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Copy of 2019 Price List for Website.Xlsx Service Code Service Description Charge 1100000 PRIVATE ROOM AND BOARD 3,339.00 1100001 ISOLATION ROOM 3,892.00 1200000 SEMI-PRIVATE ROOM AND BOARD 3,339.00 1200001 SWINGBED ROOM AND BOARD 2,593.00 1200002 ICU/MONITORED BED 4,048.00 1200005 SIU-ROOM AND BOARD 4,457.00 1700000 NURSERY ROOM AND BOARD 959.00 2000000 ICU ROOM AND BOARD 4,457.00 2500005 AHC MED CHARGE I 25.00 2500010 AHC MED CHARGE II 65.00 2500011 ACETAMINOPHEN 325MG TAB PO 9.00 2500020 PPD 33.00 2500100 ACTIDOSE/SORB 50GM/240ML SUSPO 107.00 2500110 ALBUTEROL 0.5% NEBSOL 20ML INH 97.00 2500135 BUDESONIDE 0.5/2ML NEB SOL INH 40.00 2500137 BUPIVACAINE 0.25% INJ 10 ML IV 66.00 2500138 BUPIVACAINE 0.5% INJ 10 ML IV 69.00 2500140 BUPIVACAINE MPF 0.75% INJ 10ML 52.00 2500141 BUPIVACAINE/EPI 0.25% INJ 10ML 75.00 2500142 BUPIVACAINE/EPI 0.5% INJ 10 ML - 2500143 BUPIVACAINE MPF 0.5% INJ 30ML 47.00 2500145 CALCIUM CARB 1000MG TABS PO 13.00 2500160 CEFUROXIME 250 MG TAB PO 34.00 2500165 CEPHALEXIN 500MG CAP PO 17.00 2500167 CHLORHEXIDINE 4% SOL 240ML TOP 47.00 2500169 CHLOROPROCAINE 3% 20 ML INJ 90.00 2500170 CHOLESTRYRAMINE 4GM LT POWD PO 18.00 2500173 CLOTRIMAZOLE 10MG TROCHE PO 17.00 2500180 CRASH CART ACCESS 330.00 2500185 D5/NACL 0.9% KCL20 MEQ 1000 ML 39.00 2500186 D5W 100 ML BAG IV 40.00 2500187 D5W 250 ML BAG IV 40.00 2500200 EPINEPHRINE 1MG/ML (1:1000)INJ 17.00 2500201 EPINEPHRINE 1MG/ML MDV 30M INJ 42.00 2500205 ETHYL CHLORIDE SPR 103.1ML TOP 79.00 2500215 FLUTIC/SALM 100/50 ADVAIR INH 340.00 2500216 FLUTIC/SALM 250/50 ADVAIR INH 430.00 2500221 FUROSEMIDE 10MG/ML INJ 10ML IV 17.00 2500222 FUROSEMIDE 10MG/ML INJ 2ML IV 17.00 2500230 GLIPIZIDE XL 5MG TAB PO 17.00 2500238 GUAIFENESIN DM SYRUP 10ML UDC 21.00 2500244 HUMULIN R U-100 INJ 3 ML 17.00 2500245 HYDRALAZINE 25MG TAB PO 17.00 2500250 IBUPROFEN 600 MG TAB PO 17.00 2500260 INSULIN LISPRO 100U/ML INJ 10M 17.00 2500267 LAMOTRIGINE 25 MG TAB PO 26.00 2500272 LEVALBUTEROL 0.63MG/3ML INH 21.00 2500273 LEVALBUTEROL 1.25MG/3ML INH 20.00 2500275 LEVETIRACETAM 250 TAB PO 18.00 2500276 LEVETIRACETAM 750 TAB PO 23.00 2500280 LIDOCAINE 2% GEL 5GM TOP 57.00 2500283 LIDOCAINE MPF 0.5% INJ 50ML IV 112.00 2500287 LORAZEPAM 2MG/ML INJ 10ML MDV 156.00 2500293 MANNITOL 20% 500ML BAG IV - 2500298 METHYLPRED 40 MG-SOLUMED INJ 19.00 2500300 MIRTAZAPINE 15 MG TAB PO 20.00 2500305 MUPIROCIN 2% OINT 22GM TOP 200.00 2500310 NACL 0.45%/KCL20MEQ 1000ML BAG 19.00 2500313 NAFCILLIN 2GM INJ IV 88.00 2500322 NOREPINEPHRNE 4MG/ML INJ4ML IV 69.00 2500335 PHYTONADIONE 10 MG/ML INJ SQ 41.00 2500338 POLYVINYL SOLN 15 ML OPTH 27.00 2500347 RHO(D) IMMUNE GLOB 300MCG INJ 537.00 2500352 SIMETHICONE 40MG/0.6ML ORAL 30 38.00 2500358 SOD CHLORIDE 4MEQ/ML 30ML IV 17.00 2500366 TIOTROPIUM INH (SPIRIVA) INH 156.00 2500368 TRIAMCINOLONE 0.1%CRM 15GM TOP 27.00 2500370 TRIAMTERENE/HCTZ 37.5/25MG TAB 17.00 2500376 ALCOHOL (GRAIN) PO 14.00 2500392 ISOSORBIDE MONO 30MG PO 17.00 2500393 LISINOPRIL 40MG TAB PO 17.00 2500394 LITHIUM 150MG CAP PO 17.00 2500396 MAG SULFATE 40 GRAM 500ML IV 40.00 2500398 OSELTAMIVIR 75MG CAP PO 47.00 2500399 PENICILLIN 250MG/5ML PO(ED) 38.00 2500402 SILVER SULFADIAZ 1%CRM 50G TOP 60.00 2500405 KCL 20MEQ/10ML VIAL IV 17.00 2500409 BRIMONIDINE 0.15% OPTH SOLN 219.00 2500410 CEFOXITIN 1 GM INJ IV 58.00 2500412 FLUOXETINE 10MG CAPS PO 19.00 2500413 FLUOXETINE 20 MG CAPS PO 20.00 2500414 ESCITALOPRAM 10 MG TABS PO 19.00 2500415 VENLAFAXINE XR 75MG CAPS PO 24.00 2500417 GABAPENTIN 100MG CAPS PO 23.00 2500421 EC ASA TABS PO 11.00 2500422 ACETAMINOPHEN 80MG DISSOLV TAB 11.00 2500426 VITAMIN B-6 TAB PO 17.00 2500429 STERILE WATER INJ 1L BAG IV 18.00 2500430 NIACIN 500MG TAB PO 17.00 2500431 GEMFIBROZIL 600MG TAB PO 17.00 2500432 CEPACOL LOZENGES PO 11.00 2500433 ACETYLCYSTEINE 30 ML IV 521.00 2500436 FLUDROCORTISONE 0.1MG TAB PO 17.00 2500437 FERROUS GLUCONATE 300MG PO 17.00 2500438 INSULIN GLARG 100U/ML 10ML INJ 271.00 2500440 ATORVASTATIN 40MG TAB PO 17.00 2500442 GLIPIZIDE XL 2.5MG TAB PO 17.00 2500443 ENOXAPARIN 100MG SYG INJ 286.00 2500444 D5 1/2 NS W/40mEq KCL 1L IV 17.00 2500446 OLANZAPINE 10MG IM INJ 103.00 2500447 TRIAMCINOLONE 200MG/5ML MDV IV 172.00 2500456 GUAIFENESIN AC 5ML UDC PO 17.00 2500457 PROMETHAZINE/CODIENE 5ML UD PO 17.00 2500458 DETROL LA 2MG CAP PO 17.00 2500460 CLARITHROMYCIN 250MG TAB PO 17.00 2500464 NA CITRATE/CITRC AC 3/2G UD PO 17.00 2500469 LINEZOLID (ZYVOX) 600MG TAB PO 262.00 2500470 LINEZOLID (ZYVOX) 600MG BAG IV 331.00 2500474 IOTHALAMATE MEGLUMINE VIAL IV 72.00 2500476 SOD BICARB 8.4% VIAL IV 17.00 2500477 SALINE NASAL SPRAY 17.00 2500480 ROCURONIUM (ZEMURON) 10 ML IV 152.00 2500483 PRAMIPEXOLE 0.125 TAB PO 17.00 2500492 CYCLOPENTOLATE 1% OPTH SOL 2ML 34.00 2500499 DONEPEZIL 10MG TAB 40.00 2500500 IRON SUCROSE 100MG/5ML INJ 267.00 2500501 RANITIDINE ELIXIR 150MG/10ML 46.00 2500503 PROPRANOLOL 10MG TAB 17.00 2500508 TERAZOSIN 5MG CAP 17.00 2500510 PED INFLUENZA VAC INJ 6-35 MO 67.00 2500512 ENALAPRIL IV - 2500513 EC ASA TAB - 2500514 RISPERIDONE 0.25MG TAB PO - 2500515 QUETIAPINE 25MG TAB - 2500516 OLANZAPINE 2.5MG TAB PO - 2500517 AMMONIA SALTS INH - 2500519 MAG CL TAB - 2500520 NICODERM 7MG PATCH TOP - 2500524 METHOTREXATE 200MG/8ML INJ - 2500526 LR 5000ML BAG IRRIG SOLUTION - 2500527 NACL 0.9%/KCL 20MEQ 1000ML IV - 2500528 PEN G BENZATHINE 2ML SYR INJ - 2500566 FOSPHENYTOIN 500MG VIAL IV - 2500567 WARFARIN 3MG TAB PO - 2500570 DUONEB 3ML AMPULE INH SOLN - 2500573 ACETAMINOPHEN 325MG/10ML PO - 2500574 IBUPROFEN SUSP 100MG/5ML PO - 2500575 DIPHENHYDRAMINE 12.5MG/5ML PO - 2500576 LEVAQUIN 750MG IV - 2500578 EZETIMIBE 10 MG PO TAB - 2500584 ESTRADIOL 1 MG TAB PO - 2500585 ACETAZOLAMIDE 250 MG PO TAB - 2500586 NS W/40MEQ KCL LVIV 1 L - 2500589 FINASTERIDE 5 MG TAB PO - 2500598 DILTIAZEM 125MG/25ML VIAL - 2500599 BOOSTRIX (Tdap) INJ >7YRS - 2500601 ENOXAPARIN 40MG/0.4ML SYR - 2500602 ADVAIR 500/50 INHALER - 2500613 HEPARIN 100 UNIT/ML 3ML SYR IV - 2500621 LIDOCAINE 2% 2ML AMP PRES FREE - 2500622 NS 3000 ML IRRIGATION - 2500626 MONTELUKAST 10MG TAB PO - 2500628 OXYBUTYNIN 5 MG IR TAB PO - 2500629 CHLORDIAZEPOXIDE 10MG TAB PO - 2500633 ALTEPLASE 2 MG INJ - 2500636 DULOXETINE DR 30MG CAPS PO - 2500639 MEMANTINE 10 MG TAB - 2500641 METHADONE 10 MG TAB - 2500645 BUSPIRONE 5 MG TABS - 2500648 ACETAMINOPHEN SUPP 650 MG - 2500649 MOXIFLOXACIN 0.5% 3ML OPTH - 2500650 THROMBIN 20000 UNITS/VIAL TOP - 2500651 MANNITOL 5% 1000ML IV BAG - 2500653 ACETAMINOPHEN 500 MG TAB PO - 2500654 TIMOLOL MALEATE 0.5% OPTH DROP - 2500655 SULFASALIZINE 500 MG TAB PO - 2500658 VANCOMYCIN 125 CAP PO - 2500660 LIDOCAINE 0.5%/EPIN 50ML MDV - 2500664 NEUTRA PHOS ORAL PACKET - 2500669 ONDANSETRON 4MG DISINT TAB - 2500671 LIDOCAINE 40MG/ML 5 ML AMP - 2500680 GELFOAM SIZE 100 SPONGE EA - 2500681 GELFOAM SIZE 50 SPONGE EA - 2500682 ADENOSINE 90MG/30ML INJ 848.00 2500687 GELFOAM POWDER 1 EA - 2500692 BACLOFEN 10MG TAB PO - 2500695 LACTATED RINGERS 500ML BAG IV - 2500697 PREDNISONE 5MG TAB PO - 2500700 CALCITRIOL 0.25 MCG TAB PO - 2500710 MEROPENEM 1 GM IV - 2500712 CEFEPIME HCL 1 GM INJ - 2500715 HYDROCORTISONE 10MG PO - 2500716 BUPROPION HCL 150MG PO - 2500718 LIDOCAINE HCL 4% TOP SOLN - 2500719 MIDAZOLAM HCL 5MG/ML IV - 2500721 NICOTINE TRANSDERM PATCH 14MG - 2500722 METOPROL TARTRATE 25MG TAB - 2500731 LEVOFLOXACIN 250MG TAB BLISTER - 2500732 ATENOLOL 50 MG TABS - 2500736 PREGABALIN 75 MG CAPSULE PO - 2500739 CELECOXIB 200MG CAPSULES PO - 2500740 NORTRIPTYLINE 25MG CAPS - 2500748 ZOLEDRONIC ACID 5MG INJ - 2500753 NADOLOL 40MG TAB PO - 2500756 PHENYLEPHRINE 10% OPH SOL 5ML - 2500760 LIDOCAINE 5% PATCH 54.00 2500767 CITALOPRAM 20MG TAB PO 27.00 2500772 ICODEXTRIN 4% 1500ML IP/IRR 691.00 2500780 BUPIVACAINE/EPI 0.5% INJ 30 ML - 2500784 POTASSIUM PHOS MONO 500MG PO - 2500786 DAPTOMYCIN 500MG INJ IV - 2500787 MAGNESIUM OXIDE 400MG TAB - 2500788 METHOCARBAMOL 1000MG/10ML INJ - 2500794 SITAGLIPTIN 100MG TAB PO - 2500795 LIDO/EPI 1% MPF 10ML IV - 2500798 VECURONIUM 10MG IV - 2500800 FLEETS OIL ENEMA RECTAL - 2500806 EMPTY EVAC CONT 1000ML GLS - 2500807 EMPTY FLEX CONT 250ML PLTC - 2500810 EPHEDRINE 25MG/5ML INJ SYR - 2500811 ONDANSETRON 4MG/5ML PO SOL - 2500812 ONDANSETRON 4MG/5ML UDC - 2500813 LIDOCAINE 2% GEL PF 5GM SYR - 2500821 PREVNAR-13 PEDS VACCINE - 2500823 LABETALOL 20MG/4ML INJ IV - 2500830 SYMBICORT 160/4.5 MCG INH - 2500832 RABIES VACCINE IM 2.5 IU VIAL - 2500836 DEXTROSE 50% INJ IV VIAL - 2500841 CELESTONE-BETAMETH 5ML VIAL - 2500849 IRON DEXTRAN 50MG/ML INJ 10CT - 2500864 WATER STRL IRRIG 250ML 24CT - 2500865 SOD CL 0.9% IRR 250ML 24CT - 2500887 OXYBUTYNIN 5MG ER TAB PO 17.00 2500890 IRON DEXTRAN 100MG/2ML VIAL - 2500891 HYDROMORPHONE 2MG TAB PO - 2501005 SUCCINYLCHOLINE 100MG/5ML SYR - 2501013 OXYMETAZOLINE 0.05% 15ML SPRY - 2501014 ROCURONIUM 50 MG/5 ML SYR - 2501019 DENOSUMAB INJ 60MG - 2501020 PROCAINAMIDE 1GM/10ML IV - 2501022 EPINEPHRINE 0.3 MG AUTO INJ TW - 2501029 QUETIAPINE 25MG TAB - 2501032 PERFLUTREN LIP MICROS 1.1MG/ML - 2501035 NALBUPHINE HCL 10MG AMP IV - 2501036 OXYCODONE 5 MG TAB IR PO - 2501041 KETOROLAC 0.5% OPHTH SOLN 5ML - 2501057 CASSETTE RESERVOIR 100 ML - 2501063 HYDROCODONE/APAP 5-325 TAB PO - 2501064 HYDROCODONE/APAP 5-325 6PK PO - 2501065 ALBUTEROL 1.25MG NEB SOLN INH - 2501067 BACITRACIN OINT 15G - 2501069 SULFAMETH/TRIM SUSP 30ML BTL - 2501070 PREDNISOLONE 1% OPTH SOLN 15ML - 2501071 ONDANSETRON 4MG DISINT TAB 4PK - 2501072 CHOLECALCIFEROL 1000 U TAB - 2501074 IOPAMIDOL 61%/50ML INJ VIAL - 2501078 METOPROLOL XL 25MG TAB PO - 2501081 NYSTATIN 100000U CRM 15 GM TOP - 2501083 FLU VACCINE 65 YRS & > IM - 2501085 LIDOCAINE 2% 5ML INJ PF 67.00 2501086 CLINDAMYCIN 600MG/50ML IVPB - 2501087 CLINDAMYCIN 900MG/50ML IVPB
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