|
Inj cyclophosphamd auromedic
|
$314.70 |
$314.70 |
$314.70 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$1,829.61 |
$1,829.61 |
$1,829.61 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$110.83 |
$110.83 |
$110.83 |
$110.83
|
|
Inj daptomycin (xellia)
|
$40.60 |
$40.60 |
$40.60 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$124.89 |
$124.89 |
$124.89 |
$295.94
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$413.10 |
$413.10 |
$413.10 |
$1,214.78
|
|
Injection carpal tunnel therapeutic (both sides)
|
$226.35 |
$226.35 |
$226.35 |
$504.90
|
|
Injection, edaravone, 1 mg
|
$449.55 |
$449.55 |
$449.55 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$1,078.65 |
$1,078.65 |
$1,078.65 |
$1,156.80
|
|
Injection eye drug
|
$222.75 |
$222.75 |
$222.75 |
$644.50
|
|
Injection for bladder x-ray
|
$227.25 |
$227.25 |
$227.25 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$197.10 |
$197.10 |
$197.10 |
$494.65
|
|
Injection, fulvestrant
|
$2,159.62 |
$2,159.62 |
$2,159.62 |
$1,719.16
|
|
Injection glatiramer acetate
|
$202.94 |
$202.94 |
$202.94 |
$811.20
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$650.70 |
$650.70 |
$650.70 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$475.20 |
$475.20 |
$475.20 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$900.90 |
$900.90 |
$900.90 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$234.00 |
$234.00 |
$234.00 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$668.70 |
$668.70 |
$668.70 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$234.00 |
$234.00 |
$234.00 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$695.25 |
$695.25 |
$695.25 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$413.10 |
$413.10 |
$413.10 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$413.10 |
$413.10 |
$413.10 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$300.15 |
$300.15 |
$300.15 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$227.70 |
$227.70 |
$227.70 |
$522.55
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$369.45 |
$369.45 |
$369.45 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$64.80 |
$64.80 |
$64.80 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$96.75 |
$96.75 |
$96.75 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$64.80 |
$64.80 |
$64.80 |
$135.20
|
|
Inject sacroiliac joint
|
$413.10 |
$413.10 |
$413.10 |
$963.00
|
|
Inj, epinephrine (belcher)
|
$2,743.03 |
$2,743.03 |
$2,743.03 |
$6.24
|
|
Inj, fosaprepitant (teva)
|
$89.14 |
$89.14 |
$89.14 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$1,144.81 |
$1,144.81 |
$1,144.81 |
$1,065.08
|
|
Inj gemcitabine hcl (accord)
|
$130.65 |
$130.65 |
$130.65 |
$113.90
|
|
Inj glycopyrrolate fres kabi
|
$27.41 |
$27.41 |
$27.41 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$19.44 |
$19.44 |
$19.44 |
$24.28
|
|
Inj, idacio, 1 mg
|
$1,122.74 |
$1,122.74 |
$1,122.74 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$267.75 |
$267.75 |
$267.75 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$9.83 |
$9.83 |
$9.83 |
$40.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$7,618.20 |
$7,618.20 |
$7,618.20 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$215.05 |
$215.05 |
$215.05 |
$103.60
|
|
Inj, linezolid (hospira)
|
$202.50 |
$202.50 |
$202.50 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$1,292.73 |
$1,292.73 |
$1,292.73 |
$2,375.23
|
|
Inj, meropenem (b. braun)
|
$93.39 |
$93.39 |
$93.39 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$97.60 |
$97.60 |
$97.60 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$121.88 |
$121.88 |
$121.88 |
$89.40
|
|
Inj. mycophenolate mofetil
|
$226.35 |
$226.35 |
$226.35 |
$252.66
|
|
Inj pantoprazole(hikma) 40mg
|
$41.06 |
$41.06 |
$41.06 |
$34.61
|
|
Inj pemetrexed (accord) 10mg
|
$1,304.48 |
$1,304.48 |
$1,304.48 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$61.96 |
$61.96 |
$61.96 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$1,982.50 |
$1,982.50 |
$1,982.50 |
$200.85
|
|
Inj romidepsin non-lyo 0.1mg
|
$9,938.78 |
$9,938.78 |
$9,938.78 |
$9,892.69
|
|
Inj. tigecycline (accord)
|
$390.99 |
$390.99 |
$390.99 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$132.27 |
$132.27 |
$132.27 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$45.90 |
$45.90 |
$45.90 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$78.02 |
$78.02 |
$78.02 |
$40.24
|
|
Insert cath pleura without image
|
$959.40 |
$959.40 |
$959.40 |
$2,019.00
|
|
Insertion catheter bladder non indwelling
|
$126.90 |
$126.90 |
$126.90 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$144.00 |
$144.00 |
$144.00 |
$229.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$1,869.30 |
$1,869.30 |
$1,869.30 |
$2,510.50
|
|
Insertion of heart electrode 33211
|
$8,167.05 |
$8,167.05 |
$8,167.05 |
$7,392.84
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,869.30 |
$1,869.30 |
$1,869.30 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,108.70 |
$2,108.70 |
$2,108.70 |
$2,414.10
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$8,873.10 |
$8,873.10 |
$8,873.10 |
$7,513.67
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,655.35 |
$3,655.35 |
$3,655.35 |
$5,236.80
|
|
Ins/rplc spi npg/rcvr pocket
|
$25,469.55 |
$25,469.55 |
$25,469.55 |
$23,746.69
|
|
Instillation anticarcinogenic agent bladder
|
$456.75 |
$456.75 |
$456.75 |
$621.40
|
|
Insulin total
|
$56.70 |
$56.70 |
$56.70 |
$66.64
|
|
Intrinsic factor antibody
|
$27.45 |
$27.45 |
$27.45 |
$66.60
|
|
Intubation endotracheal emergency procedure
|
$373.05 |
$373.05 |
$373.05 |
$589.60
|
|
Iron
|
$93.60 |
$93.60 |
$93.60 |
$74.40
|
|
Iron binding capacity
|
$50.40 |
$50.40 |
$50.40 |
$63.79
|
|
Irrigation implantable venous access device for drug delivery systems
|
$117.45 |
$117.45 |
$117.45 |
$142.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$64.80 |
$64.80 |
$64.80 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$24.30 |
$24.30 |
$24.30 |
$151.80
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$240.75 |
$240.75 |
$240.75 |
$439.56
|
|
John cunningham antibody
|
$26.10 |
$26.10 |
$26.10 |
$72.60
|
|
Ketamine and metabolite screen - quest
|
$166.95 |
$166.95 |
$166.95 |
$72.14
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$45.90 |
$45.90 |
$45.90 |
$60.20
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$28.52 |
$28.52 |
$28.52 |
$23.50
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$374.85 |
$374.85 |
$374.85 |
$664.20
|
|
Kit gene analys d816 variant
|
$70.20 |
$70.20 |
$70.20 |
$374.61
|
|
Knee MRI (with and without contrast)
|
$2,131.65 |
$2,131.65 |
$2,131.65 |
$3,022.20
|
|
Knee MRI (without contrast)
|
$1,096.20 |
$1,096.20 |
$1,096.20 |
$2,169.60
|
|
Knee X-ray
|
$130.50 |
$130.50 |
$130.50 |
$425.55
|
|
Kras gene variants exon 2
|
$175.95 |
$175.95 |
$175.95 |
$486.45
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$68.71 |
$68.71 |
$68.71 |
$32.34
|
|
Lactate dehydrogenase (ldh)
|
$32.40 |
$32.40 |
$32.40 |
$55.44
|
|
Lactic acid
|
$46.80 |
$46.80 |
$46.80 |
$107.00
|
|
Lactoferrin fecal qualitative
|
$24.30 |
$24.30 |
$24.30 |
$80.08
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$8,359.28 |
$8,359.28 |
$8,359.28 |
$19,124.00
|
|
Lead capillary
|
$81.90 |
$81.90 |
$81.90 |
$57.50
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$340.65 |
$340.65 |
$340.65 |
$1,088.26
|
|
Leishmania antibody
|
$18.00 |
$18.00 |
$18.00 |
$68.25
|
|
Leuprolide acetate injeciton
|
$2,227.65 |
$2,227.65 |
$2,227.65 |
$1,322.50
|
|
Levetiracetam therapeutic drug level
|
$150.75 |
$150.75 |
$150.75 |
$88.92
|
|
Lidocaine therapeutic drug level
|
$19.80 |
$19.80 |
$19.80 |
$89.70
|
|
Lipase
|
$43.65 |
$43.65 |
$43.65 |
$93.58
|
|
Lipoprotein direct measurement hdl
|
$73.35 |
$73.35 |
$73.35 |
$57.50
|
|
Lipoprotein direct measurement ldl
|
$48.60 |
$48.60 |
$48.60 |
$61.60
|