|
Inj, lenacapavir, 1 mg
|
$39,000.00 |
$39,000.00 |
$39,000.00 |
$24,398.00
|
|
Inj, levothyroxine, freskabi
|
$368.67 |
$368.67 |
$368.67 |
$303.45
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,045.00 |
$1,045.00 |
$1,045.00 |
$784.00
|
|
Inj mepivacaine hcl/10 ml
|
$17.15 |
$17.15 |
$17.15 |
$33.86
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$118.50 |
$118.50 |
$118.50 |
$1,496.55
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$77,288.19 |
$77,288.19 |
$77,288.19 |
$8,304.04
|
|
Inj multihance
|
$6.00 |
$6.00 |
$6.00 |
$73.49
|
|
Inj multihance multipack
|
$31.71 |
$31.71 |
$31.71 |
$2.80
|
|
Inj naloxone hydrochloride
|
$42.30 |
$42.30 |
$42.30 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$7,275.00 |
$7,275.00 |
$7,275.00 |
$1,413.35
|
|
Inj nivolumab 2 mg hyaluron
|
$31,772.32 |
$31,772.32 |
$31,772.32 |
$15,599.68
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,609.38
|
|
Inj ocrelizumab 1mg hya-ocsq
|
$72,243.36 |
$72,243.36 |
$72,243.36 |
$66,582.27
|
|
Inj octafluoropropane mic,ml
|
$478.50 |
$478.50 |
$478.50 |
$211.40
|
|
Inj onase abepar-xioi treat
|
$1,883,468.18 |
$1,883,468.18 |
$1,883,468.18 |
$3,572,794.09
|
|
Inj pantoprazole(hikma) 40mg
|
$13.17 |
$13.17 |
$13.17 |
$34.67
|
|
Inj, pegcetacoplan, 1mg
|
$4,927.50 |
$4,927.50 |
$4,927.50 |
$3,662.96
|
|
Inj peritoneal venous shunt
|
$1,008.50 |
$1,008.50 |
$1,008.50 |
$413.70
|
|
Inj., perseris, 0.5 mg
|
$25.00 |
$25.00 |
$25.00 |
$5,146.85
|
|
Inj proc ankle arthr
|
$590.50 |
$590.50 |
$590.50 |
$405.31
|
|
Inj proc elbow arthro
|
$22,367.00 |
$22,367.00 |
$22,367.00 |
$419.60
|
|
Inj proc for lymphang
|
$410.50 |
$410.50 |
$410.50 |
$682.00
|
|
Inj proc lumbr disk ea lvl
|
$1,311.00 |
$1,311.00 |
$1,311.00 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$1,182.50 |
$1,182.50 |
$1,182.50 |
$830.50
|
|
Inj proc sialogram
|
$954.00 |
$954.00 |
$954.00 |
$373.00
|
|
Inj prohance multipack
|
$57.02 |
$57.02 |
$57.02 |
$9.59
|
|
Inj retacrit esrd on dialysi
|
$42.39 |
$42.39 |
$42.39 |
$349.45
|
|
Inj retro urethrocysto
|
$4,618.00 |
$4,618.00 |
$4,618.00 |
$443.50
|
|
Inj, rimabotulinumtoxinb
|
$1,300.00 |
$1,300.00 |
$1,300.00 |
$746.79
|
|
Inj scleros sol mult veins
|
$675.00 |
$675.00 |
$675.00 |
$675.00
|
|
Inj scleros sol sgl vein
|
$2,078.00 |
$2,078.00 |
$2,078.00 |
$558.97
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$519.50 |
$519.50 |
$519.50 |
$436.80
|
|
Inj sulf hexa lipid microsph
|
$35.19 |
$35.19 |
$35.19 |
$256.14
|
|
Inj, susvimo 0.1 mg
|
$180.00 |
$180.00 |
$180.00 |
$2,598.44
|
|
Inj teclistamab cqyv 0.5 mg
|
$11,722.90 |
$11,722.90 |
$11,722.90 |
$17,517.56
|
|
Inj teplizumab mzwv 5 mcg
|
$28,369.40 |
$28,369.40 |
$28,369.40 |
$22,340.08
|
|
Inj. teprotumumab-trbw 10 mg
|
$88,552.85 |
$88,552.85 |
$88,552.85 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$0.50 |
$0.50 |
$0.50 |
$123.24
|
|
Inj testosterone cypionate
|
$14.47 |
$14.47 |
$14.47 |
$64.80
|
|
Inj thiotepa nos 1 mg
|
$165.66 |
$165.66 |
$165.66 |
$3,170.16
|
|
Inj thrc fascial pln blk bi w/wo image
|
$1,166.00 |
$1,166.00 |
$1,166.00 |
$1,152.97
|
|
Inj thrc fascial pln blk uni w/wo image
|
$930.50 |
$930.50 |
$930.50 |
$837.50
|
|
Inj, tislelizumab-jsgr
|
$16,722.00 |
$16,722.00 |
$16,722.00 |
$9,764.09
|
|
Inj triamcinolone ace X-ray 1mg
|
$3,104.00 |
$3,104.00 |
$3,104.00 |
$1,090.75
|
|
Inj, trivisc 1 mg
|
$337.50 |
$337.50 |
$337.50 |
$6.67
|
|
Inj, tyenne, 1 mg
|
$8,120.97 |
$8,120.97 |
$8,120.97 |
$3,525.12
|
|
Inj ustekinumab-kfce, 1 mg
|
$2,564.94 |
$2,564.94 |
$2,564.94 |
$5,244.37
|
|
Inj, uzedy, 1 mg
|
$50.50 |
$50.50 |
$50.50 |
$11,475.96
|
|
Inj vocal cord bulking agent
|
$1,138.13 |
$1,138.13 |
$1,138.13 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$1,458.00 |
$1,458.00 |
$1,458.00 |
$503.92
|
|
Inj xipere 1 mg
|
$93.00 |
$93.00 |
$93.00 |
$93.00
|
|
Inj., yutiq, 0.01 mg
|
$20,241.00 |
$20,241.00 |
$20,241.00 |
$14,458.60
|
|
Inj zanidatamab-hrii, 2 mg
|
$30,099.00 |
$30,099.00 |
$30,099.00 |
$11,091.60
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$60,454.21 |
$60,454.21 |
$60,454.21 |
$44,026.28
|
|
Ins cath ren art 1st bi
|
$5,356.50 |
$5,356.50 |
$5,356.50 |
$5,753.10
|
|
Ins cath ren art 1st uni
|
$16,509.00 |
$16,509.00 |
$16,509.00 |
$4,660.00
|
|
Ins cath ren art 2nd+ bi
|
$6,844.00 |
$6,844.00 |
$6,844.00 |
$5,500.86
|
|
Ins cath ren art 2nd+ uni
|
$5,104.00 |
$5,104.00 |
$5,104.00 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$1,100.67 |
$1,100.67 |
$1,100.67 |
$480.28
|
|
Insert abdomen-venous drain
|
$8,398.00 |
$8,398.00 |
$8,398.00 |
$3,147.06
|
|
Insert and remove bone pin
|
$5,199.00 |
$5,199.00 |
$5,199.00 |
$4,410.60
|
|
Insert ant drainage device
|
$2,459.67 |
$2,459.67 |
$2,459.67 |
$4,881.00
|
|
Insert brain-fluid device 61215
|
$11,500.50 |
$11,500.50 |
$11,500.50 |
$7,181.20
|
|
Insert cath pleura with image
|
$2,338.00 |
$2,338.00 |
$2,338.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$32,814.00 |
$32,814.00 |
$32,814.00 |
$2,073.18
|
|
Insert drug delivery implant
|
$10,519.75 |
$10,519.75 |
$10,519.75 |
$280.00
|
|
Insert epicardial lead open 33202
|
$11,693.50 |
$11,693.50 |
$11,693.50 |
$3,775.20
|
|
Insert hepatic shunt (tips)
|
$22,368.00 |
$22,368.00 |
$22,368.00 |
$7,571.20
|
|
Insert intervert bimech device 22854
|
$6,932.07 |
$6,932.07 |
$6,932.07 |
$1,573.00
|
|
Insert intracorporeal device
|
$4,117.00 |
$4,117.00 |
$4,117.00 |
$6,261.00
|
|
Insert intrauterine device iud
|
$4,305.50 |
$4,305.50 |
$4,305.50 |
$347.10
|
|
Insertion catheter bladder non indwelling
|
$216.50 |
$216.50 |
$216.50 |
$205.40
|
|
Insertion catheter bladder temporary simple
|
$10,691.75 |
$10,691.75 |
$10,691.75 |
$232.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$8,067.50 |
$8,067.50 |
$8,067.50 |
$4,782.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,287.00 |
$2,287.00 |
$2,287.00 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$14,314.00 |
$14,314.00 |
$14,314.00 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$5,631.50 |
$5,631.50 |
$5,631.50 |
$2,505.60
|
|
Insertion of catheter vein
|
$1,087.50 |
$1,087.50 |
$1,087.50 |
$1,477.00
|
|
Insertion of catheter vein
|
$822.00 |
$822.00 |
$822.00 |
$836.25
|
|
Insertion of heart electrode 33211
|
$3,587.00 |
$3,587.00 |
$3,587.00 |
$6,903.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$24,249.00 |
$24,249.00 |
$24,249.00 |
$12,384.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$28,839.34 |
$28,839.34 |
$28,839.34 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$21,128.00 |
$21,128.00 |
$21,128.00 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,051.50 |
$2,051.50 |
$2,051.50 |
$2,079.50
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,010.50 |
$2,010.50 |
$2,010.50 |
$2,419.65
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$42,598.00 |
$42,598.00 |
$42,598.00 |
$29,042.52
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$9,511.50 |
$9,511.50 |
$9,511.50 |
$7,200.05
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$25,381.34 |
$25,381.34 |
$25,381.34 |
$7,312.80
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$18,709.00 |
$18,709.00 |
$18,709.00 |
$9,332.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$10,404.00 |
$10,404.00 |
$10,404.00 |
$5,223.20
|
|
Insert lens prosthesis
|
$4,976.33 |
$4,976.33 |
$4,976.33 |
$3,173.34
|
|
Insert multi-comp penis pros
|
$12,544.50 |
$12,544.50 |
$12,544.50 |
$21,998.10
|
|
Insert nasal septal button
|
$4,627.50 |
$4,627.50 |
$4,627.50 |
$1,783.50
|
|
Insert ocular implant
|
$1,945.17 |
$1,945.17 |
$1,945.17 |
$4,462.45
|
|
Insert pessary/other device
|
$364.50 |
$364.50 |
$364.50 |
$278.50
|
|
Insert pm/icd lead dual
|
$10,685.50 |
$10,685.50 |
$10,685.50 |
$7,115.20
|
|
Insert/repl sq defib w/eltrd
|
$36,077.50 |
$36,077.50 |
$36,077.50 |
$32,800.04
|
|
Insert spine infusion device 62360
|
$5,695.00 |
$5,695.00 |
$5,695.00 |
$17,262.84
|
|
Insert sq defib electrode
|
$3,587.00 |
$3,587.00 |
$3,587.00 |
$8,167.68
|
