|
Inj., patisiran, 0.1 mg
|
$25,049.60 |
$25,049.60 |
$25,049.60 |
|
|
Inj, pegcetacoplan, 1mg
|
$226.00 |
$338.50 |
$4,927.50 |
|
|
Inj pemetrexed, hospira 10mg
|
$618.28 |
$650.94 |
$1,038.78 |
|
|
Inj pemetrexed (sandoz) 10mg
|
$164.09 |
$164.09 |
$164.09 |
|
|
Inj peritoneal venous shunt
|
$1,008.50 |
$1,008.50 |
$1,008.50 |
|
|
Inj., perseris, 0.5 mg
|
$17.00 |
$25.00 |
$10,179.60 |
|
|
Inj proc ankle arthr
|
$306.00 |
$306.00 |
$590.50 |
|
|
Inj proc elbow arthro
|
$197.00 |
$374.50 |
$22,367.00 |
|
|
Inj proc for lymphang
|
$85.50 |
$86.00 |
$410.50 |
|
|
Inj proc lumbr disk ea lvl
|
$162.00 |
$390.50 |
$1,311.00 |
|
|
Inj proc myelogram lumbar
|
$234.50 |
$771.50 |
$4,751.00 |
|
|
Inj proc sialogram
|
$320.50 |
$332.50 |
$2,762.50 |
|
|
Inj prohance multipack
|
$28.51 |
$57.02 |
$255.15 |
|
|
Inj retacrit esrd on dialysi
|
$1.50 |
$2.50 |
$169.55 |
|
|
Inj retro urethrocysto
|
$65.00 |
$169.00 |
$4,618.00 |
|
|
Inj, rimabotulinumtoxinb
|
$13.00 |
$19.50 |
$1,300.00 |
|
|
Inj scleros sol mult veins
|
$80.00 |
$464.00 |
$1,524.50 |
|
|
Inj scleros sol sgl vein
|
$40.50 |
$64.80 |
$2,078.00 |
|
|
Inj secukinumab intrav 1mg
|
$5,767.61 |
$9,902.97 |
$26,231.87 |
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$54.50 |
$59.00 |
$859.00 |
|
|
Inj sulf hexa lipid microsph
|
$35.19 |
$35.19 |
$70.37 |
|
|
Inj, susvimo 0.1 mg
|
$86.00 |
$180.00 |
$180.00 |
|
|
Inj teclistamab cqyv 0.5 mg
|
$11,722.90 |
$11,722.90 |
$13,397.60 |
|
|
Inj tedizolid phosphate
|
$21.90 |
$21.90 |
$21.90 |
|
|
Inj teplizumab mzwv 5 mcg
|
$28,369.40 |
$28,369.40 |
$28,369.40 |
|
|
Inj. teprotumumab-trbw 10 mg
|
$541.00 |
$811.00 |
$113,475.30 |
|
|
Inj testostero enanthate 1mg
|
$0.50 |
$0.50 |
$0.80 |
|
|
Inj testosterone cypionate
|
$0.50 |
$5.27 |
$450.00 |
|
|
Inj thiotepa nos 1 mg
|
$165.66 |
$165.66 |
$165.66 |
|
|
Inj thrc fascial pln blk bi w/wo image
|
$77.50 |
$976.00 |
$1,166.00 |
|
|
Inj thrc fascial pln blk uni w/wo image
|
$649.00 |
$818.00 |
$1,142.40 |
|
|
Inj., tildrakizumab, 1 mg
|
$20,032.59 |
$20,032.59 |
$43,107.46 |
|
|
Inj, tislelizumab-jsgr
|
$16,722.00 |
$16,722.00 |
$16,722.00 |
|
|
Inj triamcinolone ace X-ray 1mg
|
$32.50 |
$48.50 |
$3,104.00 |
|
|
Inj., triptorelin X-ray 3.75 mg
|
$44,595.34 |
$44,595.34 |
$44,595.34 |
|
|
Inj, trivisc 1 mg
|
$25.00 |
$37.50 |
$337.50 |
|
|
Inj, tyenne, 1 mg
|
$2,943.85 |
$4,060.49 |
$8,120.97 |
|
|
Inj ustekinumab-kfce, 1 mg
|
$2,564.94 |
$2,564.94 |
$2,564.94 |
|
|
Inj, uzedy, 1 mg
|
$34.00 |
$50.50 |
$12,780.90 |
|
|
Inj, vancomycin hcl (mylan)
|
$40.31 |
$40.31 |
$43.00 |
|
|
Inj, vancomycin hcl (xellia)
|
$18.30 |
$48.72 |
$82.35 |
|
|
Inj vancomycin (xellia) 10mg
|
$36.60 |
$59.52 |
$114.60 |
|
|
Inj vocal cord bulking agent
|
$1,138.13 |
$1,138.13 |
$1,138.13 |
|
|
Inj w/fluor eval cv device
|
$35.50 |
$345.00 |
$1,458.00 |
|
|
Inj xipere 1 mg
|
$62.00 |
$93.00 |
$99.20 |
|
|
Inj., yutiq, 0.01 mg
|
$772.50 |
$1,158.50 |
$20,241.00 |
|
|
Inj zanidatamab-hrii, 2 mg
|
$30,099.00 |
$30,099.00 |
$30,099.00 |
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$60,454.21 |
$60,454.21 |
$60,454.21 |
|
|
Inpatient consultation
|
$73.00 |
$73.00 |
$116.80 |
|
|
Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
|
$45.00 |
$45.50 |
$72.80 |
|
|
Inpt/ed teleconsult30
|
$96.00 |
$97.50 |
$156.00 |
|
|
Inpt/ed teleconsult50
|
$134.50 |
$135.00 |
$215.20 |
|
|
Inpt/ed teleconsult70
|
$192.00 |
$193.00 |
$308.80 |
|
|
Inpt/tele follow up 15
|
$41.50 |
$41.50 |
$66.40 |
|
|
Inpt/tele follow up 25
|
$73.00 |
$73.00 |
$116.80 |
|
|
Inpt/tele follow up 35
|
$107.00 |
$107.00 |
$171.20 |
|
|
Ins cath ren art 1st bi
|
$373.00 |
$2,865.50 |
$9,698.50 |
|
|
Ins cath ren art 1st uni
|
$2,772.50 |
$3,582.00 |
$16,509.00 |
|
|
Ins cath ren art 2nd+ bi
|
$436.50 |
$698.40 |
$6,844.00 |
|
|
Ins cath ren art 2nd+ uni
|
$358.00 |
$572.80 |
$7,330.50 |
|
|
Ins cerv dilator (sep proc)
|
$73.00 |
$416.00 |
$1,100.67 |
|
|
Insert abdomen-venous drain
|
$8,398.00 |
$8,398.00 |
$8,398.00 |
|
|
Insert and remove bone pin
|
$3,761.00 |
$3,981.50 |
$5,733.50 |
|
|
Insert ant drainage device
|
$1,799.83 |
$1,799.83 |
$2,459.67 |
|
|
Insert brain-fluid device 61215
|
$11,500.50 |
$11,500.50 |
$11,500.50 |
|
|
Insert cannula vein-to-vein hemodialysis
|
$124.50 |
$124.50 |
$199.20 |
|
|
Insert cath pleura with image
|
$151.00 |
$1,802.50 |
$4,089.50 |
|
|
Insert cath pleura without image
|
$137.50 |
$2,500.00 |
$32,814.00 |
|
|
Insert drug delivery implant
|
$70.00 |
$173.00 |
$10,519.75 |
|
|
Insert epicardial lead open 33202
|
$8,158.00 |
$9,790.00 |
$13,052.80 |
|
|
Insert hepatic shunt (tips)
|
$22,368.00 |
$22,368.00 |
$22,368.00 |
|
|
Insert intervert bimech device 22854
|
$2,266.00 |
$4,007.50 |
$6,932.07 |
|
|
Insert intracorporeal device
|
$4,117.00 |
$4,117.00 |
$4,117.00 |
|
|
Insert intrauterine device iud
|
$51.00 |
$1,026.67 |
$9,887.00 |
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$113.50 |
$113.50 |
$181.60 |
|
|
Insertion catheter bladder non indwelling
|
$127.50 |
$216.50 |
$318.50 |
|
|
Insertion catheter bladder temporary simple
|
$104.50 |
$229.50 |
$10,691.75 |
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$210.50 |
$3,135.00 |
$8,067.50 |
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,298.50 |
$2,287.00 |
$4,777.00 |
|
|
Insertion intra-aortic circulation dev 33970
|
$2,247.00 |
$2,247.00 |
$2,247.00 |
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$225.50 |
$5,039.50 |
$14,314.00 |
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,616.40 |
$2,803.00 |
$6,095.00 |
|
|
Insertion of cannula
|
$198.50 |
$203.00 |
$324.80 |
|
|
Insertion of cannula(s)
|
$1,510.50 |
$1,550.50 |
$2,480.80 |
|
|
Insertion of catheter vein
|
$1,087.50 |
$1,087.50 |
$1,087.50 |
|
|
Insertion of catheter vein
|
$822.00 |
$937.50 |
$937.50 |
|
|
Insertion of heart electrode 33211
|
$2,502.50 |
$3,003.00 |
$5,915.00 |
|
|
Insertion of infusion pump
|
$703.00 |
$734.00 |
$1,174.40 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$537.00 |
$4,988.50 |
$24,249.00 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$496.50 |
$794.40 |
$28,839.34 |
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$474.00 |
$6,744.83 |
$28,892.50 |
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$102.00 |
$2,051.50 |
$3,437.60 |
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,495.00 |
$1,816.50 |
$4,042.50 |
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$10,728.00 |
$11,646.50 |
$50,545.50 |
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$169.00 |
$3,082.50 |
$11,891.40 |
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$2,502.50 |
$3,003.00 |
$25,381.34 |
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$2,619.50 |
$4,191.20 |
$18,709.00 |
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$346.50 |
$5,112.00 |
$13,601.00 |
|
|
Insertion ureth cath
|
$514.50 |
$518.50 |
$829.60 |
|
|
Insert lens prosthesis
|
$720.50 |
$765.50 |
$4,976.33 |
|
