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NCH_Charge_Master_1_1_2019
Charge Master Code Description Price
100007 INTUBATION ENDOTRACHEAL EMERGENCY PROCED 639
100008 BLOOD OCCULT PEROXIDASE A CM_CTV QUAL FECES 50
100013 GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC 41
100014 IP IV INFUSION HYDRATION INITIAL 31 MIN-1 H 363
100015 IV INFUSION HYDRATION EACH ADDITIONAL HR 133
100016 IV INFUS THER/PROPHYLAXIS/DX 1ST TO 1HR 402
100017 IV INFUSION THERAPY PROPHYLAXIS/DX EA HR 143
100018 IP THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM 43
100021 INSJ NON-NDWELLG BLADDER CATHETER 182
100022 INSJ TEMP NDWELLG BLADDER CATHETER SIMPL 223
100024 SKIN TEST TUBERCULOSIS INTRADERMAL 44
100025 INCISION & DRAINAGE ABSCESS SIMPLE/SINGL 480
100026 ABDOM PARACENTESIS DX/THER W/O IMAG GUID 809
100032 IV INFUSION THER PROPH ADDL SEQ TO 1 HR 174
200010 FETAL NON STRESS TEST 272
200012 IRRIGATION IMPLANTED VENOUS ACCESS DRUG DELIVERY SYSTEM 117
200015 PRESSURIZED/NON PRESS. INHALATION TREATM 48
200018 FINE NEEDLE ASPIRATION; W/O IMAGING GUID 362
200020 ADMINISTRATION/PNEUMOCOCCAL VACCINE 22
200021 ADMINISTRATION/INFLUENZA VIRUS VACCINE 22
200023 DBRDMT OPEN WOUND EACH ADDL 20 SQ CM 203
200025 DBRDMT EXT ECZEMA/INFE CM_CT SKIN UP 10% BOD 243
200026 PARING/CUTTING B9 HYPERKERATOTIC LES 2-4 108
200027 EXC B9 LESION MRGN SCP SK TG .6-1.0CM 337
200028 ABDOM PARACENTESIS DX/THER W/IMAGING DEV 1478
200030 REMOVAL INTRAUTERINE DEVICE IUD 371
200031 FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR 202
200033 CHANGE CYSTOSTOMY TUBE SIMPLE 282
200040 APPLICATION CAST ELBOW FINGER SHORT ARM 232
200041 OP THER PROPH/DX INJX IV PUSH SINGLE/1ST SBST/DRUG 193
�1
200042 OP THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG 62
200043 OP THER PROPH /DX INJX EA SEQL IV PUSH SBST/DRUG FAC 150
200047 RMVL TUN CVC W/O SUBQ PORT/PMP 747
200048 RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 1096
300001 DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/I 118
300005 INFLUENZA A/B SCR EACH 98
300006 NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH 867
300011 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 345
300012 EXCISION NAIL MATRIX PERMANENT REMOVAL 824
300013 BLDR IRRIGATION SMPL LAVAGE&/INSTLJ 354
300018 INCISION & REMOVAL FOREIGN BODY SUBQ TIS 187
300026 BLOOD OCCULT PEROXIDASE A CM_CT QUAL FECES 1 47
300027 DRS &/ DBRDMT-THKNS BURNS 1ST/SUBQ MEDIU 367
300028 DRS &/ DBRDMT-THKNS BURNS 1ST/SUBQ SMALL 231
300029 DRS &/ DBRDMT-THKNS BURNS 1ST/SUBQ LARGE 545
300031 ARTHROCENTESIS ASPIRI&/INJ INTERM JT/BUR 415
300032 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA 245
300043 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE 43
300053 LARYNGOSCOPY INDIRE CM_CT W/REMOVAL FOREIGN 445
300060 AVULSION NAIL PLATE PARTIAL/COMPLETE SIM 302
300070 WOUND CLOSURE ADHESIVE ONLY (DERMABOND) 351
300079 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< 455
300080 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM 422
300081 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM 448
300082 REPAIR INTERMEDIATE S/A/T/E 12.6-20 CM 509
300083 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM 1162
300086 REPAIR INTERM F/E/E/N/L&/MUC 2.5 CM/< 447
300087 REPAIR INTERM F/E/E/N/L&/MUC 2.6-5.0 429
300088 REPAIR INTERM F/E/E/N/L&/MUC 5.1-7.5 759
300093 CARDIOPULMONARY RESUSCITATION 878
300112 REMOVE FB CONJUN CM_CTIVAL SUPERFICIAL 309
300113 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP 315
300114 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP 352
�2
300115 CLOSED TX RADIAL SHAFT FX W/O MANIPULATI 229
300119 CLOSED TX RADIAL&ULNAR SHAFT FX W/O MANI 492
300122 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHE 223
300126 TRANSFUSION BLOOD/BLOOD COMPONENTS 875
300136 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ 201
300137 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA 470
300139 CLTX HIP DISLOCATION TRAUMATIC W/O ANEST 899
300143 CLOSED TX ANKLE DISLOCATION W/O ANESTHES 474
300145 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS 800
300154 APPLICATION LONG ARM SPLINT SHOULDER HAN 307
300155 APP SHORT ARM SPLINT FOREARM-HAND STATIC 282
300156 APPLICATION FINGER SPLINT STATIC 245
300158 REMOVAL IMPA CM_CTED CERUMEN INSTRUM UNILAT 201
300159 EMERGENCY DEPT VISIT LIMITED/MINOR PROB 266
300160 EMERGENCY DEPT VISIT LOW/MODER SEVERITY 369
300161 EMERGENCY DEPT VISIT MODERATE SEVERITY 612
300162 EMERGENCY DEPT VISIT HIGH/URGENT SEVERIT 991
300163 EMERG DEPT VISIT HIGH SEVERITY/THREAT 1443
300164 CRITICAL CARE ILL/INJUR PT INIT 30-74MIN 791
300165 CRITICAL CARE ILL/INJURED PT ADDL 30 MIN 348
300166 TRAUMA A CM_CTIVATION 1605
300170 APPLIC LONG LEG SPLINT THIGH ANKLE/TOES 302
300171 APPLICATION SHORT LEG SPLINT CALF FOOT 259
300190 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETA 490
300196 CLSD TX SHOULDER DISLC W/MANIPU REQ ANES 1464
300198 REPAIR INTERM N/H/F/XTRNL GENT 2.6-7.5CM 391
300199 CLTX CARPO/METACARPAL DISLOC THUMB WMANI 473
300200 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM 471
300201 TUBE THORACOSTOMY INCLUDES WATER SEAL 610
300209 INJE CM_CTION SINGLE/MLT TRIGGER POINT 1/2 M 490
300210 REMOVAL FOREIGN BODY PHARYNX 309
300211 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH D 1945
300216 CM_CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 394
�3
300217 CM_CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 334
300219 IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT 147
300220 CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/ 697
300221 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELET 1121
300222 CLSD TX SHOULDER DISLC W/MANJ W/O ANES 595
300224 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 136
300225 REPAIR INTERMEDIATE N/H/F/XTRNLGENT 2.5CM/< 550
400003 INCISION & DRAINAGE ABSCESS COMPLICATED/ 484
400005 REMOVAL FB INTRANASAL OFFICE PROCEDURE 352
400006 REMOVAL FB MUSCLE/TENDON SHEATH SIMPLE 422
400013 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE 255
400015 DEBRIDEMENT SUBQ TISSUE ADDL 20 SQ 116
400019 DEBRIDEMENT W/RMVL FM FX& DISLC 1863
400020 DEBRIDEMENT W/RMVL FM FX& DISLC 2298
400021 DEBRIDEMENT OPEN WOUND 20 SQ CM/< 172
400023 DEBRIDEMENT FX/DISLC SUBQ T/M/F BONE 3105
400024 DEBRIDEMENT SUBQ TISSUE 20 SQ CM/< 434
400025 DEBRIDEMENT MUSC FASCIA 20 SQ CM/< 932
400027 SIMPLE RPR SCALP/NECK/AX/GENI/TR 2.5CM/< 317
400028 SIMPLE RPR SCALP/NECK/AX/GE/TR 2.6-7.5CM 350
400029 SIMPLE RPR SCAL/NECK/AX/GE/TR 7.6-12.5CM 411
400030 SIMPLE RPR SCAL/NECK/AX/GE/TR 12.6-20.0C 545
400031 WOUND CLOSURE ADHESIVE ONLY (DERMABOND) 296
400032 SIMPLE REPAIR F/E/E/N/L/M 2.5 CM/< 327
400033 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM 370
400034 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM 444
400058 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM 970
400059 RPR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< 261
400067 TREATMENT CLSD ELBOW DISLOCATION W/O ANE 869
400073 CLOSED TX RADIAL SHAFT FRA CM_CTURE W/MANIPU 1310
400078 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MAN 927
400089 CLTX IPHAL JT DISCL W/MANJ W/O ANES 701
400097 CLTX FX GRT TOE PHLX/PHLG W/MANJ 428
�4
400107 RMVL FB XTRNL AUDITORY CANAL W/O ANES 168
400123 TREATMENT CLSD ELBOW DISLOCATION REQ ANE 1498
400126 CLOSED TX PATELLAR DISLOCATION W/O ANEST 513
400127 CLTX FEM FX DSTL END MEDIA/LAT CON W/MAN 1052
400189 CLTX BIMALLEOLAR ANKLE FRA CM_CTURE W/MANJ 1242
400191 PARING/CUTTING BENIGN HYPERKERATOTIC LES 121
400193 CLTX IPHAL JT DISLC W/MANJ REQ ANES 962
400199 I&D PERIANAL ABSCESS SUPERFICIAL 276
400207 AMP F/TH 1/2 JT/PHALANX W/NEURE CM_CT W/DIR 1913
400214 CLTX METACARPAL FX W/O MANIP EACH BONE 685
400217 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH 575
400218 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER:AGE 5 YEARS OR OLDER669
500002 INITIAL OBSERVATION CARE/DAY 30 MINUTES 282
500004 SBSQ HOSPITAL CARE/DAY 15 MINUTES 153
500006 SBSQ HOSPITAL CARE/DAY 25 MINUTES 217
500007 OBSERVATION/INPATIENT HOSP 40 MINUTES 414
500008 OBSERVATION CARE DISCHARGE MANAGEMENT 226
500010 INITIAL OBSERVATION CARE/DAY 50 MINUTES 384
500012 INITIAL OBSERVATION CARE/DAY 70 MINUTES 482
500016 INITIAL HOSPITAL CARE/DAY 30 MINUTES 305
500017 INITIAL HOSPITAL CARE/DAY 50 MINUTES 412
500018 INITIAL HOSPITAL CARE/DAY 70 MINUTES 608
500020 SBSQ HOSPITAL CARE/DAY 35 MINUTES 316
500023 OBSERVATION/INPATIENT HOSP CARE 50 MINUT 544
500025 OBSERVATION/INPATIENT HOSP CARE 55 MINUT 673
500029 HOSPITAL DISCHARGE MANAGEMENT 30 MIN/< 256
500031 HOSPITAL DISCHARGE MANAGEMENT > 30 MIN 319
500045 NURS FAC DISCHARGE MANAGEMENT 30 MIN 224
500047 NURS FAC DISCHARGE MANAGEMENT >30 MIN 280
500049 E/M NURS FAC ASSESS STABLE 30 MINUTES 277
500087 SBSQ OBSERVATION CARE/DAY 15 MINUTES 101
500088 SBSQ OBSERVATION CARE/DAY 25 MINUTES 193
500089 SBSQ OBSERVATOPM CARE/DAY 35 MINUTES 275
�5
500760 VITAL CAPACITY TOTAL SEPARATE PROCEDURE 72
700009 XR SKELETAL SURVEY 891
800485 EVACUATION OF SUBUNGUAL HEMATOMA 178
800886 DRAINAGE OF FINGER ABCESS 937
1000001 17 HYDROXYCORTICOSTEROID 111
1000004 ALKALINE PHOS ISOENZYMES 104
1000010 21-HYDROXYLASE ANTIBODY 157
1000011 RPR 30
1000013 CHLAMYDIA ANTIBODY IGG 74
1000014 CHLAMYDIA ANTIBODY IGM 64
1000022 EHRLICHIA ANTIBODY 133
1000023 ANTI SMITH ANTIBODY 100
1000025 EBV EARLY AG 96
1000027 CLIN CHEM TEST NOT LISTED 113
1000041 GASTRIN 133
1000051 URINE UREA NITROGEN 60
1000053 PTH INTA CM_CT 249
1000063 PROTEIN ELE CM_CTROPHORESIS SERUM 107
1000064 PROTEIN ELE CM_CTROPHORESIS URINE 117
1000066 PROT ELE CM_CT URINE 34
1000067 FLOW CYTO FIRST MARKER 56
1000068 FLOW CYTO EA ADD'L MARKER 56
1000069 FLOW CYTO INTERP >=16 MKR 172
1000076 5-HIAA 91
1000077 BB TYPING ABO 57
1000078 BB TYPING RH (D) 56
1000079 17 HYDROXYPROGESTERONE 134
1000082 ACE ANGIO CONVERT EN 114
1000088 ADRENOCORTICOTROPIC HOR 200
1000091 ALBUMIN 55
1000092 ALBUMIN BODY FLUID 58
1000094 ALDOSTERONE 204
1000095 ALKALINE PHOSPHATASE 60
�6
1000097 ALUMINUM 124
1000101 AMMONIA 142
1000102 IMMUNOASSAY QUANT OTHER 492
1000103 PHOSPHOLIPID AB 203
1000104 CHLAMYDIA/GC PROBE 261
1000106 AMYLASE 101
1000107 ANA 113
1000108 CULTURE ANAEROBIC 158
1000114 BB ANTIBODY SCREEN 108
1000120 PTT 86
1000121 MITOCHONDRIAL AB (M2) 158
1000122 ANTISTREPTOLYSIN O TITER 82
1000126 BMP 148
1000132 BILIRUBIN DIRE CM_CT 60
1000133 BILIRUBIN TOTAL 60
1000135 MEDICARE DRUG SCREEN (DEFINITIVE) 168
1000136 ALCOHOL (ETOH) 168
1000137 CULTURE BLOOD 170
1000138 LYME DISEASE B BURGDORF 201
1000139 BRUCELLA ANTIBODY 113
1000140 BUN 55
1000141 EIA QL SEMI QUANT MULTI 128
1000142 EIA QL CDIFF TOXIN MULTI 140
1000143 C-REA CM_CTIVE PROTEIN 82
1000144 C-PEPTIDE 114
1000145 CRP CARDIO 107
1000146 CA 125 68
1000147 ALPHA FETO PROTEIN 144
1000148 CA 15-3 150
1000149 CA 19.9 147
1000151 CALCITONIN 165
1000152 CALCIUM 57
1000153 CO2 46
�7
1000154 CARBON MONOXIDE 118
1000155 BRCA1 2766
1000156 BRCA2 2766
1000159 LEUKOCYTE ANTIBODY ID 174
1000160 URINE MICRO ONLY 42
1000161 URINE CATECHOLAMINES 172
1000162 CBC WITH PLATELETS REFLEX 79
1000163 CBC AUTO DIFF REFLEX 98
1000164 CEA 167
1000166 CERULOPLASMIN 91
1000167 COMPLEMENT TOTAL CH50 161
1000168 ASPERGILLUS GALA CM_CTOMANNAN AG 54
1000169 CALPROTE CM_CTIN FECES 89
1000170 CHLORIDE 46
1000171 CHOLESTEROL TOTAL 57
1000173 HERPES VIRUS 6 AB 346
1000174 CK(TOTAL) 82
1000175 CKMB 136
1000177 PARVOVIRUS AB 120
1000179 CMV AB IGG 113
1000180 CMV AB IGM 120
1000181 CMV UBS SCREEN 94
1000185 CMP 196
1000188 TRANSFERRIN 105
1000190 CORTISOL 148
1000194 CREATININE 59
1000195 URINE CREATININE RANDOM 60
1000196 URINE CREAT CLEARANCE 123
1000201 FUNGUS CULTURE 89
1000205 CYCLOSPORINE 182
1000208 D-DIMER 152
1000210 DHEA 167
1000211 DHEA-S 164
�8
1000213 MANUAL DIFFERENTIAL REFLEX 47
1000214 DIGOXIN 135
1000215 PHENYTOIN 146
1000219 DNA AB (DOUBLE STRAND) 120
1000226 GLUCOSE POST DOSE 62
1000236 EBV VCA IGG 113
1000238 EBV NUCLEAR AG 96
1000239 ERYTHROPOIETIN 67
1000240 ESR-SED RATE AUTOMAT 59
1000241 ESR-MANUAL 59
1000242 ESTRADIOL 194
1000243 ESTROGEN FRA CM_CTIONATED 165
1000245 ESTRONE 129
1000246 ETHOSUXIMIDE 144
1000249 COAG FA CM_CTOR VIII 208
1000250 FECAL FAT QUANTITATIVE 157
1000252 FECAL FAT QUALITATIVE 62
1000253 FERRITIN 131
1000262 FOLATE 126
1000265 FSH (FOLLICLE STIM HORM) 157
1000266 CRYPTOSPORIDIUM AND GIARDIA 146
1000267 FTA-ABS 92
1000268 CULTURE FUNGUS SKIN HAIR NAIL 104
1000269 CRYPTOSPORIDIUM AG EIA 90
1000270 THYROID STIMULATING IMMUNOGLOBINS 282
1000271 CYTOLOGY 190
1000276 GENTAMICIN LEVEL 164
1000277 GGT 77
1000278 ENTAMOEBA HISTOLYTICA AG 70
1000279 GIARDIA AG EIA 103
1000281 GTT 3 SPECIMENS 138
1000282 GTT EACH >3 SPECIMENS 44
1000285 GLUCOSE FINGER STICK 35
�9
1000287 GLUCOSE AUTOMATED 54
1000288 BODY FLUID PH 47
1000289 SODIUM OTHER SOURCE 56
1000291 GROWTH HORMONE (HGH) 112
1000292 H PYLORI 96
1000293 H PYLORI STOOL 149
1000296 HEP B CORE ANTIBODY 105
1000297 HEP B SURFACE ANTIGEN 100
1000298 HCG QUAL (SERUM) 112
1000299 HCG QUANTITATIVE 177
1000301 HEP C VIRAL LOAD 411
1000302 HDL DIRE CM_CT 77
1000303 ARSENIC 103
1000304 HEMATOCRIT 37
1000305 HEMOGLOBIN 37
1000306 HEMOGLOBIN A1C 98
1000307 HEMOGLOBIN S 101
1000315 HEP C VIRUS GENOTYPE 890
1000316 HEP C ANTIBODY 135
1000317 HEP C RIBA CONFIRMATORY 239
1000321 HEP A ANTIBODY IGM 106
1000322 HEP A ANTIBODY IGG/IGM 96
1000323 CADMIUM 204
1000324 HEP B SURFACE ANTIBODY 105
1000325 ACUTE HEPATITIS PANEL 365
1000326 HSV AB TYPE 1 82
1000328 HIV 1/2 CONFIRMATORY 168
1000333 HOMOCYSTEINE 154
1000334 HSV BY PCR 226
1000335 HEP B SURF AB QUANT 146
1000336 CHROMOGRANIN A 185
1000338 VITAMIN D 1.25 DEHYDROXY 239
1000339 IMMUNOGLOBULIN 94
�10
1000340 IMMUNOGLOBULIN E 123
1000342 IGF-1 SOMATOMEDIN 172
1000346 INSULIN 100
1000352 IRON 72
1000353 IB CM_CT 76
1000356 CLOBAZAM 117
1000357 LACOSAMIDE 219
1000358 OXCARBAZEPINE 157
1000359 LEVETIRACETAM 196
1000362 ENDOMYSIAL ANTIBODIES IGA 89
1000363 ALLERGY PANEL E-95 712
1000364 LDH 71
1000366 LDL DIRE CM_CT 73
1000367 LEAD 85
1000368 COPPER SERUM 29
1000373 LIPASE 104
1000375 LIPID PANEL 148
1000377 LITHIUM 90
1000378 HEPATIC FUN CM_CTION PANEL 147
1000382 MAGNESIUM 82
1000383 RUBELLA IGG OR IGM EACH 93
1000384 MERCURY 96
1000385 METANEPHRINE 182
1000389 METHYMALONIC ACID 179
1000390 MICROALBUMIN 81
1000393 MONOSPOT 82
1000394 MUMPS IGG OR IGM (EA) 96
1000396 MYCOPLASMA IGG OR IGM 105
1000398 MYOGLOBIN 125
1000401 NICOTINE 245
1000404 PORPHYRINS TOTAL PLASMA 37
1000405 PORPHOBILINOGEN URINE 51
1000406 XXX OBSTETRIC PANEL 250
�11
1000407 OCB GUAIAC CANCER SCR 45
1000409 OSMOLALITY BLOOD 89
1000413 BB PACKED RBC UNIT 610
1000416 PERIPHERAL SMEAR/PAT 41
1000419 BODY FLUID CELL COUNT 111
1000420 BODY FLUID GLUCOSE 70
1000423 PHENOBARBITAL 146
1000425 PHOSPHORUS 60
1000430 PLATELET COUNT AUTOMATED 60
1000434 POTASSIUM 55
1000435 PREALBUMIN 108
1000436 BNP 227
1000438 PROGESTERONE 150
1000439 PROLA CM_CTIN 174
1000444 COCCIDIOIDES AB 148
1000445 PT/INR 62
1000447 PSA TOTAL (SCREENING) 142
1000449 Q FEVER IGG/IGM (X2) 118
1000450 PSA TOTAL AND FREE 264
1000451 RICKETTSIA ROCKY MTN IGM 104
1000455 RBC AUTOMATED 30
1000456 RENAL FUN CM_CTION PANEL 154
1000457 BMP ISTAT 148
1000458 RENIN A CM_CTIVITY 134
1000460 XXX RETICULOCYTE COUNT MANUAL 62
1000461 VITAMIN A 80
1000462 HEMOGLOBIN ELE CM_CTROPHORESIS 124
1000463 RHEUMATOID FA CM_CTOR 74
1000464 THIAMIN 400
1000465 RISTOCETIN COFA CM_CTOR(VIII) 174
1000469 RSV 142
1000470 RUBEOLA IGG OR IGM (EA) 100
1000471 ARGININE VASOPRESSIN 291
�12
1000473 SALICYLATE 134
1000476 SEMEN PRESENCE OF SPERM 81
1000477 ROTAVIRUS AB 138
1000479 AST 62
1000480 ALT 62
1000484 SODIUM 54
1000487 STONE ANALYSIS (CALCULUS) 112
1000488 CULTURE STOOL 128
1000490 OVA & PARASITES 192
1000494 PEMPHIGOID BMZ IGG & IGA 190
1000496 BODY FLUID PROTEIN 78
1000498 THYROID FREE T3 151
1000499 THYROID T3 REVERSE 129
1000500 THYROID T3 TOTAL 129
1000501 THYROID T3 UPTAKE 81
1000502 URIC ACID OTHER SOURCE 61
1000503 THYROID FREE T4 114
1000504 URINALYSIS MISC 42
1000505 THYROID T4 TOTAL 86
1000506 URINE BA CM_CTERIA SLIDE SCRN 61
1000507 CARBAMAZEPINE (TEGRETOL) 156
1000508 TESTOSTERONE TOTAL 181
1000509 THEOPHYLLINE 134
1000513 THYROID TBG 105
1000517 PROTEIN TOTAL 56
1000523 HLA-DQB1 187
1000524 TRIGLYCERIDES 67
1000527 TROPONIN-I 207
1000528 BB TYPE AND SCREEN 217
1000529 THYROID TSH 152
1000530 BB ABO RH 109
1000531 URIC ACID 61
1000532 UA DIP (MANUAL) 31
�13
1000533 URINE CALCIUM 43
1000534 DIRE CM_CT COOMBS TEST 45
1000535 BB CROSSMATCHING 217
1000536 STOOL SMEAR WBC 60
1000537 UA DIP W/MICRO (MANUAL) 45
1000539 CULTURE URINE 105
1000540 PREGNENALONE 124
1000545 URINE POTASSIUM 62
1000546 URINE SODIUM 64
1000548 OSMOLALITY URINE 86
1000550 VALPROIC ACID 149
1000551 VANCOMYCIN 165
1000553 VZV IGG OR IGM (EACH) 107
1000555 SYPHILIS TEST NON TREP QU 61
1000558 VITAMIN B 12 131
1000559 VITAMIN B 6 152
1000560 VITAMIN D 25 HYDROXY 192
1000561 VANILLYLMANDELIC ACID UR 109
1000562 CULTURE VIRAL NONRESPIRATORY 202
1000563 FA CM_CTOR VIII VONWILLEBRAND 340
1000564 WET PREP (SAL- KOH) 62
1000565 WBC AUTOMATED 43
1000566 URINE CHLORIDE 62
1000567 ZINC 88
1000576 ELE CM_CTROLYTE PANEL 106
1000577 SUSCEPT AGAR DILUTION 48
1000579 UA W/MICRO (AUTO) REFLEX 70
1000580 URINE PHOSPHORUS 56
1000583 VITAMIN K 209
1000585 T CELL ABSOLUTE CD4 COUNT 151
1000586 THYROID PEROXIDASE AB 106
1000589 SIROLIMUS (RAPAMURE) 167
1000590 TACROLIMUS 207
�14
1000591 SUSCEPT DISK ID 78
1000592 SUSCEPT ENZ DETE CM_CTION 88
1000594 HIV-1 112
1000595 ALDOLASE 105
1000596 LH (LEUTINIZING HORMONE) 156
1000598 URINE PROTEIN 70
1000599 HIV 1/2 SCREEN 123
1000601 HUMAN METAPNEUMOVIRUS 108
1000602 RESPIRATORY SYNCYTIAL VIRUS 98
1000603 ADENOVIRUS 98
1000604 TESTOSTERONE FREE 159
1000605 LAMOTRIGINE 149
1000608 INFLUENZA B 98
1000609 INFLUENZA A 98
1000610 PARAINFLUENZA 98
1000613 HIV-1 VIRAL LOAD 434
1000615 RESPIRATORY VIRAL PANEL ASSAY 172
1000621 PSA FREE 118
1000622 SLIDE REVIEW BLOOD 34
1000623 STAIN SMEAR GRAM-WRIGHT 61
1000624 ACID FAST BACCILI CULTURE 138
1000625 XXX FOOD ALLERGY (DONT USE) 7
1000626 ACID FAST BACILLI STAIN 64
1000629 GC/CHLAMYDIA URINE 300
1000630 XXX GONORRHEA URINE 149
1000635 IMMUNOFIXATION URINE 162
1000637 LA CM_CTATE 124
1000639 CULTURE URINE 81
1000642 HSV AB NON SPECIFIC-CRMC 95
1000644 THYROID THYROGLOBULIN AB 101
1000647 GC/CHLAMYDIA SWAB 150
1000649 KOH PREP SKIN HAIR NAIL 59
1000650 THYROID THYROGLOBULIN TUM 114
�15
1000655 SENSITIVITY TEST 100
1000656 ID AEROBIC DEFINITIVE 74
1000659 ANDROSTENEDIONE SERUM 146
1000660 HIV-1 PCR 300
1000661 STREP A RAPID TEST 85
1000662 ARTERIAL BLOOD GAS 241
1000665 OCCULT BLOOD RF 47
1000666 UA DIP (AUTO) REFLEX 46
1000667 CALCIUM IONIZED 114
1000668 OCB GUAIAC OTHER SOURCE 55
1000700 CORTISOL FREE SERUM 137
1000709 ID ANAEROBIC 91
1000710 HSV AB TYPE 2 91
1000713 STOOL ELASTASE 288
1000715 TULARENSIS ANTIBODY 160
1000716 LEGIONELLA ANTIBODY 95
1000720 ASSAY OF SEROTONIN 163
1000722 SEX HORMONE BIND GLOBULIN 101
1000723 LEPTOSPIRA ANTIBODY 114
1000724 WEST NILE VIRUS IGM 107
1000725 WEST NILE VIRUS IGG 111
1000727 ID FUNGUS 88
1000728 ANA TITER 104
1000729 RETICULOCYTE COUNT AUTO 62
1000734 VITAMIN D 25 MASS SPEC 169
1000737 URINE HOMOVANILLIC ACID 101
1000739 CULTURE STL EA ADD' PATH 60
1000740 CDIFF 143
1000741 ID YEAST 91
1000742 PCR 258
1000753 IDTYPING IMMUNOLOGIC METH 48
1000755 BODY FLD CELL CM_CT W DIFF 106
1000756 CYCLIC CITRULLINATED PEPTIDE 125
�16
1000758 OVA & PARASITE STAIN 86
1000762 LA CM_CTOFERRIN (STOOL WBC) 96
1000764 CULTURE FUNGUS BLOOD 141
1000765 IMMUNOFIXATION SERUM 158
1000773 XYLOSE ABSORPTION 86
1000800 VITAMIN E 95
1000811 SERUM FREE LIGHT CHAIN 129
1000813 BETA 2 MICROGLOBULIN 143
1000901 COLLE CM_CTION DOT 45
1000902 COLLE CM_CTION NON-DOT 30
1000903 DRAW FEE ARTERIAL 78
1000904 DRAW FEE CAPILLARY 24
1000905 DRAW FEE CATHETER 60
1000906 DRAW FEE VENOUS 24
1000907 DNA SWAB COLLE CM_CT LABCORP 48
1000908 SPECIMEN HANDLING FEE 35
1000911 URINE TIMED VOLUME 26
1000912 SYNOVIAL FLUID CRYSTALS 77
1000913 HE4 43
1000914 DARKFIELD EXAM NO COLLE CM_CT 22
1000916 CONCENTRATE INF AGENT 49
1000918 CULTURE WOUND 168
1000920 LISTERIA AB BY CF 24
1000921 IGG SUBCLASSES 155
1000922 PSA MEDICARE/AID 177
1000923 CULT ANAER BA CM_CTERIAL 182
1000924 SHIGA TOXIN 2 107
1000925 CULTURE SCREEN GRP B STREP 127
1000926 CITRATE URINE 240
1000927 INSULIN FREE 137
1000928 HFE GENE ANALYSIS 30
1000929 FA CM_CTOR V LEIDEN 157
1000931 PROTHROMBIN G20210A MUTAT 210
�17
1000932 CYSTIC FIBR MUT ANALASIS 302
1000933 PML/RARA QUANT PCR 1077
1000934 FRAGILE X SYNDROME 554
1000935 ALPHA 1 ANTITRYPSIN DEF 124
1000936 ALPHA 1 ANTITRYPSIN DEF 124
1000937 ALPHA 1 ANTITRYPSIN DEF 124
1000938 MTHFR C677T MUTATION 274
1000939 QUAD SCREEN 2ND TRIMESTER 103
1000940 JAK2 GENE V617F MUTATION 255
1000943 RABIES RFFIT TITER 576
1000945 URICULT 98
1000946 HAPTOGLOBIN 114
1000949 COAGULATION FA CM_CTOR V ASSAY 113
1000980 VON WILLEBRAND FA CM_CTOR MULTIMER 228
1000981 DOPAMINE RECEPTOR D4 GENOTYPE 1088
1000982 URINE TOX SCREEN 157
1000983 URINE TOX SCREEN (MEDICAL) 172
1000984 LEGIONELLA ANTIGEN URINE 53
1000985 HEPATITIS B DNA QUANTITATIVE 185
1000986 METHEMOGLOBIN 34
1000988 PRIMIDONE 148
1000989 HEPARIN XA ASSAY LMW 152
1000994 HLA B27 163
1000995 ROTAVIRUS STOOL 112
1000996 C2 COMPLEMENT FUNCTIONAL 124
1000998 INFLUENZA IAADIADOO 49
1000999 ANCA TITER 112
1001011 CYTOLOGY BODY FLUID 290
1001017 INHIBINA 100
1001019 PROTEIN S ACTIVITY 242
1001020 PROTEIN C ACTIVITY 202
1001021 ANTI THROMBIN ANTIGEN 153
1001022 CHRONIC LYMPHOCYTIC LEUKEMIA, FISH 150
�18
1001023 GLUTAMIC ACID DECARBOXYLASE 121
1001024 CRYOGLOBULIN 83
1001025 CRYOFIBRINOGEN 89
1001026 VIT B3 NIACIN 54
1001027 T CELLS TOTAL COUNT 132
1001030 CK ISOENZYMES 101
1001031 INTERPRETATION AND REPORT CYTO 122
1001033 APOLIPOPROTEIN B 187
1001034 LIPOPROTEIN A 66
1001035 NMR LIPOPROTEIN W/IR MARKERS 234
1001036 ROHYPNOL 200
1001040 PATERNITY TESTING COLLECTION 45
1001045 BARTONELLA ANTIBODY PANEL 356
2000010 SPIROMETRY W/GRAPH 282
2000011 CPAP 551
2000013 MAX BREATHING CAPACITY 158
2000016 SPIROMETRY PRE/POST BROCHO TREAT 535
2100001 PT ELECTRICAL STIMULATION MANUAL/15 53
2100002 OT ELECTRICAL STIMULATION MANUAL/15 53
2100003 OT GAIT TRAINING/15 75
2100004 OT MECHANICAL TRACTION 51
2100005 OT MANUAL THERAPY/15 65
2100007 PT ADL/15 77
2100020 PT EVALUATION LOW 20 MIN 172
2100023 PT FUNCTIONAL ACTIVITY/15 74
2100024 PT GAIT TRAINING/15 MIN 75
2100025 PT EVALUATION MODERATE 30 MIN 172
2100026 PT EVALUATION HIGH 45 MIN 172
2100027 PT RE EVALUATION 20 MIN 117
2100034 PT MECHANICAL TRACTION 51
2100035 PT MANUAL THERAPY/15 65
2100038 PT NUEROMUSC RE-ED/15 83
2100041 OT ADL/15 77
�19
2100045 OT FUNCTIONAL ACTIVITY/15 74
2100047 OT NEUROMUS RE-ED/15 83
2100051 OT THERAPEUTIC EXERCISE/15 85
2100052 OT ULTRASOUND/15 MIN 52
2100064 PT THERAPEUTIC EXERCISE/15 85
2100065 PT ULTRASOUND/15 MIN 52
2100097 OT RE EVALUATION 30 MIN 110
2100098 OT EVALUATION HIGH 60 MIN 167
2100099 OT EVALUATION MODERATE 45 MIN 167
2100100 OT EVALUATION LOW 30 MIN 167
2100111 PT SWALLOW STUDY 493
2100115 ST SWALLOW TREATMENT 252
2190420 EVAL SPEECH SOUNDS PRODUCT LANG COMP 709
2190421 GN TX SPEECH LANG VOICE COMMJ & AUDITORY 186
3000003 ABD PADS 8 X 10 10
3000028 SALEM SUMP ANTI REFLEX VALVE 43.75
3000062 FOLEY CATH HOLDER 10
3000078 COBAN 4 X 5 YD 14
3000079 COBAN 6 X 5 YD 20
3000094 ENEMA BUCKET 16
3000095 EPISTAXIS CATHETER KIT 770
3000100 CATHETER KIT FEMALE 34
3000115 FOLEY CATHETER 22 FR 52
3000120 GAUZE STERILE 3 X 3 12 PLY (2/PK) 10
3000124 GRADUATE CONTAINER 10
3000127 HEALING SHOE SM WOM 60
3000137 IRRIGATION TRAY 12
3000152 DUO-THERM PAD 14 X 20 77
3000153 KERLIX 4.5 X 4.1 YD 10
3000165 GASTRIC LAVAGE KIT W/SPIKE 553
3000168 LEG BAG 1000 ML 28
3000181 MORGAN LENSES 275
3000183 DRAPE NON FENESTRATED 10
�20
3000184 SODIUM CHLORIDE 1000 ML 33
3000195 NU GAUZE PLAIN 1/4 X5' 33
3000205 RHINO ROCKET SLIM/XLG 150
3000207 RIB BELT WOMEN 77
3000212 SCOTCH CAST 3 64
3000218 STERISTRIP 1/2 X 4 10
3000219 STERILE WATER 1500ML 22
3000222 STERISTRIP 1/4 X 4 12
3000223 ANKLE SPRT STIRRUP REGULAR, LT 232
3000226 SUCTION CANISTER DISPOSABLE 26.25
3000236 SUTURE DERMABOND DB1 224.75
3000247 SUTURE PROLENE 6-0 P -1 DO NOT REORDER 131
3000265 THORACIC CATHETER 36FR 67
3000275 ENDO TRACH TUBE 6.5 UC 12
3000286 UNNA BOOT 105
3000291 URETHRAL CATH TRAY 22
3000304 ADAPTIC 5 X 9 13
3000307 YANKAUER SU CM_CTION 21
3000332 ORTHO GLASS 5 51
3000338 STRETCH BANDAGE NS 6 X 82 10
3000359 TED HOSE KNEE XLG 43
3000361 TED HOSE THIGH MED 106
3000362 TED HOSE KNEE LG REG 62
3000380 SUCTION TUBING NS 17
3000382 SODIUM CHLORIDE 500ML 12
3000390 SUTURE PROLENE 4-0 PS-2 DO NOT REORDER! 112
3000394 SUTURE ETHILON 3-0 FS-1 DO NOT REORDER! 17
3000402 STYLET 10 FR 41
3000403 SUCTION CATHETER 12FR 18
3000405 O2 TUBING 7 10
3000406 AEROSOL MASK ADULT 10
3000407 O2 CANNULA ADULT 7' 10
3000418 SPLASH GUARD - ZEROWET 18.25
�21
3000422 ADAPTIC 3 X 3 10
3000425 O2 CANNULA 25 28.25
3000428 HUMIDIFIER DISP 14
3000447 PERI WASH BOTTLE 16
3000455 O2 MASK SIMPLE ADULT 10
3000456 O2 MASK SIMPLE INF 39
3000457 O2 MASK NON REBREATHER 18
3000478 SUTURE VICRYL 3-0 32
3000493 O2 SENSOR PREMIE 126
3000496 O2 SENSOR INFANT I-20 163.75
3000497 O2 SENSOR PED D20 135
3000511 CRUTCHES CHILD 14
3000513 STERILE WATER 500ML 11
3000516 SKIN STAPLER DS-15 71.5
3000519 NASOPHARYNGE AIRWAY 34 FR 35
3000528 ABDU CM_CTION FINGER SPLINT- XLG. 109
3000540 SUTURE ETHILON 6-0 PS-3 DO NOT REORDER! 96
3000553 O2 CANNULA PED 16
3000572 CERVICAL COLLAR PHIL LG 228
3000574 THORACIC CATHETER 40FR 73
3000575 SPIROMETER 28.5
3000587 PEAK FLOW METER 103
3000591 SUTURE MASTISOL 18
3000596 BAIR HUG BLANKET UP BODY 64
3000597 BAIR HUG BLANKET LOW BODY 108
3000608 OPTIHALER SPACER MD1 55
3000628 O2 CANNULA NASAL 7 INFANT 18
3000649 WOUND CLOSE FORCEPS 29
3000650 ELASTOPLAST 4 56
3000658 SUTURE ETHILON 3-0 PS-1 34
3000675 URINARY DRAIN BAG ANTI REFLUX 2000 ML 61
3000678 TOOMEY SYRINGE 39
3000681 SUTURE ETHILON 4-0 FS-2 16
�22
3000686 SUTURE VICRYL 3-0 PS2 34
3000689 SUTURE ETHILON 5-0 PS-3 137
3000697 SUTURE PLAIN GUT FST 6-0 64.5
3000720 NEBULIZER PEDIATRIC 68
3000729 NEBULIZER HI FLOW 59
3000730 MASK BI-FLO PED 24
3000731 O2 MASK BI- FLOW ADULT 20
3000736 FINGER SPLINT FROG SM 16
3000738 FINGER COT PADDED SM 20
3000759 KLING BANDAGE 4 X 75 STERILE 10
3000769 KANGAROO PUMP SET 48
3000773 THUMB SPIKA RT LG 164
3000782 QUIK COMBO READY PAK ADULT 513.75
3000793 ENDO TRACH TUBE 6.0 UC 15
3000795 ET TUBE HOLDER INFANT 93
3000797 C-COLLAR LAERDAL CHILD 88
3000798 ARM SLING ADULT LG 26.75
3000801 FOLEY TRAY 8FR PED 120
3000819 VENTILATION CIRCUIT 72
3000820 QUIK COMBO REDI PAK PED 488
3000833 OXYGEN PER DAY 441
3000834 OXYGEN PER HOUR 14
3000841 KNEE IMMOBILIZER MED 20 172
3000845 KNEE SPORTS BRACE SM 215
3000861 SHOE HORN 24 29
3000870 BATH SPONGE LONG HANDLE 35
3000873 COVADERM DRESSING 4 X 4 13
3000886 CHEST DRAIN VALVE 223
3000892 OXYGEN NOSE CLIPS LATEX FREE 10
3000901 ANKLE SUPPORT XXLG 41
3000903 INTRODUCER INTUBATOR ADULT MALLEABLE 67
3000909 SUTURE SOFSILK SIZE 0 72
3000914 DUODERM EXTRA THIN 4 X 4 20
�23
3000915 ANOSCOPE SPECULA DISP 15
3000916 SUTURE ETHILON 3-0 PS-2 33
3000920 MASK BI-PAP LG 192
3000921 CUSHION PRESSURE W/COVER 14.25
3000923 LARYNGOSCOPE GLV-3 169.25
3000924 KING LTSD KIT SIZE 4 441
3000929 COUDE CATH FOLEY 16FR 120
3000931 SAFETY SCAPEL #10 DISP STERILE 16
3000932 SAFETY SCAPEL #15 DISP STERILE 15.75
3000933 SAFETY SCAPEL #11 DISP STERILE 16
3000937 FLEXIBLE SOCK & STOCKING AID 139.75
3000939 PLEURAGUIDE DISP CHEST TUBE KIT 694
3000940 ACAPELLA FLUTTER-VALVE BLUE 432.25
3000941 ACAPELLA FLUTTER-VALVE GREEN 623.25
3000942 THORACIC CATHETER 12FR 37.5
3000943 THORACIC CATHETER 16FR 39
3000944 THORACIC CATHETER 20FR 39
3000945 REACHER, 31 BLUE 152.25
3000947 SURESITE 123 DRESSING 4 X 4.8 10
3000948 XTRAXORB SUPER ABSORB STERILE 4 X 5 37
3000950 MEDI HONEY NON-ADHESIVE HCS 4.3 X 4.3 84.5
3000951 MEDI HONEY CALCIUM ALGINATE 40
3000952 MEDI HONEY ADHESIVE HCS 2.8 X 2.8 48
3000954 MEPILEX HEEL FOAM DRESSING 5 X 8 71.75
3000956 RANGER PED/NEONATE DISP FLUID WARMING ST 256
3000957 RANGER STAND FLW DISP FLUID WARM ST W/EX 104.25
3000958 RANGER HIGH FLOW DISP FLUID WARM SET 567
3000959 SURGICAL AIRWAY KIT 343
3000960 LARYNGOSCOPE GVL-0 179
3000961 LARYNGOSCOPE GLV-1 179
3000962 LARYNGOSCOPE GLV-2 179
3000965 INSTANT COLD PACK 10.5
3000966 KING LTSD KIT SIZE 3 441.25
�24
3000967 KING LTD KIT SIZE 2 387
3000968 GLOVES 6.5 SENSICARE STERILE SURG 19
3000969 GLOVES 7 SENSICARE STERILE SURG 19
3000970 GLOVES 7.5 SENSICARE STERILE SURG 22.5
3000971 GLOVES 8 SENSICARE STERILE SURG 19
3000972 GLOVES 8.5 SENSICARE STERILE SURG 19
3000977 SUTURE CHROMIC 4-0 27 REVERSE CUTTING 28
3000978 SUTURE CHROMIC 5-0 27 REVERSE CUTTING 31
3000979 SCOTCHCAST PLUS CAST TAPE 2 X 4YD 21
3000980 SCOTCHCAST PLUS CAST TAPE 3 X 4YD 27
3000981 SCOTCHCAST PLUS CAST TAPE 4 X 4YD 27
3000982 LMA UNIQUE SIZE 1.5 79
3000984 LMA UNIQUE SIZE 4 79
3000985 ENDO TRACH TUBE 5.5 UC 12
3000986 ENDO TRACH TUBE 6.5 CUFF 12
3000987 LMA UNIQUE SIZE 1 78
3000990 SPECULUM VAGINAL SMALL BUILT IN LIGHT 51
3000991 SPECULUM VAGINAL MEDIUM BUILT IN LIGHT 51
3000992 SPECULUM VAGINAL LARGE BUILT IN LIGHT 51
3000993 ENDO TRACH TUBE 3.5 UC 12
3000994 SPECIMEN PAN 10
3000995 COBAN 1 10
3000996 ANKLE WALKER SM STANDARD 248
3001004 BAIR HUG BLANKET TORSO 64
3001005 DUO-THERM PAD 18 X 24 77
3001009 EMESIS BASIN 10
3001010 WRIST SPLINT 8 LT MED 91
3001012 STERILE WATER 1000ML 16
3001013 LUMBOSACRAL SUPPORT MD 187
3001014 FRACTURE PAN 12
3001015 RESUSCITATION ADU (HUD) 280.75
3001017 THORACENTESIS TRAY 246
3001018 ENDO TRACH TUBE 3.0 UC 11
�25
3001019 ENDO TRACH TUBE 4.5 UC 10.25
3001020 ENDO TRACH TUBE 9.0 CUFF 15
3001022 TRACH TUBE DIC 7.0 236
3001023 SUTURE CHROMIC 3-0 27 REVERSE CUTTING 28
3001024 INTRODUCER INTUBATOR BOUGIE COUDE TIP 61.24
3001025 AIRWAY ORAL 100 MM 10
3001026 DIAGNOSTIC PEN 85
3001027 SCOTCHCAST PLUS 5 81
3001029 EYE PADS SM OVAL 10
3001032 ET TUBE HOLDER PEDIATRIC 72
3001033 CATHETER STABILIZATION DEVICE 12
3001034 DELEE SUCTION TUBE 10 FR 20
3001035 ENDO TRACH TUBE 4.0 UC 10.75
3001036 ENDO TRACH TUBE 5.0 UC 11
3001037 ENDO TRACH TUBE 5.5 CUFF 15
3001038 ENDO TRACH TUBE 8.5 CUFF 15
3001042 O2 CAPNOLINE 18
3001043 STERILE WATER 500ML *B BRAUN* 20.05
3001045 THORACIC CATHETER 24FR 37
3001046 THORACIC CATHETER 32FR 37
3001047 THORACIC CATHETER 28FR 37
3001048 CATHETER FOLEY 3 WAY 35
3001050 LARYNGOSCOPE BLADE MIL 0 DISP 94
3001051 LARYNGOSCOPE BLADE MIL 1 DISP 94
3001052 LARYNGOSCOPE BLADE MIL 2 DISP 101.5
3001053 LARYNGOSCOPE BLADE MIL 3 DISP 94
3001054 LARYNGOSCOPE BLADE MIL 4 DISP 94
3001055 LARYNGOSCOPE BLADE MAC 1 DISP 101.5
3001056 LARYNGOSCOPE BLADE MAC 2 DISP 94
3001057 LARYNGOSCOPE BLADE MAC 3 DISP 101.5
3001058 LARYNGOSCOPE BLADE MAC 4 DISP 101.5
3001060 ARGYLE SALEM SUMP 24
3001062 SODIUM CHLORIDE 500ML *B BRAUN* 14
�26
3001064 SUCTION TRANSFER TUBING 18
3001065 ENDO TRACH TUBE 5.0 CUFF 15
3001066 ENDO TRACH TUBE 7.0 CUFF 34.75
3001068 LMA MAD NASAL 65.75
3001069 SPLINT SAM ORANGE / BLUE STANDARD 36 RL 99.5
3001070 INSTANT HOT PACK 30.25
3001071 AIRWAY ORAL 50 MM 10
3001072 AIRWAY ORAL 60 MM 10
3001078 AIRWAY ORAL 40 MM 10
3001079 AIRWAY ORAL 70 MM 10
3001080 URINE STRAINER 10
3001082 LMA UNIQUE SIZE 3 77.5
3001083 CATHETER PLUG 10
3001084 SMART CAPNOLINE PLUS ADULT/INTERMEDIATE CO2 147.15
3001085 TED HOSE KNEE 2XL 33.75
3001086 THORA - PARA TRAY 292
3001088 DRESSING GEL FIBER OPTICELL 2 X 2 21.25
3001093 PORTA CATH KIT 10
3001094 IODOFORM PACKING STRIPS 1/4" X 15' 17
3001096 HEEL RAISER PRO II HEEL PROTECTOR 315
3001097 STOCKINGNET 2 10
3001098 BANDAGE TUBULAR MEDIGRIP SIZE F 1 YD 45.75
3001099 STOCKINGNET 1 10
3001100 STOCKINGNET 3 10
3001101 STOCKINGNET 4 10
3001103 YANKAUER SUCTION W/ VENT 22.25
3001105 PESSARY RING W/SUPPORT SIZE 3 378
3001107 WATER/GEL FILLED WHEELCHAIR CUSHION 289.25
3001110 NEEDLE DECOMPRESSION 10G X 3.25" 151.75
3001112 TOURNI-COT FINGER/TOE MIXED BOX 48
3001113 GEL MEDIHONEY 1.5 OZ TUBE 107.5
3001114 SAM PELVIC SLING II 574.25
3001115 NASOPHARYNGE AIRWAY 14 FR 89.5
�27
3001116 NASOPHARYNGE AIRWAY 18 FR 89.5
3001117 NASOPHARYNGE AIRWAY 20 FR 48
3001118 NASOPHARYNGE AIRWAY 24 FR 91.25
3001119 NASOPHARYNGE AIRWAY 26 FR 89.5
3001120 LABOR & DELIVERY SURGICAL TRAY STERILE 262.5
3001121 BEDPAN BARIATRIC 35.87
3001122 POLIGRIP SUPER DENTURE ADHESIVE CREAM 2.4OZ 5.85
3001124 NASAL PACKING WITH STRING 4.5CM 44.75
3001125 LARYNGOSCOPE GVL-2.5 211.5
3001126 ISOLATION - SURGICAL GOWNS STERILE 24.75
3001128 FOAM LIMB HOLDER 32
3001129 SILICONE 18 FR 2-WAY CATHETER 91.5
3001131 CANISTER 500ML WITH GEL FOR INFOVAC 339.75
3001132 DRESSING MEDIUM VAC GRANUFOAM 404.75
3001133 DRAPE VAC KCI 30.5CM X 26CM 63.25
3001134 TED HOSE THIGH X-LARGE REGULAR 80
3001135 PLEURAGUIDE DISPOSABLE CHEST TUBE KIT W/OUT LIDOCAINE 728.25
3001136 STYLET PEDIATRIC GLIDERITE SINGLE USE 59.5
3001138 TUBING W/ CLAMP & CONNECTOR FOR WOUND VAC 168.5
3001139 BANDAGE SURGITUBE SZ 1 5/8" X 50Y 10
3001793 SUTURE ETHILON 5-0 P-3 126.25
3001794 SUTURE VICRYL 4-0 PS2 109.5
3001795 SUTURE PROLENE 6-0 P-3 188.25
3090002 TED HOSE KNEE MED-REG 43
3090003 TED HOSE THIGH LG REG 105.5
3090004 STERISTRIP 1/8 X 3 10
3090014 FOLEY CATHETER, 10 FR 77
3090015 FOLEY CATHETER, 16 FR 34
3090016 FOLEY CATHETER, 18 FR 50.75
3090017 FOLEY CATHETER 20 FR 2 WY 33.75
3090025 RHINO-ROCKET W/XLG 217.25
3090026 RHINO-ROCKET W/LG 195
3090027 RHINO-ROCKET W/MED 124
�28
3090028 TELFA 3 X 8 STERILE 10
3090033 SUTURE ETHILON 4-0 P-3 125.75
3090047 URINAL WITH COVER 10
3090048 LACERATION TRAY 48
3090058 O2 MASK SIMPLE PED 10
3090061 STYLET 14 FR 17.5
3090062 STYLET 6 FR 17.5
3090063 ET TUBE HOLDER 46
3090064 ENDO TRACH TUBE 2.0 UC 21
3090065 ENDO TRACH TUBE 2.5 UC 21
3090073 ENDO TRACH TUBE 4.0 CUFF 61
3090074 ENDO TRACH TUBE 4.5 CUFF 61
3090077 ENDO TRACH TUBE 6.0 C 18
3090080 ENDO TRACH TUBE 7.5 CUFF 34
3090081 ENDO TRACH TUBE 8.0 CUFF 19
3090083 LEVIN TUBE 16 FR 23.25
3090084 LEVIN TUBE 10 FR 23.25
3090085 LEVIN TUBE 12 FR 23.25
3090086 LEVIN TUBE 14 FR 23.25
3090087 SUCTION CATHETER 8 FR W/CONTROL PORT 10
3090088 SUCTION CATHETER 10FR 10
3090089 SUCTION CATHETER 14FR 10
3090090 SUCTION CATHETER 18FR 10
3090091 SUCTION CATHETER 16FR 10
3090093 CO2 DETE CM_CTOR EASY CAP 78.75
3090094 PENROSE DRAIN 1/4 X 12 10
3090096 AIRWAY ORAL 90 MM 10
3090097 AIRWAY ORAL 80 MM 10
3090100 NASOPHARYNGE AIRWAY 28 FR 41
3090101 NASOPHARYNGE AIRWAY 30 FR 39
3090102 ORTHO GLASS 2 23.75
3090103 ORTHO GLASS 3 35.5
3090104 ORTHO GLASS 4 42.5
�29
3090105 ORTHO GLASS 6 28.75
3090128 SCOTCH CAST 2 52
3090129 SCOTCH CAST 4 81.75
3090135 CLAVICLE SPLINT MED 50.75
3090143 CERVICAL COLL FOAM SM/LON 61.5
3090146 AB BINDER SMALL/MED 60.25
3090147 AB BINDER LG/XL 69.25
3090151 C-COLLAR LAERDAL ADULT 78.5
3090164 AIR WALKER XL 361.25
3090168 STAPLE REMOVAL KIT 16.25
3090182 KNEE SPORTS BRACE LG 240.5
3090196 RHINO ROCKET SM/SLIM 117.5
3090198 LMA UNIQUE SIZE 5 77.5
3090203 LMA UNIQUE SIZE 2 207
3090206 ARM BAND TENNIS ELBOW 71.5
3090208 MASK BI-PAP MED 248
3090212 CO2 DETE CM_CTOR PEDI 78.75
3090217 FOLEY CATHETER 24 FR 5CC 51.75
3090218 KLING BANDAGE 2 X 75 STERILE 10
3090220 RHINO-ROCKET SLIM MED 151.5
3090221 RHINO-ROCKET SLIM.LG 151.5
3090222 TED HOSE THIGH SM-SHORT 105.75
3090223 TED HOSE KNEE SM-REG 61.5
3090238 TIB FIB NON PADDED SM 7 IN 204
3090242 FOLEY CATHETER, 8 FR 77.25
3090243 LEG BAG HOLDER 71.25
3090244 POUCH CONVATEC DRAINABLE 11.75
3090253 PANTS MESH 21
3090254 CATHETER TEXAS MALE EXTERNAL MED 10
3090255 COUDE TIP WOVEN 6 FR 575.25
3090256 FOLEY CATHETER, 14 FR 50.75
3090257 FOLEY CATHETER, 12 FR 50.75
3090258 EAR SYRINGE BLUE BULB 14.5
�30
3090259 PERINEAL COLD PACK 10.5
3090262 VASHE WOUND THERAPY 4OZ 69
3090268 SUTURE MERSILENE 3-0 FS-1 20
3090269 KNEE, WRAP AROUND SM 318.5
3090271 UNIV BUCK'S TRA CM_CTION W/FOOT PAD 112.5
3090272 SCOTCH CAST 5 81.75
3090282 DUO-THERM PAD 12 X 17 10
3090630 NEBULIZER MICROMIST HUD 1883 10
4000003 ACETAMINOPHEN W/CODEINE 30 MG TAB 11.7
4000006 ACETAMINOPHEN 160MG/5 ML DROPS 30 ML 6
4000008 ACETAMINOPHEN 120 MG SUPPOSITORY 11.95
4000010 ACETAMINOPHEN 650 MG SUPPOSITORY 13
4000011 ACETYLCYSTEINE ORAL SOLN 20% 10ML 86.67
4000022 ALPRAZOLAM 0.25 MG TAB 11.5
4000028 AMIODARONE 200 MG TAB 12.15
4000030 AMLODIPINE 5 MG TAB 11.45
4000032 AMOXICILLIN SUSP 400/5 ML, 75 ML BTL 18.1
4000033 AMOXICILLIN/CLAVULANATE 875 TAB 12.7
4000036 AMOXICILLIN 250 MG CAP 11.3
4000038 AMOXICILLIN 500 MG CAP 11.5
4000040 AMPICILLIN/SULBA CM_CTAM VL 1.5 GM 43
4000042 AMPICILLIN 1GM VIAL 42.8
4000046 ASCORBIC ACID 500 MG 12
4000050 ATORVASTATIN 20 MG TAB 12.4
4000056 AZITHROMYCIN 500 MG VIAL 47.55
4000057 AZITHROMYCIN SUSP 200 MG/5 ML 15 ML 47.55
4000068 BISACODYL 10 MG SUPPOSITORY 11.55
4000074 BUPIVACAINE 0.5% 50 ML 47
4000086 CAPTOPRIL 25 MG TAB 15.8
4000087 CARBAMAZEPINE 200 MG TAB 14
4000095 CEFAZOLIN 1 GM VIAL 39.7
4000105 MULTIVITAMIN TAB 32.65
4000106 CEPHALEXIN 250 MG CAP 11.65
�31
4000108 CEPHALEXIN 500 MG CAP 11.7
4000114 CIPROFLOXACIN 500MG TAB 11.8
4000118 CLINDAMYCIN 150 MG CAP 12
4000120 CLONIDINE 0.1 MG TAB 11.35
4000124 CYCLOBENZAPRINE 10 MG TAB 11.4
4000126 DEXAMETHASONE 4 MG TABLET 4 mg 15.45
4000127 DEXTROSE 50% 500 MG/ML 50 ML SYRINGE 71.55
4000128 DIAZEPAM 10 MG/2 ML SYRINGE 128.25
4000129 DIAZEPAM 5 MG TAB 11.35
4000131 DICYCLOMINE 20 MG TAB 12
4000133 DIGOXIN 125 MCG TAB 11.6
4000135 DIGOXIN 500 MCG/2 ML AMP 63.65
4000137 DILTIAZEM CD 120 MG CAP 12.75
4000138 DILTIAZEM HCL CD 180 MG CAP 12.2
4000140 DIPHENHYDRAMINE LIQUID 12.5 MG/5 ML UD 19.25
4000141 DIPHENHYDRAMINE 25 MG CAP 11.25
4000142 DIPHENHYDRAMINE 50 MG/ML SDV 37.15
4000147 DOCUSATE SODIUM 100 MG SOFTGELS 11.25
4000149 DOPAMINE 400 MG/250 ML PREMIX 112
4000155 ENOXAPARIN 30 MG/0.3 ML SYRINGE 56.4
4000158 RACEMIC EPI 2.5% NEB 0.5ML 16.95
4000165 ERYTHROMYCIN OPHTHALMIC 3.5 GM OINT 54.05
4000170 EYE IRRIGATING SOLN 120 ML BOTTLE 41
4000171 FAMOTIDINE 20 MG TAB 11.8
4000174 FENTANYL 25 MCG/HR PATCH 43.6
4000177 FERROUS SULFATE 324 MG TAB 11.55
4000179 FLUMAZENIL 0.5MG/5ML 50.45
4000180 FLUORESCEIN SODIUM OPHTH STRIPS 1EA 12
4000181 FLUOXETINE 20MG CAP 11.55
4000183 FLUTICASONE PROPRIONATE 50MCG NASAL SPRY 26.9
4000184 FOLIC ACID 1MG TAB 11
4000188 FUROSEMIDE 20MG TAB 11.35
4000190 FUROSEMIDE 40MG/4ML SDV 40.15
�32
4000203 GUAIFEN/CODEINE 10MG/ 5ML UD 16.7
4000208 HALOPERIDOL 5MG/ML AMP 61.75
4000209 HYDROCHLOROTHIAZIDE 25MG TAB 11.35
4000214 HEPATITIS-B 20MCG/ML SDV 239.6
4000218 HYDRALAZINE 20MG/ML SDV 46
4000219 HYDRALAZINE 25MG TAB 11.6
4000225 HYDROCORTISONE SODIUM SUCCINATE 100 MG 59.05
4000231 IBUPROFEN 800MG TAB 11.15
4000232 IBUPROFEN SUSPENSION 100MG/5ML SUSP UD 14.2
4000237 INSULIN 70/30 MDV 100 UNITS/ML 3ML VIA 16
4000239 KETOROLAC 10MG TAB 14
4000240 KETOROLAC 30MG/ML SDV 38.3
4000242 LABETOLOL 100MG TAB 13
4000249 LIDOCAINE HYDROCHLORIDE JELLY 2% 5ML TUBE 36
4000250 VISCOUS LIDOCAINE UD 15ML SYRUP UD 15.2
4000257 LORAZEPAM 1 MG TAB 11.4
4000258 LORAZEPAM 2 MG/ML SDV 37
4000259 LOSARTAN 50 MG TAB 12.55
4000262 MAG-AL PLUS SIMETHICON 120MG/30ML SUS UD 18.05
4000264 MAGNESIUM OXIDE 400 MG TAB 11.5
4000275 METFORMIN 500MG TAB 11.35
4000279 METHYLPREDNISOLONE 125MG SDV 72
4000284 METOCLOPRAMIDE 10MG/2ML SDV 39.4
4000285 METOCLOPRAMIDE 10MG TAB 11.55
4000293 MAGNESIUM HYDROXIDE 30 ML LIQUID UD 0.65
4000296 MORPHINE SULFATE 10 MG/ML CARP 43
4000301 MULTIVITAMIN W IRON TAB 12
4000305 NALOXONE 2 MG/2 ML SYRINGE 162.65
4000306 NAPROXEN 500 MG TAB 12.05
4000311 NEOMYCIN/POLYMYX/HYDROCORT 10 ML OTIC 208.15
4000314 NICOTINE PATCH 21 MG 26.5
4000318 NITROFURANTOIN 100MG CAP 25.6
4000320 NITROGLYCERIN OINTMENT ESP 1GM OINT 21
�33
4000321 NITROGLYCERIN 50MG/250ML IV PREMIX 156.05
4000329 ONDANSETRON HCL 4MG/2ML SDV 37.1
4000331 OXYBUTYNIN 5MG TAB 13.35
4000332 OXYCODONE/APAP 5/325MG TAB 12
4000334 OXYMETAZOLINE 15ML SPRAY 27.4
4000336 PAROXETINE HCL 20 MG TABLET 11.95
4000339 PENICILLIN VK 500MG TAB 11.75
4000343 PHENAZOPYRIDINE 100MG TAB 15
4000348 PHENYLEPHRINE HCL 0.5% 15ML SPRAY 27.4
4000349 PHENYTOIN 250MG/5ML SDV 48.05
4000350 PHENYTOIN ER 100MG CAP 13.4
4000351 PHYTONADIONE 10MG/1ML AMP 229.7
4000357 POTASSIUM CHLORIDE ER 10MEQ CAP 14.8
4000362 PRAVASTATIN 40MG TAB 15.05
4000365 PREDNISONE 20MG TAB 11.9
4000373 PROMETHAZINE 25MG/ML SDV 38.05
4000376 PROPOFOL 1% 200MG/20ML EACH 45.6
4000384 ROCURONIUM 10 MG SDV 58.35
4000387 SENNA 8.6MG TAB 11.3
4000388 SERTRALINE HCL 50MG TAB 12
4000390 SILVER SULFADIAZENE 20GM CREAM 50.45
4000391 SIMVASTATIN 20MG TAB 11.5
4000392 SODIUM POLYSTRENE 15GM/60ML SUSP UD 48.5
4000393 SODIUM BICARB 8.4% ADULT 50MEQ/50ML SYRG 74.55
4000394 SODIUM CHLOR 0.9% SDV 10ML 38.75
4000396 SOTALOL 80MG TAB 11.45
4000397 SPIRONOLACTONE 25MG TAB 11.65
4000398 SPIRONOLA CM_CTONE/H CM_CTZ 25/25 TAB 14.9
4000401 SULFACETAMIDE SODIUM OPTH SOL 15ML BTL 173.2
4000403 SULFAMETHOXAZOLE/TRMETHOPRIM 800MG TAB 11.45
4000405 SUMATRIPTAN SUCCINATE 6MG/0.5ML SDV 70.35
4000410 TERAZOSIN 2MG CAP 12
4000412 TERBUTALINE 1MG/ML SDV 53.95
�34
4000422 THIAMINE 200MG/2ML 63.9
4000425 TRAMADOL 50MG TAB 13.2
4000426 TRAZODONE 50MG TAB 11.6
4000427 TRIAMCINOLONE ACETONIDE 0.1% 15G CREAM 34.65
4000440 VERAPAMIL ER 240MG TAB 21
4000442 WARFARIN 5MG TAB 11.3
4000443 WARFARIN 2MG TAB 11.3
4000444 ZOLPIDEM 5 MG TAB 11.4
4000446 ALLOPURINOL 100 MG TAB 12.3
4000447 AZITHROMYCIN 250 MG TAB 14.35
4000460 LEVOTHYROXINE 75 MCG TAB 16.95
4000465 METOPROLOL TARTRATE 50 MG TAB 11.35
4000473 SUCCINYCHOLINE CHLORIDE 200 MG/10 ML SDV 111.8
4000479 DILTIAZEM HCL 30 MG TAB 13
4000482 BISACODYL 5 MG TAB 12
4000486 VENLAFAXINE HCL XR 75MG CAP 13.65
4000490 LEVOFLOXACIN 500MG/100ML PREMIX IV SOL 85.25
4000491 LEVOFLOXACIN 500MG TAB 12.25
4000495 DOXYCYCLINE 100 MG TAB 14.05
4000497 CLOTRIMAZOLE 1% CREAM 30 GM 33.25
4000509 SILVER NITRATE STICK EACH 13.35
4000526 IPRATROPIUM BROMIDE 0.5MG/2.5ML NEB 13.55
4000529 GEMFIBROZIL 600MG TAB 12.05
4000530 CITALOPRAM 20 MG TAB 11.4
4000538 ORPHENADRINE CITRATE 60 MG/2 ML AMP 50
4000540 CLOPIDOGREL 75 MG TAB 11.85
4000541 CEPHALEXIN 125 MG/5 ML 100 ML SUSP 79
4000545 LORATADINE 10 MG TAB 12.3
4000558 LISINOPRIL 20 MG TAB 11.4
4000574 GABAPENTIN 300MG CAP 13.4
4000575 GUAIFENESIN ER 600 MG TAB 15.25
4000585 NORTRIPTYLINE HCL 25MG CAP 13.4
4000592 BACITRACIN 0.9 GM PACKET 11.65
�35
4000597 IRBESARTAN 150MG TAB 11.7
4000603 SALINE NASAL SPRAY 45 ML 26.1
4000612 TOBRAMYCIN 0.3% OPTH SOLN BOTTLE 5 ML 39.3
4000618 METOPROLOL SUCCINATE 100MG TAB 18
4000618 metoprolol succ ER 100 MG TAB 100 mg, 100 eaches 13.1
4000620 glipiZIDE ER 5 MG TABLET 5 mg, 100 eaches 11.5
4000634 CLONAZEPAM 0.5 MG TAB 11.2
4000661 METHYLPREDNISOLONE 1GM SDV 214.05
4000667 NYSTATIN CREAM 15GM 27.4
4000687 HYDROXYZINE HCL 25MG TAB 12.15
4000688 NITROGYLCERIN 0.4MG *3 TAB/BOTTLE* 18.3
4000695 VALACYCLOVIR HCL 500 MG TAB 22.35
4000697 ASPIRIN ENTERIC COATED 325MG TAB 0.55
4000698 TAMSULOSIN 0.4MG CAP 12.5
4000705 GLUCOSE GEL 31G TUBE 17
4000710 CARBIDOPA/LEVODOPA 25/100 MG TAB 11.85
4000720 MONTELUKAST 10 MG TAB 12.7
4000728 SWI 10ML SDV 38.55
4000730 MUPIROCIN OINT 2% TUBE 52.45
4000740 LEVOTHYROXINE 50 MCG TAB 13.2
4000743 TETRACAINE HCL OPTHALMIC SOL 2ML BOTTLE 48
4000749 AMITRIPTYLINE 10 MG TAB 11.7
4000752 LIDOCAINE 2% 20ML 40.3
4000771 D5 0.45% NS W/20 MEQ KCL 1000 ML 80
4000786 SODIUM CHLORIDE 0.9% NEBS 3 ML NEBULE 13.5
4000788 VANCOMYCIN 1G SDV 49.5
4000794 PROMETHAZINE HCL 25MG TAB 12
4000831 DEXTROSE 25% 250 MG/ML 10 ML SYRINGE 72.9
4000833 SODIUM BICARB 4.2% 10ML PFS 75
4000841 SIMETHICONE 80 MG TAB 7.5
4000852 ASPIR-LOW EC 81 MG TABLET 0.55
4000854 TENE CM_CTEPLASE 50MG VIAL 8392
4000868 OSELTAMIVIR PHOSPHATE 75MG CAP 54.35
�36
4000879 IRON GLUCONATE 62.5 MG/5 ML VIAL 93
4000920 CEREBYX 500 MG PE/10 ML VIAL 198
4000930 VALPROATE SODIUM 500MG/5ML SDV 67.15
4000951 CLARITHROMYCIN 500 MG TAB 14.5
4000956 METOPROLOL SUCCINATE 25MG TAB 14.15
4000962 POLYETHYLENE GLYCOL 17GM PACKET 16.4
4000971 LEVOTHYROXINE 175 MCG TAB 16.95
4000996 ALBUTEROL SULF 0.083% NEB 2.5 MG/3 ML 13.85
4000999 ESCITALOPRAM 10 MG TAB 11.8
4001000 BUDESONIDE INH/NEB SUSP 0.5 MG/2 ML 23.1
4001001 FAMOTIDINE 20 MG/50 ML PREMIX 93.2
4001002 CEFTRIAXONE 2 GM SDV 46.25
4001003 EPINEPHRINE INJE CM_CTION 0.3 MG 643.7
4001004 MEPERIDINE 50MG/1ML SDV 35
4001010 Pedialyte (Electrolyte Solution) 1 Liter Oral Solution 5.5
4001012 MULTIPLE VITAMIN TAB (HEALTHY EYES) 1
4001013 LEVONORGESTREL 1.5MG TAB 175.8
4001014 LIDOCAINE 1% 300 MG/30 ML VIAL 40
4001015 HYALURONATE SODIUM 48 MG/6 ML PFS 2233
4001016 RAMIPRIL 5MG CAP 11.5
4001017 GLIPIZIDE XL 2.5MG TAB 11.95
4001018 SITAGLIPTIN PHOSHATE 50 MG TAB 72.95
4001019 NICARDIPINE HCL INJ 25 MG/10 ML 103.35
4001020 BACITRACIN/POLYMYXIN OPTH OINT 3.5 GM 54.55
4001021 APIXABAN 5 MG TAB 36.9
4001023 MORPHINE ORAL SOL 10 MG/5 ML UD 17.5
4001024 PRAMIPEXOLE 0.25 MG TABLET 11.45
4001027 CHOLECALCIFEROL 1000 IU TAB 11.3
4001028 NYSTATIN TOP PWD 15 GM 27.4
4001029 RISPERIDONE 0.5 MG TAB 12.15
4001032 ARTIFICIAL TEARS EYE DROPS 15 ML 66.45
4001033 PRAVASTATIN 10MG TAB 13.05
4001034 QUETIAPINE FUMARATE 25 MG TAB 20.9
�37
4001037 CALCIUM W/D 600 MG/400 MG TAB 11.72
4001039 GLYCERIN SUPPOSITORY FOR CHILDREN (FLEET) 12.05
4001044 OSELTAMIVIR PHOSPHATE SUSP 6MG/ML 60ML 490.92
4001045 POTASSIUM CHLORIDE 20 MEQ TAB 13.6
4001048 CIPROFLOXACIN 400MG/200ML PREMIX 76
4001051 miSOPROStol 200 MCG TABLET 200 mcg, 60 eaches 14.85
4001052 NIFEdipine ER 30 MG TABLET 30 mg, 100 eaches 12.4
4001054 LIQUACEL LIQUID PROTEIN CONCENTRATE ORAL LIQUID 17.95
4001076 ATROPINE ADULT 1 MG/10 ML SYRINGE 57.5
4001078 PANTOPRAZOLE SODIUM 40MG TAB 12
4001091 ERTAPENAM 1 GM VIAL 431.05
4001094 LIDOCAINE PATCH EACH 21.8
4001102 HEPARIN LOCK FLUSH 50 UNITS/5ML SYRINGE 20
4001103 PANTOPRAZOLE SODIUM IV 40MG SDV 58.9
4001105 PREDNISONE 5MG TAB 11.65
4001106 WARFARN 2.5MG TAB 11.3
4001108 THIAMINE 100MG TAB 11.2
4001117 ATENOLOL 25 MG TAB 11.75
4001131 NYSTATIN 500,000 UNITS/5ML LIQUID UD 17.7
4001138 CIPROFLOXACIN HCL OPTH 2.5ML BOTTLE 27.9
4001140 FOLIC ACID 5 MG/ML 133.8
4001145 BUMETANIDE 1 MG/4 ML SDV 42.9
4001150 LISINOPRIL 5 MG TAB 11.65
4001151 SPIRIVA 18 MCG CP-HANDIHALER 185.65
4001154 CALAMINE/ZINC OXIDE 113 GM TUBE 51
4001157 ETHYL CHLORIDE SPRAY 120 ML SPRAY 144.55
4001160 FLUTICASONE/SALMETEROL 250/50 DISKUS 443.4
4001165 RANITIDINE SYRUP 150MG/10ML UD 26.8
4001166 CLOTRIMAZOLE/BETAMETHASONE CREAM 15 GM 53.29
4001171 AMOXICILLIN/CLAVULANATE 400 MG/5 ML SUSP, 50 ML 30
4001174 LUBRICATING EYE DROPS 15ML BOTTLE 62.68
4001179 TUBERCULIN 5 TU/0.1ML MDV 10ML VIAL 71.25
4001190 METOPROLOL TARTRATE 25 MG TAB 10.65
�38
4001193 CAMPHOR MENTHOL 30 GM OINTMENT 36
4001194 PREDNISOLONE SODIUM PHOSPHATE 15mg/5ml SYRP 11.95
4001197 SERTRALINE HCL 25MG TAB 11.85
4001200 METRONIDAZOLE 500MG/100ML IV SOL 74.95
4001202 SOLIFENACIN 5MG TAB 56.45
4001203 PENICILLIN G 1.2 MU/2ML INJE CM_CTION 43.3
4001207 PIPERCILLIN AND TAZOBAC 2.25GM INJE CM_CTION 47.5
4001218 EPOETIN ALFA 20,000 UNIT/ML 462.65
4001219 FLUCONAZOLE 200MG/100ML PREMIX 85.65
4001226 DULOXETINE HCL DR 30 MG CAP 12.05
4001297 ONDANSETRON HCL 4 MG ODT 12.7
4001313 FENTANYL 100 MCG/2 ML SDV 37.15
4001314 DIPHENOXYLATE/ATROPINE 2.5 MG/0.025 MG TAB 13.8
4001315 LIDOCAINE/EPINEPHRINE/TETRACAINE EACH 57.2
4001317 NIFEREX 150 MG CAP 11.65
4001318 HYDROCODONE/APAP 5/325MG TAB 12.35
4001319 HYDROMORPHONE 2MG TAB 12
4001324 PROPARACAINE 0.5% 15ML BOTTLE 169.6
4001326 ISOSORBIDE DINITRATE 10MG TAB 13.4
4001327 CARVEDILOL 3.125 MG TAB 11.5
4001332 ALBUMIN 25% (25 GM IN 100 ML) 384
4001337 ACETAMINOPHEN CHILDREN 160 MG/5 ML SUSP UD 1.3
4001539 CARVEDILOL 12.5 MG TAB 11.45
4001548 FINASTERIDE 5 MG TAB 15.3
4001549 ISOSORBIDE MONONITRATE ER 30MG TAB 12.65
4001602 ALBUTEROL HFA (VENTOLIN) 8 GM 100.75
4001643 IPRATROPIUM/ALBUTEROL 3MG/0.5MG/3ML NEB 14.7
4001644 ATROPINE 1% OPTH 2 ML 128.75
4001646 HYDROMORPHONE 1MG/ML CARP 44
4001704 PREGALBIN 75MG CAP 37
4001732 OXYCODONE IMMEDIATE RELEASE 5 MG TAB 12
4001736 OXYCODONE ER 10MG TAB 26.35
4001737 METHADONE 5MG TAB 12
�39
4001738 HYDROCODONE/APAP 7.5/325MG TAB 12.55
4001742 BUMETANIDE 2 MG TAB 14.85
4001750 LEVOTHYROXINE 150MCG TAB 14.15
4001751 OXYBUTYNIN XL 10MG TAB 14.1
4001765 MAGNESIUM CITRATE SOLUTION 296 ML 29.75
4001766 ZOLEDRONIC ACID 5MG/100ML 408.85
4002000 DAPTOMYCIN 500 MG VIAL 512.3
4002009 GLYCERIN SUPPOSITORY PEDIATRIC 11.8
4002015 LEVETIRACETAM 750 MG TAB 11.75
4002016 LAMOTRIGINE 25 MG TAB 11.6
4002017 FLUCELVAX QUAD 2017-2018 (PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRINGE95.05
4002019 FLULAVAL QUAD 2017-2018 (PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRINGE105.85
4002020 DICLOFENAC SODIUM 1% GEL 141.95
4002022 CYCLOBENZAPRINE *TAKE HOME PACK* 10 MG TAB X 6 EA ORAL TAB 13
4002024 FUL-GLO 0.6 MG EYE STRIPS 11.6
4002025 DULOXETINE HCL DR 60 MG CAP 11.5
4002026 SHINGRIX VACCINE 461.75
4002028 XYLOCAINE-MPF 1% AMPUL 10 MG/ML, 10 ML 47
4002029 methIMAzole 10 MG TABLET 10 mg, 100 eaches 14.05
4002030 methylPREDNISolone 4 MG DOSEPK 4 mg, 21 eaches 38.95
4002031 TRIAMTERENE-HCTZ 75-50 MG TAB 1 unit, 100 eaches 11.7
4002032 OXYTOCIN 10 UNITS/ML VIAL 10 unit, 1 mL 37.5
4002033 DEBROX 6.5% EAR DROPS 1 unit, 15 mL 6.65
4002036 K-PHOS ORIGINAL TABLET 1 unit, 100 eaches 13.5
4002037 DULERA 200 MCG/5 MCG INHALER 200 mcg, 13 g 709.75
4002038 DOXEPIN 150 MG CAPSULE 150 mg, 50 eaches 15
4100019 NS 0.9% 1000 ML 104
4100021 D5 1000 ML 104
4100022 NS 0.9% 100 ML 62
4100023 NS 0.9% 50 ML 62
4100024 NS 0.9% 500 ML 62
4100025 LR 1000 ML 104
4100026 NS 0.9% 250 ML 62
�40
4100028 D5 250 ML 62
4100029 D5 NS 0.9% 1000 ML 104
4100030 D5 0.45% NS 1000 ML 104
4100031 NS 0.45% 1000 ML 104
4100050 ADDEASE BINARY CONNE CM_CTORS FOR 100ML NS 0.74
4100051 ADDEASE BINARY CONNE CM_CTORS FOR 250ML NS 0.98
4100052 PERIPHERAL STANDARD BORE EXT SET 21 10
4100054 SECONDARY ADMIN SETS 165.67
4100056 GRAVITY IV SET W/CARESITE INJ SITES 2.97
4100057 IV SPIKE ADAPTER VENTABLE 13
4100058 IV EXTENSION SET STD BORE 8 W/CARESITE 17.25
4100059 DRESSING BIOPATCH 1 DISK 4MM 96.75
4100061 D5 0.20% NS 250 ML 62
4100062 ARMBOARD SMALL 16
4100063 ARMBOARD MEDIUM 30.75
4100064 ARMBOARD LARGE 83.85
4100065 PICC LINE DRESSING KIT 148.5
4100070 T-CON EXT W/ MICRO FILTER 5.12
4100071 BURRETTE IV PUMP SET 113
4100072 20G CLOSED IV CATHETER SYSTEM 1.25 5.02
4100074 CUROS TIP STRIPS 0.35
4100075 CUROS JET STRIPS 0.35
4100077 VACUTAINER 21G 3/4 X 1/2 1.08
4100078 VACUTAINER 23G 3/4 X 1/2 1.79
4100079 18G CLOSED IV CATHETER SYSTEM 1.25 4.65
4100081 22G CLOSED IV CATHETER SYSTEM 1.25 4.65
4100082 CVC KIT 30 CM 202.75
4100083 IV CATHETER 14 X 1.75 1.64
4100084 IV CATHETER 16 X 1.16 1.59
4100085 IV CATHETER 18 X 1.16 19.7
4100086 IV CATHETER 20 X 1 19.75
4100087 IV CATHETER 22 X 1 1.87
4100088 IV CATHETER 24 X 3/4 1.59
�41
4100089 IV START KIT 50.25
4100091 IV STOPCOCKS DISCOFIX 0.46
4100092 IV ADAPTOR CLAVE MALE REPLACE W/4100053 0.81
4100093 NTG TUBING-PRMRY PLUMSET 12.04
4100094 IV PRIMARY PLUMSET 103 96.75
4100095 BLOOD PLUM SET 106.75
4100098 HUBER 20 X 3/4 SAFETY NEEDLESS CAP 59.75
4100099 EZ-IO NEEDLE 15MM 15GA 1062.5
4100100 EZ-IO NEEDLE 25MM 15GA 1062.5
4100101 EZ-IO NEEDLE 45MM 1062.5
4100102 EZ-IO STABILIZER 150.25
4100104 CVC KIT MULTI-LUMEN 7 FR 8" 756.5
4100105 PHLEBOTOMY KIT W/ 16G 500 ML 87.75
4100109 PUR INTROCAN SAFETY 3 20 G X 1" 16.5
4100122 PRESSURE INFUSER 1000 CC 177.5
4100123 CVC 3 LUMEN 30 CM 689.8
4100125 START KIT 27
4100130 PRESSURE ADMINISTRATION CUFF 1.24
5000003 BIOPSY EXTERNAL EAR 435
5000004 INCISION&DRAINAGE UPPER ARM/ELBOW BURSA 326
5000007 DRAINAGE EXT EAR ABSCESS/HEMATOMA SIMPLE 392
5000009 ACNE SURGERY 196
5000012 INCISION THROMBOSED HEMORRHOID EXTERNAL 455
5000018 NON INVASIVE EAR/PULSE OXIMETRY MULTI 54
5000019 NON INVASIVE EAR/PULSE OXIMETRY SINGLE 33
5000047 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA 120
5000072 TDAP VACCINE 7 YRS/> IM *RHC* 182.55
5000074 PNEUMOCOCCAL 23 VAC 2YR/ADULT *RHC* 231.5
5000077 HEPATITIS B VACCINE ADULT 3 DOSE IM *RHC 222
5000080 INSJ NON-BIODEGBRADABLE DRUG DELIVERY IM 252
5000081 REMV NON-BIODEGBRADABLE DRUG DELIVERY IM 252
5000090 INJE CM_CTION INTRALESIONAL UP TO 7 114
5000094 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE 34
�42
5000096 URINE PREGNANCY TEST VISUAL COLOR CMPRSN 97
5000103 PARING/CUTTING BENIGN HYPERKERATOTIC LES 67
5000110 SMPL REPAIR SCALP/NECK/AX/20.1-30.0CM 728
5000113 BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADD 77
5000116 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA 204
5000118 EXC B9 LESION SK TG S/N/H/F/G .5< 243
5000120 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 91
5000121 SHVG SKIN LESION 1 TRUCK/ARM/LEG DIAM 0. 155
5000122 BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 151
5000123 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM>2. 227
5000124 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 109
5000125 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6 169
5000126 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1 202
5000127 SHAVING SKIN LESION 1 S/N/H/F/G DIAM>2.0 239
5000128 EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3 418
5000129 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 C 225
5000130 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1 297
5000131 EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2 330
5000132 EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4 629
5000133 EXC B9 LESION MRGN XCP STG F/E/E/N/0.6-1 381
5000135 EXCISION TUMOR THIGH/KNEE SUBQ<3CM 2221
5000136 EXCIS TMR SOFT TISSUE SHOULDER SUBQ 3CM1 1296
5000138 ASPIRATION&INJE CM_CTION GANGLION CYST 236
5000143 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER 27
5000148 WEDGE EXCISION SKIN NAIL FOLD 317
5000162 INSERTION INTRAUTERINE DEVICE IUD 413
5000180 PUN CM_CTURE ASPIRATION ABSCESS HEMATOMA 333
5000286 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DE 87
5000299 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTR 40
5000300 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTR 61
5000301 HLTH&BEHAV IVNTJ EA 15MIN FAM W/0 PT 29
5000407 DESTRU CM_CTION PREMALIGNANT LESION 1ST 164
5000409 DESTRU CM_CTION PREMALIGNANT LESION 2-14 EA 14
�43
5000412 DESTRU CM_CTION BENIGN LESIONS UP TO 14 199
5000413 DESTRU CM_CTION BENIGN LESIONS 15/> 249
5000541 TOBACCO USE CESSATION INTERMED. 3-10 MIN 46
5000542 TOBACCO USE CESSATION INTENSIVE >10 MIN 95
5000597 HOME VISIT EST PT SELF LIMITED/MINOR 15 157
5000598 HOME VISIT EST PT LOW-MOD SEVERITY 25 MI 236
5000631 ANNUAL WELL VISIT 65YRS&>SUBSEQ 128
5000632 ANNUAL WELL VISIT 65YRS&>INITIAL 334
5000641 BASIC LIFE AND/OR DISABILITY EXAMINATION 126
5000642 WORK RELATED/MED DBLT XM TREATING PHYS 123
5000676 WWC PRE EMPLOY PHYSI 123
5000677 WWC SCBA EVALUATION 123
5000678 WWC SCBA PHYSICAL 123
5000679 WWC YEARLY PHYSICAL 123
5000705 INJE CM_CTION SINGLE/MLT TRIGGER POINT 3/> M 125
5000737 SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1 193
5000745 EXCISION MAL LESION TRUNK/ARM/LEG .6-1.0 438
5000746 EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3. 538
5000747 EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2. 482
5000748 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 289
5000749 EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4. 675
5000760 VITAL CAPACITY TOTAL SEPARATE PROCEDURE 72
5000761 RESPIRATORY FLOW VOLUME LOOP 261
5000764 EXCISION MALIGNANT LESION TRUNK/ARM/LEG> 939
5000765 EXCISION MALIGNANT LESION F/E/E/N/L 3.1- 875
5000769 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE 149
5000771 IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT 21
5000772 IM ADM THRU 18YR ANY RTE ADDL VAC/TOX CO 21
5000773 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE 21
5000774 INJE CM_CTION 1 TENDON SHEATH/LIGAMENT APONE 116
5000779 COLOR VISION XM EXTENDED ANOMALOSCOPE/EQ 142
5000782 ADMINISTRATION OF HEPATITIS B VACCIN 22
5001030 DEPO-MEDROL 40MG RHC 64.2
�44
5001050 DEPO-PROVERA 150MG RHC 407.7
5001100 DEXAMETHASONE 10 MG/ML RHC 38.65
5003301 TRIAMCINOLO NE ACETONIDE 40 MG/ML RHC 78.85
5003420 VITAMIN B 12 INJE CM_CTION 9.5
5004000 MENINGOCOCCAL 4MCG/0.5ML SDV *RHC* 372.5
5004001 HEPATITIS A VACCINE 720ELU/0.5ML *RHC* 142.92
5004002 HUMAN PAPILLOMAVIRUS QUADRIVALENT *RHC* 565.95
5004003 PNEUMOCOCCAL 13 VAC PFS *RHC* 457.65
5004006 WOUND SEAL POWDER 4PK *RHC* 45.15
5004008 DIHYDROERGOTAMINE MESYLATE 1MG/ML *RHC* 353.35
5004013 HEPATITIS A VACCINE ADULT *RHC* 154.93
5004014 INFLUENZA VAC 0.25ML PFS 6-35 MO RHC 127.1
5004015 INFLUENZA VAC 0.5ML PFS 3 YR + RHC 105.8
5004016 RHO(D) 50 MCG RHC 184.05
5004017 ZOSTAVAX 0.65 ML SDV WITH STERILE DILUENT 0.7 ML SDV RHC 497.9
5069211 REMOVAL IMPA CM_CTED CERUMEN IRRIG/LVG UNIL 62
5099304 INT NURSING FAC CARE/DAY 25 MIN 236.5
5099305 INT NURSING FAC CARE/DAY 35 MIN 333
5099306 INT NURSING FAC CARE/DAY 45 MIN 426
5099307 SBSQ NURS FAC CARE/DAY E/M 10 MIN 113.5
5099308 SBSQ NURS FAC CARE/DAY MINOR COMP 15 MIN 174.5
5099309 SBSQ NURS FAC CARE/DAY NEW PROB 25 MN 229
5099310 SBSQ NURS FAC CARE/DAY UNSTABLE/NEW PROB 341.5
5099379 SWING BED CARE PLAN < 29 MIN 155
5099380 SWING BED CARE PLAN > 30 MIN 243
7000008 XR ABD ACUTE 547
7000011 XR AC JNTS BL LT 356
7000012 XR AC JNTS BL RT 356
7000015 XR ANKLE 2 VIEW LT 291
7000016 XR ANKLE 2 VIEW RT 291
7000018 XR ANKLE MIN 3 VIEW LT 352
7000019 XR ANKLE MIN 3 VIEW RT 352
7000028 XR C SPINE MIN 4 VIEWS 564
�45
7000029 XR C SPINE 2-3 VIEWS 391
7000030 XR C SPINE CMPLT OBL/ F/E 631
7000031 XR CLAVICLE CMPLT LT 322
7000032 XR CLAVICLE CMPLT RT 322
7000036 XR CHEST CMPLT MIN 4 VIEW 441
7000041 XR CHEST SPECIAL VIEWS 270
7000045 XR ELBOW 2 VIEWS LT 293
7000046 XR ELBOW 2 VIEWS RT 293
7000051 XR ELBOW CMPLT MIN 3 VIEW LT 360
7000052 XR ELBOW CMPLT MIN 3 VIEW RT 360
7000054 XR EYE FOREIGN BODY LT 289
7000055 XR EYE FOREIGN BODY RT 289
7000057 XR FACE BONES 1-2 VIEWS 339
7000058 XR FACE BONES MIN 3V 474
7000064 XR FINGER MIN 2 VIEWS LT 264
7000065 XR FINGER MIN 2 VIEWS RT 264
7000074 XR FOOT 2 VIEW LT 292
7000075 XR FOOT 2 VIEW RT 292
7000080 XR FOOT CMPLT MIN 3 VIEWS LT 349
7000081 XR FOOT CMPLT MIN 3 VIEWS RT 349
7000083 XR FOREARM 2 VIEW LT 321
7000084 XR FOREARM 2 VIEW RT 321
7000088 XR HAND 2 VIEW LT 293
7000089 XR HAND 2 VIEW RT 293
7000094 XR HAND MIN 3 VIEW LT 350
7000095 XR HAND MIN 3 VIEW RT 350
7000102 XR HUMERUS MIN 2 VIEW LT 330
7000104 XR HUMERUS MIN 2 VIEW RT 330
7000109 XR INFT LOW EXT MIN 2V L 263
7000113 XR KNEE 1-2 VIEWS LT 319
7000114 XR KNEE 1-2 VIEWS RT 319
7000119 XR KNEE CMPLT MIN 4 VIEWS 434
7000120 XR KNEE CMPLT MIN 4 VIEWS 434
�46
7000122 XR KNEE 3 VIEWS LT 382
7000123 XR KNEE 3 VIEWS RT 382
7000124 XR KNEE STANDING AP RT 269
7000125 XR KNEE BL STANDING AP 269
7000127 XR L SPINE 2-3 VIEWS 426
7000129 XR L SPINE CMPLT W/BEND 673
7000130 XR L SPINE MIN 4 VIEWS 608
7000133 XR MANDIBLE MIN 4 VIEWS 430
7000134 XR MANDIBLE 1-3 VIEWS 300
7000136 XR MASTOID 1-2V PER SIDE 226
7000137 XR MASTOID MN 3V PER SIDE 381
7000138 XR NASAL BONES MIN 3 VIEW 352
7000139 XR INF/CHLD NOSE-RE CM_CT FB 255
7000140 XR OPTIC FORAMINA LT 300
7000141 XR ORBITS CMPLT MIN 4 V LT 449
7000142 XR CALCANEUS MIN 2 V LT 294
7000143 XR OPTIC FORAMINA RT 300
7000144 XR ORBITS CMPLT MIN 4 V RT 449
7000145 XR CALCANEUS MIN 2 V RT 294
7000148 XR RIB UL 2 VIEWS 482
7000149 XR PELVIS 1-2 VIEWS 316
7000150 XR PELVIS CMPLT MIN 3 V 404
7000151 XR RIB UL W/PA CHST MIN 3 VIEWS 482
7000152 XR RIB BL 3 VIEWS 482
7000153 XR RIB BL W/PA CHST MN 4V 580
7000154 XR RIB 2 VW W/PA CHEST LT 419
7000155 XR RIB 2VW W/PA CHEST RT 419
7000156 XR RIB UL 2 VIEW LT 337
7000157 XR RIB 2 VIEW RT 337
7000158 XR SACRUM COCCYX MN 2V 362
7000159 XR SCAPULA CMPLT LT 335
7000160 XR SCAPULA CMPLT RT 335
7000164 XR SP SCOLIOSIS W/SUP ERE 444
�47
7000165 XR SCOLIOSIS 462
7000166 XR SELLA TURCICA 188
7000167 XR SHOULDER 1 VIEW LT 272
7000168 XR SHOULDER 1 VIEW RT 272
7000170 XR SHOULDER MIN 2 VIEW LT 373
7000171 XR SHOULDER MIN 2 VIEW RT 373
7000180 XR SACROILIAC JNT 1-2 V 299
7000181 XR SINUS PARANASAL 1-2V 294
7000182 XR SINUS PARANASAL MIN 3V 471
7000183 XR SKULL 1-3 VIEWS 360
7000184 XR SKULL CMPLT MIN 4 V 541
7000185 XR NECK SOFT TISSUE 306
7000186 XR STERNCLAV JNTS MIN 3V 308
7000188 XR T SPINE MIN 4 VIEWS 458
7000189 XR STERNUM MIN 2 VIEW 360
7000193 XR L SP BEND ONLY 2/3 VWS 398
7000194 XR T SPINE 1 VIEW 297
7000195 XR T SPINE 2 VIEW 380
7000196 XR T SPINE 3 VIEW 455
7000197 XR THORACOLUMBAR SPINE 2V 407
7000198 XR TIBIA FIBULA 2 VIEW LT 341
7000199 XR TIBIA FIBULA 2 VIEW RT 341
7000203 XR TMJ OPEN & CLOSED BL 453
7000204 XR TMJ OPEN & CLOSED UL 290
7000205 XR TOE(S) MIN 2 VIEW RT 263
7000206 XR TOE(S) MIN 2 VIEW LT 263
7000216 XR WRIST CMPLT MIN 3V LT 348
7000217 XR WRIST CMPLT MIN 3V RT 348
7000222 XR WRIST 2 VIEW LT 285
7000223 XR WRIST 2 VIEW RT 285
7000249 XR SACROILIAC JNT MIN 3V 369
7000250 XR HIPS BILAT MIN 5 VW W/WO PELVIS 593
7000251 XR HIPS BILAT 3-4 VW W/WO PELVIS 474
�48
7000252 XR HIPS BILAT 2 VW W/WO PELVIS 354
7000253 XR HIP RT MIN 4 VW W/WO PELVIS 474
7000254 XR HIP LT MIN 4VW W/WO PELVIS 474
7000255 XR HIP LT 2-3 VWS W/WO PELVIS 354
7000256 XR HIP RT 2-3 VWS W/WO PELVIS 354
7000257 XR HIP RT 1 VW W/WO PELVIS 264
7000258 XR HIP LT 1 VW W/WO PELVIS 264
7000259 XR ENTIRE SPINE C,T,L SPINE 2VW 391
7000260 XR ENTIRE SPINE C,T,L SPINE 1VW 297
7000261 XR FEMUR RT 1 VW 291
7000262 XR FEMUR LT 1 VW 291
7000263 XR FEMUR RT MIN 2VW 352
7000264 XR FEMUR LT MIN 2VW 352
7000300 XR CHEST 1 VIEW 279
7000301 XR CHEST 2 VIEW AP/L 346
7000302 XR CHEST AP/L API LORD 378
7000303 XR CHEST AP/L OBL PROJ 407
7000304 XR ABD AP I VIEW 309
7000305 XR ABDOMEN 2 VIEWS 366
7000306 XR ABDOMEN 3 OR MORE VIEWS 410
7100002 CM_CT C SPINE W/ CONTRAST 2627
7100003 CM_CT C SPINE W/O CONTRAST 2293
7100004 CM_CT C SPINE W/WO CONTRAST 3037
7100010 CM_CT THORAX W/ CONTRAST 2496
7100012 CM_CT THORAX W/O CONTRAST 2055
7100014 CM_CT THORAX W/WO CONTRAST 2911
7100020 CM_CT HEAD/BRAIN W/ CONTRAST 2250
7100021 CM_CT HEAD/BRAIN W/O CONTRAST 1883
7100023 CM_CT HEAD/BRAIN W/WO CONTRAST 2678
7100025 CM_CT ORBIT/FOSSA/EAR W/ CONTRAST 2236
7100026 CM_CT ORBIT/FOSSA/EAR W/O CONTRAST 2000
7100027 CM_CT ORB/FOSSA/EAR W/WO CONTRAST 2612
7100029 CM_CT L SPINE W/ CONTRAST 2699
�49
7100030 CM_CT L SPINE W/O CONTRAST 2328
7100031 CM_CT L SPINE W/WO CONTRAST 3072
7100032 CM_CT LOWER EXTREMITY W/O CONTRAST LT 2254
7100033 CM_CT LOWER EXTREMITY W/O CONTRAST RT 2254
7100035 CM_CT LOWER EXTREMITY W/ CONTRAST LT 1956
7100036 CM_CT LOWER EXTREMITY W/ CONTRAST RT 1956
7100038 CM_CT LOW EXTREMITY W/WO CONTRAST LT 2612
7100039 CM_CT LOW EXTREMITY W/WO COMTRAST RT 2612
7100040 CM_CT SOFT TISS NECK W/ CONTRAST 2348
7100042 CM_CT SOFT TISS NECK W/O CONTRAST 1954
7100045 CM_CT SFT TISS NECK W/WO CONTRAST 2660
7100047 CM_CT ABD/PELVIS W/ CONTRAST 2424
7100048 CM_CT PELVIS W/ CONTRAST 2391
7100049 CM_CT PELVIS W/O CONTRAST 2024
7100050 CM_CT ABD/PELVIS W/O CONTRAST 2033
7100051 CM_CT PELVIS W/WO CONTRAST 2779
7100052 CM_CT ABD/PELVIS W/WO CONTRAST 2839
7100054 CM_CT MAXILLOFACIAL W/ CONTRAST 2221
7100055 CM_CT MAXILLOFACIAL W/O CONTRAST 1862
7100056 CM_CT MAXILLOFACIAL W/WO CONTRAST 2585
7100057 CM_CT T SPINE W/ CONTRAST 2575
7100058 CM_CT T SPINE W/O CONTRAST 2221
7100059 CM_CT UPPER EXTREMITY W/ CONTRAST LT 2153
7100060 CM_CT T SPINE W/WO CONTRAST 2844
7100061 CM_CT UPPER EXTREMITY W/O CONTRAST LT 1925
7100062 CM_CT UPPER EXTREMITY W/O CONTRAST RT 1925
7100064 CM_CT UPPER EXTREM W/WO CONTRAST LT 2608
7100065 CM_CT UPPER EXTREM W/WO CONTRAST RT 2608
7100066 CM_CT ABDOMEN W/ CONTRAST 2532
7100070 CM_CT ABDOMEN W/O CONTRAST 2076
7100071 CM_CTA LOWER EXTREMITY RT 2571
7100072 CM_CT ABDOMEN W/WO CONTRAST 3003
7100073 CM_CTA ABD AORTA W/ CONTRAST 2830
�50
7100074 CM_CTA CHEST NONCORONARY(PE) 2948
7100075 CM_CTA HEAD 2518
7100076 CM_CTA LOWER EXTREMITY LT 2571
7100077 CM_CTA NECK 2497
7100078 CM_CTA PELVIS 2671
7100079 CM_CTA UPPER EXTREMITY LT 2360
7100080 CM_CTA ABDOMEN 2722
7100081 CM_CTA UPPER EXTREMITY RT 2360
7101000 IOPAMIDOL 300MG/ML 100ML 2
7200002 RHYTHM STRIP 139
7200003 TELE PER 48 817
7200008 CM_EKG TELEMETRY-PER 48 HRS 537
7200010 ECG W/LEAST 12 LEADS W/I&R 295
7200011 ECG W/LEAST 12 LEADS I&R ONLY 188
7200012 ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 226
10000968 MRSA SCREEN PCR 195
30000337 NORCO 5/325 6 TABS TAKE HOME PACK 18.45
30001016 LEVIN TUBE 18 FR 10
30001041 FOLEY CATHETERIZATION TRAY 16 FR 97
30900209 O2 MASK NON REBREATHER PED 13.5
30900212 LMA UNIQUE SIZE 2.5 81.25
30900214 RESUSCITATION PED 335.75
30900215 RESUSCITATION INFANT 232.5
30900580 BODY BAGS 83.75
30900625 LARYNGOSCOPE GLV-4 169.25
30900671 OPTIFOAM SACRUM 6X5.5 85.25
30900673 OPTIFOAM GENTLE 6X6 86.25
40000002 AMOXICILLIN 875 MG TAB 11.8
40000005 PSEUDOPHEDRINE HCL 30 MG TAB 12
40000006 IRON SUCROSE INJ 100 MG/5 ML SDV 176.8
40000007 FLUTICASONE/SALMETER 100/50 DISKUS 693.95
40000010 TRIPLE ANTIBIOTIC OINT 0.9 GM PACKET 12
40000012 BETAMETHASONE INJE CM_CTION *30 MG/5 ML* MDV 185.45
�51
40000014 TOBRAMYCIN/DEXAMETHASONE OPTH SUSP 2.5 ML 198.15
40000015 NICOTINE PATCH 7 MG 28
40000018 LIDOCAINE/EPI 2% 20 ML 42.1
40000020 EPINEPHRINE NASAL SOLN 30 MG/30 ML 597.1
40000021 SULFAMETHOXAZOLE/TRIMETHO ORAL SUSP 20 ML 31
40000022 GUAIFENESIN/DEXTROMETH SYRUP 10 ML UD 14
40000023 AMMONIA INHALANT PER EA 13.7
40000025 HEMORRHOIDAL OINT 30GM 55.35
40000032 ENEMA MINERAL OIL 133 ML FLEET 2.6
40000033 ACTIVATED CHARCOAL AQUEOUS 50 GM/240 ML 127.7
40000037 GLUCAGON 1MG INJ 563.5
40000044 BENZONATATE 100 MG CAP 12.7
40000047 LUTEIN 10 MG TAB 12
40000049 NICOTINE 2 MG GUM 13.95
40000050 HYDROGEL WOUND DRESSING 30GM 103.9
40000051 WOUND SEAL POWDER 4 PK 48
40000053 GABAPENTIN 100MG CAP 11.25
40000056 HEPARIN 5,000 UNITS/1ML SDV 38.9
40000062 SODIUM CHLORIDE 3% HYPERTONIC 500 ML IV 81.6
40000082 LIDOCAINE 2% INJ 100 MG/5 ML SYRINGE 46.75
40000084 STERILE WATER FOR INJECTION 20 ML 39.3
40000090 GUAIFENESIN 400MG TAB 12
40000091 GLYCERIN ADULT SUPPOSITORY 12.3
40000103 CALCIUM CARBONATE 1000 MG (400 MG Elemental Calcium) TAB 0.65
40000122 FLUCONAZOLE 150 MG TAB 19.6
40000144 O CM_CTREOTIDE ACETATE *SYRINGE* 30 MG 10355.6
40000147 RIVAROXABAN 10 MG TABLET 56.3
40000149 DOXAZOSIN 2 MG TAB 14.4
40000175 ETONOGESTREL IMPLANT 68 MG 1247
40000264 LEVETIRACETAM 500 MG TAB 11.9
40000265 DONEPEZIL 10 MG TAB 11.7
40000269 MELOXICAM ORAL TAB 15 MG 12
40000282 LOPERAMIDE HCL 2 MG CAP 14.05
�52
40000293 ACIDOPHILUS-PECTIN CAPSULE 1 unit, 100 eaches 11.25
40000296 IBUPROFEN 200MG TAB 0.55
40000298 GLYCERIN LIQUID SUPPOSITORY PED (FLEET) 2
40000336 LORAZEPAM 1 MG TAB TAKE HOME PACK 13
40000362 DENOSUMAB 60 MG/ML SYRINGE 2233.9
40000377 DIPHENHYDRAMINE, LIDOCAINE, MAALOX (FIRST/MAGIC MOUTHWASH)122.1
40000392 ACETAMINOPHEN 500 MG TAB 0.55
40000394 ACETAMINOPHEN 325 MG TAB 0.6
40000404 MAGNESIUM SULFATE PREMIX 2 GM/50 ML BAG 112.65
40000406 ALTEPLASE 100 MG KIT 16389.8
40000411 BENAZEPRIL 20 MG TAB 12
40000412 CEFDINIR 300 MG CAP 13.15
40000416 AMIODARONE 360 MG/200 ML BAG (1.8 MG/ML) 268.9
40000423 ENEMA SALINE 133 ML (FLEET) 1.7
40000468 CEFEPIME 1 GM SDV 46.7
40000470 MECLIZINE 12.5 MG TAB 13.3
40000482 ADENOSINE 6 MG/2 ML VIAL 6 mg, 2 mL 65.05
40000521 METRONIDAZOLE 500 MG TAB 13.45
40000526 MIDAZOLAM ORAL SYR 10 MG/5 ML UD 37.05
40000527 BACITRACIN OINT 28 GM TUBE 27.4
40000529 LIDOCAINE 1% 20 ML 39
40000556 FERRIC CARBOXYMALTOSE 750 MG/15 ML 1562.35
40000568 ONDANSETRON HCL 4 MG ODT TAKE HOME PACK 16.2
40000579 SULFAMETHOXAZOLE/TRMETHOPRIM 800MG TAB TAKE HOME PACK 13
40000580 AMOXICILLIN 500 MG 6 CAPS TAKE HOME PACK 13.45
40000581 CIPRO 500 MG 6 TAB *TAKE HOME PACK* 17
40000582 AZITHROMYCIN 250MG TAB TAKE HOME PACK 25.3
40000858 buPROPion HCL SR 150 MG TABLET 150 mg, 60 eaches 12
40001042 ACETYLCYSTEINE INJE CM_CTION SDV 6 GM/ 30 ML 293.05
41000115 IV START KIT W/OUT EXT 10
ECF DAILY ROOM ECF DAILY ROOM CHARGE 244
ER-OBS INITIAL HOURER-OBS INITIAL HOUR CHARGE 250
ER-OBS SUBSEQUENT HOURER-OBS SUBSEQUENT HOUR CHARGE 23
�53
IP DAILY ROOM IP DAILY ROOM CHARGE 2288
SWING DAILY ROOM SWING BED DAILY ROOM CHARGE 1494
�54
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