|
Infectious agent nucleic acid quantification hepatitis c
|
$117.80 |
$117.80 |
$117.80 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$95.95 |
$95.95 |
$95.95 |
$373.60
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$91.58 |
$91.58 |
$91.58 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$417.24 |
$417.24 |
$417.24 |
$2,043.22
|
|
Infuse radioactive materials
|
$87.02 |
$87.02 |
$87.02 |
$744.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$70.11 |
$70.11 |
$70.11 |
$293.25
|
|
Initiation & management bipap/cpap initial day
|
$391.97 |
$391.97 |
$391.97 |
$570.50
|
|
Inj, acetaminophen (b braun)
|
$19.00 |
$19.00 |
$19.00 |
$33.73
|
|
Inj acetaminophen -fresenius
|
$19.00 |
$19.00 |
$19.00 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$19.00 |
$19.00 |
$19.00 |
$56.70
|
|
Inj allopurinol sodium 1 mg
|
$2,087.25 |
$2,087.25 |
$2,087.25 |
$6,968.99
|
|
Inj, bortezomib freseniuskab
|
$1,127.27 |
$1,127.27 |
$1,127.27 |
$2,464.14
|
|
Inj, bortezomib, hospira
|
$43.85 |
$43.85 |
$43.85 |
$175.35
|
|
Inj calcitriol per 0.1 mcg
|
$19.00 |
$19.00 |
$19.00 |
$23.28
|
|
Inj cefazolin sodium, baxter
|
$33.06 |
$33.06 |
$33.06 |
$27.18
|
|
Inj cefazolin sodium, hikma
|
$19.00 |
$19.00 |
$19.00 |
$28.51
|
|
Inj cefazolin (wg crit care)
|
$19.00 |
$19.00 |
$19.00 |
$17.00
|
|
Inj. cefepime hcl (baxter)
|
$151.62 |
$151.62 |
$151.62 |
$86.84
|
|
Inj, cefepime hcl (b braun)
|
$78.70 |
$78.70 |
$78.70 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$19.00 |
$19.00 |
$19.00 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$112.29 |
$112.29 |
$112.29 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$68.55 |
$68.55 |
$68.55 |
$2,584.85
|
|
Inj cyclophos dr.reddy's 5mg
|
$3,325.00 |
$3,325.00 |
$3,325.00 |
$4,725.00
|
|
Inj cyclophosphamd auromedic
|
$221.45 |
$221.45 |
$221.45 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$1,287.51 |
$1,287.51 |
$1,287.51 |
$683.35
|
|
Inj, daptomycin (hospira)
|
$93.59 |
$93.59 |
$93.59 |
$110.83
|
|
Inj daptomycin (xellia)
|
$34.29 |
$34.29 |
$34.29 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$87.88 |
$87.88 |
$87.88 |
$310.09
|
|
Inj disk cerv-thor ea lev
|
$345.80 |
$345.80 |
$345.80 |
$957.60
|
|
Inj dx for sinogram
|
$140.41 |
$140.41 |
$140.41 |
$413.82
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$222.87 |
$222.87 |
$222.87 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$90.06 |
$90.06 |
$90.06 |
$500.50
|
|
Injection carpal tunnel therapeutic (both sides)
|
$95.57 |
$95.57 |
$95.57 |
$502.64
|
|
Injection, doxercalciferol
|
$19.00 |
$19.00 |
$19.00 |
$23.83
|
|
Injection during cath supravalvular aortography
|
$416.86 |
$416.86 |
$416.86 |
$1,027.26
|
|
Injection, edaravone, 1 mg
|
$316.35 |
$316.35 |
$316.35 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$283.29 |
$283.29 |
$283.29 |
$1,153.03
|
|
Injection eye drug
|
$92.91 |
$92.91 |
$92.91 |
$648.96
|
|
Injection for arthrography wrist (both sides)
|
$168.72 |
$168.72 |
$168.72 |
$438.00
|
|
Injection for bladder x-ray
|
$47.50 |
$47.50 |
$47.50 |
$459.20
|
|
Injection for hip x-ray
|
$160.93 |
$160.93 |
$160.93 |
$662.40
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$162.64 |
$162.64 |
$162.64 |
$494.65
|
|
Injection for ureter x-ray
|
$61.18 |
$61.18 |
$61.18 |
$515.21
|
|
Injection, fulvestrant
|
$911.84 |
$911.84 |
$911.84 |
$1,719.16
|
|
Injection glatiramer acetate
|
$142.81 |
$142.81 |
$142.81 |
$830.51
|
|
Injection of sinus tract
|
$752.40 |
$752.40 |
$752.40 |
$1,640.99
|
|
Injection radioactive tracer sentinel node (both sides)
|
$126.35 |
$126.35 |
$126.35 |
$699.68
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$283.29 |
$283.29 |
$283.29 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$357.39 |
$357.39 |
$357.39 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$168.72 |
$168.72 |
$168.72 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$393.30 |
$393.30 |
$393.30 |
$2,031.18
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$283.29 |
$283.29 |
$283.29 |
$1,008.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$491.72 |
$491.72 |
$491.72 |
$1,781.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$168.53 |
$168.53 |
$168.53 |
$1,002.76
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$491.72 |
$491.72 |
$491.72 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$323.76 |
$323.76 |
$323.76 |
$1,783.60
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$260.68 |
$260.68 |
$260.68 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$109.06 |
$109.06 |
$109.06 |
$478.20
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$95.19 |
$95.19 |
$95.19 |
$546.40
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$158.27 |
$158.27 |
$158.27 |
$634.40
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$55.10 |
$55.10 |
$55.10 |
$163.83
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$48.26 |
$48.26 |
$48.26 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$120.27 |
$120.27 |
$120.27 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$52.63 |
$52.63 |
$52.63 |
$136.00
|
|
Inject sacroiliac joint
|
$283.29 |
$283.29 |
$283.29 |
$1,028.95
|
|
Inj epidural sgl cerv-thor without img
|
$158.08 |
$158.08 |
$158.08 |
$1,311.74
|
|
Inj epidural sgl lumb-sacral without img
|
$158.08 |
$158.08 |
$158.08 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$2,316.34 |
$2,316.34 |
$2,316.34 |
$6.55
|
|
Inj for ext venography
|
$91.58 |
$91.58 |
$91.58 |
$654.00
|
|
Inj for mammo ductogram
|
$62.51 |
$62.51 |
$62.51 |
$397.80
|
|
Inj, fosaprepitant (teva)
|
$62.73 |
$62.73 |
$62.73 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$483.36 |
$483.36 |
$483.36 |
$961.54
|
|
Inj gemcitabine hcl (accord)
|
$91.94 |
$91.94 |
$91.94 |
$130.65
|
|
Inj glycopyrrolate fres kabi
|
$23.14 |
$23.14 |
$23.14 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$19.00 |
$19.00 |
$19.00 |
$26.85
|
|
Inj, idacio, 1 mg
|
$790.08 |
$790.08 |
$790.08 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$104.88 |
$104.88 |
$104.88 |
$235.13
|
|
Inj intralesional > 7 lsns
|
$99.94 |
$99.94 |
$99.94 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$19.00 |
$19.00 |
$19.00 |
$38.94
|
|
Inj, lanreotide, (cipla) 1mg
|
$5,360.95 |
$5,360.95 |
$5,360.95 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$151.33 |
$151.33 |
$151.33 |
$103.60
|
|
Inj, linezolid (hospira)
|
$171.00 |
$171.00 |
$171.00 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$909.70 |
$909.70 |
$909.70 |
$1,791.90
|
|
Inj, meropenem (b. braun)
|
$78.86 |
$78.86 |
$78.86 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$82.42 |
$82.42 |
$82.42 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$102.92 |
$102.92 |
$102.92 |
$89.40
|
|
Inj, moxifloxacin 100 mg
|
$116.14 |
$116.14 |
$116.14 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$191.14 |
$191.14 |
$191.14 |
$252.66
|
|
Inj naloxone hydrochloride
|
$105.19 |
$105.19 |
$105.19 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$228.95 |
$228.95 |
$228.95 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$573.04 |
$573.04 |
$573.04 |
$2,373.55
|
|
Inj pantoprazole(hikma) 40mg
|
$34.67 |
$34.67 |
$34.67 |
$34.70
|
|
Inj pemetrexed (accord) 10mg
|
$917.97 |
$917.97 |
$917.97 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$43.60 |
$43.60 |
$43.60 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$1,395.09 |
$1,395.09 |
$1,395.09 |
$200.85
|
|
Inj proc ankle arthr
|
$90.06 |
$90.06 |
$90.06 |
$405.60
|
|
Inj proc elbow arthro
|
$168.72 |
$168.72 |
$168.72 |
$434.00
|
|
Inj proc lumbr disk ea lvl
|
$188.48 |
$188.48 |
$188.48 |
$1,106.93
|
|
Inj proc myelogram lumbar
|
$112.29 |
$112.29 |
$112.29 |
$843.84
|
|
Inj progesterone per 50 mg
|
$83.70 |
$83.70 |
$83.70 |
$14.93
|