|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$25.20 |
$25.20 |
$25.20 |
$92.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$48.00 |
$48.00 |
$48.00 |
$108.21
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$46.00 |
$46.00 |
$46.00 |
$185.00
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$310.60 |
$310.60 |
$310.60 |
$727.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$86.00 |
$86.00 |
$86.00 |
$283.20
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$177.60 |
$177.60 |
$177.60 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$486.00 |
$486.00 |
$486.00 |
$285.60
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$315.20 |
$315.20 |
$315.20 |
$237.70
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$199.40 |
$199.40 |
$199.40 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$187.00 |
$187.00 |
$187.00 |
$373.60
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$92.60 |
$92.60 |
$92.60 |
$303.59
|
|
Infliximab 100 mg intravenous solution
|
$263.52 |
$263.52 |
$263.52 |
$2,043.22
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$79.60 |
$79.60 |
$79.60 |
$293.25
|
|
Initiation & management bipap/cpap initial day
|
$113.20 |
$113.20 |
$113.20 |
$570.50
|
|
Inj, acetaminophen (b braun)
|
$8.47 |
$8.47 |
$8.47 |
$33.73
|
|
Inj acetaminophen -fresenius
|
$8.40 |
$8.40 |
$8.40 |
$36.60
|
|
Inj, acetaminophen (hikma)
|
$6.30 |
$6.30 |
$6.30 |
$56.70
|
|
Inj allopurinol sodium 1 mg
|
$1,318.27 |
$1,318.27 |
$1,318.27 |
$6,968.99
|
|
Inj, bortezomib freseniuskab
|
$711.96 |
$711.96 |
$711.96 |
$2,464.14
|
|
Inj, bortezomib, hospira
|
$27.70 |
$27.70 |
$27.70 |
$175.35
|
|
Inj calcitriol per 0.1 mcg
|
$9.08 |
$9.08 |
$9.08 |
$23.28
|
|
Inj cefazolin sodium, baxter
|
$17.40 |
$17.40 |
$17.40 |
$27.18
|
|
Inj cefazolin sodium, hikma
|
$7.29 |
$7.29 |
$7.29 |
$28.51
|
|
Inj cefazolin (wg crit care)
|
$5.40 |
$5.40 |
$5.40 |
$17.00
|
|
Inj. cefepime hcl (baxter)
|
$79.80 |
$79.80 |
$79.80 |
$86.84
|
|
Inj, cefepime hcl (b braun)
|
$41.42 |
$41.42 |
$41.42 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$9.15 |
$9.15 |
$9.15 |
$48.96
|
|
Inj cntr knee arthro incl ct/mri
|
$94.80 |
$94.80 |
$94.80 |
$436.80
|
|
Inj cyclophos dr.reddy's 5mg
|
$2,100.00 |
$2,100.00 |
$2,100.00 |
$4,725.00
|
|
Inj cyclophosphamd auromedic
|
$139.87 |
$139.87 |
$139.87 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$813.16 |
$813.16 |
$813.16 |
$683.35
|
|
Inj, daptomycin (hospira)
|
$49.26 |
$49.26 |
$49.26 |
$110.83
|
|
Inj daptomycin (xellia)
|
$18.04 |
$18.04 |
$18.04 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$55.51 |
$55.51 |
$55.51 |
$310.09
|
|
Inj dx for sinogram
|
$54.40 |
$54.40 |
$54.40 |
$413.82
|
|
Injection arthrography hip without anesthesia (both sides)
|
$94.80 |
$94.80 |
$94.80 |
$500.50
|
|
Injection, doxercalciferol
|
$5.55 |
$5.55 |
$5.55 |
$23.83
|
|
Injection during cath supravalvular aortography
|
$47.00 |
$47.00 |
$47.00 |
$1,027.26
|
|
Injection, edaravone, 1 mg
|
$199.80 |
$199.80 |
$199.80 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$344.40 |
$344.40 |
$344.40 |
$1,153.03
|
|
Injection eye drug
|
$103.00 |
$103.00 |
$103.00 |
$648.96
|
|
Injection for arthrography wrist (both sides)
|
$94.80 |
$94.80 |
$94.80 |
$438.00
|
|
Injection for bladder x-ray
|
$52.60 |
$52.60 |
$52.60 |
$459.20
|
|
Injection for hip x-ray
|
$58.60 |
$58.60 |
$58.60 |
$662.40
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$87.40 |
$87.40 |
$87.40 |
$494.65
|
|
Injection for ureter x-ray
|
$66.00 |
$66.00 |
$66.00 |
$515.21
|
|
Injection, fulvestrant
|
$959.83 |
$959.83 |
$959.83 |
$1,719.16
|
|
Injection glatiramer acetate
|
$90.20 |
$90.20 |
$90.20 |
$830.51
|
|
Injection of sinus tract
|
$1,627.60 |
$1,627.60 |
$1,627.60 |
$1,640.99
|
|
Injection radioactive tracer sentinel node (both sides)
|
$152.40 |
$152.40 |
$152.40 |
$699.68
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$376.20 |
$376.20 |
$376.20 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$178.80 |
$178.80 |
$178.80 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$422.00 |
$422.00 |
$422.00 |
$2,031.18
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$354.40 |
$354.40 |
$354.40 |
$1,781.40
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$354.40 |
$354.40 |
$354.40 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$393.40 |
$393.40 |
$393.40 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$141.60 |
$141.60 |
$141.60 |
$478.20
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$61.80 |
$61.80 |
$61.80 |
$546.40
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$169.20 |
$169.20 |
$169.20 |
$634.40
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$73.80 |
$73.80 |
$73.80 |
$163.83
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$73.80 |
$73.80 |
$73.80 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$160.00 |
$160.00 |
$160.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$56.20 |
$56.20 |
$56.20 |
$136.00
|
|
Inj epidural sgl lumb-sacral without img
|
$166.40 |
$166.40 |
$166.40 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$1,219.12 |
$1,219.12 |
$1,219.12 |
$6.55
|
|
Inj for ext venography
|
$184.00 |
$184.00 |
$184.00 |
$654.00
|
|
Inj, fosaprepitant (teva)
|
$39.62 |
$39.62 |
$39.62 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$508.80 |
$508.80 |
$508.80 |
$961.54
|
|
Inj gemcitabine hcl (accord)
|
$58.07 |
$58.07 |
$58.07 |
$130.65
|
|
Inj glycopyrrolate fres kabi
|
$12.18 |
$12.18 |
$12.18 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$8.64 |
$8.64 |
$8.64 |
$26.85
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$49.60 |
$49.60 |
$49.60 |
$1,439.90
|
|
Inj, idacio, 1 mg
|
$499.00 |
$499.00 |
$499.00 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$123.60 |
$123.60 |
$123.60 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$4.37 |
$4.37 |
$4.37 |
$38.94
|
|
Inj, lanreotide, (cipla) 1mg
|
$3,385.87 |
$3,385.87 |
$3,385.87 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$95.58 |
$95.58 |
$95.58 |
$103.60
|
|
Inj, linezolid (hospira)
|
$90.00 |
$90.00 |
$90.00 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$574.55 |
$574.55 |
$574.55 |
$1,791.90
|
|
Inj, meropenem (b. braun)
|
$41.50 |
$41.50 |
$41.50 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$43.38 |
$43.38 |
$43.38 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$54.17 |
$54.17 |
$54.17 |
$89.40
|
|
Inj, moxifloxacin 100 mg
|
$61.12 |
$61.12 |
$61.12 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$100.60 |
$100.60 |
$100.60 |
$252.66
|
|
Inj naloxone hydrochloride
|
$55.36 |
$55.36 |
$55.36 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$241.00 |
$241.00 |
$241.00 |
$1,413.35
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$669.00 |
$669.00 |
$669.00 |
$2,484.00
|
|
Inj pantoprazole(hikma) 40mg
|
$18.25 |
$18.25 |
$18.25 |
$34.70
|
|
Inj pemetrexed (accord) 10mg
|
$579.77 |
$579.77 |
$579.77 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$27.54 |
$27.54 |
$27.54 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$881.11 |
$881.11 |
$881.11 |
$200.85
|
|
Inj proc elbow arthro
|
$94.80 |
$94.80 |
$94.80 |
$434.00
|
|
Inj proc myelogram lumbar
|
$209.20 |
$209.20 |
$209.20 |
$843.84
|
|
Inj progesterone per 50 mg
|
$44.05 |
$44.05 |
$44.05 |
$14.93
|
|
Inj retro urethrocysto
|
$59.20 |
$59.20 |
$59.20 |
$450.00
|
|
Inj romidepsin non-lyo 0.1mg
|
$4,417.23 |
$4,417.23 |
$4,417.23 |
$9,892.69
|
|
Inj scleros sol mult veins
|
$84.20 |
$84.20 |
$84.20 |
$687.96
|
|
Inj scleros sol sgl vein
|
$84.20 |
$84.20 |
$84.20 |
$561.88
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$72.00 |
$72.00 |
$72.00 |
$436.80
|
|
Inj testostero enanthate 1mg
|
$164.12 |
$164.12 |
$164.12 |
$157.81
|
