Orchard Hospital Chargemaster Item # Description Charge ... master - cms website posting.pdf · 2000009 pt therapy initial 30 mins mcal $ 128.24 2000017 pt tests/measur -ea add'l

Orchard Hospital Chargemaster

Item # Description Charge

100210 TRANSFUSION BLOOD OR COMPONENT 700.00$

100215 PICC INSERTION FOR PATIENT >5 3,000.00$


400005 OBSERVATION SERVICES - 1ST HR 280.91$

400010 OBSERVATION SERVICES - 2ND HR 156.06$

400015 OBSERVATION SERVICES - 3RD HR 104.04$

400020 OBSERVATION SERVICES - ADDL HR 52.02$


1200011 SIGMOIDOSCOPE 290.55$

1212002 SURGERY RM SETUP-PK 1,126.59$

1212008 RECOVERY RM 1HR 674.88$

1212009 RECOVERY RM 2HR 640.97$

1212014 MINOR RM SUPPLY S/UP 2,642.82$

1213390 MAJOR RM SUPPLY S/UP 3,111.46$

1213391 ORTHOPEDIC RM SET-UP 1,906.94$

1213430 OPERATING RM 3 HR 6,088.33$

1217012 PROCEDURE ROOM 645.81$

1230035 EXC CA TRUNK 630.77$

1251000 OPERATING RM 1 HR 2,437.90$

1251002 OR 1ST ADDTL 1/2 HR 1,209.26$

1251003 OR 2ND ADDTL 1/2 HR 1,209.26$

1400004 BIER BLOCK 132.50$

1400010 SPINAL 317.93$

1412006 NURSE ANES 1/2 HR 310.59$

1412007 NURSE ANES 1 HR 687.99$

1500001 99281 ER EXAM ROOM I 369.75$

1500002 99283 ER EXAM ROOM III 701.25$

1500003 99284 ER EXAM ROOM IV 1,083.75$

1500004 99285 ER EXAM ROOM V 1,572.10$

1500005 99282 ER EXAM ROOM II 554.65$

1500010 99292 ER CRITICAL CARE ADD'L 30 MIN 600.00$

1500025 CHARGE VOIDED 933.75$

1500031 EAR WAX REMOVAL 65.70$

1500035 ER IV BUNDLE 132.05$

1500417 SNELLEN EYE TEST 7> 17.85$

1502000 IV INFUSION INITIAL UP 1 HR 529.95$

1502001 IV INFUSION EA ADD'L HR. 97.90$

1502002 IV INFUSION HYDRAT EA ADD'L HR 97.90$

1502003 INJECTION EA ADD'L PUSH 141.80$

1502004 INJECTION SUBCUTAN OR IM 141.80$

1502005 INJECTION IV PUSH SINGL OR INI 141.80$

1502006 SUBCUT OR IM INJECT 1 VACCINE 113.40$

1502007 INSERT TEMP BLADDER CATH SIMPL 179.60$


1502008 STRAPPING SHOULDER - RIGHT 218.90$

1502009 STRAPPING SHOULDER LEFT 218.90$

1502010 INJECTION EA ADD SEQUENT PUSH 141.80$

1502011 IV INFUSION HYDRATION 31M-1HR 158.80$

1502012 CONTROL NASAL HEMORRHAGE SIMPL 283.00$

1502013 CPR 582.85$

1502015 STRAPPING HAND OR FINGER 195.45$

1502016 SHORT ARM SPLIT - LEFT 342.60$

1502017 SIMPLE REPAIR 2.6 CM TO 5 CM 310.75$

1502018 SIMPLE REPAIR 2.6CM TO 7.5 CM 310.75$

1502019 SHORT ARM SPLINT - RIGHT 342.60$

1502020 SIMPLE REPAIR 2.5 CM OR LESS 310.75$

1502021 REPAIR COMPLETE 1.1CM TO 2.5CM 729.10$

1502022 CONTROL NASAL HEMORRHAGE INITI 283.00$

1502023 SIMPLE REPAIR 2.5 OR LESS 310.75$

1502025 SHORT LEG SPLINT LT CALF/FOOT 342.60$

1502026 SHORT LEG SPLIT RT CALF/FOOT 342.60$

1502030 DISLOCATED SHOULD REDUCTION RT 542.45$

1502031 DISLOCATED SHOULD REDUCTION LT 542.45$

1502032 FOLEY CATHETER - COMPLICATED 332.80$

1502033 FOREIGN BODY REMOVAL EAR - RT 201.50$

1502034 FOREIGN BODY REMOVAL EAR - LT 243.00$

1502037 DIGIT NERVE BLCK LT HAND 2ND D 1,057.25$

1502038 DIGITAL NERVE BLOCK TOE - T5 1,057.25$

1502039 NAIL REMOVAL - TOE - T5 344.75$

1502040 FINGER SPLINT - LEFT THUMB 195.45$

1502041 STRAPPING KNEE - LT 218.90$

1502042 STRAPPING KNEE - RT 218.90$

1502043 LONG ARM SPLINT - RT 342.60$

1502044 LONG ARM SPLIT - LT 342.60$

1502045 FB REMOVAL NOSE - LEFT 195.45$

1502046 FB REMOVAL OF NOSE - RIGHT 195.10$

1502047 BURN DRESSING/DEBRIDE SMALL 310.10$

1502048 STRAPPING TOES 195.45$

1502049 SOFT TISSUE FB REMOVAL 759.80$

1502050 FINGER SPLINT LT HAND 5TH DIGI 195.45$

1502052 WOUND REPAIR INTERM 2.5 CM < 911.35$

1502055 FINGER SPLIT-LT HAND 3RD DIGIT 195.45$

1502056 FINGER SPLIT-LF HAND 2ND DIGIT 195.35$

1502057 FINGER SPLIT-RT HAND 2ND DIGIT 195.45$

1502058 WOUND REPAIR-FACE 2.6CM-5.0CM 911.35$

1502059 IV INFUSION ADDL SEQ - UP 1 HR 128.70$

1502060 FINGER SPLIT-LT HAND/4TH DIGIT 195.45$

1502061 FINGER SPLINT - RT HAND THUMB 195.45$


1502062 IV INFUSION/RX CONCURRENT INF 97.90$

1502063 THORACENTESIS W/O IMAGING GUID 1,426.20$

1502064 DIGIT NERVE BLCK RT HAND 5TH D 1,057.25$

1502065 FINGER SPLIT - RT HAND 3RD DIG 195.45$

1502066 FINGER SPLIT RT HAND 5TH DIGIT 195.45$

1502067 CONTROL NASAL HEMORRHAGE 316.95$

1502068 WOUND REPAIR - INTERM. 729.10$

1502069 LONG LEG SPLINT - RIGHT 342.60$

1502070 LONG LEG SPLINT - LEFT 342.60$

1502071 CERUMEN REMOVAL UNILATERAL 179.90$

1502078 FOREIGN BODY REMOVAL 268.40$

1502079 WOUND REPAIR EYE NOSE LIPS 1,020.70$

1502080 INCISION&DRAINAGE ABSCESS 509.20$

1502081 INSERTION NON TUNNELED CATHETE 2,848.70$

1502082 BURN DRESSING/DEBRIDEMENT MED 387.60$

1502083 INITIAL TMNT 1ST DEGREE BURNS 259.25$

1502084 INSERTION NONINDWELLING CATHET 288.80$

1502085 INSERTION TEMP CATHETER COMPLI 621.55$

1502086 WOUND REPAIR 7.6 CM TO 12.5 CM 310.75$

1502087 99291 ER CRITICAL CARE FIRST 30-75 MIN 1,554.25$

1502088 CHEST TUBE 1,195.55$

1502089 FB REMOVAL - NOSE RIGHT 195.45$

1502090 SOFT TISSUE FB REMOVAL - RT 2,114.95$

1502091 SOFT TISSUE FB REMOVAL - LT 2,114.95$

1502092 REMOVAL OF FB RT 247.00$

1502093 REMOVAL OF FB LT 247.00$

1502094 FRACTURE AND/OR DISLOCATION RT 552.90$

1502095 FRACTURE AND/OR DISLOCATION LT 552.90$

1502096 FOREIGN BODY REMOVAL - EYE/LT 268.40$

1502097 FOREIGN BODY REMOVAL - EYE/RT 268.40$

1502100 ARTHROCENTESIS 612.00$

1502105 WOUND REPAIR 7.6CM TO 12.5CM 428.40$


1503000 STRAPPING ACE BANDAGE-F-ARM 195.35$

1509560 STRAPPING - ANKLE AND/OR FOOT 218.90$

1510005 ET INTUBATION 282.75$

1510024 BLADDER IRRIGATION 152.00$

1510067 INCISION & DRAINAGE 181.35$

1512015 MODERATE SEDATION - E.R. 357.00$

1512016 INTERMEDIATE REPAIR 2.5 CM OR LESS 450.00$

1512017 INTERMEDIATE REPAIR 2.6 TO 7.5 CM 450.00$



1512020 IV BUNDLE - SPECIFIC TO ER 132.05$


2000005 PT MCAL 1ST 30 MIN/RPT 160.44$

2000006 PT ELECTRICAL STIMUL UNATTENDED 58.14$

2000007 PT BALANCED TX SET UP 108.05$

2000009 PT THERAPY INITIAL 30 MINS MCAL 128.24$

2000017 PT TESTS/MEASUR -EA ADD'L 15M 80.17$

2000024 PT THER ACTIVITY 69.57$

2000026 PT GAIT TRAINING 91.80$

2000031 PT SELF CARE ADL 75.03$

2000032 PT PARAFFIN BATH 58.66$

2000037 PT THERAPY EA ADD'L 15 MINS MCAL 64.12$

2000038 PT CONTRAST BATH 65.48$

2000040 PT THER EX 87.72$

2000041 PT HOT OR COLD PACKS 47.75$

2000048 PT WHIRLPOOL 45.90$

2000055 PT MECHANICAL TRACTION 96.90$

2000070 PT RE-EVAL 143.82$

2000083 PT TENS 144.62$

2000088 PT MANUAL THERAPY - EA 15 MINS. 112.20$

2000089 PT ULTRA SOUND 63.24$

2000090 PT WHEEL CHAIR TRAINING 59.16$

2000093 PT WOUND CARE MAJOR 924.12$

2000100 PT DRESSING/DEBRIDEMENT 255.00$

2000105 PT DRESSING/DEBRIDEMENT ADD'L 255.00$

2000115 PT NEUROMUSC. RE-ED 137.79$

2000120 PT MASSAGE 69.57$

2000140 PT CANALITH REPOSITION PRO/PERDAY 89.76$

2000150 PT PHYSICAL PERF TESET&MEASURE 68.34$

2000155 PT ELEC. STIM. (MANUAL) 71.40$

2003000 PT EVALUATION LOW COMPLEXITY 249.66$

2003005 PT EVALUATION MODERATE COMPLEX 249.66$

2003010 PT EVALUATION HIGH COMPLEXITY 249.66$

2003015 PT ORTHOTIC MANAGEMENT 84.66$

2100004 ST SWALLOW EVAL 265.20$

2100006 ST SWALLOW FUNCTION TX 191.20$

2100007 ST SWALLOW DYSFUCNTION TX 264.18$

2100010 ST SPEECH TREATMENT GROUP 182.58$

2100011 ST SPEECH FLUENCY EVAL 341.70$

2100012 ST EVAL OF SPEECH SOUND PRODUCTIO 576.30$

2100013 ST EVAL OF SPEECH W/LANG COMPREH 576.30$

2100014 ST EVAL SPEECH GEN DEVICE 1ST HR 210.12$

2100015 ST EVAL SPCH GEN DEVICE EA SUB30M 81.60$

2100016 ST FLOUROSCOPIC SWALLOW EVAL 437.58$

2100020 ST APHASIA EVAL PER HR INTERP/RPT 214.20$

2100021 ST DEVELOP TESTING W/INTER/RPT 340.68$


2100022 ST COGNITIVE TRAINING 91.80$

2100025 ST SENSORY INTEGRATIVE TECHNIQUES 60.18$

2100026 ST BEHAV/QUALITAT ANALYSIS VOICE 419.22$

2100027 ST EVAL USE/FITTING VOICE PROSTH 398.82$

2100029 ST THERAP SVCS USE SPCH GEN DEVIC 229.50$

2200004 OT SELF CARE ADL 75.03$

2200005 OT ELEC.STIM.(MANUAL) 71.40$

2200011 OT THER EX 69.57$

2200022 OT NEUROMUSCULAR RE-EDUCATION 137.79$

2200024 OT THERAPY EXERCISE 87.72$

2200035 OT RE EVALUATION 124.14$

2200043 OT MASSAGE 69.57$

2200044 OT PHYSICAL PERF TEST&MEASURE 68.34$

2200620 OT TENS 144.53$

2200625 OT HOT OR COLD PACKS 47.75$

2200630 OT ELECTRICAL STIMUL UNATTENDED 58.14$

2203000 OT EVALUATION LOW COMPLEXITY 163.50$

2203005 OT EVALUATION MODERATE COMPLEX 163.50$

2203010 OT EVALUATION HIGH COMPLEXITY 163.50$

2206000 OT PARAFFINE BATH 58.66$

2206005 OT CONTRAST BATH 65.48$

2206010 OT ULTRA SOUND 63.24$

2206015 OT MANUAL THERAPY 112.20$

2206020 OT ADL RETRAINING 75.03$

2206021 OT THERAPEUTIC ACTIVITY 69.57$

2206022 OT COGNITIVE THERAPY 91.80$

2206023 OT COMMUNITY WORK REINTEGRATION 75.03$

2206052 OT ORTHOTIC MANAGEMENT 84.66$

2206060 OT MCAL-EVAL 30 MINS PLUS REPORT 160.44$

2206065 OT MCAL - EVAL ADD'L 15 MINS/RPT 80.17$

2206070 OT MCAL -TREATMENT INITIAL 30 MIN 127.63$

2206075 OT MCAL - EA ADD'L 15 MINS 64.12$

2301000 RN INFUSION THERAPY - 1ST HR 432.43$

2301005 RN IV INFUSION EA ADD'L HR 79.87$

2400005 16-37MINS INDIV. PSYCHOTHERAPY 331.50$

2400010 38-52MIN INDIV. PSYCHOTHERAPY 357.00$

2400015 53-67MIN INDIVD PSYCHOTHERAPY 382.50$

2400020 FAMILY PSYCHOT W/O PT PRESENT 382.50$

2400025 FAMILY PSYCHOTHER W/PT PRESENT 382.50$

2400030 GROUP PSYCHOTHERAPY 300.90$

2400035 TELEHEALTH FACILITY FEE 51.00$

3000003 ALBUMIN 70.94$

3000004 ALCOHOL/ETHYL 189.26$

3000005 ALK. PHOSPHATASE 107.15$


3000006 ALT 126.63$

3000007 AMMONIA 187.83$

3000008 AMYLASE 179.52$

3000010 AST 126.63$

3000011 BASIC METABOLIC 119.70$

3000012 BILIRUBIN DIRECT 125.26$

3000013 BILIRUBIN TOTAL 104.65$

3000015 BNP 283.87$

3000016 BUN 114.09$

3000017 CALCIUM 102.97$

3000019 CHLORIDE 100.22$

3000020 CHOLESTEROL 84.86$

3000021 CK 169.78$

3000023 COMP METABOLIC 185.08$

3000024 CREATININE 114.09$

3000025 CREATININE 24 HR URINE 34.78$

3000026 CREATININE CLEARANCE 69.56$

3000027 CREATINE RANDOM URINE 20.86$

3000028 D-DIMER 181.66$

3000029 DIGOXIN LEVEL 137.75$

3000030 DILANTIN/PHENYTOIN 129.44$

3000033 CBC W/ AUTO DIFF 153.40$

3000035 GLUCOSE BLOOD 97.41$

3000036 FECAL OCCULT BLOOD 29.22$

3000037 FERRITIN 107.15$

3000038 FOLATE 32.03$

3000039 FREE T4 164.22$

3000042 GGT 148.87$

3000043 GLUCOSE BLOOD 83.20$

3000045 GLUCOSE ADDITIONAL 66.81$

3000049 GLUCOSE POST DOSE 121.07$

3000050 GLUCOSE TOL 3 SPEC 307.53$

3000053 HEMOGRAM 104.70$

3000054 HEPATIC FUNC PANEL 96.03$

3000055 HGB A1C 33.41$

3000056 HIV RAPID 102.97$

3000057 INFLUENZA A/B 203.75$

3000058 IRON 55.64$

3000059 LACTATE (LACTIC ACID) 86.29$

3000060 LDL CHOLESTEROL DIR 18.11$

3000061 LIPASE 118.27$

3000062 LIPID PANEL 126.63$

3000063 LYTES 105.77$

3000064 MAGNESIUM 105.77$


3000065 MANUAL DIFF 90.83$

3000067 MICROALBUMIN 24 HR URINE 45.90$

3000068 MICROALBUMIN URINE RANDOM 40.34$

3000069 MONO TEST 121.07$

3000070 PHOSPHORUS 65.38$

3000073 POTASSIUM 112.71$

3000074 POTASSIUM 24 HR URINE 28.65$

3000078 FINGERSTICK GLUCOSE IN-HOUSE 66.81$

3000081 PROTEIN TOTAL 24 HR URINE 68.20$

3000082 PROTHROMBIN TIME 104.70$

3000083 PSA TOTAL 157.23$

3000084 PTT 119.85$

3000085 HCG QUANT BETA 69.56$

3000087 RA TITER 48.71$

3000097 RENAL FUNCTION PANEL 8.36$

3000098 RETIC COUNT-AUTOMATED 79.51$

3000101 RSV 238.22$

3000104 SEDIMENTATION RATE 79.51$

3000108 STOOL WBC 29.02$

3000110 PROTEIN TOTAL 57.07$

3000111 TOTAL VOLUME 24 HR URINE 49.10$

3000114 TSH 193.44$

3000117 UREA NITROGEN URINE 51.71$

3000119 URINALYSIS DIP 42.30$

3000120 URINALYSIS MICROSCOPIC ONLY 84.60$

3000121 MICRO (UA) 96.85$

3000122 URINE DRUGS OF ABUSE 273.87$

3000127 VANCOMYCIN 164.22$

3000128 VENIPUNCTURE 25.04$

3000129 VIT B-12 11.12$

3000130 WET MOUNT KOH PREP 66.81$

3000132 URINE DIPSTICK 15.05$

3000140 KETONES 41.77$

3000157 RA FACTOR 16.68$

3000204 TRIGLYCERIDE 98.79$

3000205 TROPONIN I 208.74$

3000206 TSH 193.44$

3000207 QUALITATIVE BETA HCG 122.40$

3000210 URIC ACID BLOOD 114.09$

3000217 VALPROIC ACID 129.44$

3000233 URINE SODIUM 73.75$

3000234 POTASSIUM RAND URINE 83.49$

3000236 PROTEIN TOTAL RAN UR 72.37$

3000300 STREP A RAPID 105.77$


3001300 DIP STICK URINE 23.20$

3002002 URINE PREGNANCY 140.56$

3003500 BUN - UREA NITROGEN - ISTAT 17.49$

3003502 CHLORIDE - ISTAT 20.40$

3003503 C02 CONTENT - ISTAT 21.73$

3003504 CREATININE - ISTAT 22.75$

3003505 GLUCOSE BLOOD - ISTAT 17.44$

3003506 POTASSIUM SERUM - ISTAT 112.71$

3003507 SODIUM - ISTAT 35.24$

3003508 HEMOGLOBIN - ISTAT 9.54$

3003509 HEMATOCRIT - ISTAT 9.54$

3003511 TROPONIN I - ISTAT 43.66$

3003512 BNP - ISTAT 150.60$

3005000 CLOSTR DIFF/CDA - INHOUSE 161.26$

3005089 SALICYLATES SERUM 189.26$

3005094 SODIUM 100.22$

3005104 GASTROCULT SLIDE 16.68$

3005105 HDL 51.51$

3005180 VITAMIN D 25 HYDROXY 156.06$

3005181 ECO2 21.73$

3005182 ACETAMINOPHEN 189.26$

3005183 DIRECT IBC 77.49$

3005184 TRANSFERRIN 7.50$

3200010 THYROGLOBULIN A&B SEND OUT 6.30$

3200086 PROTEIN CREATINE SEND OUT 5.76$

3200088 RAPID PLASMIN REAGIN RPR SEND OUT 3.26$

3200102 RUBELLA IGG SEND OUT 8.73$

3200105 CARBOXY HEROGLOBIN SEND OUT 87.74$

3200106 PATHOLOGY DURING SUGGERY SEND OUT 97.37$

3200107 SODIUM 24 HR URINE SEND OUT 14.98$

3200109 STAIN MICO ORGANISMS SEND OUT 196.24$

3200112 GROSS MICRO LEVEL V SEND OUT 450.79$

3200113 QUINIDINE SEND OUT 160.50$

3200115 IGF-BP3 SEND OUT 19.00$

3200116 UREA NITRO 24HR URINE SEND OUT 16.05$

3200118 ADH SEND OUT 87.74$

3200131 URINE I.D. SEND OUT 2.13$

3200142 HUMAN T CELL LYMPHO SEND OUT 79.18$

3200145 POTASSIUM 24HR URINE SEND OUT 13.91$

3200160 THYROGLOBULIN PANEL SEND OUT 19.58$

3200178 RUBELLA AB SEND OUT 7.76$

3200180 GROSS MICRO EXAM LEVEL III SEND OUT 147.66$

3200181 CYTOPATHOLOGY FINE NEEDLE SEND OUT 205.98$

3200182 CYTOPATHOLOGY SEND OUT 54.89$


3200183 GROSS MICRO EXAM LEVEL IV SEND OUT 202.12$

3200184 GROSS EXAM LEVEL I SEND OUT 68.69$

3200200 GROSS MICRO EXAM LEVEL IV SEND OUT 202.12$

3200230 PIN WORM EXAM SEND OUT 17.12$

3200235 PROTEIN 24 HR URINE SEND OUT 13.91$

3200241 FOOD ALLERGY SEND OUT 163.71$

3200242 IGE SEND OUT 22.47$

3200244 ALLERGEN PROFILE SEND OUT 84.84$

3200245 CYCLIC CITRULLINATED SEND OUT 42.00$

3200246 PORPHYRINS URO COPRO URINE SEND OUT 70.87$

3200688 KEPPRA LEVEL SEND OUT 42.00$

3201000 REERSE T3 - QUEST SEND OUT 15.75$

3201534 CYCLOSPORINE BLOOD SEND OUT 25.20$

3202009 FORTICAL CALCITONIN NASAL SPR SEND OUT 47.94$

3203501 CALCIUM - ISTAT 22.00$

3205001 AEROBIC CULTURE SEND OUT 9.70$

3205002 AFP TUMOR SEND OUT 12.60$

3205003 ANA SEND OUT 5.25$

3205004 ANAEROBIC CULTURE SEND OUT 11.90$

3205005 BETA-2 MICROGLOBULIN SEND OUT 16.05$

3205006 BLOOD CULTURE SEND OUT 9.70$

3205007 CA 125 SEND OUT 12.60$

3205008 CA 19-9 SEND OUT 14.70$

3205009 CA 27-29 SEND OUT 12.60$

3205011 CEA SEND OUT 13.58$

3205012 CHLAMYDIA GC URINE OR SWAB SEND OUT 21.00$

3205013 COMPLEMENT C3 SEND OUT 10.00$

3205014 COMPLEMENT C4 SEND OUT 10.00$

3205015 CORTISOL SEND OUT 9.45$

3205016 CORTISOL URINE 24 HR SEND OUT 182.97$

3205017 C-REACTIVE PROTEN CARDIAC SEND OUT 6.42$

3205018 C-REACTIVE PROTEIN SEND OUT 5.82$

3205019 CULTURE URINE SEND OUT 11.64$

3205020 ESTRADIOL SEND OUT 24.61$

3205021 ESTROGEN SEND OUT 25.25$

3205022 DHEA SULFATE IMMUNOASSAY SEND OUT 9.45$

3205023 TESTOSTERONE FREE SEND OUT 9.98$

3205024 GENTAMICIN SEND OUT 12.60$

3205025 GRAM STAIN SEND OUT 2.38$

3205026 HELICOBACTER-ANTI PY SEND OUT 114.49$

3205027 HCV RNA PCR QI RFLX SEND OUT 141.75$

3205028 HEP C RNA PCR QUAL SEND OUT 116.63$

3205029 NGI HCV QUANTASURE SEND OUT 92.40$

3205030 HEP. B SURFACE A-B SEND OUT 9.63$


3205031 MYOGLOBIN SERUM SEND OUT 17.85$

3205032 HEP A B C PANEL SEND OUT 41.73$

3205033 HEP C VIRAL AB SEND OUT 7.76$

3205034 HERPES CULTURE SEND OUT 58.85$

3205035 HIV 2 AB SEND OUT 115.56$

3205036 HIV-1 AB SEND OUT 26.75$

3205037 H-PYLORI STOOL SEND OUT 43.97$

3205038 B12 UNSATURATED BINDING CAP SEND OUT 13.65$

3205039 HSV 1&2 HERPES SIMPLE TYP 1 SEND OUT 353.10$

3205040 IGF-1 SEND OUT 18.90$

3205041 CULTURE OTH SOURCE NOT BLOOD SEND OUT 5.25$

3205042 ISLET CELL DYSFU SEND OUT 7.76$

3205043 CALCIUM IONIZED SEND OUT 12.60$

3205044 LYME DISEASE IGG WBA SEND OUT 19.97$

3205045 LEAD SEND OUT 8.40$

3205046 LEAD BLOOD PEDIATRIC SEND OUT 25.68$

3205047 THEOPHYLLINE SEND OUT 13.65$

3205048 LUTEINIZING HORMONE SEND OUT 7.35$

3205049 LYME DISEASE AB SEND OUT 37.45$

3205050 METHYLMALONIC ACID SERUM SEND OUT 35.00$

3205051 CULTURE MRSA SCREEN SEND OUT 7.80$

3205052 MUMPS AB IGG TITER SEND OUT 8.73$

3205053 PROTEIN S FUNCTIONAL SEND OUT 23.10$

3205054 OSMOLALITY URINE SEND OUT 24.65$

3205055 OVA & PARASITE SEND OUT 10.50$

3205056 PHENOBARBITAL SERUM SEND OUT 11.55$

3205057 PRE ALBUMIN SEND OUT 7.35$

3205058 PROGESTERONE SEND OUT 10.50$

3205059 PROLACTIN SEND OUT 9.45$

3205060 PTH-C-TERMINAL SEND OUT 18.49$

3205061 UPPER RESPIRATORY CULTURE SEND OUT 9.08$

3205062 RUBEOLA ANTIBODIES IGG SEND OUT 8.73$

3205063 CULTURE STOOL SEND OUT 8.73$

3205064 ANTIBODY IDENT LEUKOCYTE ATIB SEND OUT 26.25$

3205065 ANTI MULLERIAN HORMONE SEND OUT 102.00$

3205066 T3 TOTAL RIA SEND OUT 8.73$

3205067 T3 FREE SEND OUT 7.35$

3205068 T3 UPTAKE SEND OUT 5.25$

3205069 T4 TOTAL SEND OUT 8.40$

3205070 TACROLIMUS FK506 BLOOD SEND OUT 42.00$

3205071 CARBAMAZEPINE TEGRETOL SEND OUT 10.50$

3205072 HEMOGLOBIN (HAB)SOLU SEND OUT 22.47$

3205073 TESTOSTERONE TOTAL SEND OUT 9.70$

3205074 CULTURE THROAT/NOSE SEND OUT 38.63$


3205075 THYROID PEROXIDASE SEND OUT 10.97$

3205076 UNSTATURATED IRON INDING TIBC SEND OUT 75.97$

3205077 LIPOPROTEIN SEND OUT 116.63$

3205078 VARICELLA ZOSTER A-B SEND OUT 5.82$

3205079 VITAMIN D 1 25 HYDRO SEND OUT 19.40$

3205080 LACOSAMIDE LC/MC/MS SEND OUT 90.68$

3205081 FOLATE RBC PROFILE SEND OUT 6.30$

3205082 SUSCEPTIBILITY SEND OUT 5.33$

3205083 INSULIN FREE SEND OUT 67.50$

3205084 ANGIOTENSIN CONV ENZ SEND OUT 15.75$

3205085 CELL CNT BODY FLUID SEND OUT 92.02$

3205086 URIC ACID 24 HR URINE SEND OUT 22.47$

3205087 CMV I/B IGG & IGM SEND OUT 22.47$

3205088 FACTOR VIII ACTIVITY CLOTTING SEND OUT 98.23$

3205089 FACTOR IX ACTIVITY COAG SEND OUT 42.00$

3205090 ANTI SMOOTH MUSCLEAB SEND OUT 9.85$

3205091 MITOCHONDRIAL M2 AB SEND OUT 19.00$

3205092 HEPATITIS A IGM SEND OUT 7.76$

3205093 ASO-SCREEN SEND OUT 6.30$

3205094 CSF PROTEIN SEND OUT 3.34$

3205095 ANCA X2 SEND OUT 87.74$

3205096 COLD AGGLUTINATION SEND OUT 117.70$

3205097 FEBRILE AGGLUTININX6 SEND OUT 149.80$

3205098 EOSINOPHILL URINE RA SEND OUT 51.36$

3205099 CALCULI URINE SEND OUT 38.52$

3205100 PREGNANCY SERUM 39.59$

3205101 HT LVI / HTLV II SEND OUT 27.00$

3205102 DHEA SEND OUT 41.31$

3205103 ASSAY OF PROGESTERONE SEND OUT 48.15$

3205104 BETA 2-GLYCOPROTEIN I SEND OUT 54.46$

3205105 PROTHROMBIN GENE ANALYSIS SEND OUT 92.40$

3205106 THROMBIN TIME SEND OUT 3.26$

3205107 STONE ANALYSIS SEND OUT 36.75$

3205108 SPECIAL STAINS-MISCELLANEOUS SEND OUT 59.43$

3205109 ZONISAMIDE SEND OUT 39.22$

3205110 IGFBP-3 SEND OUT 33.25$

3205111 LACTIC ACID DEHYDROGENASE SEND OUT 3.26$

3205112 THYROXINE SEND OUT 4.19$

3205113 COPPER SEND OUT 10.50$

3205114 ALDOLASE SEND OUT 3.21$

3205115 OSMOLALITY SERUM SEND OUT 8.40$

3205116 TESTOSTERONE SEND OUT 9.70$

3205117 FSH SERUM SEND OUT 7.49$

3205118 ACTH PLASMA SEND OUT 25.25$


3205119 VITAMIN B6 SEND OUT 24.65$

3205122 CYTOMEGALOVIRUS CMV AB SEND OUT 6.56$

3205124 HSV CULTURE AND TYPING SEND OUT 10.50$

3205125 GENITAL CULTURE ROUTINE SEND OUT 25.20$

3205126 C-PEPTIDE SEND OUT 21.00$

3205127 H PLYLORI IGM IGG IGA AB SEND OUT 14.85$

3205129 CCP IGG/IGA SEND OUT 42.00$

3205130 LOWER RESPIRATORY CULTURE SEND OUT 12.84$

3205131 H PYLORI BREATH TEST SEND OUT 111.36$

3205132 HSV CULTURE WITHOUT TYPING SEND OUT 19.72$

3205133 HCV QUANT REAL TIME PCR SEND OUT 92.40$

3205135 HOMOCYSTEINE PLASMA SEND OUT 34.43$

3205136 FREE K+L LT CHAINS QN S SEND OUT 80.18$

3205137 VITAMIN B1 THIAMINE BLOOD SEND OUT 17.85$

3205138 CYTOMEGALOVIRUS CMV QUAT SEND OUT 8.53$

3205140 TOTAL PROTEIN SEND OUT 13.91$

3205141 PROTEIN ELECTROPHORECTIC SEND OUT 9.08$

3205144 STOOL AEROBIC PATHOGENS ISO SEND OUT 9.40$

3205145 STOOL SHIGA LIKE TOXIN SEND OUT 56.70$

3205146 OVA AND PARASITE COMPLEX SEND OUT 10.50$

3205150 WEST NILE VIRUS IGM SEND OUT 55.95$

3205151 WEST NILE VIRUS SEND OUT 55.95$

3205154 GL CELIAC DISEASE GAM/IMMUN SEND OUT 7.74$

3205155 HSV 1&2 HERPES SIMPLEX SEND OUT 16.00$

3205157 NEISSERIA GONORRHOEAE AMP SEND OUT 42.00$

3205159 EBV ACUT EB NUCLEAR ANTIGEN SEND OUT 32.62$

3205160 EBV ACUTE EB EARLY ANTIGEN SEND OUT 14.05$

3205161 EBV ACUTE EB VIRAL CAPSID SEND OUT 32.62$

3205163 IGA QUANT SERUM SEND OUT 7.81$

3205164 DEAMIDATED GLIADIN IGA SEND OUT 33.33$

3205165 DEAMIDATED GLIADIN IGG SEND OUT 29.11$

3205166 HSV 1&2 HERPES SIMPLEX 2 SEND OUT 20.12$

3205167 TISSUE TRANGULATIMASE IGA SEND OUT 29.11$

3205168 TISSUE TRANGLUTAMINASE IGG SEND OUT 29.11$

3205172 HEPATITIS C ANTIBODY SEND OUT 74.68$

3205173 HEPATITIS A AB IGM SEND OUT 7.76$

3205174 HEPATITIS B CORE AB IGM SEND OUT 226.54$

3205190 ANTI-DSDNA ANTIBODIES SEND OUT 8.40$

3205191 HIV 1 & 2 SEND OUT 57.27$

3205602 CA 15-3 SEND OUT 12.26$

3205603 ZINC SEND OUT 12.60$

3206000 TRANSFERRIN SEND OUT 7.35$

3206001 SCLERODERMA ANTIBODY SEND OUT 9.90$

3206002 PROTEIN ELECTROPHORESIS PANEL SEND OUT 19.95$


3206003 DONOR SYPHILLS IGG ANTIBODY SEND OUT 55.37$

3206004 VITAMIN A (RETINOL) SEND OUT 14.70$

3206005 CALPROTECTIN STOOL SEND OUT 133.64$

3206006 DRVVT CONFIRM SEND OUT 41.31$

3206007 HEXAGONAL PHASE CONFIRM SEND OUT 41.31$

3206008 THROMBIN CLOTTING TIME SEND OUT 3.26$

3206009 DRVVT 1:1 MIX SEND OUT 26.72$

3206010 BK VIRUS DNA TIME PCR URINE SEND OUT 131.25$

3206011 ALPHA-1-ANTITRYPSIN QUANTITIVE SEND OUT 10.50$

3206012 CATECHOLAMINES FRAC 24HR URINE SEND OUT 18.48$

3206013 HEPATITIS C VIRAL RNA SEND OUT 136.50$

3206014 VISCOSITY SEND OUT 14.70$

3206015 CHROMOGRANIN SEND OUT 95.00$

3206016 GAMMA-HYDROXYBUTYRIC ACID(GHB) SEND OUT 106.00$

3206017 METANEPHRINES SEND OUT 131.44$

3206018 LAMOTRIGINE SEND OUT 19.03$

3206019 BETA CAROTENE SEND OUT 12.60$

3207000 RBC ANTIBODY ID - BLOOD SOURCE SEND OUT 105.00$

3207005 COOMBS TST DIRECT BLOOD SOURCE SEND OUT 51.00$

3207038 SELENIUM 2.5% SUSP TOPICAL SEND OUT 104.86$

3207121 ALDOSTERONE SEND OUT 20.47$

3207126 RUBELLA SEND OUT 8.73$

3207127 ACUTE HEPATITIS PANEL SEND OUT 21.29$

3207130 PRENATAL/OB PANEL SEND OUT 32.34$

3207135 HEPATITIS B CORE IGM SEND OUT 7.76$

3207136 HEPATITIS B SURFACE AG SEND OUT 3.85$

3207137 HEPATITIS C AB SEND OUT 6.05$

3207138 RPR SEND OUT 3.26$

3207145 HEPATITIS B SURFACE AB SEND OUT 3.85$

3207153 AGINITIS PLUS VG SEND OUT 47.87$

3207154 PARASITE INDETIFIY SEND OUT 17.00$

3207155 TUBERCULOSIS SUSCEPT SEND OUT 9.06$

3207180 PROTEIN ELECTROPHORESIS SEND OUT 9.10$

3207181 HEREDITARY HEMO DNA ANALYSIS SEND OUT 131.25$

3207182 DIHYDROTESTERONE DHT SEND OUT 68.40$

3207183 CERULOPLASMIN SEND OUT 7.35$

3208000 IMMUNO ER PR HER-2 SEND OUT 77.30$

3208585 TSH SEND OUT 6.30$

3208787 FECAL IMMUNOCHEM SEND OUT 49.00$

3209055 DRUG CONFIRMATION EA PROCEDUR SEND OUT 45.00$

3215001 ANDROSTENEDIONE SEND OUT 23.10$

3215002 CYCLIC AMP URINE SEND OUT 104.07$

3215003 FREE ANDROGEN SEND OUT 104.07$

3215005 ORO-SPUTUM CULTURE SEND OUT 2.13$


3215006 CRYPTOSPORIDIUM ANTIGEN SEND OUT 63.00$

3215007 URINE PROTEIN TOTAL W/O CREAT SEND OUT 3.84$

3215008 ALLERGY EVAL 5 NORTH CENTRAL SEND OUT 7.07$

3215009 TSI-THYROID STIMULATING IMMUN SEND OUT 52.50$

3215010 OVA & PARASITES W/GIARDIA ANTI SEND OUT 10.50$

3215011 LEUK/LYMPHOMA 1ST MARKER SEND OUT 15.50$

3215012 SEX HORMONE BINDING GLOBULIN SEND OUT 17.85$

3215013 HLA-B27 ANTIGEN SEND OUT 18.82$

3215016 VITAMIN C LC/MS/MS SEND OUT 9.45$

3215017 LEUK/LYMPHOMA 2ND ADDTL MARKER SEND OUT 15.50$

3215018 LEUK/LYMPHOMA 16+ MARKERS SEND OUT 15.50$

3215019 MERCURY QUANTITATIVE SEND OUT 17.85$

3215020 COXIELLA BURNETII (Q FEVER) SEND OUT 66.82$

3215021 ACETYLCHOLINE RECEPTOR BINDING SEND OUT 84.19$

3215024 GLUTAMIC ACID DECARB-65 ANTIBY SEND OUT 66.82$

3215025 FUNGAL STAIN SEND OUT 10.50$

3215026 FUNGAL TISSUE/SKIN SEND OUT 25.41$

3215027 RED CELL ANTIBODY SCREEN SEND OUT 103.00$

3215028 MYSOLINE SEND OUT 10.50$

3215029 AMYLASE ISOENZYMES SEND OUT 25.21$

3215030 ARSENIC URINE SEND OUT 15.75$

3215032 SPECTROPHOTOMETRY SEND OUT 15.00$

3215033 COCCIDIOIDES ANTIBODIES SEND OUT 15.51$

3215034 ORO-GLUCOSE BODY FLUID NOT BL SEND OUT 5.39$

3215035 ORO-WET MOUNT FOR INFECTIONS SEND OUT 5.86$

3215036 CYTOPATH/CELL ENHANCER SEND OUT 40.68$

3215037 FECES ANALYTE SEND OUT 26.01$

3215039 HIV-1 QUANTIFICATION INCL REV SEND OUT 92.40$

3215040 GABAPENTIN SEND OUT 20.05$

3215042 TETANUS SEND OUT 25.28$

3215043 DIPHTHERIA SEND OUT 26.25$

3215045 TRICHOMONAS VAGINALIS AMPLIFY SEND OUT 99.78$

3215046 HAPTOGLOBIN SEND OUT 9.45$

3215048 PORPHOBILINOGEN QUANTITATIVE SEND OUT 10.50$

3215049 POPHYRINS TOTAL PLASMA SEND OUT 81.97$

3215051 ANTITHROMBIN III ACTIVITY SEND OUT 13.65$

3215052 PROTEIN C FUNCTIONAL SEND OUT 32.55$

3215054 FOLATE RBC SEND OUT 6.30$

3215055 NOROVIRUS RNA PCT RT SEND OUT 113.62$

3215056 CORTICOSITERIOS BDING GLOB SEND OUT 60.00$

3215057 ORO-GRAM STAIN DX SEND OUT 5.78$

3215058 ALUMINUM SEND OUT 12.60$

3215059 ESTRADIOL FREE LC/MS/MS SEND OUT 16.80$

3215060 INSULIN ATIBODIES SEND OUT 10.50$


3215061 HANDLING FEE SEND OUT 25.00$

3215062 PROTEIN CSF FLUID SEND OUT 9.10$

3215063 FUNGUS NOT ELSEWHERE SPECIFY SEND OUT 47.04$

3215066 CALCIUM 24-HR URINE W/O CREAT SEND OUT 5.59$

3215067 ORO-ANTIBODY RBC PANELS SEND OUT 123.00$

3215068 ORO-ANTIHUMAN GLOBIN(COOMBS) SEND OUT 15.00$

3215069 ORO-STAT HANDLING FEE SEND OUT 113.00$

3215070 FLUOXETINE SEND OUT 28.79$

3215071 PSA TOTAL W/REFLEX TO PAS FREE SEND OUT 8.40$

3215072 DRUG ABUSE 9 ITH CONFIRM SEND OUT 136.50$

3215073 LUPUS ANTICOAG EVAL W/REFLEX SEND OUT 6.30$

3215074 POLIOVIRUS (TYPES 1 3) AB NEUT SEND OUT 52.75$

3215075 BACTERIUM PNEUNOMITIS SEND OUT 11.22$

3215076 ASPERGILLIS SEND OUT 11.22$

3215077 ALLERGEN SPEC IGC QUANTATIVE SEND OUT 11.22$

3215078 RETICULOCYTE COUNT AUTOMATED SEND OUT 4.20$

3215079 ASPERGILLUS ANTGN EIA SEND OUT 99.57$

3215082 IHC INTIAL SINGLE AB STAIN SEND OUT 97.76$

3215085 EGFR SEND OUT 477.28$

3215086 LACTOFERRIN FECAL QUALITATIVE SEND OUT 70.35$

3215087 PANCREATIC ELASTASE-1 SEND OUT 224.00$

3215090 FACTOR X ACTIVITY CLOTTING SEND OUT 48.36$

3215091 FACTOR XII ACTIVITY CLOTTING SEND OUT 28.35$

3215092 VON WILLEBRAND FACTOR ANTIGEN SEND OUT 92.40$

3215093 GLYCOMARK SEND OUT 38.31$

3215095 CALCITONIN SEND OUT 18.90$

3215096 HEMOGLOBINOPATHY SEND OUT 3.94$

3215097 HEMOGLOBINOPATHY EVAL SEND OUT 3.94$

3215098 PROTEIN C ANTIGEN SEND OUT 25.20$

3215099 VITAMIN K SEND OUT 99.75$

3215100 REPTILASE TEST SEND OUT 70.35$

3215101 FIBRINOGEN ANTIGEN SEND OUT 9.45$

3215102 FIBRINOGEN ACTIVITY SEND OUT 9.45$

3215103 CARDIOLIPIN AB IGA IGG IGM SEND OUT 30.44$

3215111 ANA TITER/PATTERN SEND OUT 7.35$

3215112 ALDOSTERONE/PRAR LC/MS/MS SEND OUT 39.37$

3215113 ROTAVIRUS ANTIGEN DETECTION SEND OUT 14.70$

3215114 ST.LOUIS ENCEPHALITIS VIRUS SEND OUT 146.05$

3217182 MTHFR DNA MUTATION SEND OUT 173.25$

3217183 LITHIUM SEND OUT 5.25$

3218000 CLOSTR DIFF/CDA - QUEST SEND OUT 90.68$

3280005 CLOSTR DIFF/CDA - OROVILLE SEND OUT 47.80$

3400089 BB RBC UNIT 1 IGG GEL COMPATIBILI 93.20$

3400090 BB RBC UNIT 1 IS TUBE COMPATIBILI 264.65$




3400093 BB RBC UNIT 3 IGG GEL COMPATIBITI 264.65$




3400099 BB R H FACTOR 85.95$

3400100 BB ABO GROUP 85.95$

3400101 BB ANTIBODY SCREEN 90.05$

3400102 BB CYROPRECIPITATE EA. UNIT 483.64$

3400103 BB DIRECT COOMBS - REF LAB 10.59$

3400104 BB PLATELET PHERESIS 645.00$

3400105 BB PRBC #1 CHARGE 263.00$

3400106 BB PRBC #2 CHARGE 263.00$

3400107 BB PRBC #3 CHARGE 263.00$

3400108 BB PRBC #4 CHARGE 263.00$

3400109 BB RHOGAM 447.75$

4000001 XR FACIAL BONES 418.25$

4000002 XR MANDIBLE RT 469.50$

4000003 XR MASTOIDS RT 413.55$

4000004 XR NASAL BONES RT 301.75$

4000005 XR ORBITS RT 189.25$

4000006 XR SINUSES 362.30$

4000007 XR SKULL COMPLETE 570.85$

4000008 XR SKULL LTD LESS THAN 4V 305.20$

4000009 XR NECK SOFT TISSUE 189.90$

4000010 XR TEMPOROMANDIBULAR RT 313.35$

4000025 XR ENTIRE SPINE SURVEY 251.30$

4001001 XR CHEST 1V 179.40$

4001002 XR CHEST 2V 340.15$

4001003 XR CHEST 3V 438.05$

4001004 XR CHEST SP VIEWS 224.85$

4001006 XR RIB BIL W/CHEST 4 VIEWS RT 375.00$

4001007 XR STERNUM 305.20$

4002001 XR CERVICAL SPINE 1V 224.85$

4002002 XR CERVICAL SPINE COMPLETE 5V 414.70$

4002003 XR CERVICAL SPINE COMPLETE + FLEX/EXT 560.35$

4002004 XR CERVICAL SPINE LTD 2V OR 3V 241.15$

4002005 XR LUMBAR SPINE COMPLETE 560.35$

4002006 XR LUMBAR SPINE FLEX/EXT 2,212.35$

4002007 XR LUMBAR SPINE LTD 2V OR 3V 305.20$

4002008 XR PELVIS 1 or 2V 209.70$

4002009 XR PELVIS COMPLETE 305.20$

4002010 XR HIP UNILAT W/ PELVIS 1V RT 228.35$


4002011 XR SACRUM & COCCYX 285.45$

4002012 XR SCOLIOSIS STUDY 1V 305.20$

4002013 XR SI JOINTS 295.90$

4002014 XR THORACIC SPINE LTD 2V 313.35$

4002015 XR THORACIC SPINE 4V COMPLETE 224.85$

4002016 XR THORACO-LUMBAR JNCT 2V 213.10$

4002065 .XR CERVICAL SPINE 1V 50.00$

4003001 XR AC JOINT BILAT 313.35$

4003002 XR ANKLE COMPLETE RT 263.30$

4003003 XR ANKLE LTD 2V RT 259.80$

4003004 XR CLAVICLE RT 293.55$

4003005 XR ELBOW COMPLETE 3V RT 464.85$

4003006 XR ELBOW LTD 2V RT 464.85$

4003007 XR FEMUR LTD VIEW RT 363.45$

4003008 XR FINGER(S) 2V RT 138.25$

4003009 XR FOOT COMPLETE RT 363.45$

4003011 XR FOREARM RT 293.55$

4003012 XR HAND COMPLETE RT 384.45$

4003013 XR HAND LTD 2V RT 238.80$

4003014 XR CALCANEUS RT 251.65$

4003015 XR HIP BILAT 2V W/ PELVIS 482.30$

4003017 XR HUMERUS RT 362.30$

4003018 XR KNEE COMPLETE RT 411.25$

4003019 XR KNEE COMPLETE RT 411.25$

4003020 XR KNEE LTD 2V RT 265.60$

4003021 XR KNEE STANDING BILAT 296.95$

4003022 XR SCAPULA 285.45$

4003023 XR SHOULDER 1V RT 224.85$

4003024 XR SHOULDER COMPLETE RT 363.45$

4003026 XR TIBIA & FIBULA 2V RT 301.75$

4003027 XR TOES RT 161.95$

4003028 XR WRIST COMPLETE RT 376.30$

4003029 XR WRIST LTD 2V RT 244.65$

4004001 XR ABDOMEN 2V 259.80$

4004002 XR ACUTE ABDOMEN SERIES COMPLETE 414.70$

4004003 XR ABDOMEN (KUB) SINGLE VIEW 187.55$

4004004 XR ACUTE ABD SERIES COMP (INCL CHEST) 455.50$

4004005 XR SINGLE FILM CHILD FOREIGN BODY 224.85$

4005240 XR RIBS UNILAT W/ 1V CHEST RT 313.35$

4007001 XR BONE AGE 322.70$

4007002 XR BONE LENGTH 405.85$

4007003 XR BONE SURVEY INFANT 379.80$

4007004 XR BONE SURVEY METASTATIC 592.90$

4007010 XR HIP BILAT 3-4V 565.00$


4007015 .XR HIP BILAT 3-4V 80.00$

4007020 XR HIP BILAT 5V OR MORE 790.00$

4007025 .XR HIP BILAT 5V OR MORE 100.00$

4035002 .XR ABDOMEN (GB) 53.85$

4040002 XR MANDIBLE LT 469.50$

4040003 XR MASTOIDS LT 413.55$

4040004 XR NASAL BONES LT 301.75$

4040005 XR ORBITS LT 189.25$

4040010 XR TEMPOROMANDIBULAR LT 313.35$

4040080 XR HIP UNILAT 2V LT 265.20$

4040090 XR HIP UNILAT W/PELVIS MIN 4V LT 295.80$

4041003 XR SHOULDER ARTHRO LT 696.65$

4041005 XR RIBS UNILAT W/ 1V CHEST LT 313.35$

4041006 XR RIB BIL W/CHEST 4 VIEWS LT 375.00$

4042010 XR HIP UNILAT W/ PELVIS 1V LT 228.35$

4043002 XR ANKLE COMPLETE LT 263.30$

4043003 XR ANKLE LTD 2V LT 259.80$

4043004 XR CLAVICLE LT 293.55$

4043005 XR ELBOW COMPLETE 3V LT 464.85$

4043006 XR ELBOW LTD 2V LT 464.85$

4043007 XR FEMUR LTD VIEW LT 363.45$

4043008 XR FINGER(S) 2V LT 138.25$

4043009 XR FOOT COMPLETE LT 363.45$

4043011 XR FOREARM LT 293.55$

4043012 XR HAND COMPLETE LT 384.45$

4043013 XR HAND LTD 2V LT 238.80$

4043014 XR CALCANEUS LT 251.65$

4043017 XR HUMERUS LT 362.30$

4043018 XR KNEE COMPLETE LT 411.25$

4043019 XR KNEE COMPLETE LT 411.25$

4043020 XR KNEE LTD 2V LT 265.60$

4043023 XR SHOULDER 1V LT 224.85$

4043024 XR SHOULDER COMPLETE LT 363.45$

4043026 XR TIBIA FIBULA 2V LT 301.75$

4043027 XR TOES LT 161.95$

4043028 XR WRIST COMPLETE LT 376.30$

4043029 XR WRIST LTD 2V LT 244.65$

4050002 XR MANDIBLE BILAT 469.50$

4050003 XR MASTOIDS BILAT 413.55$

4050004 XR NASAL BONES BILAT 301.75$

4050005 XR ORBITS BILAT 189.25$

4050006 .XR AC JOINT BILAT 50.55$

4050007 .XR ANKLE COMPLETE 42.85$

4050008 .XR ANKLE LTD 2V 30.75$


4050009 .US EXT BILAT VENOUS DOP UPP/LOW 113.20$

4050010 XR TEMPOROMANDIBULAR BILAT 313.35$

4050012 .XR BONE AGE 46.15$

4050013 .XR BONE LENGTH 126.40$

4050019 .XR CERVICAL SPINE COMPLETE 5V 67.05$

4050020 .XR CERVICAL SPINE LTD 2V OR 3V 27.50$

4050022 .XR CHEST SP VIEWS 36.25$

4050023 .XR CHEST 1V 28.55$

4050024 .XR CHEST 2V 54.95$

4050025 .XR CHEST 3V 70.35$

4050028 .XR CLAVICLE 34.10$

4050029 .XR COLON B.E. 101.10$

4050030 .XR CYSTOGRAM 34.10$

4050032 .XR DEXA VFA (PERIPH/RADIUS,WRIST,HEEL) 14.30$

4050033 XR B.E. STUDY W/ OR W/O KUB 142.85$

4050036 .XR ELBOW COMPLETE 42.85$

4050037 .XR ELBOW LTD 2V 34.10$

4050038 .XR UPP GI VIDEO SWALLOW STUDY 60.45$

4050039 .XR FACIAL BONES 67.05$

4050040 .XR FEMUR LTD 26.40$

4050041 .XR FINGER(S) 2V 23.10$

4050042 .XR FISTULA TRACT 96.70$

4050043 .XR FLUOROSCOPY UP TO 1HR 35.15$

4050044 .XR FOOT COMPLETE 42.85$

4050045 .XR FOOT LTD 26.40$

4050046 .XR FOREARM 34.10$

4050048 .XR HAND LTD 2V 23.10$

4050049 .XR HAND COMPLETE 42.85$

4050050 .XR CALCANEUS 34.10$

4050051 .XR HIP ARTHRO 36.25$

4050052 .XR HIP UNILAT 34.10$

4050053 .XR HIP BILAT 2V W/ PELVIS 40.65$

4050054 .XR HUMERUS 34.10$

4050056 .XR KNEE COMP 49.45$

4050057 .XR KNEE LTD 2V 30.75$

4050058 .XR KNEE COMPLETE 36.25$

4050059 .XR KNEE ARTHRO 122.00$

4050060 .XR KNEE STANDING BILAT 36.25$

4050061 .XR LAMINOGRAPHY 104.40$

4050063 .US EXT BILAT ARTERIAL DOP UPP/LOW 64.85$

4050064 .US EXT UNILAT ARTERIAL DOP UPP/LOW 53.85$

4050066 .XR LUMBAR SPINE FLEX/EXT 37.35$

4050067 .XR LUMBAR SPINE LTD 2V OR 3V 49.45$

4050068 .XR LUMBAR SPINE COMPLETE 90.10$


4050070 .XR MANDIBLE 75.85$

4050072 .XR NASAL BONES 48.35$

4050073 .XR NECK SOFT TISSUE 30.75$

4050080 .XR PELVIS 1 or 2V 34.10$

4050085 .XR LUMBAR SPINE COMPLETE W/ FLEX/EXT 7V 37.35$

4050087 .XR RIBS UNILAT W/ 1V CHEST 50.55$

4050088 .XR RIBS BILAT W/ CHEST 4V 67.05$

4050089 .XR RIBS BILAT 3V 67.05$

4050090 .XR SACRUM & COCCYX 46.15$

4050094 .XR SHOULDER COMPLETE 49.45$

4050095 .XR SHOULDER ARTHRO 105.50$

4050096 .XR SHOULDER 1V 36.25$

4050097 .XR SI JOINTS 36.25$

4050098 .XR SINGLE FILM CHILD FOREIGN BODY 36.25$

4050100 .XR SKULL COMPLETE 92.30$

4050101 .XR SKULL LTD LESS THAN 4V 49.45$

4050103 .XR SPECIMEN RADIOG 26.40$

4050105 XR UPP GI VIDEO SWALLOW STUDY 57.15$

4050107 .XR THERAPEUTIC ENEMA 81.35$

4050108 .XR THORACIC SPINE 4V COMPLETE 36.25$

4050109 .XR THORACIC SPINE LTD 2V 50.55$

4050110 .XR THORACO-LUMBAR JNCT 2V 36.25$

4050112 .XR TIBIA & FIBULA 2V 34.10$

4050113 .XR TEMPOROMANDIBULAR 50.55$

4050114 .XR TOES 26.40$

4050128 .XR WRIST COMPLETE 41.75$

4050129 .XR WRIST LTD 2V 30.75$

4050202 .XR ENTIRE SPINE SURVEY 102.00$

4051002 .XR ABDOMEN (KUB) SINGLE VIEW 30.75$

4051003 XR SHOULDER ARTHRO RT 696.65$

4051004 .XR ABDOMEN 2V 41.75$

4051005 .XR ACUTE ABDOMEN SERIES COMPLETE 92.30$

4051006 XR RIBS BILAT W/ CHEST 4V 375.00$

4051012 .XR SCOLIOSIS STUDY 1V 49.45$

4052003 .XR ACUTE ABD SERIES COMP (INCL CHEST) 36.25$

4052031 .XR B.E. STUDY W/ OR W/O KUB 215.40$

4053002 XR ANKLE COMPLETE BILAT 263.30$

4053003 XR SHOULDER ARTHRO BILAT 696.65$

4053004 XR CLAVICLE BILAT 293.55$

4053005 XR ELBOW COMPLETE 3V BILAT 464.85$

4053006 XR ELBOW LTD 2V BILAT 464.85$

4053009 XR FOOT COMPLETE BILAT 363.45$

4053011 XR FOREARM BILAT 293.55$

4053012 XR HAND COMPLETE BILAT 384.45$


4053013 XR HAND LTD 2V BILAT 238.80$

4053017 XR HUMERUS BILAT 362.30$

4053018 XR KNEE COMPLETE BILAT 411.25$

4053019 XR KNEE COMPLETE BILAT 411.25$

4053020 XR KNEE LTD 2V BILAT 265.60$

4053023 XR SHOULDER 1V BILAT 224.85$

4053024 XR SHOULDER COMPLETE BILAT 363.45$

4053026 XR TIBIA FIBULA 2V BILAT 301.75$

4053028 XR WRIST COMPLETE BILAT 376.30$

4053029 XR WRIST LTD 2V BILAT 244.65$

4054003 XR ANKLE LTD 2V BILAT 259.80$

4060003 .XR MASTOIDS 50.00$

4080001 XR DEXA BASIC (HIPS,PELVIS,SPINE) 446.20$

4080002 XR DEXA VFA (PERIPH,RADIUS,WRIST,HEEL) 109.25$

4090020 XR FLUORO GUIDE SPINE OR PARASPINE 715.00$

4090025 .XR FLUORO GUIDE SPINE OR PARASPINE 129.55$

4090030 XR FLURO GUIDE CENTRAL VENOUS 739.50$

4090035 .XR FLUORO GUIDE CENTRAL VENOUS 79.55$

4090070 XR FLUOROSCOPY UP TO 1HR 990.40$

4090075 .XR FLURO (SEP PROC)UP 1 HR 36.80$

4090080 XR HIP UNILAT 2V RT 265.20$

4090085 .XR HIP UNILAT 2V 35.70$

4090090 XR HIP UNILAT W/PELVIS MIN 4V RT 295.80$

4090095 .XR HIP UNILAT W/PELVIS MIN 4 51.00$

4090100 XR RIBS BILAT 3V 350.00$

4090101 XR FINGER(S) 2V BILAT 138.50$

4090102 XR FOOT LTD LT 209.10$

4090103 XR FOOT LTD RT 209.10$

4090104 XR HIP ARTHRO 196.85$

4090105 XR KNEE ARTHRO 1,039.70$

4090106 XR LUMBAR SPINE COMPLETE W/ FLEX/EXT 7V 550.00$

4090107 XR SC JOINT BILAT 195.85$

4090108 XR SC JOINT LT 195.85$

4090109 XR SC JOINT RT 195.85$

4090110 XR SCOLIOSIS COMPLETE 775.00$

4090111 XR THORACIC SPINE 3V COMPLETE 800.00$

4090112 XR UPP GI W/ SMALL BOWEL F/T (BARIUM) 751.75$

4090113 XR WRIST ARTHRO 960.85$

4090114 .XR BONE SURVEY INFANT 105.00$

4090115 .XR BONE SURVEY METASTATIC 128.60$

4090116 .XR DEXA BASIC (HIPS,PELVIS,SPINE) 35.00$

4090117 .XR HIP UNILAT W/ PELVIS 1V 36.25$

4090118 .XR SC JOINT 35.00$

4090119 .XR SCOLIOSIS COMPLETE 75.00$


4090120 .XR THORACIC SPINE 3V COMPLETE 75.00$

4090122 .XR SCAPULA 46.15$

4090123 .XR RIBS UNILATERAL 2 VIEW 45.00$

4090124 XR RIBS UNILATERAL 2 VIEW RT 350.00$

4090125 XR RIBS UNILATERAL 2 VIEW LT 350.00$

4253601 .MM DIAGNOSTIC MAMMOGRAM BILAT 62.65$

4253602 .MM MAMMOGRAPHY ROUTINE SCREENING 54.95$

4253603 .MM DIAGNOSTIC MAMMOGRAM UNILAT 38.45$

4290001 MM DIAGNOSTIC MAMMOGRAM UNILAT RT 213.20$

4290002 MM DIAGNOSTIC MAMMOGRAM BILAT 230.80$

4290003 MM MAMMOGRAPHY ROUTINE SCREENING 200.00$

4290004 MM DIAGNOSTIC MAMMOGRAM UNILAT LT 213.20$

4300001 MRI CHEST W/ & W/O CONT 3,414.40$

4300002 MRI CHEST W/O CONT 3,375.80$

4300004 MRI CERVICAL SPINE W/O CONT 3,265.45$

4300006 MRI BRAIN W/O CONT 3,051.10$

4300007 MRI LOWER EXT JOINT W/O RT 2,830.95$

4300008 MRI LOW EXTREM JOINT W & W/O RT 2,878.40$

4300010 MRI KNEE W/O CONT RT 2,830.95$

4300011 MRI LOW EXT W/ & W/O CONT RT 3,879.45$

4300012 MRI LOW EXT W/ CONT RT 3,111.15$

4300013 MRI LUMBAR SPINE W/ & W/O CONT 2,620.30$

4300014 MRI LUMBAR SPINE W/O CONT 3,051.10$

4300016 MRI ORBIT/FACE/NECK W/ & W/O CONT 3,908.10$

4300019 MRI ABDOMEN W/O CONT 3,109.35$

4300020 MRI ABDOMEN W/ CONT 3,345.85$

4300023 MRI BRAIN W/ & W/O CONT 3,980.65$

4300025 MRI PELVIS W/ & W/O CONT 3,119.45$

4300026 MRI PELVIS W/O CONT 3,109.35$

4300028 MRI THORACIC SPINE W/ & W/O CONT 4,086.25$

4300029 MRI THORACIC SPINE W/O CONT 4,009.85$

4300031 MRI UPP EXTRE JOINT W/O CONT RT 3,096.25$

4300033 MRI UPP EXT JOINT W/ & W/O CONT RT 2,878.40$

4300034 MRI UPP EXT W/ & W/O CONT RT 2,043.35$

4300035 MRI UPP EXT NOT JOINT W/O CONT RT 3,109.35$

4301000 MRI ABDOMEN W/ & W/O CONT 1,363.25$

4301002 MRA HEAD W/ & W/O CONT 3,146.70$

4301003 MRA HEAD W/O CONT 3,146.70$

4301004 MRA HEAD W/ CONT 1,216.65$

4301007 MRA NECK (CAROTIDS) W/ & W/O CONT 1,606.35$

4301008 MRA NECK (CAROTIDS) W/ CONT 2,500.00$

4301012 MRI LOW EXT W/O CONT RT 3,051.10$

4301013 PROHANCE 10ML SYRINGE CONT 491.85$

4301021 .MRI PITUITARY W&W/O READING 262.65$


4301022 MRA NECK (CAROTIDS) W/O CONT 1,606.35$

4301023 .MRA NECK (CAROTIDS) W/O CONT 151.35$

4301024 MRI ORBIT/FACE/NCK SFT TIS W/ & W/O CONT 1,880.25$

4301025 .MRI ORBIT/FACE/NCK SFT TIS W/ & W/O CON 195.65$

4301026 MRI CERVICAL SPINE W/ & W/O CONT 1,733.65$

4301027 .MRI CSPINE W & W/O 286.85$

4301028 MRI HIP W/O CONT RT 2,830.95$

4301029 .MRI HIP W/O CONT 150.55$

4301030 MRI LOW EXT JOINT W/ & W/O CONT RT 3,806.65$

4301032 MRI LOW EXT JOINT W/O CONT RT 2,830.95$

4301033 .MRI LOW EXT JOINT W/O CONT 149.45$

4301034 MRI FOOT W/O CONT RT 2,830.95$

4301035 .MRI FOOT CONT W/O 149.45$

4301036 MRI SHOULDER W/O CONT RT 1,910.65$

4301037 .MRI SHOULDER W/O CONT 97.80$

4301038 MRI UPP EXT JOINT W/O CONT RT 1,910.65$

4301039 .MRI UPP EXT JOINT W/O CONT 97.80$

4301040 MRI WRIST W/O CONT RT 1,910.65$

4301041 .MRI WRIST W/O CONT 97.80$

4301042 MRI UPP EXT W/O CONT RT 1,910.65$

4301043 .MRI UPP EXT NOT JOINT W/O CONT 97.80$

4301050 .MRI ABDOMEN W/ & W/O CONT 224.90$

4301823 .MRI LOW EXT W/O CONT 179.50$

4301825 MRI BREAST UNILAT W/ & W/O CONT RT 3,960.65$

4301830 .MRI BREAST UNILAT W/ & WO CONT 348.85$

4301835 .MRA HEAD W/ & W/O CONT 386.60$

4301840 MRI CERVICAL SPINE W/ CONT 3,265.45$

4301845 .MRI CERVICAL SPINE W/ CONT 178.05$

4340007 MRI LOWER EXT JOINT W/O LT 2,830.95$

4340008 .MRI LOW EXT JOINT W/ & W/O CONT 2,878.40$

4340010 MRI KNEE W/O CONT LT 2,830.95$

4340011 MRI LOW EXT W/ & W/O CONT LT 3,879.45$

4340012 MRI LOW EXT W/ CONT LT 3,111.15$

4340031 MRI UPP EXTRE JOINT W/O CONT LT 3,096.25$

4340033 MRI UPP EXT JOINT W/ & W/O CONT LT 2,878.40$

4340034 MRI UPP EXT W/ & W/O CONT LT 2,043.35$

4340035 MRI UPP EXT NOT JOINT W/O CONT LT 3,109.35$

4341012 MRI LOW EXT W/O CONT LT 3,051.10$

4341028 MRI HIP W/O CONT LT 2,830.95$

4341030 MRI LOW EXT JOINT W/ & W/O CONT LT 3,806.65$

4341032 MRI LOW EXT JOINT W/O CONT LT 2,830.95$

4341034 MRI FOOT W/O CONT LT 2,830.95$

4341036 MRI SHOULDER W/O CONT LT 1,910.65$

4341038 MRI UPP EXT JOINT W/O CONT LT 1,910.65$


4341040 MRI WRIST W/O CONT LT 1,910.65$

4341042 MRI UPP EXT W/O CONT LT 1,910.65$

4343037 MRI UPP EXT W/ & W/O CONT LT 2,020.95$

4350312 MRI ORBIT/FACE/NECK W/ CONT 1,062.85$

4353001 .MRI ABDOMEN W/ CONT 192.35$

4353002 .MRI ABDOMEN W/O CONT 249.50$

4353003 .MRI ABD W/O CONT 161.55$

4353004 .MRI BRAIN W/O CONT 163.75$

4353005 .MRI BRAIN (PITUITARY) W/ & W/O CONT 262.65$

4353007 .MRI CERVICAL SPINE W/O CONT 178.05$

4353008 .MRI CERVICAL SPINE W/ & W/O CONT 286.85$

4353010 .MRI CHEST W/O CONT 160.45$

4353011 .MRI CHEST W/ & W/O CONT 251.65$

4353013 .MRI ORBIT/FACE/NECK W/ & W/O 237.40$

4353015 .MRI UPP EXT W/ & W/O CONT 239.60$

4353017 .MRI UPP EXT W/O CONT 149.45$

4353021 .MRI LOWER EXT W/O 150.55$

4353023 .MRI LUMBAR SPINE W/ & W/O CONT 262.65$

4353024 .MRI LUMBAR SPINE W/O CONT 164.85$

4353025 .MRI PELVIS W/ CONT 192.35$

4353026 .MRI PELVIS W/O CONT 162.65$

4353027 .MRI PELVIS W/ & W/O CONT 250.60$

4353028 .MRI KNEE W/O CONT 149.45$

4353029 .MRI LOW EXT W/ CONT 179.15$

4353030 .MRI LOW EXT W/ & W/O CONT 238.50$

4353032 .MRI THORACIC SPINE W/ & W/O CONT 286.85$

4353033 .MRI THORACIC SPINE W/O CONT 178.05$

4353034 .MRI TMJ W/O CONT 153.85$

4353037 MRI UPP EXT W/ & W/O CONT RT 2,020.95$

4353038 .MRI UPP EXT JOINT W/ & W/O CONT 180.25$

4353501 .MRA HEAD W/ CONT 129.70$

4353503 .MRA NECK (CAROTIDS) W/ CONT 190.00$

4353504 .MRA NECK (CAROTIDS) W/ & W/O CONT 195.65$

4353505 .MRA PELVIS W/ & W/O CONT 206.60$

4353506 MRA ABDOMEN W/ & W/O CONT 1,363.25$

4353507 MRA PELVIS W/ & W/O CONT 1,272.70$

4353508 MRI BREAST BILAT W/ & W/O CONT 3,980.65$

4353509 MRI ORBIT/FACE/NECK W/O CONT 1,179.25$

4353510 MRI PELVIS W/ CONT 3,510.85$

4353511 MRI THORACIC SPINE W/ CONT 2,933.35$

4353512 .MRA ABDOMEN W/ & W/O CONT 280.00$

4353513 .MRA HEAD W/O CONT 258.05$

4353514 .MRI BREAST BILAT W/ & WO CONT 348.85$

4353515 .MRI ORBIT/FACE/NECK W/ CONT 138.50$


4353516 .MRI ORBIT/FACE/NECK W/O CONT 149.45$

4353517 .MRI THORACIC SPINE W/ CONT 275.00$

4353518 .MRI UPP EXT W/ & W/O CONT 1,910.65$

4353519 MRI BREAST UNILAT W/ & W/O CONT LT 3,960.65$

4363037 .MRI UPP EXT W/ & W/O CONT 225.00$

4400000 US ABDOMEN COMPLETE 1,045.00$

4400001 US NON OB PELVIC LTD 394.55$

4400002 US ABDOMEN LTD (GB) 513.75$

4400003 US KIDNEYS 513.75$

4400004 US AORTA 609.30$

4400005 US OB AFTER 1ST TRIMESTER 1,045.00$

4400006 .US NON OB TRANSVAGINAL 94.50$

4400007 US NON OB PELVIC COMPLETE 611.60$

4400008 US SCROTUM & CONTENTS 611.60$

4400009 US BREAST UNILAT COMPLETE (W/ AXILLA) RT 611.60$

4400011 US EXT BILAT ARTERIAL DOP UPP/LOW 527.75$

4400012 US LOW EXT/ART/UNILAT KIT RT 440.05$

4400013 US EXT BILAT VENOUS DOP UPP/LOW 719.80$

4400014 US ANY EXT/VEN/UNIL RT 415.45$

4400015 US UPP EXT/ART/UNILAT RT 527.75$

4400018 US CAROTID 930.80$

4400020 US GUID NEEDLE BX/ASP/INJ/LOCALIZATION 504.70$

4400021 US PERCUTANEOUS DRAIN 501.60$

4400022 US CHORIONIC 930.80$

4400023 US UNSPECIFIED EXAM 588.35$

4401013 US SOFT TISSUE CHEST (MEDIASTINUM) 631.40$

4401016 US NON OB TRANSVAGINAL 597.55$

4401073 US EXT UPP/LOW NON VASCULAR STUDY RT 339.00$

4401075 US EXT UPP/LOW NON VASCULAR LTD STUDY 65.30$

4403002 US ANKLE BRACHIAL INDEX RT 677.30$

4405005 US ABD PARACENTESIS W/ IMG GUIDE 1,651.40$

4405010 .US ABD PARACENTESIS W/ IMG GUIDE 471.25$

4405015 US THORACENTESIS W/O IMG GUIDE 1,390.25$

4405020 .US THORACENTESIS W/O IMG GUIDE 380.45$

4405025 US THORACENTESIS W/ IMG GUIDE 1,644.25$

4405030 .US THORACENTESIS W/ IMG GUIDE 485.50$

4405035 US GUIDE FOR VASCULAR ACCESS 469.20$

4405040 .US GUIDE FOR VASCULAR ACCESS 76.50$

4405045 .US NON OB PELVIC COMPLETE 146.90$

4405050 US OB < 14 WEEKS PREG 1ST TRIMESTER 1,058.75$

4405055 .US OB < 14 WEEKS PREG 1ST TRIMESTER 218.30$

4405060 US OB TRANSVAGINAL 1,023.05$

4405065 .US OB TRANSVAGINAL 164.75$

4405075 US GUIDED BREAST BIO W/PLACEMENT 2,868.40$


4405076 .US GUIDED BREAST BIO W/PLACEMENT 699.50$

4405077 US GUIDED BREAST BIO ADD LESION 2,340.55$

4405078 .US GUIDED BREAST BIO ADD LESION 339.95$

4405079 US GUIDED PLACEMENT OF BREAST 1,983.00$

4405080 .US GUIDED PLACEMENT OF BREAST 374.60$

4405081 US GUID PLACE OF BREAST ADD 1,692.05$

4405082 .US GUID PLACE OF BREAST ADD 188.45$

4405085 US FINE NDL ASP 982.25$

4405086 .US FINE NDL ASP 281.90$

4405090 US RENAL DOPPLER 1,224.00$

4405500 US LUMBAR RT OR LT FLANK 513.75$

4405510 US SOFT TISSUE UPP BACK R/L QUADRANT 631.40$

4405600 US DIALYSIS GRAFT DOPPLER 1,000.00$

4405610 .US DIALYSIS GRAFT DOPPLER 125.00$

4410001 US ECHO COMPLETE 2,000.00$

4410002 US ECHOCARD WAVE/DOP 552.20$

4410003 US ECHOCARD COLOR FL 552.20$

4440012 US EXT UNILAT ARTERIAL DOP UPP/LOW RT 440.05$

4440014 US EXT UNILAT VENOUS DOP UPP/LOW RT 415.45$

4440015 US UPP EXT/ART/UNILAT LT 527.75$

4441073 US EXT UPP/LOW NON VASCULAR STUDY LT 339.00$

4443002 US ANKLE BRACHIAL INDEX LT 677.30$

4443701 US BILAT ART UPP OR LOW EXT 1-2 LVL 498.55$

4450001 .US LUMBAR RT OR LT FLANK 64.85$

4450010 .US EXT UNILAT VENOUS DOP UPP/LOW 84.65$

4450011 .US AORTA 61.55$

4450016 .US BREAST UNILAT COMPLETE (W/ AXILLA) 61.55$

4450017 .XR CERVICAL SPINE COMPLETE + FLEX/EXT 90.10$

4450018 .US CAROTID 150.55$

4450026 .US CARDIOGRAPHY 103.30$

4450027 .US CHOLANGIOGRAPHY 45.05$

4450055 .US KIDNEYS 62.65$

4450062 .US EXT UPP/LOW NON VASCULAR STUDY 84.15$

4450065 .CT LOW EXT W/O CONT 229.70$

4450075 .US OB AFTER 1ST TRIMESTER 74.75$

4450077 .XR ORBITS 23.10$

4450078 .US PELVIS & HIPS/CHILD 36.25$

4450079 .XR PELVIS COMPLETE 38.45$

4450081 .US CHORIONIC 61.55$

4450082 .US PERCUTANEOUS DRAIN 62.65$

4450091 .US SCAPULA 46.15$

4450093 .US SCROTUM & CONTENTS 58.25$

4450099 .XR SINUSES 30.75$

4450102 .US SMALL BOWEL 67.05$


4450104 .XR STERNUM 49.45$

4450111 .US SOFT TISSUE THYROID/PARATHYROID 45.05$

4450115 .XR UPP GI W/ SMALL BOWEL F/T (BARIUM) 97.80$

4450117 XR SMALL BOWEL F/T 117.60$

4450118 .XR SMALL BOWEL F/T 108.80$

4450119 .US UPPER EXT/BILAT 97.80$

4450120 .US UPP EXT/ART/UNILAT 64.85$

4450122 .US UROGRAPHY BOLUS 100.00$

4450124 .US RENAL DOPPLER 244.80$

4450125 .US VENOGRAM UNIL 117.60$

4450126 .US VOIDING CYSTOGRAM 36.25$

4450127 .XR WRIST ARTHRO 36.25$

4451001 .US FETAL US MULTI 287.95$

4451002 .US SOFT TISSUE UPP BACK R/L QUADRANT 84.65$

4451003 .US EXTREMITY N/V 70.35$

4451004 .US NON OB PELVIC LTD 70.35$

4451005 .US GUID CYST ASP 152.75$

4451006 .US GUID FOR PARA 95.60$

4451007 .US GUID NEEDLE BX/ASP/INJ/LOCALIZATION 75.00$

4451008 US SOFT TISSUE THYROID/PARATHYROID 611.60$

4452005 .US C-SPINE W/CONT 285.75$

4452011 .US CT GUID CYST ASP 382.45$

4452014 .US ABDOMEN COMPLETE 106.60$

4452028 .CT ORBITS/IAC W/ & W/O CONT 251.65$

4452035 .US HIP CT UNILAT 251.65$

4453002 US ANKLE BRACHIAL INDEX BILAT COMPLETE 677.30$

4453701 .US NONINVASIVE UPPER/LOWER 63.75$

4453702 .US ANKLE BRACHIAL INDEX COMPLETE 74.75$

4453703 US ABDOMEN LTD 513.75$

4453704 US AORTA/ILIAC DOPPLER COMPLETE 1,350.00$

4453705 US AORTA/ILIAC DOPPLER LTD 550.00$

4453706 US BLADDER COMPLETE 611.60$

4453707 US BLADDER LTD 609.30$

4453708 US BREAST BILAT COMPLETE (W/ AXILLA) 611.60$

4453709 US BREAST LTD BILAT 775.00$

4453710 US BREAST LTD UNILAT LT 575.00$

4453711 US BREAST LTD UNILAT RT 575.00$

4453712 US DIALYSIS GRAFT DOPPLER 1,000.00$

4453713 US GROIN DOPPLER BILAT 527.75$

4453714 US GROIN DOPPLER UNILAT LT 440.05$

4453715 US GROIN DOPPLER UNILAT RT 440.05$

4453716 US GROIN NON VASCULAR ONLY 233.60$

4453717 US LIVER DOPPLER 1,224.00$

4453718 US LIVER DOPPLER LTD 550.00$


4453719 US MESENTERIC DOPPLER COMPLETE 1,224.00$

4453720 US MESENTERIC DOPPLER LTD 550.00$

4453721 US RENAL DOPPLER LTD 550.00$

4453722 US RETROPERI COMPLETE (RENAL & BLADDER) 609.30$

4453723 US RETROPERI LTD (AORTA OR RENAL) 1,050.00$

4453724 US SCROTAL W/ DOPPLER COMPLETE 1,224.00$

4453725 US SCROTAL W/ DOPPLER LTD 550.00$

4453726 .US SOFT TISSUE HEAD/NECK 82.45$

4453727 US SOFT TISSUE LUMP OR MASS 233.60$

4453728 US UPP EXT/ART/BILAT COMPLETE 1,000.00$

4453729 .US ABDOMEN LTD 62.65$

4453730 .US ABDOMEN LTD (GB) 64.85$

4453731 .US AORTA/ILIAC DOPPLER COMPLETE 115.00$

4453732 .US AORTA/ILIAC DOPPLER LTD 80.00$

4453733 .US BILAT ART UPP OR LOW EXT 1-2 LVL 63.75$

4453734 .US BLADDER COMPLETE 146.90$

4453735 .US BLADDER LTD 61.55$

4453736 .US BREAST BILAT COMPLETE (W/ AXILLA) 61.55$

4453737 .US BREAST LTD BILAT 125.00$

4453738 .US BREAST LTD UNILAT 100.00$

4453739 .US DIALYSIS GRAFT DOPPLER 125.00$

4453740 .US ECHO COMPLETE 110.00$

4453741 .US EXT UPP/LOW NON VASCULAR LTD STUDY 65.30$

4453742 .US GROIN DOPPLER BILAT 64.85$

4453743 .US GROIN DOPPLER UNILAT 53.85$

4453744 .US GROIN NON VASCULAR ONLY 65.30$

4453745 .US KIDNEYS 64.85$

4453746 .US LIVER DOPPLER 244.80$

4453747 .US LIVER DOPPLER LTD 80.00$

4453748 .US MESENTERIC DOPPLER COMPLETE 244.80$

4453749 .US MESENTERIC DOPPLER LTD 80.00$

4453750 .US RENAL DOPPLER LTD 80.00$

4453751 .US RETROPERI COMPLETE(RENAL & BLADDER) 61.55$

4453752 .US RETROPERI LTD (AORTA OR RENAL) 85.00$

4453753 .US SCROTAL W/ DOPPLER COMPLETE 244.80$

4453754 .US SCROTAL W/ DOPPLER LTD 80.00$

4453755 .US SOFT TISSUE CHEST (MEDIASTINUM) 84.65$

4453756 US SOFT TISSUE HEAD/NECK 611.60$

4453757 .US SOFT TISSUE LUMP OR MASS 65.30$

4453759 .US UPP EXT/ART/BILAT COMPLETE 125.00$

4453760 US BREAST UNILAT COMPLETE (W/ AXILLA) LT 611.60$

4453761 US EXT UNILAT ARTERIAL DOP UPP/LOW LT 440.05$

4453762 US EXT UNILAT VENOUS DOP UPP/LOW LT 415.45$

4500001 CT ABDOMEN W/ & W/O CONT 2,762.15$


4500002 CT ABDOMEN W/O CONT 1,050.45$

4500003 CT ABDOMEN W/ CONT 1,128.65$

4500004 CT CHEST W/ & W/O CONT 2,762.15$

4500005 CT CHEST W/O CONT 2,327.65$

4500006 CT CHEST W/ CONT 2,580.45$

4500009 CT CERVICAL SPINE W/ & W/O CONT 2,605.80$

4500010 CT CERVICAL SPINE W/O CONT 1,973.50$

4500012 CT HEAD W & W/O CONT 3,224.70$

4500013 CT HEAD W/O CONT 1,973.50$

4500014 CT HEAD W/ CONT 2,226.30$

4500015 CT HIP UNILATERAL W/O CONT RT 1,546.20$

4500020 CT LOW EXT W/ & W/O CONT RT 2,605.80$

4500021 CT LOW EXT W/O CONT RT 1,546.20$

4500022 CT LOW EXT W/ CONT RT 2,100.25$

4500023 CT LUMBAR SPINE W/O CONT 1,973.50$

4500024 CT ORBITS/IAC/TEMP BONES W/O CONT RT 1,973.50$

4500025 CT ORBITS/IAC W/ CONT RT 2,141.70$

4500026 CT PELVIS W/ & W/O CONT 2,405.90$

4500027 CT PELVIS W/O CONT 1,973.50$

4500028 CT PELVIS W/ CONT 1,843.90$

4500029 CT SINUSES W/ & W/O CONT 2,211.95$

4500030 CT MAXILLOFACIAL/SINUS W/O CONT 1,973.50$

4500031 CT SOFT TISSUE NECK W/ & W/O CONT 2,769.15$

4500032 CT SOFT TISSUE NECK W/O 510.85$

4500033 CT SOFT TISSUE NECK W/ CONT 2,226.30$

4500034 CT THORACIC SPINE W/O CONT 1,613.45$

4500035 CT UPP EXT W/ & W/O CONT RT 2,762.15$

4500036 CT UPP EXT W/O CONT RT 2,830.90$

4500037 CT UPP EXT W/ CONT RT 2,185.95$

4501000 CTA CHEST W/ CONT 2,637.95$

4501001 CTA ABDOMEN W/ & W/O CONT 1,197.10$

4501003 CTA HEAD W/ & W/O CONT 1,197.10$

4501004 CTA LOW EXT W/ CONT RT 1,194.00$

4501005 CTA NECK/CAROTID W/ & W/O CONT 1,197.10$

4501006 CTA PELVIS W/ & W/O CONT 1,194.00$

4501007 CTA UPP EXT W/ CONT RT 1,124.75$

4501008 CT ISOVUE 300/100 ML CONT MED 744.90$


4501010 CT ABDOMEN/PELVIS W/O CONT 1,977.25$

4501011 .CT ABDOMEN/PELVIS W/O CONT 231.55$

4501012 CT ABDOMEN/PELVIS W/ CONT 2,507.75$

4501013 .CT ABDOMEN/PELVIS W/ CONT 228.50$

4501014 CT ABDOMEN/PELVIS W/ & W/O CONT 1,209.50$

4501015 .CT ABDOMEN/PELVIS W/ & W/O CONT 252.95$


4501016 CTA ABDOMEN AORTA & BIL/RUNOFF 1,316.60$

4501017 .CTA ABDOMEN AORTA & BIL/RUNOFF 299.90$

4501018 CTA ABDOMEN/PELVIS W/ CONT 1,552.25$

4501019 .CTA ABDOMEN/PELVIS W/ CONT 275.40$

4501021 .CTA HEAD W/ & W/O CONT 219.30$

4501022 CT MAXILLOFACIAL W/ CONT 721.15$

4501023 .CT MAXILLOFACIAL W/ CONT 173.40$

4501025 CT LUMBAR SPINE W/ & W/O CONT 4,207.50$

4501030 .CT LUMBAR SPINE W/ & W/O CONT 271.30$

4501035 CT CARDIAC CALCIUM HEART SCORE 1,159.75$

4501040 .CT CARDIAC CALCIUM HEART SCORE 204.00$

4511014 CT GASTROGRAFIN 30 ML - CONT 52.95$

4540015 CT HIP UNILATERAL W/O CONT LT 1,546.20$

4540020 CT LOW EXT W/ & W/O CONT LT 2,605.80$

4540021 CT LOW EXT W/O CONT LT 1,546.20$

4540022 CT LOW EXT W/ CONT LT 2,100.25$

4540024 CT ORBITS/IAC/TEMP BONES W/O CONT LT 1,973.50$

4540025 CT ORBITS/IAC W/ CONT LT 2,141.70$

4540035 CT UPP EXT W/ & W/O CONT LT 2,762.15$

4540036 CT UPP EXT W/O CONT LT 2,830.90$

4540037 CT UPP EXT W/ CONT LT 2,185.95$

4541004 CTA LOW EXT W/ CONT LT 1,194.00$

4541007 CTA UPP EXT W/ CONT LT 1,124.75$

4550024 CT ORBITS/IAC/TEMP BONES W/O CONT BILAT 1,973.50$

4550025 CT ORBITS/IAC W/ CONT BILAT 2,141.70$

4550106 .CT THORACIC SPINE W/O CONT 251.65$

4552001 .CT ABDOMEN W/ & W/O CONT 347.30$

4552002 .CT ABDOMEN W/ CONT 285.75$

4552003 .CT ABDOMEN W/O CONT 251.65$

4552004 .CT CERVICAL SPINE W/ & W/O CONT 36.25$

4552006 .CT CERVICAL SPINE W/O CONT 251.65$

4552007 .CT CHEST W/ & W/O CONT 273.65$

4552008 .CT CHEST W/ CONT 286.85$

4552009 .CT CHEST W/O CONT 181.35$

4552012 .CT LOW EXT W/ CONT 125.30$

4552013 .CT MAXILLOFACIAL/SINUS W/O CONT 397.85$

4552016 .CT ORBITS/IAC W/ CONT 149.45$

4552019 .CT SOFT TISSUE NECK W/O 140.70$

4552020 .CT UPP EXT W/O CONT 97.80$

4552021 .CT UPP EXT W/ CONT 125.30$

4552022 .CT UPP EXT W/ & W/O CONT 133.00$

4552023 .CTA ABDOMEN W/ & W/O CONT 206.60$

4552024 .CTA CHEST W/ CONT 208.80$

4552026 .CTA NECK/CAROTID W/ & W/O CONT 191.25$


4552027 .CTA PELVIS W/ & W/O CONT 197.85$

4552032 .CT HEAD W & W/O CONT 319.80$

4552033 .CT HEAD W/ CONT 252.80$

4552034 .CT HEAD W/O CONT 252.80$

4552036 .CT LUMBAR SPINE W/O CONT 251.65$

4552037 .CT SOFT TISSUE NECK W/ CONT 285.75$

4552038 .CT SOFT TISSUE NECK W/ & W/O CONT 251.65$

4552039 .CT ORBITS/IAC/TEMP BONES W/O CONT 251.65$

4552040 .CT PELVIS W/ & W/O CONT 285.75$

4552041 .CT PELVIS W/ CONT 251.65$

4552042 .CT PELVIS W/O CONT 285.75$

4552043 .CT SINUSES W/ & W/O CONT 153.85$

4552048 .CTA LOW EXT W/ CONT 252.80$

4552050 .CTA UPP EXT W/ CONT 197.85$

4552060 .CT LOW EXT W/ & W/O CONT 285.75$

4553000 CT CERVICAL SPINE W/ CONT 2,100.25$

4553001 ISOVUE 300/75 ML CONT MED 744.90$


4553003 CT LUMBAR SPINE W/ CONT 3,000.00$

4553004 CT ORBITS/IAC W/ & W/O CONT 1,470.50$

4553005 CT THORACIC SPINE W/ & W/O CONT 1,200.00$

4553006 CT THORACIC SPINE W/ CONT 1,800.00$

4553007 CTA ABDOMEN W/ CONT 1,197.10$

4553008 CTA ABDOMEN/PELVIS W/ & W/O CONT 1,552.25$

4553009 CTA HEAD W/ CONT 1,197.10$

4553010 CTA NECK/CAROTID W/ CONT 1,197.10$

4553011 .CT CERVICAL SPINE W/ CONT 285.75$

4553012 .CT LUMBAR SPINE W/ CONT 200.00$

4553013 .CT THORACIC SPINE W/ & W/O CONT 125.00$

4553014 .CT THORACIC SPINE W/ CONT 200.00$

4553015 .CTA ABDOMEN W/ CONT 206.60$

4553016 .CTA ABDOMEN/PELVIS W/ & W/O CONT 275.40$

4553017 .CTA HEAD W/ CONT 219.30$

4553018 .CTA NECK/CAROTID W/ CONT 191.25$

4553019 .CT HIP UNILATERAL W/O CONT 229.70$

5100001 EKG - TRACING ONLY (TECH) 311.71$

5500002 CEREBRAL DEATH EVAL 588.90$

5500004 OXYGEN 22.29$

5501000 CPAP/BIPAP MGMT 341.29$

5501002 OXIMETRY SINGLE 67.01$

5501003 OXIMETERY MULTI 171.16$

5501004 OVERNIGHT PULSE OXIMETRY 593.33$

5502000 VENTILATOR 1ST DAY 2,698.21$

5502001 VENTILATOR SUB DAY 2,450.50$


5502014 CO2 EXPIRED GAS DETERMINATION 57.68$

5502030 MDI INI TX 195.33$

5502031 MDI SUB TX 195.33$

5502032 CONTINUOUS NEB 1ST HOUR 309.47$

5502033 CONTINUOUS NEB SUB HOUR 276.32$

5503000 HAND HELD NEB INT TX 116.89$

5503001 HAND HELD NEB SUB TX 116.89$

5503501 IPPB INITIAL TX 321.71$

5503502 IPPB SUBSEQUENT TX 109.09$

5504500 INCENTIVE SPIROMETER SUB 66.81$

5504501 INCENTIVE SPIROMETER INI 158.15$

5505000 CHEST PERCUSS INITIAL TX 222.67$

5505001 CHEST PERCUSSION SUB 93.53$

5506000 INDUCED SPUTUM COLLECT 47.33$

5506003 TRACHEAL SUCTION 42.08$

5509000 ABG ANALYSIS 300.59$

5509001 ARTERIAL PUNTURE 54.57$

5509015 NITROGEN WASHOUT LUNG VOLUMES 186.46$

5509016 NITROGEN WASHOUT LUNG PRO FEE 34.53$

5520001 CARDIAC STRESS TEST TREADMILL 756.99$

5540000 HOLTER MONITOR W/INTERP 292.23$

5540001 MDI SUBSEQ INHALATION TREATMNT 2ND FREQ 195.33$

5540002 MDI SUBSEQ INHALATION TREATMNT 3RD FREQ 195.33$

5540004 HAND HELD NEB SUB TX 2ND FREQUENCY 116.89$

5540005 HAND HELD NEB SUB TX 3RD FREQUENCY 116.89$

5540006 HAND HELD NEB SUB TX ER ONLY 116.89$

5540007 VBG ANALYSIS 300.59$

5540008 CARBOXYHEMOGLOBIN 89.49$

5600000 EEG 744.45$

5600001 PFT SPIROMETRY 311.71$

5600002 PFT PRE/POST BRONCHO 574.41$

5600003 FLOW VOLUME LOOP 240.72$

5600004 SLOW VITAL CAPACITY 80.73$

5600005 MVV MAXIMAL VENTILAT 80.73$

5600006 THORACIC GAS VOL.TGV 205.73$

5600007 AIRWAY RESISTANCE 398.00$

5600008 DLCO DIFFUSION CAPAC 398.00$

5600009 COMPLIANCE STUDY 267.19$

5600010 MIPS / MEPS 80.73$

5600011 BRONCHIAL PROVOCATIO 928.15$

5600012 PULMONARY STRESS TEST 794.58$

5600013 PLETHYSMOGRAPHY 166.46$

5601000 PULSE OXIMETRY SINGLE 141.93$

5601006 GAS DILUTION 121.28$


5601008 HHN OR MDI EVAL/DEMO 156.26$

5601009 PFT SPIROMETRY READING 38.96$

5601010 PFT PRE/POST BRONCHO READING 61.25$

5601011 DLCO DIFFUSION CAPAC READING 44.52$

5601015 RTR SINGLE 15 MIN 135.25$

5601020 RTR SINGLE OTHER 15 MIN 135.25$

5601025 RTR MULTI 135.25$

5607000 CPR 594.51$

5609003 PH BODY FLUID/XBLOOD 194.82$

5609004 PH ONLY BLOOD 194.82$

5610003 RYTHUM STRIP N/INTER 114.09$

6000002 DEBROX (CARBAMIDE PEROXIDE) 6.5 % EAR DR 5.14$

6000003 Cortisporin-TC (neomycin-colist) Otic 461.70$

6001001 BETAXOLOL (BETOPTIC) 0.5% Opth 283.66$

6001003 AZOPT(BRINZOLAMIDE)1% Opth 261.08$

6001004 CIPROFLOXACIN (CILOXAN) 0.3% Opth 139.27$

6001005 CROMOLYN (CROLOM) 4% Opth 90.74$

6001006 CYCLOPENTOLATE (CYCLOGEL) 2% OPTH 15.41$

6001007 ERYTHROMYCIN (ILOTYCIN) OPTH OINT 52.20$

6001008 GENTAMICIN (GENTAK) OPHTH SOL 10.70$

6001010 KETOROLAC (ACULAR) 0.5% 3ML OPTH DROPS 812.34$

6001012 LACRI-LUBE (MINERAL OIL) 56.8-42.5% 18.83$

6001013 LATANOPROST (XALATAN) 0.005% OPTH DROPS 10.70$

6001014 VIGAMOX (MOXIFLOXACIN HCL) 0.5% 195.46$

6001015 PATANOL (OLOPATADINE HCL) 0.1% 176.34$

6001016 REFRESH LUBRICATING EYE DROPS 29.10$

6001017 SULFACETAMIDE SODIUM 10% 148.32$

6001018 TIMOLOL (TIMOPTIC) 0.5% 472.83$

6001019 TOBRAMYCIN (TOBRADEX) 0.3-0.1% 314.30$

6001020 TOBRAMYCIN (TOBREX) 0.3% 78.46$

6001021 BIO GLO (FLUORESCEIN SODIUM) 1MG Opth 17.12$

6001022 tetracaine HCl 0.5% 4mL 49.90$

6001023 sulfacetamide-prednisolone 10%-0.23% 104.33$

6001024 EYE WASH(Na BORATE/BORIC ACID/NaCl) 4 OZ 10.70$

6001025 neomycin-polymyxin-dexameth (MAXITROL) 110.50$

6001026 LIQUI-TEARS(POLYVINYL ALCOHOL) OPTH 15ML 21.09$

6001028 ATROPINE SULF 1% OPTH DROPS 104.16$

6001029 neomycin-polymyxin(NEOSPORIN) 10.91$

6001030 ATROPINE SULF 1% OPTH OINTMENT 3.5GM 106.38$

6002001 COMBIVENT (IPRATROPIUM-ALBUTEROL) INH 351.40$

6002002 ALBUTEROL SULFATE(VENTOLIN HFA) 90MCG 158.10$

6002003 ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) 7.80$

6002004 IPRATRO-ALBUT (DUONEB) 0.5 MG-3 MG 3ML 7.90$

6002005 AMMONIA AROMATIC (AMMONIA) 15% AMP 10.70$


6002006 AZELASTINE (ASTELIN)137MCG NASAL SPRAY 160.07$

6002007 QVAR (BECLOMETHASONE) 40MCG 173.77$

6002008 BUDESONIDE (PULMICORT) 0.5MG/2ML INH 43.66$

6002010 SUPRANE (DESFLURANE) 240ML 1,069.12$

6002011 ADVAIR DISKUS(FLUTICA/SALMETE)100-50MCG 593.21$



6002014 HEPARIN (PORCINE) / D5W 25,000UNIT/250ML 52.00$

6002016 IPRATROPIUM BRO (ATROVENT) 0.5MG/2.5ML 95.82$

6002017 XOPENEX (LEVALBUTEROL HCL) 0.31MG / 3 ML 96.86$

6002018 XOPENEX (LEVALBUTEROL HCL) 0.63MG/3 ML 96.86$

6002019 ASMANEX(MOMETASONE FUROATE)220MCG 768.78$

6002020 SOJOURN (SEVOFLURANE) 250ML 1,057.16$

6002022 SPIRIVA (TIOTROPIUM BROMIDE) 18MCG MDI 107.70$

6002023 SODIUM CHLORIDE 0.9% 3ML INH 32.53$

6002024 LEVALBUTEROL HCl (XOPENEX) 1.25MG / 3ML 32.53$

6002025 S2 RACEPINEPHRINE 2.25% 0.5ML 96.86$

6002026 budesonide(PULMICORT)0.25mg / 2ml INH 53.39$

6002027 PULMICORT (BUDESONIDE) 1MG/2ML NEB 125.67$

6002028 ALBUTEROL SULFATE 2.5MG/0.5ML INHALATION 42.80$

6002030 PERFOROMIST (FORMOTEROL) 20MCG/2ML 51.41$

6003001 ACETYLCYSTEINE (ACETADOTE) 200MG/ML 30ML 1,307.37$

6003003 ACYCLOVIR (ZOVIRAX) 500MG TAB 126.86$

6003006 CATHFLO ACTIVASE (ALTEPLASE) 2MG INJ 153.22$

6003007 AMINOCAPROIC ACID(AMICAR)250MG/ML IV 228.55$

6003011 AMPICILLIN SODIUM 500MG INJ 16.42$

6003013 AMPICILLIN-SULBACTAM (Unasyn) 3GM INJ 51.48$

6003014 ANTIVENIN LATRODECTUS(Black Widow) 109.57$

6003015 ATROPINE SULF 1MG/10ML (0.1MG/ML) SYR 75.33$

6003017 ATROPINE SULF 0.4MG/ML INJ 13.91$

6003018 ZITHROMAX (AZITHROMYCIN) 500MG INJ 370.94$

6003020 BACITRACIN 50,000 UNIT INJ 331.70$

6003021 BENZTROPINE (COGENTIN) 2MG/2ML INJ 65.91$

6003022 MARCAINE SPINAL 7.5MG/ML 2ML AMP 11.98$

6003023 SENSORCAINE (BUPIVACAINE ) 0.25% 2.5MG 30.82$

6003024 LANTUS SOLOSTAR (INSULIN GLARGINE) 147.01$

6003025 SENSORCAINE(BUPIVACAINE HCL/PF) 0.5% 5MG 30.82$

6003026 SENSORCAINE(BUPIVACAINE HCL/PF)7.5MG 18.83$

6003027 SENSORCAINE-MPF/EPINEPHRINE VIAL 31.67$

6003029 CALCIUM CHLORIDE 10% 100MG/10ML SYR 51.36$

6003030 CANCIDAS (CASPOFUNGIN ACE) 50MG INJ 888.53$

6003031 CANCIDAS (CASPOFUNGIN ACET) 70MG INJ 888.53$

6003032 CEFAZOLIN (ANCEF) 1GM INJ 16.80$

6003033 CEFEPIME (MAXIPIME) 1GM INJ 113.12$


6003034 CEFEPIME (MAXIPIME) 2GM INJ 224.51$

6003040 CEFTRIAXONE (ROCEPHIN) 1GM INJ 31.50$

6003041 CEFTRIAXONE (ROCEPHIN) 250MG INJ 80.46$

6003044 CHLORPROMAZINE (THORAZINE) 25MG/ML INJ 104.66$

6003045 CIPROFLOXACIN / D5W IVPB: 400MG/200ML 201.16$

6003046 SODIUM CHLORIDE 0.9 % 10ML FLUSH 9.10$

6003048 CLINIMIX E 2.75/D10 2.75% 1000ML IV 1,523.68$

6003049 CLINIMIX E 4.25/D10 4.25% 1000ML IV 275.68$

6003050 CLINIMIX E 5%/D15 5% 1000ML IV 80.88$

6003051 CORTROSY (COSYNTROPIN)0.25MG Inj 155.06$

6003052 CROFAB (ANTIVENIN,CROTALIDAE FAB(OVIN) 3,619.10$

6003053 CYANOCOBALAMIN (VIT B-12) 1000MCG/ML INJ 10.70$

6003054 DANTRIUM (DANTROLENE SOD) 20MG IV 591.85$

6003055 CUBICIN (DAPTOMYCIN) 500MG IV 1,562.20$

6003056 PROLIA (DENOSUMAB) 60MG/ML SUBQ INJ 1,140.23$

6003057 DEXMETHASONE (DECADRON) 4MG/ML INJ 35.10$

6003058 D5W 1/4 NS 500ML IV 211.22$

6003060 D5W 1/2 NS 1000ML IV 211.22$

6003061 D5W NS 500ML IV 211.22$

6003062 D5W 1/4 NS 1000ML IV 201.16$

6003063 D5W NS 1000ML IV 211.22$

6003064 DEXTROSE 10% IN WATER (D10W)1000 ML IV 201.16$

6003065 DEXTROSE 5% IN WATER NITRO BAG 500ML IV 211.43$

6003066 DEXTROSE 5% IN WATER 250ML IV 211.22$





6003073 DEXTROSE 50% IN WATER 50 ML IV 211.22$

6003074 DEXTROSE 50% (25GM / 50ML) SYR 211.22$

6003076 DIAZEPAM (VALIUM) 5MG/ML INJ 41.94$

6003077 DILTIAZEM (CARDIZEM) 5MG/ML 25ml 29.44$

6003078 DILTIAZEM (CARDIZEM) 5MG/ML 10ml 10.70$

6003079 DIPHENHYDRAMINE (BENADRYL) 50MG/ML INJ 10.70$

6003080 DOBUTAMINE (DOBUTREX) 250 MG/20 ML INJ 73.62$

6003081 dopamine 40mg/ml 5ml 120.70$

6003082 DOPAMINE 400 MG/5 ML INJ 68.48$

6003083 DOXAPRAM (DOPRAM) 20MG/ML 340.34$

6003084 ENALAPRILAT (VASOTEC) 2.5MG/2ML INJ 150.87$

6003085 LOVENOX (ENOXAPARIN SOD) 100MG/1ML INJ 69.49$

6003086 LOVENOX (ENOXAPARIN SODIUM) 30MG/0.3 ML 69.49$



6003089 EPHEDRINE SULFATE 50MG/ML INJ 10.70$


6003090 EPI-PEN (EPINEPHRINE) 0.3MG/0.3 ML 878.00$

6003091 EPINEPHRINE 1MG/1ML AMP FOR INJECTION 58.60$

6003093 L.E.T TOPICAL 143.38$

6003094 ESMOLOL HCL (BREVIBLOC) 100MG/10ML INJ 152.94$

6003095 DELESTROGEN(ESTRADIOL VALERATE)10MG/ML 492.20$

6003096 AMIDATE(ETOMIDATE)20MG/10ML IV 107.00$

6003097 FAMOTIDINE (PF) (PEPCID) 20MG/2ML INJ 82.74$

6003098 FOLIC ACID (1MG=0.2ML) 5MG/ML INJ 32.53$

6003099 CEREBYX (FOSPHENYTOIN) 500MG PE/10ML INJ 190.03$

6003100 FOSPHENYTOIN (CEREBYX) 100MG PE/2 ML 88.17$

6003101 FUROSEMIDE (LASIX) 20MG/2ML INJ 86.73$

6003102 FUROSEMIDE (LASIX) 40MG/4ML INJ 86.73$

6003103 FUROSEMIDE (LASIX) 40MG/5ML ORAL LIQ 18.68$

6003104 GARDASIL(QUADRIVALENT) 20MCG/0.5 ML 905.43$

6003105 GENTAMICIN 80MG/2ML INJ 10.70$

6003106 GLUCAGEN KIT (GLUCAGON) 1MG/ML 229.84$

6003107 GLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ 54.32$

6003109 HALOPERIDOL LACTATE (HALDOL) 5MG/ML INJ 42.84$

6003111 HEPARIN SOD (PORCINE) 5,000UNIT/ML INJ 97.37$

6003112 ENGERIX-B (VACCINE HEP B) 20MCG/ML 141.83$

6003113 HUMALOG KWIK PEN (INSULIN LISPRO) 335.18$

6003114 HUMULIN R (INSULIN REGULAR )100UNIT/ML 96.30$

6003115 HYDROMORPHONE (DILAUDID) 1MG/ML INJ 24.00$

6003116 HYDROMORPHONE (DILAUDID) 2MG/ML INJ 23.40$

6003117 IMIPENEM CLISTATIN (PRIMAXIN) 500MG INJ 53.70$

6003118 INVANZ (ERTAPENEM SODIUM) 1GM INJ 421.19$

6003119 IPOL (POLIOMYELITIS)40-8-32UNIT/0.5 ML 141.25$

6003120 D5-NS WITH 20MEQ KCL 1000ML IV 211.22$

6003121 D5W & 20MEQ KCL 1000ML IV 211.22$

6003122 D5W 1/4 NS WITH 20MEQ KCL 1000ML IV 211.22$

6003123 D5-1/2 NS WITH 20 MEQ KCL 1000ML IV 211.22$

6003124 D5-LR WITH 20MEQ KCL 1000ML IV 211.22$

6003125 D5-NS & 40MEQ KCl 1000ML IV 211.22$

6003126 D5W 0.45% NS W/ 40MEQ POT CHL 1000ML IV 211.22$

6003127 KENALOG (TRIAMCINOLONE) 40MG/ML INJ 54.64$

6003128 KETOROLAC (TORADOL) 60MG/2ML INJ 16.00$

6003129 KETOROLAC (TORADOL) 30MG/ML INJ 25.39$

6003131 LABETALOL (TRANDATE) 100MG / 20ML VIAL 13.18$

6003132 LACTATED RINGERS (RINGERS) 1000ML IV 43.80$

6003135 LIDOCAINE HCL 10MG/ML (1 %) 50ml inj 10.70$

6003136 LIDOCAINE HCL 1% 200MG/20ML VIAL 80.18$

6003137 lidocaine 0.4%/D5W 500ml IV 201.16$

6003138 LIDOCAINE HCL/EPINEPHRINE1%-1:100000 1ML 25.04$

6003139 ZYVOX (LINEZOLID) 600 MG/300ML IV 809.39$


6003140 INTRALIPID (FAT EMULSION) 100ML IV 252.95$

6003141 MAGNESIUM SULFATE 2GM/50ML IVPB 100.76$

6003142 MAGNESIUM SULFATE 50% 1GM/2ML INJ 10.70$

6003143 MAGNESIUM SULFATE/D5W: 1GM/100ML IVPB 82.41$

6003144 MANNITOL 25% 50ML INJ 69.34$

6003145 MARCAINE (BUPIVACAINE HCL) 0.25% VIAL 115.17$

6003147 DEMEROL (MEPERIDINE HCL/PF) 25MG/ML INJ 64.20$

6003148 DEMEROL (MEPERIDINE HCL/PF) 50MG/ML INJ 80.25$

6003150 CARBOCAINE(MEPIVACAINE HCL/PF)15MG/ML 62.49$

6003151 BREVITAL (METHOHEXITAL SOD) 500MG IV 409.17$

6003152 METOCLOPRAMIDE (REGLAN) 10MG/2ML INJ 115.56$

6003153 METOPROLOL TART (TOPROL) 5MG/5ML INJ 37.66$

6003154 MIDAZOLAM (VERSED) 2MG/2ML INJ 33.38$

6003155 MIDAZOLAM (VERSED) 10MG/2ML INJ 47.08$

6003156 M-M-R II 1,000-12,500TCID50/0.5 ML VIAL 358.50$

6003157 MORPHINE 2MG/ML INJ 42.80$

6003158 MORPHINE (Surgery USE ONLY) 5MG/ML 34.24$



6003164 MULTITRACE-5 0.01-1-.5-.06-5MG/ML VIAL 31.67$

6003165 MULTIVITAMIN (INFUVITE) INJ ADULT 10ML 35.88$

6003166 NABI-HB(HEPATITIS B) 1,560UNIT/5 ML 1,110.12$

6003167 NAFCILLIN (UNIPEN) 1GM INJ 81.18$

6003168 NALBUPHINE (NUBAIN) 10MG/ML INJ 8.68$

6003169 NALOXONE (NARCAN) 0.4MG/ML INJ 58.14$

6003171 NEOSTIGMINE METHYLSULFATE 1MG/ML 87.74$

6003172 NITROPRESS (NITROPRUSSIDE Na) 25MG/ML 948.86$

6003174 olanzapine (ZYPREXA) 10MG INJ 260.78$

6003175 ONDANSETRON HCl (ZOFRAN) 4MG/2ML INJ 5.00$

6003176 PENICILLIN G (PFIZERPEN-G) 5 MILLION UN 48.41$

6003177 PHENOBARBITAL 65MG/ML INJ 32.53$

6003178 PHENTOLAMINE (REGITINE) 5MG 699.39$

6003180 PIPERACILLIN-TAZOBACT (ZOSYN) 2.25GM INJ 84.90$

6003181 PIPERACILLIN-TAZOBAC (ZOSYN) 3.375GM INJ 127.42$

6003183 PNEUMOVAX 23 25MCG/0.5 ML 770.44$

6003184 POTASSIUM CHLORIDE 40MEQ/100 ML 179.54$

6003185 NS WITH KCl 40MEQ/1000ML IV 211.22$

6003186 KCL IN 1/2 NORMAL SALINE 20MEQ/1000ML 34.24$

6003187 PROCAINAMIDE (PROCAN) 1GM/2ML INJ 130.86$

6003188 PROCHLORPERAZINE (COMPAZINE) 5MG/ML INJ 62.23$

6003189 PROMETHAZINE (PHENERGAN) 25MG/ML INJ 23.30$

6003190 ADACEL (T-DAP) 0.5ML VACCINE 141.40$

6003192 PROPOFOL (DIPRIVAN) 200MG/20ML 33.00$

6003193 FLUCONAZOLE/NS (DIFLUCAN) 200MG/100ML IV 291.90$


6003194 PROPOFOL (DIPRIVAN) 500MG/50ML 32.00$

6003195 PROPRANOLOL (INDERAL) 1MG/ML INJ 548.06$

6003196 PROTAMINE 50MG/ML INJ 150.23$

6003197 PROTONIX (PANTOPRAZOLE) 40MG INJ 30.00$

6003198 PROTOPAM CHL (PRALIDOXIME CHL) 1G INJ 578.88$

6003199 IMOGAM RABIES-HT 150UNIT/ML 2,393.63$

6003200 IMOVAX RABIES VACCINE 2.5UNIT 1,435.40$

6003201 RINGERS SOLUTION 1000ML IV 211.22$

6003202 rocuronium (ZEMURON) 100mg/10ml 486.85$

6003204 SODIUM CHL 0.45% (1/2 NS) 1000ML IV 171.20$

6003206 SODIUM CHLORIDE 0.9% 1000ML IV 32.36$





6003217 SOLU-CORTEF 100MG/2ML INJ 72.76$

6003218 SOLU-MEDROL(METHYLPRED) 125MG/2ML INJ 32.44$

6003219 SOLU-MEDROL (METHYLPRED) 1GM/8 ML INJ 82.18$

6003220 SOLU-MEDROL (METHYLPRED) 40MG/ML INJ 20.14$

6003221 SOLU-MEDROL 500MG 71.90$

6003222 QUELICIN(SUCCINYLCHOLINE)1000MG/10ML 20.98$

6003223 TERBUTALINE (BRETHINE) 1MG/ML INJ 267.07$

6003224 TESTOSTERONE CYP( DEPO-TEST) 100MG/ML 329.06$

6003226 THIAMINE (VITAMIN B1) 200MG/2ML 34.24$

6003227 THROMBIN bovine 5,000UNIT 479.17$

6003228 TNKASE (TENECTEPLASE) 50MG INJ 7,537.10$

6003229 TOBRAMYCIN (TOBREX) 80MG/2ML INJ 273.75$

6003230 APLISOL (TUBERCULIN ) 5UNIT/0.1 ML 23.94$

6003231 VANCOMYCIN (VANCOCIN) 1GM INJ 28.00$

6003232 VANCOMYCIN (VANCOCIN) 500MG INJ 31.00$

6003233 POTASSIUM (KCL) 20MEQ/100ML IVPB 179.54$

6003234 VECURONIUM (NORCURON) 10MG INJ 46.22$

6003235 VERAPAMIL 5MG/2ML 42.80$

6003236 VITAMIN K1 (PHYTONADIONE) 10MG/ML INJ 90.02$

6003237 XYLOCAINE (LIDOCAINE HCL) 2% 20ML VIAL 16.00$

6003238 XYLOCAINE (LIDOCAINE HCL) 5MG/ML 80.18$

6003239 XYLOCAINE-EPINEPHRINE 2%-1:100,000 102.65$

6003240 XYLOCAINE(LIDOCAINE HCL)5MG/ML 84.06$

6003241 XYLOCAINE/EPINEPHRINE 1%-1:200,000 VIAL 73.85$

6003242 XYLOCAINE/EPINEPHRINE 1%-1:100,000 VIAL 16.36$

6003243 GEODON (ZIPRASIDONE MESYLATE) 20MG INJ 112.61$

6003244 SODIUM BICARB 8.4%10ml 56.46$

6003245 SODIUM BICARBONATE VIAL 8.4% 50MEQ/50ML 10.70$

6003248 AZTREONAM (AZACTAM) 1GM INJ 220.00$


6003249 BUPIVACAINE (PF) 0.25% 2.MG/ML INJ 115.17$

6003250 DOPAMINE 400MG/D5W 250ML IV PREMIX 211.01$

6003251 LEVOFLOXACIN (LEVAQUIN) IVPB 750MG/150ML 339.23$

6003252 LEVOFLOXACIN (LEVAQUIN) D5W 500MG/100ML 339.23$

6003257 SUMATRIPTAN (IMITREX) 6MG/0.5ML INJ 54.70$

6003258 PHENYLEPHRINE (VAZCULEP) 10MG/ML INJ 201.53$

6003262 DEXTROSE 5%-LACTATED RINGERS 1000ML IV 211.22$

6003263 metronidazole NaCl (FLAGYL) 500mg/100ml 75.33$

6003264 PYRIDOXINE (VITAMIN B6) 100MG/ML INJ 160.07$

6003265 CEFTRIAXONE (ROCEPHIN) 500MG INJ 126.69$

6003267 NORMAL SALINE & 20MEQ/L KCl 1000ML IV 211.22$

6003268 LEVOPHED (NOREPINEPHRINE) 1MG/ML INJ 59.92$

6003269 IRON SUCROSE (VENOFER) 200MG/5ML INJ 505.04$

6003270 HYDRALAZINE (APRESOLINE) 20MG/ML INJ 96.73$

6003271 flumazenil (ROMAZICON) 0.5MG/5ML 834.76$

6003272 DEPO-MEDROL (METHYLPRED) 40MG/ML INJ 219.14$

6003273 AMIODARONE (CORDARONE) 150MG/3ML INJ 117.70$

6003274 BUMETANIDE (BUMEX) 0.25MG/ML INJ 283.34$

6003275 WATER BACTERIOSTATIC 30ML INJ 42.80$

6003278 Menomune Vaccine 50MCG/0.5ML INJ 724.86$

6003279 Neut (sodium bicarbonate) 5ML 54.50$

6003281 SODIUM ACETATE 4MEQ/ML 26.08$

6003282 ACETAZOLAMIDE (DIAMOX) 500MG TAB 287.94$

6003283 labetolol (TRANDATE) 20mg/4ml 35.95$

6003286 bupivacaine (PF) 0.5% 5MG INJ 115.17$

6003287 LORAZEPAM (ATIVAN) 2MG/ML INJ 43.66$

6003289 FENTANYL CITRATE 250MCG/5ML INJ 235.40$

6003290 FENTANYL CITRATE 100MCG/2ML INJ 41.94$

6003292 CYANOKIT (HYDROXOCOBALAMIN) 5GM IV 1,096.74$

6003302 albumin, human 25 % IV 25GM 1,201.82$

6003303 KETALAR (KETAMINE) 500MG/5ML INJ 42.80$

6003304 tetracaine HCl 1% 2mL 141.70$

6003306 Bicillin C-R(penicillin G) 1.2MU/2ML IM 187.90$

6003307 FLUPHENAZINE (PROLIXIN)125MG/5ML INJ 115.18$

6003309 rifampin (Rifadin) 600MG 774.51$

6003310 DICYCLOMINE (BENTYL) 20MG/2ML INJ 160.00$

6003311 PHENYTOIN SOD (DILANTIN) 250MG/5ML VL 11.02$

6003312 PHENYTOIN SODIUM 100MG/2ML INJ 20.47$

6003435 Neupogen (filgrastim) 480MCG 42.80$

6003437 LIDOCAINE 2% 100MG/5ML SYR 42.80$

6003438 AMIODARONE (NEXTERONE)150MG/100ML IV 42.80$

6003439 AMIODARONE (NEXTERONE) 360MG/200ML IV 42.80$

6003440 LIDOCAINE HCl (XYLOCAINE) MPF- 0.5% 50ML 42.80$

6003441 DEXTROSE 25% (2.5GM/10ML) SYR 42.80$


6003444 SODIUM BICARBONATE SYR 50MEQ/50ML 42.80$

6003445 nicardipine (Cardene) 25MG/10ML 42.80$

6003447 ANECTINE 20MG/ML(SUCCINYLCHOLINE CL) INJ 42.80$

6003449 HUMULIN 70/30 PEN (INSULIN NPH-REGULAR) 42.80$

6003450 DigiFab 40MG INJ 5,782.11$

6003451 DIGOXIN (LANOXIN) 500MCG/2ML INJ 41.94$

6003452 PHYSOSTIGMINE SALICYLATE 2MG/2ML INJ 31.35$

6003455 sodium chloride 23.4% 30ML 42.80$

6003456 CEFTRIAXONE/D5W 1GM/50ML PREMIX 77.45$

6003457 CEFAZOLIN 1GM/50ML (ANCEF) D5W PREMIX 41.70$

6003458 HESPAN 6% IN NORMAL SALINE 500ML IV 201.16$

6004001 DDAVP (DESMOPRESSIN)10MCG/SPRAY NASAL 291.90$

6004002 DESMOPRESSIN(DESMOPRESSIN)4MCG/ML Inj 63.34$

6004003 fluticasone (FLONASE) 50MCG/SPRAY NASAL 171.20$

6004004 NEO-SYNEPHRINE (PHENYLEPHRINE HCL) 0.5% 79.34$

6004005 NEO-SYNEPHRINE (PHENYLEPHRINE HCL) 1% 19.03$

6004006 SALINE(SODIUM CHLORIDE) 0.65% SPRAY 10.70$

6005001 AGGRENOX(ASPIRIN/DIPYRIDAMOLE)200-25MG 22.26$

6005003 ACETAM-CODEINE(TYLENOL # 3) 300-30MG TAB 10.27$

6005004 ACETAMINOPHEN (TYLENOL)160MG/5ML *ADULT* 26.65$

6005005 ACETAMINOPHEN (TYLENOL/MAPAP) 500MG TAB 8.56$

6005006 TYLENOL (ACETAMINOPHEN) 325MG TAB 8.56$

6005008 acetylcysteine(MUCOMYST)200MG/ML 30 ML 35.10$

6005009 ACIDOPHILUS-PECTIN 25MU TAB 5.90$

6005011 ALBUTEROL (PROVENTIL) 4MG TAB 33.38$

6005012 ALENDRONATE (FOSAMAX) 70MG TAB 47.94$

6005013 ALLOPURINOL (ZYLOPRIM) 100MG TAB 21.40$

6005014 ALLOPURINOL (ZYLOPRIM) 300MG TAB 6.85$

6005015 ALPRAZOLAM (XANAX) 0.25MG TAB 11.98$

6005016 ALPRAZOLAM (XANAX) 0.5MG TAB 11.98$

6005018 AMANTADINE HCl (SYMMETREL)100MG TAB 21.80$

6005019 AMIODARONE (CORDARONE) 200MG TAB 20.54$

6005020 AMITRIPTYLINE (ELAVIL) 25MG TAB 8.56$

6005022 AMLODIPINE (NORVASC) 5MG TAB 17.12$

6005023 AMOXICILLIN-POTAS CLAV (AUGMENTIN) 500MG 17.12$

6005024 AMOXILCILLIN-POTA CLAV (AUGMENTIN) 875MG 17.12$

6005027 AMOXICILLIN (AMOXIL) 500MG CAP 9.42$

6005028 ACETAM-CODEINE 120-12MG/5 ML ELIX 19.97$

6005029 ARIPIPRAZOLE (ABILIFY)10MG TAB 10.30$

6005031 ASPIRIN (ASA) 325MG TAB 10.70$

6005032 ASPIRIN (ASA) 81MG CHEWABLE TAB 10.70$

6005033 ASPIRIN (ASA)81MG EC DELAYED REL TAB 10.70$

6005035 ATENOLOL (TENORMIN) 50MG TAB 10.70$

6005037 AZITHROMYCIN (ZITHROMAX) 250MG TAB 17.12$


6005038 AZITHROMYCIN (ZITHROMAX)200MG/5ML -RECON 194.07$

6005039 BACLOFEN (LIORESOL)10MG TAB 6.85$

6005040 BENAZEPRIL (LOTENSIN) 10MG TAB 10.70$

6005044 BENZONATATE (TESSALON) 100MG CAP 9.42$

6005045 BENZTROPINE (COGENTIN) 1MG TAB 16.73$

6005046 BETHANECHOL (URECHOLINE) 25MG TAB 10.27$

6005047 BISACODYL (DULCOLAX) 5MG TAB 10.70$

6005049 BUMETANIDE (BUMEX) 1MG TAB 11.98$

6005051 BUPROPION HCl(WELLBUTRIN XL)150MG XL TAB 17.12$

6005052 BUPROPION (WELLBUTRIN) HCl 100MG TAB 17.12$

6005053 BUPROPION HCl(WELLBUTRIN SR)150MG SR TAB 17.12$

6005054 BUSPIRONE (BUSPAR) 5MG TAB 11.98$

6005055 CALCITRIOL (ROCALTROL) 0.25MCG CAP 10.70$

6005056 ANTACID (CALCIUM CARBONATE-TUMS) 500 MG 6.85$

6005057 ATACAND(CANDESARTAN CILEXETIL) 8MG TAB 15.97$

6005058 CARBAMAZEPINE (TEGRETOL) 200MG TAB 16.73$

6005059 carbidopa-levodopa(SINEMET)25/100MG TAB 10.70$

6005060 CARBIDOPA-LEVODOPA(SINEMET)25-250MG TAB 6.85$

6005061 CARISOPRODOL (SOMA) 350MG TAB 11.98$

6005062 CARVEDILOL (COREG) 3.125MG TAB 12.84$

6005065 ACTIDOSE/SORBITOL 50GRAM/240ML 111.28$

6005066 ACTIDOSE-AQUA (CHARCOAL)50GRAM/240 ML 140.38$

6005067 CHLORDIAZEPOXIDE(LIBRIUM) 25MG CAP 10.70$

6005068 CHOLESTYRAMINE-SUCROSE(QUESTRAN)4GRAM 40.23$

6005071 CIPROFLOXACIN (CIPRO) 250MG TAB 10.70$

6005073 CITROMA (MAGNESIUM CITRATE) 296ML Oral 10.70$

6005075 CLINDAMYCIN (CLEOCIN) 150MG CAP 17.12$

6005076 CLONAZEPAM (KLONOPIN) 0.5MG TAB 11.98$

6005077 CLONIDINE (CATAPRESS) 0.1MG TAB 10.70$

6005078 PLAVIX (CLOPIDOGREL) 75MG TAB 17.12$

6005079 CLOTRIMAZOLE (MYCELEX)10MG LOZ/TROCHE 17.12$

6005080 COLCRYS (COLCHICINE) 0.6MG TAB 17.12$

6005081 CYCLOBENZAPRINE (FLEXERIL) 10MG TAB 10.70$

6005082 DANTROLENE (DANTRIUM) 25MG CAP 17.12$

6005084 DIAZEPAM (VALIUM) 5MG TAB 10.70$

6005085 DICLOFENAC SOD (VOLTAREN) 75MG TAB 15.06$

6005086 DIGOXIN (LANOXIN) 0.25MG/5ML LIQ 193.57$

6005087 DIGOXIN (LANOXIN) 125MCG TAB 10.70$

6005090 DILTIAZEM HCl (CARIZEM ER) 120MG CAP 10.70$

6005091 DILTIAZEM (CARDIZEM CD) 180MG CAP 17.12$

6005093 DILTIAZEM (CARDIZEM) 60MG TAB 14.55$

6005094 DILTIAZEM (CARDIZEM CD) 300MG CAP 17.12$

6005098 DIPHENHYDRAMINE (BENADRYL) 25MG/10ML LIQ 29.96$

6005099 DIPHENHYDRAMINE (BENADRYL) 25MG TAB 10.70$


6005101 DIPHENOXY ATROPINE (LOMOTIL)2.5-0.025MG 10.70$

6005102 DOCUSATE SODIUM (COLACE) 100MG/10ML LIQ 10.70$

6005103 DOCUSATE SODIUM (COLACE) 100MG CAP 10.70$

6005104 DOCUSATE SODIUM (COLACE) 250MG CAP 10.70$

6005106 DONEPEZIL (ARICEPT) 5MG TAB 5.90$

6005107 DONNATAL 16.2-0.1037-0.0194 MG/5 ML 115.40$

6005108 DOXYCYCLINE HYCLATE(VIBRA TAB) 100MG CAP 10.70$

6005109 DULOXETINE (CYMBALTA) 30MG CAP 10.70$

6005110 AVODART (DUTASTERIDE) 0.5MG CAP 10.70$

6005111 ENALAPRIL (VASOTEC) 5MG TAB 11.98$

6005112 ERYTHROMYCIN (ERY BASE) 250MG TAB 10.70$

6005113 ZETIA (EZETIMIBE) 10MG TAB 31.47$

6005114 FAMOTIDINE (PEPCID) 20MG TAB 15.06$

6005115 ULORIC (FEBUXOSTAT) 40MG TAB 17.12$

6005117 FLUOXETINE (PROZAC) 20MG CAP 15.97$

6005118 FOLIC ACID (FOLATE) 1MG TAB 10.70$

6005119 FOLIC ACID 400MCG TAB 10.70$

6005120 FUROSEMIDE (LASIX) 20MG TAB 10.70$

6005123 GABAPENTIN (NEURONTIN) 100MG CAP 10.70$

6005125 GEMFIBROZIL (LOPID) 600MG TAB 10.70$

6005126 GLIMEPIRIDE (AMARYL) 2MG TAB 11.98$

6005127 GLIPIZIDE (GLUCOTROL) 5MG TAB 10.70$

6005128 GLYBURIDE (DIABETA) 5MG TAB 10.70$

6005129 CODEINE-GUAIFENESIN 10-100MG/5 ML Oral 10.70$

6005131 GUAIFENESIN (ROBITUSSIN) 100MG/5ML LIQ 10.70$

6005133 HALOPERIDOL (HALDOL) 0.5MG TAB 10.70$

6005134 HALOPERIDOL (HALDOL) 2MG TAB 10.70$

6005135 HALOPERIDOL (HALDOL) 5MG TAB 14.55$

6005136 HYDRALAZINE (APRESOLINE) 25MG TAB 10.70$

6005137 HYDRALAZINE (APRESOLINE) 10MG TAB 10.70$

6005138 HYDROCHLOROTHIAZIDE (HCTZ) 25MG TAB 10.70$

6005139 HYDROCODONE-APAP 10-325MG (NORCO) TAB 11.98$

6005141 HYDROCODONE-APAP (NORCO) 7.5/325 MG TAB 14.55$

6005142 HYDROCORTISONE (CORTEF) 10MG TAB 10.70$

6005143 HYDROMORPHONE (DILAUDID) 2MG TAB 10.70$

6005144 HYDROXYUREA (HYDREA) 500MG CAP 10.70$

6005145 HYDROXYZINE PAMOATE (VISTARIL) 25MG CAP 11.98$

6005146 IBUPROFEN (MOTRIN) 100MG/5ML LIQ *ADULT* 10.70$

6005147 IBUPROFEN (MOTRIN) 200MG TAB 13.38$



6005150 INDOMETHACIN (INDOCIN SR) 75MG CAP 17.25$

6005152 ISONIAZID 300MG TAB 10.70$

6005153 ISOSORBIDE DINITRATE (ISORDIL) 10MG TAB 10.70$


6005155 POTASSIUM CHLORIDE (K-DUR) 20MEQ TAB 10.70$

6005156 KLOR-CON (POTASSIUM CHLORIDE) 8MEQ TAB 10.70$

6005161 SYNTHROID (LEVOTHYROXINE) 25MCG TAB 10.70$


6005163 ESCITALOPRAM (LEXAPRO) 10MG TAB 10.70$

6005164 LIDOCAINE HCL VISCOUS 2% 15ML SOL 10.70$

6005165 ZYVOX (LINEZOLID) 600MG TAB 242.95$

6005167 LORAZEPAM (ATIVAN) 0.5MG TAB 11.98$

6005168 LORAZEPAM (ATIVAN) 1MG TAB 11.98$

6005169 LOSARTAN (COZAAR) 50MG TAB 11.98$

6005170 MAG AL PLUS (MYLANTA) 30ML ORAL LIQ 10.70$

6005171 MAGNESIUM OXIDE (MAG OX) 400MG TAB 10.70$

6005173 METFORMIN HCL (GLUCOPHAGE) 500MG TAB 10.27$

6005174 METHADONE 10MG TAB 10.70$

6005176 METOCLOPRAMIDE (REGLAN) 5MG TAB 10.70$

6005178 METOCLOPRAMIDE (REGLAN) 10MG/10ML LIQ 10.70$

6005180 METOLAZONE (ZAROXOLYN) 5MG TAB 10.70$

6005181 METOPROLOL SUCC (TOPROL XL) 25MG TAB 10.70$

6005184 METOPROLOL TARTRATE (LOPRESSOR) 25MG TAB 10.70$

6005185 METRONIDZOLE (FLAGYL) 250MG TAB 10.70$

6005186 METRONIDAZOLE (FLAGYL) 500MG TAB 11.98$

6005188 MIRTAZAPINE (REMERON) 15MG TAB 10.70$

6005190 MORPHINE (MS CONTIN) 30MG TAB 10.70$

6005191 AVELOX (MOXIFLOXACIN HCL) 400MG TAB 57.56$

6005195 NABUMETONE (RELAFEN) 500MG TAB 10.70$

6005196 NAMENDA (MEMANTINE HCL) 10MG TAB 10.70$

6005197 NAPROXEN (NAPROSYN) 250MG TAB 10.70$

6005200 NEXIUM (ESOMEPRAZOLE) 40MG CAP 17.12$

6005202 NIFEDIPINE (PROCARDIA XL) 30MG 17.12$

6005203 NITROFURANTOIN 100MG CAP 17.12$

6005204 NITROSTAT (NITROGLYCERIN) 0.4MG SL TAB 56.58$

6005205 ZYPREXA (OLANZAPINE) 2.5MG TAB 17.12$

6005206 OLANZAPINE (ZYPREXA) 10MG TAB 53.00$

6005207 BENICAR (OLMESARTAN MEDOXOMIL) 20MG TAB 17.12$

6005208 OMEPRAZOLE (PRILOSEC) 20MG CAP 17.12$

6005209 ONDANSETRON (ZOFRAN ODT) 4MG TAB 10.70$

6005211 OXCARBAZEPINE (TRILEPTAL) 300MG TAB 17.12$

6005212 OXYBUTYNIN (DITROPAN) 5MG TAB 10.27$

6005213 OXYCODONE (OXY IR) 5MG TAB 14.55$

6005215 OXYCODONE-APAP (PERCOCET) 5/325MG TAB 17.12$

6005216 OXYCONTIN (OXYCODONE HCL) 10MG TAB 15.06$

6005217 OXYCONTIN (OXYCODONE HCL) 40MG TAB 17.12$

6005218 CALCIUM CARB-VITD3 (OSCAL)500MG-200U TAB 6.85$

6005219 PANTOPRAZOLE (PROTONIX) 40MG TAB 17.12$


6005221 PENICILLIN V POTASSIUM 250MG TAB 17.12$

6005222 PENTOXIFYLLINE (TRENTAL) 400MG TAB 10.27$

6005223 PHENAZOPYRIDINE (PYRIDIUM) 200MG TAB 11.98$

6005224 PHENOBARBITAL 40MG/10ML ORAL LIQ 15.30$

6005226 PHENOBARBITAL 32.4MG TAB 10.70$

6005227 PHENYTOIN (DILANTIN) 100MG/4ML ORAL SUSP 10.70$

6005228 PHENYTOIN (DILANTIN) ER 100MG CAP 6.85$

6005229 PHOSPHA NEUTRAL (PHOSPHORUS) 250MG 6.85$

6005232 PIROXICAM (FELDENE) 20MG CAP 17.12$

6005233 PEG 3350 (MIRALAX) 17G PACKET ORAL 10.70$

6005234 POTASSIUM CHL 40MEQ /30ML ORAL SOLN 35.83$

6005235 POTASSIUM CHLORIDE (K-DUR) 10MEQ TAB 211.01$

6005237 MULTI-VITAMIN (THERA-M PLUS) TAB 10.70$

6005238 PRAMIPEXOLE (MIRAPEX) 0.25MG TAB 10.70$

6005239 PREDNISOLONE (ORAPRED) 15MG/5ML ORAL SOL 10.70$

6005240 PREDNISONE (DELTASONE) 10MG TAB 10.70$

6005243 LYRICA (PREGABALIN) 50MG CAP 17.12$

6005244 LYRICA (PREGABALIN) 75MG CAP 17.12$

6005245 PREMARIN (CONJ ESTROGENS) 0.625MG TAB 10.27$

6005246 PRIMIDONE (MYSOLINE) 50MG TAB 10.27$

6005247 PROCHLORPERAZINE (COMPAZINE) 5MG TAB 12.84$

6005248 PROMETHAZINE-CODEI 6.25-10MG/5 ML 18.41$

6005249 PROMETHAZINE (PHENERGAN) 25MG TAB 10.27$

6005250 PROMETHAZINE 6.25MG/5 ML ORAL LIQ 10.70$

6005251 PROMETHAZINE-DM 6.25-15MG/5 ML 10.70$

6005253 PROPAFENONE (RYTHMOL) 150MG TAB 11.98$

6005254 PROPANOLOL (INDERAL) 20MG TAB 17.12$

6005255 PROPYLTHIOURACIL (PTU) 50MG TAB 17.12$

6005256 PSEUDOEPHEDRINE (SUDAFED) 30MG TAB 10.70$

6005257 METAMUCIL (PSYLLIUM FIBER) PACK 10.70$

6005258 VITAMIN B-6 (PYRIDOXINE HCL) 50MG TAB 10.70$

6005264 ZIDOVUDINE (RETROVIR) 300MG TAB 10.70$

6005265 RIFAMPIN (RIFADIN) 300MG CAP 17.12$

6005266 RISPERIDONE (RISPERIDAL) 1MG TAB 17.12$

6005267 RISPERIDONE (RISPERIDAL) 0.25MG TAB 17.12$

6005269 ROPINIROLE HCL (REQUIP) 0.25MG TAB 17.12$

6005271 SENNA (SENOKOT) 528MG/15ML ORAL SYRUP 10.70$

6005272 SENNA (SENOKOT) 8.6MG TAB 10.70$

6005274 QUETIAPINE (SEROQUEL) 100MG TAB 42.40$

6005275 QUETIAPINE (SEROQUEL) 25MG TAB 10.70$

6005276 SERTRALINE (ZOLOFT) 50MG TAB 17.12$

6005277 SIMETHICONE (MYLICON) 80MG CAP 10.70$

6005278 SIMVASTATIN (ZOCOR) 10MG TAB 10.70$

6005280 MONTELUKAST (SINGULAIR) 10MG TAB 17.12$


6005282 SLOW FE (FERROUS SULFATE) 142 MG TAB 10.70$

6005283 SODIUM CITRA /CITRIC ACID (BICITRA) 15ML 79.28$

6005284 SORBITOL SOLUTION 70% 46.18$

6005285 SPIRONOLACTONE (ALDACTONE) 25MG TAB 15.06$

6005286 Kayexalate(SODIUM POLYSTYRENE)15G/60 ML 17.12$

6005287 SSKI (POTASSIUM IODIDE) 1GRAM/ML 53.55$

6005289 SUCRALFATE (CARAFATE) 1GM TAB 10.27$

6005290 SULFAMETH/TRIMET (BACTRIM/SEPTRA DS) TAB 18.83$

6005291 SULFAME/TRIME (BACTRIM) 800/160MG LIQ 12.84$

6005292 SULFASALAZINE (AZULFADINE) 500MG TAB 10.70$

6005294 TAMSULOSIN (FLOMAX) 0.4MG CAP 23.45$

6005295 MICARDIS (TELMISARTAN) 20MG TAB 17.12$

6005296 TEMAZEPAM (RESTORIL) 15MG CAP 17.12$

6005297 TERAZOSIN (HYTRIN) 5MG CAP 10.70$

6005298 TETRACYCLINE (SUMYCIN) 500MG CAP 10.70$

6005299 THEOPHYLLINE (THEO-24) 200 MG CAP 10.70$

6005303 TOPIRAMATE (TOPAMAX) 100MG TAB 10.27$

6005304 TOPIRAMATE (TOPAMAX) 25MG TAB 10.70$

6005305 TRAMADOL (ULTRAM) 50MG TAB 11.98$

6005306 TRAZODONE (DESYREL) 50MG TAB 10.70$

6005307 TRIAMTERENE-HCTZ( DYAZIDE) 37.5-25MG CAP 10.70$

6005308 URSODIOL (ACTIGALL) 300MG CAP 17.12$

6005309 VALACYCLOVIR (VALTREX) 500MG TAB 17.12$

6005310 VALPROIC ACID 250MG/5 ML ORAL LIQ 10.70$

6005312 DIOVAN (VALSARTAN) 80MG TAB 17.12$

6005315 VERAPAMIL 120MG CAP 17.12$

6005316 TOTAL B/C (VITAMIN B COMP W-C) TAB 10.70$

6005317 VITAMIN B-1 (THIAMINE HCl) 100MG TAB 21.40$

6005318 VITAMIN B-12 (CYANOCOBALAMIN) 500MCG TAB 10.70$

6005319 VITAMIN C (ASCORBIC ACID) 500MG TAB 10.70$

6005322 COUMADIN (WARFARIN SODIUM) 1 MG TAB 6.85$

6005323 COUMADIN (WARFARIN SODIUM) 2.5MG TAB 6.85$

6005328 ZINC SULFATE 220 MG (50MG ELEMENTAL) TAB 10.70$

6005330 ZOLPIDEM (AMBIEN) 5MG TAB 25.70$

6005332 LISINOPRIL (ZESTRIL/PRINIVIL) 20MG TAB 17.12$

6005333 ATORVASTATIN (LIPITOR) 20MG TAB 17.12$

6005335 CEPHALEXIN (KEFLEX) 250MG CAP 16.26$

6005336 ATORVASTATIN (LIPITOR)10MG TAB 17.12$

6005337 CARVEDILOL (COREG)12.5MG TAB 12.84$

6005338 CILOSTAZOL (PLETAL) 100MG TAB 10.70$

6005341 DIVALPROEX (DEPAKOTE) 250MG TAB 11.98$

6005343 GABAPENTIN (NEURONTIN) 300MG CAP 17.12$




6005350 LORATADINE (CLARITIN) 10MG TAB 11.98$

6005351 MEDROXYPROGESTERONE (PROVERA) 2.5MG TAB 10.27$

6005352 LANSOPRAZOLE (PREVACID) 30MG CAP 11.13$

6005353 LEVETRIACETAM (KEPPRA) 500MG TAB 10.70$

6005354 MELOXICAM (MOBIC) 15MG TAB 10.70$

6005358 OXYBUTYNIN Cl (DITROPAN XL) 5MG ER TAB 10.70$

6005359 TRIHEXYPHNIDYL (ARTANE) 2MG TAB 10.70$

6005361 VENLAFAXINE (EFFEXOR) XR 37.5MG CAP 17.12$

6005363 AMOXICILLIN (AMOXIL) 250mg/5ml (Recon) 10.70$

6005365 GOLYTELY (PEG 3350) 4000ML ORAL LIQ 42.80$

6005369 FLUCONAZOLE (DIFLUCAN) 150MG TAB 14.55$

6005370 DEXTROMETHOR-GUAIFENE 10-100MG/5ML LIQ 10.70$

6005371 FERROUS SULFATE 300MG/5ML ORAL LIQ 10.70$

6005372 CIPROFLOXACIN (CIPRO) 500MG TAB 17.12$

6005373 LACTULOSE (ENULOSE) 20GM/30ML ORAL SOLN 10.70$

6005382 AMITRIPTYLINE (ELAVIL) 100MG TAB 10.70$

6005384 ISOSORBIDE MONONITRATE (IMDUR) 30MG TAB 17.12$

6005385 LOPERAMIDE (IMODIUM) 2MG TAB 10.70$

6005387 DEXAMETHASONE (DECADRON) 4MG TAB 10.70$

6005389 COUMADIN (WARFARIN SODIUM) 5 MG TAB 10.70$

6005390 PRAVASTATIN (PRAVACHOL) 20MG TAB 17.12$

6005391 NAPROXEN (NAPROSYN) 375MG TAB 10.70$

6005392 MECLIZINE (ANTIVERT) 25MG TAB 10.70$

6005393 LISINOPRIL (ZESTRIL/PRINIVIL) 5MG TAB 10.70$

6005394 METHOTREXATE (TREXALL) 2.5MG TAB 10.70$

6005395 FERROUS SULFATE (FEOSOL) 324MG TAB 10.70$

6005397 DOXAZOSIN (CARDURA) 2MG TAB 10.70$

6005398 MEGESTROL (MEGACE) 400MG/10ML ORAL SUSP 10.70$

6005400 ACCUPRIL (QUINAPRIL) 10MG TAB 10.70$


6005402 LEVOFLOXACIN (LEVAQUIN) 500MG TAB 10.70$

6005403 FLUDORCORTISONE (FLORINEF) 0.1MG TAB 14.55$

6005405 FINASTERIDE (PROSCAR) 5MG TAB 10.70$

6005406 ACYCLOVIR (ZOVIRAX) 400MG TAB 10.70$

6005407 MILK OF MAGNESIA (MOM) 30ML LIQ 10.70$

6005408 ALBUTEROL SULF (PROVENTIL) 4MG TAB 10.70$

6005411 SODIUM CHLORIDE 1GM TAB 10.00$

6005412 PAROXETINE HCl (PAXIL) 20 MG TAB 17.12$

6005414 NYSTATIN ORAL SUSP 500,000UNIT/5ML 10.70$

6005415 BUPROPION (WELLBUTRIN) HCL 100MG SR TAB 21.40$

6005419 Senna Plus (sennosides)8.6mg/50mg 21.40$

6005420 DICYCLOMINE (BENTYL) 20MG/10ML INJ 260.34$

6005422 XARELTO (RIVARIXABAN) 10MG TAB 22.87$

6005423 OXYCONTIN (OXYCODONE) 20MG TAB 21.40$


6005425 PROCRIT (EPOETIN ALFA) 20,000 U/ML INJ 2,405.36$

6005427 NICARDIPINE (CARDENE) 30MG CAP 21.40$

6005428 NICARDIPINE (CARDENE) 20MG CAP 21.40$

6005431 CALCIUM ACETATE (PHOSLO) 667MG CAP 21.40$

6005436 SUMATRIPTAN SUCCINATE (IMITEX) 50MG TAB 21.40$

6005437 THEOPHYLLINE(Theo-24) 80MG/15ML ORAL LIQ 69.66$

6005438 TIZANIDINE (ZANAFLEX) 4MG TAB 10.70$

6005441 CHOLECALCIFEROL (VIT-D3) 1000UNIT TAB 21.40$

6005450 HYDROCODONE/ACET (NORCO) 7.5-500MG/15ML 17.09$

6005451 HYDROCODONE-APAP 5MG-325MG (NORCO) TAB 10.70$

6005453 METHYLERGONOVINE (METHERGINE) 0.2MG INJ 156.10$

6005454 NORTRIPTYLINE (PAMELOR) 25MG CAP 10.70$

6005460 sodium phosphate 3 mmo/ml 149.80$

6005999 VERAPAMIL 120MG TAB 21.40$

6006001 ACEPHEN (ACETAMINOPHEN)120MG SUPP 9.63$

6006002 ACEPHEN (ACETAMINOPHEN) 325MG SUPP 8.56$

6006003 ACEPHEN (ACETAMINOPHEN) 650MG SUPP 8.56$

6006004 ASPIRIN (ASA) 300MG SUPP 10.70$

6006005 BISAC-EVAC(BISACODYL/DULCOLAX) 10MG SUPP 6.85$

6006006 GLYCERIN (CHILD) SUPP 10.70$

6006007 GLYCERIN (ADULT) SUPP 6.85$

6006008 PROCTOSOL HC (HYDROCORTISONE) 2.5% CREAM 138.82$

6006009 ANUCORT-HC(HYDROCORTISONE ACE) 25MG SUPP 8.56$

6006010 PHENADOZ (PROMETHAZINE) 12.5MG SUPP 17.12$

6006011 PHENADOZ (PROMETHAZINE) 25MG SUPP 17.12$

6006013 Fleet Enema (sodium phosphates) 10.70$

6006014 PROCHLORPERAZINE (COMPAZINE) 25MG SUPP 25.88$

6006050 Rowasa 4GM 21.40$

6007003 BACITRACIN ZINC OINT 91.59$

6007004 CATAPRES-TTS(CLONIDINE)0.1MG/24 HR PATCH 27.39$

6007006 CLOTRIMAZOLE (LOTRIMIN) 1% TOPICAL CRM 13.70$

6007008 ETHYL CHLORIDE (PAIN EASE) 100% SPRAY 36.81$

6007009 EXELON (RIVASTIGMINE) 4.6MG/24 HOUR 57.14$

6007011 FENTANYL (DURAGESIC) 100MCG/HR PATCH 280.86$


6007013 FLUOCINONIDE (SYNALAR) 0.05% 71.90$

6007014 FLUOCINONIDE (LIDEX) 0.05% 60.78$

6007015 GELFOAM SPONGE SIZE 100 (GELATIN) 278.15$

6007016 HURRICAINE (BENZOCAINE) 20% SPRAY 60gr 168.26$

6007017 HYDROCERIN (MINERAL OIL/PETROLATUM) 23.37$

6007018 HYDROCORTISONE 1% CREAM 28GM 4.28$

6007019 INDIGO CARMINE 40MG/5ML 110.00$

6007020 KETOCONAZOLE (NIZORAL) 2% CREAM 60GM 234.14$

6007021 lidocaine-prilocaine (EMLA) 5G 73.06$


6007022 LIDOCAINE HCL 4% TOPICAL SOL (50ML) 38.52$

6007023 LIDOCAINE (LIDODERM) 5% PATCH 52.63$

6007024 MUPIROCIN (BACTROBAN) 2% OINTMENT 248.43$

6007026 NICOTINE (NICODERM) 21MG/24 HR 17.12$

6007027 nicotine (nicotine) 7MG/HR TD patch 17.12$

6007028 NITRO-BID 2% OINT UD PACK 6.85$

6007029 NITROGLYCERIN 0.4MG/HR PATCH 28.03$

6007030 NYSTATIN 100,000UNIT/G OINT 30G 14.55$

6007031 NYSTATIN 100,000UNIT/G 30GM CREAM 17.12$

6007035 nystatin-triamcinolone OINTMENT 30G 218.30$

6007036 NYSTOP (NYSTATIN) 100,000UNIT/G POWDER 36.80$

6007037 RISAMINE(MENTHOL/ZINC)0.44-20.625% 10.70$

6007039 SILVER NITRATE APPLICATORS 75-25% 53.76$

6007040 SSD SILVER SULFADIAZINE 1% 400gm JAR 393.15$

6007041 SILVER SULFADIAZINE (SSD) 1% 50GM TUBE 49.45$

6007042 TRANSDERM-SCOP 1.5MG 104.20$

6007043 TRIAMCINOLONE ACETONIDE 0.1% CREAM 30G 383.58$

6007045 triamcinolone acetonide (KENALOG) 0.5% 10.70$

6007048 ZINC OXIDE 20% OINTMENT 10.27$

6007050 ZOVIRAX (ACYCLOVIR) 5% 911.88$

6007051 POVIDONE-IODINE 10% 10.70$


6007053 FENTANYL (DURAGESIC) 25 MCG/HR PATCH 80.23$

6007054 permethrin (ELIMITE) 5% 60GM CREAM 617.76$

6007055 TRIPLE ANTIBIOTIC OINTMENT 5.35$

6007057 Mentax (butenafine) 1% 263.33$

6007058 lidocaine (XYLOCAINE) 2% TOPICAL JELLY 10.70$

6007059 bacitracin-polymyxin B(POLYSPORIN) 6.40$

6007060 Santyl (collagenase) 250u/GM 265.95$

6007062 lidocaine HCl(UROJET)200mg/10ml Gel 47.46$

6008001 PREMARIN (ESTROGENS) 0.625MG/G 902.22$

6008002 miconazole nitrate (MONISTAT 7) VAGINAL 10.70$

6009001 WATER (WATER FOR IRRIGATION,STERILE) 43.00$

6009003 WATER(WATER FOR IRRIGATION,STERILE)250ML 201.16$

6009004 WATER FOR INJECTION,STERILE 31.67$

6009005 WATER STERILE FOR INJ 10ML 82.41$

6009006 WATER (WATER FOR INJECTION,STERILE) 21.40$

6009007 MINERAL OIL MISCELLANEOUS 473ML 44.51$

6009010 CALCIUM GLUCONATE 100MG/ML IV 40.23$

6009011 SODIUM CHLORIDE 0.9% SOLN 3000ML 211.22$

6009012 SODIUM CHLORIDE 0.9% IRRIGATION 250ML 83.89$

6009014 ISOVUE-300 (IOPAMIDOL) 61% 100ML 48.00$

6009016 ISOVUE-370 (IOPAMIDOL) 76% 150ML 62.49$

6009017 Prohance (gadoteridol) 10ML 42.80$


6009064 Bicillin L-A(penicillin G) 1.2MU IM 445.98$

6009126 SODIUM CHLORIDE 0.9 % 10ML VIAL 31.67$

6009143 BUTRANS (BUPRENORPHINE) 5MCG/HR PATCH 222.90$

6009146 SYNTHROID (LEVOTHYROXINE) 100MCG/5ML INJ 510.83$

6009147 DILTIAZEM HCl 50MG/10ML (CARDIZEM) INJ 14.14$

6009148 TOLTERODINE (DETROL LA) 2MG CAP 42.09$

6009150 PREDNISONE 1MG TAB 10.70$

6009151 3% SODIUM CHLORIDE 4ML INH 10.70$

6009152 SODIUM CHLORIDE 0.9% IRRIGATION 1000ML 26.84$

6009153 MEROPENEM/NS 1GM IVPB 119.50$

6009154 PEDIATRIC ELECTOLYTE (PEDIALYTE) 1000ML 18.70$

6009155 HEPARIN LOCK FLUSH 100 UNITS/ML 5ML SYR 12.70$

6009156 ACETAZOLAMIDE (DIAMOX) 250MG TAB 10.00$

6009157 Ofirmev (acetaminophen) 1000mg/100ml 77.56$

6009158 potassium phosphate dibasic 3mM/ML 13.10$

6009159 CITALOPRAM (CELEXA) 10MG TAB 12.22$

6009161 LEVOFLOXACIN (LEVAQUIN) 250MG TAB 45.28$

6009162 PIOGLITAZONE (ACTOS) 15MG TAB 36.10$

6009163 ZIPRASIDONE HCl (GEODON) 20MG CAP 25.09$

6009165 LACTULOSE 20G/30ML 8OZ BOTTLE 240ML 10.00$

6009166 XIFAXAN (RIFAXIMIN) 550MG TAB 116.48$

6009167 SYMBICORT (BUDESONIDE-FORMOTEROL)160/4.5 998.71$

6009169 ascorbic acid(VITAMIN C) 500mg/ml 50ml 184.80$

6009171 Dakin's Sol (sodium hypochlorite) 473ML 40.00$

6009172 IRBESARTAN (AVAPRO) 150MG TAB 17.74$

6009173 Gastrografin 30ml(diatrizoate meglumine) 143.99$

6009174 MIDODRINE (PROAMATINE) 5MG TAB 10.00$

6009175 METHYLENE BLUE (ANTIDOTE)10mg/ml 45.56$

6009176 PERMETHRIN (NIX) 1% 60ml LIQUID 42.60$

6009178 NITROGLYCERIN 25MG/D5W 250ML IV PREMIX 33.34$

6009179 TAMIFLU (OSELTAMIVIR) 75MG CAP 42.88$

6009180 dextrose 50%/water 500ML(D50W) IV 33.60$

6009181 NASAcort (triAMCINolone acetonide) 55MCG 45.60$

6009183 PAMIDRONATE 30MG/10ML INJ 37.84$

6009184 VOLTAREN (DICLOFENAC SOD) 1% 2GM TOPICAL 98.16$

6009185 CLINIMIX E 5/D20 1000ML IV 81.44$

6009186 VECURONIUM BROMIDE (VECURON) 20MG INJ 36.38$

6009187 BISMUSTH SUBSALICYLATE(PEPTO-BISMOL) LIQ 16.88$

6009188 RabAvert 2.5U 376.20$

6009189 FAMOTIDINE (PEPCID) 40MG/4ML INJ 19.84$

6009190 CELEBREX (CELECOXIB) 100MG CAP 24.16$

6009193 COENZYME Q10 100MG CAP 5.04$

6009195 Pancrelipase 5000UNIT cap 9.44$

6009197 Fluzone High-Dose 131.70$


6009198 Fluzone Quad Pedi 87.40$

6009199 Fluzone Quad (6 months and up) 0.5ml 84.40$

6009200 FLUMIST QUAD 0.2ML 75.28$

6009201 CHOLECALCIFEROL (VIT-D3) 5000IU CAP 5.20$

6009203 DIOVAN (VALSARTAN) 40MG TAB 26.70$

6009205 Florastor (saccharomyces) 250mg pack 5.70$

6009207 METHENAMINE (MANDELAMINE) 500MG TAB 13.80$

6009213 DOBUTAMINE/D5W 250MG/250ML (DOBUTREX) IV 43.00$

6009215 malathion (OVIDE) 283.30$

6009216 MORPHINE SULF IR (MSIR) 15MG TAB 5.80$

6009217 LAMOTRIGINE (LAMICTAL) 25MG TAB 5.90$

6009219 MELATONIN 3MG TAB 5.30$

6009220 LEVETRIACETAM (KEPPRA) 500MG/5ML INJ 37.70$

6009221 MORPHINE 10MG/5ML ORAL SOLN 8.80$

6009223 ITRACONAZOLE (SPORANOX) 100MG CAP 32.00$

6009225 FETZIMA (LEVOMILNACIPRAN) 40MG CAP 63.18$

6009226 AMITIZA (LUBIPROSTONE) 8MCG TAB 50.49$

6009227 BILTRICIDE (PRAZIQUANTEL) 600MG TAB 313.16$

6009228 fondaparinux (ARIXTRA) 2.5mg/0.5ml 75.40$

6009230 CLOTRIMAZOLE-BETAMETHASONE (LOTRISONE) 82.00$

6009231 zoledronic acid (RECLAST) 5mg/100ml 268.20$

6009234 INDAPRAMIDE (LOZOL) 2.5MG TAB 8.10$

6009237 MEROPENEM (MERREM) 500MG INJ 39.30$

6009238 GUANFACINE (TENEX) 1MG TAB 5.60$

6009242 CRESTOR (ROSUVASTATIN) 10MG TAB 48.50$

6009243 HYDROXYZINE HCL (ATARAX) 50MG/ML INJ 28.60$

6009244 sildenafil (REVATIO) 20MG tab 8.37$

6009245 clobetasol(TEMOVATE)0.05% Topical 190.90$

6009250 ELIQUIS (APIXABAN) 5MG TAB 29.60$

6009252 PREDNISONE (DELTASONE) 50MG TAB 7.50$

6009253 butorphanol tartrate (STADOL) 1mg/ml Inj 30.20$

6009258 ACETYLCYSTEINE (MUCOMYST) 200MG/ML 4ML 30.40$

6009261 salsalate 500mg 10.80$

6009266 BETHANECHOL CHL (URECHOLINE) 10MG TAB 8.90$

6009268 CEFUROXIME AXETIL (CEFTIN) 250MG TAB 16.50$

6009269 Hydrogel 100GM 59.10$

6009270 DIVALPROEX (DEPAKOTE) 500MG TAB 10.90$

6009272 pyridostigmine bromide 60mg 11.10$

6009276 DRONABINOL (MARINOLl) 2.5MG CAP 24.10$

6009278 cefoxitin 1g/D5W 50mL Premixed Bag 54.50$

6009279 ceftriaxone/D5W 2Gm/50ML Premix 87.00$

6009280 VANCOMYCIN (VANCOCIN) 125MG CAP 31.30$

6009281 VANCOMYCIN (VANCOCIN) 750MG INJ 32.60$

6009282 CLINDAMYCIN/D5W 300MG/50ML IVPB PREMIX 34.20$


6009283 cefazolin/D5W 2gm/50ML Premix 40.80$

6009284 HEPARIN LOCK FLUSH 10 UNITS/5ML SYR 11.40$

6009285 METFORMIN (GLUCOPHAGE) 850MG TAB 10.10$

6009286 hyoscyamine sulfate TAB 104.50$

6009287 vitamin A 10,000U cap (retinyl) 10.00$

6013004 ADENOSINE(ADENOCARD)3MG/ML IV 134.39$

6013010 AMPICILLIN SODIUM 1GM INJ 41.06$

6013012 AMPICILLIN-SULBACTAM (UNASYN) 1.5GM INJ 87.48$

6013093 EPINEPHRINE 1MG/10ML SYR 33.38$

6014000 CL-CEFAZOLIN (ANCEF) 1GM INJ 13.00$

6014001 CL-CEFTRIAXONE (ROCEPHIN) 1GM INJ 99.50$

6014002 CL-CEFTRIAXONE (Rocephin) 1GM IM/Vialmat 99.50$

6014003 CL-CEFTRIAXONE (ROCEPHIN) 500MG INJ 15.80$

6014004 CL-CYANOCOBALAMIN (VIT B-12) 1000MCG INJ 27.60$

6014005 CL-DIPHENHYDRAMINE (BENADRYL) 50MG/ML VL 13.20$

6014006 CL-DEBROX (CARBAMIDE PEROXIDE) 6.5% 15ML 14.10$

6014007 CL-EPINEPHrine 1MG/1ML INJ 18.10$

6014008 CL-EPIPEN (EPINEPHRINE) 0.3MG/0.3 ML 346.70$

6014009 CL-FOLIC ACID (1MG=0.2ML) 5MG/ML INJ 90.00$

6014010 CL-FUROSEMIDE (LASIX) 40MG/4ML INJ 29.10$

6014011 CL-INFUVITE ADULT INJ 10ML 50.40$

6014012 CL-KENALOG (TRIAMCINOLONE) 40MG/ML 49.00$

6014013 CL-KETOROLAC (TORADOL) 30MG/ML INJ 22.50$

6014014 CL-KETOROLAC (TORADOL) 60MG/2ML INJ 14.10$

6014015 CL-LABETALOL 100MG/20ML INJ 24.68$

6014016 CL-LIDOCAINE (XYLOCAINE) 2% 20ML INJ 32.30$

6014017 CL-LIDOCAINE HCL 10MG/ML (1 %) 179.80$

6014018 CL-LIDOCAINE HCL/EPINEPHRINE1%-1:100000 18.30$

6014019 CL-LIDOCAINE VISCOUS 2% 15ML UDC 12.30$

6014020 CL-MAGNESIUM SULFATE 2GM/50ML 34.60$

6014021 CL-MARCAINE (BUPIVACAINE HCL) 0.25% VIAL 19.20$

6014022 CL-METOPROLOL TARTRATE (TOPROL) 5MG/5 ML 182.20$

6014023 CL-NITROSTAT (NITROGLYCERIN) 0.4MG TAB 67.20$

6014024 CL-ONDANSETRON (ZOFRAN ODT) 4MG TAB 6.80$

6014025 CL-ONDANSETRON HCl (ZOFRAN) 4MG/2ML INJ 28.30$

6014026 CL-PROLIA (DENOSUMAB) 60MG/ML 1,368.50$

6014027 CL-PROMETHAZINE (PHENERGAN) 25MG/ML INJ 12.60$

6014028 CL-PYRDIOXINE (VITAMIN B-6) 100MG/ML INJ 35.30$

6014029 CL-SANTYL (COLLEGENASE) 250U/GM 273.30$

6014030 CL-SENSORCAINE-MPF/EPINEPHRINE 20ML VL 23.80$

6014031 CL-SILVER SULFADIAZINE (SSD) 1% 50GM 54.10$

6014032 CL-SIMETHICONE (MYLICON) 80MG TAB 5.40$

6014033 CL-SODIUM CHLORIDE 0.9% 100 ML 24.70$

6014034 CL-SODIUM CHLORIDE 0.9% 1000ML 25.20$


6014035 CL-SODIUM CHLORIDE 0.9% 50ML 25.40$

6014036 CL-SOLU-MEDROL 125MG/2 ML 32.60$

6014037 CL-SOLU-MEDROL 40MG/ML INJ 32.10$

6014038 CL-SOLU-MEDROL1,000MG/8 ML 94.80$

6014039 CL-SIMATRIPTAN (IMITREX) 6MG/0.5ML 62.10$

6014040 CL-SUPRANE (DESFLURANE) 240ML 240.90$

6014041 CL-TESTOSTERONE CYP( DEPO-TEST) 100MG/ML 36.30$

6014042 CL-VANCOMYCIN 1GM INJ 41.30$

6014043 CL-ZOLEDRONIC ACID (RECLAST) 5MG/100ML 309.80$

6014044 CL-DEPO PROVERA 150MG/ML INJ 56.00$

6014045 CL-DICYCLOMINE (BENTYL)10MG/5ML ORAL LIQ 15.00$

6014046 CL-MAG AL PLUS (MYLANTA) 30ML ORAL LIQ 11.00$

6014047 CL-LIDOCAINE VISC 2% ORAL LIQ 30ML 11.00$

6014049 CL-DALVANCE (DALBAVANCIN) INJ 1,575.00$

6070017 ACETAMINOPHEN (TYLENOL)160MG/5ML *PEDIA* 26.65$

6070018 IBUPROFEN (MOTRIN) 100MG/5ML *PEDIA* 10.70$

6070019 AMOXICILLIN (AMOXIL) 250mg/5ml *PEDIA* 10.70$

6070020 AZITHROMYCIN(ZITHROMAX)200MG/5ML *PEDIA* 194.07$

6070022 LIDOCAINE HCL INJ 1% 50MG/5ML SYR 44.00$

6070024 AMINOPHYLLINE 250MG/10ML INJ 58.00$

6070025 LIDOCAINE HCL 2% JELLY TOPICAL 30ML 37.00$

6070027 ACETAZOLAMIDE (DIAMOX) 500MG INJ 75.00$

6070029 CLINDAMYCIN (CLEOCIN) 900MG/6ML INJ 28.00$

6070030 CLINDAMYCIN (CLEOCIN) 300MG/2ML INJ 22.00$

6070031 3% SODIUM CHL(HYPERTONIC SALINE)500ML IV 22.50$

6070032 NS W/ 20MEQ KCL 1000ML IV 32.50$

6070033 KCL 10MEQ/100ML IVPB PREMIX 32.50$

6070034 ACETIC ACID 0.25% IRRIGATION 1000ML 29.00$

6070035 SODIUM CHL 0.9% 1000ML IRRIGATION BAG 35.50$

6070036 ATENOLOL (TENORMIN) 25MG TAB 7.50$

6070037 WATER STERILE FOR INJ 100ML VL 23.00$

6070038 LIDOCAINE (XYLOCAINE) 1% 20ML VIAL 19.00$

6070039 CHLORHEXIDINE GLUC (PERIDEX) ORAL RINSE 76.50$

6070040 MAGNESIUM SULF IVPB: 4GM / 100ML 48.50$

6070041 LIDOCAINE (XYLOCAINE) 0.5% 50ML VL 27.00$

6070042 BENZOCAINE (CEPACOL) LOZ 6.50$

6070043 POTASSIUM CHLOR 20MEQ/10ML 10ML VL 12.60$

6070044 XYLOCAINE (LIDOCAINE 1%) 30ML VL 28.60$

6070045 HURRICAINE ORAL SPRAY UD (unit dose) 140.48$

6070065 DICYCLOMINE (BENTYL) 10MG/5ML ORAL LIQ 15.00$

6070067 PROPOFOL (DIPRIVAN) 500MG/50ML IVPB *ER* 32.00$

6070156 NON VFC - ADACEL (T-DAP) 0.5ML VACCINE 107.00$

6070157 NON VFC - BOOSTRIX (T-DAP) 0.5ML VACCINE 101.00$

6070158 NON VFC-TUBERCULIN PURIFIED PROTEIN VAC 141.64$


6070159 NON VFC-DIPH-TET-ACELL PERT VAC(ADACEL) 134.76$

6070160 NON VFC-VARICELLA VIRUS VACCINE(VARIVAX) 122.95$

6070161 NON VFC-HEPATITIS A VACCINE (HAVRIX) 119.04$

6070162 NON VFC-HEP B VAC RECOMB (ENGERIX B) 90.62$

6070163 NON VFC-HUMAN PAP VIRUS (GARDASIL 9) 100.90$

6070164 NON VFC-PNEUM STREPTOCOCCUS VAC 92.07$

6070168 CL- DEXMETHASONE (DECADRON) 4MG/ML INJ 8.97$

6070169 FluBlok Quad (18yr and older) 0.5ml 46.46$

6070185 DESMOPRESSIN 0.2MG 1.84$

6070200 NON VFC- ZOSTAVAX 218.66$

6070205 NON VFC- MEASLES-MUMPS-RUBELLA VACCINE 638.85$

6070212 CL-SILVER NITRATE APPLICATORS 0.53$

6070230 levophed 300mg/100ml 42.80$

7000001 KIT NEELDE GUIDE 21GA 115.83$

7000002 KIT NEEDLE GUIDE 20GA 105.60$

7000003 KIT NEEDLE GUIDE 18GA 141.24$

7000004 BIO PATCH DISK PROTECTIVE 78.07$

7000005 PICC DRESSING CHANGE KIT 93.75$

7000006 PICCLINE 5FR DL 712.50$

7000007 SIDESTREAM ACCESSORY KIT 450.45$

7000008 WARMING GOWN BAIR PAWS 113.12$

7000009 SUCTION CATHETER CLOSED VENTILATION 85.33$

7000010 AEROCHAMBER PLUS W/MED MASK 116.16$

7000011 AEROCHAMBER PLUS W/SM MASK 163.28$

7000012 OXY THERAPY KIT HIGH FLOW 7' 86.24$

7000013 SYSTEM CHEST DRAINAGE PLEUR-EVAC 292.50$

7000014 GASTRIC LAVAGE SYSTEM 547.72$

7000015 THORACENTESIS/PARACENTESIS TRAY CATHETER 164.88$

7000016 SPINAL TRAY PENCAN 99.82$

7000017 PRESSURE BAG INFU-SURG 80.92$

7000018 KNEE IMMOBILIZER 16 SM 93.30$

7000019 KNEE IMMOBILIZER 16 MED 93.30$

7000020 KNEE IMMOBILIZER 16 LG 93.30$

7000021 KNEE IMMOBILIZER16 XL 93.30$




7000025 KNEE IMMOBILIZER 20 XL 107.47$

7000026 KNEE IMMOBILIZER 20 XXL 107.47$




7000030 KNEE IMMOBILIZER 22 XXL 109.87$

7000031 KNEE IMMOBILIZER 22 XL 109.87$


7000032 ANKLE BRACE UNI 78.07$

7000033 ANKLE BRACE SM 6 109.23$

7000034 ANKLE BRACE GEL 10 85.50$

7000035 ABD BINDER XXL 106.39$

7000036 ABD BINDER XL 106.39$

7000037 SKIN ADHESIVE LIQUIBAND 0.8ML 91.80$

7000038 UNNA BOOT 4 x10YD BANDAGE GELOCAST 38.99$

7000039 ELECTRODE ONESTEP COMPLETE ADULT 384.54$

7000040 ELECTRODE ONESTEP COMPLETE PEDI 316.68$

7000041 CATHETER FOLEY 12FR COUDE 106.76$



7000044 CATHETER IRRIGATION 24FR 30CC 3-WAY 115.96$

7000045 CATHETER TROCAR 24FR 16 L 108.10$

7000046 PLEURX DRAINAGE KIT 1000ML 446.60$

7000047 INJECTOR DOUBLE 102.97$

7000048 LUMBAR PUNCTURE TRAY PED/INFANT 86.55$

7000049 CATHETER KIT MULTI-MED TRIPLE LUMEN 7F 318.88$

7000051 CATHETER FOLEY 16FR 5CC COUDE 106.76$

7000052 FLOW STANDARD WARMING SET RANGER 80.32$

7000053 CATHETER FOLEY 16FR 30CC 3-WAY 116.09$

7000054 SKIN ADHESIVE SWIFTSET 95.62$

7000055 EGGCRATE BIOFOAM 2 3/4 164.70$

7000062 PICC LINE 4FR SL 675.00$

7000063 LAP CHOLE KIT 933.75$

7000064 ROPE, TEGADERM ALGINATE AG SILVER 1 X12 100.54$

9000001 99217 OP HOS OBSERVATION CARE DIS 233.78$

9000002 99218 INITIAL OP HOS OBS CARE - LOW 300.59$

9000003 99219 INITIAL OBS CARE - MOD 434.16$

9000004 99220 INITIAL OBS CARE - HIGH 567.73$

9000005 99221 INITIAL HOSPITAL CARE H&P LOW 333.95$

9000006 99222 INITIAL HOSPITAL CARE H&P MOD 434.16$

9000007 99223 INITIAL HOSPITAL CARE H&P HIGH 667.95$

9000008 99231 SUBSEQ CARE ROUNDS - LOW 133.57$

9000009 99232 SUBSEQ CARE ROUNDS - MOD 233.78$

9000010 99233 SUBSEQ CARE ROUNDS - HIGH 333.95$

9000011 99234 OBS OR IP CARE SERVICES - LOW 434.16$

9000012 99235 OBS OR IP CARE SERVICES - MOD 551.06$

9000013 99236 OBS OR IP CARE SERVICES - HIGH 718.03$

9000014 99238 HOSPITAL DISCHG SVCS -30/LESS 233.78$

9000015 99239 HOSPITAL DISCH SVCS > 30 MINS 350.68$

9000016 99291 CRITICAL CARE E&M 30-74 MINS 751.43$

9000017 99292 CRITICAL CARE E&M EA ADD'L 30M 378.52$

9000020 99281 E.R. CONSULT - LEVEL ONE 275.71$


9000021 99282 E.R. CONSULT - LEVEL TWO 494.19$

9000023 99283 E.R. CONSULT - LEVEL THREE 598.23$

9000024 99284 E.R. CONSULT - LEVEL FOUR 1,420.15$

9000025 99285 E.R. CONSULT - LEVEL FIVE 1,976.76$

9000026 99304 INITIAL NURSING FACILITY CARE LOW 294.70$

9000027 99305 INITIAL NURSING FACILITY CARE MOD 425.65$

9000028 99306 INITIAL NURSING FACILITY CARE HIGH 556.50$

9000029 99307 SUBSEQ CARE ROUNDS LOW 130.95$

9000030 99308 SUBSEQ CARE ROUNDS MOD 229.20$

9000031 99309 SUBSEQ CARE ROUNDS HIGH 327.40$

9000032 99310 SUBSEQ CARE ROUNDS COMPLEX 425.00$

9000033 99315 HOSPITAL DISCHG SVCS -30 MINS/LESS 229.20$

9000034 99316 HOSPITAL DISCHG SVCS > 30 MINS 343.80$

9800001 99201 NEW PATIENT, LEVEL I 125.00$

9800002 99202 NEW PATIENT LEVEL 2 185.00$



9800005 99213 EST PATIENT LEVEL 3 170.00$






9800020 99304 INITIAL NURSING FACILITY CARE1 240.00$

9800021 99305 INITIAL NURSING FAC CARE II 340.00$

9800022 99306 INITIAL NURSING FAC CARE III 430.00$

9800023 99307 SUBSEQ NURSING FACILITY CARE I 115.00$

9800024 99308 SUBSEQ NURSING FACILITY CAREII 180.00$

9800025 99309 SUBSEQ NURSING FAC CARE III 235.00$

9800026 99310 SUBSEQ NURSING FAC CARE IV 350.00$

9800028 99315 NURSING HOME DISCHARGE 190.00$

9800075 INHALA-DUONEB0.5/3.0 7.90$

9800080 COAGUCHEK - POCT 80.00$

9800168 LACERATION / PROCEDURAL TRAY 185.00$

9800436 CHEMICAL CAUTERIZATI 50.00$

9801004 RMV IMPACT CERUMEN 46.00$

9801006 HEMOGLOBIN FINGER STICK 37.45$

9801007 EXCISION OF WART 26.00$

9801008 DIP STICK URINE 14.77$

9801010 TRAY LACERATION 197.95$

9801012 GLUCOSE SCAN - FINGERSTICK MSC 51.36$

9801014 HCG PREGNANCY URINE 108.07$

9801017 ANOSCOPY, PROCEDURE 50.00$

9801033 MIRENA IUD 2,181.00$


9802003 INCISION & DRAINAGE 127.00$

9802004 TB MANTOUX 39.59$

9802005 STREP A RAPID 81.32$

9802020 INFLUENZA A/B - POCT 80.00$

9803000 VFC ADMIN. OF VACCINE 26.03$

9803001 ADMIN. OF VACCINE 109.00$

9803009 FLU VACCINE 70.62$

9803012 MYLANTA 30ML PO 9.63$

9803019 TDAP INJ 97.91$

9803022 VISTARIL IM 39.59$

9803050 IPRATROPIUM 0.02% INH 95.23$

9803052 HAND HELD NEB INT TX 112.35$

9805015 EXCISION,TUMOR,THIGH/KNEE<5CM 550.00$

9805016 HEARING TEST, SCREENING 75.00$

9805083 PROPHYLACTIC INJECTION 109.00$

9805500 99490 CHRONIC CARE MANAGEMENT 50.00$

9805560 99395 EST. PREVENTIVE 18-39 YRS 145.00$

9805565 99396 EST. PREVENTIVE E&M 40-64 YRS 145.00$

9809132 99204 PHYSICAL, DMV FCC 96.00$

9810008 BLINK REFLEX TEST 125.00$

9810028 I&D SEBACEOUS CYST 73.00$

9883104 GARDASIL 20-40-40-20 MCG/0.5ML 197.94$

9883112 HEPATITIS B VACCINE ADULT 85.59$

9883119 IPOL VACCINE INJ 52.42$

9883138 LIDOCAINE/EPINE 1%-1:100,000 13.38$

9883145 MARCAINE PF 0.25% 2.5MG/ML INJ 59.92$

9883156 MEASLES, MUMPS, RUB (VACCINE) 102.71$

9883183 PNEUMOVAX 25MCG/.5ML INJ 68.47$

9883230 APLISOL 5UN/0.1ML INJ 13.38$

9885077 CLONIDINE (CATAPRES) 0.1MG TAB 13.38$

9885420 DICYCLOMINE (BENTYL) 10MG/5ML LIQ 13.38$

9887040 SILVADENE CRM 400GM 189.02$

80000001 CATHETER FOLEY 14FR 5CC SILICONE COATED 38.10$

90000082 CRICOTHYROTOMY CATH SET MELKER 634.95$

90000101 DRESSING AG AQUACELL SURGICAL 3.5X13.75 230.04$

90000102 DRESSING AG AQUACELL SURGICAL 3.5X9.75 224.40$

90000113 ENDO JAW BIOPSY FORCEPS DISP 145.86$

90000114 ENDO JAW HOT BIOPSY FORCEPS DISP 105.46$

90000120 EZIO NEEDLE 45MM 512.25$

90000156 GRASPER 5MM X 35CM LAP 270.00$

90000182 LARYNGOSCOPE FIBER OPTIC W/MAC SZ 3 100.05$

90000229 PATIENT CIRCUIT BREATHPATH 93.75$

90000243 PREVENT FLOW SENSOR 851.25$

90000251 PUMP TUBE 154.96$


90000295 SUTURE ETHIBOND 0 30 GREEN V-34 89.77$

90000299 SUTURE MONOCRYL 5/0 18 UNDYED 158.88$

90000357 THORACIC VENT TRAY 900.00$

90000379 T-TUBE DEAVER DRAINAGE 5 CROSSBAR 10FR 91.80$





90000395 URINE BELLY COLLECTION BAG 157.08$

90000431 MORGAN LENS DELIVERY SET 146.85$

90000432 NASAL PACKING RAPID RHINO 6.5CM 102.96$




90000450 VIREX II 256 GERMICIDAL J-FILL 2.5L 2/CS 164.07$

90000451 OXIVIR FIVE 16 J-FILL 2.5L 2/CS 207.48$

90000452 PROMINENCE H/D CLEANER J-FILL 2.5L 2/CS 293.65$

90000453 PERDIEM GP CLEANER J-FILL 2.5L 2/CS 190.80$

90000454 GOOD SENSE AIR FRESHENER J-FILL 2.5L 2/C 356.99$

90000455 GP FORWARD CLEANER J-FILL 2.5L 2/CS 163.08$

90000456 SPRAY BOTTLE 32OZ PLAIN W/GRADUATIONS 6.97$

90000457 TRIGGER ULTRA SPRAY 6.82$

90000458 SYRINGE 20ML LUERLOCK 66.07$

90000462 VENTRALEX ST LARGE CIRCLE MESH 1,646.25$

90000463 VENTRALEX ST MED CIRCLE MESH 1,496.25$

90000465 VENTRALEX ST SMALL CIRCLE MESH 1,158.75$

90000467 4 PORT MANIFOLD NEPTUNE 109.56$

90000471 BLADE RECIP DBLE SIDE 268.38$

90000473 SERFAS ENERGY PROBE CONTOUR 537.22$

90000474 ARTHRO PUMP FLOSTEADY DISP TUBE SET 364.18$

90000475 BLADE RESECTOR SHAVER 4.0MM 366.15$



90000478 CAPTIVATOR LX ROUND STIFF 236.94$

90000479 PNEUMOSURE HEATED TUBE SET 328.04$

90000480 PROLENE MESH 4 LARGE PHSL 886.23$

90000481 RETRIVAL SYSTEM 10MM 252.00$

90000482 SUCTION/IRRIGATOR FLOW DISP 275.76$

90000483 MIXING BOWL W/SPATULA DISP 89.77$

90000484 BLADE PRECISION OSCILL TIP SAW CART 581.25$

90000485 BIOMET BONE CEMENT R 417.93$

90000486 CLIP ENDO II 10MM APPLIER 421.54$

90000501 SHIELDED BLADE Kii 11 X 100 162.00$

90000502 SHIELDED BLADE Kii 5 x 100 112.20$


90000504 BLADE FORMULA BARREL BUR 6 FLUTE 5.5MM 344.63$

90000505 MULTI ORIFICE TIP W/SOFTCONE SPLASH SHIE 66.68$

90000506 TOURNIQUET 24 X 4 SINGLE YELLOW 163.02$

90000507 TOURNIQUET 30 x 4 SINGLE ROYAL BLUE 160.14$

90000508 TOURNIQUET 34 X 4 SINGLE PURPLE 172.08$

90000509 TOURNIQUET 44 X 4 SINGLE NAVY BLUE 188.28$

90000510 TOURNIQUET 18 X 5.5 DOUBLE RED 215.70$

90000511 TOURNIQUET 24 X 5.5 DOUBLE YELLOW 239.70$

90000514 SUTURE GRASPER PASSOR PRO 105.27$

90000515 PULSE IRRIGATION SYSTEM W/MULTI ORIFICE 153.99$

90000516 DRAIN BLAKE HUBLESS FULL FLUTED 15FR 138.00$

90000517 HEMOVAC WOUND DRAIN 100ML 10MM X 20CM 164.34$

90000534 MASK LARYNGEAL SUPREME AIRWAY SZ 3 153.00$

90000570 EZIO NEEDLE 15MM 427.50$

90000571 PULSE OXIMETER FINGERTIP 345.85$

90000572 FACE MASK VENTED SM BIPAP 145.41$

90000590 PEG SYSTEM GASTMY INIT PLAC KIT 20FR 1,282.50$

90000598 VECTRA FLOOR FINISH 2.5L 113.81$

90000604 SUTURE GRASPER 105.27$

90000605 BUFFER FORMALIN 10% NEUT 90ML 90.43$

90000610 AIRWAY NASAL ROBERTAZZI LF 26F 259.98$

90000611 CAST SAW BLADES DESOUTTER CLEANCAST 5/PK 259.98$

90000612 BLOOD TRANSFER DEVICE 259.98$

90000621 BLADE MEDIUM MED 18.5MM X 9.0MM 239.82$

90000622 BLADE 239.82$

90000623 BLADE 239.82$

90000624 BLADE 239.82$

90000625 CUSHION ROHO 18 X 20 334.83$

90000626 TRAY SPINAL 25G WHITACRE NDL W/PHARM 150.80$

90000631 BLADE RESECTOR SHAVER 4.5 334.83$

90000636 EPIDURAL FULL TRAY PERIFIX CE18TKO 129.20$

90000637 INTRODUCER STYLET 15FR W/COUDE TIP 86.24$

90000638 PAPER RECORDING CHART BLOOD BANK TEMP 86.25$

90000642 SCISSOR LAPA EPIX 5MMX45CM 228.00$

90000645 SUSPENSORY W/LEG STRAP 0-2 LRG 105.96$

90000653 LEG PROTECTIVE SLEEVE WHT 115.96$

90000665 FACE MASK VENTED MED BIPAP 145.41$

90000666 FACE MASK VENTED LARGE BIPAP 145.41$

90000668 GLIDESCOPE BLADE #3 GVL 3 STAT 118.80$

90000669 GLIDESCOPE BLADE #4 GVL 4 STAT 118.80$

90000670 SHEET LARGE FAN-FOLDED 6.97$

90000671 EZIO NEEDLE 25MM 512.25$

90000673 INJECTOR FORCE MAX 25G 5MM 153.00$

90000676 RETRIEVAL DEVICE SPIDER NET 342.20$


90000677 SURGICEL ABSORBABLE HEMOSTAT 4 X 8 231.50$

Documents

Orchard Hospital Chargemaster Item # Description Charge ... master - cms website posting.pdf · 2000009 pt therapy initial 30 mins mcal $ 128.24 2000017 pt tests/measur -ea add'l