|
Inj, ocriplasmin, 0.125 mg
|
$1,424.43 |
$1,424.43 |
$1,424.43 |
|
|
Inj octafluoropropane mic,ml
|
$124.80 |
$160.00 |
$160.00 |
|
|
Inj ogivri 10 mg
|
$91.01 |
$104.02 |
$171.21 |
|
|
Inj, olaratumab, 10 mg
|
$59.36 |
$59.36 |
$59.36 |
|
|
Inj onase abepar-xioi treat
|
$3,844,193.16 |
$3,844,193.16 |
$3,844,193.16 |
|
|
Inj pantoprazole(hikma) 40mg
|
$32.88 |
$35.78 |
$79.25 |
|
|
Inj, pasireotide long acting
|
$589.60 |
$589.60 |
$589.60 |
|
|
Inj., patisiran, 0.1 mg
|
$189.87 |
$189.87 |
$189.87 |
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$123.59 |
$123.59 |
$132.92 |
|
|
Inj pemetrexed, hospira 10mg
|
$9.37 |
$10.28 |
$11.30 |
|
|
Inj pemetrexed (sandoz) 10mg
|
$9.91 |
$13.32 |
$684.75 |
|
|
Inj peritoneal venous shunt
|
$61.60 |
$453.42 |
$485.00 |
|
|
Inj proc ankle arthr
|
$152.90 |
$460.00 |
$869.25 |
|
|
Inj proc elbow arthro
|
$139.15 |
$460.00 |
$812.80 |
|
|
Inj proc for lymphang
|
$195.00 |
$195.00 |
$913.19 |
|
|
Inj proc lumbr disk ea lvl
|
$242.00 |
$1,230.00 |
$1,918.40 |
|
|
Inj proc myelogram lumbar
|
$264.55 |
$669.92 |
$2,401.28 |
|
|
Inj proc sialogram
|
$175.00 |
$288.32 |
$613.21 |
|
|
Inj progesterone per 50 mg
|
$1.59 |
$2.28 |
$75.48 |
|
|
Inj prohance multipack
|
$18.40 |
$18.40 |
$18.40 |
|
|
Inj protirelin per 250 mcg
|
$16.43 |
$16.43 |
$16.43 |
|
|
Inj retro urethrocysto
|
$335.50 |
$450.00 |
$969.57 |
|
|
Inj, rimabotulinumtoxinb
|
$13.78 |
$17.10 |
$28.00 |
|
|
Inj scleros sol mult veins
|
$326.04 |
$425.00 |
$1,201.51 |
|
|
Inj scleros sol sgl vein
|
$142.50 |
$142.50 |
$848.80 |
|
|
Inj sebelipase alfa 1 mg
|
$990.57 |
$990.57 |
$990.57 |
|
|
Inj secretin synthetic human
|
$54.61 |
$54.61 |
$54.61 |
|
|
Inj secukinumab intrav 1mg
|
$27.91 |
$60.19 |
$4,351.48 |
|
|
Inj, spesolimab-sbzo, 1 mg
|
$203.10 |
$203.10 |
$104,832.76 |
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$125.00 |
$125.00 |
$550.00 |
|
|
Inj, sutimlimab-jome, 10 mg
|
$44.08 |
$44.08 |
$44.08 |
|
|
Inj, taliglucerace alfa 10 u
|
$70.52 |
$70.52 |
$70.52 |
|
|
Inj teclistamab cqyv 0.5 mg
|
$56.73 |
$71.53 |
$81.41 |
|
|
Inj. teprotumumab-trbw 10 mg
|
$271.75 |
$498.64 |
$1,225.99 |
|
|
Inj testostero enanthate 1mg
|
$0.53 |
$0.53 |
$0.53 |
|
|
Inj testosterone cypionate
|
$0.09 |
$0.28 |
$171.00 |
|
|
Inj thiotepa nos 1 mg
|
$67.20 |
$67.20 |
$67.20 |
|
|
Inj thrc fascial pln blk bi w/wo image
|
$508.00 |
$775.00 |
$7,733.00 |
|
|
Inj thrc fascial pln blk uni w/wo image
|
$650.00 |
$650.00 |
$3,866.50 |
|
|
Inj., tildrakizumab, 1 mg
|
$148.40 |
$448.86 |
$466.77 |
|
|
Inj, tislelizumab-jsgr
|
$30,756.20 |
$30,756.20 |
$30,756.20 |
|
|
Inj triamcinolone ace X-ray 1mg
|
$20.14 |
$28.00 |
$37.70 |
|
|
Inj, tyenne, 1 mg
|
$8.04 |
$8.04 |
$13.19 |
|
|
Inj, vancomycin hcl (mylan)
|
$31.47 |
$31.47 |
$31.47 |
|
|
Inj, vancomycin hcl (xellia)
|
$926.92 |
$926.92 |
$926.92 |
|
|
Inj vancomycin (xellia) 10mg
|
$0.84 |
$0.88 |
$0.90 |
|
|
Inj, vasopressin (baxter)
|
$9.60 |
$9.60 |
$9.60 |
|
|
Inj, vegzelma, 10 mg
|
$8,929.02 |
$8,929.02 |
$8,929.02 |
|
|
Inj vocal cord bulking agent
|
$801.48 |
$801.48 |
$801.48 |
|
|
Inj w/fluor eval cv device
|
$246.45 |
$377.50 |
$2,011.88 |
|
|
Inj. xembify, 100 mg
|
$39.81 |
$39.81 |
$39.81 |
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$4,187.38 |
$4,187.38 |
$4,187.38 |
|
|
Inpt/ed teleconsult30
|
$251.37 |
$251.37 |
$429.60 |
|
|
Inpt/ed teleconsult50
|
$359.10 |
$373.35 |
$584.80 |
|
|
Inpt/ed teleconsult70
|
$463.41 |
$463.41 |
$865.60 |
|
|
Inpt/tele follow up 15
|
$91.20 |
$91.20 |
$168.00 |
|
|
Inpt/tele follow up 25
|
$160.74 |
$168.72 |
$309.60 |
|
|
Inpt/tele follow up 35
|
$241.68 |
$241.68 |
$447.20 |
|
|
Ins cath ren art 1st bi
|
$3,060.00 |
$5,820.00 |
$14,166.37 |
|
|
Ins cath ren art 1st uni
|
$1,789.70 |
$3,355.00 |
$8,106.03 |
|
|
Ins cath ren art 2nd+ bi
|
$3,060.00 |
$6,400.00 |
$15,499.32 |
|
|
Ins cath ren art 2nd+ uni
|
$2,519.00 |
$4,569.40 |
$11,717.77 |
|
|
Ins cerv dilator (sep proc)
|
$67.84 |
$382.50 |
$1,267.86 |
|
|
Insert abdomen-venous drain
|
$7,145.00 |
$7,145.00 |
$7,145.00 |
|
|
Insert and remove bone pin
|
$7,810.44 |
$7,810.44 |
$9,636.44 |
|
|
Insert balloon device
|
$5,399.20 |
$5,399.20 |
$5,399.20 |
|
|
Insert cath pleura with image
|
$1,228.54 |
$1,537.00 |
$5,149.82 |
|
|
Insert cath pleura without image
|
$1,087.02 |
$1,172.36 |
$3,045.51 |
|
|
Insert cv cath inf & sup app
|
$25,367.56 |
$25,367.56 |
$25,367.56 |
|
|
Insert drug delivery implant
|
$111.30 |
$305.00 |
$685.71 |
|
|
Insert epicardial lead open 33202
|
$8,871.20 |
$14,844.24 |
$14,844.24 |
|
|
Insert hepatic shunt (tips)
|
$4,970.87 |
$11,055.00 |
$34,662.00 |
|
|
Insert intracorporeal device
|
$18,362.40 |
$18,362.40 |
$18,362.40 |
|
|
Insert intrauterine device iud
|
$235.41 |
$570.00 |
$654.44 |
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$688.00 |
$688.00 |
$688.00 |
|
|
Insertion catheter bladder non indwelling
|
$58.85 |
$121.37 |
$705.50 |
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$2,991.85 |
$3,125.00 |
$8,427.53 |
|
|
Insertion intra aortic balloon assist device percutaneous
|
$1,078.55 |
$2,529.45 |
$9,080.49 |
|
|
Insertion intra-aortic circulation dev 33970
|
$5,276.00 |
$5,276.00 |
$5,276.00 |
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$3,090.00 |
$7,082.35 |
$16,954.70 |
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,085.00 |
$1,489.95 |
$6,284.44 |
|
|
Insertion of cannula
|
$2,915.88 |
$2,915.88 |
$2,915.88 |
|
|
Insertion of cannula(s)
|
$3,868.00 |
$3,868.00 |
$3,868.00 |
|
|
Insertion of catheter vein
|
$14.30 |
$880.00 |
$8,073.49 |
|
|
Insertion of catheter vein
|
$760.00 |
$811.25 |
$2,728.97 |
|
|
Insertion of heart electrode 33211
|
$12,333.63 |
$12,333.63 |
$14,440.91 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$5,939.45 |
$9,284.54 |
$32,928.01 |
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$5,940.00 |
$12,087.24 |
$26,611.16 |
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$1,981.10 |
$5,838.36 |
$33,872.82 |
|
|
Insertion palate prosthesis
|
$1,569.60 |
$1,569.60 |
$1,569.60 |
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,085.00 |
$1,525.70 |
$3,289.44 |
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$173.85 |
$2,015.00 |
$4,303.75 |
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$15,899.40 |
$28,989.41 |
$101,115.28 |
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$4,342.80 |
$7,200.05 |
$16,097.94 |
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$5,464.80 |
$6,991.76 |
$28,698.88 |
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$5,034.48 |
$10,313.27 |
$23,716.96 |
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$771.21 |
$3,447.12 |
$7,579.29 |
|
|
Insertion ureth cath
|
$2,036.05 |
$2,036.05 |
$2,036.05 |
|
|
Insert multi-comp penis pros
|
$3,803.20 |
$3,803.20 |
$3,803.20 |
|
|
Insert nasal septal button
|
$392.20 |
$392.20 |
$976.00 |
|
