93
Charge Code Descript Departm UB RevenueCode Procedure Code Rate Status 4500031 .09% NA IV 258 J7030 31.80 Active 4500036 .09% NA IV 258 J3490 44.52 Active 4500032 .09% NA IV 258 J3490 27.56 Active 4500030 .09% NA IV 258 J3490 27.56 Active 4500035 .45% NA IV 258 34.98 Active 4500034 .O9% NA IV 258 31.80 Active 4700020 0-2 CAN OXY 270 19.08 Active 4551236 1 12 DIH LAB 300 82652 272.46 Active 4401860 1 ML SY SUP 270 28.62 Active 4400931 10CC SY SUP 270 5.30 Active 4401931 16" SUP SUP 270 53.00 Active 4401930 16" SUP SUP 270 L1830 53.00 Active 4550864 17-HYDR LAB 300 83498 182.32 Active 4559020 2 Hour Glucose Tolerance Test Active 4551192 21-HYDR LAB 300 160.06 Active 4559019 3 Hour Glucose Tolerance Test Active 4400466 3" J-SPL SUP 270 21.20 Active 4250152 3" POSI PT 270 23.32 Active 4400842 3-0 CHR SUP 270 30.74 Active 4400467 4" J-SPL SUP 270 29.68 Active 4400831 5-0 PRO SUP 270 51.94 Active 4552089 5-Hydrox LAB 300 83497 125.08 Active 4250158 6" POSI SUP 270 53.00 Active 4400229 8" COMB SUP 270 8.48 Active 4550424 A1C (HG LAB 300 83036 90.10 Active 4550933 AAT LAB 300 82103 102.82 Active 4600002 AB Elutio BB 300 86860 182.32 Active 4600003 AB ID Pa BB 300 86870 152.64 Active 4600006 AB Scre BB 300 86850 125.08 Active 4600005 AB Scre BB 300 86850 86.92 Active 4600004 AB SCR BB 300 86850 86.92 Active 4750002 AB SER XRAY 320 74022 225.78 Active 4400230 ABD PA SUP 270 8.48 Active 4400003 ABD PA SUP 270 8.48 Active 4750003 ABD SE XRAY 320 74019 217.30 Active 4750006 ABD SE XRAY 320 74021 225.78 Active 4400004 ABDOM SUP 270 A4463 56.18 Active 4750005 ABDOM XRAY 320 74018 172.78 Active 5880009 ABDOM DNU 402 450.29 Active 4650004 ABDOM XRAY 402 76705 407.04 Active 4400009 ABDUCT SUP 270 121.90 Active 4400008 ABDUCT SUP 270 124.02 Active 4550003 ABGs -A LAB 300 82803 204.58 Active 4600007 ABO Typ BB 300 86900 78.44 Active 4400010 ABSORB SUP 270 135.68 Active 4750143 AC JTs XRAY 320 73050 225.78 Active

Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

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Page 1: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

Charge Code DescriptionDepartmentUB RevenueCode Procedure Code Rate Status

4500031 .09% NACL 1000CCIV 258 J7030 31.80 Active

4500036 .09% NACL 100CCIV 258 J3490 44.52 Active

4500032 .09% NACL 250CCIV 258 J3490 27.56 Active

4500030 .09% NACL 500CCIV 258 J3490 27.56 Active

4500035 .45% NACL 1000CCIV 258 34.98 Active

4500034 .O9% NACL 1000CCIV 258 31.80 Active

4700020 0-2 CANNULA SUPPORTOXY 270 19.08 Active

4551236 1 12 DIHYDROXYVITAMIN DLAB 300 82652 272.46 Active

4401860 1 ML SYRINGE BOXSUP 270 28.62 Active

4400931 10CC SYRINGE SAFETYSUP 270 5.30 Active

4401931 16" SUPER KNEE SPLINT LGESUP 270 53.00 Active

4401930 16" SUPER KNEE SPLINT XLSUP 270 L1830 53.00 Active

4550864 17-HYDROXYPROGESTERONELAB 300 83498 182.32 Active

4559020 2 Hour Glucose Tolerance Test Active

4551192 21-HYDROXYLASE ANTIBODIESLAB 300 160.06 Active

4559019 3 Hour Glucose Tolerance Test Active

4400466 3" J-SPLINT PER FOOTSUP 270 21.20 Active

4250152 3" POSITIONING ROLLPT 270 23.32 Active

4400842 3-0 CHROMIC GUT (UR-SUP 270 30.74 Active

4400467 4" J-SPLINT PER FOOTSUP 270 29.68 Active

4400831 5-0 PROLENE (FS-2) 8SUP 270 51.94 Active

4552089 5-Hydroxyindoleacetic Acid (5-HIAA) 24 HLAB 300 83497 125.08 Active

4250158 6" POSITIONING ROLLSUP 270 53.00 Active

4400229 8" COMBSUP 270 8.48 Active

4550424 A1C (HGB)LAB 300 83036 90.10 Active

4550933 AAT LAB 300 82103 102.82 Active

4600002 AB Elution (ARC)BB 300 86860 182.32 Active

4600003 AB ID Panel (ARC)BB 300 86870 152.64 Active

4600006 AB Screen (ARC)BB 300 86850 125.08 Active

4600005 AB Screen, AHGBB 300 86850 86.92 Active

4600004 AB SCREEN, INCBB 300 86850 86.92 Active

4750002 AB SERIES W/ PA CHEST 3 VXRAY 320 74022 225.78 Active

4400230 ABD PAD 5X9SUP 270 8.48 Active

4400003 ABD PAD 8 X 10SUP 270 8.48 Active

4750003 ABD SERIES UPRIGHT + KUBXRAY 320 74019 217.30 Active

4750006 ABD SERIES UPRIGHT W/ DECUXRAY 320 74021 225.78 Active

4400004 ABDOM BINDERSUP 270 A4463 56.18 Active

4750005 ABDOMEN (KUB) 1 VIEWXRAY 320 74018 172.78 Active

5880009 ABDOMIN ULT COMPL HAVREDNU 402 450.29 Active

4650004 ABDOMINAL, LIMITEDXRAY 402 76705 407.04 Active

4400009 ABDUCTION PILLOW MEDSUP 270 121.90 Active

4400008 ABDUCTION PILLOW SMASUP 270 124.02 Active

4550003 ABGs -ARTERIAL BLOOD GASLAB 300 82803 204.58 Active

4600007 ABO Type (ARC)BB 300 86900 78.44 Active

4400010 ABSORBABLE HEMOSTATSUP 270 135.68 Active

4750143 AC JTs W/ WT 2-4 VIEWSXRAY 320 73050 225.78 Active

Page 2: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4750007 AC JTs W/O WT 1-2 VIEWSXRAY 320 73050 201.40 Active

4401855 ACAPELLA MOUOTHPIECESUP 270 151.58 Active

4401768 ACCOMMODATOR SPLINTSUP 270 72.08 Active

4400011 ACE BANDAGE 6" X-LOSUP 270 29.68 Active

4400012 ACE BANDAGE 2"SUP 270 S8431 8.48 Active

4400013 ACE BANDAGE 3"SUP 270 8.48 Active

4400018 ACE BANDAGE 3" X-LONSUP 270 15.90 Active

4400015 ACE BANDAGE 4 X-LONGSUP 270 15.90 Active

4400014 ACE BANDAGE 4"SUP 270 8.48 Active

4400017 ACE BANDAGE 6 XLONGSUP 270 29.68 Active

4400016 ACE BANDAGE 6"SUP 270 8.48 Active

4401115 ACE WRAPSUP 270 11.66 Active

4550934 ACE: ANGIOTENSIN CONV ENZLAB 300 82164 117.66 Active

4451602 ACETADOTE 3 BAG PROTOCOLPHAR 259 J3490 462.16 Active

4451434 ACETAMIN/DIPHEN TAB 500/25MGPHAR 250 6.40 Active

4550004 ACETAMINOPHEN (SERUM)LAB 300 G0480 184.44 Active

4450541 ACETAMINOPHEN 120MG SUPPPHAR 250 J0132 6.40 Active

4451201 ACETAMINOPHEN 325MG SUPPPHAR 250 6.40 Active

4450539 ACETAMINOPHEN 325MG TABPHAR 250 J3490 6.40 Active

4450536 ACETAMINOPHEN 500MG TABPHAR 250 J3490 6.40 Active

4450540 ACETAMINOPHEN 650MG SUPPPHAR 250 J3490 6.40 Active

4450538 ACETAMINOPHEN CHILD 160MG/5MLPHAR 250 J3490 6.40 Active

4450537 ACETAMINOPHEN INFANT 80MG/0.8MLPHAR 250 6.40 Active

4450542 ACETAMINOPHEN/ CODEINE 30MG TABPHAR 250 6.40 Active

4450075 ACETAMINOPHEN/CODEINE 12MG/5MLPHAR 250 11.70 Active

4550005 ACETONE (SERUM)LAB 300 82009 34.98 Active

4550196 Acetone Urine ConfirmationLAB 300 81002 1.06 Active

4550006 ACETONE/ACETEST (URINE)LAB 300 81002 22.26 Active

4450353 ACETYLCYSTEINE 200MG/ML INJPHAR 636 J0132 526.13 Active

4451098 ACETYLCYSTEINE 3CC INHALPHAR 250 6.36 Active

4450767 ACETYLCYSTEINE INHALATION SOL 20%PHAR 250 J3490 58.40 Active

4551213 ACH RECEPTOR (MUSCLE) BINDING ABLAB 300 83519 169.96 Active

4551237 ACH RECEPTOR (MUSCLE) MODULATING ABLAB 300 83519 169.96 Active

4551214 ACHR GANGLIONIC NEURONAL ABLAB 300 62.54 Active

4451126 ACTENOL 35MG. P.O.PHAR 250 120.84 Active

4550871 ACTH LAB 300 82024 210.94 Active

4451438 Actidose Susp (Charcoal) 25 gmPHAR 250 58.40 Active

4250170 ACTIVA PATCHSUP 270 21.20 Active

4552068 Activated Protein C Resistance V (APCRV)LAB 300 85307 182.32 Active

4250001 ACTIVITIES OF DAILYPT 420 97535 69.96 Active

4451089 ACYCLOVIR 400MG TABPHAR 250 J3490 6.40 Active

4451309 ACYCLOVIR 500MG IVPHAR 636 J0133 58.40 Active

4550457 Acylcarnitine by MS/MSLAB 300 82017 48.76 Active

4400021 ADAPTIC DRESSING 3X3SUP 270 8.48 Active

4400020 ADAPTIC DRESSING 3X8SUP 270 8.48 Active

4250110 ADDL' GAIT TRAININGPT 270 30.74 Active

4250121 ADDL' PROSTHETIC TRAININGPT 420 97761 90.10 Active

Page 3: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4250106 ADDL' THERAPEUTIC EXERCISPT 420 97110 47.70 Active

4450010 ADENOSINE 90MG/30MLPHAR 636 J0150 1039.90 Active

4451586 ADENOSINE INJ 6MG/2MLPHAR 259 23.30 Active

4552012 ADENOVIRUS DIRECT DETECTION BY PCRLAB 300 87798 212.00 Active

4401854 ADHESIVE TAPE REMOVERSUP 270 7.81 Active

4250184 ADJ. BACK APIN BRACESUP 270 200.00 Active

4250002 ADL ADD'L 15 MINUTESPT 420 97535 39.22 Active

4451227 ADRIAMYCIN 20 MG IVPHAR 259 132.50 Active

4700006 ADULT CAP II CO2 DETOXY 270 84.80 Active

4700001 AERO CHAMBER (EASIVEOXY 270 37.10 Active

4550013 AFB PANEL: CULT W IISOLALAB 300 87116 102.82 Active

4550012 AFB PANEL: SMEARLAB 300 87206 63.60 Active

4250122 AFO MD/RTPT 270 272.42 Active

4250095 AFO SPLINTPT 270 L1930 177.02 Active

4250181 AFO-10.5SUP 270 110.24 Active

4550018 AFP: MATERNALLAB 300 82105 136.74 Active

4550017 AFP: TUMOR MARKER (SERUM)LAB 300 82105 102.82 Active

4600008 AG Screen (ARC) SCR1 1-10BB 300 86904 142.04 Active

4600049 AG TESTING (ARC) PER AGBB 300 86902 157.94 Active

4300085 AIIRFIT P10 NASAL HEADGEARDME 270 A7035 73.14 Active

4300082 AIRFIT F10 FF CUSHIONDME 270 A7032 97.52 Active

4300081 AIRFIT F10 FULL FACE MASKDME 270 A7034 254.40 Active

4300084 AIRFIT P10 NASAL CUSHIONDME 270 A7032 73.14 Active

4800084 AIRFIT P10 NASAL CUSHIONDME 270 A7032 73.14 Active

4300083 AIRFIT P10 NASAL MASKDME 270 A7034 166.42 Active

4401877 AIRTRAQ BLADE SZ 2SUP 270 56.18 Active

4401951 AIRTRAQ INFANT SIZE 0SUP 270 212.00 Active

4550020 ALBUMINLAB 300 82040 34.98 Active

4451357 ALBUMIN INFUS 25% 100 MLPHAR 259 238.75 Active

4451232 ALBUTEROL (iN PPD)PHAR 250 6.36 Active

4451336 ALBUTEROL 0.63MG/3ML NEB. SOL.PHAR 250 J3490 6.40 Active

4451289 ALBUTEROL 1.25MG/ML NEB. SOL.PHAR 250 J3490 6.40 Active

4450012 ALBUTEROL 2.5MG/3ML NEB. SOL.PHAR 259 J3490 6.40 Active

4450013 ALBUTEROL INHALERPHAR 259 J3490 264.00 Active

4550024 ALCOHOL ETOH-URINELAB 300 80320 63.60 Active

4550022 ALCOHOL ETOH-SERUMLAB 300 80320 110.24 Active

4551151 ALCOHOL BREATH RETESTLAB 300 82075 28.62 Active

4551150 ALCOHOL- ETOH BREATHLAB 300 82075 57.24 Active

4400024 ALCOHOL PREP-PAD BOXSUP 270 8.48 Active

4400921 ALCOHOL SWABSTICKS (SUP 270 8.48 Active

4550937 ALDOLASELAB 300 82085 90.10 Active

4550935 ALDOSTERONE (SERUM)LAB 300 82088 187.62 Active

4450768 ALENDRONATE 70MGPHAR 250 115.00 Active

4401875 ALGINATE DRSG 4X8SUP 270 22.26 Active

4451305 ALIMTA 100MG INJPHAR 636 1134.20 Active

4451302 ALIMTA 500MG INJPHAR 636 J9305 5679.48 Active

4559007 Alkaline Phosphatase, Total and Isoenzym Active

Page 4: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4451316 ALLEGRA D POPHAR 250 6.36 Active

4355117 Allergen Immunotherapy 2 or more InjPROC 940 95117 43.46 Active

4359511 Allergen Immunotherapy Single InjPROC 940 95115 29.15 Active

4450608 ALLOPURINOL 100MG TABPHAR 250 6.40 Active

4450607 ALLOPURINOL 300MG TABPHAR 250 J3490 6.40 Active

4552024 Almond- IgELAB 300 86003 33.92 Active

4451252 ALOXI 0.25MG/5MLPHAR 636 J2469 1134.20 Active

4550027 ALP LAB 300 84075 48.76 Active

4550026 ALP ISOENZYMESLAB 300 84080 110.24 Active

4451193 ALPRAZOLAM 0.5MG TABPHAR 250 6.40 Active

4550029 ALT/SGPTLAB 300 84460 48.76 Active

4450020 ALTACE 10MG TABPHAR 250 6.36 Active

4451137 ALTEPLASE 100MG INJ.PHAR 636 J2997 12683.80 Active

4552047 Alternaria Tenuis, IgELAB 300 86003 33.92 Active

4300052 Alternating Air MattressDME 270 E0181 44.52 Active

4450169 ALUM SULFATE-CA ACETATE 1PKGPHAR 250 6.40 Active

4300065 AMARA LG MASKDME 270 A7034 254.40 Active

4300077 AMARA VIEW FF CUSHIONDME 270 A7031 97.52 Active

4300076 AMARA VIEW FULL FACE MASKDME 270 A7030 214.12 Active

4300078 AMARA VIEW HEADGEARDME 270 A7035 73.14 Active

4401847 AMBULANCE PILLOW CASESSUP 270 76.32 Active

3300001 AMBULANCE RUN NURSEED 450 99285 113.00 Active

4401846 AMBULANCE SHEETSSUP 270 248.04 Active

5880001 AMBULANCE TRIP CHARGESDNU 320 0.00 Active

4451624 AMIKACIN 500MG/2MLPHAR 259 58.40 Active

4551235 AMIKACIN PEAK LEVELLAB 300 80150 104.94 Active

4551234 AMIKACIN TROUGH LEVELLAB 300 80150 104.94 Active

4550456 Amino Acids by MS/MSLAB 300 82136 22.26 Active

4450026 AMINOPHYLLINE 250MG/10ML INJPHAR 636 J0280 58.40 Active

4450027 AMIODARONE 150MG/3MLPHAR 636 J0282 58.40 Active

4450890 AMIODARONE 200 MGPHAR 250 J3490 6.40 Active

4451323 AMITRIPTYLINE 10 MG TABPHAR 250 6.40 Active

4450182 AMITRIPTYLINE 25MG TABPHAR 250 6.40 Active

4450387 AMLODIPINE 5MG TABPHAR 250 J3490 6.40 Active

4451130 AMLODIPINE 10MG TABPHAR 250 J8499 6.40 Active

4550930 AMMONIA (PLASMA)LAB 300 82140 132.50 Active

4450706 AMOX/CLAV SUSP 400MG/5ML 50ML BTLPHAR 250 J3490 6.40 Active

4451255 AMOX/CLAV SUSP 400MG/5ML/100ML BTLPHAR 250 J3490 107.15 Active

4451242 AMOX/CLAV SUSP 600MG/42.9MG/5ML BTLPHAR 250 153.70 Active

4450029 AMOX/CLAV SUSP 600MG/5ML/75ML BTLPHAR 250 153.70 Active

4451131 AMOX/CLAV TAB 500MGPHAR 250 58.40 Active

4451132 AMOX/CLAV TAB 875MG/125PHAR 250 J3490 6.40 Active

4451389 AMOX/CLAV TAB 875MG/125 *OUT PT PK*PHAR 250 J3490 11.70 Active

4450612 AMOXICILLIN 500 MG TABPHAR 250 J3490 6.40 Active

4450031 AMOXICILLIN 500MG TAB *OUT PT PK*PHAR 250 11.70 Active

4451386 AMOXICILLIN 875MG TABPHAR 250 6.40 Active

4451378 AMOXICILLIN 875MG TAB *OUT PT PK*PHAR 250 J3490 6.40 Active

Page 5: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450028 AMOXICILLIN SUSP 250MG/5ML 100ML BTLPHAR 250 13.78 Active

4451637 AMOXICILLIN SUSP 125MG/5ML 100ML BTLPHAR 250 11.70 Active

4451273 AMOXICILLIN SUSP 400MG/5ML/100ML BTLPHAR 250 6.36 Active

4451405 AMOXICILLIN SUSP 400MG/5ML/50ML BTLPHAR 250 58.40 Active

4450030 AMOXICILLIN SUSP 400MG/5ML/75ML BTLPHAR 250 23.32 Active

4550036 AMP CONFIRM: QUANTLAB 300 80324 58.30 Active

4552094 Amphetamine Confirmation, SerumLAB 300 80324 67.84 Active

4551209 AMPHIPHYSIN ABLAB 300 62.54 Active

4451166 AMPICILLIN 2GM. I.V.PHAR 259 58.30 Active

4450033 AMPICILLIN SODIUM 1GM VIALPHAR 636 J0290 23.30 Active

4450546 AMPICILLIN/SULBACTAM 3GM INJPHAR 636 J0295 58.40 Active

4550040 AMY: AMYLASE (SERUM)LAB 300 82150 57.24 Active

4550045 ANA SCREENLAB 300 86038 37.10 Active

4550046 ANA TITERLAB 300 86039 68.90 Active

4550048 ANCA PANEL: TITERLAB 300 86256 218.36 Active

4550047 ANCA SCREENLAB 300 86255 151.58 Active

4550939 ANCA-VASCREF PANEL: PR-3LAB 300 86021 184.44 Active

4450035 ANDEHIST NR ORAL DROPHAR 250 58.30 Active

4559001 Anemia Panel Active

4559029 ANEMIA PANEL Active

4401726 ANGIOCATH 14GA 3.25"SUP 270 72.08 Active

4750009 ANKLE (LEFT) 2 VIEWSXRAY 320 73600 144.16 Active

4750011 ANKLE (LEFT) 3 VIEWSXRAY 320 73610 160.06 Active

4750159 ANKLE (RIGHT) 2 VIEWSXRAY 320 73600 144.16 Active

4750158 ANKLE (RIGHT) 3 VIEWSXRAY 320 73610 160.06 Active

4401899 ANKLE AIR/GEL 81/2SUP 270 53.00 Active

4400035 ANKLE AIR/GEL BRACESUP 270 L4350 125.08 Active

4451178 ANTACID LIQUID 30CC/DOSEPHAR 250 6.36 Active

4450357 ANTACID/ANTII-GAS ORAL SUSP. 30CCPHAR 250 6.40 Active

4550057 ANTI- DNA (DS)LAB 300 86225 62.54 Active

4400037 ANTI EMBOLISM THIGH MEDSUP 270 10.60 Active

4400038 ANTI EMBOLISM THIGH LGSUP 270 10.60 Active

4400036 ANTI EMBOLISM THIGH SMSUP 270 10.60 Active

4400039 ANTI EMBOLISM THIGH XLSUP 270 15.90 Active

4551205 ANTI GLIAL NUCLEAR AB TYPE 1LAB 300 62.54 Active

4551087 ANTI MULLERIAN HORMONELAB 300 83520 284.08 Active

4551202 ANTI NEURONAL NUCLEARAB TYPE 1LAB 300 62.54 Active

4551203 ANTI NEURONAL NUCLEARAB TYPE 2LAB 300 62.54 Active

4551204 ANTI NEURONAL NUCLEARAB TYPE 3LAB 300 62.54 Active

4550058 ANTI:RA, IgMLAB 300 86431 90.10 Active

4558350 ANTI-BASEMENT MEMBRANE ZONELAB 300 88350 307.40 Active

4600010 Antibody ScreenBB 300 86850 86.92 Active

4400045 ANTIEMBOLISM KNEE LGESUP 270 10.60 Active

4400044 ANTIEMBOLISM KNEE MEDSUP 270 10.60 Active

4400043 ANTIEMBOLISM KNEE SMSUP 270 15.90 Active

4400046 ANTIEMBOLISM KNEE XLGESUP 270 10.60 Active

4400041 ANTIEMBOLISM STOCK TSUP 270 72.08 Active

Page 6: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4558346 ANTI-INTERCELLULAR SUBSTANCELAB 300 88346 113.42 Active

4550060 ANTI-JO-1LAB 300 86235 62.54 Active

4550061 ANTI-MYOCARD SCREENLAB 300 86255 57.24 Active

4550063 ANTI-MYOCARDIAL TITERLAB 300 86256 124.02 Active

4559165 Antineutrophilic Cytoplasmic Antibodies Active

4551065 ANTIPHOSPHATIDYLERIN IGMLAB 300 86148 77.38 Active

4551064 ANTIPHOSPHATIDYLSERIN IGGLAB 300 86148 77.38 Active

4451105 ANTIPYRINE/BENZOCAINE OTIC *ER ONLY*PHAR 250 6.36 Active

4450038 ANTIPYRINE/BENZOCAINE OTIC 54-14MG/MLPHAR 250 58.40 Active

4401717 ANTI-REFLUX VALVESUP 270 15.90 Active

4550059 ANTI-SCL 70, IgGLAB 300 86235 62.54 Active

4550056 ANTI-SMITH (SM) IgGLAB 300 86235 62.54 Active

4550062 ANTI-SMOOTH MUSCLE SCREENLAB 300 86255 42.40 Active

4550065 ANTI-SMOOTH MUSCLE TITERLAB 300 86256 57.24 Active

4550055 ANTI-SM-RNPLAB 300 86235 62.54 Active

4552065 Antithrombin ActivityLAB 300 85300 169.60 Active

4551239 ANTITHROMBIN ANTIGENLAB 300 85301 169.60 Active

4550054 ANTI-TPOLAB 300 86376 97.52 Active

4401952 AORTRAQ PEDS SIZE 1SUP 270 212.00 Active

4450041 APAP #3 (TYL #3) (SEPHAR 250 0.00 Active

4550743 APOLIPOPROTEIN BLAB 300 82172 192.92 Active

30629105 APPLICATION LONG ARM SPLINTLOC 521 29105 259.70 Active

4401076 AQUA KPAD P/DAYSUP 270 45.58 Active

4401784 AQUACEL DRESSINGSUP 270 29.68 Active

4450043 ARANESP 200MCG/MLPHAR 636 J0881 3466.00 Active

4451643 ARANESP INJ 300MCGPHAR 259 3674.25 Active

4451649 ARANESP INJ 60 MCGPHAR 259 1039.90 Active

4250163 ARCO SHOULDER SUPPORTSUP 270 212.00 Active

4550008 Arginine Vasopressin, PlasmaLAB 300 84588 288.00 Active

4451276 ARIXTRA 2.5 MG INJPHAR 250 226.84 Active

4400054 ARM IMMOBILIZER XLSUP 270 15.90 Active

4400053 ARM IMMOBILIZER LADISUP 270 79.50 Active

4250171 ARM SLEEVE WRIST TO AXILLSUP 270 212.00 Active

4400660 ARM SLING MED.SUP 270 14.84 Active

4400661 ARM SLING LARGESUP 270 14.84 Active

4400658 ARM SLING SMSUP 270 14.84 Active

4400659 ARM SLING XLGESUP 270 14.84 Active

4451097 ARMOUR THYROID 30MG.PHAR 250 6.36 Active

4400653 ARM-SHOULDER IMMOBILSUP 270 109.18 Active

4550501 ARSENIC (BLOOD)LAB 300 82175 122.96 Active

4550069 ARTERIAL PUNCTURELAB 300 36600 207.76 Active

4559117 Arthritis Panel I Active

4559118 Arthritis Panel II Active

4550072 ARTHRITIS PANEL PANEL ASOLAB 300 86060 34.98 Active

4550073 ASO TITERLAB 300 86060 68.90 Active

4450907 ASPERCREMEPHAR 250 11.66 Active

4554046 Aspergillus Fumigatus, IgELAB 300 86003 33.92 Active

Page 7: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450047 ASPIRIN 325MG TABPHAR 250 J3490 6.40 Active

4450048 ASPIRIN CHILDRENS 81PHAR 250 J3490 6.40 Active

4451605 ASPIRIN EC 325 MGPHAR 250 J3490 6.40 Active

4451277 ASPIRIN ENTERIC COAT 81MGPHAR 250 J3490 6.40 Active

4451299 ASPIRIN SUPP 300MGPHAR 250 6.36 Active

4550076 AST [SGOT]LAB 300 84450 42.40 Active

4450900 ATACAND 32MG TABPHAR 250 11.66 Active

4450777 ATENOL/CHLORTHAL. 50/25PHAR 250 6.36 Active

4450504 ATENOLOL 25MG TABPHAR 250 11.70 Active

4450793 ATENOLOL 50 MG TABPHAR 250 6.40 Active

4450308 ATORVASTATIN 10MG TABPHAR 250 J3490 6.40 Active

4450310 ATORVASTATIN 40MG TABPHAR 250 J3490 6.40 Active

4450054 ATROPINE 0.1MG/ML SYRINGEPHAR 259 58.40 Active

4450055 ATROPINE 1MG/1ML VialPHAR 259 6.40 Active

4450057 ATROVENT INHALERPHAR 250 226.84 Active

4050004 ATTENDANT CAREPALS 990 T1019 4.95 Active

4050002 ATTENDANT SERVICESPALS 990 T1019 5.50 Active

4400055 ATTENDS ADULT DIAPESUP 270 8.48 Active

4450064 AVANDIA 2MG TABPHAR 250 11.66 Active

4451077 AZATHIOPRINE 50MGPHAR 250 6.36 Active

4451006 AZITHROMYCIN 100MG/5ML 15ML BOTTLEPHAR 259 112.00 Active

4450946 AZITHROMYCIN 200MG/5ML 15 ML BOTTLEPHAR 250 J3490 58.40 Active

4451210 AZITHROMYCIN 250MG *Z-PACK* ORALPHAR 250 J3490 11.70 Active

4450971 AZITHROMYCIN 250MG TABPHAR 250 J3490 6.40 Active

4451102 AZITHROMYCIN 500 MG IVPBPHAR 636 J0456 58.40 Active

4451585 AZITHROMYCIN 500MG TAB 3 PACKPHAR 250 58.30 Active

4451288 AZITHROMYCIN 600MG INJPHAR 259 153.70 Active

4451421 AZTREONAM 2GM INJPHAR 259 231.10 Active

4451422 AZULFIDINE TAB 500 MGPHAR 250 6.40 Active

4401900 B/P CUFF DISP. ADULTSUP 270 5.30 Active

4401901 B/P CUFF DISP. PEDSSUP 270 5.30 Active

4450615 B-12 INJECTIONPHAR 250 J3420 18.02 Active

4550081 B-2 GlycoProtein IgGLAB 300 86146 232.19 Active

4550088 B-2 MicroGlobulinLAB 300 82232 134.62 Active

4401974 BABY BOTTLESUP 270 10.00 Active

4401829 BABY SHAMPOOSUP 270 6.36 Active

4451125 BACITRACIN/POLYMIXIN OPTH OINTMENTPHAR 250 153.70 Active

4401812 BACK RAFTSUP 270 143.10 Active

4451246 BACLOFEN 10MG TABPHAR 250 11.70 Active

4450813 BACLOFEN 20MG TABPHAR 250 6.36 Active

4451600 BACLOFEN PF 1000MCG/MLPHAR 259 264.00 Active

4401712 BAIR HUGGER B LANKETSUP 270 29.68 Active

4401713 BAIR HUGGER MACHINESUP 270 30.74 Active

4551090 Banana- IgELAB 300 86003 33.92 Active

4400064 BANDAIDS 3/4" OR 1"SUP 270 15.90 Active

4400063 BANDAIDS X-LG 2SUP 270 8.48 Active

4550085 BAR CONFIRM: QUANTLAB 300 80345 44.52 Active

Page 8: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4551089 Barley IgELAB 300 86003 33.92 Active

4401826 BARRIER FILM (HH)SUP 270 6.36 Active

4401825 BARRIER FLANGE SF (HH)SUP 270 61.48 Active

4401827 BARRIER RING(HH)SUP 270 240.62 Active

4559155 BARTONELLA ANTIBODY PANEL Active

4551197 BARTONELLA HENSELAE IGGLAB 300 43.46 Active

4551198 BARTONELLA HENSELAE IGMLAB 300 43.46 Active

4551199 BARTONELLA QUINTANA IGGLAB 300 43.46 Active

4551200 BARTONELLA QUINTANA IGMLAB 300 43.46 Active

4451109 BEANO PHAR 250 6.36 Active

4250185 BED RAILSUP 270 155.00 Active

4400067 BELT SACROILIACSUP 270 72.08 Active

4451208 BENAZEPRIL 5MG TABPHAR 250 23.30 Active

4450081 BENICAR 20MG TABPHAR 250 11.66 Active

3000500 BENTYL 20MG/2ML INJ(M)DR 521 J0500 153.70 Active

4450114 BENZOC/TETRA/BUTAM SPRAYPHAR 259 6.40 Active

4551195 BENZODIAZEPINES CONFIRMATION URINELAB 300 80346 94.34 Active

4400083 BENZOIN TINCTURE COMSUP 270 A4364 6.36 Active

4450505 BENZONATATE 100MG TABPHAR 250 6.40 Active

4451296 BENZTROPINE 1MG TABPHAR 250 11.70 Active

4552041 Bermuda Grass -IgELAB 300 86003 33.92 Active

4551238 Beta 2 Glycoprotein 1 Anti IgmLAB 300 86146 232.14 Active

4552002 Beta-CrossLaps (Beta-CTx), SerumLAB 300 82523 333.90 Active

4401716 BETADINE SCRUBSUP 270 14.84 Active

4451391 BETAPACE TAB 80MGPHAR 250 11.70 Active

4550080 B-HCG QUANT (SERUM)LAB 300 84702 140.98 Active

4450088 BICILLIN LA 1.2 MILLION UNIT/2MLPHAR 636 J0561 462.20 Active

4450089 BICILLIN LA 600,000UPHAR 259 153.70 Active

4550090 Bile/IctotestLAB 300 81002 12.72 Active

4550092 BILLIRUBIN - DIRECTLAB 300 82248 48.76 Active

4550091 BILLIRUBIN-TOTALLAB 300 82247 42.40 Active

4401728 BIOFREEZE TUBE/ROLL ONSUP 270 15.90 Active

4401932 BIOPATCH DRSGSUP 270 10.60 Active

4401679 BIOPSY FORCEPS RADIAL JAWSUP 270 280.90 Active

4400317 BIOPSY FORCEPS W/NEESUP 270 280.90 Active

4550459 BiotinidaseLAB 300 82261 14.84 Active

4700037 BIPAP OXY 270 403.86 Active

4401902 BI-PAP (DISP) MEDSUP 270 191.86 Active

4401737 BI-PAP (DISPOSABLE) LARGESUP 270 191.86 Active

4700158 BIPAP TUBINGOXY 270 13.78 Active

4300028 BIPAP UNITDME 270 358.28 Active

4450173 BISACODYL 5MG TABPHAR 250 6.40 Active

4450063 BISACODYL SUPP 10MGPHAR 250 J3490 6.40 Active

4400087 BITE BLOCKSUP 270 7.42 Active

4552088 BK Virus, Molecular Detection, QuantitatLAB 300 87799 204.58 Active

4350015 BLADDER IRRIGATIONPROC 270 16.96 Active

4401083 BLOOD PRESSURE/HEARTSUP 929 93784 182.32 Active

Page 9: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4600011 Blood Type - ABOBB 300 86900 46.64 Active

4600045 Blood Type - DuBB 300 86905 86.92 Active

4600012 Blood Type - Rh (D)BB 300 86901 46.64 Active

4400092 BLUE PADS 1 CASESUP 270 72.08 Active

4550098 BMP-BASIC METABOLIC PANELLAB 300 80048 102.82 Active

4550100 BNP LAB 300 83880 218.36 Active

4552003 Bone Alkaline Phosphatase, SerumLAB 300 84080 132.50 Active

4550093 BORD:PERTUSSIS +PARA PCRLAB 300 87798 212.00 Active

4401870 BOUGIE FLEX GUIDE 10 FRSUP 270 56.18 Active

4401869 BOUGIE FLEX GUIDE 15 FRSUP 270 56.18 Active

4552048 Box Eld/Maple, S, IgELAB 300 86003 33.92 Active

4553516 BP 180 LAB 300 83516 113.42 Active

4558351 BP 230 LAB 300 83516 113.42 Active

4401178 BRACE CIPERTECH 500 MEDIUSUP 270 L0627 584.06 Active

4401965 BRACE K-64 KNEE XSSUP 270 143.10 Active

4400001 BRACE KNEESUP 270 72.08 Active

4250006 BRACE KNEE SLEEVE SUPT 270 138.86 Active

4450892 BRIMONIDINE 0.15% OPTH DROPPHAR 250 634.98 Active

4550861 Bruce + Tal AB: BrucellaLAB 300 86622 57.24 Active

4550862 Bruce + Tul AG:TularemiaLAB 300 86668 57.24 Active

4700002 BUBBLE HUMIDIFEROXY 270 7.42 Active

4450449 BUDESONIDE 0.5MG/2ML NEB. SOL.PHAR 250 J3490 12.00 Active

4451618 BUDESONIDE 1MG/2MLPHAR 250 J3490 58.40 Active

4450450 BUDESONIDE0.25MG/2ML NEB. SOL.PHAR 250 J3490 11.70 Active

4558352 BULLOUS PEMPHIGOID BP 180-230 Active

4450957 BUMETANIDE 1MG TABPHAR 250 6.40 Active

4450095 BUMETANIDE 1MG/4ML INJPHAR 259 11.70 Active

445160 BUMEX TAB 2mgPHAR 250 J8499 6.40 Active

4550103 BUN: UREA NITROGENLAB 300 84520 42.40 Active

4451199 BUPIVACAINE HCL POWDERPHAR 636 J3490 155.80 Active

4451411 BUPROPION 75MG TABPHAR 250 6.40 Active

4451393 BUPROPION SR 100MG TABPHAR 250 6.40 Active

4450775 BUPROPION SR 150MG TABPHAR 250 J3490 23.30 Active

4500081 BURETROL SOLUTION SETIV 264 13.78 Active

4500096 BURETTE PUMP SETSUP 270 56.18 Active

4350016 BURN DEBRIDEMENTPROC 270 31.80 Active

4450921 BUSPAR 15MGPHAR 250 6.36 Active

4450750 BUSPAR 5 MG TABPHAR 250 J3490 6.40 Active

4450720 BUTALBITAL/ACET/CAFFEINEPHAR 250 6.36 Active

4451403 BYSTOLIC TAB 10MGPHAR 250 11.66 Active

4451291 BYSTOLIC TAB 5 MGPHAR 250 11.70 Active

4550086 BZO CONFIRM:QUALLAB 300 80346 55.12 Active

4750078 C SPINE W EXT AND FLEX 5 V'SXRAY 320 72050 287.26 Active

4750015 C SPINE W OBLIQUE AND EXT AND FLEXXRAY 320 72052 287.26 Active

4750904 C SPINE W OBLIQUE AND EXT AND FLEX 7 VSXRAY 320 72052 390.08 Active

4550180 C-3: COMPLEMENT AG (SERUMLAB 300 86160 28.62 Active

4550182 C-4: CCOMPLEMEt AG (SERUMLAB 300 86160 28.62 Active

Page 10: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4552008 C8-C18 Fatty AcidLAB 300 82544 252.28 Active

4550112 CA 15-3 AG (BREAST)LAB 300 86300 178.08 Active

4550113 CA 19-9 AG (GI TRACT)LAB 300 86301 169.60 Active

4550900 CA 27.29 AGLAB 300 86300 178.08 Active

4550116 CA: ARTERIALLAB 300 82310 42.40 Active

4550115 CA: CALCIUMLAB 300 82310 42.40 Active

4550114 CA-125 AG (OVARIES)LAB 300 86304 177.02 Active

4550489 Cadmium (Blood)LAB 300 82300 139.92 Active

4550117 CALCITONINLAB 300 82308 490.78 Active

4451339 CALCITRIOL 0.25 MCG CAPPHAR 250 58.40 Active

4550897 Calcium - IonizedLAB 300 82330 120.84 Active

4552010 CALCIUM 24 HR URINELAB 300 82340 61.48 Active

4450101 CALCIUM 600 W/ D TABPHAR 250 J3490 6.40 Active

4450001 CALCIUM ANTACID CHEWABLE 500MGPHAR 250 J3490 6.40 Active

4451642 CALCIUM CARB 750MGPHAR 250 6.40 Active

4450100 CALCIUM GLUCONATE 10% INJ 10MLPHAR 259 J0610 11.70 Active

4552081 CalprotectinLAB 300 83993 157.94 Active

4250160 CAMP XXI - LGESUP 270 212.00 Active

4300067 CANE ADJUSTABLEDME 270 E0100 28.62 Active

4700003 CANNULA NASAL OXYGENPROC 270 8.48 Active

4700004 CANNULA O2 PEDIATRICOXY 270 23.32 Active

4700005 CANOPY TENT OXYGENOXY 270 59.36 Active

4450865 CAPTOPRIL 50MG TABPHAR 250 6.36 Active

4450503 CARBAMAZEPINE 200MG TABPHAR 250 6.40 Active

4450104 CARBAXEFED DM ORAL GPHAR 250 153.70 Active

4451092 CARBIDOPA/LEVODOPA 25/100 MG TABPHAR 250 J7340 6.40 Active

4451155 CARBMIDE PEROXIDE 6.5% OTIC GTTSPHAR 250 83.95 Active

4451258 CARBOPLATIN 450MG INJPHAR 636 J9045 196.10 Active

4451306 CARBOPLATIN 50MG INJPHAR 636 58.30 Active

4451253 CARBOPLATIN 650MG IVPHAR 636 J9045 188.68 Active

4551165 Cardiac Panel Active

4559010 Cardiac Serial Enzymes Active

4450105 CARDIZEM CD 120 MG POPHAR 250 6.40 Active

4451382 CARDIZEM CD CAP [180MG]PHAR 250 6.40 Active

4450108 CARDURA 4MG TABPHAR 250 6.40 Active

4450862 CARISOPRODOL 350MG TABPHAR 250 6.36 Active

4550126 CaroteneLAB 300 82380 97.52 Active

4650014 CAROTID COMPIP 320 93880 998.84 Active

4450130 CARVEDILOL 6.25MG POPHAR 250 J3490 6.40 Active

4450883 CARVEDILOL 12.5MG TABPHAR 250 11.70 Active

4450132 CARVEDILOL 25MG TABPHAR 250 6.40 Active

4450131 CARVEDILOL 3.125MG TABPHAR 250 J3490 6.40 Active

4451264 CARVEDILOL 6.25MG OP 2TABPHAR 250 11.66 Active

4250129 CASH BRACE HINGEDPT 270 566.04 Active

4552077 Cashew-IgELAB 300 86003 33.92 Active

4350017 CAST REMOVALPROC 270 14.84 Active

4401964 CAST SHOE M/LGESUP 270 21.20 Active

Page 11: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4401963 CAST SHOE M/SMSUP 270 21.20 Active

4400148 CASTING FIBERGLASS SSUP 270 45.58 Active

4552039 Cat Epithelium - IgELAB 300 86003 33.92 Active

4550127 Catechol Frac - 24 Hr UrLAB 300 82384 233.20 Active

4400163 CATH CARE KITSUP 270 8.48 Active

4401732 CATH EXT TUBESUP 270 8.48 Active

4401947 CATH FOLEY 14FR 5CC LFSUP 270 10.60 Active

4401979 CATH FOLEY COUDE TIP 12 FR 5CCSUP 270 10.00 Active

4500013 CATH NEED IV AUTOG 24GAIV 264 20.14 Active

4500011 CATH NEEDLE AUTOG 20GAIV 264 15.90 Active

4500012 CATH NEEDLE AUTOG 22GIV 264 15.90 Active

4400167 CATH SECURESUP 270 8.48 Active

4401985 CATH TRAY 14 FR LFSUP 270 50.00 Active

4400164 CATH TRAY 14FRSUP 270 29.68 Active

4400374 CATH TRAY 16 FRSUP 270 72.08 Active

4400732 CATH TRAY 18FRSUP 270 68.23 Active

4350018 CATHETER INSERTIONPROC 270 162.18 Active

4400166 CATHETER PLUGSUP 270 8.48 Active

4451596 Cathflo ActivasePHAR 259 462.20 Active

4550129 CBC + AUTO DIFFLAB 300 85025 57.24 Active

4550505 CBC w/o Auto DiffLAB 300 85027 42.40 Active

4550131 CCP: Anti-Cyclic CitrLAB 300 86200 154.76 Active

3100002 CCU/ICUIP 211 1154.34 Active

4550132 CEA LAB 300 82378 173.84 Active

4451436 CEFAZOLIN 1 GM PREMIX IVPBPHAR 636 J0690 11.70 Active

4451561 CEFAZOLIN PREMIX 2GM/50mlPHAR 636 J0690 23.30 Active

4450638 CeFAZolin SODIUM 1GM INJPHAR 636 J0690 11.70 Active

4451439 CEFDINIR 300MG OUTPT PACKPHAR 250 13.00 Active

4451240 CEFEPIME 2GM/100ML NACL IVPBPHAR 636 J0692 81.60 Active

4451589 CEFPROZIL 125MG/5ML/50ML BTLPHAR 250 100.00 Active

4451615 CEFPROZIL 125MG5ml/ 100ML BTLPHAR 250 J3490 155.80 Active

4451590 CEFPROZIL 250MG/5ML/100ML BTLPHAR 259 J3490 231.10 Active

4451593 CEFPROZIL 500MG OUT PT PKPHAR 250 58.40 Active

4451591 CEFPROZIL TAB 250MGPHAR 250 11.70 Active

4451592 CEFPROZIL TAB 500MGPHAR 250 6.40 Active

4451647 CEFPROZIL250MG/5ML/50ML BTLPHAR 250 100.00 Active

4454457 CEFTAZIDIME 1GM INJPHAR 636 J0713 12.00 Active

4451595 CEFTAZIDIME 1GM/50ML PREMIXPHAR 259 58.40 Active

4450463 CEFTRIAXONE 1GM INJ.PHAR 636 J0696 11.70 Active

4451578 Ceftriaxone 1gm/D5W 50 ml PremixPHAR 259 58.40 Active

4450464 CEFTRIAXONE 500MG VIALPHAR 636 J0696 6.40 Active

3010696 CEFTRIAXONE SODIUM 250MG (TO)NP1 521 J0696 13.78 Active

4451177 CEFUROXIME 500 MG TABPHAR 250 11.70 Active

4450110 CELECOXIB 200MG TABPHAR 250 J3490 6.40 Active

4552005 Celiac Disease Comprehensive Cascade Active

4552084 Celiac Disease Serology Cascade Active

4559114 Celiac Pn: Endomysial IgALAB 300 86256 114.48 Active

Page 12: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4559112 Celiac Pn: Gliad Pep IgALAB 300 83516 108.12 Active

4559113 Celiac Pn: Gliad Pep IgGLAB 300 83516 108.12 Active

4559115 Celiac Pn: IgALAB 300 82784 86.92 Active

4559111 Celiac Pn: Transglut IgALAB 300 83516 136.74 Active

4559116 Celiac Pn: TTG IgGLAB 300 83516 136.74 Active

4551040 CELL CT: BODY FLUIDLAB 300 89050 80.56 Active

4450984 CEPHALEXIN 250MG/5ML/200ML/SUSPPHAR 250 155.80 Active

4451000 CEPHALEXIN 500MG TABPHAR 250 6.40 Active

4450278 CEPHALEXIN 500MG TAB OP PKPHAR 250 J3490 6.40 Active

4400180 CERVICAL PHILADELPHISUP 270 72.08 Active

4250113 CERVICAL PILLOW/WATERBASEPT 270 163.24 Active

4250013 CERVICAL ROLL ORTHPT 270 25.44 Active

4750031 CERVICAL SPINE 1 VIEWXRAY 320 72020 132.50 Active

4750030 CERVICAL SPINE 2-3 VIEWSXRAY 320 72040 204.58 Active

4750029 CERVICAL SPINE 4 VIEWSXRAY 320 72050 272.42 Active

4750028 CERVICAL SPINE 5 VIEWSXRAY 320 72052 287.26 Active

4750903 CERVICAL SPINE W EXT AND FLEX 5 VSXRAY 320 72050 287.26 Active

4250151 CERVICAL TRACTION DEVICEPT 270 687.94 Active

4450609 CETIRIZINE 10MG TABPHAR 250 6.40 Active

4450006 CHARCOAL/SORBITOL SUSP 50GMPHAR 250 J3490 58.40 Active

4451437 CHARCOCAPS 260MGPHAR 250 6.36 Active

4459000 Chemo at NMHPHAR 636 J9179 7681.39 Active

4350020 CHEMOTHERAPY INFUSIOPROC 335 96422 428.24 Active

4350019 CHEMOTHERAPY, PUSH TPROC 331 96420 428.24 Active

4750032 CHEST 1 VIEWXRAY 320 71045 155.82 Active

4750033 CHEST 2VXRAY 320 71046 200.34 Active

5880006 CHEST CT W & W/O CONTRASTDNU 320 0.00 Active

4750039 CHEST LATERAL DECUBXRAY 320 71035 157.94 Active

4350021 CHEST TUBE PLACEMENTPROC 270 77.38 Active

4750038 CHEST W/ APICLA LORD 3 VXRAY 320 71047 225.78 Active

4400195 CHINSTRAP FOR CPAPSUP 270 42.40 Active

4550135 CHLAM TRACH DNA PROBELAB 300 87491 131.44 Active

4559015 Chlamydia and GC DNA Amp Active

4401696 CHLORAPREP APPLICATORSUP 270 8.48 Active

4450298 CHLORDIAZEPOXIDE 25MG TABPHAR 250 6.40 Active

4450831 CHLOROPHYLL 3MG TAB (ENNDS)PHAR 250 11.70 Active

4450512 CHLORPROMAZINE 50MG/2ML INJPHAR 636 J3230 155.80 Active

4451292 CHLORTHALIDONE 25MG TABPHAR 250 6.40 Active

4552030 Chocolate/Cocoa - IgELAB 300 86003 33.92 Active

4550147 CHOL (CHOLESTEROL)LAB 300 82465 48.76 Active

4250015 CHO-PAT KNEE STRAPPT 420 53.00 Active

4551173 CHROMIUM (HEAVEY METALSLAB 300 82495 230.02 Active

4551217 CHROMOGRANIN ALAB 300 184.27 Active

4559154 CHRONIC HEPATITIS PANELLAB 300 1.06 Active

4050025 CI and ShoppingPALS 990 S5126 5.50 Active

4450844 CILOSTZOL 100MG TABPHAR 250 6.36 Active

4450499 CIMETIDINE 400MG TABPHAR 250 6.40 Active

Page 13: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450498 CIMETIDINE 300MG/2MLPHAR 259 11.66 Active

4450118 CIPRO 400MG *IVPB*PHAR 636 J0744 11.70 Active

4450120 CIPROFLOXACIN 500MG TABPHAR 250 J3490 6.40 Active

4450951 CIPROFLOXACIN 0.3% OPHTHPHAR 250 23.30 Active

4451315 CIPROFLOXACIN 500MG *OUT PT PK*PHAR 250 11.70 Active

4451224 CIPROFLOXACIN 750MG POPHAR 250 11.66 Active

4451010 CIPROFLOXACIN PREMIX 400MG IVPBPHAR 636 J0744 11.70 Active

4451387 CITALOPRAM TAB 10 MGPHAR 250 11.70 Active

4450112 CITALOPRAM TAB 20MGPHAR 250 6.40 Active

4450121 CITRACAL TABPHAR 250 6.36 Active

4550150 CITRATE (24 HR URINE)LAB 300 82507 233.20 Active

4450122 CITRUCEL TABPHAR 250 6.36 Active

4550152 CK-MB LAB 300 82553 178.08 Active

4550154 CL CHLORIDELAB 300 82435 42.40 Active

3062002 CL LOC LAC 2.6-7.5 SIM (SCALP, NECK)LOC 521 12002 563.92 Active

3062011 CL LOC LAC REP SIM 2.5<(FACE, EARS)LOC 521 12011 563.92 Active

30600060 CL Locum Incision & Drainage Simp/SingleLOC 521 10060 228.96 Active

3060610 CL Locum Major Joint Aspiratio/InjectionLOC 521 20610 262.88 Active

3060730 CL Locum Nail Avulsion Prt/Cmp Sim/SinglLOC 521 11730 187.62 Active

3060552 CL LOCUM TRIGGER POINT INJ 1-2 MUSCLESLOC 521 20552 238.50 Active

3060381 CL Locum Well child New Patient <1yrLOC 521 99381 212.00 Active

30101404 CL0 Exc Benign trunk, arm, leg 3.1-4.0NP1 521 11404 583.00 Active

4552045 Cladosporium - IgELAB 300 86003 33.92 Active

4450087 CLARITHROMYCIN 500MG TABPHAR 250 J3490 6.40 Active

4550869 Classic GalactosemiaLAB 300 82775 22.26 Active

3943650 CLAVICAL SPLINTLOC 521 L3650 32.86 Active

4400206 CLAVICAL SUPPORT SSUP 270 39.22 Active

4400201 CLAVICAL SUPPORT ADUSUP 270 29240 15.90 Active

4750041 CLAVICLE (LEFT)XRAY 320 73000 163.24 Active

4750179 CLAVICLE (RIGHT)XRAY 320 73000 163.24 Active

4401971 CLAVICLE SUPPORT INFANTSUP 270 10.00 Active

4400215 CLEAN CATCHSUP 270 8.48 Active

3020396 CLG Adult Wellness 40-64yrsNP2 521 99396 321.00 Active

3023784 CLG Ambulatory Blood Pressure MonitorNP2 521 93784 363.58 Active

3024550 CLG App Surface/transcut NeurostimulatorNP2 521 64550 38.16 Active

3029085 CLG App. Cast Hand/lower ForearmNP2 521 29085 149.46 Active

3020022 CLG App. Finger SplintNP2 521 29130 131.44 Active

302065 CLG App. Long Arm CastNP2 521 29065 243.80 Active

30229105 CLG App. Long Arm SplintNP2 521 29105 259.70 Active

30229505 CLG App. Long Leg SplintNP2 521 29505 283.02 Active

3029075 CLG App. Short Arm CastNP2 521 29075 330.72 Active

30229125 CLG App. Short Arm SplintNP2 521 29125 221.54 Active

30229515 CLG App. Short Leg SplintNP2 521 29515 183.38 Active

302565 CLG Arm SlingNP2 521 A4565 55.12 Active

3020410 CLG Biopsy of PenisNP2 521 54100 386.90 Active

3020100 CLG Biopsy of Skin Single/SimpleNP2 521 11100 228.96 Active

302270 CLG Cardiac Event MonitorNP2 521 93270 175.96 Active

Page 14: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

302010 CLG Cast SuppliesNP2 521 A4590 81.66 Active

3020551 CLG Chest Tube PlacementNP2 521 32551 839.52 Active

3029490 CLG CHRONIC CARE MANAGEMENTNP2 521 G0511 83.00 Active

3020235 CLG Clavicle Fx, Closed TxNP2 521 23500 768.50 Active

3023650 CLG Clavicle SplintNP2 521 L3650 32.86 Active

3020211 CLG Clinic Visit Level 1NP2 521 99211 76.00 Active

3020212 CLG Clinic Visit Level 2NP2 521 99212 108.00 Active

3020213 CLG Clinic Visit Level 3NP2 521 99213 135.00 Active

3020214 CLG Clinic Visit Level 4NP2 521 99214 206.00 Active

3020215 CLG Clinic Visit Level 5NP2 521 99215 323.00 Active

3020480 CLG Closed Reduction of TMJNP2 521 21480 518.34 Active

3020840 CLG Closed Tx Ankle Disl w/o anesthesiaNP2 521 1909.06 Active

302278 CLG Closed Tx Bimalleolar Ankle w/Man.NP2 521 27810 1477.64 Active

3020250 CLG Closed Tx Hip Disl. w/o anesNP2 521 27250 1455.38 Active

3020770 CLG Closed Tx Inphal Dis w/man w/o anesNP2 521 26770 911.60 Active

3026705 CLG CLOSED TX METACARPOPH W/MAN & ANESNP2 521 26705 1366.34 Active

3020565 CLG Closed Tx Radial/Ulnar w/Man.NP2 521 25565 662.50 Active

3026720 CLG Closed Tx Shaft Frac. Finger/ThumbNP2 521 26720 601.02 Active

30223655 CLG Closed Tx Shoulder Disl w/Man & AnesNP2 521 23655 1463.86 Active

3026641 CLG Closed Tx Thumb Disl. w/Man.NP2 521 26641 1155.40 Active

302027818 CLG Closed Tx Trimalleolar Ankle w/Man.NP2 521 27818 2309.74 Active

30227816 CLG Closed Tx Trimalleolar Ankle w/o ManNP2 521 27816 1121.48 Active

3022553 CLG CLOSED TX ULNAR SHAFT W/MANIPULATIONNP2 521 25535 1802.00 Active

302650 CLG Clsed Tx Radial head/neck Fx w/o manNP2 521 24650 1016.54 Active

302950 CLG CPRNP2 521 92950 654.02 Active

3020291 CLG Critical Care 1st HrNP2 521 99291 1090.00 Active

3020292 CLG Critical Care Each Add'l 30 min.NP2 521 99292 545.00 Active

30217110 CLG Cryo/Surgical Curettement 14 lesionsNP2 521 17110 186.56 Active

30217111 CLG Cryotherapy 15 or more Ben les.NP2 521 17111 377.36 Active

302000 CLG Debridement skin up to 10% body sur.NP2 521 11000 316.94 Active

3020989 CLG Debridement SubQ tissue 20 sq cm/<NP2 521 11042 298.92 Active

3020450 CLG Dental BlockNP2 521 64450 538.48 Active

3027003 CLG DESTRUCTION PREMALIG LESION 2-14NP2 521 17003 38.16 Active

3021700 CLG DESTRUCTION PREMALIGNANT 1ST LESIONNP2 521 17000 171.72 Active

3024450 CLG Digital BlockNP2 521 64450 511.98 Active

302214 CLG DOT ExamNP2 521 99214 187.00 Active

3020601 CLG Drainage Finger Abscess SimpleNP2 521 26010 358.28 Active

3020442 CLG Dressing SuppliesNP2 521 A6442 28.62 Active

3020005 CLG EKGNP2 521 93000 132.50 Active

3020366 CLG EKG Welcome to Medicare PXNP2 521 G0403 132.50 Active

3020640 CLG Elbow ReductionNP2 521 24640 463.22 Active

3020901 CLG Epistaxis Anterior Cauter/packingNP2 521 30901 236.38 Active

3020905 CLG Epistaxis Posterior w/nasal packsNP2 521 30905 236.38 Active

3020281 CLG ER Level 1NP2 521 99281 251.00 Active

3020282 CLG ER Level 2NP2 521 99282 269.00 Active

3020283 CLG ER Level 3NP2 521 99283 510.00 Active

3020284 CLG ER Level 4NP2 521 99284 761.00 Active

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3020285 CLG ER Level 5NP2 521 99285 1135.00 Active

30211640 CLG ex Mal les 0.5 <(face, ears...)NP2 521 11640 358.28 Active

3020440 CLG Exc Ben Les 0.5 < (face, ears..)NP2 521 11440 358.28 Active

302420 CLG Exc Ben Les 0.5 < (scalp, neck..)NP2 521 11420 316.94 Active

30201400 CLG Exc Ben Les 0.5 < (trunk, arms..)NP2 521 11400 269.24 Active

3020441 CLG Exc Ben Les 0.6-1.0 (face, ears..)NP2 521 11441 375.24 Active

3020421 CLG Exc Ben Les 0.6-1.0 (scalp, neck..)NP2 521 11421 432.48 Active

302401 CLG Exc Ben Les 0.6-1.0 (trunk, arms..)NP2 521 11401 359.34 Active

302442 CLG Exc Ben Les 1.1-2.0 (face, ears..)NP2 521 11442 434.60 Active

3020402 CLG Exc Ben Les 1.1-2.0 (trunk, arms..)NP2 521 11402 442.02 Active

3020423 CLG Exc Ben Les 2.1-3.0 (scalp, neck..)NP2 521 11423 509.86 Active

3020403 CLG Exc Ben Les 2.1-3.0 (trunk, arms..)NP2 521 11403 419.76 Active

3020424 CLG Exc Ben Les 3.1-4.0 (scalp, neck..)NP2 521 11424 588.30 Active

30201404 CLG Exc Benign trunk, arm, leg 3.1-4.0NP2 521 11404 583.00 Active

3021422 CLG Exc BenLes 1.1-2.0 cm SCALP NECK HANNP2 521 11422 487.60 Active

3020600 CLG Exc Mal Les 0.5 <(trunk, arms, legs)NP2 521 11600 500.32 Active

3029940 CLG Exc Mal Les 2.1-3.0(scalp,neck..)NP2 520 11623 750.72 Active

3020641 CLG Exc Malg Les 0.6-1.0 (face, ears..)NP2 521 11641 375.24 Active

302601 CLG Exc Malg Les 0.6-1.0 (trunk, arms..)NP2 521 11601 359.34 Active

3021642 CLG Exc Malg Les 1.1-2.0 (face, ears..)NP2 521 11642 694.30 Active

3020602 CLG Exc Malg Les 1.1-2.0 (trunk, arms..)NP2 521 11602 390.08 Active

3021643 CLG EXC MALIG LES F/E/E/N/L 2.1-3.0NP2 521 11643 818.32 Active

3020750 CLG Excision of Nail PermanentNP2 521 11750 504.56 Active

3022012 CLG Eye ExamNP2 521 92081 169.60 Active

3025210 CLG FB Removal Conjuctival/Sub or SCLNP2 521 65210 226.84 Active

3025205 CLG FB Removal Conjunctiva SuperficialNP2 521 65205 208.82 Active

3025220 CLG FB Removal Cornea w/o Slit LampNP2 521 65220 244.86 Active

3029200 CLG FB Removal EarNP2 521 69200 355.10 Active

3027938 CLG FB Removal Eyelid EmbeddedNP2 521 67938 401.74 Active

3020190 CLG FB Removal Foot SubcutaneousNP2 521 28190 204.58 Active

3020511 CLG FB Removal LarynxNP2 521 31511 378.42 Active

3020300 CLG FB Removal NoseNP2 521 30300 183.38 Active

3027086 CLG FB REMOVAL PELVIS/HIP SUBCUTANEOUSNP2 521 27086 589.36 Active

3020120 CLG FB Removal Subcutaneous TissueNP2 521 10120 183.38 Active

3027000 CLG Finger Reduction w/o AnesNP2 521 26700 911.60 Active

3020404 CLG Finger SplintNP2 521 Q4049 17.01 Active

3020951 CLG Finger/Thumb Amputations w/ClosureNP2 521 26951 2038.38 Active

3020653 CLG Flu ShotNP2 521 90686 40.00 Active

3020056 CLG Foot Care Corn/Callus 2-4 LesionsNP2 521 11056 128.26 Active

3020055 CLG Foot Care Corn/Callus Single LesionNP2 521 11055 74.20 Active

302829 CLG GlucometerNP2 521 82948 50.88 Active

3020466 CLG Hemorrhoid BandingNP2 521 46221 246.98 Active

3020083 CLG Hemorrhoid Incision of ExternalNP2 521 46083 510.92 Active

3020140 CLG I&D Hematoma Seroma/Fluid Coll.NP2 521 10140 172.78 Active

3020060 CLG Incision & Drainage Simple/SingleNP2 521 10060 228.96 Active

30220551 CLG INJ SINGLE TENDON ORIGIN/INSERTIONNP2 521 20551 185.00 Active

30220550 CLG Inj Single Tendon Sheath/LigamentNP2 521 20550 202.46 Active

Page 16: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

30211981 CLG INSERTION NON BIODEGRADABLE IMPLANTNP2 521 11981 331.74 Active

3021065 CLG Intermediate Joint Inj/aspirationNP2 521 20605 214.12 Active

3020011 CLG IntubationNP2 521 31500 679.46 Active

3020238 CLG IP Discharge < 30 min.NP2 521 99238 225.00 Active

3020239 CLG IP Discharge > 30 min.NP2 521 99239 281.00 Active

3020223 CLG IP High Comp AdmitNP2 521 99223 495.00 Active

3020233 CLG IP High Daily RoundNP2 521 99233 271.00 Active

3020221 CLG IP Low Complex AdmitNP2 521 99221 299.00 Active

3020231 CLG IP Low Daily RoundNP2 521 99231 141.00 Active

3020222 CLG IP Med Complex AdmitNP2 521 99222 404.00 Active

3020232 CLG IP Med Daily RoundNP2 521 99232 199.00 Active

3020301 CLG IUD RemovalNP2 521 58301 435.66 Active

30201722 CLG Knee Brace Neoprene HingedNP2 521 L1820 181.26 Active

3020830 CLG Knee ImmobilizerNP2 521 L1830 110.24 Active

3020102 CLG Lac 2.6-7.5 Simple (scalp, neck..)NP2 521 12002 563.92 Active

302035 CLG Lac Interm 12.6-20.0 (scalp, axilla)NP2 521 12035 1041.98 Active

3022054 CLG Lac Interm 7.6-12.5 (face, ears..)NP2 521 12054 1230.66 Active

3022045 CLG Lac Repair Interm 12.6-20(neck,handsNP2 521 12045 1161.76 Active

302051 CLG Lac Repair Interm 2.5<(face,ears)NP2 521 12051 751.54 Active

302204 CLG Lac Repair Interm 2.5<(neck,hands..NP2 521 12041 632.82 Active

3020052 CLG Lac Repair Interm 2.6-5.0 (face,earsNP2 521 12052 854.36 Active

302042 CLG Lac Repair Interm 2.6-7.5(neck,handsNP2 521 12042 751.54 Active

3022032 CLG Lac Repair Interm 2.6-7.5(scalp,axilNP2 521 12032 683.70 Active

3022053 CLG Lac Repair Interm 5.1-7.5 (face,earsNP2 521 12053 991.10 Active

302012044 CLG Lac Repair Interm 7.6-12.5(neck,handNP2 521 12044 888.28 Active

3020014 CLG Lac Repair Interm 7.6-12.5(scalp,axiNP2 521 12034 769.56 Active

3020016 CLG Lac Repair Sim 12.6-20(face,ears..NP2 521 12016 1244.44 Active

3020205 CLG Lac Repair Sim 12.6-20(scalp,neckNP2 521 12005 738.82 Active

3020012 CLG Lac Repair Sim 2.5 < (scalp, neck..)NP2 521 12001 466.40 Active

3020111 CLG Lac Repair Sim 2.5<(face,ears..NP2 521 12011 563.92 Active

3020013 CLG Lac Repair Sim 2.6-5.0(face,ears..NP2 521 12013 661.44 Active

302014 CLG Lac Repair Sim 5.1-7.5(face,ears..NP2 521 12014 699.60 Active

3020991 CLG Lac Repair Sim 7.6-12.5(face,ears..NP2 521 12015 856.48 Active

3020104 CLG Lac Repair Sim 7.6-12.5(scalp,neck..NP2 521 12004 699.60 Active

302007 CLG Lac Repair Simple >30(scalp,neck..NP2 521 12007 572.40 Active

302210 CLG Major Joint Aspiration/InjectionNP2 521 20610 262.88 Active

30211600 CLG Malg Les 0.5 < (trunk..)NP2 521 509.86 Active

3020439 CLG MEDICARE ANNUAL WELLNESS EXAM, SUBSENP2 521 G0439 276.00 Active

3020344 CLG MEDICARE ANNUAL WELLNESS, INITIALNP2 521 G0438 276.00 Active

302600 CLG Minor joint inj/asp (finger/toes)NP2 521 20600 207.23 Active

30299143 CLG Mod Sed <5yrs Initial 15 minNP2 521 99151 201.40 Active

30299144 CLG Mod Sed 5yrs and up Initial 15 minNP2 521 99152 166.42 Active

30299145 CLG Mod Sed each add'l 15 min any ageNP2 521 99153 44.52 Active

3020732 CLG Nail Avulsion Part/Comp Add'l NailNP2 521 11732 113.00 Active

3020730 CLG Nail Avulsion Prtl/Com Sim/SinNP2 521 11730 187.62 Active

302011720 CLG Nail Debridement 1-5 any methodNP2 521 11720 57.24 Active

302721 CLG Nail Debridement 6 or more any mthdNP2 521 11721 85.86 Active

Page 17: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3020740 CLG Nail Trephanation (exc Hematoma)NP2 521 11740 110.24 Active

3020719 CLG Nail Trimming nondystrophic nailsNP2 521 11719 47.70 Active

3020946 CLG Nebulizer TxNP2 521 94640 50.88 Active

3021002 CLG Needle AspirationNP2 521 10021 342.38 Active

302644 CLG Nerve Block Trigerminal NerveNP2 521 64400 217.30 Active

3020201 CLG New Patient Clinic Level 1NP2 521 99201 166.00 Active

3020202 CLG New Patient Clinic Level 2NP2 521 99202 198.00 Active

3020203 CLG New Patient Clinic Level 3NP2 521 99203 264.00 Active

3020204 CLG New Patient Clinic Level 4NP2 521 99204 355.00 Active

3029387 CLG NEW PATIENT WELLNESS > 64 YRSNP2 521 99387 436.00 Active

3029385 CLG NEW PATIENT WELLNESS 18-39 YRSNP2 521 99385 354.00 Active

3029386 CLG NEW PATIENT WELLNESS 40-64 YRSNP2 521 99386 387.00 Active

3020017 CLG NG TubeNP2 521 43752 306.34 Active

3020304 CLG NH AdmitNP2 521 99304 191.00 Active

3020311 CLG NH Round Level 1NP2 521 99307 106.00 Active

3020312 CLG NH Round Level 2NP2 521 99308 144.00 Active

3020313 CLG NH Round Level 3NP2 521 99309 209.00 Active

302236 CLG OBS HighNP2 521 99220 460.00 Active

3020234 CLG OBS LowNP2 521 99218 269.00 Active

302235 CLG OBS ModNP2 521 99219 367.00 Active

3020091 CLG PAP SMEAR COLLECTIONNP2 521 Q0091 25.44 Active

30294010 CLG PFT (Spirometry)NP2 521 94010 155.82 Active

3020160 CLG Puncture Aspiration Abcess, HematomaNP2 521 10160 125.08 Active

3020660 CLG Radiocarpal/intercarpal Disloc.NP2 521 25660 180.20 Active

3025222 CLG REMOVAL FB; CORNEA, W/SLIT LAMPNP2 521 65222 258.64 Active

3020007 CLG REMOVAL IMPACTED CERUMEN W INSTRNP2 521 69210 138.00 Active

3021983 CLG REMOVAL WITH REINSERTION IMPLANTNP2 521 11983 361.46 Active

3021982 CLG REMOVAL, NON-BIODEGRADABLE IMPLANTNP2 521 11982 331.78 Active

30249445 CLG REPLACEMENT OF JEJUNOSTOMY TUBENP2 521 43760 887.22 Active

302220 CLG Rib BeltNP2 521 L0220 37.10 Active

3011302 CLG Shave biopsy sng lesion 0.6 to1.0cmNP2 521 11301 217.18 Active

3020310 CLG Shave Epidermal/Dermal Les .5<(face.NP2 521 11310 217.30 Active

302311 CLG Shave Epidermal/Dermal Les .6-1.0NP2 521 11311 279.84 Active

3020306 CLG Shave Sin Les 0.6-1.0 (scalp,neck..)NP2 521 11306 236.38 Active

30200300 CLG Shave single lesion (trunk,arms..NP2 521 11300 189.74 Active

30211305 CLG Shaving Epidermal/Dermal Les .5 or <NP2 521 11305 202.46 Active

3020307 CLG Shaving Epidermal/Dermal les 1.1-2.0NP2 521 11307 261.82 Active

3020015 CLG Short Leg CastNP2 521 29405 349.80 Active

3020655 CLG Shoulder Reduction w/Man & No AnesNP2 521 23650 1023.96 Active

3020200 CLG Skin Tag Removal any method up to 15NP2 521 11200 200.34 Active

3021201 CLG Skin Tag removal; ea additional 10NP2 521 11201 73.14 Active

3020940 CLG Spirometry Pre/Post BronchodilatorNP2 521 94060 223.66 Active

302211 CLG Sports Physical SpecialNP2 521 30.00 Active

3020777 CLG Swing Bed RoundNP2 524 99213 110.00 Active

3020552 CLG Trigger Point Inj 1 or 2 musclesNP2 521 20552 238.50 Active

30220553 CLG Trigger Point Inj 3 or more musclesNP2 521 20553 246.98 Active

3020127 CLG TRIMMING OF DYSTROPHIC NAILS ANY #NP2 521 G0127 58.30 Active

Page 18: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3021402 CLG Welcome to Medicare(first 12 months)NP2 521 G0402 292.56 Active

3020391 CLG Well Child < 1 yrNP2 521 99391 174.00 Active

3020394 CLG Well Child 12-17 yrsNP2 521 99394 217.00 Active

3020392 CLG Well Child 1-4 yrsNP2 521 99392 186.00 Active

3020393 CLG Well Child 5-11 yrsNP2 521 99393 201.00 Active

3020381 CLG Well Child New Patient < 1 yrNP2 521 99381 212.00 Active

3020384 CLG Well Child New Patient 12-17 yrsNP2 521 99384 262.00 Active

3020382 CLG Well Child New Patient 1-4 yrs.NP2 521 99382 229.00 Active

3029383 CLG WELL CHILD NEW PATIENT 5-11NP2 521 99383 245.00 Active

3020395 CLG Wellness Exam 18-39 yrsNP2 521 99395 294.00 Active

3023908 CLG Wrist 7 Lace Up SupportNP2 521 L3908 27.56 Active

3020908 CLG Wrist/Foremarm DeluxeNP2 521 L3908 10.60 Active

3020807 CLG Wrist/Thumb Comfort FormNP2 521 L3807 53.00 Active

3025605 CLG Writs Fx/reduction w/ManipulationNP2 521 25605 2014.00 Active

30399396 CLH Adult Wellness 40-64NP3 521 99396 321.00 Active

3030784 CLH Ambulatory Blood Pressure MonitorNP3 521 93784 363.58 Active

3034550 CLH App Surface/transcut NeurostimulatorNP3 521 64550 38.16 Active

3030085 CLH App. Cast Hand/lower ForearmNP3 521 29085 149.46 Active

3030130 CLH App. Finger SplintNP3 521 29130 131.44 Active

3030065 CLH App. Long Arm CastNP3 521 29065 243.80 Active

3030105 CLH App. Long Arm SplintNP3 521 29105 259.70 Active

3030505 CLH App. Long Leg SplintNP3 521 29505 283.02 Active

3030075 CLH App. Short Arm CastNP3 521 29075 330.72 Active

3030125 CLH App. Short Arm SplintNP3 521 29125 221.54 Active

3030515 CLH App. Short Leg SplintNP3 521 29515 183.38 Active

304100 CLH Biopsy of PenisNP3 521 54100 386.90 Active

3030100 CLH Biopsy of Skin Single/SimpleNP3 521 11100 228.96 Active

303010 CLH Cast SuppliesNP3 521 A4590 81.66 Active

3030551 CLH Chest Tube PlacementNP3 521 32551 839.52 Active

3039490 CLH CHRONIC CARE MANAGEMENTNP3 521 G0511 83.00 Active

3030500 CLH Clavicle Fx, Closed TxNP3 521 23500 768.50 Active

3030211 CLH Clinic Visit Level 1NP3 521 99211 76.00 Active

3030212 CLH Clinic Visit Level 2NP3 521 99212 108.00 Active

3030213 CLH Clinic Visit Level 3NP3 521 99213 135.00 Active

3030214 CLH Clinic Visit Level 4NP3 521 99214 206.00 Active

3030215 CLH Clinic Visit Level 5NP3 521 99215 323.00 Active

303605 CLH Closed Red Radial SedationNP3 521 24605 2038.38 Active

3030480 CLH Closed Reduction of TMJNP3 521 21480 518.34 Active

3030810 CLH Closed Trmt Bimalleolar Ankle FracNP3 521 27810 1477.64 Active

3030840 CLH Closed Tx Ankle Disl w/o anesthesiaNP3 521 1909.06 Active

3030250 CLH Closed Tx Hip Disl. w/o anesNP3 521 27250 1455.38 Active

3030770 CLH Closed Tx Inphal Dis w/man w/o anesNP3 521 26770 911.60 Active

3036705 CLH CLOSED TX METACARPOPH W/MAN & ANESNP3 521 26705 1366.34 Active

3030565 CLH Closed Tx Radial/Ulnar w/Man.NP3 521 25565 662.50 Active

3030655 CLH Closed Tx Shoulder Disl w/Man & AnesNP3 521 23655 1463.86 Active

3030641 CLH Closed Tx Thumb Disl. w/ManNP3 521 26641 1155.40 Active

3030818 CLH Closed Tx Trimalleolar Ankle w/ManNP3 521 27818 2309.74 Active

Page 19: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3030816 CLH Closed Tx Trimalleolar Ankle w/o ManNP3 521 27816 1121.48 Active

3032553 CLH CLOSED TX ULNAR SHAFT W/MANIPULATIONNP3 521 25535 1802.00 Active

303650 CLH Clsed Tx Radial head/neck Fx w/o manNP3 521 24650 1016.54 Active

3030950 CLH CPRNP3 521 92950 654.02 Active

3030291 CLH Critical Care 1st hrNP3 521 99291 1090.00 Active

3030292 CLH Critical Care Each Add'l 30 min.NP3 521 99292 545.00 Active

3030110 CLH Cryo/Surgical Curettement 14 lesionsNP3 521 17110 186.56 Active

3030111 CLH Cryotherapy 15 or more Ben LesNP3 521 17111 377.36 Active

3030000 CLH Debridement skin up to 10% body sur.NP3 521 11000 316.94 Active

3030989 CLH DEBRIDEMENT SUBQ TISSUE 20 SQ CM/<NP3 521 11042 298.92 Active

3030450 CLH Dental BlockNP3 521 64450 538.48 Active

3037003 CLH DESTRUCTION PREMALIG LESION 2-14NP3 521 17003 38.16 Active

3037000 CLH DESTRUCTION PREMALIGNANT 1ST LESIONNP3 521 17000 171.72 Active

3034450 CLH Digital BlockNP3 521 64450 511.98 Active

303214 CLH DOT ExamNP3 521 99214 187.00 Active

30306010 CLH Drainage Finger Abscess SimpleNP3 521 26010 358.28 Active

3033005 CLH EKGNP3 521 93000 132.50 Active

3030366 CLH EKG Welcome to Medicare PXNP3 521 G0403 132.50 Active

3030640 CLH Elbow ReductionNP3 521 24640 463.22 Active

3030901 CLH Epistaxis Anterior Cauter/packingNP3 521 30901 236.38 Active

3030905 CLH Epistaxis Posterior w/nasal packsNP3 521 30905 236.38 Active

3030281 CLH ER Level 1NP3 521 99281 251.00 Active

3030282 CLH ER Level 2NP3 521 99282 269.00 Active

3030283 CLH ER Level 3NP3 521 99283 510.00 Active

3030284 CLH ER Level 4NP3 521 99284 761.00 Active

3030285 CLH ER Level 5NP3 521 99285 1135.00 Active

3030040 CLH Ex Ben Les 0.5< (face, ear)NP3 521 11440 358.28 Active

3031400 CLH Exc Ben Les 0.5 <(trunk, arms, legs)NP3 521 11400 269.24 Active

3030420 CLH Exc Ben Les 0.5< (scalp, neck..)NP3 521 11420 316.94 Active

3030441 CLH Exc Ben Les 0.6-1.0 (face, ears)NP3 521 11441 375.24 Active

3030421 CLH Exc Ben Les 0.6-1.0 (scalp, neck..)NP3 521 11421 432.48 Active

3030401 CLH Exc Ben Les 0.6-1.0 (trunk, arms..)NP3 521 11401 359.34 Active

303442 CLH Exc Ben Les 1.1-2.0 (face, ears..)NP3 521 11442 434.60 Active

3030422 CLH Exc Ben Les 1.1-2.0 (scalp, neck..)NP3 521 11422 487.60 Active

3030402 CLH Exc Ben Les 1.1-2.0 (trunk,arms..)NP3 521 11402 442.02 Active

3030423 CLH Exc Ben Les 2.1-3.0 (scalp, neck..)NP3 521 11423 509.86 Active

3030403 CLH Exc Ben Les 2.1-3.0(trunk, arms..)NP3 521 11403 419.76 Active

3030424 CLH Exc Ben Les 3.1-4.0 (scalp, neck..)NP3 521 11424 588.30 Active

30301404 CLH Exc Benign trunk, arm, leg 3.1-4.0NP3 521 11404 583.00 Active

3036400 CLH Exc Mal Les 0.5< (face, ears..)NP3 521 11640 358.28 Active

3031160 CLH Exc Mal Les 0.5<(trunk, arms, legs)NP3 521 11600 500.32 Active

303641 CLH Exc Mal Les 0.6-1.0 (face, ears..)NP3 521 11641 375.24 Active

3031642 CLH Exc Mal Les 1.1-2.0 (face, ears..)NP3 521 11642 694.30 Active

3030602 CLH Exc Mal Les 1.1-2.0 (trunk, arms..)NP3 521 11602 390.08 Active

3039940 CLH Exc Mal Les 2.1-3.0(scalp,neck..)NP3 521 11623 750.72 Active

303601 CLH Exc Malg Les 0.6-1.0 (trunk, arm..)NP3 521 11601 359.34 Active

3031643 CLH EXC MALIG LES F/E/E/N/L 2.1-3.0NP3 521 11643 818.32 Active

Page 20: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3030750 CLH Excision of Nail PermanentNP3 521 11750 504.56 Active

3030081 CLH Eye ExamNP3 521 92081 169.60 Active

3030205 CLH FB Removal Conjuctiva SuperficialNP3 521 65205 208.82 Active

3030210 CLH FB Removal Conjuctival/Sub or SCLNP3 521 65210 226.84 Active

3030220 CLH FB Removal Cornea w/o Slit LampNP3 521 65220 244.86 Active

3039200 CLH FB Removal EarNP3 521 69200 355.10 Active

3030938 CLH FB Removal Eyelid EmbeddedNP3 521 67938 401.74 Active

3030190 CLH FB Removal Foot SubcutaneousNP3 521 28190 204.58 Active

3030511 CLH FB Removal LarynxNP3 521 31511 378.42 Active

30300300 CLH FB Removal NoseNP3 521 30300 183.38 Active

3037086 CLH FB REMOVAL PELVIS/HIP SUBCUTANEOUSNP3 521 27086 589.36 Active

3030120 CLH FB Removal Subcutaneous TissueNP3 521 10120 183.38 Active

3030700 CLH Finger Reduction w/o Anes.NP3 521 26700 911.60 Active

3030951 CLH Finger/thumb Amputation w/Dir ClosurNP3 521 26951 2038.38 Active

3030724 CLH Flu ShotNP3 521 90686 40.00 Active

3030056 CLH Foot Care Corn/Callus 2-4 LesionsNP3 521 11056 128.26 Active

303055 CLH Foot Care Corn/Callus Single LesionNP3 521 11055 74.20 Active

3030948 CLH GlucometerNP3 521 82948 50.88 Active

3036221 CLH Hemmorhoid BandingNP3 521 46221 246.98 Active

3030083 CLH Hemorrhoid Incision ExternalNP3 521 46083 510.92 Active

3030140 CLH I & D Hematoma Seroma/Fluid Col.NP3 521 10140 172.78 Active

3030060 CLH Incision and Drainage Simple/SingleNP3 521 10060 228.96 Active

3032055 CLH INJ SINGLE TENDON ORIGIN/INSERTIONNP3 521 20551 185.00 Active

3030550 CLH Inj Single Tendon Sheath/LigamentNP3 521 20550 202.46 Active

30311981 CLH Insertion non biodegradable implantNP3 521 11981 331.74 Active

3030605 CLH Intermediate joint inj/aspiraitonNP3 521 20605 214.12 Active

3031500 CLH IntubationNP3 521 31500 679.46 Active

3030238 CLH IP Discharge <30 min.NP3 521 99238 225.00 Active

3030239 CLH IP Discharge >30 min.NP3 521 99239 281.00 Active

3030223 CLH IP High Complex AdmitNP3 521 99223 495.00 Active

3030233 CLH IP High Daily RoundNP3 521 99233 271.00 Active

3030221 CLH IP Low Complex AdmitNP3 521 99221 299.00 Active

3030231 CLH IP Low Daily RoundNP3 521 99231 141.00 Active

3030222 CLH IP Med Complex AdmitNP3 521 99222 404.00 Active

3030232 CLH IP Med Daily RoundNP3 521 99232 199.00 Active

3030301 CLH IUD REMOVALNP3 521 58301 435.66 Active

3030002 CLH Lac 2.6-7.5 Simple (scalp, neck..)NP3 521 12002 563.92 Active

3030054 CLH Lac Interm (fac, ears..)NP3 521 12054 1230.66 Active

3030035 CLH Lac Interm 12.6-20 (axillae, trunk..NP3 521 12035 1041.98 Active

3030051 CLH Lac Repair Interm 2.5<(face,ears)NP3 521 12051 751.54 Active

303204 CLH Lac Repair Interm 2.5<(neck,hands..NP3 521 12041 632.82 Active

3030052 CLH Lac Repair Interm 2.6-5.0 (face,earsNP3 521 12052 854.36 Active

3030042 CLH Lac Repair Interm 2.6-7.5(neck,handsNP3 521 12042 751.54 Active

30303032 CLH Lac Repair Interm 2.6-7.5(scalp,axilNP3 521 12032 683.70 Active

3030053 CLH Lac Repair Interm 5.1-7.5 (face,earsNP3 521 12053 991.10 Active

3030044 CLH Lac Repair Interm 7.6-12.5(neck,handNP3 521 12044 888.28 Active

3030034 CLH Lac Repair Interm 7.6-12.5(scalp,axiNP3 521 12034 769.56 Active

Page 21: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3030016 CLH Lac Repair Sim 12.6-20(face,ears..NP3 521 12016 1244.44 Active

3030005 CLH Lac Repair Sim 12.6-20(scalp,neckNP3 521 12005 738.82 Active

3030011 CLH Lac Repair Sim 2.5<(face,ears..NP3 521 12011 563.92 Active

3030113 CLH Lac Repair Sim 2.6-5.0(face,ears..NP3 521 12013 661.44 Active

3030014 CLH Lac Repair Sim 5.1-7.5(face,ears..NP3 521 12014 699.60 Active

3030991 CLH Lac Repair Sim 7.6-12.5(face,ears..NP3 521 12015 856.48 Active

3030004 CLH Lac Repair Sim 7.6-12.5(scalp,neck..NP3 521 12004 699.60 Active

3032007 CLH Lac Repair Simple >30(scalp,neck..NP3 521 12007 572.40 Active

3030610 CLH Major Joint Aspiration/InjectionNP3 521 20610 262.88 Active

3030439 CLH MEDICARE ANNUAL WELLNESS EXAM, SUBSENP3 521 G0439 276.00 Active

3030438 CLH MEDICARE ANNUAL WELLNESS INITIALNP3 521 G0438 276.00 Active

3030600 CLH Minor Joint Inj/asp (fingers/toes)NP3 521 20600 207.23 Active

3030151 CLH Mod Sed <5 yrs Initial 15 min.NP3 521 99151 201.40 Active

3030152 CLH Mod Sed 5 yrs and up Initial 15 minNP3 521 99152 166.42 Active

3030153 CLH Mod Sed each add'l 15 min any ageNP3 521 99153 44.52 Active

3030732 CLH Nail Avulsion Part/Comp Add'l NailNP3 521 11732 113.00 Active

3030730 CLH Nail Avulsion Prtl/Com Sim/SinNP3 521 11730 187.62 Active

3030720 CLH Nail Debridement 1-5 any methodNP3 521 11720 57.24 Active

3030721 CLH Nail Debridement 6 or more any mthdNP3 521 11721 85.86 Active

3030740 CLH Nail Trephination (exc Hematoma)NP3 521 11740 110.24 Active

303719 CLH Nail Trimming nondystrophic nailsNP3 521 11719 47.70 Active

3030946 CLH Nebulizer TxNP3 521 94640 50.88 Active

3031002 CLH Needle AspirationNP3 521 10021 342.38 Active

3030400 CLH Nerve Block Trigerminal NerveNP3 521 64400 217.30 Active

3030201 CLH New Patient Clinic Level 1NP3 521 99201 166.00 Active

3030203 CLH New Patient Clinic Level 3NP3 521 99203 264.00 Active

3030204 CLH New Patient Clinic Level 4NP3 521 99204 355.00 Active

30399205 CLH NEW PATIENT LEVEL 5NP3 521 99205 474.00 Active

3039387 CLH NEW PATIENT WELLNESS > 64 YRSNP3 521 99387 436.00 Active

3039385 CLH NEW PATIENT WELLNESS 18-39 YRSNP3 521 99385 354.00 Active

3039386 CLH NEW PATIENT WELLNESS 40-64 YRSNP3 521 99386 387.00 Active

3030752 CLH NG TubeNP3 521 43752 306.34 Active

3030304 CLH NH AdmitNP3 521 99304 191.00 Active

303311 CLH NH Round Level 1NP3 525 99307 106.00 Active

3030312 CLH NH Round Level 2 (moderate)NP3 525 99308 144.00 Active

303313 CLH NH Round Level 3NP3 525 99309 209.00 Active

303236 CLH Obs HighNP3 521 99220 460.00 Active

303234 CLH Obs LowNP3 521 99218 269.00 Active

303235 CLH Obs ModNP3 521 99219 367.00 Active

3030091 CLH PAP SMEAR COLLECTIONNP3 521 Q0091 25.44 Active

3030010 CLH PFT (Spirometry)NP3 521 94010 155.82 Active

3030160 CLH Puncture Aspiration Abcess, HematomaNP3 521 10160 125.08 Active

3035222 CLH REMOVAL FB; CORNEA, W/SLIP LAMPNP3 521 65222 258.64 Active

3030692 CLH REMOVAL IMPACTED CERUMEN W INSTRCOMP 521 69210 138.00 Active

3031983 CLH REMOVAL WITH REINSERTION IMPLANTNP3 521 11983 361.46 Active

3031982 CLH REMOVAL, NON-BIODEGRADABLE IMPLANTNP3 521 11982 331.78 Active

3030451 CLH REPLACEMENT OF JEJUNOSTOMY TUBENP3 521 43760 887.22 Active

Page 22: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3030311 CLH Shave Epidermal/Dermal les .6-1.0NP3 521 11311 279.84 Active

30311306 CLH Shave Sin Les 0.6-1.0(scalp,neck..)NP3 521 11306 236.38 Active

3030300 CLH Shave single lesion (trunk,arms..NP3 521 11300 189.74 Active

30311305 CLH Shaving Epidermal/Dermal Les .5 or <NP3 521 11305 202.46 Active

3030307 CLH Shaving Epidermal/Dermal les 1.1-2.0NP3 521 11307 261.82 Active

303310 CLH Shaving Sin Les 0.5< (face, ears..)NP3 521 11310 217.30 Active

3030405 CLH Short Leg CastNP3 521 29405 349.80 Active

3030650 CLH Shoulder Reduction w/Man & no AnesNP3 521 23650 1023.96 Active

3030200 CLH Skin Tag Removal any method up to 15NP3 521 11200 200.34 Active

3030960 CLH Spirometry Pre/Post BronchodilatorNP3 521 94060 223.66 Active

303211 CLH Sports Physical SpecialNP3 521 30.00 Active

3030777 CLH Swing Bed RoundNP3 524 99213 110.00 Active

3030552 CLH Trigger Point Inj 1 or 2 musclesNP3 521 20552 238.50 Active

3030553 CLH Trigger Point Inj 3 or more musclesNP3 521 20553 246.98 Active

3030127 CLH TRIMMING OF DYSTROPHIC NAILS ANY #NP3 521 G0127 58.30 Active

3030344 CLH Welcome to Medicare(first 12 months)NP3 521 G0402 292.56 Active

3030391 CLH Well Child <1 yrNP3 521 99391 174.00 Active

3030394 CLH Well Child 12-17 yrsNP3 521 99394 217.00 Active

3039392 CLH Well Child 1-4 yrsNP3 521 99392 186.00 Active

3030393 CLH Well Child 5-11 yrsNP3 521 99393 201.00 Active

3030381 CLH Well Child New Patient <1 yrNP3 521 99381 212.00 Active

3030384 CLH Well Child New Patient 12-17NP3 521 99384 262.00 Active

303382 CLH Well Child New Patient 1-4NP3 521 99382 229.00 Active

3039383 CLH WELL CHILD NEW PATIENT 5-11NP3 521 99383 245.00 Active

3030395 CLH Wellness Exam 18-39 yrsNP3 521 99395 294.00 Active

3039397 CLH Wellness Exam Adult >65 yrs.NP3 521 99397 365.00 Active

3035605 CLH Wrist Fx/Reduction w/ManipulationNP3 521 25605 2014.00 Active

3030045 CLHLac Repair Interm 12.6-20(neck,handsNP3 521 12045 1161.76 Active

3035001 CLHLac Repair Sim 2.5< (scalp, neck..)NP3 521 12001 466.40 Active

3030202 CLHNew Patient Clinic Level 2NP3 521 99202 198.00 Active

4450790 CLINDAMYCIN 900MG/6ML IVPHAR 259 11.66 Active

4450799 CLINDAMYCIN 150 MG TABPHAR 250 J3490 6.40 Active

4450791 CLINDAMYCIN 300 MG TABPHAR 250 11.66 Active

4451352 CLINDAMYCIN 300MG/2ML INJPHAR 636 J3490 11.70 Active

4450124 CLINDAMYCIN 600MG /4ML INJPHAR 636 J3490 113.05 Active

4451559 CLINDAMYCIN 900MG/50mLPHAR 636 J3490 58.40 Active

4451606 CLINDAMYCIN PREMIX IV 600MGPHAR 636 J3490 58.40 Active

AIC 101 CLINIC CHARGESDR 521 0.00 Active

4451311 CLINIMIR IV SOLUTION/ TPNPHAR 259 127.20 Active

4401787 CLIPPER BLADESUP 270 8.48 Active

6600134 CLIPPER, NAIL CHROMESUP 270 5.30 Active

30609125 CLL App Short Arm SplintLOC 521 29125 221.54 Active

3060950 CLL CPRLOC 521 92950 654.02 Active

3050653 CLL FLU SHOTPA 521 90686 40.00 Active

30606083 CLL Hemorrhoid Incision of ExternalLOC 521 46083 510.92 Active

30099396 CLM Adult Wellness 40-64DR 521 99396 321.00 Active

3003784 CLM Ambulatory Blood Pressure MonitorDR 521 93784 363.58 Active

Page 23: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3000550 CLM App Surface/transcut NeurostimulatorDR 521 64550 38.16 Active

3009085 CLM App. Cast Hand/lower ForearmDR 521 29085 149.46 Active

3000022 CLM App. Finger SplintDR 521 29130 131.44 Active

300065 CLM App. Long Arm CastDR 521 29065 243.80 Active

30029105 CLM App. Long Arm SplintDR 521 29105 259.70 Active

30029505 CLM App. Long Leg SplintDR 521 29505 283.02 Active

3009075 CLM App. Short Arm CastDR 521 29075 330.72 Active

30029125 CLM App. Short Arm SplintDR 521 29125 221.54 Active

30029515 CLM App. Short Leg SplintDR 521 29515 183.38 Active

3000410 CLM Biopsy of PenisDR 521 54100 386.90 Active

3000100 CLM Biopsy of Skin Single/SimpleDR 521 11100 228.96 Active

3003270 CLM Cardiac Event MonitorDR 521 93270 175.96 Active

300457 CLM Cast SuppliesDR 521 A4590 81.66 Active

3000551 CLM Chest Tube PlacementDR 521 32551 839.52 Active

3009490 CLM CHRONIC CARE MANAGEMENTDR 521 G0511 83.00 Active

3000235 CLM Clavicle Fx, Closed TxDR 521 23500 768.50 Active

3003650 CLM Clavicle SplintDR 274 L3650 32.86 Active

3000211 CLM Clinic Visit Level 1DR 521 99211 76.00 Active

3000212 CLM Clinic Visit Level 2DR 521 99212 108.00 Active

3000213 CLM Clinic Visit Level 3DR 521 99213 135.00 Active

3000214 CLM Clinic Visit Level 4DR 521 99214 206.00 Active

3000215 CLM Clinic Visit Level 5DR 521 99215 323.00 Active

3000480 CLM Closed Reduction of TMJDR 521 21480 518.34 Active

3000278 CLM Closed Trmt Bimalleolar Ankle FracDR 521 27810 1477.64 Active

3000840 CLM Closed TX Ankle Disl w/o anesthesiaDR 521 27840 1909.06 Active

3000250 CLM Closed Tx Hip Disl. w/o anesDR 521 27250 1455.38 Active

3000770 CLM Closed Tx Intphal Dis w/man w/o anesDR 521 26770 911.60 Active

3006705 CLM CLOSED TX METACARPOPH W/MAN & ANESDR 521 26705 1366.34 Active

300565 CLM Closed Tx Radial/Ulnar w/Man.DR 521 25565 662.50 Active

3006720 CLM Closed Tx Shaft Frac. Finger/ThumbDR 521 26720 601.02 Active

30023655 CLM Closed Tx Shoulder Disl w/Man & AnesDR 521 23655 1463.86 Active

3006641 CLM Closed Tx Thumb Disl. w/ManipDR 521 26641 1155.40 Active

30027818 CLM Closed Tx Trimalleolar Ankle w/Man.DR 521 27818 2309.74 Active

30027816 CLM Closed Tx Trimalleolar Ankle wo Man.DR 521 27816 1121.48 Active

3002553 CLM CLOSED TX ULNAR SHAFT W/MANIPULATIONDR 521 25535 1802.00 Active

300650 CLM Clsed Tx Radial head/neck Fx w/o manDR 521 24650 1016.54 Active

300950 CLM CPRDR 521 92950 654.02 Active

3000291 CLM Critical Care 1st hrDR 521 99291 1090.00 Active

3000292 CLM Critical Care Each Add'l 30 min.DR 521 99292 545.00 Active

30017110 CLM Cryo/Surgical Curettement 14 lesionsDR 521 17110 186.56 Active

30017111 CLM Cryotherapy 15 or more Ben LesDR 521 17111 377.36 Active

300000 CLM Debridement skin up to 10% body sur.DR 521 11000 316.94 Active

3000989 CLM Debridement SubQ tissue 20 sq cm/<DR 521 11042 298.92 Active

3000450 CLM Dental BlockDR 521 64450 538.48 Active

3007003 CLM DESTRUCTION PREMALIG LESION 2-14DR 521 17003 38.16 Active

3007000 CLM DESTRUCTION PREMALIGNANT 1ST LESIONDR 521 17000 171.72 Active

3004450 CLM Digital BlockDR 521 64450 511.98 Active

Page 24: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

300214 CLM DOT ExamDR 521 99214 187.00 Active

3000010 CLM Drainage Finger Abscess SimpleDR 521 26010 358.28 Active

3000442 CLM Dressing SuppliesDR 521 A6442 28.62 Active

3000005 CLM EKGDR 521 93000 132.50 Active

3000366 CLM EKG Welcome to MedicareDR 521 G0403 132.50 Active

3000640 CLM Elbow ReductionDR 521 24640 463.22 Active

300901 CLM Epistaxis Anterior Cautery/packingDR 521 30901 236.38 Active

3000905 CLM Epistaxis Posterior w/nasal packsDR 521 30905 236.38 Active

3000281 CLM ER Level 1DR 521 99281 251.00 Active

3000282 CLM ER Level 2DR 521 99282 269.00 Active

3000283 CLM ER Level 3DR 521 99283 510.00 Active

3000284 CLM ER Level 4DR 521 99284 761.00 Active

3000285 CLM ER Level 5DR 521 99285 1135.00 Active

3000040 CLM Ex.Ben. Les 0.5cm or less (face,ear)DR 521 11440 358.28 Active

3000420 CLM Exc Ben Les 0.5 < (scalp, neck..)DR 521 11420 316.94 Active

3001400 CLM Exc Ben Les 0.5 <(trunk, arms, legs)DR 521 11400 269.24 Active

3000441 CLM Exc Ben Les 0.6-1.0 (face, ears..)DR 521 11441 375.24 Active

3000421 CLM Exc Ben Les 0.6-1.0 (scalp, neck..)DR 521 11421 432.48 Active

3000401 CLM Exc Ben Les 0.6-1.0 (trunk, arms..)DR 521 11401 359.34 Active

300442 CLM Exc Ben Les 1.1-2.0 (face, ears..)DR 521 11442 434.60 Active

3000422 CLM Exc Ben Les 1.1-2.0 (scalp, neck..)DR 521 11422 487.60 Active

3000402 CLM Exc Ben Les 1.1-2.0 (trunk, arms..)DR 521 11402 442.02 Active

3000423 CLM Exc Ben Les 2.1-3.0 (scalp, neck..)DR 521 11423 509.86 Active

3000424 CLM Exc Ben Les 3.1-4.0 (scalp, neck..)DR 521 11424 588.30 Active

3000403 CLM Exc Ben Les2.1-3.0 (trunk, arms..)DR 521 11403 419.76 Active

30001404 CLM Exc Benign trunk, arm, leg 3.1-4.0DR 521 11404 583.00 Active

3000812 CLM EXC LES MUCOSA/SBLMCL SIMPLE REPAIRDR 521 40812 753.66 Active

3000600 CLM Exc Mal Les 0.5<(trunk, arms, legs)DR 521 11600 500.32 Active

3001642 CLM Exc Mal Les 1.1-2.0 (face, ears..)DR 521 11642 694.30 Active

3000602 CLM Exc Mal Les 1.1-2.0 (trunk, arms..)DR 521 11602 390.08 Active

3009940 CLM Exc Mal Les 2.1-3.0(scalp,neck..)DR 520 11623 750.72 Active

3006400 CLM Exc Malg Les 0.5 < (face, ears...)DR 521 11640 358.28 Active

300641 CLM Exc Malg Les 0.6-1.0 (face, ears..)DR 521 11641 375.24 Active

300601 CLM Exc Malg Les 0.6-1.0 (trunk, arm..)DR 521 11601 359.34 Active

3001643 CLM EXC MALIG LES F/E/E/N/L 2.1-3.0DR 521 11643 818.32 Active

3000750 CLM Excision of Nail PermanentDR 521 11750 504.56 Active

3002012 CLM Eye ExamDR 521 92081 169.60 Active

3005205 CLM FB Removal Conjuctiva SuperficialDR 521 65205 208.82 Active

3005210 CLM FB Removal Conjuctival/Sub or SCLDR 521 65210 226.84 Active

3005220 CLM FB Removal Cornea w/o Slit LampDR 521 65220 244.86 Active

30069200 CLM FB Removal EarDR 521 69200 355.10 Active

3007938 CLM FB Removal Eyelid EmbeddedDR 521 67938 401.74 Active

3000190 CLM FB Removal Foot SubcutaneousDR 521 28190 204.58 Active

3000511 CLM FB Removal LarynxDR 521 31511 378.42 Active

3000303 CLM FB Removal NoseDR 521 30300 183.38 Active

3007086 CLM FB REMOVAL PELVIS/HIP SUBCUTANEOUSDR 521 27086 589.36 Active

3000120 CLM FB Removal Subcutaneous TissueDR 521 10120 183.38 Active

Page 25: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

300700 CLM Finger Reduction w/o Anes.DR 521 26700 911.60 Active

3004049 CLM Finger SplintDR 274 Q4049 17.01 Active

3000951 CLM Finger/thumb Amputation w/Dir ClosurDR 521 26951 2038.38 Active

300724 CLM Flu ShotDR 521 90686 40.00 Active

3000056 CLM Foot Care Corn/Callus 2-4 LesionsDR 521 11056 128.26 Active

300055 CLM Foot Care Corn/Callus Single LesionDR 521 11055 74.20 Active

3000829 CLM GlucometerDR 521 82948 50.88 Active

3000466 CLM Hemmorhoid BandingDR 521 46221 246.98 Active

3050083 CLM Hemorrhoid Incision of ExternalDR 521 46083 510.92 Active

3000140 CLM I & D Hematona Seroma/Fluid Col.DR 521 10140 172.78 Active

3000060 CLM Incision and Drainage Simple/SingleDR 521 10060 228.96 Active

30020551 CLM INJ SINGLE TENDON ORIGIN/INSERTIONDR 521 20551 185.00 Active

30020550 CLM Inj Single Tendon Sheath/LigamentDR 521 20550 202.46 Active

30011981 CLM INSERTION NON BIODEGRADABLE IMPLANTDR 521 11981 331.74 Active

3002060 CLM Intermediate Joint Inj /aspirationDR 521 20605 214.12 Active

3000105 CLM IntubationDR 521 31500 679.46 Active

3000238 CLM IP Discharge <30 min.DR 521 99238 225.00 Active

3000239 CLM IP Discharge >30 min.DR 521 99239 281.00 Active

3000223 CLM IP High Complex AdmitDR 521 99223 495.00 Active

3000233 CLM IP High Daily RoundDR 521 99233 271.00 Active

3000221 CLM IP Low Complex AdmitDR 521 99221 299.00 Active

3000231 CLM IP Low Daily RoundDR 521 99231 141.00 Active

3000222 CLM IP Med Complex AdmitDR 521 99222 404.00 Active

3000232 CLM IP Med Daily RoundDR 521 99232 199.00 Active

3000301 CLM IUD REMOVALDR 521 58301 435.66 Active

3004466 CLM Knee Elastic SupportDR 521 A4467 14.84 Active

3000830 CLM Knee ImmoblizerDR 274 L1830 110.24 Active

3000002 CLM Lac 2.6-7.5 Simple (scalp, neck..)DR 521 12002 563.92 Active

3002054 CLM Lac Interm (face ears...)DR 521 12054 1230.66 Active

3000035 CLM Lac Interm 12.6-20 (axillae, trunk.)DR 521 12035 1041.98 Active

3002045 CLM Lac Repair Interm 12.6-20(neck,handsDR 521 12045 1161.76 Active

3000051 CLM Lac Repair Interm 2.5<(face,ears)DR 521 12051 751.54 Active

300204 CLM Lac Repair Interm 2.5<(neck,hands..DR 521 12041 632.82 Active

3000052 CLM Lac Repair Interm 2.6-5.0 (face,earsDR 521 12052 854.36 Active

3000042 CLM Lac Repair Interm 2.6-7.5(neck,handsDR 521 12042 751.54 Active

300032 CLM lac Repair Interm 2.6-7.5(sclap,axilDR 521 12032 683.70 Active

3002053 CLM Lac Repair Interm 5.1-7.5 (face,earsDR 521 12053 991.10 Active

300012044 CLM Lac Repair Interm 7.6-12.5(neck,handDR 521 12044 888.28 Active

300034 CLM Lac Repair Interm 7.6-12.5(scalp,axiDR 521 12034 769.56 Active

3000016 CLM Lac Repair Sim 12.6-20(face,ears..DR 521 12016 1244.44 Active

300005 CLM Lac Repair Sim 12.6-20(scalp,neckDR 521 12005 738.82 Active

3005001 CLM Lac Repair Sim 2.5 < (scalp, neck..)DR 521 12001 466.40 Active

3000011 CLM Lac Repair Sim 2.5<(face,ears..DR 521 12011 563.92 Active

3000113 CLM Lac Repair Sim 2.6-5.0(face,ears..DR 521 12013 661.44 Active

3000014 CLM Lac Repair Sim 5.1-7.5(face,ears..DR 521 12014 699.60 Active

3000991 CLM Lac Repair Sim 7.6-12.5(face,ears..DR 521 12015 856.48 Active

300004 CLM Lac Repair Sim 7.6-12.5(scalp,neck..DR 521 12004 699.60 Active

Page 26: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3002007 CLM Lac Repair Simple >30(scalp,neckDR 521 12007 572.40 Active

3007785 CLM LIGATION DIVISION EXC VARICOSE VEINDR 521 37785 1155.00 Active

3000610 CLM Major Joint Aspiration/InjectionDR 521 20610 262.88 Active

3000439 CLM MEDICARE ANNUAL WELLNESS EXAM, SUBSEDR 521 G0439 276.00 Active

3000438 CLM MEDICARE ANNUAL WELLNESS INITIALDR 521 G0438 276.00 Active

300311 CLM MH Round Level 1DR 521 99307 106.00 Active

300600 CLM Minor joint inj/asp (fingers & toes)DR 521 20600 207.23 Active

30099143 CLM Mod Sed <5yrs Initial 15 minDR 521 99151 201.40 Active

30099144 CLM Mod Sed 5yrs and up Initial 15 minDR 521 99152 166.42 Active

30099145 CLM Mod Sed each add'l 15 min any ageDR 521 99153 44.52 Active

3000732 CLM Nail Avulsion Part/Comp Add'l NailDR 521 11732 113.00 Active

3000730 CLM Nail Avulsion Prtl/Com Sim/SinDR 521 11730 187.62 Active

300011720 CLM Nail Debridement 1-5 any methodDR 521 11720 57.24 Active

3000721 CLM Nail Debridement 6 or more any mthdDR 521 11721 85.86 Active

3000740 CLM Nail Trephination (Exc Hematoma)DR 521 11740 110.24 Active

300719 CLM Nail Trimming nondystrophic nailsDR 521 11719 47.70 Active

3000946 CLM Nebulizer TxDR 521 94640 50.88 Active

3001002 CLM Needle AspirationDR 521 10021 342.38 Active

300644 CLM Nerve Block Trigerminal NerveDR 521 64400 217.30 Active

3000201 CLM New Patient Clinic Level 1DR 521 99201 166.00 Active

3000202 CLM New Patient Clinic Level 2DR 521 99202 198.00 Active

3000203 CLM New Patient Clinic Level 3DR 521 99203 264.00 Active

3000204 CLM New Patient Clinic Level 4DR 521 99204 355.00 Active

3009387 CLM NEW PATIENT WELLNESS > 64 YRSDR 521 99387 436.00 Active

3009385 CLM NEW PATIENT WELLNESS 18-39 YRSDR 521 99385 354.00 Active

3009386 CLM NEW PATIENT WELLNESS 40-64 YRSDR 521 99386 387.00 Active

3000017 CLM NG TubeDR 521 43752 306.34 Active

3000304 CLM NH AdmitDR 521 99304 191.00 Active

3000312 CLM NH Round Level 2 (moderate)DR 525 99308 144.00 Active

300313 CLM NH Round Level 3DR 525 99309 209.00 Active

300236 CLM Obs HighDR 521 99220 460.00 Active

300234 CLM OBS lowDR 521 99218 269.00 Active

300235 CLM Obs ModDR 521 99219 367.00 Active

3000091 CLM PAP SMEAR COLLECTIONDR 521 Q0091 25.44 Active

30094010 CLM PFT (Spirometry)DR 521 94010 155.82 Active

3000160 CLM Puncture Aspiration Abcess, HematomaDR 521 10160 125.08 Active

3005222 CLM REMOVAL FB; CORNEA, W/SLIT LAMPDR 521 65222 258.64 Active

3000210 CLM REMOVAL IMPACTED CERUMEN W INSTRDR 521 69210 138.00 Active

3001983 CLM REMOVAL WITH REINSERTION IMPLANTDR 521 11983 361.46 Active

3001982 CLM REMOVAL, NON-BIODEGRADABLE IMPLANTDR 521 11982 331.78 Active

30049445 CLM REPLACEMENT OF JEJUNOSTOMY TUBEDR 521 43760 887.22 Active

3002100 CLM Rib BeltDR 521 L0220 37.10 Active

3011301 CLM Shave Biopsy Single Les 0.6-1.0 cmDR 521 11301 217.18 Active

300310 CLM Shave Epidermal/Dermal Les .5<(faceDR 521 11310 217.30 Active

3000311 CLM Shave Epidermal/Dermal les .6-1.0DR 521 11311 279.84 Active

3001313 CLM SHAVE LES FACE/EARS, MUC MEM >2.0CMDR 521 11313 399.62 Active

30011306 CLM Shave Sin Les 0.6-1.0 (scalp,neck..)DR 521 11306 236.38 Active

Page 27: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3000300 CLM Shave single lesion (trunk,arms..DR 521 11300 189.74 Active

30011305 CLM Shaving Epidermal/Dermal Les .5 or <DR 521 11305 202.46 Active

3000307 CLM Shaving Epidermal/Dermal Les 1.1-2.0DR 521 11307 261.82 Active

3000405 CLM Short Leg CastDR 521 29405 349.80 Active

3000650 CLM Shoulder ImmobilizerDR 274 L3650 102.82 Active

3000655 CLM Shoulder Reduction w/Man & No AnesDR 521 23650 1023.96 Active

3000200 CLM Skin Tag Removal any method up to 15DR 521 11200 200.34 Active

3001201 CLM Skin Tag removal; ea additional 10DR 521 11201 73.14 Active

3000940 CLM Spiromety Pre/Post BronchodilatorDR 521 94060 223.66 Active

300211 CLM Sports Physical SpecialDR 521 30.00 Active

3000777 CLM Swing Bed RoundDR 524 99213 110.00 Active

30004466 CLM Tennis Elbow StrapDR 521 A4467 34.98 Active

3000923 CLM Thumb GuardDR 274 L3923 67.84 Active

3000552 CLM Trigger Point Inj 1 or 2 musclesDR 521 20552 238.50 Active

30020553 CLM Trigger Point Inj 3 or more musclesDR 521 20553 246.98 Active

3000127 CLM TRIMMING OF DYSTROPHIC NAILS ANY #DR 521 G0127 58.30 Active

3000344 CLM Welcome to Medicare(first 12 months)DR 521 G0402 292.56 Active

3000391 CLM Well Child <1 yrDR 521 99391 174.00 Active

3000394 CLM Well Child 12-17 yrsDR 521 99394 217.00 Active

3000393 CLM Well Child 5-11 yrsDR 521 99393 201.00 Active

3000384 CLM Well Child New Paitent 12-17DR 521 99384 262.00 Active

3000381 CLM Well Child New Patient <1 yrDR 521 99381 212.00 Active

300382 CLM Well Child New Patient 1-4DR 521 99382 229.00 Active

3009383 CLM WELL CHILE NEW PATIENT 5-11DR 521 99383 245.00 Active

3000395 CLM Wellness Exam 18-39 yrsDR 521 99395 294.00 Active

3003908 CLM Wrist 7-lace Up SupportDR 274 L3908 27.56 Active

3005605 CLM Wrist Fx/Reduction w/ManipulationDR 521 25605 2014.00 Active

3000908 CLM Wrist/forearm DeluxeDR 274 L3908 10.60 Active

3003807 CLM Wrist/Thumb Splint Comfort FormDR 274 L3807 53.00 Active

3010396 CLO Adult Wellness 40-64 yrsNP1 521 99396 321.00 Active

3013784 CLO Ambulatory Blood Pressure MonitorNP1 521 93784 363.58 Active

301550 CLO App Surface/transcut NeurostimulatorNP1 521 64550 38.16 Active

3019085 CLO App. Cast Hand/Lower ForearmNP1 521 29085 149.46 Active

3010034 CLO App. Finger SplintNP1 521 29130 131.44 Active

3010290 CLO App. Long Arm CastNP1 521 29065 243.80 Active

3010105 CLO App. Long Arm SplintNP1 521 29105 259.70 Active

3019505 CLO App. Long Leg SplintNP1 521 29505 283.02 Active

3010022 CLO App. Short Arm CastNP1 521 29075 330.72 Active

3019125 CLO App. Short Arm SplintNP1 521 29125 221.54 Active

3019515 CLO App. Short Leg SplintNP1 521 29515 183.38 Active

3010565 CLO Arm SlingNP1 521 A4565 55.12 Active

3010410 CLO Biopsy of PenisNP1 521 54100 386.90 Active

3011100 CLO Biopsy of Skin Single/SimpleNP1 521 11100 228.96 Active

3013270 CLO Cardiac Event MonitorNP1 521 93270 175.96 Active

301040 CLO Cast SuppliesNP1 521 A4590 81.66 Active

3010027 CLO Chest Tube PlacementNP1 521 32551 839.52 Active

3019490 CLO CHRONIC CARE MANAGEMENTNP1 521 G0511 83.00 Active

Page 28: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

2010235 CLO Clavicle Fx, Closed TxNP1 521 23500 768.50 Active

3010211 CLO Clinic Visit Level 1NP1 521 99211 76.00 Active

3010212 CLO Clinic Visit Level 2NP1 521 99212 108.00 Active

3010213 CLO Clinic Visit Level 3NP1 521 99213 135.00 Active

3010214 CLO Clinic Visit Level 4NP1 521 99214 206.00 Active

3010215 CLO Clinic Visit Level 5NP1 521 99215 323.00 Active

3010480 CLO Closed Reduction of TMJNP1 521 21480 518.34 Active

3010278 CLO Closed Tx bimalleolar Ankle w/Man.NP1 521 27810 1477.64 Active

3010250 CLO Closed Tx Hip Disl. w/o anesNP1 521 27250 1455.38 Active

3010770 CLO Closed Tx Intphal Dis w/man w/o anesNP1 521 26770 911.60 Active

3016705 CLO CLOSED TX METACARPOPH W/MAN & ANESNP1 521 26705 1366.34 Active

301565 CLO Closed Tx Radial/Ulnar w/Man.NP1 521 25565 662.50 Active

3016720 CLO Closed Tx Shaft Frac. Finger/ThumbNP1 521 26720 601.02 Active

3012365 CLO Closed Tx Shoulder Disl w/Man & AnesNP1 521 23655 1463.86 Active

3016641 CLO Closed Tx Thumb Disl. w/ManipNP1 521 26641 1155.40 Active

3017818 CLO Closed Tx Trimalleolar Ankle w/Man.NP1 521 27818 2309.74 Active

3017816 CLO Closed Tx Trimalleolar Ankle w/o ManNP1 521 27816 1121.48 Active

3012553 CLO CLOSED TX ULNAR SHAFT W/MANIPULATIONNP1 521 25535 1802.00 Active

301650 CLO Clsed Tx Radial head/neck Tx w/o manNP1 521 24650 1016.54 Active

301570 CLO Colles SplintNP1 521 A4570 13.78 Active

301950 CLO CPRNP1 521 92950 654.02 Active

3010291 CLO Critical Care 1st HourNP1 521 99291 1090.00 Active

3010292 CLO Critical Care Each Add'l 30 Min.NP1 521 99292 545.00 Active

3017110 CLO Cryo/Surgical Curettement 14 lesionsNP1 521 17110 186.56 Active

3017111 CLO Cryotherapy 15 + Ben LesionsNP1 521 17111 377.36 Active

3010000 CLO Debridement Skin up to 10% body Sur.NP1 521 11000 316.94 Active

3011042 CLO Debridement SubQ tissue 20 sq cm/<NP1 521 11042 298.92 Active

3010450 CLO Dental BlockNP1 521 64450 538.48 Active

3500039 CLO DESTRUCTION PRE MALIGNANT 1ST LESIONNP1 521 17000 171.72 Active

3017003 CLO DESTRUCTION PREMALIG LESION 2-14NP1 521 17003 38.16 Active

3014450 CLO Digital BlockNP1 521 64450 511.98 Active

301214 CLO DOT ExamNP1 521 99214 187.00 Active

3016010 CLO Drainage Finger Abscess SimpleNP1 521 26010 358.28 Active

3010442 CLO Dressing SuppliesNP1 521 A6442 28.62 Active

3010930 CLO EKGNP1 521 93000 132.50 Active

3010366 CLO EKG Welcome to MedicareNP1 521 G0403 132.50 Active

3010640 CLO Elbow ReductionNP1 521 24640 463.22 Active

3010901 CLO Epistaxis Anterior Cautery/packingNP1 521 30901 236.38 Active

3010905 CLO Epistaxis Posterior w/nasal packsNP1 521 30905 236.38 Active

3010281 CLO ER Level 1NP1 521 99281 251.00 Active

3010282 CLO ER Level 2NP1 521 99282 269.00 Active

3010283 CLO ER Level 3NP1 521 99283 510.00 Active

3010284 CLO ER Level 4NP1 521 99284 761.00 Active

3010285 CLO ER Level 5NP1 521 99285 1135.00 Active

3011440 CLO Exc Ben Les 0.5 < (face, ears..)NP1 521 11440 358.28 Active

3011420 CLO Exc Ben Les 0.5 < (scalp, neck..)NP1 521 11420 316.94 Active

30101140 CLO Exc Ben Les 0.5 <(trunk, arms,legs)NP1 521 11400 269.24 Active

Page 29: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3011441 CLO Exc Ben Les 0.6-1.0 (face, ears..)NP1 521 11441 375.24 Active

3010421 CLO Exc Ben Les 0.6-1.0 (scalp, neck..)NP1 521 11421 432.48 Active

3010401 CLO Exc Ben Les 0.6-1.0 (trunk, arms..)NP1 521 11401 359.34 Active

301442 CLO Exc Ben Les 1.1-2.0 (face, ears..)NP1 521 11442 434.60 Active

3010422 CLO Exc Ben Les 1.1-2.0 (scalp, neck..)NP1 521 11422 487.60 Active

3011402 CLO Exc Ben Les 1.1-2.0 (Trunk arms..)NP1 521 11402 442.02 Active

3010423 CLO Exc Ben Les 2.1-3.0 (scalp, neck...)NP1 521 11423 509.86 Active

3011403 CLO Exc Ben Les 2.1-3.0 (trunk, arms..)NP1 521 11403 419.76 Active

3010424 CLO Exc Ben Les 3.1-4.0 (scalp, neck..)NP1 521 11424 588.30 Active

3011600 CLO Exc Mal Les 0.5 <(trunk, arms, legs)NP1 521 11600 500.32 Active

3019940 CLO Exc Mal Les 2.1-3.0(scalp,neck..)NP1 520 11623 750.72 Active

3011640 CLO Exc Malg Les 0.5 < (face ears..)NP1 521 11640 358.28 Active

3011641 CLO Exc Malg Les 0.6-1.0 (face ears..)NP1 521 11641 375.24 Active

3011601 CLO Exc Malg Les 0.6-1.0 (trunk arms..)NP1 521 11601 359.34 Active

3011642 CLO Exc Malg Les 1.1-2.0 (face ears..)NP1 521 11642 694.30 Active

3011602 CLO Exc Malg Les 1.1-2.0 (trunk, arms..)NP1 521 11602 390.08 Active

3011643 CLO EXC MALIG LES F/E/E/N/L 2.1-3.0NP1 521 11643 818.32 Active

3010750 CLO Excision of Nail PermanentNP1 521 11750 504.56 Active

3012012 CLO Eye ExamNP1 521 92081 169.60 Active

3015210 CLO FB Removal Conjuctival/Sub or SCLNP1 521 65210 226.84 Active

3015205 CLO FB Removal Conjunctiva SuperficialNP1 521 65205 208.82 Active

3015220 CLO FB Removal Cornea w/o Slit LampNP1 521 65220 244.86 Active

3010045 CLO FB Removal EarNP1 521 69200 355.10 Active

3017938 CLO FB Removal Eyelid EmbeddedNP1 521 67938 401.74 Active

3010190 CLO FB Removal Foot SubcutaneousNP1 521 28190 204.58 Active

3010511 CLO FB Removal LarynxNP1 521 31511 378.42 Active

301300 CLO FB Removal NoseNP1 521 30300 183.38 Active

3017086 CLO FB REMOVAL PELVIS/HIP SUBCUTANEOUSNP1 521 27086 589.36 Active

3011120 CLO FB Removal Subcutaneous TissueNP1 521 10120 183.38 Active

3010700 CLO Finger Reduction w/o Anes.NP1 521 26700 911.60 Active

3010951 CLO Finger/thumb Aputation w/closureNP1 521 26951 2038.38 Active

3010653 CLO Flu shotNP1 521 90686 40.00 Active

3011056 CLO Foot Care Corn/Callus 2-4 LesionsNP1 521 11056 128.26 Active

301055 CLO Foot Care Corn/Callus Single LesionNP1 521 11055 74.20 Active

3010829 CLO GlucometerNP1 521 82948 50.88 Active

3016221 CLO Hemorrhoid BandingNP1 521 46221 246.98 Active

3016083 CLO Hemorrhoid Incision of ExternalNP1 521 46083 510.92 Active

3010140 CLO I&D Hematoma Seroma or Fluid Coll.NP1 521 10140 172.78 Active

3011006 CLO Incision and Drainage Siimple/SingleNP1 521 10060 228.96 Active

30120551 CLO INJ SINGLE TENDON ORIGIN/INSERTIIONNP1 521 20551 185.00 Active

3012055 CLO Inj Single Tendon Sheath/LigamentNP1 521 20550 202.46 Active

30111981 CLO INSERTION NON BIODEGRADABLE IMPLANTNP1 521 11981 331.74 Active

3011065 CLO Intermediate Joint Inj/aspirationNP1 521 20605 214.12 Active

3011500 CLO IntubationNP1 521 31500 679.46 Active

3010221 CLO IP Admit Low ComplexNP1 521 99221 299.00 Active

3010222 CLO IP Admit Med ComplexNP1 521 99222 404.00 Active

3010233 CLO IP Daily Round HighNP1 521 99233 271.00 Active

Page 30: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3010231 CLO IP Daily Round LowNP1 521 99231 141.00 Active

3010232 CLO IP Daily Round MedNP1 521 99232 199.00 Active

3010238 CLO IP Discharge < 30 min.NP1 521 99238 225.00 Active

3010239 CLO IP Discharge > 30 min.NP1 521 99239 281.00 Active

3010223 CLO IP High Comp AdmitNP1 521 99223 495.00 Active

3010301 CLO IUD REMOVALNP1 521 58301 435.66 Active

3011722 CLO Knee Mate Brace Neoprene HingedNP1 274 L1820 181.26 Active

3010051 CLO Lac 2.6-7.5 Simple (Scalp, neck..)NP1 521 12002 563.92 Active

3010135 CLO Lac Interm 12.6-20 (scalp, axillae.)NP1 521 12035 1041.98 Active

3012054 CLO Lac Interm 7.6-12.5 (face ears..)NP1 512 12054 1230.66 Active

3012045 CLO Lac Repair Interm 12.6-20(neck,handsNP1 521 12045 1161.76 Active

3012051 CLO Lac Repair Interm 2.5<(face,ears)NP1 521 12051 751.54 Active

3012041 CLO Lac Repair Interm 2.5<(neck,hands..NP1 521 12041 632.82 Active

3012052 CLO Lac Repair Interm 2.6-5.0 (face,earsNP1 521 12052 854.36 Active

3012042 CLO Lac Repair Interm 2.6-7.5(neck,handsNP1 521 12042 751.54 Active

3010103 CLO Lac Repair Interm 2.6-7.5(scalp,axilNP1 521 12032 683.70 Active

3012053 CLO Lac Repair Interm 5.1-7.5(face,earsNP1 521 12053 991.10 Active

301012044 CLO Lac Repair Interm 7.6-12.5(neck,handNP1 521 12044 888.28 Active

3012034 CLO Lac Repair Interm 7.6-12.5(scalp,axiNP1 521 12034 769.56 Active

30100016 CLO Lac Repair Sim 12.6-20(face,ears..NP1 521 12016 1244.44 Active

301005 CLO Lac Repair Sim 12.6-20(scalp,neckNP1 521 12005 738.82 Active

3015001 CLO Lac Repair Sim 2.5 < (scalp, neck..)NP1 521 12001 466.40 Active

3010113 CLO Lac Repair Sim 2.6-5.0(face, ears..NP1 521 12013 661.44 Active

30112014 CLO Lac Repair Sim 5.1-7.5(face,ears..NP1 521 12014 699.60 Active

3010991 CLO Lac Repair Sim 7.6-12.5(face,ears..NP1 521 12015 856.48 Active

3012004 CLO Lac Repair Sim 7.6-12.5(scalp,neck..NP1 521 12004 699.60 Active

3012011 CLO Lac Repair Sim2.5<(face,ears..NP1 521 12011 563.92 Active

3012007 CLO Lac Repair Simple >30(scalp,neckNP1 521 12007 572.40 Active

3010610 CLO Major Joint Aspiration/injectionNP1 521 20610 262.88 Active

3010439 CLO MEDICARE ANNUAL WELLNESS EXAM, SUBSENP1 521 G0439 276.00 Active

3010438 CLO MEDICARE ANNUAL WELLNESS INITIALNP1 521 G0438 276.00 Active

301600 CLO Minor joint inj/asp (fingers & toes)NP1 521 20600 207.23 Active

3019143 CLO Mod Sed <5yrs Initial 15 minNP1 521 99151 201.40 Active

3019144 CLO Mod Sed 5yrs and up Initial 15 minNP1 521 99152 166.42 Active

3019145 CLO Mod Sed each add'l 15 min any ageNP1 521 99153 44.52 Active

3010732 CLO Nail Avulsion Part/Comp Add'l NailNP1 521 11732 113.00 Active

3010117 CLO Nail Avulsion Prtl/Com Sim/SinNP1 521 11730 187.62 Active

3011720 CLO Nail Debridement 1-5 any methodNP1 521 11720 57.24 Active

3010721 CLO Nail Debridement 6 or more any mthdNP1 521 11721 85.86 Active

3010740 CLO Nail Trephination (exc Hematoma)NP1 521 11740 110.24 Active

3011719 CLO Nail Trimming nondystrophic nailsNP1 521 11719 47.70 Active

3010946 CLO Nebulizer TxNP1 521 94640 50.88 Active

3011002 CLO Needle AspirationNP1 521 10021 342.38 Active

3014400 CLO Nerve Block Trigerminal NerveNP1 521 64400 217.30 Active

3010201 CLO New Patient Clinic Level 1NP1 521 99201 166.00 Active

3010202 CLO New Patient Clinic Level 2NP1 521 99202 198.00 Active

3010203 CLO New Patient Clinic Level 3NP1 521 99203 264.00 Active

Page 31: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3010204 CLO New Patient Clinic Level 4NP1 521 99204 355.00 Active

3019205 CLO New Patient Clinic Level 5NP1 521 99205 474.00 Active

3019387 CLO NEW PATIENT WELLNESS > 64 YRSNP1 521 99387 436.00 Active

3019385 CLO NEW PATIENT WELLNESS 18-39 YRSNP1 521 99385 354.00 Active

3019386 CLO NEW PATIENT WELLNESS 40-64 YRSNP1 521 99386 387.00 Active

3013752 CLO NG TubeNP1 521 43752 306.34 Active

3019308 CLO NH Round Level 2NP1 525 99308 144.00 Active

3019309 CLO NH Round Level 3NP1 525 99309 209.00 Active

3019304 CLO Nursing Home AdmitNP1 521 99304 191.00 Active

301236 CLO OBS HighNP1 521 99220 460.00 Active

3010234 CLO OBS lowNP1 521 99218 269.00 Active

301235 CLO OBS ModNP1 521 99219 367.00 Active

3010091 CLO PAP SMEAR COLLECTIONNP1 521 Q0091 25.44 Active

301181 CLO Patella StablizerNP1 274 L1830 116.60 Active

3019401 CLO PFT (Spirometry)NP1 521 94010 155.82 Active

3010160 CLO Puncture Aspiration Abcess, HematomaNP1 521 10160 125.08 Active

3015222 CLO REMOVAL FB; CORNEA, W/SLIT LAMPNP1 521 65222 258.64 Active

3010692 CLO REMOVAL IMPACTED CERUMEN W INSTRNP1 521 69210 138.00 Active

3011983 CLO REMOVAL WITH REINSERTION IMPLANTNP1 521 11983 361.46 Active

3011982 CLO REMOVAL, NON-BIODEGRABLE IMPLANTNP1 521 11982 331.78 Active

30149445 CLO REPLACEMENT OF JEJUNOSTOMY TUBENP1 521 43760 887.22 Active

3010210 CLO Rib BeltNP1 521 L0220 37.10 Active

3017602 CLO RMVL DVT TISS DEBRIDEMENT WO ANESNP1 521 97602 133.08 Active

3011303 CLO Shave biopsy sng lesion 0.6 to 1.0cmNP1 521 11301 217.18 Active

3010310 CLO Shave Epidermal/Dermal Les .5<(face.NP1 521 11310 217.30 Active

3011311 CLO Shave Epidermal/Dermal Les .6-1.0NP1 521 11311 279.84 Active

3011306 CLO Shave Sin Les 0.6-1.0 (scalp,neck..)NP1 521 11306 236.38 Active

3010300 CLO Shave single lesion (trunk,arms..NP1 521 11300 189.74 Active

3011305 CLO Shaving Epidermal/Dermal Les .5 or <NP1 521 11305 202.46 Active

3010307 CLO Shaving Epidermal/Dermal Les 1.1-2.0NP1 521 11307 261.82 Active

3010405 CLO Short Leg CastNP1 521 29405 349.80 Active

3013655 CLO Shoulder Reduction w/Man & No AnesNP1 521 23650 1023.96 Active

3010200 CLO Skin Tag Removal any method up to 15NP1 521 11200 200.34 Active

3011201 CLO Skin Tag removal; ea additional 10NP1 521 11201 73.14 Active

3010940 CLO Spirometry Pre/Post bronchodilatorNP1 521 94060 223.66 Active

3019211 CLO SPORTS PHYSICALNP1 521 30.00 Active

3010777 CLO Swing Bed RoundNP1 524 99213 110.00 Active

3010552 CLO Trigger Point Inj 1 or 2 musclesNP1 521 20552 238.50 Active

3010553 CLO Trigger Point Inj 3 or more musclesNP1 521 20553 246.98 Active

3010127 CLO TRIMMING OF DYSTROPHIC NAILS ANY #NP1 521 G0127 58.30 Active

3010344 CLO Welcome to Medicare(first 12 months)NP1 521 G0402 292.56 Active

3010392 CLO Well Child 1-4 yrs.NP1 521 99392 186.00 Active

3010394 CLO Well Child Exam 12-17 yrsNP1 521 99394 217.00 Active

3010393 CLO Well Child Exam 5-11 yrsNP1 521 99393 201.00 Active

3010381 CLO Well Child New Patient < 1 yrNP1 521 99381 212.00 Active

3010384 CLO Well Child New Patient 12-17NP1 521 99384 262.00 Active

3019938 CLO Well Child New Patient 1-4 yrsNP1 521 99382 229.00 Active

Page 32: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3019383 CLO WELL CHILD NEW PATIENT 5-11NP1 521 99383 245.00 Active

3010395 CLO Wellness Adult 18-39 yrs.NP1 521 99395 294.00 Active

3010391 CLO Wellness Exam < 1 yr.NP1 521 99391 174.00 Active

3010397 CLO Wellness Exam Adult >65 yrs.NP1 521 99397 365.00 Active

3013908 CLO Wrist 7 Lace Up SupportNP1 274 L3908 27.56 Active

3105605 CLO Wrist Fx/Reduction w/ManipulationNP1 521 25605 2014.00 Active

3010908 CLO Wrist/Forearm DeluxeNP1 274 L3908 10.60 Active

3010807 CLO Wrist/Thumb SplintNP1 274 L3807 53.00 Active

4450898 CLONAZEPAM 0.5MG TABPHAR 250 6.40 Active

4451380 CLONAZEPAM 1MG TABPHAR 250 6.40 Active

4451151 CLONIDINE 0.1MG TABPHAR 250 J3490 6.40 Active

4451375 CLONIDINE 0.3MG TABPHAR 250 6.40 Active

4450421 CLOPIDOGREL 75MG TABPHAR 250 J3490 6.40 Active

4500464 CLOSED IV SYS 20GAIV 264 40.28 Active

3000605 CLOSED RED RADIAL SEDATIONDR 521 24605 2038.38 Active

3020605 CLOSED RED RADIAL SEDATIONNP2 521 24605 2038.38 Active

3015660 CLOSED RED REDIOCARNP1 521 25660 190.80 Active

4550159 CLOSTRIDIUM DIFFICILELAB 300 87324 63.60 Active

4552071 Clostridium difficile rapid testLAB 300 87324 63.60 Active

4451622 CLOTRIMAZOLE 1% 28GMPHAR 259 11.70 Active

4450319 CLOTRIMAZOLE CRM 15G TUBEPHAR 250 6.36 Active

4451187 CLOTRIMAZOLE LOZENGE 10MGPHAR 250 58.40 Active

4451322 CLOTRIMAZOLE/BETAMETHAZONE 45MG CREAMPHAR 250 231.08 Active

4550160 CMP: COMPREHMETOBOLIC PANLAB 300 80053 204.58 Active

4550901 CMV - Quant by PCRLAB 300 87497 327.54 Active

4600013 CMV AB Testing (ARC)BB 300 86644 172.78 Active

4550161 CMV IGGLAB 300 86644 77.38 Active

4550259 CMV IGMLAB 300 86645 77.38 Active

4550989 CO: Carbon MonoxideLAB 300 82376 77.38 Active

4550873 CO2: CARBON DIOXIDELAB 300 82374 48.76 Active

4552091 Coagulation Factor VIII Activity AssayLAB 300 85240 208.82 Active

4551172 COBALT (HEAVEY METALS)LAB 300 83018 281.96 Active

4401832 COBAN 2SUP 270 61.48 Active

4550169 COC Confirm: QuantLAB 300 82520 58.30 Active

4551196 COCAINE CONFIRMATION URINELAB 300 80353 77.38 Active

4550176 Coccidioides AB PanelLAB 300 86635 157.94 Active

4552043 Cockroach - IgELAB 300 86003 33.92 Active

4552023 Coconut IgELAB 300 86003 33.92 Active

4551092 Codfish - IgELAB 300 86003 33.92 Active

4450128 COLCHICINE 0.6MG TABPHAR 250 23.30 Active

4400439 COLD / HOT PACKSUP 270 15.90 Active

4551240 COLD AGGLUTININ TITERLAB 300 86157 82.68 Active

4400219 COLESTOMY WAFERSUP 270 15.90 Active

4401684 COLLES SPLINT LG PADSUP 270 15.90 Active

4400698 COLLES SPLINT MED-RSUP 270 14.84 Active

4400717 COLLES SPLINT XL-LSUP 270 15.90 Active

3500007 COLONSCOPY - DIAGNOSENDO 750 45378 816.20 Active

Page 33: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3500032 COLONSCOPY POLYP REMOVED WITH SNAREENDO 750 45385 822.56 Active

3500008 COLONSCOPY W/BIOPSYENDO 750 45380 1224.30 Active

4550172 Colorado Tick Fever, IgGLAB 300 86790 121.90 Active

4400223 COLOSTOMY ADAPT SKINSUP 270 29.68 Active

4400224 COLOSTOMY ADAPT STRISUP 270 15.90 Active

4400220 COLOSTOMY FLANGE 2 1SUP 270 152.64 Active

4401048 COLOSTOMY POUCHSUP 270 245.92 Active

4400226 COLOSTOMY POUCH TWOSUP 270 156.88 Active

4400222 COLOSTOMY,OSTOMY DEOSUP 270 131.44 Active

4400028 COMB 8"SUP 270 7.42 Active

4400231 COMBITUBE TRACHEAL ASUP 270 217.30 Active

4450734 COMBIVENT INHALERPHAR 250 476.00 Active

4300026 COMFORT 2 LITE MASKDME 270 A7034 166.42 Active

4401774 COMFORT BATHSUP 270 8.48 Active

4401919 COMFORT FORM WRIST/THUMBSUP 270 21.20 Active

4401920 COMFORT FORM WRIST/THUMB L-LGESUP 270 21.20 Active

4401918 COMFORT FORM WRIST/THUMB L-SMSUP 270 21.20 Active

4401921 COMFORT FORM WRIST/THUMB L-XLSUP 270 21.20 Active

4401916 COMFORT FORM WRIST/THUMB R-LGSUP 270 21.20 Active

4401914 COMFORT FORM WRIST/THUMB R-SMSUP 270 21.20 Active

4401917 COMFORT FORM WRIST/THUMB R-XLSUP 270 21.20 Active

4300001 COMFORT GEL FULL CUSHIONDME 270 A7031 97.52 Active

4300017 COMFORT GEL FULL FACE MASKDME 270 A7030 254.40 Active

4300071 COMFORT GEL NASAL MASKDME 270 A7034 166.42 Active

4300024 COMFORT GEL SILCONE FLAPDME 270 A9999 26.50 Active

4300030 COMFORT LITE 2 MASKDME 270 A7034 254.40 Active

4401738 COMFORT LITE 2 MASKDME 270 A7034 260.76 Active

4401740 COMFORT LITE CUSH ELBOWSUP 270 A7045 15.90 Active

4300044 COMFORT SELECT NASAL MASKDME 270 A7034 166.42 Active

4300034 COMFORTSELECT NASAL CUSHIONDME 270 A7032 73.14 Active

4300035 COMFT FULL MASK 2DME 270 A7030 254.40 Active

4300038 COMMODE OVERSIZEDME 270 172.78 Active

4300002 COMMODE PURCHASEDME 270 E0164 172.78 Active

4450623 COMPAZINE TAB 5 MGPHAR 250 23.30 Active

4551127 COMPLEMENT, TOTAL SERUMLAB 300 86162 241.68 Active

4250169 COMPRESSION GLOVESUP 270 10.60 Active

4401959 COMPRESSION SLEEVE - LGSUP 270 143.10 Active

4401960 COMPRESSION SLEEVE - MEDSUP 270 143.10 Active

4300003 CONCENTRATOR DMEDME 270 E1390 450.50 Active

4700008 CONCENTRATOR OXYGENOXY 270 403.86 Active

4551063 CONFIRMATION OXYCODONELAB 300 82205 57.24 Active

4550442 Congenital Adrenal HyperplasiaLAB 300 83498 22.26 Active

4550633 Congenital HypothyroidismLAB 300 84437 22.26 Active

4700009 CONTENTRATOR OXYGENOXY 270 146.31 Active

4300054 CONTINUOUS PULSE OXIMETRYDME 460 94762 113.42 Active

4401777 CONTOURED BACK SUPPORTSUP 270 72.08 Active

4551031 Copper (Serum)LAB 300 82525 97.52 Active

Page 34: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450129 CORDARONE 200MG TABPHAR 250 11.66 Active

4250102 CORFIT BELTPT 270 152.64 Active

4401705 CORNSTARCH POWDERSUP 270 8.48 Active

4550186 CORT (24 UR): FREELAB 300 82530 68.90 Active

4550184 CORTISOLLAB 300 82533 161.12 Active

4550185 CORTISOL - POST-ACTHLAB 300 82533 161.12 Active

4551187 Cortisol, SalivaLAB 300 82533 161.12 Active

4550188 CORTISOl: FREE(24 HR UR)LAB 300 82530 165.36 Active

4450605 CORTROSYN 0.25MG IMPHAR 636 257.58 Active

4451154 COTROSYN 0.25 MG IVPHAR 259 226.84 Active

4552055 Cottonwood- IgELAB 300 86003 33.92 Active

4451424 COUGH DROPPHAR 250 6.40 Active

4551926 Cow Dander, IgELAB 300 28.62 Active

4250118 COWBOY COLLARPT 270 230.02 Active

4400216 CO-WRAP 2"SUP 270 8.48 Active

4400217 CO-WRAP 3"SUP 270 8.48 Active

4400218 CO-WRAP 4"SUP 270 8.48 Active

4450939 COZAAR 100MG POPHAR 250 11.66 Active

4300079 CPAP POWER CORD 1005894DME 270 40.28 Active

4300075 CPAP TUBING WITH INTEGRATED HEATINGDME 270 A4604 101.76 Active

4300004 CPAP UNITDME 270 E0601 222.60 Active

4300086 CPAP WATER CHAMBERDME 270 A7046 33.92 Active

4300055 CPAP WIPESDME 270 E1399 11.66 Active

4550895 C-PeptideLAB 300 84681 212.00 Active

4451257 C-PHEN DM DROPS 1 MLPHAR 250 6.36 Active

4550190 CPK LAB 300 82550 68.90 Active

4550956 CPK Isoenzymes PanelLAB 300 82552 124.02 Active

3300002 CPR ED 450 92950 490.78 Active

4552033 Crab- IgELAB 300 86003 33.92 Active

4451272 CRANBERRY TABPHAR 250 6.36 Active

4550193 CREAT (24 HR URINE)LAB 300 82570 57.24 Active

4550195 CREAT (CREATININE)LAB 300 82565 42.40 Active

4551231 CREATININE BODY FLUIDLAB 300 82570 51.19 Active

4550198 Creatinine ClearanceLAB 300 82575 90.10 Active

4450958 CRESTOR 20MGPHAR 250 11.66 Active

4451425 CRESTOR TAB 5MGPHAR 250 6.40 Active

4400516 CRISS-CROSS LUMBAR SSUP 270 160.06 Active

4552096 Crithidia, IFALAB 300 86255 1.06 Active

3060291 CRITICAL CARE 1ST HR (LOCUM)LOC 521 99291 1090.00 Active

3300004 Critical Care 74 minutes - FacilityED 450 99291 817.00 Active

3060292 CRITICAL CARE ADD 30 MIN (LOCUM)LOC 521 99292 545.00 Active

3300005 Critical Care Each Add'l 30 min - Fac.ED 450 99292 409.00 Active

4551210 CRMP 5 IGGLAB 300 62.54 Active

4600014 CrossmatchBB 300 86921 111.30 Active

4600053 Crossmatch 2BB 300 86921 111.30 Active

4451142 CROTALIDAE POLYVALENT (1BX/2VIALS)PHAR 636 J3490 4891.15 Active

4700010 CROUP TENT P/DAYOXY 270 47.70 Active

Page 35: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4550202 CRP LAB 300 86140 67.84 Active

4550200 CRP - HS (HIGH SENSITIVE)LAB 300 86141 102.82 Active

4401922 CRUTCH LARGESUP 270 53.00 Active

4300006 CRUTCH PURCHASEDME 270 E0111 32.86 Active

4400240 CRUTCHES MEDSUP 270 72.08 Active

4559011 Cryglobulin and Cryofibrinogen Panel Active

4550205 CryofibrinogenLAB 300 82585 68.90 Active

4550206 CryoglobulinLAB 300 82595 63.60 Active

4559163 Cryoglobulin and Cryofibrinogen Panel Active

4551135 CRYPTOSPORIDIUM AG STOOLLAB 300 87272 80.56 Active

4570060 CT ABD/PEL W & W/O CONTRACT 350 74178 2760.24 Active

4570059 CT ABD/PEL W/ CONTRASTCT 350 74177 2113.64 Active

4570058 CT ABD/PEL W/O CONTRASTCT 350 74176 1380.12 Active

4570003 CT ABDOMEN WITH AND WITHOUT CONTRASTCT 350 74170 1635.58 Active

4570002 CT ABDOMEN WITH CONTRASTCT 350 74160 1362.10 Active

4570001 CT ABDOMEN WITH OUT CONTRASTCT 350 74150 1310.16 Active

4570125 CT ABDOMEN WO AND W CONTRASTCT 350 74170 2234.48 Active

4570004 CT C Spine w/o ContrastCT 350 72125 1446.90 Active

4570124 CT CHEST ABD PEL W CONTRAST Active

4570123 CT CHEST ABD PEL W O CONTRAST Active

4570118 CT CHEST HI RESOLUTIONCT 350 1478.70 Active

4570008 CT Chest-Thorax w ContrasCT 350 71260 1757.48 Active

4570007 CT Chest-Thorax w/o ContrCT 350 71250 1406.62 Active

4570009 CT Chest-Thorax w/o+w ConCT 350 71270 2126.36 Active

4570010 CT Facial-Sinus w/o ContrCT 350 70486 1270.94 Active

4570012 CT Facial-Sinus w/o+w ConCT 350 70488 1732.64 Active

4570014 CT Head-Brain w ContrastCT 350 70460 1503.08 Active

4570013 CT Head-Brain w/o ContrasCT 350 70450 1135.26 Active

4570015 CT Head-Brain w/o+w ContrCT 350 70470 1832.74 Active

4570119 CT IVP KIDNEYS-URETERS-BLADDERCT 352 74177 2124.24 Active

4570017 CT L Spine w/o ContrastCT 350 72131 1417.22 Active

4570039 CT Low Extrem Right w ContrastCT 350 73701 1274.12 Active

4577370 CT LOWER EXT LEFTCT 352 73700 1155.40 Active

4570038 CT LOWER EXT LEFT W CONCT 350 73701 1274.12 Active

4570040 CT LOWER EXT LEFT W O AND W CONCT 350 73702 1614.38 Active

4573700 CT LOWER EXT RIGHTCT 352 73700 1155.40 Active

4753702 CT LOWER EXT RIGHT W O AND W CONCT 350 73702 1614.38 Active

4570120 CT NECK SOFT TISSUE W WO CONTRASTCT 350 70492 1758.54 Active

4570022 CT Neck Tissue w ContrastCT 350 70491 1419.34 Active

4570021 CT Neck Tissue w/o ContraCT 350 70490 1284.72 Active

4570061 CT PELVISCT 350 72192 1250.80 Active

4570057 CT RENAL STONECT 350 74150 1380.12 Active

4570116 CT SINUSES/FACIAL W/CONTRASTCT 350 70487 1455.38 Active

4570035 CT T Spine w/o ContrastCT 350 72128 1422.52 Active

4570041 CT UP EXT (LEFT) W/O CONCT 350 73200 1132.08 Active

4570115 CT UP EXT RIGHT) W/O CONCT 350 73200 1132.08 Active

4570043 CT Up Extrem w/o+w ContraCT 350 73202 1369.52 Active

Page 36: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

5880011 CT/MRI N. MT HOSP (HAVRE)DNU 320 0.00 Active

4570050 CTA AAA AbdCT 350 2233.42 Active

4570056 CTA PE PulmonaryCT 350 71275 2489.94 Active

4550221 CULT: SPUTUMLAB 300 87070 79.50 Active

4550216 CULT: WOUNDLAB 300 87070 79.50 Active

4550235 CULTURE + GS: BODY FLUIDLAB 300 126.14 Active

4552062 CULTURE VIRAL RESPIRATOYLAB 300 163.24 Active

4550243 CULTURE: ANAEROBIC NOT BILAB 300 87075 91.16 Active

4550095 CULTURE: BLOOD - AER + ANA Set #1LAB 300 87040 136.74 Active

4550096 CULTURE: BLOOD -AER + ANA Set #2LAB 300 87040 136.74 Active

4550247 CULTURE: MISCLAB 300 87070 79.50 Active

4550230 CULTURE: STREP B SCN- VAGLAB 300 87070 79.50 Active

4550241 CULTURE: THROATLAB 300 87070 79.50 Active

4550242 CULTURE: URINELAB 300 87086 79.50 Active

4451265 CULTURELLE CAPPHAR 250 6.36 Active

4450004 CULTURELLE PROBIOTIC CAP.PHAR 250 J3490 6.40 Active

4401698 CUSHION CPAP MASKSUP 270 62.54 Active

4558834 CUTANEOUS IMMUNOFLUROESCENCE ANTI IGG Active

3060211 CV LEVEL 1 (LOCUM)LOC 521 99211 76.00 Active

3060212 CV LEVEL 2 (LOCUM)LOC 521 99212 108.00 Active

3060213 CV LEVEL 3 (LOCUM)LOC 521 99213 135.00 Active

3060214 CV LEVEL 4 (LOCUM)LOC 521 99214 206.00 Active

3060215 CV LEVEL 5 (LOCUM)LOC 521 99215 323.00 Active

4401769 CVL STAT #3SUP 270 72.08 Active

4401770 CVL STAT #4SUP 270 72.08 Active

4550249 CYANIDELAB 300 82600 258.64 Active

4450205 CYCLOBENZAPRINE 10MGPHAR 250 6.40 Active

4450204 CYCLOBENZAPRINE 10MG *OUT PT PK*PHAR 250 6.40 Active

4550256 CYCLOSPORINE (EDTA BLOOD)LAB 300 80158 118.72 Active

4451149 CYPROHEPTADINE HCL 4MG.PHAR 250 6.36 Active

4550438 Cystic FibrosisLAB 300 83516 22.26 Active

4551193 CYSTIC FIBROSIS MUTATION ANALYSIS 106 MPLAB 300 81220 394.32 Active

4451114 CYTOMEL 25 MCQ POPHAR 250 6.36 Active

4550158 CZP: ClonazepamLAB 300 80154 165.36 Active

4500018 D5W 1000CCIV 258 34.98 Active

4500019 D5W 100CCIV 258 44.52 Active

4500006 D-5-W 250 ML GLASS BIV 270 19.08 Active

4500016 D5W 250CCIV 258 28.62 Active

4500015 D5W 500CCIV 258 19.08 Active

4451340 DAIRY AID SUPPLEMENTPHAR 250 6.36 Active

4559025 Dairy and Grain Allergen Profile Active

4451630 DAPTOMYCIN INJ 500MGPHAR 259 J0878 1155.40 Active

4450738 DARBEPOETIN ALFA 100mcg/0.5mLPHAR 636 J0881 1620.15 Active

4451274 DARBEPOETIN ALFA 25mcg/0.42mlPHAR 636 J0881 706.30 Active

4451060 DARBEPOETIN ALPHA 40MCG VIALPHAR 636 J0881 630.70 Active

4450925 DARBEPOETIN ALPHA 60MCG VIALPHAR 636 J0881 1020.78 Active

4600001 DAT BB 300 86880 66.78 Active

Page 37: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4600016 DAT (ARC)BB 300 86880 66.78 Active

4551927 D-DIMERLAB 300 85379 135.68 Active

3020721 DEBRIDMENT TOENAILS 6 OR MORENP2 521 11721 85.86 Active

4350025 DECUBITUS CAREPROC 270 11.66 Active

4450156 DEEP SEA NASAL SRY BTL1.5PHAR 250 6.36 Active

4400245 DEFIB PADS *1SUP 270 15.90 Active

4350026 DEFIBRILLATIONPROC 270 40.28 Active

4350027 DEFIBRILLATION SYNCOPROC 270 40.28 Active

3100010 DELIVERYIP 720 769.56 Active

4300021 DELUXE CHIN STRAPDME 270 A7036 62.54 Active

4451051 DEMECYCLINE 300MG. P.O.PHAR 259 58.30 Active

3012175 DEMEROL/MEPERIDNE 50 MG (TO)NP1 521 J2175 58.30 Active

4401678 DENTURE ADHESIVESUP 270 15.90 Active

4400247 DENTURE CUPSUP 270 8.48 Active

4400248 DEODRANTSUP 270 11.66 Active

4451143 DEPAKOTE 125 MGPHAR 250 6.40 Active

4450909 DEPAKOTE 500MG POPHAR 250 11.66 Active

4450148 DEPR-MEDROL 80MG/MLPHAR 259 23.32 Active

4400249 DERMABOND TOPICAL SKSUP 270 145.22 Active

4401799 DERMAGRANSUP 270 129.32 Active

4401842 DERMAGRAN-BSUP 270 61.48 Active

4450150 DERMOGRAMPHAR 250 58.30 Active

4450153 DETROL LA 2MG TABPHAR 250 6.40 Active

4500029 DEX 5 % / LACTATED RINGERS 1000MLIV 258 45.58 Active

4500021 DEX 5% W/ .9% NACLIV 258 37.10 Active

4770000 DEXA BONE DENSITY SCN AXLDEXA 320 77080 333.90 Active

4450142 DEXAMETH SOD 0.1% OPTHALPHAR 250 231.10 Active

4451233 DEXAMETHASONE (IN PPD)PHAR 250 6.36 Active

3021100 DEXAMETHASONE 1 MGNP2 521 J1100 11.66 Active

4450155 DEXAMETHASONE 10MG/MLPHAR 636 J1100 6.40 Active

4450749 DEXAMETHASONE 4MG POPHAR 250 J3490 11.70 Active

4450141 DEXAMETHASONE 4MG/MLPHAR 636 J1100 11.70 Active

4500023 DEXTROSE 5% W/.45% NACLIV 258 37.10 Active

4451343 DEXTROSE 50% SYRINGEPHAR 636 J3490 58.40 Active

4550266 DHEA SULFATELAB 300 82627 178.08 Active

4550267 DHEA UNCONJUGATEDLAB 300 82626 218.36 Active

4401670 DIABETISHIELD (RESOURCE)SUP 270 8.48 Active

4401905 DIAPER ADULT XLGESUP 270 5.30 Active

4400251 DIAPER ATTENDS MED;SUP 270 166.42 Active

4401976 DIAPER, INFANT SIZE 2SUP 270 5.00 Active

4401977 DIAPER, INFANT SIZE 3SUP 270 5.00 Active

4401978 DIAPER, INFANT SIZE 4SUP 270 5.00 Active

4401723 DIAPER, PULL-UP EACHSUP 271 8.48 Active

4400266 DIAPERS ADULT MEDSUP 270 14.84 Active

4400257 DIAPERS PAMPERSSUP 270 4.24 Active

4400265 DIAPERS/ ADULT LGESUP 270 8.48 Active

4450549 DIAZEPAM 5MG TABPHAR 250 6.40 Active

Page 38: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450548 DIAZEPAM 10MG/2ML INJPHAR 636 J3360 112.65 Active

4450941 DICLOFENAC /MISOPROSTOL TAB 75MGPHAR 250 11.70 Active

4451303 DICLOFENAC 75MG TABPHAR 250 J3490 6.40 Active

4451159 DICLOFENAC OPTH SOL 0.1%PHAR 250 58.40 Active

4450082 DICYCLOMINE 20MG TABPHAR 250 J3490 6.40 Active

4450083 DICYCLOMINE HCL 20MG/2ML INJPHAR 636 J0500 162.65 Active

4550268 DIFF (MANUAL)LAB 300 85007 28.62 Active

4451217 DIGIBINDPHAR 259 1869.84 Active

4550269 DIGOXIN (LANOXIN)LAB 300 80162 97.52 Active

4451198 DIGOXIN .5MG/2ML INJPHAR 636 J1160 23.30 Active

4450285 DIGOXIN 0.125MG TABPHAR 250 6.40 Active

4450286 DIGOXIN 0.25MG TABPHAR 250 J3490 6.40 Active

4450880 DIITIAZEM ER180 MG POPHAR 250 6.36 Active

4550273 DILANTIN (PHENYTOIN)LAB 300 80185 102.82 Active

4450942 DILANTIN 100MG TABPHAR 250 6.36 Active

4450970 DILTIAZEM ER 360MGPHAR 259 11.66 Active

4450987 DILTIAZEM 125MG/25MLPHAR 259 58.30 Active

4450106 DILTIAZEM 25MG/5MLPHAR 259 11.70 Active

4450826 DILTIAZEM 300 MGPHAR 250 11.66 Active

4450963 DILTIAZEM 60MGPHAR 250 6.36 Active

4451202 DILTIAZEM ER 180 MGPHAR 250 6.40 Active

4451080 DILTIAZEM ER 240MG TABPHAR 250 83.80 Active

4451562 DILTIAZEM TAB 60MGPHAR 250 6.40 Active

4450162 DIOVAN 80MG TABPHAR 250 6.40 Active

4451281 DIPHENHYDRAMINE 2% CREAMPHAR 250 11.66 Active

4450078 DIPHENHYDRAMINE 25MG CAPPHAR 250 6.40 Active

4450727 DIPHENHYDRAMINE 50 MG CAPPHAR 250 6.40 Active

4450077 DIPHENHYDRAMINE 50MG/MLPHAR 636 J1200 6.40 Active

4451266 DIPHENHYDRAMINE CREAMPHAR 250 11.66 Active

4450079 DIPHENHYDRAMINE ELIXIR 12.5MG/5MLPHAR 250 6.40 Active

4451057 DIPHENOX /ATROPINE 2.5mgPHAR 250 J3490 6.40 Active

4450164 DIPRIVAN 1% 10mg/mLPHAR 259 58.40 Active

4451570 DIPYRIDAMOLE 50MG TABPHAR 250 6.40 Active

4401850 DISP B/P CUFFSUP 270 11.66 Active

4401849 DISP DIGITAL THERMOMETERSUP 270 11.66 Active

4400611 DISP RAZORSUP 270 7.42 Active

4300007 DISPOSABLE FINE FILTDME 270 A7038 11.66 Active

4401715 DISPOSABLE FRACTURE PANSUP 270 15.90 Active

4400002 DISPOSABLE GLOVESSUP 270 28.62 Active

4401709 DISPOSABLE SCAPEL #10SUP 270 8.48 Active

4400269 DISPOSABLE SCAPEL #11SUP 270 8.48 Active

4400270 DISPOSABLE SCAPEL #15SUP 270 8.48 Active

4450736 DIVALPROEX 250MG DR TABPHAR 250 6.40 Active

4401672 DNA COLLECT/SWABSUP 270 15.90 Active

4450168 DOBUTAMINE 250MG/20MLPHAR 250 12.00 Active

4451334 DOCUSATE LIQUID 60mg/15mlPHAR 250 6.40 Active

4450839 DOCUSATE SOD 100 MGPHAR 250 J3490 6.40 Active

Page 39: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4451406 DOCUSATE SOD./SENNA 50MG/8.6MGPHAR 250 J3490 6.40 Active

4552040 Dog Dander - IgELAB 300 86003 33.92 Active

4250096 DON JOY BRACEPT 270 L1845 1060.00 Active

4450045 DONEPEZIL 10MG TABPHAR 250 J3490 6.40 Active

4450046 DONEPEZIL 5 MG TABPHAR 250 J3490 6.40 Active

4450802 DOPAMINE 200MG/5MLPHAR 636 J1265 6.40 Active

4451417 DOPAMINE 400MG/5MLPHAR 250 6.40 Active

4451100 DOXAZOSIN 1MG TABPHAR 250 6.36 Active

4451374 DOXAZOSIN 8 MG TABPHAR 250 6.40 Active

4450561 DOXYCYCLINE 100MG TABPHAR 250 J3490 6.40 Active

4450999 DOXYCYCLINE 100MG TAB *OUT PT PK*PHAR 250 11.70 Active

4401699 DR. BOB TRACTION KIT-PTSUP 270 143.10 Active

4401864 DRAPE SHEETSUP 270 5.30 Active

4401129 DRESSING CHANGESUP 270 30.74 Active

4250166 DRESSING STICK/SHOEHORNSUP 270 21.20 Active

4401871 DRESSING XEROFORM 1X8SUP 270 5.30 Active

4400278 DRESSING XEROFORM PESUP 270 8.48 Active

4450126 DUCOSATE SODIUM 100MG POPHAR 250 6.36 Active

4450174 DULCOLAX 10MG SUPPPHAR 250 6.36 Active

4450759 DULOXETINE 30MG CAPPHAR 250 6.40 Active

4450966 DULOXETINE 60MG CAPPHAR 250 155.80 Active

4400283 DUO DERM (CGF) 6X8SUP 270 29.68 Active

4400285 DUODERM 4X4 CGFSUP 270 15.90 Active

4400286 DUODERM 4X4 XTHINSUP 270 8.48 Active

4400281 DUODERM CGF 6X6SUP 270 72.08 Active

4400287 DUODERM X-THIN 6X6SUP 270 15.90 Active

4450903 DUTASTERIDE 0.5MG TABPHAR 250 J3490 6.40 Active

4559151 E1 & E2 Active

4400288 EAR GOUDE T TUBES 12SUP 270 125.08 Active

4300036 EASY LIFE MASKDME 270 A7034 166.42 Active

4300042 EASY LIFE REPLACMENT CUSHDME 270 A7032 73.14 Active

4300051 EASY PULSE REGULATOR-CONSDME 270 248.04 Active

4550290 EBV-IGA AB BY IFALAB 300 86665 136.74 Active

4550280 EBV-IGG ABLAB 300 86665 48.76 Active

4550282 EBV-IGG AB TO EARLYLAB 300 86663 117.66 Active

4550281 EBV-IGM ABLAB 300 86665 57.24 Active

4550287 EBV-NALAB 300 86664 48.76 Active

4650017 ECHO - FETALDNU 320 76825 436.72 Active

4650018 ECHO DOPPLER COLOR FUS 521 93308 622.06 Active

4653308 ECHO THORACIC LIIMITEDUS 402 93308 485.00 Active

4400290 EGG SHELL FOAM BED PSUP 270 72.08 Active

4400291 EGG SHELL FOAM-CHAIRSUP 270 58.30 Active

4551095 Egg White - IgELAB 300 86003 33.92 Active

4551155 EGG WHITE IGE ANTIBODYLAB 300 40.28 Active

4401876 EGGCRATE WHEELCHAIR PADSUP 270 11.66 Active

4401735 EGGSERCIZERPT 270 15.90 Active

3060005 EKG (LOCUM)LOC 521 93005 132.50 Active

Page 40: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

3450001 EKG HOSPITAL-ER-OBS- MEDICARE CLINICEKG 730 93005 132.50 Active

3010650 ELASTIC SHOULDER IMMOBNP1 521 L3650 102.82 Active

4750044 ELBOW (LEFT) 2 VIEWSXRAY 320 73070 144.16 Active

4750045 ELBOW (LEFT) 3-4 VIEWSXRAY 320 73080 172.78 Active

4750160 ELBOW (RIGHT) 2 VIEWSXRAY 320 73070 144.16 Active

4750161 ELBOW (RIGHT) 3-4 VIEWSXRAY 320 73080 172.78 Active

4401969 ELBOW SLEEVE LGESUP 270 10.60 Active

4401968 ELBOW SLEEVE MEDSUP 270 10.60 Active

4401967 ELBOW SLEEVE SMSUP 270 10.60 Active

4401970 ELBOW SLEEVE XLGSUP 270 10.60 Active

4250022 ELECT.STIM UNATTENDEDPT 420 97014 51.94 Active

4250025 ELECTRIC STIMULATIONPT 420 G0283 51.94 Active

4250024 ELECTRICAL STIMULATIPT 420 97032 59.36 Active

4400303 ELECTRODE POLYHESIVESUP 270 28.62 Active

4400305 ELECTRODES (HUGGABLESUP 270 12.72 Active

4400304 ELECTRODES 3/PKGSUP 270 8.48 Active

4400306 ELECTRODES 5/PKSUP 270 8.48 Active

4550292 ELECTROLYTE PANELLAB 300 80051 97.52 Active

4552052 Elm, IgELAB 300 86003 33.92 Active

4451301 EMEND 150 MG INJPHAR 636 799.24 Active

3300013 EMERGENCY ROOM - L1ED 450 99281 189.00 Active

3300011 EMERGENCY ROOM - L2ED 450 99282 254.00 Active

3300008 EMERGENCY ROOM - L3ED 450 99283 383.00 Active

3300012 EMERGENCY ROOM - L4ED 450 99284 571.00 Active

3300010 EMERGENCY ROOM - L5ED 450 99285 852.00 Active

4401816 EMESIS BAGSUP 270 7.42 Active

4401898 EMESIS BASIN SMALLSUP 270 5.30 Active

4400315 EMESIS BASISN DISP.SUP 270 8.48 Active

4450556 ENALAPRIL 1.25MG/ML INJPHAR 259 155.80 Active

4451028 ENALAPRIL 2.5MG. P.O.PHAR 250 6.36 Active

4454456 ENALAPRIL 5MG TABPHAR 250 6.40 Active

4500095 ENDO EXT SETSUP 270 5.30 Active

4400319 ENDO TUBE CUFFEDSUP 270 8.48 Active

4401754 ENDO TUBE HOLDERSUP 270 72.08 Active

4550879 Endomysial IgA ABLAB 300 86256 171.72 Active

4401090 ENDOSCOPY BIOPSY FORSUP 270 189.74 Active

4400318 ENDOTRACHEAL TUBE 2.5 UNCUFFEDSUP 270 8.48 Active

4400326 ENDOTRACHEAL TUBE 7 CUFFEDSUP 270 33.92 Active

4400322 ENDOTRACHEAL TUBE 7.5 CUFFEDSUP 270 34.98 Active

4400333 ENEMA BUCKETSUP 270 8.48 Active

4350028 ENEMASPROC 270 19.08 Active

4401973 ENFAMIL SINGLE PACKSUP 270 5.00 Active

4450324 ENOXAPARIN 100MG INJPHAR 636 J1650 58.40 Active

4450735 ENOXAPRIN 150MG INJPHAR 636 J1650 305.28 Active

4450321 ENOXAPRIN 30MG INJPHAR 636 J1650 231.10 Active

4450322 ENOXAPRIN 40MG INJPHAR 636 J1650 23.30 Active

4450674 ENOXAPRIN 60MG INJPHAR 636 J1650 58.40 Active

Page 41: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450323 ENOXAPRIN 80MG INJPHAR 636 J1650 58.40 Active

4550760 Enteric Cult: CampyLAB 300 87046 34.98 Active

4550758 Enteric Cult: E coli 0157LAB 300 87046 34.98 Active

4550759 Enteric Cult: Sal + ShigLAB 300 87045 63.60 Active

4551162 Enteric Stool Culture Active

4552061 ENTEROVIRUS NAATLAB 300 217.30 Active

4451158 ENTOCORT EC 3MG. P.O.PHAR 250 11.66 Active

4450185 EPINEPHRINE [1 MG/ mL] AMPULEPHAR 636 J0170 58.40 Active

4450186 EPINEPHRINE [1MG/10ml] SYRINGEPHAR 259 12.00 Active

4550297 EPO: ERYTHROPOTIN ABLAB 300 82668 117.66 Active

4450191 EPOGEN 3000U/VIALPHAR 636 J0885 153.70 Active

4450190 EPOGEN 4000U/VIALPHAR 636 J0885 226.84 Active

4559152 Epstein-Barr Virus (EBV) Antibody Profil Active

4450887 EPTIFIBATIDE 200MG/100MLPHAR 259 2846.00 Active

4401866 ER BOWLSUP 270 5.30 Active

3060281 ER LEVEL 1 (LOCUM)LOC 521 99281 251.00 Active

3060282 ER LEVEL 2 (LOCUM)LOC 521 99282 269.00 Active

3060283 ER LEVEL 3 (LOCUM)LOC 521 99283 510.00 Active

3060284 ER LEVEL 4 (LOCUM)LOC 521 99284 761.00 Active

3060285 ER LEVEL 5 (LOCUM)LOC 521 99285 1135.00 Active

4450194 ERYTHROMYCIN 0.5% OPTH OINTMENTPHAR 250 J3490 23.30 Active

4451135 ERYTHROMYCIN 250 MG TABPHAR 250 6.40 Active

4551216 ERYTHROPOIETIN (EPO)LAB 300 35.25 Active

4550716 ESR [Sed Rate]LAB 300 85651 39.22 Active

4550300 ESTRADIOL (E2)LAB 300 82670 198.22 Active

4550302 ESTRIOLLAB 300 82677 321.18 Active

4550303 ESTROGEN UR + CREAT: URLAB 300 82672 307.40 Active

4550305 ESTROGEN: SERUMLAB 300 82672 258.64 Active

4550306 ESTRONE (E1)LAB 300 82679 198.22 Active

4401806 ETHILON 2-0 FSSUP 270 7.42 Active

4400884 ETHILON 3-0 PS-2SUP 270 41.34 Active

4400900 ETHILON 4-0 (FS-2)SUP 270 8.48 Active

4400839 ETHILON 4-O (P-3)SUP 270 22.26 Active

4401734 ETHILON 5-0 P-1SUP 270 24.38 Active

4400888 ETHILON 5-0 P-3SUP 270 22.26 Active

4400904 ETHILON 5-0 PS-3SUP 270 15.90 Active

4400889 ETHILON 5-0 PS-4SUP 270 47.70 Active

4552095 Ethylene Glycol-SerumLAB 300 80320 155.82 Active

4451628 ETOMIDATE INJ 2 MG/MLPHAR 250 J3490 23.30 Active

4450982 EUCERIN CREAM 4 OZPHAR 250 11.66 Active

4250130 EVAL W/COMP.BANDAGESPT 420 97001 225.78 Active

4250026 EVALUATION - LOW COMPLEXITYPT 420 97161 108.12 Active

4250126 EVALUATION INITIAL/15 MINUTESPT 420 97001 92.22 Active

4250167 EVALUATION MODERATE COMPLEXITYPT 420 97162 146.28 Active

4250027 EVALUATION-HIGH COMPLEXITYPT 420 97163 183.38 Active

3021603 EXCISION, MAL LESION TR/AR/LEGAL 2.1-3CMNP2 521 11603 537.42 Active

3010061 Excision, mal lesion, tr/ar/legl 2.1-3cmNP1 521 11603 537.42 Active

Page 42: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450990 EXELON 3MG POPHAR 250 11.66 Active

4700157 EXHALATION PORTOXY 270 144.16 Active

4500087 EXT SET / FILTERIV 270 13.78 Active

4350031 EYE DROP ADMINISTRATPROC 270 7.42 Active

4451313 EYE MULTIVITAMIN TABPHAR 250 J3490 6.40 Active

4400335 EYE PADSUP 270 8.48 Active

4401780 EYE PATCH W/STRAPSUP 270 8.48 Active

4401773 E-Z WRAPSUP 270 8.48 Active

4750049 FACIAL BONES 2 VIEWSXRAY 320 70140 193.98 Active

4750048 FACIAL BONES 3-6 VIEWSXRAY 320 70150 248.04 Active

4550007 Factor V Activity AssayLAB 300 85220 198.22 Active

4550310 Factor V Leiden MutationLAB 300 81241 479.12 Active

4451401 FAMOTIDINE 10MG TABPHAR 250 6.40 Active

4451400 FAMOTIDINE 20MG TABPHAR 250 6.40 Active

4450401 FAMOTIDINE 20MG/2ML INJPHAR 636 S0028 80.35 Active

4450400 FAMOTIDINE 40 MG TABPHAR 250 6.36 Active

4451328 FASLODEX 500MG INJPHAR 636 J9395 3624.14 Active

4451599 FASLODEX INJ 250MG/5MLPHAR 259 3466.00 Active

4401820 FASTRACESUP 270 6.36 Active

4550317 Fat: Feces (QuLAB 300 82710 120.84 Active

4559143 Fatigue Panel Active

4550322 FECAL FAT - QUAL + RANDOMLAB 300 89125 82.68 Active

4550321 FECAL FAT - QUANT + TIMEDLAB 300 82710 171.72 Active

4550320 FECAL WBC STAINLAB 300 87205 57.24 Active

4400340 FEEDING TUBE INFANTSUP 270 6.36 Active

4450422 FELODIPINE ER 5MG TABPHAR 250 6.36 Active

4451245 FELODIPINE 10MG POPHAR 250 11.66 Active

4750050 FEMUR (LEFT) 2 VIEWSXRAY 320 73552 172.78 Active

4750162 FEMUR (RIGHT) 2 VIEWSXRAY 320 73552 172.78 Active

4450197 FENTANYL 100MCG/2ML INJPHAR 636 J3010 23.32 Active

301301 FENTANYL 100MGNP1 521 J3010 200.34 Active

3023010 FENTANYL 100MGNP2 521 J3010 200.34 Active

4450569 FENTANYL CIT PF 2000MCG/MLPHAR 259 638.00 Active

4450784 FENTANYL PATCH 100MCGPHAR 250 318.00 Active

4451365 FENTANYL PATCH 12MGPHAR 250 81.20 Active

4451066 FENTANYL PATCH 25 MCG.PHAR 250 J3490 13.00 Active

4451067 FENTANYL PATCH 50 MCG.PHAR 250 J3490 58.40 Active

3003010 FENTANYL100MG (M)DR 521 J3010 200.34 Active

4450733 FEOSOL 325MG TABPHAR 250 6.36 Active

4451648 FERAHEME INJ 510 MGPHAR 259 1750.30 Active

4550325 Ferr (Ferritin)LAB 300 82728 48.76 Active

4550326 Ferritin LAB 300 82728 90.10 Active

4451031 FERRLECIT 62.5MG IVPHAR 636 J2916 153.70 Active

4450198 FERROUS SULFATE 325MG TABPHAR 250 J3490 6.40 Active

4451447 Ferrous Sulfate 65 MG TABPHAR 250 6.36 Active

4350032 FETAL MONITOR CHECKPROC 270 40.28 Active

4401874 FETAL MONITOR STRAPSUP 270 11.66 Active

Page 43: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450989 FEXOFENADINE 180 MG POPHAR 250 6.36 Active

4600017 FFP: Random Donor UnitBB 390 P9017 157.94 Active

4450856 FIBER SUPPLEMENT POWDERPHAR 250 J8499 6.40 Active

4450199 FIBER SUPPLEMENT TABPHAR 250 6.40 Active

4550207 FIBRINOGENLAB 300 85384 82.68 Active

4451279 FILGRASTIM 300 MCG INJPHAR 636 J1442 1039.90 Active

4450366 FILGRASTIM 480MCG INJPHAR 636 J1441 1155.40 Active

4450885 FINASTERIDE 5 MG TABPHAR 250 J3490 6.40 Active

4401929 FINGER COT, PADDED 3"SUP 270 5.30 Active

4750051 FINGERS (LEFT) 2-4 VIEWSXRAY 320 73140 124.02 Active

4750163 FINGERS (RIGHT) 2-4 VIEWSXRAY 320 73140 124.02 Active

4451588 FIORICET TAB 50/325/40PHAR 250 6.40 Active

4300066 FITLIFE TOTAL FACE MASKDME 270 A7030 254.40 Active

4400343 FIX DISINFECTANT CLESUP 270 14.84 Active

4400227 FLANGE FLEXTEND 2 1SUP 270 156.88 Active

4400225 FLANGE FLEXTEND 2 3SUP 270 153.70 Active

4550329 FlecaindeLAB 300 80299 132.50 Active

4400344 FLEESE BED PADS 30XSUP 270 84.80 Active

4400346 FLEESE PAD 30X40SUP 270 63.60 Active

4400347 FLEET ENEMASUP 270 6.40 Active

4300022 FLEXFIT 431 STRAPS CPAPDME 292 68.90 Active

4300033 FLEXIFIT 431 FULL MASKDME 270 A7034 254.40 Active

4451608 FLORANEX GRANULESPHAR 250 6.36 Active

4552073 Flow Cytometry with InterpretationLAB 300 86360 212.00 Active

4400348 FLOW LENS MORGANSUP 270 72.08 Active

4451113 FLUCONAZOLE 100 MG. P.O.PHAR 250 J3490 11.70 Active

4451124 FLUCONAZOLE 150MG POPHAR 250 11.70 Active

4451294 FLUCONAZOLE 200MG INJPHAR 259 12.00 Active

4451008 FLUCONAZOLE 200MG POPHAR 250 6.36 Active

4451115 FLUDROCORTISONE 0.1MGPHAR 250 58.40 Active

4550331 Fluid Smear CrystalLAB 300 89060 55.12 Active

4450465 FLUMAZENIL 0.5MG/5ML INJ.PHAR 259 23.30 Active

4350033 FLUORISCEN-ER EYE STPROC 270 16.96 Active

4450977 FLUOXETINE 10MG TABPHAR 250 6.40 Active

4450212 FLUOXETINE 20MG TABPHAR 250 J3490 6.40 Active

4450211 FLUOXETINE 40 MGPHAR 250 11.66 Active

4350034 FLUSH HEPLOCK/GROSHOPROC 259 8.48 Active

4450207 FLUTICASONE NASAL SPRAYPHAR 250 58.40 Active

4450808 FLUTICASONE/SALMETERO DISCUS 250/50MCGPHAR 250 J3490 624.34 Active

4450011 FLUTICASONE/SALMETEROL DISCUS 100/50MCGPHAR 250 J3490 304.22 Active

4451212 FLUTICASONE/SALMETEROL HFA [115/21]PHAR 250 594.66 Active

300203 FLUZONE (M)DR 521 32.89 Active

4450633 FLUZONE INJ *FLU SHOT*PHAR 259 90686 58.40 Active

4401736 FOAM HAND GRIPPT 270 9.54 Active

4400350 FOAM PAD - DONUTSUP 270 15.90 Active

4250164 FOAM ROLLER 6'X12'SUP 270 21.20 Active

4400351 FOAM WEDGE PADSUP 270 142.04 Active

Page 44: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4400371 FOLEY CATH 16FR SILISUP 270 15.90 Active

4401695 FOLEY 2-WAY DEVICESUP 270 29.68 Active

4401804 FOLEY 2-WAY DEVICESUP 270 14.84 Active

4401132 FOLEY CATHSUP 270 50.88 Active

4400358 FOLEY CATH 12 FR 30SUP 270 45.58 Active

4400356 FOLEY CATH 12 FR 5CCSUP 270 72.08 Active

4400360 FOLEY CATH 14 FR IM0SUP 270 28.62 Active

4401169 FOLEY CATH 14 FR 30 CCSUP 270 15.90 Active

4400359 FOLEY CATH 14 FR 5CCSUP 270 72.08 Active

4400361 FOLEY CATH 16 FR 5CCSUP 270 45.58 Active

4400362 FOLEY CATH 16 FR 30 USUP 270 14.84 Active

4400368 FOLEY CATH 16 FR HARDSUP 270 72.08 Active

4400363 FOLEY CATH 18 FR 5CCSUP 270 107.06 Active

4400367 FOLEY CATH 18FR 30CCSUP 270 14.84 Active

4400370 FOLEY CATH 20 FR 30CSUP 270 72.08 Active

4400364 FOLEY CATH 20 FR 5CCSUP 270 15.90 Active

4401688 FOLEY CATH 22 FR 5CCSUP 270 72.08 Active

4401682 FOLEY CATH 22FR 5CCSUP 270 15.90 Active

4400365 FOLEY CATH 24 FR 30CSUP 270 15.90 Active

4400366 FOLEY CATH 8 FR 3CCSUP 270 15.90 Active

4400799 FOLEY CATH 8FRSUP 270 77.38 Active

4400355 FOLEY CATH SIZE 10 FRSUP 270 29.68 Active

4400353 FOLEY CATH TRAY - NOSUP 270 47.70 Active

4400372 FOLEY CATH TRAY 18 FRSUP 270 72.08 Active

4401746 FOLEY INSER TRAYSUP 270 15.90 Active

4400354 FOLEY STRAIGHT CATH 1SUP 270 8.48 Active

4450755 FOLIC ACID 1MGPHAR 250 6.36 Active

4450743 FOLIC ACID 1MG TABPHAR 250 J3490 6.40 Active

4451243 FOLIC ACID INJECT 5MG/MLPHAR 259 11.70 Active

4451560 FOLIC ACID TAB 400MCGPHAR 250 6.36 Active

4750057 FOOT (LEFT) 2 VIEWSXRAY 320 73620 144.16 Active

4750056 FOOT (LEFT) 3-4 VIEWSXRAY 320 73630 178.08 Active

4750164 FOOT (RIGHT) 2 VIEWSXRAY 320 73620 144.16 Active

4750165 FOOT (RIGHT) 3-4 VIEWSXRAY 320 73630 178.08 Active

4750058 FOREARM (LEFT) 2 VIEWSXRAY 320 73090 144.16 Active

4750166 FOREARM (RIGHT) 2 VIEWSXRAY 320 73090 144.16 Active

4350035 FOREIGN BODY REMOVALPROC 270 40.28 Active

4400176 FORM FIT CERVICAL COLLAR - MESUP 270 15.90 Active

4400177 FORM FIT CERVICAL COLLAR - SMSUP 270 48.76 Active

4400179 FORM FIT CERVICAL COLLAR XLGSUP 270 15.90 Active

4450213 FOSAMAX + D POPHAR 250 122.96 Active

4550863 Francisella tularensis Serology Active

4401817 FREEDOM CATH(CASE)SUP 270 272.42 Active

4550335 FSH [Foll Stim Hormone]LAB 300 83001 134.62 Active

4550991 FSH + LD: FSHLAB 300 83001 134.62 Active

4550992 FSH + LD: LDLAB 300 83002 134.62 Active

4550339 Fung Organ ID+Sens: IDLAB 300 87107 48.76 Active

Page 45: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4550338 Fungal Yeast Org ID [MSL]LAB 300 87106 82.68 Active

4550342 Fungus (Dermal) CultureLAB 300 87101 82.68 Active

4550341 Fungus (Non-Dermal) CultuLAB 300 87102 82.68 Active

4451332 FUROSEMIDE 100 MG/10ML INJPHAR 636 J1940 58.40 Active

4450289 FUROSEMIDE 20MG TABPHAR 250 J3490 6.40 Active

4450962 FUROSEMIDE 20MG/2ML INJPHAR 636 J1940 11.70 Active

4450290 FUROSEMIDE 40MG TABPHAR 250 6.40 Active

4450961 FUROSEMIDE 40MG/4ML INJPHAR 636 J1940 11.70 Active

4451395 GABAPENTIN 100MG CAPPHAR 250 6.40 Active

4451070 GABAPENTIN 300MG CAPPHAR 250 J3490 6.40 Active

4250031 GAIT TRAININGPT 420 97116 82.68 Active

4450871 GAS RELIEF DROPS 40MG/0.6MLPHAR 250 6.36 Active

4450214 GAS RELIEF EXTRA STRENGTH 125MG TABPHAR 250 6.40 Active

4350039 GASTRIC LAVAGEPROC 270 40.28 Active

4400380 GASTRIC LAVAGE KIT (SUP 270 72.08 Active

4400381 GASTRIC LAVAGE TUBESUP 270 15.90 Active

4401928 GASTRIC-JEJUNAL FEEDING TUBESUP 270 530.00 Active

4550347 Gastrin (Serum)LAB 300 82941 126.14 Active

4401814 GASTROCCULTSUP 270 18.02 Active

4400388 GAUZE 2X2 2 PKSUP 270 8.48 Active

4400387 GAUZE 3X3 STERILESUP 270 8.48 Active

4400383 GAUZE 4X4 TRAYSUP 270 10.60 Active

4400385 GAUZE SPONGE 2X2 BULSUP 270 8.48 Active

4400393 GAUZE SPONGE 4X4 BULSUP 270 15.90 Active

4400384 GAUZE SPONGE 4X4 PKSUP 270 8.48 Active

4400382 GAUZE SPONGE 4X4 TRASUP 270 8.48 Active

4400389 GAUZE SPONGE DRAIN 4SUP 270 8.48 Active

4400391 GAUZE SPONGES 3X3 BUSUP 270 15.90 Active

4450312 GEMFIBROZIL 600MG TABPHAR 250 87.80 Active

4451259 GEMZARPHAR 636 J9201 0.00 Active

4450217 GENTAMICIN 80MG/2MLPHAR 636 J1580 6.40 Active

4550349 Gentamicin: PeakLAB 300 80170 110.24 Active

4550348 Gentamicin: TroughLAB 300 80170 110.24 Active

4450216 GENTAMYCIN 0.3% OPTH DROPSPHAR 250 58.40 Active

4451327 GENTAMYCIN 0.3% OPTH OINTMENTPHAR 250 86.60 Active

4451641 GENTAMYCIN 100MG/50MLPHAR 259 11.70 Active

3020486 GEODON 10MGNP2 521 J3486 64.66 Active

3013486 GEODON 10MG (TO)NP1 521 J3486 64.66 Active

300486 GEODON 10MG(M)DR 521 J3486 64.66 Active

4550883 GGT [Gamma GT]LAB 300 82977 68.90 Active

4450219 GI COCKTAIL 60ccPHAR 250 J3490 23.32 Active

4550350 Giardia AG (Feces)LAB 300 87329 151.58 Active

4551134 GIARDIA AG SCREEN STOOLLAB 300 87269 81.62 Active

4451408 GINKGO BILOBA 500MGPHAR 250 6.40 Active

4550877 Gliadin Panel: IgALAB 300 83516 90.10 Active

4550878 Gliadin Panel: IgGLAB 300 83516 90.10 Active

4450023 GLIMEPIRIDE 2MG TABPHAR 250 6.36 Active

Page 46: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4451213 GLIMEPIRIDE 4 MG TABPHAR 250 J3490 6.40 Active

4451087 GLIPIZIDE 5MG TABPHAR 250 6.40 Active

4451054 GLIPIZIDE 5MG. ER P.O.PHAR 250 6.40 Active

4250172 GLOVE TO WRISTSUP 270 254.40 Active

4401783 GLOVE, SURGICAL 61/2 LFSUP 270 8.48 Active

4401872 GLOVE, SURGICAL 71/2 LFSUP 270 5.30 Active

4401983 GLOVE, SURGICAL SZ 6 LFSUP 270 5.00 Active

4401982 GLOVE, SURGICAL SZ 7 LFSUP 270 5.00 Active

4401981 GLOVE, SURGICAL SZ 8 LFSUP 270 5.00 Active

4400392 GLOVES BIOGELSUP 270 15.90 Active

4401702 GLOVES NITRILESUP 270 29.68 Active

4400402 GLOVES PF LGESUP 270 15.90 Active

4400401 GLOVES PF MEDSUP 270 15.90 Active

4400400 GLOVES PF SMALLSUP 270 14.84 Active

4400403 GLOVES PF XLGESUP 270 14.84 Active

4400399 GLOVES PF XSMALLSUP 270 15.90 Active

4400409 GLOVES SIZE 8SUP 270 8.48 Active

4400408 GLOVES SURG SIZE 7 1/2SUP 270 8.48 Active

4401793 GLOVES SURGICAL SZ 6SUP 270 8.48 Active

4400410 GLOVES SURGICAL SZ 61/2SUP 270 8.48 Active

4400407 GLOVES SURGICAL SZ 7SUP 270 A4649 8.48 Active

4550357 Glu: Post DoseLAB 300 82950 57.24 Active

4550352 Glu: 1 Hr Post 50 mg DoseLAB 300 82950 57.24 Active

4450220 GLUCAGON 1MG/ML (EMERGENCY KIT)PHAR 636 J1610 673.95 Active

4350040 GLUCOMETER P/TIMEPROC 270 11.66 Active

4450223 GLUCOSAMINE/CHRONPHAR 250 J3490 6.40 Active

4550353 GlucoseLAB 300 82947 42.40 Active

4550214 GLUCOSE - CSFLAB 300 82947 57.24 Active

4450780 GLUCOSE GEL ORAL 15GMPHAR 250 11.70 Active

4451161 GLUCOSE TABLETPHAR 250 6.36 Active

4559018 Glucose Tolerance Test- Sherry Garriett Active

4550351 Glucose: FastingLAB 300 82947 42.40 Active

4550356 Glucose: Urine (24 Hr)LAB 300 82945 89.04 Active

4550032 GLUTEN, IGELAB 300 86003 33.92 Active

4450337 GLYBURIDE 5MG TABPHAR 250 6.40 Active

4450225 GLYCERIN SUPP 1GM (CHILDRENS)PHAR 250 6.40 Active

4450772 GLYCOLAXPHAR 250 6.36 Active

4450953 GOLD BOND POWDERPHAR 250 11.66 Active

4552049 Grey Alder, IgELAB 300 86003 33.92 Active

4250162 GRIP HANDLE BUTTON HOOS ZIPPER PULLSUP 270 10.60 Active

4500083 GRIPPER PLUS 1"IV 270 53.00 Active

4500078 GRIPPER PLUS EXT SETIV 270 64.66 Active

4401711 GROSHONG CHGSUP 270 24.38 Active

4550880 Growth Hormone: HGHLAB 300 83003 90.10 Active

4550574 Growth Panel: IGF-1LAB 300 84305 132.50 Active

4550346 Growth Panel: IGFBP-3LAB 300 83520 117.66 Active

4451407 GUAIFENESIN 400MG TABPHAR 250 6.40 Active

Page 47: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450352 GUAIFENESIN 600MG TABPHAR 250 J3490 6.40 Active

4451285 GUAIFENESIN CHILDREN 1 TSPPHAR 250 6.36 Active

4451192 GUAIFENESIN/PSEUDOEPHEDRINEPHAR 250 6.36 Active

4450809 GUAIFENESIN/PSUDE 600/125PHAR 250 6.36 Active

4451287 GUAIFENSESIN/COD 100MG/10MG PER 5MLPHAR 250 23.30 Active

4450760 GUAIFENSIN 100MG/5ML SYRUPPHAR 250 96.00 Active

4450534 GUAIFENSIN DM 200/10/5ML LIQUIDPHAR 250 6.40 Active

4451575 GUANFACINE 1MGPHAR 250 6.40 Active

4550388 H Pylori LAB 300 86677 127.20 Active

4550487 Haemophilus Influenza TypeB Antibody IgGLAB 300 86684 103.88 Active

4450635 HALDOL 5MG TABPHAR 250 J1630 58.40 Active

4450996 HALOPERIDOL 2MG POPHAR 250 6.36 Active

4450228 HALOPERIDOL 5MG/ML VIALPHAR 636 J1630 58.40 Active

4451574 HALOPERIDOL DEC 50MG/MLPHAR 259 155.80 Active

4451631 HALOPERIDOL TAB 2 MGPHAR 250 6.40 Active

4750060 HAND (LEFT) 2 VIEWSXRAY 320 73120 136.74 Active

4750059 HAND (LEFT) 3-4 VIEWSXRAY 320 73130 171.72 Active

4750167 HAND (RIGHT) 2 VIEWSXRAY 320 73120 136.74 Active

4750168 HAND (RIGHT) 3-4 VIEWSXRAY 320 73130 171.72 Active

4552020 Hantavirus IgG & IgM Active

4550374 Hantavirus Panel: IgM ABLAB 300 86790 136.74 Active

4550373 Hantvirus Panel: IgG ABLAB 300 86790 136.74 Active

4550376 Haptoglobin (Serum)LAB 300 83010 136.74 Active

4550382 HCG [PG], QualitativeLAB 300 84703 85.86 Active

4550385 Hct [Hematocrit]LAB 300 85014 22.26 Active

4550387 HDL CholesterolLAB 300 83718 68.90 Active

4401810 HEAD BLK STRPS/PADSSUP 270 14.84 Active

4300008 HEADGEARDME 270 A7035 73.14 Active

4300009 HEATED HUMIDIFERDME 270 E0562 495.02 Active

4300088 HEATED TUBING FOR CPAPDME 270 A4604 118.56 Active

4550903 Heavy Metals-U: ArsenicLAB 300 82175 34.98 Active

4550725 Heavy Metals-U: CadmiumLAB 300 82300 34.98 Active

4550726 Heavy Metals-U: LeadLAB 300 83655 90.10 Active

4550723 Heavy Metals-U: MercuryLAB 300 83825 34.98 Active

4250032 HEEL LIFTPT 270 12.72 Active

4400426 HEEL/ELBOW PROTECTORSUP 270 29.68 Active

4401851 HEIMLICH CHEST DRN VALVESUP 270 151.58 Active

4350041 HEIMLICH MANUVER - APROC 270 16.96 Active

4551186 Helicobacter pylori Antigen, FecesLAB 309 87338 153.70 Active

4550741 Hemochromatosis HFE Gene Analysis, BloodLAB 300 81256 380.54 Active

4401813 HEMOCULTSUP 270 7.42 Active

4559166 Hemoglobin and Hematocrit Active

4555660 HEMOGLOBIN S SCREENLAB 300 85660 81.00 Active

4550917 HemoglobinopathiesLAB 300 83020 22.26 Active

4551126 HEP B S AG CONFIRMATIONLAB 300 87341 58.30 Active

4550410 Hep Be AB+AG: ABLAB 300 86707 82.68 Active

4550411 Hep Be AB+AG: AGLAB 300 87350 57.24 Active

Page 48: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4550395 Hep Bs Antigen (Reflex)LAB 300 87340 77.38 Active

4550953 Hep C Virus Quant by bDNALAB 300 87522 395.38 Active

4500091 HEP FLUSH 100ML BOXIV 259 53.00 Active

4550416 Hep P: B+C UnkChr - Bc ABLAB 300 86704 57.24 Active

4550391 Hep P: B+C UnkChr - C ABLAB 300 86803 82.68 Active

4550418 Hep P: B+C UnkChr- Bs AGLAB 300 87340 34.98 Active

4550419 Hep P:B+C UkChr-Bc AB-MLAB 300 86705 55.12 Active

4550407 Hep Pan: ABC PE - Bc ABLAB 300 86704 57.24 Active

4550417 Hep Pan: ABC PE - Bs ABLAB 300 86706 57.24 Active

4550409 Hep Pan: ABC PE - Bs AGLAB 300 87340 34.98 Active

4550420 Hep Pan: ABC PE - C ABLAB 300 86803 82.68 Active

4550406 Hep Pan: ABC PE- A AB TotLAB 300 86708 82.68 Active

4550414 Hep Pan: B Chronic-Be ABLAB 300 86707 82.68 Active

4550415 Hep Pan: B Chronic-Be AGLAB 300 87350 57.24 Active

4550413 Hep Pan: B Chronic-Bs AGLAB 300 87340 34.98 Active

4550408 Hep Pan: B+C UnkChr-BsABLAB 300 86706 94.34 Active

4450233 HEPARIN 1000U/MLPHAR 259 J1642 11.70 Active

4450235 HEPARIN 20,000U/MLPHAR 259 58.30 Active

4450234 HEPARIN 5000U/MLPHAR 636 J1644 11.70 Active

4450383 Heparin/Saline LockPHAR 258 6.36 Active

4550392 Hepatic (Liver) PanelLAB 300 80076 102.82 Active

4550399 Hepatitis A AB - IgMLAB 300 86709 102.82 Active

4550398 Hepatitis A AB, TotalLAB 300 86708 102.82 Active

4450237 HEPATITIS B 20MCG/MLPHAR 259 231.10 Active

4550400 Hepatitis Bc (Total) ABLAB 300 86704 106.00 Active

4550401 Hepatitis Bc AB - IgMLAB 300 86705 115.54 Active

4550402 Hepatitis Be ABLAB 300 86707 102.82 Active

4550421 Hepatitis Be AGLAB 300 87350 77.38 Active

4550397 Hepatitis Bs ABLAB 300 86706 94.34 Active

4550404 Hepatitis Bs AB TiterLAB 300 86706 94.34 Active

4550396 Hepatitis C ABLAB 300 86803 102.82 Active

4552004 Hepatitis C GenotypeLAB 300 87902 810.90 Active

4552087 Hepatitis C Virus (HCV) FibroSURE Active

4550783 Hepatitis C Virus-Quant-RNA (RT-PCR)LAB 300 87522 525.76 Active

4550875 Hepatitis Pan: ABC AcuteLAB 300 80074 238.50 Active

4559027 Hepatitis Panel, Previous Exposure Active

3000786 HEPATITIS VACCINEDR 521 G0010 226.84 Active

3010786 HEPATITIS VACCINENP1 521 G0010 226.84 Active

3020786 HEPATITIS VACCINENP2 521 G0010 226.84 Active

4451263 HEPFLUSH 100U/ML 3 MLPHAR 636 J1642 6.36 Active

4450236 HEP-LOCK FLUSH 100U/ML VIAPHAR 636 J1642 6.40 Active

4450231 HEP-LOCK FLUSH 10U/ML 5MLPHAR 636 J1642 6.40 Active

4451254 HERCEPTIN 420 IVPHAR 636 J9355 5631.78 Active

4551049 HERPES SIMP 1 & 2 BY PCRLAB 300 87529 178.08 Active

4551184 Herpes Simplex Type I & II Antibody- IgG Active

4550425 Hgb [Hemoglobin]LAB 300 85018 22.26 Active

4000016 HH care provided in assisted living faciHH 551 Q5002 0.01 Active

Page 49: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4000017 HH care provided in other placeHH 551 Q5009 0.01 Active

4000015 HH Care Provided in Patients homeHH 551 Q5001 0.01 Active

4000000 HH SERVICESHH 23 0.00 Active

4000004 HH SKILLED AIDEHH 571 G0156 17.76 Active

4000005 HH SKILLED NURSINGHH 551 156.88 Active

4000003 HH SKILLED NURSING-WCHH 551 156.88 Active

4300048 HI LINE DAILY 02 RENTALDME 270 E1390 10.00 Active

4450239 HIBICLENS 4oz bottleSUP 270 61.48 Active

4451129 HIBICLENS 5CCPHAR 270 6.36 Active

4300041 HILINE PORTABLE OXYGENDME 270 10.00 Active

4750064 HIP (LEFT) 1 VIEWXRAY 320 73501 144.16 Active

4750670 HIP (RIGHT) 1 VIEWXRAY 320 73501 144.16 Active

4750906 HIP 2-3 VIEWS LEFT WITH PELVISXRAY 320 73502 140.00 Active

4750905 HIP 2-3 VIEWS RIGHT WITH PELVISXRAY 320 73502 140.00 Active

4550435 HIV 1, P24 AGLAB 300 87390 136.74 Active

4550434 HIV 1/ 2 AB (combo)LAB 300 86703 117.66 Active

4550750 HIV 1+2 AB- Post ExposureLAB 300 86703 110.24 Active

4550439 HIV-1 AB, Western BlotLAB 300 86689 165.36 Active

4550164 HIV-1 ABIMMUNOFLUORENCELAB 300 86689 68.90 Active

4550441 HIV-1 AG, RNA, UltraSensLAB 300 86689 382.66 Active

4550440 HIV-1, AB, RNA, QuantLAB 300 87536 382.66 Active

4550443 HIV-2 ABLAB 300 86702 151.58 Active

4551229 HLA ANTIBODY CLASS ONELAB 300 81372 477.00 Active

4551230 HLA ANTIBODY CLASS TWOLAB 300 81375 265.00 Active

4551220 HLA B27LAB 300 212.00 Active

4550444 HLA-B27LAB 300 86812 191.86 Active

4551088 HLA-DQ typingLAB 300 86816 391.14 Active

4401771 HND SNTZER 2OZSUP 270 8.48 Active

4350090 HOLTER MONITOR 24-48HRPROC 731 93225 348.74 Active

4250033 HOME EVALUATIONPT 420 97535 197.16 Active

4000011 HOME HEALTH AIDE W/CHH 571 17.76 Active

4000018 Home Health Private Pay AidePDN 990 6.40 Active

4000007 HOME HEALTH PT VISITHH 420 G0151 169.60 Active

4550445 Homocystine (Plasma)LAB 300 83090 124.02 Active

4551925 Horse Dander IgELAB 300 28.62 Active

4300045 HOSE ELBOWDME 270 A7045 13.78 Active

3100013 HOSPICE ROOMIP 115 275.60 Active

4350042 HOT MOIST PACKSPROC 270 11.66 Active

4250125 HOTDOG INSERTPT 270 272.42 Active

4552038 House Dust Mites D. farinaeLAB 300 86003 33.92 Active

4552037 House Dust Mites D. pteronyssinusLAB 300 86003 33.92 Active

4559167 HSV 1&2 / VZV PCR Active

4550448 HSV AB Pan: IgG (Type 1)LAB 300 86695 90.10 Active

4550450 HSV AB Pan: IgG (Type 2)LAB 300 86696 90.10 Active

4550453 HSV Culture (Types 1+)LAB 300 87252 165.36 Active

4550458 HTLV - I & II AB (EIA)LAB 300 86687 102.82 Active

4450240 HUMALOG INS PER UNITPHAR 259 2.12 Active

Page 50: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4451577 HUMALOG KWIKPEN 3MLPHAR 259 247.05 Active

4750065 HUMEROUS (LEFT) 2-3 VIEWSXRAY 320 73060 182.32 Active

4750172 HUMEROUS (RIGH) 2-3 VIEWSXRAY 320 73060 182.32 Active

4450242 HUMULIN 70/30 PER UNITPHAR 259 2.12 Active

4450243 HUMULIN N INS PER UNITPHAR 259 2.12 Active

4450241 HUMULIN R INS PER UNITPHAR 259 2.12 Active

3023348 HVG LOW TO MODERATE PROBLEM 25 MINNP2 522 99348 180.00 Active

3029348 HVG MODERATE TO HIGH PROBLEM 40 MINNP2 522 99349 261.00 Active

3021719 HVG NAIL TRIMMING NONDYSTROPHIC NAILSNP2 521 11719 47.70 Active

3029344 HVG NP HIGH SEVERITY 60 MINNP2 522 99344 415.00 Active

3029341 HVG NP HOME VISIT LOW SEVERITY 20 MINNP2 522 99341 180.00 Active

3029342 HVG NP MODERATE SEVERITY 30 MINNP2 522 99342 225.00 Active

3029343 HVG NP MODERATE TO HIGH SEVERITY 45 MINNP2 522 99343 293.00 Active

3029345 HVG NP UNSTABLE SIGNIFICANT PROBLEM75MINNP2 522 99345 561.00 Active

3029347 HVG SELF-LIMITED OR MINOR PROBLEM 15 MINNP2 522 99347 140.00 Active

3021270 HVG TRIMMING OF DYSTROPHIC NAILS ANY #NP2 521 G0127 58.30 Active

3029350 HVG UNSTABLE SIGNIFICANT PROBLEM 60 MINNP2 522 99350 417.00 Active

3039348 HVJ LOW TO MODERATE PROBLEM 25 MINNP3 522 99348 180.00 Active

3039349 HVJ MODERATE TO HIGH PROBLEM 45 MINNP3 522 99349 261.00 Active

3031719 HVJ NAIL TRIMMING NONDYSTROPHIC NAILSNP3 521 11719 47.70 Active

3039342 HVJ NP MODERATE SEVERITY 30 MINNP3 522 99342 225.00 Active

3039343 HVJ NP MODERATE TO HIGH SEVERITY 45 MINNP3 522 99343 293.00 Active

3039344 HVJ NP HIGH SEVERITY 60 MINNP3 522 99344 414.00 Active

3039341 HVJ NP HOME VISIT LOW SEVERITY 20 MINNP3 522 99341 180.00 Active

3039345 HVJ NP UNSTABLE SIGNIFICANT PROBLEM75MINNP3 522 99345 561.00 Active

3039347 HVJ SELF-LIMITED OR MINOR PROBLEM 15 MINNP3 522 99347 140.00 Active

3031270 HVJ TRIMMING OF DYSTROPHIC NAILS ANY #NP3 521 G0127 58.30 Active

3039350 HVJ UNSTABLE SIGNIFICANT PROBLEM 60 MINNP3 522 99350 417.00 Active

4451632 HYALGAN INJ 20MGPHAR 259 J7321 436.00 Active

4450566 HYDOXYZINEL 25MG TABPHAR 250 6.36 Active

4450042 HYDRALAZINE INJ 20MG/MLPHAR 636 J0360 231.10 Active

4451639 HYDRALAZINE TAB 25 MGPHAR 250 6.40 Active

4400431 HYDRASORB FORM DRESSSUP 270 15.90 Active

4450229 HYDROCHLOROTHIAZIDE 25MG TABPHAR 250 J3490 6.40 Active

4451353 HYDROCOD/ACETAMIN 7.5MG/500MG/15MLPHAR 250 6.40 Active

4450834 HYDROCOD/AP 7.5/325 *OUT PT PK*PHAR 250 12.00 Active

4450249 HYDROCOD/APAP 5/325 *OUT PT PK*PHAR 250 12.00 Active

4451118 HYDROCODONE/APAP 10/325MG TABPHAR 250 J3490 6.40 Active

4451170 HYDROCODONE/APAP 5/325MG TABPHAR 250 J3490 6.40 Active

4451418 HYDROCODONE/APAP 10/325MG *OUT PT PK*PHAR 250 13.00 Active

4450244 HYDROCODONE/APAP 7.5/325MG TABPHAR 250 J3490 6.40 Active

4450563 HYDROCODONE/IBUPROFEN 7.5/200MGPHAR 250 6.36 Active

4450051 HYDROCORTISONE 100MG INJPHAR 636 J1720 23.30 Active

4450252 HYDROCORTISONE 20MGPHAR 250 6.36 Active

4450478 HYDROCORTISONE 500MG INJPHAR 636 J1720 118.35 Active

4450040 HYDROCORTISONE ACETATE 25MGPHAR 250 23.30 Active

4451079 HYDROCORTIZONE CREAM 1%PHAR 250 6.36 Active

Page 51: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4400436 HYDROGEN PEROXIDE (HSUP 270 8.48 Active

4451636 HYDROMORPHONE 10MG/MLPHAR 259 58.30 Active

4451307 HYDROMORPHONE 2MG TABPHAR 250 J3490 6.40 Active

4451351 HYDROMORPHONE 2MG/MLPHAR 259 J3490 23.32 Active

4451350 HYDROMORPHONE 4MG TABPHAR 250 6.40 Active

4451601 HYDROMORPHONE 4MG/MLPHAR 259 23.32 Active

4050027 HydrotherapyPALS 990 H2032 32.00 Active

4450567 HYDROXYZINE 25MG INJPHAR 636 J3410 97.90 Active

4450660 HYDROXYZINE 50MG CAPPHAR 250 6.40 Active

4450568 HYDROXYZINE 50MG OPPHAR 250 11.66 Active

4450913 HYDROXYZINE 50MG/MLPHAR 259 11.66 Active

4454460 HYDROXYZINE HCL TAB 10MGPHAR 250 6.40 Active

4450255 HYDROXYZINE HCL TAB 25MGPHAR 250 6.40 Active

4451430 HYDROXYZINE PAM 25MG OUT PT PKPHAR 250 6.40 Active

4451429 HYDROXYZINE PAM CAP 25MGPHAR 250 6.40 Active

4450256 HYOSCYAMINE .125 MG TABPHAR 250 6.40 Active

4451582 HYOSCYAMINE SULFATE ORAL SOL 0.125MG/1MLPHAR 250 6.40 Active

4451409 HYPERSAL 7% INHPHAR 250 6.40 Active

4559119 Hypertenstion Panel Active

4551086 HYPOGLYCEMIC AGENT SCREENLAB 300 80100 345.56 Active

4450689 HYTRIN 1MG TABPHAR 250 11.70 Active

4401797 I.V. DEL. MODULESUP 270 280.90 Active

4450351 IBUPROFEN 200MG TABPHAR 250 J3490 6.40 Active

4451101 IBUPROFEN 600 MGPHAR 250 6.36 Active

4450349 IBUPROFEN 800MG TABPHAR 250 J3490 6.40 Active

4451359 IBUPROFEN INFANT ORAL SUSP.PHAR 250 6.40 Active

4450348 IBUPROFEN SUSP 100MG/5CC *CHILD*PHAR 250 6.40 Active

4451423 IBUPROFEN/DIPHENHYDRAMINE 200/25MG TABPHAR 250 6.36 Active

4550465 IgA LAB 300 82784 102.82 Active

4550468 IgD LAB 300 82784 102.82 Active

4550467 IgE LAB 300 82785 132.50 Active

4550466 IgG LAB 300 82784 102.82 Active

4451345 IgG IV 30GRAMSPHAR 636 J1568 5444.16 Active

4550471 IgM LAB 300 82784 102.82 Active

4450260 IMDUR 60MG TABPHAR 250 6.40 Active

302030 IMITREX 6 MGNP2 521 J3030 215.18 Active

300030 IMITREX 6MG (M)DR 521 J3030 215.18 Active

4350107 IMMUNIZATION ADMINSTRATIONPROC 771 90471 57.24 Active

4550481 ImmunoFix ELP - SerumLAB 300 86334 90.00 Active

4552097 Immunoglobulin Light Chains Active

4559110 Immunoglobulins (IgA, IgG, and IgM) Active

4350043 INCISION AND DRAINAGPROC 270 21.20 Active

4451042 INDAPAMIDE 1.25 MG TABPHAR 250 6.36 Active

4451572 INDAPAMIDE 2.5 MG TABPHAR 250 6.40 Active

4450267 INDERAL 1MG/ML AML VPHAR 259 58.40 Active

4600019 Indirect Titer (ARC)BB 300 86886 91.16 Active

4451182 INDOMETHACIN 50 MG TABPHAR 250 6.36 Active

Page 52: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4401835 INDUSTRIAL BACK SUPPORTSUP 270 61.48 Active

4401836 INDUSTRIAL BACK SUPPORTSUP 270 61.48 Active

4750066 INFANT (LEFT) LOW-EXT 2 VXRAY 320 73592 151.58 Active

4750173 INFANT (RIGH) LOW-EXT 2 VXRAY 320 73592 151.58 Active

4450350 INFANT MOTRIN 50MG/1.25MLPHAR 250 6.36 Active

4750067 INFANT PELVIS W/ HIPS 2 VXRAY 320 73540 165.36 Active

30099381 INFANT PREVENTATIVEDR 521 99380 117.00 Active

4750068 INFANT UPPER EXT 2 VIEWS LEFTXRAY 320 73092 136.74 Active

4750190 INFANT UPPER EXT 2 VIEWS RIGHTXRAY 320 73092 136.74 Active

4451293 INFED INJ 100MG/2MLPHAR 259 J1570 115.50 Active

4550484 Infl A AB Panel: IgGLAB 300 86710 51.94 Active

4550483 Infl A AB Panel: IgMLAB 300 86710 49.82 Active

4551120 Infl A Subtyping By PCRLAB 300 87801 182.32 Active

4550486 Infl B AB Panel: IgGLAB 300 86710 49.82 Active

4550485 Infl B AB Panel: IgMLAB 300 86710 49.82 Active

4450901 INFLIXIMAB 100MG INJPHAR 636 J1745 2880.00 Active

4559158 INFLUENZA A B ANTIGENLAB 300 87804 0.00 Active

4551232 INFLUENZA A B MOLECULARLAB 300 87502 157.94 Active

4559030 INFLUENZA A B MOLECULAR PANEL Active

4551119 Influenza A By PCRLAB 300 87798 182.32 Active

4551227 INFLUENZA A MOLECULARLAB 300 87502 78.97 Active

4551233 Influenza A/B AgLAB 300 87804 92.22 Active

4550490 Influenza AG Scn: ALAB 300 87400 51.94 Active

4550491 Influenza AG Scn: BLAB 300 87400 51.94 Active

4550947 Influenza AG Screen A/BLAB 300 87400 103.88 Active

4551228 INFLUENZA B MOLECULARLAB 300 87502 78.97 Active

4559009 INFLUENZA SCREEN A & B Active

4350108 Infusaport AccessPROC 270 296.80 Active

4350044 INGROWN TOENAIL REMOPROC 270 25.44 Active

4451623 INJECTAFER 750MGPHAR 259 2302.32 Active

4350102 INJECTION FEEPROC 940 96372 14.84 Active

4401790 INNER TUBESSUP 271 29.68 Active

3100006 INPATIENT CARDIAC ROIP 120 2130.00 Active

3100007 INPATIENT ISOLATIONIP 120 1830.00 Active

3100003 INPATIENT ROOM PRIVAIP 120 1830.00 Active

3100004 INPATIENT ROOM W/MONITORIP 120 2130.00 Active

3150001 INPT RESPITE RMIP 120 H0045 239.56 Active

4401907 INSTANT PACK / HOTSUP 270 5.30 Active

4401175 INSTANT PACKS/ COLDSUP 270 8.48 Active

4550896 Insulin ABsLAB 300 86337 222.60 Active

4451620 INSULIN DRIP 100 UNITS/ 100ML NSPHAR 259 58.40 Active

4550493 Insulin Growth Factor 1LAB 300 84305 233.20 Active

4550037 INSULIN SERUMLAB 300 83525 137.80 Active

4550882 Insulin: FreeLAB 300 83527 155.82 Active

3040211 INSURANCE EXAMCOMP 521 99211 65.00 Active

4551149 INSURANCE SP COL,& P/HLAB 300 99001 63.60 Active

4450270 INTEGRILIN 20MG/10MLPHAR 259 453.68 Active

Page 53: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4401927 INTERDRY DRESSING 5"X10"SUP 270 6.36 Active

4550494 Interpretation & ReportLAB 300 84165 42.40 Active

4551201 INTERPRETIVE COMMENTSLAB 300 64.66 Active

4350046 Intra-arterial/intraPROC 940 90783 80.56 Active

4401798 INTRAOSSEOUS MODULESUP 270 280.90 Active

4400450 INTRAOSSEOUS NEEDLESUP 270 163.24 Active

4350098 INTRATHECAL PUMP REFILLPROC 261 166.42 Active

4552011 INTRINSIC FACTOR BLOCKING ABLAB 300 86340 164.30 Active

4350047 INTUBATION ENDOTRACHPROC 270 40.28 Active

4401796 INTUBATION MODULESUP 270 254.40 Active

4350048 INTUBATION NASOGASTRPROC 270 16.96 Active

4451604 INVANZ INJ 1GMPHAR 636 J1335 251.80 Active

4401837 IO NEEDLE 45MMSUP 270 114.00 Active

4500090 IO STABILIZERSUP 264 5.30 Active

4400456 IODINE SWABSSUP 270 8.48 Active

4550144 Iodine, SerumLAB 300 83018 165.36 Active

4250128 IONTO PADSPT 270 25.44 Active

4250036 IONTONOPHORESISPT 420 97033 90.10 Active

3060238 IP DISCHARGE (30 MIN) LOCUMLOC 521 99238 225.00 Active

3060239 IP DISCHARGE OVER 30 MIN (LOCUM)LOC 521 99239 281.00 Active

3060223 IP HIGH COMPLEX ADMIT (LOCUM)LOC 521 99223 495.00 Active

3060233 IP HIGH DAILY ROUNDS (LOCUM)LOC 521 99233 271.00 Active

3060221 IP LOW COMPLEX ADMIT (LOCUM)LOC 521 99221 299.00 Active

3060231 IP LOW DAILY RDS (LOCUM)LOC 521 99231 141.00 Active

3060222 IP MED COMPLEX ADMIT (LOCUM)LOC 521 99222 404.00 Active

3060232 IP MED DAILY ROUNDS (LOCUM)LOC 521 99232 199.00 Active

3100005 IP RM W/NUR SURVEILLANCEIP 120 2257.80 Active

4450272 IPECAC SYRUP 1 BTLPHAR 250 11.66 Active

4450056 IPRATROPIUM NEB SOL. 0.02%PHAR 259 6.40 Active

4451300 IPRATROPIUM/ALBUTEROL NEBPHAR 250 J3490 6.40 Active

4450812 IRBESARTAN 150MG TABPHAR 250 6.36 Active

4451388 IRBESARTAN 75MG TABPHAR 250 11.70 Active

4550691 IRON LAB 300 83540 68.90 Active

4559138 Iron Panel Active

4550319 IRON PANEL: FE + % SATLAB 300 83540 57.24 Active

4450680 IRON SUCROSE 100MG INJPHAR 636 J1756 150.75 Active

4600047 Irradiation of Blood ProdBB 300 86945 178.08 Active

4350049 IRRIGATION - EARPROC 521 69209 21.20 Active

4350050 IRRIGATION - EYEPROC 270 21.20 Active

4400462 IRRIGATION H20 250CCSUP 270 8.48 Active

4400458 IRRIGATION NACL 1000SUP 270 6.40 Active

4400461 IRRIGATION NACL 9%SUP 270 8.48 Active

4400459 IRRIGATION STERILE WSUP 258 8.48 Active

4401862 IRRIGATION TRAYSUP 270 5.30 Active

4401972 IRRIGATOR, IGLOO WOUNDSUP 270 5.00 Active

4450273 ISOPROTEREN 1MG AMPPHAR 259 231.10 Active

4451211 ISOPTO HOMATRINE 5% OPHTHPHAR 250 153.70 Active

Page 54: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450798 ISOSORBIDE MON ER 60MG TABPHAR 250 6.36 Active

4451099 ISOSORBIDE MONO 20MG. P.O.PHAR 250 6.40 Active

4450259 ISOSORBIDE MONO ER 30MG TABPHAR 250 J3490 6.40 Active

4500100 IV BAG STERILE EMPTYSUP 270 10.60 Active

4500463 IV CATH EXT SETSUP 264 40.28 Active

450465 IV CATH 18GA 21/2"SUP 270 5.30 Active

4500004 IV CATH AUTO WINGEDIV 264 15.90 Active

4500008 IV CATH NEEDLE AUTOGIV 264 20.14 Active

4500009 IV CATH NEEDLE AUTOG 16GAIV 264 20.14 Active

4500010 IV CATH NEEDLE AUTOG 18GAIV 264 20.14 Active

4500075 IV INFUSE/HYDRATE ADL HRSIV 260 96361 55.12 Active

4500074 IV INFUSION/HYDRATIONIV 260 96360 171.72 Active

4401949 IV IO NEEDLE 15MMSUP 270 278.78 Active

4401950 IV IO NEEDLE 25MMSUP 270 278.78 Active

4350051 IV SET UPPROC 270 163.24 Active

4500079 IV STOP COCKIV 264 7.42 Active

4500039 IV Y-TYPE EXT SETIV 264 38.16 Active

4451342 JANUVIA 50 MGPHAR 250 23.32 Active

4401700 JEVITY 1 CALSUP 270 8.48 Active

4401673 JEVITY 1.5SUP 270 8.48 Active

4401720 JEVITY 1.5 / 1.5 LITERSUP 111 29.68 Active

4400468 JEVITY/CASESUP 270 280.90 Active

4400469 JOBST ARM SLEEVESUP 270 145.22 Active

4250040 JOBST MEASUREPT 420 97799 86.92 Active

4250038 JOBST STOCKINGPT 270 261.82 Active

4250041 JOINT MOBILIZATIONPT 420 97140 72.08 Active

4451607 JUVEN PACKETPHAR 250 6.36 Active

4550497 K [Potassium]LAB 300 84132 42.40 Active

4550498 K [Potassium] (Arterial)LAB 300 84132 42.40 Active

4451563 K PHOS NEUTAL 250MLPHAR 259 6.36 Active

4401758 K4-U KNEE BRACEPT 270 1.06 Active

4401759 K-64 KNEE BRACEPT 270 191.86 Active

4401926 K-64 KNEE BRACE 2XLGESUP 270 191.86 Active

440193 K-64 KNEE BRACE 3XLGESUP 270 143.10 Active

4401924 K-64 KNEE BRACE LGESUP 270 191.86 Active

4401923 K-64 KNEE BRACE MEDSUP 270 191.86 Active

4401731 K64 KNEE BRACE SMSUP 270 191.86 Active

4401925 K-64 KNEE BRACE XLGESUP 270 191.86 Active

4552078 Kappa Free Light ChainLAB 300 83883 130.38 Active

4450701 KCL 8 MEQ TABPHAR 259 6.36 Active

4450425 KCL LIQ 20MEQPHAR 250 6.36 Active

3020330 KENALOG 60MG (G)NP2 521 J3301 64.66 Active

3000330 KENALOG 60MG (M)DR 521 J3301 64.66 Active

3050301 KENALOG 60MG (S)PA 521 J3301 64.66 Active

3010330 KENALOG 60MG (TO)NP1 521 J3301 64.66 Active

4451396 KENALOG 60MG IMPHAR 636 J3301 64.66 Active

4401819 KENDRICK SPLINTSUP 270 321.18 Active

Page 55: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4451635 KEPPRA INJ 100MG/MLPHAR 636 J1953 6.40 Active

4401913 KERLIX 2" STERILESUP 270 5.30 Active

4400475 KERLIX ROLLSSUP 270 15.90 Active

4451004 KETORLAC 30MG VIALPHAR 259 J1885 6.36 Active

4450523 KETOROLAC 10MG TABPHAR 250 6.36 Active

4450524 KETOROLAC 30MG/ML INJPHAR 636 J1885 6.40 Active

4451091 KETOROLAC 60MG INJPHAR 636 J1885 6.36 Active

4451005 KETOROLAC 60MG/2ML INJ.PHAR 636 J1885 6.40 Active

4451611 KETOROLAC CARPUJECT 30MGPHAR 636 J1885 11.70 Active

4451640 KETOROLAC OPHTH SOL. 0.5%PHAR 250 58.40 Active

4550499 Kilodalton Protein - 68LAB 300 84182 408.10 Active

4401958 KING AIRWAY SZ-2SUP 270 168.54 Active

4401904 KING AIRWAY SZ-3SUP 270 224.72 Active

4401844 KING AIRWAY SZ-4SUP 270 224.72 Active

4401903 KING AIRWAY SZ-5SUP 270 224.72 Active

4350092 KING OF HEARTSPROC 731 93268 444.14 Active

4350091 KING OF HEARTS MONITPROC 731 93268 444.14 Active

4400477 KLEENEXSUP 270 8.48 Active

4400478 KLING 1SUP 270 8.48 Active

4400234 KLING 2"SUP 270 8.48 Active

4400235 KLING 3"SUP 270 8.48 Active

4400237 KLING 4"SUP 270 8.48 Active

4750071 KNEE BILAT STANDINGXRAY 320 73565 153.70 Active

4750074 KNEE (LEFT) 2 VIEWSXRAY 320 73560 152.64 Active

4750073 KNEE (LEFT) 3 VIEWSXRAY 320 73562 172.78 Active

4750072 KNEE (LEFT) 4-6 VIEWSXRAY 320 73564 209.88 Active

4750174 KNEE (RIGHT) 2 VIEWSXRAY 320 73560 152.64 Active

4750175 KNEE (RIGHT) 3 VIEWSXRAY 320 73562 172.78 Active

4750176 KNEE (RIGHT) 4-6 VIEWSXRAY 320 73564 209.88 Active

30001722 Knee Brace Neoprene (hinged)DR 274 L1820 181.26 Active

4401170 KNEE BRACE ROMSUP 270 384.78 Active

4401722 KNEE MATE BRACESUP 270 L1810 143.10 Active

3021810 KNEE MATT BRACENP2 521 L1810 181.26 Active

4401173 KNEE PATELLA SUPPORTSUP 270 143.10 Active

4450284 KYTRIL 4MG/4MLPHAR 259 569.22 Active

4750080 L SPINE 1 VIEWXRAY 320 72020 132.50 Active

4750083 L SPINE 2-3 VIEWSXRAY 320 72100 201.40 Active

4750082 L SPINE 4 VIEWXRAY 320 72110 279.84 Active

4750079 L Spine Bending View only 2-3 viewsXRAY 320 72120 174.90 Active

4750081 L Spine w/Bending views, miminum of 6XRAY 320 72114 271.36 Active

4250044 L/S SUPPORT 10" ELASPT 270 143.10 Active

4451185 LABETALOL 100MG POPHAR 250 6.40 Active

4451074 LABETALOL HCL 100MG/20ML INJPHAR 259 6.40 Active

4451383 LABETALOL HCL 200MG TABPHAR 250 6.40 Active

3050032 LAC REP INT 2.6-7.5 TRKPA 521 12032 683.70 Active

4450699 LACRILUBEPHAR 259 58.30 Active

4552082 Lactate LAB 300 83605 95.40 Active

Page 56: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4500027 LACTATED RINGERS 1000IV 258 43.46 Active

4450998 lACTULOSE 1 PINTPHAR 250 129.32 Active

4450832 LACTULOSE 10GM/15MLPHAR 250 J3490 6.40 Active

4552079 Lambda Free Light ChainLAB 300 83883 130.38 Active

4551221 LAMOTRIGINE (LAMICTAL)LAB 300 96.46 Active

4550506 Lamotrigine: LamictalLAB 300 80299 117.66 Active

4451215 LANSOPRAZOLE 15 MG CAPPHAR 250 J3490 6.40 Active

4450666 LANSOPRAZOLE 30 MG CAPPHAR 250 155.80 Active

4450696 LANTUS INS 1 UNIT/0.01ML (PER INJ)PHAR 259 2.12 Active

4451410 LANTUS PREFILLED PEN 3MLPHAR 259 202.75 Active

4550507 LAP: Leukocytic ALPLAB 300 85540 124.02 Active

4552032 Latex - IgELAB 300 86003 33.92 Active

4551117 LATIC ACID ( LACTATE)LAB 300 83605 151.58 Active

4350052 LAUNDRY SPECIAL DAILPROC 270 11.66 Active

4550987 LD (LDH)LAB 300 83615 68.90 Active

4550508 LDH IsoenzymesLAB 300 83625 136.74 Active

4550509 LDH Iso's: IsoenzymesLAB 300 83625 77.38 Active

4550510 LDH Iso's: LDHLAB 300 83615 68.90 Active

4550512 LDL DirectLAB 300 83721 90.10 Active

4550515 Lead - BloodLAB 300 83655 90.10 Active

4401042 LEG BAG LARGSUP 270 11.66 Active

4250157 Leg Lifter StrapPT 420 23.32 Active

4401863 LEG STRAP SMSUP 270 11.66 Active

4400490 LEMON GLYCERIN SWABSSUP 270 8.48 Active

4450584 LEVALBUTEROL 0.63MG/3ML NEB. SOLU.PHAR 250 J3490 11.70 Active

4450583 LEVALBUTEROL 1.25MG/3ML NEB. SOL.PHAR 250 J3490 6.40 Active

4450293 LEVAQUIN 500MG TABPHAR 250 J3490 6.40 Active

4451354 LEVAQUIN 750MG TABPHAR 250 J3490 6.40 Active

4451341 LEVEMIR 1 UNIT/0.01MLPHAR 636 J1815 2.12 Active

4451576 LEVEMIR PEN 3MLPHAR 259 231.08 Active

4451625 LEVETIRACETAM 750 MGPHAR 250 6.40 Active

4550520 Levetiractam [Keppra]LAB 300 80177 98.58 Active

4450283 LEVETRIACETAM 500MG TABPHAR 250 6.40 Active

4451610 LEVOFLOXACIN 500MG INJPHAR 636 J1956 58.40 Active

4450294 LEVOFLOXACIN 500MG/100ML IV PREMIXPHAR 636 J1956 23.30 Active

4450822 LEVOFLOXACIN 750MG/100ML IV PREMIXPHAR 636 J1956 23.30 Active

4451397 LEVOTHYROXINE 100MCG TABPHAR 250 J3490 6.40 Active

4450295 LEVOTHYROXINE 112MCG TABPHAR 250 J3490 6.40 Active

4450496 LEVOTHYROXINE 125MCG TABPHAR 250 6.40 Active

4451569 LEVOTHYROXINE 137 MCG TABPHAR 250 6.40 Active

4450494 LEVOTHYROXINE 150MCG TABPHAR 250 6.36 Active

4450943 LEVOTHYROXINE 175MCG TABPHAR 250 11.70 Active

4451160 LEVOTHYROXINE 50 MCG TABPHAR 250 J3490 6.40 Active

4450492 LEVOTHYROXINE 75MCG TABPHAR 250 6.40 Active

4451205 LEVOTHYROXINE 88 MCG TABPHAR 250 J3490 6.40 Active

4450297 LEXAPRO 10MG TABPHAR 250 6.40 Active

4551012 LFAS: Ur Adulterant StripLAB 300 81003 28.62 Active

Page 57: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4400634 LG SHARPS CONTAINERSUP 270 10.00 Active

4550521 LH LAB 300 83002 134.62 Active

4451634 LIBRAX/CLIDINIUM BR TAB 5/2.5MGPHAR 250 11.70 Active

4451209 LICE SHAMPOOPHAR 250 11.66 Active

4450300 LIDOCAINE 0.5% 5CCPHAR 259 6.40 Active

4450299 LIDOCAINE 2% 100MG/5ML INJPHAR 259 11.70 Active

4450305 LIDOCAINE 2% VISCOUSPHAR 250 6.40 Active

4450301 LIDOCAINE HCL 4%PHAR 250 11.66 Active

4451579 LIDOCAINE HCL JELLY 2% 5ML UROJETPHAR 250 J3490 23.30 Active

4450304 LIDOCAINE INJ 1% WITH EPI 1 MLPHAR 259 11.70 Active

4450303 LIDOCAINE INJ 2% 1 mLPHAR 636 J3490 6.40 Active

4450663 LIDOCAINE INJ 2% WITH EPI 1 mLPHAR 259 6.40 Active

4450302 LIDOCAINE INJ. 1% 1 mLPHAR 636 J2001 6.40 Active

4400492 LIDOCAINE JELLY 2%SUP 250 11.70 Active

4450306 LIDOCAINE OINT 5%PHAR 250 23.30 Active

4451117 LIDOCAINE PATCHPHAR 250 J3490 23.32 Active

4451094 LIDOCAINE/PRILOCAINE CREAM 2.5%PHAR 250 6.40 Active

4451175 LIDODERM PATCH 5MG/12HRPHAR 259 58.40 Active

4401559 LIMB RESTRAINTSSUP 270 25.44 Active

4401727 LIMB RESTRAINTSSUP 270 25.44 Active

4450926 LINDANE LOTION 1 BTLPHAR 250 453.68 Active

4401741 LINEN SAVER LGE (CASE)SUP 270 110.24 Active

4400495 LINEN SAVERS 2/PK XLSUP 270 8.48 Active

4401496 LINEN SAVERS 2PK SMALLSUP 270 8.48 Active

4401786 LINEN SVR SUPERSUP 270 8.48 Active

4451140 LINEZOLID 600MG/300ML PREMIX IVPHAR 636 J2020 231.10 Active

4451573 LINZESS 145 MCGPHAR 250 58.40 Active

4451609 LINZESS TAB 290 MCGPHAR 250 J3490 58.40 Active

4550523 Lipase LAB 300 83690 90.10 Active

4550525 Lipid PanelLAB 300 80061 111.30 Active

4550527 Lipoprotein-(a)LAB 300 82170 90.10 Active

4400530 LIQUID ADHESIVE MASTSUP 270 8.48 Active

4450979 LISINOPRIL 10MG POPHAR 250 J3490 6.40 Active

4450968 LISINOPRIL 20MG TABPHAR 250 J3490 6.40 Active

4450938 LISINOPRIL 40MG TABPHAR 250 6.36 Active

4451167 LISINOPRIL 5MG TABPHAR 250 6.40 Active

4451566 LISINOPRIL TAB 2.5 MGPHAR 250 6.36 Active

4451372 LISINOPRIL/HCTZ 20/12.5MG TABPHAR 250 6.40 Active

4450763 LISINOPRIL/HCTZ 10/12.5MG TABPHAR 250 6.36 Active

4550528 Lithium LAB 300 80178 90.10 Active

4552036 Lobster - IgELAB 300 86003 33.92 Active

3060104 LOC LAC SIMPLE 7.6-12.5 (SCALP, NECK)LOC 521 12004 699.60 Active

3069075 Locum Application Short arm CastLOC 521 29075 330.72 Active

30617110 LOCUM Cryo/Surgical Curette 1-14 LesionsLOC 521 17110 186.56 Active

3060721 LOCUM DEBRIDE NAILS 6 OR MORE (LOCUM)LOC 521 11721 85.86 Active

306011720 LOCUM DEBRIDMENT NAILS 1-5 ANY METHODLOC 521 11720 57.24 Active

306214 LOCUM DOT ExamLOC 521 99214 187.00 Active

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3061403 LOCUM Exc Ben Les 2.1-3.0(trunk, arms..)LOC 521 11403 419.76 Active

3060600 Locum Minor joint injection/aspirationLOC 521 20600 207.23 Active

3064640 LOCUM NEBULIZER TXLOC 521 94640 50.88 Active

3060205 LOCUM NEW PT CLINIC LEVEL 5LOC 521 99205 474.00 Active

3064010 LOCUM PFT SPIROMETRYLOC 521 94010 155.80 Active

306211 LOCUM SPORTS PX SPECIALLOC 521 30.00 Active

3061270 LOCUM TRIMMING DYSTROPHIC NAILSLOC 521 G0127 58.30 Active

3061719 LOCUM TRIMMING NONDYSTROPHIC NAILSLOC 521 11719 47.70 Active

3060395 LOCUM WELLNESS 18-39LOC 521 99395 294.00 Active

3010505 LONG LEG SPLINTNP1 521 29505 302.10 Active

4450311 LONOX 2.5MG TABPHAR 250 6.36 Active

4450262 LOPERAMIDE 2MG. P.O.PHAR 250 6.40 Active

4451627 LOPERAMIDE SUSP 1MG/7.5MLPHAR 250 11.66 Active

4401177 LOPEZ VALVESUP 270 15.90 Active

4451065 LORATADINE/PSEUODOPHEDRINE 5/120MGPHAR 250 6.40 Active

4451295 LORATIDINE 10MG TABPHAR 250 J3490 6.40 Active

302060 LORAZEOAN 2 MGNP2 521 J2060 58.30 Active

30060 LORAZEOAN 2MG (M)DR 521 J2060 58.40 Active

4552086 Lorazepam (Ativan), SerumLAB 300 135.68 Active

4450053 LORAZEPAM 0.5 MG TABPHAR 250 J3490 6.40 Active

4451183 LORAZEPAM 1MG TABPHAR 250 J3490 6.40 Active

4450965 LORAZEPAM 2MG/ML INJPHAR 636 J2060 58.30 Active

3012060 LORAZEPAN 2 MG (TO)NP1 521 J2060 58.30 Active

4450034 LOSARTAN 50MG TABPHAR 250 J3490 6.40 Active

4451645 LOSARTAN TAB 25 MGPHAR 250 6.40 Active

4450257 LOSARTAN/HCT 50/12.5MG TABPHAR 250 11.66 Active

4450317 LOTENSIN 20MG TABPHAR 250 6.36 Active

4400507 LOTION CALMOSEPTINESUP 270 29.68 Active

4400501 LOTION HAND 4 OZSUP 270 8.48 Active

4451206 LOVASTATIN 20MGPHAR 250 11.66 Active

4451433 LUBRICATING EYE DROPS 15 ML BTLPHAR 250 53.00 Active

4250180 LUMBAR BRACE W/REMOVABLE PADSUP 270 143.10 Active

4400514 LUMBAR PUNCTURE KITSUP 270 113.42 Active

4400515 LUMBAR PUNCTURE KITSUP 270 115.54 Active

4250123 LUMBAR ROLLPT 270 28.62 Active

4400518 LUMBO SACRAL SUPPORTSUP 270 142.04 Active

4400519 LUMBO SACRAL SUPPORTSUP 270 142.04 Active

4400517 LUMBO SARAL SUPP 361SUP 270 142.04 Active

4250046 LUMBOSACRAL SUPPORTPT 270 55.12 Active

4450326 LUNESTA 3 MG POPHAR 250 6.40 Active

4451025 LUPRON 22.5 MGPHAR 636 J9217 4622.66 Active

4451638 LUPRON DEPOT 45 MGPHAR 259 13422.78 Active

4551128 LUPUS ANTICOAG PANELLAB 300 85612 37.10 Active

4559147 Lupus Anticoagulant Panel Active

4550532 Lyme's AB Eval: IgGLAB 300 86617 68.90 Active

4550533 Lyme's AB Eval: IgMLAB 300 86617 68.90 Active

4550531 Lyme's AB Eval: SerologyLAB 300 86618 57.24 Active

Page 59: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4552018 Lyme's Antibody Conf. Western Blot Active

4550197 MA/C: CREAT(URINE)LAB 300 82570 47.70 Active

4550548 MA/C: MicroAlb (Ur)LAB 300 82043 81.62 Active

4450327 MAALOX 30CC DOSEPHAR 250 6.36 Active

4451148 MAGNESIUM CITRATEPHAR 250 J3490 6.40 Active

4450827 MAGNESIUM CITRATE 1 BTLPHAR 250 6.36 Active

4450830 MAGNESIUM OXIDE 400MG TABPHAR 250 J3490 6.40 Active

4450330 MAGNESIUM SULF. 5GM/10ML INJPHAR 259 J3475 6.40 Active

4760001 MAMMOGRAM SCREENINGMAMM 403 77067 171.72 Active

4760003 MAMMOGRAM UNILAT BREAST DIAGMAMM 401 77065 201.40 Active

4760005 MAMMOGRAM UNILATERAL SCREENINGMAMM 403 77067 159.00 Active

4760002 MAMMOGRAM, BILAT BREAST DIAGMAMM 401 77066 159.00 Active

4550534 MAMP Confirm: QualLAB 300 80102 68.90 Active

4551019 MAMP Confirm: QuantLAB 300 82542 68.90 Active

4750085 MANDIBLE (LEFT) 1-3 VIEWSXRAY 320 70100 149.46 Active

4750084 MANDIBLE (LEFT) 4-6 VIEWSXRAY 320 70110 218.36 Active

4750177 MANDIBLE (RIGH) 1-3 VIEWSXRAY 320 70100 149.46 Active

4750178 MANDIBLE (RIGHT) 4-6 VIEWXRAY 320 70110 218.36 Active

4450331 MANNITOL 25% 250MG/ML INJPHAR 259 86.80 Active

4100006 MAPD LPN NURSE VISITPDN 990 T1003 7.73 Active

4100003 MAPD RN VISITPDN 990 T1002 9.50 Active

4451237 MARCAINE 0.25% 5CCPHAR 250 604.20 Active

4450332 MARCAINE 0.5% 5CCPHAR 636 J3490 11.70 Active

4451441 Marcaine/Epi 0.5% 1 mLlPHAR 259 6.40 Active

4450751 MARY'S MOUTHWASHPHAR 250 155.82 Active

4700015 MASK ADULT/SURGERYOXY 270 39.22 Active

4700012 MASK MULTI VENT OXYGOXY 270 22.26 Active

4700011 MASK OXYGENOXY 270 13.78 Active

4700014 MASK PEDS SURGERYOXY 270 43.46 Active

4700013 MASK W/BAG OXYGENOXY 270 19.08 Active

4450333 MAXALT 10MGPHAR 250 58.30 Active

4450899 MAYO ENEMAPHAR 250 6.36 Active

4451583 MECLIZINE 12.5MG TABPHAR 250 6.40 Active

4450039 MECLIZINE 25MG TABPHAR 250 6.40 Active

430002 MED PROFILE LITEW/HEADGEADME 270 A7034 179.14 Active

4300027 MED PROFILE LITEW/HEADGEADME 270 A7034 179.14 Active

4050020 MEDICAL ESCORTPALS 990 T2001 5.50 Active

4050009 MEDICAL TRANSPORTATIPALS 580 A0080 0.35 Active

4000014 Medicare LPN SkilledHH 551 G0300 39.22 Active

4000013 Medicare RN SkilledHH 551 G0299 39.22 Active

4401800 MEDIHONEY DRSNGSUP 270 117.66 Active

4401873 MEDIHONEY TUBESUP 270 56.18 Active

4401749 MEDTRONIC REFILL KITSUP 270 A4220 118.72 Active

4451402 MEGESTROL 40MG TABPHAR 250 6.40 Active

4451241 MEGESTROL ACE 40MG/ML 5MLPHAR 250 11.66 Active

4450682 MELATONIN 3MG TABPHAR 250 J3490 6.40 Active

4451665 MELATONIN ER TAB 5 MGPHAR 250 6.40 Active

Page 60: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450905 MEMANTINE 10MG TABPHAR 250 6.40 Active

4450359 MEMANTINE 5MG TABPHAR 250 11.66 Active

4559002 Menopause Panel Active

4451564 MEPERDINE 100MG/MLPHAR 636 J2175 23.32 Active

3020175 MEPERIDINE 50 MGNP2 521 J2175 58.30 Active

4450147 MEPERIDINE 50MG/2MLPHAR 636 J2180 23.32 Active

4451184 MEPHYTON 5 MG TABPHAR 250 23.32 Active

4550539 Mercury (Blood)LAB 300 83825 148.40 Active

4451414 MESALAMINE TAB 800MGPHAR 250 12.00 Active

4401833 MESH HEEL/ELBOWSUP 270 12.72 Active

4550540 Metanephrine - Free PlasmaLAB 300 83835 192.92 Active

4551118 Metanephrine 24 hr urineLAB 300 83835 171.72 Active

4451027 METFORMIN 500MG TABPHAR 250 J3490 6.40 Active

4450964 METFORMIN 850MGPHAR 250 J3490 6.40 Active

4450742 METFORMIN XR 500MG TABPHAR 250 6.40 Active

4552093 Methadone and Metabolites, SerumLAB 300 80358 175.96 Active

4551194 METHADONE CONFIRMATION URINELAB 300 80358 83.74 Active

4451398 METHADONE TAB 10MGPHAR 250 6.40 Active

4451356 METHADONE TAB 5MGPHAR 250 6.40 Active

4550542 MethanolLAB 300 84600 165.36 Active

4451330 METHIMAZOLE 5MG POPHAR 250 6.36 Active

4551559 METHOTREXATE TAB 2.5MGPHAR 250 11.70 Active

4451214 METHYLNALTREXONE BROMIDE 12MG/0.6MLPHAR 259 J2212 227.85 Active

4451152 METHYLPREDNISOLONE 125MG INJPHAR 636 J2930 58.40 Active

4451319 METHYLPREDNISOLONE 4 MGPHAR 250 J3490 6.40 Active

4450334 MethylPREDNIsolone PAK [4MG]PHAR 250 J7509 58.40 Active

4450976 METOCLOPRAMIDE 10MG TABPHAR 250 6.40 Active

4451580 METOCLOPRAMIDE 5MG TABPHAR 250 6.40 Active

4450457 METOCLOPRAMIDE 5MG/ML INJ.PHAR 259 11.70 Active

4450313 METOPROLOL 25MG TABPHAR 250 J3490 6.40 Active

4451335 METOPROLOL 100 MG TABPHAR 250 6.40 Active

4450314 METOPROLOL 50MG TABPHAR 250 6.40 Active

4450992 METOPROLOL 5MG/5ML INJPHAR 259 6.40 Active

4451318 METOPROLOL SUCC. ER 100 MG TABPHAR 250 6.40 Active

4451138 METOPROLOL SUCC. ER 25MG. TABPHAR 250 J3490 6.40 Active

4451147 METOPROLOL SUCC. ER 50MG ORALPHAR 250 J3490 6.40 Active

4451048 METRONIDAZOLE 250MG P.O.PHAR 250 11.70 Active

4450202 METRONIDAZOLE 500MG TABPHAR 250 J8499 6.40 Active

4450201 METRONIDAZOLE/ NACL 500MG/100ML PREMIXPHAR 636 J0744 11.70 Active

4550544 MG [Magnesium]LAB 300 83735 57.24 Active

4451621 MICONAZOLE NITRATE 2% CREAMPHAR 250 6.40 Active

4550386 MicroAlbumin [only]LAB 300 82043 81.62 Active

4551183 Microalbumin/Creatinine 301 Active

4550551 Microployspora faeni IgGLAB 300 86671 171.72 Active

4451324 MIDAZOLAM 10MG/10ML VIALPHAR 259 11.66 Active

4450559 MIDAZOLAM 2MG/2ML INJPHAR 636 J2250 6.40 Active

4451238 MIDAZOLAM SYRUP 2MG/MLPHAR 250 11.70 Active

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4050001 MILEAGEPALS 990 S0215 0.35 Active

4551093 Milk IgE LAB 300 86003 33.92 Active

4450342 MILK OF MAGNESIA 10MLPHAR 250 J3490 6.40 Active

4450338 MINERAL OIL 30CCPHAR 250 11.66 Active

4300046 MIRAGE ACTIVA MASK LGDME 270 203.52 Active

4300070 MIRAGE FX NASAL MASKDME 270 A7034 166.42 Active

4300069 MIRAGE QUATRO FULL FACE CUSHIONDME 270 A7031 97.52 Active

4300049 MIRAGE QUATRO MSK FULLDME 270 A7030 254.40 Active

4450744 MIRTAZAPINE 15MG TABPHAR 250 11.66 Active

4451144 MIRTAZAPINE 30MGPHAR 250 11.66 Active

4550609 Mitochondrial AB - M2LAB 300 83516 108.12 Active

4550555 MMA - Quant (Serum)LAB 300 83921 165.36 Active

4550554 MMA - Quant (Urine)LAB 300 83921 165.36 Active

4559168 MMRV Immune Status Profile Active

4450340 MOBIC 7.5MG POPHAR 250 11.66 Active

4250154 MOBILITY EVALUATION 15MINPT 420 97755 140.98 Active

4250165 MOLDED SOCK AIDSUP 270 10.60 Active

4550557 Mono ABLAB 300 86308 63.60 Active

4559150 Monoclonal Protein Study, Expanded Panel Active

4450470 MONTELUKAST 10MG TABPHAR 250 J3490 6.40 Active

4451286 MONTELUKAST 4MG TABPHAR 250 11.66 Active

4451412 MONTELUKAST 5MG CHEWPHAR 250 6.40 Active

4400246 MORGAN LENS DEL SETSUP 270 15.90 Active

4451619 MORPHINE 50MG DRIPPHAR 259 116.60 Active

4451644 MORPHINE INJ [4 MG]PHAR 259 23.32 Active

4451654 MORPHINE INJ 10MG/10MLPHAR 259 58.40 Active

4450347 MORPHINE SULFATE 10MG/ML INJPHAR 636 J2270 23.32 Active

4451310 MORPHINE SULFATE 20MG/1ML SYRUPPHAR 250 6.40 Active

4451110 MORPHINE SULFATE ER 15 MG TABPHAR 250 J3490 6.40 Active

4451308 MORPHINE SULFATE ER 30MG TABPHAR 250 11.66 Active

4450691 MOTRIN 600MG TABPHAR 250 6.36 Active

4451446 MOTRIN TAB 800MG OUTPT PACKPHAR 250 11.70 Active

4552050 Mountain Cedar, IgELAB 300 86003 33.92 Active

4401779 MOUTH MOISTURIZERSUP 270 8.48 Active

4450067 MOXIFLOXACIN *IVPB* PREMIX 400MG/250MLPHAR 636 J2280 169.75 Active

4450068 MOXIFLOXACIN 400MG TABPHAR 250 58.30 Active

4550568 MPO [Myeloperoxidase AB]LAB 300 86021 193.98 Active

4750900 MRI @ FMDH W/AMBULANCE TRIPXRAY 320 72148 1210.00 Active

4750902 MRI BRAIN STEM W/ABMULANCE @FMDHXRAY 320 70551 4149.90 Active

4750901 MRI NUCLEAR MEDICINE W/AMBULANCE @NMHXRAY 320 78306 4757.28 Active

4451200 MS POWDERPHAR 636 J3490 118.72 Active

4550556 MTD Confirm: QualLAB 300 80102 68.90 Active

4550559 MTD Confirm:QuantLAB 300 83840 62.54 Active

4551564 MTHFR C677T, MUTATIONLAB 300 81291 300.00 Active

4401984 MUCOSAL ATOMIZATION DEVICSUP 270 20.00 Active

4552058 Mugwort- IgELAB 300 86003 33.92 Active

4552056 Mulberry - IgELAB 300 86003 33.92 Active

Page 62: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450354 MULTI VITAMIN INFUSIONPHAR 259 58.40 Active

4451108 MULTIVITAMIN TABPHAR 250 J3490 6.40 Active

4551028 Mumps AB Pn: IgGLAB 300 86735 82.68 Active

4451326 MUPIROCIN 2% 44 GRAMPHAR 250 226.84 Active

4450074 MUPIROCIN 2% OINT 22GMPHAR 250 J3490 58.40 Active

4551218 MUSCLE SPECIFIC KINASE AUTOANTIBODYLAB 300 1263.52 Active

4250168 MUSCLE TESTING, MANUAL EXTREMITYPT 420 95831 204.98 Active

4559159 MYASTHENIA GRAVIS EVAL W MUSK REFLEX Active

4451275 MYCAMINE 100MG VIALPHAR 250 584.06 Active

4551225 MYCOPHENOLIC ACID (CELLCEPT)LAB 300 80180 208.82 Active

4551078 MYCOPLASMA PNEUMO IGM IFALAB 300 86738 318.00 Active

4550564 Mycoplasma Pneumoniae IgGLAB 300 86732 77.38 Active

4550565 Mycoplasma Pneumoniae IgMLAB 300 86738 77.38 Active

4550572 MyoglobinLAB 300 83874 151.58 Active

4550570 Myoglobin (Urine)LAB 300 83874 127.20 Active

4551212 N TYPE CALCIUM CHANNEL ABLAB 300 62.54 Active

4550573 NA (Arterial)LAB 300 84295 42.40 Active

4550575 NA [Sodium]LAB 300 84295 42.40 Active

4451278 NABUMETONE 500MG TABPHAR 250 6.40 Active

4451558 NABUMETONE 750 MG POPHAR 250 6.40 Active

4451344 NACL 0.9% 10ml VIALIV 258 J3490 6.36 Active

4500080 NACL 3% 500MLIV 258 J3490 26.50 Active

4450360 NALOXONE 0.4MG/ML INJ.PHAR 259 J3490 58.40 Active

4451062 NAPROXEN 220MG POPHAR 250 6.40 Active

4451064 NAPROXEN 500MG P.O.PHAR 250 J3490 6.40 Active

4401961 NASAL ASPIRATOR 41/2"SUP 270 10.60 Active

4750088 NASAL BONE 3 VIEWSXRAY 320 70160 163.24 Active

4300010 NASAL CANNULA (DME)DME 270 A4615 9.54 Active

4700040 NASAL CANNULA HFSUP 270 5.30 Active

4401760 NASAL DRESSING 4.5SUP 270 29.68 Active

4401761 NASAL DRESSING 8.1SUP 270 29.68 Active

4300018 NASAL PILLOWDME 270 A7033 73.14 Active

4300072 NASAL SOFT CPAP CUSHION (PAD)DME 270 A7032 23.32 Active

4450361 NASAL SPRAY 1.5 0Z BTLPHAR 250 6.40 Active

4400546 NASALSTAT CONTROL OFSUP 270 280.90 Active

4451248 NASONEX NASAL SPRAYPHAR 250 418.00 Active

4401830 NASOPHARYNGEAL AIRWAYSUP 270 12.72 Active

4450362 NATRECOR 1.5MG/VIALPHAR 636 J2325 2256.74 Active

4550945 NB: Neonatal BiliLAB 300 82247 48.76 Active

4700016 NEBULIZER HAND HELDOXY 270 17.01 Active

4700041 NEBULIZER PEDS CHARACTERSUP 270 5.30 Active

4300043 Nebulizer Purchase CostDME 270 113.42 Active

4300011 NEBULIZER RENTALDME 270 E0570 33.92 Active

4300013 NEBULIZER SETDME 270 6.36 Active

4350104 Nebulizer Treatment outpatientPROC 270 115.54 Active

4750145 NECK SOFT TISSUE 1-2 VIEWXRAY 320 70360 155.82 Active

4500042 NEEDLE ANGIO CATH 14IV 264 15.90 Active

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4500043 NEEDLE ANGIO CATH 16IV 264 15.90 Active

4500044 NEEDLE ANGIO CATH 16IV 264 15.90 Active

4500045 NEEDLE ANGIO CATH 20IV 264 10.60 Active

4500054 NEEDLE IV 24GAIV 264 13.78 Active

4500060 NEEDLE SUBCLAVIAN JUIV 264 56.18 Active

4550579 Neis gon (GC) DNA ProbeLAB 300 87591 146.28 Active

4451368 NEOMY/POLYMYX/DEX OPTH OINTPHAR 250 87.40 Active

4451367 NEOMY/POLYMYX/DEXAMETH OPTH DROPSPHAR 250 155.80 Active

4451428 NEOMYCIN/POLY/HCT *OTIC*PHAR 250 231.10 Active

4450363 NEO-SYNEPHRINE NASALPHAR 259 6.40 Active

4250052 NEUROMUSCULAR REEDUCPT 420 97112 72.08 Active

4552090 Neuromyelitis Optica (NMO)/Aquaporin-4-ILAB 300 86255 365.70 Active

4551215 NEURONAL VG K CHANNEL ABLAB 300 62.54 Active

4559006 New Hepatitis C Diagnosis/Referral Active

3060201 NEW PATIENT LEVEL 1 (LOCUM))LOC 521 99201 166.00 Active

3060202 NEW PT LEVEL 2 (LOCUM)LOC 521 99202 198.00 Active

3060203 NEW PT LEVEL 3 (LOCUM)LOC 521 99203 264.00 Active

3060204 NEW PT LEVEL 4 (LOCUM)LOC 521 99204 355.00 Active

4552022 Newborn Screening Active

4451379 NEXIUM 20MG TABPHAR 250 6.40 Active

4450371 NEXIUM 40MG TABPHAR 250 J3490 6.40 Active

4451633 NEXPLANON IMPLANT 68MGPHAR 259 J7307 1039.90 Active

3050313 NH RD HIGH (S)PA 525 99309 209.00 Active

3019307 NH RD LOW (TO)NP1 525 99307 106.00 Active

3050312 NH RD MED (S)PA 525 99308 144.00 Active

4450372 NIACIN ER 500MGPHAR 250 6.40 Active

4551174 NICKEL (HEAVEY METAL)LAB 300 83885 217.30 Active

4450375 NICODERM PATCH 7MGPHAR 250 6.40 Active

4550581 Nicotine + Metab (Urine)LAB 300 80323 179.14 Active

4550582 Nicotine + Metabo (Serum)LAB 300 80323 179.14 Active

4451565 NICOTINE LOZENGE 2MGPHAR 250 6.40 Active

4450374 NICOTINE TRANSDERM. PATCH 14MGPHAR 250 6.40 Active

4450745 NICOTINE TRANSDERM. PATCH 21 MGPHAR 250 6.40 Active

4451594 NIFEDIPINE XL TAB 30MGPHAR 250 6.40 Active

4250124 NIGHT ROLLPT 270 143.10 Active

4450328 NITROFURANTOIN 100MG *OUT PT PK*PHAR 250 58.40 Active

4450991 NITROFURANTOIN 100MG TABPHAR 250 J3490 6.40 Active

4450381 NITROGLYCERIN 0.4MG TABPHAR 250 J3490 6.40 Active

4450378 NITROGLYCERIN 2% OINTMENTPHAR 250 11.70 Active

4450719 NITROGLYCERIN INJ 200MCG/MLPHAR 259 83.60 Active

4450380 NITROPRESS 50MG/2MLPHAR 259 1701.50 Active

4700018 NITROS OXIDEOXY 270 43.46 Active

4700019 NITROS OXIDEOXY 270 43.46 Active

4500077 NON CHEM ADMINISTRATIONIV 261 64.66 Active

4401097 NON-STRESS TESTPROC 270 59025 83.74 Active

4450993 NOREPINEPHRINE 4MG/4ML INJPHAR 259 58.40 Active

4450866 NORMAL SALINE 3-5ML VIALPHAR 259 6.40 Active

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4559153 Norovirus Active

4550586 NortriptylineLAB 300 80182 144.16 Active

4550963 Norwalk: Extraction (wPCRLAB 300 83891 42.40 Active

4550964 Norwalk: Genotype 1 PCRLAB 300 87798 79.50 Active

4550962 Norwalk: Genotype 2 PCRLAB 300 87798 79.50 Active

4451617 NOVOLIN R INSULIN 1 UNITPHAR 259 2.12 Active

4451603 NOVOLOG FLEXPEN 100UNITPHAR 636 J3490 247.05 Active

4450697 NOVOLOG INS 1 UNIT/0.01ML (PER UNIT)PHAR 259 J3490 2.12 Active

4401845 NU HOPE SUPPORT BELTSUP 270 299.98 Active

4400568 NUGAUZE IODOFORM 1"SUP 270 15.90 Active

4400567 NUGAUZE IODOFORM 1/2SUP 270 15.90 Active

4400566 NUGAUZE IODOFORM 1/4SUP 270 15.90 Active

4050010 NURSE SUPERVIOSRPALS 990 T1019 5.11 Active

3100001 NURSEY ROOMIP 120 897.82 Active

4250119 NURSING HOME VISITSPT 420 97001 183.38 Active

3300021 NURSING SERVICENS 450 99211 88.00 Active

4350009 Nursing Service SetupPROC 940 99211 48.76 Active

4559149 Nuts Allergen Profile Active

4401853 NUTURA MINI POUCHSUP 270 56.18 Active

4450710 NYSTATIN 5CCPHAR 259 6.36 Active

4451014 NYSTATIN CREAM 15GMPHAR 259 11.66 Active

4450708 NYSTATIN CREAM 100,000u/GM [TUBE]PHAR 250 115.55 Active

4451047 NYSTATIN POWDERPHAR 250 J3490 58.40 Active

4450390 NYSTATIN SUSP 100,000uPHAR 250 6.40 Active

4551032 O + P: Complex Stain SmLAB 300 87209 57.24 Active

4550587 O + P: Conc + IDLAB 300 87177 63.60 Active

4551136 O&P DIRECT SMEAR IDLAB 300 87177 81.62 Active

4550607 O+P [Ova+Parasites]LAB 300 87177 102.82 Active

4700022 O2 ADULT OXISENSOR IOXY 270 108.12 Active

4700036 O2 CANNULA 15 FTOXY 270 10.60 Active

4401795 O2 DELIVERY MODULESUP 270 134.62 Active

4700160 O2 ENRICHMENT DEVICEOXY 270 13.78 Active

4700023 O2 HOOD (NEWBORN)OXY 270 107.06 Active

4700021 O2 INFANT OXISENSOR SATOXY 270 121.90 Active

4700017 O2 NEBULIZER W/PEDS MASKOXY 270 15.90 Active

4401725 O2 TUBING 14'SUP 270 8.48 Active

4552051 Oak, IgELAB 300 86003 33.92 Active

4551098 Oat- IgELAB 300 86003 33.92 Active

4350054 OB CHECKPROC 270 25.44 Active

4400569 OB PANT MESHSUP 270 15.90 Active

3060236 OBS HIGH (LOCUM)LOC 521 99220 460.00 Active

3060234 OBS LOW (LOCUM)LOC 521 99218 269.00 Active

3060235 OBS MOD (LOCUM)LOC 521 99219 367.00 Active

3600002 OBSERVATION 1ST DAYOBS 762 G0378 53.00 Active

3600001 OBSERVATION 1ST HROBS 762 G0378 295.74 Active

3600003 OBSERVATION 2ND DAYOBS 762 G0378 53.00 Active

3600004 OBSERVATION 3RD DAYOBS 762 G0378 53.00 Active

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3600007 OBSERVATION DISCHARGEOBS 762 G0378 230.02 Active

3100051 OBSERVATION W/TELEMETRY 1ST HROBS 762 439.90 Active

3020822 OCCULT BLOODNP2 521 82270 46.64 Active

4550592 Occult Blood: Ur-DipLAB 300 81003 14.84 Active

4551176 OCCULT STOOLLAB 300 82270 34.98 Active

4260000 OCCUPATIONAL THERAPYDNU 430 G0152 144.16 Active

4450250 OCTAGAM 10GM/200ML INJPHAR 636 J1568 1806.80 Active

445251 OCTAGAM 10GRAMS/BOTTLEPHAR 250 1814.72 Active

4450391 OCUVITE TABPHAR 250 6.36 Active

4450059 OFLOXACIN 0.3% OPTHALMICPHAR 250 58.30 Active

4450640 OLANZAPINE 2.5MG TABPHAR 250 J3490 6.40 Active

4451267 OLANZAPINE 5 MG TABPHAR 250 J3490 6.40 Active

4450491 OLANZAPINE-FLUOXETINE 6/50MG CAPPHAR 250 J3490 58.30 Active

4552053 Olive-Tree, IgELAB 300 86003 33.92 Active

4451384 OLMESARTAN MED 20MG TABPHAR 250 23.30 Active

4450923 OLMESARTAN MED 40MG TABPHAR 250 12.00 Active

4451373 OLMESARTAN MED/HCT 20/12.5MGPHAR 250 11.70 Active

4450794 OLMESARTAN MED/HCT 40/12.5MGPHAR 250 11.66 Active

4451333 OMEGA 3 - 1000 MG CAPSULEPHAR 250 J3490 6.40 Active

4450436 OMEPRAZOLE 20 MG CAPPHAR 250 J3490 6.40 Active

4450783 OMNICEF 300MG CAPPHAR 250 6.40 Active

4451086 ONDANSETRON 4MG ODTPHAR 250 J3490 6.40 Active

4451016 ONDANSETRON 4MG/2MLPHAR 636 J2405 11.70 Active

4450721 ONDASTERON 4MG TABPHAR 250 J3490 6.40 Active

4401675 ONE PIECE CLOSED END POUCSUP 270 8.48 Active

4401669 ONE-PIECE CLOSED END POUCSUP 270 8.48 Active

4451244 ONLANZAPINE 10MG INJPHAR 259 J2358 155.80 Active

4550595 OPI Conf: QualLAB 300 80102 68.90 Active

4551020 OPI Confirm: QuantLAB 300 83925 74.20 Active

4551223 OPIATE CONFIRMATION URINELAB 300 80362 99.64 Active

4450393 OPTHAINE .5 % 15ml.PHAR 250 23.32 Active

4450258 OPTI VITAMINPHAR 250 6.36 Active

4401792 OPTIFOAM 4X4SUP 270 15.90 Active

4401896 OPTIFOAM 6X6SUP 270 21.20 Active

4450807 ORAL BALANCE 1 TUBEPHAR 250 11.66 Active

4550601 Org Def ID: Aerobe->RLLAB 300 87077 82.68 Active

4550602 Org Def ID: Anaerobe->RLLAB 300 87076 110.24 Active

4550600 Org Def ID: Fungi MoldLAB 300 87107 82.68 Active

4550603 Org Def ID: Fungi YeastLAB 300 87106 82.68 Active

4550599 Organism ID Aerobe #1LAB 300 87077 68.90 Active

4552014 Organism ID Aerobe #2LAB 300 87077 68.90 Active

4552016 Organism ID Aerobe #3LAB 300 87077 68.90 Active

4550721 Organism Sensitivity MIC #1LAB 300 87186 90.10 Active

4552015 Organism Sensitivity MIC #2LAB 300 87186 90.10 Active

4552017 Organism Sensitivity MIC #3LAB 300 87186 90.10 Active

4451239 ORPHENADRINE 100MG TABPHAR 250 J3490 6.40 Active

3012360 ORPHENADRINE 60 MG (TO)NP1 521 J2360 127.20 Active

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3020360 ORPHENADRINE 60MG (G)NP2 521 J2360 127.20 Active

3002360 ORPHENADRINE 60MG (M)DR 521 J2360 127.20 Active

4450693 ORPHENADRINE CITRATE 30MG/ML INJPHAR 636 J2360 81.40 Active

4250150 ORTHOTIC CORRECTIONPT 270 157.94 Active

4250116 ORTHOTIC TRAINING/FITTINGPT 420 97760 135.68 Active

4250053 ORTHOTICSPT 420 L3010 191.86 Active

4250058 ORTHOTICSPT 270 L3010 358.28 Active

4750061 OSCALCIS (LEFT) 2-3 VIEWSXRAY 320 73650 136.74 Active

4750169 OSCALCIS (RIGH) 2-3 VIEWSXRAY 320 73650 136.74 Active

4450500 OSELTAMIVIR CAP 75MGPHAR 250 G9019 58.40 Active

4451362 OSELTAMIVIR SUSP. 6MG/ML ORALPHAR 250 462.20 Active

4550606 Osmolality (Serum)LAB 300 83930 63.60 Active

4550605 Osmolality (Urine)LAB 300 83935 77.38 Active

4401822 OSTOMY BELT LARGESUP 270 12.72 Active

4401694 OSTOMY DRAINABLE POUCHSUP 270 7.42 Active

4401703 OSTOMY POUCH TRIM TO FITSUP 270 280.90 Active

4559133 Ova & Parasite Screen Active

4400999 OVER DOOR HOME TRACTSUP 270 118.72 Active

4250069 OVERDOORSHOULDER PULPT 270 42.40 Active

4550608 Oxalate (24 Hr Ur)LAB 300 83945 102.82 Active

4700038 OXIMETER FOR SCOPESOXY 270 64.66 Active

4700024 OXIMETER PULSE PEROXY 270 27.56 Active

4700025 OXIMETER PULSE OP/OBOXY 270 146.31 Active

4700039 OXIMETRY CONTINOUS MONITOOXY 469 94762 173.84 Active

4700026 OXISENSOR II PEDSOXY 270 153.70 Active

4551131 OXY OXYCODONELAB 300 G0430 7.42 Active

4451337 OXYBUTYNIN ER 10 MGPHAR 250 J3490 6.40 Active

4451116 OXYBUTYRIN 5MGPHAR 250 6.40 Active

4450819 OXYCODONE 20MG TABPHAR 250 11.66 Active

4451426 OXYCODONE TAB 10 MGPHAR 250 J3490 6.40 Active

4551224 OXYCODONE WITH METABOLITE CONFIRMATIONLAB 300 83945 1.06 Active

4552085 Oxycodone, SerumLAB 300 130.38 Active

4451427 OXYCODONE/ ACE 10/325PHAR 250 6.36 Active

4450466 OXYCODONE/APAP 5/325MG TABPHAR 250 6.40 Active

4700028 OXYGENOXY 270 27.56 Active

4700029 OXYGEN - OR/SCOPESOXY 270 64.66 Active

4700027 OXYGEN (INPATIENT/OB/EXTENDED ER)OXY 270 150.52 Active

4300012 OXYGEN PORTABLEDME 270 E0431 65.72 Active

4300053 Oxygen Portable bottlesDME 270 16.96 Active

4451225 OXYMETAZOLINE 0.05% NASAL SPRAYPHAR 250 6.36 Active

4450420 OXYTOCIN 10U/ML INJPHAR 259 6.40 Active

4550550 P/C: Creatinine (Urine)LAB 300 82570 63.60 Active

4550549 P/C: Protein (Urine)LAB 300 84156 63.60 Active

4551178 P/H UDS AFTER HOURSLAB 300 80.56 Active

4350055 PACKING A NOSEPROC 270 43.46 Active

30157180 PACKING FOR SPONTANIOUS OR TRAMATIC VAGNP1 521 57180 536.35 Active

4400563 PACKING STRIP 1/4"SUP 270 12.72 Active

Page 67: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4400564 PACKING STRP 1/2"SUP 270 24.38 Active

4450395 PACLITAXEL 100MG IVPHAR 259 226.84 Active

1111112 PAIN PUMP REFILL AS Active

4050022 PALS PRIVATE PAYPALS 990 T1019 6.04 Active

4050017 PALS PRIVATE PAY MILEAGEPALS 580 S0215 0.57 Active

4050021 PALS RESPITEPALS 990 T1019 5.00 Active

4451443 PAMIDRONATE DIS 3MG/MLPHAR 636 J2430 11.70 Active

4451651 PAMIDRONATE INJ 60 MGPHAR 259 155.80 Active

4450748 PAMIDRONATE IV 30MG/10MLPHAR 636 J2430 12.00 Active

4451283 PANTOPRAZOLE 20MGPHAR 250 J3490 6.36 Active

4450447 PANTOPRAZOLE 40MG INJPHAR 636 J3490 23.30 Active

4450446 PANTOPRAZOLE 40MG TABPHAR 250 6.40 Active

4451290 PAPAYA TABPHAR 250 6.36 Active

4350056 PARACENTESISPROC 270 40.28 Active

4350103 PARACENTESISPROC 542 1.06 Active

4552000 PARACENTESIS (NMH)AMBULANCELAB 300 3969.70 Active

4552013 PARAINFLUENZA BY REAL TIME PCRLAB 300 87631 212.00 Active

4559157 PARANEOPLASTIC AUTOANTIBODY EVAL Active

4552080 Parathyroid Hormone-Related PeptideLAB 300 82397 93.28 Active

4450397 PAROXETINE 10MG TABPHAR 250 J3490 6.40 Active

4451082 PAROXETINE 20MG TABPHAR 250 J3490 6.40 Active

4550614 Parvovirus B-19 AB PanelLAB 300 87798 178.08 Active

4550612 Parvovirus: IgGLAB 300 86747 90.10 Active

4550613 Parvovirus: IgMLAB 300 86747 90.10 Active

4401775 PATELLA STABILIZERSUP 270 L1800 116.60 Active

4401955 PATELLA STABILIZER LGESUP 270 53.00 Active

4401954 PATELLA STABILIZER MEDSUP 270 53.00 Active

4401956 PATELLA STABILIZER XLSUP 270 53.00 Active

4401957 PATELLA STABILIZER XXLSUP 270 53.00 Active

4551146 PATERNITY TESTING COLLECTLAB 300 99001 42.40 Active

4250097 PATTIBOBPT 270 136.74 Active

4551021 PCP Confirm: QualLAB 300 80102 57.24 Active

4551022 PCP Confirm: QuantLAB 300 83992 110.24 Active

4551130 PCP PHENCYCLIDINELAB 300 G0430 34.98 Active

4552028 Peach- IgELAB 300 86003 33.92 Active

4400579 PEAK FLOW METERSUP 270 118.72 Active

4551100 Peanut-IgELAB 300 86003 33.92 Active

4552025 Pecan- IgELAB 300 86003 33.92 Active

4401730 PEDIA-LAXSUP 271 7.42 Active

4700030 PEDIATRIC 02 MASKOXY 270 10.60 Active

4700007 PEDI-CAP CO2 DETECOXY 270 84.80 Active

4401848 PEDS ECG ELECTRODESUP 270 5.30 Active

4700156 PEDS NONREBREATHEROXY 270 7.42 Active

4401975 PEDS SIPPY CUPSUP 270 10.00 Active

4450673 PEGFILGRASTIM 6 MG/0.6MLPHAR 636 J2505 9399.20 Active

4451260 PEGFILGRASTIN 6 MGPHAR 636 J2505 7060.66 Active

4550462 PE-IF-F-S: Fr Prof InterpLAB 300 84165 42.40 Active

Page 68: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4350057 PELVIC EXAMINATIONPROC 270 40.28 Active

5880010 PELVIC ULT HAVREDNU 402 405.34 Active

4750095 PELVIS 1-2 VIEWSXRAY 320 72170 201.40 Active

4750094 PELVIS 3-5 VIEWSXRAY 320 72190 252.28 Active

4750142 PELVIS W/ HIPS 2 VIEWSXRAY 320 73521 238.50 Active

4750908 PELVIS WITH LEFT HIP 2-3 VIEWSXRAY 320 73502 140.00 Active

4750907 PELVIS WITH RIGHT HIP 2-3 VIEWSXRAY 320 73502 140.00 Active

4552044 Penicillium chrysogenum - IgELAB 300 86003 33.92 Active

4400581 PENROSE DRAIN TUBESUP 270 8.48 Active

4450967 PENTOXIFYLLINE 400MG TABPHAR 250 6.40 Active

4401690 PERCUSSION MACHINESUP 270 443.08 Active

4401892 PERCUSSION VEST LGESUP 270 280.90 Active

4401894 PERCUSSION VEST MEDSUP 270 280.90 Active

4401691 PERCUSSION VEST SMSUP 270 280.90 Active

4401893 PERCUSSION VEST XLGSUP 270 280.90 Active

4400582 PERI BOTTLESUP 270 88.10 Active

4450402 PERIACTIN 4MG TABPHAR 250 6.40 Active

4350059 PERICARDIAL CENTESISPROC 270 72.08 Active

4250063 PERIODIC RE-EVALUATIONPT 420 97164 115.54 Active

4350060 PERITONEAL DIAYLSISPROC 270 24.38 Active

4400584 PERSONAL SUPPLIES KISUP 270 20.14 Active

4551033 Pertussis - Def DLAB 300 87077 110.24 Active

4550615 Pertussis Culture [ScreenLAB 300 87081 82.68 Active

4550661 PE-S-QNT: Prof InterpLAB 300 84165 42.40 Active

4550660 PE-S-QNT:Prot ElectroLAB 300 84165 97.52 Active

4550663 PE-Ur-QNT: Prof IntrerpLAB 300 84166 42.40 Active

4550662 PE-Ur-QNT: Protein ElectLAB 300 84166 117.66 Active

4550617 pH [only] - Blood - OptiLAB 300 82800 57.24 Active

4552092 pH, Urine - 24HourLAB 300 83986 68.90 Active

4550619 pH: Body FluidLAB 300 83986 68.90 Active

4550618 pH: FecesLAB 300 83986 68.90 Active

4450452 PHENAZOPYRIDINE 200MG *OUT PT PK*PHAR 250 J3490 58.40 Active

4451081 PHENAZOPYRIDINE 200MG TABPHAR 250 J3490 12.00 Active

4451440 PHENAZOPYRIDINE TAB 95mgPHAR 250 6.40 Active

3010550 PHENERGAN 25MGNP1 521 J2550 23.32 Active

3020255 PHENERGAN 50 MGNP2 521 J2550 23.32 Active

300255 PHENERGAN 50MG (M)DR 521 J2550 23.32 Active

4450410 PHENERGAN TAB 25MG OPPHAR 250 11.66 Active

4450170 PHENOBARB/ATROPINE/HYOS/SCOP ELIX 5 CCPHAR 250 58.40 Active

4551034 PhenobarbitalLAB 300 80184 102.82 Active

4450912 PHENOL ORAL ANESTH LOZENGEPHAR 250 6.40 Active

4550623 Phenothiazine ScreenLAB 300 84022 136.74 Active

4550632 PhenylketoniuriaLAB 300 84030 28.62 Active

4450418 PHENYTOIN 100MG/2ML INJPHAR 636 J1165 6.40 Active

4450161 PHENYTOIN ER 100MG TABPHAR 250 6.40 Active

4550629 Phos [Phosphorus]LAB 300 84100 57.24 Active

4550124 Phospholipid (CardioLipin) Antibody, IgGLAB 300 86147 31.80 Active

Page 69: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4550125 Phospholipid (CardioLipin) Antibody, IgMLAB 300 86147 31.80 Active

4559148 Phospholipid Antibody Panel Active

4551563 PHOSPHORUS TAB 250MGPHAR 250 6.40 Active

4552098 PHYSICIAN ORDERED PATH REVIEWLAB 300 85060 50.00 Active

4350058 PHYSIOTHERAPY POSTURPROC 270 11.66 Active

4450661 PHYTONADIONE 10MG/ML INJPHAR 636 J3430 231.10 Active

4400587 PICC/CENTRAL LINE DRESSINGSUP 270 15.90 Active

4551132 PIN WORM SMEARLAB 300 87172 47.70 Active

4552029 Pineapple - IgELAB 300 86003 33.92 Active

4450009 PIOGLITAZONE HCL 15MG TABPHAR 250 J3490 6.36 Active

4450007 PIOGLITAZONE HCL 30MG TABPHAR 250 J3490 6.40 Active

4450606 PIPERACILLIN SOD/TAZOBACTAM 3.375 GM INJPHAR 636 J2543 58.40 Active

4552083 Platelet AntibodyLAB 300 86022 292.56 Active

4250156 PlatformPT 420 294.68 Active

4401865 PLEUR-EVACSUP 270 224.72 Active

4550635 PLT - Platelet CountLAB 300 85049 34.98 Active

4600020 PLT-Pheresis LR UnitBB 390 P9035 816.20 Active

4600021 PLT-Pheresis: LR + IrradBB 390 P9037 1416.16 Active

4500086 PLUM IV SETIV 264 64.66 Active

4500085 PLUMSET BLOOD TUBINGIV 264 64.66 Active

4500093 PLUMSET NITRO TUBINGSUP 264 31.80 Active

4401762 PNEUMOTHORAX TRAYSUP 270 340.26 Active

4450645 PNEUMOVAX 23PHAR 250 90732 253.60 Active

4450339 POLYETHYLENEGLYCOL [17GM]PHAR 250 J3490 6.40 Active

4401801 POLYMEM DRSGSUP 270 28.62 Active

4400316 POLYPECTOMY (SNARE)SUP 270 191.86 Active

4451626 POLYTRIM OPTHPHAR 250 58.40 Active

4300039 PORTABLE O2 CONCENTRATORDME 270 E1392 212.00 Active

4300040 PORTABLE O2 CONTENTSDME 270 E0443 127.20 Active

4401062 PORTABLE VOLUME VENTSUP 270 45.58 Active

4350061 PORTABLE WOUND SUCTIPROC 270 28.62 Active

4401815 POSEY TORSO SUPPORTDME 270 96.46 Active

4500082 POSI-FLOW IV SITEIV 264 7.42 Active

4400591 POSIFLOW IV SITE B-DSUP 270 15.90 Active

4401718 POSITIONING ROLLSUP 270 15.90 Active

4401692 POSITRAP SEGORA BASKETSUP 270 662.50 Active

4559145 POST EXPOSURE, EMPLOYEE Active

4559144 POST EXPOSURE, PATIENT Active

4400596 POSTOPERATIVE SHOE WSUP 270 12.72 Active

4400597 POSTURE SUPPORT ELASSUP 270 L0430 191.86 Active

4451104 POTASSIUM 10MEQ TABPHAR 250 J3490 6.40 Active

4451376 POTASSIUM ACETATE 40MeQ/20ML IVPHAR 636 J3480 6.40 Active

4451366 POTASSIUM BICARB 10 MEQ TABPHAR 250 6.40 Active

4451419 POTASSIUM BICARB 20 mEq TABPHAR 250 6.40 Active

4451020 POTASSIUM CHLORIDE 20 mEq/10mL IVPHAR 636 J3480 11.70 Active

4451358 POTASSIUM CHLORIDE ORAL SOL. 10%PHAR 250 6.40 Active

4451377 POTASSIUM CL TAB 20MEQPHAR 250 J3490 6.40 Active

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4401803 POUCH /#18193SUP 270 34.98 Active

4400598 POUCH CLAMPSSUP 270 7.42 Active

4401824 POUCH SF(HH)SUP 270 108.12 Active

4300080 POWER SUPPLY CORD FOR CPAPDME 270 57.24 Active

4451614 PPD SYRUP OUT PT BOTTLEPHAR 250 J3490 23.30 Active

4450646 PPD TINE TESTPHAR 250 86580 46.64 Active

4551023 PPX Confirm: QualLAB 300 80101 68.90 Active

4551024 PPX Confirm: QuantLAB 300 80299 102.82 Active

4551211 PQ TYPE CALCIUM CHANNEL ABLAB 300 62.54 Active

4451431 PRADAXA TAB 150MGPHAR 250 12.00 Active

4450986 PRAVASTATIN 40 MG TABPHAR 250 11.66 Active

4550923 PreAlbuminLAB 300 84134 102.82 Active

4451584 PREDNISOLONE 15MG/5ML OUT PT BTLPHAR 250 58.40 Active

4450430 PREDNISOLONE LIQ 15MG/5MLPHAR 250 J3490 6.40 Active

4450427 PREDNISONE 10MGPHAR 250 J3490 6.36 Active

4450429 PREDNISONE 1MG TABPHAR 250 J3490 6.40 Active

4451076 PREDNISONE 20MG TABPHAR 250 6.40 Active

4450428 PREDNISONE 5MG TABPHAR 250 J3490 6.40 Active

4450431 PREDNISONE OPTH SOLPHAR 250 231.10 Active

4250182 PREFAB PEDIACTRIC ORTHOTICSUP 270 L1930 233.20 Active

4250183 PREFAB PEDIATRIC ORTHOTIC EACHSUP 270 174.90 Active

4450960 PREGABALIN 25MG TABPHAR 250 6.36 Active

4451218 PREGABALIN 300 MGPHAR 250 11.66 Active

4451652 PREGABALIN 50 MGPHAR 250 58.40 Active

4450877 PREGABALIN 50MG TABPHAR 250 11.66 Active

4450933 PREGABALIN 75MGPHAR 250 96.55 Active

4551116 PREGNENOLONELAB 300 84140 154.76 Active

4450433 PREMARIN 0.3MG TABPHAR 250 6.36 Active

4450432 PREMARIN 0.625MG TABPHAR 250 11.70 Active

4450779 PREMARIN 1.25MGPHAR 250 6.36 Active

4401739 PREMIUM CHIN STRAPSUP 270 A7036 72.08 Active

4559016 Prenatal Panel with HIV 1 & 2 Active

4550437 Prenatal Panel: HIV 1+ 2LAB 300 86703 68.90 Active

4550588 Prenatal Panel: MostTestsLAB 300 80055 136.74 Active

4451223 PRENATAL VITAMINPHAR 250 6.40 Active

4450973 PREPARATION H RECTAL SUPPHAR 250 J3490 6.40 Active

445250 PRESTIQ 50MG POPHAR 250 11.66 Active

4401856 prevail padsSUP 270 5.30 Active

4451616 PRIALT PFPHAR 259 3466.00 Active

4451568 PRILOSEC DR 40MG POPHAR 250 J3490 6.40 Active

4550622 Prim + Phen: PhenobarbLAB 300 80184 78.99 Active

4451103 PRIMAXIN 500MG IVPHAR 636 J3490 58.40 Active

4401858 PRISMA DRESSINGSUP 270 22.26 Active

4100002 PRIVATE PAY NURSINGPDN 580 11.24 Active

4451598 PRIVIGEN 10% 40 GMPHAR 636 J1459 4620.00 Active

4451404 PRIVIGEN IMMUNE GLOBULINPHAR 636 J1459 4986.60 Active

4401881 PRO STEP WALKER BOOT- MEDSUP 270 110.24 Active

Page 71: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4400599 PRO STEP WALKER BOOT SMSUP 270 L4386 106.00 Active

4401883 PRO STEP WALKER BOOT- XLSUP 270 L4386 151.58 Active

4401882 PRO STEP WALKER BOOT-LGESUP 270 L4386 110.24 Active

4451056 PROCAINAMIDE 100MG/ML INJPHAR 259 231.10 Active

4450437 PROCAINAMIDE HCL 1GMPHAR 259 6.36 Active

4550867 ProcalcitoninLAB 300 82397 218.36 Active

4450440 PROCARDIA 10MG TABPHAR 250 58.40 Active

4401676 PROCELLSUP 270 8.48 Active

4450805 PROCHLORPERAZINE 10MG TABPHAR 250 6.40 Active

4450806 PROCHLORPERAZINE 5MG/1MLPHAR 636 J0780 97.70 Active

4552001 Procollagen I Intact N-Terminal, SerumLAB 300 83519 432.48 Active

4450442 PROCRIT 10,000U/MLPHAR 636 J0885 1749.60 Active

4450647 PROCRIT 20,000 /MLPHAR 636 J0885 1155.40 Active

4450443 PROCRIT 40,000U VIALPHAR 636 J0885 1992.80 Active

4550646 PROGESTERONELAB 300 84144 146.28 Active

4250161 PROGRESS ELBOW HINGE SPLINTSUP 270 234.26 Active

4551011 ProinsulinLAB 300 84206 224.72 Active

4550647 ProlactinLAB 300 84146 146.28 Active

4451629 PROLASTIN-C INJPHAR 259 0.00 Active

4401807 PROLENE 4-0 P-3SUP 270 50.00 Active

4451435 PROLIA INJ. 60MG/MLPHAR 636 J0897 2603.85 Active

302550 PROMETHAZINE (G)NP2 521 J2550 23.32 Active

4451234 PROMETHAZINE (IN PPD)PHAR 250 0.00 Active

4451194 PROMETHAZINE 25MG SUPPPHAR 250 23.30 Active

4451169 PROMETHAZINE 25MG TAB *OUT PT PK*PHAR 250 11.70 Active

4451015 PROMETHAZINE 25MG/MLPHAR 636 J2550 6.36 Active

4450409 PROMETHAZINE 25MG/ML INJ.PHAR 636 J3490 11.70 Active

4450407 PROMETHAZINE 50MG/ML INJPHAR 636 J2550 11.70 Active

4450413 PROMETHAZINE DM 5MLPHAR 250 6.36 Active

4451083 PROMETHAZINE DM SYRUP 10CPHAR 250 6.36 Active

4450414 PROMETHAZINE SUPP 50MGPHAR 250 58.30 Active

4450415 PROMETHAZINE SUPP. 12.5MGPHAR 250 58.40 Active

4451112 PROMETHAZINE SYURP W/ CODEINE *OUT PT PKPHAR 250 J3490 11.70 Active

4450406 PROMETHAZINE TAB 25MGPHAR 250 Q0169 6.40 Active

4450412 PROMETHAZINE W/ CODEINE 6.25/10MG/5MLPHAR 250 6.36 Active

3002550 PROMETHAZINE-(M)DR 521 J2550 23.32 Active

4551079 PROMETHEUS THIOPURINE METLAB 300 82491 507.74 Active

3012550 PROMETHIAZINE 25 MG THADNP1 521 J2550 23.32 Active

4400600 PROMISE DAY PAD CASESUP 270 208.82 Active

4400601 PROMISE PAD PK/6SUP 270 8.48 Active

4400602 PROMISE PADS PKGS/2SUP 270 29.68 Active

4450394 PROPARACAINE HCL 0.5% OPHTHALMICPHAR 250 J3490 6.40 Active

4450266 PROPRANOLOL 10MG TABPHAR 250 6.40 Active

4451120 PROPRANOLOL 1MGPHAR 636 J1800 58.30 Active

4450886 PROPRANOLOL 20MGPHAR 250 6.36 Active

4451666 PROPRANOLOL LA 80 MGPHAR 250 11.70 Active

4250120 PROSTHETIC/ORTHO CHECKPT 420 97760 85.86 Active

Page 72: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4552066 Protein C ActivityLAB 300 85303 199.28 Active

4550655 Protein Elect-QNT-SerumLAB 300 84165 136.74 Active

4552006 Protein Elect-QNT-UrineLAB 300 84166 136.74 Active

4551241 PROTEIN ELECTROPHORESIS OTHER FLUIDLAB 300 84166 121.01 Active

4451360 PROTEIN POWDERPHAR 250 6.40 Active

4552009 Protein S ActivityLAB 300 85306 207.76 Active

4550652 Protein S AG: FREELAB 300 85306 160.06 Active

4550656 Protein S AG: TotalLAB 300 85305 90.10 Active

4551189 Protein/Creat Ratio Urine Active

4550130 PROTEUS PAN: Q FEV II LGLAB 300 86638 48.76 Active

4552067 Prothrombin G20210A Mutation, BloodLAB 300 81240 384.78 Active

PUMP FILL PROVIDER PUMP FILLED 761 99213 110.00 Active

4550671 PSA Free + Total: FreeLAB 300 84154 116.60 Active

4550668 PSA Free + Total: TotalLAB 300 84153 139.92 Active

4559124 PSA Free and Total Active

4550672 PSA -Prostate Specific AGLAB 300 84153 139.92 Active

4550670 PSA ScreenLAB 300 G0103 139.92 Active

4550674 PseudocholinesteraseLAB 300 82480 102.82 Active

4451415 PSEUDOEPHEDRINE 15MG/5ML ORAL LIQ.PHAR 250 6.40 Active

4451250 PSEUDOEPHEDRINE 30MG TABPHAR 250 6.40 Active

4451320 PSEUDOEPHEDRINE ER 120 MGPHAR 250 6.36 Active

4450335 PSYLLIUM (1TBS)PHAR 250 6.40 Active

4550675 PT - Protime + INRLAB 300 85610 42.40 Active

4551074 PT (PROTIME-INR) BCLAB 300 85610 42.40 Active

4250134 PT BODY POS CURRENT STATUSPT 420 G8981 1.06 Active

4250136 PT BODY POS D/C STATUSPT 420 G8983 1.06 Active

4250135 PT BODY POS GOAL STATUSPT 420 G8982 1.06 Active

4250137 PT CARRY CURRENT STATUSPT 420 G8984 1.06 Active

4250139 PT CARRY D/C STATUSPT 420 G8986 1.06 Active

4250138 PT CARRY GOAL STATUSPT 420 G8985 1.06 Active

4250131 PT MOBILITY CURRENT STATUSPT 420 G8978 1.06 Active

4250133 PT MOBILITY D/C STATUSPT 420 G8980 1.06 Active

4250132 PT MOBILITY GOAL STATUSPT 420 G8979 1.06 Active

4250143 PT OTHER PT/OT CURRENT STATUSPT 420 G8990 1.06 Active

4250145 PT OTHER PT/OT D/C STATUSPT 420 G8992 1.06 Active

4250144 PT OTHER PT/OT GOAL STATUSPT 420 G8991 1.06 Active

4250140 PT SELF CARE CURRENT STATUSPT 420 G8987 1.06 Active

4250142 PT SELF CARE D/C STATUSPT 420 G8989 1.06 Active

4250141 PT SELF CARE GOAL STATUSPT 420 G8988 1.06 Active

4250146 PT SUB PT/OT CURRENT STATUSPT 420 G8993 1.06 Active

4250148 PT SUB PT/OT D/C STATUSPT 420 G8995 1.06 Active

4250147 PT SUB PT/OT GOAL STATUSPT 420 G8994 1.06 Active

4600024 Pt. Phenotype (ARC)BB 300 86905 144.16 Active

4550676 PTH - Intact (only)LAB 300 83970 266.06 Active

4559028 PTH Intact with Reflex Active

4550677 PTH PanelLAB 300 178.08 Active

4550111 PTH Panel: CALAB 300 82310 28.62 Active

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4550194 PTH PANEL: CREATLAB 300 82565 22.26 Active

4550628 PTH Panel: PhosLAB 300 84100 22.26 Active

4551035 PTH Panel: PTHLAB 300 83970 266.06 Active

4551075 PTT (BILLINGS CLINIC)LAB 300 85730 68.90 Active

4550683 PTT- Partial Thrombo TimeLAB 300 85730 68.90 Active

4400256 PULL-UPS - MEDSUP 270 72.08 Active

4400262 PULL-UPS LGESUP 270 53.00 Active

4400255 PULL-UPS SMSUP 270 53.00 Active

4400252 PULL-UPS XLGSUP 270 53.00 Active

4500063 PUMP IV DAILY CHARGEIV 270 27.56 Active

4500061 PUMP IV PUMP & POLEIV 270 43.46 Active

4500062 PUMP IV RENTALIV 270 8.48 Active

4400606 PUMP KANGAROO 1000MLSUP 270 8.48 Active

1111111 PUMP REFILL Active

4401721 PURACOL DRESSING/ BXHH 270 493.96 Active

4551206 PURKINJE CELL CYTOPLASMIC AB TYPE 1LAB 300 62.54 Active

4551207 PURKINJE CELL CYTOPLASMIC AB TYPE 2LAB 300 62.54 Active

4551208 PURKINJE CELL CYTOPLASMIC AB TYPE TRLAB 300 62.54 Active

4250153 PUTTY PT 270 11.66 Active

4550927 Q Fever Panel: IgGLAB 300 86638 90.10 Active

4550926 Q Fever Panel: IgG + IgMLAB 300 192.92 Active

4550928 Q Fever Panel: IIgMLAB 300 86638 82.68 Active

4400610 Q-TIPS 3" OR 6" STERSUP 270 3.18 Active

4559003 Quad Screen Active

4550019 QUAD: AFPLAB 300 82105 68.90 Active

4550301 QUAD: ESTRIOL- UE3LAB 300 82677 82.68 Active

4550384 QUAD: HCG - Total B-subLAB 300 84702 140.98 Active

4550492 QUAD: Inhibin-ALAB 300 86336 82.68 Active

4551190 QUANTIFERON GOLD TB EXPOSURELAB 300 86480 192.92 Active

4451581 QUETIAPINE 50 MG TABPHAR 250 6.40 Active

4401174 QUIK-COMBO ECG ELECTRODESSUP 270 191.86 Active

4401895 QUIK-COMBO PEDSSUP 270 151.58 Active

4550689 RA AB-IgM (Quant)LAB 300 86431 82.68 Active

4550687 RA [Rheumatoid Factor]LAB 300 86430 63.60 Active

4450005 RABEprazole SODIUM 20MG TABPHAR 250 J3490 11.66 Active

4451369 RABIES IMMUNE GLOBULIN (HUMAN)PHAR 636 90376 1155.40 Active

4451370 Rabies VaccinePHAR 636 90675 653.20 Active

4450455 RACEMIC EPINEPHRINE 2.25% NEB. SOL.PHAR 250 J3490 6.40 Active

4300014 RAISED TOILET SEATDME 270 E0625 33.92 Active

4551057 RANDOM URINE CREATININELAB 300 82570 47.70 Active

4551056 RANDOM URINE SODIUMLAB 300 84300 42.40 Active

4450585 RANITIDINE 150MG TABPHAR 250 6.40 Active

4450140 RANITIDINE 50MG/2ML INJPHAR 636 J2780 58.40 Active

4550690 RBC [Red Cells]LAB 300 85041 28.62 Active

4600022 RBC Pretreat-Chem (ARC)BB 300 86970 102.82 Active

4600023 RBC Pretreat--Enzym (ARC)BB 300 86971 40.28 Active

4600025 RBC: Leuko-reduced UnitBB 390 P9016 389.02 Active

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4600046 RBC: LR + Irradiated UnitBB 381 P9040 585.12 Active

4500084 RECONSTITUTION DEVICEIV 270 7.42 Active

4350062 RECTAL EXAMINATIONPROC 270 11.66 Active

2552061 Red Sorrel - IgELAB 300 86003 29.68 Active

4551181 REDUCING SUBSTANCE, FECESLAB 300 82945 89.04 Active

3022212 RELISTOR 12 MGNP2 521 J1745 226.84 Active

3002212 RELISTOR 12MGDR 521 J1745 226.84 Active

3011745 RELISTOR 12MGNP1 521 J1745 226.84 Active

4401828 REMEDY CLEANSERSUP 270 12.72 Active

4401831 REMEDY SKIN REPAIRSUP 270 12.72 Active

4550692 Renal PanelLAB 300 80069 117.66 Active

4550693 Renin (Plasma)LAB 300 84244 201.40 Active

4300025 REPLACEMENT CUSHIONDME 270 A7032 66.78 Active

4350063 RESETTING A NOSEPROC 270 40.28 Active

4551924 Respiratory Panel, Region 11, Rocky Moun Active

4150006 RESPITE CARE PALSRSP 990 T1019 5.11 Active

4150007 RESPITE LPNORSP 990 37.10 Active

4150004 RESPITE NURSEORSP 990 40.00 Active

3100009 RESPITE ROOMIP 120 256.52 Active

3100008 RESPITE ROOM SELF PAYIP 120 H0045 169.60 Active

4400624 RESUSCITATOR ADULTSUP 270 72.08 Active

4401707 RESUSCITATOR INFANTSUP 440 72.08 Active

4400625 RESUSCITATOR TODDLERSUP 270 191.86 Active

4550697 Retics [Reticulocytes]LAB 300 85045 57.24 Active

4300023 REUSABLE FILTER (BLACK)DME 270 A7039 22.26 Active

4600028 Rh Phenotype (ARC)BB 300 86906 144.16 Active

4600029 Rh Type (ARC)BB 300 86901 62.54 Active

4401834 RHINO ROCKET LGESUP 270 94.21 Active

4401906 RHINO ROCKET MEDSUP 270 94.21 Active

4401145 RIB BELT 6:SUP 270 29.68 Active

4401701 RIB BELT UNIVERSALSUP 270 15.90 Active

4750099 RIBS (LEFT) + PA CHEST 3VXRAY 320 71101 248.04 Active

4750100 RIBS (LEFT) 2 VIEWSXRAY 320 71100 200.34 Active

4750181 RIBS (RIGH) + PA CHEST 3VXRAY 320 71101 248.04 Active

4750180 RIBS (RIGHT) 2 VIEWSXRAY 320 71100 200.34 Active

4750101 RIBS BILAT 3 VIEWSXRAY 320 71110 238.50 Active

4750098 RIBS BILAT W/ PA CHEST 4+XRAY 320 71111 279.84 Active

4551102 Rice - IgELAB 300 86003 33.92 Active

4550183 Rickettsial Pan: RMSF IgGLAB 300 86757 57.24 Active

4559005 Rickettsial Serolgy Panel Active

4451361 RIFAMPIN 300MG TABPHAR 250 11.70 Active

4500037 RINGERS 1000CCIV 258 43.46 Active

4450462 RISPERIDONE 0.25MG TABPHAR 250 J3490 6.40 Active

4450677 RISPERIDONE 1MG TABPHAR 250 J3490 6.40 Active

4451650 RISPERIDONE TAB 0.50 MGPHAR 250 6.40 Active

4550698 RistocetinN CoFactorLAB 300 85245 172.78 Active

4550699 Ritalin (Methyphenidate)LAB 300 82491 184.44 Active

Page 75: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4451282 ROBITUSSIN GEL TABPHAR 250 6.36 Active

4551219 ROCKY MOUNTAIN ALLERGENS 15LAB 300 86003 425.64 Active

4451106 RONDEC DM 10CC DOSEPHAR 250 6.36 Active

4450459 ROPINIROLE 0.25MG TABPHAR 250 J3490 11.70 Active

4451268 ROPINIROLE 0.5MG TABPHAR 250 J3490 6.40 Active

4450695 ROPINIROLE 1MG TABPHAR 250 J3490 6.40 Active

4451364 ROPINIROLE 2MG TABPHAR 250 J3490 6.40 Active

4451163 ROPINIROLE 3MG P.O.PHAR 250 11.66 Active

4451297 ROPINIROLE 5MG TABPHAR 250 J3490 6.40 Active

4450138 ROSUVASTIN CALCIUM 10MG TABPHAR 250 J3490 6.40 Active

4550097 ROTAVIRUS AG (FECES)LAB 300 87425 136.74 Active

4552060 Rough Pigweed - IgELAB 300 86003 33.92 Active

4451195 ROZEREM 8MGPHAR 250 11.66 Active

4550836 RPR - Reflex (VDRL)LAB 300 86592 68.90 Active

4550703 RSV AGLAB 300 87807 117.66 Active

4550705 Rubella IgM ABLAB 300 86762 136.74 Active

4550704 Rubella - PremaritalLAB 300 86762 73.14 Active

4550706 Rubella IgG AB (Rt)LAB 300 86762 57.24 Active

4550710 Rubeola AB: IgGLAB 300 86765 68.90 Active

4550708 Rubeola AB: IgMLAB 300 86765 68.90 Active

4552074 Russell's Viper Venom-DRVVT DilutedLAB 300 85613 99.64 Active

4550711 Russell's Viper Venon Time:DRVVTLAB 300 85612 37.10 Active

4552059 Russian Thistle - IgELAB 300 86003 33.92 Active

4551103 Rye - IgELAB 300 86003 33.92 Active

4750103 SACRUM / COCCYX 2-3 VIEWSXRAY 320 72220 217.30 Active

4401785 SAFETY IV CATHSUP 270 8.48 Active

4550713 SalicylatesLAB 300 80196 165.36 Active

4451612 SALINE NASAL SPRAYPHAR 250 6.36 Active

4401934 SAM PELVIC SLING-LGSUP 270 212.00 Active

4401750 SAM PELVIC SLING-REGSUP 270 280.90 Active

4401841 SAM SPLINT 36"SUP 270 61.48 Active

4401840 SAM SPLINT JUNIORSUP 270 24.38 Active

SAMPLE SAMPLEPHAR 250 0.00 Active

4750104 SCAPULA (LEFT)XRAY 320 73010 185.50 Active

4750182 SCAPULA (RIGHT)XRAY 320 73010 185.50 Active

4150002 SCOPE RESPITE ROOMRSP 990 159.00 Active

4401763 SCOTCHCAST 2" (EA INCH)SUP 270 15.90 Active

4401764 SCOTCHCAST 3" (EA INCH)SUP 270 15.90 Active

4401765 SCOTCHCAST 4" (EA INCH)SUP 270 15.90 Active

4401766 SCOTCHCAST 5" (EA INCH)SUP 270 8.48 Active

4401154 SCOTCHCOST PLUS 2"SUP 270 15.90 Active

4559026 Seafood Allergen Profile Active

3800007 SEDATION BY ORAL METDNU 370 25.44 Active

4400165 SELF CATH 10 FR PEDSSUP 270 72.08 Active

4401714 SELF CATH MALE 14FRSUP 270 8.48 Active

4551067 Semen Analysis Sperm Presence/MotilityLAB 300 89321 42.40 Active

4450972 SENNA 8.6 TABPHAR 250 J3490 6.40 Active

Page 76: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450683 SENNA PLUS TABPHAR 250 J3490 11.70 Active

4451355 SENNASIDES/ DOCUSATE SODIUM 8.8MGPHAR 250 6.36 Active

4550715 Sens: B-LactamaseLAB 300 28.62 Active

4550902 Sens-Aer=MIC @ RLLAB 300 87186 102.82 Active

4550042 SENS-ANAEROBIC AB#1LAB 300 87181 34.98 Active

4551115 Sens-Anaerobic: AB #2LAB 300 87181 34.98 Active

4550213 SENS-ANAEROBIC: AB #3LAB 300 87181 34.98 Active

4451587 SEPTRA SUSP OUT PTPHAR 250 J3490 155.80 Active

4451165 SEROQUEL 25MG POPHAR 250 11.66 Active

4451191 SEROQUEL 300MGPHAR 250 58.30 Active

4550722 Serotonin (Serum)LAB 300 84260 110.24 Active

4550724 Serous Fluid: AMYLAB 300 82150 68.90 Active

4450959 SERTRALINE 100 MG TABPHAR 250 6.40 Active

4451363 SERTRALINE 25MG TABPHAR 250 6.40 Active

4450978 SERTRALINE 50 MG TABPHAR 250 6.40 Active

4600033 Serum Diff Absorp (ARC)BB 300 86978 186.56 Active

4600030 Serum Dilution (ARC)BB 300 86976 72.08 Active

4600031 Serum Iincub: Drugs (ARC)BB 300 86975 562.86 Active

4552076 Sesame Seed- IgELAB 300 86003 33.92 Active

4550433 Severe Combined ImmunodeficiencyLAB 300 87143 68.90 Active

4550727 Sex Hormone Binding GlobuLAB 300 84270 169.60 Active

4401706 SHAMPOO CAPSUP 270 15.90 Active

4401962 SHAVE CREAM 1.5 OZSUP 270 5.30 Active

4350064 SHAVE PREPPROC 270 16.96 Active

SHERIFF SHERIFF'S BLOOD DRAW/ER CHGPROC 969 97.52 Active

4300031 Shielded DC Power CordDME 270 45.58 Active

4050023 SHOPPING AND INTEGRATIONPALS 990 S5126 5.74 Active

4552057 Short Ragweed IgELAB 300 86003 33.92 Active

4551163 Shortness of Breath Panel Active

4750110 SHOULDER (LEFT) 1 VIEWXRAY 320 73020 136.74 Active

4750107 SHOULDER (LEFT) 2-3 VIEWSXRAY 320 73030 186.56 Active

4750108 SHOULDER (LEFT) 4+ VIEWSXRAY 320 73030 238.50 Active

4750184 SHOULDER (RIGH) 2-3 VIEWSXRAY 320 73030 186.56 Active

4750183 SHOULDER (RIGHT) 1 VIEWXRAY 320 73020 136.74 Active

4750185 SHOULDER (RIGHT) 4+ VIEWSXRAY 320 73030 238.50 Active

4401910 SHOULDER IMM. MEDSUP 270 10.60 Active

4401911 SHOULDER IMM. SMSUP 270 10.60 Active

4401966 SHOULDER IMM. XLGSUP 270 10.60 Active

3020650 SHOULDER IMMOB (G)NP2 521 L3650 102.82 Active

3010236 SHOULDER IMMOBLIZATION (TO)NP1 274 L3650 102.82 Active

4401168 SHOULDER PULLEY #240SUP 270 A9300 21.20 Active

4300016 SHOWER BENCH/BACK-PURCHASDME 270 69.96 Active

4552034 Shrimp - IgELAB 300 86003 33.92 Active

4750111 SI JOINTS 1-2 VIEWSXRAY 320 72200 186.56 Active

4750102 SI JOINTS 3-4 VIEWSXRAY 320 72202 225.78 Active

4250070 SI SEROLA BELTPT 270 L0621 98.58 Active

4401772 SIGHT SAVERSSUP 270 72.08 Active

Page 77: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4401099 SIGMOIDOSCOPESUP 270 29.68 Active

4451338 SILFEDRINE LIQUID PER 5MLPHAR 250 6.36 Active

4250173 SI-LOC BELTSUP 270 114.48 Active

4450467 SILVADENE CREAM 1 OZPHAR 250 11.66 Active

4451009 SILVADENE CRM 50GM/2OZPHAR 250 58.40 Active

4451084 SILVADENE SULFADIAZINE 1% 400G CREAMPHAR 250 231.10 Active

4450782 SILVER NITRATE STICKPHAR 270 6.40 Active

4450870 SIMETHICONE 80MG TABPHAR 250 6.36 Active

4450814 SIMVASTATIN 10MG TABPHAR 250 J3490 6.36 Active

4450600 SIMVASTATIN 20MG TABPHAR 250 J3490 6.40 Active

4450601 SIMVASTATIN 40MG TABPHAR 250 6.40 Active

4450599 SIMVASTATIN 80MG TABPHAR 250 J8499 11.66 Active

4450468 SINEMET CR 50/200MGPHAR 250 J3490 6.40 Active

4750113 SINUSES 1-2 VIEWSXRAY 320 70210 170.66 Active

4750112 SINUSES 3-6 VIEWSXRAY 320 70220 261.82 Active

4450747 SIPRASIDONE 20MG TABPHAR 250 155.80 Active

4400642 SITZ BATHSUP 270 15.90 Active

4450471 SKELAXIN 800MG TABPHAR 250 11.66 Active

4050024 SKILL ACQUISITIONPALS 990 5.74 Active

4400794 SKIN BARRIER WIPES PTSUP 270 21.20 Active

4401802 SKIN BARRIES/ #14603SUP 270 68.90 Active

4401821 SKIN GEL WIPESSUP 270 12.72 Active

4400650 SKIN OINTMENT 2.5OZSUP 270 8.48 Active

4400648 SKIN STAPLER 15 WSUP 270 29.68 Active

4401839 SKIN STAPLER REG 15SUP 270 24.38 Active

4401838 SKIN STAPLER REG 5SUP 270 12.72 Active

4750115 SKULL 1-3 VIEWSXRAY 320 70250 198.22 Active

4750114 SKULL 4-6 VIEWSXRAY 320 70260 281.96 Active

4800002 SLEEP STUDY-POLYSM 4/>SLP 920 95810 1947.22 Active

4800003 SLEP STDY POLYM W/CPAP TXSLP 920 95811 2100.92 Active

4400657 SLING ARM DELUXESUP 270 15.90 Active

4400666 SLIPPERS SMALLSUP 270 11.66 Active

4400667 SLIPPERS LGESUP 270 8.48 Active

4401908 SLIPPERS MEDSUP 270 5.30 Active

4400668 SLIPPERS NON SLIP X-SUP 270 11.66 Active

4400635 SMALL SHARPS CONTAINSUP 270 5.00 Active

4300087 SMART CARDDME 270 40.28 Active

4550733 Smear: Eos (Nasal)LAB 300 89190 43.46 Active

4550734 Smear: GramLAB 300 87205 48.76 Active

4550502 Smear: KOHLAB 300 87220 63.60 Active

4550948 Smear: Peripheral ->PathLAB 300 1.06 Active

4550736 Smear: PinwormLAB 300 87172 47.70 Active

4551139 SMOOTH MUSCLE ABLAB 300 86255 157.94 Active

4550099 SOB PANEL: BNPLAB 300 83880 151.58 Active

4550390 SOB Panel: CK (CPK)LAB 300 82550 42.40 Active

4550262 SOB PANEl: D-DIMERLAB 300 85379 151.58 Active

4550571 SOB Panel: MyoglobinLAB 300 83874 151.58 Active

Page 78: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4550739 SOB Panel: Short o BreathLAB 300 789.70 Active

4550805 SOB Panel: Troponin-ILAB 300 84484 151.58 Active

4450473 SODIUM BICARB 50MEQ/50ML INJ.PHAR 259 58.40 Active

4450475 SODIUM BICARB PEDIATRIC 1MEQ/1ML INJ.PHAR 259 58.40 Active

4500088 SODIUM CHLOR. 0.9% 10ML FLUSHIV 258 J3490 6.36 Active

4454458 SODIUM EDECRIN 50 MGPHAR 250 2070.18 Active

4450275 SODIUM POLYSTYRENE SULF 15GM POPHAR 250 11.70 Active

4250176 SOLE INSOLE ACTIVESUP 270 95.40 Active

4250177 SOLE INSOLE ACTIVE W/ MET PADSUP 270 106.00 Active

4250179 SOLE INSOLE CASUALSUP 270 127.20 Active

4250175 SOLE INSOLE LIFESTYLESUP 270 95.40 Active

4250178 SOLE INSOLE PERFORMANCESUP 270 106.00 Active

4250174 SOLE INSOLE SPORTSUP 270 53.00 Active

4451207 SOLU MEDROL 500MG IVPHAR 259 110.24 Active

4552064 Soluable Fibrin MonomerLAB 300 85366 96.46 Active

4450477 SOLU-CORTEF 100MG/2MPHAR 259 11.66 Active

4450481 SOLU-CORTEF 250MG INJPHAR 636 J1720 83.70 Active

3000920 SOLUMEDROL 125mg (M)DR 521 J2920 11.66 Active

3012920 SOLUMEDROL 125MG (TO)NP1 521 J2920 11.66 Active

3020920 SOLUMEDROL 125MG INJNP2 521 J2920 11.66 Active

4450479 SOLU-MEDROL 1GM VIALPHAR 259 231.10 Active

4551104 Soybean- IgELAB 300 86003 33.92 Active

4550752 Spec Collect - CapillaryLAB 300 36415 25.44 Active

4552069 Special coagulation interpretationLAB 306 85390 1.06 Active

4550748 Special Ship + HandlingLAB 300 99000 68.90 Active

4550753 SPECIMEN COLLECT VENOUSLAB 300 36415 25.44 Active

4550747 Specimen, Prep & HandlingLAB 300 99001 55.12 Active

4400672 SPECIPAN (URINE HAT)SUP 270 8.48 Active

4260001 SPEECH EVAL/ASSESSHH 440 92506 381.07 Active

4260002 SPEECH TREATMENTHH 440 92507 180.52 Active

4559004 SPEP w/ Interp Active

4401719 SPICA THUMB SPLINTSUP 270 72.08 Active

4750118 Spine- C,T,+L - AP + LatXRAY 320 72082 531.06 Active

4450484 SPIRIVA INHALERPHAR 250 751.54 Active

4451012 SPIRONOLACTONE [25MG] TABPHAR 250 J3490 6.40 Active

4401687 SPLINIT MULTIBOOT FT DROPSUP 270 182.32 Active

4400701 SPLINT COLLES LGE-LSUP 270 36.04 Active

4400700 SPLINT COLLES LGE-RSUP 270 54.06 Active

4400699 SPLINT COLLES MED-LSUP 270 38.16 Active

4400697 SPLINT COLLES SM-LSUP 270 12.72 Active

4400696 SPLINT COLLES SM-RSUP 270 55.12 Active

4400695 SPLINT COLLES XS LSUP 270 15.90 Active

4400694 SPLINT COLLES XS-RSUP 270 42.40 Active

4400712 SPLINT FINGER 11/2"SUP 270 6.36 Active

4400713 SPLINT FINGER 3SUP 270 8.48 Active

4400716 SPLINT FINGER 6"SUP 270 7.42 Active

4400709 SPLINT FINGER ABDUCTSUP 270 28.62 Active

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4401100 SPLINT LEG RENTALSUP 270 96.46 Active

4401889 SPLINT WRIST 7 LACE LG-LSUP 270 21.20 Active

4401888 SPLINT WRIST 7 LACE LG-RSUP 270 21.20 Active

4401887 SPLINT WRIST 7 LACE MED-LSUP 270 S8451 21.20 Active

4401886 SPLINT WRIST 7 LACE MED-RSUP 270 21.20 Active

4401885 SPLINT WRIST 7 LACE SM-LSUP 270 21.20 Active

4401884 SPLINT WRIST 7 LACE SM-RSUP 270 21.20 Active

4401891 SPLINT WRIST 7 LACE XLG-LSUP 270 21.20 Active

44011891 SPLINT WRIST 7 LACE XL-LSUP 270 21.20 Active

4401890 SPLINT WRIST 7 LACE XL-RSUP 270 21.20 Active

4401945 SPLINT WRIST 7 LACE XSM LSUP 270 21.20 Active

4401946 SPLINT WRIST 7 LACE XSM RSUP 270 21.20 Active

4400743 SPLINT WRIST CONFORT L-LGSUP 270 67.84 Active

4400741 SPLINT WRIST CONFORT L-MDSUP 270 64.66 Active

4400739 SPLINT WRIST CONFORT L-SMSUP 270 67.84 Active

4400745 SPLINT WRIST CONFORT L-XLSUP 270 67.84 Active

4400744 SPLINT WRIST CONFORT R-LGSUP 270 67.84 Active

4400742 SPLINT WRIST CONFORT R-MDSUP 270 67.84 Active

4400740 SPLINT WRIST CONFORT R-SMSUP 270 67.84 Active

4400746 SPLINT WRIST CONFORT R-XLSUP 270 67.84 Active

4400726 SPLINT WRIST ELASTICSUP 270 10.60 Active

4400727 SPLINT WRIST ELASTICSUP 270 21.20 Active

4400734 SPLINT WRIST FOREARMSUP 270 68.90 Active

4400736 SPLINT WRIST FOREARMSUP 270 36.04 Active

4400722 SPLINT WRIST LACE-UPSUP 270 L3908 11.66 Active

4401915 SPLINT WRIST/FOREARM LSUP 270 11.66 Active

4400735 SPLINT WRIST/FOREARM RSUP 270 L3908 11.66 Active

4400685 SPLINT WRIST/THUMB ASUP 270 67.84 Active

4401683 SPLINTING SUPPLIESSUP 270 0.00 Active

4551007 Spotted Fever: IgGLAB 300 86757 57.24 Active

4551008 Spotted Fever: IgMLAB 300 86757 57.24 Active

4400750 SPUTUM COLLECTION (FSUP 270 8.48 Active

4550730 SSA AB (RO)LAB 300 86235 62.54 Active

4550729 SSB AB (LA)LAB 300 86235 62.54 Active

4400751 STAPLE REMOVER KITSUP 270 A4649 8.48 Active

4500094 STATLOCK PICCSUP 270 21.20 Active

4400754 STERI STRIP 1/2 INCHSUP 270 8.48 Active

4400753 STERI STRIP 1/4X11/2SUP 270 8.48 Active

4400752 STERI STRIP 1/8SUP 270 8.48 Active

4400756 STERILE DRAPESUP 270 8.48 Active

4401953 STERILE DRAPE NON-FENESTRATEDSUP 270 5.30 Active

4401149 STERILE TRAYSUP 270 77.38 Active

4401897 STERI-STRIP 1/4 X 3"SUP 270 5.30 Active

4750150 STERNOCLAVICULAR JT 3-4 VXRAY 320 71130 248.04 Active

4750120 STERNUM 2-3 VIEWSXRAY 320 71120 200.34 Active

4401805 STIFNECK COLLARSUP 270 28.62 Active

4401912 STIFNECK COLLAR PEDSSUP 270 21.20 Active

Page 80: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4400785 STOMA AHESIVE PASTESUP 270 15.90 Active

4400775 STOMA AHESIVE POUCHSUP 270 191.86 Active

4400784 STOMA AHESIVE WAFERSUP 270 132.50 Active

4400797 STOMA OSTOMY WAFERSUP 270 14.84 Active

4400774 STOMA SKIN CREAMSUP 270 33.92 Active

4400770 STOMA WAFER BOXSUP 270 152.64 Active

4400782 STOMACH TUBES - REUSSUP 270 38.16 Active

4400783 STOMACH TUBES - REUSSUP 270 38.16 Active

4400781 STOMACH TUBES 10 FRSUP 270 14.84 Active

4400777 STOMACH TUBES 12 FRSUP 270 8.48 Active

4400778 STOMACH TUBES 14 FRSUP 270 8.48 Active

4400779 STOMACH TUBES 16 FRSUP 270 8.48 Active

4400780 STOMACH TUBES 18 FRSUP 270 14.84 Active

4400789 STOMAHESIVE WAFER 1SUP 270 41.34 Active

4550707 Stone Analysis: CalculusLAB 300 82365 117.66 Active

4400801 STRAIGHT CATH TRAY W/CATHSUP 270 7.42 Active

4400802 STRAP TENNIS ELBOWSUP 270 10.60 Active

4551105 Strawberry - IgELAB 300 86003 33.92 Active

4550761 Strep A Antigen(Rapid)LAB 300 87430 43.46 Active

4551226 STREP GROUP A MOLECULARLAB 300 87651 107.06 Active

4400804 STRESS LINER PKG/12SUP 270 8.48 Active

4551048 STRIATIONAL MUS AB SLAB 300 83520 122.96 Active

4350066 SUBCLAVIAN CATHETERPROC 270 31.80 Active

4451325 SUCCINYLCHOLINE 20 MG/ML INJPHAR 259 155.80 Active

4450103 SUCRALFATE 1GM TABPHAR 250 J3490 6.40 Active

4401867 SUCTION CANNISTER 1200 MLSUP 270 5.30 Active

4401868 SUCTION CANNISTER 2000 MLSUP 270 5.30 Active

4400813 SUCTION CATHETER 18SUP 270 8.48 Active

4400809 SUCTION CATHETER 10SUP 270 8.48 Active

4400810 SUCTION CATHETER 12FSUP 270 8.48 Active

4400811 SUCTION CATHETER 14SUP 270 8.48 Active

4400812 SUCTION CATHETER 16SUP 270 8.48 Active

4400808 SUCTION CATHETER 8 FSUP 270 8.48 Active

4400806 SUCTION CONNECTING TSUP 270 8.48 Active

4400807 SUCTION CONNECTING TSUP 270 8.48 Active

4401101 SUCTION GUMCOSUP 270 40.28 Active

4401103 SUCTION POLY TRAPSUP 270 29.68 Active

4401102 SUCTION PUMPSUP 270 45.58 Active

4401781 SUCTION TOOTHBRUSHSUP 270 8.48 Active

4400805 SUCTION TUBE ATTACHMSUP 270 8.48 Active

4400817 SUCTION YANKAUER NOSUP 270 7.42 Active

4451442 SUDAFED PEPHAR 250 6.40 Active

4552031 Sugar Cane (Saccharum officinarum) -IgELAB 300 86003 33.92 Active

4450985 SULFAMETH/TMP DS 800/160MG *OUT PT PK*PHAR 250 J3490 12.00 Active

4450726 SULFAMETH/TMP DS 800/160MG TABPHAR 250 J3490 6.40 Active

4450488 SULFAMETH/TRIMP 200/40MG/5ML ORAL SUSP.PHAR 250 6.40 Active

4450261 SUMATRIPTAN 6MG/0.5MLPHAR 636 J3030 202.85 Active

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3020303 SUMATRIPTAN 6 MGNP2 521 J3030 274.54 Active

300303 SUMATRIPTAN 6MG (M)DR 521 J3030 274.54 Active

3013030 SUMATRIPTAN 6MG (TO)NP1 521 J3030 274.54 Active

4401944 SUPER KNEE 16" MEDSUP 270 53.00 Active

4401948 SUPER KNEE 16" XXLSUP 270 53.00 Active

4401943 SUPER KNEE 16"SMALLSUP 270 53.00 Active

4400483 SUPER KNEE 24" LGSUP 270 98.58 Active

4400482 SUPER KNEE 24" MEDSUP 270 98.58 Active

4400481 SUPER KNEE 24" SMSUP 270 98.58 Active

4401693 SUPERFEET INSOLESUP 270 L3030 68.90 Active

4401937 SUPPORT ELASTIC KNEE LGESUP 270 15.90 Active

4401936 SUPPORT ELASTIC KNEE MEDSUP 270 15.90 Active

4401938 SUPPORT ELASTIC KNEE XLGESUP 270 15.90 Active

4401980 SUPPORT KNEE ELASTIC 2XLSUP 270 24.38 Active

4400818 SUPPORT KNEE ELASTIC SMSUP 270 15.90 Active

4551041 SURG PATH LEVEL IV (FMDH)LAB 382 88305 72.08 Active

4400822 SURGICAL BLADE SIZESUP 270 4.24 Active

4401671 SURGICAL BOOT/SHOESUP 270 L3260 280.90 Active

4400828 SURGICAL SCRUB BRUSHSUP 270 8.48 Active

4401767 SURGILUBE TUBESUP 270 8.48 Active

4401745 SURGILUBE-BOXSUP 270 29.68 Active

4400887 SURURE ETHILON 4-0SUP 270 30.74 Active

4400840 SUTRUE 3-0 ETHILON (SUP 270 29.68 Active

4400885 SUTURE ETHILON 3-0SUP 270 20.14 Active

4400838 SUTURE 3-0 PROLENE FSUP 270 15.90 Active

4400837 SUTURE 6-0 ETHILON (SUP 270 12.72 Active

4400901 SUTURE CHROMIC GUT 4SUP 270 15.90 Active

4400868 SUTURE CHROMIC GUT 5SUP 270 96.46 Active

4400844 SUTURE CHROMIC GUT 6SUP 270 59.36 Active

4400848 SUTURE ETHILON 2.0SUP 270 22.26 Active

4400883 SUTURE ETHILON 2-0 (SUP 270 20.14 Active

4400835 SUTURE ETHILON 3-0 (SUP 270 8.48 Active

4400892 SUTURE ETHILON 3-0 (SUP 270 20.14 Active

4400886 SUTURE ETHILON 4-0 PSUP 270 62.54 Active

4400890 SUTURE ETHILON 6-0 (SUP 270 47.70 Active

4400847 SUTURE ETHILON 6-0 PSUP 270 20.14 Active

4400841 SUTURE PLAIN GUT 2-0SUP 270 29.68 Active

4400849 SUTURE PROLENE 2-0SUP 270 20.14 Active

4400896 SUTURE PROLENE 3-0 (SUP 270 48.76 Active

4400897 SUTURE PROLENE 4-0SUP 270 20.14 Active

4400845 SUTURE PROLENE 4-0 (SUP 270 41.34 Active

4400899 SUTURE PROLENE 5-0 (SUP 270 15.90 Active

4400898 SUTURE PROLENE 6-0 P.3SUP 270 8.48 Active

4400850 SUTURE REMOVAL KITSUP 270 8.48 Active

4400909 SUTURE SILK 0 (T-5)SUP 270 20.14 Active

4400911 SUTURE SILK 1 (MH TASUP 270 16.96 Active

4400913 SUTURE SILK 2-0 FSSUP 270 20.14 Active

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4400912 SUTURE SILK 2-0 T-5SUP 270 20.14 Active

4400916 SUTURE SILK 3-0 (FSLSUP 270 15.90 Active

4400830 SUTURE SILK 3-0 (tapSUP 270 8.48 Active

4400914 SUTURE SILK 3-0 M-13SUP 270 42.40 Active

4400915 SUTURE SILK 4-0SUP 270 20.14 Active

4400832 SUTURE SILK 5-0 FS2SUP 270 8.48 Active

4400917 SUTURE SILK 6-0 (P-1SUP 270 20.14 Active

4400910 SUTURE SILK O (FSL CSUP 270 14.84 Active

4400846 SUTURE VICRYL 3-0SUP 270 59.36 Active

4400843 SUTURE VICRYL 5-0SUP 270 49.82 Active

4400905 SUTURE VICRYL COATEDSUP 270 24.38 Active

4400906 SUTURE VICRYL COATEDSUP 270 68.90 Active

4350067 SUTURE/STAPLE REMOVAPROC 270 11.66 Active

4400836 SUTURES ETHILON 6-0SUP 270 24.38 Active

4400829 SUTURES PROLENE 4-0SUP 270 29.68 Active

4400903 SUTURES PROLENE 5-0SUP 270 74.20 Active

4400908 SUTURES VICRYL 4-0 FS-1SUP 270 14.84 Active

4400907 SUTURES VICRYL 4-0 PS-2SUP 270 24.38 Active

4250008 SWEDE-O ANKLE BRACEPT 270 94.68 Active

4300047 SWIFT FX NASAL PILLOWDME 270 A7033 73.14 Active

3060777 SWING (LOCUM)LOC 521 99213 104.00 Active

3200001 SWING BEDSB 121 1613.00 Active

3050777 SWING BED (S)PA 524 99213 104.00 Active

4250077 SWISS BALL 45 CMPT 270 53.00 Active

4250078 SWISS BALL 65 CMPT 270 53.00 Active

4250098 SWISS BALL 75CMPT 270 53.00 Active

4250099 SWISS BALL 85CMPT 270 A9300 53.00 Active

4551188 Synthetic Glucocorticoid Screen, UrineLAB 300 82544 191.86 Active

4450495 SYNTHROID 0.050MG TAPHAR 250 6.36 Active

3017325 SYNVIC 1 MGNP1 521 38.16 Active

3007325 SYNVISC 1 MGDR 521 38.16 Active

3027325 SYNVISC 1 MGNP2 521 38.16 Active

4550763 Syphilis ABs: IgGLAB 300 86592 63.60 Active

4550764 Syphilis ABs: IgMLAB 300 86592 63.60 Active

4400932 SYRINGE 10CCSUP 270 8.48 Active

4400926 SYRINGE 12CCSUP 270 8.48 Active

4400933 SYRINGE 20CCSUP 270 8.48 Active

4400930 SYRINGE 30 CCSUP 270 8.48 Active

4400927 SYRINGE 35CCSUP 270 8.48 Active

4400934 SYRINGE 6CCSUP 270 8.48 Active

4400936 SYRINGE EARSUP 270 8.48 Active

4400939 SYRINGE IRRIGATION BSUP 270 8.48 Active

4400928 SYRINGE MONJECT 60CCSUP 270 8.48 Active

4400940 SYRINGE PISTON IRRIGSUP 270 8.48 Active

4400941 SYRINGE SLIP TOP 10CSUP 270 8.48 Active

4400765 T.E.D. KNEE HI XLSUP 270 53.00 Active

4400762 T.E.D. KNEE-HI- LGESUP 270 72.08 Active

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4400763 T.E.D. KNEE-HI MEDSUP 270 53.00 Active

4400764 T.E.D. KNEE-HI SMSUP 270 72.08 Active

4550765 T-3 FreeLAB 300 84481 175.96 Active

4550766 T-3 ReverseLAB 300 84482 97.52 Active

4550768 T-3 TotalLAB 300 84480 68.90 Active

4550767 T-3 UptakeLAB 300 84479 63.60 Active

4550770 T-4 FreeLAB 300 84439 119.78 Active

4550769 T-4 TotalLAB 300 84436 56.18 Active

4550771 Tacrolimus FK 506LAB 300 80197 165.36 Active

4450206 TAMSULOSIN 0.4MG TABPHAR 250 J3490 6.40 Active

4401104 TAPE 2" CLOTH SURGICSUP 270 15.90 Active

4400957 TAPE 3" SURGICAL CLOSUP 270 15.90 Active

4400952 TAPE CLOTH (SILK) 1SUP 270 7.42 Active

4400953 TAPE CLOTH 2"SUP 270 8.48 Active

4400956 TAPE CLOTH HYPO-ALLESUP 270 12.72 Active

4400955 TAPE CLOTH SILK 2"SUP 270 13.78 Active

4401171 TAPE HYPAFIX RETENTIONSUP 270 15.90 Active

4401677 TAPE MEDIPORE CLOTH HYPOASUP 270 15.90 Active

4400959 TAPE MICROSPORE 1SUP 270 8.48 Active

4400958 TAPE MICROSPORE 1/2SUP 270 8.48 Active

4400960 TAPE MICROSPORE 2SUP 270 8.48 Active

4400962 TAPE TRANSPORE 1SUP 270 8.48 Active

4400961 TAPE TRANSPORE 1/2SUP 270 8.48 Active

4400950 TAPE TRANSPORE 2SUP 270 8.48 Active

4400964 TAPE ZONAS 1"SUP 270 8.48 Active

4400963 TAPE ZONAS 2SUP 270 8.48 Active

4450501 TAPOZOLE 5MG TABPHAR 250 6.40 Active

4451251 TAXOTERE 130 MG IVPHAR 636 6284.74 Active

4450911 TAZICEF I GMPHAR 259 11.66 Active

4550973 TBG: Thyroxine Bind GlobLAB 300 84442 102.82 Active

4550547 TCA Confirm: QualLAB 300 80102 68.90 Active

4550558 TCA Confirm: QuantLAB 300 80307 140.98 Active

4401809 TEGADERM 6X8SUP 270 5.30 Active

4400965 TEGADERM DRESSINGSUP 270 8.48 Active

4400966 TEGADERM DRESSING 4XSUP 270 8.48 Active

4401152 TEGADERM IV 2 3/4 X 3 1/4SUP 270 8.48 Active

4550772 Tegretol / CarbamazepineLAB 300 80156 110.24 Active

4451220 TEGRETOL XR 400PHAR 250 6.36 Active

4451247 TEKTURNA 150MG POPHAR 250 11.66 Active

30300050 TELEPSYCHCOMP 780 Q3014 31.80 Active

4400975 TELFA ISLAND DRESSINSUP 270 8.48 Active

4401689 TELFA ISLAND DRSG 5X10SUP 270 8.48 Active

4400970 TELFA PAD 2X3 ADHESIVESUP 270 8.48 Active

4400969 TELFA PADS 2X3 STERSUP 270 8.48 Active

4400971 TELFA PADS 3X4 STERISUP 270 8.48 Active

4400972 TELFA PADS 3X8 STERILESUP 270 8.48 Active

4400974 TELFA PADS ADHESIVESUP 270 7.42 Active

Page 84: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4450460 TEMAZEPAM 15MG TABPHAR 250 6.40 Active

4450517 TENECTEPLASE 50MG INJPHAR 636 J3101 9203.00 Active

4400977 TENNIS ELBOW STRAPSUP 270 10.60 Active

4250127 TENS PT 420 64550 62.54 Active

4451226 TERAZOSIN 2MG TABPHAR 250 6.40 Active

4451222 TERAZOSIN 5MG TABPHAR 250 6.36 Active

4450092 TERBUTALINE 1MG/MLPHAR 259 11.70 Active

4551044 TESTOST BIOAVAILABLELAB 300 82978 103.88 Active

4551164 Testosterone Total and Free Active

4550773 TESTOSTRONE FREELAB 300 84402 196.10 Active

4550776 TESTOSTRONE TOTALLAB 300 84403 157.94 Active

3010670 TETANUS & DIPTHERIANP1 521 J1670 139.92 Active

4450506 TETANUS /DIPTHERIA 0.5ML INJPHAR 636 J3490 155.80 Active

4451203 TETANUS/DIPTH/PERTUSSUSPHAR 636 J1670 203.70 Active

4450507 TETRACYCLINE TAB 250MGPHAR 250 6.36 Active

4400978 TEXAS CATHETER - MALSUP 270 7.42 Active

4551025 THC Confirm: QualLAB 300 80102 68.90 Active

4551026 THC Confirm: QuantLAB 300 80349 68.90 Active

4550780 THEOPHYLLINELAB 300 80198 102.82 Active

4450508 THEOPHYLLINE 200MG TABPHAR 250 11.70 Active

4450667 THEOPHYLLINE 300MG TABPHAR 250 6.40 Active

4450509 THEOPHYLLINE ER 400MG TABPHAR 250 6.40 Active

4500076 THER/PROPH/DIAG IV, INFIV 261 172.78 Active

4401857 THERABAND (BOX)SUP 270 79.50 Active

4550625 Therap Phleb: BagSUP 270 28.62 Active

4550624 Therap Phleb: PhlebotomyLAB 300 99195 100.70 Active

4350010 THERAPEUTIC 1 SHOTPROC 940 96372 15.90 Active

4350011 THERAPEUTIC 2 SHOTSPROC 940 96372 31.80 Active

4350012 THERAPEUTIC 3 SHOTSPROC 940 96372 47.70 Active

4250079 THERAPEUTIC ACTIVITIPT 420 97530 83.74 Active

4550626 TherapeuticPhlebotomy+BagLAB 300 99195 97.52 Active

4250080 THERAPUETIC EXERCISEPT 420 97110 93.28 Active

4450510 THERMOTAB 1 TABPHAR 250 6.36 Active

4551076 THIOPURINE METHYLTRANSFERLAB 300 83789 474.88 Active

4350069 THORACENTESISPROC 270 40.28 Active

4400985 THORACIC CATHSUP 270 79.50 Active

4400986 THORACIC CATH 20 FRSUP 270 79.50 Active

4400991 THORACIC CATHETER 16FRSUP 270 80.56 Active

4400981 THORACIC CATHETER 28SUP 270 79.50 Active

4400982 THORACIC CATHETER 32SUP 270 85.86 Active

4400988 THORACIC CATHETER 36FR 20"SUP 270 80.56 Active

4400987 THORACIC CATHETER TOSUP 270 80.56 Active

4400989 THORACIC CATHETER TOSUP 270 80.56 Active

4400990 THORACIC CATHETER TOSUP 270 80.56 Active

4400983 THORACIC CHEST DRAINSUP 270 280.90 Active

4400984 THORACIC DRAIN COLLESUP 270 72.08 Active

4750123 THORACIC LUMBAR JUNCT 2 VXRAY 320 72080 209.88 Active

Page 85: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4750122 THORACIC SPINE 1 VIEWXRAY 320 72020 132.50 Active

4750121 THORACIC SPINE 2 VIEWSXRAY 320 72070 218.36 Active

4750152 THORACIC SPINE 3 VIEWSXRAY 320 72072 222.60 Active

4750124 THORACIC SPINE 4 VIEWSXRAY 320 72074 238.50 Active

4500064 THREADED LOCK CANNULIV 264 10.60 Active

4550475 Thrombin TimeLAB 300 85670 66.78 Active

4559017 Thrombophilia Profile Active

4550695 Thyroglobulin AB ScreenLAB 300 86800 97.52 Active

4550787 Thyroglobulin ABsLAB 300 86800 97.52 Active

4550785 Thyroglobulin Pan: ABLAB 300 86800 82.68 Active

4550784 Thyroglobulin Pan:Tumor MLAB 300 84432 136.74 Active

4551171 THYROID STIMULATING IMMUGLAB 300 84445 446.26 Active

4550645 Thyrotoropin Receptor Antibody SerumLAB 300 83520 156.00 Active

4750127 TIB/FIB (LEFT) 2 VIEWSXRAY 320 73590 165.36 Active

4750186 TIB/FIB (RIGHT) 2 VIEWSXRAY 320 73590 165.36 Active

4551145 TIBC LAB 300 83550 57.24 Active

4550788 TIBC CALCULATED FROM UIBCLAB 300 83550 42.40 Active

4450516 TIMENTIN 3.1GM VIALPHAR 636 S0040 231.10 Active

4552042 Timothy Grass -IgELAB 300 86003 33.92 Active

4551175 TITANIUM (HEAVEY METALS)LAB 300 83018 347.68 Active

4451381 TOBRAMYCIN 0.3% OPTH. SOL.PHAR 250 231.10 Active

4451613 Tobramycin/Dex 0.1% Opthal SuspPHAR 250 231.10 Active

4450670 TOBREX BOTTLEPHAR 259 44.52 Active

4550790 Tocainide HCL [Tonocard]LAB 300 80299 132.50 Active

4750130 TOES (LEFT) 2-3 VIEWSXRAY 320 73660 133.56 Active

4750187 TOES (RIGHT) 2-3 VIEWSXRAY 320 73660 133.56 Active

4401782 TOILET SAFETY RAILSUP 270 115.54 Active

4450152 TOLTERODINE LA 4MG TABPHAR 250 11.70 Active

4401843 TOOTHBRUSHSUP 270 6.36 Active

4400994 TOOTHETTE'S 10 EASUP 270 8.48 Active

4400995 TOOTHPASTESUP 270 8.48 Active

4551222 TOPIRAMATE (TOPMAX)LAB 300 96.46 Active

4450518 TOPIRAMATE 50MG TABPHAR 250 6.40 Active

4450525 TORADOL 30MG/ML 2MLPHAR 259 6.36 Active

4451256 TORESEMIDE 100MG TABPHAR 250 J8499 6.40 Active

4450144 TORESMIDE 10MG TABPHAR 250 6.36 Active

4450143 TORSEMIDE 20MG TABPHAR 250 J3490 6.40 Active

4450145 TORSEMIDE 20MG/2ML 2MLPHAR 259 23.32 Active

4550793 Toxoplasma AB Panel: IgGLAB 300 86777 100.70 Active

4550794 Toxoplasma AB Panel: IgMLAB 300 86778 130.38 Active

4550423 Toxoplasma IgG ABLAB 300 86777 100.70 Active

4550795 Toxoplasma IgM ABLAB 300 86778 130.38 Active

4550791 TP: Total ProteinLAB 300 84155 42.40 Active

4552070 TPMT GeneticsLAB 300 83912 1.06 Active

4550884 TPO LAB 300 86376 97.52 Active

4451312 TRACE ELEMENTS IVPHAR 250 6.36 Active

4401861 TRACH CARE KITSUP 270 5.30 Active

Page 86: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4401852 TRACH SUCTION KITSUP 270 22.26 Active

4400997 TRACHEOSTOMY TUBE 8.0mmSUP 270 224.72 Active

4401105 TRACTION TRAPEZE BARSUP 270 22.26 Active

4250081 TRACTION, MECHANICALPT 420 97012 46.64 Active

4450526 TRAMADOL 50MG TABPHAR 250 J3490 6.40 Active

4451445 TRAMADOL TAB 50MG OUTPT PACKPHAR 250 J3490 6.40 Active

4451646 TRANEXAMIC ACID INJ 1000 MGPHAR 259 155.80 Active

4451597 TRANSDERM SCOPPHAR 250 85.60 Active

4300019 TRANSFER SHOWER BENCHDME 270 E0240 127.20 Active

4550800 TransferrinLAB 300 84466 133.56 Active

4550260 TRANSFERRIN RECEPTORLAB 300 84238 171.72 Active

4600036 TransfusionBB 391 36430 331.78 Active

4600051 Transfusion of Units Active

4600037 Transfusion ReactionBB 300 86078 250.16 Active

4401778 TRANSQE ELECTRODE KT BXSUP 270 280.90 Active

3300028 TRAUMA ACTIVATIONED 689 G0390 903.12 Active

4401823 TRAUMA DRSNGSUP 270 6.36 Active

4401106 TRAY OB INSTRUMENTSSUP 270 47.70 Active

4401010 TRAY DISPOSAL SUTURESUP 270 33.92 Active

4401006 TRAY EYESUP 270 15.90 Active

4401724 TRAY NOSESUP 270 45.58 Active

4401003 TRAY THORACENTESISSUP 270 184.44 Active

4454459 TRAZODONE 50MGPHAR 250 J3490 6.40 Active

4450002 TRIAM HCTZ 37.5/25MG POPHAR 250 J3490 6.40 Active

4451061 TRIAM HCTZ 50/25MG P.O.PHAR 250 6.36 Active

4450282 TRIAMCINOLONE ACETONIDE 40MG/MLPHAR 636 J3301 23.30 Active

4451317 TRIAMCINOLONE CREAM 30G TUBEPHAR 250 23.30 Active

4450080 TRIAMTERENE 100MG POPHAR 250 6.36 Active

4550804 Trig: TriglyceridesLAB 300 84478 48.76 Active

4551182 TRILEPTALLAB 300 80183 190.80 Active

4450531 TRIPLE ANTIBIOTIC OINTPHAR 250 11.66 Active

4451270 TRIXAICIN CREAMPHAR 250 6.36 Active

4550118 TROPONIN-ILAB 300 84484 178.08 Active

4551179 TRYPTASELAB 300 83520 240.62 Active

4550806 TSH LAB 300 84443 77.38 Active

4550899 TSH-CascadeLAB 300 84443 77.38 Active

4550976 TSTGP Panel: IgALAB 300 83516 136.74 Active

4550977 TSTGP Panel: IgGLAB 300 83516 136.74 Active

4450532 TUBERCULIN 0.1ML SQPHAR 259 J3490 58.40 Active

4700032 TUBING 50' OXYGENOXY 270 23.32 Active

4700031 TUBING 7' OXYGENOXY 270 5.30 Active

4500065 TUBING ADD A LINE (PIV 264 12.72 Active

4500066 TUBING BLOODIV 264 36.04 Active

4500067 TUBING EXTENTION SETIV 264 12.72 Active

4300015 TUBING FOR CPAPDME 270 A7037 62.54 Active

4500068 TUBING IV W/FILTERIV 264 39.22 Active

4500069 TUBING NITROGLYERINIV 264 68.90 Active

Page 87: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4500070 TUBING REG. NO FILTERIV 264 20.14 Active

4552035 Tuna - IgELAB 300 86003 33.92 Active

4451444 TYLENOL #3 TAB OUTPT PACKPHAR 250 23.30 Active

4600050 Type and Crossmatch Panel Active

4600052 Type and Screen Panel Active

4401023 UA CUPSUP 270 8.48 Active

4550807 UA Dipstick (Auto)LAB 300 81003 28.62 Active

4550808 UA: Auto Dip + MicroLAB 300 81001 31.80 Active

4550745 UDS DOT&NON COL & P/HLAB 300 99001 53.00 Active

4550276 UDS: MED PURPOSE (12)LAB 300 80305 66.78 Active

4550277 UDS: NON-DOT EMPLOYEES(9+LAB 300 80305 66.78 Active

3500028 UGI ENDOSCOPYENDO 750 43235 816.20 Active

3500029 UGI ENDOSCOPY WITH BENDO 750 43239 1156.46 Active

4700033 ULTRASONIC NEBULIZEROXY 270 23.32 Active

4250083 ULTRASOUNDPT 420 97035 59.36 Active

4760004 ULTRASOUND EXAM BREAST(S)MAMM 402 76642 233.20 Active

4650670 ULTRASOUND FAST EXAM Active

4401025 UMBILICAL VESSELL CASUP 270 59.36 Active

4451001 UNASYN 500MG P.O.PHAR 250 11.66 Active

4250117 UNLOADER ONE BRACEPT 270 1359.98 Active

4401027 UNNA BOOTSUP 270 45.58 Active

4552007 UPEP w/Interp Active

4550812 Uric AcidLAB 300 84550 63.60 Active

4401031 URINAL DISPOSIBLESUP 270 8.48 Active

4401808 URINARY BAG XLGESUP 270 28.62 Active

4401811 URINARY DRN BAG 4000MLSUP 270 28.62 Active

4400162 URINARY FEMALE CATH KITSUP 270 15.90 Active

4401035 URINARY LEG BAG MEDSUP 270 15.90 Active

4401032 URINARY LEG BAG STRASUP 270 15.90 Active

4400489 URINARY LRG STRAP LASUP 270 15.90 Active

4550874 Urine CALAB 300 82340 57.24 Active

4550817 Urine CL RandomLAB 300 82491 57.24 Active

4401040 URINE DRAINAGE BAGSUP 270 8.48 Active

4400271 URINE GRADSUP 270 8.48 Active

4552072 URINE- IODINE 24 HourLAB 300 83018 165.36 Active

4550823 Urine K RandomLAB 300 84133 57.24 Active

4550436 Urine Micro [ONLY]LAB 300 81015 28.62 Active

4550824 Urine NA (24 Hr)LAB 300 84300 57.24 Active

4550620 URINE PH DIPSTICKLAB 300 81003 28.62 Active

4559164 Urine Protein Electrophoresis Active

4550728 URINE SPECIFIC GRAVITYLAB 300 81003 28.62 Active

4401041 URINE STRAINERSUP 270 8.48 Active

4550826 Urine TP (24 Hr)LAB 300 84156 68.90 Active

4550988 Urine TP (Random)LAB 300 84156 68.90 Active

4550827 Urine Uric Acid (24 Hr)LAB 300 84560 68.90 Active

4550818 Urine Volume (timed)LAB 300 81050 26.50 Active

4401044 UROLOGICAL CATH COUDE TIP 14FRSUP 270 11.66 Active

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4656700 US Abdomen, completeUS 402 76700 896.76 Active

4656770 US ABDOMIANAL AORTAUS 402 76770 433.54 Active

4656706 US ABDOMINAL AORTAUS 402 76706 351.92 Active

4657670 US Abdominal, limitedUS 402 76705 641.30 Active

4657685 US BLADDERUS 402 76857 356.16 Active

4656641 US BREAST COMPLETE UNILATERALUS 402 76641 378.42 Active

4656642 US BREAST LIMITED UNILATERALUS 402 76642 292.56 Active

4653880 US CAROTID DOPPLER COMPLETEUS 402 93880 1214.76 Active

4653882 US CAROTID DOPPLER LIMITEDUS 402 93882 797.12 Active

4656604 US CHESTUS 402 76604 307.40 Active

4653970 US DUPLEX EXTREM VEINS, COMPLETE BILATERUS 402 93970 1947.22 Active

4653925 US DUPLEX LWR EXTERM ARTIERIES, COMPLETEUS 402 93925 1869.84 Active

4653926 US DUPLEX UNILAT/LMTD LOWER EXTREM ARTERUS 402 93926 1129.96 Active

4653931 US DUPLEX UNILAT/LMTD UPPER EXTREM ARTERUS 402 93931 985.80 Active

4653930 US DUPLEX UPR EXTREM ARTERY COMPLETE BIUS 402 93930 1632.40 Active

4656882 US EXTREMITY NON VASCULAR LIMITEDUS 402 76882 82.68 Active

4659397 US Extremity w DopplerUS 402 93971 1328.18 Active

4657688 US Extremity, nonvascular, completeUS 402 76881 949.76 Active

4656818 US FETAL BIOPHYSICAL PROFILE W/NONSTRESSUS 402 76818 411.28 Active

4656819 US FETAL BIOPHYSICAL PROFILE WO/NONSTRESUS 402 76819 443.08 Active

4656821 US FETAL DOPPLER CEREBRAL ARTERYUS 402 76821 487.60 Active

4656820 US FETAL DOPPLER UMBILICAL ARTERYUS 402 76820 394.32 Active

4656946 US GUIDANCE FOR AMNIOCENTESISUS 402 76946 705.96 Active

4656942 US GUIDANCE FOR NEEDLE PLACEMENTUS 402 76942 1072.72 Active

4656937 US GUIDANCE FOR VASCULAR ACCESSUS 402 76937 191.86 Active

4657653 US NECK NON VASCULARUS 402 76536 348.74 Active

4656856 US PELVIC COMPLETEUS 402 76856 319.06 Active

4656857 US PELVIC LIMITEDUS 402 76857 356.16 Active

4656830 US PELVIC TRANSVAGINALUS 402 76830 364.64 Active

4656801 US PREGNACNY < 14 WEEKSUS 402 76801 469.58 Active

4656802 US PREGNANCY < 14 WKS MULTIPLE FETUSUS 402 76802 214.12 Active

4656810 US PREGNANCY > 14 WEEKSUS 402 76810 205.64 Active

4657681 US PREGNANCY >14 WKS MULTIPLE FETUSUS 402 76810 205.64 Active

4656816 US PREGNANCY FOLLOWUPUS 402 76816 265.00 Active

4656815 US PREGNANCY LIMITEDUS 402 76815 342.38 Active

4656817 US PREGNANCY TRANSVAGINALUS 402 76817 384.78 Active

4657677 US RENAL BILATERALUS 402 76770 433.54 Active

4656775 US RETRO, REALTIME W/IMAGE DOC LIMITEDUS 402 76775 637.06 Active

4656870 US SCROTUMUS 402 76870 508.80 Active

4656536 US THYROIDUS 402 76536 348.74 Active

4050026 VA AIDEPALS 579 G0156 6.92 Active

4401757 VAC ATS THERAPY UNITSUP 270 305.28 Active

4401756 VAC CANISTER W/GEL 5PKSUP 270 710.20 Active

4550828 Valpric Acid/DepakoteLAB 300 80164 163.24 Active

4451432 VALPROATE INJ 500MG/5MLPHAR 259 155.80 Active

4450167 VALSARTAN/HCT 160/12.5 MGPHAR 250 11.66 Active

4451394 VALSARTAN/HCT 160MG/25MGPHAR 250 6.36 Active

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4451385 VALSARTAN/HCT TAB 80MG/12.5MGPHAR 250 6.40 Active

4450550 VALTREX 1GM TABPHAR 250 6.40 Active

4550829 Vancomycin - PeakLAB 300 80202 266.06 Active

4550830 Vancomycin - TroughLAB 300 80202 266.06 Active

4450551 VANCOMYCIN 1GM INJ.PHAR 636 J3370 23.30 Active

4451136 VANCOMYCIN 500MG INJPHAR 636 J3370 11.70 Active

4451420 VANCOMYCIN 750 MG INJ.PHAR 259 11.70 Active

4451416 VANCOMYCIN ORAL SUSP 250MG/5mLPHAR 250 152.40 Active

4401818 VASELINE GAUZE 1/2X72SUP 270 7.42 Active

4401704 VASELINE GAUZE 3X9SUP 270 8.48 Active

4401058 VASELINE PETRO GAUZE 1X36SUP 270 8.48 Active

4401057 VASELINE PETROL GAUZE 1X8SUP 270 8.48 Active

4401060 VASELINE SM. TUBESUP 270 8.48 Active

4552075 Vasoactive Intestinal Polypeptide (VIP)LAB 300 84586 286.20 Active

4450553 VASOPRESSIN 20U/ ML INJPHAR 259 216.60 Active

4450931 VASOTEC 10MG TABPHAR 250 6.40 Active

4450835 VECURONIUM 10MG/ML INJPHAR 259 23.30 Active

4451653 VENLAFAXINE HCL ER 37.5 MGPHAR 250 6.40 Active

4450180 VENLAFAXINE XR 150MG TABPHAR 250 155.80 Active

4450179 VENLAFAXINE XR 75MG POPHAR 250 6.40 Active

4700034 VENTILATION ASSIST 1PROC 410 94002 186.56 Active

4700035 VENTILATION ASSIST AOXY 270 94656 117.66 Active

4401935 VENTLINE SETSUP 270 53.00 Active

4450558 VERAPAMIL 10MG VIALPHAR 259 23.32 Active

4451055 VERAPAMIL 2.5MG/ML INJPHAR 259 J3490 23.30 Active

4450557 VERAPAMIL 80MG TABPHAR 250 11.70 Active

4451168 VERAPAMIL ER 180MG P.O.PHAR 250 11.70 Active

4451146 VERAPAMIL SR 120 MG CAPPHAR 250 12.00 Active

4450676 VERAPAMIL SR 240MG TABPHAR 250 6.40 Active

4450876 VIGAMOX OPTH DROPSPHAR 250 253.34 Active

4559122 Viral Cult Non-Resp: HomoLAB 300 87176 48.76 Active

4559123 Viral Cult Non-Resp: IDLAB 300 48.76 Active

4559121 Viral Cult Non-Resp: InocLAB 300 87252 159.00 Active

4550838 Viral Culture: RespiratorLAB 300 87252 159.00 Active

4552063 VIRAL IDLAB 300 162.18 Active

4559146 Viral Respiratory Panel PCR Active

4550064 Viral Respiratory Panel, All OthersLAB 300 87798 1298.50 Active

4550028 Viral Respiratory Panel, BordetellaLAB 300 87633 159.00 Active

4550563 Viral Respiratory Panel, M. pneumoniaeLAB 300 87581 159.00 Active

4550137 Viral Respiratoyr Panel, C. pneumoniaLAB 300 87486 159.00 Active

4401107 VISUAL MONITORSUP 270 51.94 Active

4550840 Vit B-12+Folate: B-12LAB 300 82607 118.72 Active

4550334 Vit B-12+Folate: FolateLAB 300 82746 132.50 Active

4550712 Vit B-2: RiboflavinLAB 300 84252 136.74 Active

4551010 Vit B-3: NiacinLAB 300 84591 160.06 Active

4550981 Vit D 25-OH D2+D3: D2LAB 300 82306 77.38 Active

4550980 Vit D 25-OH D2+D3: D3LAB 300 82306 77.38 Active

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4401074 VITAL SIGNS MONITORINGSUP 270 4.24 Active

4451269 VITAMIN A 10,000IU POPHAR 250 6.36 Active

4550079 VITAMIN B -1 PLASMALAB 300 84425 179.14 Active

4450571 VITAMIN B COMPLEXPHAR 253 6.40 Active

4450572 VITAMIN B1 100MG TABPHAR 250 11.70 Active

4450578 VITAMIN B1 100MG/ML INJPHAR 636 J3411 58.40 Active

4550842 Vitamin B-12LAB 300 82607 118.72 Active

302342 VITAMIN B12 (G)NP2 521 J3420 40.28 Active

3003420 VITAMIN B-12 (M)DR 521 J3420 40.28 Active

3014320 VITAMIN B12 (TO)NP1 521 J3420 40.28 Active

4450895 VITAMIN B12 1000MCGPHAR 259 J3490 6.40 Active

4450573 VITAMIN B12 INJ 1000 MCGPHAR 636 J3420 11.70 Active

4550979 VITAMIN B-6LAB 300 84207 11.70 Active

4450778 VITAMIN C 500MG TABPHAR 250 J3490 6.40 Active

4550961 Vitamin D 1,25 H2 (Serum)LAB 300 82652 136.74 Active

4451204 VITAMIN D 1000 UNITS CAPPHAR 250 J3490 6.40 Active

4551030 Vitamin D 25-OH (only)LAB 300 82306 97.52 Active

4451399 VITAMIN D 50,000 UNITPHAR 250 81.30 Active

4451413 VITAMIN D3 2000 UNITS CAPPHAR 250 J3490 6.40 Active

4451371 VITAMIN D3 5000 UNITS CAPPHAR 250 J3490 6.40 Active

4550849 Vitamin ELAB 300 84446 112.36 Active

4450574 VITAMIN E 200 UNIT TABPHAR 250 6.40 Active

4550843 Vitamin Folate [RBC]LAB 300 82747 159.00 Active

4550978 Vitamin Folate [Serum]LAB 300 82746 132.50 Active

4451164 VITAMIN K 2.5MG POPHAR 250 6.36 Active

4550850 VMA (24 HR Urine)LAB 300 84585 167.48 Active

4400443 VOLUMETRIC EXERCISERSUP 270 72.08 Active

4551191 von Willebrand Factor ActivityLAB 300 85397 128.26 Active

4550851 Von Willebrand Factor AntigenLAB 300 85246 255.46 Active

4559008 von Willebrand Profile Active

4450908 VYTORIN TAB 10/20MGPHAR 250 11.66 Active

4450916 VYTORIN TAB 10/40 MGPHAR 250 112.20 Active

4550834 VZV (Swab) by PCRLAB 300 87798 246.98 Active

4550835 VZV AB - QualLAB 300 86787 77.38 Active

4550831 VZV AB Panel: IgGLAB 300 86787 110.24 Active

4550832 VZV AB Panel: IgMLAB 300 86787 110.24 Active

4550914 VZV CultureLAB 300 87252 159.00 Active

4552019 VZV IgG & IgM Active

4401791 W/C COVER FLEECESUP 270 37.10 Active

4401941 WALKER BOOT PEDS LGESUP 270 143.10 Active

4401940 WALKER BOOT PEDS MEDSUP 270 143.10 Active

4401939 WALKER BOOT PEDS SMSUP 270 L4386 143.10 Active

4401942 WALKER BOOT PEDS XLGSUP 270 143.10 Active

4401109 WALKER BRAKES ONLYSUP 270 72.08 Active

4401110 WALKER RENTAL / MONTSUP 270 45.58 Active

4401686 WALKER SEATSUP 270 E0156 45.58 Active

4401111 WALKER WHEELS ONLYSUP 270 79.50 Active

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4401108 WALKER WITH WHEELSSUP 270 274.54 Active

4401112 WALKER/WEEKLY RENTALSUP 270 11.66 Active

4401113 WALLPULLEY (C-SPINESUP 270 80.56 Active

4552026 Walnut-IgELAB 300 86003 33.92 Active

4450134 WARFARIN 1MG TABPHAR 250 6.40 Active

4450672 WARFARIN 2.5MG POPHAR 250 6.40 Active

4450133 WARFARIN 2MG TABPHAR 250 6.40 Active

4450135 WARFARIN 3MG TABPHAR 250 6.40 Active

4450848 WARFARIN 4MG POPHAR 250 11.70 Active

4450136 WARFARIN 5MG TABPHAR 250 J3490 6.40 Active

4350077 WARM COMPRESS/HOT WAPROC 270 24.38 Active

4401744 WARMER LG ARMLAB 270 15.90 Active

4401743 WARMER MED ARMLAB 270 15.90 Active

4401742 WARMER: INFANT HEELLAB 270 9.54 Active

4401114 WASH BASIN RENTALSUP 270 11.66 Active

4401063 WASHCLOTH 6/PKG.SUP 270 8.48 Active

4300073 WATER CHAMBER CPAPDME 270 A7046 33.92 Active

4450828 WATER STERILE INJPHAR 259 J3490 11.70 Active

4552027 Watermelon- IgELAB 300 86003 33.92 Active

4550853 WBC (Feces)LAB 300 87205 63.60 Active

4551068 WBC WITH AUTO DIFFLAB 300 85004 41.34 Active

4550852 WBC: White Blood CellsLAB 300 85048 28.62 Active

4401043 WEE BAG PEDSSUP 270 8.48 Active

4250149 Weights from PTPT 270 16.96 Active

3060391 WELL BABY LESS THEN 1 YR (LOCUM)LOC 521 99391 110.00 Active

3060382 WELL CHILD (1-4) NEW PT (LOCUM)LOC 521 99382 229.00 Active

3009391 WELL CHILD 0-1 yr (M)DR 521 99391 165.00 Active

3029391 WELL CHILD 0-1YRS (G)NP2 521 99391 165.00 Active

3019391 WELL CHILD 0-1YRS (O)NP1 521 99391 165.00 Active

3029394 WELL CHILD 12-17 YRS (G)NP2 521 99394 207.00 Active

3060394 WELL CHILD 12-17 YRS (lOCUM)LOC 521 99384 262.00 Active

3009394 WELL CHILD 12-17 YRS (M)DR 521 99394 207.00 Active

3019394 WELL CHILD 12-17 YRS (O)NP1 521 99394 207.00 Active

3060392 WELL CHILD 1-4 (LOCUM)LOC 521 99392 110.00 Active

3029392 WELL CHILD 1-4 YRS (G)NP2 521 99392 175.00 Active

3009392 WELL CHILD 1-4 YRS (M)DR 521 99392 175.00 Active

3019392 WELL CHILD 1-4 YRS (O)NP1 521 99392 175.00 Active

3060393 WELL CHILD 5-11 LOCUMLOC 521 99393 201.00 Active

30699396 WELLNESS 40-64 (LOCUM)LOC 521 99396 321.00 Active

3060397 WELLNESS ADULT 65 YRS AND OLDER (LOCUM)LOC 521 99397 365.00 Active

3029397 WELLNESS EXAM ADULT 65 YRS AND OLDER (G)NP2 521 99397 365.00 Active

3009397 WELLNESS EXAM ADULT 65 YRS AND OLDER (M)DR 521 99397 365.00 Active

4550857 West Nile Virus, Molecular Detection PCRLAB 300 87798 150.88 Active

4550735 WET MOUNTLAB 300 87210 42.40 Active

4551108 Wheat - IgELAB 300 86003 33.92 Active

4401748 WHEEL CHAIR TIRESSUP 270 72.08 Active

4250155 WHEEL CHAIR TRAININGPT 420 97542 47.70 Active

Page 92: Charge Code DescriptionDepartmentUB RevenueCode … · 4451357 albumin infus 25% 100 mlphar 259 238.75 active 4451232 albuterol (in ppd)phar 250 6.36 active 4451336 albuterol 0.63mg/3ml

4401733 WHEEL CHAIR TUBESSUP 270 15.90 Active

4401697 WHEELCHAIRSUP 270 K0001 560.74 Active

4401747 WHEELCHAIR CUSHIONSUP 270 1260.34 Active

4300037 WHEELCHAIR-MONTHLYDME 270 K0001 66.78 Active

4401788 WHEELED SHOWER CHAIRSUP 270 219.42 Active

4300029 WHEELED WALKER WITH SEATDME 270 E0144 254.40 Active

4300032 WHEELED WALKER XLDME 270 249.10 Active

4350078 WHIRLPOOLPROC 270 39.22 Active

4350096 WHIRLPOOL PALSPROC 270 T2013 15.90 Active

4050018 WHIRLPOOL-PALSPALS 990 T2013 12.72 Active

4700159 WHISPER SWIVERLOXY 270 64.66 Active

4401065 WIPES ADULTSSUP 270 8.48 Active

4300074 WISP CLEAR FRAMEDME 270 A7035 45.58 Active

4300050 WISP CUSHIONDME 270 A7032 73.14 Active

4300068 WISP NASAL MASKDME 270 A7034 166.42 Active

4550925 WNV IgG AB (only)LAB 300 86318 97.52 Active

4550924 WNV IgM AB (only)LAB 300 86318 97.52 Active

4550854 WNV Panel: IgG + IgMLAB 300 120.84 Active

4350080 WOUND CLEANSING/DRESSEDPROC 270 39.22 Active

4350079 WOUND DEBRIDEMENTPROC 270 31.80 Active

4350081 WOUND DRESSINGPROC 270 15.90 Active

4401668 WOUND V.A.C SMALL DRSGSUP 270 191.86 Active

4401755 WOUND VAC DRSG MED 5PKSUP 270 866.02 Active

4401753 WOUND VAC LGE DRSNGSUP 270 191.86 Active

4750139 WRIST (LEFT) 2 VIEWSXRAY 320 73100 144.16 Active

4750140 WRIST (LEFT) 3-4 VIEWSXRAY 320 73110 172.78 Active

4750188 WRIST (RIGHT) 2 VIEWSXRAY 320 73100 144.16 Active

4750189 WRIST (RIGHT) 3-4 VIEWSXRAY 320 73110 172.78 Active

302390 WRIST ELE SUPPORT (G)NP2 521 L3908 63.60 Active

300908 WRIST ELE SUPPORT (M)DR 274 L3908 63.60 Active

3100390 WRIST HAND ORTHOTIC, WRIST EXTENSIONNP1 521 L3908 22.26 Active

30003908 WRIST HAND ORTHOTICS, WRIST EXTENSIONDR 274 L3908 22.26 Active

3013807 Wrist Lace Up SplintNP1 274 L3908 27.56 Active

3000807 WRIST SPLINT (M)DR 274 L3807 64.66 Active

4451571 XARELTO 10MG TABPHAR 250 58.30 Active

4451567 XARELTO TAB 20MGPHAR 250 J3490 58.30 Active

4451329 XGEVA 120MG/1.7MLPHAR 636 J0897 3173.60 Active

4600040 X-Match, AHGBB 300 86922 132.50 Active

4600039 X-Match, IncBB 300 86921 111.30 Active

4600044 X-Match: AHG (ARC)BB 300 86922 132.50 Active

4600041 X-Match: Immed SpinBB 300 86920 124.02 Active

4401909 YANKER SUCTION OPENSUP 270 5.30 Active

4450765 ZAFIRLUKAST 20MG TABPHAR 250 6.36 Active

4451390 ZAROXOLYN 2.5 MG TABPHAR 250 6.40 Active

4450587 ZAROXOLYN 5MG TABPHAR 250 11.70 Active

4450829 ZELNORM 6MG TABPHAR 250 11.66 Active

4450594 ZETIA 10MGPHAR 250 6.40 Active

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4550631 Zinc (serum)LAB 300 84630 140.98 Active

4450218 ZIPRASIDONE INJ 20MG/MLPHAR 636 J3486 179.80 Active

4450597 ZITHROMAX SUSP 600MG BTLPHAR 250 58.30 Active

4451231 ZOLEDRONIC ACID 5MG/100MLPHAR 636 J3489 1735.60 Active

4450024 ZOLPIDEM 5MG TABPHAR 250 J3490 6.40 Active

4450922 ZOLPIDEM TARTRATE 12.5MG TABPHAR 250 11.66 Active

4451024 ZOMETA 4MG IVPHAR 636 J3487 2540.82 Active