|
Inj, abilify maintena, 1 mg
|
$8,854.05 |
$8,854.05 |
$8,854.05 |
$5,355.30
|
|
Inj, acetaminophen (hikma)
|
$147.49 |
$147.49 |
$147.49 |
$56.70
|
|
Inj., benralizumab, 1 mg
|
$15,277.76 |
$15,277.76 |
$15,277.76 |
$11,310.00
|
|
Inj, bupivacaine liposome
|
$1,681.29 |
$1,681.29 |
$1,681.29 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$125.02 |
$125.02 |
$125.02 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$241.38 |
$241.38 |
$241.38 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$138.43 |
$138.43 |
$138.43 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$813.90 |
$813.90 |
$813.90 |
$436.80
|
|
Injection arthrography hip without anesthesia (both sides)
|
$778.70 |
$778.70 |
$778.70 |
$503.50
|
|
Injection epidural blood patch or clot
|
$753.10 |
$753.10 |
$753.10 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$697.80 |
$697.80 |
$697.80 |
$436.00
|
|
Injection for bladder x-ray
|
$424.30 |
$424.30 |
$424.30 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$626.25 |
$626.25 |
$626.25 |
$497.76
|
|
Injection, fulvestrant
|
$4,503.64 |
$4,503.64 |
$4,503.64 |
$1,719.16
|
|
Injection,onabotulinumtoxina
|
$5,626.54 |
$5,626.54 |
$5,626.54 |
$2,277.65
|
|
Injection, pentamidine iseth
|
$1,162.88 |
$1,162.88 |
$1,162.88 |
$383.03
|
|
Injection radioactive tracer sentinel node (both sides)
|
$423.80 |
$423.80 |
$423.80 |
$685.44
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$282.10 |
$282.10 |
$282.10 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$380.60 |
$380.60 |
$380.60 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$546.60 |
$546.60 |
$546.60 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$230.85 |
$230.85 |
$230.85 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$475.10 |
$475.10 |
$475.10 |
$1,855.36
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$514.65 |
$514.65 |
$514.65 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$507.50 |
$507.50 |
$507.50 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$114.65 |
$114.65 |
$114.65 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$116.05 |
$116.05 |
$116.05 |
$548.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$133.65 |
$133.65 |
$133.65 |
$637.92
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$179.50 |
$179.50 |
$179.50 |
$145.60
|
|
Inject sacroiliac joint
|
$1,619.65 |
$1,619.65 |
$1,619.65 |
$1,029.04
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$42,037.54 |
$42,037.54 |
$42,037.54 |
$32,176.93
|
|
Inj epidural sgl cerv-thor without img
|
$319.05 |
$319.05 |
$319.05 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$693.75 |
$693.75 |
$693.75 |
$1,450.84
|
|
Inj fluphenazine hcl 1.25 mg
|
$66.92 |
$66.92 |
$66.92 |
$40.33
|
|
Inj for mammo ductogram
|
$392.80 |
$392.80 |
$392.80 |
$397.80
|
|
Inj herzuma 10 mg
|
$13,681.28 |
$13,681.28 |
$13,681.28 |
$7,775.46
|
|
Inj intralesional <= 7 lsn(s)
|
$114.40 |
$114.40 |
$114.40 |
$235.13
|
|
Inj, invega hafyera/trinza
|
$18,652.11 |
$18,652.11 |
$18,652.11 |
$32,073.55
|
|
Inj ivig privigen 500 mg
|
$19,678.28 |
$19,678.28 |
$19,678.28 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$15,907.34 |
$15,907.34 |
$15,907.34 |
$11,648.70
|
|
Inj levocarnitine per 1 gm
|
$314.36 |
$314.36 |
$314.36 |
$136.62
|
|
Inj, levothyroxine, freskabi
|
$1,677.32 |
$1,677.32 |
$1,677.32 |
$308.21
|
|
Inj, lidocaine w epinephrine
|
$227.62 |
$227.62 |
$227.62 |
$45.60
|
|
Inj lwr xtr fscl pln blk uni w/wo image
|
$1,120.50 |
$1,120.50 |
$1,120.50 |
$794.70
|
|
Inj mepivacaine hcl/10 ml
|
$169.23 |
$169.23 |
$169.23 |
$34.34
|
|
Inj multihance
|
$136.63 |
$136.63 |
$136.63 |
$70.54
|
|
Inj naloxone hydrochloride
|
$266.85 |
$266.85 |
$266.85 |
$83.16
|
|
Inj, nithiodote, 3mg / 125mg
|
$1,184.41 |
$1,184.41 |
$1,184.41 |
$468.10
|
|
Inj ontruzant 10 mg
|
$12,921.93 |
$12,921.93 |
$12,921.93 |
$6,706.27
|
|
Inj, pemivibart, 4500 mg
|
$3,277.45 |
$3,277.45 |
$3,277.45 |
$1,235.55
|
|
Inj proc ankle arthr
|
$680.20 |
$680.20 |
$680.20 |
$405.31
|
|
Inj proc elbow arthro
|
$674.85 |
$674.85 |
$674.85 |
$432.00
|
|
Inj retro urethrocysto
|
$232.15 |
$232.15 |
$232.15 |
$447.74
|
|
Inj secukinumab intrav 1mg
|
$8,769.42 |
$8,769.42 |
$8,769.42 |
$4,413.21
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$328.00 |
$328.00 |
$328.00 |
$436.80
|
|
Inj. teprotumumab-trbw 10 mg
|
$48,500.13 |
$48,500.13 |
$48,500.13 |
$35,034.78
|
|
Inj testostero enanthate 1mg
|
$33.19 |
$33.19 |
$33.19 |
$123.09
|
|
Inj testosterone cypionate
|
$16.40 |
$16.40 |
$16.40 |
$64.96
|
|
Inj thrc fascial pln blk bi w/wo image
|
$268.15 |
$268.15 |
$268.15 |
$1,049.50
|
|
Inj thrc fascial pln blk uni w/wo image
|
$268.15 |
$268.15 |
$268.15 |
$818.00
|
|
Inj, vancomycin hcl (mylan)
|
$203.93 |
$203.93 |
$203.93 |
$72.33
|
|
Inj vocal cord bulking agent
|
$715.00 |
$715.00 |
$715.00 |
$1,480.00
|
|
Inj w/fluor eval cv device
|
$705.90 |
$705.90 |
$705.90 |
$504.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$59,856.32 |
$59,856.32 |
$59,856.32 |
$41,083.73
|
|
Inpt/ed teleconsult30
|
$184.85 |
$184.85 |
$184.85 |
$164.40
|
|
Inpt/ed teleconsult50
|
$249.70 |
$249.70 |
$249.70 |
$223.80
|
|
Inpt/ed teleconsult70
|
$372.55 |
$372.55 |
$372.55 |
$330.60
|
|
Insert and remove bone pin
|
$396.80 |
$396.80 |
$396.80 |
$4,433.36
|
|
Insert cath pleura with image
|
$3,583.40 |
$3,583.40 |
$3,583.40 |
$2,194.40
|
|
Insert cath pleura without image
|
$1,482.00 |
$1,482.00 |
$1,482.00 |
$2,099.70
|
|
Insertion catheter bladder non indwelling
|
$188.95 |
$188.95 |
$188.95 |
$208.01
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,485.95 |
$1,485.95 |
$1,485.95 |
$2,585.25
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$832.80 |
$832.80 |
$832.80 |
$2,103.75
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$637.05 |
$637.05 |
$637.05 |
$2,453.83
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$399.50 |
$399.50 |
$399.50 |
$7,183.68
|
|
Insert pessary/other device
|
$144.30 |
$144.30 |
$144.30 |
$278.90
|
|
In situ hybridization per specimen each additional single probe stain
|
$105.90 |
$105.90 |
$105.90 |
$243.50
|
|
In situ hybridization per specimen initial single probe stain
|
$105.90 |
$105.90 |
$105.90 |
$338.40
|
|
Ins tun cvad 2 cath w/subq port(s)
|
$13,865.35 |
$13,865.35 |
$13,865.35 |
$7,826.00
|
|
Ins tun cv cath wo subq prt/pm
|
$1,698.00 |
$1,698.00 |
$1,698.00 |
$4,218.00
|
|
Insulin total
|
$156.55 |
$156.55 |
$156.55 |
$66.64
|
|
Interdiscal perq aspir dx
|
$1,652.05 |
$1,652.05 |
$1,652.05 |
$1,222.26
|
|
Interrog device eval heart
|
$137.50 |
$137.50 |
$137.50 |
$162.40
|
|
Interrog evl pm/ldls pm ip
|
$46.25 |
$46.25 |
$46.25 |
$127.20
|
|
Intranasal biopsy 30100
|
$228.10 |
$228.10 |
$228.10 |
$2,265.00
|
|
Intraoral i+d tongue/floor lingual 41000
|
$303.75 |
$303.75 |
$303.75 |
$1,331.45
|
|
Intrinsic factor antibody
|
$272.15 |
$272.15 |
$272.15 |
$65.00
|
|
Intro long gi tube w/mult fluo
|
$481.85 |
$481.85 |
$481.85 |
$469.00
|
|
Intubation endotracheal emergency procedure
|
$1,241.70 |
$1,241.70 |
$1,241.70 |
$601.28
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$179.48 |
$179.48 |
$179.48 |
$165.67
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$137.80 |
$137.80 |
$137.80 |
$279.10
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$92,780.74 |
$92,780.74 |
$92,780.74 |
$62,692.46
|
|
Ip/obs cnsltj new/est low 45
|
$286.10 |
$286.10 |
$286.10 |
$174.20
|
|
Ip/obs cnsltj new/est mod 60
|
$363.10 |
$363.10 |
$363.10 |
$284.45
|
|
Ip/obs consltj new/est hi 80
|
$422.45 |
$422.45 |
$422.45 |
$332.80
|
|
Ip/obs consltj new/est sf 35
|
$209.15 |
$209.15 |
$209.15 |
$134.46
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$696.83 |
$696.83 |
$696.83 |
$173.98
|
|
Iron
|
$112.00 |
$112.00 |
$112.00 |
$75.00
|
|
Iron binding capacity
|
$133.65 |
$133.65 |
$133.65 |
$63.91
|
|
Iron dextran 50 mg/ml injection solution
|
$301.49 |
$301.49 |
$301.49 |
$80.67
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$878.66 |
$878.66 |
$878.66 |
$187.06
|