PRICES EFFECTIVE 1/1/2020

PRICES EFFECTIVE 1/1/2020

Description Pricing

.Hepatitis C Antibody RHI 112.00

.HIV-1 Antibody RHI 66.00

.Occult Blood, Stool, Reflex RHI 25.00

.Occult Blood, Stool, Vomitus RHI 25.00

.Urinalysis RHI 18.00

.Vitamin D2 +D3, 25-Hydroxy RHI 231.00

.Wright Stain Stool RHI 33.00

.Wright Stain Urine RHI 37.00

00002-3227-30 - atomoxetine 10 mg Cap

[RHI]

60.05


[RHI]

60.80

00002-3235-60 - duloxetine 20 mg Cap

[RHI]

31.05


[RHI]

32.45


[RHI]

55.95

00002-3240-33 - duloxetine 30 mg Cap

[RHI]

9.00

00002-4165-30 - Raloxifene Tab 60 mg

[RHI]

22.15

00002-5123-30 - prasugrel 10 mg Tab

[RHI]

68.40

00002-7510-17 - insulin lispro 100

units/mL SubQ Inj 3 mL [RHI]

7.60

00002-7511-01 - insulin lispro-insulin

lispro protamine 25 units-75 units/mL

SubQ Susp 10 mL [RHI]

7.95

00002-8215-17 - insulin regular human

recombinant 100 units/mL Inj Sol 3

mL[RHI]

7.45

00002-8315-01 - insulin isophane human

recombinant 100 units/mL SubQ Inj [RHI]

7.45

00002-8315-17 - insulin isophane human

recombinant 100 units/mL SubQ Inj 3 mL

[RHI]

7.70

00002-8400-01 - teriparatide 600 mcg/2.4

mL Devi [RHI]

4,800.40

00002-8715-01 - Insulin NPH/Reg 70/30

100units/mL 10 mL [RHI]

104.30

00002-8715-17 - Insulin NPH/Reg 70/30

100units/mL 3 mL [RHI]

7.45

00003-0293-05 - triamcinolone acetonide

40 mg/mL Inj Susp [RHI]

112.05

00003-0894-21 - apixaban 5 mg Tab [RHI] 29.35

00004-0038-22 - valganciclovir 450 mg

Tab [RHI]

152.20

00004-0039-09 - Valganciclovir 50

mg/mL [RHI]

2,973.20

00004-0186-82 - ibandronate 150 mg oral

tablet [RHI]

549.90

00004-0261-29 - Mycophenolate Mofetil

200mg/ml [RHI]

4,135.30

00004-0800-85 - oseltamivir 75 mg Cap

[RHI]

31.85

00005-1971-02 - pneumococcal 13-valent

conjugate vaccine - Susp UD [RHI]

373.60

00006-0112-28 - sitagliptin 50 mg oral

tablet [RHI]

53.25

00006-0227-61 - raltegravir 400 mg oral

tablet [RHI]

107.10

00006-3822-10 - caspofungin 50 mg IV

Inj [RHI]

389.80

00006-3843-71 - ertapenem 1 g Inj [RHI] 345.85

00006-4943-00 - pneumococcal 23-valent

vaccine Inj Sol 0 mL [RHI]

380.10

00008-0019-01 - promethazine 12.5 mg

Tab [RHI]

7.55

00008-0607-04 - pantoprazole 40 mg

Oral EC Tab [RHI]

8.10

00008-0923-55 - pantoprazole 40 mg IV

Inj [RHI]

90.60

00008-1030-06 - sirolimus 1 mg/mL Oral

Sol [RHI]

5,577.10

00008-1040-10 - sirolimus 0.5 mg Tab

UD [RHI]

45.40

00008-1041-10 - sirolimus 1 mg Tab [RHI] 41.35

00008-1211-14 - desvenlafaxine 50 mg

Tab- [RHI]

53.75

00009-0003-02 - methylPREDNISolone

500 mg preservative-free REC [RHI]

139.90

00009-0018-20 - methylPREDNISolone 1

g preservative-free REC [RHI]

149.55



84.95



89.00

00009-0417-01 - testosterone cypionate

200 mg/mL IM Sol [RHI]

51.95


g Inj [RHI]

132.55

00009-0746-30 -

medroxyPROGESTERone 150 mg/mL IM

Susp [RHI]

189.45

00009-0825-01 - hydrocortisone 100 mg

preservative-free REC [RHI]

109.95



28.45



44.85

00009-5135-03 - linezolid 600 mg Tab

[RHI]

489.55

00013-8303-04 - latanoprost Opth

0.005% Sol [RHI]

7.35

00023-0312-04 - ocular lubricant Oint

[RHI]

7.90

00023-1145-01 - onabotulinumtoxinA 100

units REC [RHI]

2,561.60

00023-8694-30 - azelaic acid Top 20%

Crm [RHI]

850.80

00023-9163-30 - cycloSPORINE Opth

0.05% Emul [RHI]

932.15

00023-9187-03 - bimatoprost 0.01% Opth

Sol [RHI]

16.05

00024-1353-01 - phenylephrine Nasal

0.5% Spry [RHI]

10.05

00024-1596-01 - primaquine phosphate

26.3 mg (15 mg base) Tab [RHI]

12.70

00024-4142-60 - dronedarone 400 mg

Tab [RHI]

48.05

00025-1520-34 - celecoxib 100 mg Cap

[RHI]

20.20

00029-1527-22 - mupirocin Top 2% Crm

[RHI]

262.70

00032-1212-01 - pancrelipase 60,000

units-12,000 units-38,000 units Cap- [RHI]

17.80

00032-1708-01 - Progesterone 100mg

[RHI]

11.00

00046-0872-21 - conjugated estrogens

0.625 mg/g Vag Crm w/Appl [RHI]

1,384.90

00046-1102-81 - conjugated estrogens

0.625 mg Tab [RHI]

28.10

00049-3160-44 - voriconazole 40 mg/mL

Oral Liq [RHI]

3,360.60

00049-3180-30 - voriconazole 200 mg

Tab [RHI]

23.35

00051-8450-30 - testosterone 50 mg/5 g

TD Gel [RHI]

77.50

00054-0007-13 - calcitriol 0.25 mcg Oral

Cap [RHI]

8.90

00054-0018-20 - predniSONE 20 mg Tab

[RHI]

8.05


[RHI]

8.20

00054-0021-25 - lithium 300 mg ER Tab

[RHI]

8.70

00054-0046-41 - ipratropium Nasal

0.06% Spry [RHI]

69.95

00054-0088-26 - calcium acetate 667 mg

Cap [RHI]

3.65

00054-0224-63 - levetiracetam 100

mg/mL Oral Sol [RHI]

44.00

00054-0235-25 - morphine 15 mg Tab

[RHI]

7.75

00054-0244-24 - codeine sulfate 30 mg

Tab [RHI]

8.85

00054-3027-02 - acetylcysteine 10% Inh

Sol 10 mL [RHI]

9.30

00054-3120-41 - calcitriol 1 mcg/mL Oral

Liq [RHI]

334.10

00054-3270-99 - fluticasone Nasal 0.05

mg/inh Spry [RHI]

22.15

00054-3294-50 - furosemide 10 mg/mL

Oral Liq [RHI]

48.95

00054-3505-47 - lidocaine Top 4% Sol

[RHI]

17.50

00054-3532-44 - lorazepam 2 mg/mL

Oral Conc [RHI]

70.30

00054-3542-58 - megestrol 40 mg/mL

Oral Susp [RHI]

63.85

00054-3727-63 - Propranolol HCL

20mg/5ml [RHI]

40.70

00054-4496-13 - leucovorin 5 mg Tab

[RHI]

10.20

00054-4721-25 - propantheline 15 mg

Tab [RHI]

8.95

00054-8084-25 - azathioprine 50 mg Tab

[RHI]

8.75

00054-8174-25 - dexamethasone 1 mg

Tab [RHI]

8.60

00054-8175-25 - dexamethasone 4 mg

Tab [RHI]

8.90

00054-8526-25 - Lithium Carbonate

150mg [RHI]

7.95


[RHI]

7.50


[RHI]

7.90

00056-0510-30 - efavirenz 600 mg Tab

[RHI]

95.10

00062-0205-02 - emollients, topical -

Emul [RHI]

191.70

00064-3900-60 - balsam Peru/castor

oil/trypsin Top Oint [RHI]

58.35

00064-5010-30 - collagenase Top 250

units/g Oint [RHI]

884.30

00065-0002-03 - nepafenac Opth 0.1%

Susp [RHI]

585.10

00065-0246-10 - betaxolol Opth 0.25%

Susp [RHI]

669.00

00065-0271-05 - olopatadine Opth 0.1%

Sol [RHI]

753.45

00065-0275-10 - brinzolamide Opth 1%

Susp [RHI]

1,095.35

00065-0397-02 - cyclopentolate Opth 2%

Sol [RHI]

146.40

00065-0416-25 - Natural Tears [RHI] 50.15

00065-0431-32 - ocular lubricant Sol [RHI] 22.65

00065-0644-35 - tobramycin Opth 0.3%

Oint [RHI]

380.80

00065-0648-35 - dexamethasone-

tobramycin Opth 0.1%-0.3% Oint [RHI]

644.60

00065-0654-35 - ciprofloxacin Opth 0.3%

Oint [RHI]

462.70

00065-4013-03 - moxifloxacin 0.5% Opth

Sol [RHI]

598.15

00065-8531-10 - ciprofloxacin-

hydrocortisone Otic Susp [RHI]

1,176.10

00065-8533-02 - ciprofloxacin-

dexamethasone 0.3%-0.1% Otic Susp

[RHI]

802.95

00067-0949-15 - Miconazole Powder 2%

45 GM [RHI]

8.80

00067-4345-04 - scopolamine 1.5 mg

Transderm ER Film [RHI]

60.55

00067-5125-14 - nicotine 14 mg/24 hr


5.50

00069-0468-56 - varenicline 0.5 mg oral

tablet [RHI]

33.50

00069-0807-60 - maraviroc 150 mg oral

tablet [RHI]

107.80

00069-3150-83 - azithromycin 500 mg IV

Inj [RHI]

197.00

00069-4190-68 - sildenafil 20 mg oral

tablet [RHI]

9.10

00069-4200-30 - sildenafil 25 mg Tab

[RHI]

121.45

00069-5810-43 - dofetilide 250 mcg Cap

[RHI]

27.20

00071-0007-40 - Phenytoin Tab Chew 50

mg [RHI]

10.25

00071-0418-13 - nitroglycerin 0.4 mg

sublingual Tab [RHI]

119.80

00071-1012-68 - pregabalin 25 mg oral

capsule [RHI]

34.85


capsule [RHI]

34.85


capsule [RHI]

36.75


capsule [RHI]

36.75

00074-2452-02 - hydromorphone 1

mg/mL Oral Liq [RHI]

11.60

00074-3074-90 - niacin 500 mg Tab [RHI] 7.60

00074-4317-30 - paricalcitol 1 mcg oral

capsule [RHI]

30.45

00074-4332-49 - vancomycin 500 mg IV

Inj [RHI]

95.40

00074-4552-11 - levothyroxine 50 mcg

(0.05 mg) Tab [RHI]

8.45

00074-6023-04 - morphine 1 mg/mL Inj

Sol [RHI]

13.30

00074-6633-30 - ritonavir 100 mg Cap

[RHI]

31.30


(0.15 mg) Tab [RHI]

8.10

00074-7269-50 - cycloSPORINE

microEmul 100 mg/mL Oral Liq [RHI]

818.00

00075-0620-40 - enoxaparin 40 mg/0.4

mL SC Sol [RHI]

17.15

00075-0620-41 - enoxaparin 40 mg/0.4

mL SC Sol [RHI]

25.45

00075-0621-60 - enoxaparin 60 mg/0.6

mL SC Sol [RHI]

34.55

00075-0622-80 - enoxaparin 80 mg/0.8

mL SC Sol [RHI]

42.50

00075-0623-00 - enoxaparin 100 mg/mL

SubQ Sol [RHI]

70.00

00075-0624-30 - enoxaparin 30 mg/0.3

mL SC Sol [RHI]

22.70

00075-2451-01 - desmopressin 4

mcg/mL IV Sol [RHI]

150.05

00075-2912-01 - Enoxaparin Inj 120

mg/0.8 mL [RHI]

75.60

00075-7700-60 - riluzole 50 mg Tab [RHI] 11.45

00078-0110-22 - cycloSPORINE 100


1,958.10

00078-0180-03 - octreotide 50 mcg/mL

Inj Sol [RHI]

20.75


microEmul 25 mg Cap [RHI]

15.10



29.95


microEmul 100 mg/mL Oral Liq [RHI]

1,299.35

00078-0327-05 - entacapone 200 mg Tab

[RHI]

10.95

00078-0357-52 - OXcarbazepine Susp 60

mg/mL Bottle [RHI]

537.35

00078-0358-34 - valsartan 80 mg Tab

[RHI]

8.25

00078-0359-34 - valsartan 160 mg Tab

[RHI]

26.65

00078-0385-66 - mycophenolic acid 180

mg Oral EC Tab [RHI]

17.00

00078-0386-66 - mycophenolic acid 360


39.70

00078-0409-05 -

carbidopa/entacapone/levodopa 37.5 mg-

200 mg-150 mg Tab [RHI]

24.20

00078-0423-15 - valsartan 40 mg Tab

[RHI]

19.90

00078-0429-97 - ocular lubricant Gel

[RHI]

60.55

00078-0435-61 - zoledronic acid 5

mg/100 mL IV Sol [RHI]

2,131.30

00078-0473-97 - ocular lubricant Oint

[RHI]

7.90

00078-0486-15 - aliskiren 300 mg oral

tablet [RHI]

24.10

00078-0501-15 - rivastigmine 4.6 mg/24

hr TD film, ER [RHI]

47.05

00078-0501-61 - rivastigmine 4.6 mg/24


46.65

00078-0502-15 - rivastigmine 9.5 mg/24


50.30

00078-0510-05 - carbamazepine 100 mg

ER Tab [RHI]

12.20

00078065920 - Sacubitril-Valsartan 24

mg Tab

7.35

00078-0777-20 - sacubitril-valsartan 49

mg-51 mg Tab(RHI)

37.65

00085-0566-05 - betamethasone acetate-

betamethasone sodium phosphate 3 mg-

3 mg Inj Susp 5 mL [RHI]

35.50

00085-1194-03 - ribavirin 200 mg Cap

[RHI]

42.85

00085-1328-01 - posaconazole 40

mg/mL Sus[RHI]

4,861.60

00085-1341-04 - mometasone 220

mcg/inh Inh Aer Pwdr [RHI]

304.30

00085-1402-01 - formoterol 12 mcg Inh

Cap [RHI]

248.30

00085-1733-02 - moxifloxacin 400 mg

Tab [RHI]

34.00

00085-3315-35 - nitroglycerin 0.3 mg/hr


69.50

00087-6674-17 - didanosine 400 mg Oral

EC Cap [RHI]

35.15

00088-2220-33 - insulin glargine 100

units/mL SubQ Sol [RHI]

7.85

00088-2500-33 - insulin glulisine 100

units/mL SC Sol [RHI]

179.20

00093-0173-56 - leflunomide 10 mg Tab

[RHI]

8.40

00093-0174-56 - leflunomide 20 mg Tab

[RHI]

25.40

00093-0199-01 - venlafaxine 25 mg Tab

[RHI]

8.30

00093-0264-30 - fluocinonide Top 0.05%

Oint [RHI]

97.75

00093-0314-01 - ketorolac 10 mg Tab

[RHI]

14.60

00093-0810-01 - nortriptyline 10 mg Cap

[RHI]

8.65

00093-0819-01 - NIFEdipine 30 mg ER

Tab [RHI]

8.45

00093-1061-01 - sotalol 80 mg Tab [RHI] 8.50

00093-2055-42 - tolterodine 2 mg Tab

[RHI]

11.05

00093-2158-01 - trimethoprim 100 mg

Tab [RHI]

8.30

00093-3107-93 - amoxicillin 250 mg Cap

[RHI]

7.75

00093-3122-98 - ethinyl estradiol-

norethindrone 5 mcg-1 mg Tab [RHI]

14.40

00093-3145-01 - cephalexin 250 mg Cap

[RHI]

7.60

00093-4146-64 - levalbuterol 0.63 mg/3

mL Inh Sol [RHI]

28.65

00093-4148-64 - levalbuterol 1.25 mg/3

mL Inh Sol [RHI]

35.70

00093-4177-73 - cephalexin 250 mg/5

mL Oral Liq [RHI]

97.30

00093-5171-20 - alendronate 70 mg Tab

[RHI]

10.40

00093-5420-88 - cabergoline 0.5 mg Tab

[RHI]

42.90

00093552856 - Atazanavir 300 mg Cap 117.20

00093-5767-56 - olanzapine 2.5 mg Tab

[RHI]

8.15

00093-5851-01 - escitalopram 10 mg Tab

[RHI]

7.90

00093-6300-16 - cetirizine 1 mg/mL Oral

Syrup [RHI]

16.55

00093-6815-45 - budesonide 0.25 mg/2

mL Inh Susp [RHI]

31.15

00093-6815-73 - budesonide 0.25 mg/2

mL Inh Susp [RHI]

37.35

00093-6816-73 - budesonide 0.5 mg/2

mL Inh Susp [RHI]

35.00

00093-7146-56 - azithromycin 250 mg

Tab [RHI]

9.95

00093-7219-06 - topiramate 100 mg Tab

[RHI]

8.15

00093-7316-01 - desmopressin 0.1 mg

Tab [RHI]

11.60

00093-7365-98 - Losartan Tab 50 mg

[RHI]

7.80

00093-7618-43 - dorzolamide Opth 2%

Sol [RHI]

145.15

00093-7620-56 - letrozole 2.5 mg Tab

[RHI]

7.80

00093-8739-01 - mexiletine 150 mg Cap

[RHI]

9.35

00093-8740-01 - mexiletine 200 mg Cap

[RHI]

8.75

00093-8940-01 - acyclovir 200 mg Cap

[RHI]

8.20

00115-1328-01 - amphetamine-

dextroamphetamine 5 mg ERCap [RHI]

17.05

00115-3511-01 - pyridostigmine 60 mg

Tab [RHI]

10.10

00115-4411-01 - dantrolene 25 mg Cap

[RHI]

9.10

00115-9822-01 - digoxin 250 mcg (0.25

mg) Tab [RHI]

7.90

00116-2001-16 - chlorhexidine Top

0.12% Liq 480 mL [RHI]

16.25

00121-0462-30 - mineral oil 100% Oral

Liq 30 mL [RHI]

2.80

00121-0504-16 - acetaminophen-codeine

120 mg-12 mg/5 mL Oral Liq 473 mL

[RHI]

15.50

00121-0527-10 - magnesium hydroxide

24% Oral Conc 10 mL [RHI]

4.65

00121-0544-10 - docusate sodium

100/10 mL Oral Liq [RHI]

3.20

00121-0576-16 - metoclopramide 5 mg/5

mL Oral Syrup [RHI]

7.80

00121-0581-04 - haloperidol 2 mg/mL

Oral Conc [RHI]

1,192.60

00121-0646-10 - amantadine 50 mg/5 mL

Oral Syrup [RHI]

14.45

00121-0646-16 - amantadine 50 mg/5 mL

Oral Syrup [RHI]

18.40

00121-0655-15 - acetaminophen-

HYDROcodone 500 mg-7.5 mg/15 mL

Oral Elix 15 mL [RHI]

19.95

00121-0675-16 - valproic acid 250 mg/5

mL Oral Syrup [RHI]

20.40

00121-0775-04 - codeine-guaiFENesin

10 mg-100 mg/5 mL Syr

15.55

00121-4577-30 - lactulose 10 g/15 mL

Oral Syrup [RHI]

8.85

00121-4675-55 - valproic acid 250 mg/5

mL Oral Syrup [RHI]

186.65

00121-4810-00 - nystatin 100,000

units/mL Oral Susp [RHI]

7.45

00131-2477-35 - lacosamide 50 mg Tab

[RHI]

47.35

00131-2480-35 - lacosamide 200 mg Tab

[RHI]

67.65

00135-0200-01 - docosanol Top 10%

Crm [RHI]

35.35


Tab [RHI]

8.60

00143-1458-05 - phenobarbital 100 mg

Tab [RHI]

8.45

00143-1480-01 - propylthiouracil 50 mg

Tab [RHI]

9.35

00143-1769-01 - isosorbide dinitrate 5

mg Tab [RHI]

9.50

00143-9784-10 - flumazenil 0.1 mg/mL IV

Sol [RHI]

91.55

00143-9982-01 - amoxicillin-clavulanate

400 mg-57 mg/5 mL Oral Liq 100 mL

[RHI]

50.85

00145-1501-03 - miconazole Top 2%

Pwdr [RHI]

13.05

00168-0004-80 - triamcinolone Top 0.1%

Crm [RHI]

105.65


Oint [RHI]

18.70

00168-0007-30 - nystatin Top 100,000

units/g Oint [RHI]

58.15

00168-0011-16 - bacitracin topical zinc

500 units/g Oint [RHI]

69.30

00168-0014-31 - hydrocortisone Top

0.5% Crm [RHI]

6.30

00168-0035-01 - vitamin A & D Top Oint

[RHI]

5.10

00168-0055-15 - betamethasone Top

dipropionate 0.05% Crm [RHI]

99.25

00168-0056-15 - betamethasone Top

dipropionate 0.05% Oint [RHI]

147.70

00168-0062-31 - zinc oxide Top 20% Oint

[RHI]

5.65

00168-0080-31 - Hydrocortisone 2.5%

[RHI]

15.90

00168-0202-30 - clindamycin Top 1% Gel

[RHI]

187.85

00168-0269-50 - clobetasol Top 0.05%

Sol [RHI]

135.95

00168-0275-45 - MetroNIDAZOLE Gel

0.75% 45 GM [RHI]

556.55

00169-0081-81 - repaglinide 0.5 mg Tab

[RHI]

21.00

00169-0082-81 - repaglinide 1 mg Tab

[RHI]

8.70

00169-3685-12 - insulin aspart-insulin

aspart protamine 30 units-70 units/mL

SubQ Susp 10 mL [RHI]

328.40

00169-5176-03 - estradiol topical 10 mcg

Tab [RHI]

43.25

00172-2907-10 - furosemide 40 mg Tab

[RHI]

7.60

00172-3759-10 - lisinopril 10 mg Tab

[RHI]

7.55

00172-5241-60 - anagrelide 1 mg Cap

[RHI]

13.00

00172-5411-10 - fluconazole 100 mg Tab

[RHI]

9.40

00172-6406-59 - cromolyn 10 mg/mL Inh

Sol [RHI]

13.15



21.55

00173-0378-10 - cefTAZidime 1 g Inj

[RHI]

125.40

00173-0520-00 - salmeterol 50 mcg Inh

Pwdr [RHI]

453.85

00173-0547-00 - atovaquone 750 mg/5

mL Oral Susp [RHI]

1,282.20

00173-0662-00 - lamivudine 100 mg Tab

[RHI]

61.85

00173-0682-24 - albuterol CFC free 90

mcg/inh Inh Aer w/Adapt [RHI]

96.20

00173-0695-04 - fluticasone-salmeterol

100 mcg-50 mcg Inh Pwdr [RHI]

379.65



405.55



780.90

00173-0712-15 - dutasteride 0.5 mg Cap

[RHI]

27.65

00173-0718-20 - fluticasone CFC free 44

mcg/inh Inh Aer w/adapter [RHI]

465.40

00173-0719-20 - fluticasone CFC free

110 mcg/inh Inh Aer w/adapter [RHI]

878.70

00173-0720-20 - fluticasone CFC free

220 mcg/inh Inh Aer w/adapter [RHI]

1,360.85

00173-0859-14 - fluticasone-vilanterol

100 mcg-25 mcg Powder [RHI]

441.80

00173-0882-14 - fluticasone-vilanterol

200 mcg-25 mcg/inh Pow

23.15

00185-0128-01 - BuMETAnide Tab 0.5

mg [RHI]

10.65

00185-0415-60 - buPROPion 150 mg ER

Tab [RHI]

9.30

00185-0613-01 - hydrOXYzine pamoate

25 mg Cap [RHI]

7.60

00186-0776-60 - ticagrelor 60 mg Tab 29.40

00186-0777-39 - ticagrelor 90 mg Tab

UD [RHI]

29.45

00186-6040-01 - esomeprazole 40 mg IV

Inj [RHI]

254.65

00187-3013-30 - pyridostigmine 180 mg

ER Tab [RHI]

60.05

00187-5101-02 - pimecrolimus Top Crm

[RHI]

1,744.05

00223-1760-01 - sodium chloride 1 g Tab

[RHI]

2.70

00224-1801-24 - psyllium 100% Oral

Pwdr [RHI]

7.95

00225-0525-47 - sodium chloride nasal

0.65% Gel [RHI]

8.05

00228-2551-11 - diclofenac sodium 75


8.85

00228-2620-11 - isosorbide mononitrate

20 mg Tab [RHI]

9.40

00245-0003-31 - potassium iodide 1 g/mL

Oral Sol [RHI]

49.30

00245-0036-60 - cholestyramine 4 g/5.5 g

REC UD [RHI]

9.90

00245-0041-01 - potassium chloride 10

mEq ER Tab [RHI]

0.72


mEq ER Tab [RHI]

8.80

00245-0108-11 - ferrous sulfate 325 mg

Oral EC Tab [RHI]

2.75

00245-0147-01 - amiodarone 200 mg

Tab [RHI]

8.10

00245-0181-89 - divalproex sodium 250


7.35

00245-0212-01 - midodrine 5 mg Tab

[RHI]

9.55

00245-0212-11 - midodrine 5 mg Tab

[RHI]

8.85

00245-0271-11 - oxandrolone 2.5 mg Tab

[RHI]

22.55

00245-0860-70 - metronidazole 0.75%

Vag Gel w/Appl [RHI]

94.85

00259-1610-01 - incobotulinumtoxinA

100 units REC [RHI]

2,055.85

00259-3192-82 - Mederma [RHI] 81.40

00264-7612-00 - Dextrose 5% Sod

Chloride 0.45% 1000 mL [RHI]

30.00

00270-1411-11 - iopamidol 41%

intrathecal Sol 10 mL [RHI]

82.45

00270-1411-25 - iopamidol 41%

intrathecal Sol 20 mL [RHI]

10.60

00270-1412-15 - Iopamidol 61% 15ml

[RHI]

15.00

00281-0326-30 - nitroglycerin 2% Top

Oint [RHI]

107.05

00299-3921-08 - Emollient/Skin

Cleanser(Cetaphil) [RHI]

34.50

00299-5500-04 - fluocinolone Top 0.01%

Shampoo [RHI]

1,358.85

00310-0201-30 - anastrozole 1 mg Tab

[RHI]

8.70

00310-0751-39 - rosuvastatin 10 mg Tab

[RHI]

26.20

00310-1970-30 - naloxegol 25 mg Tab 50.95

00338-0004-04 - Sterile Water Irrigation

1000mL [RHI]

11.30

00338-0013-06 - Sterile Water Irrigation

2000mL [RHI]

10.55

00338-0017-03 - Dextrose 5% in Water

IV Sol 500 mL [RHI]

24.90

00338-0017-04 - Dextrose 5% in Water

IV Sol 1000 mL [RHI]

30.00

00338-0049-03 - Sodium Chloride 0.9%

IV Sol 500 mL [RHI]

13.90

00338-0049-04 - Sodium Chloride 0.9%

IV Sol 1000 mL [RHI]

19.85

00338-0049-11 - Sodium Chloride 0.9%

IV Sol 50 mL [RHI]

4.00

00338-0049-18 - Sodium Chloride 0.9%

IV Sol 100 mL [RHI]

4.00

00338-0553-18 - Sodium Chloride 0.9%

IV Sol 100 mL [RHI]

7.90

00338-0671-04 - Dextrose 5% Sod

Chloride 0.45% KCl 20 mEq 1000 mL

PREMIX [RHI]

21.50

00338-0675-04 - Dextrose 5% Sod

Chloride 0.45% KCl 40 mEq 1000 mL

PREMIX [RHI]

27.20

00338-0691-04 - Sodium Chloride 0.9%

with KCl 20 mEq/l IV Sol 1000 mL [RHI]

30.00

00338-1055-48 - MetroNIDAZOLE Inj

500mg in Sodium Chloride 0.9% 100mL

PREMIX [RHI]

122.25

00378-0030-01 - clorazepate 3.75 mg

Tab [RHI]

8.00

00378-0156-01 - probenecid 500 mg Tab

[RHI]

9.45

00378-0722-19 - Tizanidine HCL 2 mg

[RHI]

8.10

00378-1125-01 - glyBURIDE micronized

3 mg Tab [RHI]

8.35

00378-1454-01 - estradiol 1 mg Tab [RHI] 8.05

00378-2658-01 - Morphine Tab SA 15 mg

[RHI]

8.05

00378-2659-01 - morphine 30 mg ER

Tab [RHI]

10.10

00378-3286-91 - etidronate 200 mg Tab

[RHI]

19.80

00378-3350-99 - estradiol 0.05 mg/24

hours weekly Transderm ER Film [RHI]

71.45

00378-3352-99 - estradiol 0.1 mg Cream

[RHI]

811.80

00378-4105-91 - abacavir 300 mg Tab

[RHI]

20.70

00378-6380-01 - verapamil 180 mg

ERCap [RHI]

8.45

00378-6605-01 - oxybutynin 5 mg ER

Tab [RHI]

16.00

00378-6750-82 - balsalazide 750 mg Cap

[RHI]

9.30

00378-6987-89 - sodium chloride 0.9%

Inh Sol 15 mL [RHI]

10.25

00378-7001-93 - paroxetine 10 mg Tab

[RHI]

7.70

00378-7100-77 - fenofibrate 54 mg Tab

[RHI]

9.45

00378-7110-35 - bromfenac 0.09% Opth

Sol [RHI]

429.60

00395-1031-16 - glycerin compounding

Liq 480 mL [RHI]

11.65


hydrocodone 500 mg-5 mg Tab [RHI]

7.55


hydrocodone 325 mg-5 mg Tab [RHI]

8.10

00406-0484-62 - acetaminophen-codeine


7.85


oxycodone 325 mg-5 mg Tab [RHI]

8.25

00406-0552-62 - oxycodone 5 mg Tab

[RHI]

8.30

00406-1142-01 - methylphenidate 5 mg

Tab [RHI]

9.15

00406-1144-01 - methylphenidate 10 mg

Tab [RHI]

8.15

00406-5771-01 - methadone 10 mg Tab

[RHI]

7.75

00406-9960-01 - temazepam 7.5 mg Cap

[RHI]

19.05

00409-1078-20 - Sodium Chloride 0.9%

[RHI]

8.90

00409-1215-01 - naloxone 0.4 mg/mL Inj

Sol [RHI]

137.35

00409-1316-32 - heparin 10,000 units/mL

Inj Sol [RHI]

93.80

00409-1402-12 - heparin 5000 units/mL

Sol [RHI]

14.55

00409-1560-10 - bupivacaine 0.5% PF Inj

Sol 10 mL [RHI]

87.30

00409-1582-29 - bupivacaine 0.75% PF

Inj Sol 30 mL [RHI]

93.90


Sol [RHI]

17.05


Sol [RHI]

17.05

00409-1966-07 - sodium chloride

bacteriostatic 0.9% Inj Sol 30 mL [RHI]

10.60

00409-2267-20 - labetalol 5 mg/mL IV Sol

[RHI]

88.50

00409-2305-17 - midazolam 1 mg/mL

preservative-free Inj Sol [RHI]

79.35

00409-2585-01 - cefazolin 1 g Inj [RHI] 85.90

00409-2987-03 - ampicillin-sulbactam 2 g-

1 g Inj [RHI]

100.85

00409-3356-01 - hydromorphone 2

mg/mL Inj Sol [RHI]

81.80

00409-3378-13 - Piperacillin/Tazobactam

3.375 GM ADD [RHI]

54.15

00409-3379-04 - piperacillin-tazobactam

4 g-0.5 g IV Inj [RHI]

109.20

00409-3383-02 - Piperacillin-Taz Inj 2.25

GM (UD) [RHI]

92.20

00409-3414-01 - metoclopramide 5

mg/mL Inj Sol [RHI]

84.40

00409-3795-01 - ketorolac 30 mg/mL Inj

Sol [RHI]

81.00

00409-3977-03 - Sterile Water Inj Bact 30

mL [RHI]

10.05

00409-4276-01 - lidocaine 1% Inj Sol

[RHI]

14.80

00409-4277-01 - lidocaine 2% Inj Sol 20

mL [RHI]

16.30

00409-4279-02 - lidocaine 1% PF Inj Sol

30 mL [RHI]

18.70

00409-4688-23 - Fluconazole Inj 200mg

in Sodium Chloride 0.9% 100mL PREMIX

[RHI]

1,390.95

00409-4777-02 - ciprofloxacin 400

mg/200 mL IV Sol [RHI]

87.90

00409-4887-10 - Water Sterile Injection

[RHI]

11.05

00409-4888-10 - sodium chloride 0.9%

Inj Sol 10 mL [RHI]

10.45


5 mL [RHI]

20.65

00409-4921-34 - epinephrine 0.1 mg/mL

Inj Sol [RHI]

94.40

00409-6102-04 - furosemide 10 mg/mL

Inj Sol [RHI]

83.70

00409-6143-09 - Acetic Acid 0.25% [RHI] 14.60

00409-6533-01 - vancomycin 1 g IV Inj

[RHI]

202.10

00409-6535-01 - vancomycin 1 g IV Inj

Addv [RHI]

146.40

00409-6625-02 - sodium bicarbonate

8.4% IV Sol 50 mL [RHI]

73.75

00409-6637-34 - sodium bicarbonate

8.4% IV Sol 50 mL [RHI]

59.10


mEq/mL IV Sol [RHI]

43.60


mEq/mL IV Sol [RHI]

42.15

00409-6727-23 - magnesium sulfate 10

mg/mL-D5W intravenous solution [RHI]

61.95

00409-6778-02 - lorazepam 2 mg/mL Inj

Sol [RHI]

81.40

00409-7101-02 - Sodium Chloride 0.9%

IV Sol 250 mL Addv [RHI]

8.50

00409-7101-66 - Sodium Chloride 0.9%

50 mL Addv [RHI]

6.10

00409-7101-67 - Sodium Chloride 0.9%

IV Sol 100 mL Addv [RHI]

6.10

00409-7333-04 - ceftriaxone 1 g Inj [RHI] 93.70



00409-7391-72 - sodium phosphate 3

mmol/mL Inj Sol 15mL [RHI]

230.90

00409-7517-16 - glucose 50% IV Sol 50

mL [RHI]

96.95

00409-7941-09 - Dextrose 5% Sod

Chloride 0.9% 1000 mL [RHI]

19.80

00409-7983-02 - Sodium Chloride 0.9%

IV Sol 250 mL [RHI]

3.18

00409-7985-09 - Sodium Chloride 0.45%

IV Sol 1000 mL [RHI)

6.65

00409-9094-25 - fentaNYL 50 mcg/mL Sol 15.00

00409-9158-01 - phytonadione 10 mg/mL

Inj Sol [RHI]

108.20

00430-0170-15 - darifenacin 7.5 mg ER

Tab [RHI]

29.30

00430-0472-03 - Risedronate Tab 35 mg

[RHI]

139.50

00430-0753-27 - mesalamine 400 mg

Cap [RHI]

15.80

00436-0936-16 - sodium hypochlorite

Top 0.25% Sol [RHI]

22.65

00436-0946-16 - sodium hypochlorite

Top 0.5% Sol [RHI]

23.20

00456-0095-30 - roflumilast 500 mcg Tab

[RHI]

37.25

00456-0458-01 - thyroid desiccated 30

mg Tab [RHI]

7.85

00456-0459-01 - Thyroid Desiccated Tab

60 mg [RHI]

8.65


(0.175 mg) Tab [RHI]

8.25

00456-1410-30 - Nebivolol Tab 10 mg

[RHI]

23.05

00456-1525-60 - milnacipran 25 mg Tab

[RHI]

17.00

00456-1550-60 - milnacipran 50 mg Tab

[RHI]

28.55

00456-3205-63 - memantine 5 mg Tab

[RHI]

9.00

00456-3210-63 - memantine 10 mg Tab

[RHI]

23.75

00456342833 - Memantine XR 28mg oral

capsule [RHI]

53.95

00456-4300-08 - fosfomycin 3 g Oral

Pwdr [RHI]

272.35

00469-0420-99 - isavuconazonium 372

mg Pow [RHI]

1,057.50

00469-0617-11 - tacrolimus 1 mg Cap

[RHI]

23.30

00469-0657-11 - Tacrolimus Cap

(Prograf) **5 mg** [RHI]

20.75

00469-2601-30 - mirabegron 25 mg Tab 54.25

00469-3051-30 - amphotericin B

liposomal 50 mg IV Inj [RHI]

288.65

00469-3211-10 - micafungin 100 mg IV

Inj [RHI]

374.55

00472-0345-56 - hydrocortisone Top 1%

Oint [RHI]

5.15

00472-1738-03 - miconazole 200 mg Vag

Supp [RHI]

65.70

00472-5242-67 - permethrin Top 1%

lotion [RHI]

12.00

00487-0201-01 - Albuterol-Ipratropium

Inh Soln 3 mL [RHI]

10.45

00487-5901-99 - racepinephrine 2.25%

Soln UD [RHI]

12.05

00487-9501-01 - albuterol 0.083% Inh Sol

3 mL [RHI]

8.80

00487-9801-30 - ipratropium 0.02% Inh

Sol 2 mL [RHI]

7.95

00487-9901-30 - albuterol 0.5% Inh Sol

[RHI]

8.70

00517-0031-25 - cyanocobalamin 1000

mcg/mL Inj Sol [RHI]

81.35

00517-0401-25 - atropine 0.4 mg/mL Inj

Sol [RHI]

85.75

00517-0830-01 - latanoprost Opth

0.005% Sol [RHI]

27.45

00517-0955-01 - olanzapine 10 mg IM Inj

[RHI]

136.20

00517-2340-10 - iron sucrose 20 mg/mL

IV Sol [RHI]

210.30

00517-2610-25 - magnesium sulfate 50%

Inj Sol 10 mL [RHI]

42.95


Sol 4 mL [RHI]

20.35


Sol [RHI]

11.10

00521-2311-00 - Vaseline Jelly [RHI] 12.75

00521-2750-00 - Vaseline Lip Therapy

[RHI]

4.25

00527-1050-01 - AcetaZOLAMIDE Tab

(Diamox) 250 mg [RHI]

14.30

00527-1301-01 - primidone 50 mg Tab

[RHI]

7.65

00527-1313-01 - pilocarpine 5 mg Tab

[RHI]

11.50

00527-1315-30 - rifampin 300 mg Cap

[RHI]

10.40



8.20



12.00



8.35

00536-0122-97 - Acetaminophen

160mg/5ml [RHI]

10.40

00536-0160-97 - Ascorbic Acid

500mg/5ml [RHI]

24.70

00536-1275-59 - senna 8.8 mg/5 mL Oral

Syrup [RHI]

10.50

00536-1362-23 - nicotine 2 mg Oral

transmucosal Gum [RHI]

46.35

00536-1945-83 - Maalox 200/200/20mg

[RHI]

5.40

00536-1970-72 - ocular lubricant

preserved Sol [RHI]

5.55

00536-1995-53 - Selenium Sulfide 1%

[RHI]

17.95

00536-2220-75 - simethicone 40 mg/0.6

mL Oral Liq [RHI]

7.40

00536-3030-06 - nicotine 4 mg Oral

transmucosal Gum [RHI]

50.40

00536-3422-01 - calcium lactate 650 mg

Tab [RHI]

2.50


mcg Tab [RHI]

2.50


mcg Tab [RHI]

2.50

00536-3985-01 - meclizine 12.5 mg Tab

[RHI]

7.50

00536-4069-01 - niacinamide 500 mg

oral Tab [RHI]

2.50

00536-4092-56 - benzoyl peroxide Top

10% Gel [RHI]

14.85

00536-4306-11 - polycarbophil 625 mg

Tab [RHI]

2.55

00536-4408-01 - pyridoxine 50 mg Tab

[RHI]

7.45

00536-4787-01 - Vitamin B Complex Cap

[RHI]

2.50

00536-5150-26 - tolnaftate Top 1% Pwdr

[RHI]

6.25

00536-5894-88 - nicotine 7 mg/24 hr


4.95

00536-5896-88 - nicotine 21 mg/24 hr


5.05

00536-6731-01 - Lysine 500mg [RHI] 2.50

00548-5900-00 - cosyntropin 0.25 mg Inj

[RHI]

82.60

00555-0252-02 - dipyridamole 25 mg Tab

[RHI]

8.90

00555-0972-02 - amphetamine-

dextroamphetamine 10 mg Tab [RHI]

9.75

00555-0973-02 - amphetamine-

dextroamphetamine 20 mg Cap [RHI]

19.65

00555-0997-02 - fludrocortisone 0.1 mg

Tab [RHI]

8.95

00555-1009-16 - clonidine 0.1 mg/24 hr


113.40

00555-1010-16 - clonidine 0.2 mg/24 hr


100.00

00555-1011-16 - clonidine 0.3 mg/24 hr


159.35

00573-0212-25 - Benzocaine 10% [RHI] 11.65

00573-1925-50 - Chapstick [RHI] 4.85

00573-2871-10 - phenylephrine topical

0.25% Oint [RHI]

13.80

00573-3010-03 - Thermacare LRG/XL

[RHI]

4.60

00574-0106-01 - bromocriptine 2.5 mg

Tab [RHI]

20.15

00574-0107-77 - clotrimazole 10 mg Loz

[RHI]

10.35

00574-0220-01 - liothyronine 5 mcg Tab

[RHI]

9.25

00574-0222-01 - liothyronine 25 mcg Tab

[RHI]

10.75

00574-0292-01 - amiloride 5 mg Tab [RHI] 9.15

00574-0412-07 - Miralax packet1 12.35

00574-7234-12 - promethazine 25 mg

Supp [RHI]

20.10

00591-0444-01 - guanfacine 1 mg Tab

[RHI]

8.20

00591-0810-55 - silver sulfADIAZINE Top

1% Crm [RHI]

57.20

00591-0900-30 - glipiZIDE 2.5 mg ER

Tab [RHI]

12.35



11.80

00591-2224-55 - Cyclosporin 100 mg/ml

[RHI]

517.20

00591-2235-01 - tetracycline 500 mg Cap

[RHI]

20.95

00591-2919-23 - levalbuterol 0.63 mg/3

mL Inh Sol [RHI]

20.25

00591-2920-23 - levalbuterol 1.25 mg/3

mL Inh Sol [RHI]

21.00

00591-3198-72 - fentanyl 25 mcg/hr


18.40

00591-3205-30 - pioglitazone 15 mg Tab

[RHI]

8.30

00591-3206-30 - pioglitazone 30 mg Tab

[RHI]

8.60

00591-3212-72 - fentanyl 50 mcg/hr


28.25

00591-3214-72 - fentanyl 100 mcg/hr


28.05

00591-3219-01 - ASA/butalbital/caffeine

Cap [RHI]

9.25

00591-3774-19 - atorvastatin 10 mg Tab

[RHI]

7.75

00591-5335-01 - trihexyphenidyl 2 mg

Tab [RHI]

8.00

00591-5440-50 - doxycycline hyclate 100

mg Cap [RHI]

8.50

00591-5695-50 - minocycline 100 mg

Cap [RHI]

9.60

00597-0001-60 - aspirin-dipyridamole 25

mg-200 mg ERCap [RHI]

39.40

00597-0013-14 - albuterol-ipratropium Inh

Aer w/Adapt [RHI]

867.85

00597-0075-75 - Tiotropium Inh Cap 18

mCg #5 [RHI]

178.00

00597-0135-60 - dabigatran 150 mg Cap

UD [RHI]

29.60

00597-0149-60 - dabigatran 75 mg Cap

UD [RHI]

22.45

00603-0441-50 - bacitracin Top 500

units/g Oint [RHI]

5.35

00603-0535-50 - Hydrocortisone 1% [RHI] 4.75

00603-0599-50 - povidone iodine Top

10% Oint [RHI]

5.85

00603-0648-88 - capsaicin Top 0.025%

Crm [RHI]

9.40

00603-0649-88 - capsaicin Top 0.075%

Crm [RHI]

9.50

00603-0855-94 - Guaifenesin DM Soln

100 mg-10mg/5 mL Bottle [RHI]

4.25

00603-0857-94 - Guaifenesin Soln 100

mg/5 mL Bottle [RHI]

4.65

00603-1075-54 - codeine-guaifenesin 10

mg-100 mg/5 mL Oral Syrup 120 mL

[RHI]

12.75

00603-1393-64 - lidocaine Top 2% Sol

100 mL [RHI]

13.00

00603-1491-58 - oxybutynin 5 mg/5 mL

Oral Syrup [RHI]

16.35

00603-1508-58 - phenobarbital 20 mg/5

mL Oral Elix [RHI]

286.80


mEq/15 mL Oral Liq [RHI]

53.90

00603-2115-21 - allopurinol 100 mg Tab

[RHI]

8.45

00603-3180-21 - glycopyrrolate 1 mg Tab

[RHI]

9.00

00603-4110-21 - isosorbide mononitrate

30 mg ER Tab [RHI]

8.90

00603-4112-21 - Isosorbide Mononitrate

120mg ER [RHI]

9.80

00603-4209-21 - lisinopril 2.5 mg Tab

[RHI]

7.45

00603-4224-02 - losartan 25 mg Tab

[RHI]

7.55

00603-5780-21 - sulfamethoxazole-

trimethoprim 400 mg-80 mg Tab [RHI]

7.75

00603-7038-41 - acetic acid Otic 2% Sol

[RHI]

109.10

00603-7805-50 - miconazole Top 2%

Crm [RHI]

7.30

00603-7818-78 - nystatin Top 100,000

units/g Crm [RHI]

77.55

00641-0367-25 - dexamethasone 10

mg/mL Inj Sol [RHI]

28.10

00641-0376-25 - diphenhydrAMINE 50

mg/mL Inj Sol [RHI]

81.00

00641-0928-25 - promethazine 25 mg/mL

Inj Sol [RHI]

80.80

00641-6027-25 - fentanyl 0.05 mg/mL Inj

Sol [RHI]

15.25

00703-9040-03 - amikacin 250 mg/mL IV

Sol [RHI]

130.25

00713-0101-25 - Glycerin Adult Supp

[RHI]

2.60

00713-0101-26 - Glycerin Adult Supp

[RHI]

2.55

00713-0109-01 - bisacodyl 10 mg Supp

[RHI]

4.35

00713-0135-12 - prochlorperazine 25 mg

Supp [RHI]

41.10

00713-0197-57 - miconazole 100 mg Vag

Supp [RHI]

6.45

00713-0252-37 - miconazole 2% Vag

Crm w/Appl [RHI]

13.10


Supp [RHI]

42.85

00781-1047-13 - perphenazine 4 mg Tab

[RHI]

11.00


mg Tab [RHI]

9.85

00781-1764-13 - imipramine 25 mg Tab

[RHI]

8.25

00781-1787-01 - diclofenac sodium 50


9.00

00781-2144-01 - ampicillin 250 mg Cap

[RHI]

8.60

00781-2176-60 - cefdinir 300 mg Cap

[RHI]

9.00

00781-2614-13 - rivastigmine 1.5 mg Cap

[RHI]

18.05

00781-3010-95 - Ondansetron Inj 2

mg/mL 2 mL (UD) [RHI]

16.05

00781-3125-95 - nafcillin 2 g Inj [RHI] 113.50

00781-3165-75 - Octreotide Acetate 0.2

mg/mL [RHI]

269.25

00781-3222-95 - cefepime 1 g Inj [RHI] 88.90

00781-3265-95 - meropenem 500 mg IV

Inj [RHI]

106.30

00781-3413-92 - ampicillin 2 g Inj [RHI] 92.05

00781-5439-20 - cefpodoxime 200 mg

Tab [RHI]

29.45

00781-6041-46 - amoxicillin 250 mg/5 mL

Oral Liq [RHI]

14.30

00781-7240-55 - fentanyl 12 mcg/hr TD

film, ER [RHI]

40.80

00799-0001-03 - menthol-zinc oxide

topical 0.44%-20.625% Oin[RHI]

24.25

00832-0511-01 - bethanechol 10 mg Tab

[RHI]

8.50

00832-0512-00 - bethanechol 25 mg Tab

[RHI]

9.05

00832-1211-01 - warfarin 1 mg Tab [RHI] 8.50


00832-1213-01 - warfarin 2.5 mg Tab

[RHI]

7.90


00832-1215-01 - Warfarin Tab 4 mg

(Jantoven) [RHI]

8.60


00832-1218-01 - warfarin 7.5 mg Tab

[RHI]

8.10

00832-1219-00 - warfarin 10 mg Tab

[RHI]

7.75

00869-0602-43 - magnesium sulfate

compounding Pwdr [RHI]

4.85

00869-4206-10 - Mineral Oil (BULK

BOTTLE) [RHI]

18.95

00903-7149-31 - Azithromycin Susp 40

mg/mL Bottle [RHI]

65.75

00904-0005-14 - Maalox Plus

400/400/40mg [RHI]

6.10

00904-0036-20 - loperamide 1 mg/5 mL

Oral Liq [RHI]

8.35

00904-0270-60 - vitamin E 100 intl units

Cap [RHI]

2.50


Cap [RHI]

7.45


Cap [RHI]

2.55

00904-0523-61 - ascorbic acid 500 mg

Tab [RHI]

2.50

00904-0530-61 - Multiple Vitamins Tab

[RHI]

2.50

00904-0544-60 - thiamine 100 mg Tab

[RHI]

2.50

00904-0629-60 - niacin 250 mg ERCap

[RHI]

2.55

00904-0631-60 - niacin 500 mg ERCap

[RHI]

2.55


ERCap [RHI]

8.75

00904-0734-31 -

bacitracin/neomycin/polymyxin B Top

Oint [RHI]

18.35


[RHI]

7.65


[RHI]

8.65

00904-1258-92 - calcium carbonate 500

mg Chew Tab [RHI]

5.20

00904-1313-09 - Bismuth Subsal 262

mg/15 mL Bottle [RHI]

6.05

00904-1453-61 - metronidazole 250 mg

Tab [RHI]

8.75

00904-1465-16 - ferrous sulfate 220 mg/5

mL Oral Elix [RHI]

3.75

00904-1882-61 - Calcium Carbonate wiith

Vitamin D 250mg/125 U [RHI]

7.45

00904-1883-61 - Calcium Carbonate 500

mg [RHI]

7.65

00904-2009-60 - aspirin 325 mg Tab [RHI] 2.50

00904-2013-60 - aspirin 325 mg Oral EC

Tab [RHI]

2.50


mg Cap [RHI]

7.50

00904-2085-60 - vitamin A 10,000 units

Cap [RHI]

2.50

00904-2137-61 - ferrous gluconate 325

mg Tab [RHI]

2.50


mg Tab [RHI]

10.55

00904-2244-61 - docusate sodium 100

mg Cap [RHI]

2.50

00904-2533-00 - calamine Top 8% Lotion

[RHI]

4.25

00904-2621-60 - Multiple Vitamins Chew

Tab [RHI]

2.50

00904-2720-46 - potassium bicarbonate

25 mEq Eff Tab [RHI]

8.10

00904-2821-61 - oxybutynin 5 mg Tab

[RHI]

8.60

00904-2920-61 - verapamil 80 mg Tab

[RHI]

7.65

00904-2924-61 - verapamil 120 mg Tab

[RHI]

7.75

00904-2992-35 - tetrahydrozoline Opth

0.05% Sol [RHI]

5.60

00904-3162-60 - Selenium 50 mcg [RHI] 7.40

00904-3220-35 - carbamide peroxide Otic

6.5% Sol [RHI]

5.25


mg Tab [RHI]

2.50

00904-3233-92 - calcium-vitamin D 600

mg-400 intl units oral tablet [RHI]

2.80

00904-3365-61 - Baclofen Tab 10 mg

[RHI]

8.20

00904-3535-78 - sodium biphosphate-

sodium phosphate 19 g-7 g Rectal

Enema 135 mL [RHI]

4.25


Chew Tab [RHI]

8.75

00904-3865-75 - sodium chloride Nasal

0.65% Spry [RHI]

3.80

00904-3990-61 - trazodone 50 mg Tab

[RHI]

7.55

00904-4040-73 - Aspirin Tab Chew 81

mg [RHI]

2.50

00904-4043-60 - omega-3

polyunsaturated fatty acids 1000 mg Cap

[RHI]

2.75


mcg Tab [RHI]

2.50

00904-5015-46 - Coenzyme Q10 30 mg

[RHI]

8.05

00904-5017-35 - ocular lubricant

preserved Sol [RHI]

5.40

00904-5046-61 - captopril 25 mg Tab

[RHI]

7.60

00904-5053-60 - pseudoephedrine 30 mg

Tab [RHI]

2.50

00904-5135-59 - Acetaminophen-Aspirin-

Caffeine Tab [RHI]

7.45

00904-5165-61 - senna 8.6 mg Tab [RHI] 2.50

00904-5182-52 - melatonin 3 mg Tab

[RHI]

2.60

00904-5222-61 - baclofen 20 mg Tab

[RHI]

8.60

00904-5224-52 - lactase 3000 units Tab

[RHI]

2.60

00904-5255-35 - acetaminophen 80

mg/0.8 mL Oral Susp [RHI]

5.00

00904-5272-60 - Calcium

Carbonate/Vitamin D 315mg/250Units

[RHI]

2.50

00904-5293-52 - Glucosamine 500mg

cap [RHI]

7.70


mg Cap [RHI]

2.50

00904-5309-20 - ibuprofen 100 mg/5 mL

Oral Susp [RHI]

11.85

00904-5313-60 - Prenatal Multivitamins

with Folic Acid 0.8 mg Tab [RHI]

7.45

00904-5332-60 - zinc sulfate 220 mg Cap

[RHI]

2.50

00904-5379-61 - gemfibrozil 600 mg Tab

[RHI]

8.25

00904-5395-61 - iron polysaccharide 150

mg Cap [RHI]

2.65

00904-5481-52 -

Glucosamine/Chondroitin 500/400mg

[RHI]

2.60

00904-5486-52 - Certa-Vite Tablet [RHI] 2.50

00904-5492-13 - Therapeutic Multiple

Vitamins with Minerals Tab [RHI]

2.50



9.30

00904-5512-61 - docusate-senna 50 mg-

8.6 mg Tab [RHI]

2.50

00904-5610-61 - enalapril 10 mg Tab

[RHI]

7.65

00904-5632-61 - gabapentin 300 mg Cap

[RHI]

7.75

00904-5656-61 - clonidine 0.1 mg Tab

[RHI]

7.55

00904-5657-61 - clonidine 0.2 mg Tab

[RHI]

7.60

00904-5709-09 - Bismuth Subsalicylate

262mg [RHI]

21.80

00904-5711-35 - oxymetazoline Nasal

0.05% Spry [RHI]

4.90

00904-5728-89 - loratadine 10 mg Tab

[RHI]

8.35

00904-5784-61 - fluoxetine 10 mg Cap

[RHI]

7.70

00904-5785-61 - FLUoxetine Cap 20 mg

[RHI]

7.70


[RHI]

7.60

00904-5803-15 - pseudoephedrine 120

mg ER Tab [RHI]

8.70

00904-5809-61 - Lisinopril Tab 20 mg

[RHI]

7.65

00904-5823-60 - cholecalciferol 400 intl

units Tab [RHI]

2.50

00904-5824-61 - Cholecalciferol Tab

1,000 Units (Vitamin D3) [RHI]

2.50

00904-5840-61 - promethazine 25 mg

Tab [RHI]

8.25

00904-5854-61 - ibuprofen 600 mg Tab

[RHI]

7.70

00904-5858-61 - alprazolam 0.25 mg Tab

[RHI]

7.60

00904-5887-61 - theophylline 100 mg ER

Tab [RHI]

7.90

00904-5889-61 - theophylline 300 mg ER

Tab [RHI]

8.15

00904-5895-78 - mineral oil 100% Rectal

Enema 133 mL [RHI]

4.70

00904-5921-61 - digoxin 125 mcg (0.125

mg) Tab [RHI]

10.30

00904-5929-61 - labetalol 200 mg Tab

[RHI]

9.00

00904-5951-61 - spironolactone 25 mg

Tab [RHI]

7.65

00904-5980-61 - lorazepam 0.5 mg Tab

[RHI]

7.60

00904-5984-26 - Ammonium Lactate

Lotion 12% 225 mL [RHI]

28.35


mg ER Tab [RHI]

8.55

00904-5993-61 - amlodipine 10 mg Tab

[RHI]

7.70

00904-6025-61 - Miralax packet1 10.20

00904-6069-61 - naproxen 250 mg Tab

[RHI]

7.50


mg ER Tab [RHI]

8.90


[RHI]

7.50

00904-6083-61 - zolpidem 10 mg Tab

[RHI]

7.55

00904-6085-61 - citalopram 20 mg Tab

[RHI]

7.80

00904-6090-61 - metformin 500 mg Tab

[RHI]

7.55

00904-6091-61 - metformin 850 mg Tab

[RHI]

7.70


[RHI]

7.80

00904-6107-61 - MetFORMIN Tab XR

500 mg [RHI]

8.20

00904-6119-61 - tramadol 50 mg Tab

[RHI]

7.55

00904-6121-61 - acyclovir 400 mg Tab

[RHI]

8.30

00904-6128-61 - terazosin 5 mg Cap

[RHI]

7.95

00904-6156-61 - tamsulosin 0.4 mg Oral

Cap [RHI]

8.35

00904-6221-60 - Ursodiol Cap 300 mg

[RHI]

12.60

00904-6237-61 - carbidopa-levodopa 25

mg-100 mg Tab [RHI]

8.00

00904-6242-61 - donepezil 5 mg Tab

[RHI]

7.85

00904-6247-61 - Venlafaxine Cap XR 75

mg [RHI]

8.05

00904-6249-61 - LEVofloxacin Tab 250

mg [RHI]

8.10

00904-6269-08 - ziprasidone 20 mg Cap

[RHI]

11.55

00904-6277-61 - quetiapine 25 mg Tab

[RHI]

7.90


[RHI]

7.70

00904-6297-61 - naproxen 500 mg Tab

[RHI]

7.75

00904-6300-61 - carvedilol 3.125 mg Tab

[RHI]

7.65

00904-6305-21 - Phenol Spray 177 mL

(Chloraseptic) [RHI]

6.90

00904-6314-61 - escitalopram 10 mg Tab

[RHI]

7.95

00904-6339-61 - docusate-senna 50 mg-

8.6 mg Tab [RHI]

2.50


[RHI]

12.80

00904-6377-61 - olanzapine 5 mg Tab

[RHI]

8.55

00904-6550-61 - propranolol 10 mg Tab

[RHI]

8.20

00904-7688-22 - phenylephrine Top

0.25% Supp [RHI]

2.70


mg Chew Tab [RHI]

5.45

00904-7704-18 - aspirin 81 mg Oral EC

Tab [RHI]

2.55

00904-7735-52 - Antioxidant Multiple

Vitamins and Minerals Tab [RHI]

2.50

00904-7927-61 - bisacodyl 5 mg Oral EC

Tab [RHI]

2.50

00944-2944-01 - Antihemophilic Factor

VIII Human (Humate-P) [RHI]

32,722.20

00998-0615-05 - dexamethasone Opth

0.1% Susp [RHI]

210.20

0100351079294 - tamsulosin 0.4 mg Oral

Cap [RHI]

8.90

0120705031003122 - surgicel fibrillar 1

EA Dressing

522.95

04138-8210-41 - Blistex Camphor/Phenol

[RHI]

15.60

04200-2302-68 - Tucks Pads/Witch

Hazel [RHI]

9.90

04746-9002-88 - Coenzyme Q Cap 100

mg [RHI]

3.35

070074-630816 - Vital High Protein 1,000

mL Soln

46.00

08327-0309-09 - Silver Dressing [RHI] 82.80

08472-4000-01 - Bismuth Subgallate Tab

200 mg [RHI]

8.00

08881-5701-21 - sodium chloride 0.9%

Inj Sol 10 mL [RHI]

19.70

10019-0553-88 - scopolamine 1.5 mg


58.30

10139-0062-02 - methotrexate 25 mg/mL

PF Inj Sol [RHI]

119.45

10147-0953-03 - paliperidone 6 mg Tab 67.80

10181-0041-65 - Palmer's Cocoa Butter

400 mL Lotion

13.05

10310-0283-40 - benzocaine Top 20%

mucous membrane gel [RHI]

11.65


mg ER Tab [RHI]

11.90

11523-7268-03 - polyethylene glycol 3350

- Pow

11.75

11845-0131-31 - Flax seed Oil 1000mg

[RHI]

2.60

11845-1183-01 - Vitamin D 400units [RHI] 7.40

12 MINI BORE EXTENSION" 41.00

12496-1283-02 - buprenorphine-naloxone

2 mg-0.5 mg sublingual Dis Tab [RHI]

29.05

12496-1306-02 - buprenorphine-naloxone

8 mg-2 mg sublingual Dis Tab [RHI]

27.10

12870-0001-02 - Silver Nitrate Applicator

[RHI]

8.30

13310-0153-07 - quinine 324 mg oral

capsule [RHI]

16.60

13668-0093-90 - pramipexole 0.5 mg Tab

[RHI]

7.60

15054-0500-01 - abobotulinumtoxinA 500

units Pow

3,356.35

15584-0101-01 -

efavirenz/emtricitabine/tenofovir 600 mg-

200 mg-300 mg oral tablet [RHI]

348.25

16252-0524-01 - acarbose 50 mg Tab

[RHI]

9.40

16252-0599-44 - alendronate 35 mg Tab

[RHI]

9.20

16571-0141-50 - timolol Opth 0.5% Sol

[RHI]

21.60

1719040010H7L611 - Cefazolin 2g/50ml

duplex sol 2g/50ml Soln-IV

106.85

17204-0434-40 - magnesium amino acids

chelate 133 mg oral tablet [RHI]

2.60

17314-9313-02 - potassium phosphate-

sodium phosphate 250mg-280mg-160mg

Oral Pwdr [RHI]

5.75

17433-9876-03 - docusate 283 mg Rectal

Enema [RHI]

10.60

17478-0070-35 - erythromycin Opth 0.5%

Oint [RHI]

33.10

17478-0209-10 - ketorolac Opth 0.5% Sol

[RHI]

19.90

17478-0235-35 -

bacitracin/neomycin/polymyxin B Opth

Oint [RHI]

185.00

17478-0238-35 - bacitracin-polymyxin B

Opth Oint [RHI]

32.65

17478-0283-10 - gentamicin Opth 0.3%

Sol [RHI]

69.05

17478-0622-35 - sodium chloride,

hypertonic, Opth 5% Oint [RHI]

11.30

17478-0705-10 - betaxolol Opth 0.5% Sol

[RHI]

211.20

17478-0711-30 - lidocaine Top 2% Gel

w/Appl [RHI]

31.00

17478-0715-10 - brimonidine Opth 0.2%

Sol [RHI]

16.25

17478-0717-10 - ketotifen 0.025% Opth

Sol [RHI]

13.10

17478-0811-30 - lidocaine Top 2% Gel

w/Appl [RHI]

25.35

17478-0892-25 - diclofenac Opth 0.1%

Sol [RHI]

22.25

17478-0934-01 - hydrALAZINE 20 mg/mL

Inj Sol [RHI]

20.05

18FR Peg tube w/ balloon replacement 173.00

2 COBAN" 4.00

20 MINIBORE EXTENSION" 42.00

20 X 28 EXU-DRYWOUND DRESSING 56.00

20526 Carpal Tunnel Therapeutic

Injection RHI

811.00

20550 Injection Single Tendon

Sheath/Ligament Aponeurosis RHI

1,185.00

20551 Injection Single Tendon

Origin/Insertion RHI

335.00

20552 Injection Single/Multiple Trigger

Points 1 or 2 Muscles RHI

1,293.00

20553 Injection Single/Multiple Trigger

Points 3 or more Muscles RHI

1,503.00

20600 Arthrocentesis/Aspiration Injection

Small Joint/Bursa RHI

811.00


Intermediate Joint/Bursa RHI

811.00


Major Joint/Bursa RHI

811.00

20G X 3.5 TOUGHY SPINAL NDL 26.00

20G X 4.5 TOUGHY SPINAL NDL 1,107.00

20G X 6IN TOUGHY SPINAL NDL 42.00

23155-0002-01 - hydrALAZINE 25 mg

Tab [RHI]

7.55

23155-0070-01 - methimazole 5 mg Tab

[RHI]

7.75

23155-0108-30 - nimodipine 30 mg Cap

[RHI]

13.30

23G X 2" SPINAL NEEDLE 17.00

23G X 3.5" SPINAL NEEDLE 11.00

23G X 5" SPINAL NEEDLE 50.00

23G X 6.0 SPINAL NEEDLE 52.00

23x3.5 Quincke Spinal Needle 10.00

23x5 Quincke spinal needle 48.00

24208-0276-15 - sodium chloride,

hypertonic, Opth 2% Sol [RHI]

35.05

24208-0290-05 - tobramycin Opth 0.3%

Sol [RHI]

52.85

24208-0295-25 - dexamethasone-

tobramycin Opth 0.1%-0.3% Susp [RHI]

167.90

24208-0299-05 - loteprednol Opth 0.5%

Susp [RHI]

497.70

24208-0315-10 - polymyxin B-

trimethoprim Opth Sol [RHI]

30.35

24208-0342-05 - desmopressin 10

mcg/inh Nasal Spry [RHI]

409.05

24208-0398-30 - ipratropium Nasal

0.03% Spry [RHI]

78.75

24208-0410-05 - ofloxacin Otic 0.3% Sol

[RHI]

16.65

24208-0434-05 - ofloxacin Opth 0.3% Sol

[RHI]

36.45

24208-0505-05 - levobunolol Opth 0.5%

Sol [RHI]

25.10

24208-0561-62 - antipyrine-benzocaine

Otic Sol [RHI]

46.00

24208-0632-10 -

Multivitamin/Mineral/Lutein [RHI]

8.75

24208-0715-10 - prednisoLONE Opth

sodium phosphate 1% Sol [RHI]

175.00

24208-0750-60 - atropine Opth 1% Sol

[RHI]

46.90

24338-0102-13 - erythromycin 250 mg

Tab [RHI]

31.85

24338-0134-02 - erythromycin

ethylsuccinate 200 mg/5 mL Oral Liq [RHI]

971.75

24658-0220-20 - doxycycline hyclate 100

mg Tab [RHI]

7.90

25 MM NEEDLE & STABILIZER 398.00

25010-0205-15 - ethacrynic acid 25 mg

Tab [RHI]

75.50

25010-0405-15 - Phytonadione Tab 5 mg

[RHI]

136.05

25021-0102-99 - cefazolin 1 g Inj [RHI] 101.95

25021-0115-04 - clindamycin 150 mg/mL

IV Sol [RHI]

86.55

25021-0122-50 - cefepime 2 g Inj [RHI] 116.40

25021-0130-30 - levofloxacin 25 mg/mL

IV Sol [RHI]

136.00

25021-0400-01 - heparin 1000 units/mL

Inj Sol [RHI]

15.20

25021-0402-01 - heparin 5000 units/mL

Sol [RHI]

15.15

25021-0806-01 - haloperidol 5 mg/mL Inj

Sol [RHI]

85.75

25G X 2.5IN QUINCKE SPINAL NDL 8.00

25G X 3.5 QUINCKE SPINAL NEEDL 10.00

26-33-3500EA Nif-Tee Adapter 13.00

27096 Injection Sacroiliac Joint RHI 1,293.00

27434-0002-11 - acetylcysteine 600 mg

oral capsule [RHI]

8.00

27434-0010-17 - Copper 2 mg Cap 2.55

28409-0847-02 - Saliva Substitute Spray

45 mL [RHI]

30.50

3' SUCTION TUBING 31.00

30 Min Swedish Massage 35.00

301311810679 - lacosamide injection 200

mg Injection

272.85

301-435EA Bacteria Filter 26.00

301730873064 - Umeclidinium INH 62.5

mcg Inhaler

210.50

305361970727 - Artificial Tear Solution

1.4 Bottle

5.25

30768-0119-00 - Cranberry 475 mg [RHI] 2.60

30768-6007-30 - Biotin 1000 mcg tab

[RHI]

7.65

31357-0040-25 - azithromycin Opth 1%

Sol [RHI]

372.15

31722-0302-01 - alfuzosin 10 mg ER Tab

[RHI]

8.55

31722-0832-60 - valganciclovir 450 mg

Tab [RHI]

74.50

345802150653 - Alogliptin 25 mg Tab 27.50

347781468132 - oseltamivir 30mg cap 30

mg Cap

31.20

36-11112EA Heat Moisture Exchanger 44.00

36652-0267-69 - docusate-ferrous

fumarate 100 mg-150 mg ER Tab [RHI]

2.80

36652-0916-81 - Cranberry 500mg

capsule [RHI]

2.75

37000-0544-01 - Vicks Vaporub [RHI] 7.00

37205-0110-38 - magnesium citrate

8.85% Oral Liq 300 mL [RHI]

4.60

37205-0831-43 - Mineral Oil (BULK

BOTTLE) [RHI]

19.25

37205-0871-34 - Hydrogen Peroxide 3%

[RHI]

10.75

38779-1938-08 - Phenol 89% [RHI] 10.75

38779-1969-08 - emu oil [RHI] 640.60

39328-0357-60 - ergocalciferol 8000 intl

units/mL Oral Sol [RHI]

131.55

39822-0617-02 - colistimethate 150 mg

(colistin base) Pow

50.75

4 IN 1 CLEANSING LOTION 19.00

40985021154 - Selenium 200 mcg Cap 7.35

41608-0087-47 - Summers Eve Douche 1

EA Soln

5.70

41616-0485-83 - bicalutamide 50 mg Tab

[RHI]

8.15

42858-0302-25 - hydromorphone 4 mg

Tab [RHI]

8.25

43386-0440-24 - NIFEdipine 10 mg Cap

[RHI]

9.45

43478-0900-88 - propranolol 60 mg

ERCap [RHI]

9.35

43478-0901-88 - propranolol 80 mg

ERCap [RHI]

12.85

43547-0288-10 - buPROPion 100 mg/12

hours Tab

8.00

43598-0210-50 - silver sulfADIAZINE Top

1% Crm [RHI]

15,052.35

43900-0976-47 - guar gum oral Pwdr

[RHI]

8.80

44087-0044-03 - interferon beta-1a 44

mcg/0.5 mL SubQ Sol [RHI]

1,434.90

45802-0032-03 - tolnaftate Top 1% Crm

[RHI]

6.75

45802-0040-64 - selenium sulfide Top

2.5% Lotion [RHI]

46.10

45802-0046-35 - gentamicin Top 0.1%

Oint [RHI]

48.75

45802-0050-03 - dibucaine Top 1% Oint

[RHI]

16.30

45802-0056-35 - gentamicin Top 0.1%

Crm [RHI]

51.30

45802-0061-70 -

bacitracin/neomycin/polymyxin B Top

Oint [RHI]

2.80

45802-0087-65 - alogliptin 6.25 mg Tab 33.00

45802-0098-51 - mesalamine 4 g/60 mL

Rectal Enema [RHI]

59.65

45802010365 - Alogliptin 12.5 mg Tab 27.45

45802-0112-22 - mupirocin Top 2% Oint

[RHI]

27.10

45802-0174-53 - Muscle Rub [RHI] 8.00

45802-0216-96 - benzoyl peroxide Top

5% Gel [RHI]

81.95

45802-0269-37 - permethrin Top 5% Crm

[RHI]

174.60

45802-0283-06 - hydrocortisone Top 1%

Lotion [RHI]

24.95

45802-0356-53 - trolamine salicylate Top

10% Crm [RHI]

7.30

45802-0358-03 - diphenhydramine-zinc

acetate Top 2%-0.1% Crm [RHI]

6.05

45802-0434-11 - clotrimazole Top 1%

Crm [RHI]

5.05

45802-0465-64 - ketoconazole Top 2%

Shampoo [RHI]

40.10

45802-0717-08 - Terconazole 80 mg

[RHI]

147.25

45802-0730-30 - acetaminophen 650 mg

Supp [RHI]

3.10

45945-0151-01 - baclofen 0.05 mg/mL

Sol[RHI]

417.70

45945-0155-02 - baclofen 0.5 mg/mL

Sol[RHI]

991.45

45945-0156-02 - baclofen 1 mg/mL Sol 1,508.25

45945-0157-01 - baclofen 2 mg/mL

Sol[RHI]

2,891.15

45945-0157-02 - baclofen 2 mg/mL

Sol[RHI]

2,804.45

45963-0538-30 - ondansetron 4 mg Tab

[RHI]

8.70

45963-0539-30 - Ondansetron Tab 8 mg

[RHI]

8.00

45963-0558-30 - valacyclovir 500 mg Tab

[RHI]

9.05

46287-0006-01 - sodium polystyrene

sulfonate 15 g/60 mL Oral Susp [RHI]

37.95

46287-0507-04 - Emollient Skin

Cleanser(Hydrocerin) [RHI]

26.25

47335-0715-83 - finasteride 5 mg Tab

[RHI]

7.80

48102-0007-35 - bacitracin Opth 500

units/g Oint [RHI]

258.15

48433-0202-30 - mineral oil 100% Oral

Liq 30 mL [RHI]

58.75

49281-0589-01 - meningococcal

conjugate vaccine IM Sol [RHI]

405.40

49281-0752-22 - tuberculin purified

protein derivative 5 TU/0.1 mL ID Sol

[RHI]

87.45

49502-0500-01 - epinephrine 0.3 mg Inj

kit [RHI]

1,279.20

49502-0605-61 - formoterol 20 mcg/2 mL

Inh Sol [RHI]

11.45

49502-0640-15 - sodium chloride 3% Inh

Sol 15 mL [RHI]

10.15

49702-0205-48 - lamivudine 10 mg/mL

Oral Sol [RHI]

452.85

49702-0228-13 - dolutegravir 50 mg

Tab[RHI]

196.40

49708-0644-90 - theophylline 80 mg/15

mL Oral Elix [RHI]

84.90



9.00

49884-0289-01 - megestrol 20 mg Tab

[RHI]

8.10

49884-0678-01 - NIFEdipine Tab ER 60

mg [RHI]

10.50

49884-0724-01 - hydroxyurea 500 mg

Cap [RHI]

8.75

49884-0867-02 - dronabinol 2.5 mg Cap

[RHI]

13.25

49884-0985-01 - nateglinide 120 mg Tab

[RHI]

9.75

49938-0102-30 - dapsone 25 mg Tab

[RHI]

16.45

5.0 XLT Inner cannula 23.00

500ML CANISTER WITH GELL 186.00

50111-0917-01 - torsemide 20 mg Tab

[RHI]

7.90

50242-0041-64 - alteplase 2 mg Powder

[RHI]

314.20

50268-0348-15 - gabapentin 300 mg Cap 7.80

50268-0756-15 - torsemide 20 mg Tab

[RHI]

9.00


mcg Tab [RHI]

2.75

50383-0167-16 - Ascorbic Acid

500mg/5ml [RHI]

17.55

50383-0233-10 - dorzolamide-timolol

Opth 22.3%-6.8% Sol [RHI]

768.10

50383-0241-06 - levetiracetam 100


21.60

50383-0282-02 - ciprofloxacin Opth 0.3%

Sol [RHI]

16.45

50383-0667-30 - lidocaine-prilocaine Top

2.5%-2.5% Crm [RHI]

42.30

50383-0771-16 - docusate sodium

100/10 mL Oral Liq [RHI]

4.45


trimethoprim 200 mg-40 mg/5 mL Oral

Susp 473 mL [RHI]

67.30

50458-0295-15 - itraconazole 10 mg/mL

Oral Sol [RHI]

927.85

50458-0550-01 - paliperidone 3 mg oral

ER Tab [RHI]

74.50

50458-0579-30 - rivaroxaban 20 mg

Tab[RHI]

51.75

50458-0580-30 - rivaroxaban 10 mg Tab

[RHI]

43.20

50474-0100-01 - theophylline 100 mg/24

hours Oral ER Cap [RHI]

13.35

51079-0020-03 - budesonide 3 mg

ERCap [RHI]

40.05

51079-0058-20 - chlorthalidone 25 mg

Tab [RHI]

7.80

51079-0067-20 - atropine-diphenoxylate

0.025 mg-2.5 mg Tab [RHI]

8.25


[RHI]

7.55


[RHI]

7.55

51079-0074-20 - hydrALAZINE 10 mg

Tab [RHI]

7.75

51079-0083-20 - isoniazid 300 mg Tab

[RHI]

7.95

51079-0086-01 - mirtazapine 15 mg Tab

[RHI]

7.95

51079-0086-20 - mirtazapine 15 mg Tab

[RHI]

7.60

51079-0094-20 - phenobarbital 15 mg

Tab [RHI]

7.85

51079-0107-20 - amitriptyline 25 mg Tab

[RHI]

8.20

51079-0119-20 - dicyclomine 20 mg Tab

[RHI]

7.50


trimethoprim 800 mg-160 mg Tab [RHI]

8.10


[RHI]

7.75


[RHI]

7.60

51079-0141-20 - chlordiazepoxide 25 mg

Cap [RHI]

9.15

51079-0182-20 - ciprofloxacin 500 mg

Tab [RHI]

8.15

51079-0190-20 - indomethacin 25 mg

Cap [RHI]

8.10


[RHI]

8.20


[RHI]

9.40

51079-0255-20 - metoprolol 25 mg Tab

[RHI]

7.60


[RHI]

8.00


[RHI]

7.95


[RHI]

9.30

51079-0284-20 - diazepam 2 mg Tab

[RHI]

7.60

51079-0285-20 - diazepam 5 mg Tab

[RHI]

7.55

51079-0301-20 - clonidine 0.3 mg Tab

[RHI]

7.65

51079-0306-30 - Miralax packet1 10.20

51079-0348-20 - nitrofurantoin

macrocrystals-monohydrate 100 mg Cap

[RHI]

12.00

51079-0374-20 - chlordiazepoxide 5 mg

Cap [RHI]

8.00

51079-0379-20 - mycophenolate mofetil

500 mg Tab [RHI]

11.30


Tab [RHI]

9.70

51079-0386-20 - lorazepam 1 mg Tab

[RHI]

7.95

51079-0418-21 - temazepam 15 mg Cap

[RHI]

7.70

51079-0419-20 - temazepam 30 mg Cap

[RHI]

7.85

51079-0434-20 - megestrol 20 mg Tab

[RHI]

8.65

51079-0436-20 - doxepin 10 mg Cap

[RHI]

8.80

51079-0437-20 - Doxepin Cap 25 mg

[RHI]

9.25



12.15


(0.1 mg) Tab [RHI]

12.00



8.10



8.95

51079-0451-20 - amlodipine 5 mg Tab

[RHI]

7.65

51079-0457-20 - meloxicam 7.5 mg Tab

[RHI]

7.85

51079-0462-20 - risperidone 1 mg Tab

[RHI]

8.00

51079-0481-20 - amantadine 100 mg

Cap [RHI]

8.30

51079-0498-20 - lamotrigine 25 mg Tab

[RHI]

7.75

51079-0519-20 - chlorproMAZINE 25 mg

Tab [RHI]

11.70


Tab [RHI]

7.75


Tab [RHI]

7.80

51079-0557-20 - clopidogrel 75 mg Tab

[RHI]

8.00

51079-0561-03 - modafinil 100 mg Tab

[RHI]

9.20

51079-0597-20 - cetirizine 10 mg Tab

[RHI]

7.85

51079-0621-82 - balsam Peru/castor

oil/trypsin topical 87 mg-788 mg-0.12

mg/g Spra [RHI]

45.60

51079-0623-81 - Mafenide Cream 8.5%

57 GM [RHI]

141.70

51079-0629-20 - metoclopramide 5 mg

Tab [RHI]

7.85

51079-0630-20 - prazosin 1 mg Cap [RHI] 13.10

51079-0644-20 - cyclobenzaprine 10 mg

Tab [RHI]

7.60

51079-0670-05 - methotrexate 2.5 mg

Tab [RHI]

10.25

51079-0673-06 - clarithromycin 500 mg

Tab [RHI]

26.60

51079-0684-20 - atenolol 50 mg Tab [RHI] 7.55

51079-0685-20 - atenolol 100 mg Tab

[RHI]

7.85

51079-0690-20 - loperamide 2 mg Cap

[RHI]

10.10

51079-0721-20 - mycophenolate mofetil

250 mg Cap [RHI]

8.50

51079-0724-20 - zolpidem 5 mg Tab [RHI] 7.65

51079-0726-20 - topiramate 25 mg Tab

[RHI]

7.85

51079-0734-20 - haloperidol 1 mg Tab

[RHI]

7.70

51079-0736-20 - haloperidol 5 mg Tab

[RHI]

7.80

51079-0745-20 - diltiazem 30 mg Tab

[RHI]

7.85

51079-0746-20 - diltiazem 60 mg Tab

[RHI]

7.75

51079-0759-20 - atenolol 25 mg Tab [RHI] 7.60


[RHI]

7.65

51079-0776-20 - hydrochlorothiazide 12.5

mg Cap [RHI]

7.85


[RHI]

7.55


[RHI]

7.60

51079-0810-20 - glipiZIDE 5 mg Tab [RHI] 8.15

51079-0811-20 - glipiZIDE 10 mg Tab

[RHI]

7.60

51079-0812-20 - nadolol 20 mg Tab [RHI] 13.15

51079-0813-20 - nadolol 40 mg Tab [RHI] 8.25

51079-0821-20 - levetiracetam 500 mg

Tab [RHI]

7.90

51079-0852-03 - galantamine 4 mg Tab

[RHI]

17.50

51079-0865-20 - lamotrigine 150 mg Tab

[RHI]

9.35

51079-0868-01 - indapamide 2.5 mg Tab

[RHI]

7.35


Chew Tab [RHI]

7.90

51079-0871-20 - sucralfate 1 g Tab [RHI] 8.25

51079-0872-20 - glyBURIDE 2.5 mg Tab

[RHI]

8.25

51079-0873-20 - glyBURIDE 5 mg Tab

[RHI]

8.60

51079-0882-20 - clonazepam 1 mg Tab

[RHI]

7.45

51079-0889-20 - pentoxifylline 400 mg

ER Tab [RHI]

7.95

51079-0892-20 - bumetanide 1 mg Tab

[RHI]

9.40

51079-0894-20 - verapamil 120 mg ER

Tab [RHI]

8.00

51079-0899-20 - verapamil 180 mg ER

Tab [RHI]

15.25

51079-0905-20 - phenytoin 100 mg

ERCap [RHI]

9.25

51079-0921-20 - cloZAPine 25 mg Tab

[RHI]

8.90

51079-0928-20 - labetalol 100 mg Tab

[RHI]

8.65


[RHI]

7.65


[RHI]

7.70

51079-0932-20 - carvedilol 25 mg Tab

[RHI]

7.50

51079-0936-20 - terazosin 1 mg Cap

[RHI]

7.80

51079-0943-20 - buPROPion 75 mg Tab

[RHI]

11.45

51079-0944-20 - buPROPion 100 mg

Tab [RHI]

8.75

51079-0951-20 - enalapril 5 mg Tab [RHI] 7.60

51079-0957-20 - doxazosin 1 mg Tab

[RHI]

9.60

51079-0959-20 - doxazosin 4 mg Tab

[RHI]

9.60

51079-0966-20 - famotidine 20 mg Tab

[RHI]

7.55

51079-0981-20 - lisinopril 5 mg Tab [RHI] 7.55


[RHI]

7.60

51079-0985-20 - busPIRone 5 mg Tab

[RHI]

7.65

51079-0998-20 - tizanidine 4 mg Tab

[RHI]

8.35

51224-0154-50 - flavoxate 100 mg Tab

[RHI]

10.35

51248-0150-52 - solifenacin 5 mg Tab

[RHI]

53.00

51525-0294-03 - azelastine Nasal 137

mcg/inh Spry [RHI]

176.75


Crm [RHI]

34.60


Crm [RHI]

297.75

51672-1258-02 - clobetasol Top 0.05%

Crm [RHI]

46.70

51672-1259-02 - clobetasol Top 0.05%

Oint [RHI]

36.90

51672-1263-02 - nystatin-triamcinolone

Top Crm [RHI]

297.45

51672-1272-02 - nystatin-triamcinolone

Top Oint [RHI]

519.90

51672-1292-01 - hydrocortisone Top

valerate 0.2% Oint [RHI]

294.90

51672-1298-02 - ketoconazole Top 2%

Crm [RHI]

170.40

51672-1303-01 - econazole Top 1% Crm

[RHI]

43.35

51672-2080-02 - terbinafine Top 1% Crm

[RHI]

13.85

51672-4018-01 - etodolac 400 mg Tab

[RHI]

7.90

51672-4026-06 - ketoconazole 200 mg

Tab [RHI]

8.45

51672-4047-09 - carbamazepine 100

mg/5 mL Oral Susp [RHI]

66.75

51672-4048-01 - betamethasone-

clotrimazole Top 0.05%-1% Crm [RHI]

86.25

51672-4051-01 - etodolac 400 mg ER

Tab [RHI]

8.70

51672-4069-01 - phenytoin 125 mg/5 mL

Oral Susp [RHI]

101.45

51672-4117-04 - nystatin 100,000


35.15


ER Tab [RHI]

9.95


ER Tab [RHI]

12.25

51798 Measurement Of Post-Voiding

Residual Urine And/Or Bladder Capacity

By Ultrasound, Non-Imaging

214.00

51862-0180-15 - Pramoxine Foam 1% 15

GM [RHI]

72.45

51991-0084-90 - Vitamin B Complex with

Folic Acid Tab [RHI]

3.40


Oral Pwdr for Recon [RHI]

42.80

51991-0566-01 - Prenatal Vit/Fe

Fumarate [RHI]

8.05

51991-0813-90 - Methylcob-Pyridoxal-

Metafolin [RHI]

10.00

52183-0199-13 - cromolyn Nasal 5.2

mg/inh Spry [RHI]

16.60

52246-0929-04 - spinosad topical 0.9%

Susp [RHI]

802.45

52380-1272-04 - Chlorhexidine

Gluconate 4% [RHI]

14.35


SubL Spry [RHI]

731.70

52544-0470-30 - testosterone 5 mg/24

hours Transderm ER Film [RHI]

8.10

52544-0691-30 - diltiazem 180 mg/24

hours ER Tab [RHI]

16.65

52544-0922-26 - sodium ferric gluconate

complex 12.5 mg/mL IV Sol [RHI]

205.45

52800-0488-26 - Lubriderm Lotion [RHI] 7.90

53489-0386-01 - minoxidil 2.5 mg Tab

[RHI]

7.90

53489-0387-01 - minoxidil 10 mg Tab

[RHI]

8.25

53489-0551-01 - propafenone 150 mg

Tab [RHI]

8.10

53746-0110-05 - 325mg-10mg 9.20


oxycodone 500 mg-7.5 mg Tab [RHI]

10.20

54092-0252-90 - Lanthanum Carbonate

[RHI]

55.25

54162-0500-02 - AQUAPHOR Top Oint

[RHI]

18.10

54162-0700-16 - Sorbitol Soln 70% Bottle

[RHI]

4.00

54838-0010-70 - Multiple Vitamins with

Minerals Oral Liq 237 mL [RHI]

5.30

54838-0523-40 - fluoxetine 20 mg/5 mL

Oral Sol [RHI]

155.25

54859-0515-08 - Proteinex [RHI] 12.50

55111-0164-30 - olanzapine 5 mg Tab

[RHI]

8.80

55111-0292-09 - SUMAtriptan Tab 50 mg

[RHI]

20.75

55390-0004-01 - glucagon recombinant 1

mg Inj [RHI]

1,021.20

55513-0002-04 - darbepoetin alfa 25


428.80



681.70



978.10



1,416.10



1,415.85



2,824.30

55513-0025-04 - Darbepoetin 100

mcg/0.5 mL Syringe[RHI]

1,693.15

55513-00-2504 - darbepotin alfa

100mcg/0.5ml 100 mcg Syringe

1,415.85

55513-0073-30 - cinacalcet 30 mg Tab

[RHI]

92.35



4,232.75

55513-0546-10 - filgrastim 300 mcg/1ml

Inj Sol [RHI]

2,026.90

55513-0810-60 - ivabradine 7.5 mg Tab

(RHI)

31.30

55566-4100-01 - sodium hyaluronate 10

mg/mL intra-articular Sol [RHI]

638.45

57648-0002-01 - Bisacodyl suppository

(Magic Bullet) 10mg sup [RHI]

10.20

57896-0629-12 -

Aluminum/Magnesium/Simeth Susp 360

mL [RHI]

5.35

57896-0635-06 - Magnesium Chloride

Tab SR 70 mg [RHI]

2.60

58160-0879-52 - influenza virus vaccine,

inactivated preservative-free Susp [RHI]

40.55

58160097606 - meningococcal B vaccine

4 -comp 0.5 mL Injection

592.85

58281-0560-01 - baclofen 0.5 mg/mL

intrathecal Sol [RHI]

757.70

58281-0562-01 - baclofen 0.05 mg/mL


387.95

58281-0563-01 - baclofen 2 mg/mL


2,797.70

58281-0563-02 - baclofen 2 mg/mL


5,517.70

58406-0425-34 - etanercept 25 mg SubQ

Inj [RHI]

1,121.20

58468-0021-01 - sevelamer 800 mg Tab

[RHI]

30.70

58468-0090-01 - hylan G-F 20 8 mg/mL

intra-articular Sol [RHI]

418.65

58468-0090-03 - hylan G-F 20 8 mg/mL

intra-articular Sol [RHI]

1,255.90

58468-0126-01 - doxercalciferol 2


90.60

58468-0130-01 - sevelamer carbonate

800 mg Tab [RHI]

9.15

58468-0132-02 - sevelamer carbonate

0.8 g REC [RHI]

49.05

58914-0170-14 - sucralfate 1 g/10 mL

Oral Susp [RHI]

174.50

58914-0790-10 - Ursodiol 500 mg [RHI] 18.40

58980-0780-21 - balsam Peru-castor oil

topical 87 mg-788 mg/g Oin [RHI]

105.30

59011-0410-20 - oxycodone 10 mg ER

Tab [RHI]

20.80

59011-0420-20 - oxycodone 20 mg ER

Tab [RHI]

28.40

59011-0440-20 - oxycodone 40 mg ER

Tab [RHI]

43.40


Tab [RHI]

7.75

59075-0711-10 - botulinum toxin type B

5000 units/mL Inj Sol [RHI]

2,234.35

59148-0006-13 - aripiprazole 2 mg oral

tablet [RHI]

9.40

59148-0007-35 - aripiprazole 5 mg oral

Tab [RHI]

9.60

59148-0008-13 - aripiprazole 10 mg Tab

[RHI]

20.10

59417-0102-10 - lisdexamfetamine 20

mg Cap [RHI]

46.20

59417-0103-10 - lisdexamfetamine 30

mg oral capsule [RHI]

40.30

59627-0002-05 - interferon beta-1a 30

mcg/0.5 mL IM kit [RHI]

3,938.95

59676-0562-01 - darunavir 600 mg Tab

[RHI]

97.45

59746-0121-06 - meclizine 25 mg Tab

[RHI]

8.25

59762-0104-01 - sulfasalazine 500 mg

Oral EC Tab [RHI]

8.10

59762-0450-01 - colestipol 1 g Tab [RHI] 10.85

59762-1710-02 - eplerenone 25 mg Tab

[RHI]

15.85


mg Tab [RHI]

10.55

59762-4940-01 - sertraline 20 mg/mL

Oral Conc [RHI]

153.00

59762-5007-01 - misoprostol 100 mcg

Tab [RHI]

9.15

59762-5008-01 - misoprostol 200 mcg

Tab [RHI]

10.55

59762-5025-01 - gabapentin 250 mg/5

mL Oral Sol [RHI]

49.10

59762-5032-01 - glipiZIDE 5 mg ER Tab

[RHI]

8.00

59762-5033-01 - glipiZIDE 10 mg ER Tab

[RHI]

8.80

59781-0540-02 - Juven Unflavored [RHI] 7.15

6 FT TUBING 10.00


60 Min Swedish Massage 65.00

60258-0006-01 - DONT USE 2.85

60258-0162-01 - Vitamin B Complex with

C and Folic Acid Cap [RHI]

9.25

60258-0172-01 - magnesium gluconate

500 mg Tab [RHI]

2.55

60258-0850-01 - cyproheptadine 4 mg

Tab [RHI]

7.70

60432-0537-60 - nystatin 100,000


40.50

60432-0608-04 - promethazine 6.25 mg/5

mL Oral Syrup [RHI]

21.90

60432-0831-16 - levetiracetam 100


31.45

60505-0823-06 - calcitonin 200 intl

units/inh Nasal Spry [RHI]

202.45

60505-0829-01 - fluticasone Nasal 0.05

mg/inh Spry [RHI]

79.60

60505-2522-01 - cilostazol 100 mg Tab

[RHI]

7.90

60505-2656-01 - hydrochlorothiazide-

triamterene 25 mg-37.5 mg Tab [RHI]

8.10

60505-3110-00 - olanzapine 2.5 mg Tab

[RHI]

8.10


[RHI]

8.45

60505-6078-04 - fondaparinux 2.5 mg/0.5

mL SubQ Sol [RHI]

47.90

60505-6079-04 - fondaparinux 5 mg/0.4

mL SC Sol [RHI]

132.30

60505-6080-04 - fondaparinux 7.5 mg/0.6

mL SC Sol [RHI]

153.30

60505-7003-02 - fentanyl 75 mcg/hr


33.45

60505-7012-00 - fentanyl 50 mcg/hr


22.60

60687-0245-01 - rosuvastatin 10 mg Tab

[RHI]

12.70

60758-0880-05 - fluorometholone Opth

0.1% Susp [RHI]

37.50

60793-0411-30 - diclofenac topical 1.3%

ER F [RHI]

153.30

61314-0203-15 - pilocarpine Opth 1% Sol

[RHI]

340.15

61314-0224-05 - timolol Opth 0.25% Gel

forming Sol [RHI]

131.15

61314-0225-05 - timolol Opth 0.5% Gel

forming Sol [RHI]

153.60

61314-0226-05 - timolol Opth 0.25% Sol

[RHI]

17.55

61314-0631-36 -

dexamethasone/neomycin/polymyxin B

Opth Susp [RHI]

46.25

61314-0637-05 - prednisoLONE Opth

acetate 1% Susp [RHI]

175.65

61314-0646-10 -

hydrocortisone/neomycin/polymyxin B

Otic Sol [RHI]

101.20

61314-0701-01 - Sulfacetamide Ophth

Soln 10% 15 mL [RHI]

186.25

61442-0121-01 - famotidine 20 mg Tab

[RHI]

8.10

61570-0031-50 -

bacitracin/HC/neomycin/polymyxin B Top

Oint [RHI]

317.75

61958-0401-01 - tenofovir 300 mg Tab

[RHI]

115.10

61958-0601-01 - emtricitabine 200 mg

Cap [RHI]

78.65

61958-1003-01 - ranolazine 500 mg oral

ER Tab [RHI]

23.55

61958190101 -

ELVIT/COBIC/EMTRIC/TENOF 150 mg-

150 mg-200 mg -10 mg oral tablet [RHI]

349.85

61958-2002-01 - emtricitabine-tenofovir

200 mg-25 mg Tab

230.15

62037-0830-01 - metoprolol 25 mg ER

Tab [RHI]

9.25

62037-0831-01 - MetoPROLOL

Succinate Tab XL 50 mg [RHI]

9.50

62037-0832-01 - metoprolol 100 mg ER

Tab [RHI]

12.20

62175-0262-37 - NIFEdipine 90 mg ER

Tab [RHI]

10.25


with electrolytes Oral Pwdr for Sol 4000

mL [RHI]

47.50

62205-0000-20 - lipase - Dev 234.10

62310 Single Injection Epidural

Cervical/Thoracic RHI

2,281.00

62311 Single Injection Epidural

Lumbar/Sacral RHI

2,281.00

62369 Analysis/Reprogram/Refill Pump

RHI

1,406.00

62559015304 - Opium 10mg/ml 10

mg/mL Soln

17.70

62559-0153-04 - Opium Tincture (USP)

per Drop [RHI]

42.50

62559-0159-01 - fluvoxamine 50 mg Tab

[RHI]

9.05

62584-0143-01 - oxcarbazepine 300 mg

Tab [RHI]

8.80


[RHI]

7.55

62584-0734-01 - hydrALAZINE 50 mg

Tab [RHI]

7.90

62584-0897-01 - folic acid 1 mg Tab [RHI] 7.55

62584-0975-01 - Diltiazem Cap CD 180

mg [RHI]

8.35

62756-0260-02 - zonisamide 100 mg Cap

[RHI]

7.80

62756-0294-88 - cephalexin 500 mg Cap

[RHI]

7.85

62756-0349-44 - octreotide 100 mcg/mL

Inj Sol [RHI]

90.00

62756-0461-88 - Carbidopa-Levodopa

Tab CR 25 mg-100 mg [RHI]

8.40

62756-0513-44 - levetiracetam 100

mg/mL IV Sol [RHI]

97.80

62756-0520-69 - sumatriptan 25 mg Tab

[RHI]

10.15


[RHI]

14.70

63304-0296-01 - hydroxychloroquine 200

mg Tab [RHI]

17.50

63304-0694-01 - minocycline 50 mg Cap

[RHI]

8.30

63323-0010-02 - gentamicin 40 mg/mL

Inj Sol [RHI]

80.80


mg/mL Inj Sol [RHI]

81.15


mg/mL Inj Sol [RHI]

88.75

63323-0285-20 - ropivacaine 0.2% Inj Sol

20 mL [RHI]

106.35

63323-0311-10 - calcium gluconate 100

mg/mL Inj Sol [RHI]

47.20

63323-0325-20 - acyclovir 50 mg/mL IV

Sol [RHI]

108.80

63323-0338-20 - vancomycin 125 mg

Cap [RHI]

56.70

63323-0339-20 - vancomycin 250 mg

Cap [RHI]

76.00

63323-0412-25 - midazolam 5 mg/mL Inj

Sol [RHI]

83.85

63323-0464-17 - bupivacaine 0.25% PF

Inj Sol 10 mL [RHI]

82.00

63323-0472-17 - bupivacaine 0.75% PF

Inj Sol 10 mL [RHI]

84.30


5 mL [RHI]

17.40


2 mL [RHI]

17.50

63323-0508-31 - meropenem 1 g IV Inj

[RHI]

122.45

63323-0877-15 - pentamidine 300 mg Inh

Pwdr for Recon [RHI]

395.10

63402-0510-01 - levalbuterol CFC free 45

mcg/inh Inh Aer w/adapter [RHI]

234.60

63402-0911-30 - arformoterol 15 mcg/2

mL Inh Sol [RHI]

24.10

63481-0684-47 - diclofenac Top 1% gel

[RHI]

173.40

63481-0687-01 - lidocaine Top 5% film

[RHI]

36.45

63481-0687-06 - lidocaine Top 5% film

[RHI]

16.00

63650 Percutaneous Implant

Neurostimulator Electrode Array Epidural

RHI

21,898.00


mg-100 mg Tab [RHI]

8.35


mg-250 mg Tab [RHI]

8.25

63739-0128-10 - Hydrochlorothiazide Tab

25 mg [RHI]

7.50

63739-0141-10 -

Hydrocodone/Acetaminophen 7.5/500mg

[RHI]

8.00

63739-0166-10 - methocarbamol 500 mg

Tab [RHI]

8.00

63739-0201-10 - phenobarbital 32.4 mg

Tab [RHI]

7.60

63739-0225-10 - simethicone 80 mg

Chew Tab [RHI]

2.55

63739-0263-10 - clonazepam 0.5 mg Tab

[RHI]

7.45

63739-0269-10 - tamoxifen 10 mg Tab

[RHI]

8.00

63739-0283-10 - diltiazem 120 mg/24

hours ERCap [RHI]

8.70

63739-0285-10 - diltiazem 240 mg/24

hours ERCap [RHI]

10.15


[RHI]

7.90


[RHI]

8.25


Tab [RHI]

2.50


Tab [RHI]

2.50

63739-0442-10 - ibuprofen 400 mg Tab

[RHI]

7.55


[RHI]

7.80


Tab [RHI]

7.95


Tab [RHI]

8.90



8.55

63807-0100-01 - sodium chloride 0.9%

Inj Sol 10 mL [RHI]

22.25

63807-0100-10 - Sodium Chloride 0.9%

[RHI]

8.85

63824-0008-15 - guaifenesin 600 mg ER

Tab [RHI]

9.15

63824-0172-65 - dextromethorphan 30

mg/5 mL Oral Susp, ER [RHI]

25.45

63824-0720-16 - benzocaine-menthol

topical 15 mg-4 mg Loze [RHI]

38.25

64253-0333-35 - heparin flush 100

units/mL Soln [RHI]

8.15

64405 Injection Anesthetic Agent

Greater Occipital Nerve RHI

303.00


Suprascapular Nerve RHI

845.00


Intercostal Nerve Single RHI

450.00


Intercostal Nerves Multiple RHI

1,352.00


Ilioinguinal/Iliohypogastric Nerves RHI

613.00

64445 Injection Anesthetic Agent Sciatic

Nerve Single RHI

2,281.00


Femoral Nerve Single RHI

1,180.00

64450 Injection Anesthetic Agent Other

Peripheral Nerve RHI

485.00

64455-0993-95 - acyclovir Top 5% Oint

[RHI]

477.20

64479 Injection Transforaminal Epidural

Cervical or Thoracic RHI

2,281.00


Cervical or Thoracic Each Additional

Level RHI

1,293.00


Lumbar or Sacral RHI

2,281.00


Lumbar or Sacral Each Additional Level

RHI

1,293.00

64490 Injection Paravertebral Facet

Cervical or Thoracic Single Level RHI

2,281.00


Cervical or Thoracic Second Level RHI

1,268.00


Cervical or Thoracic Third Level or Add

RHI

1,293.00


Lumbar or Sacral Single Level RHI

2,281.00


Lumbar or Sacral Second Level RHI

1,293.00


Lumbar or Sacral Third Level or Add RHI

1,293.00

64520 Injection Paravertebral

Lumbar/Thoracic RHI

2,281.00

64611 Chemodenervation

Parotid/Submandibluar Salivary Glands,

Bilateral RHI

454.00

64612 Chemodenervation Facial Nerve

RHI

1,079.00

64613 Chemodenervation Neck Muscle

RHI

1,202.00

64614 Chemodenervation

Extremity/Trunk Muscle 1-4 Muscles RHI

1,379.00

64615 Chemodenervation Chronic

Migraine RHI

495.00

64617 Chemodenervation muscles:

larynx, unilateral, percutaneous RHI

607.00

64626 Destruction Paravertebral Facet

Cervical or Thoracic Single Level RHI

2,138.00

64627 Destruction Paravertebral Facet

Cervical or Thoracic Each Add Level RHI

1,070.00

64640 Destruction Neurolytic Peripheral

RHI

763.00

64643 Chemodenervation extremity/

trunk muscle 1-4 muscles each

additional; 1-4 RHI

343.00

64644 Chemodenervation 1 extremity; 5

or more muscles RHI

725.00

64645 Chemodenervation 1 extremity;

each additional extremity, 5 or more

muscles RHI

362.00

64646 Chemodenervation trunk muscle;

1-5 muscles RHI

725.00

64647 Chemodenervation trunk muscle;

6 or more muscles RHI

791.00

64679-0154-02 - ropinirole 0.25 mg Tab

[RHI]

7.75

64679-0174-02 - ropinirole 3 mg Tab

[RHI]

9.40

64679-0434-04 - pantoprazole 40 mg

Oral EC Tab [RHI]

7.65

64679-0962-01 - azithromycin 600 mg

Tab [RHI]

18.15

64720-0139-10 - methenamine hippurate

1 g Tab [RHI]

13.75


Tab [RHI]

9.95

64764-0080-60 - lubiprostone 8 mcg Cap

[RHI]

31.90

64764-0119-07 - colchicine 0.6 mg Tab

[RHI]

33.60

64764-0240-60 - Lubiprostone Cap 24

mCg [RHI]

29.10

64764-0543-11 - lansoprazole 15 mg Dis

Tab [RHI]

37.95

64764-0805-30 - ramelteon 8 mg oral

tablet [RHI]

57.55

64764-0918-30 - febuxostat 40 mg Tab

[RHI]

43.10

64980-0104-01 - potassium phosphate-

sodium phosphate 250 mg-45 mg-298

mg Tab [RHI]

7.90

64980-0129-50 - lactobacillus acidophilus

and bulgaricus Chew Tab [RHI]

2.65

64980-0130-09 - levocarnitine 330 mg

Tab [RHI]

9.25

64980-0146-12 - lactobacillus acidophilus

and bulgaricus Oral Gran [RHI]

9.55

64980-0157-01 - ergocalciferol 50,000 intl

units Cap [RHI]

8.65

64980-0182-10 - sodium bicarbonate 650

mg Tab [RHI]

2.50

64980-0301-30 - hydrocortisone 2.5%

Rectal Crm w/Appl [RHI]

17.30


Paste [RHI]

175.65

65162-0302-09 - venlafaxine 37.5 mg

Tab [RHI]

8.50


Tab [RHI]

9.10

65162-0517-10 - RHIPYRI100 21.45

65162-0554-10 - demeclocycline 150 mg

Tab [RHI]

24.25

65162-0642-10 - Flecainide Tab 100 mg

[RHI]

8.30

65162-0664-90 - ranitidine 15 mg/mL

Oral Syrup [RHI]

27.75

65162-0669-10 - acebutolol 200 mg Cap

[RHI]

7.90

65580-0643-71 - metolazone 2.5 mg Tab

[RHI]

11.30

65597-0701-18 - colesevelam 625 mg

Tab [RHI]

13.95

65649-0301-03 - rifaximin 200 mg Tab

[RHI]

71.20

65649-0303-03 - rifaximin 550 mg Tab

UD [RHI]

153.30

65862-0017-01 - amoxicillin 500 mg Cap

[RHI]

7.60

66582-0414-28 - ezetimibe 10 mg Tab

[RHI]

49.15



9.15



9.30


hydrocodone 325 mg-7.5 mg/15 mL Oral

Sol 15 mL [RHI]

22.50

66689-0038-50 - lactulose 10 g/15 mL

Oral Syrup [RHI]

8.65

66780-0210-07 - exenatide 5 mcg/0.02

mL SC Sol [RHI]

172.85

66780-0212-01 - exenatide 10 mcg/0.04

mL SC Sol [RHI]

2,589.25

66825-0002-01 - saccharomyces

boulardii lyo 250 mg oral capsule [RHI]

3.75

66993-0022-27 - levalbuterol 0.63 mg/3

mL Inh Sol [RHI]

74.70

66993-0877-61 - calcipotriene Top

0.005% Crm [RHI]

1,426.00

67253-0201-10 - Penicillin V Potassium

250 mg Tab [RHI]

7.90

67253-0700-06 - selegiline 5 mg Tab

[RHI]

14.15

67386-0311-01 - clobazam 10 mg Tab

[RHI]

9.30

67405-0543-03 - terbinafine 250 mg Tab

[RHI]

8.50

67618-0150-09 - Povidone Iodine Top

Soln 10% 240 mL [RHI]

16.15

67767-0141-30 - buPROPion 150 mg/24

hours ER Tab [RHI]

12.45

67877-0105-01 - benzonatate 100 mg

Cap [RHI]

7.65

67877-0251-15 - Triamcinolone Cream

0.1% 15 GM [RHI]

15.75

67919-0011-01 - daptomycin 500 mg IV

Inj [RHI]

661.10

68012-0104-30 - omeprazole-sodium

bicarbonate 20 mg-1100 mg oral capsule

[RHI]

10.00

68084-0013-01 - tizanidine 4 mg Tab

[RHI]

7.90

68084-0019-01 - alprazolam 0.5 mg Tab

[RHI]

7.55

68084-0028-01 - busPIRone 5 mg Tab

[RHI]

10.15

68084-0032-01 - nortriptyline 25 mg Cap

[RHI]

8.25


[RHI]

8.20


[RHI]

8.05

68084-0060-01 - lisinopril 5 mg Tab [RHI] 7.60


[RHI]

7.65


[RHI]

7.85


Tab [RHI]

8.30


Tab [RHI]

7.85

68084-0072-01 - MetFORMIN Tab XR

500 mg [RHI]

8.20

68084-0086-01 - Hydrochlorothiazide Tab

25 mg [RHI]

7.65

68084-0091-01 - metoclopramide 10 mg

Tab [RHI]

7.70

68084-0128-01 - omeprazole 20 mg Oral

EC Cap [RHI]

7.65

68084-0181-01 - sertraline 50 mg Tab

[RHI]

7.75

68084-0182-01 - sertraline 100 mg Tab

[RHI]

7.75


Tab [RHI]

8.00

68084-0243-01 - clindamycin 150 mg

Cap [RHI]

8.35

68084-0253-01 - hydrOXYzine

hydrochloride 10 mg Tab [RHI]

8.40

68084-0267-01 - ramipril 5 mg Cap [RHI] 7.85

68084-0270-01 - RisperiDONE Tab 0.25

mg [RHI]

8.80

68084-0292-01 - RHIPYRI100 8.00


mg Oral EC Cap [RHI]

10.25

68084-0326-01 - glimepiride 2 mg Tab

[RHI]

7.85

68084-0327-01 - glimepiride 4 mg Tab

[RHI]

7.85


[RHI]

10.45

68084-0388-01 - benztropine 1 mg Tab

[RHI]

8.60

68084-0396-01 - APAP/butalbital/caffeine

300 mg-50 mg-40 mg Tab [RHI]

8.75


mEq ERCap [RHI]

10.00


Tab [RHI]

7.90

68084-0440-01 - pramipexole 0.25 mg

Tab [RHI]

8.15

68084-0449-01 - tacrolimus 0.5 mg Oral

Cap [RHI]

12.85

68084-0450-01 - tacrolimus 1 mg Cap

[RHI]

12.05

68084-0484-01 - venlafaxine 37.5 mg

ERCap [RHI]

9.30

68084-0486-01 - venlafaxine 150 mg

ERCap [RHI]

8.50


[RHI]

7.75


[RHI]

8.00

68084-0577-01 - Ranitidine Tab 150 mg

[RHI]

7.70

68084-0578-21 - lamivudine 150 mg Tab

[RHI]

37.50


[RHI]

7.75

68084-0620-01 - montelukast 10 mg Tab

[RHI]

9.40

68084-0713-01 - venlafaxine 150 mg

ERCap [RHI]

8.70


[RHI]

7.70


[RHI]

11.70

68180-0150-01 - famotidine 40 mg/5 mL

Oral Liq [RHI]

206.15

68180-0303-20 - cefuroxime 250 mg Tab

[RHI]

12.75

68220-0144-10 - hydrocortisone-

pramoxine Rectal Foam [RHI]

843.75

68308-0152-15 - nystatin Top 100,000

units/g Pwdr [RHI]

43.45

68308-0324-10 - Vitamin B12/B6/FA [RHI] 8.00

68462-0103-40 - fluconazole 150 mg Tab

[RHI]

8.15

68462-0196-90 - pravastatin 20 mg Tab

[RHI]

8.10

68462-0197-90 - Pravastatin Tab 40 mg

[RHI]

10.00

68462-0255-01 - ropinirole 1 mg Tab

[RHI]

7.70

68462-0358-01 - nabumetone 500 mg

Tab [RHI]

8.00

68462-0361-01 - hydrOXYzine

hydrochloride 25 mg Tab [RHI]

9.95

68516-5216-01 - albumin human 25% IV

Sol 50 mL [RHI]

220.10

68546-0229-56 - rasagiline 1 mg oral

tablet [RHI]

38.85

68546-0317-30 - glatiramer 20 mg/mL

SubQ Sol [RHI]

593.80

68546-0325-12 - glatiramer 40 mg/mL Sol 1,805.30

68585-0006-41 - magnesium oxide 400

mg Tab [RHI]

2.60

70 Min Deep tissue massage 80.00

70074-0407-29 - Twocal HN [RHI] 8.75

70074-0509-05 - Glucerna 1.2 [RHI] 3.95

70074-05-1149 - POLY-PHREE [RHI] 19.25

70074-0518-73 - Promote with Fiber [RHI] 8.70

70074-0531-19 - Jevity 1.2 [RHI] 3.25

70074-0531-21 - Osmolite 1.2 [RHI] 9.00

70074-0535-35 - Glucerna 1.5 [RHI] 11.30

70074-0548-45 - Ensure Pudding Vaniila

[RHI]

3.10

70074-0548-47 - Ensure Pudding [RHI] 58.00

70074-0548-49 - Ensure Pudding

ButterScotch [RHI]

3.10

70074-0560-53 - Glucerna Shake [RHI] 3.00

70074-0562-79 - VITAL 1.5 cal [RHI] 18.20

70074-0565-43 - Vital AF 1.2 Cal [RHI] 22.55

70074-0565-59 - Ensure Vanilla Muscle

Health [RHI]

8.25

70074-0565-61 - Ensure Chocolate

Muscle Health [RHI]

2.85

70074-0565-65 - Ensure Complete

Vanilla Clinical Str [RHI]

2.90

70074-0566-04 - Ensure Clear [RHI] 3.90

70074-0566-43 - Enlive Berry [RHI] 3.95

70074-0573-34 - Jevity 1.5 [RHI] 3.00

70074-0574-70 - Osmolite 1.5 cal [RHI] 8.40

70074-0583-00 - Ensure Enlive Shake

[RHI]

2.65

70074060746 - POLYCOSE [RHI] 6.60

70074-0620-11 - Ensure Complete

Strawberry Clinical Str [RHI]

2.90

70074-0620-13 - Ensure Strawberry

Muscle Health [RHI]

2.85

70074-0620-95 - Nepro [RHI] 10.30

70074-0621-20 - Pediasure Peptide

Vanilla [RHI]

2.50

71525-6100-01 - magnesium citrate

8.85% Oral Liq 300 mL [RHI]

6.25

73-1069467 Vent Circuit 48.00

74312-0006-40 - riboflavin 100 mg Tab

[RHI]

2.50

76439-0308-10 - hyoscyamine 0.125 mg

Tab [RHI]

9.85

77002 Fluroscopic Guidance for Needle

Placement RHI

387.00

77003 Fluroscopic Guidance/Localization

Needle for Spine Injection RHI

309.00

77080 DXA Bone Density Study, Axial

Skeleton RHI

500.00


80208-0000-04 - Dermaide Aloe [RHI] 74.75

83490-0107-60 - sodium chloride 7% Inh

Sol 4 mL [RHI]

11.65

86832 Ab ID LEUKOCYTE Ab ADS

CLASS 1

1,304.00

86833 Ab ID LEUKOCYTE Ab ADS

CLASS 2

1,312.00

86833 AB ID LEUKOCYTE AB CLASS 2 1,312.00

89220-0002-00 - Clog Zapper [RHI] 103.00

9 X 15 EXU-DRYWOUND DRESSING 18.00

90 Day Employment 700.00

95860 Needle Electromyography 1

Extremity with/without Related

Paraaspinal Areas RHI

271.00


Extremities RHI

387.00


Extremities RHI

463.00


Extremities RHI

529.00

95869 Needle Electromyography

Thoracic Paraspinal Muscles RHI

151.00


Muscle Extremity RHI

160.00

95873 Electrical Stimulation Conjunction

with Chemodenervation RHI

147.00

95874 Needle Electromyography

Conjunction with Chemodenervation RHI

144.00

95903 Motor Nerve Conduction Test RHI 203.00

95910 Nerve conduction studies, 7-8 RHI 696.00

96365 Intravenous Infusion Therapy

Initial Hour RHI

486.00

96366 Intravenous Infusion Therapy

Initial Each Add Hour RHI

153.00

96374 Therapeutic Injection Single

Intravenous Push RHI

271.00

96375 Therapeutic Injection Each Add

Sequential Intravenous Push New Drug

RHI

178.00

97597 Selective Debridement < 20 cm

RHI

231.00

97598 Non-selective Debridement > 20

cm RHI

301.00

97605 Negative Press Wound <50 sq cm

RHI

132.00

97606 Negative Press Wound >50 sq cm

RHI

153.00

99201 Office/Outpatient Visit, New RHI 220.00




99212 Office/Outpatient Visit, Est RHI 329.00




99999-9980-99 - Prolo Therapy 1 EA

Injection

29.45

99999-9988-88 - Phenol 6% Solution 6 %

Soln

127.95

99999-9991-00 - Cholestyramine in

Hydrophor 10% ointment[RHI]

318.15

99999-9999-50 - TPN - Charge [RHI] 1,231.60

99999-9999-59 - Ensure Enlive Shake-

Charge [RHI]

10.35

99999-9999-63 - Pharmacy MTM

Anticoagulation Level 2 Charge[RHI]

56.00

99999-9999-64 - Pharmacy MTM


63.00

99999-9999-65 - Pharmacy MTM


84.00

99999-9999-66 - Phenol 5% Solution

[RHI]

45.75

99999-9999-66 - Phenol 5% Solution

[RHI]

867.20

99999-9999-67 - Creon-Sodium

Bicarbonate Solution [RHI]

45.75

99999-9999-68 - Gentamicin Bladder

Irrigation 4.8% [RHI]

73.05

99999-9999-82 - Dakins 1/8 Strength

[RHI]

45.75


[RHI]

45.75

99999-9999-83 - Vancomycin 125mg/5ml

[RHI]

582.70


[RHI]

45.75

99999-9999-85 - Dakins Full [RHI] 45.75

99999-9999-86 - Smog Enema [RHI] 45.75

99999-9999-88 - clorpactin irrigation [RHI] 45.75

99999-9999-90 - Tacrolimus 0.5 mg/mL

Suspension [RHI]

561.20

99999-9999-90 - Tacrolimus 0.5 mg/mL

Suspension [RHI]

561.20

99999-9999-91 - GI Cocktail [RHI] 138.60

99999-9999-93 - Mary's Magic

Mouthwash [RHI]

54.75

99999-9999-94 - Riley Butt Cream [RHI] 165.95

99999-9999-94 - Riley Butt Cream [RHI] 181.50

99999-9999-95 - Omeprazole

Suspension [RHI]

870.00

99999-9999-96 - warfarin 1.5 mg Tab

[RHI]

7.50

99999-9999-97 - warfarin 0.5 mg Tab

[RHI]

8.00

99999-9999-99 - Non-Formulary

Medication [RHI]

398.30

ABDUCTION PILLOW 70.00

ABG KIT PRO-VENT+N6:Q38 48.00

ABG Kit Pro-Vent+N6:Q38N6:Q39 48.00

ABO/Rh RHI 423.00

ABO/Rh Verify RHI 129.00

ABT SCI Wellness 1 Session 79.00

ABT SCI Wellness 12 Session 787.50

ACE BANDAGE 4" 3.00

ACE BANDAGE 6" 4.00

ACTH 1 HR Stimulation Ser QN RHI 254.00

ADAPTABLE GERIATRIC HAND -

LARGE LEFT

195.80


LARGE RIGHT

195.80


MEDIUM LEFT

195.80


MEDIUM RIGHT

195.80


SMALL LEFT

195.80


SMALL RIGHT

195.80

ADAPTABLE RESTING HAND - LARGE

LEFT

195.80

ADAPTABLE RESTING HAND - LARGE

RIGHT

195.80

ADAPTABLE RESTING HAND -

MEDIUM LEFT

195.80

ADAPTABLE RESTING HAND -

MEDIUM RIGHT

195.80

ADAPTABLE RESTING HAND - SMALL

LEFT

195.80

ADAPTABLE RESTING HAND - SMALL

RIGHT

195.80

ADAPTIC DRESSING 3X8 3PLY 6.00

Adaptic Touch Silicone Dressing 5x6 22.00

Adrenocorticotropic Hormone(ACTH) RHI 225.00

ADULT LOPEZ VALVE 10.00

Advanced Life Support 1 - Emergency: 463.00

Advanced Life Support 1 - Non-

Emergency:

293.00

Advanced Life Support 2: 671.00

AERO DRAIN BAG Y 73.00

AEROCHAMBER PLUS 43.00

Aerosol Initial 617.00

AEROSOL MASK 3.00

Aerosol Subsequent 202.00

AIRWAY SUCTION Charge 861.00

Albumin RHI 40.00

Aldosterone Urine Timed RHI 237.00

Alkaline Phosphatase RHI 41.00

Allevyn GB Lite 3 IN x 3 IN 33.00

Allevyn Life Sacrum Small 117.00

Allevyn Sacrum 6 3/4 x 6 3/4 29.00

Ambulance Service 9.00

Amikacin Pre RHI 118.00

Ammonia RHI 114.00

Amylase RHI 51.00

ANA Ab RHI 87.00

ANGIO CATH 20GX1 8.00

ANGIO CATH 22GX1 8.00

ANGIO CATH 24X.75 8.00

Anti-dsDNA QN RHI 102.00

ANTI-SPAS SPLINT LG LEFT 133.00

ANTI-SPAS SPLINT LG RIGHT 133.00

ANTI-SPAS SPLINT MED LEFT 133.00

ANTI-SPAS SPLINT MED RIGHT 133.00

ANTI-SPAS SPLINT SMALL LEFT 133.00

ANTI-SPAS SPLINT SMALL RT 133.00

Antithrombin III Ag RHI 55.00

Anti-Thyroglobulin Antibody QN (86800)

RHI

93.00

Application of multi-layer compression;

leg (below knee); including ankle and foot

158.00

Application of multi-layer compression;

thigh and leg; including ankle and foot,

when performed

158.00

aPTT RHI 31.00

Aquaporin-4 Receptor AB, S RHI 276.00

Aquatics Program 1 Session 5.00

Aquatics Program Monthly 40.00

ASPEN REPLACEMENT PAD 76.00

BACTERIA FILTER 26.00

BACTIFILTERS 8.00

BAG URINE 2000ML SNGL HOOK 18.00

BALLARD SUCTION KIMVENT 320.00

BANDAGE COVER ROLL STRETCH 31.00

Bard Tray, Uretheral, Catheterization tray 7.00

BARRIER FILM SKINCARE 2.7 ML 39.00

BARRIER, CNVX FT, CTF 1W/TAPE" 9.00

BARRIER, CNVX FT, CTF 2W/TAPE" 9.00

BARRIER, SKIN FORMAFLEX, 2 3/4 6.00

Basic Life Support - Emergency: 390.00

Basic Life Support - Non-Emergency: 244.00

Basic Metabolic Panel RHI 66.00

BAXTER SECONDARY TUBING 3.00

BAXTER TPN FILTER TUBING 17.00

BELT SAFETY ROLL COTTON WITH 33.00

Beta hCG Blood RHI 118.00

Beta-2 Microglobulin CSF RHI 125.00

BICS RF 14.00

Bill BB Antigen RHI

BINDER AB 10 SOLID PANEL" 28.00

BiPAP/CPAP Initial 606.00

BiPAP/CPAP Subsequent 202.00

BiPAP/CPAP Subsequent 202.00

BK Virus QN RHI 233.00

BLADDER IRRIGATION SET 27.00

Bladder Scan 214.00

Blood Culture RHI 82.00

BNP RHI 264.00

BOOT MULTI PODUS LARGE 340.00

BOOT MULTI PODUS MEDIUM 340.00

BOOT MULTI PODUS SMALL 340.00

BOOT MULTI PODUS XLARGE 340.00

C diff Assay QL RHI 71.00

C diff PCR Assay RHI 204.00

C difficile Testing Algorithm RHI 71.00

C1778 Lead Neurostimulator Implant RHI 1,815.00

CA 19-9 RHI 162.00

CALAZIME PASTE PROTECTANT 15.00

Calcium Ionized QN RHI 66.00

Canalith Repositioning Procedure Units 151.00

CANNISTER VAC FREEDOM 171.00

CANNULA DISPOSABLE INNER SIZE4 14.00

Carbamazepine RHI 114.00

CATH VAPRO INTRMT TCH 14FR 16"

COU

17.00

Catheter - 16 French - Coude (each)

CHARGE

Catheter - 8 French (each) CHARGE 8.00

CATHETER COUDE 14FR 16IN LONG 6.00

CATHETER FOLEY 14FR 5CC BARDEX 17.00

CATHETER FOLEY 18FR 2-WAY 5CC 23.00

CATHETER FOLEY 20FR 2-WAY 5CC 17.00

CATHETER FOLEY 24FR 5CC BARDEX 23.00

CATHETER SELF CATH FEMALE 14FR 2.00

CATHETER SOFT STRGHT TIP 14FR

Catheter Stabilization Device - Foley 18.00

CATHETER, INTERMITNT, VAPRO,

COUDE, 12FR, 16"

10.00

CATHETER, VAPRO PLUS, 14FR 40CM 10.00

CD4 Followup RHI 209.00

CEA RHI 148.00

CELLERATION MIST THERAPY KITS 204.00

CERVICAL COLLAR LG 18.00

CERVICAL COLLAR MED 17.00

CERVICAL COLLAR SM 17.00

Chair Massage per 15 minutes 15.00

CHALGREN NEEDLES 37X26 61.00

CHANGE TRAY 18.00

Chlamydia PCR Qualitative RHI 176.00

Cholesterol RHI 33.00

Chromogranin A Ser QN RHI 114.00

CK MB RHI 90.00

CK RHI 51.00

CLEANSER WOUND SKINTEGRITY 8OZ 8.00

CLIP, NOSE, PLASTIC, FOAM, STERILE 3.00

CMV QN PCR 231.00

Coban 2 Compression System 23.00

COBAN 3" Latex Free 4.00

COLLAR CERVICAL LOW CONTOUR 10.00

Colostomy/Ileostomy Kit - Hollister (each)

CHARGE

6.00

COLOSTOMY/ILEOSTOMY KIT 19106 15.00

Complement C3 RHI 94.00

Complement C4 RHI 94.00

Complete Blood Count RHI 51.00

Complete Blood Count w/Differential RHI 61.00

Comprehensive Metabolic Panel RHI 84.00

CONFORMANT DRESSING 22.00

CONTINU-FLO SOLUTION SET 10.00

Cortisol RHI 131.00

CovRSite Dressing 6 IN x 6 IN 19.00

C-Peptide SerPl QN RHI 121.00

CPT Initial RT Charge 342.00

CPT Subsequent 114.00

C-Reactive Protein RHI 41.00

Crossmatch Computer RHI 74.00

Crossmatch IS RHI 74.00

Crossmatch MTS RHI 74.00

CUFF CRYO KNEE MEDIUM WITH 315.00

CURTH KIT - REHAB HOSP 7.00

CURVED CANNULA 20 G 10 CM 2,421.00

CUSTOM KIT SILBERT XRAY ONLY 21.00

Cyclosporine RHI 141.00

Date of Intubation

D-Dimer RHI 78.00

Debridement - each additional 20 sq cm 158.00

Debridement - first 20 sq cm or less 158.00

DEBRIDEMENT KIT 8.00

Declogger 25.00

Dehydroepiandrosterone by TMS RHI 148.00

Destruction Neurolytic Agent, Lumbar or

Sacral, Each Additional Facet Joint

2,281.00

Destruction Neurolytic Agent, Lumbar or

Sacral, Single Facet Joint

4,194.00

DIGITAL STIMULATOR 216.00

Digoxin RHI 102.00

Dipstick UA Manuali, POC 14.00

Direct Bilirubin RHI 40.00

DISP GROUNDING PAD WITH PLUG 1,826.00

DISPOSABLE RF ELECTRODE 10CM 242.00

DISPOSABLE RF ELECTRODE 15CM 242.00

DISPOZ-A-BAG FLIP-FLO 32OZ 15.00

DRESSING ALGINATE 1.2x18IN 21.00

DRESSING BORDER MEPILEX 3X3 51.00

DRESSING OPSITE 2X3 2.00

DRESSING OPSITE 4X5 4.00

DRESSING RESTORE 17SQ 68.00

DRESSING RESTORE 4X4 9.00

DRESSING RESTORE IMPREG 4X4 17.00

DRESSING, TEGADERM, OVAL, 2.75" X

3.5"

11.00

DRESSING,MEPILEX 4X4, SILICONE 72.00

Drinking System - Hydrant Replacement

Parts (each) CHARGE

273.00

Drug Screen Blood RHI 107.00

Drugs of Abuse Screen Urine RHI 300.00

DUODERM SIGNAL SCR 8.3X8.7"" 52.00

Dx Class Month-Month 12.60

EBV EA-D IgG RHI 101.00

EKG RT Charge 178.00

ELECTRODE, 10CM RADIO

FREQUENCY

299.00

Electrolytes Urine RHI 54.00

EMG NEEDLE 87.00

EMG, in addition to NCS - each extremity,

complete

344.00

EMG, in addition to NCS - each extremity,

limited

218.00

EMMA AIRWAY ADAPTER 120.00

End Tidal CO2 849.00

Endotracheal Tube 26.00

Ethanol Pl QN RHI 447.00

EXHALATION PORT 5.00

EXTENSION TUBING FOR LEG BAG 3.00

EZ PAP W/ DISP MANOMETER 104.00

EZPAP 101.00

EZPAP INITIAL 707.00

EZPAP SUBSEQUENT 202.00

Factor XIII Activity RHI 85.00

FEEDING BAG FOR USE W/PUMP 17.00

FEEDING BAG/ AMBULATORY 25.00

Feeding Tube Extension Set - Mic-Key*

(12") - (each) CHARGE

23.00

FEEDING, TRANSPORTER BAG 368.00

Ferritin RHI 107.00

FES Bike 1 Session 20.00

FES Bike 10 Session 180.00

FES Electrode Lower 50.00

FES Electrode Upper 42.00

Fibrinogen RHI 46.00

Fit and 50 200.00

FK 506 RHI 108.00

FLEXIBLE MIRROR 75.00

Folate RHI 116.00

Folate, RBC RHI 136.00

Foley Catheter - 24 French/5cc - Infection

Control (each) CHARGE

28.00

Follicle Stimulating Hormone RHI 108.00

FSI DTA 2,616.00

FSI DTA 2,616.00

FULL FACE MASK 108.00

Fungus Culture and Stain RHI 61.00

F-V DNA Leiden Bld PCR RHI 314.00

FVC Actual 464.00

G0260 Injection Sacroiliac Joint with or

without Arthrography RHI

2,281.00

GAIT BELT (54)" 23.00

GASTROSTOMY TUBE TRI FUNNEL

18FR, 20CC

68.00

Gentamicin Post RHI 127.00

Gentamicin Pre RHI 127.00

GGT RHI 56.00

GLOVE LG PAIR 97.00

GLOVES LG PAIR NO FINGERTIPS 84.00

GLOVES MED PAIR NO FINGERTIP 84.00

GLOVES SM PAIR 97.00

GLOVES SM PAIR NO FINGERTIP 84.00

Glucose Fasting SerPl QN RHI 24.00

Glucose Monitoring Continuous HENR 78.00

Glucose POC RHI 31.00

Glucose RHI 19.00

Gluc-Strip, POC RHI 25.00

Gonorrhea PCR Qualitative RHI 176.00

Granufoam XL Dressing 154.00

Group Class 12 Week Member 11.81



H&B Initial - 248.00

H&B Intervention - 1st 30 minutes 114.00

H&B Intervention - each additional 15

minutes

114.00

H&B Intervention 2 or more - 1st 30

minutes

40.00

H&B Intervention 2 or more - each

additional 15 minutes

40.00

H&B Intervention family present - 1st 30

minutes

112.00

H&B Intervention family present - each

additional 15 minutes

112.00

H&B Intervention family present w/o

patient present - 1st 30 minutes

158.00

H&B Intervention family present w/o

patient present - each additional 15

minutes

158.00

Haptoglobin RHI 98.00

HDL Cholesterol RHI 33.00

HEAT MOISTURE EXCHANGER 44.00

Heated & Humidified High Flow 638.00

HEEL PILLOW 65.00

HEMI SLING 89.00

Hemoccult, POC RHI 199.00

Hemoglobin A1c RHI 75.00

Hemoglobin RHI 19.00

Hemoglobin, Free RHI 19.00

HEMOSTAT KELLY STRAIGHT 7.00

Heparin Induced Platelet Antibody RHI 142.00

Hepatic Function Panel RHI 65.00

Hepatitis B Core Antibody RHI 94.00

Hepatitis B Core Antibody, IgM RHI 93.00

Hepatitis B Surface Ab RHI 85.00

Hepatitis B Surface Ag RHI 82.00

Hepatitis C (VIRAL LOAD) RHI 120.00

Hepatitis Screen (Hep A, B, C Ab/Ag) RHI 252.00

Herpes Simplex Type 1 and 2, IgM RHI 73.00

HIT - 1 Session 40.00

HIT - 2x per week/1 Month 280.00

HIT - 3x per week/1 Month 440.00

HIV 1/2 Antibody and Antigen RHI 137.00

HIV Antigen (non-ICD) RHI 151.00

HLA LUMINEX HD ABID, CL 1 RHI 1,304.00

HLA LUMINEX HD ABID, CL 2 RHI 1,312.00

Homocysteine RHI 132.00

HSV IgG, EIA RHI 102.00

Hydrofera Blue 4x4 Foam Dressing 28.00

IGF-1 Ser QN RHI 112.00

Incentive Spirometry Initial 453.00

Incentive Spirometry Subsequent 148.00

Indirect Antiglobulin Test RHI 130.00

Inner Cannula Extended Length - Shiley

6mm 60XLTIN

17.00


7mm (each) CHARGE

17.00


8mm (each) CHARGE

17.00

Innovations 1:1 16 Hour Pack 57.75

Inpatient Hemodialysis 664.00

InterDry (10"x36") - (each) CHARGE 231.00

Intrinsic Factor Blocking Ab RHI 222.00

INTUBATING STYLET FLEX 13.00

Intubation Charge 70.00

IODOFORM PACKING STRIP 101.00

IPPB Initial 936.00

IPPB Subsequent 606.00

Iron and TIBC RHI 51.00

Iron RHI 51.00

IRRIGATION TRAY 60CC PISTON 3.00

iSTAT Chem8 POC RT RHI 247.00

iSTAT, CHEM8 POC RHI 12.00

IV Catheters - BD 22g x 1 (each)

CHARGE

6.00

IV Catheters - BD 24g x 0.75 (each)

CHARGE

8.00

IV START KIT 6.00

Keppra (Levetiracetam) Level RHI 107.00

KIMVENT SUCTION BALLARD 320.00

KNEE CRYO/CUFF LRG 340.00

KNEE IMMOBILIZER 366.00

KNEE SPREADER MIRROR 207.00

L pneumophila Ag, Urine RHI 94.00

Lactate Arterial Pl QN RHI 63.00

Lactate Venous Pl Qn RHI 56.00

Lamotrigine RHI 107.00

LARGE DRESSING VAC FREEDOM 261.00

Latex Free Sterile Gloves (pair) CHARGE 97.00

LDH RHI 48.00

LDL, Measured RHI 74.00

LEUKOSTRIP 1/4 X 3 3.00

Levetiracetam (Keppra) RHI 107.00

Lipase RHI 53.00

Lipid Panel RHI 76.00

Lithium RHI 52.00

Love your Brain 6 Session 169.00

LOW AIRLOSS SYRINGE LOS 352.00

Luteinizing Hormone SerPl QN 2nd IS RHI 108.00

Magnesium RHI 52.00

Manual Differential RHI 29.00

MASIMO PROBE 119.00

Massage Therapy Services Per Minute 1.00

Measles Antibody (IgG) EIA RHI 100.00

MEDI-HONEY DRESSING PASTE 1.5 oz 28.00

MEDIPORE DRESSING 3.5" X 13.75" 8.00

MEDIPORE DRESSING 3.5" X 4" 5.00

MEDIPORE DRESSING 3.5" X 8" 6.00

MEDIPORE DRESSING 6" X 6" 7.00

MEDIUM DRESSING VAC FREEDOM 245.00

MELGISORB AG 4X4 21.00

MEPILEX 6X6 LITE 23.00

MEPILEX AG 8x8 104.00

MEPILEX BORDER 3" X 3" Charge 58.00

MEPILEX BORDER 4X8 IN 114.00

Mepilex Border Sacrum REF282055 29.00

Mepitel 4x7 Dressing 37.00

MERCURY SEAL MOUTH 24.00

Meter Dose Inhaler (MDI) Initial 649.00

Meter Dose Inhaler (MDI) Subsequent 202.00

Mextra Suberabsorbent 10 CM x 15 CM

(4 IN x 6 IN)

36.00

Mist Kit Equipment 72.00

Mitochondrl Antibody IF Quantitative 63.00

MITT FINGER CONTROL PADDED 64.00

MMO17448-Ref 100620 Emma Airway

Adapter

120.00

MRSA PCR RHI 52.00

Multi-layer compression; below knee 210.00

Multi-layer compression; thigh down 238.00

Multiple - Quinidine Solution 10 mg/mL

Soln

45.75

Mumps Virus Antibody (IgG) EIA RHI 101.00

NASAL CANNULA CONSERVING 83.00

Nasogastric Sump Tube 12Fr/48" - Bard

(each) CHARGE

39.00

NCV: motor and/or sensory using

preconfigured electrode array (each limb)

249.00

Needle, Huber 20G x 3/4" 18.00

Negative pressure wound therapy -

greater than 50 sq cm

237.00

Negative pressure wound therapy - less

than or equal to 50 sq cm

158.00

Negative Pressure Wound Therapy <

50cm

278.00

Negative Pressure Wound Therapy >

50cm

488.00

Nerve Conduction Studies 5-6 Studies 553.00

Nerve Conduction Studies, 1-2 357.00



Neuropsych Eval 1,856.00

Neuropsych Exam - 1st Hour 226.00

Neuropsych Exam - Additional Hour 226.00 Neuropsych Testing -Tech 1st hour 102.00

Neuropsych Testing -Tech each

additional hour

102.00

Neuropsych Testing-Professional 1st hour285.00

Neuropsych Testing-Professional each

additional hour

285.00

NIF-TEE ADAPTER 39.00

No Show Charge - 1 session 25.00

No Show Charge - 2 sessions 50.00

Non-selective Debridement 278.00

Non-selective debridement 158.00

Non-thermal, non-contact ultrasound 158.00

N-Terface Dressing (12"x12") - (each)

CHARGE

122.00

NVA Final Report 2,200.00

O+P Screen RHI 47.00

Occult Blood RHI 25.00

Oral Drug Screen 10.00

OSCILLATORY PEP SYSTEM 182.00

Osmolality RHI 52.00

Ostomy - Skin Barrier - floating flange

and tape (2-1/4") - (each) CHARGE

6.00

Ostomy - Skin Barrier - floating flange

and tape (2-1/4") - (per box - 5) CHARGE

6.00

OSTOMY 1 3/4 2PC POUCH - DRNBL 4.00

OSTOMY 1PC CTF 2 1/8 DRAINABLE 7.00

OSTOMY 2PC DRNBL 1 3/4 POUCH 4.00

OSTOMY- 2PC DRNBL POUCH 2 3/4 4.00

OSTOMY 2PC POUCH 2 1/4 CLAMP 4.00

OSTOMY 2PC POUCH 2 3/4 LNR 4.00

OSTOMY DRAINABLE POUCH 2.5 LNR 7.00

OSTOMY POUCH CLAMP 3.00

OSTOMY-2PC POUCH 2 1/4 LNR 4.00

OT Aquatic Exercise Assistant Units 153.50

OT Aquatic Exercise Units 158.00

OT Assistive Technology Eval Units 158.00

OT Attended E-Stim Assistant Units 251.50

OT Attended E-Stim Units 260.00

OT Biofeedback Assistant Units 612.00

OT Cognitive Function Assistant Units 613.00

OT Cognitive Function Medicare

Assistant Units

153.50

OT Cognitive Function Medicare Units 158.00

OT Cognitive Function Units 633.00

OT Cognitive Skills Development Rehab

Units

158.00

OT Cognitive Test Units 530.00

OT Community, Work Reintegration

Assistant Units

153.50

OT Community, Work Reintegration Units 158.00

OT Contrast Bath Assistant Units 153.50

OT Contrast Bath Units 158.00

OT Double Therapy Assistant Units 522.00

OT Double Therapy Units 1,054.00

OT Evaluation High Complexity Units 754.00

OT Evaluation Low Complexity Units 754.00

OT Evaluation Moderate Complexity Units 754.00

OT Evaluation Units 754.00

OT Group Therapy Assistant Units 522.00

OT Group Therapy Rehab Units 539.00

OT High Complex Units 754.00

OT Hot, Cold Pack Assistant Units -

OT Hot, Cold Pack Units -

OT Infrared Assistant Units 612.00

OT Iontophoresis Assistant Units 251.50

OT Iontophoresis Units 260.00

OT Low Complex Units 754.00

OT Manual Therapy Assistant Units 153.50

OT Manual Therapy Units 158.00

OT Massage Assistant Units 153.50

OT Massage Rehab Units 158.00

OT Mechanical Traction Assistant Units 612.00

OT MMT, Extremity, Trunk Units 632.00

OT MMT, Hand Units 632.00

OT MMT, Total Body Without Hand Units 632.00

OT Moderate Complex Units 754.00

OT Multi-Layer Compress Below Knee

Assistant Units

153.50

OT Neuromuscular Reeducation

Assistant Units

153.50

OT Neuromuscular Reeducation Rehab

Units

158.00

OT Non-Thermal/Contact Ultrasound

Assistant Units

153.50

OT Orthoptic/Pleoptic Training Units 203.00

OT Orthotic Management, Train Units 158.00

Ot Orthotic Mgmt/Train Establish

Assistant Units

153.50

OT Orthotic Mgmt/Train Establish Rehab

Units

158.00

OT Paraffin Bath Assistant Units 612.00

OT Paraffin Bath Units 632.00

OT Phonophoresis Assistant Units 153.50

OT Physical Performance Test Assistant

Units

153.50

OT Prosthetic Management, Train Units 158.00

OT ReEval Units 378.00

OT Re-Evaluation Units 378.00

OT Self Care, Home Management Units 158.00

OT Self Care, Home Mgmt Assistant Units 184.50

OT Sensorimotor Examination Units 203.00

OT Sensory Integrative Techniques Units 158.00

OT Strapping, Elbow, Wrist Units 266.00

OT Strapping, Hand, Finger Units 266.00

OT Strapping, Low Back Units 266.00

OT Strapping, Shoulder Units 266.00

OT Swallow Dysfunction Assistant Units 614.50

OT Therapeutic Activities Assistant Units 153.50

OT Therapeutic Activities Rehab Units 158.00

OT Therapeutic Exercise Assistant Units 153.50

OT Therapeutic Exercise Rehab Units 158.00

OT Ultrasound Assistant Units 153.50

OT Ultrasound Units 158.00

OT US/Estim Combo Assistant Units 153.50

OT Vasopneumatic Devices Assistant

Units

612.00

OT Wheelchair Management Assistant

Units

153.50

OT Wheelchair Management Units 158.00

OT Whirlpool Therapy Assitant Units 612.00

OT Whirlpool, Fluidotherapy Units 632.00

OT Work Hardening-Each Addl Hour

Assistant Units

337.50

OT Work Hardening-Each Addl Hour

Units

348.00

OT Work Hardening-Initial 2 Hours

Assistant Units

674.00

OT Work Hardening-Initial 2 Hours Units 696.00

Oxygen Therapy with Exercise 108.00

Oxymizer 139.00

Oxymizer 77.00

Pain Pump Analysis, Reprogramming 806.00

Parathyroid Hormone-Related Peptide. 74.00

PASSY MUIR VALVE PMV 2001 288.00

PASTE 2OZ ADAPT FOR OSTOMY 14.00

Peak Flow Rate 70.00

PELVIC HOLDER LARGE 60.00

PELVIC HOLDER MEDIUM 60.00

PELVIC HOLDER SMALL 61.00

Personal Training 1:1 Session 72.45

Phase II Multi Podus Large 577.00

Phase II Multi Podus Medium 577.00

PHASE II PODUS BOOT-AVERAGE SZ 654.00

PHASE II PODUS BOOT-LARGE 654.00

PHASE II PODUS BOOT-XLARGE 595.00

Phenytoin RHI 102.00

Phosphorus RHI 37.00

Physical therapy evaluation 754.00

Physical therapy re-evaluation 377.00

PICC Line Insertion 2,096.00

PINK SLIP 17.00

PLAK VAC ORAL HYG SUCT BRUSH 51.00

PLEURX DRAINAGE KIT 462.00

POSEY ALARM CHAIR PAD 68.00

Posey Bed Alarm Pad 66.00

POSEY BELT, GAIT (72)" 31.00

POSEY LIMB HOLDER PR 19.00

Postural 106.00

Potassium RHI 37.00

Potassium, POC RHI 37.00

POWDER 1OZ PUFF BOTTLE OSTOMY 7.00

Prealbumin RHI 114.00

Precise PGX Skin Stapler 17.00

PREMIUM HEADGEAR 173.00

Press on Prism - 1 Diopter 86.00




Prevena Peel & Place Dressing 13cm 547.00

Prevena Peel & Place Patch Strips

Dressing

547.00

PreWork Screen 359.00

Primapore Specialty Absorbent Dressing

11 - 3/4 IN x 4 IN

41.00


11 - 3/4 IN x 4 IN

41.00


8 IN x 4 IN

33.00

Procalcitonin EIA Qn RHI 135.00

PROFORE COMPRESSION BANDAGE 50.00

Prolactin SerPl QN 3rd IS RHI 113.00

PROTECTOR LARGE WHITE HEEL AND 18.00

PROTECTOR XLARGE HEEL AND 18.00

Protector, Heel Raiser 10.00

Protein C Antigen RHI 61.00

Protein S Antigen RHI 77.00

Prothrombin G20210A Mutation PCR RHI 257.00

Protime-INR RHI 31.00

PSA RHI 144.00

Psychotherapy - 30 minutes 142.00



Psychotherapy - family no patient 247.00

Psychotherapy - family with patient 308.00

Psychotherapy - group 72.00

Psychotherapy - multiple family 83.00

PT Application of Paste Boot Units 266.00

PT Application of Short Leg Splint Units 639.00

PT Aquatic Assistant Units 153.50

PT Aquatic Units 158.00

PT Assistive Technology Eval Units 158.00

PT Attended E-Stim Assistant Units 251.50

PT Attended E-Stim Units 260.00

PT Biofeedback Assistant Units 612.00

PT Biofeedback Units 632.00

PT Cognitive Function Assistant Units 613.00

PT Cognitive Function Medicare Units 158.00

PT Cognitive Function Units 633.00

PT Contrast Bath Assistant Units 153.50

PT Contrast Bath Units 158.00

PT Double Therapy Assistant Units 1,021.00

PT Double Therapy Units 1,054.00

PT Evaluation High Complexity Units 754.00

PT Evaluation Low Complexity Units 754.00

PT Evaluation Moderate Complexity Units 754.00

PT Evaluation Units 754.00

PT Gait Training Assistant Units 153.50

PT Gait Training Units 158.00

PT Group Therapy Assistant Units 522.00

PT Group Therapy Units 539.00

PT High Complex Units 754.00

PT Infrared Assistant Units 612.00

PT Infrared Units 632.00

PT Iontophoresis Assistant Units 251.50

PT Iontophoresis Units 260.00

PT Low Complex Units 754.00

PT Manual Therapy Assistant Units 153.50

PT Manual Therapy Units 158.00

PT Massage Assistant Units 153.50

PT Massage Units 158.00

PT Mechanical Traction Assistant Units 612.00

PT Mechanical Traction Units 632.00

PT MMT, Extremity, Trunk Units 632.00

PT MMT, Total Body Exclude Hand Units 632.00

PT MMT, Total Body With Hand Units 632.00

PT Moderate Complex Units 754.00

PT Neuromuscular Reeducation

Assistant Units

153.50

PT Neuromuscular Reeducation Units 158.00

PT Orthotic Management, Train Assistant

Units

153.50

PT Orthotic Management, Train Units 158.00

PT Orthotic Mgmt/Train Establish Rehab

Units

158.00

PT Paraffin Assistant Units 612.00

PT Paraffin Units 632.00

PT Physical Performance Assistant Test 153.50

PT Physical Performance Test 158.00

PT Prosthetic Management, Train

Assistant Units

153.50

PT Prosthetic Management, Train Units 158.00

PT ReEval Units 378.00

PT Re-Evaluation Units 378.00

PT ROM Measurement Hand Units 632.00

PT Self Care, Home Management

Assistant Units

184.50

PT Self Care, Home Management Units 191.00

PT Strapping Ankle, Foot Units 266.00

PT Strapping Elbow, Wrist Units 266.00

PT Strapping Hand, Finger Units 266.00

PT Strapping Hip Units 266.00

PT Strapping Knee Units 266.00

PT Strapping Low Back Units 266.00

PT Strapping Shoulder Units 266.00

PT Strapping Toes Units 266.00

PT Therapeutic Activity Assistant Units 153.50

PT Therapeutic Activity Units 158.00

PT Therapeutic Exercise Assistant Units 153.50

PT Therapeutic Exercise Units 158.00

PT Ultrasound Assistant Units 153.50

PT Ultrasound Units 158.00

PT Vasopneumatic Devices Assistant

Units

612.00

PT Vasopneumatic Devices Units 632.00

PT Wheelchair Management Assistant

Units

153.50

PT Wheelchair Management Units 158.00

PT Whirlpool, Fluidotherapy Assistant

Units

612.00

PT Whirlpool, Fluidotherapy Units 632.00

PT Work Hardening Initial 2 Hours

Assistant Units

674.00

PT Work Hardening Initial 2 Hours Units 696.00

PT Work Hardening-Each Addl Hour

Assistant Units

337.50

PT Work Hardening-Each Addl Hour Units 348.00

PT/INR POC RT RHI 31.00

PTH, Intact RHI 322.00

Reality break per 15 minutes 15.00

Reevaluation Units 378.00

Rehab Driving Evaluation 450.00

Rehab Driving Final Inspection 37.50

Rehab Driving Lesson 37.50

Rehab Driving Mileage 0.38

Rehab Driving Re-Eval 318.50

Rehab Driving Travel Time 70.00

Rehab Driving Vehicle Mod 37.50

Rehab Night Driving 37.50

Rehab Van Access Eval 497.00

REMEDY SKIN REPAIR CREAM 2 OZ 10.00

Renal Function Panel RHI 67.00

Resource Facility Initial Intake 200.55

Resource Facility Services Per 15 M 12.60

Respiratory Culture and Stain RHI 67.00

Respiratory Therapy Charges 70.00

Respiratory Therapy/ea 15 min 103.00

RESTING HAND SPLINT LG LEFT 100.00

RESTING HAND SPLINT LG RIGHT 100.00

RESTING HAND SPLINT MED LEFT 100.00

RESTING HAND SPLINT MED RT 100.00

RESTING HAND SPLINT SMALL LFT 100.00

RESTING HAND SPLINT SMALL RT 106.00

Retic Count RHI 33.00

RF Bus Passes 30.00

RF Gas Card RHI 30.00

RF Hotel 96.00

RF Mileage 0.38

RF Unit 1 500.00

RF Unit 2 1,250.00

RF3 Unit 3 1,250.00

Rheumatoid Factor RHI 44.00

ROOM/BED: Private 2,083.00

ROOM/BED: Semi Private 2,083.00

ROOM/BED: Specialty Private 2,083.00

ROOM/BED: Specialty Semi Private 2,083.00

RT ABG W/Direct Meas O2 Sat Charge 325.00

RT Airway Suction Charge 861.00

RT Cardiopulmonary Resuscitation

Charge

809.00

RT CPT w/ Vest Initial Charge 342.00

RT CPT w/ Vest Subsequent Charge 114.00

RT Education/Instruction Charge 606.00

RT Intubation, Emergency Charge 581.00

RT Overnight Oximetry Charge 563.00

RT Oxygen Per Day Charge 443.00

RT POX, Single Determination Charge 119.00

RT POX, Single Determination Charge 119.00

RT Ventilator Services - Sub Charge 500.00

RT Vital Capacity, Total Charge 456.00

Rubella Antibodies, IgG RHI 112.00

RVP PCR Panel RHI 2,154.00

SALINE WOUND WASH 23.00

Scalpel #15 (disposable) 372615 (each) 2,782.00

SCD Garment - Knee Length - Small

(each) CHARGE

290.00

SCD SLEEVE LARGE 368.00

SCD SLEEVE MEDIUM 306.00

SED Rate RHI 22.00

Selective Debridement (<20cm) 503.00

Selective Debridement (>20cm) 503.00

Shiley Tracheostomy Tube XLT Cuffless

50XLTUP

259.00

Sinus/Migraine release 25.00

Sirolimus Bl QN 74.00

SKU-BHL2F7114 Sterile H20 -2000ml 86.00

SKUDYND40589 Trach Cleaning Kit 27.00

SLP Analysis of Voice & Resonance Units 754.00

SLP Assessment of Aphasia Units 754.00

SLP Auditory Processing Eval Units 754.00

SLP Auditory Processing Tx Units 634.00

SLP Cog Ther Intervent, Addl 15Min Units 153.50

SLP Cog Ther Intervent,First 15Min Units 153.50

SLP Cognitive Function Medicare Units 158.00

SLP Cognitive Function Units 634.00

SLP Cognitive Skills Development Units 158.00

SLP Cognitive Test Units 754.00

SLP Double Therapy Units 1,054.00

SLP Fluoroscopic Evaluation Units 754.00

SLP Group Therapy Units 539.00

SLP Non-Speech AAC Device Eval Units 754.00

SLP Non-Speech AAC Device Tx Units 634.00

SLP Pharyngeal Swallow Eval Units 754.00

SLP Sensory Integrative Techniques Units 158.00

SLP Sound Prod w/ Lang Comp Eval

Units

754.00

SLP Sound Production Eval Units 754.00

SLP Speech AAC Eval Addl Half Hour

Units

377.00

SLP Speech AAC Eval First Hour Units 754.00

SLP Swallow Dysfunction Oral Feed Units 634.00

SLP Treatment of speech, language,

voice, communication, and/or auditory

processing disorder

634.00

SLP Tx Generating Device Units 634.00

SLP Use,Fit Speech Prosthetic Eval Units 754.00

SMALL DRESSING VAC FREEDOM 194.00

SMALL VOLUME NEB 8.00

Smear Review RHI 47.00

Sodium RHI 39.00

SOFTGOODS FOR CPM 98.00

Specialty Care Transport 792.00

Specific Organism Culture RHI 64.00

SPECIMEN TRAP 21.00

Speech Generating Device Eval

Additional 30 Min

191.00

Spinal Fluid Glucose RHI 31.00

SPINAL NEEDLE 23GX5 56.00

SPINAL NEEDLE 23GX6 53.00

SPIRETTE 8.00

SPIRETTE MOUTHPIECES 7.00

SPLINT AIR CAST LEFT 124.00

SPLINT AIR CAST RIGHT 134.00

SpO2 119.00

SPORTSTAPE LEUKOTAPE 22.00

Sputum Induction - RT Charge 27.00

Staff Yoga 1 Class 7.00

Staff Yoga Monthly pkg 25.00

STAPLE REMOVER SKIN 3.00

STERILE H20-1000ML 12.00

STERILE H20-2000ML 11.00

STOCKING ANTI-EMBOLISM 25.00

STOCKING ANTI-EMBOLISM-ATS XXL 29.00

STOCKING KNEE LENGTH LARGE 19.00

STOCKING KNEE LENGTH MED 20.00

STOCKING NYLON KNEE SML REGULR 20.00

STOCKING THIGH LENGTH LARGE-

LONG

26.00

STOCKING THIGH LENGTH LARGE-

REGULAR

26.00

STOCKING THIGH LENGTH MEDIUM 26.00

STOCKING THIGH LENGTH SMALL 33.00

STOCKING THIGH LENGTH X-LARGE 33.00

STOCKING THIGH MED-LONG 32.00

Stool Culture RHI 74.00

SUCTION CANNISTER 138.00

Suction Cath-N-Glove Kit - 10 Fr (each)

44-10 CHARGE

4.00


44-12 CHARGE

3.00


44-14 CHARGE

3.00

SUCTION KIT 6.00

SUPPOSITORY INSERTER 228.00

SUTURE REMOVAL TRAY 7.00

Suture Strips 1/2x4 4.00

Syphilis Treponemal IgG RHI 102.00

Syphilis Treponemal Total (IgM/IgG) RHI 310.00

T3, Free RHI 132.00

T3, Total RHI 110.00

T4 RHI 53.00

T4 w/T3 Uptake RHI 51.00

T4, Free, Direct RHI 70.00

TAPE HYTAPE PLASTIC 1INx5YD 29.00

TB Skin Test 63.00

TB SKIN TEST 63.00

TED Hose - Knee - Medium - Long (pair)

CHARGE

10.00

TED Hose - Knee - XX-Large - Regular

(pair) CHARGE

10.00

TED Hose - Thigh - Large - Short (pair)

CHARGE

47.00

Testosterone, Total RHI 202.00

Therapeutic activities, each 15 mins 158.00

THERMOMETER DIGITAL FAHRENHEIT 22.00

Thyroglobulin Ser (cpt 84432) RHI 93.00

Thyroid Peroxidase Ab RHI 85.00

Thyroid Stimulating Immunoglobulin RHI 39.00

Tobramycin Pre RHI 125.00

Total Bilirubin RHI 40.00

TOUCHLESS MALE CATHETER 10.00

TOWEL OR 17x27IN BLUE 22.00

TRAC PAD - WOUND VAC 87.00

TRACH CLEANING KIT 27.00

TRACH MASK 9.00

TRACH STRAP, VELCRO 9.00

Trach Tube - Bivonia Silicone Adult Mid

Range Cuff (each)

202.00

Trach Tube - Bivonia Silicone Pediatric

Cuffless (3.0mm) - (each) CHARGE

291.00

Trach Tube - Bivonia Silicone Pediatric

Cuffless (3.5mm) - (each) CHARGE

291.00

Trach Tube Cuffless - Shiley 3.5 PED

(each) CHARGE

19.00

Trach Tube Cuffless - Shiley 4.0 PED

(each) CHARGE

24.00

Trach Tube XLT Cuffless - Shiley 6

(each) CHARGE

166.00

Tracheostomy Tube, Inner

Cannula,Orange 6mm (Medline SKU:

PTX526060)

4.58

Tracheostomy Tube, Uncuffed,

Nonfenestrated; 6mm (Medline SKU:

PTX502060)

61.74

Tracheostomy Tube, Uncuffed,

Nonfenestrated; 7mm (Medline SKU:

PTX502070)

61.74

Transfer Belt 95.00

Transferrin RHI 99.00

TRAP SPECIMEN 4.00

TRAY LATEX FREE URETHERAL 10.00

Trichomonas Exam Wet Prep RHI 87.00

Trichomonas Prep RHI 87.00

Triglyceride SerPl QN RHI 30.00

Troponin I RHI 61.00

Troponin I, POC RHI 76.00

TSH, 3rd Gen RHI 132.00

Tube changed 608.00

Tube changed 581.00

TUBE SUCTION CONNECTING 2.00

TUBE TRACH DISPOSABLE 4 171.00

TUBE, NG/SALEM 12F 2.00



Tx of Speech/Lang/Voice/Comm/Auditory

Chg Medicaid

634.00

UA Dipstick POC RHI 14.00

UA Dipstick RHI 14.00

UNIVERSAL SHOULDER IMMOBILIZER 114.00

Urethral Red Rubber Catheter - 14

French - Coude (each) 120614 CHARGE

9.00


French (each) CHARGE

3.00


French - Coude (each) CHARGE

4.00

Uric Acid RHI 36.00

URINAL HOLDER W/ VELCRO STRAP 31.00

Urinalysis Complete RHI 18.00

Urinalysis Dipstick only RHI 20.00

Urinary Catheter Insertion - Indwelling

(RHI)

39.00

Urine Calcium, Random RHI 48.00

Urine Creatinine, Random RHI 41.00

Urine Culture RHI 64.00

Urine Microscopic RHI 25.00

Urine Osmolality, Random RHI 53.00

Urine Protein, Random RHI 28.00

Urine Sodium RHI 39.00

Urine Specific Gravity RHI 19.00

Urine Urea Nitrogen RHI 37.00

UROSTOMY 2PC DRNBL POUCH 1 3/4 4.00

UROSTOMY 2PC POUCH 2 1/4 4.00

UROSTOMY 2PC POUCH TNSP 2 3/4 4.00

UROSTOMY DRAIN TUBE ADAPTER 7.00

VAC ULTA VERALINK 313.00

VAC VERAFLOR CLEANSE CHOICE 601.00

VAC Veralink Cassette 710.00

VAD Dressing Change Kit 44.00

Valproic Acid RHI 107.00

Vancomycin Post RHI 107.00

Vancomycin Pre RHI 107.00

Varicella Zoster Antibody (IgG) EIA RHI 100.00

Varicella Zoster Virus Antibody, IgM RHI 65.00

VENT CIRCUIT 48.00

VENT CIRCUT TUBING 48.00

Ventilator Management Protocol initial 1,498.00

Ventilator Services Initial 1,500.00

VISTA COLLAR REPLACEMENT PADS 191.00

Vitamin B12 RHI 118.00

Vitamin C RHI 76.00

Vitamin D, 1,25 Dihydroxy RHI 231.00

Vitamin D, 25-Hydroxy RHI 231.00

VOC Placement 700.00

VOLUMETRIC INCENTIVE SPIRO 10.00

VRE Screen Culture RHI 64.00

WAFFLE FOOT 161.00

WAFFLE MATTRESS 127.00

Weaning Negative Inspiratory Force 418.00

Wheelchair Van 40.00

Wheelchair Van 2.00

Wound Culture and Stain RHI 67.00

Wound Evaluation 754.00

Wound Re-Evaluation 377.00

Wound Therapeutic activities, each 15

mins

158.00

Wright Stain RHI 33.00

XEROFORM DRESS/GAUZE ROLL 17.00

XEROFORM DRESSING 3.00

XR Abdomen 1 View w/ Decubitus Left 161.00

XR Abdomen 1 View w/ Decubitus Left 161.00

XR Abdomen 1 View w/ Decubitus Right 161.00

XR Abdomen 1 View w/ Decubitus Right 161.00

XR Abdomen 2 Views 99.00

XR Abdomen 2 Views 99.00

XR Abdomen AP 99.00

XR Abdomen AP 99.00

XR Abdomen Decubitus Left 161.00

XR Abdomen Decubitus Left 161.00

XR Abdomen Decubitus Right 161.00

XR Abdomen Decubitus Right 161.00

XR Abdomen KUB 99.00



XR Abdomen Lateral Left 99.00

XR Abdomen Lateral Left 99.00

XR Abdomen Lateral Right 99.00

XR Abdomen Lateral Right 99.00

XR Abdomen Multi Views 99.00

XR Abdomen Multi Views 99.00

XR Abdomen Series 192.00

XR Abdomen Series 192.00

XR AC Joints Bilateral w/ + w/o wts 117.00

XR AC Joints Bilateral w/ + w/o wts 117.00

XR AC Joints Bilateral w/ wts 117.00

XR AC Joints Bilateral w/ wts 117.00

XR Ankle 2 Views Left 117.00


XR Ankle 2 Views Right 117.00






XR Barium Enema Regular w/ or w/o KUB 99.00

XR Barium Enema Regular w/ or w/o KUB 99.00

XR BASW Modified 754.00

XR BASW Modified 754.00

XR Bone Length Studies Scanograms 154.00

XR Bone Length Studies Scanograms 154.00

XR Bone Survey (metastatic) 277.00

XR Bone Survey (metastatic) 277.00

XR Bone Survey Complete 277.00

XR Bone Survey Complete 277.00

XR Bone Survey Limited (Mets) 277.00

XR Bone Survey Limited (Mets) 277.00

XR Calcaneus Min 2 View Lt 114.00

XR Calcaneus Min 2 View Lt 114.00

XR Calcaneus Min 2 View Rt 114.00

XR Calcaneus Min 2 View Rt 114.00

XR Cervical Spine 1 view 158.00

XR Cervical Spine 2 Views 158.00




XR Chest 1 View 122.00

XR Chest 1 View 208.00

XR Chest 1 View Frontal 122.00

XR Chest 1 View Frontal 122.00

XR Chest 2 Views 122.00


XR Chest 2 Views w/ Apical Lordotic 151.00

XR Chest 2 Views w/ Oblique Left 191.00

XR Chest 2 Views w/ Oblique Left 191.00

XR Chest 2 Views w/ Oblique Right 191.00

XR Chest 2 Views w/ Oblique Right 191.00


XR Chest AP/PA 122.00

XR Chest Decubitus Left 94.00

XR Chest Decubitus Left 94.00

XR Chest Decubitus Right 94.00

XR Chest Decubitus Right 94.00

XR Chest Inspiration/Expiration 94.00

XR Chest Inspiration/Expiration 94.00

XR Clavicle Left 117.00

XR Clavicle Left 117.00

XR Clavicle Right 117.00

XR Clavicle Right 117.00

XR Elbow 2 Views Left 116.00

XR Elbow 2 Views Left 116.00

XR Elbow 2 Views Right 116.00

XR Elbow 2 Views Right 116.00

XR Elbow 3 Views Min Lt 136.00

XR Elbow 3 Views Min Lt 136.00

XR Elbow 3 Views Min Rt 136.00

XR Elbow 3 Views Min Rt 136.00

XR Facial Bones Minimum 3 Views 170.00

XR Facial Bones Minimum 3 Views 170.00

XR Femur 2 Views Lt 114.00

XR Femur 2 Views Lt 114.00

XR Femur 2 Views Rt 114.00

XR Femur 2 Views Rt 114.00

XR Finger 2nd Digit Left 132.00

XR Finger 2nd Digit Left 132.00

XR Finger 2nd Digit Right 132.00

XR Finger 2nd Digit Right 132.00

XR Finger 3rd Digit Left 132.00

XR Finger 3rd Digit Left 132.00

XR Finger 3rd Digit Right 132.00

XR Finger 3rd Digit Right 132.00

XR Finger 4th Digit Left 132.00


XR Finger 4th Digit Right 132.00






XR Finger Thumb Left 132.00

XR Finger Thumb Left 132.00

XR Finger Thumb Right 132.00

XR Finger Thumb Right 132.00

XR Foot 1 View Lt 109.00

XR Foot 1 View Lt 109.00

XR Foot 1 View Rt 109.00

XR Foot 1 View Rt 109.00

XR Foot 2 Views Left 109.00


XR Foot 2 Views Right 109.00






XR Forearm 2 Views Left 110.00

XR Forearm 2 Views Left 110.00

XR Forearm 2 Views Right 110.00

XR Forearm 2 Views Right 110.00

XR GI Tube Long Intro Fluoro and Film 99.00

XR GI Tube Long Intro Fluoro and Film 99.00

XR Hand 2 Views Left 112.00


XR Hand 2 Views Right 112.00






XR Hip 1 View Left 106.00

XR Hip 1 View Left 106.00

XR Hip 1 View Right 106.00

XR Hip 1 View Right 106.00

XR Hip 2 Views Min Lt 108.00

XR Hip 2 Views Min Lt 108.00

XR Hip 2 Views Min Rt 108.00

XR Hip 2 Views Min Rt 108.00

XR Hip Operative Left 106.00

XR Hip Operative Left 106.00

XR Hip Operative Right 106.00

XR Hip Operative Right 106.00

XR Hips Bilat Min 2 Views w/ AP Pelvis 157.00

XR Hips Bilat Min 2 Views w/ AP Pelvis 157.00

XR Humerus 2 Views Min Lt 118.00

XR Humerus 2 Views Min Lt 118.00

XR Humerus 2 Views Min Rt 118.00

XR Humerus 2 Views Min Rt 118.00

XR Knee 1 or 2 Views Left 124.00

XR Knee 1 or 2 Views Left 124.00

XR Knee 1 or 2 Views Right 124.00

XR Knee 1 or 2 Views Right 124.00

XR Knee 1 View Lt 124.00

XR Knee 1 View Lt 124.00

XR Knee 1 View Rt 124.00

XR Knee 1 View Rt 124.00

XR Knee 3 Views Left 148.00

XR Knee 3 Views Right 148.00

XR Knee 3 Views Right 148.00

XR Knee 4 Views Min Lt 173.00

XR Knee 4 Views Min Lt 173.00

XR Knee 4 Views Min Rt 173.00

XR Knee 4 Views Min Rt 173.00

XR Knee w/ Patella Left 124.00

XR Knee w/ Patella Left 124.00

XR Knee w/ Patella Right 124.00

XR Long Alignment Legs 154.00

XR Long Alignment Legs 154.00

XR Lumbar Spine 1 View 147.00

XR Lumbar Spine 1 View 147.00

XR Lumbar Spine 2 Views 147.00






XR Mandible Complete Minimum 4 Views 158.00

XR Mandible Complete Minimum 4 Views 158.00

XR Manual Stress Application to Joint Lt 109.00

XR Manual Stress Application to Joint Lt 109.00

XR Manual Stress Application to Joint Rt 109.00

XR Manual Stress Application to Joint Rt 109.00

XR Nasal Bones Minimum 3 Views 133.00

XR Nasal Bones Minimum 3 Views 133.00

XR Neck Soft Tissue 108.00

XR Neck Soft Tissue 108.00

XR Orbits Complete Bilateral 176.00

XR Orbits Complete Bilateral 176.00

XR Patella Sunrise Left 124.00

XR Patella Sunrise Left 124.00

XR Patella Sunrise Right 124.00

XR Patella Sunrise Right 124.00

XR Pelvis 1 or 2 Views 106.00



XR Pelvis 1 or 2 Views + Hip 1 View Lt 157.00

XR Pelvis 1 or 2 Views + Hip 1 View Lt 157.00

XR Pelvis 1 or 2 Views + Hip 1 View Rt 157.00

XR Pelvis 1 or 2 Views + Hip 1 View Rt 157.00

XR Pelvis 2 or More Views 170.00

XR Pelvis AP 106.00

XR Pelvis Complete Minimum 3 Views 170.00

XR Pelvis Inlet/Outlet Views 108.00

XR Pelvis Inlet/Outlet Views 108.00

XR Pelvis Judet Views 108.00

XR Pelvis Judet Views 108.00

XR Pelvis w/ Hip Left 157.00

XR Pelvis w/ Hip Left 157.00

XR Pelvis w/ Hip Right 157.00

XR Pelvis w/ Hip Right 157.00

XR Pelvis w/lateral Hips 157.00

XR Pelvis w/lateral Hips 157.00

XR Ribs 2 Views Left 131.00

XR Ribs 2 Views Left 131.00

XR Ribs 2 Views Right 131.00

XR Ribs 2 Views Right 131.00

XR Ribs min 3 views/PA Chest Left 131.00

XR Ribs min 3 views/PA Chest Left 131.00

XR Ribs min 3 views/PA Chest Right 131.00

XR Ribs min 3 views/PA Chest Right 131.00

XR Ribs w/ PA Chest Bilateral 162.00

XR Ribs w/ PA Chest Bilateral 162.00

XR Ribs w/ PA Chest Left 131.00

XR Ribs w/ PA Chest Left 131.00

XR Ribs w/ PA Chest Right 131.00

XR Ribs w/ PA Chest Right 131.00

XR Sacroiliac Joints 1 or 2 Views 120.00

XR Sacroiliac Joints 1 or 2 Views 120.00

XR Sacroiliac Joints Minimum 3 Views 139.00

XR Sacroiliac Joints Minimum 3 Views 139.00

XR Sacrum/Coccyx Minimum 2 Views 117.00

XR Sacrum/Coccyx Minimum 2 Views 117.00

XR Scapula Left 125.00

XR Scapula Left 125.00

XR Scapula Right 125.00

XR Scapula Right 125.00

XR Shoulder 1 View Left 95.00

XR Shoulder 1 View Left 95.00

XR Shoulder 1 View Right 95.00

XR Shoulder 1 View Right 95.00

XR Shoulder 2 Views Left 123.00

XR Shoulder 2 Views Right 123.00

XR Shoulder Complete Left 123.00



XR Shoulder Complete Right 123.00



XR Sinuses Complete 124.00

XR Sinuses Complete 124.00

XR Sinuses Paranasal < 3 Views 124.00

XR Sinuses Paranasal < 3 Views 124.00

XR Sinuses Paranasal Complete 158.00

XR Sinuses Paranasal Complete 158.00

XR Skull < 4 Views 191.00



XR Skull < 4 views 379.00

XR Skull 1 View 148.00

XR Skull 1 View 148.00

XR Skull Complete 191.00



XR Spine 1 View Cervical 94.00

XR Spine 1 View Cervical 94.00

XR Spine Cervical 2 or 3 Views 94.00

XR Spine Cervical 2 or 3 Views 94.00

XR Spine Cervical Comp w/ Obliques 94.00

XR Spine Cervical Comp w/ Obliques 94.00

XR Spine Cervical Cross-Table Lateral 94.00

XR Spine Cervical Cross-Table Lateral 94.00

XR Spine Cervical Flexion + Extension 158.00

XR Spine Cervical Flexion + Extension 158.00

XR Spine Cervical Minimum 4 Views 94.00

XR Spine Cervical Minimum 4 Views 94.00

XR Spine Cervical w/ Flex and/or Ext 273.00

XR Spine Cervical w/ Flext and/or Ext 273.00

XR Spine Entire Survey AP/Lat 309.00

XR Spine Entire Survey AP/Lat 309.00

XR Spine Lumbar Flexion + Extension 147.00

XR Spine Lumbar Flexion + Extension 147.00

XR Spine Lumbar Xtl Lateral 147.00

XR Spine Lumbar Xtl Lateral 147.00

XR Spine Lumbosacral 2 or 3 Views 147.00

XR Spine Lumbosacral 2 or 3 Views 147.00

XR Spine Lumbosacral Bending Only 176.00

XR Spine Lumbosacral Complete w/

Bending

201.00

XR Spine Lumbosacral Complete w/

Bending

201.00

XR Spine Scoliosis 202.00

XR Spine Scoliosis Study Standing 202.00

XR Spine Scoliosis Study Standing 202.00

XR Spine Scoliosis Supine + Standing 202.00

XR Spine Scoliosis Supine + Standing 202.00

XR Spine Thoracic 3 Views 134.00

XR Spine Thoracic 3 Views 134.00

XR Spine Thoracic Minimum 4 Views 177.00

XR Spine Thoracic Minimum 4 Views 177.00

XR Spine Thoracolumbar 2 Views 145.00

XR Spine Thoracolumbar 2 Views 145.00

XR Sternoclavicular Joint(s) 150.00

XR Sternoclavicular Joint(s) 150.00

XR Sternum Minimum 2 Views 125.00

XR Sternum Minimum 2 Views 125.00

XR Thoracic Spine 1 View 134.00

XR Thoracic Spine 1 View 134.00

XR Thoracic Spine 2 Views 134.00

XR Thoracic Spine 2 Views 134.00

XR Tibia +Fibula 2 Views Lt 110.00

XR Tibia +Fibula 2 Views Lt 110.00

XR Tibia +Fibula 2 Views Rt 110.00

XR Tibia +Fibula 2 Views Rt 110.00

XR TMJ Open and Closed Bilateral 194.00

XR TMJ Open and Closed Bilateral 194.00

XR Toe(s) 2 Views Min Lt 119.00

XR Toe(s) 2 Views Min Lt 119.00

XR Toe(s) 2 Views Min Rt 119.00

XR Toe(s) 2 Views Min Rt 119.00

XR Wrist 2 Views Left 125.00


XR Wrist 2 Views Right 125.00






XR Wrist Complete Left 148.00

XR Wrist Complete Left 148.00

XR Wrist Complete Right 148.00

XR Wrist Complete Right 148.00

XR Zygomatic Arches 158.00

XR Zygomatic Arches 158.00

Yankauer 28.00

Yankauer covered with in/off suction

handle (Medline SKU: MDS876629H)

9.03

YANKAUER WITH SWITCH 4.00

Y-TYPE BLOOD/SOLUTION SET 15.00

zzXR Spine Lumbosacral Bending Only 176.00

Documents

PRICES EFFECTIVE 1/1/2020