|
Inf lwr xtr fscl pln blk uni w/wo image
|
$233.25 |
$233.25 |
$233.25 |
$780.00
|
|
Inf thrc fascial pln blk bi w/wo image
|
$248.25 |
$248.25 |
$248.25 |
$593.50
|
|
Inf thrc fascial pln blk uni w/wo image
|
$233.25 |
$233.25 |
$233.25 |
$780.00
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$69.00 |
$69.00 |
$69.00 |
$293.25
|
|
Initiation & management bipap/cpap initial day
|
$309.45 |
$309.45 |
$309.45 |
$576.00
|
|
Inj, acetaminophen (b braun)
|
$6.36 |
$6.36 |
$6.36 |
$33.31
|
|
Inj acetaminophen -fresenius
|
$6.30 |
$6.30 |
$6.30 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$4.73 |
$4.73 |
$4.73 |
$58.50
|
|
Inj allopurinol sodium 1 mg
|
$988.70 |
$988.70 |
$988.70 |
$6,968.99
|
|
Inj, bortezomib freseniuskab
|
$533.97 |
$533.97 |
$533.97 |
$2,527.00
|
|
Inj, bortezomib, hospira
|
$20.77 |
$20.77 |
$20.77 |
$175.35
|
|
Inj calcitriol per 0.1 mcg
|
$6.81 |
$6.81 |
$6.81 |
$23.28
|
|
Inj cefazolin sodium, baxter
|
$13.05 |
$13.05 |
$13.05 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$5.46 |
$5.46 |
$5.46 |
$28.08
|
|
Inj cefazolin (wg crit care)
|
$4.05 |
$4.05 |
$4.05 |
$18.05
|
|
Inj. cefepime hcl (baxter)
|
$59.85 |
$59.85 |
$59.85 |
$86.84
|
|
Inj, cefepime hcl (b braun)
|
$31.07 |
$31.07 |
$31.07 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$6.86 |
$6.86 |
$6.86 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$71.10 |
$71.10 |
$71.10 |
$436.80
|
|
Inj, cyclophos (baxter) 5mg
|
$32.47 |
$32.47 |
$32.47 |
$2,584.85
|
|
Inj cyclophos dr.reddy's 5mg
|
$1,575.00 |
$1,575.00 |
$1,575.00 |
$4,725.00
|
|
Inj cyclophosphamd auromedic
|
$104.90 |
$104.90 |
$104.90 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$609.87 |
$609.87 |
$609.87 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$36.95 |
$36.95 |
$36.95 |
$113.35
|
|
Inj daptomycin (xellia)
|
$13.53 |
$13.53 |
$13.53 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$41.63 |
$41.63 |
$41.63 |
$310.09
|
|
Inj dx for sinogram
|
$40.80 |
$40.80 |
$40.80 |
$422.59
|
|
Injection arthrography hip without anesthesia (both sides)
|
$68.10 |
$68.10 |
$68.10 |
$495.84
|
|
Injection, doxercalciferol
|
$4.16 |
$4.16 |
$4.16 |
$23.86
|
|
Injection during cath supravalvular aortography
|
$37.20 |
$37.20 |
$37.20 |
$952.66
|
|
Injection, edaravone, 1 mg
|
$149.85 |
$149.85 |
$149.85 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$211.80 |
$211.80 |
$211.80 |
$1,156.80
|
|
Injection eye drug
|
$98.40 |
$98.40 |
$98.40 |
$644.50
|
|
Injection for arthrography wrist (both sides)
|
$71.10 |
$71.10 |
$71.10 |
$428.40
|
|
Injection for bladder x-ray
|
$39.45 |
$39.45 |
$39.45 |
$459.20
|
|
Injection for hip x-ray
|
$74.55 |
$74.55 |
$74.55 |
$710.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$68.70 |
$68.70 |
$68.70 |
$494.65
|
|
Injection for ureter x-ray
|
$49.50 |
$49.50 |
$49.50 |
$515.21
|
|
Injection, fulvestrant
|
$719.87 |
$719.87 |
$719.87 |
$1,817.65
|
|
Injection glatiramer acetate
|
$67.65 |
$67.65 |
$67.65 |
$830.51
|
|
Injection jugular
|
$224.85 |
$224.85 |
$224.85 |
$790.00
|
|
Injection of sinus tract
|
$1,220.70 |
$1,220.70 |
$1,220.70 |
$1,627.60
|
|
Injection radioactive tracer sentinel node (both sides)
|
$120.00 |
$120.00 |
$120.00 |
$670.64
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$282.15 |
$282.15 |
$282.15 |
$1,348.56
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$134.10 |
$134.10 |
$134.10 |
$1,023.50
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$316.35 |
$316.35 |
$316.35 |
$1,952.40
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$265.80 |
$265.80 |
$265.80 |
$1,814.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$265.80 |
$265.80 |
$265.80 |
$1,995.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$255.60 |
$255.60 |
$255.60 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$283.65 |
$283.65 |
$283.65 |
$1,681.24
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$106.20 |
$106.20 |
$106.20 |
$472.76
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$114.15 |
$114.15 |
$114.15 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$126.90 |
$126.90 |
$126.90 |
$632.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$58.05 |
$58.05 |
$58.05 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$58.05 |
$58.05 |
$58.05 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$120.00 |
$120.00 |
$120.00 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$41.25 |
$41.25 |
$41.25 |
$135.60
|
|
Inj epidural sgl cerv-thor without img
|
$124.80 |
$124.80 |
$124.80 |
$1,318.80
|
|
Inj epidural sgl lumb-sacral without img
|
$124.80 |
$124.80 |
$124.80 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$914.34 |
$914.34 |
$914.34 |
$6.55
|
|
Inj for ext venography
|
$144.60 |
$144.60 |
$144.60 |
$649.95
|
|
Inj for mammo ductogram
|
$60.30 |
$60.30 |
$60.30 |
$399.60
|
|
Inj, fosaprepitant (teva)
|
$29.71 |
$29.71 |
$29.71 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$381.60 |
$381.60 |
$381.60 |
$1,043.05
|
|
Inj gemcitabine hcl (accord)
|
$43.55 |
$43.55 |
$43.55 |
$130.65
|
|
Inj glycopyrrolate fres kabi
|
$9.14 |
$9.14 |
$9.14 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$6.48 |
$6.48 |
$6.48 |
$26.26
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$37.20 |
$37.20 |
$37.20 |
$1,439.90
|
|
Inj hrt cath w/s&i sel right vent
|
$37.20 |
$37.20 |
$37.20 |
$965.33
|
|
Inj, idacio, 1 mg
|
$374.25 |
$374.25 |
$374.25 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$92.70 |
$92.70 |
$92.70 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$3.28 |
$3.28 |
$3.28 |
$38.94
|
|
Inj, lanreotide, (cipla) 1mg
|
$2,539.40 |
$2,539.40 |
$2,539.40 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$71.68 |
$71.68 |
$71.68 |
$109.92
|
|
Inj, linezolid (hospira)
|
$67.50 |
$67.50 |
$67.50 |
$153.30
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$218.25 |
$218.25 |
$218.25 |
$784.00
|
|
Inj melpha hydroch nos 50 mg
|
$430.91 |
$430.91 |
$430.91 |
$1,791.90
|
|
Inj, meropenem (b. braun)
|
$31.13 |
$31.13 |
$31.13 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$32.53 |
$32.53 |
$32.53 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$40.63 |
$40.63 |
$40.63 |
$89.40
|
|
Inj, moxifloxacin 100 mg
|
$45.84 |
$45.84 |
$45.84 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$75.45 |
$75.45 |
$75.45 |
$252.66
|
|
Inj naloxone hydrochloride
|
$41.52 |
$41.52 |
$41.52 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$180.75 |
$180.75 |
$180.75 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$501.75 |
$501.75 |
$501.75 |
$2,837.09
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$501.75 |
$501.75 |
$501.75 |
$2,609.38
|
|
Inj octafluoropropane mic,ml
|
$31.50 |
$31.50 |
$31.50 |
$211.40
|
|
Inj pantoprazole(hikma) 40mg
|
$13.69 |
$13.69 |
$13.69 |
$34.67
|
|
Inj pemetrexed (accord) 10mg
|
$434.83 |
$434.83 |
$434.83 |
$579.77
|
|
Inj pemetrexed (sandoz) 10mg
|
$20.66 |
$20.66 |
$20.66 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$660.83 |
$660.83 |
$660.83 |
$200.85
|
|
Inj peritoneal venous shunt
|
$63.75 |
$63.75 |
$63.75 |
$413.70
|
|
Inj proc ankle arthr
|
$71.10 |
$71.10 |
$71.10 |
$405.31
|
|
Inj proc elbow arthro
|
$71.10 |
$71.10 |
$71.10 |
$419.60
|
|
Inj proc for lymphang
|
$141.90 |
$141.90 |
$141.90 |
$682.00
|
|
Inj proc myelogram lumbar
|
$156.90 |
$156.90 |
$156.90 |
$830.50
|
|
Inj proc sialogram
|
$63.75 |
$63.75 |
$63.75 |
$373.00
|
|
Inj progesterone per 50 mg
|
$33.04 |
$33.04 |
$33.04 |
$15.00
|
|
Inj retro urethrocysto
|
$44.40 |
$44.40 |
$44.40 |
$443.50
|
|
Inj romidepsin non-lyo 0.1mg
|
$3,312.93 |
$3,312.93 |
$3,312.93 |
$9,892.69
|
