|
Inj pantoprazole(hikma) 40mg
|
$20.99 |
$20.99 |
$20.99 |
$34.61
|
|
Inj pemetrexed (accord) 10mg
|
$666.73 |
$666.73 |
$666.73 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$31.67 |
$31.67 |
$31.67 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$1,013.28 |
$1,013.28 |
$1,013.28 |
$200.85
|
|
Inj proc ankle arthr
|
$103.96 |
$103.96 |
$103.96 |
$405.31
|
|
Inj proc elbow arthro
|
$103.96 |
$103.96 |
$103.96 |
$432.00
|
|
Inj proc myelogram lumbar
|
$309.81 |
$309.81 |
$309.81 |
$856.00
|
|
Inj progesterone per 50 mg
|
$50.66 |
$50.66 |
$50.66 |
$14.93
|
|
Inj retro urethrocysto
|
$68.08 |
$68.08 |
$68.08 |
$450.00
|
|
Inj romidepsin non-lyo 0.1mg
|
$5,079.82 |
$5,079.82 |
$5,079.82 |
$9,892.69
|
|
Inj testostero enanthate 1mg
|
$188.74 |
$188.74 |
$188.74 |
$157.81
|
|
Inj testosterone cypionate
|
$249.66 |
$249.66 |
$249.66 |
$62.80
|
|
Inj. tigecycline (accord)
|
$199.84 |
$199.84 |
$199.84 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$67.60 |
$67.60 |
$67.60 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$23.46 |
$23.46 |
$23.46 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$39.88 |
$39.88 |
$39.88 |
$40.24
|
|
Inj w/fluor eval cv device
|
$154.33 |
$154.33 |
$154.33 |
$463.40
|
|
Ins cath ren art 1st bi
|
$2,420.98 |
$2,420.98 |
$2,420.98 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$2,335.65 |
$2,335.65 |
$2,335.65 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$2,483.08 |
$2,483.08 |
$2,483.08 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$2,483.08 |
$2,483.08 |
$2,483.08 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$196.19 |
$196.19 |
$196.19 |
$488.35
|
|
Insert cath pleura with image
|
$738.30 |
$738.30 |
$738.30 |
$2,194.40
|
|
Insert cath pleura without image
|
$626.06 |
$626.06 |
$626.06 |
$2,019.00
|
|
Insertion catheter bladder non indwelling
|
$44.39 |
$44.39 |
$44.39 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$44.39 |
$44.39 |
$44.39 |
$229.32
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$1,601.95 |
$1,601.95 |
$1,601.95 |
$4,731.80
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,322.58 |
$3,322.58 |
$3,322.58 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$2,355.89 |
$2,355.89 |
$2,355.89 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$822.02 |
$822.02 |
$822.02 |
$2,511.00
|
|
Insertion of catheter vein
|
$631.12 |
$631.12 |
$631.12 |
$1,657.32
|
|
Insertion of catheter vein
|
$154.10 |
$154.10 |
$154.10 |
$836.25
|
|
Insertion of heart electrode 33211
|
$4,174.27 |
$4,174.27 |
$4,174.27 |
$7,392.84
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$9,591.46 |
$9,591.46 |
$9,591.46 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$9,591.46 |
$9,591.46 |
$9,591.46 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$11,884.10 |
$11,884.10 |
$11,884.10 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$396.29 |
$396.29 |
$396.29 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$503.24 |
$503.24 |
$503.24 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$19,617.16 |
$19,617.16 |
$19,617.16 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$4,320.09 |
$4,320.09 |
$4,320.09 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$3,739.80 |
$3,739.80 |
$3,739.80 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$5,965.28 |
$5,965.28 |
$5,965.28 |
$9,397.50
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$2,033.89 |
$2,033.89 |
$2,033.89 |
$5,236.80
|
|
Insert pm/icd lead dual
|
$3,739.80 |
$3,739.80 |
$3,739.80 |
$7,388.80
|
|
Insert/repl sq defib w/eltrd
|
$14,802.57 |
$14,802.57 |
$14,802.57 |
$33,297.72
|
|
Insert swan-ganz cath
|
$717.60 |
$717.60 |
$717.60 |
$2,210.50
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$1,135.28 |
$1,135.28 |
$1,135.28 |
$5,018.25
|
|
Insert tunneled cv cath
|
$2,033.89 |
$2,033.89 |
$2,033.89 |
$6,075.30
|
|
Insert vad art access left hrt arterial access
|
$3,488.18 |
$3,488.18 |
$3,488.18 |
$4,221.97
|
|
Ins icd gen exist mlt leads
|
$18,194.61 |
$18,194.61 |
$18,194.61 |
$31,286.77
|
|
Ins icd gen exist sgl lead
|
$16,698.00 |
$16,698.00 |
$16,698.00 |
$23,742.75
|
|
Insitu hybridization auto
|
$630.20 |
$630.20 |
$630.20 |
$371.00
|
|
Insitu hybridization manual
|
$143.75 |
$143.75 |
$143.75 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$79.81 |
$79.81 |
$79.81 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$72.68 |
$72.68 |
$72.68 |
$326.04
|
|
Ins lv lead exist pm/icd
|
$11,884.10 |
$11,884.10 |
$11,884.10 |
$12,087.24
|
|
Ins mark abd/pel for right perq
|
$777.63 |
$777.63 |
$777.63 |
$2,376.00
|
|
Ins picad w subq port 5yr>
|
$1,202.90 |
$1,202.90 |
$1,202.90 |
$3,912.93
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$566.49 |
$566.49 |
$566.49 |
$1,609.25
|
|
Ins pm gen exist dual lead
|
$17,327.74 |
$17,327.74 |
$17,327.74 |
$24,696.00
|
|
Ins pm gen w/exist mlt leads
|
$11,283.80 |
$11,283.80 |
$11,283.80 |
$14,804.40
|
|
Ins pq tunnld ip cath w/img
|
$1,808.26 |
$1,808.26 |
$1,808.26 |
$5,377.00
|
|
Ins/rpl ldless pm right vent w img & eval
|
$8,633.28 |
$8,633.28 |
$8,633.28 |
$23,369.00
|
|
Ins/rpl pm gen exist dual lead
|
$8,448.59 |
$8,448.59 |
$8,448.59 |
$11,408.40
|
|
Ins/rpl pm gen exist sgl lead
|
$8,448.59 |
$8,448.59 |
$8,448.59 |
$9,558.78
|
|
Ins/rpl pm w/tv ld atrl
|
$11,283.80 |
$11,283.80 |
$11,283.80 |
$12,371.40
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$23,638.48 |
$23,638.48 |
$23,638.48 |
$25,807.00
|
|
Instillation anticarcinogenic agent bladder
|
$184.23 |
$184.23 |
$184.23 |
$621.40
|
|
Ins tun cv cath wo subq prt/pm
|
$1,515.47 |
$1,515.47 |
$1,515.47 |
$5,324.80
|
|
Ins tun cv cath wo subq prt/pm
|
$1,515.47 |
$1,515.47 |
$1,515.47 |
$4,202.70
|
|
Inst via cath agent pleurds
|
$287.96 |
$287.96 |
$287.96 |
$1,093.50
|
|
Insulin total
|
$36.57 |
$36.57 |
$36.57 |
$66.64
|
|
Intens cardiac rehab no exer
|
$128.11 |
$128.11 |
$128.11 |
$238.40
|
|
Intens cardiac rehab w/exerc
|
$93.38 |
$93.38 |
$93.38 |
$238.40
|
|
Interdiscal perq aspir dx
|
$277.84 |
$277.84 |
$277.84 |
$1,180.84
|
|
Interrogate subq defib
|
$32.43 |
$32.43 |
$32.43 |
$125.76
|
|
Interrog dev eval icpms ip
|
$46.00 |
$46.00 |
$46.00 |
$104.00
|
|
Interrog device eval heart
|
$46.00 |
$46.00 |
$46.00 |
$162.40
|
|
Interrog evl pm/ldls pm ip
|
$31.28 |
$31.28 |
$31.28 |
$124.80
|
|
Intra-atrial pacing
|
$2,945.84 |
$2,945.84 |
$2,945.84 |
$4,683.25
|
|
Intra-atrial recording
|
$2,945.84 |
$2,945.84 |
$2,945.84 |
$5,252.30
|
|
Intracard echo interv w/s&i
|
$2,265.50 |
$2,265.50 |
$2,265.50 |
$3,429.40
|
|
Intraop epicard/endocard/pace/map/ 93631
|
$3,993.49 |
$3,993.49 |
$3,993.49 |
$3,500.60
|
|
Intrapul surf admin endo tube
|
$60.26 |
$60.26 |
$60.26 |
$220.80
|
|
Intraventricular pacing
|
$2,945.84 |
$2,945.84 |
$2,945.84 |
$5,609.50
|
|
Intrinsic factor antibody
|
$48.76 |
$48.76 |
$48.76 |
$66.60
|
|
Intro cath dialysis circuit
|
$327.29 |
$327.29 |
$327.29 |
$2,035.00
|
|
Intro cath dialysis circuit w/pta
|
$2,399.13 |
$2,399.13 |
$2,399.13 |
$8,761.00
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$4,661.87 |
$4,661.87 |
$4,661.87 |
$15,805.00
|
|
Intro catheter aorta
|
$424.81 |
$424.81 |
$424.81 |
$1,654.05
|
|
Intro cath svc/ivc
|
$521.64 |
$521.64 |
$521.64 |
$1,329.90
|
|
Intro long gi tube
|
$370.99 |
$370.99 |
$370.99 |
$990.00
|
|
Intro long gi tube w/mult fluo
|
$138.69 |
$138.69 |
$138.69 |
$449.40
|
|
Intro windpipe wire/tube
|
$638.94 |
$638.94 |
$638.94 |
$2,369.76
|
|
Intrvasc Ultrasound noncoronary 1st vessel
|
$2,311.50 |
$2,311.50 |
$2,311.50 |
$3,303.76
|
|
Intrvasc Ultrasound noncoronary addl vessel
|
$2,311.50 |
$2,311.50 |
$2,311.50 |
$1,633.03
|
|
Intubation endotracheal emergency procedure
|
$259.67 |
$259.67 |
$259.67 |
$589.60
|
|
Iodine i-123 sod iodide mil
|
$322.68 |
$322.68 |
$322.68 |
$350.74
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$64.69 |
$64.69 |
$64.69 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$240.90 |
$240.90 |
$240.90 |
$279.10
|