Bill Item Long Desc Explanation Notes Price Stool for Occult Blood POC 44.00 Blood Glucose Monitoring POC 15.00 Urine Dipstick POC 51.00 URINE PREGNANCY TEST POC 47.00 Amylase Level 85.00 Home Visit Level 1 Established - 125.00 Home Visit Level 2 Established 170.00 Home Visit Level 3 Established 200.00 Hospital Discharge Management 30 min or Less - 160.00 Initial Hospital Care Level 1 - 200.00 Initial Hospital Care Level 2 - 300.00 Initial Hospital Care Level 3 - 400.00 Initial Observation Care Level 1 200.00 Initial Observation Care Level 2 - 300.00 Initial Observation Care Level 3 400.00 Nursing Facility Discharge Management 30 min or Less 150.00 Obs/ Same Day Inpatient Care Level 1 300.00 Observation/ Same Day Inpatient Care Level 2 400.00 Observation/ Same Day Inpatient Care Level 3 500.00 Observation Care Discharge - 160.00 Office/Outpatient Visit Level 1 Established 40.00 Office/Outpatient Visit Level 3 Established Specialty 160-190 Preventive Medicine 1-4 years New 235.00 Preventive Medicine 12-17 years Established 235.00 Preventive Medicine 12-17 years New 275.00 Preventive Medicine 18-39 years Established 240.00 Preventive Medicine 18-39 years New 275.00 Preventive Medicine 40-64 years Established 280.00 Preventive Medicine 40-64 years New 345.00 Preventive Medicine 5-11 years New 245.00 Preventive Medicine 65+ years Established 285.00 Preventive Medicine 65+ years New 270.00 Preventive Medicine < 1 year Established 200.00 Preventive Medicine < 1 year New 225.00 Subsequent Hospital Care Level 1 - 100.00 Subsequent Hospital Care Level 2 - 175.00 Subsequent Hospital Care Level 3 - 230.00 .Glucose Fasting 70-210 Glucose Level 70.00 Blood Urea Nitrogen 70.00 Creatinine Level 70.00 Sodium Level 70.00 Potassium Level 70.00 Chloride Level 70.00 Carbon Dioxide Level 90.00 Alanine Aminotransferase 70.00 Aspartate Aminotransferase 70.00 Albumin Level 66.00 Alkaline Phosphatase 70.00 Ammonia Level 88.00 Bilirubin Direct 70.00 Bilirubin Total 70.00 Arterial Blood Gas 1 182.00 Calcium Level 70.00 Cholesterol High Density Lipid 85.00 Cholesterol Low Density Lipids 85.00 Cholesterol Total 70.00 Creatine Kinase 77.00 C-Reactive Protein 110.00 D-Dimer 110.00 Digoxin Level 124.00 Gamma Glutamyl Transferase 61.00 HEMOGLOBIN 105.00 Hematocrit 105.00 Hemoglobin A1c 85.00 Lactic Acid 85.00 Lactate Dehydrogenase 30.00 Lipase Level 70.00 Lithium Level 105.00 Magnesium Level 35.00 Prothrombin Time 55.00 Partial Thromboplastin Time 55.00 Phosphorus Level 70.00 Platelet Count 105.00 Protein Level 24 Hour Urine 70.00 Protein, total, refractometry; serum, plasma or whole blood 70.00 Protein Level Urine 70.00 Sedimentation Rate 105.00 Thyroid Stimulating Hormone 110.00 Triglycerides 70.00 Uric Acid 70.00 Vitamin B12 Level 110.00 White Blood Count 105.00 Bladder Scan 260.00 Hepatitis A Adult Vaccine 64.00 Hepatitis A Peds/Adol Vaccine 2 Dose Sched Charge 42.00 Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose), IM POC 26.00 Flu Vaccine Split 6-35 Months IM POC 15.00 Flu Vaccine Split 3 yrs and above IM 15.00 Flu Vaccine Live Intranasal POC 15.00 Pneumococcal Conjugate Polyvalent Vaccine < 5yrs POC 140.00 Rabies Vaccine IM Charge 695.00 DTaP Diphtheria/Pertussis, acellular/Tetanus Vaccine DTaP Under 7 yrs POC 34.00 MMR Measles/Mumps/Rubella Virus Vaccine POC 121.00 IPV Inactivated Poliovirus Vaccine POC 43.00 Varicella Virus Vaccine POC 214.00 Diphth/Haemophilus/Pertusis,Acel/Tetanus Vaccine POC 59.00 Diphth/HepB/Pertussis,Acel/Polio/Tetanus Vaccine POC 129.00 Pneumococcal 23-Valent Adult Vaccine POC 150.00 Meningococcal Vaccine POC 144.00 Hepatitis B Vaccine, Pediatric 3 Dose Sched POC 32.00 Hepatitis B Vaccine, Adult 78.00 EKG 12 Lead, Interp/Report Only Charge 251.00 Wet Mount POC 37.00 KOH POC 49.00 HEMOGLOBIN POC 34.00 Rapid Strep POC 44.00 Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge 140.00 Shave (Epi)Dermal Lesion, Single, Scalp, Neck, Hands, Feet, Genital; Diam 0.6 to 1.0 cm Charge 330.00 Inj(s); Single Tendon Sheath, or Ligament, Aponeurosis (eg, Planterar ""Fascia"") Charge 116.00 Inj(s); Single or Mult Trigger Point(S), One or Two Muscle(s) Charge 106.00 Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for IM Use POC 55.00 Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use POC 145.00 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use POC 354.00 Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, for use in individuals 7 yrs POC 56.00 Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for IM Use POC 203.00 Pressurized or nonpressurized inhalation treatment for acute airway obstruction Charge 32.00 Monospot POC 62.00 Tetanus, diphtheria toxoids & acellular pertussis vaccine (TdaP), 7 years or older, IM use POC 64.00 Zoster (shingles) vaccine, live, subcutaneous injection POC 228.00 Influenza virus vaccine, splie virus, preservative free, for children 6-35 months of age, IM POC (in 10.00 Lead Level POC 105.00 Human Papilloma virus (HPV) Vaccine POC 186.00 Creatine Kinase-MB 156.00 Human Papilloma virus (HPV) Vaccine POC 167.00 Telemetry 208.00 Administration of Blood 860.00 Rapid Respiratory Syntycial Virus (RSV) 185.00 Screening Pap Smear w/Prep & Transfer To Lab (Task/Charge) 34.00 COLLECTION: Arterial Draw 40.00 COLLECTION: Venous Draw 40.00 COLLECTION: 24 Hour Urine 40.00 Therapeutic Phlebotomy 193.00 BD DEXA Axial Skeleton 370.00 CT Abdomen w/ + w/o Cont Other charges may apply 3,730.00 CT Abdomen w/ Cont Other charges may apply 2,015.00 CT Abdomen w/o Cont Other charges may apply 1,590.00 CT Head or Brain w/ + w/o Cont Other charges may apply 1,820.00 CT Head or Brain w/ Cont Other charges may apply 1,575.00 CT Head or Brain w/o Cont Other charges may apply 1,370.00 CT LE w/ Cont Lt Other charges may apply 1,740.00 CT LE w/ Cont Rt Other charges may apply 1,740.00 CT LE w/o Cont Lt Other charges may apply 1,465.00 CT LE w/o Cont Rt Other charges may apply 1,465.00 CT Orbit Sella etc. w/ Cont Other charges may apply 1,945.00 CT Orbit Sella etc. w/o Cont Other charges may apply 1,495.00 CT Pelvis w/ + w/o Cont Other charges may apply 1,965.00 CT Pelvis w/ Cont Other charges may apply 1,750.00 CT Pelvis w/o Cont Other charges may apply 1,390.00 CT Spine Cervical w/o Cont Other charges may apply 1,580.00 CT Spine Lumbar w/o Cont Other charges may apply 1,550.00 CT Spine Thoracic w/o Cont Other charges may apply 1,520.00 CT UE w/ Cont Lt Other charges may apply 1,765.00 CT UE w/ Cont Rt Other charges may apply 1,765.00 CT UE w/o Cont Lt Other charges may apply 1,470.00 CT UE w/o Cont Rt Other charges may apply 1,470.00 MRA Head w/ Cont Other charges may apply 2,710.00 MRA Neck w/o Cont Other charges may apply 1,935.00 MRI Brain w/ + w/o Cont Other charges may apply 3,600.00 MRI Brain w/ Cont Other charges may apply 2,735.00 MRI Brain w/o Cont Other charges may apply 2,650.00 MRI Chest w/ + w/o Cont Other charges may apply 3,595.00 MRI Face Neck Orbit w/ + w/o Cont Other charges may apply 3,720.00 MRI Face Neck Orbit w/ Cont Other charges may apply 3,005.00 MRI LE Joint w/ + w/o Cont Lt Other charges may apply 3,625.00 MRI LE Joint w/ + w/o Cont Rt Other charges may apply 3,625.00 MRI LE Joint w/o Cont Lt Other charges may apply 2,445.00 MRI LE Joint w/o Cont Rt Other charges may apply 2,445.00 MRI Pelvis w/ Cont Other charges may apply 2,790.00 MRI Pelvis w/o Cont Other charges may apply 2,495.00 MRI Spine Cervical w/ Cont Other charges may apply 2,830.00 MRI Spine Cervical w/o Cont Other charges may apply 2,510.00 MRI Spine Lumbar w/ Cont Other charges may apply 2,800.00 MRI Spine Lumbar w/o Cont Other charges may apply 2,550.00 MRI Spine Thoracic w/ Cont Other charges may apply 2,655.00 MRI Spine Thoracic w/o Cont Other charges may apply 2,535.00 MRI UE Joint w/o Cont Lt Other charges may apply 2,380.00 MRI UE Joint w/o Cont Rt Other charges may apply 2,380.00 NM Bone Ltd Other charges may apply 1,000.00 NM Bone Whole Body Other charges may apply 1,440.00 NM Bone 3 Phase Study Other charges may apply 1,665.00 NM Cardiac Blood Pool Gated Single Other charges may apply 1,635.00 NM GI Blood Loss Other charges may apply 1,645.00 NM Kidney w/ Flow w/ Pharm Other charges may apply 2,015.00 NM Pulm Perf Other charges may apply 1,055.00 NM Thyroid Only Other charges may apply 875.00 US Abdomen Comp 695.00 US Abdomen Ltd 635.00 US Carotid Duplex Bil 1,145.00 US Chest 505.00 US Head +Neck Soft Tissue 835.00 US Pregnant < 14 Weeks Ea Addl Gest 610.00 US Pregnant Transvaginal 490.00 US Retroperitoneal Comp 695.00 US Scrotum +Contents 555.00 US UE Veins Duplex Bil 909.00 US UE Veins Duplex Lt 659.00 XR Abdomen 1 View 190.00 XR Abdomen 2 Views 260.00 XR Ankle Comp Min 3 Views Lt 205.00 XR Ankle Comp Min 3 Views Rt 205.00 XR Heel Min 2 Views Lt 180.00 XR Heel Min 2 Views Rt 180.00 XR Chest 1 View 170.00 XR Chest 2 Views 220.00 XR Clavicle Comp Lt 185.00 XR Clavicle Comp Rt 185.00 XR Elbow 2 Views Lt 200.00 XR Elbow 2 Views Rt 200.00 XR Facial Bones < 3 Views 190.00 XR Facial Bones Comp Min 3 Views 270.00 FLUOROSCOPY, Up to 1 Hour 290.00 XR Foot 2 Views Lt 180.00 XR Foot 2 Views Rt 180.00 XR Foot Comp Min 3 Views Lt 205.00 XR Foot Comp Min 3 Views Rt 205.00 XR Forearm 2 Views Lt 190.00 XR Forearm 2 Views Rt 190.00 XR Eye FB Bil 175.00 XR Hand 2 Views Lt 175.00 XR Hand 2 Views Rt 175.00 XR Hand Min 3 Views Lt 220.00 XR Hand Min 3 Views Rt 220.00 XR Humerus Min 2 Views Lt 200.00 XR Humerus Min 2 Views Rt 200.00 XR Knee 3 Views Lt 230.00 XR Knee 3 Views Rt 230.00 XR Knee 1 or 2 Views Lt 190.00 XR Knee 1 or 2 Views Rt 190.00 XR Mandible Comp Min 4 Views 670.00 XR Nasal Bones Comp Min 3 Views 210.00 XR Neck Soft Tissue 170.00 XR Pelvis 1 or 2 Views 185.00 XR Ribs 2 Views Lt 210.00 XR Ribs 2 Views Rt 210.00 XR Ribs 3 Views Bil 275.00 XR Sacrum +Coccyx Min 2 Views 205.00 XR Scapula Comp Lt 205.00 XR Scapula Comp Rt 205.00 XR Shoulder 1 View Lt 170.00 XR Shoulder 1 View Rt 170.00 XR Sinuses Paranasal Comp Min 3 Views 245.00 XR Skull < 4 Views 225.00 XR Spine Cerv 2 or 3 Views 220.00 XR Spine Lumbosacral 2 or 3 Views 245.00 XR Spine Lumbosacral Min 4 Views 330.00 XR Spine Thoracic 2 Views 225.00 XR Spine Thoracic 3 Views 260.00 XR Sternoclavicular Joint(s) Min 3 Views 215.00 XR Sternum Min 2 Views 210.00 XR Wrist Comp Min 3 Views Rt 230.00 XR Wrist Comp Min 3 Views Lt 230.00 XR Wrist 2 Views Rt 185.00 XR Wrist 2 Views Lt 185.00 NM Parathyroid Other charges may apply 1,050.00 NT Pro-BNP 320.00 Preventive Medicine 5-11 years Established 215.00 Preventive Medicine 1-4 years Established 210.00 RBC CP2D AS3 500 LR 540.00 PACKED CELLS LR 540.00 Aph Plt ACDA LR 1,188.00 Aph Plt ACDA LR 1 1,188.00 Aph Plt ACDA LR 2 1,188.00 Acetaminophen Level 320.00 Free T4 110.00 Vancomycin Level 105.00 IMM ADM >8 1ST ORL/N NSG Charge 15.00 ROOM/BED: Semi Private 978.00 Troponin I 85.00 Antibody Screen 150.00 Ab ID Interp 265.00 CT Abdomen +Pelvis w/ + w/o Cont Other charges may apply 3,730.00 CT Abdomen +Pelvis w/ Cont Other charges may apply 3,315.00 CT Abdomen +Pelvis w/o Cont Other charges may apply 2,705.00 CT Angio Neck w/ Cont Other charges may apply 2,335.00 CT Chest +Abdomen +Pelvis w/ + w/o Cont Other charges may apply 5,860.00 CT Chest +Abdomen +Pelvis w/ Cont Other charges may apply 5,274.00 CT Chest +Abdomen +Pelvis w/o Cont Other charges may apply 4,981.00 CT Chest w/o Cont Other charges may apply 1,545.00 CT Chest w/ + w/o Cont Other charges may apply 2,160.00 CT Chest +Abdomen w/ + w/o Cont Other charges may apply 4,212.00 CT Chest +Abdomen w/o Cont Other charges may apply 3,580.00 CT Orbit Sella etc. w/ + w/o Cont Other charges may apply 1,950.00 CT Sinus or Facial w/ Cont Other charges may apply 1,655.00 CT Soft Tissue Neck w/ + w/o Cont Other charges may apply 1,960.00 CT Soft Tissue Neck w/ Cont Other charges may apply 1,695.00 CT Soft Tissue Neck w/o Contrast Other charges may apply 1,115.00 CT Spine Cervical w/ + w/o Cont Other charges may apply 1,535.00 CT Spine Cervical w/ Cont Other charges may apply 1,635.00 CT Spine Lumbar w/ + w/o Cont Other charges may apply 1,535.00 CT Spine Lumbar w/ Cont Other charges may apply 1,750.00 CT Spine Thoracic w/ + w/o Cont Other charges may apply 2,105.00 CT Spine Thoracic w/ Cont Other charges may apply 1,755.00 CT UE w/ + w/o Cont Lt Other charges may apply 1,980.00 CT UE w/ + w/o Cont Rt Other charges may apply 1,980.00 MRA Head w/ + w/o Cont Other charges may apply 4,165.00 MRA Head w/o Cont Other charges may apply 2,845.00 MRA Neck w/ + w/o Cont Other charges may apply 3,555.00 MRA Neck w/ Cont Other charges may apply 2,460.00 MRI Abdomen w/ + w/o Cont Other charges may apply 3,690.00 MRI Abdomen w/ Cont Other charges may apply 2,840.00 MRI Abdomen w/o Cont Other charges may apply 2,545.00 MRI Chest w/ Cont Other charges may apply 3,015.00 MRI Chest w/o Cont Other charges may apply 2,725.00 MRI Face Neck Orbit w/o Cont Other charges may apply 2,450.00 MRI LE Joint w/ Cont Lt Other charges may apply 2,665.00 MRI LE Joint w/ Cont Rt Other charges may apply 2,665.00 MRI LE Non Joint w/ + w/o Cont Lt Other charges may apply 3,755.00 MRI LE Non Joint w/ + w/o Cont Rt Other charges may apply 3,755.00 MRI LE Non Joint w/ Cont Lt Other charges may apply 2,925.00 MRI LE Non Joint w/ Cont Rt Other charges may apply 2,925.00 MRI LE Non Joint w/o Cont Lt Other charges may apply 2,725.00 MRI LE Non Joint w/o Cont Rt Other charges may apply 2,725.00 MRI Pelvis w/ + w/o Cont Other charges may apply 3,425.00 MRI Spine Cervical w/ + w/o Cont Other charges may apply 3,715.00 MRI Spine Lumbar w/ + w/o Cont Other charges may apply 3,680.00 MRI Spine Thoracic w/ + w/o Cont Other charges may apply 3,515.00 MRI TMJ Other charges may apply 2,440.00 MRI UE Joint w/ + w/o Cont Lt Other charges may apply 3,445.00 MRI UE Joint w/ + w/o Cont Rt Other charges may apply 3,445.00 MRI UE Joint w/ Cont Lt Other charges may apply 2,815.00 MRI UE Joint w/ Cont Rt Other charges may apply 2,815.00 MRI UE Non Joint w/ + w/o Cont Lt Other charges may apply 3,955.00 MRI UE Non Joint w/ + w/o Cont Rt Other charges may apply 3,955.00 MRI UE Non Joint w/ Cont Lt Other charges may apply 2,795.00 MRI UE Non Joint w/ Cont Rt Other charges may apply 2,795.00 MRI UE Non Joint w/o Cont Lt Other charges may apply 2,620.00 MRI UE Non Joint w/o Cont Rt Other charges may apply 2,620.00 NM Bone Mult Areas Other charges may apply 1,195.00 NM Bone Spect Other charges may apply 1,320.00 NM Gastric Emptying Study Other charges may apply 1,405.00 NM Kidney w/ Flow w/o Pharm Other charges may apply 2,230.00 NM Kidney Spect Other charges may apply 1,540.00 NM Liver Spect Other charges may apply 1,230.00 NM Liver w/ Vascular Flow Other charges may apply 1,220.00 NM Liver Static Only Other charges may apply 1,425.00 NM Liver +Spleen Static Only Other charges may apply 1,255.00 NM Liver +Spleen w/ Vascular Flow Other charges may apply 1,130.00 NM Myocard Perf Spect Mult Other charges may apply 1,955.00 NM Pulm Perf w/ Vent Other charges may apply 1,540.00 US Pregnant Fol-Up 435.00 US Pregnant > 14 Weeks Ea Addl Gest Other charges may apply 585.00 US Pelvic Non-OB Comp 625.00 US Pelvic Non-OB Ltd 490.00 US Pregnant Ltd 375.00 US Retroperitoneal Ltd 260.00 XR Ankle 2 Views Lt 180.00 XR Ankle 2 Views Rt 180.00 XR Bone Age Studies 155.00 XR Elbow Comp Min 3 Views Lt 240.00 XR Elbow Comp Min 3 Views Rt 240.00 XR Fluoro Guide Ndl Placement 333.00 XR Fluoro Over 1 Hour 475.00 XR Knee Comp Min 4 Views Lt 280.00 XR Knee Comp Min 4 Views Rt 280.00 XR Knee Standing AP Bil 230.00 XR Mandible Partial < 4 Views 235.00 XR Mastoids < 3 Views Bil 210.00 XR Mastoids Comp Min 3 Views Bil 265.00 XR Ribs Min 3 Views Rt w/ AP Chest 285.00 XR SI Joints 1 or 2 Views 190.00 XR Sinuses Paranasal < 3 Views 185.00 XR Skull Comp Min 4 Views 305.00 XR Spine Cerv Comp w/ Obl +Flex +/or Ext 370.00 XR Spine Lumbosacral Comp w/ Bending 390.00 XR Spine 1 View Specify Level 175.00 XR Spine Thoracolumbar 2 Views 255.00 XR TMJ Open +Closed Bil 265.00 Aph RBC CP2D AS3 LR 540.00 Aph RBC ACDA AS3 LR 540.00 Aph RBC ACDA AS3 LR 1 540.00 Aph RBC ACDA AS3 LR 2 540.00 HCG QUANTITATIVE 110.00 PSA Screen 139.00 PSA Diagnostic 85.00 Complete Blood Count with Auto Diff 105.00 Alcohol Level 1 85.00 CT Sinus or Facial w/ + w/o Cont Other charges may apply 1,815.00 US Aorta Duplex IVC Iliac Comp 995.00 US Aorta Duplex IVC Iliac Ltd 655.00 XR Cholangiography Intraoperative 330.00 XR Optic Foramina Lt 245.00 XR Optic Foramina Rt 245.00 XR Pelvis Comp Min 3 Views 250.00 XR SI Joints Min 3 Views 210.00 US Guide Ndl Placement 740.00 Initial Nursing facility care (History, Examination and MDM) 180.00 Initial Nursing facility care (History, Examination and MDM of moderate complexity) 250.00 Subsequent nursing facility care (History, Examination and MDM) 90.00 Subsequent nursing facility care (History, Examination and MDM of low complexity 130.00 CT Chest w/ Cont Other charges may apply 1,820.00 XR Chest Special Views 205.00 XR Spine Cerv Min 4 Views 325.00 US Pregnant < 14 Weeks 1st Gest 515.00 Iron Level 70.00 .GTT-1 Hr 70.00 .GTT-2 Hr 70.00 .GTT-3 Hr 70.00 CT LE w/ + w/o Cont Lt Other charges may apply 2,345.00 CT LE w/ + w/o Cont Rt Other charges may apply 2,345.00 NM Kidney Morph w/ Vascular Flow Other charges may apply 910.00 US Carotid Duplex Lt 770.00 US Carotid Duplex Rt 770.00 US Guide Intraoperative 325.00 US Transrectal 710.00 XR Chest Comp Min 4 Views 280.00 XR Fluoro Guide CVA Placement 290.00 XR Pharynx or Larynx w/ Fluoro 355.00 XR Spine Lumbosacral Bending Only 240.00 Subsequent nursing facility care (History, Examination and MDM of moderate complexity) 170.00 Initial eval mgmnt of pt an annual nsg facility assessment. Physician spends 45 minutes 350.00 Path Consult Frozen Add 28.00 Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule,intramuscular 165.00 CT Angio Chest w/ Cont Other charges may apply 2,260.00 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use 316.00 Initial preventive exam 130.00 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intramuscular 35.00 Immunization Administration 1 vaccine 15-38 Administration Each additional vaccine 15-38 PT ELECTRICAL STIMULATION CHARGE 110.00 PT MASSAGE CHARGE 65.00 OT ELECTRICAL STIMULATION CHARGE 110.00 OT NEUROMU RE-EDU CHARGE 75.00 MA Diag Bil. Other charges may apply 348-408 ED Level 1 -Critical Care, Facility & Pro 445-3700 MA Diag Rt. Other charges may apply 253-313 CT Chest +Abdomen w/ Cont Other charges may apply 3,790.00 DTaP-Hib-IPV Vaccine IM 109.00 CT Angio Abdomen +Pelvis w/ Cont Other charges may apply 2,670.00 Methylprednisolone injection 33.00 Office/OP New Visit Level 2 165.00 Office/OP New Visit Level 3 230.00 Office/OP New Visit Level 4 350.00 Office/OP Established Visit Level 2 105-115 Office/OP Established Visit Level 4 220-275 Office/OP Established Visit Level 5 275-370 Salicylate Level 320.00 Serum Pregnancy Test POC 64.00 NM Hepa Duct System w/ Pharm 1,820.00 NM Hepa Duct System w/o Pharm Other charges may apply 1,405.00 XR Shoulder Comp Min 2 Views Lt 230.00 XR Shoulder Comp Min 2 Views Rt 230.00 Hematocrit POC 34.00 Hematocrit POC 34.00 MRA UE w/ Cont Rt Other charges may apply 2,435.00 Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above 15.00 Subsequent observation care, per day 150.00 Annual Wellness Visit, Initial (AWV) 200.00 Annual Wellness Visit, Subsequent (AWV) 200.00 Subsequent observation care, per day, for the evaluation and management of a patient,w/ 2 key 100.00 annual nursing facility assessment visit 200.00 XR AC Joints w/ or w/o Weights Bil 225.00 XR Bone Survey Comp 520.00 XR Bone Survey Ltd Mets 330.00 XR IVP 685.00 Antibody Screen 150.00 DIETARY CONSULT Individual (15 mins) CHARGE 50.00 Holter Monitor upto 48 hr 349.00 Adrenalin epinephrine inject 29.00 Blood Typing History Check 42.00 US Pregnant > 14 Weeks 1st Gest 610.00 US Pregnant Detailed 1st Gest 690.00 OXYGEN/HR 20.00 ABO/Rh Interp 115.00 Crossmatch AHG Interp 245.00 Microalb/Creat Ratio 55.00 Urine Micro Albumin 55.00 Urine Creatinine 70.00 CT Angio Abdomen w/ +/or w/o Cont Other charges may apply 2,625.00 INFRARED UNATTENDED 60.00 OT THERAPEUTIC ACTIVITY 90.00 SWALLOW EVALUATION 320.00 .GTT-4 Hr 85.00 OXYGEN CANNULA 22.00 NM Cardiac Blood Pool Gated Rest +Stress Other charges may apply 2,160.00 US Extremity Nonvascular Ltd Lt 330.00 US Extremity Nonvascular Ltd Rt Other charges may apply 330.00 XR Ribs Min 4 Views Bil w/ PA Chest 370.00 Office/OP New Visit Level 5 440.00 Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use 185.00 Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-I 89.00 PT ULTRASOUND 80.00 PT IONTOPHORESIS 85.00 PT NEUROMUSCULAR REEDUCATION 80.00 PT THERAPEUTIC ACTIVITIES 90.00 PT MANUAL THERAPY 90.00 OT IONTOPHORESIS 85.00 OT THERAPEUTIC EXERCISE 85.00 OT MANUAL THERAPY 90.00 PT WHIRLPOOL THRPY/VIST 120.00 PT DEBRIDEMENT SELECTIVE <= 20CM 135.00 PT DEBRIDEMENT SELECTIVE >20CM 200.00 XR Fluoro Guide Therapeutic Inj 330.00 CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION WITH MANIPULATION CHARGE 785.00 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE COLLES OR SMITH TYPE OR EPIPHYSEAL SEPARATION WITH MANIPU 1,070.00 NM Myocard Perf Spect Single Other charges may apply 1,330.00 ABO Typing 115.00 CT Sinus or Facial w/o Cont Other charges may apply 1,280.00 MRA Abdomen w/ Cont Other charges may apply 2,670.00 MRA Chest w/ Cont Other charges may apply 2,565.00 MRA LE w/ Cont Lt Other charges may apply 2,740.00 MRA LE w/ Cont Rt Other charges may apply 2,740.00 XR Radiologic Examination, Abdomen 3 or More Views 310.00 XR Femur 2 Views Lt 200.00 XR Femur 2 Views Rt 200.00 XR Ribs Min 3 Views Lt w/ AP Chest 285.00 XR Tibia +Fibula 2 Views Lt 200.00 XR Tibia +Fibula 2 Views Rt 200.00 Ferritin Level 140.00 PT WORK HARDENING INIT 2 HRS CHARGE 265.00 OT ORTHOTIC FITTING/TRAINING/15 MIN CHARGE 70.00 Automated Differential 1 105.00 Bill Path Consult Frozen 85.00 NM Thyroid Uptake Single Other charges may apply 385.00 Allergy Injection Single POC 22.00 Allergy Injection Multi POC 26.00 Blood Glucose POC 15.00 Path IH Stain Each Ab 810.00 Rh(D) Type 115.00 DIRECT COOMBS (DAT) 53.00 Path Enzyme Histo 62.00 MOD SEDATION SERV; >5Y EA ADD 15 MIN 36.00 MOD SEDATION SERV; > 5 1ST 30MIN 316.00 Flu A&B Nasal Swab POC 56.00 Hepatic Panel 1 150.00 DIPHTH.,TETANUS, PERTUSSIS 26.00 TRTMT CLOSED PATELLAR DISCLOCATION W/O ANES CHARGE 670.00 Aph RBC CP2D AS3 LR 1 540.00 APH RBC CP2D AS3 LR 2 540.00 ROOM/BED: Day Surgery 505.00 RSV POC 135.00 Elution 114.00 Rh Phenotype 170.00 Microalbumin POC 46.00 FLU 65 YRS AND OVER/FLU INJECTION CVX 135 60.00 WBC w/ Abs Neut 105.00 Surg Level I 55.00 Surg Level II 120.00 Bill Surg Level III 88304 75.00 Bill Surg Level IV 88305 75.00 Surg Level V 375.00 Surg Level VI 510.00 Surg Decal 30.00 Surg Stains Micro Org 88312 210.00 Bill Surg Stains Non-Micro 88313 175.00 SLEEP STUDY WITH CPAP (SPLIT STUDY) 3,538.00 MRA UE w/ Cont Lt Other charges may apply 2,435.00 NM Intestine Other charges may apply 1,385.00 NM Spleen w/ or w/o Vascular Flow Other charges may apply 845.00 Lipid Panel 2 150.00 Ambulance Mileage per loaded mile 9.00 -22.00 per mile NEGATIVE PRESSUR WOUND THERAPY CHARGE 80.00 Antigen Type 571.00 ID Urine 40.00 PT GAIT TRAINING 85.00 PT THERAPEUTIC EXERCISE 85.00 OT FLUIDOTHERAPY 175.00 OT ULTRASOUND 115.00 US Extremity Nonvascular Comp Lt Other charges may apply 505.00 US Extremity Nonvascular Comp Rt Other charges may apply 505.00 XR Fingers Min 2 Views 2nd Digit Lt 185.00 XR Fingers Min 2 Views 2nd Digit Rt 185.00 XR Fingers Min 2 Views 3rd Digit Lt 185.00 XR Fingers Min 2 Views 3rd Digit Rt 185.00 XR Fingers Min 2 Views 4th Digit Lt 185.00 XR Fingers Min 2 Views 4th Digit Rt 185.00 XR Fingers Min 2 Views 5th Digit Lt 185.00 XR Fingers Min 2 Views 5th Digit Rt 185.00 XR Fingers Min 2 Views Thumb Lt 185.00 XR Fingers Min 2 Views Thumb Rt 185.00 XR Toe Min 2 Views 2nd Digit Lt 170.00 XR Toe Min 2 Views 2nd Digit Rt 170.00 XR Toe Min 2 Views 3rd Digit Lt 170.00 XR Toe Min 2 Views 3rd Digit Rt 170.00 XR Toe Min 2 Views 4th Digit Lt 170.00 XR Toe Min 2 Views 4th Digit Rt 170.00 XR Toe Min 2 Views 5th Digit Lt 170.00 XR Toe Min 2 Views 5th Digit Rt 170.00 XR Toe Min 2 Views Great Lt 170.00 XR Toe Min 2 Views Great Rt 170.00 IN-SITU Hybridization Fixed Tissue. 420.00 GASTROSCOPY CHARGE Bundle Charge 3,089.00 COLONOSCOPY W/BIOPSY CHARGE Bundle Charge,Pro, Tech 5,542.00 EPIDURAL ANES FACILITY CHARGE includes fluro 2,233.00 CT Angio Chest +Angio Abd w/ + w/o Cont Other charges may apply 3,941.00 CT Angio Chest +Angio Abd+Pelvis w/ Cont Other charges may apply 3,941.00 CARDIAC REHAB/MONITOR 295.00 Bleeding Time 32.00 KOH Prep 70.00 Electrolytes 3 150.00 Direct Coombs 51.00 Creatinine Clearance 1 85.00 OT APPLY HOT COLD PACKS CHARGE 60.00 OT EVALUATION CHARGE 188.00 OT RE-EVALUATION CHARGE 115.00 PT RE-EVALUATION CHARGE 100.00 PT TENS APPLICATION CHARGE 75.00 OMT 1-2 body regions 60.00 OMT 3-4 body regions 90.00 Acetylcholine Receptor Binding Antibody MCL 150.00 Adrenocorticotropic Hormone MCL 180.00 Albumin Body Fluid MCL 64.00 Aldolase MCL 75.00 Aldosterone MCL 90.00 Allergen IgE Latex MCL 45.00 Alpha 1 Antitrypsin MCL 105.00 Aminolevulinic Acid Urine Timed MCL 200.00 Androstenedione MCL 95.00 Angiotensin Converting Enzyme MCL 85.00 Anti Neutrophil Cytoplasmic Antibody Screen MCL 75.00 Anti Thrombin III Activity MCL 45.00 Antinuclear Antibody IFA Confirmation with Titer MCL 60.00 Antistreptolysin O MCL 65.00 Arginine Vasopressin MCL 190.00 BCR-ABL Gene Rearrangement MCL 415.00 Bile Acids Total Conjugated MCL 135.00 BK Virus DNA Quantitation MCL 375.00 .Peripheral Blood Smear Pathologist MCL 74.00 C Peptide MCL 95.00 CA 125 MCL 65.00 CA 19-9 MCL 95.00 Calcitonin MCL 155.00 Calcium Urine Random MCL 30.00 Campylobacter Antigen MCL 60.00 Carbamazepine Level MCL 105.00 Carcinoembryonic Antigen MCL 90.00 Blood Smear Review for Pathologist MCL 50.00 Cell Count Body Fluid MCL 30.00 Ceruloplasmin MCL 75.00 Chlamydia Culture MCL 95.00 LDL MCL 40.00 Cholinesterase MCL 40.00 Chromogranin A MCL 165.00 Citrate Urine Timed MCL 145.00 Clozapine and Norclozapine Level MCL 220.00 Cold Agglutinin Titer MCL 40.00 Complement C3 MCL 60.00 Complement C4 MCL 60.00 Copper Level MCL 75.00 Cortisol PM MCL 80.00 Cryoglobulin Qualitative MCL 30.00 Cryptococcus Antigen MCL 60.00 Cryptosporidium Antigen MCL 60.00 Culture AFB MCL 55.00 Culture Blood MCL 50.00 Culture Body Fluid + Smear MCL 40.00 Culture Fungal MCL 30.00 Culture Genital + Smear MCL 40.00 Culture Nasopharyngeal MCL 40.00 Culture Sputum + Smear MCL 40.00 Culture Throat MCL 40.00 Culture Urine MCL 90.00 Culture Viral MCL 40.00 Cyclic Citrullinated Peptide Ab MCL 65.00 Cyclosporin Level Peak MCL 85.00 Cyclosporin Level Trough MCL 85.00 Cystine Urine Timed MCL 320.00 Cytomegalovirus DNA by PCR MCL 525.00 Cytomegalovirus IgG Antibody MCL 70.00 Cytomegalovirus IgM Antibody MCL 80.00 Dehydroepiandrosterone Sulfate MCL 105.00 DNA Double Stranded Antibody MCL 100.00 E chaffeensis Antibody IgG and IgM MCL 175.00 Eosinophil Smear Body Fluid MCL 20.00 Epstein Barr Virus Early Antigens Antibody MCL 85.00 Erythropoietin Level MCL 100.00 Estradiol Level MCL 130.00 Estrogens Fractionated (E1 and E2) MCL 100.00 Estrone MCL 120.00 Factor V Assay MCL 120.00 Factor V Leiden MCL 275.00 Factor VII Assay MCL 160.00 Factor VIII Assay MCL 90.00 Factor X Assay MCL 165.00 Fecal Fat Qualitative MCL 25.00 Fecal Fat Quantitative MCL 210.00 Fecal Lactoferrin MCL 95.00 Fibrinogen MCL 40.00 Folate Level MCL 101.00 Follicle Stimulating Hormone MCL 90.00 Gabapentin Level MCL 155.00 Gamma Hydroxybutyric Acid MCL 195.00 Gastrin MCL 90.00 Giardia Antigen MCL 60.00 Glucose Body Fluid MCL 20.00 Glucose Cerebrospinal Fluid MCL 20.00 Glutamic Acid Decarboxylase Ab MCL 220.00 Gram Stain only MCL 20.00 Haptoglobin MCL 150.00 Helicobacter pylori Antigen Stool MCL 115.00 Heparin Induced Thrombocytopenia Ab MCL 85.00 Hepatitis A Antibody IgM MCL 55.00 Hepatitis A Antibody Total MCL 70.00 Hepatitis B Core Antibody Total MCL 45.00 Hepatitis B DNA Quant MCL 465.00 Hepatitis B Surface Antibody Qualitative and Quantitative MCL 160.00 Hepatitis B Surface Antigen MCL 45.00 Hepatitis Be Antibody MCL 135.00 Hepatitis C Antibody Screen MCL 115.00 Hepatitis C Virus Genotyping MCL 450.00 Hepatitis Panel Acute MCL 195.00 Hereditary Hemochromatosis Gene MCL 255.00 Histoplasma Antigen Urine MCL 575.00 HLA B27 MCL 115.00 Homocysteine MCL 80.00 H. pylori Antibody MCL 80.00 Human Papilloma Virus PCR MCL 165.00 Immunofixation Urine MCL 105.00 Immunoglobulin A MCL 45.00 Immunoglobulin E MCL 75.00 Immunoglobulin G MCL 90.00 Immunoglobulin M MCL 45.00 Inhibin A MCL 190.00 Insulin Antibodies MCL 255.00 Insulin Growth Factor 1 MCL 145.00 Insulin Level MCL 55.00 Intrinsic Factor Block Antibody MCL 170.00 Islet Cell Antibody MCL 145.00 JAK2 V617F Mutation Detection MCL 345.00 JO 1 Antibody MCL 62.00 Keppra Level MCL 115.00 Lactate Dehydrogenase Body Fluid MCL 30.00 Lamotrigine Level MCL 110.00 Lead Level Capillary MCL 40.00 Legionella Antigen MCL 60.00 Leptospira Antibody MCL 105.00 Lipoprotein a MCL 80.00 Lithium Level MCL 73.00 Liver Kidney Microsomal Antibody MCL 90.00 Luteinizing Hormone MCL 90.00 Lyme Antibody Screen MCL 204.00 Malaria Smear MCL 20.00 Mercury Level MCL 85.00 Metanephrines Fractionated Free LC MS MCL 210.00 Methylmalonic Acid MCL 85.00 Mitochondrial Antibody MCL 75.00 Mumps Virus IgG Antibody MCL 65.00 Myoglobin Quantitative MCL 85.00 Nortriptyline Level MCL 150.00 N-Telopeptides Cross Linked Urine MCL 200.00 Organic Acids, Urine MCL 455.00 Osmolality MCL 35.00 Osmolality Urine MCL 35.00 Outreach Calcium, Ionized MCL 75.00 Ova and Parasites Basic MCL 60.00 Oxalate Urine Timed MCL 100.00 Oxcarbazepine Trileptal MCL 110.00 Pancreatic Elastase, Fecal MCL 270.00 Parathyroid Hormone Intact MCL 195.00 Parathyroid Hormone Related Peptide MCL 66.00 pH Body Fluid MCL 20.00 Phenobarbital Level MCL 55.00 Phosphorous Urine Timed MCL 25.00 Pinworm Prep MCL 20.00 Plasma Free Hemoglobin MCL 60.00 Porphyrin Urine Random MCL 130.00 Procainamide with NAPA MCL 95.00 Progesterone 17 Hydroxy MCL 60.00 Progesterone Level MCL 100.00 Prolactin MCL 90.00 Prostate Specific Antigen Free MCL 90.00 Prostatic Acid Phosphatase MCL 135.00 Protein Body Fluid MCL 20.00 Protein C Activity MCL 65.00 Protein Electrophoresis Urine MCL 150.00 Protein S Activity MCL 95.00 Q Fever Antibody MCL 60.00 Quinidine Level MCL 140.00 RBC Folate MCL 65.00 Reducing Substance Stool MCL 15.00 Renin Activity MCL 120.00 Reticulin Antibodies (A,G,M) MCL 105.00 Reticulocyte Count MCL 30.00 Rheumatoid Factor MCL 30.00 Rocky Mt Spotted Fever Antibody MCL 75.00 Rotavirus Direct Antigen Stool MCL 60.00 Rubella IgG Antibody MCL 70.00 Rubella IgM Antibody MCL 100.00 Rubeola IgG Antibody MCL 135.00 Rubeola IgM Antibody MCL 135.00 Scleroderma 70 Antibodies MCL 62.00 Selenium MCL 140.00 Sex Hormone Binding Globulin MCL 95.00 Sickle Cell Screen MCL 40.00 Sjogren's A Antibody MCL 70.00 Sjogren's B Antibody MCL 70.00 Smooth Muscle Antibody MCL 75.00 Soluble Transferrin Receptor MCL 130.00 Specific Gravity Body Fluid MCL 25.00 T3 Free MCL 80.00 T3 Reverse MCL 140.00 T3 Total MCL 60.00 T3 Uptake MCL 75.00 T4 Total MCL 35.00 Tacrolimus Level MCL 65.00 Testosterone Free MCL 55.00 Testosterone Total MCL 120.00 Tetanus Antibody IgG MCL 215.00 Thyroglobulin Antibody MCL 115.00 Thyroid Peroxidase Antibody MCL 70.00 Thyroid Stimulating Immunoglobulin MCL 305.00 Tissue Transglutaminase IgA Antibody MCL 90.00 Tissue Transglutaminase IgG Antibody MCL 90.00 Toxigenic E Coli MCL 60.00 Transferrin MCL 60.00 Trypsin like Immunoreactivity MCL 160.00 Tryptase MCL 155.00 Uric Acid Urine Random MCL 25.00 Uric Acid Urine Timed MCL 25.00 Vanillymandelic Acid Urine Timed MCL 125.00 Varicella Zoster Virus IgG Antibody MCL 65.00 Vitamin A MCL 95.00 Vitamin B1 Level MCL 115.00 Vitamin B6 MCL 150.00 Vitamin D 1 25 Dihydroxy MCL 180.00 Vitamin D Hydroxy 175.00 Vitamin E MCL 150.00 Vitamin K1 MCL 260.00 Zinc Level MCL 75.00 Zonisamide Level MCL 160.00 STANDARD SLEEP STUDY CHARGE 3,098.00 OT ADL TRAINING CHARGES 85.00 DAT 4 53.00 Pre TR DAT 4 53.00 Post TR DAT 4 53.00 Folate Level 97.00 Microalbumin Level Urine 55.00 ANCA Pat MCL 75.00 Stool Culture MCL 45.00 RNP Ab MCL 62.00 SSA Ab MCL 62.00 SSB Ab MCL 62.00 ST SPEECH EVAL CHARGE 430.00 ST SPEECH THERAPY CHARGE 295.00 ST TX SWAL DYSFUNC CHARGE 255.00 ST VIDEOFLUOR SWALLOW CHARGE 305.00 NEG PRESSURE WND THER >50SQ CM CHARGE 74.00 Psychotherapy, 60 minutes with patient and/or family member 390.00 Family psychotherapy (without the patient present) 390.00 US Pelvis Non-OB Comp Transvaginal 595.00 MONO SCREEN 10.00 Amitriptyline Lvl MCL 90.00 Nortriptyline Lvl MCL 80.00 Nordiazepam MCL 210.00 Diazepam Lvl MCL 210.00 Diptheria Ab MCL 105.00 Tetanus Ab MCL 105.00 Doxepin Lvl MCL 180.00 Nordoxepin MCL 32.00 Echo 6 MCL 100.00 Echo 7 MCL 100.00 Echo 9 MCL 100.00 Echo 11 MCL 100.00 Echo 30 MCL 100.00 Egg White IgE MCL 25.00 Peanut IgE MCL 25.00 Soybean IgE MCL 25.00 Milk IgE MCL 25.00 Clam IgE MCL 25.00 Shrimp IgE MCL 25.00 Walnut IgE MCL 25.00 Codfish (Whitefish) IgE MCL 25.00 Scallop IgE MCL 25.00 Wheat IgE MCL 25.00 Corn IgE MCL 25.00 Sesame IgE MCL 25.00 Arsenic MCL 95.00 Lead MCL 70.00 Mercury MCL 85.00 HSV 1 IgG Ab Interp MCL 65.00 HSV 2 IgG Ab Interp MCL 35.00 Imipramine Lvl MCL 115.00 Desipramine Lvl MCL 150.00 LD 1 MCL 160.00 LD Tot MCL 30.00 Kappa Free Lt Chains, Serum MCL 70.00 Lambda Free Lt Chains, Serum MCL 70.00 PTT Lupus Sens MCL 25.00 DRVVT Scr MCL 35.00 Thrombin MCL 30.00 Staclot MCL 85.00 Primidone Lvl MCL 40.00 Phenobarbital Lvl MCL 55.00 D. Pteronyssinus (Mite) IgE MCL 25.00 D. Farinae (Mite) IgE MCL 25.00 Cat Dander IgE MCL 25.00 Dog epi IgE MCL 25.00 Bermuda Grass IgE MCL 25.00 Timothy grass IgE MCL 25.00 Cockroach IgE MCL 25.00 Penicillium notatum IgE MCL 25.00 Cladosporium herbarum IgE MCL 25.00 Aspergillus fumigatus IgE MCL 25.00 Alternaria alternata IgE MCL 25.00 Maple (Boxelder) Tree IgE MCL 25.00 Mountain Cedar IgE MCL 25.00 Oak IgE MCL 25.00 Elm Tree IgE MCL 25.00 Maple Leaf Sycamore (London Plane) IgE M 25.00 Cottonwood Tree IgE MCL 25.00 White Ash Tree IgE MCL 25.00 Walnut Tree IgE MCL 25.00 Pecan/Hickory IgE MCL 25.00 Mulberry Tree IgE MCL 25.00 Ragweed IgE MCL 25.00 Russian Thistle (Salwort) IgE MCL 25.00 Rough Pigweed IgE MCL 25.00 Rough Marsh Elder IgE MCL 25.00 Total IgE MCL 45.00 WNV IgG Ab MCL 115.00 UA Micro 5 50.00 Iron Binding Capacity 85.00 .Protein Urine Timed MCL 20.00 Cardio IgG MCL 120.00 Cardio IgM MCL 120.00 Cardio IgA MCL 120.00 B2 Glyco IgG MCL 120.00 B2 Glyco IgM MCL 120.00 B2 Glyco IgA MCL 120.00 Treponemal Ab MCL 20.00 Flow Cytom 9-15 Markers - Flow Cytom Add'l Marker 135.00 Flow Cytom 1st Marker 230.00 Immunofluorescent 320.00 Bill Culture ID Fungus 30.00 Sensitivity MIC 45.00 Carnitine MCL 135.00 Catecholamines Fractionated Urine Timed MCL 200.00 Cortisol AM MCL 80.00 Culture Routine + Smear MCL 40.00 Herpes Simplex Virus IgM Antibody MCL 90.00 Histoplasmosis Immunodiffusion MCL 100.00 Immunofixation Serum MCL 105.00 Legionella Pneumophila Antibody 1-6, IgM MCL 130.00 Mycoplasma IgM Antibody EIA MCL 65.00 Mycoplasma IgG Antibody MCL 130.00 Bordetella Pertussis PCR MCL 195.00 Insulin like Growth Factor Bind Prot 3 MCL 63.00 5 Hydroxyindolacetic Acid Urine Timed MCL 80.00 Chlam Trachomatis DNA MCL 165.00 N gonorrhea DNA MCL 165.00 EBV Nuc IgG MCL 75.00 EBV Capsid IgM MCL 85.00 EBV Capsid IgG MCL 85.00 Plat Ab HPA1a/1a, HPA3a/3a, HPA4a MCL 95.00 Plat Ab HPA 5b/5b MCL 95.00 Plat Ab HPA 5a/5a MCL 95.00 Plat Ab GPIb/IX MCL 95.00 Plat Ab GPIV MCL 95.00 Factor VIII Activity MCL 225.00 VW Ag MCL 270.00 VW Factor VIII Activity MCL 225.00 Gliad IgG Ab MCL 90.00 Gliad IgA Ab MCL 90.00 IgG Subclass 1 MCL 45.00 IgG Subclass 2 MCL 45.00 IgG Subclass 3 MCL 45.00 IgG Subclass 4 MCL 45.00 Parvovirus B19 IgG Ab MCL 85.00 Parvovirus B19 IgM Ab MCL 85.00 Testosterone Total, Free, Bioavailable, SHBG MCL 430.00 Hepatitis B Core Antibody IgM MCL 35.00 Hepatitis C RNA and Quant (R-PCR) MCL 345.00 T Pallidum Particle Agglutination MCL 105.00 Lyme Ab WB IgG MCL 135.00 Lyme Ab WB IgM MCL 135.00 Flow Cytom Add'l Marker TC 135.00 ROOM/BED: Observation Direct Admit 780.00 EKG 12 Lead, W/Interp/Report 34.00 Crossmatch AHG 245.00 Crossmatch IS 245.00 HOSPITAL DISCHR 30 MIN OR LESS CHARGE 115.00 PT OTH PT/OT CURR STAT 0 Medicare Requirement 0.01 PT OTH PT/OT DC STAT 0 Medicare Requirement 0.01 PT OTH PT/OT GOAL STAT 0 Medicare Requirement 0.01 PT SUB PT/OT CURR STAT 0 Medicare Requirement 0.01 PT SUB PT/OT GOAL STAT 0 Medicare Requirement 0.01 SP LANG EXP CURR STAT 0 Medicare Requirement 0.01 SP LANG EXP DC STAT 0 Medicare Requirement 0.01 SP LANG EXP GOAL STAT 0 Medicare Requirement 0.01 SP MOTOR SP DC STAT 0 Medicare Requirement 0.01 SP MOTOR SP GOAL STAT 0 Medicare Requirement 0.01 SP SWALLOW CURR STAT 0 Medicare Requirement 0.01 SP SWALLOW DC STAT 0 Medicare Requirement 0.01 SP SWALLOW GOAL STAT 0 Medicare Requirement 0.01 SP MOTOR SP CURR STAT 0 Medicare Requirement 0.01 EKG 12 Lead with Interp/Report 251.00 HIV Type 1 and 2 MCL 45.00 .HIV 1 Western Blot MCL 175.00 Basic Metabolic Panel 5 150.00 Comprehensive Metabolic Panel 5 150.00 Urinalysis with Microscopic 1 76.00 Urinalysis 2 51.00 Urine Drug Screen 3 75.00 Influenza Virus Vaccine, Quadrivalent, Live, Intranasal 30.00 Alpha Fetoprotein Tumor Marker MCL 80.00 Hemogram 6 105.00 UA Micro 6 55.00 Influenza A&B 2 60.00 Rapid Strep A Screen 1 60.00 PREGNANCY TEST URINE, QUAL 75.00 Pregnancy Test Serum 1 75.00 Stool Occult Blood Screen 4 75.00 Bill Antigen Type Product 92.00 SUTURES TO 2.5 CM 245-280 SUTURES 2.6-7.5 CM 305.00 SUTURES 7.5-12.5 CM 370.00 SUTURES FACE 2.5-5.0 CM 320.00 SUTURES FACE 5-7.5 CM 355.00 SUTURES FACE 7.5-12.5 CM 380.00 SPLINT-SHORT ARM ED Charge 170.00 SPLINT-LONG ARM ED Charge 335.00 BURN TX-INITIAL/FU 160-185 HEMORRHAGE-NASAL CAUTER. ED Charge 280.00 NASAL PACKING ED Charge 360.00 FOR. BODY IN EYE EMBEDDED 140.00 FB-EXTER. AUDITORY CANAL 225.00 FB-INTRANASAL 315-475 FB-SUBCUTANEOUS TISSUE 415-435 SUTURE FACE LAYERED 5-7.5 ED Charge 510.00 SUTURES-LAYERED-2.5-7EXTR 575-815 LAYER CLSR/HAND 7.6-12.5 ED Charge 575.00 REDUCTION DISLOC-SHOULDER ED Charge 555.00 SPLINT-SHORT LEG POSTERIO ED Charge 170.00 LAYER CLSR/HAND 2.5 CM ED Charge 495.00 VAGINAL DELIVERY ONLY ED Charge 2,370.00 EXPLORATION OF WOUND EXT 1,055.00 LAYER CLSR/HAND 2.6-7.5 ED Charge 525.00 REDUCTION DISLOC-ELBOW ED Charge 755.00 REMOVE FOR. BODY FOOT ED Charge 555.00 DISLOCATED SHOULDER W/AN ED Charge 1,170.00 CLSD TX RADIAL/ULNAR FX ED Charge 705.00 CLOSED FX MTP JOINT ED Charge 225.00 CLOSED TX CLAVICL FX WRED ED Charge 610.00 REMOVE IUD 185-230 ARTHROCENTESIS 165-240 EXTENDED FACE TO FACE ED Charge 290.00 CL TX RADIAL HD/NECK FX; ED Charge 595.00 COGNITIVE SKILLS ASSESMENT 85.00 SELF CARE CURRENT STATUS Medicare Requirement 0.01 SELF CARE GOAL STATUS Medicare Requirement 0.01 .Antinuclear Antibody Titer MCL 120.00 Bill Cold Agg Screen 45.00 ntigen Type RBC 150.00 MRI Brain (ACHS) Other charges may apply 290.00 Pretreat RBC Chemical 210.00 EKG TECHNICAL ONLY 251.00 ISOLATION-SETUP 160.00 ISOLATION-DAILY 72.00 CARDIAC REHAB MAINT charge per visit 5.00 ASPIRATION ABCESS HEMA Clinic Charge 350.00 DEBRIDEMENT-SKIN & SUBCUT Clinic Charge 157.00 REMOVAL OF SKIN TAG TO 15 Clinic Charge 240.00 Remove Skin Tags ea Addl 10 Clinic Charge 55.00 SHAVE LESION .6-1CM Clinic Charge 325.00 SHAVE LESION 1.1-2 Clinic Charge 380.00 SHAVE LES F/E/N/L; 0.5CM/ Clinic Charge 310.00 SHAVE LES F/E/N/L; > 2.0C Clinic Charge 505.00 EXC LESION .5 CM OR LESS Clinic Charge 340.00 EXCISION LESION .6-1CM Clinic Charge 405.00 EXC LESION 1.1-2 CM Clinic Charge 450.00 EXCISION LESION 2.1-3 CM Clinic Charge 520.00 REM LES TRUNK 3.1-4 CM Clinic Charge 590.00 REM LES EXT OVER 4CM Clinic Charge 850.00 EXC F/E/E/N/L MAL+MRG 0.6 Clinic Charge 640.00 Excise mal. lesion face 2 Clinic Charge 865.00 DEBRIDEMENT OF NAILS 1-5 Clinic Charge 90.00 DEBRIDEMENT NAILS 6 OR MORE Clinic Charge 125.00 AVULSION OF NAIL Clinic Charge 285.00 DRAIN BLOOD UNDER NAIL Clinic Charge 135.00 NAIL REMOVAL Clinic Charge 415.00 SIMPLE REPAIR FACE <2.5 300.00 DESTR LESION Premalign 1st one 180.00 DESTR LESION premalign 2-14 EA 15.00 Destruct benign lesion up to 14 300.00 Destr Malign Lesion to 5c 260.00 INJECTION GANGLION CYST 165.00 CL TX SC/TC HUMERUS FX WO Clinic Charge 644.00 CLSD TX DIST RAD FX Clinic Charge 890.00 CLSD TX FX NAV W/ MAN Clinic Charge 571.00 CLSD TX FX HAND Clinic Charge 800.00 Closed Tx Finger Fx Clinic Charge 540.00 Closed Tx Prox Fibula Clinic Charge 830.00 CLSED RED FX FIBULA Clinic Charge 607.00 Closed TX ankle FX w/o Man Clinic Charge 905.00 Finger Stick Spec Collection Clinic Charge 9.00 Remove Fx Body Ext Eye Clinic Charge 155.00 REMOVAL FB CORNEA 111.00 REM FB EYE W/ SLIT LAMP 145.00 EAR FLUSH Clinic Charge 155.00 IV Infusion seq 31 min to 1 hr 78.00 IV Infusion concurrent 1st hr 78.00 CIRCUMCISION CHARGE. 921.00 SPERMATOCELE EXCISION CHARGE 6,375.00 VENOUS ACCESS PORT REMOVE CHARGE 6,060.00 PART REMOVAL OF METATARSA CHARGE 2,208.00 EXC LESION CONJUNCTIVA CHARGE 1,375.00 DEBRIDEMENT OF DECUBITUS CHARGE 2,208.00 THORACENTESIS CHARGE 738.00 SPHINCTEROTOMY CHARGE 1,919.00 PILONDIAL CYSTECTOMY CHARGE 4,084.00 SIGMOIDOSCOPY W/BX CHARGE Bundle Charge 3,089.00 APPENDECTOMY CHARGE Bundle Charge 15,180.00 HERNIA REPAIR CHARGE Bundle Charge,Pro, Tech 19,969.00 CARPAL/CUBITAL TUNNEL REL CHARGE Bundle Charge,Pro, Tech 6,995.00 COLONOSCOPY CHARGE Bundle Charge,Pro, Tech 5,925.00 COLONOSCOPY REM POLYP FCP CHARGE Bundle Charge,Pro, Tech 6,610.00 EGD CHARGE Bundle Charge,Pro, Tech 5,960.00 EGD W/ BIOPSY CHARGE Bundle Charge,Pro, Tech 5,705.00 LAP CHOLECYSTECOMY W/O CH CHARGE Bundle Charge,Pro, Tech 17,285.00 LAP CHOLECYSTECOMY W/CHOL CHARGE Bundle Charge,Pro, Tech 19,025.00 COLONOSCOPY/BIOPSY/POLYEC CHARGE Bundle Charge,Pro, Tech 4575-5510 HERNIA-BILATERAL INGUINA CHARGE Bundle Charge, Pro,Tech 19,969.00 HERNIA-UMBILICAL REPAIR CHARGE Bundle Charge,Pro, Tech 17,454.00 HERNIA-VENTRAL REPAIR CHARGE Bundle Charge,Pro, Tech 15905-19969 EXC/ DESTRUCTION LESION CHARGE 1,448.00 EXOSTECTOMY CHARGE Bundle Charge 10,000.00 EXCISION LUMP BIOPSY CHARGE 1,448.00 EXC LESIONS CHARGE 1,448.00 EXCISION LIPOMA CHARGE Bundle Charge,Pro, Tech 2335-6000 EXCISION CYST/GROWTH CHARGE 1,448.00 TOE AMPUTATION CHARGE 2,208.00 INSERT PORT CHARGE 2,626.00 TRIGGER FINGER RELEASE CHARGE 5,555.00 DUPUYTREN'S CONTRACTURE CHARGE 2318-6330 EGD W/ BIOPSY AND POLYPECT CHARGE 4785-5960 EGD W/ POLYPECTOMY CHARGE 4785-5960 I&D-ABSCESS 320 - 995 ROOM/BED: Hospice Respite 189.00 ROOM/BED: Skilled Nursing 504.00 Culture MRSA MCL 50.00 HCG Blood Quantitative MCL 60.00 Metanephrines Fractionated Urine Timed MCL 195.00 Ammonia Venous MCL 85.00 Valproic Acid Level MCL 65.00 Testosterone Total, Female and Child MCL 430.00 D Dimer Quantitative MCL 157.00 Fluzone Single Dose 18 Months+ 25.00 Fluzone Single Dose 6-35 Months 25.00 Gamma Glutamyltransferase MCL 150.00 Anti DNAse B MCL 80.00 CA 15-3 MCL 120.00 Hepatitis Be Antigen MCL 120.00 Culture Strep A Confirmation MCL 30.00 Man Diff 10 105.00 Bill General Health Profile 323.00 RECOVERY ROOM ADD'L 15 108.00 RECOVERY ROOM 30 MIN 347.00 TREATMENT ROOM-PROCEDURE 138.00 TREATMENT RM PICC LINE 1,038.00 Prothrombin 20210 Mutation 275.00 Methylenetetrahydrofolate Mutation MCL 305.00 Renal Function Panel 9 150.00 Uric Acid Crystals Body Fluid MCL 35.00 INTMD WND REPAIR S/A/T/EXT (ED Charge) 615.00 NEW PATIENT - PROBLEM FOCUSED 85.00 NEW PATIENT - EXPANDED PROBLEM FOCUSED 135.00 SC - EXCISION, TUMOR, SQ FOREARM, WRIST <3 CM 322.00 Bill CMV Antibodies 70.00 FFP 184.00 EPIDURAL - Cervical/Thoracic 62310 includes fluro 2,233.00 BLOOD PATCH 433.00 NERVE BLOCK ILIOING/ILIOH 604.00 ACNE SURGERY MILIA CYSTS Clinic Charge 295.00 TRIM SKIN LESION Clinic Charge 130.00 EXC S/N/H/F/G MAL+MRG 0.6 Clinic Charge 620.00 DESTR >14 LESIONS 390.00 APPLY SHORT ARM SPLINT Clinic Charge 210.00 FLU VACC 4 VAL 3 YRS PLUS 15.00 Active Wound Care 2 cm< Clinic Charge 225.00 NSW DEBRIDEMENT WO A/SESSION Clinic Charge 82.00 ALS 1 Emergency 1,140.00 ALS 1 Emergency 2nd Patient 840.00 ALS 1 Non Emergency 973.00 ALS 1 Non Emergency 2nd Patient 539.00 ALS 2 1,650.00 ALS 2 2nd Patient 1,222.00 ALS Tier Service 685.00 Assess/Treat No Transport 228.00 BLS Emergency 961.00 BLS Emergency 2nd Patient 711.00 BLS Non-Emergency 807.00 BLS Non-Emergency 2nd Patient 447.00 Body Removal 253.00 Med Transport wait time 30.00 Transport only-Nonemergency 150.00 EMPLOYMENT SCREEN 84.00 -151.00 Bill DOT/Employee Drug Collect 69.00 Bill Drug/Alcohol Collection 52.00 ACHS NM Hepa Duct Contract RX Other charges may apply 785.00 ACHS NM Bone Scan Exams RX Other charges may apply 255.00 ACHS NM Thyroid Image I-123 RX Other charges may apply 500.00 ACHS NM Pulm Perf RX Other charges may apply 180.00 ACHS NM Kidney Flow w/ or w/o Pharm RX Other charges may apply 1,310.00 ACHS NM Hepa Duct Imaging RX Other charges may apply 400.00 ACHS NM GI Blood Loss RX Other charges may apply 555.00 ACHS NM Thyroid Uptake Exam RX Other charges may apply 535.00 ACHS NM Parathyroid Exams RX Other charges may apply 535.00 ACHS NM Spleen Scan RX Other charges may apply 660.00 ACHS NM Liver Only Exams RX Other charges may apply 660.00 ACHS NM Liver+Spleen Exams RX Other charges may apply 660.00 ACHS NM Kidney Spect RX Other charges may apply 1,310.00 ACHS NM Gastric Emptying RX Other charges may apply 335.00 ACHS NM Cardiac Blood Pool RX Other charges may apply 555.00 ACHS NM Intestine RX Other charges may apply 150.00 ACHS NM Kidney Morph w/ VF RX Other charges may apply 235.00 ACHS NM Liver w Vas Flow RX Other charges may apply 555.00 ACHS NM Pulm Vent RX Other charges may apply 365.00 ACHS CT Low Os 300-399mg/ml 0.25 COUMADIN CLINIC CHARGE 123.00 CT Urogram w/ 3D Reconstruction Other charges may apply 4,326.00 A1Atrypsin MCL 265.00 A1A Pheno MCL 115.00 Acid Fast Bacilli Stat Smear Only MCL 40.00 Amino Acid Plasma Quantitative MCL 400.00 RBC CPD AS1 500 LR Irr Dv 540.00 HOME DELIVERED MEALS 7.00 Protein UR MCL 20.00 Amylase Urine Random MCL 30.00 Beta 2 Microglobulin Urine MCL 100.00 Blastomycosis Complement Fixation MCL 105.00 C Reactive Protein High Sensitive MCL 65.00 CA 27.29 MCL 120.00 Cell Count Cerebrospinal Fluid MCL 30.00 Chloride Urine Random MCL 25.00 Clonazepam Level MCL 175.00 Coccidiomycosis Complement Fixation MCL 95.00 Creatinine Body Fluid MCL 25.00 Culture Eye + Smear MCL 40.00 Dehydroepiandrosterone Unconjugated MCL 80.00 Dilantin Level MCL 65.00 Epstein Barr Virus Quantitative PCR, Whole Blood MCL 930.00 Ethosuximide Zarontin Level MCL 130.00 Factor II Assay MCL 130.00 Gentamicin Level Peak MCL 80.00 Hemoglobin Electrophoresis MCL 220.00 Histone Autoantibodies MCL 130.00 HLA B27 Confirmation MCL 130.00 Human Growth Hormone MCL 85.00 Immunoglobulin D MCL 150.00 Itraconazole Level MCL 510.00 KOH Exam MCL 20.00 Norovirus PCR Stool MCL 195.00 Porphobilinogen Urine Timed MCL 140.00 Porphyrins Total Serum MCL 155.00 Potassium Urine Random MCL 20.00 Prealbumin MCL 70.00 Respiratory Syncytial Virus Ag MCL 60.00 Smith Antibody MCL 62.00 Sodium Urine Random MCL 15.00 Synovial Fluid Analysis MCL 30.00 Theophylline Level MCL 70.00 Tobramycin Level Peak MCL 80.00 Tobramycin Level Trough MCL 80.00 Toxoplasma IgM Antibody MCL 75.00 Uric Acid Body Fluid MCL 35.00 West Nile Virus IgG Antibody MCL 115.00 West Nile Virus IgM Antibody MCL 120.00 Amy Pancreatic MCL 30.00 Amy Salivary MCL 30.00 B. henselae IgG Ab MCL 165.00 B. henselae IgM Ab MCL 165.00 Brucella IgG Ab MCL 160.00 Brucella IgM Ab MCL 160.00 Cardio IgG MCL 50.00 Cardio IgM MCL 50.00 C4 MCL 60.00 Gentamicin Level Trough MCL 80.00 Histo 1 MCL 100.00 Histo 2 MCL 60.00 Beta-hydroxybutyric Acid MCL 40.00 Cortisol Baseline MCL 130.00 Ketosteroids 17 Urine Timed MCL 160.00 Cardio IgA MCL 50.00 Morph Analysis 88360 190.00 Culture Stool Yeast MCL 30.00 Culture Fungal Blood MCL 45.00 Cytomegalovirus IgM Antibody TORCH MCL 80.00 US ABD/Pelvic/Scrotal Art/VeinLtd IHM 790.00 US Aorta Duplex IVC Iliac Comp-IHM 995.00 US Aorta Duplex IVC Iliac Ltd-IHM 655.00 US Carotid Duplex Bil-IHM 1,145.00 US Carotid Duplex Lt-IHM 770.00 US Carotid Duplex Rt-IHM 770.00 US Echo 2D Comp w/ Color Flow Doppler-IH 1,915.00 US Echo 2D Ltd-IHM 755.00 US Echo Doppler Color Flow Mapping-IHM 380.00 US Echo Doppler Ltd-IHM 410.00 US LE Art Duplex Bil -IHM 970.00 US LE Art Duplex Lt -IHM 765.00 US LE Art Duplex Rt -IHM 765.00 US LE Veins Duplex Bil - IHM 1,105.00 US LE Veins Duplex Lt - IHM 625.00 US LE Veins Duplex Rt - IHM 625.00 US UE Art Doppler Mult Level Bil -IHM 371.00 US UE Art Doppler Single Level Bil -IHM 327.00 US UE Art Duplex Bil -IHM 830.00 US UE Art Duplex Lt -IHM 675.00 US UE Art Duplex Rt -IHM 675.00 US UE Veins Duplex Bil - IHM 441.00 US UE Veins Duplex Lt - IHM 441.00 US UE Veins Duplex Rt - IHM 441.00 XR Fluoro Epidural 333.00 Rh Type 42.00 Clostridium difficile PCR 110.00 Blastomyces CF 2 38.00 Smear 38.00 Cryptosporidium 92.00 PSA MCL 138.00 Rubella IgG Interp MCL 70.00 CMV IgG Ab Interp MCL 70.00 Rubella IgM Ab MCL 100.00 CMV IgM Ab Interp MCL 80.00 US LE Art Doppler Mult Level Bil - IHM 625.00 US LE Art Doppler Single Level Bil - IHM 430.00 HIV 1/2 Ab 1 100.00 MRSA Screen 70.00 Strep A PCR 210.00 Bill Cytopathology selective cellular enhancement 135.00 Flow Cytom 2- 8 markers - Bill Alcohol Saliva 46.00 Flow Cytom 16 or more markers 230.00 Bacteria ID- Aerobe 35.00 Streptex 35.00 Micro ID Charge 35.00 Bacteria ID- Aerobe /1 40.00 MIC Type 38 45.00 Pos Mic Type 29 45.00 Neg Bp Combo 44 45.00 Giardia Ag 60.00 NG Cyto path Enhance 105.00 Blood Culture 50.00 Strep ID Quad Plate 35.00 Cyclospora 50.00 AFB Concentrate 20.00 Bill Crypycoccus Ag 33.00 Urine Coll. Vol. and Time 112.00 Orfadin Level 395.00 Surg IPX (Each Antibody) G0461 (1st) 165.00 Bill Cytopath Fluid Smear with Interp 100.00 Path Cyto Exam 90.00 Path Cyto Exam Add 55.00 Bill Cytopath FNA Interp 195.00 ACHS NM Myocard Single RX Other charges may apply 535.00 Stool for Occult Blood POC 50.00 Lead Venous MCL 60.00 CLOSED TX METATARSAL FX 595.00 ROOM/BED: Observation 1st Hour 780.00 ROOM/BED: Observation Addtl Hour 10.00 ROOM/BED:Observation DIRECT ADMT 780.00 US Abd/Pelvic/Scrotal Art/Vein Comp-IHM 1,085.00 Employee Physical Other charges may apply 80.00 - 100.00 BCE - XR Humerus Min 2 Views Lt Other charges may apply 44.00 Occult Blood Screen 1-3 44.00 Rest and Stress Cardiac 3,587.00 Tc99/study to 40mc 440.00 Sports Physical 98.00 SIMPLE REPAIR 12.6-20 CM 440.00 IMMUNIZATION ADMIN ONE VACCINE MC 45.00 Blood Type Antigen Donor EA 150.00 OTH SUB PT/OT CURRENT STATUS CHARGE Medicare Requirement 0.01 OTH SUB PT/OT GOAL STATUS CHARGE Medicare Requirement 0.01 OTH SUB PT/OT D/C STATUS CHARGE Medicare Requirement 0.01 Bill Antibody ID Test 265.00 Toxoplasma IgG Antibody MCL 75.00 Drain bl w/cath insertion Bundle Charge 6,900.00 Prostatectomy (turp) . Bundle Charge 13,040.00 Stool Culture MCL [BCE] {ACMH] 45.00 Injection, intralesional, up to and including 7 lesions 155.00 Fecal Occult Blood 44.00 OMT 5-6 body regions 120.00 Shave lesion, t/a/l/; 0.5 cm or less 265.00 MethylMalonic Acid Urine MCL 85.00 Panorama Prenatal Test MCL 659.00 Creatinine, Urine 64.00 Incision, extensor tendon sheath, wrist 1,065.00 Suture, layered, face < 2.5 cm 595-695 CT Chest Low Dose Screen w/o Cont Other charges may apply 1,545.00 Wet Mount 7 70.00 QFTTB MCL 120.00 AFP Estriol MoM MCL 180.00 AFP HCG MoM MCL 175.00 AFP Inhibin MoM MCL 150.00 AFPM Interp MCL 160.00 US Breast Comp Lt. 575.00 US Breast Comp Rt. 575.00 US Breast Ltd Lt. 450.00 US Breast Ltd Rt. 450.00 HSV DNA 1 165.00 HSV DNA 2 150.00 Excise Benign Lesion Depended on site and size 330-4000 Strapping; knee 115.00 Strapping; toes. 60.00 Unna boot 110.00 Strapping; ankle and/or foot 85.00 Strapping; hip 110.00 Mobility: walking & moving around functional limitation, current status at therapy episode outset a Medicare Requirement 0.01 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode Medicare Requirement 0.01 Mobility: walking & moving around functional limitation, discharge sttus, at discharge from therapy Medicare Requirement 0.01 Changing & Maintaining body position functional limitation, current status, at therapy episode outse Medicare Requirement 0.01 Changing & maintaining body position functional limitation, project goal status, at therapy episode Medicare Requirement 0.01 Changing & maintaining body position functional limitation, discharge status, at discharge from ther Medicare Requirement 0.01 Carrying, moving & handling objects functional limitation, current status, at therapy episode outset Medicare Requirement 0.01 Carrying, moving & handling objects functional limitation, current status, at reporting intervals, a Medicare Requirement 0.01 Carrying, moving & handling objects functional limitation, current status, at discharge from therapy Medicare Requirement 0.01 Self care functional limitation, discharge status, at discharge from therapy or to end reporting Medicare Requirement 0.01 Other physical or occupational subsequent functional limitation, current status, at therapy episode Medicare Requirement 0.01 Other physical or occupational subsequent functional limitation, projected goal status, at therapy e Medicare Requirement 0.01 Other physical or occupational subsequent functional limitation, discharge status, at discharge from Medicare Requirement 0.01 Spoken language comprehension functional limitation, current status at time of initial therapy treat Medicare Requirement 0.01 Spoken language comprehension functional limitation, projected goal status at initial therapy treatm Medicare Requirement 0.01 Spoken language comprehension functional limitation, discharge status at discharge from therapy/end Medicare Requirement 0.01 Attention functional limitation, current status at time of initial therapy treatment/episode outset Medicare Requirement 0.01 Attention functional limitation, projected goal status at initial therapy treatment/outset and t dis Medicare Requirement 0.01 Attention functional limitation, discharge status at discharge from therapy/end of reporting on limi Medicare Requirement 0.01 Memory functional limitation, current status at time of initial therapy treatment/episode outset and Medicare Requirement 0.01 Memory functional limitation, projected goal status at initial therapy treatment/outset and at disch Medicare Requirement 0.01 Memory functional limitation, discharge status at discharge from therapy/end of reporting on limitat Medicare Requirement 0.01 Voice functional limitation, current status at time of initial therapy treatment/episode outset and Medicare Requirement 0.01 Voice functional limitation, projected goal status at initial therapy treatment/outset and at discha Medicare Requirement 0.01 Voice functional limitation, discharge status at discharge from therapy/end of reporting on limitati Medicare Requirement 0.01 Other speech language pathology functional limitation, current status at time of initial therapy tre Medicare Requirement 0.01 Other speech language pathology functional limitation, projected goal status at initial therapy trea Medicare Requirement 0.01 Other speech language pathology functional limitation, discharge status at discharge from therapy/en Medicare Requirement 0.01 SQ HORMONE PELLET IMPLANTATION 175.00 CA SCRNING PELV & BRST EXAM Clinic Charge 105.00 General Health Panel 5 - CT rule 150.00 Coakatiel Bird Feather Allergy 25.00 Cotinine (Alkaloids) 184.00 Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day 95.00 US Nuchal Translucency Addl - A/V 545.00 Change of cystostomy tube; simple 140-295 Glucose Tolerance 2 137.00 Lupus PTT Mix 25.00 DRVVT Confirm 35.00 CT Angio Head w/ Cont Other charges may apply 2,195.00 Magnesium Urine Random MCL 25.00 Urine Microscopic MCL 15.00 Carbon Monoxide 90.00 H. pylori Stool Antigen 115.00 Arterial Blood Gas CO-OX 85.00 Urine Culture 70.00 US Nuchal Translucency 1st Gest - A/V 545.00 Occult Blood Diagnostic 4 75.00 Viral Culture Result MCL 170.00 Viral Culture Report Status MCL 80.00 Methadone & Metabolites MCL 186.00 US Pelvis Non-OB Transvaginal 595.00 Herpes PCR Swab MCL 330.00 IMMUNIZATION ADMIN EA ADDL 20.00 THIRD TIME NO SHOW CHARGE 35.00 Verigene Gram Neg Report MCL 50.00 Verigene ID Add-On MCL 50.00 Stachybotrys Chartarum IgA MCL 130.00 Stachybotrys Chartarum IgG MCL 130.00 Stachybotrys Chartarum IgE MCL 25.00 Bill Thioguanine Nucleotide MCL 82.00 Bill Methyl Mercaptopurine Nucleotide MCL 82.00 Closed treatment of interphalangeal joint dislocation with manipulation, without anesthesis 515.00 Injection, single or multiple trigger point(s); 3 or more muscles 274.00 Chemical cauterization of granulation tissue (proud flesh, sinus, or fistula) 189.00 Insertion, non biodegradable drug delivery implant 385.00 Removal, non biodegradable drug delivery implant 430.00 Insertion of non dwelling bladder catheter (e.g. straight cath for residual urine) 98.00 Psychotherapy, 30 minutes with patient and/or family member 338.00 Layered Repair extremity 7.6 -12.5 705.00 US Aorta Screening 205.00 Sodium, Urine Timed MCL 15.00 pH, Urine MCL 20.00 Human Papilloma Virus (HPV9) Vaccine POC 357.00 Verigene Gram Pos Report MCL 50.00 Microstep Plus Panel MCL 45.00 Hyaluronic Acid, Fibrospect II MCL 220.00 Alpha 2 Macroglobulin, Fibrospect II MCL 150.00 TIMP-1, Fibrospect II MCL 220.00 INCISION OF THROMBOSED HEMORRHOID,EXTERNAL 379.00 REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS 565.00 Testosterone Total and Free MCL 170.00 Testosterone Free SO MCL 55.00 Dressing and/or debridement of partial thickness burns, initial or subsequent; 5-10% BSA ED Charge 375.00 closed treatment of ulnar shaft fracture; WITHOUT MAINPULATION 715.00 Calculus Analysis Qual MCL 62.00 Dressings and/or debridement of partial thickness burns, initial or subsequent; small 225-285 US Echo 2D Rest +Stress-IHM 1,380.00 OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATION WHEN PERFORM 428.00 BIOPSY OF VULVA OR PERINEUM(SEPARATE PROCEDURE); 1 LESION 595.00 BIOPSY OF VULVA OR PERINEUM(SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION 71.00 Closed treatment of hip dislocation, traumatic; without anesthesia 700.00 Work hardening/conditioning; each additional hour 135.00 Alkaline Phosphatase, Bone Specific 70.00 C Telopeptide Beta Crosslinked 200.00 CLOSED TREATMENT OF PATELLA FRACTURE; WITHOUT MANIPULATION 880.00 Rabies Ab IgG 270.00 Calcium Creatinine Ratio Random Urine MCL 40.00 Endomysial Antibody IgA, MCL 220.00 Patient Antigen Profile 452.00 Haemophilus influenza b vaccine (Hib), PRP-T conjugate 38.00 Chromosome Microarray Testing MCL 2,055.00 Thiopurine Metabolites MCL 290.00 Methyl Mercaptopurine Nucleotide MCL 79.00 Nicotine Level MCL 295.00 Leukotriene E4 MCL 530.00 Closed Treatment of Fracture Great Toe, Phalanx or phalanges; w/o manipulation 400.00 Neuroplasty and/or transposition; ulnar nerve at elbow 1,725.00 Iodine Level MCL 170.00 Nash Alpha 2 Macroglobulin 120.00 Nash Haptoglobin 120.00 Nash Apolipoprotein A 120.00 Nash GGT 120.00 Nash Total Bilirubin 120.00 Nash ALT 120.00 Nash Total Cholesterol 120.00 Nash Triglycerides 120.00 Nash Serum Glucose 120.00 Nash AST 120.00 Procalcitonin MCL 135.00 XR Femur 1 View Lt 205.00 XR Femur 1 View Rt 205.00 XR Hip 1 View Lt w/ Pelvis 230.00 XR Hip 1 View Rt w/ Pelvis 230.00 XR Hip 2-3 Views Lt w/ Pelvis 265.00 XR Hip 2-3 Views Rt w/ Pelvis 265.00 XR Hip Min 4 Views Lt w/ Pelvis 290.00 XR Hip Min 4 Views Rt w/ Pelvis 290.00 XR Hips Bil w/ Pelvis 2 Views 290.00 XR Hips Bil w/ Pelvis 3-4 Views 260.00 XR Hips Bil w/ Pelvis Min 5 Views 480.00 XR Spine Entire 1 View 205.00 XR Spine Entire 2-3 Views 315.00 XR Spine Entire 4-5 Views 345.00 XR Spine Entire Min 6 Views 425.00 Psychotherapy, 45 minutes with patient and/or family member 364.00 Family psychotherapy (conjoint psychotherapy) (with patient present) 390.00 Group psychotherapy (other than of a multiple-family group) 307.00 Telehealth originating site facility fee 75.00 Office/OP New Visit Level 1 80.00 Tech Office or other outpatient visit for the evaluation and management of an established patient 37.00 Removal and Reinsertion of Etonogestrel (Nexplanon) 68mg Implant 620.00 Closed treatment of fracture of weight bearing articular portion of distal tibia( eg, pilon or 855.00 Destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 o 355.00 Morphine U Confirm MCL 115.00 6 MAM (Heroin Metabolite) Urine MCL 80.00 Oxycodone Urine MCL 20.00 Repair, intermediate, wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 7.6 cm to 715.00 Peripheral Smear BCR FISH 1 MCL 415.00 Peripheral Smear ABL FISH 2 MCL 415.00 Shaving of epidermal lesion, single, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 270.00 BCR-ABL Gene Rearrangement MCL 337.00 Remove impacted cerumen using irrigation/lavage, unilateral facility 45.00 Calprotectin, Fecal MCL 445.00 Pemphigoid (BP 180/230) Panel MCL 232.00 HYDRATION FIRST HOUR 150.00 HYDRATION, EA ADDL HR 78.00 ED IV Infusion Initial up to 1 hour 438.00 ED INFUSION Add HR 78.00 Subq/IM Injection 103.00 IV Injection, single/initial 78.00 IV Injection, add new drug 78.00 IV Injection, add same drug 78.00 Heparin Induced Thrombocytopenia AB Confirmatory MCL 85.00 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, A/O MUCOUS MEMBRNES; 2.6-5.0 CM 595.00 Travel allowance one way in connection with medically necessary laboratory specimen collection drawn .01 - 20.00 Gastroccult 1 77.00 CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION 411.00 Quetiapine Serum MCL 257.00 Telehealth originating site facility fee, 80.00 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips lesion diamete 300.00 MRSA Screen 71.00 TRANS CARE MGMT 14 DAY DISCH 210.00 TRANS CARE MGMT 7 DAY DISCH 300.00 DNA Double Stranded (dsDNA) Scrn w/Rflx, IgG MCL 100.00 Room/Bed: Observation addl day hour 40.00 ACHS US Pelvis Non-OB Transvaginal 538.00 Insert Foley Cath - ED (ACMH) 182.00 BEXSERO VACCINE 307.00 Excision of ganglion, wrist (dorsal or volar); primary 570.00 HCV Fibrosure MCL 895.00 Digoxin Level MCL 65.00 Simple repair of superficial wound of scalp, neck, axillae, external genitalia, trunk and/or extremi 480.00 Neg Urine Combo 74 45.00 Neg Combo Panel 68 45.00 Neg MIC Type 45 45.00 Biopsy of cervix, single or mutiple, or local excision of lesion, with or without fulguration 450.00 ACHS US Pregnant Transvaginal 538.00 Gastrointestinal Panel MCL 885.00 Uric Cry BF MCL 35.00 Physical Therapy Evaluation: Low Complexity 150.00 Physical Therapy Evaluation: Moderate Complexity 170.00 Physical Therapy Evaluation: High Complexity 250.00 Occupational Therapy Evaluation: Low Complexity 170.00 Occupational Therapy Evaluation: Moderate Complexity 190.00 Occupational Therapy Evaluation: High Complexity 285.00 PT Re-eval Est Plan Care 100.00 OT Re-eval Est Plan Care CHARGE 115.00 Debridement (eg. HP waterjet, sharp, selective debridement), open wound, including topical appl and 268.00 Cardioversion, elective, electrical conversion of arrhythmia; external 631-820 Respiratory Panel by PCR MCL 750.00 MM MAMMO DIAGNOSTIC BILAT Other charges may apply 405.00 MA Diag Lt w/ Cad. Other charges may apply 220-280 MA Diag Rt w/ Cad. Other charges may apply 220-280 MA Routine Screen Bil w/ Cad. Other charges may apply 405-465 MA Routine Screen Lt w/ Cad. Other charges may apply 220-280 MA Routine Screen Rt w/ Cad. Other charges may apply 220-280 Nicotine and Metabolites Urine, MCL 220.00 Cystourethroscopy (separate procedure) - ACMH Bundle Charge 3,565.00 Cystourethroscopy, with biopsy(s) - ACMH Bundle Charge 5,400.00 Cystourethroscopy, with removal foreign body, calculus, or ureteral stent from urethra or bladder - Bundle Charge 3,365.00 Cystourethroscopy, with insertion of indwelling ureteral stent (eg Gibbons or double J type) - ACMH Bundle Charge 7,300.00 Lithotripsy, extracorporeal shock wave - ACMH Bundle Charge 9,350.00 Insertion of multicomponent inflatable penile prosthesis, including placement of pump, etc. - ACMH Bundle Charge 32,450.00 DRUG TEST DEF 1-7 CLASSES Charge 0.01 DRUG TEST DEF 8-14 CLASSES Charge 0.01 Behavioral and qualitative analysis of voice and resonance 155.00 Closed treatment of carpal bone fx (excluding carpal scaphoid); w/o man 830.00 Sling operation for stress incontinence (eg. fascia or synthetic) 7,170.00 Biopsy, prostate; needle or punch; single or multiple, any approach 3,270.00 Zoster (shingles) vaccine (HZV), recombinant, sub-unit 245.00 Excision of Lesion Vestibule of Mouth W/O Repair 556.00 Transurethral resection; of postoperative bladder neck contracture Bundle Charge 6,100.00 Ethyl Glucoronide Urine Screen MCL 270.00 Thyroglob Ab, MCL 85-115 Cystourethroscopy, with fulguration (including cryosurgery or laser surger) and/or resection of: Bl Bundle Charge 3,350.00 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of: LA Bundle Charge 8,220.00 Excision Lesion including margins, face, ears, eyelids, nose, lips; 0.5cm/< 545.00 Post Operative Extended Stay Hourly Charge 50.00 HIV 1 & 2 210.00 Incision and drainage; upper arm or elbow area; bursa 265.00 CT Chest Low Dose Diag w/o Cont Other charges may apply 1,545.00 Closed treatment of clavicular fracture; without manipulation 360.00 Stone (Calculus) Analysis MCL 100.00 ORCHIECTOM RADICAL - ING APPR 7,910.00 EXC VARICOCELE OR LIGATE SPERM VEINS 5,220.00 I & D HEMATOMA/FLUID 500.00 Urinalysis, Culture if Indicated 45.00 NASH FibroSure MCL 120.00 Injection(s); single or multiple trigger poin(s), 3 or more muscles ACMH 230.00 XR Abdomen 3 Views 310.00 XR Chest 3 Views 230.00 INTMD WND REPAIF S/A/T/EXT 415.00 OB Panel with HIV 555.00 Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each 345.00 Treponemal Antibodies IgG/IgM MCL 95.00 Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan 90.00 NASH FibroSure MCL 70.00 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm. 575.00 Lyme IgM Antibody MCL 135.00 Lyme IgG Antibody MCL 135.00 Quantiferon TB Gold Plus MCL 120.00 ICF/SNF EST COMPREHENSIVE 270.00 AL-EST COMPREHENSIVE 385.00 AL-EST DETAILED 270.00 AL-EST EPF 190.00 AL-EST PF 120.00 AL - NEW PROLONGED 430.00 AL-NEW COMP 370.00 AL-NEW Detailed 280.00 AL-NEW EPF 160.00 AL-NEW PF 110.00 ANA Scr, reflex Confirmation MCL 110.00 ACHS NM Myocard Mult RX Other charges may apply 1,065.00 ACHS NM Hepa Duct System RX Other charges may apply 395.00 Bruker MALDI ID 35.00 Cortisol Free Timed Urine MCL 145.00 PT/INR Patient Care 30.00 Coumadin Clinic 123.00 Surg IPX, additional antibody 165.00 Microscan GPC ID Only 35.00 RIV4 VACC RECOMBINANT DNA IM 60.00 Bill Post Accident Drug Collection 77.00 Dry Needling Procedure 10.00 - 120.00 Cardiac Stress Test 730.00 - 5840.00 Anesthesia per unit 100.00 Punch biopsy of skin (including simple closure, when performed); single lesion 390.00 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; diameter 2.1 to 6,955.00 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; diameter 3.1 to 4.0 c 6,955.00 APPLY SH LEG CAST 255.00 Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) 140.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, Bundle Charge,Pro, Tech 7,120.00 Abdomen Surgery Procedure Bundle Charge,Pro, Tech 8,365.00 BLADDER CATH TEMP FOLEY Charge 195.00 XRORTHO AC Joints w/ or w/o weights bil 260.00 XRORTHO Ankle comp min 3 views 235.00 XRORTHO Elbow comp min 3 views 270.00 XRORTHO Femur 2 views 230.00 XRORTHO Finger min 2 views 210.00 XRORTHO Foot comp min 3 views 230.00 XRORTHO Forearm 2 views 220.00 XRORTHO Hand min 3 views 250.00 XRORTHO Heel min 2 views 205.00 XRORTHO Hip 2-3 views w/ pelvis 300.00 XRORTHO Humerus min 2 views 230.00 XRORTHO Knee 3 views 260.00 XRORTHO Sacrum + Coccyx min 2 views 235.00 XRORTHO Scapula comp 235.00 XRORTHO Shoulder comp min 2 views 260.00 XRORTHO SI Joints 1 or 2 views 220.00 XRORTHO Spine Cerv 4-5 views 375.00 XRORTHO Spine Lumbosacral min 4 views 380.00 XRORTHO Spine Thoracic 2 views 260.00 XRORTHO Tib + Fibula 2 views 230.00 XRORTHO Toe min 2 views 195.00 XRORTHO Wrist comp min 3 views 260.00 XRORTHO Clavicle Comp 215.00 XRORTHO Hips Bil w/ Pelvis 3-4 views 310.00 XRORTHO Pelvis 1 or 2 views 215.00 WC Visit, New, Brief 400.00 WC Visit New Limited 445.00 WC Visit New Intermediate 500.00 WC Visit New Extended 550.00 WC Visit New Complex 600.00 WC Visit Established Brief 345.00 WC Visit, Limited Established 395.00 WC Visit, Intermediate Established 440.00 WC Visit, Extended Established 495.00 WC Visit Complex Established 545.00 WC Debridement, subcutaneous tissue; first 20 sq cm or less Bundle Charge,Pro, Tech 935-1735 WC Debridement, muscle and/or fascia; first 20 sq cm or less Bundle Charge,Pro, Tech 1465-2265 WC Debridement, bone; first 20 sq cm or less Bundle Charge,Pro, Tech 4045-4845 WC Debridement, subcutaneous tissue; each additional 20 sq cm, or part thereof Bundle Charge,Pro, Tech 935-1735 WC Debridement, muscle and/or fascia ; each additional 20 sq cm, or part thereof Bundle Charge,Pro, Tech 1465-2265 WC Debridement, bone; each additional 20 sq cm Bundle Charge,Pro, Tech 4045-4845 WC Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions Bundle Charge,Pro, Tech 530-1330 WC Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia Bundle Charge,Pro, Tech 510-1310 WC Neg Pressure Wound Tx- DME > 50 SQ CM Bundle Charge,Pro, Tech 935-1735 WC Neg Pressure Wound Tx- Non DME 50 SQ CM Bundle Charge,Pro, Tech 935-1735 WC Sharp Selective Debridement (hp waterjet, scissors, scalpel and forceps), first 20 sq cm or Bundle Charge,Pro, Tech 510-1310 WC Sharp Selective Debridement (hp waterjet, scissors, scalpel and forceps), each additional 2 Bundle Charge,Pro, Tech 35-835 WC Application of multi-layer compression system; leg (below knee), including ankle and foot - Bundle Charge,Pro, Tech 405-1205 WC Application of skin sub graft to trunk, arms, legs, total wound surface area up to 100 sq c Bundle Charge,Pro, Tech 1465-2265 WC Application of skin sub graft to trunk, arms, legs; each additional 25 sq cm wound surface Bundle Charge,Pro, Tech 1465-2265 WC Application of skin sub graft to trunk, arms, legs, total wound surface area greater than o Bundle Charge,Pro, Tech 4565-5365 WC Application of skin sub graft to trunk, arms, legs; each additional 100 sq cm wound surface Bundle Charge,Pro, Tech 4565-5365 WC Application of skin sub graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia Bundle Charge,Pro, Tech 1465-2265 WC Wound Repair Simple: =<2.5Cm Tc Bundle Charge,Pro, Tech 510-1310 WC Biopsy of Skin, Lesion Bundle Charge,Pro, Tech 935-1735 WC Biopsy of Skin, Addl Lesions Bundle Charge,Pro, Tech 935-1735 WC I&D Hematoma: Simple Bundle Charge,Pro, Tech 4045-4845 WC Evacuation: Subungual Hematoma Bundle Charge,Pro, Tech 315-1115 WC Remove Fb Foot: Subcutaneous Bundle Charge,Pro, Tech 1720-2520 WC Neg Press Wound Therapy <50 sq cm Bundle Charge,Pro, Tech 510-1310 WC Skin Sub Graft Face/Nk/Hf/G Addl Bundle Charge,Pro, Tech 1465-2265 WC Skin Sub Graft F/N/H/G Child Initial Bundle Charge,Pro, Tech 1465-2265 WC Skin Sub Graft F/N/H/G Child Addl Bundle Charge,Pro, Tech 1465-2265 WC Wound Repair Simple: 2.6-7.5Cm Bundle Charge,Pro, Tech 530-1330 WC Incision & Removal of Foreign Body Bundle Charge,Pro, Tech 935-1735 WC Incision and drainage simple/single Bundle Charge,Pro, Tech 510-1310 WC Puncture aspiration abscess hematoma bulla/cyst Bundle Charge,Pro, Tech 935-1735 WC Pairing or cutting of benign hyperkeratotic lesion 1 Bundle Charge,Pro, Tech 510-1310 WC Dressing/debridement burn Small, up to 5% Bundle Charge,Pro, Tech 510-1310 WC Dressing/debridement burn Medium, 5%-10% Bundle Charge,Pro, Tech 530-1330 WC Dressing/debridement burn Large, greater than 10% Bundle Charge,Pro, Tech 985-1785 WC Chemical cauterzation of granulation tissue Bundle Charge,Pro, Tech 510-1310 WC Strapping Unna Boot Bundle Charge,Pro, Tech 410-1210 WC Drainage of Pilonidal Cyst -simple Bundle Charge,Pro, Tech 1720-2520 WC I & D Post-op Infection Bundle Charge,Pro, Tech 6975-7775 WC Permanent Nail Removal Bundle Charge,Pro, Tech 935-1735 WC Simple closure of wound dehiscence Bundle Charge,Pro, Tech 1465-2265 WC Split thick autograft, trnk/arm/leg 1st 100sqcm Bundle Charge,Pro, Tech 4705-5505 WC Epidermal autograft, T/A/L 1st 100sqcm Bundle Charge,Pro, Tech 4705-5505 WC Epidermal autograft, F/H/Ft 1st 100sqcm Bundle Charge,Pro, Tech 4705-5505 WC Split thickness autograft, F/H/Ft 1st 100sqcm Bundle Charge,Pro, Tech 8130-5930 WC Biopsy of Bone - superficial, needle Bundle Charge,Pro, Tech 4045-4845 WC Biopsy of Bone - deep, needle Bundle Charge,Pro, Tech 4070-4870 WC Aspiration/Injection of Small Joint/Bursa Bundle Charge,Pro, Tech 735-1535 WC Aspiration/Inject. intermediate Joint/Bursa Bundle Charge,Pro, Tech 760-1560 WC Level 3 I&D Drain Bursa Foot Bundle Charge,Pro, Tech 4045-4845 WC Tenotomy, toe, single Bundle Charge,Pro, Tech 4050-4850 WC Removal of Gauntlet/Boot/Body Cast Bundle Charge,Pro, Tech 710-1510 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm 1,090.00 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm 1,090.00 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each ad 2,070.00 Irrigation of implanted venous access device for drug delivery systems[MCHC] 85.00 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm 2,070.00 Punch biopsy of skin (including simple closure, when performed); single lesion 2,335.00 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm 2,335.00 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm 1,090.00 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, no 1,090.00 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq sm or le 985.00 Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) 140.00 CIRCUMCISION 28 DAYS OR OLDER 4,675.00 REMOVE WRIST TENDON LSN CHARGE 6,065.00 PF REPR CPX TRUNK 2.6-7.5 CM CHARGE 2,070.00 Remove bladder stone . 8,710.00 Cystouretero w/lithotripsy . 8,810.00 CLO TX DIST PHAL FX FINGE 580.00 EXC BACK LES SC 3 CM/> 7,555.00 Skin sub graft trnk/arm/leg . 5,035.00 DBRD; SKIN SUBQ TISSUE/MU CHARGE 5,040.00 Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us 620.00 ANAL CANAL LESION RMVL CHARGE 5,355.00 Destruction of internal hemorrhoid(s) by thermal energy (eg. Infrared, coagulation, cautery, radiofr 4,450.00 Foreskin Manipulation Including Lysis Of Preputial Adhesions And Stretching 180.00 Bladder irrigation, simple, lavage and/or instillation ED CHARGE 190.00 Removal of embedded foreign body, eyelid 710.00 FULL GRAFT FACE INCL DIRE CHARGE 6,165.00 AMPUTATION, TOE; METATARSOPHALANGEAL JOINT 8,705.00 CL TX PHAL SHAFT FRACTUR ED Charge 620.00 Application, cast, shoulder to hand (long arm) 590.00 Injection, theapeutic (eg, local anesthetic, corticosteroid), carpal tunnel 245.00 Injeciton(s); single tendon origin/insertion 170.00 Closed Treatment of radial head or neck fracture; without manipulation 825.00 Application, cast; hand and lower forearm (gauntlet) 245.00 Application of long arm splint (shoulder to hand) 210.00 Application of short arm splint (forearm to hand); static 165.00 Closed Treatment of distal phalangeal fracture, finger or thumb; with manipulation, each 810.00 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with man 870.00 Closed treatment of metacarpal fracture, single; with manipulation, each bone 835.00 Closed treatment of carpal scaphoid (navicular) fracture; with mainipulation 1,245.00 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, incl 1,390.00 Repair, complex, eyelids, nose, ears and/or lips; 2.6-7.5 cm 2,560.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h Bundle Charge,Pro, Tech 6,280.00 Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each 565.00 Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, T Bundle Charge,Pro, Tech 11,055.00 EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND Bundle Charge,Pro, Tech 7,815.00 CYSTO W DIR VISION INT URETHROTOMY 6,820.00 Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articu 180.00 Ultrasound study follow-up (Vascular Exam) 280.00 US COMPL JOINT R-T W/IMG 280.00 DRAIN/INJ JOINT/BURSA W/US (Small Joint- Fingers/Toes) 235.00 DRAIN/INJ JOINT/BURSA W/US (Intermediate joint- elbow/ankle/wrist) 255.00 DRAIN/INJ JOINT/BURSA W/US (Large joint- shoulder/hip/knee) 290.00 Excision benign lesion including margins; trunk, arms or legs; excised diameter 1.1-2.0 cm 3,050.00 REPAIR INTERMEDIATE CHARGE 1,880.00 Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purp 60.00 Arthocentesis / injection with ultrasound guidance, ACS Other charges may apply 1,760.00 Incise & drain bladder . 4,350.00 single or multiple trigger point 1-2 muscles 795.00 APPLY SHORT ARM CAST 275.00 EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE Bundle Charge,Pro, Tech 7,385.00 Transplant forearm tendon . Bundle Charge,Pro, Tech 20,600.00 APP TOPICAL FLUORIDE VARNISH 40.00 Closed treatment of interphalangeal joint dislocation; without anesthesia 875.00 Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia 1,035.00 INJECT TRIGGER POINTS 3/>. Bundle Charge,Pro, Tech 1,190.00 Injection, anesthetic agent; greater occipital nerve Bundle Charge,Pro, Tech 885.00 DRAIN/INJ MAJOR JOINT/BURSA BIL 50 MOD Bundle Charge,Pro, Tech 1,190.00 INJ ANESTH; AXILLARY NERVE 2,230.00 Repair hand joint . Bundle Charge,Pro, Tech 8,075.00 Cystoscopy chemodenervation . Additional Pharmacy Charges 3,565.00 REM IMP WAX 1/BTH EA/PF Removal impacted cerumen requiring instrumentation, unilateral Bundle Charge,Pro, Tech 290.00 DILATE URETHRA STRICTURE 1,340.00 EXC BNGN LSN 2.1-3.0CM CHARGE Bundle Charge,Pro, Tech 4,135.00 TRANSPLANT FOREARM TENDON Bundle Charge,Pro, Tech 23,115.00 NEUROPLASTY AND/OR TRANSPOSTION ULNAR NERVE AT ELBOW Bundle Charge,Pro, Tech 7,890.00 Creatinine, 24 Hr Urine 70.00 Antineuronal Nuclear Antibody MCL 355.00 Mumps Virus IgM Antibody MCL 75.00 Vitamin C Level MCL 180.00 Candida DNA MCL 60.00 Trichomonas DNA MCL 60.00 Gardnerella DNA MCL 60.00 Centromere Ab MCL 62.00 dsDNA Ab by ELISA, IgG MCL 62.00 ANA Scrn w/Rflx ENA and IFA MCL 60.00 Lead U Measured MCL 70.00 Arsenic U Measured MCL 35.00 Mercury U Measured MCL 85.00 HSV DNA 1 MCL 165.00 HSV DNA 2 MCL 150.00 US Extremity Nonvascular Comp EO 280.00 US Extremity Nonvascular Ltd EO 180.00 US UE Veins Duplex Lt 659.00 US UE Veins Duplex Rt 659.00 US Extremity Nonvascular Comp 280.00 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint ACMH2 Per facet joint level 4235-4265 Misc. Ortho Supplies 0-5000 ALLEVYN DRESSING, 4 x 4 6.00 ALLEVYN DRESSING, 5 x 5 9.00 ALLEVYN DRESSING, 6.75 x 6.75 15.00 ALLEVYN LIFE SACRUM, SMALL 11.00 ALLEVYN THIN DRESSING 5.00 AQUACEL AG ROPE DRESSING 35.00 AQUACEL AG XTRA HYDROFIBER DRESSING 4X5 14.00 BABY BUNTING, FOIL 10.00 CHEST DRAIN, PLEUR-EVAC 43.00 COMPRESSION STOCKING, LARGE 79.00 COMPRESSION STOCKING, SMALL 55.00 COMPRESSION STOCKING, THIGH HI, MEDIUM 42.00 DRESSING MEPILEX, SACRUM, 9 x 9 20.00 DRESSING, MEPILEX, 4 x 10 11.00 DRESSING, MEPITEL, 4 X 7.2 17.00 ENDOFORM DRESSING, 2X2 44.00 GELFOAM DRESSING, SZ. 50 27.00 GRANUFOAM DRESSING 24.00 GRANUFOAM DRESSING, BRIDGE 99.00 HOLLISTER HYDROFERA BLUE READY DRESSING, 4X5 13.00 HYDROFERA BLUE 4X4 15.00 HYDROGEL, 4 OZ. 35.00 MEPILEX DRESSING, 3 x 3 4.00 MEPILEX DRESSING, 4 x 4 6.00 MEPILEX DRESSING, 4 x 4, BORDER 6.00 MEPILEX DRESSING, 6 X 6 BORDER 10.00 MEPILEX DRESSING, 7 x 7, SACRUM 55.00 MEPILEX DRESSING, 8 x 20 130.00 MEPITEL DRESSING, 3 x 4 9.00 NASOPORE DRESSING, FIRM, 8cm 465.00 PENILE IMPLANT CHARGE 11,187.00 PLUG, HERNIA - LARGE 834.00 PLUG, HERNIA - MEDIUM 826.00 PLUG, HERNIA - XLARGE 971.00 SOFT POLYPROPYLENE MESH 889.00 VOLUMETRIC EXERCISER 4.00 ACETAMINOPHEN 1000MG/100ML INJ VIAL 102.75 ACETAMINOPHEN 120 MG SUPPOSITORY-CHILD 5.25 ACETAMINOPHEN 325 MG SUPPOSITORY 5.25 ACETAMINOPHEN 650 MG SUPPOSITORY 5.25 ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID 4.75 ACETAMINOPHEN 325 MG TABLET 4.25 ACETAMINOPHEN 500 MG TABLET 4.25 ACETAMINOPHEN/CODEINE 120-12 MG/5 ML LIQUID 4.25 ACETYLCSTEINE MDV 20% 200 MG/ML-30 ML INJ VIAL 154.25 ACETYLCSTEINE SDV 20% 20%-200MG/ML-4ML INH VIAL 44.00 ACTIVATED CHARCOAL SORBITOL 25 GRAM LIQUID 35.75 ACTIVATED CHARCOAL SORBITOL 50 GRAM LIQUID 15.50 ACYCLOVIR 400 MG TABLET 12.75 ADENOSINE 6 MG/2 ML INJ VIAL 26.00 ALBUMIN HUMAN 25% 12.5 GR INJ VIAL 216.00 ALBUTEROL INHALER 90 MCG INHALER 52.75 ALBUTEROL INHALER 90 MCG INHALER 44.75 ALBUTEROL NEB 0.083%-2.5MG/3ML SOLUTION 6.50 ALBUTEROL PEDS NEB 0.042%-1.25MG/3ML SOLUTION 10.75 ALBUTEROL/IPRATROPIUM NEB 3MG/0.5MG/3ML SOLUTION 11.00 ALCOHOL ISOPROPYL 0.7 LIQUID 16.75 ALENDRONATE 70 MG TABLET 4.25 ALLOPURINOL 100 MG TABLET 4.25 ALPHA 1 PROTEINASE 1000 MG INJ VIAL 1,241.50 ALPRAZOLAM 0.5 MG TABLET 5.50 ALPRAZOLAM 0.25 MG TABLET 5.25 ALTEPLASE 100 MG INJ VIAL 26,785.75 ALTEPLASE 2 MG INJ VIAL 480.75 AMANTADINE 100 MG TABLET 6.75 AMINOPHYLLINE 250 MG/10 ML INJ VIAL 46.50 AMIODARONE 50MG/ML-3ML INJ VIAL 36.50 AMIODARONE 200 MG TABLET 4.25 AMLODIPINE 5 MG TABLET 4.25 AMMONIA INHALANT AMP 0.33 ML INHALER 26.00 AMMONIUM LACTATED CR 12% 140 GM CREAM 45.75 AMOXICILLIN 250MG/5ML-80ML SUSPENSION 12.50 AMOXICILLIN 250 MG CAPSULE 4.25 AMOXICILLIN/CLAV 875MG/125MG TABLET 17.00 AMOXICILLIN/CLAV 500MG-125MG TABLET 6.50 AMOXICILLIN/CLAV SUSP 200MG/28.5MG 5ML-100ML SUSPENSION 44.50 AMPICILLIN FLIP TOP 1 GM INJ VIAL 47.25 AMPICILLIN/SULB FLIP TOP 1.5 GM INJ VIAL 49.25 AMPICILLIN/SULD FLIP TOP 3 GM INJ VIAL 54.00 APIXABAN 2.5 MG TABLET 20.75 ARTIFICAL SALIVA (SALIVA SUBSTITUTES) 1.5 OZ SOLUTION 20.25 ARTIFICAL TEARS 3.75 GM OINTMENT 43.75 ARTIFICAL TEARS (OCULAR LUBRICANT SOLN) 1.4%-15ML SOLUTION 21.75 ASPIRIN 81 MG CHEWABLE 2.00 ASPIRIN EC 325 MG TABLET 2.00 ASPIRIN EC 81 MG CHEWABLE 2.00 ATENOLOL 50 MG TABLET 4.75 ATENOLOL 25 MG TABLET 4.25 ATORVASTATIN 10 MG TABLET 4.25 ATORVASTATIN 40 MG TABLET 4.25 ATROPINE 1 MG/10ML INJ SYR 37.50 ATROPINE 0.4MG/1ML INJ VIAL 26.00 ATROPINE OPHTH 1%-5 ML SOLUTION 142.50 AZITHROMYCIN 250 MG TABLET 4.25 AZITHROMYCIN FLIP TOP 500 MG INJ VIAL 31.50 AZITHROMYCIN SUSP 200MG/5ML-15ML SUSPENSION 34.00 AZTREONAM 2 GM INJ VIAL 180.75 BACITRACIN 500 UN/0.9GM OINTMENT 4.25 BACLOFEN 10 MG TABLET 4.25 BENAZEPRIL 20MG TABLET 4.50 BENZOCAINE SPRAY 20% 20%/ 57GM SPRAY 64.75 BENZONATATE 100 MG CAPSULE 4.25 BENZTROPINE 2MG/2ML INJ VIAL 136.00 BENZTROPINE 1 MG TABLET 4.25 BETADINE OPHTHALMIC OINTMENT OPHTHALMIC UNG 34.00 BETAMETHASONE 6MG/ML-5ML INJ VIAL 116.00 BISACODYL 5 MG TABLET 4.25 BISACODYL 10 MG SUPPOSITORY 5.25 BISMATROL 236 ML LIQUID 10.50 BISOPROLOL 5 MG TABLET 4.25 BUDESONIDE 0.25MG/2ML SOLUTION 33.50 BUMETANIDE 0.25MG/ML 4ML INJ VIAL 26.00 BUMETANIDE 1 MG TABLET 4.25 BUPIVACAINE SDV 0.25% - 10ML INJ VIAL 26.00 BUPIVACAINE SDV 0.75%-10ML INJ VIAL 26.00 BUPIVACAINE SDV PF 0.5%-10 ML INJ VIAL 26.00 BUPROPION XL 150 MG TABLET 4.25 BUSPIRONE 10 MG TABLET 4.25 CALAMINE LOTION LOTION 12.25 CALCITRIOL 0.25 MCG CAPSULE 5.00 CALCIUM CARB 500 MG TABLET 2.00 CALCIUM CARB VIT D 600 MG/400IU TABLET 2.00 CALCIUM CHLORIDE 10% 100MG/ML 10ML INJ SYR 30.00 CALCIUM CIT VIT D 315 MG/250 IU TABLET 2.00 CALCIUM GLUCONATE 10% 100MG/ML 10ML INJ VIAL 51.25 CALCIUM POLYCARBOPHIL 625 MG TABLET 2.00 CARBAMAZEPINE 200 MG TABLET 4.25 CARBIDOPA/LEVODOPA 10-100MG TABLET 5.00 CARBIDOPA/LEVODOPA 25-100MG TABLET 4.25 CARVEDILOL 12.5MG TABLET 4.25 CARVEDILOL 6.25MG TABLET 4.25 CASTOR OIL 60ML LIQUID 16.50 CEFAZOLIN FLIP TOP 1 GM INJ VIAL 36.50 CEFAZOLIN IN D5W 50ML 2 GM PREMIX BAG 35.75 CEFDINIR 300 MG CAPSULE 4.25 CEFDINIR SUSP 250MG/5ML-60ML SUSPENSION 32.25 CEFEPIME FLIP TOP 2 GM INJ VIAL 46.50 CEFEPIME FLIP TOP 1 GM INJ VIAL 35.50 CEFETRIAXONE FLIP TOP 500 MG INJ VIAL 36.50 CEFTRIAXONE FLIP TOP 2 GM INJ VIAL 38.50 CEFTRIAXONE FLIP TOP 1 GM INJ VIAL 26.00 CELECOXIB 100 MG CAPSULE 14.75 CEPHALEXIN 500 MG CAPSULE 4.25 CEPHALEXIN SUSP 250MG/5ML-100ML SUSPENSION 48.75 CETIRIZINE 10 MG TABLET 2.00 CHLORDIAZEPOXIDE 25 MG CAPSULE 5.25 CHLORHEXIDINE 0.0012 LIQUID 40.00 CHLORHEXIDINE/GLUC 120ML LIQUID 13.75 CHOLESTYRAMINE 4 GM PKT POWDER 7.00 CIPRO 0.3%/DEXAMETHASONE 0.1% OTIC 0.3%/0.1% SUSPENSION 649.25 CIPROFLOXACIN 500 MG TABLET 4.25 CIPROFLOXACIN OPHTH DROPS 0.3%-2.5ML LIQUID 31.00 CITALOPRAM 10 MG TABLET 4.25 CLINDAMYCIN 150 MG CAPSULE 4.75 CLINDAMYCIN FLIP TOP 600 MG/4ML INJ VIAL 27.50 CLONAZEPAM 0.5 MG TABLET 4.25 CLONIDINE 0.1 MG PATCH 34.75 CLONIDINE 0.1 MG TABLET 4.25 CLOPIDOGREL 75 MG TABLET 25.25 CLOTRIMAZOLE 1%-30GM CREAM 35.00 CLOTRIMAZOLE/BETAMETH 15 GM CREAM 15.50 COLCHICINE 0.6MG TABLET 19.25 CYCLOBENZAPRINE 10 MG TABLET 4.25 CYCLOSPORINE MODIFIED 25 MG CAPSULE 4.50 DABIGATRAN 75MG CAPSULE 17.50 DANTROLENE 20 MG INJ VIAL 357.00 DAPTOMYCIN 500 MG INJ VIAL 1,306.00 DENOSUMAB 60MG INJ SYR 3,724.75 DEXAMETHASONE 4MG/ML 5ML INJ VIAL 26.00 DEXAMETHASONE 1MG/1ML 30ML SOLUTION 10.50 DEXAMETHASONE 4MG TABLET 4.25 DEXTROSE 40% 37.5 GM GEL 8.00 DEXTROSE 50% 50 ML INJ VIAL 38.50 DEXTROSE 50% 50 ML INJ SYR 26.00 DIAZEPAM 10MG/2ML INJ SYR 113.75 DIAZEPAM 5MG TABLET 5.25 DICYCLOMINE 10 MG CAPSULE 4.25 DIGOXIN 0.25MG/ML 2ML INJ VIAL 31.25 DIGOXIN 0.125MG TABLET 4.25 DILTIAZEM 5MG/ML 25ML INJ VIAL 56.00 DILTIAZEM 5MG/ML 10 ML INJ VIAL 36.50 DILTIAZEM 5MG/ML 5ML INJ VIAL 36.50 DILTIAZEM 60MG TABLET 4.25 DILTIAZEM CD 180MG CAPSULE 5.50 DILTIAZEM CD 120MG CAPSULE 4.25 DIPHENHYDRAMINE 50MG/ML INJ VIAL 26.00 DIPHENHYDRAMINE 12.5MG/5ML LIQUID 4.25 DIPHENHYDRAMINE 25MG CAPSULE 2.00 DIPYRIDAMOLE/ASA 25/200MG CAPSULE 13.00 DIVALPROEX DR 250MG TABLET 6.50 DOBUTAMINE 12.5MG/ML 20ML INJ VIAL 37.25 DOCUSATE 100MG/10ML SYRUP 4.25 DOCUSATE 100MG CAPSULE 2.00 DONEPEZIL 5 MG TABLET 4.25 DOPAMINE PREMIX 400MG/250ML INJ PREMIX 39.00 DOXAZOSIN 2 MG TABLET 4.25 DOXYCYCLINE 100MG TABLET 18.50 DULOXETINE 30MG CAPSULE 23.75 ENALAPRIL 1.25MG/1ML 2ML INJ VIAL 26.00 ENOXAPARIN 80MG/0.8ML INJ SYR 47.25 ENOXAPARIN 60MG/0.6ML INJ SYR 46.75 ENOXAPARIN 100MG/1ML INJ SYR 26.00 ENOXAPARIN 30MG/0.3ML INJ SYR 26.00 ENOXAPARIN 40MG/0.4ML INJ SYR 26.00 ENOXAPARIN MDV 100MG/ ML 3ML INJ VIAL 42.00 ENSURE 240 ML LIQUID 4.75 EPHEDRINE 50MG/1ML INJ VIAL 26.50 EPINEPHRINE 1MG/10ML 1:10,000 INJ SYR 30.75 EPINEPHRINE 1MG/1ML 1:1000 AMPOULE 26.00 EPINEPHRINE ANAPHYLAXIS KIT 1MG/1ML 1:1000 AMPOULE 11.50 EPOETIN ALFA 20000U/1ML INJ VIAL 1,033.00 ERTAPENEM 1 GM INJ VIAL 187.79 ERYTHROMYCIN OPHT 3.5 GM OINTMENT 52.25 ESCITALOPRAM 10 MG TABLET 4.25 ESCITALOPRAM 20 MG TABLET 4.25 ESMOLOL 10MG/ML 10ML INJ VIAL 26.00 EYE STRIPS FLUORESCEIN 1.0 MG STERILE STRIP 26.00 EYE TAB - MULTIVITAMIN EYE TAB MULTI VIT TABLET 2.00 EZETIMIBE 10 MG TABLET 29.25 FAMOTIDINE 20MG INJ VIAL 26.00 FAMOTIDINE 20 MG TABLET 4.25 FEBUXOSTAT 80 MG TABLET 24.50 FENOFIBRATE 160 MG TABLET 6.50 FENTANYL 100MCG/2ML INJ SYR 26.00 FENTANYL PATCH 12 MCG PATCH 48.00 FENTANYL PATCH 25 MCG PATCH 31.25 FENTANYL PATCH 75 MCG PATCH 29.50 FENTANYL PATCH 50 MCG PATCH 20.75 FERROUS GLUCONATE 324 MG TABLET 2.00 FERROUS SULFATE 325 MG TABLET 2.00 FEXOFENADINE 180 MG TABLET 4.00 FINASTERIDE 5 MG TABLET 4.25 FISH OIL 1000 MG CAPSULE 2.00 FLUCONAZOLE 100 MG TABLET 6.25 FLUMAZENIL 0.1MG/ML 5ML INJ VIAL 35.50 FLUOXETINE 20 MG CAPSULE 4.25 FLUTICASONE NASAL 50 MCG SPRAY 19.25 FOLIC ACID 5MG/ML 10ML INJ VIAL 91.50 FOLIC ACID 10 MG TABLET 4.25 FUROSEMIDE 10MG/1ML-10ML INJ VIAL 32.25 FUROSEMIDE 10MG/1ML-4ML INJ VIAL 26.00 FUROSEMIDE 20 MG TABLET 4.25 FUROSEMIDE 40 MG TABLET 4.25 GABAPENTIN 100 MG CAPSULE 4.25 GABAPENTIN 300 MG CAPSULE 4.25 GABAPENTIN 400 MG CAPSULE 4.25 GENTAMICIN OPTH 0.003 SUSPENSION 12.50 GENTAMICIN 40MG/ML 2ML INJ VIAL 36.50 GLIMEPIRIDE 2 MG TABLET 4.25 GLIPIZIDE 5 MG TABLET 4.25 GLUCAGON EMERG KIT 1 MG INJ VIAL 317.00 GLYBURIDE 5 MG TABLET 4.25 GLYCERIN ADULT SUPPOSITORY 5.25 GLYCOPYRROLATE 0.4mg/2mL INJ VIAL 27.75 GUAIFENESIN XR 600 MG TABLET 2.50 GUAIFENESIN/CODEINE 100/10MG/5ML LIQUID 4.25 GUAIFENESIN/DEXTROMETH 200/20MG/10ML LIQUID 4.25 HALOPERIDOL 5MG/ML INJ VIAL 26.00 HALOPERIDOL 1 MG TABLET 4.25 HEPARIN 5,000U/ 1ML INJ SYR 26.00 HEPARIN LOCK FLUSH 100U/ML 5ML INJ SYR 8.25 HEPARIN PREMIX 100U/ML-250ML INJ PREMIX 51.75 HYDRALAZINE 20MG/ML INJ VIAL 26.00 HYDRALAZINE 10 MG TABLET 4.25 HYDRALAZINE 25 MG TABLET 4.25 HYDROCERIN (EMOLLIENT TOPICAL) 4 OZ CREAM 21.25 HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE 4.25 HYDROCHLOROTHIAZIDE 25 MG TABLET 4.25 HYDROCOD/ACET 10MG/325MG TABLET 5.75 HYDROCOD/ACET 7.5MG/325MG TABLET 5.25 HYDROCOD/ACET 5MG/325MG TABLET 4.25 HYDROCOD/ACET ELIX 7.5/325MG-15ML LIQUID 13.25 HYDROCORTISONE 1%-0.5 OZ CREAM 22.25 HYDROCORTISONE 2.5%-30GM CREAM 15.50 HYDROCORTISONE 25 MG SUPPOSITORY 15.00 HYDROGEN PEROXIDE 3%-240ML SOLUTION 15.50 HYDROMORPHONE 2MG/1ML INJ SYR 26.00 HYDROMORPHONE 2 MG TABLET 7.50 HYDROXYCHLOROQUINE 200MG TABLET 9.75 HYDROXYZINE 50MG/1ML INJ VIAL 28.00 HYDROXYZINE 25 MG TABLET 4.25 IBUPROFEN 50MG/1.25ML SUSPENSION 26.00 IBUPROFEN 400MG TABLET 4.25 IBUPROFEN 600 MG TABLET 4.25 IBUPROFEN 100MG/5ML LIQUID 4.00 IDARUCIZUMAB 5G/100ML INJ VIAL 11,590.25 INDOMETHACIN 25 MG CAPSULE 4.25 INS NPH/R MIX 70U/30U/ML INJ VIAL 26.25 INS-ASPART PEN 100U/ML INJ SYR 337.00 INS-DETEMIR PEN 100U/ML INJ SYR 281.25 INS-GLARGINE PEN 100U/ML INJ SYR 92.50 INS-NPH HUMAN 100U/ML INJ VIAL 58.25 INS-NPH REGULAR HUMAN 100U/ML INJ VIAL 58.25 IOPAMIDOL 61%-30ML INJ VIAL 26.75 IPRATROPIUM NEB 0.02%-0.5MG/2.5ML SOLUTION 8.25 IPRATROPIUM/ALBUTEROL INHALER 482.75 IRON SUCROSE 20MG/ML-5ML INJ VIAL 95.50 ISONIAZID 100 MG TABLET 4.25 ISOSORBIDE DINITRATE 5 MG TABLET 4.25 ISOSORBIDE MONO ER 60 MG TABLET 4.25 KETAMINE 10MG/ML 20ML INJ VIAL 70.75 KETOROLAC 30 MG/ML INJ VIAL 26.00 KETOROLAC 60 MG/ML INJ VIAL 26.00 LABETALOL 5MG/ML 20ML INJ VIAL 51.25 LABETALOL 100 MG TABLET 4.25 LACTULOSE ORAL 10GM /15ML SYRUP 9.00 LAMORTIGINE 100 MG TABLET 4.25 LAMORTIGINE 25 MG TABLET 4.25 LATANOPROST OPHTH 0.005%-2.5ML SOLUTION 45.00 LEVALBUTEROL NEB 1.25 MG SOLUTION 27.50 LEVETIRACETAM 100MG/ML 5ML INJ VIAL 33.00 LEVETIRACETAM 500 MG TABLET 4.25 LEVOBUNOLOL OPHTH 0.5%-5ML SOLUTION 66.75 LEVOFLOXACIN 250 MG TABLET 4.25 LEVOFLOXACIN 500 MG TABLET 4.25 LEVOFLOXACIN D5W PREMIX 250MG/50ML SOLUTION 31.25 LEVOFLOXACIN D5W PREMIX 500MG/100ML SOLUTION 31.25 LEVOFLOXACIN D5W PREMIX 750MG/150ML SOLUTION 31.25 LEVONORGESTREL 1.5 MG TABLET - LEVOTHYROXINE 100 MCG TABLET 4.25 LEVOTHYROXINE 112 MCG TABLET 4.25 LEVOTHYROXINE 125 MCG TABLET 4.25 LEVOTHYROXINE 25 MCG TABLET 4.25 LEVOTHYROXINE 50 MCG TABLET 4.25 LEVOTHYROXINE 75 MCG TABLET 4.25 LEVOTHYROXINE 88 MCG TABLET 4.25 LIDOCAINE 1% 10MG/ML 5ML INJ VIAL 32.00 LIDOCAINE 1% 10MG/ML 10ML INJ VIAL 26.00 LIDOCAINE 1% 10MG/ML 20ML INJ VIAL 26.00 LIDOCAINE 1% 5MG/ML 5ML INJ AMP 26.00 LIDOCAINE 1% METHYL PARABEN FREE 10MG/ML 2ML INJ VIAL 26.00 LIDOCAINE 2% 20MG/ML 2ML INJ VIAL 26.00 LIDOCAINE 2% MDV 20MG/ML 10ML INJ VIAL 26.00 LIDOCAINE 4% 4% 5 GRAM CREAM - LIDOCAINE 4% PF 4% PF 5ML INJ AMPOULE 31.00 LIDOCAINE 5% PATCH PATCH 21.25 LIDOCAINE PREMIX 0.4% 2G/500 ML IV SOLUTION 31.25 LIDOCAINE STERILE JELLY 2% 5 ML JELLY 32.50 LIDOCAINE STERILE JELLY 2% 30 ML JELLY 15.50 LIDOCAINE SYRINGE 2% 100MG/5ML INJ SYRINGE 26.00 LIDOCAINE TOPICAL 4% 40MG/ML 50 ML SOLUTION 26.00 LIDOCAINE VISCOUS 2% UNIT DOSE 15ML SOLUTION 7.75 LIDOCAINE/EPI 1% MULTI DOSE VIAL 1% 1:100,000 20 ML INJ VIAL 26.75 LIDOCAINE/EPI 1% SDV 1% 1:100,000 10 ML INJ VIAL 26.00 LIDOCAINE/EPI 2% 1:100,000 AMP 2% 1:100,000 1.7ML INJ AMPOULE 26.00 LIDOCAINE/EPI 2% SINGLE DOSE VIAL 2% 1:200,000 10 ML INJ VIAL 26.00 LIDO-EPI-TETRACYCLINE 2 ML SYRINGE TOPICAL SOLUTION 36.50 LINEZOLID PREMIX 600MG/ 300ML SOLUTION 83.50 LISINOPRIL 10 MG TABLET 4.25 LISINOPRIL 40 MG TABLET 4.25 LISINOPRIL 5 MG TABLET 4.25 LOPERAMIDE 2 MG CAPSULE 4.25 LORATADINE 10 MG TABLET 3.25 LORAZEPAM 2MG/ML INJ VIAL 26.00 LORAZEPAM 0.5 MG TABLET 4.25 LORAZEPAM ORAL 2MG/1ML 30 ML ORAL SOLUTION 31.18 LOSARTAN 50 MG TABLET 4.25 MAGNESIUM CITRATE 300ML SOLUTION 9.00 MAGNESIUM HYDROX 30 ML LIQUID 2.00 MAGNESIUM OXIDE 400 MG TABLET 2.00 MAGNESIUM SULFATE 1G/ 2ML INJ VIAL 26.00 MAGNESIUM SULFATE PREMIX 1 GM/ 50ML SOLUTION 31.25 MECLIZINE 25 MG TABLET 4.25 MEDROXYPROGESTERONE 150MG/ML INJ VIAL 99.25 MELATONIN 3 MG TABLET 2.00 MELOXICAM 7.5 MG TABLET 4.25 MEMANTINE 10 mg TABLET 4.25 MEROPENEM 500MG/100ML INJ VIAL 44.00 METFORMIN 500 MG TABLET 4.25 METFORMIN 850 MG TABLET 4.25 METHADONE 10 MG TABLET 4.25 METHIMAZOLE 5 MG TABLET 4.25 METHYLERGONOVINE 0.2MG/1 ML INJ AMPOULE 39.00 METHYLNALTREXONE 12MG/0.6 ML SYRINGE 214.75 METHYLPHENIDATE 5 MG TABLET 4.25 METHYLPREDNISOLONE SUCCINATE 40MG/ 1ML INJ VIAL 26.50 METHYLPREDNISOLONE ACETATE 80MG/ML INJ VIAL 26.00 METHYLPREDNISOLONE SUCCINATE 1 GM/ 8ML INJ VIAL 144.50 METHYLPREDNISOLONE SUCCINATE 125MG/ 2ML INJ VIAL 37.25 METOCLOPRAMIDE 5MG/ML 2 ML INJ VIAL 26.00 METOCLOPRAMIDE 10 MG TABLET 4.25 METOLAZONE 2.5 MG TABLET 4.25 METOPROLOL 5MG/5ML INJ VIAL 26.00 METOPROLOL SUCC XL 25 MG TABLET 4.25 METOPROLOL SUCC XL 50 MG TABLET 4.25 METOPROLOL TART 25 MG TABLET 4.25 METOPROLOL TART 50 MG TABLET 4.25 METRONIDAZOLE 500 MG TABLET 4.25 METRONIDAZOLE PREMIX 500MG/100ML SOLUTION 31.25 MIDAZOLAM 10MG/2ML INJ VIAL 26.00 MIDAZOLAM 2 MG INJ SYRINGE 26.00 MINERAL OIL STERILE 25 ML OIL 10.50 MINERAL OIL U/D 15 ML OIL 1.25 MIRTAZAPINE 15 MG TABLET 4.25 MOMETASONE FUROATE INHALER 100MCG INHALER 290.75 MOMETASONE FUROATE INHALER 200MCG INHALER 290.75 MOMETASONE FUROATE MDI 220MCG/ACTU-14 INHALATION POWDER 65.30 MONTELUKAST 10MG TABLET 4.25 MORPHINE 10 MG/ML INJ SYR 26.00 MORPHINE 2MG/ML INJ SYR 26.00 MORPHINE 4MG/ML INJ SYR 26.00 MORPHINE IR 15 MG IR TABLET 5.25 MORPHINE ORAL CONCENTRATE 10MG/0.5ML SOLUTION 10.50 MULTIVITAMIN DAILY TABLET 2.00 MULTIVITAMIN W/MINERALS TABLET 2.00 MUPIROCIN 2%-22 GM OINTMENT 33.00 NABUMETONE 500 MG TABLET 5.25 NALOXONE 1MG/ML 2ML INJ SYR 100.75 NAPROXEN 500 MG TABLET 5.00 NAPROXEN 220 MG TABLET 2.00 NEBIVOLOL 2.5 MG TABLET 10.25 NEO/POLY/DEX OPHTH 0.1%-5 ML SUSPENSION 20.50 NEO/POLY/HC OTIC 10ML SUSPENSION 15.00 NEOSTIGMINE 1MG/ML 10 ML INJ VIAL 49.25 NIACIN CR 500 MG TABLET 2.00 NICARDIPINE 2.5MG/ML-10ML INJ VIAL 84.50 NICOTINE PATCH 14 MG PATCH 11.00 NICOTINE PATCH 21 MG PATCH 11.00 NIFEDIPINE ER 30 MG TABLET 4.25 NITROFURANTION 100 MG CAPSULE 11.75 NITROGLYCERIN PREMIX 100MCG/ML-250ML INJ SOLUTION 31.25 NITROGLYCERIN SL 0.4MG TABLET 48.00 NITROGLYCERIN U/D PKT 2%-1 IN OINTMENT 15.50 NITROPRUSSIDE 25MG/ML-2ML INJ VIAL 97.25 NOREPINEPHRINE 1 MG/ML-4ML INJ VIAL 26.00 NORTRIPTYLINE 10MG CAPSULE 4.25 NYSTATIN CRM 100,000UNT, GM 30GM CREAM 45.75 NYSTATIN POWDER 100,000UNT-15GM POWDER 18.50 NYSTATIN SUSP 500,000 UNIT/ ML 60 ML SUSPENSION 4.25 OFLOXACIN OTIC 0.3%-5ML SOLUTION 45.00 OMEPRAZOLE 20MG CAPSULE 4.25 ONDANSETRON 2MG/ML-2ML INJ VIAL 26.00 ONDANSETRON ODT 4 MG TABLET 4.25 ORITAVANCIN 400 MG INJ VIAL 5,458.75 OSELTAMIVIR 75 MG TABLET 42.50 OXCARBAZEPINE 300 MG TABLET 9.75 OXYBUTYNIN 5 MG TABLET 4.25 OXYCODONE CR 20 MG TABLET 18.75 OXYCODONE IR 5 MG TABLET 5.25 OXYCODONE/APAP 5-325 MG TABLET 5.25 OXYMETAZOLINE NSL 0.05%-15ML SPRAY 14.00 OXYTOCIN 10UNT/1ML INJ VIAL 36.50 PANTOPRAZOLE 40 MG INJ VIAL 36.50 PANTOPRAZOLE DR 40 MG TABLET 4.25 PAROXETINE 20 MG TABLET 4.25 PETROLATUM JELLY 1 OZ TUBE JELLY 10.25 PHENAZOPYRIDINE 100 MG TABLET 4.25 PHENOL EZ SWABS 0.89 SWAB 31.25 PHENOL LOZ LOZENGE 2.00 PHENYLEPHRINE 10 MG/ML INJ VIAL 49.75 PHENYLEPHRINE OPHTHALMIC 2.5% 2 ML EYE DROP 97.75 PHENYTOIN 250MG/5ML INJ VIAL 26.00 PHENYTOIN 100 MG CAPSULE 4.25 PIOGLITAZONE 15 MG TABLET 4.25 PIPERACILLIN TAZOBACTAM 3.375 GM INJ VIAL 38.00 PIPERACILLIN TAZOBACTAM 2.25 GM INJ VAL 30.75 PIPERACILLIN TAZOBACTAM 4.5 GM INJ VIAL 29.25 POLYETHYLENE GLYCOL 17 GM POWDER 7.00 POTASSIUM CL ER 10 MEQ TABLET 4.25 POTASSIUM CL ER 20 MEQ TABLET 4.25 POTASSIUM CL ORAL 10%-20MEQ/15ML SOLUTION 4.25 POTASSIUM CL PREMIX 10 MEQ/50 ML SOLUTION 31.25 POTASSIUM/SOD PHOS ORAL POWDER 4.25 POVIDONE-IODINE 10%-1 OZ OINTMENT 28.00 POVIDONE-IODINE 10%-8 oz SOLUTION - PRALIDOXIME 1 GM INJ VIAL 349.75 PRAMIPEXOLE 0.5 MG TABLET 10.25 PRAMIPEXOLE 0.125 MG TABLET 4.25 PREDNISOLONE 15MG/ 5ML ORAL SOLUTION 4.25 PREDNISONE 10 MG TABLET 4.25 PREDNISONE 20 MG TABLET 4.25 PREDNISONE 5 MG TABLET 4.25 PREGABALIN 25 MG CAPSULE 15.75 PREGABALIN 75 MG CAPSULE 15.75 PRIMIDONE 50MG TABLET 4.25 PROBIOTIC LATABACILLUS 4.25 PROMETHAZINE 25 MG SUPPOSITORY 31.25 PROMETHAZINE 25MG/ML AMPOULE 26.00 PROMETHAZINE 25 MG TABLET 4.25 PROMETHAZINE/COD 6.25MG/10MG-5ML LIQUID 4.25 PROPAFENONE 150 MG TABLET 4.25 PROPARACAINE OPHTH 0.005 SOLUTION 69.75 PROPOFOL 10MG/ ML 20 ML INJ VIAL 26.00 PROPRANOLOL 20 MG TABLET 4.25 PROTAMINE SULF 250MG/25ML INJ VIAL 93.75 PSEUDOEPHEDRINE 30 MG TABLET 4.25 PSYLLIUM FIBER 6 GM POWDER 4.25 QUETIAPINE 25 MG TABLET 13.00 QUETIAPINE 100 MG TABLET 4.25 RABIES IMMUNE GLOB 150UNIT/ ML 10ML INJ VIAL 9,640.75 RABIES IMMUNE GLOB 150 UNIT/ML 2 ML INJ VIAL 1,462.25 RACEPINEPHRINE NEB 2.25%-0.5ML SOLUTION 8.25 RANITIDINE 50 MG/ 2ML INJ VIAL 37.50 RANITIDINE 150 MG TABLET 4.25 REFRESH OPTIVE 15 ML SOLUTION 21.75 REGADENOSON 0.4MG/5ML INJ VIAL 636.50 RIFAMPIN 300 MG CAPSULE 7.50 RISPERIDONE 0.25MG TABLET 4.25 RISPERIDONE 0.5MG TABLET 4.25 RISPERIDONE 4 MG TABLET 4.25 RIVAROXABAN 10 MG TABLET 28.50 ROCURONIUM 10MG/ML 10ML INJ VIAL 28.25 ROPINIROLE 1 MG TABLET 4.25 SCOPOLAMINE PATCH 1.5 MG PATCH 57.00 SENNOSIDES 8.6MG TABLET 2.00 SENNOSIDES/DOCUSATE 8.6MG/50MG TABLET 2.00 SERTRALINE 100 MG TABLET 4.25 SERTRALINE 50 MG TABLET 4.25 SEVOFLURANE 250 ML LIQUID 109.00 SILVER NITRATE STICKS APPLICATOR 15.50 SILVER SULFADIAZINE CRM 1%-50 GM CREAM 44.50 SIMETHICONE CHEW 80 MG CHEWABLE 4.25 SITAGLIPTIN 50 mg TABLET 27.75 SODIUM BICARB 650 MG TABLET 4.25 SODIUM BICARB 8.4% 50 MEQ/ 50 ML INJ SYR 34.25 SODIUM BICARB 4% 2.4MEQ/ 5ML INJ VIAL 20.00 SODIUM BICARB INFANT 4.2% 5 MEQ/ 10 ML INJ SYR 34.00 SODIUM CHLORIDE 0.9%-20 ML INJ VIAL 26.00 SODIUM CHLORIDE 0.0065 INHALANT 5.25 SODIUM CHLORIDE 1 GM TABLET 4.25 SODIUM CHLORIDE FLUSH 0.9%-3 ML INJ SYR 8.25 SODIUM CHLORIDE PICC FLUSH 0.9%-10 ML INJ SYR 8.25 SODIUM PHOSPHATE ENEMA 4.5 OZ LIQUID 36.50 SODIUM POLYSTERENE SULFONATE 15MG/60ML SUSPENSION 28.50 SOTALOL 80 MG TABLET 4.25 SPIRONOLACTONE 25 MG TABLET 4.25 STERILE WATER 10 ML LIQUID 26.00 SUCCINYLCHOLINE 20MG/ML-10ML INJ VIAL 26.00 SUCRALFATE 1 GM TABLET 4.25 SUCRALFATE SUSP 1 GM-10ML SUSPENSION 14.50 SULFACETAMIDE OPTH 0.1 SOLUTION 12.50 SULFAMETH/TMP 200-40 MG-5ML SUSPENSION 4.25 SULFAMETH/TMP DS 800-160 MG TABLET 4.25 SUMATRIPTAN 25 MG TABLET 4.25 TAMOXIFEN 10 MG TABLET 4.25 TAMSULOSIN 0.4MG CAPSULE 4.25 TENECTEPLASE 50 MG INJ VIAL 17,847.00 TERAZOSIN 5 MG CAPSULE 6.25 TERAZOSIN 1 MG CAPSULE 6.00 TERBUTALINE 1MG/ML INJ VIAL 30.00 THEOPHYLLINE ER 100 MG TABLET 6.00 THIAMINE 100MG-2ML INJ VIAL 2.00 TICAGRELOR 90MG TABLET 16.25 TIOTROPIUM MDI 18MCG INHALER 43.75 TIZANIDINE 2 MG TABLET 9.00 TOBRAMYCIN-DEXAMETHASONE 0.1/0.3% 3.5 GM OPHTH OINT 669.00 TOPIRAMATE 25 MG TABLET 7.75 TORSEMIDE 20 MG TABLET 4.25 TRAMADOL 50 MG TABLET 4.25 TRAZODONE 50 MG TABLET 4.25 TRIAMCINOLONE 40MG/ ML 1 ML INJ VIAL 44.25 TRIAMTERENE/HCTZ 37.5MG/25MG TABLET 4.25 TROSPIUM 20MG TABLET 10.00 TUBERCULIN PPD 5TU/0.1ML INJ VIAL 30.75 TXA - TRANEXEMIC ACID 1000mg/ 10mL INJ VIAL 50.25 VACC-INFLUENZA HIGH DOSE 0.5 ML INJ SYR 81.83 VACC-INFLUENZA REGULAR 0.5 ML INJ SYR 61.50 VACC-PNEUMOCOCCAL 23 0.5ML INJ VIAL 288.75 VAC-RABIES 2.5UN/1 ML INJ VIAL 887.75 VAC-T-DAP 0.5ML INJ VIAL 107.00 VANCOMYCIN 125MG CAPSULE 30.00 VANCOMYCIN FLIP TOP 1 GM INJ VIAL 34.75 VANCOMYCIN FLIP TOP 500 MG INJ VIAL 26.00 VANCOMYCIN FLIP TOP 750 MG INJ VIAL 26.00 VECURONIUM 1MG/ML 20 ML INJ VIAL 40.75 VENLAFAXINE XR 37.5 MG CAPSULE 4.25 VENLAFAXINE XR 75 MG CAPSULE 4.25 VERAPAMIL 120 MG TABLET 4.25 VERAPAMIL ER 120 MG CAPSULES 7.25 VIT B COMPLEX COMBO MED TABLET 2.00 VIT B-1 100 MG TABLET 2.00 VIT B-12 1000MCG/ML INJ VIAL 26.00 VIT B-12 500 MCG TABLET 2.00 VIT C 500 MG TABLET 2.00 VIT D-3 5000 UNITS TABLET 4.25 VIT D-3 1000 UNITS TABLET 2.00 VIT E 400 UNITS CAPSULE 2.00 VIT K 10MG/ML AMPOULE 154.00 WARFARIN 5 MG TABLET 6.25 WARFARIN 4 MG TABLET 6.00 WARFARIN 1 MG TABLET 5.75 WARFARIN 2 MG TABLET 5.75 WARFARIN 2.5 MG TABLET 4.25 ZOLPIDEM 5 MG TABLET 5.25 ZONISAMIDE 100MG TABLET 8.00 BUMETANIDE 0.25MG/ML 10ML INJ VIAL 26.00 ISOSORBIDE MONO ER 30 MG TABLET 6.25 DEXTROSE 5% 100 ML 15.5 DEXTROSE 5% 250ML 15.5 DEXTROSE 5% 1000ML 19 DEXTROSE 5%/LACTATED RINGERS 1000ML 26 DEXTROSE 5%/ 0.45% SODIUM CHLORIDE 1000ML 26 DEXTROSE 5%/0.9% SODIUM CHLORIDE 1000ML 26 DEXTROSE 5%/ 0.45% SODIUM CHLORIDE/ 20 MEQ KCL 1000ML 26 LACTATED RINGERS 1000ML 26 POTASSIUM 20MEQ/0.9% SODIUM CHLORIDE 1000ML 26 POTASSIUM 40MEQ/0.9% SODIUM CHLORIDE 1000ML 26 SODIUM CHLORIDE 0.45% 1000ML 26 SODIUM CHLORIDE 0.9% 250ML 26 SODIUM CHLORIDE 0.9% 500ML 26 SODIUM CHLORIDE 0.9% 1000ML 26 SODIUM CHLORIDE 0.9% 50ML MINI BAG 40.25 SODIUM CHLORIDE 0.9% 100ML MINI BAG 26 SODIUM CHLORIDE 0.9% 50ML MINI BAG PLUS 15.5 SODIUM CHLORIDE 0.9% 100ML MINI BAG PLUS 15.5 THP ALBUTEROL INHALER 90 MCG INHALE VIAL 52.75 THP ALPRZOLAM 0.25 MG TABLETS 20.25 THP AMOXICILLIN 250 MG CAPSULES 13.5 THP AMOXICILLIN 250 MG/5 ML SUSPENSION 12.5 THP AMOXICILLIN K CLAV 875 MG/125 MG TABLETS 15.25 THP AMOXICILLIN K CLAV 200 MG/28 MG/5 ML SUSPENSION 44.5 THP AZITHROMYCIN 250 MG TABLETS 19.25 THP AZITHROMYCIN 200 MG/5 ML SUSPENSION 34 THP CEFDINIR 300 MG CAPSULES 19.25 THP CEPHALEXIN 500 MG CAPSULES 13 THP CEPHALEXIN 250 MG/5 ML SUSPENSION 12.5 THP CIPROFLOXACIN 500 MG TABLETS 28.5 THP CLYNDAMYCIN 150 MG CAPSULES 12.5 THP CYCLOBENZAPRINE 10 MG TABLETS 12.5 THP HYDROCODONE APAP 325 MG/5 MG TABLETS 12.5 THP LAMIVUDINE 150 MG TABLETS 129.75 THP LEVOFLOXACIN 500 MG TABLETS 12.5 THP LOPINAVIR/RITONAVIR 100 MG/25 MG TABLETS 249 THP NEO/POLY/DEXAMETH EYE DROPS 0.1% /5 ML SUSPENSION 20.5 THP NEO/POLY/ HYDROCORT OTIC DROPS 10 ML SUSPENSION 15 THP NITROFURANTION 100 MG CAPSULES 19.25 THP ONDANSETRON ODT 4 MG TABLETS 12.5 THP OSELTAMIVIR 75 MG CAPSULES 12.5 THP OSELTAMIVIR 6 MG/ ML SUSPENSION 470.25 THP PREDNISOLONE 15 MG/5 ML SOLUTION 14.25 THP PREDISONE 10 MG TABLETS 16.25 THP SULFACETAMIDE EYE DROPS 0.1 SOLUTION 12.5 THP SULFAMETHOXAZOLE/ TRIMETHOPRIM 800 MG/160 MG TABLETS 13.75 THP SULFAMETHOXAZOLE/ TRIMETHOPRIM 200 MG/40 MG/ 5 ML SUSPENSION 19.5 THP TRAMADOL 50 MG TABLETS 23 THP TOBRAMYCIN EYE DROPS 0.003 SOLUTION 12.5 THP VANCOMYCIN 125 MG CAPSULES 13 THP ZIDOVINE 300 MG TABLETS 24.75