BillItemID_CDM CDMDescription CPT_HCPCS Price 8531321290189 .Gestational GTT 1-Hr 82951 $45.00 11607991290134 .GTT-2 Hr 82951 $100.00 11608001290143 .GTT-3 Hr 82951 $100.00 16815161290147 .GTT-4 Hr 82951 $100.00 2640914310090320 1.6 VITALLIUM CABLE $1,328.00 2640909510090270 12.7MM DHS/DCS LAG SCREW $1,140.00 2640906910090230 135 DHS 4 HOLE PLATE $1,840.00 2640993810091430 13MM X 160MM RFN $3,426.00 2640914410090320 2.0 VITALLIUM CABLE $1,328.00 2640995210091440 2.4 X 10 CORTEX SCREW $169.00 2640995110091440 3.5 LCP HOOK PLATE $1,481.00 241592991700028 36600 ABG PUNCTURE CHARGE 36600 $250.00 2640922810090410 3FR DOUBLE LUMEN TRAY $147.00 2640991510091400 4.5 POSITIONING PIN $549.00 2640922710090410 4FR DOUBLE LUMEN TRAY $234.00 2640979010091270 5 X 36 SCREW 36MM $673.00 2640993910091430 5.0MM X 80MM LOCKING SCREW $673.00 259830591390748 54150 Circumcision using clamp or other device with regiona 54150 $1,100.00 14237941700058 6 MINUTE WALK 94618 $300.00 270172781430271 64415 BRACHIAL PLEXUS NERVE BLOCK CHARGE 64415 $1,912.00 270172871430273 64417 AXILLARY NERVE BLOCK CHARGE 64417 $1,912.00 2551190437064450 64418 - Injection anesthetic agent; suprascapular nerve 64450 $564.00 270172881430274 64445 SCIATIC NERVE BLOCK CHARGE 64445 $1,497.00 269578831430272 64447 ANES FEMORAL NERVE BLOCK 64447 $1,497.00 270172891430276 64486 TAP BLOCK UNILATERAL CHARGE 64486 $1,200.00 270172901430277 64488 TAP BLOCK BILATERAL CHARGE 64488 $1,200.00 2695787636064990 64999 ANES QL BLOCK 64999 $529.00 2695787537076940 76942 ANES USE OF ULTRASOUND FOR BLOCK/NEEDLE PLACEMENT 76942 $480.00 265873421290976 80307- Component 80307 $20.00 265869041290149 82952- Component 82952 $33.00 269532741390770 90471 Admin Newborn Vaccine Self Pay 90471 $21.93 85360494010 94010 Pulmonary Function Testing PFT 94010 $193.00 178243951700052 94640 INTL NEB TREATMENT CHARGE 94640 $486.00 263496601700070 94664 DEMO/EVAL AEROSOL GENNEB MDI IPPB DEVICE 94664 $200.00 108889531700013 94799 RT UNLISTED SERVICE CHARGE 94799 $125.00 263381521800011 95782 INITIAL YOUNGER THAN 6 YEARS OLD 95782 $1,100.00 263381461800012 95783 CPAP/BI-PAP YOUNGER THAN 6 YEARS OLD 95783 $1,100.00 263381611800006 95805 MSLT/MWT 95805 $2,156.00 263381601800007 95806 HOME SLEEP TEST 95806 $545.00 263381621800004 95810 INITIAL SLEEP STUDY 95810 $2,156.00 263380321800005 95811 C-PAP/BI-PAP TITRATION 95811 $2,156.00 263381451800100 95812 EEG EXTENDED 41-60 MIN 95812 $661.00 263381441800101 95813 EEG EXTENDED > 1 HOUR 95813 $661.00 263381431800102 95816 EEG INCLUDING AWAKE & DROWSY 20-40 MIN 95816 $661.00 263381421800103 95819 EEG INCLUDING AWAKE & ASLEEP 20-40 MIN 95819 $661.00 260213101795860 95860 EMG-1 EXTREMITY CHARGE 95860 $125.00 263379721795861 95861 EMG-2 EXTREMITY CHARGE 95861 $165.00 260213111795863 95863 EMG-3 EXTREMITY CHARGE 95863 $195.00 263379731795864 95864 EMG-4 EXTREMITY CHARGE 95864 $245.00 263379751795886 95885 NEEDLE EMG FULL ONE EXTREMITY 95886 $115.00 263379741795885 95886 NEEDLE EMG PARTIAL ONE EXTREMITY 95885 $162.00 263379761440639 95907 NERVE CONDUCTION MOTOR W/O F-WAVE 95907 $310.00 263379771440640 95908 NERVE CONDUCTION MOTOR WITH F-WAVE 95908 $460.00 263379791795909 95909 5-6 NERVE CONDUCTION STUDIES 95909 $610.00 263379811795910 95910 NERVE CONDUCTION SENSORY 95910 $760.00 263379821795911 95911 9-10 NERVE CONDUCTION STUDIES 95911 $910.00 263379831795912 95912 11-12 NERVE CONDUCTION STUDIES 95912 $1,060.00 263383421795913 95913 13+ NERVE CONDUCTION STUDIES 95913 $1,360.00 263381411800105 95951 EEG LOCALIZATION OF SEIZURE EA 24 HRS 95951 $2,141.00 263381401800106 95953 EEG LOCALIZATION OF SEIZURE EA 24 HRS 95953 $991.00 174427791700068 99407 SMOKING/TOBACCO CESS >10 MIN CHARGE 99407 $81.00 25936341 ABATACEPT 250 mg IV Inj [UGH] J0129 $5,323.36 253735141461087 ABDOMINAL PARACENTESIS-FAC 49083 $1,041.00 253735131461049 ABDOMINAL PARACENTESIS-FACILITY 49082 $1,210.00 14818491290025 ABO/Rh 86900 $38.00 25934306 ACARBOSE 50 mg Tab [UGH] $5.00 27067088 ACD Solution 500ml [UGH] $48.00 2640938910090840 ACETABULAR INSERT 52MM 32MM ID $2,250.00 2640976410091250 ACETABULAR SHELL 300 SERIES 50MM $2,375.00 2640938710090840 ACETABULAR SHELL 52MM $2,250.00 8577761290130 ACETAMINOPHEN 80307 $103.00 26010451 acetaminophen 10 mg/mL Sol 100 mL [UGH] J0131 $208.60 25934307 ACETAMINOPHEN 120 mg SUPP [UGH] $5.00 26430675 acetaminophen 160 mg/5 ml Oral Liq [UGH] $12.21 26798627 acetaminophen 160 mg/5 mL Sus[UGH] $5.00 25934316 ACETAMINOPHEN 325 mg SUPP [UGH] $5.96 26980453 acetaminophen 325 mg Tab $5.00 25934317 ACETAMINOPHEN 325 mg TAB [UGH] $5.00 26030315 ACETAMINOPHEN 325 mg/10.15 mL ORAL LIQ [UGH] $10.91 25934318 ACETAMINOPHEN 500 mg TAB [UGH] $5.00 25934319 ACETAMINOPHEN 650 mg SUPP [UGH] $5.00 26011095 acetaminophen 650 mg Tab [UGH] $5.00 25934314 acetaminophen 650mg/20.3ml Oral Liq [UGH] $8.02 25934320 acetaminophen 80 mg Chew Tab [UGH] $5.00 25934321 ACETAMINOPHEN 80 mg SUPP [UGH] $5.00 27129243 acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab $8.44 26030695 acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab [UGH] $5.00 27088147 acetaminophen-codeine 120 mg-12 mg/5 mL Liq $7.75 25934725 acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 118 mL [UGH] $5.00 25934726 ACETAMINOPHEN-CODEINE 300 mg-30 mg TAB [UGH] $5.00 26846298 acetaminophen-codeine 300 mg-30 mg/12.5 mL Liq [UGH] $9.13 25934727 acetaminophen-diphenhydrAMINE 500 mg-25 mg Tab [UGH] $5.00 25983926 ACETAMINOPHEN-HYDROcodone 300 mg-10 mg/15 mL LIQ [UGH] $36.42

26949589 ACETAMINOPHEN-HYDROcodone 325 mg-10 mg TAB [UGH] $7.83 25934731 ACETAMINOPHEN-HYDROcodone 325 mg-5 mg TAB [UGH] $7.00 27129855 acetaminophen-hydrocodone 325 mg-7.5 mg Tab $7.00 25934732 ACETAMINOPHEN-HYDROcodone 325 mg-7.5 mg TAB [UGH] $7.00 27103359 acetaminophen-hydrocodone 325 mg-7.5 mg/15 mL Sol $44.69 26846315 acetaminophen-hydrocodone 325 mg-7.5 mg/15 mL Sol UD [UGH] $24.30 25934733 ACETAMINOPHEN-oxyCODONE 325 mg-10 mg TAB [UGH] $17.75 25934734 ACETAMINOPHEN-oxyCODONE 325 mg-5 mg TAB [UGH] $7.00 25934735 acetaminophen-oxyCODONE 325 mg-7.5 mg Tab [UGH] $13.58 25934736 acetaZOLAMIDE 250 mg TAB [UGH] $14.42 25934737 acetaZOLAMIDE 500 mg ER CAP [UGH] $21.45 26010439 acetaZOLAMIDE 500 mg Pow [UGH] J1120 $192.00 25934739 acetic acid Top 0.25% Sol 1000 mL [UGH] $52.00 25934754 acetylcholine ophthalmic 1% Pwdr for Recon [UGH] $194.16 7943141290340 ACETYLCHOLINE RECPTOR ANTIBODIES 83519 $203.00 6338851290741 ACETYLCHOLINE RECPTOR BLOCKING 83519 $100.00 6338841290935 ACETYLCHOLINE RECPTOR MODULATING 83519 $115.00 25935761 acetylcysteine 10% Inh Sol 30 mL [UGH] J7608 $58.80 27151916 acetylcysteine 10% Sol J7608 $19.93 26010725 acetylcysteine 10% Sol [UGH] J7608 $44.83 25934755 acetylcysteine 20% Inh Sol 30 mL [UGH] J7608 $144.00 25934756 acetylcysteine 20% IV Sol 30 mL [UGH] J0132 $902.40 27154534 acetylcysteine 20% Sol J0132 $1,400.00 26075450 acetylcysteine 20% Sol [UGH] J7608 $57.60 2640961210091090 ACHILLES TENDON W/O BONE BLOCK $4,840.00 7836091290197 ACTH 82024 $133.00 25935762 Activated Charcoal 25 g Oral Susp 120 mL [UGH] $66.80 25935763 Activated Charcoal w/sorb 25 g Oral Susp 120 mL [UGH] $66.72 12398311720049 ACTIVE WOUND CARE <=20CM 97597 $115.00 26196861720050 ACTIVE WOUND CARE >20CM 97598 $115.00 25934757 acyclovir 200 mg Cap [UGH] $5.00 25934758 acyclovir 200 mg/5 mL Oral Susp [UGH] $22.61 25934759 acyclovir 500 mg IV Inj [UGH] J0133 $72.09 26858349 acyclovir 800 mg Tab $21.08 25936345 ACYCLOVIR 800MG [UGH] $18.33 25935765 acyclovir Top 5% Oint 5gm [UGH] $561.50 25936347 ADACEL (ADOLESCENT & ADULT) SUSP 2-5-3-5-5 LF-MCG-LF/0.5ML 90715 $207.60 0.5 [UGH] 25934308 adalimumab 40 mg/0.8 mL SubQ Sol [UGH] J0135 $9,832.97 2640978610091270 ADAPTA DR 3.2MM 263 STD $12,203.00 2640913010090300 ADAPTER BIOLOX OPTION TAPER $943.00 25934760 adenosine 3 mg/mL IV Sol [UGH] J0153 $59.13 25935766 adenosine 3 mg/mL IV Sol 2ml Syringe [UGH] J0153 $86.40 115198491390756 ADMIN EA ADDL VACCINE 90472 $50.00 115198511480385 ADMINISTRATION VACCINE SINGLE 90471 $127.00 262777391050113 ADMINISTRATION INFLUENZA VACCINE $127.00 256629631440636 ADMINISTRATION OF BLOOD PRODUCTS 36430 $540.00 261825961050114 ADMINISTRATION PNEUMOCOCCAL VACCINE $127.00 93840221390768 ADMINISTRATION VACCINE HEP B $60.00 2640968110091160 ADVISA DR MRI SURESCAN $14,446.00 2640954810091020 ADVISA DR-MRI SURESCAN $12,200.00 250727671290348 Aerobic Bacterium ID And Susceptibility QST 87077 $126.00 28992171740011 AEROSOL SETUP & INITIAL TREATMENT 94640 $486.00 269321801700070 AEROSOL TX INITIAL 94664 $486.00 28992181700052 AEROSOL TX SUBSEQUENT 94640 $486.00 2953621300103 AFB STAIN 88312 $50.00 6336431290289 AFP-TUMOR MARKER 82105 $133.00 55692121700065 AIRVO/ CPAP 94660 $486.00 25934761 Al hydroxide/Mg hydroxide/simethicone 200 mg-200 mg-20 mg/5 mL Oral $17.25 Susp 30 mL [UGH] 25934762 Al hydroxide/Mg hydroxide/simethicone 200 mg-200 mg-20 mg/5 mL Oral $5.00 Susp 360 mL [UGH] 25934763 Al hydroxide/Mg hydroxide/simethicone 400 mg-400 mg-40 mg/5 mL Oral $14.70 Susp 30 mL [UGH] 6336341290057 ALBUMIN 82040 $44.00 25934764 albumin human 25% IV Sol 50 mL [UGH] P9047 $277.72 27052032 albumin human 25% Sol P9047 $275.52 25934765 albuterol 0.083% Inh Sol 3 mL [UGH] J7613 $5.00 25935767 albuterol 0.5% Inh Sol 20 ml [UGH] J7611 $160.00 25934766 albuterol 2 mg/5 mL Oral Syrup [UGH] $5.00 25935859 albuterol HFAA 90 mcg/inh Inh Aer w/Adapt [UGH] $88.13 25935860 albuterol per PUFF 90mcg/act HFAA [UGH] $20.00 27016634 albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Sol J7620 $11.50 25934767 albuterol-ipratropium Inh Aer w/Adapt [UGH] $961.39 25934768 albuterol-ipratropium Inh Sol 3 mL [UGH] J7620 $10.95 10196201290058 ALCOHOL - BLOOD ETOH 80320 $98.00 261667351290539 ALCOHOL ISOPROPYL 84600 $100.00 256291271290719 ALCOHOL METHYL BLOOD 84600 $84.00 21949741290198 ALDOLASE 82085 $34.00 6336401290199 ALDOSTERONE-SERUM 82088 $183.00 25934769 alfuzosin 10 mg ER Tab [UGH] $21.07 25934770 aliskiren 150 mg oral tablet [UGH] $29.71 7942931290460 ALK PHOS BONE SPECIFIC 84075 $85.00 15495201290201 ALK PHOS ISOENZYMES 84080 $117.00 6336421290059 ALKALINE PHOSPHATASE 84075 $68.00 264888471290720 ALLERGEN EACH 86003 $21.00 25934771 allopurinol 300 mg Tab [UGH] $5.00 25954977 ALLOPURINOL TAB 100 MG [UGH] $5.00 256290891291071 ALMOND IgE 86003 $21.00 27122587 AlOH/diphenhyd/lidocaine/MgOH/simeth topical 3.15 g-0.2 g-1.6 g-3.15 g- $5.68 0.315 g/237 mL Sus 261666701291100 ALPHA 1 ANTITRYPSIN FECES 82103 $55.00 7871051290202 ALPHA-1 ANTI TRYPSIN 82103 $137.40 25934773 ALPRAZolam 0.25 mg Tab [UGH] $5.00 25934774 ALPRAZolam 0.5 mg Tab [UGH] $5.00 25934775 ALPRAZolam 1 mg Tab [UGH] $5.07 25934776 alprostadil 0.5 mg/mL Inj Sol [UGH] J0270 $520.06 25934777 alteplase 100 mg IV Inj [UGH] J2997 $42,241.72 25934778 alteplase 2 mg IV Inj [UGH] J2997 $734.68 15495231291058 ALTERNARIA ALTERNATE IgE 86003 $21.00 25934779 aluminum sulfate-calcium acetate Top Pwdr [UGH] $5.00 27151803 amantadine 100 mg Cap $10.10 25934780 amantadine 100 mg Cap [UGH] $5.00 25934781 amantadine 50 mg/5 mL Oral Syrup [UGH] $5.00 25934782 amikacin 250 mg/mL Sol [UGH] J0278 $117.65 257371501290544 AMIKACIN TROUGH 80150 $74.00 25954987 Amino Acids 2.75% with 5% Dextrose (Clinimix Sulfite-Free) IV Sol 1000 $41.77 mL [UGH] 25954989 Amino Acids 3% with Electrolytes (Procalamine) IV Sol 1000 mL [UGH] $122.08

25954991 Amino Acids 4.25% with 20% Dextrose (Clinimix Sulfite-Free) IV Sol 1000 $213.15 mL [UGH] 25954997 Amino Acids 4.25% with 5% Dextrose (Clinimix Sulfite-Free) IV Sol 1000 $247.00 mL [UGH] 25955001 Amino Acids 4.25% with 5% Dextrose (Clinimix Sulfite-Free) IV Sol 2000 $494.00 mL [UGH] 25955005 Amino Acids 4.25% with 5% Dextrose and Electrolytes (Clinimix E Sulfite- $247.00 Free) IV Sol 1000 mL [UGH] 25955011 Amino Acids 4.25% with 5% Dextrose and Electrolytes (Clinimix E Sulfite- $494.00 Free) IV Sol 2000 mL [UGH] 26010430 Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) intravenous $247.00 solution Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) Sol [UGH] 26010435 Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) intravenous $494.00 solution Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) Sol 2000 mL [UGH] 26012022 Amino Acids 5% with 20% Dextrose and Electrolytes (Clinimix E Sulfite- $247.00 Free) intravenous solution Amino Acids 5% with 20% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol 1000 mL [UGH]

26012021 Amino Acids 5% with 20% Dextrose and Electrolytes (Clinimix E Sulfite- $494.00 Free) intravenous solution Amino Acids 5% with 20% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol 2000 mL [UGH]

255522561290413 AMINO ACIDS PANEL PLASMA 82139 $500.00 250336841290412 AMINO ACIDS URINE 82139 $635.80 25934783 aminocaproic acid 250 mg/mL IV Sol [UGH] S0017 $34.43 25934784 aminocaproic acid 500 mg Tab [UGH] $98.90 25934785 aminophylline 25 mg/mL IV Sol [UGH] J0280 $61.38 25934786 amiodarone 150 mg/100 mL-D5% Sol [UGH] J0282 $166.51 25934787 amiodarone 200 mg Tab [UGH] $16.90 25934788 amiodarone 360 mg/200 mL-D5% Sol [UGH] J0282 $193.80 25961986 amiodarone 50 mg/mL IV Sol [UGH] J0282 $90.00 26009666 AMITRIPTYLINE TAB 10 MG [UGH] $5.00 25934790 AMITRIPTYLINE TAB 25 MG [UGH] $5.00 25934791 amitriptyline-perphenazine 25 mg-2 mg Tab [UGH] $9.77 26949960 amLODIPine 10 mg Tab $22.55 25934792 amLODIPine 5 mg Tab [UGH] $5.00 26011054 AMLODIPINE TAB 10 MG 100 [UGH] $11.28 6336481290061 AMMONIA 82140 $142.00 26103191 Ammonia Inhalant [UGH] $5.00 36931471400158 AMNIOCENTESIS DIAGNOSTIC 59000 $755.00 26008953 amoxicillin 250 mg cap [UGH] $5.00 25934795 amoxicillin 250 mg/5 mL Oral Liq [UGH] $5.00 26981608 amoxicillin 250 mg/5 mL Pow $5.00 25935768 amoxicillin 400 mg/5 mL Oral Liq 50 ml [UGH] $5.00 25934796 amoxicillin 875 mg Tab [UGH] $5.00 26010739 AMOXICILLIN CAP 500 MG 100 [UGH] $5.00 25934797 amoxicillin-clavulanate 1000 mg-62.5 mg ER Tab [UGH] $31.41 25934798 amoxicillin-clavulanate 125 mg-31.25 mg/5 mL Oral Liq 100 mL [UGH] $13.21

25934799 amoxicillin-clavulanate 250 mg-62.5 mg/5 mL Oral Liq 75 mL [UGH] $22.66 27050818 amoxicillin-clavulanate 250 mg-62.5 mg/5 mL Pow $21.58 25934800 amoxicillin-clavulanate 400 mg-57 mg/5 mL Oral Liq 75 mL [UGH] $15.61 25934801 amoxicillin-clavulanate 500 mg-125 mg Tab [UGH] $18.92 25934802 amoxicillin-clavulanate 600 mg-42.9 mg/5 mL Oral Liq 75 mL [UGH] $17.28 25934803 amoxicillin-clavulanate 875 mg-125 mg Tab [UGH] $24.50 25934804 amphotericin B 50 mg IV Inj [UGH] J0285 $182.40 25934805 amphotericin B liposomal 50 mg IV Inj [UGH] J0289 $1,088.32 25934806 ampicillin 1 g Inj [UGH] J0290 $35.40 25934807 ampicillin 125 mg Inj [UGH] J0290 $26.10 25934808 ampicillin 2 g Inj [UGH] J0290 $47.65 25934809 ampicillin 250 mg Inj [UGH] J0290 $25.00 25934810 ampicillin 500 mg Inj [UGH] J0290 $25.00 26989894 ampicillin 500 mg Pow J0290 $25.00 25934811 ampicillin-sulbactam 1 g-0.5 g Inj [UGH] J0295 $45.59 25962100 ampicillin-sulbactam 2 g-1 g Inj [UGH] J0295 $77.49 6315671290060 AMYLASE 82150 $73.00 112182201290526 AMYLASE BODY FLUID 82150 $65.00 6336551290208 ANA 86038 $68.00 25934813 anagrelide 0.5 mg Cap [UGH] $44.65 253735111460179 ANAL/RECTAL PROC - UNLISTED 46999 $1,080.00 262926211460088 ANAL/RECTAL PROC-LEVEL I 45900 $870.00 253735061460089 ANAL/RECTAL PROC-LEVEL III 46040 $3,132.00 27141616 anastrozole 1 mg Tab $53.21 25934814 anastrozole 1 mg Tab [UGH] $62.98 20862801290424 ANCA-NEUTROPHIL CYTOPLASMIC ANTIBODY 86021 $320.00 2640967510091150 ANCHOR 4.5MM FOOTPRINT $832.00 2640978510091270 ANCHOR PITON 2.8MM $745.00 2640995710091450 ANCHORSURE ANCHOR $1,063.00 27811561290297 ANDROSTENEDIONE 82157 $103.00 10256921290204 ANGIOTENSIN CONVERTING ENZYME 82164 $69.00 2640891210010010 ANKLE BRACE UNIV $30.00 2640934710090750 ANKLE STIRRUP UNIV FLEXIBLE REG. $34.00 2640934810090750 ANKLE STIRUP-STANDARD AIR GEL $23.00 2640934910090750 ANKLE STIRUP-TRAINER AIR GEL $23.00 253735101461088 ANOSCOPY W/ REMOVAL FOREIGN BODY- FAC 46608 $1,882.00 262926261460102 ANTERIOR SEGMENT EYE PROC-LV1 66999 $600.00 27811461293647 ANTI MULLERIAN HORMONE ASSESS R 83520 $120.00 251615281290015 Antibody Screen 86885 $63.00 7871361290352 ANTI-DNA DOUBLE STRANDED 86225 $89.00 25934815 antihemophilic factor-von Willebrand factor IV Inj [UGH] J7187 $50.00 20135351290210 ANTI-MYELOPEROXIDASE ANTIBODY 86021 $65.00 26203961290855 ANTIPHOSPHOLIPID ABY PANEL 86148 $585.00 7871611290192 ANTI-SMOOTH MUSCLE ANTIBODY 86255 $112.00 27811611290184 ANTI-THROMBIN III ACTIVITY 85300 $166.00 25934816 antivenin (black widow spider) 6000 units Inj [UGH] $133.00 25934817 antivenin (Crotalidae) polyvalent - Pow [UGH] J0840 $15,350.40 8577411290022 Aph Plt ACDA LR 3 $628.00 10119191290001 Aph RBC ACDA AS3 LR $360.00 25934819 apixaban 2.5 mg Tab [UGH] $39.97 25934820 apixaban 5 mg Tab [UGH] $39.97 261667081291027 APPLE IgE 86003 $22.00 48113651730009 Application of a modality to 1 or more areas; contrast baths 97034 $50.00 6913241730007 Application of a modality to 1 or more areas; electrical sti 97032 $50.00 242413191730004 Application of a modality to 1 or more areas; hot or cold pa 97010 $35.00 6913231730008 Application of a modality to 1 or more areas; iontophoresis 97033 $50.00 19696751730006 Application of a modality to 1 or more areas; whirlpool 97022 $75.00 254847811750063 APPLY SKIN SUB EA ADD 100 SQ CM FEET-FAC 15278 $1,578.00 253877781750062 APPLY SKIN SUB EA ADD 100 SQ CM LEGS-FAC 15274 $1,578.00 254847791750059 APPLY SKIN SUB EA ADD 25 SQ CM FEET- FAC 15276 $1,578.00 253877761750058 APPLY SKIN SUB EA ADD 25 SQ CM LEGS- FAC 15272 $1,578.00 254847801750061 APPLY SKIN SUB FIRST 100 SQ CM FEET- FAC 15277 $4,275.00 253877771750060 APPLY SKIN SUB FIRST 100 SQ CM LEGS- FAC 15273 $4,275.00 253877791750057 APPLY SKIN SUB FIRST 25 SQ CM FEET - FAC 15275 $2,822.00 253877751750056 APPLY SKIN SUB FIRST 25 SQ CM LEGS - FAC 15271 $2,822.00 253702401750048 APPLY TOTAL CONTACT LEG CAST - FAC 29445 $624.00 25934821 apracloNIDine Ophth 0.5% Sol [UGH] $399.12 25983375 Aquaphor Healing Emollients Ointment 85 g [UGH] $31.37 12398301720011 AQUATIC THERAPY EXERCISE 97113 $80.00 26305021 arformoterol 15 mcg/2 mL Sol [UGH] J7605 $77.68 25934822 ARIPiprazole 2 mg oral tablet [UGH] $128.44 26957427 ARIPiprazole 5 mg Tab $128.30 25934823 ARIPiprazole 5 mg Tab [UGH] $138.69 491865110090506 ARM SLING UNIVERSAL $26.00 195278021290086 ARTERIAL BLOOD GASES 82803 $130.00 22800361700028 ARTERIAL PUNCTURE 36600 $250.00 25935861 Artificial Tears [UGH] $18.95 27811691290781 ASCA IgA 86671 $150.00 141061981290782 ASCA IgG 86671 $150.00 25934824 ascorbic acid 500 mg Tab [UGH] $5.00 7871631290046 ASO TITER 86060 $45.00 15495321291040 ASPERGILLUS FUMIGATES IgE 86003 $21.00 253735181461075 ASPIRATION BLADDER-INSERT SUPRAPUBIC CAT 51102 $2,752.00 258545581461135 ASPIRATION GANGLION CYST FAC 20612 $693.00 25934825 aspirin 300 mg Supp [UGH] $7.29 25934826 aspirin 325 mg Oral EC Tab [UGH] $5.00 25934827 aspirin 325 mg Tab [UGH] $5.00 25934828 aspirin 600 mg Supp [UGH] $7.54 25934829 aspirin 81 mg Chew Tab [UGH] $5.00 25934830 aspirin 81 mg Oral EC Tab [UGH] $5.00 25934831 aspirin-dipyridamole 25 mg-200 mg ERCap [UGH] $41.82 99627421710004 ASSESS ASSISTIVE TECHNOLOGY W/ REPORT 97755 $60.00 2640949410090960 ASSURITY PACEMAKER U PR PM2240 $12,338.00 25934832 atenolol 25 mg Tab [UGH] $5.00 26769653 atenolol 50 mg Tab $5.00 26103962 atenolol 50 mg Tab [UGH] $5.00 25934833 atenolol-chlorthalidone 50 mg-25 mg Tab [UGH] $9.42 25934834 atorvastatin 20 mg Tab [UGH] $7.10 25935862 atropine 0.1 mg/mL 10 ml Syringe [UGH] J0461 $48.60 25935863 ATROPINE 0.4 MG/ML 1 ml vial [UGH] J0461 $42.00 26011109 atropine 0.4 mg/mL Sol 20mL [UGH] J0461 $168.48 25934835 atropine Ophth 1% Oint [UGH] $77.08 25935769 atropine Ophth 1% Sol 15ml [UGH] $151.40 25935770 atropine Ophth 1% Sol 5ml [UGH] $102.00 25934836 atropine-diphenoxylate 0.025 mg-2.5 mg Tab [UGH] $5.00 25934837 atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL Oral Liq 60 mL [UGH] $31.50

2640985010091340 ATTUNE TIBIAL INSERT SZ 5 $2,375.00 2640966310091140 AVANCE NERVE GRAFT $6,100.00 2640983010091320 AVIVE SOFT TISSUE MEMBRANE $7,380.00 91154931750052 AVULSION NAIL PLATE (1) - FAC 11730 $353.00 254847651750053 AVULSION NAIL PLATE EA ADDL- FAC 11732 $175.00 2640976210091240 AXOGUARD NERVE GRAFT 1-2 X 30MM $6,100.00 2640950610090970 AXOGUARD NERVE PROTECTOR 10 X 40 $4,500.00 2640966210091140 AXOGUARD NERVE PROTECTOR 3 X 15 $3,100.00 2640976310091240 AXOGUARD NERVE PROTECTOR 40MM $4,500.00 2640966110091140 AXOGUARD NERVE PROTECTOR 5 X 40 $4,500.00 2640950710090980 AXOGUARD NERVE PROTECTOR 7 X 40 $1,359.00 25934838 azaTHIOprine 50 mg Tab [UGH] J7500 $34.09 25934839 azelastine Nasal 137 mcg/inh Spry [UGH] $537.76 25935864 azithromycin 200 mg/5 mL Oral Liq 30ml [UGH] Q0144 $26.16 27051090 azithromycin 200 mg/5 mL Pow Q0144 $232.59 25934840 azithromycin 250 mg Tab [UGH] $32.26 25934841 azithromycin 500 mg IV Inj [UGH] J0456 $40.00 26781512 azithromycin 500 mg Tab $329.54 25934842 azithromycin 500 mg Tab [UGH] $30.92 25934843 aztreonam 1 g Inj [UGH] S0073 $158.16 25934844 aztreonam 2 g Inj [UGH] S0073 $321.36 25934845 bacitracin 50,000 units IM Inj [UGH] $59.89 26934905 bacitracin topical 500 units/g Oin $18.00 25935865 bacitracin topical zinc 500 units/g Oint 15gm [UGH] $18.50 25983788 bacitracin/neomycin/polymyxin B ophthalmic 400 units-3.5 mg-10000 $210.16 units/g Oin[UGH] 25935771 bacitracin/neomycin/polymyxin B Top Oint 15gm tube [UGH] $43.60 25935772 bacitracin/neomycin/polymyxin B Top Oint ud packet [UGH] $5.00 27129147 bacitracin/neomycin/polymyxin B topical 400 units-3.5 mg-5000 units/g Oin $40.98

26010858 bacitracin/neomycin/polymyxin B topical 400 units-3.5 mg-5000 units/g Oin $31.77 [UGH] 25935773 bacitracin-polymyxin B Ophth Oint 3.5 gm [UGH] $114.60 25935774 bacitracin-polymyxin B Top Oint 15gm [UGH] $45.00 25934846 baclofen 10 mg Tab [UGH] $12.36 26908708 baclofen 2 mg/mL SoL [UGH] J0475 $244.00 26010755 BACLOFEN TAB 20 MG 100 [UGH] $23.09 261666791291041 BAHIA GRASS IgE 86003 $21.00 269505141440620 BAIR HUGGER UNIT $64.00 2640922910090410 BALLOON CERVICAL RIPENING W/STYLET $131.00 2640921710090400 BALLOON DILA UROMAX 12FX4CM $748.00 2640921810090400 BALLOON DILA UROMAX 15FR $796.00 2640921610090400 BALLOON DILATION UROMAX ULTRA 24FRX8CM $823.00 25934847 balsam Peru/castor oil/trypsin topical 87 mg-788 mg-0.12 mg/g Spr [UGH] $77.64

194356071290133 BASIC METABOLIC PANEL(BCP-7) 80048 $82.00 138164691290021 BB FFP $85.00 8577381290022 BB PLT PHERESIS PROCESSING FEE $628.00 8576111290001 BB PRBC PROCESSING FEE $360.00 269740621300357 BCR/ABL 1 KINASE 81170 $830.00 7813861710013 BEDSIDE SWALLOW EVAL 92610 $150.00 25934848 belladonna-opium 16.2 mg-30 mg Supp [UGH] $137.59 25934849 benazepril 10 mg Tab [UGH] $5.00 25934850 benazepril 20 mg Tab [UGH] $5.05 26011511 benzathine penicillin-procaine penicillin 900,000 units-300,000 units/2 mL J0558 $602.12 Sus 2 mL [UGH] 25934851 benzocaine Top 20% mucous membrane spray [UGH] $162.68 25934852 benzocaine Top 20% Spry [UGH] $24.48 25934853 benzocaine Top 7.5% mucous membrane gel [UGH] $20.95 25934854 benzocaine/butamben/tetracaine Top Aer [UGH] $18.10 25934855 benzocaine-menthol topical 15 mg-3.6 mg Loz [UGH] $5.00 25934856 benzoin compound Top tincture [UGH] $24.75 25934857 benzonatate 100 mg Cap [UGH] $5.00 25934858 benztropine 0.5 mg Tab [UGH] $6.00 25934859 benztropine 1 mg Tab [UGH] $5.00 26011033 benztropine 1 mg/mL Inj Sol 2ml [UGH] J0515 $335.84 27051999 benztropine 1 mg/mL Sol J0515 $235.00 25934860 beractant 25 mg/mL intratracheal Sol [UGH] $3,253.76 269505151440621 BERKLEY EVACUATOR $47.00 261666771291042 BERMUDA GRASS IgE 86003 $21.00 25934861 betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj J0702 $42.36 Susp 5 mL [UGH] 25934862 betamethasone Top dipropionate 0.05% Crm [UGH] $211.32 25934863 betamethasone-clotrimazole Top 0.05%-1% Crm [UGH] $80.92 25934864 bethanechol 25 mg Tab [UGH] $13.35 2640995310091440 BI POLAR HEAD 28MM 50MM $1,375.00 2640992410091410 BI POLAR HEAD 28MM ID 49MM OD $1,375.00 255522671290895 BILE ACIDS 82239 $90.00 261667291291008 BILE ACIDS FRACTIONATED AND TOTAL 83789 $25.00 2640922010090400 BILIARY STENT 7FR/10CM $267.00 2640921910090400 BILIARY STENT 7FR/12CM $267.00 2640922110090400 BILIARY STENT 7FR/15CM $267.00 2640924810090440 BILIARY STENT COTTON CLBS-7-5 $411.00 2640925010090440 BILIARY STENT COTTON-LEUNG 7-7 $411.00 2640922310090410 BILIARY STENT KIT 7FR X 10CM $144.00 2640924910090440 BILIARY STENT SET COTTON LEUNG 7-9 $384.00 2640924710090430 BILIARY STENT ZIMMON 7FR. $297.00 6336721290080 BILIRUBIN (TOTAL) 82247 $48.00 46033241290728 Bill Antibody ID Each 86870 $646.00 30290701290729 Bill Antigen Type 86905 $35.00 64471641290727 Bill Antigen Type Product 86902 $35.00 11379871290017 Bill DAT 86880 $43.00 29254191290753 Bill Elution 86870 $35.00 100520701720047 BIOFEEDBACK ANY MODALITY 90901 $65.00 261996901720048 BIOFEEDBACK PERINEAL 90911 $120.00 71368711100 BIOPSY SKIN LESION 11100 $677.00 18869321700002 BIPAP MGMT EA SUBSEQUENT DAY 94660 $758.00 18869311700001 BIPAP MGMT INITIAL 94660 $758.00 2640916210090340 BIPOLAR ASSEMBLY $4,400.00 2640903910090190 BIPOLAR- ASSEMBLY $3,960.00 2640939110090850 BIPOLAR ASSEMBLY +-0 MM $3,960.00 2640942510090890 BIPOLAR ASSEMBLY +-0MM 28MM X 47MM $3,960.00 2640982710091310 BIPOLAR ASSEMBLY 28 X 55 $3,960.00 2640908010090250 BIPOLAR ASSEMBLY 28MM X 42MM $3,960.00 2640927710090470 BIPOLAR ASSEMBLY 28MM X 43MM -5MM $3,960.00 2640909810090270 BIPOLAR ASSEMBLY 28MM X 44MM $3,960.00 2640925810090450 BIPOLAR ASSEMBLY 28MM X 45MM $3,960.00 2640920610090390 BIPOLAR ASSEMBLY 28MM X 46MM +-0MM $3,960.00 2640914210090310 BIPOLAR ASSEMBLY 28MM X 48MM $3,960.00 2640977310091250 BIPOLAR ASSEMBLY 28MM X 51MM $3,960.00 2640912910090300 BIPOLAR ASSEMBLY 28MM X 52MM $3,960.00 2701955210091700 BIPOLAR ASSEMBLY 28MM X 53MM $3,960.00 2640908610090250 BIPOLAR ASSEMBLY -5MM $4,400.00 2640926310090450 BIPOLAR ASSEMBLY 5MM 28MM X 47MM $3,960.00 2640919510090370 BIPOLAR ASSEMBLY SZ +-0MM $3,960.00 2640927310090460 BIPOLAR ASSEMBLY SZ +-0MM 28MM X 42MM $3,960.00 2640942810090890 BIPOLAR ASSEMBLY SZ +5 MM $3,960.00 2640917310090350 BIPOLAR ASSEMBLY SZ 28MM X 46MM $4,400.00 2640915810090330 BIPOLAR ASSEMBLY SZ 28MMX54MM +5MM $3,960.00 2640936510090810 BIPOLAR ASSEMBLY SZ -5MM $3,960.00 2640964210091120 BIPOLAR HIP ASSEMBLY SZ -5MM $3,960.00 261666871291043 BIRCH IgE 86003 $21.00 26970896 bisacodyl 10 mg Sup $5.00 25961896 bisacodyl 10 mg Supp [UGH] $5.00 25934866 bisacodyl 5 mg Oral EC Tab [UGH] $5.00 26587446 Bismuth & Bourbon [UGH] $44.00 25934867 bismuth subsalicylate 262 mg Chew Tab [UGH] $5.00 26010704 bismuth subsalicylate 262 mg/15 mL Oral Susp [UGH] $5.00 27052006 bismuth subsalicylate 262 mg/15 mL Sus $5.00 26981622 bisoprolol 5 mg Tab $7.01 25934870 bisoprolol 5 mg Tab [UGH] $6.10 26010800 bisoprolol-hydrochlorothiazide 2.5 mg-6.25 mg Tab [UGH] $5.64 25934871 bisoprolol-hydrochlorothiazide 5 mg-6.25 mg Tab [UGH] $5.71 259716771400163 BLADDER SCAN 51798 $163.00 258121911460150 BLEPHAROTOMY-DRAINAGE OF ABCESS EYELID 67700 $624.00 261708081290027 Blood Alcohol Legal 80320 $20.00 7961801290140 BLOOD COLLECT FEE 36415 $8.00 7961621290140 BLOOD COLLECTION FEE 36415 $8.00 241593041480105 BLOOD DRAW CENTRAL LINE 36592 $274.00 256619761480104 BLOOD DRAW IMPLANTED PORT 36591 $274.00 10037581290114 BLOOD GAS CAPILLARY 82803 $130.00 258646541290565 BLOOD GAS VENOUS 82803 $100.00 259830771390760 BLOOD PUSH TRANS <2 YEARS 36440 $700.00 104195601290025 Blood Type & Rh 86900 $38.00 253730351460049 BONE/JOINT MANIPULATION W ANESTHESIA 23655 $2,460.00 253730861460063 BONE/JOINT MANIPULATION W/ ANESTHESIA 26775 $2,460.00 269505161440622 BOVIE UNIT $62.00 2640928110090470 BRACE HIP ORTHOSIS LG LEFT $615.00 2640927910090470 BRACE HIP ORTHOSIS LG RIGHT $615.00 2640928010090470 BRACE HIP ORTHOSIS MED LEFT $615.00 2640927810090470 BRACE HIP ORTHOSIS MED RIGHT $615.00 2640928910090480 BRACE KNEE HINGED MD/LG $91.00 2640928810090480 BRACE KNEE HINGED XS/SM $91.00 269719861300153 BRAF BY PCR 81210 $325.00 256290881291072 BRAZIL NUT IgE 86003 $21.00 25934872 brimonidine Ophth 0.15% Sol [UGH] $566.79 27067351 brimonidine ophthalmic 0.2% Sol $17.08 26164853 brimonidine-timolol ophthalmic 0.2%-0.5% Sol[UGH] $128.34 25934873 bromocriptine 2.5 mg Tab [UGH] $28.21 25934874 brompheniramine/dextromethorphan/PSE 2 mg-10 mg-30 mg/5 mL Oral $6.23 Syrup 118 mL [UGH] 25934875 budesonide 0.25 mg/2 mL Inh Susp [UGH] J7626 $41.83 25934876 budesonide 0.5 mg/2 mL Inh Susp [UGH] J7633 $49.23 27090572 budesonide 3 mg Cap $88.00 25934877 budesonide 3 mg ERCap [UGH] $91.21 25934878 bumetanide 0.25 mg/mL Inj Sol [UGH] $25.00 25934879 bumetanide 0.5 mg Tab [UGH] $5.00 25934880 bumetanide 1 mg Tab [UGH] $5.00 6336051290062 BUN 84520 $43.00 25934881 bupivacaine 0.25% PF Inj Sol 10 mL [UGH] J3490 $25.00 25934882 bupivacaine 0.25% PF Inj Sol 30 mL [UGH] J3490 $29.00 25934883 bupivacaine 0.5% PF Inj Sol 10 mL [UGH] J3490 $25.00 25934884 bupivacaine 0.5% PF Inj Sol 30 mL [UGH] J3490 $25.00 25934885 bupivacaine 0.5%-EPINEPHrine 1:200,000 Inj Sol 50 mL [UGH] J3490 $59.45 25934886 bupivacaine 0.75% PF Inj Sol 10 mL [UGH] J3490 $25.00 26553250 bupivacaine 0.75%-D8.25% preservative-free Sol[UGH] $25.00 26832171 bupivacaine liposome 1.3% (13.3 mg/mL) Sus [UGH] C9290 $840.48 25934887 bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 10 mL [UGH] J3490 $25.00 25934888 bupivacaine-EPINEPHrine 0.5%-1:200,000 PF Inj Sol 10 mL [UGH] J3490 $25.00 25934889 buprenorphine 0.3 mg/mL Inj Sol [UGH] J0592 $65.56 25934890 buPROPion 100 mg Tab [UGH] $5.30 26979180 buPROPion 100 mg/12 hours Tab $9.70 26010806 buPROPion 150 mg/12 hours Tab [UGH] $9.05 25934891 buPROPion 75 mg Tab [UGH] $7.73 26918783 busPIRone 15 mg Tab $10.10 25934892 busPIRone 15 mg Tab [UGH] $10.10 27086801 busPIRone 5 mg Tab $5.00 25934893 busPIRone 5 mg Tab [UGH] $5.00 25934894 butorphanol 1 mg/mL Inj Sol [UGH] J0595 $25.00 25934895 butorphanol 2 mg/mL Inj Sol [UGH] J0595 $25.00 25934896 C1 esterase inhibitor, human 500 intl units Kit [UGH] J0597 $13,512.00 20135371293720 C1 Inhibitor Functional QST 86308 $80.00 27811621293720 C1 Inhibitor Protein QST 86738 $106.00 21950021290225 C3 COMPLEMENT 86160 $68.00 21950071290227 C4 COMPLEMENT 86160 $68.00 10257091290339 CA 125 86304 $111.00 10257111290367 CA 19-9 86301 $60.00 11580041290370 CA 27.29 86300 $76.00 2640991410091400 CABLE WITH CRIMP 1.7MM $1,472.00 25934897 caffeine citrate 20 mg/mL IV Sol [UGH] J0706 $182.48 25934898 caffeine-sodium benzoate 125 mg-125 mg/mL Inj Sol 2 mL [UGH] j0706 $98.44 26011188 calamine-zinc oxide topical 8%-8% Lot 180 mL [UGH] $12.45 21949791290396 CALCITONIN 82308 $175.00 25934899 calcitonin 200 intl units/inh Nasal Spry [UGH] $474.16 26795437 calcitonin 200 intl units/mL Inj Sol [UGH] J0630 $12,974.72 25934901 calcitriol 0.25 mcg Oral Cap [UGH] $6.40 6336901290063 CALCIUM 82310 $44.00 26957428 calcium acetate 667 mg Cap $5.13 25934903 calcium acetate 667 mg Cap [UGH] $5.00 25934904 calcium carbonate 500 mg Chew Tab [UGH] $5.00 25934905 calcium carbonate 600 mg Tab [UGH] $5.00 26011078 calcium carbonate-magnesium chloride 119 mg-71.5 mg Tab [UGH] $5.00 26168628 calcium chloride 100 mg/mL Inj Sol 10 ml syringe [UGH] $48.60 25935777 calcium chloride 100 mg/mL Inj Sol 10 ml vial [UGH] $104.36 25934309 calcium gluconate 100 mg/mL Inj Sol [UGH] J0610 $32.40 15495411290374 CALCIUM IONIZED 82330 $96.00 16735861600015 CALCIUM SCORING TEST 75571 $145.00 26165130 calcium-vitamin D 1 EA Tab [UGH] $5.00 25934310 calcium-vitamin D 500 mg-200 intl units Tab [UGH] $5.00 26553150 calcium-vitamin D 600 mg-800 intl units Tab [UGH] $5.00 15495421290879 CALPROTECTIN STOOL 83993 $225.00 25934311 camphor/menthol/methyl salicylate topical 4%-10%-30% Cre [UGH] $29.34 139243451720058 CANALITH REPOSITIONING PROCEDURE 95992 $85.00 2640901410090160 CANCELLOUS BONE SCREW 30MM $270.00 2640958710091060 CANCELLOUS BONE SCREW SZ 25MM $270.00 2640958810091060 CANCELLOUS BONE SCREW SZ 35MM $270.00 2640957010091040 CANCELLOUS BONE SCREW SZ 40MM $90.00 2640952910091000 CANCELLOUS BONE SCREW SZ 45MM $270.00 2640957310091050 CANCELLOUS CHIPS 5CC $615.00 2640981410091300 CANCELLOUS MORSELS 5CC $585.00 25934907 candesartan 16 mg Tab [UGH] $15.28 25934908 candida albicans extract ID Sol 1 mL [UGH] $80.10 2640954710091020 CAPSUREFIX NOVUS 52CM $1,992.00 2640954610091020 CAPSUREFIX NOVUS 58CM $1,992.00 25934909 captopril 12.5 mg Tab [UGH] $8.58 25934910 carbachol Ophth 0.01% Sol [UGH] $148.69 25934911 carBAMazepine 100 mg/5 mL Oral Susp [UGH] $5.00 25934912 carBAMazepine 200 mg Tab [UGH] $8.00 25934913 carbamide peroxide Otic 6.5% Sol [UGH] $14.95 25934914 carbidopa-levodopa 25 mg-100 mg ER Tab [UGH] $5.00 25934915 carbidopa-levodopa 25 mg-250 mg Tab [UGH] $8.07 26010408 CARBIDOPA-LEVODOPA TAB 25-100 MG [UGH] $5.00 25934916 carboprost 250 mcg/mL Inj Sol [UGH] 0 $1,308.38 256350031290360 CARBOXYHEMOGLOBIN 82375 $68.00 25962186 CARBOXYMETHYLCELLULOSE 0.5% [UGH] $5.00 11575171700053 CARDIAC EVENT MONITOR HOOK UP 93270 $91.00 259721541740007 CARDIAC REHAB SESSION W/ ECG MONITOR 93798 $312.00 177800011740021 CARDIAC REHAB SESSION W/O ECG MONITOR 93797 $312.00 26876411290182 CARDIOLIPIN ANTIBODY 86147 $99.00 253674941460107 CARDIOPULMONARY RESUSCITATION TECH FEE 92950 $661.00 259723561440016 CARDIOVERSION (EXTERNAL) 92960 $1,104.00 26850268 cariprazine 1.5 mg Cap UD[UGH] $192.13 26984561 carisoprodol 350 mg Tab $5.00 25934917 carisoprodol 350 mg Tab [UGH] $5.00 255522761290522 CARNITINE 82379 $157.00 259830181390747 CARSEAT NEONATE EA ADD 30 MIN 94781 $90.00 190601151390746 CARSEAT NEONATE INIT 60 MIN 94780 $55.00 25934918 carvedilol 25 mg Tab [UGH] $9.75 25934919 carvedilol 6.25 mg Tab [UGH] $10.67 26010766 CARVEDILOL TAB 12.5 MG 100 [UGH] $10.67 26008984 CARVEDILOL TAB 3.125 MG 100 [UGH] $10.67 256290901291082 CASEIN IgE 86003 $21.00 256290831291073 CASHEW IgE 86003 $21.00 25934920 caspofungin 50 mg IV Inj [UGH] J0637 $1,621.00 25934921 caspofungin 70 mg IV Inj [UGH] J0637 $1,684.24 253733811460128 CAST APPLICATION INC SPLINT/STRAPPING 29105 $180.00 253733951461041 CAST/SPLINT APPL 29515 $180.00 253733941460134 CAST/SPLINT APPL PF 29505 $180.00 253733981461064 CAST/SPLINT APPLICATION TOES-FAC 29550 $168.00 255522771291044 CAT DANDER IgE 86003 $21.00 164768101290441 CAT SCRATCH FEVER (BARTONELLA ANTIBODIES 86611 $100.00 15495431290404 CATECHOLAMINES FREE FRACTIONATED URINE 82384 $125.00 2640932610090650 CATH 3-WAY 18FR 30CC FOLEY IRRIGATE $39.00 2640932710090650 CATH 3-WAY 20FR 30CC FOLEY IRRIGATE $39.00 2640932910090650 CATH 3-WAY 22FR 30CC FOLEY IRRIGATE $36.00 2640933010090650 CATH 3-WAY 24FR 30CC FOLEY IRRIGATE $39.00 2640932810090650 CATH COUDE 12FR 5CC 2-WAY $64.00 2640933610090680 CATH COUDE 18FR 5CC 2-WAY $64.00 2640945010090920 CATH DILATION PYLORIC 15MM BALLOON $343.00 2640929710090510 CATH FOLEY TEMP SENS $63.00 256596181400166 CATH SIMPLE 51702 $235.00 256596211400167 CATH STRAIGHT 51701 $165.00 2640934210090720 CATHETER 18FR 30CC FOLEY LATEX FREE $23.00 2640993410091420 CATHETER 18FR 5 CC 2WAY $19.00 2640991210091400 CATHETER 22FR 30CC 3WAY COUDE $47.00 2640923010090420 CATHETER 3.5 CRICOTHYROTOMY SET AIRWAY $525.00 2640923110090420 CATHETER 4 MM CRICOTHYROTOMY SET AIRWAY $509.00 2640923210090420 CATHETER 6MM CRICOTHYROTOMY SET $499.00 2640929010090480 CATHETER CONTURA FLEX 4.0-5.0 $5,500.00 2640929110090480 CATHETER CONTURA FLEX 4.5-6.0 $5,500.00 2640931410090610 CATHETER COUDE 14FR 5CC 2-WAY $59.00 2640931510090610 CATHETER COUDE 16FR 5CC 2-WAY $64.00 2701877010091510 CATHETER COUNCIL 16FR RED $31.00 2640923410090420 CATHETER DIALATION ATB ADVANCE $838.00 2640929510090500 CATHETER FOLEY 12 FR 5 CC $22.00 2640931610090630 CATHETER FOLEY 14 FR 5 CC $20.00 2640931910090640 CATHETER FOLEY 16 FR 30 CC $21.00 2640931710090640 CATHETER FOLEY 16 FR 5 CC $20.00 2640931810090640 CATHETER FOLEY 18 FR 5 CC $20.00 2640929610090500 CATHETER FOLEY 20 FR 30 CC $23.00 2640932010090640 CATHETER FOLEY 20 FR 5 CC $20.00 2640934110090710 CATHETER FOLEY 22 FR 30 CC $23.00 2640932410090640 CATHETER FOLEY 22 FR 5 CC $22.00 2640932510090640 CATHETER FOLEY 24 FR 5 CC $22.00 2640933110090650 CATHETER FOLEY 3-WAY 26FR 30CC IRRIGATE $29.00 2640895910010470 CATHETER FOLEY 5CC 2WAY 12FR COUDE I.C. $63.00 2640892710010110 CATHETER FOLEY 5CC 2WAY 12FR I.C. $22.00 2640896010010470 CATHETER FOLEY 5CC 2WAY 14FR COUDE I.C. $63.00 2640892810010110 CATHETER FOLEY 5CC 2WAY 14FR I.C. $22.00 2640892410010100 CATHETER FOLEY 5CC 2WAY 16FR COUDE I.C. $63.00 2640892910010120 CATHETER FOLEY 5CC 2WAY 16FR I.C. $20.00 2640892510010110 CATHETER FOLEY 5CC 2WAY 18FR COUDE I.C. $63.00 2640893010010120 CATHETER FOLEY 5CC 2WAY 18FR I.C. $22.00 2640893110010120 CATHETER FOLEY 5CC 2WAY 20FR I.C. $9.00 2640893210010120 CATHETER FOLEY 5CC 2WAY 22FR I.C. $22.00 2640892610010110 CATHETER FOLEY 5CC 2WAY 24FR I.C. $32.00 253735221461125 CATHETER INSERTION COMPLICATED FAC 51703 $389.00 2640930510090580 CATHETER INTRODUCER 16 FR SUPRA-PUBIC $57.00 2640896610010510 CATHETER LIBERTY 3.0 MALE EXTERNAL $36.00 2640991910091410 CATHETER POWERLINE CENTRAL VENOUS $705.00 2640924510090430 CATHETER STAMEY PERCUTANEOUS SUPRAPUBIC $128.00 2640929810090510 CATHETER TRAY W/16 FR FOLEY CATHETER $23.00 2640929910090510 CATHETER TRAY W/O CATHETER $22.00 2640923810090420 CATHETER URETERAL POLLACK OPEN END $506.00 2640925410090440 CATHETERS KUMAR $101.00 201353212901011 CBC 85025 $63.00 256420591290028 CBC (HEMOGRAM) 85027 $63.00 250303791290101 CBC w/ AUTO DIFF 85025 $63.00 10257171290220 CEA 82378 $82.00 25934922 cefaclor 250 mg Cap [UGH] $9.95 25934923 cefadroxil 500 mg Cap [UGH] $18.60 27078598 ceFAZolin 1 g Inj [UGH] J0690 $60.00 25934925 ceFAZolin 2 g/50 mL Sol [UGH] J0690 $120.00 25934926 cefdinir 125 mg/5 mL Oral Susp [UGH] $21.25 27090556 cefdinir 125 mg/5 mL Pow $21.25 25934927 cefdinir 300 mg Cap [UGH] $22.99 25934928 cefepime 1 g Inj [UGH] J0692 $91.49 25934929 cefepime 2 g Inj [UGH] J0692 $120.00 25934930 cefotaxime 1 g Inj [UGH] J0698 $45.00 25934931 cefotaxime 2 g Inj [UGH] J0698 $90.00 25934932 cefotaxime 500 mg Inj [UGH] J0698 $40.00 25934933 cefoTEtan 2 g Inj [UGH] S0074 $184.66 25934934 cefOXitin 1 g Inj [UGH] J0694 $38.30 25934935 cefOXitin 2 g Inj [UGH] J0694 $54.00 26971822 cefOXitin 2 g Pow J0694 $68.85 25934936 cefprozil 250 mg/5 mL Oral Liq [UGH] $19.70 25934937 cefTAZidime 1 g Inj [UGH] J0713 $60.00 25934938 cefTAZidime 2 g Inj [UGH] J0713 $120.00 25934939 cefTAZidime 500 mg Inj [UGH] J0713 $6.47 25934940 cefTRIAXone 1 g Inj [UGH] J0696 $120.00 25934941 cefTRIAXone 2 g Inj [UGH] J0696 $240.00 25934942 cefTRIAXone 250 mg Inj [UGH] J0696 $30.00 25934943 cefTRIAXone 500 mg Inj [UGH] J0696 $90.00 25934944 cefuroxime 1.5 g Inj [UGH] J0697 $120.00 25934945 cefuroxime 250 mg Tab [UGH] $22.00 25934946 cefuroxime 250 mg/5 mL Oral Liq [UGH] $48.03 25934947 cefuroxime 750 mg Inj [UGH] J0697 $60.00 25934948 celecoxib 100 mg Cap [UGH] $39.69 48568351290574 CELIAC DISEASE COMPREHENSIVE PANEL $175.00 269665091440021 CELL SAVER SERVICES CHARGE $900.00 173925561480084 CENTRAL LINE FLUSH 96523 $150.00 7773811400187 Central Line Insertion 36556 $1,025.00 2640924010090430 CENTRAL VENOUS CATH KIT MULTI-LUMEN 7 FR $475.00 2640924110090430 CENTRAL VENOUS CATH KIT NO DRUGS $345.00 7871851290575 CENTROMERE ABY SCREEN 86038 $81.00 25934949 cephalexin 125 mg/5 mL Oral Liq [UGH] $5.94 27052007 cephalexin 250 mg Cap $5.00 25934950 cephalexin 250 mg Cap [UGH] $5.00 25934951 cephalexin 250 mg/5 mL Oral Liq [UGH] $7.19 25934952 cephalexin 500 mg Cap [UGH] $6.88 253734561461071 CEREBRAL THROMBOLYSIS BY IV INFUSION 37195 $585.00 25934953 certolizumab 200 mg/mL Kit [UGH] J0717 $14,716.20 15495451290221 CERULOPLASMIN SERUM 82390 $67.00 2640936010090810 CERVICAL COLLAR FOAM MED. LOW DENSITY $21.00 2640904010090190 CERVICAL COLLAR PEDIATRIC PHILADELPHIA $43.00 25934954 cetirizine 1 mg/mL Oral Syrup [UGH] $7.60 25934955 cetirizine 10 mg Tab [UGH] $12.47 253734971460144 CHANGE OF GASTROSTOMY TUBE PERCUTANEOUS 43760 $180.00 253537151750055 CHEM CAUT GRAN TISSUE - FAC 17250 $353.00 18869331700011 CHEST PERCUSSION THERAPY 94667 $300.00 18869341700066 CHEST PERCUSSION THERAPY SUBSEQUENT 94668 $164.00 259831161400136 CHILDBIRTH CLASS $25.00 26010708 CHILDREN'S IBUPROFEN SUSP 100 MG/5 ML [UGH] $5.00 261666961293655 CHILI PEPPER IgE 86003 $21.00 10257201290173 Chlamydia Trachomatis/ N. gonorrheae DNA Probe QST 87491 $160.00 26984677 chlordiazePOXIDE 10 mg Cap $5.00 25962239 chlordiazePOXIDE 10 mg Cap [UGH] $5.00 25962238 chlordiazePOXIDE 25 mg Cap [UGH] $5.00 25963031 chlordiazePOXIDE-clidinium 5 mg-2.5 mg Cap [UGH] $23.14 6336211290087 CHLORIDE 82435 $44.00 25934959 chloroprocaine 3% PF Inj Sol 20 mL [UGH] J2400 $107.42 25966826 chlorothiazide 0.5 g Inj [UGH] j1205 $288.00 26020577 chlorpheniramine-HYDROcodone 8 mg-10 mg/5 mL Oral Susp, ER 473 $14.33 mL [UGH] 26984866 chlorpheniramine-hydrocodone 8 mg-10 mg/5 mL Sus $14.68 26337157 chlorpheniramine-hydrocodone 8 mg-10 mg/5 mL Susp-ER [UGH] $31.59 25934962 chlorproMAZINE 25 mg Tab [UGH] Q0161 $34.38 26974984 chlorproMAZINE 25 mg/mL Sol J3230 $252.40 26010444 chlorproMAZINE 25 mg/mL Sol 2 mL [UGH] J3230 $144.56 26010497 chlorthalidone 25 mg Tab [UGH] $11.48 25934966 cholecalciferol 1000 intl units oral tablet [UGH] $5.00 25934967 cholecalciferol 400 intl units Tab [UGH] $5.00 25934968 cholecalciferol 5000 intl units Cap [UGH] $5.00 6337051290065 CHOLESTEROL 82465 $48.00 26969452 cholestyramine 4 g/9 g Oral Pwdr [UGH] $16.85 255522781290858 Chromatin Antibody 86235 $85.00 15495491290532 CHROMOGRANIN A 86316 $135.00 27811731290798 CHROMOSOME ANALYSIS ROUTINE BLOOD PHA 88262 $650.00 25934970 ciclopirox Top 0.77% Crm [UGH] $126.40 25934971 cilostazol 100 mg Tab [UGH] $9.12 25934972 cinacalcet 30 mg Tab [UGH] J0604 $129.04 25934973 ciprofloxacin 250 mg Tab [UGH] $24.56 25935778 ciprofloxacin 400 mg/ 40mL IV Sol [UGH] J0744 $120.00 25934974 ciprofloxacin 400 mg/200 mL IV Sol [UGH] J0744 $90.00 25934975 ciprofloxacin 500 mg Tab [UGH] $15.89 25983819 ciprofloxacin ophthalmic 0.3% Sol 5 mL [UGH] $189.16 259830501390750 CIRCUMCISION <28 DAYS 54160 $1,000.00 259830261390751 CIRCUMCISION >28 DAYS 54161 $1,100.00 259830511390749 CIRCUMCISION CLAMP W/O BLOCK 54150 $1,000.00 26008989 citalopram 20 mg Tab UD [UGH] $5.00 26010664 citric acid-sodium citrate 334 mg-500 mg/5 mL Oral Sol 30 mL [UGH] $19.50

6337121290066 CK 82550 $50.00 7859691290469 CKMB 82553 $85.00 261667161291060 CLADOSPORIUM/HORMENDENDRUM IgE 86001 $21.00 261667411293664 CLAM IgE 86003 $21.00 25934977 clarithromycin 125 mg/5 mL Oral Liq [UGH] $22.32 25934978 clarithromycin 500 mg Tab [UGH] $27.07 2640897010090020 CLAVICLE SHOULDER BRACE UNIVERSAL $25.00 2640891510010040 CLAVICLE UNIVERSAL SPLINT $23.00 26008992 clindamycin 150 mg Cap [UGH] $5.00 25935779 clindamycin 150 mg/mL IV Sol 2 ml vial [UGH] s0077 $40.00 25935780 clindamycin 150 mg/mL IV Sol 4 ml vial [UGH] s0077 $80.00 26148363 clindamycin 150 mg/mL Sol [UGH] s0077 $120.00 25934980 clindamycin 300 mg/50 mL-D5W IV Sol [UGH] S0077 $49.19 25934981 clindamycin 600 mg/50 mL-D5W IV Sol [UGH] S0077 $66.78 26010673 clindamycin 75 mg/5 mL Oral Liq [UGH] 0 $15.51 25934983 clindamycin 900 mg/50 mL-D5W IV Sol [UGH] S0077 $81.56 25935781 clindamycin 900 mg/6 mL Addvantage vial [UGH] s0077 $120.00 2640919010090370 CLIP FILSHIE TUBAL DISPOSABLE $364.00 25934984 clobetasol Top 0.05% Crm [UGH] $1,025.76 25935867 clobetasol Top 0.05% Oint 15 gm [UGH] $621.80 25934985 clonazePAM 0.5 mg Tab [UGH] $5.00 25955135 cloNIDine 0.1 mg Tab [UGH] $5.00 25934987 cloNIDine 0.1 mg/24 hr Transderm ER Film [UGH] $255.77 25934988 cloNIDine 0.2 mg/24 hr Transderm ER Film [UGH] $430.67 25966201 cloNIDine 0.3 mg/24 hr Transderm ER Film [UGH] $309.44 26010761 CLONIDINE TAB 0.2 MG 25 [UGH] $5.00 25934991 clopidogrel 300 mg Tab UD [UGH] $123.75 27108971 clopidogrel 75 mg Tab $31.32 25955349 clopidogrel 75 mg Tab [UGH] $30.66 25934993 clorazepate 7.5 mg Tab [UGH] $14.22 253734701460140 CLOSE LACERATION VESTIBULE MOUTH >2.5CM 40831 $679.20 253734691460158 CLOSE LACERATION VESTIBULE OF MOUTH 40830 $523.20 253731021461141 CLOSED REDUCTION KNEE FAC 27550 $645.00 258121401461084 CLOSED TREATMENT CALCANEAL FRACTURE-FAC 28400 $546.00 253730991461094 CLOSED TREATMENT FEMORAL SHAFT FX FAC 27502 $2,193.00 253730791461048 CLOSED TREATMENT FINGER FRACTURE-FACIL 26755 $520.00 253730921461047 CLOSED TREATMENT HIP DISLOCATION 27265 $520.00 253730391461123 CLOSED TREATMENT HUMERAL SHAFT FX FAC 24505 $2,193.00 253731081461082 CLOSED TREATMENT MEDIAL MALLEOLUS FX-FAC 27760 $546.00 253730461461091 CLOSED TREATMENT RADIAL HEAD FX FAC 24655 $2,191.00 253730311461051 CLOSED TREATMENT SCAPULA FX-FACILITY 23575 $520.00 253731011461083 CLOSED TREATMENT TIBIAL PLATEAU FX-FAC 27530 $546.00 258121161461079 CLOSED TREATMENT ULNAR FRACTURE-FAC 24670 $432.00 253730471461092 CLOSED TREATMENT ULTA FX FAC 24675 $2,191.00 253731231460068 CLOSED TX DISTAL FIB FX FAC 27788 $270.00 253731171461077 CLOSED TX DISTAL FIB FX-FAC 27786 $546.00 253731281461133 CLOSED TX DISTAL TIBIA FX FAC 27825 $2,435.00 253730971461076 CLOSED TX HIP DISLOCATION-FAC 27266 $2,301.00 253731091461060 CLOSED TX MEDIAL MALLEOLUS FX-FACILITY 27762 $3,756.00 253733751461085 CLOSED TX METATARSOPHALANGEAL JOINT-FAC 28630 $546.00 253731071461132 CLOSED TX TIBIAL SHAFT FX FAC 27752 $2,435.00 112023491290973 CLOSTRIDIUM DIFFICILE BY DNA AMPLIFICATI 87493 $80.00 113898281290467 CLOtest 86677 $68.00 25961759 clotrimazole 1% Vag Crm w/Appl [UGH] $48.00 25934995 clotrimazole 10 mg Loz [UGH] $7.14 25961764 clotrimazole Top 1% Crm [UGH] $23.81 26189477 clotrimazole topical 1% Cre [UGH] $38.66 26876251290496 CMV DNA QNT RT PCR QST 87497 $140.00 6336261290088 CO2 82374 $36.00 2640896210010510 COBAN 2 LAYER COMPRESSION LITE 2794 $33.00 2640935610090800 COBAN 2 LAYER COMPRESSION LITE -2794 $33.00 2640935510090790 COBAN 2 LAYER COMPRESSION SYSTEM 2094 $33.00 25934997 cocaine Top 40 mg/mL Sol [UGH] $892.48 261667011291046 COCKROACH IgE 86003 $21.00 18868711700007 CODE 99 92950 $347.00 25984028 codeine sulfate 30 mg Tab [UGH] $7.00 25962180 codeine-guaiFENesin 10 mg-100 mg/5 mL Oral Syrup 5 mL [UGH] $5.00 255522821290747 COENZYME Q10 82542 $85.00 26008987 colchicine 0.6 mg Tab [UGH] $44.60 25935002 colesevelam 625 mg Tab [UGH] $20.82 25962540 colestipol 1 g Tab [UGH] $6.31 25935004 collagenase Top 250 units/g Oint [UGH] $983.04 8859071480012 Colonoscopy $1,100.00 18155961480058 Colonoscopy Diagnostic 45378 $1,100.00 258950031480059 Colonoscopy Screening $1,100.00 29021501480108 Colonoscopy Screening High Risk $1,100.00 261666801291055 COMMON RAGWEED IgE 86003 $21.00 99630521730023 COMMUNITY/WORK REINTEGATION 15 MIN 97537 $50.00 17796511290019 Compatible 86922 $55.00 261667451290583 COMPLEMENT C1Q 86160 $106.00 7836131290228 COMPLEMENT CH50 86162 $204.00 253730001461068 COMPLEX LACERATION REPAIR TECH FEE 13131 $597.00 253730021461095 COMPLEX REPAIR ADDL 5 CM TECH FEE 13133 $125.00 253730011461052 COMPLEX REPAIR OF WOUND OR LESION TECH FEE 13132 $1,020.00 253729971461072 COMPLEX REPAIR SCALP ARM OR LEG TECH FEE 13120 $660.00 194356081290458 COMPREHENSIVE METABOLIC PANEL 80053 $130.00 253750211750005 COMPRESSION SYSTEM- ARM/ FOREARM 29583 $358.00 103430371750006 COMPRESSION SYSTEM-ARM/ FOREARM BILAT 29583 $358.00 253750221750007 COMPRESSION SYSTEM-ARM/ HAND/ FING 29584 $358.00 103430391750008 COMPRESSION SYSTEM-ARM/HAND/FING BILAT 29584 $358.00 253750191750001 COMPRESSION SYSTEM-LEG BELOW KNEE 29581 $358.00 103430351750002 COMPRESSION SYSTEM-LEG BELOW KNEE BILAT 29581 $358.00 25935005 conjugated estrogens 0.3 mg Tab [UGH] $28.08 25935006 conjugated estrogens 0.625 mg Tab [UGH] $23.32 25935007 conjugated estrogens 0.625 mg/g Vag Crm w/Appl [UGH] $1,793.08 25935008 conjugated estrogens 25 mg IV Inj [UGH] J1410 $1,424.00 2640902310090170 CONSENSUS HIP SYSTEM +5MM $1,688.00 28526501700059 CONT INHALATION TRMT-AEROSOL MED 94644 $214.00 18869391700059 CONT INHALATION TRMT-AEROSOL MED 1ST HR 94644 $214.00 18869401700060 CONT INHALATION TRMT-AEROSOL MED ADD HR 94645 $100.00 8849142700034 CONTINUOUS OXIMETRY 94762 $381.00 48113581720009 CONTRAST BATH THERAPY 15 MIN 97034 $50.00 7835611290229 COPPER 82525 $54.00 6337101290025 Cord Blood Type and Rh 86900 $38.00 257371651291084 CORN IgE 86003 $21.00 2640906510090230 CORTEX SCREW 4.5MM 34MM $96.00 2640906610090230 CORTEX SCREW 4.5MM 36MM $96.00 2640906710090230 CORTEX SCREW 4.5MM 38MM $96.00 10257281290232 CORTISOL 82533 $76.00 11580141290454 CORTISOL AM 82533 $76.00 261667181293642 CORTISOL FREE LC/MS/MS 82530 $100.00 21950081290455 CORTISOL PM 82533 $76.00 15496471290366 Cortison Free 24 Hr Urine QST 82530 $88.00 25935009 cosyntropin 0.25 mg Inj [UGH] J0834 $511.60 261666911291016 COTTONWOOD IgE 86003 $21.00 20136531290417 C-PEPTIDE SERUM 84681 $76.00 269321861700011 CPT AND/OR PD 94667 $170.00 261667041293667 CRAB IgE 86003 $21.00 6337161290443 C-Reactive Protein 86140 $83.00 11615322290443 C-Reactive Protein QST 86140 $83.00 6336061290068 CREATININE 82565 $36.00 11379471290588 CREATININE 24 HR URINE 82570 $36.00 262728491290122 CREATININE CLEARANCE 82575 $91.00 11579831290122 Creatinine Clearance w/eGFR QST 82575 $91.00 6336071290115 CREATININE URINE 82570 $36.00 253734191461115 CRICOTHYROTOMY - FAC 31605 $1,724.00 2640891610010060 CRICOTHYROTOMY KIT 4.0MM $509.00 2640891710010060 CRICOTHYROTOMY KIT 6.0MM $509.00 29407111290019 Crossmatch AHG Gel Compatible 86922 $55.00 29407131290019 Crossmatch AHG Gel Least Incompatible 86922 $55.00 21715381290019 Crossmatch AHG Interp 86922 $55.00 21715391290019 Crossmatch AHG Interp Incompatible 86922 $55.00 16818781290019 Crossmatch AHG Tube Compatible 86922 $55.00 257446851290019 Crossmatch AHG Tube Least Incompatible 86922 $55.00 255287061290019 Crossmatch Immediate Spin Compatible 86922 $55.00 2640976710091250 CRTP MRI US $23,100.00 2640901110090150 CRYO ICE ROD NET PROSTATE KIT $10,000.00 269505171440623 CRYO UNIT $68.00 12002581290835 CRYOGLOBULIN SERUM 82595 $68.00 15496521290739 Cryptosporidium Ag DFA QST 87328 $50.00 11580151300011 CRYSTAL EXAM SYNOVIAL FLUID 89060 $55.00 2640902410090170 CS2 ACETABULAR CUP INSERT SZ 50MM $2,500.00 2640902510090170 CS2 ACETABULAR CUP SZ 50MM $2,000.00 265683541600007 CT 3D Reconstruction w/ Workstation 76377 $300.00 95629441600072 CT ABCESS DRAINAGE 75989 $720.00 8213281600021 CT ABD W 74160 $2,370.00 8213301600002 CT ABD W/O 74150 $1,650.00 8213261600028 CT ABD W/WO 74170 $2,520.00 10051121600081 CT ABD/PEL W/O 74176 $1,800.00 10051061600079 CT ABD/PEL W/WO 74178 $2,520.00 10051091600078 CT ABD/PEL WITH CONTRAST 74177 $2,370.00 263499401600079 CT Abdomen + Pelvis w/ + w/o Contrast 74178 $2,520.00 262445171600078 CT Abdomen + Pelvis w/ Contrast 74177 $2,370.00 10051491600028 CT Abdomen w/ + w/o Cont 74170 $2,520.00 12022331600021 CT Abdomen w/ Cont 74160 $2,370.00 10215291600060 CT ANKLE LT 73700 $1,800.00 10215311600036 CT ANKLE RT 73700 $1,800.00 262445181600081 CT Chest + Abdomen + Pelvis w/o Contrast 74176 $1,800.00 256044051600012 CT CHEST HI-RES W/O 71250 $1,650.00 11363071600013 CT CHEST W 71260 $2,010.00 10051311600014 CT Chest w/ + w/o Cont 71270 $2,160.00 263499451600014 CT Chest w/ + w/o Contrast 71270 $2,160.00 10051341600013 CT Chest w/ Cont 71260 $2,010.00 263499441600013 CT Chest w/ Contrast 71260 $2,010.00 10051431600011 CT CHEST W/O 71250 $1,650.00 10051371600011 CT Chest w/o Cont 71250 $1,650.00 263499431600011 CT Chest w/o Contrast 71250 $1,650.00 10051461600014 CT CHEST W/WO 71270 $2,160.00 10051521600002 CT CHEST/ABD W/O 74150 $1,650.00 8213721600016 CT C-SPINE W/O 72125 $1,680.00 33291681600045 CT DENTAL SCAN 70486 $450.00 10215331600061 CT ELBOW LT 73200 $1,860.00 10215351600063 CT ELBOW RT 73200 $1,860.00 8213461600052 CT FACIAL BONES W 70487 $1,920.00 8213481600044 CT FACIAL BONES W/O 70486 $1,620.00 10051851600083 CT FACIAL BONES W/WO 70488 $2,040.00 12867791286779 CT Femur w/o Cont Rt 73200 $1,800.00 12867771600089 CT FEMUR W/O CONTRAST 73700 $1,800.00 10215451600040 CT FOOT LT 73700 $1,800.00 10215471600039 CT FOOT RT 73700 $1,800.00 12868211600082 CT HAND 73200 $1,860.00 12868231600082 CT Hand w/o Cont Lt 73200 $1,860.00 8213341600009 CT HEAD W 70460 $1,440.00 8213361600001 CT HEAD W/O 70450 $1,320.00 8213321600010 CT HEAD W/WO 70470 $2,280.00 11636231600086 CT HEART CALCIUM STUDY W CONTRAST 75574 $835.00 10215571600037 CT HIP LT 73700 $1,800.00 10215591600038 CT HIP RT 73700 $1,800.00 26203971600070 CT IAC'S W 70481 $2,040.00 11635901600066 CT IAC'S W/O 70480 $1,800.00 11635871600071 CT IAC'S W/WO 70482 $2,040.00 10215691600041 CT KNEE LT 73700 $1,800.00 10215711600042 CT KNEE RT 73700 $1,800.00 10051731600057 CT LIMITED 76380 $660.00 178243341600088 CT LOW DOSE LUNG SCREENING $338.00 11635991600084 CT LOWER EXT W/WO 73702 $2,160.00 8213741600018 CT L-SPINE W/O 72131 $1,800.00 10052171600085 CT L-SPINE W/O & W 72133 $2,160.00 10052101600053 CT NECK SFT TISS W/O 70490 $1,680.00 10052041600051 CT NECK SFT W/O & W/ 70492 $2,160.00 10052071600054 CT NECK SOFT TISS W 70491 $1,920.00 8213521600068 CT ORBITS W/O 70480 $1,800.00 10051871600069 CT ORBITS W/WO 70482 $2,040.00 172998291600032 CT PE STUDY(RAPID SCAN) 71275 $2,100.00 8213591600020 CT PELVIS W 72193 $2,160.00 8213611600019 CT PELVIS W/O 72192 $1,800.00 8213571600027 CT PELVIS W/WO 72194 $2,520.00 10215731600062 CT SHOULDER LT 73200 $1,860.00 10215751600056 CT SHOULDER RT 73200 $1,860.00 11635571600046 CT SINUSES 70486 $1,620.00 10215771600067 CT SINUSES W/WO 70488 $2,040.00 8213631600080 CT STONE PROTOCOL 74176 $1,800.00 1163614160090 CT Stroke Study 70450 $1,320.00 8213761600017 CT T-SPINE W/O 72128 $1,680.00 10215801600064 CT WRIST LT 73200 $1,860.00 10215821600065 CT WRIST RT 73200 $1,860.00 31248661600034 CTA ABD/AORTA 74174 $2,040.00 10051181600031 CTA CAROTIDS WITH 70498 $1,680.00 221641931600030 CTA CIRCLE OF WILLIS 70496 $2,880.00 2640975010091230 CTA HEAD SZ 44MM X 18MM $3,648.00 133839521600029 CTA KIDNEY 74175 $2,160.00 10051151600032 CTA THORACIC AORTA 71275 $2,100.00 156654271290937 CULTURE - VRE 87081 $45.00 8507521290006 CULTURE BLOOD $85.00 10257441290241 Culture Fungus (Other) QST 87102 $73.00 11515191290007 CULTURE GC 87070 $40.00 10680681290590 CULTURE GP B STREP VAG 87075 $68.00 6338921290003 CULTURE ROUTINE 87070 $83.00 11515161290004 CULTURE STOOL 87046 $85.00 8507551290160 CULTURE THROAT 87070 $68.00 8507561290002 CULTURE URINE 87086 $83.00 26795022 cyanocobalamin 1 EA Tab-DIS [UGH] $5.00 25961641 cyanocobalamin 1000 mcg Tab [UGH] $5.00 25962019 cyanocobalamin 1000 mcg/mL Inj Sol [UGH] J3420 $42.50 27108770 cyanocobalamin 1000 mcg/mL Sol J3420 $25.00 25935012 cyanocobalamin 500 mcg Tab [UGH] $5.00 7836191290209 CYCLIC CITRULLINATED PEPTIDE CCP 86200 $106.00 26009664 cyclobenzaprine 10 mg Tab [UGH] $5.00 25935014 cyclopentolate Ophth 1% Sol [UGH] $65.32 25983805 cyclopentolate Ophth 2% Sol [UGH] $118.04 26981645 cyclopentolate ophthalmic 1% Sol $67.20 255522881290592 CYCLOSPORINE BLOOD 80158 $96.00 25955347 cyproheptadine 4 mg Tab [UGH] $5.34 255522891290495 CYSTIC FIBROSIS CARRIER SCREEN 81220 $325.00 2953801300010 CYTOLOGY 88104 $37.80 253374801300115 CYTOLOGY CELL BLOCK 88305 $45.00 253374741300114 CYTOPATH FLUID 88112 $60.00 27017097 dabigatran 75 mg Cap $38.94 25935017 dabigatran 75 mg Cap UD [UGH] $32.77 25935018 dantrolene 20 mg IV Inj [UGH] $425.48 25935019 dantrolene 25 mg Cap [UGH] $5.91 25935020 dapsone 100 mg Tab [UGH] $16.80 26772573 DAPTOmycin 500 mg IV Inj [UGH] J0878 $2,138.36 27153873 DAPTOmycin 500 mg Pow J0878 $2,138.32 25935022 darbepoetin alfa 300 mcg/0.6 mL Inj Sol [UGH] J0881 $11,147.52 25935023 darbepoetin alfa 500 mcg/mL Inj Sol [UGH] J0881 $18,579.52 25935024 darifenacin 7.5 mg ER Tab [UGH] $44.36 26957430 darifenacin 7.5 mg Tab $44.23 241591671290017 DAT Complement 86880 $43.00 244997301290017 DAT Poly Gel 86880 $43.00 63367012900641 DBIL 82248 $48.00 6337181290475 D-DIMER (PLASMA) 85379 $108.00 253348991750037 DEBRIDE BONE EA ADDL 20 SQ CM - FAC 11047 $1,034.00 253348961750036 DEBRIDE BONE FIRST 20 SQ CM - FAC 11044 $2,355.00 253348981750035 DEBRIDE MUS/FASC EA ADDL 20 SQ CM - FAC 11046 $354.00 253348951750034 DEBRIDE MUSC/FASC FIRST 20 SQ CM - FAC 11043 $1,072.00 253396301750050 DEBRIDE NAIL (1-5) - FAC 11720 $274.00 253396311750051 DEBRIDE NAIL (6+) - FAC 11721 $168.00 253348971750033 DEBRIDE SUBQ EACH ADDL 20 SQ CM - FAC 11045 $354.00 253348931750032 DEBRIDE SUBQ FIRST 20 SQ CM - FAC 11042 $677.00 259186971460037 DEBRIDEMENT - LEVEL I 17999 $72.00 253729531460131 DEBRIDEMENT - LEVEL I TECH FEE 11740 $72.00 253729571460015 DEBRIDEMENT - LEVEL II TECH FEE 11765 $126.00 19697031730037 Debridement (eg high pressure waterjet with/without suction 97597 $115.00 12398321720026 DEBRIDEMENT NONSELECTIVE LARVAL THERAPY 97602 $140.00 253681151461057 DEBRIDEMENT OPEN WOUND >20CM TECH FEE 97597 $442.00 253681171461128 DEBRIDEMENT OPEN WOUND ADDL 20 SQ CM TECH FEE 97598 $157.00 253537181750012 DEBRIDEMENT SELECTIVE <=20 SQ CM 97597 $677.00 253537191750013 DEBRIDEMENT SELECTIVE >20 SQ CM 97598 $439.00 2953601300007 DECALCIFICATION 88311 $25.20 36331671480103 DECLOTTING VAD 36593 $599.00 25935025 deferoxamine 500 mg Inj [UGH] J0895 $46.90 261666761290938 Delta Aminolevulinic Acid 24hr Urine 82135 $150.00 251551521740006 DEMONSTRATION / INSTRUCTION AEROSOL GEN 94664 $486.00 25935026 denosumab 60 mg/mL Sol [UGH] J0897 $5,851.48 253734761461046 DENTOALVEOLAR STRUCTURE 41899 $204.00 269505091440624 DERMATOME $37.00 15496971291048 DERMATOPHAGOIDES FARINAE IgE 86003 $21.00 15496981291049 DERMATOPHAGOIDES PTERONYSSIS IgE 86003 $21.00 25935027 desflurane 100% Inh Liq 240 mL [UGH] $300.00 25935028 desipramine 25 mg Tab [UGH] $9.11 25935029 desmopressin 0.2 mg Tab [UGH] $34.27 25935030 desmopressin 10 mcg/inh Nasal Spry [UGH] $985.00 25935031 desmopressin 4 mcg/mL IV Sol [UGH] J2597 $36.88 25935032 desoximetasone Top 0.05% Crm [UGH] $249.72 25966436 desoximetasone Top 0.25% Crm [UGH] $233.12 26010845 desoximetasone topical 0.05% Cre [UGH] $1,469.76 27145840 dexamethasone 0.5 mg Tab J8540 $5.00 25935034 dexamethasone 0.5 mg Tab [UGH] J8540 $5.00 26989506 dexamethasone 0.5 mg/5 mL Liq J8540 $5.00 25966207 dexamethasone 0.5 mg/5 mL Oral Elix [UGH] J8540 $6.63 25935036 dexamethasone 0.75 mg Tab [UGH] J8540 $5.00 25935037 dexamethasone 10 mg/mL Inj Sol [UGH] J1100 $25.00 25935038 dexamethasone 4 mg Tab [UGH] J8540 $6.02 25935039 dexamethasone 4 mg/mL Inj Sol [UGH] J1100 $25.00 27102994 dexamethasone 4 mg/mL Sol J1100 $25.00 26054344 dexamethasone/neomycin/polymyxin B ophthalmic 1 mg-3.5 mg-10000 $79.44 units/g Oin [UGH] 25935040 dexamethasone-tobramycin Ophth 0.1%-0.3% Oint [UGH] $1,095.40 25935041 dexamethasone-tobramycin Ophth 0.1%-0.3% Susp [UGH] $261.24 25935042 dextran, low molecular weight 10%-D5W IV Sol 500 mL [UGH] J7100 $145.86 25935043 dextran, low molecular weight 10%-NS IV Sol 500 mL [UGH] J7100 $150.12 25935044 dextromethorphan 30 mg/5 mL Oral Susp, ER [UGH] $5.00 27017357 dextromethorphan-guaifenesin 10 mg-100 mg/5 mL Liq $5.00 26217807 dextromethorphan-guaifenesin 10 mg-100 mg/5 mL Liq UD 5 mL [UGH] $5.00

26010535 dextromethorphan-guaiFENesin 10 mg-100 mg/5 mL Oral Liq 120 [UGH] $5.00

26217806 dextromethorphan-guaiFENesin 10 mg-100 mg/5 mL Oral Liq 120 mL $12.50 [UGH] 25962673 dextromethorphan-guaiFENesin 30 mg-600 mg ER Tab [UGH] $5.00 26053830 Dextrose 10% in Water IV Sol 1000 mL [UGH] $90.00 26053831 Dextrose 10% in Water IV Sol 500 mL [UGH] $90.00 26104630 Dextrose 5% in Lactated Ringers IV Sol 1000 mL [UGH] J7121 $90.00 26130994 Dextrose 5% in Water IV Sol 100 mL [UGH] J7060 $40.00 26011499 Dextrose 5% in Water IV Sol 1000 mL [UGH] J7060 $90.00 26104624 Dextrose 5% in Water IV Sol 250 mL [UGH] J7060 $90.00 26053923 Dextrose 5% in Water IV Sol 250 mL AVIVA Bag [UGH] J7060 $40.00 26053846 Dextrose 5% in Water IV Sol 500 mL [UGH] J7060 $90.00 26010775 Dextrose 5% with 0.2% NaCl IV Sol 1000 mL [UGH] $90.00 26053848 Dextrose 5% with 0.2% NaCl IV Sol 500 mL [UGH] $90.00 26011241 Dextrose 5% with 0.45% NaCl and KCl 20 mEq/L Sol 1000 mL [UGH] $90.00

26053850 Dextrose 5% with 0.45% NaCl and KCl 30 mEq/l IV Sol 1000 mL [UGH] $90.00

26053852 Dextrose 5% with 0.45% NaCl and KCl 40 mEq/l IV Sol 1000 mL [UGH] $90.00

25935047 Dextrose 5% with 0.45% NaCl IV Sol 1000 mL [UGH] $90.00 26011478 Dextrose 5% with 0.9% NaCl Sol 1000 mL [UGH] J7042 $90.00 26010924 Dextrose 5% with NS and KCl 20 mEq/l IV Sol 1000 mL [UGH] $90.00 26053854 Dextrose 5% with NS and KCl 40 mEq/l IV Sol 1000 mL [UGH] $90.00 6338901290376 DHEAS 82627 $67.00 265709151530034 DIAGNOSTIC DBT UNILATERAL OR BILATERAL $78.00 2640920910090390 DIALATOR BALLOON 10-12 FIXED WIRE $597.00 2640921210090390 DIALATOR BALLOON 15-18 FIXED WIRE $516.00 2640921010090390 DIALATOR BALLOON FIXED WIRE 12-15 $516.00 25935048 diazepam 10 mg rectal kit [UGH] $809.12 26867359 diazePAM 2 mg Tab [UGH] $5.00 25935049 diazepam 2.5 mg rectal kit [UGH] $1,364.16 26053994 diazepam 5 mg Tab [UGH] $5.00 25934312 diazepam 5 mg/mL Inj Sol [UGH] J3360 $131.28 25934313 dibucaine Top 1% Oint [UGH] $35.60 25935051 diclofenac sodium 100 mg ER Tab [UGH] $14.07 25935052 diclofenac sodium 75 mg Oral EC Tab [UGH] $7.22 27075673 diclofenac sodium 75 mg Tab $8.87 25935053 diclofenac Top 1% gel [UGH] $144.82 26934865 diclofenac topical 1% Gel $210.48 25962532 dicyclomine 10 mg Cap [UGH] $5.00 25935055 dicyclomine 10 mg/mL Inj Sol [UGH] J0500 $384.64 27053426 dicyclomine 20 mg Tab $5.00 25935056 dicyclomine 20 mg Tab [UGH] $5.00 6337191290096 DIGOXIN 80162 $85.00 27017271 digoxin 125 mcg (0.125 mg) Tab $11.50 25935057 digoxin 125 mcg (0.125 mg) Tab [UGH] $5.00 25935058 digoxin 250 mcg/mL (0.25 mg/mL) Inj Sol [UGH] j1160 $37.40 27129179 digoxin 250 mcg/mL (0.25 mg/mL) Sol j1160 $482.20 25935059 digoxin 50 mcg/mL (0.05 mg/mL) Oral Elix [UGH] $56.00 25935061 digoxin immune FAB 40 mg Inj [UGH] J1162 $16,228.00 26011039 DIGOXIN TAB 250 MCG 100 [UGH] $11.50 25935062 dihydroergotamine 1 mg/mL Inj Sol [UGH] J1110 $315.24 251492161290597 DIHYDROTESTOSTERONE 80307 $155.00 2640908710090250 DILATATOR BALLOON FIXED WIRE 18-20MM $516.00 2640922510090410 DILATER COLONIC BALLOON 12MM $343.00 2640922610090410 DILATER COLONIC BALLOON 8MM $211.00 2640944310090910 DILATOR BALLOON EZDILATE 18-19-20 $558.00 2640937410090830 DILATOR COLONIC BALLOON 10MM $211.00 2640937510090830 DILATOR COLONIC BALLOON 18MM $343.00 2640937610090830 DILATOR COLONIC BALLOON 20MM $343.00 2640924410090430 DILATOR DISPOSABLE PET BALLOON 8CMX180CM $672.00 2640921410090400 DILATOR QUANTUM TTC BALLOON 18X8 $264.00 25935868 diltiazem 100 mg IV Inj Addvantage vial [UGH] $65.30 25935063 diltiazem 120 mg/24 hours ERCap [UGH] $5.98 25935064 diltiazem 180 mg/24 hours ERCap [UGH] $9.03 26008997 dilTIAZem 30 mg Tab UD [UGH] $5.00 25935065 diltiazem 300 mg/24 hours ERCap [UGH] $13.17 25935782 diltiazem 5 mg/mL IV Sol 25ml vial [UGH] $25.00 25935783 diltiazem 5 mg/mL IV Sol 5ml vial [UGH] $25.00 26841813 dilTIAZem 5 mg/mL Sol [UGH] $26.18 25935066 diltiazem 60 mg ERCap [UGH] $19.87 25935067 diltiazem 60 mg Tab [UGH] $5.00 26010760 DILTIAZEM HCL CP24 240 MG 100 [UGH] $5.00 25935068 dimenhyDRINATE 50 mg Tab [UGH] $5.00 25935869 dinoprostone 10 mg Vag Insert [UGH] $1,470.08 25935069 dinoprostone 20 mg Vag Supp [UGH] $10,599.20 26985228 diphenhydrAMINE 12.5 mg/5 mL Liq Q0163 $5.00 25935070 diphenhydrAMINE 12.5 mg/5 mL Oral Liq [UGH] Q0163 $5.00 25935071 diphenhydrAMINE 25 mg Cap [UGH] Q0163 $5.00 25935072 diphenhydrAMINE 50 mg/mL Inj Sol [UGH] j1200 $25.00 25935073 diphenhydrAMINE-zinc acetate Top 2%-0.1% Crm [UGH] $16.45 27017265 diphenhydramine-zinc acetate topical 2%-0.1% Cre $10.60 26164703 diphtheria-tetanus toxoids (DT) ped pediatric Sus [UGH] $121.36 261667301290390 DIPTHERIA ANTITOXOID 86648 $95.00 25935074 dipyridamole 25 mg Tab [UGH] $5.00 2698915510764 Direct Admit $310.00 253401021750084 DISP NEG PRESSURE WOUND THER <50 SQ CM 97607 $732.00 253401031750085 DISP NEG PRESSURE WOUND THER >50 SQ CM 97608 $732.00 25962569 divalproex sodium 125 mg Oral EC Cap [UGH] $7.09 26009672 divalproex sodium 250 mg ER Tab [UGH] $12.27 25935077 divalproex sodium 250 mg Oral EC Tab [UGH] $8.81 25935075 divalproex sodium Sprinkles 125 mg [UGH] $7.09 26136256 Do Not Use - Amiodarone Additive [UGH] $0.00 26136243 Do Not Use - Dextrose Diluent [UGH] $0.00 26136261 Do Not Use - Dobutamine Additive [UGH] $0.00 26136260 Do Not Use - Dopamine Additive [UGH] $0.00 26188660 Do Not Use - Eptifibatide Additive [UGH] $0.00 26136262 Do Not Use - Esmolol Additive [UGH] $0.00 26136273 Do Not Use - Heparin Additive [UGH] $0.00 26136274 Do Not Use - Hetastarch Additive [UGH] $0.00 26136275 Do Not Use - Lidocaine Additive [UGH] $0.00 26136289 Do Not Use - Magnesium Additive [UGH] $0.00 26136279 Do Not Use - Mannitol Additive [UGH] $0.00 26136281 Do Not Use - Nicardipine Additive [UGH] $0.00 26131659 Do Not Use - Nitro Additive [UGH] $0.00 26136329 Do Not Use - Oxytocin Additive [UGH] $0.00 26137549 Do Not Use - Potassium Chloride Additive [UGH] $0.00 26136322 Do Not Use - Premix Diluent [UGH] $0.00 26136317 Do Not Use - Propofol Additive [UGH] $0.00 26136264 Do Not Use - Sodium Chloride Diluent [UGH] $0.00 26136323 Do Not Use - Vasopressin Additive [UGH] $0.00 26011243 DOBUTAMINE IN D5W SOLP 250 MG/250 ML (1 MG/ML) 250 [UGH] J1250 $115.49

25935870 DOBUTAMINE SOLN 250 MG/20 ML (12.5 MG/ML) [UGH] J1250 $423.36 25935078 docosanol Top 10% Crm [UGH] $62.00 26957935 docusate 10 mg/mL Liq $5.00 25935079 docusate calcium 240 mg Cap [UGH] $5.00 27128397 docusate sodium 100 mg Cap $5.00 25935080 docusate sodium 100 mg Cap [UGH] $5.00 25935871 docusate sodium 100 mg/10 mL Oral Liq [UGH] $5.00 25935081 docusate-ferrous fumarate 100 mg-150 mg ER Tab [UGH] $5.00 25935082 docusate-senna 50 mg-8.6 mg Tab [UGH] $5.00 261666951291047 DOG DANDER IgE 86003 $21.00 26772695 donepezil 10 mg Tab $5.00 25955055 donepezil 10 mg Tab [UGH] $28.66 26975213 donepezil 5 mg Tab $5.00 25935084 donepezil 5 mg Tab [UGH] $80.98 25935784 DOPamine 40 mg/mL IV Sol 10ml vial [UGH] J1265 $25.00 25935785 DOPamine 400 mg/250mL-D5W intravenous solution [UGH] J1265 $90.00 1360414813604140 DOPPLER WAVEFORM REC AND ANALYSIS 1-2 LV 93922 $248.00 1360414913604140 DOPPLER WAVEFORM REC AND ANALYSIS 3+ LVL 93923 $386.00 25935085 dorzolamide Ophth 2% Sol [UGH] $267.28 25935086 dorzolamide-timolol Ophth 2%-0.5% Sol [UGH] $490.40 25935087 doxapram 20 mg/mL IV Sol [UGH] $220.80 25935088 doxazosin 2 mg Tab [UGH] $18.79 25935089 doxazosin 4 mg Tab [UGH] $19.72 25935090 doxepin 10 mg Cap [UGH] $5.00 25935091 doxepin 25 mg Cap [UGH] $5.00 25935092 doxepin 50 mg Cap [UGH] $5.00 25935093 doxercalciferol 0.5 mcg Oral Cap [UGH] $69.77 25935094 doxycycline 100 mg IV Inj [UGH] $126.40 25935095 doxycycline 25 mg/5 mL Oral Liq [UGH] $20.57 25935096 doxycycline hyclate 100 mg Cap [UGH] $7.07 25935097 doxycycline hyclate 50 mg Cap [UGH] $9.00 2598736020605 DRAIN/INJ JOINT/BURSA W/O US 20605 $324.00 2640920810090390 DRAINAGE KIT APD LOOP/10/25 REG-K $645.00 151266401750040 DRESS/DEBRIDE PART THK BURN LARGE - FAC 16030 $677.00 151266391750039 DRESS/DEBRIDE PART THK BURN MED - FAC 16025 $677.00 254847701750038 DRESS/DEBRIDE PART THK BURN SM - FAC 16020 $353.00 2640966010091140 DRESSING ALLEVYN GENTLE SACRUM 7X7 $18.00 290676510090806 Dressing Aquacel 3/4x18 $25.00 2640949210090960 DRESSING AQUACEL 8 X 5.5 HEEL $18.00 2640896110010500 DRESSING AQUACEL AG 3/4 X 18 RIBBON/ROPE $25.00 2640934510090730 DRESSING AQUACEL AG 6.7X6 W/SILVER $99.00 2436668610090800 DRESSING AQUACEL AG EXTRA 4 X 5 $21.00 2640929210090490 DRESSING BIOPATCH 4MM $17.00 2640953310091000 DRESSING CUTIMED SORBACT GAUZE 2.75 X 3. $17.00 2640896410010510 DRESSING CUTIMED SORBACT RIBBON $20.00 2640896510010510 DRESSING CUTIMED SORBION SORBACT 4 X 8 $38.00 2640952010090990 DRESSING CUTIMED-SORBACT RIBBON $20.00 2640977810091260 DRESSING DRAWTEX 3/8 X 18 $21.00 2640985710091340 DRESSING DRAWTEX 4 X 4 $20.00 2701336410091690 DRESSING DRAWTEX 4X11.5 EDEMA WRAP $52.00 2640949110090960 DRESSING DUODERM HEEL $29.00 2640896310010510 DRESSING MEDIHONEY GEL $35.00 2640944510090910 DRESSING MEDIHONEY -GEL $34.00 2640934610090740 DRESSING MEPILEX 6 X 6 $20.00 2640983110091320 DRESSING MEPILEX TRANSFER 6 X 8 $19.00 2640946510090930 DRESSING POLYMEM 4 X 5 $5.31 2640946410090930 DRESSING POLYMEM AG 4 X 4 $35.00 2640935910090800 DRESSING PROMOGRAN PRISMA 4 X 4 $25.00 2640957610091050 DRESSING SILVERCEL 4 X 4 NON ADHERENT $22.00 2640944610090910 DRESSING SORBION SACHET 4 X 8 $38.00 2640946310090930 DRESSING SORBION SACHET 4X4 $17.00 2640949310090960 DRESSING SUREPRESS $22.00 269505081440625 DRILL ENT $59.00 269505101440626 DRILL ORTHO $62.00 25935098 dronedarone 400 mg Tab [UGH] $50.45 25935099 droperidol 2.5 mg/mL Inj Sol [UGH] J1790 $25.00 261686401290235 Drug Panel Commerical 80307 $25.00 50291871290235 DRUG SCREEN COLLECTION COMMERCIAL $25.00 261109021291747 DRUG SCREEN RAPID - MEDICAL 80307 $80.00 261667131290308 DRUG SCREEN-MECONIUM 80307 $155.00 25935100 DULoxetine 30 mg Cap [UGH] $35.33 27151804 DULoxetine 60 mg Cap $35.29 25935101 DULoxetine 60 mg Cap [UGH] $43.11 25935102 dutasteride 0.5 mg Cap [UGH] $34.63 132324291290497 EBV DNA Qnt RT-PCR QST 87799 $275.00 261666721290603 EBV EARLY AG ABY 86663 $92.00 174463261550085 ECHO WITH CONTRAST $1,677.00 11611501580001 ECHOCARDIOGRAM 93306 $1,500.00 18837041580002 ECHOCARDIOGRAM LTD 93308 $700.00 241772191580005 ECHOCARDIOGRAM STRESS 93351 $923.00 31251481580007 ECHOCARDIOGRAM TEE 93312 $1,200.00 25935103 econazole Top 1% Crm [UGH] $869.40 25935872 edrophonium 10 mg/mL Inj Sol 15ml [UGH] $384.00 269740701300361 EGFR/HER2 INDEL PANEL 81445 $1,495.00 257371531291079 EGG WHITE IgE 86003 $21.00 261667101291078 EGG YOLK IgE 86003 $21.00 20755231700057 EKG (TECHNICAL COMPONENT) 93005 $205.00 6922581720008 ELECTRIC CURRENT THPY 15 MIN 97033 $50.00 100520621720057 ELECTRICAL STIM UNATTENDED NON MC 97014 $40.00 6922591720007 ELECTRICAL STIMULATION 15 MIN 97032 $50.00 240736501290097 ELECTROLYTES 80051 $68.00 261666891291050 ELM IgE 86003 $21.00 251593281460118 EMERGENCY DEPARTMENT LEVEL I 99281 $155.33 251593301460119 EMERGENCY DEPARTMENT LEVEL II 99282 $232.99 251593311460120 EMERGENCY DEPARTMENT LEVEL III 99283 $310.66 251593351460121 EMERGENCY DEPARTMENT LEVEL IV 99284 $595.42 251593411460122 EMERGENCY DEPARTMENT LEVEL V 99285 $828.42 251593491460123 EMERGENCY DEPARTMENT LEVEL VI (30 - 74 MIN) 99291 $1,449.73 251593501460124 EMERGENCY DEPARTMENT LEVEL VI (ADD 30 MIN) 99292 $207.10 253734131460169 EMERGENCY INTUBATION 31500 $424.80 25935104 emollients, Top Lotion [UGH] $20.10 265888711290000 Employee Package $20.00 25935873 enalapril 1.25 mg/mL IV Sol 1ml [UGH] $25.00 26010881 enalapril 5 mg Tab [UGH] $9.26 916440310091221 END CAP $732.00 2640994010091430 END CAP TI T40 $639.00 9960321430081 ENDO Double Charges $2,200.00 22451851290203 ENDOMYSIAL ANTIBODY IGA 86255 $272.00 340919475099584 Endoscopic Retrograde Cholangiopancreatography 43260 $1,100.00 259830841390763 ENDOTRACH INTUBATION NEWBORN 31500 $225.00 261666821291022 ENGLISH PLANTAIN IgE 86003 $21.00 25935106 enoxaparin 100 mg/mL SubQ Sol [UGH] J1650 $397.38 25935107 enoxaparin 30 mg/0.3 mL SC Sol [UGH] J1650 $119.08 25935108 enoxaparin 40 mg/0.4 mL SC Sol [UGH] J1650 $158.76 25935109 enoxaparin 60 mg/0.6 mL SC Sol [UGH] J1650 $238.43 25935110 enoxaparin 80 mg/0.8 mL SC Sol [UGH] J1650 $317.92 253734101460079 ENT PROCEDURE - LEVEL I 30903 $156.00 253730251460043 ENT PROCEDURE-LEVEL I 21310 $156.00 253734641460085 ENT PROCEDURE-LEVEL III 40650 $1,050.00 253734721460151 ENT PROCEDURES - LEVEL I 41250 $156.00 25935111 entacapone 200 mg Tab [UGH] $31.50 15499981290958 ENTEROVIRUS RNA QUAL PCR 87498 $425.00 26009667 ENTRESTO TAB 24-26 MG [UGH] $41.67 25935112 ePHEDrine 50 mg/mL Inj Sol [UGH] $211.12 2640977910091260 EPICORD 2 X 3 $648.00 151265261750082 EPIDERMAL AUTOGRAFT ADD 100 CM FAC 15116 $250.00 151265231750079 EPIDERMAL AUTOGRAFT EXTREMITY 100CM FAC 15110 $2,822.00 151265241750080 EPIDERMAL AUTOGRAFT EXTREMITY ADD 100 F 15111 $250.00 151265251750081 EPIDERMAL AUTOGRAFT HANDS FACE 100CM F 15115 $2,822.00 259831221400168 EPIDURAL BLOCK LUMBAR 62322 $1,085.00 1054196010090920 EPIFIX $258.00 2640945110090920 EPIFIX 18MM DISK $744.00 2640945210090920 EPIFIX 2x3 $648.00 2640972210091200 EPIFIX 4 X 4.5 $2,790.00 2640945410090920 EPIFIX MESH 3.5 X 3.5 $87.00 25935786 EPINEPHrine 0.1 mg/mL Inj Sol 1ml syringe [UGH] J0171 $27.36 25935787 EPINEPHrine 1 mg/mL Inj Sol 1ml vial [UGH] J0171 $25.00 25935788 EPINEPHrine 1 mg/mL Inj Sol 30ml vial [UGH] J0171 $41.66 25935113 EPINEPHrine-lidocaine 1:100,000-1% Inj Sol 20 mL [UGH] $25.00 25935115 EPINEPHrine-lidocaine 1:100,000-1% Inj Sol 50 mL [UGH] $25.00 25935116 EPINEPHrine-lidocaine 1:100,000-2% Inj Sol 20 mL [UGH] $25.00 26798845 epinephrine-lidocaine 1:100000-1% Sol [UGH] $25.00 25935117 EPINEPHrine-lidocaine 1:200,000-0.5% Inj Sol 50 mL [UGH] $25.00 25935118 EPINEPHrine-lidocaine 1:200,000-1% PF Inj Sol 10 mL [UGH] $44.30 25935119 EPINEPHrine-lidocaine 1:200,000-2% PF Inj Sol 10 mL [UGH] $48.24 26798796 epinephrine-lidocaine 1:200,000-2% preservative-free Sol [UGH] $27.12 26847544 epinephrine-lidocaine-tetracaine topical soln [UGH] $37.00 25935120 epoetin alfa 20,000 units/mL Inj Sol [UGH] J0885 $2,469.28 25935121 epoetin alfa 4000 units/mL preservative-free Sol [UGH] J0885 $493.88 256350121290812 EPSTEIN-BARR VIRUS (VCA) AB IGG 86665 $75.00 256350131290813 EPSTEIN-BARR VIRUS (VCA) AB IGM 86665 $75.00 11580231290386 EPSTEIN-BARR VIRUS ANTIBODY PANEL 86665 $180.00 25935122 eptifibatide 0.75 mg/mL IV Sol [UGH] J1327 $2,611.44 253381531300037 ER IMAGE 88361 $130.00 25935123 ergocalciferol 50,000 intl units Cap [UGH] $9.56 25935124 ertapenem 1 g Inj [UGH] J1335 $617.56 25935125 erythromycin 250 mg Oral EC Tab [UGH] $5.48 25935126 erythromycin 500 mg Tab [UGH] $5.91 25935127 erythromycin ethylsuccinate 200 mg/5 mL Oral Liq [UGH] $10.93 25935128 erythromycin lactobionate 500 mg Inj [UGH] J1364 $365.44 25935129 erythromycin Ophth 0.5% Oint [UGH] $74.60 26069724 erythromycin ophthalmic 0.5% Oin [UGH] $39.13 7836071290359 ERYTHROPOIETIN 82668 $50.00 25935130 escitalopram 10 mg Tab [UGH] $41.08 25935874 esmolol 10 mg/mL IV Sol 10ml vial [UGH] $65.66 26814277 esmolol 2500 mg/250mL IV Premix Bag [UGH] $1,513.62 25935131 esomeprazole 40 mg oral Pwdr for recon, delayed release [UGH] $43.36 2640895410010390 ESOPHAGEAL BALLOON DILATOR 10MM $687.00 2640895510010430 ESOPHAGEAL BALLOON DILATOR 1213.515 $516.00 2640894610010300 ESOPHAGEAL BALLOON DILATOR 1516.518 $516.00 2640894710010300 ESOPHAGEAL BALLOON DILATOR 181920 $687.00 2640894510010300 ESOPHAGEAL BALLOON DILATOR 18MM $687.00 2640921110090390 ESOPHAGEAL BALLOON DILATOR 8910 $516.00 8859151480001 Esophagogastroduodenoscopy 43200 $1,100.00 29130451480055 Esophagogastroduodenoscopy with Band Ligation $1,100.00 17835381480048 Esophagogastroduodenoscopy with Biopsy $1,100.00 29130721480046 Esophagogastroduodenoscopy with Dilation $1,100.00 29130667502913000 Esophagogastroduodenoscopy with Dilation and Colonoscopy 43245 $1,100.00 9956891480054 Esophagogastroduodenoscopy with Foreign Body Removal $1,100.00 29508701480050 Esophagogastroduodenoscopy with Percutaneous Endoscopic Gast $1,100.00 173989881400143 EST PATIENT FACILITY E&M LEVEL I 99211 $100.00 158131171400145 EST PATIENT FACILITY E&M LEVEL II 99212 $200.00 158131181400147 EST PATIENT FACILITY E&M LEVEL III 99213 $300.00 158131191400149 EST PATIENT FACILITY E&M LEVEL IV 99214 $400.00 173989891400197 EST PATIENT FACILITY E&M LEVEL V 99215 $500.00 178245011750022 ESTAB PATIENT FACILITY E&M LEVEL III 99213 $300.00 178243801750020 ESTAB PATIENT FACILITY E&M LEVEL I 99213 $100.00 178245001750021 ESTAB PATIENT FACILITY E&M LEVEL II 99212 $200.00 178245021750023 ESTAB PATIENT FACILITY E&M LEVEL IV 99214 $400.00 178245031750024 ESTAB PATIENT FACILITY E&M LEVEL V 99215 $500.00 11580241290303 ESTRADIOL 82670 $133.00 25935132 estradiol 0.075 mg/24 hours weekly Transderm ER Film [UGH] $158.17 25935133 estradiol 1 mg Tab [UGH] $5.00 7835651290306 ESTROGENS TOTAL 82672 $165.00 15500051290518 ESTRONE 82679 $110.00 25935134 etanercept 50 mg/mL SubQ Sol [UGH] J1438 $5,729.48 25935135 ethacrynic acid 50 mg IV Inj [UGH] $24,070.36 27129177 ethacrynic acid 50 mg Pow $18,240.00 25935136 ethambutol 100 mg Tab [UGH] $5.00 27120137 ethanol topical 62% ethyl alcohol Swab $0.00 25935137 ethyl chloride Top 100% Spry [UGH] $118.52 26781170 ethyl chloride topical 100% Spr $129.86 256291281290462 ETHYLENE GLYCOL-SERUM 82693 $142.00 25935138 etodolac 400 mg Tab [UGH] $7.30 25935139 etomidate 2 mg/mL IV Sol [UGH] $38.35 26850808 etomidate 2 mg/mL Sol $37.30 27017250 Evacuated Container [UGH] $40.00 7871141700062 EVENT MONITOR-REMOTE CARDIO TELEMETRY 93229 $956.00 269739971300193 EXAM AND SELECTION OF ARCHIVED MATERIAL 88363 $75.00 253729461461050 EXCISION LESION 1.1 TO 2.0CM TECH FEE 11422 $1,600.00 91154951750054 EXCISION OF NAIL - FAC 11750 $685.00 253731321460072 EXCISION/BIOPSY-LEVEL II 28190 $1,140.00 265888691290001 Executive Profile $50.00 28637841453578 Extended Recovery- Daily $400.00 2573917110090370 Eye Lens Surgery $1,500.00 253735491460100 EYE TREATMENT - LEVEL II 65205 $150.00 253735531460103 EYE TREATMENT - LEVEL III 67938 $312.00 26010797 ezetimibe 10 mg Tab [UGH] $45.19 26781193 ezetimibe-simvastatin 10 mg-40 mg Tab $44.24 25935140 ezetimibe-simvastatin 10 mg-40 mg Tab [UGH] $54.67 7943171290777 FACTOR II ACTIVITY CLOTTING 85210 $180.00 21950501290427 FACTOR V (LEIDEN) MUTATION ANALYSIS 81241 $283.00 261667141290397 FACTOR V ACTIVITY PLASMA 85220 $150.00 250505801290419 FACTOR VIII ACTIVITY 85240 $98.00 25935141 famciclovir 500 mg Tab [UGH] $50.76 26011529 famotidine 10 mg/mL IV Sol [UGH] $25.00 25935142 famotidine 20 mg Tab [UGH] $8.70 25935143 famotidine 20 mg/50 mL IV Sol [UGH] $28.80 25935144 Fat Emul, 20% IV 250 mL [UGH] $197.60 25935145 Fat Emul, 20% IV 500 mL [UGH] $181.89 15500121290238 FECAL FAT - QUALITATIVE 82705 $97.00 25936032 felodipine 5 mg ER Tab [UGH] $7.55 253735301460096 FEMALE REPRO PROC-LEVEL II 56420 $246.00 253735291460095 Female Reprod Proc Level II 56405 $246.00 2640910510090280 FEMORAL 2154-0-0004 $2,880.00 2640972510091200 FEMORAL ATTUNE SZ 4 LEFT $2,375.00 2640902910090170 FEMORAL COMPONENT CEMENTED $2,880.00 2640943710090900 FEMORAL COMPONENT CEMENTED SZ 3 $2,880.00 2640919110090370 FEMORAL COMPONENT CEMENTED SZ 4 $2,880.00 2640942610090890 FEMORAL COMPONENT CEMENTED SZ 6 $2,880.00 2640913810090310 FEMORAL COMPONENT CEMENTED SZ5 $2,880.00 2640936310090810 FEMORAL COMPONENT COCR NP SZ 6 $2,880.00 2640944810090910 FEMORAL COMPONENT COCR SZ 6 $2,880.00 2640901710090160 FEMORAL COMPONENT RLP CEMENT $3,200.00 2640902010090170 FEMORAL COMPONENT RLP CEMENTED $2,880.00 2640903010090180 FEMORAL COMPONENT RLP CEMENTED SZ5 $2,520.00 2640956210091040 FEMORAL COMPONENT RLP CEMENTED SZ6 $2,880.00 2640906010090220 FEMORAL COMPONENT RLP COCR NP $2,880.00 2640951110090980 FEMORAL COMPONENT RLP COCR SZ 2 $2,880.00 2640905810090220 FEMORAL COMPONENT RLP COCR SZ 3 $2,880.00 2640925510090440 FEMORAL COMPONENT RLP COCR SZ 6 $2,880.00 2640910410090280 FEMORAL COMPONENT SZ 2 $2,880.00 2640917610090350 FEMORAL COMPONENT SZ 5 $2,880.00 2704673510091700 FEMORAL COMPONENT SZ 7 LEFT $5,000.00 2640937210090820 FEMORAL COMPONENT SZ3 $6,100.00 2640915910090340 FEMORAL COMPONENTNON-POR SZ 2 $2,880.00 2640984810091330 FEMORAL CRUCIATE LEFT SZ 5N $2,375.00 2640975410091230 FEMORAL CRUCIATE RETAINING SZ 6 $2,375.00 2640969110091170 FEMORAL CRUCIATE RETAINING SZ 8 $2,375.00 2640995910091450 FEMORAL CRUCIATE RIGHT SZ 5 $2,375.00 2640977010091250 FEMORAL CRUCIATE SZ 6 LEFT $2,375.00 2640979510091280 FEMORAL CRUCIATE SZ 6N LEFT $2,375.00 2640938810090840 FEMORAL HEAD 32MM $1,688.00 2640967310091150 FEMORAL HEAD 36 MM $2,000.00 2640967610091150 FEMORAL HEAD 36MM $2,375.00 2640968010091160 FEMORAL HEAD 36MM +5 12/14 $2,000.00 2640975910091240 FEMORAL LEFT SZ 7 $2,375.00 2640891810010090 FEMORAL LEG SPLINT LARGE $88.00 2640891910010090 FEMORAL LEG SPLINT MEDIUM $75.00 2640892010010090 FEMORAL LEG SPLINT SMALL $76.00 2640992610091410 FEMORAL NARROW SZ 6N RIGHT $2,375.00 2640994410091430 FEMORAL PFC SIGMA ADAPTER $744.00 2640994510091430 FEMORAL PFC SIGMA ADAPTER 5 DEGREE $4,060.00 2640984910091330 FEMORAL POSTERIOR RIGHT SZ 5 $2,375.00 2640992110091410 FEMORAL POSTERIOR SZ 6 $2,375.00 2640983210091320 FEMORAL RIGHT CEMENTED SZ 7 $2,375.00 2640967710091150 FEMORAL STEM 12/14 13.5MM $4,500.00 2640891110091470 FEMORAL STEM 12/14 140MM $4,400.00 2640976610091250 FEMORAL STEM 12/14 TAPER 15MM $2,375.00 2640985810091340 FEMORAL STEM 12/14 TAPER SZ 135MM $1,187.50 2640909910090270 FEMORAL STEM 9MM $4,500.00 2640922410090410 FEMORAL STEM LATERAL 13.5MM $4,500.00 2640914110090310 FEMORAL STEM LATERAL 6MM $4,500.00 2640903810090180 FEMORAL STEM LATERAL 7.5MM $4,500.00 2640909410090260 FEMORAL STEM LATERAL 9MM $4,500.00 2640917410090350 FEMORAL STEM LATERAL SZ 12MM $5,000.00 2640915710090330 FEMORAL STEM LATERAL SZ 15MM $5,000.00 2640966410091140 FEMORAL STEM STANDARD 15MM $4,500.00 2640940710090870 FEMORAL STEM STANDARD SZ 10.5MM $4,500.00 2640990910091400 FEMORAL SZ 3 LEFT $2,375.00 2640974110091220 FEMORAL SZ 4 RIGHT $2,375.00 2640978210091260 FEMORAL SZ 5 $2,375.00 2640890910091470 FEMORAL SZ 5 LEFT $2,375.00 2640991810091410 FEMORAL SZ 8 LEFT $2,375.00 2640974210091220 FEMORAL SZ 8 RIGHT $2,375.00 2640994310091430 FEMORAL TC3 CEMENTED SZ 2 RIGHT $11,692.00 25935147 fenofibrate 134 mg Oral Cap [UGH] $9.80 27109800 fenofibrate 145 mg Tab $25.78 25961620 fenofibrate 145 mg Tab [UGH] $5.58 25966154 fenofibrate 48 mg Tab [UGH] $5.00 25935150 fentaNYL 100 mcg/hr Transderm ER Film [UGH] $267.70 25984019 fentaNYL 12 mcg/hr TD film, ER [UGH] $101.51 25935789 fentaNYL 25 mcg/hr Transderm ER Film [UGH] $71.84 27107144 fentaNYL 50 mcg/hr Fil $131.80 25935152 fentaNYL 50 mcg/hr Transderm ER Film [UGH] $131.92 25983980 fentaNYL 50 mcg/mL Sol 2 mL [UGH] J3010 $25.00 25984053 fentaNYL 50 mcg/mL Sol 50 mL [UGH] J3010 $73.50 26136484 fentaNYL 50 mcg/mL Sol[UGH] J3010 $25.00 25984017 fentaNYL 75 mcg/hr Transderm ER Film [UGH] $296.55 26952429 Fentanyl-Ropivacaine 2mcg/ml-0.1% [UGH] $300.00 33432041293714 Fern Test 87210 $18.00 22151001290307 FERRITIN 82728 $62.00 26011018 ferrous gluconate 324 mg Tab UD [UGH] $5.00 25935878 ferrous sulfate 220 mg/5 mL Oral Elix [UGH] $5.00 27154755 ferrous sulfate 325 mg Tab $5.00 25936033 ferrous sulfate 325 mg Tab [UGH] $5.00 25935879 ferumoxytol 30 mg/mL Sol [UGH] q0138 $4,661.40 36735731291096 FETAL FIBRONECTIN 82731 $70.00 240393521400169 FETAL MONITOR W/ INTERPRETATION CHARGE 59050 $305.00 28965571400133 Fetal Nonstress Test 59025 $250.00 260127791290884 FETAL ROM TEST 84112 $228.00 256724011290902 Fetal Screen 85460 $50.00 26781306 fexofenadine 180 mg Tab $5.00 26103991 fexofenadine 180 mg Tab [UGH] $5.00 26933584 fexofenadine 60 mg Tab $5.00 25935880 FEXOFENADINE TAB 60 MG 12 [UGH] $5.00 2640916710090340 FFIB FROZEN FIBULA $2,136.00 15755281290239 FIBRINOGEN ACTIVITY 85384 $65.00 21950651290791 FIBRINOGEN DEGRADATION PRODUCTS 85362 $83.00 25935155 fidaxomicin 200 mg Tab [UGH] $883.60 25935156 filgrastim 300 mcg/mL Inj Sol [UGH] j1442 $1,511.20 25935157 filgrastim 480 mcg/1.6 mL Inj Sol [UGH] j1442 $2,406.40 26975803 finasteride 5 mg Tab $15.63 25935158 finasteride 5 mg Tab [UGH] $16.65 29430581550021 FINE NEEDLE ASP 10022 $480.00 259716761480027 FINE NEEDLE ASPIRATION W/O IMAGING GUIDE 10021 $150.00 2640964410091120 FINGER IMPLANT SMCP-500-05 $3,258.00 2640964310091120 FINGER IMPLANT SZ 1 $3,258.00 25935881 flavoxATE 100 mg Tab [UGH] $7.32 25935159 flecainide 100 mg Tab [UGH] $17.90 253534431480080 Flex Sigmoidoscopy $1,100.00 2640946910090940 FLEXHD MEDIUM SHAPED PERFORATED $11,120.00 2640961410091090 FLEXHD PERF LRG PLIABLE SHAPED 13X22 $13,820.00 2640950510090970 FLEXHD PERF MED PLIABLE SHAPED 11X20 $20,350.00 2640985610091340 FLEXHD PLIABLE 16 X 20 $19,735.00 2640959710091070 FLEXHD STRUCTURAL 2X4 $628.00 2640905910090220 FLOSEAL(HEMOSTATIC MATRIX) $599.00 253374771300028 FLOW CYTOMETRYFIRST MARKER 88184 $339.00 25935882 FLUARIX QUADRIVALENT 2017-2018 0.5 ML [UGH] $86.76 26099127 fluconazole 10 mg/mL Oral Liq [UGH] $143.60 25962228 fluconazole 100 mg Tab [UGH] $39.61 25966420 fluconazole 100 mg/50 mL-NaCl 0.9% Sol [UGH] J1450 $49.73 25935161 fluconazole 150 mg Tab [UGH] $55.73 25966135 fluconazole 200 mg/100 mL-NS IV Sol [UGH] j1450 $27.00 25935884 fluconazole 40 mg/mL Oral Liq [UGH] $523.04 25955229 fludrocortisone 0.1 mg Tab [UGH] $5.00 25966765 flumazenil 0.1 mg/mL IV Sol [UGH] $39.00 25935886 fluocinonide Top 0.05% Crm [UGH] $385.32 26159049 fluorescein ophthalmic 1 mg Test Strip [UGH] $5.00 26653186 fluorescein-proparacaine ophthalmic 0.25%-0.5% Sol [UGH] $39.78 7818371710013 Fluoroscopic Evaluation of Swallow Function 92611 $185.00 25961561 FLUoxetine 10 mg Cap [UGH] $5.00 26009689 FLUoxetine 20 mg Cap UD [UGH] $12.58 25935166 FLUoxetine 20 mg/5 mL Oral Sol [UGH] $24.58 25935167 flurbiprofen Ophth 0.03% Sol [UGH] $39.29 25935168 fluticasone CFC free 110 mcg/inh Inh Aer w/adapter [UGH] $1,202.84 25935169 fluticasone CFC free 220 mcg/inh Inh Aer w/adapter [UGH] $1,813.88 26010832 fluticasone Nasal 0.05 mg/inh Spry [UGH] $337.28 26337145 fluticasone nasal 50 mcg / 1 inh Spray [UGH] $80.00 25935791 fluticasone-salmeterol 100 mcg-50 mcg Inh Pwdr [UGH] $728.32 25935171 fluticasone-salmeterol 250 mcg-50 mcg Inh Pwdr [UGH] $728.32 25935172 fluticasone-salmeterol 500 mcg-50 mcg Inh Pwdr [UGH] $1,186.64 26010465 fluvoxaMINE 100 mg Tab [UGH] $13.15 36752791290998 FOLATE SERUM-INHOUSE 82746 $82.00 2640935710090800 FOLEY CATH 2 WAY COUDE 20FR 5CC $59.00 1965951010010100 FOLEY CATH TRAY 16FR $23.00 2640892210010100 FOLEY CATH TRAY 18FR $23.00 2640892310010100 FOLEY CATH TRAY W/O CATHETER $22.00 25935173 folic acid 0.4 mg Tab [UGH] $5.00 26988386 folic acid 1 mg Tab $5.00 25936035 folic acid 1 mg Tab [UGH] $5.00 25935887 folic acid 5 mg/mL Inj Sol [UGH] $216.56 26008999 FOLTX TAB 2.5-25-2 MG [UGH] $5.00 27107255 fomepizole 1 g/mL Sol J1451 $7,200.00 26026933 fomepizole 1.5 g/mL IV Sol 1.5ml [UGH] J1451 $4,530.00 25935175 fondaparinux 7.5 mg/0.6 mL SC Sol [UGH] J1652 $628.20 15500151290804 FOOD ALLERGY PROFILE 86003 $150.00 25935176 fosinopril 10 mg Tab [UGH] $10.11 25935889 fosphenytoin (PE) 100 mg/2 mL Inj Sol [UGH] Q2009 $81.00 25935177 fosphenytoin (PE) 500 mg/10 mL Inj Sol [UGH] Q2009 $477.69 2640960210091080 FRACTURE PL NARROW VOLAR LF $2,484.00 259830651390761 FRENOTOMY 41010 $1,380.00 5928171300009 FROZEN SECTION 88331 $58.80 10257701290310 FSH - FOLLICLE STIMULATING HORMONE 83001 $78.00 11580301290479 FTA-ABS 86780 $68.00 7835931290620 Fungal Stain Send Out QST 87206 $35.00 25961964 furosemide 10 mg/mL Inj Sol 10ml vial [UGH] J1940 $25.00 26104877 furosemide 10 mg/mL Inj Sol 2 ml vial [UGH] J1940 $25.00 25961965 furosemide 10 mg/mL Inj Sol 4ml vial [UGH] J1940 $25.00 25935178 furosemide 10 mg/mL Oral Liq [UGH] $5.00 26010483 furosemide 20 mg Tab UD [UGH] $5.00 26010479 furosemide 40 mg Tab UD [UGH] $5.00 26414488 furosemide 80 mg Tab $5.00 26011046 furosemide 80 mg Tab UD [UGH] $5.00 262926301460045 FX TREATMENT - RIB/STERNUM TECH FEE 23500 $270.00 253731291460070 FX TX - ANKLE/FOOT/TOE 27840 $246.00 253731241460069 FX TX - ANKLE/FOOT/TOE-LEVEL II 27810 $852.00 253730421460050 FX TX - ARM/ELBOW 24600 $270.00 253730531460053 FX TX - ARM/WRIST 25600 $246.00 253730321460047 FX TX - ARM-ELBOW 23605 $2,742.00 253730711460060 FX TX - FINGER/TOE/TRUNK 26725 $270.00 253731111460177 FX TX - LEG/KNEE 27781 $2,404.80 258121451460157 FX TX - METATARSAL WITH MANIPULATION 28475 $296.40 253730901460065 FX TX - PELVIS DISLOCATION 27250 $270.00 253730291460046 FX TX - SHOULDER/CLAVICLE 23500 $270.00 253730641460056 FX TX - WRIST/HAND/FINGER 26600 $246.00 253730691460152 FX TX WRIST/HAND/FINGER 26700 $246.00 253730871460064 FX TX-FRACTURE/DISLOCATION 26785 $4,152.00 174427951740002 G0237 PR - THERAPUTIC ACTIVITY CHARGE $274.00 174427971740004 G0239 PR GROUP SESSION CHARGE $92.00 263646611740004 G0239 PULM REHAB NON COPD RESP FUNC 2 OR MORE $92.00 263381551800008 G0398 HST TYPE II $545.00 263381541800009 G0399 HST TYPE III $545.00 263381531800010 G0400 HST TYPE IV $545.00 15500221290492 G-6-PD GLUCOSE-6-PHOSPHATE DEHYDROGENASE 82955 $90.00 26011052 gabapentin 100 mg Cap UD [UGH] $5.00 26010382 gabapentin 300 mg Cap UD [UGH] $6.88 26009725 GABAPENTIN CAP 400 MG [UGH] $6.11 6922471720015 GAIT TRAINING THERAPY 15 MIN 97116 $50.00 26011066 galantamine 4 mg Tab UD [UGH] $15.91 6337331290072 GAMMA GT 82977 $95.00 21950741290242 GASTRIN 82941 $81.00 2640934410090730 GASTRO REPLACEMENT TRIFUNAL TUBE 20FR $204.00 2640933710090690 GASTROSTOMY P.E.G. 20FR GUIDEWIRE SYSTEM $405.00 2640934310090730 GASTROSTOMY REPLACEMENT TUBE 20FR TRAY $765.00 69171831461145 Gastrostomy Tube Change 43762 $694.00 25966569 gatifloxacin ophthalmic 0.5% Sol [UGH] $472.64 26847604 Gelfilm 12.5 sq cm [UGH] $6,444.88 26175103 Gelfoam [UGH] $199.92 26952217 Gelfoam 12-7mm Sponge [UGH] $41.24 26010472 gemfibrozil 600 mg Tab [UGH] $11.58 30431421430248 General ANES EA ADDITIONAL 30 MIN Charge $285.00 2640905010090210 GENESYS HTA PROCERVA PROCEDURE $2,796.00 25935893 gentamicin 10 mg/mL Inj Sol 2ml vial [UGH] J1580 $25.00 25935181 gentamicin 100 mg/100 mL-NS IV Sol [UGH] J1580 $75.00 25935792 gentamicin 40 mg/mL Inj Sol 2 ml vial [UGH] j1580 $25.00 25935895 gentamicin 40 mg/mL Inj Sol 20 ml vial [UGH] J1580 $25.00 25935793 gentamicin 80 mg/100 mL-NS IV Sol [UGH] j1580 $75.00 25935794 gentamicin Ophth 0.3% Oint [UGH] $78.68 25935182 gentamicin Ophth 0.3% Sol [UGH] $86.80 27089967 gentamicin ophthalmic 0.3% Sol $171.40 8587861290125 GENTAMICIN PEAK 80170 $130.00 6335961290484 GENTAMICIN RANDOM 80170 $130.00 25961720 gentamicin Top 0.1% Crm [UGH] $197.52 25936036 gentamicin Top 0.1% Oint [UGH] $197.52 8587871290127 GENTAMICIN TROUGH 80170 $130.00 25935795 gentian violet Top 1% Sol [UGH] $36.09 26744538 GI Cocktail 30 mL [UGH] $20.00 35047371290136 Giardia Antigen EIA Stool QST 87329 $48.00 15500211290420 Gliadin IgG IgA Ab QST 83516 $134.00 2640897910090090 GLIDEWIRE ANGLED .038 $131.00 2640897710090090 GLIDEWIRE STRAIGHT .035 $655.00 2640897810090090 GLIDEWIRE STRAIGHT .038 $131.00 25935184 glimepiride 2 mg Tab [UGH] $6.15 25935796 glipiZIDE 10 mg ER Tab [UGH] $5.00 26789839 glipiZIDE 10 mg Tab $5.00 25935185 glipiZIDE 10 mg Tab [UGH] $5.00 25935186 glipiZIDE 5 mg ER Tab [UGH] $5.00 25935187 glipiZIDE 5 mg Tab [UGH] $5.00 2640976110091240 GLOBAL CTA HEAD SZ 48MM X18MM $4,872.00 261667311290627 GLUCAGON 82943 $45.00 26010441 glucagon 1 mg Inj [UGH] j1610 $823.68 26172274 glucosamine 500 mg Cap[UGH] $5.00 6335941290069 GLUCOSE 82947 $44.00 6076091740012 GLUCOSE - ACCUCHECK 82962 $13.00 26011487 glucose 25% infant dextrose 25% Sol 10 mL [UGH] $45.84 26542080 glucose 40% Gel [UGH] $22.40 25935797 glucose 50% IV Sol 50 mL syringe [UGH] $25.00 25935798 glucose 50% IV Sol 50 mL vial [UGH] $25.00 24356221290981 Glucose- Accucheck 82962 $13.00 112182231290525 GLUCOSE BODY FLUID 82945 $36.00 149844921290534 GLUCOSE CSF 82945 $43.00 40612051290134 GLUCOSE TOLERANCE 2 HR 82951 $100.00 16815171290146 GLUCOSE TOLERANCE 5 HOUR 82951 $100.00 40612091290143 Glucose Tolerance Test 3-Hour 82951 $100.00 255522501290806 GLUTEN IgG 86001 $20.00 25935189 glyBURIDE 2.5 mg Tab [UGH] $5.00 26010771 glyBURIDE 5 mg Tab [UGH] $5.00 25935190 glycerin adult Supp [UGH] $5.00 25935191 glycerin infant rectal Supp [UGH] $5.00 25935192 glycine Irr 1.5% Irr Sol 3000 mL [UGH] $48.72 25935897 glycopyrrolate 0.2 mg/mL Inj Sol 2ml [UGH] $110.40 25935193 golimumab 50 mg/4 mL Sol [UGH] J1602 $8,728.84 2640945510090920 GORE BIOA TISSUE REINFORCEMENT $2,268.00 2640918910090370 GRACILIS HAMSTRING TENDON $2,892.00 26175104 Grain Alcohol 95% [UGH] $5.00 8507531290005 GRAM STAIN 87205 $53.00 6922691720019 GROUP THERAPEUTIC 2 OR MORE 97150 $55.00 11580331290243 GROWTH HORMONE 83003 $45.00 25935194 guaiFENesin 100 mg/5 mL Oral Liq [UGH] $5.00 25935899 guaiFENesin 200 mg Tab [UGH] $5.00 26010395 guaiFENesin 600 mg ER Tab [UGH] $5.00 26054074 guaifenesin-hydrocodone 100 mg-5 mg/5 mL Liq [UGH] $7.00 2640922210090410 GUIDE WIRE JAGWIRE .035 $624.00 2640898010090100 GUIDEWIRE AMPLATZ .035 $113.00 2640898110090100 GUIDEWIRE AMPLATZ .038 $80.00 2640897610090080 GUIDEWIRE COATED AMPLATZ EXTRA STIFF $81.00 2640943510090900 GUIDEWIRE OLIVE $165.00 260990761700052 H F NEB SINGLE EVENT 94640 $486.00 256762671290180 H. PYLORI 86677 $56.00 26010499 haloperidol 1 mg Tab UD [UGH] $5.00 26054076 haloperidol 5 mg Tab UD [UGH] $5.46 25935901 haloperidol 5 mg/mL Inj Sol [UGH] J1630 $25.00 25935196 haloperidol decanoate 50 mg/mL Inj Sol [UGH] J1630 $134.80 26204682 haloperidol decanoate 50 mg/mL Sol J1630 $124.28 21950861290245 HAPTOGLOBIN 83010 $81.00 256290871291074 HAZELNUT IgE 86003 $21.00 165498201750027 HBO - PHYS/NP/PA SUPERVISED - FAC 99183 $325.00 32614591750026 HBO TREATMENT EACH 30 MIN - FAC $323.00 10195341290319 HCG QUANTITATIVE 84702 $81.00 8532211290013 HCG SERUM QUALITATIVE 84703 $45.00 24939071290009 HCG URINE QUALITATIVE 81025 $53.00 6337031290116 HDL CHOLESTEROL 83718 $47.00 2640971510091190 HEAD BI POLAR 28MM 44MM $1,375.00 2640968710091160 HEAD BI POLAR 28MM 51MM $1,375.00 2640968910091170 HEAD BI POLAR 28MM 54MM $1,375.00 2705553310091700 HEAD BI POLAR 28MM ID 46MM OD $1,375.00 2640913110090300 HEAD BIOLOX DELTA OPTION $6,482.00 2640969910091180 HEAD BI-POLAR 28MM 55MM $1,375.00 2640975210091230 HEAD BI-POLAR 28MM X 48MM $2,015.00 2640968310091160 HEAD BI-POLAR SELF CENTERING 45MM $1,375.00 2640971310091190 HEAD FEMORAL 12/14 32MM $2,375.00 2640968410091160 HEAD FEMORAL 28MM 12/14 TAPER $1,375.00 2640970410091180 HEAD FEMORAL ARTICUL 12/14 TAPER 32MM $2,000.00 2640971710091190 HEAD HUMERAL SZ 48 X 18 $3,954.00 2640891010091470 HEAD HUMERAL SZ 48MM X 21MM $2,433.00 2640971610091190 HEAD POROCOAT SZ 12 137MM $6,693.00 268090341440627 HEADLIGHT 01 $38.00 261667191290512 HEAVY METALS URINE 24 HR 82175 $95.40 46924571390762 HEEL STICK EACH 36416 $9.75 261667371291018 HELMINTHOSPORIUM HALODES IgE 86003 $21.00 6337421290032 HEMATOCRIT 85014 $23.00 6337411290031 HEMOGLOBIN 85018 $15.00 6337431290246 HEMOGLOBIN A1C 83036 $82.00 10257901290247 HEMOGLOBINOPATHY EVALUATION 83021 $106.00 21951081290315 HEP BsAB QUANTITATIVE 86317 $46.00 25935197 heparin 10,000 units/mL Inj Sol [UGH] J1644 $43.75 27060273 heparin 100 units/mL-D5% Sol J1644 $711.93 25935198 heparin 1000 units/mL Inj Sol [UGH] J1644 $25.00 25935902 heparin 5000 units/mL Inj Sol [UGH] J1644 $25.00 25935903 HEPARIN DRIP 25,000UNITS PER 250ML [UGH] J1644 $90.00 26798792 heparin flush 1 units/mL Sol [UGH] J1642 $25.00 25935904 heparin flush 10 units/mL Sol 5 ml syr [UGH] J1642 $25.00 25935799 heparin flush 100 units/mL Sol 5ml [UGH] J1642 $15.00 24837421293649 HEPARIN INDUCED PLATELET ANTIBODY 86022 $75.00 198867811290105 HEPATIC PANEL(LFT'S) 80076 $97.00 6337451290312 HEPATITIS A AB TOTAL 86708 $60.00 26552768 hepatitis A adult vaccine 50 units/mL Sus [UGH] $292.81 11579871290452 HEPATITIS A IGM ANTIBODY 86709 $40.00 25935199 hepatitis A pediatric vaccine 720 units/0.5 mL PF IM Susp [UGH] $130.97 21951411290453 HEPATITIS B AB QUAL 86706 $60.00 26054084 hepatitis B adult vaccine 20 mcg/mL Sus [UGH] $279.36 10257831290314 HEPATITIS B CORE AB 86704 $60.00 22449091290313 HEPATITIS B CORE AB IgM 86705 $53.00 26162848 hepatitis B immune globulin - Sol [UGH] J1571 $3,217.76 25935200 hepatitis B immune globulin IM Sol 0.5 mL [UGH] J1571 $700.16 25966734 hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [UGH] $110.24 26552773 hepatitis B pediatric vaccine 5 mcg/0.5 mL Sus [UGH] $209.02 255523071290632 HEPATITIS BE ABY 86707 $68.00 10257871290356 HEPATITIS C ANTIBODY (HCV) 86803 $60.00 15500391290377 HEREDITARY HEMOCHROMATOSIS ANALYSIS 81256 $270.00 15215161290284 HERPES SIMPLEX I & II IgG 86695 $172.00 7873311290961 HERPES SIMPLEX VIRUS TYPE 1&2 DNA PCR 87529 $325.00 26989924 hetastarch 60 mg/mL-NaCl 0.9% Sol $90.05 25935905 hetastarch 60 mg/mL-NS IV Sol [UGH] $90.00 261666941291019 HICKORY PECAN IgE 86003 $21.00 2640949910090970 HIGH PROFILE GEL IMPLANTS 350-5004 $2,450.00 2640950010090970 HIGH PROFILE GEL IMPLANTS 350-5504 $2,450.00 2640902610090170 HIP SYSTEM FEMORAL STEM 10.5MM $4,500.00 250727521290493 Histone Antibodies QST 83516 $96.00 224891681290336 HIV 87389 $68.00 269740651300358 HLA CHIMERISM UNFRACTIONATING 81267 $711.00 15500441290244 HLA-B27 86812 $135.00 2640967110091150 HOLE ELIMINATOR PS APEX $750.00 268090361440610 HOLMIUM LASER Charge $625.00 128673731700022 HOLTER MONITOR 93225 $153.00 262777321700022 HOLTER SCAN 93225 $153.00 25935202 homatropine-HYDROcodone 1.5 mg-5 mg/5 mL Oral Syrup 473 mL [UGH] $437.20

263498241720017 HOME EXERCISE INSTRUCTION 97139 $50.00 10257931290368 HOMOCYSTINE 83090 $120.00 99630381730004 HOT OR COLD PACKS 97010 $35.00 261666991291017 HOUSE DUST IgE 86003 $21.00 261667461290516 HTLV I/II ANTIBODY EIA 86790 $105.00 25935203 hyaluronidase 150 units/mL Inj Sol [UGH] J3470 $267.84 26008959 hydrALAZINE 10 mg Tab [UGH] $5.00 25936039 hydrALAZINE 20 mg/mL Inj Sol [UGH] J0360 $70.65 25935906 HYDRALAZINE TAB 25 MG [UGH] $5.00 115198441050111 HYDRATION IV INFUSION 1ST HOUR 96360 $480.00 115198481050112 HYDRATION IV INFUSION EA ADDL HOUR 96361 $60.00 25935206 hydrochlorothiazide 25 mg Tab [UGH] $5.00 26841390 hydrochlorothiazide-lisinopril 12.5 mg-10 mg Tab $5.60 25935207 hydrochlorothiazide-lisinopril 12.5 mg-20 mg Tab [UGH] $6.06 25961676 hydrochlorothiazide-lisinopril 25 mg-20 mg Tab [UGH] $6.14 26010495 hydrochlorothiazide-losartan 12.5 mg-50 mg Tab [UGH] $12.51 26846609 hydrochlorothiazide-triamterene 25 mg-37.5 mg Cap $5.00 26053944 hydrochlorothiazide-triamterene 25 mg-37.5 mg Cap [UGH] $5.00 25935209 hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab [UGH] $5.00 25935210 hydrocortisone 10 mg Tab [UGH] $5.00 25966813 hydrocortisone 100 mg preservative-free Pow [UGH] J1720 $72.54 25935211 hydrocortisone 100 mg/60 mL Rectal Susp [UGH] $42.66 25961872 hydrocortisone 2.5% Rectal Crm w/Appl [UGH] $330.11 26846949 hydrocortisone 25 mg Supp [UGH] $90.67 25935214 hydrocortisone 250 mg preservative-free Pow [UGH] J1720 $86.00 26858326 hydrocortisone 5 mg Tab $8.20 25935908 hydrocortisone 5 mg Tab [UGH] $5.00 25935215 hydrocortisone Top 0.5% Crm [UGH] $29.70 25935800 hydrocortisone Top 1% Crm [UGH] $24.00 25935216 hydrocortisone Top 10% Gel [UGH] $360.00 26011236 hydrocortisone Top 2.5% Crm [UGH] $44.00 25935217 hydrocortisone Top 2.5% Lotion [UGH] $208.12 27090591 hydrocortisone topical 1% Cre $9.27 25935218 hydrocortisone/neomycin/polymyxin B Ophth Susp [UGH] $683.10 25966566 hydrocortisone/neomycin/polymyxin B Otic Sol [UGH] $419.52 25966564 hydrocortisone/neomycin/polymyxin B Otic Susp [UGH] $419.52 25935802 hydrocortisone-pramoxine Top 1%-1% Crm w/Appl [UGH] $582.32 25966245 hydrocortisone-pramoxine topical 1%-1% Foa [UGH] $388.24 26165126 hydrogen peroxide topical - Soln [UGH] $4,790.00 26553226 HYDROmorphone 0.5 mg/0.5 mL Sol [UGH] J1170 $25.00 25935222 HYDROmorphone 1 mg/mL Inj Sol [UGH] J1170 $25.00 25935909 HYDROmorphone 10 mg-NS/50 mL IV Sol [UGH] J1170 $185.00 25935223 HYDROmorphone 2 mg Tab [UGH] $7.00 26020582 HYDROmorphone 2 mg/mL Inj Sol 1ml vial [UGH] J1170 $25.00 25935911 HYDROmorphone 2 mg/mL Inj Sol 20ml vial [UGH] J1170 $54.60 26767998 HYDROmorphone 4 mg Tab $7.00 25935912 HYDROmorphone 4 mg Tab [UGH] $7.00 25935224 HYDROmorphone 4 mg/mL Inj Sol [UGH] J1170 $25.00 25935225 hydroxocobalamin 5 g Pow [UGH] $3,117.40 25935226 hydroxychloroquine 200 mg Tab [UGH] $23.52 25935227 hydroxyurea 500 mg Cap [UGH] S0176 $7.37 26814143 hydrOXYzine hydrochloride 10 mg Tab [UGH] $5.00 25935913 hydrOXYzine hydrochloride 10 mg/5 mL Oral Syrup [UGH] $5.00 25935228 hydrOXYzine hydrochloride 25 mg Tab [UGH] $5.00 25935229 hydrOXYzine hydrochloride 25 mg/mL IM Sol [UGH] J3410 $104.54 25935230 hydrOXYzine hydrochloride 50 mg/mL IM Sol [UGH] J3410 $40.63 27090440 hydrOXYzine pamoate 25 mg Cap Q0177 $5.00 26010538 hydrOXYzine pamoate 25 mg Cap UD [UGH] Q0177 $5.00 25935231 hyoscyamine 0.125 mg sublingual Tab [UGH] $5.48 25935804 hyoscyamine 0.125 mg Tab [UGH] $5.00 26010724 hyoscyamine 0.125 mg/5 mL Oral Liq [UGH] $5.58 25935914 hyoscyamine 0.125 mg/mL Oral Drops [UGH] $159.16 25935915 hyoscyamine 0.375 mg ER Tab [UGH] $8.07 25935233 hyoscyamine/methena/mblue/phenylsal/sodbiphos 0.12 mg-81 mg-10.8 $23.49 mg-32.4 mg-40.8 mg Tab [UGH] 259831701400157 I & D VULVA/PERINEUM 56405 $775.00 253734821461078 I&D PERITONSILLAR ABSCESS-FAC 42700 $773.00 26011085 ibandronate 1 mg/mL IV Sol 3 mL[UGH] J1740 $2,000.00 25935234 ibuprofen 100 mg Chew Tab [UGH] $5.00 26984867 ibuprofen 100 mg/5 mL Sus $5.00 25935236 ibuprofen 200 mg Tab [UGH] $5.00 25935916 ibuprofen 40 mg/mL Oral Susp [UGH] $5.00 27088051 ibuprofen 400 mg Tab $5.00 25936040 ibuprofen 400 mg Tab [UGH] $5.00 25935917 ibuprofen 600 mg Tab [UGH] $5.00 26765695 ibuprofen 800 mg Tab $5.00 25935238 ibuprofen 800 mg Tab [UGH] $5.00 25935239 ibutilide 0.1 mg/mL IV Sol [UGH] J1742 $2,170.88 261752311290162 ID Bacteria 87077 $38.00 189118821290162 ID BACTI (EACH) 87077 $38.00 25935240 idaruCIZUmab 2.5 g/50 mL Sol [UGH] $16,800.00 15500541290428 IGA 82784 $52.00 10258001290252 IGE 82785 $96.00 255523201293660 IGF BINDING PROTEIN 3 82397 $58.00 15500521293672 IGF BINDING PROTEIN-1 83519 $56.00 15500531290473 IGF-1 84305 $224.00 10258011290393 IGG SERUM 82784 $80.00 10258021290253 IGM 82784 $54.00 25935805 imipenem-cilastatin 250 mg Inj [UGH] J0743 $67.50 25962035 imipenem-cilastatin 500 mg Inj [UGH] J0743 $120.00 25935242 imipramine 10 mg Tab [UGH] $5.00 26010507 imipramine 25 mg Tab [UGH] $5.00 25935243 immune globulin 10% IV Sol 100 mL [UGH] J1561 $6,672.00 26407939 immune globulin 10% IV Sol 100ml [UGH] J1561 $5,582.36 25935244 immune globulin 10% IV Sol 200 mL [UGH] J1561 $13,344.00 25935246 immune globulin 10% IV Sol 200ml [UGH] J1561 $11,164.64 26407940 immune globulin 10% IV Sol 50ml [UGH] J1561 $2,791.12 25935245 immune globulin IM Sol 2 mL [UGH] J1560 $195.52 26850269 immune globulin intravenous 5G 10% Sol[UGH] J1599 $75.06 10258051290254 IMMUNOFIXATION SERUM 86334 $66.00 10258061290389 IMMUNOFIXATION URINE (IFP) 86335 $104.00 7959981290643 IMMUNOGLOBULIN D 82784 $96.00 261667321290894 IMMUNOGLOBULIN G SUBCLASS 2 82787 $90.00 255523211293646 IMMUNOGLOBULIN G SUBCLASS 4 82787 $138.00 11580381290414 IMMUNOGLOBULIN G SUBCLASS PANEL 82787 $289.00 253374851300195 IMMUNOPEROXIDASE EA ADDL 88341 $65.00 2953661300015 IMMUNOPEROXIDASE INITIAL 88342 $65.00 2640951010090980 IMPL SYS CMC MINI T ROPE 1.1MM $1,313.00 2640994210091430 IMPL SYS CMC MINI T ROPE 1.1MM KIT $2,238.00 58591921740003 IMPROVED RESPIRATORY FUNCTION 15 MIN $168.00 91153811750042 INCISION & DRAIN ABSCESS COMPLEX - FAC 10061 $685.00 94542911750041 INCISION & DRAIN ABSCESS SIMPLE - FAC 10060 $353.00 262926101460176 INCISION & DRAINAGE - PELVIS OR HIP 26990 $2,239.20 253735541460104 INCISION & DRAINAGE LEVEL I 69000 $198.00 240634321460002 INCISION & DRAINAGE LEVEL I TECH FEE 10060 $198.00 253735271460139 INCISION & DRAINAGE LEVEL II 55100 $1,800.00 253737191470005 INCISION & DRAINAGE PRO FEE - LEVEL I 10061 $198.00 253730121460129 INCISION & DRAINAGE SOFT TISSUE ABSCESS 20005 $1,320.00 253726611460004 INCISION & DRAINAGE TECH FEE - LEVEL I 10080 $198.00 253729261460005 INCISION & DRAINAGE TECH FEE - LEVEL II 10081 $1,800.00 253730131460038 INCISION & DRAINAGE-LEVEL II 20103 $1,800.00 253730601460054 INCISION & DRAINAGE-LEVELI 26010 $198.00 253734681460165 INCISION AND DRAINAGE LEVEL I 40800 $318.00 254847621750075 INCISION AND DRAINAGE OF HEMATOMA 10140 $2,353.00 253735081460138 INCISION OF THROMBOSED HEMORRHOID;EXT 46083 $300.00 259187001460180 INCISION/DRAINAGE UPPER ARM ELBOW-BURSA 23931 $1,800.00 269574041750090 INCISIONAL BIOPSY SKIN 1-LESION FAC 11106 $265.00 269574061750091 INCISIONAL BIOPSY SKIN ADDL LESION FAC 11107 $142.00 17796461290019 Incompatible 86922 $55.00 25935247 indapamide 1.25 mg Tab [UGH] $7.11 25935248 indapamide 2.5 mg Tab [UGH] $7.75 25935918 indigo carmine 8 mg/mL Inj Sol [UGH] $825.00 26010491 indomethacin 25 mg Cap [UGH] $5.00 25935250 inFLIXimab 100 mg IV Inj [UGH] J1745 $5,605.52 7942911290148 Influenza A & B Antibodies QST 86710 $98.00 26814483 influenza virus vaccine, inactivated high-dose preservative-free trivalent Q2038 $80.00 Sus [UGH] 26011543 influenza virus vaccine, inactivated preservative-free pediatric quadrivalent $100.41 Sus 0.25 mL [UGH] 26814484 influenza virus vaccine, inactivated preservative-free quadrivalent Sus Q2038 $50.00 [UGH] 262940011290910 INFLUENZAE B ANTIGEN 87804 $27.00 256762551290909 INFLUENZAE A ANTIGEN 87804 $27.00 93840111400171 INFUSION THERAPY - CONCURRENT 96368 $60.00 115198371050109 INFUSION THERAPY - SEQUENTIAL 96367 $60.00 115198341050107 INFUSION THERAPY 1 HR 96365 $480.00 250725101480081 INFUSION THERAPY 1 HR - HIGH COMPLEX DRUG 96413 $728.00 115198351050108 INFUSION THERAPY EA ADDL HOUR 96366 $60.00 111999751480082 INFUSION THERAPY EA ADDL HOUR - HIGH COMPLEX DRUG 96415 $70.00 253730071461058 INITIAL BURN TREATMENT-FACILITY 16000 $182.00 259831241400161 INJ EPIDURAL/ BLOOD PATCH 62273 $825.00 262926251461134 INJECTION ANESTHETIC OCCIPITAL NERVE FAC 64405 $693.00 251593111460116 INJECTION IV PUSH DIFF DRUG 96375 $180.00 251593121460117 INJECTION IV PUSH EA ADDL SAME DRUG 96376 $90.00 251593061460115 INJECTION IV PUSH INITIAL 96374 $180.00 165498441400178 INJECTION SUBQ OR IM 96372 $120.00 2640901910090160 INSERT 2142-1-1212 $2,520.00 2704673910091700 INSERT ARTICULAR SZ 5-6 $2,400.00 259831631400159 INSERT CERVICAL RIPENING AGENT 59020 $671.00 259830811390759 INSERT CHEST TUBE 32551 $875.00 2640995010091440 INSERT TIBIAL PLATFORM SZ 2 $5,506.00 2640993310091420 INSERT TIBIAL SZ 4 10MM $2,375.00 2640972010091200 INSERT TIBIAL SZ 5-6 14MM $3,528.00 2640992010091410 INSERT TIBIAL SZ 7 $2,375.00 259830751390767 INSERT UMBILICAL VENOUS CATH 36510 $240.00 253734501461086 INSERTION OF PICC LINE-FAC 36569 $1,795.00 15500551290256 INSULIN 83525 $127.00 25935806 insulin aspart 100 units/mL SubQ Sol [UGH] J1815 $30.00 25935253 insulin aspart-insulin aspart protamine 30 units-70 units/mL SubQ Susp 10 J1815 $36.01 mL [UGH] 25935254 insulin glargine 100 units/mL SubQ Sol [UGH] J1815 $30.00 26011545 insulin isophane (NPH) human recombinant 100 units/mL Sus 10 mL J1815 $30.00 [UGH] 26011544 insulin lispro 100 units/mL Sol 3 mL [UGH] J1817 $30.00 25935807 insulin lispro 100 units/mL SubQ Inj [UGH] J1815 $30.00 25935255 insulin lispro-insulin lispro protamine 25 units-75 units/mL SubQ Susp 10 J1815 $30.00 mL [UGH] 25935808 insulin NPH human recomb 100 units/mL SubQ Inj [UGH] J1815 $30.00 25935809 insulin NPH-Regular 70/30 100 units/mL SubQ Inj [UGH] J1815 $30.00 25935256 insulin regular human recombinant 100 units/mL Inj Sol [UGH] J1815 $30.00 27016838 insulin regular human recombinant 100 units/mL Sol J1815 $30.00 102280110010352 INTERJECT $153.00 2482922610090370 INTRAOCULAR LENS $1,510.00 259831601400214 INTRAUTERINE PRESSURE CATHETER 59051 $126.00 2640933810090690 INTRODUCER MICRO KIT $101.00 30060771700030 INTUBATION 31500 $347.00 2640923310090420 INTUBATION RETROGRADE SET $299.00 26768858 iohexol 180 mg/mL Sol Q9965 $258.12 26765945 iohexol 180 mg/mL Sol[UGH] Q9965 $462.08 100520951720008 Iontophoresis 97033 $50.00 28992191700069 IPPB DEMONSTRATION 94664 $486.00 25935258 ipratropium 0.02% Inh Sol 2.5 mL [UGH] J7644 $6.60 25935259 ipratropium CFC free 17 mcg/inh Inh Aer [UGH] $1,724.47 25935260 ipratropium Nasal 0.03% Spry [UGH] $179.26 25935261 ipratropium Nasal 0.06% Spry [UGH] $382.84 27088050 irbesartan 150 mg Tab $15.36 26008970 irbesartan 150 mg Tab [UGH] $15.36 11376801290073 IRON 83540 $52.00 258129731290084 Iron Deficiency Panel (TIBC) 83550 $58.00 25935810 iron dextran 50 mg/mL Inj Sol [UGH] J1750 $121.24 26009723 iron polysaccharide 150 mg Cap [UGH] $5.00 25935811 iron sucrose 20 mg/mL IV Sol [UGH] J1756 $230.40 2640895110010340 IRRIGATION GUN $49.00 269739991300060 ISH KAPPA-PATH 88365 $367.00 25935263 isoniazid 300 mg Tab [UGH] $6.18 25935264 isoproterenol 0.2 mg/mL IV Sol [UGH] $231.29 25955276 isosorbide dinitrate 10 mg Tab [UGH] $6.25 25963037 isosorbide mononitrate 20 mg Tab [UGH] $5.00 25955247 isosorbide mononitrate 30 mg ER Tab [UGH] $8.22 25935920 isosulfan blue 10 mg/mL Inj Sol [UGH] $3,044.80 2640962610091100 ISTENT BYPASS $3,600.00 2640916910090350 ISTENT RIGHT TRABECULAR MICRO-BYPASS $2,310.00 26470822 IV POLE LOCK BOX KEY [UGH] $0.00 93840041480076 IV TNKASE CORONARY INFUSION 92977 $89.00 25935267 ivermectin 3 mg Tab [UGH] $24.85 255523341290646 JAK2 MUTATION ANALYSIS 81270 $187.00 21951851290861 JO-1 ANTIBODY 86235 $85.00 261666711290648 KAPPA/LAMBDA LT CHAINS SERUM 83883 $175.00 255523361290838 KAPPA/LAMBDA LT CHAINS URINE 83883 $300.00 15500591290169 KEPPRA / LEVETIRACETAM 80177 $76.00 2682196810091640 KERECIS OMEGA3 14MM $86.00 25935921 ketamine 10 mg/mL Inj Sol 20 ml vial [UGH] $89.10 25935922 ketamine 100 mg/mL Inj Sol 5 ml vial [UGH] $53.41 26553123 ketamine 50 mg/mL Sol 10 ml vial [UGH] $25.20 26655544 Ketamine 50mg/5ml Syringe [UGH] $100.00 25935268 ketoconazole 200 mg Tab [UGH] $15.80 26075296 ketoconazole Top 2% Crm [UGH] $208.44 8877021290110 KETONE 82009 $55.00 25935270 ketorolac 10 mg Tab [UGH] $10.79 26010442 ketorolac 15 mg/mL Inj Sol [UGH] J1885 $25.00 25962106 ketorolac 30 mg/mL Inj Sol 1ml vial [UGH] J1885 $30.00 25962104 ketorolac 30 mg/mL Inj Sol 2ml vial [UGH] J1885 $37.50 26159020 ketorolac 30 mg/mL Inj Sol vial [UGH] J1885 $30.00 26769457 ketorolac 60 mg/2 mL Sol J1885 $25.00 25935924 ketorolac 60 mg/mL Inj Sol 2ml vial [UGH] J1885 $25.00 25936313 ketorolac Ophth 0.5% Sol [UGH] $1,258.68 25935812 ketotifen 0.025% Ophth Sol [UGH] $42.54 15495761290257 KIDNEY STONE ANALYSIS 82360 $94.00 2640894910010320 KNEE BRACE HINGED LARGE $51.00 2640894810010320 KNEE BRACE HINGED MED $51.00 2640893310010170 KNEE BRACE HINGED SMALL $57.00 2640895010010320 KNEE BRACE HINGED XLARGE $51.00 2640911510090290 KNEE SYSTEM FEMORAL COMPONENT $2,880.00 2640916810090350 KNEE SYSTEM FEMORAL COMPONENT CEMENETED $2,880.00 2640908410090250 KNEE SYSTEM PATELLAR COMPONENT $1,575.00 2640909210090260 KNEE SYSTEM TIBIAL BASEPLATE STEMMED $2,880.00 2640909310090260 KNEE SYSTEM TIBIAL INSERT $2,520.00 34972311290258 KOH PREP 87220 $27.00 269739901300152 KRAS BY PCR 81275 $600.00 261708071290477 Lab Card Collection 36415 $12.00 261708061290478 LabCorp Collection 36415 $10.00 25935273 labetalol 200 mg Tab [UGH] $5.00 26147108 labetalol 5 mg/mL IV Sol 20 ml vial [UGH] $42.00 25935926 labetalol 5 mg/mL IV Sol 4 ml syringe [UGH] $37.62 26130989 labetalol 5 mg/mL IV Sol 40 ml vial [UGH] $40.80 26010895 Lactated Ringers IV Sol 1000 mL [UGH] J7120 $90.00 26053867 Lactated Ringers IV Sol 500 mL [UGH] J7120 $90.00 6337681291095 LACTIC ACID 83605 $50.00 262245061291095 LACTIC ACID SCREEN 83605 $50.00 25935274 lactobacillus acidophilus and bulgaricus Chew Tab [UGH] $5.00 25935275 lactobacillus acidophilus and bulgaricus Oral Gran [UGH] $10.16 26932916 lactobacillus rhamnosus GG - Cap $5.00 25935927 lactobacillus rhamnosus GG 80 mg oral capsule [UGH] $5.00 261666741290764 LACTOFERRINQUANTITATIVE STOOL 83631 $95.00 26010671 lactulose 10 g/15 mL Oral Syrup 15 mL UD cup [UGH] $12.55 26010669 lactulose 10 g/15 mL Oral Syrup 473 ml bottle [UGH] $140.85 27051129 lactulose 10 g/15 mL Syr $5.81 2640906810090230 LAG SCREW 12.7MM 70MM $1,140.00 2640937010090820 LAG SCREW 12.7MM X 65MM $1,313.00 292947410090287 LAG SCREW 50MM $1,250.00 261666831291021 LAMB'S QUARTERS IgE 86003 $21.00 7835791290431 LAMICTAL/LAMOTRIGINE 80175 $83.00 26957929 lamoTRIgine 100 mg Tab $23.37 25935276 lamoTRIgine 100 mg Tab [UGH] $23.76 26011032 lamoTRIgine 25 mg Tab UD [UGH] $5.00 26245213 lanolin/menthol/petrolatum/Zn oxide top 15.7%-0.44%-24%-20.6% $22.50 Oin[UGH] 25935929 lansinoh oint [UGH] $9.89 26781509 lansoprazole 15 mg Cap $11.30 26011063 lansoprazole 15 mg Cap [UGH] $26.54 26009697 lansoprazole 15 mg Dis Tab [UGH] $66.42 26011549 latanoprost Ophth 0.005% Sol [UGH] $380.00 6337701290075 LDH 83615 $60.00 112207291290524 LDH BODY FLUID 83615 $53.00 15497051290435 LDL-DIRECT MEASURMENT 83721 $45.00 2695258817201 LDR SERVICES HRLY $36.00 110186017201 LDR SERVICES INPT $855.00 36233671400151 LDR-FETAL STRESS TEST (OXYTOCIN) 59020 $310.00 6337741290320 LEAD 83655 $37.00 2640978810091270 LEAD ATRIAL 2088TC $1,438.00 27081806 leflunomide 20 mg Tab $65.62 25962524 leflunomide 20 mg Tab [UGH] $27.00 7835851290387 Legionella Antigen Urine QST 87449 $110.00 261666981291038 LEMON IgE 86003 $22.00 2640935010090770 LENS MORGAN MEDI FLOW $85.00 25935933 levalbuterol 0.31 mg/3 mL Inh Sol [UGH] J7614 $17.00 26245859 levalbuterol 0.63 mg/3 mL Sol [UGH] J7614 $17.00 26010415 levalbuterol 1.25 mg/0.5 mL Sol UD [UGH] J7612 $17.00 25935277 levalbuterol 1.25 mg/3 mL Inh Sol [UGH] J7614 $17.00 268141831440060 Level 6 $16,000.00 2601337410764 LEVEL I EXTENDED ASSESSMENT-DIRECT ADMIT $310.00 25983402 levETIRAcetam 100 mg/mL IV Sol [UGH] J1953 $56.70 25962182 levETIRAcetam 100 mg/mL Oral Sol [UGH] $5.00 25955279 levETIRAcetam 500 mg Tab [UGH] $5.00 25935934 levobunolol Ophth 0.5% Sol [UGH] $96.72 25935280 levOCARNitine 200 mg/mL Inj Sol [UGH] J1955 $158.98 25966426 levoFLOXacin 25 mg/mL Sol 30 mL [UGH] J1956 $236.00 25935281 levofloxacin 250 mg/50 mL IV Sol [UGH] J1956 $100.00 25955295 levofloxacin 500 mg Tab [UGH] $14.09 25935283 levofloxacin 500 mg/100 mL IV Sol [UGH] J1956 $150.00 26970869 levoFLOXacin 500 mg/100 mL Sol J1956 $150.00 25935284 levofloxacin 750 mg/150 mL IV Sol [UGH] J1956 $200.00 25935285 levonorgestrel 1.5 mg Tab [UGH] $156.00 25935935 levonorgestrel 20mcg/24 hr intrauteral Dev [UGH] J7301 $3,745.44 25935936 levothyroxine 100 mcg (0.1 mg) Pow [UGH] $506.80 25935286 levothyroxine 100 mcg (0.1 mg) Tab [UGH] $5.00 25961608 levothyroxine 112 mcg (0.112 mg) Tab [UGH] $7.08 26010520 levothyroxine 125 mcg (0.125 mg) Tab [UGH] $7.24 25935289 levothyroxine 137 mcg (0.137 mg) Tab [UGH] $5.00 25935291 levothyroxine 25 mcg (0.025 mg) Tab [UGH] $5.00 26010530 levothyroxine 50 mcg (0.05 mg) Tab UD [UGH] $5.00 25935292 levothyroxine 75 mcg (0.075 mg) Tab [UGH] $5.00 27107170 levothyroxine 88 mcg (0.088 mg) Tab $5.00 25935937 levothyroxine 88 mcg (0.088 mg) Tab [UGH] $5.00 25935293 lidocaine 0.4%-D5W Inj Sol 500 mL [UGH] J2001 $90.00 25966801 lidocaine 0.5% PF 50ml Inj Sol [UGH] J2001 $68.00 26407597 lidocaine 1% 10ml Sol [UGH] J2001 $25.00 25966799 lidocaine 1% Inj Sol 20ml MDV [UGH] J2001 $25.00 25966501 lidocaine 1% PF Inj Sol 2 mL [UGH] J2001 $25.00 25935295 lidocaine 1% PF Inj Sol 30 mL [UGH] J2001 $55.35 25935296 lidocaine 1% PF Inj Sol 5 mL [UGH] J2001 $25.00 27148471 lidocaine 1% Sol J2001 $25.00 26407647 lidocaine 2% Inj Sol 50ml MDV [UGH] J2001 $37.20 25935298 lidocaine 2% preservative-free Sol [UGH] J2001 $25.00 26010446 lidocaine 2% preservative-free Sol 5 mL [UGH] J2001 $25.00 25935299 lidocaine 5%-D7.5% Inj Sol 2 mL [UGH] J2001 $45.02 25983395 Lidocaine and Prilocaine 2.5% Crm 5 g [UGH] $160.80 25966493 lidocaine Top 2% JELLY 5ml [UGH] $37.80 25935821 lidocaine Top 4% mucous membrane Sol [UGH] $24.00 26010995 lidocaine topical 2% Gel 30 mL [UGH] $366.72 26131652 lidocaine topical 2% Gel[UGH] $31.05 26407752 lidocaine topical 4% Sol 4ml [UGH] $96.00 26010973 lidocaine topical 5% Fil [UGH] $42.12 26011233 lidocaine topical 5% Oin 35 g [UGH] $1,200.00 26010418 lidocaine viscous 2% Sol 100 mL [UGH] $52.80 26010419 lidocaine viscous 2% Sol UD 15 mL [UGH] $5.40 260133141740019 LIFESTYLE RISK REDUCTION MONTHLY DUES $69.00 269505111440611 LIGHT SOURCE $38.00 2640996410091450 LINER ACE 32MM 52MM $2,375.00 2640970210091180 LINER ACETABULAR 32MM 48MM $2,375.00 2640976510091250 LINER ACETABULAR 32MM 50MM $2,375.00 2640967210091150 LINER ACETABULAR 36MM $2,000.00 2640967810091150 LINER ACETABULAR 36MM 58 MM $2,375.00 2640913210090300 LINER MODULAR ACETABULAR $3,320.00 25935938 linezolid 2 mg/mL IV Sol [UGH] j3370 $240.00 26010794 linezolid 600 mg Tab [UGH] $734.69 6337761290261 LIPASE 83690 $83.00 261667391290166 LIPASE URINE 83690 $83.00 241046541290131 LIPID SCREEN 80061 $68.00 15500601290434 LIPO PROTEIN A - Lp(a) 82172 $108.00 25935304 lisinopril 10 mg Tab [UGH] $6.18 26010801 lisinopril 20 mg Tab [UGH] $5.00 26946259 lisinopril 40 mg Tab $7.78 26011153 lisinopril 40 mg Tab UD [UGH] $5.00 25935305 lisinopril 5 mg Tab [UGH] $5.00 26053873 LISINOPRIL-HYDROCHLOROTHIAZIDE TAB 10-12.5 MG [UGH] $5.55 27811471291009 LISTERIA ANTIBODY 86609 $53.00 13995681290262 LITHIUM 80178 $63.00 25935306 lithium 150 mg Cap [UGH] $5.00 25935307 lithium 300 mg Cap [UGH] $5.00 25935939 lithium 450 mg ER Tab [UGH] $5.00 247800991290765 LIVER KIDNEY MICROSOME 86376 $75.00 26655517 l-methylfolate 7.5 mg Tab [UGH] $14.82 261667091293669 LOBSTER IgE 86003 $21.00 2640947910090950 LOCKING SCREW 1.5MM 13MM BLUE $495.00 2640947510090940 LOCKING SCREW 1.5MM 6MM BLUE $327.00 2640947610090940 LOCKING SCREW 1.5MM 7MM BLUE $327.00 2640947710090950 LOCKING SCREW 1.5MM 8MM BLUE $495.00 2640947810090950 LOCKING SCREW 1.5MM 9MM BLUE $495.00 25935308 loperamide 1 mg/5 mL Oral Liq [UGH] $5.00 26011030 loperamide 2 mg Cap UD [UGH] $5.25 25935309 loratadine 10 mg Tab [UGH] $5.00 25935940 loratadine 5 mg/5 mL Oral Syrup [UGH] $5.00 26979406 loratadine 5 mg/5 mL Syr $5.00 25935310 LORazepam 0.5 mg Tab [UGH] $5.00 26010990 LORazepam 1 mg Tab [UGH] $5.00 27109445 LORazepam 2 mg/mL Con $159.20 25935311 LORazepam 2 mg/mL Inj Sol [UGH] J2060 $25.00 25966744 LORazepam 2 mg/mL Oral Conc [UGH] $151.44 26011510 LORazepam 2 mg/mL Sol 10 mL [UGH] J2060 $40.68 26471148 LORAZEPAM KEY (ATIVAN) [UGH] $0.00 25935313 losartan 100 mg Tab [UGH] $5.00 26989947 losartan 25 mg Tab $8.06 25955184 losartan 25 mg Tab [UGH] $8.40 26769491 losartan 50 mg Tab $11.31 25955185 losartan 50 mg Tab [UGH] $9.61 27141621 lovastatin 20 mg Tab $11.86 25935315 lovastatin 20 mg Tab [UGH] $11.86 25935316 lubiprostone 8 mcg Cap [UGH] $33.39 263542671400188 LUMBAR PUNCTURE 62270 $860.00 259062171400188 Lumbar Puncture Procedure 62270 $860.00 2640930210090570 LUMBO-SACRAL SUPPORT UNIVERSAL $55.00 26876341290185 Lupus Anticoagulant Evaluation w/ Reflex QST 85300 $152.00 73231411290260 LUTEINIZING HORMONE 83002 $110.00 26486272 LVP solution with potassium Dextrose 5% with 0.2% NaCl and KCl 20 $90.00 mEq/L Sol [UGH] 26251350 LVP solution with potassium Dextrose 5% with 0.45% NaCl and KCl 10 $90.00 mEq/L Sol [UGH] 7922991290326 LYME DISEASE ANTIBODY IgM & IgG 86617 $168.00 11580491290325 LYMES TITER BY ELISA 86618 $99.00 250727321290430 LYMPHOCYTE SUBSET PANEL 5 86361 $360.00 25935317 Lypholyte II/Nutrilyte II/TPN Electrolytes IV Sol 20 mL [UGH] $25.00 10035781540148 MA Breast Tissue Specimen 76098 $120.00 251487561530028 MA Diag Implant Lt. 77065 $198.00 251487591530027 MA Diag Implant Rt. 77065 $198.00 251487621530023 MA Routine Screen Bil Implant. $192.00 265709121530023 MA Routine Screen Digital Bil. 77067 $192.00 257498811530033 MA Routine Screen Implant w/ Tomo Bil. 77067 $192.00 228392291530033 MA Screen Breast Tomo Bil. 77063 $78.00 257498871530035 MA Screen Breast Tomo Rt. 77067 $192.00 9955221440612 MAC/ Block Anesthesia $345.00 27067164 Magic Mouthwash [UGH] $30.00 27067168 Magic Mouthwash w/Decadron [UGH] $60.00 6337811290076 MAGNESIUM 83735 $82.00 10155542590659 MAGNESIUM 24 HR URINE 83735 $68.00 26971023 magnesium citrate 8.85% Oral Liq 296 mL [UGH] $10.51 25935823 magnesium hydroxide 8% Oral Susp 30 mL [UGH] $11.70 26011048 magnesium oxide 400 mg (240 mg elemental magnesium) Tab UD [UGH] $5.00

255523421290939 MAGNESIUM RBC 83735 $82.00 27052012 magnesium sulfate 10 mg/mL-D5% Sol J3475 $90.00 25935319 magnesium sulfate 10 mg/mL-D5W intravenous solution [UGH] J3475 $90.00 26866529 magnesium sulfate 2 g/50 mL-sterile water Sol j3475 $86.63 25935320 magnesium sulfate 2 g/50 mL-sterile water Sol [UGH] j3475 $78.75 27016556 magnesium sulfate 40 g/1000 mL-sterile water Sol J3475 $394.56 25935321 magnesium sulfate 40 g/1000 mL-sterile water Sol [UGH] J3475 $90.00 26814274 magnesium sulfate 454 gm Soln [UGH] $14.95 25935824 magnesium sulfate 50% Inj Sol 2 mL [UGH] j3475 $25.00 25935323 magnesium sulfate 50% Inj Sol 20 mL [UGH] J3475 $25.00 262423201290659 Magnesium U24 (w/o Creat) QST 83735 $68.00 2640898310090110 MALE SLING KIT ADVANCE $10,500.00 25935324 mannitol 20% IV Sol 500 mL [UGH] J2150 $114.30 25935325 mannitol 25% IV Sol 50 mL [UGH] J2150 $25.00 259441881290039 MANUAL DIFF 85007 $24.00 6922521720018 MANUAL THERAPY 15 MIN 97140 $55.00 6913191730016 Manual therapy techniques (eg mobilization/ manipulation m 97140 $55.00 261666861291051 MAPLE (BOX ELDER) IgE 86003 $21.00 6922511720016 MASSAGE THERAPY 15 MIN 97124 $50.00 79881186765 Measles Ab IgG QST 86765 $50.00 32357481290511 MEASLES ANTIBODY IGG 86765 $50.00 26011547 measles/mumps/rubella virus vaccine - Pow [UGH] $349.39 6922201720003 MECHANICAL TRACTION THERAPY 97012 $50.00 26949582 meclizine 12.5 mg Tab $5.00 25962218 meclizine 12.5 mg Tab [UGH] $5.00 26008958 meclizine HCl 25 mg Tab UD [UGH] $5.00 25935327 medroxyPROGESTERone 10 mg Tab [UGH] $5.00 25961994 medroxyPROGESTERone 150 mg/mL IM Susp [UGH] J1050 $460.80 25935329 medroxyPROGESTERone 5 mg Tab [UGH] $5.00 25935330 megestrol 40 mg Tab [UGH] $5.23 27081798 megestrol 40 mg/mL Sus $20.88 26010421 megestrol 40 mg/mL Sus UD [UGH] $21.15 26798160 melatonin 3 mg Tab $5.00 26414312 melatonin 3 mg Tab [UGH] $5.00 2640925110090440 MELKER EMERGENCY CRICOTHYROTOMY $1,137.00 26795255 meloxicam 15 mg Tab $24.22 25935944 meloxicam 15 mg Tab [UGH] $21.29 25955320 meloxicam 7.5 mg Tab [UGH] $15.49 25955331 MEMANTINE 10MG [UGH] $27.46 25935946 memantine 5 mg Tab [UGH] $5.00 2704594110091200 MEMORY GEL BREAST IMPLANT 300CC $2,450.00 2640946710090940 MEMORYGEL BREAST IMPLANTS $2,700.00 2640958610091060 MEMORYGEL BREAST IMPLANTS 300 CC $2,700.00 2640958410091060 MEMORYGEL BREAST IMPLANTS 334-1002 225CC $2,700.00 2640958510091060 MEMORYGEL BREAST IMPLANTS 334-1159 305CC $2,700.00 2640958310091060 MEMORYGEL BREAST IMPLANTS 334-1402 620CC $2,700.00 2640957110091040 MEMORYGEL BREAST IMPLANTS 334-1452 $2,500.00 2640957410091050 MEMORYGEL BREAST IMPLANTS 334-1455 $2,840.00 2640949710090970 MEMORYGEL BREAST IMPLANTS 350-3504 $2,450.00 2640949810090970 MEMORYGEL BREAST IMPLANTS 350-4004 $2,450.00 2640961010091090 MEMORYGEL BREAST IMPLANTS 354-1158 $2,700.00 2640960910091080 MEMORYGEL BREAST IMPLANTS 354-1208 $2,700.00 2640960810091080 MEMORYGEL BREAST IMPLANTS 354-1258 $2,700.00 2640961110091090 MEMORYGEL BREAST IMPLANTS 354-1308 $2,700.00 2640995510091440 MEMORYGEL BREAST IMPLANTS XTRA $2,456.00 2640995610091440 MEMORYSHAPE BREAST IMPLANT $2,840.00 25935334 meperidine 25 mg/0.5 mL Inj Sol [UGH] J2175 $25.00 25935332 meperidine 25 mg/mL Inj Sol [UGH] J2175 $32.13 26553268 meperidine 25 mg/mL Sol [UGH] J2175 $25.00 25935333 meperidine 50 mg Tab [UGH] $15.10 26765697 meperidine 50 mg/mL Sol J2175 $25.00 26010996 meperidine 50 mg/mL Sol 1 mL vial[UGH] J2175 $33.21 25935335 mepivacaine 1% PF Inj Sol 30 mL [UGH] J0670 $32.00 25935336 mercaptopurine 50 mg Tab [UGH] $10.42 7835811290771 MERCURY BLOOD 83825 $50.00 25966140 meropenem 1 g IV Inj [UGH] J2185 $139.88 27122720 meropenem 1000 mg Pow J2185 $208.00 25935948 meropenem 500 mg IV Inj [UGH] J2185 $174.80 27070629 meropenem 500 mg Pow J2185 $104.00 25935338 mesalamine 250 mg ERCap [UGH] $18.22 25935339 mesalamine 4 g/60 mL Rectal Enema [UGH] $97.16 26008980 mesalamine 400 mg Oral EC Tab [UGH] $21.26 2640898510090110 MESH 3D LIGHT MEDIM LEFT $780.00 2640898610090110 MESH 3D LIGHT MEDIM RIGHT $780.00 2640985210091340 MESH 3D MAX LARGE LEFT 4.3 X 6.3 $450.00 2640985410091340 MESH 3D MAX LARGE RIGHT 4.3 X 6.3 $450.00 2640985310091340 MESH 3D MAX XLARGE LEFT 5 X 7 $615.00 2640985510091340 MESH 3D MAX XLARGE RIGHT 5 X 7 $615.00 2640898710090110 MESH 3DMAX LITE LARGE LEFT $605.00 2640898810090110 MESH 3DMAX LITE LARGE RIGHT $605.00 2640905310090210 MESH 3DMAX LITE X LARGE LEFT $668.00 2640899010090120 MESH 3DMAX LITE XLARGE RIGHT $668.00 2640899810090130 MESH 6'' ROUND PARIETEX $1,976.00 2640900210090130 MESH COMPOSIX 3 X 6 $885.00 2640900410090140 MESH COMPOSIX 8 X 10 $2,588.00 2640900310090140 MESH COMPOSIX LAP VENTRAL 10X15CM $1,410.00 2640900010090130 MESH COMPOSIX LP ELLIPSE 4X6 $1,213.00 2640900510090140 MESH DUALEX OVAL 15 X 19 $3,000.00 2640905510090220 MESH HERNIA PLUG LARGE MARLEX PERFIX $867.00 2640905410090220 MESH HERNIA PLUG MEDIUM MARLEX PERFIX $2,169.00 2640899910090130 MESH HERNIA PLUG X-LARGE MARLEX PERFIX $900.00 2640898410090110 MESH HERNIA REPAIR 2 X 4 MARLEX POLY $420.00 2640905610090220 MESH HERNIA REPAIR 6X6 $461.00 2640899610090130 MESH PARIETEX COMPOSITE 14.5X11 $4,619.00 2640899710090130 MESH PARIETEX COMPOSITE 8X10 $3,062.00 2640899210090120 MESH SEPRA 4X6 $954.00 2640900110090130 MESH SEPRA 6X8 $1,881.00 2640955310091030 MESH SEPRA 7X9 $2,674.00 2640899310090120 MESH SEPTRA 8X12 $3,554.00 2640899410090120 MESH ULTRAPRO PARTIALLY ABSORBABLE $496.00 2640900610090150 MESH VENTRALEX 1.7 CIRCLE $975.00 2640900710090150 MESH VENTRALEX 2.5 CIRCLE $1,163.00 2640900810090150 MESH VENTRALEX 3.2 CIRCLE $1,500.00 2640911710090290 MESH VENTRALIGHT ST MESH 8 X 10 $2,666.00 2640942010090880 MESH VENTRIO ST HERNIA LG CIRCLE 4.5 $1,613.00 2640941910090880 MESH VENTRIO ST HERNIA LG OVAL 5.4 X 7 $2,150.00 2640942110090880 MESH VENTRIO ST HERNIA XLG OVAL 8.7 X 10 $3,548.00 15496861290403 METANEPHRINESPLASMA FRACTIONATED 83835 $204.00 25935340 metaxalone 800 mg Tab [UGH] $22.93 26009001 metFORMIN 500 mg ER Tab [UGH] $5.00 25955243 metFORMIN 500 mg Tab [UGH] $5.00 27090578 metFORMIN 850 mg Tab $6.05 26009002 metFORMIN 850 mg Tab [UGH] $6.02 26957185 methadone 10 mg Tab S0109 $7.00 25935950 methadone 10 mg Tab [UGH] S0109 $7.00 27139617 methadone 40 mg DSP [UGH] S0109 $7.00 25935342 methadone 5 mg Tab [UGH] S0109 $7.00 25935343 methadone 5 mg/5 mL Oral Sol [UGH] S0109 $7.00 25962718 methenamine hippurate 1 g Tab [UGH] $10.46 25935344 methimazole 5 mg Tab [UGH] $5.00 26010457 methocarbamol 100 mg/mL Inj Sol [UGH] J2800 $464.00 25955323 methocarbamol 500 mg Tab [UGH] $5.00 25935953 methocarbamol 750 mg Tab [UGH] $5.00 25935346 methotrexate 2.5 mg Tab [UGH] J8610 $28.07 25935347 methotrexate 25 mg/mL Inj Sol [UGH] J9250 $42.95 25983772 methotrexate 25 mg/mL Sol 10 mL [UGH] J9250 $161.24 25935348 methylcellulose compounding Pwdr [UGH] $15.00 25935349 methyldopa 250 mg Tab [UGH] $5.00 25935350 methylene blue 10 mg/mL Inj Sol 1 mL [UGH] $45.45 25983774 methylene blue 10 mg/mL Sol 10 mL [UGH] $805.43 27152986 methylene blue 5 mg/mL Sol $96.65 25962693 methylergonovine 0.2 mg Tab [UGH] $298.63 25935955 methylergonovine 0.2 mg/mL Inj Sol [UGH] J2210 $42.89 25935956 methylPREDNISolone 1 g preservative-free Pow [UGH] J1030 $201.08 25935351 methylPREDNISolone 125 mg preservative-free Pow [UGH] J1030 $52.34 25955324 methylPREDNISolone 4 mg Tab [UGH] J7509 $8.25 25935957 methylPREDNISolone 40 mg preservative-free Pow [UGH] J2920 $36.10 25935958 methylPREDNISolone 40 mg/mL Inj Susp [UGH] J1030 $57.06 25935353 methylPREDNISolone 500 mg Inj [UGH] J2930 $110.96 25966828 methylPREDNISolone 80 mg/mL Inj Susp [UGH] J1030 $99.05 26010786 metoclopramide 5 mg Tab [UGH] $5.00 25935356 metoclopramide 5 mg/5 mL Oral Syrup [UGH] $5.00 26011474 metoclopramide 5 mg/mL Inj Sol 2mL[UGH] J2765 $25.00 25935959 METOCLOPRAMIDE TAB 10 MG 100 [UGH] $5.00 25966122 metolazone 2.5 mg Tab [UGH] $12.89 26011144 metolazone 5 mg Tab [UGH] $7.54 26054061 metoprolol 1 mg/mL Inj Sol [UGH] $25.00 25961617 metoprolol 25 mg ER Tab [UGH] $5.53 27086091 metoprolol 25 mg Tab $5.58 25935359 metoprolol 25 mg Tab [UGH] $5.00 25936318 metoprolol 50 mg ER Tab [UGH] $5.58 26980447 metoprolol 50 mg Tab $6.29 26010468 metoprolol 50 mg Tab UD [UGH] $5.00 25935361 metroNIDAZOLE 250 mg Tab [UGH] $5.00 25935362 metroNIDAZOLE 500 mg/100 mL IV Sol [UGH] S0030 $75.00 10052941530012 MG ADDT'L DIGITAL DIAG VIEWS BILAT 77066 $210.00 11363101530011 MG ADDT'L DIGITAL DIAG VIEWS LT 77065 $198.00 10053031530010 MG ADDT'L DIGITAL DIAG VIEWS RT 77065 $198.00 228392171530038 MG DIGITAL DIAG LT TOMO/CAD 77065 $192.00 228392231530037 MG DIGITAL DIAG RT TOMO/CAD 77065 $198.00 228392111530034 MG DIGITAL DIAG W TOMO/CAD $192.00 52313041530029 MG DIGITAL DIAGNOSTIC BILAT 77066 $210.00 52313071530028 MG DIGITAL DIAGNOSTIC UNILAT LT 77065 $198.00 52313101530027 MG DIGITAL DIAGNOSTIC UNILAT RT 77065 $198.00 52313131530023 MG DIGITAL SCREENING BILAT 77067 $192.00 257498841530036 MG DIGITAL SCREENING LT TOMO 77067 $192.00 250358411530036 MG DIGITAL SCREENING LT TOMO/CAD 77067 $192.00 250358441530035 MG DIGITAL SCREENING RT TOMO/CAD 77067 $192.00 254887611530030 MG DIGITAL SCREENING UNILAT LT 77067 $192.00 254887671530031 MG DIGITAL SCREENING UNILAT RT 77067 $192.00 228392261530023 MG DIGITAL SREENING W TOMO/CAD 77067 $192.00 12868991530032 MG NEEDLE LOC LT 19281 $234.00 12869011530019 MG NEEDLE LOC RT 19281 $234.00 12407091530022 MG SURG SPECIMEN 76098 $528.00 25935960 micafungin 100 mg IV Inj [UGH] J2248 $897.60 26814141 micafungin 50 mg IV Inj [UGH] J2248 $448.80 25961821 miconazole 2% Vag Crm w/Appl [UGH] $38.70 26952219 Miconazole 3 Combo Pack [UGH] $53.56 25935364 miconazole Top 2% Crm [UGH] $11.80 16575871290465 MICROALBUMIN URINE 82043 $88.00 268090431440613 MICROSCOPE $225.00 194386981290527 MICROSCOPIC EXAM URINE 81015 $16.00 25935961 midazolam 1 mg/mL preservative-free Inj Sol 2 ml vial [UGH] J2250 $25.00 25935962 midazolam 1 mg/mL preservative-free Inj Sol 5 ml vial [UGH] J2250 $25.00 25935827 midazolam 2 mg/mL Oral Syrup 5ml [UGH] $32.99 26071209 midazolam 5 mg/mL 2 mL [UGH] J2250 $25.00 25935963 midodrine 5 mg Tab [UGH] $13.55 256290861291085 MILK COW IgE 86003 $21.00 26010450 milrinone 1 mg/mL IV Sol 10 ml vial [UGH] J2260 $450.00 27157162 milrinone 1 mg/mL Sol J2260 $48.00 26010715 mineral oil 100% Liq 473 mL [UGH] $31.05 25935365 mineral oil 100% Oral Liq 30 mL [UGH] $5.00 27111204 mineral oil/petrolatum/phenylephrine topical 14%-74.9%-0.25% Oin $14.70 26010952 mineral oil/petrolatum/phenylephrine topical 14%-74.9%-0.25% Oin 57 gm $14.70 [UGH] 2640964010091120 MINI QUICK ANCHOR WITH 2/0 ORTHO SUTURE $1,323.00 2640964110091120 MINI QUICK ANCHOR WITH 3/0 ORTHO SUTURE $1,323.00 26010396 minocycline 100 mg Cap [UGH] $16.99 26010469 minoxidil 2.5 mg Tab UD [UGH] $8.48 25935366 mirabegron 25 mg Tab [UGH] $61.49 26011073 mirtazapine 15 mg tablets [UGH] $5.00 26098531 misoprostol 100 mcg Tab [UGH] $5.00 11580501290295 MITOCHONDRIAL ANTIBODY 86255 $82.00 25935367 mivacurium 2 mg/mL IV Sol [UGH] $143.42 7924251290436 MMA-METHYLMALONIC ACID 83921 $200.00 25966820 modafinil 100 mg Tab [UGH] $105.51 259186811461130 MODERATE SEDATION EA ADDL 15 MIN TECH FEE 99153 $27.00 262926291461131 MODERATE SEDATION INITIAL 15 MIN TECH FEE 99151 $125.00 98520421710014 MODIFIED BARIUM SWALLOW STUDY 92611 $185.00 25966139 moexipril 7.5 mg Tab [UGH] $6.95 25935967 mometasone Nasal 50 mcg/inh Spry [UGH] $1,206.88 13039351290049 MONOTEST 86308 $43.00 26010776 montelukast 10 mg Tab [UGH] $5.00 26010774 montelukast 5 mg Chew Tab [UGH] $20.53 26010773 montelukast sodium chewable 4 mg tabs [UGH] $22.63 25984011 morphine 1 mg/mL preservative-free Sol 10 mL [UGH] J2274 $76.30 25935372 morphine 10 mg/mL preservative-free Sol [UGH] J2270 $25.00 25983905 morphine 15 mg ER Tab UD [UGH] $9.36 25935968 morphine 15 mg IR Tab [UGH] $7.00 26071210 morphine 20 mg/mL Con [UGH] $12.55 25935970 morphine 20 mg/mL Oral Conc [UGH] $126.00 25983899 morphine 30 mg ER Tab [UGH] $16.65 25983911 morphine 4 mg/mL preservative-free Sol [UGH] J2270 $25.00 26952487 morphine 50 mg / 50 mL Syringe [UGH] $185.00 25983915 MORPHINE SYRG 2 MG/ML [UGH] J2274 $25.00 25935374 moxifloxacin 0.5% Ophth Sol [UGH] $788.44 25962530 moxifloxacin 400 mg Tab [UGH] $108.78 22140111650010 MRA ABDOMEN 74185 $1,230.00 265683591600006 MRA ABDOMEN /MRCP 76376 $210.00 10053651650008 MRA BRAIN 70544 $1,410.00 10053781650017 MRA CAROTID 70548 $1,410.00 10053721650015 MRA LOWER EXT 73725 $1,410.00 10053851650018 MRA SPINE 72159 $1,440.00 13956481650016 MRA UPPER EXT 73225 $1,230.00 31250911650009 MRA/MRV BRAIN 70544 $1,800.00 10053911650065 MRI ABDOMEN W/ W/O CONTRAST 74183 $2,040.00 11609771650062 MRI ANKLE LT 73721 $1,800.00 11611191650063 MRI ANKLE RT 73721 $1,800.00 11636531163653 MRI Ankle w/ + w/o Cont Lt 73723 $1,642.00 11636551163655 MRI Ankle w/ + w/o Cont Rt 73723 $1,642.00 8213921650073 MRI BRACHIAL PLEXUS W W/O 73220 $2,160.00 15255231650072 MRI BRACHIAL PLEXUS W/O 73218 $1,920.00 8214001650020 MRI BRAIN W 70552 $2,250.00 8214021650019 MRI BRAIN W/O 70551 $1,890.00 8213981650021 MRI BRAIN W/WO 70553 $2,370.00 106078851650023 MRI BRAIN/IACS W/WO 70553 $2,370.00 17797911650022 MRI BRAIN/PITUITARY W/WO 70553 $2,370.00 10054151650025 MRI CHEST 71550 $1,560.00 8214411650026 MRI C-SPINE 72141 $1,560.00 8214391650027 MRI C-SPINE W 72142 $1,890.00 10055011650033 MRI C-SPINE W/WO 72156 $2,040.00 11611221650046 MRI ELBOW LT 73221 $1,800.00 11611241650047 MRI ELBOW RT 73221 $1,800.00 11636611163661 MRI Elbow w/ + w/o Cont Lt 73223 $2,000.00 11636631163663 MRI Elbow w/ + w/o Cont Rt 73223 $2,000.00 261437021650006 MRI Face + Orbits w/o Cont 70540 $1,320.00 10054201650004 MRI Face Neck Orbit w/o Cont 70540 $1,800.00 8214101650052 MRI FEMUR LT 73718 $2,160.00 8214121650053 MRI FEMUR RT 73718 $2,160.00 11611271161127 MRI Femur w/ + w/o Cont Lt 73720 $2,160.00 11611301161130 MRI Femur w/ + w/o Cont Rt 73720 $2,160.00 10054361650056 MRI FOOT LT 73718 $2,160.00 10054381650057 MRI FOOT RT 73718 $2,160.00 10054241005424 MRI Foot w/ + w/o Cont Lt 73720 $2,160.00 10054261005426 MRI Foot w/ + w/o Cont Rt 73720 $2,160.00 11636771650040 MRI FOREARM LT 73218 $1,920.00 11636791650041 MRI FOREARM RT 73218 $1,920.00 11611321161132 MRI Forearm w/ + w/o Cont Lt 73220 $2,160.00 11611351161135 MRI Forearm w/ + w/o Cont Rt 73220 $2,160.00 13198941650042 MRI HAND LT 73218 $1,920.00 13198961650043 MRI HAND RT 73218 $1,920.00 13198901319890 MRI Hand w/ + w/o Cont Lt 73220 $2,160.00 13198921319892 MRI Hand w/ + w/o Cont Rt 73220 $2,160.00 13199021650058 MRI HIP LT 73721 $1,800.00 13199041650059 MRI HIP RT 73721 $1,800.00 13198981319898 MRI Hip w/ + w/o Cont Lt 73723 $1,642.00 13199001319900 MRI Hip w/ + w/o Cont Rt 73723 $1,642.00 13199101650038 MRI HUMERUS LT 73218 $1,920.00 13199121650039 MRI HUMERUS RT 73218 $1,920.00 13199061319906 MRI Humerus w/ + w/o Cont Lt 73220 $2,160.00 13199081319908 MRI Humerus w/ + w/o Cont Rt 73220 $2,160.00 8214571650075 MRI JOINT UPPER EXT W/O 73721 $1,800.00 11611391650060 MRI KNEE LT 73721 $1,800.00 11611421650061 MRI KNEE RT 73721 $1,800.00 13199141319914 MRI Knee w/ + w/o Cont Lt 73723 $1,642.00 13199161319916 MRI Knee w/ + w/o Cont Rt 73723 $1,642.00 10053951650011 MRI LIVER W/O CONTRAST 74181 $1,800.00 8214161650078 MRI LOWER EXTREMITY JOINT W W/O 73723 $1,642.00 8214431650032 MRI L-SPINE W 72149 $2,160.00 8214451650030 MRI L-SPINE W/O 72148 $1,800.00 10055031650035 MRI L-SPINE W/WO 72158 $2,520.00 10054661650074 MRI LWR EXT NON JOINT W/WO 73720 $1,800.00 244672641650013 MRI MRCP 74181 $1,800.00 261437051650004 MRI Neck w/o Cont 70540 $1,800.00 94804951650005 MRI NECK W/WO 70543 $1,800.00 8214081650003 MRI ORBIT FACE NECK W/CONTRAST 70542 $1,800.00 8214061650001 MRI ORBITS W/WO 70543 $2,400.00 821432821432 MRI Pelvis w/ Cont 72196 $1,920.00 8214341650036 MRI PELVIS W/O 72195 $1,800.00 10054971650037 MRI PELVIS W/WO 72197 $2,280.00 112207851650031 MRI SACRUM/COCCYX 72195 $1,800.00 119509221650051 MRI SHOULDER ARTH LT 73222 $1,800.00 119509251650050 MRI SHOULDER ARTH RT 73222 $1,800.00 13199221650048 MRI SHOULDER LT 73221 $1,800.00 13199241650049 MRI SHOULDER RT 73221 $1,800.00 13199181319918 MRI Shoulder w/ + w/o Cont Lt 73223 $2,000.00 13199201319920 MRI Shoulder w/ + w/o Cont Rt 73223 $2,000.00 8214491650028 MRI THORACIC SPINE W/O 72146 $1,800.00 13199301650054 MRI TIB/FIB LT 73718 $2,160.00 13199321650055 MRI TIB/FIB RT 73718 $2,160.00 13199261319926 MRI Tibia/Fibula w/ + w/o Cont Lt 73720 $2,160.00 13199281319928 MRI Tibia/Fibula w/ + w/o Cont Rt 73720 $2,160.00 10055071650067 MRI TMJ'S 70336 $2,160.00 8214471650029 MRI T-SPINE W 72147 $2,160.00 10055051650034 MRI T-SPINE W/WO 72157 $2,280.00 10075241650076 MRI UPPER EXT NON JOINT W W/O 73220 $2,160.00 10075701650044 MRI WRIST LT 73221 $1,800.00 10075721650045 MRI WRIST RT 73221 $1,800.00 10075581007558 MRI Wrist w/ + w/o Cont Lt 73223 $2,000.00 10075601007560 MRI Wrist w/ + w/o Cont Rt 73223 $2,000.00 257596291290735 MRSA SCREEN 87081 $45.00 25935972 Multiple Vitamins IV Sol 10 mL [UGH] $194.24 25935376 Multiple Vitamins Tab [UGH] $5.00 25935973 Multivitamin Liquid [UGH] $94.84 26009728 multivitamin Vitamin B Complex with C and Folic Acid Tab [UGH] $5.00 26010543 multivitamin with iron Vitamin B Complex with Iron and Intrinsic Factor $5.00 Cap [UGH] 26009722 multivitamin with minerals Antioxidant Multiple Vitamins and Minerals Cap $5.00 [UGH] 26488663 multivitamin with minerals Multiple Vitamins with Minerals Liq [UGH] $5.00 154963686735 Mumps IgG Ab QST 86735 $96.00 25935974 mupirocin Top 2% Crm [UGH] $980.64 25935377 mupirocin Top 2% nasal Oint w/appl [UGH] $73.11 26011105 mupirocin Top 2% Oint [UGH] $100.00 100520771720033 MUSCLE TEST W/R BDY 95833 $55.00 100520731720034 MUSCLE TEST W/R EXT 95831 $40.00 100520751720035 MUSCLE TEST W/R HAND 95832 $40.00 261667111291086 MUSTARD IgE 86003 $21.00 260262201290401 MYCOPLASMA ANTIBODIES (IgG & IgM) 86738 $106.00 15496341290266 MYOGLOBIN 83874 $129.00 2640904910090210 MYOSURE LITE TISSUE REMOVAL DEVICE $1,322.00 2404114510090210 MYOSURE TISSUE REMOVAL DEVICE $2,061.00 256290991290323 MYSOLINE (PRIMIDONE) 80188 $66.00 26769530 nabumetone 500 mg Tab $6.46 25935379 nabumetone 500 mg Tab [UGH] $6.48 27107254 nadolol 40 mg Tab $20.06 25935380 nadolol 40 mg Tab [UGH] $32.52 26099364 nafcillin 1 g Inj [UGH] s0032 $65.70 26099369 nafcillin 2 g Inj [UGH] $149.40 2640971810091190 NAIL 12 X 170 $3,344.00 2640970810091180 NAIL 9 X 170 $3,831.00 2640973410091210 NAIL FEMORAL 12MM $3,809.00 2640974610091230 NAIL FEMORAL 13MM 180MM $3,925.00 2640974710091230 NAIL FEMORAL 75MM $1,710.00 2701336110091690 NAIL LONG 320MM 125 RIGHT $6,232.00 2640964910091130 NAIL LONG 320MM X 125 $6,232.00 2705553710091700 NAIL LONG 340MM 125 LEFT $6,232.00 2705553510091700 NAIL LONG 360MM 125 RIGHT $6,232.00 2640965110091130 NAIL LONG 380MM X 125 $6,232.00 2640977510091260 NAIL SHORT 220MM X 130 DEGREE $5,112.00 2640978010091260 NAIL TFNA 10 X 170 $3,344.00 25935381 nalbuphine 10 mg/mL Inj Sol [UGH] j2300 $25.00 25935976 nalbuphine 20 mg/mL Inj Sol [UGH] j2300 $37.40 25983770 naloxone 0.4 mg/mL Sol 1 mL [UGH] J2310 $85.50 25935977 naloxone 1 mg/mL Inj Sol 2ml syringe [UGH] j2310 $158.40 25935383 naphazoline-pheniramine Ophth 0.025%-0.3% Sol [UGH] $40.59 25935978 naproxen 375 mg Tab [UGH] $5.32 25955330 naproxen 500 mg Tab [UGH] $5.00 27110506 naproxen sodium 220 mg Tab $5.00 25935384 naproxen sodium 220 mg Tab [UGH] $5.00 253734091460078 NASAL CAUTERIZATION/PACKING 30901 $156.00 262926141461067 NASAL PROCEDURE-FACILITY 30999 $252.00 186165517000072 NASOTRACHEAL ASPIRATION 31720 $488.00 25935385 natalizumab 300 mg/15 mL IV Conc [UGH] J2323 $21,187.20 26010536 nateglinide 120 mg Tab UD [UGH] $10.34 25935386 nebivolol 5 mg Tab [UGH] $23.55 2640924610090430 NEEDLE CATHETER YUEH CENTISIS DISPOSABLE $48.00 254847731750009 NEG PRESSURE WOUND THERAPY <=50 SQ CM 97605 $353.00 253401011750010 NEG PRESSURE WOUND THERAPY > 50 SQ CM 97606 $353.00 142750141720051 NEGATIVE PRESSURE WOUND THPY <=50 CM2 97605 $100.00 219720471720052 NEGATIVE PRESSURE WOUND THPY >50 CM2 97606 $215.00 26009726 neomycin 500 mg Tab [UGH] $6.82 25935980 NEOMYCIN-BACITRACIN-POLY-HC OINT 3.5-400-10,000 MG-UNIT/G- $260.20 1% 3.5gm opth oint [UGH] 25935829 neomycin-polymyxin B sulfate GU irrigant Sol 1 mL [UGH] $146.51 25935830 neomycin-polymyxin B sulfate GU irrigant Sol 20 mL [UGH] $583.60 26010697 NEOMYCIN-POLYMYXIN-DEXAMETH DRPS 3.5-10,000-0.1 MG/ML- $39.60 UNIT/ML-% 5 ml ophth drops [UGH] 25935982 NEOMYCIN-POLYMYXIN-GRAMICIDIN DROP 1.75-10K-0.025 MG-UNIT- $247.76 MG/ML 10 ml ophth drops [UGH] 26492636 neostigmine 0.5 mg/mL Sol [UGH] J2710 $36.60 25935983 neostigmine 1 mg/mL Inj Sol [UGH] j2710 $468.00 25935387 neostigmine 15 mg Tab [UGH] $12.74 26952215 Neostigmine 5mg/5ml Syringe [UGH] $74.25 253730181460154 NERVE INJECTION LEVEL I 20553 $453.60 253730171460039 NERVE INJECTIONS-LEVEL I 20552 $324.00 253735381460097 NERVE INJECTIONS-LEVEL II 62270 $564.00 25935388 nesiritide 1.5 mg IV Inj [UGH] j2325 $825.64 6922381720014 NEUROMUSCULAR RE-EDUC 15 MIN 97112 $50.00 173989901400203 NEW PATIENT FACILITY E&M - LEVEL I 99201 $125.00 173989911400205 NEW PATIENT FACILITY E&M - LEVEL II 99202 $250.00 173989921400207 NEW PATIENT FACILITY E&M - LEVEL III 99203 $375.00 158131201400209 NEW PATIENT FACILITY E&M - LEVEL IV 99204 $500.00 173989931400211 NEW PATIENT FACILITY E&M - LEVEL V 99205 $625.00 259830221390745 NEWBORN HEARING SCREENING 92585 $245.00 259830211397435 NEWBORN HEARING TEST - ABR EVALUATION 92585 $345.00 253734951461089 NG TUBE PLACEMENT- FAC 43752 $576.00 25935389 niacin 500 mg ER Tab [UGH] $24.48 25935390 niacin 750 mg ER Tab [UGH] $34.92 26485132 niacinamide 100 mg Tab [UGH] $5.00 25935984 niCARdipine 2.5 mg/mL Inj Sol [UGH] $228.50 25935391 niCARdipine 20 mg/200 mL-NaCl 0.86% IV Sol [UGH] $456.00 25966452 nicotine 14 mg/24 hr Filnicotine 14 mg/24 hr Patch [UGH] $10.71 25935831 nicotine 14 mg/24 hr Patch [UGH] $21.42 25935832 nicotine 21 mg/24 hr Patch [UGH] $10.67 26010503 nicotine 4 mg Oral transmucosal Gum [UGH] $5.00 25935392 nicotine 7 mg/24 hr Patch [UGH] $12.59 26009692 NIFEdipine 10 mg Cap [UGH] $6.43 25935985 NIFEdipine 30 mg ER Tab [UGH] $6.70 27107645 NIFEdipine 30 mg Tab $7.94 25935393 nitazoxanide 500 mg Tab [UGH] $494.40 25955308 nitrofurantoin macrocrystals 50 mg Cap [UGH] $39.80 25935395 nitrofurantoin macrocrystals-monohydrate 100 mg Cap [UGH] $22.96 18868901700021 NITROGEN WASHOUT & DLCO 94727 $193.00 25935396 nitroglycerin 0.1 mg/hr Transderm ER Film [UGH] $9.29 25935397 nitroglycerin 0.2 mg/hr Transderm ER Film [UGH] $8.08 25935398 nitroglycerin 0.3 mg sublingual Tab [UGH] $5.00 25935399 nitroglycerin 0.3 mg/hr Transderm ER Film [UGH] $11.83 25935400 nitroglycerin 0.4 mg SubL Spry [UGH] $911.33 26790522 nitroglycerin 0.4 mg sublingual Tab [UGH] $5.13 25935402 nitroglycerin 0.4 mg/hr Transderm ER Film [UGH] $9.23 25935403 nitroglycerin 0.6 mg/hr Transderm ER Film [UGH] $10.18 25935404 nitroglycerin 2% Top Oint [UGH] $13.80 25935405 nitroglycerin 50 mg/250 mL-D5W IV Sol [UGH] $116.00 25935406 nitroprusside 25 mg/mL IV Sol [UGH] $276.72 8233701590001 NM BONE SCAN 78306 $1,380.00 8233721590002 NM BONE SCAN 3 PHASE 78315 $1,500.00 8233681590003 NM BONE SCAN/LIMITED 78300 $700.00 10075921590040 NM BONE SPECT (ECT) 78320 $825.00 263499481590055 NM CV Stress Test Treadmill w/ Tracing 93017 $447.60 11678451590055 NM EXERCISE STRESS TEST 93017 $448.00 10076061590042 NM GASTRIC EMPTYING N/M 78264 $950.00 8233781590049 NM GI BLEED SCAN 78278 $900.00 8233861590025 NM Hepa Duct System 78227 $1,560.00 98814441590025 NM HIDA SCAN WITHOUT KINEVAC 78227 $1,560.00 10076171590005 NM LIVER SCAN 78201 $600.00 8233941590006 NM LUNG (PERF) SCAN 78580 $930.00 28936301590008 NM LUNG PERF-VENT SCAN 78582 $1,380.00 29429911590008 NM LUNG QUANT PERF-VENT SCAN 78598 $1,380.00 10076331590010 NM LYMPHOSCINTIGRAPHY 78195 $1,100.00 186701421590014 NM MECKLES SCAN 78290 $780.00 10076021590039 NM MUGA/REST 78472 $950.00 8233921590023 NM MYOCARDIAL PERFUSION REST STRESS 78452 $2,640.00 8253241590056 NM PARATHYROID IMAGING 78070 $900.00 29429711590050 NM RBC SCAN 78140 $1,300.00 8233831590055 NM REG TREADMILL 93017 $447.60 8233881590022 NM RENAL SCAN W/ FLOW W/ PHARM 78708 $1,080.00 10076111590021 NM RENAL SCAN W/FLOW W/O PHARM 78707 $1,080.00 21604881590023 NM STRESS TEST 1 DAY 78452 $2,640.00 33511491590012 NM THYROID (I-123) SCAN 78012 $1,680.00 10076911590062 NM VOIDING CYSTOGRAM 78740 $1,042.55 25943868 Non-Formulary Medication [UGH] $0.00 25935407 norEPINEPHrine 1 mg/mL IV Sol [UGH] $104.69 27070630 norepinephrine 1 mg/mL Sol $47.25 25935408 nortriptyline 25 mg Cap [UGH] $5.00 2640904710090210 NOVASURE STERILE DISP KIT NS2007US $2,173.00 269739911300317 NRAS 81311 $739.00 25935409 nystatin 100,000 units/mL Oral Susp [UGH] $6.31 26985074 nystatin 100000 units/mL Sus $5.55 25935410 nystatin Top 100,000 units/g Crm [UGH] $70.00 25935411 nystatin Top 100,000 units/g Pwdr [UGH] $215.28 27110507 nystatin topical 100,000 units/g Cre $70.00 26110925 nystatin topical 100000 units/g Cre [UGH] $105.00 27151053 nystatin topical 100000 units/g Oin $70.00 26010959 nystatin topical 100000 units/g Oin 15 g [UGH] $70.00 27050934 nystatin topical 100000 units/g Pow $149.84 26278936 nystatin topical 100000 units/g Pow [UGH] $109.86 25935412 nystatin-triamcinolone Top Crm [UGH] $447.76 25935413 nystatin-triamcinolone Top Oint [UGH] $447.76 27148469 nystatin-triamcinolone topical 100000 units/g-0.1% Oin $78.00 7873291290787 O & P 87177 $64.00 261666881291052 OAK IgE 86003 $21.00 261667031291087 OAT IgE 86003 $21.00 110185710763 OBSERVATION PER HOUR $25.00 2691869610783 Observation Telemetry $34.78 6337871290489 OCCULT BLOOD-GASTRIC 82271 $32.00 6337881290008 OCCULT BLOOD-STOOL 82272 $32.00 254339981730177 Occupational therapy evaluation high complexity requiring 97167 $228.00 254339941730175 Occupational therapy evaluation low complexity requiring t 97165 $228.00 254339961730175 Occupational therapy evaluation moderate complexity requir 97166 $228.00 25935414 octreotide 100 mcg/mL Inj Sol [UGH] J2354 $39.00 26253399 octreotide 200 mcg/mL Inj Sol [UGH] J2354 $477.04 26423174 octreotide 50 mcg/mL Sol[UGH] J2354 $27.00 2701877210091690 OCTRODE LEAD $4,400.00 26010667 ocular lubricant - Sol [UGH] $5.00 25983778 ofloxacin ophthalmic 0.3% Sol 5 mL [UGH] $83.76 26552720 ofloxacin otic 0.3% Sol [UGH] $1,179.48 25935417 OLANZapine 10 mg IM Inj [UGH] j2358 $164.72 26854036 OLANZapine 10 mg Pow j2358 $214.56 25935418 OLANZapine 2.5 mg Tab [UGH] $49.54 25935419 OLANZapine 5 mg Tab [UGH] $58.47 25935420 olmesartan 20 mg Tab [UGH] $26.19 26957429 olmesartan 5 mg Tab $25.44 25935421 olmesartan 5 mg Tab [UGH] $28.24 25935422 olopatadine Ophth 0.1% Sol [UGH] $1,315.96 27017400 olopatadine ophthalmic 0.1% Sol $1,026.00 25935423 omalizumab 150 mg SubQ Inj [UGH] J2357 $5,206.36 27108064 omalizumab 150 mg/mL Sol [UGH] J2357 $5,206.36 25935424 omega-3 polyunsaturated fatty acids ethyl esters 1000 mg oral capsule $13.21 [UGH] 25935425 omeprazole 20 mg Oral EC Cap [UGH] $5.57 25935426 onabotulinumtoxinA 100 units Pow [UGH] j0585 $2,884.80 25935427 ondansetron 2 mg/mL Inj Sol [UGH] j2405 $25.00 25935986 ondansetron 4 mg Dis Tab [UGH] Q0162 $92.45 26441878 ondansetron 4 mg Tab [UGH] Q0162 $89.13 25935428 ondansetron 4 mg/5 mL Oral Sol [UGH] Q0162 $95.92 26908395 ondansetron 4 mg/5 mL Sol Q0162 $95.60 3931310G8978GOCH OP G8978 CH 0% impaired $0.01 3931309G8978GOCI OP G8978 CI At least 1% but less than 20% impaired $0.01 3931308G8978GOCJ OP G8978 CJ At least 20% but less than 40% impaired $0.01 3931307G8978GOCK OP G8978 CK At least 40% but less than 60% impaired $0.01 3931306G8978GOCL OP G8978 CL At least 60% but less than 80% impaired $0.01 3931305G8978GOCM OP G8978 CM At least 80% but less than 100% impaired $0.01 3931304G8978GOCN OP G8978 CN 100% impaired $0.01 3931324G8979GOCH OP G8979 CH 0% impaired $0.01 3931323G8979GOCI OP G8979 CI At least 1% but less than 20% impaired $0.01 3931322G8979GOCJ OP G8979 CJ At least 20% but less than 40% impaired $0.01 3931321G8979GOCK OP G8979 CK At least 40% but less than 60% impaired $0.01 3931320G8979GOCL OP G8979 CL At least 60% but less than 80% impaired $0.01 3931319G8979GOCM OP G8979 CM At least 80% but less than 100% impaired $0.01 3931318G8979GOCN OP G8979 CN 100% impaired $0.01 3931317G8980GOCH OP G8980 CH 0% impaired $0.01 3931316G8980GOCI OP G8980 CI At least 1% but less than 20% impaired $0.01 3931315G8980GOCJ OP G8980 CJ At least 20% but less than 40% impaired $0.01 3931314G8980GOCK OP G8980 CK At least 40% but less than 60% impaired $0.01 3931313G8980GOCL OP G8980 CL At least 60% but less than 80% impaired $0.01 3931312G8980GOCM OP G8980 CM At least 80% but less than 100% impaired $0.01 3931311G8980GOCN OP G8980 CN 100% impaired $0.01 3931238G8981GOCH OP G8981 CH 0% impaired $0.01 3931237G8981GOCI OP G8981 CI At least 1% but less than 20% impaired $0.01 3931236G8981GOCJ OP G8981 CJ At least 20% but less than 40% impaired $0.01 3931235G8981GOCK OP G8981 CK At least 40% but less than 60% impaired $0.01 3931234G8981GOCL OP G8981 CL At least 60% but less than 80% impaired $0.01 3931233G8981GOCM OP G8981 CM At least 80% but less than 100% impaired $0.01 3931232G8981GOCN OP G8981 CN 100% impaired $0.01 3931252G8982GOCH OP G8982 CH 0% impaired $0.01 3931251G8982GOCI OP G8982 CI At least 1% but less than 20% impaired $0.01 3931250G8982GOCJ OP G8982 CJ At least 20% but less than 40% impaired $0.01 3931249G8982GOCK OP G8982 CK At least 40% but less than 60% impaired $0.01 3931248G8982GOCL OP G8982 CL At least 60% but less than 80% impaired $0.01 3931247G8982GOCM OP G8982 CM At least 80% but less than 100% impaired $0.01 3931246G8982GOCN OP G8982 CN 100% impaired $0.01 3931245G8983GOCH OP G8983 CH 0% impaired $0.01 3931244G8983GOCI OP G8983 CI At least 1% but less than 20% impaired $0.01 3931243G8983GOCJ OP G8983 CJ At least 20% but less than 40% impaired $0.01 3931242G8983GOCK OP G8983 CK At least 40% but less than 60% impaired $0.01 3931241G8983GOCL OP G8983 CL At least 60% but less than 80% impaired $0.01 3931240G8983GOCM OP G8983 CM At least 80% but less than 100% impaired $0.01 3931239G8983GOCN OP G8983 CN 100% impaired $0.01 3931259G8984GOCH OP G8984 CH 0% impaired $0.01 3931258G8984GOCI OP G8984 CI At least 1% but less than 20% impaired $0.01 3931257G8984GOCJ OP G8984 CJ At least 20% but less than 40% impaired $0.01 3931256G8984GOCK OP G8984 CK At least 40% but less than 60% impaired $0.01 3931255G8984GOCL OP G8984 CL At least 60% but less than 80% impaired $0.01 3931254G8984GOCM OP G8984 CM At least 80% but less than 100% impaired $0.01 3931253G8984GOCN OP G8984 CN 100% impaired $0.01 3931273G8985GOCH OP G8985 CH 0% impaired $0.01 3931272G8985GOCI OP G8985 CI At least 1% but less than 20% impaired $0.01 3931271G8985GOCJ OP G8985 CJ At least 20% but less than 40% impaired $0.01 3931270G8985GOCK OP G8985 CK At least 40% but less than 60% impaired $0.01 3931269G8985GOCL OP G8985 CL At least 60% but less than 80% impaired $0.01 3931268G8985GOCM OP G8985 CM At least 80% but less than 100% impaired $0.01 3931267G8985GOCN OP G8985 CN 100% impaired $0.01 3931266G8986GOCH OP G8986 CH 0% impaired $0.01 3931265G8986GOCI OP G8986 CI At least 1% but less than 20% impaired $0.01 3931264G8986GOCJ OP G8986 CJ At least 20% but less than 40% impaired $0.01 3931263G8986GOCK OP G8986 CK At least 40% but less than 60% impaired $0.01 3931262G8986GOCL OP G8986 CL At least 60% but less than 80% impaired $0.01 3931261G8986GOCM OP G8986 CM At least 80% but less than 100% impaired $0.01 3931260G8986GOCN OP G8986 CN 100% impaired $0.01 3931370G8987GOCH OP G8987 CH 0% impaired $0.01 3931369G8987GOCI OP G8987 CI At least 1% but less than 20% impaired $0.01 3931368G8987GOCJ OP G8987 CJ At least 20% but less than 40% impaired $0.01 3931367G8987GOCK OP G8987 CK At least 40% but less than 60% impaired $0.01 3931366G8987GOCL OP G8987 CL At least 60% but less than 80% impaired $0.01 3931365G8987GOCM OP G8987 CM At least 80% but less than 100% impaired $0.01 3931364G8987GOCN OP G8987 CN 100% impaired $0.01 3931384G8988GOCH OP G8988 CH 0% impaired $0.01 3931383G8988GOCI OP G8988 CI At least 1% but less than 20% impaired $0.01 3931382G8988GOCJ OP G8988 CJ At least 20% but less than 40% impaired $0.01 3931381G8988GOCK OP G8988 CK At least 40% but less than 60% impaired $0.01 3931380G8988GOCL OP G8988 CL At least 60% but less than 80% impaired $0.01 3931379G8988GOCM OP G8988 CM At least 80% but less than 100% impaired $0.01 3931378G8988GOCN OP G8988 CN 100% impaired $0.01 3931377G8989GOCH OP G8989 CH 0% impaired $0.01 3931376G8989GOCI OP G8989 CI At least 1% but less than 20% impaired $0.01 3931375G8989GOCJ OP G8989 CJ At least 20% but less than 40% impaired $0.01 3931374G8989GOCK OP G8989 CK At least 40% but less than 60% impaired $0.01 3931373G8989GOCL OP G8989 CL At least 60% but less than 80% impaired $0.01 3931372G8989GOCM OP G8989 CM At least 80% but less than 100% impaired $0.01 3931371G8989GOCN OP G8989 CN 100% impaired $0.01 3931331G8990GOCH OP G8990 CH 0% impaired $0.01 3931330G8990GOCI OP G8990 CI At least 1% but less than 20% impaired $0.01 3931329G8990GOCJ OP G8990 CJ At least 20% but less than 40% impaired $0.01 3931328G8990GOCK OP G8990 CK At least 40% but less than 60% impaired $0.01 3931327G8990GOCL OP G8990 CL At least 60% but less than 80% impaired $0.01 3931326G8990GOCM OP G8990 CM At least 80% but less than 100% impaired $0.01 3931325G8990GOCN OP G8990 CN 100% impaired $0.01 3931345G8991GOCH OP G8991 CH 0% impaired $0.01 3931344G8991GOCI OP G8991 CI At least 1% but less than 20% impaired $0.01 3931343G8991GOCJ OP G8991 CJ At least 20% but less than 40% impaired $0.01 3931342G8991GOCK OP G8991 CK At least 40% but less than 60% impaired $0.01 3931341G8991GOCL OP G8991 CL At least 60% but less than 80% impaired $0.01 3931340G8991GOCM OP G8991 CM At least 80% but less than 100% impaired $0.01 3931339G8991GOCN OP G8991 CN 100% impaired $0.01 3931338G8992GOCH OP G8992 CH 0% impaired $0.01 3931337G8992GOCI OP G8992 CI At least 1% but less than 20% impaired $0.01 3931336G8992GOCJ OP G8992 CJ At least 20% but less than 40% impaired $0.01 3931335G8992GOCK OP G8992 CK At least 40% but less than 60% impaired $0.01 3931334G8992GOCL OP G8992 CL At least 60% but less than 80% impaired $0.01 3931333G8992GOCM OP G8992 CM At least 80% but less than 100% impaired $0.01 3931332G8992GOCN OP G8992 CN 100% impaired $0.01 3931391G8993GOCH OP G8993 CH 0% impaired $0.01 3931390G8993GOCI OP G8993 CI At least 1% but less than 20% impaired $0.01 3931389G8993GOCJ OP G8993 CJ At least 20% but less than 40% impaired $0.01 3931388G8993GOCK OP G8993 CK At least 40% but less than 60% impaired $0.01 3931387G8993GOCL OP G8993 CL At least 60% but less than 80% impaired $0.01 3931386G8993GOCM OP G8993 CM At least 80% but less than 100% impaired $0.01 3931385G8993GOCN OP G8993 CN 100% impaired $0.01 3931405G8994GOCH OP G8994 CH 0% impaired $0.01 3931404G8994GOCI OP G8994 CI At least 1% but less than 20% impaired $0.01 3931403G8994GOCJ OP G8994 CJ At least 20% but less than 40% impaired $0.01 3931402G8994GOCK OP G8994 CK At least 40% but less than 60% impaired $0.01 3931401G8994GOCL OP G8994 CL At least 60% but less than 80% impaired $0.01 3931400G8994GOCM OP G8994 CM At least 80% but less than 100% impaired $0.01 3931399G8994GOCN OP G8994 CN 100% impaired $0.01 3931398G8995GOCH OP G8995 CH 0% impaired $0.01 3931397G8995GOCI OP G8995 CI At least 1% but less than 20% impaired $0.01 3931396G8995GOCJ OP G8995 CJ At least 20% but less than 40% impaired $0.01 3931395G8995GOCK OP G8995 CK At least 40% but less than 60% impaired $0.01 3931394G8995GOCL OP G8995 CL At least 60% but less than 80% impaired $0.01 3931393G8995GOCM OP G8995 CM At least 80% but less than 100% impaired $0.01 3931392G8995GOCN OP G8995 CN 100% impaired $0.01 3931217G9165GOCH OP G9165 CH 0% impaired $0.01 3931216G9165GOCI OP G9165 CI At least 1% but less than 20% impaired $0.01 3931215G9165GOCJ OP G9165 CJ At least 20% but less than 40% impaired $0.01 3931214G9165GOCK OP G9165 CK At least 40% but less than 60% impaired $0.01 3931213G9165GOCL OP G9165 CL At least 60% but less than 80% impaired $0.01 3931212G9165GOCM OP G9165 CM At least 80% but less than 100% impaired $0.01 3931211G9165GOCN OP G9165 CN 100% impaired $0.01 3931231G9166GOCH OP G9166 CH 0% impaired $0.01 3931230G9166GOCI OP G9166 CI At least 1% but less than 20% impaired $0.01 3931229G9166GOCJ OP G9166 CJ At least 20% but less than 40% impaired $0.01 3931228G9166GOCK OP G9166 CK At least 40% but less than 60% impaired $0.01 3931227G9166GOCL OP G9166 CL At least 60% but less than 80% impaired $0.01 3931226G9166GOCM OP G9166 CM At least 80% but less than 100% impaired $0.01 3931225G9166GOCN OP G9166 CN 100% impaired $0.01 3931224G9167GOCH OP G9167 CH 0% impaired $0.01 3931223G9167GOCI OP G9167 CI At least 1% but less than 20% impaired $0.01 3931222G9167GOCJ OP G9167 CJ At least 20% but less than 40% impaired $0.01 3931221G9167GOCK OP G9167 CK At least 40% but less than 60% impaired $0.01 3931220G9167GOCL OP G9167 CL At least 60% but less than 80% impaired $0.01 3931219G9167GOCM OP G9167 CM At least 80% but less than 100% impaired $0.01 3931218G9167GOCN OP G9167 CN 100% impaired $0.01 3931289G9168GOCH OP G9168 CH 0% impaired $0.01 3931288G9168GOCI OP G9168 CI At least 1% but less than 20% impaired $0.01 3931287G9168GOCJ OP G9168 CJ At least 20% but less than 40% impaired $0.01 3931286G9168GOCK OP G9168 CK At least 40% but less than 60% impaired $0.01 3931285G9168GOCL OP G9168 CL At least 60% but less than 80% impaired $0.01 3931284G9168GOCM OP G9168 CM At least 80% but less than 100% impaired $0.01 3931283G9168GOCN OP G9168 CN 100% impaired $0.01 3931303G9169GOCH OP G9169 CH 0% impaired $0.01 3931302G9169GOCI OP G9169 CI At least 1% but less than 20% impaired $0.01 3931301G9169GOCJ OP G9169 CJ At least 20% but less than 40% impaired $0.01 3931300G9169GOCK OP G9169 CK At least 40% but less than 60% impaired $0.01 3931299G9169GOCL OP G9169 CL At least 60% but less than 80% impaired $0.01 3931298G9169GOCM OP G9169 CM At least 80% but less than 100% impaired $0.01 3931297G9169GOCN OP G9169 CN 100% impaired $0.01 3931296G9170GOCH OP G9170 CH 0% impaired $0.01 3931295G9170GOCI OP G9170 CI At least 1% but less than 20% impaired $0.01 3931294G9170GOCJ OP G9170 CJ At least 20% but less than 40% impaired $0.01 3931293G9170GOCK OP G9170 CK At least 40% but less than 60% impaired $0.01 3931292G9170GOCL OP G9170 CL At least 60% but less than 80% impaired $0.01 3931291G9170GOCM OP G9170 CM At least 80% but less than 100% impaired $0.01 3931290G9170GOCN OP G9170 CN 100% impaired $0.01 259716751480106 OP TREATMENT ROOM $200.00 253730801460160 OPEN TREATMENT DISTAL PHALANGEAL FRACTUR 26765 $3,786.00 25935429 Ophth irrigation, extraocular Sol [UGH] $18.10 25935430 Ophth irrigation, intraocular Balanced Salt Sol [UGH] $39.04 9960333602883 OR Endo Procedures $1,100.00 261667071291031 ORANGE IgE 86003 $22.00 259831511400138 OR-CESAREAN SCHEDULED 59514 $3,250.00 259831491400139 OR-CESAREAN UNSCHEDULED 59514 $3,850.00 261667501290411 ORGANIC ACIDS QUANTITATIVE URINE 83918 $390.00 26875655 oritavancin 400 mg Pow [UGH] J2407 $4,779.22 26010447 orphenadrine 30 mg/mL Sol 2 mL [UGH] J2360 $99.90 6922431720020 ORTHOTIC TRAINING 15 MIN 97760 $65.00 13419901730018 Orthotic(s) management and training (including assessment an 97760 $65.00 259831641400152 OR-TUBAL LIGATE W DELIVERY 58605 $1,500.00 25935432 oseltamivir 12 mg/mL Oral Liq [UGH] $41.00 25935433 oseltamivir 30 mg Cap [UGH] $66.88 25935434 oseltamivir 6 mg/mL Pow [UGH] $60.75 25961610 oseltamivir 75 mg Cap [UGH] $61.83 6337911290267 OSMOLALITY SERUM 83930 $81.00 6337921290268 OSMOLALITY URINE 83935 $81.00 254392401730177 OT EVAL HIGH COMPLEX 60 MIN 97167 $228.00 254392381730175 OT EVAL LOW COMPLEX 30 MIN 97165 $228.00 254392391730176 OT EVAL MOD COMPLEX 45 MIN 97166 $228.00 257516231730039 OT Orthotic Prosthetic Use Check Out Units 97762 $75.00 254392441730178 OT RE-EVAL EST PLAN CARE 97168 $159.00 100435361730002 OT RE-EVALUATION 97004 $120.00 6913271730003 OT SELF CARE/HOME MGMT TRNG 97535 $50.00 262026241730022 OT Sensory Integrative Techniques Units 97533 $50.00 262026201730020 OT Therapeutic Activities Units 97530 $50.00 262026091730010 OT Ultrasound Units 97035 $50.00 269578861430275 Other Peripheral Nerve Block Charge 64450 $1,497.00 2640928210090470 OVAL 8 RING SPLINT SZ 8 $16.00 25935436 oxcarbazepine 300 mg Tab [UGH] $13.05 25935437 oxcarbazepine 300 mg/5 mL Oral Susp [UGH] $827.20 25935438 oxybutynin 10 mg ER Tab [UGH] $15.38 25935439 oxybutynin 3.9 mg/24 hr Transderm ER Film [UGH] $271.72 26781316 oxybutynin 5 mg Tab $5.00 25935440 oxybutynin 5 mg Tab [UGH] $5.00 25935441 oxyCODONE 10 mg ER Tab [UGH] $11.03 25935442 oxyCODONE 15 mg Tab [UGH] $7.00 25935443 oxyCODONE 20 mg ER Tab [UGH] $21.08 25935444 oxyCODONE 20 mg/mL Oral Conc [UGH] $1,849.00 25935445 oxyCODONE 40 mg ER Tab [UGH] $37.39 26975883 oxyCODONE 5 mg Tab $7.00 25935446 oxyCODONE 5 mg Tab [UGH] $7.00 25935447 oxyCODONE 80 mg ER Tab [UGH] $70.34 15584311700055 OXYGEN HOURLY $10.00 150233681700055 OXYGEN LIMITED CHARGE $10.00 26010830 oxymetazoline nasal 0.05% Spr 15 mL [UGH] $6.40 25936321 oxytocin 10 intl units/mL Inj Sol [UGH] j2590 $25.00 27130015 oxytocin 30 units/500 mL-0.9% Soln J2590 $18.10 26847799 oxytocin 30 units/500 mL-NS Inj Sol [UGH] J2590 $18.10 261667421293665 OYSTER IgE 86003 $21.00 2640952710091000 PACEMAKER GENERATOR ADAPTA $7,700.00 2640956910091040 PACEMAKER GENERATOR IPG SENSIA $7,800.00 2640959610091070 PACEMAKER GENERATOR VIVA C6TR01 $22,300.00 2640992510091410 PACER ADVISA SR MRI SURESCAN SINGLE $11,160.00 25935987 Pain Ease (norflurane-hfc) [UGH] $132.00 25935451 palivizumab 100 mg/mL IM Sol [UGH] $5,664.92 25935988 pamidronate 30mg/10ml vial [UGH] J2430 $169.20 255523581290749 PANCREATIC ELASTASE-1 82656 $260.00 2640924210090430 PANCREATIC STENT 3FT 3CM SET $384.00 2640924310090430 PANCREATIC STENT 3FTX4CM SET $375.00 26798949 pancrelipase 12,000 units-38,000 units-60,000 units Cap[UGH] $15.41 25935452 pancrelipase 5000 units-17,000 units-27,000 units Cap [UGH] $5.00 25935453 pantoprazole 40 mg IV Inj [UGH] s0164 $30.00 25935454 pantoprazole 40 mg Oral EC Tab [UGH] $5.00 6913121720005 PARAFFIN BATH THERAPY 97018 $45.00 261667471290903 PARANEOPLASTIC NEURONAL AB PANEL 86255 $175.00 253396261750043 PARING/CUT HYPERKERATOTIC LESION 1 - FAC 11055 $353.00 253396271750044 PARING/CUT HYPERKERATOTIC LESION 2-4 FAC 11056 $353.00 253396281750045 PARING/CUT HYPERKERATOTIC LESION 5+ FAC 11057 $677.00 25935456 PARoxetine 10 mg Tab [UGH] $14.07 25935457 PARoxetine 20 mg Tab [UGH] $13.64 26876261290399 PARVOVIRUS B19 AB (IGG&IGM) 86747 $92.00 2640901310090160 PATELLA 2764-0-7501 $1,575.00 2640973910091220 PATELLA 36MM $2,375.00 2640969410091170 PATELLA ATTUNE MEDIALIZED 38MM $2,375.00 2640978410091270 PATELLA DOME 41MM $2,375.00 2640977610091260 PATELLA MEDIALIZED 32MM $2,375.00 2704674110091700 PATELLAR COMPONENT 32MM $2,000.00 2640902210090170 PATELLAR COMPONENT CIRCULAR ALL POLY $1,575.00 2640910210090270 PATELLAR COMPONENT SZ 1 $1,575.00 2640945910090930 PATELLAR COMPONENT SZ 2 $1,575.00 2640972110091200 PATELLAR COMPONENT SZ 3 10 MM $1,890.00 158035191291025 PATHOLOGIST REVIEW PERIPHERAL SMEAR 85060 $75.00 26471149 PATIENT SPECIFIC BIN [UGH] $0.00 26471150 PATIENT SPECIFIC NARCOTIC BIN [UGH] $0.00 26471159 PATIENT SPECIFIC RESPIRATORY [UGH] $0.00 26471165 PATIENTS OWN MED [UGH] $0.00 25935458 patiromer 8.4 g Pow [UGH] $131.33 26471170 PCA PUMP KEYS [UGH] $0.00 26471171 PCA WASTE BIN [UGH] $0.00 2640916610090340 PCAN5 14 CANCELLOUS CHIPS $444.00 15496021291075 PEANUT IgE 86003 $21.00 25935459 pegfilgrastim 6 mg/0.6 mL SubQ Inj [UGH] j2505 $25,959.84 25935460 penicillin G benzathine 1,200,000 units/2 mL Sus [UGH] J0558 $755.36 25935461 penicillin G benzathine 600,000 units/mL Sus [UGH] J0558 $332.73 25935462 Penicillin G Potassium 20,000,000 units Pow [UGH] J2540 $243.04 25935463 Penicillin G Potassium 5,000,000 units Pow [UGH] J2540 $68.36 25935464 Penicillin V Potassium 125 mg/5 mL Pow [UGH] $5.00 25962640 Penicillin V Potassium 250 mg Tab [UGH] $5.00 25935466 Penicillin V Potassium 250 mg/5 mL Pow [UGH] $5.00 25955345 Penicillin V Potassium 500 mg Tab [UGH] $5.00 15496011291053 PENICILLIUM NOTATUM IgE 86003 $21.00 26010545 pentoxifylline 400 mg Tab UD [UGH] $7.49 25935468 perindopril 2 mg Tab [UGH] $9.87 5928271300331 PERIPHERAL SMEAR PATH 85060 $75.00 25935469 permethrin Top 5% Crm [UGH] $742.52 29430422943042 PET Ltd Area w/ CT Scan 78814 $2,754.00 29430532943053 PET Skull Base to Midthigh w/ CT Scan 78815 $2,754.00 11635311163531 PET Whole Body w/ CT Scan 78816 $2,754.00 112207321290834 PH BODY FLUID 83986 $30.00 256595001290129 PH Cord Blood 82800 $53.00 26470687 Pharmacy to Dose - Bactrim IV [UGH] $0.00 26974836 Pharmacy to dose - cipro [UGH] $0.00 26278823 Pharmacy to Dose - Daptomycin [UGH] $0.00 26278780 Pharmacy to Dose - Gentamicin [UGH] $0.00 26470797 Pharmacy to Dose - Infed [UGH] $0.00 26278820 Pharmacy to Dose - Levaquin [UGH] $0.00 26470804 Pharmacy to Dose - Lovenox [UGH] $0.00 26470682 Pharmacy to Dose - Meropenem [UGH] $0.00 26974845 Pharmacy to dose - Unasyn [UGH] $0.00 26277720 Pharmacy to Dose - Vancomycin [UGH] $0.00 26278788 Pharmacy to Dose - Zosyn [UGH] $0.00 261742071451579 Phase II Recovery $125.00 25935470 phenazopyridine 100 mg Tab [UGH] $6.25 25935471 PHENobarbital 130 mg/mL Inj Sol [UGH] J2560 $221.95 25935473 PHENobarbital 16.2 mg Tab [UGH] $5.00 25935474 PHENobarbital 20 mg/5 mL Oral Elix [UGH] $5.00 25935475 PHENobarbital 32.4 mg Tab [UGH] $5.00 25935476 PHENobarbital 65 mg/mL Inj Sol [UGH] J2560 $100.29 6338001290085 PHENOBARBITOL 80184 $103.00 25935477 phenol Top 1.4% Spry [UGH] $21.00 25966776 phentolamine 5 mg Inj [UGH] J2760 $2,040.00 25935989 phenylephrine 10 mg/mL Inj Sol [UGH] J2370 $31.88 25935479 phenylephrine nasal 0.25% Sol 15 mL [UGH] $19.00 25935480 phenylephrine Nasal 0.5% Spry [UGH] $19.00 25935481 phenylephrine nasal 1% spray [UGH] $21.35 25935482 phenylephrine Ophth 10% Sol [UGH] $71.52 25935483 phenylephrine Ophth 2.5% Sol 15 mL [UGH] $432.00 25983777 phenylephrine ophthalmic 2.5% Sol 2 mL [UGH] $162.52 25935484 phenylephrine Top 0.25% Supp [UGH] $5.00 8587881290078 PHENYTOIN 80185 $47.00 25935486 phenytoin 100 mg ERCap [UGH] $5.00 25935487 phenytoin 125 mg/5 mL Oral Susp [UGH] $5.00 27090444 phenytoin 25 mg/mL Sus $5.00 25935990 phenytoin 50 mg/mL Inj Sol 2ml [UGH] J1165 $25.00 25935991 phenytoin 50 mg/mL Inj Sol 5ml [UGH] J1165 $25.00 6338031290077 PHOSPHORUS 84100 $48.00 25935488 physostigmine 1 mg/mL Inj Sol [UGH] $26.30 25935489 phytonadione 1 mg/0.5 mL Inj Sol [UGH] J3430 $108.00 25935490 phytonadione 10 mg/mL Inj Sol [UGH] J3430 $231.56 25962710 phytonadione 5 mg Tab [UGH] $256.41 294379210090697 PICC INTRODUCER KIT $67.00 2640906410090230 PICC KIT BARD DOUBLE $594.00 269745073601440000 PICC LINE INSERTION/PLACEMENT CHARGE $3,900.00 2640906310090230 PICC POWER BARD TRIPLE LUMEN $698.00 2640893910010230 PICC SECURITY SYSTEM $20.00 25935492 pilocarpine Ophth 2% Sol [UGH] $403.24 256290841293654 PINE NUT IgE 86003 $21.00 261666931293659 PINE WHITE IgE 86003 $21.00 257371081290983 PINEAPPLE IgE 86003 $30.00 2640977210091250 PINNACLE ACETABULAR LINER 38MM 54MM $2,375.00 2640977110091250 PINNACLE ACETABULAR SHELL 54MM $2,375.00 25935992 pioglitazone 30 mg Tab [UGH] $83.85 26563802 piperacillin-tazobactam 2 g-0.25 g ADDvan Pow [UGH] J2543 $46.80 25935834 piperacillin-tazobactam 2 g-0.25 g IV Inj [UGH] J2543 $38.17 25935835 piperacillin-tazobactam 3 g-0.375 g IV Inj [UGH] J2543 $55.62 26980896 piperacillin-tazobactam 3 g-0.375 g Pow J2543 $74.88 25935836 piperacillin-tazobactam 4 g-0.5 g IV Inj [UGH] J2543 $46.21 26563797 piperacillin-tazobactam 4 g-0.5 g Pow [UGH] J2543 $63.67 256290851291077 PISTACHIO IgE 86003 $21.00 12068971290206 PKU NEWBORN METABOLIC SCREEN $45.00 253734551461114 PLACEMENT OF INTRAOSSEOUS NEEDLE FAC 36680 $274.00 22440871290674 Plasminogen Activity QST 85415 $115.00 2640990510091390 PLATE 1.8MM 3.5MM $714.00 2640979910091280 PLATE 1/3 TBLR 2.7/3.5 $645.00 2640996810091460 PLATE 140MM 3.5MM $1,674.00 2640996710091460 PLATE 168MM 3.5MM $1,854.00 2640996910091460 PLATE 189MM 3.5MM $1,789.00 2640909610090270 PLATE 5 HOLE 135 ANGLE 281.15 $1,785.00 2640955410091030 PLATE 6 HOLE ULNA SHORTENING $2,278.00 2640953110091000 PLATE BLUE 1.5 LOCKING 3/3 HOLE $1,491.00 2640958110091060 PLATE BLUE 1.5 LOCKING 3/5 HOLE $1,462.00 2640948610090950 PLATE BLUE 2.0/2.3 4 HOLE CURVED $1,982.00 2640951910090990 PLATE COMPRESSION GOLD 1.2/1.5 3/8 $1,056.00 2640961910091100 PLATE COMPRESSION GOLD 2.0/2.3 6HOLE $982.00 2640962010091100 PLATE COMPRESSION GOLD 2.0/2.3 8HOLE $1,108.00 2640972910091210 PLATE DIS RADIUS $2,499.00 2640948010090950 PLATE FIXATION GOLD 1.2/1.5 16 HOLE $940.00 2640948110090950 PLATE FIXATION GOLD 1.5MM $940.00 2640981810091300 PLATE FUSION $3,846.00 2640948410090950 PLATE GOLD 1.2/1.5 1 HOLE $1,058.00 2640991310091400 PLATE LCP 4.5MM 152MM $1,359.00 2640908110090250 PLATE LG FRAG $1,308.00 2640950110090970 PLATE LOCKING BLUE 2.0/2.3 T SHAPED 2/4 $2,294.00 2640958910091060 PLATE LOCKING BLUE 2.0/2.3 T SHAPED 3/4 $1,547.00 2640952110090990 PLATE LOCKING BLUE T SHAPED 2/8 HOLES $2,426.00 2640947010090940 PLATE LOCKING TRILOCK PI 5X2H $1,287.00 2640943210090890 PLATE MTP LEFT $3,520.00 2640980010091280 PLATE OB L T 52X10X1.5 $1,014.00 2640980110091280 PLATE OB L T 63X10X1.5 $1,063.00 2640980210091280 PLATE OB L T 74X10X1.5 $1,111.00 2640980310091290 PLATE OB L T 96X10X1.5 $1,203.00 2640980410091290 PLATE OB R T 52X10X1.5 $1,012.00 2640918210090360 PLATE ONE THIRD 57MM $506.00 2640916510090340 PLATE ONE THIRD LCP 8 HOLES 93MM $750.00 2640992710091410 PLATE RAD 2.4MM $4,950.00 2640993010091420 PLATE RAD 2.4MM LCP $4,950.00 2640973310091210 PLATE RADIUS $2,499.00 2640980810091290 PLATE RT ANG 67X10X1.5 $1,027.00 2640980910091290 PLATE RT ANG 78X10X1.5 $1,197.00 2640981010091290 PLATE RT ANG 87X10X1.5 $1,500.00 2640980710091290 PLATE SCR 111X11X3.4 $978.00 2640940510090860 PLATE SIDE 130 X 38MM 4 HOLE $1,125.00 2640937910090830 PLATE SIDE 135 X 38MM 3 HOLE $1,125.00 2640920410090380 PLATE SIDE 135 X 38MM 4 HOLE $1,500.00 2640939310090850 PLATE STANDARD R MTP $4,600.00 2640980610091290 PLATE STD 114MM 3.5MM $3,604.00 2640980510091290 PLATE STD 90MM 3.5MM $3,050.00 2560618910091030 PLATE TACK $330.00 2640957710091050 PLATE TRILOCK TOTAL WRIST FUS. LONG BEND $4,586.00 2640956410091040 PLATE TRILOCK TOTAL WRIST FUS. STRAIGHT $4,171.00 2640962710091100 PLATE WRIST FUSION $2,488.00 6338071290035 PLATELET COUNT 85049 $53.00 269665101440012 PLATELET GEL SERVICES CHARGE $1,125.00 2640918810090370 PLATES TUBULAR LCP ONE THIRD 241.361 $506.00 2640926510090450 PLATES TUBULAR LCP ONE THIRD 241.371 $593.00 2640903710090180 PLATES-T 3.5 LCP 63MM 241.041 $1,233.00 2640923910090420 PNEOMOTHORAX TRAY WAYNE SELDINGER $540.00 25935493 pneumococcal 13-valent conjugate vaccine - Sus UD [UGH] 90732 $1,807.28 25935494 pneumococcal 23-valent vaccine Inj Sol 0.5 mL [UGH] 90732 $480.92 25935495 polycarbophil 625 mg Tab [UGH] $5.00 26866881 polyethylene glycol 3350 - Pow [UGH] $81.80 26010550 polyethylene glycol 3350 - Pow 238 gm [UGH] $81.80 25935496 polyethylene glycol 3350 Oral Pwdr for Recon [UGH] $5.29 25935497 polyethylene glycol 3350 with electrolytes Oral Pwdr for Sol 4000 mL $65.84 [UGH] 25935498 polymyxin B-trimethoprim Ophth Sol [UGH] $53.76 27111504 poractant alfa 80 mg/mL Sus {UGH} $4,045.20 261667061290984 PORK IgE 86003 $21.00 2640901010090150 PORT-A-CATH TITANIUM VENOUS $1,203.00 2695755911120 Post Delivery Obstetrics $800.00 2640977710091260 POSTERIOR STABILIZED NARROW SZ 5 $2,375.00 6336161290091 POTASSIUM 84132 $53.00 25935499 potassium acetate 2 mEq/mL IV Sol [UGH] $25.00 25935500 potassium acid phosphate 500 mg Tab [UGH] $5.00 26985062 potassium chloride 10 mEq Cap $20.00 25935993 potassium chloride 10 mEq ER Tab [UGH] $7.51 26855574 potassium chloride 10 mEq ERCap [UGH] $5.25 25935502 potassium chloride 10 mEq/100 mL IV Sol [UGH] J3480 $25.00 25935837 potassium chloride 2 mEq/mL IV Sol 10 ml vial [UGH] J3480 $25.00 25935838 potassium chloride 2 mEq/mL IV Sol 20 ml vial [UGH] J3480 $25.00 25955251 potassium chloride 20 mEq ER Tab [UGH] $5.00 25935504 potassium chloride 20 mEq/100 mL IV Sol [UGH] J3480 $25.00 27092915 potassium chloride 20 mEq/15 mL Liq $66.82 25961922 potassium chloride 20 mEq/15 mL Oral Liq [UGH] $81.12 25935506 potassium chloride-sodium chloride Tab [UGH] $5.00 6336181290055 POTASSIUM LEVEL 24 HOUR 84133 $53.00 25935507 potassium phosphate 3 mmol/mL IV Sol [UGH] $25.00 26010427 potassium phosphate 3 mmol/mL Sol 15 mL [UGH] $75.42 25963035 potassium phosphate-sodium phosphate 250 mg-45 mg-298 mg Tab $5.00 [UGH] 8877311290679 POTASSIUM RANDOM URINE 84133 $53.00 25935509 povidone iodine Ophth 5% Sol [UGH] $56.81 25935510 povidone iodine Top 10% Oint [UGH] $28.80 2640945710090930 PPM MERLIN CONNECTIVITY ASSURITY PACEMAK $10,388.00 25935511 pralidoxime 1 g IV Inj [UGH] J2730 $416.16 25962682 pramipexole 0.125 mg Tab [UGH] $16.71 25955326 pramipexole 0.25 mg Tab [UGH] $14.58 25962663 pramipexole 1 mg Tab [UGH] $16.71 25935515 pramoxine Top 1% Rectal Foam [UGH] $199.52 25935516 prasugrel 5 mg Tab [UGH] $31.60 25962634 pravastatin 20 mg Tab [UGH] $16.34 25935518 pravastatin 40 mg Tab [UGH] $23.97 25935519 prazosin 1 mg Cap [UGH] $5.00 20136341290108 PREALBUMIN 84134 $72.00 26165338 prednisoLONE (as sodium phosphate) 5 mg/5 mL Liq[UGH] J7510 $20.44 25935520 prednisoLONE Ophth acetate 1% Susp [UGH] $221.28 27138684 prednisoLONE ophthalmic acetate 1% Sus $211.20 26011485 prednisoLONE ophthalmic acetate 1% Sus 1 mL [UGH] $110.50 25935521 prednisoLONE sodium phosphate 15 mg/5 mL Oral Liq [UGH] J7510 $7.81 25935994 predniSONE 1 mg Tab [UGH] J7512 $5.00 25935522 predniSONE 10 mg Tab [UGH] J7512 $5.00 27076402 predniSONE 20 mg Tab J7512 $5.00 25935523 predniSONE 20 mg Tab [UGH] J7512 $5.00 27138683 predniSONE 5 mg Tab J7512 $5.00 25955355 predniSONE 5 mg Tab [UGH] J7512 $5.00 26010702 predniSONE 5 mg/5 mL Sol [UGH] J7512 $20.00 25935525 pregabalin 100 mg oral capsule [UGH] $42.14 25935526 pregabalin 25 mg oral capsule [UGH] $42.14 25935527 pregabalin 50 mg oral capsule [UGH] $41.20 25935528 pregabalin 75 mg oral capsule [UGH] $28.49 2640938510090840 PRELOADED WITH FORCE FIBER SUTURE $988.00 26009704 Prenatal Multivitamins with Folic Acid 1 mg Tab [UGH] S0197 $5.00 261742181440615 Pre-Op Charge $150.00 25935530 primidone 250 mg Tab [UGH] $5.00 25935995 primidone 50 mg Tab [UGH] $5.00 8532291292491 PRO BNP N TERMINAL 83880 $142.00 25935531 probenecid 500 mg Tab [UGH] $5.73 25935532 procainamide 100 mg/mL Inj Sol [UGH] J2690 $316.51 25935533 procainamide 500 mg/mL Inj Sol [UGH] J2690 $344.08 25935534 prochlorperazine 10 mg Tab [UGH] Q0164 $7.87 25935535 prochlorperazine 25 mg Supp [UGH] $50.33 25935536 prochlorperazine 5 mg Tab [UGH] Q0164 $5.00 26952433 prochlorperazine 5 mg/mL Inj Sol [UGH] j0780 $97.20 6338081290287 PROGESTERONE 84144 $88.00 6338091290273 PROLACTIN 84146 $104.00 25935538 promethazine 12.5 mg Supp [UGH] $19.47 26702395 Promethazine 12.5mg/50 mL NS [UGH] $40.00 25935539 promethazine 25 mg Supp [UGH] $70.82 25935540 promethazine 25 mg Tab [UGH] Q0169 $5.00 25935541 promethazine 25 mg/mL Inj Sol [UGH] j2550 $25.00 25935542 promethazine 6.25 mg/5 mL Oral Syrup [UGH] Q0169 $33.08 26953582 promethazine 6.25 mg/5 mL Syr Q0169 $24.74 26010780 propafenone 150 mg Tab [UGH] $5.00 25935543 proparacaine Ophth 0.5% Sol [UGH] $110.40 26981668 proparacaine ophthalmic 0.5% Sol $168.44 25935996 propofol 1000mg/100 mL IV Emul [UGH] J2704 $144.00 25935997 propofol 200 mg/20 mL IV Emul [UGH] J2704 $36.00 25935544 propranolol 1 mg/mL IV Sol [UGH] j1800 $45.00 25935545 propranolol 10 mg Tab [UGH] $5.00 27090579 propranolol 20 mg Tab $5.00 25935546 propranolol 20 mg Tab [UGH] $5.00 27082502 propranolol 40 mg Tab $5.00 25935547 propranolol 40 mg Tab [UGH] $5.00 25935548 propranolol 60 mg ERCap [UGH] $6.64 25935549 propranolol 80 mg ERCap [UGH] $9.47 25935550 propylthiouracil 50 mg Tab [UGH] $5.00 10425741290288 PROSTATIC ACP 84066 $52.00 2682187710091600 PROSTHESIS PENILE 14MM X 16CM $13,920.00 99634961720028 PROSTHETIC CHECKOUT EST PAT 15 MIN $75.00 99639951720021 PROSTHETIC TRAINING 15 MIN 97761 $116.00 12386511730019 Prosthetic(s) training upper and/or lower extremity(ies) i 97761 $55.00 25935551 protamine 10 mg/mL Inj Sol [UGH] J2720 $168.48 25935998 protamine 10 mg/mL Inj Sol 5 ml vial [UGH] J2720 $66.38 112208691290523 PROTEIN BODY FLUID 84157 $55.00 21951971290183 PROTEIN C 85303 $127.00 26203881291005 PROTEIN C ANTIGEN 85302 $50.00 149844931290535 PROTEIN CSF 84157 $45.00 6338161293721 Protein Electrophoresis QST 84165 $98.00 15495961290275 PROTEIN ELECTROPHORESIS SERUM 84165 $98.00 11580571290327 PROTEIN ELECTROPHORESIS-URINE 84166 $63.00 21954591290186 PROTEIN S ACTIVITY 85306 $126.00 261666661290684 PROTEIN S ANTIGEN FREE 85306 $88.00 26203911290685 PROTEIN S ANTIGEN TOTAL 85305 $85.00 6338191290153 PROTEIN URINE-RANDOM 84156 $36.00 256290821290807 PROTEINASE-3 ANTIBODY 86021 $130.00 25935552 prothrombin complex - Pow [UGH] C9132 $6,994.64 6337931290042 PROTIME 85610 $63.00 10195361290190 PSA 84153 $85.00 11579891290381 PSA (Free and Total) QST 84154 $113.00 15495931290476 PSA-ENHANCED (ULTRA SENSITIVE) 84153 $102.00 10195351290285 PSA-SCREENING $85.00 25935553 pseudoephedrine 120 mg ER Tab [UGH] $5.00 25935554 pseudoephedrine 30 mg Tab [UGH] $5.00 2640996210091450 PSN ASF PS 20MM PLY L 6-9EF $3,810.00 2640996110091450 PSN FEM PS CMT CCR NRW SZ 6 L $12,584.00 2640996310091450 PSN STR HYB ST 14 X 30 $4,830.00 2640996010091450 PSN TIB STEM 5 DEG SZ E L $5,475.00 25935555 psyllium 3.4 g/11 g Oral Pwdr [UGH] $5.00 254342871720210 PT EVAL HIGH COMPLEX 45 MIN 97163 $235.00 254342831720194 PT EVAL LOW COMPLEX 20 MIN 97161 $235.00 254342851720195 PT EVAL MOD COMPLEX 30 MIN 97162 $235.00 3931484G8978GPCH PT G8978 CH 0% impaired $0.01 3931483G8978GPCI PT G8978 CI At least 1% but less than 20% impaired $0.01 3931482G8978GPCJ PT G8978 CJ At least 20% but less than 40% impaired $0.01 3931481G8978GPCK PT G8978 CK At least 40% but less than 60% impaired $0.01 3931480G8978GPCL PT G8978 CL At least 60% but less than 80% impaired $0.01 3931479G8978GPCM PT G8978 CM At least 80% but less than 100% impaired $0.01 3931478G8978GPCN PT G8978 CN 100% impaired $0.01 3931498G8979GPCH PT G8979 CH 0% impaired $0.01 3931497G8979GPCI PT G8979 CI At least 1% but less than 20% impaired $0.01 3931496G8979GPCJ PT G8979 CJ At least 20% but less than 40% impaired $0.01 3931495G8979GPCK PT G8979 CK At least 40% but less than 60% impaired $0.01 3931494G8979GPCL PT G8979 CL At least 60% but less than 80% impaired $0.01 3931493G8979GPCM PT G8979 CM At least 80% but less than 100% impaired $0.01 3931492G8979GPCN PT G8979 CN 100% impaired $0.01 3931491G8980GPCH PT G8980 CH 0% impaired $0.01 3931490G8980GPCI PT G8980 CI At least 1% but less than 20% impaired $0.01 3931489G8980GPCJ PT G8980 CJ At least 20% but less than 40% impaired $0.01 3931488G8980GPCK PT G8980 CK At least 40% but less than 60% impaired $0.01 3931487G8980GPCL PT G8980 CL At least 60% but less than 80% impaired $0.01 3931486G8980GPCM PT G8980 CM At least 80% but less than 100% impaired $0.01 3931485G8980GPCN PT G8980 CN 100% impaired $0.01 3931433G8981GPCH PT G8981 CH 0% impaired $0.01 3931432G8981GPCI PT G8981 CI At least 1% but less than 20% impaired $0.01 3931431G8981GPCJ PT G8981 CJ At least 20% but less than 40% impaired $0.01 3931430G8981GPCK PT G8981 CK At least 40% but less than 60% impaired $0.01 3931429G8981GPCL PT G8981 CL At least 60% but less than 80% impaired $0.01 3931428G8981GPCM PT G8981 CM At least 80% but less than 100% impaired $0.01 3931427G8981GPCN PT G8981 CN 100% impaired $0.01 3931447G8982GPCH PT G8982 CH 0% impaired $0.01 3931446G8982GPCI PT G8982 CI At least 1% but less than 20% impaired $0.01 3931445G8982GPCJ PT G8982 CJ At least 20% but less than 40% impaired $0.01 3931444G8982GPCK PT G8982 CK At least 40% but less than 60% impaired $0.01 3931443G8982GPCL PT G8982 CL At least 60% but less than 80% impaired $0.01 3931442G8982GPCM PT G8982 CM At least 80% but less than 100% impaired $0.01 3931441G8982GPCN PT G8982 CN 100% impaired $0.01 3931440G8983GPCH PT G8983 CH 0% impaired $0.01 3931439G8983GPCI PT G8983 CI At least 1% but less than 20% impaired $0.01 3931438G8983GPCJ PT G8983 CJ At least 20% but less than 40% impaired $0.01 3931437G8983GPCK PT G8983 CK At least 40% but less than 60% impaired $0.01 3931436G8983GPCL PT G8983 CL At least 60% but less than 80% impaired $0.01 3931435G8983GPCM PT G8983 CM At least 80% but less than 100% impaired $0.01 3931434G8983GPCN PT G8983 CN 100% impaired $0.01 3931454G8984GPCH PT G8984 CH 0% impaired $0.01 3931453G8984GPCI PT G8984 CI At least 1% but less than 20% impaired $0.01 3931452G8984GPCJ PT G8984 CJ At least 20% but less than 40% impaired $0.01 3931451G8984GPCK PT G8984 CK At least 40% but less than 60% impaired $0.01 3931450G8984GPCL PT G8984 CL At least 60% but less than 80% impaired $0.01 3931449G8984GPCM PT G8984 CM At least 80% but less than 100% impaired $0.01 3931448G8984GPCN PT G8984 CN 100% impaired $0.01 3931468G8985GPCH PT G8985 CH 0% impaired $0.01 3931467G8985GPCI PT G8985 CI At least 1% but less than 20% impaired $0.01 3931466G8985GPCJ PT G8985 CJ At least 20% but less than 40% impaired $0.01 3931465G8985GPCK PT G8985 CK At least 40% but less than 60% impaired $0.01 3931464G8985GPCL PT G8985 CL At least 60% but less than 80% impaired $0.01 3931463G8985GPCM PT G8985 CM At least 80% but less than 100% impaired $0.01 3931462G8985GPCN PT G8985 CN 100% impaired $0.01 3931461G8986GPCH PT G8986 CH 0% impaired $0.01 3931460G8986GPCI PT G8986 CI At least 1% but less than 20% impaired $0.01 3931459G8986GPCJ PT G8986 CJ At least 20% but less than 40% impaired $0.01 3931458G8986GPCK PT G8986 CK At least 40% but less than 60% impaired $0.01 3931457G8986GPCL PT G8986 CL At least 60% but less than 80% impaired $0.01 3931456G8986GPCM PT G8986 CM At least 80% but less than 100% impaired $0.01 3931455G8986GPCN PT G8986 CN 100% impaired $0.01 3931544G8987GPCH PT G8987 CH 0% impaired $0.01 3931543G8987GPCI PT G8987 CI At least 1% but less than 20% impaired $0.01 3931542G8987GPCJ PT G8987 CJ At least 20% but less than 40% impaired $0.01 3931541G8987GPCK PT G8987 CK At least 40% but less than 60% impaired $0.01 3931540G8987GPCL PT G8987 CL At least 60% but less than 80% impaired $0.01 3931539G8987GPCM PT G8987 CM At least 80% but less than 100% impaired $0.01 3931538G8987GPCN PT G8987 CN 100% impaired $0.01 3931558G8988GPCH PT G8988 CH 0% impaired $0.01 3931557G8988GPCI PT G8988 CI At least 1% but less than 20% impaired $0.01 3931556G8988GPCJ PT G8988 CJ At least 20% but less than 40% impaired $0.01 3931555G8988GPCK PT G8988 CK At least 40% but less than 60% impaired $0.01 3931554G8988GPCL PT G8988 CL At least 60% but less than 80% impaired $0.01 3931553G8988GPCM PT G8988 CM At least 80% but less than 100% impaired $0.01 3931552G8988GPCN PT G8988 CN 100% impaired $0.01 3931551G8989GPCH PT G8989 CH 0% impaired $0.01 3931550G8989GPCI PT G8989 CI At least 1% but less than 20% impaired $0.01 3931549G8989GPCJ PT G8989 CJ At least 20% but less than 40% impaired $0.01 3931548G8989GPCK PT G8989 CK At least 40% but less than 60% impaired $0.01 3931547G8989GPCL PT G8989 CL At least 60% but less than 80% impaired $0.01 3931546G8989GPCM PT G8989 CM At least 80% but less than 100% impaired $0.01 3931545G8989GPCN PT G8989 CN 100% impaired $0.01 3931505G8990GPCH PT G8990 CH 0% impaired $0.01 3931504G8990GPCI PT G8990 CI At least 1% but less than 20% impaired $0.01 3931503G8990GPCJ PT G8990 CJ At least 20% but less than 40% impaired $0.01 3931502G8990GPCK PT G8990 CK At least 40% but less than 60% impaired $0.01 3931501G8990GPCL PT G8990 CL At least 60% but less than 80% impaired $0.01 3931500G8990GPCM PT G8990 CM At least 80% but less than 100% impaired $0.01 3931499G8990GPCN PT G8990 CN 100% impaired $0.01 3931519G8991GPCH PT G8991 CH 0% impaired $0.01 3931518G8991GPCI PT G8991 CI At least 1% but less than 20% impaired $0.01 3931517G8991GPCJ PT G8991 CJ At least 20% but less than 40% impaired $0.01 3931516G8991GPCK PT G8991 CK At least 40% but less than 60% impaired $0.01 3931515G8991GPCL PT G8991 CL At least 60% but less than 80% impaired $0.01 3931514G8991GPCM PT G8991 CM At least 80% but less than 100% impaired $0.01 3931513G8991GPCN PT G8991 CN 100% impaired $0.01 3931512G8992GPCH PT G8992 CH 0% impaired $0.01 3931511G8992GPCI PT G8992 CI At least 1% but less than 20% impaired $0.01 3931510G8992GPCJ PT G8992 CJ At least 20% but less than 40% impaired $0.01 3931509G8992GPCK PT G8992 CK At least 40% but less than 60% impaired $0.01 3931508G8992GPCL PT G8992 CL At least 60% but less than 80% impaired $0.01 3931507G8992GPCM PT G8992 CM At least 80% but less than 100% impaired $0.01 3931506G8992GPCN PT G8992 CN 100% impaired $0.01 3931565G8993GPCH PT G8993 CH 0% impaired $0.01 3931564G8993GPCI PT G8993 CI At least 1% but less than 20% impaired $0.01 3931563G8993GPCJ PT G8993 CJ At least 20% but less than 40% impaired $0.01 3931562G8993GPCK PT G8993 CK At least 40% but less than 60% impaired $0.01 3931561G8993GPCL PT G8993 CL At least 60% but less than 80% impaired $0.01 3931560G8993GPCM PT G8993 CM At least 80% but less than 100% impaired $0.01 3931559G8993GPCN PT G8993 CN 100% impaired $0.01 3931579G8994GPCH PT G8994 CH 0% impaired $0.01 3931578G8994GPCI PT G8994 CI At least 1% but less than 20% impaired $0.01 3931577G8994GPCJ PT G8994 CJ At least 20% but less than 40% impaired $0.01 3931576G8994GPCK PT G8994 CK At least 40% but less than 60% impaired $0.01 3931575G8994GPCL PT G8994 CL At least 60% but less than 80% impaired $0.01 3931574G8994GPCM PT G8994 CM At least 80% but less than 100% impaired $0.01 3931573G8994GPCN PT G8994 CN 100% impaired $0.01 3931572G8995GPCH PT G8995 CH 0% impaired $0.01 3931571G8995GPCI PT G8995 CI At least 1% but less than 20% impaired $0.01 3931570G8995GPCJ PT G8995 CJ At least 20% but less than 40% impaired $0.01 3931569G8995GPCK PT G8995 CK At least 40% but less than 60% impaired $0.01 3931568G8995GPCL PT G8995 CL At least 60% but less than 80% impaired $0.01 3931567G8995GPCM PT G8995 CM At least 80% but less than 100% impaired $0.01 3931566G8995GPCN PT G8995 CN 100% impaired $0.01 100520601720003 PT Mechanical Traction Rehab Units 97012 $50.00 100521151720014 PT Neuromuscular Reeducation Rehab Units 97112 $50.00 254342901720197 PT RE-EVAL EST PLAN CARE 97164 $159.00 100520991720010 PT Ultrasound Units 97035 $50.00 40471511291098 PTH INTACT 83970 $169.00 15495911290843 PTH RELATED PROTEIN 83519 $215.00 6337941290045 PTT 85730 $68.00 8849151700061 PULMONARY FUNCTION PRE & POST 94060 $650.00 263646711740001 PULMONARY REHAB COPD W/ MONITOR 1 HR $168.00 35093961740004 PULMONARY REHAB NON COPD W/ MONITOR 1HR $92.00 117352491740001 PULMONARY REHAB W/ EXERCISE $168.00 269574001750088 PUNCH BIOPSY SKIN 1-LESION FAC 11104 $218.00 269574021750089 PUNCH BIOPSY SKIN ADDL LESION FAC 11105 $119.00 2497316610091030 PURAPLY AM $336.00 2640956110091030 PURAPLY AM 2 X 2 $130.00 25935556 pyridostigmine 60 mg Tab [UGH] $6.38 25935557 pyridoxine 100 mg/mL Inj Sol [UGH] J2415 $82.08 25935558 pyridoxine 50 mg Tab [UGH] $5.00 255523661290748 PYRUVATE 81225 $85.00 15495891290911 QUANTIFERON TB GOLD 86480 $200.00 25935999 QUEtiapine 100 mg Tab [UGH] $19.43 25935559 QUEtiapine 150 mg Tab [UGH] $65.54 25935560 QUEtiapine 25 mg Tab [UGH] $23.31 25935561 QUEtiapine 50 mg Tab [UGH] $41.06 25935562 quinapril 10 mg Tab [UGH] $6.12 23105961290050 RA LATEX FIXATION 86430 $53.00 25936322 rabies immune globulin, human 150 intl units/mL IM Sol [UGH] 90376 $1,792.52 26842062 rabies immune globulin, human 150 intl units/mL Sol [UGH] 90376 $13,567.44 26854050 rabies immune globulin, human 300 intl units/mL 5ml Sol [UGH] 90376 $15,557.68 26851624 rabies immune globulin, human 300 intl units/mL Sol [UGH] 90376 $3,408.56 25935564 rabies vaccine, human diploid cell 2.5 intl units IM Inj [UGH] 90675 $1,710.48 25935565 rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [UGH] $1,222.84 25935566 racepinephrine 2.25% Sol UD [UGH] $9.00 261666811291023 RAGWEED GIANT IgE 86003 $21.00 25935567 raloxifene 60 mg Tab [UGH] $33.00 25935568 ramipril 2.5 mg Cap [UGH] $8.57 25935569 ramipril 5 mg Cap [UGH] $10.19 25935570 ranitidine 15 mg/mL Oral Syrup [UGH] $5.00 25935571 ranolazine 500 mg oral ER Tab [UGH] $22.63 27811721290483 Rapamycin QST 80299 $142.00 90451871291099 RAPID HIV 86703 $56.00 26876101290309 RBC FOLATE 82747 $70.00 269787951450003 Recovery Room Ea Add 15 min Charge $27.50 259831011400215 RECOVERY TIME - 2 HOURS $250.00 259831001400216 RECOVERY TIME EA ADDL 15 MIN $27.50 254340011730178 Re-evaluation of occupational therapy established plan of ca 97168 $159.00 26010665 Refresh Lacri-Lube [UGH] $29.21 26471173 REFRIGERATED MED [UGH] $0.00 25935572 regadenoson 0.4 mg/5 mL IV Sol [UGH] J2785 $0.00 2640898210090110 RELIEVA GUIDEWIRE 80 LNG. 20 TIP ANGLE $465.00 25935573 remifentanil 1 mg IV Inj [UGH] $202.43 255121501461139 REMOVAL FB FOOT DEEP FAC 28192 $2,696.00 253734081460077 REMOVAL FOREIGN BODY 30300 $96.00 253735571461127 REMOVAL IMPACTED CERUMEN W IRRIGATION F 69209 $164.00 260777741460166 REMOVAL OF FOREIGN BODY 27372 $1,722.00 254847711750074 REMOVAL OF IMPACTED CERUMEN UNILATERAL 69210 $140.00 253735341461042 REMOVAL OF INTRAUTERINE DEVICE (IUD) 58301 $234.00 253729381460181 REMOVAL OF SKIN TAGS - 1 TO 15 LESIONS TECH FEE 11200 $178.80 259867711750083 REMOVAL/BIVALVING GAUNTLET BOOT CAST F 29700 $623.00 258121761461146 REMOVE FECAL IMPACTION 45915 $2,449.00 253735521461061 REMOVE FOREIGN BODY FROM EYE-FACILITY 65222 $232.00 207221491290472 RENAL FUNCTION PANEL 80069 $82.00 25935574 repaglinide 0.5 mg Tab [UGH] $30.71 25935575 repaglinide 1 mg Tab [UGH] $30.71 253730631461140 REPAIR EXTENSOR TENDON FINGER W/O FREE 26418 $2,700.00 262926221460091 REPAIR INGUINAL HERNIA-FACILITY FEE 49525 $4,440.00 253729561460014 REPAIR OF NAIL BED - LEVEL I TECH FEE 11760 $222.00 40552471400156 REPAIR OF VAGINA 57200 $2,800.00 253734741460175 REPAIR-LACERATION OF TONGUE FLOOR> 2.6CM 41252 $1,434.00 2640935410090790 RESTING L/L HAND SPLINT $102.00 2640935210090790 RESTING L/R HAND SPLINT $102.00 2640932310090640 RESTING M/L HAND SPLINT $102.00 2640932210090640 RESTING M/R HAND SPLINT $102.00 2640935310090790 RESTING S/L HAND SPLINT $102.00 2640932110090640 RESTING S/R HAND SPLINT $102.00 2640946810090940 RESTORELLE DIRECTFIX $3,070.00 259830191390765 RESUSCITATION NEWBORN CPR 99465 $875.00 14916691290036 RETICULOCYTE COUNT 85044 $63.00 2640961710091090 REVEAL LINQ SYSTEM $10,590.00 253406441291095 Rfx Lactic Acid 83605 $50.00 261597441290026 Rh 86901 $38.00 11579941293719 Rheumatoid Factor QST 86431 $61.00 261657221290692 RHEUMATOID FACTOR QUANT 86430 $61.00 8576281290018 RHIG $129.00 7872861290693 Rickettsia Antibody QST 86757 $68.00 25961564 rifampin 150 mg Cap [UGH] $7.29 25935578 rifampin 300 mg Cap [UGH] $9.50 25935579 rifaximin 200 mg Tab [UGH] $99.41 25961576 rifAXIMin 550 mg Tab UD [UGH] $141.14 25935581 risperiDONE 0.25 mg Tab [UGH] $19.46 25935582 risperiDONE 0.5 mg Dis Tab [UGH] $24.58 25935583 risperiDONE 1 mg Dis Tab [UGH] $25.85 25935839 risperiDONE 1 mg Tab [UGH] $22.71 7870621290421 RISTOCETIN COFACTOR 85245 $155.00 25961654 rivaroxaban 10 mg Tab [UGH] $71.68 25935585 rivaroxaban 15 mg Tab [UGH] $71.68 25935586 rivaroxaban 20 mg Tab [UGH] $57.54 27151805 rivastigmine 1.5 mg Cap $23.31 26011019 RIVASTIGMINE 1.5 MG CAP [UGH] $21.22 25935587 rivastigmine 4.6 mg/24 hr TD film, ER [UGH] $95.00 25935588 rivastigmine 9.5 mg/24 hr TD film, ER [UGH] $95.00 25935589 rizatriptan 10 mg Dis Tab [UGH] $151.35 250727301293722 RNP Antibody QST 86235 $127.00 26952432 rocuronium 10 mg/mL IV Sol 5ml [UGH] $25.20 2640970710091180 ROD REAMING 2.5 $344.00 26008973 roflumilast 500 mcg Tab UD [UGH] $47.21 100520811720036 ROM W/R EXT/TRUNK 95851 $40.00 100520831720037 ROM W/R HAND 95852 $40.00 925911112000 ROOM CHG-ICU $1,300.00 301585411701 ROOM CHG-NURSERY LEVEL 1 $625.00 301585211702 ROOM CHG-NURSERY LEVEL 2 $675.00 301585511703 ROOM CHG-NURSERY LEVEL 3 $725.00 86736011110 ROOM CHG-PVT-MEDICAL $800.00 952462311190 ROOM CHG-PVT-RESPITE $400.00 1139184511900 ROOM CHG-PVT-SKILLED NC $500.00 86736613000 ROOM CHG-PVT-TELE $1,000.00 25936003 ropinirole 0.25 mg Tab [UGH] $12.63 25936004 rOPINIRole 1 mg Tab [UGH] $12.53 25935590 ropivacaine 0.2% Inj Sol 10 mL [UGH] J2795 $116.20 25935591 ropivacaine 0.2% Inj Sol 20 mL [UGH] J2795 $52.27 25935592 ropivacaine 0.5% Inj Sol 30 mL [UGH] J2795 $104.20 34931571290328 ROTAVIRUS 86759 $56.00 261666841291054 ROUGH PIGWEED IgE 86003 $21.00 15495831290051 RPR 86592 $38.00 250728301290051 RPR Titer 86592 $38.00 261780691290329 RSV ANTIGEN-RESPIRATORY SYNCYTIAL ANTIG 87280 $54.00 15495821290117 RUBELLA 86762 $38.00 256291021290830 Rubella Antibody 86762 $65.00 2640945810090930 RV LEAD ISOFLEX $1,438.00 264888491291039 S PNEUM SEROTYPE 86317 $22.00 25935594 saccharomyces boulardii lyo 250 mg oral capsule [UGH] $5.00 27081807 sacubitril-valsartan 24 mg-26 mg Tab $40.72 25935595 sacubitril-valsartan 49 mg-51 mg Tab UD [UGH] $33.11 25935596 sacubitril-valsartan 97 mg-103 mg Tab UD [UGH] $33.11 12795961290079 SALICYLATE 80307 $103.00 261667001293666 SCALLOP IgE 86003 $21.00 7871621290437 SCLERODERMA ANTIBODY SCL-70 86235 $127.00 25935597 scopolamine 1.5 mg Transderm ER Film [UGH] $85.60 265709211530033 SCREENING DBT BILAT 77063 $78.00 2640993610091420 SCREW 11MM/130 RIGHT $4,686.00 2640942310090890 SCREW 2.3 X 16MM $988.00 2640942410090890 SCREW 3.0 X 16MM $988.00 2640903310090180 SCREW 3.5MM 10MM $64.00 2640903510090180 SCREW 3.5MM 18MM $64.00 2640903210090180 SCREW 3.5MM LOCK SLF-TPNG 212.101 $142.00 2640986110091350 SCREW 3MM 10MM SELF TAP $596.00 2640986210091350 SCREW 3MM 11MM SELF TAP $596.00 2640986310091350 SCREW 3MM 12MM SELF TAP $596.00 2640986410091350 SCREW 3MM 13MM SELF TAP $596.00 2640986510091350 SCREW 3MM 14MM SELF TAP $596.00 2640986610091350 SCREW 3MM 15MM SELF TAP $596.00 2640986710091350 SCREW 3MM 16MM SELF TAP $596.00 2640986810091350 SCREW 3MM 17MM SELF TAP $596.00 2640986910091360 SCREW 3MM 18MM SELF TAP $596.00 2640987010091360 SCREW 3MM 19MM SELF TAP $596.00 2640987110091360 SCREW 3MM 20MM SELF TAP $596.00 2640987210091360 SCREW 3MM 21MM SELF TAP $596.00 2640987310091360 SCREW 3MM 22MM SELF TAP $596.00 2640987410091360 SCREW 3MM 23MM SELF TAP $596.00 2640987510091360 SCREW 3MM 24MM SELF TAP $596.00 2640987610091360 SCREW 3MM 25MM SELF TAP $596.00 2640987710091360 SCREW 3MM 26MM SELF TAP $596.00 2640987810091360 SCREW 3MM 27MM SELF TAP $596.00 2640987910091370 SCREW 3MM 28MM SELF TAP $596.00 2640988010091370 SCREW 3MM 29MM SELF TAP $596.00 2640988110091370 SCREW 3MM 30MM SELF TAP $596.00 2640988210091370 SCREW 3MM 32MM SELF TAP $596.00 2640988310091370 SCREW 3MM 34MM SELF TAP $596.00 2640988410091370 SCREW 3MM 36MM SELF TAP $596.00 2640988510091370 SCREW 3MM 38MM SELF TAP $596.00 2640988610091370 SCREW 3MM 40MM SELF TAP $596.00 2640985910091350 SCREW 3MM 8MM SELF TAP $596.00 2640986010091350 SCREW 3MM 9MM SELF TAP $596.00 2640988710091370 SCREW 4.5MM 20MM $621.00 2640988810091370 SCREW 4.5MM 22MM $621.00 2640988910091380 SCREW 4.5MM 24MM $621.00 2640989010091380 SCREW 4.5MM 26MM $621.00 2640989110091380 SCREW 4.5MM 28MM $621.00 2640989210091380 SCREW 4.5MM 30MM $621.00 2640989310091380 SCREW 4.5MM 32MM $621.00 2640989410091380 SCREW 4.5MM 34MM $621.00 2640989510091380 SCREW 4.5MM 46MM $621.00 2640989610091380 SCREW 4.5MM 48MM $621.00 2640989710091380 SCREW 4.5MM 50MM $621.00 2640989810091380 SCREW 4.5MM 52MM $621.00 2640989910091390 SCREW 4.5MM 54MM $621.00 2640990010091390 SCREW 4.5MM 56MM $621.00 2640990110091390 SCREW 4.5MM 60MM $621.00 2640990210091390 SCREW 4.5MM 64MM $621.00 2640990310091390 SCREW 4.5MM 68MM $621.00 2640990410091390 SCREW 4.5MM 72MM $603.00 2640983710091320 SCREW 4MM 10MM $590.00 2640983810091320 SCREW 4MM 12MM $675.00 2640983910091320 SCREW 4MM 14MM $675.00 2640984010091330 SCREW 4MM 16MM $675.00 2640984110091330 SCREW 4MM 18MM $675.00 2640984210091330 SCREW 4MM 20MM $675.00 2640984310091330 SCREW 4MM 22MM $675.00 2640984410091330 SCREW 4MM 24MM $675.00 2640984510091330 SCREW 4MM 26MM $675.00 2640964610091120 SCREW 4MM 28MM $590.00 2640964710091120 SCREW 4MM 30MM $590.00 2640979810091280 SCREW 4MM 32MM $590.00 2640979710091280 SCREW 4MM 34MM $590.00 2640979310091280 SCREW 4MM 36MM $590.00 2640982810091310 SCREW 4MM 40MM $590.00 2640984610091330 SCREW 4MM 42MM $675.00 2640982910091310 SCREW 4MM 44MM $590.00 2640984710091330 SCREW 4MM 50MM $675.00 2640997710091470 SCREW 5 X 30 LOCKING $700.00 2640970910091190 SCREW 5 X 34 $628.00 2640971910091200 SCREW 5 X 40 $642.00 2640983610091320 SCREW 5 X 42 $673.00 2640973510091210 SCREW 5 X 72 $603.00 2640993510091420 SCREW 5.0MM TI LOCKING $673.00 2640973610091220 SCREW 5X38 $603.00 2640969610091170 SCREW 7.3 CANN. 55MM 209.855 $739.00 2640944210090910 SCREW 7.3 CANN. 80MM 209.880 $993.00 2640944110090910 SCREW 7.3 CANN. 85MM 209.885 $993.00 2640943910090900 SCREW 7.3 CANN. 90MM 209.890 $993.00 2640956510091040 SCREW BLUE LOCKING 2.5MM 08MM $495.00 2640956610091040 SCREW BLUE LOCKING 2.5MM 10MM $495.00 2640954010091010 SCREW BLUE LOCKING 2.5MM 12MM $327.00 2640956710091040 SCREW BLUE LOCKING 2.5MM 14MM $495.00 2640957910091050 SCREW BLUE LOCKING 2.5MM 16MM $327.00 2640954110091010 SCREW BLUE LOCKING 2.5MM 18MM $327.00 2640954210091010 SCREW BLUE LOCKING 2.5MM 20MM $327.00 2640954310091010 SCREW BLUE LOCKING 2.5MM 22MM $327.00 2640956810091040 SCREW BLUE LOCKING 2.5MM 24MM $495.00 2640960510091080 SCREW BLUE LOCKING 2.5MM 26MM $495.00 2640981210091290 SCREW BN 4MM 48MM $675.00 2640981110091290 SCREW BN 4MM 5MM 1.35MM 46MM $675.00 2640981510091300 SCREW BN 7.3MM 8.2MM 95MM 32MM $739.00 2640913410090310 SCREW BONE 6.5MM 70MM $149.00 2640913510090310 SCREW BONE 6.5MM 80MM $149.00 2640948510090950 SCREW BONE CORTEX 1.2MM 08MM $306.00 2640966510091140 SCREW BONE CORTEX GOLD 1.2MM 14MM $237.00 2640962110091100 SCREW BONE GOLD 2.0 06MM $306.00 2640948710090960 SCREW BONE GOLD 2.0 08MM $306.00 2640962210091100 SCREW BONE GOLD 2.0 12MM $306.00 2701518610091680 SCREW CANCELLOUS 4.0MM 35MM $278.00 2640965410091130 SCREW CANCELLOUS 4.0MM 35MM HEX $57.00 2640965310091130 SCREW CANCELLOUS 4.0MM 50MM $57.00 2640965210091130 SCREW CANCELLOUS 4.0MM 55MM $60.00 2640979610091280 SCREW CANCELLOUS 4MM 16MM $52.00 2640926210090450 SCREW CANCELLOUS 4MM 18MM $86.00 2640990710091390 SCREW CANNLUATED 4.0MM 32MM $590.00 2640990810091390 SCREW CANNLUATED 4.0MM 34MM $590.00 2640979410091280 SCREW CANNULATED 4.0 X 38 $675.00 2682167510091490 Screw Cannulated 4.0mm 44mm $550.00 2640970610091180 SCREW CANNULATED 6.5MM 100MM $743.00 2640971010091190 SCREW CANNULATED 6.5MM 90MM $743.00 2640970510091180 SCREW CANNULATED 6.5MM 95MM $743.00 2640971110091190 SCREW CANNULATED 6.5MM 95MM 32MM $743.00 2640912210090290 SCREW CANNULATED 7.0MM 100MM $758.00 2640912410090300 SCREW CANNULATED 7.0MM 105MM $900.00 2640914510090320 SCREW CANNULATED 7.0MM 85MM $900.00 2640914610090320 SCREW CANNULATED 7.0MM 90MM $900.00 2640912110090290 SCREW CANNULATED 7.0MM 95MM $900.00 2640912710090300 SCREW CANNULATED 7.3 208.900 $739.00 2640897510090050 SCREW CANNULATED 7.3 65MM 208.865 $900.00 2640897310090040 SCREW CANNULATED 7.3 75MM 208.875 $993.00 2640897410090040 SCREW CANNULATED 7.3 80MM 208.880 $774.00 2640911210090280 SCREW CANNULATED 7.3 85MM 208.885 $774.00 2640911310090280 SCREW CANNULATED 7.3 90MM 208.890 $645.00 2640912610090300 SCREW CANNULATED 7.3 95MM 208.895 $645.00 2640912510090300 SCREW CANNULATED 7.3MM 105MM $739.00 2640940210090860 SCREW CANNULATED 7.3MM 110MM $739.00 2682190010091610 SCREW CANNULATED 7.3MM 115MM $722.00 2640969810091170 SCREW CANNULATED 7.3MM 209.865 $739.00 2640969510091170 SCREW CANNULATED 7.3MM 209.870 $739.00 2640943810090900 SCREW CANNULATED 7.3MM 32MM $993.00 2682174610091530 SCREW CANNULATED 7.3MM 70MM $722.00 2640913610090310 SCREW CANNULATED 7.3MM WASHER $108.00 2640951710090990 SCREW CANULATED 2.2 38MM $1,097.00 2640996510091450 SCREW CANULATED 26MM 2.2MM $748.00 2640954910091020 SCREW CANULATED COMPR 22 MM $1,097.00 2640955910091030 SCREW CANULATED COMPR 24MM $1,097.00 2640955010091020 SCREW CANULATED COMPR 26MM $1,097.00 2640961810091090 SCREW CANULATED COMPR 30MM $1,097.00 2640960610091080 SCREW CANULATED COMPR 32MM $1,097.00 2640960710091080 SCREW CANULATED COMPR 36MM $1,097.00 2640955110091020 SCREW CANULATED COMPR 40MM $1,097.00 2640967410091150 SCREW CANULATED COMPRESSION 21MM $748.00 2701614610091690 Screw Compression 2.2 Cannulated $748.00 2640940810090870 SCREW COMPRESSION 26MM $225.00 2640919810090380 SCREW COMPRESSION 32MM $225.00 2640907010090230 SCREW COMPRESSION 36MM 280.990 $182.00 2640947110090940 SCREW CORTEX 1.5MM 11MM GOLD $306.00 2640947210090940 SCREW CORTEX 1.5MM 13MM GOLD $306.00 2640947310090940 SCREW CORTEX 1.5MM 6MM GOLD $306.00 2640947410090940 SCREW CORTEX 1.5MM 7MM GOLD $306.00 2640948210090950 SCREW CORTEX 1.5MM 8MM GOLD $306.00 2640948310090950 SCREW CORTEX 1.5MM 9MM GOLD $306.00 2640993710091420 SCREW CORTEX 2.4 X 12 $169.00 2640976810091250 SCREW CORTEX 2.4 X 16 $193.00 2640992810091420 SCREW CORTEX 2.4MM $169.00 2640993210091420 SCREW CORTEX 2.4MM 16MM $313.00 2640993110091420 SCREW CORTEX 2.4MM SELF TAP $313.00 2640982110091310 SCREW CORTEX 2.7 X 22 $130.00 2640973210091210 SCREW CORTEX 2.7MM X 14MM $131.00 2640920510090380 SCREW CORTEX 2.7MM 12MM $140.00 2640917910090360 SCREW CORTEX 2.7MM 16MM $98.00 2640918010090360 SCREW CORTEX 2.7MM 18MM $140.00 2640918110090360 SCREW CORTEX 2.7MM 20MM $140.00 2640919710090370 SCREW CORTEX 2.7MM 28MM $98.00 2640997010091460 SCREW CORTEX 2.7MM 30MM $137.00 2640997110091460 SCREW CORTEX 2.7MM 34MM $137.00 2640997210091460 SCREW CORTEX 2.7MM 36MM $137.00 2640997310091460 SCREW CORTEX 2.7MM 38MM $137.00 2640997410091460 SCREW CORTEX 2.7MM 45MM $137.00 2640997510091460 SCREW CORTEX 2.7MM 50MM $137.00 2640997610091470 SCREW CORTEX 2.7MM 55MM $118.00 2640972610091200 SCREW CORTEX 2.7X12 $115.00 2640982510091310 SCREW CORTEX 3.5 X 18 $87.00 2640982210091310 SCREW CORTEX 3.5 X 20 $87.00 2640927110090460 SCREW CORTEX 3.5MM 28MM $71.00 2640965510091130 SCREW CORTEX 3.5MM 30MM $52.00 2698884610091680 SCREW CORTEX 3.5MM T15 12MM $71.00 2698884710091690 SCREW CORTEX 3.5MM T15 22MM $71.00 2640910110090270 SCREW CORTEX 3.5MM WITH T15 $142.00 2640907310090240 SCREW CORTEX 4.5 SLF TAPP. 42MM 214.842 $96.00 2640917810090360 SCREW CORTEX 4.5MM $101.00 2640907610090240 SCREW CORTEX 4.5MM 214.850 $96.00 2640909010090260 SCREW CORTEX 4.5MM 40MM $96.00 2640909110090260 SCREW CORTEX 4.5MM 42MM $96.00 2640910810090280 SCREW CORTEX 4.5MM 44MM $96.00 2640910910090280 SCREW CORTEX 4.5MM 46MM $96.00 2640911010090280 SCREW CORTEX 4.5MM 48MM $96.00 2640907510090240 SCREW CORTEX 4.5MM SELF TAP. 214.846 $96.00 2640907110090240 SCREW CORTEX 4.5MM SLF TAP 38MM 214.838 $96.00 2640907210090240 SCREW CORTEX 4.5MM SLF TAP 40MM 214.840 $99.00 2640907410090240 SCREW CORTEX 4.5MM SLF TAP 44MM 214.844 $96.00 2640907810090240 SCREW CORTEX 4.5MM SLF TAP 52MM $96.00 2640952510090990 SCREW CORTEX BLUE 2.0 11MM $495.00 2640959310091070 SCREW CORTEX BLUE 2.0 12MM $495.00 2640952610091000 SCREW CORTEX BLUE 2.0 16MM $495.00 2640959410091070 SCREW CORTEX BLUE 2.0 18MM $495.00 2640951210090980 SCREW CORTEX GOLD 1.5MM 10MM $306.00 2640951810090990 SCREW CORTEX GOLD 1.5MM 12MM $306.00 2640959110091070 SCREW CORTEX GOLD 2.0 10MM $306.00 2640950210090970 SCREW CORTEX GOLD 2.0 11MM $306.00 2640952210090990 SCREW CORTEX GOLD 2.0 13MM $306.00 2640952310090990 SCREW CORTEX GOLD 2.0 15MM $306.00 2640952410090990 SCREW CORTEX GOLD 2.0 16MM $306.00 2640959210091070 SCREW CORTEX GOLD 2.0 19MM $306.00 2640959010091070 SCREW CORTEX GOLD 2.0 9MM $306.00 2640962310091100 SCREW CORTEX GOLD 2.3 08MM $306.00 2640962410091100 SCREW CORTEX GOLD 2.3 11MM $306.00 2640983410091320 SCREW CORTEX NON LOCKING 2.5MM 18MM $237.00 2640962810091100 SCREW CORTICAL 2.7 12MM $249.00 2640962910091110 SCREW CORTICAL 2.7 14MM $249.00 2640963010091110 SCREW CORTICAL 2.7 18MM $249.00 2640963110091110 SCREW CORTICAL 2.7 20MM $249.00 2640963410091110 SCREW CORTICAL 3.2 12MM $249.00 2640963510091110 SCREW CORTICAL 3.2 16MM $249.00 2640963610091110 SCREW CORTICAL 3.2 18MM $249.00 2640963710091110 SCREW CORTICAL 3.2 20MM $249.00 2640919910090380 SCREW CORTICAL 4.5MM X 30MM $114.00 2640978710091270 SCREW CORTICAL 4.5MM X 32MM $114.00 2640920010090380 SCREW CORTICAL 4.5MM X 34MM $114.00 2640927410090460 SCREW CORTICAL 4.5MM X 36MM $114.00 2640920110090380 SCREW CORTICAL 4.5MM X 38MM $114.00 2640927510090460 SCREW CORTICAL 4.5MM X 40MM $114.00 2640920210090380 SCREW CORTICAL 4.5MM X 42MM $114.00 2640937710090830 SCREW CORTICAL 4.5MM X 44MM $114.00 2640961510091090 SCREW CORTICAL 4.5MM X 46MM $114.00 2640963210091110 SCREW CORTICAL LOCKING 2.7 14MM $300.00 2640963310091110 SCREW CORTICAL LOCKING 2.7 18MM $300.00 2640963810091110 SCREW CORTICAL LOCKING 3.2 12MM $300.00 2640963910091120 SCREW CORTICAL LOCKING 3.2 20MM $300.00 2640951610090980 SCREW FLAT HEAD SZ LONG $462.00 2640954410091020 SCREW GOLD NON LOCKING 2.5MM 12MM $237.00 2640955210091020 SCREW GOLD NON LOCKING 2.5MM 14MM $237.00 2640960310091080 SCREW GOLD NON LOCKING 2.5MM 16MM $306.00 2640957810091050 SCREW GOLD NON LOCKING 2.5MM 20MM $306.00 2640954510091020 SCREW GOLD NON LOCKING 2.5MM 22MM $306.00 2640960410091080 SCREW GOLD NON LOCKING 2.5MM 24MM $237.00 2640960010091080 SCREW GOLD NON LOCKING 2.5MM 26MM $306.00 2640955610091030 SCREW HEX LOCKING 3.5MM X 14MM $375.00 2640955710091030 SCREW HEX NON-LOCKING 3.5MM X 14MM $375.00 2640955810091030 SCREW HEX NON-LOCKING 3.5MM X 16MM $375.00 2640977410091260 SCREW LAG 11MM X 100MM $2,400.00 2640965010091130 SCREW LAG 11MM X 105MM $2,400.00 2640964810091120 SCREW LAG 11MM X 95MM $2,400.00 2640946610090930 SCREW LAG 12.7MM X 115MM $1,313.00 2640940910090870 SCREW LAG 12.7MM X 70MM $1,313.00 2640927610090460 SCREW LAG 12.7MM X 75MM $630.00 2640920310090380 SCREW LAG 12.7MM X 80MM $1,313.00 2640937810090830 SCREW LAG 12.7MM X 85MM $1,313.00 2640958010091050 SCREW LAG 12.7MM X 90MM $1,313.00 2640961610091090 SCREW LAG 12.7MM X 95MM $1,313.00 2640908210090250 SCREW LAG 4.00MM $576.00 2640910710090280 SCREW LAG 90MM 280.900 $1,140.00 2640926110090450 SCREW LAG 95MM 280.950 $1,175.00 2640912010090290 SCREW LAG DHS/DCS 100MM 12.7M $1,240.00 2640973110091210 SCREW LOCKING 2.4 MM X 10 MM $407.00 2640972710091210 SCREW LOCKING 2.4 X 12 $407.00 2640972810091210 SCREW LOCKING 2.4 X 14 $407.00 2640992910091420 SCREW LOCKING 2.4MM $666.00 2640939510090850 SCREW LOCKING 2.7 X 10 $435.00 2640939610090850 SCREW LOCKING 2.7 X 14 $435.00 2640973010091210 SCREW LOCKING 2.7 X 16 $115.00 2640939810090850 SCREW LOCKING 2.7 X 18 $435.00 2640982010091310 SCREW LOCKING 2.7 X 20 $407.00 2640981910091300 SCREW LOCKING 2.7 X 22 $407.00 2640939710090850 SCREW LOCKING 2.7 X16 $435.00 2640982410091310 SCREW LOCKING 3.5 X 16 $431.00 2640982310091310 SCREW LOCKING 3.5 X 26 $431.00 2640943110090890 SCREW LOCKING 3.5MM X 12MM $720.00 2640942910090890 SCREW LOCKING 3.5MM X 14MM $720.00 2640943010090890 SCREW LOCKING 3.5MM X 16MM $720.00 2640981610091300 SCREW LOCKING 5 X 38 $673.00 2640975710091240 SCREW LOCKING 5.0MM X 48MM $642.00 2640974910091230 SCREW LOCKING 5MM 32MM $642.00 2640974810091230 SCREW LOCKING 5MM 68MM $642.00 2701614710091690 Screw Locking Blue 1.5 10mm $327.00 2701614810091690 Screw Locking Blue 1.5 11mm $327.00 2640953210091000 SCREW LOCKING BLUE 1.5MM 12MM $327.00 2640948810090960 SCREW LOCKING BLUE 2.0 07MM $495.00 2640948910090960 SCREW LOCKING BLUE 2.0 08MM $495.00 2640949010090960 SCREW LOCKING BLUE 2.0 09MM $495.00 2640950310090970 SCREW LOCKING BLUE 2.0 13MM $495.00 2640950410090970 SCREW LOCKING BLUE 2.0 14MM $495.00 2640983310091320 SCREW LOCKING BLUE 2.5MM 14MM $327.00 2640939410090850 SCREW NON LOCKING 2.7 X 10 $435.00 2640943310090900 SCREW NONLOCKING 3.5MM X 12MM $720.00 2640943410090900 SCREW NONLOCKING 3.5MM X 16MM $720.00 2640908910090260 SCREW ONE STEP LAG 80MM 280.80 $1,140.00 2640909710090270 SCREW SELF TAPPING 36MM 214.836 $96.00 2701336210091690 SCREW SHAFT 3.5MM 16MM $51.00 2701336310091690 SCREW SHAFT 3.5MM 18MM $52.00 2640965610091130 SCREW SLF TPNG 3.5MM 12MM $431.00 2640965710091130 SCREW SLF TPNG 3.5MM 16MM $431.00 2640965810091130 SCREW SLF TPNG 3.5MM 30MM $431.00 2640965910091140 SCREW SLF TPNG 3.5MM 60MM $431.00 2640901510090160 SCREWS 0013-1-6550 50MM $270.00 2640918610090360 SCREWS 3.5MM COR. SELF-TP 12MM 204.812 $64.00 2640903410090180 SCREWS 3.5MM COR. SELF-TP 14MM 204.814 $64.00 2640918410090360 SCREWS 3.5MM COR. SELF-TP 16MM 204.816 $64.00 2640916410090340 SCREWS 3.5MM COR. SELF-TP 24MM 204.824 $71.00 2640939210090850 SCREWS 3.5MM COR. SELF-TP 26MM 204.826 $64.00 2640938010090830 SCREWS 3.5MM COR. SELF-TP 30MM 204.830 $101.00 2640964510091120 SCREWS 3.5MM COR. SELF-TP 34MM 204.834 $73.00 2640930010090550 SCREWS 3.5MM COR. SELF-TP 38MM 204.838 $580.00 2640908810090250 SCREWS 3.5MM COR. SELF-TP 40MM 204.840 $73.00 2640935110090790 SCREWS 3.5MM COR. SELF-TP 45MM 204.845 $71.00 2640918710090360 SCREWS 3.5MM COR. SELF-TP 50MM 204.850 $71.00 2640946010090930 SCREWS 3.5MM COR. SELF-TP 55MM 204.855 $100.00 2640946110090930 SCREWS 3.5MM COR. SELF-TP 60MM $73.00 2640903610090180 SCREWS 3.5MM CORT. SELF-TP 20MM 204.820 $64.00 2640916310090340 SCREWS 3.5MM CORT. SELF-TP 22MM 204.822 $64.00 2640938110090830 SCREWS 4.0MM CANC. BONE 12MM $52.00 2640938210090830 SCREWS 4.0MM CANC. BONE 14MM $60.00 2640938410090840 SCREWS 4.0MM CANC. BONE 30MM $86.00 2640938310090840 SCREWS 4.0MM CANC. BONE 40MM $86.00 2640905710090220 SCREWS 4.0MM CANC. BONE 60MM 206.060 $83.00 2640919210090370 SCREWS CORTEX 2.7MM 14MM $98.00 2640919310090370 SCREWS CORTEX 2.7MM 22MM $140.00 2640919410090370 SCREWS CORTEX 2.7MM 40MM $98.00 6338301290037 SED RATE 85651 $48.00 2640901210090160 SEEDS IODINE BRACHYSOURCE $45.00 25935598 selegiline 5 mg Cap [UGH] $11.52 45990081720056 SELF CARE ADL / 15 $58.00 2640985110091340 SELF CENTERING BI POLAR HEAD SZ 28MM $1,375.00 260133231740015 SELF PAY INITIAL ASSESSMENT CARDIAC REHAB $75.00 260133221740016 SELF PAY INITIAL ASSESSMENT PULMONARY REHAB $75.00 260133171740017 SELF PAY MAINTENANCE CARDIOPULMONARY REHAB $50.00 260133151740018 SELF PAY MAINTENANCE PRORATION 1 WEEK $12.50 25936005 senna 8.6 mg Tab [UGH] $5.00 2949461290161 SENSITIVITY (EACH) 87186 $65.00 48113621720055 SENSORY INTEGRATION / 15 $50.00 7802411710002 SENSORY INTEGRATION 15 MIN 97533 $50.00 12723391730022 Sensory integrative techniques to enhance sensory processing 97533 $50.00 269505131440616 SEQ COMPRESSION UNIT $95.00 25935599 sertraline 25 mg Tab [UGH] $14.22 25961681 sertraline 50 mg Tab [UGH] $5.00 25935601 sevelamer 800 mg Tab [UGH] $38.10 25935602 sevoflurane Inh Liq 250 mL [UGH] $300.00 15495791290696 SEX HORMONE BIND GLOBULIN 84270 $89.00 6336331290070 SGOT (AST) 84450 $63.00 6336321290071 SGPT (ALT) 84460 $63.00 259186391461054 SHAVE SKIN LESION - TECH FEE 11306 $251.00 261666851291056 SHEEP SORREL IgE 86003 $21.00 2640970110091180 SHELL ACETABULAR 48MM $2,375.00 2640967010091150 SHELL ACETABULAR 52MM $2,000.00 2640967910091160 SHELL ACETABULAR 58MM $2,375.00 2640981710091300 SHELL POROCOAT 56MM $2,375.00 262462982291212 SHIGA TOXINS (E.COLI 0157) 87427 $68.00 2640933510090680 SHORT LEG WALK SPLINT SMALL $26.00 2640894010010240 SHOULDER IMMOBILIZER CHILD $22.00 2640896810090010 SHOULDER IMMOBILIZER- CHILD $17.00 2640895310010380 SHOULDER IMMOBILIZER DELUXE W/ STRAP $23.00 2640904110090190 SHOULDER IMMOBILIZER SMALL MALE $17.00 2404117410090010 SHOULDER IMMOBILIZER UNIVERSAL $20.00 257371641293668 SHRIMP IgE 86003 $21.00 25935603 silodosin 8 mg Cap [UGH] $34.02 25935604 silver nitrate Top Stick [UGH] $5.00 26246218 silver sulfADIAZINE Top 1% Crm [UGH] $259.81 25935841 silver sulfADIAZINE Top 1% Crm 85 gm [UGH] $105.88 25935606 simethicone 40 mg/0.6 mL Oral Liq [UGH] $11.10 25935607 simethicone 80 mg Chew Tab [UGH] $5.00 27052035 simethicone 80 mg Tab $5.00 253729731460159 SIMPLE CLOSURE SUPERFICIAL WOUND DEHISCENCE TECH FEE 12020 $720.00 253729581460016 SIMPLE REPAIR <= 2.5 CM TECH FEE 12001 $180.00 253729651460020 SIMPLE REPAIR <= 2.5CM TECH FEE 12011 $180.00 253729611460019 SIMPLE REPAIR 12.6 TO 20 CM TECH FEE 12005 $180.00 253729691460024 SIMPLE REPAIR 12.6 TO 20.0 CM TECH FEE 12016 $180.00 253729661460021 SIMPLE REPAIR 2.6 TO 5.0 CM TECH FEE 12013 $180.00 253729591460017 SIMPLE REPAIR 2.6 TO 7.5 CM TECH FEE 12002 $180.00 253729631460148 SIMPLE REPAIR 20.1 TO 30.0 CM TECH FEE 12006 $192.00 253729671460022 SIMPLE REPAIR 5.1 TO 7.0 CM TECH FEE 12014 $180.00 253729601460018 SIMPLE REPAIR 7.6 TO 12.5 CM TECH FEE 12004 $180.00 25935608 sincalide 5 mcg Pow [UGH] J2805 $485.62 258545571461065 SINGLE TENDON INJECTION-FACILITY 20551 $607.00 25935609 sitaGLIPtin 25 mg oral tablet [UGH] $60.96 25935610 sitaGLIPtin 50 mg oral tablet [UGH] $72.19 7835901290528 SJOGRENS ABYS 86235 $106.00 11579921293723 Sjogren's Antibody (SS-A) QST 86235 $106.00 254847601750046 SKIN BIOPSY 1 LESION - FAC 11100 $677.00 254847611750047 SKIN BIOPSY EA ADDL LESION - FAC 11101 $163.00 2640944910090910 SLING SINGLE INCISION $3,510.00 2640899110090120 SLING SYSTEM ALTIS $2,328.00 98520701710193 SLP Analysis of Voice & Resonance Rehab Units 92524 $290.00 262041481710002 SLP Sensory Integrative Techniques Units 97533 $50.00 98520681710190 SLP Speech Fluency Eval Rehab Units 92521 $343.00 257371031290440 SM & SM/RNP ANTIBODIES 86235 $127.00 2640900910090150 SMART PORT CT TITANIUM POWER-INJECTABLE $811.00 174427781700067 SMOKING CESSATION 3-10 MIN 99406 $81.00 178245481740013 SMOKING CESSATION EDUCATION > 10 MIN 99407 $76.00 263047131740013 SMOKING CESSATION EDUCATION >10MIN 99407 $81.00 269574091750076 SMOKING CESSATION EDUCATION 3-10 MIN 99406 $81.00 15495191290192 Smooth Muscle Ab QST 86255 $112.00 246312772290192 Smooth Muscle Ab w/rflx QST 86255 $112.00 269740681300360 SNAPSHOT CANCER MUTATION 81403 $1,250.00 6336111290093 SODIUM 84295 $53.00 25935611 sodium acetate 2 mEq/mL IV Sol [UGH] $25.00 25935842 sodium bicarbonate 4% IV Sol 5 mL (Neut) [UGH] $45.80 25935843 sodium bicarbonate 4.2% IV Sol 10 mL syringe [UGH] $25.00 26104599 sodium bicarbonate 4.2% IV Sol 5 mL [UGH] $101.79 25935613 sodium bicarbonate 650 mg Tab [UGH] $5.00 25935844 sodium bicarbonate 8.4% IV Sol 50 mL syringe [UGH] $57.02 25935845 sodium bicarbonate 8.4% IV Sol 50 mL vial [UGH] $52.34 25935614 sodium biphosphate-sodium phosphate 1.5 g Tab [UGH] $30.31 26010778 Sodium Chloride 0.45% Sol 1000 mL [UGH] $90.00 26010908 Sodium Chloride 0.45% with KCl 20 mEq/l IV Sol 1000 mL [UGH] J3480 $90.00 26184621 Sodium Chloride 0.9% 1 EA Soln [UGH] $5,997.60 25935615 sodium chloride 0.9% Inh Sol 3 mL [UGH] $5.00 25935616 sodium chloride 0.9% Inj Sol 10 mL [UGH] $15.00 26252954 sodium chloride 0.9% Inj Sol 20 mL [UGH] $7.50 25935617 sodium chloride 0.9% Inj Sol 5 mL [UGH] $0.00 26011476 Sodium Chloride 0.9% Intravenous Sol 1000 mL [UGH] J7040 $90.00 25935618 sodium chloride 0.9% Irr Sol 1000 mL [UGH] $28.35 25935619 sodium chloride 0.9% Irr Sol 3000 mL [UGH] $65.95 25935620 sodium chloride 0.9% Irr Sol 500 mL [UGH] $19.85 26010878 Sodium Chloride 0.9% IV Sol 100 mL Addvantage [UGH] J7040 $40.00 26010903 Sodium Chloride 0.9% IV Sol 100 mL Bag [UGH] J7040 $40.00 26053889 Sodium Chloride 0.9% IV Sol 25 mL [UGH] J7040 $40.00 26011500 Sodium Chloride 0.9% IV Sol 250 mL [UGH] J7050 $90.00 26098728 Sodium Chloride 0.9% IV Sol 50 mL bag [UGH] J7040 $40.00 26053955 Sodium Chloride 0.9% IV Sol 50 mL vial [UGH] J7040 $15.00 26011240 Sodium Chloride 0.9% IV Sol 500 mL bag [UGH] J7040 $90.00 26095460 Sodium Chloride 0.9% Sol 100 mL Mini Bag [UGH] J7040 $40.00 26157062 Sodium Chloride 0.9% with KCl 20 mEq/l IV Sol 1000 mL [UGH] $90.00 25935622 Sodium Chloride 0.9% with KCl 40 mEq/l IV Sol 1000 mL [UGH] $90.00 25935623 sodium chloride 1 g Tab [UGH] $5.00 25935624 sodium chloride 14.6% IV Sol 20 mL [UGH] J7131 $25.00 25935625 sodium chloride 23.4% IV Sol 30 mL [UGH] J7131 $25.00 26010910 Sodium Chloride 3% IV Sol 500 mL [UGH] J7131 $90.00 25935626 sodium chloride bacteriostatic 0.9% Inj Sol 30 mL [UGH] $12.00 26095808 Sodium Chloride Flush 10 mL [UGH] A4216 $0.00 25935628 sodium chloride infant nasal 0.65% Sol 30 mL [UGH] $11.95 25935627 sodium chloride nasal 0.65% Gel [UGH] $15.40 25935629 sodium chloride Nasal 0.65% Spry [UGH] $5.00 25935630 sodium chloride, hypertonic, Ophth 2% Sol [UGH] $72.88 25935631 sodium chloride, hypertonic, Ophth 5% Sol [UGH] $48.44 25935632 sodium ferric gluconate complex 12.5 mg/mL IV Sol [UGH] J2916 $152.64 25935633 sodium hypochlorite Top 0.125% Sol [UGH] $45.36 25935634 sodium hypochlorite Top 0.25% Sol [UGH] $45.36 25935635 sodium hypochlorite Top 0.5% Sol [UGH] $46.00 27052004 sodium nitroprusside 25 mg/mL Sol $432.00 25935636 sodium phosphate 3 mmol/mL Inj Sol [UGH] $79.97 25935637 sodium polystyrene sulfonate 15 g/60 mL Sus [UGH] $340.00 26010547 sodium polystyrene sulfonate 15 g/60 mL Sus UD [UGH] $45.00 25983782 sodium sulfacetamide Ophth 10% Sol [UGH] $222.60 26010525 sorbitol 70% Liq [UGH] $11.20 26949896 sotalol 120 mg Tab $17.09 25935640 sotalol 120 mg Tab [UGH] $17.09 25936006 sotalol 80 mg Tab [UGH] $13.04 257371601291090 SOYBEAN IgE 86003 $21.00 2640907710090240 SPECIAL PLATE $1,585.00 261690701290103 SPECIFIC GRAVITY 84315 $20.00 2640966810091140 SPEED IMPLANT 11 X 10 X 10 $2,106.00 2640982610091310 SPEED IMPLANT 11 X 8 X 8 $2,106.00 2640966910091150 SPEED IMPLANT 13 X 12 X 12 $2,106.00 2640969010091170 SPEEDSCREW 5.5MM $988.00 2640969710091170 SPEEDSCREW 6.5MM $988.00 39211471290010 SPERM COUNT QUALITATIVE 89320 $33.00 9955261440612 Spinal Anesthesia $345.00 258553961290034 SPINAL FLUID PROFILE 89051 $80.00 253735391460171 SPINAL PUNCTURE LUMBAR THERAPEUTIC 62272 $726.00 25936007 spironolactone 25 mg Tab [UGH] $5.00 2640928710090480 SPLINT FINGER OVAL EIGHT SIZE 6 $16.00 2640928610090480 SPLINT FINGER OVAL EIGHT SIZE 9 $16.00 2640928410090470 SPLINT FINGER SIZE 11 OVAL 8 $16.00 2640928510090470 SPLINT FINGER SIZE 12 OVAL 8 $16.00 2640928310090470 SPLINT FINGER SIZE 7 OVAL 8 $16.00 100436491730030 SPLINT FINGER STATIC-APPLICATION 29130 $90.00 2640936910090820 SPLINT HAND ORTHOSIS LARGE $189.00 2640936810090820 SPLINT HAND ORTHOSIS MEDIUM $189.00 2640937310090820 SPLINT HAND ORTHOSIS RIGHT MEDIUM $189.00 2640940110090860 SPLINT RESTING HAND ORTHOSIS MED LEFT $150.00 2640940010090860 SPLINT RESTING HAND ORTHOSIS SMALL RIGHT $150.00 263498211720039 SPLINT SHRT ARM STATIC 29125 $90.00 2640933410090670 SPLINT THUMB ARTHRITIS LEFT MEDIUM $75.00 2640933310090670 SPLINT THUMB ARTHRITIS RT. MEDIUM $75.00 2640934010090710 SPLINT THUMB UNIVERSAL $28.00 30233371700029 SPUTUM COLLECTION 89220 $300.00 60873071710190 ST FLUENCY EVALUATION 92521 $343.00 3931661G8996GNCH ST G8996 CH 0% impaired $0.01 3931660G8996GNCI ST G8996 CI At least 1% but less than 20% impaired $0.01 3931659G8996GNCJ ST G8996 CJ At least 20% but less than 40% impaired $0.01 3931658G8996GNCK ST G8996 CK At least 40% but less than 60% impaired $0.01 3931657G8996GNCL ST G8996 CL At least 60% but less than 80% impaired $0.01 3931656G8996GNCM ST G8996 CM At least 80% but less than 100% impaired $0.01 3931655G8996GNCN ST G8996 CN 100% impaired $0.01 3931676G8997GNCH ST G8997 CH 0% impaired $0.01 3931675G8997GNCI ST G8997 CI At least 1% but less than 20% impaired $0.01 3931674G8997GNCJ ST G8997 CJ At least 20% but less than 40% impaired $0.01 3931673G8997GNCK ST G8997 CK At least 40% but less than 60% impaired $0.01 3931672G8997GNCL ST G8997 CL At least 60% but less than 80% impaired $0.01 3931671G8997GNCM ST G8997 CM At least 80% but less than 100% impaired $0.01 3931670G8997GNCN ST G8997 CN 100% impaired $0.01 3931669G8998GNCH ST G8998 CH 0% impaired $0.01 3931668G8998GNCI ST G8998 CI At least 1% but less than 20% impaired $0.01 3931667G8998GNCJ ST G8998 CJ At least 20% but less than 40% impaired $0.01 3931666G8998GNCK ST G8998 CK At least 40% but less than 60% impaired $0.01 3931665G8998GNCL ST G8998 CL At least 60% but less than 80% impaired $0.01 3931664G8998GNCM ST G8998 CM At least 80% but less than 100% impaired $0.01 3931663G8998GNCN ST G8998 CN 100% impaired $0.01 3931196G8999GNCH ST G8999 CH 0% impaired $0.01 3931195G8999GNCI ST G8999 CI At least 1% but less than 20% impaired $0.01 3931194G8999GNCJ ST G8999 CJ At least 20% but less than 40% impaired $0.01 3931193G8999GNCK ST G8999 CK At least 40% but less than 60% impaired $0.01 3931192G8999GNCL ST G8999 CL At least 60% but less than 80% impaired $0.01 3931191G8999GNCM ST G8999 CM At least 80% but less than 100% impaired $0.01 3931190G8999GNCN ST G8999 CN 100% impaired $0.01 3931203G9158GNCH ST G9158 CH 0% impaired $0.01 3931202G9158GNCI ST G9158 CI At least 1% but less than 20% impaired $0.01 3931201G9158GNCJ ST G9158 CJ At least 20% but less than 40% impaired $0.01 3931200G9158GNCK ST G9158 CK At least 40% but less than 60% impaired $0.01 3931199G9158GNCL ST G9158 CL At least 60% but less than 80% impaired $0.01 3931198G9158GNCM ST G9158 CM At least 80% but less than 100% impaired $0.01 3931197G9158GNCN ST G9158 CN 100% impaired $0.01 3931619G9159GNCH ST G9159 CH 0% impaired $0.01 3931618G9159GNCI ST G9159 CI At least 1% but less than 20% impaired $0.01 3931617G9159GNCJ ST G9159 CJ At least 20% but less than 40% impaired $0.01 3931616G9159GNCK ST G9159 CK At least 40% but less than 60% impaired $0.01 3931615G9159GNCL ST G9159 CL At least 60% but less than 80% impaired $0.01 3931614G9159GNCM ST G9159 CM At least 80% but less than 100% impaired $0.01 3931613G9159GNCN ST G9159 CN 100% impaired $0.01 3931633G9160GNCH ST G9160 CH 0% impaired $0.01 3931632G9160GNCI ST G9160 CI At least 1% but less than 20% impaired $0.01 3931631G9160GNCJ ST G9160 CJ At least 20% but less than 40% impaired $0.01 3931630G9160GNCK ST G9160 CK At least 40% but less than 60% impaired $0.01 3931629G9160GNCL ST G9160 CL At least 60% but less than 80% impaired $0.01 3931628G9160GNCM ST G9160 CM At least 80% but less than 100% impaired $0.01 3931627G9160GNCN ST G9160 CN 100% impaired $0.01 3931626G9161GNCH ST G9161 CH 0% impaired $0.01 3931625G9161GNCI ST G9161 CI At least 1% but less than 20% impaired $0.01 3931624G9161GNCJ ST G9161 CJ At least 20% but less than 40% impaired $0.01 3931623G9161GNCK ST G9161 CK At least 40% but less than 60% impaired $0.01 3931622G9161GNCL ST G9161 CL At least 60% but less than 80% impaired $0.01 3931621G9161GNCM ST G9161 CM At least 80% but less than 100% impaired $0.01 3931620G9161GNCN ST G9161 CN 100% impaired $0.01 3931640G9162GNCH ST G9162 CH 0% impaired $0.01 3931639G9162GNCI ST G9162 CI At least 1% but less than 20% impaired $0.01 3931638G9162GNCJ ST G9162 CJ At least 20% but less than 40% impaired $0.01 3931637G9162GNCK ST G9162 CK At least 40% but less than 60% impaired $0.01 3931636G9162GNCL ST G9162 CL At least 60% but less than 80% impaired $0.01 3931635G9162GNCM ST G9162 CM At least 80% but less than 100% impaired $0.01 3931634G9162GNCN ST G9162 CN 100% impaired $0.01 3931654G9163GNCH ST G9163 CH 0% impaired $0.01 3931653G9163GNCI ST G9163 CI At least 1% but less than 20% impaired $0.01 3931652G9163GNCJ ST G9163 CJ At least 20% but less than 40% impaired $0.01 3931651G9163GNCK ST G9163 CK At least 40% but less than 60% impaired $0.01 3931650G9163GNCL ST G9163 CL At least 60% but less than 80% impaired $0.01 3931649G9163GNCM ST G9163 CM At least 80% but less than 100% impaired $0.01 3931648G9163GNCN ST G9163 CN 100% impaired $0.01 3931647G9164GNCH ST G9164 CH 0% impaired $0.01 3931646G9164GNCI ST G9164 CI At least 1% but less than 20% impaired $0.01 3931645G9164GNCJ ST G9164 CJ At least 20% but less than 40% impaired $0.01 3931644G9164GNCK ST G9164 CK At least 40% but less than 60% impaired $0.01 3931643G9164GNCL ST G9164 CL At least 60% but less than 80% impaired $0.01 3931642G9164GNCM ST G9164 CM At least 80% but less than 100% impaired $0.01 3931641G9164GNCN ST G9164 CN 100% impaired $0.01 3931154G9165GNCH ST G9165 CH 0% impaired $0.01 3931153G9165GNCI ST G9165 CI At least 1% but less than 20% impaired $0.01 3931152G9165GNCJ ST G9165 CJ At least 20% but less than 40% impaired $0.01 3931151G9165GNCK ST G9165 CK At least 40% but less than 60% impaired $0.01 3931150G9165GNCL ST G9165 CL At least 60% but less than 80% impaired $0.01 3931149G9165GNCM ST G9165 CM At least 80% but less than 100% impaired $0.01 3931148G9165GNCN ST G9165 CN 100% impaired $0.01 3931168G9166GNCH ST G9166 CH 0% impaired $0.01 3931167G9166GNCI ST G9166 CI At least 1% but less than 20% impaired $0.01 3931166G9166GNCJ ST G9166 CJ At least 20% but less than 40% impaired $0.01 3931165G9166GNCK ST G9166 CK At least 40% but less than 60% impaired $0.01 3931164G9166GNCL ST G9166 CL At least 60% but less than 80% impaired $0.01 3931163G9166GNCM ST G9166 CM At least 80% but less than 100% impaired $0.01 3931162G9166GNCN ST G9166 CN 100% impaired $0.01 3931161G9167GNCH ST G9167 CH 0% impaired $0.01 3931160G9167GNCI ST G9167 CI At least 1% but less than 20% impaired $0.01 3931159G9167GNCJ ST G9167 CJ At least 20% but less than 40% impaired $0.01 3931158G9167GNCK ST G9167 CK At least 40% but less than 60% impaired $0.01 3931157G9167GNCL ST G9167 CL At least 60% but less than 80% impaired $0.01 3931156G9167GNCM ST G9167 CM At least 80% but less than 100% impaired $0.01 3931155G9167GNCN ST G9167 CN 100% impaired $0.01 3931175G9168GNCH ST G9168 CH 0% impaired $0.01 3931174G9168GNCI ST G9168 CI At least 1% but less than 20% impaired $0.01 3931173G9168GNCJ ST G9168 CJ At least 20% but less than 40% impaired $0.01 3931172G9168GNCK ST G9168 CK At least 40% but less than 60% impaired $0.01 3931171G9168GNCL ST G9168 CL At least 60% but less than 80% impaired $0.01 3931170G9168GNCM ST G9168 CM At least 80% but less than 100% impaired $0.01 3931169G9168GNCN ST G9168 CN 100% impaired $0.01 3931189G9169GNCH ST G9169 CH 0% impaired $0.01 3931188G9169GNCI ST G9169 CI At least 1% but less than 20% impaired $0.01 3931187G9169GNCJ ST G9169 CJ At least 20% but less than 40% impaired $0.01 3931186G9169GNCK ST G9169 CK At least 40% but less than 60% impaired $0.01 3931185G9169GNCL ST G9169 CL At least 60% but less than 80% impaired $0.01 3931184G9169GNCM ST G9169 CM At least 80% but less than 100% impaired $0.01 3931183G9169GNCN ST G9169 CN 100% impaired $0.01 3931182G9170GNCH ST G9170 CH 0% impaired $0.01 3931181G9170GNCI ST G9170 CI At least 1% but less than 20% impaired $0.01 3931180G9170GNCJ ST G9170 CJ At least 20% but less than 40% impaired $0.01 3931179G9170GNCK ST G9170 CK At least 40% but less than 60% impaired $0.01 3931178G9170GNCL ST G9170 CL At least 60% but less than 80% impaired $0.01 3931177G9170GNCM ST G9170 CM At least 80% but less than 100% impaired $0.01 3931176G9170GNCN ST G9170 CN 100% impaired $0.01 3931683G9171GNCH ST G9171 CH 0% impaired $0.01 3931682G9171GNCI ST G9171 CI At least 1% but less than 20% impaired $0.01 3931681G9171GNCJ ST G9171 CJ At least 20% but less than 40% impaired $0.01 3931680G9171GNCK ST G9171 CK At least 40% but less than 60% impaired $0.01 3931679G9171GNCL ST G9171 CL At least 60% but less than 80% impaired $0.01 3931678G9171GNCM ST G9171 CM At least 80% but less than 100% impaired $0.01 3931677G9171GNCN ST G9171 CN 100% impaired $0.01 3931697G9172GNCH ST G9172 CH 0% impaired $0.01 3931696G9172GNCI ST G9172 CI At least 1% but less than 20% impaired $0.01 3931695G9172GNCJ ST G9172 CJ At least 20% but less than 40% impaired $0.01 3931694G9172GNCK ST G9172 CK At least 40% but less than 60% impaired $0.01 3931693G9172GNCL ST G9172 CL At least 60% but less than 80% impaired $0.01 3931692G9172GNCM ST G9172 CM At least 80% but less than 100% impaired $0.01 3931691G9172GNCN ST G9172 CN 100% impaired $0.01 3931690G9173GNCH ST G9173 CH 0% impaired $0.01 3931689G9173GNCI ST G9173 CI At least 1% but less than 20% impaired $0.01 3931688G9173GNCJ ST G9173 CJ At least 20% but less than 40% impaired $0.01 3931687G9173GNCK ST G9173 CK At least 40% but less than 60% impaired $0.01 3931686G9173GNCL ST G9173 CL At least 60% but less than 80% impaired $0.01 3931685G9173GNCM ST G9173 CM At least 80% but less than 100% impaired $0.01 3931684G9173GNCN ST G9173 CN 100% impaired $0.01 3931412G9174GNCH ST G9174 CH 0% impaired $0.01 3931411G9174GNCI ST G9174 CI At least 1% but less than 20% impaired $0.01 3931410G9174GNCJ ST G9174 CJ At least 20% but less than 40% impaired $0.01 3931409G9174GNCK ST G9174 CK At least 40% but less than 60% impaired $0.01 3931408G9174GNCL ST G9174 CL At least 60% but less than 80% impaired $0.01 3931407G9174GNCM ST G9174 CM At least 80% but less than 100% impaired $0.01 3931406G9174GNCN ST G9174 CN 100% impaired $0.01 3931426G9175GNCH ST G9175 CH 0% impaired $0.01 3931425G9175GNCI ST G9175 CI At least 1% but less than 20% impaired $0.01 3931424G9175GNCJ ST G9175 CJ At least 20% but less than 40% impaired $0.01 3931423G9175GNCK ST G9175 CK At least 40% but less than 60% impaired $0.01 3931422G9175GNCL ST G9175 CL At least 60% but less than 80% impaired $0.01 3931421G9175GNCM ST G9175 CM At least 80% but less than 100% impaired $0.01 3931420G9175GNCN ST G9175 CN 100% impaired $0.01 3931419G9176GNCH ST G9176 CH 0% impaired $0.01 3931418G9176GNCI ST G9176 CI At least 1% but less than 20% impaired $0.01 3931417G9176GNCJ ST G9176 CJ At least 20% but less than 40% impaired $0.01 3931416G9176GNCK ST G9176 CK At least 40% but less than 60% impaired $0.01 3931415G9176GNCL ST G9176 CL At least 60% but less than 80% impaired $0.01 3931414G9176GNCM ST G9176 CM At least 80% but less than 100% impaired $0.01 3931413G9176GNCN ST G9176 CN 100% impaired $0.01 3931210G9186GNCH ST G9186 CH 0% impaired $0.01 3931209G9186GNCI ST G9186 CI At least 1% but less than 20% impaired $0.01 3931208G9186GNCJ ST G9186 CJ At least 20% but less than 40% impaired $0.01 3931207G9186GNCK ST G9186 CK At least 40% but less than 60% impaired $0.01 3931206G9186GNCL ST G9186 CL At least 60% but less than 80% impaired $0.01 3931205G9186GNCM ST G9186 CM At least 80% but less than 100% impaired $0.01 3931204G9186GNCN ST G9186 CN 100% impaired $0.01 60873111710192 ST SOUND AND LANGUAGE EVALUATION 92523 $578.00 98520661710191 ST SOUND PRODUCTION EVALUATION 92522 $278.00 60873131710193 ST VOICE AND RESONANCE EVALUATION 92524 $290.00 2640953810091010 STABILIZING PEG SZ SHORT $576.00 2953641300031 STAIN NON-MICROBE ALCIAN BLUE 88313 $35.00 2640971410091190 STEM FEMORAL 12/14 155MM $4,400.00 2640983510091320 STEM FEMORAL 12/14 TAPER 130MM $3,115.00 2640971210091190 STEM FEMORAL 12/14 TAPER 160MM 40MM $4,500.00 2640970010091180 STEM FEMORAL 12/14 TAPER BASIC SZ 7 $3,115.00 2640975310091230 STEM FEMORAL 12/14 TAPER SZ 8 150MM $3,115.00 2640968510091160 STEM FEMORAL 135MM 12/14 TAPER $4,400.00 2640968610091160 STEM FEMORAL 145MM 12/14 TAPER $3,115.00 2640912810090300 STEM FEMORAL LATERAL 16.5MM $5,000.00 2640968810091160 STEM FEMORAL TRI-LOCK 107MM $10,942.00 2640994910091440 STEM FLUTED UNI 75MM X 10MM $3,104.00 2640994610091430 STEM FLUTED UNI 75MM X 12MM $3,104.00 2640994110091430 STEM STANDARD SZ 10 138MM $4,872.00 2640975110091230 STEM STANDARD SZ 12 145MM $4,872.00 2640951410090980 STEM STRAIGHT CEMENTLESS SZ 80MM $1,490.00 2640953710091010 STEM STRAIGHT SZ 14MM 150MM $2,175.00 2640925310090440 STENT 5FR X 24CM $177.00 2640914810090320 STENT 5FR X 28CM $177.00 2640915510090330 STENT 6 X 28CM CONTOUR $342.00 2640926610090450 STENT 4.8FR 22-30 $342.00 2640911810090290 STENT 6X24 CONTOUR $442.00 2640915410090330 STENT 6X26 CONTOUR $342.00 2640915010090320 STENT APPLIED 4.6FR X 24CM $420.00 2640915110090320 STENT APPLIED 4.6FR X 26CM $420.00 2640925210090440 STENT APPLIED 4.6FR X22-30CM $540.00 2640914710090320 STENT APPLIED 5X26CM $177.00 2640914910090320 STENT APPLIED 6FR X22-30CM $360.00 2640941010090870 STENT CONTOUR URETERAL 6FR X 22CM $442.00 2640941110090870 STENT CONTOUR URETERAL 6FR X 24CM $342.00 2640941210090870 STENT CONTOUR URETERAL 6FR X 26CM $442.00 2640941310090870 STENT CONTOUR URETERAL 6FR X 28CM $486.00 2640921310090390 STENT PERCUFLEX PLUS 6X24 $342.00 2640941410090870 STENT PERCUFLEX PLUS URETERAL 4.8 X 20CM $342.00 2640941510090870 STENT PERCUFLEX PLUS URETERAL 4.8 X 22CM $342.00 2640941610090870 STENT PERCUFLEX PLUS URETERAL 4.8 X 24CM $342.00 2640941710090880 STENT PERCUFLEX PLUS URETERAL 4.8 X 26CM $486.00 2640941810090880 STENT PERCUFLEX PLUS URETERAL 4.8 X 28CM $442.00 2640915210090330 STENT POLARIS ULTRA 5 X 24 $431.00 2640915310090330 STENT POLARIS ULTRA 6 X 22 $717.00 2640940310090860 STENT POLARIS ULTRA 6 X 28 $431.00 2640950910090980 STENT SILHOUETTE 4.6 X 28 $360.00 2640921510090400 STENT URETERAL CONTOUR VL 4.8FR 22-30CM $442.00 2640926910090460 STENT XTRAFLO URETERAL 6 X 24 $360.00 2640927010090460 STENT XTRAFLO URETERAL 6 X 26 $420.00 2640994810091440 STEP REVISION MBT SZ 2 $3,827.00 151266671530035 Stereotactic breast biopsy addl lesion 19082 $720.00 10053211530024 STEREOTACTIC BREAST BIOPSY SINGLE LESION 19081 $1,800.00 10053151530024 STEREOTACTIC BREAST BIOPSY SINGLE LESIONc 19081 $1,800.00 269505071440617 STERILE INSTRUMENT TRAY $52.00 27151811 sterile water - Sol A4217 $15.10 26136305 sterile water - Soln [UGH] $0.00 25935641 sterile water bacteriostatic Inj Sol 30 mL [UGH] A4216 $5.00 25935846 sterile water Inj 1000ml Bag [UGH] A4217 $90.00 25935847 sterile water Inj Sol 10 ml [UGH] A4217 $1.04 25935848 sterile water Inj Sol 20 ml [UGH] A4217 $5.00 25935849 sterile water Inj Sol 50 ml [UGH] A4217 $12.00 25935642 sterile water Irr Sol 1000 mL [UGH] A4217 $18.25 25935643 sterile water Irr Sol 3000 mL [UGH] A4217 $43.09 25935644 sterile water Irr Sol 500 mL [UGH] A4217 $20.45 253733871460076 STRAPPING AND CAST APPLICATION-LEVEL I 29130 $180.00 100521671720040 STRAPPING ANKLE 29540 $90.00 100521461720041 STRAPPING ELBOW/WRIST 29260 $90.00 100521501720042 STRAPPING HAND/FINGER 29280 $90.00 100521621720043 STRAPPING KNEE 29530 $90.00 253733891461063 STRAPPING OF SHOULDER-FACILITY 29240 $168.00 100521421720044 STRAPPING SHOULDER 29240 $90.00 12678131720045 STRAPPING UNNA BOOT 29580 $90.00 254839431750003 STRAPPING; UNNA BOOT 29580 $358.00 103430441750004 STRAPPING; UNNA BOOT BILATERAL 29580 $358.00 257371231291091 STRAWBERRY IgE 86003 $21.00 18869371700063 STRENGHTEN RESP MUSCLES 15 MIN $80.00 64413321700063 STRENGTHEN RESP MUSCLES EA 15 MIN $120.00 261780611290187 STREP SCREEN 87880 $55.00 18215941291039 STREPTOCOCCUS PNEUMONIA IgG ANTIBODY 86317 $644.00 25935645 streptomycin 1 g IM Inj [UGH] J3000 $101.25 256423321580005 STRESS ECHOCARDIOGRAM 93351 $923.00 6338801290742 STRIATED MUSCLE ANTIBODY SCREEN 86255 $50.00 26814282 succinylcholine 20 mg Syringe [UGH] $100.00 25962156 succinylcholine 20 mg/mL Inj Sol [UGH] j0330 $103.59 27017125 succinylcholine 20 mg/mL Sol j0330 $107.91 27017268 sucralfate 1 g Tab $23.31 25935647 sucralfate 1 g Tab [UGH] $5.00 25936008 sucralfate 1 g/10 mL Oral Susp UD cup [UGH] $43.85 27108979 sucralfate 1 g/10 mL Sus $41.80 26471243 Sucrose solution 24% [UGH] $10.00 18616571700013 SUCTION-RESP THERAPY 94799 $125.00 25936009 SUFentanil 50 mcg/mL IV Sol 2ml amp [UGH] $25.00 26010437 SUGAMMADEX 100MG/ML SOLN 5ML [UGH] J3490 $759.27 25935649 sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Oral Susp 473 mL $40.99 [UGH] 25962183 sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus[UGH] $40.99 25935650 sulfamethoxazole-trimethoprim 80 mg-16 mg/mL IV Sol 10 mL [UGH] s0039 $60.19

25966425 sulfamethoxazole-trimethoprim 80 mg-16 mg/mL Sol 5 mL [UGH] $34.52 25961585 SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG [UGH] $5.00 25935651 sulfaSALAzine 500 mg Tab [UGH] $5.00 25935652 SUMAtriptan 100 mg Tab [UGH] $10.63 25935653 SUMAtriptan 25 mg Tab [UGH] $10.65 26981650 SUMAtriptan 6 mg/0.5 mL Sol j3030 $115.20 25966816 SUMAtriptan 6 mg/0.5 mL SubQ Sol [UGH] j3030 $340.00 2640936610090820 SUPPORT ELBOW IMAK $121.00 2640936710090820 SUPPORT ELBOW ORTHOSIS COMFY $429.00 259830201390769 SURFACTANT ADMINISTRATION 94610 $440.00 9960341440100 SURGERY LEVEL 1 $3,900.00 9960351440200 SURGERY LEVEL II $6,000.00 9960361440300 SURGERY LEVEL III $8,500.00 9960371440400 SURGERY LEVEL IV $11,500.00 9960381440500 SURGERY LEVEL V $15,000.00 2953461300001 SURGICAL LEVEL I PATHOLOGY 88300 $22.40 2953481300002 SURGICAL LEVEL II PATHOLOGY 88302 $63.00 2953501300003 SURGICAL LEVEL III PATHOLOGY 88304 $68.25 2953521300004 SURGICAL LEVEL IV PATHOLOGY 88305 $93.45 2953541300005 SURGICAL LEVEL V PATHOLOGY 88307 $131.25 2953561300006 SURGICAL LEVEL VI PATHOLOGY 88309 $205.80 2640929310090500 SUSPENDORY W/ LEG STRAP 0-2 XLARGE $30.00 2640906210090220 SUTURE ALLTHREAD TITANIUM #2 5.0MM $644.00 2640953610091010 SUTURE DELIVERY DEVICE $934.00 2640953510091010 SUTURE POLYPROPYLENE 0-0 DIGITEX $98.00 2640953410091000 SUTURE POLYPROPYLENE 2-0 DIGITEX $98.00 2701877310091700 SWIFT LOCK ANCHOR $450.00 261666901291024 SYCAMORE IgE 86003 $21.00 2640962510091100 SYRINGE 1.0CC $708.00 2640959510091070 SYRINGE 2.5CC $1,418.00 6338341290391 T3 FREE 84481 $120.00 256291191290490 T3 REVERSE 84482 $120.00 6338331290279 T3 TOTAL 84480 $68.00 15495731290094 T3 Uptake 84479 $35.00 6338351290094 T3-UPTAKE 84479 $35.00 8578491290331 T4 FREE 84439 $83.00 12812231290095 T4 TOTAL 84436 $58.00 116127651290439 TACROLIMUS (PROGRAF) 80197 $152.00 25935655 tacrolimus 1 mg Cap [UGH] J7507 $22.30 25935656 tamoxifen 10 mg Tab [UGH] $9.48 26956908 tamsulosin 0.4 mg Cap $5.00 25955230 tamsulosin 0.4 mg Oral Cap [UGH] $5.00 269573951750086 TANGENTIAL BIOPSY SKIN 1-LESION FAC 11102 $174.00 269573971750087 TANGENTIAL BIOPSY SKIN ADDL LESION FAC 11103 $100.00 2640970310091180 TAPER FEMORAL STEM 12/14 155MM $4,500.00 2640907910090240 TAPERSET HIP SYSTEM STEM SZ 7.5MM $4,500.00 254847691750030 TcPO / ABI BILAT 1-2 LEVELS - FAC 93922 $274.00 254847751750029 TcPO / ABI BILAT 3 OR MORE - FAC 93923 $389.00 103591301750031 TcPO / ABI UNILATERAL 1-2 LEVELS - FAC 93922 $274.00 2640894110010270 TEGADERM HYDROCOLLOID 6X8 $23.00 6336941290121 TEGRETOL 80156 $96.00 267873981461090 TELEHEALTH FACILITY FEE $100.00 258121931461090 TELEHEALTH ORIGINATING SITE FAC FEE - ED $100.00 93840261480077 TELEHEALTH ORIGINATING SITE FACILITY FEE $50.00 263497861461090 TELEHEALTH ORIGINATING SITE FEE $100.00 25935658 telmisartan 40 mg Tab [UGH] $31.44 25935659 telmisartan 80 mg Tab [UGH] $35.96 25935660 temazepam 15 mg Cap [UGH] $5.00 25935661 temazepam 7.5 mg Cap [UGH] $44.73 26131655 Template Non-Formulary - Misc [UGH] $0.00 2640949510090960 TENDRIL LEADS 2088TC/ $1,438.00 2640949610090960 TENDRIL STSLEADS 2088TC/58 U MY $1,438.00 26010445 tenecteplase 50 mg IV Inj [UGH] j3101 $28,136.96 100435781730046 TENS APPLICATION 97032 $40.00 26980449 terazosin 1 mg Cap $8.03 25955245 terazosin 1 mg Cap [UGH] $8.03 25935664 terazosin 2 mg Cap [UGH] $7.23 25935665 terazosin 5 mg Cap [UGH] $7.23 25935666 terbinafine 250 mg Tab [UGH] $52.09 25936011 TERBINAFINE CREA 1 % 30 GM [UGH] $5.00 26011087 terbutaline 1 mg/mL Inj Sol [UGH] j3105 $25.00 25935668 terbutaline 2.5 mg Tab [UGH] $5.00 26053912 terconazole 0.4% Vag Crm [UGH] $178.16 25935669 terconazole 80 mg Vag Supp [UGH] $391.52 6338381290281 TESTOSTERONE 84403 $99.00 25935670 testosterone cypionate 200 mg/mL IM Sol [UGH] J1071 $114.52 11580671290530 TESTOSTERONE FEMALE OR CHILD 84403 $99.00 15495701290915 TESTOSTERONEFREEBIOAVAILABLE&TOTAL 84402 $116.00 25935671 tetanus immune globulin 250 units IM Sol 1 EA [UGH] 90714 $1,812.52 26217940 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL 90714 $206.62 Sus [UGH] 25935672 tetanus-diphth toxoids (Td) adult/adol 5 units-2 units/0.5 mL preservative- 90714 $234.06 free Sus UD [UGH] 26213200 tetracaine 1% Sol [UGH] $180.80 25935850 tetracaine Ophth 0.5% Sol 15 ml [UGH] $42.16 26989895 tetracaine ophthalmic 0.5% Sol $172.80 25983784 tetracaine ophthalmic 0.5% Sol 4 mL [UGH] $49.12 25935673 tetrahydrozoline Ophth 0.05% Sol [UGH] $19.30 2640978910091270 TFNA NAIL 11 X 170 $3,344.00 17636871290120 THEOPHYLLINE 80198 $97.00 25935674 theophylline 200 mg ER Tab [UGH] $5.00 25935675 theophylline 300 mg ER Tab [UGH] $5.00 26832190 theophylline 400 mg/24 hours Tab [UGH] $6.22 6922451720022 THERAPEUTIC ACTIVITIES 15 MIN 97530 $50.00 6913041730020 Therapeutic activities direct (one-on-one) patient contact 97530 $50.00 100521131720022 Therapeutic Activity 97530 $50.00 6922171720013 THERAPEUTIC EXERCISES 15 MIN 97110 $50.00 25935676 Therapeutic Multiple Vitamins Tab [UGH] $5.00 25935677 Therapeutic Multiple Vitamins with Minerals Tab [UGH] $5.00 65391531290113 THERAPEUTIC PHLEB 99195 $83.00 265193791290113 Therapeutic Phlebotomy (44) 99195 $83.00 12386471730011 Therapeutic procedure 1 or more areas each 15 minutes; aqu 97113 $80.00 6913181730014 Therapeutic procedure 1 or more areas each 15 minutes; mas 97124 $50.00 6913161730013 Therapeutic procedure 1 or more areas each 15 minutes; neu 97112 $50.00 6913061730012 Therapeutic procedure 1 or more areas each 15 minutes; the 97110 $50.00 28485271730017 Therapeutic procedure(s) group (2 or more individuals) 97150 $55.00 254329291740003 THERAPIST ASSIST 94799 $168.00 25935678 thiamine 100 mg Tab [UGH] $5.00 25935679 thiamine 100 mg/mL Inj Sol [UGH] J3411 $53.73 25935680 thioridazine 10 mg Tab [UGH] $5.00 25935681 thioridazine 25 mg Tab [UGH] $5.00 253734291460155 THORACENTESIS PROCEDURE 32554 $955.20 253734301461066 THORACENTESIS-FACILITY 32555 $1,043.00 26587563 THP - Percocet 5/325mg [UGH] $14.00 26798146 THP - Take-Home Pack [UGH] $15.00 26918785 THP - Tylenol #3 [UGH] $10.00 26918801 THP - Zofran 4 mg ODT Tab [UGH] $178.00 25935682 thrombin topical bovine 20,000 intl units Pow [UGH] $1,296.87 26014974 thrombin topical recombinant 5000 intl units Pow [UGH] $412.80 6338411290332 THYROGLOBULIN ANTIBODY 86800 $75.00 15495671290177 THYROGLOBULIN PANEL 84432 $150.60 25935684 thyroid desiccated 60 mg Tab [UGH] $5.00 15495661290292 THYROID PEROXIDASE ANTIBODY 86376 $102.00 15495561290825 THYROID STIMULATING ANTIBODY 83516 $115.00 2640908510090250 TIB 2584-0-0002 $2,880.00 2640894210010270 TIB FIB SPLINT LARGE $53.00 2640894310010280 TIB FIB SPLINT MEDIUM $71.00 2640894410010280 TIB FIB SPLINT SMALL $68.00 2640981310091300 TIBAIL INSERT SZ 5 $2,375.00 22151011290084 TIBC 83550 $58.00 2640951510090980 TIBIAL AUGMENT CEMENTED SZ 10MM $768.00 2640969210091170 TIBIAL BASE FIXED BEARING SZ 8 $2,375.00 2640995810091450 TIBIAL BASE FIXED SZ 3 $2,375.00 2640972410091200 TIBIAL BASE FIXED SZ 4 $2,375.00 2640979110091270 TIBIAL BASE FIXED SZ 5 $2,375.00 2640979210091270 TIBIAL BASE FIXED SZ 7 $2,375.00 2640991710091400 TIBIAL BASE FIXED SZ 8 $2,375.00 2640975510091240 TIBIAL BASE FIXED SZ6 $2,375.00 2640974010091220 TIBIAL BASE SZ 3 $2,375.00 2682164410091400 TIBIAL BASE SZ 7 $2,375.00 2640974310091220 TIBIAL BASE SZ7 $2,375.00 2640917110090350 TIBIAL BASEPLATE STEMMED S 5 $2,880.00 2640902110090170 TIBIAL BASEPLATE STEMMED SZ 1 $2,880.00 2640926710090460 TIBIAL BASEPLATE STEMMED SZ 5 $2,880.00 2640901810090160 TIBIAL BASEPLATE STEMMED W/ HOLES CEMENT $2,880.00 2640913710090310 TIBIAL BASEPLATE STEMMED W/HOLES $2,880.00 2640917010090350 TIBIAL BASEPLATE STEMMED W/HOLES CEMENTE $3,200.00 2640906110090220 TIBIAL BASEPLATE STEMMED W/HOLES SZ 1 $2,880.00 2640902710090170 TIBIAL BASEPLATE STEMMED W/HOLES SZ 3 $2,880.00 2640951310090980 TIBIAL BASEPLATE SZ 2 $5,614.00 2640913310090310 TIBIAL INSERT 1-2 10MM $2,520.00 2640968210091160 TIBIAL INSERT 5-6 12MM $2,520.00 2640957510091050 TIBIAL INSERT CONG VITALITE 10MM $3,528.00 2640926410090450 TIBIAL INSERT CONG VITALITE 12MM $3,528.00 2640936410090810 TIBIAL INSERT CONG VITALITE SZ 5-6 $3,528.00 2640912310090300 TIBIAL INSERT CONGRUENT $2,520.00 2640956310091040 TIBIAL INSERT CONGRUENT 3-4 $2,520.00 2640902810090170 TIBIAL INSERT CONGRUENT 3-4 10MM $2,520.00 2640915610090330 TIBIAL INSERT CONGRUENT 3-4MM $2,520.00 2640940610090860 TIBIAL INSERT CONGRUENT SZ 10MM $2,520.00 2640939010090840 TIBIAL INSERT CONGRUENT SZ 12MM $2,520.00 2640942710090890 TIBIAL INSERT CONGRUENT SZ 14 MM $2,520.00 2640927210090460 TIBIAL INSERT CONGRUENT SZ 3-4 $2,520.00 2640925610090440 TIBIAL INSERT CONGRUENT SZ 5-6 12MM $2,520.00 2640916110090340 TIBIAL INSERT CONGRUENT UHMWPE $2,520.00 2640939910090850 TIBIAL INSERT CONGRUENT VITALITE 12MM $4,410.00 2640950810090980 TIBIAL INSERT CONGRUENT VITALITE SZ 12MM $3,528.00 2640944010090900 TIBIAL INSERT CONGRUENT VITALITE SZ 3-4 $3,528.00 2640944710090910 TIBIAL INSERT CONGRUENT VITALITE SZ 5-6 $3,528.00 2640961310091090 TIBIAL INSERT CONGRUENT VITALITE3-4 14MM $3,528.00 2640969310091170 TIBIAL INSERT FIXED BEARING CRUCIATE SZ $2,375.00 2640975610091240 TIBIAL INSERT FIXED BEARING SZ 6 8MM $2,375.00 2640996610091460 TIBIAL INSERT FIXED SZ 5 10MM $2,375.00 2640995410091440 TIBIAL INSERT FIXED SZ 6 $2,375.00 2640976910091250 TIBIAL INSERT FIXED SZ 6 8 MM $2,375.00 2640991610091400 TIBIAL INSERT FIXED SZ 8 7MM $2,375.00 2640925710090440 TIBIAL INSERT PCL SUB 12MM $3,528.00 2640911610090290 TIBIAL INSERT PCL SUB 3-4MM 12MM $2,520.00 2640903110090180 TIBIAL INSERT PCL SUB 3-4MM 14MM $2,520.00 2640926010090450 TIBIAL INSERT PCL SUB SZ 14MM $2,520.00 2640945610090920 TIBIAL INSERT PCL SUB SZ 16MM $2,520.00 2640937110090820 TIBIAL INSERT PCL SUB SZ 18 MM $2,880.00 2640958210091060 TIBIAL INSERT PCL SUB SZ 5-6 14MM $2,520.00 2640916010090340 TIBIAL INSERT PCL SUB SZ1-2 14MM $2,800.00 2640926810090460 TIBIAL INSERT PCL SUB SZ5 6 $2,520.00 2640917210090350 TIBIAL INSERT PCL SUB SZ5-6 $2,800.00 2640920710090390 TIBIAL INSERT PCL SUB VITALITE $3,920.00 2640938610090840 TIBIAL INSERT PCL SUB VITALITE 12MM $3,528.00 2640946210090930 TIBIAL INSERT PCL SUB VITALITE SZ 10 MM $3,528.00 2640944410090910 TIBIAL INSERT PCL SUB VITALITE SZ 1-2 $3,528.00 2640940410090860 TIBIAL INSERT PCL SUB VITALITE SZ 12MM $3,528.00 2640952810091000 TIBIAL INSERT PCL SUB VITALITE SZ 5-6 $3,528.00 2640901610090160 TIBIAL INSERT PCL SUBSTITUTING 10MM $2,520.00 2640908310090250 TIBIAL INSERT PCL SUBSTITUTING 12MM $2,800.00 2640910610090280 TIBIAL INSERT PCL SUBSTITUTING 14MM $2,520.00 2640918310090360 TIBIAL INSERT PCL SUBSTITUTING 3-4 12MM $2,520.00 2640913910090310 TIBIAL INSERT PCL SUBSTITUTING SZ 3-4 $2,520.00 2640975810091240 TIBIAL INSERT PCL SZ 3-4 $2,520.00 2640953010091000 TIBIAL INSERT PCL VITALITE SZ 1-2 $3,528.00 2640925910090450 TIBIAL INSERT PCL VITALITE SZ 14MM $3,528.00 2640917710090350 TIBIAL INSERT PCL VITALITE SZ 3-4 $3,528.00 2640914010090310 TIBIAL INSERT PCLSUB SZ 14MM $2,520.00 2640991110091400 TIBIAL INSERT SZ 3 10 MM $2,375.00 2640918510090360 TIBIAL INSERT SZ 3-4 12MM $2,520.00 2701614510091690 Tibial Insert SZ 3-4 14mm $2,520.00 2640972310091200 TIBIAL INSERT SZ 4 7MM $2,375.00 2640973810091220 TIBIAL INSERT SZ 4 8MM $2,375.00 2640978110091260 TIBIAL INSERT SZ 5 8MM $2,375.00 2640992310091410 TIBIAL INSERT SZ 6 $2,375.00 2640976010091240 TIBIAL INSERT SZ 7 6MM $2,375.00 2640974410091220 TIBIAL INSERT SZ 8 12MM $2,375.00 2640978310091270 TIBIAL INSERT SZ 8 6MM $2,375.00 2640910310090270 TIBIAL INSERT SZ1-2 $2,520.00 2704594010091660 TIBIAL INSERT SZ4 $2,375.00 2640942210090880 TIBIAL INSERT VITALITE SZ 10MM $3,528.00 2640917510090350 TIBIAL INSERT VITALITE SZ 3-4 $3,528.00 2640992210091410 TIBIAL KNEE SYSTEM SZ 5 $2,375.00 2640994710091430 TIBIAL ROTATING PLATFORM SZ 2 $9,771.00 2640991010091400 TIBIAL SZ 4 $2,375.00 2704673710091700 TIBIAL SZ 6 $3,000.00 25935685 ticagrelor 90 mg Tab UD [UGH] $33.67 25935686 tigecycline 50 mg IV Inj [UGH] J3243 $751.20 25935687 timolol 5 mg Tab [UGH] $6.88 25935688 timolol Ophth 0.25% Sol [UGH] $60.00 25935689 timolol Ophth 0.5% Sol [UGH] $68.00 261666781291057 TIMOTHY GRASS IgE 86003 $21.00 25935690 tiotropium 18 mcg Inh Cap [UGH] $81.66 15495651290394 TISSUE TRANSGLUTAMINASE IGA 83516 $131.40 7923101290856 TISSUE TRANSGLUTAMINASE IGG 83516 $131.40 25935691 tiZANidine 4 mg Tab [UGH] $12.75 257371611290355 TOBRAMYCIN 80200 $153.00 25935692 tobramycin 1.2 g Inj [UGH] J3260 $840.00 25936012 tobramycin 40 mg/mL Inj Sol 2ml vial [UGH] J3260 $25.00 25935693 tobramycin Ophth 0.3% Oint [UGH] $1,028.92 25966567 tobramycin Ophth 0.3% Sol [UGH] $58.24 120895912903717 Tobramycin Peak 80200 $153.00 22451961290908 Tobramycin Trough 80200 $153.00 25935852 tocilizumab 200 mg/10 mL Sol [UGH] J3262 $4,153.77 25935853 tocilizumab 80 mg/4 mL Sol [UGH] J3262 $1,661.50 25935695 tolterodine 2 mg ERCap [UGH] $45.19 25962568 tolterodine 2 mg Tab [UGH] $16.98 26781144 tolterodine 4 mg Cap $42.96 25935697 tolterodine 4 mg ERCap [UGH] $58.40 261667051290805 TOMATO IgE 86003 $20.00 250727491290702 TOPIRAMATE 80201 $78.00 25935698 topiramate 100 mg Tab [UGH] $27.19 25935699 topiramate 25 mg Tab [UGH] $12.77 25935700 torsemide 100 mg Tab [UGH] $15.20 25962571 torsemide 20 mg Tab [UGH] $5.00 256504201293718 Total Glutathione QST 82978 $137.00 6338181290082 TOTAL PROTEIN 84155 $53.00 253374831300145 TOUCH PREP FIRST 88333 $35.00 268090541440618 TOURNIQUET 01 $52.00 25935702 trace elements 10 mcg-1 mg-0.5 mg-5 mg/mL IV Sol 1 mL [UGH] $66.15 2640931210090590 TRACH. CANN. SZ.4 FENSTR NO CUFF $87.00 2640931110090590 TRACH. CANN. SZ.4 NON/FENSTR. NO CUFF $128.00 2640930910090580 TRACH. CANN. SZ.6 FENSTRATED NO CUFF $134.00 2640931010090590 TRACH. CANN. SZ.6 NON/FENSTR. NO CUFF $128.00 2640931310090590 TRACH. CANN. SZ.8 FENSTRATED NO CUFF $76.00 262926161461070 TRACHEOBRONCHOSCOPY THRU EST TRACH-FAC 31615 $1,362.00 2640930810090580 TRACHEOSTOMY CANNULA TUBE 10 CUFFED $85.00 2640930710090580 TRACHEOSTOMY CANNULA TUBE 4 LOW PRESSURE $83.00 2640930610090580 TRACHEOSTOMY CANNULA TUBE 6 CUFFED $94.00 2640933210090660 TRACHEOSTOMY CANNULA TUBE 8 CUFFED $134.00 253734181461069 TRACHEOSTOMY-FACILITY 31603 $1,363.00 27093287 traMADol 50 mg Tab $5.00 25935703 traMADol 50 mg Tab [UGH] $5.00 26952520 trandolapril 2 mg Tab [UGH] $6.20 25935705 tranexamic acid 100 mg/mL IV Sol [UGH] $107.91 27012128 tranexamic acid 100 mg/mL Sol $201.60 259830241390766 TRANSCUTANEOUS BILI EACH 88720 $21.00 15495611290463 TRANSFERRIN-SERUM 84466 $52.00 27070648 traZODone 50 mg Tab $5.37 25935706 traZODone 50 mg Tab [UGH] $5.00 253730491461062 TREAT FX OF RADIUS-FACILITY 25505 $1,122.00 258121391461080 TREATMENT OF BIMALLEOLAR ANKLE FX-FAC 27808 $546.00 98520381710003 TREATMENT OF SWALLOW/ORAL FUNCTION 92526 $150.00 7802371710003 Treatment of swallowing dysfunction and/or oral function for 92526 $150.00 262926121461056 TREATMENT OF TOE DISLOCATION-FACILITY 28635 $2,504.00 106323881710005 TREATMENT SPEECH LANG VOICE COMM' 92507 $150.00 7812021710005 TREATMENT SPEECHLANGVOICE COMM 92507 $150.00 25935707 triamcinolone acetonide 40 mg/mL Inj Susp [UGH] J3301 $50.54 25936013 triamcinolone Top 0.1% Crm 15 gm Tube [UGH] $25.11 25935854 triamcinolone Top 0.1% Oint 15 gm Tube [UGH] $25.06 25935855 triamcinolone Top 0.1% Oint 454 gm Jar [UGH] $165.36 25935708 triamcinolone Top 0.1% Paste [UGH] $322.36 25935709 triamterene 50 mg Cap [UGH] $45.98 6338521290081 TRIGLYCERIDE 84478 $68.00 253396291750049 TRIM NONDYSTROPHIC NAILS - FAC 11719 $168.00 25935710 trimethobenzamide 100 mg/mL IM Sol [UGH] J3250 $127.76 25935711 trimethobenzamide 300 mg Cap [UGH] $8.21 25935712 trimethoprim 100 mg Tab [UGH] $5.00 2640957210091050 TRINITY ELITE MEDIUM $6,890.00 25935713 triple dye Top swab [UGH] $23.39 26011156 trolamine salicylate Top 10% Crm [UGH] $18.95 26946059 tropicamide Ophth 1% Sol 15ml [UGH] $42.60 25936014 tropicamide Ophth 1% Sol 2ml [UGH] $40.00 9085271290196 TROPONIN I 84484 $87.00 25935716 trypan blue Ophth 0.06% Sol [UGH] $320.00 7836121290474 TRYPTASE 83520 $112.00 6338441290099 TSH 84443 $85.00 2640990610091390 TUBE JJNSTM $654.00 253734281460082 TUBE THORACOSTOMY 32551 $750.00 2640891410010030 TUBE TRACH SZ4 CANN NO CUFF SHILEY $74.00 2640891310010030 TUBE TRACH SZ6 CANN. NO CUFF SHILEY DISP $156.00 26013400 tuberculin purified protein derivative 5 TU/0.1 mL ID Sol [UGH] $48.83 2640966710091140 TWINFIX 5.5MM SUTURE ANCHOR $764.00 2640966610091140 TWINFIX 6.5MM SUTURE ANCHOR $764.00 259831471400155 TX OF MISCARRIAGE LDR 59812 $2,800.00 98520541710007 TX USE OF SPEECH GENERATING DEVICE 92609 $150.00 264014761290135 UDS COLLECTION (COMMERICAL) $20.00 269476401540169 UGH CONTRAST DEFINITY PER ML Q9957 $132.00 267839511540159 UGH CONTRAST ISO-300 50ML PER ML $1.00 267839711540160 UGH CONTRAST ISOVUE 300 100ML $100.00 267839731650071 UGH CONTRAST PROHANCE 5 ML PER ML $9.00 1003598FILTERED UGH FILTERED SULPHUR COLLOID $500.00 263631051540158 UGH ISO-300 50ML $50.00 267839471540160 UGH ISO-300 50ML (100CC) $100.00 263630901600075 UGH ISOVUE 370 BOTTLES 100ML $1.50 263630931600076 UGH ISOVUE 370 BOTTLES 200ML $1.00 263630951600077 UGH ISOVUE 370 BOTTLES 500ML $1.25 2696957122002560 UGH LEXISCAN PER 1 MG $895.00 269579381590036 UGH NM FILTERED SULPHUR COLLOID $500.00 267839631590029 UGH NM I-123 PER 100 MCI $102.00 267839591590033 UGH NM ISPTOPE/DTPA $153.60 267839691590035 UGH NM LABELED RBC PER 30 MCI $273.60 267839571590032 UGH NM MAA PER 10 MCI $60.00 267839651590026 UGH NM MEBROFENIN PER 15 MCI $210.00 267839671590030 UGH NM MERTIATIDE PER 15 MCI $741.60 267839531590027 UGH NM OXIDRONATE PER 30 MCI $108.00 267839611590033 UGH NM PENTETATE PER 75 MCI $153.60 269579401590031 UGH NM PYP PER 25 MC $195.00 267839491590057 UGH NM SESTAMIBI PER STUDY DOSE $250.00 267839551590034 UGH NM SULPHUR COLLOID PER 20 MCI $180.00 261742191450002 UGH PACU 1st hour $250.00 269063661420004 UGH PET FDG ISOTOPE PER DOSE $300.00 263630751650068 UGH PROHANCE 10ML PER ML $9.75 263630811650069 UGH PROHANCE 15ML PER ML $8.75 263630851650070 UGH PROHANCE 20ML PER ML $9.00 263630881650071 UGH PROHANCE 5ML PER ML $9.00 262926271461129 ULTRASOUND GUIDANCE ASPIRATION ABSCESS F 76942 $525.00 6922371720010 ULTRASOUND THERAPY 15 MIN 97035 $50.00 253730481461093 UNLISTED PROC HUMERUS OR ELBOW FAC 24999 $517.00 253734611460147 UNLISTED PROCEDURE VASCULAR SURGERY 37799 $114.00 253003051720012 UNLISTED THERAPEUTIC PROCEDURE 97039 $50.00 260138831290470 UREA CLEARANCE 24 HR URINE 84545 $120.00 11379351290708 UREA NITROGEN 24 HR URINE 84540 $38.00 6338571293703 Urea Nitrogen Urine 84540 $38.00 2640923510090420 URETERAL CATH SET ILLUMINATING $540.00 2640923610090420 URETERAL STENT SET 5.0 FR C-FLEX $357.00 2640923710090420 URETERAL STENT SET 6.0 FR C-FLEX $357.00 6338581290083 URIC ACID 84550 $53.00 250306941290444 URIC ACID 24 HOUR URINE 84560 $54.00 260133091293650 URINALYSIS - DIPSTICK ONLY 81003 $30.00 1943869712900530 URINALYSIS W/ MICRO IF INDICATED 81000 $48.00 253735231460094 URINARY & ANAL PROCEDURE-LEVEL II 51705 $300.00 6337691290054 URINE ACETONE 81005 $20.00 11595271290216 URINE CALCIUM 24 HR 82340 $54.00 33431591290982 URINE CHLORIDE 82436 $53.00 194386991290976 Urine Drug Screen Standard 80307 $80.00 261752321290499 URINE IDENTIFICATION BACTERIA 87088 $38.00 21953511290265 URINE METANEPHRINES 24 HR 83835 $102.00 2640930110090550 URINE METER TRAY W/O CATHETER $21.00 11580541290514 URINE MYGLOBIN 83874 $118.00 6338111290274 URINE PROTEIN 24HR 84156 $104.00 8877301290188 URINE SODIUM (SPOT) 84300 $53.00 6336131290056 URINE SODIUM 24Hr 84300 $53.00 261657241290296 URINE STREP PNEUMO AG 86403 $128.00 2640960110091080 UROLIFT SYSTEM 1 TO 3 IMPLANTS $6,968.00 2640959810091070 UROLIFT SYSTEM 4 OR MORE IMPLANTS $11,179.00 25935718 ursodiol 300 mg Cap [UGH] $33.08 8234041550010 US ABDOMEN COMPLETE 76700 $870.00 8234061550064 US ABDOMEN/LIMITED 76705 $630.00 95777901550070 US ABI 93922 $480.00 263499391550070 US Ankle Brachial Index 93922 $480.00 10077631550035 US AORTA 76770 $480.00 241892691550081 US AORTA SCREENING 76706 $480.00 8234361550056 US ART DOPPLER DUPLEX 93925 $840.00 8234381550055 US ART DOPPLER LIMITED 93926 $600.00 8234711550057 US ART UPPER EXTREMITY 93930 $840.00 33131451550009 US BLADDER 76857 $360.00 11363571550046 US BLADDER POST VOID RESIDUAL 76857 $390.00 11813851550061 US Breast Bil. 76642 $480.00 8234101550061 US BREAST BILATERAL 76642 $480.00 10077301550059 US BREAST LEFT 76642 $480.00 11813881550059 US Breast Lt. 76642 $480.00 10077351550060 US BREAST RIGHT 76642 $480.00 11813911550060 US Breast Rt. 76642 $480.00 8234121550048 US CAROTID 93880 $500.00 8234141550015 US CHEST 76604 $480.00 241772141580005 US Echo 2D Rest +Stress w/ ECG Monitoring 93351 $923.00 8234221550069 US EXTREMITY (NON-VASCULAR) 76881 $480.00 8234261550022 US Extremity Nonvascular 76882 $480.00 155963731550022 US EXTREMITY NON-VASCULAR LIMITED 76882 $480.00 22141851550002 US GALLBLADDER 76705 $630.00 253735601461144 US GUIDANCE VASCULAR ACCESS 76937 $187.00 16736861550013 US GUIDED BREAST CYST ASPIRATION 19000 $480.00 29430641550014 US GUIDED BREAST LOCALIZATION 19285 $450.00 10077431550003 US GUIDED LIVER BIOPSY 47000 $858.00 10077461550031 US GUIDED LYMPH NODE BIOPSY 38505 $777.60 12869231550029 US GUIDED NECK BIOPSY 21550 $1,346.40 11363781550058 US GUIDED PARACENTESIS 49083 $1,043.00 29425231550030 US GUIDED PAROTID BIOPSY 42400 $756.00 31251931550054 US GUIDED THORACENTESIS 32555 $1,043.00 10077521550006 US GUIDED THYROID BIOPSY 60100 $420.00 10756621550028 US IMAGING GUIDANCE 76942 $480.00 10077581550026 US INTRACRANIAL 76506 $480.00 22142091550033 US LIVER 76705 $630.00 247971961550063 US LIVER HEPATIC ART 93975 $1,200.00 8234581550086 US MISCELLANEOUS 76999 $276.00 106079151550051 US OB BPP 76819 $276.00 93804951550038 US OB COMPLETE 76805 $570.00 11363901550083 US OB DIAG PREG 1ST TRI ABD ONLY 76801 $540.00 31251751550043 US OB DIAG PREG 1ST TRI ABD/TRANSVAG 76801 $540.00 10077661550044 US OB FOLLOW-UP 76816 $360.00 10078131550066 US OB LIMITED 76815 $330.00 31251781550043 US OB MULT GEST < 14 WEEKS ABD/TRANSVAG 76801 $540.00 15255291550038 US OB MULT GEST > 14 WEEKS 76805 $570.00 8234561550082 US OB TRANSVAG ONLY 76817 $248.40 25830211550074 US OB UMBILICAL ARTERY 76820 $240.00 17799181550034 US PANCREAS 76705 $630.00 10077881550036 US PEL/ TRANSABD & TRANSVAG 76856 $840.00 10216351550067 US PELVIC FOLLOW-UP 76857 $330.00 265709691550050 US Pelvic Non-OB Limited 76856 $475.00 10077911550036 US PELVIC TRANSABDOMINAL 76856 $570.00 236909321550050 US PELVIC TRANSVAGINAL ULTRASOUND 76830 $570.00 265708911550043 US Pregnant < 14 Weeks 1st Gest+Transvaginal 76801 $540.00 31251841550008 US Pregnant > 14 Weeks Ea Addl Gest 76810 $450.00 265709021550038 US Pregnant Complete 76805 $570.00 265709681550066 US Pregnant Limited 76815 $330.00 38491531550027 US RENAL 76770 $720.00 112207911550062 US RENAL ARTERIAL/VASCULAR DUPLEX 93975 $960.00 10715131550018 US RENAL TRANSPLANT 76776 $720.00 31251331550023 US RUQ 76705 $630.00 8234631550047 US SCROTAL 76870 $630.00 8234321550072 US SEGMENTAL DOPPLER 93923 $840.00 11609661550073 US SEGMENTAL DOPPLER W/EXERCISE 93924 $960.00 11015421550025 US SOFT TISSUE NECK 76536 $480.00 11015601550089 US Soft Tissue?Chest Wall 76882 $480.00 22142361550039 US SPLEEN 76705 $630.00 10078371550042 US THYROID 76536 $480.00 823473823473 US UE Art Duplex Lt 93931 $600.00 8234461550076 US VEN LOWER EXT RT 93971 $720.00 8234421550052 US VEN LWR EXT BILAT 93970 $900.00 8234441550075 US VEN LWR EXT LEFT 93971 $720.00 8234771550019 US VEN UPPER EXT BILAT 93970 $900.00 8234791550020 US VEN UPPER EXT LT 93971 $720.00 8234811550020 US VEN UPPER EXT RT 93971 $720.00 247971991550078 US VISCERAL VASCULARPLEX UNILATERAL 93975 $1,560.00 26978341 ustekinumab 5 mg/mL Sol J3358 $295.38 35071421400140 VAG DELIVERY LEVEL 1 $2,000.00 35071451400142 VAG DELIVERY LEVEL 2 $2,500.00 259830991400217 VAG DELIVERY LEVEL 3 $3,000.00 259830971400218 VAG DELIVERY MULT INDUCTION/EPIDURAL $3,000.00 259831031400141 VAG DELIVERY MULTIPLE $2,500.00 2640911410090290 VAGINAL ANTERIOR ELEVATE $4,758.00 27151936 valACYclovir 1 g Tab $49.50 25935719 valACYclovir 1 g Tab [UGH] $50.57 25935720 valACYclovir 500 mg Tab [UGH] $51.14 6338681290333 VALPROIC ACID 80164 $83.00 25935721 valproic acid 250 mg/5 mL Oral Syrup [UGH] $5.00 25935856 valproic acid 500 mg/5 mL Sol [UGH] $135.76 26781204 valsartan 160 mg Tab $24.99 25935722 valsartan 160 mg Tab [UGH] $18.15 25935723 valsartan 80 mg Tab [UGH] $16.88 25935724 vancomycin 1 g IV Inj [UGH] J3370 $140.00 27070623 vancomycin 1 g Pow J3370 $140.00 25935725 vancomycin 125 mg Cap [UGH] $139.29 25935726 vancomycin 250 mg Cap [UGH] $256.80 25962143 vancomycin 500 mg IV Inj [UGH] J3370 $70.00 28464561290459 VANCOMYCIN PEAK 80202 $153.00 8587891290446 VANCOMYCIN RANDOM 80202 $153.00 28464551290126 VANCOMYCIN TROUGH 80202 $153.00 15495541290334 Varicella Zoster IgG Ab QST 86787 $100.00 11580691290872 VARICELLA ZOSTER IgM Ab 87290 $100.00 21952001290361 VASOACTIVE INTESTINAL PEPTIDE 84586 $256.00 12735521720004 VASOPNEUMATIC DEVICE THERAPY 97016 $60.00 26011516 vasopressin 20 units/mL Sol [UGH] $604.28 9865301290346 VDRL S/F 86592 $53.00 25966787 vecuronium 10 mg IV Inj [UGH] J3490 $37.54 27017441 vecuronium 10 mg Pow J3490 $37.80 26011473 vecuronium 20 mg Pow [UGH] $54.00 25935730 vedolizumab 300 mg Pow [UGH] J3380 $30,146.36 25955219 venlafaxine 37.5 mg ERCap [UGH] $5.00 26052152 venlafaxine 37.5 mg Tab [UGH] $10.00 25935733 venlafaxine 75 mg ERCap [UGH] $23.30 6336771290814 VENOUS BLOOD GASES 82803 $100.00 25935734 verapamil 180 mg ER Tab [UGH] $12.46 25966806 verapamil 2.5 mg/mL IV Sol [UGH] $139.89 26969487 verapamil 2.5 mg/mL Sol $154.32 25955118 verapamil 240 mg ER Tab [UGH] $12.99 27052025 verapamil 240 mg/12 hours Tab $8.18 25935737 verapamil 80 mg Tab [UGH] $5.00 259831581400153 VERSION EXT CEPH 59412 $1,800.00 269660221440619 VIDEO TOWER $64.00 256350231290711 VISCOSITY SERUM 85810 $72.00 15495521290712 VITAMIN A 84590 $89.00 25935738 vitamin A & D Top Oint [UGH] $16.75 26010925 vitamin A & D topical - Oin 120 gm [UGH] $19.95 25935739 Vitamin B Complex Tab [UGH] $5.00 27811661290770 VITAMIN B1 BLOOD 84425 $65.00 247531581290407 VITAMIN B1 PLASMA 84425 $100.00 6338711290997 VITAMIN B-12- INHOUSE 82607 $82.00 11580711290784 VITAMIN B2 84252 $130.00 11595211290150 VITAMIN B6 84207 $160.00 11580721290380 VITAMIN D 1 25-DIHYDROXY 82652 $160.00 210075891291097 VITAMIN D 25-HYDROXY 82306 $121.00 11580741290714 VITAMIN E 84446 $89.00 25935740 vitamin E 200 intl units Cap [UGH] $5.00 25935741 vitamin E 400 intl units Cap [UGH] $5.00 27811711290715 VITAMIN K 84597 $87.00 15495551290282 VMA 84585 $68.00 49160311290466 VOLUME MEASUREMENT-URINE 81050 $15.00 18869481700006 VOLUME VENTILATOR MGMT SUBSEQUENT DAYS 94003 $758.00 7873361290974 VON WILLEBRAND FACTOR ANTIGEN 85246 $93.90 25935743 voriconazole 200 mg IV Inj [UGH] J3465 $716.11 27048337 vortioxetine 5 mg Tab $61.40 2640895710010460 WALKER PROSTEP LARGE $55.00 2640895610010460 WALKER PROSTEP SMALL $55.00 2640930410090570 WALKERSHORT LEG LARGE $55.00 2640930310090570 WALKERSHORT LEG MEDIUM $55.00 25935744 warfarin 1 mg Tab [UGH] $5.00 25935745 warfarin 10 mg Tab [UGH] $19.19 25935746 warfarin 2 mg Tab [UGH] $5.00 27075849 warfarin 2.5 mg Tab $5.00 25935747 warfarin 2.5 mg Tab [UGH] $12.16 25935748 warfarin 5 mg Tab [UGH] $5.00 25935749 warfarin 7.5 mg Tab [UGH] $5.00 2640943610090900 WASHER 7MM $76.00 2640953910091010 WATERSHED PLATE LEFT 2.5MM $2,174.00 2640959910091070 WATERSHED PLATE LONG LEFT $2,831.00 2640974510091230 WATERSHED PLATE RIGHT $2,174.00 8874501290716 WBC STOOL 89055 $38.00 265888701290002 Wellness Profile $30.00 260128731290142 WET PREP VAGINAL 87210 $48.00 240811571290142 WET PREP-SALINE (VAG. OR FECAL LEUKOCYE) 87210 $48.00 256350241291093 WHEAT IgE 86003 $21.00 261667121290992 WHEAT IgG QUEST 86001 $21.00 12386491730024 Wheelchair management (eg assessment fitting training) e 97542 $50.00 6922401720024 WHEELCHAIR MGT TRAINING 15 MIN 97542 $50.00 99630411730006 WHIRLPOOL FLUIDOTHERAPY 97022 $75.00 261666921291015 WHITE ASH IgE 86003 $21.00 2640911910090290 WIRE THREADED WIRE 230MM 2.0MM $183.00 255391031730037 WOUND CARE <= 20 SQ CM 97597 $115.00 253729841460174 WOUND REPAIR - INTERMEDIATE 12.6 TO 20.0 CM TECH FEE 12045 $720.00 253729901460146 WOUND REPAIR- INTERMEDIATE 7.6 TO 12.5 CM TECH FEE 12054 $192.00 253729811460028 WOUND REPAIR - LAYER <=2.5 CM TECH FEE 12041 $186.00 253729871460031 WOUND REPAIR - LAYER <2.5 CM FACE TECH FEE 12051 $294.00 253729781460149 WOUND REPAIR - LAYER 12.6 TO 20.0 CM TECH FEE 12035 $294.00 253729821460029 WOUND REPAIR - LAYER 2.6 TO 5.0 CM TECH FEE 12042 $294.00 253729761460026 WOUND REPAIR - LAYER 5.1 TO 7.5 CM TECH FEE 12032 $603.60 253729751460025 WOUND REPAIR - LAYER TECH FEE 12031 $603.60 253729791461136 WOUND REPAIR 20.1 TO 30.0 CM TECH FEE 12036 $1,133.00 253729981461044 WOUND REPAIR COMPLEX 2.6 TO 7.5 CM TECH FEE 13121 $540.00 253729991461045 WOUND REPAIR COMPLEX EA ADD 5 CM TECH FEE 13122 $192.00 253729941460034 WOUND REPAIR COMPLEX TRUNK TECH FEE 13100 $714.00 253729831460030 WOUND REPAIR INTERMEDIATE 7.6 TO 12.5 CM TECH FEE 12044 $186.00 253729771460027 WOUND REPAIR-LAYER 12034 $294.00 2640910010090270 WRIST FIXATOR $3,640.00 2640936110090810 WRIST O PRENE UNIVERSAL LEFT $21.00 2640936210090810 WRIST O PRENE UNIVERSAL RIGHT $21.00 2640897210090030 WRIST SPLINT COCK-UP RIGHT X-LRG $21.00 2640896910090010 WRIST X-SMALL COCK-UP LEFT SPLINT $25.00 2640897110090020 WRIST X-SML COCK-UP RIGHT SPLINT $26.00 8234861540034 XR ABD-FLAT/UPRIGHT 74019 $372.00 263499661540033 XR Abdomen 1 View 74018 $150.00 13199511540065 XR ACROMIOCLAVICULAR JOINTS 73050 $420.00 22142451540154 XR ACUTE ABD SERIES 74022 $420.00 10078531540014 XR ANKLE 2-VIEWS LT 73600 $240.00 10078551540015 XR ANKLE 2-VIEWS RT 73600 $240.00 8234921540051 XR ANKLE COMPLETE LT 73610 $300.00 8234941540049 XR ANKLE COMPLETE RT 73610 $300.00 11637991540114 XR ARTHR SHOULDER RT 73040 $840.00 13976401540110 XR BA SWALLOW 74220 $510.00 10079611540153 XR BA SWALLOW MODIFIED 74230 $330.00 10078711540108 XR BARIUM ENEMA 74270 $660.00 10078751540111 XR BARIUM ENEMA W/AIR 74280 $930.00 246491911540126 XR BE REPEAT 74270 $180.00 10078771540151 XR BONE AGE 77072 $180.00 11635281640002 XR BONE DENSITY PERIPHERAL VIEWS 77081 $246.00 35333931640001 XR BONE DENSITY STUDY 77080 $420.00 10051011640003 XR BONE DENSITY VERTEBRAL FRACT 1+ 77085 $247.00 13199571540150 XR BONE SURVEY 77075 $600.00 31252591540132 XR C-ARM 76000 $325.00 7889421540030 XR Chest 1 View Portable 71045 $105.00 33292381540030 XR CHEST 1-VIEW/PORTABLE 71405 $105.00 8235121540017 XR CHEST 2-VIEWS 71046 $225.00 31252051540023 XR CHEST WITH DECUB 71406 $140.00 147604791540146 XR CHOLANGIOGRAM T-TUBE 47531 $480.00 8235161540096 XR CLAVICLE COMP LT 73000 $246.00 8235181540095 XR CLAVICLE COMP RT 73000 $246.00 10080761540075 XR C-SPINE 1-VIEW 72020 $234.00 11363311540072 XR C-SPINE 5-VIEWS 72050 $510.00 31253341540071 XR C-SPINE LIMITED 72040 $390.00 10078841540124 XR C-SPINE W/ OBL/FLEX/EXT 72052 $630.00 13199631540113 XR CYSTOGRAM 74430 $420.00 8235201540013 XR ELBOW 2-VIEWS LT 73070 $240.00 8235221540012 XR ELBOW 2-VIEWS RT 73070 $240.00 10079321540100 XR ELBOW COMP LT 73080 $270.00 10079341540099 XR ELBOW COMP RT 73080 $270.00 257498121540127 XR ERCP 74328 $480.00 8235261540083 XR FACIAL BONES 3-VIEWS 70150 $360.00 22142481540058 XR FEMUR LT 73552 $300.00 22142511540057 XR FEMUR RT 73552 $300.00 10079421540041 XR FINGERS LT 73140 $246.00 10079451540042 XR FINGERS RT 73140 $246.00 2503040477002 XR Fluoro Pain Management 77002 $200.00 8235541540003 XR FOOT 2-VIEWS LT 73620 $270.00 8235561540004 XR FOOT 2-VIEWS RT 73620 $270.00 8235581540044 XR FOOT 3-VIEWS LT 73630 $300.00 8235601540043 XR FOOT 3-VIEWS RT 73630 $300.00 8235621540040 XR FOREARM LT 2 VIEWS 73090 $252.00 8235641540039 XR FOREARM RT 2 VIEWS 73090 $252.00 10079071540021 XR FOREIGN BODY CHILD 76010 $105.00 8235681540007 XR HAND 2-VIEWS LT 73120 $270.00 8235701540002 XR HAND 2-VIEWS RT 73120 $270.00 8235721540036 XR HAND 3-VIEWS LT 73130 $300.00 8235741540035 XR HAND 3-VIEWS RT 73130 $300.00 8234961540048 XR HEEL/CALCANEUS LT 73650 $234.00 8234981540047 XR HEEL/CALCANEUS RT 73650 $234.00 8235761540009 XR HIP 1-VIEW LT 73501 $144.00 8235781540008 XR HIP 1-VIEW RT 73501 $144.00 8235801540059 XR HIP 2-VIEWS LT 73502 $300.00 8235821540060 XR HIP 2-VIEWS RT 73502 $300.00 10216401540062 XR HIP LT W/AP PELVIS 73502 $300.00 24458201540061 XR HIP RT W/AP PELVIS 73502 $300.00 250598221540063 XR HIPS BIL W/AP PELVIS 73521 $360.00 8235881540098 XR HUMERUS LT 73060 $270.00 8235901540097 XR HUMERUS RT 73060 $270.00 10079851540121 XR HYSTEROSALPINGOGRAM 74740 $810.00 22142601540164 XR INFANT LOWER EXTREMITY LT 73592 $201.60 22142631540163 XR INFANT LOWER EXTREMITY RT 73592 $201.60 13199841540104 XR IVP WITH KUB 74400 $576.00 24372271540123 XR IVP-FOLLOW UP 74019 $360.00 11637821540139 XR J-TUBE INJ/FLUORO 49465 $240.00 8235961540011 XR KNEE 1-2 VIEWS LT 73560 $240.00 8235981540010 XR KNEE 1-2 VIEWS RT 73560 $240.00 8235921540171 XR Knee 3 Views Lt 73562 $186.00 8235941540170 XR KNEE 3 VIEWS RT 73562 $186.00 10079961540055 XR KNEE COMPLETE LT 73564 $390.00 10079981540054 XR KNEE COMPLETE RT 73564 $390.00 10080021540056 XR KNEE STANDING BILATERAL 73565 $240.00 8234831540033 XR KUB 74018 $150.00 112207941540125 XR KUB PORTABLE 74018 $150.00 10216621540073 XR L-SPINE 1 VIEW 72020 $246.00 8236411540066 XR L-SPINE 3-VIEWS 72100 $420.00 8236431540068 XR L-SPINE COMPLETE 72110 $540.00 10078881540067 XR L-SPINE COMPLETE W/FLEX & EXT 72114 $660.00 8236001540085 XR Mandible Complete 70110 $360.00 10080151540086 XR MASTOIDS 1-5 VIEWS 70120 $240.00 8236021540084 XR NASAL BONE 70160 $330.00 8236041540076 XR NECK-SOFT TISSUE AP/LAT 70360 $234.00 8236061540088 XR ORBITS 70200 $420.00 8236081540078 XR PELVIS 1-2 VIEW 72170 $252.00 10216561540064 XR PELVIS COMPLETE 72190 $360.00 11638211540130 XR PERCUT TRANS CHOLANGIOGRAM 47532 $780.00 269665341540166 XR Port Flush 36598 $550.00 31253731540129 XR RETROGRADE URETHROGRAM 74450 $474.00 17357151540026 XR RIBS W/CHEST BILAT 71111 $540.00 36191451540025 XR RIBS W/CHEST LT 71101 $390.00 22142781540024 XR RIBS W/CHEST RT 71101 $390.00 179118011540029 XR RIBS W/O CHEST BILAT 71110 $540.00 22142751540027 XR RIBS WITHOUT CHEST LT 71100 $390.00 10080481540028 XR RIBS WITHOUT CHEST RT 71100 $390.00 10216581540016 XR SACROILIAC JOINTS 3-VIEWS 72202 $450.00 10080541540022 XR SACROILIAC JOINTS LTD 72200 $144.00 8236171540077 XR SACRUM/COCCYX 72220 $270.00 13199951540112 XR SB SERIES 74250 $540.00 8236191540094 XR SCAPULA LT 73010 $330.00 8236211540093 XR SCAPULA RT 73010 $330.00 11638051540069 XR SCOLIOSIS STUDY 72083 $450.00 8236231540089 XR SHOULDER 1-VW LT 73020 $240.00 8236251540090 XR SHOULDER 1-VW RT 73020 $240.00 11637971540114 XR Shoulder Arthrography Lt 73040 $840.00 265709081540114 XR Shoulder Arthrography Rt 73040 $480.00 12846941540091 XR SHOULDER COMP LT 73030 $330.00 12846971540092 XR SHOULDER COMP RT 73030 $330.00 8236311540081 XR SINUSES COMPLETE 70220 $450.00 10080701540082 XR SINUSES LIMITED 70210 $330.00 8236331540080 XR SKULL 2-VIEWS 70250 $330.00 10080721540079 XR SKULL COMPLETE 70260 $474.00 10080741540112 XR SMALL BOWEL SERIES 74250 $540.00 8236511540032 XR STERNOCLAVICULAR JOINTS 71130 $240.00 8236531540031 XR STERNUM 71120 $300.00 10081011540161 XR THORACOLUMBAR SPINE 2-VIEWS 72080 $108.00 22142901540053 XR TIB/FIB LT 73590 $372.00 22142931540052 XR TIB/FIB RT 73590 $372.00 10081051540087 XR TMJ BILATERAL 70330 $360.00 11363331540045 XR TOES LT 73660 $216.00 11363361540046 XR TOES RT 73660 $216.00 10216641540074 XR T-SPINE 1 VIEW 72020 $210.00 8236491540070 XR T-SPINE COMPLETE 72072 $390.00 10081261540105 XR UGI SERIES W/AIR 74247 $510.00 10081221540106 XR UGI SERIES W/O AIR 74240 $360.00 10081301540107 XR UGI WITH SMALL BOWEL 74249 $990.00 11639011540138 XR UROGRAPHY(ANTE/LOOP/NEPHR) 74425 $360.00 13199661540128 XR VOIDING CYSTOGRAM 74455 $570.00 8236851540005 XR WRIST 2-VIEWS LT 73100 $270.00 8236831540006 XR WRIST 2-VIEWS RT 73100 $270.00 8236811540038 XR WRIST COMPLETE LT 73110 $330.00 8236791540037 XR WRIST COMPLETE RT 73110 $330.00 99636651720001 z PT EVALUATION 97001 $140.00 25962517 zafirlukast 20 mg Tab [UGH] $10.81 26632237 zidovudine 10 mg/mL Sol [UGH] J3485 $140.11 25935751 zidovudine 100 mg Cap [UGH] $10.10 26651569 zidovudine 50 mg/5 mL Syr [UGH] $5.88 7835921290349 ZINC 84630 $55.10 25936330 zinc oxide Top 20% Oint [UGH] $16.15 25935857 zinc oxide Top 20% Oint 56.7 gm Jar [UGH] $23.90 26013626 zinc oxide topical - Oin [UGH] $25.93 25936015 zinc oxide topical 10% Ointment [UGH] $17.00 25935753 zinc sulfate 220 mg Cap [UGH] $5.00 25935754 ziprasidone 20 mg Cap [UGH] $40.34 25935755 ziprasidone 20 mg IM Inj [UGH] J3486 $238.48 25935756 ziprasidone 40 mg Cap [UGH] $61.30 25935757 zoledronic acid 4 mg/5 mL IV Sol [UGH] J3489 $864.00 25935758 zoledronic acid 5 mg/100 mL IV Sol [UGH] J3489 $4,017.68 27094110 zoledronic acid 5 mg/100 mL Sol J3489 $4,017.68 25935759 ZOLMitriptan 2.5 mg Tab [UGH] $200.51 25935760 zolpidem 5 mg Tab [UGH] $23.10