|
Injection, caplacizumab-yhdp
|
$16,319.16 |
$16,319.16 |
$16,319.16 |
$16,642.50
|
|
Injection, daratumumab 10 mg
|
$1,408.08 |
$1,408.08 |
$1,408.08 |
$5,164.24
|
|
Injection, doxercalciferol
|
$9.52 |
$9.52 |
$9.52 |
$23.12
|
|
Injection epidural blood patch or clot
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,156.80
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$591.75 |
$591.75 |
$591.75 |
$494.65
|
|
Injection, fulvestrant
|
$1,919.66 |
$1,919.66 |
$1,919.66 |
$1,719.16
|
|
Injection glatiramer acetate
|
$865.10 |
$865.10 |
$865.10 |
$830.51
|
|
Injection, inclisiran, 1 mg
|
$6,679.35 |
$6,679.35 |
$6,679.35 |
$6,679.35
|
|
Injection, isavuconazonium
|
$787.67 |
$787.67 |
$787.67 |
$787.67
|
|
Injection, necitumumab, 1 mg
|
$8,572.91 |
$8,572.91 |
$8,572.91 |
$8,572.91
|
|
Injection,onabotulinumtoxina
|
$2,510.64 |
$2,510.64 |
$2,510.64 |
$2,241.61
|
|
Injection, peramivir
|
$684.00 |
$684.00 |
$684.00 |
$775.82
|
|
Injection, renflexis
|
$1,491.72 |
$1,491.72 |
$1,491.72 |
$1,341.52
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,045.65
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$741.45 |
$741.45 |
$741.45 |
$1,029.45
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$741.45 |
$741.45 |
$741.45 |
$1,064.70
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,482.45 |
$1,482.45 |
$1,482.45 |
$1,961.05
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$441.30 |
$441.30 |
$441.30 |
$460.94
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$517.24
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$441.30 |
$441.30 |
$441.30 |
$625.00
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$145.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$192.15 |
$192.15 |
$192.15 |
$261.00
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$146.85 |
$146.85 |
$146.85 |
$135.20
|
|
Inj., eravacycline, 1 mg
|
$237.60 |
$237.60 |
$237.60 |
$206.64
|
|
Inj, etelcalcetide, 0.1 mg
|
$212.36 |
$212.36 |
$212.36 |
$343.35
|
|
Inj herzuma 10 mg
|
$7,775.46 |
$7,775.46 |
$7,775.46 |
$7,775.46
|
|
Inj human fibrinogen con nos
|
$3.95 |
$3.95 |
$3.95 |
$3.95
|
|
Inj hydroxyprogst capoat nos
|
$1,589.94 |
$1,589.94 |
$1,589.94 |
$1,228.59
|
|
Inj imip 4 cilas 4 releb 2mg
|
$662.97 |
$662.97 |
$662.97 |
$662.97
|
|
Inj ivig privigen 500 mg
|
$6,967.29 |
$6,967.29 |
$6,967.29 |
$6,967.29
|
|
Inj levoleucovorin nos 0.5mg
|
$117.00 |
$117.00 |
$117.00 |
$103.60
|
|
Inj, levothyroxine, freskabi
|
$59.87 |
$59.87 |
$59.87 |
$363.97
|
|
Inj. meloxicam 1 mg
|
$203.04 |
$203.04 |
$203.04 |
$167.04
|
|
Inj melpha hydroch nos 50 mg
|
$4,962.63 |
$4,962.63 |
$4,962.63 |
$2,375.23
|
|
Inj mepivacaine hcl/10 ml
|
$33.86 |
$33.86 |
$33.86 |
$33.86
|
|
Inj., meropenem, vaborbactam
|
$466.56 |
$466.56 |
$466.56 |
$536.27
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$8,922.99 |
$8,922.99 |
$8,922.99 |
$8,304.04
|
|
Inj, moxifloxacin 100 mg
|
$107.25 |
$107.25 |
$107.25 |
$107.25
|
|
Inj. mycophenolate mofetil
|
$466.47 |
$466.47 |
$466.47 |
$252.66
|
|
Inj naloxone hydrochloride
|
$83.16 |
$83.16 |
$83.16 |
$83.16
|
|
Inj octafluoropropane mic,ml
|
$421.20 |
$421.20 |
$421.20 |
$211.40
|
|
Inj ogivri 10 mg
|
$5,197.61 |
$5,197.61 |
$5,197.61 |
$4,492.28
|
|
Inj., omadacycline, 1 mg
|
$865.34 |
$865.34 |
$865.34 |
$865.34
|
|
Inj ontruzant 10 mg
|
$7,343.90 |
$7,343.90 |
$7,343.90 |
$6,706.27
|
|
Inj proc lumbr disk ea lvl
|
$401.10 |
$401.10 |
$401.10 |
$1,139.40
|
|
Inj progesterone per 50 mg
|
$6.00 |
$6.00 |
$6.00 |
$14.93
|
|
Inj, rimabotulinumtoxinb
|
$672.44 |
$672.44 |
$672.44 |
$714.24
|
|
Inj, sezaby, 1 mg
|
$288.11 |
$288.11 |
$288.11 |
$235.85
|
|
Inj tedizolid phosphate
|
$664.72 |
$664.72 |
$664.72 |
$664.72
|
|
Inj testostero enanthate 1mg
|
$8.29 |
$8.29 |
$8.29 |
$157.81
|
|
Inj testosterone cypionate
|
$54.70 |
$54.70 |
$54.70 |
$62.80
|
|
Inj, vancomycin hcl (xellia)
|
$70.56 |
$70.56 |
$70.56 |
$85.20
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$44,026.28 |
$44,026.28 |
$44,026.28 |
$44,026.28
|
|
Insert cath pleura with image
|
$2,414.10 |
$2,414.10 |
$2,414.10 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,825.70 |
$2,825.70 |
$2,825.70 |
$2,019.00
|
|
Insertion catheter bladder non indwelling
|
$205.20 |
$205.20 |
$205.20 |
$205.20
|
|
Insertion catheter bladder temporary simple
|
$188.70 |
$188.70 |
$188.70 |
$229.32
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,899.95 |
$2,899.95 |
$2,899.95 |
$2,511.00
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$2,510.55 |
$2,510.55 |
$2,510.55 |
$2,079.43
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$2,414.10 |
$2,414.10 |
$2,414.10 |
$2,414.10
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,648.15 |
$3,648.15 |
$3,648.15 |
$5,236.80
|
|
Insert pessary/other device
|
$234.30 |
$234.30 |
$234.30 |
$273.54
|
|
Insert swan-ganz cath
|
$3,286.50 |
$3,286.50 |
$3,286.50 |
$2,210.50
|
|
Insitu hybridization manual
|
$318.00 |
$318.00 |
$318.00 |
$388.20
|
|
In situ hybridization per specimen each additional single probe stain
|
$416.40 |
$416.40 |
$416.40 |
$243.60
|
|
In situ hybridization per specimen initial single probe stain
|
$353.40 |
$353.40 |
$353.40 |
$326.04
|
|
Ins picad w subq port 5yr>
|
$2,984.25 |
$2,984.25 |
$2,984.25 |
$3,912.93
|
|
Instill, bupivac and meloxic
|
$637.01 |
$637.01 |
$637.01 |
$687.60
|
|
Ins tun cvad 2 cath w/subq port(s)
|
$10,115.70 |
$10,115.70 |
$10,115.70 |
$7,651.38
|
|
Ins tun cv cath wo subq prt/pm
|
$3,045.90 |
$3,045.90 |
$3,045.90 |
$4,202.70
|
|
Insulin total
|
$22.14 |
$22.14 |
$22.14 |
$66.64
|
|
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm
|
$5,124.80 |
$5,124.80 |
$5,124.80 |
$8,629.72
|
|
Integra meshed bil wound mat
|
$486.69 |
$486.69 |
$486.69 |
$9,924.00
|
|
Integra os putty 2.5cc - cost per 0.5cc
|
$4,440.00 |
$4,440.00 |
$4,440.00 |
$3,825.00
|
|
Interferon alfa-2b inj
|
$1,409.92 |
$1,409.92 |
$1,409.92 |
$1,409.92
|
|
Interferon alfa-n3 inj
|
$59.64 |
$59.64 |
$59.64 |
$59.64
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$4,091.60 |
$4,091.60 |
$4,091.60 |
$10,427.90
|
|
Interferon beta-1b / .25 mg
|
$289.67 |
$289.67 |
$289.67 |
$1,662.71
|
|
Interfyl, 1 mg
|
$5,659.20 |
$5,659.20 |
$5,659.20 |
$5,118.52
|
|
Intraoral i+d tongue/floor lingual 41000
|
$1,536.00 |
$1,536.00 |
$1,536.00 |
$1,445.00
|
|
Intrinsic factor antibody
|
$157.80 |
$157.80 |
$157.80 |
$66.60
|
|
Intro long gi tube w/mult fluo
|
$383.10 |
$383.10 |
$383.10 |
$449.40
|
|
Intro windpipe wire/tube
|
$1,584.00 |
$1,584.00 |
$1,584.00 |
$2,369.76
|
|
Intubation endotracheal emergency procedure
|
$539.85 |
$539.85 |
$539.85 |
$589.60
|
|
Iopamidol 250 mg iodine/ml (51 %) intravenous solution
|
$405.00 |
$405.00 |
$405.00 |
$172.98
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$315.00 |
$315.00 |
$315.00 |
$279.10
|
|
Ioxaglate 39.3%-19.6% inj 200 ml
|
$763.50 |
$763.50 |
$763.50 |
$763.50
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$67,577.14 |
$67,577.14 |
$67,577.14 |
$62,692.46
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$77.27 |
$77.27 |
$77.27 |
$163.87
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$5,476.68 |
$5,476.68 |
$5,476.68 |
$5,476.68
|
|
Iron
|
$217.80 |
$217.80 |
$217.80 |
$74.40
|
|
Iron binding capacity
|
$7.50 |
$7.50 |
$7.50 |
$63.79
|
|
Iron dextran 50 mg/ml injection solution
|
$44.75 |
$44.75 |
$44.75 |
$80.95
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$143.26 |
$143.26 |
$143.26 |
$187.06
|
|
Irradiation of blood product each unit reference
|
$223.50 |
$223.50 |
$223.50 |
$119.83
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$394.35 |
$394.35 |
$394.35 |
$191.75
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$61.50 |
$61.50 |
$61.50 |
$157.50
|
