|
Inj cefazolin (wg crit care)
|
$5.40 |
$5.40 |
$5.40 |
$18.30
|
|
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 |
$48.39
|
|
Inj cntr knee arthro incl ct/mri
|
$88.00 |
$88.00 |
$88.00 |
$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 |
$742.72
|
|
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 |
$295.94
|
|
Inj dx for sinogram
|
$52.40 |
$52.40 |
$52.40 |
$413.82
|
|
Injection arthrography hip without anesthesia (both sides)
|
$91.20 |
$91.20 |
$91.20 |
$500.50
|
|
Injection, doxercalciferol
|
$5.55 |
$5.55 |
$5.55 |
$23.12
|
|
Injection during cath supravalvular aortography
|
$47.60 |
$47.60 |
$47.60 |
$904.17
|
|
Injection, edaravone, 1 mg
|
$199.80 |
$199.80 |
$199.80 |
$1,136.59
|
|
Injection epidural blood patch or clot
|
$271.60 |
$271.60 |
$271.60 |
$1,156.80
|
|
Injection eye drug
|
$92.60 |
$92.60 |
$92.60 |
$644.50
|
|
Injection for arthrography wrist (both sides)
|
$48.80 |
$48.80 |
$48.80 |
$441.12
|
|
Injection for bladder x-ray
|
$42.00 |
$42.00 |
$42.00 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$88.00 |
$88.00 |
$88.00 |
$494.65
|
|
Injection, fulvestrant
|
$959.83 |
$959.83 |
$959.83 |
$1,719.16
|
|
Injection glatiramer acetate
|
$90.20 |
$90.20 |
$90.20 |
$830.51
|
|
Injection radioactive tracer sentinel node (both sides)
|
$153.80 |
$153.80 |
$153.80 |
$683.28
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$289.20 |
$289.20 |
$289.20 |
$1,582.12
|
|
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)
|
$172.00 |
$172.00 |
$172.00 |
$1,045.65
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$405.60 |
$405.60 |
$405.60 |
$1,939.60
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$340.80 |
$340.80 |
$340.80 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$340.80 |
$340.80 |
$340.80 |
$1,961.05
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$363.60 |
$363.60 |
$363.60 |
$1,704.78
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$136.20 |
$136.20 |
$136.20 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$59.40 |
$59.40 |
$59.40 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$158.00 |
$158.00 |
$158.00 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$74.40 |
$74.40 |
$74.40 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$74.40 |
$74.40 |
$74.40 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$74.40 |
$74.40 |
$74.40 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$53.20 |
$53.20 |
$53.20 |
$135.20
|
|
Inj epidural sgl lumb-sacral without img
|
$160.00 |
$160.00 |
$160.00 |
$1,415.50
|
|
Inj, epinephrine (belcher)
|
$1,219.12 |
$1,219.12 |
$1,219.12 |
$6.24
|
|
Inj for mammo ductogram
|
$67.00 |
$67.00 |
$67.00 |
$433.50
|
|
Inj, fosaprepitant (teva)
|
$39.62 |
$39.62 |
$39.62 |
$152.10
|
|
Inj, fulvestrant (fresenius)
|
$508.80 |
$508.80 |
$508.80 |
$1,065.08
|
|
Inj gemcitabine hcl (accord)
|
$58.07 |
$58.07 |
$58.07 |
$113.90
|
|
Inj glycopyrrolate fres kabi
|
$12.18 |
$12.18 |
$12.18 |
$12.18
|
|
Inj heparin, pfizer, 1000u
|
$8.64 |
$8.64 |
$8.64 |
$24.28
|
|
Inj, idacio, 1 mg
|
$499.00 |
$499.00 |
$499.00 |
$14.63
|
|
Inj intralesional <= 7 lsn(s)
|
$113.20 |
$113.20 |
$113.20 |
$235.13
|
|
Inj labetalol hcl hikma, 5mg
|
$4.37 |
$4.37 |
$4.37 |
$40.00
|
|
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 |
$2,375.23
|
|
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 pantoprazole(hikma) 40mg
|
$18.25 |
$18.25 |
$18.25 |
$34.61
|
|
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
|
$88.00 |
$88.00 |
$88.00 |
$432.00
|
|
Inj progesterone per 50 mg
|
$44.05 |
$44.05 |
$44.05 |
$14.93
|
|
Inj romidepsin non-lyo 0.1mg
|
$4,417.23 |
$4,417.23 |
$4,417.23 |
$9,892.69
|
|
Inj scleros sol mult veins
|
$229.20 |
$229.20 |
$229.20 |
$602.50
|
|
Inj testostero enanthate 1mg
|
$164.12 |
$164.12 |
$164.12 |
$157.81
|
|
Inj testosterone cypionate
|
$217.10 |
$217.10 |
$217.10 |
$62.80
|
|
Inj. tigecycline (accord)
|
$173.77 |
$173.77 |
$173.77 |
$182.46
|
|
Inj, vancomycin hcl (mylan)
|
$58.79 |
$58.79 |
$58.79 |
$76.59
|
|
Inj, vancomycin hcl (xellia)
|
$20.40 |
$20.40 |
$20.40 |
$85.20
|
|
Inj vasopressin (am reg) 1 u
|
$34.68 |
$34.68 |
$34.68 |
$40.24
|
|
Inj w/fluor eval cv device
|
$135.20 |
$135.20 |
$135.20 |
$463.40
|
|
Ins cath ren art 1st bi
|
$2,024.20 |
$2,024.20 |
$2,024.20 |
$5,741.00
|
|
Ins cath ren art 1st uni
|
$1,952.80 |
$1,952.80 |
$1,952.80 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$2,076.20 |
$2,076.20 |
$2,076.20 |
$5,408.65
|
|
Ins cath ren art 2nd+ uni
|
$2,076.20 |
$2,076.20 |
$2,076.20 |
$5,419.00
|
|
Ins cerv dilator (sep proc)
|
$170.60 |
$170.60 |
$170.60 |
$488.35
|
|
Insert cath pleura with image
|
$617.00 |
$617.00 |
$617.00 |
$2,194.40
|
|
Insert cath pleura without image
|
$399.40 |
$399.40 |
$399.40 |
$2,019.00
|
|
Insert drug delivery implant
|
$44.80 |
$44.80 |
$44.80 |
$280.00
|
|
Insertion catheter bladder non indwelling
|
$37.20 |
$37.20 |
$37.20 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$37.20 |
$37.20 |
$37.20 |
$229.32
|
|
Insertion intra aortic balloon assist device percutaneous
|
$2,916.60 |
$2,916.60 |
$2,916.60 |
$2,529.45
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$1,969.80 |
$1,969.80 |
$1,969.80 |
$7,034.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$583.20 |
$583.20 |
$583.20 |
$2,511.00
|
|
Insertion of heart electrode 33211
|
$1,849.00 |
$1,849.00 |
$1,849.00 |
$7,392.84
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$9,434.60 |
$9,434.60 |
$9,434.60 |
$12,508.08
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$9,434.60 |
$9,434.60 |
$9,434.60 |
$12,384.25
|
|
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator
|
$10,433.20 |
$10,433.20 |
$10,433.20 |
$10,100.35
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$331.40 |
$331.40 |
$331.40 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$420.80 |
$420.80 |
$420.80 |
$2,414.10
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$16,402.40 |
$16,402.40 |
$16,402.40 |
$29,146.96
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$3,792.00 |
$3,792.00 |
$3,792.00 |
$7,513.67
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$3,490.20 |
$3,490.20 |
$3,490.20 |
$7,342.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$4,987.60 |
$4,987.60 |
$4,987.60 |
$9,397.50
|
|
Ins icd gen exist mlt leads
|
$15,212.80 |
$15,212.80 |
$15,212.80 |
$31,286.77
|
|
Ins icd gen exist sgl lead
|
$13,961.60 |
$13,961.60 |
$13,961.60 |
$23,742.75
|
|
Insitu hybridization auto
|
$131.80 |
$131.80 |
$131.80 |
$371.00
|
