Charge# Description Price 0011106 ROOM CARE SEMI-PRIV-MB LD 4,399.00 0011155 ROOM CARE SEMI PRIV-OVERFLOW 61701 4,399.00 0011205 ROOM CARE SEMI PRIV-CCU CCU 4,399.00 0011254 ROOM CARE SEMI PRIV-OPC2 OPC2 4,399.00 0011452 ROOM CARE SEMI PRIV-SCN 4,399.00 0011502 ROOM CARE SEMI-PRIV-MB OBS 4,399.00 0011551 ROOM CARE SEMI PRIV-1E 1E 4,399.00 0012104 ROOM CARE SEMI PRIV-2N 2N 4,399.00 0012203 ROOM CARE SEMI PRIV-OVERFLOW 61500 4,399.00 0012302 ROOM CARE SEMI PRIV-2E 2E 4,399.00 0012500 ROOM CARE SEMI PRIV-2W 2W 4,399.00 0012609 ROOM CARE SEMI PRIV-3N 3N 4,399.00 0012708 ROOM CARE SEMI-PRIV-3S 3S 4,399.00 0012807 ROOM CARE SEMI PRIV-2N 2N 4,399.00 0012906 ROOM CARE SEMI PRIV-2S 2S 4,399.00 0013102 ROOM CARE SEMI PRIV-3N 3N 4,399.00 0013201 ROOM CARE SEMI PRIV-3S 3S 4,399.00 0013300 ROOM CARE SEMI PRIV-3S 3S 4,399.00 0013409 ROOM CARE SEMI PRIV-3N 3N 4,399.00 0014159 ROOM CARE SEMI PRIV-4N 4N 4,399.00 0014209 ROOM CARE SEMI PRIV-4S 4S 4,399.00 0021154 ROOM CARE TELEMETRY-OVERFLOW 61701 6,903.00 0021204 ROOM CARE TELEMETRY-CCU CCU 6,903.00 0021253 ROOM CARE TELEMETRY-OPC2 OPC2 6,903.00 0021451 ROOM CARE TELEMETRY-SCN SCN 6,903.00 0021550 ROOM CARE TELEMETRY-1E 1E 6,903.00 0022103 ROOM CARE TELEMETRY-2N 2N 6,903.00 0022202 ROOM CARE TELEMETRY-OVERFLOW 61500 6,903.00 0022301 ROOM CARE TELEMETRY-2E 2E 6,903.00 0022509 ROOM CARE TELEMETRY-2W 2W 6,903.00 0022608 ROOM CARE TELEMTRY-3N 3N 6,903.00 0022707 ROOM CARE TELEMETRY-3S 3S 6,903.00 0022806 ROOM CARE TELEMETRY-2N 2N 6,903.00 0022905 ROOM CARE TELEMETRY-2S 2S 6,903.00 0023101 ROOM CARE TELEMETRY-3N 3N 6,903.00 0023200 ROOM CARE TELEMETRY-3S 3S 6,903.00 0023309 ROOM CARE TELEMETRY-3S 3S 6,903.00 0023408 ROOM CARE TELEMETRY-3N 3N 6,903.00 0024158 ROOM CARE TELEMETRY-4N 4N 6,903.00 0024208 ROOM CARE TELEMETRY-4S 4S 6,903.00 0031203 ROOM CARE ICU-CCU CCU 10,799.00 0031252 ROOM CARE ICU-OPC2 OPC2 10,799.00 0031401 ROOM CARE NURSERY-NSY NSY 2,076.00 0031559 ROOM CARE ICU-1E 1E 10,799.00 0032201 ROOM CARE ICU-1W 1W 10,799.00 0032300 ROOM CARE ICU - 2E 2E 10,799.00 0032508 ROOM CARE ICU-2W 2W 10,799.00 0032904 ROOM CARE ICU-2SO 2SO 10,799.00 0041103 ROOM CARE SEMI PRIV-LDRP LD 4,399.00 0041152 ROOM CARE ADMIN DAY-LOW SNF 61701 1,858.00 0041202 ROOM CARE ADMIN DAY-ICU LOW SNF ICU 1,858.00 0041251 RM CARE ADMIN DAY-OPC2 LOW SNF OPC2 1,858.00 0041509 ROOM CARE SEMI PRIV LDRP-MB OBS 4,399.00 0041558 ROOM CARE ADMIN DAY-1E LOW SNF 1E 1,858.00 0042101 ROOM CARE ADMIN DAY-2NO LOW SNF 2NO 1,858.00 0042200 ROOM CARE ADMIN DAY-LOW SNF 61500 1,858.00 0042309 ROOM CARE ADMIN DAY-2E LOW SNF 2E 1,858.00 0042507 ROOM CARE ADMIN DAY-2W LOW SNF 2W 1,858.00 0042804 ROOM CARE ADMIN DAY-2N LOW SNF 2N 1,858.00 0042903 ROOM CARE ADMIN DAY-2S LOW SNF 2S 1,858.00 0044156 ROOM CARE ADMIN DAY-4NO LOW SNF 4NO 1,858.00 0044206 ROOM CARE ADMIN DAY-4SO LOW SNF 4SO 1,858.00 0051151 ROOM CARE ADMIN HIGH SUB ACT 61701 2,000.00 0051201 ROOM CARE ADMIN HIGH SUB ACUTE ICU 2,000.00 0051250 ROOM CARE ADMIN HIGH SUB ACUTE OPC2 2,000.00 0051508 ROOM CARE ADMIN HIGH SUB ACUTE OBS 2,000.00 0051557 ROOM CARE ADMIN HIGH SUB ACUTE 1E 2,000.00 0052100 ROOM CARE ADMIN HIGH SUB ACUTE 2NO 2,000.00 0052209 ROOM CARE ADMIN HIGH SUB ACUT 61500 2,000.00 0052308 ROOM CARE ADMIN HIGH SUB ACUTE 2E 2,000.00 0052506 ROOM CARE ADMIN HIGH SUB ACUTE 2W 2,000.00 0052803 ROOM CARE ADMIN HIGH SUB ACUTE 2NO 2,000.00 0052902 ROOM CARE ADMIN HIGH SUB ACUTE 2S 2,000.00 0054155 ROOM CARE ADMIN HIGH SUB ACUTE 4NO 2,000.00 0054205 ROOM CARE ADMIN HIGH SUB ACUTE 4SO 2,000.00 0061200 ROOM CARE PCU-CCU CCU 6,903.00 0061259 ROOM CARE PCU-OPC2 OPC2 6,903.00 0062109 ROOM CARE PCU - 2N 2N 6,903.00 0062208 ROOM CARE PCU-OVERFLOW 61500 6,903.00 0062307 ROOM CARE PCU-2E 2E 6,903.00 0062505 ROOM CARE PCU-2W 2W 6,903.00 0062802 ROOM CARE PCU-2N 2N 6,903.00 0062901 ROOM CARE PCU-2S 2S 6,903.00 0100016 SUTURE VALVE 3,175.00 0100024 SUTURE CABG W/AV/MV 3,614.00 0100032 SUTURE CABG 1,591.00 0100040 STERNAL ZIPFIX WITH NEEDLE 293.00 0100057 ENDOSCOPY BLUNT CHERRY 132.00 0100065 ENDO PEANUT BLUNT DISSECTOR 63.00 0100073 ENDO MINI RETRACT 225.00 0100602 CORNEAL PROCESSING-TISSUE ANGIOGDYE 8,067.00 0100651 MINOR SURG-C 1/4 HR 659.00 0102962 MAJOR SURG-A 1 HR 9,973.00 0102970 MAJOR SURG-A 1/4 HR 1,879.00 0103721 MAJOR SUTURE SET 605.00 0103739 MINOR SUTURE SET 328.00 0104059 MAJOR SUTURE A SET 1,241.00 0104729 CABG OR SERVICES 25,780.00 0104760 MAJOR B WITH HIGH TECH 15,247.00 0104778 MAJOR A WITH HIGH TECH 23,205.00 0104786 COSMETIC 1/4 HOUR SSS 110.00 0104794 COSMETIC A SSS 990.00 0104802 UTERINE MANIPULATOR COOPER 2,155.00 0104836 MINOR SURG-C 1 HR 7,332.00 0104919 MICRO VENTRICULAR BOLT PRESSUR 4,430.00 0104927 GRAFT CV PATCH 965.00 0104935 KIT CEMENT HIP 864.00 0104943 VALVE POLARIS 11,713.00 0104950 PASSER SHEATH 65MM 371.00 0104968 CASPAR DISP PIN ALL SIZES 426.00 0104976 VALVE SHUNT PROGRAMMABLE 15,137.00 0104984 BURR MIDAS REX 613.00 0104992 NEURO PERFORATOR (ACUCUT) 935.00 0105007 PIN GUIDE LG 383.00 0105015 MAYFIELD PINS 376.00 0105023 ETHICON SECURE STRAP 2,560.00 0105031 CAROTID SHUNT ALL SIZES 1,902.00 0105049 CSF DRAINAGE EDS3 517.00 0105056 VENTRICULAR DRAINAGE SYSTEM 652.00 0105064 BONE ACF 6.14.11 SOFAMOR 3,456.00 0105072 BN CEMENT KYPHON 1,206.00 0105080 BN CEMENT TOBRA 1,859.00 0105098 BN PUTTY 5CC 2,280.00 0105106 BN PUTTY 1CC 579.00 0105114 RAINEY GUN 612.00 0105122 WHITNEY KNIFE 96.00 0105130 SPLINT S/LEG ADLT 296.00 0105148 SPLINT L/ARM ADLT 356.00 0105155 BURR 660.00 0105163 DRILL BIT 401.00 0105171 KIT VERTEBROPLASTY 2,684.00 0105189 GIRTIE MAX SPINAL NEEDLE 76.00 0105197 FEM CANAL IRRIG/PLUG/RING 315.00 0105205 FACE FM HEAD REST PILLOW 88.00 0105213 MONITOR LINE 16.00 0105221 JACKSON/ANDREWS TABLE KIT 1,610.00 0105239 ZERO TIP 782.00 0105247 FRAZIER TIP DISPOSABLE 20.00 0105254 ABDUCTOR PILLOW 247.00 0105262 FACE SHIELD 130.00 0105270 FIBER WIRE 143.00 0105288 FEMORAL BRUSH 171.00 0105296 FEMORAL CANAL TIP 289.00 0105304 FEMORAL CANAL IRRIG HIGH FLOW 368.00 0105312 KIT CEMENT - STRYKER KNEE 494.00 0105338 ORTHO HOOD 316.00 0105346 CATH URETERAL ADAPTER 99.00 0105353 PIN AND DRILL SET 1,030.00 0105361 CO2 FILTER TUBING 83.00 0105379 TUBING SMOKE EVAC 378.00 0105387 FOLEY HOLDER 23.00 0105403 IMAGER II GAUGE 236.00 0105411 SHEATH APPL 2,149.00 0105429 STONE CATCHER 1,445.00 0105437 CATH QUINTON 451.00 0105445 BAG DECANTER 7.00 0105460 STONE EXTRACTOR HELICAL BOS SC 875.00 0105478 TRUCUT BIOP NEEDLE 70.00 0105486 URO DRA BAG 41.00 0105494 SHEATH ACCESS - ALL 683.00 0105502 CAUTERY DISP CORD 99.00 0105510 ELECTRODE KNIFE LOOP. BALL 589.00 0105528 LONE STAR STAYS 209.00 0105536 LONE STAR RETRACTOR 224.00 0105544 HEYMAN DILATOR 50.00 0105551 URETERAL CONN. ADAPTER 15.00 0105569 TUBING CYSTO 126.00 0105577 J-PRATT RESERVOIR 573.00 0105650 CO2 FILTER TUBING HUMID 470.00 0105676 ENDO PATH TRISTAR 2,477.00 0105684 TUBING TUR 193.00 0105692 DB URETHRAL 400.00 0105700 H-U MANIP 464.00 0105718 FALOPE RX2 1,189.00 0105726 KENDALL HOSE 275.00 0105734 TAUT-CHOL 369.00 0105742 SKIN MARKER 61.00 0105759 HYPOTHERMIA PAD 361.00 0105767 CATH URETERAL 67.00 0105783 SCLERAL BLADE 372.00 0105791 RIGID NEEDLE 153.00 0105809 SMART THERMAL TIP 117.00 0105817 IVAC TUBING 37.00 0105825 ADDITIVE SET 98.00 0105833 SECONDARY SET 105.00 0105841 IV T/NO I SITE 73.00 0105858 INTRA CATH 70.00 0105866 CATH TRIPLE LUMEN 481.00 0105874 EXT T 36.00 0105882 MICRO PTSX1 379.00 0105890 ANAEROBIC CULT TB 120.00 0105908 OP SITE 63.00 0105916 COVADERM 31.00 0105924 EYE SHIELD 28.00 0105932 ULTRASOUND BIOPSY PROBE 14GA 763.00 0105940 TED HOSE/KNEE 159.00 0105957 PACK-VAG 92.00 0105965 PACK IODO 1-2 101.00 0105973 PACK IODO 1/4-1/2 117.00 0105981 SPLINT L/LEG ADLT 412.00 0105999 SURGICEL 2X14 289.00 0106005 SHLDR IMMOB 394.00 0106013 WIRE-KIRSCHNR 121.00 0106021 CEM MIX BOWL 204.00 0106039 CEM BOX X1 459.00 0106047 WATER PIK W/TUBNG 718.00 0106062 BLADE ENDO 2,782.00 0106088 TPS RASP 499.00 0106096 CONNECTION TUBE DISP 47.00 0106104 TPS SAWBLADE 244.00 0106112 QUILL SUTURE 118.00 0106120 ARM SLING 130.00 0106138 POST OP K D/L/A 722.00 0106153 BRAD POINT TIP GUIDE PIN 499.00 0106161 BLD WARMING BAG 300.00 0106179 MANIFOLD NEPTUNE 108.00 0106187 NOVASURE ABLATER 3,920.00 0106195 VERSA STEP INSULFLATOR NEEDLE 236.00 0106203 ORTHO CORD 152.00 0106211 TPS BURR 392.00 0106229 WIRE K (ALL SIZE) 126.00 0106237 PACKING PLAIN 86.00 0106245 AUTO SUTURE GIA 1,686.00 0106252 SKIN STAPLER 112.00 0106260 ELECTRO GPX3 72.00 0106278 CANNISTER INITIAL 21.00 0106286 CATH/URET DISP 286.00 0106294 CATH/URET ILLU 432.00 0106302 CATH/URET STEN 1,178.00 0106310 PLEUREVAC 1,146.00 0106328 TUR LOOPS 613.00 0106336 CATH DISTAL ATRIAL/PERITIONEAL 668.00 0106344 DRILL 2.0 & 2.5 403.00 0106351 DRILL BIT SS PLF 1,626.00 0106369 ON Q PAIN PUMP 1,547.00 0106377 ENDO TRACH TUBE EMG 916.00 0106385 NERVE STIMULATOR 349.00 0106393 FILLAFORM & FOLLOWER 443.00 0106401 SLEEVE 754.00 0106419 BLADES ORTHO 518.00 0106427 WIRE-KIRSCH-THR 199.00 0106435 URO DR THPSN 168.00 0106443 O2 CATHETER 36.00 0106450 GELFOAM SP#100 340.00 0106468 SURGICEL 2X3 252.00 0106476 GZ XEROFORM 38.00 0106492 KLING 51.00 0106500 RL KERLIX 4.5 57.00 0106534 CLIPS-RAINY EA 8.00 0106542 SURG PAD 8X10 19.00 0106559 J-PRATT TUB 573.00 0106567 02 CANNULA 51.00 0106575 BAKER JEJU T 988.00 0106583 CLIPS WECK X1 127.00 0106591 CAUTERY PENCIL 20.00 0106609 CATH MAHUKAR 520.00 0106617 TEMP-A-STRIP 19.00 0106625 NASAL AIRWAY 159.00 0106633 VACUR TIP/T 261.00 0106641 CATH VENTRICULAR 668.00 0106666 ANCHOR PORT KIT 1,113.00 0106674 RUMI KOH-EFFICIENT (ALL SIZES) 286.00 0106682 CARTER-THOMPSON PORT CLS SYSTM 386.00 0106690 THUNDERBEAT 5MM 35CM 1,590.00 0106708 PLASMA J-HOOK W/CORD 33CM 954.00 0106724 TRACH T SIL 834.00 0106732 TRACH T SHIL 511.00 0106740 SOD CHL IRR 282.00 0106757 SPECIMEN TRAP NAKAS QUICK 39.00 0106765 TSK ACE CUT BIOPSY DEVICE 134.00 0106773 INSTRUMENT POUCH 3 COMPARTMENT 16.00 0106781 APPLIED OPTIVE VIEW PORT 791.00 0106807 ENDO SHEARS 321.00 0106823 STEALTH NAVIGATOR 11,575.00 0106831 SHAVER / HAIR CLIPPER 58.00 0106849 RVAC SUCT KIT 45.00 0106856 SUP ADULT 172.00 0106864 WATER 2000CC 158.00 0106880 KIT HIP PREP 572.00 0106898 DRILL INTERTAN LAG SCREW 2,400.00 0106906 GRAFT VASCULAR GORETEX 2,119.00 0106914 V-LOCK WOUND CLOSURE 94.00 0106922 APPLIED PORT 5MM 67.00 0106930 GUIDEWIRE ARCHER SUPER STIFF 607.00 0106948 MICRO - INTRODUCER KIT 111.00 0106955 BONE CEMENT WITH GENTAMICIN 840.00 0106963 RUMI TIP (ALL COLORS) 140.00 0106971 BLADE PATELLAR REAMER 496.00 0106989 DEFOG HEATED ENDO LENS PROTECT 127.00 0107011 APPLICATOR TIP 248.00 0107037 COVIDIEM LIGASURE SMALL 1,907.00 0107045 COVIDIEN LIGASURE MED 2,060.00 0107052 COVIDIEN LIGASURE LARGE 2,687.00 0107060 SMOKE FILTER W/THUMBWHEEL CLMP 70.00 0107078 SALEM SUMP TUBE 122.00 0107086 SEALANT DURASEAL 1,908.00 0107102 CATH SUCT 74.00 0107110 FIBRIJET RATIO APP/ASSEMB KIT 73.00 0107128 COVIDIEN LIGASURE MYOSURE XL 4,667.00 0107130 BLADE KAHOOK 1,488.00 0107136 FIBRIJET APP TIP DUAL 20X2 65.00 0107144 FIBRIJET APP TIP DUAL 20X18 69.00 0107169 DRILL SHAFT 535.00 0107177 C/ROBINSON 96.00 0107185 CATH/FOLY/3WAY 267.00 0107193 ANGEL BLOOD ACCESS KIT 229.00 0107201 SAWBLADE 439.00 0107219 ANGEL WH BLOOD SEP PROCESS KIT 916.00 0107243 PLASMAX 5,864.00 0107250 ZOLL PADS 234.00 0107268 BIO GLUE 2,950.00 0107284 COBAN 15.00 0107292 CRANIAL ACCESS KIT 1,380.00 0107300 ANCHOR PORT ARC 5LU 223.00 0107318 CATH/FOLEY/SIL 145.00 0107342 YANKAUR SUCTION TUBE 79.00 0107359 ISOCOOL FORCEPS TIPS 1,526.00 0107367 ETHIBOND SUTURES ALL SIZES 633.00 0107383 RELOADS CONTOUR 761.00 0107417 FIBRIJET APP W/DUAL SPRAY 122.00 0107433 LUKI TUBE 37.00 0107441 FEEDING T 38.00 0107458 C/F/A 264.00 0107466 F CATH TRAY 349.00 0107474 URINARY DB 192.00 0107482 PRINT ARTHROS 22.00 0107490 PIN BUTTERFLY 395.00 0107508 HEMOVAC ALL SIZES 1,040.00 0107516 MEDTRONIC NEUROSTIMULATOR 55,687.00 0107524 DRILL 7.0MM 926.00 0107532 COAPTITE INJECTABLE IMPLANT 1,082.00 0107540 THORACOPORT ALL 84.00 0107557 CEEA ALL SIZES 1,665.00 0107565 TA PREMIUM 30 55 90 ALL 277.00 0107573 MULTI FIRE ENDO HERNIA 4.0 & 4 222.00 0107581 MULTI FIRE VERSA TAC 383.00 0107599 ENDO STITCH SUTURE 331.00 0107607 ROTICULATOR ENDO GIA LOADS 610.00 0107615 ENDO GIA & GIA LOADS ALL 1,335.00 0107623 ENDO GIA & GIA UNIVER INSTR. 1,741.00 0107631 GLUTERALDYHDE CAPPS 321.00 0107649 SPRING GRIP 27.00 0107656 PROTACK 999.00 0107664 VERSA STEP ALL 650.00 0107672 INLET CLOSURE DEVICE 75.00 0107680 LAPARATY XC200 721.00 0107698 CVP INF SU 631.00 0107706 BIOPATCH 48.00 0107714 SURGIFOAM 472.00 0107722 CATH FOG 614.00 0107730 PROFIX BONE SPIKES 290.00 0107748 ENDO CLIP ALL SIZES 598.00 0107755 SUTURE ASSIST DEVICE 1,691.00 0107763 BASKET 907.00 0107771 CONROY DYE 599.00 0107789 MEGADYNE BOULE SPATULA HOOK 254.00 0107797 SPLINT S/ARM 215.00 0107805 TOOMEY SYRINGE 7.00 0107813 BERKLEY SUCTION CANISTER 34.00 0107821 CATH P/D 1,673.00 0107839 GI CONNECTING TUBE/SUCTION 117.00 0107854 BLADELESS TROCAR 579.00 0107862 ENDO CATCH 345.00 0107870 STAPLER CUTTER CONTOUR 1,519.00 0107888 VCS STAPLER ALL 1,599.00 0107896 PROXIMATE SKIN STAPLES 155.00 0107920 CLPS HEMO REG ALL SIZES 134.00 0107938 CLIPS HEM LOC ENDO 538.00 0107946 RANFAO SUTURE PASSER 118.00 0107961 BERKLEY SUCTION TIP 61.00 0107979 5% DW 045% NAC 143.00 0107987 COMBO SWAN W/VIP 902.00 0107995 STAPLER INCISIVE SURGICAL 183.00 0108001 DRILL 2.8 178.00 0108019 DRILL 2.9 413.00 0108027 DRILL 4.8 X 3.2 585.00 0108043 PIN GUIDE 3.2 572.00 0108050 ART L SU 982.00 0108068 EVICEL 2ML 817.00 0108084 GORTEX SUTURE 96.00 0108100 L/RG 250/5C/1M 105.00 0108118 SC INJ SOL 106.00 0108126 GLYC 2000 CC 224.00 0108142 SENSOR ANGLE TIP DUAL FLEX 417.00 0108159 DRILL 3.2 308.00 0108167 EMBOLIZATION PROTECTION DEVICE 4,952.00 0108175 WIRE ZEBRA 308.00 0108183 5% DW 250-500 108.00 0108191 DAVOL IRRIGATOR 710.00 0108209 EXTRA SUCTION 349.00 0108217 FEMORAL ARTRY LINE KIT 104.00 0108225 RECTAL PROBE 149.00 0108233 OCTOBASE-MEDRC 236.00 0108241 FLOSEAL 693.00 0108258 DERMABOND 134.00 0108266 KIMBERLY CLARK ELECTRODES 102.00 0108274 FILTER 75.00 0108282 EVICEL 5ML 1,879.00 0108308 POUCH IRRIGATION V 32.00 0108324 SEALANT FIBR 381.00 0108332 DURAGEN 3X3 DP1033 3,305.00 0108340 CAPIO SUTURE CAPTR DVC INSTR 1,635.00 0108357 CAPIO SUTURE 120.00 0108365 CATHETER/CHEST 210.00 0108373 DERMATOME HD 296.00 0108381 OMNIPAQUE 300/50ML 14.00 0108399 DURAGUARD 791.00 0108407 FIBRILLAR 355.00 0108423 UROMAX ULTRA 954.00 0108431 A-LINE EXT TUBING 19.00 0108456 KELLER FUNNEL 413.00 0108464 SCREW PEDICLE ACF SPISOL/USSPI 1,473.00 0108472 CATH COUDE/FOLEY 57.00 0108480 ESSURE 6,344.00 0108506 CONT IRR SET 154.00 0108514 INTRODUCER NEEDLE 595.00 0108522 INTERMED BRUSH 220.00 0108530 NIPPLE/PORT SEALS 98.00 0108548 BALLOON CATHETER 1,698.00 0108555 ROD BALL TIP GUIDE 702.00 0108563 BN CHIP 15CC 763.00 0108571 PIN GUIDE SM 266.00 0108589 PRO BONE SPIKE SHORT 290.00 0108597 ACE BANDAGE 33.00 0108605 ROTICULATOR PADDLE GRASP STITC 594.00 0108621 OR STENT NON-CORONARY TEMPORARY 580.00 0108623 OXYGEN MASK/ADULT 66.00 0108639 OR CATH TRANSLUMINAL BALLOON 789.00 0108647 OR CATH DUAL LUMEN 482.00 0108654 PINS GUIDE 14 X 3.2 547.00 0108662 OR WIRE GUIDE/GLIDE/SENSOR 198.00 0108670 OR CATH PALIND SAPPHIRE 7,288.00 0108688 SLING BLADDER 4,489.00 0108696 BLD DERM BRN 323.00 0108738 THERA DIAG BK 1,042.00 0108753 5% D/0 NACL 126.00 0108761 VITREC/TUB KT/BSS 828.00 0108779 CORNEAL PROCESSING 11,038.00 0108787 TREPHINE 756.00 0108795 PHACO-SITE 2,699.00 0108811 BREAST IMPLANTS INAMED 2,620.00 0108829 RADIESSE VOICE IMPLANT 965.00 0108837 SUTURE RETRIEVER 179.00 0108845 VERSAPORT 5/12 MM 745.00 0108860 DISECT FORCEPS LYONS 5MM,33CM 859.00 0108878 VESSEL MARKER 42.00 0108886 GRAFT BIF 3,813.00 0108894 5% D/W 100ML 37.00 0108910 ISOLYTE 191.00 0108928 URIMETER 317.00 0108936 HYPOTHERM PROBE 268.00 0108944 SCALP VEIN 38.00 0108951 HEART SUPPORT HOLDER 317.00 0108969 PACING CABLE (SCREW TYPE) 281.00 0108973 WOUND DRESSING PROCELLERA 61.25 0108985 CHROMOTUBATION CATHTHER HSG 65.00 0108986 TISSEEL SEALANT 4ML 680.46 0108993 SEAL SET 30.00 0108995 TISSEEL SEALANT 10ML 1,669.89 0109002 SPRAYER 30 1,135.54 0109017 FLUID SAFE CANISTER 30.00 0109018 SPRAYER 40 763.85 0109025 FLUID SAFE TUBING 285.00 0109029 PREVENA KCI WOUND VAC 1,717.50 0109033 BERKLEY SUCTION TUBING DISP 47.00 0109058 4.0 LONG PILOT DRILL 1,180.00 0109082 BEACH CHAIR KIT-TRIMANO 262.50 0109090 ENDO BLUE KIT 60.00 0109108 ELECTRODE BUTTON-OLYMPUS 1,372.00 0109116 STERILE TURNIQUET ALL SIZES 92.00 0109124 ECHELON LOAD 2,654.00 0109132 ECHELON STAPLER 3,244.00 0109140 PREVENA PLUS CANISTER 91.00 0109157 AQUACELL DRESSING ALL 133.00 0109165 BARD UROLOGYIST TRAY 840.00 0109172 AORTIC BALLOON CATHETER 3,395.00 0109173 KII BALLOON BLUNT TIP SYSTEM 84.00 0109181 BN CANCELLOUS CHIPS 30CC 1,830.00 0109199 SEPRAFILM 1,020.00 0109207 MINICAP EXTENDED LIFE PD 230.00 0109215 MINICAP W/POVIDONE IODINE 21.00 0109223 BROCHOSCOPE DISP SLIM 3.8OD 955.00 0109231 BROCHOSCOPE DISP REG 5.0OD 955.00 0109249 BROCHOSCOPE DISP LRG 5.8OD 1,099.00 0109256 ACTICOAT FLEX 7 49.77 0109264 AMSCO FOOT TRACTION BOOT 521.16 0109272 HALO OBTARYX SLING 4,900.00 0109280 ATRICLIP FLEX ALL SIZES 5,550.00 0109306 CATH SUPRAPUBIC ONE STEP ALL 266.00 0109322 BONE MARROW ASPIRATION NEEDLE 675.00 0109330 QUICKSET KIT 10,474.00 0109348 RETRACTOR ALEXIS FLEXIBLE 156.00 0109355 BN CEMENT 1/2 DOSE 222.00 0109363 PIRANHA FORCEPS 953.00 0109371 RADICAL JAW FORCEPS 953.00 0109389 IRRIGATION TUBESET MISONIX 150.00 0109397 BONE SCALPEL/SHAVER MISONIX 1,215.00 0109405 PROXICOR CMCV-003-402 4,736.00 0109413 HALO CERVICAL 9,579.00 0109421 MRI COMPATIBLE SYSTEM 3,393.00 0109439 BLADE PLASMA AQUAMANTIS 1,755.00 0109447 HAND IMMOBILIZER ALUMINUM 114.00 0109454 MALYUGIN RING 240.00 0109462 ECHELON STAPLER 45 2,450.00 0109470 ECHELON LOAD 45 1,259.00 0109496 PURSESTRING AUTOSUTURE ALL 199.00 0109504 HARMONIC FOCUS 1,548.00 0109512 CAROTID SHUNT PRUITT F3 2,796.00 0109520 SMOKE EVACUATOR PUREVIEW 73.00 0109538 ATRICLIP FLEX V ALL 6,475.00 0109546 TALC BLOWER NOVATECH 126.00 0109553 SHUKLA EXTRACTION 753.00 0109561 NEEDLE TOUGHY ALL SIZES 487.00 0109579 NEEDLE SPINAL ALL SIZES 220.00 0109595 COR-KNOT KIT 2,172.00 0109637 SHUNT CAROTID PRUITT 2,637.00 0109645 GLIDEWIRE ADVANTAGE 1,380.00 0109652 PERIPHERAL NERVEBLOCK 3,340.00 0300244 ANES LOCAL/MAC ANESTH 547.00 0300780 IABP BALLOON CATHETER 4,692.00 0300806 ANESTHESIA UP TO 3 HOURS 3,514.00 0300814 GEN ANES OVER 3 HOURS 8,968.00 0300822 ESOPH STETH 156.00 0300830 SPINAL ANESTHESIA TRAY 158.00 0300848 DUO TRACH KIT 190.00 0608638 CLIPS WECK X 1 127.00 0608646 TSEAL 2ML 1,250.00 0608661 GUIDE PINS 133.00 0608687 BLADE 294.00 0608695 ACL KIT 929.00 0608703 SCORPION NEEDLE 579.00 0608745 VISION BLUE DYE 209.00 0608794 LEEP BALL/LOOP 244.00 0608802 FISHER CONE BIOPSY 159.00 0608810 BSS 15ML 9.00 0608836 IV STARTER KIT 27.00 0608844 INTRA CATH 58.00 0608851 HEPARIN LOCK 36.00 0608877 ADDITIVE SET 82.00 0608885 IVAC TUBING 37.00 0608893 MICRODRIP 102.00 0608901 BLOOD COMP INF SET 108.00 0608919 GRAFT EYE 2.0 AMNIOTIC 2,486.00 0608927 EXTENSION TUB 102.00 0608950 SET EXT W/ T 51.00 0608968 TUBING DRIPRIVAN 79.00 0608984 LENS IOL POSTERIOR 2,475.00 0609008 LENS IOL POSTERIOR NEW TECHNOLOGY 4,475.00 0609024 CONN TUBE DISP 47.00 0609115 VERSAPORT 7/8MM 612.00 0609149 PACU INITAL HOUR 4,500.00 0609150 OPSC INITIAL HOUR 1,202.00 0609156 PACU ADD'L 15 MINUTES 699.00 0609157 OPSC ADD'L 15 MINUTES 267.00 0609180 FIBER STICK 290.00 0609206 MYOSURE 4,118.00 0609222 SUSP KIT SHOULDER 505.00 0609230 SUTURE LASSO 890.00 0609263 HAMONIC SCALPEL 796.00 0609305 SPL-SHRT LEG ADLT 296.00 0609313 LATERAL TRACTION KT DISP 419.00 0609339 BOVIE CONCEPT 877.00 0609347 BLADE SAW 244.00 0609354 CANNULA SHOULD 251.00 0609362 CUTTER ARTHROS 809.00 0609388 TUBING ART PMP 562.00 0609404 PAIN BUSTER INFUSION PUMP 763.00 0609420 OSI POSITIONER KIT 244.00 0609438 NASAL INSERT 182.00 0609446 SPLINT NASAL 254.00 0609453 SUCTION CAUTERY 123.00 0609461 TUBE X EAR X 1 226.00 0609479 KERRWAX MOLD 32.00 0609495 SUPPORTER-ADLT 172.00 0609511 CATHETER-SUCTION 51.00 0609529 ATRHROCARE WAND 807.00 0609537 SALEM SUMP TUBE 122.00 0609552 CATH/ROBINSON 96.00 0609560 SCREW CANNULATED ANY SIZE 1,099.00 0609578 SHAVE PREP KIT 58.00 0609636 MANNITOL 20% 369.00 0609644 SOD CHL 0.9% 129.00 0609651 LACTATED RINGER-ALL 126.00 0609677 5% D/W 045% 1M 143.00 0609693 FLO SEAL SEALANT 693.00 0609701 5% D/W 1000 CC 141.00 0609719 DEBRIDERS DIEGO (ALL SZ) 665.00 0609735 IRIS RETRACTOR 448.00 0609743 EPIDURAL TRAY ARROW 99.00 0609750 NEEDLE TOUHY 99.00 0609768 NEEDLE CHIBA 89.00 0609776 SIENTRA BREAST IMPLNT (ALL SZ) 3,506.00 0609784 GYRUS IRR TUBING 101.00 0609792 EAR DRESSING KIT 117.00 0609818 CUTTING BLOCK 381.00 0609826 KERLIX 65.00 0609834 KLING 51.00 0609842 XEROFORM GAUZE 43.00 0609859 BAIR HUGGER 200.00 0609891 EYE PATCH X 1 22.00 0609909 ADAPTIC 3 X 3 36.00 0609925 GELFOAM #100 387.00 0609933 CORNEAL SHIELD 217.00 0609941 EYE PACK 1,038.00 0609974 SCLERA KN BL 211.00 0609990 FILT UN SWINNE 118.00 0610014 OP-SITE SMALL 22.00 0610022 VEIN STRIP DIS 373.00 0610063 SEQUENTIALS 264.00 0610071 FALOPE RNGS X2 1,189.00 0610089 HUMI-UTER MANI 464.00 0610139 TUR TUBING 193.00 0610154 MICROCATH CANLPLSTY 3,797.00 0610170 SURGIPAD 8 X 10 22.00 0610196 CAUTERY 312.00 0610212 INTRODUCER NEEDLE 448.00 0610220 CORK SCREW ANCHOR 1,091.00 0610238 PACK IOD 1-2 90.00 0610253 COVADERM 31.00 0610261 ADAPTIC 3 X 8 45.00 0610287 FOLEY CATH KIT 264.00 0610303 WIRE K (ALL SIZE) 61.00 0610311 SURGINEEDLE 94.00 0610329 BREAST IMPLANTS ALLERGAN 5,751.00 0610337 SPL-LNG ARM CHILD 293.00 0610352 FIBER CHAIN 178.00 0610360 ACE BANDAGE 33.00 0610378 ELECTR-GEL PAD 63.00 0610386 POLARUS ROD 8 X 200MM 3,853.00 0610394 SHAVER BLADE OLYMPUS ALL SIZES 2,176.00 0610403 NEOTRACT UROLIFT PER IMPLANT 2,975.00 0610410 CALIBRATED REAMER 668.00 0610428 CANNULA OXYGEN 51.00 0610444 MULTIDEBRIDER TUBESET 688.00 0690016 LENS IOL ANTERIOR CHAMBER 2,798.00 0696450 CEMENT MIXING SYSTEM 622.00 0696468 CEMENT FEMORAL BONE PREP KIT 990.00 0700039 AMNIOCENTESIS 974.00 0700047 LD CERCLAGE 12,453.00 0700062 LD FETAL MONITORING 674.00 0700096 LD MINOR SURGERY 4,000.00 0700120 LD OR MAJOR SURG 10,638.00 0700153 FETAL CONTRACTION STRESS TEST 538.00 0700161 NON-STRESS TEST 500.00 0700336 PHOTOTHERAPY-DLY 73.00 0700344 TEMPA-A-STRIP 19.00 0700351 CATHETER SUCTION 51.00 0700369 YANK SUCTION TUBE 79.00 0700377 SKIN MARKER 61.00 0700385 CANNISTER INITIAL 929.00 0700393 LDRP LACTATED RINGERS 126.00 0700401 SKIN STAPLES 262.00 0700419 CAUTERY PAD 136.00 0700427 ADAPTIC 3X8 45.00 0700435 OXYGEN CANNULA 51.00 0700443 OXYGEN MASK 66.00 0700450 ELECTRODE GEL PAD 158.00 0700468 CULTERETTE II 22.00 0700476 EPIDURAL PUMP TUBING 114.00 0700484 ANESTHESIA BAG-INFANT 144.00 0700492 STERIWATER 2000CC 156.00 0700500 VACUUM EXTRACTOR 244.00 0700526 OR ONE HR 45 MIN 9,308.00 0700534 LDRP SOD CHL IRRI(ALL SIZES) 282.00 0700542 NORMAL SALINE 105.00 0700559 EPIDURAL PUMP DAILY 485.00 0705004 LDRP DELIVERY-NSVD 1,492.00 0705020 OB LABOR FEE C-SECTION 5,322.00 0705038 LD OB RECOVERY ROOM 2,108.00 0705046 OB OBS IV PUSH INITIAL 479.00 0705053 OB OBS INFUSION HYDR ADDL HR 218.00 0705061 OB OBS SUBQ/1M INJECTION 306.00 0705079 OB OBS CATH INSERTION 357.00 0705087 OB OBS IV INFUSION HYDR 31-60M INTL 759.00 0705095 OB OBS IV PUSH ADDL NEW DRUG 545.00 0705103 OB BLOOD PATCH 901.00 0705111 OB OBS HRS ADMIT D/C SAME DAY 3,333.00 0705129 I&D OF VULVA/PERINEUM 670.00 0705152 OB OBS IV INFS HYD 31-60M INT MOD59 1,510.00 0705160 OB OBS INFSN HYD ADDL HR >31M MOD59 137.00 0705178 OB OBS THERAPEUTIC INF INTL MOD 59 1,510.00 0705186 OB OBS THRP INF ADDL HR >31M MOD59 137.00 0705194 OB OBS THRP INF SEQ 16-60M MOD 59 137.00 0705202 OB OBS SUBQ/1M INJECTION MOD59 306.00 0705210 OB OBS IV PUSH INITIAL MOD 59 981.00 0705228 OB OBS IV PUSH ADDL NEW DRUG MOD 59 1,018.00 0705236 OB OBS IV PUSH ADDL SAME DRUG MOD59 162.00 0705244 OBS BIOPHYSICAL WITHOUT NST 677.00 0705251 CERVICAL RIPENING BALLOON 51.00 0751271 BLOOD TRANSFUSION-OB 3,050.00 0751289 STAPLER INCISIVE SURGICAL 183.00 0800326 THORACIC RIB BELT 502.00 0800342 BINDER ABDOMINAL UNIV 19.00 0800821 CANNULA OXYGEN 51.00 0802041 FOAM C COLLAR-BO 502.00 0802447 CRUTCHES COMPLETE 40.00 0802454 PHILADELPHIA CERVICAL COLLAR 502.00 0805382 DRESSING GAUZE 4X4 6/TRAY 10.00 0807206 TRAY SPINAL ADULT 25.00 0807214 TRAY SPINAL PEDS 25.00 0809103 STOPCOCKS (3-WAY) 25.00 0812065 TRAY THORACENTISE 25.00 0815050 BLOOD PUMP SET 25.00 0816553 TUBE EXTENSION K-50 52.00 0816884 HEMOSTAT SURGICAL 454.00 0816934 KIT CENTRAL VEIN 25.00 0821637 HO ABDUCTION POST 4,052.00 0822072 REMOVER STAPLE 25.00 0830190 NEEDLE LOCALIZATION PERCUGUIDE 523.00 0831115 DILATORS 675.00 0833178 LONG LEG SPLINT PLASTER 481.00 0834374 SET PRIMARY IV NONVENTED 1857 25.00 0835819 PAD INTELLI FLO KNEE 127.00 0836361 WIRE FRAME COLLAR 652.00 0837120 OXYGEN MASK/ADULT 66.00 0839134 PLST FEM FX BRAC 6,164.00 0839480 LSO FULL CORSET 709.00 0843599 CONTINUOUS FLOW CAUTERY CORD DAC 25.00 0847012 MRI COMPAT HALO 3,723.00 0849455 MOTION KNEE JOINT 713.00 0850032 SPINAL ORTHOSIS 884.00 0852996 ANKLE JTS FOR AFO 502.00 0853085 PL AFO W/ANKS JTS 1,843.00 0854588 KOPANE BREAST LESION NEEDLE/WIRE 324.00 0854612 DRESSING MEPILEX 4X4 FOAM 74.00 0855031 HANDPIECE VACUUM ASSTEXCISION 2,990.00 0855122 INTRODUCER LOCALIZATION SET 1,666.00 0855387 CORE BIOPSY SYSTEM MAGNUM 226.00 0855395 BIOPSY SITE IDENTIFIER 640.00 0855890 DRESSING MEPILEX LITE 62.00 0856880 FAB HIP ABD BRACE 1,824.00 0857375 INTRODUCER 150.00 0857466 BREAST TISSUE MARKER 309.00 0857557 MAMMOTOME PROBE 2,000.00 0858431 TLSO SAGITTAL-CORONAL CONTROL 2,886.00 0858522 BIOPSY DEVICE ROTATIONAL/VACUUM 2,254.00 0860890 CATH 2 WAY 30CC 68.00 0860908 CATHETER 10 FR MAHURKAR 1,453.00 0860916 PILLOW ABDUCT 403.00 0860924 CATHETER COUDE 16FR 186.00 0860932 TRAY FOLEY 18FR 207.00 0860940 CATHETER COUDE 18FR 186.00 0860957 ENEMA KIT 21.00 0860965 CATHETER 11.5 FR MAHURKAR 1,583.00 0860973 CATH ROBNEL 46.00 0860981 WOUND VAC THERAPY DRESSING LRG 252.00 0860999 CATH-FOLEY 8-11 117.00 0861005 FLEET ENEMA 16.00 0861013 URETHAL KIT PEDS 61.00 0861021 CATHETER 12 FR MAHURKAR 1,809.00 0861039 TRAY FOLEY 16FR 195.00 0861047 TUBE FEEDING ENT 143.00 0861054 IABP MONITORING/DAY 890.00 0861062 IRR NACL .9 250CC 27.00 0861070 BELT RIB ALL SZS 86.00 0861088 PLEURAVAC 517.00 0861096 WOUND VAC THRPY CANISTER W/GEL 216.00 0861104 ORTHO APPLIANCE 1,304.00 0861112 LSO SAGITTAL CNTRL RGD A&P PAN 4,241.00 0861120 TLSO A-P W/APRON FRONT 1,329.00 0861138 DRESSING-PLASTER BANDAGE 27.00 0861146 PELVIC BAND AND BELT 502.00 0861153 CHEST TU/TROCAR 254.00 0861161 FEM LENGTH SOCK 1,357.00 0861179 TRACH SUCT KIT 113.00 0861187 KNEE BRACE (KO) 2,461.00 0861195 FLEXI SEAL 3,483.00 0861203 POST-OP SHOE 99.00 0861211 CAST BOOT S-L 98.00 0861229 KNEE IMMOBZ 20 502.00 0861237 KNEE IMMOBZ 24 502.00 0861245 KNEE IMMOBZ 16 502.00 0861252 SUPPORT LUMBAR 176.00 0861260 TRACTION SPLINT 181.00 0861278 AFO SOLID ANKLE 2,178.00 0861286 C-COLLAR L/N 47.00 0861294 PRE-TIBAL SHELL 502.00 0861302 INTUBATION TRAY NEWBORN 273.00 0861310 SHOE INSERT-PLSTC 502.00 0861328 ADJ KNEE JNT 2 EA 502.00 0861336 PNEUM WLK. SPLINT 1,079.00 0861344 C-COLLAR SEMI-RIG 642.00 0861351 CORSET FOR B BRACE 540.00 0861369 FLEX EXT FOR HIP ABDUCT BRACE 1,260.00 0861377 ABOVE KNEE SOFT INTERFACE 502.00 0861385 FEM FX CAST (KAFO) 3,909.00 0861393 CHEST TU PLAIN 205.00 0861401 TRANSDUCER NEONAT 188.00 0861419 PLST AFO PRE-FAB 938.00 0861427 EPID ANES TRAY 485.00 0861435 TRAY UMB CATH 853.00 0861443 BLADDER FOLEY TRAY 16FR 555.00 0861450 CATH UMBILICAL 249.00 0861468 CATH UMBILICAL 243.00 0861476 DRESSING FOAM 69.00 0861484 NU-GAUZE PACKING 66.00 0861492 VASE GAUZE 1/2X72 20.00 0861500 BIOPATCH 123.00 0861518 BOOT SUSPENSION 511.00 0861526 C-COLLAR 52.00 0861534 TRAY INCISION & DRAINAGE 398.00 0861542 WOUND VAC THERAPY DRESSING MED 193.00 0861559 CLAMP CHEST TUBE 27.00 0861567 KIT ORAL SUCTION 2 HR 563.00 0861575 KIT ORAL SUCTION 4 HR 373.00 0861583 PERIOCARD TRAY 2,504.00 0861591 BONE MARROW TRAY 419.00 0861609 CRASH CART 2,271.00 0861617 BURN PACK STERILE 41.00 0861625 HUBER NEEDLE 143.00 0861633 TRAY PER-Q-CATH 554.00 0861641 TRANSDUCER TUBING 51.00 0861658 INTRAOSSEOUS 261.00 0861666 SWAN GANZ CATHETER 1,146.00 0861674 UROLOGY CART 318.00 0861682 TRANSDUCER A LINE 272.00 0861690 SURGINET 13-24 27.00 0861708 BASIC BIOP TRAY 180.00 0861716 A-LINE KIT 266.00 0861724 HEMODIALYSIS TRAY 1,332.00 0861732 FEMOSTOP 1,436.00 0861740 POST-OP SHOE 98.00 0861757 IV-MANNITOL 293.00 0861765 GENTRAN 40/ 96.00 0861773 IV SOL HEPARIN 50.00 0861781 WEBRIL-ALL SIZES 20.00 0861799 SURGICAL BINDR 154.00 0861807 XEROFORM 1X8 18.00 0861815 ARMSLING 502.00 0861823 SUTURE RMV SET 33.00 0861831 AMBU BAG 201.00 0861849 SKIN STAPL RMV 99.00 0861856 IMMOBILIZER KN 502.00 0861864 SURGICAL BINDER 141.00 0861872 CANNULA NASAL 41.00 0870014 D BAZA CREAM 89.00 0870022 D CATH 2 WAY 5CC 59.00 0870030 D CATH 3 WAY 30CC 153.00 0870048 D CATH 3 WAY 5CC 213.00 0870055 D CATHETER LEG STRAP 65.00 0870071 D CLAV STRAP 122.00 0870089 COMFEEL 54.00 0870097 D DISP TRACH CANNULA 52.00 0870105 D DISP TRACH TUBE 669.00 0870113 D DOUBLE SUBCATH 1,248.00 0870139 D GASTRC LAVAGE 313.00 0870147 D GEL DRESSING WOUND 99.00 0870154 D INTUBATION TRAY 273.00 0870170 D L/ARM SPLINT ADLT 306.00 0870196 D NU-GAUZE/IODOFORM 1/4 - 1/2 46.00 0870204 D NU-GAUZE PLAIN 1/2 55.00 0870212 D DRESSING OP SITE WND 52.00 0870220 D DRESSING OP SITE SMALL 15.00 0870238 D PAD ELECTRODE ADT 313.00 0870246 D PERCUTANEOUS INTRO 577.00 0870253 D PLASTER SPLINT 238.00 0870261 D POST-OP SHOE 98.00 0870279 D S/ARM SPLINT 251.00 0870287 D S/LEG SPLINT ADLT 300.00 0870295 D SALEM SUMP TUBE 63.00 0870303 D SHT ARM SPLINT 66.00 0870311 D SPLINT FINGER 86.00 0870329 D STERI STRIP 1/8 X 3 24.00 0870337 D STIFNECK COLLAR 98.00 0870360 D SURGI GEL 4X8 250.00 0870394 D TRACH SUCT KIT 113.00 0870402 D TRAY 16FR FOLEY-FBC 161.00 0870410 D TRAY DISP LAC 216.00 0870428 D TUBE FEEDING 34.00 0870451 D VASE GAUZE 3X18 31.00 0870469 D XEROFORM GZ 43.00 0870477 D PLASTER SPLINT 2' 389.00 0870485 D PLASTER SPLINT 3' 66.00 0870493 IV-5% DW 9% SOD 124.00 0870501 5% D/W 45% SOD 500 69.00 0870519 IV BUTTERFLY CATH 25.00 0870527 5% DW 45%SOD 500 133.00 0870535 5% DW 500 CC 88.00 0870543 IV SOD CHL 77.00 0870550 IV SOL-10% DW 83.00 0870568 IV-SOL 5% DW 50CC 33.00 0870576 IV SOD CHL 77.00 0870584 IV-SOD CHL SOL 107.00 0870592 5% DW 250CC 93.00 0870600 5% DW 250CC 93.00 0870618 10%D/W IN 1000CC 77.00 0870626 5% D/W IN-100 CC 130.00 0870634 5% D/W IN 1000 CC 141.00 0870642 10 MEQ POT CHL D5 0.45% 127.00 0870659 IV-5% DW L R 92.00 0870667 IV-5% DW 9% SOD 124.00 0870675 IV-SOD CHL SOL 107.00 0870683 LAC RG PLAIN 1M 109.00 0870691 20 MEQ POT CHL D5 0.45% 127.00 0870709 IV 5% DW 45% SOD 1000CC 124.00 0870717 IV-SOD CHL SOL 107.00 0870725 SOD CLR INJ 1C 71.00 0870733 9% SOD 250CC 88.00 0870741 POST-OP SHOE 99.00 0870758 CATH ROBINSON 96.00 0870766 SUCTION CATH 244.00 0870774 ELASTOPLAST - 4 74.00 0870782 STOMAHESIVE POWDR 88.00 0870790 TUBING IRRIGATION FOR GU MEDS 30.00 0870808 FOLEY BAG EXT 120.00 0870824 AIRWAY NASAL 44.00 0870832 BAG-INSTANT COLD PACK 9.00 0870840 POST-OP SHOE 98.00 0870857 DRAINAGE POUCH 619.00 0870865 POST-OP SHOE 98.00 0870873 STOMAHESIVE PASTE 149.00 0870881 TUBING IRRIGATION STRAIGHT 50.00 0870899 DRESSING CALCIUM ALGINATE 58.00 0870907 SUBCLAV CATH 1,465.00 0870915 LYOFOAM 69.00 0870923 SUR-FIT UROSTOMY 25.00 0870931 SUBCLAVIAN CATH 400.00 0870949 SUCTION CATH TRAC 250.00 0870956 SUR-FIT FLANGES 25.00 0870964 CATH IUP 515.00 0870972 ACTIVE LIFE OSTOMY 21.00 0870980 ULCER DRESSING 33.00 0870998 SUR-FIT POUCH 39.00 0871004 SHOULDER IMMOB 138.00 0871012 LOPEZ VALVE 39.00 0871020 STERI STRIP/CLOSURE STRP 1/2X4 28.00 0871038 TELFA 54.00 0871046 INTERNAL ELECTROD 515.00 0871053 FEEDING TUBING/PUMP 122.00 0871061 ELASTIC BANDAGE 67.00 0871079 IV-SOD CHL SOL 24.00 0871087 IV CATH 35.00 0871095 AFO PRE-TIB SHELL 502.00 0871103 LS ORTHOSIS 681.00 0871111 BDY JACT W/INFACE 5,645.00 0871129 KNEE BRACE-FITTED 3,906.00 0871137 PLS TIBIA FX CAST 3,760.00 0871145 K-T BACK BRACE 1,679.00 0871152 HIP JNT ADJ FLEXION 502.00 0871160 HO ABDUCTION 669.00 0871178 BODY SOCK 502.00 0871186 KAFO CUSTOM-PLASTIC 5,117.00 0871194 DORSAL LS SUPPORT 703.00 0871202 BREAST BIOPSY TRAY 1,510.00 0871210 NS 0.45% 1L 4.00 0891325 TRAY TRIPLE LUMEN PICC 304.00 0892174 CELOX HEMOSTATIC PAD 80.00 0892406 IMPLANT BREAST TISSUE EXPANDER 5,757.50 0895292 SKAFFOLD 5CC 8,750.00 0895300 CEMENT MIXING SYSTEM(SKAFFOLD 5CC) 531.00 0895771 MIRENA IUD 4,250.00 0901074 glycerin suppository - PEDIATRIC 1.15 0901124 NON Formulary - Regular (see below) 0.01 0902783 diphenhydrAMINE (BENADRYL) capsule 1.40 0902809 diphenhydrAMINE (BENADRYL) oral li 29.75 0902882 diphenhydrAMINE (BENADRYL) injectio 14.25 0902965 cyproheptadine (PERIACTIN) tablet - 11.85 0903096 rifabutin (MYCOBUTIN) capsule - 150 194.15 0903179 zinc sulfate 220 mg capsule 0.40 0903443 nitrofurantoin monohydrate/macrocry 39.25 0903534 hydroxychloroquine (PLAQUENIL) tabl 45.40 0903930 flucytosine (ANCOBON) capsule - 250 416.25 0903948 flucytosine (ANCOBON) capsule - 500 497.55 0903955 isoniazid tablet - 100 mg 1.65 0903963 isoniazid tablet - 300 mg 14.30 0903989 ethambutol (MYAMBUTOL) tablet - 400 17.35 0904003 ketoconazole (NIZORAL) tablet - 200 35.10 0904060 amantadine (SYMMETREL) 100 mg capsu 22.75 0904094 sulfaSALAzine (AZULFIDINE) tablet - 2.70 0904276 sulfamethoxazole-trimethoprim (BACT 12.85 0904342 clotrimazole 1% (GYNE-LOTRIMIN) vag 89.95 0904508 metroNIDAZOLE (FLAGYL) tablet - 500 8.10 0904516 acyclovir (ZOVIRAX) 500 mg injecti 250.45 0904532 phenazopyridine (PYRIDIUM) tablet - 30.00 0904540 phenazopyridine (PYRIDIUM) tablet - 32.40 0904680 aztreonam (AZACTAM) 2 gram injectio 772.60 0904821 erythromycin lactobionate injection 1,084.15 0904870 clindamycin (CLEOCIN) capsule - 15 8.15 0904896 clindamycin (CLEOCIN) injection - 1 38.65 0904938 amoxicillin (AMOXIL) 250 mg capsule 2.80 0905232 polymyxin B injection - 500,000 uni 149.85 0905240 dicloxacillin (DYNAPEN) capsule - 2 15.30 0905257 penicillin V potassium (PEN VK) tab 8.15 0905331 penicillin G potassium 5,000,000 un 168.65 0905356 penicillin G potassium 20,000,000 u 25.55 0905364 rifampin (RIFADIN) capsule - 300 mg 15.15 0905372 metroNIDAZOLE (FLAGYL) tablet - 250 5.30 0905513 ampicillin 500 mg injection 48.95 0905521 ampicillin 1 gram injection 95.85 0905539 ampicillin 2 gram injection 186.00 0905737 nafcillin injection - 1 gm 146.55 0905745 nafcillin injection - 2 gm 313.90 0905877 cefOXitin (MEFOXIN) injection - 1 g 85.05 0905885 cefOXitin (MEFOXIN) injection - 2 g 249.75 0905893 cephalexin (KEFLEX) capsule - 250 m 7.75 0905901 cephalexin (KEFLEX) capsule - 500 m 13.60 0905950 cefaclor (CECLOR) capsule - 250 mg 22.10 0906008 ceFAZolin (ANCEF) injection - 1 gm 14.05 0906032 amphotericin B conventional (FUNGIZ 506.20 0906156 gentamicin PF 10 mg/mL Syringe 49.50 0906164 gentamicin injection - 40 mg/mL ( 2 14.80 0906222 tobramycin injection - 40 mg/mL (2 31.45 0906305 amikacin 250 mg/mL (2 mL) injection 108.85 0906388 neomycin tablet - 500 mg 18.10 0906438 penicillin G benzathine (BICILLIN L 1,461.25 0906453 vancomycin injection - 1 gm 82.90 0906487 erythromycin base (ERYC) delayed re 67.00 0906495 amoxicillin-clavulanate (AUGMENTIN) 42.05 0906560 cefTRIAXone (ROCEPHIN) injection - 40.00 0906578 tobramycin injection - 1.2 gm 2,220.00 0906594 cefTRIAXone (ROCEPHIN) injection - 38.00 0906644 cefTAZidime (FORTAZ) injection - 1 55.95 0906719 cefTAZidime (FORTAZ) injection - 2 146.55 0906750 clotrimazole (LOTRIMIN) 1% cream - 94.45 0906784 imipenem-cilastatin (PRIMAXIN) 500 333.00 0906792 pyrazinamide tablet - 500 mg 70.10 0906917 tetracycline capsule - 250 mg 87.45 0906974 aztreonam (AZACTAM) 1 gram injectio 363.80 0907154 bacitracin injection - 50,000 units 147.75 0907204 doxycycline (VIBRAMYCIN) injection 292.30 0907212 doxycycline (VIBRAMYCIN) capsule - 18.35 0907220 doxycycline (VIBRAMYCIN) capsule - 25.05 0907261 clindamycin (CLEOCIN-T) 1% lotion - 1,332.00 0907287 bacitracin zinc ointment - 500 unit 2.60 0907329 ciprofloxacin (CIPRO) tablet - 250 2.75 0907345 ampicillin-sulbactam (UNASYN) 3 gr 84.60 0907345 ampicillin-sulbactam (UNASYN) 3 gr 170.65 0907352 ampicillin-sulbactam (UNASYN) 1.5 85.90 0907378 metroNIDAZOLE (FLAGYL) IVPB - 500 m 24.45 0907444 cefotaxime (CLAFORAN) injection - 1 29.35 0907469 demeclocycline (DECLOMYCIN) tablet 118.05 0907899 cefuroxime (ZINACEF) injection - 1. 59.95 0907923 clarithromycin (BIAXIN) tablet - 25 66.80 0907956 azithromycin (ZITHROMAX) 250 mg tab 86.45 0908079 cycloSPORINE non-modified (SandIMMU 6,101.65 0908095 PARoxetine (PAXIL) tablet - 20 mg 31.00 0908103 rifampin (RIFADIN) injection - 600 2,378.40 0908202 ganciclovir (CYTOVENE) 500 mg Injec 1,078.95 0908210 fluconazole (DIFLUCAN) tablet - 20 151.10 0908228 fluconazole (DIFLUCAN) tablet - 10 97.75 0908236 fluconazole (DIFLUCAN) IVPB - 400 m 186.50 0908244 fluconazole (DIFLUCAN) IVPB - 200 m 53.30 0908293 itraconazole (SPORANOX) capsule - 1 103.00 0908327 dinoprostone (CERVIDIL) VAGINAL ins 4,487.55 0908996 vancomycin 5 mg/mL IV Syringe 49.50 0913277 azaTHIOprine (IMURAN) 50 mg tablet 26.05 0913350 cyclophosphamide (CYTOXAN) capsule 171.85 0913624 hydroxyurea (HYDREA) capsule - 500 9.80 0913657 tamoxifen (NOLVADEX) tablet - 10 mg 21.05 0913673 megestrol (MEGACE) tablet - 40 mg 11.65 0913863 methotrexate injection - 25 mg/mL 44.75 0914242 leucovorin 5 mg tablet 31.10 0915272 azithromycin (ZITHROMAX) 500 mg inj 79.95 0915322 bupivacaine 0.5% injection - 10 mL 24.65 0915330 fentaNYL 50 mcg/mL ( 2 mL) injectio 13.35 0916429 succinylcholine (ANECTINE) injectio 266.20 0916502 trihexyphenidyl (ARTANE) tablet - 2 4.10 0916619 atropine 0.1 mg/mL ( 5 mL) injectio 110.60 0916627 norepinephrine (LEVOPHED) 1 mg/mL ( 269.55 0916676 dicyclomine (BENTYL) capsule - 10 m 2.95 0916759 phenylephrine (NEO-SYNEPHRINE) 10 m 42.65 0916767 PHYSOstigmine 1 mg/mL Injection (2 449.70 0916890 sucralfate (CARAFATE) tablet - 1 gm 8.15 0916924 benztropine (COGENTIN) injection - 652.15 0916932 benztropine (COGENTIN) tablet - 0. 13.35 0916965 prazosin (MINIPRESS) capsule - 1 mg 9.95 0917146 methocarbamol (ROBAXIN) tablet - 50 5.65 0917153 methocarbamol (ROBAXIN) tablet - 75 4.15 0917211 methocarbamol (ROBAXIN) injection - 791.25 0917245 glycopyrrolate (ROBINUL) injection 180.40 0917252 cyclobenzaprine (FLEXERIL) tablet - 12.80 0917260 baclofen (LIORESAL) tablet - 10 mg 5.60 0917286 glycopyrrolate (ROBINUL) 1 mg table 14.60 0917419 neostigmine (BLOXIVERZ) injection - 244.55 0917427 scopolamine (TRANSDERM-SCOP) patch 224.25 0917492 ePHEDrine injection - 50 mg/mL (1 m 457.90 0917500 EPINEPHrine 1 mg/mL (1 mL) injectio 199.25 0917625 isoproterenol (ISUPREL) 0.2 mg/mL ( 23,844.20 0917641 terbutaline (BRETHINE) injection - 239.65 0917666 terbutaline (BRETHINE) tablet - 2.5 60.45 0917757 pseudoephedrine (SUDAFED) tablet - 0.40 0917807 carisoprodol (SOMA) tablet - 350 mg 6.65 0917856 bethanechol (URECHOLINE) tablet - 1 17.85 0917864 bethanechol (URECHOLINE) tablet - 2 29.65 0917906 dicyclomine (BENTYL) injection - 10 519.50 0917930 pancuronium (PAVULON) injection - 1 59.50 0918003 atropine 1 mg/mL ( 1 mL) injection 76.35 0918029 famotidine (PEPCID) tablet - 20 mg 1.70 0918052 ketamine 50 mg/mL (10 mL) Injectio 58.30 0918144 sodium bicarbonate 8.4% injection - 147.35 0918177 nicotine (HABITROL) patch - 14 mg/2 23.80 0918185 nicotine (HABITROL) patch - 21 mg/2 23.80 0918193 nicotine (HABITROL) patch - 7 mg/2 23.80 0918201 misoprostol (CYTOTEC) tablet - 100 9.15 0918227 DOPamine 40 mg/mL (5 mL) injection 24.65 0918268 EPINEPHrine 1 mg/mL (30 mL) injecti 3,337.70 0918292 misoprostol (CYTOTEC) tablet - 200 15.90 0918300 cisatracurium (NIMBEX) 10 mg/mL (20 3,956.05 0918318 cisatracurium (NIMBEX) 2 mg/mL (10 325.90 0920702 albumin human 25% 50 mL injection 666.00 0920710 albumin human 25% 100 mL injection 1,541.80 0920728 albumin human 5% 250 mL injection 768.70 0920736 albumin human 5% 500 mL injection 1,287.60 0920819 hepatitis B immune globulin (NABI-H 8,929.30 0920835 hepatitis B (ENGERIX-B) 10 mcg/0.5 305.40 0921502 aminocaproic acid (AMICAR) 250 mg/m 67.95 0921585 ferrous sulfate enteric coated tabl 0.75 0921619 ferrous gluconate (FERGON) tablet - 0.70 0921783 protamine injection - 10 mg/mL (25 299.15 0921809 heparin injection - 1,000 units/mL 18.20 0921817 heparin injection - 5,000 units/mL 26.65 0921940 warfarin (COUMADIN) tablet - 2 mg 23.85 0921973 warfarin (COUMADIN) tablet - 5 mg 25.65 0922005 warfarin (COUMADIN) tablet - 2.5 m 24.60 0922062 protamine injection - 10 mg/mL ( 5 100.60 0922104 Surgifoam (GELFOAM) Size 50 371.20 0922112 Surgifoam (GELFOAM) Size 100 555.00 0922260 heparin injection - 1,000 units/mL 35.75 0922385 warfarin (COUMADIN) tablet - 1 mg 22.85 0922419 heparin (HEPARINIZED SALINE) infusi 53.85 0923797 digoxin (LANOXIN PEDIATRIC) injecti 725.25 0923995 lidocaine 1% (XYLOCAINE) 50 mg/5 m 56.10 0924001 lidocaine 1% (XYLOCAINE) 20 mL Inje 18.95 0924076 lidocaine 2 gm/500 mL D5W infusion 74.35 0924084 lidocaine 2% (XYLOCAINE) 100 mg/5m 53.30 0924217 digoxin (LANOXIN) injection - 250 m 73.30 0924225 captopril (CAPOTEN) tablet - 25 mg 15.30 0924241 digoxin (LANOXIN) tablet - 125 mc 28.45 0924290 metoprolol (LOPRESSOR) tablet - 50 7.05 0924316 metoprolol (LOPRESSOR) tablet - 100 10.15 0924456 procainamide (PRONESTYL) injection 605.95 0924498 propranolol (INDERAL) tablet - 10 m 4.55 0924506 propranolol (INDERAL) tablet - 20 m 5.70 0924589 NIFEdipine (PROCARDIA) capsule - 10 14.30 0924787 phentolamine (REGITINE) 5 mg 5,938.30 0924829 verapamil (ISOPTIN) injection - 2.5 182.60 0924845 verapamil (CALAN) tablet - 80 mg 6.35 0924878 hydrALAZINE (APRESOLINE) injection 1,417.80 0924886 hydrALAZINE (APRESOLINE) tablet - 1 5.95 0924894 hydrALAZINE (APRESOLINE) tablet - 2 6.95 0924902 hydrALAZINE (APRESOLINE) tablet - 5 1.80 0924910 atenolol (TENORMIN) 50 mg tablet 9.95 0924969 minoxidil (LONITEN) tablet - 2.5 mg 8.70 0924977 methyldopa (ALDOMET) tablet - 250 m 4.15 0925057 cloNIDine (CATAPRES) tablet - 0.1 2.90 0925065 cloNIDine (CATAPRES) tablet - 0.2 5.05 0925149 DOBUTamine 12.5 mg/mL (20 mL) injec 73.30 0925180 dipyridamole (PERSANTINE) tablet - 11.80 0925321 cholestyramine (PREVALITE) oral pac 37.40 0925354 quiNINE capsule - 324 mg 81.35 0925412 isosorbide dinitrate (ISORDIL) tabl 8.15 0925487 nitroglycerin (NITRO-DUR) patch - 0 20.65 0925511 enalaprilat (VASOTEC) injection - 1 58.60 0925552 nitroglycerin (NITRO-DUR) patch - 0 18.55 0925685 nitroglycerin (NITROSTAT) sublingua 4.85 0925693 nitroglycerin 5 mg/mL (10 mL) injec 138.55 0925719 nitroglycerin (NITRO-TIME) extended 9.90 0925735 nitroglycerin (NITRO-DUR) patch - 0 20.85 0925743 nitroglycerin (NITRO-TIME) extended 8.90 0925792 diltiazem (CARDIZEM) tablet - 30 m 11.10 0925800 diltiazem (CARDIZEM) tablet - 60 m 7.85 0925826 disopyramide (NORPACE CR) extended 42.65 0925891 labetalol (TRANDATE) 200 mg tablet 5.35 0925917 pentoxifylline (TRENTAL) extended r 16.65 0925982 captopril (CAPOTEN) tablet - 12.5 m 14.10 0926006 cloNIDine (CATAPRES) tablet - 0.3 2.45 0926022 metoprolol (LOPRESSOR) injection - 14.00 0926055 cloNIDine (CATAPRES TTS-1) patch - 368.10 0926063 cloNIDine (CATAPRES TTS-2) patch - 619.00 0926071 cloNIDine (CATAPRES TTS-3) patch - 858.70 0926089 nitroglycerin (NITRO-DUR) patch - 0 35.05 0926105 mexiletine (MEXITIL) capsule - 150 28.15 0926147 amiodarone (PACERONE) 200 mg tablet 37.00 0926170 labetalol (TRANDATE) 100 mg tablet 25.35 0926360 terazosin (HYTRIN) capsule - 5 mg 17.85 0926386 nitroglycerin 50 mg/250 mL D5W infu 234.10 0926428 amLODIPine (NORVASC) 5 mg tablet 19.20 0926451 milrinone (PRIMACOR) 1 mg/mL (20 mL 122.35 0926642 doxazosin (CARDURA) tablet - 2 mg 12.25 0926659 verapamil (CALAN SR) extended relea 16.00 0926683 NIFEdipine (PROCARDIA XL/ADALAT CC) 29.65 0926709 terazosin (HYTRIN) capsule - 1 mg 17.85 0926733 niMODipine (NIMOTOP) capsule - 30 m 204.40 0926766 nitroglycerin (NITROLINGUAL) SPRAY 2,491.65 0926774 labetalol (TRANDATE) 5 mg/mL (20 mL 31.10 0926782 NIFEdipine (PROCARDIA XL/ADALAT CC) 436.90 0926790 NIFEdipine (PROCARDIA XL/ADALAT CC) 25.70 0926808 diltiazem (CARDIZEM) tablet - 90 m 23.80 0926840 adenosine (ADENOCARD) 3 mg/mL ( 2 m 82.60 0926857 esmolol (BREVIBLOC) 10 mg/mL (10 mL 97.70 0926873 lisinopril (ZESTRIL) tablet - 20 m 11.80 0926881 lisinopril (ZESTRIL) tablet - 10 m 11.05 0926899 lisinopril (ZESTRIL) tablet - 5 m 5.35 0926964 digoxin immune fab (DIGIFAB) inject 38,974.35 0926972 isosorbide mononitrate (ISMO) table 4.60 0927020 divalproex (DEPAKOTE) delayed rele 15.80 0927038 divalproex (DEPAKOTE) delayed rele 11.95 0927053 zolpidem (AMBIEN) 10 mg tablet 51.60 0927186 FLUoxetine (PROzac) capsule - 10 mg 26.90 0927194 risperiDONE (RISPERDAL) tablet - 1 50.45 0927210 verapamil (CALAN SR) extended relea 1,429.25 0927236 atorvastatin (LIPITOR) 10 mg tablet 7.05 0927244 atorvastatin (LIPITOR) 20 mg tablet 5.85 0927335 sotalol (BETAPACE) tablet - 80 mg 28.45 0927343 atenolol (TENORMIN) 25 mg tablet 9.10 0927368 isosorbide mononitrate (IMDUR) exte 22.50 0927376 diltiazem (CARDIZEM) 5 mg/mL ( 5 mL 41.45 0927392 amLODIPine (NORVASC) 10 mg tablet 26.50 0927400 losartan (COZAAR) tablet - 25 mg 18.60 0927459 losartan (COZAAR) tablet - 50 mg 25.45 0930677 morphine injection - 4 mg/mL (1 m 24.40 0930859 morphine (ROXANOL) 20 mg/mL Oral Sy 16.50 0930958 butalbital-aspirin-caffeine-codeine 30.45 0930966 clonazePAM (KlonoPIN) tablet - 0.5 8.35 0930974 clonazePAM (KlonoPIN) tablet - 1 mg 9.50 0930990 aspirin (ECOTRIN) 325 mg enteric co 0.20 0931006 nortriptyline (PAMELOR) capsule - 2 9.80 0931097 ibuprofen (MOTRIN) tablet - 600 mg 4.05 0931220 ibuprofen (MOTRIN) tablet - 400 mg 0.85 0931402 naloxone (NARCAN) injection - 0.4 m 263.30 0931493 indomethacin (INDOCIN) capsule - 25 4.50 0931568 acetaminophen (TYLENOL) 325 mg tabl 0.01 0931675 acetaminophen-codeine (TYLENOL NO. 5.85 0931709 acetaminophen (TYLENOL) 160 mg/5 mL 0.01 0931741 acetaminophen (TYLENOL) 500 mg tabl 0.01 0931782 acetaminophen (TYLENOL) 650 mg/20.3 0.01 0931816 butorphanol (STADOL) injection - 2 71.05 0931873 meperidine (DEMEROL) injection - 5 62.35 0931949 methadone (DOLOPHINE) 5 mg tablet 5.15 0931956 methadone (DOLOPHINE) tablet - 10 m 5.85 0931998 fentaNYL 50 mcg/mL (20 mL) injectio 113.25 0932046 HYDROmorphone (DILAUDID) 2 mg table 4.15 0932053 HYDROmorphone (DILAUDID) 1 mg/mL (1 27.75 0932095 oxyCODONE-acetaminophen (PERCOCET 15.20 0932178 aspirin 325 mg tablet 0.65 0932186 aspirin 81 mg chewable tablet 1.10 0932244 carBAMazepine (TEGRETOL) tablet - 2 3.40 0932608 aspirin 300 mg suppository 16.20 0932624 morphine (ASTRAMORPH) injection - 1 72.60 0932707 carBAMazepine (TEGRETOL) chewable t 7.70 0932715 nortriptyline (PAMELOR) capsule - 1 6.30 0932822 midazolam (VERSED) injection - 1 mg 6.30 0932921 LORazepam (ATIVAN) tablet - 0.5 mg 7.15 0932947 butalbital-acetaminophen-caffeine ( 18.75 0932954 ibuprofen (MOTRIN) tablet - 800 mg 0.95 0932996 busPIRone (BUSPAR) tablet - 5 mg 8.60 0933085 fentaNYL 50 mcg/mL ( 5 mL) injectio 21.55 0933184 PHENobarbital 10 mg/mL IV Syringe 49.50 0933200 morphine injection - 10 mg/mL (1 m 13.50 0933267 amitriptyline (ELAVIL) 10 mg tablet 3.35 0933275 amitriptyline (ELAVIL) 25 mg tablet 7.10 0933283 amitriptyline (ELAVIL) 50 mg tablet 12.90 0933432 SUMAtriptan (IMITREX) injection - 6 319.70 0933481 doxepin (SINEQUAN) capsule - 10 mg 4.60 0933499 doxepin (SINEQUAN) capsule - 25 mg 9.15 0933531 naloxone (NARCAN) injection - 1 mg/ 439.60 0933549 diazepam (VALIUM) injection - 5 mg/ 209.80 0933580 sertraline (ZOLOFT) tablet - 50 mg 53.55 0933762 fentaNYL (DURAGESIC) patch - 100 mc 873.70 0933820 fentaNYL (DURAGESIC) patch - 50 mc 430.95 0933838 fentaNYL (DURAGESIC) patch - 25 mc 236.00 0933895 fentaNYL (DURAGESIC) patch - 75 mc 658.25 0933911 morphine PCA infusion - 1 mg/mL (3 159.85 0933937 propofol (DIPRIVAN) injection - 10 32.00 0933945 ibuprofen (ADVIL) tablet - 200 mg 0.80 0934034 phenytoin (DILANTIN) 100 mg/4 mL Or 17.35 0934117 diclofenac sodium (VOLTAREN) enteri 8.95 0934208 imipramine (TOFRANIL) tablet - 10 m 4.80 0934216 imipramine (TOFRANIL) tablet - 25 m 8.00 0934232 lithium capsule - 300 mg 2.35 0934257 lithium 60 mg/mL Oral Syringe 2.10 0934398 PHENobarbital injection - 65 mg/mL 319.50 0934554 temazepam (RESTORIL) 15 mg capsule 9.05 0934877 traZODone (DESYREL) tablet - 50 mg 11.95 0934919 hydrOXYzine (ATARAX) injection - 5 296.40 0934943 hydrOXYzine hydrochloride (ATARAX) 3.10 0934992 LORazepam (ATIVAN) tablet - 1 mg 9.35 0935049 LORazepam (ATIVAN) injection - 2 mg 10.00 0935098 haloperidol (HALDOL) tablet - 0.5 3.65 0935122 haloperidol (HALDOL) tablet - 5 mg 10.85 0935155 haloperidol lactate (HALDOL) inject 79.85 0935247 chlorproMAZINE (THORAZINE) injectio 384.80 0935270 chlorproMAZINE (THORAZINE) tablet 84.85 0935528 diazepam (VALIUM) tablet - 5 mg 2.25 0935536 diazepam (VALIUM) tablet - 10 mg 3.70 0935726 prochlorperazine (COMPAZINE) tablet 6.80 0935734 prochlorperazine (COMPAZINE) tablet 9.95 0935775 prochlorperazine (COMPAZINE) inject 246.45 0935783 promethazine (PHENERGAN) 25 mg/mL I 20.00 0935817 promethazine (PHENERGAN) tablet - 2 6.70 0935825 promethazine (PHENERGAN) suppositor 196.55 0935924 thioridazine (MELLARIL) 25 mg table 5.35 0935965 trifluoperazine (STELAZINE) tablet 9.75 0935981 trifluoperazine (STELAZINE) tablet 18.60 0936153 ALPRAZolam (XANAX) 0.25 mg tablet 6.85 0936161 ALPRAZolam (XANAX) 0.5 mg tablet 8.25 0936203 phenytoin (DILANTIN) injection - 50 42.65 0936211 phenytoin (DILANTIN) injection - 50 22.00 0936237 phenytoin (DILANTIN) extended relea 7.15 0936294 phenytoin (DILANTIN INFATAB) chewab 5.85 0936302 primidone (MYSOLINE) tablet - 50 m 10.60 0936310 primidone (MYSOLINE) tablet - 250 m 11.10 0936336 valproic acid (DEPAKENE) capsule - 11.20 0936344 valproic acid (DEPAKENE) oral liqui 24.00 0936377 methylphenidate (RITALIN) tablet - 8.15 0936401 carbidopa-levodopa (SINEMET) table 8.60 0936419 carbidopa-levodopa (SINEMET) table 17.95 0936492 oxyCODONE (OxyCONTIN) 20 mg Tablet 71.35 0936500 oxyCODONE (OxyCONTIN) 10 mg Tablet 38.30 0936526 divalproex (DEPAKOTE) delayed rele 9.95 0936534 haloperidol decanoate injection - 5 344.90 0936542 gabapentin (NEURONTIN) capsule - 30 15.30 0936567 propafenone (RYTHMOL) tablet - 150 18.20 0936591 gabapentin (NEURONTIN) capsule - 10 6.50 0936609 fosphenytoin 50 mg PE/mL Injection 299.70 0936617 fosphenytoin 50 mg PE/mL Injection 441.80 0936658 valproic acid (DEPACON) injection - 89.25 0936682 OLANZapine (ZyPREXA) tablet - 5 mg 146.70 0936716 PARoxetine (PAXIL) tablet - 10 mg 31.25 0942771 indigo carmine 8 mg/mL (5 mL) injec 95.95 0942789 methylene blue 1% injection - (10 m 2,235.10 0942847 candida skin test antigen injection 1,838.20 0942896 tuberculin purified protein derivat 64.20 0943126 traMADol (ULTRAM) tablet - 50 mg 8.85 0943944 potassium acetate injection - 2 mEq 6.45 0943977 sodium chloride 23.4% injection - 4 10.70 0943985 sodium acetate injection - 2 mEq/mL 39.10 0944439 potassium bicarbonate (K-LYTE) effe 4.35 0944454 sodium chloride tablet - 1 gm 0.90 0944504 calcitriol (ROCALTROL) capsule - 0. 14.25 0944520 calcium GLUCONATE tablet - 500 mg 1.85 0944710 sodium bicarbonate tablet - 650 mg 0.15 0944728 sodium bicarbonate 8.4% injection - 133.20 0944744 sodium bicarbonate 8.4% injection - 116.55 0944777 sodium polystyrene sulfonate (KAYEX 175.50 0944793 potassium iodide (SSKI) solution - 253.10 0944884 metolazone (ZAROXOLYN) tablet - 2.5 25.20 0944892 metolazone (ZAROXOLYN) tablet - 5 m 30.90 0944967 fat emulsion (INTRALIPID) 20% infus 371.85 0945097 lactulose oral liquid - 10 gm/15 mL 385.75 0945105 bumetanide (BUMEX) tablet - 1 mg 23.70 0945113 bumetanide (BUMEX) injection - 0.25 30.35 0945212 spironolactone (ALDACTONE) tablet 9.80 0945220 desmopressin (DDAVP) injection - 4 506.20 0945238 furosemide (LASIX) injection - 10 m 65.70 0945279 furosemide (LASIX) tablet - 20 mg 5.75 0945287 furosemide (LASIX) tablet - 40 mg 1.90 0945311 potassium chloride (K-DUR) extended 6.30 0945329 bumetanide (BUMEX) injection - 0.25 32.90 0945337 potassium phosphate-sodium phosphat 5.80 0945360 dextrose 25% injection - 10 mL syri 80.95 0945386 sodium bicarbonate 4.2% injection - 144.00 0945402 indapamide (LOZOL) tablet - 2.5 mg 17.20 0945428 citric acid-sodium citrate (BICITRA 33.05 0945493 aMILoride (MIDAMOR) 5 mg tablet 3.00 0945527 furosemide (LASIX) injection - 10 m 29.10 0945535 furosemide (LASIX) injection - 10 m 58.10 0945634 hydrochlorothiazide (HYDRODIURIL) t 0.95 0945691 triamterene (DYRENIUM) capsule - 50 127.65 0945709 ethacrynic acid (EDECRIN) 25 mg tab 268.55 0945725 hydrochlorothiazide-triamterene (DY 4.25 0945840 mannitol 25% (OSMITROL) injection - 49.40 0945956 spironolactone (ALDACTONE) tablet 4.80 0945972 probenecid (BENEMID) tablet - 500 m 10.95 0948927 hemin (PANHEMATIN) 7 mg/mL IV Syrin 125,169.55 0948976 torsemide (DEMADEX) 20 mg tablet 9.25 0948984 calcium carbonate-vitamin D (OS CAL 0.45 0948992 torsemide (DEMADEX) 5 mg tablet 7.05 0949016 isosulfan blue 10 mg/mL (5 mL) Inje 13,458.20 0949693 acetylcysteine 20% (MUCOMYST) 30 mL 129.50 0949842 benzonatate (TESSALON) perles - 10 27.80 0949867 guaiFENesin (ROBITUSSIN) SUGAR FREE 7.15 0949941 promethazine (PHENERGAN) oral liqui 3.45 0950402 levOCARNitine 200 mg/mL (5 mL) Inje 426.25 0951392 acetaZOLAMIDE (DIAMOX) 250 mg table 32.05 0951418 acetaZOLAMIDE (DIAMOX) 500 mg injec 437.15 0951541 fluorometholone 0.1% (FML) ophthal 823.00 0951608 phenylephrine 0.25% (NEO-SYNEPHRINE 43.30 0951749 ARTIFICIAL TEARS ophthalmic solutio 1,198.80 0951764 sodium hyaluronate (HEALON) ophthal 1,778.80 0951897 tobramycin 0.3% (TOBREX) ophthalmic 153.85 0951996 neomycin-polymyxin B-gramicidin (NE 687.10 0952002 bacitracin-neomycin-polymyxin B (NE 632.15 0952051 bacitracin-polymyxin B (AK-POLY-BAC 285.30 0952077 tobramycin 0.3% (TOBREX) ophthalmic 2,334.15 0952101 trifluridine (VIROPTIC) 1% Ophthalm 2,474.65 0952143 timolol maleate 0.5% (TIMOPTIC) oph 72.85 0952150 timolol maleate 0.25% (TIMOPTIC) op 166.50 0952176 atropine 1% 3.5 gram ophthalmic oin 221.10 0952184 atropine 1% 5 mL ophthalmic solutio 283.05 0952218 cyclopentolate 0.2%-phenylephrine 1 370.75 0952226 cyclopentolate (CYCLOGYL) 1% Ophtha 181.30 0952291 pilocarpine 1% (ISOPTO CARPINE) oph 1,029.35 0952309 phenylephrine 10% (NEO-SYNEPHRINE) 555.00 0952416 phenylephrine 2.5% (AK-DILATE) 2 m 451.00 0952457 neomycin-polymyxin B-dexamethasone 488.40 0952499 ophthalmic irrigation (EYE WASH) so 36.70 0952523 bacitracin-neomycin-polymyxin B-hyd 722.10 0952531 neomycin-polymyxin B-hydrocortisone 639.40 0952614 Balanced Salt Solution (BSS) Ophth 104.90 0952655 carbamide peroxide 6.5% (DEBROX) ot 50.95 0952697 pilocarpine 2% (ISOPTO CARPINE) oph 167.85 0952721 acetylcholine 1% (MIOCHOL-E) 20 mg 1,096.15 0952820 phenol 1.4% (CHLORASEPTIC) mouth/th 53.20 0952846 dexamethasone 0.1% (DECADRON) ophth 717.95 0952986 prednisoLONE acetate 1% (PRED FORTE 586.10 0953000 ipratropium (ATROVENT) MDI - 17 mcg 5,479.75 0953083 sulfacetamide sodium 10% (BLEPH-10) 677.20 0953109 proparacaine 0.5% (OPHTHETIC) ophth 486.85 0953158 sodium chloride 0.65% (SALINE) nasa 23.00 0953182 carbachol 0.01% (MIOSTAT) intraocul 448.65 0953307 flurbiprofen 0.03% (OCUFEN) ophthal 96.85 0953414 albuterol (PROVENTIL) 0.4 mg/mL Ora 16.50 0953463 fluorescein (BIO-GLO) ophthalmic st 2.05 0953471 polymyxin B-trimethoprim (POLYTRIM) 149.20 0953521 albuterol (VOSPIRE or VOLMAX) 4 mg 19.85 0953588 albuterol 0.083% 2.5 mg/3 mL inhala 15.55 0953604 sodium chondroitin-hyaluronate opht 1,628.40 0953828 guaiFENesin (MUCINEX) extended rele 11.90 0953893 latanoprost 0.005% (XALATAN) ophtha 1,054.50 0953927 fluticasone (FLONASE) nasal spray - 944.85 0956375 bismuth subsalicylate (PEPTO-BISMOL 26.65 0956417 bisacodyl (DULCOLAX) enteric coated 0.45 0956433 bisacodyl (DULCOLAX) suppository - 11.65 0956458 docusate sodium (COLACE) capsule - 0.45 0956482 charcoal, activated (ACTIDOSE with 185.15 0956524 senna (SENOKOT) tablet - 8.6 mg 0.30 0956714 docusate sodium (COLACE) capsule - 0.75 0956821 diphenoxylate-atropine (LOMOTIL) 2. 9.75 0956904 mineral oil - 30 mL cup 9.00 0956920 loperamide (IMODIUM) capsule - 2 mg 9.75 0956938 aspirin 600 mg suppository 16.75 0956961 glycerin suppository - ADULT 8.70 0957035 simethicone (MYLANTA GAS) chewable 0.50 0957068 simethicone (MYLICON INFANT) drops 73.30 0957159 aluminum hydroxide-magnesium hydrox 11.35 0957506 magnesium citrate (CITROMA) oral li 16.65 0957563 meclizine (ANTIVERT) tablet - 12.5 0.30 0957589 meclizine (ANTIVERT) tablet - 25 mg 9.55 0957696 metoclopramide (REGLAN) tablet - 10 8.00 0957704 metoclopramide (REGLAN) injection - 14.80 0957902 polyethylene glycol 3350 with elect 255.30 0958074 ursodiol (ACTIGALL) 300 mg capsule 81.60 0958181 ranitidine (ZANTAC) injection - 25 41.55 0958215 ondansetron (ZOFRAN) injection - 2 104.60 0958231 calcium acetate (PHOSLO) capsule - 11.40 0958256 mesalamine (ROWASA) enema - 4 gm/60 269.75 0958397 aluminum hydroxide (AMPHOJEL) 64 mg 4.00 0958447 charcoal,activated 25 gm/120 mL bot 185.15 0958454 cherry syrup oral liquid - 5 mL 1.70 0958496 mesalamine (PENTASA) extended relea 28.65 0958637 ondansetron (ZOFRAN) injection - 2 6.25 0958652 metoclopramide (REGLAN) oral liquid 7.25 0958686 famotidine (PEPCID) injection - 10 11.90 0958710 dorzolamide 2% (TRUSOPT) ophthalmic 741.50 0961342 deferoxamine (DESFERAL) injection - 104.20 0961615 betamethasone sodium phosphate-beta 532.80 0961623 calcitonin (MIACALCIN) injection - 36,004.85 0961698 glyBURIDE (DIABETA) tablet - 2.5 mg 5.10 0961722 dexamethasone (DECADRON) injection 29.35 0961839 dexamethasone (DECADRON) tablet - 13.10 0961896 methylPREDNISolone (Solu-MEDROL) in 80.55 0961904 methylPREDNISolone (Solu-MEDROL) in 129.00 0961912 methylPREDNISolone (Solu-MEDROL) in 150.05 0961920 methylPREDNISolone (Solu-MEDROL) in 378.40 0961953 methylPREDNISolone acetate (DEPO-ME 191.40 0961995 hydrocortisone (Solu-CORTEF) inject 195.70 0962043 vasopressin (VASOSTRICT) 20 units/m 80.50 0962100 predniSONE tablet - 1 mg 3.10 0962118 predniSONE tablet - 2.5 mg 2.05 0962126 predniSONE tablet - 5 mg 2.30 0962134 predniSONE tablet - 10 mg 2.90 0962159 predniSONE tablet - 20 mg 3.20 0962175 predniSONE tablet - 50 mg 4.70 0962324 estradiol (ESTRACE) tablet - 1 mg 7.55 0962365 methylPREDNISolone (MEDROL) tablet 18.35 0962431 triamcinolone acetonide (KENALOG 10 147.10 0962464 triamcinolone acetonide (KENALOG 40 113.25 0962563 liothyronine (CYTOMEL) 5 mcg tablet 9.45 0962589 methimazole (TAPAZOLE) tablet - 10 8.55 0962597 propylthiouracil (PTU) tablet - 50 10.00 0962662 glipiZIDE (GLUCOTROL) tablet - 5 4.50 0962746 glucagon injection - 1 mg 2,153.40 0962753 conjugated estrogens (PREMARIN) inj 2,928.30 0962779 conjugated estrogens (PREMARIN) tab 52.85 0962811 conjugated estrogens (PREMARIN) tab 52.85 0962910 insulin regular (NovoLIN R) 100 un 66.10 0962928 calcium carbonate (OS CAL) tablet 1.20 0962936 cosyntropin (CORTROSYN) injection - 1,174.40 0962944 calcium chloride injection - 100 mg 90.40 0962951 calcium GLUCONATE injection - 100 m 71.95 0963009 fludrocortisone (FLORINEF) tablet - 8.85 0963033 levothyroxine (SYNTHROID) tablet - 8.05 0963041 levothyroxine (SYNTHROID) tablet - 9.75 0963082 levothyroxine (SYNTHROID) tablet - 14.70 0963124 thyroid, desiccated tablet - 60 mg 8.10 0963215 liothyronine (CYTOMEL) tablet - 25 11.55 0963280 levothyroxine (SYNTHROID) tablet - 15.45 0963447 medroxyPROGESTERone (PROVERA) 5 mg 5.30 0963728 prednisoLONE 3 mg/mL 5 mL Cup 21.40 0965517 glipiZIDE (GLUCOTROL XL) extended r 4.55 0965533 metFORMIN (GLUCOPHAGE) tablet - 850 0.80 0965541 metFORMIN (GLUCOPHAGE) tablet - 500 7.80 0965558 medroxyPROGESTERone (DEPO-PROVERA) 894.25 0965566 levothyroxine (SYNTHROID) tablet - 7.85 0965624 insulin aspart (NovoLOG) 100 units/ 66.10 0965632 levothyroxine (SYNTHROID) tablet - 6.75 0965640 levothyroxine (SYNTHROID) tablet - 4.90 0965657 levothyroxine (SYNTHROID) tablet - 7.85 0966101 lidocaine 1% preservative-free Inje 30.00 0966127 lidocaine topical 4% (XYLOCAINE) to 717.65 0966176 lidocaine 1% (XYLOCAINE MPF) 2 mL I 27.20 0966184 lidocaine-EPINEPHrine 2%-1:100,000 50.65 0966192 lidocaine 2% (XYLOCAINE MPF) injec 80.40 0966226 lidocaine-EPINEPHrine 1%-1:100,000 28.20 0966242 lidocaine 1% preservative-free Inje 32.35 0966317 lidocaine 1% (XYLOCAINE) 50 mL Inje 30.80 0966341 bupivacaine 0.5% injection - 30 mL 98.95 0966473 lidocaine 2% (XYLOCAINE) injection 23.10 0966499 bupivacaine 0.75% spinal injection 60.75 0966507 bupivacaine 0.25% injection - 30 m 45.65 0966515 bupivacaine 0.25% injection - 10 m 21.45 0966531 lidocaine-EPINEPHrine 1.5%-1:200,00 152.85 0966549 lidocaine-EPINEPHrine 2%-1:200,000 170.75 0966556 bupivacaine 0.75% injection - 10 m 26.65 0966572 miconazole (MONISTAT) vaginal suppo 10.40 0967612 methylergonovine (METHERGINE) table 746.25 0967620 methylergonovine (METHERGINE) injec 95.25 0967646 oxytocin (PITOCIN) injection - 10 u 49.95 0967695 carboprost (HEMABATE) injection - 2 3,013.60 0968347 tetanus immune globulin (HyperTET S 5,532.70 0968354 crotalidae polyvalent immune FAB ov 30,129.85 0968362 latrodectus mactans (antivenin blac 369.10 0968487 pneumococcal polysaccharide (PPV or 1,155.00 0968503 tetanus-diphtheria toxoids (Td) (DE 785.45 0968511 measles-mumps-rubella (MMR-II) inje 831.45 0969428 miconazole (MONISTAT) 2% vaginal cr 95.45 0969667 triamcinolone (KENALOG) 0.1% cream 64.80 0970046 methyl salicylate-menthol (MUSCLE R 25.10 0970053 povidone iodine 10% (BETADINE) oint 70.95 0970129 gentamicin 0.1% cream - 15 gm 364.65 0970343 dibucaine 1% (NUPERCAINAL) ointment 66.55 0970350 silver sulfADIAZINE 1% (SILVADENE) 706.00 0970368 silver sulfADIAZINE 1% (SILVADENE) 167.65 0970384 lidocaine topical 5% (XYLOCAINE) oi 2,981.00 0970509 glycerin-witch hazel 10%-50% topica 0.70 0970517 benzocaine 20%-menthol 0.5% (DERMOP 55.30 0970541 acetaminophen (TYLENOL) 120 mg supp 0.01 0970558 acetaminophen (TYLENOL) 325 mg supp 0.01 0970566 acetaminophen (TYLENOL) 650 mg supp 0.01 0970624 prochlorperazine (COMPRO) supposito 148.75 0970707 hydrocortisone suppository - 25 mg 238.85 0970780 bacitracin zinc ointment (30 gram) 79.60 0970806 hydrocortisone 0.5% cream (30 gram) 36.00 0970814 conjugated estrogens (PREMARIN) vag 3,841.50 0970822 hydrocortisone 1% cream - 30 gm 44.30 0970830 hydrocortisone 1% ointment - 30 gm 44.30 0970855 nystatin-triamcinolone (MYCOLOG-II) 1,242.60 0970863 nystatin topical powder - 15 gm 304.85 0970871 EPINEPHrine 1 mg/mL topical solutio 2,530.80 0971010 hydrocortisone (COLOCORT) 100 mg/60 117.90 0971259 gentamicin 0.1% ointment - 15 gm 364.65 0971325 nystatin cream - 15 gm 194.35 0971333 nystatin ointment - 15 gm 155.40 0971416 white petrolatum ointment 29.75 0971473 hydrogen peroxide 3% topical soluti 15.75 0971556 silver nitrate topical stick 7.95 0971648 sodium hypochlorite 0.25% (DAKIN'S 127.90 0971671 nitroglycerin 2% (NITRO-BID) ointme 27.85 0971697 collagenase (SANTYL) ointment - 30 2,727.95 0972596 ketoconazole 2% (NIZORAL) shampoo - 309.05 0972620 dapsone tablet - 100 mg 33.60 0975912 aminophylline 25 mg/mL (10 mL) inje 125.70 0975953 papaverine injection - 30 mg/mL (2 156.20 0976167 oxybutynin (DITROPAN) tablet - 5 m 8.45 0976225 pyridoxine (Vitamin B6) 25 mg table 0.35 0977975 cyanocobalamin (VITAMIN B-12) injec 97.05 0978049 multivitamin adult (INFUVITE) injec 134.75 0978056 folic acid tablet - 1 mg 4.05 0978171 pyridoxine (Vitamin B6) tablet - 50 0.35 0978239 thiamine (VITAMIN B1) tablet - 100 0.60 0978270 thiamine (VITAMIN B1) injection - 1 118.45 0978346 ascorbic acid (VITAMIN C) 250 mg ta 0.35 0978353 ascorbic acid (VITAMIN C) 500 mg ta 0.40 0978437 vitamin E capsule - 400 units 0.60 0978494 multivitamin with Iron (POLY VI SOL 94.95 0978528 phytonadione (Vitamin K) (AQUAMEPHY 569.70 0978569 phytonadione (Vitamin K) (AQUAMEPHY 239.80 0978734 multivitamin, prenatal tablet with 0.70 0978858 pyridoxine (Vitamin B6) injection - 155.75 0978908 ergocalciferol (VITAMIN D) capsule 21.90 0978916 multivitamin with minerals (THERAGR 0.55 0980490 bromocriptine (PARLODEL) tablet - 2 45.95 0980508 allopurinol (ZYLOPRIM) 100 mg table 5.40 0980516 allopurinol (ZYLOPRIM) 300 mg table 8.45 0980532 colchicine (COLCRYS) tablet - 0.6 m 79.80 0980771 pamidronate (AREDIA) injection - 3 359.65 0980789 Talc Irrigation 1,864.80 0981407 neomycin-polymyxin B-dexamethasone 220.45 0982140 cocaine 4% topical solution - 4 mL 2,937.10 0982256 atropine 0.1 mg/mL (10 mL) injectio 73.50 0982306 EPINEPHrine 0.1 mg/mL (10 mL) injec 66.60 0982314 atropine 0.4 mg/mL ( 1 mL) injectio 48.60 0982389 ketorolac (TORADOL) 30 mg/mL (1 mL) 11.60 0982413 dextrose 50% injection - 50 mL syri 86.60 0982769 antipyrine-benzocaine (AURODEX) 10 199.00 0983460 finasteride (PROSCAR) tablet - 5 mg 14.50 0983577 glimepiride (AMARYL) 1 mg tablet 4.50 0983593 glimepiride (AMARYL) tablet - 4 mg 13.65 0983601 donepezil (ARICEPT) tablet - 5 mg 8.65 0983619 amoxicillin-clavulanate (AUGMENTIN) 56.10 0983684 bicalutamide (CASODEX) 50 mg tablet 205.80 0983726 carvedilol (COREG) tablet - 6.25 21.65 0983791 venlafaxine (EFFEXOR XR) 75 mg Caps 51.80 0983825 tamsulosin (FLOMAX) capsule - 0.4 m 5.30 0983916 levoFLOXacin (LEVAQUIN) 500 mg tabl 186.75 0983932 enoxaparin (LOVENOX) injection - 4 53.45 0983999 methotrexate tablet - 2.5 mg 69.25 0984013 cycloSPORINE modified (NEORAL) caps 61.05 0984021 cycloSPORINE modified (NEORAL) caps 15.30 0984435 acarbose (PRECOSE) 50 mg tablet 10.75 0984450 midodrine (PROAMATINE) tablet - 5 m 11.55 0984468 promethazine-codeine (PHENERGAN WIT 5.40 0984484 mirtazapine (REMERON) tablet - 15 m 30.20 0984492 mesalamine (CANASA) suppository - 1 206.35 0984518 diltiazem (TIAZAC) extended releas 5.70 0984526 topiramate (TOPAMAX) tablet - 25 m 23.35 0984534 flecainide (TAMBOCOR) tablet - 50 28.45 0984542 metoprolol (TOPROL XL) extended rel 12.35 0984559 magnesium oxide tablet - 400 mg 2.05 0984617 rocuronium (ZEMURON) 10 mg/mL Injec 48.65 0984625 rocuronium (ZEMURON) 10 mg/mL Injec 136.90 0984690 amiodarone (CORDARONE) 50 mg/mL ( 3 27.75 0984708 aspirin (ECOTRIN) 81 mg enteric co 0.35 0984724 isosorbide mononitrate (IMDUR) exte 18.45 0984757 repaglinide (PRANDIN) tablet - 0.5 36.90 0984864 cephalexin (KEFLEX) 25 mg/mL Oral S 16.50 0985242 gabapentin (NEURONTIN) capsule - 40 2.75 0985291 nevirapine (VIRAMUNE) tablet - 200 156.45 0985309 cetirizine (ZyrTEC) tablet - 10 mg 27.70 0985317 terbinafine (LamISIL) tablet - 250 144.60 0985325 morphine (MS CONTIN) extended rele 20.80 0985390 lamoTRIgine (LaMICtal) tablet - 100 2.60 0985416 pramipexole (MIRAPEX) tablet - 0.25 37.10 0985432 lactulose oral liquid - 20 gm/30 mL 33.00 0985598 hepatitis B immune globulin (HYPERH 1,178.20 0985606 buPROPion (WELLBUTRIN SR) extended 8.50 0985655 diltiazem (TIAZAC) extended releas 14.45 0985671 venlafaxine (EFFEXOR XR) 37.5 mg Ca 46.25 0986059 acyclovir (ZOVIRAX) 400 mg tablet 21.95 0986109 mycophenolate mofetil (CELLCEPT) ca 44.05 0986125 nadolol (CORGARD) tablet - 20 mg 40.75 0986133 dantrolene (DANTRIUM) injection - 2 70,842.45 0986182 glycerin 80 % NEONATAL enema 0.2 mL 0.15 0986208 hyoscyamine (LEVSIN) tablet - 0.125 6.35 0986257 levoFLOXacin (LEVAQUIN) 250 mg tabl 183.10 0986364 tacrolimus (PROGRAF) 1 mg capsule 49.55 0986372 mercaptopurine (6-MP) tablet - 50 m 45.40 0986414 octreotide (SandoSTATIN) injection 905.80 0986422 carbidopa-levodopa (SINEMET) table 14.10 0986448 diltiazem (TIAZAC) extended releas 18.40 0986471 valACYclovir (VALTREX) tablet - 500 80.20 0986927 amLODIPine (NORVASC) 2.5 mg tablet 17.70 0987024 ammonium lactate 12% (AMLACTIN or L 423.15 0987032 SUMAtriptan (IMITREX) tablet - 25 300.30 0987040 raloxifene (EVISTA) tablet - 60 mg 49.40 0987156 octreotide (SandoSTATIN) injection 53.30 0987222 citalopram (CeleXA) tablet - 20 mg 29.90 0987263 carvedilol (COREG) tablet - 12.5 21.65 0987313 tolterodine (DETROL) tablet - 2 mg 37.75 0987719 ethiodized oil (LIPIODOL) 48% Injec 13,357.75 0987735 ethyl chloride topical spray 344.10 0987768 hydrocortisone 2.5% cream (30 gram) 122.25 0987842 metroNIDAZOLE 0.75% (FLAGYL) vagina 1,696.20 0987941 repaglinide (PRANDIN) tablet - 1 mg 40.65 0988014 montelukast (SINGULAIR) tablet - 10 62.75 0988030 methimazole (TAPAZOLE) tablet - 5 6.70 0988048 diltiazem (TIAZAC) extended releas 16.65 0988170 piperacillin-tazobactam (ZOSYN) inj 146.55 0988550 brinzolamide 1% (AZOPT) ophthalmic 3,330.00 0988576 alteplase (ACTIVASE) 1 mg/mL (100 m 113,806.65 0988592 aminocaproic acid (AMICAR) 500 mg t 271.20 0988600 anastrozole (ARIMIDEX) 1 mg tablet 133.20 0988725 alteplase (CATH-FLO) 2 mg injection 1,675.80 0988758 sodium hyaluronate (DUOVISC) ophtha 2,515.30 0988766 leucovorin 25 mg tablet 142.65 0988782 celecoxib (CeleBREX) capsule - 100 51.15 0988816 onabotulinumtoxinA (BOTOX) 100 unit 7,712.30 0988840 topiramate (TOPAMAX) tablet - 100 m 77.30 0988972 lidocaine topical 5% (LIDODERM) pat 103.90 0989376 buPROPion (WELLBUTRIN) tablet - 7 8.85 0989384 buPROPion (WELLBUTRIN) tablet - 10 11.80 0989426 enoxaparin (LOVENOX) injection - 6 80.20 0989434 enoxaparin (LOVENOX) injection - 8 211.80 0989442 enoxaparin (LOVENOX) injection - 10 133.75 0989459 oseltamivir (TAMIFLU) capsule - 75 171.60 0989517 tiZANidine (ZANAFLEX) 4 mg tablet 19.60 0989533 venlafaxine (EFFEXOR) 37.5 mg table 22.20 0989608 indocyanine green (IC GREEN) 25 mg 1,176.50 0989624 pioglitazone (ACTOS) tablet - 15 mg 77.80 0989657 mupirocin 2% (BACTROBAN) ointment - 949.00 0989723 eptifibatide (INTEGRILIN) infusion 7,246.75 0989731 propofol (DIPRIVAN) injection - 10 189.85 0989830 perphenazine (TRILAFON) tablet - 2 19.40 0990192 tenecteplase (TNKase) injection - 5 65,718.45 0990200 zolpidem (AMBIEN) 5 mg tablet 51.30 0990218 clopidogrel (PLAVIX) tablet - 75 m 4.60 0990234 HYDROcodone-acetaminophen (NORCO) 13.45 0990259 oxyCODONE (OXY IR) 5 mg tablet 6.90 0990309 linezolid (ZYVOX) IVPB - 600 mg/D5W 2.90 0990481 etomidate (AMIDATE) injection - 2 m 130.65 0990499 pantoprazole (PROTONIX) injection - 94.35 0990572 vitamin B complex with vitamin C (T 0.50 0990598 budesonide (PULMICORT) inhalation s 104.50 0991026 tobramycin-dexamethasone (TOBRADEX) 724.95 0991042 caffeine citrate 20 mg/mL IV Syring 319.70 0991059 cefTRIAXone (ROCEPHIN) injection - 10.00 0991109 pravastatin (PRAVACHOL) tablet - 20 7.50 0991216 levalbuterol (XOPENEX) inhalation s 22.25 0991224 levalbuterol (XOPENEX) inhalation s 22.25 0991299 pamidronate (AREDIA) injection - 9 1,246.20 0991331 entacapone (COMTAN) tablet - 200 mg 45.30 0991349 vitamin E capsule - 1,000 units (4 3.65 0991372 dorzolamide 2%-timolol 0.5% (COSOPT 1,354.20 0991406 voriconazole (VFEND) 200 mg Injecti 1,693.65 0991455 divalproex (DEPAKOTE ER) extended r 45.25 0991463 divalproex (DEPAKOTE ER) extended r 6,812.65 0991844 racepinephrine 2.25% inhalation sol 11.10 0991869 morphine injection - 2 mg/mL (1 m 24.35 0991877 ciprofloxacin 0.3% (CILOXAN) ophtha 139.90 0991943 ziprasidone (GEODON) 20 mg capsule 36.75 0991976 OLANZapine (ZyPREXA Zydis) oral dis 777.00 0991984 cyanocobalamin (VITAMIN B-12) table 3.40 0991992 AQUAPHOR ORIGINAL FORMULA 396 gram 124.35 0992024 OLANZapine (ZyPREXA) tablet - 2.5 124.30 0992123 midazolam (VERSED) 10 mg/5 mL Syrup 81.45 0992156 budesonide (PULMICORT) inhalation s 123.05 0992172 naproxen (NAPROSYN) tablet - 250 mg 8.60 0992206 sodium chloride (AYR SALINE NASAL G 34.20 0992214 acetaminophen (TYLENOL) 80 mg supp 0.01 0992222 cadexomer iodine 0.9% (IODOFLEX GEL 195.20 0992248 propofol (DIPRIVAN) injection - 10 389.65 0992339 fondaparinux (ARIXTRA) 2.5 mg/0.5 m 303.35 0992388 clindamycin (CLEOCIN) IVPB - 900 mg 201.20 0992396 perflutren lipid microspheres (DEFI 721.20 0992412 hepatitis A (HAVRIX) 1440 units/mL 924.90 0992453 celecoxib (CeleBREX) capsule - 200 84.15 0992487 acetylcysteine 20% (ACETADOTE) 30 m 2,504.20 0992503 levoFLOXacin (LEVAQUIN) IVPB - 250 20.55 0992511 meloxicam (MOBIC) tablet - 7.5 mg 35.20 0992552 fentaNYL (DURAGESIC) patch 12 mcg/ 225.40 0992560 HYDROmorphone (DILAUDID) 6 mg/30 mL 93.15 0992586 cyanocobalamin (VITAMIN B-12) table 2.40 0992594 salmeterol (SEREVENT) DISKUS - 50 m 2,536.80 0992628 lidocaine topical 2% (XYLOCAINE) je 86.60 0992719 megestrol (MEGACE) oral liquid - 40 50.30 0992743 sorbitol 70% Cup 30 mL 20.65 0992768 ibuprofen (MOTRIN) oral liquid - 10 9.70 0992784 tigecycline (TYGACIL) injection - 5 1,587.30 0992842 DOBUTamine 500 mg/250 mL D5W infusi 464.80 0992859 lidocaine (LMX) 4% cream (5 gram) 73.30 0992867 barium sulfate 2.1% (READI-CAT 2) o 100.55 0992909 DOPamine 400 mg/250 mL D5W infusion 121.80 0992982 levETIRAcetam (KEPPRA) 100 mg/mL (5 131.90 0993022 metoprolol (LOPRESSOR) tablet - 25 2.70 0993030 fluticasone-salmeterol 100 mcg-50 m 1,717.20 0993048 levOCARNitine (CARNITOR) 100 mg/mL 16.50 0993097 fluticasone-salmeterol 250 mcg-50 m 1,715.65 0993139 DOPamine 32 mg in Dextrose 5% 20 mL 137.30 0993154 fluticasone-salmeterol 500 mcg-50 m 2,797.20 0993162 benzocaine 20% (HURRICAINE) topical 416.15 0993204 lidocaine 1% (XYLOCAINE MPF) 5 mL I 30.10 0993261 sodium hyaluronate (HEALON 5) ophth 1,632.15 0993311 desmopressin (DDAVP) nasal spray - 2,733.40 0993329 lidocaine 0.5% (XYLOCAINE) 50 mL In 73.85 0993337 lidocaine-EPINEPHrine 1%-1:100,000 104.90 0993345 esmolol (BREVIBLOC) 2,500 mg/250 mL 6,229.50 0993360 bivalirudin (ANGIOMAX) 250 mg injec 12,623.70 0993378 zonisamide (ZONEGRAN) 100 mg capsul 10.05 0993394 diphenhydrAMINE 2% (BENADRYL) cream 44.30 0993402 caffeine with sodium benzoate 500 m 255.15 0993436 calcitonin (MIACALCIN) nasal spray 1,315.80 0993444 lidocaine-EPINEPHrine 0.5%-1:200,00 81.60 0993469 erythromycin 0.5% ophthalmic ointme 137.80 0993485 memantine (NAMENDA) tablet - 5 mg 10.60 0993501 bupivacaine 0.5% injection - 50 mL 149.20 0993519 enoxaparin (LOVENOX) injection - 3 79.55 0993527 ondansetron (ZOFRAN ODT) orally dis 247.45 0993543 iron sucrose (VENOFER) 20 mg/mL (5 666.00 0993576 metoprolol (TOPROL XL) extended rel 11.95 0993584 escitalopram (LEXAPRO) tablet - 10 58.20 0993634 oxybutynin (DITROPAN XL) extended r 38.60 0993659 tiotropium (SPIRIVA) capsule for in 209.85 0993717 levoFLOXacin (LEVAQUIN) IVPB - 750 29.45 0993725 piperacillin-tazobactam (ZOSYN) inj 305.85 0993774 levoFLOXacin (LEVAQUIN) 750 mg tabl 392.85 0993790 ezetimibe (ZETIA) tablet - 10 mg 125.40 0993808 lidocaine 0.5% (XYLOCAINE MPF) 50 m 167.65 0993816 albuterol 0.042% 1.25 mg/3 mL inhal 18.45 0993824 sterile water for injection - 100 m 3.50 0993857 pregabalin (LYRICA) capsule - 25 mg 70.00 0993881 sodium chloride 3% Inhalation (15 m 9.95 0993899 hyaluronidase (AMPHADASE/HYLENEX) i 743.30 0993907 lamoTRIgine (LaMICtal) tablet - 25 46.05 0993915 pregabalin (LYRICA) capsule - 50 mg 93.55 0993931 albuterol 0.5% 2.5 mg/0.5 mL inhala 10.00 0993949 calcium carbonate (TUMS) chewable 0.75 0993972 pregabalin (LYRICA) capsule - 75 mg 84.25 0993998 clindamycin (CLEOCIN) IVPB - 600 mg 164.85 0994525 octreotide (SandoSTATIN) injection 132.45 0994541 vancomycin IVPB - 1 gm/D5W 200 mL 306.90 0994558 nystatin oral liquid - 500,000 unit 11.25 0994681 piperacillin-tazobactam (ZOSYN) IVP 203.25 0994707 labetalol (TRANDATE) 5 mg/mL (4 mL) 98.55 0994723 sodium chloride 0.9% (SALINE FLUSH) 40.55 0994749 piperacillin-tazobactam (ZOSYN) IVP 304.95 0994764 magnesium hydroxide (MOM) oral liqu 9.25 0994772 valsartan (DIOVAN) tablet - 160 mg 23.15 0994798 thrombin topical 5,000 units KIT 975.15 0994806 piperacillin-tazobactam (ZOSYN) IVP 386.40 0994814 furosemide (LASIX) 10 mg/mL Oral S 16.50 0994855 ropivacaine (NAROPIN) 0.5% injecti 84.25 0994863 misoprostol (CYTOTEC) tablet - 25 6.90 0994871 haloperidol (HALDOL) 2 mg/mL Oral S 16.50 0994954 zidovudine (RETROVIR) 300 mg tablet 27.50 0995027 adenosine (ADENOSCAN) 3 mg/mL (20 m 879.15 0995035 arformoterol (BROVANA) 15 mcg/2 mL 167.85 0995084 ferric subsulfate (MONSELS SOLUTION 158.45 0995100 cetirizine (ZyrTEC) 1 mg/mL Oral S 16.50 0995134 niacin (NIASPAN) extended release t 28,948.80 0995142 carvedilol (COREG) tablet - 3.12 21.65 0995167 azithromycin (ZITHROMAX) 40 mg/mL 16.50 0995183 albuterol (PROAIR or VENTOLIN HFA) 293.75 0995191 promethazine (PHENERGAN) suppositor 196.55 0995209 heparin infusion - 25,000 units/D5W 135.90 0995282 caffeine citrate 20 mg/mL Oral Syri 155.40 0995324 lidocaine topical 2% (XYLOCAINE) vi 22.00 0995357 risperiDONE (RISPERDAL) 1 mg/mL Ora 56.40 0995373 clindamycin (CLEOCIN) 2% vaginal cr 999.60 0995399 dextrose 40% (GLUTOSE 15) oral gel 109.50 0995415 amoxicillin-clavulanate (AUGMENTIN) 16.50 0995423 sucralfate (CARAFATE) oral liquid - 87.40 0995449 phenylephrine (NEO-SYNEPHRINE) 10 m 293.75 0995472 cephalexin (KEFLEX) 50 mg/mL Oral S 16.50 0995480 voriconazole (VFEND) 200 mg tablet 48.90 0995498 temazepam (RESTORIL) 7.5 mg capsule 110.35 0995514 levoFLOXacin (LEVAQUIN) IVPB - 500 27.75 0995555 carbidopa-levodopa (SINEMET CR) con 10.35 0995597 ferrous sulfate drops 15 mg/mL Oral 16.50 0995605 permethrin (RID or NIX) 1% lotion ( 111.90 0995670 sodium thiosulfate injection - 250 1,078.95 0995704 atovaquone (MEPRON) 750 mg/5 mL ora 372.70 0995761 calcium gluBIONate 23 mg/mL Oral Sy 16.50 0995803 estradiol (ESTRACE) 0.01% vaginal c 3,770.25 0995829 rOPINIRole (REQUIP) tablet - 2 mg 27.85 0995845 azithromycin (ZITHROMAX) 600 mg tab 206.80 0995902 QUEtiapine (SEROquel) tablet - 100 6.70 0995969 QUEtiapine (SEROquel) tablet - 25 41.25 0995985 triamcinolone (KENALOG) 0.025% crea 49.50 0996025 atorvastatin (LIPITOR) 40 mg tablet 9.55 0996124 digoxin (LANOXIN) 50 mcg/mL Oral S 27.55 0996132 clopidogrel (PLAVIX) tablet - 300 m 213.85 0996140 cefuroxime (CEFTIN) tablet - 250 mg 48.85 0996165 ferrous sulfate oral liquid - 300 m 6.35 0996223 digoxin (LANOXIN) 125 mcg/ 2.5 mL E 68.80 0996249 erythromycin ethylsuccinate (EES) 4 44.10 0996264 carvedilol (COREG) tablet - 25 mg 23.35 0996272 coagulation factor VIIA recombinant 53,280.00 0996280 docusate sodium (COLACE) oral liqui 7.80 0996355 coagulation factor VIIA recombinant 26,640.00 0996397 niCARdipine (CARDENE) 2.5 mg/mL (10 268.30 0996447 tranexamic acid 100 mg/mL (10 mL) I 666.00 0996470 ipratropium 0.02% (ATROVENT) inhala 14.70 0996488 Surgicel 2 x 14 gauze 940.35 0996504 Surgicel 2 x 3 gauze 651.65 0996553 FLOSEAL Hemostatic Matrix 10 mL 4,707.40 0996587 OLANZapine (ZYPREXA) 5 mg/mL Inject 460.65 0996603 levETIRAcetam (KEPPRA) tablet - 500 38.70 0996629 immune globulin (PRIVIGEN) 10% 10 g 18,115.20 0996637 fibrin sealant (TISSEEL DUPLOJECT) 2,031.10 0996694 DAPTOmycin (CUBICIN) injection - 50 2,397.60 0996728 rOPINIRole (REQUIP) tablet - 0.25 m 6.55 0996744 ARIPiprazole (ABILIFY) 10 mg tablet 353.80 0996793 atazanavir (REYATAZ) 300 mg capsule 592.90 0996801 abacavir (ZIAGEN) 300 mg tablet 111.50 0996843 sodium chloride 0.9% solution for i 1.80 0996868 linezolid (ZYVOX) tablet - 600 mg 2,038.65 0996900 tobramycin 10 mg/mL IV Syringe 49.50 0996926 lopinavir-ritonavir (KALETRA) 200-5 77.90 0997056 permethrin 5% (ELIMITE) cream - 60 1,345.35 0997148 EPINEPHrine PF 1 mg/mL (1 mL) injec 194.25 0997163 meropenem (MERREM) injection - 500 79.95 0997197 nafcillin 40 mg/mL IV Syringe 49.50 0997254 ceFAZolin (ANCEF) 330 mg/mL IM Syri 49.50 0997262 morphine preservative free 1 mg in 111.00 0997270 isoniazid 10 mg/mL Oral Syringe 16.50 0997312 inFLIXimab (REMICADE) 100 mg inject 13,605.50 0997411 sildenafil (REVATIO) tablet - 20 mg 244.75 0997429 epoetin alfa PF 2,000 units/mL IV S 425.15 0997544 influenza PF vaccine (FLUARIX) - 0. 167.30 0997627 regadenoson (LEXISCAN) injection - 2,990.35 0997791 argatroban (ACOVA) 100 mg/mL (2.5 m 6,660.00 0997841 digoxin (LANOXIN) 10 mcg/mL IV Syri 145.90 0997882 NICU Admission TPN D5W 250 mL bag 669.70 0997957 isosorbide mononitrate (ISMO) table 5.65 0998005 OXcarbazepine (TRILEPTAL) tablet - 29.35 0998013 adenosine (ADENOSCAN) 3 mg/mL (30 m 2,610.75 0998104 midazolam (VERSED) 4 mg in Dextrose 49.50 0998120 ceFAZolin (ANCEF) 20 mg/mL IV Syri 49.50 0998153 morphine preservative free 10 mg in 106.60 0998229 cefotaxime (CLAFORAN) 50 mg/mL IV 49.50 0998260 alprostadil (PGE-1) 500 mcg/D5W 50 65,490.00 0998286 fat emulsion (INTRALIPID) 20% IV Sy 49.50 0998302 penicillin aqueous crystalline 100, 49.50 0998336 fentaNYL 200 mcg in Dextrose 5% 20 543.90 0998351 phenytoin (DILANTIN) 10 mg/mL IV Sy 49.50 0998419 aminophylline 5 mg/mL IV Syringe 49.50 0998476 cefTRIAXone (ROCEPHIN) 40 mg/mL IV 164.30 0998526 cefuroxime (ZINACEF) 30 mg/mL IV Sy 49.50 0998641 metoclopramide (REGLAN) 1 mg/mL Ora 16.50 0998690 metoclopramide (REGLAN) 1 mg/mL IV 49.50 0998724 dexamethasone (DECADRON) 0.1 mg/mL 16.50 0998815 ampicillin-sulbactam (UNASYN) 30 mg 49.50 0998872 digoxin (LANOXIN) 100 mcg/mL IV Syr 1,458.55 0998963 calcium GLUCONATE 50 mg/mL IV Syri 49.50 0998997 midazolam (VERSED) 2 mg in Dextrose 49.50 0999045 midazolam (VERSED) 2 mg/mL Oral Syr 16.50 0999078 risperiDONE (RISPERDAL) tablet - 0. 43.25 0999094 clotrimazole (MYCELEX) oral lozenge 38.15 0999300 hydrocortisone 0.5% ointment - 30 g 44.00 0999318 sulfamethoxazole-trimethoprim (BACT 16.50 0999326 sodium bicarbonate 150 mEq in 1000 142.00 0999334 lansoprazole (PREVACID) 3 mg/mL Or 16.50 0999458 Ibutilide (CORVERT) injection - 0.1 6,024.20 0999508 imatinib (GLEEVEC) 100 mg tablet 3,554.70 0999607 iodine 5%-potassium iodide 10% (LUG 234.45 0999623 SUMAtriptan (IMITREX) tablet - 100 279.10 0999672 tacrolimus (PROGRAF) injection - 5 2,197.95 0999680 ceFAZolin (ANCEF) IVPB - 1 gm/D5W 5 59.70 0999706 ivermectin (STROMECTOL) tablet - 3 55.20 0999730 cefepime (MAXIPIME) injection - 1 g 225.75 0999755 lamiVUDine (EPIVIR) tablet - 150 mg 79.40 0999813 pyridostigmine (MESTINON) tablet - 14.20 0999821 triamcinolone (KENALOG) 0.5% cream 112.25 0999870 valGANciclovir (VALCYTE) tablet - 4 735.15 0999888 cilostazol (PLETAL) tablet - 50 mg 24.80 0999904 lidocaine 2% (XYLOCAINE MPF) injec 38.00 0999961 rifaximin (XIFAXAN) tablet - 200 mg 195.85 0999979 varicella (VARIVAX) injection - 0.5 1,432.60 0999987 clobetasol 0.05% (TEMOVATE) cream - 1,423.45 1000041 sodium chloride 0.9% 1000 mL LVP 128.85 1000058 lactated ringers LVP - 1000 mL 128.85 1000066 dextrose 5%-NaCl 0.45% LVP - 1000 m 128.85 1000082 dextrose 10% IVPB - 250 mL 128.85 1000165 sodium chloride 0.9% irrigation - 1 44.40 1000181 sodium chloride 0.45% 1000 mL LVP 128.85 1000199 sodium chloride 0.9% 500 mL IVPB 128.85 1000207 sodium chloride 0.9% 250 mL IVPB 128.85 1000231 dextrose 5% 1000 mL LVP 128.85 1000348 sterile water for irrigation - 1000 128.85 1000363 dextrose 5% 500 mL IVPB 128.85 1000371 dextrose 5% 250 mL IVPB 128.85 1000454 dextrose 5%-NaCl 0.225% LVP - 1000 128.85 1000579 TPN - Neonatal 669.70 1000603 potassium chloride injection - 2 mE 43.20 1000611 potassium chloride injection - 2 mE 26.65 1000751 sterile water for injection - 10 mL 1.05 1000801 sodium chloride 0.9% injection - 10 10.35 1000934 sodium chloride 0.9% 100 mL IVPB 128.85 1001007 sterile water for irrigation - 1000 20.80 1001064 folic acid injection - 5 mg/mL (10 601.00 1001080 dextrose 5%-lactated ringers LVP - 128.85 1001148 dextrose 5% 50 mL IVPB 128.85 1001189 dextrose 5%-NaCl 0.9% LVP - 1000 mL 128.85 1001197 dextrose 5% 100 mL IVPB 128.85 1001239 sodium chloride 0.9% 50 mL IVPB 128.85 1001999 TPN - Adult 1,053.80 1002203 sodium chloride 0.9% irrigation - 3 99.90 1003300 sodium chloride 3% (HYPERTONIC SALI 128.85 1003326 electrolyte (PLASMA-LYTE A / NORMOS 128.85 1003409 dextrose 10% LVP - 1000 mL 128.85 1003417 dextrose 5%-NaCl 0.45% IVPB - 500 m 128.85 1003425 dextrose 5%-NaCl 0.9% IVPB - 500 mL 128.85 1003433 dextrose 5%-NaCl 0.225% IVPB - 500 128.85 1003441 NICU Admission TPN D10W 250 mL bag 669.70 1003508 sodium chloride 0.45%-KCl 20 mEq LV 128.85 1003540 dextrose 5%-NaCl 0.45%-KCl 30 mEq/L 128.85 1003557 dextrose 5%-NaCl 0.45%-KCl 40 mEq/L 128.85 1003565 dextrose 12.5% 250 mL 128.85 1003581 dextrose 5%-NaCl 0.9%-KCl 40 mEq/L 108.70 1003607 dextrose 5%-KCl 20 mEq/L LVP - 1000 128.85 1003615 methylnaltrexone (RELISTOR) 12 mg/0 1,332.00 1003623 cholecalciferol (Vitamin D3) tablet 0.55 1003656 dextrose 5%-lactated ringers-KCl 20 128.85 1003664 levETIRAcetam (KEPPRA) oral liquid 415.00 1003698 dextrose 5%-NaCl 0.9%-KCl 20 mEq/L 128.85 1003706 potassium chloride IVPB - 20 mEq/SW 35.45 1003730 oxytocin (PITOCIN) LVP - 20 units/l 88.80 1003748 sodium chloride 0.9%-KCl 20 mEq LVP 128.85 1003755 sodium chloride 0.9%-KCl 40 mEq LVP 128.85 1003763 tacrolimus (PROGRAF) capsule - 0.5 40.20 1003771 dexamethasone (INTENSOL) 1 mg/mL CO 16.50 1003789 magnesium sulfate IVPB - 4 gm/SW 1 96.60 1003797 dextrose 5%-0.45% NaCl - KCl 20 mEq 128.85 1003821 HYDROmorphone (DILAUDID) 2 mg/mL (1 29.85 1003839 magnesium sulfate infusion - 20 gm/ 82.05 1003862 polyethylene glycol 3350 (MIRALAX) 12.80 1003870 fondaparinux (ARIXTRA) 10 mg/0.8 mL 779.25 1003912 dexmedetomidine (PRECEDEX) 100 mcg/ 254.30 1003961 dexamethasone (DECADRON) tablet - 4.70 1004001 dextrose 5%-0.45% NaCl - KCl 10 mEq 128.85 1004019 fondaparinux (ARIXTRA) 7.5 mg/0.6 m 1,427.60 1004027 cholecalciferol (Vitamin D3) tablet 3.15 1004068 heparin PF (HEPARIN FLUSH) injectio 7.85 1004076 epoetin alfa (PROCRIT) 20,000 units 6,233.80 1004084 DULoxetine (CYMBALTA) capsule - 60 65.80 1004191 fluconazole (DIFLUCAN) IVPB - 100 m 122.70 1004290 immune globulin (PRIVIGEN) 10% 5 gr 8,658.00 1004324 insulin detemir (LEVEMIR) 100 units 66.10 1004423 prasugrel (EFFIENT) tablet - 10 mg 183.25 1004480 ACD Solution A 1,000 mL 128.85 1004498 emtricitabine-tenofovir (TRUVADA) t 609.10 1004514 dronedarone (MULTAQ) tablet - 400 m 114.70 1004522 pancrelipase (CREON 12,000) capsule 34.75 1004530 mannitol 20% (OSMITROL) infusion - 395.00 1004548 raltegravir (ISENTRESS) tablet - 40 285.85 1004720 DULoxetine (CYMBALTA) capsule - 20 19.40 1004753 fomepizole (ANTIZOL) 1.5 gram/1.5 19,980.00 1004779 DULoxetine (CYMBALTA) capsule - 30 87.20 1004787 cefepime (MAXIPIME) injection - 2 g 448.00 1004803 potassium acid phosphate (K-PHOS OR 5.35 1004845 hydroxocobalamin (CYANOKIT) 5 gram 9,166.40 1004860 aztreonam (AZACTAM) 1 gram/D5W 50 m 443.45 1004878 buPROPion (WELLBUTRIN XL) extended 57.95 1004886 nystatin-triamcinolone (MYCOLOG-II) 1,243.80 1004902 acetaminophen (OFIRMEV) 1 gram/100 473.25 1004936 desmopressin (DDAVP) tablet - 0.1 58.70 1004944 mycophenolic acid (MYFORTIC) delaye 50.75 1004993 omega-3 acid ethyl esters (LOVAZA) 23.00 1005024 colistimethate (COLISTIN) 150 mg In 372.85 1005032 buPROPion (WELLBUTRIN SR) extended 18.75 1005180 ranolazine (RANEXA) extended releas 71.30 1005198 vancomycin IVPB - 750 mg/D5W 150 m 321.80 1005222 morphine (ASTRAMORPH) injection - 0 78.85 1005230 rifaximin (XIFAXAN) tablet - 550 mg 373.25 1005370 tolvaptan (SAMSCA) tablet - 15 mg 4,766.05 1005388 diclofenac sodium (VOLTAREN) enteri 16.35 1005537 aztreonam (AZACTAM) 2 gram/D5W 50 m 887.45 1005552 amiodarone (NEXTERONE) 150 mg/D5W 1 462.10 1005578 oseltamivir (TAMIFLU) 6 mg/mL Oral 26.80 1005669 isoflurane (FORANE) anesthesia inha 166.50 1005719 sevoflurane (ULTANE) 4.20 1005727 fidaxomicin (DIFICID) tablet - 200 2,324.10 1005735 levothyroxine (SYNTHROID) 100 mcg I 1,476.65 1005883 sennosides-docusate (SENNA PLUS) ta 0.25 1005966 magnesium sulfate IVPB - 2 gm/SW 5 154.85 1006014 lidocaine 1% (XYLOCAINE) 10 mL Inje 28.20 1006063 lacosamide (VIMPAT) 50 mg tablet 107.35 1006345 povidone iodine (BETADINE) 10% Topi 20.85 1006402 colistimethate (COLY-MYCIN M) injec 373.00 1006428 bupivacaine liposome (EXPAREL) 1.3% 3,496.30 1006451 iohexol (OMNIPAQUE) 180 mg/mL (20 m 694.65 1006501 iohexol (OMNIPAQUE) 240 mg/mL (10 m 675.90 1006527 micafungin (MYCAMINE) injection - 1 2,490.85 1006543 sodium chloride 0.9% irrigation - 22.20 1006550 iohexol (OMNIPAQUE) 240 mg/mL (20 m 714.40 1006568 rivaroxaban (XARELTO) tablet - 10 m 148.00 1006576 rivaroxaban (XARELTO) tablet - 15 m 148.00 1006600 iohexol (OMNIPAQUE) 350 mg/mL (50 m 672.35 1006626 linagliptin (TRADJENTA) tablet - 5 158.60 1006659 iohexol (OMNIPAQUE) 350 mg/mL (100 1,340.90 1006667 chlorhexidine gluconate 0.12% (PERI 14.70 1006691 ticagrelor (BRILINTA) 90 mg tablet 89.95 1006709 iohexol (OMNIPAQUE) 350 mg/mL (150 1,851.50 1006725 triamcinolone (KENALOG) 0.1% ointme 61.95 1006741 docusate sodium (VACUANT MINI ENEMA 5.00 1006766 multivitamin, adult oral liquid (CE 16.50 1006808 iodixanol (VISIPAQUE) 320 mg/mL 50 763.70 1006857 iodixanol (VISIPAQUE) 320 mg/mL 150 1,986.35 1006899 nitroglycerin 100 mcg/mL (10 mL) in 49.50 1006949 milrinone (PRIMACOR) 20 mg/100 mL D 202.50 1006956 gadobenate dimeglumine (MULTIHANCE) 774.70 1007004 gadobenate dimeglumine (MULTIHANCE) 1,133.70 1007103 tretinoin 10 mg capsule 336.60 1007129 acetylcysteine (MUCOMYST) 100 mg/mL 16.50 1007137 tocilizumab (ACTEMRA) 400 mg Inject 30,713.30 1007178 sevelamer carbonate (RENVELA) table 67.70 1007210 leuprolide (LUPRON DEPOT) 22.5 mg D 49,856.65 1007251 ceftaroline fosamil (TEFLARO) injec 2,687.00 1007319 barium sulfate (E-Z HD) 98% 135 mL 74.95 1007327 PHENobarbital tablet - 64.8 mg 9.40 1007335 sodium chloride 0.9% irrigation - 44.40 1007368 barium sulfate (E-Z PASTE) 60% 454 564.30 1007376 PHENobarbital tablet - 32.4 mg 5.15 1007418 barium sulfate (E-Z DISK) 700 mg ta 30.85 1007467 citric acid-simethicone-sodium bica 31.45 1007541 gadobenate dimeglumine (MULTIHANCE) 394.95 1007574 piperacillin-tazobactam (ZOSYN) inj 136.65 1007582 epoprostenol (FLOLAN) 1.5 mg Inject 821.70 1007616 benzocaine (HURRICAINE ONE) 20% Ora 129.90 1007624 iodixanol (VISIPAQUE) 320 mg/mL 100 1,526.25 1007632 iohexol (OMNIPAQUE) 300 mg/mL (50 m 615.50 1007640 EUCERIN cream - 120 gm 46.65 1007665 sevelamer carbonate (RENVELA) 800 m 126.00 1007681 iohexol (OMNIPAQUE) 300 mg/mL (100 1,208.80 1007699 calcium carbonate (CALTRATE) tablet 0.35 1007764 rivaroxaban (XARELTO) tablet - 20 m 208.70 1007806 heparin 25 units D5W 50 mL bag 111.00 1007814 heparin 25 units NaCl 0.45% 50 mL b 111.00 1007897 sterile water for injection LVP - 1 128.85 1007954 apixaban (ELIQUIS) 5 mg tablet 110.80 1007962 factor IX complex human (PROFILNINE 8,991.00 1007996 tetanus/diphtheria/acellular pertus 509.30 1008069 DOPamine 40 mg/mL Injection (10 mL) 27.45 1008077 mesalamine (DELZICOL) delayed relea 46.55 1008085 HYDROcodone-acetaminophen (NORCO) 7.70 1008119 calamine 8% lotion - 6 oz 27.65 1008135 HYDROcodone-acetaminophen (NORCO) 9.85 1008143 prothrombin complex human (KCENTRA) 15,373.50 1008150 apixaban (ELIQUIS) 2.5 mg tablet 110.80 1008168 desmopressin (DDAVP) injection - 4 6,235.55 1008259 dexmedetomidine (PRECEDEX) 200 mcg/ 739.95 1008333 benzocaine-menthol (CEPACOL) lozeng 1.20 1008358 hydrocortisone (Solu-CORTEF) inject 211.25 1008382 lidocaine-prilocaine (EMLA) 2.5%-2. 110.10 1008440 niCARdipine (CARDENE) 20 mg/200 mL 1,265.40 1008465 sulfamethoxazole-trimethoprim (BACT 167.10 1008515 ascorbic acid (VITAMIN C) 500 mg/mL 204.25 1008580 bupivacaine 0.75% preservative-free 87.25 1008598 oseltamivir (TAMIFLU) capsule - 30 160.65 1008622 atropine 0.4 mg/mL (20 mL) injectio 467.55 1008747 hetastarch 6% (HESPAN) infusion - 3 167.10 1008796 dextrose 20% 250 mL 128.85 1008820 bupivacaine 0.25%-EPINEPHrine 1:200 70.75 1008960 amiodarone (CORDARONE) 50 mg/mL ( 9 58.40 1008986 fibrin sealant (TISSEEL FROZEN SYRI 3,423.70 1009000 ceftaroline fosamil (TEFLARO) injec 2,687.00 1009018 sodium chloride 0.45% 500 mL IVPB 128.85 1009067 tenofovir (VIREAD) tablet - 300 mg 405.30 1009075 rasburicase (ELITEK) 1.5 mg Injecti 11,379.15 1009083 ceFAZolin (ANCEF) injection - 10 gm 113.25 1009166 diazoxide (PROGLYCEM) 50 mg/mL Oral 137.50 1009190 dornase alfa (PULMOZYME) 2.5 mg inh 1,457.85 1009216 bupivacaine 0.5%-EPINEPHrine 1:200, 28.00 1009240 cinacalcet (SENSIPAR) tablet - 30 m 340.30 1009406 ARISTA AH hemostat kit 3 gram 2,333.25 1009489 ARIPiprazole (ABILIFY) 5 mg tablet 353.30 1009513 vitamin E (AQUASOL E) 50 units/mL O 9.10 1009539 ceFAZolin (ANCEF) IVPB - 2 gm/D5W 5 97.25 1009562 betaxolol (BETOPTIC) 0.5% Ophthalmi 735.60 1009604 vancomycin injection - 5 gm 400.95 1009638 sorbitol 3% Urologic Irrigation 3,0 266.40 1009729 romiPLOStim (NPLATE) 250 mcg inject 21,184.15 1009836 vancomycin 500 mg RETENTION ENEMA 66.60 1009844 HYDROcodone-acetaminophen (HYCET) o 60.90 1009943 oxyCODONE-acetaminophen (PERCOCET 1 39.45 1009992 amphotericin B liposomal (AMBISOME) 2,178.40 1010008 dextrose 5% 30 mL Flush 49.50 1010057 TPN - CLINIMIX (Amino Acids 4.25% w 421.80 1010065 TPN - CLINIMIX (Amino Acids 5% with 477.30 1010073 levETIRAcetam (KEPPRA) IVPB - 500 364.45 1010081 levETIRAcetam (KEPPRA) IVPB - 1,000 607.40 1010115 dolutegravir (TIVICAY) 50 mg tablet 811.00 1010131 phenylephrine-mineral oil (PREPARAT 55.40 1010172 TPN - CLINIMIX E (Amino Acids 5% wi 477.30 1010180 TPN - CLINIMIX (Amino Acids 5% with 477.30 1010230 barium sulfate (POLIBAR) 105% 1900 464.00 1010248 cefTAZidime-avibactam (AVYCAZ) inje 3,986.05 1010255 TPN - CLINIMIX E (Amino Acids 5% wi 521.70 1010263 nitroglycerin 25 mg in D5W 250 mL 233.10 1010305 TPN - CLINIMIX E (Amino Acids 4.25% 444.00 1010396 heparin 25 units NA ACETATE 0.45% 5 114.00 1010412 meropenem (MERREM) injection - 1 gm 266.40 1010453 influenza PF vaccine HIGH DOSE (FLU 712.75 1010578 tirofiban (AGGRASTAT) 12.5 mg/250 m 6,895.90 1010669 isavuconazonium (CRESEMBA) 186 mg c 1,067.15 1010701 acetylcysteine (MUCOMYST) 200 mg/mL 16.50 1010743 idaruCIZUMAB (PRAXBIND) 2.5 gram In 28,499.90 1010834 lamiVUDine (EPIVIR) 10 mg/mL Oral S 5.55 1010917 theophylline (THEO-24) 100 mg/24 ho 20.05 1010941 abacavir-lamivudine-zidovudine (TRI 321.65 1010958 acetylcysteine 20% (MUCOMYST) 4 mL 166.15 1010966 acyclovir (ZOVIRAX) 1000 mg injecti 333.00 1010974 acyclovir 5% (ZOVIRAX) 15 gram oint 4,017.15 1010982 albendazole (ALBENZA) 200 mg tablet 1,358.50 1011006 albuterol-ipratropium (DUONEB) 2.5 24.55 1011030 ampicillin 250 mg injection 46.50 1011048 AQUAPHOR ORIGINAL FORMULA 10 gram o 58.95 1011055 atorvastatin (LIPITOR) 80 mg tablet 21.60 1011063 azithromycin (ZITHROMAX) 500 mg tab 76.30 1011071 bacitracin zinc ointment - 500 unit 39.45 1011089 bacitracin-neomycin-polymyxin B (NE 2.60 1011097 bacitracin-polymyxin B (POLYSPORIN 2.80 1011139 bupivacaine 0.25%-EPINEPHrine 1:200 107.90 1011147 calcitriol (ROCALTROL) injection - 83.00 1011154 calcium carbonate-vitamin D tablet 2.00 1011162 cardioplegia, blood - INDUCTION 4:1 1,821.75 1011170 cardioplegia, blood - MAINTENANCE 4 1,821.75 1011188 cardioplegia, del Nido formula - 10 643.80 1011196 cefotaxime (CLAFORAN) injection - 20.00 1011204 chlorhexidine gluconate 4% (HIBICLE 77.50 1011220 cisatracurium (NIMBEX) 2 mg/mL ( 5 208.85 1011238 clindamycin (CLEOCIN) IVPB - 300 mg 109.25 1011246 cloZAPine (CLOZARIL) tablet - 50 mg 18.35 1011253 danazol 100 mg capsule 100.70 1011279 dexamethasone (DECADRON) injection 26.00 1011287 diatrizoate meglumine (CYSTOGRAFIN) 735.95 1011311 dibucaine 1% (NUPERCAINAL) rectal o 79.95 1011329 diltiazem (CARDIZEM) 5 mg/mL (25 mL 6.10 1011337 diphenhydramine-lidocaine 2% viscou 2.00 1011345 donepezil (ARICEPT) tablet - 10 mg 8.65 1011352 doripenem (DORIBAX) injection - 250 255.30 1011360 doripenem (DORIBAX) injection - 500 556.00 1011378 efavirenz (SUSTIVA) capsule - 200 m 124.80 1011386 efavirenz-emtricitabine-tenofovir ( 983.60 1011394 emtricitabine (EMTRIVA) 10 mg/mL Or 1,679.45 1011402 enalaprilat (VASOTEC) injection - 1 104.60 1011410 enoxaparin (LOVENOX) injection - 12 317.70 1011428 eptifibatide (INTEGRILIN injection 2,081.70 1011444 ergoloid mesylates tablet - 1 mg 90.00 1011451 fenofibrate tablet - 54 mg 8.80 1011469 fenofibrate tablet - 160 mg 32.00 1011477 ferric gluconate (FERRLECIT) inject 423.60 1011493 fibrin sealant (TISSEEL) topical - 8,399.40 1011501 fluocinonide 0.05% (LIDEX) topical 1,286.75 1011519 fosamprenavir (LEXIVA) 50 mg/mL Or 2,047.95 1011527 gentamicin IVPB - 80 mg/NS 50 mL 44.40 1011535 gentamicin IVPB - 100 mg/NS 100 mL 46.55 1011543 gentamicin IVPB - 120 mg/NS 100 mL 45.30 1011550 glycopyrrolate (ROBINUL) injection 306.40 1011568 guaiFENesin-codeine (CHERATUSSIN AC 5.65 1011576 heparin injection - 1,000 units/mL 3.20 1011584 hydrocortisone (CORTEF) tablet - 5 3.80 1011600 hypromellose 0.3% (GENTEAL TEARS) o 93.95 1011618 iohexol (OMNIPAQUE) 240 mg/mL (50 m 520.60 1011626 iohexol (OMNIPAQUE) 350 mg/mL (75 m 1,003.20 1011634 ketoconazole 2% (NIZORAL) cream - 1 343.00 1011642 lactobacillus acidophilus capsule - 1.20 1011659 lanthanum carbonate (FOSRENOL) tabl 124.50 1011667 levETIRAcetam (KEPPRA) tablet - 250 28.75 1011675 levobunolol 0.5% (BETAGAN) ophthalm 268.40 1011683 lidocaine 1% (XYLOCAINE MPF) 10 mL 68.85 1011691 lidocaine-EPINEPHrine 1%-1:200,000 137.20 1011709 lidocaine 2% (XYLOCAINE) injection 82.70 1011717 lidocaine 3.5% (AKTEN) ophthalmic g 294.75 1011725 lidocaine (LARYNG-O-JET) 4% 4 mL 266.40 1011733 lidocaine 5%-dextrose 7.5% injectio 91.95 1011741 pancrelipase (CREON 36,000) capsule 104.70 1011758 lisinopril (ZESTRIL) tablet - 2.5 7.20 1011766 LORazepam (ATIVAN) injection - 2 mg 90.35 1011774 magnesium sulfate IVPB - 1 gm/D5W 108.30 1011790 meperidine (DEMEROL) injection - 2 60.50 1011816 methotrexate injection - 25 mg/mL ( 120.35 1011824 methylnaltrexone (RELISTOR) injecti 1,332.00 1011832 metoclopramide (REGLAN) tablet - 5 1.55 1011857 mineral oil (FLEET MINERAL OIL) adu 23.65 1011865 modafinil (PROVIGIL) tablet - 100 m 245.00 1011873 morphine injection - 8 mg/mL (1 m 14.95 1011881 mupirocin 2% (BACTROBAN) nasal oint 197.75 1011899 naphazoline-pheniramine (NAPHCON-A) 36.95 1011907 naproxen (NAPROSYN) tablet - 375 mg 11.85 1011949 oxymetazoline 0.05% (AFRIN) Nasal S 20.85 1011964 pantoprazole (PROTONIX GRANULES) gr 121.75 1011972 pantoprazole (PROTONIX) delayed rel 5.15 1011980 penicillin G potassium IVPB - 2 mil 117.15 1011998 potassium chloride (K-DUR) extended 7.00 1012004 propofol (DIPRIVAN) injection - 10 40.00 1012012 piperonyl butoxide-pyrethrins (RID 67.60 1012038 sincalide (KINEVAC) injection - 5 m 1,111.20 1012053 sodium hypochlorite 0.5% (DAKIN'S F 126.05 1012061 sodium nitrite injection - 30 mg/mL 1,078.95 1012079 sodium PHOSPHATE Injection - 3 mmol 142.95 1012087 sulindac (CLINORIL) tablet - 200 mg 13.35 1012111 triamcinolone (KENALOG) 0.1% topic 470.90 1012129 vancomycin 100 mg/mL Oral Syringe 8.05 1012137 vancomycin IVPB - 500 mg/D5W 100 m 87.95 1012160 vitamin B complex capsule 0.55 1012186 multivitamin tablet 0.35 1012194 vitamin B complex-vitamin C-folic a 1.60 1012202 ritonavir (NORVIR) tablet - 100 mg 102.80 1012251 zinc oxide-menthol (CALMOSEPTINE) o 55.50 1012277 zinc oxide 20% ointment - 60 gm 53.30 1012319 hydrOXYzine hydrochloride (ATARAX) 4.40 1012327 potassium phosphate-sodium phosphat 5.65 1012343 potassium PHOSPHATE injection - 3 m 143.20 1012350 sulfacetamide 10%-prednisoLONE 0.25 208.15 1012368 psyllium (METAMUCIL) packet - 12 gm 3.80 1012434 cefTAZidime (FORTAZ) 40 mg/mL IV Sy 66.55 1012442 dexamethasone (DECADRON) 0.1 mg/mL 49.50 1012582 benzocaine 14%-butamben 2%-tetracai 803.65 1012624 morphine preservative free 5 mg in 106.60 1012657 hepatitis B (ENGERIX-B) injection - 688.20 1012673 filgrastim-sndz (ZARXIO) injection 3,671.80 1012681 filgrastim-sndz (ZARXIO) injection 7,309.05 1012715 multivitamin with Iron (POLY VI SOL 69.20 1012756 polidocanol (ASCLERA) 1% Injection 366.30 1012764 sterile water for irrigation - 2000 128.85 1012780 glycopyrrolate (ROBINUL) injection 146.55 1012806 droxidopa (NORTHERA) 100 mg capsule 289.30 1012830 multivitamin pediatric (POLY VI SOL 16.50 1012848 potassium bicarbonate (EFFER-K) eff 5.35 1012855 potassium bicarbonate (EFFER-K) eff 5.35 1012863 loxapine (LOXITANE) capsule - 25 mg 21.35 1012871 sugammadex (BRIDION) 100 mg/mL Inje 1,265.40 1012921 succinylcholine (ANECTINE) injectio 138.75 1012939 ePHEDrine injection - 10 mg/mL (5 m 185.95 1012970 tetracaine 0.5% (PONTOCAINE) ophtha 1,634.95 1012996 ketorolac 0.5% (ACULAR) ophthalmic 1,171.05 1013077 tropicamide 1% (MYDRIACYL) ophthalm 118.25 1013085 methylene blue (PROVAYBLUE) 0.5% In 3,169.80 1013275 ferric carboxymaltose (INJECTAFER) 15,180.35 1013374 acetylcysteine 10% (MUCOMYST) 4 mL 110.65 1013481 doxycycline INTRAPLEURAL 321.80 1013549 paliperidone (INVEGA SUSTENNA) 234 0.01 1013564 JW ALTEPLASE 50 MG INJECTION 56,903.30 1013572 JW ALTEPLASE 100 MG INJECTION 113,806.65 1013606 paliperidone (INVEGA SUSTENNA) 156 0.01 1013762 sacubitril-valsartan (ENTRESTO) 24 113.05 1013770 sacubitril-valsartan (ENTRESTO) 49 113.05 1013846 fentaNYL 10 mcg/mL IV Syringe (1 m 49.50 1013853 morphine PF 0.5 mg/mL (ASTRAMORPH P 27.95 1014000 norepinephrine (LEVOPHED) 8 mg/250 205.35 1014109 dextrose 50% injection - 50 mL Vial 36.10 1014117 magnesium sulfate injection - 4 mEq 23.10 1014133 povidone iodine (BETADINE) 5% Ophth 171.20 1014208 dexamethasone (DECADRON) injection 69.80 1014430 carboxymethylcellulose 1% (CELLUVI 4.30 1014562 vitamin A & D ointment - 113 gm 42.65 1014612 iothalamate (CYSTO CONRAY) 17.2% 2 335.80 1014836 minocycline (MINOCIN) 100 mg Capsul 37.75 1014869 methadone 10 mg/mL Oral Syringe 16.50 1014943 Investigational Drug - IVPB 0.01 1015213 remdesivir 100 mg Injection 6,349.20 1015602 gadobutrol (GADAVIST) 1 mmol/mL (10 1,105.60 1015603 ioversol (OPTIRAY) 350 mg/mL 150 mL 709.30 1015604 ioversol (OPTIRAY) 350 mg/mL 50 mL 253.10 1016690 mitoMYcin ophthalmic (MITOSOL) KIT 3,984.90 1016708 insulin regular (HumuLIN R) 100 uni 66.10 1016716 sterile water for irrigation - 250 38.85 1016724 sterile water for irrigation - 500 38.85 1016751 potassium chloride IVPB - 10 mEq/SW 45.55 1016757 chlordiazePOXIDE (LIBRIUM) capsule 4.45 1016765 chlordiazePOXIDE (LIBRIUM) capsule 7.45 1016781 bacitracin-neomycin-polymyxin B (NE 4.00 1016799 bismuth subgallate powder 822.55 1016807 desflurane (SUPRANE) 2,133.90 1016815 lactated ringers LVP - 250 mL 128.85 1016849 selegiline (ELDEPRYL) capsule - 5 m 25.60 1016856 sodium chloride 0.9% (15 mL) UD inh 5.35 1016880 sodium chloride 0.9% irrigation - 1 83.25 1016906 tincture benzoin spray 120 mL 99.90 1016955 glycine 1.5% irrigation - 3000 mL 166.50 1016963 benazepril (LOTENSIN) 5 mg tablet 11.70 1017128 indomethacin (INDOCIN) 5 mg/mL Oral 124.90 1017151 niCARdipine (CARDENE) capsule - 20 24.75 1017169 niCARdipine (CARDENE) capsule - 30 35.45 1017292 lidocaine-EPINEPHrine 1%-1:100,000 39.85 1017334 mineral oil, light (MURI-LUBE) - 10 185.45 1017615 lurasidone (LATUDA) 120 mg tablet 671.50 1017623 dimethyl fumarate (TECFIDERA) 240 m 846.40 1017771 lacosamide (VIMPAT) tablet - 200 mg 177.75 1017797 TPN - CLINIMIX E (Amino Acids 2.75% 510.60 1017813 TPN - CLINIMIX E (Amino Acids 5% wi 477.30 1017821 TPN - CLINIMIX (Amino Acids 4.25% w 532.80 1017839 TPN - CLINIMIX (Amino Acids 4.25% w 477.30 1017896 chlorthalidone (HYGROTON) 25 mg tab 13.40 1017904 cetirizine (ZyrTEC) tablet - 5 mg 27.70 1017961 mycophenolate mofetil (CELLCEPT) 50 965.70 1017979 fibrin sealant (TISSEEL DUPLOJECT) 3,411.70 1017987 phytonadione (VITAMIN K) 1 mg/mL Or 64.30 1017995 povidone iodine (BETADINE) 10% topi 2.60 1018001 fluticasone-salmeterol 55 mcg-14 m 1,323.70 1018019 lidocaine topical 2% (URO-JET) 20 m 102.85 1018027 emtricitabine-rilpivirine-tenofovir 1,190.30 1018035 bisoprolol (ZEBETA) 5 mg tablet 15.60 1018043 TPN - CLINIMIX (Amino Acids 4.25% w 555.00 1018050 butalbital-aspirin-caffeine (FIORIN 18.90 1018068 calfactant (INFASURF) suspension 35 5,050.55 1018084 RHo (D) immune globulin (RHOGAM) 15 1,411.95 1018100 cloBAZam 10 mg tablet 217.55 1018118 fluticasone furoate 100 mcg (ARNUIT 1,078.80 1018126 saliva substitute (BIOTENE MOISTURI 58.50 1018134 pimavanserin (NUPLAZID) 17 mg table 432.90 1018142 minocycline (MINOCIN) 100 mg Tablet 66.85 1018167 epoetin alfa epbx (RETACRIT) inject 293.85 1018175 epoetin alfa epbx (RETACRIT) inject 440.80 1018183 epoetin alfa epbx (RETACRIT) inject 587.70 1018191 epoetin alfa epbx (RETACRIT) inject 1,469.20 1018266 TPN - CLINIMIX (Amino Acids 5% with 510.60 1018274 midazolam (VERSED) injection - 1 mg 10.80 1018282 calcitonin (MIACALCIN) - 200 units/ 36,071.45 1018290 nitroglycerin 200 mcg/mL (10 mL) in 85.50 1018308 ribavirin (REBETOL) 200 mg capsule 110.30 1018316 fluticasone furoate 200 mcg (ARNUIT 1,444.45 1018324 potassium chloride (KLOR-CON) 20 mE 119.25 1018332 electrolyte replacement (PEDIALYTE) 13.35 1018340 promethazine-dextromethorphan (PHEN 5.15 1018357 carBAMazepine (TEGRETOL) 100 mg/5 m 40.30 1018365 esomeprazole (NexIUM) 40 mg injecti 666.00 1018373 sodium chloride bacteriostatic 0.9% 12.00 1018381 HYDROmorphone (DILAUDID) 4 mg/mL (1 34.10 1018407 triamcinolone (KENALOG) 0.5% ointme 112.10 1018415 immune globulin (PRIVIGEN) 10% 20 g 36,230.40 1018423 morphine 4 mg/mL (1 mL) preservativ 25.05 1018431 amikacin 250 mg/mL (2 mL) preservat 103.25 1018449 bupivacaine liposome (EXPAREL) 1.3% 2,332.35 1018456 eslicarbazepine (APTIOM) 800 mg tab 429.85 1018464 HYDROmorphone (DILAUDID) 10 mg/50 m 155.25 1018472 tobramycin 300 mg/7.5 mL Inhalation 121.55 1018480 dexamethasone (DECADRON) 1 mg/mL Or 16.50 1018498 cefOXitin (MEFOXIN) 1 gm/D5W 50 mL 168.90 1018514 lidocaine-EPINEPHrine 1%-1:100,000 67.60 1018522 balsam Peru-castor oil (VENELEX) Oi 330.35 1018530 influenza PF vaccine (FLUCELVAX) - 328.70 1018548 isavuconazonium (CRESEMBA) 372 mg I 3,635.95 1018555 flumazenil (ROMAZICON) injection - 18.05 1018563 sodium chondroitin-hyaluronate opht 2,515.30 1018571 atovaquone-proguanil (MALARONE) 250 79.35 1018589 meningococcal group B (BEXSERO) vac 2,385.95 1018597 collagen topical (AVITENE ULTRAFOAM 294.75 1018605 collagen topical (AVITENE ULTRAFOAM 1,030.45 1018613 ARISTA AH hemostat kit 1 gram 1,165.50 1018621 eculizumab (SOLIRIS) 300 mg injecti 86,886.40 1018639 sodium hyaluronate (HEALON) ophthal 1,318.15 1018647 baloxavir marboxil (XOFLUXA) tablet 999.00 1018654 remifentanil (ULTIVA) 2 mg Injectio 3,265.60 1018662 barium sulfate (E-Z PAQUE) 60% 355 67.00 1018670 sodium zirconium cyclosilicate (LOK 299.55 1018688 sodium zirconium cyclosilicate (LOK 299.55 1018696 silodosin (RAPAFLO) capsule - 4 mg 88.55 1018720 prothrombin complex human (KCENTRA) 33,300.00 1018738 cefdinir (OMNICEF) capsule - 300 mg 56.80 1018746 bupivacaine 0.125%-fentanyl 2 mcg/m 274.75 1018753 methadone 1 mg/mL Oral Syringe 16.50 1018761 PROGEL Pleural Air Leak Sealant 4 m 10,578.30 1018779 sodium hyaluronate (PROVISC) ophtha 2,368.90 1018787 sodium hyaluronate (HEALON DUET PRO 2,719.50 1018795 ciprofloxacin 0.2% otic solution - 91.75 1018829 riTUXimab-abbs (TRUXIMA) 100 mg Inj 11,262.75 1018837 riTUXimab-abbs (TRUXIMA) 500 mg Inj 56,313.65 1018845 ambrisentan 5 mg Tablet 4,094.90 1018852 fluPHENAZine (PROLIXIN) 2.5 mg tabl 75.50 1018878 bacteriostatic water for injection 0.60 1018886 levOCARNitine 330 mg tablet 12.20 1018902 lidocaine 2% (XYLOCAINE) injection 40.00 1018910 sodium bicarbonate 4.2% injection - 101.65 1018936 immune globulin (FLEBOGAMMA) 10% 10 11,867.05 1018944 chlorhexidine gluconate 4% (HIBICLE 94.50 1018969 midazolam (VERSED) injection - 1 mg 15.25 1018977 sodium chloride 0.9% injection - 50 33.85 1018985 buprenorphine (SUBUTEX) 8 mg sublin 94.20 1018993 buprenorphine (SUBUTEX) 2 mg sublin 50.35 1019017 baricitinib (OLUMIANT) 2 mg tablet 1,005.70 1019025 sodium chloride-sodium hyaluronate 61.30 1019058 brimonidine 0.2% (ALPHAGAN) ophthal 194.25 1019066 insulin NPH-insulin regular (HumuLI 66.10 1019074 febuxostat (ULORIC) 80 mg tablet 146.55 1019082 tranexamic acid 650 mg tablet 57.90 1019090 Surgicel FIBRILLAR 4 x 4 2,190.45 1019108 ketamine 100 mg/mL (5 mL) Injection 177.70 1019116 QUEtiapine (SEROquel) tablet - 50 m 6.30 1019132 guaiFENesin-dextromethorphan (ROBIT 14.70 1019157 fluticasone-salmeterol 113 mcg-14 m 1,323.70 1019165 fluticasone-salmeterol 232 mcg-14 m 1,323.70 1019181 sodium polystyrene sulfonate (KAYEX 1,940.20 1019207 amoxicillin (AMOXIL) 25 mg/mL Oral 16.50 1019215 calcium gluconate IVPB - 1 gm/NS 50 312.85 1019223 colchicine (COLCRYS) capsule - 0.6 72.55 1019231 midazolam (VERSED) injection - 1 mg 210.90 1019249 sevelamer carbonate (RENVELA) 2.4 g 126.00 1019264 calcium gluconate IVPB - 2 gm/NS 10 526.15 1019272 mitoMYcin injection - 40 mg 15,713.65 1019876 insulin NPH (HumuLIN N) 100 units/m 66.10 1100130 NARCAN 4MG/10ML INJ 5.00 1100478 ATROVENT INH 157.00 1100486 INDERAL 1MGAMP 7.00 1100726 XYLOC OINT35GM 11.00 1100734 CYCLOMYDRIL 2ML OPHTHALMIC SOLUTION 3.00 1100759 LASIX SOLN 9.00 1100775 OCEAN NAS SOLN 2.00 1100783 SSD CRM 50GM 5.00 1100825 PROZAC 20MG CAP 3.00 1100882 FORTAZ 1GM INJ 15.00 1100890 HYDROCOR 1%CRM 2.00 1100908 TRACRIUM 5ML 6.00 1100916 CORTIS OTICSUS 7.00 1100981 FORTAZ 1GM INJ 16.00 1100999 ZOVIR500MG INJ 6.00 1101039 TETRACAIN OPHT 2.00 1101047 HYDROCOR2.5%CRM 8.00 1101070 MOTRIN 800MG TAB 6.00 1101088 IMDUR 30MG TAB 14.00 1101096 TNKASE 50 MG INJ 1,260.00 1101104 DDAVP 0.01% NASAL 647.00 1101112 ZITHROMAX IV 500 MG 25.00 1101120 ADENOSCAN 90MG IV 315.00 1101138 ADENOSCAN 60MG IV 210.00 1101146 CIPRO HC OTIC SUSP 1,311.00 1101153 CARDIZEM 125MGIV 20.00 1101161 ZOVIR 400MG TAB 2.00 1101179 REMERON 15MG 27.00 1101195 CELEBREX 100MG CAP 15.00 1101203 IMITREX 25MG TAB 18.00 1101229 LEVAQUIN IV 250MG 123.00 1101237 INSULIN LANTUS INJ 100U 109.00 1101245 TOPAMAX 25 MG TAB 21.00 1101252 VASOTEC 2.5MG INJ 79.00 1101260 FLOMAX 0.4MG CAP 2.00 1101278 DECADRON 2MG TAB 7.00 1101286 MUCOMYST 10% 19.00 1101294 CELLCEPT 250 MG 30.00 1101310 NEURONTIN 400MG CAP 2.00 1101344 PROZAC 10MG CAP 2.00 1101369 CILOXAN OPHTH. SOLN. 20.00 1101377 ZOVIRAX 800MG CAP 3.00 1101393 VANCOMYCIN 1GM INJ 16.00 1101427 FENTANYL 0.1 MG 2.00 1101435 PAXIL 20MG TAB 2.00 1101443 ZYPREXA 5MG TAB 12.00 1101468 ZYVOX 600MG TAB 872.00 1101476 ZEMURON 10MG/ML INJ 13.00 1101500 LOVENOX 30MG INJ 15.00 1101518 DIOVAN 160MG TAB 38.00 1101526 ZAROXOLYN 2.5MGTAB 2.00 1101534 AMARYL 4MG TAB 10.00 1101542 CELEBREX 200MG CAP 27.00 1101559 NIX 1% SHAMPOO 102.00 1101567 ZYVOX 600MG INJ 97.00 1101575 PRANDIN 1MG 13.00 1101591 MAGNESIUM SULF 2GM/50ML D5W 2.00 1101609 MAGNESIUM SULFATE 50GM/D5W 500ML 4.00 1101617 VORICONAZOLE 200 MG 31.00 1101625 RANEXA 500MG 3.00 1101633 ATORVASTATIN CALCIUM 40 3.00 1101658 AZITHROMYCIN 500 7.00 1101666 DIPHENHYDRAMINE HCL 2.00 1101690 SIMVASTATIN 80MG 3.00 1101708 REQUIP 0.25MG 17.00 1101724 RISPERIDONE 0.25 3.00 1101732 LIDODERM 5% PATCH 101.00 1101740 PROCRIT 2000 UNITS 31.00 1101765 MESALAMINE 1000MG SUPP 23.00 1101773 NORVASC 2.5MG 7.00 1101781 LYRICA 25 MG TAB 23.00 1101799 REQUIP (ROPINIROLE) 4MG TAB 37.00 1101807 KEPPRA 500MG/5ML INJ 328.00 1101815 NIACIN 250 MG 6.00 1101823 LYRICA 75MG TAB 26.00 1101856 ZONISAMIDE 100MG 2.00 1101864 VITAMIN D 400 IU 6.00 1101872 AMARYL 2MG PO 10.00 1101880 GLUCOTROL 5MG XL 10.00 1101898 VIT E 1000 UNITS 7.00 1101906 KEPPRA 500MG 27.00 1101914 OCTREOTIDE 0.05MG 9.00 1101922 MAGNESIUM OXIDE 400 MG 7.00 1101930 BACTROBAN 2% 8.00 1101948 PRECOSE 50 MG 12.00 1101955 TOPAMAZ 100 MG TAB 46.00 1101971 MAGSULFATE4GM/D5W100MLBAG 2.00 1101989 OXCARBAZEPINE 300MG 2.00 1101997 IBUPROFEN 100 4.00 1102003 LAMICTAL 25MG TAB 36.00 1102011 PRANDIN 2MG TAB 15.00 1102029 REMINYL 4MG CAP 33.00 1102037 MIRALAX 17 GM PWD 31.00 1102045 ZOCOR 40 MG/1 TAB 39.00 1102052 PROGRAF 1MG/CAP 45.00 1102060 COREG 12.5MG 2.00 1102078 VFEND 200MG 92.00 1102086 FLEBOGAMMA 5% 609.00 1102094 COREG 12.5MG 2.00 1102102 MARCAINE-MPF 0.25% 3.00 1102128 BICILL-CR1.2MU 13.00 1102177 PREP H OINT 3.00 1102193 MORPHIN10MGINJ 2.00 1102201 AMP 1GM INJ 7.00 1102219 AMP 2GM IVPB 10.00 1102227 ATIVAN 2MG INJ 11.00 1102268 BICIL-LA 1.2MU 48.00 1102284 COMPAZ10INJ 5.00 1102300 PROCTOCORT 1% 7.00 1102318 PRED-FORTE 5ML 3.00 1102326 ADENOCARD 6MG IV 23.00 1102342 DEMEROL 1MG INJ 2.00 1102359 COCAINE 4%4ML 18.00 1102367 DIFLUCAN PO 100MG 7.00 1102383 NS 3% IV 500ML 6.00 1102391 PYRIDOX100MG 3.00 1102425 D5W 250ML BAG 2.00 1102433 D5W 500ML BAG 2.00 1102441 D5W 1L BAG 2.00 1102458 D5W 50ML BAG 2.00 1102466 D5W 100ML BAG 2.00 1102482 DEXTROSE 25GM/250ML(D10W/250ML) 3.00 1102490 D10W 1L BAG 3.00 1102516 MANNITOL 25% 50ML 5.00 1102532 NS .9% 1L 2.00 1102540 NS .9% 50ML 2.00 1102557 NS 0.45% 500ML 2.00 1102565 BACITRACIN 50,000 UNITS POW F/INJ 13.00 1102599 DEPOMED40MGINJ 5.00 1102607 DEPOMED80MGINJ 12.00 1102615 KAOPECTATE SUS 3.00 1102631 BLEPHAMIDE 5ML 8.00 1102649 MANNITOL 20%250 28.00 1102672 CARDIZEM 25MG INJ 4.00 1102680 BETOPTIC 0.25% 33.00 1102698 CARDURA 1MG 12.00 1102714 TEGRETOL SUSP. 4.00 1102722 CARDIZEM CD 300MG 2.00 1102730 SANDIMMUNE 25MG 2.00 1102748 RIFADIN INJ. 65.00 1102755 ROWASA SUPP 3.00 1102763 BIAXIN 500MG TAB 4.00 1102771 ROCEPHIN 250MG 14.00 1102805 AREDIA 30MG/10ML 181.00 1102813 SENSORCAINE-MPF 0.75% 2.00 1102839 PROCARDIA XL 90MG 2.00 1102854 DIPRIVAN 10MG INJ 13.00 1102862 NORVASC 5MG TAB 18.00 1102896 PCA-M.S. 30 MG 7.00 1102904 KEPPRA ORAL SOLUTION 100MG/ML 12.00 1102920 TOBRAMYCIN PWD 40.00 1102938 MARCAINE-MPF 0.5% 5.00 1102946 COLACE LIQ 3.00 1102961 METH BLUE 10ML 2.00 1102987 NIMOTOP 30MGCAP 8.00 1102995 CANDIDA 1:100 5.00 1103001 FLURBIPROFEN 0.03% EYE SOLU 54.00 1103019 TORADOL 30MG INJ 4.00 1103027 TORADOL 60MG INJ 11.00 1103043 ATROP .05MG/ML 4.00 1103068 DIGIBIND INJ. 765.00 1103092 ELIMITE 5% CRM 16.00 1103126 NEUPOGEN 300MCG 2,694.00 1103134 NEUPOGEN 480MCG 4,268.00 1103142 ZOFRAN 4 MG INJ 19.00 1103167 OCTREOTIDE 0.1MG 20.00 1103175 OCTREOTIDE .5MG 87.00 1103183 DIFLUCAN INJ 200MG 61.00 1103431 ACIDOPHILUS TAB 6.00 1103738 HEPARIN SODIUM 2000UN/1000ML 88.55 1103746 DITROPAN XL 5MG TAB 1.91 1103753 DITROPAN XL 10MG TAB 1.96 1103761 DEXTROSE 5% / AVIVA BAG 108.00 1103779 XOPENEX 1.25MG/3ML INH 2.96 1103860 ELIQUIS 5MG TAB 9.00 1103878 EMTRIVA 10MG/ML 170ML 36.00 1103886 ARAVA 10MG TAB 65.33 1103894 PAPAVERINE 30MG/ML 2ML 35.28 1103902 ROCEPHIN 1 GM/50ML 925.00 1103910 PHOSPHA 250 NEUTRAL 2.00 1103928 REQUIP (ROPIRINOLE) 2MG TAB 35.00 1103936 PRADAXA 150 MG CAP 40.00 1103944 PRADAXA 75 MG CAP 40.00 1103951 SANTYL 30 GM OINTMENT 852.00 1104108 FIRST MOUTHWASH BLM 39.88 1104256 ZOLOFT 50 MG 2.00 1104264 OLANZAPINE 2.5MG TABLET 3.00 1104272 AZITHROMYCIN 200MG/5ML SUSP 47.00 1104280 ZOCOR 10 MG TAB 2.00 1104298 ZOCOR 20MG TAB 2.00 1104348 COZAAR 50MG TAB 2.00 1104355 CORDARONE INJ. 86.00 1104389 MELOXICAM 7.5MG TABLET 2.00 1104397 ZITHROMAX 250 MG 7.00 1104413 NIMBEX INJ 2MG/ML 21.00 1104421 LAMICTAL 100MG 3.00 1104439 MIDAZOLAM(VERSED)2MG/2ML SOL F/INJ 5.00 1104454 ATIVAN DRIP 2.00 1104488 EPIVIR 150MG 4.00 1104496 XALATAN 0.005% 64.00 1104504 MEPRON 750MG SUSP. 15.00 1104512 XARELTO 20MG TAB 79.00 1104520 IODOSORB 40GM GEL 768.00 1104538 BUMEX 1MG TAB 9.00 1104546 KEPPRA 250MG TAB 11.00 1104553 ANTIZOL 1.5 GM/1.5ML INJ 16,110.00 1104561 PAXIL 10MG TAB 13.00 1104579 NITROGLYCERIN 2%OINT 60 GM 182.00 1104587 FENOFIBRATE 54MG TAB 12.00 1104595 FENOFIBRATE 160MG TAB 18.00 1104603 ARIPIPRAZOLE 5MG TAB 196.00 1104611 ARIPIPRAZOLE 10MG TAB 196.00 1104629 XARELTO 10 MG TAB 79.00 1104637 VITAMIN D 1 000 UNIT TABLET 6.00 1104645 XARELTO 15 MG TAB 79.00 1104652 MELOXICAM 15MG TABLET 2.00 1104660 MERREM I GM IV 273.00 1104678 CYTOTEC 25MCG PO 11.00 1104686 ERYTHROMYCIN 0.55 OPTHALMIC 108.00 1104694 LEVEMIR 100UNITS/10 ML VIAL 296.00 1104736 STROMECTOL 3MG PO 58.00 1104751 TRANEXAMIC ACID 1000MG/10ML VL 642.00 1104769 NEORAL 100MG 5.00 1104777 AQUA MEPHYTON 1MG/0.5ML 85.00 1105030 TRANS-SCOP 3.00 1105055 DIFLUCAN 400MG IV 131.00 1105071 OCUFLOX 0.3% OPH 32.00 1105097 COREG 3.125MG 2.00 1105105 VERSED LIQ 2MG 3.00 1105121 LEVAQUIN 500MG INJ 22.00 1105139 CEFOXITIN 1GM INJ 10.00 1105147 LEVAQUIN 250MG TAB 109.00 1105154 LEVAQUIN 500MG TAB 162.00 1105162 MERREM 500MGIV 23.00 1105204 ACTIVASE 5MG 1,126.00 1105212 TRUSOPT SML 24.00 1105220 NO 0.45% 1L 2.00 1105238 CALCUIM GLUCONATE 5MEG/10ML 32.00 1105246 ROCEPHIN 500MG IV 201.00 1105253 KCL PREMIXED 20 MEQ 85.00 1105261 KCL PREMIXED 10MEQ 85.00 1105279 IRRIGATION 22.00 1105329 VANCOMYCIN HCL/D5W 7.00 1105337 INVANZ (ERTAPENEM) 1GM 744.00 1105345 STARLIX 120MG TAB 18.00 1105352 PHENERGAN VC 5 ML 12.00 1105360 AGGRENOX CAP 31.00 1105378 CEFEPIME(MAXIPIME)2GM POWDER F/INJ 409.00 1105394 ESOMEPRAZOLE MAG TRIHYDRATE 40.00 1105402 TIGECYCLINE 50 45.00 1105410 ZIPRASIDONE HCL 20 81.00 1105428 PEN G POT/DEXTROSE-WATER 2MU 2.00 1105436 VISCOUS LIDOCAINE 2% 100ML 2.00 1105444 TAMIFLU 9.00 1105451 CLINDAMYCIN PHOSPHATE/D5W 10.00 1105469 CANCIDAS 50 MG INJ 410.00 1105477 EZETIMIBE/SIMVASTATIN 2.00 1105485 EZETIMIBE/SIMVASTATIN 2.00 1105493 PITOCIN 30 UNIT/D5LR 1 LITER 6.00 1105501 PITOCIN 30 UNIT/LR 1 LITER 5.00 1105519 TROPHAMINE 10% 231.00 1105527 NORMAL SALINE 10ML PFS 40.00 1105535 CAFCIT 20MG/ML-3ML VIAL 471.00 1105543 INSULIN(NOVOLOG 70/30)1000U/10ML 17.00 1105550 METOCLOPRAMIDE 5MG TAB 9.00 1105568 BETADINE 10% OINTMENT 60.00 1105584 ESMOLOL HCL 2500MG/SOD CL IV 96.00 1105592 DEXTROSE 15% 500ML 63.00 1105618 SULAR 20 MG 18.00 1105642 INTEGRELIN 20MG IV 103.00 1105659 WINRHO 1000MCG 655.00 1105667 RECOMBIVAX TF PED 10.00 1105675 REOPRO 10MG/5ML INJ 546.00 1105683 ALPHAGAN 5ML 17.00 1105691 ACTOS 15MG 4.00 1105709 PROTONIX IV 40MG 276.00 1105717 AMBIEN 10MG 3.00 1105725 DEXTROSE 14% 500ML 63.00 1105733 NEUTRA PHOS PKTS 8.00 1105741 ARICEPT 10MG TAB 4.00 1105758 ZANAFLEX 4MG TAB 20.00 1105766 FERRLECIT 62.5MG/5ML SOLUTION F/INJ 28.00 1105774 EFFEXOR 75MG TAB 20.00 1105782 AYR NASAL GEL 2.00 1105790 ADVAIR 100/50 3,887.00 1105808 EVISTA 60MG 2.00 1105816 HUMALOG 75/25 INJ 100U 655.00 1105824 SUDAFED 120MG ER 9.00 1105832 ZETIA 10MG TAB 3.00 1105840 SUFENTA 5ML INJ 200.00 1105857 WINRHO 300 MCG 198.00 1105873 COLISTIMETHATE 150MG/VIAL 307.00 1105881 MORPHINE SULFATE 4MG/1ML SOL F/INJ 2.00 1105980 COMBIVENT INH 173.00 1106004 MVI 10ML 5.00 1106145 KALETRA 200MG TAB 72.00 1106152 CELEXA 10MG TAB 19.00 1106160 DORIBAX 250MG VIAL 358.00 1106178 PAVULON 1MG/ML 10ML VIAL 67.00 1106186 MMR II VACCINE 0.5 ML INJ 606.00 1106194 STARLIX (NATEGLINIDE) 60MG TAB 24.00 1106202 SURVANTA 25MG/ML 4ML VL IT 2,964.00 1106210 JANUVIA 100MG TAB 80.00 1106228 DULOXETINE 30MG CAP 63.00 1106236 VALPORIC ACID 250MG/5ML SOLN 11.00 1106244 ALBUTEROL 0.5% 20ML INH 267.00 1106251 LOVENOX 80MG 42.00 1106269 CLINDAMYCIN 300MG/50ML 399.00 1106277 TALC POWDER 5 GM 88.00 1106285 GI COCKTAIL 110ML 92.00 1106293 AVAPRO 300MG TAB 19.00 1106301 DILAUDID 1MG/ML CARPUJECT 61.00 1106319 GLYCOPHOS VIAL 249.00 1106327 LOVAZA 1 GM CAPSULE 24.00 1106343 HEPARIN SODIUM 1000UNITS/500ML 160.00 1106350 CEFAZOLIN 2 GM - D5W BAG 350.00 1106392 ROWASA ENEMA 16.00 1106426 TYLEN/COD ELIX 6.00 1106467 PNEUMOVAX VIAL 53.00 1106491 DILAN 100MG IV 2.00 1106525 MTE CONC 1ML 2.00 1106533 BETADINE SPRAY 5.00 1106541 HYDROCOR250INJ 3.00 1106558 NIPRIDE VIAL 18.00 1106566 NEOSTIGMINE 10MG/10ML INJ 6.00 1106608 SODPOLY-SULFON 5.00 1106624 AFRIN NAS SOLN 3.00 1106640 ANCEF500MGVIAL 5.00 1106657 COMPZINE SYRUP 13.00 1106673 METHOTREX 50MG INJ 4.00 1106699 ETHYL CHLORIDE 13.00 1106707 INDIGO CARMINE 7.00 1106723 XYLOC MPF 1% 7.00 1106731 STER H2O 100ML 2.00 1106756 DILAUDID-2 TAB 3.00 1106764 ISOPTIN IV 3.00 1106780 DECLOMYCIN 150 4.00 1106806 MINOCIN 100CAP 2.00 1106814 THORAZINE 50MG AMP 2ML 2.00 1106848 TB PPD 5U 120.00 1106863 DESITIN OINT 2.00 1106871 PAPAVER INJ 30MG/ML 2ML 3.00 1106889 ONCOVIN 2MG IV 58.00 1106897 TOBRA80MG VIAL 2.00 1106905 AMINO 250 VIAL 4.00 1106921 HYDROCOR100INJ 2.00 1106947 MARCAINE SPINAL 3.00 1106954 LET SOLUTION 2.00 1106970 DEMEROL/PHENERGAN 61.00 1106988 DILAN100MG/4ML 2.00 1106996 LOCOID .1% CRM 6.00 1107010 DOPAMINE/D5W 400MG 7.00 1107028 XYLOC/EPI 1% 7.00 1107044 TOBRADEX OPH OINT 20.00 1107051 CIPRO 400MG IV 26.00 1107077 PERIDEX RINSE 12.00 1107085 PHENOBARBITAL 130MG INJ 4.00 1107093 CARDIZEM CD 240MG 2.00 1107119 PRAVACHOL 10MG 3.00 1107135 TRIAMCINOLONE LOTION 21.00 1107176 MYCOBUTIN 150MG 3.00 1107184 MUCOMYST 20% SOLN. 6.00 1107192 MYCAMINE 100MG INJ 2,249.00 1107200 LIDO-MPF 1% 5ML 9.00 1107218 D5/.9NS 1L 2.00 1107267 OPHTHAIN OPSOL 5.00 1107283 PRONESTYL 100MG/ML 10ML VL 12.00 1107317 D2.5NS.45 1L 2.00 1107325 D5LR 1L 2.00 1107333 ISOPROTERENOL INJ 1MG/5ML 3.00 1107341 D5/.2NS 1L 2.00 1107358 PHENERGAN 12.5 SUPP 3.00 1107366 LR 1L BAG 2.00 1107374 NS .9% 500ML 2.00 1107382 CLEOCIN PEDSOL 12.00 1107408 LEVOTH0.2MGINJ 8.00 1107416 RYNATAN PEDSUS 16.00 1107424 DEMEROL50MGINJ 2.00 1107432 DEMEROL 100MGINJ 2.00 1107440 DILAUDID4MGINJ 2.00 1107473 THORAZ 25MGAMP 2.00 1107523 AMOX PO 250/150ML 3.00 1107531 THERAGRAN SOLN 5.00 1107549 AMP 250MG100ML 2.00 1107564 KENALOG-40 INJ 40MG 8.00 1107572 KENALOG-10 INJ 10MG 4.00 1107580 FUNGIZONE VIAL 50MG 33.00 1107598 AZACTAM 2GM 29.00 1107622 CHLORAS SPRAY 4.00 1107630 AZOPT 1% OPH 1,245.00 1107655 COMPAZ25MGSUPP 3.00 1107671 PEPTO-BISMOL 2.00 1107689 MONISTAT-7 CRM 8.00 1107697 MICONAZOLE CRM 10.00 1107705 SPECTAZOLE85GM 13.00 1107713 DILAN-125 SUSP 10.00 1107721 ADRENALIN INJ 2.00 1107739 NITROSTAT.4MG 2.00 1107747 AZACTAM 1GM 19.00 1107770 TYLENOL SOLN 160MG/5ML 7.00 1107846 LACTULOSE 30ML 2.00 1107853 MYCELEX10MGLOZ 2.00 1107911 AQUAMEPH1MGAMP 2.00 1107929 VIT-K 10MG AMP 5.00 1107937 PRIMAXIN250INJ 12.00 1107945 PRIMAXIN500INJ 26.00 1107960 TIMOPT.25% OPH 3.00 1107978 TIMOPT .5% OPTH 5.00 1107986 TIMOPTIC.5%10M 5.00 1107994 VASOTEC 1.25MG INJ 3.00 1108000 ZAROXOLYN 5TAB 2.00 1108042 ROBINUL INJ1ML 5.00 1108067 BUMEX 1MG INJ 3.00 1108133 VALIUM 10MG SYR 3.00 1108141 CELEST SOLUSPN 6MG/ML 5.00 1108166 LOTRIMIN 15GM 4.00 1108190 VERSED 5MGINJ 11.00 1108240 UNASYN 1.5GM INJ 7.00 1108257 NITROLINGUAL 29.00 1108281 VALIUM10MG AMP 3.00 1108299 ROBINUL INJ20M 5.00 1108315 PEN 5000000 U 3.00 1108323 ANCEF 2GM IVPB 13.00 1108398 DONNATAL ELIX 4OZ 2.00 1108406 REGLAN10MG INJ 3.00 1108497 FLAGYL 500MGIV 3.00 1108513 VALISON.1% CRM 2.00 1108539 PROVENTIL INH 4.00 1108547 LOTRIMIN 1%CRM 3.00 1108711 HEPAR5000U/ML 5.00 1108729 REGLAN 10MG/2ML AMP 9.00 1108737 LITHIUM SOLN 12.00 1108752 MAGIC MOUTHWASH 90 ML 64.00 1108778 NOVOSEVEN 5000 MCG VIAL 68,072.00 1108786 DEBROX OTIC 15 3.00 1108794 NITROGLYCERIN IV 50MG 16.00 1109008 LIDEX-E.05%CRM 7.00 1109016 LIDEX.05% CRM 8.00 1109024 LIDEX.05% OINT 13.00 1109073 HESPAN 500ML 19.00 1109123 ERYTHR 500MGIV 6.00 1109149 NOVOSEVN 1200MCG PER VIAL 14,817.00 1109164 SUBLIMAZE 250MCG 5.00 1109198 AMICAR 5GM IV 14.00 1109206 SUBLIMAZE 500MCG 6.00 1109214 MGSO410GM VIAL 144.00 1109222 FENTANYL 1MG 17.00 1109230 ARIST-A .1%CRM 7.00 1109255 ARIST-A .5%CRM 3.00 1109271 METHOTREX2.5MG 2.00 1109321 VIBRA 100MG IV 12.00 1109396 MYDRIACYL 1% 15ML 11.00 1109404 BETOPTIC.5%OPH 15.00 1109412 MAXITROL 3.5GM 3.00 1109420 TETRACAINE 2ML 4.00 1109438 TOBREX OP SOLN 3.00 1109446 PRED-FORTE10ML 5.00 1109453 BETAGAN.5% OPH 11.00 1109479 LASIX 100MG IV 2.00 1109487 LIDO LARYNGJET 4.00 1109503 OXYTOCIN IOU 2.00 1109560 NIZORAL 2% CRM 12.00 1109602 DAPTOMYCIN 500MG 1,936.00 1109628 MYCOSTATIN PWD 18.00 1109636 MONISTAT-3 VAG 10.00 1109644 GARAMY OPH UNG 2.00 1109651 PREMARIN IV 25MG 1,247.00 1109693 PEPCID 20MG IV 13.00 1109719 RANITIDINE 50 MG VL 2.00 1109727 ANGIOMAX 250MG 7,389.00 1109735 VALACYCLOVIR HCL 500MG TABLET 15.00 1109743 POLYTRIM 10ML 8.00 1109776 MYLICON DROPS 2.00 1109784 MINERAL OIL LT 3.00 1109842 HUMULIN R U-500 3,617.00 1109859 METHYLPRED SOD SUCC 125MG 3.00 1109875 INSTANT GLUCOSE 3.00 1109883 ELDEPRYL 5MG 2.00 1109891 VASOPRESSIN 20UNITS/ML INJ 5.00 1109917 METHYLPRED SOD SUCC 1GM 17.00 1109925 DEPO-PROVERA INJ 150MG/ML 317.00 1109933 CORTROSYN .25MG 68.00 1109958 CASPOFUNGIN ACETATE 70MG INJ 198.00 1109974 BROVANA 15MCG/2ML INH 97.00 1109982 DOBUTREX250INJ 31.00 1109990 DEPAKOTE ER 250 MG TAB 24.00 1110006 SPIRIVA W/HANDIHALER 18MCG/CAP 293.00 1110022 PHENERGAN EXP 5ML 9.00 1110030 NPLATE 250MCG SQ 5,944.00 1110048 SUMATRIPTAH SUCCINATE 208.00 1110089 AMOX TR/POTASSIUM CLAVULANATE 4.00 1110121 ACTOS 30MG 5.00 1110139 LOVENOX 100MG 49.00 1110147 NAFCIL 1GM INJ 7.00 1110154 ZOSYN 3.375GM IV 15.00 1110162 WELLBUTRIN SR 100MG RELEASE TAB 2.00 1110188 ARIMIDEX 1MG 7.00 1110196 PARLODEL2.5TAB 2.00 1110204 ZOSYN 4.5GM INJ 19.00 1110220 OPTIMYD OP SOL 13.00 1110246 XOPENEX 0.63MG 6.00 1110253 DEPACON 500MG INJ 10.00 1110279 LOVENOX 40MG 20.00 1110287 H-BIG 0.5ML INJ 783.00 1110295 SLOW RELEASE IRON 6.00 1110303 PROTAM250MGINJ 9.00 1110352 HEP 25000U BAG 3.00 1110360 HEPARIN 100U/ML 5ML PFS 42.00 1110378 DIAMOX500 INJ 15.00 1110394 LIDO 50MG SYR 2.00 1110402 NICOTINE 14MG PATCH 5.00 1110410 NICOTINE 7MG PATCH 5.00 1110428 NICOTINE 21MG PATCH 5.00 1110451 BRETHINE AMP 1MG 23.00 1110469 CYCLOMYDRIL 5ML 5.00 1110501 LEVOPHED AMP 4MG 10.00 1110519 LAMASIL 250MG TAB 107.00 1110550 TRANDATE VIAL 16.00 1110568 DEPAKOTE 500MG 2.00 1110576 XYLOCAINE 1% 30ML VIAL 4.00 1110592 APRES 20MG AMP 4.00 1110626 LOPRESSOR AMP 3.00 1110659 PLAVIX 300 MG TAB (CLOPIDOGEL) 196.00 1110667 SEROQUEL 25MG TAB 2.00 1110683 ROCEPHIN 1GM INJ 43.00 1110691 VANCO 500MG PO 5.00 1110709 ANCEF1GM IVPB 8.00 1110717 TEFLARO 400MG IV 616.00 1110725 NAFCIL 2GM INJ 13.00 1110741 AMP 1GM IVPB 3.00 1110758 CLINDAMYCIN 900MG/6ML 77.00 1110766 CLINDAMYCIN PHOSPHATE 36.00 1110774 LEXAPRO 10 MG TAB 2.00 1110790 ACYCLOVIR 34.00 1110808 FLUDARABINE 50MG 272.00 1110840 UNASYN 1.5GM INJ 7.00 1110857 MEGESTROL ACETATE 6.00 1110865 LANOX .5MG AMP 2.00 1110873 SURVANTA IT 478.00 1110881 COGENT 2MG AMP 7.00 1110899 TIGAN200MG AMP 2.00 1110907 FLOVENT 110MCG 1,548.00 1110915 CARBOPROST(HEMABATE)250UG/1ML F/INJ 574.00 1110923 EUCERIN CREAM 6.00 1110949 METHOTREX 25MG INJ 24.00 1110964 SEROMYCIN 250MG CAP 3.00 1110972 NAMENDA 5 MG TAB 3.00 1110980 ABELCET 100MG/20ML 193.00 1110998 CERVIDIL 10MG SUPP 189.00 1111004 SPORANOX 100MG CAP 107.00 1111038 CLAFORAN 500MG INJ 5.00 1111046 UNASYN 3GM INJ 13.00 1111053 CELEXA 20MG TAB 2.00 1111061 DEPAKENE SOLN 3.00 1111079 LUMIGAN OPTH SOLN 1,229.00 1111095 D25% 500ML 7.00 1111103 VASOCON OP SOL 6.00 1111129 MVI-12 4.00 1111160 NORCO TAB 8.00 1111178 KETOROLAC TROMETH OPH SOL 3.00 1111202 DEPAKOTE ER 500MG 2.00 1111210 PERCOCET 10-325MG TAB 14.00 1111228 OXYCONTIN 40MG PO 3.00 1111269 PROM VC/COD 2.00 1111277 PHENERG50MGSUP 3.00 1111285 PHEN 50MG INJ 2.00 1111301 METHERGINE 0.2MG AMP 3.00 1111319 ATROP .5MG SYR 2.00 1111327 GENT 80MG INJ 3.00 1111335 GARAMY OPH SOL 2.00 1111343 SULFACETAMIDE 10% OPTH SOL 5ML 373.00 1111376 CORTIS OPH UNG 5.00 1111384 NEOSYN2.5% OPH 4.00 1111392 CYCLOGYL1% 5ML 5.00 1111418 TIMOLOL MALEATE/DORZOLAM HCL 9.00 1111426 NEBCIN 1.2GM BULK 184.00 1111434 NEOSP OPH SOLN 2.00 1111442 NEO-SYNEPH INJ 10MG 2.00 1111475 DEMADEZ 10MG PO 10.00 1111483 ALTEPLASE INJ 2MG 1,166.00 1111491 CYCLOGYL1% 2ML 3.00 1111533 ASA 81MG CHEWTAB 6.00 1111541 AFRIN PED NAS 3.00 1111558 DILAUDID 2MG INJ 2.00 1111574 DEMEROL 75MG INJ 2.00 1111616 MORPHINE15MGINJ 2.00 1111624 EFFEXOR 37.5MG TAB 23.00 1111640 NARCAN 1MG/ML 5.00 1111673 FENTANYL/BUPIVAC HCL/NS/PF 16.00 1111707 HALDOL 5MG AMP 7.00 1111749 PROPOFOL 10MG/ML 100ML 692.00 1111756 DURAGESIC 50 MCG 19.00 1111772 DURAGESIC 100MCG 31.00 1111780 ADRIAYMIN 50MG 37.00 1111806 ZIAGEN 300MG 76.00 1111814 DURAMORPH 10MG 5.00 1111822 FONDAPARINUX 2.5MG/0.5ML SYR 176.00 1111848 OSMITROL 20% 611.00 1111855 PRAVACHOL 20MG TAB 3.00 1111863 SINGULAIR 10MG TAB 3.00 1111871 IPRATROPIUM/ALBUTEROL .5MG 40.00 1111897 VENTOLIN INH REFILL 17 15.00 1111905 XYLOC 1% 50ML 3.00 1111921 FLOVENT 220MCGINH 82.00 1111939 TEMOVATE .05% CRM 24.00 1111947 NITROGLYCERIN/D5W 4.00 1111970 TIMENTIN3.1INJ 13.00 1111988 NORCO 10MG/325MG TAB 9.00 1111996 BOTULINUM TOXIN TYPE A 100 6,771.00 1112002 NUBAIN 10MG 2.00 1112010 RENVELA 800MG TAB 32.00 1112028 DESMOPRESSIN 4MCG 24.00 1112044 CETACAINE SPRAY 38.00 1112051 LEVOFLOXACIN 750MG/D5%-WATER 18.00 1112077 ROPIVACAINE HCL 0.5% 5MG/ML 13.00 1112085 CLINDAMYCIN 600MG/4ML 67.00 1112093 CLEOCIN300 INJ 4.00 1112101 MIACALCIN NAS 42.00 1112119 PLAVIX 75MG 6.00 1112127 ACTIGALL 300MG 2.00 1112135 CASCARA 5ML 6.00 1112143 MAR.5/EPI 1:2 7.00 1112150 QUINAPRIL HCL 16.00 1112184 TRAVATAN OPTH 2.5ML 159.00 1112192 NILSTAT SUSP 2.00 1112200 NIASPAN 500 MG 28.00 1112218 PHENERG25MGSUP 3.00 1112226 AUGMENTIN 500 3.00 1112242 ACTOS 45MG 91.00 1112259 IMOGAM RABIES 41.00 1112267 LIDOCAINE 2GM/500ML PREMIX BAG 220.00 1112275 D5/.45NS 1L 2.00 1112283 HEPARIN FLUSH 1U/ML SYR 41.00 1112291 DIP TET ADULT 0.5 ML 261.00 1112309 SODIUM CHLORIDE 10% INH 15ML 46.00 1112317 HYDROCOR 1%UNG 2.00 1112325 BACTRIM 400MG INJ 3.00 1112341 LOTRISONE CRM 21.00 1112366 METRONIDAZOLE 64.00 1112382 CLAFORAN 1GM INJ 11.00 1112408 NS .9% 100ML 2.00 1112416 BETADIN 10% SOLN 8.00 1112424 VANCO500MG INJ 8.00 1112440 MUCOMYST 20% SOLN. 9.00 1112465 AMIKIN INJ 500MG 23.00 1112473 AMPIC 250MGINJ 4.00 1112481 SSKI SOLN 6.00 1112499 LEVETIRACETAM-NACL 1 000MG/100 462.00 1112515 MEFOXIN 2GM INJECTION 119.00 1112523 INTRALIPID 20% 250ML 7.00 1112556 UNASYN 3GM INJ 13.00 1112564 DEFINITY CONTRAST PER ML 394.00 1112580 D20W 500ML BOT 3.00 1112598 JANUVIA 50MG TAB 7.00 1112606 BIMATOPROST 78.00 1112705 EFFEXOR XR 37.5MG 28.00 1112713 DORIBAX(DORIPENEM)500MG/VIAL 297.00 1112721 TUCKS REC SWAB 2.00 1112739 ADVAIR 250/50MCG DISK #60 2,964.00 1112770 XYL 2%/EPI 1:1 2.00 1112788 GARAMY .1% UNG 6.00 1112804 POLYMYX INJ 500MU 3.00 1112853 WATER IRRIGATION IL 190.00 1112861 IBUTILIDE INJ 1MG 174.00 1112879 VIREAD 300 MG TAB 162.00 1112887 SEPTRA SUSP 9.00 1112903 RELISTOR 12MG/0.6ML INJ 493.00 1112937 KALETRA CAPSULE 34.00 1112945 CARPINE2% 15ML 3.00 1112952 ADRENLIN TOPICAL 5.00 1113000 BENADRYL ELIX 4.00 1113034 FLUORESCITE 10% 13.00 1113042 REGITIN5MG INJ 64.00 1113075 LAMISIL 1% CREAM 12GM 99.00 1113117 FLOVENT 44MCG 1,157.00 1113125 DURAGESIC 25MCG 16.00 1113141 SEREVENT INHAL. 52.00 1113166 HEPARIN 100 UNITS/ML VIAL 45.00 1113174 NORCURON VIAL 15.00 1113182 MVI PEDIATRIC 9.00 1113190 OCTREOTIDE ACET 200MCG/ML 5ML VL 143.00 1113208 PROTAM 50MGINJ 2.00 1113216 NEOSYN.25% 3.00 1113224 TET TOX PLAIN 0.5ML 278.00 1113232 XIFAXAN 200MG PO 130.00 1113257 LIDOCAINE HCL 3.5% PF 18.00 1113265 XYL 1%/EPI 1:1 2.00 1113273 PRASUGREL(EFFIENT)5MG TAB 68.00 1113299 ROBIT SOL120ML 3.00 1113315 DURAGESIC 75MCG 277.00 1113323 NARCAN.4MG INJ 5.00 1113331 HURRICAINE SPRAY 13.00 1113349 XYLO 2%/EPI .0005% MPF 138.00 1113356 PLETAL 50 MG TAB 14.00 1113364 BENTYL20MG AMP 17.00 1113398 PROVIGIL 100MG 5.00 1113406 MEVACOR 20MG 2.00 1113414 TEFLARO 600MG IV 616.00 1113422 AVC CREAM 124.00 1113448 PHENOBARB INJ 3.00 1113455 GENTAMICIN 80MG IN SOD CHLOR 3.00 1113463 PROGRAF 0.5 MG CAP 22.00 1113471 OXYCONTIN 20MG TAB 2.00 1113489 DULOXETINE 20 MG CAP 57.00 1113497 PREMARIN VAG 1,419.00 1113513 NEOSYN10% OPH 5.00 1113521 CHARCOAL SUSP. 13.00 1113547 ADVAIR 500/50 131.00 1113562 PRASUGREL(EFFIENT)10MG TAB 68.00 1113570 DULOXETINE 60MG CAP 63.00 1113588 XYLOCAINE MPF 1% STERILE PAK 65.00 1113596 HYLENEX 150 UNITS / ML 535.00 1113638 MORPHINE8MGINJ 2.00 1113646 ROMAZICON 0.5 MG/VIAL 40.00 1113653 INTEGRELIN 75MG/100ML VL 324.00 1113661 CLINDAMYCIN PHOSPHATE/D5W 15.00 1113687 WELLBUTRIN SR 150 MG 23.00 1113703 BENADRYL 25MG/10ML 10.00 1113745 INSUL-HUM-NPH INJ 100U 14.00 1113752 BUPIVACAINE PF 0.5% 10ML SOL F/INJ 3.00 1113760 GLUCAGON INJ 1MG VL 86.00 1113778 CIPRO 250MG 3.00 1113786 ROBAXIN 1000MG/10ML VIAL 7.00 1113794 MUPRIOCIN 2% 21.00 1113810 PROCARDIA XL 60MG 1,271.00 1113828 ARICEPT 5MG TAB 4.00 1113851 BREVIBLOC 100MG 12.00 1113885 CIPRO 500MG 3.00 1113893 GOLYTELY 4L 5.00 1113943 XOPENEX 1.25 MG 6.00 1113968 ETOMIDAE 2MG/ML 10ML VIAL 14.00 1113976 INTROPIN 400MG 2.00 1113984 STADOL 2 MG INJ 100.00 1113992 SOLUMED 500MG IV 9.00 1114016 XYLOC-MPF 2% 6.00 1114024 DETROL 2MG TAB 2.00 1114032 ADVAIR 250/50 89.00 1114040 OXYTOCIN IOU 5.00 1114057 LOVENOX/ENOXAPARIN 120MG/0.8ML 803.00 1114073 XYLOC 2% 20ML 55.00 1114081 XYLOC 2% JELLY 9.00 1114099 MARCAINE .5% 7.00 1114123 DURAMORPH 5MG 8.00 1114131 PHEN 25MG INJ 2.00 1114198 METHYLPRED SOD SUCC 40MG 2.00 1114222 THROMB-TOP 5MU 65.00 1114230 ROCEPHIN 2GMINJ 85.00 1114255 ANCEF 1GM VIAL 8.00 1114263 INSUL-HUM-REG INJ 100U 14.00 1114271 NOVULIN 70/30 INJ 100U 14.00 1114305 COLCHIC.6MGTAB 61.00 1114313 NS .9% 250ML 2.00 1114321 NS .9% 100ML 2.00 1114354 DEMEROL25MGINJ 2.00 1114370 EPINEPHRINE SYRN 1MG 3.00 1114396 DEXTROSE 50% 3.00 1114412 INTEGRELIN 200MG/100ML VL 10,010.00 1114420 PROTONIX 40MG 30.00 1114438 SEROQUEL 100MG PO 65.00 1114446 MORPHINE 2MG INJ 2.00 1114453 PROAMATINE 5MG 2.00 1114461 NOVOLOG ASP INJ 100U 44.00 1114479 COMTAN 200MG TAB 20.00 1114487 TOPROL XL 50MG 14.00 1114495 EFFEXOR XR 75MG 3.00 1114503 ZOSYN 2.25GM INJ 10.00 1114529 ATORVASTATIN CALCIUM 80 3.00 1114537 DOBUTAMINE HCL 500/D5W 8.00 1114545 ATORVASTATIN CALCIUM 20 4.00 1114552 LEVALBUTEROL TARTRATE 45 536.00 1114560 ATORVASTATIN 10MG TAB 34.00 1114578 PITOCIN 20 UNIT/D5LR 1 LITER 6.00 1114586 FLONASE NASAL SPRAY 135.00 1114594 LEVAQUIN 500MG PMX PB 190.00 1114602 ZOFRAN 4MG TAB 12.00 1114628 CEFEPIME 1GM IV 194.00 1114636 MULTAQ 400MG TAB 46.00 1114644 ZOLPIDEM 5 MG TAB 35.00 1114651 NORCO 5MG/325MG TAB 8.00 1114669 LEVOTHYROXINE 0.1MG/5ML INJ 643.00 1114677 SODIUM CHLORIDE 0.9% 3ML INH 41.00 1114685 CALMOSEPTINE 113GM OINT 79.00 1114693 LEXISCAN 0.4MG/5ML 2,381.00 1114701 NICARDIPINE 25MG/250D5W 287.00 1114727 LOVENOX 60MG 31.00 1114743 LEVOTHR3MG INJ 58.00 1114750 FLUORESCEIN 40.00 1114768 DAKINS 13.00 1114776 WATER FOR INJECTION 139.00 1114792 VIRA-A OPH UNG 8.00 1114818 GANCICLOVIR 500MG IV 30.00 1114826 MILRINONE LACTATE 20/D5W 17.00 1114834 ADVAIR 100/50MCG DISK #60 2,393.00 1114842 GRANULEX SOLN 9.00 1114925 HEALON GV OPTH 14MG/ML 0.85ML SYR 435.80 1115716 AZITHROMYCIN 600MG TAB 28.65 1300441 RESP CPAP PER DAY 3,653.00 1300466 RESP IPPB INITIAL 306.00 1300540 RESP AEROSOL TREATMENT INITIAL 306.00 1300581 RESP SPUTUM COLLECTION INITIAL 306.00 1300771 RESP INHALER TREATMENT INITIAL 306.00 1300839 BRONCHIAL HYGIENE SUB SAME DAY 326.00 1300961 RESP BRONCHIAL HYGIENE INITIAL 524.00 1301019 SUPER DIMENSION BRONCHOSCOPY 6,891.00 1301076 MECH CHEST WALL OSCILLATION INITIAL 1,074.00 1301100 MECH CHEST WALL OSCILLATION SUBS 1,074.00 1301134 HHN TREATMENT SUBSEQUENT 306.00 1301142 MDI SUSP CHAMBER 51.00 1301159 PULSE OXIMETRY OVERNIGHT 696.00 1301167 PULSE OXIMETRY/TITRATING O2 180.00 1301175 INFANT RECOVRY RT 441.00 1301183 CONT NEB INITIAL HOUR 644.00 1301191 IPPB TREATMENT SUBSEQUENT 306.00 1301225 RESP BRONCHIAL ALVEOLAR LAVAGE 4,591.00 1301258 INTER PERCUSS VENTILATION INITIAL 524.00 1301274 RESP INTER PERCUSS VENT SUBSEQUENT 326.00 1301308 RESP PEAK FLOW IP ONLY DX 441.00 1301324 NEONATAL RESUSCITATION 1,751.00 1301332 HHN IPPB INLINE SUPPLY CHNG 46.00 1301340 VENT SUPPLY 109.00 1301357 CONT NEB TX EA ADDL HOUR 359.00 1301365 PULSE OXIMETRY MULTIPLE 719.00 1301373 VENTILATOR NEONATE INITIAL DAY 6,592.00 1301381 RESP BIPAP PER DAY 3,653.00 1301449 RESP VENT - 2 TOWER SUBSEQUENT 4,764.00 1301456 RESP VENT 2-TOWER DAY ONE 6,592.00 1301464 RESP VENTILATOR SUBSEQUENT 4,764.00 1301472 RESP VENTILATOR INITIAL DAY 6,592.00 1301498 RESP ADULT OSCILLATOR DAY ONE 6,592.00 1301506 RESP ADULT OSCILLATOR SUBSQUENT 4,764.00 1301514 CPR 1,751.00 1301522 O2 INITIAL 48.00 1301530 OXIMETRY/OP WALK ASSESSMENT 719.00 1301548 PUL MVV 243.00 1301555 IP BLOOD GAS 621.00 1301563 AEROSOL TREATMENT SUBSEQUENT 306.00 1301571 ABG CAPILLARY 18.00 1301589 O2 PER HOUR 88.00 1301597 PH CORD BLOOD 360.00 1301605 OP CODE BLUE W/ PULM RESUSCITATION 441.00 1301654 AEROSOL TX INIT 251.00 1301662 VENTILATOR NEONATE SUBSEQ DAY 4,764.00 1301670 OP/ER BLOOD GAS 621.00 1301761 BLOOD GAS ANALYSIS 999.00 1350297 BLOOD GASES & ELECTROLYTES 1,478.00 1350305 BLOOD GASES VENOUS 1,478.00 1350313 PULSE OXIMETRY ONE-TIME ONLY 180.00 1350321 LAB BODY FLUID-PH 203.00 1350370 IONIZED CALCIUM 268.00 1350388 PULMONARY STRESS TEST 6 MINUTE WALK 1,101.00 1350396 AIRWAY RESISTANCE BY OSCLMT 580.00 1350404 ARTERIAL PUNCTURE 658.00 1350412 CAPNOGRAPHY 829.01 1370030 BRONCHOSCOPY FIBEROPTIC 4,174.00 1370824 ULTRASONIC BRONCHOSCOPY 693.00 1380427 NITRIC OXIDE ADMINISTRATION PER HR 828.00 1390087 HYPERBARIC THERAPY INIT. 3,612.00 1390095 HYPERBARIC THERAPY BASIC 3,612.00 1390434 RESP FREE FLOW INITIAL TX/DAY 306.00 1390475 HYPERBARIC TRANSCUT STUDY-IP 1,589.00 1390574 HYPERBARIC M/CARE EA 30 MIN 434.00 1390582 HYPERBARIC M/CAL SUBQ 15 MIN 221.00 1390590 HYPERBARIC M/CAL 1ST 15 MIN 221.00 1390608 RESP OXIMETRY TREND OVERNIGHT STUDY 696.00 1390616 SMOKING CESSATION OP SYMPTOMS >10M 199.00 1390624 TRACH CARE OP ONLY 441.00 1390632 CCU-BROCHOSCOPE DISP LRG 5.8OD 1,099.00 1390640 CCU-BROCHOSCOPE DISP REG 5.0 OD 955.00 1390657 CCU-BRONCHOSCOPE DISP SLIM 3.8 OD 955.00 1400076 PUL FUNC RESID 745.00 1400084 LAB PF-VITAL CAP 331.00 1400092 LAB PF-SCREENING 653.00 1400100 LAB PF-BEFORE 653.00 1400118 PUL COMP PFT 1,368.00 1400126 LAB N2 WASHOUT 745.00 1400134 LAB THORACIC GAS VOL 518.00 1400159 DIFFUSING STUDY 638.00 1400167 LAB PF C02 INFRARED 1,227.00 1400225 LAB PF BEDSIDE SCRN 869.00 1400258 LAB AIRWY RESISTANCE 518.00 1500081 SP PULMONARY 4,982.00 1500156 SP ARCH AORTA DSA 8,891.00 1500370 ABD ANGIO TRANSLUMBAR 6,239.00 1500412 SP RENAL UNILATERAL 13,574.00 1500438 SP ADRENAL BILAT 4,854.00 1500479 SP RENAL BILAT 13,574.00 1500552 SP AORTA ILIAC FEMORAL ANGIO 6,239.00 1500610 SP EXTREMITY ANGIOGRAM UNILATERAL 8,891.00 1500636 XR ANGIO IN SURG. 1,677.00 1500644 XR SUP.VENA CAVA 6,136.00 1500743 SP VENACAVA DSA INFERIOR 5,689.00 1500776 SP RENAL REN ONLY 4,275.00 1500834 XR VENOGRAM UNILAT EXTREM 2,121.00 1500842 XR VENOGRAM BILATERAL EXT 2,929.00 1500883 XR FLUOROSCOPY LESS THAN 1 HR 789.00 1501063 SP ABSCESS DRAIN CATH PLACMNT 6,236.00 1501147 SP PTA TIBIOPER ARTERY & BRANCHS 20,384.00 1501170 SP PTA ILIAC ARTERY 20,384.00 1501188 SP PTA FEMORAL-POPLITEAL ARTERY 20,384.00 1501196 SP ANGIOPLASTY INITIAL ARTERY 28,125.00 1501444 SP INFUSION THROMBOLYSIS 4,057.00 1501477 SP PERC PLCMNT IVC FILTER 6,894.00 1501568 SP CHANGE BIL DRAIN CATH 2,844.00 1501584 SP PERC DILAT BILIARY W/STENT 7,370.00 1501931 XR EYE F.B.W/LOCAL 1,010.00 1501949 XR MANDIBLE LIMIT 504.00 1501956 XR MANDIBLE COMPLETE 1,127.00 1501972 XR MASTOID MIN 3 VWS PER SIDE 1,701.00 1501980 XR INT AUDITRY CAN 485.00 1502004 XR FACIAL BONE ITD 986.00 1502012 XR FACIAL BONES 1,226.00 1502038 XR FACIAL W/NASAL 1,226.00 1502046 XR NASAL BONES 776.00 1502061 XR OPTIC FORAMINA 842.00 1502079 XR SINUSES LIMITED 724.00 1502087 XR SINUSES COMPLETE 1,174.00 1502095 XR SELLA TURCICA 702.00 1502103 XR SKULL LIMIT 808.00 1502111 XR SKULL 1,420.00 1502145 XR TEETH COMPLETE 884.00 1502152 XR TMJ JOINTS 1,114.00 1502160 XR NECK (TISSUES) 617.00 1502178 XR MAXILLA 1,226.00 1502186 XR LARYNGOGRAPHY 1,677.00 1502202 XR SIALOGRAM 945.00 1502277 XR IVPW/TOMOGRAPH 2,301.00 1502301 XR CHEST 1 VIEW 571.00 1502319 XR CHEST 2 VIEW 914.00 1502327 XR CHEST W APICAL LORDOTI 823.00 1502335 XR CHEST 4 V 764.00 1502343 XR CHEST W/FLUORO 558.00 1502400 XR RIBS BILATERAL 854.00 1502418 XR STERNUM 767.00 1502426 XR STERNOCLAVICLAR 649.00 1502459 XR SPINE ANY LEVEL 1 VIEW 666.00 1502467 XR SPINE CERV 3 OR 4 VIEWS 1,294.00 1502483 XR SPINE CERV W/OB 1,241.00 1502491 XR SPIN CERV W/BND 1,241.00 1502509 XR T-SPINE 3 VIEWS 867.00 1502525 XR SPINE THORCOLUM 2V 705.00 1502558 3R SPINE LUMBAR 2 OR 3 VIEWS 1,102.00 1502566 XR SPINE LUMBISAC COMP W/OBLIQUE 1,458.00 1502574 XR SPINE LS COMP W/BENDING VIEW 1,710.00 1502590 XR PELVIS 1V 781.00 1502608 XR PELVIS 2 VIEW 781.00 1502624 XR SACRO-ILIAC MIN 3 VIEWS 688.00 1502632 XR SACRUM&COCCYX 833.00 1502640 XR MYELOGRAM CERV 2,760.00 1502657 XR MYELOGRAM COMP 2,760.00 1502665 XR MYELOGRM LUMBAR 2,760.00 1502681 XR DISCOGRAM LUMBAR 3,429.00 1502707 CLAVICLE BILATERAL 615.00 1502731 SHOULDER BILATERAL 730.00 1502749 XR ARTHROGRAM SHOULDER LT 1,539.00 1502756 XR AC JOINTS BI. 772.00 1502798 ELBOW BILATERAL 678.00 1502806 XR ELBOW ARTHROGRAM 1,260.00 1502848 XR WRIST ARTHROGRAM 1,061.00 1502863 HAND BILATERAL 679.00 1502871 XR FINGERS RIGHT 446.00 1502921 XR HIP,BILATERAL 2V 595.00 1502939 XR HIP ARTHROGRAM 1,416.00 1502947 HIP DURING SURG ADD VIEWS 1,829.00 1502962 XR PELVIS INFANT 2V 1,008.00 1503010 XR KNEE ARTHROGRM 1,395.00 1503036 XR LOWER EXTREMITY INFANT LT 343.00 1503069 ANKLE BILATERAL 657.00 1503077 XR ANKLE ARTHROGRAM LT 1,370.00 1503093 FOOT BILATERAL 701.00 1503119 XR TOES RIGHT 625.00 1503143 XR ABD 1 VIEW 586.00 1503150 XR ABDOMEN 2V 866.00 1503168 ABD FOR FETAL POSITION 2V 1,075.00 1503184 XR ESOPHAGUS 1,239.00 1503200 XR UPPER GI TRACT W/KUB 1,984.00 1503218 XR UGI SINGLE CONTRAST 1,984.00 1503226 XR UPPER GI&BOWEL 2,909.00 1503234 XR UGI W/KUB HD BARIUM 1,677.00 1503259 XR SMALL BOWEL 1,614.00 1503267 XR HYPTNC DUODENGM 1,921.00 1503275 EN COLON BARIUM 1,691.00 1503283 XR BARIUM ENMA/AIR 2,103.00 1503309 XR CHOLECYSTO (GB) 1,077.00 1503325 XR CHOLANG SURG 1,391.00 1503333 XR CHOLANG SURG ADDED SET 187.00 1503341 XR CHOLANG-T-TUBE 1,200.00 1503358 XR CHOLANG POSTOPERATIVE 2,935.00 1503366 XR CHOLANG IV TOM 1,200.00 1503374 SP PERCUT TRANSHEP CHOLANGIOGRM 1,200.00 1503382 SP CHOLANGIOGRAM PERCUT 1,200.00 1503408 XR BILIARY STONE REMOV POST OP 1,358.00 1503416 XR BILIARY ENDOSCOPIC CATHETER 2,227.00 1503424 XR PANCREATIC ENDOSCOPIC CATH 2,280.00 1503432 XR GI TUBE PLACEMENT 1,022.00 1503440 XR NASAL GASTROINTEST INAL 1,361.00 1503465 XR ESOPHEAGEAL DILATION 7,370.00 1503473 XR ERCP-BILIARY & PANCREATIC 3,208.00 1503499 XR IVP (UROGRAPHY) 2,301.00 1503523 XR ANTEGRADE PYELOGRAM 1,214.00 1503531 XR RETRO PYLOGRAM 1,791.00 1503549 SP PERC ANTEGRADE PYELOGRAM 1,214.00 1503556 SP URETER STENT PLACEMENT 3,042.00 1503564 XR CYSTOGRAM 880.00 1503598 XR RETRO URETH 1,130.00 1503606 XR URETHROCYSTOGRAPHY VI 1,501.00 1503614 XR VOIDING CYSTOURETHROGRAM 1,501.00 1503630 XR RENAL CYST STUDY 2,846.20 1503655 SP NEPHROSTOMY DILATIONAL 7,295.00 1503663 XR PELVIMETRY 1,543.00 1503689 ABD FOR FETAL POSITION 1V 586.00 1503697 XR HYSTEROSALPINGRAM 1,041.00 1503747 SP AORTOGRAPHY THORACIC BY SERI 8,891.00 1503770 SP CERVICOCEREBRL (ARCH) 13,502.00 1503812 SP CAROTID EXTERNAL UNILATERAL 16,014.00 1503820 SP EMBOLIZATION TRANSCATH THER 9,130.00 1503838 SP CAROTID/CERE COMMON UNILAT 25,922.00 1503911 SP VERTEBRAL NON SELECTIVE UNIL 14,642.00 1503937 SP SPINAL ANGIO SELECTIVE 7,434.00 1503960 SP EXTREMITY ANGIO BILATERAL 6,360.00 1503986 SP VISCERAL SUPRASEL ANGIO 6,239.00 1503994 SP ADRENAL UNILAT SELECT ANGIO 9,992.00 1504000 SP PELVIC SELECT ANGIO 8,891.00 1504018 SP PULMONARY UNILAT SELECT ANG 4,982.00 1504026 SP PULMONARY BIL SELECT ANGIO 8,891.00 1504034 SP INTERNAL MAMMARY ANGIO 4,982.00 1504042 ANGIO ANY ADDED VESSEL 4,982.00 1504059 SP AV DIALYSIS SHUNT ANGIOGRAM 4,000.00 1504109 SP LYMPHANGIO PELV/ABD UNI 3,944.00 1504133 SP VENOGRAPHY CAVAL SUPERIOR S 6,136.00 1504166 SP VENOGRAPHY ADRENAL BI SELEC 11,710.00 1504174 SP VENOGRAPHY SINUS/JUGULAR CA 8,921.00 1504182 SP VENOGRAPHY ORBITAL 7,434.00 1504190 SP PERCUT TRANSHEP PORT W/HEMO 7,362.00 1504208 SP PERCUT TRANSHEP PORT W/O 7,362.00 1504216 SP INFUSION EMBOLIZATION 4,057.00 1504232 SP PERCUT PLACMT IVC FILTER 20,123.00 1504281 SP ANGIOPLASTY,EA ADD'L-ADD ON CODE 7,030.00 1504299 SP VENOPLASTY EACH ADD'L VEIN-ADD 7,030.00 1504315 SP VENOPLASTY INITIAL VEIN 28,125.00 1504455 XR FB INFANT 1 FILM 241.00 1504463 XR BONE AGE 278.00 1504471 XR BONE LENGTH 1,391.00 1504489 XR BONE SURVEY COMPLETE 2,831.00 1504497 XR BONE SURVEY LIMITED 1,557.00 1504505 XR INFANT SURVEY 2,061.00 1504513 XR JOINT SURVEY 1 VIEW 615.00 1504521 XR FISTULA-SINUS 1,436.00 1504596 BC DUCTOGRAM 1,058.00 1504604 SPECIMEN RADIOGRAPH 606.00 1504638 BC MAMMOGRAM MOTHERS DAY 489.00 1504661 XR FLUORO GUIDE FOR NEEDLE PCMT 789.00 1504687 XR ESOPHAGUS W/VID 1,405.00 1504810 US THYROID NECK 1,668.00 1504828 US THORACENTESIS 3,599.00 1504836 US CHEST 1,220.00 1504869 US PLEURAL EFFUSION 1,220.00 1504877 US GUIDE CYST 3,782.00 1504885 US ABDOMEN COMPLETE 2,011.00 1504893 US ABDOMEN RLQ(APPENDIX) 1,507.00 1504901 US LIVER 1,507.00 1504919 US GALLBLADDER 1,507.00 1504927 US KIDNEY 1,508.00 1504935 US PANCREAS 1,507.00 1504943 US SPLEEN 1,507.00 1504950 US AORTA DUPLEX SCAN 2,547.00 1504968 US RETROPERITONEAL COMP 1,677.00 1504976 US URINARY BLADDER 1,508.00 1504992 US OB AFTER 1ST TRIMESTER 2,089.00 1505007 US OB REPEAT 1,491.00 1505015 US BIOPYSICAL PROFILE 677.00 1505023 US PLACENTAL LOCAL 825.00 1505031 US PELVIC ENDOVAGINAL 1,432.00 1505049 US IUD LOCALIZTION 1,673.00 1505056 US PELVIC NON-OB 1,673.00 1505064 US OB POSITION 825.00 1505072 US ECHOGRAPHY TRANSRECTAL-PROSTATE 1,692.00 1505080 US AMNIOCENTESIS 2,367.00 1505098 US NEONATE HEAD 379.00 1505106 US PELVIC NON-OB LIMITED 1,056.00 1505114 US TESTICULAR WITHOUT DUPLEX DOPPLE 1,640.00 1505122 US SHOULDER 2,448.00 1505130 US EXTREMITY COMPLETE 2,448.00 1505163 US AMNIOTIC FLUID INDEX 825.00 1505197 US GUIDANCE 76942 3,782.00 1505205 US THERAPY PLN ECHO FOLLOW-UP 3,260.00 1505213 US ECHOGRAPHY INTRAOPERATIVE 1,790.00 1505221 US ECHOGRAPHY TRANSRECTAL 1,692.00 1505429 XR HYPAQUE ENEMA 1,691.00 1505445 SP NEPH TUBE PLACEMENT/EXT DRN 3,910.00 1505510 XR CINERADIOGRAPHY 1,424.00 1505536 BC MAMMARY DUCT MULITPLE DUCTS 1,147.00 1505544 US OB LIMITED 825.00 1505577 US BILIARY 2,011.00 1505585 XR HIP INFANT 2V 1,008.00 1505650 BC US GUIDED BREAST FNA 3,782.00 1505668 US DOPPLER ABD RENAL OR PELVIS 2,596.00 1505676 BC US BREAST CYST ASPIRATION 3,782.00 1505742 US LIMITED QUADRANT 1,507.00 1505759 US GUIDANCE DRAINAGE 3,782.00 1505767 XR SPINE CERV 2 OR 3 VIEWS 714.00 1505775 US GROIN 2,058.00 1505791 XR MYELOGRAM THORACIC 2,760.00 1505809 XR BE FOR REDUCTION OF INTUSS 2,081.00 1505874 US PYLORIC STENOSIS 1,507.00 1505965 XR LOOQOGRAM 1,214.00 1505981 ENTEROCLYSIS TRAY 1,431.00 1505999 BC-US GUIDED SKIN MARKING LOC 1,274.00 1506005 BC INTERVENTIAL RADIOLOGY 2 2,616.00 1506013 BC MOTHERS DAY MAMMO W/TOMO 489.00 1506021 BC SCREENING MAMMO W/TOMO 489.00 1506039 BC SCREENING MAMMO IMP W/TOMO 489.00 1506187 US SPINAL CANAL & CONTENTS 1,277.00 1506583 US RETROPERITONEAL LIMITED 1,508.00 1506591 BC DIAG MAMMO BILAT W/TOMO 935.00 1506609 BC DIAG MAMMO RIGHT W/TOMO 364.00 1506617 BC DIAG MAMMO LEFT W/TOMO 364.00 1506641 BC INTERVENTIONAL RADIOLOGY 4 4,542.00 1506666 XR PEDIATRIC CHEST SINGLE VIEW 571.00 1506674 XR PEDIATRIC ABDOMEN 586.00 1506682 XR BONE SURVEY-CHD(1>COMPLETE 2,831.00 1506690 SP REMOVAL VENOUS PORT CATH 789.00 1506708 SP TRANSCATHETER BIOPSY 4,855.00 1506716 SP EMBOLIZATION OR INFUSION THY F/U 2,243.00 1506724 SP FLUOROGUIDE-PLACE INJ PORT 789.00 1506732 SP FLUORO-GUIDE VENOUS CATH CHK 882.00 1506740 SP NERVE BLOCK CERV OR THORACIC 4,157.00 1506757 SP FACET INJ CERV OR THORACIC 4,492.00 1506765 SP ADDITIONAL FACET/NERVE INJECT 1,635.00 1506773 SP EPIDURAL/CAUDAL INJECTION 2,454.00 1506781 SP EPIDURAL BLOOD PATCH 2,974.00 1506799 SP TRIGGER POINT INJECTION 1,401.00 1506807 SP INSERTION EPIDURAL CATHETER 2,479.00 1506815 SP INTERCOSTAL NERVE MULTIPLE 2,466.00 1506849 SP PARAVERTEBRAL FACET MULTIPLE 2,479.00 1506856 SP PARAVERTEBRAL FACET SINGLE 2,479.00 1506864 SP REMOVE DRAINAGE CATHETER 615.00 1506872 SP NEPHRO CATH CHANGE 2,844.00 1506914 SP DISCOGRAM CERVICAL 4,822.00 1506922 SP SACROILIAC INJECTION 4,157.00 1506948 SP LUMBAR PUNCT/DIAG.W/FLURO INJ 1,704.00 1506955 SP MICRO CATHETER 2,476.00 1506963 SP PICC LINE PLACEMENT-FLUOROGD 789.00 1506971 SP STELLATE GANGLION INJECTION 2,479.00 1506989 SP CHEST TUBE INJERTION 2,256.00 1506997 SP CERVICAL EPIDURAL INJECTION 2,479.00 1507003 SP PERC TRANSHEPATIC BIL DRAINAGE 4,003.00 1507011 SP PERC BILIARY INT/EXT DRIANGE 3,287.00 1507029 SP CHANGE GASTROSTOMY TUBE 3,976.00 1507037 SP PERC PLACEMENT GASTROSTOMY TB 3,686.00 1507045 BIOPSY WITH FLUORO 789.00 1507052 SP BALLOON CUTTING 4,000.00 1507060 SP BALLOON OCCLUSION 1,508.00 1507078 SP PICC LN PLCMT PED-FLUOROGUID 789.00 1507086 SP CENTRAL LINE PLACEMENT 4,403.00 1507110 INTERVENTIONAL RADIOLOGY 1 3,000.00 1507128 INTERVENTIONAL RADIOLOGY 2 3,250.00 1507136 INTERVENTIONAL RADIOLOGY 3 4,550.00 1507144 SP MICRO CATHETER/WIRE SET 3,528.00 1507151 SP TRANDUCER KIT 79.00 1507169 SP SUTURE 16.00 1507177 SP TIPPS 5,561.00 1507185 US GUIDANCE FLUID ASPIRATION 3,782.00 1507193 SP CHORO PREP 25.00 1507219 US OB TRANSVAGINAL 1,044.00 1507227 US GUIDANCE FOR VASCULAR ACCESS 768.00 1507235 US PARACENTESIS 4,134.00 1507250 BC US NEEDLE LOCALIZATION 3,782.00 1507268 US ABDOMEN RUQ 1,507.00 1507284 US EYE (OPHTHALMIC) 1,901.00 1507292 US SOFT TISSUES OF HEAD&NECK 1,668.00 1507300 US GUIDED COMPRESSION REPAIR 1,901.00 1507318 SP CHANGE OF TUBE OR CATH W/CNT 2,844.00 1507326 SP FLUOROGUIDE REPOST CENT LINE 4,585.00 1507367 SP PELVIS ANGIOGRAM/SELECTIVE 8,891.00 1507383 SP RENAL VENOUS UNILAT 4,738.00 1507391 SP RENAL VENOUS BILAT 5,628.00 1507516 BC SPECIAL VIEWS RIGHT W/TOMO 364.00 1507524 BC SPECIAL VIEWS LEFT W/TOMO 364.00 1507532 US OB-1ST TRIMESTER 1,438.00 1507540 US OB-1ST TRIMESTER EA ADD GEST 593.00 1507557 US OB TRANSVAGINAL 1,044.00 1507565 US OB AFTER 1ST TRIM EA ADD GES 1,149.00 1507573 US BREAST-RADIOLOGY AFTER HOURS 1,274.00 1507581 BC SPECIAL VIEWS BILAT W/TOMO 935.00 1507607 SP EPIDURAL INJECTION-CERVICAL 1,704.00 1507615 SP EPIDURAL INJECTION -LUMBAR 1,704.00 1507623 SP EPIDURAL INJECTION -THORACIC 1,704.00 1507631 SP ADRENAL BILAT ANGIO 4,854.00 1507664 SP CATHETER STRIPPING 630.00 1507698 SP HEPATIC VENOGRAM W/O HEMODYNAMIC 4,982.00 1507706 SP ABCESS THERAPY INTRACATH 4,057.00 1507714 SP ULTRASOUND ACCESS GUIDANCE 1,394.00 1507730 INTERVENTIONAL RADIOLOGY 4 5,850.00 1507748 SP TRANSCERVICAL CATH OF FALL TB 1,935.00 1507755 XR INCISIONAL BIOPSY NON IMAGING 3,379.00 1507763 SP VERTEBROPLASTY LUMBAR 14,144.00 1507771 SP VERTEBROPLASTY THORACIC/CERVICAL 14,002.00 1507797 SP VERTEBROPLASTY ADD LEVEL 5,162.00 1507805 INTERVENTIONAL RADIOLOGY 5 7,150.00 1507813 INTERVENTIONAL RADIOLOGY 6 8,450.00 1507821 INTERVENTIONAL RADIOLOGY 7 9,750.00 1507839 INTERVENTIONAL RADIOLOGY 8 13,650.00 1507847 SP PAIN MANAGEMENT CONSULT 719.00 1507854 SP PAIN MGMT CONSULT W/ADD TEST 719.00 1507862 SP E&M LEVEL 5 91MIN & OVER 174.00 1507870 XR SM BOWEL ENTEROCYYSIS STUDY 3,572.00 1507896 BC DIAG MAMMO BILAT IMP W/TOMO 935.00 1507904 BC DIAG MAMMO RIGHT IMP W/TOMO 364.00 1507912 BC DIAG MAMMO LEFT IMP W/TOMO 364.00 1507938 BC MOTHERS DAY MAMMO W/IMPLANTS 489.00 1507946 BC MOTHERS DAY MAMMO IMP W/TOMO 489.00 1507953 XR ANKLE MIN 3 VIEWS RIGHT 657.00 1507961 XR ANKLE MIN 3 VIEWS LEFT 657.00 1507979 XR ANKLE 2 VIEWS RIGHT 551.00 1507987 XR ANKLE 2 VIEWS LEFT 551.00 1507995 XR CLAVICLE RIGHT 615.00 1508001 XR CLAVICLE LEFT 615.00 1508019 XR ELBOW COMPLETE RIGHT 678.00 1508027 XR ELBOW COMPLETE LEFT 678.00 1508035 XR ELBOW LIMITED RIGHT 602.00 1508043 XR ELBOW LIMITED LEFT 602.00 1508050 XR EYE FOR FOREIGN BODY RIGHT 1,010.00 1508068 XR EYE FOR FOREIGN BODY LEFT 1,010.00 1508191 XR FOOT MIN 3 VIEWS RIGHT 701.00 1508209 XR FOOT MIN 3 VIEWS LEFT 701.00 1508217 XR FOOT LIMITED 2 VIEWS RIGHT 607.00 1508225 XR FOOT LIMITED 2 VIEWS LEFT 607.00 1508233 XR FOREARM RIGHT 608.00 1508241 XR FOREARM LEFT 608.00 1508258 XR HAND 3-4 VIEWS RIGHT 679.00 1508266 XR HAND 3-4 VIEWS LEFT 679.00 1508274 XR HAND 2 VIEWS RIGHT 491.00 1508282 XR HAND 2 VIEWS LEFT 491.00 1508290 XR HEEL RIGHT 566.00 1508308 XR HEEL LEFT 566.00 1508316 XR HIP IN SURGERY RIGHT 503.00 1508324 XR HIP IN SURGERY LEFT 503.00 1508332 XR HIP UNILATERAL 1 VIEW RIGHT 543.00 1508340 XR HIP UNILATERAL 1 VIEW LEFT 543.00 1508357 XR HIP UNILATERAL 2V RIGHT 1,008.00 1508365 XR HIP UNILATERAL 2V LEFT 1,008.00 1508373 XR HUMERUS 2 JOINTS RIGHT 688.00 1508381 XR HUMERUS 2 JOINTS LEFT 688.00 1508399 XR KNEE RT 1-2 VIEWS 596.00 1508407 XR KNEE LT 1-2 VIEWS 596.00 1508415 XR KNEE 4 VIEWS RIGHT 891.00 1508423 XR KNEE 4 VIEWS LEFT 891.00 1508431 XR ORBITS BILATERAL 1,100.00 1508449 XR ORBITS ONE EYE 1,100.00 1508456 XR RIBS UNILATERAL RIGHT 746.00 1508464 XR RIBS UNILATERAL LEFT 746.00 1508472 XR SCAPUAL RIGHT 669.00 1508480 XR SCAPULA LEFT 669.00 1508498 XR SHOULDER 1V RIGHT 566.00 1508506 XR SHOULDER 1V LEFT 566.00 1508514 XR SHOULDER COMPLETE RIGHT 730.00 1508522 XR SHOULDER COMPLETE LEFT 730.00 1508530 XR TIBIA/FIBULA RIGHT 699.00 1508548 XR TIBIA/FIBULA LEFT 699.00 1508654 XR WRIST AP&LAT RIGHT 616.00 1508662 XR WRIST AP&LAT LEFT 616.00 1508670 XR WRIST COMPLETE RIGHT 748.00 1508688 XR WRIST COMPLETE LEFT 748.00 1508696 XR CHEST SPCIAL VIEWS(DECUB) 706.00 1508704 XR KNEES BOTH STANDING AP 635.00 1508712 XR SPINE LS BENDING VIEWS ONLY 1,360.00 1508738 XR FEMUR AP&LAT RIGHT 776.00 1508746 XR FEMUR AP&LAT LEFT 776.00 1508753 XR KNEE 3 VIEWS-RIGHT 783.00 1508761 XR KNEE 3 VIEWS-LEFT 783.00 1508795 BC-INTERVENTIONAL DRAIN W/CATH 908.00 1508803 XR CHEST 2V W OBLIQUE 706.00 1508811 XR ABD SERIES AND PA CHEST 1,087.00 1508829 XR VASOGRAPHY 1,692.00 1508837 XR UPPER EXTREMITY INFANT LT 378.00 1508845 XR ANKLE ARTHROGRAM RT 1,330.00 1508852 SP E&M LEVEL 1 LESS THAN 15 MIN 719.00 1508860 SP E&M LEVEL 2 16-30 MIN 84.00 1508878 XR ARTHROGRAM SHOULDER RT 1,539.00 1508894 SP E&M LEVEL 3 31-60 MIN 100.00 1508902 SP NERVE BLOCK LUMB OR SACRAL 5,040.00 1508910 SP PERCUT TNL CATH PLCMT-FL GDE 789.00 1508928 SP NERVE BLOCK LUMORSAC ADD LVL 2,656.00 1508936 SP FLUROGUIDE FOR SPINE INJECT 1,704.00 1508944 XR ERCP-BILIARY DUCTAL SYSTEM 2,227.00 1508951 XR ERCP-PANCREATIC DUCTAL SYSTEM 2,280.00 1508969 US PARATHYROID 1,668.00 1508977 ZILVER DRUG ELUTING STENT 140MM 12,975.00 1508993 SP FACET INJ LUMBAR/SACRAL ADDL 1,635.00 1509009 SP ANGIO SEAL DEVICE 1,757.00 1509017 SP NERVE BLOCK CERORTHO ADD LVL 2,213.00 1509025 SP FACET INJ LUMBAR/SACRAL 4,492.00 1509041 ZILVER DRUG ELUTING STENT 40-60MM 7,475.00 1509058 SP DIALYSIS CATH INSERTION-FLOR 789.00 1509066 SP HEPATIC VENOGRAM W HEMODYNAMIC 4,982.00 1509074 SP FLUORO GUIDE FOR CNT VENOUS 789.00 1509082 XR FLUORO FOR CENTRAL VENOUS CATH 789.00 1509090 BALLOON EXPANDABLE STENT 8,670.00 1509108 SP AUX ANGIOJET CATH 4,651.00 1509116 SP XVG ANGIOJET CATH 15,447.00 1509124 CATH VAXCEL DIALYSIS 28CM 5,210.00 1509132 DIALYSIS CATH 1,750.00 1509140 CATH VAXCEL DIALYSIS 19CM 2,715.00 1509157 STENT BILIARY LG PALMAZ BALL EXP 10,086.00 1509165 INTRO COOK CHECK-FLO LARGE VALVE 820.00 1509173 AMPLATZ RENA DILATOR SET 1,833.00 1509181 WALLSTENT BILIARY TRANSHEPATIC 8,741.00 1509199 STENT PALMAZ BILIARY BALL EXPAND 8,404.00 1509223 WALLGRAFT STENT TRACHEO 50MM 18,825.00 1509231 WALLGRAFT STENT TRACHEO 30MM 18,825.00 1509249 WALLGRAFT STENT TRACHEO 20MM 18,825.00 1509256 WALLGRAFT STENT TRACHEO 70MM 18,825.00 1509264 STENT URETERAL PERCUFLEX 1,076.00 1509272 WALLSTENT ENTERAL DELIVERY 90MM 10,421.00 1509280 WALLSTENT RP BILIARY DELIVERY 80M 9,412.00 1509298 WALLSTENT RP BILIARY DELIVERY SYS 9,412.00 1509306 STENT SMART BILIARY SYSTEM 80MM 7,733.00 1509314 STENT SMART BILIARY SYSTEM 60MM 7,733.00 1509322 STENT SMART BILIARY SYSTEM 40MM 7,733.00 1509330 STENT SMART BILIARY SYSTEM 20MM 7,733.00 1509348 STENT MED PALMAZ BILIARY/DELIVER 10,421.00 1509355 STENT CORINTHIAN 1Q & DELIVERY SY 8,067.00 1509363 STENT PALMAZ CORINTHIAN 1Q 7,398.00 1509371 CATH FLEXIMA BILIARY DRAIN W/PIG 865.00 1509389 THROMBO ARROW TERROTOLA 5,391.00 1509397 CATH VISTA BRITE TIP GUIDE 5FR 1,124.00 1509405 CATH VISTA BRITE TIP GUIDE 6FR 1,124.00 1509413 CATH VISTA BRITE TIP GUIDE 7FR 1,124.00 1509421 CATH VISTA BRITE TIP GUIDE 8FR 1,124.00 1509462 BALLOON CATH OPTA 5 PTA 2,267.00 1509470 BALLOON CATH POWERFLEX EXTREME 2,267.00 1509488 BALLOON CATH OPTA LP PTA 2,267.00 1509496 BALLOON CATH CENTURION OPTIPLAST 2,156.00 1509504 BALLOON CATH TALON 5,175.00 1509520 HYDROLYSER THROMBECTOMY CATH 7FR 6,902.00 1509538 HYDROLYSER THROMBECTOMY CATH 6FR 6,902.00 1509546 OASIS THROMBECTOMY CATH 6,450.00 1509553 WALLSTENT BILIARY TRANSHEPATIC 1K 10,086.00 1509561 WALLSTENT TIPS SYSTEM 60MM 10,086.00 1509579 WALLSTENT TIPS SYSTEM 40MM 10,086.00 1509587 WALLSTENT TIPS SYSTEM 20MM 10,086.00 1509595 WALLSTENT PERMALUME COVER&UNISTEP 12,775.00 1509603 STENT CORDIS SMART NITINOL 11,766.00 1509611 STENT CORINTHIAN BILIARY PALMAZ 8,908.00 1509629 WALLSTENT TRACHEOBRONCH COVERED 11,685.00 1509637 WALLSTENT TRACHEOBRONCHIAL/PERMU 10,546.00 1509645 PORTACATH 5,045.00 1509652 R-PORT PREMIER IMPLANTABLE DEVICE 5,045.00 1509660 BALLOON CATH ULTRATHIN DIAMOND 2,915.00 1509678 BALLOON CATH BLUE MAX 20 2,915.00 1509686 BALLOON CATH MARSHAL 2,915.00 1509694 BALLOON CATH RADIAL EXPANSION 2,479.00 1509702 PERCLOSE VAS DEVICE 1,681.00 1509710 VASOSEAL ES CLOSURE DEVICE 2,069.00 1509728 SP ANGIO SEAL INSERTION 4,615.00 1509736 SP ANGIOJET PUMP KIT 9,267.00 1509744 SP KYPHOPLASTY LUMBAR 41,704.00 1509751 SP INSERT DUODEN OR JEJUN TUBE 3,686.00 1509769 SP REPLACE GASTRO OR J-TUBE 3,976.00 1509785 SP CHOLANG THRU EXISTING CATH 2,935.00 1509801 VISAPAQUE 320MG/ML IODINE PER ML 2.00 1509819 OMNIPAQUE 300MG/ML I0DINE PER ML 2.00 1509827 ZILVER DRUG ELUTING STENT 80-100MM 6,285.00 1509835 SP ATHERECTOMY PERIPHERAL 18,559.00 1509850 SP KYPHOPLASTY SUPPLY KIT 41,323.00 1509868 SP KYPHOPLASTY ADD'L LEVEL 8,681.00 1509884 SP THROMBC CT ART NON SHUNT SNDY 4,566.00 1509892 SP THROMBECT VENOUS NON SHUNT P 11,150.00 1509900 SP THROMABECT VENOUS NON SHUNT A 11,150.00 1509918 SP FLUOROSCOPIC PROCEDURE INTV 1,024.00 1509934 SP ATHERECTOMY PERIPH EA ADDL 16,380.00 1509942 SP ATHERECTOMY RENAL 18,559.00 1509959 SP ATHERECTOMY VISCERAL 18,559.00 1509967 SP US GUIDANCE FOR VICERAL ACC 3,782.00 1509975 SP VENOGRAPHY SUP SAGITTAL SIN 8,921.00 1509991 SP MECH REMOVAL THRU DEVICE 984.00 1510007 SP AORTIC STENT ENDOVAS REPAIR-IP 4,359.00 1510015 SP AORTIC STENT EXTENSION 1 PER IP 2,180.00 1510023 SP THROMBECT ART NON SHUNT PRMY 11,150.00 1510031 SP THROMBECT ART NON SHUNT AD U 4,566.00 1510049 INTERVENTIONAL RADIOLOGY 9 19,500.00 1510072 SP NEPHROSTOGRAM THRU EXST CATH 1,214.00 1510080 SP DILAT OF NEPHRO TRACT-ENDOUR 7,295.00 1510098 SP GI(NG G-TUBE J-TUBE) CHECK 945.00 1510106 XR TOES LEFT 625.00 1510114 XR FINGERS LEFT 446.00 1510148 SP RF ABLATION LUMBAR 5,870.00 1510155 SP BILATERAL URETER STENT PLACEMENT 6,970.00 1510163 SP RF ABLATION THORACIC 3,400.00 1510171 SP PRESSURE WIRE 3,475.00 1510189 SP KYPHOPLASTY THORACIC/CERVICAL 41,323.00 1510197 LOW OSMOLAR CONTRAST 300-399MG/ML 2.00 1510205 SP UTERINE FIBROID EMBOLIZATION 56,855.00 1510221 SP INTRAPERITONEAL CATH PL PLEUREX 14,015.00 1510239 XR DISCOGRAM THORACIC 4,822.00 1510247 SP OFFICE CONSULTATION 719.00 1510254 SP ENDOVASC ILIAC STENT GRAFT 10,272.00 1510262 SP RFA VENOUS 5,868.00 1510270 SP RFA VENOUS ADD'L LEVEL 1,677.00 1510288 SP INJECTION THERAPY OF VEIN - 1 299.00 1510296 SP INJECTION THERAPY OF VEINS 299.00 1510304 STENT COVERED 5-9 W/DELIVERY SYS 19,475.00 1510312 STENT COVERED 10-14 W/DELIVERY SYS 14,611.00 1510320 DIAMONDBACK ATHERETOMY CATH 20,275.00 1510338 WIRE VIPER 1,165.00 1510346 CLOSER FAST RFA CATHETHER 4,049.00 1510353 PERFORATOR RFA CATH 1,957.00 1510361 HUBER POWERLOC NEEDLE 20 GX.75 36.00 1510387 PICC LINE INSERTION - OP 4,000.00 1510395 TRAY TRIPLE LUMEN PICC 304.00 1510403 TRAY DUAL LUMEN PICC 247.00 1510411 RFA ELECTRODES 17,746.00 1510429 LC BEADS CHEMO 11,819.00 1510452 SP CHEMOTHERAPY ADM ARTERIAL 653.00 1510478 SP SHUNT 2ND ACCESS 398.00 1510486 SP DECLOT OF VAS ACCESS DEVICE 1,214.00 1510494 SP IVUS CATHETER 4,875.00 1510502 US FOLLICLES LIMITED 1,056.00 1510551 US SONOHYSTEROGRAPHY (SIS) 2,448.00 1510569 US GUIDE MONITOR TISSUE ABLTN 769.00 1510577 INTERVENTIONAL RADIOLOGY US GDN 2,158.00 1510593 US FAST SCAN FOR TRAUMA 1,507.00 1510627 IVUS CORONARY OR GRAFT 4,389.00 1510643 US INTRAVASCULAR (NON-CORONARY) 961.00 1510650 IVUS ADD'L VSL 324.00 1510668 XR EXTREMITY ANGIO UNILAT-MOD 59 8,891.00 1510676 XR EXTREMITY ANGIOGRAM UNILATERAL 8,891.00 1510684 SP US COVER 33.00 1510692 SP IO BAN 51.00 1510700 SP BACK STOP 41.00 1510718 SP G TUBE 1,373.00 1510726 SP AVA MAX VERT NEEDLE 2,726.00 1510734 SP TRIPLE LUMEN 132.00 1510759 CATH YUEN CENTESIS 418.00 1510775 SP SHUNTOGRAM 595.00 1510783 SP SUBCUTANEOUS SPINE INJECTION 550.00 1510791 SP SCLEROTHERAPY FLUID COLLECTION 2,911.00 1510809 SP RFA GANGLION 1,324.00 1510817 SP REMOVAL OF ABSCESS DRAIN CATH 719.00 1510825 CYSTOGRAFIN 141MG IOD 300ML PER ML 2.00 1510833 SINOGRAFIN 380MG IOD/10ML PER ML 5.00 1510841 SP REMOVAL OF URETERAL STENT 10,144.00 1510858 SP DILAT OF BIL DUCT ST W/WO STENT 7,370.00 1510866 PTA ILIAC ARTERY ADD LEVEL 20,384.00 1510874 PTA ADD'L TIBIOPERONEAL 20,384.00 1510882 INTRAVACULAR STENT ILIAC UNILATERAL 24,475.00 1510890 INTRAVASCULAR STENT ILIAC EA ADD'L 24,475.00 1510908 INTRVSCLR STNT FMRL/POP W/WO PLASTY 24,475.00 1510916 INTRVSCLR STNT FMRL/POP&ARTHRCTMY 24,475.00 1510924 INTRVSCLR STENT TBOPRNL W/WO PLASTY 24,475.00 1510932 INTRAVASCULAR STENT TBOPRNL EA ADD 24,475.00 1510940 LOW OSMOLAR CONTRAST 300-399MG/ML 2.00 1510957 LOW OSMOLAR CONTRAST 100-199MG/ML 2.00 1510965 LOW OSMOLAR CONTRAST 200-299MG/ML 2.00 1510973 GASTROVIEW 367MG/ML PER ML 2.00 1510981 CYSTOGRAFIN 300MG/ML PER ML 2.00 1510999 XR SPINE SCOLIOSIS SUP & ERECT 1,095.00 1511005 XR ESOPHAGUS PHRYNX / OR CERVCL 1,486.00 1511013 XR PEDIATRIC CHEST CROSS TABLE 571.00 1511039 XR FLOURO FOR SPINE INJECTION 1,704.00 1511047 XR LUMBAR PUNCTURE AT BEDSIDE 2,435.00 1511054 XR RIBS UNILAT RT W CHEST PA 1,396.00 1511062 XR RIBS UNILAT LT W CHEST PA 1,396.00 1511070 INTVSCLR STN TBOPRNL&ATHRCTMY EA AD 24,475.00 1511088 ATHERECTOMY ILIAC EACH VESSEL 16,380.00 1511096 ATHRECTOMY TIB/PERONEAL W/WO PLASTY 18,559.00 1511104 ATHRCTMY ADD'L TIB/PRNL W/WO PLSTY 16,380.00 1511112 ATHERECTOMY ABDOMINAL AORTA 18,559.00 1511120 ATHERECTOMY BRACHIOCEPHALIC 18,559.00 1511138 INTRVSCLR STNT TBOPRNL&ARTHERECTOMY 24,475.00 1511146 SP SCLEROTHERAPY CYST 14,203.00 1511153 XR ABD 3 VIEWS 1,075.00 1511161 CATH PIONEER 13,975.00 1511179 COIL VASCULAR PLUG 5,039.00 1511187 BC-SCRNING MAMMO DIGITAL BILAT 489.00 1511195 BC-SCREENING IMPLANT DIGITAL BI-LAT 489.00 1511203 BC-DIAG MAMMOGRAM DIGITAL BI-LAT 935.00 1511211 BC-DIAG IMPLANT DIGITAL BILAT 935.00 1511229 BC-UNLIATERAL RIGHT DIGITAL 624.00 1511237 BC-UNILATERAL LEFT DIGITAL 624.00 1511245 BC-SPECIAL VIEWS LT DIGITAL 624.00 1511252 BC-SPECIAL VIEWS RT DIGITAL 624.00 1511302 BC DIAG MAMMO IMPLANT - LEFT 624.00 1511310 BC DIAG MAMMO IMPLANT-RIGHT 624.00 1511328 INTERVENTIONAL LOCALIZATION 1 5,856.00 1511336 INT LOCALIZATION 1 ADD'L SITE 5,856.00 1511344 INTERVENTIONAL LOCALIZATION 2 6,197.00 1511351 INT LOCALIZATION 2 ADD'L SITE 4,463.00 1511377 BC - BILATERAL SPEC VIEWS - DIGITAL 935.00 1511393 INTERVENTIONAL BIOPSY 1 8,273.00 1511401 INT BIOPSY 1 ADD'L SITE 8,273.00 1511419 US AAA SCREENING 1,508.00 1511427 BC SURGICAL SPECIMEN ULTRASOUND 606.00 1511435 BC INTERVENTIONAL RADIOLOGY 5 7,088.00 1511443 BC GUIDANCE TISSUE MARKER PLACEMENT 3,782.00 1511468 BC MRI CAD BREAST 81.00 1511476 BC GUIDANCE FOR LYMPHNODE BX 3,782.00 1511484 XR FLURO FOR PORTACATH NON RAD 789.00 1511492 XR CHEST 1V LATERAL 706.00 1511500 US EXTREMETY LIMITED 2,058.00 1511518 SP GJ TUBE INSERTION 5,072.00 1511526 XR ERCP BILIARY DUCTAL SYSTEM-OR 2,227.00 1511534 XR ERCP PANCREATIC DUCTAL SYS-OR 2,280.00 1511542 XR ERCP BILIARY&PANCREATIC-OR 3,208.00 1511559 XR ABDOMEN 1-VIEW SITZ MARKER 586.00 1511567 XR UGI TRACT W/O KUB 559.00 1511575 US LEFT THOROCENTESIS 2,475.00 1511583 XR GI(NG,G-TUBE,J-TUBE) CHECK 869.00 1511591 XR REMOVE ESOPHAGUS OBST W FLUORO 300.00 1511609 XR RIB SERIRES BILAT W CHEST PA 522.00 1511617 US TRANSPLANTED KIDNEY W DOPPLER 773.00 1511625 SP TUNNLD PERITONEAL CATH FOR DRNG 15,072.00 1511633 SP REMOVAL OF NEPH TUBE W FLUORO 3,617.00 1511641 SP RENAL UNILATERAL 2ND ORDER 13,574.00 1511658 SP RENAL BILATERAL 2ND ORDER 13,574.00 1511682 USHER CROSSER SUPPORT 2,187.00 1511690 EKKOS CATHETER 14,475.00 1511708 SP IVC FILTER REMOVAL 13,814.00 1511716 SP IVC FILTER REPOSITION 13,814.00 1511724 SP RFA LUMBAR/SACRAL EA ADDL JNT 3,400.00 1511732 SP RFA CERVICAL/THORACIC EA ADDL 1,189.00 1511757 PARACENTESIS W/O GUIDANCE 2,507.00 1511765 SP NASO OR ORO GASTRIC TUBE PL 574.00 1511773 SP INSERTION OF INDWELLING TN CATH 14,012.00 1511781 SP PERCUT CHOLECYSTOSTOMY 13,274.00 1511799 SP PERCUT CYSTOSTOMY 7,442.00 1511807 SP EMBOLIZATION OF ABSCESS/FISTULA 2,418.00 1511815 SP REMOVE&REPLACE IN/EX URT STENT 7,397.00 1511823 SP PERITONEOGRAM 1,759.00 1511831 SP INSTALL VIA CHEST/CATH PLEURODES 2,228.00 1511849 SP SECONDARY THROMBECTOMY 11,150.00 1511856 EMP CHEST IV 571.00 1511864 SP TIPS REVISION 52,665.00 1511872 SP PERINEOGRAM 1,059.00 1511880 SP BIL ENDOSCOP W BIOPSY SNG OR MLT 13,286.00 1511898 SP ABLATION RENAL TUMOR UNILAT 29,265.00 1511906 SP PLEURAL DRAINAGE W/INDWLLNG CATH 2,475.00 1511914 SP THROMBOLYSIS ARTERIAL INFUSION 4,782.00 1511922 SP THROMBOLYSIS VENOUS INFUSION 4,782.00 1511930 SP THROMBOLYSIS CONTINUED TREATMENT 10,669.00 1511948 SP THROMBOLYSIS CESSATION OF TRTMNT 10,669.00 1511955 SP CAROTID CEREBRAL INTERNAL UNILAT 22,082.00 1511963 SP VERTEBRAL SELECTIVE UNILATERAL 22,082.00 1511971 SP INTRACRANIAL BR OF CAROT OR VERT 1,070.00 1511989 SP DECLOG JEJUNOSTOMY OR OTHER TUBE 2,675.00 1511997 SP EXTREMITY ANGIO UNI W INTERVNTN 8,891.00 1512003 SP INTRO OF CATH TO URTER EPL RENAL 11,610.00 1512011 SP SELECTIVE ADDED VESSEL 4,982.00 1512029 SP VENOGRAM BILATERAL EXT 2,929.00 1512045 SP EXTREMITY ANGIO BILATERAL WI 6,360.00 1512052 FLOURO GUIDE FOR NEEDLE PLACEMENT 1,704.00 1512060 FLUORO GUIDE FOR NDLE PL NON SPINE 789.00 1512078 SP RECONSTRUCTION IMAGES SAME WS 1,061.00 1512086 SP RECONSTRUCTION IMAGES SP WK 759.00 1512102 SP VISERAL SUPRASEL ANGIO ADDTL 6,239.00 1512128 US INFANT HIPS DYNAMIC 393.00 1512136 US INFANT HIPS LIMITED STATIC 393.00 1512144 SP STENT PLCMNT INTRAV PERCUT ARTRL 51,828.00 1512151 SP ADDTNL STENT PLCMNT INTRAV PERCU 25,065.00 1512169 SP STENT PLCMNT INTRAV PRCT-VENOUS 51,828.00 1512177 SP ADDTNL STENT PLCMNT -VENOUS 25,065.00 1512185 SP EMBOLIZATION NON NEURO 56,855.00 1512193 US GUIDANCE FOR VASCULAR ACCESS 1,394.00 1512201 SP IMAGE GUIDE FL CL DRN BY CATH 7,025.00 1512227 SP POWER GLIDE INSERTION 5,092.00 1512235 SP PSEUDOANEURYSM TRT DRT PNCT 1,096.00 1512243 SP IVAS EACH ADD'L LEVEL 324.00 1512250 BC-INTERVENTIONAL LOC 3 5,856.00 1512268 BC-INTERVENTIONAL LOC 3 ADD'L SITE 5,856.00 1512276 BC-BREAST TOMO SCREENING 230.00 1512284 BC-BREAST TOMO DIAGNOSTIC UNILAT 230.00 1512292 BC-BREAST TOMO DIAGNOSTIC BILAT 230.00 1512300 BC-BREAST U/S COMPLETE RIGHT 1,274.00 1512318 BC-BREAST U/S COMPLETE LEFT 1,274.00 1512326 BC-BREAST U/S LIMITED RIGHT 1,274.00 1512334 BC-BREAST U/S LIMITED LEFT 1,274.00 1512342 BC-BREAST U/S LIMITED-BILAT 2,548.00 1512359 BC-BREAST U/S COMPLETE-BILAT 2,548.00 1512367 EMBOL PARTICLES(MICROSPHERES) 1,197.00 1512433 NEEDLE HOLDER SHORT STOP 64.00 1512466 CATHETER QUICK CROSS 4FR 5,550.00 1512656 GUIDEWIRE ANGLED ADVANTAGE 975.00 1512672 TR BAND REGULAR TERUMO 225.00 1512722 BALLOON HYPERFORM 7,120.00 1512755 BALLOON ECHELON 3,230.00 1512771 CATHETER MARKSMAN STENT 4,725.00 1512847 NAVIEN DSC 5,120.00 1512854 BALLOON HYPERGLIDE 5,815.00 1512862 CATHETER ORION 4,480.00 1512888 CATHETER CELLO BALLOON GUIDE 4,785.00 1512896 DX SLIM DELIVERY CATHETER 4,650.00 1512904 NEURON MAX DELIVERY CATHETER 1,975.00 1512912 NEURON DELIVERY CATHETER 2,975.00 1512920 REPERFUSION CATHETER 6,900.00 1512946 VELOCITY DELIVERY MICROCATHETER 4,650.00 1512979 BARE AXIOM COIL 5,500.00 1512987 AXIUM 3D COIL 7,000.00 1512995 BARE AXIUM 3D COIL 5,500.00 1513001 BARE AXIUM PRIME 3D COIL 5,500.00 1513027 CONCERTO HELIX COIL 2,975.00 1513043 COIL 400 COMPLEX EXTRA SOFT 12,500.00 1513050 COIL 400 CURVE EXTRA SOFT 10,500.00 1513068 J COIL 12,500.00 1513076 COIL 400 SOFT 12,500.00 1513084 COIL 400 STANDARD 12,500.00 1513092 AXIUM HELIX COIL 6,000.00 1513118 BARE AXIUM HELIX COIL 5,000.00 1513142 CATHETER POWERGLIDE FULL 422.50 1513159 GATEWAY PTA BALLOON 5,366.00 1513183 TARGET DETACHABLE COIL ULTRA 9,096.00 1513191 TARGET DETACHABLE COIL HELICAL 5,760.00 1513258 SYNCHRO GUIDEWIRE 2,424.00 1513282 BALLOON GUIDE CATHETER 4,375.00 1513290 TREVO PRO VUE SYSTEM 36,475.00 1513308 SOLITAIRE FR DEVICE 31,685.00 1513332 BAG-A-JET 330.00 1513423 CONNECTING TUBE HPCT8.880PFM 471.00 1513506 WIRE GLIDE 895.00 1513514 WIRE REG 0.35 482.00 1513522 EMBOL COIL .018 1,483.00 1513589 ROTATING HEMOSTATIC VALVE 958.00 1513621 GI KIT 3,191.00 1513753 STERILE DRAPE COVER 156.00 1513761 TRAY ARTERIOGRAM 993.00 1513811 SHEATH REG 658.00 1513829 SHEATH LONG 549.00 1513837 IV CATHETER QUICK 22X1 57.00 1513886 SYRINGE DISP 200MI MED-RAD 273.00 1513894 MONARCH SYRINGE IN2001 2,021.00 1513910 DEVICE TORQUE OTD-100 243.00 1513928 CATHETER PICS 501 MPIS 1,331.00 1513936 LIVER BX SET 3,011.00 1513944 INTRODUCER MPIS-501-NT 786.00 1514058 EMBOL COIL .035 1,026.00 1514231 TUNNELED DIALYSIS CATHETER 1,569.00 1514249 WIRE FILTER SPIDER 6,500.00 1514256 BALLOON REGULAR 4,038.00 1514265 STENT SELF EXPANDING 13,269.00 1514272 WIRE COIL PUSHER 16 175CM 2,156.00 1514280 IVC FILTER PERMAMENT 7,900.00 1514298 IVC FILTER REMOVABLE 7,900.00 1514306 ACUSTICK INTRODUCER SYSTEM 1,526.00 1514314 INFUSION WIRE 11,985.00 1514322 BILIARY CATH 1,755.00 1514330 INFUSION CATH 1,630.00 1514348 NEPHROSTOMY SYSTEM 8F 1,526.00 1514355 NEPH URETER INT STENT 2,516.00 1514363 GUIDEWIRE TRANSEND .014 2,479.00 1514371 GUIDEWIRE V-18 150CM 1,513.00 1514405 US POST THYROIDETOMY HEAD/NECK 2,278.00 1514413 SHEATH GUIDING SHUTTLE SELECT 648.00 1514421 CATHETER MARATHON FLOW DIR 13,585.00 1514439 TRANSEND GUIDEWIRE SOFT/PLATINUM 2,111.00 1514447 GUIDEWIRE MIRAGE 2,100.00 1514454 GUIDEWIRE AVIGO 1,935.00 1514462 SNARES 3,755.00 1514470 INTRODUCER MPSIS-NT 786.00 1514488 BALLOON SM3 OR LESS 4,881.00 1514496 SHEATH CONTRALATERAL 525.00 1514504 CATH GLIDE/SLIP 1,027.00 1514512 CATH REG NON GLIDE 551.00 1514520 ARC STROKE SUPPORT CATHETER 11,000.00 1514538 SP BONE TUMOR ABLATION 22,000.00 1514553 XR SHUNT SERIES 580.00 1514579 XR PELVIS AND HIPS 2V 590.00 1514587 XR FEMURE RIGHT 1V 590.00 1514629 XR PEDIATRIC CHEST 2V 914.00 1514926 SP CONV NEPHROSTOMY TO NEPHROURETER 2,622.00 1514934 SP ENDOLUMIN BX URETER RENAL PELVIS 7,532.00 1514942 URTERAL EMBOLIZATION OR OCCLUSION 7,532.00 1514959 SP REMOVE BILLIARY TUBE W/FLUORO 2,235.00 1514967 SP PLACE ACCESS THRU BILIARY TREE 16,690.00 1514975 SP REMOVAL CALCULUS FROM BILE OR GB 4,175.00 1515048 SP SHUNT WITH PERIPHERAL PTA 28,125.00 1515055 SP SHUNT WITH STENT INSERTION 56,850.00 1515063 SP SHUNT WITH THROMBECTOMY 28,125.00 1515071 XR FEMUR LEFT 1V 590.00 1515089 SP COILING CAROTID CEREBRL INT UNIL 22,082.00 1515112 NC - XR CR IMAGES 0.01 1515121 SP SHUNT W/THOMBECT & PERIPH PTA 56,850.00 1515139 SP SHUNT W/THROMB & PERIPH STENT 86,175.00 1515147 SP PTA OF CENTRAL DIALYSIS SECTION 7,030.00 1515154 SP STENT PLD IN CENT DIALY SEGMENT 7,030.00 1515162 SP DIALYSIS CIRCUIT EMBOLIZATION 7,030.00 1515204 MOD SEDAT-INITIAL 15MIN,< 5 YR OLD 130.00 1515212 MOD SEDAT-INITIAL 15MIN,> 5 YR OLD 70.00 1515220 MOD SEDAT-EA ADD'D 15MIN 65.00 1515238 MOD SEDAT OTHER PHY-INIT 15MIN <5YR 500.00 1515246 MOD SEDAT OTHER PHY-INIT 15MIN >5YR 410.00 1515253 MOD SEDAT OTHER PHY-EA ADD'D 15MIN 310.00 1515261 SP REM AND REP EXT ACC NEPH CATH 9,588.00 1515279 COIL TARGET ULTRA 360 10,750.00 1515287 COIL AXIUM BARE PRIME 8,975.00 1515295 PIPELINE EMBO DEVICE 71,500.00 1515311 LIFESTREAM BALLOON COVERED STENT 12,250.00 1515345 NAV 6 EMBO FILTER 8,475.00 1515352 NEURO GLUE EMBOLIC 19,635.00 1515360 KIT ONYX EMBOLIC 12,500.00 1515394 NEURO ENTERPRISE Z STENT 30,666.00 1515402 NEURO CODMAN COIL 9,998.00 1515410 STRYKER TREVO STROKE PACK 49,825.00 1515444 CATD INDIGO CATHETER 13,950.00 1515451 LANTERN MICROCATHETER 3,250.00 1515469 CATD SEPATATOR 8,400.00 1515501 VERTEBROPLASTY CEMENT 2,232.00 1515519 SP CHANGE URETERAL STENT THRU ILEAL 4,603.00 1515535 DRUG COATED BALLOON PTA CATHETER 7,000.00 1515543 BARRICADE COIL 2,085.00 1515550 ENDOCARE AMICA MICROWAVE PROBE 11,000.00 1515568 PULSE RIDER DEVICE 62,500.00 1515600 TURBO ELITE LASER CATHETER 11,200.00 1515634 XR ELBOW LT 2V(POST REDUCTION) 207.00 1515642 XR ELBOW RT 2V(POST REDUCTION) 207.00 1515659 XR ELBOW LT 2V(SURGERY ONLY) 207.00 1515667 XR ELBOW RT 2V(SURGERY ONLY) 207.00 1515675 AXIUM DETACHABLE COIL 7,000.00 1515683 XR HAND LT 2V(POST REDUCTION) 378.00 1515691 XR HAND RT 2V(POST REDUCTION) 378.00 1515709 XR HAND LT 2V(SURGERY ONLY) 378.00 1515717 XR HAND RT 2V(SURGERY ONLY) 378.00 1515733 XR SHOULDER LT 2V(POST REDUCTION) 207.00 1515741 XR SHOULDER RT 2V(POST REDUCTION) 207.00 1515758 XR SHOULDER LT 1V(SURGERY ONLY) 207.00 1515766 XR SHOULDER RT 1V(SURGERY ONLY) 207.00 1515782 XR WRIST LT 2V(POST REDUCTION) 207.00 1515790 XR WRIST RT 2V(POST REDUCTION) 207.00 1515808 XR WRIST LT 2V(SURGERY ONLY) 207.00 1515816 XR WRIST RT 2V(SURGERY ONLY) 207.00 1515832 VALIENT CAPTIVIA STENT GRAFT 53,617.00 1515840 EDURANT BIFURCATED GRAFT 33,166.00 1515857 EDURANT CONTRA LIMB GRAFT 16,542.00 1515865 EDURANT ILIAC EXTENSION GRAFT 16,542.00 1515881 EDURANT AORTIC EXTENSION GRAFT 24,855.00 1515899 APTUS ENDO ANCHOR 1,488.00 1515907 TALENT OCCLUDER 9,013.00 1515915 SENTRANT INTRO SHEATH 788.00 1515931 US SCLEROTHERAPHY FLUID COLLECTION 1,890.00 1515949 SP ANGIO W/LASER ARTHERECTOMY 49,505.00 1515956 SP ANGIO,LASER ATHER & STENT PLACEM 75,455.00 1515964 SP TIBIAL/PERO ANGIO W/LASER ATHERE 75,455.00 1515980 SP TIBIAL/PERO ANGIO LASER ATH/STEN 75,455.00 1515992 POWER LASER CATHETER 12,932.00 1515998 POD OCCLUSION DEVICE 8,950.00 1516004 POD PACKING COIL 8,950.00 1516012 NEUROFORM ATLAS STENT 36,250.00 1516020 XR ANKLE LT 2V(SURGERY ONLY) 360.00 1516038 XR ANKLE RT 2V(SURGERY ONLY) 360.00 1516046 XR ANKLE LT 2V(POST REDUCTION) 360.00 1516053 XR ANKLE RT 2V(POST REDUCTION) 360.00 1516087 XR FOOT LT 2V(SURGERY ONLY) 360.00 1516095 XR FOOT RT 2V(SURGERY ONLY) 360.00 1516103 XR FOOT LT 2V(POST REDUCTION) 607.00 1516111 XR FOOT RT 2V(POST REDUCTION) 360.00 1516129 XR KNEE LT 2V(SURGERY ONLY) 360.00 1516137 XR KNEE RT 2V(SURGERY ONLY) 360.00 1516145 XR KNEE LT 2V(POST REDUCTION) 360.00 1516152 XR KNEE RT 2V(POST REDUCTION) 360.00 1516160 XR TIBIA-FIBULA LT(SURGERY) 699.00 1516178 XR TIBIA-FIBULA RT(SURGERY) 360.00 1516186 XR TIBIA-FIBULA LT(POST REDUCTION) 360.00 1516194 XR TIBIA-FIBULA RT(POST REDUCTION) 360.00 1516228 XR KNEE LT 2V WEIGHT BEARING ONLY 360.00 1516236 XR KNEE RT 2V WEIGHT BEARING ONLY 360.00 1516244 PROTEGE CAROTID STENT 10,875.00 1516251 SPIDER EMBOLIC PROTECTION DEVICE 7,975.00 1516269 OPTIMA COIL 7,975.00 1516277 LUTONIX DRUG BALLOON .018 7,250.00 1516285 JET-7 REPERFUSION CATHETER 14,175.00 1516293 REVASCULARIZATION DEVICE 3D 26,950.00 1516301 REACT CATHETER 9,750.00 1516319 REACT CATHETER - 71 9,750.00 1516327 SNIPER OCCLUSION MICROCATHETER 6,000.00 1516335 PWR MIDLINE PROVENA 3FR SINGL LUMEN 715.00 1516343 PWR MIDLINE PROVENA 4FR SNGL LUMEN 666.00 1516350 COVERA COVERED STENT 13,250.00 1516368 VENOVO STENT 8,500.00 1516376 EMBOTRAP STOKE RETRIEVER 32,000.00 1516384 JET D ASPIRATION CATHETER 14,175.00 1516392 PRESSURE SENSING SHEATH 8FRX25CM 4,250.00 1516400 JET D REPERFUSION CATHETER 13,975.00 1516418 SWIFT NINJA MICRO CATHETER 8,000.00 1516434 XR UGI AND SMALL BOWEL FOLLOW THROU 2,909.00 1516442 SP PROSTATE ARTERY EMBOLIZATION 56,855.00 1516459 SP SELECTIVE ADDED VESSEL-XU 4,982.00 1516467 SP CHEMICAL ABLATION-SINGLE VEIN 5,868.00 1516483 VENASEAL CLOSURE SYSTEM CATHETER 9,195.00 1520063 BC US AXILLA UNILATERAL 462.00 1520071 BC US AXILLA BILATERAL 924.00 1530013 NONIN EXT ART NO EX 1,589.00 1530021 U/S GUIDED NEEDLE PLACEMENT 3,782.00 1530039 U/S GUIDED CATH INSERTION 1,394.00 1530054 DPLX CAROTID LTD 1,279.00 1530062 PSEUDO ANEURSYM INJECTION 653.00 1530070 UPPER VENOUS UNILATERAL 2,725.00 1530088 UPPER VENOUS BILATERAL 2,725.00 1530096 LOWER VENOUS UNILATERAL 2,725.00 1530104 LOWER VENOUS BILATERAL 2,725.00 1530112 ART/VEIN MAPPING DIALYSIS ACCESS 2,725.00 1550003 ICG 495.00 1550011 CHEST X-RAY POST PICC PLCMNT 571.00 1550029 CHEST PORTABLE 571.00 1550037 CHEST FLOURO 789.00 1550052 XR SPINE THORACIC 2 VIEWS 744.00 1550060 XR PELVIS COMPLETE 777.00 1550078 SPINAL DISC ASPIRATION 1,683.00 1550086 XR HIP BILAT AP 4 VIEW 1,236.00 1550094 CALCIS/HEEL LT 566.00 1550102 NEONAT(P)ABD/CHEST 1,087.00 1550110 PEDIATRIC 2VW CHEST 771.00 1550128 ESOPH BY VID 1,405.00 1550136 GI W/SM BWL 2,009.00 1550144 COLON-BE 1,691.00 1550151 CHANGE PERC CATH 2,844.00 1550169 HYPERTENSIVE IVP 1,358.00 1550177 PERICUT/NEPHROS 3,042.00 1550185 FLUID COLLECT DRAIN;IMAGE GUID 2,507.00 1550193 ABD/AOR SER 6,239.00 1550201 ABD W/RUN-OFF 6,239.00 1550219 RENAL ANGIO UNI 11,043.00 1550227 ABD/AOR/SEL 6,239.00 1550235 EXTREMITY ANGIO BIL 6,360.00 1550243 ARTERIOVENOUS SHUNT 4,209.00 1550250 ARTERIOVENOUS FISTULA 4,209.00 1550268 CATH/OCC/VCSS 9,130.00 1550276 PLASTY VENOUS VES 9,300.00 1550284 CESSATION OF THERAPY W/CATH RM 1,736.00 1550292 VENO/INF/VC 5,689.00 1550300 LYMPH COM 3,238.00 1550326 ULTRA SOUND GUIDANCE 1,394.00 1550334 ERCP C-ARM PORTABLE USE 789.00 1550342 BRONCH C-ARM PORTABLE USE 789.00 1550359 CATH TRANSLUMINAL ANGIO NON-LASER 550.00 1550367 CATH DRAINAGE 959.00 1550375 NEPH PTC CATH DRAINAGE 563.00 1550383 BIO-THOR SUP 373.00 1550391 FILTER DEVICE VENA CAVA 4,035.00 1550417 SUPPLIES ADD 54.00 1550425 SUPPLY INJEC 27.00 1550433 SUPPLIES TRAY 134.00 1550441 LOW OSMOLAR CONTRAST 300/100ML/ML 2.00 1550458 LOW OSMOLAR CONTRAST 300/50ML/ML 2.00 1550466 LOW OSMOLAR CONTRAST 300/150ML/ML 2.00 1550474 LOW OSMOLAR CONTRAST 370/50ML/ML 2.00 1550482 LOW OSMOLAR CONTRAST M-300/15ML/ML 5.00 1550490 STENT INTRO ARTERIAL 6,892.00 1550508 STENT INTRO ARTERIAL ADD 5,418.00 1550516 STENT INTRO VENOUS 5,418.00 1550524 TRANS CATH THERAPY NON THROMBO 4,556.00 1550532 CATHETER THROMBECTOMY 2,664.00 1550540 THROMBO SUP 2 4,794.00 1550557 THROMBO SUP ADD 2,398.00 1550565 CATH PICC 3,167.00 1550573 TRANS CATH FB RETRIEVAL 5,331.00 1550581 THROMBOLYTIC THERAPY SUBSEQNT 2,243.00 1550599 MIDLINE CATHETER KIT 282.00 1550607 GUIDEWIRE DIAGNOSTIC 852.00 1550615 CLOSURE DEVICE 2,048.00 1550623 SHEATH NON-GUIDE/NON-EP/NON-LASER 630.00 1555085 DIGITAL D CAD 228.00 1555093 DIGITAL S CAD 228.00 1555101 MAMMO DUCTOGRAM S 1,058.00 1555119 INJECT FOR DUCTOGRAM 629.00 1555135 MAMMO IMPLANTS 935.00 1555143 MAMMO DIAGNOSTIC 935.00 1555176 BREAST NEEDLE LOCALIZATION 1,894.00 1555184 BREAST INCIS BIO 8,236.00 1555192 MAMMOTONE SUPPLY 899.00 1555200 BREAST STEREOTACTIC BIOPSY 2,234.00 1555218 BREAST MARKER 370.00 1555226 BREAST STEREOTACTIC BIOPSY ADD 1,754.00 1555234 CLIP/WIRE PLACE W/ MAMMO 196.00 1555242 CLIP/WIRE PLACE W/ STEREO 185.00 1555259 C A D SCREENING 228.00 1555267 C A D DIAGNOSTIC 228.00 1555275 DIGITAL BREAST TOMO UNILATERAL 230.00 1555283 DIGITAL BREAST TOMO BILATERAL 230.00 1555291 SCREENING DIGITAL BREAST TOMO BIL 230.00 1560002 UNLISTED PRO 648.00 1560010 BREAST MARKER 308.00 1560028 LIVER BIOPSY 1,725.00 1560036 BIOPHYSICAL PROFILE W/STRESS 1,000.00 1560044 OB US FETAL DETAIL 1,745.00 1560051 CERV LENGTH 648.00 1560069 BREAST ULTRASOUND COMPLETE 1,274.00 1560085 ABD RETRO BIOPSY 1,725.00 1560101 BPP NON STRESS ADDITIONAL 677.00 1560119 MAMMTOME SUP 899.00 1560127 VENO/SUP/VC 6,136.00 1560135 PERCUTANEOUS CHOLECYSTOSTOMY 1,709.00 1560143 CHOLECYSTOSTOMY W/ FLUORO 6,236.00 1560150 CHANGE NEPHROS TUBE 4,219.00 1560168 INTRO CATH VENA CAVA 2,417.00 1560176 PICC REPLACEMENT 4,523.00 1560184 AAA STENTING PROCEDURE 9,246.00 1560192 VAC ASST BIOP WO CLIP 7,136.00 1560200 ABDOMEN AAA STENT PLACEMENT 4,732.00 1560218 PELVIS AAA STENT PLACEMENT 5,331.00 1560226 BONE BIOPSY PUNC 3,055.00 1560234 INTERV SUP ADDITIONAL 134.00 1560242 GASTROJEJUNOSTOMY TUBE STD 1,235.00 1590488 BC US GUIDED CORE BX 3,782.00 1595271 INTERVENTIONAL BIOPSY 2 8,714.00 1595289 INT BIOPSY 2 ADD'L SITE 6,980.00 1595297 BC INTERVENTIAL RADIOLOGY 1 1,911.00 1595305 BC INTERVENTIAL RADIOLOGY 3 4,463.00 1595313 MAM SURGICAL SPECIMEN EXAM 606.00 1595321 BC US VACUUM ASSISTED BX 3,782.00 1595347 BC GUIDANCE FLUID ASPIRATION 3,782.00 1595354 SP CAROTID CEREBRAL ANGIO UNILAT 8,169.00 1595461 PERITONEAL CATH KIT 2,729.00 1595479 BREAST ULTRASOUND LIMITED 1,274.00 1595489 MIDLINE INSERTION - OP 4,000.00 1595495 XR SPINE SCOLIOSIS 1 VIEW 282.00 1595503 US DOPPLER STUDY LMTD ART&VEN FLOW 2,000.00 1600097 PACEMAKER INSERT SGL CH 18,000.00 1600154 PTCA SINGLE VESSEL - 92920 12,579.00 1600717 LOW OSMOLAR CONTRAST 300-399MG 2.00 1600725 IMAG SUPERVISION INJECT CATH ANGIO 569.00 1600733 IMAG SUPERVISION CORONARY ANGIO 569.00 1600766 EP DEFIB THRESHOLD EVAL LEAD/GEN 3,805.00 1600774 ANGIO RENAL UNILAT SEL S&I 13,574.00 1600782 ANGIO RENAL BILAT SEL S&I 13,574.00 1600816 PTA RENAL OR VISCERAL 28,125.00 1600832 CATH STENT PLACE NON-COR 1 EA ADDL 23,480.00 1600865 RIGHT HEART CATH ONLY 19,244.00 1600873 SELECTIVE CORONARY ONLY 23,862.00 1600881 SELECTIVE CORONARY W/GRAFTS 32,757.00 1600899 SELECTIVE CORONARY W/RT HEART CATH 47,725.00 1600907 SLCTV CRNRY W/GRFTS & RT HRT CATH 45,661.00 1600915 SELECTIVE CORONARY W/LT HEART CATH 28,452.00 1600923 SELECTIVE CRNRY W/GRFTS< HRT CATH 37,345.00 1600931 SELECTIVE CORONARY W/RT< HRT CATH 52,314.00 1600949 SLCT CRNRY W/RT< HRT CTH W/GRFTS 49,361.00 1600956 LT HEART CATH W/TRASSEPTAL PUNCTUR 17,823.00 1600964 AORTIC ROOT W/93460 & 93461 569.00 1600972 MICROPUNCTURE SET 204.00 1600980 PERIVAC KIT 892.00 1600998 INTRACORONARY STENT PLCMNT NODES 44,634.00 1601004 AORTOGRAPHY INJECTION 3,496.00 1601012 ARTERIAL CONDUIT INJECTION 3,417.00 1601020 BIOPSY FORCEPS 1,627.00 1601038 BIOPSY SHEATHS 299.00 1601046 CARDIAC OUTPUT SEPARATE PROCEDURE 1,428.00 1601053 STENT PLACEMENT ADDL VSL 8,425.00 1601061 CV TRAY CHARGES 1,590.00 1601079 DIAGNOSTIC HEART CATHETERS 120.00 1601087 SHEATH 151.00 1601103 GRAFTS INJECTION 3,757.00 1601111 GUIDE WIRE 487.00 1601129 IABP INSERTION 835.00 1601145 INTRACRNRY STNT PLCMNT DES 44,634.00 1601160 LT HEART CATHETERIZATION W/LV 12,526.00 1601194 LV ANGIOGRAPHY 3,132.00 1601251 PERMANENT PACEMAKER REMOVAL 3,259.00 1601269 PERMANENT PACER INSERT ATRIAL 4,022.00 1601277 PACER INSERT DUAL CH 21,704.00 1601285 PERMANENT PACER INSERT VENTRICULR 4,022.00 1601301 PTCA ADDITIONAL VESSEL 14,609.00 1601327 PTCA BALLOON GUIDE WIRE 704.00 1601335 PTCA GUIDING CATHETER 666.00 1601343 PTCA INDEFLATORS 666.00 1601350 PTCA KITS 304.00 1601368 PULMONARY ANGIO 4,067.00 1601376 RIGHT HEART CATHETERIZATION 6,564.00 1601384 RT & LT HEART CATHETERIZATION 15,498.00 1601426 SELECTIVE CORONARY ANGIOGRAPHY 3,883.00 1601434 SWAN GANZ INSERTION 1,170.00 1601442 TEMP PACEMAKER INSERT 7,068.00 1601459 TEMP PACEMAKER WIRE 997.00 1601541 PHARM AGENT ADMIN NITRIC OXIDE 954.00 1601574 STENT CORONARY MAGIC WALL LONG 12,354.00 1601590 STENT CORONARY MAGIC WALL SHORT 8,361.00 1601616 CORONARY STENT PL EA ADD NODES 8,425.00 1601640 CANCELLED CATH LAB PROCEDURE 1,911.00 1602747 SWAN GANZ CATHETER 359.00 1602754 INTRAVAS STENT ILIAC UNILATERAL 24,475.00 1602762 INSERT BIVENT PACER GEN ONLY 23,373.00 1602770 INSERT SC PACER GEN ONLY 40,220.00 1602796 TEE WITH CONTRAST 5,942.00 1602986 ANGIO-SEAL CLOSURE DEVICE 1,757.00 1603000 PERCUTANEOUS CORONARY THROMBECTOMY 3,816.00 1603026 CORONARY THROMBECTOMY CATHETER 1,557.00 1603042 LEAD PACER T-VEIN VDD SNGL PASS 267.00 1603208 FFR HEART FLOW RESERVE MEASURE 1,447.00 1603216 EXTERNAL ELECTRICAL CARDIOVERSION 3,447.00 1603232 COR ATHER W PTCA SINGLE VESSEL 44,634.00 1603240 COR ATHER W PTCA ADD VESSELS 44,634.00 1603257 PERC ATHER W STENT DES - 92933 60,400.00 1603265 PERC ATHER W STENT NO DES 60,400.00 1603273 ATHERECTOMY W/STENT ADD'L VESSEL 22,091.00 1603281 PERC ATHER W STENT DES ADD VES 22,091.00 1603299 REVASC COR GRAFT W DES - 92937 44,634.00 1603307 REVASC COR GRAFT W NO DES 44,634.00 1603315 REVAS COR ADD GRAFT W DES - 92938 22,091.00 1603323 REVAS COR ADD GRAFT W NO DES 22,091.00 1603349 REVAS STEMI W DES - 92941 44,634.00 1603356 REVAS STEMI W NO DES 44,634.00 1603364 REVAS CTO W DES 44,634.00 1603372 REVAS CTO W NO DES 44,634.00 1603380 REVAS CTO W DES ADD VES 22,091.00 1603398 REVAS CTO W NO DES ADD VES 22,091.00 1603406 DRUG ADM & HEMODYN MEASUREMENT 954.00 1603414 L&CORS W OR W/O LV GRAM 15,224.00 1603422 L & CORS W/LV GRAM & GRAFTS 15,224.00 1603430 RHC & CORS NO LV GRAM 15,224.00 1603448 CORS W/GRAFTS NO LV GRAM 15,224.00 1603455 COR ANGIO W/O CONCMT LHRTCAT 15,224.00 1603463 RT LT HRT CTH W/LV GRM NO CORS 12,686.00 1603471 1000 ML NACL BAG FLUSH 56.00 1603489 INTRAVASC FR MSMT INIT VESSEL 5,322.00 1603497 RADI GUIDEWIRE 1,886.00 1603505 ICD GEN ONLY W/EXIST MULTI LDS 81,390.00 1603539 US GUIDANCE VASCULAR ACCESS 1,394.00 1603554 SWAN GANZ FOR MONITORING 3,056.00 1603562 RIGHT HEART CATH 14,901.00 1603588 500ML NACL BAG 45.00 1603596 EX INFLATE DEV 439.00 1603646 R/L & CORS W/LV GRAM 15,224.00 1603661 R/L & CORS W/LV GRAM & GRAFTS 15,224.00 1603687 PROGRAM EVENT RCDR/ENCOUNTER 123.00 1603703 EX 063 WIRE 309.00 1603711 EX SWAN GANZ 930.00 1603729 500 ML HEPARIN SALINE BAG 29.00 1603745 DIAG CATHETER GUIDING 852.00 1603778 CLOSURE DEVICE VAS 180.00 1603786 TR BAND 206.00 1603794 SHEATH RADIAL 191.00 1603802 EX IONIC CONTRAST 2.54 1603810 CATH TRANSLUMINAL BALLOON 2,556.00 1603828 GUIDEWIRE DIAGNOSTIC 431.00 1603836 CATH BALLOON CUTTING TRANSLUM 2,519.00 1603844 CARDIOVERSION 3,447.00 1603851 GUIDEWIRE PTCA/INTERVENTIONAL 1,458.00 1603869 LARGE BORE HEMO VALVE 154.00 1603877 DE STENT PROCEDURE 44,634.00 1603885 AORTOGRAPHY INJ (SUPRAVALVULAR) 2,663.00 1603893 SHEATH PEEL-AWAY 707.00 1603901 CATH RADIAL DIAGN OR GUIDE 334.00 1603919 BACK STOP 80.00 1603927 ADDITL VESSEL FFRM 934.00 1603935 D-STAT 817.00 1603943 IOBAN 57.00 1603950 IV CATHETER 41.00 1603968 GROUNDING/CAUTERY PAD 18.00 1603976 DELIVERY SYSTEM 668.00 1603992 MICROPUNCTURE KIT 137.00 1604008 A-LINE INITIAL 134.00 1604016 THROMBOLYSIS - IC 623.00 1604024 HOLD DEVICE 361.00 1604032 R2 PADS 29.00 1604040 SKIN STAPLER 766.00 1604057 STENT COATED/COVERED W/DELIVER 4,478.00 1604065 STENT NON COATED W/DELIVERY 8,404.00 1604073 OCCLUSION BALLOON CATHETER 3,273.00 1604081 YANKAUER SUCTION 79.00 1604099 CAUTERY PENCIL 20.00 1604107 02 MASK 65.00 1604115 1000 ML NACL POUR BOTTLE 56.00 1604123 ACT TESTING 252.00 1604131 IV TUBING 69.00 1604149 GUIDEWIRE FILTER 4,140.00 1604156 CV TRAY CHARGE 200.00 1604164 O2 CANNULA 50.00 1604172 OPSITE 63.00 1604180 CATHETER TRANSLUMINAL ROTATION 2,815.00 1604198 EX BURR 6,135.00 1604206 IVUS CATHETER 2,957.00 1604313 LEADLESS PACEMAKER INSERT/REPLACE 89,795.00 1610609 PERCLOSE VASCULAR CLOSURE DEVICE 1,648.00 1612936 AORTOGRAPHY ABDOMINAL W/ILIOFEM 6,239.00 1612944 GUIDELINER CATHETER 2,304.00 1612969 VENOGRAM UNILAT EXTREMITY 4,738.00 1612977 VENOGRAM BILATERAL EXTREMITY 2,929.00 1612993 ABDOMINAL AORTOGRAM 6,239.00 1613009 ABDOM AORTOGRAM W/RUN OF W/CC 6,239.00 1613017 ANGIOGRAPHY EXTREM UNILATERAL 8,891.00 1613025 ANGIOGRAPHY EXTREM BIALTERAL 6,360.00 1613066 VENOGRAPHY SINUS OR JUGLAR 8,921.00 1613140 ANGIO RAD S&I EA ADDL VESSEL 4,982.00 1613157 THORACIC AORTOGRAM 8,891.00 1613264 VISCERAL ANGIO S&I 6,239.00 1613306 ANGIO PULMONARY SELECT UNILATERAL 4,982.00 1613314 ANGIO PULMONARY SELECT BILATERAL 8,891.00 1613322 ANGIO PULMONARY NON-SELECTIVE 4,982.00 1613371 RENAL SELECTIVE UNILATERAL 4,738.00 1613397 STENT ARTERY RENAL 12,681.00 1613504 STENT ARTERY ADD'L (RENAL) 12,681.00 1613512 VISIPAQUE 300-399MG/ML 33.00 1613546 EP RIGHT VENTRICULAR RECORDING 19,012.00 1613553 EP MAP TACHYCARDIA ADD-ON 19,012.00 1613561 EP INTRA-ATRIAL PACING 19,012.00 1613579 EP INTRAVENTRICULAR PACING 19,012.00 1613587 EP ELECTROPHYS MAP 3D ADD-ON 19,012.00 1613595 EP ESOPHAGEAL RECORDING 19,012.00 1613603 EP ESOPHAGEAL RECORDING W/PACING 19,012.00 1613629 EP COMPREHENSIVE EP W/O INDUCTN 19,811.00 1613637 EP COMPREHENSIVE EP W INDUCTION 19,811.00 1613645 EP LA RECORDING & PACING FRM COR 19,811.00 1613652 EP LV RECORDING AND PACING 19,811.00 1613660 EP STIMULATION POST IV DRUG INF 19,012.00 1613678 EP F/U TESTING (NIPS) 19,811.00 1613686 EP EVAL PREV PLACED ICD (NIPS) 7,089.00 1613694 EP ABLATION AV NODE 27,446.00 1613702 COMP EPS W/ SVT ABLATION 67,794.00 1613710 COMP EPS W/ VT ABLATION & 3D MAP 67,794.00 1613728 TILT TABLE EVALUATION 2,971.00 1613736 TRANSEPTAL HEART CATH 21,419.00 1613744 EP EVAL OF ICD LEADS AT INT INJ 636.00 1613751 OP EVAL OF ICD LEADS AT INT INSERT 3,805.00 1613769 EP BUNDLE OF HIS RECORDING 19,012.00 1613777 EP INTRA-ATRIAL RECORDING 19,012.00 1613785 EP INTRACARDIAC ECG (ICE) 23,136.00 1613793 AFIB ABLATION (W) TRANSEPTAL 67,794.00 1613801 INTERVENTIONAL CARDIOLOGY 1 1,911.00 1613835 INTERVENTIONAL CARDIOLOGY 4 10,144.00 1613843 INTERVENTIONAL CARDIOLOGY 5 14,201.00 1613850 INSERT NEW SC PACER RA SYSTEM 26,825.00 1613868 INSERT NEW RV SC PACER SYSTEM 26,825.00 1613876 INSERT NEW DC PACER SYSTEM 26,825.00 1613918 REPLACE DC PACER GEN 23,904.00 1613926 UPGRADE PACER SC TO DC 22,623.00 1613934 REPOSITION ELECTRODE PACER/AICD 8,959.00 1613942 INSERT SINGLE ELECTRODE ANY DEV 25,984.00 1613959 INSERT TWO ELECTRODES ANY DEV 25,984.00 1613967 REPAIR SINGLE ELECTRODE ANY DEV 8,959.00 1613975 REPAIR TWO ELECTRODES ANY DEV 8,959.00 1613983 REVISE/RELOCATE POCKET - PACER 5,206.00 1613991 REVISE/RELOCATE POCKET - ICD 2,471.00 1614007 INSERT LV LEAD TO EXISTING DEVICE 18,031.00 1614015 INSERT LV LEAD TO NEW IMPLANT 18,031.00 1614031 REMOVE PACER GENERATOR 4,174.00 1614049 REMOVE LEAD FROM SC PACEMAKER 26,825.00 1614056 REMOVE LEAD FROM DC PACEMAKER 26,825.00 1614064 INSERT SC ICD GEN ONLY 26,712.00 1614072 REMOVE LEAD(S) ICD 3,673.00 1614080 INSERT NEW SC-DC ICD SYSTEM 24,876.00 1614098 REMOVE ICD GEN. ONLY SC OR DC 4,174.00 1614106 IMPLANT CARDIAC RECORDER 11,520.00 1614114 REMOVE CARDIAC RECORDER 1,536.00 1614122 REPLACE BIVENT ICD GENERATOR 53,500.00 1614130 REPLACE SC ICD GENERATOR ONLY 53,500.00 1614148 REPLACE DC ICD GENERATOR 53,500.00 1614155 INSERT DC ICD GEN ONLY 53,500.00 1614163 INSERT BIVENT ICD GEN ONLY 53,500.00 1614171 REMOVAL PACEMAKER W/REPLMT DUAL LD 47,027.00 1614189 REPLACE BIVENT PACER GEN 47,027.00 1614197 INSERT DC PACER GEN ONLY 17,697.00 1614205 REPLACE SC PACER GEN ONLY 23,904.00 1614213 FLUTTER ALBATION WITH AFIB ABL 535.00 1614221 ABLATION OF SECONDARY ARRHYTHMI 535.00 1614452 DEFLECTABLE D-TYPE CATH DECA EP 3,256.00 1614460 3EFLECTABLE D-TYPE CATH QUAD EP 2,258.00 1614478 QUAD CATH FIXED EP 799.00 1614486 1EFLEXION SPIRAL DUO-DECA EP 8,477.00 1614494 LIVEWIRE DUO-DECA LG CURVE EP 5,486.00 1614502 OPTIMA LASSO EP 8,477.00 1614510 QUAD SUPREME FIXED EP 1,695.00 1614528 DEFLECTABLE DECA EP 3,491.00 1614536 ARRAY CATHETER EP 25,614.00 1614544 NAV X SURFACE ELECTRODE KIT 8,112.00 1614551 LBL ABLATION EP 7,973.00 1614569 SAFIRE ABLATION EP 6,584.00 1614577 DECAPOLAR FIXED LSL W LUMEN EP 3,592.00 1614585 COOLPATH ABLATION EP 13,022.00 1614593 TRANSSEPTAL NEEDLE EP 2,049.00 1614601 AGILIS NXT INTRODUCER EP 8,531.00 1614619 TRANSSEPTAL SHEATH INTRODUCER EP 1,538.00 1614627 ABL LIVEWIRE TC LG 7FR 4MM TIP 5,078.00 1614635 BW HEX D CRV 6FR 222 4,236.00 1614643 BW HEX FIX 6FR 222 1,793.00 1614668 INTRO SEPT 8FR 1,592.00 1614676 INTRO SAFL 8FR 60CM 1,437.00 1614684 TRIO INTRO 12FR 320.00 1614692 INTRO RAMP 8FR 60CM 1,397.00 1614700 DECA LIVEWIRE MED 3,445.00 1614718 DECA LIVEWIRE XL 3,445.00 1614726 DECA CSL 6FR 282 2,866.00 1614734 DECA CSL 7 FR 120CM 2,902.00 1614742 ABL COOLPATH BR MD 11,838.00 1614759 ABL COOLPATH BR XL 11,838.00 1614767 ABL COOLPATH BD LG 11,838.00 1614775 DUPLEX SCAN EXTREMITY VEINS LMT 1,430.00 1614783 ATTAIN VENO BALLOON 908.00 1614791 WHISPER EDS WIRE 1,087.00 1614809 WHOLEY WIRE 175CM 761.00 1614817 WRENCH KIT PACER 350.00 1614825 WORLEY GUIDE CSG 1,260.00 1614833 COPILOT 381.00 1614841 SAFE SHEATH 567.00 1614858 ATTAIN SELECT 1,476.00 1614874 CATH VENTURE 5,045.00 1614882 CATH TORNUS 963.00 1614890 CATH TWIN PASS 2,329.00 1614908 BENT TIP RETREVAL CATH 582.00 1614916 MICROSNARE 4,346.00 1614924 PACER INTEGRATION IN PERSON 305.00 1614932 PACER EVAL 276.00 1614940 PACEMAKER PROGRAMMING SINGLE CH 438.00 1614957 PACEMAKER PROGRAMMING DUAL CHAMB 580.00 1615079 COMPLETE ECHOCARDIOGRAM 3,740.00 1615145 HOLTER MONITOR SCANNING 1,486.00 1615152 HOLTER MONITOR HOOKUP 1,479.00 1615194 CW NUC ISOTOPE PHARMACOLOGICAL 2,035.00 1615202 STRESS TEST 2,006.00 1615269 IVUS CATHETER 4,875.00 1615277 PRESSURE WIRE 3,718.00 1615285 US INTRAVASCULAR CORONARY VESSEL 642.00 1615293 US INTRAVASCULAR EA ADD'L VESSEL 250.00 1615335 VENOUS ABLATION CLOSURE SURGERY 11,556.00 1615343 BW DECA F-CURVE UNIDIR 858.00 1615350 CARTO REF PATCH 2,060.00 1615368 BW ABL THERMO F-CURVE UNIDIR 13,720.00 1615376 BW LASSO D-CURVE ECO 4,410.00 1615384 COOLFLOW TUBING 440.00 1615392 INTRO CATH AORTA 3,657.00 1615400 CATH PLACEMENT 1ST ORDER VESSEL 6,106.00 1615418 CATH PLACE 2ND ORDER VESSEL 4,607.00 1615426 CATH PLACE 3RD ORDER VESSEL 4,607.00 1615434 CATH PLACEMENT ADD'L VESSEL 3,797.00 1615442 ANGIO RENAL UNILAT 4,606.00 1615459 ANGIO RENAL BILAT 4,766.00 1615467 PTA VENOUS 8,437.00 1615475 PTA ILIAC UNILATERAL 7,155.00 1615483 PTA ILIAC ADD'L VESSEL 2,471.00 1615491 PTA FEMORAL POPLITEAL 6,678.00 1615509 PTA TIBIAL/PERONEAL 15,125.00 1615517 PTA TIBIAL/PERONEAL ADD'L VESSEL 2,471.00 1615525 PTA AORTIC 7,981.00 1615533 PTA BRACHIOCEPHALIC 11,448.00 1615541 STENT ILIAC ARTERY UNILATERAL 39,505.00 1615558 STENT ILIAC ARTERY ADD'L VESSEL 2,471.00 1615566 STENT FEM/POP UNILATERAL 39,505.00 1615574 STENT TIBIAL/PERONEAL UNILATERAL 60,918.00 1615582 STENT TIB/PERONEAL ADD'L VESSEL 2,471.00 1615590 ATH STENT FEM/POP 60,918.00 1615608 ATH STENT TIB/PERONEAL 60,918.00 1615616 ATH STENT TIB/PERONEAL ADD'L VESSEL 2,471.00 1615624 ATH RENAL S&I 5,009.00 1615632 ATH VISCERAL S&I 5,009.00 1615640 ATH AROTIC 15,419.00 1615657 ATH ILIAC 7,513.00 1615665 ATHRECTOMY FEMORAL POPLIT 11,130.00 1615673 ATH TIBIOPERONEAL 10,685.00 1615681 REVASCULARIZATION EACH ADD'L VESSEL 2,471.00 1615699 CARDIOVERSION - INTERNAL 3,447.00 1615715 INFUSION CATHETER 2,800.00 1615723 INTRA AORTIC BALLOON 3,395.00 1615731 INTRA NEEDLE/INTRACATH AORTA 320.00 1615749 PERICARDIOCENTESIS-INITIAL 1,715.00 1615756 BI-V PACEMAKER INSERTION(INC RA/RV) 23,373.00 1615764 LEAD REPOSITION RA OR RV 4,091.00 1615772 LEAD INSERT/ONE PCR OR ICD 11,165.00 1615780 LEAD INSERT/TWO PCR OR ICD 12,188.00 1615798 PACEMAKER POCKET RELOCATE 2,471.00 1615806 LEAD REPOSITION LV 4,091.00 1615814 LEAD REMOVAL(ONE) 3,673.00 1615822 LEAD REMOVAL(TWO) 4,885.00 1615830 REMOVE/REPLACE ICD GEN(DUAL) 23,904.00 1615848 INTRO NEEDLE/INTRACATH ARTERY 2,965.00 1615855 ATHERECTOMY 44,636.00 1615863 ATHERECTOMY ADDL VSL 44,636.00 1615871 ATHERECTOMY W/STENT ADD'L VSL 22,091.00 1615889 REVASC CTO ADDL VSL 22,091.00 1615897 THROMBOLYSIS-INTRAVENOUS 623.00 1615905 PERICARDIOCENTESIS-SUBSEQUENT 1,715.00 1615913 IVUS NON-CORONARY 4,389.00 1615921 IVUS NON-CORONARY ADDL VSL 324.00 1615939 ABDOM AORTOGRAM W/RUN OFF INDEPENT 6,239.00 1615947 INTRA CORONARY BM STENT PLACEMENT 44,634.00 1615954 INTRA CORONARY BM STENT PLAC EA ADD 8,425.00 1615962 SP VENOPLASTY INITIAL VEIN 28,125.00 1615970 CATH DRUG COATED BALLOON 5,215.00 1615988 CATH ATHERECTOMY 12,110.00 1615996 EPICARDIAL LEAD 3,325.00 1616002 PERC DRUG ELUTING CORONARY STENT 48,140.00 1616010 AQUACEL DRESSING 99.85 1616028 PICO WOUND DRESSING ANY SIZE 681.00 1616036 FLEX STRIP 648.00 1616044 CANNISTER ANY SIZE 366.00 1616051 ALLY ADAPTER DRAPE 375.00 1616069 TRACH KIT ALL SIZES 900.00 1616168 CW-DOBUTAMINE CARDIOLITE STRESS TES 2,035.00 1616176 ELECTIVE CARDIOVERSION EXTERNAL 2,557.00 1616192 RICORS W/GRAFTS 15,224.00 1616200 ANTIBACTERIAL ENVELOPE 4,007.00 1616475 SP CHEMICAL ABLATION-MULTIPLE VEIN 5,868.00 1700558 DNY FOLLOW-UP COMPLEX 999.00 1701242 DNY FOLLOW-UP INTERMEDIATE 719.00 1701259 DNY FOLLOW-UP COMPREHENSIVE 897.00 1701317 DNY FOLLOW-UP SIMPLE 511.00 1701598 DNY CONSULTATION 2 1,034.00 1702000 DNY CONSULTATION 1 1,426.00 1800010 CT HEAD W/C 15 SL 4,770.00 1800051 CT SPINE LUMB 3LVL W/O 3,871.00 1800069 CT SPINE THOR 3LVL W/O 3,947.00 1800077 CT SPINE CERV 3LVL W/O 3,760.00 1800085 CT CHEST WITH IV CONTRAST 4,930.00 1800093 CT ORBITS W/O CONTRAST MEDIA 3,417.00 1800119 CT ORBITS WITH CONTRAST 3,797.00 1800135 CT TEMPORAL BONELIC W/O 3,417.00 1800143 CT GUIDE FOR NEEDLE PLACEMENT 4,643.00 1800168 CT RT LOWER EXTREMITY W/O CONTRAST 5,514.00 1800226 CT HEAD NO CONTRAST 15SL 4,575.00 1800234 CT HEAD W/WO CONT 4,979.00 1800259 CT TEMPORAL BONE NO IV CONTRAST 3,417.00 1800267 MRI TEMPOROMANDIBULAR JOINT 5,818.00 1800291 CT SELLA/PITUITRY W/O 3,417.00 1800317 CT SINUSES W/O 3,601.00 1800325 CT FACIAL BONES W/O 3,601.00 1800341 MRI ORBIT W/O CONTRAST 4,452.00 1800366 MRI NECK W/O CONTRAST 4,452.00 1800374 MRI HEAD W/O CONT 7,784.00 1800382 MRI HEAD W/CONTRAST 8,268.00 1800408 MRI CHEST W/O CONTRAST 4,644.00 1800416 CT COR SAG OBC AND OR RECONSTR 1,061.00 1800432 MRI LUMBAR SPINE W/O CONTRAST 7,738.00 1800440 MRI CERVICAL SPINE W/O CONT 7,875.00 1800457 MRI CERVICAL SPINE W/CONTRAST 9,572.00 1800465 MRI THORACIC SPINE W/O CONTRAS 6,131.00 1800481 MRI LUMBAR SPINE W/CONTRAST 9,572.00 1800515 CT RT UPPER EXT W/O CONTRAST 5,290.00 1800523 CT RT UPPER EXT W/W/O CONTRAST 5,290.00 1800531 CT RT UPPER EXT W/CONTRAST 5,290.00 1800549 MRI RT UPPER EXT NO JOINT WO&W 9,668.00 1800564 CT RT LOW EXT W/CONTRAST 5,514.00 1800572 CT RT LOW EXT W&W/O CONTRAST 5,514.00 1800606 MRI ABDOMEN W/O CONTRAST 5,806.00 1800622 CT PELVIS 30 SL W/CONTRAST 4,070.00 1800630 CT NECK NO CONTRAST 3,556.00 1800655 CT NECK WITH IV CONTRAST 3,816.00 1800663 CT GUIDE CYST ASPIRATION 4,643.00 1800705 CT ABDOMEN NO IV CONTRAST 4,463.00 1800713 CT ABDOMEN W/O & W IV CONTRAST 5,108.00 1800804 CT ABD WITH IV CONTRAST 4,695.00 1800812 CT PELVIS W/O 3,943.00 1800820 CT CHEST NO IV CONTRAST 4,698.00 1800838 CT NEEDLE LOCALIZATION 4,643.00 1800853 CT PERCUT ABCESS DRAIN WITH CATH 6,236.00 1800861 CT FACIAL BONES W/CONTRAST 3,879.00 1800879 CT FACIAL BONES W&WO CONTRAST 5,593.00 1800895 CT VERTEBROPLASTY UNDER CT 1,906.00 1800903 CT CHEST W/O & W CONTRAST 4,965.00 1800929 CT SPINE LUMB W/CONTRAST 4,304.00 1800937 CT SPINE LUMB W/O & W CONTRAST 6,437.00 1800978 CT ANGIO HEAD W/WO IV CNTRST VIZ 4,831.00 1800986 CT LUNG SCREENING-LDCT 4,000.00 1800994 CT ANGIOGRAPHY NECK W/O & W CONT 4,728.00 1801000 CT ANGIOGRAPHY CHEST W/O & W CONT 5,024.00 1801018 CT ANGIOGRAPHY LWR EXT W/O& W CONT 4,591.00 1801026 CT ANGIOGRAPHY HEAD W/O & W CONT 4,831.00 1801034 CT ANGIOGRAPHY ABD W/O & W CONT 4,732.00 1801042 ABDOMINAL ILIO-FEMORAL ANGIO 5,882.00 1801059 CT ANGIOGRAPHY PELVIS W/O & W CONT 5,331.00 1801067 CT ANGIO LEFT UPR EXT W/O & W CONT 4,407.00 1801075 CT PELVIS W/O & W CONTRAST 4,349.00 1801083 CT NECK W & W/O CONTRAST 4,170.00 1801091 CT ORBIT W & W/O CONTRAST 5,593.00 1801109 CT SPINE CERV W/CONTRAST 4,556.00 1801117 CT SPINE CERV W&W/O CONTRAST 6,437.00 1801125 CT SPINE THORACIC W/CONTRAST 4,304.00 1801133 CT SPINE THORACIC W/O & W CONTRAST 6,437.00 1801141 CT SINUS W/CONTRAST 3,879.00 1801158 CT LOWER EXTREMITY W/O CONTRAST 5,514.00 1801166 CT LOWER EXT W&WO CONTRAST 5,514.00 1801174 CT LOWER EXT W/CONTRAST 5,514.00 1801182 CT GUIDANCE FOR TISSUE ABLATION 783.00 1801257 CT LT UPPER EXT W/O&W CONTRAST 5,290.00 1801265 CT LT UPPER EXT W/O CONTRAST 5,290.00 1801273 CT UPPER EXT W/CONTRAST 5,290.00 1801315 CT RECONSTRUCT ON SEP WORKSTATN 759.00 1801323 CT H W/O CON 4,575.00 1801331 CT TEMPORAL BONE WITH IV CONTRAST 3,797.00 1801349 CT SINUS W/WO 5,593.00 1801356 CT TEMPOROMANDIBULAR JOINT W*WO 5,593.00 1801364 CT TEMPOROMANDIBULAR JOINT W CNT 3,879.00 1801372 CT CHEST W/O CON HIGH RES 4,698.00 1801398 CT SACROILIAC JOINT NO CONT 3,943.00 1801406 CT THORACOLUMBAR SPINE NO CONT 3,871.00 1801430 LOW OSMOLAR CONT 300-399MG P/ML 2.00 1801448 LOW OSMOLAR CONTRAST 300-399MG P/ML 2.00 1801455 GASTROVIEW 367 MG/ML PER ML 2.00 1801463 CT LEFT SHOULDER NO IV CONT 5,290.00 1801471 CT LEFT SHOULDER WO/W IV CONT 5,290.00 1801489 CT LEFT SHOULDER WITH IV CONT 5,290.00 1801497 CT RIGHT SHOULDER NO IV CONT 5,290.00 1801505 CT RIGHT SHOULDER WO/W IV CONT 5,290.00 1801513 CT RIGHT SHOULDER WITH IV CONT 5,290.00 1801521 CT LEFT HIP NO IV CONT 5,514.00 1801539 CT LEFT HIP WO/W IV CONT 5,514.00 1801547 CT LEFT HIP WITH IV CONT 5,514.00 1801554 3T LEFT ANKLE NO IV CONT 5,514.00 1801562 CT LEFT ANKLE WO/W IV CONT 5,514.00 1801588 CT LEFT KNEE NO IV CONT 5,514.00 1801596 CT LEFT KNEE WO/W IV CONT 5,514.00 1801604 CT LEFT KNEE WITH IV CONT 5,514.00 1801612 CT LEFT FOOT NO IV CONT 5,514.00 1801620 CT LEFT FOOT WO/W IV CONT 5,514.00 1801638 CT LEFT FOOT WITH IV CONT 4,771.00 1801646 CT RIGHT HIP NO IV CONT 5,514.00 1801653 CT RIGHT HIP WO/W IV CONT 5,514.00 1801661 CT RIGHT HIP WITH IV CONT 5,514.00 1801679 CT RIGHT KNEE NO IV CONT 5,514.00 1801687 CT RIGHT KNEE WO/W IV CONT 5,514.00 1801695 CT RIGHT KNEE WITH IV CONT 5,514.00 1801703 CT RIGHT ANKLE NO IV CONT 5,514.00 1801711 CT RIGHT ANKLE WO/W IV CONT 5,514.00 1801737 CT RIGHT FOOT NO IV CONT 5,514.00 1801794 CT RIGHT FOOT WO/W IV CONT 5,514.00 1801802 CT RIGHT FOOT WITH IV CONT 4,771.00 1801810 CTLOW EXT (BOTH)WITH IV CONTRAST 5,514.00 1801836 CT TEMPORAL BONE W/WO IV CONTRAST 5,593.00 1801851 CT HEART WITH IV CONT (CHD) 6,564.00 1801869 CT ANGIO HRT W/WO IV CON (CRN ART) 6,564.00 1801893 CT HEART NO IV CONTRAST (COR CA) 6,564.00 1801901 CT HEART WITH IV CONTRAST (PULUN) 6,564.00 1801935 CT CEREBRAL PERFUSION WITH CONTRAST 5,697.00 1801943 CT ABD/PELVIS W/WO CONT (UROGRAM) 9,246.00 1801950 CT ABDOMEN/PELVIS WC (ENTEROGRAPHY) 8,406.00 1801984 CTA ABD-PELVIS W/WO IV CONTRAST 9,246.00 1801992 CT SACROILIAC INJECTION 4,157.00 1802008 CT ANGIO RIGHT UPR EXT W/O & W CONT 4,407.00 1802016 CT GUIDE FOR RENAL TISSUE ABLATION 783.00 1802024 CT THORACOLUMBAR SPINE W CONTRAST 4,304.00 1802057 CT ANGIO CHEST W/WO IV CNTRST AORTA 5,024.00 1802065 CT LEFT UPPER EXT ARTHROGRAM W/C 5,290.00 1802073 CT RIGHT LOWER EXT ARTHROGRAM W/C 5,514.00 1802081 CT LEFT LOWER EXT ARTHROGRAM W/C 5,514.00 1802123 CT RIGHT THORACENTESIS 2,787.00 1802131 CT LEFT THORACENTESIS 2,787.00 1802149 CT RIGHT UPPER EXT ARTHROGRAM W/C 5,290.00 1802156 CT CHEST NO IV CONT(INIT LDCT(NCCN) 4,000.00 1802164 CT CHEST NO IV CONT(SUBSEQ LDCT NCC 4,000.00 1802172 CT CHEST NO IV CONT(NOD F/U LDCT NC 4,000.00 1802180 CT VENOGRAM ABD/PELVIS W/IV CONT 9,246.00 1802198 CT VENOGRAM LOWER EXT W/IV CONTRAST 4,591.00 1802354 MRA CHEST WO/W CONTRAST 9,668.00 1802362 MRA ABDOMEN WO/W CONTRAST 9,572.00 1802370 MRA PELVIS W/WO CONTRAST 9,668.00 1802388 MRA RT UPPER EXT W/WO CONTRAS 9,668.00 1802404 MRA HEAD W/O CONTRAST 7,657.00 1802412 MRA HEAD W/CONTRAST 7,950.00 1802420 MRA HEAD W/WO CONTRAST 9,572.00 1802438 MRA NECK W/O CONTRAST 9,572.00 1802453 MRA NECK W/WO CONTRAST 9,572.00 1802479 MRA RT LOWER EXT W/CONTRAST 9,668.00 1802487 MRA ABDOMEN W/CONTRAST 9,572.00 1802495 MRA ABDOMEN W/O CONTRAST 9,572.00 1802503 MRI HEAD W&W/O CONTRAST 8,656.00 1802511 MRI LUMBAR SPINE WO/W CONTRAST 8,357.00 1802529 MRI THORACIC SPINE WO/W CONTRAST 8,285.00 1802537 MRI PELVIS WO/W CONTRAST 8,565.00 1802545 MRI CERVICAL SPINE WO/W CONTRAST 8,687.00 1802578 MRI ABD WO/W CONTRAST 8,178.00 1802586 MRI PELVIS W/O CONTRAST 5,465.00 1802594 MRI CHEST WO/W CONTRAST 9,668.00 1802602 MRI RT SHOULDER W/O CONTRAST 9,668.00 1802628 MRI RT SHOULDER W/O&W CONTRAST 9,668.00 1802636 MRI FACE W/O CONTRAST 4,452.00 1802651 MRI FACE W/O & W 8,151.00 1802669 MRI NECK W/O & W 8,151.00 1802693 MRI ORBIT W/O & W 8,151.00 1802735 MRI RT UPPER EXT ANY JNT W/O&W 9,668.00 1802792 BC MRI RT BRST UNILAT W/O &W CNTRT 9,572.00 1802800 BC MRI BREAST BILAT WO&W CONTRAST 6,995.00 1802826 MRI PROSTATE NO IV CONTRAST 5,465.00 1802834 MRI PROSTATE W/W/O IV CONTRAST 8,565.00 1802842 MRI LT SHOULDER W/O CONTRAST 9,668.00 1802867 MRI LT SHOULDER W/O & W CONTRAST 9,668.00 1802875 MRI CARD F/MORPHOLOGY & FNCTN W/WO 3,111.00 1802933 BC MRI BREAST BILATERAL WO/C 9,572.00 1802941 BC MRI LT BREAST UNILAT WO CONTRAST 9,572.00 1802958 BC MRI RT BREAST UNILAT WO CNTRST 9,572.00 1802974 BC MRI LT BREAST UNILAT WO&W CNTRST 9,572.00 1802982 MRA PELVIS W/O CONTRAST 9,668.00 1802990 MRA PELVIS W/WO IV CONTRAST 9,668.00 1803006 MRA CHEST W/O CONTRAST 9,668.00 1803014 MRA CHEST W/CONTRAST 9,668.00 1803055 MRA LT UPPER EXT W/WO CONTRAST 9,668.00 1803162 MRI LT UPPER EXT NO JOIMT W/O&W 9,668.00 1803188 GADOLINIUM PER ML 30.00 1803279 MRV ABDOMEN W/WO IV CONSTRAST 9,572.00 1803287 MRV PELVIS W/WO IV CONTRAST 9,668.00 1803295 MRI & MRCP ABDOMEN NO IV CONTRAST 5,806.00 1803303 MRV HEAD W/O CONTRAST 7,657.00 1803311 MRI RECONSTRUCTION IMAGES SAME WS 1,061.00 1803329 MRV HEAD WITH IV CONTRAST 7,950.00 1803337 MRV HEAD WO&W IV CONTRAST 9,572.00 1803345 MRI SPECTROSCOPY 9,572.00 1803410 MRI RECONSTRUCTION IMAGES SP WS 759.00 1803444 MRI LEFT ANKLE WO/W IV CONTRAST 9,668.00 1803469 MRI LEFT KNEE NO IV CONTRAST 9,668.00 1803477 NRI LEFT ANKLE NO IV CONTRAST 9,668.00 1803493 MRI LEFT HIP NO IV CONTRAST 9,668.00 1803501 MRI LEFT HIP W/WO IV CONTRAST 9,668.00 1803527 MRI LEFT FOOT NO IV CONTRAST 9,668.00 1803535 MRI LEFT FOOT WO/W IV CONTRAST 9,668.00 1803550 MRI LEFT THIGH NO IV CONTRAST 9,668.00 1803568 MRI LEFT THIGH WO/W IV CONTRAST 9,668.00 1803584 MRI LEFT CALF NO IV CONTRAST 9,668.00 1803592 MRI LEFT CALF WO/W IV CONTRAST 9,668.00 1803618 MRI LEFT ELBOW NO IV CONTRAST 9,668.00 1803626 MRI LEFT ELBOW WO/W CONTRAST 9,668.00 1803642 MRI LEFT WRIST NO IV CONTRAST 9,668.00 1803659 MRI LEFT WRIST WO/W IV CONTRAST 9,668.00 1803667 MRI LEFT WRIST WITH IV CONTRAST 9,668.00 1803675 MRI LEFT HAND NO IV CONTRAST 9,668.00 1803683 MRI LEFT HAND WO/W IV CONTRAST 9,668.00 1803709 MRI LEFT HUMERUS NO IV CONTRAST 9,668.00 1803717 MRI LEFT HUMERUS WO/W IV CONTRAST 9,668.00 1803733 MRI LEFT FOREARM NO IV CONTRAST 9,668.00 1803741 MRI LEFT FOREARM WO/W IV CONTRAST 9,668.00 1803766 MRI RIGHT ANKLE NO IV CONTRAST 9,668.00 1803774 MRI RIGHT ANKLE WO/W IV CONTRAST 9,668.00 1803790 MRI RIGHT KNEE NO IV CONTRAST 9,668.00 1803808 MRI RIGHT KNEE WO/W IV CONTRAST 9,668.00 1803818 MRI LEFT KNEE WO/W CONTRAST 9,668.00 1803824 MRI RIGHT HIP NO IV CONTRAST 9,668.00 1803832 MRI RIGHT HIP WO/W IV CONTRAST 9,668.00 1803857 MRI RIGHT FOOT NO IV CONTRAST 9,668.00 1803865 MRI RIGHT FOOT WO/W IV CONTRAST 9,668.00 1803881 MRI RIGHT THIGH NO IV CONTRAST 9,668.00 1803899 MRI RIGHT THIGH WO/W IV CONTRAST 9,668.00 1803915 MRI RIGHT CALF NO IV CONTRAST 9,668.00 1803923 MRI RIGHT CALF WO/W IV CONTRAST 9,668.00 1803949 MRI RIGHT ELBOW NO IV CONTRAST 9,668.00 1803956 MRI RIGHT ELBOW WO/W IV CONTRAST 9,668.00 1803972 MRI RIGHT WRIST NO IV CONTRAST 9,668.00 1803980 MRI RIGHT WRIST WO/W IV CONTRAST 9,668.00 1804004 MRI RIGHT HAND NO IV CONTRAST 9,668.00 1804012 MRI RIGHT HAND WO/W IV CONTRAST 9,668.00 1804038 MRI RIGHT HUMERUS NO IV CONTRAST 9,668.00 1804046 MRI RIGHT HUMERUS WO/W IV CONTRAST 9,668.00 1804061 MRI RIGHT FOREARM NO IV CONTRAST 9,668.00 1804079 MRI RIGHT FOREARM WO/W IV CONTRAST 9,668.00 1804095 MRA LOWER EXTREMITY BILAT W/WO 9,668.00 1804103 MRI INTERVENTIONAL RADIOLOGY 1 1,623.00 1804111 BC MRI INTERVENTIONAL RADIOLOGY 2 1,834.00 1804129 MRI PITUITARY WO/W IV CONTRAST 8,656.00 1804137 MRI PITUITARY NO IV CONTRAST 7,784.00 1804145 MRI IAC WO/W IV CONTRAST 8,656.00 1804152 MRI IAC NO IV CONTRAST 7,784.00 1804228 CT BONE LENGTH 892.00 1804269 MRI SINUS NO IV CONTRAST 4,452.00 1804277 MRI SINUS WO/W IV CONTRAST 8,151.00 1804285 MRI LOWER EXT NO JOINT W/O&W CONT 9,668.00 1804293 MRI LOWER EXT NO JOINT NO CONTR 9,668.00 1804301 MRI & MRCP ABDOMEN W/WO IV CONTRAST 8,178.00 1804335 CT ABD & PELVIS NO IV CONTRAST 8,268.00 1804343 CT ABD & PELVIS WITH IV CONTRAST 8,406.00 1804350 CT ABD&PELVIS W/WO IV CONTRAST 9,246.00 1804376 MRV RT UPPER EXTRMTY W/WO IV CONTRS 6,995.00 1804384 MRV LT UPPER EXTRMTY W/WO IV CONTR 6,995.00 1804426 MRI TMJ WITH CONTRAST PER PROTOCOL 5,818.00 1804434 MRV BILAT LOWER EXTREMITY W/WO 9,668.00 1804459 MRI AND MRCP SS ABDOMEN NO IV CON 6,995.00 1804491 MRI HEAD AND IAC W/WO IV CONT 8,656.00 1804509 MRI HEAD AND IAC NO IV CONTRAST 7,784.00 1804517 MRI RIGHT ELBOW ARTHROGRAM W/C 9,668.00 1804525 MRI LEFT ELBOW ARTHROGRAM W/CON 9,668.00 1804533 MRI RIGHT SHOULDER ANTHROGRAM W/C 9,668.00 1804541 MRI LEFT SHOULDER ARTHROGRAM W/C 9,668.00 1804558 MRI RIGHT HIP ARTHROGRAM W/CONT 9,668.00 1804566 MRI LEFT HIP ARTHROGRAM W/CON 9,668.00 1804574 MRI RIGHT KNEE ARTHROGRAM W/C 9,668.00 1804582 MRI LEFT KNEE ARTHROGRAM W/CONT 9,668.00 1804590 MRI RIGHT ANKLE ARHTROGRAM W/C 9,668.00 1804608 MRI LEFT ANKLE ARTHROGRAM W/C 9,668.00 1804616 MRI CARDIAC FOR MORPHOLOGY&FUN W/WO 9,572.00 1804624 MRI RIGHT WRIST ARTHROGRAM W/CON 9,668.00 1804632 MRI LEFT WRIST ARTHROGRAM W/CON 9,668.00 1804640 MRI HEAD & PITUITARY W/WO IV CNTRST 8,656.00 1804657 MRI HEAD & PITUITARY NO IV CNTRST 7,784.00 1804665 MRI HEAD & CSF FLOW NO IV CONT 7,784.00 1804673 MRI HEAD & CSF FLOW W/WO IV CON 8,656.00 1804681 MRI CSF FLOW STUDY NO IV CONT 7,784.00 1804707 MRI BREAST CORE BIOPSY 6,353.00 1804715 MRI BREAST CORE BIOPSY EA ADD'L 3,457.00 1804723 MRI NEEDLE LOCALIZATION 4,729.00 1804731 MRI NEEDLE LOCALIZATION EA ADD'L 1,834.00 1804749 MRI SACRUM NO IV CONTRAST 6,995.00 1804756 MRI SACRUM W/WO IV CONTRAST 6,995.00 1804764 MRI CLAVICLE NO IV CONTRAST-RT 6,995.00 1804772 MRI CLAVICLE W/WO IV CONTRAST-RT 6,995.00 1804780 MRI CSF FLOW STUDY W/WO IV CONT 8,656.00 1804798 MRI CLAVICLE NO IV CONTRAST-LT 6,995.00 1804814 CT CHEST NO IV CONTRAST (LDCT) 4,000.00 1804822 CT IMAGE GUIDE FL CL DRN BY CATH 7,025.00 1804863 MRI THORACIC WITH CONTRAST 6,995.00 1804897 MRI CLAVICLE W/WO CONTRAST-LT 6,995.00 1804939 MRV NECK W/WO IV CONTRAST 6,995.00 1805001 CTA HEART W/WO IV CONTRAST - TAVR 6,564.00 1805019 CTA HEART W/WO IV CONTRAST - TAVR 6,564.00 1860006 LOWER EXT NONJOINT W&W/O CON 8,052.00 1860014 MRA UP EXT W CON 9,668.00 1860016 MRI LOW EXT ANY JOINT W/WO CONTR 9,668.00 1860030 GADOLINIUM 10ML/ML 19.00 1860048 BRAIN W/O & W CONTRAST 8,656.00 1860055 LW EX NO JNT 9,668.00 1860063 UPPER EXTREM JOINT WO/W CONTRAST 9,668.00 1860071 LOW EXT JOINT W/O 9,668.00 1860089 UPPER EXT JOINT WO/W CONTRAST 9,668.00 1860097 UPPER EXT W/WO 9,668.00 1860113 MRI UP EXT NO JNT 9,668.00 1860121 MRA NECK W/CONTRAST 7,789.00 1860139 ENDO REC COIL 431.00 1860147 POWER INJECTOR SUPPLY 94.00 1860154 GADOLINIUM 5ML/ML 19.00 1860162 LOWER EXT W/WO 8,052.00 1860170 ORBIT FACE NECK W/GADOLINIUM 4,770.00 1860188 MRI ORBIT FACE NECK W/O CONTRAST 4,452.00 1860196 BREAST W/O & W CONTRAST UNILAT 3,606.00 1860204 BRAIN NO CONTRAST 7,784.00 1860212 MRI CHEST W/CONTRAST 9,668.00 1860220 MRI ORBIT/FACE/NECK W&W/O CONT 8,151.00 1860238 UPPER EXT JOINT W/CONTRAST 9,668.00 1860246 MRI UNLISTED PROCEDURE 885.00 1860253 UP EXT JOINT W/O CONT 9,668.00 1860261 GADOLINIUM 15ML/ML 19.00 1865005 CONTRAST 300-399 130 ML 2.00 1865013 SUPPLY INJECTOR 76.00 1865021 CONTRAST 300-399 150 ML 2.00 1865039 CONTRAST 300-399 100ML/ML 2.00 1865047 CONTRAST 300-399 50 PER ML 2.00 1865054 CT ABD/PELV W&W/O CONTRAST 9,246.00 1865062 CT ABD PELVIS W/ORAL CONTRAST 8,268.00 1865070 ABDOMEN W/ORAL CONTRAST 4,463.00 1865088 CT ABD W/WO PELV W/CONTRAST 9,246.00 1865096 PELVIS W/ORAL CONTRAST 3,943.00 1865104 BONE MINERAL IND 1,002.00 1865112 BONE MINERAL SUP 505.00 1865120 FACIAL/SINUS LIM 2,134.00 1865138 CONTRAST 300-399 75 PER ML 2.00 1865146 CT CONTRAST 300/50ML/ML 2.00 1865153 CT PELVIS LIMITED 2,134.00 1900059 NM THYROID UPTAKE MULT W/O IMAGING 693.00 1900091 NM THYROID IMAGING W MULT UPTAKE 1,542.00 1900141 NM THYROID CA MET IMAGE WB 3,070.00 1900240 NM WHITE BLOOD CELL LOCAL WHLE 3,067.00 1900257 NM SENTINEL NODE INJECTN W/IMAGING 2,766.00 1900281 NM LIVER W/VASC FLOW 2,047.00 1900299 NM LIVER IMAGING (SPECT) 3,545.00 1900307 NM LIVER-SPLEEN SCAN 2,583.00 1900315 NM LIVER &SPLEEN W/VASC FLOW 2,451.00 1900349 NM HEPATOBIL IMAGE 2,784.00 1900422 NM GASTRIC EMPTYING STUDY 2,663.00 1900463 NM MECKELS 2,366.00 1900471 NM PERITONEAL-VENOUS SHUNT 2,213.00 1900497 NM BONE-LIMITED 2,059.00 1900505 NM BONE-MULTIPLE 1,931.00 1900521 NM BONE SCAN WHOLE BODY 3,776.00 1900539 NM BONE 3 PHASE 3,992.00 1900547 NM BONE SPECT 4,739.00 1900695 NM MYOCARD PERF SPECT SINGLE 2,463.00 1900703 NM MYOCARD PERF SPECT MULTIPLE 4,999.00 1900745 NM MUGA REST CARD BLOOD SINGLE 2,469.00 1900828 NM PULM VENT/PERF PARTICULATE 2,047.00 1900869 NM PULM VENT IMAG GASEOUS SGL 1,965.00 1900927 NM BRAIN W/VASC FLOW 4+VIEWS 1,533.00 1900935 NM BRAIN IMAGING TOMO GRAPHIC 3,972.00 1900950 NM CEREBRAL VASCULAR FLOW ONLY 2,569.00 1900968 NM CISTERNOGRAM 2,714.00 1900984 NM CSF SHUNT FLOW 2,865.00 1900992 NM CSF-LEAK-FLOW (30) 2,458.00 1901032 NM RENOGRAM W/FLOW&FUNC W/O RX 2,702.00 1901123 NM URETERAL CYSTOGRAM 1,826.00 1901131 NM TESTICULAR IMAG W/VASC FLOW 2,569.00 1901206 NM MUGA REST ONLY 2,469.00 1901222 NM MUGA REST-STRESS 1,602.00 1901289 NM GALLIUM IMAGING WB 2ORMORE D 5,665.00 1901297 WHOLE BODY SINGLE DAY IMAGING SPECT 5,470.00 1901305 NM INDIUM LEUKOYT WB 3,067.00 1901354 WHOLE BODY SINGLE DAY IMAGING 5,470.00 1901362 NM RADIOPHARM THERAPY ORAL ADM 3,509.00 1901404 NM THYROID CA THP ORAL ADMIN 3,509.00 1901552 NM GI BLOOD LOSS 2,272.00 1901578 NM HEPATOBIL IMAGE W/RADIOPPHA 1,908.00 1901610 NM LIVER IMAGING STATIC ONLY 2,633.00 1901636 NM TC99M MEDRONATE UP TO 30 MCI 356.00 1901644 NM TC99M SESTAMIBI PER DOSE 1,285.00 1901651 NM TC99M SULFUR COLLOID PER DOSE 437.00 1901677 NM TC99M MAA STUDY DS TO 10MCI 395.00 1901685 NM XENON 133 PER 10 MCI 164.00 1901693 NM GA 67 PER MCI 335.00 1901701 NM I123 PER 100 UCI CAPSULE 484.00 1901719 NM TL 201 PER MCI 128.00 1901768 NM I-131 SOD IOD CAP PER MCI TX 230.00 1901776 NM IN 111 OXYQUIN DX PER 0.5 MCI 3,185.00 1901784 NM TC99M MERTIATIDE DS TO 15MCI 746.00 1901800 NM TC99M EXAMETAZ DS TO 25 MCI 3,222.00 1901859 NM IN 111 PENTETATE PER 0.5MCI 1,198.00 1901883 NM TC99M DISOFENIN DS TO 15MCI 4,000.00 1901891 NM TC99M LABEL RBC DS TO 30 MCI 674.00 1901933 NM TC99M MEBROFENIN UP TO 15 MCI 474.00 1901941 NM INDIUM WBC LTD AREA 1,623.00 1901958 PULM/PERF/VENT AEROSAL 2,645.00 1901966 NM KIDNEY SCAN W/FLOW 2,585.00 1901974 LYMPHOSCINTOGRAPH 2,766.00 1901982 RED CELL MASS/SIN 1,034.00 1901990 MUGA SCAN 1,608.00 1902014 NM RENOGRAM W/RX INTERV SINGLE 3,498.00 1902022 NM BRAIN SCAN LTD W/FLOW 1,533.00 1902048 NM GALLIUM SCAN WB SGL DAY 3,532.00 1902055 MYOCAR-STR & R 2,584.00 1902063 MYO PERFUSION W/EJECTION 2,584.00 1902071 NM WALLMOTION MYO PERF SGL STUDY 1,383.00 1902501 NM GALLIUM SCAN LTD AREA 887.00 1902543 NM BONE DENSITY DEXA AXIAL SKEL 1,449.00 1902550 NM MYOCARD PERF SPECT MULT STUDIES 4,999.00 1902568 NM MYOCARD PERF SPECT SINGLE STUDY 2,463.00 1902576 NM BONE MARROW WHOLE BODY 2,850.00 1902592 NM ISO OCTREOSCAN STUDY DOSE 7,337.00 1902634 NM SM 153 IEXIDRONAMM UPTO 150MCI 13,993.00 1902642 NM TC99M SULF COLLOID TO 25 MCI 437.00 1902725 NM TC99M BICISATE TO 25 MCI 3,212.00 1902733 NM SOD IODIDE CAP P/UCI TX 230.00 1902741 NM IN111 PENTETREOTIDE UP TO 6 MCI 14,377.00 1902808 NM I131 MIBG IOBEN-SUFATE 0.5MCI 8,764.00 1902832 NM TC99M TETROFOSMIN PER DOSE 783.00 1902923 NM PHYSICIAN CONSULTATION 719.00 1902931 NM PHYSICIAN F/U W/TESTS/PROC 719.00 1903053 NM PARATHYROID IMAGING 1,978.00 1903178 NM WHOLE BODY SCAN 2OR MORE DAYS 5,665.00 1903186 NM LIVER IMG SPECT W/VASC FLOW 4,071.00 1903202 NM MYOCARD REST ONLY VIAB SPECT 2,463.00 1903244 NM PULMONARY QUANTITATIVE PERFUSION 2,040.00 1903269 NM TC 99M DTPA TO 25MCI 616.00 1903301 NM DEXA VERTEBRAL FX ASSESSMENT 1,664.00 1903392 NM FDG F-18 UP TO 45 MCI 1,342.00 1903400 NM TC99M PERTECHNETATE PER MCI 3.00 1903442 NM 18F NAF PER STUDY DOSE 1,259.00 1903673 NM PULM QUANT VENT/PERF 1,430.00 1903675 NM PULM QUANT PERF 1,078.00 1903681 NM PULMONARY VENT & PERFUSION 2,645.00 1903707 NM SENTINEL NODE INJECTION 1,070.00 1903715 NM I123 MIBG 16,050.00 1903723 NM PARATHYROID IMAGING W SPECT 1,929.00 1903731 NM I 125 SEED MARKER EA 1,000.00 1903749 RENAL SCAN W/ & W/O PHARM 1,437.00 1903780 NM GASTROINTESTINAL PROCEDURE 1,469.00 1903897 NM SENTINEL NODE LEFT INJ W IMAGING 3,363.00 1903905 NM SENTINAL RT INJ W IMAGING 3,363.00 1903913 NM SENTINAL NODE LT INJ W/O IMAGING 1,070.00 1903921 NM SENTINEL NODE RT INJ W/O IMAGING 1,070.00 1903939 NM RADIOPHARMACY THERAPY,INTR-ART 1,470.00 1903947 NM BASIC DOSIMETRY 631.85 1903954 NM SPEC MED RAD PHYSICS CONSULT 980.25 1903962 NM RENOGRAM W/WO PHARM INTERVENTION 2,702.00 1903970 TECHNECTIUM TC-99M PYROPHOSPHATE 370.00 1903988 NM I131 SOD IODIDE CAP(S) DIAG/MCI 135.00 1903996 NM TC99M DTPCA TO 25MCI 85.00 1904085 TC99M CERETEC PER DOSE 4,922.00 1950005 PET CT FDG SB TO MID THIGH INT 11,163.00 1950013 PET CT FDG WHOLE BODY INITIAL 11,163.00 1950021 PET MYOCARDIAL METABOLIC EVAL 6,627.00 1950039 PET MYOCARDIAL SNG REST OR STRESS 6,627.00 1950047 PET MYOCARDIAL MLT REST OR STRESS 6,627.00 1950054 PET BRAIN IMAGING METABOLIC EVAL 6,627.00 1950062 PET CT FDG SB TO MID THIGH SUBS 11,163.00 1950070 PET CT FDG WHOLE BODY SUBS 11,163.00 1950088 PET CT FDG SB-MID THIGH SQ NOPR 11,163.00 1950096 PET CT FDG WHOLE BODY SUBQ NOPR 11,163.00 1950104 NM INDIUM-111 WBC 4,918.00 1950112 NM TC99M PENTETATE AREOSOL UP TO 75 721.00 1950120 NM PULMONARY PERF PARTICULATE ONLY 2,047.00 2000008 BLOOD FILTER 245.00 2000016 BLD PUMP Y TYPE 121.00 2000024 JACKSON PRATT TUB 573.00 2000032 JACKSN PRAT RV 573.00 2000040 PLEURAVAC 1,146.00 2000057 CARDIOPLEGIA 235.00 2000065 HYPOTHERM PAD 361.00 2000073 BLAKE DRAIN Y ADAPTER 54.00 2000081 CVP SET-UP 535.00 2000099 ARTERIAL LINE 982.00 2000107 LACTATED RINGERS 126.00 2000115 SOD CHLORIDE 199.00 2000123 BLAKE DRAIN 201.00 2000131 PLASMALYTE 16.00 2000149 HEART PACK 2,230.00 2000156 CATHETER SUCTION 51.00 2000164 SALEM SUMP PUMP 122.00 2000172 YANKAUR SUCTION 79.00 2000180 VESSEL CANNULA 66.00 2000198 TEMP FOLEY /URI 211.00 2000206 BLD WARMIMG BAG 300.00 2000214 SOD CHLORIDE 199.00 2000222 IAB PUMP W/CATH 11,826.00 2000230 ARISTA 1,103.00 2000248 CATHETER CHEST 210.00 2000255 STAT LOCK 95.00 2000263 FINGER PROBE 107.00 2000271 SAW BLADE 163.00 2000289 CARDIO PL CANN 243.00 2000297 PACER CABLE 94.00 2000305 OFF BYPASS 954.00 2000313 SKIN MARKER 61.00 2000321 CARDIO BYPASS 15,183.00 2000339 OR CARDIO VASC 1ST HOUR 8,348.00 2000347 OR CARDIO VASC EA ADD'L 15 MIN 1,584.00 2000354 SLUSH 116.00 2000362 PACER WIRES 123.00 2000370 AORTIC PUNCH 364.00 2000388 HEMOCC W/TUBING 1,584.00 2000396 BARD FELT 626.00 2000404 FOLEY TRAY W/ URI 394.00 2000412 FRED OIL 247.00 2000420 LONG BOVIE TIP 109.00 2000438 SURGIFOAM 472.00 2000453 HEMOPRO EVH KIT 3,560.00 2000461 DERMABOND 134.00 2000479 ARROW INSERT KIT 186.00 2000487 COUDE (ALL SIZES) 57.00 2000495 ENDOSCOPIC MAQUET 3,342.00 2000503 FILTER 75.00 2000511 KIMBERLY CLARK ELECTRODES 102.00 2000529 MISTER BLOWER 191.00 2000537 SCORPION 60.00 2000545 CULTURE TUBE 105.00 2000552 DERMABOND PRINEO 1,290.00 2000560 MULTI CLIP ALLPIER (SMALL) 635.00 2000578 ELECT GEL PADS 158.00 2000586 SKIN STAPLES 766.00 2000594 CAUTERY PENCIL 18.00 2000602 CLIPS LIGATURE 19.00 2000610 GELFOAM #100 387.00 2000628 FLOSEAL 693.00 2000636 OP SITE 63.00 2000644 CATH SWAN GANZ 824.00 2000651 MULTI CLIP APPLIER (MEDIUM) 748.00 2000669 INTRACATH 70.00 2000677 IV TUBING 68.00 2000685 SECONDARY SET 105.00 2000693 TUBING IMED 42.00 2000701 EXTENSION TUBING 122.00 2000719 CEREBRAL OXIMETER 532.00 2000727 BIOPATCH 48.00 2000743 SURGICEL 2X14 289.00 2000750 RETRACTOR OFF PUMP #29400 1,520.00 2000768 FLOW THRU SHUNT 164.00 2000776 SUTURE GUIDE RACK 109.00 2000784 CATHETER ROBINSON 85.00 2000792 CONNECT TUBE DIS 42.00 2000800 ACE BANDAGE 33.00 2000818 CAPNOLINE PLUS O2 41.40 2000826 BREATHING CIRCUIT 56.40 2000834 LARGNGEAL MASK AIRWAY 22.35 2101152 RETRIEVAL BASKET 1,107.00 2101160 ENDO-LOOP 287.00 2101178 TISSUE MARKER STAIN 102.00 2101186 TISSUE CLIP 338.00 2101194 ERPC CATHETER 443.00 2101202 GASTROSTOMY TUBE 511.00 2101210 SPEEDBAND 1,773.00 2101228 RADIAL JAW FORCEP 270.00 2101236 OCCLUSION BALLOON 899.00 2101244 SCLERO NEEDLE 273.00 2101251 GI CYTOLOGY BRUSH 249.00 2101269 BILLARY BRUSH 648.00 2101277 APC PROBE 1,104.00 2101285 SNARE 210.00 2101293 CRE GUIDE BALOON DLTN CATHRTR 1,373.00 2101301 PEG TRAY 868.00 2101319 CAUTERY PAD 136.00 2101327 CYTOLOGY BRUSH PULM 224.00 2101335 LUKI TUBE 70.00 2101343 GLIDE WIRE 780.00 2101350 ELECT-COAG PROBE 2,071.00 2101368 TISSUE MARKER CLIP 287.00 2101376 BIOPSY MEDIA 145.00 2101384 BILIARY DIL BALN 400.00 2101392 PAPILLOTOME 1,666.00 2101426 MICRO BRUSH PULMONARY 220.00 2101434 STENT-PLASTIC-BILLARY 650.00 2101475 GI INJECTION BICAP PROBE 1,754.00 2101483 GI BICAP PROBE 1,628.00 2101491 GI BICAP PROCEDURE 1,628.00 2101509 GI LAB REGULAR 1ST HOUR 7,829.00 2101517 GI LAB MINOR 3,913.00 2101525 GI LAB REGULAR WITH HIGH TECH 13,411.00 2101533 GI LAB EACH ADD'L 30 MINUTES 3,913.00 2101558 COLON DILATATION 2,250.00 2101566 WALL STENT ENTERAL 5,827.00 2101574 COLON-STENT-METAL 2,870.00 2101608 GI APC PROBE 868.00 2101616 GI LAB EACH ADD'L 15 MINUTES 1,957.00 2101624 CAPNOLINE PLUS O2 41.40 2101657 GI OUTPT FACILITY FEE-LEVEL2 84.00 2101707 GI LAB EACH ADD'L 15 MINUTES 1,957.00 2101715 PLUM TRANSBRONCHIAL STENT 8,265.00 2101731 N001344 LARGE FORCEPS 2,208.00 2101749 D10002 JUMBO FORCEPS 4,442.00 2101756 DREAMTOME CATH 501132 1,410.00 2200004 OMT 1-2 BODY REGIONS 32.00 2200012 OMT 3-4 BODY REGIONS 46.00 2200020 OMT 5-6 BODY REGIONS 60.00 2200038 OMT 7-8 BODY REGIONS 73.00 2200046 OMT 9-10 BODY REGIONS 87.00 2200053 OMT CONSULT LEVEL 1 89.00 2200061 OMT CONSULT LEVEL 2 123.00 2200079 OMT CONSULT 3 1 AREAS EA 15 MIN 184.00 2300051 CYTOLOGY - SMEARS 154.00 2300127 SPECIAL STAIN-TRICHROME 120.00 2300267 BONE MARROW IRON STAIN 120.00 2300317 SPECIAL STAIN-ELASTIC 120.00 2300341 SPECIAL STAIN - ALCIAN BLUE 120.00 2300457 SPECIAL STAIN-DIFF QUICK 144.00 2300564 CYTOSPIN PREP 439.00 2300622 ASP BX-SMEARS 273.00 2300630 ASP BX-CELL BLOCK 520.00 2300721 RETICULUM /GMS 144.00 2300739 DECAL,BONE 75.00 2300796 SPECIAL STAIN-GMS 144.00 2300846 IRON STAIN 120.00 2300861 GRAM STAIN-TISSUE 144.00 2300887 SPECIAL STAIN-PAS 120.00 2300895 MUCIKERATIN STAIN 120.00 2300903 ACID FAST STAIN - TISSUE 144.00 2300937 FROZEN SECTION 835.00 2300945 FRZN SXN, ADD'L 244.00 2301356 GROSS & MICROSCOPIC LEVLE 1 277.00 2301364 GROSS & MICROSCOPIC LEVEL 2 308.00 2301372 GROSS & MICROSCOPIC LEVEL 3 421.00 2301380 GROSS & MICROSCOPIC LEVEL 4 520.00 2301398 GROSS & MICROSCOPIC LEVEL 5 700.00 2301406 GROSS & MICROSCOPIC LEVEL 6 728.00 2301422 BONE MARROW ASPIRATION ONLY 4,132.90 2301455 CYTOPATHOLOGY FOR SPEC ADEQUACY 209.00 2301471 BONE MARROW SM,INTERP 2,040.00 2301521 SPECIAL STAIN,CONGO RED 120.00 2301547 SPECIAL STAIN,PAS/DIASTASE 120.00 2301570 BONE MARROW ASPIRATE 1,612.00 2301604 T PREP EXAM DURING SURGERY 60.00 2301612 T PREP EXAM DURING SURGERY EA ADDL 60.00 2301620 PATH CONSULT,REFERRED BLOCK 140.00 2400000 VENIPUNCTURE 14.00 2400059 CAPILLARY BLOOD COLLECTION 18.00 2501500 XR HYPAQUE UGI SM BOWEL 2,909.00 2501542 XR HYPAQUE SM BOWEL FOLLOW THR 1,614.00 3000015 UREA NITROGEN URINE RANDOM 134.00 3000049 SALICYLATE 292.00 3000056 RHEUMATOID FACTOR QUANT 32.00 3000064 PROTEIN 24 HR URINE 145.00 3000072 PROTEIN TOTAL 65.00 3000080 PROTEIN CSF 129.00 3000122 ALBUMIN FLUID 122.00 3000130 IGM 178.00 3000148 BENZODIAZEPINES, URINE 26.00 3000189 DILANTIN, FREE 238.00 3000205 WET MOUNT 131.00 3000213 URIC ACID, 24 HR URINE 117.00 3000221 GLUCOSE CSF 91.00 3000239 GLUCOSE QT 128.00 3000247 GLUCOMETER GLUCOSE 98.00 3000254 GLUCOSE 2 HR PP 194.00 3000262 ANA 15.00 3000320 MAGNESIUM, 24 HR URINE 229.00 3000338 SODIUM 24 HR URINE 69.00 3000353 PREGNANCY URINE (HCG QUAL) 164.00 3000361 PREGNANCY BLOOD QT 247.00 3000387 POTASSIUM 24 HR URINE 84.00 3000478 KLEIHAUER-BETHE STAIN 397.00 3000528 CRYOPRECIPITATE X 1 96.00 3000585 FFP X1 131.00 3001013 CULTURE, WOUND 607.00 3001021 CULTURE SPUTUM/BRONCH WASH AERO 133.00 3001047 CULTURE, CATHETER TIPS 607.00 3001054 CULTURE ANAEROBIC NOT BLOOD 410.00 3001062 CREATININE RANDOM URINE 95.00 3001070 CORTISOL P.M. 210.00 3001088 CORTISOL A.M.-W 7.00 3001104 CHLORIDE URINE RANDOM 84.00 3001120 ELUTION 250.00 3001153 SENSITIVITY MIC 142.00 3001203 CRYPTOSPORIDIUM SMEAR 258.00 3001237 T4 (THYROXINE) 206.00 3001252 WET-MOUNT INDIA INK 131.00 3001294 ACETAMINOPHEN 361.00 3001310 PROPOXYPHENE, URINE 26.00 3001328 PROTEIN, AMNIOTIC FLUID 116.00 3001336 AMMONIA 157.00 3001351 BARBITURATES, URINE 26.00 3001369 BASIC METABOLIC PANEL 691.00 3001385 CULTURE G.C.SCREEN 189.00 3001393 CULTURE BLOOD AEROBIC 191.00 3001401 FLUID CELL COUNT W/DIFF 166.00 3001443 OPIATES, URINE 26.00 3001450 PHENCYCLIDINE, URINE 26.00 3001468 PROSTATIC SPECIFIC ANTIGEN (PSA) 129.00 3001484 ACID-FAST CULTURE 299.00 3001500 CBC 125.00 3001534 METHAQUALINE, URINE 26.00 3001542 PRIMIDONE 259.00 3004991 ALCOHOL (ETHYL) 376.00 3008257 SODIUM URINE RANDOM 69.00 3008281 COMPLEMENT C3 7.00 3008299 AMYLASE FLUID 252.00 3008323 POTASSIUM URINE RANDOM 84.00 3008349 AMYLASE URINE RANDOM 252.00 3008356 URINE FOR EOSINOPHILS 60.00 3008372 CULTURE, JOINT REPLACEMENT 607.00 3008448 GLUCOSE FLUID 91.00 3008463 LDH FLUID 78.00 3009347 D-DIMER 247.00 3009404 TRANSFERRIN-W 13.68 3009495 SPECIFIC GRAVITY 31.00 3009594 RESPIRATORY SYNCITIAL VIRUS EI 349.00 3009958 ASO TITER 209.00 3010709 OCCULT BLOOD NON-COLORECT NEOPLASM 47.00 3011400 DRUG SCREEN, URINE 150.00 3011715 CULTURE, CSF 607.00 3011723 CULTURE, JOINT FLUID 607.00 3011731 CULTURE MRSA SCREEN 189.00 3011749 SPLIT BLOOD PRODUCTS 86.00 3011756 AUTO WHOLE BLOOD UNIT 540.00 3011871 HEPATITIS C VIRUS ANTIBODY-W 10.00 3011889 CARDIAC RISK PANEL 440.00 3011939 PREALBUMIN 242.00 3011988 PLATELETS X 1, REDUCED VOLUME 104.00 3012002 BACTERIAL ANTIGENS PANEL 509.00 3012051 CREATINE KINASE TOT/CKMB (REFLEX) 93.00 3012069 CKMB QUANTITATIVE 116.00 3012119 ELECTROLYTE PANEL 413.00 3012135 VALPROIC ACID TOTAL 406.00 3012143 LIVER PROFILE 585.00 3012218 CATH/TAP URINALYSIS 66.00 3012275 ACETONE SEMI-QNT SERUM 144.00 3012333 ALBUMIN PLASMA 49.00 3012408 AMIKACIN (AMIKIN)-W 22.64 3012465 AMPHETAMINES, URINE 26.00 3012473 AMYLASE 252.00 3012523 PHENOBARBITAL 159.00 3012614 CALCIUM 75.00 3012648 CALCIUM 24 HR URINE 140.00 3012671 CARBAMZEPINE (TEGRETOL)TOTAL 147.00 3012689 CARBON DIOXIDE (CO2) 173.00 3012788 CHLORIDE, BLOOD 173.00 3012838 CHOLESTEROL 88.00 3012895 COCAINE, URINE 26.00 3012952 CPK 238.00 3012986 CREATININE BLOOD 138.00 3013000 CREAT.CLEARANCE 225.00 3013018 CRYOGLOBULINS 277.00 3013042 VITAMIN B12 107.00 3013091 DIGOXIN TOTAL 145.00 3013265 FAT,QUALITATIVE 75.00 3013281 FIBRINOGEN ACTIVITY 120.00 3013299 FOLATE (SERUM) 104.00 3013307 FOLATE, RBC 56.00 3013414 GLUC TOLERANCE PRENATAL 209.00 3013463 GGTP 295.00 3013489 BETA HCG QUANT 552.00 3013547 HAPTOGLOBIN-W 10.00 3013570 FETAL HEMOGLOBIN (APT) 47.00 3013588 HEMOGLOBIN A1C 209.00 3013729 IRON (TOTAL ONLY) 66.00 3013810 LACTIC ACID (LACTATE) 376.00 3013828 LDH 78.00 3013869 LIDOCAINE 243.00 3013877 LIPASE 192.00 3013919 LITHIUM, LAB-W 10.07 3013935 MAGNESIUM 82.00 3014032 OSMOLALITY BLOOD 151.00 3014040 OSMOLALITY URINE 317.00 3014123 DILANTIN (PHENYTOIN)TOTAL 393.00 3014164 ALK. PHOSPHATASE 64.00 3014172 PHOSPHORUS 81.00 3014180 PHOSPHORUS,24 HR URINE 170.00 3014214 POTASSIUM PLASMA 65.00 3014305 FLUID PROTEIN 129.00 3014420 SODIUM PLASMA 53.00 3014537 CANNABINOIDS, URINE 26.00 3014545 THEOPHYLLINE 144.00 3014628 TSH 314.00 3014644 SGOT (AST) 211.00 3014651 SGPT (ALT) 222.00 3014669 TRIGLYCERIDES 87.00 3014677 T3,TOTAL-W 5.00 3014701 BUN (UREA NITROGEN) 139.00 3014719 URIC ACID BLOOD 88.00 3014735 VANCOMYCIN 314.00 3014800 GENTAMICIN 330.00 3014818 TOBRAMYCIN 459.00 3014891 EOSINOPHILE COUNT 76.00 3014909 HEMATOCRIT 87.00 3014933 CBC WITH DIFF 320.00 3014966 RETICULOCYTE COUNT AUTOMATED 59.00 3015229 PLATELET COUNT 75.00 3015237 PROTHROMBIN TIME 66.00 3015260 SEDIMENTATION RATE NON-AUTO 59.00 3015278 SICKLE CELL PREPARATION 76.00 3015294 PTT PLASMA/WB 66.00 3015385 CRP QUANTITATIVE (HS) 145.00 3015468 ANTIBODY SCREEN 184.00 3015492 ANTIBODY IDENTIFICATION 531.00 3015518 DIRECT,COOMBS 186.00 3015526 ANTIBODY TITER 531.00 3015575 COMPATIBILITY TESTING, AHG 194.00 3015666 ANTIGEN TYPING-DIRECT 207.00 3015765 CEA-W 7.00 3015773 FERRITIN 242.00 3016045 ANA, QUANTITATIVE 277.00 3016284 RUBELLA AB SCREEN-W 247.00 3016300 COLD AGGLUTININS 217.00 3016318 HEP B SURFACE ANTIGEN-W 6.18 3016342 HEP SURFACE AB-W 9.00 3016391 HEP A VIRUS IGM-W 11.00 3016409 HETEROPHILE SCREEN 201.00 3016466 IMMUNOGLOBULIN PANEL-Q.I.G. 437.00 3016490 CRYPTOCCOCCUS ANTIGEN 220.00 3016581 GLUCOSE URINE GTT 66.00 3016789 ACID FAST SMEAR CONCENTRATE 83.00 3016805 CULTURE STOOL AEROBIC S&S 171.00 3016821 CULTURE,EYE/EAR/NOSE/THROAT 607.00 3016839 CULTURE,BODY FLUIDS 607.00 3016870 STREP GROUP A SCREEN 239.00 3016888 CULTURE URINE 322.00 3016920 CULTURE FUNGUS 38.00 3016946 ACID FAST CULTURE BLOOD 176.00 3017035 CLOSTRIDIUM DIFFICILE TOXIN 324.00 3017043 OVA & PARASITES 432.00 3017092 GRAM STAIN 133.00 3017100 ACID FAST SMEAR, DIRECT 258.00 3017126 MALARIA SMEAR 156.00 3017597 NEWBORN ADDITIONAL UNIT 217.00 3017639 SPERM EXAM - PRESENCE/ABSENCE 144.00 3017647 ABO TYPING 166.00 3017654 RH TYPING 144.00 3017662 RBC COUNT 120.00 3017670 WBC COUNT 120.00 3017688 IRON BINDING CAPACITY,DIRECT 120.00 3017696 GTT SPECIMENS FIRST THREE 288.00 3017704 GTT SPECIMENS, FOURTH SPECIMEN 125.00 3017712 GTT SPECIMENS, FIFTH SPECIMEN 125.00 3017720 IGG, QUANTITATIVE 228.00 3017738 IGA, QUANTITATIVE 178.00 3017779 COMPREHENSIVE METABOLIC PANEL 977.00 3017860 GROUP B STREP SCREEN 239.00 3017902 CARDIAC TROPONIN I QT 355.00 3017910 MYOGLOBIN, SERUM 203.00 3017928 CULTURE, VRE SCREEN 239.00 3017936 RPR SEROLOGY QL 114.00 3017969 HELICOBACTER PYLORI SCREEN 239.00 3017985 RAPID GROUP B STREP SCREEN 334.00 3018009 PRENATAL PANEL 1,339.00 3018017 HIV 1/2 ANTIBODY-EIA 150.00 3018140 COMPLEMENT, C4 323.00 3018157 FREE T4 (FT4) 184.00 3018165 FREE T3 (FT3)-W 50.88 3018173 CAFFEINE 299.00 3018181 BILIRUBIN TOTAL 153.00 3018199 BILIRUBIN DIRECT 69.00 3018207 OCCULT BLOOD, URINE 60.00 3018223 CORTISOL TOTAL-W 7.00 3018231 FETAL FIBRONECTIN ASSAY-W 210.00 3018264 ACUTE HEPATITIS PANEL 1,358.00 3018272 GTT SPECIMENS, SIXTH SPECIMEN 125.00 3018298 COMPATIBILITY TEST, EACH UNIT 672.00 3018314 RENAL FUNCTION PANEL 648.00 3018322 HDL CHOLESTEROL 100.00 3018330 LDL CHOLESTEROL 104.00 3018363 MICROALBUMIN-W 20.72 3018371 PROTEIN URINE RANDOM 145.00 3018389 CALCIUM URINE RANDOM 75.00 3018405 METHADONE, URINE 26.00 3018488 BNP B NATRIURETIC PEPTIDE 373.00 3018496 LEGIONELLA ANTIGEN,URINE 210.00 3018504 STREP PNEUMONIAE AG,URINE 210.00 3018512 E.D.URINE HCG 164.00 3018520 RUBEOLA AB SCREEN-W 33.29 3018538 VARICELLA ZOSTER AB SCREEN 247.00 3018553 BILIRUBIN, NURSERY/NICU 116.00 3018561 PLATELET FUNCTION TEST 333.00 3018579 HEPATITIS B CORE AB,IGM-W 12.00 3018587 FLUID CHOLESTEROL 169.00 3018595 FLUID TRIGLYCERIDES 87.00 3018603 INFLUENZA A&B TEST 294.00 3018611 CULTURE, VAP,QUANTITATIVE 607.00 3018629 ALPHA FETO PROTEIN-W 10.00 3018637 CA 15-5-W 14.00 3018645 CA 125-W 10.00 3018652 CA 19-9-W 13.00 3018678 CULTURE GENITAL OB/GYN AEROBIC 133.00 3018686 E COLI 0157 H7 SCREEN 205.00 3018710 LACTATE ABG 242.00 3018769 PPD SKIN TEST 62.00 3018777 PTH INTACT-W 25.00 3018884 RAPID MRSA SCREEN 479.00 3018900 FLUID CELL COUNT, NO DIFF 203.00 3018918 URIC ACID,FLUID 144.00 3018926 URINE PH 66.00 3018934 FLUID SPECIFIC GRAVITY 33.00 3018942 SKIN TEST FOR CANDIDA 62.00 3018959 CDIFF TOXIN DNA BY PCR 128.00 3018967 CLOSTRIDIUM DIFFICILE AG, EIA 321.00 3018975 URINE DRUG SCREEN 135.00 3018983 PROCALCITONIN 413.00 3018991 VITAMIN D,25-HYDROXY-W 81.89 3019007 VALPROIC ACID,NON PROTEIN BOUND 269.00 3019015 POOLED BLOOD PRODUCT PROC CHG 118.00 3019023 BETAHYDROXYBUTYRATE QT 144.00 3019031 NICU DRUG RESISTANT ORG SCREEN 239.00 3019056 OCCULT BLOOD-ON SINGLE COLLECTION 121.00 3019064 HEMOGLOBIN 36.00 3019072 SHIGA TOXIN TEST 192.00 3019080 SHIGA TOXIN 1 DETECTION 98.00 3019098 SHIGA TOXIN 2 DETECTION 98.00 3019106 PROSTATIC SPECIFIC ANTIGEN(PSA)SCRN 286.00 3019114 OCCULT BLD,STL,1-3 BY IMMUNOASSAY 60.00 3019122 HEP B SURFACE AG CONFIRM 500.00 3019130 URINE DRUG SCREEN-EMPHEALTH 135.00 3019148 T-4 FREE DLAB 4.00 3019155 HEP C AB-DLAB 10.00 3019163 HEP B SURF AG W/REFLEX TO CONF-DLAB 6.18 3019171 HEP B SURF CONFIRM-DLAB 33.86 3019189 HEP A IGM AB-DLAB 11.00 3019197 HEP B CORE IGM AB-DLAB 12.00 3019205 HEP B SURF AB QL-DLAB 9.00 3019213 CEA-DLAB 7.00 3019221 VIT D 250H LC/MS/MS-DLAB 81.89 3019239 PTH,INTACT & CALCIUM-DLAB 25.00 3019247 T-3, FREE D-LAB 50.88 3019254 T-3, TOTAL-DLAB 5.00 3019262 CORISTOL, TOTAL-DLAB 7.00 3019270 HAPTOGLOBIN-DLAB 10.00 3019288 MICROALBUMIN RAND UR-DLAB 20.72 3019296 RUBELLA IMMUNE-DLAB 5.00 3019304 TRANSFERRIN-DLAB 13.68 3019312 LITHIUM-DLAB 10.07 3019320 FETAL FIBRONECTIN-DLAB 210.00 3019338 AFP,TUMOR-DLAB 10.00 3019346 CA125-DLAB 10.00 3019353 CA 15-3-DLAB 14.00 3019361 CA 19-9-DLAB 13.00 3019379 AMIKACIN-DLAB 22.64 3019387 ACUTE HEPATITIS PANEL-DLAB 39.18 3019395 HIV 1/2 ANTIBODY, SCREENING 240.00 3019403 VARICELLA ZOSTER,IMMUNE,IGG,AB-W 63.25 3019411 MUMPS IGG-DLAB 53.20 3019429 RUBEOLA IGG-DLAB 33.29 3019437 ANA W/RFX-DLAB 8.78 3019445 ANA RFX-DLAB 14.00 3019452 MUMPS IGG AB-W 53.20 3019460 URINALYSIS WITH MICROSCOPY 255.00 3019478 URINALYSIS WITHOUT MICROSCOPY 213.00 3019486 CCP ANTIBODIES-W 277.00 3019502 SYPHILIS AB 128.00 3019510 CPEPTIDE 210.00 3019528 RPR TITER 128.00 3019536 ANA ANTIBODY,EIA SCRN-W 240.00 3019544 DS DNA ANTIBODY,EIA-W 180.00 3019551 SSA ANTIBODY-W 180.00 3019569 SSB ANTIBODY-W 180.00 3019577 SM ANTIBODY-W 180.00 3019585 SM/RNP ANTIBODY-W 180.00 3019593 JO1 ANTIBODY-W 180.00 3019601 SC170 ANTIBODY-W 180.00 3019619 CENTROMERE ANTIBODIES(ANA) 180.00 3019627 HIV1 AB, HIV2 AB, P24AG SCREEN 280.00 3019635 POCT INR 257.00 3019650 AMIKACIN PEAK 335.00 3019668 AMIKACIN TROUGH 335.00 3019676 CHLAMYDIA TRACHOMATIS AMPLIF RNA-W 200.00 3019684 NEISSERIA GONORRHOEAE AMPLIF RNA-W 200.00 3019734 EVALUATION OF SPERM ABSENCE/PRESENC 156.00 3019742 CANDIDA AURIS SCREEN 239.00 3019759 PATHOLOGIST PERIPHERAL BLD SMR RVW 64.33 3019767 PATHOLOGIST BODY FLUID SMEAR REVIEW 160.69 3019775 INFLUENZA A/B VIRUS BY PCR 450.00 3019783 SARS-COV-2 RNA, QUALITATIVE RT PCR 250.00 3019791 SARS-COV-2 IGG ANTIBODY QUALITATIVE 150.00 3019809 SARS-COV-2 IGM ANTIBODY QUALITATIVE 75.00 3019817 VERIFYNOW - ASPIRIN 175.00 3019825 VERIFYNOW - PRU 175.00 3019833 SARS-COV-2 TOTAL ANTIBODY QUALITATV 75.00 3019841 RP2 MULTI RESP PCR PNL-12-25 TARGTS 416.00 3019858 RP2 MULTI RESP PCR PANEL-C.PNEUMO 35.00 3019866 RP2 MULTI RESP PCR PANEL-M.PNEUMO 35.00 3019874 RP2 MULTI RESP PCR PANEL-SARS-COV-2 51.00 3019882 SARS-COV2-ANTIGEN BY FIA 91.00 3020195 SARS-COV-2 RT PCR-ABBOTT IDKNOW 250.00 3020203 WESTPAC SPECIAL HNDLNG FEE-WEST PAC 50.00 3020211 LYRA SARSCOV2 PCR HI THRU INST ADD 25.00 3020229 LYRA SARS-COV-2 PCR HI THRUPUT INST 475.00 3020237 SALV DRCT COV2 PCR HI THRU INST ADD 25.00 3020245 SALIVA DIRCT COV2 PCR HI THRU INST 475.00 3060977 LP RIBOSOMAL P ANTIBODY 15.00 3060985 LP DNA (DS) ANTIBODY 15.00 3060993 LP SCL-70 ANTIBODY 15.00 3061009 LP THYROID PEROXIDASE ANTIBODY 15.00 3061017 LP RHEUMATOID FACTOR 15.00 3061025 BLOOD SMEAR EXAM - PHHD 61.00 3061033 FIBRIN PROD SEMI-QUANT 112.00 3061041 EOSINOPH SMEAR 51.00 3061058 WRIGHT STAIN 133.00 3061066 CRYSTALS IDENT 64.00 3061074 PROTHROMBIN TIME 66.00 3061082 PROTHROMB TIME PLASMA SUBSTN 66.00 3061090 PROTHROM TIME PLASMA SUBSTN 66.00 3061108 PTT PLASMA/WB 66.00 3061116 PTT PLASMA SUBSTITUTION 66.00 3061124 PTT PLASMA SUBSTITUTION 66.00 3061132 ORGANISM ID AEROBIC 127.00 3061140 ORGANISM ID URINE 76.00 3061157 ORGANISM ID ANAEROBIC 191.00 3061165 SENSITIVITY DISK METHOD 89.00 3061173 ADDL ANTIBIO SUSCEPTABILITY STUDY 19.00 3061181 CLOTEST 173.00 3061199 CULT FUNGUS CSF 144.00 3061207 CULTURE FUNGUS OTHER 144.00 3061215 CULTURE BLOOD AEROBIC 191.00 3061223 AFB CONCENTRATION 84.00 3061231 C DIFFICILE TOXIN AG A/B 77.00 3061249 RSV BY EIA 67.00 3061256 STREP TYPING IMMUNOLOGIC METH 101.00 3061264 STREP PNEUMO AG EIA MULTI-STEP 49.00 3061272 INFLUENZA A AG 90.00 3061280 INFLUENZA B AG 46.00 3061298 HIV-1 ANTIBODY 196.00 3061306 DISCHARGE MRSA SCREEN 189.00 3061314 T3 UPTAKE 242.00 3061322 VANCOMYCIN TR 314.00 3061330 VANCOMYCIN PK 314.00 3061348 TOBRAMYCIN 459.00 3061355 GENTAMYCIN 330.00 3061363 GLUCOSE 2HR PP 118.00 3061371 GLUCOSE URINE GTT 66.00 3061389 CREAT UR TIMED 95.00 3061397 URN VOL MEASURE 28.00 3061405 COMP METABOLIC 977.00 3061413 CSF CELL COUNT W/DIFF 166.00 3061421 GLUCOSE WB REAGENT STRIP 128.00 3061439 D-DIMER(DRMC)QT 45.00 3061447 ALBUMIN BODY FLD 49.00 3061454 CHOLESTEROL BF 88.00 3061462 RPR QUANTITAT 41.00 3061470 URINALYSIS 176.00 3061488 ADENOVIRUS 48.00 3061496 MUMPS-W 53.20 3061504 RUBEOLA-W 33.29 3061520 GTT EA ADD OVER 87.00 3061538 GTT EA ADD OVER 87.00 3061546 GTT EA ADD OVER 87.00 3061553 GTT EA ADD OVER 87.00 3061561 GTT EA ADD OVER 87.00 3061579 GLUCOSE URINE GTT 66.00 3061587 GLUCOSE URINE GTT 66.00 3061595 GLUCOSE URINE GTT 66.00 3061603 GLUCOSE URINE GTT 66.00 3061611 GLUCOSE URINE GTT 66.00 3061629 GLUCOSE URINE GTT 66.00 3061637 GLUCOSE URINE GTT 66.00 3061645 HETEROPHILE TITER 10.44 3061652 TISSUE GROSS 72.00 3900008 WHOLE BLOOD, ONE UNIT 1,240.00 3900016 RED BLOOD CELLS,ONE UNIT 1,311.00 3900024 CRYOPRECIPITATE,ONE UNIT 413.00 3900040 FRESH FROZEN PLASMA,ONE UNIT 413.00 3900123 SPECIAL SCREEN,PER ANTIGEN 184.00 3900156 RH IG PRODUCT 475.00 3900255 PLATELETPHERESIS UNIT 2,583.00 3900263 THERAPEUTIC PHLEBOTOMY 439.00 3900321 AUTOLOGOUS ADMINISTRATIVE PROC 186.00 3900412 RH IMM GLOB ADMIN 531.00 3900578 ARC AUTO RBC UNIT 1,311.00 3900925 BLOOD TRANSFUSION/HIM 3,050.00 3900941 CRYOPRECIPITATE POOLED X5 ARC UNIT 70.00 3900974 ANTIGEN SCREEN 2 58.00 3900982 LEUKO-DEPLETED PC 210.00 3900990 PLATELET ANTIBODY PER TEST,HLA-ARC 700.00 3901006 PLATELET ANTIGEN TYPING-ARC 400.00 3901014 FRESH FROZEN PLASMA,ONE UNIT 413.00 3901022 CRYOPRECIP ARC 70.00 3901030 FRESH FROZEN PLAZMA 24HR 413.00 3901048 PLT PHER ARC 460.00 3901055 PLTPH WBC REDUCED 460.00 3901063 RBC PED6 CMV ARC 1,311.00 3901071 PRETREAT/ENZYMES 133.00 3901089 ANTIGEN SCREEN 3 58.00 3901097 STAT SAMPLE TRANS 100.00 3901105 ANTIGEN SCREEN 4 58.00 3901113 ANTIGEN SCREEN 3 58.00 3901121 ANTIGEN SCREEN 2 58.00 3901139 ANTIGEN SCREEN 1 58.00 3901147 DIFF ADSORPTION 62.00 3901154 PRETREAT/CHEMICAL 133.00 3901162 SAMPLE TRANSPORT 35.00 3901170 ANTIBODY ID 361.00 3901188 WB DIRECTED ARC 577.00 3901204 RED BLOOD CELLS,ONE UNIT 1,311.00 3901212 ARC AUTO RBC UNIT 1,311.00 3901220 ELUTION 65.00 3901246 ANTIBODY SCREEN 221.00 3901253 ANTIGEN TYPE ARC 55.00 3901261 ABO TYPE 19.00 3901279 RH TYPE 96.00 3901287 RH PHENOTYPE 124.00 3901295 RBC PHENOTYPE 95.00 3901303 DAT 176.00 3901311 ANTIGEN TYPING 266.25 3901337 ANTIGEN TYPING PI 45.00 3901352 CELL WASH PIH 98.00 3901378 STAT HANDLING PIH 32.00 3901386 DONORS SCRN ABO RH 25.00 3901410 HLA TYPING ARC 275.00 3901428 PLATELET AB SCREEN 206.00 3901436 SICKLE CELL TEST 29.00 3901444 TRANS REACT ARC 425.00 3901451 WASH CELLS ARC 525.00 3901477 RBC FREEZING 250.00 3901493 SPECIAL SCRN ARC 75.00 3901501 RETIC SEPARATION 89.00 3901519 DILUTION OF SERUM 141.00 3901527 INHIBITION/SERUM 143.00 3901535 TITRATION 65.00 3901543 THAW/PREP RBC 969.00 3901550 HEMOLYSIN/AGGLUT 89.00 3901568 INCUBATE SERUM 131.00 3901576 MONOCYT MONOLAYER 630.00 3901584 DAT INVESTIGATION 289.00 3901592 ABO DESCREPANCY 189.00 3901600 SCREEN BLD UNIT 477.00 3901634 PRODUCT HANDLING / PREP 65.00 3901642 ANTIGEN SCREEN 5 58.00 3901659 ANTIGEN SCREEN 6 58.00 3901667 ANTIGEN SCREEN 7 58.00 3901675 SPECIAL RECUITEMENT PLATELET DONOT 68.00 3901683 SPECIAL RECUITMENT RBC DONER 68.00 3901691 ANTIGEN SCREEN 4 58.00 3901709 ANTIGEN SCREEN 5 58.00 3901725 SKELETAL MUSCLE BX ANALYSIS PTH-LBM 564.75 3901733 MUSCLE BX SPECIAL STAINS PTH-LBM 97.75 3901741 SKELETAL MUSCLE BX PTH - LBM 173.98 4900106 SEROTONIN BLOOD -NI 92.34 4900189 ANTI PARIETAL AB-MAYO 24.69 4900197 ANTI CARDIOLIPIN AB -MAYO 12.65 4900221 IGG SUBCLASS-NI 104.00 4900239 CMV, IGG + IGM AB -MAYO 9.08 4900254 LIPIDS, TOTAL,FECAL, -MAYO 30.00 4900262 DHEA S-MAYO 14.55 4900296 ESTRADIOL, 17 BETA-MAYO 13.22 4900320 G6PDH -MAYO 17.07 4900346 FTA ABS -MAYO 18.94 4900379 ARSENIC, BLOOD-NI 33.10 4900411 ESTROGEN TOTAL BLOOD-NI 40.55 4900437 PORPHYRINS 24 HR QUANT -MAYO 37.86 4900445 CELL BOUND PLATELET AB-MAYO 75.00 4900478 COCCI AB, CF -MAYO 9.47 4900486 CMV CULTURE-MAYO 66.89 4900536 ARSENIC, URINE-NI 51.00 4900593 FREE T4-MAYO 16.06 4900619 ALDOSTERONE SERUM -MAYO 15.31 4900627 GASTRIN -MAYO 17.96 4900635 CATECHOLAMINES, URINE-MAYO 30.00 4900668 ANTI MITOCHONDRIAL AB -MAYO 10.82 4900684 MICROALBUMIN -MAYO 16.13 4900783 MARIJUANA(THC)QUANTITATIVE-NI 43.69 4900791 METHAQUALONE (QUAALUDE)-NI 49.00 4900817 PCP (QUALITATIVE),GCMS CONF-NI 49.00 4900833 B PERTUSSIS CULTURE-NI 46.00 4900874 SJOGRENS SSA,SSB AB-NI 36.11 4900924 HIV WESTERN BLOT-MAYO 19.75 4900999 COXACKIE B ANTIBODIES -NI 55.30 4901021 EPSTEIN BARR PANEL-MAYO 13.61 4901088 ANTI SMOOTH MUSCLE AB-MAYO 12.90 4901104 SENDOUT PROCESSING CHARGE 23.00 4901112 LEAD, BLOOD -MAYO 9.56 4901161 CALCULUS ANALYSIS-ARAWAK 41.00 4901187 RISTOCETIN COFACTOR-QUEST 69.00 4901203 TOXOPLASMA AB, IGM-MAYO 19.48 4901211 T3 REVERSE - MAYO 31.22 4901229 CA 15 3-MAYO 20.85 4901302 PROINSULIN -NI 78.03 4901336 INSULIN LEVEL-MAYO 9.99 4901344 ANTI PLATELET AB-MAYO 50.00 4901351 C1 ESTERASE INHIBITOR -MAYO 22.60 4901369 R CHROMOSOME STUDY,TISSUE-MAYO 625.00 4901385 PROTEIN C-MAYO 29.05 4901393 PROTEIN S ANTIGEN-MAYO 22.75 4901419 CHLAMYDIA AB PANEL, IFA TWAR -MRL 198.90 4901468 HISTOPLASMA AB,CSF-MAYO 44.72 4901526 R HYPERSEN PNEUMONITIS PNL-MAYO 40.36 4901534 ASPERGILLUS AB, CF -MAYO 33.10 4901542 PREGNENOLONE -NI 77.35 4901559 AMIODARONE -MAYO 21.90 4901625 ALLERGEN, INDIVIDUAL-MAYO 9.74 4901708 B.BURGDORF.(LYMES) AB CSF-MRL 67.50 4901765 CHROMOGRANIN A -NI 87.55 4901856 R PARVOVIRUS B19, ANTIBODY-MAYO 11.23 4901930 IGF I (SOMATOMEDIN C)-NI 60.86 4901997 CERULOPLASMIN-MAYO 9.50 4902045 TOXIC SHOCK SYNROME PNL-MRL 200.70 4902060 A1 ANTITRYPSIN +PHENOTP-MAYO 23.22 4902110 ALLERGY PANEL FOOD PRO 1-NI 92.00 4902268 CARNITINE LEVEL-MAYO 30.67 4902326 R RUBEOLA IGG & IGM AB -MAYO 12.50 4902342 COCCI AB, CSF-MAYO 55.30 4902375 RUBELLA AB IGM-NI 38.59 4902409 THYROID STIMULATING IG-MAYO 50.03 4902425 CORTISOL, URINARY FREE-MAYO 22.00 4902466 DRUG SCREEN, BLOOD-MAYO 124.00 4902508 HEPATITIS A AB TOTAL-NI 62.40 4902516 HEPATITIS B CORE AB IGM-MAYO 15.00 4902532 ETHOSUXIMIDE-MAYO 38.74 4902680 IRON, QUANT, TISSUE-MAYO 62.87 4902706 ETHYLENE GLYCOL-MAYO 71.45 4902755 GMI ANTIBODY PANEL-MAYO 30.00 4902847 COMPLEMENT CH50 -MAYO 13.89 4902862 TREPONEMA PALLIDUM DFA -NI 18.08 4902870 JO 1 ANTIBODY-NI 30.80 4902995 HIV2 EIA SCREEN/WB REFLEX-NI 24.30 4903019 VITAMIN D, 1,25 DIHYDROXY-MAYO 16.67 4903043 ALPHA 1 ANTITRYPSIN QNT-MAYO 9.27 4903084 HERPES VIRUS 6, HUMAN-MRL 162.00 4903092 R HEMOGLOBIN ELECTROPHORESIS-MAYO 35.58 4903142 ACTH -MAYO 15.06 4903183 ALUMINUM-MAYO 21.00 4903191 DELTA AMINOLEVOLINIC ACID-NI 41.00 4903217 ANDROSTENEDIONE-MAYO 32.66 4903225 ANGIOTENSIN CONV ENZ -MAYO 10.00 4903258 CALCITONIN-NI 49.20 4903308 CATECHOLAMINES, SERUM - QUEST 47.55 4903324 CHLORAMPHENICOL-MAYO 65.41 4903340 LIBRIUM(CHLORDIAZEPOXIDE)-NI 26.24 4903357 TORCH PANEL IGM 86645-MAYO 18.00 4903365 ACETYLCHOLINE RECEPTOR AB-MAYO 52.38 4903381 COPPER, SERUM -MAYO 15.00 4903407 C PEPTIDE-MAYO 16.54 4903423 CYANIDE -MAYO 89.00 4903456 DIAZEPAM NORDIAZEPAM-MAYO 58.60 4903563 ESTRIOL, SERUM-NI 8.50 4903597 IGD-MAYO 38.75 4903605 IGE -MAYO 10.64 4903639 FSH, BLOOD -MAYO 9.73 4903654 GROWTH HORMONE-MAYO 15.85 4903696 17-OH CORTICOSTEROIDS-NI 44.00 4903704 5 HIAA (SEROTONIN METAB) -MAYO 20.00 4903720 IMIPRAMINE -MAYO 20.35 4903787 METANEPHRINES,24 HR URINE -MAYO 22.50 4903803 R METHEMALBUMIN-MAYO 101.00 4903837 5 NUCLEOTIDASE-MAYO 233.38 4903845 OXALATE, URINE -MAYO 21.01 4903860 PORPHOBILINOGREN 24HR UR-MAYO 30.31 4903894 PROGESTERONE, SERUM -MAYO 10.12 4903902 17 OH PROGESTERONE-MAYO 22.84 4903944 RENIN (PLASMA) -MAYO 12.07 4903977 THYROGLOBULIN TUMOR MARKER-MAYO 10.96 4903993 VMA, URINE -MAYO 22.34 4904017 ZINC-MAYO 12.22 4904033 ANTI THROMBIN III-MAYO 17.00 4904058 VISCOSITY, SERUM -MAYO 25.00 4904066 TRICHINELLA AB-MAYO 47.29 4904082 INTRINSIC FACTOR AB-NI 26.25 4904090 INSULIN AB-NI 58.50 4904108 ANCA CYTOPLASMIC NEUT AP,SER-MAYO 20.96 4904116 ANTI STRIATED MUSCLE AB -MAYO 23.00 4904140 ADENOVIRUS AB-MAYO 90.43 4904157 R EPSTEIN BARR VIRUS PANEL -MAYO 7.00 4904199 POLIO AB -NI 67.90 4904215 R Q FEVER AB -MAYO 30.00 4904223 TOXOPLASMA AB IGG-MAYO 15.37 4904231 ECHOVIRUS AB-NI 123.30 4904249 R V ZOSTER AB,IGG/IGM -MAYO 12.50 4904256 ANTI CENTROMERE AB-MAYO 10.73 4904280 GLOMERULAR BASMNT.MEMB.AB-MAYO 10.88 4904298 BETA-2 MICROGLOBULIN -MAYO 26.00 4904330 R CHLAMYDIA GROUP AB -MAYO 12.77 4904355 ERYTHROPOETIN-NI 24.03 4904397 HISTONE AUTOANTIBODIES-QUEST 24.71 4904413 BETA GLUCURONIDASE -NI 64.00 4904496 HISTOPLASMA AB,SERUM-MAYO 31.32 4904546 HLA B 27-MAYO 38.73 4904561 ANTI THYROGLOBULIN AB-NI 14.88 4904595 MYCOPLASMA CULTURE -MAYO 79.93 4904603 LEGIONELLA CULTURE-MAYO 13.01 4904694 LEGIONELLA AB(COMPLETE) -MAYO 23.41 4904801 SENS & MOTOR NEUROPATHY PNL-MRL 928.80 4904868 ANTI GLIADIN ANTIBODIES,IGG,IGA-NI 79.27 4904926 STOOL FOR ALPHA1 ANTITRYPSIN-SKB 20.00 4904975 TESTOSTERONE,TOTAL-MAYO 12.24 4905014 R COAG FACTOR II-MAYO 60.00 4905105 LYMES AB,EARLY,NONREFLEXED-NI 59.00 4905113 PLASMA HEMOGLOBIN-MAYO 39.74 4905147 AFB ID CONVENTIONAL-MRL 79.00 4905170 TYPHUS FEVER ANTIBODY-MAYO 49.70 4905238 LYME DISEASE AB,REFLEXED-NI 23.60 4905246 GIARDIA LAMBLIA ANTIGEN-MAYO 20.99 4905253 HELICOBACTER PYLORI AB-MAYO 14.51 4905295 LYME'S DISEASE AB, W BLOT-MAYO 30.00 4905303 BRUCELLA AB-MAYO 34.84 4905436 METHANOL URINE -QUEST 23.33 4905444 COAG FACTOR VIII - MAYO 49.30 4905493 PROSTATIC ACID PHOS BY RIA-MAYO 21.80 4905519 VITAMIN D 25 HYDROXY-MAYO 8.00 4905535 METHOTREXATE-MAYO 50.56 4905584 OSTEOCALCIN-NI 44.07 4905634 HEPATITIS BE AB-MAYO 15.95 4905667 CALCIUM IONIZED -MAYO 15.80 4905725 R RICKETTSIAL DISEASE PANEL-QUEST 34.05 4905741 BORRELIA BURGDORFERI DNA,PCR-MAYO 86.28 4905782 VITAMIN A-MAYO 14.05 4905865 LUPUS(PHOSPHOLIPID)AB REFLX-MAYO 36.50 4905873 R ALK PHOS ISOENZYMES-MAYO 13.00 4905964 FK506 (TACROLIMUS)-MAYO 24.06 4905972 ISLET CELL AB (IA-2)-MAYO 27.37 4906061 SEX HORMONE BINDING GLOBULIN-NI 37.50 4906194 THYROPEROXIDASE (TPO)AB-MAYO 9.88 4906335 BETA GLUCURONIDASE,CSF-MAYO 55.29 4906343 PSEUDOCHOLINESTERASE-MAYO 29.04 4906426 DEOXYCORTICOSTERONE-MAYO 36.67 4906467 BENZODIAZEPINES URINE-MAYO 76.60 4906509 POC CHROMOSOMAL ANALYSIS CHG2-MAYO 160.00 4906566 ALDOLASE -MAYO 9.00 4906582 R T & B CELL ANALYSIS-MAYO 18.17 4906608 MYCOPL PNEUM IGM & TOTAL-MAYO 21.87 4906624 ANTI ENA-MAYO 3.00 4906632 VIRAL CULTURE-MAYO 30.66 4906723 ALDOSTERONE URINE-MAYO 55.00 4906731 CANDIDA ANTIBODY -NI 97.85 4906749 VDRL, CSF -MAYO 7.50 4906814 CLONAZEPAM -MAYO 28.91 4906822 AFB PRIMARY DRUG SUSCEPT PNL-MRL 141.30 4906855 LEPTOSPIRA ANTIBODY -MAYO 50.00 4906871 PENTOBARBITAL-NI 50.58 4906889 THYROID PEROXIDASE AB(TPO AB)-NI 38.50 4906954 PROLACTIN-MAYO 10.13 4907028 ALLERGY PNL, ADULT-NI 262.00 4907135 COAG FACTOR IX-MAYO 60.00 4907150 MYOGLOBIN, SERUM-NI 45.50 4907234 MYOGLOBIN, URINE-NI 35.00 4907366 LEGIONELLA ANTIGEN,DFA-MAYO 75.00 4907457 LUTEINIZING HORMONE-MAYO 9.84 4907499 NEISSERIA GONORRHOEAE PROBE-NI 27.32 4907515 HEPATITIS B VIRUS, DNA QNT-NI 107.61 4907564 COUMADIN LEVEL-NI 78.00 4907689 AEROBIC MIC CUSTOM 3 DRUGS -MRL 163.80 4907762 MAG ANTIBODY -MRL 225.90 4907861 MYELOPEROXIDASE AB-MAYO 31.70 4907887 ALPHA GALACTOSIDASE-MAYO 119.58 4907952 CK ISOENZYMES-MAYO 30.19 4907986 CA 27.29-MAYO 15.50 4907994 HEPARIN THROMBOCYTOPENIA-MAYO 35.03 4908026 LAMOTRIGINE-MAYO 15.00 4908034 GABAPENTIN-MAYO 21.70 4908067 HOMOCYSTEINE, TOTAL PLASMA-MAYO 16.85 4908075 HEPARIN ASSAY-MAYO 55.00 4908083 STREP PNEUMONIA SEROTYPING-MRL 157.00 4908091 CELIAC DISEASE FULL PNL FOCUS A-MRL 84.29 4908125 AEROBIC MIC/MBC 3 DRUGS-MRL 216.00 4908232 CRYPTOCOCCUS AG-MAYO 31.91 4908240 HOMOCYSTEINE,URINE-MAYO 68.47 4908265 3246OSOME ANAL,BLD,HEMAT-MAYO 576.84 4908273 AMINO ACID QN ION EXC, UR -MAYO 100.00 4908349 HCV QUANT, CHIRON RNA-MAYO 119.87 4908364 ALLERGEN,INDIVIDUAL-NI 18.44 4908430 R PSA FREE & TOTAL -MAYO 10.00 4908489 ANTI DNA,DOUBLESTRANDED-MAYO 11.89 4908497 INFLUENZA VIRUS DIR AG DETECT-NI 36.31 4908547 TISSUE PROCESSING-MAYO 43.86 4908562 LAMBERT EATON AUTOANTIBODY-MAYO 13.67 4908570 HISTOPLASMA ANTIGEN,URINE-MAYO 79.56 4908620 PI LINKED ANTIGEN,PNH-MAYO 99.88 4908679 INTERFERON, ALPHA-MAYO 60.00 4908711 R COAG FACTOR VII-MAYO 25.00 4908729 CITRATE,24 HR URINE-MAYO 35.09 4908737 ACETYLCHOLINE RECP MOD AB-MAYO 79.56 4908745 RUBELLA AB,IGG-MAYO 21.02 4908786 SOMATOMEDIN C,PLASMA-MAYO 28.69 4908828 CAFFEINE,SERUM-MAYO 21.07 4908836 ANTIFUNGAL SUSCEPT PANEL-MRL 369.90 4908851 AUTOANTIBODIES SSA-MAYO 19.49 4908869 AUTOANTIBODIES SSB-MAYO 19.49 4908877 AUTOANTIBODIES SM-MAYO 20.09 4908885 AUTOANTIBODIES SCL 70-MAYO 18.26 4908893 AUTOANTIBODIES U1 RNP-MAYO 20.09 4908927 MAGNESIU RBC & PLASMA-NI 20.75 4908950 CHROMIUM-MAYO 25.38 4908984 METANEPHRINE,24HR URINE-QUEST 99.53 4909024 IGG,IGM,IGA-MAYO 25.64 4909057 D/L AMPHETAMINE-NI 47.59 4909099 ELECTRON MICROSCOPY-MAYO 501.69 4909123 HCV BY RIBA-MAYO 106.34 4909131 DRUG SCREEN, SERUM-NI 72.14 4909180 R TESTOSTERONE, TOTAL & FREE-MAYO 14.33 4909263 AMITRIPTYLINE-MAYO 24.52 4909271 HERPES SIMPLEX PCR,CSF-MAYO 45.00 4909305 FRUCTOSAMINE-NI 17.09 4909321 COAG,VON WILLEBRAND DIS.-MAYO 372.42 4909339 VITAMIN C, ASCORBIC ACID-MAYO 10.08 4909396 AEROBIC MIC, CUSTOM, 2 DRUGS-MRL 150.30 4909404 AEROBIC MIC, CUST,4 DRUGS-MRL 233.10 4909461 SPECIAL STAINS GROUP 11-CS 72.00 4909511 PATHOLOGY CONSULTATION-MAYO 190.19 4909552 ACTIVATED PROTEIN C RESIST-MAYO 40.00 4909586 ESTRONE, SERUM-MAYO 28.87 4909602 APOLIPOPROTEIN A 1,B-MAYO 21.58 4909628 R BARTONELLA AB PANEL-MAYO 10.00 4909636 VITAMIN B1-NI 56.30 4909644 VITAMIN E-MAYO 9.93 4909651 R HEAVY METALS,WHOLE BLOOD-MAYO 11.82 4909669 IGF BP3-MAYO 13.21 4909677 R TRYPANOSOMA CRUZI ABS-MAYO 47.62 4909701 TOPIRAMATE (TOPAMAX)-MAYO 31.34 4909743 GLUCAGON,PLASMA-MAYO 43.96 4909768 DOXEPIN-MAYO 20.74 4909792 ARYLSULFATASE A, LEUK.-MAYO 90.63 4909842 MERCURY-MAYO 24.24 4909867 E HISTOLYTICA (AMEBIC)AB-MAYO 35.40 4909883 PORPHYRINS,FECES-MAYO 166.54 4909917 ANTI SPERM AB-NI 54.50 4909925 METHYLMALONIC ACID, SERUM-MAYO 20.24 4909933 HEMOGLOBIN S SCREEN-MAYO 43.39 4909941 AFB ID,DNA PROBE-MRL 80.10 4909958 AFB MAI MIC SENSITIVITIES-MRL 186.30 4909966 AFB PRIMARY SENSITIVITIES-MRL 112.50 4909974 AFB RAPID GROWER SENSI-MRL 115.20 4909990 AFB MTB COMPLEX DNA,PCR-MRL 233.81 4910006 VOLATILE SCREEN, BLOOD-MAYO 41.03 4910022 TRYPTASE-MAYO 44.90 4910048 ANAEROBIC BACTERIAL ID-MRL 90.90 4910055 ANAEROBE SUSCEPT MIC-MRL 95.40 4910063 ANTINUCLEAR ANTIBODIES-MAYO 8.90 4910097 AEROBIC BACTERIAL ID-MRL 78.30 4910147 MYCOBACTERIA,PCR,MISC-NI 95.40 4910170 R COAG FACTOR V-MAYO 60.00 4910188 R COAG FACTOR X-MAYO 60.00 4910212 MANGANESE-MAYO 289.00 4910220 HEPATITIS B SURFACE AB QNT-NI 38.50 4910261 IGF 1 SOMATOMEDIN C-MAYO 19.94 4910303 CYSTICERCUS IGG AB-MAYO 74.60 4910311 CYSTICERCUS AB CSF -MAYO 78.00 4910360 MICROSPORIDIA SPORE DETECT-MRL 94.50 4910394 FUNGAL SUSCEPTIBILITY MIC-1-MRL 130.00 4910410 VITAMIN B2,RIBOFLAVIN-MAYO 23.19 4910444 VITAMIN B6-MAYO 143.51 4910469 PEROXISOMAL PANEL(VLCFA(-MAYO 57.04 4910527 METHYLMALONIC ACID,URINE-MAYO 25.00 4910535 INHIBIN-NI 73.50 4910584 CARNITINE LEVEL, URINE-MAYO 62.46 4910659 CMV DNA,PCR-MRL 149.35 4910691 AEROBIC MIC,CUSTOM, 1 DRUG-MRL 74.70 4910766 MYASTHENIA GRAVIS PNL ADULT-MAYO 40.00 4910790 LIPOPROTEIN A-MAYO 37.14 4910832 LEUKOCYTE ALKALINE PHOS-MAYO 86.60 4910865 FACTOR VIII ACTIVITY-UCI 57.00 4910873 FACTOR VIII INHIBITOR-UCI 110.00 4910899 FACTOR VIII INHIBITOR PANEL-MAYO 373.46 4910915 HCV DNA GENOTYPING-MAYO 136.59 4910980 FLECANIDE-MAYO 66.71 4911046 HCV RNA DECT/QUANT,S-MAYO 88.50 4911079 GQ1B IGG ANTIBODY-MRL 148.50 4911087 ASCA, ANCA AB-PROM 415.00 4911095 SPECIAL STAINS, GROUP II-CS 39.10 4911129 SKELETAL MUSCLE BX ANALYSIS-LBM 564.75 4911145 FATTY ACID PROFILE-MAYO 91.62 4911228 ALDOSTERONE,SERUM-NI 81.50 4911236 RENIN ACTIVITY,PLASMA-NI 49.00 4911293 R FERRITIN-MAYO 53.55 4911319 BCR/ABL RN QT-MAYO 90.00 4911327 HEXAGONAL PHOSPHOLIPID PTT-NI 42.04 4911335 DRVVT CONFIRMATION-NI 42.04 4911350 ORGANIC ACIDS QNT,URINE-NI 569.34 4911400 BETA 2 GLYCOPROTEIN 1 AB-MAYO 50.00 4911442 FUNGAL SUSCEPT CUST MIC 2-MRL 167.11 4911459 M AVIUM-INTRAC MIC PANEL-MRL 140.40 4911467 STREP PNEUMO ANTIGEN,LA-MRL 74.70 4911475 NEURON SPECIFIC ENOLASE,CSF-MAYO 13.21 4911483 JC VIRUS DNA-MAYO 74.68 4911525 COCAINE QNT,CONFIRM-NI 43.57 4911533 METHADONE CONFIRMATION-NI 49.00 4911541 PROPOXYPHENE CONFIRMATION-NI 49.00 4911574 BENZODIAZEPINES,URINE QT-NI 52.43 4911756 BARBITURATES,U,QL,CONF-NI 44.40 4911764 AMPHETAMINES,UR,QNT-NI 124.06 4911798 OPIATES,U,QL,CONF-NI 44.70 4911871 IN SITU HYBRIDIZATION-MAYO 50.00 4911897 CYTOGENETICS REPORT-MAYO 50.00 4911947 MTHF REDUCTASE-QUEST 153.50 4911962 BILE ACIDS-NI 150.00 4911988 VON WILLEBRANDS MULTIMER 33.00 4912028 MEM VIRAL AB EVAL CSF-MRL 278.25 4912044 COBALT-NI 101.15 4912051 CADMIUM-MAYO 37.50 4912077 RISTOCETIN COFACTOR-MAYO 40.00 4912085 VON WILLEBRAND FACTOR AG-MAYO 30.00 4912200 CRP-HIGH SENSITIVITY-MAYO 23.25 4912218 ANGIOTENSIN CONV ENZ,CSF-MAYO 76.50 4912226 CMV BY PCR,URINE-MAYO 65.78 4912259 E COLI 0157 H7 SEROTYPING-MRL 60.30 4912317 FUNGAL SUSCEPT CUST MIC,3-MRL 320.40 4912358 VARICELLA ZOSTER AB-MAYO 16.80 4912366 R PROTEIN ELECTROPHORESIS-MAYO 14.21 4912374 HEMOGLOBIN A1C-MAYO 9.41 4912408 LEUK/LYMPHOMA CONSULT-MAYO 48.95 4912416 LEUK/LYPHM FLOW/C-MAYO 37.15 4912432 LEUKEMIA PHENOTYPE ACUTE-MAYO 128.80 4912465 HYPERCOAG PANEL-MAYO 789.42 4912473 SYPHILIS,IGG-MAYO 18.94 4912499 H PYLORI AG,FECE-QUEST 102.30 4912507 SELENIUM-MAYO 12.10 4912549 BORON - NI 71.00 4912564 R ECHOVIRUS AB PANEL-MRL 25.38 4912580 PTH RELATED PEPTIDE-MAYO 10.73 4912606 PROT.ELECTROPH,URINE-MAYO 33.94 4912614 MYCOPLASMA PNEUMO,CULTURE-MRL 99.00 4912648 LEVETIRACETAM(KEPPRA)-MAYO 12.91 4912655 CMV QUANT BY PCR,PLASMA-MAYO 354.20 4912689 HEPARIN PF4 AB-MAYO 42.48 4912713 B BURGDORFER DNA,PCR-MRL 268.20 4912739 14-3-3 PROTEIN-MAYO 106.08 4912754 FOLATE,RBC-MAYO 52.50 4912762 FUNGAL IDENTIFICATION-MRL 91.80 4912788 LYMPHOCYTE CHROMOSOMES A-GCTR 245.00 4912796 LYMPHOCYTE CHROMOSOMES B-GCTR 166.00 4912804 LYMPHOCYTE CHROMOSOMES C-GCTR 37.00 4912812 LYMPHOCYTE CHROMOSOMES D-GCTR 28.00 4912838 CMV PCR, SERUM-MAYO 62.00 4912846 TRILEPTAL (OXYCARB)-MAYO 21.23 4912887 HLA CLASS II TYPING-MAYO 132.17 4912911 MYCOBACTERIA PCR,CSF-NI 144.41 4912937 FTA-ABS IGG AND TPI-MAYO 72.85 4912945 IMMUNE COMPLEX PNL-MRL 277.20 4912952 HSV 1/2 DNA,PCR-MRL 292.50 4912960 E COLI SHIGA LIKE TOX-MRL 118.80 4912978 HSV 1/2 TYPING,IGG-MRL 186.30 4912986 BARTONELLA AB PNL-MRL 206.10 4913018 IBD P_ANCA_IFA PERINUCLR-PROM 41.00 4913026 83520 PROMETHEUS-PROM 63.75 4913109 VWD VON WILLEBRAND PANEL-MAYO 70.00 4913166 DIHYDROHDMN MYRISTATE ACETATE-MAYO 111.63 4913190 BABESIA MICROTI IGG-MAYO 40.35 4913216 COXIELLA BURNETII AB-MRL 129.60 4913240 FEBRILE AGGLUTININS-QUEST 29.29 4913257 IGF II-NI 98.60 4913265 IBD SG1 DIAGNOSTIC-PROM 35.00 4913273 IBD P_ANCA_DNASE-PROM 135.00 4913299 CAMPYLOBACTER J AB-NI 58.43 4913323 MOTOR NEUROPATHY PANEL-MRL 236.85 4913349 FUNGUS ANTIBODY PANEL,SERUM-NI 312.30 4913364 SENSORY NEUROPATHY PNL-MRL 471.60 4913422 ECHNIOCOCCUS IGG AB-MRL 153.00 4913430 ECHOVIRUS AB PANEL-MRL 123.30 4913471 HANTA VIRUS AB(IGG,IGM)-MAYO 86.86 4913489 MYCOPLASMA DNA,PCR-QUEST 161.50 4913505 EPSTEIN BARR(EBV)DNA,PCR-MRL 268.20 4913521 BETA 2 MICROGLOBULIN,CSF-MRL 94.50 4913547 ANTI NEURONAL AB SERUM CSF-MRL 159.30 4913570 B 2 MICROBLOGULIN,SERUM-MAYO 10.61 4913596 THYROTROP RECEPT AB-MAYO 26.00 4913638 PARAINFLUENZA VIRUS AG-DFA-QUEST 75.00 4913653 ASPERGILLUS AB-MRL 41.00 4913661 BLASTOMYCES AB-MRL 25.33 4913679 COCCIDIOIDES AB-MRL 40.80 4913687 CRYPTOCOCCUS AB-QUEST 84.27 4913695 HISTOPLASMA AB-MRL 40.80 4913703 CRYPTOCOCCUS AB, EIA-MRL 24.00 4913729 VIRAL CULTURE COMPREHENS-MRL 232.20 4913778 AFB,M.AV/INTRACELL MIC X7-MRL 352.80 4913786 CHROMOSOMES SPECIAL BANDING-GCTR 15.00 4913794 MYCOPHENOLIC ACID-MAYO 28.35 4913828 IMMUNOHISTOCHEMISTRY-USLABS 58.00 4913877 HEMOSIDERIN,URINE-MAYO 36.67 4913885 CYLIC CITRULLINATED PEPTD-MAYO 13.80 4913893 COMPLEMENT C1Q-MAYO 40.47 4913901 RAJI CELL IMMUN COMPLEX-MAYO 61.01 4913919 N-TELOPEPTIDE,SERUM-MAYO 70.00 4913943 METHYL ALCOHOL-MAYO 70.09 4913950 GAMMAHYDROXY BUTYRATE-MAYO 98.50 4914057 ANTI SS DNA-QUEST 130.25 4914073 CUTANEOUS IMMUNOFLUORSNCE-MAYO 64.46 4914081 COAG FACTOR XIII-MAYO 64.60 4914107 PLASMINOGEN ACTIVITY-MAYO 59.37 4914115 ALPHA 2 ANTIPLASMIN-MAYO 71.65 4914123 FRANCISELLA ANTIBODY-MAYO 125.00 4914172 AMNIOTIC L/S RATIO-UCI 50.00 4914180 AMNIOTIC FLUID P/G-UCI 46.00 4914198 AMNIOTIC FLM-UCI 39.00 4914214 FACTOR II ASSAY-UCI 65.00 4914222 FACTOR IX ASSAY-UCI 52.00 4914248 FACTOR VII ASSAY-UCI 88.00 4914255 FACTOR VIII ASSAY-UCI 52.00 4914271 FACTOR XI ASSAY-UCI 88.00 4914289 FACTOR XII ASSAY-UCI 88.00 4914297 FACTOR XIII QUALITATIVE-UCI 30.00 4914305 BARBITURATES CONFIRM-UCI 18.00 4914313 BENZODIAZEPINES CONFIRM-UCI 63.95 4914321 COCAINE METABOLITE CONFIRM-UCI 18.00 4914339 PROPOXYPHENE CONFIRM-UCI 18.00 4914347 OPIATES CONFIRM-UCI 63.95 4914354 THC CONFIRM-UCI 63.95 4914362 PHENCYCLIDINE CONFIRM-UCI 18.00 4914388 METHOTREXATE-UCI 17.00 4914396 POTASSIUM,FECES-MAYO 36.14 4914404 SODIUM,FECES-MAYO 36.17 4914412 CRYPOPORIDIUM,ISOSPORA DFA-MRL 126.90 4914438 TISSUE CULTURE-MAYO 280.49 4914446 DNA PROBE-MAYO 312.22 4914453 IN SITU HYBRIDIZATION-MAYO 312.22 4914461 INTERPRETATION,REPORT-MAYO 312.22 4914479 ELECTROLYTES,FECES-MAYO 16.20 4914495 HSV & VZV DNA,PCR,DERMAL-MAYO 115.81 4914511 ZONISAMIDE-MAYO 54.30 4914537 RUBEOLA AB SCREEN,IGG-MAYO 13.45 4914545 AMPHETAMINE CONFIRMATION-UCI 63.95 4914552 METHADONE CONFIRMATION-UCI 18.00 4914560 HIV P24 ANTIGEN-MAYO 247.78 4914586 CMV RAPID PCR,URINE-MAYO 66.89 4914594 GUADIN,IGA ANTIBODIES-MAYO 29.74 4914602 ENDOMYSIAL IGA AB-MAYO 20.00 4914628 LEAD WITH DEMOGRAPHICS-MAYO 8.00 4914636 PROCAINAMIDE PLUS NAPA-MAYO 26.91 4914651 AMIKACIN-UCI 18.00 4914669 COXSACKIE&ENTERO CSF PCR-MAYO 65.59 4914677 EPSTEIN BARR PCR-MAYO 50.00 4914693 COXSACKIE A ANTIBODY-MAYO 94.00 4914719 STRONGYLOIDES IGG AB-MAYO 40.25 4914727 COAG FACTOR XI-MAYO 60.00 4914735 COAG FACTOR XII-MAYO 60.00 4914750 DNASE ANTIBODIES-NI 34.00 4914776 HEPATITIS E IGG,IGM AB-NI 88.50 4914784 RENAL BX LIGHT MICROSCOPY-CS 52.15 4914792 RENAL BX ELECTRON MICROS-CS 631.13 4914800 RENAL BX IMMUNOFLUORESCENCE-CS 248.00 4914818 ROTAVIRUS ANTIGEN-NI 49.50 4914826 IMMUNOFIXATION SERUM-MAYO 15.76 4914834 AMINO ACID QN ION EXC,P-MAYO 100.00 4914842 COLORADO TICK FEVER AB-MAYO 78.40 4914859 DNA PROBE,MOLECULAR CYTOGEN-GCTR 122.00 4914891 IMMUNOHISTOCHEM STAIN-LABC 40.00 4914909 IMAGE ANALYSIS-ADPL 55.00 4914941 FTA IGM AB-MAYO 50.31 4915047 STREPTOCOCCAL ANTIBODIES-MAYO 21.98 4915062 HYPOGLYCEMIC SCREEN-MAYO 90.00 4915070 HTLV I/II AB-MAYO 20.03 4915088 ENTEROVIRUS DETECT,PCR-MRL 250.29 4915096 HERPES VIRUS 6 DNA,PCR-MRL 268.20 4915104 V ZOSTER DNA,PCR-MRL 268.20 4915153 ENTEROVIRUS AB PANEL 2-MAYO 247.85 4915161 WEST NILE VIRUS RNA,PCR-MAYO 268.20 4915187 MYCOPLASMA AB CF CSF-MRL 72.90 4915195 IMMUNE COMPLEX DETECTION 1-NI 118.50 4915203 HEPATITIS E IGM AB-NI 76.06 4915229 VITAMIN K1-NI 105.00 4915237 ANTI SM/RNP AB-NI 26.00 4915260 KAPPA/LAMBDA LT CHAINS-MAYO 14.95 4915286 COPPER,URINE-MAYO 12.66 4915302 PROTEINASE 3 AB(PR3)-MAYO 37.90 4915328 PAP CYTOLOGY-ADPL 22.00 4915351 MONOCLONAL PROTEIN STUDY-MAYO 16.00 4915401 DRUG SCREEN, COMPREHENSIVE-UCI 104.00 4915435 WEST NILE VIRUS AB,S IGG-MRL 32.47 4915443 WEST NILE VIRUS AB,CSF IGM-MRL 35.02 4915468 COMP C1 ESTERASE INHIB-MAYO 43.98 4915526 CHROMATIN AB-NI 44.50 4915567 RIBOSOMAL P ANTIBODY-NI 53.00 4915609 HEPATITIS BE AG-MAYO 17.04 4915617 CSF IGG INDEX-MAYO 9.63 4915625 MYELIN BASIC PROTEIN-MAYO 60.75 4915633 OLIGOCLONAL BANDS-MAYO 23.00 4915641 PLASMA METANEPHRINES-MAYO 13.61 4915658 HSV AB SCRN,IGM,E1A CHG1-MAYO 7.61 4915724 HEAVY METALS, URINE-MAYO 11.79 4915732 ACYLCANRITINES,QNT-MAYO 53.03 4915740 ACYLGLYCINES,QNT-MAYO 141.84 4915955 HSV AB,IGM,S BY IFA(CONFIRM)-MAYO 15.99 4915963 PROTEIN C ACTIVITY-MAYO 25.09 4915971 FLOW CYTOMETRY,FIRST MARKER-MAYO 24.54 4915989 FLOW CYTOMETRY,ADDED MARKERS-MAYO 21.46 4916037 CHLAMYDIA,GC RAPID PCR-MAYO 17.35 4916045 TORCH PANEL,IGG-MAYO 91.61 4916102 NB SCREEN COLLECTION-LB 7.00 4916136 TOXOPLASMA DNA,PCR-MRL 268.20 4916144 SALMONELLA TYPHI AB-NI 46.50 4916151 CYLCOSPORINE-UCI 45.00 4916169 PYRUVIC ACID-MAYO 62.96 4916177 H PYLORI IGG,IGM,IGA AB-MAYO 62.30 4916185 INFLUENZA A/B, PCR-MAYO 72.05 4916201 ARGININE VASOPRESSIN-MAYO 51.04 4916227 HIV DETECTION PANEL CSF-MRL 280.80 4916235 GAD65 ANTIBODY-MAYO 22.75 4916276 PATH VIS,MORPH ANALYSIS-USLABS 112.50 4916284 HIV 1 GENOTYPING-MAYO 543.78 4916334 RETICULIN AB-MAYO 18.07 4916375 TISSUE CULTURE-MAYO 423.24 4916383 CHROMOSOME ANALYS E KARYOTYPES-MAYO 423.24 4916391 CHROMOSOMES INTERP/RPT-MAYO 41.48 4916417 MUSCLE BX SPECIAL STAINS-LBM 97.75 4916508 COCCI ID IGG & IGM-UCDAVIS 36.00 4916516 COCCIDIOIDES CF-UCDAVIS 44.00 4916672 INFLUENZA A IGG,IGM AB-MAYO 16.02 4916680 INFLUENZA B IGG,IGM AB-MAYO 14.34 4916698 B PERTUSSIS RAPID PCR-MAYO 35.00 4916706 SIROLIMUS B-MAYO 21.18 4916755 SACCHAROMYCES CER IGG AB-MAYO 70.39 4916797 IN SITU HYBRD 10:30 CELLS-GCTR 122.00 4916805 CYTOGENETICS INTERPRET-GCTR 40.00 4916821 NICOTINE & METABOLITE,U -MAYO 26.04 4916839 17 HYDROXY PREGNENOLONE-MAYO 69.59 4916953 TISSUE TRANSGLUTAMASE IGG AB-MAYO 15.00 4916995 DENGUE FEVER IGG,IGM AB-MAYO 102.75 4917019 MULTIPLE SCLEROSIS PANEL-MAYO 104.01 4917076 PRO PREDICT METABOLITES-PROM 270.00 4917134 RBC FRAGILITY-MAYO 85.00 4917159 ENTEROVIRUS RAPID PCR-MAYO 69.53 4917183 PROTEIN S ACTIVITY-MAYO 33.24 4917191 MENIGITIS,ASEPTIC,CSF-MRL 733.50 4917209 RIBOSOME P AB,IGG-MAYO 41.55 4917225 VASOACT INT POLYPETIDE-MAYO 50.00 4917241 DRUG SCREEN ON MECONIUM-MAYO 30.93 4917258 CYSTATIN C-MAYO 41.46 4917290 ADENOVIRUS DFA-MRL 95.40 4917308 MORPHOMETRIC ANALYSIS,EA AB-USLABS 73.00 4917316 ADENOSINE DEAMINASE,FL-MAYO 120.00 4917324 BK VIRUS DNA,PCR-MAYO 55.99 4917332 CHLAMYDIA/GC DNA PROBE-MAYO 39.00 4917340 THYROGLOBULIN ANTIBODY-MAYO 19.25 4917357 HIV 1 AB IFA ASSAY-MAYO 19.75 4917365 HIV AB TYPE 2 EIA-MAYO 59.36 4917373 INTERLUKIN 5-MAYO 54.80 4917399 MS PROFILE-MAYO 10.00 4917415 TESTOSTERONE-ESTRX 41.00 4917464 T3 UPTAKE-MAYO 12.89 4917472 HEPATITIS A AB,IGG,IGG-MAYO 15.90 4917522 MUMPS AB,IGG,IGM-MAYO 25.00 4917563 LYMES DISEASE AB,RFLX WB-NI 23.60 4917589 SERTRALINE (ZOLOFT)-MAYO 70.84 4917621 HER 2/NEU QUANTITATIVE-MAYO 156.81 4917647 TISSUE TRANSGLUTAMINASE IGA AB-MAYO 15.00 4917688 TOXOPLASMA DNA,PCR,CSF-MAYO 89.51 4917696 ALPHA GLOBIN GENE ANALYSIS-MAYO 319.86 4917753 LATEX ALLERGEN,IGE-MAYO 4.50 4917829 PATH CONSULT,REPORT-MAYO 190.19 4917845 PNEUMOCOCCAL IGG AB-MAYO 11.12 4917852 NEUROMYELITIS OPTICAL AB-MAYO 169.70 4917860 CORTISOL LEVEL-ESTRX 37.00 4917902 MUMPS AB,IGG/IGA,IFA-MRL 133.20 4917936 NB METABOLIC SCREENING PANEL-LB 141.25 4917951 HIV P24 (ICD) ANTIGEN-MRL 198.00 4918025 A1 ANTITRYPSIN GENOTYPE-MAYO 239.98 4918041 BILE ACIDS,TOTAL-MAYO 40.28 4918082 CRMP 5IGG WESTERN BLOT-MAYO 120.30 4918090 HEMOCHROMATOSIS HFE GENE-MAYO 70.00 4918116 HEP B VIRAL DNA,QUANT-MAYO 142.00 4918124 NIACIN-MAYO 85.00 4918132 PARANEOPLASTIC EVAL-MAYO 26.75 4918173 LUPUS PNL 83516-NI 36.00 4918207 COPPER RBC(WHOLE BLOOD)-NI 37.50 4918215 MYCOPLASMA DNA,PCR-MAYO 186.01 4918223 LUPUS PNL 83520-NI 36.00 4918231 ANA IFA SCREEN W/REFLEX TITER-NI 36.50 4918249 LUPUS PNL 86160-NI 36.00 4918256 LUPUS PNL 86235-NI 36.00 4918264 LUPUS PNL 86255-NI 36.00 4918330 CHOLESTEROL, VAP-MAYO 27.50 4918348 LP-PLA2-PAYO 150.00 4918355 HIV1 PROVIRAL DNA BY PCR-MAYO 50.00 4918363 ALLERGEN,INDIVIDUAL,ICG-NI 18.50 4918439 LACTOFERRIN DETECTION,FECAL-MAYO 91.22 4918454 THIOPURINE METHYLTRANSFERATE-MAYO 73.02 4918488 VARICELLA ZOSTER,RAPID PCR-MAYO 60.00 4918496 PARAINFLUENZA DFA-MRL 145.00 4918504 APOLIPOPROTEIN B-MAYO 17.00 4918538 HEP B DNA PCR, QNT,SERUM-MAYO 85.00 4918611 JC VIRUS DNA BY PCR-MAYO 75.00 4918629 FLOW CYTOMETRY AT-NGLABS 91.00 4918637 FLOW CYTOMET,ADDL MARKERS-NGLABS 15.00 4918645 FLOW INTERP 2-8 MARKERS-MAYO 76.00 4918652 FLOW INTERP 9-15 MARKERS-MAYO 121.00 4918660 FLOW INTERP 16+ MARKERS-NGLABS 145.70 4918678 TISSUE CULT AT-NGLABS 120.00 4918686 CYTOGENETICS AT-NGLABS 160.00 4918694 ADDED KARYOTYPES AT-NGLABS 35.00 4918702 ADDED CELL CT AT-NGLABS 33.00 4918710 TISSUE CULT NO GROWTH-NGLABS 90.00 4918728 CONSULT-NGLABS 188.00 4918736 IHC STAINS TC AT-NGLABS 35.00 4918744 INITIAL KARYOTYPES AT-NGLABS 70.00 4918777 LYME DISEASE ABS (IGG,IGM)-MAYO 100.00 4918785 T3 UPTAKE-MAYO 11.00 4918793 ORGANIC ACID SCREEN URINE-MAYO 52.54 4918819 ANCA VASCULITIDES-MAYO 9.47 4918835 ACETYLCHOLINE RCPT MOD AB-MAYO 107.00 4918850 VALPORIC ACID, FREE & TOTAL-MAYO 54.28 4918868 ACTIN ANTIBODY IGG 34.20 4918876 ADENOVIRUS DNA QNT PCR-MAYO 65.00 4918918 PNEUMOCCAL ANTIBODY TITER-MAYO 123.78 4918934 COXSACKIE B AB PANEL,CSF-MRL 134.10 4918942 ECHOVIRUS AB,CSF-MRL 132.30 4918975 CALIF ENCEPHALITIS AB,IFA,CSF-MRL 81.00 4918983 EAST EQUINE ENCHPHLTS AB,IFA,CS-MRL 144.00 4918991 ST LS ENCEPHALITIS AB,IFA,CSF-MRL 159.30 4919007 WEST EQUINE ENCHEPH IGG/IGM,CSF-MRL 172.80 4919023 FLOW CYTOMETRY ADDL MARKERS A-MAYO 24.00 4919049 FLOW CYTOMETRY ADDL MARKERS C-MAYO 14.37 4919056 FLUORES NONINFECTIOUS AGENT AB-MAYO 95.40 4919064 IMMUNOASSAY QNT NOT SPECIFIED-MAYO 112.95 4919072 PLASMINOGEN ACT INHIB AG-MAYO 150.85 4919114 PORPHYRIN PROFILE PLASMA-MAYO 32.30 4919122 SOLUBLE TRANSFERRIN RECPT-MAYO 29.00 4919130 HEPARIN LOW MOLECULAR WT-UCI 60.00 4919148 PROTEIN S AG,TOTAL-MAYO 22.06 4919155 TOXOCARA CANIS AB-MRL 137.20 4919163 HIV1 RNA QUANT RT PCR-NI 291.00 4919171 BETA-2 TRANSFERRIN,FLD-MAYO 81.97 4919189 TUMOR NECROSIS FACTOR-MAYO 155.38 4919213 FISH PROBE-NGLABS 191.00 4919221 ENTEROCOCCUS RNA RT PCR,QL-MRL 250.29 4919239 HSV 1/2 DNA,RT PCR-MRL 292.50 4919346 ADAM TS13 ACT INHIBIT-MAYO 132.60 4919353 CORTISOL,SALIVA-MAYO 53.47 4919361 PROTNHEMADSORPTION/HEMAGLUTIN-MAYO 42.33 4919379 VIRAL SMEAR,SHELL VIAL-MAYO 46.90 4919395 VWFACTOR COLLAGEN BIND-MAYO 110.00 4919411 VORICONAZOLE-MAYO 64.05 4919429 DIPHTHERIA IGG AB-MAYO 30.38 4919437 TETANUS IGG AB-MAYO 31.38 4919445 SEROTONIN,24HR URINE-MAYO 30.00 4919452 TOTAL T4-MAYO 54.60 4919460 ALPHA FETOPROTEIN L3% - MAYO 90.00 4919510 ANTITHROMBIN AG,PLASMA-MAYO 33.67 4919544 CALPROTECTIN,STOOL-MAYO 100.00 4919569 MUSK AB-MAYO 550.00 4919577 ANA, FLUID-MAYO 85.00 4919585 ERYTHROPOIETIN-MAYO 12.00 4919619 QUANTIFERON TB GOLD-NI 240.00 4919627 GONADOTROPIN RELEASING HORMONE-MAYO 250.00 4919643 TPMT,QNT HPLC-PROM 110.00 4919650 TPMT,ENZYME ACTIVITY-PROM 110.00 4919668 T.PALLIDUM DNA,PCR-MRL 268.20 4919676 FUNGITELL ASSAY1,3 B D GLUCANS-MAYO 143.00 4919684 PROCOLLAGEN TYPE 1-MAYO 200.41 4919700 INTERLUKIN 6-MAYO 130.00 4919783 IBD SGI PANEL CHG01-MAYO 203.00 4919791 IBD SGI PANEL EIA-MAYO 50.00 4919809 ANTITHROMBIN ACTIVITY-MAYO 21.22 4919817 LEGIONELLA PCR-MAYO 91.00 4919825 ASPERGILLUS AG GALACTOMANNAN-MAYO 50.00 4919833 COENZ Q10 REDUCED & TOT-MAYO 136.68 4919874 HSV CULTURE RAPID METHOD-NI 33.50 4919882 IMMUNE CELL FUNCTION-NI 275.00 4919890 CIC PANEL IMMUNE COMPLEX-MAYO 120.00 4919908 CIC PANEL CHG2-MAYO 31.09 4919916 ASCEPT MENINIGITIS PHL CHG1-MRL 38.60 4919924 ASCEPT MENINIGITIS PNL CHG2-MRL 38.61 4919932 ASCEPT MENINIGITIS PNL CHG3-MRL 38.61 4919940 ASCEPT MENINIGITIS PNL CHG4-MRL 38.61 4919957 ASCEPT MENINIGITIS PNL CHG5-MRL 38.63 4919965 DILANTIN FREE & TOTAL-MAYO CHG 1 12.65 4919973 MENINGOENCAPHALITIS CFS CHG1-MRL 23.17 4919981 MENINGOENCEPHALITIS CFS CHG2-MRL 22.54 4919999 MENINGOENCEPHALITIS CFS CHG3-MRL 23.53 4920005 MENINGOENCEPHALITIS CFS CHG4-MRL 23.53 4920013 MENINGOENCEPHALITIS CSF CHG5-MRL 23.53 4920021 MENINGOENCEPHALITIS CSF CHG6-MRL 23.54 4920039 MENINGOENCEPHALITIS CSF CHG7-MRL 23.54 4920047 MENINGOENCEPHALITIS CSF CHG8-MRL 23.54 4920054 MENINGOENCAPHALITIS CFS CHG9-MRL 23.54 4920070 R LAMBERT EATON AUTOANTIBODY-MAYO 13.66 4920088 MYASTHENIA GRAVIS ADULT-MAYO 41.92 4920096 ARSENIC,URINE-MAYO 35.63 4920112 CMV IGG/IGM CHARGES-MAYO 9.08 4920120 TOXOPLASMA A GONDII PCR,CSF-MAYO 104.40 4920138 DOXEPIN/NORDOXEPIN-MAYO 20.74 4920153 RNP IGG AB 81357-MAYO 18.26 4920161 FCL CHLORIDE,FECES-MAYO 35.90 4920179 CELIAC DISEASE ANTIBODY,FOCUS B-MRL 84.29 4920187 TIAGABINE 82524-MAYO 54.02 4920195 HYPERSENSITIVE PNEUMO IGG-MAYO 13.45 4920203 HIV 2 AB IBL-MAYO 101.69 4920211 MS PROFILE CHARGE1-MAYO 10.00 4920229 MS PROFILE CHARGES2-MAYO 15.00 4920237 MS PROFILE CHARGE3-MAYO 15.00 4920245 SENSORY AND MOTOR NEUROP 01-MAYO 50.10 4920252 SENSORY AND MOTOR NEUROP 02-MAYO 50.09 4920260 SEROTONIN RELEASE, UF HEPARIN-MAYO 295.00 4920278 SEROTONIN RLS, LLMW HEPARIN-MAYO 295.00 4920302 IMMUNOHISTO AB-CLARIENT 57.58 4920310 IMMUNOHIST TUMOR-CLARIENT 92.75 4920435 5 CELLS, 1 KAROTYPE-NGLABS 209.00 4920443 THIAMINE,VITAMIN B1-MAYO 32.00 4920450 MYCOPLASM PNEUM CULT-QUEST 45.23 4920468 ROTAVIRUS AG,FECES-MAYO 45.79 4920476 PROINSULIN,PLASMA-MAYO 30.00 4920484 INTRINSIC FAC BLK AB-MAYO 21.21 4920492 BK VIRUS DNA PCR,U -MAYO 35.80 4920500 SEROTONIN,S-MAYO 47.38 4920518 ENTEROVIRUS,PCR-MAYO 65.59 4920526 WARFARIN,SERUM-MAYO 38.00 4920534 EBVIRUS,DNA,QNT,PCR-MAYO 84.68 4920542 BARTONELLA,PCR,BLD-MAYO 144.08 4920559 ERYTHROPOIETIN,S-MAYO 14.62 4920567 HSV,RAPID,PCR-MAYO 46.10 4920575 INSULIN AB,S-MAYO 43.07 4920591 FUNGAL AB PANEL 86606-MRL 41.00 4920609 FUNGAL AB PANEL 86612-MRL 40.80 4920617 FUNGAL AB PANEL 86628-MRL 40.80 4920625 FUNGAL AB PANEL 86635-MRL 40.80 4920633 FUNGAL AB PANEL 86698-MRL 40.80 4920641 COAG CONSULT PROTIME-MAYO 40.00 4920658 COAG CONSULT PTT-MAYO 40.00 4920666 COAG CONSULT DRVV-MAYO 40.00 4920674 COAG CONSULT THROMBIN TIME-MAYO 40.00 4920682 COAG CONSULT FIBRINOGEN-MAYO 40.00 4920690 COAG CONSULT D DIMER-MAYO 40.00 4920708 COAG CONSULT PROT C ACTIVITY-MAYO 40.00 4920716 COAG CONSULT PROT S AG,FREE-MAYO 40.00 4920724 COAG CONSULT AT III ACTIVITY-MAYO 40.00 4920781 COAG CONSULT ACTPROT RESIST V-MAYO 40.00 4920799 CMV PCR, FLUIDS-MAYO 60.00 4920807 PYRIDINIUM COLL XLINK, UR-MAYO 122.35 4920815 HIV 1 QUANTITATIVE PCR-MAYO 85.00 4920823 T SPOT TB TEST-OXFORD 52.00 4920831 PAP SMEAR LIQUID PREP-ADPL 24.50 4920849 JO 1 ANTIBODIES, IGG-MAYO 18.26 4920856 COAG FACTOR II ACTIVITY-MAYO 64.62 4920864 COAG FCTR VIII ACTVTY ASSY, PL-MAYO 50.00 4920906 SPINAL FLUID INDEX CHG-MAYO 9.60 4920922 ZONIZAMIDE-MAYO 51.36 4920948 SEX HORMONE BINDING GLOBULIN-MAYO 20.00 4920955 COXSACKIE A AB PANEL, SERUM-QUEST 8.50 4920963 COXSACKIE A AB PANEL,SERUM-QUEST 8.50 4920971 COXSACKIE B AB PANEL,SERUM-QUEST 10.67 4920989 COXSACKIE B AB PANEL,SERUM-QUEST 10.67 4920997 ADRENAL ANTBDY(21 HYDROXYLS AB-MAYO 55.00 4921003 DRUG SCR PRESCRIPT OTC,PLASMA-MAYO 61.35 4921011 POLIOVIRUS AB,NEUTRALIZATION-NI 74.12 4921029 TORCH PROFILE IGG CMV-MAYO 11.00 4921037 TORCH PROFILE IGG HSV1-MAYO 9.26 4921045 TORCH PROFILE IGG HSV2-MAYO 11.00 4921052 TORCH PROFILE IGG RUBELLA-MAYO 11.00 4921060 TORCH PROFILE IGG TOXO-MAYO 11.00 4921078 HIV GENOTYPE DRUG RESISTANCE-MAYO 400.00 4921086 HCV FIBROSURE CHG1-MAYO 322.81 4921094 HCV FIBROSURE CHG2-MAYO 40.00 4921102 HCV FIBROSURE CHG3-MAYO 40.00 4921110 HCV FIBROSURE CHG4-MAYO 40.00 4921128 HCV FIBROSURE CHG5-MAYO 40.00 4921136 HCV FIBROSURE CHG6-MAYO 40.00 4921144 BCR/ABL FISH STUDY 88271-MAYO 87.03 4921151 BCR/ABL FISH STUDY 88275-MAYO 88.00 4921169 BONE ALKALINE PHOSPH,S-MAYO 14.90 4921177 PROPHYRINS, 24 HR QUANT-MAYO 8.61 4921185 AMINOLEVULONIC ACID, UR-MAYO 70.24 4921193 HISTAMINE-MAYO 130.00 4921201 TOXOPLASMA IGG IGM ANTIBODY-MAYO 15.36 4921219 PREGNENOLONE,SERUM-MAYO 65.83 4921227 CHLAMYDIA GROUP AB-MAYO 12.78 4921235 EBV AB PROFILE-MAYO 5.00 4921243 PARANEOPLASTIC AUTO1-MAYO 34.00 4921250 PARANEOPLASTIC AUTO2-MAYO 34.00 4921268 MYCOPLASMA PCR-MAYO 150.00 4921276 HSV TYPE 1 AB,IGG CHG2-MAYO 7.00 4921284 HSV TYPE 2 AB,IGG CHG3-MAYO 7.00 4921292 WEST NILE VIRUS BY PCR,CSF-MAYO 60.00 4921300 NEURON SPECIFIC ENOLASE, SERUM-MAYO 25.00 4921318 HANTAVIRUS ANTIBODY-MAYO 59.12 4921326 BILE ACIDS, TOTAL, SERUM-MAYO 40.00 4921334 VAP CHOLESTEROL CHG1-MAYO 27.50 4921342 BETA HYDROXYBUTYRATE DEHYROGEN-MAYO 32.28 4921359 PARANEOPLASTIC AB EVAL-MAYO 35.00 4921367 FCLL CHRONIC LYMPH LEUKEMIA-MAYO 34.59 4921375 FCLL CLL FISH PANEL 1-MAYO 34.59 4921383 HEAVY METALS SCREEN,B CHG1-MAYO 15.67 4921391 HEAVY METALS SCREEN,B CHG2-MAYO 15.66 4921409 HEAVY METALS SCREEN,B CHG3-MAYO 15.66 4921417 POC CHROMOSOMAL ANALYSIS CHG1-MAYO 160.00 4921425 ACID FAST BACTERIA (MTB) PCR-MAYO 145.00 4921433 HSVP 1/2 PCR 87529-MAYO 45.00 4921441 ARBOVIRUS ANTIBODY PANEL, SERUM-MRL 78.08 4921458 ARBOVIRUS ANTIBODY PANEL,1-MRL 78.08 4921466 ARBOVIRUS ANTIBODY PANEL 2-MRL 78.08 4921474 ARBOVIRUS ANTIBODY PANEL,3-MRL 78.08 4921482 STREPTOZYME-MAYO 62.00 4921490 WEST NILE VIRUSAB,S IGM-MRL 32.47 4921508 WEST NILE VIRUS AB CSF IGG-MRL 35.02 4921524 ENDOMYCELIAL AB IGG A-MAYO 38.59 4921532 ARBOVIRUS AB PANEL,CSF CHG1-MRL 78.08 4921540 ARBOVIRUS AB PANEL,CSF CHG2-MRL 78.08 4921557 ARBOVIRUS AB PANEL,CSF CHG3-MRL 78.08 4921565 ARBOVIRUS AB PANEL,CSF CHG4-MRL 78.08 4921573 WESTERN EQUINE ENCEP,CSF-QUEST 84.15 4921581 HGB ELECTROPHORESIS-MAYO 17.79 4921599 HEPATITIS B VIRUS QT-MAYO 142.04 4921623 HEAVY METALS SCREEN,01-MAYO 11.79 4921631 HEAVY METALS SCREEN,02-MAYO 11.79 4921644 N GONORRHOEA,RNA-MAYO 17.35 4921649 HEAVY METALS SCREEN,3-MAYO 11.79 4921656 LEAD URINE-MAYO 30.89 4921664 NEISERRIA GC PCR CHARGE-MAYO 17.35 4921672 LACTOFERIN DETECTION STOOL-MAYO 100.00 4921680 ANCA VASCULIT 83876-MAYO 9.48 4921698 MEXILETINE-MAYO 86.47 4921706 RIBISOME P AB IGG-MAYO 10.73 4921714 INTRINSIC FACTOR BLOCKING AB,S-MAYO 22.48 4921722 IBD SGI 88350-MAYO 196.00 4921730 FREE LIGHT CHAIN,URINE-MAYO 29.17 4921763 CHROMATIN ANTIBODIES ELISA-MAYO 92.75 4921771 CHROMOGRANIN A,SERUM-MAYO 20.00 4921797 IMIPRAMINE-MAYO 19.00 4921805 IGG SUBCLASS PANEL-MAYO 8.20 4921813 IGG SUBCLASS PANEL 2-MAYO 10.14 4921854 FEBRILE AB PANEL CHARGE1-QUEST 29.29 4921862 FEBRILE AB PANEL CHARGE2-QUEST 29.29 4921912 SEROTONIN, SERUM-MAYO 30.00 4921920 ELECTROLYTES,FECAL 82438-MAYO 16.20 4921938 ELECTROLYTES,FECAL 83735-MAYO 16.20 4921946 ELECTROLYTES,FECAL 84302-MAYO 16.20 4921953 EHRLICHIA AB IGG/IGM-MRL 91.35 4921961 HIV2 AB 86702-MAYO 59.36 4921979 ALPHA 1 ANTITRYPSIN,FECES-MAYO 33.05 4921987 SS A, SS B IGG ANTIBODIES-MAYO 15.00 4921995 TORCH PANEL IGM 86694-MAYO 18.00 4922001 ASP FUMIGATUS IGG AB-MAYO 30.30 4922019 ARSENIC BLOOD-MAYO 203.70 4922027 TORCH PANEL IGM 86778-MAYO 19.00 4922035 MONOCLONAL PROTEIN STUDY 84155-MAYO 18.99 4922043 MONOCLONAL PROTEIN STUDY 84165-MAYO 15.76 4922050 CHROMOSOME ANALYSIS 88230-MAYO 65.00 4922068 CHROMOSOME ANALYSIS 88262-MAYO 55.00 4922076 CHROMOSOME ANALYSIS 88291-MAYO 55.00 4922084 MONOCLONAL PRTN URINE 84156-MAYO 17.00 4922092 MONOCLONAL PROTEIN URINE 84166-MAYO 17.00 4922100 CALCITONIN,SERUM-MAYO 20.00 4922118 EPSTEIN BARR VIRUS,PCR-MAYO 33.20 4922126 TACROLIMUS LEVEL -UCI 40.00 4922134 H1N1 VIRAL DNA BY PCR-MRL 268.20 4922142 H1N1 VIRAL DNA,PCR,CHG2-MRL 97.50 4922175 BK VIRUS PCR-MAYO 55.99 4922183 COBALT,SERUM-MAYO 61.28 4922191 CHLORDIAZEPOXIDE (LIBRIUM)-MAYO 68.46 4922209 CHROMOSOME STUDY TISSUE-MAYO 326.31 4922217 EAST EQUINE ENCEPH VRS AB,CSF-MAYO 69.30 4922241 HEPATITIS BE AG CHARGE-MAYO 18.06 4922266 VIRAL CULTURE NONRESPIRATORY-MAYO 44.45 4922274 THIAMIN VITB1-MAYO 9.93 4922282 VON WILLEBRAND CHG1-MAYO 70.00 4922290 VON WILLEBRAND CHG2-MAYO 60.00 4922308 THYROGLOBULIN TUMOR MKR CHG1-MAYO 10.67 4922316 TESTOSTERONE FREE/TOTAL-MAYO 14.20 4922324 T AND B CELL QT CHG1-MAYO 14.53 4922332 T AND B CELL QT CHG2-MAYO 18.16 4922340 T AND B CELL QT CHG3-MAYO 18.16 4922357 T AND B CELL QT CHG4-MAYO 18.16 4922365 ST.LOUIS ENCEPH VIRUS AB,S-MRL 59.04 4922373 ST.LOUIS ENCEPH VIRUS AB,CSF-MRL 77.40 4922381 SPINAL FLUID INDEX CHG2-MAYO 9.80 4922399 PSA FREE/TOTAL CHG1-MAYO 10.00 4922449 PROTEIN ELECTROPHORESIS S CHG-MAYO 12.63 4922456 PENTOBARBITAL SERUM-MAYO 50.58 4922464 PARIETAL CELL ANTIBODY-MAYO 26.18 4922472 MUMPS IGG/M AB CSF-MRL 68.40 4922480 MENINGOENCEPHALITIS PANEL S-MRL 70.38 4922498 MENINGOENCEPHALITIS PNL S CHG1-MRL 70.38 4922506 MENINGOENCEPHALITIS PNL S CHG2-MRL 70.38 4922514 MENINGOENCEPHALITIS PNL S CHG3-MRL 35.19 4922522 MENINGOENCEPHALITIS PNL S CHG4-MRL 35.19 4922530 MENINGOENCEPHALITIS PNL S CHG5-MRL 35.19 4922548 MENINGOENCEPHALITIS PNL S CHG6-MRL 35.19 4922555 MEM PNL SERUM CHG7-MRL 35.19 4922563 MENINGOENCEPHALITIS PNL S CHG8-MRL 35.19 4922597 PORPHYRINS PROFILE CHARGE-MAYO 71.05 4922605 ALDOSTERONE CORTISOL RATIO-NI 47.49 4922613 ALDOSTERONE CORTISOL RATIO CHG2-NI 47.49 4922621 KIDNEY STONE ANALYSIS-MAYO 11.79 4922639 IN SITU COMP ASSISTED-CLARIENT 230.53 4922647 IN SITU MANUAL ASSISTED-CLARIENT 200.92 4922654 HEMOGLOBIN AIC-UCI 18.00 4922662 STRONGYLOIDES AB,IGG 35.00 4922670 PLASMINOGEN INHIB ACTIVITY 1-MAYO 150.00 4922688 MTB QUANTIFERON GOLDTEST-MAYO 85.00 4922696 VITAMIN K1 LEVEL-MAYO 76.00 4922787 URINE SUPERSAT,SODIUM-MAYO 9.86 4922795 URINE SUPERSAT,POTASSIUM-MAYO 8.72 4922803 URINE SUPERSAT,CALCIUM-MAYO 12.22 4922811 URINE SUPERSAT,MAGNESIUM-MAYO 13.58 4922829 URINE SUPERSAT,CHLORIDE-MAYO 10.18 4922837 URINE SUPERSAT PHOS-MAYO 10.48 4922845 URINE SUPERSAT SULFATE-MAYO 9.62 4922852 URINE SUPERSAT CITRATE-MAYO 50.96 4922860 URINE SUPERSAT OXALATE-MAYO 26.09 4922878 URINE SUPERSAT PH-MAYO 7.26 4922886 URINE SUPERSAT URIC ACID-MAYO 9.62 4922894 URINE SUPERSAT CREATININE-MAYO 10.40 4922902 URINE SUPERSAT OSMOLALITY-MAYO 13.20 4922936 DIHYDROTESTERON-MAYO 45.23 4922944 LYME DISEASE PCR,BLOOD-MAYO 86.28 4922969 LYME DISEASE AB,EIA,SERUM-MAYO 20.10 4922977 LYME DISEASE AB,EIA,CSF-MAYO 35.00 4922985 LYME DISEASE AB WB,CSF-MAYO 31.59 4923009 THROMBOPHILIA,FIBRINOLYSIN-MAYO 11.37 4923017 THROMBOPHILIA,SOLUBLE FIBRIN-MAYO 40.00 4923025 MYOGLOBIN,URINE-MAYO 19.64 4923033 HEMOGLOBIN A2 AND F-MAYO 70.90 4923041 RNA POYMERASAE III AB,IGG-MAYO 44.11 4923058 HISTOPLASMA AG,SERUM-MAYO 119.00 4923066 BETA CROSSLAPS (B-CTX)-MAYO 60.00 4923074 ENDOMYSIAL AB, IGG-MAYO 97.00 4923082 SM ANTIBIOTICS,IGG - MAYO 18.26 4923090 CYSTICERSOSIS,IGG AB S-MAYO 70.00 4923108 BK VIRUS PCR,QUAN,PLASMA-MAYO 83.68 4923116 JC POLYOMA DNA,QN PCR,PLASMA-MAYO 311.34 4923124 C ALBICANS AB IGG,IGA,IGM-MAYO 97.85 4923140 TESTOSTERONE BIOAVAILALBE-MAYO 57.69 4923181 PROTHROMBIN FRAGMENT 1+2-MAYO 169.00 4923215 LEPTIN-MAYO 113.00 4923256 STREP PNEUMO IGG AB-MAYO 63.71 4923264 SPECIMEN TRANSPORT-UCI 23.00 4923272 SPECIMEN TRANSPORT-CS 70.00 4923280 PERIODIC FEVER PANEL CHG1-GENEDX 275.00 4923298 PERIODIC FEVER PANEL CH2-GENEDX 275.00 4923306 PERIODIC FEVER PANEL CHG3-GENEDX 1,650.00 4923363 ANTIMULLERIAN HORMONE-MAYO 60.75 4923371 AMPHETAMINE CONFIRMATION-MAYO 50.00 4923421 PARANEOPLASTIC AB EVAL,CSF-MAYO 55.00 4923439 PARANEOPLASTIC AB CHG1,CSF-MAYO 60.00 4923447 INFLUENZA A/B & RSV,PCR,NP SWAP-MAY 76.72 4923454 RSV PCR DETECTION-MAYO 110.02 4923462 CERVICAL VAGINAL CYTOLOGY-PATHINC 30.00 4923470 HPV NAAT FRM CRVCL CYTOLOGY-PATHINC 39.00 4923488 CHLAMYDIA BY PCR-PATHINC 39.00 4923496 GONORRHEA BY PCR-PATHINC 39.00 4923629 MONOCLONAL PROTEIN STDY RAND U-MAYO 25.00 4923637 MONOCLONAL PRTN STDY,RAND U1-MAYO 25.00 4923645 GANGLIOSIDE ANTIBODY PNL - MAYO 30.00 4923678 MAG ANTIBODY-MAYO 140.00 4923686 MAG-SGPG AB-MAYO 105.00 4923694 MAG-IGM AB TITER-MAYO 115.00 4923702 HU ANTIBODY-MAYO 185.00 4923710 HU AB WESTERN BLOT-MAYO 105.00 4923728 HU AB TITER-MAYO 182.50 4923736 HIV1 SUSCEPTABILITY ANALYSIS-MAYO 120.00 4923744 HIV1 RT BASED DRUG ANALYSIS-MAYO 125.00 4923751 HIV1 DRUG RESISTANCE 1-10-MAYO 553.00 4923769 HIV1 DRUG RESIST EA ADDED DRUG-MAYO 55.00 4923835 THC CONFIRMATION,MECONIUM-MAYO 96.01 4923843 AMPHETAMINE/METHAMPH,MECONIUM-MAYO 46.01 4923850 VAGINITIS PCR SCREEN CHG1-PATH INC 25.00 4923868 VAGINITIS PCR SCREEN CHG2-PATH INC 25.00 4923876 VAGINITIS PCR SCREEN CHG3-PATH INC 25.00 4923884 FETAL LUNG MATURITY-LBC-UCI 39.00 4923892 N TERMINAL PRO-BNP-MAYO 71.77 4923942 CGH MORPHOMETRIC - GCTR 200.00 4923959 CGH INTERP - GCTR 200.00 4924007 MITOCHONDRIA INTERP-GCTR 60.00 4924015 COCAINE CONF ON MECONIUM-MAYO 96.01 4924023 FLOW CYTOMETRY 16+MARKERS-MAYO 141.30 4924031 PCP CONFIRMATION,MECONIUM-MAYO 146.48 4924049 CARBOHYDRATE DEF TRANSFERIN-MAYO 45.73 4924098 ESCITALOPRAM (LEXPRO)-MAYO 52.95 4924106 NEUTROPHIL SPECIFIC ANTIBODIES-MAYO 71.10 4924114 SACCHAROMYCES(IBD) ANTIBODIES-MAYO 70.00 4924122 ACANTHAMOEBA CULTURE-MRL 162.00 4924130 CHROMOSOME ANALYSIS CULTURE-MAYO 100.00 4924148 CHROMOSOME ANALYSIS CVS-MAYO 450.62 4924155 CHROMOSOME ANALYSIS IN SITU-MAYO 67.91 4924163 CHROMOSOME ADDL KARYOTYPES-MAYO 26.00 4924171 CHROMOSOME INTERP-MAYO 30.00 4924189 CHROMOSOME CYTOGENETICS-MAYO 100.00 4924221 HLA B5701 NA PROBE AMP-MAYO 517.73 4924247 RBC ENZYME EVAL CHG1-MAYO 71.69 4924254 RBC ENZYME EVAL CHG2-MAYO 69.80 4924262 RBC ENZYME EVAL CHG3 - MAYO 76.32 4924270 RBC ENZYME EVAL CHG4 - MAYO 133.51 4924288 RBC ENZYME EVAL CHG5 - MAYO 197.80 4924296 FLOW CYT BONE MARROW 1ST M-GEMINI 86.69 4924304 FLOW CYT BONE MARROW SUBS M-GEMINI 64.00 4924320 FLOW CYT LYMPH NODE SUBS M -GEMINI 34.00 4924338 FLOW CYT 1ST MARKER - GEMINI 55.14 4924346 FLOW CYT ADDED MARKERS-GEMINI 33.31 4924353 IHC STAIN TC-GEMINI 40.00 4924361 ACGH WHOLE GENOME CONSIT-MAYO 1,535.10 4924411 COXSACKIE B ANTINODY PANEL-QUEST 12.66 4924429 COXSACKIE B ANTIBODY_PANEL-QUEST 12.66 4924437 COXSACKIE A ANTIBODY PANEL-MAYO 18.14 4924445 COXSACKIE A ANTIBODY_PANE-MAYO 18.13 4924452 TCD4 T CELL COUNT - MAYO 21.60 4924460 TCD4 CD4/CD8 COUNT - MAYO 23.05 4924478 PSA ULTRASENSATIVE - MAYO 123.40 4924486 FIBRINOGEN ANTIGEN-NI 35.50 4924494 HE-4 OVARIAN TUMOR MARKER-MAYO 145.00 4924502 NMO EVALUATION W REFLEX-MAYO 169.70 4924510 C DIFFICILE CULTURE-MAYO 81.48 4924528 HEMOPHILUS MIC PANEL-MRL 80.10 4924536 OXCARBAZEPINE METABOLITE-MAYO 21.31 4924544 #N/A 10.00 4924551 FREE THYROXINE INDEX CHG2-MAYO 25.69 4924569 NOVOVIRUS ANTIGEN EIA-MAYO 123.00 4924577 LIPOPROTEIN A-SERUM-MAYO 15.39 4924585 HUMAN HERPES VIRUS 6 PCR-MAYO 116.50 4924593 HUMAN HERPES VIRUS 8 IGG-MAYO 156.44 4924601 GRANULOCYTE AB,SERUM-MAYO 72.89 4924619 UPG DECARBOXYLASE-MAYO 189.80 4924627 FACTOR VII INHIBITOR SCREEN-MAYO 54.45 4924635 FACTOR VII ASSAY-MAYO 88.85 4924668 FCTR V LEIDEN GENE MUTTN F5DNA-MAYO 50.00 4924676 CYTOCHORME P450 2C19,2C19S-MAYO 733.84 4924684 BCR/ABL P210,QNT,BCRAB-MAYO 350.06 4924692 CHRONIC GRAN DISEASE MUT PNL-GENEDX 2,860.00 4924700 CHRONIC GRAN DZ MUT PNLB-GENEDX 2,035.00 4924718 CYSTIC FBRSS GENE CAR PNL,CFPB-MAYO 121.31 4924726 FRGL X CHROMOSOME MUT PNL,FXPB-MAYO 290.99 4924734 HLA-B 5701 GENOTYPE,ABACAVIR,BLD-MA 597.00 4924742 HEREDITARY HFE GENE ANL,HHEMO-MAYO 150.00 4924759 JAK2 V617F MUT DETECT, JAK2B-MAYO 200.00 4924767 KIT ASP816VAL MUT ANL Q ,KITAS-MAYO 438.90 4924775 MITOCHONRIAL DNA ANALYSIS-GCTR 600.00 4924791 PROTHROMBIN G20210A MUTTN,PTNP-MAYO 48.63 4924809 SMA GENE CARRIER PNL,SMAGEN-MAYO 623.50 4924817 TPMT GENETC ANALYS PCR ,FPRTG-MAYO 380.50 4924825 HLA CLS 1 MOL TYP DISEASE,DISI-MAYO 29.37 4924833 RESPIRATORY ALLERGY PNL 10655X1-N1 9.60 4924841 RESPIRATORY ALLERGY PNL 10655X2-NI 7.20 4924858 RESPIRATORY ALLERGY PNL 10655X3-NI 48.00 4924866 FOOD ALLERGY PROFILE (10715X)A-NI 10.80 4924874 FOOD ALLERGY PROFILE (10715X)B-NI 9.60 4924882 NMDA RECEPTOR AB SERUM-MAYO 445.32 4924890 NMDA RECEPTOR AB,CSF-MAYO 450.00 4924908 LMP CHOLESTEROL-MAYO 10.00 4924916 LMP TRIGLYCERIDES-MAYO 10.00 4924924 LMP APOLIPOPROTIEN B-MAYO 15.00 4924932 LMP HDL CHOLESTEROL-MAYO 10.00 4924940 LMP LP (A) CHOLESTEROL-MAYO 25.07 4924957 CREATINE DISORDERS 01-MAYO 20.00 4924965 CREATINE DISORDERS 02-MAYO 20.00 4924973 CREATINE DISORDERS 03-MAYO 71.66 4924981 CHLAMYDIA TRACHOMATIS CULTURE-MAYO 89.38 4924999 C1 ESTERASE INHIBITOR,FUNCT-MAYO 43.98 4925004 MI-2 AB-MAYO 80.00 4925012 SRP ANTIBODIES-MAYO 80.00 4925020 FLUOXETINE,SERUM-MAYO 56.89 4925038 VITAMIN B12 BINDING UNSATUREATE-NI 39.50 4925046 CHROMOSOMES ADDL HIGH RES STDY-GCTR 27.00 4925053 URINE PROTEIN ELECTROPHORESIS-MAYO 30.00 4925061 URINE IMMUNOFXTN EL PHORESIS-MAYO 131.50 4925079 SEROTNN REL.ASSAY,UNFRCT-HEPRN-MAYO 367.00 4925087 TPMT GENOTYPE-MAYO 390.00 4925095 D-LACTATE,PLASMA-MAYO 56.58 4925103 INSULIN-LIKE GROWTH FACT PROT3-MAYO 22.00 4925111 EGFR GENE MUTATION ANALYSS-CLARIENT 1,291.64 4925129 KRAS GENE-CLARIENT 327.16 4925137 LEVETIRACETAM (KEPRA) LEVEL-UCI 60.40 4925145 SYPHILIS IGG AB W REFLEX-MAYO 12.75 4925152 HEAVY METAL SCREEN CHG4 - MAYO 15.66 4925160 R RICKETTSIAL DISEASE PNL CHG2-QUES 34.05 4925178 CELIAC DISEASE IGA-MAYO 12.00 4925186 CELIAC DISEASE HLA-DQ-MAYO 80.62 4925194 GLIADIN DEAMINATED IGA AB-MAYO 23.13 4925202 GLIADIN DEAMINATED IGG AB-MAYO 10.00 4925210 SYPHILIS AB BY TP-PA,S-MAYO 37.51 4925228 IN SITU HYBRIDIZATION-PATH INC 130.00 4925236 THROMBIN CLOTTING TIME-NI 37.18 4925244 PMLR RAR QUANT,PCR-MAYO 437.12 4925251 IBD SGI DIAGNOSTIC CHG4-PROM 41.00 4925269 IBD SGI DIAGNOSTIC CHG2-PROM 41.00 4925277 IBD SGI DIAGNOSTIC CHG3-PROM 41.00 4925319 BONE MARROW CHROMSM ANALYSS CHG1-GI 180.00 4925327 BONE MARROW CHRMSME ANALSS CHG2-GI 250.00 4925335 BONE MARROW CHRMSME ANALYSS CHG3-GI 20.00 4925343 6MAMU,6-MAM,U-MAYO 153.50 4925350 ACYCLOVIR-MAYO 146.00 4925368 REDUCING SUBSTANCES,STOOL-MAYO 20.00 4925376 COLLAGEN TYPE I C-TELOPEPTIDE-NI 69.50 4925384 ALPHA-GLOBIN COMMON MUT ANAL-CHG1 Q 299.00 4925434 COLOVANTAGE - QUEST-NI 355.00 4925442 ALDOSTERONE/PLSM RENIN RATION-NI 70.75 4925459 ALDOSTERONE/PLSM RENIN RATIO 1-NI 70.75 4925467 LEGIONELLA ANTIGEN DFA-FOCUS 86.40 4925475 DNA ANALYSIS FOR METHYLTN STDY-GCTR 500.00 4925483 DNA ANALYSIS CGH MICROARRAY-GCTR 1,100.00 4925491 HISTAMINE RLS(CHRONIC URTICARIA)-NI 150.00 4925509 DHEA (DEHYDROEPIANDROSTERONE)-NI 89.00 4925517 HEPATITIS B VRS DNA QNT RLTM APT-NI 110.00 4925525 HEPATITIS B VRS DNA QNT RLTM PCR-NI 259.44 4925533 TREPONEMA PALLIDUM AB IFA(CSF)-NI 43.50 4925541 OROTIC ACID,URINE MAYO 61.89 4925558 HTLV I,II DNA,RT,PCR-MAYO 249.67 4925566 CHILDHD ALLRGY PRFL 10659X CHG1-NI 40.80 4925574 PANCREATIC ELAST IN STOOL-MAYO 91.65 4925582 HEPATITIS BC AB IGG & M-MAYO 16.60 4925590 FRUCTOSAMINE,SERUM-MAYO 18.00 4925608 FLT3(ITD)&D835 VARNT DET CHG1-MAYO 162.50 4925616 FLT3(ITD)&D835 VARIANT DET CH2-MAYO 162.50 4925624 CEBRA MUTATION ANALYSIS-MAYO 413.00 4925632 KIT ASP816VAL MUTTN ANALYSIS,V-MAYO 380.24 4925640 NUCLEOPHOSMIN MUTATN ANALYSIS-MAYO 556.70 4925657 GANGLIOSIDE GQ1B AB(IGG)-MAYO 136.70 4925665 NICOTINE & METABOLITES, S - MAYO 53.47 4925673 DHEA-MAYO 21.90 4925681 HEPARIN,LOW MOLEC WT ANTI-XA-UCI 60.00 4925699 CORTISOL, TOTAL, LC/MS/MS-NI 97.78 4925707 HE4, OVARIAN CA MONITORING-MAYO 41.93 4925715 SSDNA (SNGL STRANDED DNA) IGG AB-NI 65.12 4925723 NEUROMYLTS OPTICA IGG ATOANTBDY-NI 295.00 4925731 HIV1 GENOSURE PRIME-M-BIOSCIENCE 300.00 4925749 HIV1 GENOSURE PRIME2-M-BIOSCIENCE 290.00 4925756 HIV1 GENOSURE PRIME3-M-BIOSCIENCE 300.00 4925764 HIV1 PHENSNS INTEGRACE-M-BIOSCIENCE 725.00 4925772 HIV1 PHNSNS ADDL DRGS-M-BIOSCIENCE 95.50 4925780 CA 19-9 CARBOHYDRATE AG-MAYO 18.21 4925798 NOROVIRUS RNA,RT PCR-MAYO 95.00 4925806 HSV TYPES 1&2 DNA,RT PCR-MRL 141.35 4925814 VON WILLEBRAND FACTOR ACTIVITY-MAYO 75.00 4925830 TSH ANTIBODY-NI 106.20 4925848 LACOSAMIDE (VIMPAT)-MAYO 96.00 4925855 CHROMIUM,SERUM-MAYO 20.69 4925863 HEMOSIDERIN-URINE-MAYO 34.59 4925871 RASPBERRY IGG-MAYO 39.80 4925889 SOYBEAN IGG-MAYO 39.80 4925897 PECAN FOOD IGG-MAYO 39.80 4925905 BETA-2 TRANSFERRIN BF-MAYO 88.64 4925913 MICROSPORIDIA STAIN CHRG1-MAYO 24.54 4925921 MICROSPORIDIA STAIN CHRG2-MAYO 24.54 4925939 CO-SEN NEURO PROFILE CHRG1-MAYO 1,256.92 4925947 CO-SEN NEURO PROFILE CHRG2-MAYO 1,256.92 4925954 DRVVT 1:1 MIX-NI 22.50 4925962 QUANTIFERON-TB GOLD-NI 258.30 4925970 ANTIMCRBRL SSCP,HMPHLS,MICPNL-FOCUS 80.10 4925988 MEFV GENE ANALYSIS FMF-MAYO 675.00 4926002 RBC FOLATE-NI 56.20 4926010 HEPATITIS A IGG ANTIBODY-MAYO 16.87 4926028 DPD GENE MUTATION-MAYO 287.50 4926044 INFLXMB&ANTI-INFLXMB AB CHRG1-MAYO 212.50 4926051 INFLXMB&ANTI-INFLXMB AB CHRG2-MAYO 212.50 4926069 MUCOPLYSCCHRDS (MPS)QN,U-MAYO 58.35 4926077 HELICOBACTER PYLORI AB,19M,S-MAYO 675.00 4926085 DES-GAMMA-CARBOXY PROTHRMBN,S-MAYO 150.00 4926093 H.PYLORI C UREA BREATH.T-MAYO 64.24 4926101 CEA,PERITONEAL FLUID-MAYO 186.90 4926119 INFLUENZA A&B,PCR-UCI 185.00 4926127 RESP VIRUS PCR PANEL III-FOCUS 1,386.90 4926135 CELIAC HLA DQ TYPING ALPHA-MAYO 101.50 4926143 CELIAC HLA DQ TYPING BETA-MAYO 101.50 4926168 IGE QUANTITATIVE-MAYO 10.64 4926176 ALLERGEN SPECIFIC IGE-MAYO 4.50 4926184 HSV AND VZV,PCR CHRG1-MAYO 45.00 4926192 HSV AND VZV,PCR CHRG2-MAYO 45.00 4926200 INTERLEUKIN 1-ALPHA-MAYO 260.00 4926218 INTERLEUKIN 1-BETA-MAYO 260.00 4926226 IL-6,SERUM-MAYO 164.60 4926234 MYOSITIS ANTIBODY PANEL-MAYO 310.00 4926242 HSV1/2(IGG),TYPE-SPEC AB CHG1-NI 43.00 4926259 HSV1/2(IGG) TYPE SPCFC AB CHG2-NI 43.00 4926267 BORDTLLA P/PARAPER DNA,QL RT PCR-NI 170.00 4926275 ETHANOL,U-MAYO 53.70 4926283 ANA, HEP-2 SUBSTATE-MAYO 18.12 4926291 ANA REFLEX TO TITER-MAYO 24.96 4926325 HUNTINGTON DISEASE ANALYSIS-MAYO 250.00 4926358 CLOBAZAM (ONFI) - MAYO 71.60 4926408 DRUG SCREEN BLOOD CHG 1 - MAYO 83.96 4926432 HIV-1/2-2 AG AND AB SCREEN,S-MAYO 25.00 4926440 HIV-1/2-2 AB DIFF,S CHRG 1-MAYO 20.00 4926457 HIV-1/2-2 AB DIFF,S CHRG2-MAYO 27.12 4926465 HIV-1 AB CONFIRM BY WB,S-MAYO 19.75 4926473 HIV-2 AB CONFIRMATION,S-MAYO 57.80 4926481 ANT SUS,GRAM-POS RDS,MIC PNL-FOCUS 82.80 4926499 HSV CX W/RFLX TO TYPING-FOCUS 60.30 4926507 HSV 1 AND 2 AG,DFA CHRG 1-FOCUS 40.50 4926515 HSV 1 AND 2 AG DFA CHRG2-FOCUS 40.50 4926523 CHLAMYDIA TRACHOMATIS AG,DFA-FOCUS 81.00 4926531 MYCOPLASMA IGG IGM AB-MAYO 17.33 4926549 MYOSITIS AB 2 PANEL CHRG 1 - MAYO 162.50 4926556 MYOSITIS AB 2 PANEL CHRG 2 - MAYO 162.50 4926564 INFLXMB & ANTI-INFLIX AB CHRG1-MAYO 212.50 4926572 INFLXMB & ANTI-INFLIX AB CHRG2-MAYO 212.50 4926580 RAJI CELL IMMUNE COMPLEX ASSAY-MAYO 295.60 4926705 UGT1A1 GENE SEQ IRINOTECAN-MAYO 953.80 4926713 TRICHOMONAS VAGINALIS PCR-PATHINC 38.30 4926721 CEA PLEURAL FLUID-MAYO 186.90 4926739 FACTOR X CHROMOGENIC ACT ASSY-MAYO 193.85 4926747 VON WILLEBRAND PROF CHGI-MAYO 30.00 4926754 VON WILLEBRAND PROF CHG2-MAYO 30.00 4926762 VON WILLEBRAND PROF CHG3-MAYO 30.00 4926770 BETHESDA UNITS RX-MAYO 145.60 4926788 COAG FACTOR VII INHIB SC RX -MAYO 296.60 4926796 RISTOCETIN CO-FACTOR-PL RX-MAYO 33.00 4926804 SPECIAL COAGULATION INTERP RX-MAYO 36.00 4926812 CTRACH/N GNONORR AMPLIFIED RNA-MAYO 43.83 4926820 BILE ACIDS FRACTNTD AND TOT-MAYO 84.86 4926838 HSV(NEONATES) CULTURE-MAYO 301.00 4926846 DRUGS SCREEN BLD 10 WB-MAYO 123.00 4926853 HSV TYPES 1&2 AB IGG-CHG1-MAYO 8.87 4926861 HSV TYPES 1&2 AB IGG CHG2-MAYO 9.00 4926879 FACTOR V(LEIDEN) MUT W/RX HR2-QUEST 192.18 4926887 FACTOR V REFLEX TO HR2CHG-QUEST 230.00 4926895 YEAST SUSCEPTIBILITY COMP PNL-FOCUS 497.23 4926903 SPECIAL STAIN, GRP2-ADPL-PATHINC 40.00 4926911 HPV LOW RISK DNA ISH-MAYO 565.10 4926929 AUTOIMM HEP DX CHG1-QUEST 61.00 4926937 AUTOIMM HEP DX CHG2-QUEST 61.00 4926945 AUTOIMM HEP DX CHG3-QUEST 61.00 4926952 AUTOIMM HEP DX CHG4-QUEST 61.00 4926960 IMAGE ANALYSIS(ASPERIO) PATHINC 177.33 4926978 OSTEOCALCIN-MAYO 62.95 4926986 THERMOACTIN VULGARIS IGG-MAYO 59.23 4926994 MICROPOLYSPORA FAENI-IGG-MAYO 44.25 4927000 URIC ACID-MAYO 25.65 4927034 CARBOHYDRATE, URINE - MAYO 49.45 4927042 THYROXINE BIND GLOBULIN-MAYO 30.68 4927059 CORTISONE SERUM - NI 132.30 4927067 ALLERGEN SPECIFIC IGG(8)-MAYO 17.92 4927075 HISTOPLASMA AG URINE-MAYO 92.80 4927091 BUPROPION (WELLBUTRIN)-MAYO 89.68 4927109 FLOWCYTOMETRY/TC 1 MARKER-CLARIENT 62.00 4927117 FLOWCYTOMETRY/TC,ADD-ON-CLARIENT 12.00 4927158 LIVER/KIDNEY MICROSOM AB - MAYO 22.87 4927216 ESTRIOL,UNCONJUGATED-MAYO 18.94 4927224 PANCREATIC POLYPEPTIDE-MAYO 93.64 4927232 FIBROGEN ANTIGEN-MAYO 95.00 4927240 C1 EST INHIB FUNCTIONAL-MAYO 12.25 4927257 BETA-GLOBIN COMPLETE - NI 349.00 4927281 RA DGNSTC PNL W/14-3-3 ETA CHG1-NI 108.00 4927299 RA DGNSTC PNL W/14-3-3 ETA CHG2-NI 85.75 4927307 RA DGNSTC PNL W/14-3-3 ETA CHG 3-NI 85.75 4927315 ZINC, RBC-MAYO 81.84 4927323 BRAF MUT ANAL PCR-CLARIENT 78.12 4927331 BRAF MUT FDA MELANOMA-CLARIENT 78.12 4927349 ALK REAMNT,FISH-CLARIENT 401.84 4927356 MSI BY PCR - CLARIENT 275.52 4927364 HEV IGM AB SCRN-MAYO 81.65 4927372 CYSTINURIA PRF,QN,24HRS-MAYO 107.34 4927380 KAPPA/LAMDA LT CHN,UR CHG2-MAYO 47.75 4927398 KAPPA/LAMDA LT CHN,UR CHG3-MAYO 47.75 4927406 KAPPA/LAMDA LT CHN,UR CHG1-MAYO 47.75 4927414 HCV RNA NS3 GENOTYPE-NI 700.00 4927448 CALPROTECTIN,STOOL-NI 140.00 4927463 PAN ANCA PLUS W/REFLEX CHG 1-NI 131.95 4927471 PAN ANCA PLUS W/REFLEX CHG 2-NI 131.95 4927489 PAN ANCA PLUS W/REFLEX CHG3-NI 131.95 4927497 LACTOFERRIN,QUAL,STOOL-NI 185.00 4927505 PAN ANCA PLUS W/REFLEX CHG4-NI 13.12 4927620 RPR-MAYO 30.00 4927638 DILANTIN FREE & TOTAL-MAYO CHG 2 12.66 4927646 DNA ANNALY CGH MICROARRAY 180K-GENE 1,100.00 4927653 NRAS MUTATION ANALYSIS-CLARIENT 542.40 4927661 CHROMOSOMES,CONGENITAL-MAYO 191.32 4927679 ACH RECEPT(MUSCLE)BINDING AB-MAYO 19.00 4927687 CASR GENE,FULL GENE ANALYSIS-MAYO 1,300.00 4927695 NOTCH3 DNA SEQUENCING-MAYO 2,525.00 4927703 WEST NILE VIRUS PCR(PLASMA)-MAYO 35.80 4927711 FREE THYROXINE INDEX(FTI)CHG 2-MAYO 10.29 4927729 AEROBIC BACTERIAL ID(7925)-FOCUS 78.30 4927737 AEROBIC MIC ROUTINE(7429)-FOCUS 51.00 4927745 AFB SUSCEPTIBILITY MTB(7235)-FOCUS 112.50 4927752 AFB SLOW GROW MIC SUSCEPT(92522)-MR 140.40 4927760 AFB RAPID GROW MIC SUSCEPT(7913)-MR 109.80 4927778 ANAEROBIC MIC PANEL(7921)-FOCUS 214.20 4927786 FUNGAL ID,MOLD(8028)-FOCUS 85.24 4927802 VANILLYLMANDELIC ACD-MAYO 22.34 4927810 YERSINIA AB IG(A,G,M)-MAYO 224.64 4927828 QUINIDINE-MAYO 41.52 4927836 PNEUMOCYSTS JIROVEC-QUEST 84.00 4927844 PARAINFLU(TYPES1,2,3)-MAYO 77.50 4927851 HLA CLAS I MOL TYPE-MAYO 29.37 4927869 IMMUNOGLOBULIN D-MAYO 41.07 4927885 PHENYLALAMIME&TYRSN CHG1-MAYO 53.55 4927893 PHENYLALANNE&TYRSN CHG2-MAYO 47.79 4927901 INHIBIN A,B CHG1-MAYO 40.00 4927919 INHIBIN A,B CHG2-MAYO 40.00 4927927 FAT STAIN(CHYLURIA CHG1-MAYO 20.68 4927935 FAT STAIN(CHYLURIA) CHG2-MAYO 20.68 4927943 FAT STAIN(CHYLURIA)CHG3-MAYO 20.68 4927950 BRAZIL NUT,IGE-MAYO 4.50 4927968 MAGNESIUM,RBC-MAYO 47.80 4927976 PREGABALIN(LYRICA)-MAYO 70.00 4927984 FATTY ACID PROFILE COMP(C8-26)-MAYO 125.07 4927992 OVA & PARASITIC EXAM-MAYO 27.76 4928008 BACTERIAL VAGINOSIS-LABC 75.00 4928016 BACTERIAL VAGINOSIS PNL CHRG 1-LABC 24.15 4928024 BACTERIAL VAGINOSIS PNL CHRG 2-LABC 24.15 4928032 BACTERIAL VAGINOSIS PNL CHRG 3-LABC 55.10 4928040 BACTERIAL VAGINOSIS PNL CHRG 4-LABC 55.10 4928057 TACROLIMUS-MAYO 25.00 4928065 ER/PR ESTRGN/PRGSTRNE RCPTR IMAGE-C 185.62 4928081 ZIKA VIRUS REAL-TIME RT-PCR,URINE-M 220.00 4928099 SUSCEPTIBILITY YEAST PANEL-MAYO 150.00 4928107 SULFAMETHOXAZOLE-MAYO 50.89 4928115 NMO/AQP4 FACS TITER-MAYO 150.00 4928123 JC PLYMA VRS DNA,QL,RT PCR PLSM-NI 161.50 4928131 DCP-QUEST 137.50 4928149 VON WILLEBRAND DIS TYPE-QUEST 220.00 4928156 NEOENCEPH PARANEO W/REFLEX-QUEST 3,780.00 4928164 IMMUNOFIXATION SERUM-MAYO 55.00 4928172 IMMUNOGLOBULIN G-MAYO 12.00 4928180 IMMUNOGLOBULIN M-MAYO 12.00 4928198 IMMUNOGLOBULIN A-MAYO 12.00 4928206 HSV CSF-MAYO 45.00 4928214 MP STUDY,IFE-MAYO 57.80 4928222 MP STUDY,PEL-MAYO 29.82 4928313 PROFESSIONAL CONSULT-CLARIENT 310.00 4928339 IHC QUAL EA SPEC,INIT AB T-CL 57.58 4928370 IHC IN SITU HYBRID TC-CLARIENT 98.23 4928396 ANTIBODY SCREEN, EA MEDIA-ARC 45.00 4928404 ABID/EACH PANEL & MEDIA-ARC 34.00 4928412 DAT,EACH ANTISERA-ARC 25.00 4928420 ABO TYPE-ARC 25.00 4928438 RBC AG,OTHER THAN ABO OR D,EACH-ARC 40.00 4928446 RH PENOTYPING,COMP-ARC 60.00 4928453 PRE-RX RBCS W/CHEMI/DRUGS-ARC 50.00 4928461 PRE-TREATMENT W/ENZYMES-ARC 20.00 4928479 ELUTION-ARC 80.00 4928487 1RBC AG NEG/UNIT-ARC 80.00 4928495 ANTI-CMV TEST-ARC 50.00 4928503 SHP-UNSCHEDULED(STAT FEE)-ARC 40.00 4928511 UNIT W/4 EMPTY BAG-EMP4(EDS BAG)ARC 80.00 4928537 OFF HOUR CONSULT/HR-ARC 158.00 4928545 SAMPLE TRANSPORTATION-ARC 35.00 4928560 SODIUM,FECES-QUEST 27.00 4928578 POTASSIUM,FECES,QUEST 26.00 4928586 LEVEL IV BIOPSY,NERVE OR MUSCLE-UCI 300.00 4928636 BLOOD TYPING FOR RH(D)-ARC 20.00 4928644 DIFFERENTIAL RBC ABSORBTION-ARC 39.00 4928651 AMIKACIN PEAK-UCI 18.00 4928669 AMIKACIN TROUGH-UCI 18.00 4928677 PRIMIDONE-MAYO 25.00 4928685 PHENOBARBITAL-MAYO 25.00 4928693 PLT AG NEG/OTHER COMP HLA-ARC 400.00 4928701 PT SERA AG SCREEN/UNIT-ARC 60.00 4928719 THAWING RARE REAGENT CELLS-ARC 40.00 4928727 DILUTION OF SERUM,PER ALIQUOT-ARC 30.00 4928735 INDIRECT TITER,PER ANTIBODY-ARC 80.00 4928743 SPECIAL ANTIGLOBULIN TEST-ARC 1,000.00 4928750 RENAL BX IHC STAIN-CS 251.34 4928768 RENAL BX SPCL STAIN-CS 37.10 4928776 HLA ANTIBODY ID,CLASS 1,IGG-ARC 800.00 4928784 HLA MOLECULAR AB TYPING-ARC 900.00 4928792 PLT ASSOC IGG,IGM TESTING DIR-ARC 242.00 4928800 GENITAL HSV1,2 BY PCR-QUEST 358.75 4928818 N-ACETYLPROCAINAMIDE-MAYO 26.91 4928826 FLOW INTERPRETATION(2-8)-CL 55.82 4928834 FLOW INTERPRETATION(9-15)-CL 68.59 4928842 FLOW INTERPRETATION(16+MARKERS)-CL 75.00 4928859 FISH AUTO-TECH-CL 355.04 4928867 BLADDER CANCER FISH GLOBAL-CL 800.00 4928875 KRAS GENE ANALYSIS-CL 303.00 4928883 KRAS GENE ANALYSIS_-CL 130.00 4928891 CEBPA MUTATION ANALYSIS-CL 358.00 4928909 IDH1,IDH2 MUTATIONS ANALYSIS-CL 265.00 4928917 MICROSATELLITE INSTABILITY ANAL-CL 536.00 4928925 NPM1 MUTATION ANAL-LIQUID BX-CL 300.00 4928933 IHC QUALITATIVE;ADDN'L STAIN-CL 57.58 4928941 IHC QUANTITATIVE TECH-CL 65.64 4928958 INSULIN-LIKE GRWTH FACTOR-BIND PRO3 18.21 4928966 CORTISOL,SERUM,LC-MS/MS-MAYO 53.27 4928974 CORTISOL,FREE,SERUM-MAYO 76.00 4928982 PANCREATIC ESTERASE,STOOL 224.00 4928990 IGF-1 LC/MS 29.91 4929006 PLATELET GLYCOPROTEIN FLOW 1 MARKER 172.85 4929014 PLATELET GLYCOPROTEIN FLOW ADDON 63.87 4929022 PLATELET BLYCOPROTEIN FLOW READ 2-8 97.46 4929048 CHROMOSOME CONGENTIAL CLTRE 01-MAYO 243.17 4929055 CTYO/MOLECULAR REPORT-MAYO 63.09 4929063 ADD'L SPECIALIZED BANDING-MAYO 10.00 4929071 LD ISOENZYMES-MAYO 6.97 4929089 PHOSPHLIPHASE A2 REC ANTIBODY SCRE 213.35 4929097 PHOSPHOLIPASE A2 REC ANIBODY TITER 185.00 4929113 RANDOM URINE FRACTIONATED CATECHOL 75.50 4929121 TREE NUT ALLERGY PANEL 94.00 4929139 CARDIO IQ APOLIPOPROTEIN B 28.50 4929147 CARDIO IQ LIPOPROTEIN FRACTIONATION 50.00 4929154 CARDIO IQ OMEGA-3,6 FATTY ACID 50.00 4929162 HCV RNA GENOTYPE 3 NSSA DRUG RESIST 563.71 4929170 JC POLYOMA VIRUS DNA 301.34 4929188 SCHISTOSOMA IGG ANTIBODY 66.20 4929196 T3 FREE,QUEST 50.00 4929204 T3 TOTAL,QUEST 50.00 4929212 AEROBIC MIC CUSTOM,1 DRUG MRL 74.70 4929220 METHYLENEDIOXY AMPHETAMINE CONFIRM 43.97 4929238 CHC 4Q12 GENE DELETION-MAYO 55.37 4929246 CHIC GENE DELETION REPORT-MAYO 61.74 4929253 FATTY ACID PROFILE,ESSENTIAL-MAYO 82.93 4929261 HEP E VIRUS IGM AB-MAYO 94.10 4929279 HEP E VIRUS IGM AB CONFIRM-MAYO 143.70 4929287 LD ISOENZYMES INTERP-MAYO 14.39 4929295 PHOSPHOLIPASE A2 RECEP.IFA-MAYO 185.00 4929303 FIBROTEST-HAPTOCLOBIN-MAYO 70.75 4929311 FIBROTEST-APO-A1-MAYO 78.34 4929329 FIBROTEST-BILIRUBIN-MAYO 12.47 4929337 FIBROTEST-GGTP-MAYO 12.47 4929345 FIBROTEST-ALT-MAYO 12.47 4929352 IGG4-MAYO 125.40 4929360 SOLUBLE LIVER AG AUTOAB-MAYO 77.97 4929378 24 HR MICROALBUMIN NO CREAT-MAYO 5.90 4929386 TOPHERYMA WHIPPLEI PCR-MAYO 119.06 4929394 IGA TOTAL-MAYO 124.11 4929402 IGA SUBCLASS 1-MAYO 106.99 4929410 IGA SUBCLASS 2-MAYO 107.00 4929428 E HISTOLYTICA AG-MAYO 106.26 4929436 PROLACTIN,TOTAL-MAYO 30.20 4929444 PROLACTIN,UNPRECIPITATED-MAYO 30.20 4929451 ESTROGEN FRACTIONATION-MAYO 25.01 4929469 ADDED TESTING,VIRAL ID-MAYO 55.20 4929477 AFB NUCLEIC ACID SEQUENCE-MAYO 442.80 4929485 MIC,EACH MULTIMICROBIAL-MAYO 157.50 4929519 NEURONAL(V-G)K+CHANNEL AB,S-MAYO 120.92 4929527 ACH RECEPTOR(MUSCLE)BINDING AB-MAYO 120.92 4929535 N-TYPE CALCIUM CHANNEL AB-MAYO 120.92 4929543 P/Q-TYPE CALCIUM CHANNEL AB-MAYO 120.92 4929550 GAD65 ANTIBODY ASSAY-MAYO 177.11 4929568 PURKINUE CEL CYTOPLAMC AP TYPE TR-M 107.86 4929576 CRMP-5-IGG,S-MAYO 107.87 4929584 ANTI-NEURONAL AB,TYPE 3-MAYO 107.87 4929592 PURKINUE CEL CYTOPLASMC AP TYPE 2-M 107.87 4929600 ACHR GANGLIONIC NEURONAL AB,S-MAYO 120.92 4929618 ANTI-NEURONAL NUCLEAR AB,TYPE 1-MAY 107.87 4929626 ANTI-NEURONAL NUCLEAR AB,TYPE 2-MAY 107.87 4929634 AMPHYIPHYSIN AB,S-MAYO 107.87 4929642 ANTI-GLIAL NUCLEAR AB,TYPE 1-MAYO 107.87 4929659 NMDA-R AB CBA,SERUM-MAYO 107.86 4929667 AMPA-R AB CBA,SERUM-MAYO 107.87 4929675 GABA-B-R AB CBA,SERUM-MAYO 107.87 4929683 LGI1-IGG CBA,S-MAYO 107.87 4929691 CASPR2-IGG CBA,S-MAYO 107.87 4929717 THYROID RFLX,FT3-NI 69.50 4929725 THYROID RFLX,FT4-NI 41.00 4929733 THYROID RFLX,TSH-NI 38.00 4929741 FIBROBLAST CULT FOR GENE CHG1-MAYO 250.00 4929758 FIBROBLAST CULT FOR GENE CHG2-MAYO 42.27 4929766 MATERNAL CELL CONT,B-MAYO 426.66 4929774 AMNIOTIC FLUID CUL/GENE CHG1-MAYO 690.27 4929782 AMNIOTIC FLUID CUL/GENE CHG2-MAYO 60.03 4929790 OVAPARASITES NONSTOOL CONCTRICHRM-M 99.60 4929808 14.3.3 ETA PROTEIN-QUEST 127.92 4929816 ALKALINE PHOSPHATASE,TOTAL-MAYO 29.30 4929824 ISOPROPANOL-MAYO 46.17 4929832 TRANSFERRIN-MAYO 16.23 4929840 BRCA1/BRCA2 FULL GENE ANALYSIS-MAYO 1,795.20 4929857 PRADER-WILLI/ANGELMAN SYNDROM-MAYO 328.39 4929865 ALLERGY-ICE-QUEST 10.00 4929873 MYOGLOBIN SERUM-MAYO 71.55 4929881 ANA LUPUS PANEL-QUEST 407.58 4929899 NTX-TELOPEPTIDE,CREAT URINE CHG1-MA 16.13 4929907 NTX-TELOPEPTIDE,URINE CHG2-MAYO 13.13 4929915 ALPHA-1-ANTITRYPSIN,SERUM CHG1-MAYO 17.50 4929923 ALPHA-1-ANTITRYPSIN,PHENO CHG2-MAYO 17.50 4929931 MYELOPEROXIDASE AB,MPO-MAYO 6.24 4929949 ANCA PANEL FOR VASCULITIS(PR3,MPO)M 18.95 4929956 DIPHTHERIA TOXOID IGG AB,S-MAYO 35.79 4929964 B.PERTUSSIS AB,IGG,S-MAYO 80.00 4929972 CREATININE BODY FLUID-MAYO 28.37 4929980 ANGIOTENSIN CONVERTING ENZY,CSF-MAY 64.70 4929998 LYSOZUME,SERUM-MAYO 76.60 4930004 C.TRACH,MISC,RNA-MAYO 50.17 4930012 CAMPLYLOBACTER JEJUNI ANTIBODY-MAYO 99.83 4930020 PANCREASTATIN-MAYO 165.00 4930038 HEPATITIS A TOTAL ANTIBODY-MAYO 10.57 4930046 RHEUMATOID ARTHRITIS PANEL3 CHG1-QU 25.25 4930053 RHEUMATOID ARTHRTIS PANEL3 CHG2-QUE 25.25 4930061 RHEUMATOID ARTHRTIS PANEL3 CHG3-QUE 25.25 4930079 FSH,PEDIATRICS-QUEST 93.63 4930087 LH,PEDIATRICS-QUEST 93.64 4930095 CYP2C19 GENOTYPE,B-MAYO 801.40 4930129 BCR/ABL1 CYTOGENETICS DNA PROBE-MAY 84.11 4930137 BCR/ABL1 CYTOMOLECULRE REPORT-MAYO 46.89 4930145 ANTI-DNASE B TITER,S-MAYO 122.90 4930152 SRY YP11.3 CYTOGENETICS DNA PROBE-M 161.96 4930160 SRY YP11.3 CYTOGENETICS REPORT-MAYO 90.29 4930178 CHLAMYDIA RNA,RECTAL-QUEST 60.00 4930186 LIVER FIBROSIS TEST PANEL-MAYO 250.00 4930194 MOTOR & SENSORY NEUROPATHY PANEL-MA 2,500.00 4930202 HLA-B 5801 GENOTYPE ALLOPURINOL-MAY 218.10 4930210 BILIRUBIN,BODY FLUID-MAYO 117.50 4930228 RHEUMATOID FACTOR,BODY FLUID-QUEST 22.50 4930236 CORTISOL,FREE-QUEST 62.50 4930244 ACID FAST BACILLI ID-JEWISH HEALTH 304.50 4930251 M.ABSCESSUS DIFFERNTIATION-JEW HEAL 108.77 4930269 MIC 20 DRUG COMBO-JEWISH HEALTH 389.62 4930277 PDL-1 BY ICHC-IO 340.00 4930285 ROS1 BY FISH-IO 550.00 4930293 FREE FATTY ACIDS,TOTAL SERUM-MAYO 42.52 4930301 PNH,PL-LINKED AG1 MARKER-MAYO 31.76 4930319 PNH,PL-LINKED AG ADD-ON-MAYO 68.12 4930327 TRICHOPHYTON RUBRUM IGE-QUEST 10.00 4930335 ROCKY MOUNTAIN SPOTTED FEVER IGG-MA 22.78 4930343 ROCKY MOUNTAIN SPOTTED FEVER IGM-MA 22.79 4930350 CYTOGENETICS ADD KARYOTYPES-NG 45.00 4930368 CYTOGENETICS ADD CULTURE-NG 90.00 4930376 IHC,ADDNL STAIN PROC-NEOGENOMICS 93.16 4930384 IHC BY ISH-NEOGENOMICS 147.92 4930392 TSH RECEPTOR ANTIBODY-MAYO 13.78 4930400 BETA CAROTENE-MAYO 122.75 4930418 HLA SELECT XMATCHED PLATELETS-ARC 1,000.00 4930426 RED CELLS LUERED AUTOLOGOUS-ARC 345.00 4930434 MUTATION ANALY BIDIRECT SEQ-NEOGEN 200.00 4930442 T.VAGINALIS RNA,QUAL TMA,MALES-QUES 75.34 4930459 COLLOIDAL IRON STAIN-LABCROP 20.00 4930467 SMMHC STAIN,FIRST ANTIBODY-LABCROP 40.00 4930475 SMMHC STAIN,EACH ADDNL AB-LABCORP 40.00 4930483 AMPHETAMINES CONFIRMATION,URINE-MAY 23.91 4930491 MDA CONFIRMATION,URINE-MAYO 23.91 4930509 BCR/ABL,P190,QUANT MONITOR-MAYO 350.06 4930517 COLLAGEN CROSSLNKD N-TELOPEP,URI-QU 58.50 4930525 HEREDTRY HEMOCHROM DNA MUT ANALY-QU 196.50 4930533 ANA MULTIPLEX W/REFLEX-QUEST 14.47 4930541 LIVER KIDNEY MICROSOMAL ANTBDY-MAYO 24.28 4930566 THYROID FUNCTION CASCADE - MAYO 10.04 4930574 BETA GLOBIN GENE SEQNC BLOOD-MAYO 600.00 4930582 CYP2D6 GEMOTYPE CASCADE-MAYO 561.90 4930590 MVISTA COCCIDIOIDES ANTIGN URN-MAYO 119.00 4930608 HLA TYPING FOR CELIAC DISEASE-QUEST 220.63 4930616 ALAKALINE PHOSPHATASE BN SPC-QUEST 61.00 4930624 MORPHANA TUMOR IMMUNO-LABCORP 388.00 4930632 IHC MULTIPLEX X1 TECHNICAL-LABOCRP 114.00 4930640 APHERESIS PLTS IRRAD LEUKORED-ARC 502.00 4930657 CUTANEOUS IMMFLUOR STAIN-MAYO 49.76 4930665 IHC-EACH ADDITIONAL STAIN-LABC 40.00 4930673 HERPES SMPLX VRS PCR (NON-BLD)-MAYO 46.10 4930681 MDS PANEL - INTEGRATED 80.00 4930699 MDS PANEL 88275 - INTEGRATED 80.00 4930707 STRATIFY JCV ANTIBODY W REFLEX-QUES 1,511.08 4930715 GONAD RELEASING HORMONE-MAYO 260.00 4930723 BCL-2 TRANSLOCATION T(14:18)-NG 315.00 4930731 BRAF MUTATION ANALYSIS-NEOGENOMICS 200.00 4930749 UNLISTED MOLECULAR PATHOLOGY - MAYO 110.00 4930756 MOPATH PROCEDURE LEVEL 2 - MAYO 110.00 4930764 MOPATH PROCEDURE LEVEL 5 - MAYO 110.00 4930772 MOPATH PROCEDURE LEVEL 6 - MAYO 110.00 4930780 MOPATH PROCEDURE LEVEL 7 - MAYO 110.00 4930798 MOPATH PROCEDURE LEVEL 8 - MAYO 110.00 4930806 MOPATH PROCEDURE LEVEL 9 - MAYO 110.00 4930814 THROMBIN TIME-MAYO 41.40 4930822 RHEUMATOID FACTOR,BODY FLUID-MAYO 79.00 4930830 CARDIO IQ LIPOPROTEIN(A)-MAYO 25.00 4930848 HEPATITIS C VIRL RNA GENO LIPA-QUES 193.00 4930855 AEROBIC BACTERIA SUSPECTIBILITY-QUE 133.67 4930863 AFB SEQUENCING 1-QUEST 442.80 4930871 POLIOVIRUS(TYPES 1,3)AB NEUT-MAYO 180.52 4930889 ALPHA-SUB OF PIT GLYCO-MAYO 35.00 4930897 IN SITU HYBRIDIZATION-1ST-LABCORP 125.00 4930905 IN SITU HYBRIDIZATION-EA ADDNL-LABC 125.00 4930913 3 RBC AG NEG UNIT-ARC 220.00 4930921 MAC PROBE-FOCUS 221.40 4930939 MAC MIC SUSCEPTIBILITY-FOCUS 161.50 4930947 RESPIRATORY VIRAL PANEL-MAYO 521.80 4930954 PNEUMOCYSTIS JEROVECII,DFA-MAYO 121.40 4930962 GANGLIOSIDE GM1,GM2,GD1A,GD1B,GQ1BM 310.40 4930970 AVOCADO,IGE-MAYO 5.33 4930988 INHIBIN A-QUEST 83.38 4930996 INHIBIN B-QUEST 135.00 4931002 KIT(C-KIT)MUTATION ANALY-NEOGENOMIC 304.00 4931010 FLT3(INCL D385)MUTATION ANALY-NEO 300.00 4931028 STAT3 MUTATION ANALY-NEO 490.00 4931036 TP53 MUTATION ANALY BI-DIRECT-NEO 900.00 4931044 NEOTYPE AML PROGNOSTIC PROFILE-NEO 1,630.00 4931051 ALCOHOL,METHYL-QUEST 68.25 4931069 BRUCELLA TOTAL AB,AGGLUT(CONF)-MAYO 20.45 4931077 14.3.3 ETA PROTEIN-MAYO 159.80 4931085 FECAL LEUKOCYTES-MAYO 45.76 4931093 UGT1A1 FULL GENE SEQUENCING-MAYO 1,000.00 4931101 MALDI-TOF ID-QUEST 221.40 4931119 PNEUMOCYSTIS JIROVECII,DFA-QUEST 42.00 4931127 ABL T3151 MUTATION IN CML-QUEST 500.00 4931135 PD-L1-NEOGENOMICS 150.00 4931143 MUMPS IGM ANTIBODY-MAYO 161.50 4931150 HSV IGM AB BY EIA-MAYO 7.64 4931168 DNA ANALY SKELTAL DYSPLSIA-GEN CNTR 495.00 4931176 C3A LEVEL - MAYO 126.86 4931184 C4A LEVEL - MAYO 126.86 4931192 PANCREATIC AMYLASE, SERUM - MAYO 42.76 4931200 FETOMTNL BLD,FLW CYTO-MAYO 538.80 4931218 COMPLEMENT COMP C3,BODY FLUIDS-NI 23.68 4931226 COMPLEMENT COMP C4,BODY BLUIDS-NI 23.68 4931234 OPIATE MECONIUM CONF CHG1-MAYO 59.89 4931242 OPIATE MECONIUM CONF CHG2-MAYO 49.95 4931259 BRAF MUTATION SNAPSHOT-INTEGRATED 325.00 4931267 CRYPTOCOCCUS AG TITER,LFA,CSF-MAYO 19.36 4931275 QUETIAPINE(SEROQUEL),S-MAYO 76.16 4931309 MDM2 GENE AMP FISH-INTEGRATED 540.00 4931317 MICRODISSECTION GLOBAL-INTEGRATED 55.00 4931325 ESTROGEN RECEPT IMAGE ANALY-INTEGRA 97.00 4931333 PROGEST RECEPT IMAGE ANALY-INTEGRAT 97.00 4931341 K167 IMAGE ANALYSIS-INTEGRATED 97.00 4931358 HER2 IMAGE ANALYSIS-INTEGRATED 97.00 4931366 PI-LINKED AG 1ST MARKRS-MAYO 15.00 4931374 PLINKED AG ADDL MARKRS-MAYO 10.00 4931382 TESTOSTERONE, FREE - MAYO 9.44 4931390 TESTOSTERONE,FREE-MAYO 9.56 4931408 TESTOSTERONE,FREE---MAYO 10.34 4931416 TESTOSTERONE,BIOAVAILALE-MAYO 20.55 4931424 CYTOGENITICS DNA PROBE,IMRGF-MAYO 192.36 4931432 CYTO/MOLECULAR REPORT,IMRGF-MAYO 121.87 4931440 EVEROLIMUS,BLOOD-MAYO 41.42 4931457 APOLIPOPROTEIN E GENO-MAYO 318.24 4931473 F-ACTIN AB,IGG,SERUM-MAYO 51.59 4931481 CHIKUNGUNYA IGM AB,SERUM-MAYO 90.00 4931499 CHIKUNGUNYA IGG AB,SERUM-MAYO 90.00 4931507 ZIKA VIRUS MAC-ELISA,IGM SERUM-MAYO 90.00 4931515 CASHEW NUT,IGE-MAYO 4.50 4931523 MOG FACS,SERUM-MAYO 525.00 4931531 CHICKEN IGG-MAYO 49.80 4931549 LETTUCE IGG-MAYO 49.80 4931556 SHRIMP IGG-MAYO 49.80 4931564 TRANSFORMING GROWTH FACTOR BETA-MAY 195.00 4931572 UGT1A1 GENE POLYMORPHISM-QUEST 210.00 4931580 QUANTITAT THYROGLOBUL W/O AB-QUEST 15.86 4931598 PAIN MGMT,ALCOHOL METAB QUANT-QUEST 85.00 4931606 IGF BINDIN PROTEIN-3,QUEST 80.51 4931614 STONE ANALYSIS-QUEST 47.36 4931622 CLL PROGNOSTIC PANEL COMPRENS-QUEST 2,120.01 4931630 BK VIRUS DNA QUANT PCR-QUEST 234.40 4931648 TOTAL GLUTATHIONE-QUEST 76.00 4931655 COTTONWOOD(T13)IGE-QUEST 10.07 4931663 DOG DANDER(E5)IGE-QUEST 10.07 4931671 ACACIA(T19)IGE-QUEST 10.07 4931689 WHITE ASH(T15)IGE-QUEST 10.07 4931697 CAT DANDER(E1)IGE-QUEST 18.44 4931705 MITOCHONDRIAL ANTIBODY TITIER-QUEST 19.72 4931713 MITOCHONDRIAL ANTIBODY TITIER-QUEST 18.20 4931721 HEPATITIS B SURFACE AB,QUANT-QUEST 43.16 4931739 LYMPHOCYTE SUBSET PANEL 5-QUEST 44.96 4931747 SURESWAB BACTERIAL VAGINOSIS-QUEST 650.00 4931754 LP-PLA2 ACTIVITY-QUEST 50.00 4931762 TPMT ACTIVITY PROFILE,RBC-MAYO 135.00 4931770 DHR FLOW FMLP ENZYME ACT-MAYO 66.94 4931788 DHR FLOW FMLP FLOWCYTOM/MARKER-MAYO 205.16 4931796 T CELL RECEPTOR GENE-PRB REARRAN-MA 257.75 4931804 T CELL RECEPTOR GENE-TRG REARRANG-M 248.59 4931812 ELASTASE-MAYO 260.00 4931820 PARVO VIRUS B19,PCR-MAYO 119.87 4931838 FLT3 MUTATION-INTEG 1,642.50 4931846 CEBPA MUTATION-INTEG 390.00 4931853 NPM1 MUTATION-INTEG 374.00 4931861 IGG SUBCLASS PANEL-QUEST 104.00 4931879 ALPHA-GLOBULIN MUTATION ANALY-QUEST 299.00 4931887 XSENSE,FRAGILE X SCREEN-QUEST 269.00 4931895 XSENSE,FRAGILE X REFLEX-QUEST 75.00 4931903 AUSTRAILAN PARROT DROPPINS IGE-QUES 10.00 4931911 HERPESVIRUS 8 IGG ANTIBODY-QUEST 45.60 4931929 HUMAN METAPNEU(HMPV)RNA-MAYO 335.00 4931937 EGFR MUTATN COBASV2 CG1 INTEGRATED 500.00 4931945 EFGR MUTATN ANALY COBASV2 CG2-INTGD 500.00 4931952 ALK GENE MUTATION CHG1 - INTEGRATED 400.00 4931960 ALK GEEN MUTATION CHG2 - INTEGRATED 200.00 4931978 MONOCLONAL GMMPTHY MNTR CHG1-MAYO 3.62 4931986 MONOCLONAL GMMPTHY MNTR CHG2-MAYO 10.59 4931994 5-FLUCYSTONE, SERUM-MAYO 73.28 4932000 IODINE SERUM/PLASMA-QUEST 72.96 4932018 MPN,CALR GENE MUT,EXON9-MAYO 689.80 4932026 T4 FREE,DIRECT DIALYSIS-QUEST 21.80 4932034 ENCEPHALPTHY-AUTOIMMN EVAL CSF-MAYO 850.00 4932042 MPL EXON 10 MUT DETECT-MAYO 291.72 4932059 OXYCODONE-FREE(UNCONJUGATED)-MAYO 120.00 4932067 OXYCODONE W/METABOLIC CONF URN-MAYO 43.04 4932075 MPSEX CHG1-IMMUNOFIXATION,S-MAYO 50.97 4932083 MPSEX CHG2-TOTAL PROTEIN,S-MAYO 8.36 4932091 MPSEX CHG3-PROTN ELECTRPHRSS,S-MAYO 24.49 4932109 MPSEX CHG4-KAPPA/LAMBDA FREELT-MAYO 62.04 4932117 GHRELIN, TOTAL-QUEST 275.00 4932125 MUSCLE BIOPSY CHARGE 1 - LGB 625.00 4932133 MUSCLE BIOPSY CAHRGE 2 - LGB 625.00 4932141 MUSCLE BIOPSY CHARGE 3 - LGB 625.00 4932158 MUSCLE BIOPSY CHARGE 4 - LGB 625.00 4932166 CHROMOSOMAL MICROARRAY,POV-MAYO 1,300.00 4932174 CHROMOSOMES,HEMATOLOGIC,BLD,CHG1 159.11 4932182 CHROMOSOMES,HEMATOLOGIC,BLD,CHG2 37.17 4932190 NOTCHB DNA SEQ MOPATH PRCDR L7-MAYO 2,525.00 4932208 CRYPTOSPORIDIUM ANTIGEN,FECES-MAYO 49.95 4932216 CYCLOSPORA SPECIAL STAIN-MAYO 22.16 4932224 CYCLOSPORA STAIN CONCENTRATION-MAYO 24.69 4932232 HERPES SIMPLX VIRUS PCR, BLOOD-MAYO 59.84 4932240 FLU A&B W/SUBTYPE,RT-PCR CHG1-QUEST 379.95 4932257 FLU A&B W/SUBTYPE,RT-PCR CHG2-QUEST 379.95 4932265 SACCHAROMYCES CER AB,IGG-MAYO 74.63 4932273 COCCIDNS IMMTS ID, DNA PROBE-QUEST 75.00 4932281 DRUG ABUSE PNL 9,W/CONFIM SRM-QUEST 143.00 4932299 ANTIPHSPHLPD SYNDRM DX PNL C1-QUEST 80.86 4932307 ANTIPHSPHLPD SYNDRM DX PNL C2-QUEST 80.86 4932315 ANTIPHSPHLPD SYNDRM DX PNL C3-QUEST 80.86 4932323 ANTIPHSPHLPD SYNDRM DX PNL C4-QUEST 80.86 4932331 BIRD FANCIER PRECIPITIN PNL I-MAYO 132.50 4932349 DRD3 GENOTYPE-MAYO 600.00 4932356 PROLACTIN,PITUITARY MACROADNMA-MAYO 51.16 4932364 COCCIDIOIDES DNA PROBE-QUEST 167.18 4932372 MYOSITIS ANTBDY PNL CHG 84182-QUEST 519.22 4932380 MYOSITIS ANTBDY PNL CHG 86235-QUEST 432.69 4932398 ANTI-HMGCR ANTIBODY IGG-QUEST 190.00 4932406 ADAMS TS13 ANTIBODY-LABCORP 287.75 4932414 MYCOPLASMA HOMINIS PCR-MAYO 115.25 4932422 HBS ANTIBODY,S-MAYO 14.08 4932430 ASPERIGILLUS PRECIP,ID,S-MAYO 108.45 4932448 MEASLES(RUBEOLA)AB,IGM,S-MAYO 24.04 4932455 INHIBIN B,S-MAYO 61.30 4932463 C3 NEPHRITIC FACTOR(C3NEF)-QUEST 72.06 4932471 HLA-B51 DETERMINATION-QUEST 80.00 4932489 ASPERGILLUS FUMIGATUS(M3)IGE-QUEST 10.07 4932497 ACETYLCHOLINE RCPTR BNDNG AB-QUEST 100.00 4932505 MOG ANTIBDY W REFLEX TO TITER-QUEST 528.00 4932513 NEUTROPHIL ANTIBODY,FLOW CYT-QUEST 142.04 4932521 FONDAPARINUX SODIUM(XA INHIB)-QUEST 152.00 4932539 MICROSPORIDIA EXAM-QUEST 60.30 4932547 STONE RISK DIAGNOSTIC PROFILE-QUEST 100.00 4932554 LIPASE,BODY FLUID-MAYO 10.13 4932562 COLLAGEN TYPE II ANTIBODIES-QUEST 78.60 4932570 BACTERIAL MENNINGITIS AG PNL-QUEST 98.50 4932588 SUSCEPTIBILITY,MIC,AEROBIC XI-QUEST 89.25 4932596 TPMT GENOTYPE-QUEST 420.00 4932604 PHOSPHOLIPASE A2 RECPT AB,SRM-QUEST 227.05 4932612 PHOSPHOLIPASE A2 RCPT AB(IFA)-QUEST 227.05 4932620 TPMT ACTIVITY-QUEST 285.03 4932638 MUSCLE BX-HISTO SPCL STN HSPST2-UCI 95.00 4932646 MUSCLE BX-HISTO SPCL STN HSPST3-UCI 206.34 4932653 STONE ANALYSIS PROCESSING CHRG-MAYO 10.00 4932661 LIVER FIBROSIS TST ACTTST PNL-QUEST 288.75 4932679 OXALATE,SERUM-QUEST 107.00 4932687 MYOMAKER IMMUNOASSAY NONANTBDY-MAYO 151.58 4932695 MYOMAKER ANTIGEN ANTIBODY-MAYO 183.42 4932703 HMG-COA ELISA,SERUM-MAYO 200.00 4932711 ASPERGILLUS FUMIGATUS,IGE-MAYO 4.50 4932729 BUPRENORPHINE SCREEN WREFLEX,U-MAYO 116.40 4932737 BUPRENORPHINE METABOLITES,U-MAYO 98.24 4932745 EGFR MUTATION ANALYSIS NSCLS-INTGRD 575.00 4932752 BRAF MUTATN DETCT MELNOMA CG1-INTGR 225.00 4932760 BRAF MUTATN DETCT MELNOMA CG2-INTGR 225.00 4932778 FLOW MARKER,FIRST - INTEGRATED 35.00 4932786 FLOW MARKER, ADDITIONAL- INTEGRATED 13.00 4932794 INTERPRETATION (2-8 MARKERS)-INTRGR 57.00 4932802 INTERPRETATION (9-15 MARKERS)-INTGR 70.00 4932810 INTERPRETATION (16+ MARKERS)-INTGRR 60.00 4932828 CKAPPA FLOW TECH - INTEGRATED 13.00 4932836 CLAMBDA FLOW TECH - INTEGRATED 13.00 4932844 HER2 GASTRIC(MD) - INTEGRATED 320.00 4932851 DSDNA AB BY CRITHIDIA IFA,IGG-MAYO 138.50 4932869 IODINE,SERUM - MAYO 45.74 4932877 NMDA RECPTR NR1-SUBUNT AUTOAB-QUEST 500.00 4932885 LIVER CYTOSOL(LC-1)AUTOAB - QUEST 138.00 4932893 H PYLORIA UREA BREATH TEST - QUEST 160.00 4932901 B PERTUSSIS TOXIN AB-IGG,IGA-QUEST 175.00 4932919 SURESWAB HSV 1-2 MRNA-QUEST 200.00 4932927 LYMPHOCYTE SUBSET PANEL 3- QUEST 134.88 4932935 HEPATITIS C VIRAN RNA,QUALTTV-QUEST 149.00 4932943 JC POLYOMA VRS DNA QL PCR CSF-QUEST 311.34 4932950 SNP MICROARRAY(REVL)PRODCNDP-LACORP 1,400.00 4932968 POMPE DISEASE, BS-MAYO 225.00 4932976 FENTANYL W/METAB CONF, U - MAYO 96.46 4932984 NK/NKT SUBST PNL NK CELL TCNT-MAYO 177.50 4932992 NK/NKT SUBSET MONONUC CELL AG-MAYO 377.90 4933008 NK/NKT SUBST PNL TCELL TCOUNT-MAYO 177.50 4933032 ANTIMICRO SUSECPT,AERO CUST MIC3-NI 201.26 4933040 FACTOR X ACTIVITY CHROMOGENIC-QUEST 145.00 4933057 ENTEROVIRUS CULTURE-QUEST 62.00 4933065 CORTISOL FREE URINE-MAYO 21.08 4933073 CORTISOL COL CHROMOTOGRPHY URN-MAYO 27.34 4933099 PARANEOPLASTIC PEMPHIGS,IGG AB-MAYO 330.90 4933107 IL-2 RECEPTOR(SOUBLE) BY MAFD-MAYO 130.00 4933115 TRICHOMONAS VAGINALIS AMP RNA-MAYO 61.30 4933123 RESPIRATORY PATHOLGN PNLS PCR-MAYO 500.00 4933131 METANEPHRINES,FRCTNTD,RNDM URN-MAYO 22.50 4933149 MLTPL MYELOMA MMRD BY FLW MRK1-MAYO 353.72 4933156 MLTPL MYELOMA MMRD BY FLW ADMK-MAYO 130.72 4933164 MLTPL MYELOMA MMRD BYFLW INTRP-MAYO 336.93 4933172 HER2 BREAST (MO) - INTEGRATED 794.00 4933180 MG/LES EVALUATION-MAYO 375.00 4933198 HCV ANTBDY W REFLEX TO HCV PCR-MAYO 28.31 4933206 MICROSPORIDIA PCR - MAYO 60.00 4933214 ETHYL GLUCURONIDE SCREEN,URINE-MAYO 116.40 4933222 CENTROMERE B ANTIBODY - QUEST 36.00 4933230 TRAMADOL AND METABOLIE,URINE-MAYO 40.00 4933248 ECHINOCOCCUS AB IGG,SERUM-MAYO 30.00 4933255 COCCIDIODES COMP FIX IMMUNODIF-MAYO 54.90 4933263 CHROMOSOMES,HEMA BMARROW,CULT-MAYO 141.86 4933271 CHROMOSOMES, HEMA BMRRW MOLRPT-MAYO 33.14 4933289 CHROMO HEMA BMRRW METAPHAS1-19-MAYO 175.00 4933297 CHROMO HEMA BMRRW METAPHS20-25-MAYO 175.00 4933313 CHROMO HEMA BMRRW AGNOR/CBLSTN-MAYO 11.60 4933321 TISSUE TRANSGLUTAMINASE IGG AB-MAYO 15.00 4933339 SARS-COV-2-RNA,QUALITTV RTPCR-QUEST 100.00 4933347 SARS-COV-2 BY RT-PCR - WESTPAC 70.00 4933354 SARS-COV-2 IGG ANTIBODY-MAYO 43.00 4933362 ANTISTREP-O TITER,S(ASO)-MAYO 19.50 4933370 SARS-COV-2 BY RT-PCR-PANGEA 80.00 4933388 SARS-COV2 BY RT-PCR-NEXTGEN 70.00 4933420 BRCA1/2 MUTA DD ANALYSIS-NEO 295.00 4933438 CEBPA MUTATION ANALYSIS-NEO 322.00 4933446 CALR MUTATION ANALYSIS-NEO 280.00 4933453 IGVH MUTATION ANALYSIS-NEO 417.00 4933461 JAK2 V617F MUTA ANALYSIS-NEO 250.00 4933479 KIT (C-KIT) MUTA ANALYSIS-NEO 274.00 4933487 MYD88 MUTATION ANALYSIS-NEO 290.00 4933495 NPM1 MUTATION ANALYSIS-NEO 270.00 4933503 T-CELL RECEPT BETA RRNGMNT-NEO 500.00 4933511 T-CELL RECEP GAMMA RRNGMNT-NEO 256.00 4933529 MPL MUTATION ANALYSIS-NEO 221.00 4933537 JAK2 EXON MUTA ANALYSIS-NEO 316.00 4933545 STAT3 MUTATION ANALYSIS-NEO 442.00 4933552 TP53 MUTATION ANALYSIS-NEO 810.00 4933560 NEOTYPE MDS/CML PROF-NEO 2,400.00 4933578 NEOTYPE MYELOID PROF-NEO 2,600.00 4933586 IDH1/IDH2 MUTA ANALYSIS-NEO 265.00 4933594 FLT3 MUTATION ANALYSIS-NEO 300.00 4933602 BCR-ABL1 STD P210,P190-NEO 388.00 4933610 B-CELL GENE RRNGMNT-NEO 492.00 4933628 MPN EXTENDED RFLX PNL-NEO 1,067.00 4933636 NEOTYPE CLL P PROFILE-NEO 420.00 4933644 STD LEUK/LYMPH FLO/CYT-NEO 168.00 4933651 CLL MRD FLOW CYTOMETRY-NEO 25.00 4933669 PNH FLOW CYTOMETRY-NEO 25.00 4933677 BCR/ABL1 FISH 88374-NEO 200.00 4933685 CCND1 IGH FISH 88374-NEO 200.00 4933693 PML RARA FISH 88374-NEO 200.00 4933701 AML FAVORABLE RISK 88374-NEO 200.00 4933719 CLL FISH PANEL 88374-NEO 200.00 4933727 EOSIOPHILIA FISH 88374-NEO 200.00 4933735 LG SML CELL LYMPH 88374-NEO 200.00 4933743 AML NONFVRABLE RISK 88374-NEO 400.00 4933750 MDS EXTENDED FISH PNL 88374-NEO 400.00 4933768 NEOTYPE CLL P PROFILE 88374-NEO 400.00 4933776 STD LEUK/LYMPH FLO/C 88185-NEO 35.00 4933784 CLL MRD FLOW CYTOMETRY 88185-NEO 28.00 4933792 PNH FLOW CYTOMETRY 88185-NEO 28.00 4933800 BCR/ABL1 FISH 88377-NEO 180.00 4933818 CCND1 IGH FISH 88377-NEO 180.00 4933826 PML RARA FISH 88377-NEO 180.00 4933834 AML FAVORABLE RISK 88377-NEO 180.00 4933842 CLL FISH PANEL 88377-NEO 180.00 4933859 EOSINOPHILA FISH 88377-NEO 180.00 4933867 LG SML CELL LYMPH 88377-NEO 180.00 4933875 AML NONFVRABLE RISK 88377-NEO 360.00 4933883 MDS EXTENDED FISH PNL 88377-NEO 360.00 4933891 CHLAMYDIA TRACHOMATS AMPLFD RNA-WPL 23.38 4933909 NEISSERIA GONRRHOEAE AMPLFD RNA-WPL 23.38 4933917 IBUPROFEN-QUEST 15.00 4933925 LIPOPROTEIN FRACTIONATN ULTRA-QUEST 113.00 4933933 CHLAMYDIA TRACHOMATIS RNA TMA-QUEST 60.00 4933941 NEISSERIA GONRRHOEAE RNA TIMA-QUEST 60.00 4933958 C TRACHOMATIS RNA ALT TARGET-QUEST 60.00 4933966 N GONNORRHOEAE RNA ALT TARGET-QUEST 60.00 4950002 CRYOGLOBULIN 26.00 4950010 CATECHOL FRACT,24HR URINE-QUEST 30.00 4950028 PREALBUMIN 10.00 4950036 URIC ACID URINE 8.00 4950044 PHOSPHORUS URINE 11.00 4950051 SEROTONIN UR 17.00 4950069 HEP B SURF AG IND 6.00 4950077 HEP C AB IND 10.00 4950085 HOMOCYSTEINE 30.00 4950093 ANTISTREP O 11.00 4950101 LEAD 27.00 4950119 ARSENIC 27.00 4950127 MERCURY 27.00 4950135 AMPHETAMINES 4.00 4950143 ANALGESICS 4.00 4950150 HGB A2 29.00 4950168 ANTICOVALSANTS 4.00 4950176 ANTIDEPRESSANTS 4.00 4950184 ANTIHISTAMINES 4.00 4950192 COCAINE/METABOLITES 4.00 4950200 NARCOTICS 4.00 4950218 SEDATIVES/HYPNOTICS 4.00 4950226 TRANQUILIZERS 4.00 4950234 VOLATILES 4.00 4950242 HGB FETAL 16.00 4950259 HCV RNA BY PCR-QUEST 90.00 4950267 VMA 22.00 4950275 OLIGOCLONAL BANDS 30.00 4950283 MYELIN BASIC PROTEIN 31.00 4950291 ALBUMIN 11.00 4950309 GAMMAGLOBULIN X 1 11.00 4950317 GAMMAGLOBULIN X 2 11.00 4950325 NEPHELOMETRY 11.00 4950333 INHIBIN A 144.00 4950341 INHIBIN B 135.00 4950358 ALDOLASE 8.40 4950366 AMPHETAMINES 6.00 4950374 ANALGESICS 6.00 4950382 ANTICONVULSANTS 6.00 4950390 ANTIDEPRESSANTS 6.00 4950408 ANTIHISTAMINES 6.00 4950416 COCAINE & METABOLITES 6.00 4950424 NARCOTICS 6.00 4950432 SEDATIVES/HYPNOTICS 6.00 4950440 TRANQUILIZERS 6.00 4950457 VOLATILES 6.00 4950465 HGB ELECTROPHOR 20.00 4950473 EXTRACTION NUCLEIC ACID(PRT) 48.00 4950515 EOSINOPH COUNT 28.00 4950523 BENCE-JONES PROT 25.00 4950531 TACROLIMUS (FK506) 127.00 4950549 IGF BINDING PROTEIN-1 57.00 4950556 CK ISOENZYME 25.00 4950564 LUPUS EXPANDED PANEL 1 47.40 4950572 PROLACTIN 18.00 4950580 CEA BY RIA 7.00 4950598 LUPUS EXPANDED PANEL 2 47.40 4950606 LITHIUM 10.00 4950622 HCG QUANT 20.00 4950648 ALPHA FETO PROT 10.00 4950655 LUPUS EXPANDED PANEL 3 47.40 4950663 LUPUS EXPANDED PANEL 4 47.40 4950671 CHLAMYDIA TRACHOMATIS DNA 60.00 4950689 LACTIC ACID 15.00 4950697 LUPUS EXPANDED PANEL 5 47.40 4950705 LUPUS EXPANDED PANEL 6 47.40 4950713 LUPUS EXPANDED PANEL 7 47.40 4950721 LUPUS EXPANDED PANEL 8 47.40 4950739 T3 TOTAL 5.00 4950747 QUINIDINE 18.00 4950754 AMIKACIN RANDOM 27.00 4950762 HLA-B27 31.00 4950770 ANA 9.00 4950788 C-REACTIVE PROT 9.00 4950796 RHEUMATOID FACTOR 7.00 4950804 URIC ACID 5.00 4950812 HLA B27 25.00 4950820 HSV 1 BY PCR 123.00 4950838 HSV 2 BY PCR 123.00 4950846 MARIJUANA METABOLITES 32.00 4950853 ELECTROPHORESIS URINE 9.00 4950861 PROTEIN TOTAL URINE 9.00 4950879 CREATININE URINE 9.00 4950911 EXTRACTION OF NUCLEIC ACID 40.00 4950929 PH BODY FLUID 40.00 4950937 TECHOIC ACID AB 28.00 4950945 TEICHOIC ACID AB TITER 28.00 4950952 PROT ELEC SER 10.80 4950960 PROT ELEC CSF 17.00 4950978 AMPHETAMINES 6.00 4950986 ANALGESICS 6.00 4950994 ANTICONVULSANTS 6.00 4951000 ANTIDEPRESSANTS 6.00 4951018 ANTIHISTAMINES 6.00 4951026 COCAINE & METABOLITES 6.00 4951034 NARCOTICS 6.00 4951042 SEDATIVES/HYPNOTICS 6.00 4951059 TRANQUILIZERS 6.00 4951067 VOLATILES 6.00 4951083 FOLLICLE STIM HOR 20.00 4951091 MICROSOMAL AB HA 24.00 4951109 PROGESTERONE-QUEST 26.66 4951117 PTH-INTACT 18.00 4951125 C 4 13.00 4951133 HEPATITIS CAB 10.00 4951141 LEAD BLOOD 10.00 4951158 ALDOSTERONE SERUM 33.00 4951166 ALK P'TASE FRACT 22.00 4951174 CATACHOLAMIN FRAC 16.00 4951182 ALKALINE PHOSPHATASE ISOENZYME 22.00 4951190 HEPATITIS A B & C PANEL 41.00 4951208 HEPATITIS A (IGM) 11.00 4951216 HEP B SURF AG 6.00 4951224 HEP B CORE AB 13.00 4951232 VITAMIN B12 19.00 4951240 LIDOCAINE 18.00 4951257 HAPTOGLOBIN 10.00 4951265 ACID PHOS PROSTATIC 14.00 4951273 BETA-2-MICROGLOB-QUEST 25.75 4951281 MHA-TP 16.00 4951299 G6PD 21.00 4951307 C3 COMPLEMENT 14.00 4951315 FTA 11.00 4951323 CALCIUM 7.00 4951331 CATACHOLAMIN TOTL 16.00 4951349 AMIODARONE 46.00 4951356 AMITRIPTYLINE 45.00 4951364 ANTI ENA SM 40.00 4951372 ANTI ENA RNP 40.00 4951380 ALPHA ANTITRYPSIN 15.00 4951398 CARBON MONOXIDE-QUEST 34.40 4951406 DHEA-S 36.00 4951414 FETAL FIBRONECTIN 210.00 4951422 ESTRADIOL 33.00 4951430 GROWTH HORMONE 21.00 4951448 CALCIUM IONIZED 16.12 4951455 PARIETAL CELL AB 55.00 4951463 SJOGRENS AB SS-A 45.00 4951471 SJOGRENS AB SS-B 45.00 4951489 METHOTREXATE 110.00 4951497 VIP 51.00 4951505 CA 27-29 28.00 4951513 PORPHYRINS QUANT 35.00 4951521 FACTOR VII 120.00 4951539 FACTOR VIII 137.00 4951547 FACTOR IX 137.00 4951554 FACTOR X 137.00 4951562 PROTEIN C 55.00 4951570 PROTEIN S 55.00 4951588 ANTI-THROMBIN 111 140.00 4951596 HCV GENOTYPE-QUEST 256.00 4951604 OVA AND PARASITES 22.00 4951620 CHLORIDE UR RANDOM 66.00 4951638 ANTIGLIADIN AB IGA 52.00 4951646 ANTIGLIADIN AB IGG 52.00 4951653 CCP AB IGG 90.00 4951661 C-PEPTIDE 20.00 4951679 CARDIO CRP-QUANTITATIVE-QUEST 25.00 4951687 SEROTONIN RELEASE ASSAY 260.00 4951695 HEP-INDUCED THROMBOCYTOPENIAAB 124.00 4951703 B2 - GLYCO PROTEIN IGG 48.00 4951711 B2 - GLYCO PROTEIN IGA 48.00 4951729 B2 - GLYCO PROTEIN IGM 48.00 4951737 T3 FREE 51.00 4951745 FREE T4 4.00 4951752 MICROALBUMIN 21.00 4951760 MICROALBUMIN 21.00 4951778 COXSACKIE B 98.00 4951786 CARDIOLIPIN ANTIBODIES 63.00 4951794 RSV BY DFA 68.00 4951802 ASPERGILLUS ID 44.00 4951810 BLASTOMYCOS CF 49.00 4951828 COXS VIR CF 98.00 4951836 ECHINOCOCC AGG 122.00 4951844 CHLAMYDIA GR 91.00 4951851 CHLAMYDIA CULT 40.00 4951869 HERPES CULTURE 58.00 4951877 WESTERN BLOT 74.00 4951885 SCHLICTER TST 72.00 4951893 ANTI-NEUT IFA 79.00 4951901 ROTAVIRUS ANTIGEN 64.00 4951919 PSITTACOSIS CF 125.00 4951927 VIRAL CULTURE 43.00 4951935 Y ENTEROCOLITICA 45.00 4951943 Y PSEUDOTUBERCULO 45.00 4951950 OUCHTERLONY 13.00 4951968 ASPERGILLUS ELAV 13.00 4951976 ASPERGILLUS NIGER 13.00 4951984 ASPERGILLUS 13.00 4951992 ACTINOMYCETE #1 13.00 4952008 ACTINOMYCETE #2 13.00 4952016 SPINAL FLUID VDRL 36.00 4952024 ACTINOMYCETE #3 13.00 4952032 LUPUS ANTICOAG 71.00 4952040 CULTURE C. DIFF. 58.00 4952057 CRYPTOSP. STAIN 61.00 4952065 FAT STAIN STOOL 54.00 4952073 AEROBIC SENSI 59.00 4952081 CHLAMYDIA SM 63.00 4952099 HIV (SEND OUT) 24.00 4952107 ACTINOMYCETE #4 13.00 4952115 AFB SENSITIVITY 22.00 4952123 AFB STAIN URINE - FOCUS 23.52 4952131 SHIGELLA TYPING A 15.00 4952149 SHIGELLA TYPING B 15.00 4952156 SHIGELLA TYPING C 15.00 4952164 SHIGELLA TYPING D 15.00 4952172 CULT FUNGUS BLOOD 61.00 4952180 ACTINOMYCETE #5 13.00 4952198 AFB SENSITIVITY 22.00 4952206 AFB SENSITIVITY 22.00 4952214 AFB SENSITIVITY 22.00 4952222 AFB SENSITIVITY 22.00 4952230 ANTI-CENTROMERE 16.00 4952248 ANTI-NUCLEAR AB 16.00 4952255 ANTI-RNP AB 16.00 4952271 ANTI-SM AB 16.00 4952289 ANTI-SS-A AB 16.00 4952297 ANTI-SS-B AB 16.00 4952305 C3 16.00 4952313 C4 16.00 4952321 INFLUENZA A 33.00 4952339 INFLUENZA B 33.00 4952347 ECHO VIRUS TYPE 4 19.00 4952354 ECHO VIRUS TYPE 7 19.00 4952362 ECHO VIRUS TYPE 9 19.00 4952370 ECHO VIRUS TYPE 11 19.00 4952388 ECHO VIRUS TYPE 30 19.00 4952396 HERPES 1 IGG 38.00 4952404 HERPES 1 IGM 38.00 4952412 HERPES 2 IGG 38.00 4952420 HERPES 2 IGM 38.00 4952438 CARDIOLIPN AB IGG 47.00 4952446 CARDIOLIPN AB IGM 47.00 4952453 AMEBIASIS ELISA 59.00 4952461 AMEBIASIS ID 59.00 4952479 COCCIDIO, CF SERUM - FOCUS 53.90 4952487 COCCIDIO ID SERUM A - FOCUS 24.85 4952495 COCCIDIO ID SERUM B - FOCUS 24.85 4952503 CYTOMEGALOVIRUS ANTIBODY(IGG)FOCUS 49.70 4952511 CYTOMEGALOVIRUS ANTIBODY(IGM)FOCUS 49.70 4952529 HISTOPLASMOSIS ID 44.00 4952537 HISTOPLASMOSIS CF 44.00 4952545 LEGIONELL PNEUMO 29.00 4952552 LEGIONELL SPECIES 29.00 4952560 CHLAM PNEUMO IGG 15.00 4952578 CHLAM PNEUMO IGA 15.00 4952586 CHLAM PNEUMO IGM 15.00 4952594 CHLAM TRACH IGG 15.00 4952602 CHLAM TRACH IGA 15.00 4952610 CHLAM TRACH IGM 15.00 4952628 CHLAM PSITT IGG 15.00 4952636 CHLAM PSITT IGA 15.00 4952644 CHLAM PSITT IGM 15.00 4952651 EB VIRUS VCA IGG 31.00 4952669 ANTIBODY EB VIRUS,VIRAL CAPSID 42.91 4952677 ANTIBODY EB VIRUS NUCLEAR ANTIGEN 42.91 4952685 ANTIBODY EB VIRUS,EARLY ANTIGEN 42.91 4952693 LEGIONELLA AG/DFA 31.00 4952701 VERICELLA ZOS IGG 32.00 4952719 VARICELLA ZOS IGM 32.00 4952727 CANDIDA PRECIP AG 50.00 4952735 INFLUENZA A DFA 37.00 4952743 INFLUENZA B DFA 37.00 4952750 TOXOPLASMA IGG 54.00 4952768 TOXOPLASMA IGM 54.00 4952776 AFB STAIN,PEROTONEAL FLUID-FOCUS 23.52 4952784 AFB CULT BLD 31.00 4952792 H PYLORI IGG 52.00 4952800 H PYLORI IGA 52.00 4952818 CYSTICERCOSIS AB IGG - QUEST 65.30 4952826 CYSTICERCOSIS AB 86.00 4952834 HISTONE AB 68.00 4952842 RUBEOLA AB IGG-PIHW 33.29 4952859 RUBEOLA AB IGM 21.00 4952867 P CARINII DFA/STN 77.00 4952875 TULAREMIA AB 70.00 4952883 AGBM ANTIBODY 49.00 4952891 BRUCELLA ABOR IGG 47.00 4952909 BRUCELLA ABOR IGM 47.00 4952917 WEIL-FELIX TEST 47.00 4952925 WIDAL AGGLUTININS 47.00 4952933 AFB CULTURE ID 57.00 4952941 ANA 11.00 4952958 C4 11.00 4952966 CENTROMERE AB 11.00 4952974 DSDNA AB 11.00 4952982 MITOCHONDRIAL AB 11.00 4952990 MYOCARDIAL AB 11.00 4953006 PARIETAL CELL AB 11.00 4953014 RETICULIN AB 11.00 4953022 RIBOSOMAL P AB 11.00 4953030 RNP AB IGG 11.00 4953048 SM AB IGG 11.00 4953055 SCL-70 IGG 11.00 4953063 SMOOTH MUSCLE AB 11.00 4953071 SS-A AB IGG 11.00 4953089 SS-B AB IGG 11.00 4953097 STRIATIONAL MUSCLE AB 11.00 4953105 TPO AB 11.00 4953113 T CELLS (CD3) 29.00 4953121 B CELLS (CD19) 29.00 4953139 T HELPER CELLS 29.00 4953147 T SUPPRESSOR CELLS 29.00 4953154 BACT AG H FLU 59.00 4953162 BACT AG A/Y & CW135 59.00 4953170 BACT AG B/E COLI 59.00 4953188 BACT AG NEISSERIA 59.00 4953196 BACT AG S PNEUMO 59.00 4953204 PLATELET ANTIBODIES A - FOCUS 49.50 4953212 PLATELET ANTIBODIES B - FOCUS 49.49 4953220 PLT ASSOC AB IGG 50.00 4953238 PLT ASSOC AB IGM 52.00 4953246 PLATELET ANTIBODIES C - FOCUS 49.49 4953253 PLT ASSOC AB IGA 52.00 4953261 BRUCELLA IGG 38.00 4953279 BRUCELLA IGM 38.00 4953287 W NILE VIRUS IGG 66.00 4953295 W NILE VIRUS IGM 31.00 4953303 W NILE VIRUS IGG 71.00 4953311 W NILE VIRUS IGM 34.00 4953329 PHOSPHOLIPID AB IGG 76.00 4953337 PHOSPHOLIPID AB IGM 76.00 4953345 PHOSPHOLIPID AB IGA 76.00 4953352 MUMPS IGG AB-W 53.20 4953360 CHROMOSOME ANALYSIS 88237 175.00 4953378 CHROMOSOME ANALYSIS 88239 175.00 4953386 CHROMOSOME ANALYSIS 88262 175.00 4953394 KLEIHAUER-BETKE 69.00 4953402 NEWBORN GENETIC SCREEN MCAL - LB 112.00 4953436 STONE ANALYSIS 29.00 4953444 FLOW CYTOMETRY ADD'L ANTIBODY - PI 21.00 4953451 FLOW CYTOMETRY ADD'L ANTIBODY-PI 21.00 4953469 FLOW CYTOMETRY ADD'L ANTIBODY - PI 21.00 4953477 FLOW CYTOMETRY ADD'L ANTIBODY - PI 21.00 4953485 FLOW CYTOMETRY ADD'L ANTIBODY - PI 21.00 4953493 FLOW CYTOMETRY ADD'L ANTIBODY-PI 21.00 4953501 FLOW CYTOMETRY ADD'L ANTIBODY-PI 21.00 4953519 FLOW CYTOMETRY ADD'L ANTIBODY-PI 21.00 4953527 FLOW CYTOMETRY ADD'L ANTIBODY-PI 21.00 4953535 FLOW CYTOMETRY ADD'L ANTIBODY-PI 21.00 4953543 CYCLOSPORINE 31.00 4953550 MITOCHOND AB 20.00 4953568 HGB PLASMA 46.00 4953576 CORTISOL FREE 81.00 4953584 HISTOPLASMA AG URINE 103.00 4953592 METHYLMALONIC ACID 155.00 4953600 ANA TITER 18.00 4953618 ANTI-DNA 14.00 4953626 TRANSFERRIN 14.00 4953634 COMPLEMENT TOT 24.00 4953642 VIT D 1 25 DIHYDROXY 70.00 4953659 AMIKACIN TROUGH 27.00 4953667 AMIKACIN PEAK 27.00 4953675 CHLAMYDIA TRACHOMATIS DNA SDA 60.00 4953683 ACTH 47.04 4953691 CAROTENE 15.00 4953709 HEP B SURF AB QUANT 8.00 4953717 VITA D 25-HYDROXY 82.00 4953725 INFLUENZA A PCR 98.00 4953733 INFLUENZA 2009 H1N1 98.00 4953741 CHLAMYDIA TRACHOMATIS RNA TMA 60.00 4953758 CHLAMYDIA/GC RNA,TMA 120.00 4953766 CERULOPLAS 14.00 4953774 GASTRIN 21.00 4953782 INSULIN 14.00 4953790 SMOOTH MUSCLE 24.00 4953808 SMOOTH MUSCLE AB TITER 24.00 4953816 MYOGLOBIN URINE 20.00 4953824 MYOGLOBIN 27.00 4953832 IMMUNOGLO A IGA 11.00 4953840 ANGI COVER ENZ 13.00 4953857 IMMUNOGLO D 21.00 4953865 IMMUNOGLO E 13.00 4953873 IMMUNOELECT UR 39.00 4953881 IMMUNOGLO G 11.00 4953899 IMMUNOGLO M 11.00 4953907 IMMUNOELEC SERUM 39.00 4953915 IMMUNOGLOBULIN G 11.00 4953923 IMMUNOGLOBULIN A 11.00 4953931 LUTENNIZ HORMONE 15.00 4953949 LAB FAT FECAL QUALITATIVE 22.00 4953956 IMMUNOGLOBULIN M 11.00 4953964 TESTOSTERONE - QUEST 16.50 4953972 CA-19-9 13.00 4953980 CA-125-W 10.00 4953998 ZINC SERUM-QUEST 15.76 4954004 THYROGLOBULIN PANEL 18.00 4954012 TYHROGLOBULIN AB 18.00 4954020 HGB URINE 27.00 4954038 CA 15-3 14.00 4954046 D-DIMER - QUEST 35.00 4954061 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954079 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954087 FLOW CYTOMETRY ADD'L ANTIBODY-PI 21.00 4954095 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954103 FLOW CYTOMETRY BLOOD 43.00 4954111 FLOW CYTOMETRY BONE MARROW 43.00 4954129 FLOW CYTOMETRY TISSUE 43.00 4954137 INFUENZA A&B QUAL PCR-FOCUS 208.60 4954145 MASS SPECTROMETRY 16.00 4954152 GALACTOSE-1-PHOS 16.00 4954160 TSH 16.00 4954178 HEMOGLOBINOPATHY 15.62 4954186 IMMUNOREACTIVE TRYPSINOGEN 16.00 4954194 BIOTINIDASE 16.00 4954202 HYDROXYPROGESTERONE 16.00 4954210 HANDLING FEE 18.00 4954228 RIBOSOMAL P ANITBODY 14.00 4954236 ANA SCREEN IFA 14.00 4954244 COMPLEMENT C3C AND C4C 7.00 4954251 DNA (DS) ANTIBODY 14.00 4954269 SCL-70 ANTIBODY 14.00 4954277 THYROID PEROXIDASE ANTIBODY 14.00 4954285 RHEUMATOID FACTOR 14.00 4954293 ALPHA FETO PROTEIN-W 10.00 4954301 AMIKACIN PEAK-W 22.64 4954319 AMIKACIN TROUGH-W 22.64 4954327 AMIKACIN RANDOM-W 22.64 4954335 CA 15-5-W 14.00 4954343 CA 19-9-W 13.00 4954350 CA 125-W 10.00 4954368 CEA-W 7.00 4954376 CORTISOL TOTAL-W 7.00 4954384 FETAL FIBRONECTIN ASSAY-W 210.00 4954392 HAPTOGLOBIN-W 10.00 4954400 HEP A VIRUS IGM-W 11.00 4954418 HEPATITIS B CORE AB,IGM-W 12.00 4954426 HEP SURFACE AB-W 9.00 4954434 HEP B SURFACE ANTIGEN-W 6.18 4954442 HEPATITIS C ANTIBODY-W 10.00 4954459 LITHIUM, LAB-W 10.07 4954467 MICROALBUMIN-W 20.72 4954475 PTH INTACT-W 25.00 4954483 RUBELLA AB SCREEN-W 5.00 4954491 FREE T3 (FT3)-W 50.88 4954509 T3,TOTAL-W 5.00 4954517 FREE T4 (FT4) 184.00 4954525 TRANSFERRIN-W 13.68 4954533 VITAMIN D,25-HYDROXY-W 81.89 4954541 HEPATITIS A B & C PANEL 39.18 4954558 VARICELLA-W 63.25 4954566 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954574 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954582 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954590 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954608 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954616 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954624 FLOW CYTOMETRY ADD'L ANTIBODY 21.00 4954640 BM ADD'L ANTIBODY W/EXPLOSION 21.00 4954657 FLOW CYTO ADD'L COMPONENT 2 93.00 4954673 LEVEL II SURG PTH 470.00 4954681 LEVEL III SUR PTH 650.00 4954699 LEVEL IV SURG PTH 823.00 4954707 LEVEL V SURG PTH 901.00 4954715 LEVEL VI SURG PTH 1,047.00 4954723 FROZ/CONS 375.00 4954731 FROZ EA ADD - PHHD 263.00 4954749 SP STAIN SIM 165.00 4954756 SP STAIN COM 90.00 4954764 FNA/ CONS - PHHD 650.00 4954772 CYTOLOGY SMEAR 302.00 4954780 C BLK CYTO - PHHD 823.00 4954798 BN MAR-ASP INT - PHHD 112.00 4954806 BN MAR-INTERPRETATN - PHHD 823.00 4954814 FNA ST CONSULT - PHHD 244.00 4954822 CELL WASH INTERPT - PHHD 901.00 4954830 CELL BLK ADD'L - PHHD 823.00 4954848 CONCENTRATE/BLK - PHHD 901.00 4954855 DECALCIFICATION - PHHD 23.00 4954863 ORX-IMAG CONSUL 375.00 4954871 FNA ST ADD CONSUL - PHHD 244.00 4954889 LVL 4 GRS + MICRO 901.00 4954897 DIR IMMFLOUR AB 47.00 4954905 SPECIAL STAIN GRP II 90.00 4954913 PLASMA THAW & HANDL 61.00 4954921 ABO TYPING 24.00 4954939 PHENOTYPE 33.00 4954947 ANTIGEN TYPING 266.25 4954954 DIRECT COOMBS 14.00 4954962 RH TYPING 27.00 4954970 RH TYPE UNIT SCRN 27.00 4954988 DIRECT COOMBS 14.00 4954996 RHO DU TEST 24.00 4955001 DAT IGG 14.00 4955019 DAT C3(NON IGG) 14.00 4955027 FETAL SCREEN 30.00 4955035 SPEC XM PROCEDURE 127.00 4955043 ANTIBODY ID 43.00 4955050 POOLING BLD PROD 49.00 4955068 ANTIBODY SCRN PT 33.00 4955076 UNIT SCRN ABO TYPE 52.00 4955084 SPECIAL AB PANEL 43.00 4955092 CROSSMATCH 437.92 4955100 SPLITTING OF UNIT 31.00 4955118 ABSORPTION BLOOD 77.00 4955126 ANA-W 8.78 4955142 ACUTE HEPATITIS PANEL 39.18 4955159 HEP B SURFACE AG CONFIRM-W 33.86 4960001 AFB SMEAR-FOCUS 23.52 4960019 PROCALCITONIN - QUEST 200.00 4960027 CRYTOCOCCAL ANTIGEN - FOCUS 35.10 4960035 JAK 2 MUTATION-QUANTITATIVE-QUEST 449.00 4960043 NOROVIRUS, STOOL - FOCUS 62.78 4960050 QUANTIFERON TB GOLD-QUEST 60.00 4960068 MTB,PCR CFS-FOCUS 141.64 4960076 ANTIPYRINE - FOCUS 170.00 4960084 TSI-THYROID STIMLTNG IMMGLBN-QUEST 307.07 4960092 ANCA VASCULITIDES A - QUEST 100.00 4960118 RSV,PCR - FOCUS 208.60 4960126 ANCA VASCULITIDES B - QUEST 100.00 4960134 ANTIPYRINE - QUEST 170.00 4960142 BCR/ABL,PCR - QUEST 220.00 4960159 GIARDIA, STOOL - FOCUS 77.00 4960167 AFB STAIN, ASCITIC FLUID-FOCUS 23.52 4960175 BILE ACDS,FRCTN TTL PREGNANCY-QUEST 120.61 4960183 RHMTD ARTHRITIS PANEL A CCP-QUEST 48.44 4960191 RHMTD ARTHRTS PNL B FCTR QNT-QUEST 48.44 4960209 FECAL GLOBIN-QUEST 60.00 4960217 FREE LGHT KAPPA LAMBDA CHN A-QUEST 25.00 4960225 FREE LGHT KAPPA LAMBDA CHN B-QUEST 25.00 4960233 21 HYDROXYLASE ANTIBODY-QUEST 107.00 4960241 CYSTIC FIBROSIS CARRIER SCRN-QUEST 180.69 4990008 ER, PR BY IA - GLOBAL A - LABCORP 150.00 4990016 ER, PR BY IA - GLOBAL B - LABCORP 150.00 4990024 BCR/ABL QUANTIATIVE PCR A -LABCORP 486.00 4990032 BCR/ABL QUANTIATIVE PCR B-LABCORP 486.00 4990040 EGFR MUTATION, NSCLC - LABCORP 992.25 4990057 EGFR MUTATION, TUMOR ANALYSIS A-LC 450.00 4990065 EGFR MUTATION, TUMOR ANALYSIS B -LC 450.00 4990073 KRAS MUTATION - LABCORP 587.88 4990081 ALK BY FISH - LUNG A - LABCORP 216.67 4990099 ALK BY FISH - LUNG B - LABCORP 216.67 4990107 ALK BY FISH - LUNG C - LABCORP 216.67 4990115 HER 2 BY FISH - BREAST/GASTRIC A-LC 106.67 4990123 HER 2 BY FISH - BREAST/GASTRIC B-LC 106.67 4990131 HER 2 BY FISH - BREAST/GASTRIC C-LC 106.67 4995007 TC PRIMARY IHC STAIN - PATH INC 40.00 4995015 TC ADDITIONAL IHC STAINS - PATH INC 40.00 4995023 CONSULTATION WITHOUT IHC STAINS -PI 125.00 4995031 CONSULTATN WITH IHC STAINS-PATH INC 225.00 4995049 H. PYLORI STOOL - QUEST 102.30 4995064 ENTAMOEBA HISTOLYTICA,STOOL-FOCUS 63.00 4995072 ENTAMEOBA HISTOLYTICA ANTIGEN-QUEST 44.00 4995080 ENTAMOEBA HISTILYTICA,STOOL-FOCUS 63.00 4995098 ENTAMOEBA HISTOLYTICA ANTIGEN-FOCUS 63.00 4995106 H. PYLORI STOOL-FOCUS 90.30 4995114 H. PYLORI SERUM-FOCUS 90.30 4995122 KEPPRA(LEVITERACETAM)SERUM-QUEST 65.25 4995130 COCCIDIO ID,SERUM-FOCUS 49.70 4995148 COCCIDIO ID,SERUM-FOCUS 53.90 4995155 COCCIDIODES ANTIBODY-QUEST 46.44 4995163 COXIELLA BURNETTI(Q-FEVER)-FOCUS 163.17 4995171 ECHINOCOCCUS AB(IGG)W/RFLX TO WB 128.63 4995189 STRONGYLOIDES ANTIBODY,IGG-QUEST 56.75 4995197 BRUCELLA IGG,IGM-FOCUS 40.80 4995205 HISTAMINE RELEASE 100.00 4995213 ALLERGEN SPECIFIC,IGE-QUEST 10.37 4995221 TRYPTASE-QUEST 69.97 4995239 ANTI-MULLERIAN HORMONE(AMH)-QUEST 102.00 4995247 PLATELET ANTIBODY,DIRECT-FOCUS 135.98 4995254 BETA PROSTAGLANDIN F2-QUEST 197.10 4995262 VIT B6-QUEST 147.00 4995270 TREPONNEMA PALLIDUM(TPPA)-QUEST 69.30 4995288 INFLUENZA A&B PCR W/O REFLEX-QUEST 284.00 4995296 BARTONELLA PCR,BLOOD-FOCUS 208.60 4995304 BARTONELLA,SERUM-FOCUS 150.00 4995312 CMV,PCR SERUM-FOCUS 208.60 4995320 CMV,URINE-FOCUS 208.60 4995338 CMV,BLOOD-FOCUS 208.60 4995346 PROTHROMBIN GENE MUTATION-QUEST 158.56 4995353 ACETYLCHOLINE RECPTORS ANTIBODY-QUE 48.96 4995379 ACETYLCHOLINE RECEPTOR ANTI BY BLOC 135.78 4995387 ACETYLCHOLINE MODULATING ANTIBODY-Q 141.00 4995411 WEST NILE,PCR,CSF-FOCUS 65.63 4995429 AFB CULTURE W/STAIN-FOCUS(87015) 44.10 4995437 AFB CULTURE-FOCUS 44.10 4995445 AFB CULTURE W/STAIN-FOCUS(87206) 44.10 4995452 AFB STAIN,THORACENTESIS-FOCUS 23.52 4995460 AFB STAIN,SPUTUM-FOCUS 23.52 4995478 AFB STAIN,LUNG WASH-FOCUS 23.52 4995486 AFB STAIN,BRUSHING-FOCUS 23.52 4995494 CYSTINE,URINE-QUEST 25.73 4995502 FECAL FAT,QUALITATIVE-FOCUS 32.20 4995510 FAT STOOL,QUALITATIVE-FOCUS 22.11 4995528 FOLATE,RBC-QUEST 33.00 4995536 HYPOGLYCEMIC PANEL-QUEST 90.00 4995544 ACTIVATED PROTEIN C-RESISTANCE-QUES 94.78 4995551 C1 ESTERASE INHIBITOR PROTEIN-QUEST 24.20 4995569 M PNEUMO CF-FOCUS 101.43 4995577 MARIJUANA THC-QUEST 65.23 4995585 COCCAINE-QUEST 65.23 4995593 BENZODIAZEPINE LEVEL-QUEST 71.00 4995601 CAFFEINE LEVEL-QUEST 46.15 4995619 SPECIFIC GRAVITY,BODY FLUID 22.25 4995627 BCR/ABL,PCR(P)-QUEST 752.00 4995635 FACTOR XIII-QUEST 299.00 4995643 DIHYDROPYRIMIDINE DEHYD GENE-QUEST 350.00 4995650 THIOPURINE S-METHYLTRANSERASE-QUEST 420.00 4995668 ACHONDROPLASIA MUTATION ANALY-QUEST 273.00 4995676 24HR URINE ACETATE-QUEST 136.00 4995684 ACETONE,BLOOD-QUEST 55.39 4995692 BETA-HYDROXYBUTYRATE-QUEST 58.00 4995700 URINE AMPHETHAMINE CONFIRM-QUEST 96.45 4995718 VIT B2-QUEST 102.15 4995726 CYANIDE,BLOOD-QUEST 68.80 4995734 CITRATE 167.32 4995742 ANDROSTENEDIONE-QUEST 53.76 4995759 FREE TESTOSTERONE-QUEST 50.00 4995767 TESTOSTERONE,FREE & TOTAL-QUEST 50.00 4995775 PROCALCITONIN LEVEL-FOCUS 200.00 4995783 NEUROMYELITIS OPTICA-NMO-QUEST 585.00 4995791 KAPPA/LAMBDA LIGHT CHAIN FREE W/REF 135.51 4995809 OSMOLALITY,SERUM-QUEST 13.30 4995817 24HR URINE OXALATE 19.21 4995825 PSA,FREE-QUEST 15.20 4995833 PSA,TOTAL-QUEST 15.20 4995841 PROCALCITONIN-QUEST 15.20 4995858 ERYTHROCYTE PROTOPHORPHYRIN-QUEST 33.43 4995866 SELENIUM-QUEST 59.52 4995874 SOMATOMEDIN(IGF-1)-QUEST 57.21 4995882 STOMATOSTATIN-QUEST 142.61 4995890 SULFATE,URINE-QUEST 82.43 4995908 VIT E-QUEST 18.96 4995916 VIT B3-QUEST 154.80 4995924 FACTOR IX-LBM 140.75 4995932 CLOTTING FACTOR XI-QUEST 136.82 4995940 CLOTTING FACTOR XIII-QUEST 146.00 4995957 CLOTTING FACTOR I-QUEST 136.82 4995965 CLOTTING FACTOR XII-QUEST 136.82 4995973 VISCOSITY,SERUM-QUEST 26.79 4995981 PLATELET INDIRECT IGG,IGM,IGA-FOCUS 126.42 4995999 PLATELET AB-QUEST 106.53 4996005 CCND1/IGH FISH,BLOOD-LC 550.00 4996013 SMITH ANTIBODY-QUEST 52.00 4996021 SCL-70-QUEST 55.00 4996039 ALPHA FETOPROTEIN,PLEURAL FLUID-QUE 62.78 4996047 GLUTAMIC ACID DECARBOXYLASE AB-QUES 150.00 4996054 LYMPHOCYTE SUBSET B CELLS-FOCUS 38.16 4996062 LYMPHOCYTE SUBSET T CELLS-FOCUS 38.16 4996070 LYMPHOCYTE SUBSET T CELL W/RATIO-FO 38.18 4996088 CRYPTOCOCCAL ANTIGEN-QUEST 27.84 4996096 LYME DISEASE-QUEST 30.93 4996104 Q FEVER-FOCUS 155.40 4996112 COCCIODIO,CF SERUM-FOCUS 53.90 4996120 EBV-TITER(CAPSID ANTIGEN)-FOCUS 52.50 4996138 HTLV-1&2 ANTIBODY-QUEST 88.52 4996146 ECHINOCOCCUS-FOCUS 113.83 4996153 HEPATITIS A ANTIBODY,TOTAL-IGG-QUES 18.09 4996161 BORDETELLA PERTUSSIS-FOCUS 66.50 4996179 AFB SMEAR-PARASITES FOCUS 22.40 4996187 PNEUMOCYSTIS,DFA-FOCUS 38.50 4996195 CULTURE FUNGUS,BLOOD-QUEST 61.09 4996203 MYCOPLASMA PNEUMONIAE CULTURE-FOCUS 79.10 4996211 CULTURE,VIRUS,BODY FLDS,TISSU-FOCUS 132.30 4996229 RSV,DFA-FOCUS 70.70 4996237 ASPERGILLUS ANTIGEN,SERUM-FOCUS 217.00 4996245 ASPERGILLUS ANTIGEN,SERUM-QUEST 105.00 4996252 CRYPTOSPORIDIUM AG,STOOL-FOCUS 63.95 4996260 HIV(CONFIRMATION)-FOCUS 28.05 4996278 CYTOMEGALOVIRUS,PCR-QUEST 306.00 4996286 CMV,DNA QUANT,PCR-FOCUS 224.30 4996294 17-HYDROXYPROGESTERONE-QUEST 44.65 4996302 ENTEROVIRUS PCR-CSF-FOCUS 227.50 4996310 HEPATITIS B VIRUS DNA,QUAN PCR-QUES 216.20 4996328 HEPATITIS B VIRUS DNA QUANT-QUEST 259.44 4996336 HEPATITIS B VIR DNA QUAN PCR-QUEST 135.00 4996344 RSV,PCR-QUEST 219.03 4996351 HIV,GENOTYPE-QUEST 220.00 4996369 HIV GENOTYPE(P)-QUEST 220.00 4996377 HIV GENOTYPE(P)-QUEST 134.50 4996385 HIV GENOTYPE(P)-QUEST 134.50 4996401 HEMOSIDERIN STAIN,URINE-QUEST 12.09 4996419 JAK 2 MUTATION,QUALITATIVE-QUEST 350.00 4996427 ADAMTS 13 ACTIVITY-QUEST 440.00 4996435 VARICELLA-ZOSTER ANTIBODY IGG-FOCUS 55.86 4996443 TISSUE TRANSGLUTAMINASE AB-QUEST 79.56 4996450 ADP PLATELET-LBM 54.50 4996468 SJROGRENS-QUEST 39.88 4996484 PARTICLE AGGLUTINATION-QUEST 46.84 4996492 BORDETELLA PERTUSSIS-QUEST 32.50 4996500 BORDETELLA PERTUSSIS,SERUM-FOCUS 32.50 4996518 KAPPA/LAMBDA LIGHT CHAIN FREE,URINE 120.00 4996526 KAPPA/LAMBDA LIGHT CHAIN FREE,SERUM 120.00 4996534 ASCA-ANTI SACCHROMYCES CEREVIAE AB 100.00 4996542 HSV,HERPES 1/2CSF-QUEST 162.50 4996559 LEGIONELLA SEROLOGY-FOCUS 29.00 4996567 PARVO VIRUS-QUEST 16.15 4996575 ANTIBODY,RICKETTSIA 44.67 4996583 SALMONELLA ANTIBODY-FOCUS 15.68 4996591 DENGUE FEVER-FOCUS 78.65 4996609 TISSUE TRANSGLUTAMINASE AB IGA-QUES 91.12 4996617 MYCOBACTERIUM INTRACELLULARE DNA 197.40 4996625 BORDETELLA PERTUSSIS PCR-FOCUS 104.30 4996633 LEGIONELLA,URINE-FOCUS 67.20 4996641 MDS BY FISH(P)-LAB CORP 88271 80.00 4996658 MDS BY FISH(P)-LAB CORP 88275 80.00 4996815 QUANTIERON TB GOLD-FOCUS 60.00 4996856 ANTIBODY BRUCELLA-FOCUS 72.48 4996906 JAK 2,BONE MARROW-LC 225.00 4996922 BENZODIAZEPINE-QUEST 26.71 4996930 MALARIA BLOOD-QUEST 56.79 4996963 MUSK ANTIBODY TEST-QUEST 1,065.00 4996971 IMMUNO FIXATION ELECTROPHORESIS 361.42 4997011 CALCIUM URINE QUANTITATIVE-NI 9.92 4997219 POTASSIUM,URINE-QUEST 9.92 4997235 ANTIBODY CYTOMEGALOVIRUS-QUEST 11.40 4997243 ANTIBODY CYTOMEGALOVIRUS IGM-QUEST 11.40 4997268 CONCENTRATION FOR INFECT AGENT-NI 32.00 4997359 APOLPOPROTEIN-NI 35.81 4997367 BILIRUBIN-NI 35.81 4997375 GLUTAMATE DEHYDROGENASE-NI 35.81 4997383 TRANSFERASE,ALANINE ANINO-NI 35.81 4997409 UNLISTED PROC PANEL-QUEST 352.01 4997425 NOROVIRUS,STOOL-QUEST 98.00 4997433 PYRUVATE KINASE-QUEST 127.65 4997441 BICARBONATE URINE-QUEST 39.00 4997458 BULLOUS PEMPHIGOID BP180 AB-QUEST 42.00 4997466 GABAPENTIN NEURONTIN-QUEST 84.85 4997474 YEAST SUSCEPTIBILITY COMP PANEL-MR 339.38 4997482 LAMICTAL (LAMOTRIGINE)-QUEST 19.47 4997490 HERPES SIMPLEX VIRAL CULT-QUEST 57.50 4997508 VON WILLEBRAND ANTIGEN-QUEST 136.82 4997516 PLASMINOGEN-QUEST 242.31 4997524 COLD AGGLUTININ-QUEST 8.80 4997532 OSMOLALITY FECES-QUEST 56.65 4997540 GLUCAGON-QUEST 33.43 4997557 VON WILLEBRAND MULTIMETRIC-QUEST 173.37 4997565 RISTOCETIN COFACTOR-QUEST 136.82 4997573 GAD ANTIBODY-QUEST 150.00 4997581 ISLET ANTIBODY-QUEST 84.00 4997599 SCABIES-QUEST 29.75 4997607 DELTA AMINOLEVULINIC ACID URINE-QUE 80.54 4997615 BENZODIAZEPINE W/CONFIRMATION-QUEST 124.00 4997623 OPIATES SCREEN W/CONFIRMATION-QUEST 65.23 4997631 INSULIN AUTOANTIBODY-QUEST 142.00 4997649 PORPHOBILINOGEN QUANT URINE-QUEST 34.45 4997656 COLLAGEN TELOPEPTIDE-NTX URINE-QUES 114.00 4997664 OXCARBAZEPINE-TRILEPTAL-QUEST 71.00 4997672 LISTERIA ANTIBODY-QUEST 47.10 4997680 SHIGA TOXIN EIA-FOCUS 54.40 4997698 PARTICLE AGGLUTINATION-QUEST 74.59 4997706 HEREDITARY HEMOCHROMATOSIS-QUEST 180.69 4997714 HLA-B27 ANTIGEN-QUEST 25.46 4997722 JO-1 ANTIBODY-QUEST 55.00 4997730 MI-2 AUTOANTIBODIES-QUEST 98.00 4997748 SRP ANTIBODIES-QUEST 83.00 4997755 STRATIFY JCV ANTIBODY W/REFLUX-QUES 1,363.00 4997763 CYTOMEGALOVIRUS IGG/IGM CSF-FOCUS 99.40 4997771 LISTERIA ANTIBODY SERUM-FOCUS 82.60 4997789 ENTAMOEBA HISTOLYTICA SERUM 120.40 4997797 EPINEPHRINE-QUEST 145.00 4997805 NOREPINEPHRINE-QUEST 145.00 4997813 APOLIPOPROTEINE B-QUEST 10.64 4997821 IMMUNOFIXATION URINE 38.59 5100938 VER VISUAL EVOKE RESPONSE 1,087.00 5101720 SER IN UPPER LIMBS 1,511.00 5101738 SER IN THE TRUNK OR HEAD 1,260.00 5101746 SER IN LOWER LIMBS 1,511.00 5105044 ABER AUDITORY LEVEL 977.00 5105051 EMG-1 641.00 5105069 EMG-2 1,220.00 5105085 EMG-3 841.00 5105093 EMG-4 1,631.00 5105184 EMG CRANIAL NERVE MUSC UNILAT RT 1,430.00 5105192 EMG CRANIAL NERVE MUSCLES BILAT 1,430.00 5105200 EMG CRANIAL NERVE MUSC UNILAT LT 1,430.00 5105234 EMG NON EXT W/NERVE CONDUCTION 331.00 5105242 SER IN UPPER AND LOWER LIMBS 1,511.00 5105259 EMG LIMITED W/NERVE CONDUCTION 432.00 5105267 EMG COMPLETE W/NERVE CONDUCTION 679.00 5105309 NERVE CONDUCTION STUDIES 5-6 954.45 5105317 NERVE CONDUCTION STUDIES 7-8 1,364.00 5105333 NERVE CONDUCTION STUDIES 3-4 1,393.00 5105341 INTRA OP NEURO MONITOR EA 15 MIN 268.00 5300272 UP EXTREM ARTERIAL DUPLEX COMP 2,389.00 5300280 LOWER EXT VENOUS DUPLEX COMP 2,389.00 5300447 UP EXTREM ARTERIAL DUPLEX LTD 1,413.00 5300702 UPPER EXT ARTERIAL DOPPLER LMTD 1,052.00 5300710 LOWER EXT ARTERIAL DOPPLER LMTD 1,052.00 5300728 LWR EXT ART DOPPLER W/TREADMILL 1,061.00 5300736 UPPER EXT VENOUS DOPPLER RIGHT 1,413.00 5300744 UPPER EXT VENOUS DOPPLER LEFT 1,413.00 5301080 LOWER EXT VENOUS DOPPLER RIGHT 1,413.00 5301098 LOWER EXT VENOUS DOPPLER LEFT 1,413.00 5301106 PERFLUTREN/DEFINITY PER ML 385.00 5301114 PARTIAL ECHOCARDIOGRAM 1,812.00 5301122 U/S GUIDED PERICARDIAL CENTISI 1,715.00 5301130 INTRAOP T E E 3,782.00 5301148 STRESS ECHOCARDIOGRAM 5,676.00 5301155 STAT COMPLETE ECHOCARDIOGRAM 3,740.00 5301163 STAT PARTIAL ECHOCARDIOGRAM 1,812.00 5301171 ECHOCARDIOGRAM W/CONTRAST 3,740.00 5301569 UP EXTREM VENOUS DUPLEX COMP 2,389.00 5301577 UPPER EXTREM ARTERIAL DOPPLER COMP 1,589.00 5304969 EKG/ECG TELEMETRY 276.00 5306774 HOLTER MONITOR RECORDING 1,479.00 5306790 LOWER EXT ART DOPPLER 1,589.00 5306808 ECHOCARDIOGRAPHY F/U 768.00 5306816 EP EVAL PACING-DEFIB POST IMPLANT 7,089.00 5306824 DOPPLER ECHOCARDIOGRAM F/U 931.00 5306832 ECHOCARDIOGRAM CONGEN ABN COMPL 1,769.00 5306840 ECHOCARDIOGRAM CONGENITAL ABN F/U 931.00 5306857 DUPLEX SCAN HEMODIALYSIS ACCESS 1,624.00 5308085 TRANSCRANIAL ULTRASOUND 1,291.00 5309646 ECG - OUTPATIENT 588.00 5309679 SECTOR ECHOCARD W/ CONTRAST 3,740.00 5310230 ECHOCARDIOGRAM/EX TEST 3,740.00 5310248 TRANSESOPHAGEAL ECHOCARDIOGRAM 5,316.00 5310263 EVENT RECORDING-HOOK UP 968.00 5310305 HOLTER MONITOR SCANNING & REPORT 1,486.00 5310321 LOW EXTREM ARTERIAL DUPLEX COMP 2,389.00 5310339 LOWER EXT ART LIMIT DUPL 1,413.00 5310347 NUC ISOTOPE STRESS TEST 2,006.00 5310370 TRANSTELEPHONIC PM CHECK 276.00 5310396 PENILE PETHYSMOGRAPHY 736.00 5310404 PHARM STRESS TEST 2,006.00 5310412 SECTOR ECHOCARDIOGRAM 3,740.00 5310420 STRESS TEST TRACING ONLY 2,006.00 5310438 NUC ISOTOPE PHARMACOLOGICAL 2,006.00 5310446 STRESS TEST W/ECHO 2,006.00 5310453 STRESS TEST 2,006.00 5310487 ARTERIAL DOPPLER EXAM 1,589.00 5310628 CAROTID ULTRASOUND(DUPLX) 2,470.00 5310636 DOPPLER COLOR FLOW MAPPING 1,070.00 5310644 COLOR FLOW DOPPLER ECHOCARDIOGRAM 1,070.00 5310651 DOPPLER ECHOCARDIOGRAPHY 1,380.00 5310677 ECG RHYTHM STRIP 242.00 5310693 ECG ROUTINE 588.00 5310719 ECG STAT 588.00 5310743 UPPER EXTREM VENOUS DUPLEX UNI 1,430.00 5310750 LOWER EXTREM VENOUS DUPLEX UNI 1,430.00 5310768 STAT CAROTID DUPLEX 2,470.00 5310776 STAT VENOUS DUPLEX - BILATERAL 1,945.00 5310784 STAT VENOUS DUPLEX - UNILATERAL 1,430.00 5310792 STAT LE ARTERIAL DUPLEX - BILAT 2,272.00 5310800 STAT LE ARTERIAL DUPLEX - UNI 1,359.00 5310818 EKG - REPEAT 588.00 5370069 ECG PEDIATRIC 15 LEAD 588.00 5390141 AICD OR BIIV INTERROGATION 269.00 5390158 AICD PROGRAMMING SINGLE LEAD 420.00 5390166 AICD PROGRAMMING DUAL LEAD 424.00 5390174 AICD OR BIV PROGRAMMING MULT LEAD 501.00 5390182 PACEMAKER/AICD REMOTE DATA ACQ 223.00 5390190 UPPER EXTREMITY DOPPLER WITH 1,945.00 5390216 DUPLEX SCAN EXT VEINS LIMITED 1,413.00 5390224 LOWER VENOUS UNILATERAL 1,413.00 5390232 UPPER VENOUS UNILATERAL 1,413.00 5390240 U/S GUIDED CATH INSERTION 1,394.00 5390257 ART/VEIN MAPPING DIALYSIS ACCESS 1,069.00 5390265 DUPLEX CAROTID LIMITED 1,279.00 5390273 PSEUDO ANEURSYM INJECTION 653.00 5390299 DUPLEX SCAN EXTREMITY VEINS LEFT 1,413.00 5390307 DUPLEX SCAN EXTREMITY VEINS RIGHT 1,413.00 5390315 UPPER EXTREMITY ARTERIAL DUPLEX LT 1,413.00 5390323 UPPER EXTREMITY ARTERIAL DUPLEX RT 1,413.00 5390331 CAROTID DUPLEX LEFT 1,279.00 5390349 CAROTID DUPLEX RIGHT 1,279.00 5390356 LOWER EXTREMITY ARTERIAL DUPLEX LT 1,359.00 5390364 LOWER EXTREMITY ARTERIAL DUPLEX RT 1,359.00 5390372 UPPER VENOUS DUPLEX LEFT - 93971 1,413.00 5390380 UPPER VENOUS DUPLEX RIGHT - 93971 1,413.00 5390398 ART/VEIN MAPPING DIALYSIS-UNILATERL 514.00 5390414 LINQ2020 PLUS 271.00 5501259 EEG RECORDING IN COMA OR SLEEP 1,328.00 5501275 EEG EXTENDED MONITORING 41-60MIN 1,253.00 5502018 EEG AWAKE/SLEEP 1,798.00 5502026 EEG CEREBRAL SILENCE 879.00 5502034 EEG ROUTINE 1,798.00 5502042 STAT EEG AWAKE & DROWSY 1,798.00 5502059 EEG NON-INTRACRANIAL SURG MONITOR 3,262.00 5502109 DIGITAL ANALYSIS OF EEG 678.00 5502133 STAT EEG - COMA 1,328.00 5502141 STAT EEG - BRAIN DEATH 879.00 5502158 STAT EEG-EXTENDED 41-60 MIN 1,253.00 5700562 REVISE POCKET PACEMAKER 4,194.00 5700570 PERI-PROCED EVAL&PROGRAM DEFIB 279.00 5700588 PERI-PROCED EVAL&PROGRAM PACER 223.00 5900006 PT AQUATIC THERAPY 15 MIN 229.00 5900220 PT ULTRASOUND 15 MIN 107.00 5900246 PT TRACTION - MECHANICAL 83.00 5900329 PT ELECT-STIM UNATTENDED 129.00 5900444 PT THERAPEUTIC EXERCISE 15 MIN 162.00 5900477 PT GAIT TRAINING 15 MIN 148.00 5901327 PT WHIRLPOOL 292.00 5901392 PT ADL TRAINING 15 MIN 225.00 5901632 PT IONTOPHORESIS 15 MIN 225.00 5901657 PT MANUAL THERAPY 15 MIN 228.00 5901681 M/CAL PT EVALUATION-INITIAL 30 MIN 647.00 5901699 M/CAL PT EVALUATION ADD'L 15 MIN 121.00 5901707 M/CAL PT TREATMENT ADD'L 15 MIN 214.00 5901715 M/CAL PT TREATMENT INITIAL 30 MIN 324.00 5901780 PT DEBRIDEMENT NON-SELECTIVE 30 MIN 370.00 5901814 PT DEBRIDEMENT SELECT <=20CM-60 MIN 411.00 5901822 PT DEBRIDEMENT SELECT20CM 30 MIN 411.00 5901996 PT DEBRIDEMENT SELECT >20CM 45 MIN 411.00 5902028 M/CAL SNGL MOD IONTPHRSIS INITL 30M 87.00 5902036 M/CAL SNGL MOD TRCTION INIT 30MIN 83.00 5902044 M/CAL SNGL MOD ULTRASND INITL 30 MN 120.00 5902051 M/CAL SNGL MOD WHRLPOOL INITL 30 MN 247.00 5902069 M/CAL SNGL MOD 1 AREA EA ADD'L 15MN 162.00 5902077 M/CAL SNGL PROC 1 AREA INITL 30 MIN 324.00 5902085 M/CAL SNGL MOD MASSAGE INTL 30 MIN 53.00 5902093 M/CAL SNGL PROC 1 AREA ADD 15 MIN 162.00 5902143 PT EVALUATION-120 MIN 449.00 5902150 PT THERAPEUTIC ACTIVITIES-15MIN 270.00 5902200 GP MASSAGE 15 MIN 53.00 5902218 GP ORTHOTICS TRAININIG PER 15M 180.00 5902226 GP PROSTHETIC TRAINING 15 MIN 76.00 5902234 GP NEUROMUSCULAR RE-ED 15 MIN 88.00 5902242 PT PED DEV TESTING INITIAL 1 HR 449.00 5902259 PT PED DEV TEST EACH ADDTL 30 MIN 225.00 5902267 GA-PT PED DEV TEST EA ADD 30 MIN 225.00 5902275 GY-PT PED DEV TEST EA ADD 30 MIN 225.00 5902283 KX-PT PED DEV TEST EA ADD 30 MIN 225.00 5902291 PT TRACTION-MECHANICAL-CQ 107.00 5902309 PT ELECT-STIM UNATTENDED-CQ 107.00 5902317 PT VASOPNEUMATIC DEVICE-CQ 107.00 5902325 PT ELECT-STIM ATTENDED-CQ 225.00 5902333 PT IONTOPHORESIS-CQ 225.00 5902341 PT ULTRASOUND-CQ 107.00 5902358 PT THERAPEUTIC EXERCISE-CQ 225.00 5902366 PT GAIT TRAINING-CQ 225.00 5902374 PT MANUAL THERAPY -CQ 225.00 5902382 PT THERAPEUTIC ACTIVITIES 15 MIN-CQ 225.00 5902390 PT ADL TRAINING - CQ 225.00 5902408 PT CANALITH REPOSITIONING-CQ 449.00 5905013 PT RE-EVALUATION 225.00 5907191 GY-PT DEBRIDEMENT SELECT<=20CM-60M 411.00 5907209 GY-PT DEBRIDEMENT SELECT<=20CM45MIN 411.00 5907217 GY-PT DEBRIDEMENT SELECT<=20CM30MIN 411.00 5908009 KX-PT AQUATIC THERAPY 15 MIN 229.00 5908017 KX-PT ULTRASOUND 15 MIN 107.00 5908025 KX-PT TRACTION MECHANICAL 122.00 5908033 KX-PT ELECT-STIM UNATTENDED 107.00 5908058 KX-PT THERAPEUTIC EXERCISE 15 MIN 162.00 5908066 KX-PT GAIT TRAINING 15 MIN 148.00 5908082 KX-PT WHIRLPOOL 292.00 5908090 KX-PT ADL TRAINING 15 MIN 225.00 5908108 KX-PT IONTOPHORESIS 15 MIN 225.00 5908116 KX-PT MANUAL THERAPY 15 MIN 228.00 5908132 KX-PT DEBRIDEMENT NON-SLCTV 30 MIN 370.00 5908140 KX-PT DEBRIDEMENT NON-SLCTV 45 MIN 370.00 5908157 KX-PT DEBRIDEMENT NON-SLCTV 60 MIN 370.00 5908199 KX-PT DEBRIDEMENT <=20CM 60 MIN 411.00 5908207 KX-PT DEBRIDEMENT SELECT <=20CM 45M 411.00 5908215 KX-PT DEBRIDEMENT SELECT<=20CM 30M 411.00 5908223 KX-PT THERAPEUTIC ACTIVITIES-15MIN 270.00 5908231 KX-PT DEBRIDEMENT SELECT >=20CM 60M 411.00 5908249 KX-PT CANALITH REPOSITIONING 106.00 5908298 KX-PT EVALUATION 45 MIN 449.00 5908306 KX-PT EVALUATION 60 MIN 449.00 5908322 KX-PT RE-EVALUATION 420.00 5908330 KX-PY AFL TRAINING-CQ 225.00 5908348 KX-PT CANALITH REPOSITIONING-CQ 449.00 5908355 KX-PT ELECT-STIM ATTENDED-CQ 225.00 5908363 KX-PT ELECT-STIM UNATTENDED-CQ 107.00 5908371 KX-PT GAIT TRAINING-CQ 225.00 5908389 KX-PT IONTOPHORESIS-CQ 225.00 5908397 KX-PT MANUAL THERAPY-CQ 225.00 5908405 KX-PT THERAPEUTIC ACTIVITIES 15M-CQ 225.00 5908413 KX-PT THERAPEUTIC EXERCISE-CQ 225.00 5908421 KX-PT TRACTION MECHANICAL-CQ 107.00 5908439 KX-PT ULTRASOUND-CQ 107.00 5909007 GA-PT AQUATIC THERAPY 15 MIN 229.00 5909015 GA-PT ULTRASOUND 15 MIN 107.00 5909023 GA-PT TRACTION - MECHANICAL 122.00 5909031 GA-PT ELECT-STIM UNATTENDED 107.00 5909056 GA-PT THERAPEUTIC EXERCISE 15 MIN 162.00 5909064 GA-PT GAIT TRAINING 15 MIN 148.00 5909080 GA-PT WHIRLPOOL 292.00 5909098 GA-PT ADL TRAINING 15 MIN 225.00 5909106 GA-PT IONTOPHORESIS 15 MIN 225.00 5909114 GA-PT MANUAL THERAPY 15 MIN 228.00 5909130 GA-PT DEBRIDEMENT NON-SELECTIVE 30M 370.00 5909148 GA-PT DEBRIDEMENT NON-SELECT 45 MIN 370.00 5909155 GA-PT DEBRIDEMENT NON-SELECTIVE 60M 370.00 5909197 GA-PT DEBRIDEMENT SELECT<=20CM 60M 411.00 5909205 GA-PT DEBRIDEMENT SELECT<=20CM 45M 411.00 5909213 GA-PT DEBRIDEMENT SELECT<=20CM-30M 411.00 5909221 GA-PT THERAPEUTIC ACTIVITIES-15M 270.00 5909239 GA-PT DEBRIDEMENT SELECT>=20CM 411.00 5909247 GA-PT CANALITH REPOSITIONING 106.00 5909296 GA-PT EVALUATION 45 MIN 776.00 5909304 GA-PT EVALUATION 60 MIN 776.00 5909320 GA-PT RE-EVALUATION 420.00 5909338 GA-PT ADL TRAINING-CQ 225.00 5909346 GA-PT CANALITH REPOSITIONING-CQ 449.00 5909353 GA-PT ELECT-STIM ATTENDED-CQ 225.00 5909361 GA-PT ELECT-STIM UNATTENDED-CQ 107.00 5909379 GA-PT GAIT TRAINING-CQ 225.00 5909387 GA-PT IONTOPHORESIS-CQ 225.00 5909395 GA-PT MANUAL THERAPY-CQ 225.00 5909403 GA-PT THERAPEUTIC ACTIVITIES 15M-CQ 225.00 5909411 GA-PT THERAPEUTIC EXERCISE-CQ 225.00 5909429 GA-PT TRACTION-MECHANICAL-CQ 107.00 5909437 GA-PT ULTRASOUND-CQ 107.00 5920004 KX NEUROMUSCULAR RE-ED 15 MIN 93.00 5920012 KX MASSAGE 15 MIN 53.00 5920020 KX GROUP THERAPY 519.00 5920038 KX PROSTHETIC TRAINING 15 MIN 370.00 5920046 KX ORTHOTICS TRAINING PER 15 MIN 180.00 5920053 GA GROUP THERAPY 519.00 5920061 GA MASSAGE 15 MIN 53.00 5920079 GA NEUROMUSCULAR RE-ED 15 MIN 93.00 5920087 GA ORTHOTICS TRAINING PER 15 MIN 180.00 5920095 GA PROSTHETIC TRAINING 15 MIN 76.00 5993001 CK-PT EVAL MOBILITY:WLK&MVE AROUND 0.01 5996186 PT EVAL LOW COMPLEXITY 409.00 5996194 PT EVAL OBS LOW COMPLEXITY 409.00 5996202 KX PT EVAL LOW COMPLEXITY 409.00 5996210 PT EVAL MOD COMPLEXITY 449.00 5996228 PT EVAL OBS MOD COMPLEXITY 449.00 5996236 KX PT EVAL MOD COMPLEXITY 449.00 5996244 PT EVAL HIGH COMPLEXITY 489.00 5996251 PT EVAL OBS HIGH COMPLEXITY 489.00 5996269 KX PT EVAL HIGH COMPLEXITY 489.00 5996277 PT REEVAL 225.00 5996285 PT REEVAL OBS 225.00 5996293 KX PT REEVAL 225.00 6100051 GO THERAPEUTIC EXERCISE 15 MIN 195.00 6100168 GO SPLINT CHECKOUT 15 MIN 93.00 6101190 GO THERAPEUTIC ACTIVITIES-15MIN 270.00 6101216 GO SPLINT FITTING/TRAINING-15 MIN 180.00 6101224 GO ADL/SELF MGMT TRAINING 15 MIN 155.00 6101364 GO OT EVALUATION 60 MIN 449.00 6101380 GO OT EVALUATION 45 MIN 449.00 6101398 GO OT EVALUATION 75 MIN 449.00 6101505 OT EVALUATION-120 MIN 449.00 6101513 GO COGNITIVE TRAINING-15 MIN 73.00 6101547 OT COGNITIVE TRAINING INTL 15 MIN 129.00 6101554 OT COGNITIVE TRAINING EA ADD 15MIN 125.00 6101968 OT RE-EVALUATION 30 MIN 225.00 6101984 OT IONTOPHORESIS 15MIN - CO 225.00 6101992 OT MANUAL THERAPY-15MIN-CO 225.00 6102008 OT PARAFFIN BATH - CO 107.00 6102016 OT SPLINT CHECKOUT 15MIN - CO 225.00 6102024 OT SPLINT FITTING/TRAINING 15MIN-CO 225.00 6102032 OT THERAPEUTIC ACTIVITIES-15M-CO 225.00 6102040 OT THERAPEUTIC EXERCISE 15M-CO 225.00 6102057 OT ULTRASOUND 15 MIN-CO 107.00 6102065 OT VASOPNEUMATIC DEVICE - CO 107.00 6102073 OT ELECTRICAL STIM ATTENDED-CO 225.00 6102081 OT ELECTRICAL STIM UNATTENDED-CO 107.00 6102099 OT CONTRAST BATH - CO 107.00 6102107 OT FLUIDOTHERAPY - CO 107.00 6102115 OT ADL/SLF MGMT TRAINING 15MIN - CO 225.00 6102123 OT COGNITIVE TRAINING INTL 15MIN-CO 129.00 6102131 OT COGNITIVE TRN EA ADD 15MIN-CO 125.00 6105001 KX-OT THERAPEUTIC EXERCISE 15 MIN 225.00 6105019 KX-OT SPLINT CHECKOUT 15MIN 225.00 6105027 KX-WHIRLPOOL 107.00 6105035 KX-OT THERAPEUTIC ACTIVITIES 15MIN 270.00 6105043 KX-OT SPLINT FITTING/TRAINING 15MIN 225.00 6105050 KX-OT ADL/SELF MGMT TRAINING 15 MIN 225.00 6105076 KX-OT VASOPNEUMATIC DEVICE 107.00 6105084 KX-OT PARAFFIN BATH 107.00 6105092 KX-OT ELECTRICAL STIM UNATTENDED 107.00 6105118 KX-OT ULTRASOUND 15 MIN 107.00 6105126 KX-OT IONTOPHORESIS 15 MIN 225.00 6105134 KX-OT MANUAL THERAPY 15 MIN 228.00 6105142 KX-OT CONTRAST BATH 15 MIN 107.00 6105159 KX-OT EVALUATION 45 MIN 445.00 6105167 KX-OT EVALUATION 60 MIN 890.00 6105225 KX-OT RE-EVALUATION 30 MINS 449.00 6105233 KX-DBRMNT NON-SELECTIVE 30 MIN 370.00 6105241 KX-DBRMNT SEL EA ADD 20SQCM 30 MIN 411.00 6105258 KX-OT FLUIDOTHERAPY-CO 107.00 6105266 KX-OT ADL/SELF MGMT TRAINING 15M-CO 225.00 6105274 KX-OT COGNITIVE TRAINING 15M-CO 225.00 6105282 KX-OT CONTRAST BATH-CO 107.00 6105290 KX-OT ELECTRICAL STIM ATTENDED-CO 225.00 6105308 KX-OT ELECTRICAL STIM UNATTNDED-CO 107.00 6105316 KX-OT IONTOPHORESIS 15 MIN-CO 225.00 6105324 KX-OT MANUAL THERAPY 15 MIN-CO 225.00 6105332 KX-OT PARAFFIN BATH-CO 107.00 6105340 KX-OT SPLINT CHECKOUT 15 MIN-CO 225.00 6105357 KX-OT SPLINT FIT/TRAINING 15M-COM 225.00 6105365 KX-OT THERAPEUTIC ACTIVITIES 15M-CO 225.00 6105373 KX-OT THERAPEUTIC EXERCISE 15MIN-CO 225.00 6105381 KX-OT ULTRASOUND 15 MIN-CO 107.00 6105399 KX-OT VASOPNEUMATIC DEVICE-CO 107.00 6106009 GY-OT THERAPEUTIC EXERCISE-15 MIN 225.00 6106017 GY-OT SPLINT CHECKOUT 15 MIN 225.00 6106025 GY-OT FLUIDOTHERAPY 107.00 6106033 GY-OT THERAPEUTIC ACTVITIES 15 MIN 270.00 6106041 GY-OT SPLINT FITTING/TRAINING 15MIN 225.00 6106058 GY-OT ADL/SELF MGMT TRAINING 15 MIN 225.00 6106074 GY-OT VASOPNEUMATIC DEVICE 107.00 6106082 GY-OT PARAFFIN BATH 107.00 6106090 GY-OT ELECTRICAL STIM UNATTENDED 107.00 6106124 GY-OT IONTOPHORESIS 15 MIN 225.00 6106132 GY-OT MANUAL THERAPY 15 MIN 228.00 6106157 GY-OT EVALUATION 45 MIN 445.00 6106165 GY-OT EVALUATION 60 MIN 890.00 6106223 GY-OT RE-EVALUATION 30 MIN 449.00 6107007 GA-OT THERAPEUTIC EXERCISE 15 MIN 225.00 6107015 GA-OT SPLINT CHECKOUT 15 MIN 225.00 6107023 GA-OT WHIRLPOOL 107.00 6107031 GA-OT THERAPEUTIC ACTIVITY-15 MIN 270.00 6107049 GA-OT SPLINT FITTING/TRAINING 15MIN 225.00 6107056 GA-OT ADL/SELF MGMT TRAINING 15 M 225.00 6107072 GA-OT VASOPNEUMATIC DEVICE 107.00 6107080 GA-OT PARAFFIN BATH 107.00 6107098 GA-OT ELECTRICAL STIM UNATTENDED 107.00 6107114 GA-OT ULTRASOUND 15 MIN 107.00 6107122 GA-OT IONTOPHORESIS 15 MIN 225.00 6107130 GA-OT MANUAL THERAPY 15 MIN 228.00 6107148 GA-OT CONTRAST BATH 15 MIN 107.00 6107155 GA-OT EVALUATION 45 MIN 445.00 6107163 GA-OT EVALUATION 60 MIN 890.00 6107221 GA-OT RE-EVALUATION 449.00 6107239 GA DBRMNT NON-SELECTIVE 30 MIN 370.00 6107247 GA DBRMNT NON-SELECTIVE 45 MIN 370.00 6107254 GA-OT ADL/SELF MGMT TRAINING 15M-CO 225.00 6107262 GA-OT COGNITIVE TRAINING 15M-CO 225.00 6107270 GA-OT CONTRAST BATH - CO 107.00 6107288 GA-OT ELECTRICAL STIM ATTENDED-CO 225.00 6107296 GA-OT ELECTRICAL STIM UNATTENDED-CO 107.00 6107304 GA-OT FLUIDTHERAPY-CO 107.00 6107312 GA-OT IONTOPHORESIS 15 MIN-CO 225.00 6107320 GA-OT MANUAL THERAPY 15MIN-CO 225.00 6107338 GA-OT PARAFFIN BATH - CO 107.00 6107346 GA-OT SPLINT CHECKOUT 15MIN-CO 225.00 6107353 GA-OT SPLINT FITTING/TRN 15M-CO 225.00 6107361 GA-OT THEREAPEUTIC ACTIVITY 15M-C 225.00 6107379 GA-OT THERAPEUTIC EXERCISE 15M-CO 225.00 6107387 GA-OT ULTRASOUND 15 MIN-CO 107.00 6107395 GA-OT VASOPNEUMATIC DEVICE-CO 107.00 6120000 KX-EXTREMITY TESTING (BTE)15MIN 445.00 6120018 KX-GROUP THERAPY (2 OR MORE) 58.00 6120026 KX MASSAGE 15 MIN 53.00 6120034 KX NEUROMUSC RE-ED 15 MIN 93.00 6120042 KX PROSTHETIC TRAINING 15 MIN 120.00 6120059 GA EXTREMITY TESTING (BTE) 15 MIN 445.00 6120067 GA GROUP THERAPY (2 OR MORE) 58.00 6120075 GA MASSAGE 15 MIN 53.00 6120083 GA NEUROMUSC RE-ED 15 MIN 93.00 6170005 GO ULTRASOUND 15 MIN 120.00 6170013 GY DBRMNT NON-SELECTIVE 30 MIN 370.00 6170021 GY DBRMNT NON-SELECTIVE 45 MIN 370.00 6170039 GY DBRMNT NON-SELECTIVE 60 MIN 370.00 6170047 GY DBRMNT SEL EA ADD 20SQCM 30 411.00 6170054 GY DBRMNT SEL EA ADD 20SQCM 45 411.00 6170070 GO EXTREMITY TESTING(BTE) 15MN 445.00 6170096 GO ORTHOTICS TRAINING 15 MIN 180.00 6170104 GO THERAPEUTIC EXER 15 MIN 195.00 6170112 MCAL OT TREATMENT INITIAL 30 MIN 141.00 6170120 GA PROSTHETIC TRAINING 15 MIN 120.00 6170138 GO MASSAGE 15 MIN 53.00 6170146 PHYS MED TX-JOINT MOBILIZATION 217.00 6170153 MCAL OT TREATMENT ADD 15 MIN 129.00 6170161 GO SELF CARE/HOME MGMT ADL 15M 155.00 6170179 GO PARAFFIN BATH 81.00 6170187 MCAL OT EVAL INITIAL 30 MIN 456.00 6170195 GO THERPAEUTIC ACTIVITES 15MIN 270.00 6170203 GO MANUAL THERAPY PER 15 MIN 324.00 6170211 GO NEUROMUSCULAR RE-ED 15 MIN 112.00 6170237 CHECK OUT OPRTHO/PROSTH 15 MIN 93.00 6170245 ELECT CURR (IONOTOPHOR) 15 MIN 212.00 6170260 M/CAL OT THRPY EVAL EA ADD 15 MIN 228.00 6170278 PHYS MED MODALITY ELEC-STIM UNATND 129.00 6170286 PHYS MED TX-MASSAGE 30 MIN 53.00 6170294 PHYS MED TX-NEUROMUSC RE-ED 30MIN 93.00 6170302 GO OT CONTRAST BATH 15 MIN 58.00 6170310 GO DBRDMNT NON-SELECTIVE 30 MIN 370.00 6170328 GO DBRDMNT SEL 1ST 20SQCM 30 MIN 411.00 6170336 GO DBRMNT SEL EA ADD 20SQCM 30 MIN 411.00 6170344 GO DBRMNT SEL EA ADD 20SQCM 45 MIN 411.00 6170351 GO DBRMNT SEL EA ADD 20SQCM 60 MIN 411.00 6170369 GO ELECT STIM UNATTENDED 129.00 6170377 GO GROUP THERAPY ( 2 OR MORE) 519.00 6170385 GO OCCUPATIONAL THRPY RE-EVAL 273.00 6170401 GO PROSTHETIC TRAINING 15 MIN 76.00 6170419 GO VASOPNEUMATIC DEVICE 70.00 6170427 GO WHIRLPOOL 292.00 6196182 OT EVAL LOW COMPLEXITY 409.00 6196190 OT EVAL OBS LOW COMPLEXITY 409.00 6196208 KX OT EVAL LOW COMPLEXITY 409.00 6196216 OT EVAL MOD COMPLEXITY 449.00 6196224 OT EVAL OBS MOD COMPLEXITY 449.00 6196232 KX OT EVAL MOD COMPLEXITY 449.00 6196240 OT EVAL HIGH COMPLEXITY 489.00 6196257 OT EVAL OBS HIGH COMPLEXITY 489.00 6196265 KX OT EVAL HIGH COMPLEXITY 489.00 6196273 OT REEVAL 225.00 6196281 OT REEVAL OBS 225.00 6196299 KX OT REEVAL 225.00 6300016 ED DEPT LEVEL 1 99281 525.00 6300024 ED DEPT LEVEL 2 99282 1,084.00 6300032 ED DEPT LEVEL 4 99284 3,493.00 6300073 ED DEPT LEVEL 5 99285 4,685.00 6300156 ED DEPT LEVEL 1 99281 525.00 6300172 SUTURE GENERAL/EA 59.00 6300198 ED DEPT LEVEL 3 99283 2,169.00 6300347 EMERGNCY DEPT MEDICAL TRIAGE A 321.00 6301162 LEVEL 1 PROCEDURE-ER 424.00 6301170 LEVEL 2 PROCEDURE-ER 855.00 6301188 LEVEL 3 PROCEDURE-ER 1,774.00 6301196 LEVEL 4 PROCEDURE-ER 7,379.00 6301204 ED MINOR W/PROCEDURE-TEST-25 321.00 6301212 ED REGULAR W/PROCEDURE TEST-25 1,084.00 6301220 ED INTERMEDIATE W/PROCEDURE-25 2,169.00 6301238 ED ADVANCED CARE W/PROCEDURE 4,685.00 6301246 ED MAJOR W/PROCEDURE-TEST-25 3,493.00 6301253 ED CRITICAL CARE W/PROCEDURE-25 7,064.00 6301402 PHH-D ED BLOOD ADMIN (PER DAY) 1,829.00 6301410 PHH-D ED CARDIOVRSN ELECTRIC EXT 3,447.00 6301428 PHH-D ED RYTHM ECG TRACING 242.00 6301436 PHH-D STOCKINET BIAS X 4 114.00 6301444 PHH-D STOCKINET BIAS X 5 114.00 6301451 PHH-D STOCKINETTE TUBE 47.00 6301469 PHH-D STOCKINET BIAS X2 52.00 6301477 PHH-D STOCKINETTE TUB X 2 47.00 6301485 PHH-D STOCKINETTE TUB X3 70.00 6301493 PHH-D STOCKINETTE TUB X 4 70.00 6301501 PHH-D STOCKINET BIAS X 3 52.00 6301519 ER VISIT LEVEL III SAME DAY-9928327 2,169.00 6301527 ER VISIT LEVEL IV SAME DAY-9928427 3,493.00 6301543 UA DIPSTICK OR TABLET REAGENT 99.00 6302053 ED MAJOR W/PROC >12 HRS 3,493.00 6302061 ED ADVANCED W/PROC >12 HRS 7,048.00 6302079 ED CRITICAL CARE-25 >12 HRS 11,431.00 6302517 URINALYSIS W/O MICROSCOPY 30.00 6303002 ED DEPT LEVEL 1 99281 525.00 6303010 ED DEPT LEVEL 2 99282 1,084.00 6303028 FT ED REG W/PROC TEST-25 1,084.00 6303036 FT EMERG DEPT INTERMEDIATE 2,169.00 6303044 FT ED INTERMED W/PROC-25 2,169.00 6303051 ED DEPT LEVEL 4 99284 3,493.00 6303069 FT ED MAJ W/PROC TEST-25 3,493.00 6309140 EMERGENCY DEPT CRITICAL CARE 7,064.00 6309223 ED LAC REPAIR 2.6-7.5CM-12002 1,233.00 6309231 ED IMMUNIZATION ADMIN-90471 93.00 6309264 ED LAC REPAIR FACE-<2.5 12011 1,233.00 6309272 ED LAC REPAIR <2.5-12001 1,233.00 6309280 ED APPLY ST F/ARM SPLINT 29125 594.00 6309298 ED CASTING/STRAPPING UNLIS29799 496.00 6309306 ED APPLY DYN F/ARM SPLINT-29126 496.00 6309314 ED APPLY SHORT LEG SPLINT 29515 1,190.00 6309322 ED LAC REP-LYR-FACE 2.6-5 12052 1,233.00 6309330 ED LAC REPAIR FACE 2.6-5 12013 1,233.00 6309348 ED LAC REP-LYR-<2.5-FACE-12051 1,233.00 6309355 ED APPLY FINGER SPLINT-DYN29131 491.00 6309363 ED APPLY LONG ARM SPLINT 29105 594.00 6309371 ED REMOVE NAIL PLATE-11730 1,233.00 6309389 ED SHOULDER TX CLSD-W/ANES23655 5,940.00 6309397 ED NOSEBLEED CONTROL-30901 615.00 6309405 ED SPINAL TAP-62270 1,233.00 6309413 ED BURN TX NO ANEST SMALL-16020 1,190.00 6309421 ED DRAIN ABCESS SPL-10060 1,233.00 6309439 ED DRAIN ABCESS-COMP-MULTI-10061 1,233.00 6309447 ED APPLY FINGER SPLINT-STA29130 594.00 6309454 ED INSERT CATHETER-51702 424.00 6309488 ED LAC REP-DERMABOND-TRK ACMETC 906.00 6309496 ED LAC REP-DERMABOND-FACE 906.00 6309520 THUMB SPICA SPLINT 594.00 6309991 ED IV INFUSN 16-60M 96365 759.00 6310007 ED IV INFUSION EA ADDL HR 212.00 6310015 ED IV INF SEQUENTIAL 16-60M 96367 137.00 6310023 ED INFUSION CONCURRENT 96368 137.00 6310031 ED IV INF HYDRATION ADD HR 96361 218.00 6310049 ED INJECTION IV PUSH 96374 479.00 6310056 ED INJ ADDL PUSH NEW DRUG 96375 545.00 6310064 ED IV INF HYDRATION 31-60M 96360 759.00 6310072 ED INJECTION NOT IV PUSH 96372 306.00 6310080 ED INSERT BLADDER CATHETER-51701 357.00 6310098 ED IV INFUSN 16-60M 9636559 1,510.00 6310106 ED IV INFUS EA ADDL 59 137.00 6310114 ED IV INF SEQ 16-60M 96367-59 137.00 6310122 ED INFUSION CONCURRENT 96368-59 137.00 6310148 ED IV INF HYDRATION 31-60 96360-59 1,510.00 6310155 ED IV INF HYDRATION ADD HR 96361-59 137.00 6310163 ED INJ NOT IV PUSH 96372-59 531.00 6310171 ED INJECTION IV PUSH 96374-59 980.00 6310189 ED INJ ADDL PUSH NEW DRUG 96375-59 1,018.00 6310197 ED IMMUN ADMIN EA ADDL VAC-90472 93.00 6310205 ED CARDIOPUL RESUSICITATION-92950 1,751.00 6310221 ED VENIPUNCTURE 14.00 6310239 ED CRITICAL CARE 1ST HOUR-25 7,064.00 6310247 ED CRITICAL CARE EA ADD'L 30 MIN 1,744.00 6310254 ED INSERT PICC CAT 6,032.00 6310262 ED LAC REP-INT < 2.5 - 12041 706.00 6310270 ED LAC REP - 2.6-7.5 - 12042 706.00 6310288 ED CATHETER INSERT 51702-59 424.00 6310296 ED APPLY LONG LEG SPLINT -29505 682.00 6310304 ED LAC REP - INT <2.5 - 12031 694.00 6310312 ED LAC REP-INT 2.6-7.5 12032 706.00 6310320 ED ET INSERTION 31500 1,275.00 6310338 ED CENTRAL LINE INSERTION 36556 3,465.00 6310387 BAMLANIVIMAB INFUSION & MONITORING 1,084.00 6310395 CASIRIVIMAB & IMDEVIMAB INFS & MNTR 1,084.00 6331185 OBS INITIAL MOD SEVERITY 300.00 6331623 HEPATITIS B VACCINE-WC 393.00 6331631 DIPTHERIA/TETANUS VACCINE-WC 132.00 6332514 WRIST SPLINT 502.00 6390819 ED SUB INF TXPROP IN 16-90M96369-59 1,018.00 6390827 ED SUB INF TXPROP EA ADD HR-9637059 225.00 6390843 ED SUB INF TXPPROP ADD PUMP 9637159 455.00 6390850 ED TX PROPH/DX INJ EA ADDL 96376-59 162.00 6390900 ED SUBC INFSN TX/PROP INTL 16-60M 241.00 6390918 ED SUBC INFSN TX/PROP EA ADDL HR 225.00 6390926 ED SUBC INFSN TX/PROP ADDL PUMP 455.00 6390942 ED TX PROPH OR DX INJ EA ADD SEQ 262.00 6500508 INITIAL INFANT IP HEARING SCREEN 350.00 6500516 INFANT HEARING OP RESCREENING 977.00 6500524 INITIAL INFANT OP HEARING SCREENING 977.00 6500532 INFANT HEARING RESCREENING-OP 977.00 6500565 CIRCUMCISION 306.00 6500573 INTUB TRAY INFANT 524.00 6500581 PORTAWARMER 143.00 6500599 PAMPSWADDLER 89.00 6500607 VISUAL ASSESSMENT 320.00 6500615 LINE PLCEMENT/UMBILICAL VENOUS 306.00 6500623 LINE PLACEMENT/UMBIL ARTERY 306.00 6500631 NEOBAR 46.00 6500649 HUMAN MILK FORT 73.00 6500656 BILICOMBI JACK 85.00 6500664 GEL PILLOW 57.00 6500672 NIP SHIELD 25.00 6500680 BREAST MILK BOTTLES 9.00 6500698 PNEUMOGRAM 805.00 6601470 LD ULTRASOUND 825.00 6601561 BIOPHYSICAL PROFILE W/NS TEST 1,000.00 6601579 ULTRASOUND LIMITED OB 825.00 6601611 OB OBS IV PUSH ADDL SAME DRUG 262.00 6601637 OB OBS THERAPEUTIC INF INITIAL 759.00 6601645 OB OBS THERAPEUTIC INF ADDL HR 212.00 6601710 LDRP OR FIRST HOUR 5,322.00 6601728 L&D MAJOR SURGERY 1 HR 15 MIN 6,672.00 6601744 LD DELIVERY OF PLACENTA ONLY 1,283.00 6601777 LDRP OR EACH ADD'L 15 MIN 1,330.00 6904007 ENTEROSTOMAL THERAPY 350.00 6906002 MONITORED EA ADD'L-OBS UNIT 300.00 6906010 MONITORED HOUR ONE-OBS UNIT 300.00 6906028 NONMONITORED EA ADD'L-OBS UNIT 300.00 6906036 NONMONITORED HR ONE-OBS UNIT 300.00 6907001 OBSERVATION PER HOUR-ED 300.00 6907002 OBSERVATION PER HOUR-OBS 300.00 6907015 ED BED OCCUPANCY 1,291.00 6966477 VERAJET HAND PIECE-ALL 1,735.00 6966485 SIGNAFUSE 6,000.00 7000235 peritoneal dialysis solution with 1 212.60 7000243 peritoneal dialysis solution with 1 265.75 7000250 peritoneal dialysis solution with 1 1,165.50 7000268 peritoneal dialysis solution with 2 212.60 7000276 peritoneal dialysis solution with 2 212.60 7000284 peritoneal dialysis solution with 2 1,165.50 7000292 peritoneal dialysis solution with 4 212.60 7000300 peritoneal dialysis solution with 4 277.50 7000318 Dialysate - BiBag Bicarbonate Powde 206.30 7000326 Dialysate - Calcium Chloride 0.5 mE 7.25 7000334 Dialysate - CENTRISOL Bicarbonate 74.95 7000342 Dialysate - Naturalyte - 1.0 K 0 Ca 148.75 7000359 Dialysate - Naturalyte - 1.0 K 2.5 148.75 7000367 Dialysate - Naturalyte - 2.0 K 2.5 148.75 7000375 Dialysate - Naturalyte - 3.0 K 2.5 148.75 7000383 Dialysate - Potassium Chloride 0.5 6.30 7300064 SPEECH/LANG IND.TX 15 MIN 225.00 7300155 SPEECH TX COGNITIVE TX 15 MIN 225.00 7300163 SPEECH LANG SWALLOW TREATMNT 15 MIN 225.00 7300171 SPEECH LANG SWALLOW EVAL 449.00 7300197 ST VIDEOFLUOROSCOPIC SWALLOW 60 MIN 596.00 7300254 SPEECH/LANG IND TX 30MIN 499.00 7300262 SPEECH/LANG IND TX 45MIN 449.00 7300270 SPEECH/LANG IND TX 60MIN 449.00 7300288 ST DYSPHAGIA EVAL 45 MIN 449.00 7300296 ST DYSPHAGIA EVAL 60 MIN 449.00 7300304 SPEECH/LANG SWALLOW TREAT 30MIN 420.00 7300312 SPEECH/LANG SWALLOW TREAT 45MIN 449.00 7300320 SPEECH/LANG SWALLOW TREAT 60MIN 449.00 7300338 ST VIDEO FLUOROSCOPIC SWALLOW 75MIN 449.00 7300346 ST VIDEOFLUOROSCOPIC SWALLOW 90MIN 449.00 7300387 M/CAL SPEECH EVALUATION 449.00 7300395 M/CAL SPEECH/LANG THERAPY 60MIN 449.00 7300403 ST DYSPHAGIA EVAL 75 MIN 449.00 7300411 ST DYSPHAGIA EVAL 90 MIN 449.00 7300429 M/CAL SPEECH/LANG THERAPY 30 MIN 449.00 7300437 SPCH FLUENCY EVAL 75 MIN 450.00 7300445 SPCH FLUENCY EVAL 90 MIN 450.00 7300460 SPCH SOUND PROD EVAL 75 MIN 450.00 7300478 SPCH SOUND PROD EVAL 90 MIN 450.00 7301005 LANG COMP/EXP EVAL 75 MIN 450.00 7301013 LANG COMP/EXP EVAL 90 MIN 450.00 7301047 VOICE/RESNNC ANALYS EVAL 90 MIN 450.00 7301062 SPCH FLUENCY EVAL 30 MIN 450.00 7301070 SPCH FLUENCY EVAL 45 MIN 450.00 7301088 SPCH FLUENCY EVAL 60 MIN 450.00 7301104 SPCH SOUND PROD EVAL 45 MIN 450.00 7301112 SPCH SOUND PROD EVAL 60 MIN 450.00 7301120 LANG COMP/EXP EVAL 30 MIN 450.00 7301138 LANG COMP/EXP EVAL 45 MIN 450.00 7301146 LANG COMP/EXP EVAL 60 MIN 450.00 7301161 VOICE/RESONANCE ANALYS EVAL 45 MIN 450.00 7301179 VOICE/RESONANCE ANALYS EVAL 60 MIN 450.00 7301195 GN ASSESSMENT OF APHASIA 60 MIN 560.00 7301203 GN DEV TESTING EXTENDED 60MIN 740.00 7301211 GN SP GENERATING DEV ADD 30MIN 286.00 7301229 GN SP GENERATING DEV EVAL 60 M 1,272.00 7301237 GN STND COGNTVE PERF TEST 60MIN 475.00 7301245 GN THER EX NON SPCH GEN DEVICE 462.00 7301252 GN THER EX SP GENERATE DEVICE 657.00 7301260 GN VOICE PROSTHESIS EVAL/FITING 493.00 7301278 M/CAL LANGUAGE EVALUATION 493.00 7301286 M/CAL SPEECH LANG GRP EA PT 45MIN 173.00 7301294 SPEECH TX COGNITIVE TR INTL 15 MIN 129.00 7301302 SPEECH TX COGNITV TX EA ADD 15 MIN 125.00 7302003 KX-SPEECH/LANG IND TX 15 MIN 225.00 7302011 KX-SPEECH TX COGNITIVE TX 15 MIN 225.00 7302029 KX-SPEECH LANG SWALLOW TRTMNT 15MIN 225.00 7302037 KX-SPEECH/LANG IND TX 30 MIN 449.00 7302045 KX-SPEECH/LANG IND TX 45 MIN 449.00 7302052 KX-SPEECH/LANG IND TX 60 MIN 449.00 7302060 KX-SPEECH/LANG SWALLOW TREAT 30 MIN 449.00 7302078 KX-SPEECH/LANG SWALLOW TREAT 45 MIN 449.00 7302086 KX-SPEECH/LANG SWALLOW TREAT 60 MIN 449.00 7302094 KX-ST DYSPHAGIA EVAL 60 MIN 449.00 7302102 KX-ST DYSPHAGIA EVAL 75 MIN 449.00 7302110 KX-ST DYSPHAGIA EVAL 90MIN 449.00 7302128 KX-ST DYSPHAGIA EVAL 30 MIN 449.00 7302185 KX-ST VIDEO FLUOROSCPC SWLLW 75 MIN 449.00 7302193 KX-ST VIDEO FLUORSCPC SWLLW 60 MIN 449.00 7302201 KX-ST VIDEO FLOURSCPC SWLLW 90 MIN 449.00 7302219 KX-ST DYSPHAGIA EVAL 45 MIN 449.00 7302227 KX-ST SPCH FLUENCY EVAL 75 MIN 450.00 7302235 KX-ST SPCH FLUENCY EVAL 90 MIN 450.00 7302243 KX-ST SPCH FLUENCY EVAL 120 MIN 450.00 7302250 KX-ST SPCH SOUND PROD EVAL 75 MIN 450.00 7302268 KX-ST SPCH SOUND PROD EVAL 90 MIN 450.00 7302276 KX-ST SPCH SOUND PROD EVAL 120 MIN 450.00 7302284 KX-ST LANG COMP/EXP EVAL 75 MIN 450.00 7302292 KX-ST LANG COMP/EXP EVAL 90 MIN 450.00 7302300 KX-ST LANG COMP/EXP EVAL 120 MIN 450.00 7302318 KX-ST VCE/RSNC ANLYS EVAL 75 MIN 450.00 7302326 KX-ST VCE/RSNC ANLYS EVAL 90 MIN 450.00 7302334 KX-ST VCE/RSNC ANLYS EVAL 120 MIN 450.00 7302342 KX ASSESSMENT OF APHASIA 60 MIN 560.00 7302359 KX DEV TESTING EXTENDED 60MIN 740.00 7302367 KX GROUP SPEECH THERAPY 173.00 7302375 KX SP GENERATING DEV ADD 30 MIN 286.00 7302383 KX SP GENERATING DEV EVAL 60 MIN 1,272.00 7302391 KX STND COGNTV PERF TEST 60 MIN 475.00 7302409 KX THER EX SP GENERATING DEVICE 657.00 7302417 KX VOICE PROSTHESIS EVAL/FITING 493.00 7302425 KX-SPEECH TX COGNITIVE TR INTL 15MN 129.00 7302433 KX-SPEECH TX COGNITV TR EA ADD 15M 125.00 7303001 GY-SPEECH/LANG IN TX 15 MIN 225.00 7303019 GY-SPEECH TX COGNITIVE TX 15 MIN 225.00 7303027 GY-SPEECH LANG SWALLOW TRTMNT 15 MI 225.00 7303035 GY-SPEECH/LANG IND TX 30 MIN 449.00 7303043 GY-SPEECH/LANG IND TX 45 MIN 449.00 7303050 GY-SPEECH/LANG IND TX 60 MIN 449.00 7303068 GY-SPEECH/LANG SWALLOW TREAT 30 MIN 449.00 7303076 GY-SPEECH/LANG SWALLOW TREAT 45 MIN 449.00 7303084 GY-SPEECH/LANG SWALLOW TREAT 60 MIN 449.00 7303092 GY-ST DYSPHAGIA EVAL 45 MIN 449.00 7303100 GY-ST DYSPHAGIA EVAL 60 MIN 449.00 7303118 GY-ST DYSPHAGIA EVAL 75 MIN 449.00 7303126 GY-ST DYSPHAGIA EVAL 90 MIN 449.00 7303134 GY-ST DYSPHAGIA EVAL 30 MIN 449.00 7303191 GY-ST VIDEO FLUOROSCPC SWALLOW 75 M 449.00 7303209 GY-ST VIDEO FLUOROSCPC SWALLOW 60 M 449.00 7303217 GY-ST VIDEO FLUOROSCPC SWALLOW 90 M 449.00 7303225 GY-ST SPCH FLUENCY EVAL 75 MIN 450.00 7303233 GY-ST SPCH FLUENCY EVAL 90 MIN 450.00 7303241 GY-ST SPCH FLUENCY EVAL 120 MIN 450.00 7303258 GY-ST SPCH SOUND PROD EVAL 75 MIN 450.00 7303266 GY-ST SPCH SOUND PROD EVAL 90 MIN 450.00 7303274 GY-ST SPCH SOUND PROD EVAL 120 MIN 450.00 7303282 GY-ST LANG COMP/EXP EVAL 75 MIN 450.00 7303290 GY-ST LANG COMP/EXP EVAL 90 MIN 450.00 7303308 GY-ST LANG COMP/EXP EVAL 120 MIN 450.00 7303316 GY-ST VCE/RSNC ANLYS EVAL 75 MIN 450.00 7303324 GY-ST VCE/RSNC ANLYS EVAL 90 MIN 450.00 7303332 GY-ST VCE/RSNC ANLYS EVAL 120 MIN 450.00 7304009 GA-SPEECH/LANG IND.TX 15 MIN 225.00 7304017 GA-SPEECH TX COGNITIVE TX 15 MIN 225.00 7304025 GA-SPEECH LANG SWALLOW TREATMNT 15M 225.00 7304033 GA-SPEECH/LANG IND TX 30MIN 449.00 7304041 GA-SPEECH/LANG IND TX 45 MIN 449.00 7304058 GA-SPEECH/LANG IND TX 60MIN 449.00 7304066 GA-SPEECH/LANG SWALLOW TREAT 30 MIN 449.00 7304074 GA-SPEECH/LANG SWALLOW TREAT 45MIN 449.00 7304082 GA-SPEECH/LANG SWALLOW TREAT 60MIN 449.00 7304090 GA-ST DYSPHAGIA EVAL 45 MIN 449.00 7304108 GA-ST DYSPHAGIA EVAL 60 MIN 449.00 7304116 GA-ST DYSPHAGIA EVAL 75 MIN 449.00 7304124 GA-ST DYSPHAGIA EVAL 90 MIN 449.00 7304132 GA-ST DYSPHAGIA EVAL 30 MIN 449.00 7304215 GA-MOTION FLOUROSCPY/SWALLOW 449.00 7304249 GA-EVAL SPEECH FLUENCY 450.00 7304272 GA-EVAL SPEECH SOUND PRODUCTION 450.00 7304306 GA-EVAL SP LANG COMP/EXPRESSION 450.00 7304330 GA-ST VCE/RSNC ANLYS EVAL 120 MIN 450.00 7304348 GA ASSESSMENT OF APHASIA 60 MIN 560.00 7304355 GA DEV TESTING EXTENDED 60MIN 740.00 7304363 GA GROUP SPEECH THERAPY 173.00 7304371 GA SP GENERATING DEV ADD 30 MIN 286.00 7304389 GA SP GENERATING DEV EVAL 60 MIN 1,272.00 7304397 GA STND COGNTVE PERF TEST 60 MIN 475.00 7304405 GA SWALLOWING THERAPY 350.00 7304413 GA THER EX SP GENERATING DEVICE 657.00 7304421 GA VOICE PROSTHESIS EVAL/FITING 493.00 7900640 APHERESIS,THERAPEUTIC,PLASMA 7,820.00 8300121 OUTPATIENT OBS HR ONE - 2W 300.00 8300170 OUTPATIENT OBS HR ONE 300.00 8300212 OUTPATIENT OBS EA ADD'L HR-LD 300.00 8300279 OUTPATIENT OBS EA ADD'L HR-2W 300.00 8300428 DIRECT ADMIT OBS-2W 4,399.00 8300451 DIRECT ADMIT OBS 6,903.00 8300477 DIRECT ADMIT OBS 4,399.00 8300521 DIRECT ADMIT OBS-2W(25) 4,399.00 8300522 DIRECT ADMIT OBS(25) 4,399.00 8300642 IV PUSH SINGLE OR INIT DRUG - 2S 479.00 8300683 IRRIGATE IMPL VASC ACCESS DV - 2S 396.00 8300691 CHEMO ADMIN INTRATHECAL - 2S 1,858.00 8300717 IV INFUS HYDRATE INIT HR - 2S 759.00 8300808 OBS INSERT PICC CAT 6,032.00 8300816 OBS SUB INFSN/TX/PRP INTL 16-60M 241.00 8300824 OBS SUBC INFS TX/PROP 16-60M 1,018.00 8300832 OBS SUBC INFSN TX/PROP EA ADD HR 225.00 8300840 OBS SUBC INFS TX/PROP ADDL PUMP 455.00 8300873 OBSERVATION PROCEDURE 839.00 8300881 OBS SUBC INFSN TX/PROP EA ADD HR 225.00 8300899 OBS SUBC INFSN/TX/PROP ADDL PUMP 455.00 8300907 OBSERVATION DEBRIDEMENT 2,594.00 8300931 ADMIN INFLUENZA VIRUS VAC 93.00 8301038 IMMUNIZATION ADMIN 93.00 8301046 ADMINISTRATION HEPATITIS B VAC 93.00 8301053 ADMIN PNEUMOCCAL VACCINE 93.00 8301061 ADMIN INFLUENZA VIRUS VACCINE 93.00 8301103 OP IV INFUSION 16-60M 96365 759.00 8301111 OP IV INFUSION 16-60M 96365-59 1,510.00 8301129 OP IV INFUSION EA ADD'L HR 212.00 8301137 OP IV INFUSION EA ADDL MOD 59 137.00 8301145 OP INF SEQUENTIAL 16-60M 96367 137.00 8301152 OP IV INF SEQ 16-60M 96367-59 137.00 8301160 OP INFUSION CONCURRENT 96368 137.00 8301178 OP INFUSION CONCURRENT 96368-59 137.00 8301186 OP IV INF HYDRATION ADD HR 96361 218.00 8301194 OP IV HYDRATION ADD HR 96361-59 137.00 8301202 OP INJECTION IV PUSH 96374 479.00 8301210 OP INJECTION IV PUSH 96374-59 980.00 8301228 OP INJ ADDL PUSH NEW DRUG 96375 545.00 8301236 OP INJ ADDL PUSH NEW DRUG 96375-59 1,018.00 8301244 OP IV INF HYDRATION 31-60M 96360 759.00 8301251 OP IV INF HYDRATION 31-60M 96360-59 1,510.00 8301269 OP INJECTION NOT IV PUSH 96372 306.00 8301277 OP INJ NOT IV PUSH 96372-59 531.00 8301285 OP IMMUN ADMIN FIRST VAC 90471 93.00 8301293 OP IMMUN ADMIN EACH ADDL VAC 90472 93.00 8301301 OP ADMIN INFLUENZA VACCINE 93.00 8301319 OP ADMIN PNEUMOCCAL VACCINE 93.00 8301327 OP ADMIN HEPATITIS B VACCINE 93.00 8301350 OP IV PUSH ADDL SAME DRUG 96376 262.00 8301368 OP IV PUSH ADDL SAME DRUG 96376-59 162.00 8301376 ADMIN PNEUMOCCAL VACCINE-CCC 93.00 8301384 ADMIN INFLUENZA VIRUS VACCINE-CCC 93.00 8301392 IMMUNIZATION ADMIN-CCC 93.00 8301400 ADMIN HEPATITIS B VACCINE-CCC 93.00 8301491 ADMIN PNEUMOCCAL VACCINE - P2 93.00 8301509 ADMIN INFLUENZA VIRUS VACCINE-P2 93.00 8301517 IMMUNIZATION ADMIN-P2 93.00 8301525 ADMIN HEPATITIS B VACCINE-P2 93.00 8301582 ADMIN PNEUMOCCAL VACCINE-NSY 93.00 8301590 ADMIN INFLUENZA VIRUS VACCINE-NSY 93.00 8301608 IMMUNIZATION ADMIN-NSY 93.00 8301616 ADMIN HEPATITIS B VACCINE-NSY 93.00 8301632 IMMUNIZATION EA ADD'L-90472-CCC 96.00 8301665 IMMUNIZATION EA ADD'L-90472-P2 93.00 8301707 I&O STRAIGHT CATH FOR RETAINED URIN 357.00 8301715 I&O STRGHT CATH RTND URINE MOD 59 357.00 8301723 FOLEY INSERTION SIMPLE 424.00 8301731 FOLEY INSERTION SIMPLE MOD 59 424.00 8301764 OP DECLOTTING BY THROMBOLYTIC AGENT 1,050.00 8301772 IV INFUSION THERAPY 1ST HR 759.00 8301773 OPSC IV INFUSION THERAPY 1ST HR 759.00 8301780 IV INFUSION EACH ADD'L HOUR 212.00 8301781 OPSC IV INFUSION EACH ADD'L HR 212.00 8301798 BLOOD ADMINISTRATION (PER DAY) 1,829.00 8301799 OPSC BLOOD ADMINISTRATION(PER DAY) 1,829.00 8301806 SURGERY MINI 1,500.00 8301822 PROCEDURE-SIMPLE 424.00 8301830 PROCEDURE-COMPLEX 1,774.00 8301848 RHYTHM ECG TRACING 242.00 8301855 RN ULTRASOUND GUIDE IV ACCESS 1,394.00 8301863 ACCUCHECK 19.00 8301871 DIRECT ADMIT OBS - 2E 6,903.00 8301889 OUTPATIENT OBS EA ADDL HR 2E MOD25 300.00 8301897 OUTPATIENT OBS HR ONE - 3N 300.00 8301905 DIRECT ADMIT OBS - 3N 6,903.00 8301913 OUTPATIENT OBS EA ADDL HR 3N MOD25 300.00 8301921 OUTPATIENT OBS HR ONE - 3S 300.00 8301939 DIRECT ADMIT OBS - 3S 6,903.00 8301947 OUTPATIENT OBS EA ADDL HR 3S MOD25 300.00 8301954 OUTPATIENT OBS HR ONE - 4N 300.00 8301962 DIRECT ADMIT OBS = 4N 6,903.00 8301970 OUTPATIENT OBS EA ADDL HR 4N MOD25 300.00 8301988 OUTPATIENT OBS HR ONE - 4S 300.00 8301996 DIRECT ADMIT OBS - 4S 6,903.00 8302002 OUTPATIENT OBS EA ADDL HR 4S MOD25 300.00 8302010 OUTPATIENT OBS HR ONE - LD 300.00 8302028 DIRECT ADMIT OBS - LD 4,399.00 8302036 OUTPATIENT OBS EA ADDL HR LD MOD25 300.00 8302044 OUTPATIENT OBS HR ONE - MB 300.00 8302051 DIRECT ADMIT OBS - MB 4,399.00 8302069 OUTPATIENT OBS EA ADDL HR MB MOD25 300.00 8302077 OUTPATIENT OBS HR ONE - OBS 300.00 8302085 DIRECT ADMIT OBS-DEF OBS 6,903.00 8302093 OUTPATIENT OBS EA ADDL HR MOD25 300.00 8302101 OUTPATIENT OBS HR ONE - 2N 300.00 8302119 DIRECT ADMIT OBS - 2N 6,903.00 8302127 UNCODEABLE OUTPATIENT OBS HR ONE 1,541.00 8302135 UNCODEABLE OUTPT OBS EA ADD'L HR 169.00 8302143 UNCODEABLE OUTPATIENT OBS HR ONE-P2 1,541.00 8302150 UNCODEABLE OUTPT OBS EA ADD'L HR-P2 169.00 8302168 OUTPATIENT OBS EA ADDL HR 2N MOD25 300.00 8302176 OUTPATIENT OBS HR ONE - 2S 300.00 8302184 DIRECT ADMIT OBS 2S 6,903.00 8302192 OUTPATIENT OBS EA ADDL HR 2S MOD25 300.00 8302200 OUTPATIENT OBS HR ONE - 2E 300.00 8303018 THERAPEUTIC PHLEBOTOMY 439.00 8304008 PHH-D OUTPT OBS HR ONE - DOU 300.00 8305575 OBS SUB INFSN/TXPROP INTL 16-60M-2S 241.00 8305583 OBS SUBC INFSN/TXPROP INL 16-60M-2S 1,018.00 8305591 OBS SUB INFSN/TXPROP EA ADD'L HR-2S 225.00 8305609 OBS SUBC INFSN TX/PROP ADDL PUMP-2S 455.00 8306003 ADMIN SARSCOV2 30MCG/0.3ML 1ST 60.00 8306011 ADMIN SARSCOV2 30MCG/0.3ML 2ND 99.00 8306029 ADM SARSCOV2 100MCG/0.5ML 1ST 60.00 8306037 ADM SARSCOV2 100MCG/0.5ML 2ND 99.00 8350480 OBS SUBC INFSN TX/PROP EA ADD HR-2S 225.00 8350498 OBS SUBC INFSN TX/PROP ADD PUMP-2S 455.00 8350514 IMMUNIZATION EA ADD'L - 90472 - 2S 93.00 8350522 ADMIN PNEUMOCCAL VACCNE-OBS 93.00 8350530 ADMIN INFLUENZA VIRUS VACCINE-OBS 93.00 8350548 IMMUNIZATION ADMIN - OBS 93.00 8350555 ADMIN HEPATITIS B VACCINE-OBS 93.00 8350563 OP BLOOD TRANSFUSION - 36430 1,829.00 8350571 OP BLOOD TRANSFUSION - 3643059 1,829.00 8450942 REHAB SPEECH COGNTV TR INTL 15 MIN 129.00 8450959 REHAB SPEECH COGNTV TR EA ADD15 MIN 125.00 8604134 VIDEOFLUOROSCOPIC SWALLOW 90 MIN 449.00 9613183 NC - INTER PERCUSS VENT INITIAL 524.00 9613191 NC - RESP INTER PERCUSS VENT SUSQ 326.00 9618042 NC - SP E&M LEVEL5 91 MIN & OVER 174.00 9630062 NC-DEVICE RECALL CHARGE SURGERY 0.01