt leads
|
$50,188.80 |
$50,188.80 |
$50,188.80 |
|
