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Charge Code Description CPT Charge
PRIVATE CARE 766.00
SWING-BED CARE PRIVATE 651.10
SEMI-PRIVATE CARE 716.00
SWING-BED CARE 608.60
REST BED - PRIVATE ROOM 400.00
HOSPICE RESPITE CARE Q5005 161.00
HOSPICE ACUTE CARE 561.00
OBSTETRIC CARE 643.00
E-MYCIN SULFISOXAZALE SUS 39.00
5% DEXTROSE INJECT 500ML 45.00
ANKLE WRAP, FIGURE EIGHT 26.00
CHEMO IV PUSH INITIAL 96409 516.54
CHEMO INFUSIONS 1ST HR 96413 898.59
RECOVERY ROOM 1-30MIN 348.00
RECOVERY ROOM 31-60MIN 547.00
RECOVERY ROOM 61-90MIN 630.00
RECOVERY ROOM 91-120MIN 703.00
RECOVERY ROOM 121-150MIN 735.00
RECOVERY ROOM 151-180MIN 818.00
RECOVERY ROOM 181-210MIN 880.00
RECOVERY ROOM 211-240MIN 922.00
IM/SUBCUTANEOUS INJECTION 96372 133.67
IV HYDRATION INITIAL 96360 270.23
IV HYDRATION ADDTL HR 96361 81.34
PORT DRAW 36591 242.94
IV INFUSION INITIAL 96365 433.38
IV INFUSION ADDTL HRS 96366 81.34
IV INFSN SEQUENTIAL DRUG 96367 133.67
IV PUSH/INITIAL 96374 270.23
IV PUSH DIFFERENT DRUG 96375 131.34
PORT FLUSH ONLY 96523 196.78
FETAL NON-STRESS TEST 59025 337.83
PHLEBOTOMY 99195 245.97
VACCINE ADMINISTRATION 90471 133.67
IV INFUSION CONCURRENT 96368 59.00
IV PUSH SAME DRUG 96376 65.00
CHEMO IV PUSH ADDTL DRUG 96411 226.74
CHEMO INFUSION ADDTL HR 96415 110.64
VACCINATION EA ADD'L VACC 90472 79.05
PNEUMONIA VACC.ADMIN. G0009 133.67
INFLUENZA VACC. ADMIN. G0008 88.50
CHEMO INJ/SUBCUTANEOUS IN 96401 195.40
INSERT BLADDER CATHETER 51701 328.93
INDWELILNG CATH INSERT 51702 328.93
INWELILNG CATH - COMPLEX 51703 282.69
RABIES IMM.GLOB IM ADMIN. 90376 640.95
DECLOT VASCULAR DEVICE 36593 487.34
TETANUS IMMUNE GLOBULIN TIG HUMAN IM 90389 313.97
MEAS POST VOIDING- BLADDER SCANNING 51798 172.81
NO CHARGE 0.00
OBSERVATION PER HR/ ER G0378 29.83
OBSERVATION PER HR/ DIREC G0379 983.55
PAS ANTI-EMBOLISM WRAPS 107.00
PROLENE MESH 6X6 PMH C1781 158.00
PROLENE MESH PHSM C1781 288.00
PROLENE MESH PHSE C1781 288.00
PROLENE MESH PHSL C1781 288.00
PENROSE DRAIN, STERILE 1/2 " LATEX FREE 12.50
TROCAR 5MM (VERSA STEP) 198.00
TROCAR 10/11MM (VERSA STE 194.00
TOCAR REDUCER 5MM 23.00
REMOVER PREP SOLUTION 18.00
CHOLANGIOGRAM CATH LAP-13 158.00
SKIN MARKER & RULER 4.25
TROCAR 12MM (VERSA STEP) 212.00
DISSECTORS BLUNT TIP 5MM 74.00
APPLIER CLIP LIGOMAX 319.75
APPLIER CLIP ROT LIGACLIP 219.10
LMA UNIQUE EMERGENCY KIT 58.00
NEEDLE, VERESS #S100000 75.00
TROCAR EXTRA LONG 5MM (VE 193.00
TROCAR EXTRA LONG 12MM (V 212.00
NEEDLE VERESS 14G EXTRALO 75.00
CATH INTRODUCER 18G X 2 # 4.00
SUTURE POLYSORB 3-0 #GL-6 23.00
SUTURE POLYSORB 2-0 24.00
PROBE, DISPOSABLE 5MM/32C 65.00
LAPAROTOMY PACKI 45.00
SUTURE, 0 MAXON 8.00
SUTURE, 1 MAXON 8.00
TROCAR BLUNTPORT 5MM-12MM 204.00
4 IN STERILE ACE 8.60
AMBUL OR-MINOR A 1-45 MIN 1,224.00
AMBUL OR-MINOR A 46-60MIN 1,384.00
AMBUL OR-MINOR A 61-75MIN 1,524.00
AMBUL OR-MINOR A 76-90MIN 1,644.00
AMBUL OR-MINOR A 91-105MI 1,744.00
AMBUL OR-MINOR B 1-45 MIN 1,899.00
AMBUL OR-MINOR B 46-60MIN 2,059.00
AMBUL OR-MINOR B 61-75MIN 2,199.00
AMBUL OR-MINOR B 76-90MIN 2,339.00
AMBUL OR-MINOR B 91-105MI 2,479.00
AMBUL OR-MINOR C 1-45 MIN 2,574.00
AMBUL OR-MINOR C 46-60MIN 2,734.00
AMBUL OR-MINOR C 61-75MIN 2,894.00
AMBUL OR-MINOR C 76-90MIN 3,054.00
AMBUL OR-MINOR C 91-105MI 3,214.00
MINOR PX RM-AMBULATORY SU 285.00
MINOR PX RM AMBULATORY SU 537.00
MINOR PX RM AMBULATORY SU 713.00
MINOR PX RM AMBULATORY SU 816.00
GENERAL ANESTHESIA RECOVE 156.00
GENERAL ANESTHESIA RECOVE 227.00
GENERAL ANESTHESIA RECOVE 291.00
GENERAL ANESTHESIA RECOVE 348.00
GENERAL ANESTHESIA REVOCE 398.00
GENERAL ANESTHESIA RECOVE 441.00
AMBULATORY OR MINOR B 120 2,619.00
TENDON SHEATH INCISION 26055 3,546.60
SPHINCTEROTOMY ANDAL DIVISION SPHINCTER 46080 2,315.63
NEUROPLASTY/TRANSPOS MED NERV CARPAL TUN 64721 2,936.59
AMPUTATION TOE INTERPHALANGEAL JOINT 28825 2,438.34
REPAIR UMBILICAL HERNIA 5 YR/> REDUCIBLE 49585 4,542.41
LAPAROSCOPIC CHOLECYSTECTOMY 47562 6,886.00
EXCISSION TUMOR FACE/SCALP LESS THAN 2CM 21011 1,500.00
EXCISION TUMOR FACE/SCALP OVER 2 CM 21013 1,700.00
REPAIR INITIAL INGUINAL HERNIA 5 AND UP 49505 5,080.00
EXCISION B9 LESION MARGIN >4 CM 11426 3,048.00
Excision, tumor, back greater than 3 cm 21931 1,348.03
EXCISION HYDROCELE UNILATERAL 55040 5,651.90
EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW 5> 24073 4,037.35
REPAIR RECURRENT INGUINAL HERNIA 49520 6,661.22
REMOVAL TUN CTRP VAD W PORT/PUMP REMOVAL 36590 1,092.00
CYSTOURETHROSCOPY 52000 1,800.00
BREAST LUMPECTOMY 19300 2,727.84
MAJOR JOINT INJ W/O GUIDANCE 20610 100.00
FLUOROSCOPIC NEEDLE GUIDANCE 77002 300.00
CHANGE CYSTOMSTOMY TUBE SIMPLE 51705 215.83
LUMBAR OR SACRAL, SINGLE LEVEL W/ IMAGE 64483 1,200.00
XYLOCAINE 1-2% W/WO EPIN. 21.00
XYLOCAINE 2% ADDITIONAL C 1.15
SENSORCAINE 0.5% PLAIN 30 21.00
BUPIVACAINE 0.25% INJ SOL. J2001 25.77
FORANE GAS PER USE 19.00
SEBOFORANE GAS PER USE 125.00
VERCURONIUM(NORCURON)1MG- 36.00
NA PENTOTHOL 500MG/2.5% K 18.00
XYLOCAINE 1% PLAIN 30ML 9.00
NIMBEX 2MG/ML IV 47.00
DANTROLENE (DANTRIUM) 20M 209.00
NITROBID OINTMENT 2% 30GM 18.00
TRANDATE(LABETALOL HCL) 5 3.30
ANESTHESIOLOGY SUPPLIES 132.00
ANESTHESIA GEN/LOCAL 1 - 332.00
ANESTHESIA GEN/LOCAL 31 462.00
ANESTHESIA GEN/LOCAL 61 562.00
ANESTHESIA GEN/LOCAL 91 638.00
ANESTHESIA GEN/LOCAL 121 715.00
ANESTHESIA GEN/LOCAL 151 791.00
ANESTHESIA GEN/LOCAL 181 868.00
ANESTHESIA MAC/IV SED 1 192.00
ANESTHESIA MAC/IV SED 31 268.00
ANESTHESIA MAC/IV SED 61 326.00
ANESTHESIA MAC/IV SED 91 370.00
ANESTHESIA MAC/IV SED 12 415.00
ANESTHESIA MAC/IV SED 15 459.00
ANESTHESIA MAC/IV SED 18 503.00
MARCAINE 0.5% INJ WITH EP J2001 28.53
MARCAINE LOCAL EACH ADD C 1.15
ANESTHESIA CIRCUIT PEDS 25.10
MINIDRIP CONTINUOUS FLO S 28.80
NURSE ANESTHETIST (PER UN 87.00
LIDOCAINE/ EPI 1% INJ (10 J3490 33.50
LIDOCAINE 1% INJ (10MG) J3490 34.90
LIDOCAINE/ EPI 2% INJ J3490 33.68
LIDOCAINE INJ SOLUTION 2% J3490 27.95
CRNA MAJOR JOINT INJECTION 20610 80.00
CRNA FLUOROSCOPIC NEEDLE GUIDANCE 77002 150.00
CRNA LUMBAR OR SACRAL, SINGLE LEVEL 64483 800.00
URGENT CARE OFFICE OP NEW 20 MIN 99202 123.00
URGENT CARE OFFICE OP NEW 30 MIN 99203 174.00
URGENT CARE OFFICE OP NEW 45 MIN 99204 264.00
URGENT CARE OFFICE OP EST 10 MIN 99212 66.00
URGENT CARE OFFICE OP EST 15 MIN 99213 86.00
URGENT CARE OFFICE OP EST 25 MIN 99214 217.35
5% D/W 500CC 55.00
DEXTRAN 6% 500CC 70.00
RINGERS INJ 1000CC 65.00
0.9% NACL 250ML GLASS 52.00
T.P.N. SOLUTION 322.00
PROCAL AMINE 1000CC 89.00
10% DEXTROSE 500CC 55.00
5% DEXTROSE & .33% NA CL( 65.00
DEXTROSE 10% 1000ML BAG 65.00
5% DEX/.2% NACL INJ USP 1 40.00
5% DEXTROSE INJ USP 250 M 40.00
STANDARD FLOW SET W/EXTEN 5.15
BLOOD ADMIN 0-2 HRS 36430 750.00
BLOOD ADMIN 2-4 HRS 36430 750.00
BLOOD ADMIN 4-6 HRS 36430 750.00
BLOOD ADMIN 6-8 HRS 36430 750.00
ER-CLASS 1 99281 155.31
ER-CLASS 2 99282 281.59
ER-CLASS 3 99283 495.30
ER-CLASS 4 99284 833.37
ER-CLASS 5 99285 1,230.05
ER-CLASS 6 99291 1,640.12
CC HOLDING/TRANSFER/GT 90 99291 1,394.25
CARDIOPULMONARY RESUSCITA 92950 630.00
CLINIC LVL 1 NEW PT G0463 150.00
TREATMENT ROOM-MISC NURS 99211 157.08
ONCOLOGY CLINIC VISIT G0463 150.00
TRAUMA RESPON W/HOSP CIRT G0390 2,773.44
ENTEROSTOMY CLINIC FEE 99211 253.00
ENTEROSTOMY CLINIC FEE EA 99211 157.08
EXTENDED OP CARE (EACH AD 99218 267.76
CARDIAC EXTENDED OUTPATIE 99218 295.00
CARDIAC EXTENDED OUTPAIEN 99218 430.00
ADMIN PNEUMONIA VACCINE G0009 79.05
ADMIN FLU VIRUS VACCINE G0008 79.05
REPAIR SUPERFICIAL WOUNDS 12002 245.89
BLOOD ADMIN>8 HRS 36430 710.00
APPLICATION LONG LEG SPLI 29505 300.63
REPAIR SUPERFICIAL WOUND 12001 275.43
APPLY FOREARM SPLINT 29125 328.93
INTMD WND REPAIR S/TR/EXT 12034 564.11
WOUND CLOSURE BY ADHESIVE G0168 73.86
APPLY LONG ARM SPLINT 29105 319.24
INJ TRIGGER POINT 1/2MUSC 20552 606.63
TREAT SHOULDER DISLOCATIO 23655 2,872.79
REMOVE NASAL FOREIGN BODY 30300 347.88
REPAIR SUPERFICIAL WOUNDS 12011 245.89
INTMD WND REPAIR FACE M/M 12054 624.89
INTMD WND REPAIR S/TR/EXT 12032 597.09
REMOVAL OF SKIN TAGS 11200 196.64
REPAIR SUPERFICIAL WOUNDS 12014 245.89
REPAIR SUPERFICIAL WOUNDS 12013 245.89
TREAT KNUCKLE DISLOCATION 26705 1,349.94
REMOVAL OF FOOT FOREIGN B 28190 2,063.64
INTMD WND REPAIR FACE M/M 12053 595.15
REMOVE EYELID FOREIGN BOD 67938 314.19
APPLY LOWER LEG SPLINT 29515 319.24
CONTROL NOSE BLEED 30901 328.93
TREAT FINGER DISLOCATION 26775 1,071.10
INTMD WND REPSIR FACE 12052 567.13
TREAT FINGER DISLOCATION 26770 675.58
DRAINAGE OF SKIN ABCESS 10060 478.98
TREAT ELBOW DISLOCATION 24640 520.38
STRAPPING ELBOW / WRIST 29260 78.88
REPAIR INTERMEDIATE 12031 549.08
REMOVAL FOREIGN BODY HAND 20520 1,922.73
I & D SKIN ABSCESS SKIN 10060 404.35
BURN DEBRIDEMENT 16020 442.17
FIRST DEGREE BURN 16000 168.95
EVAC/SUBUNGUAL HEMATOMA 11740 130.75
REMOVAL FOREIGN BODY EYE 65205 251.78
APPLY FINGER SPLINT 29130 130.75
FOREIGN BODY REMOVAL EAR 69200 328.93
REPAIR OF NAILBED 11760 488.20
INTMD REPAIR FACE 12051 472.06
REDUCE ANKLE DISLOCATION 27842 1,349.94
ELECTROCAUTERY 17110 168.95
REDUCE FRACTURE TOE 28515 289.22
VAGINAL DELIVERY ONLY 59409 4,363.65
SIMPLE REPAIR 7.6-12.5CM 12004 257.25
INTER.REPAIR 12.6-20.0CM 12035 754.44
I&D BARTHOLIN CYST 56420 355.68
REMOVAL IMPACT.CERUMEN / INSTRUMENT 69210 160.32
REPAIR SUPERFICIAL LACER. 12005 364.85
WOUND EXPLORATION, TRAUMA 20103 2,533.65
TRIMALLEOLAR FRAC.W/MANIPULATION 27818 1,346.76
BLADDER IRRIGATION 51700 633.30
SIMPLE REPAIR FACE 7.5cm 12015 364.85
SIMPLE REPAIR 12.6cm 12016 364.85
CLOSED TX PHALANGEAL FX 26742 1,349.94
REPAIR SCALP 20.1-30cm 12006 597.09
REMOVAL FOREIGN BODY CORNEA 65220 330.01
FRACTURE PHALANX/MANIPUL 26725 533.85
REDUCE ELBOW DISLOCATION WITH ANESTHESIA 24605 3,033.00
RMVL FOREIGN BODY MOUTH SIMPLE 40804 743.49
INCISION & DRAINAGE OF CYST 10080 572.85
REPAIR WOUND DEHISCENCE SIMPLE CLOSURE 12020 1,365.63
REPAIR COMPLEX SCALLP/ARM/LEG 2.6-7.5 CM 13121 1,322.00
SILVER SULFADIAZINE 1% CRM 400 GM 190.78
FLUSH SOD CL 0.9% FLUSH 0.00
FLUSH HEP-LOCK 100 UNT/5 ML SYR 10.74
GLIMEPIRIDE TAB 4 MG 4.91
ORPHENADRINE INJ 60MG/2ML VL 85.83
CHLORPHENIRAMINE ER CAP 12 mg 4.00
NITRO-TRANSDERM PAT 0.4MG/HR 5.54
NITRO-BID 2% OINT TUBE 5.17
PROMETHAZINE SUP 12.5 MG 53.12
ERTAPENEM INJ 1 GM VL J1335 375.10
EMLA XYLOCAINE CREAM 2.5% TOP 6.43
TOPIRAMATE TAB 125 MG 55.83
ACYCLOVIR INJ 500 MG VL J0133 76.40
KANAMYCIN 1GM 65.00
ANASTROZOLE TAB 1 MG J8999 62.96
GENTIAN VIOLET 1% TOP 4.04
SPIRIVA INHALER KIT 300.00
PSEUDO-CHLOR CAP 4 MG/ 60 MG 2.00
PREGABALIN CAP 50 MG 26.75
AMIODARONE INJ 50 MG/1ML (9 ml VL) J0282 33.14
CARBIDOPA/ LEVO TAB 25/250 MG 4.00
KEPPRA TAB 500 MG 4.00
PROPOXYPHENE CAP [65 MG] 6.33
CHOLESTYRAMINE 4 GM PACKET-BOX 153.75
AMBULANCE PHARMACY MEDS 0.00
RAMIPRIL CAP 2.5 MG 9.40
ACETAMINOPHEN TAB 325 MG 2.00
ALBUMIN HUMAN INJ 2500MG 156.09
QUETIAPINE TAB 25 MG 15.11
MEPROBAMATE 200 MG TAB 4.00
LOSARTAN TAB 25 MG 6.71
ASPIRIN TAB 325 MG 2.00
ASPIRIN SUPP 300 MG 5.83
ACETAMINOPHEN CHILD SUP 120 MG 4.58
HYDROCORTISONE SUPP 25 MG 43.28
CHARCOAL/ SORBITOL SUS 50 GM BTL 121.47
FLUTICAS/ SALMET MDI 250/50MG 394.16
FLUTICAS/ SALMET MDI 500/50 MG 623.52
AMANTADINE CAP 100 MG 9.13
DONEPEZIL TAB 10 MG 23.29
AMOX/CLAV POT TAB 875/125 MG 15.15
SPIRONOLAC/ HCTZ TAB 25/25MG 6.14
SPIRONOLACTONE TAB 25 MG 4.00
ALLOPURINOL TAB 100 MG 4.00
AMINOPHYLLINE INJ 250 MG VL 54.11
AMOXICILLIN CAP 250 MG 4.00
AMOXICILLIN SUS 125 MG/5ML (100 ML BTL) 14.36
AMOXICILLIN SUS 250 MG/5ML (80 ML BTL) 18.39
PRINCIPEN INJ 1 GM VL J0290 41.60
AMPICILLIN 250 MG TAB (50 9.00
OXYMETAZOLINE 0.05% SPR 6.15
CLARITHROMYCIN TAB 500 MG 15.03
ZOLPIDEM TAB 5 MG J3490 18.48
AUGMENTIN 500 MG TAB 15.12
OLANZAPINE TAB 2.5 MG 37.32
ALBUTEROL/ IPRATROPIUM 14.7 GM MDI 549.14
CEFAZOLIN INJ 1GM VL J0690 28.96
AZITHROMYCIN INJ 500 MG VL J0456 35.00
MELOXICAM TAB 7.5 MG 12.39
V FEND IV/PER 10 MG 13.30
MECLIZINE TAB 25 MG 4.00
VIT- K INJ 10 MG/ML (1ml/VL) J3430 153.15
J3430 153.15
SUCCINYLCHOLINE INJ 200MG/10 MG VL J0330 87.54
ALTEPLASE INJ 2 MG VL J2997 442.44
ATROVENT INHALER 14GM 75.10
BUMETANIDE INJ 0.25 MG/ML VL J3490 29.77
RT- IPRATROPIUM NEB 0.02% 25.53
LORAZEPAM TAB 0.5 MG 6.70
ALBUTEROL SYRUP PER 10CC 4.00
ATROPINE INJ 1 MG/ML VL J0461 54.38
AZTREONAM INJ 1 GM VL 110.94
ANTIPYRINE AND BENZOCAINE 10 ML 23.90
ATROPINE INJ SYR 1 MG/10ML J0461 23.24
SODIUM HYDROCHLOR SOLN 0.5% 34.01
SULFAMETH/ TMP SUS 200-40MG/5ML 9.11
TRIAMCINOLONE MDI IN 324.92
SULFAMETH/ TMP DS TAB 800-160MG 7.32
CARBIDOPA/ LEVO TAB 25/100 MG 4.00
TIMOLOL 0.5% OPTH 97.50
DIPHENHYDRAMINE CAP 25 MG 4.00
DIPHENHYDRAMINE INJ 50 MG VL J1200 29.90
J1200 29.90
DIPHENHYDRAMINE ELIX 12.5MG/5ML 2.00
DICYCLOMINE CAP 10 MG 4.00
DICYCLOMINE INJ 20 MG/2ML VL J0500 130.58
DICYCLOMINE SYRP 10MG/5ML 6.01
CALCIUM CL 10% INJ 10 ML VL 47.00
TRAVOPROST DRP (EYE) 367.74
ESCITALOPRAM TAB 10 MG 17.28
BUSPIRONE TAB 5 MG 4.00
TERBUTALINE INJ 1 MG/ML VL J3105 34.40
SUCRALFATE TAB 1 GM 4.00
CEPHALEXIN 125 MG/5ML SUSP (100 ML BTL) 32.00
DOCUSATE CAP 100 MG 4.00
CEPHALEXIN CAP 250 MG 4.00
EFFEXOR 150MG TAB 18.00
CEFUROXIME TAB 250 MG 16.99
DILTIAZEM CD CAP 180 MG 6.06
CAPTOPRIL TAB 12.5 MG 7.19
RT- BUDESONIDE NEB 0.5 MG/2ML J7626 41.75
ROPINIROLE TAB 3 MG 20.98
ASPIRIN CHEW TAB 81 MG 2.00
2.00
MAGNESIUM CITRATE SOL 4.68
COGENTIN 2MG (ORAL) 4.00
DOXAZOSIN TAB 4 MG 15.78
CLINDAMYCIN INJ 300MG J3490 31.12
CIPROFLOXACIN TAB 500 MG 15.30
CETACAINE SPY 56 GM 10.86
LEVOFLOXACIN INJ 250 MG J1956 92.08
DILTIAZEM TAB 30 MG 4.00
CALCIUM GLUC 10% 10 ML VL J0610 20.00
PROCHLORPERAZINE TAB 5 MG 4.00
PROCHLORPERAZINE INJ 10 MG/2 ML VL J0780 75.50
RT- ALBUTEROL/ IPRATROPI 2.5-0.5 MG/3 ML 25.77
MUPIROCIN OIN 2% 4.97
PROCHLORPERAZINE SUPP 25 MG 37.75
CEPHALEXIN SUS 250 MG/5ML (100 ML BTL) 86.25
COLCHICINE TAB 0.6 MG 4.00
CALCITRIOL CAP 0.25MCG 5.12
5.12
WARFARIN TAB 1 MG 4.00
9.90
CLINDAMYCIN CAP 150 MG 4.00
COLLAGENASE OIN 30GM 442.37
DILTIAZEM CD CAP 240 MG 8.20
MS CONTIN 30 MG TAB 18.00
CYCLOSPORINE DRP (BOX OF 30) 308.84
CALAMINE/ ZINC OX OIN 2.5 OZ TUBE 4.06
PROPOXYPHEN/ ACET TAB [10 6.66
CETIRIZINE TAB 10 MG 9.98
DEXAMETHASONE TAB 4 MG J8540 4.82
FINASTERIDE TAB 5 MG 12.61
DECADRON ELIX .5MG/ML 4.00
DANTROLENE INJ 20 MG VL 264.65
GABAPENTIN CAP 400 MG 6.38
COGENTIN 1MG TABS 4.00
DIAZEPAM INJ 10 MG/2ML VL J3360 95.64
J3360 95.64
CIPROFLOXACIN/D5W 400 mg PREMIX (200 ML) J0744 78.20
DEXAMETHASONE INJ 4 MG/vl (1ml/VL) J1100 27.92
MEPERIDINE INJ 50 MG/ML (1ML/VL) J2175 37.88
J2175 37.88
RT- LEVALBUTEROL NEB 1.25 MG (3ML/PC) 33.94
METHYLPREDNISOLONE INJ 40MG/ML VL J2920 46.10
DILTIAZEM ER CAP 120 MG 4.00
DEXTROSE 50% INJ 25 GM/50ML SYR J3490 44.03
DIGOXIN SOL 0.05MG/ML 11.20
HYDROCODONE ELIXIR PER CC 19.20
DIVALPR/ VALPROIC ACID CA 8.63
DIGOXIN TAB 0.125 MG 6.74
DIAZEPAM TAB 5 MG 6.32
DIPYRIDAMOLE/ ASA CAP 200/25 MG 31.33
PHENYTOIN SUS 125 MG/5ML 9.67
PHENYTOIN CAP 100 MG 4.00
DILANTIN 250MG/5CC IM/IV 40.00
PROPOFOL INJ 10 MG/ML (200 MG/20ML VL) J2704 38.00
DIMETAPP LIQ 5 ML 2.00
FENTANYL PAT (75 MCG/HR) 183.92
DIVALPR/ VALPROIC ACID 250 MG CAP 16.75
OXYBUTYNIN ER TAB 10 MG 47.82
BELLADONNA/PB ELX 16.2MG/5 ML 53.34
FENTANYL PAT (25 MCG/HR) 69.80
ATORVASTATIN TAB 20 MG 4.00
GABAPENTIN CAP 100 MG 4.00
BISACODYL SUPP 10 MG 4.27
BISACODYL TAB 5 MG 2.00
FLUCONAZOLE TAB 200 MG 42.97
TRIAMTER/ HCTZ CAP 37.5/25 MG 4.00
ERY-PED 200MG/5ML SUSPENS 16.00
DURICEF 250MG/5ML 50ML BO 69.00
FIBERCON TAB 4.00
AMITRIPTYLINE TAB 10 MG 4.00
CARDIZEM/DILTIAZEM 125MG/ 100.00
CLONIDINE TAB 0.1 MG 4.00
ERYTHROMYCIN INJ 500 MG VL J1364 225.35
EPINEPHrine 1:10 000INJ (1MG/10 ML) SYG J0171 38.00
VENLAFAXINE XR CAP 75 MG 50.67
SEVOFLURANE INH 250 ML 1.00
EPHEDRINE INJ 50 MG/ML AM 141.38
MORPHINE INJ 10 MG/ML (1ML/SYR) J2270 26.77
EMOLLIENT/ SKIN CLEANSER 15.10
ERY-TAB 333MG OR E-MYCIN 4.00
LEVOTHYROXINE TAB 88 MCG 4.00
PROPAFENONE CAP 150MG 20.26
ERYTHROCIN 1GM VIAL 25.00
CEFTAZIDIME INJ 1 GM VL J0713 33.50
FELDENE 20MG TAB (PIROXIC 10.04
CYCLOBENZAPRINE TAB 10 MG 4.00
FLUOROURACIL INJ 500MG/5 ML VL J9190 19.98
FERROUS SULF TAB 325 MG 4.00
FLUORESCEIN STRIP 4.00
DEXTROSE 40% GEL 15.80
GENTAMICIN INJ 80MG/2 ML VL J1580 25.81
GAVISCON LIQ 4.00
GAVISCON SUS 15ML 4.00
PEGS ELECTROLYTE SOL (1GAL) 120.00
FOSPHENYTOIN INJ 500 MG VL S0078 129.48
METFORMIN ER TAB 500 MG 5.35
FURADANTIN SUSP PER 10 CC 4.95
GLIPIZIDE TAB ER 5 MG 4.00
FOLIC ACID TAB 1 MG 2.00
METHYLPREDNISOLONE INJ 80 MG/ML VL J1020 75.02
ALENDRONATE TAB 70 MG 61.45
GLYCERIN SUP ADULT 4.00
LISINOPRIL TAB 5 MG 4.00
HALOPERIDOL TAB 1 MG 4.00
FLAGYL 375 MG TAB (METRON 8.20
PHILLIPS MOM 30CC 4.00
HEPARIN INJ 5,000 UNT/ML (1ML/VL) J1644 71.90
J1644 91.76
CALCIUM & VIT D TAB 600 MG 2.00
ESOMEPRAZOLE CAP 40 MG 25.54
HYDROCHLOROTHIAZIDE TAB 25 MG 4.00
HYDROCORTISONE 1.0% CRM 19.41
HYDROPRES 25 MG TAB 4.00
FERROUS SULFATE 65MG TAB 4.00
TERAZOSIN CAP 1 MG 6.42
HYDROCOD/ ACET TAB 10-325 MG 10.40
SUMATRIPTAN INJ 6 MG/0.5ML VL J3030 215.50
ISOSORBIDE MONO ER TAB 30 MG 6.64
ISOPTO CARPIN 1% EYE GTTS 33.20
FLUTICASONE MDI 110 MCG 466.16
IMODIUM A D CAP (2MG) 5.46
PROPRANOLOL TAB 10 MG 4.00
INDOMETHACIN CAP 25 MG 4.00
IPECAC LIQ 4.00
DOXYCYCLINE TAB 100 MG 9.48
TAMSULOSIN CAP 0.4 MG 16.83
CELECOXIB CAP 100 MG 26.46
VALPROIC ACID 250MG/5ML 4.00
KYTRIL INJ 1 MG VL J1626 78.95
SOD POLY SULF SUS 15GM/60mL 21.60
TRIAMCINOLONE INJ 40 MG/ML (1ML/VL) J3301 48.08
ERYTHROMYCIN EYE OIN ** 3.08
HALOPERIDOL INJ 5 MG/ML VL J1630 25.76
DOPAMINE/D5W PREMIX 400MG/250ML J1265 114.39
DIGOXIN TAB 0.25 MG 6.74
DIGOXIN IVP (0.5MG AMP) (2ml/AMP) J1160 38.69
ROSUVASTATIN TAB 5 MG 31.31
FUROSEMIDE INJ 100 MG/10ML VL J1940 484.23
FUROSEMIDE TAB 20 MG 4.00
CLOTRIMAZOLE/BETAM 0.5% CRM 15 ML TUBE 60.69
HALOPERIDOL TAB 1 MG 4.00
LEVOFLOXACIN TAB 500 MG 50.46
BACLOFEN TAB 20 MG 15.39
LIDOCAINE 2GM/ D5W PREMIX J2001 84.48
ETODOLAC (LODINE) 400MG 5.88
METOPROLOL TAR TAB 50 MG 4.00
METOPROLOL INJ 5 MG/5ML VL J3490 29.70
LORAZEPAM INJ 2 MG/ML VL J2060 20.90
J2060 20.90
DIPHENOXY/ ATR TAB 2.5MG 6.88
INDAPAMIDE/LOZOL 2.5 MG 4.00
FLUOCINONIDE 0.05% OIN 60 ML TUBE 238.21
BENAZEPRIL TAB 10 MG 4.00
MAG HYD/ AL HYD/ SIM SUS 4.00
NITROFURANTION MACRO CAP 20.70
MAG SULFATE 50% INJ 2 ML VL J3475 25.69
ENOXAPARIN INJ 100 MG/ML (3 ML MD VL) J1650 28.45
NITROFURANTOIN CAP 100 MG 15.06
VIT- B-12 TAB 500 MCG 2.00
2.00
GEMFIBROZIL TAB 600 MG 9.72
MANNITOL 25% INJ 50ML VL J2150 27.88
CLONAZEPAM TAB 0.5 MG 6.72
AQUA-MEPHYTON TAB 5 MG 36.99
PSYLLIUM PWD 2.00
METHOTREXATE INJ 50MG VL J9250 33.20
ZYPREXA 15 MG 40.41
LEUCOVORIN INJ (500 MG VL J0640 188.90
METRONIDAZOLE TAB 250 MG 4.00
METRONIDAZOLE/ SOD PREMIX 500MG/100ML J3490 71.00
EPINEPHRINE 1:1000 INJ 1MG/ML VL J0171 20.00
LOVASTATIN TAB 20 MG 9.49
POTASSIUM CL TAB 10 MEQ 6.01
GLYBURIDE TAB 2.5 MG 4.00
MILK OF MAGNESIASUS (2400/30 ML DOSE) 4.00
MORPHINE SULFATE 15MG (MS TAB 4.00
MINERAL OIL [30ML] ** 2.00
IBUPROFEN SUS 100 MG/5ML 2.00
MORPHINE INJ 4 MG/ML (1ML/VL) J2270 35.87
IBUPROFEN TAB 200MG 2.00
DALTEPARIN SOD PORC INJ 5000 UNT SR J1645 117.85
TRIPLE AB OIN TOP 0.01 OZ 2.00
ACETYLCYSTEINE SOL 20% 6000 mg (4ML/VL) 75.02
MAG HYD/ AL HYD/ SIM SUS (30 ML/CP) 4.00
SIMETHICONE DRP 40 MG/0.6ML 2.00
MULTIVITAMIN TAB 2.00
NAFCILLIN SODIUM INJ 1GM VL S0032 63.80
NAPROXEN TAB 500 MG 5.36
NALOXONE INJ 0.4 MG/ML VL J2310 79.31
METHOCARBAMOL TAB 750 MG 4.00
LACTULOSE LIQ 10 GM/15ML 10.05
NEO/ BAC/ POLY/ DEX OIN 88.00
NEO/ POLY /BAC/ZINC OINT 113.90
NEO/ POLY/ HC DRP SUS 187.54
HYDRALAZINE TAB 10 MG 4.00
AMOXICIL/ POT CLAV SUS 400/57 MG/50 ML 113.25
RT- ALBUTEROL NEB 2.5MG/3 ML J7613 25.41
NEO/ POLY/ GRAM DRP (EYE) 50.60
NEOSTIGMINE IVP VARIABLE DOSE 1mg/ml J2710 49.25
J2710 49.25
NIACIN TAB 250 MG 2.00
NITROGLYCERIN TAB 0.4 MG 4.11
TAMOXIFEN TAB 10 MG 7.58
FERREX TAB 150 MG 4.00
NORMODYN 100MG TAB 4.00
AMLODIPINE TAB 5 MG 6.92
INS- NOVOLIN R INJ 100UNIT/ML (10ml/VL) J1815 327.43
NYSTATIN SUS 100,000 UNT 4.70
OMNIPEN-N 500 MG IM OR IV 34.00
PROPARACAINE 0.5% EYE GTT 15 ML BTL 87.74
PREDNISOLONE SOL 5 MG/5ML 16.35
HUMULIN L INSULIN 10CC BO 79.18
OPTIRAY -CT SCAN 0.00
OS-CAL 250/250 MG TAB 3.00
FAMOTIDINE TAB 20 MG 6.96
INS- HUMULIN N PEN INJ 100 UNIT/ML 168.24
PAROXETINE TAB 20 MG 11.16
INS- NPH HUMAN/ REG HUMULIN 70/30 PEN 351.19
INS- LANTUS SOLO PEN 100UNIT/ML 224.06
OMEPRAZOLE CAP 20 MG 4.46
INS- LISPRO INJ 100 UNT/ML 623.35
PHENERGAN/CODEINE 5ML 22.59
PENICILLIN V K TAB 250 MG 4.76
PENICILLIN G PROC INJ 300000 UNITS VL J2510 111.63
CLOPIDOGREL TAB 75 MG 20.44
TOLTERODINE TAB 2 MG 43.80
PROMETHAZINE INJ 25 MG/ML VL J2550 24.74
J2550 24.74
PROMETHAZINE SUP 25 MG 17.79
PROMETHAZINE LIQ 6.25 MG/5 ML 22.05
REMINYL 8MG TABLET 12.39
PHENOBARBITAL LIQ 60 MG/15 ML 7.78
METFORMIN TAB 500 MG 4.00
PHENOBARBITAL INJ 130 MG/ML VL J2560 169.00
OXYTOCIN INJ 10 UNT/ML VL J2590 70.40
QUETIAPINE TAB 200 MG 45.28
REPAGLINIDE TAB 2 MG 22.52
POTASSIUM CHLORIDE SOL 20 MEQ/15ML 16.25
POTASSIUM CL INJ 20 MEQ/10 ML VL J3480 23.60
APAP DROP 2.00
PREDNISONE TAB 10 MG 4.00
FELODIPINE TAB 5 MG 4.96
GAMMAGARD INJ (1 GM VL) 1,310.37
NIFEDIPINE XL TAB 30 MG 5.25
PROCARDIA XL 60 MG ORAL CAP 13.00
PROMETHAZINE TAB 25 MG 4.00
ESTROGEN CONJ TAB 0.3 MG 19.28
FLUOXETINE CAP 20 MG 9.94
PROTAMINE SULF INJ 250 MG J2720 116.88
FLUOXETINE CAP 10 MG 10.39
PHENAZOPYRIDINE TAB 100MG 4.00
MORPHINE SOLN 5 MG/ 0.25ml (30 ML BTL) 73.29
DILTIAZEM INJ 50 MG/10 ML VL 20.00
METOCLOPRAMIDE LIQ SYRUP 4.00
METOCLOPRAMIDE TAB 5 MG 4.00
METOCLOPRAMIDE INJ 10MG/2 ML VL J2765 32.07
J2765 32.07
PHENTOLAMINE INJ VARIABLE DOSE 5 MG VL J2760 989.00
RISPERIDONE TAB 0.5 MG 17.09
GLYCOPYRROLATE INJ 0.2 MG (2ml/VL) 86.12
RT- RACEPINEPHRINE NEB 2.25% 25.44
CEFTRIAXONE INJ 1 GM VL J0696 25.40
ROCATROL CAP 0.25 MCG 5.12
FEXOFENADINE TAB 60 MG 5.59
GUAIFEN/ DM LIQ 100-10 MG/5ML 4.00
FLUMAZENIL INJ 0.1 MG/ML VL J3490 40.34
NABUMETONE TAB 500 MG 5.18
SENNA-S LAX TAB 2.00
SELDANE, PER TAB 4.00
PAVULON VIAL 4MG 90.00
HYDROXYCHLOROQUINE TAB 200 MG 17.56
INS- ASPART INJ 100 UNT/ML J1815 625.26
SILVER NITRATE STK 4.67
CARISOPODOL TAB 350 MG 4.00
SOD BICARB INJ SYR 50 MEQ (50ML) 24.29
MAGNESIUM TAB 128 MG PER 2 TABLETS 4.00
PROPRANOLOL LA CAP 80 MG 9.63
HYOSCYAMINE SOLN 0.125 MG/ML (15 ML BTL) 11.20
HYDROCORTISONE INJ 250 MG VL J1720 88.57
SOLU MEDROL INJ 125 MG VL J2930 49.06
METHYLPREDNISOLONE INJ 500 MG VL J2930 83.80
METHYLPREDNISOLONE INJ 1 GM VL J2930 176.77
AZITHROMYCIN TAB 250 MG 22.17
SULFACETAMIDE EYE GTTS 122.00
FENTANYL INJ PER 0.1MG (1ml/VL) J3010 20.96
J3010 20.96
OSELTAMIVIR CAP 75 MG 46.37
LEVOTHYROXINE TAB 100 MCG 4.00
TUBERCULIN PPD INJ 10 TU/0.1ML 86580 43.25
TRAZODONE TAB 50 MG 4.00
VIT- B-1 INJ 100 MG/ML VL J3411 51.09
EZETIMIBE TAB 10 MG 41.40
CARBAMAZEPINE TAB 200 MG 6.73
GLIPIZIDE ER TAB 2.5 MG 4.76
ATENOLOL TAB 100 MG 8.96
SALINE NASAL SPRAY 4.06
CHLORPROMAZINE INJ 25 MG VL J3230 89.16
VANCOMYCIN INJ 1 GM VL J3370 57.24
J3370 67.70
J3370 67.70
J3370 67.70
J3370 67.70
J3370 107.77
J3370 107.77
J3370 107.77
J3370 81.95
J3370 67.70
J3370 67.70
J3370 67.70
J3370 67.70
METOPROLOL XL TAB 25 MG 4.22
TRACRIUM PER VIAL INJ (OR 81.80
TRIAMTER/HCTZ CAP 50/25 MG 4.00
GUAIFENESIN SURP 100 MG/5 ML 4.00
NITRO-TRANSDERM 0.1 MG/HR 5.58
NITROGLYCERIN PREMIX 50 MG/250ML BTL 141.16
CALCIUM CARB TAB 500 MG 2.00
ACETAMIN/ COD LIQ 120/12 MG/5ML 60ML BTL 61.80
TUBARINE PER VIAL 14.75
ACETAMIN/ COD TAB 300/ 30 MG 6.36
ACETAMINOPHEN ADULT SUP 650 mg 4.67
ACETAMINOPHEN LIQ 160 MG/5ML 4.00
FLAVOXATE TAB 100 MG 5.85
VERAPAMIL INJ 2.5 MG/ML VL 69.44
VERAPAMIL ER TAB 240 MG 6.54
TRAMADOL TAB 50 MG 6.80
HYDROXYZINE CAP 25 MG 4.00
HYDROXYZINE INJ 25MG/ML VL J3410 80.50
VIT- C TAB 500 MG 2.00
2.00
RANITIDINE/ NACL INJ 50 MG/2ML VL J2780 39.34
ALPRAZOLAM TAB 0.25 MG 6.64
MIDAZOLAM INJ 5 MG/5ML VL J2250 6.73
LIDOCAINE 2% VISCOUS BTL 4.00
LIDOCAINE INJ 100 MG/5ML VL J2001 34.40
METOLAZONE TAB 2.5 MG 10.31
SERTRALINE TAB 50 MG 4.00
ENALAPRIL TAB 5 MG 6.18
SERTRALINE TAB 100 MG 13.42
RANITIDINE TAB 150 MG 4.00
PIPERACILLIN/ TAZO INJ 3.375 GM VL J2543 66.16
ZINC OXIDE 20% OIN 12.40
ZINC SULFATE CAP 220 MG 2.00
2.00
K-DUR 20 SR TAB (20 MEQ) 4.00
VINCRISTINE 1MG 200.00
CEFUROXIME INJ 1.5 GM VL J0697 29.47
VIT- E CAP 400 UNT 2.00
BISOPROL/ HCTZ TAB 5-6.25MG 4.53
LORATADINE TAB 10 MG 2.00
TRIAMCINOLONE INH 302.62
SUDAFED (PSEUDOEPH) TAB 3 3.00
RABAVERT INJ 1 ML VL 793.79
PIOGLITAZONE TAB 15 MG 21.02
Levofloxacin IVPB 500 MG/100ml D5W PreM J1956 112.71
LANSOPRAZOLE CAP 30 MG 16.99
MORPHINE SULFATE 30MG TAB 6.85
VANCOCIN, VANCOMYCIN 125M 21.00
AZITHROMYCIN SUS 100 MG/5 ML (15ML BTL) 104.64
VENLAFAXINE XR CAP 37.5 MG 45.22
QUINAPRIL TAB 10 MG 4.89
FLUTICASONE NAS SPR 16ML BTL 40.66
VIT- B-1 TAB 100 MG 2.00
NEO-SYNEPHRINE 1% INJ 10MG/ML VL J2370 33.77
FERROUS SULF LIQ 220 MG/5ML (BTL) 4.00
OXYCODONE CAP 5 MG 6.55
NYSTATIN CRM 30GM 3.36
KETOROLAC DRP 0.5% 3 ML BTL 64.97
MORPHINE SULFATE ER TAB 15 MG 13.38
TOLTERODINE CAP 4 MG 43.80
OXYFAST SOL 20MG/ ML (30 ML BTL) 686.50
MESALAMINE TAB 400 MG 8.72
METFORMIN TAB 850 MG 4.79
MIRTAZAPINE TAB 30 MG 11.18
FENTANYL PATCH TOP 50MCG 122.65
LORAZEPAM INTENSOL SUSP 2 MG/ML (30ML) 150.09
TETANUS IMM GLOB INJ [250 J1670 1,155.52
BACITRACIN OIN TOP 500U/GM TUBE 10.41
ARTIFICIAL TEARS EYE DROP 15ML 4.11
PEDIALYTE LIQ 1 LIT 19.74
HYDROCOD/ ACET TAB 7.5-325 MG 6.77
SILVER SULFADIAZINE 1% CRM 50 GM 45.36
VALSARTAN TAB 80 MG 26.67
SIMVASTATIN TAB 20 MG 19.68
19.68
PACERONE TAB 200 MG 13.29
ALBUTEROL MDI (8 GM) 81.40
172.96
OXYCODONE TAB 10 MG 24.11
VANCOMYCIN INJ 500 MG VL J3370 25.20
IRR - EYE WASH 4 OZ 8.64
DONNATAL/ XYL/ MALX SUS 10.00
FLUVASTATIN CAP 20 MG 18.36
BUPROPION XL TAB 150 MG 15.66
POLYETHYLENE GLYC PWD [11 7.48
ACYCLOVIR CAP 200MG J8499 6.12
KETOROLAC INJ 30 MG VL J1885 35.00
J1885 17.50
ROPINIROLE TAB 0.5 MG 20.23
MONTELUKAST TAB 10 MG 16.97
CITALOPRAM TAB 20 MG 10.77
MEGESTROL TAB 40 MG 5.47
HYDROCORTISONE 2.5% CRM 261.99
VIT- B-12 INJ 1000 MCG/ML 1ML/VL J3420 41.85
TRICOR 200 MG TAB 19.12
GABAPENTIN CAP 300 MG 5.51
CARVEDILOL TAB 6.25 MG 8.54
PROAMATINE 5MG TAB 8.00
VALACYCLOVIR TAB 1GM 75.16
PERMAX 0.25 MG TAB 9.00
HYDROCOD/ ACET TAB 5/500MG 6.00
PLETAL TAB 100 MG 7.30
PROSIGHT (OCUVITE) TAB 4.00
NICOTINE PAT 21 MG/24HR 6.43
MEMANTINE TAB 10 MG 26.68
DULOXETINE CAP 20MG 25.63
PIOGLITAZONE TAB 30 MG 71.26
BISOPROLOL TAB 5MG 5.41
CARVEDILOL TAB 12.5 MG 8.54
ERYTHRO/ SULF SUS 200-60O MG/5ML 45.51
GUAIFEN/ COD LIQ 100-10MG/5 ML 6.65
MIDAZOLAM SYRP 2MG/ML 20.67
CIPROFLOXACIN/ DEX DRP 472.19
KETAMINE 50MG/ML IV VL 24.00
DUTASTERIDE CAP 0.5 MG 18.15
PIPERACILLIN/ TAZO INJ 4.5 GM VL J2543 83.36
CEFTAZIDIME INJ 2 GM VL J0713 53.00
OFLOXACIN 0.3% DRP (EAR) 228.60
BENZONATATE CAP 100 MG 9.34
TIGECYCLINE IN 50 MG VL J3243 451.94
TOBRAMYCIN/ DEX DRP (EYE) 145.12
CIPROFLOXACIN 0.3% DRP 5ML BTL 13.60
FLUCONAZOLE INJ 400 MG/200 ML NACL J1450 76.80
AMBISOME 50 MG IV 350.00
BETADINE SCRUB TOP 4 OZ 4.04
ELASE OINTMENT 10GM TUBE 33.00
JEVITY CAN [8 OZ] 4.00
VAC- TETANUS/Diph 90714 110.08
DAPTOMYCIN INJ 500 MG VL J0878 1.45
RHOGAM 300MCG J2790 263.00
ADENOSINE INJ 6 MG/2ML VL J0153 68.00
ZOMETA INJ 4MG/5ML VL J3489 2,123.26
J3489 2,123.26
IRON SUCROSE INJ 100 MG/5 ML VL J1756 114.00
ARANESP INJ (60 MCG SYR) J0881 14.66
GLUCAGON EMERG KIT (1MG) J1610 660.22
J1610 660.22
IRON DEXTRAN INJ (PER 50MG VL J1750 93.20
J1750 93.20
FILGRASTIM INJ 300 MCG/1 ML SYR 737.82
NEULASTA 6MG SQ SYR 6,296.00
INTERFERON BETA 1A INJ 3O MCG VL J9212 2,039.84
VAC- PNEUMOCOCCAL 23 INJ 90732 42.68
TETANUS/DIP VAC.<7 LESS 90702 82.00
ONDANSETRON INJ 4 MG/ML (1ML/VL) J2405 23.42
IMIPENEM/CILAS INJ 500MG VL J0743 89.00
VAC- INFLUENZA VIRUS INJ 90686 118.50
FILGRASTIM INJ 480MCG/0.8 ML SYR 1,231.67
TENECTEPLASE INJ 1 MG (50 MG SYR) J3101 197.00
GAD-OMNISCAN PER 1ML A9579 16.25
NEUPOGEN 300MCG/1 ML VL 406.00
PEGFILGRASTIM INJ 6 MG J2505 10,702.26
REMICADE INJ 100 MG VL J1745 2,348.87
BEVACIZUMAB INJ (25MG/ML) 400MG VL J9035 7,464.00
GEMZAR INJ 200MG VL J9201 256.80
CEFTRIAXONE INJ 500 MG VL J0696 81.83
J0696 81.83
HALOPERIDOL INTENSOL 2 MG/ML (120ML BTL) 43.20
ABATACEPT INJ 250MG VL J0129 2,270.44
ESOMEPRAZOLE INJ 40 MG VL J3490 158.00
ZOLEDRONIC ACID INJ 5MG/100 ML BTL J3489 818.00
DIVALPROEX TAB 250 MG 9.82
INS-NOVOLOG 70/30 PEN J1815 259.92
INS - NOVOLOG 3 ML PEN 100 U/ML J1815 259.92
INS- LANTUS SOLO PEN 100UNIT/ML 130.33
INS - NPH HUMAN INJ 100U/ML J1815 168.24
OMEGA-3-ACID CAP 1 GM 4.00
LIDOCAINE 5% PATCH 11.38
OMNICEF CAP 300 MG 15.34
HYDROMORPHONE INJ 2 MG/ML VL J1170 34.92
ROCURONIUM INJ 10 MG/ML (5 ML VL) 40.32
DICLOXACILLIN CAP 250 MG 4.00
CEFDINIR SUS 250 MG/ 5 ML (60ML BTL) 316.00
CHOLESTYRAMINE PKT 4 GM 13.48
POLYSACCARIDE 150 MG TAB 4.00
VIT- D 3 CAP 1000 UNT 2.00
CEFEPIME INJ 1 GM VL J0692 37.10
TOBRAMYCIN INJ 80mg/ 2ml J3260 32.20
TIOTROPIUM MDI INH KIT 219.02
SYMBICORT MDI 160/ 4.5MCG 563.62
HYDROPHILIC POLYMER 10.18
MOXIFLOXACIN/ NACL 400 MG/250ML J2280 243.81
NORTRIPTYLINE CAP 50 MG 4.00
HEPARIN/0.45% NaCL IVPB PREMIX 250 ml J1644 95.16
LUTEIN CAP 20 MG 2.00
LABETALOL INJ 5 MG/1 ML VL 32.21
RT- ARFORMOTEROL NEB 15MCG/2ML 30.18
GLUCOSAMINE CAP 500 MG 4.00
CEFEPIME 1 GM VL 61.00
CARBAMAZEPINE SUSP 100 MG/5ML 4.00
LINEZOLID/D5W PREMIX 600MG/300ML J2020 285.00
ALLOPURINOL TAB 300 MG 4.00
AMITRIPTYLLINE TAB 25 MG 4.00
CEPHALEXIN CAP 500 MG 5.39
WARFARIN TAB 5 MG 11.10
FUROSEMIDE INJ 40 MG/4ML VL J1940 31.31
LEVOTHYROXINE TAB 25 MCG 4.00
LEVOTHYROXINE TAB 50 MCG 4.00
LISINOPRIL TAB 20 MG 4.00
NICOTINE PAT 7 MG/24HR 7.56
NITRO-TRANSDERM PAT 0.2MG/HR 4.85
NON FORMULARY DRUG 0.00
PATIENT HOME MEDICATION 0.00
PREDNISONE TAB 5 MG 4.00
TERAZOSIN 2MG CAP 7.50
AZITHROMYCIN SUS 200 MG/5 ML (15 ML BTL) 104.64
ACETAMINOPHEN TAB 500 MG 2.00
ASPIRIN EC TAB 81MG 2.00
FUROSEMIDE TAB 40 MG 4.00
IBUPROFEN TAB 600 MG 4.00
IBUPROFEN TAB 800 MG 4.00
METOPROLOL SUCC ER TAB 50 MG 4.22
EPOETIN ALFA INJ (PER 100 J0885 606.46
EPOETIN ALFA INJ (PER 100 J0885 29.26
EPOGEN INJ (PER 1000 UNIT J0885 23.70
MEDROXYPROGESTONE TAB 5 MG 4.00
DONNATAL/ XYL/ MALX SUS 19.16
DIVALPROEX E.R. 500MG TAB 4.00
ACETIC ACID 0.25% IRRG SOL 500ML 8.00
LABETALOL TAB 200 MG 4.00
DRISDOL CAP 50,000 UNITS 9.18
LOVASTATIN 40 MG TAB 4.00
REMERON 7.5MG TAB 4.00
RENVELA 800MG TAB 15.30
BAC/NEO/POLY OINT 1/32 OX PKT 2.00
TET-DIP PERTUSSIS .5ML 108.00
HYDROXYZINE TAB 10MG 4.00
SERNA LOTION 8oz BOTTLE 15.60
SEVOFLURANE 250 ML 1.31
INS- REG HUMAN INJ 100 UNIT/ML 351.19
FLURORESCEIN OPHTH STRIP 4.00
AMPICILLIN/SULB INJ 1.5GM VL J0295 63.04
NYSTATIN PWD 100,000 UNT 54.92
RT- SOD CHLORIDE 0.9% NEB 25.06
WATER STERILE INJ[10ML] 20.00
VAC- TETAN/ DIPH/Pertussis injection 90715 141.07
WATER BACT INJ 20.00
SIMVASTATIN TAB 10MG 11.16
V - HEPATITIS B SERIES WI 30.28
ONDANSETRON TAB 4 MG 69.34
GLIPIZIDE TAB 10 MG 4.00
HYDROXYZINE HCI TAB 25MG 4.00
BACLOFEN TAB 10 MG 4.00
VECURONIUM INJ 20MG/20ML VL 73.12
MEROPENEM INJ 1 GM VL J2185 100.43
FENOFIBRATE TAB 160MG 9.51
ZYVOX IV PREMIX 600MG/300ML D5W J2020 348.00
TEGRETOL TAB 200 MG 4.00
FOLIC ACID INJ 5MG/ML VL 33.54
KEPPRA XR TAB 500 MG 25.67
INFUVITE INJ 2 VL SET 50.34
FEXOFENADINE TAB (180 MG) 9.68
9.68
VALPROATE SOD INJ 500MG/5ML VL 40.10
DORIBAX INJ 500MG VL J1267 125.79
MOUTH MAGIC SWISH 4 OZ BT 34.20
DILANTIN XL CAP 30MG 5.11
CYMBALTA CAP 60 MG 28.76
LEFLUNOMIDE TAB 20 MG 49.27
DITROPAN ER TAB 10 MG 13.17
ACARBOSE TAB 25 MG 4.00
TEKTURNA TAB 150 MG 19.81
LUNESTA TAB 2 MG 56.45
CALCIUM CARBONATE SUSP 1250MG/5ML 4.00
CEROVITE CITRUS LIQ 8 OZ 4.00
SOLU-CORTEF INJ 100 MG VL J1720 60.30
J1720 60.30
TRIAMCINOLONE ACET CRM 0.1% 12.87
ARGINAID PKT 4.72
NORTRIPTYLINE CAP 25 MG 4.00
METOPROLOL TAB 25MG 4.00
MUCINEX TAB 600 MG 4.00
IRIN0TECAN 40 MG/2ML VL J9206 57.60
CANCIDAS INJ 50 MG VL J0637 789.98
VELCADE INJ (0.1 MG) 3.5MG VL J9041 4,632.00
ZOLADEX INJ 10.8 MG VL J9202 2,591.80
TRIPLE ANTIBIOTIC OINTMEN 14.12
ARANESP INJ (200 MG SYR) J0881 14.66
ABILIFY TAB 5 MG 107.04
INS - LEVEMIR INJ 300U/3ML J1815 211.29
CHLORTHALIDONE TAB 25 MG 4.83
FORTEO INJ 20MCG/DOSE PEN J3110 2,984.68
ARANESP INJ (500 MCG) J0881 14.66
BETHANECHOL TAB 50 MG 17.09
ACIDOPHILUS TAB 100 MG 4.00
EXELON PATCH TOP 9.5 MG 51.77
AZATHIOPRINE TAB 50 MG 8.44
8.44
TIOTROPIUM INH CAPSULE 18 MCG 61.81
MAGNESIUM OXIDE TAB 400 MG 4.00
LIDOCAINE HCL 0.5% 50ML J3490 36.59
NAFCILLIN SODIUM INJ 2 GM VL 98.18
NICOTINE PAT 14 MG/HR 6.43
AMOXICILLIN TAB 875 MG 4.00
HYDROMORPHONE INJ 1 MG VL J1170 39.22
J1170 39.22
CEFEPIME INJ 2 GM VL J0692 49.40
ORAJEL TUBE 14.24
RAMIPRIL CAP 10 MG 8.87
PRESERVISION TAB 4.00
BUPROPION TAB 75 MG 4.00
VIT B-6 TAB 4.00
ARANESP INJ 100MCG SYG J0881 14.66
FUSILEV INJ 50 MG VL J0641 240.00
AMPHOTERICIN B INJ 50 MG VL J0285 124.88
IVF- DEX 5%/ W 250 ML J7060 60.00
AMBISOME INJ 50 MG VL J0289 536.95
GEMZAR INJ 1GM VL J9201 180.00
BUMETANIDE TAB 1 MG 4.36
ISOSORBIDE DINITRATE TAB 20 MG 4.77
BUPROPION TAB 100 MG 4.24
RALOXIFENE TAB 60 MG 23.76
CARVEDILOL TAB 3.125 MG 8.54
VIT- D 3 CAP 400 UNT 2.00
VASOLEX ONT (60 GM TUBE) 164.25
MEROPENEM INJ 500 MG VL J2185 102.00
SULFAMETH/ TMP TAB 400-80MG 4.00
PROLIA INJ 60 MG SYR J0897 2,362.02
CALCIUM/MAG/ZINC TAB 2.00
DEPACON INJ 500 MG VL 107.54
DULOXETINE HCL 30 MG 7.68
NICORETTE GUM 2 MG 4.00
CARBIDOPA/ LEVO ER TAB 50/200 MG 7.22
POTASSIUM CL TAB 8 MEQ 4.00
OLEIC ACID LIQ 1 PT BTL 85.50
BUPIVACAINE 0.5% INJ SOL. 33.04
OCUVITE WITH LUTEIN TAB 2.00
BYSTOLIC TAB 20 MG 15.70
VALTURNA TAB 300/320 MG 16.52
ELIGARD INJ 45 MG BX J9217 5,642.48
UNISOM TAB 25 MG 2.00
PREGABALIN CAP 25 MG 26.75
SITAGLIPTIN TAB 100 MG 51.55
NIASPAN ER TAB 500 MG 18.61
VITAMIN B 12 TAB 500 MCG 4.00
BUSPIRONE TAB 15 MG 8.08
TERBINAFINE 1% 36.00
DICLOXACILLIN CAP 500 MG 4.00
BENICAR TAB 20 MG 25.13
NAPROXEN TAB 220 MG 2.00
DULERA MDI 100/5MCG 777.24
BETAPASE TAB 120 MG 48.26
MIDODRINE TAB 2.5 MG 5.73
NADOLOL TAB 80 MG 16.14
KETOROLAC INJ 15 MG VL J1885 33.50
J1885 33.50
PEPTO BISMOL OTC 30 ML DOSE 2.00
TPN 1200 ML 885.00
TRIMETHOPRIM TAB 100 MG 4.00
PROTONIX TAB 40 MG 15.80
DORZOLAMIDE/TIMOLOL EYE GTT 10ML BTL 220.68
LATANOPROST 0.005% EYE GT 48.76
FLUOROMETHOLONE OPHT 0.1% 10 ML BTL 34.10
REFRESH PLUS 0.5% EYE DRO 42.36
CREON CAP 12,000 UNIT 14.06
TUSSIONEX SUSP 10/8 MG/5ML 30.67
KETOROLAC INJ 60 MG VL J1885 38.75
PHENAZOPYRIDINE TAB 200MG 9.60
CLINDAMYCIN INJ 900MG/6ML VL J3490 32.60
EFFEXOR XR CAP 150 MG 15.25
GEODON CAP 60 MG 32.27
ENALAPRILAT INJ 2.5MG/2ML VL 26.06
HYDRALAZINE INJ 20MG/ML VL J0360 56.00
NICARDIPINE INJ 2.5MG/ML VL 81.09
INTEGRILIN INJ 20MG/ML VL J1327 499.80
DANTRIUM CAP 50 MG 6.92
MORPHINE INJ 2 MG/ML (1ml/VL) J2270 39.47
J2270 39.47
TOPIRAMATE TAB 100 MG 18.60
PRAVASTATIN TAB 10 MG 11.57
NITROFURANTION CAP 50 MG 11.06
ATROPINE OPHTH SOL 1% 5ML BTL 51.00
SITAGLIPTIN TAB 50 MG 51.55
DILTIAZEM TAB 60 MG 6.27
NORTRIPTYLINE CAP 75 MG 16.87
MICRO-GUARD ANTIFUNGAL PW 19.47
MORPHINE PER (15MG/ML 20 J2270 54.00
PIROXICAM CAP 40 MG 17.95
FLURAZEPAM CAP 30 MG 4.00
FLURAZEPAM CAP 15MG 4.00
DALIRESP TAB 500 MCG 30.95
MUCINEX TAB 1200 MG 4.00
RENVELLA TAB 800 MG 20.32
URO-JET SYR 5 ML 5.76
SLOW FE TAB 45MG 4.00
TEMAZEPAM TAB 15MG 4.00
CYCLOGEL EYE DROP 1% 5 ML BTL 114.86
ROSUVASTATIN TAB 20 MG 5.78
NATEGLINIDE TAB 120MG 17.95
CARVEDILOL CAP 80 MG 33.03
NITROPRESS INJ 50MG/2ML VL 704.00
TRANSTUZUMAB INJ 440 MG VL J9355 10,651.72
MORPHINE SULF INJ 5MG/ML (1ml/VL) J2270 39.47
J2270 39.47
HYDROXYUREA CAP 500 MG 5.90
ANAGRELIDE HCL CAP 0.5 MG 33.49
CEFTRIAXONE IM 1 GM VL J0696 25.40
LORTAB SOL.7.5/500/15ML 19.19
LIDOCAINE JELLY 2% (5ML) 23.40
PREGABALIN CAP 150 MG 26.75
OXYCONTIN TAB 40 MG 31.09
ACTIVASE INJ 100 MG VL J2997 137.74
ULORIC TAB 40 MG 38.45
THEOPHYLLINE ER TAB 300MG 4.00
IVF D5 1/2 NS WITH POTAssium 1000ml Bag J3480 60.00
IVF - 0.9% NS WITH POTASSium 1000ml Bag J3480 60.00
VESICARE TAB (5 MG) 41.17
FERREX FORTE CAP (150 MG) 4.00
IMODIUM SUSP. 1 MG/7.5ML 4.00
EFFEXOR ER CAP 75 MG 18.66
ZOLPIDEM ER TAB 12.5 MG 18.37
SUPHEDRINE 12 HR TAB 4.00
OSELTAMIVIR CAP 45 MG 42.54
TROSPIUM ER 60 MG CAP 20.21
RITUXAN INJ 100 MG VL J9310 2,168.12
RITUXAN INJ 500 MG VL J9310 10,840.56
ENABLEX TAB 7.5MG 45.73
RT- ALBUTEROL NEB 0.63MG/3ML 25.55
OCTREOTIDE SYR 0.1MG/ML J2354 43.70
PRIVIGEN INJ 20GM/200ML VL J1459 7,000.00
GAMUNEX INJ 20GM/200ML BTL J1561 6,079.20
GAMUNEX INJ 10 GM/100ML BTL J1561 2,356.77
GAMUNEX INJ 5 GM/50ML BTL J1561 1,269.71
ESOMEPRAZOLE CAP 20 MG 28.41
EXELON PATCH TOP 4.6 MG 51.77
DILANTIN TAB 30 MG 5.11
DILANTIN EXTENDED TAB 100 MG 5.93
AVAPRO TAB 300 MG 25.96
DEXAMETHASONE INJ 10 MG VL J1100 20.00
LEUCOVORIN INJ (200 MG VL J0640 75.81
PRAZOSIN TAB 1 MG 7.25
SODIUM CHLORIDE TAB 1 GM 4.00
MINOXIDIL TAB 2.5 MG 4.00
ATENOLOL TAB 25 MG 4.00
TERAZOSIN CAP 5 MG 6.42
ONDANSETRON TAB 8 MG 123.78
RABIES IMMUNE GLOBULIN IN SYR J1460 1,639.07
XARELTO 10 MG TAB 50.29
HYDRALAZINE TAB 50 MG 4.00
AMOXICILLIN TAB 500 MG 4.00
FLUDROCORT AC TAB 0.1 MG 6.39
VERAPAMIL TAB 80 MG 4.00
PRIVIGEN 10 GM/100ML VL J1459 3,500.00
SYSTANE NIGHTIME EYE OINTMENT 27.69
ETODALAC 400MG TAB 5.87
ABILIFY 10MG TAB 80.30
TOBRAMYCIN ING/200MG/30mL 3.31
FUROSEMIDE INJ 20MG/2ML VL J1940 28.58
GENTAMICIN OPHTH SOL 0.3% 5 ML BTL 25.57
GLYCERIN SUPP PEDIATRIC 4.12
HYDROCODONE/IBUP 7.5/200 10.59
INS-HUMALOG 75/25 PEN 129.78
FERAHEME INJ 510MGVL/17ML Q0138 1,968.24
OXYBUTYNIN ER TAB (5MG) 13.91
EXALON CAP 3 MG 16.97
16.97
OLANZAPINE INJ 10 MG VL J3490 115.45
OLANZAPINE DISINTERGARATI 279.84
MELATONIN 5MG TAB 4.00
HYDROCODONE/APAP 5/325 TAB 6.62
BYSTOLIC 5MG 15.70
TIZANIDINE 4MG CAP 5.86
ZIPRASIDONE 40MG CAP 26.59
VIILBRY TAB 40 MG 29.83
WELCHOL 625 MG 16.66
OXYBUTYNIN XL 15MG TAB 13.50
VAC VAQTA 50U/ML VL 207.29
ACETAZOLAMIKE 250 MG TAB 4.00
VERAPAMIL ER 120MG TAB 9.27
ROPINOROLE 2MG TAB 10.02
LUMIGAN OPTHALMIC SOL. 7.5 ML BTL 1,165.10
VENLAFAXINE ER, EFFECOR XR 225MG 37.78
GUIAFENESIN 400MG TAB 4.00
TOCILIZUMAB 200MG/10ML IV J3262 2,286.97
TOCILIZUMAB 80MG/4ML IV J3262 970.30
METHYL PREDNISOLONE DOSE PK 5.72
MMR 2 VACCINE 0.5ML VL 168.73
MEFOXIN 2GM VIAL 50.00
TIZANIDINE 2MG TAB 4.89
ESTRADIOL .5MG TAB 4.00
PROGESTERONE 100MG CAP 8.53
LIOTHYRONINE 50MCG TAB 6.36
DANTROLENE 25MG CAP 7.76
SUPHEDRINE/PSEUDOPEDRINE 30MG TAB 4.00
SENNA-GEN 8.6 TAB 2.00
MINOCYCLINE 100MG CAP 13.32
SIMETHICONE 80MG TAB 2.00
ACTEMRA INJ 400 MG VL J3262 8.62
FLUCONAZOLE 200MG/100ML IV J1450 97.38
LAC-HYDRIN FIVE LOTION 8OZ. 34.11
LUPRON DEPOT 22.5MG INJ J9217 9,191.95
ZAFIRLUKAST 20MG TAB 8.65
SYSTANE EYE DROPS 20.88
AMPICILLIN 500MG TAB 4.00
AMOXIL/CLAV 500/125MG TAB 15.14
SODIUM BICARBONATE 650MG TAB 4.00
CANDESARTAN-HCTZ 16/12.5 MG 18.88
SODIUM HYPOCHLORITE .125%SOLN 34.01
OLANZAPINE 10MG TAB 59.75
CELECOXIB 200MG CAP 43.40
MIDAZOLAM 5MG/ML INJ. VL J2250 4.00
Donepezil tab 5 mg 4.00
Actonel Oral 35 mg Tablet (Pack of 4) 292.54
Betapace 80 mg tab 10.25
FENOFIBRATE 200 mg CAP 12.60
CHLORDIAZEPOXIDE 25MG (LIBRIUM) 4.00
CARBIDOPA/LEVODOA 10/100MG TAB 4.00
VAC-BOOSTRIX T-DAP INJ 239.01
ZANTAC 150 MG/ 6 ML J2780 39.34
ATORVASTATIN 10MG TAB 16.19
QUETIAPINE 100MG TAB 20.57
DARBEPOETIN ALFA 40mcg/ML VL J0881 20.26
Levophed 1 MG/mL (4 mL VL) 74.56
CRANBERRY TAB 500 MG 4.00
TOBRAMYCIN 1.2 GM VL J3260 480.00
VESICARE 10 MG TAB 41.17
OXYBUTYNIN TAB (5 MG) 4.00
TOPIRAMATE TAB 25 MG 10.23
METHADONE TAB (10 MG) 6.30
AMPHETAMINE SALTS TAB (10 MG) 12.86
FLORAJEN 3 460MG CAP 4.00
DOXEPIN 25MG CAP 4.00
MINOCYCLINE 50MG CAP 6.79
SYNERCID 500mg INJ J2770 944.96
MIRTAZAPINE 15MG TAB 4.18
PANTOPRAZOLE DR 20MG TAB 15.80
VITAMIN B12 100MG TAB 2.00
ARANESP 300MCG SYG INJ J0881 15.40
INS-HUMULIN 70/30 (100u/mL) J1815 351.19
dexamethasone MDV 20mg/5mL inj VL J1100 35.84
PREGABALIN 75 mg CAP 29.43
CHLORDIAZEPOXIDE-CLID 5/2.5 CAP 15.43
DIGOXIN 100mcg/1ml inj. 253.37
AMIODARONE 150MG VL J0282 20.00
POTASSIUM CHLORIDE CAP 10MG 4.00
OSELTAMIVIR 6MG/ML SUSP 364.52
PREDNISOLONE 15MG/5ML SOL 9.63
AMOXICILLIN 400MG/5ML SUS 50ML BTL 19.60
MAGNESIUM SULFATE 2G/50ML INJ. 51.59
GLIMEPIRIDE ORAL 2MG TAB 7.00
Procrit 20000/mL VL J0885 90.99
SAOCHAROMYES BOULARDII 250MG CAP 5.52
CEFAZOLIN 1 GM IM VL J0690 23.96
J0690 23.96
DABIGATRAN 150MG CAP 24.03
CHLORDIAZEPOXIDE 5MG CAP 4.00
POTASSIUM CITRATE 10 MEQ TAB 9.82
APIXABAN 2.5MG TAB 25.14
IPRATROPIUM/ALBUTEROL 20MCG/100MCG MDI 253.50
CHLORDIAZEPOXIDE 10MG CAP 6.40
PROPRANOLOL 40MG TAB 4.00
FLECANIDE 100MG TAB 10.92
AMITIZA 24MCG CAP 22.27
MEROPENEM INJ. 500MG IN 50ML.9% NACL 128.38
PIPERACILLIN/TAZO INJ 2.25 GM VL J2543 56.25
IMMUNE GLOBULIN 10% 5 GR./50ML BTL J1459 1,570.40
FENTANYL PAT (12MCG/HLR) 66.91
ALAWAY OPTH DROPS .025% 82.88
HYDRALAZINE 100MG TAB 4.05
LINAGLIPTIN 5 MG TAB 49.38
PROPRANOLOL ER 60MG 8.23
DEXLANSOPRAZOLE 60MG CAP 32.91
LURASIDONE HCL 20MG TAB 100.66
PRIMIDONE 50MG TAB 4.00
MOEXIPRIL 15MB TAB 5.82
CLORAZEPATE 7.5MG TAB 12.40
PHENAZOPYRIDINE 95MG TAB OTC 2.00
ALBUTEROL SULFATE 90MCG INH 18GM 138.36
LEVALBUTEROL TARTRATE HFA INHALER 40.92
GUANFACINE ER 1 MG TAB 18.88
ZIPRASIDONE HCL 20MG TAB 26.59
MOMETASONE/FORMATOTEROL MDI 200/5MCG 777.24
NIFEDIPINE ER 90MG TAB 10.25
DILTIAZEM IVP VARIABLE DOSE/25MG 15ML J3490 33.08
HYDROMORPHONE 4MG TABS 6.69
BUDESONIDE/FORMOTEROL MDI 80/4.5 MCG 717.00
B-COMPLEX CAP 2.00
BICALUTAMIDE 50MG TAB 4.00
METHYLPHENIDATE ER 36MB TAB 25.74
NITROGLYCERIN BOTTLE (0.4MG TAB) 25 TABS 77.02
MIDODRINE 5MG TAB 8.13
FLUCONAZOLE 100MG IN 50ML 0.9% NACL 60.00
APIXABAN 5MG TAB NF 25.14
MORPHINE 25MG/ML VL 51.15
LEVETIRACETAM 750MG TAB 19.04
TRIAZOLAM 0.25MG TAB 20.67
RISPERIDONE 1MG TAB 18.20
MEDROXYPROGESTERONE 10MG TAB 4.00
BUPIVACAINE LIPOSOME 1.3% 20ML VL J3490 738.19
THYROTROPIN ALPHA 1.1MG INJ. 3,030.72
KETAMINE INJ 50 MG/ML 10MLVL J3490 20.06
CORTROSYN 0.25 MG VL 314.16
PRAVASTATIN 80MG TAB 19.16
ESMOLOL INJ 100MG/10ML VL 41.88
ETOMIDATE INJ 20MG/10ML VL 49.43
PHENYLEPHRINE 0.5% NASAL SPRAY 11.40
LIDOCAINE MPF/EPI 2%INJ 20MG/ML 67.16
ATROPINE INJ 0.4 MG/ML VL 41.88
ADENOSINE INJ 12 MG/4ML SR 36.42
SCOPOLAMINE TRANSDERM PATCH 1.5/72HR 51.11
GUANFACINE TAB 1MG 4.00
HETASTARCH 6% INJ VARIABLE RATE 114.00
FOSINOPRIL 20MG TAB 4.76
FENOFIBRATE B 4 MG CAP 7.80
DOXAZOSIN 2MG TAB 4.50
GLIPIZIDE 5 MG TAB 4.00
OSELTAMIVIR 30 MG CAP 42.54
MODAFANIL 200 MG TAB 100.00
LUTEIN 10MG TAB 2.00
GLUCAGON SURGERY INJ 1MG 493.62
DEXLANSOPRAZOLE 30MG CAP 32.91
RIFAXIMIN 550MG TAB 131.70
CEFOTETAN 1 GRAM INJ VARIABLE RATE S0074 77.69
METHADONE 5 MG TAB 6.27
LORATADINE/PSEUDOEPHEDRINE ER 10MG/240MG 2.00
VERAPAMIL 80MG TAB 4.00
PENICILLIN G BENZATHINE 600,000 U/ML IM 270.77
NaCL 0.9% MINI BAG IVF 250ML J7050 60.00
RIVAROXABAN 15mg NF TAB 50.29
CEFTRIAXONE IVPB 1GM VL J0696 41.54
VITAMIN D3 CAP 5000 IU 2.00
NATURE THROID TAB 81.25MG NF 4.00
MICAFUNGIN 100ML VIAL J2248 536.12
SULFAMETHOXAZOLE/TMP INJ 80-16MG/ML NF 57.62
DEXTROSE 5%(.500ML) IVF NF 60.00
CAMPHOR-PHENOL 6.5 GM TUBE 19.12
VISINE ADVANCED RELIEF .028 oz 5.28
PRESERVISION AREDS 2 FORMULA SOFT GEL NF 2.00
BISOPROLOL/HCTZ TAB (10-6.25MG) NF 4.52
REPINIROLE 1MG TAB NF 10.00
MIDODRINE 10MG TAB NF 19.35
CLOTRIMAZOLE/BETAMETHASON CRM TOP 45 GRM 217.82
LAMOTRIGINE 100MG TAB 19.00
VORICONAZOLE INJ 200MG VL VARIABLE RATE J3465 370.93
ENOXAPARIN INJ 100MG/ML SYR J1650 79.64
ENOXAPARIN INJ 40MG/0.4ML J1650 79.55
CO Q10 SOFTGEL 100MG NF 2.00
ENALAPRIL 10MG TAB NF 7.78
ARIPIPRAZOLE 15MG TAB NF 96.00
PRAMIPEXOLE 0.125MG TAB NF 13.37
PRAVASTATIN 40MG TAB NF 19.16
MULTIVITAMIN CHILDRENS CHEWABLE TAB NF 2.00
RAMELTEON 8MG TAB NF 45.32
TEMAZEPAM 30MG CAP NF 6.88
VORICONAZOLE 200MG TAB NF 139.31
SULINDAC 200MG TAB NF 4.80
HYOSCYAMINE 0.125MG SL TAB NF 4.00
FLUCONAZOLE 100MG TAB NF 26.26
SELEGILINE 5MG TAB NF 9.22
QUINAPRIL 20MG TAB NF 4.89
MIRABEGRON ER 50MG TAB NF 42.31
QUINAPRIL 40MG TAB NF 4.89
PHOS/SOD/POTAS ORAL PWDR 280/160/250MG 4.00
LETROZOLE 2.5MG TAB NF 54.40
IMMUNE GLOBULIN 40 GRAM / 400 ML BTL J1459 14,000.00
GENTAMICIN OPTH OINT 0.3% 3.5GM TUBE 101.26
CLOTRIMAZOLE TOP SOL 1%NF 30 ML BTL 149.46
FLUTICASONE-VILANTEROL 200-25MG INH NF 848.50
DILTIAZEM 125/25 ML INJ VL 47.82
ULORIC 80mg TAB 38.45
DENOSUMAB INJ (120mg) VL 4,932.79
FLUOXETINE ORAL SOLUTION 20mg/5ml 19.67
LORAZAEPAM 20mg/10ml INJECTION VL J2060 33.60
ACETYLCYSTEINE 20% INH/PO 200 mg/ml 4 ml 44.89
OXYCONTIN 80mg TAB 73.74
HYDROMORPHONE 2mg TAB 7.49
CILOSTAZOL ORAL TAB 50mg 13.30
LATUDA 10mg (HALF OF 20mg) 73.40
PREVNAR 13 VACCINE 532.10
SOLU-MEDROL 40mg ING 38.05
RIVAROXABAN 20MG TAB NF 50.29
VICTOZA PEN 18mg/3ml 610.50
COLESTIPOL 5.05
HYDROCORTISONE 20MG TABLET NF 4.35
ER AZITHROMYCIN 250mg tab qty 2 44.34
ER TRAMADOL 50mg TAB QTY 6 40.80
ENOXAPARIN INJ 30mg / 0.3ml 79.70
ARTHRITIS CREAM W/ LIDOCAINE 4% NF 23.94
METHOTREXATE 2.5 mg TAB NF 14.26
SULFASALAZINE 500 mg TAB NF 4.00
PSYLLIUM CAPSULE NF 4.00
DOXEPIN 10 mg CAP NF 4.00
MIDAZOLAM 2mg/2ml INJECTION 20.78
FERRIC CARBOXYMALTOSE 2,309.80
ONDANSETRON 40 mg/20 ml MDV J2405 20.00
CILOSTAZOL 100mg TAB NF 7.30
TERAZOSIN 2mg CAPSULE NF 5.78
PROPAFENONE 300mg TAB NF 11.88
TORSEMIDE 10mg TAB NF 4.00
SAVELLA 50mg TAB NF 20.93
NUCYNTA 50mg TAB NF 26.84
ER PREDNISOLONE 15mg/5ml SOLUTION 30ml 43.34
MORPHINE ORAL SOLUTION 20mg/5ml 58.53
CITRUCEL 33.66
PROPAFENONE 225mg 9.32
MEGESTROL ORAL SUSPENSION 400mg/ 10ml 401.86
EPINEPHRINE 1mg/ml SPINAL INJ 63.75
BUPIVACAINE 0.75% IN DEXTROSE 8.25% 28.34
MORPHINE 7.5mg TAB (1/2 OF 15mg) 6.26
AMIKACIN INJ 500mg / 2ml 38.38
CLOBETASOL 0.05% CREAM 30gm NF 512.52
CERAVE OINTMENT NF 38.28
ABREVA CREAM NF 55.65
PROTONIX ORAL SUSP PKT NF 51.65
PHOSPHA 250 NEUTRAL TAB NF 4.00
CREON 34000 CAP NF 20.90
MELATONIN 1mg TAB NF 2.00
DIAZEPAM IV or IM 50mg/ml 51.89
FUROSEMIDE ORAL SOL. 10mg/ml NF 27.30
HYDROMORPHONE INJ 50mg/5ml NF 68.25
VALACYCLOVIR 500mg TAB 21.21
BETAMETHASONE 30mg/5ml INJ 35.45
ACITRETIN 25mg CAP 115.38
VITAMIN K 1MG/0.5ML AMPULE J3430 32.75
PANTOPRAZOLE INJ 40MJ VIAL NF 41.25
CYCLOSPORINE MODIFIED 100mg CAP NF J7502 16.49
KETAMINE INJ 500mg/5ml 35.76
ACETAMINOPHEN ORAL LIQUID 480mg/15ml 4.00
LIDOCAINE 1% ING 50mg/5ml 28.86
BUTALBITAL-ACET-CAFF 50-325-40 TAB NF 6.75
FARXIGA 5mg TAB NF 55.75
PREDNISONE 1mg TAB NF J7512 4.00
NP THYROID 60mg TAB NF 4.00
NUCYNTA 1/2 OF 50mg=25mg NF 19.89
CALCIUM CITRATE 250mg NF 2.00
PROCRIT 3000 units/ml 232.99
ASPERCREME LIDOCAIN PATCH 4% NF 4.35
TRANEXAMIC ACID 1000mg/ml 78.20
LINACLOTIDE 72mcg CAP NF 46.45
LISDEXAMFETAMINE 50mg CAP NF 41.40
NALTREXONE 50mg TAB NF 17.10
URSODEOXYCHOLIC 300mg CAP NF 22.05
MYRBETRIQ 25mg TAB NF 42.31
GLYCINE IRRIGATION SOLUTION 48.42
Fluconazole 150mg tablet 42.03
Metronidazole 500mg tablet 5.84
Prednison 20mg tablet 11.04
Azithromycin 500 mg 56.04
Promethazine DM oral syrup 4.00
BOTOX 100 UNIT VIAL INJ 1,390.28
VENIPUNCTURE 36415 19.00
CBC-HGB,HCT,WBC,AUTO DIFF 85025 45.00
WBC 85048 29.00
HEMOGLOBIN 85018 15.00
HEMATOCRIT 85014 15.00
AUTO DIFFERENTIAL 85004 19.00
HEMOGRAM 85027 43.00
DIFFERENTIAL (MANUAL) 85007 31.00
PROTHROMBIN TIME (PT) 85610 23.00
SEDIMENTATION RATE (ESR) 85651 32.00
PARTIAL THROMBOPLASTIN TI 85730 52.00
PLATELET COUNT 85049 18.87
STREP SCREEN 87880 64.00
URINALYSIS-DIPSTICK ONLY 81002 15.00
URINALYSIS-ROUTINE 81000 40.00
OCCULT BLOOD-URINE 81002 10.80
MICROSCOPIC, URINE 81015 25.00
PROTEIN-QUANTITATIVE UA 84156 41.50
MAGNESIUM 83735 34.00
CREATININE CLEARANCE 82575 67.00
ALBUMIN SERUM 82040 37.00
AMYLASE 82150 36.00
BILIRUBIN DIRECT 82248 21.18
BILIRUBIN, TOTAL 82247 34.00
BUN (BLOOD UREA NITROGEN) 84520 25.00
CALCIUM 82310 34.00
CLOTEST 87449 54.00
CHOLESTEROL 82465 17.52
CREATINE KINASE(CK) 82550 35.00
CK/MB 82553 48.00
CHLORIDE 82435 19.41
CREATININE 82565 34.00
GESTATIONAL DIABETES SCRN 82950 41.00
BLOOD SUGAR 82947 32.00
GLUCOSE TOLERANCE TEST-3 82951 95.00
GTT (EACH ADDITIONAL SAMP 82952 32.00
IGG 82784 52.00
LDH-LACTATE DEHYDROGENASE 83615 33.00
CULTURE:OTHER BACTERIAL 87070 44.25
ALKALINE PHOSPHATASE 84075 42.00
POTASSIUM 84132 32.00
SODIUM 84295 20.31
SGOT (AST) 84450 31.00
TRIGLYCERIDES 84478 24.30
URIC ACID 84550 31.00
PHOSPHORUS SERUM 84100 32.00
BNP-BETA NATRIURETIC PEPT 83880 125.00
TOTAL PROTEIN 84155 37.00
T4 THYROID TEST 84436 41.00
LIVER PROFILE 80076 52.00
GGTP 82977 47.00
SGPT (ALT) 84460 31.00
CMP 80053 63.00
BMP-BASIC METABOLIC PANEL 80048 50.00
BLOOD TYPING: ABO 86900 25.00
BLOOD TYPE: RH 86901 25.00
IRREGULAR ANTIBODY SCREEN 86850 55.00
DIRECT COOMBS 86880 31.80
CROSSMATCH:IS 86920 129.18
CROSSMATCH: ALB 86921 129.18
CROSSMATCH:AHS 86922 129.18
MONO TEST 86308 37.00
R.A. LATEX 86430 45.00
PREGNANCY TEST 84703 60.00
H. PYLORI IGG 86677 116.00
SCREENING SFOB (SET OF 3) 82270 22.00
SCREENING SFOB (ONE SET) 82270 13.74
OCCULT BLOOD FECES (SET O 82272 13.74
OCCULT BLOOD FECES (ONE S 82270 13.74
SPERM CHECK 89300 37.65
SALIVA ALCOHOL 80320 16.00
DOT DRUG SCREEN 92.00
URINE-DRUG SCREENING COLL 16.00
ANAEROBIC CULTURE 87075 72.00
TSH 84443 91.00
FREE T4-THYROID II PROFIL 84439 62.73
THEOPHYLLINE 80198 72.00
DIGOXIN 80162 80.00
DILANTIN LEVEL 80185 80.00
PHENOBARBITAL 80184 95.45
CULTURE-URINE 87086 57.00
CULTURE:RESPIRATORY BACT 87070 29.00
CULTURE-BLOOD 87040 63.00
MIC SENSITIVITY 87186 45.00
GLYCATED HGB - A1C 83036 59.00
PSA 84153 92.33
PSA-SCREENING G0103 92.33
CEA 82378 115.00
LIPID II 80061 80.00
GENERAL ID 87077 55.00
ORGANISM TYPING 87147 19.00
ACETAMINOPHEN 80307 85.00
AFP, MATERNAL SERUM 82105 130.00
ANA SCREEN 86038 94.00
ASO 86060 59.00
B12 82607 102.00
CA 125 86304 115.00
CARBON MONOXIDE 82375 75.00
CRP 86140 53.00
DEPAKENE 80164 84.00
SPEP 84165 65.00
FECAL LEUKOCYTES 89055 111.40
FERRITIN 82728 85.00
FOLIC ACID 82746 95.00
FSH 83001 122.00
GENTAMICIN 80170 72.00
HCG QUANTITATIVE 84702 106.00
HBSAB 86706 67.00
IGM 82784 53.25
IRON 83540 45.00
TIBC 83550 45.00
LEAD 83655 80.00
LH 83002 126.00
LITHIUM 80178 48.00
PROLACTIN 84146 136.00
RITALIN 82542 124.00
SYPHILIS SEROLOGY 86592 35.00
TEGRETOL 80156 91.00
VANCOMYCIN, TROUGH; 80202 83.00
OB 1 80055 158.00
C. DIFFICILE 87493 128.00
GRAM STAIN 87205 32.00
O & P 87177 72.00
WET PREP 87210 31.00
DRUG OF ABUSE 80305 66.00
MICROALBUMIN, UA 82044 41.00
TROPONIN 84484 34.00
LIPASE 83690 41.00
HEPATITIS C ANTIBODY 86803 105.00
PTH INTACT 83970 207.22
STOOL-CULTURE 1 87045 18.00
STOOL CULTURE 2 87046 18.00
CHLAMYDIA BD PROBE 87491 113.00
GC BY BD 87591 151.00
BORDETELLA PERT.BY PCR 87798 66.50
ELECTROLYTES 80051 52.00
RETICULOCYTE COUNT 85045 35.00
CYTOMEGALOVIRUS IGM 86645 53.00
CYTOMEGALOVIRUS IGG 86644 53.00
INFLUENZA SCREEN 87804 48.00
CORTISOL 82533 84.00
VRE SCREEN 87081 37.00
CREATININE,24HR.URINE 82570 29.50
MICROALBUMIN/ CREAT RATIO 82043 77.00
FREE T3 84481 136.00
HEP BS AG 87340 53.00
HEPATITIS C VIRUS RNA 87522 458.44
JOINT FLUID CELL COUNT 89051 58.00
JOINT FLUID GLUCOSE 82945 43.00
RA, JOINT FLUID 86430 38.00
JOINT FLUID MUCIN 83872 23.00
JOINT FLUID CRYSTALS 89060 57.00
JOINT FLUID TOTAL PROTEIN 84157 11.00
MYSOLINE 80188 117.30
ZONEGRAN 82542 181.00
NEURONTIN 82542 102.00
CRYPTOSPORIDIA 87328 68.72
HEP B CORE AB, TOTAL 86704 77.00
INSULIN 83525 62.00
T UPTAKE 84479 23.00
IMMUNOFIXATION SERUM 86334 42.00
IMMUNOFIXATION URINE 86335 82.08
FUNGUS ID 87106 52.00
INFLUENZA B DFA 87275 36.00
INFLUENZA A DFA 87276 36.00
HEP A IGM AB 86709 77.00
ROTOVIRUS (EIA) 87425 98.00
RSV 87280 47.00
TETANUS AB 86774 138.00
ANTI-DS DNA 86225 79.00
PR-3 86021 194.00
URIC ACID, 24 HR UA 84560 42.00
D-DIMER 85379 60.00
VITAMIN E 84446 133.00
YEAST CULTURE 87070 43.00
FREE PSA 84154 110.00
CARDIOLIPIN IGG 86147 131.00
ENDOMYSIAL ABS 86255 85.00
T3 84480 94.00
PROGESTERONE 84144 103.00
DIRECT LDL 83721 57.00
HUMAN GROWTH HORMONE 83003 128.00
CLOZAPINE LEVEL 80159 140.00
CALCIUM, 24 HR URINE 82340 47.00
CO2 - CARBON DIOXIDE 82374 14.00
DOXEPIN LEVEL 80166 91.00
STONE ANALYSIS 82365 106.00
ALK PHOS ISOENZYMES 84080 94.00
AFP TUMOR MARKER 82105 105.00
VITAMIN A 84590 164.00
LIPOPROTEIN A 83695 143.00
IONIZED CALCIUM 82330 87.00
ALDOLASE 82085 74.00
DHEA-S 82627 94.00
ACTH 82024 195.47
CARDIAC CRP 86141 59.00
LYME DISEASE IGG 86617 96.45
HOMOCYSTEINE 83090 59.00
MYOGLOBIN 83874 179.00
CA 15-3 86300 164.00
PERIPHERAL SMEAR 85060 52.00
TESTOSTERONE; TOTAL 84403 174.00
HEMOGLOBIN ELECT 83020 138.00
ESTRADIOL 82670 191.00
IGF-1 84305 96.00
AMMONIA 82140 74.00
ANTI TISSUE TRANSGLUTAMIN 82397 151.00
FREE CORTISOL 82530 157.25
TACROLIMUS 80197 206.00
LEGIONELLA IGG 86713 132.00
ELECTROPHORESIS, 24 HR UA 84166 50.00
ANCA 86021 258.00
C3 86160 52.00
C4 86160 47.00
GIARDIA ANTIGEN 87329 75.01
CA 27.29 86300 164.00
KLONOPIN 80154 105.00
SALICYLATE 80307 85.00
ALPHA 1 ANTITRYPSIN 82103 80.08
CERULOPLASMIN 82390 79.00
CITRATE, 24 HR URINE 82507 297.00
ESTROGEN 82672 166.00
HDL 83718 34.56
MAGNESIUM, 24 HR URINE 83735 37.00
OXALATE, 24 HR URINE 83945 118.00
PHOSPHOROUS, 24 HR UA 84105 33.00
SODIUM, 24 HR UA 84300 32.00
TRANSFERRIN 84466 86.00
HEPATITIS B CORE IGM AB 86705 139.00
PARVOVIRUS GG IGM 86747 106.00
HLA B27 86812 203.58
HEP BE AG 87350 101.00
EXPOSURE PANEL 114.00
CA 19-9 86301 179.00
PREALBUMIN 84134 89.00
ACUTE HEPATITIS PANEL 80074 235.00
VMA 84585 133.00
METANEPHRINES 24 HR URINE 83835 353.00
CATECHOLAMINES 82384 242.00
C-PEPTIDE 84681 104.00
HEP A TOTAL AB 86708 113.00
URINE 5HIAA 83497 121.00
MRSA SCREEN 87081 37.00
PATERNITY COLLECTION FEE 16.00
METHYLMALONIC ACID 83921 132.77
ANTIMICROBIAL AGENT ENZYM 87185 27.00
FUNGAL CULTRUE, OTHER 87102 71.00
HYDROXYPROGESTERONE-17A 83498 207.00
CORTISOL, SALIVA 82533 240.00
PRE-EMPLOYMENT DRUG SCREE 80.00
GLIADIN ABS, IGG OR IGA 83516 118.00
COPPER 82525 84.00
HEPATITIS BE AB 86707 101.00
LACOSAMIDE 80299 143.46
ENA AB-ANTI-RNP 86235 86.00
PTT CONFIMATION 85732 57.00
DRVV TIME 85613 93.00
B2 GLYCOPROTEIN IGG 86146 99.00
KOH PREP 87220 51.57
RA FACTOR TITER 86431 47.00
BLASTOMYCES AB 86612 31.00
COCCIDIOIDES AB 86635 74.97
HISTOPLASMA AB quant (x3) 86698 21.20
HISTONE ABS 83516 70.50
SJOGRENS AB-ANTI-SSA 86235 86.00
SCLERODERMA AB 86235 157.00
THYROID PEROXIDASE AB(TPO 86376 131.75
ANTI-THYROGLOBULIN AB 86800 94.00
MUMPS AB IGG OR IGM 86735 95.00
VET SAMPLE 16.00
VITAMIN B6 84207 396.00
CRYOGLOBULINS 82595 23.00
LEAD, URINE 83655 92.00
ARSENIC URINE OR BLOOD 82175 183.00
RANDOM URINE CHLORIDE 82436 21.00
RANDOM URINE SODIUM 84300 24.93
RANDOM URINE POTASSIUM 84133 21.00
ZINC, SERUM 84630 64.60
THIAMINE (VITAMIN B1) 84425 160.00
VZV SCREEN 86787 72.97
ANCA MPO OR ANCA PR3 86021 97.00
FELBAMATE 82542 120.00
EBV IGG OR IGM 86665 110.00
MERCURY URINE OR BLOOD 83825 169.00
CYCLIC CITRULLINATED PEPT 86200 139.00
SEROTONIN 84260 229.00
CHROMOGRANIN A 86316 225.00
RANDOM URINE PROTEIN/CREA 84156 34.00
VITAMIN D.25 82306 106.00
AFB SMEAR 87206 34.00
HEPATITIS B DNA PCR 87517 275.00
RICKETTSIAL ABS 86757 220.60
HEP C GENOTYPE 87902 904.89
ACID FAST CULTURE 87116 43.00
H. PYLORI IGM 86677 229.00
FUNGAL CULTURE SKIN, HAIR 87101 48.00
KEPPRA 80177 95.25
LAMICTAL 82542 102.00
H. PYLORI AG, STOOL 87338 120.78
RUBELLA AG SCREEN 86762 58.00
TRYPTASE 83520 202.00
B. PERTUSSIS AB IGG, IGA, 86615 138.60
RSV SCREEN 87807 39.00
NOROVIRUS 87798 122.00
OSMOLALITY-SERUM 83930 37.00
OSMOLALITY-URINE 83935 36.00
PROTEIN C ACTIVITY 85303 174.00
THYROGLOBULIN TUMOR MARKE 84432 101.00
IGFBP-1 83519 100.28
SEX HORMONE BINDING GLOBU 84270 126.40
TESTOSTERONE; FREE 84402 150.00
HERPES IGM AB SCREEN 86694 140.75
HAPTOGLOBIN 83010 82.25
FLOW CYTOMETRY,1ST MARKER 88184 215.43
FLOW CYTOMETRY, ADDIT.MAR 88185 41.50
FLOW CYTOMETRY, INTERP 88189 41.50
VIT.D1,25 DIHYDROXY 82652 147.00
ANTI-SMOOTH MUSCLE AB 83516 126.75
ANTI-MITOCHONDRIAL AB 83516 90.85
GLIADIN PEPTIDE SCREEN 82397 54.60
ANGIOTENSIN CONVERTING EN 82164 117.25
PROTEIN S ANTIGEN 85305 237.00
HLA-B27 AG 86812 203.58
BETA-2 MICROGLOBULIN 82232 135.25
ERYTHROPOIETIN 82668 167.75
FIBRINOGEN 85384 76.75
CTX-COLLAGEN TYPE 1 82523 147.75
FRUCTOSAMINE 82985 44.00
CYCLOSPORINE 80158 165.40
IGE 82785 89.00
ALLERGY TEST PER ALLERGEN 86003 31.00
TOBRAMYCIN 80200 51.50
MANUAL DIFF REFLEX 85007 14.52
ANA TITER 86039 33.00
TOPAMAX 80201 94.50
ALLERGY SCREEN 86005 42.00
ALDOSTERONE 82088 279.75
RENIN 84244 159.75
LACTIC ACID 83605 63.00
VIP 84586 311.25
HEMOPHILUS INFLU B AB 86684 160.25
IMM DEF PANEL PART 1 86355 91.20
RABIES AB 86382 201.75
IMM DEF PANEL PART 2 86357 91.20
IMM DEF PANEL PART 3 86359 91.20
IMM DEF PANEL PART 4 86360 91.20
IMM DEF PANEL PART 5 88187 91.20
MYCOPLASMA/UREAPLASMA CUL 87109 129.25
ACTINOMYCES (NOCARDIA)AB 86744 31.00
ADH 84588 96.00
ISLET CELL AB 86341 181.50
AMPHETAMINE, SERUM 82145 176.50
TRICHROME STAIN 87209 67.00
AMIODARONE 82492 101.50
PROTEIN S ACTIVITY 85306 203.00
HISTOPLASMA ANTIGEN, URINE 87385 156.10
ANTI-GBM AB 83520 107.75
CH50 86162 175.25
C3 NEF 86327 194.50
AH50 86161 176.75
FACTOR H 86160 96.25
THIOPURINE 82542 253.50
HERPES 6 AB, IGG OR IGM 86790 76.00
VZV IgG OR IgM ABS 86787 72.97
FACTOR 8 85240 224.05
QUANTIFERON GOLD TB TEST 86480 188.75
VANCOMYCIN, PEAK 80202 83.00
IGA 82784 53.25
METANEPHRINES, PLASMA FR. 83835 234.00
CREATININE, RANDOM URINE 82570 29.50
EOSINOPHIL SMEAR 89190 28.25
TISSUE EXAM LEVEL III 88304 87.68
TISSUE EXAM LEVE IV 88305 141.06
PROTEIN FREE LIGHT CHAINS 83883 166.25
LEGIONELLA AG-URINE 87450 88.50
KIDNEY/LIVER MICROSAMAL 86376 137.50
HEP C RNA QUAL 87521 261.00
CMV PCR QUANT 87497 435.25
IODINE 83789 74.30
SURG PATH-GROSS ONLY 88300 46.84
ORARISK HPV 87621 175.00
ALPHA 1 ANTITRYP PHENOTYP 82104 90.90
RENAL FUNCTON PANEL 80069 51.50
ASPERGILLUS AB 86606 33.00
NON-SPECIFIED BACTERIA AB 86609 33.00
IMMUNODIFFUSION 86331 33.00
HCG TUMOR MARKER 84702 93.25
ANTI-MULLERIAN HORMONE 83516 116.00
JO-1 ANTIBODY 86235 215.25
SRP AUTOANTIBODIES 86235 133.00
LYME DISEASE IGM 86617 96.45
NMO ANTIBODY 83520 406.08
ENA AB-ANTI-SM 86235 86.00
SJOGRENS AB-ANTI-SSB 86235 86.00
CARDIOLIPIN IGM 86147 131.00
B2 GLYCOPROTEIN IGM 86146 99.00
PTT-SANFORD 85730 51.00
THIN PREP PAP-XIX 88175 95.20
THIN PREP PAP-MDCR G0145 95.20
TREPONEMA PALLIDUM AB 86780 91.90
Allergy Peanut 86003 40.00
FACTOR 5 LEIDEN MUT ANAL 81241 476.00
DECALCIFICATION PROCEDURE 88311 56.21
CALCIUM RADOM URINE 82340 57.50
Immunocytochemistry 88342 215.43
HEMOCHROMATOSIS GENE ANAL 81256 402.50
THYROTROPIN RECEPTOR AB 83520 172.00
METANEPHRINES 24 HR UA 83835 189.66
CATECHOLAMINES, 24 HR. 82384 264.46
HCG-SCREEN,SERUM 84703 53.41
MARIJUANA-URINE G0431 166.22
BARTONELLA AB 86611 64.75
86611 64.75
MICROALBUMIN, 24HR URINE 82043 101.30
G-6-PD 82955 136.25
82955 136.25
BP 180 IGG AB 83516 162.20
BP 230 IGG AB 83516 162.20
PH-STOOL 83986 14.64
T3, REVERSE 84482 196.06
PARASITE ID-BUG 87168 30.00
VITAMIN C 82180 205.50
PINWORM EXAM 87172 39.20
SODIUM, RANDOM URINE 84300 12.75
AZATHIOPRINE 82542 98.00
TRILEPTAL 83789 118.80
BK VIRUS DNA PCR 87799 578.19
ENTEROVIRUS RNA,PCR 87498 439.97
FACTOR 8 ASSAY 85240 232.22
MALARIA SMEARS 87207 66.63
CITRIC ACID RANDOM URINE 82507 79.14
TPMT ENZYME 82657 290.40
HERPES 2 IGM 86695 60.72
HERPES 1 IGM 86696 47.25
ANTI-THROMBIN 3 AG 85301 337.50
ACT PROT C RESIST 85307 199.25
CARNITINE 82379 252.41
LH-TANNER STAGES 83002 137.30
COLLAGEN X-LINKED NTP 82523 149.75
RUBEOLA (MEASLES) IgG AB 86765 134.50
PANCREATIC ELASTASE 82656 268.80
POSACONAZOLE 80299 182.43
ASCA IgG OR IgA 86671 113.45
ANTI-IgE 83516 159.50
HISTAMINE RELEASE 86343 40.00
TISSUE EXAM LEVEL II 88302 73.00
SPECIAL STAINS 88312 135.52
GENERAL HEALTH PANEL 40.00
LYME DX AB SCREEN 86618 133.70
C1 ESTERASE IN QUANT 86160 72.10
HPV DNA 87624 266.94
VITAMIN B3 (NIACIN) 84591 292.33
CYTOPATH CELL ENHANCE 88112 135.52
URINE ID (PRESUMPTIVE) 87088 54.00
VRIGENE DNA ID 87149 39.25
HERPES 1 IGG 86695 84.25
HERPES 2 IGG 86696 84.25
UREA NITROGEN, URINE 84540 25.00
COMPREHENSIVE ENTERIC PATHOGEN PANEL 87507 220.00
BASIC ENTERIC PATHOGEN PANEL 87506 233.82
ANTIMICROBIAL AGENT DISK METHOD 87184 25.98
DRUG SCREEN QUAN LAMOTRIGINE 80175 67.91
PROTEIN C ANTIGEN 85302 126.17
CULTURE ANAEROBE IDENT EACH 87076 34.73
Q FEVER ANTIBODIES 86638 36.00
C.DIFF TOXIN GENE 87324 97.37
JCV ANTIBODY 86711 1,969.38
HEMOPHILUS ETES 87181 98.27
CALPROTECTIN STOOL 83993 209.30
ESTRONE 82679 129.09
PROCALCITONIN 84145 261.22
ACHR BINDING AB 83519 99.49
CENTROMERE AB. IGG 83516 84.39
COLD AGGLUTININS 86157 58.70
EBV EARLY IGG AB 86663 77.09
CMV IGM 86645 53.03
CMV IGG 86644 53.03
CADMIUM, URINE 82300 122.59
VZV by PCR 87798 121.20
HSV by PCR 87529 169.60
VITAMIN D25 OH D2,D3 82306 155.08
APOLIPOPROTEIN A AND B 82172 67.02
DRUG ABUSE 2590 80307 85.00
NMO EVALUATION IgG 86255 245.00
AFB CONCENTRATION 87015 38.46
SICKLE CELL SCREEN 85660 39.56
TISSUE TRANSGLUTAMINASE IgG 83516 83.00
VORICONAZOLE LEVEL 80299 92.51
PTH RELATED PROTEIN 82397 311.54
VONWILLEBRAND ANTIGEN 85246 144.33
WEST NILE IgG 86789 85.80
WEST NILE IgM 86788 67.55
5,10-MTHFR 2 MUTATIONS 81291 198.28
HIV SCREEN REFLEX TO CONFIRM 87389 57.79
POTASSIUM, 24 HR URINE 84133 26.05
FOLIC ACID, RBC 82746 78.80
MYCOBACTERIAL CULTURE 87118 155.27
FUNGAS / MOLD ID 87107 70.64
TRICHOMONAS by NAD 87661 215.04
STREP PNEUMO IgG-23 SEROTYPES 86317 31.14
FECAL REDUCING SUBSTANCE 84376 91.40
LYME DISEASE AB, IMMUNOBLOT 86617 99.37
IGF BINDING PROTEIN 3 83519 100.28
MANGANESE 83785 259.43
SPECIAL STAIN GROUP 2 88313 71.00
INFLUENZA A and B by NAD 87502 115.00
IgD 82784 59.11
BETA-HYDROXYBUTYRATE (ACETONE) 82010 45.07
EBV NUCLEAR Ag Ab IgG 86664 81.23
HLA-DQ TYPING 81376 386.30
ALCOHOL, BLOOD 80307 85.00
C-REACTIVE PROTEIN 86140 58.00
LEAD, VENOUS 83655 23.31
PARANEOPLASTIC AUTOANTIBODY 86255 273.08
FATTY ACID PROFILE 82726 79.84
LEUCINE-RICH GLIOMA INACT PROTEIN-1 IgG 86255 250.00
CONTACTIN-ASSOC PROTEIN-LIKE-2 IgG 86255 250.00
HEPARIN ANTI-XA 85520 160.05
LEGIONELLA IgM 86713 141.24
LEGIONELLA IgG 86713 72.50
STREP PNEUMO IgG-14 SEROTYPES 86317 32.21
AMIKACIN, PEAK or TROUGH 80150 88.46
SMOOTH MUSCLE ANTIBODY 86255 72.93
VORICONAZOLE, SERUM 80299 92.51
CHLAMYDIA CULTURE 87110 109.89
NEURONAL (V-G) K+ CH AB 83519 147.22
BILE ACIDS 82239 50.34
NICOTINE & METABOLITES, SERUM 80323 90.59
LEPTOSPIRA AB 86720 112.05
HANTA VIRUS AB IgG OR IgM 86790 110.30
FECAL FAT QUANTITATIVE 82710 113.92
STREP PNEUMONAL-AG,URINE 87450 53.06
CRYTO AG, STOOL 87328 68.73
ADENOVIRUS PCR 87798 122.21
CULTURE BACT, STOOL SINGLE PATHOGEN 87046 54.38
RESPIRATORY PROBE 87633 571.72
CHLAMYDOPHILIA PNEUMONIAL 87486 91.80
MYCOPLASMA PNEUMONIAL 87581 420.00
BORDETELLA PARAPERTUSSIS 87798 200.00
DRUGS OF ABUSE 52 80307 131.00
C1 ESTERASE INHIBITOR FUNC 83520 67.32
PHOSPHATIDYLETHANOL (PETH) 80321 146.59
SELF PAY GENERAL HEALTH PANEL 70.00
SELF PAY LIPID PANEL 25.00
SELF PAY COMPREHENSIVE LAB PROFILE (CMP 20.00
SELF PAY COMPLETE BLOOD COUNT (CBC) 15.00
SELF PAY TSH 25.00
SELF PAY FREE T4 (FT4) 15.00
SLEF PAY HEMOGLOBIN A1C (HGBA1C) 20.00
SELF PAY GLUCOSE (GLU) 10.00
SELF PAY VITAMIN D 60.00
ITRACONAZOLE 81247 70.86
CRYOFIBRINOGEN 89.07
DOPPLER ECHO EXAM,HEART 93320 266.00
DOPPLER COLOR FLOW ADD-ON 93325 260.00
ECHO 93307 1,207.17
CARDIAC PACING 92953 512.66
STRESS TEST W/ SUPER, INTERPRET, REPORT 93015 700.00
STRESS TEST WITH SUPERVISION 93016 172.00
EKG 93005 200.00
EVENT MONITOR HOOK-UP 93270 198.75
HOLTER MONITOR HOOKUP/SCN 93226 345.00
EKG-MDCR PX G0404 200.00
STRESS TEST WITH EKG TRACING AND MONITOR 93017 750.00
ECHO TTHRC R-T 2D W/WO MODE COMPLETE 93350 1,150.00
ECHO TTHRC RT 2D - BUBBLE ECHO 93306 1,010.00
ANKLE LEFT(2 VIEWS) 73600 172.05
PELVIS (1 OR 2 VIEWS) 72170 226.00
PELVIS (3 VIEWS) 72190 263.00
SACRUM/COCCYX 72220 195.00
CERVICAL SPINE (AP-LAT) 72040 222.00
CERV SPINE, MIN 4 VWS 72050 431.00
CERVICAL SPINE (5 VIEWS-O 72052 431.00
THORACIC SPINE 72072 302.00
LUMBAR SPINE (AP-LAT) 72100 265.00
LUMBAR SPINE (5 VIEWS-OBL 72110 327.00
SCOLIOSIS SURVEY 72081 205.00
CHEST (2 VIEWS) 71046 223.00
CHEST 3 VIEWS 71047 280.00
CHEST WITH OBLIQUE (3 VIEWS) 71047 280.00
CHEST (PORTABLE) 71045 186.00
AP CHEST 71045 186.00
STERNUM (2 VIEWS) 71120 215.00
SKULL (2 VIEWS) 70250 208.00
SKULL (4 VIEWS) 70260 291.00
SKULL (5 VIEWS) 70260 300.00
FACIAL BONES (2 VIEWS) 70140 188.00
FACIAL BONES (4 VIEWS) 70150 301.00
FACIAL BONES (5 VIEWS) 70150 150.00
JAW <4 VIEWS 70100 135.12
JAW (4 VIEWS) 70110 262.00
NASAL BONES 70160 219.00
SINUS SERIES 70220 282.00
ABDOMEN 1 VIEW 74018 193.00
ABDOMEN 2 74019 246.00
ABDOMEN ACUTE ABDOMEN SERIES 74022 432.00
BARIUM MEAL (UGI)(AC) 74246 512.00
ESOPHOGRAM 74220 416.00
SMALL BOWEL SERIES 74250 428.00
UGI W AIR & BA W SBFT 74249 459.00
BARIUM ENEMA 74270 465.00
BARIUM ENEMA (AC) 74280 453.00
SINUS TRACT INJECTION 76080 689.88
SINUS-SINGLE VIEW 70210 210.00
KUB 74018 193.00
IV PYELOGRAM 74400 560.00
METASTATIC BONE SURVEY 77075 667.50
BONE DENSITOMETRY 77080 380.00
FINGER, LEFT MIN 2 VIEWS 73140 172.05
FINGER, RIGHT MIN 2 VIEWS 73140 172.05
HAND, LEFT (2 VIEWS) 73120 159.00
HAND, RIGHT (2 VIEWS) 73120 159.00
HAND, LEFT MIN 3 VIEWS 73130 209.00
HAND, RIGHT MIN 3 VIEWS 73130 209.00
ELBOW, LEFT (2 VIEWS) 73070 172.05
ELBOW, RIGHT (2VIEWS) 73070 172.05
ELBOW, LEFT (3 VIEWS) 73080 201.00
ELBOW, RIGHT (3 VIEWS) 73080 201.00
ELBOW, LEFT (4 VIEWS) 73080 201.00
ELBOW, RIGHT (4 VIEWS) 73080 201.00
WRIST, LEFT (2 VIEWS) 73100 155.00
WRIST, RIGHT (2 VIEWS) 73100 155.00
WRIST, LEFT MIN 3 VIEWS 73110 201.00
WRIST, RIGHT MIN 3 VIEWS 73110 201.00
FOREARM, LEFT 73090 183.00
FOREARM, RIGHT 73090 183.00
UPPER ARM, LEFT (2 VIEWS) 73060 208.00
UPPER ARM, RIGHT (2 VIEWS 73060 208.00
SHOULDER, LEFT 1 VIEW 73020 172.05
SHOULDER, RIGHT 1 VIEW 73020 172.05
SHOULDER, LEFT (2 VIEWS) 73030 221.00
SHOULDER, RIGHT (2 VIEWS) 73030 221.00
CLAVICLE, LEFT 73000 192.00
CLAVICLE, RIGHT 73000 192.00
SCAPULA, LEFT 73010 211.00
SCAPULA, RIGHT 73010 211.00
TOES, LEFT MIN 2 VIEWS 73660 166.00
TOES, RIGHT MIN 2 VIEWS 73660 166.00
FOOT, LEFT (2 VIEWS) 73620 172.05
FOOT, RIGHT (2 VIEWS) 73620 172.05
FOOT, LEFT (3 VIEWS) 73630 192.00
FOOT, RIGHT (3 VIEWS) 73630 192.00
HEEL, LEFT 73650 168.00
HEEL, RIGHT 73650 168.00
ANKLE RIGHT (2 VIEWS) 73600 172.05
ANKLE LEFT (3 VIEWS) 73610 208.00
ANKLE RIGHT (3 VIEWS) 73610 208.00
KNEE LEFT (1 OR 2 VIEWS) 73560 199.00
KNEE RIGHT (1 OR 2 VIEWS) 73560 199.00
KNEE LEFT (3 VIEWS) 73562 200.00
KNEE RIGHT (3 VIEWS) 73562 200.00
KNEE LEFT (4 VIEWS) 73564 216.00
KNEE RIGHT (4 VIEWS) 73564 216.00
LOWER LEG LEFT (2 OR 3 VI 73590 199.00
LOWER LEG RIGHT (2 OR 3 V 73590 199.00
UPPER LEG LEFT (2 VIEWS) 73552 227.00
UPPER LEG RIGHT (2 VIEWS) 73552 227.00
HIP LEFT (AP ONLY) 73501 172.05
HIP RIGHT (AP ONLY) 73501 172.05
HIP LEFT (2 VIEWS) 73502 209.00
HIP RIGHT (2 VIEWS) 73502 209.00
RIBS LEFT (2 OR 3 VIEWS) 71100 247.00
RIBS RIGHT (2 OR 3 VIEWS) 71100 247.00
RIBS WITH PA CHEST LEFT 71101 289.00
RIBS WITH PA CHEST RIGHT 71101 289.00
THYROID-TC99M 78012 532.00
HEPATOBILLIARY 78226 1,018.00
HB DUCT SYS W GB 78227 1,069.11
BONE LIMITED 78300 884.00
THREE PHASE BONE 78315 1,386.00
BONE TOMOGRAPHY 78320 1,386.00
LUNG PERFUSION 78580 897.00
LUNG PERFUSION AND VENT 78582 1,069.11
KIDNEY IMG MORPH VASC FLOW W/RX 78708 1,251.00
L3-SACRUM CAT SCAN 72131 1,712.00
HEAD CAT SCAN W/O CONTRAS 70450 1,512.00
HEAD CAT SCAN WITH CONTRA 70460 1,647.00
HEAD CAT SCAN W/WO CONTRA 70470 1,879.00
MAX FACE CAT SCAN W/O CON 70486 1,512.00
SOFT TISSUE NECK CAT SCAN 70491 1,647.00
SOFT TISSUE NECK CAT SCAN 70492 1,879.00
SOFT TISSUE NECK CT W/O 70490 1,512.00
LOWER EXTREMITY W/CONTRAS 73701 1,512.00
ABDOMINAL CAT SCAN W/O CO 74150 1,712.00
ABDOMINAL CAT SCAN WITH C 74160 1,879.00
ABDOMINAL CAT SCAN W/WO C 74170 2,047.00
CHEST CAT SCAN W/O CONTRA 71250 1,712.00
CHEST CAT SCAN W CONTRAST 71260 1,879.00
CHEST W/WO CONTRAST 71270 2,047.00
PELVIS CAT SCAN W/O CONTR 72192 1,712.00
PELVIS WITH CONTRAST 72193 1,879.00
PELVIS W/WO CONTRAST 72194 1,917.00
C-SPINE CAT SCAN 72125 1,712.00
T-SPINE CAT SCAN 72128 1,512.00
UPPER EXTREMITY W/O CONTR 73200 2,081.00
LOWER EXTREMITY W/O CONTR 73700 1,544.00
OB 1ST TRIMESTER 76801 434.00
OB TRANSVAG 76817 403.71
CYST POST NECK U/S 76881 403.71
ULTRASOUND ABD.LTD. 76705 413.00
ULTRASOUND OBSTETRIC 76805 410.73
ULTRASOUND FOLLOW-UP OB 76816 329.44
ULTRASOUND PELVIC -WAIST 76856 472.00
ULTRASOUND ABDOMINAL (WAI 76700 517.00
ULTRASOUND TRANSVAG PELVI 76830 378.00
ULTRASOUND SCROTUM 76870 391.00
ULTRASOUND RENAL 76775 370.00
ULTRASOUND HEAD/NECK THYR 76536 403.71
ULTRASOUND SPECIFIC ORAGA 76775 369.00
ULTRASOUND AORTA 76775 370.00
LIMITED PELVIC ULTRASOUND 76857 270.15
ULTRASOUND AAA SCREENING 76706 370.00
MAMMOGRAPHY 77067 450.00
MRI-TMJ 70336 1,293.00
MRI-ORB,FACE,NECK 70540 2,349.00
MRI-UPPER EXTREMITIES 73220 2,683.00
MRI-UPPER EXTREMITY (JOIN 73221 1,846.00
MRI-LOWER EXTREMITY W/O 73718 2,181.00
MRI-LOWER EXTREMITY (JOIN 73721 1,846.00
MRI-ANGIO LOWER EXTREMITY 73725 1,933.00
MRI-ABDOMEN 74181 2,349.00
SOFT TISSUE NECK MRI 70549 2,629.00
MRI-BRAIN 70551 2,517.00
MRI-BRAIN W/WO CONTRAST 70553 2,852.00
MRI-C-SPINE 72141 2,349.00
MRI-C-SPINE WITH CONTRAST 72142 2,376.00
MRI-THORACIC SPINE 72146 2,349.00
MRI-THORACIC SPINE WITH C 72147 2,376.00
MRI-LUMBAR SPINE 72148 2,349.00
MRI-LUMBAR SPINE WITH CON 72149 2,376.00
MRI-C-SPINE W/WO 72156 2,683.00
MRI-T-SPINE W/WO 72157 2,592.00
MRI-L-SPINE 72158 2,683.00
MRI-PELVIS 72196 2,511.00
LOCM 300-399 MG/ML IODINE Q9967 3.00
ARTERIAL DOPPLER LIMB LIM 93922 362.00
ARTERIAL DOPPLER LIMB COM 93923 591.00
DUPLEX CAROTID 93880 846.00
BILATERAL DUPLEX VENOUS EXTREMITY 93970 732.00
UNILATERAL DUPLEX VENOUS EXTREMITY 93971 336.67
US SOFT TISSUE EXT LIM 76882 369.00
MRA:CAROTIDS 70549 2,160.00
MRI:FACE W/WO 70543 2,572.00
MRA-CIRCLE OF WILLISBRAIN 70544 2,160.00
GAD-OMNISCAN PER 1 ML A9579 19.00
MRI-LOWER EXT.W/WO 73720 2,052.00
CT ABD & PELVIS WO 74176 3,424.00
CT ABD&PELV WCONTRAST 74177 3,758.00
CT ADB/PELVIS CT WO/W 74178 3,964.00
BARIUM MEAL (NOT AC) 74240 474.00
MRI-UPPER EXT W/O 73218 2,181.00
OB U/S LTD. 76815 251.06
MAX FAC CT W/CONTRAST 70487 1,647.00
BONE AGE STUDY 77072 250.96
VIDEO SWALLOW (CINE/VID X-RAY THROAT) 74230 250.96
SPINE INJECTIONS (FLUOROGUIDE FOR SPINE) 77003 213.87
CHOLANGIOGRAPHY (X-RAY BILE DUCTS/PANC) 74300 230.00
UNLISTED FLUORO PROCEDURE 76496 151.54
PORT PLACEMENT (FLUO FOR VEIN DEVICE) 77001 175.56
X-RAY EXAM OF SHOULDERS 73050 151.54
CTA ABDOMEN 74175 2,047.00
CTA ANGIO ADB&PELV 74174 3,964.00
PARATHYROID PLANAR IMAGING 78070 829.82
TC-99M SESTAMIBI DX PER STUDY DOSE A9500 213.20
TC-99M MEBROFENIN DX UP TO 15 MCI A9537 167.09
RADIOPHAR Tc66m ALBUMIN MOBILE A9540 76.74
RADIOPHAR Tc99m PENTETATE-DTPA A9567 91.98
RADIOPHAR Tc99m MIBI 1 MOB A9500 80.00
RADIOPHAR Tc99m LABEL RBC MOB A9560 65.00
CHOLECYSTOKININ (CKK) J2805 0.00
RADIOPHAR Tc99m MERITIATIDE MOB A9562 323.00
RADIOPHAR I 123 (100) MOBILE A9516 170.00
RADIOPHARTc99m A9512 65.00
RADIOPHARM Tc99m SULFER COLLOID A9541 65.00
FNA WITH IMAGING GUIDANCE 10022 572.85
ULTRASONIC GUIDANCE INTRAOPERATIVE 76998 200.00
CT TEMPORAL ORBIT, SELLA W/O CONTRAST 70480 1,114.25
CT TEMPORAL, ORBIT, SELLA WITH CONTRAST 70481 1,703.78
NECK SOFT TISSUE 70360 188.86
CTA HEAD W/CONTRAST W/NO CONTRAST 70496 2,220.19
SACROILIAC JOINTS 3 OR MORE VIEWS 72202 228.29
RIBS BILATERAL WITH PA CHEST MIN 4 VIEW 71111 367.00
SCREENING MAMMO - BILATERAL DIGTL IMAG 77067 450.00
DAIGNOSTIC MAMMO DIGTL BILATERAL IMAGING 77066 333.00
DIAGNOSTIC MAMMO BILATERAL 77066 262.00
DIGITAL BREAST TOMOSYNTHESIS UNILATERAL 77061 50.00
DIGITAL BREAST TOMOSYNTHESIS BILATERAL 77062 50.00
SCREENING DGTL TOMOSYNTHESIS BILATERAL 77063 50.00
BX BREAST W/DEVICE 1ST LESION STEREO GUI 19081 3,054.00
BX BREAST W/DEVICE ADDL LESION STEREO GU 19082 2,337.00
PERQ DEVICE PLACEMENT BREAST LOC 1ST LES 19281 1,551.00
PERQ DEVICE PLACEMENT BREAST LOC EA LESI 19282 1,282.00
RADIOLOGICAL EXAM SURGICAL SPECIMEN 76098 486.69
DIAGNOSTIC MAMMOGRAPHY - UNILATERAL 77065 131.00
ABDOMEN 3+VIEWS 74021 300.00
CHEST 4+ VIEWS 71048 320.00
CT MAXILLOFACIAL W/O & W/CONTRAST 70488 1,873.66
SPINE XRAY 1 VIEW SPECIFY LEVEL 72020 195.00
BONE/JOINT IMAGING WHOLE BODY 78306 1,288.35
TC-99M OXIDRONATE DIAGNOSTIC TO 30 A9561 227.88
SPINE THRC LUMBR CRV SAC 2/3 VIEW 72082 351.00
CTA CHEST W/CONTRAST/NONCONTRAST 71275 2,315.00
DEXA BONE 77081 295.38
ULTRASOUND BREAST UNILATERAL COMPLETE 76641 391.00
CT LOWER EXTREMIY W & W/O CONTRAST 73702 1,771.00
DUPLEX SCAN ART/ARTL BPGS COMPLETE 93925 521.00
MRI PELVIS W/O CONTRAST MATERIAL 72195 2,403.11
THYROID UPTAKE W/BLOOD FLOW SNGL/MULT QU 78014 1,026.74
SHUNTOGRAM INDWELLING NONVASCULAR SHUNT 75809 414.00
COLONOSCOPY 45378 1,971.96
COLONOSCOPY WITH BIOPSY 45380 2,002.06
COLONOSCOPY WITH POLYP RE 45385 2,011.86
COLONOSCOPY W/BIOPSY & PO 45385 2,042.07
SCRN COLONOSCOPY G0121 1,940.19
SCRN COLONOSCOPY-HI RISK G0105 1,940.19
EGD 43235 1,873.22
EGD WITH BIOPSY OR CLOTES 43239 1,904.21
EGD WITH BIOPSY AND CLOTE 43239 1,904.21
EGD WITH BIOPSY AND ESPH 43235 2,189.29
EGD WITH BIOPSY,DILATATIO 43235 2,189.29
EGD WITH ESOPHAGEAL DILAT 43245 2,658.53
FLEXIBLE SIGMOIDOSCPY 45330 1,383.00
COLON INJ INDIA INK 45381 1,971.96
FLEX SIG w/ POLYP REMOVAL 45338 2,037.55
COLONOSCOPY, FLEXIBLE WITH HOT BIOPSY 45384 2,720.03
COLONOSCOPY FLEXIBLE WITH BAND LIGATION 45398 2,185.03
COLONOSCOPY FLEX WITH CONTROL BLEEDING 45382 2,117.00
SENSORY INTEGRATIVE TECHN 97533 79.81
SITE VISIT (EA 15 MIN)-OT 97537 81.74
APPLY SPLINT SHORT ARM (D 29126 231.45
APPLY SPLINT FINGER (DYNA 29131 231.45
STRAPPING (ELBOW OR WRIST 29260 231.45
STRAPPING (HAND OR FINGER 29280 231.45
MUSCLE TESTING, MANUAL, H 95832 42.78
ROM MEASURE/REPORT, HAND- 95852 24.00
VASOPNEUMATIC DEVICE-OT 97016 50.55
PARAFFIN BATH THERAPY-OT 97018 36.00
WHIRLPOOL THERAPY-OT 97022 61.00
ELECTRICAL STIM MANUAL-OT 97032 49.00
IONTOPHORESIS, EA 15M-OT 97033 84.08
CONTRAST BATHS-OT 97034 47.27
ULTRASOUND, EA 15M-OT 97035 36.00
UNLISTED (SPECIFY TYPE & 97039 32.00
THERAPEUTIC EX (EA 15 MIN 97110 75.00
NEUROMUS RE-ED (EA 15 MIN 97112 75.00
OT-MANUAL THERAPY TECHNIQ 97140 75.00
ORTH/PROSTHETIC CHECKOUT 97530 75.00
INITIAL ORTHOTIC TRAINING 97760 75.00
THERAPEUTIC ACT DIRECT (E 97530 75.00
SELF-CARE/HOME MANAGEMENT 97535 75.00
WORK/COMM REINTEG (EA 15 97537 75.00
WHEEL CHAIR MGMT/PROPUL ( 97542 50.00
PHYSICAL PRFORM TEST (EA 97750 75.00
WOUND CARE (EA 15 MIN)-OT 97799 38.00
MUSCLE TEST TOTAL BODY EX 95833 62.04
MUSCLE TEST TOTAL BODY IN 95834 84.40
ELECTRIC STIM-OT 97014 42.40
APPLY MLTLAYR COMPRESS ARM/HAND 29584 319.24
APPLY MULTLAY COMPRS LWR LEG 29581 319.24
OT EVAL LOW COMPLEX 30 MIN 97165 150.00
OT EVAL MOD COMPLEX 45 MIN 97166 150.00
OT EVAL HIGH COMPLEX 60 MIN 97167 150.00
OT RE-EVAL EST PLAN CARE 97168 130.00
SUBSEQUENT VISIT PROSTHETIC OR ORTHOTIC 97763 75.00
MOBILITY:CURRENT 0% G8978 0.01
MOBILITY:CURRENT 01-19% G8978 0.01
MOBILITY:CURRENT 20-39% G8978 0.01
MOBILITY:CURRENT 40-59% G8978 0.01
MOBILITY:CURRENT 60-79% G8978 0.01
MOBILITY:CURRENT 80-99% G8978 0.01
MOBILITY:CURRENT 100% G8978 0.01
MOBILITY:GOAL 0% G8979 0.01
MOBILITY:GOAL 01-19% G8979 0.01
MOBILITY:GOAL 20-39% G8979 0.01
MOBILITY:GOAL 40-59% G8979 0.01
MOBILITY:GOAL 60-79% G8979 0.01
MOBILITY:GOAL 80-99% G8979 0.01
MOBILITY:GOAL 100% G8979 0.01
MOBILITY:DSCHG 0% G8980 0.01
MOBILITY:DSCHG 1-19% G8980 0.01
MOBILITY:DSCHG 20-39% G8980 0.01
MOBILITY:DSCHG 40-59% G8980 0.01
MOBILITY:DSCHG 60-79% G8980 0.01
MOBILITY:DSCHG 80-99% G8980 0.01
MOBILITY:DSCHG 100% G8980 0.01
BODY POSITION:CURRENT 0% G8981 0.01
BODY POSIT:CURRENT1-19% G8981 0.01
BODY POSIT:CURRENT 20-39% G8981 0.01
BODY POSTI:CURRENT 40-59% G8981 0.01
BODY POSIT:CURRENT 60-79% G8981 0.01
BODY POSIT:CURRENT 80-99% G8981 0.01
BODY POSIT:CURRENT 100% G8981 0.01
BODY POSIT:GOAL 0% G8982 0.01
BODY POSIT:GOAL 01-19% G8982 0.01
BODY POSIT:GOAL 20-39% G8982 0.01
BODY POSIT:GOAL 40-59% G8982 0.01
BODY POSIT:GOAL 60-79% G8982 0.01
BODY POSIT:GOAL 80-99% G8982 0.01
BODY POSIT:GOAL 100% G8982 0.01
BODY POSIT:DSCHG 0% G8983 0.01
BODY POSIT:DSCHG 01-19% G8983 0.01
BODY POSIT:DSCHG 20-39% G8983 0.01
BODY POSIT:DSCHG 40-59% G8983 0.01
BODY POSIT:DSCHG 60-79% G8983 0.01
BODY POSIT:DSCHG 80-99% G8983 0.01
BODY POSIT:DSCHG 100% G8983 0.01
CARRY OBJECTS:CURRENT 0% G8984 0.01
CARRY OBJECTS:CURNT 1-19% G8984 0.01
CARRY OBJECT:CURNT 20-39% G8984 0.01
CARRYOBJECT:CURNT 40-59% G8984 0.01
CARRY OBJECT:CURNT 60-79% G8984 0.01
CARRY OBJECT:CURNT 80-99% G8984 0.01
CARRY OBJECT:CURNT 100% G8984 0.01
CARRY OBJECT:GOAL 0% G8985 0.01
CARRY OBJECT:GOAL 01-19% G8985 0.01
CARRY OBJECT:GOAL 20-39% G8985 0.01
CARRY OBJECT:GOAL 40-59% G8985 0.01
CARRY OBJECT:GOAL 60-79% G8985 0.01
CARRY OBJECT:GOAL 80-99% G8985 0.01
CARRY OBJECT:GOAL 100% G8985 0.01
CARRY OBJECT:DSCHG 05 G8986 0.01
CARRY OBJECT:DSCHG 01-19% G8986 0.01
CARRY OBJECT:DSCHG 20-39% G8986 0.01
CARRY OBJECT:DSCHG 40-59% G8986 0.01
CARRY OBJECT:DSCHG 60-79% G8986 0.01
CARRY OBJECT:DSCHG 80-99% G8986 0.01
CARRY OBJECT:DSCHG 100% G8986 0.01
SELF CARE:CURRENT 0% G8987 0.01
SELF CARE:CURRENT 1-19% G8987 0.01
SELF CAR:CURRENT 20-39% G8987 0.01
SELF CARE:CURRENT 40-59% G8987 0.01
SELF CARE:CURRENT 60-79% G8987 0.01
SELF CAR:CURRENT 80-99% G8987 0.01
SELF CARE:CURRENT 100% G8987 0.01
SELF CARE:GOAL 0% G8988 0.01
SELF CARE:GOAL 1-19% G8988 0.01
SELF CARE:GOAL 20.39% G8988 0.01
SELF CARE:GOAL 40-59% G8988 0.01
SELF CARE:GOAL 60-79% G8988 0.01
SELF CARE:GOAL 80-99% G8988 0.01
SELF CARE:GOAL 100% G8988 0.01
SELF CARE:DSCHG 0% G8989 0.01
SELF CARE:DSCHG 1-19% G8989 0.01
SELF CARE:DSCHG 20-39% G8989 0.01
SELF CARE:DSCHG 40-59% G8989 0.01
SELF CARE:DSCHG 60-79% G8989 0.01
SELF CARE:DSCHG 80-99% G8989 0.01
SELF CARE:DSCHG 100% G8989 0.01
OTHER PRIM: CURRENT 0% G8990 0.01
OTHER PRIM:CURRENT1-19% G8990 0.01
OTHER PRIM:CURRENT 20-39% G8990 0.01
OTHER PRIM:CURRENT 40-59% G8990 0.01
OTHER PRIM:CURRENT 60-79% G8990 0.01
OTHER PRIM:CURRENT 80-99% G8990 0.01
OTHER PRIM:CURRENT 100% G8990 0.01
OTHER PRIM:GOAL 0% G8991 0.01
OTHER PRIM:GOAL 1-19% G8991 0.01
OTHER PRIM:GOAL 20-39% G8991 0.01
OTHER PRIM:GOAL 40-59% G8991 0.01
OTHER PRIM:GOAL 60-79% G8991 0.01
OTHER PRIM:GOAL 80-99% G8991 0.01
OTHER PRIM:GOAL 100% G8991 0.01
OTHER PRIM: DSCHG 0% G8992 0.01
OTHER PRIM:DSCHG 1-19% G8992 0.01
OTHER PRIM:DSCHG 20-39% G8992 0.01
OTHER PRIM:DSCHG 40-59% G8992 0.01
OTHER PRIM:DSCHG 60-79% G8992 0.01
OTHER PRIM: DSCHG 80-99% G8992 0.01
OTHER PRIM:DSCHG 100% G8992 0.01
OTHER SUB:CURRENT 0% G8993 0.01
OTHER SUB:CURRENT 1-19% G8993 0.01
OTHER SUB:CURRENT 20-39% G8993 0.01
OTHER SUB:CURRENT 40-59% G8993 0.01
OTHER SUB:CURRENT 60-79% G8993 0.01
OTHER SUB:CURRENT 80-99% G8993 0.01
OTHER SUB:CURRENT 100% G8993 0.01
OTHER SUB:GOAL 0% G8994 0.01
OTHER SUB:GOAL 1-19% G8994 0.01
OTHER SUB:GOAL 20-39% G8994 0.01
OTHER SUB:GOAL 40-59% G8994 0.01
OTHER SUB:GOAL 60-79% G8994 0.01
OTHER SUB:GOAL 80-99% G8994 0.01
OTHER SUB:GOAL 100% G8994 0.01
OTHER SUB:DSCHG 0% G8995 0.01
OTHER SUB DSCHG 1-19% G8995 0.01
OTHER SUB:DSCHG 20-39% G8995 0.01
OTHER SUB:DSCHG 40-59% G8995 0.01
OTHER SUB:DSCHG 60-79% G8995 0.01
OTHER SUB:DSCHG 80-99% G8995 0.01
OTHER SUB:DSCHG 100% G8995 0.01
APP.FINGER SPLINT STATIC 29130 167.55
ELECTRIC STIMULATION-OT G0283 42.40
APPLY FOREARM SPLINT 29125 328.93
WRIST HAND FINGER ORTHOTIC RIGID W/O JNT L3808 482.69
ATTENTION:CURRENT 0% G9165 0.01
ATTENTION:CURRENT 1-19% G9165 0.01
ATTENTION:CURRENT 20-39% G9165 0.01
ATTENTION:CURRENT 40-59% G9165 0.01
ATTENTION:CURRENT 60-79% G9165 0.01
ATTENTION:CURRENT 80-00% G9165 0.01
ATTENTION:CURRENT 100% G9165 0.01
ATTENTION: GOAL 0% G9166 0.01
ATTENTION:GOAL 1-19% G9166 0.01
ATTENTION:GOAL 20-39% G9166 0.01
ATTENTION: GOAL 40-59% G9166 0.01
ATTENTION:GOAL 60-79% G9166 0.01
ATTENTION:GOAL 80-99% G9166 0.01
ATTENTION:GOAL 100% G9166 0.01
ATTENTION: DSCHG 0% G9167 0.01
ATTENTION: DSCHG 1-19% G9167 0.01
ATTENTION: DSCHG 20-39% G9167 0.01
ATTENTION: DSCHG 40-59% G9167 0.01
ATTENTION: DSCHG 60-79% G9167 0.01
ATTENTION: DSCHG 80-99% G9167 0.01
ATTENTION: DSCHG 100% G9167 0.01
EDEMA GLOVE 19.00
SPLINT STRAP, HEAVY DUTY 8.00
KNEE STRAPPING 29530 130.75
ANKLE STRAPPING 29540 319.24
UNNA BOOT STRAPPING 29580 319.24
APPLY TENS UNIT 64550 42.00
BIOFEEDBACK TRAINING (ANY 90901 58.64
BIOFEEDBACK TRNG. (PERINE 90911 282.69
EXTREME/TRUNK, EX. HAND 95831 40.86
HAND WITH BILAT COMP 95832 42.78
TOTAL BODY, EXE HAND 95833 62.04
TOTAL BODY, INCL HANDS 95834 84.40
ROM, EXT/TRUNK EXC HAND 95851 32.00
ROM, HANDS, BILAT. COMP. 95852 24.00
TRACTION, MECHANICAL 97012 44.11
ELECTRICAL STIMULATION-PT 97014 42.40
PARAFFIN BATH THERAPY 97018 36.00
WHIRLPOOL 97022 61.00
ELECTRICAL STIM MANUAL-PT 97032 49.00
IONTOPHORESIS-15 MIN 97033 84.08
ULTRASOUND-15 MIN 97035 36.00
THERAPEUTIC EX (EA 15 MIN 97110 75.00
NEUR RE-ED(PNF/BIOFDBK) 97112 75.00
GAIT TRAINING, EA 15 MIN 97116 75.00
MANUAL THERAPY TECHNIQUES 97140 75.00
THER ACT DIR (EA 15MIN) - 97530 75.00
SELF-CARE/HOME MANAGEMENT 97535 75.00
WHEEL CHAIR MANAGEMENT-15 97542 50.00
SELECTIVE DEBRIDEMENT < 2 97597 364.85
SELECTIVE DEBRIDEMENT >20 97598 442.17
PHY PERF TEST ( EA 15 MIN 97750 50.00
INITIAL ORTHOTIC TRAINING AND FIT 97760 75.00
INITIAL PROS TRAIN INIT. (15 MIN) 97761 75.00
ELECTRIC STIMULATION (T18 G0281 42.40
ELECTRIC STIMULATION-PT G0283 42.40
CANALITH REPOSITIONING 95992 70.00
NEG PRESS WOUND TX > 50 C 97606 364.85
NEG PRESS WOUND TX < 50 C 97605 245.89
DRY NEEDLING 97799 15.00
PT EVAL LOW COMPLEX 20 MIN 97161 150.00
PT EVAL MOD COMPLEX 30 MIN 97162 150.00
PT EVAL HIGH COMPLEX 45 MIN 97163 150.00
PT RE-EVAL EST PLAN CARE 97164 125.00
SUBSEQUENT VISIT PROSTHETIC OR ORTHOTIC 97763 75.00
MOBILITY:CURRENT 0% G8978 0.01
MOBILITY:CURRENT 01-19% G8978 0.01
MOBILITY:CURRENT 20-39% G8978 0.01
MOBILITY:CURRENT40-59% G8978 0.01
MOBILITY:CURRENT 60-79% G8978 0.01
MOBILITY:CURRENT 80-99% G8978 0.01
MOBILITY:CURRENT 100% G8978 0.01
MOBILITY:GOAL 0% G8979 0.01
MOBILITY:GOAL 01-19% G8979 0.01
MOBILITY:GOAL 20-39% G8979 0.01
MOBILITY:GOAL 40-59% G8979 0.01
MOBILITY:GOAL 60-79% G8979 0.01
MOBILITY:GOAL 80-99% G8979 0.01
MOBILITY:GOAL 100% G8979 0.01
MOBILITY:DSCHG 0% G8980 0.01
MOBILITY:DSCHG 01-19% G8980 0.01
MOBILITY:DSCHG 20-39% G8980 0.01
MOBILTY:DSCHG 40-59% G8980 0.01
MOBILITY:DSCHG 60-79% G8980 0.01
MOBILITY:DSCHG 80-99% G8980 0.01
MOBILITY:DSCHG 100% G8980 0.01
BODY POSTITION:CURRENT 0% G8981 0.01
BODY POSITION:CURR.1-19% G8981 0.01
BODY POSITION:CURR.20-39% G8981 0.01
BODY POSTION:CURR.40-59% G8981 0.01
BODY POSTION:CURR.60-79% G8981 0.01
BODY POSITION:CURR 80-99% G8981 0.01
BODY POSITION:CURR 100% G8981 0.01
BODY POSITION:GOAL 0% G8982 0.01
BODY POSITION:GOAL 1-19% G8982 0.01
BODY POSITION:GOAL 20-39% G8982 0.01
BODY POSITION:GOAL 40-59% G8982 0.01
BODY POSITION:GOAL 60-79 G8982 0.01
BODY POSITION:80-99% G8982 0.01
BODY POSITION:GOAL 100% G8982 0.01
BODY POSITION:DSCHG 0% G8983 0.01
BODY POSITION:DSCHG 1-19% G8983 0.01
BODY POSITION:DSCG 20-39% G8983 0.01
BODYPOSITION:DSCHG 40-59% G8983 0.01
BODYPOSITION:DSCHG 60-79% G8983 0.01
BODYPOSITION:DSCHG 80-99% G8983 0.01
BODYPOSITION:DSCHG 100% G8983 0.01
CARRY OBJCT:CURRENT 0% G8984 0.01
CARRY OBJCT:CURRENT 1-19% G8984 0.01
CARRY OBJCT:CURRNT 20-39% G8984 0.01
CARRY OBJCT:CURNT 40-59% G8984 0.01
CARRY OBJCT:CURNT 60-79% G8984 0.01
CARRY OBJCT:CURNT 80-99% G8984 0.01
CARRY OBJCT:CURNT 100% G8984 0.01
CARRY OBJCT:GOAL 0% G8985 0.01
CARR OBJCT:GOAL 1-19% G8985 0.01
CARRY OJBCT:GOAL 20-39% G8985 0.01
CARRY OBJCT:GOAL 40-59% G8985 0.01
CARRY OBJCT:GOAL 60-79% G8985 0.01
CARRY OBJCT:GOAL 80-99% G8985 0.01
CARRY OBJCT:GOAL 100% G8985 0.01
CARRY OBJCT:DSCHG 0% G8986 0.01
CARRY OBJCT:DSCHG 1-19% G8986 0.01
CARRY OBJECT:DSCHG 20-39% G8986 0.01
CARRY OBJCT:DSCHG 40-59% G8986 0.01
CARRY OBJCT:DSCHG 60-79% G8986 0.01
CARRY OBJCT:DSCHG 80-99% G8986 0.01
CARRY OBJCT:DSCHG 100% G8986 0.01
SELF CARE:CURRENT 0% G8987 0.01
SELF CARE:CURRENT:1-19% G8987 0.01
SELF CARE:CURRENT 20-39% G8987 0.01
SELF CARE:CURRENT 40-59% G8987 0.01
SELF CARE:CURRENT 60-79% G8987 0.01
SELF CARE:CURRENT 80-99% G8987 0.01
SELF CARE:CURRENT 100% G8987 0.01
SELF CARE:GOAL 0% G8988 0.01
SELF CARE:GOAL 1-19% G8988 0.01
SELF CARE:GOAL 20-39% G8988 0.01
SELF CARE:GOAL 40-59% G8988 0.01
SELF CARE:GOAL 60-79% G8988 0.01
SELF CARE:GOAL 80-99% G8988 0.01
SELF CARE:GOAL 100% G8988 0.01
SELF CARE:DSCHG 0% G8989 0.01
SELF CARE:DSCHG 1-19% G8989 0.01
SELF CARE:DSCHG 20-39% G8989 0.01
SELF CARE:DSCHG 40-59% G8989 0.01
SELF CARE:DSCHG 60-79% G8989 0.01
SELF CARE:DSCHG 80-99% G8989 0.01
SELF CARE:DSCHG 100% G8989 0.01
OTHER PRIM:CURRENT 0% G8990 0.01
OTHER PRIM:CURRENT 1-19% G8990 0.01
OTHER PRIM:CURRENT 20-39% G8990 0.01
OTHER PRIM:CURRENT 40-59% G8990 0.01
OTHER PRIM:CURRENT 60-79% G8990 0.01
OTHER PRIM:CURRENT 80-99% G8990 0.01
OTHER PRIM:CURRENT 100% G8990 0.01
OTHER PRIM:GOAL 0% G8991 0.01
OTHER PRIM:GOAL 01-19% G8991 0.01
OTHER PRIM:GOAL 20-39% G8991 0.01
OTHER PRIM: GOAL 40-59% G8991 0.01
OTHER PRIM:GOAL 60-79% G8991 0.01
OTHER PRIM:GOAL 80-99% G8991 0.01
OTHER PRIM:GOAL 100% G8991 0.01
OTHER PRIM:DISCHG 0% G8992 0.01
OTHER PRIM:DSCHG 1-19% G8992 0.01
OTHER PRIM:DSCHG 20-39% G8992 0.01
OTHER PRIM:DSCHG 40-59% G8992 0.01
OTHER PRIM:DSCHG 60-79% G8992 0.01
OTHER PRIM: DSCHG 80-99% G8992 0.01
OTHER PRIM:DSCHG 100% G8992 0.01
OTHER SUBS:CURRENT 0% G8993 0.01
OTHER SUBS:CURRENT 1-19% G8993 0.01
OTHER SUBS:CURRENT 20-39% G8993 0.01
OTHER SUBS:CURRENT 40-59% G8993 0.01
OTHER SUBS:CURRENT 60-79% G8993 0.01
OTHER SUBS:CURRENT 80-99% G8993 0.01
OTHER SUBS:CURRENT 100% G8993 0.01
OTHER SUBS:GOAL 0% G8994 0.01
OTHER SUBS:GOAL 1-19% G8994 0.01
OTHER SUBS:GOAL 20-39% G8994 0.01
OTHER SUBS:GOAL 40-59% G8994 0.01
OTHER SUBS:GOAL 60-79% G8994 0.01
OTHER SUBS:GOAL 80-99% G8994 0.01
OTHER SUBS:GOAL 100% G8985 0.01
OTHER SUBS:DSCHG 0% G8995 0.01
OTHER SUBS:DSCHG 1-19% G8995 0.01
OTHER SUBS:DSCHG 20-39% G8995 0.01
OTHER SUBS:DSCHG 40-59% G8995 0.01
OTHER SUBS:DSCHG 60-79% G8995 0.01
OTHER SUBS:DSCHG 80-99% G8995 0.01
OTHER SUBS:DSCHG 100% G8995 0.01
BIOFEEDBACK PERI/URO/RECTAL 90911 282.69
WOUND CARE NON-SELECT 97602 364.85
APPLY MULTLAYR COMPRES LEG 29581 319.24
FOOT LONGITUDINAL ARCH SUPPORT L3010 495.95
FOOT LONGITUDE/METATARSAL SUPP L3020 564.71
FOOT ARCH SUPPORT REMOVAL PREM L3030 217.20
WRIST HAND FINGER ORTHOTIC RIGID W/O JNT L3808 482.69
WALKING BOOT NON-PNEUMATIC PREFAB CUSTOM L4386 228.99
CERVICAL FLEX NONADJUSTABLE PREFAB L0120 75.89
AFO PLASTIC/OTH MATERIAL PREFAB L1930 704.77
ANKLE FOOT ORTHOS ANK GAUNTLY PRFAB L1902 237.83
APPLY LOWER LEG SPLINT 29515 162.78
APPLICATION RIGID TOTAL CONTACT LEG CAST 29445 566.77
NEG PRESSURE WOUND THERAPY UNDER 50 SQCM 97607 624.50
NEG PRESSURE WOUND NON DME >50 SQ CM 97608 477.02
OXISENSOR, PEDS D20 44.00
OXYGEN, PER HOUR 26.00
SUB UPDRAFT TREATMENT 94640 186.38
INITIAL UPDRAFT TREATMNT 94640 86.19
PFT SCREEN 94010 266.22
PFT PRE/POST BD 94060 406.20
OXYGEN ONE TIME FEE 266.22
OXIMETRY OVERNIGHT 94762 198.75
PEAK PRE/POST BD 94060 295.86
POLYSOMNOGRAM 95810 2,342.31
SPLIT NIGHT/CPAP BIPAP 95811 2,500.00
CARRY OBJCT:DSCHG 20-39% G8986 0.01
EVALUATE SWALLOWING FUNC 92610 181.00
SPEECH/HEARING THERAPY 92507 211.18
TREAT SWALLOWING DYSFUNC 92526 233.38
APHASIA ASSESMENT,PER HR 96105 290.77
ORAL MOTOR EXERCISES ROM 97110 86.27
SPEECH/HEARING EVALUATION 92523 447.91
COGNITIVE PERFORMANCE TES 96125 323.35
SENSORY INTEGRATION 97533 83.27
EVALUATION OF SPEECH FLUENCY 92521 324.32
EVAL OF SPEECH PRODUCTION 92522 264.35
SPEECH SOUND LANG. COMPREHENSION 92523 547.42
BEHAVRAL QUALT ANALYS VOICE 92524 272.65
DEVELOPMENTAL SCREEN 96110 21.60
DEVELOPMENTAL TEST EXTEND 96111 352.26
EX FOR NONSPEECH DEVICE RX 92605 256.89
EX FOR NONSPEECH DEV.RX ADD 92618 95.35
NON-SPEECH DEVICE SERVICE 92606 205.79
EX FOR SPEECH DEVICE RX 1 HR. 92607 364.97
EX.FOR SPEECH DEVICE RX.ADDL 92608 150.12
USE OF SPEECH DEVICE SERVICE 92609 315.28
SPEECH-GEN DEV.TX 92609 315.28
MOTION FLUOROSCOPY/SWALLOW 92611 217.44
COGNITIVE AND COMPENSATORY ACTIVITY 1:1 97127 76.56
DEVELOPMENT OF COGNITIVE SKILLS EA. 15 M G0515 76.56
SWALLOWING:CURNT STAT 0% G8996 0.01
SWALLOWING:CURNT 1-19% G8996 0.01
SWALLOWING:CURNT 20-39% G8996 0.01
SWALLOWING:CURNT 40-59% G8996 0.01
SWALLOWING:CURNT 60-79% G8996 0.01
SWALLOWING:CURNT 80-99% G8996 0.01
SWALLOWING:CURNT 100% G8996 0.01
SWALLOWING GOAL 0% G8997 0.01
SWALLOWING:GOAL 1-19% G8997 0.01
SWALLOWING:GOAL 20-39% G8997 0.01
SWALLOWING:GOAL 40-59% G8997 0.01
SWALLOWING:GOAL 60-79% G8997 0.01
SWALLOWING:GOAL 80-99% G8997 0.01
SWALLOWING:GOAL 100% G8997 0.01
SWALLOWING:DISCHARGE 0% G8998 0.01
SWALLOWING:DISCRGE 1-19% G8998 0.01
SWALLOWING: DISCRG 20-39% G8998 0.01
SWALLOWING:DISCRG 40-59% G8998 0.01
SWALLOWING:DISCHRG 60-79% G8998 0.01
SWALLOWING:DISCHRG 80-99% G8998 0.01
SWALLOWING:DISCRG 100% G8998 0.01
MOTOR SPEECH:STATUS 0% G8999 0.01
MOTOR SPEECH:STATUS 1-19% G8999 0.01
MOTOR SPEECH:STAT 20-39% G8999 0.01
MOTOR SPEECH:STAT 40-59% G8999 0.01
MOTOR SPEECH:STAT 60-79% G8999 0.01
MOTOR SPEECH:STAT 800-99% G8999 0.01
MOTOR SPEECH:STAT 100% G8999 0.01
MOTOR SPEECH:GOAL 0% G9186 0.01
MOTOR SPEECH:GOAL1-19% G9186 0.01
MOTOR SPEECH:GOAL 20-39% G9186 0.01
MOTOR SPEECH:GOAL 40-59% G9186 0.01
MOTOR SPEECH:GOAL 60-79% G9186 0.01
MOTOR SPEECH:GOAL 80-99% G9186 0.01
MOTOR SPEECH:GOAL 100% G9186 0.01
MOTOR SPEECH:DISCRG 0% G9158 0.01
MOTOR SPEECH:DISCRG 1-19% G9158 0.01
MOTOR SPEECH:DSCRG 20-39% G9158 0.01
MOTOR SPEECH:DSCRG 40-59% G9158 0.01
MOTOR SPEECH:DSCRG 60-79% G9158 0.01
MOTOR SPEECH:DSCRG 80-99% G9158 0.01
MOTOR SPEECH:DSCRG 100% G9158 0.01
SL COMP:CURRENT 0% G9159 0.01
SL COMP:CURRENT 1-19% G9159 0.01
SL COMP:CURRENT 20-39% G9159 0.01
SL COMP:CURRENT 40-59% G9159 0.01
SL COMP:CURRENT 60-79% G9159 0.01
SL COMP:CURRENT 80-99% G9159 0.01
SL COMP: CURRENT 100% G9159 0.01
SL COMP:GOAL 0% G9160 0.01
SL COMP:GOAL 1-19% G9160 0.01
SL COMP:GOAL 20-39% G9160 0.01
SL COMP:GOAL 40-59% G9160 0.01
SL COMP:GOAL 60-79% G9160 0.01
SL COMP:GOAL 80-99% G9160 0.01
SL COMP:GOAL 100% G9160 0.01
SL COMP:DSCHG 0% G9161 0.01
SL COMP:DSCHG 1-19% G9161 0.01
SL COMP: DSCH 20-39% G9161 0.01
SL COMP:DSCHG 40-59% G9161 0.01
SL COMP:DSCHG 60-79% G9161 0.01
SL COMP:DSCHG 80-99% G9161 0.01
SL COMP:DSCHG 100% G9161 0.01
SL EXPRESS:CURRENT 0% G9162 0.01
SL EXPRESS:CURRENT 1-19% G9162 0.01
SL EXPRESSCURRENT 20-39% G9162 0.01
SL EXPRESS:CURRENT 40-59% G9162 0.01
SL EXPRESS:CURRENT 60-79% G9162 0.01
SL EXPRESS:CURRENT 80-99 G9162 0.01
SL EXPRESS:CURRENT 100% G9162 0.01
SL EXPRESS:GOAL 0% G9163 0.01
SL EXPRESS:GOAL1-19% G9163 0.01
SL EXPRESS:GOAL 20-39% G9163 0.01
SL EXPRESS:GOAL 40-59% G9163 0.01
SL EXPRESS:GOAL 50-79% G9163 0.01
SL EXPRESS:GOAL 80-99% G9163 0.01
SL EXPRESS:GOAL 100% G9163 0.01
SL EXPRESS: DSCHG 0% G9164 0.01
SL EXPRESS: DSCHG 01-19% G9164 0.01
SL EXPRESS:DSCHG 20-39% G9164 0.01
SL EXPRESS:DSCHG 40-59% G9164 0.01
SL EXPRESS: DSCHG 60-79% G9164 0.01
SL EXPRESS: DSCHG 80-99% G9164 0.01
SL EXPRESS: DSCHG 100% G9164 0.01
ATTENTION:CURRENT 0% G9165 0.01
ATTENTION:CURRENT 1-19% G9165 0.01
ATTENTION:CURRENT 20-39% G9165 0.01
ATTENTION:CURRENT 40-59% G9165 0.01
ATTENTION:CURRENT 60-79% G9165 0.01
ATTENTION:CURRENT 80-99% G9165 0.01
ATTENTION:CURRENT 100% G9165 0.01
ATTENTION:GOAL 0% G9166 0.01
ATTENTION: GOAL 1-19% G9166 0.01
ATTENTION:GOAL 20-39% G9166 0.01
ATTENTION:GOAL 40-59% G9166 0.01
ATTENTION: GOAL 60-79% G9166 0.01
ATTENTION:GOAL 80-99% G9166 0.01
ATTENTION: GOAL 100% G9166 0.01
ATTENTION:DSCHG 0% G9167 0.01
ATTENTION:DSCHG 1-19% G9167 0.01
ATTENTION:DSCHG 20-39% G9167 0.01
ATTENTION:DSCHG 40-59% G9167 0.01
ATTENTION:DSCHG 60-79% G9167 0.01
ATTENTION:DSCHG 80-99% G9167 0.01
ATTENTION: DSCHG 100% G9167 0.01
MEMORY:CURRENT 0% G9168 0.01
MEMORY: CURRENT 1-19% G9168 0.01
MEMORY:CURRENT 20-39% G9168 0.00
MEMORY:CURRENT 40-59% G9168 0.00
MEMORY:CURRENT 60-79% G9168 0.00
MEMORY:CURRENT 80-99% G9168 0.00
MEMORY:CURRENT 100% G9168 0.00
MEMORY: GOAL 0% G9169 0.00
MEMORY:GOAL 1-19% G9169 0.00
MEMORY:GOAL 20-39% G9169 0.00
MEMORY:GOAL40-59% G9169 0.00
MEMORY:GOAL 60-79% G9169 0.00
MEMORY:GOAL 80-99% G9169 0.00
MEMORY:GOAL 100% G9169 0.00
MEMORY:DSCHG 0% G9170 0.00
MEMORY:DSCHG1-19% G9170 0.00
MEMORY:DSCHG 20-39% G9170 0.00
MEMORY:DSCHG 40-59% G9170 0.00
MEMORY:DSCHG 60-79% G9170 0.00
MEMORY:DSCHG 80-99% G9170 0.00
MEMORY:DSCHG100% G9170 0.00
VOICE:CURRENT 0% G9171 0.00
VOICE:CURRENT 1-19% G9171 0.00
VOICE:CURRENT 20-39% G9171 0.00
VOICE: CURRENT 40-59% G9171 0.00
VOICE:CURRENT 60-79% G9171 0.00
VOICE:CURRENT 80-99% G9171 0.00
VOICE CURRENT:100% G9171 0.00
VOICE GOAL:0% G9172 0.00
VOICE:GOAL 01-19% G9172 0.00
VOICE:GOAL 20-39% G9172 0.00
VOICE:GOAL 40-59% G9172 0.00
VOICE:GOAL 60-79% G9172 0.00
VOICE 80-99% G9172 0.00
VOICE:GOAL 100% G9172 0.00
VOICE:DSCHG 0% G9173 0.00
VOICE:DSCHG 1-19% G9173 0.00
VOICE:DSCHG 20-39% G9173 0.00
VOICE:DSCHG 40-59% G9173 0.00
VOICE:DSCHG 60-79% G9173 0.00
VOICE:DSCHG 80-99% G9173 0.00
VOICE:DSCHG 100% G9173 0.00
OTHER SLP:CURRENT 0% G9174 0.00
OTHER SLP: CURRENT1-19% G9174 0.00
OTHER SLP:CURRENT 20-39% G9174 0.00
OTHER SLP:CURRENT 40-59% G9174 0.00
OTHER SLP:CURRENT6-79% G9174 0.00
OTHER SLP:CURRENT 80-99% G9174 0.00
OTHER SLP:CURRENT 100% G9174 0.00
OTHER SLP:GOAL 0% G9175 0.00
OTHER SLP:GOAL 1-19% G9175 0.00
OTHER SLP:GOAL 20-89% G9175 0.00
OTHER SLP:GOAL 40-59% G9175 0.00
OTHER SLP:GOAL 60-79% G9175 0.00
OTHER SLP:GOAL 80-99% G9175 0.00
OTHER:SLP:GOAL 100% G9175 0.00
OTHER SLP:DSCHG 0% G9176 0.00
OTHER SLP:DSCHG 1-19% G9176 0.00
OTHER SLP:DSCHG 20-39% G9176 0.00
OTHER SLP:DSCHG 40-59% G9176 0.00
OTHER SLP:DSCHG 60-79% G9176 0.00
OTHER SLP:DSCHG 80-99% G9176 0.00
OTHER SLP:DSCHG 100% G9176 0.00
DIETARY CONSULT 1/2 HOUR 97802 62.00
DIETARY CONSULT 1 HOUR 97802 124.00
DIETARY CONSULT 15 MIN 97802 31.00
GUEST MEALS 5.00
DIABETES SELF MANAGEMENT G0108 58.00
DIABETES SELF MANAGE.-GRO G0109 30.00
CARDIAC REHAB 93798 309.87
CARDIAC REHAB EVALUATION 93797 309.87
CARDIAC REHAB PHASE 3 93799 210.54
MISC CENTRAL SUPPLY & SNF 0.00
ABSORPTION DRESSING 115.65
IV CATHETER-ALL SIZES 2.80
ALCOHOL BLOOD TEST SUPPLI 17.35
ADULT REBREATHING MASK 5.60
ANTI-EM HOSE, L REG 96.50
DRESSING PRIMAPORE 4.40
ALBA HEEL & ELBOW PROTECT 25.35
BILI LIGHT, PER HOUR 4.30
BASIC PACK 28.25
BLOW BOTTLE/TRIFLOW 38.25
XEROFORM DRESSING 2X2 2.35
CATH (FOLEY TRAY) 34.75
CRUTCHES YOUTH 50.40
CATH SET, SINGLE USE 6.55
COMFEEL DRESSING 4 X 4 18.00
CERVICAL COLLAR 12.20
CIRCUMCISION SETUP & SUPP 52.50
CLAVICLE BRACE 17.40
CARRINGTON GEL 51.80
COMFEEL PASTE 49.70
CONVATEC STOMAHESIVE PAST 37.60
CASH ORTHOSIS 297.95
COBAN DRESSING PER ROLL ( 6.40
CONTINUOUS PASSIVE MOTION 33.85
DIGIFLEX EXERCISER 43.90
CRICO SET 55.15
ANTI-EM HOSE, KNEE 17.35
EAR TRAY 15.75
CLEANSING ENEMA 0.00
MATTRESS FOAM EGGCRATE 48.40
ETHYL CHLORIDE 174.40
FLEXION EXTENSION KNEE 291.45
FOOT DROP 78.15
FOOT ORTHOTICS (DRESS FLE 237.65
FOOT ORTHOTICS (SPORTHOTI 280.25
FOOT ORTHOTICS GOLDEN FIT 228.10
EAR IRRIGATION 21.00
GASTRIC FEEDING TUBE 45.00
GEL TUBING SILOPAD 20.65
HEMO-VAC 7.60
HEEL LIFT SMALL 25.45
IRRIGATION WATER 1500CC 27.45
IRRIGATION 0.9% SOD CHLOR 16.90
ISOLATION (DAILY) 46.30
KLING ROLL TO 6 INCHES 8.80
LEVINE TUBE 5.60
MORGAN MEDI-FLOW LENS 59.80
MICRO-DRIP SET 13.50
MITT SPLIT 67.05
NEW ELBOW BRACE 180.40
NUPERCANAL OINTMENT APPLI 1.60
OP SITE 2.70
PILLOW THERAPEUTIC 94.80
PHILADELPHIA CERVICAL COL 38.55
CASTING, PLASTER 2INCH 18.00
PLASTER CAST SHORT LEG 57.25
PLASTER SPLINT 15.75
PROTECTORS, ELBOW OR HEEL 2.70
SITZ BATH, DISPOSABLE 28.55
SHILEY INNER CANNULA 119.60
SUB Q SET 7.60
STAT TEMP II 7.20
SUTURE, VICRYL 5-0 J506G 10.05
TRACEOSTOMY CARE SUPPLIES 38.25
THICK IT 23.15
TUCKS 11.40
TUBULAR DRESSING 12.25
ULNAR DEVIATION SPLINT 63.70
VENOSET 78 W/CLAMP VENTED 14.25
VENOSET 78 SEC W/CLAMP VE 11.05
VENOSET PIGGYBACK W/CLAMP 12.60
VENOSET SECONDARY PIGGYBA 10.60
WALKING HEEL, CHILD 11.40
ULTRAFORM WHEEL CHAIR CUS 107.05
VENO PIGGY WITH IVEX FILT 18.65
FLEET PHOS SOL ENEMA 14.36
HEMOCLIP, MEDIUM 49.20
HEMOCLIP, LARGE 73.75
CATH TRAY, 18 FRENCH CATH 26.10
CATH TRAY, 16 FRENCH CATH 26.65
FLEXITAINER 17.75
FLEXIFLOW PUMP/DAY 14.10
COLLES SPLINT (ALL SIZES) 36.65
POST-SURGICAL SHOE 20.30
VENTI-MASK 10.60
VENTURI MASK 9.50
AMNIO HOOK 5.60
SUBCLAVIAN CATHETER 20.40
CAST BOOT SMALL 26.90
SUTURE MONOSOF 3-0 SN-663 4.60
SUCTION SET STERILE 3.40
FILLOPE RINGS, PAIR-STERI 63.95
FINGER STICK BLOOD SUGAR 82962 20.00
KNEE BRACE SMALL 39.80
VASELINE GAUZE SMALL TRAY 4.30
COCK-UP WRIST SPLINT LS 61.30
ENTRAINMENT NEBULIZER 7.00
AQUAPAK STERILE WATER 7.00
GRAVITY FEEDING BAG 8.00
ELASTIC KNEE CAP 20.00
FILTERED EXTENSION SET 17.00
ANKLE SUPPORT SM 55.00
NEOPRENE KNEE SLEEVE SM 30.00
KNEE BRACE (CARTILAGE-ALL 54.00
WRIST BRACE LS 16.00
CERVICAL ROLL 36.00
DOOR PULLEY 60.00
DIAL-A-FLO REGULATOR 19.20
PATELLAR STABILZER 50.60
UNIVERSAL KNEE SUPPORT 40.15
SACRO LUMBAR SUPPORT 52.80
ENDOTRACHEAL TUBE (NON-CU 6.00
PATELLAR KNEE SUPPORT 79.00
HINGED KNEE SUPPORT ALL S 72.75
PRIMARY IV SET MICRODRIP 5.20
PROCTOSCOPIC EXAM SUPPLIE 25.60
HEAD HALTER 7.50
WARM & FORM BRACE ALL SIZ 87.90
WARM & FORM BRACE INSERT 65.80
WOUND DRAINAGE COLLECTOR 33.20
FENWAL Y-TYPE SET 16.65
SORBSAN DRESSING 19.00
DISPOSABLE TROCAR 5MM 174.10
DISPOSABLE TROCAR 10/11 M 200.00
TROCAR REDUCER 16.10
STABILITY THREAD 23.05
VERESS NEEDLE 99.80
MULTIPLE CLIP APPLIER 340.35
CHOLANGIOGRAM CATHETER 143.45
TUBIGRIP SIZE E 4.80
FEMALE CATH KIT 7.25
THERABAND PER FOOT 1.60
TUBIGRIP SIZE F 5.00
DISPOSABLE GRASPER 242.55
ELASTOPLAST 20.75
GLYCIN 1.5% IRRIGATION 29.45
THUMBSPLINT 67.60
BUTTRESS SUPPORT INFERIOR 83.05
P.I.P.E. SPLINT 66.55
JOBST COMPRESSION STOCKIN 138.10
OXISENSO, INFANT 43.85
THUMB SPICA SPLINT 87.05
ATRAC-TAIN & 5% UREA 14.09
LATERAL PATELLA KNEE 67.15
HORSESHOE PATELLA SUPPORT 85.70
HINGED KNEE SUPPORT W/POP 145.90
KNEE LENGTH SUPPORT W/ZIP 154.55
THUMB SUPPORT NEOPRONE 35.30
BONE SPUR PAD 42.75
SPENCO HEEL SUPPORT 50.30
FINGERKNUCKLE BENDER SPLI 42.85
WRIST SPLINT WITH THUMB S 110.50
ADJUSTABLE HEMI WALKER 116.25
JOBST THIGH LENGTH STOCKI 237.00
BIOFREEZE 17.40
MALE/FEMALE STERIL CAP 1.60
PERICARE OINTMENT 16.30
CARPAL LOCK SPLINT 54.10
SKIN STAPLER DISPOSABLE 19.05
R O M WALKER 204.25
AIRCAST LEG BRACE 03AL 135.00
FEEDING TUBE (ARGYLE) 2.45
SUCTION CATHETER 1.90
OXIMETRY ADHESIVE 5.25
TAPERED ELASTIC FINGER SL 3.30
SPIRAL ELECTRODE 18.10
CATHETER RED RUBBER 3.20
UNIVERSAL VIAL ADAPTER 4.85
INTERLINK VENTED NITROGLY 21.25
PERFORATED LOCKUP WRIST S 7.45
SYRINGE 60CC/GAUGE ASSEMB 115.50
INHALATION SOLUTION 0.9% 6.25
CPR MICROSHIELD 17.45
CENTRAL VENOUS CATH KIT-M 103.50
ADHESIVE SKIN 57.40
SUPRAPUBIC CATHETHER SET 131.35
COLOSTOMY FLANGE 9.95
COLOSTOMY POUCH 5.60
UROSTOMY POUCH 14.70
ESTRODERM 0.1 MG. PATCH 11.35
CHO-PAT KNEE STRAP ALL S 57.00
XEROFORM DRESSING 5X9 2.85
DRESSING, ALLEVYN 4X4 22.43
SHLDR. IMMOB. CHILDRENS 36.75
HEEL LIFT, MEDIUM 25.45
HEEL LIFT, LARGE 25.45
CHST TUBE THORC CATH 32FR 15.75
IV CATH AUTOGUARD 16 X 1. 7.70
CHEST BANDNET 19.65
SUTURE PROLENE 4-0 8682G 11.70
SUTURE CHROMIC 4-0 793G 5.15
SUTURE PROLENE 6-0 8680G 12.00
PROBE FINGER ADULT OXISEN 31.00
SUTURE SURGIPRO 5-0 12.95
SUTURE 6-0 PROLENE 8695G 12.00
C02 CIRCUIT, CAPNOLINE H 47.85
IVF- DEX 5%/ 0.9% SOD CL J7042 60.00
GRIPPER PORT A CA 20GX1 19.75
COLLAR MINI ADJUSTABLE 39.50
COLLAR PERFIT ACE ADJUSTA 33.60
GRIPPER 20GX3/4 PORTA CA 19.75
TAPE,KINESIO 1-12 INCHES 39.10
RHINO ROCKET SLIMLINE LAR 35.90
AIR CAST, UNIVERSAL SM 120.25
INTERJECT,CONTRAST INJ TH 126.00
SPOT, INDICATOR MARKE 68.25
SUTURE, 4-0 ETHILON 662G 4.60
SUTURE, VICRYL 3-0 6.30
SUTURE-VICRYL 4-0 J496G 10.20
SUTURE, SURGILON 2-0 18.80
SUTURE, BIOSYN 4-0 0.00
SUTURE, VICRYL 2-0 J317H 12.65
SUTURE,VICRYL 3-0 J416H 5.35
SUTURE VICRYL 3-0 J104T 14.20
RHINO ROCKET, SMALL 31.35
RHINO ROCKET, MEDIUM 32.50
BITE BLOCK DISPOSABLE 6.30
NU GAUZE 1/2 8.70
K-WIRES 29.00
IVF- SOD CL 0.9% [100 ML] J7030 60.00
CANNULATED SCREW(S) 2.4 C1713 0.00
BLD - LEUKO DEPLETED PRBC P9016 472.98
SI-LOC BRACE S/M 74.95
SI-LOC BRACE L/XL 81.75
TUBES (EAR) 67.95
TENNIS ELBOW SUPP LG 15.00
TENNIS ELBOW SUPP X-LG 15.00
KNEE IMOBILIZER MED 39.80
KNEE IMOBILIZER LG 39.80
KNEE IMOBILIZER X-LG 39.80
TENNIS ELBOW SUPP:SM 15.00
CRUTCHES, ADULT 58.45
CRUTCHES, TALL 58.45
WRIST BRACE ADJ. LS 16.00
WRIST BRAS ADJ.LM 16.00
WRIST BRACE ADJ.LL 16.00
WRIST BRACE ADJ .RS 16.00
WRIST BRACE ADJ RM 16.00
WRIST BRACE ADJ RL 16.00
AIRCAST SPORT STIRRUP L. 75.40
AIRCAST UNIVERSAL MED 120.25
AIRCAST UNIVERSAL LG 120.25
AIRCAST LEG BRACE 03AR 120.75
AIRCAST LEG BRACE 03CL 135.00
AIRCAST LEG BRACE 03CR 135.00
SUTURE, ETHILON 5-0 661G 4.60
SUTURE SURGIPRO 5.0 SP 10.05
SUTURE,SURGIPRO 5.0 XP 12.95
SUTURE PROLENE 5-0 8681G 10.05
SUTURE PROLENE 3-0 8687H 10.05
CORSAN PROBE 114.40
PAS KNEE LNGTH STOCK.XL 99.00
PAS KNEE LNGHT STOCK. L 99.00
SKIN STAPLER 3M 19.50
CATHETER 18FR 5CC 12.45
DRESSING KNEE/FOOT/ELBOW 12.25
PROBE PEDS OXISENSOR 31.00
POST-OP SHOE WOMENS MED 13.95
POST OP SHOE WOMENS LG 34.45
POST-OPSHOE MENS MED 17.80
CERVICAL COLLAR SOFT MED 12.20
UNIV RIB BELT WOMENS 6.55
CERVICAL COLLAR SOFT LRG 12.20
CERVICAL COLLAR SOFT SM 12.20
CAST BOOT MED 26.90
CAST BOOT LG 26.90
CAST BOOT X-LG 26.90
COCKUP WRIST SPLNT L MED 61.30
COCKUP WRIST SPLNT L LG 61.30
COCKUP WRIST SPLNT L X-LG 61.30
COCKUP WRIST SPLNT R SM 61.30
COCKUP WRIST SPLNT R MED 61.30
COCKUP WRIST SPLNT R LG 61.30
COCKUP WRIST SPLNT R XL 61.30
TED HOSE THIGH LONG LG 96.50
TED HOSE THIGH LONG MED 96.50
TED HOSE THIGHT REG MED 96.50
TED HOSE THIGH SHORT LG 96.50
CAST SHOE MED 26.90
CAST SHOE LG 26.90
CAST SHOE X-LG 26.90
TED HOSE THIGH SHOR MED 96.50
TED HOSE THIGH REG SM 96.50
TED HOSE THIGH LONG SM 96.50
TED HOSE REG X-LG 96.50
TED HOSE THIGHSHORT SM 48.00
COLLAR (PHILADELPHIA)MED 38.55
COLLAR(PHILADELPHIA)SM 38.55
TONSIL COBLATOR EVAC 70 411.25
NASAL WAND REFLEX ULTRA45 324.00
KING AIRWAY- ALL SIZES 63.00
TUBES T-EAR MODIFIED 101.60
HIGH FLOW SET 127.75
STANDARD FLOW SET 40.30
IVF - NORM M 5% BAG [1000 60.00
IVF- DEX 5%/ 0.45% SOD CL 60.00
IVF- DEX 5%/ LACT RING [1 60.00
IVF- DEXTROSE 5% [100 ML] 60.00
IVF- DEXTROSE 5% [1000 ML 60.00
IVF- LACTATED RINGERS [10 60.00
60.00
IVF- SOD CL 0.45% [1000 M 60.00
IVF- SOD CL 0.9% [100 ML] 60.00
IVF- SOD CL 0.9% [1000 ML 60.00
IVF- SOD CL 0.9% [250 ML] 60.00
60.00
IVF- SOD CL 0.9% [500 ML] 60.00
VASELINE .60 OZ TUBE 3.00
SUTURE PROLENE 4-0 8557H 16.00
SUTURE CHROMIC 3-0 G122H 7.10
SUTURE 0 SILK A306H 4.75
SUTURE VICRYL 3-0 J4164 7.25
SUTURE VICRYL 2-0 7.15
SUTURE 3-0 PROLENE 8522H 16.00
SUTURE SILK 2.0 5.80
SUTURE VICRYL 0 8.90
SUTURE PROLENE 2.0 8411H 8.55
SUTURE PROLENE 0 8424H 8.50
SUTURE PDS2 2340H 10.08
SUTURE ETHILON 6-0 1665G 12.45
KIT WOUND MGMT MINI W/BAG 237.00
ACAPELLA MOUTHPIECE 130.35
SNARE POLYPECTOMY 61.25
MEPILEX DRESSING 3X3 9.95
MEPILEX DRESSING 4X4 13.52
SUTURE, ETHILON 5-0 698G 11.50
SUTURE ETHILON 3-0 1669H 11.45
SUTURE PROLENE 1-0 8425H 8.60
CLIP RESOLUTION 360 383.25
CAPNOLINE SMART PLUS WITH O2 42.00
DRESSING SORBIAN 4X4 BORDER 33.10
DRESSING SILVER ALGINATE 30.95
RHINO,RAPID 5.5CM 124.60
RHINO, RAPID 6CM SINU KIT 159.25
RHINO,RAPID 7.5CM 128.45
DRESSING ACTICOAT 4X4 BURN 25.80
SUTURE PROLENE 5-0 8686G 14.00
SUTURE ETHILON 5-0 1855G 11.80
SUTURE PDSII 2-0 8.65
EXTRACTOR KATZ FOREIGN BODY 133.95
TROCAR 5X100 Kii FISO 2-THR 122.50
TERBINAFINE 1% [1 OZ TUB 36.12
SNARE-CAPTIVATOR II 56.25
SUTURE MONOCRYL 4-0 18.65
SUTURE MONOCRYL 3-0 Y416H 6.80
SUTURE MONOCRYL 4-0 Y426H 15.70
SUTURE ETHILON 4-0 1667G 10.70
SUTURE MONOCRYL 3-0 MCP427H 18.00
SUTURE MONOCRYL 0 Y606H 8.10
SUTURE ETHILON 3-0 1691H 10.75
SUTURE VICRYL 2-0 J333H 5.95
DERMABOND ADVANCED PEN 63.15
PROBE INFANT SP02 37.00
PROBE ADULT SP02 28.00
PROBE PEDIATRIC SP02 28.00
SUTURE NUROLON D 28.80
MESH PROCEED VENTRAL 6.4 x 6.4 cm 660.75
MESH PROCEED VENTRAL 4.3 x 4.3 cm 552.45
MESH 3X6 CM 123.40
SUTURE, PLAIN GUT 5-0 19.00
SUTURE ETHILON 4-0 1667G 10.70
EVAC WOUND DRAIN SIL, KIT 15.95
WOUND SUCTION KIT 30.65
SUTURE CHROMIC GUT O 39.30
SUTURE MONOCRYLO 7.40
TROCAR 5X100 Kii SLEEVE Z-THR 65.65
TROCAR 11 X100 Kii FIOS Z-THR 122.50
TROCAR 12 X100 Kii FIOS Z-THR 122.50
TROCAR 12X100 Kii BALLOON BLUNT TIP 122.50
TROCAR 10mm RETRIEVAL SYSTEM 73.50
TROCAR 5mm RETIEVAL SYSTEM 73.50
DRAIN ROUND 15FR 26.25
DRAIN ROUND 19FR 26.25
DRAIN FLAT 19.35
REPAIR RECUR FEMORAL HERNIA, REDUCIBLE 49555 4,500.00
EXC, TUMOR, SFT TISSUE NECK & CHEST 3cm> 21552 3,400.00
CORRECTION HAMMERTOE 28285 3,869.00
GRASPER, TRIPOD 193.40
PUNCH BIOPSY 5mm 6.75
PUNCH BIOPSY 3mm 13.88
CURRETTE ENDOMETRIAL 3.1mm 17.68
PILLOW COMFORT PLUS ELBOW & HEEL 57.60
RHINO RAPID 4.5cm 128.45
CATH KIT, INFANT & PEDS 6.70
ER DEPT VISIT, MINIMAL 99281 86.00
ER DEPT VISIT, BRIEF 99282 124.65
ER DEPT VISIT, INTERMED 99283 219.10
ER DEPT VISIT, EXTENDED 99284 355.53
ER DEPT VISIT, COMPREHNSV 99285 520.85
SNF DISCHARGE DAY 30 MIN 99315 196.93
INTMD WND REPAIR FACE/MM 12051 506.62
SNF FAC DISCHG 31+MIN 99316 283.81
INCIS/REMOVE FOREIGN BODY 10120 564.48
INTERMEDICATE SUTURE LACE 12031 448.41
PHYS-ER CHILD RADIAL HEAD 24640 580.00
APPLICATION OF FOREARM CA 29075 256.00
APPLY FOREARM SPLINT 29125 167.00
HOSP DISCHG,30+ MIN 99239 290.92
CRITICAL CARE, FIRST HOUR 99291 733.63
CRITICAL CARE,ADD 1/2 HR 99292 311.68
OP VISIT,OBS CARE MED 99214 217.35
OBS/ADMIT SAME DAY HIGH 99236 613.81
INITIAL HOSP CARE, BRIEF 99221 276.14
INITIAL HOSP CARE INTERM 99222 376.82
INITIAL HOSP CARE, EXTEND 99223 554.96
FOLLOWUP HOSP CARE, BRIEF 99231 110.17
FOLLOWUP HOSP CARE, INTER 99232 199.53
HOSP DC DAY MANAGEMENT 99238 198.33
NURSING FAC CARE UNIT 99305 352.27
SBSQ NF CARE, NEW PROB 99309 245.33
REMOVAL OF NAILPLATE 11730 183.00
NURSING FAC CARE UNIT 99304 250.55
NURSING FAC CARE SUBSEQ 99307 121.14
NURSING FAC CARE SUBSEQ 99308 186.10
REPAIR SIMPLE 2.5 cm 12001 322.00
SIMPLE REPAIR(SC,N,T,H,F) 12002 341.00
REPAIR SUPERFICIAL WOUNDS 12004 238.48
APPLY LOWER LEG SPLINT 29515 135.35
NF CARE HI SEVERITY 99306 449.78
SBSQ HOSP CARE,EXTENDED 99233 286.34
SUTURE CLOSURE OF WOUND 12035 675.00
OP VISIT,OBS CARE LOW 99213 141.04
OBS CARE DISCHARGE 99217 198.78
OBS CARE LIMITED 99218 267.76
OBS CARE, INTERMED 99219 367.61
OBS CARE, EXTENDED 99220 504.22
OBS/ADMIT SAME DAY, LOW 99234 374.58
OBS/ADMIT/SAME DAY,MOD 99235 494.02
INJECTION SNGL/MLT TRIG 20552 244.70
REPAIR SIMPLE FACE E,N,L 12011 168.95
CONTROL NASAL HEMORRHAGE 30901 262.00
WOUND CLOSURE BY ADHESIVE G0168 161.00
CLOSED SHLDR DISL W MANIP 23650 774.00
DEBRIDE SKIN,PARTIAL 16020 168.95
REPAIR SIMPLE 2.6-5.0 CM 12013 383.00
REMOVAL FB, CONJUNCTIVA 65205 154.00
CLOSED TX RADIAL/ULNAR FX 25565 1,472.00
INTMD WND REPAIR N-HF 12041 476.50
VAGINAL DELIVERY ONLY 59409 2,272.77
INIT NB EM PER DAY HOSP 99460 266.81
FRACTURE/DISL OF SHOULDER 23655 1,349.94
APP LONG ARM SPLINT 29105 218.00
EVAC SUBUNGUAL HEMATOMA 11740 105.04
STRAPPING OF SHOULDER 29240 139.00
LAYER CLOSURE FACE,EY/NOS 12052 567.13
REPAIR LAYER CLOSUR TRUNK 12032 546.00
MAJOR JOINT INJ 20610 244.70
PUNCTURE DRAINAGE OF LESI 10160 310.80
REPAIR SUPERFICIAL WOUND( 12005 498.00
CONTROL OF NOSEBLEED 30905 576.00
APPLY FINGER SPLINT 29130 94.00
APPLY SHORT LEG CAST 29425 331.00
TREAT FRACTURE RADIUS/ULN 25605 1,403.28
REPAIR SUPERFICIAL WOUND 12014 234.92
CONTROL NASAL HEMORRH ANT 30903 407.00
INTMD WND REPAIR S/TR/EXT 12034 511.00
DRAINAGE OF SKIN ABSCESS 10061 502.00
DRAINAGE OF HEMATOMA/FLUI 10140 2,533.65
REMOVE EYELID FOREIGN BOD 67938 917.00
SUBSEQUENT OBS CARE 99224 113.50
REMOVE NASAL FOREIGN BODY 30300 347.88
INTMD WND REPAIR FACE/MM 12054 624.89
TREAT KNUCKLE DISLOCATION 26705 1,349.94
REMOVAL OF FOOT FORGEIN B 28190 572.85
TREAT FINGER DISLOCATION 26770 675.58
DRAINAGE OF SKIN ABCESS 10060 246.37
TREAT ELBOW DISLOCATION 24640 520.38
APPLY LONG LEG SPLINT 29505 300.63
STRAPPING ELBOW / WRIST 29260 167.55
SUB.OBS CARE 99225 207.60
REMOVAL FOREIGN BODY HAND 20520 1,348.03
I & D ABSCESS SKIN 10060 259.69
BURN DEPBRIDEMENT 16020 168.95
FIRST DEGREE BURN 16000 168.95
FOREIGN BODY REMOVAL EAR 69200 160.27
REPAIR OF NAILBED 11760 488.20
INTMD REPAIR FACE 12051 472.06
REDUCE ANKLE DISLOCATON 27842 1,349.94
FINGER DISLOCATION TREAT 26775 926.71
ELECTROCAUTERY 17110 168.95
REDUCE FRACTURE TOE 28515 289.22
I&D BARTHOLIN CYST 56420 255.02
REMOVAL IMPACT.CERUMEN / INSTRUMENT 69210 95.01
WOUND EXPLORATION, TRAUMA 20103 955.08
TRIMALLEOLAR FRAC W/MANIPULATION 27818 1,349.94
BLADDER IRRIGATION 51700 229.53
SIMPLE REPAIR FACE 7.5cm 12015 281.85
SIMPLE REPAIR 12.6cm 12016 382.37
CLOSED TX PHALANGEAL FX 26742 1,349.94
REPAIR SCALP 20.0-30cm 12006 343.86
REMOVAL FOREIGN BODY CORNEA 65220 330.01
FRACTURE PHALANX/MANIPUL 26725 838.42
PHYSICIAN REST BED 99336 337.42
REDUCE ELBOW DISLOCATION WITH ANESTHESIA 24605 1,349.94
RMVL FOREIGN BODY MOUTH SIMPLE 40804 743.49
INCISION & DRAINAGE OF CYST 10080 572.85
REPAIR WOUND DEHISCENCE SIMPLE CLOSURE 12020 1,365.63
REPAIR COMPLEX SCALP/ARM. LEG 2.6-7.5 CM 13121 1,322.00
16-37 MIN. INDIVIDUAL PSYCHOTHERAPY 90832 325.00
38-52 MINS. INDIVIDUAL PSYCHOTHERAPY 90834 350.00
53-67 MINS. INDIVIDUAL PSYCHOTHERAPY 90837 375.00
FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 90846 375.00
FAMILY PSYCHOTHERAPY W/ PATIENT PRESENT 90847 375.00
GROUP PSYCHOTHERAPY 90853 295.00
SENIOR LIFE TELEHEALTH FACILITY FEE Q3014 50.00
SENIOR LIFE OUTPATIENT CLINIC VISIT G0463 113.69
OCC HEALTH-FLU VACCINE SP BILL 90686 30.00
OCC HEALTH-SITE VISIT 75.00
OCC HEALTH INJECTION FEE 90471 8.00
OCC HEALTH CASE MANAGEMEN 55.00
OCC HEALTH PRE-EMP PHYSIC 60.00
HEPATITIS B SERIES 90715 165.00
OCC HLTH FIRST AID CLASS 38.00
OCC HLTH-CPR CLASS 38.00
OCC HLTH- TB SKIN TEST 86580 42.14
OCC HEALTH FIRST AID W/CP 49.00
OCC HLTH FITNESS TEST 11.00
HEP A VACCINE ADULT 90632 129.00
OCC HEALTH-FLU VACCINE ADMIN 90471 58.20
OCC HEALTH - FLU VACCINE INS BILL 90686 55.00
OCC HEALTH - HEPATITIS ADMINISTRATION 90471 58.20
Hep B w/ Titer 67.00
OUTPATIENT RENT 0.00
OUTPATIENT CLINIC PASTDUE 0.00
OUTPATIENT PHARMACY 0.00
OUTPATIENT TRANSCRIPTION 0.00
OUTPATIENT NURSING 0.00
OUTPATIENT SUPPLIES 0.00
OUTPATIENT LABORATORY 0.00
MEDICAL ALERT S5161 32.00
MEDICAL DIRECTOR FEE 400.00
TDAP VACCINE IM 32.83
Migration Charge 0.00
ACNE SURGERY COMEDONE REMOVAL 10040 168.95
I&D SIMPLE OR S 10060 240.00
I&D COMPLICATED 10061 545.00
INCISION & REMO 10120 310.80
ASPIRATION OF A 10160 310.80
DEB SUBQ TISSUE 20 SQ CM/ 11042 310.80
PARE/CUT BENIGN 11055 168.95
PARING/CUTTING LESION 2-4 11056 168.95
BIOPSY, SKIN/SU 11100 310.80
BIOPSY, SKIN SU 11101 125.00
EXCISION(SKIN T 11200 179.00
SHAVING EPIDERM 11300 168.95
SHAVE SKIN LESI 11301 180.00
SHAVE SKIN LESION 11302 225.00
SHAVE LESION, S 11305 168.95
SHAVELESS,NECK 0.6/1.0 CM 11306 168.95
SHAVE LES HAND 1.1/ 2.0CM 11307 177.27
SHAVE LESION FA 11310 178.00
SHAVE LESION FA 11311 219.00
EXC BENIGN LESI 11400 572.85
EXCISION BENIGN 11401 310.80
EXCISION LESION 11402 572.85
EXCISION BENIGN 11403 572.85
EXCISION BENIGN 11404 1,348.03
EXC. BENIGN LESION > 4.0 11406 1,348.03
EXCISION BENIGN 11420 1,348.03
EXC BENIGN LESI 11421 572.85
EXC H-F-NK-SP B9+MARG 1.1 11422 1,348.03
EX BLES S/N/EX G2.1-3.0CM 11423 1,348.03
EXC BENIGN LESI 11440 572.85
EXC BENIGN LESI 11441 572.85
EXC BENIGN LESION 1.1-2.0 11442 572.85
EXC BENIGN LESION 2.1 TO 3.0 CM 11443 450.00
EXC MALIG LESIO 11600 572.85
EXC MALIG LESIO 11601 572.85
EXC MALIG LESIO 11602 481.00
EXC MALIG LESIO 11603 598.00
EXC MALIG LESIO 11604 792.00
EXC.MALIG LESION TRNK>4.0 11606 1,348.03
EXC MALIG LESIO 11620 1,348.03
EXC MALIG LESIO 11622 572.85
EXC MALIG LESIO 11640 572.85
EXC MALIG LESIO 11641 664.00
EXC MALIG LESIO 11642 836.00
EXC MALIG LES FACE 2.1-3. 11643 1,348.03
TRIM NONDYSTROP 11719 63.00
AVULSION NAIL P 11730 191.00
EVACUATION OF S 11740 105.00
REPAIR OF NAIL 11760 488.20
WEDGE EXCISION 11765 310.80
INJECTION, INTR 11900 168.95
INJECTION, INTR 11901 168.95
REMOVE CONTRACEPTIVE CAP 11976 572.85
INSERTION BIRTH CONTROL IMPLANT 11981 700.00
REMOVE BIRTH CONT IMPLANT 11982 330.01
SIM REPAIR 2.5 12001 350.00
REPAIR SIMPLE 12002 370.00
SIMPLE REPAIR H 12004 446.00
REPAIR SIMPLE F 12011 370.00
REPAIR FACE,EAR 12013 421.00
SIMPLE REPAIR FACE 5.1&7. 12014 495.00
LAY CLOS 2.5 CM 12031 421.00
REPAIR LAYER CL 12032 573.00
LAYER CLOSURE S 12034 572.00
LAY CLO 12.6CM - 20.0CM 12035 737.00
LAYER CLOSURE O 12041 476.00
LAYER CLOSURE N 12044 587.00
REPAIR(LAYER FA 12051 517.00
LAYER CLOSURE F 12052 310.80
REPAIR COMPLEX 13101 579.00
REPAIR(COMPLEX 13132 1,258.00
TISSUE TRANSFER 14040 1,568.43
DRESS/DEBRIDE 2ND DEGREE 16020 168.95
DESTRUCT BENIGN 17000 168.95
DESTRUCTION 2\1 17003 56.00
FLAT WART DESTR 17110 209.00
DESTRUCT LESION 15 OR MOR 17111 246.00
CHEMICAL CAUTER 17250 168.95
DESTRUCT MALIGLES FACE/EA 17280 249.80
INJ. TEND. SHEA 20550 244.70
INJECTION, TEND 20551 244.70
INJECTION SNGL/ 20552 244.70
INJECTION SNGL/ 20553 517.00
ASP JOINT INJ 20600 244.70
INTER JT CYST 20605 244.70
MAJOR JOINT INJ 20610 244.70
ASPIRATION AND/ 20612 244.70
FX CLO CLAVICLE 23500 561.00
CLOSED TREAT SH 23650 839.00
CLOSED TREAT SH 23655 1,349.94
CLOSED TREATMEN 24500 787.00
TREAT ELBOW DIS 24600 1,040.00
CLOSED TREAT RA 24640 296.00
TREAT RADIUS FRACTURE 24650 214.90
CLOSED TREAT UL 25530 673.00
CLOSED TREAT UL 25535 1,214.00
CLOSED TREATMEN 25560 839.00
CLOSED TREATMEN 25565 1,593.00
CLOSED TREATMEN 25565 1,349.94
CLOSED TREAT DI 25600 726.00
FX DISTAL RADIU 25605 1,349.94
FX DISTAL RADIU 25605 1,349.94
FX DISTAL RADIU 25605 1,349.94
CLOSED TREAT CA 25630 736.00
CLOSED METACARP 26600 581.00
CLOSED TREAT ME 26700 590.00
CLOSED PHALANGE 26720 444.00
FX PHALANX WO M 26750 502.00
CLOSED TREAT DI 26755 575.00
CLOSED TREAT IP 26770 733.00
CLOSED TREAT DI 27786 773.00
CLOSED TREATMEN 27840 1,017.00
REMOVE OBJECT F 28190 779.00
CLSD TR CALC FX W/O MANIP 28400 611.78
CLOSED TREAT.TALUS FX 28430 421.62
CLOSED METATARS 28470 610.00
CLOSED TREATMEN 28490 359.00
CLOSED TREATMEN 28510 335.00
APPLY SHOULDER 29065 318.00
APPLY ELBOW TO 29075 278.00
LONG ARM SPLINT 29105 237.00
APPLY FOREARM S 29125 182.00
APPLY FINGER SP 29130 102.00
STRAPPING OF CHEST 29200 135.42
APPLY SHORT LEG CAST 29425 237.28
APPLICATION OF 29505 256.00
APPLICATION OF 29515 203.00
STRAPPING OF KNEE 29530 105.04
UNNA BOOT APPLI 29580 153.00
REMOVE OBJECT F 30300 453.00
NASAL HEMORRHAG 30901 284.00
CONTROL OF NOSEBLEED 30905 288.00
ENDOTRACHEAL IN 31500 226.00
VENIPUNCTURE 36415 19.00
REPAIR MOUTH LA 40830 446.00
INCISION OF LIN 41010 1,138.18
DRAIN ABSCESS/L 41800 461.00
REMOVE RECTUM O 45915 936.39
I&D HEMORRHOI 46083 414.00
ANOSCOPY, DIAGN 46600 193.00
INSERT NON-INDW 51701 216.00
INSERT TEMP IND 51703 331.00
URETHRAL DILIT.FEMAL:INIT 53660 136.32
URETHRAL DILIT.FEMALE:SUB 53661 105.04
CRYOSURGERY, PE 54056 418.00
INCISE & DRAIN 56420 338.00
BIOPSY, CERVIX 57500 575.60
UTERINE ASPIRA 58100 291.00
INSERTION INTRAUTERINE DEVICE IUD 58300 130.10
REMOVE INTRAUTERINE DEVIC 58301 275.76
ANTEPARTUM CARE 59425 998.00
ANTEPARTUM CARE 59426 1,593.00
POSTPARTUM CHECK 59430 379.26
N BLOCK INJ TRIGEMINAL 64400 314.00
INJECT NERVE BL 64402 314.00
INJ OCCIPITAL N 64405 310.00
REMOVE OBJECT F 65205 169.00
REMOVE OBJECT F 65220 330.01
REMOVE FOREIGN BODY/EYE 65222 159.45
INCISE/DRAIN CO 68020 808.37
REMOVE OBJECT F 69200 276.00
REMOVAL IMPACTED CERUMEN IRR/LAV UNILAT 69209 55.96
REMOVAL IMPACTE 69210 115.00
BASIC METABOLIC 80048 50.00
GENERAL HEALTH 80050 91.00
ELECTOLYTE PANE 80051 52.00
COMPREHENSIVE M 80053 63.00
OB PANEL 80055 158.00
LIPID PANEL 80061 80.00
RENAL FUNCTION PANEL 80069 52.00
ACUTE HEPATITIS PANEL 80074 235.00
HEPATIC FUNCTIO 80076 52.00
TEGRETOL LEVEL( 80156 91.00
ASSAY, DIGOXIN 80162 80.00
DIPROPYLACETIC 80164 84.00
KEPPRA 80177 95.25
LITHIUM QUANTIT 80178 48.00
ASSAY, PHENOBAR 80184 60.00
PHENYTOIN;TOTAL 80185 80.00
TOPAMAX 80201 94.50
VANCOMYCIN 80202 83.00
DRUGS OF ABUSE 80305 66.00
URINALYSIS, NON 81000 40.00
UA 81001 32.00
URINALYSIS, NON 81002 15.00
URINALYSIS AUTO 81003 30.00
MICROSCOPIC EXA 81015 25.00
PREGNANCY TEST 81025 37.00
FACTOR 5 LEIDEN MUT ANAL 81241 476.00
HEMOCHOMATOSIS GENE ANAL 81256 403.00
BETA-HYDROXYBUTYRATE (ACETONE) 82010 45.07
ACTH RADIOIMMUN 82024 195.47
ASSAY, SERUM AL 82040 37.00
TEST FOR MICROA 82043 115.00
MICROALBUMIN, S 82044 41.00
ALCOHOL (ETHANO G0480 79.00
ASSAY, BLOOD AL 82085 74.00
ALDOSTERONE 82088 280.00
ALPHA-1-ANTITRYPSIN TOTAL 82103 73.00
ALPHA-1-ANTITRYPSIN PHENOTYPE 82104 189.75
ALPHA-FETOPROTE 82105 130.00
ASSAY, BLOOD AM 82140 74.00
AMPHETAMINE, SERUM 82145 176.50
AMYLASE,SERUM 82150 36.00
ANGIOTENSIN CONVERTING EN 82164 117.25
APOLIPOPROTEIN A AND B 82172 67.00
VITAMIN C 82180 205.50
BILIRUBIN, TOTA 82247 34.00
HEMOCULT 82270 22.00
BLOOD OCCULT, Q 82274 50.00
ASSAY, VITAMIN 82306 106.00
ASSAY CALCIUM I 82310 34.00
ASSAY IONIZED C 82330 87.00
CALCIUM, 24 HR URINE 82340 47.00
CO2- CARBON DIOXIDE 82374 14.00
CARBON MONOXIDE 82375 75.00
CEA 82378 115.00
CATECHOLAMINES 82384 242.00
ASSAY, BLOOD CE 82390 79.00
GLIADIN PEPTIDE SCREEN 82397 54.60
CHOLESTEROL TOTAL 82465 18.00
THIOPURINE 82542 102.00
ASSAY, BLOOD CO 82525 84.00
ASSAY, FREE COR 82530 64.00
ASSAY, PLASMA C 82533 84.00
ASSAY, COLUMN C 82541 48.00
ASSAY CPK IN BL 82550 35.00
ASSAY CREATINE, 82553 48.00
CREATININE 82565 34.00
ASSAY, CREATINI 82570 41.00
CREATININE CLEA 82575 67.00
CYANOCOBALAMIN( 82607 102.00
ASSAY, DEHYDROE 82627 94.00
ASSAY, DIHYDROX 82652 147.00
ASSAY, ESTRADIO 82670 191.00
ASSAY TOTAL EST 82672 166.00
ASSAY, FERRITIN 82728 85.00
FOLIC ACID;SERU 82746 95.00
ASSAY, GAMMAGLO 82784 52.00
ASSAY, GAMMAGLO 82785 89.00
ASSAY, GLUCOSE, 82945 43.00
FBS 82947 32.00
STICK ASSAY OF 82948 22.00
GLUCOSE TEST 82950 41.00
GLUCOSE TOLERAN 82951 95.00
GTT-ADDED SAMPL 82952 32.00
G-6-PD 82955 136.25
GLUCOSE BLOOD T 82962 20.00
ASSAY, GGT ENZY 82977 47.00
GLYCOPROTEIN EL 82985 44.00
ASSAY, PITUITAR 83001 122.00
ASSAY, PITUITAR 83002 126.00
HUMAN GROWTH HORMONE 83003 128.00
GLYCATED (HGB) 83036 59.00
ASSAY, HOMOCYST 83090 59.00
IMMUNOASSAY, AN 83516 90.85
IMMUNOASSAY, AN 83519 99.49
TRYPTASE 83520 172.00
ASSAY, INSULIN, 83525 62.00
SERUM IRON 83540 45.00
IRON BINDING CA 83550 45.00
LACTIC ADIC 83605 63.00
LDH-LACTATE DEHYDROGENASE 83615 33.00
ASSAY BLOOD FOR 83655 80.00
LIPASE 83690 41.00
DIRECT LDL 83721 57.00
ASSAY, BLOOD MA 83735 34.00
ASSAY OF MERCURY 83825 169.00
METANEPRHINES, PLASMA FR 83835 234.00
MYOGLOBIN 83874 179.00
ASSAY, NATIURET 83880 125.00
NICOTINE SCREEN 80323 42.00
METHYLMALONIC ACID 83921 132.77
OSMOLALITY- URINE 83935 36.00
PTH INTACT 83970 207.22
ASSAY ALKALINE 84075 42.00
ASSAY ALKALINE 84080 94.00
ASSAY, BLOOD PH 84100 32.00
ASSAY, URINE PO 84110 44.00
POTASSIUM BLOOD 84132 32.00
ASSAY, PROGESTE 84144 103.00
PROLACTIN 84146 136.00
PSA 84153 92.33
ASSAY, PSA, FRE 84154 110.00
PROTEIN,TOTAL U 84155 37.00
ASSAY, PROTEIN, 84156 12.00
ASSAY, PROTEIN, 84157 11.00
PROTEIN; ELECTR 84165 65.00
ELECTROPHORESIS, 24 HR UA 84166 84.00
RENIN ACTIVITY 84244 160.00
SEROTONIN 84260 229.00
CLN ASSAY OF SEX HORMONE BINDING GLOBULI 84270 126.40
SODIUM 84295 20.31
SODIUM, 24 HR UA 84300 32.00
ASSAY, SOMATOME 84305 96.00
ASSAY, FREE TES 84402 95.00
TESTOSTERONE TO 84403 174.00
THIAMINE (VITAMIN B1) 84425 160.00
THYROXINE,4 84436 41.00
ASSAY, FREE THY 84439 62.73
THYROID STIMULA 84443 91.00
AST, TRANSFERAS 84450 31.00
SGPT TRANSAMIN 84460 31.00
TRANSFERRIN 84466 86.00
T 3 84480 94.00
ASSAY, FREE TRI 84481 136.00
T3,REVERSE 84482 196.06
ASSAY, TROPONIN 84484 34.00
BUN 84520 25.00
URIC ACID BLOOD 84550 31.00
ADH 84588 96.00
ZINC, SERUM 84630 64.60
ASSAY, C-PEPTID 84681 104.00
QUANTITATIVE HC 84702 106.00
PREGNANCY TEST 84703 60.00
BLOOD COUNT, AU 85004 19.00
DIFFERENTIAL WB 85007 31.00
HEMATOCRIT BLOO 85014 15.00
HGB (Clinic) 85018 15.00
CBC HGB, HCT, WBC, AUTO DIFF 85025 45.00
AUTOMATED HEMOG 85027 43.00
RETICULOCYTE CO 85045 35.00
WBC 85048 29.00
BLOOD SMEAR PER 85060 52.00
FACTOR 8 ASSAY 85240 232.22
PROTEIN C, ACTIVITY 85303 174.00
PROTEIN S, FREE 85306 203.00
D-DIMER 85379 60.00
FIBRINOGEN 85384 76.75
PROTHROMBIN TIM 85610 23.00
SED RATE 85651 32.00
SICKLE CELL SCREEN 85660 39.56
THROMBOPLASTIN 85730 52.00
THROMBOPLASTIN TIME 85732 57.00
ALLERGEN SPECIF 86003 31.00
ANTIBODY IDENTI 86021 194.00
ANA ANTINUCLEAR 86038 94.00
ANA TITER 86039 33.00
ANTISTREPTOLYSI 86060 59.00
C-REACTIVE PROT 86140 53.00
C-REACTIVE PROT 86141 59.00
CARDIOLIPIN ANTIBODY 86147 131.00
COMPLEMENT, ANT 86160 52.00
CYCLIC CITRULLINATED PEPTIDE ANTIBODY 86200 139.00
NUCLEAR ANTIGEN ANTIBODY 86235 86.00
FLOURESCENT NON 86255 85.00
IMMUNOASSY FOR 86301 179.00
IMMUNOASSAY FOR 86304 115.00
MONO TEST 86308 37.00
IMMUNOASSAY, IN 86317 178.00
GEL IMMUNODIFFUSION 86331 33.00
IMMUNOFIXATION 86334 42.00
ASSAY, MICROSOM 86376 77.00
RABIES AB 86382 201.75
RHEUMATOID FACT 86430 45.00
RHEUMATOID FACT 86431 47.00
CLN TUBERCULIN PURIFIED 86580 42.14
CLN (VFC) TUBERCULIN PURIFIED 86580 17.47
SYPHILIS TEST 86592 35.00
ANTIBODY, ASPIR 86606 33.00
BACTERIUM ANTI BODY 86609 33.00
BARTONELLA AB 86611 64.75
ANTIBODY, BLAST 86612 31.00
B.PERTUSSIS AB IGG, IGA 86615 138.60
LYME TITRE, ANTI 86617 96.45
LYME DX AB SCREEN 86618 133.70
ANTIBODY, COCCI 86635 74.97
CMV ANTIBODY 86644 106.00
ANTIBODY, CMV, 86645 109.00
EBV IGG OR IGM 86665 110.00
HELICOBACTER PY 86677 116.00
HEMOPHILUS INFLUB AB 86684 160.25
HERPES SIMPLEX TEST 86694 96.00
ANTIBODY, HERPE 86695 96.00
ANTIBODY, HERPE 86696 98.00
ANTIBODY, HISTO 86698 124.00
ANTIBODY, HEPAT 86704 77.00
HEPATITIS B CORE IGM AB 86705 139.00
ANTIBODY, HEPAT 86706 67.00
HEPATITIS A ANTIBODY HAAB 86708 113.00
ANTIBODY, HEPAT 86709 77.00
MUMPS AB IGG OR IGM 86735 95.00
ACTINOMYCES (NOCARDIA) AB 86744 31.00
PAROVIRUS ANTIBODY 86747 106.00
RUBELLA ANTIBODY 86762 62.00
ANTIBODY, RUBEO 86765 106.00
TREPONEMA PALLIDUM AB 86780 91.90
ANTIBODY, VARIC 86787 72.97
WEST NILE VIRUS 86788 67.55
WEST NILE VIRUS 86789 85.80
HERPES 6 AB,IGG OR IGM 86790 76.00
ANTIBODY, THYRO 86800 94.00
ANTIBODY, HEPAT 86803 105.00
HLA TYPING, A, 86812 203.58
BLOOD TYPING:ABO 86900 105.04
BLOOD TYPING, R 86901 31.80
BLOOD CULTURE, AEROBIC 87040 63.00
STOOL CULTURE F 87045 18.00
STOOL CULTURE, 87046 18.00
CULTURE SPECIME 87070 60.00
CULTURE SPECIME 87075 72.00
IDENTIFICATION, 87076 34.73
CUTURE BACTERIA 87077 55.00
CULTURE SCREEN ONLY 87081 22.00
URINE BACTERIA 87086 57.00
URINE ID (PRESUMPTIVE) 87088 54.00
SKIN FUNGI CULTURE 87101 48.00
FUNGUS ID 87106 52.00
CULTURE TYPING, 87147 19.00
PINWORM EXAM 87172 39.20
OVA AND PARASIT 87177 72.00
ANTIMICROBIAL AGENT DISK METHOD 87184 25.98
ANTIMICROBIAL AGENT 87185 27.00
ANTIBIOTIC SENS 87186 45.00
SMEAR, STAIN & 87205 32.00
SMEAR, STAIN & 87206 53.00
TRICHROME STAIN 87209 67.00
SMEAR, STAIN & 87210 31.00
KOH PREP 87220 51.57
ORARISK HPV 175.00
INFECT ANTIGEN, 87299 74.00
C.DIFF TOXIN GENE 87324 97.37
INFECT ANTIGEN, 87329 39.00
H. PYLORI AG, STOOL 87338 120.78
INFECT ANTIGEN, 87340 53.00
HIV SCREEN REFLEX TO CONFIRM 87389 57.79
INFECT ANTIGEN, 87400 42.00
INFECT ANTIGEN, 87420 47.00
ROTOVIRUS (EIA) 87425 98.00
CHLAMYDIA TRACH 87491 113.00
INFECT ANTIGEN 87493 128.00
CLN IADNA CYTOMEGALOVIRUS QUANTIFICATION 87497 435.25
BASIC ENTERIC PATHOGEN PANEL 87506 233.82
COMPREHENSIVE ENTERIC PATHOGEN PANEL 87507 220.00
HEP C RNA QUAL 87521 261.00
INFECT ANTIGEN, 87522 140.00
NEISSERIA GONOR 87591 151.00
HPV DNA 87624 266.94
TRICHOMONAS BY NAD 87661 215.04
AMPLIFIED PROBE TECHNIQUE, EACH ORGANISM 87798 122.00
DETECT AGNT MULT DNA AMPL 87801 226.00
INFECT ANTIGEN, 87804 48.00
INFECTIOUS ANTI 87807 39.00
INFECT ANTIGEN, 87880 64.00
CELL COUNT MISC 89051 58.00
LEUKOCYTE COUNT 89055 18.00
EXAM, SYNOVIAL 89060 57.00
VACCINE ADMIN W/ PROFESSIONAL THRU 18 90460 44.00
VFC VACCINE ADMIN 90460 19.68
VACCINE ADMIN EACH ADDITIONAL VACC/TOXOI 90461 24.00
IMMUNIZATION ADMIN OVER 18 90471 44.00
IMMUNIZATION ADMIN OVER 18 90472 24.00
IMMUN ADMIN, IN 90474 26.00
MENINGOCOCCAL RECOMBINANT PROTEIN 90620 198.00
MENINGOCOCCAL RECOMBINANT PROTEIN 90620 0.00
HEPATITIS A VAC 90632 74.88
CLN HEPATITIS A 90633 37.44
CLN (VFC) HEPATITIS A 90633 0.00
HIB TITER 90646 0.00
CLN HAEMOPHYL (HIB) 90648 66.88
CLN (VFC) HAEMOPHYL (HIB) 90648 0.00
CLN HPV 9 90651 244.90
CLN (VFC) HPV 9 90651 0.00
INFLUENZA SPLIT 3YRS+ Q2038 0.00
FLU VACCINE HIGH DOSE 90662 62.00
FLU VACCINE HIGH DOSE 90662 0.00
CLN PNEUMOCOCCAL 13 90670 215.16
PNEUMOCOCCAL 13 90670 0.00
CLN (VFC) PNEUMOCOCCAL 13 90670 0.00
RABBIES VACCINE IM 90675 404.40
CLN ROTAVIRUS VA 90680 98.57
CLN (VFC) ROTAVIRUS VA 90680 0.00
FLU VACCINE 6-35MO 90685 55.00
FLU VACCINE 6-35MO 90685 0.00
FLU VACCINE 90686 55.00
FLU VACCINE 90686 0.00
FLU VACCINE 90686 0.00
CLN DTAP-IPV 90696 57.24
CLH (VFC) DTAP-IPV 90696 0.00
CLN DTAP-IP-HI 90698 106.60
CLN (VFC) DTAP-IP-HI 90698 0.00
CLN DIPTH PERTUSSIS (DTAP) 90700 33.82
CLN (VFC) DIPTH PERTUSSIS (DTAP) 90700 0.00
CLN MEASLES/MUMPS 90707 82.40
CLN (VFC) MEASLES/MUMPS 90707 0.00
CLN MMR VARICELLA 90710 239.29
90710 239.29
CLN MMR VARICELLA 90710 0.00
POLIOVIRUS IPV SC/IM 90713 64.00
POLIOVIRUS IPV SC/IM 90713 0.00
CLN TETANUS DIPH 90714 39.21
CLN (VFC) TETANUS DIPH 90714 0.00
CLN TDAP (BOOSTRIX) DIPTH/PERTU 90715 43.38
CLN (VFC) TDAP (BOOSTRIX) DIPTH/PERTU 90715 0.00
CLN VARICELLA VI 90716 145.52
CLN (VFC) VARICELLA VI 90716 0.00
CLN DTAP-HEP B-IPV VACCINE IM 90723 87.84
CLN (VFC) DTAP-HEP B- IPV VACCINE IM 90723 0.00
CLN PNEUMOCOCCAL 23 90732 113.41
PNEUMOVAX 90732 0.00
CLN (VFC) PNEUMOCOCCAL 23 90732 0.01
CLN MENINGOCOCCAL 90734 198.00
CLN (VFC) MENINGOCOCCAL 90734 0.00
HEPATITIS B 90744 34.30
CLN (VFC) HEPATITIS B 90744 0.00
HEPATITIS B VAC 90746 67.80
ADM INJ SUBCU O 96372 44.00
TYMPANOMETRY 92567 62.00
UPDRAFT TX 94640 86.19
EVALUATE USE OF INHAL.NEB 94664 186.38
MEASUREMENT OF 94760 39.00
ALLERGY INJ.SNG 95115 37.03
ALLERGY INJ, 2+ 95117 41.00
IV THER. UP TO 1HR. 96365 194.03
THERAPEUTIC PRO INJ 96372 44.00
ADMN INJ IV PUSH 96374 191.09
COLLECTION/HAND 99000 29.00
POSTOP FOLLOW-UP VISIT 99024 0.00
SPEC REPORTS IN 99080 20.00
NEW OV-FOCUSED 99201 78.00
OV EXP ST FD NP 99202 123.00
OV DET/LOW N PT 99203 174.00
OV COMP/MOD COM 99204 264.00
OV MINIMAL 99211 53.00
OV FOC EST PT 99212 66.00
OV EXP PROB/LOW 99213 86.00
OV DETAILED/MOD 99214 133.00
OV COMP/HIGH CO 99215 200.00
OBSERVATION CARE 99217 193.00
INITIAL OBS CARE 99218 200.00
INTIAL OBS CARE 99219 329.00
INITIAL OBS CARE 99220 442.00
INITIAL HOSPITAL CARE-LOW COMPLEXITY 99221 213.00
INITIAL HOSPITAL CARE-MOD COMPLEXITY 99222 330.00
INITIAL HOSPITAL CARE-HIGH COMPLEXITY 99223 442.00
SUBSEQUENT OBS CARE 99224 113.50
SUBSEQUENT OBS CARE 99225 207.60
SUBSEQUENT OBS CARE 99226 299.16
SUBSEQUENT HOSPITAL CARE-LOW COMPLEXITY 99231 109.00
SUBSEQUENT HOSPITAL CARE-MOD COMPLEXITY 99232 160.00
SUBSEQUENT HOSPITAL CARE-HIGH COMPLEXITY 99233 226.00
SUBSEQUENT HOSPITAL CARE - HIGH COMPLEXI 99234 384.00
OBSERVATION/HOSP CARE 50 MIN 99235 483.00
HOSPITAL DISCHARGE 99238 195.00
HOSPITAL DISCHARGE 99239 250.00
EMERGENCY DEPT 99281 95.00
EMERGENCY DEPT 99283 219.10
EMERGENCY DEPT 99284 355.53
EMERGENCY DEPT 99285 520.85
1ST NF CARE PR 99304 177.00
1ST NF CARE PR 99305 234.00
1ST NF CARE PR 99306 306.00
SBSQ NF CARE PR 99307 100.00
SBSQ NF CARE PR 99308 151.00
SBSQ NF CARE PR 99309 209.00
SBSQ NF CARE PR 99310 276.00
NURSING SERV DI 99315 173.00
EST VISIT ASSISTED LIVING FACILITY 99334 130.00
EST VISIT ASS.LIVING FAC 99335 151.00
HOME VISIT EST PATIENT LEVEL 1 99347 158.01
HOME VISIT-LOW COMPLEXITY 99348 239.00
HOME VISIT EST PT MOD-HI SEVERITY 40 MIN 99349 280.00
INIT PM E/M NEW PAT INF 99381 182.00
INIT PM E/M NEW PAT 1-4 Y 99382 199.00
PREV VISIT NEW AGE 5-11 99383 195.00
PREV VISIT NEW AGE 12-17 99384 219.00
PREV VISIT NEW AGE 18-39 99385 250.00
PREV VISIT NEW AGE 40-64 99386 273.00
INIT PM E/M NEW PAT 65+ Y 99387 306.00
PM INFANT EST 99391 147.00
PM 1-4 YRS. EST 99392 172.00
PM 5-11 YRS EST 99393 172.00
PM EST 12-17 YR 99394 177.00
PM 18-39 EST 99395 206.00
PM 40-64 EST PT 99396 206.00
PM 65+ EST PT 99397 233.00
SMOKING CESS.COUNS.3-10MI 99406 33.12
SMOKING CESS.COUNS.>10 MI 99407 70.57
HEALTH RISK ASSESSMENT 99420 20.00
CHRONIC CARE MNGT 20 MIN 99490 71.94
TRANS CARE MGMT 14 DAY DISCHARGE 99495 293.00
TRANS CARE MGMT 7 DAY DISCHARGE 99496 414.00
ADVANCED CARE PLANNING 30MIN 99497 94.00
ADVANCED CARE PLANNING ADDL 30MIN 99498 82.00
SLING A4565 27.00
SPLINT A4570 14.00
SPLINT A4570 27.00
SPLINT A4570 30.00
SPLINT A4570 51.00
SPLINT A4570 68.00
CAST SUPPLIES A4580 26.00
CASTING MATERIA A4590 84.00
FLUORIDE VARNISH 14.00
ADMIN FLU SHOT G0008 44.00
ADM PNEUMO VACC G0009 44.00
ADM HEP B VACC G0010 45.00
PELVIC & BREAST G0101 72.00
PROSTATE CA SCREENING DRE G0102 43.00
TRIM NAILS G0127 55.96
FECAL BLOOD SCRN IA G0328 39.00
IPPE NEW MEDICA G0344 178.00
POWER MOBILITY DEVICE FOR G0372 30.00
IPPE MEDICARE G0402 216.00
SW & PSYCH SRVC EA 15 MIN G0409 27.66
ANNUAL WELLNEST VST G0438 242.00
AWV SUBSEQUENT VISIT G0439 161.00
CLH DRUG TESTS 80305 66.00
Electronic Rx G8553 0.01
INFLUENZA A (H1 G9141 14.00
HIGH-RISK ANTEPARTUM CARE H1001 5.00
ADRENALIN EPINEPHRINE INJ J0171 4.00
BICILLINLA INJ 2ML J0561 218.43
INJECTION, CEFA J0690 13.96
ROCEPHIN 250 MG J0696 11.72
J0696 31.42
INJECTION, PROC J0780 7.00
INJECTION, METH J1030 45.14
INJECTION, METH J1040 70.31
DEPO-PROVERA 1 MG J1050 0.54
DEPRO-PROVERA 1 J1050 81.00
INJECTION, DEXA J1100 6.98
BENEDRYL J1200 20.00
INJECTION, ENOX J1650 28.45
BONIVA INJ 1 MG J1740 300.00
TORADOL-15MG J1885 7.82
LORAZEPAM INJECTION 2MG J2060 20.00
INJECTION, ONDA J2405 9.00
PHENERGAN J2550 26.66
INJECTION, TOBR J3260 5.00
KENALOG 10MG J3301 10.15
INJ DIAZEPAM UP TO 5MG J3360 7.00
VISTARIL 25 MG. J3410 5.00
VITA B12 J3420 41.85
VITAMIN K PER 1 J3430 5.00
LEVONORGESTREL (IUD) 52MG J7298 1,372.80
METHOTREXATE SO J9250 3.00
THORACIC RIB BE L0210 50.00
AMBULATORY SURI L3260 24.00
PNEUMATIC ANKLE L4350 116.00
PRE-NATAL GLOBAL CARE 0.00
COLLECTION PAP Q0091 50.00
FLUZONE VAX 3YR+ INTRAMUS Q2039 55.00
FLUZONE VAX 3YR + Q2039 0.00
FLUZONE VAX 3YR+ Q2039 0.01
CAST SUP BODY CAST PLASTR Q4001 0.00
CAST SUP LONG ARM ADULT F Q4006 35.00
CAST SUP SHT ARM ADULT FB Q4010 45.00
CAST SUP SHT ARM PED PLAS Q4011 10.00
CAST SUP SHT ARM PED FBRG Q4012 10.00
CAST SUP LNG ARM SPLINT P Q4017 15.00
CAST SUP LNG ARM SPLINT F Q4018 20.00
CAST SUP LNG ARM SPLNT PE Q4020 10.00
SHORT ARM SLINT ADULT Q4021 59.00
CAST SUP SHT ARM SPLINT F Q4022 15.00
CAST SHRT ARM SPLINT PED Q4024 10.00
CAST SUP SHT LEG FIBERGL Q4038 50.00
CAST SUP SHT LEG SPLNT FB Q4046 25.00
SPORT-PX 25.00
