Charge Master Code Description Price Revenue Code 2641892 ULTANE INHALATION LIQUID $2.55 250 2650034 FLAVOXATE 100MG TABLET $3.40 250 2640020 ASPIRIN 81 MG CHEWABLE TABLET $3.40 250 2640022 HYDROXYZINE HCL 10 MG TABLET $3.40 250 2640030 VITAMIN C 500 MG TABLET $3.40 250 2640031 SULFASALAZINE 500 MG TABLET $3.40 250 2640033 DILTIAZEM 30 MG TABLET $3.40 250 2640037 DILTIAZEM CD 120 MG CAPSULEEXTENDED RELEASE 24 HR $3.40 250 2640054 BISACODYL 5 MG TABLETDELAYED RELEASE $3.40 250 2640059 FERROUS SULFATE 325 MG (65 MG IRON) TABLET $3.40 250 2640061 FOLIC ACID 1 MG TABLET $3.40 250 2640063 HALOPERIDOL 0.5 MG TABLET $3.40 250 2640068 KLOR-CON M20 MEQ TABLETEXTENDED RELEASE $3.40 250 2640070 AMOXICILLIN 250 MG CAPSULE $3.40 250 2640082 OYSTER SHELL CALCIUM-VIT D3 500 MG (1250 MG)-200 UNIT TABLET $3.40 250 2640083 SANI-SUPP (CHILD) RECTAL $3.40 250 2640087 VITAMIN B-6 50 MG TABLET $3.40 250 2640092 SENNA 8.6 MG TABLET $3.40 250 2640094 SODIUM CHLORIDE 1 GRAM TABLET $3.40 250 2640096 SYNTHROID 25 MCG TABLET $3.40 250 2640097 SYNTHROID 50 MCG TABLET $3.40 250 2640098 SYNTHROID 100 MCG TABLET $3.40 250 2640101 NP THYROID 60 MG TABLET $3.40 250 2640111 CERTAVITE SENIOR-ANTIOXIDANT 0.4 MG-300 MCG-250 MCG TABLET $3.40 250 2640115 TRIPLE ANTIBIOTIC 3.5 MG-400 UNIT-5000 UNIT TOPICAL OINTMENT IN PACKT $3.40 250 2640134 MILK OF MAGNESIA 400 MG/5 ML ORAL SUSPENSION $3.40 250 2640135 SIMETHICONE 80 MG CHEWABLE TABLET $3.40 250 2640140A NYSTATIN 100000 UNIT/ML ORAL SUSPENSION (5ML) $3.40 250 2640153 SILVER NITRATE SWAB $3.40 250 2640157 ESCITALOPRAM 10 MG TABLET $3.40 250 2640159 LORAZEPAM 0.5 MG TABLET $3.40 250 2640182 MORPHINE ER 15 MG TABLETEXTENDED RELEASE $3.40 250 2640193 NIACIN 500 MG TABLET $3.40 250 2640197 CHILDREN'S IBUPROFEN 100 MG/5 ML ORAL SUSPENSION $3.40 250 2640198 LOVASTATIN 10 MG TABLET $3.40 250 2640203 PRAVASTATIN 20 MG TABLET $3.40 250 2640206 VITAMIN B-1 100 MG TABLET $3.40 250 2640208 TUMS 200 MG CALCIUM (500 MG) CHEWABLE TABLET $3.40 250 2640210 FIBERCON 625 MG TABLET $3.40 250 2640211 SODIUM BICARBONATE 650 MG TABLET $3.40 250 2640215 FINASTERIDE 5 MG TABLET $3.40 250 2640235 MAPAP PM 25 MG-500 MG TABLET $3.40 250 2640240 ASPIRIN 81 MG TABLETDELAYED RELEASE $3.40 250 2640243 CALCIUM ACETATE 667 MG CAPSULE $3.40 250 2640251 LOSARTAN 100 MG TABLET $3.40 250 2640258 ATENOLOL 25 MG TABLET $3.40 250 2640263 CITRUCEL 500 MG TABLET $3.40 250 2640268 COENZYME Q10 100 MG CAPSULE $3.40 250 2640305 OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET $3.40 250 2640307 K-PHOS ORIGINAL 500 MG SOLUBLE TABLET $3.40 250 2640311 ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY $3.40 250 2640312 ACEPHEN 325 MG RECTAL SUPPOSITORY $3.40 250 2640313 ACEPHEN 650 MG RECTAL SUPPOSITORY $3.40 250 2640314 ALLOPURINOL 100 MG TABLET $3.40 250 2640315 ALLOPURINOL 300 MG TABLET $3.40 250 2640318 AMOXICILLIN 500 MG CAPSULE $3.40 250 2640323 BACLOFEN 10 MG TABLET $3.40 250 2640325 DIPHENHYDRAMINE 50 MG CAPSULE $3.40 250 2640326 INTEGRA F 125 MG-1 MG-40 MG-3 MG CAPSULE $3.40 250 2640329 BISACODYL 10 MG RECTAL SUPPOSITORY $3.40 250 2640334 CEPHALEXIN 250 MG CAPSULE $3.40 250 2640335 CEPHALEXIN 500 MG CAPSULE $3.40 250 2640337 CLONIDINE HCL 0.1 MG TABLET $3.40 250 2640341 WARFARIN 10 MG TABLET (10MG) $3.40 250 2640341A WARFARIN 10 MG TABLET (10MG) $3.40 250 2640342 WARFARIN 2 MG TABLET (2MG) $3.40 250 2640342A WARFARIN 2 MG TABLET (2MG) $3.40 250 2640347 DIGOXIN 125 MCG TABLET $3.40 250 2640354 DOXEPIN 10 MG CAPSULE $3.40 250 2640361 FUROSEMIDE 20 MG TABLET $3.40 250 2640362 FUROSEMIDE 40 MG TABLET $3.40 250 2640363 FUROSEMIDE 80 MG TABLET $3.40 250 2640365 GEMFIBROZIL 600 MG TABLET $3.40 250 2640367 HYDRALAZINE 25 MG TABLET $3.40 250 2640370 HYDROMORPHONE 2 MG TABLET $3.40 250 2640372 IBUPROFEN 600 MG TABLET $3.40 250 2640385 MECLIZINE 25 MG TABLET $3.40 250 2640386 METHOCARBAMOL 500 MG TABLET $3.40 250 2640387 METOCLOPRAMIDE 10 MG TABLET $3.40 250 2640388 METRONIDAZOLE 250 MG TABLET $3.40 250 2640389 MINERAL OIL TOPICAL (30ML) $3.40 250 2640394 NITROSTAT 0.4 MG SUBLINGUAL TABLET $3.40 250 2640396 OXYBUTYNIN CHLORIDE 5 MG TABLET $3.40 250 2640398 PENICILLIN V POTASSIUM 500 MG TABLET $3.40 250 2640414 SPIRONOLACTONE 25 MG TABLET $3.40 250 2640422 TRAZODONE 50 MG TABLET $3.40 250 2640425 VERAPAMIL 80 MG TABLET $3.40 250 2640427 CHELATED ZINC 50 MG TABLET $3.40 250 2640430 IBUPROFEN 800 MG TABLET $3.40 250 2640434 LEVOFLOXACIN 500 MG TABLET $3.40 250 2640435 FUL-GLO 1 MG EYE STRIPS $3.40 250 2640449 BISMATROL 262 MG CHEWABLE TABLET $3.40 250 2640456 MEPERIDINE 50 MG TABLET $3.40 250 2640458 SYNTHROID 75 MCG TABLET $3.40 250 2640465 THERMOTABS 287 MG-180 MG-15 MG TABLET $3.40 250 2640472 ISOSORBIDE MONONITRATE ER 30 MG TABLETEXTENDED RELEASE 24 HR $3.40 250 2640486 MECLIZINE 12.5 MG TABLET $3.40 250 2640492 SANI-SUPP (ADULT) RECTAL $3.40 250 2640494 MAGNESIUM OXIDE 400 MG TABLET $3.40 250 2640528 GLIMEPIRIDE 2 MG TABLET $3.40 250 2640531 SIMVASTATIN 40 MG TABLET $3.40 250 2640532 TERBINAFINE HCL 250 MG TABLET $3.40 250 2640533 ATORVASTATIN 10 MG TABLET $3.40 250 2640536 CARVEDILOL 6.25 MG TABLET $3.40 250 2640542 ATENOLOL 50 MG TABLET $3.40 250 2640546 ATORVASTATIN 20 MG TABLET $3.40 250 2640549 SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET $3.40 250 2640552 TEMAZEPAM 15 MG CAPSULE $3.40 250 2640553 TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE $3.40 250 2640559 MAPAP (ACETAMINOPHEN) 325 MG TABLET $3.40 250 2640563 BENZONATATE 100 MG CAPSULE $3.40 250 2640567 CAPTOPRIL 25 MG TABLET $3.40 250 2640569 CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET $3.40 250 2640570 CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET $3.40 250 2640573 CYCLOBENZAPRINE 10 MG TABLET $3.40 250 2640575 DEXAMETHASONE 4 MG TABLET $3.40 250 2640578 DIPHENHYDRAMINE 25 MG CAPSULE $3.40 250 2640581 GLYBURIDE 5 MG TABLET $3.40 250 2640583 HYDROCHLOROTHIAZIDE 25 MG TABLET $3.40 250 2640585 LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET $3.40 250 2640586 IBUPROFEN 200 MG TABLET $3.40 250 2640587 IBUPROFEN 400 MG TABLET $3.40 250 2640588 INDOMETHACIN 25 MG CAPSULE $3.40 250 2640589 LEVOFLOXACIN 250 MG TABLET $3.40 250 2640592 CHLORDIAZEPOXIDE 25 MG CAPSULE $3.40 250 2640602 OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET $3.40 250 2640605 PROMETHAZINE 25 MG TABLET $3.40 250 2640606 PROPRANOLOL 10 MG TABLET $3.40 250 2640617 AMITRIPTYLINE 10 MG TABLET $3.40 250 2640619 CLINDAMYCIN 150 MG CAPSULE $3.40 250 2640620 AMITRIPTYLINE 25 MG TABLET $3.40 250 2640626 ALPRAZOLAM 0.25 MG TABLET $3.40 250 2640649 MAPAP EXTRA STRENGTH 500 MG TABLET $3.40 250 2640653 OYSTER SHELL CALCIUM 500 500 MG CALCIUM (1250 MG) TABLET $3.40 250 2640672 DICYCLOMINE 10 MG CAPSULE $3.40 250 2640680 RANITIDINE 150 MG TABLET $3.40 250 2640681 DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET $3.40 250 2640688 OLANZAPINE 5 MG TABLET $3.40 250 2640693 MONTELUKAST 10 MG TABLET $3.40 250 2640716 CLOPIDOGREL 75 MG TABLET $3.40 250 2640723 CARBAMAZEPINE 200 MG TABLET $3.40 250 2640725 ALPRAZOLAM 0.5 MG TABLET $3.40 250 2640744 ANASPAZ 0.125 MG DISINTEGRATING TABLET $3.40 250 2640747 SUCRALFATE 1 GRAM TABLET $3.40 250 2640757 NAPROXEN 375 MG TABLET $3.40 250 2640758 NAPROXEN 500 MG TABLET $3.40 250 2640764 BUMETANIDE 1 MG TABLET $3.40 250 2640768 ESTRADIOL 0.5 MG TABLET $3.40 250 2640769 VENLAFAXINE 75 MG TABLET $3.40 250 2640798 DOCUSATE SODIUM 100 MG CAPSULE $3.40 250 2640802 FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET $3.40 250 2640803A MELATONIN 3 MG TABLET $3.40 250 2640806 HYDRALAZINE 10 MG TABLET $3.40 250 2640812 METHYLPHENIDATE 5 MG TABLET $3.40 250 2640822 LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION $3.40 250 2640866 I-VITE 1000 UNIT-200 MG-60 UNIT-2MG TABLET $3.40 250 2640880 ACYCLOVIR 400 MG TABLET $3.40 250 2640919 SYNTHROID 112 MCG TABLET $3.40 250 2640921 NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH $3.40 250 2640927 HYDROXYZINE PAMOATE 25 MG CAPSULE $3.40 250 2640929 GLIPIZIDE 5 MG TABLET $3.40 250 2640931 CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET $3.40 250 2640940 BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET $3.40 250 2640955 PIOGLITAZONE 15 MG TABLET $3.40 250 2640985 KETOROLAC 10 MG TABLET $3.40 250 2640988 FISH OIL 340 MG-1000 MG CAPSULE $3.40 250 2641002 LABETALOL 100 MG TABLET $3.40 250 2641005 VITAMIN B-12 1000 MCG TABLET $3.40 250 2641008 ASPIRIN 325 MG TABLETDELAYED RELEASE $3.40 250 2641010 FOLIC ACID 400 MCG TABLET $3.40 250 2641016 OMEPRAZOLE 20 MG CAPSULEDELAYED RELEASE $3.40 250 2641034 CITALOPRAM 20 MG TABLET $3.40 250 2641039 PIOGLITAZONE 30 MG TABLET $3.40 250 2641066 CIPROFLOXACIN 500 MG TABLET $3.40 250 2641076 TERAZOSIN 1 MG CAPSULE $3.40 250 2641078 TERAZOSIN 5 MG CAPSULE $3.40 250 2641084 SOTALOL 80 MG TABLET $3.40 250 2641131 FAMOTIDINE 20 MG TABLET $3.40 250 2641137 PRIMIDONE 50 MG TABLET $3.40 250 2641151 DILANTIN EXTENDED 100 MG CAPSULE $3.40 250 2641153 ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET $3.40 250 2641154 METOPROLOL TARTRATE 25 MG TABLET $3.40 250 2641156 NAPROXEN SODIUM 220 MG TABLET $3.40 250 2641162 BUSPIRONE 5 MG TABLET $3.40 250 2641169 OXYCODONE 5 MG TABLET $3.40 250 2641175 AMOXICILLIN 875 MG TABLET $3.40 250 2641191 FLUOXETINE 20 MG CAPSULE $3.40 250 2641216 PHOSPHA 250 NEUTRAL 250 MG TABLET $3.40 250 2641219 HYDROXYZINE HCL 25 MG TABLET $3.40 250 2641225 TIZANIDINE 4 MG TABLET $3.40 250 2641240 LISINOPRIL 10 MG TABLET $3.40 250 2641243 TRAMADOL 50 MG TABLET $3.40 250 2641245 LISINOPRIL 5 MG TABLET $3.40 250 2641249 METFORMIN 500 MG TABLET $3.40 250 2641264 SPIRONOLACTONE 50 MG TABLET $3.40 250 2641282 MUCINEX 600 MG TABLET EXTENDED RELEASE $3.40 250 2641285 DOXAZOSIN 2 MG TABLET $3.40 250 2641288 FLECAINIDE 100 MG TABLET $3.40 250 2641295 AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET $3.40 250 2641296 SENNA PLUS 8.6 MG-50 MG TABLET $3.40 250 2641302 METOPROLOL TARTRATE 50 MG TABLET $3.40 250 2641309 LISINOPRIL 2.5 MG TABLET $3.40 250 2641323 MIRTAZAPINE 15 MG TABLET $3.40 250 2641329 BUPROPION HCL SR 150 MG TABLETSUSTAINED-RELEASE $3.40 250 2641332 MAG-AL PLUS 200 MG-200 MG-20 MG/5 ML ORAL SUSPENSION $3.40 250 2641341 NON-DROWSY ALLERGY 10 MG TABLET $3.40 250 2641344 CEFUROXIME AXETIL 250 MG TABLET $3.40 250 2641346 PHENTERMINE 37.5 MG TABLET $3.40 250 2641351 BENAZEPRIL 10 MG TABLET $3.40 250 2641354 MAG 64 64 MG TABLETEXTENDED RELEASE $3.40 250 2641360 PAROXETINE 20 MG TABLET $3.40 250 2641370 SYNTHROID 88 MCG TABLET $3.40 250 2641371 AMIODARONE 200 MG TABLET $3.40 250 2641372 GABAPENTIN 300 MG CAPSULE $3.40 250 2641373 METFORMIN ER 500 MG TABLETEXTENDED RELEASE 24 HR $3.40 250 2641375 GABAPENTIN 100 MG CAPSULE $3.40 250 2641377 GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR $3.40 250 2641389 PROCHLORPERAZINE MALEATE 5 MG TABLET $3.40 250 2641400 QUINAPRIL 10 MG TABLET $3.40 250 2641404 HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET $3.40 250 2641430 BUPROPION HCL 75 MG TABLET $3.40 250 2641449 CILOSTAZOL 100 MG TABLET $3.40 250 2641461 HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET $3.40 250 2641466 ALLEGRA ALLERGY 180 MG TABLET $3.40 250 2641474 SIMVASTATIN 20 MG TABLET $3.40 250 2641478 VITAMIN D3 1000 UNIT TABLET $3.40 250 2641492 SIMVASTATIN 10 MG TABLET $3.40 250 2641514 CYCLOBENZAPRINE 5 MG TABLET $3.40 250 2641516 SERTRALINE 50 MG TABLET $3.40 250 2641532 ZOLPIDEM 5 MG TABLET $3.40 250 2641538 MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION $3.40 250 2641542 LORATADINE-D 10 MG-240 MG TABLETEXTENDED RELEASE 24 HR $3.40 250 2641547 ZOLPIDEM 10 MG TABLET $3.40 250 2641550 AMLODIPINE 10 MG TABLET $3.40 250 2641553 AMLODIPINE 5 MG TABLET $3.40 250 2641556 METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR $3.40 250 2641566 MELOXICAM 7.5 MG TABLET $3.40 250 2641579 METFORMIN 1000 MG TABLET $3.40 250 2641591 CETIRIZINE 10 MG TABLET $3.40 250 2641594 CARVEDILOL 25 MG TABLET $3.40 250 2641597 PANTOPRAZOLE 40 MG TABLETDELAYED RELEASE $3.40 250 2641605 ROPINIROLE 0.5 MG TABLET $3.40 250 2641611 RAMIPRIL 2.5 MG CAPSULE $3.40 250 2641639 LEVETIRACETAM 500 MG TABLET $3.40 250 2641669 TOPIRAMATE 25 MG TABLET $3.40 250 2641684 LAMOTRIGINE 25 MG TABLET $3.40 250 2641690 DIVALPROEX 250 MG TABLETDELAYED RELEASE $3.40 250 2641696 HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET $3.40 250 2641706 LOSARTAN 25 MG TABLET $3.40 250 2641710 ALIGN 4 MG CAPSULE $3.40 250 2641747 FOLBIC 2.5 MG-25 MG-2 MG TABLET $3.40 250 2641761 CHOLECALCIFEROL (VITAMIN D3) 5000 UNIT CAPSULE $3.40 250 2641764 ANASTROZOLE 1 MG TABLET $3.40 250 2641766 CO Q-10 50 MG CAPSULE $3.40 250 2641774 PRAMIPEXOLE 0.25 MG TABLET $3.40 250 2641780 TAMSULOSIN ER 0.4 MG CAPSULEEXTENDED RELEASE 24 HR $3.40 250 2641802 DONEPEZIL 5 MG TABLET $3.40 250 2641821 SUDOGEST 30 MG TABLET $3.40 250 2641845 CHILDREN'S ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION $3.40 250 2641909 TORSEMIDE 10 MG TABLET $3.40 250 2641931 ANTI-DIARRHEAL (LOPERAMIDE) 2 MG TABLET $3.40 250 2641952 MEDROXYPROGESTERONE 2.5 MG TABLET $3.40 250 2641986 POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE $3.40 250 2642001 CALCIUM 600 + D(3) 600 MG (1500 MG)-400 UNIT TABLET $3.40 250 2642010 ASPIRIN 325 MG TABLET $3.40 250 2642019 PREDNISONE 1 MG TABLET $3.40 250 2642023 PREDNISONE 5 MG TABLET $3.40 250 2642025 PREDNISONE 20 MG TABLET $3.40 250 2642026 PREDNISONE 10 MG TABLET $3.40 250 2642051 AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION $3.40 250 2642066 POTASSIUM CHLORIDE ER 10 MEQ CAPSULEEXTENDED RELEASE $3.40 250 2642183 ACIDOPHILUS-PECTIN CAPSULE $3.40 250 2642214 VITAMIN E (DL ACETATE) 400 UNIT CAPSULE $3.40 250 2642223 THERA VITAMIN TABLET $3.40 250 2642244 GLUCOSAMINE-CHONDROITIN 500 MG-400 MG CAPSULE $3.40 250 2642400 METAMUCIL SMOOTH (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET $3.40 250 2642402 CEPACOL (BENZOCAINE/MENTHOL) $3.40 250 2642403 AMOXICILLIN 250 MG CHEWABLE TABLET $3.40 250 2642406 ICAPS MV 100 MCG-1.66 MG-0.83 MG TABLETDELAYED RELEASE $3.40 250 2642413 SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION (5ML) $3.40 250 2642419 NIACIN 100 MG TABLET $3.40 250 2642420 POTASSIUM CITRATE ER 10 MEQ (1080 MG) TABLETEXTENDED RELEASE $3.40 250 2642422 LIPO-FLAVONOID PLUS 200 MG-100 MG TABLET $3.40 250 2642438 GUAIFENESIN-DM 10 MG-100 MG/5 ML ORAL LIQUID $3.40 250 2642479 GUAIATUSSIN AC 10 MG-100 MG/5 ML ORAL LIQUID $3.40 250 2650003 VITAMINS B COMPLEX CAPSULE $3.40 250 2650005 LUTEIN 10 MG TABLET $3.40 250 2650010 METOCLOPRAMIDE 5 MG TABLET $3.40 250 2650013 LISINOPRIL 20 MG TABLET $3.40 250 2650015 LIOTHYRONINE 5 MCG TABLET $3.40 250 2650019 FISH OIL 360 MG-1200 MG CAPSULE $3.40 250 2650020 ZANTAC 75 MG TABLET $3.40 250 2650022 AZO STANDARD MAXIMUM STRENGTH 97.5 MG TABLET $3.40 250 2642462 BISMATROL 262 MG/15 ML ORAL SUSPENSION (15ML) $3.40 250 2640140 NYSTATIN 100000 UNIT/ML ORAL SUSPENSION (5ML) $3.40 250 2650026 CALCITRIOL 0.25 MCG CAPSULE $3.40 250 2640462 DIAZEPAM 2 MG TABLET $3.40 250 2640576 DIAZEPAM 5 MG TABLET $3.40 250 2650027 "DIVALPROEX 125 MG TABLET, DELAYED RELEASE" $3.40 250 2650029 SYNTHROID 125 MG TABLET $3.40 250 2650039 CLONAZEPAM 0.5MG TABLET $3.40 250 2650040 CIPROFLOXACIN 250MG TABLET $3.40 250 2650057 "QUEtiapine FUMARATE 25 MG TAB 25 mg, 100 eaches" $3.40 250 2640734 BACITRACIN 500 UNIT/GRAM TOPICAL PACKET $3.40 250 2642482 ACID GONE ANTACID 95 MG-358 MG/15 ML ORAL SUSPENSION (30ML) $3.40 250 2640694 DEEP SEA NASAL 0.65 % SPRAY AEROSOL $3.40 250 2640145 GUAIFENESIN 100 MG/5 ML ORAL LIQUID $3.40 250 2642437 HYDROXYZINE HCL 10 MG/5 ML SYRUP $3.40 250 2640499 LOPERAMIDE 1 MG/5 ML ORAL LIQUID (5ML) $3.40 250 2642348 MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION (1ML) $3.40 250 2640816 PHENOBARBITAL 20 MG/5 ML ORAL ELIXIR (5ML) $3.40 250 2640138 PHENYTOIN 125 MG/5 ML ORAL SUSPENSION (5ML) $3.40 250 2642486 PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML ORAL SOLUTION (5ML) $3.40 250 2641838 Q-DRYL 12.5 MG/5 ML ORAL LIQUID (5ML) $3.40 250 2642364 REFRESH CLASSIC (PF) 1.4 %-0.6 % EYE DROPS IN A DROPPERETTE $3.40 250 2650058 "BIOTENE DRY MOUTH ORAL RINSE 1 unit," $3.40 250 2650059 "ISOSORBIDE MONONIT 10 MG TAB 10 mcg, 100 eaches" $3.40 250 2650065 VERAPAMIL ER 180 MG TABLET $3.40 250 2640948 MUCINEX D 60 MG-600 MG TABLETEXTENDED RELEASE $3.50 250 2641083 NIFEDIPINE ER 30 MG TABLETEXTENDED RELEASE 24 HR $3.64 250 2641563 TOPROL XL 50 MG TABLETEXTENDED RELEASE $3.64 250 2642376 FELODIPINE ER 2.5 MG TABLETEXTENDED RELEASE 24 HR $3.71 250 2640202 DILTIAZEM CD 180 MG CAPSULEEXTENDED RELEASE 24 HR $3.85 250 2640484 ASPIRIN 300 MG RECTAL SUPPOSITORY $3.98 250 2642367 FLEET PEDIATRIC 9.5 GRAM-3.5 GRAM/59 ML ENEMA $4.08 250 2641418 VITAMIN D2 50000 UNIT CAPSULE $4.12 250 2641182 KLOR-CON/EF 25 MEQ EFFERVESCENT TABLET $4.26 250 2641121 DILTIAZEM CD 240 MG CAPSULEEXTENDED RELEASE 24 HR $4.53 250 2640343 DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION (5ML) $4.60 250 2640907 WARFARIN 1 MG TABLET $4.70 250 2641342 METOLAZONE 2.5 MG TABLET $4.70 250 2650036 ARIPIPRAZOLE 5MG TABLET $5.00 250 2640463 FLEET ENEMA 19 GRAM-7 GRAM/118 ML $5.00 250 2642378 PROMETHAZINE 6.25 MG/5 ML SYRUP (5ML) $5.00 250 2640823 PROMETHAZINE-CODEINE 6.25 MG-10 MG/5 ML SYRUP (5ML) $5.00 250 2641289 CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH (15ML) $5.00 250 2641124 WARFARIN 2.5 MG TABLET $5.04 250 2641019 JANTOVEN 3 MG TABLET $5.07 250 2641194 JANTOVEN 4 MG TABLET $5.07 250 2641711 ONDANSETRON 4 MG DISINTEGRATING TABLET $5.11 250 2642069 ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML ORAL SOLUTION (5ML) $5.25 250 2640047A WARFARIN 5 MG TABLET (5MG) $5.28 250 2641263 AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET $5.75 250 2641355 FLUCONAZOLE 100 MG TABLET $5.99 250 2650016 OXYMORPHONE ER 5 MG TABLETEXTENDED RELEASE12 HR $6.00 250 2642349 BANOPHEN ANTI-ITCH 2 %-0.1 % TOPICAL CREAM $6.03 250 2641458 AZITHROMYCIN 250 MG TABLET $6.26 250 2641800 FAMCICLOVIR 250 MG TABLET $6.30 250 2640412 SIMETHICONE 40 MG/0.6 ML ORAL DROPSSUSPENSION $6.33 250 2641569 ALENDRONATE 70 MG TABLET $6.40 250 2641428 MIRALAX 17 GRAM ORAL POWDER PACKET $6.71 250 2640110 HYDROCORTISONE 1 % TOPICAL CREAM $7.15 250 2640565 AMANTADINE HCL 100 MG CAPSULE $7.22 250 2640523 OXYCONTIN 10 MG TABLETCRUSH RESISTANTEXTENDED RELEASE $7.45 250 2641737 LANSOPRAZOLE 30 MG CAPSULEDELAYED RELEASE $7.56 250 2640112 MICONAZOLE NITRATE 2 % TOPICAL CREAM $7.66 250 2640120 CITRATE OF MAGNESIA ORAL $7.73 250 2640120A CITROMA ORAL SOLUTION $7.73 250 2640796 DICLOFENAC SODIUM 75 MG TABLETDELAYED RELEASE $7.97 250 2650053 CHLORASEPTIC THROAT SPRAY 20ML $8.00 250 2640971 CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET $8.17 250 2641574 BYSTOLIC 5 MG TABLET $8.24 250 2642070 NITRATEST PAPER WITH DISPENSER 15 FEET MISC TEST $8.37 250 2641163 CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE $8.58 250 2641934 DOXYCYCLINE HYCLATE 100 MG TABLET $8.71 250 2640686 AYR SALINE TOPICAL GEL $8.75 250 2641204 HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION (5ML) $9.19 250 2641603 SERTRALINE 25 MG TABLET $9.22 250 2640720 TOLTERODINE 2 MG TABLET $9.26 250 2641564 OXYBUTYNIN CHLORIDE ER 5 MG TABLETEXTENDED RELEASE 24 HR $9.26 250 2641007 GOLD BOND MEDICATED 0.15 %-1 % TOPICAL POWDER $9.33 250 2640252 LANSOPRAZOLE 15 MG CAPSULEDELAYED RELEASE $9.63 250 2641072 NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH $9.74 250 2640767 VENLAFAXINE ER 37.5 MG CAPSULEEXTENDED RELEASE 24 HR $10.00 250 2641199 S2 RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION $10.00 250 2650044 BENZOIN COMPOUND TINCTURE $10.00 250 2650050 BETADINE SPRAY $10.00 250 2650043 LIDOCAINE/PRILOCAINE TOPICAL CREAM $10.00 250 2650061 "LINEZOLID 600 MG TABLET 600 mcg, 30 eaches" $10.00 250 2650068 morphine SULF ER 100 MG TABLET 100 mg $10.00 250 2641852 NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE $10.21 250 2640637 NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE $10.55 250 2642080 LUBRIFRESH PM 83 %-15 % EYE OINTMENT $10.69 250 2640946 CLOTRIM ANTIFUNGAL 1 % TOPICAL CREAM $10.72 250 2640455 GLUTOSE 15 40 % ORAL GEL $10.76 250 2640445 NEO-SYNEPHRINE (PHENYLEPHRINE) 0.5 % NASAL SPRAY $10.79 250 2640250 AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION $10.89 250 2641359 FLUCONAZOLE 150 MG TABLET $11.17 250 2641210 BENICAR 20 MG TABLET $11.34 250 2640156A HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY $11.71 250 2640490 LIDOCAINE VISCOUS 2 % MUCOSAL SOLUTION (5ML) $11.91 250 2640630 ETHYL CHLORIDE 100 % TOPICAL SPRAY $12.00 250 2650066 "SODIUM CHLORIDE 7% VIAL 7 mL, 4 mL" $12.00 250 2640303 VICKS VAPORUB 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT $12.08 250 2640538 DIOVAN 80 MG TABLET $12.70 250 2641292 PHENADOZ 12.5 MG RECTAL SUPPOSITORY $12.76 250 2640701 FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL SOLUTION (5ML) $12.76 250 2641555 CEFDINIR 300 MG CAPSULE $13.07 250 2641441 LYRICA 50 MG CAPSULE $13.72 250 2641472 LYRICA 25 MG CAPSULE $13.89 250 2641536 TEKTURNA 150 MG TABLET $13.96 250 2641312 AVODART 0.5 MG CAPSULE $14.57 250 2640464 FLEET MINERAL OIL ENEMA $14.67 250 2641744 AMITIZA 8 MCG CAPSULE $14.77 250 2640232 NASAL DECONGESTANT (OXYMETAZOLINE) 0.05 % SPRAY $14.94 250 2640871 NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH $14.98 250 2650018 ELIQUIS 2.5 MG TABLET $15.00 250 2641318 NAMENDA 10 MG TABLET $15.05 250 2640306 SAVELLA 25 MG TABLET $15.56 250 2650035 WATER FOR INJECTION $16.00 250 6340225 CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION $16.00 250 2642496 PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION $16.68 250 2640045 COLCRYS 0.6 MG TABLET $16.85 250 2640014 AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION $17.12 250 2641322 METAXALONE 800 MG TABLET $17.19 250 2640244 EAR DROPS (CARBAMIDE PEROXIDE) 6.5 % $17.70 250 2640195 PREPARATION H 0.25 %-14 %-74.9 % OINTMENT $17.84 250 2640177 EUCERIN TOPICAL CREAM $18.04 250 2640091 INDOMETHACIN ER 75 MG CAPSULEEXTENDED RELEASE $18.14 250 2641259 ZETIA 10 MG TABLET $18.55 250 2640209 NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH $19.27 250 2640888 CELEBREX 200 MG CAPSULE $19.50 250 2641702 TOVIAZ 4 MG TABLETEXTENDED RELEASE $19.64 250 2641679 PRISTIQ 50 MG TABLETEXTENDED RELEASE $20.05 250 2641955 MAGIC MOUTHWASH 1:1 60ML LIQUID $20.42 250 2640677 RALOXIFENE 60 MG TABLET $20.46 250 2641301 CRESTOR 10 MG TABLET $20.56 250 2641431 ENABLEX 7.5 MG TABLETEXTENDED RELEASE $20.83 250 2642124 DELSYM 12 HOUR 30 MG/5 ML ORAL SUSPENSIONEXTENDED RELEASE (5ML) $20.83 250 6340553 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $20.90 250 2640766 VENLAFAXINE ER 75 MG CAPSULEEXTENDED RELEASE 24 HR $21.55 250 2641685 RISPERIDONE 0.5 MG TABLET $21.79 250 6350010 PRIDOXINE 100 MG/ML INJECTION SOLUTION $21.82 250 2642308 LIDOCAINE 2 % MUCOUS MEMBRANE JELLY IN APPLICATOR $21.82 250 2650041 MYRBETRIQ 25MG TABLET $22.00 250 2641951 POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID (15ML) $22.00 250 2641912 DALIRESP 500 MCG TABLET $22.60 250 2641168 MINOCYCLINE 100 MG CAPSULE $23.11 250 2641676 ULORIC 40 MG TABLET $23.15 250 2641112 TOLTERODINE ER 4 MG CAPSULEEXTENDED RELEASE 24 HR $23.39 250 2650055 OSELTAMIVIR 30MG CAPSULE $23.50 250 2650004 BSS PLUS INTRAOCULAR SOLUTION $23.56 250 2640566 BSS INTRAOCULAR SOLUTION $23.56 250 2640632 SPS 15 GRAM/60 ML ORAL SUSPENSION $23.83 250 2641423 VESICARE 5 MG TABLET $24.07 250 2641357 DULOXETINE 30 MG CAPSULEDELAYED RELEASE $24.75 250 2640279A CLEOCIN (CLINDAMYCIN) 600MG $25.00 250 2650045 BENZOIN SPRAY $25.00 250 2641099 NEXIUM 40 MG CAPSULEDELAYED RELEASE $25.33 250 2650006 NEXIUM PACKET 40 MG GRANULES DELAYED RELEASE FOR SUSP $25.33 250 2650024 ZICAM NASAL GEL $26.00 250 2640995 TAMIFLU 75 MG CAPSULE $26.07 250 2641416 FENTANYL 25 MCG/HR TRANSDERMAL PATCH $27.23 250 2641839 TETRACAINE HCL (PF) 0.5 % EYE DROPS $27.27 250 2641699 TERBINAFINE HCL 1 % TOPICAL CREAM $27.81 250 2642251 TRADJENTA 5 MG TABLET $28.80 250 2641192 PHENADOZ 25 MG RECTAL SUPPOSITORY $28.90 250 2641144 LIDOCAINE 5 % (700 MG/PATCH) ADHESIVE PATCH $29.31 250 2642487 DONNATAL 16.2 MG-0.1037MG-0.0194MG/5ML ORAL ELIXIR (5ML) $29.78 250 2650047 TRANEXAMIC ACID 1000MG/10ML $30.00 250 2641863 XARELTO 10 MG TABLET $30.13 250 2641119 PROPARACAINE 0.5 % EYE DROPS $30.64 250 6350011 METHYLENE BLUE (ANTIDOTE) 1% (10MG/ML) INTRAVENOUS SOLUTION $30.85 250 2645577 NAMENDA XR 14 MG CAPSULE SPRINKLEER 24HR $31.04 250 2641541 JANUVIA 50 MG TABLET $31.76 250 2641806 VALACYCLOVIR 1 GRAM TABLET $32.71 250 2641680 EXELON PATCH 4.6 MG/24 HR TRANSDERMAL $33.63 250 2642546 MODAFINIL 100 MG TABLET $34.38 250 2650063 "FLUARIX QUAD 2018-2019 SYRINGE 1 ea, 0.5 mL" $35.00 250 2640633 LIDOCAINE 2 % MUCOSAL GEL $35.47 250 2641662 FLECTOR 1.3 % TRANSDERMAL 12 HOUR PATCH $36.12 250 2640882 POLYMYXIN B SULFATE 10000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS $36.59 250 2641352 CLOTRIMAZOLE 1 % VAGINAL CREAM $37.44 250 2640042 BETADINE OPHTHALMIC PREP 5 % SOLUTION $38.16 250 2640148 SILVER SULFADIAZINE 1 % TOPICAL CREAM (50G) $42.21 250 2641399 FENTANYL 50 MCG/HR TRANSDERMAL PATCH $43.13 250 2642399 LETS KIT 4 %-1:1000-0.5 % TOPICAL SOLUTION (5ML) $45.00 250 2650021 SENSIPAR 30 MG TABLET $45.10 250 2641936 CIPROFLOXACIN 0.3 % EYE DROPS $45.44 250 2641656 ACTIDOSE-AQUA 25 GRAM/120 ML ORAL SUSPENSION $45.48 250 2640634 LIDOCAINE 4 % (40 MG/ML) MUCOSAL SOLUTION $45.86 250 2641023 TOBRAMYCIN 0.3 % EYE DROPS $46.60 250 2640411 SILVADENE 1 % TOPICAL CREAM $47.59 250 2640448 NYSTATIN 100000 UNIT/GRAM TOPICAL CREAM $47.79 250 2642024 METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK $48.00 250 2641508 TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM $48.47 250 2650064 "NUTRILIPID 20% IV FAT EMULSION 250 mL, 250 mL" $50.00 250 2641027 GENTAK 0.3 % (3 MG/GRAM) EYE OINTMENT $50.21 250 2641954 GI COCKTAIL (MAALOX/DONNATAL/VISC LIDOCAINE) $50.50 250 2640480 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $50.96 250 2640945 TRANSDERM-SCOP 1.5 MG TRANSDERMAL 72 HOUR PATCH $51.81 250 2640836 NEOMYCIN 3.5 MG/G-POLYMYXIN B 10000 UNIT/G-DEXAMETH 0.1 % EYE OINT $52.76 250 2650056 NIMBEX 2MG/ML INJ $53.00 250 2640526 GENTAMICIN 0.3 % EYE DROPS $53.65 250 2640137 PHENYLEPHRINE 2.5 % EYE DROPS $56.51 250 2650054 ATROPINE 1% EYE SOLN $60.00 250 2640839 NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10000 UNIT/GRAM EYE OINT $60.01 250 2641540 FENTANYL 12 MCG/HR TRANSDERMAL PATCH $62.16 250 2640655 CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION $64.34 250 2641388 NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10000 UNIT/ML-0.1% EYE DROPS $64.88 250 2640647 GENTAMICIN 0.1 % TOPICAL OINTMENT $72.60 250 2641033 FLUCONAZOLE 10 MG/ML ORAL SUSPENSION $73.53 250 2641471 FLUTICASONE 50 MCG/ACTUATION NASAL SPRAYSUSPENSION $74.89 250 2650028 "PHYSOSTIGMINE, 1 MG/ML INJECTION SOULTION" $75.50 250 2641497 AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION $83.50 250 2640849 NITRO-BID 2 % TRANSDERMAL OINTMENT $84.42 250 2641535 AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION (15ML) $84.76 250 2641334 AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION (30ML) $84.76 250 2641387 VANCOMYCIN 125 MG CAPSULE $85.34 250 2640493 GAVILYTE-N 420 GRAM ORAL SOLUTION $90.85 250 2641141 CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM $91.70 250 2641559 AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION $92.42 250 2640378 FLUOCINONIDE 0.05 % TOPICAL CREAM $93.27 250 2640008 FENTANYL 100 MCG/HR TRANSDERMAL PATCH $93.81 250 2650062 "TRIAMCINOLONE 0.1% PASTE 1 ea, 5 g" $100.00 250 2640136 AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION $104.26 250 2641330 MUPIROCIN 2 % TOPICAL OINTMENT $109.78 250 2641686 SUMATRIPTAN 50 MG TABLET $114.34 250 2640106 PROCTOZONE-HC 2.5 % RECTAL CREAM $120.00 250 2640676 NASONEX 50 MCG/ACTUATION SPRAY $125.50 250 2640878 NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER $126.22 250 2641933 AMMONIUM LACTATE 12 % TOPICAL CREAM $137.45 250 2650037 BENTYL 20MG/2ML IM INJECT $141.00 250 2641393 PREDNISOLONE ACETATE 1 % EYE DROPSSUSPENSION $150.63 250 2640180 VANCOMYCIN 250 MG CAPSULE $157.33 250 2640502 NEOMYCIN 1.75 MG-POLYMYXIN 10000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS $158.12 250 2641589 CEFDINIR 125 MG/5 ML ORAL SUSPENSION $173.60 250 2641328 NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10000 UNIT/ML-1 % EAR SOLUTION $173.60 250 2650048 ASCORBIC ACID 500MG/ML UP TO 50ML INJ $174.75 250 2641675 VOLTAREN 1 % TOPICAL GEL $183.48 250 2640179 CYCLOPENTOLATE 1 % EYE DROPS $187.97 250 2640431 VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER $192.73 250 2640117 SILVER SULFADIAZINE 1 % TOPICAL CREAM (400G) $200.43 250 2640777 MIOCHOL-E 1:100 (20 MG/2 ML) INTRAOCULAR KIT $222.52 250 2650032 TRI FLURIDINE 1% EYE DROPS $250.00 250 2641395 SPIRIVA WITH HANDIHALER 18 MCG & INHALATION CAPSULES $268.10 250 2640730 NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM $304.83 250 2641752 ADVAIR DISKUS 100 MCG-50 MCG/DOSE POWDER FOR INHALATION $356.84 250 2641732 ADVAIR DISKUS 250 MCG-50 MCG/DOSE POWDER FOR INHALATION $368.31 250 2650042 CIPRODEX OTIC DROPS $387.00 250 6340729 ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION $387.99 250 2650067 "ZIRGAN 0.15% OPHTHALMIC GEL 5 g," $400.00 250 2641543 VIGAMOX 0.5 % EYE DROPS $430.54 250 2650060 "SAMSCA 30 MG TABLET 30 mcg, 10 eaches" $525.00 250 2641751 ADVAIR DISKUS 500 MCG-50 MCG/DOSE POWDER FOR INHALATION $600.26 250 2640876 SANTYL 250 UNIT/GRAM TOPICAL OINTMENT $602.24 250 2650046 FLOSEAL HEMOSTATIC MATRIX 10ML $750.00 250 2640371 DIAZEPAM 2.5 MG RECTAL KIT $766.82 250 2650014 PROMETHAZINE TAKE HOME PACK $13.60 253 2642315 CLEOCIN (CLINDAMYCIN) 150MG TAKE HOME PACK $13.62 253 2642318 AUGMENTIN (AMOXICILLIN/CLAVULANATE K) 875MG TAKE $13.62 253 2642323 BACTRIM DS (SULFAMETHOXAZOLE/TRIMETHOPRIM) TAKE HO $13.62 253 2642324 FLEXERIL (CYCLOBENZAPRINE) 10MG TAKE HOME PACK $13.62 253 2642326 CIPRO (CIPROFLOXACIN) 500MG TAKE HOME PACK $13.62 253 2642454 AMOXICILLIN 500MG TAKE HOME PACK $13.62 253 2642456 KEFLEX (CEPHALEXIN) 500MG TAKE HOME PACK $13.62 253 2642503 ULTRAM (TRAMADOL) 50MG TAKE HOME PACK $13.62 253 2642505 AUGMENTIN (AMOXICILLIN/CLAVULANATE K) 500MG TAKE $13.62 253 2642506 FLAGYL (METRONIDAZOLE) 250 MG TAKE HOME PACK $13.62 253 2642507 LOMOTIL (DIPHENOXYLATE/ATROPINE) 2.5/0.025MG TAKE $13.62 253 2642509 MECLIZINE 12.5MG TAKE HOME PACK $13.62 253 2642510 MECLIZINE 25MG TAKE HOME PACK $13.62 253 2642513 ROBAXIN (METHOCARBAMOL) 500MG TAKE HOME PACK $13.62 253 2642514 TESSALON (BENZONATATE) 100MG TAKE HOME PACK $13.62 253 2642515 TORADOL (KETOROLAC) 10MG TAKE HOME PACK $13.62 253 2642516 XANAX (ALPRAZOLAM) 0.25MG TAKE HOME PACK $13.62 253 2642354 HYDROCODONE/APAP 5/325MG TAKE HOME PACK $17.02 253 2642355 HYDROCODONE/APAP 7.5/325MG TAKE HOME PACK $17.02 253 2642356 HYDROCODONE/APAP 10/325MG TAKE HOME PACK $17.02 253 2642357 PERCOCET (OXYCODONE/APAP) 5/325MG TAKE HOME PACK $17.02 253 2642314 ZOFRAN (ONDANSETRON) 4MG ODT TAKE HOME PACK $20.44 253 2642512 OMNICEF (CEFDINIR) 300MG TAKE HOME PACK $27.23 253 2640004 POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS $16.00 258 2640534 SODIUM CHLORIDE 3 % INTRAVENOUS INJECTION SOLUTION $16.00 258 2641667 POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS $16.00 258 2650051 POTASSIUM 20MEQ IN D5 1/2NS 1000ML $20.00 258 2650025 CLINDAMYCIN 300 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK $25.00 258 2642853 SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION $31.66 258 2641403 SODIUM CHLORIDE 0.9 % FOR NEBULIZATION $10.00 259 2641562 IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML NEBULIZATION SOLN $10.00 259 2641339 ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION $10.00 259 2640300 IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION $10.00 259 2640277 ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION $16.00 259 2640282 NORMAL SALINE FLUSH INJECTION SYRINGE $16.00 259 2640301 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION (10ML) $16.00 259 2640577 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION (5ML) $16.00 259 2640661 GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION $16.00 259 2640665 XYLOCAINE-EPINEPHRINE 1 %-1:100000 INJECTION SOLUTION $16.00 259 2640770 METOPROLOL 5 MG/5 ML INTRAVENOUS SOLUTION $16.00 259 2640780 WATER FOR INJECTION STERILE INJECTION SOLUTION $16.00 259 2640788 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION $16.00 259 2640790 NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INJECTION SOLUTION $16.00 259 2640842 SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION $16.00 259 2640875 SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION $16.00 259 2640889 DIPRIVAN 10 MG/ML INTRAVENOUS EMULSION $16.00 259 2640903 SODIUM CHLORIDE 0.9 % BACTERIOSTATIC INJECTION SOLUTION $16.00 259 2641014 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $16.00 259 2641174 DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION $16.00 259 2641186 XYLOCAINE 20 MG/ML (2 %) INJECTION SOLUTION $16.00 259 2641340 METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK $16.00 259 2641345 LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE $16.00 259 2641635 LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION (10ML) $16.00 259 2642083 BACTERIOSTATIC WATER(PARABENS) INJECTION SOLUTION $16.00 259 2642109 XYLOCAINE-EPINEPHRINE 2 %-1:100000 INJECTION SOLUTION $16.00 259 2642821 SWABFLUSH 0.9 % INJECTION SYRINGE WITH ALCOHOL SWAB CAP $16.00 259 2650052 LIDOCAINE 0.5% PF INJ $16.00 259 2640774 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $16.00 259 2640610 LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION (20ML) $16.00 259 2640771 MANNITOL 25 % INTRAVENOUS SOLUTION $16.00 259 2640441 MARCAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION $16.00 259 2642350 MARCAINE-EPINEPHRINE 0.25 %-1:200000 INJECTION SOLUTION $16.00 259 2641771 MARCAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION $16.00 259 2640772 MARCAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION $16.00 259 2640776 SENSORCAINE-MPF/EPINEPHRINE 0.5 %-1:200000 INJECTION SOLUTION $16.00 259 2640279 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $16.00 259 2642016 BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION $16.82 259 2641094 ENALAPRILAT 1.25 MG/ML INTRAVENOUS $17.02 259 2640898 APLISOL 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION $17.34 259 2640558 VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION $17.43 259 2640280 DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE $19.20 259 6340068 PROTONIX 40 MG INTRAVENOUS SOLUTION $20.00 259 2640298 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE $21.10 259 2640957 LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION $21.14 259 2641041 LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION $21.14 259 2641090 NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS $21.68 259 2640608 FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION $22.13 259 2641189 SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE $22.33 259 2641898 KETAMINE 50 MG/ML INJECTION SOLUTION $22.98 259 2640331 CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE $24.99 259 2641527 BROVANA 15 MCG/2 ML SOLUTION FOR NEBULIZATION $27.57 259 2641120 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION $27.61 259 2641899 INFUVITE ADULT 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION $29.00 259 2650012 MURO 128 5 % EYE DROPS $30.00 259 2640749 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION $30.02 259 2642017 BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION $30.16 259 2641671 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION (25ML) $32.00 259 2640752 EPHEDRINE SULFATE 50 MG/ML INJECTION SOLUTION $38.75 259 2640859 AMIDATE 2 MG/ML INTRAVENOUS SOLUTION $39.08 259 2650030 LEVOPHED 1 MG/ML INJECTION $50.20 259 2640356 DOXY-100 100 MG INTRAVENOUS SOLUTION $60.42 259 6340559 ADACEL (TDAP ADOLESN/ADULT)(PF)2 LF-(2.5-5-3-5)-5 LF/0.5 ML IM SYRINGE $132.11 259 2640009 NEXIUM 40 MG INTRAVENOUS SOLUTION $132.18 259 2642058 REVONTO 20 MG INTRAVENOUS SOLUTION $275.72 259 2640870 VISCOAT 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE $443.64 259 2642494 AMVISC 12 MG/ML INTRAOCULAR SYRINGE $519.38 259 2642300 NITHIODOTE 300 MG/10 ML-12.5 GRAM/50 ML INTRAVENOUS SOLUTION $612.72 259 2642457 DUOVISC VISCO ELASTIC 3 %-4 % (0.5 ML) 1 %(0.55 ML) INTRAOCULAR KIT $616.74 259 2771202 DRESSING COVADERM SMALL $1.00 270 2741001 ARGINAID $1.03 270 2707724 DRESSING DUODERM SPOT $1.50 270 2701085 PHYTOPLEX SKIN PROTECTANT 4G PKT $1.55 270 2700896 PAD ABD 5X9 $2.00 270 2702777 TOWEL STERILE FIELD BARRIER $2.00 270 2705564 TUBEGAUZE #1 PER FOOT $2.00 270 2750296 CORRUGATED TUBING CONNECTOR $2.00 270 2750297 NASAL CANNULA - 7 FT $2.00 270 2770014 BRUSH (HAIR) $2.00 270 2770063 TOOTHPASTE $2.00 270 2770394 SOCKS SLIPPER $2.00 270 2770238 SHAVING CREAM $2.00 270 2772143 CREAM SHAVING $2.00 270 2702090 SWABSTICK BENZOIN $2.00 270 2750277 EZ WRAP - EAR PROTECTOR $2.00 270 2750278 AEROSOL MASK - ADULT $2.00 270 2750281 OXYGEN FACE TENT $2.00 270 2750282 CANNEASE $2.00 270 2705465 PAD ABD 8X10 $3.25 270 2705473 TUBE STOMACH 18FR $3.25 270 2705556 TUBEGAUZE #2 PER FOOT $3.25 270 2701076 SPONGE IV SOF-WICK 2X2 $3.25 270 2701399 BANDAGETUBE #1 (PER FOOT) $3.25 270 2701407 BANDAGETUBE #2 PER FT $3.25 270 2701415 BANDAGETUBE #3 (PER FOOT) $3.25 270 2701423 BANDAGETUBE #6 (PER FOOT) $3.25 270 2706034 BANDAGETUBE #4 PER FOOT $3.25 270 2701431 BANDAGETUBE #5 (PER FOOT) $3.25 270 2701555 BANDAGETUBE #5.5 (PER FOOT) $3.25 270 2701563 DRESSING TELFA 3X8 $3.25 270 2701324 PAD GAUZE 2X2 $3.25 270 2703601 "STOCKINETTE 4"" PER FOOT" $3.25 270 2701571 SPONGE 4X4X2 STERILE $3.25 270 2701605 SPONGE DRAIN 4X4X2 $3.25 270 2705903 FASTENER NG TUBE $3.25 270 2771087 DRESSING POLYMEM SMALL $3.25 270 2703924 BOARD ARM DISP $3.25 270 2709293 BANDAGETUBE #7#8 PER FT) $3.25 270 2702009 CURETTE EAR DISP $3.25 270 2704526 BRIEF ADULT (OVERNIGHT) $3.25 270 2707438 "STOCKINETTE 4"" PER FOOT" $3.25 270 2707479 "STOCKINETTE 3"" (PER FOOT)" $3.25 270 2750272 NON - REBREATHER MASK - ADULT $3.25 270 2707370 "STOCKINETTE 2"" PER FOOT" $3.25 270 2750279 AEROSOL MASK - PEDIATRIC $3.25 270 2705457 PAD ABD 5X9 $3.25 270 2771661 NS POSIFLUSH SYRINGE $4.00 270 2700904 "TUBING IV EXTENSION SET 30""" $4.25 270 2701068 "KLING 3"" SOF-KLING STERILE" $4.25 270 2750294 CORRUGATED TUBING DRAIN BAG $4.25 270 2705952 DRESSING IV CATHETER 2X3 $4.25 270 2701209 "TAPE HYPAFIX 2"" (PER FOOT)" $4.25 270 2770030 MOUTHWASH (16OZ) $4.25 270 2701332 PAD EYE OVAL $4.25 270 2701712 "KLING 4"" SOF-KLING STERILE" $4.25 270 2770600 DENTURE ADHESIVE $4.25 270 2772556 DRESSING COVADERM MEDIUM $4.25 270 2709327 KIT FLUSH-PORT-A-CATH $4.25 270 2740041 SWAB BARRIER SKIN $4.25 270 2742823 FILM SKIN BARRIER $4.25 270 2702215 BAG COLOSTOMY $4.25 270 2704740 STOCKINETTE COMPRESSION $4.25 270 2700045 UNDERPADS (PKG) $4.25 270 2750280 AEROSOL MASK - INFANT $4.25 270 2700698 BUTTERFLY 21G $4.25 270 2700706 BUTTERFLY 25G $4.25 270 2700199 "FOAM LITE DRESSING 2"" X 5""" $4.90 270 2750283 NASAL CANNULA - PEDIATRIC $5.25 270 2750285 NEBULIZER - PEDIATRIC CHARACTER $5.25 270 2750273 NON - REBREATHER MASK - PEDIATRIC $5.25 270 2705523 PACKING VASELINE GAUZE $5.75 270 2715092 ICE PACK $5.75 270 2770170 DRESSING TELFA ISLAND $5.75 270 2716009 HIBICLENS 4% SCRUB PKT 15 ML $5.75 270 2709913 ADHESIVE MASTISOL $5.75 270 2700748 TUBING IV MICRODRIP $5.75 270 2750284 NASAL CANNULA - INFANT $6.25 270 2750292 TELEMETRY CLIP - TOTE $6.25 270 2750274 NON - REBREATHER MASK - INFANT $6.25 270 2700953 STOPCOCK 3-WAY $6.75 270 2701092 TRAY SPONGE 4X4X10 $6.75 270 2705689 URINARY 24 HOUR SPECIMEN CONTAINER $6.75 270 2770139 DRESSING ALLEVYN 4X4 $6.75 270 2770147 DRESSING ALLEVYN 3X3 $6.75 270 2701217 "TAPE HYPAFIX 4"" (PER FT)" $6.75 270 2701506 "KLING 1"" SOF-KLING STERILE" $6.75 270 2706307 DRESSING ADAPTIC 3X3 $6.75 270 2703643 "STOCKINETTE 5"" PER FOOT" $6.75 270 2770196 EFFERDENT TABLETS $6.75 270 2703759 RESTON SELF-ADHERING FOAM PER FOOT $6.75 270 2701811 "BANDAGE ACE 2""" $6.75 270 2703833 IRRIGATION ST WATER 1000ML $6.75 270 2770253 DRESSING COVADERM LARGE $6.75 270 2703841 IRRIGATION ST WATER 500ML $6.75 270 2715258 "BANDAGE COBAN 1""" $6.75 270 2703957 IRRIGATION ST WATER 250ML $6.75 270 2706646 BANDAGETUBE #9#10 PER FT $6.75 270 2709319 KIT ACCESS-PORT-A-CATH $6.75 270 2704070 RING INVALID $6.75 270 2741502 CREAM TOPICARE $6.75 270 2702124 TRAY SHAVE PREP $6.75 270 2707222 BANDAGE TRIANGULAR $6.75 270 2707446 "STOCKINETTE 6"" PER FOOT" $6.75 270 2702413 CATHETER SUCTION 14FR $6.75 270 2702421 CATHETER SUCTION 18FR $6.75 270 2702728 CATHETER SELF CATH $6.75 270 2700615 TUBING IV TWIN SET $6.75 270 2750271 VENTURI MASK - ADULT $7.25 270 2707784 DRAPE STERI 1020 $8.00 270 2770154 DRESSING ALLEVYN 5X5 $8.00 270 2705861 COLD/HOT PACK $8.00 270 2706315 DRESSING ADAPTIC 3X8 $8.00 270 2706562 DRAPE FENESTRATED $8.00 270 2704237 DRESSING VASELINE GAUZE $8.00 270 2709251 CANISTER SUCTION DISP $8.00 270 2709426 APPLICATOR CHLORAPREP SMALL $8.00 270 2706992 SPECULUM DISP KLEEN SPEC $8.00 270 2704369 "DRAIN PENROSE 7/8""X12""" $8.00 270 2702439 TUBE FEEDING INFANT $8.00 270 2700201 NEEDLE SPINAL 22X3 $8.00 270 2705028 UNDERPADS (DRI-FLO) PKG $8.00 270 2770162 "PAD INCONTINENCE, EACH" $8.00 270 2750293 TENDERGRIPS $8.50 270 2750270 VENTURI MASK - PEDIATRIC $8.50 270 2750276 HIGH FLOW BUBBLER $8.50 270 2745150 "DRESSING, DERMAGRAN 4X4" $8.50 270 2702892 SHIELD EYE ALUMINUM $9.00 270 2707586 IRRIGATION ST WATER 1500ML $9.00 270 2770097 LOTION $9.00 270 2703213 SPLINT FINGER STRIP ALUMAFOAM $9.00 270 2701290 "BANDAGE KERLIX 4""" $9.00 270 2703692 "PADDING WEBRIL 6""" $9.00 270 2701639 "KLING 2"" SOF-KLING STERILE" $9.00 270 2706364 MARKER SKIN SURGICAL $9.00 270 2701720 "KLING 6"" SOF-KLING STERILE" $9.00 270 2703783 "PADDING CAST 4""" $9.00 270 2701829 "BANDAGE ACE 3""" $9.00 270 2772135 DRESSING ADAPTIC 5X9 $9.00 270 2709145 CATHETER SILICONE 22FR $9.00 270 2706547 CONTAINERS EVACUATED $9.00 270 2704146 TUBING SUCTION 12' $9.00 270 2706877 WASHCLOTHS DISP $9.00 270 2701928 ANASCOPE (DISP) $9.00 270 2709533 CAP PROTECTIVE $9.00 270 2704625 BITE BLOCK & MOUTH SUPPORT $9.00 270 2704807 "PRO-CAST 3"" PER YARD" $9.00 270 2745123 DRESSING MEPILEX BORDER $9.00 270 2750081 CROUP TENT PER HOUR $9.00 270 2702660 TRAY IRRIGATION $9.00 270 2702678 TUBE RECTAL $9.00 270 2700219 NEEDLE SPINAL 25/3 1/2 $9.00 270 2700292 BULB SYRINGE $9.00 270 2700300 SYRINGE EAR/NOSE 3OZ $9.00 270 2700599 CONNECTOR MEDEX T- $9.00 270 2700722 FILTER INLINE $9.00 270 2700763 TUBING MICRODRIP SOLUSET $9.00 270 2700821 TUBING IV BACKCHECK $9.00 270 2748000 WASH SALINE SPRAY SMALL $9.00 270 2701175 WOUND CLEANSING FOAM $9.00 270 2750295 TRACHEAL MASK - VENTURI $9.50 270 2703590 "INTER-DRY MOISTURE WICKING FABRIC 4""" $9.50 270 2715050 FINGER STICK BLOOD SUGAR SUPPLIES $10.00 270 2707710 DRESSING CARRAGAUZE 4X4 $10.00 270 2708055 TUBING IV MICRON FILTER $10.00 270 2715142 LIGHT PERI-LIGHT $10.00 270 2703544 PROTECTORS FINGER FOAM LINED $10.00 270 2706455 KIT IV START $10.00 270 2704633 AIRWAY ORAL $10.00 270 2700813 TUBING BLOOD SECONDARY $10.00 270 2715241 XEROFORM DRESSING $10.00 270 2750156 INCENTIVE SPIROMETER - SUPPLY $10.50 270 2750275 HIGH FLOW CANNULA $10.50 270 2712560 AIRWAY NASOPHARYNGEAL $11.00 270 2714350 "BANDAGE COBAN 2""" $11.00 270 2745107 DRESSING FOAM TEGADERM $11.50 270 2707206 POUCH COLOSTOMY (MANOR) $11.50 270 2508661 T.A.L. (LETS SOLN) $11.50 270 2700979 CATHETER IV 14G $12.00 270 2700995 CATHETER IV 22GA $12.00 270 2701027 CATHETER IV 26G $12.00 270 2707529 STRAP LEG FOLEY SECURE $12.00 270 2705713 KIT FEMALE CATH $12.00 270 2701373 "STRIP STERI-STRIP 1/8""X3""" $12.00 270 2705937 CATHETER IV 18GA $12.00 270 2706018 IV/WOUND DRESSING (OP-SITE) $12.00 270 2708030 BIOPSY PUNCH DISP $12.00 270 2770188 NEBULIZER $12.00 270 2706158 SPLINT STACK FINGER PLASTIC $12.00 270 2701340 "STRIP STERI-STRIP 1/2""X4""" $12.00 270 2701845 "BANDAGE ACE 6""" $12.00 270 2701365 "STRIP STERI-STRIP 1/4""X3""" $12.00 270 2706372 "CATHETER IV 24GA X 3/4""" $12.00 270 2701837 "BANDAGE ACE 4""" $12.00 270 2709129 EYE FLIUD DRAINAGE WICK $12.00 270 2709194 EGGCRATE CHAIRPAD $12.00 270 2704153 CATHETER IV 16G $12.00 270 2704062 ENEMA FLEET $12.00 270 2709400 WICK EAR $12.00 270 2707008 STRAP CATHETER $12.00 270 2707073 COLLECTOR FECAL INCONT $12.00 270 2707180 BARRIER SKIN STOMAHESIVE $12.00 270 2707198 BARRIER SKIN W/FLANGE $12.00 270 2704815 "PRO-CAST 4"" PER YARD" $12.00 270 2707412 CATHETER IV 20GA $12.00 270 2704823 DRESSING ADAPTIC 3X16 $12.00 270 2750016 NASAL CANNULA - 25 FT $12.00 270 2750024 MASK SIMPLE $12.00 270 2750040 TUBING OXYGEN SUPPLY $12.00 270 2707313 SYRINGE DISP TOOMEY $12.00 270 2712008 BUBBLER-OXYGEN $12.00 270 2705309 BUCKET ENEMA $12.00 270 2705317 ENEMA RETENTION TIP $12.00 270 2700193 NEEDLE SPINAL 18X3 1/2 $12.00 270 2771063 42628067 $12.50 270 2705481 KIT MID-STREAM COLLECTION $13.25 270 2714483 IRRIGATION NS 3000 ML $13.25 270 2705812 PACKING STRIP PLAIN $13.25 270 2703494 "PADDING WEBRIL 2""" $13.25 270 2703502 "PADDING WEBRIL 3""" $13.25 270 2701746 "BANDAGE COBAN 6""" $13.25 270 2770246 OXYGEN E-TANK (MANOR) $13.25 270 2709335 ADAPTER CLAVE IV $13.25 270 2704301 "BAG COLOSTOMY 2 3/4""" $13.25 270 2745073 DRESSING ALLEVYN THIN $13.25 270 2745099 DRESSING COMPRESSION $13.25 270 2704831 SUCTION YANKAUR TIP $13.25 270 2701894 GELFOAM 2CMX40CM $14.25 270 2705630 PENLIGHT COBALT BLUE $14.25 270 2715084 HEATING PAD - EACH TIME $14.25 270 2703742 RESTON FOAM SELF-ADHERING PAD $14.25 270 2706471 IRRIGATION NS 1000ML $14.25 270 2709152 MICROSPONGE $14.25 270 2709160 EYE DRAINAGE WICK W/80CCBAG $14.25 270 2706679 IRRIGATION NS 500ML $14.25 270 2704161 TUBING PENROSE DRAIN $14.25 270 2704245 TUBE VASELINE $14.25 270 2704252 PACKING VASELINE TUBE $14.25 270 2704377 "DRAIN PENROSE 1/2""X18""" $14.25 270 2745016 DRESSING ALLEVYN LIFE $14.25 270 2704492 REMOVER STAPLE DISP $14.25 270 2707214 BAG COLOSTOMY SUR-FIT W/FLANGE $14.25 270 2702595 TRAY CATHETER STRAIGHT $14.25 270 2700185 "NEEDLE SPINAL 18GA X 3""" $14.25 270 2700102 DRESSING AQUACEL EXTRA 4X5 $14.50 270 2706497 IRRIGATION NS 250ML $15.25 270 2740058 DRESSING MESALT $15.25 270 2707321 BRIEF ADULT (PKG) $15.25 270 2770264 WIPES COMFORT SHIELD $15.75 270 2707016 DRESSING TEGADERM IV $15.75 270 2715043 ENEMA $16.75 270 2715209 SUTURE REMOVAL $16.75 270 2709269 KIT STREP A TEST $16.75 270 2706653 PACK BED BATH (DISP) $16.75 270 2709434 APPLICATOR CHLORAPREP LARGE $16.75 270 2740207 DRESSING KALTOSTAT $16.75 270 2701084 CREAM BARRIER EXTRA PROTECTIVE $17.75 270 2708212 DRESSING MEPITEL $17.75 270 2709053 WAX BONE $17.75 270 2708213 DRESSING MEPITEL SACRUM $17.75 270 2709202 DRESSING ISLAND WOUND $17.75 270 2701902 "BANDAGE COBAN 3""" $17.75 270 2701910 "BANDAGE COBAN 4""" $17.75 270 2706869 SET SUCTION INFANT $17.75 270 2704849 PACK LAPORASCOPY DISP $17.75 270 2702447 TUBE STOMACH 16FR $17.75 270 2702454 TUBE STOMACH 14FR $17.75 270 2770303 NEBULIZER (MANOR) $19.00 270 2770212 DRESSING COMBIDERM 6X7 $19.00 270 2703916 LOTION 1000ML $19.00 270 2706695 SPONGE LAP 5PACK $19.00 270 2701859 DIGIT TOURNIQUET $19.46 270 2715068 HEATING LAMP - EACH TIME $20.00 270 2707826 SET EXT CLAVE $20.00 270 2770204 DRESSING COMBIDERM 4X4 $20.00 270 2770220 DRESSING COMBIDERM ACD $20.00 270 2774123 DRESSING MELGISORB AG $20.00 270 2709228 WASH SALINE SPRAY WOUND $20.00 270 2704300 WAFER COLOSTOMY $20.50 270 2715167 SITZ BATH $21.00 270 2715175 SOAKS $21.00 270 2715076 HEATING PAD $21.00 270 2715217 PACK WARM MOIST $21.00 270 2709004 LIGACLIPS SMALL $21.00 270 2705143 KIT MATERNITY $21.00 270 2700623 TUBING IV DIAL A FLOW $21.00 270 2700755 TUBING IV SOLUSET 250 $21.00 270 2741084 SENSI-CARE CLEAR ZINC CREAM $21.00 270 2745131 DRESSING MEPILEX AG $21.50 270 2707792 DRAPE STERI 1060 $22.00 270 2706026 SPLINT FINGER (FROG) $22.00 270 2708113 STAPLER SKIN ER $22.00 270 2706588 LOTION BAZA CLEANSE $22.00 270 2702132 CATHETER ST W/COUDE TIP $22.00 270 2745024 COFLEX W/CALOMINE $22.00 270 2700011 HOLDER ENDOTRACH TUBE $22.00 270 2750290 METER DOSE INHALER MASK - REGULAR $24.25 270 2707578 POUCH COLOSTOMY $24.25 270 2703064 BELT RIB SMALL $24.25 270 2705697 TUBING IV SECONDARY $24.25 270 2703072 BELT RIB MEDIUM $24.25 270 2703080 BELT RIB LARGE $24.25 270 2705846 PACKING IODOFORM $24.25 270 2701589 TRAY RAYTEC 4X4X10 $24.25 270 2771517 PRN OXYGEN (MANOR) $24.25 270 2709095 NEEDLE - RETROBULBUR $24.25 270 2706802 IV PUMP FILTER SET IVEX $24.25 270 2702199 TRAY CATHETERIZATION $24.25 270 2707156 CATHETER FOLEY 30FR $24.25 270 2705325 SET VAGINAL DOUCHE $24.25 270 2706022 PURACOL PLUS 2 X 2 DRESSING $24.50 270 2745470 "PAD, DEBRISOFT 4X4" $25.00 270 2706212 DRESSING AQUACEL FOAM 20X17 $25.00 270 2701118 TAMPON NASAL $25.25 270 2715290 KIT ANTIFOG $25.25 270 2709558 DRESSING ALLEVYN THIN $25.25 270 2740272 "DRESSING, KALTOSTAT (LARGE)" $25.25 270 2750287 OXIMETER SENSOR - MAX A $26.25 270 2715118 IRRIGATION $26.25 270 2715233 ISOLATION (OUT PATIENT) $26.25 270 2709103 LENS GLIDE $26.25 270 2709178 METER DOSE INHALER SPACER $26.25 270 2706753 ATOMIZER $26.25 270 2745040 LIFT HEEL $26.25 270 2745149 DRESSING PRISMA MATRIX $27.00 270 2704302 TUBING PCA PUMP EXTENSION $27.75 270 2702603 TRAY CATHETER W/O CATHETER $27.75 270 2709781 BIOPATCH PROTECTIVE DISK $27.90 270 2704286 TUBE NASOGASTRIC 10-18FR $29.00 270 2707560 KIT CHEMO PREP $30.00 270 2701035 IRRICLEAR (EAR IRRIGATION SET) $30.00 270 2701191 CREAM SWEEN CREAM $30.00 270 2708014 CREAM SWEEN 9 OZ $30.00 270 2707727 DRAIN JACKSON PRATT $30.00 270 2701860 "ELASTOPLAST 2""" $30.00 270 2708097 DRESSING ALLEVYN 7X7 $30.00 270 2702207 BAG BILE $30.00 270 2702355 STOCKINGTED HOSE KNEE $30.00 270 2702645 BAG URINARY DRAIN $30.00 270 2702488 CATHETER 14FR (RUBBER) $30.00 270 2704120 ANESTHESIA - BREATHING CIRCUIT $30.00 270 2700105 DRESSING AQUACEL AG FOAM 4X4 $30.00 270 2709541 WIRE TROCAR $31.00 270 2707388 SET ENTERAL FEEDING $31.00 270 2750288 OXIMETER SENSOR - MAX N $31.50 270 2703197 SLING ARM INFANT $32.00 270 2709020 LIGACLIPS MEDIUM/LARGE $32.00 270 2704476 BAG LEG URINARY $32.00 270 2713246 HELIOX GAS $32.00 270 2700607 "NEEDLE PORTACATH 20G 1""OR 3/4""" $32.00 270 2700714 "NEEDLE PORTACATH 20GA 1.5""" $32.00 270 2703163 SLING ARM LARGE $32.00 270 2703171 SLING ARM MEDIUM $32.00 270 2703189 SLING ARM SMALL $32.00 270 2750289 METER DOSE INHALER MASK - SMALL $32.50 270 2708329 BANDAGE SUREPRESS $33.00 270 2716017 BIOFREEZE 4 OZ $33.00 270 2709475 BLANKET HYPOTHERMIA PEDIATRIC $33.00 270 2745065 SAFE GEL TOPICAL OINTMENT $33.00 270 2700110 SPLINT THUMB SPICA $34.25 270 2701886 "ELASTOPLAST 3""" $35.25 270 2702942 UNIV IMMOBILIZER SLING $37.25 270 2707743 TUBE ENDO-TRACH 2.5 $37.25 270 2707750 TUBE ENDO-TRACH 3.0 $37.25 270 2707768 TUBE ENDO-TRACH 3.5 $37.25 270 2707776 TUBE ENDO-TRACH 4.0 $37.25 270 2709012 LIGACLIPS MEDIUM $37.25 270 2709038 LIGACLIPS LARGE $37.25 270 2706513 TUBE FEEDING DOBBHOFF $37.25 270 2706836 TUBE ENDO-TRACH 3.0 4.0 5.0 $37.25 270 2706844 TUBE ENDO-TRACH 10.0 $37.25 270 2706968 TUBE ENDO-TRACH MALINDRODT $37.25 270 2702223 DRAIN BAG G2 OSTOMY $37.25 270 2750164 INCENTIVE SPIROMETER $37.25 270 2750214 PEAK FLOW METER SUPPLY $37.25 270 2703809 IRRIGATION CYSTO NS 1000ML $38.75 270 2703817 IRRIGATION ST WATER CYSTO $38.75 270 2709590 DRESSING ALLEVYN HEEL $38.75 270 4200051 CPM 1 DAY $38.75 270 2707800 TUBING IV PLUM CLAVE $40.00 270 2707818 TUBING IV BACKCHECK CLAVE $40.00 270 2709509 BLANKET HYPOTHERMIA ADULT $40.00 270 2709582 INK TATTOO $40.00 270 2709442 KIT DRESSING CVL $41.00 270 2745115 DRESSING AQUACEL RIBBON $41.50 270 2701159 PENCIL CAUTERY HAND HELD $42.00 270 2701878 "ELASTOPLAST 4""" $42.00 270 2715001 BILI LITE $43.00 270 2715159 LAMP RADIANT HEAT $43.00 270 2707487 "SCOTCHCAST 3""" $44.00 270 2707651 "BINDERABDOMINAL 10"" SMALL" $44.00 270 2707669 "BINDERABDOMINAL 10"" MEDIUM" $44.00 270 2707677 "BINDERABDOMINAL 10"" LARGE" $44.00 270 2707685 "BINDERABDOMINAL 10"" X-LARGE" $44.00 270 2703114 BRACE CLAVICLE SHOULDER SMLXL $44.00 270 2707693 "BINDERABDOMINAL 10"" XX-LARGE" $44.00 270 2703239 COLLAR CERVICAL SMALL $44.00 270 2707701 "BINDERABDOMINAL 14"" X-LARGE" $44.00 270 2703247 COLLAR X-FIRM FOAM $44.00 270 2707719 "BINDER ABDOMINAL 14"" XX-LARGE" $44.00 270 2703486 "SCOTCHCAST 2""" $44.00 270 2702025 SLING UNIVERSAL IMMOBILIZER XSM/SM $44.00 270 2702033 SLING UNIV IMMOB MED $44.00 270 2702041 SLING UNIV IMMOB LG $44.00 270 2702058 SLING UNIV IMMOB XLG $44.00 270 2750149 AEROSOL SUPPLIES $44.00 270 2702397 CATHETER FOLEY 26FR 2-WAY $44.00 270 2750057 OXYGEN SUPPLIES $44.00 270 2750073 SPUTUM INDUCTION - SET UP $44.00 270 2714384 AIRWAY LMA $45.25 270 2750291 END TIDAL CO2 DETECTOR $47.25 270 2715191 SUCTION - PER DAY $47.25 270 2715134 NGT - LOW SUCTION PER DAY $47.25 270 2705853 EGGCRATE MATTRESS $47.25 270 2745081 BANDAGE COMPRILAN $47.25 270 2702371 PROTECTOR HEEL $47.25 270 2702389 PROTECTOR HEEL/ELBOW $47.25 270 2750123 OXYGEN-OUT-PATIENT CHARGES/4 HRS $47.25 270 2740025 COFLEX W/ZINC $48.25 270 2714400 DRAPE LAP CHOLE $51.00 270 2705721 CATHETER 16FR 5CC ALL SILICONE $52.00 270 2705747 CATHETER ALL SILICONE 18FR 5CC $52.00 270 2703130 STRAP CLAVICLE YOUTH (PADDED) $52.00 270 2703148 STRAP CLAVICLE CHILD (PADDED) $52.00 270 2705788 CATHETER FOLEY 12FR $52.00 270 2703155 STRAP CLAVICLE INFANT (PADDED) $52.00 270 2703874 CATHETER FOLEY 16FR 30CC $52.00 270 2703882 CATHETER FOLEY 14FR 30CC $52.00 270 2715308 CORD LAP DISPOSABLE $52.00 270 2706851 CATHETER SILICONE COATED 16 18FR $52.00 270 2707172 CATHETER PHILLIPS FOLLOWERS $52.00 270 2702298 CATHETER FOLEY 26FR 3-WAY $52.00 270 2702504 CATHETER FOLEY 16FR 5CC $52.00 270 2702512 CATHETER FOLEY 18FR $52.00 270 2702520 CATHETER FOLEY 14FR 5CC $52.00 270 2702538 CATHETER FOLEY 20FR $52.00 270 2702546 CATHETER FOLEY 22FR 30CC $52.00 270 2702553 CATHETER FOLEY 22FR 5CC $52.00 270 2702561 CATHETER FOLEY 24FR $52.00 270 2702611 CATHETER FOLEY 16FR 5CC $52.00 270 2702496 CATHETER FOLEY 14FR $52.00 270 2750286 OXIMETER SENSOR - FOREHEAD $52.50 270 2700136 KIT PYLORITEK $53.00 270 2750008 CONTINUOUS MIST $54.00 270 2712578 SPLINT ONE STEP 2X10 $55.25 270 2707248 IMMOBILIZER KNEE X-LARGE $58.25 270 2705739 DETECTORCO2 $59.25 270 2708063 KIT VACUUM DELIVERY $59.25 270 2706216 SLING & SWATHE MEDIUM $59.25 270 2706224 SLING & SWATHE LARGE $59.25 270 2706232 SLING & SWATHE X-LARGE $59.25 270 2708154 UNDERPADS (CASE) $59.25 270 2709046 SUTURE SINGLE ATRAMATIC $59.25 270 2709079 NEEDLE RICHARD ALLEN $59.25 270 2702348 STOCKING TED HOSE THIGH X-LARGE $59.25 270 2702363 STOCKINGTED HOSE THIGH $59.25 270 2702629 TRAY CATHETER 16FR $59.25 270 2702637 TRAY CATHETER 18FR $59.25 270 2750099 CROUP TENT SET-UP $59.25 270 2700805 SLEEVE SKIN $59.25 270 2700870 TUBING IV PLUM PUMP $59.25 270 2700862 IV PUMP BLOOD SET $62.00 270 2770501 RESPIRATORY ASSISTANCE DEVICE $64.00 270 2702959 SPLINT COLLES SM MED LG $66.25 270 2702975 SPLINT ONE STEP 3X12 $66.25 270 2703577 "SCOTCHCAST 5""" $66.25 270 2702017 SLING UNIV SLING & SWATHE $66.25 270 2707024 KIT GASTRIC LAVAGE $66.25 270 2702751 PACK BASIC (CATARACT SURGERY) $67.25 270 2707503 CAST BOOT W/ROCKER SOLE CLOSED TOE $67.25 270 2703981 MATTRESS (AIR-PULSATE) $67.25 270 2709210 ADHESIVE SKIN $67.25 270 2709350 PUMP PCA (DAILY CHARGE) $67.25 270 2709392 INFUSOR PRESSURE IV $67.25 270 2770189 NEBULIZER COMPRESSOR $68.25 270 2706021 PURACOL PLUS 4 X 4 $68.50 270 2703122 STRAP CLAVICLE XL $72.00 270 2709376 FORCEP BIOPSY DISPOSABLE $73.00 270 2705036 CRUTCHES $73.00 270 2708022 INTRAUTERINE PRESSURE DEVICE $74.00 270 4601050 PEAK FLOW METER INSTRUCTION $74.00 270 2703940 COLLAR STIF NECK (ADJUSTABLE) $74.00 270 2721058 LENS MORGAN $74.00 270 2707115 NEEDLE BIOPSY 2N2704 $74.00 270 2705150 PACK OB DISP $74.00 270 2707404 PACK LAPOROTOMY DISP $74.00 270 2702736 SPLINT W/FA XLG LT $75.00 270 2706208 SLING & SWATHE SMALL $76.25 270 2706240 BRACE ANKLE SM LACE $76.25 270 2706257 BRACE ANKLE MED LACE $76.25 270 2706265 BRACE ANKLE LG LACE $76.25 270 2706273 BRACE ANKLE XL LACE $76.25 270 2709368 SNARE DISPOSABLE $76.25 270 2706950 TUBE LEVINE DOUBLE LUMEN $76.25 270 2709905 SLING UNIVERSAL PADDED $76.25 270 4200044 CPM SET UP $76.25 270 2703320 SPLINT W/FA XL RT $79.25 270 2715373 CUFF FOOT/LEG $79.25 270 2705374 SPLINT WRIST/FOREARM LARGE RIGHT $79.25 270 2705382 SPLINT WRIST/FA LG LEFT $79.25 270 2705390 SPLINT WRIST/FA MED RIGHT $79.25 270 2705408 SPLINT WRIST/FA MED LEFT $79.25 270 2703304 SPLINT COCKUP SMALL RIGHT $79.25 270 2703312 SPLINT COCKUP SMALL LEFT $79.25 270 2703338 SPLINT COCKUP LG RIGHT $79.25 270 2703346 SPLINT COCKUP LG LEFT $79.25 270 2703353 SPLINT COCKUP X-LG RIGHT $79.25 270 2703361 SPLINT COCKUP XLG LEFT $79.25 270 2703379 SPLINT COCKUP X-SM $79.25 270 2706430 SPLINT COCKUP MEDIUM RIGHT $79.25 270 2706448 SPLINT COCKUP MEDIUM LEFT $79.25 270 2702769 SHEET OPHTHALMOLOGY $87.25 270 2707289 IMMOBILIZER KNEE XX-LARGE $87.25 270 2700961 KIT BONE MARROW ASPIRATING $88.25 270 2707511 CAST BOOT W/ROCKER SOLE OPEN TOE $88.25 270 2702983 SPLINT ONE STEP 4X30 $88.25 270 2703536 "SCOTCHCAST 4""" $88.25 270 2704039 TRAY EPIDURAL $88.25 270 2704336 STOCKINGTED HOSE WAIST HIGH $88.25 270 2704674 UNDERGARMENTS (CASE) $90.25 270 2707230 IMMOBILIZER KNEE UNIVERSAL $92.50 270 2702702 TRAY SPINAL ANESTHESIA $95.00 270 2702710 TRAY LUMBAR PUNCTURE $95.00 270 2707040 SPLINT ONE STEP 5X30 $96.00 270 2703049 BRACE ANKLE AIRCAST $100.25 270 2740215 DRESSING MEPILEX $102.50 270 2709566 NEEDLE CLICK TIP $108.25 270 2704021 STAPLER ETHICON OR $116.00 270 2703007 BELT PELVIC TRACTION UNIVERSAL SIZE $118.25 270 2715019 CARDIAC MONITOR $118.25 270 2706109 BELT TRACTION PELVIC SIZE 26-30 $118.25 270 2706117 BELT PELVIC TRACTION SIZE 34-38 $118.25 270 2706125 BELT PELVIC TRACTION SIZE 42-46 $118.25 270 2709087 SUTURE ALCON $118.25 270 2707032 NEEDLE BONE BIOPSY $118.25 270 2715126 ISOLATION $120.25 270 2707297 CATHETER SUPRAPUBIC $125.50 270 2707305 PACK PELVISCOPY/LAPAROSCOPY $125.50 270 2750222 "ACAPELLA, SUPPLY" $126.00 270 2702744 TRAY THOROCENTESIS $128.00 270 2715183 STOMACH PUMP $129.25 270 2709999 FLOSEAL ENDOSCOPIC APPLICATOR $130.00 270 2709483 MATTRESS (MIGHTY AIR) $134.50 270 2706380 KITINTRODUCER $142.25 270 2708956 BOOT WALKING $147.50 270 2715365 TROCAR APPLIED 5 MM $147.50 270 2715266 SAC PLEATMAN $158.50 270 2700029 AIRWAY COMBITUBE $162.25 270 2708998 FETAL HEART MONITOR $163.25 270 2730000 ANESTHESIA - SUPPLIES PER SURGERY $163.25 270 2704484 STAPLER SKIN OR $167.50 270 2714475 TROCAR APPLIED BLUNT 12MM $179.50 270 2709624 RETRACTOR IRIS $182.25 270 2706751 SPHENOCATHETER $183.75 270 2706463 KIT ELECTOR/CATHETER PACING $185.25 270 2750206 MECHANICAL VENTILATION SET-UP $185.25 270 2770402 O2 CONCENTRATOR/OXYGEN (MANOR) $191.75 270 2709574 NET SPIDER $191.75 270 2701126 CATHETER NASAL BLYMP $201.50 270 2708048 BOOT ARTICULATE WALKING $201.50 270 2715357 SURGICEL 2X14 $201.50 270 2700144 TUBING IV NITRO SET $207.50 270 2709525 BLADE SAW $217.25 270 2714376 TUBING INSUFLOW $252.50 270 2706754 KIT - DOUBLE LUMEN PICC $260.00 270 2750115 OXYGEN-IN-PATIENT PER DAY $267.75 270 4200069 CPM 1 WEEK $272.50 270 2714368 ASPIRATOR IRRIGATION $278.75 270 2709921 TRACH QUICKTRACH $313.00 270 2719557 NEEDLE INTRAOSSEOUS $317.75 270 2721009 RING MALYUGIAN $347.50 270 2706828 CATHETER SUPRAPUBIC 10FR $361.75 270 2715274 SYSTEM CLOSURE $368.00 270 2715225 CAPD DAILY RATE $369.50 270 2700128 SET PNEUMOTHORAX $400.00 270 2709459 BRACE CASH $402.75 270 2709517 KIT PEG TUBE $402.75 270 2708071 PLUG & PATCH MESH $409.00 270 2704856 PACK C-SECTION DISP $421.00 270 2705762 PLUER-E-VAC $481.00 270 2706398 KIT GROSHONG CATHETER $481.00 270 2700938 KIT PERIPHERALLY INSERTED CEN CATH $518.25 270 2700839 KIT ARROW TRIPLE LUMEN CV $518.25 270 2715316 TROCAR BLADELESS 12MM $540.25 270 2714392 CATHETER CHLANGIOGRAM $550.25 270 2709608 RETRACTOR FAN $554.50 270 2714434 SCISSORS ENDO 5MM $586.50 270 2700175 TROCAR DILATING TIP 11MM $638.00 270 2714418 TROCAR ETHICON 12MM $663.50 270 2715282 BABCOCK $679.25 270 2714129 PLUG BI0-A HERNIA $697.75 270 2709467 PLUG MESH XL $703.50 270 2714426 TROCAR BLADELESS 5MM $803.75 270 2715324 APPLIER LAP CLIP $803.75 270 2714459 STAPLES LAP 3.5 $838.00 270 2715332 STAPLER LAP 2.5 $838.00 270 2706539 CATHETER PORTACATH $878.75 270 2715381 PATCH VENTRALUX HERNIA $882.00 270 2708204 PATCH COMPOSIX "$1,054.25 " 270 2714442 STAPLER LAP 3.5 "$1,650.50 " 270 2715340 STAPLES LAP 2.5 "$1,650.50 " 270 2760015 LENS INTRAOCULAR $388.00 276 3099215 DAT SAMPLE FEE $9.50 300 3064169 CAPILLARY BLOOD COLLECTION PT/INR $13.25 300 3064167 CAPILLARY BLOOD COLLECTION GLUCOSE $13.25 300 3082963 BLOOD GLUCOSE STICK $22.00 300 3096328 NFHS-GLUCOSE STICK $22.00 300 30603082 ENVIRONMENTAL ALLERGY PANEL $24.25 300 3060308 ALLERGEN SPECIFIC IGE $24.25 300 3010154 URINE MICRO ONLY $24.25 300 30603081 RAST FOOD PROFILE $24.25 300 3090255 NFHS-URINALYSIS W/O MICRO $24.25 300 3099819 WELLNESS-UA $24.25 300 3010022 URINALYSIS $24.25 300 3099199 DAT URINE TEST $24.25 300 3083037 FINGER STICK BLOOD SUGAR $25.00 300 3097383 NFHS-FINGER STICK BLOOD SUGAR $25.00 300 3099413 WELLNESS-DRAWING FEE $27.75 300 3000015 DRAW FEE $27.75 300 3096302 NFHS-OCCULT BLOOD STOOL (SCREEN) $30.00 300 3005004 "BLOOD COUNT, AUTO DIFF WBC" $31.00 300 3050143 HEMATOCRIT $32.00 300 3050077 MANUAL DIFF $32.00 300 3094653 NFHS-HEMOGLOBIN $33.00 300 3050184 HEMOGLOBIN $33.00 300 3006008 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTIT $34.50 300 3019700 CMS - OCCULT BLOOD STOOL $35.00 300 3093101 NFHS-PROTIME $35.00 300 3022720 OCCULT 1 SPECIMEN $35.00 300 3056108 PROTIME W/ INR $35.00 300 3099132 DAT PT/INR $35.00 300 3050416 RBC $36.00 300 3072055 GRAM STAIN $36.75 300 3087087 STREP B VAG/CERV/RECT $36.75 300 3024650 CHOLESTEROL $37.25 300 3094521 NFHS-OCCULT BLOOD STOOL (DX) $38.00 300 3045507 URIC ACID $40.00 300 3024353 CHLORIDE $40.00 300 3071859 ENZYME DETECTION PER ENZYME $40.00 300 3099876 DAT URIC ACID $40.00 300 3045200 BUN $41.00 300 3056512 SED RATE $41.00 300 30295273 GLUCOSE 3 HR. $41.00 300 30295274 GLUCOSE 4 HR. $41.00 300 30295275 GLUCOSE 5 HR. $41.00 300 3029527 GLUCOSE 2 HR. $41.00 300 3099009 PERTUSSIS SHIPPING & HANDLING $41.00 300 3099108 DAT SED RATE $41.00 300 3044781 TRIGLYCERIDE $42.00 300 3083872 CULTURE SYNOVIAL FLUID 2 $43.00 300 3010006 URINALYSIS WITH MICRO $44.00 300 3087202 STOOL WBC $45.25 300 3082649 HYDROMORPHONE $45.25 300 3025657 CREATININE BLOOD $46.25 300 3041001 PHOSPHOROUS $47.00 300 3037181 HDL $48.25 300 3086006 ALLERGY CACAO LGG $48.25 300 3008927 MOLECULAR DIAG/ENZYMATIC $52.00 300 3044609 ALT $52.00 300 3044500 AST $52.00 300 3040755 ALKALINE PHOS ISOENZYMES $52.00 300 3099595 WELLNESS-T4 $54.00 300 3036159 LACTATE DEHYDROGENASE $54.00 300 3044369 T4 $54.00 300 30443691 THYROID PANEL $54.00 300 3000365 OXYCODONE LEVEL $54.00 300 3000359 METHYLENEDIOXYAMPHETAMINES $54.00 300 3099091 DAT T4 $54.00 300 3099173 DAT THYROID PANEL $54.00 300 3025509 CK $55.25 300 3043007 URINE SODIUM 24 HR $55.25 300 30214581 AMPHETAMINES URINE $55.25 300 3051117 REFERENCE COLLECTION FEE/PATERNITY $55.25 300 3050002 REFERENCE COLLECTION FEE $55.25 300 3041563 PROTEIN RANDOM URINE $55.50 300 30415631 PROTEIN/CREAT RATIO $55.50 300 3057304 PTT $56.00 300 3022472 BILIRUBIN TOTAL $56.00 300 3041324 POTASSIUM SERUM $56.00 300 3029477 GLUCOSE $59.00 300 3069010 RH $59.00 300 3099090 DAT GLUCOSE $59.00 300 3069002 ABO BLOOD TYPE $60.00 300 3099066 DAT ABO/RH $60.00 300 3083987 "PH, FECES" $61.00 300 3039302 "OSMOLALITY, SERUM" $61.50 300 3071842 SUSCEPTIBILITY STUDIES DISK METHOD $62.50 300 3020401 ALBUMIN BLOOD $63.00 300 3070885 CULTURE ID URINE $64.00 300 3023108 CALCIUM $64.00 300 3099405 WELLNESS-CRP $65.00 300 3099256 WELLNESS-CBC $65.00 300 3021508 AMYLASE $65.00 300 3035409 IRON TOTAL $65.00 300 3050242 CBC W/ AUTO DIFF & PLT $65.00 300 30614051 C-REATIVE PROTEIN $65.00 300 3045408 UREA 24 HR URINE $65.00 300 3086317 "HEPATITIS B SURFACE ANTIBODY IMMUNITY, QUANTITATIVE" $65.00 300 3091405 DAT CRP $65.00 300 3099058 DAT CBC $65.00 300 3041555 PROTEIN TOTAL $66.00 300 3055951 PLATELET $66.00 300 3041332 POTASSIUM 24 HR URINE $66.00 300 3023405 CALCIUM 24 HR URINE $66.00 300 3042959 SODIUM $66.00 300 30559512 PLATELET COUNT CITRATE $66.00 300 3023744 CARBON DIOXIDE $67.25 300 3064318 RHEUMATOID FACTOR $67.25 300 3050028 BLEEDING TIME $68.00 300 3022480 BILIRUBIN DIRECT $68.00 300 3050275 CBC W/O AUTO DIFF $68.00 300 3001096 RPR SYPHILIS $69.00 300 3086881 COOMBS TEST DIRECT $70.00 300 3036902 LIPASE $70.00 300 3002201 FUNGAL STAIN $70.00 300 3068806 DIRECT COOMBS $70.00 300 3070158 CONCENTRATION FOR INFECTION $71.00 300 3037355 MAGNESIUM $72.00 300 3083735 "MAGNESIUM,RBC" $72.00 300 3099024 DAT MAGNESIUM $72.00 300 3027059 FECAL FAT QUAL $73.00 300 3024361 CHLORIDE 24 HR URINE $73.00 300 3071479 CULTURE IMMUNOLOGIC-PER ANTISERUM $74.00 300 3070455 CULTURE STOOL $74.00 300 3044393 T4 (FREE) $74.00 300 3039146 MUTATION ID BY ENZYMATIC LIGATION $76.25 300 3070869 CULTURE URINE $76.75 300 3021458 AMPHETAMINE PANEL SERUM $76.75 300 3008257 COCAINE (SENDOUT) $76.75 300 3005305 CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S $78.00 300 3070752 CULTURE ANAEROBE $78.75 300 3070703 CULTURE THROAT $79.00 300 30707031 CULTURE SPUTUM $79.00 300 3076007 CULTURE NOSE $79.00 300 3050003 REFERENCE COLLECTION FEE-ALTERED CHAIN $80.25 300 3069226 CROSSMATCH EACH UNIT $80.50 300 3070760 CULTURE ANAEROBIC - EACH ID $80.75 300 3070778 CULTURE AEROBIC-EACH ID $80.75 300 30707033 AEROBIC CULTURE $80.75 300 3050481 WBC $81.50 300 3071867 SUSCEPTIBILITY $82.00 300 3036555 LEAD $82.00 300 3092566 NFHS-MONO $83.00 300 3064037 MONONUCLEUSIS TEST $83.00 300 3066743 GIARDIA/CRYPTOSPORIDIUM AG $83.00 300 3099025 DAT MONO $83.00 300 3072097 OVA AND PARASITE STAIN $84.00 300 3006684 "ANTIBODY, HAEMOPHILUS INFLUENZA" $84.00 300 3000494 BMP $85.00 300 3025707 CREATININE URINE $85.00 300 3090048 DAT BMP $85.00 300 3025954 CRYOGLOBULIN $86.00 300 3068525 ANTIBODY SCREEN $86.00 300 3047032 HCG QUALITATIVE $87.25 300 3099124 DAT SERUM PG $87.25 300 7615540 WBC ALKALINE PHOSPHATASE $88.75 300 3007044 CULTURE VIBRIO $89.00 300 3000460 CULTURE YERSINIA $89.00 300 3070463 CAMPYLOBACTER CULTURE $89.00 300 3099363 WELLNESS-HEMOGLOBIN A1C $90.25 300 3030368 HEMOGLOBIN A1C PANEL $90.25 300 3099074 DAT HEMOGLOBIN A1C $90.25 300 3066008 ARTERIAL PUNCTURE $91.25 300 3000692 RENAL $91.25 300 30862531 ENDOMYSIAL ANTIBODY IGA $91.50 300 3006889 ANTIBODY TITER $92.00 300 3001781 LITHIUM $92.00 300 3039252 OPIATES SERUM $92.50 300 3000510 ELECTROLYTE PANEL $95.00 300 3098639 STREP PNEUMO (14 SEROTYPES) $95.75 300 3008631 "HEP B SURFACE AB, QUANTITATIVE" $95.75 300 3070406 BLOOD CULTURE $96.00 300 3060605 ANTI-STREPTOLYSIN O $96.00 300 3069051 RBC ANTIGEN $96.00 300 3066156 B. PERTUSSIS IGG/ IGA $97.00 300 3007986 "CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY" $97.25 300 3039351 OSMOLALITY URINE $98.00 300 3089992 REDUCING SUBST STOOL $98.00 300 3060225 "HEPARAIN INDUCED PH, AB" $98.00 300 3006376 "MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY" $98.00 300 3020435 MICROALBUMIN URINE $98.25 300 3099100 DAT MICROALBUMIN $98.25 300 3071065 CULTURE FUNGAL ID YEAST $99.00 300 3080500 GENO PHENO REVIEW $100.00 300 3006704 HEPATITIS B CORE ANTIBODY $100.00 300 3069200 CROSSMATCH IM SPIN $100.50 300 3061579 COLD AGGLUTINES $101.00 300 3060001 FEBRILE ANTIBODIES $101.25 300 3080324 "AMPHETAMINES, QUANTITATIVE, GC/MS, URINE" $102.00 300 3099520 WELLNESS-LIPID $102.50 300 3000619 LIPID PANEL $102.50 300 3099033 DAT LIPID $102.50 300 3007999 FUNGAL ISOLATE ID $104.00 300 3035508 TOTAL IRON BINDING CAPACITY $105.00 300 3029774 GGT $105.00 300 3007272 CRYPTOSPORDIUM 2 $106.00 300 30625511 ANTI-CENTROMERE AB $106.00 300 30625512 ANTI-NUCLEAR AB SCREEN $106.00 300 3062551 ANA SCREEN $106.00 300 3044807 T3 $108.25 300 3082595 CRYOGLOBULIN SCREEN W/REFLEX PROFILE $108.50 300 3086160 C4A LEVEL $109.00 300 3000168 ETHOSUXIMIDE $110.00 300 3067881 WEST NILE ABS. IGM $110.00 300 3067907 "WEST NILE ABS, IGG" $110.00 300 3015401 XANAX (ALPRAZOLAM) $111.25 300 3020856 ALDOLASE $112.00 300 3086238 ANTI-SCLERODERMA 70 AB $112.25 300 30862381 ANTI-SM/RNP AB $112.25 300 3038767 MYOGLOBIN URINE $113.50 300 3071073 CULTURE FUNGAL ID MOLD $114.00 300 3099017 DAT CMP $114.00 300 3099546 WELLNESS-CMP $114.50 300 3000544 CMP $114.50 300 3083888 NICOTINE & METABOLITE $115.00 300 3010253 URINE HCG $117.00 300 3090271 NFHS-URINE HCG $117.00 300 3099116 DAT UPG $117.00 300 3062569 ANA TITER & PATTERN $118.00 300 3025756 CREATININE CLEARANCE $118.00 300 3064003 C. DIFF TOXIN $118.00 300 3074275 SHIGA TOXINS EA $118.00 300 3092475 NFHS-INFLUENZA(QUICK) $118.00 300 3093309 NFHS-STREP (QUICK) $118.00 300 3080348 BUPRENORPHINE AND NALOXONE $119.00 300 3027877 IGG SUBCLASSES $120.00 300 3002060 SMEAR FLUORESCENT/ACID STAIN $122.00 300 3072063 AFB STAIN $122.00 300 3093515 CELIAC DISEASE PANEL $122.00 300 3006635 ANTIBODY; COCCIDIOIDES $123.00 300 3041654 PROTEIN ELECTROPHORESIS $123.50 300 3067105 INFLUENZA AB TYPE A & B $124.00 300 3007385 HISTOPLASMA GALACTOMANNAN AG URINE $124.00 300 3027844 IMMUNOGLOBULIN IGG $124.50 300 30278441 IMMUNOGLOBULIN IGA $124.50 300 30278442 IMMUNOGLOBULIN IGM $124.50 300 3001963 SALICYLATES $124.50 300 3046307 ZINC $127.00 300 3044799 T3 UPTAKE $128.00 300 3000150 "AMIKACIN, TROUGH" $128.00 300 3001751 LAMOTRIGINE (LAMICTAL) $129.00 300 3067014 HIV 1/2 $129.00 300 3001005 URINE DRUG SCREEN $129.25 300 3099207 DAT URINE DRUG SCREEN $129.25 300 3086907 ANTIGEN TESTING DONOR BLOOD $130.00 300 3044427 THYROXINE BINDING GLOBULIN $132.25 300 3020039 ACETAMINOPHEN $132.25 300 3006698 ANTIBODY; HISTOPLASMA $132.50 300 3041662 PROTEIN ELECTROPHORESIS UR 28 $133.00 300 3029519 GLUCOSE 1 HR. $133.00 300 3067915 FTA AB $134.50 300 3025533 CK-MB $134.50 300 3041340 PREALBUMIN $135.00 300 3001625 DIGOXIN $138.00 300 3001856 PHENYTOIN (DILANTIN) $138.00 300 3023751 CARBOXYHEMOGLOBIN $138.00 300 3025525 CK INSOENZYMES $138.00 300 3026077 VITAMIN B12 $138.00 300 3023900 CERULOPLASMIN $138.00 300 30424471 ALDOSTERONE RENIN ACTIVITY $138.00 300 3066958 HERPES SIMPLEX VIRUS 1/2 IGG $139.00 300 3074259 ROTOVIRUS $139.25 300 3073012 ADENOVIRUS AG DETECTION $139.25 300 3099561 WELLNESS-PSA $139.25 300 3022324 BETA 2 MICROGLOBULIN $140.00 300 3091600 FECAL MUSCLE FIBERS $140.00 300 3086972 RBC ANTIBODY IDENTIFICATION $140.25 300 3030103 HAPTOGLOBIN $141.00 300 3099603 WELLNESS-TSH $141.25 300 3073285 CRYPTOSPORIDIUM AG DFA $141.25 300 3044435 TSH $141.25 300 3099157 DAT TSH $141.25 300 3026937 ETHYLENE GLYCOL $142.00 300 3030203 THALASSEMIA AND HEMOGLOBINOPATHY COMP $142.00 300 3006641 ANTIBODY; CRYPTOCOCCUS $142.00 300 3071776 OVA AND PARASITE $142.25 300 3067089 HEPATITIS A ANTIBODY $142.50 300 3000551 OB PANEL $143.25 300 3036050 LACTIC ACID $144.50 300 3063179 GIARDIA AG $144.50 300 3007493 C DIFF 3 $145.00 300 3093606 GROWTH HORMONE $145.00 300 3027109 FECAL FAT QUANT $145.00 300 3067477 PARVOVIRUS B19 $145.50 300 3023306 CALCIUM IONIZED $146.00 300 3021409 AMMONIA $146.00 300 3073046 HEP B SURFACE AG $146.00 300 3025335 CORTISOL $146.30 300 30253352 CORTISOL PM $146.50 300 3000585 HEPATIC $146.50 300 30253351 CORTISOL AM $146.50 300 3053840 FIBRINOGEN ACTIVITY $147.00 300 3004255 SELENIUM $148.00 300 30680041 THYROID CANCER MONITOR $148.50 300 3038254 INSULIN $149.00 300 3020096 ACETONE $149.00 300 30200962 KETONES SERUM $149.00 300 3082010 BETA-HYDROXYBUTYRIC ACID $149.00 300 3099140 DAT INSULIN $149.00 300 3090503 C DIFF TOXIN 2 $150.00 300 3066651 EBV SCREEN-VCA $150.00 300 3066644 EBV ACUTE GROUP $150.00 300 3040103 PSA SCREENING $150.00 300 3099082 DAT PSA $150.00 300 3027281 FERRITIN $150.25 300 3063765 THYROID PEROXIDASE AB $151.00 300 3096377 ANTI-KIDNEY/LIVER MICROSOME AB $151.00 300 3000171 GENTAMICIN PEAK $152.00 300 30001710 GENTAMICIN TROUGH $152.00 300 3067386 MYCOPLASMA ANITBODIES $152.00 300 3044468 VITAMIN E $153.00 300 3056132 LUPUS ANTICOAGULANT $153.00 300 3001989 THEOPHYLLINE $153.25 300 3038742 MYOGLOBIN $154.25 300 3045853 24HR URINE VMA $154.25 300 3083524 ANTIPHOSPHOLIPID AB PANEL $155.00 300 3027463 FOLATE $155.50 300 3025251 COPPER SERUM $156.00 300 3040805 ALKALINE PHOSPHATASE $157.00 300 3038833 KAPPA/LAMBDA $160.00 300 3041548 "PSA, FREE" $160.50 300 3041530 "PSA, TOTAL" $160.50 300 3091274 NFHS-RSV $161.25 300 3067568 RSV $161.25 300 3086220 ANTI-DNA DS $161.25 300 3065885 STREP $162.00 300 3067626 RUBELLA AB IGG $163.00 300 3001849 PHENOBARBITAL $164.00 300 3068301 HEP C AB $164.00 300 3002011 TOPIRAMATE (TOPAMAX) $165.00 300 3082674 ESTRONE $165.00 300 3002029 VANCOMYCIN $165.50 300 3001641 VALPROIC ACID $165.50 300 3034972 5-HIAA $166.50 300 30349721 5-HIAA24 $166.50 300 7618312 SPECIAL STAINS GROUP 1 $166.75 300 3108818 SURGICAL PATH $166.75 300 3021805 VITAMIN C $167.00 300 3002003 TOBRAMYCIN TROUGH $167.00 300 30020030 TOBRAMYCIN PEAK $167.00 300 3009999 QUEST DRUG SCREEN-LAW ENFORCEMENT CUSTODY $167.05 300 3067055 HEP B CORE AB W/REFLEX $168.00 300 3067097 "HEPATITIS A, IGM ANTIBODY" $168.00 300 3073384 H PYLORI STOOL AG $169.00 300 3086256 ANTI-SMOOTH MUSCLE AB W/ REFL $169.00 300 3053006 ANTI-THROMBIN III ACTIVITY $170.00 300 3067063 HEP B SURFACE AB QUAL $171.00 300 3075918 GC/CHLAMYDIA $173.00 300 3008612 BETA-2-GLYCOPROTEIN IGG $173.00 300 3051604 ANTI-PHOSPHOLIPID AB IGG $173.00 300 3108302 SURGICAL PATH $174.00 300 3068004 THYROGLOBULIN AB $174.25 300 3047024 HCG QUANTITATIVE $176.00 300 3074911 GC/CHLAMYDIA PROBE $176.00 300 3063401 INTRINSIC FACTOR BLOCKING AB $176.50 300 3000304 AFP TUMOR MARKER $177.00 300 3026770 ESTRIOL $177.00 300 3063005 CA 27-29 $177.50 300 30866753 H. PYLORI IGG IGA IGM $178.00 300 3053626 D-DIMER $178.50 300 3023785 CEA $178.50 300 3045903 VITAMIN A-RETINOL $179.50 300 3038262 MERCURY $179.50 300 3002995 URINE DRUG PANEL 10 QUANT $180.00 300 30029952 DEXAMETHASONE $180.00 300 30029951 SINEMET $180.00 300 3003993 "CALPROTECTIN, FECAL" $182.00 300 3029410 GASTRIN $183.00 300 3038809 B-NATIURETIC PEPTIDE $183.25 300 3099306 DAT B-NATIURETIC PEPTIDE $183.25 300 3027851 GENERAL ALLERGY $184.00 300 3044252 VITAMIN B1 (THIAMIN) $184.00 300 3067352 MUMPS ANTIBODY PANEL (IGG/IGM) $184.00 300 3021649 ANGIOTENSION CONVERTING ENZYME $184.25 300 3080301 "COCAINE AND METABOLITES SCREEN, BLOOD" $185.00 300 3035169 CYCLIC CITRULLINATE PEPTIDE $185.25 300 3023702 STONE ANALYSIS $185.25 300 3063013 CA 19-9 $186.00 300 3052107 CA125 $186.50 300 3086303 CA 15-3 $186.50 300 3061413 CRP-HS $187.00 300 7618313 SPECIAL STAINS GROUP 2 $187.00 300 3026523 VITAMIN D 1 25 DIHYDROXY $190.00 300 3080327 DIHYDROTESTOERONE $191.00 300 3008112 CYTO TC 1 $192.00 300 3066453 CMV IGG/IGM $192.00 300 3081080 CYTOLOGY/URINESPUTUMETC $192.00 300 3008185 PNH W/FLAER 2 $192.00 300 308185 ZAP-70 ADDITIONAL MARKERS (EA) $192.00 300 3008188 PNH W/FLAER 3 $192.00 300 30085598 LUPUS ANTICOAG HEX $193.00 300 3071024 CULTURE FUNGUS (NOT HAIR SKIN) $197.00 300 3030020 LH $198.00 300 3071172 CULTURE AFB $199.00 300 3082103 ALPHA-1-ANTITRYPSIN; TOTAL $199.00 300 3050440 RETIC COUNT $200.50 300 3042447 RENIN $201.00 300 3060217 ANCA SCREEN $201.00 300 30602171 ANCA VASCULITIES $201.00 300 3086253 ANTI-MITOCHONDRIAL AB $201.00 300 3044849 TROPONIN I $201.50 300 3063419 ISLET CELL AB SCREEN W/ TITER $201.50 300 3004591 VITAMIN B3 $201.50 300 3044815 T3 (FREE) $202.75 300 3090511 SYNOVIAL FLUID ANALYSIS $203.00 300 3044666 TRANSFERRIN $205.00 300 3046810 C-PEPTIDE $205.25 300 3061603 C3 COMPLEMENT $205.25 300 3061611 C4 COMPLEMENT $205.25 300 3044328 THYROGLOBULIN PANEL $206.00 300 3080183 TRILEPTAL (OXCARBAZEPINE) $206.00 300 3066446 CMV IGG $207.00 300 3067873 VARICELLA ZOSTER VIRUS AB $208.00 300 3090602 CULTURE SYNOVIAL FLUID 1 $209.00 300 3068707 ANTIBODY ID PANEL $211.00 300 3007305 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY $211.00 300 3003175 RABIES VAC TITER $211.50 300 3067659 MEASELS AB IGG $214.00 300 3063369 INHIBIN A $215.00 300 3028032 ARTERIAL OR VENOUS BLOOD GAS $215.25 300 3030012 FSH $216.00 300 3006612 ANTIBODY; BLASTOMYCES $216.50 300 3025301 CORTISOL FREE 24 HR URINE $217.00 300 30253012 CORTISOL SALIVA $217.00 300 3021573 ANDROSTENEDIONE $217.25 300 3035193 21-HYDROXYLASE AB $219.00 300 30351932 IGF BINDING PROTEIN-3 $219.00 300 3005302 CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C $220.00 300 3042520 VITAMIN B2 (RIBOFLAVIN) $221.00 300 3026267 DHEA $224.00 300 3041449 PROGESTERONE $225.00 300 3026275 DHEA-SULFATE $228.50 300 3038353 METANEPHRINES FREE $230.00 300 3001567 TEGRETOL $231.50 300 3066172 LYME DIS IGG/IGM WBA $235.00 300 3052115 FACTOR II ACTIVITY CLOTTING $235.00 300 3033404 IMMUNOFIXATION IEP $235.75 300 3026689 ERYTHROPOIETIN $235.75 300 3066289 LYME DISEASE $241.00 300 3082393 PENTA SCREEN $242.00 300 3002557 ALCOHOL BLOOD $243.00 300 3099181 DAT ALCOHOL $243.00 300 3041464 PROLACTIN $246.00 300 3061470 ANTI-CARDIOLIPIN AB IGM/IGG $246.00 300 1 CARDIOLIPIN (PHOSPHOLIP) AB $246.00 300 3108834 SURGICAL PATH $250.00 300 3006480 "TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN" $257.00 300 3091956 THERAPEUTIC PHLEBOTOMY $259.00 300 3084480 T3 REVERSE $260.00 300 3001955 RAPAMUNE (SIROLIMUS) $260.00 300 3053030 PROTEIN C $264.00 300 3053063 PROTEIN S $264.00 300 3044062 TESTOSTERONE $264.50 300 3023082 CALCITONIN $269.00 300 3021755 ARSENIC BLOOD $270.50 300 3067576 RICKETTSIA (RMSF) $271.00 300 3044021 TESTOSTERONE FREE $274.50 300 3034980 17-HYDROXYPROGESTORNE $275.00 300 3001971 FK506 TACROLIMUS $278.75 300 3068129 HLA-B27 $287.00 300 3021318 HOMOCYSTINE $287.00 300 3063344 IMMUNOFIX-UPEP $288.00 300 3023843 CATECHOLAMINES FRACTIONATED $293.50 300 3001583 CYCLOSPORINE $294.00 300 3006682 SCHISTOSOMA ANTIBODY IGG $302.00 300 30066821 STRONGYLOIDES AB IGG $302.00 300 3020245 ACTH $307.00 300 3087257 CULTURE HSV W/ REFLEX $309.00 300 3020880 ALDOSTERONE $317.00 300 3043056 IGF-1 $317.00 300 7615097 BONE MARROW INTERPRETATION $320.00 300 3005597 PHOSPHOLIPID NEUTRALIZATION; PLATELET $320.00 300 3026721 ESTROGEN $323.00 300 3008521 VON WILLEBRAND SCREEN $326.00 300 30085245 RISTOCETIN COFACTOR $326.00 300 3052404 FACTOR VIII ACTIVITY $329.00 300 3026705 ESTRADIOL $331.00 300 3061629 COMPLEMENT TOTAL (CH 50) $333.00 300 3041811 HSP-70 AB (ANTI-68 KD AG) $337.00 300 3007517 "HEPATITUS B VIRUS, DNA" $345.00 300 3086352 INFLIXIMAB QUANT W/ REFLEX TO AB $352.00 300 3008341 "IMMUNOHISTOCHEMISTRY, EA ADDTL AB STAIN" $353.50 300 3008342 "IMMUNOHISTOCHEMISTRY, SINGLE AB STAIN" $353.50 300 3042702 SEX HORMONE BINDING GLOBULIN $366.00 300 3039708 PTH INTACT W/O CA $373.00 300 3027901 RHO GAM $375.00 300 30081403 JAK2 EXONS 12 & 13 $375.00 300 3088184 PNH WITH FLAER (HS) $375.00 300 308184 ZAP-70 $375.00 300 3030848 FACTOR V LEIDEN MUTATION ANALYSIS $376.00 300 3030889 HISTAMINE PLASMA $380.00 300 30779891 RICKETTSIA RICKETTSII DNA $398.00 300 3008372 IODINE $400.00 300 3000177 KEPRA LEVEL $404.00 300 3008017 LEVETIRACETAM $404.00 300 3001240 "F2 (PROTHROMBIN, COAGULATION FACTOR II)" $404.00 300 3045978 VITAMIN K $410.00 300 3099827 WELLNESS-VITAMIN D $415.00 300 3023066 VITAMIN D (25 HYDROXY) $415.00 300 3008254 CANNABINOIDS $415.00 300 3099272 DAT VITAMIN D (25-HYDROXY) $415.00 300 3008265 PANCREATIC ELASTASE $416.00 300 3108305 SURGICAL PATH LEVEL IV $420.00 300 3039211 METHYLMALONIC ACID $430.00 300 3042074 VITAMIN B6 $440.00 300 3005244 CLOTTING; FACTOR VIII RELATED ANTIGEN $468.00 300 3024924 AMIODARONE (CORDARONE) $489.00 300 3008307 "LEVEL V - SURGICAL PATHOLOGY, G & M" $495.00 300 3000742 ACUTE HEPATITIS PROFILE $498.00 300 301263 "CHRONIC LYMPHOCYTIC LEUKEMIA, IGVH MUTATION STATUS, CELL-BASED" $510.00 300 3001256 "HFE (HEMOCHROMATOSIS) (EG, HEREDITARY HEMOCHROMATO" $510.00 300 3008189 "FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS" $515.00 300 3075215 HCV RNA GENOTYPE $517.75 300 3008794 HEPATITIS C VIRAL RNA $525.00 300 3053071 ACTIVATED PROTEIN C RESIS $553.25 300 3075223 HCV RNA QUAN PCR $574.00 300 3083011 H PYLORI BREATH TEST $574.00 300 3008779 BK VIRUS DNA QNT PCR $594.00 300 3081257 ALPHA THALASSEMMIA MUT. ANAL $644.00 300 3044450 THYROID STIM IMMUNOGLOBIN $865.00 300 3969458 PRBC TRANSFUSED PER UNIT $875.00 300 3081270 JAK 2 V617F MUTATION $931.00 300 3202421 XR BODY COMPOSITION SCAN $40.00 320 3208519 XR BODY COMPOSITION SCAN WELLNESS $40.00 320 3200300 XR ORBIT FOR FOREIGN BODY $195.00 320 3273551 XR FEMUR AP SINGLE VIEW $195.00 320 3235009 XR HIP 1V $195.00 320 3273501 XR HIP (AP) W/ PELVIS 1 VIEW $195.00 320 3473521 HIP - BILATERAL X-RAY 1V EACH $200.00 320 3201209 XR MASTOID LIMITED <3 VIEW $245.00 320 3201407 XR FACIAL BONES 1 OR 2 VIEWS $245.00 320 3202108 XR SINUSES PARANASAL <3V $245.00 320 3203288 XR TEMPOROMANDIBULAR JOINT UNILATERAL $245.00 320 3203601 "XR NECK, AP AND LATERAL" $245.00 320 3211000 XR RIBS 2 VIEWS $245.00 320 3211208 XR STERNUM 2 VIEWS $245.00 320 3220704 XR SPINE THORACIC AP AND LATERAL $245.00 320 3221702 XR PELVIS AP SINGLE VIEW $245.00 320 3230000 XR CLAVICLE 2 VIEWS $245.00 320 3230109 XR SCAPULA 2 VIEWS $245.00 320 3230208 XR SHOULDER SINGLE VIEW $245.00 320 3230901 XR RADIUS AND ULNA 2 VIEWS $245.00 320 3231008 XR WRIST 2 VIEWS $245.00 320 3231206 XR HAND 2 VIEWS $245.00 320 3235603 XR KNEE 1 OR 2 VIEWS $245.00 320 3235652 XR KNEE - BILATERAL AP STANDING 1 VIEW $245.00 320 3236007 XR ANKLE 2 VIEWS $245.00 320 3236205 XR FOOT 2 VIEWS $245.00 320 3240009 XR ABDOMEN AP SINGLE VIEW $245.00 320 3201001 XR MANDIBLE <4 VIEWS $295.00 320 3202504 XR SKULL <4 VIEWS $295.00 320 3201134 XR STERNOCLAVICULAR JOINTS MIN 3 VIEW $295.00 320 3220407 XR SPINE CERVICAL 2 OR 3 VIEWS $295.00 320 3221009 XR SPINE LUMBAR 2 OR 3 VIEWS $295.00 320 3222205 XR SACRUM AND COCCYX MIN 2 VIEWS $295.00 320 3230307 XR SHOULDER MIN 2 VIEWS $295.00 320 3230703 XR ELBOW 2 VIEWS $295.00 320 3231404 XR FINGER MIN 2 VIEWS $295.00 320 3235504 XR FEMUR MIN 2 VIEWS $295.00 320 3235629 XR KNEE 3 VIEWS $295.00 320 3235900 XR TIBIA AND FIBULA 2 VIEWS $295.00 320 3236502 XR CALCANEUS MIN 2 VIEWS $295.00 320 3236601 XR TOES MIN 2 VIEWS $295.00 320 3273502 XR HIP AP AND LATERAL W/PELVIS 2-3 VIEWS $295.00 320 3240108 XR ABDOMEN 2 VIEWS $295.00 320 3241023 XR CHEST 3 VIEW INCLUDING APICAL $295.00 320 3235108 XR HIP 2V $295.00 320 3273522 XR HIP BILATERAL W/PELVIS 1 VIEW $295.00 320 3211018 XR RIBS - UNILATERAL AND PA CHEST MIN 3 VIEW $325.00 320 3201100 XR MANDIBLE MIN 4 VIEWS $345.00 320 3201605 XR NASAL BONES MIN 3 VIEWS $345.00 320 3201506 XR FACIAL BONES MIN 3 VIEWS $345.00 320 3201308 XR MASTOID MIN 3 VIEWS $345.00 320 3202207 XR SINUSES MIN 3 VIEWS $345.00 320 3200334 XR TEMPOROMANDIBULAR JOINT - BILATERAL $345.00 320 3220746 XR SPINE THORACIC MIN 4 VIEWS $345.00 320 3222023 XR SACROILIAC JOINT 3 OR MORE VIEWS $345.00 320 3230505 XR ACROMIOCLAVICULAR JOINT - BILATERAL X-RAY W OR WO WEIGHT $345.00 320 3230604 XR HUMERUS MIN 2 VIEWS $345.00 320 3230802 XR ELBOW MIN 3 VIEWS $345.00 320 3231107 XR WRIST MIN 3 VIEWS $345.00 320 3231305 XR HAND MIN 3 VIEWS $345.00 320 3236106 XR ANKLE MIN 3 VIEWS $345.00 320 3236304 XR FOOT MIN 3 VIEWS $345.00 320 3272190 XR PELVIS X-RAY MIN 3 VIEWS $345.00 320 3235207 XR HIP BILATERAL AP AND LATERAL W/PELVIS FROG $345.00 320 3373522 XR HIP - BILATERAL 2 VIEW EACH $345.00 320 3202009 XR ORBIT - BILATERAL MIN 4 VIEWS $415.00 320 3202603 XR SKULL MIN 4 VIEWS $415.00 320 3220803 XR SPINE THORCO LUMBAR MIN 2 VIEW $415.00 320 3273503 XR HIP MIN 4 VIEWS $415.00 320 3260767 XR SPINE CERVICAL 4-5 VIEWS $425.00 320 3221207 XR SPINE LUMBAR BENDING 2 OR 3 VIEWS $430.00 320 3260759 BONE DXA BONE DENSITY $460.00 320 3221108 XR SPINE LUMBAR MIN 4 VIEWS $465.00 320 3211109 XR RIBS - BILATERAL 3 VIEWS $495.00 320 3220100 XR SPINE CERVICAL/THORACIC/LUMBAR 2V EACH $495.00 320 3240223 XR CHEST AND ABDOMEN AP (SUPINE AND UPRIGHT) AND PA CHEST $495.00 320 32072114 XR L-SPINE/MIN 6 VIEW INCLUDING BENDING $495.00 320 3201217 XR KNEE 4 OR MORE VIEWS $495.00 320 3220506 XR SPINE CERVICAL AP/OBLIQUE/LATERAL W FLEXION AND W EXT MIN 6V $525.00 320 3211117 XR RIBS - BILATERAL AND PA CHEST MIN 4 VIEWS $545.00 320 3207602 XR SINUS TRACT FLUOROSCOPY W CONTRAST $650.00 320 3243003 BILIARY DUCTS AND GALLBLADDER FLUOROSCOPY DURING SURGERY W CONTRAST BILIARY DUCT $650.00 320 3207073 XR BONE SURVEY INFANT LIMITED $675.00 320 3260627 XR BONE SURVEY "$1,250.00 " 320 3210101 XR CHEST SINGLE VIEW $195.00 324 3210200 XR CHEST 2 VIEWS $245.00 324 3210358 XR CHEST 4 VIEW INCLUDING LATERAL DECUB $345.00 324 3485877 NM LUNG VENTILATION SCAN $855.00 340 3480100 NM THYROD SCAN $880.00 340 3407806 NM PARATHYROID SCAN $880.00 340 3482155 NM LIVER SCAN $880.00 340 3482643 NM GASTRIC EMPTYING STUDY $880.00 340 3482908 NM MECKELS DIVERTICULUM SCAN $880.00 340 3483005 NM BONE SCAN LIMITED $880.00 340 3483153 NM BONE SCAN 3 PHASE SINGLE AREA $880.00 340 3487071 NM RENAL SCAN $880.00 340 3483054 NM BONE SCAN 3 VIEWS PHASE MULTIPLE AREAS "$1,005.00 " 340 3485802 NM LUNG SCAN PERFUSION "$1,005.00 " 340 3483062 NM WHOLE BODY BONE SCAN "$1,130.00 " 340 3407822 NM HIDA SCAN "$1,260.00 " 340 3485822 NM LUNG VENTILATION & PERFUSION "$1,490.00 " 340 3407855 NM MYOCARDIAL PERFUSION "$1,810.00 " 340 3439503 NM TC 99 MDP $310.00 343 3439541 NM TC 99M SULFUR COLLOID UP TO 20 ML $372.00 343 3495124 NM TC 99 PERTECHNETATE $375.00 343 3439502 NM TC 99 CARDIOLITE/SESTAMBI $395.00 343 3495371 NM TC 99 CHOLETEC $460.00 343 3439569 NM TC 99 PENTETATE $465.00 343 3435401 NM TC 99 APCITIDE $545.00 343 3517042 CT CAROTID ARTERY ANGIOGRAM W CONTRAST IV "$2,135.00 " 350 3504800 CT ORBIT/EAR W/O $880.00 351 3524885 CT FACIAL BONES AND MAXILLA WO CONTRAST $880.00 351 3504867 CT SINUSES WO CONTRAST $880.00 351 3504503 CT HEAD W/O CONTRAST $880.00 351 3370487 CT FACIAL BONES W CONTRAST "$1,050.00 " 351 3504701 CT HEAD W AND WO CONTRAST IV "$1,245.00 " 351 3504826 CT ORBIT W AND WO CONTRAST IV "$1,245.00 " 351 3524881 CT FACIAL BONES AND MAXILLA W/WO CONTRAST IV "$1,245.00 " 351 3514965 CT HEAD VESSELS ANGIOGRAM W AND WO CONTRAST IV "$2,150.00 " 351 3512506 CT CHEST WO CONTRAST $880.00 352 3521259 CT SPINE CERVICAL WO CONTRAST $880.00 352 3521283 CT SPINE THORACIC WO CONTRAST $880.00 352 3521929 CT PELVIS WO CONTRAST $880.00 352 3521317 CT SPINE LUMBAR WO CONTRAST $880.00 352 3523701 CT LOWER EXTREMITY WO CONTRAST $880.00 352 3523206 CT UPPER EXTREMITY WO CONTRAST $880.00 352 3504909 CT NECK WO CONTRAST $880.00 352 3541505 CT ABDOMEN WO CONTRAST $880.00 352 3512605 CT CHEST W CONTRAST IV "$1,050.00 " 352 3521937 CT PELVIS W CONTRAST IV "$1,050.00 " 352 3541604 CT ABDOMEN W CONTRAST "$1,050.00 " 352 3537016 CT LOWER EXTREMITY W CONTRAST IV "$1,050.00 " 352 3532017 CT UPPER EXTREMITY W CONTRAST IV "$1,050.00 " 352 3504917 CT NECK W CONTRAST "$1,050.00 " 352 3504925 CT NECK W AND WO CONTRAST IV "$1,245.00 " 352 3512704 CT CHEST W AND WO CONTRAST IV "$1,245.00 " 352 3521945 CT PELVIS W AND WO CONTRAST IV "$1,245.00 " 352 3541703 CT ABDOMEN W AND WO CONTRAST IV "$1,245.00 " 352 3527025 CT LOWER EXTREMITY W AND WO CONTRAST IV "$1,245.00 " 352 3522026 CT UPPER EXTREMITY W AND WO CONTRAST IV "$1,245.00 " 352 3541760 CT ABDOMEN AND PELVIS WO CONTRAST "$1,525.00 " 352 3541778 CT ABDOMEN AND PELVIS W CONTRAST IV "$1,575.00 " 352 3544178 CT ABDOMEN AND PELVIS W AND WO CONTRAST IV "$1,865.00 " 352 3522604 CT CHEST VESSELS MULTISECTION FOR PULMONARY EMBOLUS "$2,110.00 " 352 3517414 CT RENAL VESSELS ANGIOGRAM W AND WO CONTRAST "$2,185.00 " 352 3527322 CT UPPER EXTREMITY VESSELS ANGIOGRAM W AND WO CONTRAST IV "$2,185.00 " 352 3556354 CT ABDOMINAL VESSELS ANGIOGRAM W AND WO CONTRAST IV (AAA) "$2,345.00 " 352 3526357 CT LOWER EXTREMITY VESSELS ANGIOGRAM W AND WO CONTRAST IV (RUNOFF) "$2,345.00 " 352 3612506 CT LUNG CA SCREENING $880.00 359 3573706 CTA LOWER EXTREMITY RUNOFF "$2,750.00 " 359 3600558 PORT-A-CATH REMOVAL "$1,392.25 " 360 3600053 CARPAL TUNNEL "$1,711.50 " 360 3601143 EXCISION/SKIN 0.6-1.0 CM T/A/L "$1,800.00 " 360 3606589 REMOVAL TUNNELED CV CATH W/O PORT "$2,060.00 " 360 3695053 HERNIA REPAIR "$2,219.75 " 360 3604721 OR CARPAL TUNNEL SURGERY "$3,750.00 " 360 3606590 REMOVAL TUNNELED CV CATH W/PORT "$4,100.00 " 360 3606274 OR REMOVAL-ANAL FISTULA "$4,975.00 " 360 3609561 OR REPAIR VENTRAL HERN INIT BLOCK "$5,010.00 " 360 3609565 OR LAP REPAIR RECURRENT INCIS OR VENT HERNIA "$5,460.00 " 360 3600046 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTR "$5,490.00 " 360 3609560 OR REPAIR VENTRAL HERN INIT REDUC "$5,500.00 " 360 3603396 OR CATARACT SURGERY "$5,825.00 " 360 3609585 OR REPAIR UMBIL HERN REDUC > 5 YR "$6,450.00 " 360 3605870 OR REPAIR UMBILICAL HERNIA-INCARCERATED "$6,555.00 " 360 3609587 OR REPAIR UMBIL HERN BLOCK > 5 YR "$6,575.00 " 360 3629848 LAP WRIST CARPAL TUNNEL "$8,200.00 " 360 3608570 LAP LYMPH NODE BIOPSY "$8,425.00 " 360 3609567 OR MESH INSERTION/HERNIA CLOSURE "$8,750.00 " 360 3604005 OR ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROC) "$9,675.00 " 360 3649654 LAP REPAIR INCISIONAL HERNIA W/MESH "$10,000.00 " 360 3600566 LAP CHOLECYSTECTOMY "$10,475.00 " 360 3644202 LAP ENTERECTOMY RESECTION SM INTESTINE "$10,540.00 " 360 3604180 "LAPAROSCOPY, SURGICAL, ENTEROLYSIS" "$10,800.00 " 360 3644970 OR LAP APPENDECTOMY "$11,750.00 " 360 3604204 " LAP COLECTOMY, PARTIAL; WITH ANASTOMOSIS" "$11,750.00 " 360 3649655 LAP REPAIR INCISIONAL HERNIA STRANG/INCARC "$12,000.00 " 360 3607561 LAP CHOLECYSTECTOMY W/CHOLANGIOGRAM "$12,650.00 " 360 3609651 "OR LAP, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA" "$14,150.00 " 360 3603280 LAP ESOPHAGOGASTRIC FUNDOPLASTY "$15,725.00 " 360 3603332 "OR LAP REPAIR, PARAESOPHAGEAL HIATAL HERNIA W/FUNDOPLASTY" "$15,725.00 " 360 3604965 "LAP, REPAIR INGUINAL HERNIA" "$15,775.00 " 360 3649652 LAP REPAIR VENT/UMB/EPIGAS HERNIA W/MESH "$15,800.00 " 360 3613281 OR LAP REPAIR OF DIAPHRAGMATIC HERNIA W/FUNDOPLASTY "$17,350.00 " 360 3649653 LAP REPAIR VENT/UMB/EPI HERNIA STRANG/INCARC "$19,550.00 " 360 3603281 LAP PARAESOPHAG HERN REPAIR "$19,725.00 " 360 3643281 LAP REPAIR HIATAL HERNIA W/O MESH "$19,725.00 " 360 3643282 LAP REPAIR HIATAL HERNIA W/MESH "$20,375.00 " 360 3090172 PLASMA/FRESH FROZEN (FFP) $184.25 390 3900024 PLATELETS (1 UNIT) $792.75 390 3900016 PRBC 1 UNIT $424.75 391 3914306 BLOOD ADMINISTRATION $729.00 391 3916434 BLOOD ADMINISTRATION ADD'L HOUR $729.00 391 4060953 "BREAST - DIAG DIGITAL BREAST TOMOSYNTHESIS, UNI OR BILATERAL" $75.00 401 4060901 BREAST - UNILATERAL MAMMOGRAM DIAGNOSTIC W COMPUTER AIDED DETECTION $275.00 401 4060919 BREAST - BILATERAL MAMMOGRAM DIAGNOSTIC W COMPUTER AIDED DETECTION $275.00 401 4060950 BREAST - 3D UNILATERAL MAMMOGRAM DIAGNOSTIC $325.00 401 4060951 BREAST - 3D BILATERAL MAMMOGRAM DIAGNOSTIC $325.00 401 4066452 US BREAST $275.00 402 4066429 US BREAST LIMITED $275.00 402 4068011 US FETAL NARRATIVE STUDY OBSERVATION 1ST TM $300.00 402 4068151 US FETAL NARRATIVE STUDY OBSERVATION LIMITED $300.00 402 4069993 US UNSPECIFIED BODY REGION $300.00 402 4067666 US CHEST $375.00 402 4068029 US FETAL NARRATIVE STUDY OBSERVATION 1ST TM MULT FETUS $375.00 402 4068177 US FETAL NARRATIVE STUDY OBSERVATION TRANSVAGINAL 1ST TM $375.00 402 4068185 US FETAL BIOPHYSICAL PROFILE WO NON STRESS $375.00 402 4076604 US CHEST LIMITED $375.00 402 4070116 US ABDOMEN LIMITED $475.00 402 4000691 US ABDOMINAL WALL $475.00 402 4067757 US AORTA LIMITED $475.00 402 4067708 US KIDNEY LIMITED $475.00 402 4068573 US PELVIS LIMITED $475.00 402 4066882 US EXTREMITY JOINT OR SOFT TISSUE LIMITED $475.00 402 4076705 US ABDOMINAL LIMITED - LOWER BACK $475.00 402 4068805 US EXTREMITY JOINT OR SOFT TISSUE COMPLETE $525.00 402 4067005 US ABDOMEN COMPLETE $600.00 402 4068052 US FETAL NARRATIVE STUDY OBSERVATION 2ND TM $600.00 402 4068300 US PELVIS TRANSVAGINAL $600.00 402 4068565 US PELVIS COMPLETE $600.00 402 4068706 US SCROTUM AND TESTICLE $600.00 402 4069423 US GUIDANCE FOR PLACEMENT OF NEEDLE IN UNSPECIFIED BODY REGION $600.00 402 4077004 US RENAL COMPLETE (KUB) $600.00 402 4068102 US FETAL NARRATIVE STUDY OBSERVATION 2ND TM MULT FETUS $675.00 402 9397936 US AORTA DOPPLER LIMITED $885.00 402 9239906 US AV FISTULA $885.00 402 4065363 US THYROID OR NECK $945.00 402 4060954 "BREAST - SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL" $75.00 403 4060927 BREAST - BILATERAL MAMMOGRAM SCREENING W COMPUTER AIDED DETECTION $275.00 403 4060952 BREAST - 3D BILATERAL MAMMOGRAM SCREENING $325.00 403 4607206 NASOTRACHEAL SUCTION $319.00 410 4106449 CONTINUOUS NEBULIZER 1ST HOUR $441.00 410 4106456 CONTINUOUS NEBULIZER ADD'L HOUR $441.00 410 4200382 MASSAGE 15 MINUTES $20.00 421 4200400 GENERAL WELLNESS $30.00 421 4200390 MASSAGE 30 MINUTES $30.00 421 4200259 PARAFFIN BATH - PHYSICAL THERAPY $48.00 421 4200416 MASSAGE 60 MINUTES $60.00 421 4200291 ULTRASOUND - PHYSICAL THERAPY $60.00 421 4200077 E-STIM (ATTENDED) $63.00 421 4200515 VASOPNEUMATIC DEVICE $68.00 421 4270161 VASOPNEUMATIC DEVICES $68.00 421 4200374 IONTOPHORESIS (15 MIN) $70.00 421 4200283 TRACTION $74.00 421 4200507 HOME ASSESSMENT $77.00 421 4270146 E-STIM (UNATTENDED) $78.00 421 4200267 SOFT TISSUE MASSAGE $78.00 421 4200119 ORTHOTIC-CHECK OUT/PT $85.00 421 4292116 WOUND CARE MGNT 10 CM/5-10 MIN $85.00 421 4200127 GAIT TRAINING INITIAL 20 MINUTES $85.00 421 4200085 THERAPEUTIC EXERCISE 15 MIN $91.00 421 4200473 NEUROMUSCULAR RE-EDUCATION $93.00 421 4200226 MANUAL THERAPY $93.00 421 4219770 PROSTHETIC TRAINING PT $93.00 421 4200465 THERAPEUTIC ACTIVITIES PT $95.00 421 4219713 AQUATIC THERAPY/EXERCISE $98.00 421 4200317 WHIRLPOOL $98.25 421 4200457 HOME CERVICAL TRACTION INSTRUCTIONS $100.00 421 4200101 ORTHOTIC FITTING (BRACE-JOBST)PT $109.00 421 4219754 PHYSICAL PERFORMANCE TESTING $110.00 421 4292124 WOUND CARE MGNT 11-25 CM/15-20 MIN $117.00 421 4202131 WOUND CARE MGNT 26-50 SQCM 25-35MIN $150.00 421 4209219 WOUND CARE MGNT 51-75 SQCM-40-60MIN $195.00 421 4200192 DEBRIDEMENT - MINOR $250.00 421 4206025 NON SELECT/DEBRIDEMENT W/O FORCEPS $250.00 421 4219762 WOUND VAC $250.00 421 4209201 WOUND CARE MGNT 76 SQ CM>60 MIN $274.50 421 4200184 DEBRIDEMENT - MAJOR $334.00 421 4219580 UNNA BOOT APPLICATION $525.00 421 4200275 TENS UNIT - INSTRUCTIONS (PT) $575.00 421 4200523 EVALUATION-LEVEL II PHYSICAL THERAP $67.25 424 4200242 PHYSICAL THERAPY RE-EVAL $103.00 424 4297164 RE-EVALUATION -PT 20 MINUTES $150.00 424 4297161 EVALUATION - PT 20 MINUTES $195.00 424 4297162 EVALUATION - PT 30 MINUTES $210.00 424 4297163 EVALUATION PT- 45 MINUTES $245.00 424 4375457 WORK HARDENING/CONDITION (2 HOURS) $33.25 431 4370185 PARAFFIN BATH - OCCUPATIONAL THERAP $54.00 431 4377701 "COGNITIVE FUNCTION INTERVENTIONS, PER 15 MIN" $54.00 431 4377032 ORTHOTIC CHECK OUT/OT $56.00 431 4371241 MASSAGE $61.00 431 4377763 "ORTHOTIC(S)/PROSTHETIC(S) MGMT, SUBSEQUENT EA 15 MIN" $70.00 431 4375044 ORTHOTIC FITTING & TRAIN (15 MIN) $73.00 431 4370359 ULTRASOUND OT (15 MIN) $75.00 431 4371100 THERAPEUTIC EXERCISE (15 MIN) $77.00 431 4375374 HOME/SELF CARE TRAINING/ADL $77.00 431 4309019 BIOFEEDBACK TRAINING OCC THERAPY $77.25 431 4358313 MMT TRUNK OR EXTREMITY $77.25 431 4358321 MUSCLE TESTING HAND $77.25 431 4358347 MMT BODY AND HANDS $77.25 431 4358511 ROM TRUNK OR EXTREMITY - OCCUPATION $77.25 431 4375382 COMMUNITY/WORK REINTEGRATI (15 MIN) $77.25 431 4375424 WHEELCHAIR TRAINING OT (15 MIN) $77.25 431 4375465 WORK HARDENING (ADDITIONAL HOURS) $77.25 431 4370144 ELECTRICAL STIMULATION (UNATTENDED) $78.00 431 4370425 ULTRASOUND WITH EMS $78.00 431 4370326 ELECTRIC STIMULATION MANUAL (15MIN) $78.00 431 4370334 IONTOPHORESIS-OT (15 MIN) $82.00 431 4370342 CONTRAST BATH OT (15 MIN) $90.00 431 4371126 NUEROMUSCULAR RE-ED $90.00 431 4372504 MYOFASCIAL RELEASE/STM (15 MIN) $90.00 431 4372652 JOINT MOBILIZATION (15 MIN) $90.00 431 4371407 MANUAL THERAPY $90.00 431 4358529 ROM HANDS - OCCUPATIONAL THERAPY $92.00 431 4319778 PROSTHETIC TRAINING OT $93.00 431 4375309 THERAPEUTIC ACTIVITIES $95.00 431 4319711 AQUATIC THERAPY/EXERCISE $98.00 431 4319752 PHYSICAL PERFORMANCE TESTING $110.00 431 4376125 "COGNITIVE PERFORMANCE TESTING, PER HOUR" $210.00 431 4391264 APPLICATION-ARM SPLINT-OCC THERA $331.75 431 4391314 APPLICATION-FINGER SPLINT OT $331.75 431 4345500 TENS UNIT - INSTRUCTIONS (OT) $420.00 431 4392122 EVALUATION - FOLLOW-UP RE-EVAL/OCC $142.00 434 4397168 RE-EVALUATION- OT 30 MINUTES $150.00 434 4390019 HOME ASSESSMENT OCCUPATIONAL THERAP $164.25 434 4397165 EVALUATION -OT 30 MINUTES $210.00 434 4392023 EVALUATION - OCCUPATIONAL THERAPY $214.00 434 4392114 EVALUATION-DAILY-OCCUPATIONAL THERA $214.00 434 4397167 EVALUATION- OT 60 MINUTES $245.00 434 4397166 EVALUATION -OT 45 MINUTES $245.00 434 4425070 SPEECH THERAPY TREATMENT $197.00 441 4425260 SWALLOW DYSFUNCTION TREATMENT $208.00 441 4425064 EVALUATION - SPEECH - SOUND PROD. $311.00 444 4425063 EVALUATION - SPEECH FLUENCY $311.00 444 4425065 EVALUATION - SPEECH - LANG COMPLEX $311.00 444 4425066 EVALUATION - SPEECH - VOICE ANALYSIS $311.00 444 4425252 EVALUATION - SWALLOW FUNCTION $315.00 444 4500773 IV PUSH-SEQUENTIAL-SAME DRUG $78.75 450 4507752 IV PUSH-SEQUENTIAL-DRUG $83.00 450 4502027 IV PUSH - INJECTION $83.00 450 4502019 SUB Q IM ADMINISTRATION $87.00 450 4507141 ADMINISTRATION TETANUS/DIPHTERIA IN $87.00 450 4507158 TETANUS/DIPHTERIA/PERTUSSIS INJ $87.00 450 4507745 PORT-A-CATH/PICC/FLUSH $89.00 450 4505178 BLADDER SCAN $111.00 450 4560009 INTRAVENOUS ACCESS $120.00 450 4507687 IV THERAPY-CONCURRENT INFUSION $161.75 450 4502092 BLOOD COLLECTION FROM PORT $185.00 450 4505921 BLOOD COLLECTION/PICC LINE $185.00 450 4500344 LAC REPAIR-FACE/EAR/EYELID <12.5 CM $187.50 450 4500542 APPLICATION-FINGER CAST $200.00 450 4502076 IV THERAPY (ADDL HOUR) $200.50 450 4507612 IV INFUSION-HYDRATION-ADDL HOUR $200.50 450 4507679 IV THERAPY-SEQUENTIAL-DRUG 1ST HOUR $200.50 450 4501003 EMERGENCY ROOM LEVEL I $210.00 450 4501004 EMERGENCY ROOM LEVEL I $210.00 450 4509050 FETAL MONITORING DURING LABOR BY CONS PHYS $215.00 450 4504445 DRAIN NAIL HEMATOMA $258.00 450 4502001 EMERGENCY ROOM LEVEL II $265.00 450 4502002 EMERGENCY ROOM LEVEL II $265.00 450 4508032 CONTROL NASAL HEMOR-POST SUBSEQUENT $289.00 450 4502050 IV THERAPY (1ST HOUR) $293.00 450 4507604 IV INFUSION-HYDRATION--INITIAL $293.00 450 4508008 GASTRIC LAVAGE/ASPIRATION OD TX $315.00 450 4500435 APPLICATION-SHORT ARM SPLINT $325.00 450 4500534 APPLICATION-FINGER SPLINT $325.00 450 4500526 APPLICATION-SHORT LEG SPLINT $325.00 450 4509204 FOREIGN BODY REMOVAL-EAR $325.00 450 4503009 EMERGENCY ROOM LEVEL III $328.00 450 4503010 EMERGENCY ROOM LEVEL III $328.00 450 4592408 APPLICATION-SHOULDER STRAPPING $330.00 450 4502977 REMOVAL SHORT ARM CAST $375.00 450 4505525 TRIGGER POINT INJECTION 1-2 MUSCLES $377.00 450 4501441 CONSCIOUS SEDATION-ER $382.00 450 4509501 APPLICATION-LONG LEG SPLINT $390.00 450 4503454 APPLICATION-LONG LEG CAST $425.00 450 4507869 APPLICATION-SHORT LEG CAST $425.00 450 4505202 REMOVAL FOREIGN BODY/CONJUNCTIVA $425.00 450 4506804 INTRAOSSEOUS NEEDLE PLACEMENT $430.00 450 4579389 REMOVAL FOREIGN BODY EYELID $438.00 450 4564494 "INJ PARA FACET W/IMAGING, SINGLE VIEW" $442.75 450 4511739 REMOVAL TOENAIL $445.00 450 4503033 REMOVAL FOREIGN BODY NOSE $455.00 450 4512011 RPR F/E/E/N/L/M 2.5 CM/< $470.00 450 4506051 INJ/ASPIRATION-INTERMEDIATE JOINT $485.00 450 4512001 RPR S/N/AX/GEN/TRNK 2.5CM/< $515.00 450 4504455 "INJ, ANESTHETIC AGENT, PLANTAR/DIGITAL NERVE" $530.00 450 4504007 EMERGENCY ROOM LEVEL IV $542.00 450 4504008 EMERGENCY ROOM LEVEL IV $542.00 450 4500617 INJ/ASPIRATION-MAJOR JOINT $560.00 450 4506143 INTRODUCTION NEEDLE/CATHETER ARTERY $565.00 450 4502514 REDUCTION TOE FRACTURE $580.00 450 4500419 APPLICATION-LONG ARM CAST $580.00 450 4500757 APPLICATION-SHORT ARM CAST $580.00 450 4509212 REMOVAL EAR WAX $610.00 450 4500369 LAC REPAIR SCALP/NECK/TRUNK <12.5CM $615.00 450 4512002 RPR S/N/AX/GEN/TRNK2.6-7.5CM $615.00 450 4564495 "INJ PARA FACET W/IMAGING, 3 OR MORE LEVELS" $635.00 450 4513133 CMPLX RPR F/C/C/M/N/AX/G/H/F $645.00 450 4506101 CRITICAL CARE--ADDITIONAL 30 MIN $650.00 450 4504402 "INJ, ANESTHETIC AGENT, FACIAL NERVE" $650.00 450 4508016 CONTROL NASAL HEMOR-ANTERIOR $655.00 450 4531505 INTUBATION $660.00 450 4506920 "REMOVAL, IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL" $660.00 450 4507505 REMOVAL FINGERNAIL $690.00 450 4513122 CMPLX RPR S/A/L ADDL 5 CM/> $711.00 450 4508024 CONTROL NASAL HEMOR-POSTERIOR $727.00 450 4503090 BLOOD ADMINISTRATION-ER <4HRS $729.00 450 4513120 CMPLX RPR S/A/L 1.1-2.5 CM $739.00 450 4513100 CMPLX RPR TRUNK 1.1-2.5 CM $739.00 450 4512013 RPR F/E/E/N/L/M 2.6-5.0 CM $780.00 450 4502209 REMOVAL FOREIGN BODY CORNEA $781.00 450 4504304 BLOOD ADMINISTRATION-ER 4-8 HRS $785.00 450 4505004 EMERGENCY ROOM LEVEL V $797.00 450 4505005 EMERGENCY ROOM LEVEL V $797.00 450 4512041 INTMD RPR N-HF/GENIT 2.5CM/< $800.00 450 7611420 EXC H-F-NK-SP B9+MARG 0.5/< $800.00 450 4512004 RPR S/N/AX/GEN/TRK7.6-12.5CM $825.00 450 4501052 NASOGASTRIC TUBE INSERTION $825.00 450 4504379 GASTRIC LAVAGE/GI BLEED $825.00 450 4507000 CARDIOPULMONARY RESUSCITATION $826.00 450 4512051 INTMD RPR FACE/MM 2.5 CM/< $880.00 450 4516010 "DRAINAGE OF FINGER ABSCESS, SIMPLE" $880.00 450 4513102 CMPLX RPR TRUNK ADDL 5CM/< $956.00 450 4513151 CMPLX RPR E/N/E/L 1.1-2.5 CM $964.00 450 4513153 CMPLX RPR E/N/E/L ADDL 5CM/< $970.00 450 4516025 "DRAINAGE OF PALM BURSA, SINGLE" $970.00 450 4516034 "INCISION, HAND/FINGER BONE LESION" $970.00 450 4512005 RPR S/N/A/GEN/TRK12.6-20.0CM "$1,035.00 " 450 4564493 "INJ PARA FACET W/IMAGING, SINGLE VIEW" "$1,047.25 " 450 4513131 CMPLX RPR F/C/C/M/N/AX/G/H/F "$1,055.00 " 450 4503504 CLOSED TX CLAVICLE FRACTURE W/O MANIPULATION "$1,080.00 " 450 4535050 CLOSED TX CLAVICULAR FX W/MANIPULATION "$1,080.00 " 450 4504601 CLOSED TX ELBOW DISLOCATION "$1,080.00 " 450 4502662 TX DISLOCATED METACARPAL W/MANIPULATION "$1,080.00 " 450 4506770 TX DISLOCATED INTERPHALANGEAL JOINT "$1,080.00 " 450 4507265 CLOSED TX DISLOCATED HIP PROTHESIS "$1,080.00 " 450 4512014 RPR F/E/E/N/L/M 5.1-7.5 CM "$1,090.00 " 450 4512042 INTMD RPR N-HF/GENIT2.6-7.5 "$1,090.00 " 450 4512052 INTMD RPR FACE/MM 2.6-5.0 CM "$1,090.00 " 450 4513121 CMPLX RPR S/A/L 2.6-7.5 CM "$1,151.00 " 450 4506507 CLOSED TX SHOULDER DISLOCATION W/MANIP "$1,200.00 " 450 4502084 THROMBOLYTIC THERAPY "$1,230.00 " 450 4503207 CHEST TUBE PLACEMENT "$1,293.00 " 450 4512053 INTMD RPR FACE/MM 5.1-7.5 CM "$1,300.00 " 450 4513132 CMPLX RPR F/C/C/M/N/AX/G/H/F "$1,305.00 " 450 4510060 "I & D OF ABCESS, SIMPLE" "$1,365.00 " 450 4501508 SKIN GRAFT DONOR SITE PREPARE "$1,370.00 " 450 4511100 BIOPSY SKIN LESION "$1,375.00 " 450 4512044 INTMD RPR N-HF/GENIT7.6-12.5 "$1,380.00 " 450 4512015 RPR F/E/E/N/L/M 7.6-12.5 CM "$1,400.00 " 450 4513152 CMPLX RPR E/N/E/L 2.6-7.5 CM "$1,407.00 " 450 4516011 "DRAINAGE OF FINGER ABSCESS, COMPLEX" "$1,420.00 " 450 4513101 CMPLX RPR TRUNK 2.6-7.5 CM "$1,440.00 " 450 4501011 REMOVAL FOREIGN BODY-SKIN "$1,440.00 " 450 4512054 INTMD RPR FACE/MM 7.6-12.5CM "$1,510.00 " 450 4502670 TX FINGER SHAFT FX W/MANIPULATION "$1,520.00 " 450 4501037 WOUND EXPLORATION-EXTREMITY "$1,561.00 " 450 4500112 THORACENTESIS "$1,595.00 " 450 4512031 INTMD RPR S/A/T/EXT 2.5 CM/< "$1,615.00 " 450 4616030 "DRAINAGE OF PALM BURSA, MULTIPLE" "$1,650.00 " 450 4512045 INTMD RPR N-HF/GENIT12.6-20 "$1,670.00 " 450 4512016 RPR FE/E/EN/L/M 12.6-20.0 CM "$1,710.00 " 450 4512055 INTMD RPR FACE/MM 12.6-20 CM "$1,720.00 " 450 7611400 EXC TR-EXT B9+MARG 0.5 CM< "$1,800.00 " 450 4512006 RPR S/N/A/GEN/TRK20.1-30.0CM "$1,830.00 " 450 4616020 "DRAIN HAND TENDON SHEATH, EA" "$1,895.00 " 450 4512056 INTMD RPR FACE/MM 20.1-30.0 "$1,930.00 " 450 4512046 INTMD RPR N-HF/GENIT20.1-30 "$1,960.00 " 450 4516070 "ARTHROTOMY, CARPO JOINT W/TX" "$1,985.00 " 450 4516075 "ARTHROTOMY, METACAR JOINT W/TX, EA" "$1,985.00 " 450 4516080 "ARTHROTOMY, INTERPHAL JOINT W/TX, EA" "$1,985.00 " 450 4502052 REMOVAL - FOREIGN BODY - LEG "$2,017.00 " 450 4512017 RPR FE/E/EN/L/M 20.1-30.0 CM "$2,020.00 " 450 4500468 I & D PERIANAL ABSCESS "$2,054.00 " 450 4501318 CLOSED TRMT NASAL FRACTURE "$2,060.00 " 450 4506002 CRITICAL CARE--1ST HOUR "$2,195.00 " 450 4512047 INTMD RPR N-HF/GENIT >30.0CM "$2,250.00 " 450 4512057 INTMD RPR FACE/MM >30.0 CM "$2,250.00 " 450 7611403 EXCISION/SKIN 0.6-1.0 CM T/A/L "$2,330.00 " 450 4512007 RPR S/N/AX/GEN/TRNK >30.0 CM "$2,340.00 " 450 4512018 RPR F/E/E/N/L/M >30.0 CM "$2,340.00 " 450 4512032 INTMD RPR S/A/T/EXT 2.6-7.5 "$2,510.00 " 450 4505608 CLOSED TX RADIAL FX W/MANIPULATION "$2,585.00 " 450 4581906 "REMOVAL FOREIGN BODY FOOT, SUBCU" "$2,660.00 " 450 7616238 EXCISION/MAL LES 2.1-3.0 S/N/H/F "$2,810.00 " 450 4507810 ER CLOSED TX OF ANKLE FX WITH MANIPULATION "$2,860.00 " 450 7611402 EXC TR-EXT B9+MARG 1.1-2 CM "$2,860.00 " 450 4506747 TX FINGER ARTICULAR FX W/MANIPULATION "$3,360.00 " 450 4512034 INTMD RPR S/TR/EXT 7.6-12.5 "$3,405.00 " 450 4506556 INSERTION CENTRAL VENOUS CATHETER "$3,565.00 " 450 7611404 EXC TR-EXT B9+MARG 3.1-4 CM "$3,920.00 " 450 4512035 INTMD RPR S/A/T/EXT 12.6-20 "$4,300.00 " 450 4512036 INTMD RPR S/A/T/EXT 20.1-30 "$5,195.00 " 450 4512037 INTMD RPR S/TR/EXT >30.0 CM "$6,090.00 " 450 4509409 ER VAGINAL DELIVERY ONLY W OR WO EPISIOTOMY "$6,790.00 " 450 4646642 AEROSOL TREATMENT $85.00 460 4646659 AEROSOL TREATMENT - SUBSEQUENT TX $85.00 460 4641007 ACAPELLA SUBSEQUENT $89.00 460 4646683 CHEST PHYSIOTHERAPY SUBSEQUENT $89.00 460 4647608 PULSE OXIMETRY - PER SPOT CHECK $140.75 460 4640017 ACAPELLA INITIAL $163.00 460 4646675 CHEST PHYSIOTHERAPY $163.00 460 4604625 SIX MINUTE WALK $192.00 460 4647616 PULSE OXIMETRY - PER DAY/SURGERY $246.75 460 4642203 MDI-SUBSEQUENT TX $264.00 460 4641106 MDI-INITIAL TX $264.00 460 4647624 AEROSOL INSTRUCTION SUQ TIMES/DAY $264.00 460 4647632 PULSE OXIMETRY OVER NIGHT $320.00 460 4640603 PULMONARY FUNCTION (PRE & POST) $379.00 460 4640108 PULMONARY FUNCTION (SIMPLE) $480.00 460 4646600 C PAP $941.00 460 4646618 BI PAP $941.00 460 4833083 CARDIAC ECHO IMAGING DEVICE IMAGE QUALITY NARRATIVE BY US "$1,391.00 " 480 4833067 CARDIAC ECHO IMAGING DEVICE IMAGE QUALITY BY US "$2,200.00 " 480 4808929 US ECHO COMPLETE W/ DEFINITY "$2,300.00 " 480 7330152 NM CARDIAC STRESS TEST "$3,675.00 " 482 4893325 US CARDIAC COLOR $600.00 483 4893320 US CARDIAC DOPPLER $600.00 483 4893321 US CARDIAC DOPPLER LIMITED $600.00 483 5103015 TELEMEDICINE $45.00 510 5100011 OUT-PATIENT LEVEL ESTABLISHED PATIENT $79.00 510 5100012 OUT-PATIENT LEVEL ESTABLISHED PATIENT - MCD $79.00 510 7619208 OUT-PATIENT LEVEL-NEW PATIENT $90.00 510 7612120 OUT-PATIENT LEVEL-TREATMENT ROOM $115.00 510 7612138 OUT-PATIENT LEVEL-TREATMENT ROOM $145.00 510 6141816 MRI ABDOMEN WO CONTRAST "$1,425.00 " 610 6115505 MRI CHEST WO CONTRAST "$1,425.00 " 610 6137210 MRI LOWER EXTREMITY JOINT WO CONTRAST "$1,425.00 " 610 6137186 MRI LOWER EXTREMITY WO CONTRAST "$1,425.00 " 610 6105407 MRI ORBIT AND FACE AND NECK WO CONTRAST "$1,425.00 " 610 6121958 MRI PELVIS WO CONTRAST "$1,425.00 " 610 6103360 MRI TEMPOROMANDIBULAR JOINT "$1,425.00 " 610 6132211 MRI UPPER EXTREMITY JOINT WO CONTRAST "$1,425.00 " 610 6132187 MRI UPPER EXTREMITY WO CONTRAST "$1,425.00 " 610 6121487 MRI SPINE LUMBAR WO CONTRAST "$1,425.00 " 610 6121412 MRI SPINE CERVICAL WO CONTRAST "$1,425.00 " 610 6121461 MRI SPINE THORACIC WO CONTRAST "$1,425.00 " 610 6141824 MRI ABDOMEN W CONTRAST IV "$1,775.00 " 610 6115513 MRI CHEST W CONTRAST IV "$1,775.00 " 610 6137228 MRI LOWER EXTREMITY JOINT W CONTRAST IV "$1,775.00 " 610 6137194 MRI LOWER EXTREMITY W CONTRAST IV "$1,775.00 " 610 6105423 MRI ORBIT AND FACE AND NECK W CONTRAST IV "$1,775.00 " 610 6121966 MRI PELVIS W CONTRAST IV "$1,775.00 " 610 6132195 MRI UPPER EXTREMITY NON JOINT W CONTRAST IV "$1,775.00 " 610 6132229 MRI UPPER EXTREMITY JOINT W CONTRAST IV "$1,775.00 " 610 6121420 MRI SPINE CERVICAL W CONTRAST IV "$1,775.00 " 610 6121495 MRI SPINE LUMBAR W CONTRAST IV "$1,775.00 " 610 6121479 MRI SPINE THORACIC W CONTRAST IT "$1,775.00 " 610 6141832 MRI ABDOMEN W AND WO CONTRAST IV "$2,125.00 " 610 6115521 MRI CHEST W AND WO CONTRAST IV "$2,125.00 " 610 6137236 MRI LOWER EXTREMITY JOINT W AND WO CONTRAST IV "$2,125.00 " 610 6137202 MRI LOWER EXTREMITY W AND WO CONTRAST IV "$2,125.00 " 610 6105431 MRI ORBIT AND FACE AND NECK W AND WO CONTRAST IV "$2,125.00 " 610 6121974 MRI PELVIS W AND WO CONTRAST IV "$2,125.00 " 610 6132237 MRI UPPER EXTREMITY JOINT W AND WO CONTRAST IV "$2,125.00 " 610 6132203 MRI UPPER EXTREMITY NON JOINT W AND WO CONTRAST IV "$2,125.00 " 610 6121560 MRI SPINE CERVICAL W AND WO CONTRAST IT "$2,125.00 " 610 6121586 MRI SPINE LUMBAR W AND WO CONTRAST IV "$2,125.00 " 610 6121578 MRI SPINE THORACIC W AND WO CONTRAST IV "$2,125.00 " 610 6105514 MRI BRAIN WO CONTRAST "$1,425.00 " 611 6105530 MRI BRAIN W AND WO CONTRAST IV "$2,125.00 " 611 6105449 MRA HEAD VESSELS ANGIOGRAM WO CONTRAST "$1,650.00 " 615 6105498 MRA NECK VEINS ANGIOGRAM W AND WO CONTRAST IV "$1,650.00 " 615 6100547 "MRA, NECK WITHOUT CONTRAST" "$1,650.00 " 615 6340630A OMNIPAQUE 300 300 MG IODINE/ML INTRAVENOUS SOLUTION (1ML) $9.50 636 6350001A OMNIPAQUE 350 350 MG IODINE/ML INTRAVENOUS SOLUTION (1ML) $9.50 636 6350019 MYCOPHENOLIC ACID 360MG TABLET $15.00 636 6340020 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION $16.00 636 6340024 METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION $16.00 636 6340070 AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION $16.00 636 6340072 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION $16.00 636 6340109 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION $16.00 636 6340115 GENTAMICIN 40 MG/ML INJECTION SOLUTION $16.00 636 6340142 LORAZEPAM 2 MG/ML INJECTION SOLUTION $16.00 636 6340144 MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION $16.00 636 6340171 SOLU-MEDROL (PF) 40 MG/ML SOLUTION FOR INJECTION $16.00 636 6340174 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $16.00 636 6340187 MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION $16.00 636 6340195 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (50ML) $16.00 636 6340216 CEREBYX 100 MG PE/2 ML INJECTION SOLUTION $16.00 636 6340227 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION $16.00 636 6340245 TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION $16.00 636 6340269 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $16.00 636 6340556 MORPHINE 10 MG/ML INTRAVENOUS CARTRIDGE $16.00 636 6340592 CALCIUM GLUCONATE 10% $16.00 636 6340679 HYDROMORPHONE 2 MG/ML INJECTION SOLUTION $16.00 636 6340048 DEMEROL (PF) 25 MG/ML INJECTION SYRINGE $16.00 636 6340049 DEMEROL (PF) 50 MG/ML INJECTION SYRINGE $16.00 636 6340052 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (2ML) $16.00 636 6340080 ATROPINE 0.4 MG/ML INJECTION SOLUTION $16.00 636 6340133 KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION $16.00 636 6340137 FUROSEMIDE 10 MG/ML INJECTION SOLUTION (4ML) $16.00 636 6340165A ZANTAC 50 MG/2 ML (25 MG/ML) INJECTION SOLUTION $16.00 636 6340196 SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK (100ML) $16.00 636 6340205 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (500ML) $16.00 636 6340214 ATROPINE 0.1 MG/ML INJECTION SYRINGE $16.00 636 6340551 PROMETHAZINE 25 MG/ML INJECTION SOLUTION $16.00 636 6340581 DEMEROL (PF) 100 MG/ML INJECTION SYRINGE $16.00 636 6340582 MORPHINE 4 MG/ML INTRAVENOUS CARTRIDGE $16.00 636 6340584 MORPHINE 2 MG/ML INTRAVENOUS CARTRIDGE $16.00 636 6340804 PROMETHAZINE 50 MG/ML INJECTION SOLUTION $16.00 636 6340888 DEXAMETHASONE 4 MG/ML INJECTION SOLUTION (1ML) $16.00 636 6340938 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (100ML) $16.00 636 6340939 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (250ML) $16.00 636 6350003 VANCOMYCIN 500 MG INTRAVENOUS SOLUTION $16.00 636 6340165 RANITIDINE 50 MG/2 ML (25 MG/ML) INJECTION SOLUTION (2ML) $16.00 636 6340136 FUROSEMIDE 10 MG/ML INJECTION SOLUTION (2ML) $16.00 636 6350004 HYDROXYZINE HCL 25 MG/ML INTRAMUSCULAR SOLUTION $16.00 636 6340199 SODIUM CHLORIDE 0.9% INTRAVENOUS SOLUTION (100ML) $16.00 636 6340726 PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION $16.00 636 6350016 DEXAMETHASONE 10MG/ML INJ $16.00 636 6340744 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (150ML) $16.00 636 6340640 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION (50ML) $16.00 636 6340739 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (5ML) $16.00 636 6340713 DEXAMETHASONE 4 MG/ML INJECTION SOLUTION (5ML) $16.00 636 6340161 PITOCIN 10 UNIT/ML INJECTION SOLUTION $16.00 636 6350020 "ketorolac 15 MG/ML VIAL 15 mcg, 1 mL" $16.00 636 6340226 MORPHINE 5 MG/ML INJECTION SOLUTION $16.00 636 6350017 HYDROMORPHONE 1MG/ML INJ $16.00 636 6350024 "LACTATED RINGERS INJECTION 500 mL, 500 mL" $16.00 636 6340125 HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION $16.17 636 6340805 OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION $17.22 636 6340629 OMNISCAN 10 MMOL/20 ML (287 MG/ML) INTRAVENOUS SYRINGE $17.50 636 6340201 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (1000ML) $17.63 636 6340104 LANOXIN 250 MCG/ML INJECTION SOLUTION $18.72 636 6340190 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (1000ML) $19.25 636 6340206 LACTATED RINGERS INTRAVENOUS SOLUTION $19.25 636 6340197 SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK (250ML) $19.25 636 6340193 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (250ML) $19.25 636 6340192 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (500ML) $19.25 636 6340168 SOLU-MEDROL (PF) 125 MG/2 ML SOLUTION FOR INJECTION $19.68 636 6350018 ZORTRESS 0.25MG TABLET $20.00 636 6340315 FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK $20.46 636 6350007 FLUCONAZOLE 100 MG/50 ML IN SODIUM CHLORIDE (ISO) INTRAVENOUS PIGGYBACK $20.46 636 6340143 METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION $20.87 636 6340184 VITAMIN K 1 MG/0.5 ML INJECTION SOLUTION $21.51 636 6340710 DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION $23.35 636 6340580 SOLU-CORTEF (PF) 100 MG/2 ML SOLUTION FOR INJECTION $24.50 636 6340272 CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK $25.00 636 6340093 TAZICEF 1 GRAM SOLUTION FOR INJECTION $25.00 636 6340046 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION $26.14 636 6340657 CEFAZOLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK $26.14 636 6340705 DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION $26.35 636 6340236 VANCOMYCIN 1000 MG INTRAVENOUS SOLUTION $29.75 636 6340311 VANCOMYCIN 1GM INJ $29.75 636 6350022 "COLISTIMETHATE 150 MG VIAL 150 mcg, 1 each" $30.00 636 6340735 DOPAMINE 200 MG/250 ML (800 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN $30.64 636 6340157 PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION $31.42 636 6340134 KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION (2ML) $32.00 636 6340122 HEPARIN (PORCINE) 10000 UNIT/ML INJECTION SOLUTION $32.34 636 6340077 QUELICIN 20 MG/ML INJECTION SOLUTION $32.81 636 6340339 LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK $33.02 636 6340079 AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION $33.25 636 6340764 ADRENALIN 1 MG/ML (1:1000) (1 ML) INJECTION SOLUTION $33.70 636 6340069 EPINEPHRINE 0.1 MG/ML (1:10000) INJECTION SYRINGE $33.70 636 6340182 THIAMINE HCL HCL 100 MG/ML INJECTION SOLUTION $33.87 636 6340377 PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION $34.45 636 6340059 DIAZEPAM 5 MG/ML INJECTION SYRINGE $34.79 636 6340280 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION $36.46 636 6340169 SOLU-MEDROL 500 MG INTRAVENOUS SOLUTION $38.43 636 6340277 CEFEPIME 1 GRAM SOLUTION FOR INJECTION $39.00 636 6340177 KENALOG 40 MG/ML SUSPENSION FOR INJECTION $39.21 636 6340189 SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION $40.17 636 6340078 HYDRALAZINE 20 MG/ML INJECTION $40.44 636 6340660 HEPARIN LOCK FLUSH (PORCINE) (PF) 100 UNIT/ML INTRAVENOUS SYRINGE $40.85 636 6340051 DEPO-MEDROL 80 MG/ML SUSPENSION FOR INJECTION $41.32 636 6340394 NALOXONE 0.4 MG/ML INJECTION SOLUTION $42.31 636 6340248 CEFTRIAXONE 500 MG SOLUTION FOR INJECTION $42.89 636 6340610 ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION $44.93 636 6340127 SOLU-CORTEF (PF) 250 MG/2 ML SOLUTION FOR INJECTION $45.50 636 6340088 CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION $46.23 636 6340112 DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS $50.55 636 6350025 "ceFAZolin 2 G/50 ML-DEXTROSE 2 g, 1 each" $52.00 636 6340139 LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK $52.76 636 6340981A ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION (2ML) $57.60 636 6340981 ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION (2ML) $57.60 636 6340159 PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION $64.95 636 6340237 TENIVAC (PF) 5 LF UNIT-2 LF UNIT/0.5 ML INTRAMUSCULAR SYRINGE $68.90 636 6350006 LEVETIRACETAM 500MG/5ML IV $70.00 636 6340030 ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE $75.88 636 6340723 NESACAINE-MPF 30 MG/ML (3 %) INJECTION SOLUTION $76.18 636 6309957 PERFLUTREN (DEFINITY) PER ML $77.00 636 6340140 LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK $79.14 636 6340243 CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION $85.78 636 6340310 CEFTRIAXONE 1 GRAM INTRAVENOUS SOLUTION $85.78 636 6340031 ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE $101.17 636 6340301 SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION $114.34 636 6350012 "EPOGEN 3,000 UNIT/ML INJECTION SOLUTION" $115.00 636 6340095 PRIMAXIN 500 MG INTRAVENOUS SOLUTION $115.50 636 6340894 ROBAXIN 100 MG/ML INJECTION SOLUTION $119.14 636 6340141 LINEZOLID 600 MG/300 ML INTRAVENOUS SOLUTION $129.60 636 6340032 ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE $151.75 636 6340034 ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE $202.33 636 6340185 VITAMIN K1 10 MG/ML INJECTION SOLUTION $215.13 636 6340987 MORPHINE (PF) 30 MG/30 ML PCA INTRAVENOUS SOLUTION $221.26 636 6340305 INVANZ 1 GRAM SOLUTION FOR INJECTION $240.83 636 6340035 ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE $252.92 636 6340013 RECOMBIVAX HB (PF) 10 MCG/ML INTRAMUSCULAR SUSPENSION $265.07 636 6340602 EPIPEN JR 2-PAK 0.15 MG/0.3 ML (1:2000) INJECTIONAUTO-INJECTOR $280.80 636 6340369 PROTOPAM CHLORIDE 1 GRAM SOLUTION FOR INJECTION $295.13 636 6340727 ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE $303.50 636 6340036 LOVENOX 300 MG/3 ML SUBCUTANEOUS SOLUTION $310.00 636 6340738 EPIPEN 2-PAK 0.3 MG/0.3 ML (1:1000) INJECTIONAUTO-INJECTOR $442.79 636 6350021 "AVYCAZ 2.5 GRAM VIAL 2.5 g, 1 each" $500.00 636 6340770 NABI-HB GREATER THAN 312 UNIT/ML INTRAMUSCULAR SOLUTION $500.22 636 6340117 GLUCAGON EMERGENCY KIT (HUMAN-RECOMB) 1 MG INJECTION $515.71 636 6340045 CATHFLO ACTIVASE 2 MG SOLUTION FOR INJECTION $524.01 636 6340294 PROCRIT 10000 UNIT/ML INJECTION SOLUTION $657.99 636 6340990 MORPHINE (PF) 150 MG/30 ML PCA INTRAVENOUS SOLUTION $724.03 636 6340299 LEXISCAN 0.4 MG/5 ML INTRAVENOUS SYRINGE $745.58 636 6340265 PROCRIT 20000 UNIT/ML INJECTION SOLUTION $791.45 636 6340019 IMOVAX RABIES VACCINE (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION $841.95 636 6340019A RABAVERT (PF) 2.5 UNIT INTRAMUSCULAR SUSPENSION (2.5UNIT) $841.95 636 6340229 HUMULIN 70/30 100 UNIT/ML SUBCUTANEOUS SUSPENSION $960.00 636 6340758 HUMULIN R 100 UNIT/ML INJECTION SOLUTION $960.00 636 6340130 HUMALOG 100 UNIT/ML SUBCUTANEOUS SOLUTION $960.00 636 6340771 HUMULIN N 100 UNIT/ML SUBCUTANEOUS SUSPENSION $960.00 636 6340266 PROCRIT 40000 UNIT/ML INJECTION SOLUTION "$1,063.35 " 636 6340271 SYNVISC 16 MG/2 ML INTRA-ARTICULAR SYRINGE "$1,129.62 " 636 6340025 HYPERTET S/D (PF) 250 UNIT INTRAMUSCULAR SYRINGE "$1,168.53 " 636 6340304 SYNVISC-ONE 48 MG/6 ML INTRA-ARTICULAR SYRINGE "$1,194.67 " 636 6340844 NEUPOGEN 300 MCG/0.5 ML INJECTION SYRINGE "$1,293.52 " 636 6340839 RECLAST 5 MG/100 ML INTRAVENOUS SOLUTION "$1,321.00 " 636 6350013 ZOLEDRONIC ACID 5MG/100ML INTRAVENOUS SOLN "$1,321.00 " 636 6340231 CUBICIN 500 MG INTRAVENOUS SOLUTION "$1,361.60 " 636 6350008 NEUPOGEN 480 MLG INJECTION SYRINGE "$1,526.00 " 636 6340309 XOLAIR 150 MG SUBCUTANEOUS SOLUTION "$2,130.00 " 636 6340028 REMICADE 100 MG INTRAVENOUS SOLUTION "$2,253.00 " 636 6340318 PROLIA 60 MG/ML SUBCUTANEOUS SYRINGE "$2,285.00 " 636 6350023 "STELARA 130 MG/26 ML VIAL 130 mcg, 26 mL" "$2,800.00 " 636 6340278 NOVOLOG 100 UNIT/ML SUBCUTANEOUS SOLUTION "$3,200.00 " 636 6340300 LEVEMIR 100 UNIT/ML SUBCUTANEOUS SOLUTION "$3,200.00 " 636 6340230 LANTUS 100 UNIT/ML SUBCUTANEOUS SOLUTION "$3,200.00 " 636 6340807 PROLASTIN-C 1000 MG INTRAVENOUS SOLUTION "$5,300.00 " 636 6350015 NUCALA 100MG INJ "$5,570.00 " 636 6340857 CROFAB SOLUTION FOR INJECTION "$5,800.00 " 636 6340855 DIGIFAB 40 MG INTRAVENOUS SOLUTION "$6,053.50 " 636 6340924 LUPRON DEPOT (3 MONTH) 22.5 MG INTRAMUSCULAR SYRINGE KIT "$6,333.00 " 636 6340040 NEULASTA 6 MG/0.6 ML SUBCUTANEOUS SYRINGE "$9,672.00 " 636 6340029 TNKASE 50 MG INTRAVENOUS KIT "$10,380.50 " 636 6350005 LUPRON DEPOT (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT "$15,450.00 " 636 6350009 ACTIVASE 100 MG INTRAVENOUS SOLUTION "$16,000.00 " 636 7100308 RECOVERY-STEP DOWN-EACH ADD'L 15MIN $29.00 710 7100209 RECOVERY-STEP DOWN-1ST 30 MIN $202.75 710 7330053 EKG 12 LEAD OR RHYTHM STRIP $201.50 730 7332240 HOLTER MONITOR HOOK UP $355.00 731 7332323 HOLTER MONITOR ANALYZE $355.00 731 7627888 IM ANTIBIOTIC ADMINISTRATION $54.50 760 7627821 SUB Q IM ADMINISTRATION $95.00 760 7627847 IV PUSH - INJECTION $95.00 760 7627755 IV PUSH-SEQUENTIAL-DRUG $95.00 760 7607765 IV PUSH-SEQUENTIAL-SAME DRUG $95.00 760 7626005 INTRAVENOUS ACCESS $100.25 760 7627748 PORT-A-CATH/PICC/FLUSH $120.00 760 7617681 IV THERAPY-CONCURRENT INFUSION $161.75 760 7627615 IV INFUSION-HYDRATION--ADDL HOUR $164.00 760 7627813 IV THERAPY (ADDL HOUR) $165.00 760 7627672 IV THERAPY-SEQUENTIAL DRUG 1ST HOUR $165.00 760 7605926 BLOOD COLLECTION FROM PICC LINE $185.00 760 7605918 BLOOD COLLECTION FROM PORT $185.00 760 7627607 IV INFUSION-HYDRATION--INITIAL $290.00 760 7627805 IV THERAPY (1ST HOUR) $295.00 760 7610439 IM ANTIBIOTIC ADMINISTRATION $69.75 761 7619216 OUT-PATIENT LEVEL-ESTABLISHED LEVEL $85.00 761 7664022 INJECTION HORMONAL ANTI-NEOPLASTIC $87.00 761 7614712 RABIES VACCINATION ADMINISTRATION $87.00 761 7610389 SUB Q IM ADMINISTRATION $95.00 761 7617756 IV PUSH-SEQUENTIAL-DRUG $95.00 761 7610777 IV PUSH-SEQUENTIAL-SAME DRUG $95.00 761 7610785 IV PUSH - INJECTION $95.00 761 7610280 PORT-A-CATH/PICC/CENTRAL LINE FLUSH $120.00 761 7610405 INTRA-ARTERIAL ADMINISTRATION $136.50 761 7660004 INTRAVENOUS ACCESS $145.00 761 7627680 IV THERAPY-CONCURRENT INFUSION $170.00 761 7617616 IV INFUSION-HYDRATION--EACH ADDL HR $245.00 761 7610413 IV THERAPY (ADDL HOUR) $245.00 761 7619752 DEBRIDEMENT LESION $250.00 761 7613003 SHAVING LESION 0.5-LESS T/A/L $260.00 761 7613102 SHAVING LESION 0.5-LESS F/E/N/L $265.00 761 7610561 TRIM SKIN LESION $285.00 761 7616592 BLOOD COLLECTION FROM PORT $285.00 761 7615925 BLOOD COLLECTION FROM PICC LINE $285.00 761 7617673 IV THERAPY SEQUENTIAL DRUG-1ST HR $285.00 761 7617608 IV INFUSION-HYDRATION--INITIAL $315.00 761 7610421 IV THERAPY (1ST HOUR) $315.00 761 7610553 INJECTION TRIGGER POINT (1 OR 2) $377.00 761 7618010 IV THERAPY HIGH/COMP DRUG ADD'L HR $420.00 761 7611301 SHAVING LESION 0.6-1.0 CM T/A/L $425.00 761 7615172 BLADDER INSTILLATION $425.00 761 7611791 BLADDER SCAN $425.00 761 7619703 REMOVAL SHORT ARM CAST $450.00 761 7614134 IV THERAPY HIGH/COMPLEX DRUG 1ST HR $456.00 761 7611130 SHAVING LESION 0.6-1.0 F/E/N/L $469.00 761 7612849 DESTRUCTION MALIG LESION F/E/E/N $525.00 761 7611107 BIOPSY OF SKIN ADDITIONAL LESION $540.00 761 7610009 DESTRUCTION PREMALG. LESION $560.00 761 7611304 SHAVING LESION >2 CM S/N/H/F $650.00 761 7610256 INTUBATION $660.00 761 7610298 DECLOTTING BLOCKED CENTRAL LINE $665.00 761 4511755 BIOPSY NAIL UNIT $685.00 761 7611010 ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPH $685.00 761 7612005 LAC REPAIR EXTRIMITY $705.00 761 7610587 BLOOD ADMINISTRATION <4HRS $729.00 761 7616006 INJECTION JOINT-SMALL $735.00 761 7610022 BREAST BIOPSY FINE NEEDLE ASPIRATION $755.00 761 7610021 BREAST BIOPSY FINE NEEDLE ASPIRATION W/O GUIDANCE $755.00 761 7616444 INJ TRIGEMINAL NERVE BLOCK $775.00 761 7616055 INJECTION-INTERMEDIATE JOINT $780.00 761 7610371 BLOOD ADMINISTRATION 4-8 HOURS $785.00 761 7614209 EXCISION/SKIN 0.5 CM & LESS S/N/H/F $800.00 761 7611620 EXC H-F-NK-SP MAL+MARG 0.5/< $875.00 761 7615008 DRAINAGE OF HYDROCELE $879.00 761 7610306 INJECTION-MAJOR JOINT $895.00 761 7612062 PROFESSIONAL-MAJOR JOINT INJECTION $895.00 761 7611640 EXC F/E/E/N/L MAL+MRG 0.5CM< $900.00 761 7611600 EXC TR-EXT MAL+MARG 0.5 CM/< $920.00 761 7611007 ASPIRATION CYST $985.00 761 7614376 GASTROSTOMY TUBE CHANGE W/O GUIDANCE $990.00 761 7612708 "SPINAL PUNCTURE, LUMBAR" "$1,050.00 " 761 7612278 INJECT EPIDURAL PATCH "$1,050.00 " 761 7619100 BIOPSY BREAST NEEDLE CORE "$1,110.00 " 761 7610504 BIOPSY GENITAL ORGAN "$1,120.00 " 761 7616527 REMOVAL FOREIGN BODY CORNEA "$1,165.00 " 761 7611106 BIOPSY OF SKIN "$1,175.00 " 761 7612310 EPIDURAL INJ STEROID C-SPINE/T-SPINE "$1,265.00 " 761 7610074 EPIDURAL INJ STEROID L-SPINE "$1,265.00 " 761 7611440 EXC FACE-MM B9+MARG 0.5 CM/< "$1,285.00 " 761 7614159 CIRCUMCISION "$1,295.00 " 761 7614217 EXCISION/SKIN 0.6-1.0 CM S/N/H/F "$1,330.00 " 761 7611421 EXC H-F-NK-SP B9+MARG 0.6-1 "$1,330.00 " 761 7612427 REMOVAL FOREIGN BODY-UPPERARM "$1,350.00 " 761 7612554 "THORACENTESIS, ASPIRATE PLEURA W/O IMAGING" "$1,370.00 " 761 7614415 EXCISION/SKIN 0.6-1.0CM F/E/N/L "$1,450.00 " 761 7611441 EXC FACE-MM B9+MARG 0.6-1 CM "$1,450.00 " 761 7616014 EXCISION/MAL LESION 0.6-1.0 T/A/L "$1,470.00 " 761 7619083 PARACENTESIS W/GUIDANCE "$1,495.00 " 761 7614407 EXCISION/SKIN 0.5CM & LESS F/E/N/L "$1,495.00 " 761 7645378 COLONOSCOPY DIAG - PROCEDURE HAULTED "$1,500.00 " 761 7611621 EXC S/N/H/F/G MAL+MRG 0.6-1 "$1,520.00 " 761 7611201 REMOVE SKIN TAGS EA ADDTL 10 "$1,550.00 " 761 7616410 EXCISION/MAL LESION 0.6-1.0 F/E/N/L "$1,550.00 " 761 7611641 EXC F/E/E/N/L MAL+MRG 0.6-1 "$1,550.00 " 761 7612555 ASPIRATE PLEURA W/ IMAGING "$1,590.00 " 761 7614423 EXCISION/SKIN 1.1-2.0 CM F/E/N/L "$1,615.00 " 761 7611442 EXC FACE-MM B9+MARG 1.1-2 CM "$1,615.00 " 761 7612054 LAYER CLOSURE 2.6-5.0 CM F/E/N/L "$1,625.00 " 761 7610132 ASPIRATION-SKIN "$1,745.00 " 761 7614431 EXCISION/SKIN 2.1-3.0 CM F/E/N/L "$1,750.00 " 761 7610058 SIGMOIDOSCOPY DIAGNOSTIC "$1,750.00 " 761 7611700 BLADDER INSTILLATION - CHEMO DRUG "$1,750.00 " 761 7616589 REMOVAL TUNNELED CV CATH "$1,765.00 " 761 7613450 DILATION OF ESOPHAGUS 1/+ PASS "$1,765.00 " 761 7611443 EXC FACE-MM B9+MARG 2.1-3 CM "$1,780.00 " 761 7611148 EXCISION/SKIN 0.5CM & LESS T/A/L "$1,800.00 " 761 7603004 REMOVAL NASAL PACKING "$1,820.00 " 761 7616600 ANOSCOPY DIAGNOSTIC "$1,825.00 " 761 7616612 ANOSCOPY-LESION REMOVAL "$1,825.00 " 761 7614449 EXCISION/SKIN 3.1-4.0 CM F/E/N/L "$1,945.00 " 761 7611444 EXC FACE-MM B9+MARG 3.1-4 CM "$1,945.00 " 761 7611015 REMOVAL FOREIGN BODY/FOREARM "$1,980.00 " 761 7611602 EXC TR-EXT MAL+MARG 1.1-2 CM "$2,020.00 " 761 7612323 EPIDURAL INJ STEROID W/FLUOROSCOPY "$2,065.00 " 761 7611446 EXC FACE-MM B9+MARG >4 CM "$2,100.00 " 761 7617004 "LIVER BIOPSY, NEEDLE" "$2,125.00 " 761 7616451 INJ SPHENO GANGLION BLOCK "$2,125.00 " 761 7616236 EXCISION/MAL LESION 1.1/2.0 S/N/H/F "$2,165.00 " 761 7611622 EXC S/N/H/F/G MAL+MRG 1.1-2 "$2,165.00 " 761 7613213 ESOPHAGOSCOPY RETRO BALLOON "$2,175.00 " 761 7613214 ESOPHAGOSC DILATE BALLOON 30 "$2,175.00 " 761 7613220 ESOPHAGOSCOPY BALLOON <30MM "$2,177.00 " 761 7613226 ESOPH ENDOSCOPY DILATION "$2,177.00 " 761 7611642 EXC F/E/E/N/L MAL+MRG 1.1-2 "$2,200.00 " 761 7610121 COLONOSCOPY SCREENING "$2,225.00 " 761 7611401 EXC TR-EXT B9+MARG 0.6-1 CM "$2,330.00 " 761 7614233 EXCISION/SKIN 2.1-3.0 CM S/N/H/F "$2,390.00 " 761 7611423 EXC H-F-NK-SP B9+MARG 2.1-3 "$2,390.00 " 761 7612000 CYSTOURETHROSCOPY "$2,425.00 " 761 7613233 EGD BALLOON DIL ESOPH 30 MM/> "$2,425.00 " 761 7613235 EGD WITH BIOPSY "$2,425.00 " 761 7613248 EGD WITH GUIDE WIRE INSERTION "$2,425.00 " 761 7610041 EGD DIAGNOSTIC - SPECIMEN COLL BRUSH/WASH "$2,425.00 " 761 7616555 INSERT NON-TUNNEL CV CATH >5YRS "$2,450.00 " 761 7616563 INSERT TUNNELED CV CATH W/PUMP "$2,450.00 " 761 7619180 "BIOPSY, ABDOMINAL OR RETROPERI MASS, NEEDLE" "$2,450.00 " 761 7611601 EXCISION/MAL LESION 2.1-3.0 T/A/L "$2,570.00 " 761 7611603 EXC TR-EXT MAL+MARG 2.1-3 CM "$2,570.00 " 761 7611422 EXC H-F-NK-SP B9+MARG 1.1-2 "$2,640.00 " 761 7614225 EXCISION/SKIN 1.1-2.0 CM S/N/H/F "$2,640.00 " 761 7617335 EXCISION SOFT TISSUE BACK <3CM "$2,675.00 " 761 7619704 REMOVAL OF EPIDURAL CATHETER "$2,675.00 " 761 7620313 LAYER CLOSURE 2.5 CM/LESS A/S/T/E "$2,700.00 " 761 7603247 "EGD, W/FOREIGN BODY REMOVAL" "$2,725.00 " 761 7611623 EXC S/N/H/F/G MAL+MRG 2.1-3 "$2,810.00 " 761 7610231 PERIPHERALLY INSERTED CENTRAL CATH (PICC) 5YR/+ "$2,840.00 " 761 7611163 EXCISION/MALLESION 2.1/3.0 F/E/N/L "$2,850.00 " 761 7614027 EXCISION/SKIN 1.1-2.0 CM T/A/L "$2,860.00 " 761 7610264 VASECTOMY "$2,875.00 " 761 7614241 EXCISION/SKIN 3.1-4.0 CM S/N/H/F "$2,920.00 " 761 7611424 EXC H-F-NK-SP B9+MARG 3.1-4 "$2,920.00 " 761 7616560 INSERT TUNNELED CV CATH <5YR "$2,925.00 " 761 7611122 REMOVAL SKIN TAGS-15 OR LESS LESION "$3,105.00 " 761 7616048 EXCISION/MAL/LESION 3.1-4.0CM T/A/L "$3,120.00 " 761 7611604 EXC TR-EXT MAL+MARG 3.1-4 CM "$3,120.00 " 761 7612047 LAYER CLOSURE 2.6-7.5 CM N/H/F "$3,150.00 " 761 7616220 EXCISION EXTERNAL SKIN TAG SINGLE "$3,180.00 " 761 7615388 COLONOSCOPY W/BIOPSY "$3,190.00 " 761 7613847 COLONOSCOPY W/TUMOR POLYP REMOVAL "$3,190.00 " 761 7615389 COLONOSCOPY W/TUMOR REMOVAL SNARE "$3,190.00 " 761 7610082 COLONOSCOPY W/ABLATION OF TUMOR "$3,190.00 " 761 7610033 COLONOSCOPY DIAGNOSTIC "$3,190.00 " 761 7613249 EGD WITH ESOPH DILATION <30 MM "$3,250.00 " 761 7614035 EXCISION/SKIN 2.1-3.0 CM T/A/L "$3,390.00 " 761 7613499 ESOPHAGUS SURGERY PROCEDURE "$3,426.00 " 761 7610322 LAYER CLOSURE 2.6-7.5 CM A/S/T/E "$3,450.00 " 761 7616246 EXCISION/MAL LES 3.1-4.0CM S/N/H/F "$3,455.00 " 761 7611624 EXC S/N/H/F/G MAL+MRG 3.1-4 "$3,455.00 " 761 7610025 CARPAL TUNNEL "$3,458.00 " 761 7614266 EXCISION/SKIN>4.0 CM S/N/H/F "$3,465.00 " 761 7611426 EXC H-F-NK-SP B9+MARG >4 CM "$3,465.00 " 761 7611643 EXCISION/MAL LESION 3.1-4.0 F/E/N/L "$3,500.00 " 761 7611644 EXC F/E/E/N/L MAL+MRG 3.1-4 "$3,500.00 " 761 7614621 HEMORRHOID BANDING "$3,500.00 " 761 7610447 EXCISION TUMOR LEG 3CM/+ "$3,505.00 " 761 7612507 EXCISION TUMOR FOREARM >3CM "$3,505.00 " 761 7610462 PORT-A-CATH REMOVAL "$3,525.00 " 761 7616590 REMOVAL TUNNELED CV CATH "$3,525.00 " 761 7612281 CYSTOSCOPY AND TREATMENT "$3,580.00 " 761 7681901 "REMOVAL FOREIGN BODY FOOT, SUBCU" "$3,670.00 " 761 7611606 EXCISION/MAL LESION>4CM T/A/L "$3,680.00 " 761 7616565 INSERT TUNNELED CV CATH (2) "$3,780.00 " 761 7616160 REMOVE TENDON SHEATH LESION HAND/FINGER "$3,820.00 " 761 7612044 LAYER CLOSURE 7.6-12.5 N/H/F "$3,900.00 " 761 7614043 EXCISION/SKIN 3.1-4.0 CM T/A/L "$3,920.00 " 761 7611627 EXCISION/MAL LESION>4CM S/N/H/F "$4,120.00 " 761 7611626 EXC S/N/H/F/G MAL+MRG >4 CM "$4,120.00 " 761 7616469 EXCISION/MAL LESION> 4CM F/E/N/L "$4,150.00 " 761 7611646 EXC F/E/E/N/L MAL+MRG >4 CM "$4,150.00 " 761 7612039 LAYER CLOSURE - 7.6-12.5 CM S/T/E "$4,200.00 " 761 7613453 "DILATION OF ESOPHAGUS, GUIDE WIRE" "$4,250.00 " 761 7615111 REMOVE WRIST TENDON LESION "$4,290.00 " 761 7617630 REMOVAL OF TENDON LESION LEG/ANKLE "$4,340.00 " 761 7612294 EXCISION SOFT TISSUE ABD 3CM/+ "$4,340.00 " 761 7619125 EXCISION BREAST MASS "$4,380.00 " 761 7614068 EXCISION/SKIN > 4CM T/A/L "$4,465.00 " 761 7611406 EXC TR-EXT B9+MARG >4.0 CM "$4,465.00 " 761 7613899 "UROLOGY SURGERY PROCEDURE, UNLISTED" "$4,550.00 " 761 7613243 EGD WITH PEG TUBE PLACEMENT "$4,585.00 " 761 7614076 EXCISION SOFT TISSUE UPPER ARM <3CM "$4,675.00 " 761 7618515 LYMPH NODE BIOPSY "$4,825.00 " 761 7612195 EXCISION SOFT TISSUE BACK 3CM/+ "$4,910.00 " 761 7616556 INSERT NON-TUNNEL CV CATH 5YR/+ "$4,910.00 " 761 7612773 EXCISION SOFT TISSUE LEG 3CM/+ "$5,250.00 " 761 7618092 REMOVAL OF TOE LESIONS "$5,275.00 " 761 7618090 REMOVAL OF FOOT LESION "$5,275.00 " 761 7612407 EXCISION TUMOR UPPER ARM OR ELBOW 5CM/+ "$5,450.00 " 761 7612153 EXCISION SOFT TISSUE CHEST 3CM/+ "$5,670.00 " 761 7616561 INSERT TUNNELED CV CATH 5YR/+ "$5,780.00 " 761 7616566 INSERT TUNNELED CV CATH "$6,400.00 " 761 7613236 EGD W/DIRECTED SUBMUCOSAL INJECTION "$6,815.00 " 761 7615206 EXCISION CORD LIPOMA "$8,490.00 " 761 7614341 REPAIR ARM TENDON/MUSCLE "$8,515.00 " 761 7620017 OBSERVATION ROOM - EACH ADDL HOUR $30.00 762 7620008 OBSERVATION ROOM - 1ST HOUR $730.00 762 7620009 OBSERVATION ROOM - 1ST HOUR $730.00 762 7620016 OBSERVATION ROOM - EACH DAY BCBS $852.50 762 9239229 US ANKLE BRACHIAL INDEX $700.00 921 9238809 CAROTID ARTERY US.DOPPLER $750.00 921 9239310 UPPER EXTREMITY ARTERY US DOPPLER LIMITED $750.00 921 9239260 US LOWER EXTREMITY ARTERIAL DOPPLER UNILATERAL $750.00 921 9239716 VEIN US.DOPPLER LIMITED $765.00 921 9239765 HEPATIC VEIN PEAK SYSTOLIC FLOW BY US.DOPPLER $794.00 921 9239708 VEIN US.DOPPLER $870.00 921 9239252 LOWER EXTREMITY ARTERY - BILATERAL US.DOPPLER $900.00 921 9239781 AORTA US.DOPPLER $904.00 921 9239302 UPPER EXTREMITY ARTERY US.DOPPLER "$1,021.00 " 921 9239757 RENAL ARTERY US.DOPPLER "$1,203.00 " 921 9293978 PORTAL VEIN AND HEPATIC VEIN US.DOPPLER "$1,203.00 " 921 9430034 CARDIAC REHAB PHASE II MON EXERCISE $180.00 943 4190237 "PR STRENGTH/ENDURANCE 1-ON-1, EA 15 MIN" $78.50 948 4190238 PULM REHAB THERAPEUTIC PROC TO IMPROVE RESP FUNCT $192.00 948 4190424 PULMONARY REHAB EXERCISE $375.00 948 3700142 ANESTHESIA - CATERACT $150.00 964 3700740 ANESTHESIA - EGD $150.00 964 3700830 ANESTHESIA - INGUINAL HERNIA $150.00 964 3700532 ANESTHESIA - PICC LINE INSERT $150.00 964 3700604 ANESTHESIA - C SPINE PROCEDURE $150.00 964 3700300 ANESTHESIA - TRIGGER POINT $150.00 964 3700635 ANESTHESIA - L SPINE PROCEDURE $150.00 964 3701935 ANESTHESIA - IMAGE GUIDED PROCEDURE - DIAG $150.00 964 3701936 ANESTHESIA - IMAGE GUIDED PROCEDURE - THER $150.00 964 3700010 ANESTHESIA - ANESTHESTIST PER POINT $150.00 964 3700810 ANESTHESIA - COLONOSCOPY $150.00 964 9600811 ANESTHESIA - COLONOSCOPY DIAG $150.00 964 9600812 ANESTHESIA - COLONOSCOPY SCREENING $150.00 964 9600813 ANESTHESIA - COLONOSCOPY W/EGD $150.00 964 9600731 ANESTHESIA - EGD $150.00 964 3700790 ANESTHESIA - LAP CHOLE $150.00 964 9640840 ANESTHESIA - LAP APPENDECTOMY $150.00 964 3700083 ANESTHESIA - LAP REPAIR INGUINAL HERNIA $150.00 964 9641810 ANESTHESIA - CARPAL TUNNEL RELEASE $150.00 964 9640520 ANESTHESIA - CLOSED CHEST PROCEDURE $150.00 964 9640921 ANESTHESIA - VASCECTOMY $150.00 964 9643280 ANES LAP ESOPHOGOGASTRIC FUNDOPLASTY $150.00 964 9643236 ANES EGD W/DIRECT SUBMUCOSAL INJ $150.00 964 9640532 ANES INSERTION OF NON-TUNNELED CENTRAL LINE $150.00 964 9641160 ANES - PROC OF PELVIS (EXCLUDING HIP) $150.00 964 9644180 "ANES PRO FEE LAPAROSCOPY, SURGICAL, ENTEROLYSIS" $150.00 964 9641610 ANES PROCEDURE ON NERVES/MUSCLES $150.00 964 9641462 ANES PROCEDURE ON LOWER LEG $150.00 964 9640300 "ANES - PROCED ON INTEG/MUSCLE SYSTEM, NECK HEAD FACE" $150.00 964 9643281 ANESTHESIA LAP REPAIR DIAG HERNIA $150.00 964 9643332 ANESTHESIA LAP REPAIR HIATAL HERNIA $150.00 964 9644005 ANESTHESIA ENTEROLYSIS $150.00 964 9649565 ANESTHESIA REPAIR RECURRENT INCIS OR VENT HERNIA $150.00 964 9640320 ANESTHESIA INTUBATION $150.00 964 9640400 ANESTHESIA - PROCEDURES ON THE INTEGUMENTARY SYS $150.00 964 9640620 ANESTHESIA - PROCEDURES ON THORACIC SPINE $150.00 964 9644202 "ANESTHESIA - LAP COLECTOMY, PARTIAL; WITH ANASTOMOSIS" $180.00 964 9758570 PRO FEE LAP LYMPH NODE BIOPSY $875.00 975 9750651 "PRO FEE LAP, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA" "$1,135.00 " 975 9754497 PRO FEE LAP APPENDECTOMY "$1,150.00 " 975 9759848 ENDO WRIST CARPAL TUNNEL "$1,210.00 " 975 9754965 PRO FEE LAP REPAIR INGUINAL HERNIA "$1,285.00 " 975 9757562 PRO FEE LAP CHOLECYSTECTOMY "$1,285.00 " 975 9759565 PRO FEE REPAIR RECURRENT INCIS OR VENT HERNIA "$1,300.00 " 975 9757563 PRO FEE LAP CHOLECYSTECTOMY W/COLANGIOGRAM "$1,400.00 " 975 9759652 PRO FEE LAP REPAIR VENT/UMB/EPIGAS HERNIA W/MESH "$1,425.00 " 975 9759654 PRO FEE LAP REPAIR INCISIONAL HERNIA W/MESH "$1,460.00 " 975 9759653 PRO FEE LAP REPAIR VENT/UMB/EPI HERNIA STRANG/INCARC "$1,625.00 " 975 4759655 PRO FEE LAP REPAIR INCISIONAL HERNIA STRANG/INCARC "$1,785.00 " 975 9754202 PRO FEE LAP ENTERECTOMY RESECTION SM INTESTINE "$1,870.00 " 975 9753280 PRO FEE LAP ESOPHOGOGASTRIC FUNDOPLASTY "$2,100.00 " 975 9754180 "PRO FEE LAPAROSCOPY, SURGICAL, ENTEROLYSIS" "$2,200.00 " 975 9754005 PRO FEE ENTEROLYSIS "$2,245.00 " 975 9753332 PRO FEE PARAESOPHAGEAL HIATAL HERNIA "$2,400.00 " 975 9753281 PRO FEE LAP REPAIR HIATAL HERNIA W/O MESH "$2,675.00 " 975 9753282 LAP REPAIR HIATAL HERNIA W/MESH "$3,000.00 " 975 9754204 " PRO FEE LAP COLECTOMY, PARTIAL; WITH ANASTOMOSIS" "$3,150.00 " 975 9753289 PRO FEE DIAPHRAGMATIC HERNIA REPAIR "$3,165.00 " 975 9606609 PROFESSIONAL-ARTERIAL PUNCTURE/ABG $36.75 981 9691304 PROFESSIONAL-SPLINT/FINGER $37.75 981 9605528 PROFESSIONAL-TRIGGER POINT INJ $51.00 981 9652058 PROFESSIONAL-FOREIGN BOD/REMOVE/EYE $57.25 981 9695156 PROFESSIONAL-SPLINT/SHORT LEG $57.25 981 9696527 PROFESSIONAL - FOREIGN/REMOVE/CORNE $57.25 981 9611740 PROFESSIONAL-NAIL DRAIN/HEMATOMA $60.50 981 9606104 PROFESSIONAL-INJECTION MAJOR JOINT $63.50 981 9692005 PROFESSIONAL-FOREIGN BOD/REMOVE/EAR $73.50 981 9692104 PROF REMOVAL IMPACTED CERUMEN $73.50 981 9693664 PROFESSIONAL - IO NEEDLE PLACEMENT $73.50 981 9669209 "PRO FEE REMOVAL, IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL" $73.50 981 9606054 PROFESSIONAL-JOINT INJECTION $75.00 981 9814455 "PRO FEE - INJ, ANESTHETIC AGENT, PLANTAR/DIGITAL NERVE" $80.00 981 9692971 PROFESSIONAL REMOVAL SHORT ARM CAST $84.00 981 9697590 PROFESSIONAL DEBRIDEMENT ABRASION $90.25 981 9690652 PROFESSIONAL-LONG ARM SPLINT $92.00 981 9692815 PROFESSIONAL-LEVEL I $94.00 981 9819050 PRO FEE - FETAL MONITORING DURING LABOR $100.00 981 9692823 PROFESSIONAL-LEVEL II $118.25 981 9660200 PROFESSIONAL DEBRIDEMENT BURN $120.75 981 9610122 PROFESSIONAL-REMOVAL FB SKIN $120.75 981 9611054 PROFESSIONAL-NASOGASTRIC TUBE $124.50 981 9609017 PROFESSIONAL-NASAL PACK/CAUTERIZED $126.00 981 9630906 PROFESSIONAL-NASAL PACK/CAUTERY/ANT $126.00 981 9692950 PROFESSIONAL - LONG LEG SPLINT $126.00 981 9691254 PROFESSIONAL-SPLINT/SHORT ARM $137.50 981 9693037 PROFESSIONAL-FOREIGN BODY/REMOVE NO $157.50 981 9617309 PROFESSIONAL-REMOVAL TOENAIL $164.75 981 9692955 PROFESSIONAL-LONG LEG CAST $164.75 981 9694050 PROFESSIONAL-SHORT LEG CAST $164.75 981 9613122 PRO FEE CMPLX RPR S/A/L ADDT'L 5 CM/> $165.00 981 9600610 PROFESSIONAL-I&D $178.50 981 9628199 PROFESSIONAL-FOREIGN BOD/REMOVE/FOO $178.50 981 9692058 PROFESSIONAL - REM FOREIGN BODY LEG $178.50 981 9600016 PROFESSIONAL-LAC REPAIR/SIMPLE $187.50 981 9612001 PROFESSIONAL-LAC REPAIR/SIMPLE $187.50 981 9612052 PROFESSIONAL-LAC REPAIR/SIMPLE $187.50 981 9612011 PROFESSIONAL-LAC REPAIR/SIMPLE $187.50 981 9612013 PROFESSIONAL-LAC REPAIR/SIMPLE $187.50 981 9612051 INTMD PRP FACE/MM 2.5 CM/< $187.50 981 9621319 PROFESSIONAL REDUCTION NASAL FX $189.50 981 9652405 PROFESSIONAL-SKIN GRAFT $190.00 981 9629817 PROFESSIONAL REDUCTION TOE FX $192.25 981 9814402 "PRO FEE - INJ, ANESTHETIC AGENT, FACIAL NERVE" $195.00 981 9692831 PROFESSIONAL-LEVEL III $204.25 981 9612004 PROFESSIONAL-LAC REPAIR/SIMPLE $216.25 981 9617507 PROFESSIONAL-REMOVAL FINGERNAIL $222.00 981 9615006 PROFESSIONAL-INTUBATION $229.50 981 9600057 PROFESSIONAL-LAC REPAIR/LAYER $253.50 981 9690751 PROFESSIONAL-SHORT ARM CAST $258.25 981 9623505 PROFESSIONAL-SPLINT CLAVICLE $263.00 981 9667700 PROFESSIONAL-REDUCT-FINGER/DISLOCAT $293.50 981 9692849 PROFESSIONAL-LEVEL IV $302.00 981 9626722 PROFESSIONAL-REDUCTION-FX FINGER $374.25 981 9612032 PROFESSIONAL FEES LAYER CLOSURE 2.6-7.5 CM A/S/T/E $379.00 981 9692922 PRO-CRITICAL CARE ADD'L 30 MINS $462.00 981 9692658 PROFESSIONAL-REDUCT/DISLOCATE/HIP $463.50 981 9692856 PROFESSIONAL-LEVEL V $465.25 981 9636507 PROFESSIONAL-REDUCTION SHOULDER/DIS $484.00 981 9646001 PROFESSIONAL-REDUCTION ELBOW-DIS $484.00 981 9612041 INTMD RPR N-HF/GENIT 2.5CM/< $523.00 981 9613121 PRO FEE CMPLX S/A/L 2.6-7.5 CM $525.00 981 9692914 PROFESSIONAL-CRITICAL CARE 1ST HOUR $525.50 981 9819464 PRO FEE - ATTENDANCE AT DELIVERY $550.00 981 9817810 PRO FEE CLOSED TX ANKLE FX W/MANIPULATION $595.00 981 9603255 PROFESSIONAL - CHEST TUBE PLACEMENT $600.00 981 9624222 PROFESSIONAL-THORACENTESIS $622.75 981 9612042 PROFESIONAL FEE - LAYER CLOSURE 2.6-7.5 CM $773.00 981 9612031 PRO FEE LAYER CLOSURE 2.5 CM/LESS A/S/T/E $807.00 981 9656059 PROFESSIONAL-REDUCTION/RADIUS FX $869.50 981 9692245 PROFESSIONAL-OBS-PN (224) $54.50 982 9699216 PROFESSIONAL - LEVEL 1 - EST $75.00 982 9692179 PROFESSIONAL-OBS-DS $97.75 982 9692252 PROFESSIONAL-OBS-PN (225) $97.75 982 9699201 PROFESSIONAL - LEVEL 1 - NEW $125.00 982 9699212 PROFESSIONAL - LEVEL II - EST $125.00 982 9824376 PRO FEE PEG TUBE REPLACEMENT $125.00 982 9695256 GLUCOSE MONITOR - INTER/REPORT $131.25 982 9692187 PROFESSIONAL-OBS-H&P (218) $132.75 982 9692260 PROFESSIONAL-OBS-PN (226) $141.25 982 9692435 PROFESSIONAL - OFFICE CONSULT $151.25 982 9693011 PROF-CARDIAC STRESS TEST SUPERVISIO $157.50 982 9829241 PROFESSIONAL - OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT $175.00 982 9821420 "PRO FEE EXC, BENIGN LESION INC MARGINS" $175.00 982 9692195 PROFESSIONAL-OBS-H&P (219) $182.25 982 9692344 PROFESSIONAL-OBS-IN/OUT (234) $184.75 982 9699213 PROFESSIONAL - LEVEL III - EST $190.00 982 9699202 PROFESSIONAL - LEVEL II - NEW $200.00 982 9821144 PRO FEE EXC FACE 0.5 CM/< $225.00 982 9692351 PROFESSIONAL-OBS-IN/OUT (235) $230.50 982 9692203 PROFESSIONAL-OBS-H&P (220) $250.00 982 9699203 PROFESSIONAL - LEVEL III - NEW $265.00 982 9699214 PROFESSIONAL - LEVEL IV - EST $265.00 982 9693540 PROFESSIONAL - PROLONGED OFC VISIT $275.00 982 9695255 GLUCOSE MONITOR VIA SUBQ SENSOR $288.00 982 9692369 PROFESSIONAL-OBS-IN/OUT (236) $297.25 982 9823236 PRO FEE EGD W/DIRECTED SUBMUCOSAL INJECTION $300.00 982 9821621 " PRO FEE - EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCAL" $315.00 982 9821422 "PRO FEE EXCISION, BENIGN LESION INCLUDING MARGINS" $325.00 982 9821010 PRO FEE ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPH) $330.00 982 9821400 "PRO FEE EXCISION, BENIGN LESION INCL MARGINS > 1CM" $335.00 982 9821402 "PRO FEE EXCISION, BENIGN LESION INCLUDING MARGINS" $335.00 982 9821403 PRO FEE EXC TR-EXT B9+MARG 0.6-1 CM $365.00 982 9699215 PROFESSIONAL - LEVEL V - EST $365.00 982 9811603 "PRO FEE EXC MALIG LESION, TRUNK" $385.00 982 9699204 PROFESSIONAL - LEVEL IV - NEW $390.50 982 9829180 "PRO FEE BIOPSY, ABDOMINAL OR RETROPERI MASS, NEEDLE" $400.00 982 9820022 PRO FEE BREAST BIOPSY FINE NEEDLE ASPIRATION W/IMAGE GUIDANCE $410.00 982 9820021 BREAST BIOPSY FINE NEEDLE ASPIRATION W/O GUIDANCE $410.00 982 9811404 PRO FEE EXCISION/SKIN 3.1-4.0 CM $425.00 982 9825250 PRO FEE VASECTOMY $425.00 982 9829100 PRO FEE BIOPSY BREAST NEEDLE CORE $430.00 982 9820740 PRO FEE EGD DIAG W/BIOPSY $435.00 982 9823235 PRO FEE EGD DIAG W/SPEC COLLECTION BRUSH/WASH $435.00 982 9821623 PRO FEE - EXCISION/MAL LES 2.1-3.0 S/N/H/F $440.00 982 9820121 PRO FEE COLONOSCOPY SCREENING $450.00 982 9823249 PRO FEE EGD WITH ESOPH DILATION <30 MM $450.00 982 9823247 PRO FEE EGD W/FOREIGN BODY REMOVAL $450.00 982 9826556 PRO FEE INSERTION OF NON-TUNNELED CENTRAL LINE $475.00 982 9699205 PROFESSIONAL - LEVEL V - NEW $502.00 982 9821406 "PRO FEE EXCISION, BENIGN LESION INCLUDING MARGINS" $590.00 982 9821626 "PRO FEE EXC, MALIG LESION INC MARGINS, SCALP HEAD NECK" $605.00 982 9826221 "PRO FEE HEMORRHOIDECTOMY, INTERNAL BANDING" $675.00 982 9825378 PRO FEE COLONOSCOPY DIAG SPEC COLL BRUSH/WASH $830.00 982 9824538 PRO FEE COLONOSCOPY DIAG REMOVAL TUMOR/POLYP BY HOT FORCEP $830.00 982 9825380 PRO FEE COLONOSCOPY DIAGNOSTIC W/BIOPSY $830.00 982 9825388 PRO FEE COLONOSCOPY DIAGNOSTIC W/ABLATION $830.00 982 9825385 PRO FEE COLONOSCOPY DIAG REMOVAL TUMOR/POLYP BY SNARE $830.00 982 9630104 PROFESSIONAL-EKG READING $36.25 985 9699232 PROFESSIONAL - SUBSEQUENT HOSP CARE $125.00 987 9699238 "PRO FEE HOSP DISCHARGE, 30MIN OR LESS" $125.00 987 9699239 "PRO FEE, HOSP DISCHARGE >30MIN" $180.00 987 9692237 PROFESSIONAL - INITIAL HOSP CARE $340.00 987 9500539 MEALS/PHYSICIANS & STUDENTS $2.00 990 9500951 MANOR TRANSPORTATION - VAN $2.00 990 9500562 MEALS/APARTMENT $4.00 990 9500505 MEALS ON WHEELS $4.00 990 9500513 MEALS/EMPLOYEE $4.00 990 9500521 MEALS/GUEST $4.00 990 9500952 MANOR TRANSPORTATION - BUS $4.00 990 9500034 MEDIMATE/LIFELINE (EXTRA PENDENT) $5.00 990 9520149 HCBS DAILY CHARGE 1 RM APARTMENT $8.50 990 9520131 HCBS DAILY CHARGE 2 RM APARTMENT $11.75 990 9520107 HOME & COMMUNITY BASED SERVICES $17.50 990 9500026 MEDIMATE INSTALLATION FEE $20.00 990 9500018 MEDIMATE/LIFELINE $25.00 990 9520040 ASSISTED LIVING/DAILY/1 RESIDENT $28.00 990 9520065 ASSISTED LIVING/DAILY/2 RESIDENTS $36.00 990 9530049 APARTMENT LIVING 1 RESIDENT $37.00 990 9530064 APARTMENT LIVING/DAILY/2 RESIDENT $39.00 990 9500950 BUS TRANSPORTATION $50.00 990 9520115 HCBS 1 ROOM APARTMENT 1 RESIDENT $250.00 990 9520123 HCBS 2 ROOM APARTMENT 1 RESIDENT $350.00 990 9520156 HCBS 2 ROOM APARTMENT 2 RESIDENTS $630.00 990 9520032 ASSISTED LIVING/MONTHLY/1 RESIDENT $814.00 990 9520057 ASSISTED LIVING/MONTHLY/2 RESIDENTS $940.00 990 9530031 APARTMENT LIVING/MONTHLY/1 RESIDE "$1,077.00 " 990 9530056 APARTMENT LIVING/MONTHLY/2 RESIDE "$1,203.00 " 990 12005 RM PRIVATE ROOM "$1,525.00 " 110 52001 RM SWING BED "$1,050.00 " 120 22004 RM SEMI PRIVATE ROOM "$1,460.00 " 120