|
Inj, acetaminophen (hikma)
|
$22.00 |
$22.00 |
$40.00 |
$61.77
|
|
Inj allopurinol sodium 1 mg
|
$2,900.19 |
$2,900.19 |
$5,273.06 |
$6,968.99
|
|
Inj, bortezomib freseniuskab
|
$1,566.31 |
$1,566.31 |
$2,847.84 |
$2,464.14
|
|
Inj, bortezomib, hospira
|
$60.93 |
$60.93 |
$110.78 |
$175.35
|
|
Inj calcitriol per 0.1 mcg
|
$22.00 |
$22.00 |
$40.00 |
$23.28
|
|
Inj cefazolin sodium, baxter
|
$38.28 |
$38.28 |
$69.60 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$22.00 |
$22.00 |
$40.00 |
$28.08
|
|
Inj cefazolin (wg crit care)
|
$22.00 |
$22.00 |
$40.00 |
$15.87
|
|
Inj. cefepime hcl (baxter)
|
$175.56 |
$175.56 |
$319.20 |
$86.84
|
|
Inj, cefepime hcl (b braun)
|
$91.13 |
$91.13 |
$165.68 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$22.00 |
$22.00 |
$40.00 |
$48.03
|
|
Inj cyclophos dr.reddy's 5mg
|
$4,620.00 |
$4,620.00 |
$8,400.00 |
$4,725.00
|
|
Inj cyclophosphamd auromedic
|
$307.71 |
$307.71 |
$559.46 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$1,788.96 |
$1,788.96 |
$3,252.65 |
$741.63
|
|
Inj, daptomycin (hospira)
|
$108.37 |
$108.37 |
$197.04 |
$110.83
|
|
Inj daptomycin (xellia)
|
$39.70 |
$39.70 |
$72.18 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$122.11 |
$122.11 |
$222.02 |
$295.94
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$232.98 |
$232.98 |
$423.60 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$770.66 |
$770.66 |
$1,401.20 |
$504.00
|
|
Injection, doxercalciferol
|
$22.00 |
$22.00 |
$40.00 |
$23.83
|
|
Injection during cath supravalvular aortography
|
$1,205.16 |
$1,205.16 |
$2,191.20 |
$990.03
|
|
Injection, edaravone, 1 mg
|
$439.56 |
$439.56 |
$799.20 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$353.76 |
$353.76 |
$643.20 |
$1,170.45
|
|
Injection for bladder x-ray
|
$52.14 |
$52.14 |
$94.80 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$770.66 |
$770.66 |
$1,401.20 |
$494.65
|
|
Injection for ureter x-ray
|
$771.10 |
$771.10 |
$1,402.00 |
$527.70
|
|
Injection, fulvestrant
|
$1,055.82 |
$1,055.82 |
$1,919.67 |
$1,719.16
|
|
Injection glatiramer acetate
|
$198.43 |
$198.43 |
$360.79 |
$830.51
|
|
Injection radioactive tracer sentinel node (both sides)
|
$153.12 |
$153.12 |
$278.40 |
$704.50
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$203.94 |
$203.94 |
$370.80 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$291.06 |
$291.06 |
$529.20 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$306.90 |
$306.90 |
$558.00 |
$2,031.18
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$156.64 |
$156.64 |
$284.80 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$313.50 |
$313.50 |
$570.00 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$183.26 |
$183.26 |
$333.20 |
$1,048.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$366.52 |
$366.52 |
$666.40 |
$1,984.32
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$232.98 |
$232.98 |
$423.60 |
$1,696.20
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$280.72 |
$280.72 |
$510.40 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$265.32 |
$265.32 |
$482.40 |
$538.00
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$148.50 |
$148.50 |
$270.00 |
$637.35
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$28.38 |
$28.38 |
$51.60 |
$168.05
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$29.48 |
$29.48 |
$53.60 |
$147.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$125.84 |
$125.84 |
$228.80 |
$259.49
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$32.56 |
$32.56 |
$59.20 |
$136.20
|
|
Inj epidural sgl cerv-thor without img
|
$232.98 |
$232.98 |
$423.60 |
$1,311.74
|
|
Inj epidural sgl lumb-sacral without img
|
$306.90 |
$306.90 |
$558.00 |
$1,424.00
|
|
Inj, epinephrine (belcher)
|
$2,682.07 |
$2,682.07 |
$4,876.50 |
$6.24
|
|
Inj for ext venography
|
$801.46 |
$801.46 |
$1,457.20 |
$654.00
|
|
Inj, fosaprepitant (teva)
|
$87.16 |
$87.16 |
$158.47 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$559.69 |
$559.69 |
$1,017.61 |
$1,065.08
|
|
Inj gemcitabine hcl (accord)
|
$127.75 |
$127.75 |
$232.27 |
$130.65
|
|
Inj glycopyrrolate fres kabi
|
$26.80 |
$26.80 |
$48.73 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$22.00 |
$22.00 |
$40.00 |
$24.28
|
|
Inj hrt cath w/s&i sel right vent
|
$54.56 |
$54.56 |
$99.20 |
$941.50
|
|
Inj, idacio, 1 mg
|
$1,097.79 |
$1,097.79 |
$1,995.98 |
$14.63
|
|
Inj labetalol hcl hikma, 5mg
|
$22.00 |
$22.00 |
$40.00 |
$40.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$7,448.91 |
$7,448.91 |
$13,543.46 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$210.28 |
$210.28 |
$382.32 |
$103.60
|
|
Inj, linezolid (hospira)
|
$198.00 |
$198.00 |
$360.00 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$1,264.00 |
$1,264.00 |
$2,298.18 |
$1,847.89
|
|
Inj, meropenem (b. braun)
|
$91.31 |
$91.31 |
$166.02 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$95.43 |
$95.43 |
$173.51 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$119.17 |
$119.17 |
$216.68 |
$89.40
|
|
Inj, moxifloxacin 100 mg
|
$134.48 |
$134.48 |
$244.50 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$221.32 |
$221.32 |
$402.41 |
$252.66
|
|
Inj naloxone hydrochloride
|
$121.80 |
$121.80 |
$221.46 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$801.46 |
$801.46 |
$1,457.20 |
$1,414.40
|
|
Inj pantoprazole(hikma) 40mg
|
$40.15 |
$40.15 |
$73.00 |
$34.61
|
|
Inj pemetrexed (accord) 10mg
|
$1,275.49 |
$1,275.49 |
$2,319.07 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$60.59 |
$60.59 |
$110.16 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$1,938.45 |
$1,938.45 |
$3,524.45 |
$200.85
|
|
Inj proc elbow arthro
|
$770.66 |
$770.66 |
$1,401.20 |
$438.00
|
|
Inj progesterone per 50 mg
|
$96.92 |
$96.92 |
$176.22 |
$14.46
|
|
Inj retro urethrocysto
|
$53.46 |
$53.46 |
$97.20 |
$450.00
|
|
Inj romidepsin non-lyo 0.1mg
|
$9,717.92 |
$9,717.92 |
$17,668.94 |
$9,892.69
|
|
Inj testostero enanthate 1mg
|
$361.07 |
$361.07 |
$656.50 |
$157.81
|
|
Inj testosterone cypionate
|
$477.62 |
$477.62 |
$868.40 |
$64.72
|
|
Inj. tigecycline (accord)
|
$382.30 |
$382.30 |
$695.09 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$129.33 |
$129.33 |
$235.15 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$44.88 |
$44.88 |
$81.60 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$76.29 |
$76.29 |
$138.71 |
$40.24
|
|
Inj w/fluor eval cv device
|
$358.82 |
$358.82 |
$652.40 |
$490.00
|
|
Ins cath ren art 1st bi
|
$1,354.10 |
$1,354.10 |
$2,462.00 |
$5,809.50
|
|
Ins cath ren art 1st uni
|
$1,743.72 |
$1,743.72 |
$3,170.40 |
$4,667.63
|
|
Ins cath ren art 2nd+ uni
|
$1,354.10 |
$1,354.10 |
$2,462.00 |
$5,395.20
|
|
Ins cerv dilator (sep proc)
|
$187.66 |
$187.66 |
$341.20 |
$473.90
|
|
Insert cath pleura with image
|
$447.26 |
$447.26 |
$813.20 |
$2,164.52
|
|
Insert hepatic shunt (tips)
|
$3,192.86 |
$3,192.86 |
$5,805.20 |
$8,367.70
|
|
Insertion catheter bladder non indwelling
|
$272.80 |
$272.80 |
$496.00 |
$209.30
|
|
Insertion catheter bladder temporary simple
|
$272.80 |
$272.80 |
$496.00 |
$235.80
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$665.50 |
$665.50 |
$1,210.00 |
$4,747.60
|
|
Insertion intra aortic balloon assist device percutaneous
|
$4,977.94 |
$4,977.94 |
$9,050.80 |
$2,565.36
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,251.04 |
$2,251.04 |
$4,092.80 |
$7,210.78
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$386.54 |
$386.54 |
$702.80 |
$2,595.45
|
|
Insertion of heart electrode 33211
|
$2,860.00 |
$2,860.00 |
$5,200.00 |
$7,048.60
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$4,859.80 |
$4,859.80 |
$8,836.00 |
$12,450.60
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$7,597.04 |
$7,597.04 |
$13,812.80 |
$10,010.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$386.54 |
$386.54 |
$702.80 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,354.10 |
$1,354.10 |
$2,462.00 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$15,759.04 |
$15,759.04 |
$28,652.80 |
$29,042.52
|
