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Grace HospitalPricing Catalog as of 01/01/21
IVNUM IVDESC IVCPTCD IVPRICE1 IVDEPT001
Dialysis 520001 DIALYSIS (HEMO) 90935 1,278.00 005 520002 PERITONEAL DIALYSIS 90945 1,771.00 005
Laboratory 1000001 COMPATIBILITY SPIN TEST 86920 89.00 010 1000002 BLOOD ADMINISTRATION 1,896.00 010 1000003 PACKED RED CELLS/TESTING 452.00 010 1000004 PLATELETS/TESTING 80.00 010 1000005 FROZEN BLOOD PREP FREEZ 86930 197.00 010 1000006 FRESH FROZEN PLASMA/TEST 67.00 010 1000007 TRANSFUSION BLD/BLD COMP 36430 1,417.00 010 1000008 COMPATIBILITY TEST ELECTR 86923 120.00 010 1000210 FFP THAWING EACH UNIT 86927 49.00 010 1000211 RBC LEUKOREDUCED WASHED P9016 1,437.00 010 1000231 ANTIBODY IDENT RBC ANTI 86870 145.00 010 1000232 ANTIBODY ELUTION (RBC) 86860 107.00 010 1000233 POOLING OF PLATELETS 86965 84.00 010 1120000 FNA INTERP/REPORT 88173 65.00 011 1120001 BLEEDING TIME 85002 55.00 011 1120002 COAGULATION TIME OTHER 85348 55.00 011 1120003 CLOT RETRACTION 85170 41.00 011 1120005 EOSINOPHIL SMEAR 89190 61.00 011 1120007 HEMOGLOBIN HGB 85018 25.00 011 1120008 IMMUNOASSAY FOR INF QUAL 86318 99.00 011 1120009 COAGULATION TIME 85345 30.00 011 1120010 SPECIAL STAIN FOR PARA 87207 80.00 011 1120011 CBC WITH AUTO DIFF 85025 60.00 011 1120012 COMPLETE CBC AUTOMATED 85027 63.00 011 1120013 OSMOTIC FRAG RBC INCUBAT 85557 87.00 011 1120014 MANUAL CELL COUNT 85032 33.00 011 1120015 RETICULOCYTE COUNT 85044 42.00 011 1120016 SEDIMENTATION RATE 85651 55.00 011 1120018 HEMATOCRIT 85014 18.00 011 1120019 BLOOD SMEAR W/DIFF WBC 85007 26.00 011 1120020 SYN FLUID CRYSTAL 89060 27.00 011 1120021 PLATELET COUNT AUTOMATED 85049 25.00 011 1120022 RETICULOCYTE AUTOMATED 85045 40.00 011 1120023 BLOOD CT AUTO DIFF WBC 85004 35.00 011 1120024 HGB BLOOD METHEMOGLOBIN 83050 43.00 011 1120025 CELL SURF/CYTO ADDL MARK 88185 65.00 011 1120026 CELL SURF/CTYO 1ST MARK 88184 65.00 011 1120070 SYN FLUID MUCIN ROPES TE 83872 40.00 011 1121000 CULTURE FUNGUS 87101 42.00 011 1121001 SMEAR PRIMARY SOURCE 87205 67.00 011 1121002 ACID FAST CULTURE 87116 150.00 011 1121003 STAIN/SMEAR FUNGL/BACT/VI 87206 56.00 011
1121004 CULTURE BACTERIAL URINE 87086 84.00 011 1121005 CULTURE OTHER SOURCE 87070 81.00 011 1121008 M I C 87186 144.00 011 1121112 FLUORESCENT NON-INF TITE 86256 160.00 011 1121114 CULTURE, BACT SINGLE ORG 87081 55.00 011 1121116 MYCOPLASMA CULTURE 87109 126.00 011 1121117 COMPLEMENT FIXATION TEST 86171 86.00 011 1121118 CHLAMYDIA CULTURE 87110 126.00 011 1121119 IMMUNOASSAY FOR INFECT A 86317 112.00 011 1121120 CULTURE FUNGI MOLD 87107 37.00 011 1121121 WET MOUNT SIMPLE STAIN 87210 89.00 011 1121123 TISSUE CULTURE ADD'L STU 87253 128.00 011 1121124 LEGIONELLA ANTIBODY SERU 86713 81.00 011 1121125 RUBELLA 86762 118.00 011 1121126 TOXIN/ANTITOX TISS CULT 87230 152.00 011 1121127 LYMPHOCYTIC CHORIOMEGING 86727 104.00 011 1121128 HISTOPLASMA ANTIBODY 86698 121.00 011 1121129 HEMOPHILUS INFLUEN ANTIB 86684 151.00 011 1121130 CULTURE VIRAL INCLD STAIN 87254 72.00 011 1121131 CULTURE ANAEROBIC 87075 51.00 011 1121132 PARVOVIRUS 86747 102.00 011 1121184 WHITE BLOOD CELL 85048 28.00 011 1121185 RED BLOODCELL COUNT ONLY 85041 28.00 011 1121187 SPUN MICROHEMATOCRIT 85013 28.00 011 1121188 FDP FIB DEG PROD FSP D-D 85362 71.00 011 1121192 CULTURE BLOOD 87040 128.00 011 1121196 CULTU/STOOL/FECAL/RECTAL 87045 64.00 011 1121198 SENSITIVITY STUDY, ANTIB 87181 38.00 011 1121203 CELL COUNT CSF FLUID 89050 30.00 011 1121209 SYPHILIS TEST 86592 44.00 011 1121211 CELL COUNT BODY FLUID 89051 42.00 011 1121212 FECAL LEUKOCYTES 89055 72.00 011 1122002 GLUCOSE, QUANT 82947 55.00 011 1122006 SYPHILIS TEST,QUANTITATI 86593 57.00 011 1122007 HETEROPHILE ANTIBODY 86308 104.00 011 1123000 COOMBS DIRECT 86880 67.00 011 1123001 ANTIBODY SCREEN/INDIRECT 86850 67.00 011 1123002 ANTIGEN TEST W REAGENT 86902 26.00 011 1123004 RH (D) TYPE 86901 41.00 011 1123005 RBC ANTIGENS 86905 22.00 011 1123007 BLOOD TYPING ABO 86900 67.00 011 1123008 COOMBS INDIRECT QUALITAT 86885 42.00 011 1123009 BLOOD SPLIT UNIT PLATELET P9011 1,868.00 011 1123010 PLATELET PHERESIS LEUKO P9035 2,581.00 011 1124000 ACETONE SERUM 82009 41.00 011 1124002 PHOSPHATASE, PROSTATIC 84066 118.00 011 1124003 ALKALINE PHOSPHATASE 84075 55.00 011 1124004 AMYLASE 82150 58.00 011 1124008 BLOOD GASES 82803 140.00 011 1124010 BUN 84520 55.00 011 1124013 URIC ACID 84550 37.00 011 1124014 CHOLESTEROL, SERUM TOTAL 82465 37.00 011
1124015 UREA CLEARANCE 84545 37.00 011 1124016 CREATININE CLEAR 24 HR 82575 95.00 011 1124017 CARBON DIOXIDE 82374 55.00 011 1124018 CREATINE KINASE CPK 82550 99.00 011 1124019 FIBRINOGEN ACTIVITY 85384 71.00 011 1124021 GLUC TOL 3 TEST 82951 122.00 011 1124022 LDH 83615 37.00 011 1124023 POTASSIUM,SERUM 84132 55.00 011 1124024 PT/PROTHROMBIN TIME 85610 37.00 011 1124025 THROMBOPLASTIN TIME-PTT 85730 63.00 011 1124027 COMPREHENSIVE METABOLIC 80053 288.00 011 1124028 SODIUM NA SERUM 84295 55.00 011 1124029 AST/SGOT 84450 37.00 011 1124030 CALCIUM, TOTAL 82310 37.00 011 1124031 ALT/SGPT 84460 37.00 011 1124032 PROTEIN TOTAL 84155 37.00 011 1124033 PROTEIN, TOTAL, URINE 84156 40.00 011 1124034 CHLORIDE, BLOOD 82435 55.00 011 1124035 CALCIUM, IONIZED 82330 107.00 011 1124036 REPTILASE TIME 85635 35.00 011 1124037 RVVT-VIPER VENOM DILUTE 85613 35.00 011 1124038 PLATELET NEUTROLIZATION 85597 106.00 011 1124039 GLUCOSE POST GLUCOSE DOS 82950 44.00 011 1124040 PHOSPHORUS,INORGANIC 84100 55.00 011 1124041 PLATELET AGGREGATION 85576 112.00 011 1124042 ALBUMIN SERUM 82040 55.00 011 1124043 BASIC METABOLIC PANEL 80048 173.00 011 1124046 ASSAY NEPHELOMETRY NOT SP 83883 76.00 011 1124047 T4, FREE 84439 50.00 011 1124048 RENAL FUNCTION PANEL 80069 109.00 011 1124049 ELECTROLYTE PANEL 80051 56.00 011 1124050 MYCOPLASMA IgM AB 86738 84.00 011 1124051 PROTEIN BODY FLUID 84157 23.00 011 1124075 HEPATITIS PANEL 80074 84.00 011 1124115 HEPATITIS B SURF ANTIBODY 86706 76.00 011 1124116 HEPATITIS B CORE ANTIBODY 86704 115.00 011 1124117 HEPATITIS B ANTIBODY 86707 76.00 011 1124118 IGM ANTIBODY 86709 88.00 011 1124119 HEPATITIS A ANTIBODY 86708 173.00 011 1124212 FACTOR X 85260 29.00 011 1125000 ASO SCREEN 86063 94.00 011 1125001 FROZEN SECTION 88331 92.00 011 1125002 C-REACTIVE PROTEIN 86140 63.00 011 1125003 PATH SURGICAL LEVEL III 88304 148.00 011 1125004 PATH SURGICAL LEVEL I 88300 104.00 011 1125005 RHEUMATOID FACTOR, QUAL 86430 59.00 011 1125006 C-REACT PROTEIN SENSITIV 86141 82.00 011 1125011 PATH SURGICAL LEVEL II 88302 104.00 011 1125015 PATH SURGICAL LEVEL IV 88305 74.00 011 1125016 PATH SURGICAL LEVEL V 88307 156.00 011 1125018 PATH CONSULT ADD'L TISSU 88332 65.00 011 1125020 SPECIAL STAIN GROUP 1 88312 104.00 011
1125021 GROUP II ALL OTHER 88313 104.00 011 1125029 DECALCIFICATION PROCEDUR 88311 87.00 011 1125033 UNLISTED SURGICAL PATH 88399 219.00 011 1125034 IMMUNOPEROXIDASE 88342 226.00 011 1125035 PATH SURGICAL LEVEL VI 88309 236.00 011 1125036 IMMUNO HISTO/HEM/CYTO AB 88341 150.00 011 1125060 BLOOD SMEAR PERIPH INTER 85060 63.00 011 1125097 BONE MARROW SMEAR 85097 153.00 011 1126001 IMMUNOGLOBINS IgG IgA IgM 82784 92.00 011 1126002 IMMUNOFIXATION ELECTROPH 86334 173.00 011 1126003 BILIRUBIN FECES 82252 42.00 011 1126004 FERRITIN 82728 140.00 011 1126005 CORTISOL TOTAL SERUM 82533 86.00 011 1126007 OCCULT BLOOD FECES 82270 49.00 011 1126008 OVA PARASITES 87177 80.00 011 1126009 URINALYSIS AUTOMATED 81001 30.00 011 1126010 BLOOD OCCULT OTHER SOURC 82271 28.00 011 1126011 SEMEN ANALYSIS PRESENCE 89300 109.00 011 1126012 ASO TITER 86060 94.00 011 1126013 GAMMAGLOBULIN IgE 82785 92.00 011 1126014 GONADOTROP,CHOR QUALITAT 84703 80.00 011 1126015 QUINIDINE 80194 94.00 011 1126016 CARBAMAZEPINE TOTAL ASSAY 80156 94.00 011 1126017 PRIMIDONE 80188 107.00 011 1126018 VALPROIC ACID/DEPAKENE 80164 145.00 011 1126019 UROBILINOGEN FECES QUANT 84577 115.00 011 1126020 AMIKACIN 80150 118.00 011 1126021 FAT/LIPID FECES QUANT 82710 111.00 011 1126022 FAT STAIN FECES,URINE,OR 89125 65.00 011 1126023 ABSOLUTE CD4&CD8 COUNT 86360 299.00 011 1126024 TOBRAMYCIN 80200 124.00 011 1126025 GENTAMICIN 80170 126.00 011 1126026 PROCAINAMIDE/NAPA/PRONE 80192 126.00 011 1126027 PROCAINAMIDE QUANT ASSAY 80190 136.00 011 1126028 VANCOMYCIN PEAK/TROUGH 80202 145.00 011 1126029 CD4 ABSOLUTE COUNT 86361 164.00 011 1126030 STOOL - OCCULT BLOOD ONLY 82272 23.00 011 1126031 EVEROLIMBUS 80169 134.00 011 1126070 Lamotrigine 64.00 011 1126078 BLD BANK TRNS INV 86078 65.00 011 1126079 BLD BANK DEV STDY 86079 65.00 011 1126102 UREA NITROGEN URINE 84540 26.00 011 1126103 URIC ACID OTHER SOURCE 84560 26.00 011 1126104 CREATININE OTHER SOURCE 82570 28.00 011 1126105 POTASSIUM,URINE 84133 25.00 011 1126106 SODIUM/NA URINE 84300 27.00 011 1126107 CALCIUM,URINE QUANT TIME 82340 37.00 011 1126108 CHLORIDE/CL URINE 82436 27.00 011 1126109 ALBUMIN URINE QUANT 82042 37.00 011 1126110 GONADOTROPIN, FSH 83001 181.00 011 1126111 IMMUNOELECTRO OTHER FLUR 86325 145.00 011 1126112 PHENOBARBITAL 80184 60.00 011
1126115 CYCLOSPORINE 80158 202.00 011 1126117 ETHOSUXIMIDE 80168 115.00 011 1126119 LIDOCAINE 80176 122.00 011 1126120 SODIUM, OTHER SOURCE 84302 32.00 011 1126122 URINE MICROALBUMIN QUANT 82043 40.00 011 1126123 ALPHA-1-FETOPROTEIN SERU 82105 88.00 011 1126124 ALPHA-1-FETOPROTEIN AMN 82106 109.00 011 1126125 CAROTENE 82380 78.00 011 1126126 CERULOPLASMIN 82390 71.00 011 1126127 COPPER SERUM 82525 107.00 011 1126128 CHEMILUMINESCENT ASSAY 82397 91.00 011 1126129 IMMUNOASSAY FOR TUMOR AN 86316 142.00 011 1126131 ACTH/ADRENOCORTICOTROPIC 82024 247.00 011 1126132 OSMOLALITY SERUM 83930 78.00 011 1126133 OSMOLALITY URINE 83935 53.00 011 1126135 GROWTH HORMONE/HGH/SOMAT 83003 109.00 011 1126136 INSULIN 83525 74.00 011 1126137 INSULIN ANTIBODIES 86337 138.00 011 1126138 TELOPEP COLLAGEN X-LINKS 82523 115.00 011 1126139 LEVETIRACETAM 80177 113.00 011 1126142 ALPHA-1-ANTITRYPSIN 82103 104.00 011 1126144 ALLERGEN SPECIFIC 86003 109.00 011 1126145 CRYOGLOBULIN 82595 170.00 011 1126152 COMPLEMENT TOTAL/CH50 86162 152.00 011 1126153 IMMUNODIFFUSION, NEC 86329 91.00 011 1126155 CHROMATOGRAPHY, QUAL NEC 82486 136.00 011 1126156 ANG CON ENZYME/ACE 82164 76.00 011 1126157 ARSENIC 82175 186.00 011 1126158 ASCORBIC ACID/VITAMIN C 82180 82.00 011 1126159 AMMONIA 82140 114.00 011 1126160 CLOT INHIB ANTITHROM III 85300 78.00 011 1126161 FACTOR XII (FIBRIN STABI) 85291 58.00 011 1126165 ACETYLCHOLINESTERASE 82013 59.00 011 1126166 ADENOSINE,5-MONOPHOS 82030 166.00 011 1126167 ALDOLASE 82085 63.00 011 1126168 ALDOSTERONE 82088 360.00 011 1126170 CALCITONIN 82308 152.00 011 1126171 CARBON MONOXIDE QUANT 82375 91.00 011 1126172 CHOLINESTERASE SERUM 82480 53.00 011 1126174 CREATINE 82540 56.00 011 1126175 CYANIDE 82600 182.00 011 1126176 DHEA/DEHYDROEPIARDROSTER 82626 242.00 011 1126177 DHEA-S DEHYDROEPIANDROST 82627 176.00 011 1126178 DIBUCAINE NUMBER 82638 118.00 011 1126179 ERYTHROPOIETIN 82668 113.00 011 1126181 ETHYLENE GLYCOL 82693 155.00 011 1126183 GALACTOSE 82760 73.00 011 1126185 GLUTATHIONE 82978 91.00 011 1126186 HAPTOGLOBIN QUANT 83010 96.00 011 1126187 HEAVY METAL SCREEN 83015 121.00 011 1126188 INTRINSIC FACTOR ANTIB S 83528 115.00 011 1126189 LACTATE/LACTIC ACID 83605 84.00 011
1126191 MERCURY,QUANTITATIVE 83825 106.00 011 1126194 IMMUNOASSAY QUANT NOS 83520 460.00 011 1126195 PH BODY FLUID 83986 33.00 011 1126196 NATRURETIC PEPTIDE 83880 259.00 011 1126197 PCP PHENCYCLIDINE 83992 119.00 011 1126198 PHENYLALANINE,PKU,BLOOD 84030 37.00 011 1126199 PHOSPHATIDYLGLYCEROL 84081 122.00 011 1126200 PYRUVATE 84210 126.00 011 1126201 PYRUATE KINASE 84220 147.00 011 1126202 RENIN 84244 170.00 011 1126203 SEROTONIN 84260 243.00 011 1126204 THIAMINE/VITAMIN B-1 84425 150.00 011 1126205 TOCOPHERAL ALPHA/VITAMIN 84446 115.00 011 1126206 TYROSINE 84510 67.00 011 1126207 VITAMIN A 84590 133.00 011 1126208 VITAMIN K 84597 104.00 011 1126209 FACTOR VIII,VW FACTOR 85245 119.00 011 1126210 FACTOR IX,PTC OR CHRISTM 85250 122.00 011 1126211 AGGLUTININS,FEBRILE 86000 46.00 011 1126212 FACTOR VIII 85240 29.00 011 1126213 HEPARIN ASSAY 85520 76.00 011 1126214 CARDIOLIPIN ANTIBODY 86147 157.00 011 1126215 HEMMAGGLUTINATION INHIB 86280 55.00 011 1126216 MYELIN BASIC PROTEIN 83873 132.00 011 1126217 CA 125 86304 109.00 011 1126218 OLIGOCLONAL BANDS 83916 145.00 011 1126219 CHROMO ANALYSIS, 2 KARYO 88262 789.00 011 1126220 MANGANESE 83785 176.00 011 1126221 GENERAL HEALTH PANEL 80050 188.00 011 1126222 TROPONIN QUANTITATIVE 84484 68.00 011 1126223 ALUMINUM 82108 161.00 011 1126224 CHROMATOGRAPH COLUMN SIN 82491 117.00 011 1126225 THYROGLOBULIN 84432 104.00 011 1126226 NUCLEOTIDASE-5 83915 87.00 011 1126227 COLUMN CHROMATO QUANT 82542 127.00 011 1126228 METANEPHRINES 83835 111.00 011 1126229 ENA ANTIBODY PANEL 86235 140.00 011 1126230 CA19-9 IMMUNOASSAY TUMOR 86301 133.00 011 1126231 IMMUNOASSAY FOR TUMOR 86300 133.00 011 1126232 JANUS KINASE 2 (JAK2) 81270 2,120.00 011 1126233 FACTOR VII 85230 29.00 011 1126234 FACTOR V 85220 29.00 011 1126235 FACTOR II ASSAY CLOTTING 85210 29.00 011 1126236 THYROID STIMULATING IMMUN 84445 310.00 011 1126237 OXCARBAZEPINE 80183 80.00 011 1126239 PHOSPHATIDYLSERINE ANTIB 86148 35.00 011 1126240 VITAMIN B3 NIACIN PLASMA 84591 66.00 011 1126268 FACTOR V LEIDIN PCK 81241 356.00 011 1126269 PROTHROMBIN MUTATION 81240 209.00 011 1126792 AMITRIPYLINE 80335 29.00 011 1127002 IRON/FE 83540 52.00 011 1127003 LIPASE 83690 84.00 011
1127004 LIPOPROTEIN (A) 83695 95.00 011 1127006 IRON BINDING CAPACITY 83550 144.00 011 1127008 TRIGLYCERIDES 84478 43.00 011 1127009 T3 % UPTAKE 84479 55.00 011 1127010 THYROXINE, TOTAL 84436 88.00 011 1127011 ANTINUCLEAR ANTIBODIES 86038 115.00 011 1127013 ANTIBODY, VIRUS NOT SPEC 86790 99.00 011 1127014 OTHER DRUG SCREEN 80299 107.00 011 1127015 CATECHOLAMINE URINE 82382 112.00 011 1127016 GONADOTROPINE, CHORIONIC 84702 96.00 011 1127017 5 HIAA URINE 83497 175.00 011 1127018 KETOSTEROIDS, 17 TOTAL 83586 159.00 011 1127019 VMA, URINE 84585 99.00 011 1127020 C-PEPTIDE 84681 159.00 011 1127021 CALCULUS,QUALATATIVE ANA 82355 118.00 011 1127022 HOMOCYSTINE 83090 216.00 011 1127023 CREATININE BLOOD 82565 35.00 011 1127024 DNA AMPLIFIED PROBE TECH 87798 268.00 011 1127025 DIGOXIN LEVEL 80162 190.00 011 1127026 CYTOPATHOLOGY SMEAR OTHE 88160 99.00 011 1127027 CYTOPATHOLOGY CONCEN TEC 88108 174.00 011 1127028 CULTURE FUNGI OTHER SOUR 87102 56.00 011 1127029 TISSUE EXAM FOR FUNGI 87220 32.00 011 1127030 TISSUE CULTURE INOCULTAT 87252 167.00 011 1127031 CATECHOLAMINES FRACTION 82384 182.00 011 1127032 KETOSTEROIDS,17,FRACTION 83593 198.00 011 1127033 ESTROGENS TOTAL 82672 161.00 011 1127034 ESTROGENS FRACTIONATED U 82671 227.00 011 1127035 HEMOSIDERIN; QUALITATIVE 83070 40.00 011 1127036 URINALYSIS, NON-AUTOMATE 81002 40.00 011 1127037 PORPHOBILINOGEN URI QUAL 84106 42.00 011 1127038 PORPHOBILIROGEN URI QUAN 84110 63.00 011 1127039 PORPHYRINS URINE QUAL 84119 57.00 011 1127040 PORPHYRINS URINE QUANT/F 84120 132.00 011 1127041 CYSTINE URINE QUALITATIV 82615 87.00 011 1127042 SPECIFIC GRAVITY NOT URI 84315 19.00 011 1127043 COLD AGGLUTININS 86156 44.00 011 1127044 IMMUNOGLOBULIN 82787 63.00 011 1127045 MYOGLOBIN 83874 67.00 011 1127046 EPSTEIN-BARR VIRUS 86663 128.00 011 1127047 EBV/EPST BARR VIRUS VCA 86665 118.00 011 1127048 LYME DISEASE 86618 89.00 011 1127049 HEPATITIS C ANTIBODY 86803 112.00 011 1127050 LEGIONELLA PHEUMOPHILA 87278 63.00 011 1127051 LACTOSE URINE QUAL 83633 80.00 011 1127053 OXALATE 83945 84.00 011 1127054 VIT D2+D3 25 HYDROXY TOTA 82306 189.00 011 1127055 STREPTOCOCCUS GRA ANTIGE 87650 104.00 011 1127056 LYME-BORRELIA BURG PCR 87476 222.00 011 1127057 IMMUNOASSY ANALYTE GUANT 83519 88.00 011 1127058 URINALYSIS AUTO W/O MIC 81003 20.00 011 1127059 CYTOMEGALOVIRUS AMPLIF 87496 222.00 011
1127060 HEMOGLOB GLYCOSYLATE A1C 83036 63.00 011 1127061 TISSUE TYPING HLA,A,B,C 86812 166.00 011 1127062 CYTOMEGALOVIRUS QUANTIT 87497 218.00 011 1127063 HEPATITIS B SURF ANTIGEN 87340 101.00 011 1127064 INF ANTI INFLUENZA B VIR 87275 95.00 011 1127065 INF ANTI INFLUENZA A VIR 87276 95.00 011 1127066 OSTEOCALCIN 83937 241.00 011 1127067 FATTY ACIDS 82725 109.00 011 1127068 TISSUE TYPING QUICK METH 86808 241.00 011 1127069 VOLUME MEASURE TIMED 81050 32.00 011 1127070 HEPATITIS B ANTIGEN 87350 76.00 011 1127071 GIARDIA LAMBLIA 86674 119.00 011 1127072 CRYPTOSPORIDIUM/GIARDIA 87328 95.00 011 1127073 HEPATITIS C ANTIGEN 87522 218.00 011 1127074 HEPATITIS C DIRECT PRO 87520 157.00 011 1127075 CRYPTOCOCCAL Ag SERUM 87327 95.00 011 1127076 LEUKEMIA LYMPHOMA PHENOT 87903 2,471.00 011 1127077 FREE T3 84481 140.00 011 1127078 ANA TITER 86039 106.00 011 1127079 INFLUENZA A OR B EACH 87400 80.00 011 1127080 HELICOBACTER PYLORI 86677 104.00 011 1127081 TOPRIAMATE DRUG ASSAY 80201 80.00 011 1127082 SHIGA TOXIN 87427 65.00 011 1127084 ANTIBODY CAMPYLOBACTER 86625 73.00 011 1127085 HEP C AB TEST CONFIRM 86804 336.00 011 1127086 HIV-I QUANT RNA VIRAL 87536 518.00 011 1127089 HIV GENOTYPING 87906 2,241.00 011 1127090 AEROBIC ISOLATIE ADD METH 87077 52.00 011 1127091 HCG QUALITATIVE URINE 81025 38.00 011 1127092 TOXOPLASMA IGM ANTIBODY 86778 57.00 011 1127093 LEGIONELLA AG URINE 87449 82.00 011 1127100 VITAMIN B12 82607 118.00 011 1127101 FOLIC ACID SERUM 82746 211.00 011 1127102 CARCINOEMBRYONIC ANTIGEN 82378 97.00 011 1127103 CPK ISOENZYMES 82552 88.00 011 1127104 LEAD 83655 133.00 011 1127105 LIPID PANEL 80061 43.00 011 1127107 CARNITINE FREE TOTAL PLAS 82379 91.00 011 1127108 MICROSOMAL ANTIBODIES 86376 76.00 011 1127109 THYROGLOBULIN ANTIBODY 86800 102.00 011 1127110 PARTICLE AGGLUTIN SCREEN 86403 67.00 011 1127111 PHENYTOIN, TOTAL 80185 190.00 011 1127114 G-6-PD 82955 63.00 011 1127116 HGB ELECTROPHOR 83020 84.00 011 1127117 FECA WBC W LACTOFERRIN 83630 107.00 011 1127118 LDH ISOENZYMES 83625 84.00 011 1127119 LH LUTEINIZING HORMONE 83002 120.00 011 1127120 DEOXYRIBONUCLEIC ACID 86225 89.00 011 1127122 LIPOPROTEIN ELECT 83700 140.00 011 1127123 LITHIUM LEVEL 80178 72.00 011 1127124 MAGNESIUM 83735 92.00 011 1127125 PROLACTIN 84146 150.00 011
1127126 PROTEIN ELECTROPHORESIS 84165 149.00 011 1127128 WESTERN BLOT TEST 84181 112.00 011 1127129 THEOPHYLLINE LEVEL 80198 209.00 011 1127130 ASSAY OF SIROLIMUS 80195 82.00 011 1127132 ZINC 84630 153.00 011 1127134 VOLATILES 84600 118.00 011 1127136 LEUK/ALK/PHOS 85540 46.00 011 1127138 IMMUNOELECTROPHORESIS SE 86320 145.00 011 1127139 LDH,DIRECT MEASUREMENT 83721 68.00 011 1127140 MB FRACTION ONLY 82553 138.00 011 1127142 PREALBUMIN 84134 114.00 011 1127143 RH PHENOTYPING 86906 80.00 011 1127144 GAMMA GLUTAMYL TRANSFERA 82977 81.00 011 1127145 GASTRIN 82941 114.00 011 1127146 GLUCOSE BODY FLUID 82945 22.00 011 1127147 CONCEN FOR PARA&OVA AFB 87015 52.00 011 1127160 HIV-1 86701 71.00 011 1127161 HTLV OR HIV CONFIRM TEST 86689 232.00 011 1127163 PSA/PROSTATE SPECIFIC AN 84153 95.00 011 1127164 PROSTATE SPECIFIC AG FRE 84154 120.00 011 1127165 GLUCOSE BLOOD REAG STRIP 82948 44.00 011 1127167 FIBRIN DEGRAD D-DIMER QU 85379 112.00 011 1127168 DRUG SCREEN MULTI CLASS G0431 252.00 011 1128011 PROCALCITONIN PCT 84145 157.00 011 1128012 PROGESTERONE 84144 134.00 011 1128013 SOMATOSTATIN 84305 136.00 011 1128014 HEPATIC FUNCTION PANEL 80076 96.00 011 1128104 CYTOPATHOLOGY,FLUID,WASH 88104 65.00 011 1128125 CYTOPATHOLOGY FORENSIC 88125 37.00 011 1128155 CYTO-GYN HORM EVL 88155 41.00 011 1128172 EVAL FINE NEEDLE APSIRAT 88172 155.00 011 1128173 CYTOPATHOLOGY CELL SLIDE 88112 226.00 011 1128245 NECROPSY WITH BRAIN 88025 26.00 011 1128346 IMMUNOFLUORESC ST 88346 276.00 011 1128401 IRON STAIN BM IRON STAIN 85536 43.00 011 1128407 PREPARATION,SCREEN & INT 88161 149.00 011 1128408 CYTOLOGY PAP SMEAR 88150 89.00 011 1128409 PROGESTERONE REC ASSAY 84234 412.00 011 1128500 CATECHOLAMINES BLOOD 82383 159.00 011 1128503 PHENYTOIN, FREE 80186 175.00 011 1128504 BILLIRUBIN, DIRECT 82248 35.00 011 1128505 BILIRUBIN, TOTAL 82247 27.00 011 1128506 BETA-2 MICROGLOBULIN 82232 63.00 011 1129011 ANTIBODY CYTOMEGALOVIRUS 86644 76.00 011 1129012 FLUORESCENT ANTI SCREEN 86255 115.00 011 1129013 CRYPTOCOCCUS 86641 92.00 011 1129014 PARATHORMONE 83970 360.00 011 1129015 PLATELET ANTIBODIES 86022 342.00 011 1129016 VITAMIN D, 25 HYDROXY 82652 294.00 011 1129017 T3-TRIIODOTHYRONINE 84480 74.00 011 1129018 THYROID STIMULATING HORM 84443 128.00 011 1129019 PHOSPHOROUS, URINE 84105 28.00 011
1129020 TRANSFERRIN 84466 67.00 011 1129021 HEMOLYSINS & AGGLUTININS 86940 55.00 011 1129022 THYROXINE BIND GLOBULIN 84442 121.00 011 1129023 PROTEIN C FUNCTION ASSAY 85303 90.00 011 1129024 AMINO ACIDS,QUANT HOMOCY 82131 111.00 011 1129025 COMPLEMENT ANTIGEN C3 86160 63.00 011 1129026 TACROLIMUS, FK506 80197 72.00 011 1129028 ACTH STIMULATION PANEL 80400 157.00 011 1129029 GLUTAMATE DEHYDROGENASE 82965 52.00 011 1129030 GEL DIFFUSION (TEICHOIC) 86331 80.00 011 1129031 GLYCATED PROTEIN 82985 96.00 011 1129032 TESTOSTERONE, TOTAL 84403 198.00 011 1129034 SICKLING OF RBC,REDUCTIO 85660 37.00 011 1129035 HERPES SIMPLEX TYPE I 86695 87.00 011 1129036 TESTOSTERONE, FREE 84402 161.00 011 1129037 PLATELET AB DIRECT IGG 86023 178.00 011 1129046 ANTI-MITOCHRONDRIAL ANTIB 86256 83.00 011 1129049 GLUCOSE 6-PHOS DEHYDRO 82960 23.00 011 1129050 THROMBIN TIME PLASMA 85670 28.00 011 1129905 RETICULO W/IRF-CELL HGB 85046 35.00 011 1129906 HIV 1&2 AB EIA 87389 143.00 011 1129907 PROTEIN FRAC/QUANT URINE 84166 106.00 011 1129908 PROTEIN S FUNCTION ASSAY 85306 59.00 011 1129909 PROTEIN C AG ASSAY 85302 41.00 011 1129990 ESTROGEN RECEPTOR ASSAY 84233 410.00 011 1129999 VENIPUNCTURE G0001 19.00 011
Speech Therapy 2090000 ST AUDIOMETRY 92553 197.00 020 2090121 ST EVAL OR/FIT VOICE DEVICE 92597 299.00 020 2091000 ST TREATMENT GROUP 92508 288.00 020 2091001 ST TREATMENT INDIVIDUAL 92507 710.00 020 2091002 ST SWALLOWING DYSF TREAT 92526 496.00 020 2091003 ST COG SKILLS DEVELO 15MIN 97532 90.00 020 2091004 ST APHASIA ASSESS PER HR 96105 352.00 020 2091007 ST SWALLOW EVALUATION 92610 1,027.00 020 2091008 ST TYMPANOMETRY 92567 136.00 020 2091010 ST MBS EVAL 92611 1,891.00 020 2091011 ST FEES 92612 655.00 020 2091012 ST EVAL LANG COMPREHENSION 92523 947.00 020 2091013 ST EVAL SPEECH PRODUCTION 92522 947.00 020 2091014 ST EVAL SPEECH FLUENCY 92521 947.00 020 2091015 ST BEHAVORAL&QUALT ANAYLSIS 92524 947.00 020 2091017 ST STAND COGNITIVE TESTING 96125 465.00 020
Respiratory Therapy 2160004 CONT OXYGEN DAILY 67.00 021 2160006 DIFFUSION CAPACITY 94729 136.00 021 2160007 GAS DILUTION FOR LUNG VOL 94727 253.00 021 2160008 SPIROMETRY 267.00 021 2160009 AEROSOL TREATMENT INITIA 94664 101.00 021 2160011 CPT CHEST PHYSIO THERAPY 94667 67.00 021
2160012 CULTURE RESP INDUCTION 94640 102.00 021 2160014 INCEN SPIRO SETUP 67.00 021 2160015 INCEN SPIRO TREAT 41.00 021 2160018 C P R 92950 1,766.00 021 2160019 CARDIOVERSION ELECTIVE 92960 1,261.00 021 2160025 ARTERIAL BLOOD DRAW 36600 118.00 021 2160026 VENT INITIAL 94002 204.00 021 2160027 VENTILATOR DAILY 94003 244.00 021 2160028 REMOVAL OF TUNNEL CVP 36589 3,587.00 021 2160030 AEROSOL SUBSEQUENT 94640 81.00 021 2160031 AEROSOL INHL PENTAMIDINE 94642 271.00 021 2160101 BRONCHODILATION RESP SPIR 94060 562.00 021 2161002 CPAP 94660 161.00 021 2161004 MDI INITIAL 94664 68.00 021 2161006 OXIMETRY SINGLE DETERMIN 94760 72.00 021 2161007 OXIMETRY MULTI EXERCISE 94761 217.00 021 2161008 OXIMETRY CONTIN NIGHT 94762 375.00 021 2161012 TRACHEOSTOMY TUBE CHANGE 31502 80.00 021 2161015 SUCTIONING EACH 94799 80.00 021 2161017 METERED DOSE INHALER SUB 94640 51.00 021 2169906 VITAL CAPACITY TOTAL 94150 99.00 021 2169996 SUBSEQUENT CPT CHST THER 94668 43.00 021
Occupational Therapy 2270000 OT SELF CARE HOME MGT 15 M 97535 129.00 022 2270001 OT EVAL MOD COMPLEXITY 97166 539.00 022 2270002 OT EVAL HIGH COMPLEXITY 97167 598.00 022 2270004 OT ECONOMY BATH SP. ROUND 99070 11.00 022 2270005 OT STAINLESS S/P GUARD LG 99070 26.00 022 2270006 OT CHECKOUT ORTHO USE 15MIN 97762 92.00 022 2270007 OT EVALUATION LOW COMPLE 97165 479.00 022 2270008 OT REEVALUATION 97168 194.00 022 2270009 OT COMM/WORK REINTEG 15MIN 97537 133.00 022 2270010 OT THER ACTIVITIES 15 MINS 97530 182.00 022 2270011 OT THERAPEUTIC PROC GROUP 97150 80.00 022 2270012 OT THER EX/PROCEDURE/CPM 97110 179.00 022 2270013 OT ORTHOTIC FIT/TRAIN 15MIN 97760 193.00 022 2270014 OT SENSORY INTEG TECHNIQUE 97533 109.00 022 2270015 OT MANUAL THERAPY TECHNIQUE 97140 111.00 022 2270016 OT APP MODALITY E-SIM 97032 71.00 022 2270017 OT PARAFFIN BATH 97018 40.00 022 2270018 OT APP MODALITY 1 OR> AREAS 97010 76.00 022 2270019 OT ULTRASOUND EACH 15 MINUTE 97035 60.00 022 2270020 OT PROSTHETIC TRAINING 97761 113.00 022 2271003 OT COGNITIVE SKILL DEV 15MI 97532 80.00 022
Physical Therapy 2370001 PT PT RE-EVALUATION EXAM POC 97164 160.00 023 2370002 PT PT INIT. EVAL LOW COMPLE 97161 436.00 023 2370003 PT IONTOPHORESIS 15 MIN 97033 160.00 023 2370004 PT PROSTHETIC TRAIN 15 MIN 97761 113.00 023 2370005 PT ORTHOTIC TRAIN 15 MIN 97760 89.00 023
2370006 PT WHEELCHAIR MGMT 15 MIN 97542 90.00 023 2370007 PT NEUROMUSCULAR REED 15MIN 97112 112.00 023 2370008 PT FUNCT ACTIVITY EA 15 MIN 97530 161.00 023 2370009 PT THER. EX/PROCEDURE/CPM 97110 179.00 023 2370010 PT APPLIC OF SURFACE NEURO 64550 50.00 023 2370011 PT THERAPEUTIC PROC'S GROUP 97150 38.00 023 2370012 PT PT EVAL MOD COMPLEXITY 97162 496.00 023 2370013 PT PT EVAL HIGH COMPLEXITY 97163 556.00 023 2370018 PT HOT/COLD PACKS 97010 76.00 023 2370027 PT GAIT TRAINING 15 MIN 97116 107.00 023 2370031 PT ULTRASOUND 15 MIN 97035 60.00 023 2370032 PT CKOUT ORTHO PROST USE 97762 92.00 023 2370033 PT TRACTION MECHANICAL 97012 60.00 023 2370034 PT APP MODALITY E-STIM 97032 71.00 023 2370035 PT MASSAGE 97124 95.00 023 2370036 PT MANUAL THERAPY TECHNIQUE 97140 111.00 023
General Anesthesia 3050002 GEN ANES 1-60 MIN 533.00 030 3050003 GEN ANES 61-90 MIN 801.00 030 3050004 GEN ANES 91-120 MIN 1,065.00 030 3050005 GEN ANES 121-150 MIN 1,332.00 030 3050006 GEN ANES 151-180 MIN 1,597.00 030 3050007 GEN ANES 181-210 MIN 1,862.00 030 3050008 GEN ANES 211-240 MIN 2,127.00 030 3050009 REG ANES 1-60 MIN 533.00 030 3050010 REG ANES 61-90 MIN 801.00 030 3050011 REG ANES 91-120 MIN 1,065.00 030 3050012 REG ANES 121-150 MIN 1,332.00 030 3050013 REG ANES 151-180 MIN 1,597.00 030 3050014 REG ANES 181-210 MIN 1,862.00 030 3050015 REG ANES 211-240 MIN 2,127.00 030 3050016 MAC 1-60 MIN 458.00 030 3050017 MAC 61-90 MIN 686.00 030 3050021 MAC 91-120 MIN 915.00 030 3050022 MAC 121-150 MIN 1,142.00 030 3050023 MAC 151-180 MIN 1,370.00 030 3050024 GEN ANES 241-270 MIN 2,396.00 030
Surgery 3102068 MAJ SURG 1-60 MIN 2,371.00 031 3102069 MAJ SURG 61-90 MIN 2,372.00 031 3102070 MAJ SURG 91-120 MIN 3,951.00 031 3102071 MAJ SURG 121-150 MIN 3,951.00 031 3102072 MAJ SURG 151-180 MIN 5,926.00 031 3102073 MAJ SURG 181-210 MIN 6,911.00 031 3102074 MAJ SURG 211-240 MIN 7,899.00 031 3102075 CARDIAC MONITOR 132.00 031 3102077 PULSE OXIMETER 86.00 031 3102082 MINOR OR 1-60 MIN 1,915.00 031 3102083 MINOR OR 61-90 MIN 2,135.00 031 3102084 MINOR OR 91-120 MIN 3,554.00 031
3102085 MINOR OR 121-150 MIN 3,555.00 031 3102168 MAJ SURG 241-270 MIN 8,885.00 031 3102169 MINOR OR 151-180 MIN 5,331.00 031 3102515 AV FISTULA DIAG ANGIO 36901 1,380.00 031 3102516 BP MONITOR 76.00 031 3102517 GI BEDSIDE SERVICE 1,315.00 031 3102518 GRAFT JACKET 4x4 PROCEDUR 5,907.00 031 3102519 GRAFT JACKET 4x8 PROCEDUR 11,403.00 031 3102520 CT FINE NEEDLE ASPIR WGUI 10022 556.00 031 3102521 THORACENTESIS NEED OR CAT 32555 2,090.00 031 3102522 THROMBECTOMY PERCUTANEOUS 36870 5,184.00 031 3102524 INSERTION OF PICC 36569 2,693.00 031 3102525 PULMONARY BY-PASS 33915 2,759.00 031 3102526 NM LUNG VENT&PERFU IMAGE 78582 2,297.00 031 3102527 CT TUBE THORACOSTOMY 32551 855.00 031 3102528 CT THORACENT TUBE INSERT 32557 1,581.00 031 3102529 INSERT INTRAVAS VC FILTER 37191 4,269.00 031 3102530 COLONOSCOPY TUMOR REMOVAL 45385 1,294.00 031 3102531 Debridement BEDSIDE 15936 1,493.00 031 3102532 VASC SURGERY UNLIST PROC 37799 1,668.00 031 3102533 INSERT CANNULA HEMODIAL 36800 7,607.00 031 3102534 CCVI AV FISTULA DECLOT D 36904 9,200.00 031 3102535 CCVI PLASTY ONLY CENTRAL 36907 6,900.00 031 3105067 EGD DIAG W/BRUSHING 43235 2,061.00 031 3105068 EGD W/DIRECTED PEG PLMT 43246 2,240.00 031 3105069 EGD W/REMOVL FOREIGN BODY 43247 2,803.00 031 3105070 EGD W/BAND LIGATION 43244 2,274.00 031 3105071 ENDOSCOPY UPPER GI EXAM 1,030.00 031 3105072 COLONOSCOPY DIAG/BRUSH 45378 2,747.00 031 3105073 EGD W/BIOP SINGLE/MULTI 43239 2,680.00 031 3105074 PERC BIL DRAIN CATH CHANG 47525 893.00 031 3105075 EGD W/CONTRL BLD ANY METH 43255 1,159.00 031 3105076 COLONOSOCPY W/BIOPSY 45380 2,938.00 031 3105077 LAPAROSCOPY URETER LITHO 50945 572.00 031 3105078 BRONCHOSCOPY W CELL WASH 31622 1,424.00 031 3105079 BRONCHOSCOPY W BRUSHING 31623 1,682.00 031 3105080 BRONCHOSCOPY W ALV LAVAGE 31624 1,941.00 031 3105081 VENA CAVA FILTER C1880 3,882.00 031 3105082 EGD W DILATA OF ESOPHAGUS 43214 991.00 031 3105083 EGD W DILATATION 43245 1,085.00 031 3105084 PLC CATH ABD INIT 2ND 2,165.00 031 3105085 VI REVASC FEM/POP UNILAT 7,837.00 031 3105086 VI REVASC TIB/PERO UNILAT 7,837.00 031
Recovery 3260002 RECOV RM 1-60 MIN 586.00 032 3260003 RECOV RM 61-90 MIN 872.00 032 3260004 RECOV RM 90-120 MIN 1,162.00 032 3260005 RECOV RM 121-150 MIN 1,454.00 032 3260006 RECOV RM 151-180 MIN 1,742.00 032 3260007 RECOV RM 181-210 MIN 2,033.00 032 3260008 RECOV RM 211-240 MIN 2,326.00 032
3260009 CARDIAC MONITOR (RR) 112.00 032 3260010 BP MONITOR (RR) 63.00 032 3260011 PULSE OXIMETER (RR) 72.00 032
Radiology 3720005 XR ABD COMP INCLUDE DECUB 74020 229.00 040 4010001 XR ABD SINGLE AP VIEW KUB 74000 187.00 040 4010002 XR ABD COMP INCLUDE DECUB 74020 229.00 040 4010003 XR AC JOINTS, BIL W/WO WEIG 73050 197.00 040 4010004 XR ANKLE COMP MIN 3V 73610 143.00 040 4010005 XR HUMORUS MIN 2V 73060 199.00 040 4010006 XR COLON BARIUM ENEMA 74270 326.00 040 4010007 XR BARIUM ENEMA W/AIR CONT 74280 511.00 040 4010010 XR CALCANEUS MIN 2V 73650 119.00 040 4010011 XR CHEST 2V FRONT & LAT 71020 389.00 040 4010012 DO NOT USE XR CHEST SPECIAL VIEWS 71035 393.00 040 4010013 XR CHEST COMP MIN 4V 71030 209.00 040 4010015 XR CHOLANGIOGRAPHY INTRAOP 74300 379.00 040 4010018 XR CHOLANGIOGRAPHY,POST OP 74305 489.00 040 4010019 XR CLAVICLE COMPLETE 73000 160.00 040 4010020 XR SHOULDER, ONE VIEW 73020 160.00 040 4010022 XR ELBOW COMP MIN 3V 73080 145.00 040 4010023 XR ESOPHAGRAM 74220 282.00 040 4010025 XR FACIAL COMP, MIN 3V 70150 241.00 040 4010026 XR FEMUR ANT/ LAT VIEWS 73550 147.00 040 4010027 XR FINGERS MIN 2V 73140 136.00 040 4010028 XR FOOT COMP MIN 3V 73630 210.00 040 4010029 XR FOREARM 2 VIEW 73090 117.00 040 4010030 XR CHOLECYSTOGRAPHY, ORAL 74290 245.00 040 4010031 XR GI TRACT UPPER W/OUT KUB 74240 387.00 040 4010032 XR GI TRACT UPPER W/ KUB 74241 393.00 040 4010033 XR GI TRACT UP W/SM BOWEL 74245 441.00 040 4010034 XR HAND MIN 3V 73130 209.00 040 4010035 XR HIP COMPLETE MIN 2V 73510 150.00 040 4010036 XR HIP UNILATERAL, 1V 73500 117.00 040 4010037 XR KNEE 1 - 2 VIEWS 73560 128.00 040 4010038 XR THERAPEUTIC ENEMA CON AIR 74283 511.00 040 4010041 XR MANDIBLE 4V OR LESS 70100 191.00 040 4010042 XR MASTOIDS COMP MIN 3V 70130 266.00 040 4010043 XR MYELOGRAPHY,LS,RAD SUP&I 72265 1,093.00 040 4010045 XR NASAL BONES,COMP MIN 3 V 70160 181.00 040 4010046 XR OPTIC FORAMINA 70190 197.00 040 4010047 XR ORBITS,COMP MIN 4 VIEWS 70200 230.00 040 4010049 XR PELVIS,ANTEROPOSTER ONLY 72170 128.00 040 4010053 XR ELBOW 2 VIEW 73070 199.00 040 4010054 XR UROGRAPHY, IV 74400 542.00 040 4010055 XR ORTHOPANTOGRAM 70355 170.00 040 4010056 XR UROGRAPHY INFUS DRIP TEC 74410 572.00 040 4010057 XR UROGRAPHY,RETROGRADE 74420 627.00 040 4010058 XR RIBS UNILATERIAL 2 VIEWS 71100 233.00 040 4010059 XR RIBS,BIL 3VIEWS W CHEST 71111 291.00 040 4010060 XR SACROILIAC JTS;3 OR>VIEW 72202 188.00 040
4010061 XR SACRUM & COCCYX,MIN 2VIE 72220 186.00 040 4010062 XR UROGRAPHY (ANTE)LOOPOGR 74425 899.00 040 4010064 XR SHOULDER MIN 2VIEW 73030 274.00 040 4010065 XR HAND MIN 2V 73120 143.00 040 4010066 XR SINUSES,PARA,COMP,MIN 3V 70220 386.00 040 4010069 XR SKULL,COMP MIN 4 VIEWS 70260 258.00 040 4010070 XR SMALL BOWEL INC MULT SER 74250 409.00 040 4010071 XR SPINE,CERVICAL;ANTER&LAT 72050 275.00 040 4010072 XR THORACIC SPINE 2 VIEW 72070 243.00 040 4010073 XR RADIO EXAM ABSCESS,FISTU 76080 503.00 040 4010074 XR SPINE,SINGLE VIEW SP LEV 72020 140.00 040 4010075 XR CYSTOGRAPHY, MIN 3 VIEWS 74430 556.00 040 4010076 XR STERNOCLAVICULAR JT MIN3 71130 182.00 040 4010077 XR STERNUM, MINIMUM 2 VIEWS 71120 182.00 040 4010078 XR TEMPOROMANDIBULAR BILAT 70330 227.00 040 4010079 XR TOES, MINIMUM OF 2 VIEWS 73660 132.00 040 4010080 XR WRIST COMP MIN 3 VIEW 73110 209.00 040 4010081 XR UROGRAPHY W/NEPHROTOMOGR 74415 646.00 040 4010082 XR CERVICAL SPINE 4VIEW 72052 414.00 040 4010083 XR SPINE LUMBARSAC 4V 72110 477.00 040 4010084 XR FLUOROSCOPY UP TO 1 HOUR 76000 538.00 040 4010085 XR CERVICAL SPINE 2VIEW 72040 351.00 040 4010087 X-RAY THORACIC SPINE 3V 72072 437.00 040 4010089 XR NECK, SOFT TISSUE 70360 133.00 040 4010090 XR MANDIBLE >4 VIEWS 70110 237.00 040 4010091 X-RAY OF PHARYNX 70370 516.00 040 4010093 XR G.I.TRACT WITH CONTRAST 74246 412.00 040 4010094 XR SHUNTOGRAM 75809 478.00 040 4010095 XR RAD EXAM PHARYNX OR ESOP 74210 298.00 040 4010096 XR FOOT 2 VIEWS 73620 120.00 040 4010097 X-RAY ANKLE, TWO VIEWS 73600 173.00 040 4010100 XR WRIST 2 VIEWS 73100 115.00 040 4010101 XR HIPS BILATERAL 73520 251.00 040 4010300 XR KNEE COMPLETE >4VIEW 73564 345.00 040 4011000 XR OSSEOUS LIMITED 77074 381.00 040 4011001 XR OSSEOUS COMPLETE 77075 381.00 040 4012002 INT AUDITORY MEATI, COMP 70134 567.00 040 4012004 XR CHEST SINGLE VIEW 71010 363.00 040 4012012 XR SPINE LUMBAR 2VIEW 72100 178.00 040 4012017 XR SKULL,<4 VIEWS W/WO STER 70250 179.00 040 4012019 XR RIBS,POST & ANT CHEST 3 71101 230.00 040 4013000 SWALLOWING FUNCTION VIDE 74230 382.00 040 4013006 XR TIBIA/FIBULA 2 VIEWS 73590 136.00 040 4013009 XR ABDOMEN AP&OBL COMP 74010 248.00 040 4013010 XR PELVIS, COMP MIN 3V 72190 253.00 040 4013011 XR LOW SPINE WITH BENDING 72114 379.00 040 4013013 XR KNEE 3 VIEWS 73562 167.00 040 4013014 XR FLUOROSCOPY >1 HOUR 76001 444.00 040 4013015 XR FLUOROSCOPIC GUIDE CVAD 77001 2,010.00 040 4013016 XR FLUOROSCOPE GUIDE W/NEEDL 77002 680.00 040 4015031 XR PERCUT PORTAL VEIN CATH 36481 2,679.00 040 4015032 XR TRANSLUMINAL BALLOON ANGI 35475 21,435.00 040
4015033 XR INSERT NEEDLE OR INTRACAT 36147 3,009.00 040 4015034 XR TRANSLUMINAL ANGIO VENOUS 35476 4,682.00 040 4015038 XR VENOGRAPHY EXTREM BILATER 75822 1,891.00 040 4015039 XR VENOGRAPHY,EXTREMITY,UNI 75820 1,237.00 040 4015040 XR VENOGRAPHY CAVAL INFERIO 75825 2,751.00 040 4015042 XR VENOGRAPHY CAVAL SUPERIOR 75827 2,539.00 040 4015043 XR VENOGRAPHY JUGULAR CATH 75860 13,397.00 040 4015048 XR AORTOGRAPHY, ABD BIL FEM 75630 4,741.00 040 4015049 XR Aortography, abdominal 75625 3,950.00 040 4015051 XR TRANS BALLOON ANGIOPLAST 75962 2,567.00 040 4015052 XR TRANSLUML BALLOON ANGIOP 75978 2,567.00 040 4015054 XR TRANSCATH BX RAD SUPER 75970 1,452.00 040 4015055 XR RAD GUIDE PERCUT DRAIN 75989 2,924.00 040 4015056 XR INTRO LONG GI TUBE FLUORO 74340 485.00 040 4015057 XR INTRO LONG GI TUBE PROCED 44500 2,897.00 040 4015058 XR CHOLANGIO PERCU TRANHEP 74320 1,957.00 040 4015059 XR TUBE CHANGE WITH CONTRAST 75984 610.00 040 4015060 XR US ABD PARACEINTESIS W/IM 49083 862.00 040 4015061 XR CHOLECYSTOSTOMY IMAGING 47490 1,315.00 040 4015062 XR INJECT PRO CHOLANGIOGRAPH 47505 1,315.00 040 4015063 XR ANGIO AORTOGRAM 75726 4,629.00 040 4015064 XR ANGIO EXTREM BILATERAL 75716 13,723.00 040 4015065 XR CATH INTRC AORTA 36200 1,429.00 040 4015066 XR IR REPL CVC TUN CATH 36581 1,638.00 040 4015067 XR CC VI EXTREMITY UNILATERA 13,434.00 040 4015068 XR DUPLEX SCAN HEMODIAL AXS 846.00 040 4015069 XR US DRAIN PERITON ABCESS 49406 5,175.00 040
Mammography 4020041 MAMMOGRAPHY, UNILATERAL 77055 179.00 040 4020042 MAMMOGRAPHY, BILATERAL 77056 179.00 040
MRI 4260000 MRI BRAIN W/O CONTRAST 70551 1,737.00 042 4260001 MRI BRAIN W/CONTRAST 70552 1,945.00 042 4260002 MRI BRAIN W/&W/O CONTRAS 70553 2,544.00 042 4260003 MRI ORBIT, FACE, NECK 70540 1,766.00 042 4260021 MRI TEMPOMANDIBULA JOINT 70336 1,631.00 042 4260024 MRI CHEST 71550 1,775.00 042 4260027 MRI CERVICAL W/O CONTRAS 72141 1,674.00 042 4260028 MRI CERVICAL SPINE W/CON 72142 2,310.00 042 4260029 MRI CERVICAL SPINE W&W/O 72156 2,701.00 042 4260030 MRI THORACIC SPINE W/O C 72146 1,775.00 042 4260031 MRI THORACIC SPINE W/CON 72147 1,501.00 042 4260032 MRI THORACIC SPINE W&W/O 72157 2,571.00 042 4260033 MRI LUMBAR SPINE W/O CON 72148 1,723.00 042 4260034 MRI LUMBAR SPINE W/CONTR 72149 2,189.00 042 4260035 MRI LUMBAR SPINE W&W/O C 72158 2,514.00 042 4260036 MRI PELVIS W CONTRAST 72196 1,867.00 042 4260037 MRI PELVIS W/O CONTRAST 72195 4,016.00 042 4260039 MRI ABDOMEN 74181 1,713.00 042 4260042 MRI UP EXT NOT JOINT W/O 73220 1,766.00 042
4260045 MRI UP EXT, ANY JOINT W/O 73221 1,661.00 042 4260051 MRI LOWER EXT NOT JOINT 73720 1,766.00 042 4260054 MRI LOWER EXT JT WO CON 73721 1,661.00 042 4260055 MRI LOW EXT NOT JOINT W/O 73718 2,396.00 042 4260056 MRI SPINE W&W/O CONTRAST 73723 2,479.00 042 4261000 MRI HEAD&ORNECKW/WO CONT 70543 2,643.00 042 4261001 MRA CHEST W/WO CONTRAST 71555 1,307.00 042 4261002 MRA PELVIS W/OR W/O CONTR 72198 2,802.00 042 4261003 MRA LOWER EXT W/WO CONTR 73725 1,272.00 042 4261004 MRA ABDOMEN W/WO CONTRAS 74185 1,489.00 042 4261005 MRA HEAD WITH CONTRAST 70545 1,766.00 042 4261007 MRA HEAD W/O CONTRAST 70544 1,824.00 042 4261008 MRA ANGIO NECK W/O CONTRA 70547 1,647.00 042 4261009 MRI ABDOMEN W/O CONTRAST 74183 2,614.00 042 4261010 MRI PELVIS W W/O CONTRAST 72197 1,941.00 042
Nuclear Medicine 4330007 NM KIDNEY IMAGING STATIC 78700 611.00 043 4330012 NM RADIOPHARM LOC WHOLE BOD 78802 1,075.00 043 4330015 NM KIDNEY IMAGING W/VAS FLO 78701 741.00 043 4330017 NM TOMOGRAPHIC (SPECT) 78803 1,086.00 043 4330020 NM BONE SCAN 78350 417.00 043 4330022 NM ACUTE GI BLOOD LOSS SCAN 78278 857.00 043 4330023 NM RADIOPHARMACEUTICAL LOC 78800 738.00 043 4330026 NM Testicular imaging 78761 342.00 043 4330027 NM RADIOPHARMACEUTICAL THERA 79005 264.00 043 4330060 NM WHOLE BODY LOCAL ABSCESS 78806 3,621.00 043 4330061 NM CARDIAC BLO0D POOL IMAGE 78472 983.00 043 4330063 NM CARDIAC BLOOD POOL MULTI 78483 830.00 043 4330065 NM LOCALIZATION ABSCESS,LTD 78805 988.00 043 4330066 NM TUMOR IMAGE PET/SKULL... 78812 1,207.00 043 4330068 NM PULMONARY PERFUSION IMAG 78580 750.00 043 4330070 NM GASTRIC EMPTYING STUDY 78264 880.00 043 4330071 NM KIDNEY FUNCTION STUDY 78725 442.00 043 4330072 NM GASTROESOPHAGEAL REFLUX 78262 674.00 043 4330073 NM VENTRICULOGRAPHY 78635 535.00 043 4335025 NM BONE &/OR JOINT IMAGING 78300 664.00 043 4335026 NM BONE SCAN, WHOLE BODY 78306 1,134.00 043 4335027 NM BONE IMAGE MULTIPLE AREA 78305 932.00 043 4335028 NM BONE/JOINT IMAGING 3-PHA 78315 1,114.00 043 4335044 NM PARATHYROID IMAGING 78070 1,176.00 043 4335046 NM BONE MARROW IMAGE W BODY 78104 593.00 043 4335047 NM BONE MARROW IMAGING LMTD 78102 1,176.00 043 4335050 NM SPLEEN IMAGING 78185 876.00 043 4335051 NM HEPATOBILIARY SYS IMAGING 78226 1,759.00 043 4335052 NM NM LUNG PERFUSION DIFF 78597 1,632.00 043 4335067 NM NM-INJECTIN OXINE A9547 1,776.00 043
Ultrasound 4460064 US TRANSRECTAL 76872 360.00 044 4465002 US ABDOMEN LIMITED 76705 326.00 044 4465003 US ABDOMEN COMPLETE 76700 449.00 044
4465006 US RETROPERITONEAL 76770 362.00 044 4465009 US PELVIC, NON-OB 76856 362.00 044 4465011 US PREGNANT UTERUS 76805 382.00 044 4465019 US HEAD AND NECK 76536 304.00 044 4465020 US CHEST 76604 266.00 044 4465021 US PROCEDURE UNLISTED 76999 241.00 044 4465022 US TRANSVAGINAL 76830 306.00 044 4465024 US SCROTUM & CONTENTS 76870 322.00 044 4465025 US GUIDANCE FOR VASCULAR 76937 753.00 044 4465029 US RETROPERITONEAL LTD 76775 397.00 044 4465030 US MEASURE POST VOID RESID 51798 142.00 044 4465031 US RENAL BX PERC TRO/NEE 50200 1,418.00 044 4465032 US CHANGE CYSTOSTOMY TUBE 51705 497.00 044 4465042 US ULTRASONIC GUIDE NEEDLBX 76942 400.00 044
CT 4540027 CT HEAD WITHOUT CONTRAST 70450 1,119.00 045 4540028 CT HEAD WITH CONTRAST 70460 897.00 045 4540029 CT HEAD W&W/O CONTRAST 70470 1,447.00 045 4540031 CT S.T. NECK W/O 70490 872.00 045 4540032 CT S.T.NECK WITH 70491 1,121.00 045 4540033 CT S.T. NECK W&W/0 70492 1,207.00 045 4540034 CT MAXILLOFACIAL W/O CON 70486 987.00 045 4540035 CT POSTERIOR FOSSA W/O 70480 822.00 045 4540036 CT POSTERIO FOSSA W 70481 864.00 045 4540037 CT POSTERIOR FOSSA W&W/O 70482 1,132.00 045 4540038 CT CHEST W/O CONTRAST 71250 1,067.00 045 4540039 CT CHEST W CONSTRAST 71260 1,642.00 045 4540040 CT CHEST W & W/O 71270 1,141.00 045 4540041 CT ABDOMEN WITHOUT CONTR 74150 1,599.00 045 4540042 CT ABDOMEN WITH 74160 1,642.00 045 4540043 CT ABDOMEN W&W/O 74170 1,725.00 045 4540044 CT PELVIS W/O 72192 1,525.00 045 4540045 CT PELVIS WITH 72193 1,587.00 045 4540046 CT PELVIS W&W/O 72194 1,129.00 045 4540047 CT CERVICAL SPINE W/O 72125 1,343.00 045 4540048 CT LUMBAR SPINE W/O CONT 72131 946.00 045 4540049 CT THORACIC SPINE W/O CO 72128 1,343.00 045 4540050 CT EXTREMITY UPPER W/O 73200 1,219.00 045 4540051 CT EXTREMITY UPPER WITH 73201 1,292.00 045 4540052 CT EXTREMITY UPPER W&W/O 73202 1,156.00 045 4540053 CT EXTREMITY LOWER W/O 73700 1,017.00 045 4540054 CT EXTREMITY LOWER WITH 73701 863.00 045 4540055 CT EXTREMITY LOWER W&W/O 73702 1,156.00 045 4540056 CT MAXILLOFACIAL W/CONTR 70487 805.00 045 4540058 CT CERVICAL SPINE WITH 72126 1,318.00 045 4540059 CT CERVICAL SPINE W&W/O 72127 1,114.00 045 4540060 CT ANGIOGRAPHY CHEST WO/W 71275 863.00 045 4540061 CT ABDOMEN & PELVIS W/O 74176 3,762.00 045 4540062 CT ABD & PELVIS W/CONTRAS 74177 4,763.00 045 4540063 CT ABDOMEN & PELVIS W/WO 74178 904.00 045 4540067 CT THORACIC SPINE W/ CONT 72129 969.00 045
4540070 CT GUIDANCE LOCALIZATION 77011 1,592.00 045 4540087 CT FOR NEEDLE BIOPSY 77012 693.00 045 4545045 US NON-INV STUDY LOWER EXT 93922 523.00 045 4545046 CTA ABD/PELV W & WO CONT 747.00 045
Cardiology 5020002 EKG (NO PROFEE) 93005 113.00 050 5020003 ECHOCARDIOGRAM 93350 1,183.00 050 5020005 STRESS TEST 93015 251.00 050 5020007 DOPPLER ECHOCARDIOGRAPY 93320 459.00 050 5020008 2D AND M-MODE 93307 707.00 050 5020009 DOPPLER ECHOCARD F/U LIM 93321 565.00 050 5020010 ECHOCARDIOGRAPH TRANSTH 93308 1,338.00 050 5020011 CAROTID DUPLEX 93880 483.00 050 5020012 ECHO COLOR FLOW VEL MAP 93325 364.00 050 5020013 US DOPLER SCAN VENOUS BIL 93970 1,530.00 050 5020014 US DOPLER SCAN VENOUS UNI 93971 719.00 050 5020016 ENDOMYOCARDIAL BIOPSY 93505 3,361.00 050 5020018 US DPLX SCAN VENOUS COMP 93975 458.00 050 5020019 INSERT TUN CVAD W/O PORT 36558 4,352.00 050 5020020 ECHOCARIOGRAPHY TRANSTHOR 93306 3,066.00 050 5020021 US DPLX SCAN VENOUS LTD 93976 973.00 050 5025049 TRANSESOPHAGEAL ECHOCARD 93315 1,407.00 050 5025050 ECHOCARD/TRANSESOPH IMAGE 93312 2,980.00 050 5025051 UP/LWR EXTREM PHYS STUDY 93923 579.00 050 5025052 LHC W/LV PRESSURE OR GRA 93458 19,404.00 050
EEG 5150001 EEG (AWAKE, DROWSY) 95816 1,145.00 051 5150006 EEG WITH SLEEP 95819 1,145.00 051 5150009 NEEDLE EMG 2 EXTREMITIES 95861 303.00 051 5150011 EEG EXTENDED 25-60 MIN 95812 1,313.00 051 5150012 EEG IN COMA OR SLEEP 95822 969.00 051
Pharmacy 6000005 DEMEROL (MEPERIDINE) 25MG/ML (1ML VIAL) 25.00 060 6000014 OXYMETAZOLINE NASAL SPRAY [0.05%] 12.95 060 6000017 IV-ALBUMIN HUMAN [25 GRAM/100 ML] 513.00 060 6000046 AMOXICILLIN CAPSULE [250 MG] 3.00 060 6000065 MECLIZINE TABLET [12.5 MG] 3.00 060 6000067 PHENYLEPHRINE SUPP [0.25%] 3.00 060 6000069 HydrocoRTISONE RECTAL SUPPOSITORY [25 M 50.50 060 6000073 HydrALAzine INJ (20 MG/ML-1 ML VIAL] 447.05 060 6000074 HydrALAzine TABLET [10 MG] 3.00 060 6000083 ASPIRIN TABLET [325 MG] 3.00 060 6000089 ASPIRIN E.C.TABLET [81 MG] 3.00 060 6000092 ASPIRIN E.C. TABLET (325 MG) 3.00 060 6000095 HydrOXYzine SYRUP [10 MG/5 ML] 8.80 060 6000097 LORazepam INJ [2 MG/ML-1 ML VIAL] 13.00 060 6000105 RT-IPRatropIUM-HFA INHALER [17 MCG-13 GM 993.25 060 6000107 AMOXICILLIN/CLAVULANATE TABLET [500-125 13.25 060 6000116 WATER FOR INJECTION STERILE [1000 ML NON 30.00 060
6000132 SULFAmetHOXAZOLE/TRIMEthoPRIM [800-160 M 3.00 060 6000141 DiphenhydrAMINE INJ [50 MG/ML] 11.55 060 6000142 DiphenhydrAMINE CAPSULE/TABLET [25 MG] 3.00 060 6000145 DICYCLOMINE CAPSULE [10MG] 3.00 060 6000154 POVIDONE-IODINE OINTMENT[10%-U/D] 3.00 060 6000165 SULFACETAMIDE OPHTH DROPS[10%-15 ML BTL] 213.50 060 6000168 VITAMIN B-6 TABLET [50 MG] 3.00 060 6000191 CALAMINE LOTION [120 ML BOTTLE-BILL 1 BO 8.25 060 6000192 VERAPAMIL TABLET [80 MG] 3.00 060 6000194 CALCIUM CARBONATE TABLET [500 MG] 3.00 060 6000197 IV-CALCIUM GLUCONATE INJ [1 GRAM/10 ML] 40.00 060 6000203 SUCRALFATE TABLET [1 GRAM] 3.00 060 6000204 DILTiazem TABLET [30 MG] 3.00 060 6000207 CloNIDine TABLET [0.1 MG] 3.00 060 6000209 CloNIDine PATCH [0.1 MG/24 HR] 117.00 060 6000210 CloNIDine PATCH [0.2 MG/24 HR] 195.40 060 6000218 CETYLPYRIDINIUM LOZENGE 3.00 060 6000235 MAGnesIUM CITRATE 300 ML BOTTLE 3.95 060 6000236 CLINDAMYCIN CAPSULE [150 MG] 3.00 060 6000242 CODEINE TABLET [30 MG] 5.00 060 6000247 DOCUSATE CAPSULE [100 MG] 3.00 060 6000251 COLCHICINE TABLET [0.6 MG] 22.00 060 6000256 PROchlorperazine SUPPOSITORY [25 MG] 10.65 060 6000258 PROchlorperazine INJ [10 MG/2 ML] 19.35 060 6000272 WARfarIN TABLET [5 MG] 9.00 060 6000279 SODIUM HYPOCHLORITE IRRIGATION [0.25 % - 40.00 060 6000290 CARBAMIDE PEROXIDE OTIC DROPS [6.5%-15 M 17.50 060 6000300 MEPERIDINE VIAL [25 MG/ML] 25.60 060 6000310 TraZODone TABLET [50 MG] 3.00 060 6000314 DEXTROSE 50%-- [50 ML SYRINGE] 25.00 060 6000319 AcetaZOLAMIDE TABLET[ 250MG] 12.00 060 6000321 AcetaZOLAMIDE INJ [500MG] 181.15 060 6000325 PhenyTOIN 50MG/ML INJ - 2ML(100MG) 20.00 060 6000326 PhenyTOIN-ER CAPSULE [100 MG] 3.00 060 6000341 OXYbutYNIN TABLET [5 MG] 3.00 060 6000360 BISACODYL SUPPOSITORY [10 MG] 3.00 060 6000361 BISACODYL TABLET [5 MG] 3.00 060 6000381 AMItriptyline TABLET [25 MG] 3.00 060 6000391 EPINEPHRINE SYRINGE [0.1 MG/ML] 60.35 060 6000412 FERROUS SULFATE TABLET [325 MG] 3.00 060 6000417 MetroNIDAZOLE TABLET [250 MG] 3.00 060 6000418 SOD PHOS M-B/NA PHOS DI-BA ENEMA 4.20 060 6000420 CYCLOBENZAPRINE TABLET [10 MG] 3.00 060 6000421 FLUDROCORTISONE TABLET [0.1 MG] 3.00 060 6000422 VITAMIN B-9 (FOLIC ACID) TABLET [ 1MG] 3.00 060 6000447 GLYCERIN ADULT SUPPOSITORY 3.00 060 6000454 HALoperiDOL TABLET [0.5 MG] 3.00 060 6000456 HALoperiDOL TABLET [5 MG] 3.45 060 6000458 HALoperiDOL INJ [5 MG/ML-1 ML VL] 26.00 060 6000463 HEparIN **DIALYSIS**[1,000 UNITS/ML-1 ML 16.25 060 6000464 HEparIN INJ [5,000 U/ML-1 ML VIAL] 16.25 060 6000466 HEparIN FLUSH SYRINGE [500 U/5ML] 13.00 060
6000471 InSULin nph HUMAN INJ [100 U/ML 10 ML VI 535.95 060 6000472 InSULin REGular HUMAN INJ [100 U/ML 10 M 536.00 060 6000480 HydrocoRTISONE CREAM [1%- 30 GRAM TUBE] 12.20 060 6000501 LOPERAMIDE CAPSULE [2 MG] 3.00 060 6000504 PROpranOLOL INJ [1 MG/ML-1 ML VIAL] 34.50 060 6000516 DEXTROSE 40% ORAL GEL (TUBE)[15 GRAM TUB 13.85 060 6000519 ISONIAZID TABLET [300 MG] 3.00 060 6000521 VERAPAMIL INJ [2.5 MG/ML-2 ML VL] 111.15 060 6000524 PILOCARPINE EYE DROPS [2%-15 ML BTL] 256.05 060 6000546 CEPHALEXIN CAPSULE [250 MG] 3.00 060 6000559 DIGOXIN TABLET [0.125 MG] 3.00 060 6000563 FUroseMIDE INJ [10 MG/ML-10 ML] 17.80 060 6000564 FUroseMIDE TABLET [20 MG] 3.00 060 6000565 FUroseMIDE INJ [10MG/ML- 2 ML ] 11.50 060 6000567 FUroseMIDE INJ [10 MG/ML-4 ML] 15.00 060 6000572 IV-NorEPINEphrine IV [1MG/ML-4 ML] 102.60 060 6000590 DiphenOXYLATE/ATROP TABLET [2.5-.025 MG] 3.00 060 6000606 NitroFURANtoin CAPSULE [50 MG] 7.00 060 6000608 IV-MANNITOL 25% IV 50 ML 40.00 060 6000623 PSYLLIUM PACKET[6 GRAM PACKET] 3.00 060 6000629 MINERAL OIL [ORAL/TOPICAL] 3.00 060 6000645 MULTIVITAMIN TABLET 3.00 060 6000647 CLOTRIMAZOLE TABLET [10 MG] 5.65 060 6000653 NYSTATIN POWDER [100000 U/G-15 GRAM BTL] 97.00 060 6000660 SIMethICONE CHEWTAB [80 MG] 3.00 060 6000661 SIMethICONE DROPS [40MG/0.6ML-30 ML BTL] 12.25 060 6000692 NEOMY SULF/BACITRA/POLYMYXIN B OINTMENT 3.00 060 6000708 NitroGLYCERin OINTMENT [2% -30 GRAM TUB 83.34 060 6000738 NYSTATIN CREAM [30 GRAM TUBE] 92.15 060 6000772 FAMOTIDINE TABLET [20 MG] 7.00 060 6000796 PHENobarbital 32.4MG TABS 3.00 060 6000818 PrednisoLONE EYE DROPS [1% - 5 ML BOTTL 55.15 060 6000822 PredniSONE TABLET [20 MG] 3.00 060 6000823 PredniSONE TABLET [5 MG] 3.00 060 6000837 NIFEdipine CAPSULE [10 MG] 3.20 060 6000852 ALBUTEROL TABLET [2 MG] 3.00 060 6000858 PHENAZOPYRIDINE TABLET [100 MG] 9.45 060 6000862 CHOLESTYRAMINE/ASPARTAME PACKET [4 GRAMS 17.90 060 6000878 RIFAMPIN CAPSULE [300 MG] 7.25 060 6000888 GLYCOPYRROLATE INJ [0.2 MG/ML] 54.60 060 6000889 GUAifenESIN SYRUP DIABETIC [200 MG/10 ML 3.00 060 6000891 GUAifenESIN-DM SYRUP [200-20 MG/10 ML UN 3.00 060 6000901 SELENIUM SULFIDE SHAMPOO [2.5%-120 ML] 69.30 060 6000911 CARBIDOPA/LEVODOPA TABLET [10 MG-100 MG] 4.05 060 6000912 CARBIDOPA/LEVODOPA TABLET [25 MG-100 MG] 3.00 060 6000947 PSEUDOEPHEDRINE TABLET [30 MG] 3.00 060 6000954 AMANtaDINE CAPSULE [100 MG] 3.00 060 6000959 LevoTHYROxine TABLET [100 MCG] 4.90 060 6000974 ARTIFICIAL TEARS [15 ML BTL-BILL 1 BTL] 20.00 060 6000976 TEMazePAM CAPSULE [15 MG] 5.00 060 6000978 CarBAMazepine TABLET [200 MG] 5.60 060 6000996 THeoPHYLLINE-ER TABLET [300 MG] 3.00 060
6001021 TIMOLOL EYE DROPS [0.25%-5 ML BOTTLE] 52.50 060 6001022 TIMOLOL EYE DROPS [0.5%-5 ML BTL] 59.50 060 6001033 LAbetaLOL TABLET [100 MG] 3.00 060 6001034 NitroGLYCERin PATCH [0.2 MG/HR] 9.10 060 6001035 NitroGLYCERin PATCH [0.4 MG/HR] 7.60 060 6001039 PENTOXIFYLLINE-ER TABLET [400 MG] 3.00 060 6001059 ACETaminoPHEN TABLET [325MG] 3.00 060 6001064 ACETaminoPHEN SUPP [650 MG] 3.00 060 6001067 CODEINE/APAP TABLET [30-300 MG] 5.00 060 6001075 CLOTRIMAZOLE/BETAMET CREAM (1-0.05% -45 257.70 060 6001078 DIAZEPAM TABLET [2 MG] 5.00 060 6001079 DIAZEPAM TABLET [5 MG] 5.00 060 6001089 ALBUTEROL SYRUP [2 MG/5 ML-BILL BY OZ.] 8.70 060 6001094 DoXYCycline TABLET [100 MG] 20.00 060 6001107 VITAMIN D CAPSULE [50,000 UNITS) 6.90 060 6001109 VITAMIN E CAPSULE [400 UNITS] 3.00 060 6001123 ALPRAZolam TABLET [0.25 MG] 5.00 060 6001135 ZINC OXIDE OINTMENT (20%-30 GRAM TUBE) 10.85 060 6001137 ZINC SULFATE CAPSULE [220 MG] 3.00 060 6001139 ACYcloVIR OINTMENT [5%-30 GRAM TUBE] 2,825.50 060 6001141 ALLopurINOL TABLET [100 MG] 3.00 060 6001144 CaPTOpril TABLET [12.5 MG] 3.00 060 6001147 VITAMIN B-12 INJ [1000 MCG/ML] 3.00 060 6001148 VITAMIN B-9 (FOLIC ACID) INJ [5 MG/ML] 112.15 060 6001176 SPIRonoLACTONE TABLET [25 MG] 3.00 060 6001180 HydrALAzine TABLET [25 MG] 3.00 060 6001181 LORazepam TABLET [0.5 MG] 5.00 060 6001183 BUSPIRONE TABLET[ 5 MG] 3.00 060 6001187 CEFuroXIME TABLETS 250MG 15.40 060 6001205 LevoTHYROxine TABLET [25 MCG] 3.00 060 6001242 InSULin (NPH/REG 70/30 MIX) 100U/ML- 10 536.00 060 6001245 CiproFLOXACIN TABLET [250 MG] 19.15 060 6001255 METHOTREXATE TABLET [2.5 MG] 21.85 060 6001259 MIDazolam VIAL [1 MG/ML-2 ML VIAL] 5.00 060 6001267 BACITRACIN/POLYMYXIN B SULFATE 500-10KU/ 37.80 060 6001277 TERAZOSIN CAPSULE [1 MG] 7.45 060 6001317 TOBRAMYCIN/DEXAMETH EYE DROPS [0.3-0.1%] 228.60 060 6001330 BENZOCAINE SPRAY [20%-60 ML CAN] 127.40 060 6001352 NIFEdipine-ER TABLET [30 MG] 4.05 060 6001355 KETOROLAC INJ [30 MG/ML] 17.50 060 6001361 SODIUM CHLORIDE 0.9% STERILE [10 ML NON- 3.00 060 6001368 BENZOCAINE/TETRACAINE/BUTAMBEN [14-2-2%] 226.05 060 6001382 URsodIOL CAPSULE [300 MG] 4.00 060 6001384 SILVER NITRATE APPLICATOR 3.00 060 6001394 ClonazePAM TABLET [0.5 MG] 5.00 060 6001399 ACETIC ACID IRRIGATION [0.25%-1000 ML] 45.85 060 6001410 DIAZEPAM CARPUJECT [5MG/ML-2 ML] 50.00 060 6001416 POVIDONE-IODINE SOLUTION [10% -8 OZ BOTT 14.70 060 6001426 GEMFIBROZILTABLET [ 600 MG] 15.05 060 6001433 PredniSONE SOLUTION [5 MG/5 ML UNIT DOS 4.30 060 6001435 MUPIROCIN CREAM [ 2%-30 GRAM TUBE] 1,052.35 060 6001446 NICOTINE PATCH [21 MG/24 HR] 8.00 060
6001450 MORPhine SULFATE CARPUJECT [2 MG/ML] 10.00 060 6001460 AMMONIUM LACTATE LOTION [12%-400 GM BOTT 149.00 060 6001492 PNEUMOCOCCAL 23-VAL P-SAC VAC (25MCG/0.5 331.40 060 6001506 GUAifenESIN-LA TABLET [600 MG] 3.00 060 6001522 TOBRAMYCIN/DEXAMETH EYE OINT [0.3-0.1%] 724.10 060 6001553 MUPIROCIN OINTMENT [2%-22 GRAM TUBE] 157.00 060 6001557 IV-VANcoMYCIN INJ [1 GRAM] 96.00 060 6001561 POTASSIUM CHLORIDE CAPSULE/TABLET [10 ME 3.00 060 6001572 FLUconaZOLE TABLET [100 MG] 84.00 060 6001573 FentaNYL PATCH [25 MCG/HR] 75.00 060 6001582 LevoTHYROxine TABLET [75 MCG] 3.00 060 6001583 MAGnesIUM OXide TABLET [400 MG] 3.00 060 6001592 COLLAGENASE OINTMENT [250 UNIT/G-30 GRAM 861.00 060 6001607 TRIAMCINOLONE NASAL SPRAY [55 MCG] 429.40 060 6001631 GLYCOPYRROLATE TABLET [1 MG] 4.75 060 6001634 BACLOFEN TABLET [10 MG] 8.65 060 6001654 LamoTRIgine TABLET [25 MG] 14.60 060 6001657 ACETaminoPHEN TABLET [500MG] 3.00 060 6001658 NICOTINE PATCH [7 MG/24 HR] 7.50 060 6001666 meTOLAzone TABLET [2.5 MG] 7.95 060 6001667 AmioDARone TABLET [200 MG] 3.00 060 6001669 BUPROPION TABLET [100 MG] 3.40 060 6001672 KETOROLAC EYE DROPS [0.5 %-5 ML BTL] 374.05 060 6001673 VITAMIN D (CALCITRIOL) CAPSULE [0.25 MCG 5.35 060 6001675 VITAMIN-MULTI TABLET (RENAL) 3.00 060 6001676 CALCIUM ACETATE CAPSULE [667 MG] 5.10 060 6001682 ETHAMBUTOL TABLET [400 MG] 6.30 060 6001692 DILTiazem-ER CAPSULE [120 MG] 4.00 060 6001701 METHYLpheniDATE TABLET [5 MG] 5.00 060 6001702 ENOXAPARIN SYRINGE [30MG/0.3ML] 104.20 060 6001706 IRON POLYSACCHARIDES COMPLEX CAPSULE [15 3.00 060 6001710 SIMvastATIN TABLET [10 MG] 10.00 060 6001715 HydrocoRTISONE TABLET [20 MG] 4.00 060 6001721 GABapenTIN CAPSULE [100 MG] 3.00 060 6001726 BACITRACIN ZINC OINTMENT [500 UNIT/G] 18.40 060 6001730 FentaNYL PATCH [100 MCG/HR] 275.50 060 6001736 MetFORMIN TABLET [500 MG] 3.00 060 6001738 EPOETIN INJ [10,000 U/ML-25 VIAL PK] 938.05 060 6001752 TAcroLIMUS CAPSULE [1 MG] 20.10 060 6001753 MYCOPHENOLATE CAPSULE [250 MG] 3.30 060 6001755 AmLODipine TABLET [10 MG] 9.00 060 6001760 IV-PIPERACILLIN SODIUM/TAZOBACTAM [3.375 121.00 060 6001766 PHENOL/PHENOLATE SPRAY [180 ML-BILL 1 BO 10.85 060 6001768 TraMADol TABLET[ 50MG] 5.00 060 6001771 VERAPAMIL-ER TABLET [120 MG] 3.75 060 6001778 ATenoLOL TABLET [25 MG] 3.00 060 6001784 PYRIdostigMINE TABLET [60 MG] 4.30 060 6001792 GliPIZide TABLET [5 MG] 3.00 060 6001794 BUPROPION TABLET [75 MG] 5.45 060 6001797 HYDROchloroHIAZIDE TABLET [25 MG] 3.00 060 6001800 RisperiDONE TABLET [1 MG] 16.00 060 6001815 HydrocoRTISONE CREAM [2.5%-30 GRAM TUBE 37.80 060
6001819 DoXAZosin TABLET [2 MG] 4.00 060 6001822 LACTULOSE SYRUP [20 GRAMS/30 ML UNIT DOS 3.00 060 6001823 LIDOCAINE SYRINGE [20 MG/ML-100 MG/5 ML] 12.65 060 6001825 meTOCLOpramide SOLUTION [10 MG/10 ML UN 3.00 060 6001827 NYSTATIN SUSP 500,000 UNITS/5ML-60ML 60.00 060 6001828 NYSTATIN SUSP [500,000 U/5 ML UNIT DOSE] 4.00 060 6001836 FERROUS SULFATE LIQUID [300 MG/5 ML UNIT 3.00 060 6001839 DOCUSATE LIQUID [100 MG/10 ML UNIT DOSE] 3.00 060 6001843 MAG HYDROX/AL HYDROX/SIMETH SUSP [200-20 3.00 060 6001846 SODIUM POLystYRENE SULFONATE [15GM/60ML] 45.00 060 6001856 NEOMY SULF/BACITRA/POLYMYXIN B OINTMENT[ 21.55 060 6001865 DONepeZIL TABLET [5 MG] 28.00 060 6001869 CALCITONIN NASAL SPRAY [3.5ML BTL IN REF 414.90 060 6001870 MENTHOL OINTMENT [0.44%-2.5 OZ JAR] 21.00 060 6001878 LORATADINE TABLET (10 MG) 3.05 060 6001881 GABapenTIN CAPSULE [400 MG] 7.00 060 6001882 LISinoPRIL TABLET [2.5 MG] 3.00 060 6001883 SOtaLOL TABLET [80 MG] 9.00 060 6001886 PRAMipexOLE TABLET [0.125 MG] 10.35 060 6001887 NitroGLYCERin PATCH [0.1 MG/HR] 6.50 060 6001889 DEXAMETHASONE INJ [4 MG/ML- 1 ML VIAL] 4.65 060 6001894 RT-IPRatropIUM INHALATION [0.5 MG/2.5ML] 7.75 060 6001901 SODIUM CHLORIDE NASAL SPRAY [0.65%-45 ML 7.35 060 6001905 LISinoPRIL TABLET [10 MG] 3.00 060 6001906 WARfarIN TABLET [1 MG] 7.20 060 6001910 VITAMIN B COMPLEX WITH C TABLET 3.00 060 6001925 CALCIUM CARBONATE/VITAMIN D2 [250 MG-125 3.00 060 6001931 VITAMIN-MULTI W/MINERALS [THERAPEUTIC] T 3.00 060 6001932 AZITHROMYCIN TABLET [250 MG] 25.10 060 6001933 TOPiraMATE TABLET [25 MG] 7.35 060 6001934 CiproFLOXACIN EYE DROPS[0.3%-5 ML BOTL] 165.60 060 6001937 NALOXONE INJ [0.4 MG/ML-1 ML AMP/VIAL] 42.20 060 6001939 RT-SALMETEROL INHALATION [50 MCG] 440.60 060 6001941 ARTIFICIAL TEARS OPTH OINTMENT[3.5 GM TU 13.60 060 6001942 VITAMIN K INJECTION [10 MG/ML 1 ML AMP] 72.45 060 6001944 WARfarIN TABLET [2.5 MG] 7.75 060 6001947 ZOLPIDEM TABLET [5 MG] 17.00 060 6001949 ASPIRIN CHEWTAB [81 MG] 3.00 060 6001950 VERAPAMIL TABLET [120 MG] 3.00 060 6001954 FentaNYL PATCH [75 MCG/HR] 207.60 060 6001963 RT-ACETylcySTEINE INHALATION [100MG/ML-4 17.85 060 6001969 LIDOCAINE/EPINEPHRINE INJ [1-0.001% 20 M 7.55 060 6001971 MINERAL OIL/PET HY-PHL OINTMENT 44.70 060 6001984 SODIUM CHLORIDE IRRIGATION SOLN 500 ML[2 34.30 060 6001994 IV-CefTRIAXone INJ [1 GRAM] 184.00 060 6002017 DIGOXIN INJ [0.25 MG/ML-2 ML AMP] 23.10 060 6002035 GLUCAGON HUMAN RECOMBINANT INJ [1 MG VIA 720.75 060 6002037 BACITRACIN ZINC OPHTH OINTMENT[500 UNIT/ 201.15 060 6002042 ISOSORBIDE DINITRATE TABLET [20 MG] 8.70 060 6002047 RT-ALBUTEROL INHALATION 2.5 MG/3 ML VIAL 3.00 060 6002048 FLUOxetiNE CAPSULE [10 MG] 9.10 060 6002049 ONDANSETRON INJ [2 MG/ML-2 ML VIAL] 4.00 060
6002056 BENZONATATE CAPSULE (100 MG) 8.75 060 6002059 IV-FOSphenytoin INJ [50MG/ML-100 MG VIA 40.00 060 6002063 TRIAMCINOLONE OINTMENT [0.1%-15 GRAM TUB 19.55 060 6002064 TUBERCULIN PURIF.PROT.DERIV. [5T U/0.1ML 177.30 060 6002074 RT-RACEPINEPHRINE INHALATION [2.25 %-0.5 7.20 060 6002075 IV-AMPICILLIN/SULBACTAM INJ [3 GRAMS] 100.30 060 6002076 IBUproFEN TABLET [200 MG] 3.00 060 6002078 AMOXICILLIN/CLAVULANATE TABLET [875-125 17.70 060 6002087 TOBRAMYCIN EYE DROPS [0.3% - 5 ML] 119.00 060 6002088 BETHANECHOL TABLET [25 MG] 11.00 060 6002096 ACETaminoPHEN LIQUID [650 MG/20 ML] 3.00 060 6002097 SELENIUM SULFIDE SHAMPOO [1%-240 ML-BILL 12.65 060 6002103 QUEtiapine TABLET [25 MG] 14.00 060 6002104 ACYcloVIR CAPSULE [200 MG] 3.95 060 6002105 HydroMORPhone TABLET [2 MG] 5.00 060 6002108 INTERFERON BETA-1A/ALBUMIN [30 MCG] 4,772.25 060 6002110 CYCLOSPORINE LIQUID [100 MG/ML-50 ML BTL 1,031.45 060 6002111 DAPSONE TABLET [100 MG] 4.55 060 6002117 ENOXAPARIN SYRINGE [40MG/0.4ML] 138.95 060 6002120 RT-ACETylcySTEINE INHALATION [200MG/ML-4 53.75 060 6002123 BACITRACIN ZINC OINTMENT [500 UNIT/G]PAC 3.00 060 6002129 ISOSORBIDE-ER TABLET [30 MG] 5.90 060 6002140 PILOCARPINE EYE DROPS [4%-15 ML BTL] 154.00 060 6002143 SILVER SULFADIAZINE CREAM [1% -20 GRAMS 64.90 060 6002149 GABapenTIN CAPSULE [300 MG] 4.85 060 6002151 CLOPidoGREL TABLET [75 MG] 23.85 060 6002155 COSYNTROPIN INJ [0.25 MG/2 ML VIAL] 447.65 060 6002159 ZIDOVUDINE SUSPENSION [10 MG/ML-BILL BY 197.50 060 6002163 ATROPINE SULFATE EYE DROPS [1%- 15 ML] 116.40 060 6002165 VITAMIN A CAPSULE [10,000 I UNITS] 3.00 060 6002167 MEGESTROL SUSPENSION [400 MG/10 ML UNIT 14.90 060 6002170 CYCLOSPORINE CAPSULE [25 MG] 4.85 060 6002173 meTOPROLol INJECTION [5MG/5ML] 11.90 060 6002178 TAcroLIMUS CAPSULE [5 MG] 83.25 060 6002182 PhenyTOIN SUSP [100 MG/4 ML UNIT DOSE] 5.50 060 6002186 DEMECLOCYCLINE TABLET [150 MG] 37.25 060 6002190 ISOSORBIDE DINITRATE TABLET [5 MG] 3.00 060 6002191 HYDROXYCHLOROQUINE TABLET [200 MG] 3.00 060 6002196 MESALAMINE DELAYED RELEASE CAPSULE [400 8.85 060 6002200 SODIUM CHloRIDE TABLET [1 GRAMS] 3.00 060 6002201 TAmsuLOSIN CAPSULE [0.4 MG] 14.75 060 6002205 TRIAMCINOLONE INJ [40 MG/ML-1 ML VIAL] 34.40 060 6002206 TRIAMCINOLONE CREAM [0.025%-15 GRAM TUBE 15.65 060 6002208 VITAMIN B COMPLEX & C/VIT E/ZINC TABLET 3.00 060 6002211 LATanoPROST EYE DROPS [0.005%-2.5 ML BTL 332.50 060 6002218 POTASSIUM BICARBONATE/CIT AC TABLET [25 3.00 060 6002219 VENLAFAXINE TABLET [25 MG] 6.80 060 6002220 LevoFLOXacin TABLET [250 MG] 57.75 060 6002225 ALBUTEROL- ER TAB [4 MG] 4.90 060 6002228 IV-LevoFLOXacin/D-5%-W [500 MG/100 ML PR 66.50 060 6002230 MONTELUKAST TABLET [10 MG] 19.80 060 6002234 DILTiazem-ER CAPSULE [180 MG] 6.35 060
6002235 MIDODRINE TABLET [10MG] 10.42 060 6002236 MIDODRINE TABLET [5 MG] 15.75 060 6002237 MESALAMINE RECTAL SUSPENSION [4 G/60 ML] 85.55 060 6002243 IV-PIPERACILLIN/TAZOBACTAM/D-5-W [3.375 97.50 060 6002251 FLUTICASONE NASAL SPRAY [50 MCG/SPRAY] 263.44 060 6002257 CaRVEDilol TABLET [12.5 MG] 6.80 060 6002258 OPIUM/BELLADONNA SUPPOSITORY [30-16.2 MG 81.10 060 6002259 ENOXAPARIN SYRINGE [100MG/ML] 347.75 060 6002260 ONDANSETRON TABLET [4 MG] 86.75 060 6002263 MORPhine SULFATE immediate release TABLE 5.00 060 6002264 RT-ALBUTEROL SULFATE/IPRATROPIUM INHALER 1,105.40 060 6002265 ValACYclovir TABLET [500 MG] 25.30 060 6002268 CELecoXIB CAPSULE [100 MG] 21.55 060 6002269 MethylPREDNISolone INJ [40 MG/ML] 18.90 060 6002276 DiphenhydrAMINE CREAM [ZINC ACET 2-0.1% 14.00 060 6002290 NYSTATIN/TRIAMCININOLONE CREAM[30 GRAM T 558.35 060 6002295 VITAMIN D (CALCITRIOL) INJ [1 MCG/ML] 21.00 060 6002296 IV-SODIUM CHLORIDE 3% [500 ML] 40.00 060 6002298 QUEtiapine TABLET [100 MG] 22.70 060 6002303 FINASTERIDE TABLET [5 MG] 11.65 060 6002304 VALsarTAN TABLET [80 MG] 16.30 060 6002307 MIRtazaPINE TABLET [15 MG] 9.55 060 6002312 IPRATROPIUM NASAL SPRAY [42 MCG] 130.20 060 6002313 IV-CLINDAMYCIN INJ [150 MG/ML -4 ML VIAL 41.00 060 6002315 IV-NitroPRUSSide INJ [25 MG/ML-2 ML VIAL 132.00 060 6002317 IV-COLISTIMETHATE INJ [150 MG] 157.60 060 6002318 MINOXIDIL TABLET [2.5 MG] 5.95 060 6002319 OCTREOTIDE INJ [50 MCG/ML] 38.70 060 6002326 CEPHALEXIN SUSPENSION [250 MG/5 ML-100 M 66.15 060 6002330 PROpranOLOL TABLET [10 MG] 3.00 060 6002339 FILGRASTIM INJ [480 MCG/1.6 ML] 1,837.30 060 6002344 TERBINAFINE CREAM [1% - 15 GRAM TUBE] 22.00 060 6002392 FentaNYL INJ [100 MCG/2 ML] VIAL/AMP 10.00 060 6002397 CiproFLOXACIN-HC OTIC SOLUTION[0.2%-1%) 722.40 060 6002399 HydrOXYzine TABLET [25 MG] 3.00 060 6002402 OXYcodone sustained release TABLET [10 M 13.25 060 6002411 TAMOXIFEN TABLET [10 MG] 8.30 060 6002412 NICOTINE PATCH [14 MG/24 HR] 7.50 060 6002413 LevoTHYROxine TABLET [88 MCG] 3.00 060 6002415 CiproFLOXACIN EYE OINT [0.3%-3.5 GM TUBE 324.05 060 6002416 LevoTHYROxine TABLET [112 MCG] 3.00 060 6002433 AMItriptyline TABLET [10 MG] 3.00 060 6002434 DORZOLAM/TIMOLOL OPHTH DROPS [0.5%-2%] 236.25 060 6002439 IV-LINEZOLID [600 MG/300 ML] 696.05 060 6002442 MEGESTROL TABLET [40 MG] 4.80 060 6002449 SODIUM HYPOCHLORITE IRRIGATION [0.5% - 1 31.90 060 6002465 LINEZOLID TABLET [600 MG] 642.85 060 6002470 CILOSTAZOL TABLET [50 MG] 6.40 060 6002479 OXYcodone immediate release TABLET [5 MG 5.00 060 6002485 HydrocoRTISONE TABLET [5 MG] 3.00 060 6002487 IV-VANcoMYCIN INJ [500 MG VIAL] 40.00 060 6002488 PhenyTOIN TABLET [50 MG] 3.00 060
6002489 IV-FERRIC GLUCONATE COMPLEX INJ [62.5 MG 153.00 060 6002493 IV-MilRINone/D-5-W [20 MG/100 ML] 73.00 060 6002497 OLOPATADINE EYE DROPS [0.1%-5 ML BOTTLE] 560.70 060 6002500 AZELASTINE HCL NASAL SPRAY [137MCG} 368.35 060 6002511 VITAMIN B-1 TABLET [100 MG] 3.00 060 6002518 PANtopraZOLE TABLET [40 MG] 18.45 060 6002530 IV-CEFEPIME INJ [1 GRAM] 81.50 060 6002531 IV-CEFEPIME INJ [2 GRAMS] 161.50 060 6002534 OSELTAMIVIR CAPSULE [75 MG] 42.65 060 6002538 ENOXAPARIN SYRINGE [60MG/0.6ML] 50.15 060 6002546 IV-POTASSIUM CHLORIDE/D5W [20 MEQ/1000 M 48.00 060 6002549 IV-POTASSIUM CHLORIDE/NS [40 MEQ/1000 ML 48.00 060 6002550 IV-POTASSIUM CHLORIDE/NS [20 MEQ/1000 ML 48.00 060 6002551 DESMOPRESSIN INJ [4 MCG/ML] 81.15 060 6002562 VITAMIN D (PARICALCITOL) INJ [5 MCG/ML1 63.65 060 6002579 CARISOPRODOL TABLET [350 MG] 15.00 060 6002585 HydrocoRTISONE RECTAL CREAM [2.5% 30 GR 87.35 060 6002591 TAcroLIMUS CAPSULE [0.5 MG] 8.70 060 6002595 IV-PANtopraZOLE INJ [40 MG] 61.00 060 6002598 AMMONIUM LACTATE LOTION [5%-240 ML BOTTL 18.35 060 6002599 OXYcodone sustained release TABLET [40 M 42.15 060 6002607 InSULin GlarGINE HUM.REC.ANLOG [100 U/ML 1,043.75 060 6002612 LIDOCAINE/PRILOCAINE CREAM [2.5-2.5%-30 185.95 060 6002617 CloNIDine TABLET [0.3 MG] 3.00 060 6002619 VENLAFAXINE-XL CAPSULE [37.5 MG] 13.15 060 6002621 SIMvastATIN TABLET [40 MG] 17.25 060 6002623 CaRVEDilol TABLET [3.125 MG] 7.35 060 6002629 SCOPOLAMINE PATCH[1.5 MG/72HR} 70.35 060 6002641 METhadONE TABLET [10 MG] 5.00 060 6002642 CHLORHEX GL/ISOPROPYL ALCOHOL [4-4%] 23.15 060 6002644 IV-OXACILLIN INJ [2 GRAMS} 113.50 060 6002662 ALENDRONATE TABLET [70 MG] 71.75 060 6002670 ENOXAPARIN SYRINGE [80MG/0.8ML] 278.20 060 6002672 LIDOCAINE PATCH [5%] 36.40 060 6002675 OXcarbazepine TABLET [150 MG] 5.30 060 6002676 ERYTHROMYCIN BASE TABLET [250 MG] 25.80 060 6002700 RT-FLUTICASONE/SALMETEROL INHALER [250-5 501.25 060 6002706 SERtraLINE TABLET [25 MG] 10.00 060 6002707 ALTEPLASE INJ [2 MG] VIAL 549.55 060 6002708 NitroGLYCERin SUBLINGUAL TABLET [0.4 MG- 33.85 060 6002709 AmLODipine TABLET [2.5 MG] 6.05 060 6002712 IV-AMINOPHYLLINE INJ [500 MG/20 ML] 65.50 060 6002713 IV-AMPICILLIN INJ [1 GRAM] 69.40 060 6002714 IV-SULFAMETHOXAZOLE/TRIMETHOPRIM INJ [80 45.00 060 6002717 IV-DOBUTAMINE 250 MG/20 ML VIAL FOR INJE 3.00 060 6002718 IV-DOPamine/D-5-W [400 MG/250 ML] 95.00 060 6002720 IV-MetroNIDAZOLE/SODIUM CHLORIDE [500 MG 40.00 060 6002721 IV-CEFTAZIDIME INJ [1 GRAM] 57.00 060 6002725 IV-VITAMIN-MULTI ADULT NO.1 WITH VIT K ( 519.15 060 6002726 IV-NAFCILLIN INJ [2 GRAMS] 111.00 060 6002727 IV-PENICILLIN G POTASSIUM 5MMU 40.00 060 6002729 MethylPREDNISolone INJ [125 MG/2 ML] 20.45 060
6002730 MethylPREDNISolone-DEPO INJ [40 MG/ML] 31.65 060 6002732 IV-TOBRAMYCIN INJ [40 MG/ML-2 ML VIAL] 54.25 060 6002740 FLUMAZENIL INJ [0.1 MG/ML-5 ML VIAL] 28.50 060 6002742 IV-SODIUM PHOS M-BASIC-D-BASIC [3 MMOL/M 95.10 060 6002743 HEP B VIR VACC RECOMB [20 MCG/ML-1 ML SY 218.75 060 6002744 IV-AMPHOTERICIN B INJ [50 MG] 98.00 060 6002746 IV-SODIUM ACETATE INJ [2 MEQ/ML-20ML] 40.00 060 6002747 IV-AMIKACIN SULFATE INJ [250 MG/ML] 63.00 060 6002751 IV-FLUconaZOLE/NORMAL SALINE [200MG/100 43.50 060 6002754 IV-FLUconaZOLE/NORMAL SALINE [400 MG/200 68.50 060 6002755 IV-CiproFLOXACIN/D5W [400 MG/200 ML] 40.00 060 6002756 OCTREOTIDE INJ [100 MCG/ML] 33.40 060 6002760 IV-PAMIDRONATE INJ [3 MG/ML-10 ML VIAL] 130.00 060 6002762 MORPhine SULFATE CARPUJECT [4 MG/ML] 10.00 060 6002768 IV-GENTAMICIN INJ [40 MG/ML-2 ML VIAL] 40.00 060 6002770 PROTAMINE SULFATE INJ [10 MG/ML-5 ML VIA 30.25 060 6002771 meTOCLOpramide INJECTION [5MG/5 ML] 4.45 060 6002772 IV-CiproFLOXACIN/D5W [200 MG/100 ML] 40.00 060 6002774 ENALAPRILAT INJ [1.25 MG/ML] 11.80 060 6002776 FILGRASTIM VIAL [300 MCG/1 ML] 1,153.95 060 6002781 ADENOSINE SYRINGE [6 MG/2 ML] 100.00 060 6002784 IV-CALCIUM CHLORIDE INJ [100 MG/ML] 40.00 060 6002785 ZZ-ATROPINE SYRINGE 1 MG [0.1 MG/ML-10 M 76.40 060 6002786 IV-DOBUTamine/D-5-W [500 MG/250 ML] 289.50 060 6002792 IV-POTASSIUM CHLORIDE INJ [2MEQ/ML-20 ML 40.00 060 6002797 IV-RIFAMPIN INJ [600 MG-30 ML VIAL] 312.00 060 6002798 SODIUM BICARBONATE INJ 50 ML [1 MEQ/ML] 54.55 060 6002799 IV-AMPICILLIN/SULBACTAM INJ [1.5 GRAMS] 40.00 060 6002807 IV-PROPOFOL INJ [10MG/ML-100 ML] 171.25 060 6002810 IV-DILTiazem VIAL [5 MG/ML-5 ML VIAL] 40.00 060 6002812 IV-DoXYCycline INJ [100 MG] 98.80 060 6002813 IV-SODIUM THIOSULFATE [25%-50 ML VIAL] 323.50 060 6002814 IV-HETASTARCH/NORMAL SALINE [6%/500 ML] 132.00 060 6002815 IV-AZTREONAM INJ [1 GRAM] 158.50 060 6002817 IV-AZTREONAM INJ [2 GRAMS] 321.50 060 6002828 IV-POTASSIUM ACETATE INJ [2 MEQ/ML-20 ML 40.00 060 6002829 IV-AMPICILLIN INJ [2 GRAMS] 95.75 060 6002830 IV-POTASSIUM PHOS M-BASIC-D-BASIC INJ [3 74.65 060 6002833 IV-ACYCLOVIR INJ [500 MG VIAL] 72.00 060 6002834 IV-NitroGLYCERin/D-5-W [50 MG/250 ML] 44.50 060 6002837 WATER FOR INJECTION STERILE [20 ML NON-B 19.15 060 6002839 IV-GANCICLOVIR INJ [500 MG] 389.50 060 6002840 IV-MEROPENEM INJ [1 GRAMS] 51.50 060 6002841 IV-AZITHROMYCIN INJ [500 MG] 138.00 060 6002842 IV-FAMOTIDINE/NORMAL SALINE [20 MG/50 ML 46.55 060 6002844 IV-LevoFLOXacin/D-5%-W [250 MG/50 ML PRE 88.00 060 6002845 IV-PIPERACILLIN/TAZOBACTAM/D-5-W [2.25 G 70.00 060 6002847 meTOCLOpramide TABLET [5 MG] 3.00 060 6002856 OLANZapine TABLET [2.5 MG] 39.20 060 6002858 PARoxetine TABLET [10 MG] 9.35 060 6002859 TiZANidine TABLET [2 MG] 4.30 060 6002862 RT-FLUTICASONE/SALMETEROL INHALER [500-5 816.95 060
6002865 CALCIUM CARBONATE CHEWTAB [500 MG] 3.00 060 6002866 MINERAL OIL ENEMA 8.00 060 6002873 VITAMIN C TABLET [250 MG] 3.00 060 6002875 OXYcodone/APAP TABLET [5-325 MG] 10.00 060 6002876 RISEDRONATE TABLET [35 MG] 95.95 060 6002885 ValGANciclovir TABLET [450 MG] 180.45 060 6002887 ESCitaloPRAM TABLET [10 MG] 15.15 060 6002911 IV-CefTRIAXone INJ[ 2 GRAMS] 313.00 060 6002927 RT-BUDESONIDE INHALATION [0.5 MG/2 ML BO 38.80 060 6002928 SUMATRIPTAN TABLET [50 MG] 88.00 060 6002934 VENLAFAXINE TABLET [75 MG] 7.65 060 6002936 POLYETHYLENE GLYCOL 3350 U/D [17 GM] 5.35 060 6002948 ARIPiprazole TABLET [15 MG] 70.35 060 6002951 HydroMORPhone CARPUJECT [2 MG/ML] 10.00 060 6002956 BRINZOLAMIDE EYE DROPS [1% -10 ML] 549.15 060 6002962 METhadONE TABLET [5 MG] 5.00 060 6002969 SODIUM BIcarBONATE TABLET [325 MG OR 10 3.00 060 6002984 IV-VALPROATE INJ [100 MG/ML-5 ML VIAL] 68.15 060 6003009 VITAMIN B-12/FOLIC ACID/PYRIDOXINE TABLE 3.20 060 6003015 EPOETIN INJ [20,000 U/ML 4 VIALS PER BOX 1,874.05 060 6003021 THROMBIN 5000 UNIT VIAL 301.45 060 6003024 RT-BUDESONIDE INHALATION [0.25 MG/2 ML B 32.95 060 6003027 IV-DAPTOMYCIN INJ [500 MG] 1,409.15 060 6003039 IV-LIDOCAINE/D-5-W [2 GRAMS/500 ML 65.00 060 6003046 LACTOBACILLUS TABLET 3.00 060 6003047 CLOBETASOL CREAM [0.05%-30 GRAM TUBE] 897.65 060 6003048 BACITRACIN/POLYMYXIN B SULFATE OPTH OINT 100.30 060 6003049 PRAMOXINE RECTAL FOAM [1%- 15 GM] 174.60 060 6003050 IV-MAGnesIUM SULFATE [1 GRAM/100 ML] 71.10 060 6003054 PrednisoLONE EYE DROPS [0.12% - 5 ML BO 86.75 060 6003063 OLANZapine INJ [10 MG] 164.05 060 6003067 InSULin ASpart [100 UN/ML 10 ML VIAL] 994.15 060 6003071 MEMANTINE TABLET [5 MG] 3.00 060 6003073 IV-MAGnesIUM SULFATE INJ [1 GRAM/2 ML] 45.90 060 6003077 VITAMIN B-3 (NIACIN-SR) CAPSULE [250 MG] 3.00 060 6003078 EZEtimIBE TABLET [10 MG] 18.80 060 6003079 GLATIRAMER INJ [20 MG] 855.47 060 6003097 InSULin ASP PRT/INSULIN ASPaRT 70-30 U 1,031.15 060 6003101 MAGnesIUM LACTATE-SR TABLET [84 MG] 3.00 060 6003102 DULOXETINE CAPSULE [20 MG] 28.60 060 6003105 DUTASTERIDE CAPSULE [0.5 MG] 18.00 060 6003106 MICONAZOLE POWDER [2% 3 OZ BOTTLE] 19.60 060 6003113 IV-CefTRIAXone in D-5-W [1 GRAM/50 ML] 215.00 060 6003116 IV-DILTiazem VIAL [100 MG ADDVANTAGE] 88.50 060 6003117 DULOXETINE CAPSULE [30 MG] 26.95 060 6003128 MICONAZOLE BARRIER OINT [2 %-60 GM TUBE] 29.65 060 6003129 IV-PHENYLEPHRINE INJ [10 MG/ML-1 ML VIAL 57.60 060 6003132 DIVALPROEX DR TABLET [125 MG] 3.30 060 6003133 VALsarTAN TABLET [40 MG] 13.60 060 6003135 ENTACAPONE TABLET [200 MG] 13.85 060 6003138 OMEGA-3 FATTY ACIDS CAPSULE [1000 MG] 3.00 060 6003141 TORsemIDE TABLET [10 MG] 3.00 060
6003148 CINACALCET TABLET [30 MG] 76.90 060 6003155 FENOFIBRATE TABLET [54 MG] 3.00 060 6003157 IV-ERTAPENEM INJ [1 GRAMS] 431.45 060 6003160 FENOFIBRATE CAPSULE [200 MG] 28.30 060 6003163 RisperiDONE TABLET [0.25 MG] 13.65 060 6003174 IV-AMINOCAPROIC ACID INJ [250 MG/ML-20 M 40.00 060 6003177 PIOglitaZONE TABLET [15 MG] 24.30 060 6003212 ENOXAPARIN SYRINGE [120 MG/0.8 ML] 50.65 060 6003216 PREGabaLIN CAPSULE [75 MG] 26.60 060 6003233 NADOLOL TABLET [20 MG] 11.90 060 6003239 FONDAPARINUX SYRINGE [2.5 MG/0.5 ML] 191.30 060 6003607 InSULin ASpart [100 UN/ML 10 ML VIAL] 994.15 060 6004048 IV-VASOPRESSIN INJ [20 UNIT/ML] 525.10 060 6004060 BOOST DIETARY SUPPLEMENT 0.00 060 6004061 BOOST PLUS DIETARY SUPPLEMENT 0.00 060 6004066 TF-PULMOCARE TUBE FEEDING [RTH 1000 ML] 0.00 060 6004067 TF-NEPRO DIETARY SUPPLEMENT [RTH 1000 ML 0.00 060 6004070 MAGNACAL RENAL DIETARY SUPPLEMENT 55.00 060 6004071 BOOST BREEZE DIETARY SUPPLEMENT 0.00 060 6004073 TF-JEVITY 1.5 TUBE FEEDING [RTH 1000 ML] 0.00 060 6004076 TF-2 CAL HN TUBE FEEDING [RTH 1000 ML] 0.00 060 6004077 TF-WATER FLUSH TUBE FEEDING 0.00 060 6004079 PATIENT OWN MEDICATION 0.00 060 6004080 INS-ACCU-CHECKS 3.00 060 6004082 PREGabaLIN CAPSULE [25 MG] 27.00 060 6004083 PREGabaLIN CAPSULE [50 MG] 26.60 060 6004085 FentaNYL PATCH CHECK PLACEMENT 0.00 060 6004086 IV-ARGATROBAN INJ [250 MG/2.5 ML} 5,674.50 060 6004090 GUAR GUM PACKET [0.14 OZ PKT] 3.00 060 6004092 IV-LevoFLOXacin/D-5%-W [750 MG/150 ML PR 63.00 060 6004095 IV-CEFTAZIDIME INJ [2 GRAMS] 114.00 060 6004099 DOFETILIDE CAPSULE [0.25 MG] 20.45 060 6004105 VITAMIN D (ERGOCALCIFEROL) DROPS [8,000 349.25 060 6004115 SOD SULF/SOD/NAHCO3/KCL/PEG'S 80.50 060 6004120 VITAMIN B COMP W-C 5MG/FOLIC ACID TABLET 3.00 060 6004123 DIGOXIN IMMUNE INJ [38 OR 40 MG] 12,289.20 060 6004131 IV-IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GM 2,382.00 060 6004132 GUAifenESIN-D/METHORPHAN TABLET[600-30 M 3.00 060 6004136 meTOPROLol TABLET [25 MG] 3.00 060 6004137 IV-VIAL MATE ADAPTOR 10.00 060 6004138 TRIAMTERENE/HYDROCHLOROTHIAZID TABLET [3 3.00 060 6004140 IV-MORPhine SULFATE PCA [1 MG/ML-30 ML-P 40.00 060 6004153 SENnosiDES TABLET (8.6 MG] 3.00 060 6004154 SENnosiDES/DOCUSATE TABLET (8.6-50 MG) 3.00 060 6004156 HydrocoRTISONE INJ [100 MG/2 ML VIAL] 31.35 060 6004163 IV-PIPERACILLIN/TAZOBACTAM/D-5-W [4.5 GM 117.00 060 6004164 B:M:X ORAL SUSPENSION (10 ML UNIT DOSE C 3.50 060 6004165 PANtopraZOLE TABLET (20 MG) 13.30 060 6004166 VITAMIN D (DOXERCALCIFEROL) CAPSULE [0.5 61.05 060 6004167 IV-DILTiazem VIAL [125 MG/25 ML] 40.00 060 6004169 NEOMY SULF/POLYMYX B SULF/HC OTIC(3.5-10 107.80 060 6004170 SODIUM CHLORIDE 10 ML SYRINGE [0.9%] 15.00 060
6004172 MORPhine SULFATEsustained release TABLET 15.05 060 6004173 MAGnesIUM HYDROXIDE SUSP [2400 MG/30 ML 3.00 060 6004175 AmioDARone TABLET [100 MG] 26.00 060 6004180 DESMOPRESSIN NASAL SPRAY [0.01 %] 861.90 060 6004184 AMOXICILLIN/CLAVULANATE SUSP[400 MG/5 ML 106.15 060 6004188 IV-VORICONAZOLE INJ [200 MG IV] 651.50 060 6004192 TOBRAMYCIN OPTH OINTMENT [0.3%] 415.80 060 6004197 CHOICE DM DIETARY SUPPLEMENT 40.22 060 6004198 ALCOHOL-ISOPROPYL [70%-16 OZ. BOTTLE] 9.65 060 6004204 VITAMIN D TABLET [400 UNITS] 3.00 060 6004206 TRIAMCINOLONE 0.1% IN ORABASE 55.12 060 6004207 IV-DEXTROSE 5%-WATER 1000 ML 40.00 060 6004210 THIOridAZINE TABLET [25 MG] 3.00 060 6004213 POTASSIUM CHLORIDE PACKET [20 MEQ] 3.00 060 6004215 RT-FLUTICASONE/SALMETEROL INHALER [100-5 459.50 060 6004218 IV-FentaNYL INJ [2500 MCG/50 ML] 84.00 060 6004219 MetFORMIN TABLET [850 MG] 4.25 060 6004221 DORZOLAMIDE EYE DROPS [2%-10 ML BOTTLE] 233.80 060 6004225 MICONAZOLE VAGINAL CREAM [2 %-45 GRAM TU 30.10 060 6004226 MIDazolam INJ [50 MG/10 ML FOR IV DRIP 156.45 060 6004227 IV-TIGECYCLINE INJ [50 MG] 540.50 060 6004232 CHLORpromazine INJ [25 MG/ML] 20.85 060 6004237 ARIPiprazole TABLET [10 MG] 108.70 060 6004242 IV-MEROPENEM INJ [500 MG] 74.50 060 6004244 PANCRELIPASE-21,000 SR CAPSULE [21K/37K/ 17.60 060 6004247 EMTRICITABINE/TENOFOVIR TABLET [200-300 179.65 060 6004248 CYCLOSPORINE EYE DROPS [0.05%/0.4 ML-BOX 24.85 060 6004252 IV-HydroMORPhone PCA [0.5 MG/ML] 50.00 060 6004255 CARBIDOPA/LEVODOPA TABLET [25 MG-250 MG] 5.65 060 6004256 AMANTADINE SYRUP[ 100 MG/10 ML UNIT DOSE 7.00 060 6004257 VAlprOIC ACID SYRUP [250 MG/5 ML UNIT DO 3.00 060 6004258 DEXAMETHASONE TABLET [0.5 MG] 3.00 060 6004260 AMOXICILLIN SUSPENSION (250 MG/5 ML -100 21.35 060 6004262 meTOPROLol TABLET [12.5 MG PER HALF TAB 3.00 060 6004265 LOPERAMIDE LIQUID [2 MG/10 ML UNIT DOSE] 7.10 060 6004270 DIPYRIDAMOLE TABLET [25 MG] 3.00 060 6004271 ACYcloVIR CREAM [5% - 5 GRAM TUBE] 1,978.35 060 6004281 ROPINIRole TABLET [0.25 MG] 3.00 060 6004287 ZIPRASIDONE CAPSULE [20 MG] 31.40 060 6004289 HYOSCYAMINE SUBLINGUAL TABLET [0.125 MG] 3.00 060 6004294 LITHIUM CARBONATE TABLET [300 MG] 3.00 060 6004295 SIMvastATIN TABLET [5 MG] 9.20 060 6004299 MethylPREDNISolone TABLET DOSE-PAK [4 M 105.05 060 6004301 MIRtazaPINE TABLET [7.5 MG/ TAB] 9.25 060 6004308 PredniSONE TABLET [2.5 MG] 3.00 060 6004309 PROchlorperazine TABLET [5 MG] 3.00 060 6004311 DiphenhydrAMINE LIQUID [25 MG/10 ML UNI 3.00 060 6004317 IV-FOSphenytoin INJ [50MG/ML-500 MG VIA 60.00 060 6004319 LIDOCAINE INJ [1% OR 10 MG/ML-5 ML VIAL] 11.40 060 6004320 LIDOCAINE INJ [2% OR 20 MG/ML-5 ML VIAL] 9.95 060 6004323 REPAGLINIDE TABLET [0.5 MG] 3.00 060 6004325 FentaNYL PATCH [12 MCG/HR] 75.00 060
6004326 RT-SODIUM CHLORIDE INHALATION [0.9%-5 ML 3.00 060 6004329 SILVER SULFADIAZINE CREAM [1% -400 GRAMS 222.60 060 6004330 BUMETANIDE INJ [0.25 MG/ML-4 ML] 4.65 060 6004331 WATER FOR INJECTION STERILE [10 ML NON-B 3.65 060 6004332 WATER FOR INJECTION STERILE [100 ML NON- 13.20 060 6004346 BUPROPION TABLET-XL [150 MG] 18.30 060 6004347 CarBAMazepine SUSPENSION [200 MG/10 ML U 8.85 060 6004351 VITAMIN B-12 TABLET [500 MCG] 3.00 060 6004352 PRAMOXINE/HYDROCORTISONE RECTAL CREAM [1 652.50 060 6004356 MODAFINIL TABLET [100 MG] 92.35 060 6004357 PETROLATUM/GLYCERIN OINTMENT[3 GM UD PAC 3.00 060 6004359 NitroGLYCERin OINTMENT [2%- 1 GRAM U/D 4.70 060 6004361 CALCITONIN INJ [200 IU/ML- 2ML VIAL] 259.80 060 6004362 IV-ERYTHROMYCIN LACTOBIONATE INJ [500 MG 111.00 060 6004365 MICONAZOLE VAGINAL TABLET (7 TABS)[2 %] 40.50 060 6004370 LIDOCAINE JEL [ 2% 30 ML TUBE] 58.35 060 6004372 RANolaZINE TABLET [500 MG-12 HOUR TAB] 16.85 060 6004375 CLOTRIMAZOLE CREAM [1%-30 GRAM TUBE] 29.05 060 6004382 RT-SODIUM CHLORIDE INHALATION [0.9%-3 ML 3.00 060 6004391 HYALuroniDASE INJ [150 UNIT/ML VIAL] 274.40 060 6004392 GENTAMICIN CREAM [0.1%-30 GM TUBE] 230.45 060 6004393 TRIAMCINOLONE CREAM [0.1%-80 GRAM TUBE] 48.80 060 6004394 TRIAMCINOLONE CREAM [0.5%-15 GRAM TUBE] 38.85 060 6004398 CITRIC ACID/SODIUM CITRATE LIQUID [334-5 3.00 060 6004400 MENTHOL/CAMPHOR/PHENOL OINTMENT[0.6/0.5% 6.61 060 6004402 TF-RESIDUAL CHECK FEEDING TUBE 0.00 060 6004403 BOOST DIABETIC DIETARY SUPPLEMENT 55.00 060 6004405 IV-POTASSIUM CHLORIDE INJ [2MEQ/ML-10 ML 40.00 060 6004412 VITAMIN B-1 INJ [100 MG/ML-2 ML VIAL] 45.00 060 6004417 NOTES 0.00 060 6004420 LIDOCAINE SOLUTION [4%-50 ML] 32.10 060 6004424 SUCCINYLCHOLINE VIAL [20 MG/ML-10 ML] 25.00 060 6004425 POVIDONE-IODINE SWAB [10%] 3.00 060 6004427 VITAMIN-MULTI TABLET FOR THE EYES 3.00 060 6004433 HYDROchloroHIAZIDE CAPSULE [12.5 MG] 3.00 060 6004438 PERMETHRIN CREAM {5%] 60 GRAM 433.15 060 6004440 PAIN SCALE 3.00 060 6004443 MELATONIN TABLET [3 MG] 3.00 060 6004445 ENSURE PLUS 4.65 060 6004446 CLOZAPINE TABLET [100 MG] 12.00 060 6004447 IV-PIPERACILLIN SODIUM/TAZOBACTAM [2.25 61.50 060 6004448 OCTREOTIDE INJ [500 MCG/ML] 390.20 060 6004451 TF-NUTRIHEP DIETARY SUPPLEMENT 0.00 060 6004452 LEVEtiraceTAM TABLET [250 MG] 9.10 060 6004453 VANcoMYCIN INJ BULK[5 GRAM VIAL] 134.40 060 6004454 VANcoMYCIN INJ BULK[10 GRAM VIAL] 600.60 060 6004457 NOVASOURCE-RENAL DIETARY SUPPLEMENT 15.60 060 6004460 KETOCONAZOLE SHAMPOO [2%-120 ML] 97.15 060 6004463 IV-PIPERACILLIN SODIUM/TAZOBACTAM [4.5 G 116.00 060 6004464 RT-FLUTICASONE/SALMETEROL INHALER [115-2 1,251.25 060 6004469 PATCH CHECK PLACEMENT 0.00 060 6004472 RIfaxiMIN TABLET [200 MG] 67.30 060
6004477 WATER FOR IRRIGATION STERILE [1000 ML NO 35.00 060 6004481 ADENOSINE SYRINGE[12 MG/4 ML] 271.85 060 6004482 RT-ALBUTEROL ORAL INHALER-HFA [90 MCG-8 222.70 060 6004483 IV-INTERLINK INJECTION SITE 2N3399 43.05 060 6004494 TIMOLOL GEL SOLN EYE DROPS [0.5%-5 ML BT 204.75 060 6004500 TF-PEPTAMEN 1.5 DIETARY SUPPLEMENT [RTH 0.00 060 6004503 EPOETIN INJ [40,000 U/ML-4 VIALS PER BOX 3,931.20 060 6004504 MORPhine SULFATE ORAL SOULTION [10 MG/5 10.00 060 6004506 LANTHANUM CHEWTABLET [500 MG] 30.90 060 6004507 LAbetaLOL SYRINGE [5 MG/ML-4 ML ] 13.90 060 6004508 RT-AMIKACIN SULFATE INH [250 MG/ML-2 ML 63.00 060 6004509 RT-GENTAMICIN INHALATION [40 MG/ML-2 ML 40.00 060 6004510 RT-TOBRAMYCIN INHALATION [40 MG/ML-2 ML 45.20 060 6004513 IV-FUROSEMIDE [10 MG/ML-10 ML] 40.00 060 6004514 IV-InSULin REGular HUMAN INJ [100 U/ML 1 187.00 060 6004515 IV-SODIUM BICARBONATE 50 ML [1 MEQ/ML] 54.55 060 6004522 ENSURE LIQUID 5.40 060 6004523 ENSURE PUDDING [4 OUNCE CUP] 6.45 060 6004526 GLYCERIN LIQUID [16 OZ BOTTLE-BILL BY OZ 3.00 060 6004529 SitaGLIPtin TABLET [25 MG] 50.90 060 6004532 PAPER FOR MEDSELECT 45.00 060 6004539 TF-OXEPA TUBE FEEDING [RTH 1000 ML] 0.00 060 6004543 IV-LEVEtiraceTAM INJ [500 MG/5 ML VIAL] 166.50 060 6004546 VORICONAZOLE SUSP [40 MG/ML-75 ML BTL] 3,769.30 060 6004548 RT-COLISTIMETHATE [150 MG/3 ML] 157.60 060 6004550 CALCIUM CARBONATE LIQUID [500 MG/5 ML U/ 3.00 060 6004551 TETRAHYDROZOLINE EYE DROPS [0.05%-15 ML 7.55 060 6004556 LamiVUDine SOLUTION [10 MG/ML-240 ML BTL 436.45 060 6004560 ABACAVIR TABLET[300 MG] 35.90 060 6004573 VITAMINS A AND D OINTMENT[U/D PACKETS] 3.00 060 6004574 SILDENAFIL TABLET [20 MG] 70.05 060 6004577 ATROPINE SYRINGE 1 MG PER 10 ML 76.40 060 6004579 EPINEPHRINE SYRINGE 1 MG PER 10 ML 60.35 060 6004582 ESTRADIOL TABLET [0.5 MG] 3.00 060 6004593 SODIUM CHLORIDE NASAL GEL [0.5 OZ. TUBE] 10.80 060 6004594 TESTOSTERONE VIAL 200 MG/ML-1 ML VIAL] 100.20 060 6004597 ASPIRIN SUPP [300 MG] 4.05 060 6004608 RIVastiGMINE PATCH [4.6 MG] 59.15 060 6004609 IMMUNOSUPPRESSANT-DRAW LEVEL 50.00 060 6004610 IMMUNOSUPPRESSANT-HOW TO GIVE 0.00 060 6004616 IBUTILIDE INJECTION [0.1 MG/ML-10 ML VIA 1,899.55 060 6004620 RT-ALBUTEROL INHALATION 1.25 MG/3 ML VIA 5.85 060 6004621 G TUBE DECLOGGER KIT(SOD BICARB/PANCREL) 10.00 060 6004622 MYCOPHENOLATE SUSPENSION [200 MG/ML-175 3,502.00 060 6004629 OXYcodone sustained release TABLET [15 M 19.45 060 6004635 GUAifenESIN-CODEINE SYRUP [100-10 MG/5 M 5.00 060 6004636 WARfarIN TABLET [0.5 MG/0.5 MG TAB] 3.40 060 6004638 VANcoMYCIN ORAL SOLUTION 250 MG/10 ML-10 101.00 060 6004641 TF-HOLD TUBE FEED 0.00 060 6004645 HydroCODone/HOMATROPINE LIQUID [5-1.5MG/ 15.00 060 6004647 TF-GLUCERNA 1.2 LIQUID (RTH 1000 ML] 0.00 060 6004649 INR LAB TEST 15.00 060
6004657 CHLORHEXIDINE GLUCONATE [15 ML U/D] 3.75 060 6004658 KETAMINE INJECTION[50 MG/ML-10 ML VIAL] 56.90 060 6004660 SODIUM CHLORIDE 0.9% STERILE [20 ML NON- 4.00 060 6004674 MENTHOL/CAMPHOR LOTION[0.5%-0.5%-7.5 OZ. 16.10 060 6004675 RT-TIOTROPIUM INHALATION KIT [5 X 18 MCG 47.75 060 6004676 HEparIN **DIALYSIS**[5,000 UNITS/ML-1 ML 16.25 060 6004677 IV-PENTAMIDINE [300 MG VIAL] 474.00 060 6004679 OXYbutYNIN SYRUP [5 MG/5 ML] 14.50 060 6004681 RIVastiGMINE PATCH [9.5 MG] 63.10 060 6004682 BENZOCAINE ORAL GEL 20% [30 GRAM ] 33.15 060 6004685 JUVEN DIETARY SUPPLEMENT 10.05 060 6004686 DESMOPRESSIN TABLET[0.1 MG] 10.60 060 6004687 RT-BUDESONIDE/FORMOTEROL INHALER[160/4.5 833.15 060 6004691 SEVELAMER CARBONATE TABLET [800 MG] 17.85 060 6004693 DOFETILIDE CAPSULE [0.125 MG] 21.15 060 6004697 LIDOCAINE OINTMENT [5%-35 GRAM] 252.00 060 6004698 RT-FLUTICASONE/SALMETEROL INHALER [230-2 1,848.45 060 6004702 IV-MICAFUNGIN INJ [100 MG] 898.00 060 6004704 SODIUM PHOS/POT PHOS TABLET [700/305MG] 3.50 060 6004708 VITAMIN D3 TABLET [1,000 UNITS] 3.00 060 6004711 VORICONAZOLE TABLET [50 MG] 45.65 060 6004717 SUSPENDING AGENT FOR DRUG COMPOUNDING 4.00 060 6004718 SWEETENING AGENT FOR DRUG COMPOUNDING 4.00 060 6004721 ACYcloVIR SUSP 5 ML U/D[200 MG/5 ML] 15.30 060 6004722 TAcroLIMUS SUSPENSION [1 MG/ML-90 ML] 2,380.00 060 6004723 BENZTROPINE TABLET [0.5 MG] 3.00 060 6004725 PERMETHRIN LOTION [1%] - 60 ML 33.95 060 6004726 IV-AZTREONAM/D-5-W [2 GRAM/50 ML] 933.00 060 6004733 FONDAPARINUX SYRINGE [7.5 MG/0.6 ML] 450.15 060 6004735 AMPULE BREAKER, DISPOSABLE 3.00 060 6004736 SWEETENING AGENT FOR DRUG COMPOUNDING 3.00 060 6004739 WATER, DISTILLED [1 GALLON] 3.00 060 6004740 TIMOLOL GEL SOLN EYE DROPS [0.25%-5 ML B 482.65 060 6004743 RT-FLUTICASONE/SALMETEROL INHALER [45-21 904.85 060 6004745 BACITRACIN/POLYMYXIN B SULFATE 500-10KU/ 3.00 060 6004747 RT-BUDESONIDE/FORMOTEROL INHALER[80/4.5M 541.05 060 6004748 LINDANE SHAMPOO[1%-60 ML BOTTLE] 479.05 060 6004750 PRAMOXINE/HYDROCORTISONE RECTAL CREAM [2 217.40 060 6004752 PHENobarbital VIAL [65 MG/1 ML] 45.75 060 6004755 PSEUDOEPHEDRINE-ER TABLET [120 MG] 3.00 060 6004758 DIVALPROEX-ER TABLET [250 MG] 8.60 060 6004759 DroneDARone TABLET [400 MG] 16.70 060 6004760 TF-OSMOLYTE 1.2 TUBE FEEDING [RTH 1000 M 21.75 060 6004761 IV-LACosaMIDE INJECTION [10 MG/ML-20 ML 269.70 060 6004765 BRIMONIDINE EYE DROPS [0.2% -10 ML] 228.35 060 6004775 RT-BECLOMETHASONE ORAL INHALER [80 MCG- 748.50 060 6004780 FentaNYL PATCH REMOVAL 0.00 060 6004785 METHIMAZOLE TABLET [5 MG] 3.00 060 6004791 CloNIDine PATCH REMOVAL 0.00 060 6004792 NICOTINE PATCH REMOVAL 0.00 060 6004793 LIDOCAINE PATCH REMOVAL 0.00 060 6004794 RIVastiGMINE PATCH REMOVAL 0.00 060
6004796 NitroGLYCERin PATCH REMOVAL 0.00 060 6004800 TF-PIVOT 1.5 TUBE FEEDING [RTU 1000 ML] 0.00 060 6004803 ESCitaloPRAM TABLET [5 MG] 14.50 060 6004804 QUEtiapine TABLET [12.5 MG PER HALF TABL 13.85 060 6004810 PANCRELIPASE 10500/61500/35500 UNITS DR 9.70 060 6004811 LYTES/YERBA SANTA MOUTH SPRAY[60 ML] 20.85 060 6004815 TF-VITAL AF 1.2 TUBE FEEDING [RTH 1000 M 70.25 060 6004816 RIfaxiMIN TABLET [550 MG] 117.70 060 6004822 IV-cefTAROline INJECTION [600 mg] 276.00 060 6004833 RT-ALBUTEROL/IPRATROP INHALATION [3/0.5M 7.70 060 6004836 LIDOCAINE CREAM [3%-30 GM] 204.25 060 6004838 IV-VANcoMYCIN INJ [750 MG VIAL] 40.00 060 6004847 PRAMOXINE RECTAL OINTMENT [1%- 30 GM] 13.90 060 6004857 FLUconaZOLE TABLET [50 MG] 18.60 060 6004858 ROFLUMILAST TABLET [500 MCG] 27.90 060 6004864 LevoTHYROxine INJ [100 MCG] 385.60 060 6004866 SEVELAMER CARBONATE POWDER [0.8 GRAMS] 64.70 060 6004873 RT-FORMOTEROL SOLUTION[20 MCG/2 ML] 43.30 060 6004878 IV-PROCAINAMIDE INJ [100 MG/ML-10 ML VIA 230.20 060 6004881 RIVaroxABAN TABLET [15 MG] 40.00 060 6004882 ARIPiprazole TABLET [2 MG] 112.30 060 6004885 HydroCODone/ACETaminoPHEN TABLET [5-325 5.00 060 6004887 RSI KIT-LAKEWOOD 700.00 060 6004891 IV-SODIUM CHLORIDE INJ [23.4% - 30 ML] 40.00 060 6004897 LIDOCAINE VISCOUS 2% [300 MG/15 ML UNIT 15.00 060 6004898 SCOPOLAMINE PATCH REMOVAL 0.00 060 6004899 CHLORHEXIDINE WASH CLOTHS [2%] 30.95 060 6004900 TF-FEEDING TUBE LARGER THAN 16 FRENCH 0.00 060 6004901 TF-FEEDING TUBE SMALLER THAN 16 FRENCH 0.00 060 6004904 TESTOSTERONE GEL PACKETS [1%-2.5 GM U/D 48.30 060 6004905 LANOLIN/MINERAL OIL LOTION [240 ML] 8.95 060 6004906 PROTEIN/AMINO ACIDS-S/F-100 SUPPLEMENT 4.30 060 6004908 ZZ-IV-AmioDARone/D5W [360 MG/200ML] 272.95 060 6004912 CALCIUM CHLORIDE INJ [100 MG/ML] 20.00 060 6004913 DEHYDRATED ALCOHOL 98% [5 ML VIAL] 170.65 060 6004914 SODIUM HYPOCHLORITE IRRIGATION [0.125 % 33.50 060 6004916 WARfarIN MANAGEMENT PROTOCOL 75.00 060 6004917 MIDazolam VIAL [5 MG/ML-1 ML VIAL] 15.00 060 6004919 MEmanTINE-XR CAPSULE [7 MG] 49.60 060 6004920 RIVaroxABAN TABLET [10 MG] 50.35 060 6004922 IV-DILTiazem VIAL [5 MG/ML-10 ML VIAL] 40.00 060 6004923 LACosaMIDE SUSP [200 MG/20 ML CUP] 87.45 060 6004925 THeoPHYLLINE LIQUID U/D [80 MG/15 ML] 43.85 060 6004926 RX PADS 0.00 060 6004927 APIxaBAN TABLET [5 MG] 23.35 060 6004930 FUroseMIDE ORAL SOLUTION [40 MG/4ML UNI 8.65 060 6004933 HALoperiDOL LIQUID [10 MG/ 5 ML U/D CUP] 7.15 060 6004936 TERbutALINE INJECTION [1 MG/ML-VIAL] 57.25 060 6004937 DiphenOXYLATE/ATROP LIQUID [2.5-.025 MG/ 21.00 060 6004938 RisperiDONE LIQUID [1 MG/ML-1 ML U/D] 17.80 060 6004939 RisperiDONE LIQUID [2 MG/ML-2 ML U/D] 17.80 060 6004940 GABapenTIN SOLUTION [100 MG/2 ML U/D SYR 10.50 060
6004941 GABapenTIN SOLUTION [300 MG/6 ML U/D CUP 10.50 060 6004942 GABapenTIN SOLUTION [400 MG/8 ML U/D CUP 10.50 060 6004943 GABapenTIN SOLUTION [600 MG/12 ML U/D CU 10.50 060 6004944 GABapenTIN SOLUTION [900 MG/18 ML U/D CU 10.50 060 6004945 GABapenTIN SOLUTION [500 MG/10 ML U/D CU 10.50 060 6004946 ARIPiprazole SOLTION [2 MG/2 ML U/D SYR] 274.85 060 6004947 ARIPiprazole SOLTION [5 MG/5 ML U/D CUP] 981.55 060 6004948 ARIPiprazole SOLTION [10 MG/10 ML U/D CU 1,269.10 060 6004949 ARIPiprazole SOLTION [15 MG/15 ML U/D CU 1,903.65 060 6004950 GABapenTIN SOLUTION [250MG/5 ML U/D CUP] 10.50 060 6004951 IV-CEFTOLOZANE/TAZOBACTAM INJ [1.5 GRAMS 388.60 060 6004952 BALSAM PERU/CASTOR OIL OINTMENT[BILL 1 T 131.25 060 6004953 EVEROLIMUS TABLET (0.5 MG) 61.30 060 6004954 IV-CEFTAZIDIME/AVIBACTAM [2/0.5 GRAM] 1,237.00 060 6004955 LINEZOLID ORAL SUSP. (600 MG/30 ML UNIT 341.07 060 6004956 BISMUTH SUBSALICYLATE SUSP (1050 MG/30 M 3.50 060 6004957 ESCITALOPRAM ORAL SOLUTION (5 MG/5 ML UN 8.35 060 6004958 RT-SODIUM CHLORIDE INHALATION [7.0%-4 ML 3.00 060 6004960 THEOPHYLLINE 400 MG EXTENDED RELEASE TAB 5.00 060 6004962 INFLUENZA VACCINE QUADRIVALENT 2018-19 ( 85.00 060 6004963 RT-LEVALBUTEROL INHALATION (1.25 MG/3 ML 7.00 060 6004964 RT-LEVALBUTEROL INHALATION (0.63 MG/3 ML 60.00 060 6004965 TF-VITAL 1.5 TUBE FEEDING (RTH 1000 ML) 271.23 060 6004967 MORPHINE SULFATE SINGLE DOSE VIAL [4 MG/ 22.60 060 6004968 HYDRALAZINE TABLET 100 MG 28.04 060 6004969 LACOSAMIDE 150 MG TABLET 65.88 060 6004970 OMEPRAZOLE 20 MG/10 ML ORAL SUSP. (90 ML 51.00 060 6004971 SENNOSIDES 8.8 MG/5 ML UNIT DOSE CUP 8.00 060 6004972 SODIUM POLYSTYRENE SULFONATE POWDER 15 G 126.00 060 6004973 IV-CEFAZOLIN-DEXTROSE IV SOLUTION 2 GM/1 47.39 060 6004974 OMEPRAZOLE 40 MG/20 ML ORAL SUSP-300ML 335.00 060 6005230 PILOCARPINE EYE DROPS [1%-15 ML BTL] 32.20 060 6005234 NF-CEFOXITIN SODIUM IV PWD FOR SOLN 2GM 78.75 060 6005235 NF-ENSURE MAX PROTEIN ORAL SUSPENSION 0.03 060 6005236 NF-CLINIMIX E 4.25/10 IV SOLN 0.17 060 6005237 CEFOXITIN (MEFOXIN) 2GM VIAL 209.47 060 6005238 NF-BIOFREEZE COLD THERAPY PAIN RELIEF GE 0.00 060 6005239 NF-BIOFREEZE COLD THERAPY PAIN RELIEF GE 0.00 060 6005240 CLINIMIX E (WITH ELECTROLYTES) 1000ML 162.75 060 6005241 VANCOMCYIN/NS IVPB 1750MG/500ML 0.00 060 6005242 VANCOMYCIN/NS IVPB 1500MG/250ML 0.00 060 6005243 VANCOMYCIN/NS IVPB 1250MG/250ML 0.00 060 6005244 VANCOMYCIN/NS IVPB 1750MG/250ML 0.00 060 6005245 EXELON PATCH REMOVAL 0.00 060 6005246 TPN SOLUTION 750.00 060 6005247 ATORVASTATIN 10MG TABLET 3.00 060 6005248 ATORVASTATIN 20MG TABLET 3.00 060 6005249 ATORVASTATIN 40MG TABLET 3.00 060 6005250 ERTAPENEM/NS IVPB 500MG \ 100 ML 0.00 060 6005251 ERTAPENEM 1GM VIAL 490.00 060 6005252 PHOS-NaK 250MG Packet 3.00 060 6005253 DRONABINOL 5MG CAPSULE 12.26 060
6005254 PHOS-NaK 250MG PACKET 3.00 060 6005255 NF-PRIMIDONE ORAL TABLET 50MG 2.78 060 6005256 NF-CLINIMIX E 4.25/10 IV SOLN 0.17 060 6005257 NF-METHENAMINE HIPPURATE TAB 1GM 7.32 060 6005258 NF-PRADAXA CAP 150MG 28.04 060 6005259 NF-XERAVA INTRAVENOUS PWD FOR SOLN 50MG 205.80 060 6005260 IV-ERAVACYCLINE (XERAVA) 50MG VIAL 171.50 060 6005261 ZONISAMIDE 100MG CAP 0.00 000 6005262 IV-ERAVACYCLINE (XERAVA) 50MG VIAL 171.50 060 6005263 NF-ZONISAMIDE CAP 100MG 7.67 060 6005264 NF-BIKTARVY ORAL TAB 50MG-200MG-25MG 432.60 060 6005265 NF-PRASUGREL HYDROCHLORIDE TAB 10MG 28.97 060 6005266 NF-METHOCARBAMOL ORAL TABLET 500MG 2.94 060 6005267 NF-ISOSOURCE 1.5 CAL LIQUID 0.02 060 6005268 NF-ATOVAQUONE ORAL SUSPENSION 750MG/5ML 35.23 060 6005269 NF-ENOXAPARIN SODIUM INJ SOLN 150MG/ML 125.20 060 6005270 NF-IVERMECTIN ORAL TABLET 3MG 17.39 060 6005271 ENOXAPARIN SOD 150MG/ML INJ 35.77 000 6005272 NF-SILODOSIN CAP 8MG 32.72 060 6005274 IV-VANCOMYCIN 1.25GM INJ 84.42 060 6005275 IV-VANCOMYCIN 1.5GM INJ 101.29 060 6005276 IV-VANCOMYCIN 1.5MG/300ML (PREMIX) 189.00 060 6005277 NF-CRANBERRY ORAL CAPSULE 425MG 0.22 060 6005278 NF-ANASTROZOLE ORAL TABLET 1MG 7.25 060 6005279 NF-URSODIOL ORAL TABLET 250MG 14.28 060 6005280 NF-ROPINIROLE HCL TAB 4MG 8.75 060 6005281 NF-SERTRALINE HYDROCHLORIDE ORAL TAB 100 1.41 060 6005282 NF-LINZESS CAP 290MCG 59.34 060 6005283 NF-MOTEGRITY ORAL TABLET 2MG 59.35 060 6005284 NF-BIOTIN ORAL CAPSULE 2500MCG 0.33 060 6005285 NF-ZELNORM TAB 6MG 27.23 060 6005286 NF-E.E.S. GRANULES PWD FOR SUSP 200MG/5M 1.47 060 6005287 NF-PREDNISONE TABLET 1MG 0.97 060 6005288 NF-FONDAPARINUX SODIUM SUBQ SOLN 5MG/0.4 1,188.25 060 6005289 FUROSEMIDE 500MG IN 50ML (10MG/ML) 0.00 060 6005290 CENTRUM LIQUID MULTIPLE VITAMINS 8OZ 7.12 060 6005291 NF-LETROZOLE ORAL TABLET 2.5MG 63.40 060 6005292 NF-BREO ELLIPTA INHALATION POWDER 20.30 060 6005293 NF-JEVITY 1.2 CAL ORAL SOLUTION 0.02 060 6005294 NF-OSELTAMIVIR PHOSPHATE CAP 30MG 49.63 060 6005295 NF-UREA TOPICAL CREAM 20% 0.60 060 6005296 NF-VITAMIN A & D OINTMENT 0.20 060 6005297 NF-TESTOSTERONE CYPIONATE IM OIL 200MG/1 82.00 060 6005298 NF-LINZESS CAP 145MCG 59.34 060 6005299 NF-ENTRESTO ORAL TABLET 24MG-26MG 35.64 060 6005302 NF-AZATHIOPRINE 50MG TAB 171.50 060 6005303 AZATHIPRINE 50MG TAB 7.38 060 6005305 NF-BREO ELLIPTA INHALATION POWDER 18.59 060 6005306 NF-PROPAFENONE HCL CAP ER 225MG 33.97 060 6005307 NF-LETAIRIS ORAL TABLET 10MG 1,359.13 060 6005308 NF-FEMARA TAB 2.5MG 98.29 060 6005309 NF-SENNA ORAL SYRUP 176MG/5ML 1.02 060
6005310 NF-NIMODIPINE LIQ CAP 30MG 64.44 060 6005311 NF-INGREZZA CAP 80MG 942.62 060 6005312 NF-TRIHEXYPHENIDYL HCL TAB 5MG 1.27 060 6005313 NF-CLONAZEPAM DISINTEGRATING TAB 1MG 5.19 060 6005314 NF-CLONAZEPAM ORAL TABLET 1MG 2.99 060 6005315 NF-CLONAZEPAM TABLET 2MG 4.14 060 6005316 BMX SUSP 90ML (BENADRYL/MAALOX/XYLOCAINE 60.00 060 6005317 NF-ERYTHROMYCIN OPHTH OINT 5MG/1GM 18.65 060 6005318 NF-PROPYLTHIOURACIL ORAL TABLET 50MG 11.76 060 6005319 NF-ALFUZOSIN HCL TAB ER 10MG 14.75 060 6005320 NF-LUPRON DEPOT IM 6 MONTH PWD FOR SUSP 41,940.08 060 6005321 NF-TORSEMIDE AVPAK ORAL TABLET 100MG 10.13 060 6005322 IV-PROPOFOL INJ (10MG/ML - 50ML) 86.63 060 6005323 A + D OINTMENT (1.5 OZ TUBE) 11.30 060 6005324 BMX 1:1:1 MOUTHWASH (PREMIX) 101.37 060 6005325 NF-VELTASSA POWDERFORSUSPENSION 8.4GM/1P 114.91 060 6005326 NF-FYCOMPA ORAL TABLET 8MG 141.12 060 6005327 GABapenTIN SOLUTION [800MG/16ML U/D CUP] 3.00 060 6005330 NF-DICLOFENAC SODIUM TOPICAL GEL 1% 1.84 060 6005331 NF-FLOVENT HFA INH ORAL/NEB 0.11MG/1ACT 90.34 060 6005332 CIMETIDINE 400MG TABLET 118.09 060 6005333 FAMOTIDINE (PEPCID) 10MG TAB 1.75 060 6005334 FAMOTIDINE 10MG TABLET 0.50 060 6005335 NF-XTAMPZA ER ORAL CAPSULE ER 36MG 65.75 060 6005336 NF-XTANDI LIQ CAP 40MG 417.14 060 6005337 NF-SULFASALAZINE TABLET 500MG 0.77 060 6005338 NF-SULFASALAZINE AVPAK TAB 500MG 1.95 060 6005339 HYDROMORPHONE 2MG/ML INJ (VIAL) 6.55 060 6005340 NF-CEFDINIR ORAL CAPSULE 300MG 17.88 060 6005341 NF-SILODOSIN CAP 8MG 17.56 060 6005342 NF-VITAMIN B12 AVPAK TABLET 100MCG 1.07 060 6005343 NF-FLUPHENAZINE HCL TAB 5MG 32.20 060 6005344 NF-HYDROXYUREA CAP 500MG 4.47 060 6005345 NF-VELTASSA POWDERFORSUSPENSION 8.4GM/1P 0.00 060 6005346 NF-FONDAPARINUX SODIUM SUBQ SOLN 5MG/0.4 1,125.34 060 6005347 DICLOFENAC Sodium TOPICAL GEL 1% 126.96 060 6005348 NF-FONDAPARINUX SODIUM NOVAPLUS 10/0.8 307.12 060 6005349 NF-MINOCYCLINE HCL ORAL CAPSULE 100MG 4.62 060 6005350 INFLUENZA VACCINE 2020-21 SEASON 85.00 060 6005352 NF-ENOXAPARIN SODIUM INJ SOLN 150MG/1ML 0.00 060 6005353 NF-SILODOSIN ORAL CAPSULE 8MG 31.37 060 6005354 NF-BREO ELLIPTA INH PWD 100MCG-25MCG/1AC 20.91 060 6005355 NF-BRIMONIDINE TARTRATE OPHTH SOLN 0.1% 141.05 060 6005356 NF-BIOTENE DRY MOUTH MOUTHWASH MM SOLUTI 3.00 060 6005357 NF-BIOTENE DRY MOUTH MOUTHWASH MM SOLUTI 3.00 060 6005358 NF-DEXAMETHASONE ORAL TABLET 1.5MG 3.00 060 6005359 NF-MEDIHONEY TOPICAL GEL 80% 3.00 060 6005360 NF-MEDIHONEY TOPICAL GEL 100% 2.59 060 6005361 NF-FONDAPARINUX SODIUM SUBQ SOLN 5MG/0.4 1,125.34 060 6005362 NF-APIXABAN TAB 2.5MG 0.00 060 6005363 DEXAMETHASONE 1.5MG TABLET 3.00 060 6005364 NF-FLOVENT HFA INH/NEB AER PWD 0.22MG/1A 79.47 060
6005365 NF-PRAZOSIN HCL CAP 1MG 6.25 060 6005366 NF-PRAZOSIN HCL CAP 2MG 8.72 060 6009998 NON FORMULARY IV/INJECTABLE 5.00 060 6009999 NON FORMULARY 3.00 060 6010002 IV-0.45% NORMAL SALINE 1000ML 40.00 060 6010030 IV-DEXTROSE 5%-0.45 NORMAL SALINE 1000ML 40.00 060 6010032 IV-DEXTROSE 5%-0.25 NORMAL SALINE 1000ML 40.00 060 6010034 IV-DEXTROSE 5%-LACTATED RINGERS 1000 ML 40.00 060 6010036 IV-DEXTROSE 5%-0.9% NORMAL SALINE 1000ML 40.00 060 6010044 IV-DEXTROSE 5%-WATER 250 ML 40.00 060 6010061 IV-DEXTROSE 5%-WATER 500 ML 40.00 060 6010066 IV-LACTATED RINGERS SOLUTION 1000 ML 40.00 060 6010076 IV-NORMAL SALINE 1000 ML 40.00 060 6010078 IV-NORMAL SALINE 250 ML 40.00 060 6010080 IV-NORMAL SALINE 500 ML 40.00 060 6010381 IV-DEXTROSE 10%-WATER 1000 ML 40.00 060 6010392 IV-POTASSIUM CHLORIDE/D5-0.45NS [20 MEQ/ 48.00 060 6010395 IV-DEXTROSE 5%-WATER 100 ML 40.00 060 6010397 IV-NORMAL SALINE 100 ML 40.00 060 6010398 IV-POTASSIUM CHLORIDE/D5-0.45NS [40 MEQ/ 48.00 060 6010401 IV-POTASSIUM CHLORIDE [20 MEQ/100 ML] 49.00 060 6010412 IV-POTASSIUM CHLORIDE/D5-NS [20 MEQ/1000 48.00 060 6010485 IV-POTASSIUM CHLORIDE/D5-NS [40 MEQ/1000 48.00 060 6010543 IV-CeFAZolin INJ [1 GRAM] 40.00 060 6010641 IV-CeFAZolin in D5W 1GM/50ML 40.00 060 6010701 IV-POTASSIUM CHLORIDE/D5-0.45NS [10 MEQ/ 48.00 060 6010702 IV-AZTREONAM/D-5-W [1GRAM/50 ML] 466.00 060 6010705 IV-DEXTROSE 5%-WATER ADD-VANTAGE [100 ML 49.90 060 6010713 IV-AMINO ACID 4.25%/DEXTROSE 25% 1000 ML 199.00 060 6010716 IV-POTASSIUM CHLORIDE/D5-0.25NS [20 MEQ/ 48.00 060 6010717 IV-POTASSIUM CHLORIDE/0.45 NS [20 MEQ/10 50.00 060 6010720 IV-DEXTRAN 10%-D-5-W [500 ML] 98.00 060 6010722 Z-IV-TUBING NITROGLYCERIN VENTED (2C8851 25.55 060 6010723 ZZ-IV-NORMAL SALINE [500 ML-2B1323Q] 35.00 060 6010724 ZZ-IV-DOPamine/D-5-W [400 MG/250 ML] 95.00 060 6010725 IV-PROTECTIVE CAP LUER [MPC-1] 3.00 060 6010727 SODIUM CHLORIDE IRRIGATION SOLN [3000 ML 45.00 060 6010729 IV-CefTRIAXone in D-5-W [2 GRAM/50 ML] 376.50 060 6010733 IV-AMINO ACID 4.25%/DEXTROSE 10% 1000 ML 196.50 060 6010735 IV-DEXTROSE 5%-WATER (AVIVA BAG 250 ML) 88.60 060 6010737 POTASSIUM PHOSPHATE IV KIT IN MEDSELECT 74.65 060 6010738 IV-MAGnesIUM SULFATE [2 GRAMS/50 ML] 101.25 060 6010739 IV-NORMAL SALINE ADD-VANTAGE [100 ML] 40.00 060 6010740 WATER FOR IRRIGATION STERILE [500 ML NON 30.00 060 6010742 IV-HEPARIN IN D5W [25,000 UNITS/250 ML] 33.00 060 6010746 IV-AmioDARone/D5W [360 MG/200ML] 312.00 060 6010750 IV-MAGnesIUM SULFATE [4 GRAMS/100 ML] 70.00 060 6010751 IV-LEVEtiraceTAM/NACL [500 MG/100 ML] 131.50 060 6010752 IV-VANCOMYCIN KIT 1 GRAM ADD-VANTAGE 86.00 060 6010753 IV-NORMAL SALINE ADD-VANTAGE [250 ML] 40.00 060 6010754 IV-TOTAL PARENTAL NUTRITION-CYCLE 750.00 060 6010755 IV-TPN MANAGEMENT PROTOCOL 86.00 060
6010756 SODIUM PHOSPHATE 15 MMOL IV KIT IN MEDSE 55.00 060 6010757 LACosaMIDE 100 MG TABLET 52.90 060 6010758 IV-CEFEPIME 1 GM/50 ML ISO-OSMOTIC D5W ( 127.50 060 6010759 IV-CEFEPIME 2 GM/100 ML ISO-OSMOTIC D5W 162.50 060 6010761 IV-VANCOMYCIN/NS (1 GRAM/200 ML) 216.00 060 6010762 IV-VANCOMYCIN/NS (750 MG/150ML) 16.00 060 6010763 IV-VANCOMYCIN/NS (500 MG/100 ML) 40.00 060 6010764 IV-IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GM 5,600.00 060 6010766 SODIUM CHLORIDE 0.9% STERILE [50 ML NON- 8.89 060 6010767 HYDROMORPHONE 0.5 MG/0.5 ML PREFILLED SY 11.34 060 6010768 ONDANSETRON INJ. (40 MG/20 ML MULTIDOSE 28.35 060 6010769 IV-LEVETIRACETAM/NACL (1000 MG/100 ML) 170.00 060 6010770 IV-LEVETIRACETAM/NACL (1500 MG/100 ML) 124.60 060 6050001 IV-ACYCLOVIR/NS IVPB : 500MG/100ML 0.00 060 6050002 IV-AMIKACIN/NS IVPB : 500MG/100ML 0.00 060 6050003 IV-AMPHOT B LIPOSOM/D5W IVPB : 50MG/100M 0.00 060 6050004 IV-AMPHOTER B LIP/D5W IVPB : 100MG/500ML 0.00 060 6050005 IV-AMPHOTERICIN/D5W IVPB : 50MG/500ML 0.00 060 6050006 IV-AMPICILL-SULBAC/NS IVPB: 1500MG/100ML 0.00 060 6050007 IV-AMPICILL-SULBAC/NS IVPB: 3000MG/100ML 0.00 060 6050008 IV-ARGATROBAN/NS IVPB : 250MG/250ML 0.00 060 6050009 IV-AZITHROMYCIN/D5W IVPB : 500MG/250ML 0.00 060 6050010 IV-AZTREONAM/NS IVPB : 2000MG/100ML 0.00 060 6050011 IV-CEFAZOLIN/NS IVPB : 2000MG/100ML 0.00 060 6050012 IV-CEFEPIME/NS IVPB : 1000MG/100ML 0.00 060 6050013 IV-CEFEPIME/NS IVPB : 2000MG/100ML 0.00 060 6050014 IV-CEFTAZIDIME/NS IVPB : 1000MG/100ML 0.00 060 6050015 IV-CEFTAZIDIME/NS IVPB : 2000MG/100ML 0.00 060 6050016 IV-CEFTRIAXONE/NS IVPB : 2000MG/100ML 0.00 060 6050017 IV-CLINDAMYCIN/NS IVPB : 600MG/100ML 0.00 060 6050018 IV-COLISTIMETHATE/NS IVPB : 150MG/100ML 0.00 060 6050019 IV-DAPTOMYCIN/NS IVPB : 500MG/100ML 0.00 060 6050020 IV-DILTIAZEM/NS IVPB : 100MG/250ML (ADV) 0.00 060 6050021 IV-DOXYCYCLINE/NS IVPB : 100MG/100ML 0.00 060 6050022 IV-ERTAPENEM/NS IVPB : 1GM/100ML 0.00 060 6050023 IV-ERYTHROMYCIN/NS IVPB : 500MG/100ML 0.00 060 6050024 IV-FERRIC GLUC/NS 125MG/100ML: 125MG/100 0.00 060 6050025 IV-FOSPHENYTOIN/NS IVPB : 100MG/50ML 0.00 060 6050026 IV-FUROSEMIDE/NS IVPB : 100MG/100ML 0.00 060 6050027 IV-GANCICLOVIR/NS IVPB : 500MG/100ML 0.00 060 6050028 IV-GENTAMICIN/NS IVPB : 40MG/100ML 0.00 060 6050029 IV-HEPARIN/NS IVLVP : 25000UN/250ML 0.00 060 6050030 IV-INSULIN REG/NS IVPB : 100UN/100ML 0.00 060 6050031 IV-LACOSAMIDE/NS IVPB : 200MG/100ML 0.00 060 6050032 IV-LEVETIRACETAM/NS IVPB : 500MG/100ML 0.00 060 6050033 IV-MEROPENEM/NS IVPB : 1000MG/100ML 0.00 060 6050034 IV-MEROPENEM/NS IVPB : 500MG/100ML 0.00 060 6050035 IV-MICAFUNGIN/NS IVPB : 100MG/100ML 0.00 060 6050036 IV-NAFCILLIN/NS IVPB : 2000MG/100ML 0.00 060 6050037 IV-NOREPINEPHRINE/D5W IVPB : 4MG/250ML 0.00 060 6050038 IV-PHENYLEPHRINE/NS IVPB : 10MG/250ML 0.00 060 6050039 IV-PIPERACILL-TAZ/NS IVPB : 2.25GM/100ML 0.00 060
6050040 IV-PIPERACILL-TAZ/NS IVPB : 3.375GM/100M 0.00 060 6050041 IV-PIPERACILL-TAZ/NS IVPB : 4.5GM/100ML 0.00 060 6050042 IV-PROCAINAMIDE/D5W IVPB : 1000MG/500ML 0.00 060 6050043 IV-RIFAMPIN/NS IVPB : 600MG/500ML 0.00 060 6050044 IV-SODIUM BICARD/D5W IVPB : 50ML/1000ML 0.00 060 6050045 IV-TIGECYCLINE/NS IVPB : 50MG/100ML 0.00 060 6050046 IV-TOBRAMYCIN/NS IVPB : 300MG/100ML 0.00 060 6050047 IV-TRIMETH-SUFLAM/D5W IVPB : 10ML/250ML 0.00 060 6050048 IV-VALPROATE/NS IVPB : 500MG/100ML 0.00 060 6050049 IV-VANCOMYCIN/NS IVPB : 1200MG/250ML 0.00 060 6050050 IV-VANCOMYCIN/NS IVPB : 1500MG/250ML 0.00 060 6050051 IV-VANCOMYCIN/NS IVPB : 750MG/250ML 0.00 060 6099999 IV-ERAVACYCLINE (XERAVA) 50MG VIAL 171.50 060
Equipment rentals 7000021 CLINITRON II BED 156.00 070 7000025 SEQUENTIAL COMP DEVICE L 11.00 070 7000026 SEQUENTIAL COMP DEVICE R 11.00 070 7000060 WOUND VACUUM 160.00 070 7000130 ADVACARE BRODA CHAIR 37.00 070 7003030 GENDRON PKG #1 97.00 070 7003031 BARI BED LTC 71.00 070 7003032 ERGOLIFT 600 57.00 070 7003033 MILLENNIUM 3 63.00 070 7003034 SENTRY 1400 35.00 070 7003035 SENTRY 1200 29.00 070 7003037 MILLENNIUM PLUS 53.00 070 7003038 IDS BARIATRIC BED 126.00 070 7003039 IDS PKG 1 BED 184.00 070 7003040 MIL STAGE 4 BED 151.00 070 7003041 BURKE PKG #1 158.00 070 7003042 BARIATRIC BED 117.00 070 7003043 TRAPEZE 3-4 POST 18.00 070 7003044 VERSACARE BED 153.00 070 7003045 LOW BOY BED 35.00 070 7003046 BRODA CHAIR 20 30.00 070 7003047 BED SIDE AIR CHAIR 23.00 070 7003048 MOBILE AIR CHAIR 23.00 070 7003049 CARE CHAIR 650 44.00 070 7003050 CARE CHAIR 851 44.00 070 7003051 CLINICAL CHAIR RECLINER 44.00 070 7003052 WHEELCHAIR 28 37.00 070 7003053 WHEELCHAIR 24 37.00 070 7003054 WHEELCHAIR 30 37.00 070 7003055 SHOWER CC 750 44.00 070 7003056 COMMODE 1000 18.00 070 7003057 COIMMODE 750 18.00 070 7003058 BARI WALKER 650 12.00 070 7003059 BARI WALKER 750 12.00 070 7003060 BARI WALKER 850 12.00 070 7003061 POSEY CANOPY BED 129.00 070 7003062 NEGATIVE PRESSURE 170.00 070
7003063 SPORT BED 355.00 070 7003064 POSEY PAD FOR LOW BOY BED 5.00 070 7003065 WHEELCHAIR 20 HIGH BACK 9.00 070 7003066 VEST SYSTEM & WRAP 69.00 070 7003067 WARMING BLANKET 76.00 070 7003068 COUGH ASSIST DEVICE 69.00 070
Room Rate 2,084.00
As a patient in a Long Term Acute Care Hospital, you will be billed for the items you receive. Depending on your insurance, your final amount due will be based on one of the following:- Medicare Long Term Acute Care DRG-% of charges determined by your insurance company-Per Day rate multiplied by the number of days for your stay
IVSUBCAT
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![Amazing Grace [Grace of God]](https://img.pdfslide.net/doc/110x75/577ce76b1a28abf103951ad7/amazing-grace-grace-of-god.jpg)
