|
Inj acetaminophen -fresenius
|
$8.82 |
$8.82 |
$8.82 |
$38.87
|
|
Inj, acetaminophen (hikma)
|
$6.61 |
$6.61 |
$6.61 |
$68.30
|
|
Inj allopurinol sodium 1 mg
|
$1,384.18 |
$1,384.18 |
$1,384.18 |
$6,968.99
|
|
Inj, bortezomib freseniuskab
|
$747.56 |
$747.56 |
$747.56 |
$2,464.14
|
|
Inj, bortezomib, hospira
|
$29.08 |
$29.08 |
$29.08 |
$175.35
|
|
Inj calcitriol per 0.1 mcg
|
$9.54 |
$9.54 |
$9.54 |
$22.69
|
|
Inj cefazolin sodium, baxter
|
$18.27 |
$18.27 |
$18.27 |
$27.38
|
|
Inj cefazolin sodium, hikma
|
$7.65 |
$7.65 |
$7.65 |
$29.10
|
|
Inj cefazolin (wg crit care)
|
$5.67 |
$5.67 |
$5.67 |
$18.30
|
|
Inj. cefepime hcl (baxter)
|
$83.79 |
$83.79 |
$83.79 |
$86.84
|
|
Inj, cefepime hcl (b braun)
|
$43.49 |
$43.49 |
$43.49 |
$69.85
|
|
Inj, clindamycin (baxter)
|
$9.61 |
$9.61 |
$9.61 |
$48.39
|
|
Inj cntr knee arthro incl ct/mri
|
$99.54 |
$99.54 |
$99.54 |
$436.80
|
|
Inj cyclophos dr.reddy's 5mg
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$4,725.00
|
|
Inj cyclophosphamd auromedic
|
$146.86 |
$146.86 |
$146.86 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$853.82 |
$853.82 |
$853.82 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$51.72 |
$51.72 |
$51.72 |
$110.83
|
|
Inj daptomycin (xellia)
|
$18.95 |
$18.95 |
$18.95 |
$56.04
|
|
Inj, decitabine (sun pharma)
|
$58.28 |
$58.28 |
$58.28 |
$295.94
|
|
Inj dx for sinogram
|
$57.12 |
$57.12 |
$57.12 |
$413.82
|
|
Injection arthrography hip without anesthesia (both sides)
|
$95.34 |
$95.34 |
$95.34 |
$500.50
|
|
Injection, doxercalciferol
|
$5.83 |
$5.83 |
$5.83 |
$23.12
|
|
Injection during cath supravalvular aortography
|
$52.08 |
$52.08 |
$52.08 |
$904.17
|
|
Injection, edaravone, 1 mg
|
$209.79 |
$209.79 |
$209.79 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$296.52 |
$296.52 |
$296.52 |
$1,156.80
|
|
Injection eye drug
|
$137.76 |
$137.76 |
$137.76 |
$644.50
|
|
Injection for arthrography wrist (both sides)
|
$99.54 |
$99.54 |
$99.54 |
$441.12
|
|
Injection for bladder x-ray
|
$55.23 |
$55.23 |
$55.23 |
$459.20
|
|
Injection for hip x-ray
|
$104.37 |
$104.37 |
$104.37 |
$669.24
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$96.18 |
$96.18 |
$96.18 |
$494.65
|
|
Injection for ureter x-ray
|
$69.30 |
$69.30 |
$69.30 |
$515.21
|
|
Injection, fulvestrant
|
$1,007.82 |
$1,007.82 |
$1,007.82 |
$1,719.16
|
|
Injection glatiramer acetate
|
$94.71 |
$94.71 |
$94.71 |
$830.51
|
|
Injection of sinus tract
|
$1,708.98 |
$1,708.98 |
$1,708.98 |
$1,627.60
|
|
Injection radioactive tracer sentinel node (both sides)
|
$168.00 |
$168.00 |
$168.00 |
$683.28
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$395.01 |
$395.01 |
$395.01 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$187.74 |
$187.74 |
$187.74 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$442.89 |
$442.89 |
$442.89 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$372.12 |
$372.12 |
$372.12 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$372.12 |
$372.12 |
$372.12 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$357.84 |
$357.84 |
$357.84 |
$1,842.00
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$397.11 |
$397.11 |
$397.11 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$148.68 |
$148.68 |
$148.68 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$159.81 |
$159.81 |
$159.81 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$177.66 |
$177.66 |
$177.66 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$81.27 |
$81.27 |
$81.27 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$81.27 |
$81.27 |
$81.27 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$168.00 |
$168.00 |
$168.00 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$57.75 |
$57.75 |
$57.75 |
$135.20
|
|
Inj epidural sgl cerv-thor without img
|
$174.72 |
$174.72 |
$174.72 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$174.72 |
$174.72 |
$174.72 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$1,280.08 |
$1,280.08 |
$1,280.08 |
$6.24
|
|
Inj for ext venography
|
$202.44 |
$202.44 |
$202.44 |
$654.00
|
|
Inj for mammo ductogram
|
$84.42 |
$84.42 |
$84.42 |
$433.50
|
|
Inj, fosaprepitant (teva)
|
$41.60 |
$41.60 |
$41.60 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$534.25 |
$534.25 |
$534.25 |
$1,065.08
|
|
Inj gemcitabine hcl (accord)
|
$60.97 |
$60.97 |
$60.97 |
$113.90
|
|
Inj glycopyrrolate fres kabi
|
$12.79 |
$12.79 |
$12.79 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$9.07 |
$9.07 |
$9.07 |
$24.28
|
|
Inj hrt cath w/s&i nonsel p-art angrp
|
$52.08 |
$52.08 |
$52.08 |
$1,237.50
|
|
Inj hrt cath w/s&i sel right vent
|
$52.08 |
$52.08 |
$52.08 |
$947.05
|
|
Inj, idacio, 1 mg
|
$523.95 |
$523.95 |
$523.95 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$129.78 |
$129.78 |
$129.78 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$4.59 |
$4.59 |
$4.59 |
$40.00
|
|
Inj, lanreotide, (cipla) 1mg
|
$3,555.16 |
$3,555.16 |
$3,555.16 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$100.36 |
$100.36 |
$100.36 |
$103.60
|
|
Inj, linezolid (hospira)
|
$94.50 |
$94.50 |
$94.50 |
$153.30
|
|
Inj melpha hydroch nos 50 mg
|
$603.27 |
$603.27 |
$603.27 |
$2,375.23
|
|
Inj, meropenem (b. braun)
|
$43.58 |
$43.58 |
$43.58 |
$71.14
|
|
Inj meropenem (wg crit care)
|
$45.55 |
$45.55 |
$45.55 |
$77.97
|
|
Inj, micafungin (par pharm)
|
$56.88 |
$56.88 |
$56.88 |
$89.40
|
|
Inj, moxifloxacin 100 mg
|
$64.18 |
$64.18 |
$64.18 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$105.63 |
$105.63 |
$105.63 |
$252.66
|
|
Inj naloxone hydrochloride
|
$58.13 |
$58.13 |
$58.13 |
$83.16
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$253.05 |
$253.05 |
$253.05 |
$1,414.40
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$702.45 |
$702.45 |
$702.45 |
$2,485.20
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$702.45 |
$702.45 |
$702.45 |
$2,431.74
|
|
Inj octafluoropropane mic,ml
|
$44.10 |
$44.10 |
$44.10 |
$211.40
|
|
Inj pantoprazole(hikma) 40mg
|
$19.16 |
$19.16 |
$19.16 |
$34.61
|
|
Inj pemetrexed (accord) 10mg
|
$608.76 |
$608.76 |
$608.76 |
$33.79
|
|
Inj pemetrexed (sandoz) 10mg
|
$28.92 |
$28.92 |
$28.92 |
$95.26
|
|
Inj pemetrexed (teva) 10mg
|
$925.17 |
$925.17 |
$925.17 |
$200.85
|
|
Inj peritoneal venous shunt
|
$89.25 |
$89.25 |
$89.25 |
$406.80
|
|
Inj proc ankle arthr
|
$99.54 |
$99.54 |
$99.54 |
$405.31
|
|
Inj proc elbow arthro
|
$99.54 |
$99.54 |
$99.54 |
$432.00
|
|
Inj proc for lymphang
|
$198.66 |
$198.66 |
$198.66 |
$805.80
|
|
Inj proc myelogram lumbar
|
$219.66 |
$219.66 |
$219.66 |
$856.00
|
|
Inj proc sialogram
|
$89.25 |
$89.25 |
$89.25 |
$373.00
|
|
Inj progesterone per 50 mg
|
$46.26 |
$46.26 |
$46.26 |
$14.93
|
|
Inj retro urethrocysto
|
$62.16 |
$62.16 |
$62.16 |
$450.00
|
|
Inj romidepsin non-lyo 0.1mg
|
$4,638.10 |
$4,638.10 |
$4,638.10 |
$9,892.69
|
|
Inj scleros sol mult veins
|
$88.41 |
$88.41 |
$88.41 |
$602.50
|
|
Inj scleros sol sgl vein
|
$88.41 |
$88.41 |
$88.41 |
$534.40
|
|
Inj testostero enanthate 1mg
|
$172.33 |
$172.33 |
$172.33 |
$157.81
|
|
Inj testosterone cypionate
|
$227.95 |
$227.95 |
$227.95 |
$62.80
|
|
Inj. tigecycline (accord)
|
$182.46 |
$182.46 |
$182.46 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$61.73 |
$61.73 |
$61.73 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$21.42 |
$21.42 |
$21.42 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$36.41 |
$36.41 |
$36.41 |
$40.24
|
|
Inj w/fluor eval cv device
|
$140.91 |
$140.91 |
$140.91 |
$463.40
|
