number description amount 5000A4649 CAT IV CATH ANY SIZE 238.67 5000A4649 IV IV START KIT 18.57 400000116 TUBE BC LAV 4ML K2EDTA PLAS 79.43 400180466 IV CATH 22X1 SAF WNG PUR 13.75 400062135 IV CATH 16X1.25 PROTECTIV+ 15.15 400057186 IV CATH 24X.75 PROTECTIV+ S 15.15 500080196 SALICYLATE 169.73 500073550 RADEX FEMUR 2 VIEWS (DELETED CODE) 471.67 500074000 RADEX ABD 1 ANTEROPOST VIEW 1149.14 5000A4208 3 CC STERILE SYRINGE&NEEDLE 47.56 5000A4649 TU IV TUBING 67.70 5000A4927 GLOVES NON-STERILE 1.76 5000A4930 GLOVES STERILE, PER PAIR 5.30 400126213 LIDOCAINE 1% MDV 10ML 7.25 400249003 ACCESS DEVICE BD LL 200/CS 5.52 400207648 HIBICLENS 4% LIQ 4OZ 31.42 400057187 IV CATH 18X1.25 PROTECTIV + 14.21 5000011982 Removal, non-biodegradable drug delivery implant 692.09 6000DB003 Benadryl 25mg cap 14.65 6000DB004 benadryl liquid susp 7.97 6000DC007 Clindamycin 300mg tab 11.16 6000DD009 digoxin 0.5mg vial 26.30 6000DL002 Lorazepam 1mg tab 16.47 6000DN006 BAG - NORMAL SALINE 250ML BAG 59.72 6000DP001 Phenergan 25mg Tab 7.97 6000DZ001 Zithromax 200mg/5ml susp 24.44 6000DT008 Tylenol 120mg sup 11.16 6000DZ002 Zofran 4MG Tab 11.25 6000002002 Tamiflu 6mg/ml PER ML 16.15 60000DULCO DULCOLAX- BISACODYL supp 10MG 7.71 60000ROBI Robitussin W/CODEINE 10 ML SUPP 144.79 60000SEPTRA SEPTRA DS TABLET 1.40 60000MAST Mastisol Adhesive 13.23 60000DIFLU Diflucan 150 mg 23.12 600000XANX .25 mg XANAX 35.94 500096360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR 380.11 500096379 INJECTION - UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS 322.28 6000IV0003 IV EXTENSION SET 27.57 6000IV0004 IV CATHETER VARIOUS SIZES 63.76 5000A4209 5+ CC STERILE SYRINGE&NEEDLE 53.04 5000A4215 NEEDLE STERILE, ANY SIZE, EACH 19.01 5000A4247 BETADINE/IODINE SWABS/WIPES 38.15 5000A4248 CHLORHEXIDINE ANTISEPT 88.40 5000A4311 CATHETER W/O BAG 2-WAY LATEX 53.04 5000A4353 INTERMITTENT URINARY CATH 35.35 5000A4554 DISPOSABLE UNDERPADS - CHUCKS PAD - CHUX 44.13 6000DN008 BAG - NORMAL SALINE 100ML BAG 40.32 6000S0014 BANDAID 1.76 5000A4649 ENEM FLEETS ENEMA 55.96 5000A4649 LAMP WOODS LAMP 26.00 5000A4649 TAM RAPID RHINO NASAL PACKING OR NASAL TAMPON 315.46 5000A4649 VAG VAGINAL SPECULUM 267.50 5000A4929 TOURNIQUET FOR DIALYSIS, EACH 43.84 5000A5200 PERCUTANEOUS CATHETER ANCHOR 176.79 5000A6211 FOAM DRG > 48 SQ IN W/O BRDR 46.77 5000A6213 FOAM DRG >16<=48 SQ IN W/BDR 17.34 5000A6217 GAUZE - NON-STERILE GAUZE>16 BUT <=48 SQ 21.39 5000A6250 SKIN SEAL PROTECT MOISTURIZER OINTMENT (NEOSPOIN/TRIP ANT) 8.40 5000L3650 SHLDER FIG 8 ABDUCT RESTRAIN 380.11 5000L3908 WRIST COCK-UP NON-MOLDED 132.60 5000Q4018 CAST SUP LNG ARM SPLINT FBRG 189.22 5000Q4038 CAST SUP SHRT LEG FIBERGLASS 132.60 5000Q4046 CAST SUP SHT LEG SPLNT FBRGL 376.12 5000Q4049 FINGER SPLINT, STATIC 312.93 6000S0005 Fabric Wrap 1 14.61 5000A4590 3 ORTHO GLASS 3 127.29 5000A4615 CANNULA NASAL O2 8.86 5000A6442 CONFORM BAND N/S W<3 21.22 5000A7001 CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH 15.03 5000A7003 NEBULIZER ADMINISTRATION SET 85.39 5000A7006 FILTERED NEBULIZER ADMIN SET 114.92 400284847 PIC CHEMISTRY CTL LVL 1/2 1408.28 400310860 CLINITEK STATUS+ PROMO 5721.84 400182530 CATH CHEST 12FR STR 10/CS 490.87 400181338 CATH CHEST 24FR STR 490.87 400153550 TUBE CHEST 32FR 10/CS 473.33 400153551 TUBE CHEST 36FR 10/CS 473.33 400005114 CATH KIT 8FR FEM W/GLOVES 27.09 400031451 TUBE NASOGASTRIC SUMP 14FR 18.19 400044307 TUBE NASOGASTRIC SUMP 16FR 18.19 400037422 CATH KIT INTRMT MALE 14FR RR 23.71 400009469 CATH TRAY FOLEY 16FR LUBRICT 79.56 400000636 TUBE BC LTBLU 4.5ML SOD CIT 127.72 400134325 HURRICAINE SPRAY 2OZ CAN 209.07 400140504 METHYLPRED ACE 80MG/ML 1ML 48.61 400019554 MANNITOL 20% 500ML INJ 24/CS 89.39 400217150 TOTAL CTL LVL1 5/BX 654.64 400160993 FORCEP HUNTER SPLNTER 4-1/8 115.37 400026268 AIRWAY ORAL OROPHARYNGEAL MDEA 11.10 400164861 NEEDLE INTRAOSSEOUS 18X3CM 374.83 400206733 CLEARVIEW HIV COMPLETE KIT 1965.81 400010207 FINGER SPLINT BASEBALL SM 6.51 400010222 COLLES SPLINT L/MED W/PAD 32.21 400010229 COLLES SPLINT R/LG W/PAD 32.21 400041224 SHOULDER IMMOB XS 35.20 400059042 ARMSLING XL CLINIC 13.49 400010471 CLAVICLE SPLINT SM 30.15 400072738 LIMB RESTRAINT FOAM UNIV 31.21 400010792 POST-OP SHOE MALE/MED 38.92 400010796 POST-OP SHOE MALE/LG 38.92 400010800 POST-OP SHOE FEM/SM 38.92 400010803 POST-OP SHOE FEM/MED 39.12 400054235 ANKLE-GEL STIRRUP SM 95.17 400054236 ANKLE-GEL STIRRUP REG 95.17 400265057 DRUG CTL POS/NEG 5ML 262.80 400009906 AMMONIA INHALANTS 10/BX 17.34 400027026 SUTURE 3-0 ETHILON PS-1 2817.56 400001409 SUTURE 5-0 ETHILON PS-2 828.03 400002004 HEMOSTAT ABSORB 1/2X2 2508.07 400001477 SUTURE 5-0 GUT CHR P-3 1474.50 400001483 SUTURE 5-0 ETHILON P-3 761.22 400001525 SUTURE 5-0 PROLENE P-3 1020.17 400016897 NEEDLE 27X1.5 24.97 400028167 HYGROMETER DIGITAL W/MEMORYEA 649.52 400015241 EYEWASH STATION OPTIKLENS I 733.53 400255988 ACETAMINOPHEN 325MG TAB; 100/EA 6.24 400175276 EYE CHART SNELLEN 37.72 400079454 MONO TEST WAIVED 25/BX 460.71 400102402 TOWEL MULTI-FOLD WHT9.25X9.5 4.19 400271083 CLOROX DISINFECT SPRAY 19OZ 29.49 400087682 CITRASTAT RX ORANGE 7OZ 46.76 400010909 MARCAINE .25% SDV PF 10ML 19.39 400207378 DEXTROSE 25% ANSYER 10ML 64.49 400250361 PROCAINAMIDE 100MGML 10ML VL 423.05 400129936 PROCAINAMIDE 500MG/ML 2ML VL 359.63 400155504 LABETALOL HCL 5MG/ML MDV 20M 15.48 400256984 LEVOPHED 1MG/ML 4ML VL 77.71 400028859 LIDOCAINE 2% 50ML 22.98 400015275 WATER ST PF 10ML VL 8.58 400044112 SODIUM BICARB 8.4% SYR 50ML 49.01 400028127 VITAMIN K1 10MG AMP 90.46 400005009 TISSUE FACIAL KLEENEX 100/BX 7.04 400001150 XEROFORM DRESS 2X2 FOIL 138.87 400062609 HEEL WARMER INFANT 7.71 400057019 GLUCAGON 1MG EMERG KIT 1ML 1440.42 400068340 KAYEXALATE POWDER 16OZ 116.13 400019829 NEO-SYNEPH X/S SPY 15ML 31.08 400018662 CILOXAN .3% OPH SOL 5ML 707.16 400074092 INTEGRILIN 2MG/ML 10ML VL 1073.63 400105395 AFRIN NO DRIP SPY 15ML 46.30 400297604 AZITHROMYCIN 250MG TAB 30EA 297.00 400046496 FLEET ENEMA ADULT 4.5OZ 8.44 400243925 PROPRANOLOL 1MG SDV 1ML 18.80 400076452 RACEPINEPH 2.25% S-2 30X.5ML 325.76 400318465 NAPROXEN SOD 220MG CPL 100BT 68.93 400287983 PHENYLEPHRINE 10MG/ML 1ML 95.37 400260395 Ipratropium Bromide .02% SOL .5 mg/2.5 mL 31.88 400237957 (Do not use) ANTIPYR/BENZ OTIC SOL 10ML 83.88 400226075 ERYTHROMYCIN 0.5% 3.5GM OINT 84.69 400083126 METRONIDAZOLE 500MG 100/EA 6.49 400246948 LEVAQUIN 500MG TABS 50/BT 6.65 400306243 HYDROCORT .5% CRM 1OZ W/ALOEEA 13.09 400177491 AZITHROMYCIN 200MG/5ML 15ML 225.66 400305778 PREDNISONE 10MG TAB UD 100BX 125.19 400158834 CHLORAPREP APPLCTR 1.5CC ST 141.80 400303668 NEEDLE 22X1.5 TW 100/BX 33.34 400303672 NEEDLE 25X5/8 TW 100/BX 33.34 400303680 SYRINGE 5CC LL 100/BX 69.28 400295251 SYRINGE 60CC LL 72.34 400218964 BACITRACIN ZINC OINT .9GM 84.21 400295253 SYRINGE 60CC CATH TIP ST 5.05 400232102 ULTRASOUND GEL 5L CLR 112.71 400002455 TAPE FOAM 2 146.77 400002456 TAPE FOAM 3 146.77 400005385 SKIN STAPLER PRECISE 15 ARCU 45.83 400004498 SWAB BENZOIN TINCTURE 1S 35.54 400013399 BETADINE SOL 4OZ 12.49 400068691 ZITHROMAX IV 500MG 10/BX 243.14 400019306 SILVADENE CRM 20GM 78.44 400148373 FLOWMETER 15L W/MALE ADAPTEREA 279.67 400057965 DIAPER PAMPERS SZ3 UNISEX 44.17 400018782 ARMBOARD INFANT 2X9 3.32 400133855 ID BAND ADULT RED 250/BX 281.66 400052304 GAUZE CONFORM 1 24.70 400052308 GAUZE CONFORM 6 23.05 400155402 MASK PROC EAR LOOP YLW 50/BX 39.58 400155404 MASK PROC EAR LOOP BLU 50/BX 27.16 400053199 BANDAGE ELAS 2 34.67 400053200 BANDAGE ELAS 3 46.48 400053202 BANDAGE ELAS 6 94.30 400001746 TOWEL PROF 13.5X18 3P WHT 121.14 400270177 SCALPEL #10 SS DISP ST 10/BX 42.50 400260629 BP UNIT ADULT DLX 228.60 400032504 GAUZE ROLL 4.5 10.43 400166088 SPONGE GAUZE 4X4X12P ST10S 7.83 400281125 STOCKINETTE 6 137.87 400121865 PACKING STRIP W/IODO 1/4 15.94 400156810 SHARPS COLL 5QT RED HORIZ 34.40 400264226 BASIN WASH 6.3QT RECT ROSE 7.51 400267308 NEEDLE 21X1 SAF PREVENT M 87.34 400267315 NEEDLE 25X5/8 SAF PREVENT M 87.34 400041633 BANDAGE ADH SHEER XL 2X4 26.90 400032547 OCCULT BLOOD TEST SGL SLIDE 351.53 400164834 LANCET HEEL INCISION 1.2MM 249.92 400226010 RESUSCITATOR PED W/MASK 88.07 400239206 BANDAGE COHES 2 7.65 400167808 NEEDLE SPINAL 25X3.5 QUINCKE 295.67 400269110 TOURNIQUET 1X18 1.53 400177507 URINE COLL BAG PED 200ML NS 189.54 400184555 PREG HCG CASSETTE WAIVED 184.36 400061797 ARMSLING SM 6/CS 18.40 400061811 KNEE IMMOB 16 118.08 400061814 WRIST&F/A SPLINT R/UNIV 63.89 400169276 CAST PAD 3 68.14 400169281 CAST PAD 6 87.40 400135790 BRIEF NIGHTINGALE-EXTRA LG 39.39 400262914 PVP SWABSTICK ST 3S 25/BX 32.94 400195821 FORCEP HARTMAN ALLIG EAR 3 346.75 400036812 DRAPE 18X26 NONFEN ST BLUE 107.05 400167884 QUICKVUE RSV 20TEST 1401.51 400182500 STICKER AWARD BERRY SPECIAL 112.10 400157009 INTRODUCER ENDOTUBE 10/BX 492.19 400002005 ADAPTIC NONADH DRESS 3X3 197.32 400013206 TRACH TUBE ENDO 2.5MM MUR NCEA 12.29 400061550 TRACH TUBE ENDO 5.0MM MUR NCEA 12.29 400024591 TRACH TUBE ENDO 6 MUR CUF 13.89 400032417 AIRWAY NASO ROBERTAZZI 26FR 29.96 400092433 AIRWAY NASO 16FR SOFT PVC ST 20.72 400133327 AIRWAY NASO 20FR ADJ FLNG 370.78 6000001331 PROPOFOL 100MG/ML VL 20ML 28.77 6000IV010 ISOLATION GOWN 44.97 6000IV011 PROCEDURE GOWN 13.49 5000L1906 AFO MULTILIGAMENTUS ANKLE SU 201.27 5000L3580 ORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE 444.75 5000L3807 WHFO, NO JOINT, PREFABRICATED 1560.52 5000L4386 NON-PNEUM WALK BOOT PREFAB 1275.81 5000L4631 AFO, WALK BOOT TYPE, CUS FAB 735.06 5000A4222 Infusion Supplies With Pump 424.34 5000A9900 SUPPLY/ACCESSORY/SERVICE 10.21 500036416 CAPILLARY BLOOD DRAW 61.88 500036591 COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE 221.00 500080047 BASIC METABOLIC PANEL CALCIUM IONIZED 386.30 500080050 GENERAL HLTH PANEL 414.02 500080061 LIPID PANEL 419.89 500080074 AQT HEP PANEL 834.44 500080178 LITHIUM 89.46 500080202 DRUG SCREEN QUANT VANCOMYCIN 346.52 500081001 URINALYSIS - URNLS DIP STICK/TABLET RGNT AUTO MIC 117.32 500081003 URNLS DIP STICK/TABLET RGNT AUTO W/O MIC 194.47 500082000 ACETALDEHYDE BLD 90.16 500082190 ATOMIC ABSRPJ SPECTROSCOPY EA ANAL 186.60 500082271 Blood, occult, by peroxidase activity (eg, guaiac), qualitat... 32.73 500082272 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC 176.79 500082274 BLD OCLT FECAL HGB DETER IA QUAL FECES 1-3 118.74 500082310 CALCIUM TOT 134.12 500082465 CHOLESTEROL SERUM/WHL BLD TOT 160.60 500082552 CREATINE KINASE ISOENZYMES 264.30 500082554 CREATINE KINASE ISOFORMS 309.21 500082800 GASES BLD PH ONLY 197.12 500082977 GGT - GLUTAMYLTRASE GAMMA 116.97 500083550 IRON BNDNG CAP 242.21 500083735 MAGNESIUM 238.67 500084450 TRANSFERASE ASPARTATE AMINO 226.18 500084460 TRANSFERASE ALANINE AMINO 202.47 500084479 THYR HORM UPTK/THYR HORM BNDNG RATIO 329.91 500084481 TRIIODOTHYRO9 T3 FR 309.38 500084520 UREA N QUAN 192.73 500085027 BLD# COMPL AUTO HHRWP 224.53 500085032 BLD# MNL C-CNT RBC WBC/PLTLT EA 230.82 500085610 PT - PROTHROMBIN TIME 259.89 500086593 Syphilis test, non-treponemal antibody; quantitative 44.21 500086701 ANTB HIV-1 219.21 500086901 BLD TYPING RH D 130.47 500087077 Culture Aerobic Identify 81.17 500087110 CUL CHLAMYDIA ANY SRC 392.40 500087528 IADNA HERPES SMPLX VIRUS DIR PRB 363.93 500089051 Cell count, miscellaneous body fluids (eg, cerebrospinal flu... 55.30 500089220 SPTM OBTG SPEC AERSL INDUCED SPX 147.61 500090460 Immunization administration through 18 yts of age via any ro... 187.24 5000P9612 CATHETERIZE FOR URINE SPEC 268.38 6000L0001 Blood Culture Pedi 397.79 500082948 GLUC BLD RGNT STRIP 116.97 500086580 SKN TST TUBERCULOSIS ID 26.53 500081000 URNLS DIP STICK/TABLET RGNT NON-AUTO MIC 194.47 500081002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MIC 194.47 500070328 RADEX TMPRMAND JT OPN&CLSD MOUTH UNI 531.70 500071120 RADEX STERNUM MINIMUM 2 VIEWS 386.30 500072074 RADEX SPI THRC MINIMUM 4 VIEWS 810.47 500072100 RADEX SPI LUMBOSAC 2/3 VIEWS 883.95 500072114 RADEX SPI LUMBOSAC COMPL W/BENDING VIEWS 707.16 500073010 RADEX SCAPULA COMPL 488.58 500073020 RADEX SHO 1 VIEW 350.29 500073030 RADEX SHO COMPL MINIMUM 2 VIEWS 591.24 500073140 RADEX Fingers MINIMUM 2 VIEWS 539.22 500073560 RADEX KNE 1/2 VIEWS 362.50 500073592 RADEX LXTR INFT MINIMUM 2 VIEWS 452.15 500073620 RADEX FOOT 2 VIEWS 579.27 500073630 RADEX FOOT COMPL MINIMUM 3 VIEWS 813.23 500071020 RADEX CH 2 VIEWS FRNT&LAT 704.11 500078223 HIDA SCAN - HEPATBL DUX SYS IMG GLBLDR 3800.99 500070470 CT HEAD/BRN C-/C+ 2571.73 500070481 CT ORBIT SELLA/POST FOSSA/EAR C+ MATRL 3599.63 500070490 CT SOFT TISS NCK C-MATRL 3049.64 500070498 Computed tomographic angiography, neck, with contrast materi... 2719.93 500071250 CT THORAX W/O CONTRAST MATERIAL 3204.61 500071275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST 4501.08 500073700 CT LXTR C-MATRL 2314.15 500073702 CT LOWER EXTREMITY C-/C+ 4446.54 500074170 CT ABD C-/C+ 4568.72 500074174 CT ANGIO ABD&PELV W/ O&W / DYE 3368.22 500075635 CT ANGIO ABDOMINAL ARTERIES 2769.96 500076775 US RPR B-SCAN&/R-T IMG LMTD 1136.26 500076805 ULTRASOUND AFTER 1ST TRI 1/1ST GESTATION 1252.57 500076814 Ultrasound, pregnant uterus, real time with image documentat... 471.71 500076817 US PG UTER R-T IMG TRVG 911.88 500076856 US PELVIC NONOB REAL-TIME IMG COMPLETE 1271.12 500076857 US PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 662.96 500076870 US SCROTUM&CNTS 1155.01 500010060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE 1287.54 500010081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED 1164.42 500010140 I&D HEMATOMA SEROMA/FLUID COLLECTION 809.97 500010160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST 1083.20 500012002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM 652.35 500012004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM 751.36 500012020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE 2591.28 500012054 REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 7.6-12.5 CM 3128.83 500013132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6 CM-7.5 CM 2213.41 500013151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM 1598.18 500013152 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM 2773.83 50002014F MENTAL STATUS ASSESSED 1.61 500020610 ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA 546.28 500021705 DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB 883.95 500023600 CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION 576.68 500024530 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX+-MNPJ 2107.34 500025505 CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION 5937.22 500025605 CLTX DSTL RDL FX/EPIPHYSL SEP +-W/MNPJ 3017.81 500025622 CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ 1786.36 500027502 CLTX FEM SHFT FX W/MNPJ +-SKN/SKEL TRACJ 2537.06 500027520 CLOSED TX PATELLAR FRACTURE W/O MANIPULATION 1824.48 500027560 Closed treatment of patellar dislocation; without anesthesia 928.95 500028510 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MNPJ 792.03 500028515 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MNPJ 942.29 500028660 CLTX IPHAL JT DISLC W/O ANES 929.81 500029085 CAST HAND&LOWER FOREARM GAUNTLET 265.19 500029515 SHORT LEG SPLINT CALF FOOT 265.19 500029580 STRAPPING UNNA BOOT 332.36 500031500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE 864.71 500031600 TRACHEOSTOMY PLANNED SPX 6240.68 500036558 INSERT TUNNELED CV CATH - INSJ TUN CTR CVC W/O SUBQ PORT/PMP... 3267.20 500041800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS 865.21 500051700 BLDR IRRIGATION SMPL LVG&/INSTLJ 146.38 500051701 CATHETERIZATION, BLADDER 350.04 500064402 NJX ANES FACIAL NRV 1519.08 500067700 BLEPHAROTOMY DRG ABSC EYELID 1172.13 500069200 REMOVAL OF FOREIGN BODY OF EAR XTRNL AUD CANAL W/O ANES 576.33 500069205 RMVL FB XTRNL AUD CANAL ANES 618.77 500096366 IV THERAPY, EACH ADDL HOUR 351.82 500096367 IV NFS THER PROPH/DX ADDL SEQUENTIAL NFS >1 HR 397.79 500099175 IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED 212.14 500099220 Initial observation care 1581.99 500099281 EMER DEPT SELF LIMITED/MINOR 758.82 5000E0275 BED PAN STANDARD 17.68 5000E0570 NEBULIZER WITH COMPRESSION 339.22 5000G0168 DERMABOND - WOUND CLOSURE BY ADHESIVE 50.51 5000S0630 REMOVAL OF SUTURES 241.51 500012037 REPAIR INTERMEDIATE S/A/T/E > 30.0 CM 4522.77 500013100 REPAIR COMPLEX TRUNK 1.1 CM-2.5 CM 1345.06 500024357 TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS 2814.76 500029131 APPLICATION FINGER SPLINT DYNAMIC 216.37 500059409 VAG DLVR ONLY 5389.90 500029355 LONG LEG SPLINT 697.94 500094621 PULM STRS TSTG CPLX 1558.94 500094760 PULSE OX -N-INVAS EAR/PLS OXIMTRY F/O2 SAT 1 DETER 167.77 500092960 CARDIOVERSION ELECTIVE ARRHYT XTRNL 1648.85 500072146 MRI SPI CANAL&CNTS THRC C-MATRL 4199.40 500073220 MRI UXTR OTH/THN JT C-/C+ 4950.12 500073223 MRI ANY JT UXTR C-/C+ 4721.28 500072148 MRI SPI CANAL&CNTS LMBR C-MATRL 4199.40 500072196 MRI PELVIS C+ MATRL 5657.29 500090658 Influenza virus vaccine, trivalent, split virus, when admini... 204.55 500090703 (DO NOT USE) TETANUS TOXOID ADSORBED INTRAMUSCULAR 229.76 500090707 MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ 287.72 5000J0290 AMPICILLIN 500 MG INJ 32.53 5000J0295 AMPICILLIN SODIUM PER 1.5 GM - UNASYN 51.11 5000J0694 CEFOXITIN SODIUM INJECTION 70.28 5000J0744 CIPROFLOXACIN IV 216.58 5000J1020 METHYLPREDNISOLONE 20 MG INJ 4.12 5000J1040 SOLU-MEDROL - METHYLPREDNISOLONE 80 MG INJ 15.72 5000J1200 BENADRYL - DIPHENHYDRAMINE HCL INJECTION 50MG 32.53 5000J1240 DIMENHYDRINATE INJECTION 50MG 49.84 5000J1335 INJ ERTAPENEM (INVANZ) 500MG 30.05 5000J1631 HALOPERIDOL DECANOATE INJ 134.21 5000J1650 LOVENOX - INJ ENOXAPARIN SODIUM PER 10MG 48.90 5000J1885 TORADOL,(KETOROLAC TROMETHAMINE) PER 15 MG 32.53 5000J1930 INJECTION, LANREOTIDE, 1 MG 260.44 5000J1940 LASIX - FUROSEMIDE INJECTION 32.53 5000J1950 LEUPROLIDE ACETATE /3.75 MG 4564.89 5000J2175 MEPERIDINE HYDROCHLORIDE 100 mg/mL; inj 41.35 5000J2540 INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS 75.23 5000J3030 SUMATRIPTAN SUCCINATE / 6 MG 9.73 5000J3320 SPECTINOMYCN DI-HCL INJ 132.60 5000J3360 VALIUM - DIAZEPAM INJECTION UP TO 5 MG 16.25 5000J3410 HYDROXYZINE HCL INJECTION 32.53 5000J3490 ASA ASA UP TO 325MG TAB 11.25 5000J3490 CODE TYLENOL W/ CODEINE 1 TSP 4.07 5000J3490 KET KETAMINE UP TO 50MG 44.21 5000J3490 LAB LABETALOL UP TO 100 MG 8.86 5000J3490 LOR LORTAB 5MG TAB 9.46 5000J3490 MAL MAALOX 30 ML (MYLANTA) 48.22 5000J3490 MOTR J3490 MOTR 10.61 5000J3490 PRO PROPOFOL 10MG 5.69 5000J3490 ROC ROCURONIUM UP TO 10MG 26.67 5000J3490 TYL TYLENOL 450MG 106.08 5000J3490 TYL5 TYLENOL UP TO 200 MG 48.62 5000J3490 VIC VICODIN 17.68 5000J3490CARD J3490CARD 11.25 5000J3490DAV J3490DAV 11.25 5000J3490PRO PROPARACAINE 26.53 5000J7030 NORMAL SALINE SOLUTION INFUS 1000CC 80.63 5000J7510 PRELONE - ORAL PREDNISOLONE PER 5 MG 11.25 5000J7510 O ORAPRED - ORAL PREDNISOLONE PER 5 MG 11.25 5000J7607 LEVALBUTEROL COMP CON 28.46 5000J7613 ALBUTEROL NON-COMP UNIT 21.39 5000J7620 ALBUTEROL IPRATROP NON-COMP 21.39 5000J7640 FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS... 40.37 5000J7699 INHALATION SOLUTION FOR DME 12.44 5000J8540 ORAL DEXAMETHASONE PER 0.25MG 1.29 5000S0028 PEPCID - INJECTION, FAMOTIDINE, 20 MG 106.78 5000S5550 INSULIN RAPID 5 U 39.97 5000S8100 SPACER WITHOUT MASK 79.56 5000S8101 MASK - NEBULIZER MASK - SPACER WITH MASK 88.40 5000V2797 VISION SUPPLY, ACCESSORY AND/OR SERVICE COMPONENT OF ANOTHER... 51.14 6000R0003 Omnipaque 300mg/ml per-1ml 3.91 6000DT002 (DO NOT USE) tet and dip toxoid inj 229.76 6000DT006 tramadol 50mg tab 51.14 500093224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I 915.80 5000G0378 HOSPITAL OBSERVATION PER HR 2443.75 500099218 Intial OBS Care 806.45 500093880 DUP-SCAN XTRC ART COMPL BI STD 1367.40 500093926 DOPPLER - DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD 1329.46 500093931 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD 707.16 500093042 RHYTHM ECG 1-3 LDS I&R ONLY 66.31 5EXPEYEXAM Explosive Eye Exam 0.00 5EXPCARDENZ Explosive Cardiac Enzyme Panel 0.00 5EXPGICKTAIL Explosive GI Cocktail 0.00 5EXP99285 Explosive E/M 99285 0.00 500036592 Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified 176.73 6000SK001 Kerlix bandges (Any size) 3.53 500012007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM 2060.92 500036680 Placement of needle for intraosseous infusion 420.79 500076827 DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE; Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete 517.16 6000DN010 250 ml N/S Irrigation 29.36 5000ZYVOXLIN Zyvox (linezolid) 600mg/300ml IV bag 492.59 500028024 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal 2004.99 500020612 Aspiration and/or injection of ganglion cyst any location 273.36 500025111 Excision of Ganglion, wrist (dorsal or volar); primary 2078.91 6000011603 SULFAM + REI, TAB 400-80MG 12.39 6000011604 SULFONAMIDE (SYSTEMIC) SULFAMETHOXAZOLE/ TRIMETHOPRIM 200-40MG/ 5mL 1254.47 6000001496 TRIPLE ANTIBIOTIC OINT .9GM 8.40 6000DS002 Simethicone Drops 22.66 500040830 Closure of laceration, vestibule of mouth; 2.5 cm or less 1273.52 6000DD003 Dextrose 5% and 45% normal saline with 20 meq potassium 1000ml bag 36.13 500083615 LDH LACTATE DEHYDROGENASE 179.31 5000EXPBMP EXPLOSIVE BMP 0.00 6000DC002 cardizem 25mg/5ml vial 17.54 500027842 Closed treatment,ankle dislocation; req anesthesia, w/ or w/o percutaneous skeletal fixation 3731.72 5000L3927 Finger orthosis, proximal/distal interphalangeal, w/o joint/spring, extension/flexion, may include soft interface material, pre-fab. 28.11 50074210 Radiologic examination; pharynx a/o cervical esophagus 2495.51 6000IN0001 Indometacin 50 Mg Oral Tab 12.48 500064455 Inj, anesthetic agent a/o steroid, plantar common digital nerve(s) 1196.93 500087207 Smr, prim src, w/ int; spec stain for inclusion bodies or parasites e.g. Malaria...... 194.86 500082306 VITAMIN D 25 HYDROXY 245.59 500076937 US GUIDE VASCULAR ACCESS 1291.43 5000Q4040 Cast sup shrt leg ped fbrgls 135.69 5000002219 Methocarbamol 500 mg tab (Robaxin) 91.48 5000G6039 Assay of Acetaminophen 91.45 500094645 CONT INHALATION TREATMENT EA ADDL HR 204.29 500028505 OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES 3828.55 500024560 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ 2140.94 5000J7512 PREDNISONE ORAL PER 1MG 11.25 6000001600 LEVAQUIN (LEVOFLOXIN) 750MG PO 11.78 500017000 DESTRUCTION PREMALIGNANT LESION 1ST 728.81 5000Q4045 Cast supplies, short leg splint, adult (11 years +), plaster 151.29 500020553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES 591.92 500082530 CORTISOL FREE 274.83 500083525 ASSAY OF INSULIN TOTAL 188.00 500011441 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM 1790.48 500076813 US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION 1639.19 5000J0692 Injection, cefepime hydrochloride, 500 mg 92.31 500086757 Antibody; Rickettsia 350.26 500026746 OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA 5089.06 500085045 Blood count; reticulocyte, automated 140.05 500081015 Urinalysis, microscopic only 100.41 500069005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX 2158.29 5000J8499DEM Demerol up to 50mg 120.24 500086694 ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST 236.79 500028475 CLTX METAR FX W/MANJ 3117.17 5000S0078 CEREBYX(FOSPHENYTOIN SODIUM)750 MG 170.18 500086709 HEPATITIS ANTIBODY HAAB IGM ANTIBODY 185.10 5000831141 MED TRED SLIPPER SOCKS 14.25 5000J3490RO Robinul (Glycopyrrolate) 45.94 500087273 IAADI HERPES SMPLX VIRUS TYPE 2 197.18 5000A6412 EYE PATCH, OCCLUSIVE, EACH 4.11 500027808 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ 4073.02 5000J1980 Levsin (hyoscyamine sulfate) up to 0.25 mg 77.63 5000L3670 So acro/clav can web pre ots 71.19 400289484 CIPROFLOXACIN 250 MG; TAB 3.53 500087798 IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM 361.00 5000G0477 Drug test presump optical 137.17 5000J8499TRO Troleandomycin Oint 1.56 5000J3490PROT Protonix-Pantoprazole 40mg Tab 103.06 500085060 BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT 339.66 500082728 Ferritin 224.23 500083540 Iron 106.50 500073503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS 689.97 500086225 DNA ANTIBODY NATIVE/DOUBLE STRANDED 225.93 5000J8499CEF Cefdinir 3.5cc 1.36 500086765 ANTIBODY RUBEOLA 211.92 500086021 ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES 247.66 500023545 CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION 4189.43 5000J1630 Injection, haloperidol, up to 5 mg 460.97 400071426 NEEDLE 18X1.5 BLUNT FILL 33.34 400045072 TUBE BC GRN 4ML LITH HEP 112.84 400180465 IV CATH 24X0.75 SAF WNG PUR 13.75 400045834 KETOROLAC 30MG SDV 1ML 9.57 400253847 LIDOCAINE 2% W/EPI 50ML 31.95 400174462 AMOXICILLIN 250MG SUS 150ML 20.39 400257309 CUP MEDICINE 1OZ GRADUATED 8.30 400038699 IV CATH 22X1 PROTECTIV+ SAF 14.16 400044479 IV CATH 20X1 PROTECTIV + SAF 14.16 500074020 RADEX ABD COMPL W/DCBTS&/ERC VIEWS 687.72 5000073206 CT ANGIOGRPHY W/WO CONTRAST UPPER EXTREMITY 2189.89 500036600 Arterial puncture, withdrawl of blood for dx 105.86 5000S0030 FLAGYL 500MG 285.69 6000DB002 bactrim DS 4.42 6000DD005 dextrose 5% and 0.2% normal saline 500ml 41.71 6000DF001 Flexeril (cyclobenzaprine) 10mg Tab 3.30 6000DG001 Gastrografin 30ML 330.60 6000DH001 Haldol 50mg Vial 591.01 6000DH002 Hydrocodone/apap 5/325 tab 9.74 6000DH003 Hydrocodone/apap 7.5/325 tab 20.32 6000DH004 Hydrocodone/ibuprofen 7.5/200 tab 9.74 6000DT003 Tuberculin PPD Refrigerator 208.87 6000DZ003 Zofram 4mg/5ml Susp 16.04 60000011417 Amoxicillin 500mg tab 3.06 60000BENTAB Bentyl 20mg tab 134.23 60000BENSUS Bentyl 10mg/ml suspension (160ml) 64.01 500096361 IV INFUSION HYDRATION EACH ADDITIONAL HOUR 353.58 500096373 INJECTION, INTRA-ARTERIAL 345.15 500099000 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB 27.14 5000A4217 STERILE WATER/SALINE, 500 ML 40.32 5000A4322 IRRIGATION SYRINGE 23.43 5000A4335 INCONTINENCE SUPPLY MISCELLANEOUS 5.30 5000A4338 INDWELLING CATHETER LATEX 17.68 5000A4566 SHOULDER SLING OR VEST DESIGN, ABDUCTION RESTRAINER, WITH OR... 182.63 5000A4649 CUP URINE SPEC CUP 5.30 5000A4649 DEC CO2 DETECTOR 27.11 5000A4649 ICE ICE PACK 8.86 5000A4649 LITE LIGHT SOURCE 53.50 5000A4649 NACL SODIUM CHLORIDE BOTTLE 1000 ML 17.68 5000A4649 NIT SILVER NITRATE STICKS EACH 61.01 5000A4649 TON TONGUE DEPRESSOR 1.76 5000A4649VBAG VOMIT BAG 9.73 5000A4657 SYRINGE WITH OR WITHOUT NEEDLE 10.58 5000A4770 BLOOD COLLECTION TUBE, VACUUM, FOR DIALYSIS, PER 50 9.04 5000A6021 COLLAGEN DRESSING <=16 SQ IN 26.45 5000A6219 GAUZE - STERILE GAUZE <= 16 SQ IN W/BORDER 21.39 5000A6224 Gauze > 48 In No W/sal W/o B 24.08 5000A6231 GAUZE - KERLIX HYDROGEL DSG<=16 SQ IN 106.78 5000A6261 WOUND FILLER GEL/PASTE /OZ 85.93 5000Q4022 CAST SUP SHT ARM SPLINT FBRG 158.54 6000S0003 BANDAGE COHES 1 13.43 400012862 Specula Ear Adult or Pedi 2.66 5000A4570 SPLINT 190.06 5000A4590 ORTHO GLASS 4 190.06 5000A6402 STERILE GAUZE <= 16 SQ IN 3.46 5000A6413 ADHESIVE BANDAGE, FIRST-AID 7.97 5000A6446 CONFORM BAND S W>=3 2.86 5000A7017 NEBULIZER MASK NOT USED W OXYGEN 85.39 5000A9150 MISC/EXPER NON-PRESCRIPT DRU 10.21 5000A9273 Hot water bottle, ice cap or collar, heat and/or cold wrap, any type 19.44 5000L1830 Knee - KO IMMOBILIZER CANVAS LONGIT 36.81 400218315 CLD EMERALD LYSE 960ML 2631.80 400284863 PIC MINIPETTE ABAXIS 0.1CC 119.35 400284864 PIC PIPET TIPS DISP 0.2CC 42.64 400120585 LIDOCAINE 2% JELLY TUBE 30ML 66.75 400236941 HYDRALAZINE HCL 20MG/ML 1ML 35.67 400173230 LIDOCAINE 2% SDV 5ML 15.21 400312867 DRAIN CHEST SYS ADLT 6/CS 366.54 400182529 CATH CHEST 10FR STR 10/CS 490.87 400089226 TUBE BC MINI AMBER SST 220.56 400058955 NEEDLE BC 21X1.25 ECL 118.35 400060111 NEEDLE BC 22X1.25 ECLIPSE 118.35 400014889 LINER SUCT CANISTER 1000CC 15.21 400008166 GOWN SURG XL ST W/TWL 20/CS 36.26 400285129 DOPAMINE 400MG/D5W 250ML 58.44 400223732 EXTEN SET 6 9.64 400217152 TOTAL CTL LVL2 5/BX 654.70 400271482 TRIAGE CARDIAC PANEL 25/BX 6.65 400237716 FORCEP SPLINTER 4.5 138.81 400116189 CAST CUTTER 115V HEX DRIVE 6449.52 400225819 LUMBAR PUNC TRAY IN 22X1-1/2 113.30 400225822 LUMBAR PUNC TRAY ADLT 22X3-1 142.06 400187931 CLEARVIEW HIV CTL LVL 1&2 261.60 400010200 FINGER SPLINT FROG SM PADDED 8.23 400010210 FINGER SPLINT BASEBALL MED 6.51 400010224 COLLES SPLINT L/LG W/PAD 32.21 400010227 COLLES SPLINT R/MED W/PAD 32.21 400010449 SHOULDER IMMOB SM 31.15 400010457 ARMSLING XS CLINIC 13.49 400010805 POST-OP SHOE FEM/LG 39.12 400014250 TUBE GAUZE 5/8 56.05 400048903 APPLICATOR CAGE #1 157.73 400201148 ALCOHOL SALIVA TEST QED 10/B 492.06 400001403 SUTURE 4-0 GUT CHR P-3 1440.62 400001517 SUTURE 4-0 PROLENE PS-2 1176.90 400001524 SUTURE 6-0 PROLENE P-1 1259.92 400001526 SUTURE 4-0 PROLENE P-3 1175.77 400015651 SUTURE 4-0 GUT CHR RB-1 2283.53 400259039 IBUPROFEN 200MG TAB 100/BX 15.35 400255606 GERI-LANTA LIQ 200MG 12OZ 12.16 400171612 CABLE ECG MULTI-LINK 1099.65 400220311 CABLE TEMP SINGLE 400 SERIES 910.19 400293638 BP CUFF START KIT DURA 3/EA 957.94 400270734 WIPE HYDROGEN PEROXIDE 155EAEA 44.84 400087686 CITRASTAT RX LIME 7OZ 46.76 400243192 ADMIN SET 100 31.48 400045843 MARCAINE .5% 50ML MDV 26.37 400021499 LIDOCAINE 1% W/EPI 50ML 25.84 400283532 KETOROLAC 60MG/2ML VL 7.57 400028324 LIDOCAINE 1% MDV 50ML 17.66 400167602 PROPOFOL 10MG/ML VL 20ML 23.98 400129943 ATROPINE .1MG/ML LS SYR 10ML 78.04 400075725 FUROSEMIDE 10MG/ML VL 4ML 16.68 400045332 SODIUM BICARB 4% NEUT 5ML 49.81 400119402 AMIDATE 2MG/ML VL 10X10ML 544.99 400285932 CEFTRIAXONE 500MG VL 14.74 400279771 EPINEPHRINE 1:1000 MDV 30ML 45.83 400203060 APLISOL 5TU PPD 10 TEST 1ML 279.54 400136729 TOILET TISSUE COTTONELLE 2PL 5.05 400207671 RHOGAM 300MCG U/F+ SYR 5/BX 3058.30 400052768 TRAY IRRIGATION 2000CC 20/CS 15.27 400001139 VASELINE GAUZE 1X36 12/BX 72.73 400003974 DRESSING CHNG TRAY CVP 745.68 400168027 PROTONIX IV 40MG VL 10/BX 400.41 400212607 FLEET GLYCERIN SUPP CHLD 12B 24.97 400181696 DOXYCYCLINE 100MG CAP 50/BT 32.59 400166524 VENTOLIN HFA 90MCG INH 18GM 349.99 400247332 ZOSYN 3.375GM VL 10/BX 1523.05 400082250 ACTIDOSE/SORB 25GM LIQ 120ML 133.09 400289480 NYSTATIN CRM 30GM 107.46 400142561 DEXAMETHASONE 10MG/ML VL 1ML 10.76 400306183 ENOXAPARIN 100MG SYR 10X1ML 2739.59 400314403 CLONIDINE HCL .1MG TAB 100 83.35 400306189 TOBRAMYCIN .3% O/S 5ML 52.34 400306193 ATROPINE SULF 1% O/S 5ML 73.85 400233774 BACITRACIN 500/UN O/O 3.5GM 471.99 400244407 LEVAQUIN 5MG/ML 150ML 223.94 400208372 LIDOCAINE 4% TOP SOL 50ML 32.48 400230462 PHENAZOPYRIDINE 100MG TABS 370.45 400297552 LEVALBUTEROL 1.25MG/3ML SOL 751.73 400052912 EYEWASH IRR SOL 4OZ 24.05 400280410 SILVER NITRATE APPLI 184.83 400021154 CUTTER FINGER RING CHROME 246.12 400111681 MASK PARTICULATE RESP N95 SM 135.88 400111682 MASK PARTICULAT RESP N95 MED 135.88 400303664 NEEDLE 18X1.5 TW 100/BX 33.34 400303670 NEEDLE 25X1 TW 100/BX 33.34 400303674 NEEDLE 27X.5 TW 100/BX 33.34 400303676 SYRINGE 10CC LL 100/BX 85.74 400306391 LUBE JELLY 4OZ FLIP TOP TUBE 9.50 400296555 CRUTCH ALUM ADLT TALL ADJ 107.66 400232101 ULTRASOUND GEL 8.5OZ CLR 15.21 400294011 TEST STRIPS OPA/28 50/BT=EA 366.93 400002493 TEGADERM DRESS 2-3/8X2.75 331.00 400003659 SKIN STAPLE REMOVER PRECISE 20.79 400015072 ENVIROCIDE DISINFECTANT 1GL 127.32 400011765 ENVIROCIDE DISINFECTANT 24OZ 41.64 400233841 SOLU MEDROL 125MG PF VL 2ML 27.04 400021193 SOLU CORTEF SDV 100MG 36.26 400047217 NITROSTAT .4MG TABS 25/BT 96.43 400193826 IBUPROFEN 100MG/5ML SUS (5 mL UD cup) 39.05 400253289 PILLOW VINYL 19X25 TAN 12/CS 47.15 400052306 GAUZE CONFORM 3 18.40 400052307 GAUZE CONFORM 4 22.92 400052433 MASK HORIZONTAL TIE-ON 50BX 31.48 400166446 GOWN ISO YLW 10/BX 5BX/CS 70.74 400022160 TAPE TRANS 1 65.95 400211528 CAST SPLINT 4 636.04 400270180 SCALPEL #15 SS DISP ST 10/BX 42.50 400260633 BP UNIT THIGH DLX 297.47 400281116 STOCKINETTE 3 78.18 400131788 WIPES DISNFCT 6X6.75 42.50 400121843 PACKING STRIP PLAIN 1/4 15.27 400169151 SPECULUM VAG GRAVES DISP MEDBX 184.36 400258238 TUBING SUCTION 1/4 5.05 400232639 OIL EMULSION DRESS 3X8 24/BX 137.55 400003597 SPONGE GAUZE 2X2X12P NS 9.64 400233616 SHARPS COLL 18GL RED 158.80 400169389 SPEC COLL COMMODE 100/CS 7.18 400169377 BASIN EMESIS 9 1.14 400248686 FORCEP KELLY 5.5 197.05 400150209 RAZOR PREP DBL EDGE 100BX 2.46 400267314 NEEDLE 23X1 SAF PREVENT M 87.34 400267316 NEEDLE 25X1 SAF PREVENT M 87.34 400066784 STOOL EXAM 5LEG BLACK 632.19 400172864 GLOVE SURG LTX 6.5 PF 40PR/B 270.30 400172866 GLOVE SURG LTX 7.5 PF 40PR/B 270.30 400226008 RESUSCITATOR ADULT W/MASK 93.64 400226018 MASK OXYGEN ADULT W/7 TUBE 5.38 400226020 MASK TRACH ADULT W/O TUBE 8.30 400255556 GAUZE ROLL 3.4 6.65 400224657 CRUTCH ALUM YOUTH 8/CS 105.54 400167807 NEEDLE SPINAL 22X3.5 QUINCKE 295.67 400161584 MARKER XRAY L/R 1 164.24 400236495 THIN FILM DRESS 4X4.75 415.75 400168460 BATTERY AA ALK 24/BX 3.32 400291113 SUCTION CATH KIT 14FR 50/CS 6.24 400054489 CURETTE EAR CHILD PINK 50/BX 15.41 400263732 SPEC COLL 4OZ NS W/LID 20BX 13.49 400061812 KNEE IMMOB 20 129.85 400169455 SUCT INSTR YANK BLB W/O VENT 5.05 400256571 GLOVE EXAM NIT MED PF 200/BX 64.81 400248010 SHEATH ULTRASOUND 51X200MM 174.87 400227784 COAGUCHEK XS 5BX PROMO 6.65 400189737 PEDIALYTE 2OZ UNFLAVORED 10.30 400263735 AZITHROMYCIN 500MG 10X10ML 459.31 400003719 WICK EAR ST 1/16 22.52 400134455 CELLDYN LINEARITY CTL 12X3ML 2973.56 400073489 STYLET ENDOTRACH 10FR 25/BX 26.24 400008715 TRACH TUBE ENDO 3MM MUR NC 12.29 400001864 TRACH TUBE ENDO 7.5 MUR CUF 13.89 400001866 TRACH TUBE ENDO 8.5 MUR CUF 13.89 400032416 AIRWAY NASO ROBERTAZZI 24FR 29.96 400306255 LMA AIRWAY UNIQUE STD SZ5 112.50 400121617 AIRWAY NASO 30FR ADJ FLNG 370.78 6000S0001 ABD Pads 0.81 6000S0002 Cepti-Seal 15.74 6000DE004 EYEWASH 30ML 24.05 6000R0007 CT Injection Syringe 86.34 5000L0150 CERV SEMI-RIG ADJ MOLDED CHN 827.28 5000L1902 ANKLE FOOT ORTHOSIS 678.82 5000L3906 WRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERF... 2466.08 5000L3923 HFO W/O JOINTS PF 542.87 5000L4380 PNEUMATIC KNEE SPLINT (DELETED 01/01/2012) 190.06 5000P7001 CULTURE BACTERIAL URINE 135.25 5000E0112 CRUTCH UNDERARM PAIR WOOD 261.76 5000E0144 WALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLDING, WHEEL... 2171.02 500080100 DRUG SCR QUAL MLT DRUG CLASSES CHROM EA PX 348.27 500080197 TACROLIMUS 530.37 500081025 URINE PREGNANCY TST VIS COLOR CMPRSN METHS 143.36 500082040 ALBUMIN SERUM PLASMA/WHOLE BLOOD 49.53 500082374 CARBON DIOXIDE 117.13 500082491 CHROM QUAN COLUMN 1 ANAL NES 75.23 500082550 CREATINE KINASE TOT 265.19 500082553 CKMB - CREATINE KINASE MB FXJ ONLY 397.79 500082565 CREATININE BLD 221.00 500082607 CYANOCOBALAMIN 111.38 500082803 GASES BLD PH CALCULATED O2 SATURATION 579.43 500082947 GLUC QUAN BLD 166.59 500082962 GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE 104.31 500083874 MYOGLOBIN 259.89 500083880 BNP - B TYPE NATRIURETIC PEPTIDE 486.17 500084439 THYROXINE FR 242.21 500084484 TROPONIN QUAN 397.79 500084550 URIC ACID BLD 228.06 500084702 GONAD CHORNC QUAN 316.19 500084703 Blood pregnancy test HCG 321.75 500085014 BLD# HEMATOCRIT 154.33 500085044 BLD# RETICULOCYTE MNL 151.51 500085378 D-DIMER - FIBRIN DGRADJ PRODUXS D-DIMER QUAL/SEMIQUAN 227.71 500085380 FIBRIN DGRADJ PRODUXS D-DIMER ULTRSENS 493.80 500085651 SEDIMENTATION RATE RBC NON-AUTO 221.00 500085730 THROMBOPLASTIN TM PRTL PLSM/WHL BLD 245.19 500086000 AGGLUTININS FEBRILE EA AG 86.80 500086759 Antibody; rotavirus 132.45 500087806 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES 396.06 5000Q4008 Cast sup long arm ped fbrgls 349.63 5000Q4037 Cast sup shrt leg plaster 214.21 5000Q4013 Cast sup gauntlet plaster 205.39 500086668 Antibody; Francisella tularensis 171.10 500080201 Topiramate 196.10 500023620 CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ 3472.77 500087522 IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION 466.69 5000A9150NAPH Naphcon-A Opthalmic drops 12.35 500087529 IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ 577.19 500011420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< 1110.53 500086622 Antibody: Brucella, 134.52 500086638 Antibody: Coxiella burnetii (Q fever) 134.52 500086788 ANTIBODY WEST NILE VIRUS IGM 134.52 5000A4649DIAL DIAL A FLOW TUBING 5.21 500086708 HEPATITIS A ANTIBODY HAAB 203.71 500084146 Prolactin 318.78 5000A7018 Water, distilled, used with large volume nebulizer, 1000 ml 76.79 500086200 Cyclic citrullinated peptide (CCP), antibody 202.75 5000A4649 SDM Sodium Chloride 0.9% Mini 50ml Ea 2.85 5000Q4042 Cast supplies, long leg splint, adult (11 years +), fiberglass 426.77 500026615 OPEN TX METACARPAL FRACTURE SINGLE EA BONE 7499.73 5EXPUSTRNSV EXPLOSIVE ULTRASOUND TRANSVAGINAL 0.00 5000VLTRX Valtrex (Acyclovir) up to 800mg 20.82 50002J8499 Atenolol 50mg Qty 100 tabs 3.01 5EXPMET8 Explosive Metlyte 8 Panel 500087507 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 3287.39 500087661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH 276.81 6000AMOXSUSP Amoxicillin 200mg/5mL Oral Sus 3.19 500093308 ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD 1607.82 500084681 ASSAY OF C-PEPTIDE 328.33 500084402 Testosterone; free 401.81 500054220 IRRIGATION CORPORA CAVERNOSA PRIAPISM 1768.70 500024605 TREATMENT CLOSED ELBOW DISLOCATION REQ ANES 6101.90 5000A4649DEFP ZOLL ADULT DEFIBRILLATOR PADS 261.51 500087498 IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP 276.81 500077076 RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT 1244.07 5000J3490GUAIF CODEINE-GUAIFENESIN, 5 mL 57.50 500086644 ANTIBODY CYTOMEGALOVIRUS CMV 227.01 500086162 COMPLEMENT TOTAL HEMOLYTIC 148.29 5000J3101 Tenecteplase (TNKase), 1 mg 177.10 500088233 TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX 2219.96 500088291 CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP 420.56 500086654 Antibody; encephalitis, Western equine 129.03 500087272 IAADI CRYPTOSPORIDIUM 189.06 500076604 US CHEST REAL TIME W/IMAGE DOCUMENTATION 1143.56 500086800 THYROGLOBULIN ANTIBODY 250.93 500011100 BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION 642.39 500084120 PORPHYRINS URINE QUANTITATION & FRACTIONATION 116.04 500086789 ANTIBODY WEST NILE VIRUS 227.01 500041252 RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX 2804.97 50000RM111 ROOM AND BOARD - PRIVATE 4025.00 5000J8499HYOS Hyosyne 1 mL PO 16.22 500086255 FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY 95.05 5000D5NS1000 D5 1/2 NS 1000mL Infusion 147.20 500087510 IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ 316.37 500087278 LEGION PNEUMOPHILIA AG IF 94.53 5000VALACINJ Valproic Acid/Depacon (Valproate Sodium) Inj 100 mg 27.60 5000HYDRA Hydralazine, 10 mg 0.46 5000J0132 Acetylcysteine (ACETADOTE), 100 mg/mL injection 54.06 500071046 RADEX CHEST 2 VIEWS 196.88 500080335 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 169.87 5000072081 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW 249.44 5000073565 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST 231.09 5000087329 IAAD IA GIARDIA 94.53 OPLAB74210 Radiologic examination; pharynx a/o cervical esophagus 1247.75 OPLABL0002 Blood Culture Adult 198.89 OPLABL0004 Blood Tube Heparin Gel 4.12 OPLAB70160 RADEX NSL B1S COMPL MINIMUM 3 VIEWS 177.41 OPLAB70250 RADEX SKL < 4 VIEWS 286.82 OPLAB70330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT 309.70 OPLAB70350 CEPHALOGRAM ORTHODONTIC 194.47 OPLAB70360 RADEX OF NECK SOFT TISSUE 516.94 OPLAB71045 RADEX CHEST 1 VIEW 128.17 OPLAB71048 RADEX CHEST 4+ VIEWS 270.25 OPLAB71100 RADEX RIBS UNI 2 VIEWS 199.69 OPLAB71101 4VWS RADEX RIBS UNI W/POSTEROANT CH 4 VIEWS 488.27 OPLAB71130 RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS 1214.02 OPLAB72040 RADEX SPI CRV 2/3 VIEWS 311.29 OPLAB72050 RADEX SPI CRV MINIMUM 4 VIEWS 371.27 OPLAB72081 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW 249.44 OPLAB72100 RADEX SPI LUMBOSAC 2/3 VIEWS 441.97 OPLAB72110 LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS 601.08 OPLAB72114 RADEX SPI LUMBOSAC COMPL W/BENDING VIEWS 353.58 OPLAB72170 RADEX PELVIS 1/2 VIEWS 287.29 OPLAB72220 RADEX SACRUM&COCCYX MINIMUM 2 VIEWS 214.98 OPLAB73050 RADEX ACROMCLAV JTS BI +-W8ED DISTRCJ 281.11 OPLAB73130 RADEX HAND MINIMUM 3 VIEWS 314.89 OPLAB73501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW 281.75 OPLAB73521 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS 264.14 OPLAB73540 Radiologic examination, pelvis and hips, infant or child, mi... 114.13 OPLAB73560 RADEX KNE 1/2 VIEWS 181.25 OPLAB73562 RADEX KNE 3 VIEWS 197.21 OPLAB73600 RADEX ANKLE 2 VIEWS 177.41 OPLAB74020 RADEX ABD COMPL W/DCBTS&/ERC VIEWS 343.86 OPLAB74220 ESOPHOGRAM/ CONTRAST X-RAY ESOPHAGUS 331.18 OPLAB74241 RADEX GI TRC UPR +-DLYD FLMS W/KUB 755.83 OPLAB76870 US SCROTUM&CNTS 577.51 OPLAB77077 JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS 616.25 OPLAB80156 Carbamazepine; total 119.78 OPLAB80162 ASSAY OF DIGOXIN 66.67 OPLAB80175 DRUG SCREEN QUANTITATIVE LAMOTRIGINE 103.85 OPLAB80178 LITHIUM 44.74 OPLAB81025 URINE PREGNANCY TST VIS COLOR CMPRSN METHS 71.68 OPLAB82040 ALBUMIN SERUM PLASMA/WHOLE BLOOD 24.77 OPLAB82248 Bilirubin; direct 41.24 OPLAB82270 BLD OCLT PROXIDASE ACTV QUAL FECES 1 DETER 114.91 OPLAB82306 VITAMIN D 25 HYDROXY 122.80 OPLAB82330 Calcium; ionized 112.48 OPLAB82465 CHOLESTEROL SERUM/WHL BLD TOT 80.29 OPLAB82491 CHROM QUAN COLUMN 1 ANAL NES 37.62 OPLAB82530 CORTISOL FREE 137.41 OPLAB82553 CKMB - CREATINE KINASE MB FXJ ONLY 198.89 OPLAB82670 ASSAY OF ESTRADIOL 220.34 OPLAB82672 ASSAY OF ESTROGENS TOTAL 68.94 OPLAB82803 GASES BLD PH CALCULATED O2 SATURATION 289.71 OPLAB82962 GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE 52.15 OPLAB82963 ASSAY OF GLUCOSIDASE BETA 169.45 OPLAB83002 GONADOTROPIN LUTEINIZING HORMONE 152.26 OPLAB83540 Iron 53.25 OPLAB83550 IRON BNDNG CAP 121.11 OPLAB83615 LDH LACTATE DEHYDROGENASE 89.65 OPLAB83930 Osmolality: Blood 40.51 OPLAB84120 PORPHYRINS URINE QUANTITATION & FRACTIONATION 116.04 OPLAB84146 Prolactin 159.39 OPLAB84295 SODIUM SERUM PLASMA OR WHOLE BLOOD 53.38 OPLAB84425 Thiamine (Vitamin B-1) 53.59 OPLAB84443 TSH - THYR STIMULATING HORM 198.89 OPLAB84478 Triglycerides 51.93 OPLAB84480 TRIIODOTHYRO9 T3 TOT 120.22 OPLAB84681 ASSAY OF C-PEPTIDE 164.16 OPLAB84703 Blood pregnancy test HCG 160.87 OPLAB8OPLAB7 Blood count; blood smear, microscopic examination w/ manual differential WBC count 136.94 OPLAB85018 BLD# HGB 77.17 OPLAB85025 CBC-BLD# COMPL AUTO HHRWP&AUTO DIFFIAL 154.70 OPLAB85044 BLD# RETICULOCYTE MNL 75.76 OPLAB85048 AUTOMATED LEUKOCYTE COUNT 20.88 OPLAB85060 BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT 169.83 OPLAB85610 PT - PROTHROMBIN TIME 129.95 OPLAB86039 ANTINUCLEAR ANTIBODIES ANA TITER 91.77 OPLAB86141 C-reactive protein; high sensitivity (hsCRP) 117.02 OPLAB86160 COMPLEMENT ANTIGEN EACH COMPONENT 94.65 OPLAB86225 DNA ANTIBODY NATIVE/DOUBLE STRANDED 112.96 OPLAB86235 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD 141.45 OPLAB86337 Insulin antibodies 136.45 OPLAB86356 MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA 121.35 OPLAB86480 TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFER 120.22 OPLAB86593 Syphilis test, non-treponemal antibody; quantitative 22.10 OPLAB86617 LYME DISEASE ANTIBODY 127.40 OPLAB86622 Antibody: Brucella, 67.25 OPLAB86631 ANTB CHLAMYDIA 98.61 OPLAB86645 ANTIBODY CYTOMEGALOVIRUS CMV IGM 64.52 OPLAB86652 Antibody; encephalitis, Eastern equine 64.52 OPLAB86689 ANTB HTLV/HIV ANTB CONFIRMATORY TST 162.64 OPLAB86710 ANTB INF VIRUS 108.28 OPLAB86717 Antibody; Leishmania 67.25 OPLAB86762 Antibody; rubella 118.39 OPLAB86765 ANTIBODY RUBEOLA 105.96 OPLAB86880 COOMBS TEST DIRECT 44.25 OPLAB86886 COOMBS TEST INDIRECT TITER 42.56 OPLAB87045 CUL BACT STL AERC ISOL SALMONELLA&SHIGELLA 194.47 OPLAB87088 CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE 30.22 OPLAB87140 CULTURE TYPE IMMUNOFLUORESC 45.83 OPLAB87177 Ova and parasites, direct smears, concentration and identification 80.43 OPLAB87272 IAADI CRYPTOSPORIDIUM 94.53 OPLAB87278 LEGION PNEUMOPHILIA AG IF 94.53 OPLAB87329 IAAD IA GIARDIA 94.53 OPLAB87340 IAAD IA HEPATITIS B SURFACE ANTIGEN 84.95 OPLAB87389 Infectious agent antigen detection by enzyme immunoassay tec... 112.91 OPLAB87449 IAAD IA MULT STEP METHOD NOS EACH ORGANISM 85.10 OPLAB87483 CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25 1643.70 OPLAB87507 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 1643.70 OPLAB87522 IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION 233.35 OPLAB87529 IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ 288.59 OPLAB87591 IADNA NEISSERIA GONORRHOEAE AMP PRB 156.98 OPLAB87633 IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET 500.00 OPLAB87801 IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ 577.30 OPLAB87804 IAADIADOO INF 128.18 OPLAB87807 IAADIADOO RSV 31.83 OPLAB87880 IAADIADOO STREPTOCOCCUS GRP 108.28 OPLAB89051 Cell count, miscellaneous body fluids (eg, cerebrospinal flu... 27.65 OPLABP9612 CATHETERIZE FOR URINE SPEC 134.18 OPLAB85300 CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY 168.25 OPLAB71250 CT THORAX W/O CONTRAST MATERIAL 3204.61 5000J0131 Ofirmev - Acetaminophen inj, 10mg/mL 5.37 OPLAB81240 F2 GENE ANALYSIS 20210G >A VARIANT 377.72 500095811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND 8533.69 5000LIDPTCH LIDOCAINE PATCH 5%, 700mg 66.93 500085046 BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS 55.70 500069020 DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS 1833.45 500086301 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 295.55 500084152 ASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXED 261.17 500086870 ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ 287.29 500087073 CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL 134.09 500087101 CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL 109.37 500080170 DRUG SCREEN QUANTITATIVE GENTAMICIN 232.53 500080198 DRUG SCREEN QUANTITATIVE THEOPHYLLINE 200.79 OPLAB96374 IV PUSH THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG 227.18 500093017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY 446.78 5000J3490VIT MULTIVITAMIN INJ 10.21 5000J0706 CAFFEINE AND SODIUM BENZOATE - 2mL vial - 250mg inj 235.98 5000j0515 Injection, benztropine mesylate, per 1 mg 559.25 500085300 CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY 168.25 500085220 CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR 250.59 500086148 ANTI-PHOSPHATIDYLSERINE ANTIBODY 228.16 OPLAB93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 198.41 5000A4649NITR NITRATEST PHENAPHTHAZINE PAPER 3.22 OPLAB73721 MRI ANY JT LXTR C-MATRL 2099.70 5000COLCH COLCHICINE - COLCRYS 0.6mg PO 11.24 OPLAB72195 MRI PELVIS C-MATRL 2099.70 5000CARB100 Carbamazepine (Tegretol) 100 MG chew tab 6.65 OPLAB93880 DUP-SCAN XTRC ART COMPL BI STD 683.70 500084305 ASSAY OF SOMATOMEDIN 271.75 500073218 MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL 4638.64 OPLAB70486 CT SCAN MAXLFCL AREA C-MATRL - SINUS AREA 1454.75 5000OXYACE OXYCODONE AND ACETAMINOPHEN (PERCOCET) 5 MG 37.26 500095992 CANALITH REPOSITIONING PROCEDURE 491.63 OPLAB73700 CT LXTR C-MATRL 1157.07 OPLAB74183 MRI ABD C-/C+ 2475.05 5000ATOR10 ATORVASTATIN (LIPITOR) 10 mg TAB 3.51 5000ATOR80 ATORVASTATIN (LIPITOR) 80MG 28.06 5000OP70492 OP CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL 1785.72 OPLAB73218 MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL 2319.32 OPLAB71260 CT THORAX C+ MATRL 2099.69 5000J8499SERT Sertraline (Zoloft) 100mg, tab 7.04 5000J8499AMIT Amitriptyline Hydrochloride (Elavil) 25mg; tab 1.40 5000J8499MELO Meloxicam (Mobic) 15 mg; tab 0.58 5000J8499PHOS Phosphate Powder w/Nak (PHOS-NAK) 17.83 5000J8499TRAZ Trazodone (Desyrel) 50 mg; tab 0.92 OPLAB93970 DUP-SCAN XTR VEINS COMPL BI STD 1119.21 500081241 F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT 843.76 5000J8499PHENO Phenobarbital 20 mg/5 mL 9.30 500064520 INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC 932.70 5000FOLACDINJ FOLIC ACID, 1mg/mL, injection 51.20 OPLAB73723 MRI ANY JT LXTR C-/C+ 3824.23 5000J8499OLAN Olanzapine 10 mg; tab 0.70 5000VIVIT Vivitrol 380 mg; IM 1544.16 5000OPTI350 Optiray 350 mg/mL contrast 48.06 5000J8499AMIO Cordarone Amiodarone Hydrochloride 200 MG; tab 3.02 5000J8499PRED Prednisolone Acetate 1% Ophthalmic Drops; 5mL bottle 57.73 5000J8499BUPREHCL Buprenorphine HCL (Subutex) 2 mg; tab 45.40 OPLAB70470 CT HEAD/BRN C-/C+ 1860.87 OPLAB72197 MRI PELVIS W/O & W/CONTRAST MATERIAL 2240.50 OPLAB86753 ANTIBODY PROTOZOA NES 68.80 500087481 IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ 38.99 500073718 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL 2946.10 5000J8499OXYHYD Oxycodone Hydrochloride 5 MG 3.75 500010005 FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION 836.90 500022513 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION 5940.50 500022514 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR 5535.60 500036140 INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY 1038.70 500036561 INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/> 3871.00 500036589 RMVL TUN CVC W/O SUBQ PORT/PMP 1575.50 500036598 CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT 422.60 500037192 REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I 3949.80 500037211 THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX 4451.30 500037212 THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX 3898.20 500037244 VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE 7699.70 500037253 INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL 844.00 500011960 INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ 11016.20 500014040 ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/< 7201.10 500015777 IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT 2482.70 500022552 ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC 4596.50 500022612 ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR 18234.70 500022840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION 8774.70 500027610 ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB 7447.30 500027658 REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH 4254.30 500027680 TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH 4852.10 500028008 FASCIOTOMY FOOT&/TOE 3373.70 500028118 OSTECTOMY CALCANEUS 4762.60 500028285 CORRECTION HAMMERTOE 4349.30 500028296 CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT 5910.10 500028308 OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA 4351.00 500029200 STRAPPING THORAX 215.80 500063035 LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR 2205.50 500063056 TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR 17113.50 500063661 RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR 3704.70 500063685 INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING 4128.50 500063710 DURAL GRAFT SPINAL 12500.40 OPLAB72128 CT THRC SPI C-MATRL 1689.77 500064420 INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE 765.50 500064483 NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL 1272.60 500064492 NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL 694.00 500064600 DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH 2642.50 5000J8499TRIAMT Triamterene Hydrochlorothiazide (Dyazide) 25 mg capsule 2.75 OPLAB83993 ASSAY OF CALPROTECTIN FECAL 10.90 OPLAB83970 ASSAY OF PARATHORMONE 293.02 500064615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE 1414.00 500064620 DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE 1993.90 500064634 DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA 777.80 500064704 NEUROPLASTY NERVE HAND/FOOT 3677.50 500064784 EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC 8312.80 500064892 NERVE GRAFT 1 STRAND ARM/LEG <4 CM 12073.50 500072202 RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS 390.50 500072275 EPIDUROGRAPY RS&I 1387.50 500084080 ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES 164.30 500090837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 1412.70 500094010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ 398.40 500095806 SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT 1555.40 500095950 MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG 3296.70 500095972 ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG 474.30 500096523 IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST 306.30 500097535 SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES 387.30 500098940 CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS 255.90 500099203 OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES 857.00 500099211 OFFICE OUTPATIENT VISIT 5 MINUTES 103.90 500049450 REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS 765.40 5000J8499LEVE Levetiracetam (Keppra) 500 mg 1.14 500075746 ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I 1658.80 500075774 ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I 928.30 5000J8499MAGCIT Magnesium Citrate (Citroma) 17.5 mg/300 mL 31.20 500075833 VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I 1811.40 500020982 ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE 4212.60 5000J8499CEFD Cefdinir (Omnicef) 300 mg; cap 107.20 5000J8499LEVS Hyoscyamine, (Levsin) Sublingual Tab, .125 mg 2.73 OPLAB85045 Blood count; reticulocyte, automated 70.02 500096521 REFILLING & MAINTENANCE PORTABLE PUMP 1643.90 500087500 INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE 389.90 OPLAB90656 INFLUENZA VIRUS VACC SPLIT PRSRV FR 3 YEARS + IM 88.44 500096413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG 1580.30 5000J3490LIDO Lidocaine Hcl (Lidocaine 2%) Mdv 2% 20 mL 14.40 500095819 ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP 4813.70 500095957 DIGITAL ANALYSIS ELECTROENCEPHALOGRAM 3741.87 OPLABQ9967 ISOVUE-Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 3.65 OPLAB76705 ULTRASOUND ABDOMINAL R-T W/IMAGE LIMITED 778.19 5000J8499NICOGUM4 Nicotine Gum; 4 MG 2.14 5000J8499HYDROAPAP Hydrocodone/APAP 7.2/325 MG Elixir 30.60 500085041 BLOOD COUNT RED BLOOD CELL AUTOMATED 33.50 OPLAB76882 US EXTREMITY NON-VASC REAL-TIME IMG LMTD 337.58 OPLAB86360 T CELLS ABSOLUTE CD4&CD8 COUNT RATIO 261.00 OPLAB84540 ASSAY OF UREA NITROGEN URINE 27.80 5000J8499PENI Penicillin V Potassium (Penicillin VK) 500 MG 10.75 5000J8499SIM Simvastatin 20 MG; PO 8.85 500093229 XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT 7947.30 5000A9575DOT10 Dotarem Contrast 10 mL vial 194.40 5000A9575DOT15 Dotarem Contrast 15 mL vial 291.70 5000J8499ZYR Cetirizine Hydrochloride (Zyrtec) 10 MG; tab 0.60 5000J8499DONN Donnatal 10 mL(GI) 18.38 5000J8499MAA MAALOX 30 ML(MYLANTA)(GI) 48.22 5000J8499MUCI MUCINEX DM ER (Guaifenesin & Dextromethorphan HBr) 600 MG - 30 MG tab 15.53 5000J8499VITD3 Vitamin D3 2000 IU; tab 0.18 500082533 Cortisol; total (Random) 231.38 5000J8499CODE TYLENOL W/ CODEINE 1 TSP 4.07 5000J8499TYL5 TYLENOL UP TO 200 MG 48.62 5000J8499TYL6 TYLENOL (Acetaminophen) 325 MG 53.04 5000J8499TOPI Topiramate (Topamax) 50MG PO; tab 0.62 5000J8499VITC Vitamin C 500 MG; tab 2.86 500088305 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM 894.24 500093978 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE 2127.00 5000J8499MOTRI MOTRIN UP TO 600MG 0.95 OPLAB82043 URINE ALBUMIN QUANTITATIVE 41.05 5000J8499ACETAELI Acetaminophen Elixir Liquid 250 MG; PO 3.60 500070549 MRA NECK W/O &W/CONTRAST MATERIAL 4791.20 500070336 MRI TEMPOROMANDIBULAR JOINT 3532.00 OPLAB70336 MRI TEMPOROMANDIBULAR JOINT 1766.00 5000ARTTEARS Artificial Tear Drops 1.4% 17.50 5000J3490TRAACD Tranexamic Acid (Lyteda) VL 1000 MG/10 mL 81.58 500093228 XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS 295.60 5000J3490LIDOC LIDOCAINE 10ML ORAL PO 56.19 5000J8499LIDC LIDOCAINE HCl 2% - 10ML ORAL PO 56.19 5000J8499PROT Protonix-Pantoprazole 40mg Tab 103.06 500082652 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED 427.80 OPLAB82652 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED 213.90 OPLAB93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D 1360.91 500070540 MRI ORBIT FACE &/NECK W/O CONTRAST 2982.00 500090853 GROUP PSYCHOTHERAPY 280.20 500096151 HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT RE-ASSMT 239.70 OPLABR0003 Omnipaque 300mg/ml per-1ml 1.95 5000J8499LAB LABETALOL UP TO 100 MG 8.86 5000J8499DIFLU Diflucan (Fluconazole) 150 mg; tab 23.12 500083921 ORGANIC ACID 1 QUANTITATIVE 212.10 5000J8499DILA Dilantin (Phenytoin) 100 mg 2.77 5000J8499POTCHL Potassium Chloride (Klor-Con, Liquid) Liq 20 meq/15 mL 126.62 5000J8499SAN Santyl Ointment (Collagenase) 250 U/GM, 30 GM tube 1088.20 500031720 CATHETER ASPIRATION NASOTRACHEAL SPX 637.50 500087634 IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE 702.00 5000J8499BACL Baclofen 10 MG; PO 1.22 500099222 INITIAL HOSPITAL CARE/DAY 50 MINUTES 1494.80 5000J8499EFFE Effexor (Venlafaxine Hcl) 75 mg; tab 2.60 OPLAB74170 CT ABD C-/C+ 2284.36 5000J8499NORV Norvasc (Amlodipine), TAB 5MG 45.64 5000A6250LIDOPRILO LIDOCAINE WITH PRILOCAINE 2.5/2.5 30 GRAM TUBE 135.13 5000J8499VEN Venlafaxine HCl 75 mg; capsule 16.83 500070546 MRA HEAD W/O & W/CONTRAST MATERIAL 4205.70 5000J8499DHAEPA DHA/EPA 200mg/300mg 1.70 5000J8499CBD CBD (Vesisorb) 334 mg 16.60 500087650 IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ 200.50 5000A6250VOLT Voltaren (diclofenac) 1% topical gel 100 gm tube 118.50 500027781 CLTX PROX FIBULA/SHFT FX W/MANJ 4587.90 OPLAB70543 MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL 2204.20 5000J8499PRAV Pravastatin 20 mg; PO 0.60 500080372 DRUG SCREENING TAPENTADOL 400.00 5000CHAP Chapstick 9.00 5000ENLY Enlyte-D 11.70 OPLAB93978 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE 1063.50 OPLAB82373 CARBOHYDRATE DEFICIENT TRANSFERRIN 90.30 OPLAB84591 ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED 85.30 OPLAB81005 URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS 10.85 500084578 ASSAY OF UROBILINOGEN URINE QUALITATIVE 44.70 500085013 BLOOD COUNT SPUN MICROHEMATOCRIT 70.00 OPLAB85009 BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT 25.35 500085049 BLOOD COUNT PLATELET AUTOMATED 44.80 OPLAB85046 BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS 27.85 OPLAB87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ 200.00 500032556 PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING 1426.40 5000G0481 Drug test def 8-14 classes 450.00 5000G0659 Drug test def simple all cl 350.00 500082955 GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE 97.00 5000DICLSDM Diclofenac Sodium 1%; ointment (Medicare) 118.50 500086769 ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID19 450.00 OPLAB86769 ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID19 200.00 5000A6250BETA Betamethasone Dipropionate Gel (Diprolene Gel); 15 GM tube 547.00 500073225 MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL 4475.40 OPLABJ7030 NORMAL SALINE SOLUTION INFUS 1000CC 53.04 500041005 INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC 1325.80 5000U00021 COVID-19 lab test non-CDC 450.00 5000PROPDRPS Proparacaine Ocular Drops 1.70 5000C1751 Cath, inf, per/cent/midline 200.00 500041008 INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE 2990.20 500044050 RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT 3255.15 500090675 RABIES VACCINE INTRAMUSCULAR 3747.20 500099223 INITIAL HOSPITAL CARE/DAY 70 MINUTES 2294.20 OPLAB99281 EMER DEPT SELF LIMITED/MINOR 100.00 500051798 MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP 205.62 500036400 VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN 216.90 5000B4081 Nasogastric tubing with stylet 186.80 5000J8499DOXA Doxazosin (Cardura) 2 mg; tab 0.35 OPLAB87804B INFLUENZA B 131.71 5000J8499ASP ASPIRIN 325MG TAB 100/BT 7.77 5000J8499PYRN Pyridium 100mg tab 19.92 OPLAB90658 IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE 102.27 5000J8499ZINC50 Zinc Gluconate 50 mg; PO 0.37 5000MAXITRN Maxitrol Neomycin Sulfate/Polym B Sulf/ Dexamethasone 0.1% Opht Drops 927.12 500021320 CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION 1529.90 OPLAB76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION 571.78 5000J8499FENO Fenofibrate 145 mg; PO 21.20 500049406 IMAGE GUIDE FLID COLLXN DRAINAGE CATH PERI PERQ 1104.05 5000M0239 Bamlanivimab, includes infusion and post administration monitoring 1548.00 OPLAB87640 IADNA S AUREUS AMPLIFIED PROBE TQ 19.50 500083872 MUCIN SYNOVIAL FLUID ROPES TEST 58.60 5000A4649SDMN Sodium Chloride 0.9% Mini 50ml Ea 2.85 500090473 IM ADM INTRANSL/ORAL 1 VACCINE 191.90 500082436 CHLORIDE URINE 57.50 500093307 ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP 1649.50 500021451 CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION 7518.20 500080143 DRUG ASSAY ACETAMINOPHEN 186.40 5000Q4044 Cast supplies, long leg splint, pediatric (0-10 years), fiberglass 195.60 500036584 COMPLETE REPLACEMENT PICC RS&I 677.50 500082164 ANGIOTENSIN I-CONVERTING ENZYME 146.00 5000M0245 Bamlanivimab, Etesevimab, incl. infusion and post admin monitoring 1548.00 OPLAB82164 ANGIOTENSIN I-CONVERTING ENZYME 73.00 OPLAB82088 ASSAY OF ALDOSTERONE 203.75 5000J8499MEM Memantine Hydrochloride 5 mg; PO 3.52 OPLAB71271 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- 846.45 500084446 ASSAY OF TOCOPHEROL ALPHA VITAMIN E 141.80 500070190 RADEX OPTIC FORAMINA 442.50 5000J8499BRI Brilinta (Ticagrelor) 60 mg; PO 79.29 5000J8499NIAC Niacin (Vitamin B3) 500 mg; tab 0.29 5000J8499HYDROXY Hydroxyurea 500 mg; PO 2.97 5000J8499BENZON Benzonatate (Tessalon Perle) 100 mg; PO 9.20 5000J8499EFFERK Effer-K 25 mEq PO 5.40 OPLABJ1885 TORADOL,(KETOROLAC TROMETHAMINE) PER 15 MG 16.27 400292225 CEFTRIAXONE 250MG VL 11.03 6000001196 DONNATAL ELIXIR GRAPE 16OZ 18.38 6000DC006 ciproflaxacin opth 11.16 6000DD002 Depomedrol 80mg vial 112.91 6000DE002 Epinephrine 1:10000 syringe 63.03 6000DL001 Lidocaine 2g in 250ml 39.05 6000DN004 Nitroglycerin Paste 260.54 6000DP002 Phenergan 50mg Vial 64.81 6000DP004 Prednisone 15mg/5ml Susp 21.21 6000DT001 Tamsulosin 0.4mg Tab 34.53 6000002001 Tamiflu 75mg Tab 101.82 400019830 Robitussin DM Destromethorphan 22.25 60000LISIN LISINOPRIL 20MG 1.40 60000CORTIS CORTISPORIN EAR DROPS (DROPS) 669.17 60000BENTYL BENTYL –DICYCLOMINE 10MG TABLET 1.40 60000TESBEN TESSALON-BENZONATE 200mg tablet 1.40 60000GENTA GENTAMICIN eye drops(drops) 185.96 60000XANX50 .5 mg XANAX 44.70 500096365 IV THERAPY 1ST >1 HOUR 802.80 500096374 IV PUSH THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG 454.35 500096376 SUBCUTANEOUS INFUSION EACH ADDITIONAL IV PUSH 334.14 5000A0394 ALS IV DRUG THERAPY SUPPLIES 1.79 5000A0396 ALS ESOPHAGEAL INTUB SUPPLS 44.21 5000A4328 FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH 6.62 5000A4352 COUDE TIP URINARY CATHETER 35.58 5000A4556 ELECTRODES, PAIR 112.62 5000A4565 SLINGS 221.00 5000A4620 MASK - VARIABLE CONCENTRATION MASK - NON-REBREATHER MASK 83.38 5000A4649 CAU ELECTROCAUTERY STICKS 61.01 5000A4649 MASK ABUTER MASK 17.68 6000S0015 STAPLE REMOVAL/REPAIR KIT 88.40 5000A4649BASIN BASIN - EMESIS BASIN STERILE 10.71 5000A4649STAPL SKIN STAPLER 273.61 5000A6198 ALGINATE DRESSING >48 SQ IN 55.09 5000A6216 GAUZE - NON-STERILE GAUZE<=16 SQ IN 21.39 5000A6218 GAUZE - NON-STERILE GAUZE > 48 SQ IN 21.39 5000A6266 IMPREG GAUZE NO H20/SAL/YARD 15.27 5000A6454 SELF-ADHER BAND W>=3 7.97 5000L3260 SURGICAL SHOE/BOOT EACH 132.60 6000S0006 Fabric Wrap 2 7.97 6000S0008 Fabric Wrap 4 7.97 6000S0009 Fabric Wrap 5 24.31 5000TOWELLET Towellete 2.99 5000A4332 LUBE STERILE PACKET 10.61 5000A4344 CATHETER - FOLEY 2 WAY SILICN 19.44 50000A4649 SUTURES ALL TYPES 22.10 5000A6410 STERILE EYE PAD OR STRIP 8.86 5000A6441 PAD BAND W>=3 44.72 5000A6449 ACE WRAP (LT COMPRES BAND >=3” <5”/YD) 17.68 5000A6453 BANDAGE - SELF-ADHER BAND W <3Ö/YD 3.55 500086787 ANTB VARICELLA-ZOSTER 199.71 500087076 CULTURE ANAEROBE IDENT EACH 81.17 500087081 CUL PRSMPTV PTHGNC ORGANISMS SCR 306.37 500087086 CUL BACT QUAN COLONY CNT URINE 292.11 500087088 CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE 60.46 500087210 SMR PRIM SRC WET MOUNT NFCT AGT 139.32 500087400 INFLUENZA B 263.42 500087430 IAAD EIA STREPTOCOCCUS GROUP A 354.82 500087591 IADNA NEISSERIA GONORRHOEAE AMP PRB 313.94 500087592 IADNA NEISSERIA GONORRHOEAE QUAN 212.14 500087621 Infectious agent detection by nucleic acid (DNA or RNA); pap... 261.61 500087807 IAADIADOO RSV 63.65 500070150 RADEX FACIAL B1S COMPL MINIMUM 3 VIEWS 756.67 500070220 RADEX SINUSES PARANSL COMPL MINIMUM 3 VIEWS 746.05 500070250 RADEX SKL < 4 VIEWS 573.64 500071100 RADEX RIBS UNI 2 VIEWS 399.37 500071111 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS 928.69 500072050 RADEX SPI CRV MINIMUM 4 VIEWS 742.52 500072072 RADEX SPI THRC 3 VIEWS 839.75 500073050 RADEX ACROMCLAV JTS BI +-W8ED DISTRCJ 562.20 500073070 RADEX ELBW 2 VIEWS 354.82 500073120 RADEX HAND 2 VIEWS 487.55 500073520 (DELETED 1/1/16) RADEX HIPS BI 2 VIEWS ANTEROPOST PELVIS 769.04 500073564 RADEX KNE COMPL 4/MORE VIEWS 595.71 500073610 RADEX ANKLE COMPL MINIMUM 3 VIEWS 734.16 500073650 RADEX CALCANEUS MINIMUM 2 VIEWS 486.17 500074247 RADEX GI UPR C+ +-GLUC +-DLYD FLMS W/KUB 1528.89 500076010 RADEX FROM NOSE RECTUM FB 1 VIEW CHLD 396.00 500070210 Radiologic examination, sinuses, paranasal, less than 3 views 479.87 500071110 RADEX RIBS BI 3 VIEWS 772.58 500078306 B1&/JT IMG WHBDY 2181.60 500078472 CARD BPI GTD =BRM PLNR 1 STD REST/STRS 3089.33 500070450 CT HEAD/BRN C-MATRL 3093.83 500070480 CT ORBIT SELLA/POST FOSSA/EAR C-MATRL 1767.90 500071260 CT THORAX C+ MATRL 4199.40 500072128 CT THRC SPI C-MATRL 3379.55 500072129 CT THRC SPI C+ MATRL 3599.63 500072133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL 6529.17 500072193 CT PELVIS C+ MATRL 2777.20 500073201 CT UPPER EXT W/DYE 2131.34 500076801 ULTRASOUND 14 WK TABDL 1/1ST GESTATION 1099.63 500094640 NEBULIZER TREATMENT AIRWAY INHALATION TREATMENT - PRESS/N-PR... 241.24 500094644 INHALATION TREATMENT - CONTINUOUS 1ST HR 239.26 500010021 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE 876.65 500010061 INCISION&DRAINAGE ABSCESS COMPLICATED/MULTIPLE 1229.37 500010080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE 706.31 500011011 DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC 397.79 500011040 DEBRIDEMENT SKIN PARTIAL THICKNESS (INVALID AS OF 01/01/2011) 311.16 500011404 EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM 1262.27 500011730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 726.34 500011740 EVACUATION SUBUNGUAL HEMATOMA 458.34 500011760 REPAIR NAIL BED 804.92 500012014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM 1083.92 500012035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM 3303.89 500012041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< 2150.83 500012051 REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 2.5 CM/< 2352.20 500013133 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA 5 CM/< 1154.99 500019020 MASTOTOMY W/EXPL/DRAINAGE ABSCESS DEEP 2084.69 500020552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES 520.31 500021480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ 662.69 500023650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES 1414.32 500025600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ 572.79 500025635 CLTX CARPL B1 FX W/MNPJ EA B1 1642.38 500025660 Closed treatment of radiocarpal or intercarpal dislocation, ... 976.37 500026600 CLTX MTCRPL FX 1 W/O MNPJ EA B1 1377.21 500026605 CLTX MTCRPL FX 1 W/MNPJ EA B1 1594.65 500026641 TREAT THUMB DISLOCATION 1645.70 500026705 TREAT KNUCKLE DISLOCATION 976.37 500026720 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR M... 951.13 500027752 Closed treatment of tibial shaft fracture (with or without f... 2980.69 500027780 CLTX PROX FIBULA/SHFT FX W/O MNPJ 1598.18 500027786 CLTX DSTL FIBULAR FX LAT MALLS W/O MNPJ 1504.49 500027810 Treatment Of Ankle Fracture 976.37 500027840 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA 576.68 500028430 CLOSED TX TALUS FRACTURE W/O MANIPULATION 985.25 500028470 closed treatment of metatarsal fracture;without manipulation 1272.89 500029260 Strapping Of Elbow Or Wrist 393.98 500030903 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX 275.95 500031502 TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT 1348.27 500031505 LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX 229.39 500033415 RESCJ/INC SUBVALVULAR TISSUE 1485.03 500037785 LIGATION, DIVISION, ANDOR EXCISION OF VARICOSE VEIN CLUSTERS 14308.83 500040650 RPR LIP FULL THKNS VERMILION ONLY 4528.92 500042700 I&D ABSC PRITONSILLAR 2031.42 500046608 ANOSC RMVL FB 220.56 500064400 NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH 1615.23 500065220 RMVL FB XTRNL EYE CRNL W/O SLIT LAMP 574.57 500065222 RMVL FB XTRNL EYE CRNL W/SLIT LAMP 678.87 500099173 VISUAL ACUITY SCREENING 441.98 500099282 EMER DEPT LOW TO MODERATE SEVERITY 1246.98 500099283 EMER DEPT MODERATE SEVERITY 2265.32 5000E0220 HOT WATER BOTTLE 53.04 5000E0325 URINAL MALE JUG-TYPE 9.73 5000E0580 NEBULIZER FOR USE W/ REGULAT 441.98 500011422 EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM 880.44 500012018 SIMPLE REPAIR F/E/E/N/L/M >30.0CM 2405.59 500012021 TX SUPERFICIAL WOUND DEHISCENCE W/PACKING 1905.64 500013101 REPAIR COMPLEX TRUNK 2.6 CM-7.5 CM 1647.63 500016030 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE 862.30 500024505 CLTX HUMERAL SHFT FX W/MANIPULATION +-SKEL TRACJ 2935.64 500024565 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MNPJ 3184.68 500031605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE 1210.43 500054001 SLITTING PREPUCE DORSAL/LAT SPX XCP NB 906.80 500065210 RMVL FB XTRNL EYE EMBEDDED SCJNCL/SCLL NONPRF8 344.55 6000R0002 Omnipaque 240 - 50ml 3.11 500036011 SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH 1805.10 500070553 MRI BRN BRN STEM C-/C+ 4950.12 500073723 MRI ANY JT LXTR C-/C+ 7648.47 500074183 MRI ABD C-/C+ 4950.12 500072156 MRI SPI CANAL&CNTS C-/C+ CRV 4950.12 500072157 MRI SPI CANAL&CNTS C-/C+ 4199.40 500072195 MRI PELVIS C-MATRL 4199.40 500090714 TD TOXOIDS ADSORBED PRSRV FR 7 YR + IM 217.70 5000G8895 ANTROM PRESCRIBE 7.30 5000J0282 AMIODARONE HCL 30MG 20.73 5000J0456 ZITHROMAX - AZITHROMYCIN 500MG 122.88 5000J0500 BENTYL - DICYCLOMINE INJECTION 20MG 32.53 5000J0540 PENICILLIN G BENZATHINE INJ 75.23 5000J0558 INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE... 98.65 5000J0641 LEVOLEUCOVORIN INJECTION 3.54 5000J0696 ROCEPHIN - CEFTRIAXONE SODIUM up to 250MG 67.14 5000J1165 PHENYTOIN SODIUM INJECTION 61.88 5000J1580 GARAMYCIN GENTAMICIN INJ 76.02 5000J1610 GLUCAGON HYDROCHLORIDE/1 MG 102.80 5000J1642 BOLUS IV LOCK PUSH - INJ HEPARIN SODIUM PER 10 U 20.33 5000J1790 DROPERIDOL INJECTION 4.82 5000J1956 LEVAQUIN - LEVOFLOXACIN INJECTION 250MG 181.21 5000J2001 LIDOCAINE 46.77 5000J2060 ATIVAN - LORAZEPAM INJECTION 2MG 150.45 5000J2270 MORPHINE SULFATE INJECTION UP TO 10MG 32.53 5000J2310 INJ NALOXONE HYDROCHLORIDE (Narcan) per 1 mg 78.57 5000J2360 NORFLEX - ORPHENADRINE UP TO 60MG 186.09 5000J2370 NEO-SYNEPHRINE - PHENYLEPHRINE HCL INJECTION 124.04 5000J2405 ZOFRAN (ONDANSETRON HCL INJECTION 1MG) 32.53 5000J2550 PHENERGAN - PROMETHAZINE HCL INJECTION UP TO 50MG 32.53 5000J2765 METOCLOPRAMIDE HCL INJECTION 45.52 5000J2790 RHOGAM INJECTION 301.96 5000J3010 FENTANYL CITRATE INJECTION 0.05 mg/mL (Up to 100MCG) 31.33 5000J3130 TESTOSTERONE ENANTHATE INJ 35.35 5000J3420 VITAMIN B12 INJECTION 135.25 5000J3475 MAGNESIUM SULFATE INJ PER 500MG 37.54 5000J3490 CARD CARDIZEM - DILTIAZEM HYDROCHLORIDE 10 MG 5.99 5000J3490 IMO IMODIUM-2MG TAB 13.27 5000J3490 LIDO VISCOUS XYLOCAINE 77.27 5000J3490 LYTE PEDIALYTE 36.62 5000J3490 RA RACONIC 0.5ML 12.11 5000J3490 TET TETRACAINE - PONTOCAINE 1% 2ML IM\IV 85.39 5000J3490 TYL3 TYLENOL 1000MG 194.47 5000J3490 TYL6 TYLENOL 325 MG 53.04 5000J3490ERYTH ERYTHROMYCIN 500MG/IV 113.84 5000J7040 NORMAL SALINE SOLUTION INFUS - 500 ML=1 UNIT 40.32 5000J7042 5% DEXTROSE/NORMAL SALINE 40.32 5000J7110 DEXTRAN 75 INFUSION 194.36 5000J7609 ALBUTEROL COMP UNIT 221.00 5000Q0091 SCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARING AND CONVE... 72.34 5000S0020 INJECTION, BUPIVICAINE HYDRO 70.77 5000S0077 CLEOCIN - CLINDAMYCIN PHOSP 300MG 48.32 5000S0164 PROTONIX - PANTROPRAZOLE 40MG 292.77 5000S1015 IV TUBING EXTENSION SET 90.28 5000S5010 STERILE SALINE - 5% DEXTROSE AND 0.45% SALINE 351.20 5000S8430 PADDING FOR COMPRSSN BDG 25.88 5000S8451 SPLINT WRIST OR ANKLE 180.33 6000DA001 Acetaminophen/Codeine 300/30 soln 53.04 6000DA002 amoxicillin/clavulanate K+ 400mg/57mg 28.43 6000DA005 (DO NOT USE) auralgan 99.61 6000DM001 Metronidazole 500mg/100ml inj 377.03 5000MAXITR Maxitrol 927.12 5000MAXOINT Maxtriol ointment 1107.57 500093005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 0.00 500093303 COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY 2398.07 500093313 TEE R-T IMG 2D W/PROBE PLMT ONLY 3976.54 500096372 INJECTION, INTRAMUSCULAR OR SUBCUTANEOUS 328.10 500096000 COMPRE CPTR MTN ALYS VIDEO TAPING 3-D KINEMATICS 1637.69 500093882 DUP-SCAN XTRC ART UNI/LMTD STD 1368.35 500093922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL 1193.33 500093971 DUP-SCAN XTR VEINS UNI/LMTD STD 1553.88 500099374 PHYS SUPVJ PT HOME HLTH AGENCY MO 15-29 MINUTES 363.27 5EXPLACRPR Explosive Laceration Repair 0.00 5EXP99283 Explosive E/M 99283 0.00 5EXP99284 Explosive E/M 99284 0.00 500036000 INTRO NDL/INTRACATH VEIN 371.25 6000DA007 ANTIVERT – Meclizine Hydrochloride 25 Tab 37.52 500036010 Introduction of catheter, superior or inferior vena cava 1266.90 500026670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES; Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia 2085.09 500021485 CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ 4070.76 6000DN009 Nitroglycerin Cardiac Drip 96.16 500072131 CT LUMBAR SPINE W/O CONTRAST MATERIAL 4428.13 6000PEPTAB PEPCID/FAMOTIDINE 20MG TAB 23.24 500023930 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA 1345.70 6000011601 CEPHALEXIN 125mg/ml 200 ml (KEFLEX) 441.35 6000011602 CEPHALEXIN 250mg/mL 100mL (KEFLEX) 329.16 6000011605 MACROBID 100MG 30.04 500097597 Rmvl devital tis 20 cm/< 178.65 500082945 Glucose, body fluid, other than blood 132.54 500087327 Infectious agent antigen detection .... Cryptococcus neoformans 107.92 500089050 Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, jt fluid), except blood 117.58 6000DG002 Glycerin Supp 24.97 6000DN003 Nitroglycerin 25mg/250ml 48.08 500087491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe technique 317.18 6000001497 TUBE BC GRN 4ML LITH HEP 112.84 500049083 Abdominal paracentesis (diagnostic or therapeutic); w/ imaging guidance 1657.79 6000001155 HUMULIN R 100U/ML VL 10ML 124.96 500023931 I&D, upper arm or elbow area; bursa 1199.61 500025530 Closed treatment of ulnar shaft fracture; w/o manipulation 1761.12 500026765 OPEN TX DISTAL PHALANGEAL FRACTURE EACH 3761.31 500087324 CLOSTRIDIUM AG EIA 216.78 6000RC001 Readi-Cat 2 (Barium Sulfate Suspension) (2.1% w/v, 2.0% w/w) 900mL 260.34 500087803 CLOSTRIDIUM TOXIN A W/OPTIC 216.84 5000J3301 Triamcinolone acet inj nos up to 10mg (40mg total) 29.36 5001J1956 LEVAQUIN 750MG IVPB 78.81 60000ROBI2 Cheratussin AC 5ML 23.18 6000DH005 Hydrocodone/apap 10/325 mg tab 22.14 6000COL02 Colace Liquid 50mg/5ml bottle (BILL ONCE THIS IS PER BOTTLE) 33.14 500073202 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL 2428.04 500071130 RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS 2428.04 500077077 JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS 1232.50 500080300 Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) 348.27 500073552 RADEX, Femur; 2V 374.50 500087641 Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique 577.19 500011055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 220.25 500036569 INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/> 1650.00 5000Q0111 Wet mounts/ w preparations 70.28 5000Q0092 Set-up portable x-ray equipment 337.13 5000Q4021 Cast sup sht arm splint plst 87.91 E0691 Uvl pnl 2 sq ft or less 8363.42 500080329 Analgesics, non-opioid; 1 or 2 398.51 5000J8499 Hyd Prescription drug, oral, non chemotherapeuticHydroxycine 10mg tab 9.49 5000A4649 TOURN Finger Tourinquet 24.25 5000J7626 Budesonide non-comp unit, up to 0.5 mg (Pulmicort) 151.80 5000J3490NORV Norvasc (Amlodipine), TAB 5MG 45.64 5000Q4019 Cast sup lng arm splnt ped p 59.52 500026725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA 4112.02 5000J2704 Injection, propofol, 10 mg 23.98 5000J3490VIS Vistaril (Hydroxyzine) tab per 25mg 39.49 500040804 RMVL EMBEDDED FB VESTIBULE MOUTH SMPL 1633.26 5000J7699MAG Magnesium Sulfate Up to 500mg 16.69 500076802 US PREG UTERUS 14 WK TRANSABDL EACH ADDL GESTATION 877.98 500086696 ANTIBODY HERPES SMPLX TYPE 2 318.41 500084482 Triiodothyronine T3; reverse 126.55 500087102 CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD 138.25 500087015 CONCENTRATION INFECTIOUS AGENTS 109.76 500027762 CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ 2946.73 50036575 RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP 486.62 500087230 TOXIN/ANTITOXIN ASSAY TISSUE CULTURE 324.82 500086060 ANTISTREPTOLYSIN O TITER 120.15 500087590 IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ 329.89 500080185 ASSAY OF PHENYTOIN TOTAL 218.07 500086039 ANTINUCLEAR ANTIBODIES ANA TITER 183.54 500067938 REMOVAL EMBEDDED FOREIGN BODY EYELID 1564.81 500082784 ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH 153.00 500084403 Testosterone; total 424.67 500083930 Osmolality: Blood 81.03 5000L4387 Non-pneum walk boot pre ots 627.05 500086705 HEP B CORE ANTIBODY IGM 193.68 500080164 Valproic acid (dipropylacetic acid); total 222.90 5000S5013 5% dextrose with potassium chloride, 1000 ml 104.55 400105236 C-COLLAR REG PERFIT 20/CS 1114.21 400240992 HALOPERIDOL 5MG/ML VL 10ML 65.62 400182531 CATH CHEST 16FR STR 10/CS 490.87 400016420 CATH KIT 5FR INF CLOSED SYS 32.41 400012861 TUBE NASOGASTRIC SUMP 12FR 18.19 400044308 TUBE NASOGASTRIC SUMP 18FR 18.19 400076321 SALINE 5CC SYR PF 30/BX 103.20 400016018 IV SET BC 23X3/4 12 7.18 400069809 BRUSH SCRUB EZ W/CHLORHX 30BBX 206.48 400049918 TUBE BC RED 4ML CLOT ACT 130.38 400011859 TUBE BC RED/GRY 8.5ML SST 147.71 400284220 ROCURONIUM BR 10MG/ML 5ML 40.25 400078473 EXTEN SET 8 17.73 400057397 ADMIN SET SEC ADULT LL 7.38 400001019 SKIN STAPLE REMOVER 6.24 400239890 SPLASH GUARD IRRIGATION ST 43.13 400026266 AIRWAY ORAL OROPHARYNGEAL LGEA 11.10 400317332 METOPROLOL 1MG/ML 5ML VL 6.31 400013831 FINGER COT SM PADDED 5.84 400013833 FINGER COT LG PADDED 5.84 400010191 FINGER SPLINT SM CVD PADDED 5.38 400010203 FINGER SPLINT FROG MD PADDEDEA 8.23 400010216 COLLES SPLINT L/SM W/PAD 32.21 400007701 COLLES SPLINT R/SM W/PAD 32.21 400025499 FINGER SPLINT STAX KIT 348.40 400010342 CAST BOOT SM 34.48 400010346 CAST BOOT LG 34.48 400010454 SHOULDER IMMOB LG 31.15 400010474 CLAVICLE SPLINT MED 30.15 400012926 CLAVICLE SPLINT UNIV 70.93 400010789 POST-OP SHOE MALE/SM 38.92 400235760 TUBE GAUZE 1 71.59 400236497 DRUG SCREEN 11 PANEL 25/BX 1834.65 400226634 NAIL POLISH REMOVER PAD 35.86 400001418 SUTURE 6-0 GUT CHR PS-6 1452.78 400003612 SUTURE 6-0 SILK P-1 864.69 400001482 SUTURE 6-0 ETHILON P-1 863.89 400013968 SUTURE 4-0 ETHILON P-3 2559.67 400001515 SUTURE 3-0 PROLENE PS-1 1146.01 400001520 SUTURE 5-0 PROLENE PS-2 946.19 400001521 SUTURE 6-0 PROLENE P-3 1268.21 400318312 ADHESIVE DERMABOND SKIN 263.13 400003946 SUTURE 6-0 VICRYL CTD P-3 919.94 400103017 SUTURE 6-0 VICRYL CTD S-29 3065.74 400022960 SUTURE 3-0 VICRYL CTD CT-1 1163.14 400294858 THERMOMETER REFRIG/FREEZ 418.93 400110247 ADENOCARD 3MG/ML SYR 2ML 299.13 400100410 INTERFACE CABLE NELLCOR 1933.47 400243926 LEADWIRE SET 5 LEAD MIXED 890.13 400001576 SILVER NITRATE APPLI 100/EA 195.12 400246687 CLINDAMYCIN 150MG/ML 4ML 25.77 400075767 DEXTROSE 50% 18G SYR L/S 50M 68.54 400195855 LIDOCAINE 2% L/S PFS 5ML 21.46 400036085 VANCOMYCIN 1GM FT 32.75 400144010 EXTRACTOR OTO RHINO 5PK/EA 2334.66 400058171 KOTEX MAXIPAD REGULAR 24/BX 31.02 400030947 MASK GUARDALL FULL VISOR 40C 12.16 400010218 THORACENTESIS TRAY W/CATH 258.21 400273173 CUP 8OZ FOAM WHT DART 25/BX 5.78 400279728 CITRATE OF MAG LEMON 10OZ 12.29 400046529 NITRAZINE PAP W/DISPENSER 306.29 400051920 NEO-SYNEPH REG SPY 15ML 30.49 400233835 FLUMAZENIL .1MG/ML MDV 5ML 30.15 400173930 IMITREX 6MG/0.5ML SYRINGE 2/BX 2000.82 400236944 NITRO-BID 2% OINT 30GM 260.54 400306182 ALBUTEROL 2.5MG SOL 25X3ML 34.67 400289571 METHOCARBAMOL 750MG 100/BT 112.10 400146242 DIPHENHYDRAMINE 50MG 1ML SDVEA 6.51 400317884 SUMATRIPTAN 6MG/0.5ML VL 5BX 1068.65 400217128 POTASSIUM CHL 20MEQTAB 100BT 225.80 400315648 ADENOSINE 3MG/ML VL 2ML 34.27 400295736 LACTULOSE 10GM/15ML SOL 16OZ 55.79 400310332 BENADRYL ALLERGY LIQ CHILD 48.29 400310795 PROMETHAZINE 50MG AMP 1ML 15.80 400246642 VECURONIUM 10MG 10X10ML 569.89 400296477 IBUPROFEN CHLD SUS BERRY 4OZEA 23.64 400175807 ACTIVASE 50MG VL 19.92 400256577 RANITIDINE 150MG TABS 100BT 55.06 400181612 BENTYL 10MG/ML AMP 5X2ML 1546.88 400072279 TIMOLOL .5% O/S 5ML 33.02 400182950 CIPROFLOXACIN .3% O/S 5ML 27.90 400297549 LEVALBUTEROL 0.63MG/3ML SOL 751.73 400303558 NALOXONE 1MG/ML SYR 2ML 137.34 400279772 ATROPINE 0.1MG/ML SYR 10ML 36.60 400306392 LUBE JELLY 3GM FOIL SURGICAL 60.90 400312188 ACETAMINOPHEN SUS GRAPE 4OZ 21.92 400004951 SKIN STAPLER PRECISE 5 ARCU 37.52 400293786 GLO STRIPS 1MG 100/BX 53.07 400252964 OMNIPAQUE 300MG 10X30ML 3148.62 400222025 OMNIPAQUE 300MG POLY 10X100M 6.65 400182627 LENS REMOVER/INSERTER 150.63 400009737 CLEANER TRANSEPTIC SOL 8.5OZ 31.88 400058080 DIAPER PAMPERS SZ5 UNISEX 45.43 400066296 ID BAND WHITE 1000/BX 264.66 400124304 ARMBOARD INFANT 1X4 4.06 400146724 ARMBOARD 2X4 24/CS 95.84 400052473 ARMBOARD WRIST 2X6 DISP 3.59 400248935 SCISSORS BNDG/UTIL 7.5 83.55 400004431 TAPE PAPER 2 37.46 400001137 TAPE CLOTH/SILK 1 62.82 400001768 DRAPE 40X48 TISSUE 2PLY WHT 13.49 400005982 ALCOHOL ISO 70% 16OZ 12/CS 12.16 400211527 CAST SPLINT 3 546.04 400270178 SCALPEL #11 SS DISP ST 10/BX 42.50 400260631 BP UNIT CHILD DLX 228.60 400260632 BP UNIT LG ADULT DLX 262.33 400281114 STOCKINETTE 2 57.86 400149524 ABD PAD 5X9 ST1S 20/BX 16.20 400121844 PACKING STRIP PLAIN 1/2 15.80 400121866 PACKING STRIP W/IODO 1/2 18.14 400169153 SPECULUM VAG GRAVES DISP LG 208.81 400008167 APPLICATOR CT 6 19.00 400009558 TONGUE BLADE JR ST 100/BX 22.39 400232638 OIL EMULSION DRESS 3X3 50/BX 117.94 400169392 STRAINER CALCULI 100/CS 11.68 400039065 CAUTERY HI-TEMP FINE 10/BX 55.52 400264224 URINAL MALE W/COVER CLR 8.18 400041634 BANDAGE ADH FLEX 3/4X3 16.61 400164831 LANCET 21G SAFETY GRN 200/BX 224.55 400226021 CANNULA NASAL ADLT STR TIP 3.27 400226031 NEBULIZER W/MOUTHPIECE ADULTCS 6.58 400226035 TUBING OXYGEN 7 CRUSH RES 3.59 400047315 COTTON BALLS MED 2BX/CS 1.40 400239215 BANDAGE COHES 3 10.63 400158132 LEG BAG 500ML MED 13.49 400235933 APRON XRAY 24X38 TALL 1476.35 400291111 SUCTION CATH KIT 10FR 50/CS 6.24 400291112 SUCTION CATH KIT 12FR 50/CS 5.98 400291114 SUCTION CATH KIT 16FR 50/CS 6.11 400232644 URINE CTL DIP 15ML LVL1/2 704.85 400101495 TUBE HLDR BC 100/BX 67.68 400056484 PIPETTES TRANS 5ML 1MLDRAW 1.53 400206540 TOWEL OR BLUE 17X26 ST4S 19.53 400061798 ARMSLING MED 6/CS 18.40 400061815 WRIST&F/A SPLINT L/UNIV 63.89 400169279 CAST PAD 4 91.72 400256570 GLOVE EXAM NIT SM PF 200/BX 64.81 400256572 GLOVE EXAM NIT LG PF 200/BX 64.81 400126228 INFLUENZA A 131.71 400182499 STICKER AWARD SPACESHIP 112.10 400182501 STICKER AWARD DINOSAUR 112.10 400165933 RHINO ROCKET LG SLIM 8/BX 104.34 400001862 TRACH TUBE ENDO 6.5 MUR CUF 13.89 400001863 TRACH TUBE ENDO 7 MUR CUF 13.89 400006382 TRACH TUBE ENDO 9 MUR CUF 13.89 400032418 AIRWAY NASO ROBERTAZZI 28FR 29.96 400032419 AIRWAY NASO ROBERTAZZI 30FR 29.96 400306253 LMA AIRWAY UNIQUE STD SZ3 112.50 400306254 LMA AIRWAY UNIQUE STD SZ4 112.50 400133329 AIRWAY NASO 12FR ADJ FLNG 370.78 400168919 AIRWAY NASO 24FR ADJ FLNG 370.78 6000001158 HYDROCORTISONE .5% CRM 1OZ W/ALOEEA 15.70 6000001478 TOURNIQUET 1X18 1.14 6000DA006 bacitracin oint packet 3.5GM 471.99 6000S0004 Cotton Tip Applicator 19.00 6000S0010 Foreign Body Remover 17.00 5001A4364 DermaBond Mini 3.32 5000L0120 CERV FLEXIBLE NON-ADJUSTABLE 486.17 5000L0978 AXILLARY CRUTCH EXTENSION 1509.43 5000L3999 UPPER LIMB ORTHOSIS NOS 265.19 5000L4350 ANKLE CONTROL ORTHOSI PREFAB 586.33 5000E0114 CRUTCH UNDERARM PAIR NO WOOD 88.40 5000E0117 UNDERARM SPRINGASSIST CRUTCH 182.79 500080048 BASIC METABOLIC PANEL CALCIUM TOTAL 408.39 500080051 ELECTROLYTE PANEL 421.28 500080053 COMPRE METAB PANEL 823.85 500082010 ACETONE/OTH KETONE BODIES SERUM QUAN 54.63 500082075 ALCOHOL BRTH 152.57 500082150 AMYLASE 318.23 500082270 BLD OCLT PROXIDASE ACTV QUAL FECES 1 DETER 229.83 500082541 COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE 182.87 500082657 NZM ACTV CELLS/TISS NONRADACT SUBSTRATE EA 224.62 500083036 Hemoglobin; glycosylated (A1C) 97.46 500083520 IMMUNOASSAY ANALYTE QUANTITATIVE NOS 217.28 500084132 POTASSIUM SERUM PLASMA/WHOLE BLOOD 197.21 500084166 PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATION 132.60 500084295 SODIUM SERUM PLASMA OR WHOLE BLOOD 106.78 500084443 TSH - THYR STIMULATING HORM 397.79 500084480 TRIIODOTHYRO9 T3 TOT 240.44 500084512 TROPONIN QUAL 233.81 500085652 SEDIMENTATION RATE RBC AUTO 141.36 500086308 MONO - HTROPHL ANTIBODIES SCR 160.61 500086325 IMMUNOELECTROPHORESIS OTH FLUS CONCENTRATION 282.87 500086374 86374 194.47 500086403 PART AGGLUJ SCR EA ANTB 201.94 500086592 SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL 53.14 500086663 ANTB EPSTEIN-BARR EB VIRUS EARLY AG EA 372.05 500086710 ANTB INF VIRUS 216.58 500086906 BLD TYPING RH PHEXYPING COMPL 130.47 500087040 BLOOD CULTURE - CUL BACT BLD AERC ISOL 397.79 500087046 STOOL CULTR AEROBIC BACT EA 94.75 500087070 CUL BACT XCPT URINE BLD/STL AERC ISOL 288.87 500087280 Infectious agent antigen detection by immunofluorescent tech... 150.20 500087389 Infectious agent antigen detection by enzyme immunoassay tec... 225.81 500087804 IAADIADOO INF 256.36 500087850 IAADIADOO NEISSERIA GONORRHOEAE 197.23 500087880 IAADIADOO STREPTOCOCCUS GRP 216.58 500099001 HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB 61.88 6000L0003 Wound Culture Anaerobes/Aerobes 248.38 6000L0004 Blood Tube Heparin Gel 8.22 500062270 SPINAL TAP FLUID 839.75 500070140 RADEX FACIAL B1S < 3 VIEWS 571.84 500070260 RADEX SKL COMPL MINIMUM 4 VIEWS 759.41 500070350 CEPHALOGRAM ORTHODONTIC 388.93 500072052 RADEX SPI CRV COMPL W/OBLQ&FLEXION&/XTN STDS 1272.89 500072069 RADEX SPI THORACOLMBR STANDING SCOLIOSIS 565.73 500072070 RADEX SPI THRC 2 VIEWS 410.69 500072170 RADEX PELVIS 1/2 VIEWS 574.57 500073000 RADEX CLAV COMPL 422.88 500073060 RADEX HUM MINIMUM 2 VIEWS 556.90 500073080 RADEX ELBW COMPL MINIMUM 3 VIEWS 510.93 500073090 RADEX F/ARM 2 VIEWS 265.19 500073110 RADEX WRST COMPL MINIMUM 3 VIEWS 555.59 500073130 RADEX HAND MINIMUM 3 VIEWS 629.77 500073562 RADEX KNE 3 VIEWS 394.43 500073590 RADEX TIBFIB 2 VIEWS 575.94 500073660 RADEX TOE MINIMUM 2 VIEWS 353.58 500074022 RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH 863.47 500071101 4VWS RADEX RIBS UNI W/POSTEROANT CH 4 VIEWS 976.53 500071030 RADEX CH COMPL MINIMUM 4 VIEWS 793.79 500078315 B1&/JT IMG 3 PHASE STD 2181.60 500078808 NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS 1591.11 500076376 3D RNDR I&R CT MRI US/OTH X REQ POSTPCX 972.35 500070460 CT HEAD/BRN C+ MATRL 4800.12 500070487 CT MAXLFCL AREA C+ MATRL 2475.06 500070488 CT MAXLFCL AREA C-/C+ 2940.91 500070496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST 3002.25 500071270 CT THORAX C-/C+ 4377.11 500072127 CT CRV SPI C-/C+ 4547.71 500072192 CT PELVIS C-MATRL 4209.37 500072194 CT PELVIS C-/C+ 7648.47 500073200 CT UXTR C-MATRL 2215.18 500074160 CT ABD C+ MATRL 3877.96 500074176 Ct Abd & pelvis W/o Contrast 2651.85 500076536 US SOFT TISS HEAD&NCK R-T IMG 1511.65 500076700 US ABDOMINAL R-T W/IMAGE DOCUMENTATION 1751.14 500077079 CT BONE MINERAL DENSITY STUDY 1+ SITS APPND 618.77 500010120 INCISION&REMOVAL FOREIGN BODY SUBQ TISS SMPL 709.02 500011750 EXCISION NAIL MATRIX PERMANENT REMOVAL 938.76 500011765 WEDGE EXCISION SKIN NAIL FOLD 516.24 500011771 EXCISION PILONIDAL CYST/SINUS EXTENSIVE 449.04 500012001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< 643.52 500012011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< 757.90 500012015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5CM 1352.42 500012044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM 2960.94 500013122 REPAIR COMPLEX SCALP/ARM/LEG EA 5 CM/< 804.92 500020551 INJ TENDON ORIGIN/INSERTION 1334.05 500020605 ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURSA 311.16 500021310 CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION 754.89 500023655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES 2008.34 500024600 Treatment of closed elbow dislocation; without anesthesia 976.37 500024640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MNPJ 786.73 500024655 CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION 3151.37 500026010 DRAINAGE FINGER ABSCESS SIMPLE 450.82 500026011 DRAINAGE OF FINGER ABCESS 2120.27 500027550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA 2070.21 500027824 Closed treatment of fracture of weight bearing articular por... 976.37 500028190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS 1127.92 500028400 CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION 929.81 500029049 CAST FIGURE-OF-8 265.19 500029105 LONG ARM SPLINT SHOULDER HAND 265.19 500029126 SHORT ARM SPLINT DYNAMIC 265.19 500029240 STRAPPING SHOULDER 392.47 500029505 LONG LEG SPLINT THIGH ANKLE/TOES 265.19 500029540 STRAPPING ANKLE &/FOOT 332.36 500029550 STRAPPING TOES 265.19 500029700 REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST 192.71 500032550 INSERT PLEURAL CATH 2755.40 50003293F ABO AND RH BLOOD TYPING DOCUMENTED AS PERFORMED 247.50 500036556 INSJ NON-TUN CTR CVC AGE 5 YR/> 1329.46 500038300 DRAINAGE LYMPH NODE ABSC/LYMPHADENITIS SMPL 458.34 500042809 Removal of foreign body from pharynx 362.64 500043752 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDN 603.55 500046040 I&D ISCHIORCT&/PRIRCT ABSC SPX 1748.46 500046050 INCISION OF ANAL ABSCESS 3209.62 500051703 INSJ TEMP NDWELLG BLDR CATH COMP 860.97 500056420 I&D OF BARTHOLINS GLAND ABSC 1127.36 500059025 FETAL NON-STRESS TEST 908.01 500064450 NERVE BLOCK ANES OTHER PRPH NRV/BRANCH 846.84 500069000 Drainage external ear, abscess or hematoma; simple 916.47 500069220 DBRDMT MSTDC CAVITY SMPL 627.15 500070030 RADEX EYE DETCJ FB 398.48 500090746 HEPATITIS B VACCINE ADULT DOSAGE INTRAMUSCULAR 120.20 500096368 IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS 380.11 500099217 Observation care discharge 504.17 500099236 Observation or inpatient hospital care 3504.83 500099291 CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN 3712.60 5000E0352 DISPOSABLE PACK W/BOWEL SYST (VAG SPECULUM) 267.50 500012017 SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0CM 2118.63 500012045 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM 3739.69 500012047 REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM 5170.08 500012056 REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 20.1-30.0CM 4793.79 500013102 REPAIR COMPLEX TRUNK EA 5 CM/< 486.88 500023665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ 2700.60 500024200 RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS 916.30 500028600 CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES 1221.32 500031603 TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL 41976.68 500092950 CARDIOPULM RESUSCITATION 1221.46 500029065 Application, cast; shoulder to hand (long arm) 467.81 500062272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) 583.30 500093980 PENILE VASCULAR STUDY 1130.44 500093351 ECHO TTHRC R-T 2D -+M-MODE REST&STRS CONT ECG 2363.51 500071550 MRI CH C-MATRL 4198.77 500073221 MRI ANY JT UXTR C-MATRL 4199.40 500073721 MRI ANY JT LXTR C-MATRL 4199.40 500074181 MRI ABD C-MATRL 4199.40 500072141 MRI SPI CANAL&CNTS CRV C-MATRL 2828.64 500070544 MRA HEAD C-MATRL 4773.33 500090660 INFLUENZA VIRUS VACCINE LIVE INTRANASAL 106.08 5000A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml 23.83 5000C9285 LIDOCAINE 70 MG/TETRACAINE 70 MG, PER PATCH 116.69 5000J0150 INJECTION ADENOSINE 6 MGCODE DELETED AS OF 01/01/2015 SEE J0153 98.65 5000J0360 HYDRALAZINE HCL INJ UP TO 20MG 261.65 5000J0461 ATROPINE SULFATE INJECTION 0.01mg 1.55 5000J0561 Penicillin Benzathine 600,000; Inj. 15.96 5000J0595 STADOL (BUTORPHANOL TARTRATE 1 MG) 21.22 5000J0690 ANCEF - CEFAZOLIN SODIUM INJECTION 500MG 32.28 5000J1100 DECADRON - DEXAMETHASONE SODIUM PHOS 32.53 5000J1265 INJECTION, DOPAMINE HCL, 40 MG 27.01 5000J1644 INJ HEPARIN SODIUM PER 1000U 46.56 5000J1670 TETANUS IMMUNE GLOBULIN INJ 61.88 5000J2250 VERSED - INJ MIDAZOLAM HYDROCHLORIDE PER 1MG 17.34 5000J2543 ZOSYN - PIPERACILLIN/TAZOBACTAM 88.40 5000J2650 PRELONE - INJECTION PREDNISOLONE ACETATE UP TO 1 ML 9.19 5000J2730 PRALIDOXINE CHLORIDE 32.53 5000J2780 RANITIDINE HYDROCHLORIDE INJ 16.23 5000J3230 CHLORPROMAZINE HCL INJECTION 92.18 5000J3411 THIAMINE HCL 100 MG (inj) 62.20 5000J3480 POTASSIUM CHLORIDE INJ - K-DUR 2.39 5000J3490 DAV DAVROCET N - TAB 11.25 5000J3490 DROP Systane (Alcon) Eye Drops 36.62 5000J3490 NITR NITRO STAT- NITROGLYCERIN 12.13 5000J3490 SPRA SPRAY - HURRICANE SPRAY 214.53 5000J3490 TYL2 TYLENOL 400 MG 97.24 5000J3490 TYL4 TYLENOL 500MG 114.92 5000J3490KDUR K-DUR PER 20MEQ PO 2.39 5000J3490MOTRI MOTRIN UP TO 600MG 0.95 5000J7120 RINGERS LACTATE INFUSION 137.20 5000J7611 ALBUTEROL NON-COMP CON 21.39 5000J8498 Mineral Oil Enema 110 g 46.77 5000J8499 Tropicamide Drops 8.06 5000Q0163 DIPHENHYDRAMINE HCL 50MG 32.53 5000Q9954 ORAL MR CONTRAST, PER 100 ML 347.94 5000Q9957 INJ PERFLUTREN LIP MICROS,ML 192.87 5000S5001 PRESCRIPTION DRUG,BRAND NAME 11.25 5000S8450 SPLINT DIGIT 127.29 6000R0004 ISOVUE-Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 7.31 5001J3010 Fentanyl 100mcg/ (Up to 100MCG) 31.33 50001J2250 Midazolam 10mg, per 2ml; IM/IV/Intranasal 21.60 500093041 RHYTHM ECG 1-3 LDS TRCG ONLY W/O I&R 221.00 500099235 EM for Observation or inpatient hospital care 2718.39 500090997 HEMOPERFUSION 618.77 500095971 ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG 760.83 500093975 Duplex scan of arterial inflow and venous outflow of abdomin... 3647.00 500099406 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES 122.94 5EXPIVSTART Explosive IV Start Kit 0.00 5EXPBASICPAN Explosive Basic Panel 0.00 5EXP99281 Explosive E/M 99281 0.00 5EXPEKG010 EXPLOSIVE EKG- INCLUDES LEADS 0.00 600000PENDRN PENROSE DRAIN 38.19 60000PRLC40 PRILOSEC 40MG TABLET 73.13 500010180 Incision and drainage, complex, postoperative wound infection 1226.51 500073720 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; C-/C+ 8764.00 500093923 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS; Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries 1874.43 500020550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar 575.79 500025560 Closed treatment of radial and ulnar shaft fractures; w/o manipulation 3101.58 6000DD004 dextrose 5% and 0.9% normal saline 500ml 41.71 500030906 Cntrl nasal hemorrhage, posterior,w/ posterior nasal packs and/or cautery,any method; subsequent 987.49 6000IV0008 CENTRAL LINE KIT 88.96 500037195 Thrombolysis, cerebral, by intravenous infusion 456.04 6000000890 Injection, Alteplase recombinantm per 1mg(ACTIVASE) 143.75 6000DN001 NARCAN 2MG INJ 289.56 6000OR0001 Reglan PO, 10 mg 6.46 6000L0007 Diphenoxylate/Atropine (Lomotil) 2.5 mg; tab 17.39 500054015 Incision and drainage of penis, deep 2313.14 60000LIQZYR Zyrtec Liquid 1ml 10.05 5002J1956 LEVAQUIN 500MG IVPB 87.20 5000G6038 Assay of Salicylate 128.31 5000J1953 Inj: Levetiracetam, per 10mg 16.86 5000Q4024 Cast sup sht arm splnt ped fib 133.10 500087265 IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS 216.78 500072200 RADEX SACROILIAC JNTS <3 VIEWS 1899.40 500099024 POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX 400.95 500097010 ICE CAP OR COLLAR 19.44 500055175 Scrotoplasty; simple 4966.57 500093623 PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS 2184.49 500097140 MANUAL THERAPY 1/> REGIONS 401.49 500085270 CLOTTING FACTOR XI PTA 294.52 500083986 PH BODY FLUID NOT ELSEWHERE SPECIFIED 58.93 500086038 Antinuclear antibodies (ANA) 218.76 6000CC001 Clave Connector 28.67 5000J2354 Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg 33.18 5000J3490 VAS Vasotec/ Enalpril 9.49 5EXPCMPLFT Explosive CMP+LFT 0.00 6000S0183 Prochlorperazine 5 mg 20.30 5000J1327 Injection, eptifibatide, 5 mg 62.97 500098925 OSTEOPATH MANJ 1-2 REGIONS 320.47 500028630 CLTX METATARSOPHLNGL JT DISLC W/O ANES 1502.25 500076642 US BREAST UNI REAL TIME WITH IMAGE LIMITED 1190.84 500042330 REMOVAL OF SALIVARY STONE 2296.18 5000Q4020 Cast sup lng arm splnt ped (0-10) fib 94.91 5000Q4023 Cast sup sht arm splnt ped plaster 44.19 500086617 LYME DISEASE ANTIBODY 254.78 500086803 HEPATITIS C ANTIBODY 234.74 500031525 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN 2216.49 5000A4550INC SURGICAL TRAY/INCISION AND DRAIN 50.78 5000A4550SUT SUTURE REMOVAL TRAY 26.81 500086706 HEPATITIS B SURF ANTIBODY HBSAB 176.66 500089060 CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID 117.74 500084134 Prealbumin 138.86 50000A9284 Spirometer, non-electronic, includes all accessories 48.06 500086900 Blood typing, serologic; ABO 49.15 5000Q4017 Cast sup lng arm splint plst (11YR+) 118.70 5000J7060 5% dextrose/water 500ML 14.04 500080156 Carbamazepine; total 239.57 500055100 DRAINAGE SCROTAL WALL ABSCESS 2278.55 500084145 Procalcitonin (PCT) 440.61 5000A9152MUL Multivitamin (Single vitamin nos) 1.05 500026645 CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ 2628.73 500082248 Bilirubin; direct 41.24 500086880 COOMBS TEST DIRECT 88.50 500027096 INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA 1160.65 500028001 INCISION&DRAINAGE BURSA FOOT 2325.76 500076512 OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN 1250.25 500082746 Folic Acid: Serum 241.87 5000A4216SAL STERILE WATER/SALINE, FLUSH 50 ML (per 10 ml) 5.30 500087490 IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ 329.89 500082355 Calculus; qualitative analysis 190.42 5000J8499CAP Captopril 25mg tab 16.18 500064405 N BLOCK INJ OCCIPITAL 866.02 5000A9530 IODINE SOLUTION PREP 1OZ 1.29 500087425 IAAD IA ROTAVIRUS 197.18 5000A9150MOT MOTRIN 800 MG TABLET 6.04 500099152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 657.65 5000G0479 Drug test presump optical (DO NOT USE. DELETED 01/01/2017) 137.17 500082009 KETONE BODIES SERUM QUALITATIVE 68.89 5000A4649 Infant Pulse Oximeter Adhesive Sensor- 300ct/box 172.50 5000Q9967350 Omnipaque 350mg/ml per-1ml 1.32 50001J8499 Atenolol 25mg Qty 100 tabs 3.22 500090661 CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE 204.55 500087252 VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT 411.24 500084110 ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE 133.17 5000NASALATO NASAL ATOMIZATION DEVICE W/O SYRINGE 61.30 500086160 COMPLEMENT ANTIGEN EACH COMPONENT 189.29 500087209 SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS 141.80 500011732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL 233.11 5000PENIVK Penicillin-VK 500mg tab 2.70 500025652 OPEN TREATMENT ULNAR STYLOID FRACTURE 8129.93 500086337 Insulin antibodies 136.45 500082963 ASSAY OF GLUCOSIDASE BETA 169.45 500086343 LEUKOCYTE HISTAMINE RELEASE TEST LHR 196.54 500087483 CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25 3287.39 5000SINGTAB Montelukast Sodium/Singulair 10 mg tab 5.21 500087480 IADNA CANDIDA SPECIES DIRECT PROBE TQ 316.37 500086790 ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED 64.52 500026952 AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP 8265.40 500086235 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD 282.90 500070492 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL 3571.44 500011406 EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM 3223.22 500027788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ 4986.29 5000A4218 Sterile saline or water, metered dose dispenser, 10 ml 5.30 500076641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE 1389.78 5000L1812 Knee orthosis, elastic with joints, prefabricated, off-the-shelf 1206.24 500094150 VITAL CAPACITY TOTAL SEPARATE PROCEDURE 322.81 500083630 LACTOFERRIN FECAL (QUAL) 309.70 5000J8499COGEN Benztropine Mesylate (Cogentin) 0.5 mg PO 2.42 5000J8499AMOX Amoxicillin/Clavulanate 875mg/125mg tab 13.51 500083519 IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY 213.10 5000CIPRO400 Ciproflaxin 400mg/200mL Infusion 34.50 500076942US US GUIDANCE NEEDLE PLACEMENT IMG S&I 780.16 500087660 IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ 316.37 500071045 RADEX CHEST 1 VIEW 256.34 500074019 RADEX ABD 2 VIEWS 215.22 500074021 RADEX ABD 3+ VIEWS 503.47 500071047 RADEX CHEST 3 VIEWS 503.82 500071048 RADEX CHEST 4+ VIEWS 270.25 5000072082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW 805.69 5000072084 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW 565.34 OPLABL0003 Wound Culture Anaerobes/Aerobes 124.19 OPLABL0006 Grey Top Lactic Acid Plasma Test 50.67 OPLAB36591 COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE 110.49 OPLAB62270 SPINAL TAP FLUID 419.88 OPLAB70110 RADEX MNDBL COMPL MINIMUM 4 VIEWS 265.86 OPLAB70200 RADEX ORBITS COMPLETE MINIMUM 4 VIEWS 272.04 OPLAB71010 RADEX CH 1 VIEW FRNT 226.21 OPLAB71101 RADEX RIBS UNI W/POSTEROANT CH 3 VIEWS 366.21 OPLAB71111 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS 464.35 OPLAB72070 RADEX SPI THRC 2 VIEWS 205.34 OPLAB72074 RADEX SPI THRC MINIMUM 4 VIEWS 405.24 OPLAB72082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW 402.85 OPLAB72083 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW 485.30 OPLAB72084 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW 565.34 OPLAB72200 RADEX SACROILIAC JNTS <3 VIEWS 949.69 OPLAB72255 MYELOGRAPY THRC RS&I 1988.45 OPLAB72265 MYELOGRAPY LUMBOSAC RS&I 2209.44 OPLAB73000 RADEX CLAV COMPL 211.44 OPLAB73020 RADEX SHO 1 VIEW 175.15 OPLAB73080 RADEX ELBW COMPL MINIMUM 3 VIEWS 255.46 OPLAB73090 RADEX F/ARM 2 VIEWS 132.60 OPLAB73100 RADEX WRST 2 VIEWS 286.22 OPLAB73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS 276.03 OPLAB73522 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS 326.03 OPLAB73550 RADEX FEMUR 2 VIEWS (DELETED CODE) 235.84 OPLAB73564 RADEX KNE COMPL 4/MORE VIEWS 297.85 OPLAB73565 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST 231.09 OPLAB73660 RADEX TOE MINIMUM 2 VIEWS 176.79 OPLAB73720 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; C-/C+ 4382.01 OPLAB74000 RADEX ABD 1 ANTEROPOST VIEW 574.56 OPLAB74018 RADEX ABD 1 VIEW 176.18 OPLAB74019 RADEX ABD 2 VIEWS 215.22 OPLAB74021 RADEX ABD 3+ VIEWS 251.74 OPLAB74022 RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH 431.73 OPLAB74400 Urography (pyelography), intravenous, with or without KUB, w... 918.51 OPLAB80047 BASIC METABOLIC PANEL CALCIUM IONIZED 193.15 OPLAB80061 LIPID PANEL 209.94 OPLAB80074 AQT HEP PANEL 417.22 OPLAB80164 Valproic acid (dipropylacetic acid); total 111.46 OPLAB80201 Topiramate 98.05 OPLAB80335 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 169.87 OPLAB82000 ACETALDEHYDE BLD 45.08 OPLAB82247 BILIRUBIN TOT 59.00 OPLAB82274 BLD OCLT FECAL HGB DETER IA QUAL FECES 1-3 59.36 OPLAB82310 CALCIUM TOT 67.07 OPLAB82355 Calculus; qualitative analysis 95.21 OPLAB82374 CARBON DIOXIDE 58.56 OPLAB82554 CREATINE KINASE ISOFORMS 154.61 OPLAB82565 CREATININE BLD 110.49 OPLAB82607 CYANOCOBALAMIN 55.68 OPLAB82784 ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH 76.50 OPLAB82800 GASES BLD PH ONLY 98.56 OPLAB82945 Glucose, body fluid, other than blood 66.26 OPLAB83036 Hemoglobin; glycosylated (A1C) 48.74 OPLAB83525 ASSAY OF INSULIN TOTAL 94.00 OPLAB83690 LIPASE 110.49 OPLAB83735 MAGNESIUM 119.34 OPLAB83880 BNP - B TYPE NATRIURETIC PEPTIDE 243.09 OPLAB83935 Osmolality: Urine 40.51 OPLAB83986 PH BODY FLUID NOT ELSEWHERE SPECIFIED 29.46 OPLAB84100 Phosphorus inorganic (phosphate 39.01 OPLAB84144 ASSAY OF PROGESTERONE 164.57 OPLAB84157 PROTEIN TOT XCPT REFRACTOMETRY OTH SRC 14.15 OPLAB84402 Testosterone; free 200.91 OPLAB84482 Triiodothyronine T3; reverse 63.27 OPLAB84550 URIC ACID BLD 114.03 OPLAB84560 URIC ACID OTH SRC 103.68 OPLAB85027 BLD# COMPL AUTO HHRWP 112.26 OPLAB85032 BLD# MNL C-CNT RBC WBC/PLTLT EA 115.41 OPLAB85347 COAGJ TM ACTIVATED 26.75 OPLAB85380 FIBRIN DGRADJ PRODUXS D-DIMER ULTRSENS 246.91 OPLAB8OPLAB AGGLUTININS FEBRILE EA AG 43.40 OPLAB86060 ANTISTREPTOLYSIN O TITER 60.08 OPLAB86162 COMPLEMENT TOTAL HEMOLYTIC 148.29 OPLAB86200 Cyclic citrullinated peptide (CCP), antibody 101.37 OPLAB86374 86374 97.23 OPLAB86403 PART AGGLUJ SCR EA ANTB 100.97 OPLAB86638 Antibody: Coxiella burnetii (Q fever) 67.25 OPLAB86654 Antibody; encephalitis, Western equine 64.52 OPLAB86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA 143.12 OPLAB86666 Antibody; Ehrlichia 73.99 OPLAB86696 ANTIBODY HERPES SMPLX TYPE 2 159.21 OPLAB86703 ANTIBODY HIV-1&HIV-2 SINGLE RESULT 112.72 OPLAB86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL 95.05 OPLAB86705 HEP B CORE ANTIBODY IGM 96.84 OPLAB86706 HEPATITIS B SURF ANTIBODY HBSAB 88.33 OPLAB86709 HEPATITIS ANTIBODY HAAB IGM ANTIBODY 92.55 OPLAB86735 ANTIBODY MUMPS 107.28 OPLAB86757 Antibody; Rickettsia 175.12 OPLAB86759 Antibody; rotavirus 66.22 OPLAB86787 ANTB VARICELLA-ZOSTER 99.85 OPLAB86788 ANTIBODY WEST NILE VIRUS IGM 67.25 OPLAB87015 CONCENTRATION INFECTIOUS AGENTS 54.88 OPLAB87046 STOOL CULTR AEROBIC BACT EA 47.38 OPLAB87076 CULTURE ANAEROBE IDENT EACH 40.58 OPLAB87081 CUL PRSMPTV PTHGNC ORGANISMS SCR 153.18 OPLAB87265 IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS 108.39 OPLAB87327 Infectious agent antigen detection .... Cryptococcus neoformans 53.96 OPLAB87400 INFLUENZA B 131.71 OPLAB87430 IAAD EIA STREPTOCOCCUS GROUP A 177.41 OPLAB87490 IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ 164.94 OPLAB87510 IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ 158.18 OPLAB87528 IADNA HERPES SMPLX VIRUS DIR PRB 181.96 OPLAB87641 Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique 288.59 OPLAB87660 IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ 158.18 OPLAB87810 CHYLMD TRACH ASSAY W/OPTIC (Urine) 94.53 OPLAB87850 IAADIADOO NEISSERIA GONORRHOEAE 98.61 OPLAB89055 Leukocyte assessment 21.45 OPLAB99001 HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB 30.94 OPLABG0477 Drug test presump optical 68.59 OPLABG6038 Assay of Salicylate 64.15 OPLAB85301 CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY 153.53 OPLAB85303 CLOTTING INHIBITORS PROTEIN C ACTIVITY 196.42 OPLAB85306 CLOTTING INHIBITORS PROTEIN S FREE 217.58 500095783 POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM 12688.53 500092100 SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRES 445.51 5000G0103 Prostate Cancer Screening; Prostate Specific Antigen test (PSA) 261.17 500087116 CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL 153.41 500087631 IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS 1821.37 500082043 URINE ALBUMIN QUANTITATIVE 82.11 500080165 DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE 192.28 OPLAB62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) 291.65 500093015 CV STRS TST XERS&/OR RX CONT ECG W/SI&R 924.37 5000J3490FLONA Flonase Nasal Spray 50mcg strength 173.65 5000J2590 Injection, oxytocin, up to 10 units (10units/mL) 24.61 500086256 FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY 171.12 500085301 CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY 153.53 500085302 CLOTTING INHIBITORS PROTEIN C ANTIGEN 170.55 500085303 CLOTTING INHIBITORS PROTEIN C ACTIVITY 196.42 500086146 BETA 2 GLYCOPROTEIN I ANTIBODY EACH 361.33 5000PSEUHYD120 PSEUDOEPHEDRINE HYDROCHLORIDE Extended-Release Tablets, SUDAFED, 120MG 8.40 5000J3490GUA200 Tussin Liquid, GUAIFENESIN; 200 mg/10mL 7.02 5000XOFLUZA Xofluza (Baloxavir Marboxil) 40mg (2 tabs) 218.16 5000J7608 Acetylcysteine (Mucolytic Agent) 20% 200mg/mL 41.04 5000J3490CAR Caramide Peroxide 6.5% wax drops 51.87 5000J2358 Olanzapine (Zyprexa), long-acting, 1 mg injection 30.44 OPLAB85598 PHOSPHOLIPID NEUTRALIZATION HEXAGONAL 114.83 OPLAB74176 Ct Abd & pelvis W/o Contrast 1440.89 OPLAB84154 ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE 117.53 OPLAB72148 MRI SPI CANAL&CNTS LMBR C-MATRL 2099.69 OPLAB93971 DUP-SCAN XTR VEINS UNI/LMTD STD 776.94 OPLAB84305 ASSAY OF SOMATOMEDIN 135.87 OPLAB70551 MRI BRN BRN STEM C-MATRL 2099.70 5000J8499GLIP Glipizide (Glucotrol) 5 MG PO 13.80 500064447 INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE 876.53 5000J8499OFL Ofloxacin (Floxin) 0.3% OTIC drops 43.93 OPLAB76857 US PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 331.48 5000J8499CLON Clonazepam 0.5mg; tab 1.60 5000J8499GAB800 Gabapentin (Neuronitin) 800mg; tab 7.56 5000J8499CYAN Cyanocobalamin (Vitamin 12) 1000 mcg/1ml 20.69 5000J8499LEVOSDM Levothyroxine Sodium 25mcg tab 16.22 500054600 RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS 6001.74 5000J8499PROP Propanolol Hydrochloride 10 mg; tab 2.30 500064418 INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE 653.30 5000J8499FLUOX Fluoxetine Hydrochloride 20 mg 0.20 5000J8499DIVA Divalproex Sodium 500 mg; tab 0.80 5000J8499PARO Paroxetine Hydrochloride Hemihydrate 20 mg; tab 0.60 5000J8499SUCRA Sucralfate (Carafate) 1GM; tab 21.10 OPLAB70553 MRI BRN BRN STEM C-/C+ 2475.06 OPLAB70490 CT SOFT TISS NCK C-MATRL 1524.82 5000J8499SPIR Spironolactone (Aldactone) 25 MG; tab 1.17 5000Q9967VISI Visipaque 320 mg/mL; Iodinated contrast (100 mL volume bottle) 790.00 500097169SP Athletic training evaluation, low complexity (School Physical) 125.00 500087542 IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION 46.40 500082656 ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN 12.81 5000J3490CHAR ACTIVATED CHARCOAL 25G 44.21 5000J8499GENTSUL Gentamicin Sulfate (GENTAK) DRP 0.3% 59.99 500022515 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH 2563.00 500036005 NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH 556.30 500036248 SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH 565.70 500036475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN 3215.80 500083003 ASSAY OF GROWTH HORMONE HUMAN 185.20 500037193 RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I 4037.90 500037227 REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL 8389.10 500037248 TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN 3444.40 500037252 INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL 1050.20 500038505 BX/EXC LYMPH NODE NEEDLE SUPERFICIAL 805.20 500015004 PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT 3056.00 500022551 ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 19625.60 OPLAB72133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL 3264.58 OPLAB84270 ASSAY OF SEX HORMONE BINDING GLOBULIN 120.75 OPLAB73718 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL 1473.05 500022558 ARTHRODESIS ANTERIOR INTERBODY LUMBAR 17618.70 500022630 ARTHRODESIS POSTERIOR INTERBODY LUMBAR 18094.60 500022632 ARTHRODESIS POSTERIOR INTERBODY EA ADDL 3710.10 500022842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 8820.50 500022852 REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION 8003.20 500027280 ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT 15529.30 500027620 ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB 5170.80 500027687 GASTROCNEMIUS RECESSION 5200.40 500028208 REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON 3621.50 500028292 CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL 5577.10 500028585 OPEN TREATMENT TALOTARSAL JOINT DISLOCATION 7810.60 500029520 STRAPPING HIP 219.80 500063047 LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR 12647.20 500063663 REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR 5155.60 500063688 REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR 4257.40 500064445 INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE 832.90 OPLAB86361 T CELLS ABSOLUTE CD4 COUNT 190.10 500084588 ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE 377.10 500064480 NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV 717.40 500064484 NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV 594.40 500064493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL 1028.90 500064495 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL 602.10 500064510 NJX ANES STELLATE GANGLION CRV SYMPATHETIC 849.60 500077003 FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON 1104.10 500064575 INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD 3807.00 500064590 INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR 1847.00 500083970 ASSAY OF PARATHORMONE 586.04 500064635 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL 2529.10 500064642 CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE 1237.00 500064708 NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC 5729.50 5000J3490CLIN CLEOCIN - CLINDAMYCIN PHOSP 300MG -MEDICARE 48.32 500072295 DISKOGRAPY LUMBAR RS&I 1156.00 500076000 FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME 529.70 500082042 OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN 77.80 500084442 ASSAY OF THYROXINE BINDING GLOBULIN 164.30 500087206 SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT 59.90 500096150 HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT 240.00 500097032 APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN 167.80 500099202 OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES 570.30 500099205 OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES 1894.60 500028090 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT 3531.40 500050432 PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I 2384.90 500060100 BIOPSY THYROID PERCUTANEOUS CORE NEEDLE 904.90 500062323 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN 1132.50 500075822 VENOGRAPHY EXTREMITY BILATERAL RS&I 1466.60 500010030 IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE 1583.00 OPLAB70487 CT MAXLFCL AREA C+ MATRL 1470.45 5000J8499HYDROB Hydrocodone/Acetaminophen 7.5mg/15mLs 43.30 OPLAB72156 MRI SPI CANAL&CNTS C-/C+ CRV 2475.06 500096415 CHEMOTHERAPY ADMN IV INFUSION TQ EA HR 342.70 5000J8499CYM Cymbalta (Duloxetine Hydrochloride) 30 MG 2.10 OPLAB74160 CT ABD C+ MATRL 1938.98 OPLAB84207 ASSAY OF PYRIDOXAL PHOSPHATE 156.10 5000J3490TRANE Tranexamic Acid (Cyklokapron) 1000 mg/10 mL; inj 278.70 500095813 ELECTROENCEPHALOGRAM EXTND MNTR >1 HR 4551.90 500095816 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY 4092.80 500095800 SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME 1909.80 500084133 POTASSIUM URINE 47.90 5000G0379 Direct admission of patient for hospital observation care 950.00 OPLAB72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL 2214.06 5000J8499NICOGUM2 Nicotine Gum; 2 MG 2.01 500087535 IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ 389.90 5000J8499SERO Seroquel (Quetiapine) 25 MG; tab 4.66 5000J8499SERO100 Seroquel (Quetiapine) 100 MG; tab 46.20 5000J8499TERA Terazosin 1 MG; cap 11.98 5000J8499GLIM Glimepriride (Amaryl) 2 MG; tab 1.36 OPLAB82570 CREATININE OTHER SOURCE 36.74 5000J8499ZOF Zofran (Ondansetron) 8 MG; tab 4.00 OPLAB76775 US RPR B-SCAN&/R-T IMG LMTD 682.06 5000J8499NIFE Nifedipine (Procardia) 30 MG; tab 4.02 5000J8499LOSAR25 Losartan Potassium 25 MG; tab 21.73 5000J8499LIDOC LIDOCAINE 10ML ORAL(GI) 56.19 500084140 PREGNENOLONE 229.70 500083655 ASSAY OF LEAD 134.50 500082300 CADMIUM 257.20 500083825 ASSAY OF MERCURY QUANTITATIVE 180.60 OPLAB82533 Cortisol; total (Random) 115.69 OPLAB83516 IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP 81.88 5000J8499SORB Sorbitol 70% solution, 30 mL PO 2.70 5000J8499FLUPRO Fluoxetine (Prozac) 10 MG; tab 7.63 5000J8499PRAZ Prazosin (Minipress) 1 MG; tab 2.56 5000J8499MELA3 Melatonin 3 MG; tab 0.07 5000J8499MELA5 Melatonin 5 MG; tab 0.08 5000J2315VIVIT Vivitrol 380 mg; IM 3220.14 5000J8499TYL TYLENOL 450MG 106.08 5000J8499TYLC TYLENOL W/ CODIENE 53.04 OPLAB93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY 3120.75 5000J8499IB IBUPROFEN UP TO 600 MG(MOTRIN/ADVIL) 10.21 500085670 THROMBIN TIME PLASMA 81.88 5000J8499 MAL MAALOX 30 ML (MYLANTA) 48.22 OPLABA9575DOT15 Dotarem Contrast 15 mL vial 145.85 500027265 CLTX POST HIP ARTHRP DISLC W/O ANES 4582.10 500090847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS 1184.60 5000J8499SUMA Sumatriptan (Imitrex) 50 MG; PO 11.43 5000J8499CLIN Clindamycin 300mg tab 11.16 5000J8499BENTYL BENTYL –DICYCLOMINE HCL 10MG TABLET 1.60 5000J8499VIS Vistaril (Hydroxyzine) tab per 25mg 39.49 OPLAB72157 MRI SPI CANAL&CNTS C-/C+ 2099.70 5000J8499TIZ Tizanidine 4 mg PO; tab 1.95 5000J8499ADD Adderall 20 mg; PO 8.65 5000J8499SODBIC Sodium Bicarbonate 650 MG; tab 0.17 OPLAB70482 CT ORBIT SELLA/POST FOSSA/EAR C-/C+ 2052.26 5000J8499LYR Lyrica (Pregabalin) 50 mg; PO 1.40 OPLAB36410 NON-ROUTINE BLOOD DRAW 3/> YRS 61.58 500046600 ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD 468.20 OPLAB43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 216.70 OPLAB86777 ANTIBODY TOXOPLASMA 71.95 5000J8499KDUR K-DUR PER 20 meq/1500 mg; PO 2.39 500070543 MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL 4408.40 OPLAB97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS 125.00 5000J3490VALACINJ Valproic Acid/Depacon (Valproate Sodium) Inj 100 mg 27.60 500087220 TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT 42.70 5000A6250DICL Diclofenac Sodium 1%; ointment 118.50 OPLAB76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED 595.42 OPLAB90471 IMADM PRQ ID SUBQ/IM NJXS 1 VACC 131.71 OPLAB90715 TDAP VACCINE 7 YR + IM 111.65 OPLAB29540 STRAPPING ANKLE &/FOOT 166.18 OPLABA6450 ACE WRAP - LT COMPRES BAND >=5 13.26 5000J3490DOXY Doxycycline 100 mg IV 308.10 5000U0001 2019 - nCoV diagnostic P 450.00 500099157 MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS 751.41 500090732 PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE 280.00 500087581 IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ 216.65 5000G2012 Brief check in by md/qhp 148.60 500080354 DRUG SCREENING FENTANYL 400.00 500080359 DRUG SCREENING METHYLENEDIOXYAMPHETAMINES 400.00 500080361 DRUG SCREENING OPIATES 1 OR MORE 400.00 5000PROTMED PROTONIX - PANTROPRAZOLE 40MG - Medicare 177.77 500083663 FETAL LUNG MATURITY FLUORESCENCE POLARIZATION 189.10 500083664 FETAL LUNG MATURITY LAMELLAR BODY DENSITY 193.20 OPLAB83664 FETAL LUNG MATURITY LAMELLAR BODY DENSITY 96.60 500084078 ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE 82.60 500084160 PROTEIN TOTAL REFRACTOMETRY ANY SRC 56.10 OPLAB84160 PROTEIN TOTAL REFRACTOMETRY ANY SRC 28.05 500081020 URINALYSIS 2/3 GLASS TEST 47.00 500084583 ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE 60.50 500085008 BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT 34.30 OPLAB85008 BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT 17.15 5000G0483 Drug test def 22+ classes 450.00 OPLAB36573 INSERTION PICC W/RS&I 5 YR/> 1631.13 OPLABU0002 COVID-19 lab test non-CDC 200.00 500086328 IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19 450.00 5000J8499METHYL Methylphenidate (Ritalin) 5 mg; tab 3.40 5000J8499GLUCE Glucerna 35.00 5000J2185MERO Meropenem (Merrem) 1 GM; vial 126.73 50087635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ 450.00 5000J8499MOTR8 MOTRIN 800 MG TABLET 6.04 5000J8499MOTMED MOTRIN 800 MG TABLET - Medicare 6.04 5000J8499TYLMED TYLENOL UP TO 1GM (1000MG) - Medicare 3.25 5000J8499ONDMED ONDANSETRON 4 MG - Medicare 21.44 5000S5520 Hit picc insert kit 200.00 500049585 RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE 5165.30 500071552 MRI CHEST W/O & W/CONTRAST MATERIAL 6266.20 500099080 Returned Item Fee 25.00 OPLAB87341 IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION 51.65 OPLABC1751 Cath, inf, per/cent/midline 100.00 5000J8499ACAMP Acamprosate Calcium 333 mg; PO 9.87 OPLAB86677 Antibody; Helicobacter pylori 119.36 500099408 ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN 381.60 OPLAB83718 LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL 58.19 OPLAB36400 VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN 108.45 500086780 ANTIBODY TREPONEMA PALLIDUM 132.40 500087426 IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS (COVID-19) 450.00 OPLAB87426 IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS (COVID-19) 200.00 500090472 IMMUNIZATION ADMIN EACH ADD 164.22 500074283 THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ 2815.90 OPLAB86406 PARTICLE AGGLUTINATION TITER EACH ANTIBODY 53.20 OPLAB86300 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 147.77 500080195 DRUG SCREEN QUANTITATIVE SIROLIMUS 137.30 OPLAB90675 RABIES VACCINE INTRAMUSCULAR 1873.60 OPLAB70546 MRA HEAD W/O & W/CONTRAST MATERIAL 2102.85 500084432 ASSAY OF THYROGLOBULIN 160.60 OPLAB84432 ASSAY OF THYROGLOBULIN 80.30 5000J8499METAM Metamucil 3.4 gm packet 4.10 500041007 INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE 2667.10 500011421 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM 1255.00 500090682 RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM 0.5 mL (18 years or older) 536.13 500090688 IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE 5 mL (6 mths or older) 536.10 500076513 OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM 1130.80 500090375 RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ 3867.32 5000J8499EZET Ezetimibe (Zetia) 10 mg; PO 3.86 5000J3490BUME Bumetanide (Bumex) 1mg; IV 26.20 5000J8499GEM Gemfibrozil 600 mg tab; PO 24.30 500087254 VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA 195.60 500090756 CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE 176.88 5000J8499HYDO Hycodan Syrup 5 mL 80.50 OPLAB36589 RMVL TUN CVC W/O SUBQ PORT/PMP 787.75 OPLAB74174 CT ANGIO ABD&PELV W/ O&W / DYE 1684.11 OPLAB73706 CT ANGIOGRAPHY LOWER EXTREMITY 2286.60 5000J8499DIGO Digoxin 0.125 mg; PO 24.42 500092953 TEMPORARY TRANSCUTANEOUS PACING 11.30 5000J3490REM Remdesivir (Veklury) 100 mg vial 5200.00 OPLAB87582 IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION 151.31 5000M0243 Casirivimab, Imdevimab incl. infusion post admin monitoring 1548.00 500092542 POSITIONAL NYSTAGMUS TEST 336.90 500042000 DRAINAGE ABSCESS PALATE UVULA 1201.30 5000A6250BENA Benadryl Topical Cream 15.10 5000J3490PYTH Phytonadione (Vitamin K), per 1 MG; inj 0.00 OPLAB70488 CT MAXLFCL AREA C-/C+ 1470.45 5000FENTPTCH Fentanyl Patch 12 mcg 269.30 OPLAB76815 US PREGNANT UTERUS LIMITED 1/> FETUSES 569.22 5000J8499ASPCHW ASPIRIN 81MG TAB ADULT CHEWABLE 6.84 500083020 HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS 128.70 500080186 DRUG SCREEN QUANTITATIVE PHENYTOIN FREE 137.60 OPLAB72126 CT CRV SPI C+ MATRL 1799.81 OPLAB72129 CT THRC SPI C+ MATRL 1799.81 500082397 CHEMILUMINESCENT ASSAY 141.20 500083695 ASSAY OF LIPOPROTEIN(A) 143.20 500084244 ASSAY OF RENIN 219.90 500087637 IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ 750.00 5000J8499METHAD Methadone Hydrochloride 10 mg; tab 3.17 5000J0875 Dalvance (Dalbavancin) 500 mg; injection 3657.38 5000J3490BUPSUB Sublocade (Buprenorphine) 300 mg (SQ/IV) 1741.94 500086331 IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY 119.80 500086609 ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED 128.80 5000L3540 Orthopedic shoe addition, sole, full 555.20 5000RECOINTRA Recothrom Intranasal 756.40 OPLAB86304 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 147.78 OPLABM0243 Casirivimab, Imdevimab incl. infusion post admin monitoring 774.00 500085732 THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA 64.70 5000J8499NORTRI Nortriptyline 25 mg; PO 1.70 500087636 IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ 750.00 OPLAB87637 IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ 375.00 OPLAB86780 ANTIBODY TREPONEMA PALLIDUM 66.20 OPLABJ1100 DECADRON - DEXAMETHASONE SODIUM PHOS 16.27 5000A9150ZI Zicam 12.08 5EXPMETLAC12 Explosive MetLac 12 0.00 500085048 AUTOMATED LEUKOCYTE COUNT 41.78 5000J1720 Inj, hydrocortisone sodium succinate, up to 100 mg 119.19 500093976 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT 2208.28 500086720 Antibody: Leptospira 134.52 500082951 GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS 211.67 500024615 OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION 9731.12 500083002 GONADOTROPIN LUTEINIZING HORMONE 304.53 500083001 Gonadotropin; follicle stimulating hormone (FSH) 305.62 500080305 DRUG TEST PRSMV QUAL DIR OPTICAL OBS PER DAY 345.32 500099151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 664.75 500080307 DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS 701.52 500011010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS 3727.50 500025607 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP 9585.60 6000BENZCAPS Benzonatate Capsules, per 100mg 10.58 500087810 CHYLMD TRACH ASSAY W/OPTIC (Urine) 189.06 5000J8499AUG Augmentin 875 tab 15.09 500086341 ISLET CELL ANTIBODY 272.90 500082670 ASSAY OF ESTRADIOL 220.34 5000J8499ELIQ ELIQUIS (APIXABAN) PER 5 MG 110.17 500087633 IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET 1000.00 500082672 ASSAY OF ESTROGENS TOTAL 68.94 500057415 REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL 2078.40 500073706 CT ANGIOGRAPHY LOWER EXTREMITY 4573.21 5000J3490VERAP VERAPAMIL HYDROCHLORIDE IV, 2.5 mg/mL 382.95 500086664 ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA 241.27 500086665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA 143.12 500086645 ANTIBODY CYTOMEGALOVIRUS CMV IGM 64.52 5EXPLUPUSPAN Explosive Lupus Panel 0.00 500088262 CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING 1966.27 500036410 NON-ROUTINE BLOOD DRAW 3/> YRS 123.17 500093225 XTRNL ECG & 48 HR RECORDING 266.00 500087255 GENET VIRUS ISOLATE HSV 534.18 5000PORTAKIT PowerLoc Port Access Ysite Kit 147.78 5000KATZEXT KATZ EXTRACTOR 1224.64 500084425 Thiamine (Vitamin B-1) 107.18 5000J0702 Betamethasone Sodium Phosphate & Acetate 5mL 550.28 5000LIDOPRILO LIDOCAINE WITH PRILOCAINE 2.5/2.5 30 GRAM TUBE 135.13 500086611 Antibody; Bartonella 129.03 500024576 CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ 3953.13 500017340 CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE 638.25 500090700 DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM 48.37 5000J1110 DIHYDROERGOTAMINE MESYLATE (D.H.E 45) INJ, PER 1MG 127.24 500086157 COLD AGGLUTININ TITER 63.60 5000AMPINJ Ampicillin 250mg Injection 25.65 5000J3105 Terbutaline Sulfate, injection, up to 1mg 62.10 5000S4990 NICODERM, Nicotine Patch 37.26 5000TRANACID Tranexamic Acid, 100 mg inj 17.54 500074018 RADEX ABD 1 VIEW 352.36 5000072083 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW 485.30 5000074450 URETHROCYSTOGRAPHY RETROGRADE RS&I 107.81 5000082365 Calculus; infrared spectroscopy 101.72 5000087449 IAAD IA MULT STEP METHOD NOS EACH ORGANISM 85.10 OPLABL0001 Blood Culture Pedi 198.89 OPLAB36415 VENIPUNCTURE 20.37 OPLAB36416 CAPILLARY BLOOD DRAW 30.94 OPLAB70100 RADEX MNDBL PRTL LESS THAN < 4 VIEWS 265.86 OPLAB70328 RADEX TMPRMAND JT OPN&CLSD MOUTH UNI 265.86 OPLAB71046 RADEX CHEST 2 VIEWS 196.88 OPLAB71110 RADEX RIBS BI 3 VIEWS 386.29 OPLAB71120 RADEX STERNUM MINIMUM 2 VIEWS 193.15 OPLAB72080 X RAY EXAM TRUNK SPINE 2VWS 167.84 OPLAB72120 RADEX SPI LUMBOSAC BENDING MINIMUM 4 VIEWS 419.88 OPLAB72190 RADEX PELVIS COMPL MINIMUM 3 VIEWS 328.92 OPLAB73010 RADEX SCAPULA COMPL 244.28 OPLAB73030 RADEX SHO COMPL MINIMUM 2 VIEWS 295.62 OPLAB73060 RADEX HUM MINIMUM 2 VIEWS 278.45 OPLAB73092 RADEX UXTR INFT MINIMUM 2 VIEWS 190.89 OPLAB73140 RADEX Fingers MINIMUM 2 VIEWS 269.61 OPLAB73520 (DELETED 1/1/16) RADEX HIPS BI 2 VIEWS ANTEROPOST PELVIS 384.51 OPLAB73551 X-RAY EXAM OF FEMUR 1V 185.59 OPLAB73552 RADEX, Femur; 2V 719.29 OPLAB73590 RADEX TIBFIB 2 VIEWS 287.97 OPLAB73592 RADEX LXTR INFT MINIMUM 2 VIEWS 226.07 OPLAB73610 RADEX ANKLE COMPL MINIMUM 3 VIEWS 367.08 OPLAB73650 RADEX CALCANEUS MINIMUM 2 VIEWS 243.09 OPLAB74450 URETHROCYSTOGRAPHY RETROGRADE RS&I 107.81 OPLAB80048 BASIC METABOLIC PANEL CALCIUM TOTAL 204.19 OPLAB80185 ASSAY OF PHENYTOIN TOTAL 109.04 OPLAB80300 Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) 174.13 OPLAB80339 Antiepileptics, not otherwise specified; 1-3 169.87 OPLAB81001 URINALYSIS - URNLS DIP STICK/TABLET RGNT AUTO MIC 58.66 OPLAB82150 AMYLASE 159.11 OPLAB82190 ATOMIC ABSRPJ SPECTROSCOPY EA ANAL 93.30 OPLAB82272 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC 88.39 OPLAB82375 Carboxyhemoglobin; quantitative 101.32 OPLAB82435 CHLORIDE BLD 48.53 OPLAB82540 CREATINE 51.72 OPLAB82541 COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE 91.44 OPLAB82627 Dehydroepiandrosterone-sulfate (DHEA-S) 182.87 OPLAB82657 NZM ACTV CELLS/TISS NONRADACT SUBSTRATE EA 112.31 OPLAB82746 Folic Acid: Serum 120.93 OPLAB82941 ASSAY OF GASTRIN 145.02 OPLAB82977 GGT - GLUTAMYLTRASE GAMMA 58.49 OPLAB83001 Gonadotropin; follicle stimulating hormone (FSH) 152.81 OPLAB83874 MYOGLOBIN 129.95 OPLAB84075 Phosphatase, alkaline; 25.76 OPLAB84110 ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE 66.59 OPLAB84132 POTASSIUM SERUM PLASMA/WHOLE BLOOD 98.60 OPLAB84134 Prealbumin 69.44 OPLAB84145 Procalcitonin (PCT) 220.31 OPLAB84155 PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD 22.09 OPLAB84403 Testosterone; total 212.34 OPLAB84436 Thyroxine; total 62.09 OPLAB84460 TRANSFERASE ALANINE AMINO 101.23 OPLAB84466 ASSAY OF TRANSFERRIN 90.62 OPLAB84484 TROPONIN QUAN 198.89 OPLAB84512 TROPONIN QUAL 116.91 OPLAB84702 GONAD CHORNC QUAN 158.10 OPLAB85384 Fibrinogen: Activity 69.85 OPLAB86038 Antinuclear antibodies (ANA) 109.39 OPLAB86157 COLD AGGLUTININ TITER 63.60 OPLAB86308 MONO - HTROPHL ANTIBODIES SCR 80.30 OPLAB86343 LEUKOCYTE HISTAMINE RELEASE TEST LHR 98.27 OPLAB86376 MICROSOMAL ANTIBODIES EACH 119.67 OPLAB86431 RHEUMATOID FACTOR QUANTITATIVE 46.67 OPLAB86592 SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL 26.57 OPLAB86611 Antibody; Bartonella 64.52 OPLAB86663 ANTB EPSTEIN-BARR EB VIRUS EARLY AG EA 186.02 OPLAB86664 ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA 120.64 OPLAB86668 Antibody; Francisella tularensis 85.55 OPLAB86701 ANTB HIV-1 109.61 OPLAB86708 HEPATITIS A ANTIBODY HAAB 101.86 OPLAB86720 Antibody: Leptospira 67.25 OPLAB86789 ANTIBODY WEST NILE VIRUS 113.51 OPLAB86790 ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED 64.52 OPLAB86800 THYROGLOBULIN ANTIBODY 125.47 OPLAB86812 HLA typing; A, B, or C (eg, A10, B7, B27), single antigen 203.55 OPLAB86900 Blood typing, serologic; ABO 24.58 OPLAB86901 BLD TYPING RH D 65.23 OPLAB87040 BLOOD CULTURE - CUL BACT BLD AERC ISOL 198.89 OPLAB87075 CUL BACT BLD ANAERC ISOL 216.57 OPLAB87102 CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD 69.13 OPLAB87110 CUL CHLAMYDIA ANY SRC 196.20 OPLAB87252 VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT 205.62 OPLAB87274 HERPES SIMPLEX 1 AG 57.50 OPLAB87280 Infectious agent antigen detection by immunofluorescent tech... 75.10 OPLAB87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe technique 158.59 OPLAB87493 INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE 149.39 OPLAB87498 IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP 276.81 OPLAB87590 IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ 164.94 OPLAB87798 IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM 180.50 OPLAB87802 IAADIADOO STREPTOCOCCUS GROUP B 94.53 OPLAB87803 CLOSTRIDIUM TOXIN A W/OPTIC 108.42 OPLAB89060 CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID 58.87 OPLAB89220 SPTM OBTG SPEC AERSL INDUCED SPX 73.81 OPLABG0479 Drug test presump optical (DO NOT USE. DELETED 01/01/2017) 68.59 500085345 COAGULATION TIME LEE AND WHITE 61.18 OPLAB74177 Ct Abdomen&pelvis W/contrast 1944.70 500094660 CPAP VENTILATION CPAP INITIATION&MGMT 499.56 5000COUMA WARFARIN SODIUM, COUMADIN 10MG TAB 4.03 500080330 DRUG SCREEN ANALGESICS NON-OPIOID 3-5 398.51 500093306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D 2721.82 500080069 RENAL FUNCTION PANEL 123.28 500080081 OBSTETRIC PANEL 1062.83 500086300 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 295.55 500083718 LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL 116.38 500087502 INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES 1208.19 500084156 PROTEIN TOTAL XCPT REFRACTOMETRY URINE 52.10 500082570 CREATININE OTHER SOURCE 73.49 500084300 ASSAY OF URINE SODIUM 69.00 500083873 MYELIN BASIC PROTEIN CEREBROSPINAL FLUID 244.26 OPLAB96375 iV PUSH ADD DRUG THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG 153.81 500093018 CV STRS TST XERS&/OR RX CONT ECG I&R ONLY 191.02 OPLAB74178 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE 2287.70 500093350 ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST 2470.32 500085306 CLOTTING INHIBITORS PROTEIN S FREE 217.58 500086147 CARDIOLIPIN ANTIBODY EACH IG CLASS 361.33 5000MIRALAX MiraLAX Powder Polythylene Glycol 17 GM 15.41 OPLAB81241 F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT 421.88 500084154 ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE 235.06 OPLAB85379 FIBRIN DGRADJ PRODUXS D-DIMER QUAN 238.92 OPLAB76536 US SOFT TISS HEAD&NCK R-T IMG 755.83 5000CEPAC Cepacol (Benzocaine) PO 2.83 OPLAB71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST 2250.54 OPLAB76856 US PELVIC NONOB REAL-TIME IMG COMPLETE 682.07 OPLAB70547 MRA NCK C-MATRL 2099.69 OPLAB76830 US TRVG 547.24 5000J8499GABA Gabapentin 300mg; cap 5.34 5000J8499LAMO Lamotrigine (Lamictal) 100mg; tab 3.54 5000J8499XAR Xarelto (Rivaroxaban) 10 mg; tab 23.59 5000J8499HYDPLA Hydroxychloroquine (Plaquenil) 200 mg; tab 10.60 500064505 INJECTION ANES AGENT SPHENOPALATINE GANGLION 1068.60 5000J8499NALT50 Naltrexone Hydrochloride 50 mg; tab 6.10 5000J8499FOLIC Folic Acid 1mg; tab 0.16 5000J8499CITA Citalopram Hydrobromide 20 mg; tab 0.30 5000J8499MIRT Mirtazapine 15 mg; tab 0.40 5000J8499LITH Lithium Carbonate ER 450 mg; tab 2.00 500086635 ANTIBODY COCCIDIOIDES 127.50 500086003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 58.00 OPLAB86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 29.00 500072197 MRI PELVIS W/O & W/CONTRAST MATERIAL 4481.00 5000MAGOXIDE MAGNESIUM OXIDE 400mg PO 3.45 5000J8499CLOTR Clotrimazole (Canesten) Cream 1% 20.50 5001J1956750 LEVAQUIN 750MG IVPB 78.81 500086753 ANTIBODY PROTOZOA NES 137.60 500087640 IADNA S AUREUS AMPLIFIED PROBE TQ 38.99 500087582 IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION 302.62 500087651 IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ 43.33 500086481 TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP 1000.00 500036012 SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC 1999.40 500036223 SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART 3635.80 500036245 SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH 2736.90 500037191 INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I 2582.00 500037228 REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI 6265.80 500037229 REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL 8148.90 500037232 REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL 2319.60 500042400 BIOPSY SALIVARY GLAND NEEDLE 617.70 500082747 ASSAY OF FOLIC ACID RBC 192.50 500011043 DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< 1769.90 500015274 APP SKN SUB GRFT T/A/L AREA>/=100SCM ADL 100SQCM 527.40 500020526 INJECTION THERAPEUTIC CARPAL TUNNEL 659.60 500020937 AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION 1931.10 OPLAB82747 ASSAY OF FOLIC ACID RBC 96.25 5000J8499HYDRA Hydralazine Hydrochloride (Apresoline) 25 MG; tab 0.72 500022614 ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL 4513.10 500022633 ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR 21299.60 500022846 ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS 8749.00 500028020 ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT 4144.40 500028035 RELEASE TARSAL TUNNEL 4086.90 500028230 TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX 3257.70 500029893 ENDOSCOPIC PLANTAR FASCIOTOMY 4919.40 500038220 DIAGNOSTIC BONE MARROW ASPIRATIONS 791.90 500062273 INJECTION EPIDURAL BLOOD/CLOT PATCH 1300.00 500062291 INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC 1854.50 500063045 LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL 14770.90 500063048 LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR 2438.30 500063650 PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL 4711.90 OPLAB84588 ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE 188.55 500064490 NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL 1208.30 500064491 NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL 686.00 500064494 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL 594.20 500083013 HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE 748.40 500064605 DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH 4007.10 500064616 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA 1256.30 500064633 DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA 2564.90 500064636 DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL 682.30 500064643 CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE 825.40 500064712 NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV 6668.40 500077002 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON 1140.10 500086905 BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH 42.50 500087106 CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST 114.70 500096152 HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV 220.00 500098943 CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGION 267.50 500099214 OFFICE OUTPATIENT VISIT 25 MINUTES 886.30 500099215 OFFICE OUTPATIENT VISIT 40 MINUTES 1249.30 500049405 IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ 1104.05 500050389 RMVL NFROS TUBE REQ FLUORO GUIDANCE 622.10 500064410 INJECTION ANESTHETIC AGENT PHRENIC NERVE 958.60 500075625 AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I 1485.30 500058301 REMOVAL INTRAUTERINE DEVICE IUD 760.60 500075827 VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I 1521.20 500075831 VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I 1530.40 5000J3490HYDRO Hydrocortisone Cream 2.5% - Topical 22.40 500083835 ASSAY OF METANEPHRINES 188.20 500037238 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST 3503.40 500060300 ASPIRATION AND/OR INJECTION THYROID CYST 573.50 5000J8499MET METHIMAZOLE (TAPAZOLE) TAB 5MG 1.70 500096416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 1584.40 500087536 IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION 945.50 5000J8499QUET Quetiapine 25 mg tab 0.46 5000J8499BUSP Buspirone 5 mg; tab 10.70 500095812 ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN 3662.80 500095801 SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL 1025.20 OPLAB76770 US RETROPERITONEAL R-T W/IMAGE COMPL 631.24 OPLAB72193 CT PELVIS C+ MATRL 1388.60 5000J8499ABIL Aripiprazole (Abilify) 10 MG 2.83 500084540 ASSAY OF UREA NITROGEN URINE 55.60 5000J1817 Insulin for administration through dme (i.e., insulin pump) per 50 units 18.58 OPLAB70544 MRA HEAD C-MATRL 2386.66 5000J8499ZYRLIQ Cetirizine Hydrochloride (Zyrtec Liquid) 5 mL 3.10 OPLAB84156 PROTEIN TOTAL XCPT REFRACTOMETRY URINE 26.05 5000J8499LINE Linezolid (Zyvox) 600 MG; Tab 43.53 5000J3490TRIAM30 Triamcinolone Acetonide (Kenalog) Topical 0.1% 30 GM 35.20 500082671 ASSAY OF ESTROGENS FRACTIONATED 358.90 OPLAB84140 PREGNENOLONE 114.85 OPLAB82671 ASSAY OF ESTROGENS FRACTIONATED 179.45 OPLAB82175 ASSAY OF ARSENIC 105.40 OPLAB83655 ASSAY OF LEAD 67.25 OPLAB82300 CADMIUM 128.60 OPLAB95806 SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT 777.70 5000J8499ISOMON Isosorbide Mononitrate (Imdur) 30 MG; tab 1.14 5000J8499TYL3 TYLENOL 1000MG 3.25 5000J8499TYL4 TYLENOL 500MG 114.92 5000J3490FOLACD FOLIC ACID, 1mg/mL, injection 51.20 500000295T XTRNL ECG & MORE THAN 48 HR RECORD SCAN STOR W/R&I 1831.60 50000296T XTRNL ECG & MORE THAN 48 HR INITIAL RECORDING AND CONNECT 532.00 50000298T XTRNL ECG CONTINUOUS RHYTHM W/I&R MORE THAN 48 HRS 549.00 500085307 ACTIVATED PROTEIN C APC RESISTANCE ASSAY 170.30 500025650 CLOSED TREATMENT ULNAR STYLOID FRACTURE 3409.30 500099407 TOBACCO USE CESSATION INTENSIVE >10 MINUTES 334.88 500084630 ASSAY OF ZINC 126.50 OPLABQ9967350 Omnipaque 350mg/ml per-1ml 0.66 500043763 PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC 958.70 500043762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 433.40 500036430 TRANSFUSION BLOOD/BLOOD COMPONENTS 393.90 500086920 COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE 238.30 5000J8499FLEACE Flecainide Acetate (Tombocor) 50 MG; tab 67.80 OPLAB32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING 642.25 5000J8499VALS Valsartan 40 mg PO 108.00 5000J8499DILHCL Diltiazem HCL 120 mg PO 9.17 5000A9576 Prohance Gadoteridol 279.3 mg/mL; injection vial 5 mL 120.00 500086738 ANTIBODY MYCOPLSM 132.40 500090674 CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE 176.88 OPLAB76801 ULTRASOUND 14 WK TABDL 1/1ST GESTATION 969.56 OPLAB83090 ASSAY OF HOMOCYSTEINE 89.60 OPLAB72192 CT PELVIS C-MATRL 2104.68 OPLAB36000 INTRO NDL/INTRACATH VEIN 185.62 500082103 ALPHA-1-ANTITRYPSIN TOTAL 134.40 OPLABA9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml 11.91 500086777 ANTIBODY TOXOPLASMA 143.90 500082693 ASSAY OF ETHYLENE GLYCOL 149.00 500087899 IAADIADOO NOT OTHERWISE SPECIFIED 184.81 5000J8499PROME Promethazine Hcl + Codeine (Phenergan w/ Codeine) 10-6.25 mg/5 mL; Syrup 1896.40 5000J8499MIRA Mirabegron (Myrbetriq) 50 mg; PO 158.00 5000J8499NABU Nabumetone 750 mg; PO 3.00 5000A6250HYDRO Hydrocortisone Cream 2.5% - Topical 22.40 5000J8499STOSFT Stool Softener 50 mg; tab 0.24 500087809 INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS 217.60 5000J8499PRO PROPARACAINE 26.53 5000J8499SULFA Sulfamethoxazole + Trimethoprim 800-160mg PO 4.42 OPLAB76817 US PG UTER R-T IMG TRVG 682.06 5000J8499AFRIN AFRIN NASAL SPRAY 70.18 5000J8499POLY (Polytrim) Polymyxin B Sulfate / Trimethoprim 1.21 OPLABE0114 CRUTCH ALUM ADLT ADJ 53.89 5000A9999 Bronchoscope Disposable 1200.00 5000U0002 COVID-19 lab test non-CDC 450.00 500099155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS 1256.26 5000J8499NAC NAC N-Acetyl-L-Cysteine 900 mg 1.80 500087635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ 450.00 5000J8499MEDR Medroxyprogesterone Acetate (Provera) 20 mg; PO 16.40 500080347 DRUG SCREENING BENZODIAZEPINES 13 OR MORE 400.00 500080353 DRUG SCREENING COCAINE 400.00 500080373 DRUG SCREENING TRAMADOL 400.00 5000J8499PRIS Pristiq (Desvenlafaxine) 50 mg; PO 4.00 OPLAB84078 ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE 41.30 500081005 URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS 21.70 OPLAB84578 ASSAY OF UROBILINOGEN URINE QUALITATIVE 22.35 OPLAB84580 UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN 47.75 OPLAB85004 BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT 32.35 500085009 BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT 50.70 OPLAB36561 INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/> 1935.50 OPLAB86328 IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19 200.00 5000J8499ALLO Allopurinol 100 mg; PO 0.32 5000J8499SIME Simethicone 80 mg; chew tab 0.30 5000J8499MISO Misoprostol (Cytotec) 100 mcg; tab 6.70 5000J8499TUMS Antacid Tums 500 mg; chewable tablets 0.30 500097026 APPLICATION MODALITY 1/> AREAS INFRARED 150.00 500054700 I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE 2474.70 OPLAB76937 US GUIDE VASCULAR ACCESS 645.71 5000U0003 Infectious agent detection by nucleic acid (DNA or RNA); sev 350.00 500076706 US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA 1466.94 OPLAB73220 MRI UXTR OTH/THN JT C-/C+ 2475.06 OPLAB76706 US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA 733.47 5000J8499RIZA Rizatriptan (Maxalt ODT) 10 mg; PO 19.70 500099221 INITIAL HOSPITAL CARE/DAY 30 MINUTES 1155.10 5000J8499FENTNAS Fentanyl Citrate (Sublimaze) 100 mcg/2 mL; Nasal Spray 27.40 500087385 IAAD IA HISTOPLASM CAPSULATUM 132.50 500086406 PARTICLE AGGLUTINATION TITER EACH ANTIBODY 106.40 500088108 CYTP CONCENTRATION SMEARS & INTERPRETATION 704.00 500088112 CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V 764.60 OPLAB87581 IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ 108.33 500076380 CT LIMITED/LOCALIZED FOLLOW UP STUDY 1636.70 5000J8499METOZA Metolazone Zaroxolyn 2.5 mg; PO 4.90 5000J8499FER Ferrous Sulfate 325 mg; tab 2.50 500090702 DT VACCINE YOUNGER THAN 7 YRS FOR IM USE 500084181 PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID 170.30 500024675 CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ 4795.00 500090371 HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM 7909.10 5000J8499ESTR Estradiol (Estrace) 5 mg; PO 0.87 500087428 IAAD by immunoassay technique and influenza virus types A and B (COVID-19) 750.00 5000J2560 Phenobarbital Sodium 130 mg vial 597.70 OPLAB87400INF IAADIADOO INF 128.18 OPLAB87428 IAAD by immunoassay technique and influenza virus types A and B (COVID-19) 375.00 500090785 PSYCHOTHERAPY COMPLEX INTERACTIVE 148.90 OPLAB96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR 190.06 OPLAB96361 IV INFUSION HYDRATION EACH ADDITIONAL HOUR 176.79 OPLAB87542 IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION 23.20 5000J8499FOSF Fosfomycin (Monurol) 3 gm packet; PO 1121.30 5000J8499GRAN E-Z Gas Effervescent Granules; PO 33.47 OPLAB90473 IM ADM INTRANSL/ORAL 1 VACCINE 95.95 OPLAB93307 ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP 824.75 500076516 OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN 97.60 500083698 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 463.10 500082542 COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC 240.90 500083497 ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA 129.00 5000Q0245 Injection, bamlanivimab and etesevimab, 2100 mg 0.00 500082024 ADRENOCORTICOTROPIC HORMONE ACTH 386.20 OPLAB73702 CT LOWER EXTREMITY C-/C+ 2223.27 OPLAB83695 ASSAY OF LIPOPROTEIN(A) 71.60 OPLAB83698 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 231.55 5000J8499CLAR Clarithromycin (Biaxin) 500 mg; tab 9.74 500071271 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- 1692.90 OPLAB70540 MRI ORBIT FACE &/NECK W/O CONTRAST 1491.00 OPLAB84590 ASSAY OF VITAMIN A 58.05 5000MOXIFLO Moxifloxacin (Vigamox) 5 mg/mL; eye drops 242.50 500082785 ASSAY OF GAMMAGLOBULIN IGE 164.60 500086602 ANTIBODY ACTINOMYCES 101.80 500077072 BONE AGE STUDIES 289.70 5000J8499HYDRMORPH Hydromorphone Hydrochloride (Dilaudid) 2 mg; PO 0.74 500082595 CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE 64.70 500086141 C-reactive protein; high sensitivity (hsCRP) 234.04 5000A4216 STERILE WATER/SALINE, FLUSH 10 ML 5.30 400180468 IV CATH 20X1 SAF WNG PUR 13.75 400005444 SPONGE GAUZE 4X4X12P NS 29.56 6000IV0005 VACUTAINER 21 OR 23 GA 9.69 500071010 RADEX CH 1 VIEW FRNT 452.42 5000Q0177 Atarax (Hydroxine pamoate) up to 25mg PO 11.90 40061813 14" Knee Immobilizer 132.34 500090715 TDAP VACCINE 7 YR + IM 223.30 5000S0039 INJECTION, SULFAMETHOXAZOLE 59.55 5000S0081 INJECTION, PIPERACILLIN SODI 3.82 6000DA004 atropine opth 1.53 6000DC001 Cardene 20mg/200ml 730.80 6000DD007 Diazepam 10mg inj 16.47 6000DD008 Diazepam 5mg tab 11.16 6000DE001 Epinephrine 1:1000 ampule 28.90 6000DR001 Rantidine 150mg tab 2.94 6000002004 Lopermide Tab 7.97 60000FIOR FIORICET-BUTALBITAL TABLET 9.37 60000ZYRTEC ZYRTEC-CETIRIZINE 10MG TABLET 1.40 60000BENT10 Bentyl 10mg/ml (20mg) per dose 235.57 500096371 Subcutaneous infusion for therapy or prophylaxis 279.74 500096375 iV PUSH ADD DRUG THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG 307.61 6000IV0002 IV TUBING PRIMARY 67.70 5000A4213 20+ CC SYRINGE ONLY 10.58 5000A4221 Maint Drug Infus Cath Per Wk 213.76 5000A4244 ALCOHOL OR PEROXIDE PER PINT 7.06 5000A4246 BETADINE/PHISOHEX SOLUTION 38.15 5000A4252 GLUCOSE TEST STRIP - BLOOD KETONE TEST OR STRIP 9.14 5000A4313 CATHETER W/BAG 3-WAY 42.42 5000A4320 IRRIGATION TRAY 23.43 5000A4327 URINE CUP FEMALE COLLECT DEV CUP 5.30 5000A4351 STRAIGHT TIP URINE CATHETER 17.23 5000A4356 EXT URETH CLMP OR COMPR DVC 412.83 5000A4358 BAG - URINARY LEG OR ABDOMEN BAG 22.10 5000A4364 DERMABOND - ADHESIVE, LIQUID OR EQUAL PER OZ. 50.51 5000A4450 TAPE NON-WATERPROOF 15.86 5000A4452 TAPE WATERPROOF 15.86 5000A4616 TUBING (OXYGEN) PER FOOT 1.99 6000S0013 SCAPLEL BLADE #11 8.86 5000A4649 BOTT HYDROGEN PEROXIDE BOTTLE 21.22 5000A4649 BUDD BUDDY TAPE 15.86 5000A4649 IRR IRRIGATION BOTTLE 23.43 5000A4649 MON CARDIAC MONITOR 437.56 5000A4649 OXY OXYGEN MASK 32.53 5000A4649 SPEC SPECULUM 267.50 5000A4649CAT A4649CAT 238.67 5000A4649STR FLUOR-I-STRIP 21.39 5000A4670 AUTOMATIC BP MONITOR, DIAL 54.10 5000A4673 SALINE LOCK 21.22 5000A5120 SWAB OR WIPE SKIN BARRIER 8.86 5000A6205 COMPOSITE DRSG > 48 SQ IN 31.83 5000A6260 WOUND CLEANSER 150.27 5000A7520 TRACH/LARYN TUBE NON-CUFFED 56.13 5000Q4051 SPLINT SUPPLIES MISC 190.06 6000L0005 Specimen Container 13.49 5000TUBEHOLD Tube holder 3.39 5000A4314 CATH W/DRAINAGE 2-WAY LATEX 19.44 5000A4550 SURGICAL TRAY/LACERATION KIT 121.10 5000A4606 OXYGEN PROBE USED W OXIMETER 192.71 5000A6407 IODOFORM - PACKING STRIPS/GAUZE , NON-IMPREG 43.77 5000A6443 CONFORM BAND N/S W>=3 5.58 5000A6448 LT COMPRES BAND <3Ö/YD 17.34 5000A6450 ACE WRAP - LT COMPRES BAND >=5 26.53 5000A6457 TUBULAR DRESSING 62.05 5000A7002 SUCTION TUBING USED W PUMP 141.77 5000A7011 NONDISPOS CORRUGATED TUBING 19.44 5000A7015 NEBULIZER MASK USED W NEBULIZER 85.39 5000A7016 NEBULIZER DOME & MOUTHPIECE 35.35 400187326 AIRWAY ORAL KIT6/SET 35.94 400218316 CLD EMERALD CLEANER 960ML 1317.62 400218314 CLD DILUENT 10L EMERALD 1384.11 400284853 PIC PAPER THERMAL RESULTS 374.30 400096273 ALGER BRUSH COMPLETE 549.44 400075336 BURR ALGER .5MM NS 5/BX 49.89 400090258 C-COLLAR PEDI PERFIT 20/CS 1114.21 400105238 C-COLLAR SHORT PERFIT 20/CS 1114.21 400126193 FOLIC ACID 5MG 10ML 175.54 400218133 TUBE CHEST 28FR 10/CS 47.29 400012859 TUBE NASOGASTRIC SUMP 10FR 18.19 400026737 IV SET BC 25X3/4 12 7.18 400281007 TUBE HLDR BC 250/BX 0.26 400008530 TUBE BC MINI LAV EDTA 198.44 400007327 IV SET BC 21X3/4 12 8.04 400217347 TRIAGE TOTAL CAL/VER 5X2 523.86 400237376 FORCEP MAGILL CATH 10 100.49 400014856 SYRINGE BULB 1OZ ST 6.45 400026269 AIRWAY ORAL OROPHARYNGEAL SMEA 11.10 400265004 TENIVAC PF (TD) SYR 10X.5ML 1760.13 400225815 LUMBAR PUNC TRAY ADLT 20X3-1 133.30 400193024 VERRUCA-FREEZE CANIST 162ML 2096.45 400013832 FINGER COT MED PADDED 5.84 400010193 FINGER SPLINT MED CVD PADDED 5.38 400010195 FINGER SPLINT LG CVD PADDED 5.38 400010205 FINGER SPLINT FROG LG PADDED 8.23 400010214 FINGER SPLINT BASEBALL LG 6.51 400155338 FINGER SPLINT STRIP 3/4X18 6.51 400013496 CAST BOOT XS 36.60 400010343 CAST BOOT MED 34.48 400010452 SHOULDER IMMOB MED 31.15 400010477 CLAVICLE SPLINT LG 30.15 400009651 BANDAGE ADH GLITTER 3/4X3 30.68 400029919 BANDAGE ADH CHARLIE BRN 3/4 26.97 400027754 BANDAGE ADH BUGS&DAFFY 26.97 400008644 SUTURE 4-0 GUT CHR FS-2 2058.26 400010489 SUTURE 3-0 PROLENE PS-2 3438.25 400014461 SUTURE 3-0 VICRYL CTD PS-2 2609.68 400001450 SUTURE 4-0 VICRYL CTD P-3 945.13 400003883 SUTURE 5-0 VICRYL CTD PS-3 869.55 400036077 SUTURE 2-0 VICRYL CTD CT-1 1166.73 400084442 PACKING NASAL LG W/STRING 48.08 400085883 RACK TEST TUBE 16MM 60PL WHT 83.28 400270708 CLOROX GERMICIDAL CLNR 32OZ 81.42 400038147 LIDOCAINE 1% W/EPI 20ML 15.08 400246656 MANNITOL 25% 50ML VL 12.22 400166777 EPINEPHRINE 1:10MU 20G 1-1/2 42.10 400232365 CALCIUM CHL 10% L/S 10ML 59.85 400048676 QUELICIN 20MG/ML 10ML 94.91 400079270 EPINEPHRINE 1:1000 AMP 1ML 20.85 400198007 CLAFORAN 1GM 17.54 400203063 APLISOL 5TU PPD 50 TEST 5ML 1118.52 400258873 PITRESSIN 20U/ML VL 1ML 30.68 400001151 XEROFORM DRESS 5X9 FOIL 314.66 400217186 EMERGENCY OB KIT 57.65 400259253 GAS RELIEF INF DRP 30ML 18.33 400319145 CO2 DETECTOR PED 65.16 400049607 TOBRADEX OPH SOL 5ML 1042.22 400123713 CIPRODEX OTIC SUS 7.5ML 7.97 400074093 INTEGRILIN .75MG/ML 100ML VL 3354.37 400288196 PREDNISOLONE 15MG/5ML 240ML 79.29 400304159 Amiodarone Hydrochloride 50 mg/3 mL; VL 10/bx 30.02 400048711 NOVOLIN R INSLN 100U/ML 10ML 770.86 400063815 ACTIDOSE AQUA 25GM LIQ 120ML 136.41 400287885 LIDOCAINE 2% VISCOUS 15 mL 15.74 400314690 PROMETHAZINE 25MG TAB 100/BT 112.04 400048737 ACETAMINOPHEN 120MG SUPP12BXBX 44.30 400160719 MILK OF MAG SUS 480ML 15.48 400306245 CYCLOPENTOLATE 1% O/S 15ML 167.89 400237961 TETRACAINE .5% O/S 15ML 63.70 400310796 PROMETHAZINE 25MG AMP 1ML 11.29 400048799 AMMONIA INH AMP 10/BX 19.33 400288323 IBUPROFEN 600MG TABS 100/BT 52.46 400091169 INFUVITE MULT VIT VL 5X2X5ML 307.96 400272217 CLOPIDOGREL 75MG TABS 30/BT 47.15 400246623 METOPROLOL 25MG TABS 100/BT 22.05 400306277 FUROSEMIDE 20MG TABS 100/BT 13.28 400316673 CEPHALEXIN 500MG CAPS 100/BT 96.16 400303669 NEEDLE 23X1 TW 100/BX 33.34 400303677 SYRINGE 20CC LL 100/BX 208.14 400303679 SYRINGE 3CC LL 100/BX 48.48 400313496 SYRINGE 1CC 25X5/8 TB 100/BX 65.09 400303691 SYRINGE 1CC TB 100/BX 58.91 400296553 CRUTCH ALUM ADLT ADJ 107.79 400312212 DIPHENHYDRAMINE 25MG TAB 14.69 400294010 DISINFECTANT OPA/28 GL 237.22 400318515 UNDERPAD MCK LITE 23X36 11.36 400003953 LENSES MORGAN MEDI FLOW 218.57 400132068 SYRINGE TRI-PACK 50/BX 3440.11 400001000 ELECTRODE SNAP VNL 40MM RND 69.14 400113964 GELFOAM SZ12 7MM 12/BX 496.71 400011151 SILVADENE CRM 400GM 486.00 400052305 GAUZE CONFORM 2 14.48 400122846 MASK WITH EYESHIELD 25/BX 147.57 400053201 BANDAGE ELAS 4 63.35 400008770 TAPE PAPER 1 37.40 400012472 TAPE CLOTH/SILK 2 62.82 400011434 TAPE TRANS 2 59.97 400005984 HYDROGEN PEROX 3% 16OZ 12/CSCS 6.58 400211526 CAST SPLINT 2 427.03 400211529 CAST SPLINT 5 809.97 400038544 SPONGE GAUZE 4X4X12P ST2S 22.39 400281124 STOCKINETTE 4 87.73 400248684 FORCEP JANSEN DRESS 6.5 273.95 400169150 SPECULUM VAG GRAVES DISP SM 184.36 400121845 PACKING STRIP PLAIN 1 18.40 400121867 PACKING STRIP W/IODO 1 20.72 400099979 PAD NON-ADH 3X4 ST LTXFR 43.17 400010018 TONGUE BLADE ADULT ST 100/BX 22.39 400264220 BEDPAN FRACT DUSTY ROSE 34OZEA 11.10 400269246 ELECTRODE TAB ADGEL LG 100EA 45.63 400267307 NEEDLE 18X1.5 SAF PREVENT M 87.34 400041635 BANDAGE ADH FLEX 1X3 19.53 400223615 COLD PACK INSTANT 6X8.75 3.45 400172865 GLOVE SURG LTX 7 PF 40PR/BX 270.30 400226019 MASK OXYGEN ADLT NO-REBREATHEA 8.44 400226032 NEBULIZER PED MASK 7 TUBE 10.83 400239219 BANDAGE COHES 4 12.96 400224656 CRUTCH ALUM CHILD 8/CS 106.00 400161434 XRAY APRON/GLOVE RACK 1527.43 400236496 THIN FILM DRESS 6X8 204.36 400168461 BATTERY AAA ALK 24/BX 4.65 400054488 CURETTE EAR ROUND GRN 50/BX 15.41 400054487 CURETTE EAR OVAL WHT 50/BX 15.41 400133520 STEP STOOL W/O RAIL 9 275.75 400170657 WIPES BABY UNSCENTED 100/BX 26.43 400061799 ARMSLING LG 6/CS 18.40 400169275 CAST PAD 2 102.21 400195819 FORCEP FOERSTER SPONGE 9.5 163.58 400036832 DRAPE 18X26 FEN ST BLUE 111.78 400238396 BETAM PHOS/BETAM ACE 6MG 5ML 255.16 400108349 FORCEP HARTMAN EAR 3.5 242.80 400165932 RHINO ROCKET SLIM SM 8/BX 88.46 400018582 SKIN STAPLER FIXED PREM 35W 65.95 400004590 TRACH TUBE ENDO 4MM MUR NC 12.29 400001865 TRACH TUBE ENDO 8 MUR CUF 13.89 400013497 PEAK FLOW METER UNIV RANGE 58.39 400031876 CANNULA NASAL PED 7 TUBE 9.23 400128420 AIRWAY NASO 28FR ADJ FLNG 370.78 400121619 AIRWAY NASO 34FR ADJ FLNG 370.78 6000000927 ALCOHOL PREP LG ST 200/BX 1.40 6000S0011 Incision and Drain Tray 0.74 6000S0012 Steri Strip All Sizes 4.73 5000L0114 L0114 88.40 5000L0172 CERV COL THERMPLAS FOAM 2 PI 61.88 5000E0116 CRUTCH UNDERARM EACH NO WOOD 88.40 500036415 VENIPUNCTURE 40.73 500080076 HEPATC FUNCJ PANEL 430.05 500080162 ASSAY OF DIGOXIN 133.33 500082247 BILIRUBIN TOT 118.00 500082435 CHLORIDE BLD 97.07 500082540 CREATINE 103.43 500083690 LIPASE 221.00 500084075 Phosphatase, alkaline; 51.51 500084155 PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD 44.18 500084157 PROTEIN TOT XCPT REFRACTOMETRY OTH SRC 28.29 500084560 URIC ACID OTH SRC 207.37 500085018 BLD# HGB 154.33 500085025 CBC-BLD# COMPL AUTO HHRWP&AUTO DIFFIAL 309.38 500085347 COAGJ TM ACTIVATED 53.50 500086356 MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA 242.71 500086430 RHEUMATOID FACTOR QUAL 111.83 500086480 TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFER 240.44 500086631 ANTB CHLAMYDIA 197.23 500086689 ANTB HTLV/HIV ANTB CONFIRMATORY TST 325.29 500086850 ANTB SCR RBC EA SERUM TQ 287.29 500087045 CUL BACT STL AERC ISOL SALMONELLA&SHIGELLA 388.93 500087075 CUL BACT BLD ANAERC ISOL 433.15 500087205 Smear, primary source with interpretation; Gram or Giemsa st... 111.04 500087274 HERPES SIMPLEX 1 AG 114.99 500087420 IAAD EIA RSV 149.20 500087493 INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE 298.77 500089055 Leukocyte assessment 42.90 6000L0002 Blood Culture Adult 397.79 500085379 FIBRIN DGRADJ PRODUXS D-DIMER QUAN 477.86 500088141 Cytopathology, cervical or vaginal 340.99 500070100 RADEX MNDBL PRTL LESS THAN < 4 VIEWS 531.70 500070110 RADEX MNDBL COMPL MINIMUM 4 VIEWS 531.70 500070160 RADEX NSL B1S COMPL MINIMUM 3 VIEWS 354.82 500070200 RADEX ORBITS COMPLETE MINIMUM 4 VIEWS 544.10 500070360 RADEX OF NECK SOFT TISSUE 1033.87 500071101 RADEX RIBS UNI W/POSTEROANT CH 3 VIEWS 732.40 500072020 RADEX SPI 1 VIEW SPEC LVL 476.16 500072040 RADEX SPI CRV 2/3 VIEWS 622.59 500072080 X RAY EXAM TRUNK SPINE 2VWS 335.69 500072110 LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS 1202.18 500072120 RADEX SPI LUMBOSAC BENDING MINIMUM 4 VIEWS 839.75 500072190 RADEX PELVIS COMPL MINIMUM 3 VIEWS 657.83 500072220 RADEX SACRUM&COCCYX MINIMUM 2 VIEWS 429.95 500072255 MYELOGRAPY THRC RS&I 3976.91 500072265 MYELOGRAPY LUMBOSAC RS&I 4418.88 500073092 RADEX UXTR INFT MINIMUM 2 VIEWS 381.78 500073100 RADEX WRST 2 VIEWS 572.45 500073540 Radiologic examination, pelvis and hips, infant or child, mi... 228.26 500073600 RADEX ANKLE 2 VIEWS 354.82 500074241 RADEX GI TRC UPR +-DLYD FLMS W/KUB 1511.65 500074400 Urography (pyelography), intravenous, with or without KUB, w... 1837.01 5000Q9966 LOCM 200-299MG/ML IODINE,1ML 31.83 500074220 ESOPHOGRAM/ CONTRAST X-RAY ESOPHAGUS 662.34 500071022 RADEX CH 2 VIEWS FRNT&LAT OBLQ PRJCJ 660.74 500032551 TUBE THORACOSTOMY INCLUDES WATER SEAL 3408.85 500078075 ADRNL IMG CORTEX&/MEDULLA 5480.50 500078320 B1&/JT IMG TOMOG SPECT 1398.77 500070482 CT ORBIT SELLA/POST FOSSA/EAR C-/C+ 2954.52 500070486 CT SCAN MAXLFCL AREA C-MATRL - SINUS AREA 2909.50 500070491 CT SOFT TISS NCK C+ MATRL 3536.80 500072125 CT CRV SPI C-MATRL 3717.89 500072126 CT CRV SPI C+ MATRL 3599.63 500072132 CT LMBR SPI C+ MATRL 5513.78 500073701 CT LXTR C+ MATRL 7648.47 500074150 CT ABD C-MATRL 3298.12 500074175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST 4896.75 500074177 Ct Abdomen&pelvis W/contrast 3889.38 500074178 CT ABDOMEN & PELVIS W W/O CONTRST 1/> BODY RE 4575.39 500072191 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST 2287.22 500099149 M-SEDATION BY PHYS OTH/THN HC PROF PERFRMG 5+ 549.82 500076705 ULTRASOUND ABDOMINAL R-T W/IMAGE LIMITED 1556.39 500076770 US RETROPERITONEAL R-T W/IMAGE COMPL 1262.49 500076830 US TRVG 1094.49 500076881 US EXTREMITY NON-VASC REAL-TIME IMG COMPL 510.62 500076882 US EXTREMITY NON-VASC REAL-TIME IMG LMTD 330.17 5000S8037 MRCP - Magnetic resonance cholangiopancreatography 1944.70 500097116 Therapeutic procedure, 1 or more areas, each 15 minutes; gai... 190.87 500010121 INCISION&REMOVAL FOREIGN BODY SUBQ TISS COMP 1272.06 500011042 REMOVAL DAMAGED SKIN AND UNDERLYING TISSUE 388.93 500011200 REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA UP&W/15< 443.74 500012005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM 997.10 500012013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0CM 853.79 500012016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0CM 1831.93 500012031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< 2097.97 500012032 Repair, intermediate, wounds of scalp, axillae, trunk and/or... 2672.97 500012034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM 2840.33 500012042 REPAIR (LACERATION)INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM 2745.63 500012052 REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 2.6-5.0 CM 2798.09 500012053 REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 5.1-7.5 CM 2989.62 500013121 REPAIR COMPLEX SCALP/ARM/LEG 2.6 CM-7.5 CM 1872.74 500013131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1 CM-2.5 CM 1182.72 500013153 REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM/< 1013.01 500016000 INITIAL TX 1ST DEGREE BURN LOCAL TX 415.46 500016020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL 408.39 500016025 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM 501.19 500020600 Arthrocentesis, aspiration and/or injection; small joint or ... 954.66 500021315 CLOSED TX NASAL FRACTURE W/O STABILIZATION 10216.09 500021800 CLOSED TX RIB FRACTURE UNCOMPLICATED EACH 643.52 500023500 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION 1232.23 500023570 CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION 1271.12 500024650 CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION 1453.21 500024670 CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MNPJ 576.69 500025565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ 2010.11 500025675 CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIP... 2121.49 500026607 CLTX MTCRPL FX W/MNPJ W/XTRNL FIXJ EA B1 2529.87 500026700 CLTX MTCARPHLNGL DISLC 1 W/MNPJ W/O ANES 929.81 500026750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MNPJ EA 936.99 500026755 CLTX DSTL PHLNGL FX FNGR/THMB W/MNPJ EA 929.81 500026770 CLTX IPHAL JT DISLC 1 W/MNPJ W/O ANES 848.60 500026775 TREAT FINGER DISLOCATION 1312.21 500027372 REMOVAL FOREIGN BODY DEEP THIGH/KNEE 530.37 500027750 CLTX TIBL SHFT FX W/O MNPJ 577.23 500027760 CLTX MEDIAL MALLS FX W/O MNPJ 1744.92 500028490 CLTX FX GRT TOE PHLX/PHLG W/O MNPJ 899.86 500028495 CLTX FX GRT TOE PHLX/PHLG W/MNPJ 572.79 500029125 SHORT ARM SPLINT FOREARM-HAND STATIC 265.19 500029130 FINGER SPLINT STATIC 265.19 500029280 STRAPPING HAND/FINGER 362.43 500029530 Strapping; knee 267.90 50003028F OXYGEN SATURATION RESULTS DOCUMENTED & REVIEWED 79.56 500030300 REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE 751.36 500030901 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 198.89 500046083 Incision of thrombosed hemorrhoid, external 1206.59 500046320 ENCL/EXC XTRNL THROMBOTIC HEMORRHOID 926.37 500051702 INSJ TEMP NDWELLG BLDR CATH SMPL 546.28 500056405 I&D VULVA/PRNL ABSC 908.01 500064640 DSTRJ NULYT OTH PRPH NRV/BRANCH 1848.75 500065205 Removal of foreign body, external eye; conjunctival superfic... 371.25 500069210 RMVL IMPACTED CERUMEN SPX 1/BTH EARS 297.01 500090471 IMADM PRQ ID SUBQ/IM NJXS 1 VACC 263.42 500094761 N-INVAS EAR/PLS OXIMTRY F/O2 SAT MLT DETERS 360.92 500099070 SUPPLIES&MATERIALS PRV BY PHYS >&ABOVE 79.91 500099284 EMER DEPT HI SEVERITY&URGENT EVAL 2774.29 500099285 EMER DEPT HIGH SEVERITY&THREAT FUNCJ 3622.86 500099292 CC E/M CRITICALLY ILL/INJURED EA 30 MIN 4189.93 5000E0445 OXIMETER NON-INVASIVE 186.50 5000G0268 REMOVAL OF IMPACTED WAX MD 275.49 500011423 EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM 1025.88 500012036 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM 3829.42 500012046 RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM 4277.63 500012055 REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 12.6-20.0CM 4147.99 500012057 REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC > 30.0 CM 5196.52 500013120 REPAIR COMPLEX SCALP/ARM/LEG 1.1 CM-2.5 CM 1540.57 500017110 DESTRUCTION BENIGN LESIONS UP TO 14 448.28 500024500 CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION 2113.18 500024535 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MNPJ 3681.24 500024620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MNPJ 3550.61 500043753 GASTRIC TUBE PLMT W/ASPIR & LAVAGE 141.46 500054450 FORESKN MNPJ W/LSS PREPUTIAL ADS&STRETCHING 376.36 500030905 Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method 690.43 500029075 Application, cast; elbow to finger (short arm) 861.37 500093000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R 374.80 500073722 MRI ANY JT LXTR C+ MATRL 4659.32 500070551 MRI BRN BRN STEM C-MATRL 4199.40 500072158 MRI SPI CANAL&CNTS C-/C+ LMBR 4242.96 500070547 MRA NCK C-MATRL 4199.40 500073725 MRA LXTR C+-MATRL 5657.29 500090656 INFLUENZA VIRUS VACC SPLIT PRSRV FR 3 YEARS + IM 176.88 5000J0170 ADRENALIN EPINEPHRINE INJECT UP TO 1 MG 12.44 5000J0171 ADRENALIN EPINEPHRINE INJECT 27.76 5000J0330 SUCCINYCHOLINE CHLORIDE INJ UP TO 20 MG 13.63 5000J0550 (DO NOT USE) BICILLIN - PENICILLIN G BENZATHINE INJ 98.65 5000J0559 (DO NOT USE) BICILLIN - PENICILLIN G BENZATHINE INJ 2500 UNITS 98.65 5000J0610 CALCIUM GLUCONATE 89 mg/mL; injection 219.57 5000J0708 J0708 32.53 5000J0735 CLONIDINE HYDROCHLORIDE 1 MG 11.25 5000J0780 COMPAZINE - PROCHLORPERAZINE 10MG 19.38 5000J1030 SOLU-MEDROL - METHYLPREDNISOLONE 40 MG INJ 7.88 5000J1170 DILAUDID - HYDROMORPHONE UP TO 4MG 61.88 5000J1815 INSULIN INJECTION 46.77 5000J2150 MANNITOL INJECTION 38.63 5000J2300 INJ NALBUPHINE HYDROCHLORIDE 76.02 5000J2690 PROCAINAMIDE HCL INJECTION 32.53 5000J2770 Quinupristin/dalfopristin 247.07 5000J2800 METHOCARBOMAL INJECTION 32.27 5000J2805 SINCALIDE INJECTION 79.56 5000J2920 METHYLPREDNISOLONE INJECTION 15.72 5000J2930 SOLU-MEDROL - METHYLPREDNISOLONE UP TO 125MG 88.70 5000J3260 TOBRAMYCIN SULFATE INJECTION 54.54 5000J3370 VANCOMYCIN HCL INJECTION 500MG 86.34 5000J3486 GEODON - ZIPRASIDONE MESYLATE 10MG 52.87 5000J3490 CHAR ACTIVATED CHARCOAL 25G 44.21 5000J3490 ETO ETOMIDATE 20MG/10ML V 10/B 24.25 5000J3490 MAC MARCAINE 10ML 75.23 5000J3490 NOR NORCO 5/325 MG (Hydrocodone Bitartrate and Acetaminophen) 41.87 5000J3490 REPI RACEMIC EPINEPHRINE (inhalation solution) 17.68 5000J3490 VICO J3490 VICO 7.06 5000J3490AFRIN AFRIN NASAL SPRAY 70.18 5000J3490TYL J3490TYL 11.25 5000J3490TYL C TYLENOL W/ CODIENE 53.04 5000J4390LIDOC LIDOCAINE 10ML ORAL PO 56.19 5000J7050 NORMAL SALINE SOLUTION INFUS 250cc 39.57 5000J7070 D5W INFUSION 106.08 5000J7610 ALBUTEROL COMP CON 21.39 5000J7612 LEVALBUTEROL NON-COMP CON 21.56 5000J7614 XOPENEX - LEVALBUTEROL NON-COMP UNIT 28.46 5000J7615 LEVALBUTEROL COMP UNIT 28.46 5000J7644 ATROVENT 0.5 (IPRATROPIUM BROMIDE) NON-COMP 46.18 5000J9027 CLOFARALINE INJECTION 212.14 5000Q0144 ZITHROMAX AZITHROMYCIN DIHYDRATE, ORAL UP TO 1 GRAM 243.97 5000Q0162 ONDANSETRON ORAL 24.40 5000Q9965 LOCM 100-199MG/ML IODINE,1ML 31.83 5000S3650 SALIVA TEST, HORMONE LEVEL; DURING MENOPAUSE 57.99 5000S5000 PRESCRIPTION DRUG, GENERIC 2.04 6000DR002 Reglan 10mg Vial 45.52 500093040 RHYTHM ECG 1-3 LDS W/I&R 256.36 500093314 TEE R-T IMG 2D IMG ACQUISJ I&R ONLY 4242.96 500099226 EM for Subsequent observation care 1611.97 500093886 TCD STD ICRA ART COMPL STD 1367.40 500093970 DUP-SCAN XTR VEINS COMPL BI STD 1893.42 500093875 N-INVAS PHYSIOLOGIC STD XTRC ART COMPL BI STD 1272.89 6000001168 INFLUENZA A+B TEST QV 25/BX 0.00 5EXPPELVEXAM Explosive Pelvic Exam 0.00 5EXPBLDDRAW Explosive Blood Draw 0.00 5EXPCARDPAN Explosive Cardiac Panel 0.00 5EXPINCDRN Explosive Incision & Drainage 0.00 5EXPLIVPAN Explosive Liver Panel 0.00 5EXP99282 Explosive E/M 99282 0.00 5000I93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 396.82 60000PRLC20 PRILOSEC 20MG TABLET 36.52 6000001446 SYRINGE 3CC 4.03 500012006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM 1654.60 500087177 Ova and parasites, direct smears, concentration and identification 160.85 5000L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each 305.76 500026675 Closed treatment of carpometacarpal dislocation, other than thumb with manipulation, each joing; requiring anesthesia 2861.98 5000L3809 Whfo w/o joints pre ots; Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type 361.87 5000J8499TOR KETOROLAC, TAB 10MG (TORADOL) 22.71 5000J7131 hypertonic saline solution, 1 ml 114.92 6000011606 Levsin PO 16.22 6000DP006 Propanolol 1mg Vial 68.21 500085007 Blood count; blood smear, microscopic examination w/ manual differential WBC count 273.87 500084153 Prostate specific antigen (PSA); total 224.68 500082140 Ammonia 131.70 500086618 Antibody; Borrelia burgdorferi (Lyme disease) 153.94 500084436 Thyroxine; total 124.18 5EXPBMPPLUS EXPLOSIVE BMP + 0.00 6000L0006 Grey Top Lactic Acid Plasma Test 101.34 500084478 Triglycerides 103.87 5000J0153 Inj, Adenosine, 1 mg 98.65 6000E0001 AMBU BAG PEDI/ADULT 73.05 6000RC000 Readi-Cat 2 (Barium Sulfate Suspension) (2.1% w/v, 2.0% w/w) 450mL 130.17 500026742 CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ 2979.16 60000C0001 Claritin 10mg tab 32.75 6000MET001 Metformin 500mg tab 20.94 5000J8499ACY Acyclovir 800MG tab (Zovirax) 14.94 6000COL01 COLACE 100MG TAB 9.72 500020611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting 733.92 500080320 DRUG SCREEN QUANTITATIVE ALCOHOLS 339.73 500087801 IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ 1154.61 500069209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT 170.87 500086677 Antibody; Helicobacter pylori 238.72 500073502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS 552.07 500087140 CULTURE TYPE IMMUNOFLUORESC 91.66 500073501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW 563.49 5EXPDPLNB DEHYDRATION TREATMENT PLAN B 0.00 500086703 ANTIBODY HIV-1&HIV-2 SINGLE RESULT 225.45 500073521 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS 528.29 500086140 C-reactive protein 129.87 500086666 Antibody; Ehrlichia 147.97 5000J7638 Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram 17.17 5000S0119 ONDANSETRON 4 MG; PO 11.25 5000J3490VER VERAPAMIL HCL, TAB 40MG (100/BT) 184.62 500020525 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP 3403.46 500085384 Fibrinogen: Activity 139.70 500087340 IAAD IA HEPATITIS B SURFACE ANTIGEN 169.90 5000J3490CRO CroFab (Crotalidae Polyvalent Immune Fab) per vial 19287.52 500084100 Phosphorus inorganic (phosphate 78.00 500027818 Closed treatment of trimalleolar ankle fracture; with manipulation 5903.59 500095921 TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP 1163.66 5000J3490SCOP Scopolamine patch 212.28 5000A9150TYL TYLENOL UP TO 1GM (1000MG) 3.25 500086695 ANTIBODY HERPES SMPLX TYPE 1 216.98 5000J0561BIC Penicillin Benzathine 1,200,000; Inj 13.69 500086376 MICROSOMAL ANTIBODIES EACH 239.33 500076815 US PREGNANT UTERUS LIMITED 1/> FETUSES 1138.43 5000Q4048 Cast sup sht leg splnt ped f 121.72 500086886 COOMBS TEST INDIRECT TITER 85.12 500076810 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO 1263.82 5000J8499HYDRO Hydrochlorothiazide 25mg tablet 0.39 5000A4369 Benzoin - Skin barrier liquid per oz 11.14 500086431 RHEUMATOID FACTOR QUANTITATIVE 93.33 500086735 ANTIBODY MUMPS 214.57 5000J3490POLY (Polytrim) Polymyxin B Sulfate / Trimethoprim 1.21 500083935 Osmolality: Urine 81.03 500041250 REPAIR TONGUE LACERATION 2134.26 500082941 ASSAY OF GASTRIN 290.04 500073551 X-RAY EXAM OF FEMUR 1V 371.19 5000G0480 Drug test def 1-7 classes 339.73 500080339 Antiepileptics, not otherwise specified; 1-3 339.73 500025574 OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA 9173.50 500031575 LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC 1053.31 5000L4361 Pneuma/vac walk boot pre ots 313.52 500086762 Antibody; rubella 236.79 500073522 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS 652.05 500082330 Calcium; ionized 224.96 500086717 Antibody; Leishmania 134.52 500082375 Carboxyhemoglobin; quantitative 202.62 500082627 Dehydroepiandrosterone-sulfate (DHEA-S) 365.75 500080175 DRUG SCREEN QUANTITATIVE LAMOTRIGINE 103.85 500099153 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS 256.36 500030802 ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL 2453.99 50003J8499 Atenolol 100mg Qty 100 tabs 5.28 5EXPCHM13 Explosive Chem 13 Panel 6000AMOXTAB Amoxicillin 875mg tab 13.67 500070330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT 619.39 500080177 DRUG SCREEN QUANTITATIVE LEVETIRACETAM 104.54 500088346 IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN 1217.85 500026567 Osteotomy; phalanx of finger, each 4353.38 500084144 ASSAY OF PROGESTERONE 329.13 500054235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT 966.69 5000ZOLPID ZOLPIDEM TARTRATE/AMBIEN 5 MG 70.27 500087802 IAADIADOO STREPTOCOCCUS GROUP B 189.06 6000BACT Brompheniramine Maleate/Bromfed DM, per 1 mL 2.30 500086652 Antibody; encephalitis, Eastern equine 64.52 500093226 EXTERNAL ECG SCANNING ANALYSIS REPORT 375.40 500040831 CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL 2994.95 5000J0133 Acyclovir 500mg/10mL IV 78.20 500082135 AMINOLEVULINIC ACID DELTA 259.56 5000J7637 Dexamethasone Sodium Phosphate 1mL 11.73 500086812 HLA typing; A, B, or C (eg, A10, B7, B27), single antigen 203.55 500023330 REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS 2022.39 500086704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL 190.10 5000AMPINJGM Ampicillin 1 GM Injection 37.95 500031231 NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX 847.44 5000CHLORHCL Chlordiazepoxide HCL (Librium), 25 mg 1.47 500020520 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE 1912.57 5000084466 ASSAY OF TRANSFERRIN 90.62 5000087290 IAADI VARICELLA ZOSTER VIRUS 94.53 OPLAB70140 RADEX FACIAL B1S < 3 VIEWS 285.91 OPLAB70150 RADEX FACIAL B1S COMPL MINIMUM 3 VIEWS 378.33 OPLAB70210 Radiologic examination, sinuses, paranasal, less than 3 views 239.94 OPLAB70220 RADEX SINUSES PARANSL COMPL MINIMUM 3 VIEWS 373.03 OPLAB70260 RADEX SKL COMPL MINIMUM 4 VIEWS 379.71 OPLAB71020 RADEX CH 2 VIEWS FRNT&LAT 352.06 OPLAB71022 RADEX CH 2 VIEWS FRNT&LAT OBLQ PRJCJ 330.37 OPLAB71030 RADEX CH COMPL MINIMUM 4 VIEWS 396.89 OPLAB71047 RADEX CHEST 3 VIEWS 251.91 OPLAB72020 RADEX SPI 1 VIEW SPEC LVL 238.07 OPLAB72052 RADEX SPI CRV COMPL W/OBLQ&FLEXION&/XTN STDS 636.44 OPLAB72072 RADEX SPI THRC 3 VIEWS 419.88 OPLAB73070 RADEX ELBW 2 VIEWS 177.41 OPLAB73110 RADEX WRST COMPL MINIMUM 3 VIEWS 277.79 OPLAB73120 RADEX HAND 2 VIEWS 243.78 OPLAB73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS 344.98 OPLAB73620 RADEX FOOT 2 VIEWS 289.64 OPLAB73630 RADEX FOOT COMPL MINIMUM 3 VIEWS 406.62 OPLAB74247 RADEX GI UPR C+ +-GLUC +-DLYD FLMS W/KUB 764.45 OPLAB76010 RADEX FROM NOSE RECTUM FB 1 VIEW CHLD 198.01 OPLAB77076 RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT 622.04 OPLAB80050 GENERAL HLTH PANEL 207.01 OPLAB80051 ELECTROLYTE PANEL 210.63 OPLAB80053 COMPRE METAB PANEL 411.93 OPLAB80076 HEPATC FUNCJ PANEL 215.03 OPLAB80100 DRUG SCR QUAL MLT DRUG CLASSES CHROM EA PX 174.13 OPLAB80177 DRUG SCREEN QUANTITATIVE LEVETIRACETAM 104.54 OPLAB80196 SALICYLATE 84.87 OPLAB80197 TACROLIMUS 265.19 OPLAB80202 DRUG SCREEN QUANT VANCOMYCIN 173.26 OPLAB80305 DRUG TEST PRSMV QUAL DIR OPTICAL OBS PER DAY 172.66 OPLAB80307 DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS 350.76 OPLAB80320 DRUG SCREEN QUANTITATIVE ALCOHOLS 169.87 OPLAB80329 Analgesics, non-opioid; 1 or 2 199.25 OPLAB81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MIC 97.23 OPLAB82009 KETONE BODIES SERUM QUALITATIVE 34.44 OPLAB82010 ACETONE/OTH KETONE BODIES SERUM QUAN 27.31 OPLAB82075 ALCOHOL BRTH 76.29 OPLAB82135 AMINOLEVULINIC ACID DELTA 129.78 OPLAB82140 Ammonia 65.85 OPLAB82271 Blood, occult, by peroxidase activity (eg, guaiac), qualitat... 16.36 OPLAB82365 Calculus; infrared spectroscopy 101.72 OPLAB82550 CREATINE KINASE TOT 132.60 OPLAB82552 CREATINE KINASE ISOENZYMES 132.16 OPLAB82728 Ferritin 112.11 OPLAB82947 GLUC QUAN BLD 83.29 OPLAB82951 GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS 105.83 OPLAB83519 IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY 106.55 OPLAB83520 IMMUNOASSAY ANALYTE QUANTITATIVE NOS 108.64 OPLAB83630 LACTOFERRIN FECAL (QUAL) 154.85 OPLAB84153 Prostate specific antigen (PSA); total 112.33 OPLAB84166 PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATION 66.30 OPLAB84439 THYROXINE FR 121.11 OPLAB84450 TRANSFERASE ASPARTATE AMINO 113.09 OPLAB84479 THYR HORM UPTK/THYR HORM BNDNG RATIO 164.96 OPLAB84481 TRIIODOTHYRO9 T3 FR 154.70 OPLAB84520 UREA N QUAN 96.37 OPLAB85014 BLD# HEMATOCRIT 77.17 OPLAB85378 D-DIMER - FIBRIN DGRADJ PRODUXS D-DIMER QUAL/SEMIQUAN 113.85 OPLAB85651 SEDIMENTATION RATE RBC NON-AUTO 110.49 OPLAB85652 SEDIMENTATION RATE RBC AUTO 70.68 OPLAB85730 THROMBOPLASTIN TM PRTL PLSM/WHL BLD 85.33 OPLAB86021 ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES 123.83 OPLAB86140 C-reactive protein 64.93 OPLAB86255 FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY 95.05 OPLAB86325 IMMUNOELECTROPHORESIS OTH FLUS CONCENTRATION 141.43 OPLAB86341 ISLET CELL ANTIBODY 136.45 OPLAB86430 RHEUMATOID FACTOR QUAL 55.91 OPLAB86618 Antibody; Borrelia burgdorferi (Lyme disease) 76.97 OPLAB86644 ANTIBODY CYTOMEGALOVIRUS CMV 113.51 OPLAB86694 ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST 118.39 OPLAB86695 ANTIBODY HERPES SMPLX TYPE 1 108.49 OPLAB86803 HEPATITIS C ANTIBODY 117.37 OPLAB86850 ANTB SCR RBC EA SERUM TQ 143.65 OPLAB86906 BLD TYPING RH PHEXYPING COMPL 65.23 OPLAB87070 CUL BACT XCPT URINE BLD/STL AERC ISOL 144.44 OPLAB87077 Culture Aerobic Identify 40.58 OPLAB87086 CUL BACT QUAN COLONY CNT URINE 146.05 OPLAB87205 Smear, primary source with interpretation; Gram or Giemsa st... 55.52 OPLAB87207 Smr, prim src, w/ int; spec stain for inclusion bodies or parasites e.g. Malaria...... 97.43 OPLAB87209 SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS 141.80 OPLAB87210 SMR PRIM SRC WET MOUNT NFCT AGT 69.67 OPLAB87230 TOXIN/ANTITOXIN ASSAY TISSUE CULTURE 162.40 OPLAB87255 GENET VIRUS ISOLATE HSV 267.09 OPLAB87273 IAADI HERPES SMPLX VIRUS TYPE 2 98.59 OPLAB87290 IAADI VARICELLA ZOSTER VIRUS 94.53 OPLAB87324 CLOSTRIDIUM AG EIA 108.39 OPLAB87420 IAAD EIA RSV 74.60 OPLAB87425 IAAD IA ROTAVIRUS 98.59 OPLAB87480 IADNA CANDIDA SPECIES DIRECT PROBE TQ 158.18 OPLAB87592 IADNA NEISSERIA GONORRHOEAE QUAN 106.08 OPLAB87621 Infectious agent detection by nucleic acid (DNA or RNA); pap... 130.80 OPLAB87661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH 276.81 OPLAB87806 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES 198.03 OPLAB88346 IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN 608.93 OPLAB89050 Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, jt fluid), except blood 58.79 OPLAB90460 Immunization administration through 18 yts of age via any ro... 93.62 OPLABG0480 Drug test def 1-7 classes 169.87 OPLABG6039 Assay of Acetaminophen 91.45 OPLABQ0092 Set-up portable x-ray equipment 168.57 OPLABQ9966 LOCM 200-299MG/ML IODINE,1ML 15.92 500085240 CLOTTING FACTOR VIII AHG 1 STAGE 254.15 500085246 CLOTTING FACTOR VIII VW FACTOR ANTIGEN 325.68 OPLAB85613 RUSSELL VIPER VENOM TIME DILUTED 68.02 OPLAB70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL 1546.92 OPLABJ3121 TESTOSTERONE ENANTHATE INJ, 1mg 17.68 5000POTCHL1000 POTASSIUM CHL 20 mEq/1000mL IV Sol Flex Bag 1000mL 493.40 500086304 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 295.55 500082378 CARCINOEMBRYONIC ANTIGEN CEA 269.22 500083721 LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL 135.47 500086902 BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH 73.03 500080184 DRUG SCREEN QUANTITATIVE PHENOBARBITAL 175.95 500086671 ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED 174.00 500083516 IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP 163.76 500085305 CLOTTING INHIBITORS PROTEIN S TOTAL 164.80 500086768 ANTIBODY SALMONELLA 168.48 5000J8499MUP MUPIROCIN (BACTROBAN) 2% OINTMENT 17.49 OPLAB70491 CT SOFT TISS NCK C+ MATRL 1768.40 5000J3490MUCI MUCINEX DM ER (Guaifenesin & Dextromethorphan HBr) 600 MG - 30 MG tab 15.53 OPLAB73200 CT UXTR C-MATRL 1107.59 OPLAB71270 CT THORAX C-/C+ 2188.55 OPLAB73221 MRI ANY JT UXTR C-MATRL 2099.69 OPLAB72146 MRI SPI CANAL&CNTS THRC C-MATRL 2099.70 OPLAB72141 MRI SPI CANAL&CNTS CRV C-MATRL 1414.33 5000CALCARB Calcium Carbonate Chew (TUMS) 500MG PO 16.79 OPLAB72158 MRI SPI CANAL&CNTS C-/C+ LMBR 2121.47 OPLAB76700 US ABDOMINAL R-T W/IMAGE DOCUMENTATION 875.56 500028665 CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES 1723.16 OPLAB70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST 1359.97 OPLAB70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST 1501.12 5000J8499SUBO Suboxone Films 8mg 119.54 5000J8499CLON1 Clonazepam (Klonopin) 1mg; tab 2.66 500093979 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD 1557.33 5000J8499CARV Carvedilol (Coreg) 6.25 mg; tab 1.37 500081291 MTHFR GENE ANALYSIS COMMON VARIANTS 653.40 500064430 INJECTION ANESTHETIC AGENT PUDENDAL NERVE 916.80 5000J8499TRAZ100 Trazodone Hydrochloride 100 mg; tab 1.20 5000J8499NAP Naproxen 500mg; tab 0.60 5000J8499RISP Risperidone 1 mg; tab 0.20 5000J8499ESCI Escitalopram 10 mg; tab 2.80 5000J8499BUPR Bupropion SR Hydrochloride 100 mg; tab 1.40 5000J8499ALPRA Alprazolam 0.5 mg; tab 0.60 5000J8499MERO Meropenem (Merrem) 1 GM; vial 126.73 5000J8499ALBU Albuked (Albumin) 25% 100 mL; vial 112.00 500093660 CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR 1800.30 500097169 SP Athletic training evaluation, low complexity (School Physical) 125.00 5000J8499THIA Thiamine (Vitamin B-1) PO 0.20 5000J1956250 LEVAQUIN - LEVOFLOXACIN INJECTION 250MG 181.21 5002J1956500 LEVAQUIN 500MG IVPB 87.20 500087486 IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ 38.99 500083993 ASSAY OF CALPROTECTIN FECAL 21.81 500087338 IAAD IA HPYLORI STOOL 177.60 500011104 PUNCH BIOPSY SKIN SINGLE LESION 569.10 500019083 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID 1820.50 500020206 BIOPSY MUSCLE PERCUTANEOUS NEEDLE 669.80 500020225 BIOPSY BONE TROCAR/NEEDLE DEEP 1223.80 500032405 BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE 1040.80 500032555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING 1284.50 500036013 INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY 1401.50 500036225 SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY 3626.90 500036247 SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH 3486.60 500036573 INSERTION PICC W/RS&I 5 YR/> 1650.00 500036590 RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 2181.40 500037187 PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN 4532.40 500037224 REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI 5128.80 500037226 REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL 6014.90 500037241 VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I 5107.70 500037243 VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT 6513.20 500037249 TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN 1678.30 500047000 BIOPSY LIVER NEEDLE PERCUTANEOUS 1028.70 5000J8499PREDELT Prednisone (Deltasone) 20 MG tab 2.43 500011044 DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/< 2615.90 500020931 ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL 1286.70 500084270 ASSAY OF SEX HORMONE BINDING GLOBULIN 241.50 500022585 ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC 3777.10 500022845 ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS 8424.70 500027605 TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES 2135.60 500028060 FASCIECTOMY PLANTAR FASCIA PARTIAL SPX 4112.90 500028108 EXC/CURTG CST/B9 TUM PHALANGES FOOT 3309.60 500028110 OSTECTOMY PRTL 5TH METAR HEAD SPX 3336.10 500028234 TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON 3025.80 500028289 HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT 5290.70 500028299 CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT 6695.70 500028306 OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR 4622.80 500029891 ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT 7687.90 500029898 ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE 6437.80 500062287 DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR 6659.20 500062290 INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR 1918.20 500063030 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR 11155.20 500063042 LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR 14892.10 500063055 TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC 18745.00 500063057 TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR 3682.80 500063075 DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC 15533.70 500063076 DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC 2844.50 500049587 RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED 5455.30 500064413 INJECTION ANESTHETIC AGENT CERVICAL PLEXUS 930.20 500064421 MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES 1053.00 500064425 INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS 1084.20 OPLAB84300 ASSAY OF URINE SODIUM 34.50 500064479 NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL 1499.40 500064517 INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS 1436.30 500064530 INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG 1049.00 500064555 PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV 3920.50 500064680 DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS 1858.00 500072285 DISKOGRAPY CERVICAL/THORACIC RS&I 1324.40 5000J3490FAMO PEPCID - INJECTION, FAMOTIDINE, 20 MG -MEDICARE 106.78 500077001 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT 1016.10 500087071 CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL 104.90 500087186 SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ 96.10 500090834 PSYCHOTHERAPY W/PATIENT 45 MINUTES 940.60 500097110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES 347.50 500097112 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA 395.40 500098941 CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS 392.10 500099204 OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES 1451.70 500099212 OFFICE OUTPATIENT VISIT 10 MINUTES 287.20 500099213 OFFICE OUTPATIENT VISIT 15 MINUTES 574.70 500015275 SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM 1092.10 500028171 RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS 12780.70 500049440 INSERT GASTROSTOMY TUBE PERCUTANEOUS 2376.10 500050200 RENAL BIOPSY PRQ TROCAR/NEEDLE 1478.90 500064486 TAP BLOCK UNILATERAL BY INJECTION(S) 642.50 500075710 ANGIOGRAPHY EXTREMITY UNILATERAL RS&I 1883.30 500075726 ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I 1626.60 500075736 ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I 1745.20 500075820 VENOGRAPHY EXTREMITY UNILATERAL RS&I 1255.20 500075825 VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I 1465.70 500077012 CT GUIDANCE NEEDLE PLACEMENT 1703.10 500093925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY 6241.51 5000J8499LISIN Lisinopril (Zestril) 10 MG, tab 0.20 500075571 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM 1164.10 500036014 SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY 1742.20 500075743 ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I 1850.20 OPLAB83835 ASSAY OF METANEPHRINES 94.10 500051610 INJ RETROGRADE URETHROCSTOGRAPY 847.09 500082105 ALPHA-FETOPROTEIN SERUM 186.40 500087505 NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN 1425.40 500084207 ASSAY OF PYRIDOXAL PHOSPHATE 312.20 5000J8499QUET100 Quetiapine 100 mg tab 0.49 5000J3490METO Metoprolol Tartrate (Lopressor) 5 MG/5 mL 11.29 500095827 ELECTROENCEPHALOGRAM ALL NIGHT RECORDING 6271.60 OPLAB84133 POTASSIUM URINE 23.95 5000J8499TERA5 Terazosin 5 MG; cap 11.98 500086360 T CELLS ABSOLUTE CD4&CD8 COUNT RATIO 522.00 5000J8499MAGAL Mag-Al + simeth, (Mylanta) Susp 200-200-20 MG 19.60 5000J8498ASPI Aspirin 300 mg; suppository 12.76 5000A9575DOT20 Dotarem Contrast 20 mL vial 390.00 5000J8499DONE Donepezil (Aricept) 5 MG; tab 15.15 5000J8499LOSAR Losartan Potassium (Cozaar) 50 MG; tab 43.46 5000J8499PROBIO Probiotics (Lactinex), tab 5.65 5000J8499CALVITD Calcium + Vitamin D 600 MG-200 U; tab 0.45 5000J8499TEMA Temazepam (Restoril) 15 MG; PO 0.51 5000J8499SODCHL Sodium Chloride Inhalation Solution 0.9% 3 mL vial 1.53 500082175 ASSAY OF ARSENIC 210.80 OPLAB83825 ASSAY OF MERCURY QUANTITATIVE 90.30 OPLAB70480 CT ORBIT SELLA/POST FOSSA/EAR C-MATRL 883.95 5000J8499OXCAR Oxcarbazepine (Trileptal) 150 MG; tab 1.06 5000J8499TYL2 TYLENOL 400 MG 97.24 OPLABQ9954 ORAL MR CONTRAST, PER 100 ML 173.97 50000RM112 ROOM AND BOARD-HOSPICE 4025.00 50000297T EXTERNAL ECG SCANNING ANALYSIS REPORT MORE THAN 48 HOURS 750.80 500081240 F2 GENE ANALYSIS 20210G >A VARIANT 656.90 500085613 RUSSELL VIPER VENOM TIME DILUTED 136.05 500087427 IAAD IA SHIGA-LIKE TOXIN 170.20 500086022 ANTIBODY IDENTIFICATION PLATELET ANTIBODIES 204.10 OPLAB86022 ANTIBODY IDENTIFICATION PLATELET ANTIBODIES 102.05 OPLAB36430 TRANSFUSION BLOOD/BLOOD COMPONENTS 196.95 OPLAB86920 COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE 119.15 500090791 PSYCHIATRIC DIAGNOSTIC EVALUATION 1416.70 500090875 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN 691.00 500090876 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN 1094.50 OPLAB86580 SKN TST TUBERCULOSIS ID 13.26 5000J3490METFLA Metronidazole 500mg/100ml inj 377.03 5000J8499REQ Requip (Ropinirole Hydrochloride) 0.25 mg PO 0.39 500097802 MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI 386.50 500083090 ASSAY OF HOMOCYSTEINE 179.20 500020606 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US 609.20 OPLAB72194 CT PELVIS C-/C+ 2162.18 OPLAB72125 CT CRV SPI C-MATRL 1858.94 500086778 ANTIBODY TOXOPLASMA IGM 144.10 OPLAB86778 ANTIBODY TOXOPLASMA IGM 72.05 5000J8499ZIPR Ziprasidone HCl (Geodon) 20 mg; PO 14.60 500084600 ASSAY OF VOLATILES 171.10 5000J7121 D5LR - 5% dextrose in lactated ringers infusion, up to 1000 cc 59.11 500056620 VULVECTOMY SIMPLE PARTIAL 6067.70 5000A6250CLOTR Clotrimazole (Canesten) Cream 1% 20.50 500085370 FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE 124.30 5000J8499CALVTD Calcium + Vitamin D 500 mg/200 U 0.19 5000J8499FLUINH Fluticasone Propionate INH 50 mcg; nasal spray 54.70 5000J8499CHOL Cholestyramine 4 gm; powder packet 20.50 5000J8499LOES Loestrin (Norethindrone Acetate) 1 mg 95.60 OPLAB93926 DOPPLER - DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD 664.73 500086361 T CELLS ABSOLUTE CD4 COUNT 380.19 5000J8499BENTAB Benadryl Tab 25 mg Medicare 14.65 5000J8499PEPTAB PEPCID/FAMOTIDINE 20MG TAB - Medicare 23.24 500036571 INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/> 3604.60 5000J8499GUA200 Tussin Liquid, GUAIFENESIN; 200 mg/10mL 7.02 500020103 EXPLORATION PENETRATING WOUND SPX EXTREMITY 3999.70 5000LETGEL Let Gel (Lido-Epi-Tetra) 3 mL Topical 125.00 500099156 MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS 984.86 5000J8499BUME Bumetanide (Bumex) 1 mg; PO 2.80 5000J8499FINA Finasteride 5 mg; PO 1.68 500053060 DRG OF SKENES GLAND ABSCESS OR CYST 1919.40 5000J8499VOLT Voltaren (diclofenac) 75 mg; PO 0.79 OPLAB86738 ANTIBODY MYCOPLSM 66.20 500099241 OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN 373.50 500080324 DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 400.00 500080348 DRUG SCREENING BUPRENORPHINE 400.00 500080358 DRUG SCREENING METHADONE 400.00 500080365 DRUG SCREENING OXYCODONE 400.00 5000J8499MUL Multivitamin (Single vitamin nos) - Medicare 1.05 500082373 CARBOHYDRATE DEFICIENT TRANSFERRIN 180.60 OPLAB83663 FETAL LUNG MATURITY FLUORESCENCE POLARIZATION 94.55 500084591 ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED 170.60 OPLAB81020 URINALYSIS 2/3 GLASS TEST 23.50 500084580 UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN 95.50 OPLAB84583 ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE 30.25 OPLAB85013 BLOOD COUNT SPUN MICROHEMATOCRIT 35.00 500085004 BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT 64.70 OPLAB85049 BLOOD COUNT PLATELET AUTOMATED 22.40 OPLAB36569 INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/> 990.00 500080299 QUANTITATION DRUG NOT ELSEWHERE SPECIFIED 186.40 5000J8499MEGACE Megace (Megestrol Acetate) 400 mg/10; PO 243.70 OPLAB96365 IV THERAPY 1ST >1 HOUR 274.91 OPLABJ2930 SOLU-MEDROL - METHYLPREDNISOLONE UP TO 125MG 44.35 OPLABL4361 Pneuma/vac walk boot pre ots 156.76 500087341 IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION 103.30 OPLABU0003 Infectious agent detection by nucleic acid (DNA or RNA); sev 175.00 5000J8499SENN Senna Lax (Senokot) 8.6 mg; tab 0.57 OPLAB93976 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT 1104.14 5000J2212 Methylnaltrexone (Relistor) ; injection 1510.60 5000NICOPTCHMED NICODERM, Nicotine Patch - Medicare 37.26 5000B4082 Nasogastric tubing without stylet 134.30 OPLAB87385 IAAD IA HISTOPLASM CAPSULATUM 66.25 5000U0004 Cov-19 test non-cdc hgh thru 350.00 OPLAB87486 IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ 19.50 500051705 CHANGE CYSTOSTOMY TUBE SIMPLE 601.00 5000J8499ZINC Zinc 220 mg; PO 0.60 OPLAB71550 MRI CH C-MATRL 2099.38 OPLAB87804A INFLUENZA A 65.85 500099072 ADDL SUPL MATRL&STAF TM DRG PHE RES-TR NFCT DS 75.00 500086413 SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative 350.00 5000J8499CELE Celebrex 100 mg; PO 11.60 5000J8499CIPRON CIPROFLOXACIN 500MG TAB 3.14 5000J8499DIT Oxybutynin (Ditropan) 5 mg; tab 1.60 5000J1450 Fluconazole (Diflucan) 400mg/0.2L (200ml) 50.50 OPLAB74150 CT ABD C-MATRL 1649.06 5000J8499RANE Ranexa (Ranolazine) 500 mg tab; PO 73.20 OPLAB87254 VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA 97.80 OPLAB70460 CT HEAD/BRN C+ MATRL 2400.06 500082642 DIHYDROTESTOSTERONE (DHT) 292.80 OPLAB82642 DIHYDROTESTOSTERONE (DHT) 146.40 500090792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 1982.20 500083916 OLIGOCLONAL IMMUNE 273.90 OPLAB82105 ALPHA-FETOPROTEIN SERUM 93.20 5000Q0243 Regeneron Injection, casirivimab and imdevimab, 2400 mg 0.00 500087563 IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH 350.90 500082085 ASSAY OF ALDOLASE 97.10 OPLAB73223 MRI ANY JT UXTR C-/C+ 2360.64 OPLAB74181 MRI ABD C-MATRL 2099.70 OPLAB88262 CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING 983.14 5000J3430 Phytonadione (Vitamin K), per 1 MG; inj 91.76 500082679 ASSAY OF ESTRONE 249.50 5000J3490ESMO Esmolol HCl (Brevibloc) 100 mg/10 mL vial 27.40 5000J8499CEFU Cefuroxime Axetil 500 mg; tab 33.00 OPLAB80143 DRUG ASSAY ACETAMINOPHEN 93.20 500082172 APOLIPOPROTEIN EACH 210.90 500082088 ASSAY OF ALDOSTERONE 407.50 OPLAB82397 CHEMILUMINESCENT ASSAY 70.60 OPLAB82172 APOLIPOPROTEIN EACH 105.45 OPLAB82542 COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC 120.45 500077075 RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL 1131.80 500084590 ASSAY OF VITAMIN A 116.10 OPLAB84446 ASSAY OF TOCOPHEROL ALPHA VITAMIN E 70.90 OPLAB86671 ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED 87.00 500086606 ANTIBODY ASPERGILLUS 150.50 OPLAB76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE 694.89 5000J8499BISO Bisoprolol Fumarate 5 mg; tab 3.60 OPLAB77072 BONE AGE STUDIES 144.85 500081270 JAK2 GENE ANALYSIS P.VAL617PHE VARIANT 916.60 5000BRIMTAR Brimonidine Tartrate 0.2% drops 5ml 180.60 5000Q0244 Injection, casirivimab and imdevimab, 1200 mg 0.00 OPLAB72132 CT LMBR SPI C+ MATRL 2756.89 5000J8499CYPRO Cyproheptadine 4 mg; PO 1.42 OPLAB87636 IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ 375.00 5000J8499TUSS Hydrocodone/Chlorpheniramine (Tussionex) 10 mg/8 mg/5 mL Suspension 459.00