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Description Charge CORONARY CARE UNIT $11,550.00 INTENSIVE CARE INTERMED $7,260.00 STEP DOWN UNIT $7,260.00 INTENSIVE CARE UNIT $11,550.00 INTENSIVE CARE OTHER $6,930.00 INTENSIVE CARE INTERMED $7,260.00 STEP DOWN UNIT $7,260.00 PRIVATE ROOM $4,054.00 SEMI-PRIVATE ROOM $3,850.00 PRIVATE ADMIN DAYS $4,054.00 SEMI-PRIVATE ADMIN DAYS $3,850.00 ONCOLOGY PRIVATE $4,054.00 ONCOLOGY SEMI-PRIVATE $3,850.00 INTENSIVE CARE INTERMED $7,260.00 STEP DOWN UNIT $7,260.00 SEMI-PRIVATE DETOX $2,173.00 PRIVATE ROOM $4,054.00 SEMI-PRIVATE ROOM $3,850.00 PRIVATE ADMIN DAYS $4,054.00 SEMI-PRIVATE ADMIN DAYS $3,850.00 ONCOLOGY PRIVATE $4,054.00 ONCOLOGY SEMI-PRIVATE $3,850.00 SEMI-PRIVATE DETOX $2,173.00 SEMI-PRIVATE ROOM TOWER 5 $3,850.00 SEMI-PRIVATE ADMIN DAYS $3,850.00 MED/SURG-OTHER PRIVATE ROOM $4,054.00 MED/SURG-OTHER SEMI-PRIVATE ROOM $3,850.00 SEMI-PRIVATE ADMIN DAYS $3,850.00 INTENSIVE CARE INTERMEDIATE $7,260.00 STEP DOWN UNIT $7,260.00 PRIVATE ROOM $4,054.00 SEMI-PRIVATE ROOM $3,850.00 PRIVATE ADMIN DAYS $4,054.00 SEMI-PRIVATE ADMIN DAYS $3,850.00 INTENSIVE CARE UNIT $11,550.00 CORONARY CARE UNIT $11,550.00 INTENSIVE CARE INTERMED $7,260.00 STEP DOWN UNIT $7,260.00 PSYCH GERIATRIC PRIVATE ADMIN DAYS $1,925.00 PSYCH GERIATRIC SEMI-PRIVATE ADMIN DAYS $1,760.00 PSYCH GERIATRIC SEMI-PRIVATE $1,760.00 PSYCH GERIATRIC PRIVATE $1,925.00 PSYCH PRIVATE ADMIN DAY $1,925.00 PSYCH SEMI-PRIVATE ADMIN DAY $1,760.00 PSYCH SEMI-PRIVATE $1,760.00 PSYCH PRIVATE $1,925.00

Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

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Page 1: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

Description Charge

CORONARY CARE UNIT $11,550.00

INTENSIVE CARE INTERMED $7,260.00

STEP DOWN UNIT $7,260.00

INTENSIVE CARE UNIT $11,550.00

INTENSIVE CARE OTHER $6,930.00

INTENSIVE CARE INTERMED $7,260.00

STEP DOWN UNIT $7,260.00

PRIVATE ROOM $4,054.00

SEMI-PRIVATE ROOM $3,850.00

PRIVATE ADMIN DAYS $4,054.00

SEMI-PRIVATE ADMIN DAYS $3,850.00

ONCOLOGY PRIVATE $4,054.00

ONCOLOGY SEMI-PRIVATE $3,850.00

INTENSIVE CARE INTERMED $7,260.00

STEP DOWN UNIT $7,260.00

SEMI-PRIVATE DETOX $2,173.00

PRIVATE ROOM $4,054.00

SEMI-PRIVATE ROOM $3,850.00

PRIVATE ADMIN DAYS $4,054.00

SEMI-PRIVATE ADMIN DAYS $3,850.00

ONCOLOGY PRIVATE $4,054.00

ONCOLOGY SEMI-PRIVATE $3,850.00

SEMI-PRIVATE DETOX $2,173.00

SEMI-PRIVATE ROOM TOWER 5 $3,850.00

SEMI-PRIVATE ADMIN DAYS $3,850.00

MED/SURG-OTHER PRIVATE ROOM $4,054.00

MED/SURG-OTHER SEMI-PRIVATE ROOM $3,850.00

SEMI-PRIVATE ADMIN DAYS $3,850.00

INTENSIVE CARE INTERMEDIATE $7,260.00

STEP DOWN UNIT $7,260.00

PRIVATE ROOM $4,054.00

SEMI-PRIVATE ROOM $3,850.00

PRIVATE ADMIN DAYS $4,054.00

SEMI-PRIVATE ADMIN DAYS $3,850.00

INTENSIVE CARE UNIT $11,550.00

CORONARY CARE UNIT $11,550.00

INTENSIVE CARE INTERMED $7,260.00

STEP DOWN UNIT $7,260.00

PSYCH GERIATRIC PRIVATE ADMIN DAYS $1,925.00

PSYCH GERIATRIC SEMI-PRIVATE ADMIN DAYS $1,760.00

PSYCH GERIATRIC SEMI-PRIVATE $1,760.00

PSYCH GERIATRIC PRIVATE $1,925.00

PSYCH PRIVATE ADMIN DAY $1,925.00

PSYCH SEMI-PRIVATE ADMIN DAY $1,760.00

PSYCH SEMI-PRIVATE $1,760.00

PSYCH PRIVATE $1,925.00

Page 2: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

INTENSIVE CARE PSYCH $440.00

NEWBORN LVL II-BOARDER-PHOTOTHERAPY $4,950.00

NEWBORN LVL II-ACUTE HIGH RISK-TRANSFER $5,310.00

NEWBORN LVL I - NORMAL AND ROOMING IN $2,225.00

SEMI-PRIVATE DETOX $2,173.00

SEMI-PVT DETOX REHAB $2,173.00

DRUG & ALCOHOL REHAB SEMI-PRIVATE $2,173.00

REHAB SEMI-PRIVATE $2,173.00

PRIVATE REHABILITATION $2,310.00

SNF PRIVATE $2,310.00

SNF SEMI-PRIVATE $2,173.00

SNF WARD $715.00

SUBACUTE-NON VENT MINIMUM $1,320.00

SUBACUTE-NON VENT $2,090.00

SUBACUTE-VENT $2,310.00

SUBACUTE-VENT COMPLICATED $2,420.00

SUBACUTE-LEAVE OF ABSENCE DAYS $1,045.00

CIRCUMCISION PROCEDURE $268.00

AMNIOCENTESIS BEDSIDE $900.00

DILATION AND CURETTAGE $4,290.00

TUBAL LIGATION $7,276.00

FETAL STRESS TEST $865.00

FETAL NON STRESS TEST $539.00

RECOV POST-SURG ADD MIN $23.00

RECOV POST-VAG 1 HOUR $744.00

RECOV POST-VAG 1ST 1/2 HOUR $398.00

RECOV POST-VAG ADD MIN $13.00

ANESTH GENERAL (L&D) 1ST HOUR $3,438.00

ANESTH GENERAL (L&D) ADD'L MIN $57.00

ANESTH GENERAL (L&D) 1ST 1/2 HOUR $1,703.00

SPINAL ANESTH (L&D) ADD'L MIN $15.00

SPINAL ANESTH (L&D) 1ST HOUR $853.00

EPIDURAL (L&D) $713.00

IV HYDRATION INTIAL, TO 1 HR $385.00

IV INF WITH MEDS 1ST HOUR (IVPB) $385.00

IV INF WITH MEDS EA ADD HR SAME BAG $220.00

IV INF SUBS BAG DIFFERENT DRUG $220.00

IV INJ OR IV PUSH, INITIAL $193.00

IV PUSH EA ADD NEW MED $193.00

IV PUSH SAME MED - 30 MIN APART $220.00

INJECTION IM/SUBQ $88.00

BREAST STIMULATION STRESS TEST $953.00

IV HYDRATION, ADD'L HOURS $193.00

HEARING SCREEN INPATIENT $164.00

OB TRIAGE OR ER 20WKS OR > $270.00

LABOR SIMPLE PER HOUR $418.00

LABOR INTERMEDIATE PER HOUR $482.00

Page 3: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LABOR COMPLEX PER HOUR $545.00

DELIVERY SVSC MODERATE INTENS $5,453.00

DELIVERY SVCS HIGH INTENS - FORCEPS $7,501.00

CESAREAN SECTION $11,073.00

L&D SURG 1ST HR MAJOR $8,775.00

L&D SURG ADD MIN MAJOR $152.00

L&D SURG 1ST 1/2 HOUR $4,290.00

RECOV POST-SURG 1 HR $1,375.00

RECOV POST-SURG 1ST 1/2 HOUR $688.00

SURGERY MAJOR EA ADD'L 15 MIN $2,280.00

SURGERY 1 HOUR MAJOR $8,775.00

SURGERY MINOR EA ADD'L 15 MIN $1,316.00

SURGERY 1 HOUR MINOR $5,265.00

CASE CANC BEFORE ANESTH $550.00

CASE CANC AFTER ANESTH $770.00

SURG LASER FLAT RT $1,208.00

RECOVERY ROOM EA ADD'L 15 MIN $344.00

RECOVERY RM 1 HOUR $1,375.00

INJ TX/PRPH/DX IVP ES DR $109.10

BONE MARROW ASPIRATION ONLY $465.00

INJ TX/PRPH/DX IVP EA NA $88.00

INJ TX/PRPH/DX IVP EA AD $88.00

IV INF T/P/D INIT HOUR $330.00

IV INF T/P/D EA SEQ INFS $220.00

IV INF T/P/D CONCURRENT $220.00

INFUSION/INJECTION OTHER $138.00

IV INFUSION (HYDRATION) 1ST HOUR $385.00

IV INFUSION EACH ADDITIONAL HOUR $193.00

INJECTION SQ OR IM $88.00

IV PUSH (IVP) 1ST $193.00

TRANSFUSION BLD/BLD COMPONENT $748.00

IV INF T/P/D EA ADD HR $220.00

PHLEBOTOMY, THERAPUETIC $107.66

ANESTH BLOCK 1 HOUR $853.00

ANESTHESIA 1 HOUR $3,438.00

ANESTHESIA ADD'L 15MIN $855.00

ANESTH BLOCK ADD'L 15MIN $225.00

MAC 1ST HR $1,699.00

MAC ADD'L 15 MIN $450.00

4050 C/S IMPLANTS CV $5,000.00

SODIUM URINE $133.00

MICROALBUMIN/CREAT PANEL $170.00

ELECTROLYTE PANEL $191.00

VANCOMYCIN RANDOM $403.00

VANCOMYCIN PEAK $403.00

VANCOMYCIN TROUGH $403.00

CBC WITHOUT DIFFERENTIAL $318.00

Page 4: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LIPID PANEL $365.00

RENAL FUNCTION PANEL $1,173.00

ACUTE HEPATITIS PANEL $1,287.00

HEPATIC FUNCTION PANEL $1,099.00

COMP METABOLIC PANEL $990.00

BASIC METABOLIC PANEL $801.00

DRUG TEST 8-14 PRESUMP NOT OPT $798.10

URINE MICROSCOPY STUDY $248.00

URINALYSIS W/O MICROSCOPY, AUTOMATED $223.00

UA QUAL/SEMIQUANT $56.00

URINALYSIS MICRO ONLY $83.00

UA SPEC GRAV NON AUTO $71.00

SALICYLATE $213.00

KETONES SERUM QUAL $123.00

BETA-HYDROXYBUTYRATE TEST $45.00

ALBUMIN SERUM $135.00

BODY FLUID ALBUMIN $152.00

THEOPHYLLINE $385.00

AMIKACIN $56.00

AMMONIA $236.00

AMYLASE FLUID $284.00

AMYLASE $284.00

AMYLASE URINE $162.00

AMYLASE URINE TIMED $162.00

BILIRUBIN TOTAL $137.00

BILIRUBIN DIRECT $152.00

OCCULT BLOOD FECES $66.00

OCCULT BLD FECES ONE SPC $81.00

OCCULT BLD OTHR SOURCE $86.00

ACETAMINOPHEN $213.00

CALCIUM $140.00

PREGNANCY URINE ER $214.00

SER PREG HCG QL $389.00

C-REACTIVE PROTEIN HS $48.00

CALCIUM IONIZED $153.00

CALCIUM URINE QUAN $212.00

CALCIUM URINE 24HR $212.00

CARBAMAZAPINE $395.00

CARBON DIOXIDE $133.00

CHLORIDE URINE $137.00

URINE CHLORIDE 24HR $159.00

CHLORIDE OTHER SOURCE $153.00

CHLORIDE $125.00

CHOLESTEROL TOTAL $152.00

LDL CHOLESTOROL $59.00

CHOLESTEROL HDL $184.00

CORTISOL TOTAL $212.00

Page 5: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CREATINE KINASE TOTAL $258.00

CK ISOENZYMES $28.00

CK MB FRACTION $347.00

CREATININE BLOOD $140.00

CREATININE URINE 24HR $151.00

CREATININE OTHER SOURCE $151.00

CREATININE CLEARANCE $257.00

VITAMIN D; 25 HYDROXY $110.00

CYANOCOBLMN(VIT B12) $410.00

DIGOXIN $361.00

PHENYTOIN TOTAL $360.00

FERRITIN $370.00

ASSAY OF FETAL FIBRONECTIN $504.00

FOLIC ACID $400.00

GLUCOSE BODY FLUID $107.00

GLUCOSE URINE RANDOM $107.00

GLUCOSE QUANT $107.00

GLUCOSE POST DOSE $208.00

GLUCOSE QUANT URINE $119.00

ACCUCHEK GLUCOSE $109.00

GLUCOSE CSF $107.00

GGT $196.00

HEMOGLOBIN GLYCATED $264.00

GENTAMICIN PEAK $445.00

GENTAMICIN TROUGH $445.00

INFLUENZA AB SCREEN $253.00

GENTAMYCIN RANDOM $445.00

H PYLORI BRTH TST $220.00

H PYLORI DRUG ADMIN $33.00

GONADTOPN CHRONC(HCG)QL $204.00

GONADTOPN CHORNC(HCG)QNT $389.00

ALCOHOL ETHYL $294.00

IG-A SERUM $165.00

IG-G SERUM $165.00

IG-M SERUM $150.00

HEPATITIS B CORE AB (IGM) $64.00

IG-G FLUID $165.00

B-TYP NATRIURETC PEPTIDE $429.00

THYROXINE FREE $189.00

TRIIODTHYRNIN TOTAL T3 $242.00

FREE ASSAY (FT-3) $63.00

IRON $176.00

IRON BINDING CAPCTY $201.00

LACTATE(LACTIC ACID) $165.00

LDH-LACTIC DEHYDROGENASE $152.00

LACTATE DEHYDROGN (LDH) $164.00

LIPASE $187.00

Page 6: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LITHIUM $211.00

MAGNESIUM $248.00

OSMOLALITY BLOOD $180.00

OSMOLALITY URINE $180.00

PH BODY FLUID EXCEPT BLD $82.00

PHENOBARBITAL $311.00

PHOSPHATASE ALKALINE $141.00

PHOSPHORUS $152.00

PHOSPHORUS URINE $205.00

EVAL AMNIOTIC FLUID PROTEIN $204.00

POTASSIUM SERUM $125.00

POTASSIUM URINE $117.00

POTASSIUM URINE 24HR $155.00

NAPA & PROCAINAMIDE $612.00

PROTEIN OTHER SOURCES $185.00

PROTEIN TOTAL $100.00

PROTEIN URINE RANDOM $100.00

PRE-ALBUMIN $125.00

PROTEIN URINE QUAN 24 HR $119.00

PROTEIN SPINAL FLUID $100.00

PROTHROMBIN TIME SUBST $129.00

TRIIODTHYRN (T-3) UPTAKE $176.00

SODIUM BLOOD $131.00

SODIUM URINE $151.00

SP-GR EXCEPT URINE $65.00

THYROXINE TOTAL $187.00

TSH $457.00

TRANSTERASE AST(SGOT) $141.00

TRANSAMINASE-SGPT (ALT) $144.00

TOBRAMYCIN TROUGH $438.00

TOBRAMYCIN PEAK $438.00

TOBRAMYCIN RANDOM $438.00

TRIGLYCERIDES $157.00

BLD UREA NITROGEN QUAN $108.00

URINE BUN CLEARANCE 24HR $327.00

URINE UREA NITROGEN 24HR $116.00

UREA NITROGEN URINE $130.00

URIC ACID BLOOD $152.00

URIC ACID URINE $130.00

VALPROIC ACID $368.00

BLEEDING TIME $123.00

C DIFF SCREEN AG $409.00

DIFF MANUAL $94.00

EOSINOPHILE COUNT MANUAL $191.00

HEMATOCRIT AUTOMATED $67.00

BLOOD HEMOGLBN $90.00

CBC/PLT/AUTO DIFF (5) $351.00

Page 7: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

RETICULOCYTE COUNT MAN $117.00

RETIC COUNT FLOW CYTO $119.00

BLOOD COUNT;LEUKOCYTE (WBC), AUTO $69.00

FDP D-DIMER QNT $171.00

FIBRINOGEN ACTIVITY $231.00

HEMOGLOBIN FETAL - FETAL SCREEN $71.00

PLT AGG EA AGN $457.00

PLATELET COUNT (AUTO) $148.00

PROTHROMBIN TIME $269.00

SEDIMENTN RATE-NON-AUTO $114.00

THROMBIN TIME PLASMA $123.00

PTT $316.00

PTT SUB EA FRACTION $369.00

VISCOSITY SERUM OR PLSMA $276.00

HETEROPHILE AB SCREEN $141.00

ANTIBDY ABSORP DIFFERNTL $37.00

COLD AGGLUTINATN TITER $180.00

RBC ANTIBODIES SCREEN $372.00

C-REACTIVE PROTEIN QN $141.00

ANTIBDY ID/ENZYME EACH $121.64

BLD TYPE ABO ONLY $196.00

BLD TYPE RH PHENOTYP CMP $132.00

CARCINO-EMBRYONIC AG $349.00

COMP TST EA UT SPIN TECH $121.64

COMP TST EA UT INCUB TCH $121.64

COMP TST EA UT AHG TECH $198.00

FFP THAW EA UNIT $247.27

HEMOLYSINS SCREEN EACH $115.00

HBS ANTIGEN $221.00

HEP B CORE AB(IGG & IGM) $218.00

HEPATITIS A AB(IGG&IGM) $281.00

HEPATITIS B SURF AB $221.00

HEPATITIS A AB IGM $144.00

HEPATITIS C ANTIBODY $193.00

HIV1/HIV2 AB SCREEN $165.00

PSA TOTAL $500.00

COMPLEMENT C3 $230.00

COMPLEMENT C4 $230.00

IMMUNOCARD STAT EHEC (TOXIN 1) $51.00

IMMUNOCARD STAT EHEC (TOXIN 2) $51.00

IMMUNOCARD STAT CAMPY $51.00

CAPILLARY BLOOD DRAW $22.00

SKIN TST TB INTRADERMAL $96.00

VDRL/RPR QUAL NON TREPON $116.00

VDRL/RPR QUAN NON TREPO $73.00

HEPATITIS B CORE IGM $64.00

AG SCRN RGNT SER EA UNIT $180.00

Page 8: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

SENSITIVITY MIC ANAEROBC $276.00

CULTURE SPUTUM $391.00

CULTURE GENITAL $391.00

CULTURE RESPIRATORY $356.00

CULTURE BACTERIAL SCREEN $181.00

CULT BLOOD AERO/ANAERO $458.00

CULTURE STOOL ADD'L ORGANISM $143.00

CULTURE BRONCH BRUSH $391.00

CULTURE VRE SCREEN $90.00

CULTURE STOOL $426.00

YERSINIA CULTURE $149.00

CULTURE EAR $391.00

CULTURE BIOPSY/SURG SPC $391.00

CULTURE CATH TIP $391.00

CULTURE OTHER SOURCE $234.00

CULTURE BACTERIA ANAEROBIC $132.00

CULTURE ENVIORNMTL $391.00

CULTURE EYE $391.00

CULTURE FLUID EX CSF $391.00

CULTURE ANAEROBIC ISOL $430.00

CULTURE, ANAEROBIC ID, EACH $165.00

CLOSTRIDIUM DIFF TOXIN $409.00

CULTURE CSF $391.00

CULTURE, AEROBICID, EACH $165.00

CULTURE STREP SCREENING $144.00

CULTURE MISC $391.00

CULTURE URINE COLONY CT $292.00

CULT BCT ISOL&PRSMPTV ID ISOLATE EA UR $114.00

CULTURE FUNGI OTHER $446.00

CULTURE FUNGI BLOOD $500.00

FUNGUS, ID, EACH $187.00

CHLAMYDIA CULTURE $72.00

CULTURE AFB $66.00

CULTURE WOUND/ABCESS $391.00

CULTURE BLOOD AFB $500.00

GC CULTURE $426.00

SUSCEPTIBILITY, E-TEST,EACH STRIP $110.00

SUSCEPTIBILITY, KB, EACH, PLATE $165.00

SUSCEPTIBILITY, MIC $276.00

MICROBE SUSCEPTIBLE MLC $125.00

SENSITIVITY ORG #1 MIC $276.00

SENSITIVITY ORG #2 MIC $276.00

SENSITIVITY ORG #3 MIC $276.00

SENSITIVITY ORG #4 MIC $276.00

SMEAR AFB $117.00

SMEAR MALARIA $273.00

STOOL FOR WBC $117.00

Page 9: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

GRAM STAIN $120.00

SPECIAL STAIN $325.00

WRIGHT S STAIN $133.00

SMEAR WET MOUNT SALINE/INK $131.00

INDIA INK PREP $132.00

KOH PREP $123.00

TROPONIN - I $358.00

VIRUS INOCULATION $94.00

RESP SYNCTIAL AG EIA $139.00

INF AGNT AG-EIA $419.00

C-DIFF BY NUCLEIC ACID $191.00

STREP A ASSAY W/OPTIC $120.63

CELL COUNT MISC BODY FLD $134.00

CELL COUNT MISC W/DIFF $238.00

FLUID CELL COUNT & DIFF $238.00

CRYST ID BODY FLD EX URN $191.00

ANTIBDY IDENT RBC EA PNL $247.27

COOMBS DIRECT $92.00

ANTIBODY TITRATION $120.67

COOMBS INDIRCT QUAL $121.54

BLD TYPE RHO(D)ONLY $113.00

RBC AG EXCPT ABO/RHO EA $121.64

PRETRTMNT RBC AB DETECT $36.02

PRETX RBC DILUTION $37.00

ANTIBDY ABSORP EA SERUM $270.00

POOLING PLATELET CONC $539.00

AUTOLOGS DONOR DRAW ONLY $740.00

CAPILLARY BLOOD DRAW $22.00

AUTOLOGOUS BLOOD C/P/S $166.00

SPLITTING BLD PROD EA UT $147.00

VENIPUNCTURE $69.00

VENIPUNCTURE $83.00

BONE MARROW ASPIR ONLY $465.00

BONE MARROW SMEAR INTRP $557.00

BONE M BIOPSY NDL TROCAR $647.00

CYTOPATH WASH/BRUSH/SM $120.00

CYTOPATH CONL SMR W/INT $120.00

CYTOLOGY SMEAR MULT >5 $148.00

CYTOLOGY SMEAR PREP $86.00

CYTOPATH C/VAG HORM EVAL $30.00

CYTOPATH OTHER SOURCE $64.00

CYTOPATH CERV/VAG BETHES $30.00

CYTO CONSLT INITIAL SITE $520.14

CYTO CONSULT EA ADD SITE $64.00

FNA: QUICK STAIN $120.67

FNA: INTRP/REPRT $78.00

BONE MARROW ASPIR ONLY $1,822.00

Page 10: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

BONE M BIOPSY NDL TROCAR $1,822.00

GROSS EXAM ONLY $79.00

GROSS & MICRO: LVL II $226.00

GROSS & MICRO EXAM III $275.00

LVL IV SURG PATH GROSS $324.00

LVL V SURG PATH GROSS $495.00

GROSS & MICRO COMPREHNSV $684.00

DECALCIFICATION $72.00

SPEC STAINS GROUP I $171.00

SPEC STAINS GROUP II $171.00

IMMUNOCYTO CHEM EA AB $247.27

CNSLT/RPT REFRD SLIDES $86.00

CONSULT/SURGERY $64.00

CONSULT/FROZEN SEC $216.00

CONSULT/FROZEN ADD $128.00

CONSULT/CYTO $520.14

CONSULT/CYTO ADD $128.00

IMMUNOCYTO CHEM EA AB $259.00

IMMUNOFLUOR EA AB $405.00

ER - PR HER-2/NEU $247.27

GROSS & MICRO EXAM III $271.00

UNLISTED MISCELLANEOUS $56.38

PC SURG PATH G&M LVL IV $308.00

FFP QUICK FREEZE 8 24 HR $98.00

BLD RCELLS WASHED $327.50

BLD RC PACKED $312.92

BLOOD RC LEUKOCYTE POOR $339.94

BLD PLT PHER LEUKO REDUC $626.77

BLOOD PLATELET CONCNTRAT $134.52

BLOOD CRYOPRECIPITATE $103.62

PLATELET PHER PACK $626.77

FR FROZEN PLASMA $105.34

PHLEBOT THERAP $70.07

BLOOD PROD ADMIN DLY CHG $748.00

PROCESS PACKED CELLS $300.00

PROCESS PACKED CELLS LR $300.00

PROCESS FFP $300.00

ARC AUTO BLD PROC ONLY $569.70

PROCESS PRC LR IRRAD $300.00

PROCESS CRYOPRECIPITATE $300.00

PROCESS PRC WASHED $300.00

PROCESS FFP <24HRS $300.00

ARC AUTOLOG/DD PRC LR $616.95

ARC AUTOLOGOUS/DD PRC $569.70

PROC PRC LR F/DEG/W/IRR $673.00

PROC PRC LR/F/D/W EA UNI $300.00

PROCESS CRYO POOR PLASMA $300.00

Page 11: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ARC PRC PROC STORAGE $414.45

ARC PRC LR PROC AND STG $434.70

ARC PRC LR WSH 500ML P S $729.00

ARC PRC LR DEGLY P AND S $1,008.45

ARC PRC LR/F/DE/W P S $1,224.45

ARC PRC F/DE/WS/IR/LR PS $1,044.90

ARC PRC LR IRR PROC AND $792.45

ARC PLTPH LR PROC AND ST $1,125.00

ARC FFP <24HRS PROC STOR $81.00

ARC FFP WITHIN 8HRS P S $81.00

ARC CRYOPRECIPITATE P S $81.00

ARC PLTPHERSIS IRRAD $849.15

"ARC PLATLETS, LR, IRRAD" $1,036.88

ARC POOLED CRYOPRECIPITAE P S $85.00

BLOOD PRODUCT IRRAND EA $290.00

PRETX SERUM AB ID DIL EA $48.93

PRETX SRM AB ID INCUB EA $76.00

PLATELETS, LEUKOREDUCED IRRAD $365.00

RBCS, L/R, CMV-NEGATIVE $451.00

RBCS, FROZEN L/R, CMV-NEG, IRRAD $561.00

PRETX RBC SERUM W/DRUG $44.44

ARC RC PACKED $307.00

RBC SPLIT AMOUNT $247.77

EKG TRACE ONLY $458.00

CARDIO STRESS TRACE ONLY $631.00

RHYTHM EKG $280.00

ECHOCARDIOGRAM M MODE+2D $2,652.00

EKG MNTR 24HRS $972.00

EKG MNTR SCAN W REPORT $1,557.00

ECHOCARDIOGRAM/MMODE/LTD $2,048.00

DOPPLER ECHO PULSE/CONT $872.00

DOPPLER ECHO COLOR FLW $953.00

ECHOCARDIOGRAM EX STRESS $3,791.00

TEE PROBE ONLY $1,559.00

TRANSESOPHAGEAL ECHO $2,559.00

ECHO M+2D W COLOR/DPPLR $3,901.00

2D ECHO LMTD W/WO CONT $3,134.00

TEE/2D W OR WO CONT $4,014.00

TEE/2D ECHO-W/ OR W/O CON $4,014.00

STRESS ECHO W/WO CONT EC $4,014.00

ANGIOPLSTY TIBIOPERONEAL $6,174.00

ANGIOPLSTY ILIAC $8,250.00

ANGIOPLSTY FEM-POP $8,250.00

ANGIOPLASTY PERC EA VESS $6,174.00

ATHERECTOMY RENAL/VISC $6,170.00

ILIAC ATHERECTOMY $25,139.00

CATH MAJOR 1ST HOUR $4,929.00

Page 12: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CATH MAJOR EA ADD MIN $75.00

CATH MINOR 1ST HR $4,047.00

CATH MINOR EA ADD MIN $64.00

CASE CANC BEFORE ANESTH $550.00

CASE CANC AFTER ANESTH $770.00

REPR AORT ANEU TUB GRFT $4,220.00

REPR AORT ANEU MOD BIFUR $4,888.00

REPR AORT AN UNI BIFUR $4,888.00

REPR AORT AN AOR PROSTH $462.00

INS IL OCCLSN DEVICE $879.00

PLAC PROS AAA EA ADD VSL $839.00

RPR DECND AO W SUBCL SI $2,136.00

RPR DCND AO W/O SUBC SI $1,830.00

UNILAT FEM CTDWN FOR AAA $1,320.00

UNILAT ILIAC CTDN FOR AA $1,848.00

PROS PLCMT AB AO/IL INIT $3,184.00

PLCMNT NEPHREOSTOMY CATH $4,024.00

EXCH/CONV NEPHROSTOMY CATH $1,393.00

REPAIR BLOCKG PERC VENOS $2,749.00

EP CARDIAC MAPPING $14,763.00

COMP EP EVAL/LA FRM CS R $19,235.00

COMP EP EVAL/LV RECORD $19,235.00

LEFT HEART CATH TRANSEPTIAL PUNCTURE $21,332.43

COMP EP W/O INDUC/ARRYTH $21,155.00

EP COMP STUDY W/INDUCTN $21,155.00

EP DRUG FOLLOW-UP STUDY $6,990.00

EP POST DRUG INFUSION $12,488.00

EP TEST AICD LEAD & GEN $5,775.00

EP EVAL AICD LEADS INIT $5,775.00

EP EVAL AICD SUBSEQ $2,418.00

ABLATION-AV NODE $21,155.00

INTRA-OP CARD PACING/MAP $7,697.00

PLCMNT URETERAL STENT PERQ $5,960.00

CARDIOVERSION ELEC $1,496.00

TRANSESOPHAGEAL ECHO $2,559.00

ARTERIAL CATH MONIT/SAMP $721.00

PERIPHERAL STENT $7,800.00

INSERT OF IVC FILTER $12,005.00

DISCOGRAPHY LUMBAR $3,210.18

REM PCMKR TRAN ELCT DUAL $4,950.00

REMOVE PM/ICD ONLY $8,140.00

INSRT/REPLACE PACEMAKER $16,853.00

REMOVE ACCESS DEVICE $880.00

REM/REPOSITION TRANSV PM ELCTD SNGL $3,850.00

CORONARY ANGIOPLASTY $12,579.00

INTRAVASC US INIT VESSEL $2,310.00

ANGIOPLASTY EA ADD'L VESSEL $12,579.00

Page 13: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

INTRAVASC US EA ADD $1,758.00

ATHERECTOMY + ANGIOPLASTY $23,985.00

ATHER + ANGIO EA ADD'L VESSEL $23,985.00

INTRACORCONARY BM STENT + ANGIO $19,105.00

INTRACORONARY BM STENT + ANGIO EA ADD'L $19,105.00

BM STENT + ATHEREC + ANGIO $18,560.00

BM STENT + ATHER + ANGIO EA ADD'L VESSEL $19,105.00

CABG + BM STENT + ATHER + ANGIO $18,560.00

CABG + BM STENT + ATHER + ANGIO EA ADD'L $19,105.00

AMI + ASP THROM + BM STNT + ATHER + ANGI $19,105.00

CTO + BM STNT + ATHER + ANGIO $18,560.00

CTO + BM STNT + ATHER + ANGIO EA ADD'L V $19,105.00

TEMP PACER INTERVENTION $3,520.00

CIRC ASSIST INT $3,940.00

PERC CORON THROMBECT $7,942.00

COR THROMBLYS-INTRA COR $3,208.00

EKG TRACE ONLY (FAA) $458.00

PERICARDIOCENTESIS INTL $2,782.00

LEAD INSERT/PM PERM/ATR $8,118.00

LEAD INSERT/PM PERM/VENT $8,118.00

LEAD INSERT/PM PERM/A-V $8,118.00

INSERT/REPLACE ICD $44,430.00

REPAIR TRANSVENOUS ELECTRODES $2,828.00

INSERT PACING LEAD $17,992.00

L VENTRIC PACING LEAD ADD-ON $55,251.00

TRANSTHOR CATH FOR STENT $1,980.00

IMPL PT ACTIV CARD RCDR $8,833.00

RIGHT HEART CATH $7,109.00

LT HRT CATH W/VENTR $13,621.00

RT & LT HEART CATH $18,054.00

CORONARY ARTERY ANGIOGRAM $11,713.00

CORONARY ART/GRFT ANGIOGRAM $12,810.00

R HRT CORO ARTERY $18,821.00

R HRT ART/GRFT ANGIO $19,918.00

L HRT ARTERY/VENTRICL W COR ANGIO $25,334.00

L HRT ART/GRFT ANGIO $26,431.00

R&L HRT ART/VENTRICLE $29,766.00

R&L HRT ART/VENT ANGIO $30,863.00

ANGIO ADD VESSEL COMP $2,125.00

CATH ATRIAL PACING $5,546.99

INJ VENTR/ATRIAL ANGIO $1,820.00

INJECT R VENTR/ATRIAL AN $1,760.00

INJ SUPRVLV AORTO $1,517.00

INJ PULM ART HRT CATH $1,517.00

PERQ TRANSCATH CLOSURE PDA $40,393.00

HIS BUNDLE RECORDING $5,546.99

RT VENTRICULAR RECORDING $7,180.00

Page 14: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

INTRAVENTRICULAR PACING $5,546.99

INTRCRD EP 3DMAP $15,974.00

INDUCTION OF ARRYTHMIA $4,904.00

INTRA-ATRIAL RECORDING $7,180.00

EP & ABLATE SUPRAVENT ARRTHY $34,848.00

EP & ABLATE VENTRIC TACHY $34,848.00

DOPP FLW/PR MSMNT INIT $2,310.00

DOPP FLW/PR MSMNT ADDL $1,758.00

TX L/R ATRIAL FIB ADD'L $17,424.00

ABLATE ARRYTHMIA ADD ON $17,424.00

TX ATRIAL FIB PULM VEIN ISOL $34,848.00

EVAL ANTITACH P $2,553.00

PERC INSERT IABP DEV $6,125.00

REPOSOTM CV CATH W/FLUOR $640.00

BILIARY DIL W/WO STENT $2,069.00

ANTEGRADE NEPHROSTOGRAM $967.00

INJ LUMBAR OR SACRAL $1,527.00

INJ LUMBR/SACRL ADD LVL $1,371.00

PERC VERTPLSTY 1 BDY T $1,650.00

PERC VERTPLSTY 1 BDY L $1,650.00

PERC VERTPLSTY EA ADD BD $1,375.00

DILATION NEPHRO/URETER $1,778.66

PERC NEPH/PYELO 0-2CM $2,771.00

THORACIC W/O SERL COMP $3,877.00

THORACIC W/SERL COMPLT $4,710.00

ABD CATHETER W/SERIAL $3,877.00

ABD W/BILAT ILIOFEMORAL $3,877.00

EXTREMITY UNI W/SERIAL $4,620.00

EXTREMITY BI W/SERIAL $4,440.00

VISCERAL SELECTIVE COMP $5,703.00

PELVIC SELECTIVE $4,620.00

PULMONARY UNI SELECTIVE $3,769.00

PULMONARY BI SELECTIVE $4,709.00

PULMONARY CATH NON-SLCT $3,210.18

SHUNTOGRAM $300.00

VENOGRAM EXTREMITY UNI $2,309.00

VENOGRAM EXTREMITY BILAT $1,570.00

INFERIOR VENACAVAGRAM $3,464.00

SUPERIOR VENACAVAGRAM $1,542.00

VENOGRAPHY RENAL UNILAT $3,877.00

VENOGRAPHY RENAL BILAT $3,877.00

VENOGRAPHY ADRENAL UNILA $3,877.00

VENOGRAPHY ADRENAL BILAT $3,877.00

HEPATIC VENOGRAM WO EVAL $3,877.00

VENOUS SAMPLING VIA CATH $3,877.00

ANGIO EXIST CATH P THRPY $2,351.00

US NON CORON PLCMNT INIT $1,760.00

Page 15: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TRANSCATHETER BIOPSY $2,490.00

PERC PLACE CENT VEN CATH $902.00

CHANGE PERC DRAIN CATH $924.00

ATHERECTOMY PERIPHERAL $9,268.00

FLUORO GD FOR VEIN DVCE $375.00

FLUOROSCOPY 1 HR < $842.00

FLUOROSCOPY 1 HR > $1,453.00

INJ PERC EXT PSEUDANYSM $283.00

TRANSCATHETER EMBOLIZATN $4,400.00

PLC CATH MN PULM ART $1,884.00

PLACE CATH THORACIC AORTA $6,941.00

PLACE CATH CAROTID/INOM ART ANGIO C $6,941.00

PLACE CATH CAROTID/INOM ART ANGIO E&C $6,941.00

PLACE CATH CAROTID ART $11,351.00

PLACE CATH SUBCLAVIAN ART $6,941.00

PLACE CATH VETERBRAL ART $11,351.00

PLACE CATH XTRNL CAROTID $3,471.00

PLACE CATH INTRACRANIAL ART $3,471.00

PLACE CATH ART RENAL 1ST ORDER $3,866.00

PLACE CATH ART RENAL 2ND ORDER $3,866.00

INSRT NONTUNNL CV CTH 5> $2,584.00

INSRT TNL CV CTH 5>WO PM $1,402.00

INSRT TUNNL VAD 5>WPORT $1,677.00

INSRT CV CATH NO PRT5> $3,300.00

REPAIR CV CATH WO SQ PMP $902.00

RPLC CVAD WO PUMP $1,045.00

THROMB W/O BALLOON CATH $3,743.00

THROMB W BALLOON CATH $4,299.00

INTRO CATH DIALYSIS CIRCUIT $7,924.00

INTRO CATH DIALYSIS CIRCUIT w ANGIOPLAST $11,195.00

INTRO CATH DIALYSIS CIRCUIT w STENT $28,807.00

THRMBC/NFS DIALYSIS CIRCUIT $10,852.00

THRMBC/NFS DIALYSIS CIRCUIT w ANGIOPLAST $21,933.00

THRMBC/NFS DIALYSIS CIRCUIT w STENT $33,106.00

BALO ANGIOP CTR DIALYSIS SEG $11,195.00

STENT PLMT CTR DIALYSIS SEG $28,807.00

DIALYSIS CIRCUIT EMBOLI $3,903.00

US GUIDE VASCULAR ACCESS $1,120.00

ARTERIAL MECHANICAL THROMBECTOMY $9,693.00

MECHANICAL VENOUS THROMBECTOMY $8,724.00

REPOSITIONING OF IVC FILTER $3,948.00

RETRIEVIAL (REMOVAL) IVC FILTER $3,948.00

REMOVE INTRAVAS FOREGIN BODY $6,966.00

THROMBOLYTIC ART THERAPY $2,458.00

THROMBOLYTIC VENIUS THERAPY $2,458.00

THROMBOLYTIC ART/VEN THERAPY $5,485.00

CESSJ THERAPY CATH REMOVAL $5,485.00

Page 16: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PLC CERV CAROTD W/PRD $8,048.00

PL ST CERV CAROTD WO/PRD $4,025.00

ILIAC REVASC $11,632.00

ILIAC REVASC W/STENT $19,431.00

ILIAC REVASC ADD-ON $6,174.00

ILIAC REVAS W/STENT $7,070.00

FEM/POPL REVASC W/TLA $11,632.00

FEM/POPL REVAS W/ATH $15,618.00

FEM/POP REVASC W/STNT $19,431.00

FEM/POPL REV ATH W/STNT $22,657.00

TIB/PER REVASC W/TLA $11,632.00

TIB/PER REVA W/ATHEREC $15,618.00

TIB/PER REVASC W/STENT $19,431.00

TIB/PER REV/ATHER W/STNT $22,657.00

TIB/PER REVASC ADD-ON $6,174.00

TIB/PER REVS W/ATHER ADD $11,476.00

REVAS OPN/PRQ TIB/PER EA $7,070.00

TIB/PER ATHER/STNT EA AD $12,371.00

OPEN/PERQ PLACE STENT 1ST ARTERY $28,807.00

OPEN/PERQ PLACE STENT EA ADD ARTERY $13,932.00

OPEN/PERQ PLACE STENT 1ST VEIN $28,807.00

OPEN/PERQ PLACE STENT EA ADD VEIN $13,932.00

VASC EMBOLIZE/OCCULDE VENOUS $27,932.00

VASC EMBOLIZE/OCCULDE ARTERY $27,932.00

VASC EMBOLIZE/OCCULDE ORGAN $27,932.00

VASC EMBOLIZE/OCCULDE BLEED $27,932.00

TRLUML BALO ANGIOP 1ST ART $6,174.00

TRLUML BALO ANGIOP ADDL ART $4,000.00

TRLUML BALO ANGIOP 1ST VEIN $6,174.00

TRLUML BALO ANGIOP ADDL VEIN $4,000.00

IVUS EA ADDL VESSEL $1,760.00

CHANGE KIDNEY TUBE $647.00

EXCH/CONV EXT BIL DRG CATH $5,784.00

REMOVAL BILIARY DRG CATH $1,283.00

PERQ PLCMNT BILE DUCT STENT $10,941.00

DRAIN KIDNEY LESION $1,940.00

EXCH INTRAVASC TX CATH $526.00

INJECT KIDNEY XRAY $1,091.00

INJECT SPINE DISK LUMBAR $278.00

INSERT BILE DUCT DRAIN $2,069.00

INSERT CATH BILE DUCT $3,002.00

INSERT URETERAL TUBE $1,663.00

OCCLSN/EMBL CATH NON-CNS $1,847.00

OCCLSN/EMBL CATH CNS $2,217.00

PLACE CATH AORTA $3,369.00

PLACE CATH AORTC TRNSLM $1,755.00

PLACE CATH ART ABD ADD $462.00

Page 17: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PLACE CATH ART ABD 1ST $2,075.00

PLACE CATH ART ABD 2ND $1,971.00

PL CATH ART ABO 3RD $2,075.00

PLACE CATH ART ADD ORDR $3,631.00

PLACE CATH ART 1ST ORDR $3,382.00

PLACE CATH ART 2ND ORDR $3,423.00

PLACE CATH ART 3RD ORDR $3,527.00

PLACE CATH ARTERY $839.00

PLACE CATH BRACH ARTERY $4,506.00

PLACE CATH EXTRM ARTERY $3,942.00

PLACE CATH PULM ARTERY $4,506.00

PLACE CATH VENACAVA $1,784.00

PLACE NEEDLE IN VEIN $682.00

PLACE CATH VEIN SHUNT $185.00

PLACE CATH VEIN 1ST ORD $1,905.00

PLACE CATH VEIN 2ND ORD $1,524.00

PL CATH CAROTD/VERTB ART $4,506.00

REPAIR BLOCKG PERC AORTC $2,749.00

REPAIR BLOCKG PERC BRACH $2,749.00

REPAIR BLOCKG PERC FEMRL $2,749.00

REPAIR BLOCKG PERC ILIAC $2,749.00

REPAIR BLCKG PERC TIBIO $2,749.00

REPAIR BLCKG PERC VISCR $2,217.00

VENOUS CATH SAMPLING $640.00

TRANSCATH RTRVL PERC FB $4,440.00

PLACE CATH LT/RT ARTERY $2,006.00

BILIARY ENDO DIL WO STNT $1,755.00

BILIARY ENDO DIL W/STENT $3,417.00

LIVER BX W/OTHER PROC $693.00

PLACE CATH SEGMNTL ARTR $1,038.00

MOD SEDAT 1ST 15 MIN $425.00

MOD SEDAT ADDL 15 MIN $425.00

INTRACORONARY DE STENT + ANGIOPLASTY $24,272.00

INTRACORONARY DE STENT + ANGIO EA ADD'L $24,272.00

DE STENT + ATHERECTOMY + ANGIO $24,272.00

DE STENT & ATHERECTOMY EA ADD'L VESSEL $24,272.00

CABG + DE STENT + ATHER + ANGIO $24,272.00

CABG + DE STENT + ATHER + ANGIO EA ADD'L $24,272.00

AMI + ASP THROM + DE STENT + ATHER + ANG $24,272.00

CTO + DE STNT + ATHER + ANGIO $24,272.00

CTO + DE STNT + ATHER + ANGIO EA ADD'L V $24,272.00

LE VENOUS DUPLEX BILAT $2,459.00

ART STUDY SNGL LVL UE/LE $643.00

ART STUDY UE OR LE $1,027.00

ARTERIAL UE/LE EXT (ABI) SNGL $600.00

ARTERIAL UE/LE EXT (ABI) MLTPL $750.00

UE VENOUS DUPLEX BILAT $2,459.00

Page 18: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LE VENOUS DUPLEX BILAT $2,459.00

UE VEIN MAPPING BILAT $2,459.00

LE VEIN MAPPING BILAT $2,459.00

DUPLEX UE ARTERY $877.00

CAROTID DUPLX IMAGING $1,254.00

DUPLEX LE ARTERY BILATERAL $2,236.00

DUPLEX LE ARTERY UNI/LMTD F/U $817.00

DUPLEX UE LTD F/U $817.00

UE VEIN MAPPING UNILAT $1,511.00

LE VENOUS DUPLEX UNILAT $1,511.00

UE VENOUS DUPLEX UNILAT $1,511.00

VAS CAROTID VESS LTD UNI $1,210.00

VAS TRANSCRANIAL COMP $1,279.00

VAS TRANSCRANIAL LTD $851.00

VAS REN/VIS/CEL COMP $1,290.00

VAS REN/VISC ART LTD $960.00

VAS AOR/IL/CVC ART COMP $1,273.00

VAS AB GFT/AN/IVC VN LTD $1,019.00

VAS DIALYSIS ACCESS $924.00

DPLR LE BILAT REST $1,350.00

LE VEIN MAPPING UNILAT $1,511.00

MULT SLEEP LATENCY TEST $3,008.00

NEUROMUSC JUNCTION TEST $550.00

EEG DIGITAL $1,210.00

EEG NONCRANIAL SX $545.00

EEG AWAKE/DROWSY $868.00

EEG AWAKE/SLEEP $1,528.00

EEG CEREBRAL DEATH EVAL $1,307.00

EEG ALL NIGHT SLEEP ONLY $2,749.00

POLYSOMNOGRAPHY 4 > $4,507.00

EMG ONE EXTREMITY $225.00

EMG TWO EXTREMITIES $575.00

EMG FOUR EXTREMITIES $575.00

EMG CRANIAL NRV BILATERL $575.00

EMG CRANIAL NRV UNILAT $575.00

IOM IN OPERATING ROOM 15 MIN $165.00

EP CNTRL MTR T/C U/L $1,011.22

EP CNTRL MTR T/C LWR LMB $1,011.22

EP CNTRL MTR UPR & LWR LIMBS $2,275.26

NSTIM ANAL PRG CPX SP C $502.00

SOMATOSENSORY EP U/LIMB $2,012.00

SOMATOSENSORY EP L/LIMB $2,012.00

SOMATOSENSORY EP HD/TRNK $2,012.00

POLYSOMNGRPHY W/CPAP $6,346.00

MYELOGRAPHY POST FOSSA $1,246.00

FNA W GUIDANCE $1,444.00

EYE DETECTION OF FOR/BDY $435.00

Page 19: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

MANDIBLE LTD/3VW MAX $373.00

MANDIBLE 4VW MIN $578.00

MASTOIDS BILCTRL 3VW MIN $557.00

FACIAL BONES 2VW MAX $373.00

FACIAL BONES 3VW MIN $850.00

ORBITS 4VW MIN $542.00

NASAL BONES 3VW MIN $563.00

DACRYOCYSTOGRAPHY NASO $514.00

OPTIC FORAMINA $245.00

SINUSES 2VW MAX $282.00

SINUSES 3VW MIN $607.00

SELLA TURCICA $422.00

SKULL < 4 VIEWS $448.00

SKULL 4VW MIN $750.00

TM JOINTS UNILATERAL $311.00

TM JOINTS BILATERAL $591.00

NECK FOR SOFT TISSUES $453.00

SALIVARY GLAND/CALCULUS $617.00

SIALOGRAPHY $617.00

CHEST SINGLE VIEW $412.00

CHEST TWO VIEWS $523.00

CHEST OBLIQUE 2 VWS $647.00

CHEST 2 VWS $739.00

CHEST APICAL LORDOTIC $647.00

CHEST 4 VIEWS $832.00

RIBS UNILAT 2VW $495.00

UNI RIBS WITH PA CHEST $839.00

RIBS BILAT 3VW MIN $564.00

BIL RIBS WITH PA CHEST $924.00

STERNUM 2VW MIN $564.00

STERNCLAVR JNTS 3VW MIN $352.00

BRONCH W TRB BX W/WO FOR $987.00

SPINE ANY LEVEL SNGL VW $189.00

SPINE CERV 2VWS $514.00

SPINE CERVICAL 4VW MIN $786.00

SPINE CERV FLEX&EXTEN $600.00

SPINE THORACIC 2 VWS $405.00

SPINE 3 VIEW T $422.00

SPINE THORACIC 4VW MIN $508.00

SPINE THORACO-LUMBAR JCT $268.00

ENTIRE SPI 1 VIEW $164.00

ENTIRE SPI 2/3 VIEWS $268.00

ENTIRE SPI 4/5 VIEWS $510.00

ENTIRE SPI 6/> VIEWS $510.00

SPINE LUMBAR 2 VWS $534.00

SPINE LUMBAR MIN 4VWS $897.00

LUMB AP/LAT/OBLIQS/BEND $600.00

Page 20: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PELVIS LIMITED $418.00

PELVIS MIN 3 VWS $511.00

SACROILIAC JOINTS 2 VWS $278.00

SACRO-ILIAC JOINTS CMPL $352.00

SACRUM & COCCYX $525.00

MYELOGRAM CERVICAL COMP $1,246.00

MYELOGRAM LUMBAR $1,246.00

MYELOGRAM 2 OR > REGIONS $1,851.00

EPIDUROGRAPHY $4,326.00

CLAVICLE $422.00

SCAPULA $519.00

SHOULDER SNGL VIEW $294.00

SHOULDER 2VW MIN $526.00

SHOULDER ARTHROGRAPHY $741.00

ACROMIO-CLVICULAR JTS BI $710.00

HUMERUS 2VW MIN $462.00

ELBOW LIMITED $432.00

ELBOW 3VW MIN $544.00

ELBOW ARTHROGRAPHY $741.00

FOREARM 2 VWS $429.00

WRIST LIMITED $450.00

WRIST 3VW MIN $514.00

WRIST ARTHROGRAPHY $741.00

HAND LIMITED $418.00

HAND 3VW MIN $487.00

FINGER(S) $310.00

HIP UNI W/PELVIS 1 VIEW $164.00

HIP UNI W/PELVIS 2-3 VIEWS $164.00

HIP UNI W/PELVIS 4/> VIEWS $268.00

HIP UNI 1 VIEW- INTRA-OP $164.00

HIP UNI 2-3 VIEWS - INTRA-OP $164.00

IHIP UNI 4/> VIEWS - INTRA-OP $268.00

HIPS BI W/PELVIS 2 VIEWS $268.00

HIPS BI W/PELVIS 3-4 VIEWS $268.00

HIPS BI W/PELVIS 5/> VIEWS $510.00

HIP ARTHROGRAPHY $741.00

FEMUR 1 VIEW $164.00

FEMUR 2/> VIEWS $164.00

KNEE 1-2 VWS $510.00

KNEES/BILAT AP STANDING $497.00

KNEE W/OBLIQUES 3 VW $486.00

KNEE COMP 4 VW MIN $673.00

KNEE ARTHROGRAPHY $741.00

TIB/FIB 2 VWS $521.00

ANKLE LIMITED $393.00

ANKLE 3VW MIN $487.00

ANKLE ARTHROGRAPHY $741.00

Page 21: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

FOOT LIMITED $415.00

FOOT 3VW MIN $487.00

OS CALCIS (HEEL) $379.00

TOE(S) $422.00

CHANGE GASTROSTOMY TUBE $601.00

ABDOMEN SINGLE VIEW(KUB) $374.00

ABD W/DECUB OR ERECT $646.00

COMP ACUTE ABD $966.00

E R C P $987.00

PHARYNX &/OR CERV ESOPH $332.00

ESOPHAGRAM $407.00

SWAL FUNC W CINE/VIDEO $373.00

UPPER GI W/O KUB $555.00

UPPER GI W/KUB $733.00

UPPER GI W/AIR $733.00

UPPER GI W/SMALL BOWEL $924.00

UPPER GI AIR/KUB $665.00

UPPER GI AIR/SMALL BOWEL $970.00

SMALL BOWEL $993.00

DUODENOGRAPHY HYPOTONIC $1,678.00

COLON BARIUM ENEMA $733.00

COLON BE W/AIR $1,219.00

CHOLECYSTROGRAPHY ORAL $329.00

CHOLANGIOGRPHY OPERATV $510.00

CHOLANGIO INTRAOP ADD SE $362.00

ENDO CATH BILIARY SYSTEM $617.00

ENDO CATH PANCREAS $913.00

GI TUBE LOCAL &/OR MANIP $329.00

PERC ENTEROCLYSIS COMP $617.00

INTRALUMINAL DILATION $1,439.00

UROGRAPHY EXCRETORY(IVP) $555.00

UROGRAM INFUSION $1,189.00

NEPHROTOMOGRAPHY $832.00

PYELOGRAPHY RETROGRADE $1,041.00

CYSTOGRAPHY COMPLETE $1,041.00

URETHROCYSTOGRAPHY RETR $453.00

URETHROCYSTOGRAPHY VOID $454.00

PELVIMETRY $430.00

HYSTEROSALPINGOGRAPHY $617.00

ANGIO OR EXTREM SNGLE $3,210.18

EXTREMITY(VENOGRPHY) BI $1,570.00

PERC DRN ABSC W/CATH $832.00

FLUOROSCOPY LESS THAN 1H $842.00

FLUOROSCOPY GREAT THN1HR $1,453.00

FLUORO BX/ASP/INJ/GUIDE $462.00

BONE AGE STUDIES $196.00

BONE SURVEY LTD $576.00

Page 22: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

BONE SURVEY COMPLETE $720.00

BONE SURVEY INFANT $443.00

FISTULA-SINUS TRCT STDY $1,574.00

SURGICAL SPECIMEN $1,574.00

REMOVAL OF TUNNELED CVC W/O PORT $1,239.00

BIOPSY ABDOMINAL MASS $987.00

BIOPSY BONE DEEP $555.00

BIOPSY BONE SUPERFICL $555.00

BIOPSY MUSCLE PERC $555.00

BIOPSY PANCREAS PERC $555.00

BIOPSY PROSTATE $739.00

BIOPSY RENAL PERC $987.00

INJECT ANKLE XRAY $278.00

INJECT BLADDER RETRO UR $231.00

INJECT ELBOW XRAY $370.00

INJECT HIP XRAY $462.00

INJECT KNEE ARTH $242.00

INJECT MYELOGRAM $370.00

INJECT PENIS STUDY $370.00

INJ SHOULDER XRAY/CT/MRI $492.00

INJECT SINUS TRACT XRAY $215.00

INJECT UTERUS/TUBE XRAY $278.00

INJECT WRIST XRAY $278.00

ASPRIATE PLEURA W/O IMAGING $1,290.00

INSERT CATH PLEURA W/O IMAGING $1,290.00

INTRO LONG GI TUBE $433.00

REPOS GI TUBE THRU DUODN $185.00

BX LIVER PERC NDL $693.00

CERVICAL 1-2 PUNCTURE $1,173.00

SPINAL PUNCTURE LUMBAR $1,331.00

INJ CHOLE THRU EXST CATH $139.00

FLUOROSCOPY SPINE $1,453.00

INSRT NONTUNNL CV CTH 5> $2,584.00

INSRT CV CATH NO PRT 5> $2,584.00

MRI Orbit/Face/Neck w/o cont $2,904.00

MRI Orbit/Face/Neck w&w/o cont $4,066.00

MRA Head w/o cont $3,080.00

MRA Neck w/cont $3,340.00

MRI BRAIN w/o cont $3,784.00

MRI BRAIN w&wo cont $5,298.00

MRI Chest w/o cont $2,904.00

MRA CHEST W CONT $2,530.00

MRA CHEST WO CONT $2,200.00

MRA CHEST WO/W CONT $3,080.00

MRI Cervical Spine w/o cont $3,080.00

MRI Thor w/o cont $3,080.00

MRI SP Lumb w/o cont $3,520.00

Page 23: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

MRI Cervical Spine w&w/o cont $4,312.00

MRI SP Lumb w/wo cont $4,312.00

MRA SPINE W W/O $2,904.00

MRI Pelvis w/o cont $2,904.00

MRA PELVIS WITH CONT $2,530.00

MRA PELVIS WO/W CONT $3,080.00

MRI Upper Extrem JT w/o $2,530.00

MRA U/E W/WO CONT $3,080.00

MRI Lower Extr/no Joint w/o cont $2,200.00

MRI Lower Extr/Joint w/o cont $2,530.00

MRA LWR EXT W CONT $2,304.00

MRA LWR EXT WO CONT $2,004.00

MRA LWR EXT WO/W CONT $3,340.00

MRI ABD w/o cont $2,904.00

MRI ABD w/cont $3,300.00

MRI ABD w & wo cont $4,066.00

MRA ABDOMEN W CONT $2,530.00

MRA ABDOMEN WO CONT $2,200.00

MRA ABDOMEN WO/W CONT $3,080.00

MRI BRST UNI W CONT $1,584.00

MRI BRST UNI WO CONT $1,347.00

MRI BRST UNI WO/W CONT $1,885.00

MRI BRST BIL W CONT $2,200.00

MRI BRST BIL WO CONT $1,870.00

MRI BRST BIL WO/W CONT $2,618.00

3D IMG W POSTPROCESS $440.00

CT HEART WO CM EVAL CALC $2,750.00

CT HRT W CM EVAL STR MRP $2,750.00

CT ANGIO HRT COR BYP GFT $2,750.00

CT FNA W GUIDANCE $1,444.00

CT BRAIN/Head W/O CM $2,733.00

CTA CHEST WO/W CONTRAST $3,434.00

CT BRAIN/Head W/CM $3,209.00

CT BRAIN/Head WO/W CM $3,569.00

CT ORBIT W/O CM $2,733.00

CT ORBIT W/CM $2,536.00

CT ORBIT WO/W CM $3,030.00

CT FACIAL W/O CM $2,733.00

CT FACIAL W/CM $1,975.00

CT FACIAL WO/W CM $2,789.00

CT NECK W/O CM $2,733.00

CT NECK W/CM $3,209.00

CTA ABD LE RO WO/W CONT $3,850.00

CTA ABD WO/W CONTRAST $3,434.00

CTA HEAD WO/W CONTRAST $2,800.00

CTA NECK WO/W CONTRAST $2,800.00

CTA PELVIS WO/W CONTRAST $3,434.00

Page 24: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CTA UE WO/W CONTRAST $2,326.00

CTA LE WO/W CONTRAST $3,850.00

CT CHEST W/CM $3,408.00

CT CHEST WO/W CM $3,727.00

CT SP CERV W/O CM $2,733.00

CT SP CERV W/CM $2,702.00

CT SP CERV WO/W CM $3,277.00

CT SP THOR W/O CM $2,733.00

CT SP THOR W/CM $2,702.00

CT SP THOR WO/W CM $3,277.00

CT SP LUMB W/O CM $2,733.00

CT SP LUMB W/CM $3,111.00

CT SP LUMB WO/W CM $3,509.00

CT CHEST W/O CM $2,733.00

CT PELVIS W/O CM $2,733.00

CT PELVIS W/CM $3,603.00

CT PELVIS WO/W CM $3,569.00

CT UE W/O CM $2,733.00

CT UE W/CM $2,316.00

CT UE WO/W CM $2,814.00

CT LE W/O CM $2,733.00

CT LE W/CM $2,316.00

CT LE WO/W CM $2,814.00

CT ABDOMEN W/O CM $3,090.00

CT ABDOMEN W/CM $3,622.00

CT ABDOMEN WO/W CM $3,569.00

CT ANGIO ABD&PELV W/O&W/DYE $6,867.00

CT ABD/PELVIS W/O CNTRST $5,770.00

CT ABD&PELVIS W/CONTRAST $7,229.00

CT ABD&PELV 1+ SE/REGNS $8,360.00

CT PERC DRN ABSC W/CATH $1,436.00

CT GUIDE NDL PLC BX ASP $2,987.00

CT GUIDE RAD THERAPY FL $1,875.00

BIOPSY ABDOMINAL $1,197.00

BIOPSY BONE DEEP $1,117.00

BIOPSY CHEST LINING NDL $299.00

BIOPSY LUNG OR MEDISTNM $1,088.00

BIOPSY MUSCLE PERC $1,197.00

BIOPSY PANCREAS PERC $1,197.00

BIOPSY RENAL PERC $1,197.00

CT PARACENTESIS W CATH $2,420.00

CT INSERT CATH PLUREA W/IMAG $1,276.00

CT DRAIN SUBDIAPHR ABSCESS $1,197.00

CT DRAIN RENAL ABSCESS PERC $1,595.00

3D IMAGNG NO POSTPROCESS $382.00

BX LIVER PERC NDL $1,197.00

CT ASPIRATE PLUREA W/IMAGING $2,064.00

Page 25: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

BX BONE MARROW $465.00

US FNA W GUIDANCE $1,444.00

US PARACENTESIS ABD $1,877.00

ART/VEN FLOW ABD COMP $1,878.00

ART/VEN FLOW ABD LTD $1,163.00

AORT/INF/IV/BPG COMP $1,254.00

US SOFT TISSUE HEAD/NECK $1,344.00

US CHEST SCAN $777.00

US THORANCENTESIS TUBE INSERT $924.00

US THORANCENTESIS $1,800.00

ULTRASOUND BREAST LIMITED $389.00

ULTRASOUND BREAST COMPLETE $777.00

US ASPIR BREAST CYST $924.00

US BX BREAST NDL GUIDED $924.00

US ASPIR BREAST CYST ADD $504.00

US ABDOMEN COMPLETE $1,509.00

US ABDOMEN LTD/QUAD/FU $893.00

US SINGLE ORGAN $722.00

US ABDL AORTA SCREEN AAA $254.00

US RETROPERITONEAL COMP $1,229.00

US RETROPERITONEAL LTD $971.00

US SCROTUM CONTENTS $1,344.00

US OB LTD 1OR> FETUS $749.00

OB US>/=14 WKS ADDL FETUS $311.00

US FETAL BIOPHYSICAL PROF $863.00

US OB/FETAL AGE <14WKS $933.00

US OB COMP>14WK SGL GEST $333.00

US OB F/U PER FETUS $615.00

US TRANSVAGINAL $1,558.00

ART/VEN FLOW PENILE COMP $325.00

ART/VEN FLOW PENILE LTD $541.00

US PELVIC COMPLETE $1,264.00

US PELVIC LTD/FU $793.00

US TRANSRECTAL $1,558.00

US GUIDE VASCULAR ACCESS $1,120.00

US GUIDE FOR AMNIOCENTESIS $762.00

US GUIDE NEEDLE PLACEMNT $1,275.00

INTRAOPERATIVE ECHO $1,865.00

VENOUS IMAGING LTD $330.00

AORT/INF/IV/BPG LTD $835.00

BX CHEST LINING NDL $924.00

BX LUNG/MEDIASTN PERC ND $693.00

BX MUSCLE PERC NDL $1,386.00

BX LIVER PERC NDL $924.00

BX PANCREAS PERC NDL $924.00

BX ABD/RETROPER PERC NDL $924.00

BX RENAL PERC NDL $1,155.00

Page 26: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

BX PROSTATE NDL $924.00

BX THYROID PERC NDL $1,155.00

US ASPRIATE PLEURA W/IMAGING $1,155.00

US INSERT CATH PLEURA W IMAGING $1,290.00

US PELVIS/RENAL CYST ASP $924.00

US PERC DRN ABSC W/CATH $1,663.00

US XTR NON-VASC COMPLETE $1,190.00

US XTR NON-VASC LMTD $777.00

MINOR GI LAB 1/2HR $1,100.00

MINOR GI LAB EA ADD'L 15 MIN $550.00

MINOR GI LAB 1HR $2,200.00

MINOR GI LAB ADDL MIN $37.00

MAJOR GI LAB 1/2HR $1,760.00

MAJOR GI LAB EA ADD'L 15 MIN $1,375.00

MAJOR GI LAB 1HR $3,520.00

MAJOR GI LAB II 1ST HR $5,500.00

MAJOR GI LAB ADDL MIN $93.00

MAJOR GI LAB II EA ADD M $62.00

MAJOR GI LAB II EA ADD'L 15 MIN $930.00

INJ TX/PROPH/DX SQ/IM $50.00

INJ TX/PRPH/DX IVP EA DR $109.10

E&M-NEW PATIENT-LVL I $192.00

E&M-EST. PATIENT-LVL I $192.00

E&M NEW/EST PATIENT MEDICARE $234.00

ESOPHAGUS-BERNSTEIN TEST $499.00

ERCP INSERT NASOBIL TUBE $2,453.00

TRANSESOPHAGEAL ECHO $2,559.00

ESOPHAGEAL DILATION<30MN $1,482.00

MOD SEDAT ENDO SERVICE >5YRS $425.00

MOD SEDAT EACH ADDL 15 MIN $425.00

TC99 FANOLESOMAB DOSE $2,640.00

GA67 CITRATE 1MCI $77.00

HDR IRID 192 PER SOURCE $578.00

IN111 DTPA .5MCI $4,773.00

IN111 OXINE .5MCI $5,491.00

TC99 MEDRONAT UPTO 30MCI $257.00

TC99 DISOFENIN VIAL $263.00

TC99 BICISATE DOSE $2,131.00

TC99 SESTAMIBI DOSE $648.00

TC99 SUCCIMER DOSE $835.00

TC99 TILMANOCEPT (LYMPHOSEEK) 0.5MCI $547.00

Na 99mTcO4 $154.00

TL201 CHLORIDE 1MCI $604.00

XENON 133 10 MCI $185.00

SR89 1MCI $5,674.00

CESIUM RIBBON $986.00

I 123 SOD CAP PER 100UCI $458.00

Page 27: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TX I131 SOD CAP PER MCI $40.70

TC99 MEBROFENIN DOSE $457.00

TC99 PENTETATE DOSE $457.00

TC99 ALBUMIN MAA DOSE $97.00

TC99 SULFUR COLLOID DOSE $458.00

TC99 GLUCEPTATE DOSE $58.00

TC99 RBC DOSE $97.00

TC99 MERTIATIDE DOSE $462.00

MYOCARD PERF SPECT SNGL $3,754.00

MYOCARD PERF SPECT MULT $7,028.00

MYOCARD PERF PLANAR SNGL $2,860.00

MYOCARD PERF PLNR MULT $3,850.00

TUMOR LOCAL MULTIPLE AREAS $2,163.00

TUMOR LOCAL WHOLEBODY $2,884.00

ABCESS SPECT $2,270.00

THYROID UPTAKE MEASUREMENT $392.77

THYROID IMAGING W/BLOOD FLOW $470.00

THYROID IMAGING W/BLOOD FLOW QUANTITATIV $729.00

THYROID C/M IMG WHOL BDY $2,217.00

PARATHYROID IMAGING $1,807.00

BONE MARROW IMAGING LTD $1,315.00

BONE MARROW IMAGING MULT $1,847.00

BONE MARROW IMG WH/BODY $2,401.00

SPLEEN IMAG VASCULAR FLO $1,333.00

INFL PR LCL/LTD $2,475.00

LYMPHATICS & LYMPH NODES $1,755.00

LIVER IMAG VASCULAR FLOW $1,724.00

LIVER IMAGING (SPECT) $1,951.00

LIVER/SPLEEN VASC FLOW $2,032.00

HEPATOBILIARY SYSTEM IMAGING $2,493.00

HEPATOBIL SYST IMAGE W/DRUG $3,740.00

SALIVARY GLND IMG STATIC $1,478.00

SALIVARY GLAND SERIAL $1,496.00

VIT B12(SCHILLNG)WO/INTR $1,201.00

VIT B12(SCHILLNG)W/INTR $1,293.00

GASTRIC EMPTYING STDY-DM $1,755.00

GASTROESOPHOGL REFLUX-DM $1,570.00

GI BLOOD LOSS STUDY $1,990.00

INTESTINE IMAGING $2,217.00

PERITONEAL SHUNT PATENCY $2,217.00

BONE IMAGING LIMITED $1,388.00

BONE IMAGING MULTIPLE $1,467.00

BONE IMAG 3 PHASE TECH $2,524.00

BONE IMG TOMOGRM (SPECT) $2,069.00

BONE IMAGE TOTAL BODY $2,802.00

GATED HEART PLANAR SNGL $2,896.00

BLOOD POOL/STRESS/EF/WM $3,552.00

Page 28: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

VASCULAR FLOW STUDY IMAG $2,015.00

VENOGRAM UNILATERAL $1,333.00

VENOGRAM BILATERAL $1,983.00

MYOCARD INFARCT IMAGING PLANAR $1,847.00

MYOCARD INFARCT IMAGING SPECT $1,831.00

PULM PERF PARTICULATE $1,654.00

LUNG VENTILATION IMAGING $1,478.00

LUNG VENTILA&PERFUS IMAGING $3,904.00

LUNG PERFUSION DIFFERENTIAL $3,641.00

LUNG PERF&VENTILAT DIFERENTL $5,118.00

BRAIN IMG TOMGRAM(SPECT) $2,494.00

CEREBRAL VASCULAR FLOW $1,254.00

CISTERNOGRAM $2,494.00

CSF LEAK DETECTION $2,124.00

KIDNEY IMAG VASC FLOW $1,847.00

KIDNEY IMG FLW/FNCT W/DR $2,128.00

KIDNEY IMG VASC/FUNCTION $2,603.00

KIDNEY IMAGING (SPECT) $1,931.00

TESTICULAR VASC FLOW $1,653.00

TUMOR LOCALIZATION-SPECT $2,270.00

TUMOR LOCALIZ MULTI DAYS $3,850.00

ABSCESS LOCAL WHOLE BODY $3,661.00

IV INJ RA DRUG DX STUDY $554.00

RADPHARM TX ORAL $2,200.00

MRI SP CERV W/WO CM $5,390.00

MRI SP THOR W/WO CM $5,390.00

MRI SP LUMB W/WO CM $5,390.00

MRA HEAD W/O CONTRAST $3,850.00

MRA HEAD W/CONTRAST $4,428.00

MRA HEAD WO/W CONTRAST $5,390.00

MRA NK W/O CONTRAST $3,630.00

MRA NECK W/CONTRAST $4,175.00

MRA NECK WO/W CONTRAST $5,082.00

MRA ABDOMEN W OR WO CONTRAST $2,220.00

MRA LOWER EXTREMITY W OR WO CONTRAST $2,220.00

MRA U/E W OR /WO CONT $3,850.00

MRA CHEST W OR WO CONTRAST $2,220.00

MRA PELVIS W OR WO CONTRAST $2,220.00

MRA SPINE W OR WO $3,630.00

MRI SP CERV W/O CM $4,130.00

MRI SP THOR W/O CM $3,850.00

MRI SP LUMB W/O CM $4,400.00

MRI BR/HEAD W/O CM $4,840.00

MRI BR/HEAD W/CM $5,440.00

MRI BR/HEAD W/WO CM $6,622.00

MRI ORB/FACE/NK W/CONT $4,175.00

MRI ORB/FACE/NK WO/W $5,082.00

Page 29: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

MRI UE NO JNT W/O CONT $2,750.00

MRI UE NO JNT W/CONTRAST $3,163.00

MRI UE/JNT W CONT $3,637.00

MRI UE JNT WO/W CONTRAST $5,091.00

MRI PELVIS W/O CONTRAST $3,630.00

MRI PELVIS WO/W CONTRAST $5,082.00

MRI CHEST W/CONTRAST $4,175.00

MRI CHEST WO/W CONTRAST $5,082.00

MRI ABD W/CONTRAST $4,125.00

MRI ABD WO/W CONTRAST $5,082.00

MRI UE NO JNT W WO $3,850.00

MRI LE NO JNT W WO $3,850.00

MRI LE NO JNT W/CONTRAST $3,163.00

MRI LE NO JNT W/O CONT $2,750.00

MRI LE JNT W/CONTRAST $3,637.00

MRI LE JNT WO/W CONTRAST $5,091.00

MRI ORBIT/FACE/NECK WO $3,718.00

MRI TMJ $3,630.00

MRI CHEST WO $3,630.00

MRI PELV W CTRS $4,175.00

MRI UE/JNT WO CTRS $3,718.00

MRI LE/JNT WO CTRS $3,718.00

MRI ABD WO CONTRAST $3,718.00

MRI SP CERV W/CM $4,428.00

MRI SP THOR W/CM $4,428.00

MRI SP LUMB W/CM $5,060.00

3D RENDER W/INTERP POSTPROCES $2,912.00

3D RENDER W/INTERP POSTPROCES $3,408.00

MRI GUID TISSUE ABLATION $1,650.00

OP MRA ABDOMEN WO CONT $2,200.00

OP MRA ABDOMEN WO/W CONT $3,080.00

OP MRA CHEST W CONT $2,530.00

OP MRA CHEST WO CONT $2,200.00

OP MRA CHEST WO/W CONT $3,080.00

OP MRA LWR EXT W CONT $2,304.00

OP MRA LWR EXT WO CONT $2,004.00

OP MRA LWR EXT WO/W CONT $3,340.00

OP MRA PELVIS WITH CONT $2,530.00

OP MRA PELVIS WO CONT $2,750.00

OP MRA PELVIS WO/W CONT $3,080.00

OP MRA UE W CONTRAST $1,859.00

OP MRA UE WO CONTRAST $1,301.00

OP MRA UE W & WO CONTRAST $1,859.00

ABACAVIR 20MG/ML $2.00

ABACAVIR/LAMIVUD/ZIDOVUD $123.00

ABACAVIR 300MG $62.00

ESOMEPRAZOLE 40MG PKT $23.00

Page 30: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ACARBOSE 50MG $18.00

ACARBOSE 100MG $18.00

ESOMEPRAZOLE 40MG PWDR P $62.00

ACEBUTOLOL 200MG CAP $19.00

ACEBUTOLOL 400MG CAP $19.00

NTG TAB GR 1/150 $3.00

THIAMINE HCL 100MG TAB $9.00

ACETAMIN/CAFFEINE/BUTAL $18.00

ACETAMINOPHEN EXST CAP $11.00

ASA/CAFFINE/BUTAL $18.00

ACETAMIN/ISOMETHEP/DIC $17.00

ACETAMINOPHEN 325MG $12.00

SAPHRIS ODT 5MG BLCK CHR $37.00

Saphris 10mg tab sublingual $33.00

ACAMPROSATE CA 333MG $6.00

ACETAZOLAMIDE 125MG $16.00

ACETAZOLAMIDE 250MG $17.00

ACETAZOLAMIDE 500MG SEQ $18.00

ACYCLOVIR 200MG $19.00

ACYCLOVIR 800MG $38.00

ACYCLOVIR 200MG/5ML $17.00

ALBENDAZOLE 200MG $13.00

ALBUTEROL TAB 2MG $17.00

ALBUTEROL REPETAB 4MG $38.00

ALBUTEROL 4MG $17.00

ALENDRONATE 10MG $29.00

ALENDRONATE 40MG $34.00

ALENDRONATE 70MG $122.00

ALLOPURINOL 100MG $17.00

ALLOPURINOL 300MG $17.00

ALPRAZOLAM .25MG $18.00

ALPRAZOLAM .5MG $17.00

ALPRAZOLAM 1MG $18.00

ALUMINUM CARB GELCAPS $16.00

ALUMINUM HYDROX GEL TAB $16.00

ALUM MAG HYDROXIDE $11.00

AMANTADINE 100MG $17.00

AMILORIDE 5MG $22.00

AMINOCAPROIC ACID 500MG $19.00

AMINOGLUTETHAMIDE 250MG $22.00

AMINOPHYLLINE 100MG $19.00

AMINOPHYLLINE 200MG $19.00

AMIODARONE 200MG $27.00

AMITRIPTYLINE 10MG $15.00

AMITRIPTYLINE 25MG $33.00

AMITRIPTYLINE 50MG $33.00

AMITRIPTYLINE 75MG $33.00

Page 31: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

RISPERIDONE .5MG $33.00

AMITRIPTYLINE 100MG $33.00

AMITRIPTYLINE 150MG $33.00

AMLODIPINE 2.5MG $28.00

AMLODIPINE 5MG $28.00

AMLODIPINE 10MG $32.00

AMMON CHLORIDE 500MG $16.00

AMOXAPINE 25MG $21.00

AMOXAPINE 50MG $17.00

AMOXAPINE 100MG TAB $17.00

AMOXAPINE 150MG $19.00

Amoxicillin/Clav 125mg-31.25mg/5ml $128.00

Amoxicilin/Clav 250mg-62.5mg/5ml $248.00

Amoxcillin/Clav 400mg-57mg/5ml $41.00

AMOXICILLIN/CLAV 250MG $23.00

AMOXICILLIN/CLAV 875MG $60.00

AMOXICILLIN/CLAV 500MG $27.00

AMOXICILLIN 250MG $9.00

AMOXICILLIN 500MG $16.00

AMPRENAVIR 150MG $38.00

AMPICILLIN 250MG $6.00

AMPICILLIN 500MG $19.00

ANAGRELIDE 0.5MG $36.00

ANALGESIC OTC TAB/CAP $3.00

ANASTROZOLE 1MG $64.00

ARIPIPRAZOLE 2MG $55.00

ARIPIPROZOLE 5MG $6.80

ARIPIPRAZOLE 15MG $39.00

ARIPIPRAZOLE 10MG $81.00

ARIPRAZOLE 20MG TAB $42.00

APRIPIPRAZOLE 30MG TAB $2.00

ANTACID OTC TAB/CAP $21.00

ASCORBIC ACID 250MG $12.00

ASCORBIC ACID 500MG $12.00

ASPIRIN EC 165MG $21.00

ASPIRIN EC 325MG $21.00

ASPIRIN EC 81MG $11.00

ASPIRIN BABY $11.00

ASPIRIN BUFFERED $11.00

ASPIRIN 325MG $9.00

ASTEMIZOLE 10MG $21.00

ATAZANAVIR 150MG $109.00

ATAZANAVIR 200MG $101.00

ATOMOXETINE 40MG $26.00

Atomoxetine 25mg cap $20.00

ATENOLOL 100MG $23.00

ATENOLOL 25MG $27.00

Page 32: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ATENOLOL 50MG $22.00

ATORVASTATIN 10MG $21.00

ATORVASTATIN 20MG $27.00

ATORVASTATIN 40MG $31.00

ATOVAQUONE 250MG $28.00

AZATHIOPRINE 50MG $18.00

AZITHROMYCIN 250MG $65.00

AZITHROMYCIN 600MG $90.00

BACLOFEN 10MG $17.00

BACLOFEN 20MG TAB $18.00

BENAZEPRIL 5MG $21.00

BENAZEPRIL 10MG $21.00

BENAZEPRIL 20MG $21.00

BENZONATATE 100MG $17.00

BENZTROPINE .5MG $17.00

BENZTROPINE 1MG $17.00

BENZTROPINE 2MG $16.00

BETHANECHOL 5MG $16.00

BETHANECHOL 10MG $17.00

BETHANECHOL 25MG $17.00

BETHANECHOL 50MG $17.00

BICALUTAMIDE 50MG $73.00

BIPERIDEN 2MG $21.00

BIRTH CONTROL PILLS 1MO $339.00

BISACODYL 5MG $12.00

BISOPROLOL/HCTZ 2.5/6.25 $19.00

BISOPROLOL/HCTZ 5/6.25 $38.00

BISMUTH SUBSALICYL TAB $21.00

LEVETIRAC ORAL SOLN 100MG/ML $3.00

BRILINTA 90MG TAB $15.00

BROMOCRIPTINE 2.5MG $23.00

BROMOCRIPTINE 5MG $26.00

BUMETANIDE .5MG $19.00

BUMETANIDE 1MG $19.00

BUPROPION 75MG $21.00

BUPROPION 100MG $22.00

BUPROPION SR 100MG $21.00

BUPROPION SR 150MG $21.00

BUPRENORPHINE 2MG $25.00

BUPRENORPHINE 8MG $45.00

BUPRENRPH/NALOX 2MG/.5MG $13.00

BUPRENRPH/NALOX 8MG/2MG $14.00

BUSPIRONE 5MG $19.00

BUSPIRONE 10MG $22.00

BYSTOLIC 5MG TAB $11.00

BXN Mouthwash 1.6G/237ml $100.00

First Mouthwash 25-200/30 $11.00

Page 33: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CABERGOLINE .5MG $161.00

CALCITRIOL .25MCG $22.00

CALCITRIOL .5MCG $23.00

CALCIUM ACETATE 667MG $15.00

CALCIUM CARBONATE $21.00

CALCIUM CARBONATE 500MG $12.00

CALCIUM CARBONATE 650MG $16.00

CALCIUM CARB/VITD600/200 $21.00

CALCIUM CITRATE 500MG $21.00

CALCIUM 500MG/VIT D $39.00

OYSTR CA 250 & D 125 $15.00

CALCIUM GLUCONATE 500MG $17.00

POLYCARBOPHIL 625MG $21.00

CANDESARTAN 4MG $14.00

CANDESARTAN 16MG $12.00

CAPECITABINE 500MG $56.00

CAPTOPRIL 12.5MG $22.00

CAPTOPRIL 25MG $22.00

CAPTOPRIL 50MG $22.00

CARBAMAZEPINE 100MG $18.00

CARBAMAZEPINE EREL 100MG $21.00

CARBAMAZEPINE EREL 200MG $21.00

CARBAMAZEPINE 200MG $17.00

CARBENICILLIN 382MG $31.00

CARBIDOPA/LEVOD 10/100 $17.00

CARBIDOPA/LEVOD 25/100 $17.00

CARBIDOPA/LEVO 25/100CR $21.00

CARBIDOPA/LEVOD 25/250 $17.00

CARBIDOPA/LEVOD 50/200 $21.00

CARISOPRODOL 350MG $16.00

LEVOCARNITINE 330MG $19.00

CARVEDILOL 3.125MG $21.00

CARVEDILOL 6.25MG $16.00

CARVEDILOL 12.5MG $21.00

CARVEDILOL 25MG $24.00

CEFDINIR 300MG CAPSULES $184.00

CEFUROXIME AXETIL 250MG $31.00

CEFUROXIME AXETIL 500MG $44.00

CELECOXIB 100MG $21.00

CETYLPYRDN/BENZOC TR 18S $16.00

CEPASTAT $21.00

CEPHALEXIN 250MG $39.00

CEPHALEXIN 500MG $56.00

ACTIVATED CHARCOAL 25GM $58.00

ACTIVATED CHARCOAL-SORBITAL 25GM $58.00

ACTIVATED CHARCOAL 260MG $16.00

CHLORAMBUCIL 2MG $19.00

Page 34: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CHLORDIAZ/CLIDIN 5/2.5 $16.00

CHLORDIAZEPOXIDE 5MG $15.00

CHLORDIAZEPOXIDE 10MG $15.00

CHLORDIAZEPOXIDE 25MG $18.00

CHLOROPHYLL TAB 3MG $6.00

CHLORPHENIRAMINE 4MG $16.00

CHLORPROMAZINE 10MG $15.00

CHLORPROMAZINE 25MG $15.00

CHLORPROMAZINE 50MG $15.00

CHLORPROMAZINE 100MG $15.00

CHLORPROMAZINE 200MG $15.00

CHLORPROPAMIDE 100MG $17.00

CHLORPROPAMIDE 250MG $17.00

CHLORTHALIDONE 25MG $22.00

CHLORTHALIDONE 50MG $21.00

CHLORZOXAZONE 500MG $16.00

CHOLINE-MG $17.00

CHOLINE MG 750MG $17.00

CHROMIUM 200MCG $21.00

CHONDROITIN SULF 250MG $21.00

CILOSTAZOL 50MG $39.00

XARELTO (RIVAROXABAN) TAB 15MG $35.00

Xarelto (rivarobadan) tab 10mg $35.00

XARELTO (RIVAROXABAN) TAB 20MG $35.00

XIFAXAN 550MG PO $72.00

CIMETIDINE 300MG $17.00

CIMETIDINE 400MG $21.00

CIMETIDINE 800MG $27.00

CINACALCET 30MG $83.00

CITALOPRAM 10MG TAB $2.00

CITALOPRAM 20MG $21.00

CIPROFLOXACIN 250MG $36.00

CIPROFLOXACIN 500MG $36.00

CIPROFLOXACIN 750MG $45.00

CLARITHROMYCIN 250MG $33.00

CLARITHROMYCIN 500MG $52.00

CLINDAMYCIN 150MG $69.00

CLOFAZIMINE 50MG $38.00

CLOMIPHENE 50MG $43.00

CLOMIPRAMINE 25MG $22.00

CLOMIPRAMINE 50MG $24.00

CLOTRIMAZOLE TROCHE $18.00

CLONAZEPAM .5MG $20.00

CLONAZEPAM 1MG $17.00

CLONAZEPAM 2MG $17.00

CLONIDINE .1MG $19.00

CLONIDINE .2MG $19.00

Page 35: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CLONIDINE .3MG $21.00

CLOPIDOGREL 75MG $27.00

CLORAZEPATE CAP 7.5MG $16.00

CLOZAPINE 25MG $30.00

CLOZAPINE 100MG $31.00

CLOZAPINE 25MG ODT $11.00

CLOZAPINE 100MG ODT $23.00

UBIDECARENONE 30MG $3.00

UBIDECARENONE 60MG $21.00

Colazal 750mg cap $3.00

COLCHICINE TAB .5MG $16.00

COLCHICINE TAB .6MG $9.00

COLESEVELAM 625MG $7.00

CONJ ESTROG.625MEDROX2.5 $17.00

CONJUGATED ESTR .3MG $15.00

CONJUGATED ESTR .625MG $15.00

CONJUGATED ESTR .9MG $21.00

CONJUGATED ESTR 1.25MG $17.00

CORTISONE 5MG $16.00

COUGH/COLD PREP 1 TAB/CA $21.00

CREON 12/38/60 CAP $10.00

CYANOCOB/FA/PYRIDOX TAB $4.00

CYCLOBENZAPRINE 10MG $17.00

CYCLOPHOSPHAMIDE 25MG $21.00

CYCLOSPORINE 25MG $39.00

CYCLOSPORIN 25MG SOFTGEL $39.00

CYCLOSPORIN 100MG CAP $59.00

CYPROHEPTADINE 4MG $17.00

DANAZOL 100MG $38.00

DANAZOL 200MG $38.00

DANTROLENE 25MG $17.00

DANTROLENE 100MG $17.00

DAPSONE 25MG $38.00

DAPSONE 100MG $9.00

DARUNAVIR 800 MG $160.00

DARUNAVIR 600MG $80.00

DIDANOSINE 100MG $21.00

DIDANOSINE 250MG $57.00

DIDANOSINE 400MG $77.00

DEMECLOCY CAP 150MG $51.00

DEMECLOCY TAB 300MG $68.00

DESIPRAMINE 10MG $16.00

DESIPRAMINE 25MG $17.00

DESIPRAMINE 50MG $16.00

DESIPRAMINE 75MG $17.00

DESIPRAMINE 100MG $17.00

DEXAMETHASONE .5MG $16.00

Page 36: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

DEXAMETHASONE .75MG $16.00

DEXAMETHASONE 1.5MG $17.00

DEXAMETHASONE 2MG $17.00

DEXAMETHASONE 4MG $18.00

DEXAMETHASONE 1MG $18.00

DEXTROMETHORPHAN 20MG/15ML $2.00

DIAZEPAM 2MG $18.00

DIAZEPAM 5MG $18.00

DIAZEPAM 10MG $47.00

DICLOFENAC 25MG $21.00

DICLOFENAC 50MG $17.00

DICLOFENAC 75MG $19.00

DICLOXACIL 250MG $19.00

DICLOXACIL 500MG $39.00

DICYCLOMINE 10MG $6.00

DICYCLOMINE 20MG $16.00

DIFLUNISAL 250MG $19.00

DIFLUNISAL 500MG $21.00

DIGESTIVE ENZYME CAP $3.00

DIGOXIN .125MG $19.00

DIGOXIN .25MG $3.00

DIHYDROTACHY .2MG $38.00

DILTIAZEM 30MG $19.00

DILTIAZEM 60MG $22.00

DILTIAZEM 90MG $22.00

DILTIAZEM 120MG $24.00

DILTIAZEM CD 120MG $24.00

DILTIAZEM CD 180 MG $25.00

DILTIAZEM CD 240 MG $27.00

DILTIAZEM CD 300 MG $29.00

DIMENHYDRINATE 50MG $11.00

DIPHENHYDRA 25MG $12.00

DIPHENHYDRAMINE 50MG $16.00

DIPHENOXYLATE/ATRP TAB $15.00

DIPYRIDAMOLE 25MG $17.00

DIPYRIDAMOLE 50MG $16.00

DIPYRIDAMOLE 75MG $16.00

DIPYRIDAMOLE/ASA SR CAP $17.00

DISOPYRAMIDE 100MG $19.00

DISOPYRAMIDE 150MG $21.00

DISOPYRAMIDE CR 100MG $21.00

DISOPYRAMIDE CR 150MG $21.00

DISULFIRAM 250MG $16.00

DISULFIRAM 500MG $16.00

DIVALPROEX NA 125MG TAB $2.00

DIVALPROEX NA 250MG $18.00

DIVALPROEX NA 500MG $22.00

Page 37: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

DIVALPROEX NA 500MG ER $16.00

DIVALPROEX NA 250MG ER $10.00

DOCUSATE CA 240MG $12.00

DOCUSATE NA/SENNOSIDES $3.00

DOCUSATE SOD 100MG $9.00

DOCUSATE SOD 250MG $9.00

DOCUSATE PHENOLPHTHALEIN $16.00

DOCUSATE NA/CASANTHRANOL $11.00

DONEPEZIL 5MG $37.00

DONEPEZIL 10MG TAB $7.00

ALBUMIN-25% 25GM/100ML INJ $289.00

DONNATAL $9.00

DONNATAL EXTENTAB $21.00

DOXAZOSIN 1MG $29.00

DOXAZOSIN 2MG $29.00

DOXEPIN 10MG $17.00

DOXEPIN 25MG $17.00

DOXEPIN 50MG $17.00

DOXEPIN 100MG $16.00

DOXERCALCIFEROL 0.5MCG $23.00

DOXERCALCIFEROL 2.5MCG $32.00

DOXYCYCLINE 50MG $22.00

DOXYCYCLINE 100MG $23.00

DULOXETINE 20MG CAP $35.00

DULOXETINE 30MG $28.00

DULOXETINE 60MG $2.00

DUTASTERIDE .5MG CAP $23.00

Edecrin 25mg Tab $12.00

EFAVIRENZ 200MG $56.00

ELIQUIS 5MG TAB $16.00

ELIQUIS 2.5MG TAB $14.00

ENALAPRIL 2.5MG $22.00

ENALAPRIL 5MG $21.00

ENALAPRIL 10MG $23.00

ENALAPRIL 20MG $23.00

EPHEDRINE 25MG $15.00

Etravirine 100mg tab $25.00

EMTRICITABINE/TENOFOVIR $184.00

EMTRICITABINE 200MG $19.00

ENTACAPONE 200MG $25.00

EPLERENONE 25MG $31.00

ERGOLOID MESYLATES 1MG $16.00

ERGOT ALK SL 1MG $16.00

ERGOTAMINE/BELL/PB $21.00

ERGOTAMINE-CAFF $17.00

ERYTHROMYCIN BASE 250MG $9.00

ERYTHROMYCIN BASE 500MG $9.00

Page 38: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ESCITALOPRAM 10MG $18.00

ESOMEPRAZOLE 20MG CAP $23.00

ESOMEPRAZOLE 40MG CAP $23.00

ESTRADIOL .5MG $4.00

ESTRADIOL 1MG $17.00

ESTRADIOL 2MG $17.00

ESTRAMUSTINE 140MG $35.00

ESTROG1.25/METHYLTST 2.5 $21.00

ESTROPIPATE 0.625MG $21.00

ESTROPIPATE 1.25MG $21.00

ETHACRYNIC ACID 50MG $19.00

ETHAMBUTOL 100MG $19.00

ETHAMBUTOL 400MG $22.00

ETHINYL ESTRADI .05MG $15.00

ETHIONAMIDE 250MG $17.00

ETHOSUXAMIDE 250MG $14.00

PALIPERIDONE 3MG $48.00

EZETIMIBE 10MG $21.00

ETOPOSIDE 50MG $178.00

ETIDRONATE 200MG $26.00

ETIDRONATE 400MG $60.00

EXCEDRIN TEN 500 MG $4.00

FAMOTIDINE 20MG $43.00

FAMOTIDINE 40MG $30.00

FAMCICLOVIR 250MG $41.00

FANAPT 2MG TAB $46.00

FANAPT 4MG TAB $46.00

FANAPT 8MG TAB $46.00

FANAPT 10MG $46.00

FANAPT 12MG TAB $45.00

FELODIPINE 2.5MG $21.00

FELODIPINE 5MG $21.00

FELODIPINE 10MG $21.00

Fenofibrate 48mg Tab $6.00

FENOFIBRATE 67MG $21.00

FENOFIBRATE MIC 54MG $8.00

FENOFIBRATE MIC 160MG $23.00

FENOFIBRATE MIC 145MG $28.00

FERROUS GLUCONATE 325MG $12.00

ETHACRYNIC ACID 25MG TAB $6.00

FERROUS SULF 160MG $16.00

FERROUS SULF 300-325MG $86.00

FERROUS SULF 300MG/5ML $2.00

FERROUS SULFAT 167MG $11.00

FEXOFENADINE 60MG $12.00

FEXOFEN/PSEUDO 60-120 $21.00

FINASTERIDE 5MG $29.00

Page 39: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

Voriconazole 50mg tab $27.00

VORICONAZOLE 200MG TAB $56.00

FLAVOXATE 100MG $16.00

Flecainide 50mg tab $3.00

FLECAINIDE 100MG $22.00

FLUCONAZOLE 50MG $45.00

FLUCONAZOLE 100MG $59.00

FLUCONAZOLE 200MG $70.00

FLUCYTOSINE 250MG $183.00

FLUCYTOSINE 500MG $30.00

FLUDROCORTISONE .1MG $17.00

FLUOXETINE 10MG $24.00

FLUOXETINE 20MG $25.00

FLUOXYMESTERONE 10MG $17.00

FLUPHENAZINE 2.5MG $18.00

FLUPHENAZINE 1MG $18.00

FLUPHENAZINE 5MG TAB $19.00

FLUPHENAZINE 10MG $19.00

FLURAZEPAM 15MG $18.00

FLURBIPROFEN 50MG $19.00

FLURBIPROFEN 100MG $21.00

FLUTAMIDE 125MG $26.00

FOLIC ACID 400MCG $21.00

FOLIC ACID 1MG $17.00

FLUVOXAMINE 50MG $24.00

FLUVOXAMINE 100MG $24.00

FOSINOPRIL 10MG $38.00

FOSINOPRIL 20MG $38.00

FOSAMPRENAVIR 700MG $81.00

FOSRENOL 1000 MG $20.00

FUROSEMIDE 20MG $19.00

FUROSEMIDE 40MG $19.00

FUROSEMIDE 80MG $19.00

GABAPENTIN 100MG $21.00

GABAPENTIN 300MG $28.00

GABAPENTIN 400MG $21.00

GANCICLOVIR 250MG CAP $35.00

GANCICLOVIR 500MG CAP $70.00

GALANTAMINE 4MG $21.00

GEMFIBROZIL 600MG $24.00

GLIMEPIRIDE 1MG $39.00

GLIMEPIRIDE 2MG $39.00

GLIMEPIRIDE 4MG $39.00

GLIPIZIDE 5MG $18.00

GLIPIZIDE XL 5MG $21.00

GLIPIZIDE 10MG $17.00

GLUCOSAMIN CHONDROL MANG $21.00

Page 40: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

GLUCOSE $21.00

GLYBURIDE 3MG MICRONIZED $32.00

GLYBURIDE TAB 1.25MG $21.00

GLYBURIDE TAB 2.5MG $18.00

GLYBURIDE TAB 5MG $18.00

GLYCOPYRROLATE 1MG $21.00

GRANISETRON 1MG TAB $12.00

GRISEOFULVIN 125/5 120ML $38.00

GRISEOFULVIN MICRO 250MG $18.00

GRISEOFULVIN MICRO 500MG $38.00

GUAIFENESIN 200MG $21.00

GUAIFENESIN 600MG $22.00

GUAIFENESIN/DM SR TA $21.00

GUANETHIDINE SU 10MG $19.00

GUANFACINE 1MG $21.00

HALOPERIDOL .5MG $17.00

HALOPERIDOL 1MG $18.00

HALOPERIDOL 2 MG $17.00

HALOPERIDOL 5MG $65.00

HALOPERIDOL 10MG $22.00

HALOPERIDOL 20MG $21.00

HYDRALAZINE 10MG $19.00

HYDRALAZINE 25MG $19.00

HYDRALAZINE 50MG $19.00

HYDRALAZINE 100MG $19.00

Tussionex 10-8mg/5ml $81.00

HYDROCHLOROTHIAZD 12.5MG $4.00

HYDROCHLOROTHIA 25MG $19.00

HYDROCHLOROTHIA 50MG $19.00

HYDROCORTISONE 5MG $21.00

HYDROCORTISONE 10MG $15.00

HYDROCORTISONE 20MG $15.00

HYDROXYCHLOROQUINE200MG $19.00

HYDROXYUREA 200MG $46.00

HYDROXYUREA 500MG $22.00

HYDROXYZINE 10MG $17.00

HYDROXYZINE PAMOATE 25MG $17.00

HYDROXYZINE PAMOATE 50MG $17.00

HYDROXYZINE PAMOATE100MG $16.00

HYOSCYAMINE .125MG $17.00

HYOSCYAMINE LA .375MG $21.00

IBUPROFEN TAB 200MG $12.00

IBUPROFEN 400MG $16.00

IBUPROFEN 600MG $17.00

IBUPROFEN 800MG $18.00

IMATINIB 400MG $105.00

IMIPRAMINE 10MG $15.00

Page 41: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

IMIPRAMINE 25MG $15.00

IMIPRAMINE 50MG $15.00

INDAPAMIDE 2.5MG $22.00

INDINAVIR 400MG $39.00

INDOMETHACIN 25MG $17.00

INDOMETHACIN 50MG $17.00

INDOMETHACIN SR 75MG $21.00

IRBESARTAN 150 MG $21.00

IRON-VIT12 INTRINSIC FAC $21.00

Raltegravir Potassium 400mg Tab $63.00

ISONIAZID 100MG $15.00

ISONIAZID 300MG $9.00

ISOSORBIDE 5MG $19.00

ISOSORBIDE 10MG $19.00

ISOSORBIDE 40MG TAB $19.00

ISOSORBIDE 20MG $19.00

ISOSORBIDE MONO 20MG $38.00

ISOSORBIDE 30MG $19.00

ISOSORBIDE MONONITR 30MG $39.00

ISOSORBIDE SR 40MG $38.00

ISOSORBID MONONI ER 60MG $38.00

ISOSORBID MONON ER 120MG $41.00

ISOSORBIDE SL 2.5MG $19.00

ISOSORBIDE SL 5MG $19.00

ISOTRETINOIN 10MG $22.00

ISOTRETINOIN 40MG $26.00

ISRADIPINE 2.5MG $38.00

ISRADIPINE 5MG $38.00

ITRACONAZOLE 100MG $68.00

KETOCONAZOLE 200MG $54.00

KETOPROFEN 75MG $21.00

KETOROLAC 10MG $21.00

L-LYSINE 500MG $21.00

LABETALOL 100MG TAB $19.00

LABETALOL 200MG TAB $21.00

LABETALOL 300MG TAB $22.00

LACTOBACILLUS CAPS $3.00

LACTOBACILLUS TABS $15.00

LAMIVUDN/ZIDOVUDN150/300 $74.00

LAMIVUDINE 150MG $36.00

LAMOTRIGINE 25MG $21.00

LAMOTRIGINE 100MG $21.00

LANSOPRAZOLE 15MG $33.00

LANSOPRAZOLE 30MG $34.00

LATUDA 40MG TAB $66.00

LATUDA 80MG TAB $66.00

LEFLUNOMIDE 10MG $22.00

Page 42: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LETROZOLE 2.5MG $70.00

LEUCOVORIN CA 5MG $66.00

LEVAMISOLE 50MG $53.00

LEVETIRACETAM 250MG TABLET PO $13.00

LEVETIRACETAM 500MG TABLET PO $18.00

LEVODOPA 100MG $15.00

LEVODOPA 250MG $15.00

LEVODOPA 500MG $16.00

LEVOFLOXACIN 250MG $48.00

LEVOFLOXACIN 500MG $56.00

LEVONORGESTREL.75MG $104.00

LEVOTHYROXIN .088MG $21.00

LEVOTHYROXIN .025MG $15.00

LEVOTHYROXIN .05MG $15.00

LEVOTHYROXIN .075MG $19.00

LEVOTHYROXIN .15MG $15.00

LEVOTHYROXIN .112MG $22.00

LEVOTHYROXIN .125MG $21.00

LEVOTHYROXIN .1MG $15.00

LEVOTHYROXIN .2MG $15.00

LEVOTHYROXIN .3MG $15.00

LINEZOLID 600MG TABLET $322.00

LIOTHYRONINE 5MCG $39.00

LIOTHYRONINE 25MCG $17.00

LIPITOR 80MG TAB $23.00

LISINOPRIL 5 MG $22.00

LISINOPRIL 10MG $21.00

LISINOPRIL 20 MG $23.00

LISINOPRIL 40MG $38.00

LITHIUM CARBONATE 150MG $39.00

LITHIUM CARBONATE 300MG $16.00

LITHIUM CARBONATE 450MG $18.00

LITHIUM CARBONATE 600MG $17.00

LOPERAMIDE 2MG $17.00

LOPINAVIR/RITONAVIR CAP 100-25mg $44.00

LOPINAVIR/RITONAVIR 200-50MG TAB $28.00

LORATADINE 10MG $21.00

LORATADINE/PSE 5/120 $6.00

LORAZEPAM .5MG $18.00

LORAZEPAM 1MG $22.00

LOSARTAN 100MG TAB $11.00

LOSARTAN 50MG $39.00

LOSARTAN HCTZ 50/12.5 $38.00

LOSARTAN 25MG $39.00

LOVASTATIN 20MG $30.00

LOXAPINE 5MG $18.00

LOXAPINE 10MG $16.00

Page 43: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LOXAPINE 25MG $17.00

LOXAPINE 50MG $18.00

MAGNESIUM CHLORIDE $21.00

MAGNESIUM OXIDE 400MG $9.00

MAGNESIUM GLUCON 500MG $21.00

MAGNESIUM SUPPLEMENT $40.00

MAPROTILINE 25MG $17.00

MECLIZINE TAB 12.5MG $16.00

MECLIZINE TAB 25MG $18.00

MEDROXYPROGEST 2.5MG $17.00

MEDROXYPROGEST 5MG $21.00

MEDROXYPROGEST 10MG $17.00

MEFLOQUINE 250MG $22.00

MEGESTROL 40MG/ML 10ML UD CUPS $7.00

MEGESTROL 40MG $24.00

MELATONIN 3MG $3.00

MELOXICAM 7.5MG $26.00

MELOXICAM 15MG TAB $2.00

MELPHALAN 2MG $26.00

MEMANTINE 10MG $14.00

MEMANTINE 5MG TAB $19.00

MERCAPTOPURINE 50MG $22.00

MESALAMINE 400MG TAB $21.00

MESALAMINE 250MG CAP $21.00

MESORIDAZINE 10MG $16.00

MESORIDAZINE 25MG $120.00

MESORIDAZINE 50MG $16.00

METAPROTERENOL 10MG $19.00

METAPROTERENOL 20MG $21.00

METFORMIN 500MG $21.00

METFORMIN 850MG $21.00

METHAZOLAMIDE 50MG $39.00

METHENAMINE 1GM $19.00

METHENAMINE HIP $39.00

METHIMAZOLE 5MG $17.00

METHIMAZOLE 10MG $16.00

METHOCARBAMOL 500MG $17.00

METHOCARBAMOL 750MG $17.00

METHOTREXATE 2.5MG $22.00

METHYLCELLULOSE PKT $21.00

METHYLDOPA 250MG $19.00

METHYLDOPA 500MG $21.00

METHYLERGONOVIN .2MG $17.00

METHYLPRED 16MG $19.00

METHYLPRED 4MG $17.00

METHYLPRED DOSEPAK $71.00

METOCLOPRAMIDE 5MG $17.00

Page 44: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

METOCLOPRAMIDE 10MG $24.00

METOLAZONE 10MG $19.00

METOLAZONE 2.5MG $19.00

METOLAZONE 5MG $19.00

METOPROLOL 50MG $19.00

METOPROLOL EXT REL 50 MG $39.00

METOPROLOL EXT REL 100MG $38.00

METOPROLOL 100MG $21.00

METOPROLOL EXT REL 200MG $38.00

METOPROLOL 25MG $2.00

METOPROLOL EXT REL 25 MG $7.00

METRONIDAZOLE 250MG $23.00

METRONIDAZOLE 500MG $27.00

MEXILETINE 150MG $19.00

MEXILETINE 200MG $21.00

MEXILETINE 250MG $21.00

MOXIFLOXACIN 400MG TABS $29.00

MICARDIS 40MG TAB $21.00

MIDODRINE 2.5MG $21.00

MIDODRINE 5MG $21.00

Midodrine 10mg Tab $21.00

MINOCYCLINE CAP 50MG $24.00

MIRTAZAPINE 30MG TAB $2.00

MIRTAZAP 15MG DT $11.00

MIRTAZAPINE 15MG $22.00

MINOXIDIL 2.5MG $6.00

MODAFINIL 100MG $64.00

MINOXIDIL 10MG $22.00

MISOPROSTOL 100MCG $19.00

MISOPROSTOL 200MCG $22.00

MITOTANE 500MG $38.00

MOLINDONE 5MG $16.00

MOLINDONE 10MG $16.00

MOLINDONE 25MG $21.00

MOLINDONE 50MG $19.00

MONTELUKAST 10MG $21.00

MONTELUKAST 5MG $31.00

MULTAQ 400MG TAB $22.00

MULTIVITAMIN THERAPEUTIC $12.00

MULTIVITAMINS-M $12.00

Vit D3 Cholecalciferol $3.00

MULTIVIT/VIT B COMPLEX $21.00

MULTIVIT/VIT B COMPLEX $16.00

MYCOPHENOLATE 250MG $39.00

NABUMETONE 500MG $21.00

NADOLOL 40MG $22.00

NALTREXONE 50MG $35.00

Page 45: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CLOPIDOGREL 300MG PO $68.00

NAPROXEN 250MG $18.00

NAPROXEN 275MG $18.00

NAPROXEN 375MG $18.00

NAPROXEN 500MG $19.00

NATEGLINIDE 60MG $9.00

Nateglinide 120mg tabs $5.00

NEFAZODONE 50MG $21.00

NEFAZODONE 100MG $21.00

NELFINAVIR 250MG $29.00

NEOMYCIN 500MG $16.00

NEOSTIGMINE 15MG $38.00

NEVIRAPINE 200MG $36.00

NIACIN 50MG $15.00

NIACIN 100MG $15.00

NIACIN 500MG $19.00

NIACIN 500MG EXT RL TAB $2.00

NIACIN ER 750MG $3.00

NIACIN ER 250MG $11.00

NICARDIPINE 20MG $19.00

NICARDIPINE 30MG $38.00

NICOTINE RESN 2MG GUM EA $17.00

NICOTINE LOZENGE 4MG $3.00

NICOTINE LOZENGE 2MG $3.00

NIFEDIPINE EXT REL 90MG $31.00

NIFEDIPINE EXT REL 60MG $30.00

NIFEDIPINE EXT REL 30MG $27.00

NIFEDIPINE 10MG $22.00

NIFEDIPINE 20MG $22.00

NIMODIPINE 30MG $49.00

NITROFURANTOIN CAP 25MG $8.00

NITROFURANTOIN CAP 100MG $25.00

NITROFURANTOIN TAB 50MG $23.00

NITROGLYCERIN CAP 2.5MG $16.00

NITROGLYCERIN CAP 6.5MG $17.00

NITROGLYCERIN SL .3MG $13.00

NITROGLYCERIN SL .4MG $13.00

NITROGLYCERIN SL .6MG $13.00

NIZATIDINE 150MG $21.00

NITAZOXANIDE 500MG $73.00

NORETHINDRONE 5MG $21.00

NORFLOXACIN 400MG $30.00

NORTRIPTYLINE 10MG $17.00

NORTRIPTYLINE 25MG $18.00

NORTRIPTYLINE 50MG $21.00

NORTRIPTYLINE 75MG $30.00

NYSTATIN 500000U TAB $19.00

Page 46: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

NYSTATIN PASTIL 200000U $38.00

OMEPRAZOLE 40MG $3.00

OMEPRAZOLE 10MG $3.00

OMEPRAZOLE 20MG $3.00

OFLOXACIN 200MG $57.00

OFLOXACIN 400MG $26.00

OLSALAZINE 250MG $21.00

ONDANSETRON 4MG ODT TABL $105.00

ONDANSETRON 4MG $82.00

ONDANSETRON 8MG $134.00

OLANZAPINE 5MG $43.00

OLANZAPINE 10MG $54.00

OLANZAPINE 2.5MG $37.00

OLANAZAPINE 15MG TAB $2.00

OSELTAMIVIR 75MG $64.00

OSELTAMIVIR 30MG CAP $40.00

OLANZAPINE ZYDIS 5MG $373.00

OLANZAPINE ZYDIS 10MG $73.00

OMEGA 3 FISH OIL 1000MG $3.00

OXAPROZIN 600MG $21.00

OXAZEPAM 10MG $18.00

OXAZEPAM 15MG $18.00

OXAZEPAM 30MG $17.00

OXCARBAZEPINE 150MG $9.00

OXCARBAZEPINE 300MG $16.00

OXYBUTYNIN 5MG $18.00

OXYBUTYNIN EXT REL 5MG $31.00

OXYMORPHONE HCL 10MG TAB $21.00

Pancrelipase 5K, 17K & 27K cap $9.00

PANTOPRAZOLE 40MG $36.00

PANTOPRAZOLE NA DR 40MG $3.00

PAPAVERINE 150MG $15.00

PAPAVERINE 300MG $16.00

PAROMYCIN 250MG $45.00

PAROXETINE 10MG $21.00

PAROXETINE 20MG $23.00

PAROXETINE 30MG $21.00

PAROXETINE 40MG $23.00

PENICILLIN V POT 250MG $19.00

PENICILLIN V POT 500MG $19.00

PENTAZOCINE/NALOXONE $16.00

PENTOXIFYLLINE 400MG $18.00

PERGOLIDE .05MG $21.00

PERGOLIDE .25MG $31.00

PERGOLIDE 1MG $34.00

PERPHENAZINE 2MG $17.00

PERPHENAZINE 4MG $16.00

Page 47: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PERPHENAZINE 8MG $6.00

PERPHENAZNE/AMITRIP 2/10 $16.00

PERPHENAZNE/AMITRIP 2/25 $17.00

PERPHENAZNE/AMITRIP 4/25 $16.00

DESMOPRESSIN 0.1MG PO $4.00

DESMOPRESSIN 0.2 MG TAB $19.00

PERPHENAZINE 16MG $21.00

PHENAZOPYRIDINE 100MG $17.00

PHENAZOPYRIDINE 200MG $16.00

PHENELZINE 15MG $15.00

PHENOL-SODIUM $27.00

PHENOLPHTHALEIN $21.00

Phenoxybenzamine 10mg cap $31.00

PHENYLEPHRN/GUAF 30/600 $16.00

PE/PHENYLP/PHENYLT/CPM $70.00

PHENYTOIN 30MG $21.00

PHENYTOIN 50MG $21.00

PHENYTOIN 100MG $19.00

PHYTONADIONE 5MG $19.00

PIMOZIDE 2MG TAB $19.00

PINDOLOL 5MG $21.00

PINDOLOL 10MG $21.00

PIOGLITAZONE 15MG TAB $2.00

PIOGLITAZONE 30MG TAB $58.00

PIOGLITAZONE 45MG TAB $48.00

PIROXICAM 10MG $25.00

PIROXICAM 20MG $27.00

POTASSIUM CL 20MEQ EXT REL TAB $2.00

POTASSIUM CL 10MEQ $9.00

POTASSIUM PHOSPHATE 500M $19.00

POTASSIUM PHOSPHAT 1.45G $39.00

SOD/POT/PHOS NEUTRAL TAB $39.00

EFFIENT 10MG TAB $30.00

PRAVASTATIN 20MG $21.00

PRAMIPEXOLE .25MG $21.00

PRAMIPEXOLE .125MG $21.00

PRAMIPEXOLE 1MG $21.00

PRAMIPEXOLE .5MG $21.00

PRAZIQUANTEL 600MG $61.00

PRAZOSIN 1MG $19.00

PRAZOSIN 2MG $19.00

PRAZOSIN 5MG $21.00

PRADAXA 75MG CAP $18.00

PRADAXA 150MG CAP $18.00

PREDNISONE 1MG $15.00

PREDNISONE 2.5MG $15.00

PREDNISONE 5MG $9.00

Page 48: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PREDNISONE 10MG $9.00

PREDNISONE 20MG $9.00

PREGABALIN 25MG CAP $22.00

PREGABALIN 100MG CAP $22.00

PREZISTA 400MG TABLET $64.00

PRIMAQUINE PHOS 26MG $22.00

PRIMIDONE 50MG $17.00

PRIMIDONE 250MG $15.00

PROBENECID 500MG $17.00

PROBENECID/COLCHICINE $21.00

Cycloserine 250mg caps $29.00

PROCAINAMIDE 250MG SR $19.00

PROCAINAMIDE 500MG SR $19.00

PROCAINAMIDE 750MG SR $21.00

PROCAINAMIDE CAP 250MG $19.00

PROCAINAMIDE CAP 375MG $19.00

PROCAINAMIDE CAP 500MG $19.00

PROCAINAMIDE Q12H 500MG $33.00

PROCAINAMIDE Q12H 1GM $38.00

PROCARBAZINE 50MG $38.00

PROCHLORPERAZINE 5MG $18.00

PROCHLORPERAZINE 10MG $18.00

ULORIC 40MG TAB $28.00

PROGESTERONE MICRO 100MG $9.00

PROMETHAZINE 12.5MG TAB $14.00

PROMETHAZINE 25MG PO $5.00

PROMETHAZINE 50MG $6.00

PROPAFENONE 150MG $39.00

PROPANTHELINE 15MG $15.00

PROPOXYPHENE 65MG $17.00

PROPOXYPHENE/APAP 65/650 $17.00

PROPOXYPHENE 100MG $21.00

PROPRANOLOL 10MG $19.00

PROPRANOLOL 20MG $19.00

PROPRANOLOL 40MG $21.00

PROPRANOLOL 80MG $21.00

PROPRANOLOL LA 60MG $22.00

PROPRANOLOL LA 80MG $21.00

PROPRANOLOL LA 120MG $22.00

PROPYLTHIOURACIL 50MG $8.00

PROTRIPTYLINE 10MG $16.00

PSEUDOEPHED 30MG $12.00

PSEUDOEPHED 60MG $15.00

PYRAZINAMIDE 500MG $22.00

PYRIDOSTIGMINE 60MG $17.00

PYRIDOSTIGMINE 180MG $21.00

PYRIDOXINE 25MG $16.00

Page 49: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PYRIDOXINE 50MG $17.00

PYRIDOXINE 100MG $17.00

PYRIMETHAMINE 25MG $31.00

QUETRAPINE 50MG TAB $2.00

QUETIAPINE 25MG $21.00

QUETIAPINE 100MG $22.00

QUETIAPINE 200MG $37.00

QUETIAPINE 300MG TAB $3.00

QUETIAPINE 400MG TAB $3.00

QUINAPRIL 5MG $39.00

QUINAPRIL 10MG $39.00

QUINAPRIL 20MG $38.00

QUINIDINE ORAL SUSP 10MG/ML $2.00

QUINIDINE 200MG $19.00

QUINIDINE 300MG $19.00

QUINIDINE GLUCONATE $21.00

QUININE 200MG $15.00

QUININE 260MG $21.00

QUININE 324MG $16.00

RALOXIFENE 60 MG $21.00

RAMIPRIL 2.5MG $21.00

RAMIPRIL 5MG $21.00

RAMIPRIL 10MG $21.00

RANITIDINE 150MG $22.00

RANITIDINE 300MG $19.00

RANITIDINE 150MG EFFGRAN $22.00

REPAGLINIDE 0.5MG $21.00

REPAGLINIDE 1MG $21.00

REPAGLINIDE 2MG $21.00

RESERPINE .25MG $19.00

RIBOFLAVIN 25MG $3.00

RIFABUTIN 150MG $61.00

RISPERIDONE .5MG M TAB $31.00

RIFAMPIN 150MG $22.00

RIFAMPIN 300MG $35.00

RIFAXIMIN 200MG $99.00

RILUZOLE 50MG $95.00

RISEDRONATE NA 35MG $120.00

RISEDRONATE NA 5MG $20.00

RIMANTADINE 100MG $21.00

RISPERIDONE 1MG $23.00

RISPERIDONE 2MG $29.00

RISPERIDONE 3MG $31.00

RISEDRONATE NA 30MG $67.00

RIZATRIPTAN 10MG MLT $129.00

ROSIGLITAZONE 4MG $23.00

ROSIGLITAZONE 2MG TAB $12.00

Page 50: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

RIVASTIGMINE 1.5MG $21.00

RITONAVIR 100 MG $39.00

ROPINIROLE 0.25MG $21.00

ROPINIROLE 0.5MG $12.00

ROPINIROLE 1MG TAB $2.00

ROPINIROLE 4MG $20.00

SALSALATE 500MG $18.00

SALSALATE 750MG $17.00

SAQUINAVIR 200MG $42.00

SAQUINAVIR 200MG $38.00

ROSUVASTATIN CA 10MG $21.00

SELEGILINE 5MG $30.00

SENNA TABLETS $12.00

SERTRALINE 25MG $23.00

SERTRALINE 50MG $24.00

SERTRALINE 100MG $28.00

SEVELAMER 403MG CAP $21.00

SEVELAMER 400MG TAB $6.00

SEVELAMER 800MG $15.00

SILDENAFIL 100MG+ $81.00

SILDENAFIL 25MG+ $75.00

SILDENAFIL 20MG $86.00

SIMETHICONE 80MG $12.00

SIMVASTATIN 5MG $21.00

SIMVASTATIN 10MG $21.00

SIMVASTATIN 20MG $35.00

SIROLIMUS 1MG TAB $64.00

SODIUM BICARBONATE 650MG $6.00

SODIUM CL 1GM $9.00

SODIUM FLU/CA CARB $21.00

SOTALOL 80MG $22.00

SPIRONOLAC-HCTZ 25MG $21.00

SPIRONOLACTONE 25MG $19.00

SPIRONOLACTONE 50MG $23.00

STAVUDINE 30MG $40.00

STAVUDINE 40MG $39.00

STAVUDINE 20MG $35.00

STAVUDINE 15MG $34.00

STRIBLID 150/150/200/300MG TAB $284.00

IVERMECTIN 3MG TABLET $17.00

SUCRALFATE 1GM $18.00

SULFADIAZINE 500MG $12.00

SULFAMET/TRIMETH 800/160 $19.00

SULFASALAZINE 500MG $3.00

SULFASALIZINE 500MG EC $19.00

SULFISOXAZOLE 500MG $19.00

SITAGLIPT 100MG $25.00

Page 51: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

SITAGLIPT 25MG $25.00

SITAGLIPT 50MG $24.00

SULINDAC 150MG $18.00

SULINDAC 200MG $19.00

SUMATRIPTAN 25MG $108.00

SUMATRIPTAN 50MG $101.00

TACRINE 10MG $21.00

TACRINE 20MG $21.00

TACRINE 40MG $21.00

TACROLIMUS ORAL PER 1MG $27.00

TACROLIMUS .5MG $18.00

TAMOXIFEN 10MG $40.00

TAMSULOSIN .4MG $21.00

TEGASEROD 6MG $20.00

TELMISARTAN 20MG $13.00

TELMISARTAN 40MG $13.00

Temazepam 30mg Cap $4.00

TEMAZEPAM 15MG $18.00

TEMAZEPAM 7.5MG $13.00

TEMOZOLOMIDE 5MG $24.00

TENOFOVIR 300MG $53.00

TERAZOSIN 1MG $19.00

TERAZOSIN 2MG $19.00

TERAZOSIN 5MG $24.00

TERBINAFINE 250MG $72.00

TERBUTALINE 2.5MG $19.00

TERBUTALINE 5MG $19.00

TETRACYCLINE 250MG $19.00

TETRACYCLINE 500MG $19.00

THEOPHYLL SA 200MG $19.00

THEOPHYLL SA 100MG $39.00

THEOPHYLL SA 200MG $19.00

THEOPHYLL SA 300MG $19.00

THEOPHYLL SR 75MG $19.00

THEOPHYLLINE SUSR 600MG $38.00

THEOPHYL TR 24H 400MG $21.00

THIAMINE 50MG $15.00

THIETHYLPERAZINE 10MG $16.00

THIOGUANINE 40MG $21.00

THIORIDAZINE 10MG $15.00

THIORIDAZINE 25MG $17.00

THIORIDAZINE 50MG $16.00

THIORIDAZINE 100MG $17.00

THIORIDAZINE 150MG $21.00

THIORIDAZINE 200MG $16.00

THIOTHIXENE 1MG $15.00

THIOTHIXENE 2MG $17.00

Page 52: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

THIOTHIXEME 5MG $17.00

THIOTHIXENE 10MG $16.00

THIOTHIXENE 20MG CAP $17.00

TIAGABINE 4 MG $16.00

THYROID 30MG $15.00

THYROID 60MG $15.00

THYROID 120MG $15.00

THYROID 180MG $38.00

TICLOPIDINE 250MG $21.00

TIZANIDINE 2MG TAB $21.00

TIZANIDINE 4MG TAB $21.00

TOCAINIDE HCL 400MG $21.00

TOLAZAMIDE 100MG $15.00

TOLAZAMIDE 250MG $16.00

TOLAZAMIDE 500MG $17.00

TOLBUTAMIDE 500MG $16.00

TOLTERODINE LA 2MG $24.00

TOLTERODINE LA 4MG $28.00

TOLMETIN 400MG $16.00

TOLTERODINE 2MG $21.00

TOPAMAX 50MG TAB $2.00

TOPIRAMATE 25MG $39.00

TOPIRAMATE 100MG $49.00

TORSEMIDE 10MG $39.00

TORSEMIDE 100MG $44.00

TOLVAPTAN 15MG TAB $1,252.00

TRANYLCYPROMINE 10MG $17.00

TRAMADOL 50MG $21.00

TRAZODONE 50MG $18.00

TRAZODONE 100MG $6.00

TRIAMCIN 4MG $19.00

TRIAMTERENE 50MG $19.00

Triamterene-HCTZ 25-37.5mg Cap $3.00

TRIAMTREN-HCTZ 37.5/25MG $22.00

TRIAMTERENE-HCTZ 75/50MG $21.00

TRIAMTERENE/HCTZ 50/25 $19.00

TRIAZOLAM .125MG $18.00

TRIAZOLAM .25MG $17.00

TRIFLUOPERAZINE 1MG $16.00

TRIFLUOPERAZINE 2MG $17.00

TRIFLUOPERAZINE 5MG $17.00

TRIFLUOPERAZINE 10MG $16.00

TRIHEXPHENIDYL 2MG $5.00

TRIHEXYPHEN 2MG $17.00

TRIHEXYPHEN 5MG $17.00

TRIMETHOBENZAMIDE 100MG $16.00

TRIMETHOBENZAMIDE 250MG $16.00

Page 53: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TRIMETHOBENZAMIDE 300MG $8.00

TRIMIPRAMINE 25MG $17.00

TRIPROLIDINE-PS $11.00

TYROSINE 500MG $16.00

URSODIOL 250MG $17.00

URSODIOL 300MG $21.00

VALACYCLOVIR 500MG $44.00

VALACYCLOVIR 1GM $55.00

VALPROIC SPRINKLE 125MG $17.00

VALPROATE 250MG $17.00

VALGANCICLOVIR 450MG $201.00

VALSARTAN 80MG $21.00

VALSARTAN 320MG TABLETS $20.00

VANCOMYCIN 125MG $60.00

VANCOMYCIN 250MG $102.00

VENLAFAXINE XR 150MG $32.00

VENLAFAXINE XR 75MG $42.00

VENLAFAXINE 25MG $21.00

VENLAFAXINE XR 37.5MG $21.00

VENLAFAXINE 50MG $21.00

VENLAFAXINE 75MG $21.00

VENLAFAXINE 100MG $21.00

Venlafaxine 37.5 tab $3.00

VERAPAMIL 40MG $39.00

VERAPAMIL 80MG $27.00

VERAPAMIL 120MG $21.00

VERAPAMIL SUST REL 240MG $23.00

VERAPAMIL SR 180MG $23.00

VERAPAMIL SR 120MG $39.00

VIMPAT (lacosamide) 50MG TAB $19.00

VITAMIN A 25MU $15.00

VITAMIN B & C COMPLEX $21.00

VITAMIN B COMPLX $15.00

VITAMIN B&C COMP W/IRON $21.00

VITAMIN B-12 500MCG $17.00

VITAMIN COMBO PLUS C $3.00

VITAMIN D 50MU $15.00

VITAMIN D 400U $8.00

VITAMIN E 200IU $21.00

VITAMIN E 400IU $6.00

VITAMIN E 1000IU $21.00

VITAMIN PRENATAL $175.00

VITAMIN RENAL FORMULA $19.00

WARFARIN 2.5MG $19.00

WARFARIN 1 MG $39.00

WARFARIN 3 MG $39.00

WARFARIN 2MG $19.00

Page 54: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

WARFARIN 4MG TAB $3.00

WARFARIN 5MG $19.00

WARFARIN 6 MG $39.00

WARFARIN 7.5MG $19.00

WARFARIN 10MG $19.00

YOHIMBINE HCL 5.4MG $21.00

ZAFIRLUKAST 20MG $21.00

ZALCITABINE .375MG $39.00

ZALCITABINE .75MG $43.00

ZALEPLON 5MG $20.00

ZIDOVUDINE 100MG $31.00

ZINC SULFATE 220MG $9.00

ZINC LOZENGES $16.00

ZOLMITRIPTAN 2.5MG $87.00

ZOLMITRIPTAN 5MG $96.00

ZOLPIDEM 5MG $24.00

ZIPRASIDONE 20MG $45.00

ZIPRASIDONE 40MG $45.00

ZIPRASIDONE 60MG $45.00

ZONISAMIDE 100MG $13.00

ZIPRASIDONE 80MG $45.00

ZOLMITRIPTAN ODT 2.5MG $85.00

ZOLMITRIPTAN ODT 5MG $94.00

Acidophilus/Bulgaricus 100mm Cell $3.00

ACETAMIN 160MG/5ML 120ML $38.00

ACETAMN 500MG/15ML 240ML $17.00

ACETAMN 325MG/10ML - UD $3.00

ACTIV CHAR 50G/240ML SRB $55.00

ACTIV CHAR 50GM/240ML PLAIN $92.00

ALBUTEROL 0-5ML $58.00

AL MG SALTS 360ML $67.00

ALUM/MAG/SIM 200/200/20 30ML $4.00

ALUM/MAG/SIM DS 400/400/40 30ML $5.00

ALUM MG HYDROX 150ML $8.00

MAG/AL HYD/SIM DS 360ML $11.00

ALUM MG HYDROX II 150ML $8.00

ALUMINUM CARBONATE 360ML $12.00

ALUMINUM HYDROXIDE 360ML $12.00

AMANTADINE SYRP 10MG/ML $20.00

AMOXICILLIN 125/5 100ML $15.00

AMOXICILLIN 200MG/5ML 50ML SUSP $5.00

AMOXICILLIN 250/5 100ML $17.00

AMOXICILLIN 250/5 150ML $48.00

AMPICILLIN 125/5 100ML $14.00

AMPICILLIN 250/5 100ML $15.00

ATOVAQUONE 750/5 5ML $74.00

ATTAPULGITE 600/15 5ML $43.00

Page 55: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

AZITHROMYCIN 200/5 30ML $49.00

PRO-STAT 64 LIQUID 15GM-30ML $4.00

FIBER-STAT LAXATION LIQUID 5.5GM/15ML $4.00

BENEFIBER 4GM PKT $5.00

BISMUTH SUBSALICYL 240ML $16.00

BISMUTH SUBSALICYL 120ML $9.00

BOWEL EVACUANT 4000ML $156.00

BROMPHENIRAMINE 0-10ML $17.00

BROMPHENIRAMINE 4OZ $16.00

CALCIUM CARBONATE PER 5 ML $16.00

CARBAMAZEPINE 100MG/5ML $82.00

CASCARA 5ML $76.00

CASTOR OIL 60ML $21.00

CEFACLOR 250MG/5ML 75ML $59.00

CEPHALEXIN 125MG/5 100ML $19.00

CEPHALEXIN 250MG/5 100ML $24.00

CHLORAL HYDRAT 500MG/5ML $18.00

CHLORPROMAZINE 30MG/ML $64.00

CHLORPROM CON 100M/M 1ML $76.00

CHLORPROMAZINE 10MG/5ML $76.00

CHOLESTYRAMINE 4G $23.00

CHOLESTYRAMINE LIGHT $26.00

CIMETIDINE 300MG/5ML $19.00

CITRATE MAGNESIUM 300ML $40.00

SULFAMETH/TRIM SUSP 20ML $19.00

DEXAMETHASONE .5/5 30ML $48.00

DICLOXACIL 125/5 80ML $16.00

DIGOXIN .05MG/ML 5ML $14.00

DIGOXIN .05MG/ML 2.5ML $22.00

DIPHENHYDRA 12.5MG/5ML $21.00

DIPHENHYDRAMINE 4OZ $16.00

DIPHENOXYLATE/ATRP 5ML $9.00

DOCUSATE 100MG/10ML UD $18.00

DONNATAL 5ML $43.00

DOXEPIN 10MG/ML 5ML $155.00

DOXYCYCLINE 25MG/5ML 60M $19.00

ERYTHROMY ES 200/5 100ML $16.00

ERYTHROMY ES 400/5 100ML $17.00

FERROUS SULF DROPS 50 ML $11.00

FERROUS SULF 220MG/5ML $15.00

FLUOXETINE20MG/5ML $9.00

FLUPHENAZINE 2.5/5 60ML $14.00

FLUPHENAZINE CONC 5MG/ML $28.00

FUROSEMIDE 10MG/ML 60ML $17.00

FUROSEMIDE 40MG/5ML UD $39.00

GUAIFEN 100MG/5ML 15ML $6.00

GUAIFEN 100MG/5ML 10ML $18.00

Page 56: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

GUAIFENESIN 120ML $5.00

GUAIFENESIN 100MG/5ML $17.00

GUAIFENESIN/CODEINE 4OZ $11.00

GUAIFENESIN/CODEINE 5ML $21.00

GUAIFENESIN/CODEINE 10ML $21.00

GUAIFENESIN DM 120ML $11.00

GUAIFENESIN DM 5ML $17.00

GUAIFENESIN DM 10ML $21.00

HALOPERIDOL 2MG/ML 120ML ORAL SOL $42.00

HALOPERIDOL 2MG/ML 15ML ORAL SOL $111.00

HYDROXYZINE 25MG/5ML $43.00

IBUPROFEN 100MG/5ML $33.00

IODINE/POT IODIDE $8.00

IPECAC 30ML $19.00

ITRACONAZOLE 10M/M 150ML $695.00

KAOLIN-PECTIN 30ML $16.00

KONDREMUL 480ML $15.00

LACTULOSE 15ML $33.00

LACTULOSE UD 30ML $25.00

LAMIVUDINE 10MG/ML $323.00

LAMIVUDINE ORAL 5MG/ML $3.00

LAXATIVE OTC 0-30ML $17.00

LITHIUM CITRATE 5ML $16.00

LANSOPRAZOLE 30MG PKT $36.00

LOPINAVIR/RITONAVIR 5ML $1,573.00

LIDOCAINE VISC 20ML $10.00

LIDOCAINE VISC 100ML $14.00

LOPERAMIDE 10ML $21.00

LOPERAMIDE 30ML $39.00

LOXAPINE 25MG/ML 30ML $115.00

MAGALDRATE 12OZ $49.00

MAGALDRATE-SIME 120Z $10.00

MEGESTROL 40MG/ML 240ML $46.00

MESORIDAZINE 25MG/ML 5ML $45.00

METAPROTERENOL 60ML $13.00

METOCLOPRAM 10ML $19.00

METOCLOPRAM 5MG/5ML $76.00

MINERAL OIL 10 ML $118.00

MINERAL OIL 30ML $12.00

MOM 30ML $16.00

MOM CASCARA 30ML $11.00

MUTIVITAMIN LIQ 5ML $17.00

NYSTATIN SUSP 5ML $2.00

OMEPRAZOLE SOLN CMPD $107.00

Ofloxacin 0.3% ear gtts $9.00

NEOM/POLY/HC-OTIC GTTS $53.00

AKTEN (LIDOCAINE EYE GTTS) 3.5% 5ML $71.00

Page 57: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

P&S (BAKERS) LIQ 120ML $13.00

PAREGORIC 5ML $12.00

PENICLLN VK 250/5 100ML $14.00

PERPHENAZINE 16MG/5ML $29.00

PHENOL/NA PHENOLATE SPRY $12.00

PHENYTOIN 300MG/12ML UD $26.00

PHENYTOIN 100MG/4ML $22.00

POLYETHYLENE GLYCOL 17GM $17.00

POLYSTYRENE 60ML $72.00

POTASS CIT CITRIC AC30ML $77.00

POTASSIUM CL 20MEQ PKT $39.00

POTASSIUM CL ELIX 20MEQ $19.00

POTASSIUM CL ELIX 40MEQ $19.00

POTASSIUM IODIDE 30ML $53.00

PREDNISONE 5MG/ML 30ML $70.00

PREDNISOLONE 15MG/5ML $132.00

PROCHLORPERAZN 10MG/10ML $69.00

PROMETHAZINE/COD 5ML $6.00

PROMETHAZIN/COD 4OZ $15.00

PROMETHAZINE 6.25/5 60ML $3.00

PROMETHAZINE/DM 4OZ $16.00

PSEUDOEPH/CHLORPH 5ML $17.00

PSEUDOEPH/CHLORPH 60ML $16.00

PSYLLIUM $19.00

PSYLLIUM 7GM $16.00

RISPERIDONE 1MG/ML 30ML $95.00

RISPERIDONE M ODT 0.5MG $20.00

RISPERIDONE M ODT 1MG $23.00

SALIVA SUBST 120ML $18.00

RISPERIDONE M ODT 2MG $38.00

RISPERIDONE M ODT 3MG $46.00

RISPERIDONE M ODT 4MG $62.00

SENNA CONC GRANULES 60G $11.00

SIMETHICONE 30ML $16.00

SOD CITRATE/CITR AC 30ML $65.00

SODIUM PHOSPH 90ML $52.00

SORBITOL 60ML $8.00

SUCRALFATE 1G/10ML SUSP $18.00

PROTONIX 40MG SUSP $22.00

TETRACYCLINE 125MG/5ML $69.00

THEOPHYLLINE 80/15 480ML $14.00

THEOPHYLLINE 80/15 30ML $19.00

EPI SOL 1% 30ML NASAL SP $80.00

THIORIDAZIN CON 100MG/ML $35.00

THIORIDAZINE 30MG/ML 4OZ $11.00

THIOTHIXENE 5MG/ML 30ML $18.00

TRANEXAMIC ACID 100MG/ML 10ML VIAL $398.00

Page 58: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TRIAMINIC EXPECT $22.00

TRIFLUOPERAZINE 10MG/ML $38.00

TRIHEXYPHENIDYL 30ML $9.00

TRIPROLIDINE/PSE 30ML $8.00

VALPROATE 250MG/5ML $17.00

VINCE ORAL RINSE $9.00

VITAMIN A 5MU/.1ML $56.00

VITAMIN C LIQUID PER 5ML $17.00

VITAMIN D DROPS $29.00

VITAMIN E 30ML $25.00

ZIDOVUDINE 10MG/ML 5ML $88.00

ACETAZOLAMIDE 500MG $200.00

ABCIXIMAB 10MG $3,719.00

ACYCLOVIR 500MG INJ $722.00

ACYCLOVIR PER 5MG IJ $8.00

ACETYLCYSTEINE PER 100MG $26.00

Lexiscan (regadenson) injection 0.1mg $1,012.00

ADENOSINE 6MG THERAPEUTC $254.00

ALBUMIN 5% 50ML $629.00

ALBUMIN 5% 250ML $226.00

ALBUMIN 25% 50ML $657.00

ALBUMIN-25% 25GM/100ML INJ $289.00

ALDESLEUKIN 22MU VIAL $4,017.00

ALCOHOL DEHYDRAT 1ML $150.00

ALCOHOL DEHYD 98% AMP $117.00

ALLOPURINOL 500MG INJ $2,456.00

ALPROSTADIL 500MCG/1ML $2,344.00

METHOTREXATE 5MG INJ $330.00

CATHFLO ACTIVASE/ALTEPLASE 2MG VIAL $379.00

ALTEPLASE PER 1MG $182.00

AMIKACIN PER 100MG $37.00

AMIFOSTINE 500MG $2,017.00

AMINOCAPROIC ACID 5GM $119.00

AMINOPHYLLINE 25M/M 10ML $217.00

AMIODARONE PER 30MG $102.00

AMMON CHLORI 100MEQ/20ML $146.00

AMPHOTER B LIP COMP 10MG $34.00

AMPHOTERICIN B 50MG $333.00

AMPHOTER B LIPOSOM 10MG $244.00

AMPICILLIN 500MG $136.00

AMPICILLIN 1GM $136.00

AMPICILLIN 2GM $231.00

AMPICILLIN 125MG $214.00

AMPICILLIN 250MG $214.00

AMPICILLIN/SULB 1.5GM $257.00

AMPICILLIN/SULB 3GM $282.00

ANTI-INHB CG CMPL EA IU $7.00

Page 59: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

AMRINONE 5MG/ML 20ML $480.00

APROTININ PER 10000KIU $579.00

ARGATROBAN 1MG INJ (FOR NON ESRD USE) $41.00

ARGATROBAN 1MG INJ (FOR ESRD ON DIAL) $41.00

ARIPIPRAZ PER 0.25MG $3.00

ASPARAGINASE 10000U/10ML $373.00

ARSENIC TRIOXIDE 1MG/1ML $444.00

ATENOLOL 5MG/10ML $67.00

ATRACURIUM 10MG/ML 5ML $250.00

ATROPINE .4MG/ML 1ML $133.00

ATROPINE 1MG/ML 1ML $66.00

ATROPINE 1MG/10ML PFS $232.00

AZITHROMYCIN 500MG INJ $289.00

AZATHIOPRINE 100MG/20ML $332.00

AZTREONAM 1GM $250.00

AZTREONAM 2GM $380.00

BACITRACIN 50000U $246.00

BACLOFEN IT SCREEN KIT $4,506.00

BOTULINUM TOX.TYPE A PE+ $26.00

BENZTROPINE 2MG/2ML $150.00

BETAMETHASONE 6MG/ML 5ML $189.00

BETAMETHASONE 3MG/ML 5ML $286.00

BETHANECHOL 5MG/ML $171.00

BEVACIZUMAB PER 10MG $342.00

BIVALIRUDIN PER 1MG $3,750.00

BLEOMYCIN 15 UNITS $1,429.00

BORTEZOMIB PER 0.1MG $208.00

BRETYLIUM 500MG/10ML $333.00

BUMETANIDE 2.5MG/10ML $265.00

BUMETANIDE .5MG/2ML $224.00

BUPIVACAINE .25% 30ML $147.00

BUPIVACAINE .25% 50ML $123.00

BUPIVACAINE .5% 50ML $150.00

BUPIVACAINE .5% 30ML $152.00

BUPIVACAINE .75% 30ML $152.00

BUPIVACAINE/EPI .25%50ML $124.00

BUPIVACAINE/EPI .25%30ML $213.00

BUPIVACAINE/EPI .5% 50ML $204.00

BUPIVACAINE/EPI.5% 30ML $155.00

BUPIVACAINE/EPI .75%30ML $152.00

BUPIVACAINE/DEX .75% 2ML $38.00

BUPRENORPHINE .3MG INJ $29.00

CALCITONIN 400IU/2ML $2,328.12

CALCITRIOL 2MCG/1ML $232.00

CALCIUM CHLOR 10%10MLSYR $59.00

CALCIUM CHLOR 10% 10ML $134.00

CALCIUM GLUC 10% 10ML $59.00

Page 60: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CANDIDA SKIN TEST $82.00

CARBOPROST 250MCG/1ML $506.00

CARBOPLATIN 50MG $586.00

CARDIOPLEGIC SOLN 1000ML $1,544.00

CARMUSTINE 100MG $3,820.75

VORICONAZOLE 10MG INJ $244.00

CASPOFUNGIN PER 5MG $151.00

CEFAZOLIN 500MG $220.00

CEFAZOLIN 1G PMX $590.00

CEFAZOLIN 500MG $17.00

CEFAZOLIN 2GM/PMX $281.00

CEFEPIME 1GM/PMX $123.00

Cefepime 2 gram vial $28.00

CEFOPERAZONE 2GM $382.00

CEFOTAXIME 1GM PMX $603.00

CEFOTAXIME 2GM PMX $654.00

CEFOTAXIME 2GM $335.00

CEFOTETAN 1GM $202.00

CEFOTETAN 2GM $278.00

CEFOTETAN 1GM PMX $492.00

CEFOXITIN 1GM $262.00

CEFOXITIN 1GM PMX $257.00

CEFOXITIN 2GM $307.00

CEFTAZIDIME 1GM $319.00

CEFTAZIDIME 2GM $432.00

CEFTAZIDIME 1GM PMX $627.00

CEFTAZIDIME 2GM PMX $423.00

CEFTIZOXIME 2GM $146.00

CEFTRIAXONE 250MG $261.00

CEFTRIAXONE 1GM/PMX $365.00

CEFTRIAXONE 2GM/PMX $489.00

CEFUROXIME 750MG $261.00

CEFUROXIME 750MG PMX $256.00

CEFUROXIME 1.5GM PMX $619.00

CEFUROXIME 1.5GM $310.00

CHLORAMPHENICHOL 1GM $241.00

CETUXIMAB PER 10MG $233.00

CHLORDIAZEPOXIDE 100MG $123.00

CHLOROPROCAINE 2% 30ML $141.00

CHLOROPROCAINE 3% 30ML $151.00

CHLOROTHIAZIDE 500MG $1,001.00

CHLORPROMAZINE 25MG/ML $133.00

CHLORPROMAZINE 50MG/2ML $137.00

CHORIONIC GONAD 5MU/10ML $199.00

CHORIONIC GONAD20MU/10ML $2,283.00

CIDOFOVIR 75MG/ML 5ML $3,508.00

CIMETIDINE 150MG/ML 2ML $143.00

Page 61: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CIPROFLOXACIN 200MG INJ $291.00

CIPROFLOXACIN 400MG INJ $325.00

CIPROFLOXACIN 200MG PMX $264.00

CISATRACURIUM 2MG/ML 10M $257.00

CISPLATIN PER 10MG $1,032.00

CLADRIBINE PER 1MG $379.00

CLINDAMYCIN 300MG/D5W 50ML $107.00

CLINDAMYCIN 600MG PMX $629.00

CLINDAMYCIN 900MG PMX $666.00

CLINDAMYCIN 900MG/6ML $355.00

CLONIDINE PER 1MG $353.00

COCCI SKN TST 1:100 .1ML $109.00

COSYNTROPIN .25MG/ML $243.00

SULFAMETHOX/TRIMETH 10ML $380.00

Cyanide Antidote Pack Tray $1,299.00

CYANOCOBALAMIN 1000MCG $122.00

CYCLOSPORINE 250MG/5ML $309.00

CYTARABINE 100MG $233.00

DACARBAZINE 100MG $83.00

DACTINOMYCIN .5MG $2,196.00

DALTEPARIN 5000IU $193.00

DANTROLENE 20MG/70ML $441.00

DANAPAROID 750U/.6ML AMP $754.00

DAPTOMYCIN PER 1MG $8.00

DARBEPOETIN ALFA PER1MCG $23.00

DARBEPOETIN ESRD PER MCG $23.00

DAUNORUBICIN PER 10MG $241.00

DAUNORUBICN LIPO PER10MG $563.00

DEFEROXAMINE 500MG $153.00

DESMOPRESSIN PER 1MCG $15.20

DEXAMETHASONE 4MG/ML 5ML $18.00

DEXAMETHASONE 4MG/ML 1ML $9.00

DEXAMETHASONE 10MG/ML1ML $21.00

DEXAMETH LA 8MG/ML 5ML $325.00

DEXMEDETOMIDINE 200MCG $402.00

DEXTRAN 1 150MG/ML 20ML $174.00

DEXTRAN 70 IN DEXTROSE $263.00

DEXTROSE 50% 50ML $99.00

DIAZEPAM 10MG/2ML AMP $148.00

DIAZOXIDE 300MG $363.00

DICYCLOMINE 10MG/ML 2ML $150.00

DIETHYLSTILBESTROL 250MG $185.00

ESOMEPRAZOLE 20MG INJ $118.00

SALINE FLUSH 10ML PFS $3.00

ESMOLOL PER 5MG DOSE $3.00

Admin Influenza Virus Vaccine $200.00

Admin Pneumococcal Vaccine $200.00

Page 62: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

STADOL 2MG/1ML VIAL $12.00

DIGOXIN .5MG/2ML $222.00

DIGOXIN IMMUNE FAB 40MG $8,875.00

DIHYDROERGOTAMI 1MG/ML $173.00

DORIPENEM 500MG VIAL $358.00

Doripenem 250mg vial $39.00

DILTIAZEM 25 MG INJ $267.00

DILTIAZEM 50 MG INJ $284.00

DILTIAZEM 125MG INJ $34.00

Dimercaprol 3ml ampule $315.00

DIMENHYDRINATE SYG 50MG $133.00

DIPHENHYDRA 50MG/ML $136.00

TDap 0.5ml Vial (Adacel) $121.00

DTap 0.5ml vial (Infanrix) $78.00

DTAP VACCINE <7YRS IM $115.00

DIPTHT/PERTUSSIS (ACELL) TETANUS VACCINE $115.00

DIPYRIDAMOLE 10MG/2ML $1,274.00

DOBUTAMINE 250MG/20ML $22.00

DOBUTAMINE PMX 250MG/250 $884.00

DOBUTAMINE PMX 500MG/250 $1,220.00

DOCETAXEL 20MG $2,114.00

DOLASETRON 12.5MG/.625ML $29.00

DOLASETRON PER 10MG $104.00

DOPAMINE 400MG VIAL 5ML $237.00

DOPAMINE 400MG PMX 250ML $373.00

DOXACURIUM 1MG/ML $293.00

DOXORUBICIN PER 10MG $493.00

DOXYCYCLINE 100MG INJ $29.00

DROPERIDOL 5MG/2ML $132.00

RETEPLASE 10U/18.1MG $4,834.00

DROTRECOGIN ALFA 5MG $1,017.00

CALC DISOD EDETATE 1GM $5,594.42

EDROPHONIUM 10MG/ML 10ML $154.00

TEFLARO 400MG/20ML $233.00

ENALAPRIL 1.25MG/1ML $273.00

ENALAPRIL 1.25MG/ML 2ML $338.00

ENOXAPARIN 30MG AMP $371.00

ENOXAPARIN 100MG SYR $470.00

ENOXAPARIN 60MG SYR $386.00

ENOXAPARIN 40 MG SYR $288.00

ENOXAPARIN 80MG SYR $409.00

EPHEDRINE 50MG/ML $166.00

ENOXAPARIN 120MG SYR $312.00

EPIRUBICIN PER 2MG $170.00

EPINEPHRINE 1:1000 1ML $136.00

EPINEPHRINE 1:1000 30ML $154.00

EPOETIN NON-ESRD 1000U $801.00

Page 63: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

EPOETIN ESRD 1000U $801.00

EPINEPHRINE SYR 1MG/10ML $232.00

EPTIFIB PER 5MG 10ML/VL $89.00

EPTIFI PER 5MG 100ML/VL $89.00

EPOPROSTENOL .5MG $252.00

EPOPROSTENOL DILUENT $340.00

ERTAPENEM 500MG $166.00

ERYTHROMY LA 500MG $247.00

ERYTHROMY LA 1GM $332.00

ESOMEPRAZOLE 40MG INJ $183.00

ESMOLOL 10MG/ML 10ML $380.00

ESMOLOL 250MG/ML 10ML $535.00

ETHACRYNATE NA 50MG $263.00

ETHANOLAMINE 5% 2ML $1,361.00

ETIDRONATE 50MG/ML 6ML $530.00

ETOMIDATE 20MG/10ML AMP $182.00

ETOPOSIDE PER 10MG $87.00

FACTOR 9 COMPL PER 100IU $1,029.00

FACTOR 8 RECOMB PER100IU $262.00

FAMOTIDINE 10MG/ML 2ML $174.00

FENOLDOPAM 10MG/ML 1ML $307.00

FLUARIX QUADRIVALENT 0.5 $56.00

FLUCONAZOLE 100MG PMX $118.00

FLOXURIDINE 500MG/5ML $431.00

FLU RIV4 VACC RECOMBINANT DNA IM $58.00

FLU SPL VACC >3YRS $169.00

FLULAVAL VACCINE > 3YRS $55.00

FLUZONE QUADRIVALENT 0.5ML $58.00

FLUVIRIN 0.5ML SYRINGE $43.00

FLUZONE HD SYR 0.5 $116.00

FLUCONAZOLE 200MG PMX $457.00

FLUCONAZOLE 400MG PMX $668.00

FLUDARABINE PHOS 50MG $1,785.00

FLUMAZENIL 5ML $287.00

FLUMAZENIL 10ML $503.00

FLUOROURACIL 50MG/ML10ML $233.00

Fluphenazine 2.5mg/ml 10ml MD Vial $268.00

FLUPHENAZINE DEC 25MG/ML $484.00

FLUPHENAZINE ENA 25MG/ML $772.00

FOLIC ACID 5MG/ML 1ML $134.00

Antizol 1gm/ml 1.5ml vial $4,294.00

FORMALDEHYDE 10% 30ML $315.00

FOSPHENYTOIN PER 50MG $111.00

FONDAPARINUX 2.5MG/0.5ML $270.00

FUROSEMIDE 100MG/10ML $253.00

FULVESTRANT PER 25MG $435.00

FUROSEMIDE 10MG/ML 2ML $220.00

Page 64: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

FUROSEMIDE 40MG/4ML $227.00

FILGRASTIM (G-CSF), 1MCG $4.00

FLOSEAL $2.00

GANCICLOVIR 500MG $346.00

GEMCITABINE PER 200MG $1,071.00

GENTAMICIN 10MG/ML 2ML $213.00

GENTAMICIN PMX 80MG $115.00

GENTAMICIN 40MG/ML 1.5ML $537.00

GENTAMICIN PMX 100MG $72.00

GENTAMICIN PMX 120MG $321.00

GENTAMICIN 40MG/ML 2ML $231.00

GENTAMICIN IT 2MG/ML 2ML $219.00

GLATIRAMER ACETATE 20MG $303.00

GLUCAGON 1MG $392.00

GLUCAGON 1MG(1U) $392.00

GLYCOPYRROLATE 0.2MG 2ML $154.00

GLYCOPYRROLATE .2MG/ML $135.00

GLYCOPYRROLATE 5ML INJ $149.00

GOLD SOD THIOM 50MG/1ML $241.00

GONADORELIN 100MCG $302.00

GRANISETRON INJ .1MG $1,107.00

HALOPERIDOL 5MG/ML 1ML INJ $144.00

HALOPERIDOL DEC 50MG/ML $289.00

HALOPERIDOL DEC 100MG/ML $438.00

HEPARIN 100U/ML 10ML $154.00

HEPARIN 100U/ML 1ML $17.00

HEPARIN 100U/ML 3ML $12.00

HEPARIN 1000/NS PMX $24.00

HEPARIN 25000/500D5W PMX $17.00

HEPARIN 5000U/ML 1ML $59.00

HEPARIN 10000U/ML 1ML $221.00

HEPARIN 1000U/ML 1ML $217.00

HEPARIN 1000U/ML 10ML $217.00

HEPARIN PORCINE1000UNITS/ML 30ML $247.00

HEPATITIS B IMM GLOB 1ML $227.00

HEPATITIS B VAC PED/ADOL $37.00

Hepatis A virus vaccine 1ml syr $222.00

HEPATITIS A VAC PED/ADOL $257.00

HETASTARCH 500ML $689.00

HISTOPLASMIN .1ML $109.00

HYALURONIDASE 150U $209.00

HYALURONAT/CHONDRO .5ML $786.00

HYDRALAZINE 20MG/1ML $224.00

HYDROCHLORIC ACID 2MG/ML $315.00

HYDROCORTISONE SS 100MG $131.00

HYDROCORTISONE SS 250MG $144.00

HYDROCORTISONE SS 500MG $174.00

Page 65: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

HYDROCORTISONE SS 1GM $228.00

RELISTOR 12MG/0.6 ML VIAL $178.00

HYDROXYZINE 100MG INJ $132.00

IBUTILIDE PER 1MG $1,649.00

HYDROXYZINE 25MG INJ $33.00

HYDROXYZINE 50MG INJ $134.00

HYOSCYAMINE .5MG/ML INJ $183.00

IDARUBICIN 5MG $2,961.00

IFOSFAMIDE 1GM $3,069.00

IMIPENEM/CILASTATIN 250 $281.00

INDIGO CARMINE AMP $127.00

RHO (D)IMM GLOB PER 100U $164.00

INFLIXIMAB PER 10MG $280.00

LEVEMIR (INS DETEMIR) PER UNIT $0.40

LEVEMIR FLEX 100UNITS $146.00

INS HUM 50/50 10ML $171.00

INS LENTE BF/PK 10ML $22.00

INS HUM NPH CART 3ML $109.00

INS GLARGINE 10ML $369.00

INS HUM 70/30 CART 3ML $151.00

INS HUM REG CART 3ML $151.00

INS REG PORK 10ML $197.00

INS ANALOG ASPAR 10ML $391.00

INS ANALOG ASPAR 3ML $154.00

INS HUM R 3ML VIAL $85.00

INS HUM REG 10ML $175.00

INS HUM REG DOSE $241.00

INS ANALOG LISPRO 10ML $391.00

INS HUM 70/30 10ML $175.00

INS HUM 70/30 3ML VIAL $85.00

INS HUM NPH 10ML $175.00

INS HUM N 3ML VIAL $85.00

INS HUM ULTRALENTE 10ML $16.00

REBIF-INTERFERON BETA 1 A/ALBUMIN $1,025.00

REBIF-INETRFERON BETA 1 A/ALBUMIN 44MCG/ $1,112.00

INTERFERON BETA-1B .3MG $526.00

INTERFERON ALFA 2A 3MU $733.57

INTERFERON ALFA 2B 1MU $231.00

IRINOTECAN PER 20MG $830.00

INJ.IRON DEXTRAN 50MG $128.00

IRON SUCROSE PER 1MG $6.00

ISONIAZID 100MG/ML $188.00

ISOPROTERENOL 1:5000 1ML $3,581.00

ISOPROTERENOL 1:5000 5ML $4,353.00

ISOSULFAN BLUE 1% 5ML $530.00

ITRACONAZOLE PER 50MG $806.00

IVIG LIQUID PER 500MG $308.00

Page 66: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

IVIG LYOPH PWD PER 500MG $313.00

KETAMINE 10MG/ML 20ML $199.00

KETAMINE 50MG/ML 10ML $203.00

KETAMINE 100MG/ML 5ML $203.00

KETOROLAC 15MG/ML 1ML $182.00

KETOROLAC 30MG/ML 1ML $173.00

KETOROLAC 30MG/ML 2ML $173.00

L-CARNITINE 1GM/5ML $307.00

LABETALOL 5MG/ML 20ML $252.00

LABETALOL HCL 5mg/ml 4ml VL $122.00

LEPIRUDIN 50MG $833.00

LEUCOVORIN CAL 50MG $263.00

LEUCOVORINE CALCIUM $12.00

LEUPROLIDE DEPOT 3.75MG $3,574.00

LEUPROLIDE PER 1MG $459.00

LEUPROLIDE DEPOT 7.5MG $2,764.00

NOREPINEPHRINE 4MG/4ML $235.00

NOREPINEPHRINE 16MCG/M IN 5% DEX 250ML $191.00

NOREPINEPHRINE 32MCG/ML IN 5% DEX 250ML $270.00

LEVETIRACETAM 500MG/100ML IVPB $148.00

LEVETIRACETAM 1000MG/100ML IVPB $169.00

LEVETIRACETAM 1500MG/100ML IVPB $191.00

LEVOFLOXACIN 750MG PMX $308.00

LEVOFLOXACIN 500MG 20ML $652.00

LEVOFLOXACIN INJ 250 MG $578.00

LEVOFLOXACIN 250MG PMX $155.00

LEVOCARNITINE 1GM/5ML $740.00

LEVOTHYROXIN .2MG/VIAL $250.00

LEVOTHYROXINE .5MG $279.00

LIDOCAINE .5%/EPI 50ML $130.00

LIDOCAINE .5% 50ML $124.00

LIDOCAINE 1% /EPI 30ML $143.00

LIDOCAIN 1%/EPI 20ML $119.00

LIDOCAINE 1% EPI 10ML $116.00

LIDOCAIN 1% 20ML $161.00

LIDOCAINE 1% 2ML $118.00

LIDOCAINE 1% 5ML $118.00

LIDOCAINE 1.5% /EPI 30ML $145.00

LIDOCAINE 1.5% 20ML $166.00

LIDOCAINE 2% 2ML $118.00

LIDOCAINE 2% 10ML $132.00

LIDOCAINE 2% /EPI 20ML $120.00

LIDOCAIN 2%/EPI 30ML $146.00

LIDOCAINE 2% 30ML $118.00

LIDOCAINE 4% 5ML $166.00

LIDOCAINE SYG 100MG $228.00

Lidocaine 10ml MDV $7.00

Page 67: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LIDOCAINE 2GM/D5W 250ML INFUSION $541.00

LIDOCAINE/GLUCO 5% 2ML $176.00

LIDOCAINE 1% W PHENYLEPHRINE 1.5% PF $59.50

LINEZOLID INJ PER 200MG $164.00

LORAZEPAM 2MG/ML 1ML SYG $150.00

Lorazepam 2mg/ml 10ml vial $23.00

Lorazepam 4mg/ml 10ml vial $35.00

LORAZEPAM SYG 4MG/ML 1 M $156.00

MAGNESIUM CHLORIDE 200MG/ML 50ML MDV $52.00

MAGNESIUM SULF 50% 10ML MDV $163.00

MAGNESIUM SULF 50% 2ML $133.00

MAGNESIUM SULF 1GM/100ML $101.00

MAGNESIUM SULFATE 2GM/50 $42.00

MAGNESIUM SULFATE 4G/100ML $137.00

MANNITOL 25% 50ML $137.00

MECHLORETHAMINE 10MG $316.00

MEDROXYPROGEST 400MG/ML $233.00

MEROPENEM 500MG/50ML NACL IVPB $115.00

MEROPENEM 1GM/50ML NACL IVPB $120.00

MEROPENEM PER 100MG $49.00

MESNA 200MG $375.00

METHOCARBAMOL 1GM/10ML $191.00

METHYLDOPATE 250MG/5ML $240.00

METHYLENE BLUE 1% 1ML $119.00

METHYLENE BLUE .5%/10ML AMP $534.00

METHYLERGONOVINE .2MG $118.00

METHYLPRED A 40MG/ML $150.00

METHYLPRED A 80MG/ML $164.00

METHYLPRED SS 40MG $136.00

METHYLPRED SS 125MG $172.00

METHYLPRED SS 1GM $546.00

METHYLPRED SS 500MG $325.00

METOCLOPRAM 5MG/ML 2ML $134.00

METOPROLOL 1MG/1ML5ML SD $206.00

METRONIDAZOLE 500MG PMX $541.00

MIDAZOLAM HCL PER 1MG $73.00

MIDAZOLAM 1MG/1ML $6.00

Midazolam 1mg/ml 2ml VL $3.00

Midazolam 1mg/ml 5ml VL $3.00

Midazolam 5mg/ml 10ml VL $16.00

MILRINONE LACT PER 5MG $272.00

PLICAMYCIN 2.5MG $1,121.00

MITOMYCIN 5MG $805.00

MITOXANTRONE PER 5MG $1,538.00

MIVACURIUM 2MG/ML 10ML $202.00

MORPHINE 1MG/ML 55ML PCA $162.00

MORPHINE 5MG/ML 1ML $59.00

Page 68: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

MOXIFLOXACIN BSS 0.1MG/0.1ML 1ML VIAL $105.00

MULTIVITAMINS 5ML INJ $127.00

MMR II 0.5ml $188.00

MUMPS ANTIGEN .1ML $222.00

MYCOPHENOLATE 500MG INJ $220.00

NAFCILLIN 1GM $219.00

NAFCILLIN 2GM $230.00

NA FERRIC GLUC 62.5MG/5ml $68.00

NALBUPHINE 10MG/ML 1ML $124.00

NALOXONE .4MG/ML 1ML $145.00

NALOXONE 1MG/ML 2ML $179.00

MAROPIN POLYAMP DUOFIT/ROPIVACAINE HCL $60.00

NESIRITIDE PER 0.1MG $215.00

NEOSTIGMINE 1:1000 10ML $137.00

OFIRMEV 1000MG/100ML $51.00

OPRELVEKIN 5MG $2,101.00

NICARDIPINE 25MG/10ML $225.00

NITROGL 50MG/ML 10ML $291.00

Nitroglycerin Premix 50mg/250ml D5W $130.00

Nitroglycerin Premix 25mg/250ml D5W $133.00

Octreotide 500 MCG/ml Vial $188.00

Octreotide 100mcg/ml Vial $37.00

Octreotide 50MCG/ml Vial $47.00

OCTREOTIDE 200MCG/ML INJ $20.00

OCTREOTIDE DEPOT PER 1MG $350.00

OCTREOTIDE PER 25MCG INJ $23.00

OLANZAPINE 10MG IM INJ $150.00

NITROPRUSSIDE 50MG/5ML $2,142.00

ONDANSETRON PER 1MG $261.00

OFLOXACIN 400MG PMX $322.00

OFLOXACIN 200MG PMX $267.00

ORPHENADRINE 30MG/ML 2ML $129.00

Oxacillin 1 gram vial $44.00

OXACILLIN 2GM $250.00

OXALIPLATIN PER 0.5MG $77.00

OXYTOCIN 10U/ML 1ML $134.00

PAMIDRONATE 30MG $1,614.00

PANCURONIUM 10MG/10ML $222.00

PANCURONIUM 2MG/ML 5ML $147.00

PANCURONIUM 2MG/ML 2ML $129.00

PANTOPRAZOLE 40MG IV $176.00

PANTOPRAZOLE 40MG SUSP $205.00

PAPAVERINE 30MG/ML 10ML $216.00

PAPAVERINE 30MG/ML 2ML $104.00

PARICALCITOL 5MCG/ML 1ML $195.00

PEGFILGRASTIM 6MG $3,896.81

PENICILLIN G POT 1MU $213.00

Page 69: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PENICILLIN G POT 3MU PMX $579.00

PENICILLIN G POT 2MU $587.00

PENICILLIN G NA 5MU $245.00

PENICILLIN G PROC 1.2MU $219.00

PENICILLIN G PROC 600KU $209.00

BICILLIN-LA 1,200,00/2ML SYR $278.00

PENTAMIDINE 300MG VIAL $671.00

PERPHENAZINE 5MG/ML 1ML $150.00

PHENOBARB 30 MG INJ $145.00

PHENOBARBITAL 60MG INJ $145.00

PHENOBARB 65MG $75.00

PHENOBARB SYR 130MG $137.00

PHENTOLAMINE 5MG/ML $478.00

PHENYLEPHRN 10MG/ML 1ML $16.00

PHENYTOIN 100MG/2ML $212.00

MYCAMINE PER 1 MG (50) $15.00

MYCAMINE PER 1 MG (100) $15.00

PHENYTOIN 250MG/5ML $17.00

PHYSOSTIGMINE 2ML $144.00

PHYTONADIONE 1MG/.5ML $137.00

PHYTONADIONE 10MG/ML 1ML $145.00

PIPECURONIUM 10MG $324.00

PIPERACILLIN 3GM $236.00

PIPERACILLIN 4GM $307.00

PIPERCLLN TAZOBACT 2.25G $259.00

PIPERCLN TAZOBACT 3.375G $286.00

PIPERCLLN TAZOBACT 4.5G $321.00

DOPAMINE 800MG PMX 250ML $529.00

PNEUMOC VACC POLYS 23VAL $220.00

POLYMIX B 500MU $161.00

POTASSIUM ACET 40MEQ/20M $57.00

POTASSIUM 30MEQ/15ML $209.00

POTASSIUM 40MEQ/20ML $214.00

POTASSIUM CL 20 MEQ/10ML $209.00

POTASSIUM CL 10MEQ/50ML $108.00

POTASSIUM CL 20MEQ/100ML $119.00

POTASS PHOS 3MM/ML 15ML $118.00

K PHOS 3MMOL/ML 1ML $6.00

PREDNISOLONE TEBU 20MG/M $160.00

PROCAINAMIDE 500MG/ML2ML $256.00

PROCAINAMIDE 100MG/10ML $261.00

PROCHLORPERAZINE 10MG IJ $154.00

PROGESTERONE 50MG/ML $271.00

PROMAZINE SYR 25MG/ML $133.00

PROMETHAZINE 25MG/ML $59.00

PROMETHAZINE 50MG/ML IM $137.00

PROPRANOLOL 1MG/ML $233.00

Page 70: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PROPOFOL 10MG/ML 20ML $235.00

Propofol 10mg/ml 100ml vial $46.00

PROTAMINE 10MG/ML 5ML $136.00

PROTAMINE 10MG/ML 25ML $141.00

PYRIDOSTIGMINE 10MG/2ML $128.00

PYRIDOXINE 100MG/ML $132.00

QUINID GLUC 80M/M 10ML $241.00

RANITIDINE 25MG/ML 2ML $155.00

RANITIDINE PMX 50MG $485.00

RABIES VACCINE IM $680.00

RAPACURONIUM 20MG/ML 5ML $281.00

REMIFENTANIL 0.4MG/ML 5M $293.00

RHO (D)IMM GLO IM 300MCG $342.00

RIFAMPIN 600MG $575.00

RISPERIDONE PER 0.5MG $44.00

RITUXIMAB 100MG/10ML $2,830.00

ROCURONIUM 5ML $267.00

ROPIVICAINE 0.5% (5MG/ML) 20ML $15.00

ROPIVICAINE 1% (10MG/ML) 20ML $22.00

SCOPOLAMINE.4MG/ML $189.00

SECRETIN 75U VIAL $518.00

SINCALIDE 5 MICROGRAMS INJ $265.00

SODIUM ACET 2ML 40MEQ INJ $10.00

SODIUM ACET 4MEQ/ML 50ML $209.00

SODIUM ACET 2MEQ/ML 10ML $189.00

SODIUM BICARB PED 4.2% $126.00

SODIUM BICARD 8.4% 50ML SYR $29.00

SODIUM BICARB 8.4% 10ML $233.00

SODIUM BICARB 50ML VL $134.00

SODIUM BICARB 7.5% 50ML $323.00

SODIUM BICARB 8.4% 50ML VL $241.00

SODIUM CIT/CIT ACID 500-334MG/5ML $6.00

SODIUM CLOR 4MEQ/ML 30ML $193.00

SODIUM CL .9% 10ML $154.00

SODIUM CL .9% INJ $132.00

SODIUM CL .9% BACT 30ML $151.00

SOD PHOS 3MM/ML 15ML $168.00

SODIUM TETRADECYL 1% 2ML $168.00

SODIUM TETRADECYL 3% 2ML $146.00

SOMATROPIN PER 1MG $357.00

SPECTINOMYCIN 2GM $174.00

STREPTOKINASE 250000U $647.00

STREPTOMYCIN 1GM $209.00

STREPTOZOCIN 1GM $1,261.00

SUCCINYLCHL 20MG/ML 1ML $735.00

SUCCINYLCHOLINE 500MG $138.00

SUCCINYLCHOLINE 1GM FP $133.00

Page 71: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

SUGAMMADEX 100MG/ML 5ML $572.00

SUGAMMADEX 100MG/ML 2ML $313.00

QUINUPR/DALFROPRST 500MG $852.00

SUMATRIPTAN 6MG INJ $683.00

TACROLIMUS 5MG/ML 1ML $1,122.00

TERBUTALINE 1MG/ML $221.00

TERIPARATIDE 750MCG/3ML $2,304.00

TETANUS IMMUNE GLOB 250U $1,316.00

TETANUS DIPTHERIA TOXIODS (PF) - TENIVAC $71.00

TETRACAINE 1% 2ML $151.00

THEOPHYLLIN PMX 400/250 $547.00

THEOPHYLLIN PMX 400/100 $547.00

THIAMINE 100MG/ML 1ML $59.00

THIETHYLPERAZNE 10MG/2ML $123.00

THIOTHIXENE 5MG/1ML $128.00

THYROTROPIN ALPHA 1.1MG $7,677.00

TICARCILLIN 1GM $228.00

TICARCILLIN/CLAV 3.1GM $244.00

TOBRAMYCIN 40MG/ML 2ML $17.00

TORSEMIDE 10MG/ML 5ML $232.00

TRACE METALS 5ML VIAL $96.00

TRASTUZUMAB PER 10MG $514.00

TRIAMCIN 10MG/ML 5ML $131.00

TRIAMCIN 40MG/ML $134.00

TRICHOPHYTON .1ML $59.00

TRIFLUOPERAZ 2MG/ML 10ML $129.00

TRIMETHOBENZ 200MG INJ $137.00

TROMETHAMINE 18G/500ML $856.00

TUBERCULIN PPD 1TU $103.00

TUBERCULIN PPD 250TU $103.00

TUBERCULIN PPD 5TU $35.00

TUBOCURARINE 3MG/ML 20ML $168.00

TUBOCURARINE 3MG/ML 10ML $183.00

UROKINASE 250000U $2,182.00

UROKINASE 5000U/ML 1ML $524.00

VALPROATE INJ 500MG/5ML $222.00

VANCOMYCIN 1GM SNGL VIAL $211.00

VANCOMYCIN 500MG $246.00

VASOPRESSIN 20U/ML $230.00

VECURONIUM 10MG VIAL $44.00

VERAPAMIL 2.5MG/ML $344.00

VIDARABINE 200MG/ML $395.00

VINCRISTINE 1MG $387.00

VINORELBINE PER 10MG $923.00

WATER FOR INJ 100CC $274.00

WATER FOR INJECTION 10ML $154.00

WATER FOR INJECTION 50ML $256.00

Page 72: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ZIDOVUDINE 10MG/ML 20ML $223.00

ZOLEDRONIC ACID PER 1MG $307.00

ZIPRASIDONE PER 10MG INJ $126.00

ASA BUTALB CAFF CODEIN30 $11.00

ACETAMIN/COD 12MG 30ML $26.00

ACETAMINOPH/COD 12MG/5ML $43.00

ACETAMINOPHEN-C 15MG $17.00

ACETAMINOPHEN-C 30MG $18.00

ACETAMINOPHEN-C 60MG $18.00

AMOBARBITAL 500MG INJ $172.00

ASA/BUTALBITAL/CAFF TAB $46.00

ASA/CODEINE 30MG $17.00

ASA/CODEINE 60MG $17.00

CHLORAL HYDRAT 250MG CAP $16.00

CHLORAL HYDRAT CAP 500MG $18.00

COCAINE SOLN 10% 4ML $118.00

COCAINE SOLN 4% 4ML $87.00

COLY-MYCIN 150MG $629.00

CODEINE INJ 30MG $189.00

CODEINE TAB 30MG $19.00

DEXTROAMPHETAMINE 5MG $22.00

DEXTRO/AMPH SLTS 10MG EX $16.00

DRONABINOL 2.5MG CAP $34.00

ETHCHLORVYNOL 500MG $16.00

FENTANYL PCA 550MCG/55ML $107.00

FENTANYL .05MG/ML 2ML $108.00

FENTANYL .05MG/ML 5ML $149.00

FENTANYL .05MG/ML 20ML $26.00

FENTANYL 25MCG/HR PATCH $94.00

FENTANYL 50MCG/HR PATCH $116.00

FENTANYL 75MCG/HR PATCH $146.00

FENTANYL 100MCG/HR PATCH $240.00

HYDROCOD/HOMATROP 10ML $19.00

HYDROCOD/HOMATROP TAB $19.00

HYDROCODONE/ACET 15ML $52.00

HYDROCOD/APAP 10/325 $20.00

HYDROCOD/APAP 10/650 $39.00

HYDROCODONE/ACETA 5/325MG TAB $3.00

HYDROCODONE/ACETA 5MG $20.00

HYDROCOD/APAP 7.5/500 $47.00

HYDROMORPHONE 0.1MG 55ML $118.00

HYDROMORPH 10MG/ML 5ML $189.00

HYDROMORPHONE 2MG INJ $59.00

HYDROMORPHONE 2MG TAB $18.00

HYDROMORPHONE 2MG INJ $189.00

HYDROMORPHONE 3MG SUPP $21.00

HYDROMORPHONE 4MG INJ $139.00

Page 73: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

HYDROMORPHONE 4MG TAB $18.00

HYDROMORPH 10MG/ML 10ML $145.00

HYDROMOR 4MG/2ML 20ML VL $21.00

MEPERIDINE SYG 50MG/ML $148.00

MEPERIDINE 50MG/ML 2ML AMP $12.00

MEPERIDINE SYG 75ML/ML $145.00

MEPERIDINE SYG 100MG/ML $148.00

MEPERIDINE 10MG/ML 30ML $284.00

MEPERIDINE TAB 50MG $18.00

METHADONE 20MG/10ML ORAL $47.00

METHADONE 10MG/ML INJ $134.00

METHADONE 10MG TAB $10.00

METHADONE 5MG TAB $18.00

METHOHEXITAL 500MG $189.00

METHYLPHENIDATE 5MG $19.00

METHYLPHENIDATE 10MG $19.00

METHYLPHENIDATE 20MG $21.00

MORPHINE 200MG/20ML INJ $848.00

MORPHINE PF 1MG/ML 10ML $200.00

MORPHINE 10MG/ML 1ML INJ $148.00

MORPHINE 15MG/ML 1ML INJ $148.00

MORPHINE 1MG/ML 30ML PCA $293.00

MORPHINE PF 0.5MG/ML 10M $162.00

MORPHINE 10MG/5ML $22.00

Morphine 10mg/ml MDV vial 10ml $24.00

MORPHINE SOLN 20MG/5ML $46.00

MORPHINE SYG 2MG/ML $148.00

MORPHINE SYG 4MG/ML $145.00

MORPHINE SYG 8MG/ML $145.00

MORPHINE INJ 15MG/ML 20M $491.00

MORPHINE TAB 15MG $47.00

MORPHINE SULCR TAB 100MG $71.00

MORPHINE SUL CR TAB 15MG $19.00

MORPHINE TAB 30MG $46.00

MORPHINE SUL CR TAB 30MG $22.00

OPIUM BELLADONNA 30MG $16.00

MORPHINE SULFATE 10MG/2.5ML ORAL SOL $2.00

OPIUM TINCT DOSE $46.00

OXANDROLONE 2.5MG TAB $44.00

OXANDROL 10MG $74.00

OXYCOD/ACET 5/500 $18.00

OXYCODONE-ASA $16.00

OXYCODONE 5MG $47.00

OXYCONDONE CR 80MG $49.00

OXYCODONE CONTR REL 10MG $8.00

OXYCODONE CONTR REL 20MG $13.00

OXYCODON IR (IMMEDIATE RELEASE) $3.00

Page 74: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PEMOLINE 37.5MG $46.00

PENTOBARBITAL 100MG $17.00

PENTOBARBITAL 100MG INJ $147.00

PENTOBARBITAL 120MG SUPP $17.00

PHENOBARB 15MG $46.00

PHENOBARB 30MG $46.00

PHENOBARB 32.4 MG $46.00

PHENOBARB 60MG $46.00

PHENOBARB 100MG $10.00

PHENOBARB 20MG/5ML $17.00

PHENTERMINE 30MG $46.00

SECOBARBITAL 100MG $17.00

TEFLARO 600MG/20ML $378.00

THIOPENTAL 2.5GM $188.00

THIOPENTAL SYR 500MG $189.00

TIGECYL PER 1 MG $5.00

ACETIC ACID 2% 15ML $77.00

ACETIC ACID 2%/HYDROC 1% $82.00

ACETYLCHOLIN SYS PAK $112.00

ACETYLCYSTEINE 10% 4ML $77.00

ACETYLCYSTEINE 10% 30ML $236.00

ACETYLCYSTEINE 20% 4ML $82.00

ACETYLCYSTEINE 20% 30ML $178.00

ALBUTEROL 90MCG 17GM $219.00

ALBUTEROL .0839% 3ML $24.00

ALBUTEROL 2.5MG/.5ML UD $3.00

AMYL NITRITE VAP $61.00

APRACLONIDINE SOLN $111.00

APRACLONIDINE .5% 5ML $270.00

AROMATIC AMMONIA $31.00

ARTIFICIAL TEARS 15ML $19.00

ATROPINE .5ML INH $131.00

ATROPINE .5% 5ML OS $16.00

ATROPINE 1% 1ML OS $11.00

ATROPINE 1% 15ML OS $12.00

ATROPINE 2% 2ML OS $16.00

ATROPINE 1% 3.5GM OO $15.00

BACITRACIN 3.5GM OO $12.00

BACITRACIN/POLYMXN 3.5GM $60.00

BECLOMETH 16.8GM NASAL $19.00

BECLOMETHASONE 12.2G $77.00

BECLOMETH 16.8GM INHAL $19.00

BECLOMETH INH 80MCG 7.3G $18.00

BECLOMETH INH 40MCG 7.3G $15.00

BETAXOLOL .5% 5ML OPHTH $27.00

BETAXOLOL .25% 5ML OS $34.00

BENZOCAINE/ANTIPYR 10ML $24.00

Page 75: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

BENZOCAINE/MENTHOL 20-0.5% $17.00

BIMATOPROST .03% 2.5ML $75.00

BRIMONIDINE.2% 5ML OS $35.00

BUTORPHANOL 2.5ML NS $82.00

BRINZOLAMIDE 1% 5ML $48.00

CALCITONIN 200U/SPRAY2ML $37.00

BUDESONIDE INH .5MG/2ML $44.00

CARBACHOL .01% 1.5ML $52.00

CARBACHOL .75% 15ML $18.00

BRIMONIDINE .15% 10ML OS $82.00

CARBACHOL 2.25% 15ML $32.00

CARBACHOL 3% 15ML $19.00

CARBOXYMETHYLCELLUL .3ML $16.00

CARBAMIDE PEROX 15ML $14.00

CARTEOLOL 1% 10ML OS $80.00

Cevimeline 30mg cap $10.00

CHERRY SYRUP 16OZ $48.00

CHLORAMPHENICOL .5%7.5ML $16.00

Ciprofloxacin 0.3% 3.5gm tube $320.00

CIPROFLOX/DEXM 7.5ML OT $85.00

CIPROFLOXACIN 2.5ML OS $99.00

CIPROFLOXACIN 5ML OS $36.00

CROMOLYN 8.1GM INHALER $54.00

CYCLOPENTOLATE .5% 15ML $32.00

CYCLOPENTOLATE 1% 2ML $22.00

CYCLOPENTOLATE 2% 2ML $19.00

CYCLOPENTOLATE 2% 5ML $13.00

SODIUM HYPOCHLORITE 0.5% $35.00

SODIUM HYPOCHLORITE 0.25% $35.00

DESMOPRESSIN .01% 5ML $163.00

DEXAMTHEASONE .05% 3.5GM $13.00

DEXAMETHASONE .1% 5ML OS $25.00

DEXAMETHASONE .1%15ML OS $32.00

DEXAMETH/NEO/POLY 5ML OS $19.00

DEXAMETHA/NEO/POLY 3.5GM $15.00

DICLOFENAC 01% 5ML $34.00

DICLOFENAC .1% 2.5ML $35.00

DICLOFENAC GEL $89.00

DIPIVEFRIN .1% 10ML OS $25.00

DORZOLAMIDE 2% 10ML OS $28.00

DORZOLAMIDE/TIMOLOL 5ML $81.00

ECOTHIOPHATE .03% 5ML $15.00

ECOTHIOPHATE .06% 5ML $16.00

ECOTHIOPHATE .125% 5ML $16.00

ECOTHIOPHATE .25% 5ML $17.00

EPINEPHRINE 1:1000 30ML $18.00

EPINEPHRINE 1% 10ML $18.00

Page 76: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

EPINEPHRINE 1% 15ML $20.00

EPINEPHRINE 2% 15ML $20.00

EPINEPHRINE 2% 10ML OS $18.00

EPINEPHRINE 2.25% SOLN $17.00

RACEPINEPHRINE 2.25% HHN $51.00

ERYTHROMY OPTH 3.5GM $116.00

FLUNISOLIDE .025% 25ML $27.00

FLUNISOLIDE 7GM $89.00

FLUORESCEIN 2%2ML $15.00

FLUORESCEIN STRIP $15.00

FLUOROMETHALONE .1 15ML $43.00

FLUOROMETH ACET .1% 5ML $19.00

FLURBIPROFEN .03% 5ML $31.00

FLUTICASONE .05%16GM $78.00

FLUTICASONE 110MCG 13GM $89.00

FLUTICASONE 220MCG 13GM $123.00

FLUTICASONE 44MCG 7.9GM $70.00

GABAPENTIN 250MG/5ML SOL $190.00

FORMOTEROL INH 12MCG CAP $13.00

GELATIN ABS $223.00

GENTAMICIN .3% 3.5GM OO $48.00

GENTAMICIN .3% 1ML OS $13.00

GENTAMICIN .3% 5ML OS $39.00

HOMATROPINE 2% 5ML $22.00

HOMATROPINE 5% 5ML $19.00

HYALURON CHONDROITIN KIT $1,043.00

HYALURON SYG 12MG/ML.8ML $181.00

HYALURON 10MG/ML .85ML $607.00

HYALURON SYG 16MG/ML .8 $187.00

HYDRXYPRPYL METHLC 15ML $13.00

INHALER SPACER UNIT $183.00

INHALER SPACER UNIT $137.00

INHALER SPACER UNIT $82.00

IPRATOPIUM .02% SOLN $76.00

IPRATROPIUM.03% NAS SPR $48.00

IPRAT-ALBUT 0.5-3 (2.5) MG/3ML $9.00

IPRATROP/ALBUT INH14.7GM $60.00

IPRATROPIUM NAS SPR 15ML $43.00

IPRATROPIUM INH 14GM $36.00

IRRIGANT OPHTH 30ML $16.00

IRRIGANT OPHTH 15ML $16.00

IRRIGANT OPHTH 120ML $16.00

ISOETHARINE SINGLE DOSE $71.00

KETOROLAC 0.5% 5ML OS $49.00

LANOLIN-CL-BUTA 3.5GM $14.00

LANOLIN-CL-BUTA .7G UD $76.00

PETRO/MO/LAN OO7.0GM $22.00

Page 77: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LATANOPROST .005% 2.5ML $53.00

LEVOBUNOLOL .5% 5ML $16.00

LEVOBUNOLOL .25% 5ML $27.00

LEVALBUTEROL 1.25MG/3ML $22.00

LEVALBUTEROL 0.63MG/3ML $22.00

LODOXAMIDE 0.1% 10ML $55.00

METAPROTERENOL .6% UD $72.00

METAPROTERENOL 14G/10ML $21.00

METIPRANOLOL .3% 5ML OS $17.00

METIPRANOLOL .3% 10ML OS $19.00

MUPIROCIN 2% 22GM $56.00

MOMETASONE 17GM NS $378.00

NAPHCON 15ML $13.00

NAPHAZOLINE .1% 15ML $25.00

NAPHAZOLINE-ANTAZ 15ML $16.00

NAPHAZOLINE-PHENIR 15ML $16.00

NATAMYCIN 5% OPHTH 15ML $126.00

NEO/POLY/HC OPHTH 5ML $18.00

NEO/POLY/HC OPHTH 7.5ML $14.00

NEOMY POLY HC OPHTH 10ML $31.00

DEXAMETH/NEOMYCIN 5ML OS $21.00

NEO/POLY/BAC/HCORTIS3.5G $16.00

NEO/POLY/HC-CORTISPORIN 7.5GM $204.00

NEOMYC/POLY/GRAMICID10ML $14.00

NEOMYC/POLY/BACITRA 3.5G $13.00

NITROGLYCERIN 13.8G SPRY $32.00

OFLOXACIN .3% 5ML OS $41.00

OLOPATADINE 5ML OS $109.00

OXYMETAZOLINE .05% 3ML $10.00

OXYMETAZOLINE 15ML .05% $13.00

LIDOCAINE HCL 2% 5ML JELLY $115.00

MITOMYCIN EYE DROPS 0.3MG/ML $193.00

MITOMYCIN EYE DROPS 0.4 MG/ML $234.00

MITOMYCIN EYE DROPS 0.2 MG/ML $522.00

PHENYLEPHRN .25% 15ML SP $12.00

PHENYLEPHRN .5% 15ML SP $12.00

PHENYLEPHRINE 1% SPRAY $12.00

PHENYLEPHRN 10% 1ML OS $17.00

PHENYLEPHRN 10% 5ML OS $17.00

PHENYLEPHRN 2.5% 3ML OS $17.00

PILOCARPINE .25% 15ML OS $17.00

PILOCARPINE .5% 15ML OS $11.00

PILOCARPINE 1% 15ML OS $11.00

PILOCARPINE 2% 1ML OS $12.00

PILOCARPINE 3% 15ML OS $11.00

PILOCARPINE 4% 15ML OS $11.00

PILOCARP 4% GEL 5GM $29.00

Page 78: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PILOCARPINE 4% 1ML OS $12.00

PILOCARPINE 6% 15ML OS $16.00

PILOCARPINE 8% 15ML $23.00

PILOCARPINE-EPI 2% 10ML $16.00

PILOCARPINE-EPI 3% 15ML $18.00

PILOCARPINE-EPI 4% 10ML $16.00

PIRBUTEROL INHALER $60.00

PREDNISOLONE .12% 5ML $17.00

PREDNISOLONE 1% 5ML $41.00

PREDNISOLONE 1% 10ML $23.00

PROPARACAINE .5% 15ML $13.00

RANITIDINE SYRUP 15MG/ML $11.00

RIMEXOLONE 1% 5ML $28.00

SALMETEROL INHALER 6.5GM $62.00

SALMETEROL DISKUS 50MCG $3.00

SALMET/FLUT DSK50/100 28 $442.00

SALMET/FLUT DSK50/250 28 $442.00

SALMET/FLUT DSK50/500 28 $785.00

SOD CL 2%OPHTH VHCL 15ML $19.00

SOD CL 5%OPHTH VHCL 15ML $16.00

SODIUM CHLORIDE 45ML $13.00

SODIUM CHLORIDE 3% 15ML $11.00

SODIUM CHLORIDE 5% 3.5GM $19.00

SODIUM SULFACET 10% 5ML $22.00

SODIUM CA SOLN 30ML $24.00

SODIUM-CALCIUM 15ML $20.00

SODIUM-CAL SOLN 500ML $145.00

SODIUM-CA PLUS SOL 500ML $866.00

SULFACETAMIDE 10% 3.5GM $16.00

SULFACETAMIDE 10% 2ML $76.00

SULFACETAMIDE 15% 2ML $76.00

SULFACETAMIDE 30% 15ML $17.00

SULFACETAMIDE S 10% 15ML $13.00

SULFACETAMIDE-PHENYL 5ML $19.00

SULFACET/PRED 0.2% 5ML $18.00

SULFACETAMID/PREDNI 3.5G $86.00

TALC STERILE POWDER $393.00

SUMATRIPTAN NASAL SP 5MG $215.00

SUMATRIPTAN NAS SP 20MG $215.00

TEA-PPO-CL-BUTA 15ML $22.00

TERBUTALINE INHALR 7.5ML $19.00

TETRACAINE .5% 1ML $77.00

TETRACAINE HCL 0.5% 4ML $15.00

TETRACAINE .5% 15ML $11.00

TETRAHYDRAZOL .1% 15ML $12.00

TIMOLOL .25% 5ML OS $18.00

TIMOLOL .5% 2.5ML GEL $37.00

Page 79: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TIMOLOL .5% 5ML OS $24.00

TIMOLOL .5% 2.5ML OS $19.00

TIOTROPIUM 18MCG INH 6 $181.00

TOBRAMYCIN OO 3.5GM $7.00

TOBRAMYCIN OS 0.3% 5ML $18.00

TOBRAMYCIN/DEXAMETH3.5GM $75.00

TOBRAMYCIN/DEXAMETH 2.5ML OS $123.00

TRIAMCINOLONE 20GINHALER $24.00

TRIAMCINOLONE 10G INHALR $51.00

TRIAMCINOLONE AQ INHALER $79.00

TRAVOPROST OS .004%2.5ML $15.00

TRIFLURIDINE 1% 7.5ML OS $33.00

TRIMETHPRM/POLYMYXN 10ML $51.00

TROPICAMIDE .5% 15ML $22.00

TROPICAMIDE 1% 15ML $24.00

TRYPAN BLUE .06% OS .5ML $248.00

ZOLMITRIPTAN SPR 5MG $125.00

ACYCLOVIR 5% 15GM $36.00

ALUMINUM ACETATE PACKET $24.00

ALUM POWDER 4 OZ $189.00

AMMONIUM LACT 12% CRM $29.00

ANTIFUNGAL 30ML $27.00

ASPERCREME 35.4GM $16.00

EUCERIN 120G $18.00

AVEENO SINGLES $92.00

BACITRACIN OINT 28G $5.00

BACITRACIN 500U/GM 28.4GM OINT $7.00

BACITRACIN 30GM $37.00

BACITRACIN/POLYMXN 15GM $12.00

BACITRACIN/POLY 10G PWD $19.00

VIT A&D CR/OINT 60GM $11.00

BECAPLERMIN GEL 0.01%15G $337.00

BENGAY GREASELESS 2OZ CREAM $13.00

BENZALKONIUM-HA $15.00

BENZO-TETRA SPRAY 56ML $23.00

BENZOCAINE 10% GEL $16.00

BENZOCAINE 60ML SPRY $21.00

BENZOCAINE 90ML SPRAY $13.00

BENZOCAINE 9.3ML $16.00

BENZOCAINE ORABASE 5G $11.00

BENZOIN COMPD TINC SPRAY $15.00

BENZOIN TINCTURE $12.00

BENZOYL PEROX GEL 5% 42 $28.00

BENZOYL PEROX GEL 42GM $15.00

BENZOYL PER 2.5%GEL 60GM $28.00

BETAMETHASONE .05% 15G C $43.00

BETAMETHASONE .05% 15G C $20.00

Page 80: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

BETAMETHASONE .05% 15G O $20.00

BETAMETHASONE .05% 60ML $27.00

BETAMETHASONE .1% 15GM C $20.00

BETAMETHASONE .1% 60ML L $22.00

BIAFINE WDE DRSNG 3.30OZ $10.00

BLISTEX 4.2GM $7.00

BORIC ACID 120ML $10.00

CADEXOMER IODINE 40G $81.00

CALAMINE 120ML $15.00

CALAMINE/PRAMOXINE 180ML $16.00

CALCIPOTRIENE CR/OT 30GM $51.00

CAMPHOR/PHENOL 22.5ML $16.00

CAPSAICIN .025% 60GM $34.00

CAPSAICIN .075% 30GM $16.00

CAPSAICIN .075% 60GM $23.00

CETAPHIL CREAM 454GM $20.00

CHLORASEPTIC SPRAY $10.00

CHLORHEXIDINE 120ML $15.00

Chlorhexidine 0.12% 15ml $3.00

CHLORHEXIDINE 480ML $20.00

CICLOPIROX .77% 15GM $37.00

CLINDAMYC/BENZ PER 25GM $68.00

CLINDAMYCIN 1% 30GM GEL $38.00

CLINDAMYCIN 1% 30ML $17.00

CLINDAMYCIN LIQ 60ML $51.00

CLOBETASOL 0.05% 15GM CREAM $103.00

CLOBETASOL .05% 30GM OINTMENT $52.00

CLOBETASOL .05% 30GM CREAM $44.00

CLOTRIMAZOLE 1% 15GM CRM $22.00

CLOTRIMAZOLE 1% 30GM $19.00

CLOTRIMAZOLE 1% 30ML $23.00

CLOTRIMAZOLE 1% 45GM VAG $24.00

CLOTRIMAZOLE 200MG 3 $16.00

CLOTRIMAZOLE 100MG VAG 7 $4.00

CLOTRIMZOL/BETAMETH 15GM $25.00

CLONIDINE HCL 0.1MG TTS $77.00

CLONIDINE HCL 0.2MG TTS $101.00

CLONIDINE HCL 0.3MG TTS $129.00

COAL TAR SHAMPOO 4OZ $17.00

COAL TAR SALICYLIC ACID $9.00

COD LIVER OIL-Z 28GM $11.00

COLLAGENASE 15GM $38.00

CONJUGATED ESTR CRM 42GM $24.00

CROTAMITON 10% 60ML $92.00

DESONIDE .05% 15GM CRM $16.00

DESOXIMETASONE .25% 15GM $28.00

DEXTRANOMER 4GM $14.00

Page 81: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

DIBUCAINE 1% 30GM $11.00

DIFLORAZONE .05% 30GM $39.00

DIPHENHYDRA/ZINC 28.4G $16.00

ECONAZOLE 1% 30GM $24.00

ERYTHROMY 2% 60ML $16.00

ERYTHROMY/BENZOYL GEL $46.00

ERYTHROMYCIN 2% 30G $38.00

ERYTHROMYCIN 5MG/GM 3.5GM OINT $23.00

ESTRADIOL 0.05 PATCH $77.00

ESTRADIOL 0.1 PATCH $81.00

ESTRADIOL 0.075 PATCH $38.00

ESTRADL 24HR PTCH/.05MG $76.00

ESTRADL 24HR PTCH/.1MG $76.00

ETHYL CHLORIDE $74.00

EUCERIN CREAM 57GM $16.00

FERRIC SUBSULFATE 60ML $76.00

FIBRIN SEALANT KIT 5ML $5,697.00

FIBRINOLYSIN-DE $32.00

FLUOCINOLONE TOP 0.01% $17.00

FLUOCINOLONE .01% 15GM $15.00

FLUOCINOLONE .01% 20ML $17.00

FLUOCINOLONE .01% 60ML $24.00

FLUOCINOLONE .025% 15GM $17.00

FLUOCINOLONE .025% 60GM $20.00

FLUOCINONIDE .05% 15GM $22.00

FLUOCINONIDE .05% 15GM $38.00

FLUOCINONIDE .05% 30GM $26.00

FLUOCINONIDE .05% 30GM $47.00

FLUOCINONIDE .05% 60GM $16.00

FLUOCINONIDE .05% 60ML $32.00

FLUORIMETHANE 120ML $27.00

FLURANDREN 4MCG 24X3 $24.00

FLUTICASONE 15 G $24.00

GELATIN ABS 100 $17.00

GELATIN ABS 12X7 $11.00

GELFILM OPHTH ABS 25X50 $669.00

GENTAMICIN .1% 15GM UNG $14.00

GLYCERIN 120ML $15.00

HYDROCORT/PRAMOXINE 10GM $19.00

HYDROCORTI .5% 30GM CRM $79.00

HYDROCORTISONE .2% 15GM $16.00

HYDROCORTISONE .2% 45GM $25.00

HYDROCORTISONE .5% 30GM $16.00

HYDROCORTISONE 1% 30GM $86.00

HYDROCORTISONE 2.5% 30GM $10.00

HYDROCORTISONE 2.5% 20GM $11.00

HYDROCORTISONE WITH ALOE 1% CREAM $14.00

Page 82: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

HYDROCORT CLIOQUINOL 20G $16.00

HYDROGEN PEROXIDE 120ML $11.00

HYDROGEN PEROXIDE 480ML $11.00

IMIQUIMOD 5% 1 PACKET $106.00

INCONT SK/CR KIT $53.00

IODINE TINCT 60ML $11.00

KETOCONAZOLE 30 GM $29.00

KETOCONAZOLE 2% CREAM $38.00

KETOCONAZOLE 2% SHAMP120 $29.00

AMMONIUM LACT 12% LOT $11.00

LANOLIN 30GM $11.00

LANOLIN 60GM $14.00

Lidocaine 5% jelly 5ml $31.00

LIDOCAINE 2% 30GM JELLY $30.00

LIDOCAINE 2.5% 35GM $25.00

LIDOC 2.5/PRILOC 2.5 5G $18.00

Lidocaine % Prilocaine 2.5%-2.5% (30GM) $152.00

LIDOCAINE 4% 50ML TOP $84.00

LIDOCAINE 5% 35GM UNG $19.00

LIDOCAINE 5% PATCH $168.00

LIDOCAINE-10% 60ML SPRAY $75.00

LINDANE LOT 60ML $59.00

LINDANE SHAMP 60ML $59.00

MAFENIDE ACETAT 411GM $20.00

MAGNESIUM SULFATE 480GM $11.00

METHYL SALICYLAT 38GM $12.00

METRONIDAZOLE .75% 30GM $37.00

METRONIDAZOLE .75% 45GM $50.00

MICONAZOL VAG T 7X100MG $5.00

MICONAZOL VAG T 3X200MG $17.00

MICONAZOLE 2% 30GM CRM $97.00

MICONAZOLE 2% 45GM CRM $20.00

MICROFIBRILLAR ENDO 5MM $19.00

MICROFIB COLLAGEN 1GM $106.00

MICROFIBRIL 70X70X1 SHET $145.00

MICROFIB COLLAGEN 5GM $240.00

MICROFIBRILLAR COLLAGEN HEMOSTAT PWDR $388.00

MOMETASONE .1% 45GM $14.00

MOXIFLOXACIN 0.5% GTTS OPTH $494.00

MUPIROCIN 2% 30GM $46.00

MUPIROCIN 2% 15GM $23.00

MUPIROCIN 2% 1GRAM TUBE $31.00

NEOMYCIN-POLYMY GU 1ML $43.00

NICOTINE TRANSDERMAL 7MG $77.00

NICOTINE TRANSDERML 14MG $77.00

NICOTINE TRANSDERML 21MG $77.00

NITROFURAZONE DRESSING $14.00

Page 83: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

NITROGLYCERIN 0.1MG/HR $77.00

NITROGLYCERIN 0.2MG/HR $76.00

NITROGLYCERIN 0.3MG/HR $22.00

NITROGLYCERIN 0.4MG/HR $77.00

NITROGLYCERIN 0.6MG/HR $76.00

NITROGLYCERIN 2% 30GM $13.00

NITROGLYCERIN UNG U-D $9.00

NYSTATIN TOP CRM 15GM $11.00

NYSTATIN TOP CRM 30GM $21.00

NYSTATIN TOP POWD 15GM $20.00

NYSTATIN TOP UNG 15GM $16.00

NYSTATIN TOP UNG 30GM $14.00

NYSTATIN VAG TAB 100MU $4.00

PAPAIN/COPPER CPD OINT30 $76.00

PAPAIN UREA SPRAY 33ML $67.00

PERMETHRIN 1% 60ML $80.00

PERMETHRIN 5% 60GM $167.00

PETROLATUM GAUZE 1 INCH $15.00

NEO/BAC/POLY/HC 15GM $18.00

POVIDONE-IODINE 5% OPTH $26.00

POVIDONE-IODINE 30GM $11.00

POVIDONE-IODINE-DOUCHE $10.00

POVIDONE-IODINE DOU 30ML $52.00

POVIDONE IODIN SOLN 8OZ $12.00

PRAMOXINE HC REC 1% 30GM $25.00

SALICYLIC ACID (RIVE) CR $23.00

SELENIUM SULFIDE 1% $12.00

SELENIUM SULF 2.5% LOTN $14.00

SCOPOLAMINE 1.5MG PATCH $35.00

SILVER NITRATE APPL $10.00

SILVER SULFADIA 1% 50GM $24.00

SILVER SULFADIA 1% 25GM $19.00

SILVER SULFADIA 1% 400G $70.00

SIVLER SULFADIA 20GM CREAM $26.00

SOD HYPOCHLORITE 480ML $10.00

SCLEROSOL AEROSOL TALC 4G $711.00

SULFANILAMIDE-A VAG SUPP $21.00

SULFANILAMIDE-A VAG CR $24.00

SURGICEL 4X8 $490.00

SURGILUBE JELLY 56.70G $6.00

SURGILUBE 127.5 GM $16.00

TERAZOL3 0.8% CR $216.00

TERBINAFINE 1% 15G $40.00

TESTOSTERONE 2.5MG/24HR $21.00

TETRACAINE 2% TOP $25.00

thrombin topical-recombinant 5000u/vial $80.00

THROMBIN 1000U $75.00

Page 84: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TOBRAMYCIN POWD 1.2GM $909.00

TOLNAFTATE 1% 10ML $14.00

TOLNAFTATE 1% 120ML SPRY $14.00

TOLNAFTATE 1% 15GM $14.00

TOLNAFTATE 1% 45GM POWD $13.00

TOPICAL ENZYME COMBO 30G $157.00

TOPICAL ENZYME CMBO 33ML $21.00

TRETINOIN .01% 45G $49.00

TRETINOIN .05% 20G $43.00

TRETINOIN CR .025% 20GM $43.00

TRIAMCIN .025% 15GM CRM $15.00

TRIAMCIN .025% 15GM UNG $12.00

TRIAMCIN .025% 454GM CRM $11.00

TRIAMCIN .025%454GM OINT $18.00

TRIAMCIN .1% 15GM CRM $107.00

TRIAMCIN .1% 15GM UNG $16.00

TRIAMCIN .1% 60ML $14.00

TRIAMCIN .1% 80GM CRM $15.00

TRIAMCIN .1% 454GM OINT $42.00

TRIAMCIN .5% 15GM CRM $16.00

TRIAMCIN A 5GM $15.00

TRIAMCIN/NYSTATIN 15G $14.00

TRIAMCINOLO NYSTATIN 30G $16.00

TRIPLE SULFA CRM 75GM $14.00

BALSAM PERU/CASTOR OIL $76.00

TRYPSIN BALSAM 60ML SPRY $27.00

TRYPSIN/BALS/CASTOIL60GM $54.00

UNDECYCLINIC ACID CR 30G $14.00

UREA CRM 85GM 20% $14.00

UREA CREAM 198.6GM 40% $66.00

UREA CREAM 85GM $29.00

VICKS VAPORUB OINT 45GM $16.00

VITAMIN E CRM 60GM $16.00

ZINC OXIDE 30GM $22.00

ACETAMINOPHEN 120MG $18.00

ACETAMINOPHEN 325MG $15.00

ACETAMINOPHEN 650MG $15.00

ASPIRIN 120MG SUPP $15.00

ASPIRIN 300MG SUPP $15.00

ASPIRIN 600MG SUPP $15.00

BISACODYL 10MG $15.00

STARCH SUPP $18.00

DINOPROSTONE 20MG $536.00

GLYCERIN ADULT $17.00

GLYCERIN INFANT $16.00

HC-BISMUTH BENZ 30GM $243.00

HC-BISMUTH-BENZ $19.00

Page 85: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

HYDROCORTISONE 100MG60ML $30.00

INDOMETHACIN 50MG SUPP $21.00

MESALAMINE 4G/60ML $312.00

MESALAMINE 500MG SUPP $35.00

PHENYL MERCURIC SUPP $17.00

POLYSTYRENE SULF 30GM $100.00

ANUSOL OINT 30GM $16.00

PREPARATION H OINTMENT $66.00

PROCHLORPERAZN 25MG SUPP $19.00

PROMETHAZINE 12.5MG SUPP $28.00

PROMETHAZINE 25MG SUPP $18.00

PROMETHAZINE 50MG SUPP $19.00

TRIMETHOBENZ 100MG SUPP $17.00

TRIMETHOBENZ 200 MG SUPP $17.00

DIMETHYL SULFOX 50% 50ML $450.01

IOTHALAMATE MEG 60% 50ML $2,530.00

VANCOMYCIN HCL 2GM/120ML ORAL SOL $13.00

VANCOMYCIN HCL 5GM BULK $373.00

COMPLEAT-MODIF 250ML $72.00

ENSURE PLUS HN 240ML $76.00

ENSURE PLUS LIQUID 8OZ $67.00

GLUCERNA RTH 1000ML $122.00

GLUCERNA OS 8OZ $66.00

INTROLITE RTH $94.00

JEVITY RTH 1000ML $121.00

LACTASE ENZYME $21.00

NEPRO 240ML $72.00

NUTRIHEP 250ML $105.00

OSMOLITE HN RTH 1000ML $96.00

OSMOLITE RTH 1000ML $91.00

PERATIVE 240ML $76.00

PERATIVE RTH 1000ML $122.00

PEDIALYTE 960 ML $102.00

PEPTINEX DT 1000ML $171.00

PROMOTE RTH 1000ML $76.00

PROPAC POWDER 8G $64.00

PULMOCARE 240ML $64.00

PULMOCARE RTH 1000ML $108.00

LOCM < = 149MG/ML ID 1ML $20.00

LOCM 150-199MG/ML ID 1ML $20.00

LOCM 200-249MG/ML ID 1ML $20.00

LOCM 250-299MG/ML ID 1ML $20.00

LOCM 300-349MG/ML ID 1ML $20.00

LOCM 350-399MG/ML ID 1ML $20.00

LOCM > = 400MG/ML ID 1ML $20.00

MR CONTRAST GAD BASE 1ML $33.00

PROHANCE PER ML $13.00

Page 86: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TYROPANOATE SOD 750MG $39.00

ALCOH0L 5% D5% 1000ML $245.00

DEXTRAN 40 D5W 500ML $347.00

DEXTRAN 40 NACL .9 500ML $347.00

D5 LRINGERS 1000ML $132.00

D5 LRINGERS 500ML $121.00

D5 RINGERS 1000ML $297.00

D5 NACL.2 1000ML $132.00

D5 NACL.2 KCL 20 1000ML $553.00

D5 NACL.2 KCL 30 1000ML $564.00

D5 NACL.45 1000ML $132.00

D5 NACL .45 KCL 10 1L $318.00

D5 NACL.45 KCL 20 1000ML $132.00

D5 NACL .45 KCL 30 1L $553.00

D5 NACL .45 KCL 40 1L $553.00

D5 NACL .9 KCL 20 1L $319.00

D5 NACL.9 1000ML $132.00

D5W 50ML $265.00

D5W 100ML $132.00

D5W 150ML $251.00

D5W 250ML $246.00

D5W 500ML $132.00

D5W 1000ML $132.00

D10W 1000ML $77.00

D5 KCL 20 1L $198.00

L RINGERS 1000ML $146.00

MANNITOL 20% 500ML $356.00

L RINGERS 500ML $112.00

NORMOSOL-R PH7.4 1L $267.00

NACL .45 50ML $274.00

NACL .45 500ML SOL $133.00

NACL .45 1000ML $148.00

NACL .9 50ML $251.00

NACL .9 100ML $72.00

NACL .9 150ML $231.00

NACL .9 250ML $132.00

NACL .9 500ML $132.00

NACL .9 1000ML $291.00

NACL 3% 500ML $76.00

NACL 5% 500ML $250.00

NACL .9% 1L 20 KCL $253.00

NACL .45% 1L 20KCL $221.00

PLASMALYTE A 1000ML $267.00

STERILE WATER 1000ML $297.00

STERILE WATER 2000ML $246.00

TPN 1000ML $1,470.00

TPN 500ML $802.00

Page 87: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

Amino Acids/D10W 4.25%-10% 1000ml IV Sol $215.00

AA 10% 1000ML $2,096.00

Amino Acids/D20W 4.25%-20% 1000ml IV Sol $189.00

Amino Acids/D10W 4.25%-10% 2000ml IV Sol $577.00

Amino Acids/CA/Lytes/D10W 4.25%-10% 2000 $579.00

Amino Acids/D15W 5%-15% 2000ml IV Sol $591.00

Amino Acids/D20W 5%-20% 2000ml IV Sol $591.00

Amino Acis/Cal/Lytes-TPN/D20W 2000ml IV $593.00

AMINO ACID 4.75%/ 5% DEXTR 2000ML IV SOL $232.00

AMINO ACIDS 4.25%W5%D 1L IV SO $232.00

DOPAMINE 800MG PMX 250ML $529.00

FAT EMULSION 10% 250ML $179.00

FAT EMULSION 10% 500ML $361.00

FAT EMULSION 20% 250ML $221.00

FAT EMULSION 20% 500ML $563.00

ACETIC ACID.25% IRR 1L $59.00

L RINGERS IRR 1000ML $57.00

NACL .9 IRR 1000ML $269.00

NACL .9 IRR 2000ML $246.00

NACL .9 IRR 3000ML $246.00

SORBITOL 3% 3000ML IRR $147.00

STERILE WATER IRR 1000ML $360.00

STERILE WATER IRR 2000ML $35.00

ST IV PCA VIAL $144.00

ST IRG CYS TUR $59.00

ST ADM P-D Y $41.00

ST IV EXT 2 $68.00

CATH IV A/S $21.00

ST IV ADM $232.00

ADPT CAP LL $12.00

BG BLD WRMR $409.00

ST BLD Y $190.00

ST BLD Y $38.00

CATH IV CUTDOWN $22.00

LINE IV INFUS $72.00

ST ADM NTG $185.00

ST VOLUMETRC PMP SOL $211.00

CATH IV JELCO $26.00

REAGENT STRIP $24.00

ABG W/CALC O2 SAT $615.00

ARTERIAL PUNCTURE FOR BLOOD GAS $191.00

ATTENDANCE AT DELIVERY $178.00

AER TX DEMO AND/OR EVAL $393.00

AEROSOL TREATMENT $308.00

HHN TX DEMO AND/OR EVAL $343.00

HAND HELD NEB TREATMENT $330.00

CONT HHN 1ST HOUR $435.00

Page 88: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CONT HHN TX ADD'L HR $316.00

TRACHEOTOMY TUBE CHANGE $248.00

CPR $1,485.00

NEONATAL (NB) RESUSCIATION $1,485.00

EMERGENCY INTUBATION $503.00

SPTM IND $343.00

IPPB TX $285.00

IPPB TX DEMO AND/OR EVAL $343.00

BIPAP INIT/MGMT $4,908.00

VOLUME VENTILATOR INTL $5,060.00

BRONCH ASPIRATN INITIAL $3,102.00

OXYGEN HOURS $94.00

OXYGEN DAILY $2,244.00

FLOW VOLUME LOOPS $525.00

SPIRO SCREEN $418.00

SPIROMETRY $720.00

BRONCHOSPASM EVAL PRE/PS $940.00

DIFFUSION CAPACITY $394.00

THORACIC GAS VOLUME $1,558.00

AIRWAY RESISTANCE $967.00

MEP/MIP $394.00

FUNCTIONAL RESID CAPAC $2,189.00

MDI DEMO AND/OR EVAL $567.00

MDI TREATMENT $308.00

PULSE OX EXER TOL $531.00

PULMONARY STRESS TEST/SIMPLE $197.00

PULSE OX SINGLE $159.00

VITAL CAPACITY $394.00

PH PLEURAL FLUID $336.00

VENT SUBSEQ/DLY $4,635.00

BIPAP MGMT DLY/SUBSEQ $4,353.00

CHST WALL MANIPULATN INI $371.00

CHST WALL MANIPULATN SUB $283.00

MECHANICAL CHEST WALL OSCIL $194.00

BLOOD GAS PH ONLY $541.00

OP CAPD $1,073.00

UNSCHED DIAL ESRD PT $1,110.00

THERAPEUTIC APHERESIS $3,142.00

INPATIENT PERITONEAL (NON-CAPD) $832.00

IP CAPD $1,073.00

HEMOFILTRATION $1,650.00

HEMODIAL RENL FAIL $4,099.00

HEMODIALYSIS PERFUSION $2,134.00

PT MANUAL THERAPY EA 15M $147.00

PT E-STIM MANUAL 15 BSC $112.00

PT THER EX EA 15 $87.00

PT THER EX EA 15 #2 $96.00

Page 89: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PT NEUROMUSC RE-ED EA15 $177.00

PT THERAPEUTC ACT EA 15 $129.00

PT THERAPEUTC ACT EA15#2 $241.00

PT COMM/WK REINT TRN EA1 $194.00

PT GRP 1 THER PROC 2+ $129.00

PT WP ATTEND EA 15 BSC $186.00

PT GAIT/STR TRN EA 15 $155.00

PT GAIT/STR TRN EA15 #2 $267.00

PT WHLCHR TRN EA 15 $128.00

PT HOT OR COLD PACKS THERAPY $136.00

PT EVAL LOW COMPLEX 20 MIN $371.00

PT EVAL MOD COMPLEX 30MIN $391.00

PT EVAL HIGH COMPLEX 45 MIN $410.00

PT RE-EVAL EST PLAN CARE $227.00

PT AST TECH ASSES EA 15 $210.00

PT-CH MOBILITY CURRENT STATUS $1.00

PT-CH MOBILITYGOAL STATUS $1.00

PT-CH MOBILITY D/C STATUS $1.00

PT-CH BODY POS CURRENT STATUS $1.00

PT-CH BODY POS GOAL STATUS $1.00

PT-CH BODY POS D/C STATUS $1.00

PT-CH CARRY CURRENT STATUS $1.00

PT-CH CARRY GOAL STATUS $1.00

PT-CH CARRY D/C STATUS $1.00

PT-CH SELF CARE CURRENT STATUS $1.00

PT-CH SELF CARE GOAL STATUS $1.00

PT-CH SELF CARE D/C STATUS $1.00

PT-CH OTHER CURRENT STATUS $1.00

PT-CH OTHER GOAL STATUS $1.00

PT-CH OTHER D/C STATUS $1.00

PT-CH SUB CURRENT STATUS $1.00

PT-CH SUB GOAL STATUS $1.00

PT-CH SUB D/C STATUS $1.00

PT-CI MOBILITY CURRENT STATUS $1.00

PT-CI MOBILITY GOAL STATUS $1.00

PT-CI MOBILITY D/C STATUS $1.00

PT-CI BODY POS CURRENT STATUS $1.00

PT-CI BODY POS GOAL STATUS $1.00

PT-CI BODY POS D/C STATUS $1.00

PT-CI CARRY CURRENT STATUS $1.00

PT-CI CARRY GOAL STATUS $1.00

PT-CI CARRY D/C STATUS $1.00

PT-CI SELF CARE CURRENT STATUS $1.00

PT-CI SELF CARE GOAL STATUS $1.00

PT-CI SELF CARE D/C STATUS $1.00

PT-CI OTHER CURRENT STATUS $1.00

PT-CI OTHER GOAL STATUS $1.00

Page 90: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PT-CI OTHER D/C STATUS $1.00

PT-CI SUB CURRENT STATUS $1.00

PT-CI SUB GOAL STATUS $1.00

PT-CI SUB D/C STATUS $1.00

PT-CJ MOBILITY CURRENT STATUS $1.00

PT-CJ MOBILITY GOAL STATUS $1.00

PT-CJ MOBILITY D/C STATUS $1.00

PT-CJ BODY POS CURRENT STATUS $1.00

PT-CJ BODY POS GOAL STATUS $1.00

PT-CJ BODY POS D/C STATUS $1.00

PT-CJ CARRY CURRENT STATUS $1.00

PT-CJ CARRY GOAL STATUS $1.00

PT-CJ CARRY D/C STATUS $1.00

PT-CJ SELF CARE CURRENT STATUS $1.00

PT-CJ SELF CARE GOAL STATUS $1.00

PT-CJ SELF CARE D/C STATUS $1.00

PT-CJ OTHER CURRENT STATUS $1.00

PT-CJ OTHER GOAL STATUS $1.00

PT-CJ OTHER D/C STATUS $1.00

PT-CJ SUB CURRENT STATUS $1.00

PT-CJ SUB GOAL STATUS $1.00

PT-CJ SUB D/C STATUS $1.00

PT-CK MOBILITY CURRENT STATUS $1.00

PT-CK MOBILITY GOAL STATUS $1.00

PT-CK MOBILITY D/C STATUS $1.00

PT-CK BODY POS CURRENT STATUS $1.00

PT-CK BODY POS GOAL STATUS $1.00

PT-CK BODY POS D/C STATUS $1.00

PT-CK CARRY CURRENT STATUS $1.00

PT-CK CARRY GOAL STATUS $1.00

PT-CK CARRY D/C STATUS $1.00

PT-CK SELF CARE CURRENT STATUS $1.00

PT-CK SELF CARE GOAL STATUS $1.00

PT-CK SELF CARE D/C STATUS $1.00

PT-CK OTHER CURRENT STATUS $1.00

PT-CK OTHER GOAL STATUS $1.00

PT-CK OTHER D/C STATUS $1.00

PT-CK SUB CURRENT STATUS $1.00

PT-CK SUB GOAL STATUS $1.00

PT-CK SUB D/C STATUS $1.00

PT-CL MOBILITY CURRENT STATUS $1.00

PT-CL MOBILITY GOAL STATUS $1.00

PT-CL MOBILITY D/C STATUS $1.00

PT-CL BODY POS CURRENT STATUS $1.00

PT-CL BODY POS GOAL STATUS $1.00

PT-CL BODY POS D/C STATUS $1.00

PT-CL CARRY CURRENT STATUS $1.00

Page 91: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PT-CL CARRY GOAL STATUS $1.00

PT-CL CARRY D/C STATUS $1.00

PT-CL SELF CARE CURRENT STATUS $1.00

PT-CL SELF CARE GOAL STATUS $1.00

PT-CL SELF CARE D/C STATUS $1.00

PT-CL OTHER CURRENT STATUS $1.00

PT-CL OTHER GOAL STATUS $1.00

PT-CL OTHER D/C STATUS $1.00

PT-CL SUB CURRENT STATUS $1.00

PT-CL SUB GOAL STATUS $1.00

PT-CL SUB D/C STATUS $1.00

PT-CM MOBILITY CURRENT STATUS $1.00

PT-CM MOBILITY GOAL STATUS $1.00

PT-CM MOBILITY D/C STATUS $1.00

PT-CM BODY POS CURRENT STATUS $1.00

PT-CM BODY POS GOAL STATUS $1.00

PT-CM BODY POS D/C STATUS $1.00

PT-CM CARRY CURRENT STATUS $1.00

PT-CM CARRY GOAL STATUS $1.00

PT-CM CARRY D/C STATUS $1.00

PT-CM SELF CARE CURRENT STATUS $1.00

PT-CM SELF CARE GOAL STATUS $1.00

PT-CM SELF CARE D/C STATUS $1.00

PT-CM OTHER CURRENT STATUS $1.00

PT-CM OTHER GOAL STATUS $1.00

PT-CM OTHER D/C STATUS $1.00

PT-CM SUB CURRENT STATUS $1.00

PT-CM SUB GOAL STATUS $1.00

PT-CM SUB D/C STATUS $1.00

PT-CN MOBILITY CURRENT STATUS $1.00

PT-CN MOBILITY GOAL STATUS $1.00

PT-CN MOBILITY D/C STATUS $1.00

PT-CN BODY POS CURRENT STATUS $1.00

PT-CN BODY POS GOAL STATUS $1.00

PT-CN BODY POS D/C STATUS $1.00

PT-CN CARRY CURRENT STATUS $1.00

PT-CN CARRY GOAL STATUS $1.00

PT-CN CARRY D/C STATUS $1.00

PT-CN SELF CARE CURRENT STATUS $1.00

PT-CN SELF CARE GOAL STATUS $1.00

PT-CN SELF CARE D/C STATUS $1.00

PT-CN OTHER CURRENT STATUS $1.00

PT-CN OTHER GOAL STATUS $1.00

PT-CN OTHER D/C STATUS $1.00

PT-CN SUB CURRENT STATUS $1.00

PT-CN SUB GOAL STATUS $1.00

PT-CN SUB D/C STATUS $1.00

Page 92: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PT MANUAL THERAPY $147.00

PT E-STIM MANUAL 15 BSC $112.00

PT US EA 15 BSC $112.00

PT THER EX EA 15 $87.00

PT THER-EX EA 15 #2 $96.00

PT NEUROMUSC RE-ED EA 15 $177.00

PT THERAPUTIC ACT EA 15 $129.00

PT THERAPUTC ACT EA 15#2 $241.00

PT COMM/WK REINT TR EA1 $194.00

PT GRP I THER PROC 2+ $129.00

PT WP ATTEND EA 15 BSC $186.00

PT GAIT/STR TRN EA 15 $155.00

PT GAIT/STR TRN EA 15 #2 $267.00

PT WHLCHR TRN EA 15 $128.00

PT HOT OR COLD PACKS THERAPY $136.00

PT EVAL LOW COMPLEX 20 MIN $371.00

PT EVAL MOD COMPLEX 30MIN $391.00

PT EVAL HIGH COMPLEX 45 MIN $410.00

PT RE-EVAL EST PLAN CARE $227.00

PT AST TECH ASSESS EA 15 $231.00

OT MANUAL THERAPY EA 15M $139.00

OT PARAFFIN BATH BSC $149.00

OT WHIRLPOOL BSC $277.00

OT E-STIM MAN EA 15 BSC $106.00

OT IONTOPHOR EA 15 BSC $119.00

OT CONT BATH EA 15 BSC $102.00

OT US EA 15 BASIC $106.00

OT THERAPTC EXER EA 15 $83.00

OT THERAPTC EXER EA15 #2 $91.00

OT NEUROMUSC RE-EDUC EA1 $168.00

OT THERAPTC MASSGE EA15 $149.00

OT THERAPTC ACT EA 15 $122.00

OT THERAPTC ACT EA 15 #2 $229.00

OT SLF CARE HM MGMT EA15 $163.00

OT SLF CARE HM MGMT 15#2 $270.00

OT COMM/WK REINT TRNG 15 $185.00

ORTHO FIT/TRN EA 15 MIN $193.00

OT GRP 1 THER PROC 2+ $122.00

OT HOT OR COLD PACKS THERAPY $136.00

OT EVAL LOW COMPLEX 30 MIN $371.00

OT EVAL MOD COMPLEX 45 MIN $371.00

OT EVAL HIGH COMPLEX 60 MIN $410.00

OT RE-EVAL EST PLAN CARE $227.00

OT COG SKL DEV EA 15 $136.00

OT SENSRY INTRGRN EA15 $136.00

STD COG PERF TEST PER HR $638.00

OT-CH MOBILITY CURRENT STATUS $1.00

Page 93: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

OT-CH MOBILITY GOAL STATUS $1.00

OT-CH MOBILITY D/C STATUS $1.00

OT-CH BODY POS CURRENT STATUS $1.00

OT-CH BODY POS GOAL STATUS $1.00

OT-CH BODY POS D/C STATUS $1.00

OT-CH CARRY CURRENT STATUS $1.00

OT-CH CARRY GOAL STATUS $1.00

OT-CH CARRY D/C STATUS $1.00

OT-CH SELF CARE CURRENT STATUS $1.00

OT-CH SELF CARE GOAL STATUS $1.00

OT-CH SELF CARE D/C STATUS $1.00

OT-CH OTHER CURRENT STATUS $1.00

OT-CH OTHER GOAL STATUS $1.00

OT-CH OTHER GOAL D/C STATUS $1.00

OT-CH SUB CURRENT STATUS $1.00

OT-CH SUB GOAL STATUS $1.00

OT-CH SUB D/C STATUS $1.00

OT-CI MOBILITY CURRENT STATUS $1.00

OT-CI MOBILITY GOAL STATUS $1.00

OT-CI MOBILITY D/C STATUS $1.00

OT-CI BODY POS CURRENT STATUS $1.00

OT-CI BODY POS GOAL STATUS $1.00

OT-CI BODY POS D/C STATUS $1.00

OT-CI CARRY CURRENT STATUS $1.00

OT-CI CARRY GOAL STATUS $1.00

OT-CI CARRY D/C STATUS $1.00

OT-CI SELF CARE CURRENT STATUS $1.00

OT-CI SELF CARE GOAL STATUS $1.00

OT-CI SELF CARE D/C STATUS $1.00

OT-CI OTHER CURRENT STATUS $1.00

OT-CI OTHER GOAL STATUS $1.00

OT-CI OTHER D/C STATUS $1.00

OT-CI SUB CURRENT STATUS $1.00

OT-CI SUB GOAL STATUS $1.00

OT-CI SUB D/C STATUS $1.00

OT-CJ MOBILITY CURRENT STATUS $1.00

OT-CJ MOBILITY GOAL STATUS $1.00

OT-CJ MOBILTY D/C STATUS $1.00

OT-CJ BODY POS CURRENT STATUS $1.00

OT-CJ BODY POS GOAL STATUS $1.00

OT-CJ BODY POS D/C STATUS $1.00

OT-CJ CARRY CURRENT STATUS $1.00

OT-CJ CARRY GOAL STATUS $1.00

OT-CJ CARRY D/C STATUS $1.00

OT-CJ SELF CARE CURRENT STATUS $1.00

OT-CJ SELF CARE GOAL STATUS $1.00

OT-CJ SELF CARE D/C STATUS $1.00

Page 94: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

OT-CJ OTHER CURRENT STATUS $1.00

OT-CJ OTHER GOAL STATUS $1.00

OT-CJ OTHER D/C STATUS $1.00

OT-CJ SUB CURRENT STATUS $1.00

OT-CJ SUB GOAL STATUS $1.00

OT-CJ SUB D/C STATUS $1.00

OT-CK MOBILITY CURRENT STATUS $1.00

OT-CK MOBILITY GOAL STATUS $1.00

OT-CK MOBILITY D/C STATUS $1.00

OT-CK BODY POS CURRENT STATUS $1.00

OT-CK BODY POS GOAL STATUS $1.00

OT-CK BODY POS D/C STATUS $1.00

OT-CK CARRY CURRENT STATUS $1.00

OT-CK CARRY GOAL STATUS $1.00

OT-CK CARRY D/C STATUS $1.00

OT-CK SELF CARE CURRENT STATUS $1.00

OT-CJ SELF CARE GOAL STATUS $1.00

OT-CK SELF CARE D/C STATUS $1.00

OT-CK OTHER CURRENT STATUS $1.00

OT-CK OTHER GOAL STATUS $1.00

OT-CK OTHER D/C STATUS $1.00

OT-CK SUB CURRENT STATUS $1.00

OT-CK SUB GOAL STATUS $1.00

OT-CK SUB D/C STATUS $1.00

OT-CL MOBILITY CURRENT STATUS $1.00

OT-CL MOBILITY GOAL STATUS $1.00

OT-CL MOBILITY D/C STATUS $1.00

OT-CL BODY POS CURRENT STATUS $1.00

OT-CL BODY POS GOAL STATUS $1.00

OT-CL BODY POS D/C STATUS $1.00

OT-CL CARRY CURRENT STATUS $1.00

OT-CL CARRY GOAL STATUS $1.00

OT-CL CARRY D/C STATUS $1.00

OT-CL SELF CARE CURRENT STATUS $1.00

OT-CL SELF CARE GOAL STATUS $1.00

OT-CL SELF CARE D/C STATUS $1.00

OT-CL OTEHR CURRENT STATUS $1.00

OT-CL OTHER GOAL STATUS $1.00

OT-CL OTHER D/C STATUS $1.00

OT-CL SUB CURRENT STATUS $1.00

OT-CL SUB GOAL STATUS $1.00

OT-CL SUB D/C STATUS $1.00

OT-CM MOBILITY CURRENT STATUS $1.00

OT-CM MOBILITY GOAL STATUS $1.00

OT-CM MOBILITY D/C STATUS $1.00

OT-CM BODY POS CURRENT STATUS $1.00

OT-CM BODY POS GOAL STATUS $1.00

Page 95: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

OT-CM BODY POS D/C STATUS $1.00

OT-CM CARRY CURRENT STATUS $1.00

OT-CM CARRY GOAL STATUS $1.00

OT-CM CARRY D/C STATUS $1.00

OT-CM SELF CARE CURRENT STATUS $1.00

OT-CM SELF CARE GOAL STATUS $1.00

PT-CM SELF CARE D/C STATUS $1.00

OT-CM OTHER CURRENT STATUS $1.00

OT-CM OTHER COAL STATUS $1.00

OT-CM OTHER D/C STATUS $1.00

OT-CM SUB CURRENT STATUS $1.00

OT-CM SUB GOAL STATUS $1.00

OT-CM SUB D/C STATUS $1.00

OT-CN MOBILITY CURRENT STATUS $1.00

OT-CN MOBILITY GOAL STATUS $1.00

OT-CN MOBILITY D/C STATUS $1.00

OT-CN BODY POS CURRENT STATUS $1.00

OT-CN BODY POS GOAL STATUS $1.00

OT-CN BODY POS D/C STATUS $1.00

OT-CN CARRY CURRENT STATUS $1.00

OT-CN CARRY GOAL STATUS $1.00

OT-CN CARRY D/C STATUS $1.00

OT-CN SELF CARE CURRENT STATUS $1.00

OT-CN SELF CARE GOAL STATUS $1.00

OT-CN SELF CARE D/C STATUS $1.00

OT-CN OTHER CURRENT STATUS $1.00

OT-CN OTHER GOAL STATUS $1.00

OT-CN OTHER D/C STATUS $1.00

OT-CN SUB CURRENT STATUS $1.00

OT-CN SUB GOAL STATUS $1.00

OT-CN SUB D/C STATUS $1.00

OT MANUAL THER EA 15MIN $139.00

OT PARAFFIN BATH BSC $149.00

OT WHIRLPOOL BSC $277.00

OT E-STIM MAN EA 15 BSC $106.00

OT IONTOPHOR EA 15 BSC $119.00

OT CONTR BATH EA 15 MIN $102.00

OT US EA 15 BSC $106.00

OT THERAPT EX EA 15' $83.00

OT THERAPTC EXER EA 15#2 $91.00

OT NEUROMUSC RE-ED EA 15 $168.00

OT THERAPTC ACT EA 15' $122.00

OT THERAPT ACT EA 15'#2 $229.00

OT SLF CAREHM MGMT EA 15 $163.00

OT SLF CARE HM MGT 15#2 $270.00

OT COMM/WK REINT TRNG 15 $185.00

OT ORTH FIT/TRN EA 15' $190.00

Page 96: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

UE ORTHOTICS FITTING $193.00

OT GRP 1THER PROC 2+ $122.00

OT HOT OR COLD PACKS THERAPY $136.00

OT EVAL LOW COMPLEX 30 MIN $371.00

OT EVAL MOD COMPLEX 45 MIN $391.00

OT EVAL HIGH COMPLEX 60 MIN $410.00

OT RE-EVAL EST PLAN CARE $227.00

OT COG SKL DEV EA 15' $136.00

OT SENSORY INTEG EA 15' $136.00

NEUROBEHV STATUS EXAM/HR $794.00

SP SWAL/ORAL TX BASIC $333.00

SP SPEECH/LANG IND $266.00

EVALUATION OF SPEECH FLUENCY $413.00

EVALUATE SPEECH PRODUCTION $413.00

SPEECH SOUND LANG COMPREHEN $825.00

BEHAVRAL QUALIT ANALYS VOICE $413.00

SP SWAL EVAL PHARYN LTD $545.00

SP EVAL CINE VIDEO $145.00

ST-CN SWALLOW CURRENT STATUS $1.00

ST-CN SWALLOW GOAL STATUS $1.00

ST-CN SWALLOW D/C STATUS $1.00

ST-CN MOTOR SPEECH CURRENT STATUS $1.00

ST-CN MOTOR SPEECH GOAL STATUS $1.00

ST-CN MOTOR SPEECH D/C STATUS $1.00

ST-CN LANG COMP CURRENT STATUS $1.00

ST-CN LANG COMP GOAL STATUS $1.00

ST-CN LANG COMP D/C STATUS $1.00

ST-CN LANG EXPRESS CURRENT STATUS $1.00

ST-CN LANG EXPRESS GOAL STATUS $1.00

ST-CN LANG EXPRESS D/C STATUS $1.00

ST-CN ATTEN CURRENT STATUS $1.00

ST-CN ATTEN GOAL STATUS $1.00

ST-CN ATTEN D/C STATUS $1.00

ST-CN MEMORY CURRENT STATUS $1.00

ST-CN MEMORY GOAL STATUS $1.00

ST-CN MEMORY D/C STATUS $1.00

ST-CN VOICE CURRENT STATUS $1.00

ST-CN VOICE GOAL STATUS $1.00

ST-CN VOICE D/C STATUS $1.00

ST-CN SPEECH LAND CURRENT STATUS $1.00

ST-CN SPEECH LANG GOAL STATUS $1.00

ST-CN SPEECH LANG D/C STATUS $1.00

ST-CH SWALLOW CURRENT STATUS $1.00

ST-CH SWALLOW GOAL STATUS $1.00

ST-CH SWALLOW D/C STATUS $1.00

ST-CH MOTOR SPEECH CURRENT STATUS $1.00

ST-CH MOTOR SPEECH GOAL STATUS $1.00

Page 97: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ST-CH MOTOR SPEECH D/C STATUS $1.00

ST-CH LANG COMP CURRENT STATUS $1.00

ST-CH LANG COMP GOAL STATUS $1.00

ST-CH LANG COMP D/C STATUS $1.00

ST-CH LANG EXPRESS CURRENT STATUS $1.00

ST-CH LANG EXPRESS GOAL STATUS $1.00

ST-CH LANG EXPRESS D/C STATUS $1.00

ST-CH ATTEN CURRENT STATUS $1.00

ST-CH ATTEN GOAL STATUS $1.00

ST-CH ATTEN D/C STATUS $1.00

ST-CH MEMORY CURRENT STATUS $1.00

ST-CH MOMORY GOAL STATUS $1.00

ST-CH MEMORY D/C STATUS $1.00

ST-CH VOICE CURENT STATUS $1.00

ST-CH VOICE GOAL STATUS $1.00

ST-CH VOICE D/C STATUS $1.00

ST-CH SPEECH LANG CURRENT STATUS $1.00

ST-CH SPEECH LANG GOAL STATUS $1.00

ST-CH SPEECH LANG D/C STATUS $1.00

ST-CI SWALLOW CURRENT STATUS $1.00

ST-CI SWALLOW GOAL STATUS $1.00

ST-CI SWALLOW D/C STATUS $1.00

ST-CI MOTOR SPEECH CURRENT STATUS $1.00

ST-CI MOTOR SPEECH GOAL STATUS $1.00

ST-CI MOTOR SPEECH D/C STATUS $1.00

ST-CI LANG COMP CURRENT STATUS $1.00

ST-CI LANG COMP GOAL STATUS $1.00

ST-CI LANG COMP D/C STATUS $1.00

ST-CI LANG EXPRESS CURRENT STATUS $1.00

ST-CI LANG EXPRESS GOAL STATUS $1.00

ST-CI LANG EXPRESS D/C STATUS $1.00

ST-CI ATTEN CURRENT STATUS $1.00

ST-CI ATTEN GOAL STATUS $1.00

ST-CI ATTEN D/C STATUS $1.00

ST-CI MEMORY CURRENT STATUS $1.00

ST-CI MOMORY GOAL STATUS $1.00

ST-CI MEMORY D/C STATUS $1.00

ST-CI VOICE CURRENT STATUS $1.00

ST-CI VOICE GOAL STATUS $1.00

ST-CI VOICE D/C STATUS $1.00

ST-CI SPEECH LANG CURRENT STATUS $1.00

ST-CI SPEECH LANG GOAL STATUS $1.00

ST-CI SPEECH LANG D/C STATUS $1.00

ST-CJ SWALLOW CURRENT STATUS $1.00

ST-CJ SWALLOW GOAL STATUS $1.00

ST-CJ SWALLOW D/C STATUS $1.00

ST-CJ MOTOR SPEECH CURRENT STATUS $1.00

Page 98: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ST-CJ MOTOR SPEECH GOAL STATUS $1.00

ST-CJ MOTOR SPEECH D/C STATUS $1.00

ST-CJ LANG COMP CURRENT STATUS $1.00

ST-CJ LANG COMP GOAL STATUS $1.00

ST-CJ LANG COMP D/C STATUS $1.00

ST-CJ LAND EXPRESS CURRENT STATUS $1.00

ST-CJ LANG EXPRESS GOAL STATUS $1.00

ST-CJ LANG EXPRESS D/C STATUS $1.00

ST-CJ ATTEN CURRENT STATUS $1.00

ST-CJ ATTEN GOAL STATUS $1.00

ST-CJ ATTEN D/C STATUS $1.00

ST-CJ MEMORY CURENT STATUS $1.00

ST-CJ MEMORY GOAL STATUS $1.00

ST-CJ MEMORY D/C STATUS $1.00

ST-CJ VOICE CURRENT STATUS $1.00

ST-CJ VOICE GOAL STATUS $1.00

ST-CJ VOICE D/C STATUS $1.00

ST-CJ SPEECH LANG CURRENT STATUS $1.00

ST-CJ SPEECH LANG GOAL STATUS $1.00

ST-CJ SPEECH LANG D/C STATUS $1.00

ST-CK SWALLOW CURRENT STATUS $1.00

ST-CK SWALLOW GOAL STATUS $1.00

ST-CK SWALLOW D/C STATUS $1.00

ST-CK MOTOR SPEECH CURRENT STATUS $1.00

ST-CK MOTOR GOAL STATUS $1.00

ST-CJ MOTOR SPEECH D/C STATUS $1.00

ST-CJ LANG COMP CURRENT STATUS $1.00

ST-CK LANG COMP GOAL STATUS $1.00

ST-CK LANG COMP D/C STATUS $1.00

ST-CK LANG EXPRESS CURRENT STATUS $1.00

ST-CK LANG EXPRESS GOAL STATUS $1.00

ST-CK LANG EXPRESS D/C STATUS $1.00

ST-CK ATTEN CURRENT STATUS $1.00

ST-CK ATTEN GOAL STATUS $1.00

ST-CK ATTEN D/C STATUS $1.00

ST-CK MEMORY CURRENT STATUS $1.00

ST-CK MEMORY GOAL STATUS $1.00

ST-CK MEMORY D/C STATUS $1.00

ST-CK VOICE CURRENT STATUS $1.00

ST-CK VOICE GOAL STATUS $1.00

ST-CK VOICE D/C STATUS $1.00

ST-CK SPEECH LANG CURRENT STATUS $1.00

ST-CK SPEECH LANG GOAL STATUS $1.00

ST-CK SPEECH LANG D/C STATUS $1.00

ST-CL SWALLOW CURRENT STATUS $1.00

ST-CL SWALLOW GOAL STATUS $1.00

ST-CL SWALLOW D/C STATUS $1.00

Page 99: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ST-CL MEMORY CURRENT STATUS $1.00

ST-CL MEMORY GOAL STATUS $1.00

ST-CL MEMORY D/C STATUS $1.00

ST-CL VOICE CURRENT STATUS $1.00

ST-CL VOICE GOAL STATUS $1.00

ST-CL VOICE D/C STATUS $1.00

ST-CL SPEECH LANG CURRENT STATUS $1.00

ST-CL SPEECH LANG GOAL STATUS $1.00

ST-CL SPEECH LANG D/C STATUS $1.00

ST-CM SWALLOW CURRENT STATUS $1.00

ST-CM SWALLOW GOAL STATUS $1.00

ST-CM SWALLOW D/C STATUS $1.00

ST-CM MOTOR SPEECH CURRENT STATUS $1.00

ST-CM MOTOR SPEECH GOAL STATUS $1.00

ST-CM MOTOR SPEECH D/C STATUS $1.00

ST-CM LANG COMP CURRENT STATUS $1.00

ST-CM LANG COMP GOAL STATUS $1.00

ST-CM LANG COMP D/C STATUS $1.00

ST-CM LANG EXPRESS CURRENT STATUS $1.00

ST-CM LANG EXPRESS GOAL STATUS $1.00

ST-CM EXPRESS D/C STATUS $1.00

ST-CM ATTEN CURRENT STATUS $1.00

ST-CM ATTEN GOAL STATUS $1.00

ST-CM ATTEN D/C STATUS $1.00

ST-CM MEMORY CURRENT STATUS $1.00

ST-CM MEMORY GOAL STATUS $1.00

ST-CM MEMORY D/C STATUS $1.00

ST-CM VOICE CURRENT STATUS $1.00

ST-CM VOICE GOAL STATUS $1.00

ST-CM VOICE D/C STATUS $1.00

ST-CM SPEECH LANG CURRENT STATUS $1.00

ST-CM SPEECH LANG GOAL STATUS $1.00

ST-CM SPEECH LANG D/C STATUS $1.00

SP SWAL/ORAL TX IND $333.00

SP SPEECH/LANG IND $266.00

EVALUATION OF SPEECH FLUENCY $413.00

EVALUATE SPEECH PRODUCTION $413.00

SPEECH SOUND LANG COMPREHEN $825.00

BEHAVRAL QUALIT ANALYS VOICE $413.00

SP SWAL EVAL PHARYN $545.00

SP EVAL CINE VIDEO $145.00

STD COG PERF TEAT PER HR $638.00

ADMINISTRATION INFLUENZA VACCINE $200.00

ADMINISTRATION OF PNEUMOCOCCAL VACCINE $200.00

ER REVISIT $275.00

ER VISIT LVL I $878.00

ER VISIT LVL II $1,347.00

Page 100: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ER VISIT LVL III $1,819.00

ER VISIT LVL IV $2,356.00

ER VISIT LVL V $2,876.00

IV INF HYDR INIT 31M-1HR $385.00

IV INF HYDR ADDL HOUR $193.00

INJ TX/PROPH/DX ART $629.00

INJ TX/PRPH/DX IVP INIT $629.00

INFUSION/INJECTION OTHER $138.00

CRIT CR-TRAUMA 30-74MIN $2,750.00

CRIT CR-TRAUMA EA ADDL30 $1,100.00

INJ TX/PROPH/DX SQ/IM $88.00

CARDIOVERSION ELECT - ER $1,496.00

IMM ADMIN SNGL/COMBO VAC $63.00

IMM ADM EA ADDL VACCINE $44.00

INJ TX/PRPH/DX IVP EA NA $193.00

INJ TX/PRPH/DX IVP EA AD $220.00

IV INF T/P/D INIT HOUR $385.00

IV INF T/P/D EA ADD HOUR $220.00

IV INF T/P/D EA SEQ INFS $220.00

IV INF T/P/D CONCURRENT $220.00

BLOOD ADMINISTRATION 1 PER DAY $748.00

SURG PROC SINGLE/MINOR $495.00

SURG PROC MULT/INTRMDTE $825.00

SURG PROC EXTENSVE/CMPLX $1,650.00

"URINARY CATH INS, SIMPLE" $220.00

SURG PROC SUBMINOR $17.00

MOD SEDAT 1ST 15MIN $425.00

MOD SEDAT EACH ADDL 15 MIN $425.00

BEHAV CHNG SMOKING 3-10 MIN $150.00

BEHAV CHNG SMOKING > 10 MIN $150.00

BLADDER CATH-SPECIMEN COLLECTION $201.00

OBS CHF/CHP/ASTH 1ST HR $97.00

OBS CHF/CHP/ASTH ADDL HR $97.00

OBS DIRECT ADM P5 MED SU $454.00

OBSERVATION-DIRECT ADMIT $2,876.00

OBS DIRECT ADM P3 ICUCCU $660.00

OBS DIRECT ADM P2 TELE $440.00

OBSERV OBSTETRICS ADD HR $74.00

OBSERV ONCOLOGY 1/HR $1,128.00

OBSERV ONCOLOGY ADD HR $135.00

OBS DIRECT ADM P3 STEPDN $550.00

OBS DIR ADM E&M NP LVL 1 $732.00

OBS DIR ADM E&M NP LVL 2 $732.00

OBS DIR ADM E&M EP LVL 1 $732.00

OBS DIR ADM E&M EP LVL 2 $732.00

PSYCH PT 30 MIN $260.00

PSYTX PT 45 MIN $345.00

Page 101: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PSYTX PT 60 MIN $345.00

FAMILY PSYTX W/PT 50 MIN $345.00

GRP PSYCHTHRPY 30 MIN $137.00

GRP PSYCHTHRPY 45 MIN $206.25

GRP PSYCHTHRPY 60 MIN $275.00

IOP GRP THER 60" NON MCARE $275.00

IOP GRP THER 30" NON MCARE $138.00

IOP GRP THER 45 " NON MCARE $206.25

CHEM DEP GROUP THERAPY $275.00

CHEM DEP GRP IOP NON MCR $275.00

PSYTX PT AND/OR FAMILY 30 MIN $260.00

PSYTX PT AND/OR FAMILY 45 MIN $345.00

PSYTX PT AND/OR FAMILY 60MIN $345.00

E&M NEW/EST PATIENT - MEDICARE $234.00

E&M NEW/EST PATIENT - MEDICARE $234.00

GAD 65 AB $79.56

CARCINOEMBRYONIC ANTIGEN $25.29

"HTLV-I/II ANTIBODY,EIA" $63.00

CORTISOL 24 HR URINE $41.25

MYCOPLASMA PNEUMONIAE AB $12.45

AMEBSIS ENTOMOEB HIST AB $43.00

STONE ANLYSYS W/STONE IM $25.00

LP-PLA2(PLAC{TM}) $178.50

AMIKACIN PEAK $12.03

AMIKACIN TROUGH $12.03

ASPERGILLUS ANTIBODY $32.70

LEGIONELLA CULTURE $25.03

HERPES AB TYPE 1/2 IGG $21.45

HERPES AB TYPE 1/2 IGM $40.88

CMV CULT EXCEPT URINE $149.85

CRYPTOCOCCUS AB $71.00

SUCROSE ACID HEMOLYSIS $67.34

OXALIC ACID 24HR URINE $32.85

CITRIC ACID 24-HR URINE $14.37

RESPIRATORY SYNCYT VIRUS $11.92

PLATELET AB DIRECT FC $19.80

LATEX HEVEA BRAZILIENSIS $41.82

M. pneumoniae Culture $49.74

SJOGRENS SSA SSB AB $58.86

ACTIVATED PROT C-RESISTA $101.66

CRYPTOCOCCUS ANTIBDY CSF $85.20

CRYPTOCOCCUS AG SCR REFX TITER $47.41

CLOZAPINE QNT SNGL $19.53

LAMOTRIGINE $37.17

NUCLEAR MATRIX PROTEINS $69.49

PBG (PORPH DEAMIN ERYTH) $156.00

ACUTE HEPATITIS PANEL $43.83

Page 102: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

SINGLE DRUG QUANT $19.53

MYASTHENIA GRAVIS PANEL $146.89

GABAPENTIN $64.21

PROPAFENONE $62.75

AMIODARONE QUANT $40.98

MEXILETINE LEVEL $54.12

FLECAINIDE $10.39

TRAZADONE $23.99

HALOPERIDOL LEVEL $68.43

DRUG SCREEN, SERUM/PLASMA $360.00

CYCLOSPORINE, BLD,LCMSMS $67.06

SULFONYLUREA-SERUM $59.66

BUPROPION $99.00

CLONAZEPAM $40.28

DRUG TESTING 8-14 $360.00

BRAF MUTATION ANALYSIS $385.00

CYSTIC FIBROSIS SCREEN $196.56

EPIDERMAL GROWTH FACTOR $500.00

STRIATED AB SCR $18.90

PM-SCL ANTIBODY QUEST $44.14

KRAS MUTATION ANALYSIS $265.00

ACETYLCHOLINE RECP BIND $100.11

CATECHOLAMINES(TOT)URINE $19.20

ACTH $21.50

DRUG SCREEN, SERUM/PLASMA $167.30

VOLATILES SNGL CLASS $20.75

ALDOLASE $8.50

ALDOSTERONE LC/MS SERUM $35.00

ALDOSTERONE URINE 24HR $94.28

ALUMINUM $69.21

COCCIDIOIDES AB CF SERUM $13.25

ALPHA FETO PROTEIN SERUM $10.25

AMIKACIN $98.28

ALA(DELTA AMINOLVLN ACID $19.73

DELTA ALA, 24 HR URINE $106.08

ANGIOTENSIN CONV ENZYME $13.85

ANTI HEPARIN ASSOC AB $35.00

HEPARIN INDUCED PLATELET AB $207.21

ARSENIC, BLOOD $61.04

ARSENIC QUANTITATIVE $23.99

BETA-2-MICROGLOBLN URINE $81.90

BETA-2-MICROGLOBLN SERUM $12.50

CORTISOL BINDG GLOB CBG $41.96

CALCITONIN SERUM $58.99

CALCIUM $12.45

ANTI-NEUTRPHL CYTOPLASM $36.00

CALCIUM IONIZED $15.41

Page 103: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

Cardiolipin Ab Screen $98.01

ANTIPHOSPHOLIPID SYNDROME $350.37

CARBOXYHEMOGLOBIN BLOOD $30.20

CAROTENE $42.56

CATECHOLAMINES FRAC $49.26

CERULOPLASMIN $17.23

TOCAINIDE QUANT $70.00

TRIMIPRAMINE $57.00

DEOXYCORTISL 11 $72.60

COPPER $10.88

COPPER URINE 24 HR $39.78

CORTISOL TOTAL SERUM $31.84

CORTISOL, FREE, LC/MS/MS $65.94

CREATINE $5.63

CRYOGLOBULINS QUAN $52.52

CYANIDE $89.75

CYSTATIN C $108.00

CYANOCOBLMN(VIT B12) $33.79

VITAMIN A $49.75

Dengue Fever Ab (IgG,M) $109.75

DEHYDROEPIANDRST SULFATE $28.82

DEHYDROEPIANDRSTRONE $63.38

LEVETIRACETAM $65.25

DIGITOXIN $45.15

VIT D 1 25-DIHYDROXY $47.52

EPSTEIN-BARR VIRUS ANTIBODY PNL $27.75

ERYTHROPOIETIN $15.50

ESTRADIOL ULTRSENSITIVE $83.05

ESTROGENS TOTAL SERUM $40.55

ESTRADIOL, FREE, LC/MS/MS $173.00

ESTRONE $28.18

ETHOSUXIMIDE $14.64

FAT OR LIPID FECES QUANT $31.68

FLUPHENAZINE $49.87

FLUCYTOSINE(5-FLURCYTSN) $85.60

FOLIC ACID $38.69

FOLIC ACID RBC $56.20

GASTRIN $20.52

GASTRIC PARIETAL CELL AB $29.12

GLUCAGON $56.13

G6PD QUANT $14.64

FRUCTOSAMINE $20.49

ZONISAMIDE $99.00

HEMOGLOBIN GLYCATED $6.49

IODINE, SERUM/PLASMA $72.96

FOLLICLE STIMLAT HORMONE $21.71

LUTEINING HORMONE $9.62

Page 104: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

GROWTH HORMONE(HGH) $30.08

INFLUENZA A H1N1 RT-PCR $195.00

B. pertussis/para PCR $340.00

PARAINFLUENZA V AG DETECT $73.70

PARAINFLUENZA 1,2,3 RNA $426.00

MYCOBAC PCR, CULT & SMR $245.49

HAPTOGLOBIN $26.41

GONADTOPN CHORNC(HCG)QNT $16.11

HEAVY METAL SCREEN URIN $166.81

HEAVY METAL SCRN BLOOD $125.14

HEMOGLOBINOPATHY EVALUAT $27.50

HEMOGLOBN FETAL CHEMICAL $10.39

HEMOGLOBIN PLASMA $32.70

FACTOR V CLOTTING $76.29

IGG SUBCLASS 4 $29.43

KIDNEY STONE ANALYSIS $47.36

FACTOR XI ACTIVITY, CLOTTING $150.91

HISTAMINE $35.43

HOMOCYSTINE QUANT $22.00

HOMOVNLLC ACID(HVA) $23.64

HCS 17-OHCS $20.08

HCS URINE 17-OHCS $20.08

HYDRXINDOL ACD5(HIAA)QT $42.15

HYDRXYPRGSTRONE 17-D $25.73

HYDRXYPROLINE TOTAL $41.28

IG-E SERUM $14.00

TISSUE TRANSGLUTAMINASE ANTIBODY $68.00

LUPUS (SLE) PANEL $188.22

IG-D SERUM $13.67

IMMUNE COMPLEX $45.75

INSULIN TOTAL $19.19

PRO-INSULIN $91.08

KAPPA CHAINS SERUM $59.62

Kappa/Lambda, Free, Serum $84.00

THYROXINE FREE $13.47

TRIIODTHYRNINE TOTAL T3 $23.00

TRYPTASE $61.04

T3 FREE $14.50

KETOGENIC STEROIDS FRACT $15.13

KETOSTEROID 17 TOTAL $11.44

CYC CITRULLINATED PEP AB $45.00

LIDOCAINE - XYLOCAINE $89.70

LDH-ISOENZYMES ELCTROPHR $35.97

LEAD QUAL $9.41

LEAD QUANTITATIVE $15.60

LEAD QUANT URINE $9.41

L/S RATIO AMNIOTIC FLUID $104.30

Page 105: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LAP-LEUCNE AMINO-PPTIDSE $33.79

LIPOPROTEIN BLD ELP QN $12.49

LIVER KIDNEY MICROSOME ANTIBODY $34.17

VERY LOW DENSITY LIPOPRO $3.70

LITHIUM $5.29

MAGNESIUM URINE 24HR $44.73

MAGNESIUM U RANDOM QUEST $44.73

OXCARBAZEPINE METABOLITE $37.00

MERCURY QUANTITATIVE $48.50

MERCURY QUANTATIVE URINE $20.36

METANEPHRINES $34.90

METANEPHRINES, FRACT FREE $131.44

METHYLMALONIC ACID $38.00

METHOTREXATE QUANT $18.62

MYOGLOBIN SERUM $51.77

MYOGLOBIN URINE $41.46

Mycobacteria ID $116.20

PTH INTACT $20.17

DISOPYRAMIDE $15.13

NUCLEOTIDASE 5- $54.35

HIV-1 RNA QUANT RT-PCR $175.00

Norovirus RNA, RT-PCR $215.00

PTH INTACT BY IRMA $82.28

PTH C-TERMINAL $27.68

M TUBERCULOSIS, PCR, NON RESP $99.73

ASSAY ORGANIC ACIDS QNT $134.00

OLIGOCLONAL BANDS $18.90

OLIGOCLONAL BANDS, IGG $28.69

PARIETAL CELL AB TITER $17.50

PAROXETINE QNT $63.36

C-PEPTIDE $12.75

ANTI-MULLERIAN HORMONE $102.00

PHOSPHATASE ACID TOTAL $8.02

GLOM BSMNT MEM AB IGG $33.00

PROSTATE SPEC ANTI-PSA $36.51

PROSTATIC ACID PHOS $9.76

PHOSPHATASE HEAT STABLE $15.42

PHOSPHATASE ISO ALK $12.27

PNEUMOCYSTIS CARINII $64.93

PORPHOBILINOGN URINE QL $10.39

PORPHOBILIN UR QN $26.70

PORPHYRN QUANT/FRACT $43.05

PORPHYRINS, FRACT, RAND UR $43.05

PRIMIDONE $62.00

PROGESTERONE $31.86

PROGESTERONE, LC/MS/MS $49.63

PROLACTIN $13.47

Page 106: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

PROPRANOLOL QUANT $14.02

PROTIEN S ACTIVITY $95.31

PROTEIN ELCTRC SERUM QN $9.79

PRE-ALBUMIN $14.88

PROTEIN ELCTRO URINE $116.48

ERYTHROCYTE PROTOPHORPHYRIN $86.58

PROTRIPTYLENE QUANT $63.40

FLUOXETINE QUANT $16.32

VITAMINE B6 $68.10

PYRUVATE $16.53

PYRUVATE KINASE $58.83

QUINIDINE $21.84

Quantiferon (R)-TB Gold $132.00

VASOACTIVE INTST POLYPEP $41.28

RAJI CELL $103.28

RENIN $16.25

TRIIODTHYRN (T-3) UPTAKE $3.37

SELENIUM $58.86

SCLERODERMA AB SCL-70 $36.93

SEROTONIN $13.53

SHBG $29.37

INSULIN GROWTH FACTOR I $16.25

TESTOSTERONE TOTAL MALE $8.02

TESTOSTERONE URINE TOTL $125.00

TESTOSTERONE FREE $36.00

THER DRUG MON2 $20.96

THIAMINE(VITAMIN B1) $67.50

THIOCYANATE $19.73

THYROXINE TOTAL $3.36

Thyroid Peroxidase Ab $6.17

TSH $8.18

THYRD STIM IMMUNGLBN(TSI $57.20

TROPIRAMATE $51.77

TRANSFERRIN $13.15

TRANSFRN RECPTR SLBLE $26.25

VMA URINE $15.41

VASOPRESSIN (ADH) $100.38

VITAMIN D/25-HYDROXY $44.80

VITAMIN K1 $114.44

XYLOSE ABSORPTION BLOOD $15.13

ZINC QUANTITATIVE SERUM $29.00

ZINC QUANTITATIVE URINE $10.88

CA 27-29 $14.60

CA 19-9 $10.82

REVERSE T3 $68.80

LIPASE 24HR URINE $17.22

CA15-3 $17.34

Page 107: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

C DIFF SCREEN AG $11.16

C DIFFICILE TOXIN A AND B $57.78

FACTOR VIII ACTIVITY, CLOT $26.70

CLOT FCTR VIII RELATE AG $116.01

CLOT FCTR VIII(AHG)1 STG $112.38

FACTR VIII VW AG CO-FCTR $453.24

FCTR VIII VW MLT CO-FCTR $134.64

FACTOR IX ANTIGEN $75.00

FACTOR X ACTIVITY, CLOTTI $76.29

CLOT FCTR XIII(FBRN STB) $242.28

ANTITHROMBIN III ACTIVITY $82.72

LUPUS TYPE ANTICOAGULANT $85.01

CLOT INHIB ANT-THRMBNIII $24.00

PROTEIN C ANTIGEN $17.25

PROTEIN C ACTIVITY $172.65

PROTEIN S TOTAL $17.25

FACTOR VIII INHIBITOR PNL $195.76

FDP/FSP PRECIPITATION $10.39

ADAMTS13 ACTVTY W/RFLX TO INHIBITOR $94.15

FIBRIN MONOMER $81.00

FIBRNOLTIC PLSMNOGEN ACT $130.11

HEINZ BODIES DIRECT $8.02

HEPARIN ASSAY $91.75

INTRINSIC FACTOR ANTIBDY $31.48

LEUKOCYTE ALKA-PHSPHTASE $12.55

PLATELET NEUTRALIZATION $43.35

RUSSL VIPR VEN TIME(DIL) $26.89

REPTILASE TEST $99.00

PTT $26.88

LUPUS ANTICOAGULANT $24.65

PAN-ANCA PLUS $752.00

INFLAMMATORY BOWEL PNL $242.32

ANCA VASCULITIDES $36.00

AGGLUTININS FEBRIL EQ QL $5.44

LE/PARTICLE AGGLUTNATION $9.62

OVA & PARASITES QUEST $43.16

APOLIPOPROTEIN B QUEST $25.00

ANTIBODY ID:PLATELET $13.20

OVA & PARASITES & GIARDIA $75.53

ANCA SCREEN W/REFLEX TO TITER $100.00

HETEROPHILE TITER $7.18

Antiphospholipid Ab Panel $138.25

ANTINUCLEAR AB(ANA)TITER $6.06

ANTINUCLEAR AB(ANA) $6.73

ANA choice Cascading rfl $22.34

CENTROMERE B ANITBODY $55.00

ANTI-STREPTOLYSN O TITER $35.97

Page 108: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ANTI-STREPTOLYSN SCREEN $7.18

ANTITRYPSIN ALPHA 1 TOTL $35.97

BLD TYPE ABO ONLY $16.50

PHOSPHATIDYLSERINE ANTIBODIES $213.00

COMPLEMENT TOTAL CH50 $15.50

COMPLEMENT C2 $47.41

BRUCELLOSIS AG(QL) $47.78

FEBRILE AGGLUTIN EA QL $8.65

Q FEVER(COXIELLA BRUNETT $49.04

HISTOPLASMOSIS AB $19.73

LEPTOSPIROSIS $13.67

LYMPHOGRANULOMA VENEREUM $89.69

Leukemia/Lymphoma Eval $834.90

COXSACKIE VIRUS $43.52

INFLUENZA A AB $18.34

INFLUENZA B AB $18.34

INFLUENZA TYPE A&B Ag, DFA $58.12

INFLUENZA AB, CULTURE, RPD $76.50

INFLUENZA TYPE A/B $284.00

DESOXYRINUCLEASE AB $17.16

DNASE-B ANTIBODY $38.69

DNA ANTIBODY DOUBL STRND $17.16

DNA ANTIBODY SNGL STRAND $15.44

RNP ANTIBODY $30.00

ANTI-RNP AB $33.81

Sm and RNP Antibodies $82.34

MYCOPLASMA IGM TITER $13.68

EX NUC AB EA $37.59

BETA-2 TRANSFERRIN $272.80

ADRENAL ANTIBODIES $17.50

PARVO VIRUS ANTIBODY $74.12

PARAVOVIRUS B19 QUANT DNA SOURCE $179.00

VARICELLA ZOSTER $8.75

CULT, VARICELLA-ZOSTER $112.00

ENDOMYSIAL ANTIBODY SCREEN (IGA) $68.00

LEGIONELLA AB $47.52

HBS ANTIGEN $6.00

HEP B CORE AB(IGG & IGM) $8.65

HEPATITIS A AB(IGG&IGM) $10.00

HEPATITIS B SURF ANTIBDY $9.00

HEPATITIS BE ANTIGEN $30.57

HEPATITIS B CORE AB(IGM) $28.12

HEPATITIS BE ANTIBODY $30.57

HEPATITIS DELTA AGENT AB $18.62

HEPATITIS A AB IGM $11.00

HEPATITIS C ANTIBODY $11.50

JAK-2 MUTATION $350.00

Page 109: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

RUBELLA QUALITATIVE $4.81

Hepatitis B Surface Antibody Quantitatio $9.00

HIV 1/2 ANTIBODY DIFFERENTIATION $155.40

HIV-1 AB WESTERN BLOT $82.29

HIV-1 GENOTYPE $325.00

IMMUNOFIXATION URINE $20.92

TECHOIC ACID AB GEL QL $42.12

IMMUNOFIXATION SERUM $20.92

T CELLS TOTAL COUNT $26.90

T CELLS T4/T8 INC RATIO $25.68

LYMPHOCYTE SUBSET PANEL 4 $89.92

ECLT $82.16

MITOCHONDRIAL AB $22.81

MICROSOMAL AB(EACH) $27.72

ACTIN AB IGG SMO MUSCLE $11.00

MYOCARDIAL AB SCREEN $48.50

NEUTRALIZATN TEST VIRAL $14.84

LAMBDA-IMMUNOGLOBULIN $26.29

STREPTOZYME $34.00

CRYPTOCOCCAL AG, LATEX SCR WITH REFLEX $47.41

RHEUMATOID FACTOR $5.51

VDRL/RPR QUAL NON TREPON $5.51

VDRL-CSF QUAL NON TREPON $23.00

TISSUE TYPING HLA-B27 $21.76

BARTONELLA SPECIES (IGG,IGM) W'RFLX TO T $149.00

LYME DISEASE AB W/RFL $116.48

THYROGLOBULIN-ANTIBODY $17.94

CMV AB IGG EIA $21.00

CMV AB IGM $15.13

COXSACKIE B $66.30

S CEREVISIAE AB (IGG,IGA) $106.32

HTLV I AB $73.41

INFLUENZA TYPES A&B PNL $40.43

SALMONELLA AB $40.50

Mumps Virus Antibodies (IgG,IgM) $27.00

MUMPS VIRUS ANTIBODY (IgG) $29.37

TOXOPLASMA ANTIBODIES (IGG,IGM) $134.46

FTA-ABS $16.19

TREP PALLIDUM TEST $16.19

HLA-ABC TYPING MULTI AG $89.26

CANCER ANTIGEN 125 $10.83

ADENOVIRUS AB $16.53

ADENOVIRUS Ag, DFA $48.50

ADENOVIRUS DNA, QL PCR $300.00

ADENOVIRUS DNA, QN PCR $275.00

CMV ANTIBODY-IGG $15.13

BK VIRUS, PLASMA RTPCR QT $234.40

Page 110: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

BK VIRUS, URINE RTPCR QT $234.40

PRETX SRM AB ID INCUB $34.50

CYCLOSPORA AND ISOPROA EXAM $56.20

CULTURE, BLOOD QUESTWH $26.71

CULTURE, CSF QUESTWH $7.96

CULTURE, THROAT QUESTWH $13.23

CULTURE, AEROB/ANAER QUESTWH $33.00

ANAEROBIC CULTURE, W/GS QUESTWH $30.04

CULTURE, EAR, EXT QUESTWH $11.58

CULTURE, NEISSERIA QUESTWH $11.58

Aerobic Bacterial ID $12.48

CLOSTRIDIUM DIFF TOXIN $22.59

PLATELET AB INDIRECT IGG $13.20

CULTURE, AEROBIC BAC QUESTWH $15.00

CULTURE, SPUTUM/LOWER QUESTWH $8.52

B. pertussis Culture $48.50

CULTURE, GP, A STREP QUESTWH $3.93

CULTURE, GENITAL QUESTWH $18.67

HERPES CULTURE $10.00

HERPES SIMPLEX VIRUS, CULTURE $10.00

CULTURE, URINE QUESTWH $12.00

CULTURE, STOOL W/RFL QUESTWH $71.01

VRE SCREEN QUESTWH $50.00

MSRA CULTURE SCREEN QUESTWH $24.30

FUNGUS CULTURE, OTHER SOURCE $31.27

CULTURE FUNGI BLOOD $39.78

YEAST IDENTIFICATION $40.00

CULTURE, RESPIRATORY VIRUS $180.00

FUNGAL ID (MOLD) $40.00

CULTURE MYCOPLASMA ANY $84.00

CULTURE TRACH0M CULTURE $42.11

MYCOPLASMA/UREAPLASMA CUL $82.72

Mycobacteria Culture, Blood $75.00

CULTURE AFB $12.26

MYCOBACTERIA AVIUM COMPLEX MIC PANEL $140.72

MYCOBACTERIUM SLOW GROW, MIC $131.00

MYCOBACTERIUM CULTURE $12.26

MYCOBACTERIUM CULTURE $12.26

CULTURE TYPNG FLUORO EA $7.68

AERO BAC AND SUSC, MIC $113.71

CULTURE, ANAEROB, GRAMW/RFL $93.27

ANAEROBIC BACTERIUM ID $27.05

C. TRACHOMATIS Ag, DFA $29.97

HERPES Ag, DFA $37.60

C TRACHOMATIS DNA, SDA $60.00

N GONORRHOEAE DNA, SDA $60.00

Legionella Cult/Dir Ag $65.00

Page 111: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CULTURE LEGIONELLA $22.53

O&P SMEAR CONC ID $17.93

CRYPTOSPORIDIUM AG SMEAR $63.95

CHLAMYDIA DNA PROBE $7.50

C. immitis ID, DNA Probe $150.00

N GONORRHOEAE Q17305 $360.00

Susceptibility, Yeast Pnl $105.70

SUSCEPT PNL W/PZA MTB $120.75

SENSITIVITY AFB $32.51

G.C.DNA PROBE $7.50

M. AVIUM COMPLEX DNA, QL $150.40

CT/NG SCR, DNA PROBE W/RFL $85.94

MYCOBACTERIUM CULTURE $12.26

MYCOBACTERIA CULT PCR, (RESPIRATORY) $238.80

VZV DNA, QL PCR $224.00

VZV AG, DFA $29.97

SCABIES EXAMINATION $36.92

KOH PREP $4.81

SMEAR MICROSPORIDIUM $11.46

VIRAL CULTURE IDENTIFY $36.60

CMV Culture $50.74

HSV/VZV Rapid Culture $157.96

VIR CUL SHLL VL W/CONC E $38.15

B. pertussis/parapertussis $25.04

CRYPTOSPORIDIUM DFA $28.10

Legionella Ag, DFA $29.80

LEGIONELLA BY DFA $54.50

RSV, DIRECT ANTIGEN, DFA $47.44

RESPIRATORY VIRUS, DFA $65.00

ASPERGILLUS ANTIGEN $105.00

RSV RNA, QUALITATIVE PCR $300.00

Giardia & Cryptospor Pnl $107.11

GIARDIA ANTIGEN EIA $10.12

H.Pylor Ag, Qual, Stool $40.00

HEPATITIS PANEL, ACUTE W/RFX TO CONF $49.83

HIV ANTIGEN AND ANTIBODY 4TH GEN $27.50

SAIM/SHIG CULTURE QUESTWH $32.80

CSF IGG SYNTHESIS RATE $31.25

CHLAMYDIA/GC RNA TMA $45.00

CHLAMYDIA GC DNA SDA $45.00

CYTOMEGALOVIRUS DNA QT RT-PCR $225.00

INFLUENZA A/B PCR W/REFLEX H1N1 $284.00

HEP C QUANT $95.00

HERPES SMPLX VIRUS 1/2 DNA QT RT-PCR $224.00

SICKLE CELL SCREEN $12.02

CYRPTO AG TITER SERUM $34.00

CYRPTO AG TITER FLUID $57.40

Page 112: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LEGIONELLA AG URINE $21.75

DNA CELL CYCLE ANALYSIS $95.37

TISS CULT F/NON-NEOPLSAT $230.00

TISS CULT F/NEOPLASTIC $518.73

Chromosome, Hematologic $425.07

CHROMOSOMES. BLOOD $568.76

PHILY CHROMOSONE STUDY $467.87

FISH LUNG CANCER (NSCLC) (ALK) $275.00

FISH BURKITTS/NHL/ALL $450.00

FISH MANTLE CELL LYMPHOMA $422.00

MOLECULR CYTO DNA PRB EA $82.50

CHRMSM ANAL INTRP/REPRT $82.50

LVL V SURG PATH GROSS $818.18

SPEC STAIN TRICHROME O&P $8.79

FISH EPIDERMAL GROWTH FACTOR $324.00

HPV LOW AND HIGH RISK DNA $134.61

SMOOTH MUSCLE AB TITER $16.53

ADRENAL AB TITER $45.23

IMMUNE COMPLEX C3D-IGG $45.75

C3D CIRCULATION IMMUNE CO $131.00

PARIETAL CELL AB $17.50

ANTI-HISTONE AB $49.05

INTRPHS IN SITU 100-300C $82.50

CHLAM/CHLAMYDOPHILA PNL $75.00

PLATELET LEUKOREUCED PC $530.00

M TUBERCULOSIS, PCR, RESP $70.07

TISS CULT INOC/OBSERV $41.29

LUPUS PANEL $188.20

EBV EARLY AG EA $14.92

STRIATED AB SCR $50.15

ACETYL RECPTR BLOCK AB $102.96

FLUCYTOSINE(5-FLURCYTSN) $70.55

IMMUNE COMPLEX $242.25

SCLERODERMA AB SCL-70 $66.30

CYSTICERCOS AB SERUM $74.80

AGGLUTININS FEBRIL EQ QL $112.20

ANTIBODY PLATELET $192.95

COCCI TITER IMMUNODIFF $37.40

PROCALCITONIN (PCT) $200.00

AMOEBIC AB $56.95

HELICOBACT PYLORI AB QUA $113.96

GLOMULAR AB $35.10

BLASTOMY COSIS AB $47.60

CMPLMNT FIXATION TEST EA $33.23

Q FEVER(COXIELLA BRUNETT $74.80

LEPTOSPIROSIS $59.50

LYMPHOGRANULOMA VENEREUM $83.61

Page 113: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

MYCOPLASMA $135.15

COXSACKIE A(7 9 10) $96.90

CRYPTOCCAL AB $29.00

ECHO VIRUS(ENTEROVIRUS) $95.20

INFLUENZA $63.75

ANTI SM RNP $51.85

VARICELLA ZOSTER $38.00

LYME DISEASE $62.05

SMOOTH MUSCL AB TITER $32.34

CYSTICERCOSIS IGG $53.17

MEASLES RUBEOLA AB $9.20

HYALURONIDASE AB QUAL $24.27

CARDIOLIPIN AB QNT $42.63

TISSUE TYPING HLA-B27 $60.35

BRUCELLA AB $75.65

CHLAMYDIA PSIT IGM $118.30

COXSACKIE B ANTIBODY $96.90

FRANCISELLA TULARENS AB $68.85

HISTOPLASMOSIS AB ID $33.15

LEGIONELLA PNEUMOPHILA ANTIBODY (IgG), I $59.20

SALMONELLA AB $61.20

CHLAMYDIA SEROLOGY AB $84.25

ASPERGILLUS AB QL $46.75

ADENOVIRUS AB $47.60

TOXOPLSMOSIS IGG AB TITR $80.00

ASPERGILLUS AB ID $35.70

CULT FUNGI ID ADD $480.00

SENSITIVITY ANTBDY AGAR $56.95

SENSITIVITY TB AFB $85.85

PNEUMOCYST CARIN AG IF $56.00

ANTI-HYALURONIDASE (AHT) $27.43

"COCCIDIOIDES AB,CF,CSF" $107.10

INFLUENZA A B AG $17.12

MTB DIR PROBE TECHNIQUE $28.80

ID/NAP M.AVIUM-INTRA $28.80

CYRPTO AG TITER CSF $47.00

CYRPTO AG TITER SERUM $34.00

CYRPTO AG TITER FLUID $57.40

GLOMERULAR BASEMNT MEMB $34.88

EBV EARLY AG EA $77.00

CHEMILUMINESCENT ASY $193.00

IMMUNE COMPLEX $91.08

MYELIN BASIC PROTEIN CSF $48.10

HCV RNA PCR QUANT $405.00

RAJI CELL $79.11

TRANSFRN RECPTR SLBLE $193.00

ANTIBODY PLATELET $136.50

Page 114: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

CANDIDA AB QUANT $39.95

DNA ANTIBODY DBL STRAND $19.50

CSMC CYCLOSPORINE WHOLE BLOOD $40.00

CSMC HEMOSIDERIN QUAL $13.65

PLATELET AGGREGATION $477.05

CLOT FACTOR II PRTHRMBN $242.28

CLOT FACTOR V (LABILE) $242.28

CLOT FACTOR VII(STABLE) $242.28

CLOT FCTR VIII(AHG)1 STG $116.01

CLOT FCTR IX(PTC/XMAS) $242.28

CLOT FCTR X(STUART-PRWR) $242.28

CLOT FCTR XI(PTA) $242.28

CLOT FCTR XII(HAGEMANN) $242.28

CLOT FCTR XIII(FBRN STB) $56.70

CSMC AMIKACIN $38.90

EUGLOBULIN LYSIS $17.05

CS LVL IV-SURG PATH, G&M $69.23

CS SPECIAL STAINS GROUP 2 $71.07

CS IMMUNOCYTOCHEMISTRY, EACH ANTIBODY $61.97

CS IMMUNOFLORESCENT STUDY, EACH ANTIBODY $13.79

CS ELECTRON MICROSCOPY, DIAGNOSTIC $181.66

BODY FLUID CELL COUNTS AND DIFF $27.50

TACROLIMUS $117.20

CYCLOSPORINE QUANT $42.40

HLA TYPING A B OR C $150.00

HLA-ABC TYPING MULTI AG $350.00

PKU-NEWBORN METABOLIC SCREENING $118.70

T CELLS T4/T8 INC RATIO $125.00

IMMUNOCYTO CHEM EA AB $132.24

ARC HLA TYPE ABC SEROLOG $315.00

ARC HLA MATCHED $362.00

ARC PLTLT XMATCH EA UNIT $121.00

ARC BLD RC PACKED $307.00

ARC BLD RC LEUKOREDUCED $322.00

ARC PLATELET LEUKORED PC $762.00

ARC FROZEN PLASMA $53.00

ARC FROZEN PLASMA 24 $48.00

ARC AUTOLOGOUS DIRECT $125.00

ARC RB LEUKO WASHED $450.33

ARC AB ID PLATELET EA TC $242.00

ARC HLA AB ID/LEUK AB $268.00

ARC AB ABSORP SER EA ABS $39.00

ARC RBC AB SCR EA TECHNQ $26.00

ARC RBC AB ELUTION EACH $65.00

ARC AB ID RBC EA PNL 6-8 $34.00

ARC AB IDENT ENZ PER BAT $20.00

ARC AB RBC TITER EACH $65.00

Page 115: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

ARC COOMBS DIRECT DAT EA $11.00

ANTI-HUMAN NEUT IGG $84.00

ARC BLD TYPE ABO ONLY $19.00

ARC AG EXCPT ABO/RHO EA $16.00

ARC BLD TYPE RHO(D) ONLY $9.00

ARC TYPE RH PHENOTYP CMP $26.00

ARC PRETR RBC AB DETECT $34.00

ARC PLATELET ASSOC IGG $131.00

ARC AG TYPE AG/UNIT $58.00

ARC PRESCRN UNIT PER UNI $39.00

ARC PRETX SER ABID BYDIL $38.00

ARC PRETX SRM AB ID INCU $38.00

HLA A B C MULTIPLE AG $315.00

HEMACARE; LEUKAPHERESIS $1,100.00

HEMACARE; RED CELL EXCHANGE $1,100.00

HEMACARE; PLATELETPHERESIS $1,100.00

HEMACARE; THERAPEUTIC PLASMA EXCHANGE $1,000.00

HEM PACKED CELLS $296.00

HEM PLATELET LEUKORED PC $535.00

HEMACARE; AUTOLOGOUS BLOOD STEM CELL $1,475.00

HEMACARE SPCL HANDLG $955.00

HEMACARE SPCL HNDLG $720.00

HEMACARE SPCL HNDLG $150.00

HEMACARE SPCL HANDLG $250.00

HEMACARE; ALBUMIN 5% (PER UNIT) $90.00

HEMACARE; THERAPEUTIC PHLEBOTOMY $500.00

COMP TST EA UT AHG TECH $52.00

PACKED CELLS $245.00

LEUKOREDUCED PACK CELLS $275.00

FRESH FROZEN PLASMA 8HR $69.00

FRESH FROZEN PLASMA 24HR $69.00

PLATELET PHERESIS $458.00

PLATELET LEUKOREDUCED $530.00

AMINOLEVULINIC ACID DEHYDRATASE $305.10

PORPHOBILINOGEN $249.90

PORPHYRINS EVALUATION BLOOD $158.70

ALBUMIN, PERICARDIAL FLUID $21.84

ALBUMIN, PERITONEAL FLUID $21.84

ALBUMIN, PLEURAL FLUID $21.84

ALBUMIN, SYNOVIAL FLUID $21.84

AMYLASE, PERITONEAL FLUID $30.02

AMYLASE, PLEURAL FLUID $30.08

GLUCOSE, AMNIOTIC FLUID $21.48

GLUCOSE, PERICARDIAL FLUID $21.84

GLUCOSE, PERITONEAL FLUID $21.84

GLUCOSE, PLEURAL FLUID $21.84

GLUCOSE, SYNOVIAL FLUID $21.84

Page 116: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

LD, PERICARDIAL FLUID $14.00

LD, PERITONEAL FLUID $14.00

LD, PLEURAL FLUID $14.00

LD, SYNOVIAL FLUID $14.00

TOTAL PROTEIN, PERICARDIAL FLUID $18.24

TOTAL PROTEIN, PERITONEAL FLUID $18.24

TOTAL PROTEIN, PLEURAL FLUID $18.24

TOTAL PROTEIN, SYNOVIAL FLUID $18.24

RECEPTOR ASSAY ESTROGEN $161.71

CHOLESTEROL, PERITONEAL FLUID $21.84

CHOLESTEROL, PLEURAL FLUID $21.84

TRIGLYCERIDES, PERITONEAL FLUID $23.60

TRIGLYCERIDES, PLEURAL FLUID $23.60

FIRST ANTIBODY $43.00

ADDITIONAL ANTIBODY $21.00

IMMUNOHISTOCHEMISTRY (PER ANTIBODY) $45.00

QUANATITIVE IHC (PER ANTIBODY) $60.00

IMAGE ANAYLSIS (PER ANTIBODY) $90.00

IN SITU HYBRIDIZATION (PER ANTIBODY) $125.00

HER 2 NEU FISH $140.00

FLOW CYTO CEL FIRST MRKR $142.50

FLOW EA ADD MARKER $142.50

MORPH ANALYSIS MANUAL $400.00

TUMOR IMMUNHIST MANUAL $60.00

ACUTE LEUKEMIA EVAL $285.00

TISS CULT F/NON-NEOPLAST $230.00

TISSUE CULT F/BN MARROW $230.00

CHRMSM ANAL 2 KARYO BAND $230.00

PHILY CHROMOSONE STUDY $230.00

HISTOCHEM ID ENZYME $30.00

HEMOGLOBIN FETAL - KLEINHAUER BETKE $95.50

TOTAL DRUG SCREEN - PRIMER LAB $798.10

1-7 DRUG TESTS CONFIRM - PRIMER LAB $1,176.50

8-14 DRUG TESTS CONFIRM - PRIMER LAB $1,609.90

15-21 DRUG TESTS COMFIRM - PRIMER LAB $2,043.40

22+ DRUG TESTS CONFIRM - PRIMER LAB $2,538.70

DRS VAC WHTFORM $40.00

VAC CONNECTOR Y $8.00

DRS DUODERM $274.00

EXUDERM ODORSHIELD 4X4" $13.00

EXUDERM ODORSHIELD 8X8" $49.00

MAXORB EXTRA ROPE 12" $42.00

MAXORB EXTRA 2X2" $14.00

MAXORB EXTRA 4X8" $28.00

MAXORB EXTRA AG ROPE 12" $45.00

OPTIFOAM NONADH 6X6" $50.00

SKINTEGRITY HYDROGEL 1OZ $6.00

Page 117: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TENDERWET 1.6" ROUND $16.00

TENDERWET 2.2" ROUND $19.00

TENDERWET 3X3" SQUARE $25.00

TENDERWET 4X5" SQUARE $33.00

DERMAGEL 4X4 HYDRO SHEET $61.00

"GZ BORDER 4X4,2.5X2.5 PD" $3.00

MARATHON SKIN PROTECTANT $31.00

REMEDY FOAMING CLNSR 5OZ $35.00

REMEDY CLR AID OINT 2OZ $34.00

REMEDY SK REP CREAM 2OZ $15.00

WOUND CLEANSER REMEDY 4" $25.00

BN GEL/PUTTY 5CC $2,596.00

CATH ASPIRATION EXPRT XT $3,740.00

CATH SUPRAPUBIC $659.00

CATH URET $89.00

"PROBE, DEKOMPRESSOR" $11,000.00

CATH URETERAL 4110 $187.00

CATH BAL NON VASCULAR $1,375.00

CATH CNTRL VEIN 4110 $50.00

CATH FGRTY EMBLA 4110 $696.00

CATH GORSHANG 4110 $2,067.00

CATH HICKMAN 4110 $823.00

CATH HICKMAN 4110 $734.00

CATH NEPHROSTOMY 4110 $438.00

CATH PORTACATH 4110 $2,581.00

COIL EMBOLIC DETACH 4110 $1,650.00

ST STENT $790.00

STNT BIL $704.00

STNT BILIARY $2,420.00

STNT DBL J URET 4110 $801.00

STENT ULTRAFLEX ESOPH $7,046.00

STNT URETERAL 4110 $911.00

GW 4110 $183.00

GW $541.00

OTSC - OVER THE SCPOPE CLIP $5,015.00

GUIDE WIRE $1,705.00

GW SUPER STIFF $759.00

ENDO MESH FX 5MM TIT TKS $1,747.00

TRAY CATH DRAINAGE $11,550.00

Cook Mutipurpose Drainage Catheter $415.00

IMPL CORNEAL TISSUE $8,599.00

EAR HOMGRFT 3105 $1,446.00

EAR INCUS 3105 $1,808.00

EAR TUBE 3105 $130.00

EAR TUBE 3105 $110.00

EYE GLAUC IMP 4110 $6,023.00

CAPSULAR TENSION RING $900.00

Page 118: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

IOL ASTIGMATISM $853.00

IOL PRESBYOPIA $853.00

IOL POSTERIOR CHMBR $376.00

EYE SILICONE SP 3105 $123.00

GRAFT AMNIOTIC MEMBRANE $1,733.00

BN CARTILAGE 3110 $3,253.00

BONE CANCELLOUS CHIPS $3,795.00

BN FILLER $4,120.00

BN FIXATOR MAJ 3110 $6,342.00

BN GRANUELS 15CC $7,120.00

BN PLUGS 3110 $1,446.00

BOLT TIBIA N+WAS 3110 $383.00

K WIRE 3110 $474.00

NAIL KUNTH/CLOVD 3110 $734.00

NUT 3110 $257.00

PIN IMPLANTABLE $755.00

PLT COMPRESION 3110 $2,277.00

PLATE ORTHOPEDIC $1,269.00

PROS ANKLE $2,200.00

SPINIAL PLATES $2.00

SPINE INSERT/INLAY $2.00

HIP LINER $2.00

HIP ACETABULAR SHELL $5,550.00

HIP FEMORAL STEM $11,976.00

HIP FEMORAL HEAD $13,788.00

KNEE-MENISCAL BEARING $2.00

KNEE-TIBIAL INSERT $2.00

KNEE-FEMORAL COMPONENT $2.00

KNEE-PATELLAR COMPONENT $2.00

KNEE-TIBIAL BASEPLATE $2.00

PROS METACARPOPHALANGEAL $755.00

PROS SHOLDR TOT $676.00

PROS SHOULDER $1,146.00

PROS TOE GREAT $1,436.00

ELBOW/WRIST IMPLANTS $2.00

RD HARINGTN 3110 $488.00

ROD SPINAL IMPLANT $657.00

SPINAL CAGE IMPLANT $2.00

RUSH PIN E-6IN $271.00

SCRW BN 3110 $1,169.00

UNIVERSAL HEAD 3110 $4,203.00

WASHER CANCL 3110 $398.00

WIRE KIRCHNER PL 3110 $49.00

WIRE KIRCHNER TH 3110 $215.00

WIRE TROCANTOR 3110 $488.00

AORTIC VALVE #2 $10,341.00

GRF GRTX PTCH2MM 3120 $1,051.00

Page 119: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

GRF GRTX STR 6MMX40CM $3,183.00

GRFT GRTX 6MM 3120 $3,313.00

MEMODERM, DERMAPSN,TRANZ OR INTE/SQ CENT $150.00

HMATRIX, PER SQ CENTIMETER $98.00

INTEGRA MESHED BIL WND MATRIX PER SQR CM $1,250.00

MESH IMPLANTABLE $1,289.00

GRAFT VASCULAR $4,699.00

IMPL SUTURE ANCHOR $1,605.00

CATH OCC 3310 $677.00

BONE CEMENT $677.00

Floseal $990.00

TISSUE EXPANDER IMPLANT $1,476.00

BAND GASTRIC ADJUST SYST $16,535.00

CATH OCC CROSSER $12,073.00

CATH REENTRY OUTBACK $11,165.00

CATH PICC LINE $935.00

STENT TRACHEOBRONCHIAL $8,470.00

CARDIOVERTER/DFIB DC $34,557.00

CARDIOVERTER/DFIB OTHR THN SNGL/DUAL CHM $101,063.00

GRAFT ABD ANEU RPR TOTAL $74,250.00

GRAFT THOR ANEU REP EACH $57,750.00

CATH PT DEV ARRW TREROTL $2,188.00

CATH ANG TRANSLUMNL NLSR LUTONIX $8,250.00

CATH EP DIAG NOT3D 19OR< $1,577.00

CATH EP DIAG NOT3D 20OR> $3,962.00

CATH EP OTH THN COOL TIP $1,915.00

CATH EP COOL TIP $4,043.00

CATH GUIDING $935.00

CATH HEMODIAL SHORT TERM $1,815.00

CATH, INTRACARDIAC ECHOCARDIOGRAPHY $12,000.00

CATH INTRASPINAL $1,779.00

CATH US INTRAVASCULAR $3,300.00

CATH INTRAVASC US PIONEE $15,373.00

CATH OCCLUSION $805.00

CATH, EP, DIAG/ABL, 3D/VECT $3,097.00

CATH THROMB/EMBOLECTOMY $3,153.00

CATH THROM TRELLIS $11,523.00

CATH ANG TRANSLUMINL LSR $5,610.00

CATH ANG TRANSLUMNL NLSR $5,886.00

CATH ATHR TRANSLUM DIREC $10,376.00

CATH ATHR TRANSLUM ROTAT $13,283.00

DEV CLOSR VASC IMP/INSRT $2,343.00

DEV REP URINARY W/SLING $5,775.00

DFIB GEM II VR SINGLE $70,912.00

DEV RETRIEVAL INSERTABLE $1,898.00

FILTER VENA CAVA $7,190.00

GINTRO EP IC FC NON-PEEL $391.00

Page 120: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

GINTRO EP IC FC PEELAWAY $391.00

IMP ADAP/EXT LD PM NSTIM $1,906.00

IMP SYS DIALYSIS ACCESS $1,561.00

IMP PMP INF PROGRAMMABLE $30,045.00

IMP GEN NSTIM NON-RECHG $33,880.00

IMP LD CARDV/DFIB EC DC $23,516.00

IMP LD CARDV/DFIB EC SC $23,516.00

IMP LD CARD/DFIB NEC/D/S $23,516.00

IOL POST CHAMB ARRAY $1,398.00

IMP LD NEUROSTIM TEST KT $3,061.00

IMP LD PM/CARD-DFIB COMB $27,966.00

IMP PORT INDWELLING $1,220.00

LD DFIB SPRINT 6942 $23,516.00

LD PM TRANSVEN VDD SPASS $2,552.00

INTRO EP IC N-LSR N-GUID $3,610.00

INTRO EP IC LASER N-GUID $439.00

INTRO/SHTH STRBLE N/PEEL $651.00

LD PM ADAPTOR $586.00

Loop Recorder $12,785.00

CLIP MARKER IMPLANT $36.00

NDL BRACHYTHERAPY $31.00

NDL BX AUTOSUT DPTH MKR $25.00

PM DC NON RATE-RESPONSIV $28,803.00

PM SC NON RATE-RESPONSIV $19,528.00

PM DC RATE-RESPONSIVE $43,187.00

PM SC RATE-RESPONSIVE $43,204.00

PM NOT SC/DC $28,803.00

PROGRAMMER PT NEUROSTIM $3,831.00

PROSTHESIS, PENILE, NON-INFLATABLE $13,377.00

PROGEL PLEURAL SEALANT $2.00

STNT COAT/COV WO DEL SYS $5,488.00

STNT NCOR TEMP W DEL SYS $3,902.00

STNT NCOAT/COV WO DELSYS $5,853.00

STENT NON CORONARY WITH DEL SYS $668.00

TISS CONNECTIVE - NON HUMAN $100.00

VAS CLS ART PERCLOSE $1,851.00

ALLOGRAFT HUMAN TISSUE $2.00

ANCH SCRW SUTR ARTHREX $1,047.00

SINUS IMPLANT $15.00

IMP GEN NSTIM RECHARGE $60,792.00

LD LFT VENT COR VEN SYS $13,038.00

LD NSTIM PISCES QD 3487A $10,472.00

MATERIAL FOR VOCAL CORD, SYN, IMPL $2.00

IMPLANT/INSERT DEVICE, NOC $2,400.00

LD PM TENDRL DX 1388K/52 $2,735.00

PROS PNILE MNTR MALLEABL $11,531.00

SYS EMBOLIZATN PROTECT $10,024.00

Page 121: Description Charge CORONARY CARE UNIT $11,550.00 … · recov post-vag 1 hour $744.00 recov post-vag 1st 1/2 hour $398.00 recov post-vag add min $13.00 anesth general ... phenobarbital

TUNNELER $2,340.00

ALLOSKIN rt, per square centimeter $1,000.00

CATH BARD OPTIFLOW DL $2,302.00

HERO, CATH HEMODIALYSIS, LONG TERM $10,753.00

IMP PRT BARDPRT MRI HARD $1,810.00

INTRODUCER UNIVERSAL $1,078.00

IMPLANT MISC $2.00