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Home , Alpha globulin, Bengay, CD120, Ethicon, Femoral canal, Fibrinolysin

Charge# Description Price 0013144 ROOM CARE SEMI PRIVATE-2T 2T 5,181.00 0013169 ROOM CARE SEMI PRIVATE -P4 P4 5,544.00 0013177 ROOM CARE SEMI PRIV-OVERFLOW 72400 5,544.00 0013185 ROOM CARE SEMI PRIV-2S 2S 5,544.00 0013193 ROOM CARE SEMI PRIV - 76410 5,544.00 0013201 ROOM CARE SEMI PRIV-61703 5,544.00 0014001 ROOM CARE MED-SURG SEMI PRIV-1N 5,544.00 0014050 ROOM CARE SEMI PRIVATE-SUR SUR 5,544.00 0014134 ROOM CARE SEMI PRIV-EHD EHD 5,181.00 0015008 ROOM CARE SEMI PRIVATE -P2S P2 5,544.00 0015081 ROOM CARE SEMI PRIV-P4 P4 5,544.00 0015206 ROOM CARE SEMI PRIVATE-1T 1T 5,544.00 0015222 ROOM CARE SEMI PRIVATE-3T 3T 5,544.00 0015255 ROOM CARE SEMI-PRIV-4T 4T 5,544.00 0016303 ROOM CARE SEMI PRIV-OVERFLOW 60300 5,544.00 0016402 ROOM CARE SEMI PRIV-2W 2W 5,544.00 0017004 ROOM CARE SEMI PRIV-SAU SAU 5,544.00 0017053 ROOM CARE SEMI-PRIV-PACU PACU 5,544.00 0017103 ROOM CARE SEMI PRIVATE-CC1 CC1 5,544.00 0017202 ROOM CARE SEMI-PRIVATE-CC2 CC2 5,544.00 0017301 ROOM CARE SEMI-PRIVATE-3PZ 3PZ 5,544.00 0017319 ROOM CARE SEMI-PRIVATE-4PZ 4PZ 5,544.00 0017335 ROOM CARE SEMI-PRIV OVRFLOW 61705 5,544.00 0017343 ROOM CARE SEMI PRIV-77401 5,544.00 0017350 ROOM CARE SEMI PRIV-P4 P4 5,544.00 0017400 ROOM CARE SEMI-PRIV-4PZ 4PZ 5,544.00 0023143 ROOM CARE TELEMETRY-2T 2T 6,470.00 0023168 ROOM CARE NURSERY-P4 2,237.00 0023176 ROOM CARE TELEMETRY-OVERFLOW 72400 6,923.00 0023184 ROOM CARE TELEMETRY-2S 2S 6,923.00 0023200 ROOM CARE TELEMETRY-61703 6,923.00 0024059 ROOM CARE PRIVATE-SUR SUR 5,544.00 0024133 ROOM CARE TELEMETRY EHD EHD 6,470.00 0024141 ROOM CARE TELEMETRY-CATH LAB CLB 6,923.00 0025007 ROOM CARE NURSERY-P2 P2 2,237.00 0025031 ROOM CARE NURSERY-NSY NSY 2,237.00 0025049 ROOM CARE NURSERY-NICU NIN 2,237.00 0025072 ROOM CARE NURSERY-P3 P3 2,237.00 0025080 ROOM CARE TELEMETRY-P4 P4 6,923.00 0025205 ROOM CARE TELEMETRY-1T 1T 6,923.00 0025221 ROOM CARE TELEMETRY-3T 3T 6,923.00 0025254 ROOM CARE TELEMETRY-4T 4T 6,923.00 0026302 ROOM CARE TELEMETY-OVERFLOW 60300 6,923.00 0027003 ROOM CARE TELEMETRY-SAU SAU 6,923.00 0027052 ROOM CARE TELEMETRY-PACU PACU 6,923.00 0027102 ROOM CARE TELEMETRY-CC1 CC1 6,923.00 0027201 ROOM CARE TELEMETRY-CC2 CC2 6,923.00 0027300 ROOM CARE TELEMETRY-3PZ 3PZ 6,923.00 0027318 ROOM CARE TELEMETRY-4PZ 4PZ 6,923.00 0027334 ROOM CARE TELEMETRY-OVERFLOW 61705 6,923.00 0027342 ROOM CARE TELEMETRY-77401 6,923.00 0027359 ROOM CARE TELEMETRY-P4 P4 6,923.00 0027409 ROOM CARE TELEMETRY-4PZ 4PZ 6,923.00 0033167 ROOM CARE PERINATOLOGY-P4 P4 6,208.00 0034058 ROOM CARE ICU INTENSIVE-SUR SUR 13,336.00 0034082 ROOM CARE TCU-1S LEVEL III 1S 2,475.00 0034140 ROOM CARE INTERMEDT-CATH LAB CLB 10,124.00 0035006 ROOM CARE PERINATOLOGY-P2 P2 6,208.00 0035048 ROOM CARE NICU SURVEILLANCE NIN 8,903.00 0035071 ROOM CARE PERINATOLOGY-P3 P3 6,208.00 0037002 ROOM CARE ICU INTENSIVE-SAU SAU 11,541.00 0037051 ROOM CARE ICU INTENSIVE-PACU PACU 11,541.00 0037101 ROOM CARE ICU INTENSIVE-CC1 CC1 13,336.00 0037200 ROOM CARE ICU INTENSIVE-CC2 CC2 13,336.00 0037309 ROOM CARE ICU INTENSIVE-3PZ 3PZ 13,336.00 0043141 ROOM CARE ADMIN DAY-2T LOW SNF 2T 1,858.00 0043166 ROOM CARE SEMI PRIV LDRP-P4 P4 5,792.00 0043174 ROOM CARE ADMIN DAY-LOW SNF 72400 1,858.00 0043182 ROOM CARE ADMIN DAY-2S LOW SNF 2S 1,858.00 0043208 ROOM CARE ADMIN DAY-LOW SNF 61703 1,858.00 0044008 ROOM CARE ADMIN DAY-1N LOW SNF 1N 1,858.00 0044081 ROOM CARE ADMIN DAY-1N LOW SNF 1S 1,858.00 0045005 ROOM CARE SEMI PRIV LDRP-P2 P2 5,792.00 0045039 ROOM CARE NURSERY-INTERMED NSY 8,903.00 0045047 ROOM CARE NICU INTERMED NIN 8,903.00 0045070 ROOM CARE SEMI PRIV LDRP-P3 P3 5,792.00 0045088 ROOM CARE ADMIN DAY P4 LOW SNF P4 1,858.00 0045203 ROOM CARE ADMIN DAY-1T LOW SNF 1T 1,858.00 0045229 ROOM CARE ADMIN DAY-3T LOW SNF 3T 1,858.00 0045252 ROOM CARE ADMIN DAY-4T LOW SNF 4T 1,858.00 0046300 ROOM CARE ADMIN DAY-LOW SNF 60300 1,858.00 0047100 ROOM CARE ADMIN DAY-CC1 LOW SNF CC1 1,858.00 0047209 ROOM CARE ADMIN DAY-CC2 LOW SNF CC2 1,858.00 0047308 ROOM CARE ADMIN DAY-3PZ LOW SNF 3PZ 1,858.00 0047316 ROOM CARE ADMIN DAY-4PZ LOW SNF 4PZ 1,858.00 0047340 ROOM CARE ADMIN DAY LOW SNF-77401 1,858.00 0047357 ROOM CARE ADMIN DAY P4 LOW SNF P4 1,858.00 0047407 ROOM CARE ADMIN DAY-4PZ LOW SNF 4PZ 1,858.00 0053140 ROOM CARE ADMIN HIGH SUB ACUTE-2T 2,000.00 0053173 ROOM CARE ADMIN HI SUB ACUTE-72400 2,000.00 0053181 ROOM CARE ADMIN HIGH SUB ACUTE-2S 2,000.00 0053207 ROOM CARE ADMIN HI SUB ACUTE-61703 2,000.00 0054007 ROOM CARE ADMIN HIGH SUB ACUTE-1N 2,000.00 0054080 ROOM CARE ADMIN HIGH SUB ACUTE-1S 2,000.00 0055038 ROOM CARE NURSERY-NICU INTENSV NSY 22,521.00 0055046 ROOM CARE NICU INTENSIVE NIN 22,521.00 0055079 ROOM CARE SEMI PRIV P3 5,544.00 0055087 ROOM CARE ADMIN HIGH SUB ACUTE-P4 2,000.00 0055202 ROOM CARE ADMIN HIGH SUB ACUTE-1T 2,000.00 0055228 ROOM CARE ADMIN HIGH SUB ACUTE-3T 2,000.00 0055251 ROOM CARE ADMIN HIGH SUB ACUTE-4T 2,000.00 0056309 ROOM CARE ADMIN HIGH SUB ACUTE60300 2,000.00 0057109 ROOM CARE ADMIN HIGH SUB ACUTE-CC1 2,000.00 0057208 ROOM CARE ADMIN HIGH SUB ACUTE-CC2 2,000.00 0057307 ROOM CARE ADMIN HIGH SUB ACUTE-3PZ 2,000.00 0057315 ROOM CARE ADMIN HIGH SUB ACUTE-4PZ 2,000.00 0057349 ROOM CARE ADMIN HI SUB ACUTE-77401 2,000.00 0057356 ROOM CARE ADMIN HIGH SUB ACUTE-P4 2,000.00 0057406 ROOM CARE ADMIN HIGH SUB ACUTE-4PZ 2,000.00 0063198 ROOM CARE DOU/ONCOLOGY - 76410 5,544.00 0063206 ROOM CARE DOU/ONCOLOGY-61703 1,055.00 0064055 ROOM CARE INTERMEDIATE SUR SUR 10,124.00 0064147 ROOM CARE INTENS CARE-CLB CLB 13,336.00 0065078 ROOM CARE DOU/ONCOLOGY-P3 P3 1,055.00 0065086 ROOM CARE DOU/ONCOLOGY-P4 P4 5,544.00 0065250 ROOM CARE DOU/ONCOLOGY-4T 4T 5,544.00 0073163 ROOM CARE TELEMETRY-OBS-IPT-P4 P4 6,923.00 0074005 ROOM CARE ARC SEMI PRIVATE - 1N 3,419.00 0074088 ROOM CARE ARC SEMI PRIVATE - 1S 3,419.00 0075077 ROOM CARE ADMIN DAY P3 LOW SNF P4 1,858.00 0083162 ROOM CARE SEMI PRIV-OBS/IPT-P4 P4 5,544.00 0083188 ROOM CARE SEMI PRIVATE-2N 2N 3,195.00 0084087 ROOM CARE TCU-1S HOSPICE 1S 2,475.00 0085076 ROOM CARE ADMIN HIGH SUB ACUTE-P4 2,000.00 0094003 ROOM CARE SEMI PRIVATE-1N 1N 3,419.00 0094086 ROOM CARE TCU-1S LEVEL 3 1S 2,475.00 0100016 SUTURE VALVE 3,175.00 0100024 SUTURE CABG W/AV/MV 3,614.00 0100032 SUTURE CABG 1,591.00 0100446 ORSDS MAJOR B 1/4 HR 1,126.00 0100453 ORSDS MAJOR B 4,655.00 0100461 ORSDS MAJOR A 1/4 HR 1,298.00 0100487 ORSDS MAJOR A 5,273.00 0100503 ORSDS RECOVERY RM B 564.00 0100552 URETERAL GUIDE WIRE 129.00 0100602 CORNEAL PROCESSING-TISSUE ANGIOGDYE 8,067.00 0100610 CRYO PROBES 6,050.00 0100628 MINOR SURG-D 1/2 HR 5,516.00 0100636 MINOR SURG-D 1/4 HR 467.00 0100651 MINOR SURG-C 1/4 HR 659.00 0100982 UTERINE MANIPULATOR 148.00 0101097 TOURNIQUET 204.00 0101557 melatonin 3 mg tablet 2.25 0102962 MAJOR SURG-A 1 HR 14,816.00 0102970 MAJOR SURG-A 1/4 HR 1,844.00 0103721 MAJOR SUTURE SET 605.00 0103739 MINOR SUTURE SET 328.00 0103812 CENTRIMED PUMP-OR 3,259.00 0104059 MAJOR SUTURE A SET 1,241.00 0104406 CUSA STRAIGHT/CURVED 1,435.00 0104505 ONCOTECH ASSAY KIT 6,281.00 0104547 KIT ICU VENTRICULOSTOMY 532.00 0104646 ORSDS GENERAL SUTURE MINOR 565.00 0104653 ORSDS GENERAL SUTURE MAJOR 850.00 0104661 ORSDS EYE SUTURE 1,126.00 0104729 CABG OR SERVICES 36,828.00 0104752 MINOR C WITH LASER 15,946.00 0104760 MAJOR B WITH HIGH TECH 23,023.00 0104778 MAJOR A WITH HIGH TECH 30,955.00 0104786 COSMETIC 1/4 HR SSS 110.00 0104794 COSMETIC A 1 HR SSS 990.00 0104836 MINOR SURG-C 1 HR 9,618.00 0109165 BARD UROLOGIST TRAY 840.00 0109173 KII BALLOON BLUNT TIP SYSTEM 84.00 0109199 SEPRAFILM 1,020.00 0109207 MINICAP EXTENDED LIFE PD 230.00 0109215 MINICAP W/POVIDONE IODINE 21.00 0201079 RECOVERY ROOM A 1 HR 4,302.00 0201103 RECOVERY ROOM A 1/4 HR 613.00 0300244 ANES LOCAL/MAC ANESTH 798.00 0300426 ACTIVATED CLOTTING TIME (ACT) 678.00 0300590 ANES SDS GENERAL ANESTHESIA 1,862.00 0300608 ANES SDS MAC ANESTHESIA 745.00 0300780 IABP BALLOON CATHETER 4,692.00 0300798 IABP FO BALLOON CATHETER 5,414.00 0300806 GEN ANES 3HRS OR LESS 4,577.00 0300814 GEN ANES OVER 3 HOURS 14,916.00 0400218 DIABETES OP TRG-INDIVIDUAL 60 MIN 492.00 0400226 DIABETES OP TRG-GROUP 60MIN 285.00 0401448 DIABETES EDUCATION CLASS SERIES 75.00 0401455 DIABETES EDUCATION GESTATIONAL 17.00 0401505 DIABETES EDUCATION INDIVIDUAL 17.00 0401604 SSS SPINAL TAP 2,648.00 0608091 SDS MINOR C 1/4 HR 924.00 0608109 SDS RECOVERY RM A 1/4 HR 299.00 0608133 SDS MAJOR A 1/4 HR 1,555.00 0608141 SDS MINOR C 1/2 HR 5,516.00 0608158 SDS MAJOR A 1 HR 8,301.00 0608166 SDS RECOVERY RM A 1 HR 1,763.00 0608174 SDS RECOVERY RM B 559.00 0608398 SDS EYE SUTURE 1,126.00 0608406 SDS GENERAL SUTURE 3> PKG 850.00 0608414 SDS GENERAL SUTURE 1-3 PKG 565.00 0608463 SDS SCLERAL TISSUE 1,343.00 0608547 SDS MINOR HIGH TECH 15,946.00 0608554 SDS MAJOR HIGH TECH 17,771.00 0608562 COSMETIC A 1 HR 990.00 0608570 COSMETIC B 1/2 HR 605.00 0608588 COSMETIC 1/4 HR 110.00 0608638 SDS CONNECTIVE TISSUE,HUMAN 1,343.00 0615088 BREAST IMPLANT 4,232.00 0700039 AMNIOCENTESIS 974.00 0700047 LD CERCLAGE 12,453.00 0700062 LD FETAL MONITORING 343.00 0700096 LD MINOR SURG 1 HR 5,516.00 0700120 LD OR MAJOR SURG 3,593.00 0700161 NON-STRESS TEST 1,220.00 0705004 LD VAGINAL DELIVERY 8,603.00 0705020 L&D C-SECTION SURGERY 9,209.00 0705038 LD OB RECOVERY ROOM 2,108.00 0705046 OB OBS IV PUSH INITIAL 980.00 0705053 OB OBS INFUSION HYDR ADDL HR (>31M) 200.00 0705061 OB OBS SUBQ/1M INJECTION 531.00 0705079 OB OBS CATH INSERTION 357.00 0705087 OB OBS IV INFUSION HYDR 31-60M INTL 1,167.00 0705095 OB OBS IV PUSH ADDL NEW DRUG 735.00 0705103 BLOOD PATCH OB 1,457.00 0705129 I&D OF VULVA/PERINEUM 670.00 0705137 OUTPATIENT OBS HR ONE P2 MOD 25 300.00 0705145 OUTPATIENT OBS EA ADDL HR P2 MOD25 300.00 0705152 OB OBS IV INFS HYD 31-60M INT MOD59 1,167.00 0705160 OB OBS INFSN HYD ADDL HR >31M MOD59 200.00 0705178 OB OBS THERAPEUTIC INF INTL MOD 59 1,510.00 0705186 OB OBS THRP INF ADDL HR >31M MOD59 137.00 0705194 OB OBS THRP INF SEQ 16-60M MOD 59 137.00 0705202 OB OBS SUBQ/1M INJECTION MOD59 531.00 0705210 OB OBS IV PUSH INITIAL MOD 59 980.00 0705228 OB OBS IV PUSH ADDL NEW DRUG MOD 59 735.00 0705236 OB OBS IV PUSH ADDL SAME DRUG MOD59 162.00 0705244 OBS BIOPHYSICAL WITHOUT NST 1,072.00 0705251 OB OBS PROCEDURE 1,590.00 0751271 BLOOD TRANSFUSION-OB 3,050.00 0800037 DRESSING ADAPTIC 90.00 0800045 DRESSING ADAPTIC 29.00 0800052 DRESSING ADAPTIC 104.00 0800102 BAG LEG DISP 124.00 0800128 BAG BARD BILE 280.00 0800136 BANDAGE 2" PLASTER 61.00 0800193 BANDAGE ACE 2" 15.00 0800201 BANDAGE ACE 3" 27.00 0800219 BANDAGE ACE 4" 16.00 0800227 BANDAGE ACE 6" 22.00 0800235 BANAGE KERLIX ROL STER 75.00 0800243 BANDAGE KLING 2" 3.00 0800250 BANDAGE KLING 3" 15.00 0800268 BANDAGE KLING 4" 16.00 0800276 BANDAGE KLING 6" 20.00 0800292 BANDAGE WEBRIL ALL SIZE 80.00 0800342 BINDER ABDOMINL UNIV 759.00 0800425 BLADE BEAVER 617.00 0800581 STAPLE BONE COV 122.00 0800656 BRUSH CYSTOLOGY 562.00 0800755 CANE 502.00 0800789 CANNULA FEMORAL 578.00 0800797 CANNULA VENOUS 228.00 0800821 CANNULA OXYGEN 107.00 0800847 ELECTRODE BIPOLA 2,899.00 0801050 CATH EMBOLECTOMY 886.00 0801068 CATH EMBOL 4 976.00 0801084 CATH AORTIC ARCH 594.00 0801126 CATH ANGIO 22X1 60.00 0801217 CATH FEMORAL COBE 525.00 0801233 CATH FOGARTY 6FR 1,130.00 0801266 CATH FOLEY 14 5CC 228.00 0801274 CATH FOLEY 16 5CC 228.00 0801282 CATH FOLEY 18 5CC 228.00 0801316 CATH FOLEY 24 5CC 244.00 0801324 CATH FOLY 28 30CC 228.00 0801332 CATH HICKMAN 1,328.00 0801340 CATH INTRODUCER 6 90.00 0801357 CATH INTRODUCER 7 710.00 0801654 CATH SUCTION 137.00 0801670 CATH SWANGANZ PAC 5,719.00 0801688 CATH THOR RT ANG 383.00 0801704 TRAY FOLEY CATH 563.00 0801738 CATH VENTRI FISHR 1,348.00 0801761 KIT DAVOL FEMALE CATH 193.00 0801860 CATH BONNANO 1,401.00 0801878 CATH ROBINSON 10 75.00 0801902 CATH ROBINSON 16 75.00 0801910 CATH ROBINSON 18 75.00 0801985 CATH URETERAL 187.00 0802017 CAUTERY EYE DISPO 354.00 0802041 CERVICAL COLLAR C 502.00 0802058 CERVICAL COLLAR C 502.00 0802124 SCLERAL CIRCLING BAND 40 551.00 0802173 CLIPS HEMO LGRE 467.00 0802181 CLIPS HEMO MED 423.00 0802199 CLIPS HEMO SM 403.00 0802371 CORTICAL SCREW 60 251.00 0802447 CRUTCHES COMPLETE 409.00 0802462 CERVICAL COLLAR P 1,274.00 0802470 CERVICAL COLLAR P 1,105.00 0802496 CERVICAL COLLAR P 502.00 0802587 TUBE CYSTO IRRIGA 109.00 0802678 DRAIN PENROSE 1" 107.00 0802736 DRESSING 1X8 XEROFOAM 55.00 0802744 DRESSING 5X9 XEROFOAM 94.00 0802769 DRESSING TEGADERM 10X12 71.00 0802785 DRESSING SURGIPAD 5X9 22.00 0802793 DRESSING FINGER 48.00 0802850 DRESSING SPAN 5 33.00 0802892 DRESSING GAUZE 29.00 0802934 EAR CENTER BOBBIN 323.00 0803072 TRAY ENDOTRACHIAL 700.00 0803106 SHIELD FOX EYE 29.00 0803171 SPONGE FLUFF STERILE TRAY/10 231.00 0803205 GAUZE VASELIN 1X8 37.00 0803213 GAUZE VASELIN 3X2 61.00 0803239 GAUZE VASELIN 5X7 100.00 0803254 GELOCAST 3 61.00 0803569 GREAT TOE PROSTH 404.00 0803577 GAUZE 2X2 O P 20.00 0803759 VALVE HEIMLICH 171.00 0803791 HEMOVAC 2500 400 1,040.00 0803825 HIP COMPRESSION LAG SCREW 1,508.00 0803999 SET CENTRAL LINE 193.00 0804005 PAD HYPOTHERMIA 643.00 0804047 FILTER IN-LINE 144.00 0804070 CONNECTOR INFUSIO 330.00 0804153 SET MINOR SUTURE INST 421.00 0804203 RING INVALID 282.00 0804211 PACKING IODOFORM 219.00 0804229 PACKING GAUZE IDOFO 1/2" 244.00 0804237 PACKING IODOFORM 152.00 0804245 PACKING IODOFORM 248.00 0804336 IV CATHETER QUICK 70.00 0804344 IV CATHETER QUICK 20 63.00 0804351 NEEDLE QUIK CATH 24 67.00 0804385 IV INFUSION ST BTRFLY 21 20.00 0804450 SET IV BURETROL 2C0148 208.00 0804518 IV STARTER KIT 152.00 0804575 KIT VESSEL CATH 961.00 0804617 KNEE PATELLAR BUT 2,387.00 0804831 NEEDLE TRUE CUT 591.00 0804856 NERVE STIMULATOR 421.00 0804880 PACKING NUGAUZE 1 156.00 0804898 PACKING NU GAUZE 1/4" 203.00 0804906 PACKING NUGAUZE 2 210.00 0804963 PERITONEAL TROCAT 856.00 0804971 SPLINT 3X15 P/P 362.00 0804989 PACEMAKER ELECTRO 584.00 0805010 PAD GROUNDING 199.00 0805135 KIT PRECUTANCOUS SHEATH 1,103.00 0805226 PLATE 5 60MM 1,999.00 0805275 PLATE SEMITUBULAR 371.00 0805317 PLATE SMALL FRAG 436.00 0805325 PLATE SMALL TUB 361.00 0805358 SET PNEUMOTHORAX 2,155.00 0805366 SNARE POLYPECTMY 1,538.00 0805382 DRESSING GAUZE 4X4 6/TRAY 40.00 0805457 PUDENZ VALVE 928.00 0805507 IMPLANT RETIN 106 380.00 0805648 SCREW OLECRAN 721.00 0805655 SCREW REG 220.00 0805663 SCREW S FRAG CAN 595.00 0805747 SHIRLEY SUMP DRAI 311.00 0805754 POST-OP WOOD SHOE M 502.00 0805762 POST-OP WOOD SHOE 502.00 0805770 POST-OP WOOD SHOE M 502.00 0805796 POST-OP WOOD SHOE L 502.00 0805812 SHOE MILLO PEDC L 502.00 0805820 SHOE MILLO PEDC M 502.00 0805838 SHOE MILLO PEDC S 502.00 0805911 CATH SILASTIC 3 F 483.00 0805952 SILICONE TIRE RE2 471.00 0806026 SLING ARM ORTHOPE 502.00 0806075 SPONGE SOF WICK 4X4 22.00 0806174 SPLINT ALUMINM-FO 94.00 0806182 SPLINT ALUMINM FI 80.00 0806240 SPLINT NASAL DENV 1,052.00 0806257 SPLINT POSTERIOR +9 707.00 0806265 SPLINT POSTERIOR ANKLE/ 707.00 0806273 SPLINT SUGAR TONG 934.00 0806299 SPLINT KNEE M 1,371.00 0806307 SPLINT KNEE S 1,143.00 0806315 SPLINT KNEE LG 1,310.00 0806323 SPLINT KNEE XLG 1,143.00 0806398 DRESSING STERI 94.00 0806406 DRESSING STERI 94.00 0806448 STOCKINET BIAS 4 29.00 0806455 STOCKINET BIAS 6 37.00 0806489 STOPCOCKS 3-WAY NYLON 117.00 0806497 SUCTION LINERS 244.00 0806562 SUSPENSOR W/O LEG 166.00 0806596 SUSPENSORIES W/LG 166.00 0806620 SET SUTURE REMOVAL 152.00 0806802 DRESSING TELFA2X3 22.00 0806810 DRESSING TELFA3X8 22.00 0806968 IMPLANT TRAPEZIUM 5,944.00 0807016 TRAY CATH 16FR STRAIGHT 165.00 0807206 TRAY SPINAL ADULT 625.00 0807214 TRAY SPINAL PEDS 518.00 0807313 TUBE ANGLED CHEST 144.00 0807347 TUBE CAROTID JAVI 370.00 0807396 TUBE LEVINE PLAST 18 55.00 0807420 TUBE LEVINE RUBBE 358.00 0807495 TUBE YANKAUER SUC 88.00 0807529 TUBE DUODENAL GI 1,687.00 0807586 FILTER BLOOD ULTIPOR 540.00 0807610 UNDERWATER CHEST 640.00 0807628 UNIPK CATRK EXT A 869.00 0807644 URETERAL BRSH KIT 1,190.00 0807677 SET URINARY DRAIN 244.00 0807693 URINE METER 603.00 0807735 VAGINAL SPECULUM 88.00 0807941 BRACE WRIST 523.00 0807966 CONNECTOR Y 847.00 0807990 WIRE KIRSHNER 155.00 0808055 STIMULATOR NERVE 649.00 0808063 SUCTION ELECTRO 354.00 0808097 TESTICULAR PROSTH 2,503.00 0808147 PIN HALF 358.00 0808154 ROD COMPRESSION 1,395.00 0808238 CATH SWANGANZ 2,826.00 0808253 SHOULDER IMMOBIL LG 730.00 0808261 SHOULDER IMMOBI MED 502.00 0808378 SET PREP DISPOS 87.00 0808386 IV CATHLON #20 135.00 0808394 IV CATHLON #18 135.00 0808543 PAD EYE OVAL EACH 20.00 0808634 CAST FULL BODY +9 1,645.00 0808683 CAST SHORT ARM +9 431.00 0808691 CAST SHORT ARM -9 87.00 0808725 CAST LO ARM PL -9 386.00 0808741 CAST LONG ARM + 9 372.00 0808782 CAST LONG LEG + 9 1,165.00 0808816 SORBITAL 226.00 0808949 PATELLA COMP RMC 4,450.00 0808980 BN GR ST PW SUPPY 19,191.00 0809103 STOPCOCKS (3-WAY) 104.00 0809319 CATH BALLOON 2,862.00 0809335 CATH FOLEY 26 5CC 228.00 0809350 DRESSING SURGICAL 4X6 33.00 0809368 DRESSING SURGICAL 6X8 55.00 0809434 DRAIN SUMP W/FLTR 769.00 0809459 DRAIN TROCAR 1/4 1,096.00 0809467 DRAIN TROCR 1/8 1,096.00 0809475 DRAIN FLAT 1/2 747.00 0809483 DRAIN FLAT 1/4 859.00 0809673 PENCIL ELECTROSURGICAL 243.00 0809681 IOL POSTERIOR CHAMBER 2,798.00 0809855 CATH VEIN 102.00 0809863 SPONGES SOF WICK 2X2 22.00 0809921 GRADIENT COMPRESSION STOCKING 502.00 0810051 FILTER REDI FLOW SYSTEM 973.00 0810085 BAG AMBU & VALVE 781.00 0810093 PROBE RECTAL DISP 663.00 0810135 CATH STAMEY SUPRAPUBIC 988.00 0810168 CATH RUTNER WEDG 409.00 0810192 DRAIN EVACUATOR 400 CC 7080 658.00 0810200 SET IRRIGATION 280.00 0810226 TRAY PARA CERVICAL BLOCK 432.00 0810283 ELECTRODE FETAL SCALP 383.00 0810424 IRRIG 4BTLE TUR 273.00 0810499 CLAMP GREEN 90.00 0810549 SWABSTICK BETADINE 20.00 0810556 SET CARDIOPLEGIC 3,437.00 0810564 DRAIN MINI 100 518.00 0810598 CATH FOLEY 3 WAY 228.00 0810903 OTOTOME BURRS 734.00 0811174 GRAFT 8MM 2,431.00 0811299 MASK DISP 80.00 0811323 CAP INJECTION 52.00 0811414 CANNULA ROOT 586.00 0811422 CANNULA ADAPTER 259.00 0811430 LIG A LOOPS 139.00 0811463 CANISTER SUCTION 1200CC 210.00 0811471 STAPLE RICHARDS 883.00 0811554 STOCKINET TUBE 6 368.00 0811570 GRAFT PIPE VASCULAR 3,626.00 0811711 WIRE GUIDE GW-35 295.00 0811760 DRAPE U 454.00 0811794 DRAPE TOWEL 124.00 0811828 DRESSING DUO DERM 228.00 0811851 DRESSING GAUZE2X2 10 PKG 17.00 0811885 TRAY VENTRICULOST 633.00 0811943 CERVICAL COLLAR 1,098.00 0811968 AB VACURETTE #6 193.00 0811976 AB TUBING 413.00 0812024 SHUNT INAHARA 1,459.00 0812065 TRAY THORACENTISE 643.00 0812214 GRATF BIONIT 3,790.00 0812297 LENS AIDE 75.00 0812354 ADMIN PUMP SET 453.00 0812420 CATH FOLEY 3 WAY 287.00 0812479 KIT NASAL PACKING 1,476.00 0812669 CATH SUCTION 14FR 61.00 0812693 CATH SUCTION DELEE MUCUS TRAP 186.00 0812727 CATH SUCTION 14FR 48.00 0812800 DRESSING TEGADERM 33.00 0812909 KIT SPINAL 25G 700.00 0812917 TRAY EPIDURAL 1,040.00 0812925 STENT BARD COIL 1,466.00 0812974 BRACE CLAVICLE SM 502.00 0812982 SLING ARM SM 502.00 0812990 SLING ARM PED 502.00 0813154 SPLINT POSITION HAND/WRIST 625.00 0813295 SET RADIAL CATH 414.00 0813360 TUBE BRONCHO 377R 626.00 0813436 GRAFT RINGED 6MM 9,174.00 0813543 TUBE FEEDING COR 889.00 0813675 INTRA AORTIC BALLOON 15,024.00 0813717 FILTER SYSTEM GREENFIELD VENA 11,092.00 0813725 BAG DRAINAGE URE 248.00 0813899 CATH FOGARTY 3FR 1,274.00 0813907 CATH DEAFLEX 1,688.00 0813949 CATH HICKMAN 1,652.00 0813972 SPLINT WRIST R 591.00 0813980 SPLIT WRIST L 649.00 0814004 TUBE LASER TRACH 2,107.00 0814079 TUBING NITRO 2C9100 658.00 0814277 GRAFT GORTEX PTCH 2,517.00 0814327 TUBE KEOFEED 5FR 438.00 0814376 HEMOCONCENTRATOR 4,267.00 0814384 STENT BILIARY 2,097.00 0814392 NEEDLE ENDOSCOPIC 1,420.00 0814400 SET PEG 2,442.00 0814434 CAST K 4" 735.00 0814442 CAST K 5" 926.00 0814483 CATH DOUBLE LUMEN 3,934.00 0814509 CAST K 2" 459.00 0814517 CAST K 3" 494.00 0814566 COVER ROLL 12X12 33.00 0814590 CONNECTOR DENVER 271.00 0814616 BLADE POWER SAW DISPOSABLE 781.00 0814640 DURA TUTOPLAST6X8 7,510.00 0814657 RING FALLOPIAN BAND 1,161.00 0814665 FILTER STORZ 80.00 0814699 PATELLAR COMPONET 2,266.00 0814723 PROBE BICAP 4,281.00 0814731 ELECTRODE EXTER 1,310.00 0814780 WIRE MEDTRONIC PACER 1,036.00 0814855 GUIDE WIRE TFJ 677.00 0814889 CONNECTOR TUBING 1,449.00 0815027 TRAY MYELOGRAM PH4320 790.00 0815035 TRAY MYELOGRAM PH4324A 594.00 0815050 BLOOD PUMP SET 626.00 0815134 KIT MULTI-LUMEN 2,063.00 0815183 TRAY SADDLE BLOCK 707.00 0815274 NEEDLE BIOPSY DGB 540.00 0815290 CATH SUBCLAVIAN 2,346.00 0815308 CATH BALLON 3,120.00 0815407 DRAIN PENROSE 1/4 94.00 0815589 KNEE RMC PAT 4,025.00 0815654 EYE CONFORMER 697.00 0815738 HIP HOWMEDICA FEM 3,215.00 0815761 CATH HEMED 11.0 DL LUMEN 2,550.00 0815787 POUCH ACTIVE LIFE 139.00 0815852 WIRE .035 EXCHANGE 524.00 0815886 AORTIC PUNCH DISP 649.00 0816033 STAPLE PROX LSV30 2,125.00 0816108 TRAY FOLEY TRU-MS 747.00 0816116 WIRE GUIDE 3610 317.00 0816124 NEEDLE CHIBA 22G 449.00 0816157 CLAMP ACTIVE LIFE 15.00 0816207 STAPLE DISP SKIN 1,129.00 0816215 CATH VACCESS DOUBLE LUMEN 1,654.00 0816249 NEEDLE ENTRY 19G 379.00 0816256 TRAY PREOPERATIVE 276.00 0816264 DRESSING BIOCLUSI 166.00 0816280 BAG BLOOD LINER 1,201.00 0816298 GUIDE WIRE TSCF 3 428.00 0816314 GUIDE WIRE TSF 32 304.00 0816330 TRAY ANESTHESIA EPIDURAL 807.00 0816348 TRAY AMNIOCENT OB 640.00 0816371 ILLUMINATOR 831.00 0816447 TRAP MUCOUS SPEC 155.00 0816454 SCREWS 530.00 0816488 SYNTHES C-CLAMP 1,051.00 0816538 ENEMA UNIT BUCKET 64.00 0816546 TUBE FEEDING 8FR 52.00 0816553 TUBE EXTENSION K-50 52.00 0816561 INJECTION SITE/DUAL 132.00 0816587 SPINAL NEEDLE REG 100.00 0816595 PLUG CATH 22.00 0816645 WAX BONE W316 28.00 0816686 ACE COLLES WRENCH 80.00 0816785 SPONGE XR DETEC 67.00 0816793 SPONGE RAY-TEC 107.00 0816801 STAPLING INTERNAL 1,423.00 0816819 ELECTRODE PACING 1,309.00 0816827 CONNECTING TUBING SUCTION STR 88.00 0816868 HEMOSTAT SURGICAL 676.00 0816876 HEMOSTAT 2X14 594.00 0816884 HEMOSTAT SURGICAL 454.00 0816892 GAUZE TUBE SIZE 10 399.00 0816934 KIT CENTRAL VEIN 1,027.00 0816942 CATH THORACIC 36 FR. 383.00 0816967 BAND BULK 6PLY 90.00 0816975 PACK CELL SAVER 5,026.00 0816983 DRAPE STERI 18X36 312.00 0816991 DRAPE STERI 48X50 453.00 0817007 STERILE DRAPE COVER 156.00 0817056 SPEARS SURGICAL 67.00 0817080 SET PLATELET 199.00 0817098 TUBE ET 90MM 124.00 0817163 DRAIN THOR 3 2,074.00 0817189 TRAY ARTHROGRAM 677.00 0817296 TRAY HYSTERO-SALPINGO 470.00 0817361 TRAY ARTERIOGRAM 993.00 0817445 SPLINT 4X30 C 540.00 0817569 CLIP SPRING SOFT 438.00 0817577 CATH TAUT 620.00 0817643 GUIDE WIRE THSF38 518.00 0817684 GUIDE WIRE THSCF 569.00 0817973 EVACUATED CONT 71.00 0818583 WATER IRRIG USP 235.00 0818591 WATER IRRIG USP 80.00 0818625 IRRIGATION 3% SOR 337.00 0818633 BAG 0.9% SOD CHLO 368.00 0818641 WATER IRRIGATION 90.00 0818658 CHLORIDE 55.00 0818690 SET EXTENSION W/2 Y INJ 46.00 0818740 CONTINU-FLO W/3 118.00 0818765 SET CYSTO IRRIG 203.00 0818773 SET Y-TYPE TUR/CB 398.00 0818880 ARTHROSCOPY TUBING 4-PRONG IRR 414.00 0818906 SUCTION TUBE 1/4 107.00 0818914 SUCTION SIGMOID 124.00 0818963 BLADE DERMATOME 449.00 0818971 STAPLE ROTICULAT 3,299.00 0818989 BAG-A-JET 330.00 0819003 DISSECTORS K 107.00 0819011 STAPLE LDS-15W 1,632.00 0819037 BLADE DERMATOME BROWN 492.00 0819094 CATH NEEDLE RTVN 996.00 0819334 STOCKINET 6" BIAS 226.00 0819359 GUIDE WIRE TSFB38 569.00 0819409 CATH PIGTAIL 4FR 035 781.00 0819516 PROBE RECTAL 580.00 0819524 CATH P5.OB 38 50 560.00 0819557 NEEDLE ASPIRAT BIOPSY 555.00 0819607 GUIDE WIRE TSF 38 260 591.00 0819623 GUIDE WIRE TSF 38 145 375.00 0819755 CATH 6FR INTRODUCER 846.00 0819847 KIT OBSTETRICAL VACC DEL 1,010.00 0819995 PACK CUSA 6,262.00 0820001 NEEDLE PERCUTANEOUS 166.00 0820027 GUIDEWIRE TSCF 35 394.00 0820050 INTRODUCER ONE STICK 2,120.00 0820068 NEEDLES BIOPSY 502.00 0820134 NEEDLE SET ONE STEP 11,210.00 0820159 CATH MALECOT NEPH 1,118.00 0820217 GUIDE WIRE AMPLAT 678.00 0820266 DILATOR VESSEL 293.00 0820589 GUIDEWIRE THSF 38 450.00 0820704 GI KIT 3,191.00 0820845 GUIDEWIRE AMP TOR 1,480.00 0820902 BANDAGE ESMARK 4" 431.00 0820910 BANDAGE ESMARK 3" 362.00 0820928 SLEEVES SCLERAL 270 431.00 0820944 CATH FOLEY CONTINOUS IRR 408.00 0820951 CATH FOLEY 22FR 30CC 436.00 0821025 URINAL DISP 46.00 0821199 SYSTEM AMPLAJZ ANCHOR 1,598.00 0821215 STOPCOCKS FLOSWITCH 273.00 0821231 AUTOTRANSFUSION SYSTEM D 1,223.00 0821454 PLATE 7 HOLE SYNTHES 1,362.00 0821462 PLATE 9 HOLE SYNTHES 1,669.00 0821553 CORD DISP CYSTO E-0503 181.00 0821603 BASKET 4 WIRE STONE 1,764.00 0821611 PERFORATOR CODMAN DISP 2,682.00 0821637 HIP ABDUCTION CONTROL 502.00 0821736 SUCTION SHOWER HEAD IRRG 389.00 0821744 IRRIGATOR SIMPULSE SUCT 1,346.00 0821827 TUBING FRAGMATOME 820-5 870.00 0821835 V-LANCE CORNEAL KNIFE 1,191.00 0821918 NAIL ZICKEL B 704.00 0821942 SCREW SELF TAPPING HARRIS GALA 946.00 0822056 SCREW KUROSAKA FIXATION 1,767.00 0822072 REMOVER ER STAPLE 243.00 0822213 PLATE SYNTHES 150 DEGREE 6 HOL 1,767.00 0822239 CONNECTOR 3/8 X 3/8 X 3/8 Y 199.00 0822247 CONNECTOR 3/8 X 3/8 STRAIGHT 155.00 0822270 CATHETER URETERAL DILATATION 3,373.00 0822312 CANNULA 6.5MM HI FLOW AORTIC A 800.00 0822320 CANNULA WIRE REINFORCED VENOUS 734.00 0822338 CLAMP UNIVERSAL SYNTHES 3,304.00 0822353 NAIL TIBIA ZIMMER 1,540.00 0822486 LIGACLIP 20/20 APPLIER 1,773.00 0822494 MESH MARLEX 6X6 410.00 0822510 ELECTRODE EXTENDED BLADE 9114 304.00 0822544 KNEE TOTAL CONDYLAR TIBIAL 11,669.00 0822569 KNEE TOTAL CONDYLAR PATELLA 3,072.00 0822593 VSCI TEFLON FELT 6X6 301.00 0822627 CANNULA 8.0MM AORTIC ARCH SARN 949.00 0822643 PROBE ELECTOHYDRAULIC 3FR ACMI 3,400.00 0822650 CONT SYSTEM-SLUSH BAGS 926.00 0822767 MYRINGOTOMY KNIFE DISP 471.00 0822809 COTTONOIDS RAND 243.00 0822841 BILATERL LIMB DRAPE 663.00 0822858 HOOD PRE PACK STERILE DISPSBL 677.00 0822874 RHINOPLASTY IMPLANT 2,572.00 0823211 OPEN LAMINAR HOOK (THORACIC) 4,007.00 0823310 OPEN LAMINAR HOOK BLADE 5,139.00 0823344 L DISPLACED LAMINAR HOOK(THORA 5,180.00 0823591 CONDYLES FEMORAL BONE 5,398.00 0823682 COTREL SCREW SACRAL 95027-45 3,952.00 0823781 FIBERS YAG LASER DISPOSABLE 3,120.00 0823799 SCREW TITANIUM SOFT TIS CONCEP 897.00 0823831 HEMOLLIP, MED 234.00 0823872 ROD 35MM BENT 20 1,888.00 0823880 ROD 35MM BENT 35 2,168.00 0823906 ROD 35MM BENT 50 1,888.00 0823922 DRILL BITS DISPOSABLE 916.00 0823971 SMOKE EVACUATOR-HOSES 141.00 0824052 BONE CANCELLOUS STRIP TEY ARC 1,162.00 0824060 BONE CORTICAL STRUT TCQ ARC 3,597.00 0824094 LIGACLIP REFILL CARTRIDGE TCRZ 1,090.00 0824128 CATH VASPORT VP100 5,591.00 0824136 STAPLE PREMIUM CEEA 28-31 AUT 5,343.00 0824144 KIT CELL SAVER FAST PACK 5,207.00 0824276 KNEE DEPUY AMK FEMORAL COMPONE 14,991.00 0824300 SHEET THYROID 368.00 0824326 SHEET LAP W/ARMBOARD 431.00 0824334 PACK SET UP BASIC 228.00 0824359 SHEET THREE QUARTER DRAPE 228.00 0824409 GRAFT ATRIUM PLASMA TFE 7,438.00 0824425 BLADE, ARTHROSCOPY DISP 2,145.00 0824433 NAIL ENDER RICHARDS 737.00 0824458 KIT SHOULDER TRACTION 1,547.00 0824482 SUCTION ASSEMBLY CELL SAVER HA 1,098.00 0824524 BOOTIES SUTURE AID YELLOW DISP 139.00 0824540 BAG DISPOSABLE DRAINAGE CYSTO 636.00 0824565 BOOTIES SUTURE AID DISPOSABLE 139.00 0824573 PEN SKIN SCRIBE DISPOSABLE 80.00 0824599 HIP UNIVERSAL TAPER HEAD OMNIF 3,409.00 0824656 SET HARVARD MICROBORE HIGH FLO 199.00 0824680 CUP BI-ARTICULAR ZIMMER 6,966.00 0824714 CATH GROSHONG SINGLE LUMEN 4,181.00 0824722 CATH GROSHONG DUAL LUMEN 6,159.00 0824730 CORD BIPOLAR DISPO 203.00 0824755 CATH FOLEY COUNCIL TIP 438.00 0824797 GRAFT HEMOSHIELD BIFURCATED 8,784.00 0824805 GRAFT HEMOSHIELD STRAIGHT 5,666.00 0824862 PLATE LUHR CURVED 1,123.00 0824870 OCCLUDER VASCULAR DISPOSABLE 1,491.00 0824920 KNEE PCA TIBIAL BASE STEM LRG 10,793.00 0824987 ANGIOSCOPE 2.3 NN DISPOSABLE 9,111.00 0825034 STAPLE CR75 RELOADING UNIT 2,512.00 0825141 KNEE ZIMMER INSALL BUR PATELLA 3,026.00 0825232 STAPLE PURSESTRING DEVICE 812.00 0825364 TRAY CONTINUOUS EPIDURAL PORTE 906.00 0825414 NEEDLE VERIES AUTOSUTURE 1,181.00 0825422 TROCAR DISPOSABLE 231.00 0825497 RETAINERS VISCERA MEDIUM 591.00 0825521 SHEATH DILATOR GUIDEWIRE ARROW 502.00 0825638 DRAPE PEDIATRIC CONVERTORS DIS 786.00 0825653 KNIFES GRIESHABER BLADE DISPOS 803.00 0825745 ENDOCLIP DISPOSABLE AUTOSUTURE 3,242.00 0825752 CONVERTOR SURGIPORT AUTOSUTURE 282.00 0825778 CANNULA RETROPLEGIA COR SINUS 2,369.00 0825786 NAIL GAMMA 12MM X 130 DEGREE 7,010.00 0825794 NAIL GAMMA LAG SCREW 12 X 80MM 3,000.00 0825802 NAIL GAMMA LOCKING SCREW SET 1,136.00 0825810 NAIL GAMMA TRANSVERSE SCREW 1,473.00 0825877 KNEE I/B FLUTED ROD 2,992.00 0825893 KNIFE GRIESHABER ALL 1,066.00 0825901 BOVIE NEEDLE POINT DISPOSABLE 55.00 0825935 PROBE VITRECTOMY DISPOSABLE 3,242.00 0825943 SHIELD VISITEC EYE 40.00 0825976 QUICKANCHOR #2 MITEK DISPOSABL 1,984.00 0825992 DRESSING GLASCOK EAR 508.00 0826073 COTREL HOOK LFT/RIGHT 84172L/R 4,093.00 0826156 COTREL ROD 84200L260 26CM 1,429.00 0826198 COTREL BLOCKER FOR SACRAL SCRE 1,086.00 0826271 IRRIGATTOR ENDO-FLOW DISPOSABL 1,877.00 0826305 HIP UNIVERSAL HEAD INTERMEDICS 3,489.00 0826362 CIRCUIT BREATHING HEATED ANEST 766.00 0826388 CANNULA ACUFEX UNIVER 5X76MM 500.00 0826396 HIP SHELL INTERMEDICS 7,887.00 0826404 HIP INSERT INTERMEDICS 28MM 3,538.00 0826412 HIP FEMORAL STEM INTERMEDICS 27,200.00 0826446 TUBE GASTROSTOMY 18 FRENCH 154 1,165.00 0826479 MESH LARGE 2,125.00 0826487 SCREW CANNULATED SYNTHES ALL 1,332.00 0826602 GLIDEWIRE 0.35 X 450CM GI LAB 2,515.00 0826818 ACROMED SCREW 6.5X40 2026-2840 1,935.00 0826834 ACROMED WASHER 5MM 2026-1205 244.00 0826925 STIMULATOR ANY BONE IMPLANTED 34,557.00 0826974 LEAD NEUROSTIMULATOR MEDTRON 10,822.00 0827048 KANEDA SCREW ANTERIOR SPINAL 5 1,935.00 0827162 STRIPPER VEIN DISPOSABLE 508.00 0827303 POUCH ENDOSCOPIC 4X4 ETHICON 1,547.00 0827402 PRESSURIZER FEMORAL CANAL DISP 791.00 0827436 KIT MIXEVAC II HIGH VAC CEMENT 1,556.00 0827501 ADAPTER TUOMY BORST INJECTION 296.00 0827568 GUARD C02 FILTRATION SYSTEM 431.00 0827592 BLANKET BEAR HUGGER ADULT DISP 476.00 0827634 FORCEP RADIAL JAW W/NEEDLE DIS 1,598.00 0827725 HIP ACETABULAR SHELL PCA HOWME 7,515.00 0827733 HIP HOODED INSERT HOWMEDICA 3,659.00 0827741 HIP FEMORAL HEAD HOWMEDICA 3,460.00 0827758 HIP DISTAL SLEEVE OSTEOLOCK HO 1,697.00 0827782 ELECTRODE LEEP DISPOSABLE ALL 625.00 0827808 CLIP HULKA TUBAL OCCULDING 686.00 0827865 PIN ABSORBABLE ORTHOSORB J&J O 1,362.00 0827873 BLOCK BITE ENDO ADULT DISPOSAB 124.00 0827907 SPLINT ANKLE AIRCAST RIGHT/LFT 819.00 0827931 STAPLE INTERNAL TLC75 TITANIU 1,187.00 0827949 STAPLE RELOAD TLC75 INTERNAL 634.00 0827956 IMPLANT HYDROXYAPATITE OCULAR 6,427.00 0827972 BONE POSTERIOR 1/2 FRESH 35,588.00 0827998 CANNULA 7CM DIP ROTOR CUFF DIS 569.00 0828012 INSERT FOGARTY SOFT JAW 386.00 0828079 RETRACTOR HOOK IRIS LID DISPOS 569.00 0828269 CATHETER P5.OB3850M450 578.00 0828392 FORCEPS SIMPSON OB SET-UP 156.00 0828665 SLEEVE KENDALL SCD 312.00 0828699 NEEDLE BIOPSY WESTCOTT 20G7 494.00 0828772 ENEMA BAG EZ-EM 310 118.00 0828814 KIT PERCUFIX CATHETER CUFF 586.00 0828889 NEPH URETER INT STENT 2,516.00 0828913 KIT URETERAL STENT 22-573 2,516.00 0829069 CATHETER P5.OB38100MNSO 523.00 0829135 FILTER LEVKOCYTE RC100 1,118.00 0829259 RAZOR DISP 16.00 0829291 COTTON LEUNG BILIARY STENT KIT 2,162.00 0829374 SCAPEL DISP #11 48.00 0829408 SPLINT WRIST RIGHT 502.00 0829465 INFUSION CATH 1,630.00 0829549 SUPPORT ANKLE LARGE 502.00 0829580 TUBE CULTURE ANAEROBIC 219.00 0829614 SUPPORT ANKLE MEDIUM 502.00 0829622 NEEDLE BIOPSY HAAGA DHBN1815.0 1,179.00 0829655 TUBE CULTURE 37.00 0829721 HEMOSTAT KELLY STERILE DISP 141.00 0829739 PERFORATOR AMNIOTIC MEMBRANE 80.00 0829747 NEPHROURETERAL STENT 8F 26CM 1,904.00 0829762 SPENCO LINER 502.00 0829788 URETERAL STENT IE/10/24 2,285.00 0829796 SCISSORS SHAFT DISP MINI MET2 5M 289.00 0829846 CATHETER TORQUE 5FR 636.00 0829861 HALO VEST 502.00 0829895 SUPPORT ELASTIC ANKLE XLARGE 502.00 0829929 CANNISTER SUCTION 1000CC 117.00 0829937 GUIDEWIRE AMPLATZ TORQUE 35CM 1,693.00 0829986 VASTACK Y INJECTION SITE 282.00 0830000 IV CATHETER QUICK 22X1 63.00 0830042 NEEDLE ENTRY 4463-11-2719 155.00 0830125 CATHETER ACKRAD 5FR 61-3005 936.00 0830174 DUODERM 4X4EA OP 37.00 0830190 NEEDLE LOCALIZATION PERCUGUIIDE 523.00 0830208 BASKET SEGURA 5B/4/70 3,451.00 0830356 GUIDE WIRE STRAIGHT 15CM 1,115.00 0830372 STENT URETERAL US/8/22 2,162.00 0830380 DUODERM 6X6BX OP 330.00 0830463 CATHETER P5.035100MNSJB1 595.00 0830661 SET MICRO INTRODUCER 401 870.00 0830687 URETERAL STENT US/8/24 1,967.00 0830745 CATHETER ANGIO UT/6-4/7/75 4,501.00 0830950 SNARES 3,755.00 0831024 GOOSE-NECK SNARE GN1500 3,755.00 0831057 URETERAL STENT 32CM 2,253.00 0831099 DILATOR VESSEL 4FR NCD4.03520 290.00 0831115 DILATORS 282.00 0831222 WIRE COIL PUSHER 16 175CM 2,156.00 0831313 SPINAL NEEDLE LONG 20G 6" 540.00 0831321 NEEDLE WESTCOTT BIOPSY 22GAX3. 463.00 0831370 CATHETER INFUSION EDM 46 46013 4,498.00 0831784 OCLUDNG SPRNG EMBOLI MWCE384.3 746.00 0831859 IVC FILTER REMOVABLE 7,900.00 0831875 PNEUMATIC WALKING SPLINT 502.00 0831917 SCOTCHCAST 4"X15" 431.00 0831925 IVC FILTER PERMANENT 7,900.00 0831982 SCOTCHCAST 5"X30" 769.00 0832006 GLIDEWIRE ANGLED .025 1,020.00 0832196 EMBOL .018 COILS 1,483.00 0832238 CATHETER HIGH FLOW 5FR PIG 664.00 0832477 SPINAL NEEDLE LONG 330.00 0832568 TRAY E.D NOSE BLEED 453.00 0832642 URETERAL DRAINAGE BAG 295.00 0832691 WIRE REG 0.35 482.00 0832717 EPIRENTAL DISSECTOR 216A 137.00 0832782 ATKINSON NEEDLE 182.00 0832923 YASARGEL ANEYRYSM CLIP 2,435.00 0832964 SPLINT SHORT ARM, PLASTER 235.00 0832972 AMPLATZ ANCHOR SYSTEM AA/10/30 1,503.00 0832998 PUDENZ CARDIAC CATHETER 3,434.00 0833020 CATHETER VTCB FIRM 10FR 2,047.00 0833103 SHORT LEG SPLINT, PLASTER 856.00 0833178 LONG LEG SPLINT, PLASTER 562.00 0833179 LONG LEG SPLINT,FIBERGLASS 562.00 0833194 GUIDEWIRE NOSE CONE 7F .035 1,452.00 0833202 DLP GUNDRY RETROGRD CANNULA SC 1,864.00 0833244 SHORT ARM SPLINT, FIBERGLASS 508.00 0833277 DLP ADULT VENT CATH 20FR (SC) 633.00 0833293 SHEATH INTRODUCER 6FR 603.00 0833319 LONG ARM SPLINT, FIBERGLASS 800.00 0833335 GUIDEWIRE NOSE CONE 9F .035 1,452.00 0833384 SHORT LEG SPLINT, FIBERGLASS 856.00 0833385 SHORT LEG SPLINT,FIBERGLASS PEDS 856.00 0833426 BILIARY EXT TUBE 1,755.00 0833517 BALLOON REG > 4 4,038.00 0833616 CATHETER DRAN ULT14.03825P6SMS 1,586.00 0833640 WIRE DEFLECT TIP 38 100 10 BH 1,057.00 0833723 CATHETER MEWISSEN INFUSION 1,925.00 0833871 BONE ILLIAC CREST OR RIB 3,898.00 0834259 INFUSION WIRE 11,985.00 0834291 ROTATING HEMOSTATIC VALVE 958.00 0834309 INTRODUCER ACCUSTICK SY 20-603 1,779.00 0834374 SET PRIMARY IV NONVENTED 1857 37.00 0834424 SET SECONDARY PIGGYBACK 1926 33.00 0834531 SET PRIMARY NITRO IV PUMP 1772 413.00 0834556 CATHETER DRAINAGE 10FR 1,367.00 0834598 STERILE IV TUBING 193.00 0834663 CATHETER GLIDE HI 100CM 32-157 1,325.00 0834747 LOWER EXTREMITY DRAPE 697.00 0834796 SYRINGE DISP 200MI MED-RAD 273.00 0834812 CATH REG NON GLIDE 551.00 0834929 CORNEAL PROTECTOR DISP 351.00 0835173 ACCUSTICK INTRODUCER SYSTEM 1,526.00 0835207 CATHETER STRAIGHT 6F100 008313 517.00 0835231 CATHETER TEGTMEYER 5.03565MNS 605.00 0835280 LEVINE TUBE, PLASTIC 48.00 0835348 KNEE IMMOBILIZER 677.00 0835405 DRAIN PENROSE 107.00 0835447 WIRE .018 COPE 667.00 0835512 MONARCH SYRINGE IN2001 2,021.00 0835744 AB VACYRETTE 10MM 312.00 0835801 TUBE JEJUNOSTOMY 12FR-36" 1,350.00 0835819 PAD KNEE CPM 383.00 0835827 EQ BED KINAIR 3 1,091.00 0835835 EQ BED FLUIDAIR PLUS ELITE 809.00 0835850 L & S CORSET 502.00 0835918 CATH PRUITT OCCLUSION 1,191.00 0835959 SHOUDLER PROST NEER II A 8,696.00 0835975 PLATE 7 HOLE 1,185.00 0836015 COMPONENT HIP DEPUY A 10,495.00 0836312 KIT HYSTEROVAC 773.00 0836569 GUIDEWIRE STRAIGHT .035 150CM 843.00 0836577 GUIDEWIRE ANGLED .038 150CM 766.00 0836700 CATHETER PRESSURE L&D 1,483.00 0836726 BINDER ABDOMINAL XXLGE 1,232.00 0836734 NEEDLE PERCUTANEOUS 18G 199.00 0836759 GUIDEWIRE STRAIGHT .035 354.00 0836841 VESSEL DILATOR 10.0 38 336.00 0836940 NEEDLE BIOPTY CUT 988.00 0836965 NEPHROSTOMY SYSTEM 8F 1,526.00 0837054 URETERAL STENT 8FR 2,768.00 0837062 GUIDEWIRE AMPLATZ STIFF .035 838.00 0837096 DRESSING TELFA 4X8 22.00 0837120 OXYGEN MASK/ADULT 46.00 0837328 NEEDLE FRAN LUNG BIOPSY 22 15 687.00 0837336 BALLOON SMALL VESSEL 4,881.00 0837385 SPONGE TONSIL STERILE 2PK 20.00 0837393 NEEDLE FRAN LUNG BIOPSY 20 20 687.00 0837450 NEEDLE FRAN LUNG BIOPSY 22 20 687.00 0837617 FILTER LEVKOCYTE REMOVAL 1,958.00 0837708 WIRE GLIDE 895.00 0837716 STUMP SHRINKER 502.00 0837930 CONNECTING TUBE HPCT8.880PFM 471.00 0838276 GUIDEWIRE WHOLEY FLOPPY 1,679.00 0838300 DRAPE FEMORAL ADULT 591.00 0838573 CATHETER HBP5.53565MC2SC2 672.00 0838680 CATHETER URI 5FR SET 870.00 0838714 TRAY UNIVERSAL PROCEDURE 42-30 843.00 0838748 SET BIOPSY LUNG CO-AXIAL 749.00 0838789 CATHETER 5FR PIGTAIL 90CM 611.00 0838995 CATHETER INTRODUCER MINI BALLO 549.00 0839092 DILATOR VESSEL JCD 5.0 38 20 266.00 0839308 LENSE MORGAN THERAPEUTIC 658.00 0839530 TIP NEEDLE POINT TEFLON COATED 231.00 0839654 ACROMED CONNECTOR 3/16" EXTENDED 2,969.00 0839662 APPLIER MULTIPLE CLIP ALL ETHICO 1,575.00 0839886 TROCAR W/DILATOR 18MM ETHICON 2,090.00 0839894 STAPLE ROTICULAR .170-200 3,963.00 0839928 STAPLE ENDO GIA MULTIFIRE 30V 3,903.00 0839936 STAPLE ENDO GIA 30 AUTOSUTURE 2,533.00 0839993 TUBE TRACH PCT #6 LO PRES CUFF 1,396.00 0840033 SCREW INTERLOCKING SYNTHES ALL 787.00 0840041 NAIL INTERLOCKING SYNTHES ALL 3,114.00 0840074 STERI STRIP 1X4 171.00 0840082 SET IV MINI PRIP CENTIUE-FLO 193.00 0840090 BAG PULMONARY ASSIST HYPERINFLAT 248.00 0840116 TUBING 3M PUMP ARTHROSCOPY 1,462.00 0840280 HIP FEMORAL STEM OSTEONICS 19,751.00 0840363 PIN GUIDE ACE MEDICAL DISPOSABLE 290.00 0840504 EPIFIX PER SQ CM WASTED 1,495.00 0840539 OTICON PONTO PLUS C MBR PROSTHETIC 15,128.75 0840546 AQUEOUS SHUNT PROSTHESIS 2,975.00 0840557 OTICON GUIDE DRILL 3-4MM DISP 1,116.25 0840575 OTICON CAP HEALING 85.50 0840793 CATHETER PICS 501 MPIS 1,331.00 0840850 CATHETER HNBR5.038100PWMSSIM2 546.00 0840942 CATHETER HNBR5.038100PWNSH1 546.00 0840975 KIT ACCESSORY AMS 3,176.00 0841007 TUBING FLUID WARMING LEVEL I 1,052.00 0841049 EXTERNAL FIXATOR KIT EBI 21,793.00 0841056 UTERINE MANIPULATOR HUMI 658.00 0841064 PUMP CONTROL ASSEMBLY AMS 29,458.00 0841072 NEOPRENE KNEE SLEEVE W/CUTOUT AL 393.00 0841098 TUBING HOT LINE L-70 DISPOSABLE 821.00 0841114 BONE CANCELLOUS CRUSHED/CHIPS 3,460.00 0841148 DILATOR PYLORIC 2,855.00 0841163 NEOPRENE WRIST SUPPORT 3D ALL 502.00 0841239 DILATOR ESOPHAGEAL 2,855.00 0841320 BIOPSY FORCEP HOT DISPOSABLE 1,547.00 0841338 WASHER DANEK 2,065.00 0841346 NEOPRENE SPRAIN WALKER SHORT 869.00 0841411 BIOPSY FORCEP DISPOSABLE 1,547.00 0841478 KIT MEMBRANE PERFUSION/CELLSAVER 10,350.00 0841502 DILATOR COLONIC 2,855.00 0841510 EQ BED TRIADYNE PROVENTA KINETIC 3,686.00 0841569 MONITORING LINE 72" 181.00 0841577 NEEDLE BIOPSY DTB 18 15.OT 751.00 0841593 POLYPECTOMY SNARE DISPOSABLE 2,203.00 0841650 CATH TEMPERATURE FOLEY 354.00 0841718 CANNULA 25' NASAL 64.00 0841742 SPLINT INTERNAL NASAL INVOTEC 282.00 0841858 STENT SELF EXPANDING 13,269.00 0841882 ARTHREX ACL DISPOSABLE KIT 1,125.00 0841940 STENT BTU7-0860-110 13,269.00 0841973 ARTHREX SCREW 1,269.00 0842054 SUCTION IRRIGATOR STRYKEFLOW 1,179.00 0842112 CATHETER BERENSTIEN 5FR 586.00 0842294 STENT BTU7-1068-110 13,269.00 0842500 BX SET 3,011.00 0842682 CATHETER HNBR5.03865PWNSRIM 377.00 0842765 CATHETER PU8.53850P32SRING 718.00 0842898 REAMER CANN 10MM ARTHREX 1,596.00 0843003 SCREW CERVICAL LOCKING SYNTHES 323.00 0843037 CATHETER HNBR5.03840PWNSKMP 546.00 0843318 CATHETER HNBR5.03865PWNSRC1 414.00 0843417 BLADE ARGON DISP VALLEYLAB 730.00 0843482 DEVICE TORQUE OTD-100 243.00 0843508 DRAIN QUAD LUMEN ZIMMER 449.00 0843599 CONTINUOUS FLOW CAUTERY CORD DAC 518.00 0843615 RETRIEVER SUTURE 525.00 0843631 DRESSING POLYMEM PAD 4X4 182.00 0843771 KIT APD CATHETER W/LOCK 10FR 2,791.00 0843813 DRESSING POLYMEM 4X12 449.00 0843888 WIRE DULL TIP GUIDE 27MM ACUFEX 1,379.00 0843979 PLUG CANN BONE TUNNEL ACUFEX 349.00 0844001 SHEATH AMPLATZ RENAL 260-153 710.00 0844035 PROBE 4.7MM SUR DYNAMICS 9,801.00 0844068 WIRE DULL TIP GUIDE 24MM ACUFEX 1,040.00 0844134 MASTISOL 46.00 0844183 CATHETER DUAL LUMEN 405-100 1,102.00 0844191 TUBING STERILE IV CONTINUE FLOW 152.00 0844209 CATHETER BALLOON 20MM-8CM 10-225 6,759.00 0844217 SHOULDER TOTAL HUMERAL BODY GLOBL 14,512.00 0844225 CASPAR DISTRACTION PINS 740.00 0844308 BANDAGE PACK SYSTEM PROFORE 437.00 0844332 STAPLE HERNIA ENDO MULTI 4MM 807.00 0844399 SHEATH PINNACLE 8FR 15-628 563.00 0844506 STONETOME 1,748.00 0844563 CATHETER BALLOON 8MM-2CM 14-442 4,652.00 0844605 STAPLE VERSATACK DISP 4.8MM 1,304.00 0844662 INTRODUCER MPIS-501-NT 786.00 0844696 MESH-MARLEX SMALL 3" X 6" BARD 922.00 0844837 FORCEP SEITZINGER TRIPOLAR DISP 4,652.00 0844886 EQ-FIRST STEP CIRRUS THERAPY MAT 934.00 0844910 KNEE SYSTEM TIBIAL INSERT 12,043.00 0844936 SCOTT RETRACTOR LONE STAR 1,420.00 0844993 STENT URETERAL GLIDEX 8FR 22CM 1,773.00 0845008 KNEE SYSTEM FEMORAL COMPONENT 18,770.00 0845016 SET PICDS 601 MPIS 6FR 1,585.00 0845024 GRAFT HEMASHIELD PATCH 1,981.00 0845115 ELASTIC SURGICAL STAYS 165.00 0845149 STENT URETERAL PERCUFLEX 1,754.00 0845156 VENOUS RESERVOIR SOFT 1,542.00 0845164 CATHETER HNBR5.038100PWNSSIM1 546.00 0845172 CATH GLIDE/SLIP 1,027.00 0845214 TIP ARTHRO WAND 90 3,229.00 0845248 GUIDEWIRE TRANSEND .014 182CM 2,479.00 0845271 SYNTHES ROD 745.00 0845305 KIT SITE RITE NEEDLE GUIDE 231.00 0845339 GUIDEWIRE V-18 150CM 1,513.00 0845370 DEFIBRILLATOR PATCH EXTERNAL FST 586.00 0845396 PATCH DURAGUARD DURAL REPAIR 1,926.00 0845529 CATHETER RCF 7.0 38 30 JRB 946.00 0845552 GI FASTENERS / ANCHORS 1,003.00 0845636 SYNTHES SCREW 2,972.00 0845651 CATHETER BALLOON 6MM 4CM 3,489.00 0845677 ACROMED KASS CAP 2,066.00 0845735 KIT GASTROSTOMY 14FR 24-853 2,195.00 0845859 KO ADJ KNEE JTS RIGID ORTHOSIS 502.00 0845982 CAGE THREADED FUSION SET RAY SO 30,492.00 0846147 SHEATH FLEX CL07800 8F 100CM 949.00 0846279 MESH PLUG DAVOL 1,382.00 0846360 KIT TOURNIQUET DLP/MEDTRONIC 1,040.00 0846410 STENT WALL 6MM 45MM H645 12,799.00 0846428 EMBOL 0.35 COILS 1,026.00 0846527 SHEATH INTRODUCER 8F 11CM 636.00 0846626 DRESSING POLYU HYDRO ALLEVYN 4 156.00 0846691 CATHETER BALLOON DIAM 10MM4CM75C 3,498.00 0846725 ROD CARBON 15MM X 150 HOWMEDICA 1,096.00 0846816 WRENCH TORQ EXT FIXATOR HOWMEDIC 1,941.00 0846881 STENT ESOPHAGEAL ULTRAFLEX 15,418.00 0846915 NEBULIZER KIT 193.00 0846923 INTRODUCER SAFE SHEATH SYSTEM 747.00 0846931 KO ADJ KNEE JOINT ORTHOSIS RIGID 502.00 0846972 TRAY SPEEDBAND MULTIPLE LIGATOR 3,820.00 0847012 HALO ADD-ON MRI CAMPATABLE SYS 502.00 0847061 STAPLE ENDORXTRACT 176613 1,828.00 0847335 STAPLE ENDO 35 RELOAD 1,520.00 0847426 STONE RETRIEVAL TIP 1,394.00 0847442 ENDO-STITCH AUTOSUTURE ALL 463.00 0847541 NEGATIVE PRESSURE WOUND THERAPY 1,603.00 0847608 TIP SPATULA 1,129.00 0847616 ROLL COBAN 3"-4" 80.00 0847665 SHUNT HEYER SCHULTE SUNDT 1,150.00 0847699 STAPLE AL LOPORT 2,527.00 0847707 DRESSING CURADERM 4X4 117.00 0847756 EYE NEEDLE 20GA FLUTE SOFT TIP 235.00 0847780 STAPLE 60 LINEAR HEAVY 1,594.00 0847798 CATH INFUSEAPORT 2.7X4.7 14FR 3,612.00 0847855 GUIDEWIRE BENTSON TSFB35 180 375.00 0847871 STAPLE RELOAD 55 VASCULAR 1,158.00 0847962 STAPLE ENDO VASFLEX 3,504.00 0848010 HIP APEX HOLE ELMTR DEPUY 1,117.00 0848044 CATHETER DIAMOND UT 5MM 2CM 40CM 3,498.00 0848085 IMPLANT FRAS NARROW ANTERIOR 20,981.00 0848143 STAPLE ARTIC 55 LINEAR 3,123.00 0848150 SUPPORT BEIGE C/D MAMMARY BRA 502.00 0848184 KNEE ROTATING HINGE BUMPER 2,605.00 0848192 HAND ALUMINUM 586.00 0848234 STAPLE HEAVY 90 1,693.00 0848275 KNEE ROTATING HING AXLE COMP 4,363.00 0848283 SPLINT ANKLE CONTRACTURE 1,068.00 0848325 STAPLE RELOAD 60 GREEN 387.00 0848382 STAPLE RELOAD ETS BLUE TR35B 1,522.00 0848416 ENDOCATCH 10MM 173050 2,252.00 0848473 STAPLE RELOAD ETS VAS WHT TR35W 1,522.00 0848499 ADAPTER SAFELOCK CATH COPY TYPII 962.00 0848564 STAPLE ETS ENDO 3,397.00 0848598 NEEDLE QUICKCORE 18G 9CM 702.00 0848622 CUTTER INNOVASIVE COR 6MM 6,877.00 0848655 STAPLE RELOAD VSCULAR 30 XR30V 887.00 0848671 BIOPSY FORCEP MULTI-BT MV 1,379.00 0848697 EMBOL PARTICLES 1,197.00 0848747 STAPLE LINEAR TXBLUE 60MM TX60B 1,485.00 0848838 STAPLE LINEAR TX BLUE TX30B 30M 1,439.00 0848853 TUBE CONNECTING 30CM 22-910 243.00 0848929 GRAFTON PUTTY AMERICAN RED CROSS 6,882.00 0849067 CATHETER EMBOLECTOMY FOGARTY 803F 1,585.00 0849174 ADDITION TO LOWER EXTREMITY 502.00 0849208 CATHETER DIAMOND UT 6M 2CM 40CM 4,024.00 0849265 BANDAGE SURE PRESS COMPRESSION 295.00 0849331 KNEE APOLLO REVISION STEM INTER 4,015.00 0849505 DRESSING CURADERM 8X8 304.00 0849539 ADDITION FRACTURE ORTHOSIS 502.00 0849604 SHEATH BALKIN 525.00 0849620 FINGER TRAP KIT 560.00 0849745 GUIDEWIRE ROADRUN RPC 35 180 301.00 0849844 PEELER DIAMOND DUSTED MEBRANE 1,970.00 0849877 DRESSING BLATAIN 4X4 170.00 0849927 SHEATH PEELAWAY 540.00 0849950 DRESSING CARRAGAUZE 2X2 55.00 0850016 SYRINGE DISCOGRAM PRESSURE 710.00 0850107 MATERIAL FOR VOCAL CORD MEDIALIZATN 2,160.00 0850149 ACROMED SYMPHONY PROCESS DIS #2 5,415.00 0850206 JAG WIRE/ZEBRA WIRE 2,249.00 0850222 GRAFT VASCULAR IMPRA CARBOFLO 5,390.00 0850255 GUIDE DRILL REVISION NAIL 1,298.00 0850297 CATHETER GOLD PROBE 2,342.00 0850305 MESH BARD COMPOSIX 3X6/2X4 1,492.00 0850347 GUIDE PIN TIP THREADED 618.00 0850362 HIP FEMORAL HEAD ENCORE 3,112.00 0850388 RETREIVAL WET 5MM 3,976.00 0850438 SCREW LOCKING 561.00 0850453 HIP BIPOLAR MODULAR ENCORE 4,210.00 0850479 NEEDLE HPC2 KNIFE PAPILLOTOME 1,153.00 0850537 SCALPEL HARMONIC 5,241.00 0850545 HIP UNIPOLAR OFFSET SLEEVE ENC 793.00 0850560 COMBO CATH #1635 1,874.00 0850578 MESH BARD COMPOSIX 8X10 80INCL 9,408.00 0850636 HIP FEMORAL ENCORE 17,753.00 0850669 MESH BARD COMPOSIX 6X8 48 INCL 3,980.00 0850677 IOL ANTERIOR CHAMBER 2,798.00 0850693 KNEE INSET PATELLAR REAMER/BIT 678.00 0850727 SCREW BIO-INTERFERENCE BIOABSORB 1,898.00 0850784 KNEE FEMORAL STEM BOLT 1,059.00 0850941 RESTORE SOFT TISSUE IMPLANT 24,001.00 0850958 LIFT ELEVATION INSIDE SHOE 502.00 0850966 KNEE DISTAL AUGMENTATION 2,866.00 0851006 EQ CITADEL PLUS BED W/MAXX AIR ETS 2,008.00 0851063 DRESSING PROMOGRAM 4.34 SQ 170.00 0851089 RAPIDFLAP BUR HOLE CLAMP 1,393.00 0851097 EQ BED CITADEL 200 1,091.00 0851105 EQ ENTERPRISE W/ATMOS AIR (TALL) 262.00 0851121 PIN DISTRACTION 625.00 0851139 PINS TEMPORARY 961.00 0851162 EQ BARIAIR PRESSURE REDUCTION 2,008.00 0851204 DRESSING ALLEVYN ADHESIVE 3X3 81.00 0851246 CERVICAL SPACER CORTICAL BONE 2,902.00 0851253 STENT COLONIC WALL 6,343.00 0851279 EQ CITADEL PLUS BED W/ATMOS AIR PLS 1,171.00 0851303 DRESSING ALLEVYN ADHESIVE 5X5 165.00 0851311 TLSO 2PC CUSTOM WITH INTERFACE 502.00 0851337 EQ BARIMAX PRESSURE REDUCTION 1,171.00 0851386 BANDAGE HONEYCOMB ELASTIC 4" 71.00 0851410 DRESSING ACTICOTE 7 BURN 4X4 341.00 0851428 CANNULA ARTERIOTOMY 153.00 0851444 HIP HEAD METAL 5,820.00 0851469 SEPRAFILM ADHESION REDUCTION 1,245.00 0851477 BANDAGE HONEYCOMB ELASTIC 6" 98.00 0851493 KIT LAP CHOLE FDCLO 10,262.00 0851501 ORTHOPEDIC WEDGE SHOE NONSTANDARD 502.00 0851519 DRILL BITTS CANNULATED 2,035.00 0851535 RAPIDFLAP LINE CLAMP 1,010.00 0851550 SHEATH TIBIAL 1,260.00 0851584 DRESSING ALLDRESS ABS FILM 6X6 304.00 0851600 BURRS / RASPS 1,036.00 0851626 AFO FX ORTHOSIS TIBIAL RIGID 502.00 0851659 HEMASEEL FIBROGEN GLUE 1,414.00 0851675 DRESSING ALLDRESS ABS FILM 4X4 295.00 0851691 WAND ARTHRO 1,335.00 0851717 ADDITION LOWER EX TIBIAL SOCK 502.00 0851782 SCOTCHCAST 3" X 12" 337.00 0851790 BLADE FEMORAL NECK 3,206.00 0851808 CARPAL TUNNEL INDIANA TOME 2,016.00 0851840 CANNISTER OMNI JUG 603.00 0851873 SCOTCHCAST 4" X 30" 633.00 0851881 GRAFT BONE INFUSE 28,875.00 0851899 AFO PLASTIC 502.00 0851956 CORKSCREW SUTURE ANCHOR 1,306.00 0851964 NOVARE INSERTS 221.00 0852012 APLIGRAF 44 SQ CM 217.00 0852020 KNEE DEPUY LCS 3 PEG ROT PATELLA 9,774.00 0852053 SAFE SHEATH CATH INTRO SET 576.00 0852103 DRESSING WOUND VEIL 4X4 29.00 0852111 KNEE DEPUY LCS PRIM POR FEMORAL 21,784.00 0852145 CATH OPTIFLOW KIT 1,726.00 0852202 KNEE DEPUY LCS ROT PIAT TIB 10,709.00 0852210 THROMBO CLOT BUSTER 7,700.00 0852236 KYPHX BONE FILLER DEVICE 1,081.00 0852293 KNEE DEPUY LCS ROT PLAT 5,816.00 0852301 CS DRESSING FIBRACOL PLUS 4X4 235.00 0852376 PROSTHETIC SOCK BK EACH 502.00 0852400 KYPHX OSTEO INTRODUCER 10,472.00 0852418 KIT ACCURUS TOTAL PLUS PK 1,933.00 0852426 KNEE TIBIA SPACER BLOCK 3,806.00 0852509 KIT INNOVIT TOTAL PLUS PK 11,906.00 0852582 KYPHXXPANDER INFLATION SYRINGE 1,158.00 0852590 SET VGIF TUBING 859.00 0852657 WOUND MATRIX OASIS PER SQ CM 30.00 0852673 NEEDLE BONE BIOPSY 355.00 0852756 GRAFT VASCULAR VECTRA W/THORAION 7,090.00 0852772 PERFLAORON KIT 3,109.00 0852830 BONE DOWELL 14MM 3,449.00 0852889 FEMORAL GLIDING NAIL 6,203.00 0852905 ADD LOW EXT VARUS/VALGUS CORR 502.00 0852939 HIP ACET LINER HOODED ENCORE 24,927.00 0852954 PROBE ENDOLASER 679.00 0852970 PIN DISTAL LOCKING 1,117.00 0853000 CATHETER CELLO BALLOON GUIDE 4,785.00 0853028 HIP ACET SHELL FLARED ENCORE 6,882.00 0853085 AFO PLASTIC W ANKLE JOINT 502.00 0853127 KNEE CEMENTED KEEL TRAY MBT 15,717.00 0853176 PROBE APC 3,176.00 0853200 MESH PROLENE HERNIA SYSTEM PHSE 2,137.00 0853218 DRILLBIT STEINMAN PIN PFC 895.00 0853267 FILTER APC 273.00 0853275 SPINAL ORTHOSIS NOT SPECIFIED 502.00 0853549 LIGASURE DISPOSABLE ELECTRODE 3,528.00 0853572 HIP ACETABULAR LINER PINNACLE 4,594.00 0853606 SHEATH BRITE TIP 841.00 0853630 AFO POST SOLID ANKLE PLASTIC 502.00 0853648 BLADE CASPAR 1,779.00 0853655 KYPHX INFLATABLE BONE TAMP 10,489.00 0853663 HIP ACETABULAR CUP PINNACLE 6,518.00 0853739 KIT IRRIGATING BIPOLAR 575.00 0853804 PACK TOTAL PLUS W/ACCURUS PROBE 4,026.00 0853812 ADD LOWER EXT ORTHOSIS INTERFACE 502.00 0853853 SCREW CANCELLOUS BONE 111.00 0853911 ADD LOWER EX ORT INTERFACE BK 502.00 0853986 FIXATION BUTTON W LOOP SUTURE 1,960.00 0853994 DRESSING ACTLCOTE 4X4 SILVER 282.00 0854018 ADD UPPER EX ORTHOSIS FRACTURE 502.00 0854083 MESH PRE-SHAPED W KEYHOLE 319.00 0854141 HIP BALL HEAD BIPOLAR 7,954.00 0854166 DRESSING KALTOSTAT 2X2 61.00 0854174 WOUND LAYER/SILICONE 4X8 399.00 0854232 HIP STEM STANDARD SL-PLUS 16,049.00 0854257 DRESSING AQUACEL 4X4 152.00 0854265 WOUND LAYER/SILICONE 2X3 203.00 0854323 GUN RANEY CLIP 1,130.00 0854349 DRESSING AQUACEL 2X2 87.00 0854448 OPTIUM PUTTY 10CC LIFENET 3,463.00 0854455 WIRE CENTERING 821.00 0854463 TLSO TRIPLANAR CONTROL 502.00 0854471 SPHERICAL MAMMOSITE RTS CATH 20,132.00 0854489 AFO ANKLE GAUNTLET 502.00 0854521 KNEE MOD SYS PFC MOD TIBIA TRAY 20,754.00 0854554 AFO SPIRAL 502.00 0854562 IMPLANT MBA SUBTALAR 9,956.00 0854588 KOPANE BREAST LESION NEEDLE/WIRE 324.00 0854596 CATHETER DIALYSIS TUNNEL 1,569.00 0854612 DRESSING MEPILEX 4X4 FOAM 74.00 0854620 PUMP ON-Q POST-OP PAIN PM015 1,172.00 0854638 KIT ASPIRATOR START UP 490.00 0854653 MESH PERMACOL 14,276.00 0854661 SET PCA TUBING 1,437.00 0854695 NAIL HUMERAL IM 10,440.00 0854737 ADD LOWER EXT ORTHOSIS 502.00 0854745 DRESSING MATRIX PROMO PRISMA 476.00 0854752 DRESSING COVERSITE 4X4 15.00 0854778 CEMENT DELIVERY SYSTEM EZ 3,806.00 0854810 ELBOW ORTHOSIS W ADJ JTS 502.00 0854828 CARDIOBLATE XL PEN 12,064.00 0854836 MESH PELVITEX POLYPROPYLENE 2,819.00 0854869 DIALYSIS CATHETER TEMP 727.00 0854919 LEAD UNIPOLAR EPICARDIAL DRUG EL 3,020.00 0854927 BONE CRUNCH 5CC 4,895.00 0854935 DRESSING COVERSITE 6X6 26.00 0854950 WALLSTENT MEDI-TECH 13,750.00 0855007 SYSTEM HOWELL DASH 1,336.00 0855015 BONE RADIUS FROZEN 9,063.00 0855023 TRAP POLYP 80.00 0855031 HANDPIECE VACUUM ASSTEXCISION 2,990.00 0855064 DRAIN MEDIASTINAL 239.00 0855106 GYRUS FORCEPS CUTTING 1,424.00 0855114 TENDON ACHILLES FROZEN 16,105.00 0855122 INTRODUCER LOCALIZATION SET 1,666.00 0855163 ACCESSORY KIT NEEDLES 3550 241.00 0855171 855171OST-OP DARCO 502.00 0855197 GYRUS TRISSECTOR 1,732.00 0855213 TISSUE FILTER 34.00 0855247 DERMAGRAFT PER SQ CM 282.00 0855288 TIGHTROPE SYNDESMOSIS REPAIR KT 1,366.00 0855361 DIALATOR HURRICANE 1,820.00 0855379 DEVICE BREEZE INFLATION 625.00 0855387 CORE BIOPSY SYSTEM MAGNUM 226.00 0855395 BIOPSY SITE IDENTIFIER 640.00 0855494 CATHETER FAS TRACKER 1,942.00 0855502 WIRE THREADED ORTHOFIX 404.00 0855510 PUMP ON-Q PAIN SYSTEM 1,205.00 0855585 NEEDLE HOLDER SHORT STOP 64.00 0855601 CLOSURE CATHETER 3,362.00 0855619 TLSO RIDGID FRAME HYPEREXTENSION 502.00 0855635 IMM/POST SURG RIGID DRESSING BK 502.00 0855643 ADD LOWER EXT ORTHOSIS ABOVE KN 502.00 0855650 CATHETER QUICK CROSS 4FR 5,550.00 0855676 STENT GENESIS 7,843.00 0855726 HYDRA JAGWIRE 1,464.00 0855734 STENT COPE NEPHROURETEROSTOMY 610.00 0855742 KYPHX CEMENT & MIXER 1,708.00 0855759 OTISMED CUSTOM KNEE CUT GUIDE 11,643.00 0855767 SHEATH RENAL 1,096.00 0855825 ADD LOWER EXT FX ORTHO AD KN JT 502.00 0855890 DRESSING MEPILEX LITE 62.00 0855924 TUBE ET/LMA 122.00 0855965 ABLATOR ASPIRATING 1,125.00 0855999 SLIDING CORE 5,125.00 0856021 DRESSING ALLEVYN 6X6 NON ADHESIVE 60.00 0856047 TISSUE TIBIALIS TENDON 8,250.00 0856088 ENDPLATE 39,531.00 0856161 VAXCEL IMP VAS ACCESS SYSTEM 1,668.00 0856203 ADD TO UPPER EXT ORTHOSIS 502.00 0856286 OP-1PUTTY BMP BONE GRAFT MAT 34,939.00 0856294 EO DOUBLE UPRIGHT FOREARM CUS 502.00 0856344 FAST FIX AB CVD ASSEMBLY 2,188.00 0856385 VERTEBRAL PLASTY KIT W HANDLE 14,398.00 0856419 DRESSING ACTISORB 2X4 98.00 0856435 SIDEKICK LOW PROFILE WALKING BOOT 502.00 0856476 EXTENSION KIT MEDTRONICS 4,205.00 0856567 UPPER LIMB ORTHOSIS NOS 502.00 0856609 KNEE SYSTEM FLUTED STEM EXTENDER 3,488.00 0856633 WRIST/THUMB SPLINT ADJUSTABLE 502.00 0856658 KNOTLESS FIXATION DEVICE 2,572.00 0856682 GRAFTJACKET MEMBRANE PER 1 CM 3,784.00 0856740 ULTRA DRIVE IMPLANTATION KIT 12,418.00 0856757 WRIST-HAND-FINGER ORTHOSIS 502.00 0856773 SCREW LEGACY 4,177.00 0856799 DRESSING SILVERLON 4X4 175.00 0856823 VITOSS SYNTHETIC BONE GRAFT 10CC 10,482.00 0856831 PATCH PERICARDIAL CORMATRIX 5,899.00 0856856 CS DRESSING FOAM CONTR/BIATA 4X4 199.00 0856872 AUTOSUTURE PROTACK 5MM 2,378.00 0856914 VITOSS SYNTHETIC BONE GRAFT 5CC 5,258.00 0856922 ADD BK ENDOSKELETAL SYSTEM 502.00 0856963 PUTTY DBX 1CC 704.00 0856971 BLADE HELICAL 2,799.00 0856989 NEEDLE SCORPION 1,025.00 0856997 KNEE SUPPORT ELASTIC 502.00 0857003 WAND PLASMA/COBLATION 1,836.00 0857011 IMMEDIATE POST SURGICAL FITTING 502.00 0857060 TISSUE MORSELATOR 1,574.00 0857078 VALVE HAKIM RT ANGLE PROGRAMABLE 27,855.00 0857094 VITOSS SCAFFOLD BONE VOID FILL 3,694.00 0857102 CERVICAL MULT POST COLLAR SUPP 502.00 0857110 DRESSING POLYMAX 114.00 0857169 DRESSING ALGINATE ALGISITE 2X2 229.00 0857185 MICRODEBRIDER TOPAZ STR ANGLED 2,990.00 0857193 CERVICAL MULTIPLE POST COLLAR 502.00 0857219 SUMP INTRACARDIAC 169.00 0857243 HO ABDUCTION CONTROL HIP JT 502.00 0857250 WHO WRIST EXT COCK-UP 502.00 0857300 SUMP PERICARDIAL 1/4 CONNECTOR 158.00 0857367 ADD LOWER EXT KNEECAP CONTROL 502.00 0857375 INTRODUCER 150.00 0857409 BIO-SUTURE TAK ANCHOR 1,678.00 0857425 DRESSING WOUND ELASTOGEL 282.00 0857441 PROSPACE DBM PUTTY 10CC 8,785.00 0857466 TISSUE MARKER 1,262.00 0857532 PROSPACE DBM PUTTY 2.5CC 3,148.00 0857540 VASO VIEW VEIN HARVESTING 7,258.00 0857557 MAMMOTOME PROBE 2,000.00 0857607 FILTER BLOOD CARDIOPLEGIC 863.00 0857615 DRESSING ACTICOAT ABSORBANT 465.00 0857672 SUTURE LASSO 1,006.00 0857722 DRESSING COBAN 2 LAYER 150.00 0857730 CORMATRIX PERICARDIAL CLOSURE 6,489.00 0857748 ESSURE PERMANET BIRTH CONTROL S 8,250.00 0857763 FASTAK GUIDE SPEAR 715.00 0857789 CATHETER ATHERECTOMY SILVERHAWK 18,115.00 0857797 KIT SYNCHROMED CATH ACCESS 8540 238.00 0857870 TRICLIP 766.00 0857896 ADD LOW EXT DORRSIFEXION EA JT 502.00 0857920 FOOT COVER RIDGID SOLE PR 626.00 0857961 LO SAGITTAL CONTROL RIGID ANT/PO 502.00 0857979 REPAIR ORTHOTIC DEVICE PARTS 502.00 0858001 FOOT INSERT REMOVABLE EACH 502.00 0858019 DRESSING FIBRACOL PLUS 2X2 61.00 0858050 STENT ENTERNAL WALL 5,502.00 0858068 KNEE ORTHOSIS LOCK KNEE JTS 502.00 0858092 IMPLANT OBELISC CENTER PIECE 20 59,164.00 0858142 CLIP DEVICE RESOLUTION 1,099.00 0858159 LUMBAR ORTHOSIS SAGITTAL CONTROL 502.00 0858167 UPPER EX FX ORTHOSIS HUMERAL 502.00 0858233 TENDON REPAIR SYSTEM TENOFIX 3,460.00 0858266 SET OATS 6MM DISPOSABLE 4,036.00 0858274 IMPLANT OBELISC END PIECE 20MM 10,582.00 0858282 COMP STOCKINGS THIGH VENOSAN EA 502.00 0858308 BIO-PREP BONE PREP KIT 924.00 0858332 LIGHT PIPE 1,682.00 0858340 SACROILIAC SURGICAL SUPPORT 502.00 0858365 SCREW PEDICLE SPINE 9,233.00 0858373 RETRACTOR MOBIUS ABDOMINAL DISP 1,049.00 0858464 WAND ENDOMETRIAL ABLATION 6,221.00 0858514 MESH PROCEED 3X6 2,713.00 0858522 BIOPSY DEVICE ROTATIONAL/VACUUM 2,254.00 0858548 MAMMOSITE CAVITY EVALUATION DEV 738.00 0858563 KNEE SYSTEM PFC FEM STEM 4,072.00 0858605 TAPE TRANS VAGINAL 7,284.00 0858639 KIT PELVIC FLOOR REPAIR ANTERIO 11,490.00 0858662 INFLATION DEVICE 677.00 0858704 VITAGEL SURGICAL HEMOSTAT 3,843.00 0858720 KIT LIBRA KNEE BALANCER 1,941.00 0858811 SENSOR LIBRA SOFT TISSUE FORCE 4,262.00 0858886 VASU-GUARD(VASCULAR GRAFT) 688.00 0858928 KNEE SYSTEM PFC TIBIA INSERT 5,137.00 0858936 BIO-TRANSFIX ARTHREX 963.00 0858951 STENT FLUENCY 9,876.00 0858977 CV PERIGUARD PATCH 1,132.00 0858993 MALYUGIN RING PUPIL DILATOR 972.00 0860007 NEPH CONNECTING TUBING 578.00 0860015 BAG LEG DISP 124.00 0860023 BIO-GUN 18G 7.5CM 889.00 0860049 CATHETER DRAINAGE 10FR 1,241.00 0860205 GUIDE WIRE TSCF 38 145 15 394.00 0860239 GUIDEWIRE COPE MANDRIL 18 811.00 0860270 SHEATH REG 658.00 0860288 INTRODUCER SHEATH 7FR 807.00 0860296 SHEATH LONG 549.00 0860304 IV CATHETER QUICK 22X1 57.00 0860312 IV CATHLON #20 128.00 0860320 IV INFUSION ST BTRFLY 21 16.00 0860361 NEEDLE BIOPSY BAUER LT18 819.00 0860536 GUIDEWIRE AMPLATZ STIFF .035 762.00 0870006 D AIRWAY NASAL 44.00 0870014 D BAZA CREAM 89.00 0870022 D CATH 2 WAY 5CC 59.00 0870030 D CATH 3 WAY 30CC 153.00 0870048 D CATH 3 WAY 213.00 0870055 D CATHETER LEG STRAP 65.00 0870063 D CERV COLAR/FOAM 59.00 0870071 D CLAV STRAP MED 122.00 0870089 D COMFEEL 54.00 0870097 D DISP TRACH CANNULA 52.00 0870105 D DISP TRACH TUBE 669.00 0870113 D DOUBLE SUBCATH 1,248.00 0870121 D ELASTIC BANDAGE 67.00 0870139 D GASTRC LAVAGE 313.00 0870147 D GEL DRESSING WOUND 99.00 0870154 D INTUBATION TRAY 273.00 0870162 D IV CATH 35.00 0870170 D L/ARM SPLINT ADLT 306.00 0870188 D LYOFOAM 69.00 0870196 D NU-GAUZE/IODOFORM 1/4 - 1/2 46.00 0870204 D NU-GAUZE PLAIN 1/2 55.00 0870212 D DRESSING OP SITE WND 52.00 0870220 D DRESSING OP SITE SMALL 15.00 0870238 D PAD ELECTRODE ADT 313.00 0870246 D PERCUTANEOUS INTRO 577.00 0870253 D PLASTER SPLINT 238.00 0870261 D POST-OP SHOE 98.00 0870279 D S/ARM SPLINT ADLT 251.00 0870287 D S/LEG SPLINT ADLT 300.00 0870295 D SALEM SUMP TUBE 63.00 0870303 D SHT ARM SPLINT 66.00 0870311 D SPLINT FINGER 86.00 0870329 D STERI/CLOSURE STRIP 1/8 X 3 24.00 0870337 D STIFNECK COLLAR 98.00 0870345 D SUBCLAVIAN CATH 400.00 0870352 D SUCTION CATH TRAC 250.00 0870360 D SURGI GEL 4X8 348.00 0870378 D TELFA 54.00 0870386 D THORA/PARACT T 348.00 0870394 D TRACH SUCT KIT 113.00 0870402 D TRAY 16FR FOLEY-FBC 161.00 0870410 D TRAY DISP LAC 216.00 0870428 D TUBE FEEDING 5/8 34.00 0870436 D TUBING IRRIGATION STRAIGHT 50.00 0870444 D ULCER DRESSING 33.00 0870451 D VASE GAUZE 3X18 31.00 0870469 D XEROFORM GZ 43.00 0870477 D PLASTER SPLINT 2' 389.00 0870485 D PLASTER SPLINT 3' 66.00 0871282 PDPM - KDCB1 0.01 0891135 SYSTEM CARTER-THOMASON CLOSESUR 855.00 0891143 END CAP SPINE 542.00 0891150 FORCEP KIRWAN BI-POLAR W CORD 167.00 0891176 SHEATH GUIDING SHUITTLE SELECT 648.00 0891192 GRAFT CLARIX CORD 1K 2.5X2.5CM 7,980.00 0891226 UNITED BIOMETRIC WOUND DRESSING 10,860.00 0891242 SLEEVE TROCAR 5 MM 47.00 0891275 GATEWAY PTA BALLOON 5,366.00 0891325 TRAY TRIPLE LUMEN PICC 1,518.00 0891333 SLEEVE TROCAR 11 / 12 MM 107.00 0891366 DAC CATHETER 4,975.00 0891408 EQ MAXXAIR ETS 353.00 0891416 ALLOGRAFT TRINITY 5CC 12,073.00 0891432 FISTULA PLUG BIODESIGN 5,225.00 0891499 DRESSING VERSIVA 4.25 76.00 0891515 ALLOMAX SURGICAL GRAFT 15,470.00 0891523 EXTENDED ANATOMICAL CHIN IMPLANT 1,575.00 0891580 ADD LOW EXT T STRAP 502.00 0891598 GRAFT BONE INFUSE SM BMPZ 18,425.00 0891622 DX SLIM DELIVERY CATHETER 4,650.00 0891630 CATHETER POWERGLIDE BASIC 262.50 0891671 OSTEOCELL 15CC 27,500.00 0891713 NEURON MAX DELIVERY CATHETER 1,975.00 0891721 CATHETER POWERGLIDE FULL 422.50 0891762 OSTEOCELL 10CC 22,000.00 0891788 CUSA TIP 2,188.00 0891804 NEURON DELIVERY CATHETER 2,975.00 0891812 EPIFIX GRAFT PER SQ CM 1,495.00 0891861 IMM POSTSURG FITTING BELOW KNEE 502.00 0891879 CUSA DISP WRENCH 330.00 0891895 REPERFUSION CATHETER 6,900.00 0891945 OSTEOCELL 5CC 11,688.00 0891986 MAX SEPARATOR 14,950.00 0891994 SOLITAIRE FR DEVICE 31,685.00 0892034 PLATE SUPERIOR/INTERIOR END 27,742.00 0892042 ADD ENDOSKELETAL SYSTEM BK 502.00 0892075 VELOCITY DELIVERY MICROCATHETER 4,650.00 0892083 PREVENA THERAPY 2,648.00 0892125 ADD LOWER EXT ANKLE MOTION JY EA 502.00 0892133 LOW EXT PROSTHESIS SACH FOOT 502.00 0892141 KIT TOBY FLEXOR TENDON REPAIR 803.00 0892166 MAX ASPIRATION TUBINS 1,980.00 0892174 CELOX HEMOSTATIC PAD 80.00 0892216 CRANIAL HELMET 502.00 0892257 SEPARATOR 13,000.00 0892265 SKIN SUBSTITUTE PRIMATRIX PER SQ CM 728.00 0892268 CS SKIN SUB PRIMATRIX/SQ CM WASTED 728.00 0892349 BARE AXIUM COIL 5,500.00 0892398 SCREW MULTI-AXIAL SPINE 9,279.00 0892422 TR BAND TERUMO 241.00 0892430 AXIUM 3D COIL 7,000.00 0892448 FLOW DIVERSION PIPELINE EMB SMLG 62,500.00 0892505 WOUND MATRIX OASIS WASTED SQ CM 30.00 0892513 SHEATH SET RADIAL-MICROPUNCTURE 225.00 0892521 BARE AXIUM 3D COIL 5,500.00 0892539 EQ BED SPIRIT SELECT W ATMOSAIR 262.00 0892588 ACTIFUSE E-Z PREP 10 MC 9,625.00 0892596 APLIGRAFT WASTED PER SQ CM 217.00 0892612 GLIDESHEATH ACCESS KIT 476.00 0892661 SCREW ACUFIX 1,238.00 0892687 DERMAGRAFT WASTED PER SQ CM 282.00 0892695 CS DRESSING TRIACT CONTACT LAYER 30.00 0892703 BARE AXIUM PRIME 3D COIL 5,500.00 0892729 SPY ELITE KIT 16,475.00 0892752 SCREW ANTEGRA LOCKING SPINE 2,838.00 0892794 COIL RELEASE 1,250.00 0892802 ELECTRODE ENDOSCOPIC BIPOLAR LOOP 2,289.00 0892844 SCREW CANCELLOUS SPINE 2,354.00 0892885 CONCERTO HELIX COIL 2,975.00 0892893 ELECTRODE ENDOSCOPIC BUTTON 2,287.00 0892935 SCREW CANCELLOUS POLYAXIL 7,282.00 0893032 ACTIFUSE 10 ML 6,875.00 0893057 DEVICE ENDOTINE FOREHEAD 2,475.00 0893065 COIL RELEASE HANLDE 1,338.00 0893073 IMPLANT COCHLEAR OPUS 2 57,000.00 0893115 SCREW AXON 4,785.00 0893156 AXIUM DETACHABLE COIL 7,000.00 0893164 IMPLANT COCHLEAR CONCERT PIN 98,000.00 0893172 EQ ROTOPRONE 10,052.00 0893206 SCREW BONE SELF DRILLING 1,166.00 0893230 ENTEROCLYSIS TRAY 1,431.00 0893339 COIL 400 COMPLEX EXTRA SOFT 12,500.00 0893388 PLATE ANTERIOR CERVICAL 5,616.00 0893396 KIT PLEURAL-VAC THORACENTESIS 244.00 0893412 KIT LAP BAND LG/STANDARD 17,975.00 0893420 COIL 400 CURVE EXTRA SOFT 10,500.00 0893438 HF RESECTION ELECTRODE LOOP 2,289.00 0893479 PLATE SPIDER CERVICAL 9,350.00 0893487 NEEDLE COAXIAL TRU-GUIDE 113.00 0893511 J COIL 12,500.00 0893529 HF RESECTION PLASMA BUTTON 2,287.00 0893560 PLATE ANTEGRA 24,372.00 0893594 STARBURST TALON SERIUM-FLEX ELE 14,129.00 0893600 STENT WALLFLEX DUODENAL 11,975.00 0893602 COIL 400 SOFT COIL 12,500.00 0893610 GRAFIX PRIME PER SQ CM 184.00 0893612 CS GRAFIX PRIME PER SQ CM WASTED 184.00 0893628 DEVICE PROTECTION EMBOLIC ANGIO 7,750.00 0893630 DEVICE PROTECTION EMBOLIC ANGIO 7,750.00 0893680 GRAFT NEOX CORD 1K 3.0X3.0CM 15,475.00 0893693 COIL 400 STANDARD COIL 12,500.00 0893701 BALLOON AVIATOR PLUS PTA .014 1,086.00 0893743 ROD ICON 2,338.00 0893750 PERMASORB FIXATION DEVICE 1,696.00 0893760 GRAFT CLARIX CORD 1K 1.5X1.5CM 5,400.00 0893784 AXIUM HELIX COIL 6,000.00 0893792 STENT PRECISE CAROTID PRO RX 8,250.00 0893834 ROD COCR HEX END 3,410.00 0893842 OATS BONE GRAFT HARVESTER 2,860.00 0893859 VASER LIPOSUCTION TUBING 71.00 0893867 MYOSURE TISSUE REMOVAL SYSTEM 6,928.00 0893875 CANISTER KIT 1,850.00 0893883 CS DRESSING CUTIMED SORBACT 4X6 3.00 0893933 LSO SAG-CORO RIDGID FRAME 502.00 0893941 INFUSION TUBING 81.00 0893958 BALLOON HYPERFORM 7,120.00 0893966 BARE AXIUM HELIX COIL 5,000.00 0893974 STENT GLAUKOS TRABECULAR R/L 8,000.00 0894014 SPACER NOVEL PEEK 12,722.00 0894055 REBAR-18 MICRO 1,925.00 0894063 CAPSULE BRAVO PH 1,170.00 0894105 SPACER VERTEBRALANT 24,316.00 0894113 STRUT CORPECTOMY IMPLANT 66,600.00 0894121 APPLICATOR FLEXITIP XL LAP 86.00 0894139 CATHETER ECHELON 3,230.00 0894147 WINGSPAN STENT SYSTEM 30,215.00 0894154 TRAPEZOID BASKET STONE RETRIEVAL 1,325.00 0894196 SPACER PILLER PEEK 25,575.00 0894204 KO ELASTIC WITH JTS PREFAB 502.00 0894212 HEMOSTAT ARISTA 1,021.00 0894220 INJECTOR CADENCE PRECISION 2,440.00 0894238 TARGET DETACHABLE COILS ULTRA 9,096.00 0894246 DILATOR BALLOON CRE W/WIRE GUIDE 952.60 0894287 SPACER CARTICO PEEL 5,869.00 0894295 CONNECTOR ADJUSTABLE 5,775.00 0894303 CONNECTOR CROSS MULTI-AXIAL 10,203.00 0894311 BALLOON ECHELON 3,230.00 0894329 TARGET DETACHABLE COILS HELICAL 5,760.00 0894337 DILATOR BALLOON CRE 1,200.00 0894378 CONNECTOR NEXLINK 550.00 0894386 IMPLANTS WASTED 0.01 0894394 HYDROCOLLOID WND FILLER PSTE PER OZ 86.00 0894402 CATHETER MARATHON FLOW DIR 13,585.00 0894410 TRANSEND GUIDEWIRE SOFT/PLATINUM 2,111.00 0894428 FORCEP RAT TOOTH DISP 341.00 0894469 CAGE CERVICAL CRYSTAL PEEK 10,296.00 0894485 FIBERWIRE 92.50 0894493 CATHETER MARKSMAN STENT 4,725.00 0894501 TRANSEND 300 GUIDEWIRE 2,520.00 0894519 STENT WALLFLEX COLONIC 12,975.00 0894550 CAGE LUCENT PEEK 14,157.00 0894568 VERTEBRAL BODY REPLACEMENT 41,000.00 0894576 FIBERLOOP 225.00 0894584 CATHETER ULTRAFLOW MICRO DIR 3,030.00 0894592 EXCELSOR SL-10 MICRO CATHETER 4,296.00 0894642 CAGE OPTIMA PEEK 16,500.00 0894659 ADD LOWER EXT WAIST BELT WEBBING 502.00 0894667 BONE MILL DISPOSABLE 1,895.00 0894675 GUIDEWIRE MIRAGE 2,100.00 0894683 EXCELSIOR XT-27 MICRO CATHETER 4,560.00 0894691 NEEDLE EXPECT SLIMLINE ENDOSCOPIC 1,025.85 0894733 CAGE SYNFIX PEEK 42,988.00 0894758 PREVENA INCISION SITE THERAPY 2,770.00 0894766 GUIDEWIRE AVIGO 1,935.00 0894774 SYNCHRO GUIDEWIRE 2,424.00 0894782 NEEDLE SLIMLINE EXPECT ULTRASOUND 2,275.00 0894824 CAGE TAPERED PEEK 18,172.00 0894832 PRO DISC 25,046.00 0894857 GUIDEWIRE X-CELERATOR 1,380.00 0894865 INZONE DETACHABLE SYSTEM 1,002.00 0894873 ASSEMBLY ALLIANCE SYRINGE 60CC 150.00 0894923 PEDIGUARD TRI TIP 9,615.00 0894931 HEMOSTAT ARISTA 1,021.00 0894949 KIT ONYX 12,439.00 0894956 IZDS CONNECTING CALBE 257.00 0894964 GRAFT NEOX 1K 1.5X1.5CM 2,280.00 0895052 SOLITARE 31,685.00 0895110 FOOT MOLDED PLASTAZOTE SHOE 502.00 0895128 DEVICE ALLIGATOR RETRIEVAL 11,535.00 0895136 BALLOON GUIDE CATHETER 4,375.00 0895144 GRAFT NEOX CORD 1K 2.0X2.0CM 3,975.00 0895152 GRAFT NEOX CORD 1K 2.0X1.0CM 1,975.00 0895201 MEDIHONEY ALGINATE 4X4 58.00 0895219 NAVIEN DSC 5,120.00 0895227 TREVO PRO VUE SYSTEM 36,475.00 0895235 GRAFT NEOX CORD 1K 2.5X2.5CM 5,660.00 0895276 FILLER BONE FORM PUTTY 5,500.00 0895284 ALLOGRAFT TRINITY 10 CC 17,975.00 0895292 MEDIHONEY ALGINATE 2X2 26.00 0895367 PIN FIXATION TEMP 1,059.00 0895375 ALLOGRAFT TRINITY 15 CC 22,475.00 0895383 GRAFT JACKET USED MAXFORCE CM 2,936.00 0895391 BALLOON HYPERGLIDE 5,815.00 0895417 GRAFT NEOX CORD 1K 3.0X2.0CM 3,975.00 0895458 CAP POSTERIOR 1,381.00 0895474 GRAFT JACKET WASTED MAXIFORCE CM 586.00 0895482 CATHETER ORION 4,480.00 0895508 GRAFT NEOX CORD 1K 4.0X3.0CM 10,540.00 0895557 CERVICAL RIPENING BALLOON 244.00 0895565 HEMOSTAT ARISTA LDRP 1,021.00 0895599 GRAFT NEOX CORD 1K 6.0X3.0CM 15,580.00 0895649 LD BALLOON BAKRI POSTPARTUM 1,392.00 0895656 VAC VIA NEG PRESSURE WOUND THERAPY 4,222.00 0895664 CATHETER SLIP-CATH BEACON TIP 401.00 0895672 NEOX SKIN WOUND MATRIX PER SQ CM 880.00 0895678 CS NEOX SKIN WOUND MAT/SQ CM WASTED 880.00 0895698 ENDO-LOOP 455.00 0895706 OVER TUBE 815.00 0895714 EUS BALLOON 115.00 0895722 CRE BALLOON DILATOR 1,075.00 0895730 STRAVIX CRYOPRESERVED TISSUE 2X4CM 9,025.00 0895748 OTSC TWIN GRASPER 2,980.00 0895755 OTSC SYSTEM SET 2,720.00 0895763 ELEVIEW SUBMUCOSAL COMPOSITION 450.00 0895771 MIRENA IUD 4,250.00 0895789 CYGNUS AMNION PATCH 10,000.00 0895805 PROLACT+4 H2MF 10ML 312.50 0895813 PROLACT+4 H2MF 20ML 625.00 0895821 PROLACT+6 H2MF 15ML 468.75 0895839 PROLACT+6 H2MF 30ML 937.50 0895847 PROLACT+8 H2MF 40ML 1,250.00 0895854 PROLACT+10 H2MF 50ML 1,562.50 0895862 PROLACT CR 10ML 200.00 0895870 PREMIELACT 10ML 42.50 0895888 PROLACT HM 4 OZ 280.00 0895896 PROLACT RTF 24 100ML 700.00 0895904 PROLACT RTF 26 100ML 1,000.00 0895912 PROLACT RTF 28 100ML 1,300.00 0895920 PROLACTA RTF 20 CAL 56.00 0895938 PROLACTA RTF 26 CAL 200.00 0901124 NON Formulary - Regular (see below) 0.01 0902783 () capsule 1.65 0902791 diphenhydrAMINE (BENADRYL) capsule 1.80 0902809 diphenhydrAMINE (BENADRYL) oral li 37.50 0902833 chlorpheniramine (CHLORTRIMETON) 4 0.85 0902882 diphenhydrAMINE (BENADRYL) injectio 16.90 0903096 (MYCOBUTIN) capsule - 150 230.90 0903138 loratadine (CLARITIN) tablet - 10 m 9.30 0903179 sulfate 220 mg capsule 3.10 0903443 monohydrate/macrocry 31.05 0903534 hydroxychloroquine (PLAQUENIL) tabl 57.95 0903930 flucytosine (ANCOBON) capsule - 250 495.00 0903948 flucytosine (ANCOBON) capsule - 500 2,096.25 0903955 tablet - 100 mg 2.00 0903963 isoniazid tablet - 300 mg 17.05 0903971 ethambutol (MYAMBUTOL) tablet - 100 6.05 0903989 ethambutol (MYAMBUTOL) tablet - 400 21.45 0904060 amantadine (SYMMETREL) 100 mg capsu 28.45 0904094 sulfaSALAzine (AZULFIDINE) tablet - 3.25 0904268 - (BACT 8.75 0904276 sulfamethoxazole-trimethoprim (BACT 4.90 0904292 nitrofurantoin (FURADANTIN) 5 mg/mL 164.50 0904359 sulfamethoxazole-trimethoprim (BACT 595.85 0904441 nitrofurantoin macrocrystals (MACRO 58.35 0904458 nitrofurantoin (MACRODANTIN) macroc 46.50 0904508 (FLAGYL) tablet - 500 9.65 0904516 acyclovir (ZOVIRAX) 500 mg injecti 297.80 0904532 phenazopyridine (PYRIDIUM) tablet - 35.65 0904540 phenazopyridine (PYRIDIUM) tablet - 52.80 0904680 (AZACTAM) 2 gram injectio 1,060.50 0904821 erythromycin lactobionate injection 1,289.25 0904870 clindamycin (CLEOCIN) capsule - 15 9.65 0904888 clindamycin (CLEOCIN) injection - 1 77.65 0904896 clindamycin (CLEOCIN) injection - 1 45.95 0904938 (AMOXIL) 250 mg capsule 3.30 0904946 amoxicillin (AMOXIL) 500 mg capsule 6.20 0905026 erythromycin 0.5% Ophthalmic Ointme 237.10 0905091 amoxicillin (AMOXIL) 50 mg/mL Oral 16.50 0905109 (ZINACEF) injection - 75 35.15 0905190 2 gram Injection 356.40 0905232 B injection - 500,000 uni 231.00 0905240 (DYNAPEN) capsule - 2 18.20 0905257 V potassium (PEN VK) tab 9.65 0905265 penicillin V potassium (PEN VK) 500 13.05 0905331 penicillin G potassium 5,000,000 un 114.85 0905364 rifampin (RIFADIN) capsule - 300 mg 25.10 0905372 metroNIDAZOLE (FLAGYL) tablet - 250 7.55 0905513 500 mg injection 58.25 0905521 ampicillin 1 gram injection 114.05 0905539 ampicillin 2 gram injection 221.10 0905562 ampicillin 500 mg capsule 5.30 0905737 injection - 1 gm 178.20 0905745 nafcillin injection - 2 gm 373.30 0905877 (MEFOXIN) injection - 1 g 95.05 0905885 cefOXitin (MEFOXIN) injection - 2 g 190.10 0905893 cephalexin (KEFLEX) capsule - 250 m 8.95 0905901 cephalexin (KEFLEX) capsule - 500 m 16.20 0905992 (ANCEF) injection - 500 46.20 0906008 ceFAZolin (ANCEF) injection - 1 gm 85.30 0906032 amphotericin B conventional (FUNGIZ 601.95 0906156 gentamicin PF 10 mg/mL IV Syringe 49.50 0906164 gentamicin injection - 40 mg/mL ( 2 17.60 0906180 gentamicin injection - 40 mg/mL (20 367.00 0906222 tobramycin injection - 40 mg/mL (2 53.75 0906305 250 mg/mL (2 mL) injection 58.65 0906388 neomycin tablet - 500 mg 26.15 0906404 penicillin G benzathine-procaine (B 1,385.15 0906412 penicillin G benzathine-procaine (B 802.20 0906420 penicillin G benzathine (BICILLIN L 558.25 0906438 penicillin G benzathine (BICILLIN L 1,737.65 0906446 500 mg Injection 50.05 0906453 vancomycin injection - 1 gm 255.30 0906487 erythromycin base (ERYC) delayed re 3.60 0906495 amoxicillin-clavulanate (AUGMENTIN) 49.95 0906560 (ROCEPHIN) injection - 23.80 0906578 tobramycin injection - 1.2 gm 1,322.65 0906594 cefTRIAXone (ROCEPHIN) injection - 56.35 0906610 cefTRIAXone (ROCEPHIN) injection - 18.25 0906644 (FORTAZ) injection - 1 71.30 0906669 streptomycin 1 gram Injection 193.40 0906719 cefTAZidime (FORTAZ) injection - 2 158.40 0906727 pentamidine 300 mg Injection 1,251.40 0906735 vancomycin 50 mg/mL Oral Syringe 16.50 0906768 acyclovir (ZOVIRAX) 200 mg capsule 20.20 0906776 imipenem- (PRIMAXIN) 250 198.00 0906784 imipenem-cilastatin (PRIMAXIN) 500 396.00 0906792 pyrazinamide tablet - 500 mg 83.40 0906818 (CEFOTAN) injection - 1 g 179.55 0906826 cefoTEtan (CEFOTAN) Injection - 2 g 360.50 0906925 tetracycline 500 mg capsule 207.90 0906974 aztreonam (AZACTAM) 1 gram injectio 521.95 0907154 injection - 50,000 units 175.70 0907204 doxycycline (VIBRAMYCIN) injection 347.60 0907212 doxycycline (VIBRAMYCIN) capsule - 52.80 0907220 doxycycline (VIBRAMYCIN) capsule - 29.75 0907261 clindamycin (CLEOCIN-T) 1% lotion - 595.60 0907279 zidovudine (RETROVIR) 100 mg capsul 26.70 0907287 bacitracin zinc ointment - 500 unit 3.05 0907311 (CIPRO) 500 mg tablet 4.60 0907329 ciprofloxacin (CIPRO) 250 mg tablet 60.65 0907345 ampicillin- (UNASYN) 3 gr 227.25 0907352 ampicillin-sulbactam (UNASYN) 1.5 120.95 0907378 metroNIDAZOLE (FLAGYL) IVPB - 500 m 29.05 0907402 (CEFTIN) 500 mg t 104.95 0907444 (CLAFORAN) injection - 1 27.20 0907444 cefotaxime (CLAFORAN) injection - 1 34.85 0907451 (DURICEF) capsule - 500 49.25 0907469 demeclocycline (DECLOMYCIN) 150 mg 140.35 0907477 demeclocycline (DECLOMYCIN) 300 mg 225.30 0907501 (TERAZOL 3) 80 mg vagin 430.70 0907543 terconazole (TERAZOL 3) 0.8% vagina 537.90 0907899 cefuroxime (ZINACEF) injection - 1. 177.45 0907931 clarithromycin (BIAXIN) 500 mg tabl 92.35 0907956 azithromycin (ZITHROMAX) 250 mg tab 19.60 0908020 cycloSPORINE (SandIMMUNE) 25 mg cap 35.35 0908053 (ALTACE) capsule - 2.5 mg 23.85 0908061 cycloSPORINE (SandIMMUNE) 100 mg ca 184.45 0908079 cycloSPORINE non-modified (SandIMMU 619.75 0908095 PARoxetine (PAXIL) tablet - 20 mg 3.55 0908103 rifampin (RIFADIN) injection - 600 2,828.40 0908202 ganciclovir (CYTOVENE) 500 mg Injec 1,140.50 0908210 fluconazole (DIFLUCAN) tablet - 20 215.80 0908228 fluconazole (DIFLUCAN) tablet - 10 316.80 0908236 fluconazole (DIFLUCAN) IVPB - 400 m 221.80 0908244 fluconazole (DIFLUCAN) IVPB - 200 m 142.60 0908285 acyclovir (ZOVIRAX) 800 mg tablet 60.10 0908293 (SPORANOX) capsule - 1 245.70 0908327 dinoprostone (CERVIDIL) VAGINAL ins 5,336.50 0908996 vancomycin 5 mg/mL IV Syringe 49.50 0913277 azaTHIOprine (IMURAN) 50 mg tablet 31.00 0913285 DACTINOmycin (COSMEGEN) 0.5 mg Inje 17.30 0913350 cyclophosphamide (CYTOXAN) capsule 110.90 0913376 cyclophosphamide (CYTOXAN) capsule 100.30 0913459 DOXOrubicin (ADRIAMYCIN) 10 mg Inje 94.15 0913467 DOXOrubicin (ADRIAMYCIN) 50 mg Inje 554.40 0913525 cytarabine (CYTOSAR) 100 mg PF Inje 88.60 0913624 hydroxyurea (HYDREA) capsule - 500 11.65 0913632 chlorambucil (LEUKERAN) 2 mg tablet 385.35 0913640 megestrol (MEGACE) tablet - 20 mg 9.15 0913657 tamoxifen (NOLVADEX) tablet - 10 mg 7.60 0913673 megestrol (MEGACE) tablet - 40 mg 18.10 0913681 thioguanine (6-TG) 40 mg tablet 199.00 0913731 vinBLAStine (VELBAN) 10 mg Injectio 419.80 0913756 cyclophosphamide (CYTOXAN) 500 mg I 1,960.10 0913814 mitoMYcin injection - 5 mg 2,185.95 0913822 mitoMYcin injection - 20 mg 9,343.25 0913863 methotrexate injection - 25 mg/mL 53.25 0913921 floxuridine (FUDR) 0.5 gram Injecti 1,848.00 0914051 carmustine (BiCNU) 100 mg Injection 2,715.15 0914077 streptozocin 1 gram Injection 2,458.50 0914242 leucovorin 5 mg tablet 42.90 0914267 etoposide (VP-16 / VEPESID) 100 mg/ 148.40 0914283 DAUNOrubicin (CERUBIDINE) 20 mg/4 m 1,249.80 0914382 dacarbazine (DTIC) 200 mg Injection 260.05 0914416 etoposide (VEPESID or VP-16) 50 mg 628.85 0914457 mitoXANTRONE (NOVANTRONE) 2 mg/mL I 10,560.00 0914473 mesna 100 mg/mL Injection (10 mL) 522.75 0914481 CARBOplatin (PARAPLATIN) 150 mg Inj 332.65 0914515 PACLitaxel (TAXOL) 30 mg Injection 204.75 0915033 loratadine- (CLARITI 9.25 0915165 (EULEXIN) 125 mg capsule 65.95 0915181 IDArubicin (IDAMYCIN) 10 mg Injecti 2,120.75 0915272 azithromycin (ZITHROMAX) 500 mg inj 79.20 0915322 bupivacaine 0.5% injection - 10 mL 29.35 0915330 50 mcg/mL ( 2 mL) injectio 15.85 0916429 succinylcholine (ANECTINE) injectio 316.55 0916619 atropine 0.1 mg/mL ( 5 mL) injectio 131.50 0916627 norepinephrine (LEVOPHED) 1 mg/mL ( 288.10 0916676 dicyclomine (BENTYL) capsule - 10 m 7.20 0916684 dicyclomine (BENTYL) 20 mg tablet 8.85 0916759 phenylephrine (NEO-SYNEPHRINE) 10 m 50.70 0916767 PHYSOstigmine 1 mg/mL Injection (2 534.80 0916775 hyoscyamine-atropine-scopolamine-ph 123.20 0916783 hyoscyamine-atropine-scopolamine-ph 284.75 0916817 cimetidine (TAGAMET) 300 mg tablet 13.30 0916890 sucralfate (CARAFATE) tablet - 1 gm 5.05 0916924 benztropine (COGENTIN) injection - 871.20 0916932 benztropine (COGENTIN) 0.5 mg table 7.80 0916940 benztropine (COGENTIN) 1 mg tablet 5.40 0916957 benztropine (COGENTIN) 2 mg tablet 6.90 0916965 prazosin (MINIPRESS) capsule - 1 mg 8.10 0916973 prazosin (MINIPRESS) 2 mg capsule 5.05 0916981 prazosin (MINIPRESS) 5 mg capsule 28.80 0917104 PYRIDOstigmine (REGONOL) 5 mg/mL In 423.50 0917146 methocarbamol (ROBAXIN) tablet - 50 6.75 0917153 methocarbamol (ROBAXIN) tablet - 75 9.60 0917211 methocarbamol (ROBAXIN) injection - 690.65 0917245 glycopyrrolate (ROBINUL) injection 110.90 0917252 cyclobenzaprine (FLEXERIL) 10 mg ta 15.20 0917260 (LIORESAL) 10 mg tablet 9.75 0917286 glycopyrrolate (ROBINUL) 1 mg table 17.35 0917419 neostigmine (BLOXIVERZ) injection - 290.80 0917427 scopolamine (TRANSDERM-SCOP) patch 303.60 0917492 ePHEDrine injection - 50 mg/mL (1 m 440.10 0917500 EPINEPHrine 1 mg/mL (1 mL) injectio 33.30 0917625 isoproterenol (ISUPREL) 0.2 mg/mL ( 20,592.00 0917641 terbutaline (BRETHINE) injection - 63.40 0917658 terbutaline (BRETHINE) tablet - 5 m 87.75 0917666 terbutaline (BRETHINE) tablet - 2.5 9.50 0917690 beclomethasone (QVAR) 40 mcg/inhala 2,681.45 0917757 pseudoephedrine (SUDAFED) tablet - 0.60 0917807 carisoprodol (SOMA) 350 mg tablet 7.90 0917849 bethanechol (URECHOLINE) 5 mg table 9.45 0917856 bethanechol (URECHOLINE) 10 mg tabl 26.40 0917864 bethanechol (URECHOLINE) 25 mg tabl 35.25 0917906 dicyclomine (BENTYL) injection - 10 643.50 0917922 cimetidine (TAGAMET) 400 mg tablet 21.55 0918003 atropine 1 mg/mL ( 1 mL) injection 90.75 0918011 (PEPCID) tablet - 40 mg 61.80 0918029 famotidine (PEPCID) tablet - 20 mg 2.05 0918052 50 mg/mL (10 mL) Injectio 91.10 0918060 vecuronium (NORCURON) 10 mg Injecti 99.80 0918110 atracurium (TRACURIUM) 10 mg/mL (10 253.45 0918144 sodium bicarbonate 8.4% injection - 232.20 0918177 nicotine (HABITROL) patch - 14 mg/2 28.30 0918185 nicotine (HABITROL) patch - 21 mg/2 28.30 0918193 nicotine (HABITROL) patch - 7 mg/2 28.25 0918201 misoprostol (CYTOTEC) tablet - 100 10.90 0918292 misoprostol (CYTOTEC) tablet - 200 25.35 0918300 cisatracurium (NIMBEX) 10 mg/mL (20 4,704.45 0918318 cisatracurium (NIMBEX) 2 mg/mL (10 435.60 0920702 human 25% 50 mL injection 765.60 0920710 albumin human 25% 100 mL injection 1,531.20 0920728 albumin human 5% 250 mL injection 1,425.60 0920736 albumin human 5% 500 mL injection 1,531.20 0920751 albumin human 5% 50 mL injection 516.15 0920835 hepatitis B (ENGERIX-B) 10 mcg/0.5 363.15 0921502 aminocaproic acid (AMICAR) 250 mg/m 142.60 0921585 ferrous sulfate enteric coated tabl 0.90 0921593 carbonyl iron (FEOSOL) caplet - 45 3.20 0921619 ferrous gluconate (FERGON) tablet - 1.50 0921643 multivitamin with Iron Vit C Folic 8.70 0921783 protamine injection - 10 mg/mL (25 342.15 0921791 100 units/mL Injection (1 m 21.30 0921809 heparin injection - 1,000 units/mL 61.35 0921817 heparin injection - 5,000 units/mL 65.90 0921833 heparin 10,000 units/mL Injection ( 120.90 0921940 (COUMADIN) 2 mg tablet 8.45 0921973 warfarin (COUMADIN) 5 mg tablet 9.00 0921981 warfarin (COUMADIN) 7.5 mg tablet 12.15 0921999 warfarin (COUMADIN) 10 mg tablet 12.45 0922005 warfarin (COUMADIN) 2.5 mg tablet 29.25 0922062 protamine injection - 10 mg/mL ( 5 185.35 0922096 Surgifoam (GELFOAM) Size 12-7 136.10 0922104 Surgifoam (GELFOAM) Size 50 441.45 0922112 Surgifoam (GELFOAM) Size 100 660.00 0922153 Surgifoam (GELFOAM) Powder 1 gram 3,114.85 0922252 Avitene Non Woven Web 70x35 2,517.80 0922260 heparin injection - 1,000 units/mL 115.15 0922286 heparin 10,000 units/mL Injection ( 406.60 0922385 warfarin (COUMADIN) 1 mg tablet 8.10 0922419 heparin (HEPARINIZED SALINE) infusi 64.05 0922427 (INDERAL LA) 60 mg Caps 29.05 0923797 digoxin (LANOXIN PEDIATRIC) injecti 1,734.50 0924001 1% (XYLOCAINE) 20 mL Inje 22.50 0924076 lidocaine 2 gm/500 mL D5W infusion 88.40 0924084 lidocaine 2% (XYLOCAINE) 100 mg/5m 53.35 0924217 digoxin (LANOXIN) injection - 250 m 87.15 0924225 (CAPOTEN) 25 mg tablet 23.75 0924233 digoxin (LANOXIN) 250 mcg (0.25 mg 22.25 0924241 digoxin (LANOXIN) 125 mcg (0.125 m 22.25 0924282 captopril (CAPOTEN) 50 mg tablet 38.30 0924290 metoprolol (LOPRESSOR) 50 mg tablet 7.60 0924316 metoprolol (LOPRESSOR) 100 mg table 1.45 0924498 propranolol (INDERAL) 10 mg tablet 5.40 0924506 propranolol (INDERAL) 20 mg tablet 6.75 0924514 propranolol (INDERAL) 40 mg tablet 9.45 0924522 propranolol (INDERAL LA) 80 mg Caps 31.80 0924530 nadolol (CORGARD) tablet - 40 mg 72.00 0924548 propranolol injection - 1 mg/mL (1 159.55 0924589 (PROCARDIA) capsule - 10 14.10 0924787 phentolamine (REGITINE) 5 mg 6,649.65 0924829 (ISOPTIN) injection - 2.5 458.45 0924845 verapamil (CALAN) 80 mg tablet 7.55 0924852 verapamil (CALAN) 120 mg tablet 9.90 0924878 hydrALAZINE (APRESOLINE) injection 207.25 0924878 hydrALAZINE (APRESOLINE) injection 1,686.05 0924886 hydrALAZINE (APRESOLINE) tablet - 1 1.65 0924894 hydrALAZINE (APRESOLINE) tablet - 2 3.40 0924902 hydrALAZINE (APRESOLINE) tablet - 5 5.85 0924910 atenolol (TENORMIN) 50 mg tablet 0.60 0924969 (LONITEN) tablet - 2.5 mg 22.40 0925016 minoxidil (LONITEN) 10 mg tablet 27.95 0925057 cloNIDine (CATAPRES) 0.1 mg tablet 3.45 0925065 cloNIDine (CATAPRES) 0.2 mg tablet 6.00 0925149 DOBUTamine 12.5 mg/mL (20 mL) injec 88.35 0925180 (PERSANTINE) 25 mg tab 14.05 0925198 dipyridamole (PERSANTINE) 75 mg tab 30.20 0925321 cholestyramine (PREVALITE) oral pac 34.10 0925354 quiNINE capsule - 324 mg 96.70 0925404 isosorbide dinitrate (ISORDIL) tabl 13.00 0925412 isosorbide dinitrate (ISORDIL) tabl 11.65 0925446 isosorbide dinitrate (ISORDIL) tabl 17.85 0925487 nitroglycerin (NITRO-DUR) patch - 0 24.55 0925511 enalaprilat (VASOTEC) injection - 1 69.65 0925552 nitroglycerin (NITRO-DUR) patch - 0 25.15 0925685 nitroglycerin (NITROSTAT) sublingua 13.80 0925693 nitroglycerin 5 mg/mL (10 mL) injec 164.75 0925719 nitroglycerin (NITRO-TIME) extended 11.75 0925735 nitroglycerin (NITRO-DUR) patch - 0 28.70 0925743 nitroglycerin (NITRO-TIME) extended 13.70 0925750 nitroglycerin (NITRO-DUR) patch - 0 167.35 0925792 (CARDIZEM) 30 mg tablet 13.20 0925800 diltiazem (CARDIZEM) 60 mg tablet 7.15 0925891 labetalol (TRANDATE) 200 mg tablet 46.05 0925909 labetalol (TRANDATE) 300 mg tablet 8.60 0925917 pentoxifylline (TRENTAL) extended r 19.80 0925982 captopril (CAPOTEN) 12.5 mg tablet 22.40 0926006 cloNIDine (CATAPRES) 0.3 mg tablet 8.35 0926014 atenolol (TENORMIN) 100 mg tablet 19.70 0926022 metoprolol (LOPRESSOR) injection - 5.75 0926055 cloNIDine (CATAPRES TTS-1) patch - 437.25 0926063 cloNIDine (CATAPRES TTS-2) patch - 736.10 0926071 cloNIDine (CATAPRES TTS-3) patch - 1,021.20 0926089 nitroglycerin (NITRO-DUR) patch - 0 31.65 0926097 (TAMBOCOR) tablet - 100 43.30 0926105 (MEXITIL) capsule - 150 33.40 0926121 (VASOTEC) tablet - 5 mg 1.10 0926139 enalapril (VASOTEC) tablet - 10 mg 15.75 0926147 (PACERONE) 200 mg tablet 104.90 0926170 labetalol (TRANDATE) 100 mg tablet 4.60 0926360 terazosin (HYTRIN) capsule - 5 mg 21.20 0926378 terazosin (HYTRIN) 2 mg capsule 21.20 0926386 nitroglycerin 50 mg/250 mL D5W infu 327.50 0926428 (NORVASC) 5 mg tablet 21.70 0926451 milrinone (PRIMACOR) 1 mg/mL (20 mL 145.50 0926501 ramipril (ALTACE) 10 mg capsule 29.30 0926584 ramipril (ALTACE) capsule - 5 mg 25.05 0926634 doxazosin (CARDURA) tablet - 1 mg 13.45 0926642 doxazosin (CARDURA) tablet - 2 mg 12.95 0926659 verapamil (CALAN SR) extended relea 19.05 0926683 NIFEdipine (PROCARDIA XL/ADALAT CC) 40.05 0926709 terazosin (HYTRIN) capsule - 1 mg 21.20 0926733 (NIMOTOP) capsule - 30 m 243.05 0926774 labetalol (TRANDATE) 5 mg/mL (20 mL 37.00 0926782 NIFEdipine (PROCARDIA XL/ADALAT CC) 17.85 0926790 NIFEdipine (PROCARDIA XL/ADALAT CC) 32.80 0926808 diltiazem (CARDIZEM) 90 mg tablet 28.30 0926824 diltiazem (CARDIZEM SR) 60 mg Capsu 41.90 0926840 adenosine (ADENOCARD) 3 mg/mL ( 2 m 99.00 0926857 esmolol (BREVIBLOC) 10 mg/mL (10 mL 116.20 0926865 diltiazem (CARDIZEM SR) 90 mg Capsu 19.95 0926873 (ZESTRIL) tablet - 20 m 1.10 0926881 lisinopril (ZESTRIL) tablet - 10 m 16.35 0926899 lisinopril (ZESTRIL) tablet - 5 m 1.05 0926964 digoxin immune fab (DIGIFAB) inject 46,347.85 0926972 isosorbide mononitrate (ISMO) table 9.90 0926980 (NARCAN) injection - 0.4 m 1,880.90 0927020 divalproex (DEPAKOTE) 500 mg delay 4.65 0927038 divalproex (DEPAKOTE) 250 mg delay 23.30 0927095 20 mg/5 mL Cup 12.85 0927103 (RISPERDAL) 3 mg tablet 109.60 0927111 (MS CONTIN) 100 mg Tablet 100.75 0927129 PARoxetine (PAXIL) 30 mg tablet 37.15 0927137 venlafaxine (EFFEXOR) 25 mg tablet 25.65 0927145 morphine (MS IR) 30 mg Tablet - Imm 8.80 0927186 (PROzac) capsule - 10 mg 31.95 0927194 risperiDONE (RISPERDAL) tablet - 1 60.25 0927210 verapamil (CALAN SR) extended relea 13.90 0927236 (LIPITOR) 10 mg tablet 6.60 0927244 atorvastatin (LIPITOR) 20 mg tablet 6.95 0927335 (BETAPACE) 80 mg tablet 5.95 0927343 atenolol (TENORMIN) 25 mg tablet 10.60 0927368 isosorbide mononitrate (IMDUR) exte 27.20 0927376 diltiazem (CARDIZEM) 5 mg/mL ( 5 mL 49.25 0927392 amLODIPine (NORVASC) 10 mg tablet 29.80 0927400 (COZAAR) tablet - 25 mg 22.15 0927459 losartan (COZAAR) tablet - 50 mg 8.35 0930677 morphine injection - 4 mg/mL (1 m 29.00 0930701 morphine injection - 15 mg/mL (20 126.75 0930727 codeine sulfate 30 mg tablet 7.55 0930966 (KlonoPIN) 0.5 mg tablet 9.50 0930974 clonazePAM (KlonoPIN) 1 mg tablet 9.35 0930982 clonazePAM (KlonoPIN) 2 mg tablet 15.65 0930990 (ECOTRIN) 325 mg enteric co 0.35 0931006 (PAMELOR) capsule - 2 8.25 0931097 (MOTRIN) tablet - 600 mg 4.00 0931220 ibuprofen (MOTRIN) tablet - 400 mg 3.45 0931337 droperidol 2.5 mg/mL Injection (2 m 56.10 0931402 naloxone (NARCAN) injection - 0.4 m 313.15 0931493 indomethacin (INDOCIN) capsule - 25 5.35 0931501 indomethacin (INDOCIN) capsule - 50 8.45 0931568 acetaminophen () 325 mg tabl 0.85 0931667 acetaminophen-codeine (TYLENOL NO. 6.80 0931675 acetaminophen-codeine (TYLENOL NO. 4.80 0931709 acetaminophen (TYLENOL) 160 mg/5 mL 16.85 0931741 acetaminophen (TYLENOL) 500 mg tabl 0.60 0931782 acetaminophen (TYLENOL) 650 mg/20.3 21.20 0931816 butorphanol (STADOL) injection - 2 84.50 0931873 meperidine (DEMEROL) injection - 5 74.15 0931949 methadone (DOLOPHINE) 5 mg tablet 6.10 0931956 methadone (DOLOPHINE) tablet - 10 m 6.95 0931964 aspirin- (PERCODAN) 325 mg 14.95 0931998 fentaNYL 50 mcg/mL (20 mL) injectio 100.60 0932012 nalbuphine (NUBAIN) 10 mg/mL Inject 52.45 0932046 HYDROmorphone (DILAUDID) 2 mg table 9.40 0932053 HYDROmorphone (DILAUDID) 1 mg/mL (1 32.95 0932095 oxyCODONE-acetaminophen (PERCOCET 18.10 0932178 aspirin 325 mg tablet 0.80 0932186 aspirin 81 mg chewable tablet 0.15 0932244 (TEGRETOL) 200 mg tab 14.80 0932517 ketorolac (TORADOL) 30 mg/mL (2 mL) 99.00 0932608 aspirin 300 mg suppository 19.25 0932624 morphine (ASTRAMORPH) injection - 1 86.35 0932673 morphine (MS CONTIN) extended rele 44.65 0932707 carBAMazepine (TEGRETOL) 100 mg che 3.05 0932715 nortriptyline (PAMELOR) capsule - 1 9.70 0932822 (VERSED) injection - 1 mg 6.40 0932921 (ATIVAN) 0.5 mg tablet 2.25 0932947 butalbital-acetaminophen-caffeine ( 22.30 0932954 ibuprofen (MOTRIN) tablet - 800 mg 5.30 0932996 busPIRone (BUSPAR) 5 mg tablet 10.20 0933002 busPIRone (BUSPAR) 10 mg tablet 16.85 0933051 SUFentanil 50 mcg/mL Injection (2 m 134.55 0933085 fentaNYL 50 mcg/mL ( 5 mL) injectio 19.95 0933135 morphine PF (INFUMORPH) 25 mg/mL pr 3,484.80 0933184 PHENobarbital 10 mg/mL IV Syringe 49.50 0933200 morphine injection - 10 mg/mL (1 m 29.00 0933267 (ELAVIL) 10 mg tablet 3.95 0933275 amitriptyline (ELAVIL) 25 mg tablet 8.35 0933283 amitriptyline (ELAVIL) 50 mg tablet 15.35 0933432 SUMAtriptan (IMITREX) injection - 6 1,122.00 0933465 morphine PF (INFUMORPH) 10 mg/mL pr 2,059.20 0933481 (SINEQUAN) capsule - 10 mg 5.70 0933499 doxepin (SINEQUAN) capsule - 25 mg 8.60 0933515 doxepin (SINEQUAN) capsule - 100 mg 19.70 0933523 doxepin (SINEQUAN) capsule - 75 mg 16.45 0933531 naloxone (NARCAN) injection - 1 mg/ 496.60 0933572 divalproex (DEPAKOTE SPRINKLES) de 10.50 0933580 sertraline (ZOLOFT) tablet - 50 mg 5.35 0933606 HYDROmorphone (DILAUDID-HP) 10 mg/m 55.30 0933648 sertraline (ZOLOFT) tablet - 100 mg 5.35 0933762 fentaNYL (DURAGESIC) patch - 100 mc 1,039.00 0933804 LORazepam (ATIVAN) injection - 4 mg 146.00 0933820 fentaNYL (DURAGESIC) patch - 50 mc 513.25 0933838 fentaNYL (DURAGESIC) patch - 25 mc 280.75 0933853 midazolam (VERSED) 5 mg/mL (10 mL) 109.30 0933895 fentaNYL (DURAGESIC) patch - 75 mc 782.85 0933937 (DIPRIVAN) injection - 10 95.05 0933945 ibuprofen (ADVIL) tablet - 200 mg 0.90 0934018 naproxen (NAPROSYN) tablet - 500 mg 3.40 0934059 triazolam (HALCION) 0.125 mg tablet 79.70 0934117 diclofenac sodium (VOLTAREN) 75 mg 23.40 0934216 (TOFRANIL) tablet - 25 m 9.55 0934232 lithium capsule - 300 mg 2.80 0934331 PHENobarbital 130 mg/mL Injection 985.80 0934398 PHENobarbital injection - 65 mg/mL 379.90 0934448 (RESTORIL) 30 mg capsule 13.20 0934554 temazepam (RESTORIL) 15 mg capsule 9.90 0934810 triazolam (HALCION) 0.25 mg tablet 48.45 0934877 traZODone (DESYREL) 50 mg tablet 1.90 0934885 traZODone (DESYREL) 100 mg tablet 2.85 0934919 hydrOXYzine (ATARAX) injection - 5 352.45 0934943 hydrOXYzine hydrochloride (ATARAX) 3.80 0934976 LORazepam (ATIVAN) 2 mg tablet 1.60 0934992 LORazepam (ATIVAN) 1 mg tablet 1.40 0935049 LORazepam (ATIVAN) injection - 2 mg 11.90 0935056 hydrOXYzine pamoate (VISTARIL) 25 m 7.95 0935064 hydrOXYzine pamoate (VISTARIL) 50 m 4.25 0935106 (HALDOL) tablet - 1 mg 4.65 0935122 haloperidol (HALDOL) tablet - 5 mg 12.00 0935155 haloperidol lactate (HALDOL) inject 94.95 0935247 chlorproMAZINE (THORAZINE) injectio 348.50 0935270 chlorproMAZINE (THORAZINE) 25 mg t 93.90 0935486 fluPHENAZine (PROLIXIN) 5 mg tablet 121.45 0935494 fluPHENAZine (PROLIXIN) 1 mg tablet 58.00 0935510 (VALIUM) 2 mg tablet 0.80 0935528 diazepam (VALIUM) 5 mg tablet 4.25 0935536 diazepam (VALIUM) 10 mg tablet 5.65 0935726 prochlorperazine (COMPAZINE) tablet 7.85 0935734 prochlorperazine (COMPAZINE) tablet 11.80 0935775 prochlorperazine (COMPAZINE) inject 293.05 0935809 (PHENERGAN) 12.5 mg ta 6.50 0935817 promethazine (PHENERGAN) tablet - 2 12.60 0935825 promethazine (PHENERGAN) suppositor 233.75 0936153 ALPRAZolam (XANAX) 0.25 mg tablet 9.20 0936161 ALPRAZolam (XANAX) 0.5 mg tablet 9.85 0936179 ALPRAZolam (XANAX) 1 mg tablet 13.05 0936203 (DILANTIN) injection - 50 18.25 0936211 phenytoin (DILANTIN) injection - 50 26.15 0936237 phenytoin (DILANTIN) extended relea 8.35 0936294 phenytoin (DILANTIN INFATAB) chewab 15.15 0936302 (MYSOLINE) tablet - 50 m 10.50 0936310 primidone (MYSOLINE) tablet - 250 m 10.55 0936336 valproic acid (DEPAKENE) capsule - 13.30 0936344 valproic acid (DEPAKENE) oral liqui 28.55 0936377 (RITALIN) tablet - 8.65 0936401 carbidopa-levodopa (SINEMET) 10 mg 4.95 0936419 carbidopa-levodopa (SINEMET) 25 mg 11.35 0936476 risperiDONE (RISPERDAL) 2 mg tablet 93.20 0936492 oxyCODONE (OxyCONTIN) 20 mg Tablet 84.85 0936500 oxyCODONE (OxyCONTIN) 10 mg Tablet 45.55 0936526 divalproex (DEPAKOTE) 125 mg delay 11.75 0936542 (NEURONTIN) capsule - 30 2.60 0936567 propafenone (RYTHMOL) tablet - 150 21.60 0936591 gabapentin (NEURONTIN) capsule - 10 1.45 0936609 fosphenytoin 50 mg PE/mL Injection 1,187.10 0936617 fosphenytoin 50 mg PE/mL Injection 76.05 0936641 venlafaxine (EFFEXOR) 100 mg tablet 30.60 0936658 valproic acid (DEPACON) injection - 273.90 0936682 OLANZapine (ZyPREXA) tablet - 5 mg 174.50 0936690 OLANZapine (ZyPREXA) tablet - 10 mg 262.95 0936716 PARoxetine (PAXIL) tablet - 10 mg 9.65 0936724 metoprolol (TOPROL XL) 100 mg exten 24.65 0942771 indigo carmine 8 mg/mL (5 mL) injec 2,761.45 0942847 candida skin test antigen injection 2,185.95 0942896 tuberculin purified derivat 525.65 0943027 methylcellulose 5 gm in Sterile Wat 660.00 0943126 (ULTRAM) tablet - 50 mg 10.55 0943944 potassium acetate injection - 2 mEq 7.70 0943977 23.4% injection - 4 43.70 0943985 sodium acetate injection - 2 mEq/mL 10.55 0944009 magnesium sulfate injection - 4 mEq 25.05 0944058 trace elements neonatal Injection ( 55.45 0944207 ethacrynic acid 50 mg Injection 60,176.20 0944256 tromethamine (THAM) solution 3,102.00 0944439 potassium bicarbonate (K-LYTE) effe 20.75 0944454 sodium chloride tablet - 1 gm 1.10 0944504 calcitriol (ROCALTROL) capsule - 0. 16.90 0944710 sodium bicarbonate 650 mg tablet 0.95 0944728 sodium bicarbonate 8.4% injection - 167.00 0944744 sodium bicarbonate 8.4% injection - 154.35 0944769 sodium Injection - 3 mmol 238.90 0944777 sodium polystyrene sulfonate (KAYEX 110.90 0944793 potassium iodide (SSKI) solution - 4,672.80 0944884 metolazone (ZAROXOLYN) tablet - 2.5 29.95 0944892 metolazone (ZAROXOLYN) tablet - 5 m 22.35 0944959 fat emulsion, intravenous 20% (500 574.20 0944967 fat emulsion (INTRALIPID) 20% infus 547.80 0945030 magnesium sulfate injection - 4 mEq 94.95 0945063 trace elements adult Injection (10 157.65 0945097 lactulose oral liquid - 10 gm/15 mL 474.55 0945105 bumetanide (BUMEX) 1 mg tablet 17.15 0945113 bumetanide (BUMEX) injection - 0.25 13.20 0945113 bumetanide (BUMEX) injection - 0.25 36.10 0945188 potassium chloride (MICRO-K) 10 mEq 13.50 0945212 spironolactone (ALDACTONE) tablet 11.50 0945220 desmopressin (DDAVP) injection - 4 931.30 0945238 (LASIX) injection - 10 m 91.50 0945279 furosemide (LASIX) tablet - 20 mg 6.80 0945287 furosemide (LASIX) tablet - 40 mg 7.75 0945311 potassium chloride (K-DUR) extended 8.60 0945329 bumetanide (BUMEX) injection - 0.25 25.10 0945337 potassium phosphate-sodium phosphat 6.90 0945360 dextrose 25% injection - 10 mL syri 96.25 0945386 sodium bicarbonate 4.2% injection - 171.25 0945428 -sodium citrate (BICITRA 39.30 0945436 magnesium gluconate 500 mg tablet 2.40 0945493 (MIDAMOR) 5 mg tablet 3.55 0945527 furosemide (LASIX) injection - 10 m 65.50 0945535 furosemide (LASIX) injection - 10 m 45.95 0945584 furosemide (LASIX) tablet - 80 mg 20.80 0945626 furosemide (LASIX) oral liquid - 10 32.55 0945634 hydrochlorothiazide (HYDRODIURIL) 2 1.15 0945642 hydrochlorothiazide (HYDRODIURIL) 5 2.20 0945709 ethacrynic acid (EDECRIN) 25 mg tab 319.35 0945725 hydrochlorothiazide- (DY 5.05 0945733 hydrochlorothiazide-spironolactone 19.35 0945840 mannitol 25% (OSMITROL) injection - 1.85 0945840 mannitol 25% (OSMITROL) injection - 77.00 0945881 mannitol 20% (OSMITROL) infusion - 349.80 0945956 spironolactone (ALDACTONE) tablet 5.65 0945964 spironolactone (ALDACTONE) tablet 11.60 0945972 probenecid (BENEMID) tablet - 500 m 13.00 0948901 (ACTIVASE) 1 mg/mL ( 50 m 67,668.75 0948927 hemin (PANHEMATIN) 7 mg/mL IV Syrin 125,169.55 0948943 gemfibrozil (LOPID) 600 mg tablet 15.40 0948976 torsemide (DEMADEX) 20 mg tablet 10.95 0948984 calcium carbonate-vitamin D (OS CAL 0.65 0949016 isosulfan blue 10 mg/mL (5 mL) Inje 16,004.35 0949693 acetylcysteine 20% (MUCOMYST) 30 mL 154.00 0949735 acetylcysteine 10% (MUCOMYST) 10 mL 192.50 0949842 benzonatate (TESSALON) perles - 10 7.85 0949867 guaiFENesin (ROBITUSSIN) SUGAR FREE 7.45 0949941 promethazine (PHENERGAN) oral liqui 3.05 0950139 guaiFENesin-codeine (CHERATUSSIN AC 9.90 0950402 levOCARNitine 200 mg/mL (5 mL) Inje 506.90 0951392 (DIAMOX) 250 mg table 57.20 0951400 acetaZOLAMIDE (DIAMOX SEQUELS) 500 56.70 0951418 acetaZOLAMIDE (DIAMOX) 500 mg injec 696.30 0951541 fluorometholone 0.1% (FML) ophthal 978.65 0951558 Lubricant Ophthalmic Ointment (3.5 51.25 0951624 phenylephrine (NEO-SYNEPHRINE) 0.5% 50.20 0951749 ARTIFICIAL TEARS ophthalmic solutio 22.05 0951764 sodium hyaluronate (HEALON) ophthal 2,115.30 0951897 tobramycin 0.3% (TOBREX) ophthalmic 183.00 0951913 neomycin--hydrocortisone 1,329.00 0951996 neomycin-polymyxin B- (NE 817.10 0952002 bacitracin-neomycin-polymyxin B (NE 751.75 0952051 bacitracin-polymyxin B (AK-POLY-BAC 339.25 0952077 tobramycin 0.3% (TOBREX) ophthalmic 2,775.70 0952101 trifluridine (VIROPTIC) 1% Ophthalm 2,942.85 0952143 timolol maleate 0.5% (TIMOPTIC) oph 224.40 0952150 timolol maleate 0.25% (TIMOPTIC) op 198.00 0952184 atropine 1% 5 mL ophthalmic solutio 739.75 0952226 cyclopentolate (CYCLOGYL) 1% Ophtha 221.80 0952267 zzzscopolamine (ISOPTO HYOSCINE) 0. 349.15 0952291 pilocarpine 1% (ISOPTO CARPINE) oph 538.60 0952309 phenylephrine 10% (NEO-SYNEPHRINE) 3,168.00 0952333 bacitracin Ophthalmic Ointment (3.5 914.80 0952416 phenylephrine 2.5% (AK-DILATE) 2 m 536.35 0952432 Gelatin Ophth Dressing (GELFILM) 1,441.75 0952457 neomycin-polymyxin B-dexamethasone 580.80 0952499 ophthalmic irrigation (EYE WASH) so 43.65 0952507 (AFRIN) 0.05% Nasal S 55.45 0952515 hydrocortisone/neomycin/polymyxin B 1,203.85 0952614 Balanced Salt Solution (BSS) Ophth 124.75 0952630 tetrahydrozoline () 0.05% Oph 1.70 0952655 carbamide peroxide 6.5% (DEBROX) ot 79.05 0952689 Balanced Salt Solution (BSS) Plain 359.45 0952697 pilocarpine 2% (ISOPTO CARPINE) oph 199.60 0952713 Balanced Salt Solution (BSS PLUS) P 991.35 0952721 acetylcholine 1% (MIOCHOL-E) 20 mg 1,303.50 0952747 tropicamide (MYDRIACYL) 0.5% Ophtha 132.10 0952820 1.4% (CHLORASEPTIC) mouth/th 39.60 0952846 dexamethasone 0.1% (DECADRON) ophth 853.80 0952986 prednisoLONE acetate 1% (PRED FORTE 730.25 0953000 ipratropium (ATROVENT) MDI - 17 mcg 6,516.45 0953083 sodium 10% (BLEPH-10) 734.60 0953109 proparacaine 0.5% (OPHTHETIC) ophth 554.40 0953141 gentamicin 0.3% ophthalmic solution 253.20 0953158 sodium chloride 0.65% (SALINE) nasa 27.30 0953182 carbachol 0.01% (MIOSTAT) intraocul 533.50 0953257 ciprofloxacin 0.3% (CILOXAN) ophtha 134.65 0953307 flurbiprofen 0.03% (OCUFEN) ophthal 570.25 0953315 alfentanil (ALFENTA) 500 mcg/mL (2 138.90 0953323 sodium hyaluronate (HEALON GV) opht 2,310.00 0953331 apraclonidine 1% (IOPIDINE) 0.1 mL 359.10 0953414 albuterol (PROVENTIL) 0.4 mg/mL Ora 16.50 0953422 tobramycin-dexamethasone (TOBRADEX) 3,614.85 0953463 fluorescein (BIO-GLO) ophthalmic st 0.01 0953471 polymyxin B-trimethoprim (POLYTRIM) 229.95 0953588 albuterol 0.083% 2.5 mg/3 mL inhala 18.50 0953604 sodium chondroitin-hyaluronate opht 1,936.45 0953828 guaiFENesin (MUCINEX) extended rele 13.25 0953844 timolol (TIMOPTIC XE) 0.5% Ophthalm 2,868.00 0953869 fluticasone 44 mcg (FLOVENT) MDI i 3,054.00 0953877 fluticasone 220 mcg (FLOVENT) MDI i 6,350.40 0953893 latanoprost 0.005% (XALATAN) ophtha 1,254.00 0953927 fluticasone (FLONASE) nasal spray - 993.60 0953950 guaiFENesin-dextromethorphan (ROBIT 28.00 0956375 bismuth subsalicylate (PEPTO-BISMOL 41.35 0956417 bisacodyl (DULCOLAX) 5 mg enteric c 1.00 0956433 bisacodyl (DULCOLAX) suppository - 2.20 0956458 docusate sodium (COLACE) 100 mg cap 2.30 0956482 charcoal, activated (ACTIDOSE with 139.15 0956524 senna (SENOKOT) tablet - 8.6 mg 0.95 0956714 docusate sodium (COLACE) 250 mg cap 4.15 0956821 diphenoxylate-atropine (LOMOTIL) 2. 11.55 0956904 mineral oil - 30 mL cup 4.80 0956920 (IMODIUM) capsule - 2 mg 11.55 0957035 simethicone ( GAS) chewable 0.60 0957068 simethicone (MYLICON INFANT) drops 29.35 0957159 aluminum hydroxide-magnesium hydrox 56.80 0957506 magnesium citrate (CITROMA) oral li 19.80 0957548 lactobacillus acidophilus (FLORANEX 5.30 0957555 lactobacillus acidophilus and bulga 10.75 0957563 (ANTIVERT) tablet - 12.5 11.15 0957589 meclizine (ANTIVERT) tablet - 25 mg 11.30 0957662 trimethobenzamide (TIGAN) injection 463.60 0957670 trimethobenzamide (TIGAN) 300 mg ca 24.25 0957696 (REGLAN) tablet - 10 9.55 0957704 metoclopramide (REGLAN) injection - 17.60 0957902 polyethylene glycol 3350 with elect 950.40 0957977 simethicone (MYLANTA GAS maximum st 3.45 0958074 ursodiol (ACTIGALL) 300 mg capsule 69.60 0958165 ondansetron (ZOFRAN ODT) 8 mg Table 490.15 0958215 ondansetron (ZOFRAN) injection - 2 124.35 0958223 cimetidine (TAGAMET) 800 mg tablet 44.00 0958256 mesalamine (ROWASA) enema - 4 gm/60 322.50 0958306 octreotide (SandoSTATIN) injection 787.10 0958397 aluminum hydroxide (AMPHOJEL) 64 mg 4.80 0958447 charcoal,activated 25 gm/120 mL bot 220.20 0958454 cherry syrup oral liquid - 5 mL 2.00 0958504 aluminum hydroxide-magnesium hydrox 0.40 0958637 ondansetron (ZOFRAN) injection - 2 15.05 0958645 lansoprazole (PREVACID) 15 mg Capsu 79.30 0958652 metoclopramide (REGLAN) oral liquid 8.60 0958678 lansoprazole (PREVACID) 30 mg Capsu 33.50 0958686 famotidine (PEPCID) injection - 10 12.50 0958710 dorzolamide 2% (TRUSOPT) ophthalmic 881.80 0958728 guaiFENesin-dextromethorphan (ROBIT 85.70 0961342 deferoxamine (DESFERAL) injection - 123.90 0961615 betamethasone sodium phosphate-beta 528.00 0961623 (MIACALCIN) injection - 42,816.60 0961672 dexamethasone (DECADRON) injection 22.60 0961680 dexamethasone (DECADRON) 2 mg table 8.60 0961698 glyBURIDE (DIABETA) tablet - 2.5 mg 6.10 0961706 glyBURIDE (DIABETA) tablet - 5 mg 10.90 0961722 dexamethasone (DECADRON) injection 13.10 0961821 dexamethasone (DECADRON) 1.5 mg tab 6.30 0961839 dexamethasone (DECADRON) 4 mg table 9.05 0961854 testosterone cypionate 200 mg/mL In 1,839.70 0961896 methylPREDNISolone (Solu-MEDROL) in 95.80 0961904 methylPREDNISolone (Solu-MEDROL) in 76.85 0961912 methylPREDNISolone (Solu-MEDROL) in 178.40 0961920 methylPREDNISolone (Solu-MEDROL) in 450.00 0961938 methylPREDNISolone Acetate (DEPO-ME 422.95 0961953 methylPREDNISolone acetate (DEPO-ME 206.85 0961987 cypionate (DEPO-ESTRADIOL 520.65 0961995 hydrocortisone (Solu-CORTEF) inject 232.75 0962027 hydrocortisone (CORTEF) tablet - 10 4.55 0962043 vasopressin (VASOSTRICT) 20 units/m 3,129.35 0962068 vasopressin (VASOSTRICT) 20 units/m 31,293.25 0962100 predniSONE tablet - 1 mg 3.70 0962126 predniSONE tablet - 5 mg 1.60 0962134 predniSONE tablet - 10 mg 3.45 0962159 predniSONE tablet - 20 mg 3.80 0962175 predniSONE tablet - 50 mg 5.55 0962183 prednisoLONE 5 mg tablet 244.60 0962266 hydrocortisone (CORTEF) tablet - 20 14.35 0962324 estradiol (ESTRACE) tablet - 1 mg 9.00 0962365 methylPREDNISolone (MEDROL) tablet 28.40 0962431 triamcinolone acetonide (KENALOG 10 174.90 0962464 triamcinolone acetonide (KENALOG 40 135.45 0962548 50 mg/mL Injection (10 538.60 0962555 medroxyPROGESTERone (PROVERA) table 6.50 0962563 liothyronine (CYTOMEL) 5 mcg tablet 11.25 0962589 methimazole (TAPAZOLE) tablet - 10 10.15 0962597 propylthiouracil (PTU) tablet - 50 7.95 0962662 (GLUCOTROL) tablet - 5 4.95 0962746 injection - 1 mg 2,700.75 0962753 conjugated (PREMARIN) inj 3,482.30 0962761 conjugated estrogens (PREMARIN) 1.2 29.05 0962779 conjugated estrogens (PREMARIN) 0.6 62.85 0962811 conjugated estrogens (PREMARIN) 0.3 62.85 0962902 NPH (NovoLIN N) 100 units/m 66.10 0962910 insulin regular (NovoLIN R) 100 un 66.10 0962928 calcium carbonate (OS CAL) 500 mg 1.45 0962936 cosyntropin (CORTROSYN) injection - 1,270.40 0962944 calcium chloride injection - 100 mg 152.90 0962951 calcium GLUCONATE injection - 100 m 144.95 0963009 fludrocortisone (FLORINEF) tablet - 10.60 0963033 levothyroxine (SYNTHROID) tablet - 6.60 0963041 levothyroxine (SYNTHROID) tablet - 9.90 0963058 levothyroxine (SYNTHROID) tablet - 10.70 0963066 levothyroxine (SYNTHROID) 300 mcg ( 14.35 0963082 levothyroxine (SYNTHROID) tablet - 7.25 0963116 thyroid desiccated 30 mg tablet 2.00 0963124 thyroid, desiccated tablet - 60 mg 9.65 0963215 liothyronine (CYTOMEL) tablet - 25 14.55 0963280 levothyroxine (SYNTHROID) tablet - 7.80 0963348 medroxyPROGESTERone (PROVERA) table 4.15 0963355 glipiZIDE (GLUCOTROL) tablet - 10 8.85 0963363 insulin NPH-insulin regular (NovoLI 66.10 0963447 medroxyPROGESTERone (PROVERA) 5 mg 5.95 0963462 estradiol (VIVELLE-DOT) BI-WEEKLY 0 238.00 0963470 estradiol (VIVELLE-DOT/ALORA) BI-WE 237.65 0965533 metFORMIN (GLUCOPHAGE) tablet - 850 15.90 0965541 metFORMIN (GLUCOPHAGE) tablet - 500 1.05 0965558 medroxyPROGESTERone (DEPO-PROVERA) 712.80 0965566 levothyroxine (SYNTHROID) tablet - 7.25 0965624 (NovoLOG) 100 units/ 66.10 0965632 levothyroxine (SYNTHROID) tablet - 7.40 0965640 levothyroxine (SYNTHROID) tablet - 5.80 0965657 levothyroxine (SYNTHROID) tablet - 9.35 0965665 esterified estrogens (MENEST) 0.625 13.95 0966101 lidocaine 1% preservative-free Inje 38.95 0966119 lidocaine 2% (XYLOCAINE) Injection 25.35 0966127 lidocaine topical 4% (XYLOCAINE) to 633.60 0966143 bupivacaine 0.25%-EPINEPHrine 1:200 213.25 0966150 lidocaine 4% preservative-free Inje 53.60 0966176 lidocaine 1% (XYLOCAINE MPF) 2 mL I 32.35 0966184 lidocaine-EPINEPHrine 2%-1:100,000 34.35 0966192 lidocaine 2% (XYLOCAINE MPF) injec 27.75 0966200 lidocaine-EPINEPHrine 2%-1:100,000 112.20 0966226 lidocaine-EPINEPHrine 1%-1:100,000 33.55 0966242 lidocaine 1% preservative-free Inje 38.45 0966317 lidocaine 1% (XYLOCAINE) 50 mL Inje 44.25 0966341 bupivacaine 0.5% injection - 30 mL 34.85 0966473 lidocaine 2% (XYLOCAINE) injection 27.50 0966499 bupivacaine 0.75% spinal injection 70.75 0966507 bupivacaine 0.25% injection - 30 m 20.20 0966515 bupivacaine 0.25% injection - 10 m 25.55 0966531 lidocaine-EPINEPHrine 1.5%-1:200,00 97.85 0966549 lidocaine-EPINEPHrine 2%-1:200,000 249.00 0966556 bupivacaine 0.75% injection - 10 m 29.00 0966598 lidocaine-prilocaine (EMLA) 2.5%-2. 605.90 0967612 methylergonovine (METHERGINE) table 985.55 0967620 methylergonovine (METHERGINE) injec 429.55 0967646 oxytocin (PITOCIN) injection - 10 u 47.55 0967695 carboprost (HEMABATE) injection - 2 5,052.85 0968347 tetanus immune (HyperTET S 6,579.45 0968354 crotalidae polyvalent immune FAB ov 35,830.10 0968362 latrodectus mactans (antivenin blac 438.90 0968487 pneumococcal polysaccharide (PPV or 1,249.80 0968503 tetanus-diphtheria toxoids (Td) (DE 397.95 0968511 measles-mumps-rubella (MMR-II) inje 988.75 0969436 clotrimazole (LOTRIMIN) 1% cream - 145.35 0969618 betamethasone dipropionate 0.05% (D 697.40 0969634 fluocinolone 0.025% (SYNALAR) cream 463.35 0969667 triamcinolone (KENALOG) 0.1% cream 73.55 0969733 betamethasone valerate (VALISONE) 0 295.25 0969840 bacitracin-neomycin-polymyxin B (NE 81.20 0969915 bacitracin-polymyxin B (POLYSPORIN 142.60 0969956 pramoxine (PROCTOFOAM) 1% rectal fo 627.10 0970046 - (MUSCLE R 29.85 0970053 povidone iodine 10% (BETADINE) oint 23.80 0970129 gentamicin 0.1% cream - 15 gm 433.65 0970152 zinc oxide 20% ointment 454 gm 89.10 0970228 diphenhydrAMINE 1% (BENADRYL) cream 49.80 0970285 selenium sulfide (SELSUN BLUE) 2.5% 217.80 0970368 silver 1% (SILVADENE) 196.45 0970384 lidocaine topical 5% (XYLOCAINE) oi 3,544.95 0970392 lidocaine topical 2% (XYLOCAINE) je 221.80 0970434 fluocinonide (LIDEX) 0.05% cream 30 1,201.20 0970442 fluocinonide 0.05% (LIDEX) cream - 601.35 0970459 fluocinonide 0.05% (LIDEX) ointment 934.60 0970467 fluocinonide E (LIDEX-E) 0.05% crea 594.80 0970509 glycerin-witch hazel 10%-50% topica 0.70 0970517 20%-menthol 0.5% (DERMOP 73.55 0970541 acetaminophen (TYLENOL) 120 mg supp 4.90 0970558 acetaminophen (TYLENOL) 325 mg supp 10.60 0970566 acetaminophen (TYLENOL) 650 mg supp 5.70 0970624 prochlorperazine (COMPRO) supposito 176.90 0970707 hydrocortisone suppository - 25 mg 783.55 0970756 acetic acid topical 0.25% 250 mL i 77.90 0970780 bacitracin zinc ointment (30 gram) 59.30 0970806 hydrocortisone 0.5% cream (30 gram) 76.85 0970814 conjugated estrogens (PREMARIN) vag 4,568.30 0970822 hydrocortisone 1% cream - 30 gm 52.70 0970830 hydrocortisone 1% ointment - 30 gm 52.70 0970855 nystatin-triamcinolone (MYCOLOG-II) 1,477.70 0970863 nystatin topical powder - 15 gm 323.55 0970871 EPINEPHrine 1 mg/mL topical solutio 3,009.60 0970921 belladonna-opium (B+O 15-A) 16.2 mg 336.35 0970939 belladonna-opium (B+O 16-A) 16.2 mg 341.00 0971010 hydrocortisone (COLOCORT) 100 mg/60 140.20 0971101 calamine-pramoxine (CALAGESIC) 8%-1 59.30 0971176 zinc oxide 20% ointment (30 gm) 32.50 0971259 gentamicin 0.1% ointment - 15 gm 433.65 0971325 nystatin cream - 15 gm 231.00 0971333 nystatin ointment - 15 gm 231.10 0971416 white petrolatum ointment 1.85 0971481 triamcinolone 0.1% topical DENTAL P 910.05 0971507 acyclovir 5% (ZOVIRAX) 30 gram oint 10,528.10 0971556 silver nitrate topical stick 9.45 0971572 fluocinolone (SYNALAR) 0.025% ointm 447.90 0971648 sodium hypochlorite 0.25% (DAKIN'S 152.10 0971671 nitroglycerin 2% (NITRO-BID) ointme 33.10 0971697 collagenase (SANTYL) ointment - 30 3,244.05 0971879 Sween Cream 65.65 0971903 dilateria Kit - Medium 217.80 0972000 Oxidized Regenerated Cellulose (INT 3,977.60 0972281 hydrocortisone (PROCTOSOL HC) 2.5% 1,152.80 0972331 betamethasone dipropionate 0.05%-cl 494.85 0972588 25 mg tablet 14.00 0972596 2% (NIZORAL) shampoo - 364.35 0975862 albuterol (PROVENTIL) 2 mg tablet 87.60 0975888 albuterol (PROVENTIL) 4 mg tablet 77.55 0975912 aminophylline 25 mg/mL (10 mL) inje 149.45 0975920 aminophylline 25 mg/mL (20 mL) inje 16.15 0975953 papaverine injection - 30 mg/mL (2 185.75 0976167 oxybutynin (DITROPAN) tablet - 5 m 0.70 0976225 pyridoxine (Vitamin B6) 25 mg table 0.40 0976480 naproxen (NAPROSYN) 550 mg DS Table 4.90 0977975 cyanocobalamin (VITAMIN B-12) injec 39.60 0978049 multivitamin adult (INFUVITE) injec 160.25 0978056 folic acid tablet - 1 mg 2.55 0978171 pyridoxine (Vitamin B6) tablet - 50 3.75 0978239 thiamine (VITAMIN B1) tablet - 100 4.15 0978270 thiamine (VITAMIN B1) injection - 1 157.65 0978346 ascorbic acid (VITAMIN C) 250 mg ta 0.45 0978353 ascorbic acid (VITAMIN C) 500 mg ta 0.90 0978429 vitamin E capsule - 200 units 0.65 0978437 vitamin E capsule - 400 units 1.65 0978528 phytonadione (Vitamin K) (AQUAMEPHY 598.30 0978569 phytonadione (Vitamin K) (AQUAMEPHY 67.35 0978734 multivitamin, prenatal tablet with 1.00 0978858 pyridoxine (Vitamin B6) injection - 185.20 0978866 magnesium chloride-calcium 64 mg-11 1.85 0978908 ergocalciferol (VITAMIN D) capsule 26.05 0978916 multivitamin with minerals (THERAGR 1.35 0980466 pralidoxime 1000 mg Injection 8,583.30 0980490 (PARLODEL) 2.5 mg tab 109.25 0980508 allopurinol (ZYLOPRIM) 100 mg table 3.95 0980516 allopurinol (ZYLOPRIM) 300 mg table 8.10 0980532 colchicine (COLCRYS) 0.6 mg tablet 88.95 0980607 (REOPRO) 2 mg/mL (5 mL) i 19,609.95 0980714 cladribine (LEUSTATIN) 1 mg/mL Inje 8,580.00 0980771 pamidronate (AREDIA) injection - 3 218.75 0980789 Talc Irrigation 1,313.40 0980797 carbidopa-levodopa (SINEMET CR) 50 23.00 0980821 (ROMAZICON) injection - 103.00 0981407 neomycin-polymyxin B-dexamethasone 580.80 0981688 methylPREDNISolone acetate (DEPO-ME 119.30 0981829 acetaminophen (TYLENOL) 80 mg chewa 1.30 0982140 4% topical solution - 4 mL 3,880.80 0982256 atropine 0.1 mg/mL (10 mL) injectio 165.00 0982306 EPINEPHrine 0.1 mg/mL (10 mL) injec 82.90 0982314 atropine 0.4 mg/mL ( 1 mL) injectio 57.75 0982389 ketorolac (TORADOL) 30 mg/mL (1 mL) 79.20 0982413 dextrose 50% injection - 50 mL syri 195.65 0982520 nitroglycerin (NITROQUICK) 0.3 mg t 2.70 0983361 poliovirus vaccine, inactivated (IP 432.65 0983411 oxacillin 40 mg/mL IV Syringe 49.50 0983460 finasteride (PROSCAR) tablet - 5 mg 10.75 0983544 spironolactone (ALDACTONE) 5 mg/mL 16.50 0983551 fexofenadine (ALLEGRA) 60 mg tablet 9.50 0983569 (ALPHAGAN P) 0.15% Opht 2,312.80 0983601 donepezil (ARICEPT) tablet - 5 mg 2.20 0983619 amoxicillin-clavulanate (AUGMENTIN) 66.70 0983676 doxazosin (CARDURA) tablet - 4 mg 13.50 0983684 (CASODEX) 50 mg tablet 240.95 0983726 carvedilol (COREG) 6.25 mg tablet 27.75 0983775 chlorothiazide 0.5 gram Injection 950.40 0983791 venlafaxine (EFFEXOR XR) 75 mg Caps 55.45 0983825 tamsulosin (FLOMAX) capsule - 0.4 m 6.30 0983833 gemcitabine (GEMZAR) 1 gram Injecti 707.00 0983916 (LEVAQUIN) 500 mg tabl 222.05 0983932 enoxaparin (LOVENOX) injection - 4 125.80 0983957 leuprolide (LUPRON DEPOT) 7.5 mg De 12,611.55 0983973 hydrochlorothiazide-triamterene (M 5.20 0983999 methotrexate tablet - 2.5 mg 82.35 0984013 cycloSPORINE modified (NEORAL) caps 72.55 0984021 cycloSPORINE modified (NEORAL) caps 27.75 0984047 zafirlukast (ACCOLATE) 20 mg tablet 27.20 0984088 multivitamin (NEPHROCAPS) capsule 8.90 0984153 hydrALAZINE (APRESOLINE) 1 mg/mL IV 49.50 0984377 0.3% (OCUFLOX) ophthalmic 106.85 0984385 calcium carbonate-vitamin D (OS CAL 0.65 0984427 acarbose (PRECOSE) 25 mg tablet 11.90 0984450 midodrine (PROAMATINE) 5 mg tablet 59.25 0984468 promethazine-codeine (PHENERGAN WIT 6.45 0984484 mirtazapine (REMERON) 15 mg tablet 35.95 0984492 mesalamine (CANASA) suppository - 1 245.40 0984518 diltiazem (TIAZAC) extended releas 6.75 0984526 (TOPAMAX) tablet - 25 m 27.75 0984534 flecainide (TAMBOCOR) tablet - 50 27.60 0984542 metoprolol (TOPROL XL) 50 mg extend 16.40 0984559 magnesium oxide tablet - 400 mg 2.00 0984617 rocuronium (ZEMURON) 10 mg/mL Injec 400.20 0984625 rocuronium (ZEMURON) 10 mg/mL Injec 112.35 0984690 amiodarone (CORDARONE) 50 mg/mL ( 3 22.30 0984708 aspirin (ECOTRIN) 81 mg enteric co 0.35 0984716 terazosin (HYTRIN) 10 mg capsule 21.15 0984724 isosorbide mononitrate (IMDUR) exte 22.15 0984757 (PRANDIN) tablet - 0.5 44.00 0984773 (PULMICORT) 180 mcg/inh 2,218.30 0984799 DOCEtaxel (TAXOTERE) 80 mg Injectio 1,346.40 0984864 cephalexin (KEFLEX) 25 mg/mL Oral S 16.50 0985242 gabapentin (NEURONTIN) capsule - 40 2.95 0985259 promethazine-dextromethorphan (PHEN 10.85 0985275 repaglinide (PRANDIN) tablet - 2 mg 8.95 0985291 nevirapine (VIRAMUNE) tablet - 200 143.00 0985309 (ZyrTEC) 10 mg tablet 32.95 0985325 morphine (MS CONTIN) extended rele 24.75 0985333 lithium capsule - 150 mg 1.85 0985390 (LaMICtal) tablet - 100 3.05 0985408 metroNIDAZOLE (FLAGYL) 0.75% gel (4 2,255.25 0985416 pramipexole (MIRAPEX) tablet - 0.25 44.15 0985424 betamethasone-clotrimazole (LOTRISO 942.70 0985432 lactulose oral liquid - 20 gm/30 mL 39.35 0985523 norethindrone (AYGESTIN) 5 mg table 35.00 0985556 hydrochlorothiazide-losartan (HYZAA 33.05 0985572 sodium chloride (ALTACHLORE) 5% Oph 159.90 0985598 hepatitis B immune globulin (HYPERH 1,401.05 0985606 (WELLBUTRIN SR) 150 mg ex 9.30 0985655 diltiazem (TIAZAC) extended releas 8.05 0985671 venlafaxine (EFFEXOR XR) 37.5 mg Ca 49.40 0986059 acyclovir (ZOVIRAX) 400 mg tablet 8.55 0986067 ipratropium (ATROVENT) 0.06% Nasal 1,263.25 0986109 mycophenolate mofetil (CELLCEPT) ca 52.40 0986125 nadolol (CORGARD) tablet - 20 mg 61.55 0986133 dantrolene (DANTRIUM) injection - 2 1,283.05 0986141 dantrolene (DANTRIUM) 25 mg capsule 15.65 0986182 glycerin 80 % NEONATAL enema 0.2 mL 0.15 0986190 topotecan (HYCAMTIN) 4 mg Injection 2,162.20 0986208 hyoscyamine (LEVSIN) tablet - 0.125 11.25 0986224 SUMAtriptan (IMITREX) 50 mg tablet 331.90 0986240 terbinafine 1% (LamISIL AT) cream - 158.80 0986257 levoFLOXacin (LEVAQUIN) 250 mg tabl 194.40 0986265 levoFLOXacin (LEVAQUIN) 500 mg Inje 253.45 0986315 flunisolide 25 mcg/inh Nasal Spray 832.95 0986349 PARoxetine (PAXIL) 40 mg tablet 39.25 0986356 (PLENDIL) 10 mg Tablet - 37.50 0986364 tacrolimus (PROGRAF) 1 mg capsule 58.90 0986372 mercaptopurine (6-MP) tablet - 50 m 54.00 0986422 carbidopa-levodopa (SINEMET) 25 mg 16.75 0986448 diltiazem (TIAZAC) extended releas 35.40 0986471 valACYclovir (VALTREX) tablet - 500 95.40 0986919 leuprolide (LUPRON DEPOT) 3.75 mg D 11,555.80 0986927 amLODIPine (NORVASC) 2.5 mg tablet 21.05 0986984 felodipine (PLENDIL) 5 mg Tablet - 20.90 0987024 ammonium lactate 12% (AMLACTIN or L 503.20 0987032 SUMAtriptan (IMITREX) tablet - 25 357.10 0987040 raloxifene (EVISTA) tablet - 60 mg 58.75 0987156 octreotide (SandoSTATIN) injection 80.20 0987222 citalopram (CeleXA) 20 mg tablet 35.55 0987248 estradiol (CLIMARA) WEEKLY 0.1 mg/2 306.35 0987263 carvedilol (COREG) 12.5 mg tablet 27.75 0987271 fluticasone (CUTIVATE) 0.05% cream 293.65 0987313 tolterodine (DETROL) tablet - 2 mg 44.75 0987719 ethiodized oil (LIPIODOL) 48% Injec 16,175.30 0987735 ethyl chloride topical spray 455.40 0987743 fludarabine (FLUDARA) 50 mg Injecti 1,742.40 0987768 hydrocortisone 2.5% cream (30 gram) 152.90 0987826 levothyroxine (SYNTHROID) 137 mcg ( 8.85 0987842 metroNIDAZOLE 0.75% (FLAGYL) vagina 2,017.10 0987859 mometasone (NASONEX) 50 mcg/inh Nas 3,382.50 0987941 repaglinide (PRANDIN) tablet - 1 mg 8.95 0987958 mirtazapine (REMERON) 30 mg tablet 37.00 0988006 riTUXimab (RITUXAN) 100 mg Injectio 14,881.70 0988014 montelukast (SINGULAIR) tablet - 10 5.25 0988030 methimazole (TAPAZOLE) tablet - 5 7.95 0988048 diltiazem (TIAZAC) extended releas 5.75 0988055 diltiazem (TIAZAC) extended releas 31.00 0988063 tobramycin (TOBI) Inhalation Soluti 1,866.00 0988089 topiramate (TOPAMAX) 200 mg tablet 95.95 0988121 capecitabine (XELODA) 500 mg tablet 527.25 0988170 - (ZOSYN) inj 243.75 0988535 timolol hemihydrate (BETIMOL) 0.5% 1,067.65 0988543 azelastine (ASETELIN) 30 mL nasal s 1,389.20 0988550 brinzolamide 1% (AZOPT) ophthalmic 3,960.00 0988576 alteplase (ACTIVASE) 1 mg/mL (100 m 135,337.65 0988584 ethanol 98% Injection (5 mL) 2,167.35 0988592 aminocaproic acid (AMICAR) 500 mg t 295.75 0988600 anastrozole (ARIMIDEX) 1 mg tablet 27.40 0988642 emollient combination no. 10 (BIAFI 363.00 0988667 irinotecan (CAMPTOSAR) 100 mg 591.10 0988725 alteplase (CATH-FLO) 2 mg injection 1,992.85 0988733 simvastatin (ZOCOR) tablet - 20 mg 2.75 0988758 sodium hyaluronate (DUOVISC) ophtha 2,991.15 0988782 celecoxib (CeleBREX) capsule - 100 61.00 0988816 onabotulinumtoxinA (BOTOX) 100 unit 9,171.40 0988840 topiramate (TOPAMAX) tablet - 100 m 81.85 0988923 cadexomer iodine 0.9% (IODOFLEX GEL 515.35 0988949 baclofen (LIORESAL Intrathecal) 2 m 13,622.40 0988956 cadexomer iodine 0.9% (IODOSORB) to 1,809.20 0988972 lidocaine topical 5% (LIDODERM) pat 123.60 0989376 buPROPion (WELLBUTRIN) 75 mg table 19.20 0989384 buPROPion (WELLBUTRIN) 100 mg tabl 23.60 0989418 pioglitazone (ACTOS) tablet - 45 mg 124.35 0989426 enoxaparin (LOVENOX) injection - 6 188.90 0989434 enoxaparin (LOVENOX) injection - 8 251.90 0989442 enoxaparin (LOVENOX) injection - 10 315.00 0989459 oseltamivir (TAMIFLU) capsule - 75 204.05 0989517 (ZANAFLEX) 4 mg tablet 23.30 0989525 venlafaxine (EFFEXOR) 75 mg tablet 28.80 0989533 venlafaxine (EFFEXOR) 37.5 mg table 26.40 0989624 pioglitazone (ACTOS) tablet - 15 mg 16.65 0989640 calfactant (INFASURF) suspension 35 10,630.40 0989657 mupirocin 2% (BACTROBAN) ointment - 563.40 0989723 (INTEGRILIN) infusion 7,747.10 0989731 propofol (DIPRIVAN) injection - 10 165.00 0989798 dronabinol (MARINOL) 2.5 mg capsule 74.85 0990192 (TNKase) injection - 5 98,506.75 0990200 (AMBIEN) 5 mg tablet 23.20 0990218 (PLAVIX) 75 mg tablet 57.60 0990234 HYDROcodone-acetaminophen (NORCO) 16.00 0990259 oxyCODONE (OXY IR) 5 mg tablet 7.15 0990267 morphine (MS CONTIN) 60 mg Tablet - 43.70 0990275 oxyCODONE (OxyCONTIN) 40 mg Tablet 117.50 0990309 (ZYVOX) IVPB - 600 mg/D5W 1,585.50 0990481 (AMIDATE) injection - 2 m 98.50 0990499 pantoprazole (PROTONIX) injection - 103.00 0990572 vitamin B complex with vitamin C (T 0.40 0990598 budesonide (PULMICORT) inhalation s 125.25 0990614 FLUoxetine (PROzac) capsule - 20 mg 32.80 0990663 palivizumab (SYNAGIS) IM syringe - 23,267.65 0991026 tobramycin-dexamethasone (TOBRADEX) 862.10 0991042 caffeine citrate 20 mg/mL IV Syring 380.20 0991059 cefTRIAXone (ROCEPHIN) injection - 14.45 0991067 DOXOrubicin liposomal (DOXIL) 2 mg/ 38,373.20 0991117 ofloxacin (FLOXIN) 0.3% OTIC Soluti 243.45 0991125 lactobacillus rhamnosus (CULTURELLE 13.50 0991158 hydrALAZINE (APRESOLINE) 4 mg/mL Or 16.50 0991208 fluticasone 110 mcg (FLOVENT) MDI i 4,088.45 0991257 ciprofloxacin 0.3% (CILOXAN) ophtha 2,776.00 0991299 pamidronate (AREDIA) injection - 9 567.90 0991315 anagrelide (AGRYLIN) 0.5 mg capsule 147.40 0991331 entacapone (COMTAN) tablet - 200 mg 53.85 0991349 vitamin E capsule - 1,000 units (4 3.40 0991398 (INVANZ) injection - 1 gm 1,980.00 0991406 voriconazole (VFEND) 200 mg Injecti 2,024.90 0991430 risedronate (ACTONEL) 35 mg tablet 474.85 0991455 divalproex (DEPAKOTE ER) 500 mg ext 50.60 0991463 divalproex (DEPAKOTE ER) 250 mg ext 20.50 0991471 hydrochlorothiazide-triamterene (MA 14.70 0991489 tolterodine (DETROL LA) 4 mg Capsul 187.15 0991497 alendronate (FOSAMAX) 35 mg tablet 270.45 0991844 racepinephrine 2.25% inhalation sol 16.50 0991869 morphine injection - 2 mg/mL (1 m 28.95 0991885 acetaminophen-codeine (TYLENOL-CODE 19.65 0991901 fexofenadine (ALLEGRA) 180 mg table 32.10 0991935 loratadine-pseudoephedrine (CLARITI 14.40 0991943 ziprasidone (GEODON) 20 mg capsule 118.35 0991950 ziprasidone (GEODON) 40 mg capsule 44.10 0991968 ziprasidone (GEODON) 80 mg capsule 51.50 0991976 OLANZapine (ZyPREXA Zydis) oral dis 184.80 0991992 AQUAPHOR ORIGINAL FORMULA 396 gram 175.60 0992024 OLANZapine (ZyPREXA) tablet - 2.5 147.85 0992040 bleomycin 30 units (IRRIGATION) 1,461.00 0992065 PARoxetine (PAXIL CR) 12.5 mg Table 74.65 0992073 cyclophosphamide (CYTOXAN) 1 gram I 3,920.30 0992123 midazolam (VERSED) 10 mg/5 mL Syrup 60.75 0992131 alendronate (FOSAMAX) 70 mg tablet 270.30 0992149 fluconazole (DIFLUCAN) tablet - 15 183.90 0992156 budesonide (PULMICORT) inhalation s 73.70 0992164 verapamil (CALAN SR) extended relea 21.60 0992172 naproxen (NAPROSYN) tablet - 250 mg 10.30 0992206 sodium chloride (AYR SALINE NASAL G 40.70 0992214 acetaminophen (TYLENOL) 80 mg supp 10.60 0992222 cadexomer iodine 0.9% (IODOFLEX GEL 254.25 0992248 propofol (DIPRIVAN) injection - 10 475.20 0992255 cloZAPine (CLOZARIL) 25 mg tablet 17.45 0992263 benzocaine dental (ORAJEL) 10% GEL 62.10 0992305 Helistat Sponge 3 x 4 2,065.15 0992339 (ARIXTRA) 2.5 mg/0.5 m 761.65 0992388 clindamycin (CLEOCIN) IVPB - 900 mg 239.20 0992396 perflutren lipid microspheres (DEFI 857.65 0992412 hepatitis A (HAVRIX) 1440 units/mL 1,099.90 0992453 celecoxib (CeleBREX) capsule - 200 100.05 0992487 acetylcysteine 20% (ACETADOTE) 30 m 2,376.00 0992503 levoFLOXacin (LEVAQUIN) IVPB - 250 114.20 0992511 meloxicam (MOBIC) tablet - 7.5 mg 40.90 0992529 modafinil (PROVIGIL) 200 mg tablet 440.00 0992545 simvastatin (ZOCOR) 5 mg tablet 3.25 0992552 fentaNYL (DURAGESIC) patch 12 mcg/ 268.00 0992560 HYDROmorphone (DILAUDID) 6 mg/30 mL 110.75 0992578 meloxicam (MOBIC) tablet - 15 mg 2.80 0992586 cyanocobalamin (VITAMIN B-12) 1,000 4.70 0992594 salmeterol (SEREVENT) DISKUS - 50 m 3,016.75 0992602 simvastatin (ZOCOR) 10 mg tablet 2.40 0992685 simvastatin (ZOCOR) tablet - 40 mg 2.75 0992719 megestrol (MEGACE) oral liquid - 40 59.80 0992727 simvastatin (ZOCOR) 80 mg tablet 6.55 0992735 silver hydrogel (SILVASORB) gel (45 403.40 0992743 sorbitol 70% Cup 30 mL 24.60 0992768 ibuprofen (MOTRIN) oral liquid - 10 11.50 0992784 (TYGACIL) injection - 5 2,471.05 0992792 triamcinolone (NASALCORT AQ) 55 mcg 217.15 0992842 DOBUTamine 500 mg/250 mL D5W infusi 195.80 0992859 lidocaine (LMX) 4% cream (5 gram) 87.15 0992909 DOPamine 400 mg/250 mL D5W infusion 206.20 0992917 methotrexate 1 gram Injection - Pre 576.05 0992958 aspirin-dipyridamole (AGGRENOX) 25 110.30 0992974 thyrotropin alpha (THYROGEN) 1.1 mg 25,908.55 0992982 (KEPPRA) 100 mg/mL (5 70.30 0993014 DOBUTamine 32 mg in Dextrose 5% 20 147.85 0993022 metoprolol (LOPRESSOR) 25 mg tablet 3.20 0993048 levOCARNitine (CARNITOR) 100 mg/mL 16.50 0993063 heparin 10 units/mL Flush Injection 9.55 0993071 DOBUTamine 64 mg in Dextrose 5% 20 295.70 0993139 DOPamine 32 mg in Dextrose 5% 20 mL 137.30 0993196 DOPamine 64 mg in Dextrose 5% 20 mL 137.30 0993212 pegaspargase (ONCASPAR) 750 units/m 213,312.00 0993261 sodium hyaluronate (HEALON 5) ophth 1,884.30 0993287 haemophilus b conjugate (ActHIB) va 176.70 0993311 desmopressin (DDAVP) nasal spray - 65.05 0993329 lidocaine 0.5% (XYLOCAINE) 50 mL In 87.80 0993337 lidocaine-EPINEPHrine 1%-1:100,000 56.40 0993345 esmolol (BREVIBLOC) 2,500 mg/250 mL 3,687.20 0993360 (ANGIOMAX) 250 mg injec 15,170.00 0993378 (ZONEGRAN) 100 mg capsul 22.75 0993386 bupivacaine 0.25% injection (50 mL) 46.10 0993394 diphenhydrAMINE 2% (BENADRYL) cream 52.70 0993402 caffeine with sodium benzoate 500 m 303.40 0993436 calcitonin (MIACALCIN) nasal spray 1,564.75 0993444 lidocaine-EPINEPHrine 0.5%-1:200,00 97.05 0993469 erythromycin 0.5% ophthalmic ointme 163.85 0993485 memantine (NAMENDA) tablet - 5 mg 12.60 0993493 triamcinolone acetonide (KENALOG 40 686.40 0993501 bupivacaine 0.5% injection - 50 mL 37.65 0993519 enoxaparin (LOVENOX) injection - 3 94.55 0993527 ondansetron (ZOFRAN ODT) orally dis 294.25 0993543 iron sucrose (VENOFER) 20 mg/mL (5 792.00 0993568 bupivacaine 0.5%-EPINEPHrine 1:200, 228.10 0993576 metoprolol (TOPROL XL) 25 mg extend 16.40 0993584 escitalopram (LEXAPRO) 10 mg tablet 57.85 0993634 oxybutynin (DITROPAN XL) extended r 36.20 0993683 diltiazem (CARDIZEM) 5 mg/mL (10 mL 89.80 0993691 oxybutynin (DITROPAN XL) extended r 43.50 0993709 ziprasidone (GEODON) 20 mg/mL Injec 744.50 0993717 levoFLOXacin (LEVAQUIN) IVPB - 750 98.90 0993725 piperacillin-tazobactam (ZOSYN) inj 308.70 0993741 lidocaine 2% (XYLOCAINE MPF) injec 42.25 0993774 levoFLOXacin (LEVAQUIN) 750 mg tabl 324.95 0993782 ketoconazole 2% cream (30 gram) 1,336.50 0993790 ezetimibe (ZETIA) tablet - 10 mg 163.65 0993808 lidocaine 0.5% (XYLOCAINE MPF) 50 m 199.35 0993816 albuterol 0.042% 1.25 mg/3 mL inhal 21.95 0993824 sterile water for injection - 100 m 3.50 0993840 risperiDONE (RISPERDAL) 0.5 mg tabl 56.40 0993857 (LYRICA) capsule - 25 mg 21.35 0993899 hyaluronidase (AMPHADASE/HYLENEX) i 883.90 0993907 lamoTRIgine (LaMICtal) tablet - 25 2.70 0993915 pregabalin (LYRICA) capsule - 50 mg 21.35 0993931 albuterol 0.5% 2.5 mg/0.5 mL inhala 11.90 0993949 calcium carbonate (TUMS) 500 mg (2 0.90 0993956 tetracaine (PONTOCAINE) 1% Injectio 1,201.60 0993964 trypan blue ophthalmic (VISION BLUE 528.00 0993972 pregabalin (LYRICA) capsule - 75 mg 21.35 0993998 clindamycin (CLEOCIN) IVPB - 600 mg 195.90 0994525 octreotide (SandoSTATIN) injection 157.45 0994541 vancomycin IVPB - 1 gm/D5W 200 mL 365.00 0994558 nystatin oral liquid - 500,000 unit 13.35 0994566 cefTRIAXone (ROCEPHIN) 1 gram in D5 681.15 0994574 ciprofloxacin (CIPRO) IVPB - 400 mg 68.65 0994590 busPIRone (BUSPAR) 15 mg tablet 26.70 0994624 DOCEtaxel (TAXOTERE) 20 mg Injectio 3,168.00 0994665 III (THROMBATE III) 50 30,756.00 0994681 piperacillin-tazobactam (ZOSYN) IVP 241.70 0994707 labetalol (TRANDATE) 5 mg/mL (4 mL) 117.15 0994723 sodium chloride 0.9% (SALINE FLUSH) 3.65 0994749 piperacillin-tazobactam (ZOSYN) IVP 362.65 0994756 FLUoxetine (PROzac) 4 mg/mL Oral Sy 16.50 0994764 magnesium hydroxide (MOM) oral liqu 34.85 0994780 cromolyn (NASALCROM) Nasal Spray 26 170.25 0994806 piperacillin-tazobactam (ZOSYN) IVP 459.50 0994814 furosemide (LASIX) 10 mg/mL Oral S 16.50 0994822 estradiol (CLIMARA) WEEKLY 0.05 mg/ 199.50 0994830 tolterodine (DETROL) 1 mg tablet 43.70 0994855 ropivacaine (NAROPIN) 0.5% injecti 447.00 0994871 haloperidol (HALDOL) 2 mg/mL Oral S 16.50 0994897 venlafaxine (EFFEXOR XR) 150 mg Cap 9.30 0994913 chloroprocaine (NESACAINE MPF) 3% i 353.80 0994939 naproxen (NAPROSYN) 25 mg/mL Oral S 33.40 0994954 zidovudine (RETROVIR) 300 mg tablet 79.45 0994962 temozolomide (TEMODAR) 20 mg capsul 759.75 0994970 (TEKTURNA) 150 mg tablet 103.15 0994996 nevirapine (VIRAMUNE) 10 mg/mL Oral 16.50 0995027 adenosine (ADENOSCAN) 3 mg/mL (20 m 2,059.20 0995035 arformoterol (BROVANA) 15 mcg/2 mL 199.60 0995043 acyclovir (ZOVIRAX) 40 mg/mL Oral S 16.50 0995050 nystatin 100,000 units/mL Oral Syri 16.50 0995076 ZOLMitriptan (ZOMIG) 2.5 mg tablet 661.70 0995084 ferric subsulfate (MONSELS SOLUTION 188.40 0995100 cetirizine (ZyrTEC) 1 mg/mL Oral S 16.50 0995118 oxybutynin (DITROPAN) 1 mg/mL Oral 16.50 0995134 (NIASPAN) extended release t 75.75 0995142 carvedilol (COREG) 3.125 mg tablet 27.75 0995167 azithromycin (ZITHROMAX) 40 mg/mL 16.50 0995175 penicillin V potassium (PEN VK) 50 16.50 0995183 albuterol (PROAIR or VENTOLIN HFA) 349.30 0995217 rabies vaccine (RABAVERT) purified 5,338.10 0995225 azithromycin (ZITHROMAX) 20 mg/mL 39.50 0995233 propranolol (INDERAL) 4 mg/mL Oral 16.50 0995282 caffeine citrate 20 mg/mL Oral Syri 380.20 0995316 ciprofloxacin 0.2%-hydrocortisone 1 3,756.60 0995324 lidocaine topical 2% (XYLOCAINE) vi 14.30 0995340 calcitriol (ROCALTROL) 1 mcg/mL Ora 157.50 0995357 risperiDONE (RISPERDAL) 1 mg/mL Ora 67.05 0995373 clindamycin (CLEOCIN) 2% vaginal cr 1,188.70 0995381 budesonide (ENTOCORT) 3 mg Capsule 273.65 0995399 dextrose 40% (GLUTOSE 15) oral gel 52.15 0995407 calcium carbonate [Elem Ca = 100 mg 16.50 0995415 amoxicillin-clavulanate (AUGMENTIN) 16.50 0995423 sucralfate (CARAFATE) oral liquid - 132.80 0995449 phenylephrine (NEO-SYNEPHRINE) 10 m 363.00 0995464 (SUPRAX) 20 mg/mL Oral Syr 58.80 0995472 cephalexin (KEFLEX) 50 mg/mL Oral S 16.50 0995480 voriconazole (VFEND) 200 mg tablet 412.85 0995498 temazepam (RESTORIL) 7.5 mg capsule 62.45 0995506 selenium 40 mcg/mL Injection (10 mL 35.40 0995514 levoFLOXacin (LEVAQUIN) IVPB - 500 96.40 0995522 chlorothiazide (DIURIL) 50 mg/mL Or 16.50 0995555 carbidopa-levodopa (SINEMET CR) 25 12.30 0995563 citalopram (CeleXA) 10 mg tablet 32.05 0995571 estradiol (ESTRACE) tablet - 0.5 mg 7.30 0995589 cimetidine (TAGAMET) 60 mg/mL Oral 16.50 0995597 ferrous sulfate drops 15 mg/mL Oral 16.50 0995605 permethrin (RID or NIX) 1% lotion ( 7,682.40 0995613 sodium iodide 100 mcg/mL Injection 106.95 0995647 ciprofloxacin (CIPRO) 100 mg/mL Ora 19.05 0995654 levETIRAcetam (KEPPRA) 100 mg/mL Or 18.35 0995662 carBAMazepine (TEGRETOL) 200 mg/10 60.10 0995670 sodium thiosulfate injection - 250 1,283.05 0995704 atovaquone (MEPRON) 750 mg/5 mL ora 545.20 0995712 gabapentin (NEURONTIN) tablet - 600 10.50 0995720 predniSONE 5 mg/5 mL Cup 14.80 0995738 cefTRIAXone (ROCEPHIN) 2 gram in D5 1,192.65 0995795 azelastine (OPTIVAR) 0.05% 6 mL oph 1,358.30 0995803 estradiol (ESTRACE) 0.01% vaginal c 1,436.20 0995829 rOPINIRole (REQUIP) tablet - 2 mg 33.00 0995845 azithromycin (ZITHROMAX) 600 mg tab 246.60 0995852 betamethasone-clotrimazole (LOTRISO 2,209.70 0995860 triamcinolone (KENALOG) 0.1% cream 167.95 0995886 clarithromycin (BIAXIN) 50 mg/mL Or 16.50 0995902 QUEtiapine (SEROquel) tablet - 100 7.95 0995944 clindamycin palmitate (CLEOCIN) 15 16.50 0995969 QUEtiapine (SEROquel) tablet - 25 4.60 0995985 triamcinolone (KENALOG) 0.025% crea 58.65 0996009 cycloSPORINE (SandIMMUNE) 100 mg/mL 99.95 0996025 atorvastatin (LIPITOR) 40 mg tablet 9.15 0996033 naphazoline-pheniramine (NAPHCON-A) 116.45 0996066 cycloSPORINE (NEORAL) 100 mg/mL MOD 79.10 0996074 fenofibrate (TRICOR) 48 mg tablet 25.25 0996082 escitalopram (LEXAPRO) 20 mg tablet 60.35 0996090 olopatadine (PATANOL) 0.1% Ophthalm 3,385.80 0996124 digoxin (LANOXIN) 50 mcg/mL Oral S 37.00 0996132 clopidogrel (PLAVIX) 300 mg tablet 254.30 0996140 cefuroxime (CEFTIN) 250 mg tablet 66.85 0996165 ferrous sulfate oral liquid - 300 m 7.55 0996181 ergocalciferol (VITAMIN D) 8,000 un 22.05 0996199 fluocinolone (SYNALAR) 0.01% cream 587.70 0996207 (CEFZIL) 250 mg tablet 57.85 0996223 digoxin (LANOXIN) 125 mcg/ 2.5 mL E 81.85 0996249 erythromycin ethylsuccinate (EES) 4 59.55 0996256 ursodiol (ACTIGALL) 25 mg/mL Oral S 16.50 0996264 carvedilol (COREG) 25 mg tablet 27.75 0996272 coagulation factor VIIA recombinant 63,360.00 0996280 docusate sodium (COLACE) oral liqui 9.30 0996306 erythromycin ethylsuccinate (EES) 8 28.80 0996314 lisinopril (ZESTRIL) tablet - 40 m 2.25 0996355 coagulation factor VIIA recombinant 26,400.00 0996389 aprepitant (EMEND) 40 mg capsule 1,451.20 0996397 (CARDENE) 2.5 mg/mL (10 319.05 0996421 80 mg/15 mL CUP 165.35 0996447 100 mg/mL (10 mL) I 329.35 0996470 ipratropium 0.02% (ATROVENT) inhala 24.40 0996488 Surgicel 2 x 14 gauze 1,118.25 0996496 Surgicel 4 x 8 gauze 1,215.80 0996504 Surgicel 2 x 3 gauze 774.90 0996538 lactase (LACTAID ORIGINAL) 3000 uni 1.75 0996546 COSEAL Surgical Sealant 4 mL 7,326.40 0996553 FLOSEAL Hemostatic Matrix 10 mL 6,626.05 0996561 FLOSEAL Hemostatic Matrix 5 mL 3,621.70 0996587 OLANZapine (ZYPREXA) 5 mg/mL Inject 547.80 0996595 fenofibrate (TRICOR) 145 mg tablet 68.00 0996603 levETIRAcetam (KEPPRA) tablet - 500 41.80 0996611 famotidine (PEPCID) 8 mg/mL Oral Sy 46.75 0996629 immune globulin (PRIVIGEN) 10% 10 g 21,542.40 0996637 sealant (TISSEEL DUPLOJECT) 2,415.35 0996660 phenol topical 89% swab 62.85 0996678 topiramate (TOPAMAX) 25 mg Sprinkle 38.60 0996686 dextromethorphan/guaifenesin/phenyl 46.75 0996694 (CUBICIN) injection - 50 7,056.50 0996728 rOPINIRole (REQUIP) tablet - 0.25 m 33.00 0996736 rOPINIRole (REQUIP) 0.5 mg tablet 33.00 0996744 ARIPiprazole (ABILIFY) 10 mg tablet 420.75 0996751 sildenafil (VIAGRA) 25 mg tablet 877.35 0996769 sildenafil (VIAGRA) 50 mg tablet 877.35 0996777 sildenafil (VIAGRA) 100 mg tablet 175.45 0996793 atazanavir (REYATAZ) 300 mg capsule 290.40 0996801 abacavir (ZIAGEN) 300 mg tablet 132.55 0996843 sodium chloride 0.9% solution for i 2.10 0996850 acetaminophen-traMADol (ULTRACET) 3 12.70 0996868 linezolid (ZYVOX) tablet - 600 mg 2,415.60 0996884 fluorometholone (FML FORTE) 0.25% O 356.15 0996892 conjugated estrogens (PREMARIN) 0.9 29.05 0996900 tobramycin 10 mg/mL IV Syringe 49.50 0996918 felodipine (PLENDIL) 2.5 mg Tablet 20.90 0996926 lopinavir-ritonavir (KALETRA) 200-5 92.65 0996942 methadone 0.5 mg/mL Oral Syringe 16.50 0996959 levothyroxine (SYNTHROID) 175 mcg ( 10.65 0996975 bevacizumab (AVASTIN) 100 mg Inject 9,642.10 0996983 loratadine (CLARITIN) 5 mg/5 mL Cup 4.70 0996991 PEMEtrexed (ALIMTA) 500 mg Injectio 38,771.70 0997031 alteplase (ACTIVASE) 10 mg/D5W 20 m 28,393.20 0997056 permethrin 5% (ELIMITE) cream - 60 386.10 0997072 LORazepam (ATIVAN) 2 mg/mL Oral Sy 20.50 0997098 calcium chloride 20 mg/mL IV Syring 49.50 0997114 phenylephrine (LITTLE NOSES) 0.125% 47.75 0997122 calcium GLUCONATE 100 mg/ml Oral Sy 16.50 0997148 EPINEPHrine PF 1 mg/mL (1 mL) injec 231.00 0997155 doxapram (DOPRAM) 1 mg/mL (diluted) 49.50 0997171 potassium chloride IVPB - 10 mEq/50 79.35 0997189 doxapram (DOPRAM) 20 mg in Dextrose 2,640.00 0997197 nafcillin 40 mg/mL IV Syringe 49.50 0997213 folic acid 100 mcg/mL IV Syringe 49.50 0997221 metFORMIN (GLUCOPHAGE XR) 500 mg Ta 11.30 0997239 potassium chloride IVPB - 20 mEq/50 79.40 0997247 insulin REGULAR 1 unit/mL IV Syring 49.50 0997254 ceFAZolin (ANCEF) 330 mg/mL IM Syri 49.50 0997262 morphine preservative free 1 mg in 132.00 0997270 isoniazid 10 mg/mL Oral Syringe 16.50 0997287 EPINEPHrine 0.3 mg in Dextrose 5% 1 132.00 0997304 pramipexole (MIRAPEX) tablet - 0.5 44.15 0997312 (REMICADE) 100 mg inject 16,179.55 0997320 fentaNYL 100 mcg in Dextrose 5% 10 132.00 0997338 levOCARNitine (CARNITOR) 200 mg/mL 105.60 0997353 pramipexole (MIRAPEX) tablet - 1 mg 44.15 0997395 milrinone (PRIMACOR) 4,000 mcg in D 3,730.35 0997411 sildenafil (REVATIO) tablet - 20 mg 18.45 0997429 PF 2,000 units/mL IV S 505.55 0997445 DOBUTamine 16 mg in Dextrose 5% 10 132.00 0997452 milrinone (PRIMACOR) 200 mcg/mL IV 49.50 0997460 morphine 20 mg/5 mL CUP 9.45 0997478 famotidine 20 mg in 50 mL NaCl 0.9% 86.50 0997494 tobramycin SUBCONJUNCTIVAL Injectio 49.50 0997502 DOPamine 16 mg in Dextrose 5% 10 mL 132.00 0997510 octreotide (SandoSTATIN) 10 mcg/mL 52.80 0997536 calcium-vitamin D (CITRACAL+D3) 315 2.85 0997544 influenza PF vaccine (FLUARIX) - 0. 272.10 0997551 TPN - Pediatric 669.70 0997569 triamcinolone ophthalmic (TRIESENCE 2,140.80 0997577 octreotide 200 mcg in Dextrose 5% 2 21,120.00 0997593 edetate disodium (EDTA) 150 mg/mL I 219.15 0997601 ceFAZolin SUBCONJUNCTIVAL Injection 49.50 0997619 levothyroxine (SYNTHROID) 20 mcg/mL 49.50 0997627 regadenoson (LEXISCAN) injection - 3,556.10 0997635 potassium PHOSPHATE 0.05 mmol/mL PE 49.50 0997650 fluconazole (DIFLUCAN) 40 mg/mL Or 48.15 0997668 cefTRIAXone (ROCEPHIN) 350 mg/mL in 198.00 0997676 enalaprilat (VASOTEC) 25 mcg/mL IV 49.50 0997692 potassium PHOSPHATE 0.12 mmol/mL CE 49.50 0997700 multivitamin with iron and fluoride 260.70 0997718 mupirocin 2% (BACTROBAN) cream - 15 2,342.35 0997726 azithromycin (ZITHROMAX) 2 mg/mL I 49.50 0997734 (ACOVA) 1,000 mcg/mL IV 83.20 0997783 ampicillin 250 mg/mL IM syringe 49.50 0997791 argatroban (ACOVA) 100 mg/mL (2.5 m 7,920.00 0997809 sodium ACETATE 0.45% 1,000.00 0997841 digoxin (LANOXIN) 10 mcg/mL IV Syri 173.45 0997866 verapamil (CALAN) 50 mg/mL Oral Syr 16.50 0997874 pyridoxine (Vitamin B6) 100 mg/mL I 49.50 0997882 NICU Admission TPN D5W 250 mL bag 669.70 0997890 posaconazole (NOXAFIL) 40 mg/mL Ora 112.95 0997932 sodium PHOSPHATE 0.05 mmol/mL PERIP 49.50 0997957 isosorbide mononitrate (ISMO) table 11.25 0997965 labetalol 20 mg in Dextrose 20 mL I 264.00 0997981 gentamicin IRRIGATION 21.15 0997999 sodium PHOSPHATE 0.12 mmol/mL CENTR 49.50 0998005 (TRILEPTAL) tablet - 36.40 0998021 cefotaxime (CLAFORAN) 300 mg/mL IM 49.50 0998039 sulfamethoxazole-trimethoprim (BACT 49.50 0998047 alteplase (ACTIVASE) 1 mg/mL (0.5 m 648.40 0998054 vecuronium (NORCURON) 1 mg/mL IV Sy 49.50 0998062 acetaZOLAMIDE (DIAMOX) 100 mg/mL IV 69.45 0998088 EPINEPHrine 0.6 mg in Dextrose 5% 2 396.00 0998096 ibuprofen lysine (NEOPROFEN) 5 mg/m 14,454.00 0998104 midazolam (VERSED) 4 mg in Dextrose 49.50 0998112 acyclovir (ZOVIRAX) 7 mg/mL IV Syri 49.50 0998120 ceFAZolin (ANCEF) 20 mg/mL IV Syri 49.50 0998138 EPINEPHrine 1.2 mg in Dextrose 5% 2 792.00 0998146 imipenem-cilastatin (PRIMAXIN) 5 mg 49.50 0998153 morphine preservative free 10 mg in 126.75 0998161 allopurinol (ZYLOPRIM) 20 mg/mL Or 16.50 0998187 erythromycin lactobionate 5 mg/mL I 49.50 0998195 indomethacin (INDOCIN) 0.5 mg/mL IV 4,422.00 0998203 morphine preservative free 2 mg in 150.50 0998211 alprostadil (PGE-1) 500 mcg/D5W 25 42,900.00 0998229 cefotaxime (CLAFORAN) 50 mg/mL IV 49.50 0998245 insulin REGULAR 2 units in Normal S 580.80 0998260 alprostadil (PGE-1) 500 mcg/D5W 50 85,800.00 0998278 cefOXitin (MEFOXIN) 40 mg/mL IV Syr 49.50 0998286 fat emulsion (INTRALIPID) 20% IV Sy 49.50 0998302 penicillin aqueous crystalline 100, 49.50 0998310 amikacin 5 mg/mL IV Syringe 49.50 0998336 fentaNYL 200 mcg in Dextrose 5% 20 646.80 0998351 phenytoin (DILANTIN) 10 mg/mL IV Sy 49.50 0998377 cefTAZidime (FORTAZ) ophthalmic 200 138.10 0998419 aminophylline 5 mg/mL IV Syringe 49.50 0998427 cefTAZidime (FORTAZ) ophthalmic 22. 138.10 0998435 flecainide (TAMBOCOR) 20 mg/mL Oral 16.50 0998476 cefTRIAXone (ROCEPHIN) 40 mg/mL IV 49.50 0998484 fluconazole (DIFLUCAN) 2 mg/mL IV 49.50 0998492 lisinopril (ZESTRIL) 2 mg/mL Oral S 16.50 0998500 piperacillin-tazobactam 50 mg/ml (o 49.50 0998518 amiodarone (PACERONE) 5 mg/mL Oral 16.50 0998526 cefuroxime (ZINACEF) 30 mg/mL IV Sy 49.50 0998534 flucytosine (ANCOBON) 10 mg/mL Oral 16.50 0998542 MCT (Medium Chain Triglycerides) Oi 16.50 0998559 potassium chloride 0.08 mEq/mL PER 49.50 0998567 amphotericin B conventional (FUNGIZ 49.50 0998575 chlorothiazide (DIURIL) 28 mg/mL IV 174.90 0998583 folic acid 1,000 mcg/mL Oral Syring 16.50 0998591 (MERREM) 20 mg/mL IV Syri 49.50 0998609 potassium chloride 0.2 mEq/mL CENTR 49.50 0998617 amphotericin B conventional (FUNGIZ 49.50 0998625 ciprofloxacin (CIPRO) 2 mg/mL IV Sy 49.50 0998641 metoclopramide (REGLAN) 1 mg/mL Ora 16.50 0998674 clindamycin (CLEOCIN) 10 mg/mL IV S 49.50 0998682 furosemide (LASIX) 2 mg/mL IV Syrin 49.50 0998690 metoclopramide (REGLAN) 1 mg/mL IV 49.50 0998716 amphotericin B conventional ophthal 323.40 0998724 dexamethasone (DECADRON) 0.1 mg/mL 16.50 0998732 furosemide (LASIX) 10 mg/mL IV Syri 49.50 0998765 amphotericin B conventional ophthal 323.40 0998773 dexamethasone (DECADRON) ophthalmic 15.45 0998781 ganciclovir (CYTOVENE) 10 mg/mL IV 49.50 0998799 metolazone (ZAROXOLYN) 1 mg/mL Oral 16.50 0998807 propranolol (INDERAL) 0.1 mg/mL IV 49.50 0998815 ampicillin-sulbactam (UNASYN) 30 mg 49.50 0998823 dexamethasone (DECADRON) ophthalmic 30.90 0998831 hyaluronidase (HYLENEX) 15 units/mL 176.80 0998856 propylthiouracil (PTU) 5 mg/mL Oral 16.50 0998864 atenolol (TENORMIN) 2 mg/mL Oral S 16.50 0998872 digoxin (LANOXIN) 100 mcg/mL IV Syr 1,734.50 0998880 hydrochlorothiazide-spironolactone 16.50 0998898 metroNIDAZOLE (FLAGYL) 5 mg/mL IV S 49.50 0998906 pyrazinamide 100 mg/mL Oral Syringe 16.50 0998914 aztreonam (AZACTAM) 20 mg/mL IV Sy 49.50 0998922 diltiazem (CARDIZEM) 1 mg/mL IV Syr 49.50 0998948 metroNIDAZOLE (FLAGYL) 15 mg/mL Ora 16.50 0998955 pyrimethamine (DARAPRIM) 2 mg/mL Or 16.50 0998963 calcium GLUCONATE 50 mg/mL IV Syri 49.50 0998997 midazolam (VERSED) 2 mg in Dextrose 49.50 0999011 carvedilol (COREG) 1.67 mg/mL Oral 16.50 0999029 enalapril (VASOTEC) in Orasweet 1 m 16.50 0999045 midazolam (VERSED) 2 mg/mL Oral Syr 16.50 0999060 rifampin (RIFADIN) 10 mg/mL Oral Sy 16.50 0999078 risperiDONE (RISPERDAL) tablet - 0. 47.30 0999086 acetic acid topical 0.25% 1000 mL i 79.20 0999094 clotrimazole (MYCELEX) oral lozenge 21.25 0999102 griseofulvin (GRIS-PEG) ultramicroc 96.90 0999110 rifampin (RIFADIN) 6 mg/mL IV Syrin 49.50 0999128 rivastigmine (EXELON) 1.5 mg capsul 56.05 0999136 amantadine (SYMMETREL) 10 mg/mL Or 16.50 0999193 SPOT Endoscopic Marker 441.45 0999219 sotalol (BETAPACE) 5 mg/mL Oral Syr 16.50 0999227 sertraline (ZOLOFT) tablet - 25 mg 5.35 0999243 cysteine 50 mg/mL Injection (10 mL) 77.00 0999276 atropine 0.05 mg/mL Oral Syringe 16.50 0999284 amphotericin B conventional ophthal 323.40 0999292 mexiletine (MEXITIL) 10 mg/mL Oral 16.50 0999318 sulfamethoxazole-trimethoprim (BACT 16.50 0999326 sodium bicarbonate 150 mEq in 1000 168.85 0999334 lansoprazole (PREVACID) 3 mg/mL Or 16.50 0999342 dexamethasone (DECADRON) ophthalmic 123.60 0999375 sodium bicarbonate 8.4% IVPB (50 mL 12.30 0999383 methimazole (TAPAZOLE) 3 mg/mL Oral 16.50 0999425 sodium chloride 4 meq/mL (23.4%) Or 0.70 0999441 dimercaprol (BAL in Oil) 10% Inject 1,501.65 0999458 (CORVERT) injection - 0.1 7,163.95 0999466 vancomycin ophthalmic 10 mg/mL 0.6 132.00 0999474 sodium hypochlorite (DAKIN QUARTER 143.65 0999482 bortezomib (VELCADE) 1 mg/mL Inject 25,391.30 0999490 diphtheria/pertussis/tetanus/hep B/ 1,060.80 0999508 imatinib (GLEEVEC) 100 mg tablet 1,334.95 0999516 vancomycin ophthalmic 50 mg/mL 0.5 132.00 0999532 brompheniramine-pseudoephedrine (Q- 59.20 0999557 -2b (INTRON A) 10 Mi 13,436.45 0999565 vecuronium (NORCURON) 20 mg in Dext 1,848.00 0999599 enalapril (VASOTEC) tablet - 2.5 m 19.25 0999607 iodine 5%-potassium iodide 10% (LUG 278.80 0999615 zidovudine (RETROVIR) 10 mg/mL Oral 16.50 0999623 SUMAtriptan (IMITREX) tablet - 100 331.90 0999631 carBAMazepine (TEGRETOL) 100 mg ext 8.00 0999672 tacrolimus (PROGRAF) injection - 5 2,613.80 0999680 ceFAZolin (ANCEF) IVPB - 1 gm/D5W 5 71.00 0999698 famciclovir (FAMVIR) 250 mg tablet 83.45 0999706 (STROMECTOL) tablet - 3 65.60 0999730 (MAXIPIME) injection - 1 g 268.45 0999755 lamiVUDine (EPIVIR) tablet - 150 mg 94.45 0999771 tolterodine (DETROL LA) 2 mg Capsul 178.95 0999789 cefprozil (CEFZIL) 50 mg/ mL Oral S 16.50 0999797 fulvestrant (FASLODEX) 250 mg/5 mL 14,397.60 0999805 levETIRAcetam (KEPPRA) tablet - 750 4.55 0999813 pyridostigmine (MESTINON) tablet - 7.95 0999821 triamcinolone (KENALOG) 0.5% cream 133.50 0999839 cefTAZdime (FORTAZ) ophthalmic 50 m 138.10 0999847 (RAZADYNE) tablet - 4 m 42.05 0999854 lidocaine 1% (XYLOCAINE MPF) 30 mL 101.55 0999862 pyrimethamine (DARAPRIM) 25 mg tabl 10,890.00 0999870 valGANciclovir (VALCYTE) tablet - 4 2,019.60 0999888 (PLETAL) 50 mg tablet 25.45 0999904 lidocaine 2% (XYLOCAINE MPF) injec 35.05 0999912 RHo (D) immune globulin (WINRHO SDF 82,022.45 0999920 vancomycin ophthalmic 50 mg/mL FORT 92.40 0999938 citric acid-potassium citrate (POLY 10.45 0999961 (XIFAXAN) tablet - 200 mg 232.85 0999979 varicella (VARIVAX) injection - 0.5 1,703.60 0999987 clobetasol 0.05% (TEMOVATE) 15 gm c 380.00 1000041 sodium chloride 0.9% 1000 mL LVP 128.85 1000058 lactated ringers LVP - 1000 mL 128.85 1000066 dextrose 5%-NaCl 0.45% LVP - 1000 m 128.85 1000082 dextrose 10% IVPB - 250 mL 128.85 1000124 dextrose 50% 500 mL 128.85 1000165 sodium chloride 0.9% irrigation - 1 79.20 1000181 sodium chloride 0.45% 1000 mL LVP 128.85 1000199 sodium chloride 0.9% 500 mL IVPB 128.85 1000207 sodium chloride 0.9% 250 mL IVPB 128.85 1000231 dextrose 5% 1000 mL LVP 128.85 1000348 sterile water for irrigation - 1000 128.85 1000363 dextrose 5% 500 mL IVPB 128.85 1000371 dextrose 5% 250 mL IVPB 128.85 1000413 Cell Saver 128.85 1000454 dextrose 5%-NaCl 0.225% LVP - 1000 128.85 1000579 TPN - Neonatal 669.70 1000587 calcium chloride 100 mg/mL Injectio 306.15 1000611 potassium chloride injection - 2 mE 31.70 1000751 Drug Diluent 0.01 1000751 sterile water for injection - 10 mL 13.90 1000884 low molecular weight dextran 10% in 349.80 1000918 albumin human 25% 20 mL injection 366.20 1000934 sodium chloride 0.9% 100 mL IVPB 128.85 1001007 sterile water for irrigation - 1000 92.40 1001064 folic acid injection - 5 mg/mL (10 714.65 1001080 dextrose 5%-lactated ringers LVP - 128.85 1001114 potassium PHOSPHATE injection - 3 m 166.35 1001148 dextrose 5% 50 mL IVPB 128.85 1001189 dextrose 5%-NaCl 0.9% LVP - 1000 mL 128.85 1001197 dextrose 5% 100 mL IVPB 128.85 1001239 sodium chloride 0.9% 50 mL IVPB 128.85 1001999 TPN - Adult 1,053.80 1002203 sodium chloride 0.9% irrigation - 3 118.80 1002286 dexrazoxane (ZINECARD) 500 mg Injec 6,320.20 1003300 sodium chloride 3% (HYPERTONIC SALI 128.85 1003326 electrolyte (PLASMA-LYTE A / NORMOS 128.85 1003375 dextrose 5%-0.225% NaCl 250 mL 128.85 1003383 lactated ringers LVP - 500 mL 128.85 1003391 dextrose 5%-lactated ringers 500 mL 128.85 1003409 dextrose 10% LVP - 1000 mL 128.85 1003417 dextrose 5%-NaCl 0.45% IVPB - 500 m 128.85 1003425 dextrose 5%-NaCl 0.9% IVPB - 500 mL 128.85 1003433 dextrose 5%-NaCl 0.225% IVPB - 500 128.85 1003441 NICU Admission TPN D10W 250 mL bag 669.70 1003508 sodium chloride 0.45%-KCl 20 mEq LV 128.85 1003516 sodium chloride 0.45% 250 mL IVPB 128.85 1003540 dextrose 5%-NaCl 0.45%-KCl 30 mEq/L 128.85 1003557 dextrose 5%-NaCl 0.45%-KCl 40 mEq/L 128.85 1003565 dextrose 12.5% 250 mL 128.85 1003573 dextrose 15% 100 mL 128.85 1003581 dextrose 5%-NaCl 0.9%-KCl 40 mEq/L 128.85 1003599 dextrose 5%-0.225% NaCl - KCl 20 mE 128.85 1003607 dextrose 5%-KCl 20 mEq/L LVP - 1000 128.85 1003615 methylnaltrexone (RELISTOR) 12 mg/0 1,037.70 1003623 cholecalciferol (Vitamin D3) 1,000 0.65 1003656 dextrose 5%-lactated ringers-KCl 20 128.85 1003664 levETIRAcetam (KEPPRA) oral liquid 91.90 1003672 PHENobarbital 4 mg/mL Oral Syringe 16.50 1003698 dextrose 5%-NaCl 0.9%-KCl 20 mEq/L 128.85 1003706 potassium chloride IVPB - 20 mEq/SW 52.80 1003748 sodium chloride 0.9%-KCl 20 mEq LVP 128.85 1003755 sodium chloride 0.9%-KCl 40 mEq LVP 128.85 1003763 tacrolimus (PROGRAF) capsule - 0.5 20.55 1003771 dexamethasone (INTENSOL) 1 mg/mL CO 16.50 1003789 magnesium sulfate IVPB - 4 gm/SW 1 125.95 1003797 dextrose 5%-0.45% NaCl - KCl 20 mEq 128.85 1003821 HYDROmorphone (DILAUDID) 2 mg/mL (1 24.70 1003839 magnesium sulfate infusion - 20 gm/ 97.55 1003862 polyethylene glycol 3350 (MIRALAX) 22.05 1003870 fondaparinux (ARIXTRA) 10 mg/0.8 mL 1,792.60 1003888 baclofen (LIORESAL Intrathecal) 0.0 1,060.00 1003912 dexmedetomidine (PRECEDEX) 100 mcg/ 302.40 1003938 baclofen (LIORESAL Intrathecal) 0.5 3,121.80 1003953 Premixed IV Solution 0.01 1003961 dexamethasone (DECADRON) 1 mg table 4.20 1003979 lamiVUDine (EPIVIR) tablet - 100 mg 212.70 1004001 dextrose 5%-0.45% NaCl - KCl 10 mEq 128.85 1004019 fondaparinux (ARIXTRA) 7.5 mg/0.6 m 1,792.60 1004027 cholecalciferol (Vitamin D3) 400 un 0.35 1004035 hyoscyamine (LEVSIN SL) 0.125 mg SU 7.70 1004068 heparin PF (HEPARIN FLUSH) injectio 49.00 1004084 DULoxetine (CYMBALTA) capsule - 60 78.25 1004100 lamiVUDine-zidovudine (COMBIVIR) 15 242.00 1004118 methenamine hippurate (HIPREX) 1 gr 27.65 1004134 sitagliptin (JANUVIA) 25 mg tablet 83.35 1004167 zanamivir (RELENZA) 5 mg Powder 44.40 1004175 ROCKSTAR Ortho Irrigation with Ster 768.90 1004183 sitagliptin (JANUVIA) 50 mg tablet 83.35 1004191 fluconazole (DIFLUCAN) IVPB - 100 m 145.90 1004217 carvedilol (COREG CR) extended rele 130.80 1004225 ROCKSTAR Ortho Irrigation Plain (10 739.20 1004233 sitagliptin (JANUVIA) 100 mg tablet 136.40 1004258 ARIPiprazole (ABILIFY) 2 mg tablet 408.05 1004266 carvedilol (COREG CR) extended rele 130.80 1004274 sodium hyaluronate (DUOVISC LARGE) 2,592.65 1004290 immune globulin (PRIVIGEN) 10% 5 gr 10,296.00 1004308 testosterone (ANDROGEL) 50 mg/5 g G 205.70 1004316 carvedilol (COREG CR) extended rele 130.80 1004332 iohexol (OMNIPAQUE) 300 mg/mL (10 m 636.80 1004340 amoxicillin-clavulanate ES (AUGMENT 16.50 1004357 rosuvastatin (CRESTOR) 5 mg tablet 94.35 1004365 rosuvastatin (CRESTOR) 10 mg tablet 94.35 1004373 (LEVEMIR) 100 units 66.10 1004399 captopril (CAPOTEN) 0.03 mg/mL Oral 16.50 1004415 rosuvastatin (CRESTOR) 20 mg tablet 94.35 1004423 (EFFIENT) tablet - 10 mg 217.90 1004464 rosuvastatin (CRESTOR) 40 mg tablet 118.10 1004472 pancrelipase (CREON 6,000) capsule 12.10 1004480 ACD Solution A 1,000 mL 128.85 1004498 emtricitabine-tenofovir (TRUVADA) t 724.35 1004514 dronedarone (MULTAQ) tablet - 400 m 182.60 1004522 pancrelipase (CREON 12,000) capsule 41.35 1004548 raltegravir (ISENTRESS) tablet - 40 339.95 1004555 conjugated estrogens-medroxyPROGEST 30.90 1004571 pancrelipase (CREON 24,000) capsule 47.10 1004589 galantamine (RAZADYNE ER) 8 mg caps 84.05 1004597 (INTELENCE) 100 mg table 143.90 1004605 conjugated estrogens-medroxyPROGEST 30.90 1004639 prasugrel (EFFIENT) tablet - 5 mg 217.90 1004647 efavirenz (SUSTIVA) 600 mg tablet 491.90 1004654 conjugated estrogens-medroxyPROGEST 47.70 1004688 insulin aspart (novoLOG) 100 units/ 66.10 1004696 abacavir-lamivudine (EPZICOM) 600 m 613.80 1004720 DULoxetine (CYMBALTA) capsule - 20 107.80 1004746 (PREZISTA) 600 mg tablet 228.80 1004753 fomepizole (ANTIZOL) 1.5 gram/1.5 27,428.70 1004779 DULoxetine (CYMBALTA) capsule - 30 78.25 1004787 cefepime (MAXIPIME) injection - 2 g 532.80 1004795 atazanavir (REYATAZ) 200 mg capsule 367.00 1004803 potassium acid phosphate (K-PHOS OR 6.35 1004829 triamcinolone (KENALOG) 0.025% crea 133.10 1004837 fondaparinux (ARIXTRA) 5 mg/0.4 mL 1,792.60 1004845 hydroxocobalamin (CYANOKIT) 5 gram 10,900.60 1004852 conivaptan (VAPRISOL) 20 mg/100 mL 9,826.10 1004860 aztreonam (AZACTAM) 1 gram/D5W 50 m 527.35 1004878 buPROPion (WELLBUTRIN XL) 150 mg/24 63.05 1004902 acetaminophen (OFIRMEV) 1 gram/100 688.40 1004910 morphine 0.4 mg/mL Oral Syringe 16.50 1004928 morphine 50 mg/250 mL NaCl 0.9% inf 150.05 1004936 desmopressin (DDAVP) 0.1 mg tablet 46.20 1004944 mycophenolic acid (MYFORTIC) delaye 66.00 1004951 polyethylene glycol 3350 with elect 1,595.40 1004985 buPROPion (WELLBUTRIN SR) 200 mg ex 50.60 1004993 omega-3 acid ethyl esters (LOVAZA) 48.20 1005024 colistimethate () 150 mg In 443.40 1005032 buPROPion (WELLBUTRIN SR) 100 mg ex 22.00 1005115 midazolam 50 mg/250 mL NaCl 0.9% in 210.15 1005131 benzonatate (TESSALON) capsule - 20 62.95 1005149 penicillin G potassium IVPB - 3 mil 180.75 1005180 (RANEXA) extended releas 84.80 1005198 vancomycin IVPB - 750 mg/D5W 150 m 382.70 1005230 rifaximin (XIFAXAN) tablet - 550 mg 443.85 1005248 riTUXimab (RITUXAN) 500 mg Injectio 74,408.40 1005271 pneumococcal 13-valent (PREVNAR 13) 2,565.30 1005289 tadalafil (ADCIRCA) 20 mg tablet 1,005.25 1005313 fentaNYL 2,000 mcg/250 mL NaCl 0.9% 343.20 1005339 tolvaptan (SAMSCA) tablet - 30 mg 5,879.55 1005347 voriconazole (VFEND) 50 mg tablet 172.15 1005362 midazolam 100 mg/250 mL in NaCl 0.9 291.50 1005370 tolvaptan (SAMSCA) tablet - 15 mg 7,455.20 1005388 diclofenac sodium (VOLTAREN) 50 mg 19.45 1005396 (PRADAXA) capsule - 75 96.15 1005404 (ZYMAXID) 0.5% Ophthal 1,149.75 1005438 ethinyl estradiol-norgestimate trip 18.55 1005446 dabigatran (PRADAXA) capsule - 150 96.15 1005487 ethinyl estradiol-norethindrone (DA 13.90 1005503 lidocaine BUFFERED 1% injection (5 107.45 1005511 Tumesence #2 Lipo Mixture Irrigatio 179.15 1005537 aztreonam (AZACTAM) 2 gram/D5W 50 m 1,055.35 1005552 amiodarone (NEXTERONE) 150 mg/D5W 1 549.50 1005560 chlorhexidine gluconate 4% (HIBICLE 164.50 1005578 oseltamivir (TAMIFLU) 6 mg/mL Oral 36.05 1005586 aminocaproic acid (AMICAR) 250 mg/m 158.95 1005610 rifampin (RIFADIN) 150 mg capsule 42.80 1005628 budesonide-formoterol (SYMBICORT) 1 3,845.20 1005669 isoflurane (FORANE) anesthesia inha 2.00 1005677 budesonide-formoterol (SYMBICORT) 8 3,342.55 1005685 travoprost 0.004% (TRAVATAN Z) opht 2,766.90 1005693 decitabine (DACOGEN) 50 mg Injectio 6,241.00 1005719 (ULTANE) 5.00 1005727 (DIFICID) tablet - 200 2,763.75 1005735 levothyroxine (SYNTHROID) 100 mcg I 1,756.00 1005818 Tumesence #1 Lipo Mixture Irrigatio 161.05 1005826 piperacillin-tazobactam (ZOSYN for 382.80 1005875 Surgical lubricant (4.25 oz) 40.30 1005883 sennosides-docusate (SENNA PLUS) 50 0.25 1005925 TPN - CLINIMIX 1,053.80 1005966 magnesium sulfate IVPB - 2 gm/SW 5 254.10 1005974 ampicillin-sulbactam (UNASYN) 200 m 100.60 1006022 (VIMPAT) 100 mg tablet 127.65 1006063 lacosamide (VIMPAT) 50 mg tablet 127.65 1006071 mycophenolic acid (MYFORTIC) 360 mg 132.00 1006113 lacosamide (VIMPAT) 10 mg/mL Oral S 29.20 1006121 immune globulin (GAMUNEX) 10% 10 gr 19,353.35 1006162 lacosamide (VIMPAT) 200 mg/20 mL In 1,294.40 1006220 dextrose 17.5% 250 mL 128.85 1006261 bimatoprost 0.01% (LUMIGAN) ophthal 2,162.30 1006279 sodium chloride 0.45% FLUSH Injecti 49.50 1006311 mycophenolate mofetil (CELLCEPT) 50 104.65 1006345 povidone iodine (BETADINE) 10% Topi 24.80 1006378 arsenic trioxide (TRISENOX) 10 mg i 9,409.00 1006386 bendamustine (TREANDA) 25 mg Inject 7,840.80 1006402 colistimethate (COLY-MYCIN M) injec 443.40 1006428 bupivacaine liposome (EXPAREL) 1.3% 4,157.75 1006436 bendamustine (TREANDA) 100 mg Injec 31,363.20 1006451 iohexol (OMNIPAQUE) 180 mg/mL (20 m 826.10 1006469 palonosetron (ALOXI) 0.25 mg/5 mL I 1,584.00 1006477 fosaprepitant (EMEND IV) 150 mg Inj 4,765.20 1006485 DAUNOrubicin liposomal (DAUNOXOME) 18,216.00 1006501 iohexol (OMNIPAQUE) 240 mg/mL (10 m 803.75 1006519 RHo (D) immune globulin (HYPERRHO) 1,869.15 1006527 micafungin (MYCAMINE) injection - 1 2,962.10 1006535 denosumab (PROLIA) 60 mg Injection 13,068.00 1006543 sodium chloride 0.9% irrigation - 72.75 1006550 iohexol (OMNIPAQUE) 240 mg/mL (20 m 849.60 1006568 (XARELTO) tablet - 10 m 260.05 1006576 rivaroxaban (XARELTO) tablet - 15 m 176.00 1006584 epirubicin (ELLENCE) 50 mg Injectio 607.20 1006592 multivitamin, prenatal (CAVAN-EC SO 37.00 1006600 iohexol (OMNIPAQUE) 350 mg/mL (50 m 799.60 1006626 linagliptin (TRADJENTA) tablet - 5 112.60 1006634 ipilimumab (YERVOY) 50 mg Injection 97,336.80 1006642 ofatumumab (ARZERRA) 100 mg Injecti 6,969.60 1006659 iohexol (OMNIPAQUE) 350 mg/mL (100 1,594.60 1006667 chlorhexidine gluconate 0.12% (PERI 28.15 1006675 zoledronic acid (RECLAST) 5 mg/100 4,752.00 1006683 ipilimumab (YERVOY) 200 mg Injectio 434,670.75 1006691 (BRILINTA) 90 mg tablet 106.95 1006709 iohexol (OMNIPAQUE) 350 mg/mL (150 2,201.80 1006725 triamcinolone (KENALOG) 0.1% ointme 73.50 1006741 docusate sodium (VACUANT MINI ENEMA 5.95 1006758 iohexol (OMNIPAQUE) 350 mg/mL (200 2,692.80 1006766 multivitamin, adult oral liquid (CE 6.35 1006782 belimumab (BENLYSTA) 120 mg Injecti 7,017.15 1006790 diphtheria/tetanus/acellular pertus 375.05 1006808 iodixanol (VISIPAQUE) 320 mg/mL 50 908.20 1006816 (NEULASTA) 6 mg/0.6 m 98,700.00 1006832 belimumab (BENLYSTA) 400 mg Injecti 23,390.40 1006840 timolol hemihydrate (BETIMOL) 0.25% 836.90 1006857 iodixanol (VISIPAQUE) 320 mg/mL 150 2,362.15 1006899 nitroglycerin 100 mcg/mL (10 mL) in 143.00 1006907 iodixanol (VISIPAQUE) 320 mg/mL 200 2,853.85 1006931 rasburicase (ELITEK) 7.5 mg Injecti 53,804.55 1006949 milrinone (PRIMACOR) 20 mg/100 mL D 240.80 1006956 gadobenate dimeglumine (MULTIHANCE) 921.25 1006964 ritonavir (NORVIR) 80 mg/mL Oral Sy 95.10 1006972 zidovudine (RETROVIR) 200 mg/20 mL 462.30 1006980 (RAPAMUNE) 1 mg tablet 225.05 1006998 senna (SENOKOT) 1.76 mg/mL Oral Syr 159.55 1007004 gadobenate dimeglumine (MULTIHANCE) 1,348.20 1007012 zidovudine (RETROVIR) 4 mg/mL IV Sy 49.50 1007020 cytarabine (CYTOSAR) 2 gram/20 mL P 331.10 1007038 sirolimus (RAPAMUNE) 1 mg/mL Oral S 416.85 1007053 gadobenate dimeglumine (MULTIHANCE) 1,665.05 1007061 diatrizoate meglumine (MD-GASTROVIE 261.40 1007079 rivastigmine (EXELON) 3 mg capsule 56.05 1007087 tocilizumab (ACTEMRA) 200 mg Inject 18,261.95 1007103 tretinoin 10 mg capsule 400.25 1007111 diatrizoate meglumine (CYSTOGRAFIN 487.10 1007129 acetylcysteine (MUCOMYST) 100 mg/mL 16.65 1007137 tocilizumab (ACTEMRA) 400 mg Inject 36,523.90 1007145 oxaliplatin (ELOXATIN) 100 mg Injec 5,600.80 1007160 barium sulfate (POLIBAR) 100% 1900 476.55 1007178 sevelamer carbonate (RENVELA) 800 m 106.10 1007186 tocilizumab (ACTEMRA) 80 mg Injecti 4,550.35 1007194 emtricitabine (EMTRIVA) 200 mg caps 252.65 1007202 vinorelbine (NAVELBINE) 50 mg Injec 1,425.60 1007210 leuprolide (LUPRON DEPOT) 22.5 mg D 59,289.00 1007228 tacrolimus (PROGRAF) 0.5 mg/mL Oral 26.15 1007236 zoledronic acid (ZOMETA) injection 697.00 1007244 glipiZIDE (GLUCOTROL XL) extended r 8.85 1007251 (TEFLARO) injec 3,195.35 1007269 barium sulfate (E-Z PAQUE) 96% 176 51.15 1007285 clobetasol (TEMOVATE) 0.05% ointmen 2,028.35 1007301 diphenoxylate-atropine (LOMOTIL) 2. 10.20 1007319 barium sulfate (E-Z HD) 98% 135 mL 89.10 1007335 sodium chloride 0.9% irrigation - 92.40 1007343 PACLitaxel (TAXOL) 300 mg Injection 1,869.15 1007368 barium sulfate (E-Z PASTE) 60% 454 671.05 1007376 PHENobarbital tablet - 32.4 mg 6.05 1007392 interferon alfa-2b (INTRON A) 50 Mi 14,747.70 1007400 PACLitaxel protein-bound (ABRAXANE) 14,770.80 1007418 barium sulfate (E-Z DISK) 700 mg ta 36.65 1007434 topiramate (TOPAMAX) 15 mg Sprinkle 31.90 1007442 leucovorin 350 mg Injection 300.20 1007467 citric acid-simethicone-sodium bica 37.40 1007475 mycophenolate mofetil (CELLCEPT) 20 119.60 1007491 barium sulfate (VOLUMEN) 0.1% 450 89.10 1007509 denosumab (XGEVA) 120 mg/1.7 mL Inj 26,136.05 1007525 paromomycin 250 mg capsule 74.85 1007533 epoprostenol (FLOLAN) 0.5 mg Inject 308.40 1007541 gadobenate dimeglumine (MULTIHANCE) 469.70 1007558 (TORISEL) 25 mg Inject 25,224.55 1007566 benzocaine (HURRICAINE) 20% GEL (30 124.75 1007574 piperacillin-tazobactam (ZOSYN) inj 162.50 1007582 epoprostenol (FLOLAN) 1.5 mg Inject 977.15 1007608 ramipril (ALTACE) 1.25 mg capsule 20.20 1007616 benzocaine (HURRICAINE ONE) 20% Ora 154.45 1007624 iodixanol (VISIPAQUE) 320 mg/mL 100 1,677.75 1007632 iohexol (OMNIPAQUE) 300 mg/mL (50 m 731.95 1007640 EUCERIN cream - 120 gm 80.80 1007657 bevacizumab (AVASTIN) 400 mg Inject 39,339.60 1007665 sevelamer carbonate (RENVELA) 800 m 149.80 1007673 oxyCODONE (OXY IR) 30 mg tablet 59.25 1007681 iohexol (OMNIPAQUE) 300 mg/mL (100 1,437.50 1007699 calcium carbonate (CALTRATE) 600 mg 0.40 1007707 CISplatin (PLATINOL) 100 mg Injecti 633.60 1007731 iohexol (OMNIPAQUE) 300 mg/mL (150 2,096.85 1007749 diatrizoate megulumine (MD GASTROVI 261.40 1007764 rivaroxaban (XARELTO) tablet - 20 m 248.20 1007772 abatacept (ORENCIA) 250 mg injectio 16,572.60 1007780 fluorouracil (5 FU) 2,500 mg/50 mL 203.55 1007806 heparin 25 units D5W 50 mL bag 132.00 1007814 heparin 25 units NaCl 0.45% 50 mL b 132.00 1007822 immune globulin (GAMMAGARD) 10% 5 g 9,853.30 1007848 cefixime (SUPRAX) capsule - 400 mg 310.55 1007863 leucovorin 200 mg Injection 333.60 1007871 immune globulin (GAMMAGARD) 10% 10 19,706.55 1007889 fentaNYL 500 mcg in Dextrose 5% 50 56.80 1007897 sterile water for injection LVP - 1 128.85 1007913 betamethasone dipropionate 0.05% (D 1,098.15 1007939 midazolam (VERSED) 20 mg in Dextros 97.70 1007954 (ELIQUIS) 5 mg tablet 88.10 1007962 factor IX complex human (PROFILNINE 5,940.00 1007988 midazolam (VERSED) 8 mg in Dextrose 39.10 1007996 tetanus/diphtheria/acellular pertus 605.65 1008002 sodium picosulfate/mag oxide/citric 1,187.25 1008028 temozolomide (TEMODAR) 180 mg capsu 6,837.20 1008036 morphine preservative free 25 mg in 148.80 1008044 ciprofloxacin-dexamethasone (CIPROD 3,551.05 1008051 interferon alfa-2b (INTRON A) 18 Mi 5,308.65 1008085 HYDROcodone-acetaminophen (NORCO) 10.50 1008093 HYDROmorphone (DILAUDID) 8 mg table 18.30 1008101 oxyCODONE (OXY IR) 10 mg tablet 9.15 1008119 calamine 8% lotion - 6 oz 31.05 1008127 cobicistat/elvitegravir/emtricitabi 1,297.45 1008135 HYDROcodone-acetaminophen (NORCO) 11.70 1008143 prothrombin complex human (KCENTRA) 18,282.00 1008150 apixaban (ELIQUIS) 2.5 mg tablet 88.10 1008168 desmopressin (DDAVP) injection - 4 9,428.00 1008192 ocular lubricant (SYSTANE OVERNIGHT 134.55 1008200 DOPamine 800 mg/250 mL D5W infusion 242.10 1008226 cyclopentolate (CYCLOGYL) 0.5% Opht 415.80 1008234 azaCITIDine (VIDAZA) 100 mg SQ inje 1,584.00 1008267 ixabepilone (IXEMPRA) 45 mg Injecti 45,813.00 1008275 sirolimus (RAPAMUNE) 0.5 mg tablet 136.70 1008283 bortezomib (VELCADE) 2.5 mg/mL Inje 25,391.30 1008309 saliva substitutes (MOUTH KOTE) Spr 142.60 1008317 ixabepilone (IXEMPRA) 15 mg Injecti 15,270.85 1008333 benzocaine-menthol (CEPACOL) lozeng 2.20 1008341 sodium hyaluronate (HEALON DUET) op 3,880.80 1008358 hydrocortisone (Solu-CORTEF) inject 251.20 1008366 mechlorethamine (MUSTARGEN) 10 mg I 37,742.80 1008382 lidocaine-prilocaine (EMLA) 2.5%-2. 106.15 1008390 darunavir (PREZISTA) 800 mg tablet 575.95 1008408 hydrocortisone (SOLU CORTEF) 500 mg 354.95 1008416 natalizumab (TYSABRI) 300 mg Inject 56,876.70 1008432 multivitamin pediatric PLAIN (POLY 16.50 1008457 testosterone cypionate 100 mg/mL In 1,012.20 1008473 albuterol-ipratropium (COMBIVENT RE 6,755.00 1008499 niCARdipine (CARDENE) 40 mg/200 mL 3,220.30 1008515 ascorbic acid (VITAMIN C) 500 mg/mL 3,036.00 1008523 immune globulin (GAMUNEX) 10% 5 gra 9,676.70 1008549 betaxolol 0.25% (BETOPTIC S) ophtha 4,318.80 1008580 bupivacaine 0.75% preservative-free 51.55 1008598 oseltamivir (TAMIFLU) capsule - 30 187.20 1008614 octreotide (SandoSTATIN LAR Depot) 83,859.35 1008622 atropine 0.4 mg/mL (20 mL) injectio 556.00 1008630 sodium ACETATE 0.45% FLUSH Injectio 49.50 1008648 posaconazole (NOXAFIL) 100 mg table 787.55 1008663 glycerin liquid suppository (FLEET 12.10 1008671 deferoxamine (DESFERAL) 2 gram Inje 652.65 1008697 lurasidone (LATUDA) 40 mg tablet 320.80 1008747 hetastarch 6% (HESPAN) infusion - 3 224.40 1008770 trolamine salicylate (MYOFLEX) 10% 57.05 1008796 dextrose 20% 250 mL 128.85 1008812 neostigmine 0.5 mg/mL Injection (10 225.10 1008838 obinutuzumab (GAZYVA) 1000 mg Injec 81,708.00 1008846 cloZAPine (CLOZARIL) 100 mg tablet 45.25 1008887 dextrose 5% FLUSH Injection 0.6 mL 79.20 1008895 brentuximab vedotin (ADCETRIS) 50 m 136,097.30 1008937 Sodium Chloride 0.9% 30 mL Flush 49.50 1008960 amiodarone (CORDARONE) 50 mg/mL ( 9 69.45 1008986 fibrin sealant (TISSEEL FROZEN SYRI 3,984.60 1009000 ceftaroline fosamil (TEFLARO) injec 3,195.35 1009018 sodium chloride 0.45% 500 mL IVPB 128.85 1009026 cetuximab (ERBITUX) 200 mg Injectio 16,130.40 1009034 calcium GLUCONATE injection - 100 m 11,880.00 1009059 cytarabine liposomal (DEPOCYT) 50 m 42,969.85 1009067 tenofovir (VIREAD) tablet - 300 mg 492.85 1009075 rasburicase (ELITEK) 1.5 mg Injecti 13,531.95 1009125 IDArubicin (IDAMYCIN) 5 mg Injectio 3,960.00 1009166 (PROGLYCEM) 50 mg/mL Oral 137.35 1009182 sodium nitrite-sodium thiosulfate ( 5,227.20 1009208 emtricitabine--tenofovir 1,083.90 1009216 bupivacaine 0.5%-EPINEPHrine 1:200, 138.60 1009240 cinacalcet (SENSIPAR) 30 mg tablet 409.20 1009257 cholecalciferol (Vitamin D3) 400 un 16.50 1009299 pertuzumab (PERJETA) 420 mg Injecti 64,532.20 1009307 memantine (NAMENDA) 7 mg Capsule - 144.50 1009315 gadoxetate (EOVIST) 181.43 mg/mL 10 2,162.20 1009349 mesalamine (ASACOL HD) delayed rele 122.45 1009356 pentafluoropropane-tetrafluoroethan 411.65 1009380 hydroxyurea (HYDREA) 40 mg/mL Oral 16.50 1009398 mesalamine (LIALDA) 1.2 gram Tablet 133.85 1009406 ARISTA AH hemostat 3 gram 2,774.65 1009430 panitumumab (VECTIBIX) 100 mg Injec 15,100.80 1009448 acetaminophen (TYLENOL) 32 mg/mL O 16.50 1009455 immune globulin (GAMMAGARD LOW IGA) 12,555.60 1009463 zonisamide (ZONEGRAN) 25 mg capsule 7.25 1009489 ARIPiprazole (ABILIFY) 5 mg tablet 420.20 1009505 immune globulin (GAMMAGARD LOW IGA) 25,111.20 1009513 vitamin E (AQUASOL E) 50 units/mL O 18.05 1009539 ceFAZolin (ANCEF) IVPB - 2 gm/D5W 5 115.65 1009562 betaxolol (BETOPTIC) 0.5% Ophthalmi 874.80 1009570 vedolizumab (ENTYVIO) 300 mg Inject 76,333.00 1009604 vancomycin injection - 5 gm 1,386.00 1009612 ado-trastuzumab emtansine (KADCYLA) 43,933.30 1009620 panitumumab (VECTIBIX) 400 mg Injec 60,403.20 1009638 sorbitol 3% Urologic Irrigation 3,0 217.70 1009646 hypromellose 1.7% (IMPROVUE) 2 mL 382.80 1009661 ado-trastuzumab emtansine (KADCYLA) 70,293.30 1009695 antihemophilic factor-von willebran 20.75 1009711 (ACTHREL) 100 mcg Inje 11,879.25 1009729 (NPLATE) 250 mcg inject 25,191.95 1009745 pegfilgrastim (NEULASTA ONPRO KIT) 98,700.00 1009752 tobramycin 40 mg/mL Injection (30 m 345.05 1009760 indomethacin (INDOCIN) 50 mg suppos 3,252.35 1009802 lanreotide (SOMATULINE DEPOT) 120 m 138,695.05 1009810 dalteparin (FRAGMIN) 7,500 intl uni 842.40 1009828 canakinumab (ILARIS) injection - 18 254,312.40 1009836 vancomycin 500 mg RETENTION ENEMA 79.20 1009844 HYDROcodone-acetaminophen (HYCET) o 60.90 1009851 nivolumab (OPDIVO) 40 mg Injection 15,193.75 1009885 dexmedetomidine (PRECEDEX) 100 mcg/ 0.01 1009893 pembrolizumab (KEYTRUDA) 100 mg Inj 68,362.80 1009901 nivolumab (OPDIVO) 100 mg Injection 37,984.35 1009935 zoledronic acid (ZOMETA) 4 mg/100 m 2,851.20 1009943 oxyCODONE-acetaminophen (PERCOCET 1 46.90 1009950 voriconazole (VFEND) 40 mg/mL Oral 185.75 1009976 adalimumab (HUMIRA) 40 mg/0.8 mL in 21,386.55 1009992 amphotericin B liposomal (AMBISOME) 2,590.50 1010008 dextrose 5% 30 mL Flush 49.50 1010016 cabazitaxel (JEVTANA) 60 mg/1.5 mL 137,179.50 1010024 golimumab (SIMPONI ARIA) 50 mg Inje 21,027.10 1010032 belatacept (NULOJIX) 250 mg Injecti 14,620.35 1010040 eribulin (HALAVEN) 1 mg/2 mL Inject 15,491.55 1010057 TPN - CLINIMIX (Amino Acids 4.25% w 501.60 1010073 levETIRAcetam (KEPPRA) IVPB - 500 293.05 1010081 levETIRAcetam (KEPPRA) IVPB - 1,000 475.20 1010099 levETIRAcetam (KEPPRA) IVPB - 1,500 633.60 1010107 amphotericin B liposomal (AMBISOME) 103.65 1010115 dolutegravir (TIVICAY) 50 mg tablet 964.40 1010131 phenylephrine-mineral oil (PREPARAT 65.90 1010149 morphine PF 0.5 mg/mL (ASTRAMORPH P 8.40 1010156 nitroglycerin (RECTIV) 0.4% ointmen 6,885.95 1010164 balsam peru-castor oil (VENELEX) oi 495.00 1010172 TPN - CLINIMIX E (Amino Acids 5% wi 567.60 1010180 TPN - CLINIMIX (Amino Acids 5% with 567.60 1010198 dextrose 70% in Water 2000 mL 404.25 1010206 Surgicel NU-KNIT 6 x 9 2,857.30 1010214 ifosfamide (IFEX) 3 gram Injection 1,703.50 1010222 lidocaine (LTA KIT) 4% 4 mL 316.80 1010230 barium sulfate (POLIBAR) 105% 1900 551.80 1010248 cefTAZidime- (AVYCAZ) inje 4,740.15 1010263 nitroglycerin 25 mg in D5W 250 mL 277.20 1010289 argatroban (ACOVA) 50 mg/NS 50 mL I 3,136.35 1010297 mirtazapine (REMERON ODT) 15 mg ODT 31.10 1010305 TPN - CLINIMIX E (Amino Acids 4.25% 528.00 1010347 JW BORTEZOMIB 3.5 MG INJECTION 25,391.30 1010388 mitoXANTRONE (NOVANTRONE) 2 mg/mL I 1,943.05 1010396 heparin 25 units NA ACETATE 0.45% 5 135.60 1010420 ziv-aflibercept (ZALTRAP) 100 mg In 21,120.00 1010438 capecitabine (XELODA) 150 mg tablet 154.85 1010453 influenza PF vaccine HIGH DOSE (FLU 847.60 1010529 pegloticase (KRYSTEXXA) 8 mg Inject 294,358.20 1010537 amiodarone (NEXTERONE) 360 mg/D5W 2 689.60 1010545 Surgicel NU-KNIT 3 x 4 1,260.55 1010560 (AGGRASTAT) 5 mg/100 mL N 3,916.45 1010586 JW DECITABINE 50 MG INJECTION 25,747.15 1010594 Radiation Esophagitis Mixture 15 mL 51.50 1010602 JW AZACITIDINE 100 MG INJECTION 1,584.00 1010610 JW PACLITAXEL PROTEIN BOUND 100 MG 17,206.90 1010636 clofarabine (CLOLAR) 20 mg Injectio 42,292.80 1010644 ticagrelor (BRILINTA) 60 mg tablet 106.95 1010651 JW PEMBROLIZUMAB 100 MG INJECTION 68,365.45 1010669 isavuconazonium (CRESEMBA) 186 mg c 1,383.25 1010701 acetylcysteine (MUCOMYST) 200 mg/mL 16.50 1010719 meningococcal conjugate (MENVEO) va 1,951.50 1010727 dimethyl sulfoxide (RIMSO-50) 50 m 7,017.15 1010735 heparin infusion - 25,000 units/NaC 152.50 1010743 idaruCIZUMAB (PRAXBIND) 2.5 gram In 33,891.75 1010750 morphine 50 mg/mL Injection (20 mL) 200.65 1010768 topical bovine 5,000 units 1,136.80 1010776 ramucirumab (CYRAMZA) 100 mg inject 16,156.80 1010784 necitumumab (PORTRAZZA) 800 mg Inje 63,360.00 1010792 hydrocortisone (CORTEF) 2 mg/mL Ora 16.50 1010800 phentolamine (REGITINE) 0.5 mg/mL I 7,061.75 1010826 antithymocyte globulin, equine (ATG 20,077.20 1010834 lamiVUDine (EPIVIR) 10 mg/mL Oral S 6.60 1010842 dextromethorphan- (NUEDEXT 179.00 1010867 synthetic human (CHIRHOSTI 4,290.00 1010883 morphine (MS IR) 15 mg Tablet - Imm 5.40 1010891 vitamin A capsule - 10,000 units 0.50 1010909 ceFAZolin (ANCEF) IVPB - 2 gm/100 m 146.55 1010917 theophylline (THEO-24) 100 mg/24 ho 23.85 1010925 theophylline (THEO-24) 200 mg/24 ho 35.45 1010933 theophylline (THEO-24) 300 mg/24 ho 43.55 1010958 acetylcysteine 20% (MUCOMYST) 4 mL 197.55 1011006 albuterol-ipratropium (DUONEB) 2.5 29.20 1011089 bacitracin-neomycin-polymyxin B (NE 3.70 1011329 diltiazem (CARDIZEM) 5 mg/mL (25 mL 91.75 1011394 emtricitabine (EMTRIVA) 10 mg/mL Or 1,997.20 1011600 hypromellose 0.3% (GENTEAL TEARS) o 103.00 1011675 levobunolol 0.5% (BETAGAN) ophthalm 319.20 1011691 lidocaine-EPINEPHrine 1%-1:200,000 161.20 1011717 lidocaine 3.5% (AKTEN) ophthalmic g 385.45 1011758 lisinopril (ZESTRIL) tablet - 2.5 9.15 1011790 meperidine (DEMEROL) injection - 2 36.60 1011832 metoclopramide (REGLAN) tablet - 5 11.95 1012145 verapamil (CALAN) 40 mg tablet 3.70 1012202 ritonavir (NORVIR) tablet - 100 mg 122.25 1012210 eplerenone (INSPRA) tablet - 25 mg 57.30 1012228 pyridoxine (Vitamin B6) 1 mg/mL ORA 148.50 1012236 sildenafil (VIAGRA) Suspension 2.5 282.75 1012244 fluorescein 10% (FLUORESCITE) ophth 662.95 1012251 zinc oxide-menthol (CALMOSEPTINE) o 66.00 1012293 hydroxyprogesterone (MAKENA) 250 mg 11,262.15 1012327 potassium phosphate-sodium phosphat 6.75 1012418 amiodarone (CORDARONE) 1.8 mg/mL IV 49.50 1012426 amiodarone (CORDARONE) 18 mg/D5W 10 49.50 1012434 cefTAZidime (FORTAZ) 40 mg/mL IV Sy 66.55 1012442 dexamethasone (DECADRON) 0.1 mg/mL 51.25 1012459 (NEUPOGEN) 15 mcg/mL IV 3,844.40 1012467 fosphenytoin (CEREBYX) 20 mg PE/mL 525.40 1012475 glycopyrrolate (ROBINUL) 50 mcg/mL 205.95 1012483 hydrocortisone (SOLU CORTEF) 1 mg/m 69.70 1012491 levETIRAcetam (KEPPRA) 15 mg/mL IV 49.50 1012509 magnesium sulfate 0.5 mEq/mL IV Syr 49.50 1012517 norepinephrine 0.2 mg in Dextrose 5 155.80 1012525 norepinephrine 0.32 mg in Dextrose 155.80 1012533 ketamine 50 mg/mL (1 mL) Injection 107.45 1012541 elotuzumab (EMPLICITI) 400 mg Injec 39,810.70 1012558 elotuzumab (EMPLICITI) 300 mg Injec 29,858.30 1012566 daratumumab (DARZALEX) 100 mg Injec 7,128.00 1012582 benzocaine 14%-butamben 2%-tetracai 955.70 1012590 atezolizumab (TECENTRIQ) 1,200 mill 136,540.80 1012608 tacrolimus (PROGRAF) 5 mg capsule 161.05 1012616 pancrelipase (VIOKACE 10) tablet 46.60 1012624 morphine preservative free 5 mg in 126.75 1012640 octreotide (SandoSTATIN LAR Depot) 44,855.10 1012657 hepatitis B (ENGERIX-B) injection - 904.90 1012665 irinotecan liposomal (ONIVYDE) 43 m 31,014.75 1012673 filgrastim-sndz (ZARXIO) injection 4,367.90 1012681 filgrastim-sndz (ZARXIO) injection 8,691.85 1012723 dantrolene (RYANODEX) injection - 2 36,432.00 1012731 JW ARSENIC TRIOXIDE 10MG/10ML INJEC 9,409.00 1012756 polidocanol (ASCLERA) 1% Injection 435.60 1012871 sugammadex (BRIDION) 100 mg/mL Inje 1,504.80 1012905 flucytosine (ANCOBON) 50 mg/mL Oral 63.65 1012913 morphine (KADIAN) 10 mg/24 hr Capsu 62.45 1012921 succinylcholine (ANECTINE) injectio 324.90 1012939 ePHEDrine injection - 10 mg/mL (5 m 221.10 1012954 antithymocyte globulin, rabbit (THY 11,603.60 1012970 tetracaine 0.5% (PONTOCAINE) ophtha 1,944.25 1012988 phytonadione (VITAMIN K) 2 mg/mL O 67.35 1012996 ketorolac 0.5% (ACULAR) ophthalmic 1,392.60 1013010 varicella zoster immune globulin (V 26,003.25 1013036 (AVELOX) 400 mg tablet 359.40 1013044 JW DARATUMUMAB 100 MG INJECTION 7,128.00 1013069 250 mg capsule 599.30 1013077 tropicamide 1% (MYDRIACYL) ophthalm 140.60 1013085 methylene blue (PROVAYBLUE) 0.5% In 3,769.45 1013093 poractant (CUROSURF) 120 mg/1.5 mL 6,140.40 1013101 poractant (CUROSURF) 240 mg/3 mL 12,108.10 1013119 JW IPILIMUMAB 200 MG INJECTION 377,925.55 1013127 JW IPILIMUMAB 50 MG INJECTION 9,733.75 1013135 doxycycline (VIBRAMYCIN) 5 mg/mL Or 16.50 1013143 phenylephrine (NEO-SYNEPHRINE) 100 94.80 1013192 JW IRINOTECAN LIPOSOMAL INJECTION 4 25,661.20 1013200 octreotide (SandoSTATIN LAR Depot) 58,746.35 1013267 pregabalin (LYRICA) capsule - 100 m 21.35 1013275 ferric carboxymaltose (INJECTAFER) 18,052.30 1013283 phenylephrine (NEO-SYNEPHRINE) 10 m 159.10 1013291 nitroprusside (NIPRIDE) 50 mg/100 m 4,736.20 1013317 procainamide 100 mg/mL Injection (1 1,346.40 1013325 ondansetron (ZOFRAN) 4 mg/5 mL oral 202.25 1013333 trastuzumab (HERCEPTIN) 150 mg Inje 24,816.00 1013341 (TYVASO) 1.74 mg/2.9 m 8,848.10 1013366 JW TRASTUZUMAB 150 MG INJECTION 24,816.00 1013390 inFLIXimab-dyyb (INFLECTRA) 100 mg 14,989.15 1013408 eslicarbazepine (APTIOM) 400 mg tab 511.20 1013424 levonorgestrel 1.5 mg tablet 483.95 1013457 sodium bicarbonate 8.4% injection - 396.00 1013473 JW CARFILZOMIB 30 MG INJECTION 17,147.20 1013481 doxycycline INTRAPLEURAL 382.70 1013499 sodium chloride 23.4% injection - 4 60.80 1013549 (INVEGA SUSTENNA) 234 0.01 1013564 JW ALTEPLASE 50 MG INJECTION 67,668.75 1013572 JW ALTEPLASE 100 MG INJECTION 135,337.65 1013580 golimumab (SIMPONI) 50 mg/0.5 mL 65,742.10 1013598 cholecalciferol (Vitamin D3) capsul 4.95 1013606 paliperidone (INVEGA SUSTENNA) 156 0.01 1013614 lidocaine 1.5% preservative-free in 143.90 1013622 lidocaine-EPINEPHrine 2%-1:100,000 14.35 1013630 levonorgestrel Intrauterine System 12,359.95 1013648 lurasidone (LATUDA) 80 mg tablet 587.85 1013655 ocrelizumab (OCREVUS) 300 mg Inject 257,400.00 1013663 dabigatran (PRADAXA) capsule - 110 97.95 1013739 benzylpenicilloyl-polylysine (PRE-P 2,353.85 1013754 nitazoxanide (ALINIA) tablet - 500 1,777.65 1013762 sacubitril- (ENTRESTO) 24 134.45 1013770 sacubitril-valsartan (ENTRESTO) 49 134.45 1013788 vinCRIStine (ONCOVIN) 1 mg/mL Injec 91.65 1013796 avelumab (BAVENCIO) 20 mg/mL Inject 24,181.10 1013812 dorzolamide 2%-timolol 0.5% (COSOPT 37.30 1013820 sacubitril-valsartan (ENTRESTO) 97 122.25 1013838 sodium chloride 3% Inhalation (4 mL 5.30 1013846 fentaNYL 10 mcg/mL IV Syringe (1 m 49.50 1013853 morphine PF 0.5 mg/mL (ASTRAMORPH P 33.25 1013879 nitroglycerin 100 mcg/mL (5 mL) Inj 49.50 1013887 bleomycin (BLENOXANE) 30 units Inje 1,024.25 1013911 trabectedin (YONDELIS) 1 mg Injecti 47,155.85 1013929 nivolumab (OPDIVO) 240 mg Injection 81,839.90 1013952 cyclobenzaprine (FLEXERIL) 5 mg tab 16.25 1013978 omalizumab (XOLAIR) 150 mg injectio 17,181.00 1013986 romiDEPsin (ISTODAX) 10 mg Injectio 50,666.65 1013994 mepolizumab (NUCALA) 100 mg Injecti 47,855.95 1014018 midodrine (PROAMATINE) 2.5 mg table 22.35 1014026 (TYMLOS) 3120 mcg/1.5 27,258.80 1014034 misoprostol (CYTOTEC) tablet - 50 16.40 1014042 tirofiban (AGGRASTAT) 3.75 mg/15 m 3,525.40 1014059 Duke's Magic Mouthwash 120 mL 126.75 1014109 dextrose 50% injection - 50 mL Vial 42.90 1014117 magnesium sulfate injection - 4 mEq 27.50 1014125 glycerin liquid suppository - ADULT 13.75 1014133 povidone iodine (BETADINE) 5% Ophth 203.55 1014141 (MICARDIS) 20 mg tablet 72.75 1014158 telmisartan (MICARDIS) 40 mg tablet 72.55 1014166 hydrochlorothiazide-telmisartan (MI 72.90 1014174 hydrochlorothiazide-telmisartan (MI 72.90 1014190 immune globulin (OCTAGAM) 10% 5 gra 11,291.30 1014216 rabies immune globulin (HYPER RAB) 53,098.75 1014232 durvalumab (IMFINZI) 120 mg/2.4 mL 13,524.20 1014240 cefprozil (CEFZIL) 25 mg/ mL Oral S 16.50 1014257 benzocaine 14%-butamben 2%/tetracai 831.90 1014273 ceFAZolin (ANCEF) injection - 100 g 1,306.80 1014281 immune globulin (OCTAGAM) 10% 2 gra 4,517.05 1014299 (KENGREAL) 50 mg Injectio 11,864.20 1014307 prednisoLONE sodium phosphate 3 mg/ 16.50 1014315 DOPamine 8 mg in Dextrose 5% 5 mL 132.00 1014323 DOBUTamine 8 mg in Dextrose 5% 5 132.00 1014331 pegfilgrastim-jmdb (FULPHILA) 6 mg/ 66,132.00 1014349 (STELARA) 130 mg Inject 26,584.30 1014356 emtricitabine- 884.80 1014364 cobicistat-darunavir (PREZCOBIX) 15 953.45 1014380 2.5 mg/mL Oral Syringe 44.00 1014398 oxyCODONE (OXY IR) 15 mg tablet 24.70 1014406 dexamethasone (DECADRON) 10 mg/mL O 20.60 1014414 QUEtiapine (SEROquel) 12.5 mg (1/2 2.25 1014422 tetracaine 0.5% (ALTACAINE) ophthal 110.70 1014430 carboxymethylcellulose 1% (CELLUVI 5.15 1014455 sodium glycerophosphate Injection - 205.95 1014463 tenofovir alafenamide fumarate (VEM 563.20 1014471 carboxymethylcellulose 1% (REFRESH 125.05 1014489 lidocaine topical 2% (GLYDO) jelly 94.25 1014497 heparin IMPELLA Purge Solution 25,0 145.10 1014505 multivitamin with iron (POLY VI SOL 16.50 1014513 multivitamin with iron (POLY VI SOL 2.30 1014521 loperamide (IMODIUM) suspension - 1 31.85 1014539 anakinra (KINERET) Injection - 100 2,329.55 1014554 triamcinolone (KENALOG) 0.1% oinmen 545.35 1014562 vitamin A & D ointment - 113 gm 68.65 1014596 atezolizumab (TECENTRIQ) 840 millig 98,467.55 1014638 polatuzumab vedotin-piiq (POLIVY) i 237,600.00 1014646 carbidopa/entacapone/levodopa (STAL 49.55 1014653 sodium hyaluronate (HEALON GV PRO) 1,989.15 1014661 ceftolozane-tazobactam (ZERBAXA) 1 1,564.00 1014679 Surgicel SNOW 4 x 4 2,936.65 1014687 ketamine 1 mg/mL IV Syringe 49.50 1014711 omalizumab (XOLAIR) 150 mg injectio 17,875.20 1014729 clindamycin (CLEOCIN) capsule - 30 17.15 1014737 cloNIDine 10 mcg/mL Oral Syringe 16.50 1014745 NON Formulary - CHEMOTHERAPY Oral S 0.05 1014786 bevacizumab-awwb (MVASI) 100 mg Inj 10,730.05 1014794 bevacizumab-awwb (MVASI) 400 mg Inj 42,920.10 1014802 trastuzumab-anns (KANJINTI) 420 mg 58,564.60 1014810 trastuzumab-hyaluronidase- oysk (HE 74,055.85 1014828 pegfilgrastim-cbqv (UDENYCA) 6 mg/0 66,132.00 1014844 lipid emulsion-fish oil-and plant b 3.50 1014851 cemiplimab (LIBTAYO) 350 mg/7 mL in 144,144.00 1014869 methadone 10 mg/mL Oral Syringe 16.50 1014885 tranexamic acid 1000 mg/100 mL IVPB 332.65 1014893 copanlisib (ALIQOPA) 60 mg Injectio 73,898.10 1014901 antihemophilic factor recombinant ( 28,776.00 1014919 antihemophilic factor recombinant ( 86,486.40 1014927 Polyvitamin drops with zinc (AQUADE 16.50 1014935 acetaminophen (OFIRMEV) 10 mg/mL IV 49.50 1014943 Investigational Drug - IVPB 0.01 1014984 rivaroxaban (XARELTO) tablet - 2.5 118.30 1015007 morphine extended release capsule - 250.90 1015015 inotuzumab ozogamicin (BESPONSA) 0. 314,247.15 1015023 lopinavir-ritonavir (KALETRA) 80 mg 43.10 1015056 sarilumab (KEVZARA) 200 mg/1.14 mL 27,557.35 1015064 hydroxychloroquine (PLAQUENIL) 25 m 57.95 1015072 lopinavir-ritonavir (KALETRA) 100 m 67.60 1015080 romosozumab-aqqg (EVENITY) 105 mg I 14,454.00 1015098 ketamine 500 mg/250 mL NaCl 0.9% in 244.60 1015114 niMODipine (NYMALIZE) 60 mg/10 mL S 1,294.85 1015122 sacituzumab govitecan (TRODELVY) 18 31,878.00 1015130 luspatercept (REBLOZYL) 25 mg injec 54,508.35 1015148 luspatercept-aamt (REBLOZYL) 75 mg 163,524.75 1015155 antihemophilic factor recombinant ( 7,458.00 1015163 dexamethasone (DECADRON) 6 mg table 23.55 1015171 (NEMBUTAL) 50 mg/mL ( 19,968.45 1015197 phenylephrine 100 mg in NS 250 mL b 1,553.65 1015205 norepinephrine (LEVOPHED) 16 mg/250 867.90 1015213 remdesivir 100 mg Injection 7,550.40 1015221 trastuzumab-dkst (OGIVRI) 150 mg In 20,982.60 1015239 vasopressin (VASOSTRICT) 20 units/N 4,268.90 1015247 dexmedetomidine (PRECEDEX) 400 mcg/ 1,330.60 1015254 trastuzumab-pkrb (HERZUMA) 150 mg I 22,215.60 1015262 trastuzumab-pkrb (HERZUMA) 420 mg I 62,203.70 1015270 ibuprofen 20 mg/mL oral syringe 16.50 1015288 famotidine 4 mg/mL IV syringe 49.50 1015296 hepatitis B immune globulin (HEPAGA 13,442.90 1015304 teprotumumab-trbw (TEPEZZA) 500 mg 236,016.00 1015312 HemaDerm ENT applicator kit 1,560.90 1015338 JW BRENTUXIMAB VEDOTIN 50 MG INJECT 136,097.30 1015353 enfortumab vedotin-ejfv (PADCEV) 20 36,067.70 1015361 enfortumab vedotin-ejfv (PADCEV) 30 54,101.55 1015379 tiotropium (SPIRIVA RESPIMAT) MDI I 7,211.05 1015387 PRALAtrexate (FOLOTYN) 20 mg/mL (2 186,294.90 1015395 potassium chloride 2 mEq/mL Oral Sy 31.70 1015403 dextrose 70% in Water 500 mL 198.50 1015411 brilliant blue G 0.025% ophthalmic 2,032.80 1015460 SARS-CoV-2 (COVID-19) mRNA-1273 vac 0.01 1015478 epinephrine 16 mg in NS 250 mL 18,707.70 1015494 hydrOXYzine hydrochloride (ATARAX) 13.90 1015502 (OLUMIANT) 1 mg tablet 1,195.95 1015510 -jjmr (VYEPTI) 100 mg/mL 23,680.80 1015528 caplacizumab-yhdp (CABLIVI) 11 mg I 115,632.00 1015536 valGANciclovir (VALCYTE) 50 mg/mL O 132.05 1015551 carfilzomib (KYPROLIS) injection - 6,808.85 1015569 JW CARFILZOMIB 10 MG INJECTION 6,808.85 1015585 trastuzumab-dkst (OGIVRI) 420 mg In 58,564.60 1015593 lidocaine-EPINEPHrine 1%-1:100,000 72.25 1015601 ioversol (OPTIRAY) 320 mg/mL 200 mL 1,050.75 1015619 erythromycin ethylsuccinate (EES) 4 192.85 1015627 epoetin alfa epbx (RETACRIT) inject 3,494.35 1015643 oxytocin (PITOCIN) injection - 10 u 625.70 1015668 bictegravir-emtricitabine-tenofovir 1,791.90 1015676 methyl salicylate-menthol () 44.40 1015684 labetalol (TRANDATE) 10 mg/mL Oral 16.50 1015692 histamine phosphate (HISTATROL) 1 m 4,181.80 1015700 JW ENFORTUMAB VEDOTIN-EJFV (PADCEV) 36,067.70 1015718 psyllium (METAMUCIL) capsule - 0.4 0.70 1015726 0.1% cream 1.5 oz 137.85 1015734 mirtazapine (REMERON) 7.5 mg tablet 34.80 1015742 metoprolol (LOPRESSOR) 12.5 mg (1/2 3.25 1015759 amiodarone (PACERONE) 100 mg tablet 220.70 1015767 baclofen (LIORESAL) 5 mg tablet 16.35 1015775 escitalopram (LEXAPRO) 5 mg tablet 59.55 1015783 hydrochlorothiazide (HYDRODIURIL) 1 5.65 1015791 sodium bicarbonate 325 mg tablet 0.40 1015809 tiZANidine (ZANAFLEX) 2 mg tablet 23.10 1015817 cyanocobalamin (VITAMIN B-12) 500 m 4.20 1015825 metoprolol (TOPROL XL) 12.5 mg (1/2 16.40 1015833 sotalol (BETAPACE) 40 mg (1/2 of 80 5.95 1015841 traZODone (DESYREL) 25 mg (1/2 of 5 2.00 1015858 LORazepam (ATIVAN) 0.25 mg (1/2 of 2.25 1015866 warfarin (COUMADIN) 0.5 mg tablet ( 8.15 1015874 propranolol (INDERAL) 5 mg tablet ( 5.40 1015882 lurbinectedin (ZEPZELCA) 4 mg Injec 105,066.75 1016690 mitoMYcin ophthalmic (MITOSOL) KIT 4,738.80 1016751 potassium chloride IVPB - 10 mEq/SW 77.65 1016815 lactated ringers LVP - 250 mL 128.85 1016849 selegiline (ELDEPRYL) capsule - 5 m 30.40 1017334 mineral oil, (MURI-LUBE) - 10 220.50 1018126 saliva substitute (BIOTENE MOISTURI 69.60 1018167 epoetin alfa epbx (RETACRIT) inject 349.45 1018175 epoetin alfa epbx (RETACRIT) inject 524.15 1018183 epoetin alfa epbx (RETACRIT) inject 698.90 1018191 epoetin alfa epbx (RETACRIT) inject 1,747.20 1018209 epoetin alfa epbx (RETACRIT) inject 6,988.65 1018282 calcitonin (MIACALCIN) - 200 units/ 42,895.80 1018514 lidocaine-EPINEPHrine 1%-1:100,000 80.40 1018548 isavuconazonium (CRESEMBA) 372 mg I 4,323.80 1018621 eculizumab (SOLIRIS) 300 mg injecti 103,324.35 1018688 sodium zirconium cyclosilicate (LOK 356.25 1018746 bupivacaine 0.125%-fentanyl 2 mcg/m 241.60 1018829 riTUXimab-abbs (TRUXIMA) 100 mg Inj 13,393.55 1018837 riTUXimab-abbs (TRUXIMA) 500 mg Inj 66,967.60 1018860 calcium acetate (PHOSLO) 667 mg tab 2.00 1018993 (SUBUTEX) 2 mg sublin 59.85 1019017 baricitinib (OLUMIANT) 2 mg tablet 1,195.95 1019041 HYDROmorphone (DILAUDID) 0.5 mg/0.5 65.75 1019280 riTUXimab-pvvr (RUXIENCE) 100 mg In 11,354.15 1300441 RESP CPAP PER DAY 4,878.00 1300466 RESP IPPB INITIAL 1,276.00 1300540 RESP AEROSOL TREATMENT INITIAL 1,276.00 1300581 RESP SPUTUM COLLECTION INITIAL 1,276.00 1300771 RESP INHALER TREATMENT INITIAL 1,276.00 1300839 BRONCHIAL HYGIENE SUB SAME DAY 847.00 1300961 RESP BRONCHIAL HYGIENE INITIAL 1,044.00 1301019 SUPER DIMENSION BRONCHOSCOPY 6,891.00 1301076 MECH CHEST WALL OSCILLATION INITIAL 1,074.00 1301100 MECH CHEST WALL OSCILLATION SUBS 1,074.00 1301225 RESP BRONCHIAL ALVEOLAR LAVAGE 4,591.00 1301241 HIGH HUMIDITY OXYGEN 1ST HOUR 1,157.00 1301258 INTER PERCUSS VENTILATION INITIAL 1,044.00 1301266 RESP HIGH HUMDITY OXYGEN ADD HR 1,157.00 1301274 RESP INTER PERCUSS VENT SUBSEQUENT 847.00 1301308 RESP PEAK FLOW IP ONLY DX 441.00 1301381 RESP BIPAP PER DAY 4,878.00 1301449 RESP VENT - 2 TOWER SUBSEQUENT 9,614.00 1301456 RESP VENT 2-TOWER DAY ONE 9,614.00 1301464 RESP VENT ICU SUBSEQUENT 9,614.00 1301472 RESP VENT ICU DAY ONE 9,614.00 1301498 RESP ADULT OSCILLATOR DAY ONE 9,614.00 1301506 RESP ADULT OSCILLATOR SUBSQUENT 9,614.00 1301605 OP CODE BLUE W/ PULM RESUSCITATION 441.00 1301613 OP CODE BLUE WITH CPR 1,522.00 1301688 RESP PDN ASSESSMENT SUBSQNT 643.00 1301696 RESP PDN ASSESSMENT INITIAL 643.00 1301761 BLOOD GAS ANALYSIS 999.00 1301779 STANDARD RESP CCM 345.00 1301787 STANDARD RESP CCM ADD-ON 190.00 1301795 COMPLEX RESP CCM 616.00 1301803 COMPLEX RESP CCM ADD-ON 220.00 1350297 BLOOD GASES & ELECTROLYTES 1,478.00 1350305 BLOOD GASES, VENOUS 1,478.00 1350313 PULSE OXIMETRY ONE-TIME ONLY 1,050.00 1350321 LAB BODY FLUID-PH 392.00 1350370 IONIZED CALCIUM 268.00 1350388 PULMONARY STRESS TEST 6 MINUTE WALK 875.00 1350396 AIRWAY RESISTANCE BY OSCLMT 580.00 1350404 ARTERIAL BLOOD GAS SINGLE USE 658.75 1370030 BRONCHOSCOPY FIBEROPTIC 4,174.00 1370824 ULTRASONIC BRONCHOSCOPY 693.00 1380054 OBRT CPAP PER DAY 4,878.00 1380062 OBRT FREE FLOW SUBSEQUENT 446.00 1380070 RTOB AEROSOL TREATMENT 446.00 1380096 OBRT SPUTUM COLLECTION 446.00 1380112 OBRT EXOSURF ADMIN 441.00 1380161 OBRT HOOD 423.00 1380310 OBRT FREE FLOW 1 PER DAY 446.00 1380328 OBRT AEROSOL TENT INITIAL 446.00 1380336 OBRT BLOOD GASSES/ELECTROLYTES 1,478.00 1380344 OBRT BLOOD GASES, VENOUS 1,231.00 1380351 OBRT PULSE OXIMETRY ONE-TIME 1,050.00 1380377 OBRT SW PSYCHOSOCIAL ASSESSMENT 511.00 1380385 OBRT INHALER TREATMENT 446.00 1380401 OBRT PNEUMOGRAM STUDY 1,618.00 1380419 OBRT NITRIC OXIDE-PER DAY 19,601.00 1380427 NITRIC OXIDE ADMINISTRATION PER HR 828.00 1390087 HYPERBARIC THERAPY INIT. 3,612.00 1390095 HYPERBARIC THERAPY, BASIC 3,612.00 1390434 RESP FREE FLOW INITIAL TX/DAY 1,276.00 1390475 HYPERBARIC TRANSCUT STUDY-IP 1,167.00 1390574 HYPERBARIC M/CARE EA 30 MIN 434.00 1390582 HYPERBARIC M/CAL SUBQ 15 MIN 221.00 1390590 HYPERBARIC M/CAL 1ST 15 MIN 221.00 1390608 RESP OXIMETRY TREND OVERNIGHT STUDY 1,382.00 1390616 SMOKING CESSATION OP SYMPTOMS >10M 199.00 1390624 TRACH CARE OP ONLY 284.00 1400076 LAB PF SINGLE BREATH 1,202.00 1400084 LAB PF-VITAL CAP 331.00 1400092 LAB PF-SCREENING 869.00 1400100 LAB PF-BEFORE 1,107.00 1400118 RESP PF BEFORE & AFTER 2,164.00 1400126 LAB N2 WASHOUT 1,202.00 1400134 LAB THORACIC GAS VOL 696.00 1400159 LAB PF-DLCO 1,015.00 1400167 LAB PF C02 INFRARED 1,227.00 1400225 LAB PF BEDSIDE SCRN 869.00 1400258 LAB AIRWY RESISTANCE 696.00 1500081 SP PULMONARY 4,982.00 1500156 SP ARCH AORTA, DSA 8,891.00 1500370 SP ABD FLUSH 4,693.00 1500412 SP RENAL UNILATERAL 13,574.00 1500438 SP ADRENAL BILAT 4,854.00 1500479 SP RENAL BILAT 13,574.00 1500552 SP AORTA ILIAC FEMORAL ANGIO 16,050.00 1500610 SP EXTREMITY ANGIOGRAM UNILATERAL 8,891.00 1500636 XR ANGIO,IN SURG. 979.00 1500644 XR SUP.VENA CAVA 6,136.00 1500743 SP VENACAVA DSA INFERIOR 7,749.00 1500776 SP RENAL REN ONLY 4,275.00 1500834 XR VENOGRAM UNILAT EXTREM 3,945.00 1500842 XR VENOGRAM, BILATERAL EXT 2,929.00 1500883 XR FLUOROSCOPY LESS THAN 1 HR 1,462.00 1501063 SP ABSCESS DRAIN CATH PLACMNT 6,236.00 1501147 SP PTA,TIBIOPER & BRANCHS 20,384.00 1501170 SP PTA,ILIAC ARTERY 20,384.00 1501188 SP PTA,FEMORAL- 20,384.00 1501196 SP ANGIOPLASTY INITIAL ARTERY 28,125.00 1501477 SP PERC PLCMNT IVC FILTER 6,894.00 1501568 SP BILIARY DRAINAGE INT/EXT 4,603.00 1501584 SP PERC BILIARY STR W OR WO STENT 7,370.00 1501931 XR EYE F.B.W/LOCAL 1,010.00 1501949 XR MANDIBLE,LIMIT 884.00 1501956 XR MANDIBLE COMPLETE 595.00 1501972 XR MASTOID MIN 3 VWS PER SIDE 595.00 1501980 XR INT AUDITRY CAN 2,106.00 1502004 XR FACIAL BONE,ITD 1,294.00 1502012 XR FACIAL BONES 1,626.00 1502038 XR FACIAL W/NASAL 1,626.00 1502046 XR NASAL BONES 995.00 1502061 XR OPTIC FORAMINA 842.00 1502079 XR SINUSES,LIMITED 724.00 1502087 XR SINUSES COMPLETE 1,695.00 1502095 XR SELLA TURCICA 702.00 1502103 XR SKULL,LIMIT 995.00 1502111 XR SKULL 1,767.00 1502145 XR TEETH COMPLETE 884.00 1502152 XR TMJ JOINTS 1,417.00 1502160 XR NECK (TISSUES) 646.00 1502178 XR MAXILLA 1,626.00 1502202 XR SIALOGRAM 945.00 1502277 XR IVPW/TOMOGRAPH 2,301.00 1502301 XR CHEST,1 VIEW 739.00 1502319 XR CHEST,2 VIEW 914.00 1502327 XR CHEST W APICAL LORDOTI 995.00 1502335 XR CHEST 4 V 764.00 1502343 XR CHEST W/FLUORO 558.00 1502400 XR RIBS BILATERAL 1,086.00 1502418 XR STERNUM 914.00 1502426 XR STERNOCLAVICLAR 842.00 1502459 XR SPINE, ANY LEVEL 1 VIEW 608.00 1502467 XR SPINE, CERV MIN 4 VIEWS 1,271.00 1502483 XR SPINE,CERV W/OB 1,571.00 1502491 XR SPIN,CERV W/BND 1,571.00 1502509 XR T-SPINE 3 VIEWS 1,069.00 1502525 XR THORACOLUMBAR JUNCTION 2V 1,417.00 1502558 XR SPINE, LUMBAR 3V 1,648.00 1502566 XR SPINE LUMBISAC COMP W/OBLIQUE 1,754.00 1502574 XR SPINE LS COMP W/BENDING VIEW 1,754.00 1502590 XR PELVIS 1V 927.00 1502608 XR PELVIS 2 VIEW 927.00 1502624 XR SACRO-ILIAC MIN 3 VIEWS 962.00 1502632 XR SACRUM&COCCYX 1,064.00 1502640 XR MYELOGRAM, CERV 5,366.00 1502657 XR MYELOGRAM, COMP 4,892.00 1502665 XR MYELOGRM,LUMBAR 2,525.00 1502681 XR DISCOGRAM, LUMBAR 3,429.00 1502749 XR ARTHRODGRAM SHOULDER 1,965.00 1502756 XR AC JOINTS,BI. 1,126.00 1502806 XR ELBOW ARTHROGRAM 1,260.00 1502848 XR WRIST ARTHROGRAM 1,061.00 1502871 XR FINGERS,RIGHT 582.00 1502921 XR HIP,BILATERAL 2V 595.00 1502939 XR HIP ARTHROGRAM 1,088.00 1502962 XR PELVIS,INFANT 2V 503.00 1503010 XR KNEE ARTHROGRM 1,924.00 1503036 XR LOWER EXTREMITY, INFANT 360.00 1503077 XR ANKLE ARTHROGRAM 1,370.00 1503119 XR TOES,RIGHT 625.00 1503143 XR ABD IV 360.00 1503150 XR ABDOMEN 2V 1,083.00 1503184 XR ESOPHAGUS 1,486.00 1503200 XR UPPER GI TRACT W/KUB 1,984.00 1503218 XR UGI SINGLE CONTRAST 1,984.00 1503226 XR UPPER GI&BOWEL 2,909.00 1503234 XR UGI W/KUB HD BARIUM 1,716.00 1503259 XR SMALL BOWEL 1,777.00 1503275 EN COLON,BARIUM 2,837.00 1503283 XR BARIUM ENMA/AIR 2,837.00 1503309 XR CHOLECYSTO (GB) 1,077.00 1503325 XR CHOLANG, SURG 1,401.00 1503333 XR CHOLANG SURG ADDED SET 187.00 1503416 XR BILIARY ENDOSCOPIC CATHETER 2,227.00 1503424 XR PANCREATIC ENDOSCOPIC CATH 2,280.00 1503432 XR GI TUBE PLACEMENT 1,022.00 1503440 XR NASAL GASTROINTEST INAL 905.00 1503465 XR ESOPHEAGEAL DILATION 7,370.00 1503473 XR ERCP-BILIARY & PANCREATIC 2,280.00 1503499 XR IVP (UROGRAPHY) 2,301.00 1503523 XR ANTEGRADE PYELOGRAM 2,080.00 1503531 XR RETRO PYLOGRAM 2,301.00 1503549 SP PERC ANTEGRADE PYELOGRAM 2,301.00 1503556 SP URETER STENT PLACEMENT 3,485.00 1503564 XR CYSTOGRAM 2,301.00 1503598 XR RETRO URETH 2,301.00 1503606 XR URETHROCYSTOGRAPHY,VI 2,301.00 1503614 XR VOIDING CYSTOURETHROGRAM 2,301.00 1503630 XR RENAL CYST STUDY 4,066.00 1503655 SP NEPHROSTOMY DILATIONAL 7,295.00 1503663 XR PELVIMETRY 1,543.00 1503697 XR HYSTEROSALPINGRAM 882.00 1503747 SP AORTOGRAPHY, THORACIC BY SERI 8,891.00 1503770 SP CERVICOCEREBRL (ARCH) 13,502.00 1503812 SP CAROTID EXTERNAL UNILATERAL 22,878.00 1503820 SP EMBOLIZATION TRANSCATH THER 9,491.00 1503838 SP CAROTID/CERE COMMON UNILAT 25,922.00 1503911 SP VERTEBRAL NON SELECTIVE UNIL 14,642.00 1503937 SP SPINAL ANGIO SELECTIVE 7,434.00 1503960 SP EXTREMITY ANGIO BILATERAL 8,891.00 1503986 SP VISCERAL SUPRASEL ANGIO 8,891.00 1503994 SP ADRENAL UNILAT SELECT ANGIO 9,992.00 1504000 SP PELVIC SELECT ANGIO 8,891.00 1504018 SP PULMONARY UNILAT SELECT ANG 4,982.00 1504026 SP PULMONARY BIL SELECT ANGIO 8,891.00 1504034 SP INTERNAL MAMMARY ANGIO 7,434.00 1504042 SP SELECTIVE ADDED VESSEL 4,778.00 1504059 SP AV DIALYSIS SHUNT ANGIOGRAM 5,936.00 1504109 SP LYMPHANGIO PELV/ABD UNI 3,944.00 1504133 SP VENOGRAPHY CAVAL SUPERIOR S 6,136.00 1504166 SP VENOGRAPHY ADRENAL BI SELEC 11,710.00 1504174 SP VENOGRAPHY SINUS/JUGULAR CA 8,921.00 1504182 SP VENOGRAPHY ORBITAL 7,434.00 1504190 SP PERCUT TRANSHEP PORT W/HEMO 7,362.00 1504208 SP PERCUT TRANSHEP PORT W/O 7,362.00 1504216 SP INTRACRAN INFU,EA ADD TERRITORY 4,057.00 1504232 SP PERCUT PLACMT IVC FILTER 20,123.00 1504281 SP ANGIOPLASTY,EA ADD'L-ADD ON CODE 7,030.00 1504299 SP VENOPLASTY EACH ADD'L VEIN-ADD 7,030.00 1504315 SP VENOPLASTY INITIAL VEIN 28,125.00 1504455 XR FB INFANT, 1 FILM 888.00 1504463 XR BONE AGE 439.00 1504471 XR BONE LENGTH 892.00 1504489 XR BONE SURVEY COMPLETE 3,198.00 1504497 XR BONE SURVEY LIMITED 1,343.00 1504505 XR INFANT SURVEY 2,061.00 1504513 XR JOINT SURVEY, 1 VIEW 615.00 1504521 XR FISTULA-SINUS 1,086.00 1504596 BC DUCTOGRAM 1,036.00 1504638 BC MAMMOGRAM, MOTHERS DAY 65.00 1504661 XR FLUORO GUIDE FOR NEEDLE PCMT 2,257.00 1504687 XR ESOPHAGUS W/VID 1,777.00 1504810 US THYROID NECK 2,278.00 1504828 US RIGHT THORACENTESIS 2,475.00 1504836 US CHEST 1,808.00 1504869 US PLEURAL EFFUSION 1,808.00 1504877 US GUIDE CYST 1,734.00 1504885 US ABDOMEN COMPLETE 3,169.00 1504893 US ABDOMEN RLQ(APPENDIX) 2,456.00 1504901 US LIVER 2,456.00 1504919 US GALLBLADDER 2,456.00 1504927 US 2,547.00 1504935 US PANCREAS 2,456.00 1504943 US SPLEEN 2,456.00 1504950 US AORTA,DUPLEX SCAN 2,547.00 1504968 US RETROPERITONEAL COMP 2,547.00 1504976 US URINARY BLADDER 2,547.00 1504992 US OB AFTER 1ST TRIMESTER 2,735.00 1505007 US OB REPEAT 1,491.00 1505015 US BIOPYSICAL PROFILE 1,912.00 1505023 US PLACENTAL LOCAL 1,160.00 1505031 US PELVIC, ENDOVAGINAL 2,448.00 1505049 US IUD LOCALIZTION 2,448.00 1505056 US PELVIC NON-OB 2,448.00 1505064 US OB POSITION 1,160.00 1505072 US ECHOGRAPHY TRANSRECTAL-PROSTATE 1,692.00 1505080 US AMNIOCENTESIS 2,367.00 1505098 US NEONATE HEAD 1,970.00 1505106 US PELVIC NON-OB LIMITED 2,343.00 1505114 US TESTICULAR WITHOUT DUPLEX DOPPLE 2,278.00 1505122 US SHOULDER 2,448.00 1505130 US EXTREMITY, COMPLETE 2,448.00 1505163 US AMNIOTIC FLUID INDEX 1,160.00 1505197 US GUIDANCE FOR NEEDLE BIOPSY 1,734.00 1505205 US THERAPY PLN ECHO FOLLOW-UP 3,260.00 1505213 US ECHOGRAPHY, INTRAOPERATIVE 3,260.00 1505221 US ECHOGRAPHY TRANSRECTAL 1,692.00 1505429 XR HYPAQUE ENEMA 2,837.00 1505445 SP NEPH TUBE PLACEMENT/EXT DRN 3,910.00 1505510 XR CINERADIOGRAPHY 1,424.00 1505536 BC MAMMARY DUCT MULITPLE DUCTS 4,264.00 1505544 US OB LIMITED 1,160.00 1505577 US BILIARY 3,169.00 1505585 XR HIP INFANT 2V 503.00 1505650 BC US GUIDED BREAST FNA 1,734.00 1505668 US DOPPLER,ABD,RENAL OR PELVIS 4,101.00 1505676 BC US BREAST CYST ASPIRATION 1,734.00 1505742 US LIMITED QUADRANT 2,456.00 1505759 US GUIDANCE DRAINAGE 1,734.00 1505767 XR SPINE,CERV 2V LIMITED 906.00 1505775 US GROIN 2,058.00 1505791 XR MYELOGRAM, THORACIC 2,525.00 1505809 XR BE FOR REDUCTION OF INTUSS 620.00 1505874 US PYLORIC STENOSIS 2,456.00 1505965 XR LOOQOGRAM 2,080.00 1505981 ENTEROCLYSIS TRAY 1,431.00 1506005 BC INTERVENTIAL RADIOLOGY 2 2,616.00 1506013 BC MOTHERS DAY MAMMO W/TOMO 65.00 1506021 BC SCREENING MAMMO W/TOMO 734.00 1506039 BC SCREENING MAMMO IMP W/TOMO 734.00 1506187 US SPINAL CANAL & CONTENTS 1,277.00 1506583 US RETROPERITONEAL LIMITED 2,547.00 1506591 BC DIAG MAMMO BILAT W/TOMO 1,051.00 1506609 BC DIAG MAMMO RIGHT W/TOMO 364.00 1506617 BC DIAG MAMMO LEFT W/TOMO 364.00 1506641 BC INTERVENTIONAL RADIOLOGY 4 4,542.00 1506666 XR PEDIATRIC CHEST SINGLE VIEW 739.00 1506674 XR PEDIATRIC ABDOMEN 360.00 1506682 XR BONE SURVEY-CHD(1>COMPLETE 3,198.00 1506690 SP REMOVAL VENOUS PORT CATH 5,453.00 1506708 SP TRANSCATHETER BIOPSY 4,855.00 1506716 SP EMBOLIZATION OR INFUSION THY F/U 1,593.00 1506724 SP FLUOROGUIDE-PLACE INJ PORT 5,453.00 1506732 SP FLUORO-GUIDE VENOUS CATH CHK 882.00 1506740 SP NERVE BLOCK CERV OR THORACIC 4,157.00 1506757 SP FACET INJ CERV OR THORACIC 4,492.00 1506765 SP ADDITIONAL FACET/NERVE INJECT 1,635.00 1506773 SP EPIDURAL/CAUDAL INJECTION 2,454.00 1506781 SP EPIDURAL BLOOD PATCH 2,974.00 1506799 SP TRIGGER POINT INJECTION 1,401.00 1506807 SP INSERTION EPIDURAL CATHETER 2,479.00 1506849 SP PARAVERTEBRAL FACET MULTIPLE 2,479.00 1506856 SP PARAVERTEBRAL FACET SINGLE 2,479.00 1506864 SP REMOVE DRAINAGE CATHETER 615.00 1506872 SP NEPHRO CATH CHANGE 4,603.00 1506880 SP THROMBECTOMY ARTERY/VENOUS 4,750.00 1506914 SP DISCOGRAM CERVICAL 4,822.00 1506922 SP SACROILIAC INJECTION 4,157.00 1506948 SP LUMBAR PUNCT/DIAG.W/FLURO INJ 2,796.00 1506955 SP MICRO CATHETER 2,476.00 1506963 SP PICC LINE PLACEMENT-FLUOROGD 5,453.00 1506971 SP STELLATE GANGLION INJECTION 2,479.00 1506989 SP CHEST TUBE INJERTION 2,256.00 1506997 SP CERVICAL EPIDURAL INJECTION 2,479.00 1507003 SP PERC BILIARY DRAINAGE EXTERNAL 4,003.00 1507011 SP PERC BILIARY DRAINAGE INT&EXT 4,964.00 1507029 SP CHANGE GASTROSTOMY TUBE 3,976.00 1507037 SP PERC PLACEMENT GASTROSTOMY TB 3,686.00 1507045 SP NEEDLE ASPIRATION UNDER FLUOR 2,257.00 1507052 SP BALLOON CUTTING 4,000.00 1507060 SP BALLOON OCCLUSION 1,508.00 1507078 SP PICC LN PLCMT PED-FLUOROGUID 5,453.00 1507086 SP CENTRAL LINE PLACEMENT 4,403.00 1507110 INTERVENTIONAL RADIOLOGY 1 3,000.00 1507128 INTERVENTIONAL RADIOLOGY 2 2,158.00 1507136 INTERVENTIONAL RADIOLOGY 3 4,463.00 1507144 SP MICRO CATHETER/WIRE SET 3,528.00 1507151 SP TRANDUCER KIT 79.00 1507169 SP SUTURE 16.00 1507177 SP TIPPS 5,561.00 1507185 US GUIDANCE FLUID ASPIRATION 1,734.00 1507193 SP CHORO PREP 25.00 1507219 US OB TRANSVAGINAL 1,491.00 1507227 US GUIDANCE FOR VASCULAR ACCESS 1,394.00 1507235 US PARACENTESIS 2,507.00 1507250 BC US NEEDLE LOCALIZATION 1,734.00 1507268 US ABDOMEN RUQ 2,456.00 1507284 US EYE (OPHTHALMIC) 1,901.00 1507292 US SOFT TISSUES OF HEAD&NECK 2,278.00 1507300 US GUIDED COMPRESSION REPAIR 1,901.00 1507318 SP CHANGE OF TUBE OR CATH W/CNT 4,603.00 1507326 SP FLUOROGUIDE REPOST CENT LINE 4,585.00 1507367 SP PELVIS ANGIOGRAM/SELECTIVE 8,891.00 1507383 SP RENAL VENOUS UNILAT 4,738.00 1507391 SP RENAL VENOUS BILAT 5,628.00 1507516 BC SPECIAL VIEWS RIGHT W/TOMO 364.00 1507524 BC SPECIAL VIEWS LEFT W/TOMO 364.00 1507532 US OB-1ST TRIMESTER 2,517.00 1507540 US OB-1ST TRIMESTER,EA ADD GEST 870.00 1507557 US OB, TRANSVAGINAL 1,491.00 1507565 US OB AFTER 1ST TRIM,EA ADD GES 2,653.00 1507573 US BREAST-RADIOLOGY AFTER HOURS 2,278.00 1507581 BC SPECIAL VIEWS BILAT W/TOMO 1,051.00 1507607 SP EPIDURAL INJECTION-CERVICAL 2,796.00 1507615 SP EPIDURAL INJECTION -LUMBAR 2,796.00 1507623 SP EPIDURAL INJECTION -THORACIC 2,796.00 1507631 SP ADRENAL BILAT ANGIO 4,854.00 1507664 SP CATHETER STRIPPING 984.00 1507698 SP HEPATIC VENOGRAM W/O HEMODYNAMIC 4,982.00 1507714 SP ULTRASOUND ACCESS GUIDANCE 768.00 1507730 INTERVENTIONAL RADIOLOGY 4 8,150.00 1507748 SP TRANSCERVICAL CATH OF FALL TB 1,935.00 1507755 XR INCISIONAL BIOPSY NON IMAGING 3,379.00 1507763 SP VERTEBROPLASTY,LUMBAR 14,144.00 1507771 SP VERTEBROPLASTY THORACIC/CERV 14,002.00 1507797 SP VERTEBROPLASTY, ADD LEVEL 5,162.00 1507805 INTERVENTIONAL RADIOLOGY 5 3,000.00 1507813 INTERVENTIONAL RADIOLOGY 6 2,635.00 1507821 INTERVENTIONAL RADIOLOGY 7 5,072.00 1507839 INTERVENTIONAL RADIOLOGY 8 10,144.00 1507847 SP PAIN MANAGEMENT CONSULT 511.00 1507854 SP PAIN MGMT CONSULT W/ADD TEST 511.00 1507862 SP E&M LEVEL 5 91MIN & OVER 1,034.00 1507896 BC DIAG MAMMO BILAT IMP W/TOMO 1,051.00 1507904 BC DIAG MAMMO RIGHT IMP W/TOMO 364.00 1507912 6C DIAG MAMMO LEFT IMP W/TOMO 364.00 1507938 BC MOTHERS DAY MAMMO W/IMPLANTS 65.00 1507946 BC MOTHERS DAY MAMMO IMP W/TOMO 65.00 1507953 XR ANKLE 4 VIEWS,RIGHT 849.00 1507961 XR ANKLE 4 VIEWS,LEFT 849.00 1507979 XR ANKLE 1-2 VIEWS,RIGHT 625.00 1507987 XR ANKLE 1-2 VIEWS,LEFT 625.00 1507995 XR CLAVICLE,RIGHT 739.00 1508001 XR CLAVICLE,LEFT 739.00 1508019 XR ELBOW,COMPLETE,RIGHT 827.00 1508027 XR ELBOW,COMPLETE,LEFT 827.00 1508035 XR ELBOW,LIMITED,RIGHT 625.00 1508043 XR ELBOW,LIMITED,LEFT 625.00 1508050 XR EYE FOR FOREIGN BODY,RIGHT 1,010.00 1508068 XR EYE FOR FOREIGN BODY,LEFT 1,010.00 1508191 XR FOOT,RIGHT 849.00 1508209 XR FOOT,LEFT 849.00 1508217 XR FOOT LIMITED,RIGHT 625.00 1508225 XR FOOT LIMITED,LEFT 625.00 1508233 XR FOREARM RIGHT 827.00 1508241 XR FOREARM,LEFT 827.00 1508258 XR HAND 3-4 VIEWS,RIGHT 849.00 1508266 XR HAND 3-4 VIEWS,LEFT 849.00 1508274 XR HAND 1-2 VIEWS,RIGHT 625.00 1508282 XR HAND 1-2 VIEWS,LEFT 625.00 1508290 XR HEEL,RIGHT 827.00 1508308 XR HEEL,LEFT 827.00 1508316 XR HIP IN SURGERY,1V RIGHT 503.00 1508324 XR HIP IN SURGERY,1V LEFT 503.00 1508332 XR HIP UNILATERAL,RT 1V 503.00 1508340 XR HIP UNILATERAL LT 1V 503.00 1508357 XR HIP UNILATERAL RT 2V 503.00 1508365 XR HIP UNILATERAL LT 2V 503.00 1508373 XR HUMERUS,2 JOINTS,RIGHT 827.00 1508381 XR HUMERUS,2 JOINTS,LEFT 827.00 1508399 XR KNEE RT 1-2 VIEWS 613.00 1508407 XR KNEE LT 1-2 VIEWS 613.00 1508415 XR KNEE 4 VIEWS RIGHT 939.00 1508423 XR KNEE 4 VIEWS LEFT 939.00 1508431 XR ORBITS BILATERAL 1,593.00 1508449 XR ORBITS ONE EYE 1,593.00 1508456 XR RIBS,UNILATERAL RIGHT 1,086.00 1508464 XR RIBS,UNILATERAL LEFT 1,086.00 1508472 XR SCAPUAL RIGHT 915.00 1508480 XR SCAPULA LEFT 915.00 1508498 XR SHOULDER 1V RIGHT 625.00 1508506 XR SHOULDER 1V LEFT 625.00 1508514 XR SHOULDER COMPLETE RIGHT 827.00 1508522 XR SHOULDER COMPLETE LEFT 827.00 1508530 XR TIBIA/FIBULA RIGHT 849.00 1508548 XR TIBIA/FIBULA LEFT 849.00 1508654 XR WRIST AP&LAT,RIGHT 625.00 1508662 XR WRIST AP&LAT,LEFT 625.00 1508670 XR WRIST COMPLETE,RIGHT 849.00 1508688 XR WRIST COMPLETE,LEFT 849.00 1508696 XR CHEST SPCIAL VIEWS(DECUB) 745.00 1508704 XR KNEES BOTH STANDING AP 939.00 1508712 XR SPINE LS BENDING VIEWS ONLY 1,360.00 1508720 XR SPINE ENTIRE SURVEY AP&LAT 1,417.00 1508738 XR FEMUR RIGHT 2V 948.00 1508746 XR FEMUR LEFT 2V 948.00 1508753 XR KNEE 3 VIEWS-RIGHT 939.00 1508761 XR KNEE 3 VIEWS-LEFT 939.00 1508795 BC-INTERVENTIONAL DRAIN W/CATH 908.00 1508803 XR CHEST 2V W OBLIQUE 831.00 1508811 XR ABD SERIES AND PA CHEST 1,396.00 1508829 XR VASOGRAPHY 1,692.00 1508837 XR UPPER EXTREMITY,INFANT 550.00 1508845 XR FLUORO GUIDE FOR NEEDLE PLCMNT 2,257.00 1508852 SP E&M LEVEL 1 LESS THAN 15 MIN 511.00 1508860 SP E&M LEVEL 2 16-30 MIN 719.00 1508878 DRUG COATED BALLOON PTA CATHETER 7,000.00 1508894 SP E&M LEVEL 3 31-60 MIN 897.00 1508902 SP NERVE BLOCK LUMB OR SACRAL 5,040.00 1508910 SP PERCUT TNL CATH PLCMT-FL GDE 5,453.00 1508928 SP NERVE BLOCK LUMORSAC,ADD LVL 2,656.00 1508936 SP FLUROGUIDE FOR SPINE INJECT 2,796.00 1508944 XR ERCP-BILIARY DUCTAL SYSTEM 2,227.00 1508951 XR ERCP-PANCREATIC DUCTAL SYSTEM 2,280.00 1508969 US PARATHYROID 2,278.00 1508977 ZILVER DRUG ELUTING STENT 140MM 12,975.00 1508993 SP FACET INJ LUMBAR/SACRAL,ADDL 1,635.00 1509009 SP ANGIO SEAL DEVICE 1,757.00 1509017 SP NERVE BLOCK CERORTHO,ADD LVL 2,213.00 1509025 SP FACET INJ LUMBAR/SACRAL 4,492.00 1509041 ZILVER DRUG ELUTING STENT 40-60MM 7,475.00 1509058 SP DIALYSIS CATH INSERTION-FLOR 5,453.00 1509066 SP HEPATIC VENOGRAM W HEMODYNAMIC 4,982.00 1509074 SP FLUORO GUIDE FOR CNT VENOUS 5,453.00 1509090 BALLOON EXPANDABLE STENT 8,670.00 1509108 SP AUX ANGIOJET CATH 4,651.00 1509116 SP XVG ANGIOJET CATH 15,447.00 1509124 CATH VAXCEL DIALYSIS 28CM 5,210.00 1509132 DIALYSIS CATH 5,210.00 1509140 CATH VAXCEL DIALYSIS 19CM 2,715.00 1509157 STENT BILIARY LG PALMAZ BALL EXP 10,086.00 1509165 INTRO COOK CHECK-FLO LARGE VALVE 820.00 1509173 AMPLATZ RENA DILATOR SET 1,833.00 1509181 WALLSTENT BILIARY TRANSHEPATIC 8,741.00 1509199 STENT PALMAZ BILIARY BALL EXPAND 8,404.00 1509223 WALLGRAFT STENT TRACHEO 50MM 18,825.00 1509231 WALLGRAFT STENT TRACHEO 30MM 18,825.00 1509249 WALLGRAFT STENT TRACHEO 20MM 18,825.00 1509256 WALLGRAFT STENT TRACHEO 70MM 18,825.00 1509264 STENT URETERAL PERCUFLEX 1,076.00 1509272 WALLSTENT ENTERAL DELIVERY 90MM 10,421.00 1509280 WALLSTENT RP BILIARY DELIVERY 80M 9,412.00 1509298 WALLSTENT RP BILIARY DELIVERY SYS 9,412.00 1509306 STENT SMART BILIARY SYSTEM 80MM 7,733.00 1509314 STENT SMART BILIARY SYSTEM 60MM 7,733.00 1509322 STENT SMART BILIARY SYSTEM 40MM 7,733.00 1509330 STENT SMART BILIARY SYSTEM 20MM 7,733.00 1509348 STENT MED PALMAZ BILIARY/DELIVER 10,421.00 1509355 STENT CORINTHIAN 1Q & DELIVERY SY 8,067.00 1509363 STENT PALMAZ CORINTHIAN 1Q 7,398.00 1509371 CATH FLEXIMA BILIARY DRAIN W/PIG 865.00 1509389 THROMBO ARROW TERROTOLA 5,391.00 1509397 CATH VISTA BRITE TIP GUIDE 5FR 1,124.00 1509405 CATH VISTA BRITE TIP GUIDE 6FR 1,124.00 1509413 CATH VISTA BRITE TIP GUIDE 7FR 1,124.00 1509421 CATH VISTA BRITE TIP GUIDE 8FR 1,124.00 1509462 BALLOON CATH OPTA 5 PTA 2,267.00 1509470 BALLOON CATH POWERFLEX EXTREME 2,267.00 1509488 BALLOON CATH OPTA LP PTA 2,267.00 1509496 BALLOON CATH CENTURION OPTIPLAST 2,156.00 1509504 BALLOON CATH TALON 5,175.00 1509520 HYDROLYSER THROMBECTOMY CATH 7FR 6,902.00 1509538 HYDROLYSER THROMBECTOMY CATH 6FR 6,902.00 1509546 OASIS THROMBECTOMY CATH 6,450.00 1509553 WALLSTENT BILIARY TRANSHEPATIC 1K 10,086.00 1509561 WALLSTENT TIPS SYSTEM 60MM 10,086.00 1509579 WALLSTENT TIPS SYSTEM 40MM 10,086.00 1509587 WALLSTENT TIPS SYSTEM 20MM 10,086.00 1509595 WALLSTENT PERMALUME COVER&UNISTEP 12,775.00 1509603 STENT CORDIS SMART NITINOL 11,766.00 1509611 STENT CORINTHIAN BILIARY PALMAZ 8,908.00 1509629 WALLSTENT TRACHEOBRONCH COVERED 11,685.00 1509637 WALLSTENT TRACHEOBRONCHIAL/PERMU 10,546.00 1509645 PORTACATH 5,045.00 1509652 R-PORT PREMIER IMPLANTABLE DEVICE 5,045.00 1509660 BALLOON CATH ULTRATHIN DIAMOND 2,915.00 1509678 BALLOON CATH BLUE MAX 20 2,915.00 1509686 BALLOON CATH MARSHAL 2,915.00 1509694 BALLOON CATH RADIAL EXPANSION 2,479.00 1509702 PERCLOSE VAS DEVICE 1,681.00 1509710 VASOSEAL ES CLOSURE DEVICE 2,069.00 1509728 SP ANGIO SEAL INSERTION 430.00 1509736 SP ANGIOJET PUMP KIT 9,267.00 1509744 SP KYPHOPLASTY,LUMBAR 41,704.00 1509751 SP INSERT DUODEN OR JEJUN TUBE 3,686.00 1509769 SP REPLACE GASTRO OR J-TUBE 3,976.00 1509785 SP CHOLANG THRU EXISTING CATH 2,935.00 1509801 VISAPAQUE 320MG/ML IODINE PER ML 2.00 1509819 OMNIPAQUE 300MG/ML I0DINE PER ML 2.00 1509827 ZILVER DRUG ELUTING STENT 80-100MM 8,975.00 1509835 SP ATHERECTOMY PERIPHERAL 18,559.00 1509850 SP KYPHOPLASTY SUPPLY KIT 41,323.00 1509868 SP KYPHOPLASTY ADD'L LEVEL 8,681.00 1509884 SP THROMBC CT ART NON SHUNT SNDY 4,566.00 1509892 SP THROMBECT VENOUS NON SHUNT P 11,150.00 1509900 SP THROMABECT VENOUS NON SHUNT A 11,150.00 1509918 SP FLUOROSCOPIC PROCEDURE INTV 1,024.00 1509934 SP ATHERECTOMY PERIPH EA ADDL 16,380.00 1509942 SP ATHERECTOMY RENAL 18,559.00 1509959 SP ATHERECTOMY VISCERAL 18,559.00 1509967 SP US GUIDANCE FOR VICERAL ACC 1,734.00 1509975 SP VENOGRAPHY,SUP SAGITTAL SIN 8,921.00 1509991 SP MECH REMOVAL THRU DEVICE 984.00 1510007 SP AORTIC STENT ENDOVAS REPAIR-IP 4,359.00 1510015 SP AORTIC STENT,EXTENSION 1 PER IP 2,180.00 1510023 SP THROMBECT ART NON SHUNT PRMY 11,150.00 1510031 SP THROMBECT ART NON SHUNT AD U 4,566.00 1510049 INTERVENTIONAL RADIOLOGY 9 14,201.00 1510056 RS-XR HIP LEFT 2V 503.00 1510058 RS-XR HIP RIGHT 2V 503.00 1510072 SP NEPHROSTOGRAM THRU EXST CATH 2,301.00 1510080 SP DILAT OF NEPHRO TRACT-ENDOUR 7,295.00 1510098 SP GI(NG,G-TUBE,J-TUBE) CHECK 945.00 1510106 XR TOES,LEFT 625.00 1510114 XR FINGERS,LEFT 582.00 1510148 SP RF ABLATION,LUMBAR 5,870.00 1510155 SP BILATERAL URETER STENT PLACEMENT 6,970.00 1510163 SP RF ABLATION,THORACIC 3,400.00 1510171 SP PRESSURE WIRE 3,475.00 1510189 SP KYPHOPLASTY,THORACIC FLOURO 41,323.00 1510197 LOW OSMOLAR CONTRAST 300-399MG/ML 2.00 1510205 SP UTERINE FIBROID EMBOLIZATION 56,855.00 1510213 SP VENOUS CATH CHECK 276.00 1510221 SP INTRAPERITONEAL CATH PL PLEUREX 14,015.00 1510239 XR DISCOGRAM THORACIC 4,822.00 1510247 SP OFFICE CONSULTATION 719.00 1510254 SP ENDOVASC ILIAC STENT GRAFT 10,272.00 1510262 SP RFA VENOUS 5,868.00 1510270 SP RFA VENOUS ADD'L LEVEL 1,677.00 1510288 SP INJECTION THERAPY OF VEIN - 1 299.00 1510296 SP INJECTION THERAPY OF VEINS 299.00 1510304 STENT COVERED 5-9 19,475.00 1510312 STENT COVERED 10-14 14,611.00 1510320 DIAMONDBACK ATHERETOMY CATH 20,275.00 1510338 WIRE VIPER 1,165.00 1510346 CLOSER FAST RFA CATHETHER 4,049.00 1510353 PERFORATOR RFA CATH 1,957.00 1510361 HUBER POWERLOC NEEDLE 20 GX.75 36.00 1510387 PICC LINE INSERTION - OP 2,800.00 1510395 TRAY TRIPLE LUMEN PICC 304.00 1510403 TRAY DUAL LUMEN PICC 247.00 1510411 RFA ELECTRODES 17,746.00 1510429 LC BEADS CHEMO 11,819.00 1510452 SP CHEMOTHERAPY ADM ARTERIAL 653.00 1510478 SP SHUNT 2ND ACCESS 398.00 1510486 SP DECLOT OF VAS ACCESS DEVICE 1,214.00 1510494 SP IVUS CATHETER 4,875.00 1510502 US FOLLICLES,LIMITED 2,343.00 1510551 US SONOHYSTEROGRAPHY (SIS) 2,448.00 1510569 US GUIDE MONITOR TISSUE ABLTN 769.00 1510577 INTERVENTIONAL RADIOLOGY US GDN 2,158.00 1510593 US FAST SCAN FOR TRAUMA 2,456.00 1510627 US INTRAVASCULAR CORONARY VESSL 796.00 1510635 US INTRAVASCULAR EA ADDL VESSEL 398.00 1510643 US INTRAVASCULAR (NON-CORONARY) 961.00 1510650 US INTRAVASCULAR EA ADD'L VESSEL 324.00 1510668 XR EXTREMITY ANGIO UNILAT-MOD 59 8,891.00 1510676 XR EXTREMITY ANGIOGRAM UNILATERAL 8,891.00 1510684 SP US COVER 33.00 1510692 SP IO BAN 51.00 1510700 SP BACK STOP 41.00 1510718 SP G TUBE 1,373.00 1510726 SP AVA MAX VERT NEEDLE 2,726.00 1510734 SP TRIPLE LUMEN 132.00 1510742 POUCH MULTI-PURPOSE FLUID COLL 66.00 1510759 CATH YUEN CENTESIS 418.00 1510767 TRAY DRAINAGE CATH SAFE T CENT 391.00 1510775 SP SHUNTOGRAM 595.00 1510783 SP SUBCUTANEOUS SPINE INJECTION 550.00 1510791 SP SCLEROTHERAPY FLUID COLLECTION 2,911.00 1510809 SP RFA GANGLION 1,324.00 1510817 SP REMOVAL OF ABSCESS DRAIN CATH 511.00 1510825 CYSTOGRAFIN 141MG IOD 300ML PER ML 2.00 1510833 SINOGRAFIN 380MG IOD/10ML PER ML 5.00 1510841 SP REMOVAL OF URETERAL STENT 10,144.00 1510858 SP DILAT OF BIL DUCT ST W/WO STENT 7,370.00 1510866 PTA ILIAC ARTERY ADD LEVEL 20,384.00 1510874 PTA,ADD'L TIBIOPERONEAL 20,384.00 1510882 INTRAVACULAR STENT ILIAC UNILATERAL 24,475.00 1510890 INTRAVASCULAR STENT ILIAC EA ADD'L 24,475.00 1510908 INTRVSCLR STNT FMRL/POP W/WO PLASTY 56,546.00 1510916 INTRVSCLR STNT FMRL/POP&ARTHRCTMY 24,475.00 1510924 INTRVSCLR STENT TBOPRNL W/WO PLASTY 24,475.00 1510932 INTRAVASCULAR STENT TBOPRNL EA ADD 24,475.00 1510940 LOW OSMOLAR CONTRAST 300-399MG/ML 2.00 1510957 LOW OSMOLAR CONTRAST 100-199MG/ML 2.00 1510965 LOW OSMOLAR CONTRAST 200-299MG/ML 2.00 1510973 GASTROVIEW 367MG/ML PER ML 2.00 1510981 CYSTOGRAFIN 300MG/ML PER ML 2.00 1510999 XR SPINE,SCOLIOSIS SUP & EREC 2/3V 1,417.00 1511005 XR ESOPHAGUS PHRYNX / OR CERVCL 1,486.00 1511013 XR PEDIATRIC CHEST CROSS TABLE 739.00 1511039 XR FLOURO FOR SPINE INJECTION 2,796.00 1511054 XR RIBS UNILAT RT W CHEST PA 1,396.00 1511062 XR RIBS UNILAT LT W CHEST PA 1,396.00 1511070 INTVSCLR STN TBOPRNL&ATHRCTMY EA AD 24,475.00 1511088 ATHERECTOMY ILIAC EACH VESSEL 16,380.00 1511096 ATHRECTOMY TIB/PERONEAL W/WO PLASTY 18,559.00 1511104 ATHRCTMY ADD'L TIB/PRNL W/WO PLSTY 16,380.00 1511112 ATHERECTOMY ABDOMINAL AORTA 18,559.00 1511120 ATHERECTOMY BRACHIOCEPHALIC 18,559.00 1511138 INTRVSCLR STNT TBOPRNL&ARTHERECTOMY 24,475.00 1511146 SP SCLEROTHERAPY CYST 14,203.00 1511153 XR ABD 3 VIEWS 1,623.00 1511161 CATH PIONEER 13,975.00 1511179 COIL VASCULAR PLUG 5,039.00 1511187 BC-SCRNING MAMMO DIGITAL BILAT 734.00 1511195 BC-SCREENING IMPLANT DIGITAL BI-LAT 734.00 1511203 BC-DIAG MAMMOGRAM DIGITAL BI-LAT 1,051.00 1511211 BC-DIAG IMPLANT DIGITAL BILAT 1,051.00 1511229 BC-UNLIATERAL RIGHT DIGITAL 364.00 1511237 BC-UNILATERAL LEFT DIGITAL 364.00 1511245 BC-SPECIAL VIEWS LT DIGITAL 364.00 1511252 BC-SPECIAL VIEWS RT DIGITAL 364.00 1511302 BC DIAG MAMMO IMPLANT - LEFT 364.00 1511310 BC DIAG MAMMO IMPLANT-RIGHT 364.00 1511328 INTERVENTIONAL LOCALIZATION 1 5,856.00 1511336 INT LOCALIZATION 1 ADD'L SITE 5,856.00 1511344 INTERVENTIONAL LOCALIZATION 2 6,197.00 1511351 INT LOCALIZATION 2 ADD'L SITE 4,463.00 1511377 BC - BILATERAL SPEC VIEWS - DIGITAL 1,051.00 1511393 INTERVENTIONAL BIOPSY 1 8,273.00 1511401 INT BIOPSY 1 ADD'L SITE 8,273.00 1511419 US AAA SCREENING 2,547.00 1511427 BC SURGICAL SPECIMEN ULTRASOUND 606.00 1511435 BC INTERVENTIONAL RADIOLOGY 5 7,088.00 1511443 BC GUIDANCE TISSUE MARKER PLACEMENT 1,734.00 1511450 INTERVENIONAL LOCALIZATION 4 3,388.00 1511468 BC MRI CAD BREAST 81.00 1511476 BC GUIDANCE FOR LYMPHNODE BX 1,734.00 1511484 XR FLURO FOR PORTACATH NON RAD 5,453.00 1511492 XR CHEST 1V LATERAL 745.00 1511500 US EXTREMETY LIMITED 2,058.00 1511518 SP GJ TUBE INSERTION 5,072.00 1511526 XR ERCP BILIARY DUCTAL SYSTEM-OR 2,227.00 1511534 XR ERCP PANCREATIC DUCTAL SYS-OR 2,280.00 1511542 XR ERCP BILIARY&PANCREATIC-OR 2,280.00 1511559 XR ABDOMEN 1-VIEW SITZ MARKER 360.00 1511567 XR UGI TRACT W/O KUB 559.00 1511575 US LEFT THOROCENTESIS 2,475.00 1511583 XR GI (NG,G-TUBE,J-TUBE) CHECK 869.00 1511591 XR REMOVE ESOPHAGUS OBST W FLUORO 300.00 1511609 XR RIB SERIES BILAT W CHEST PA 522.00 1511617 US TRANSPLANTED KIDNEY W DOPPLER 773.00 1511625 SP TUNNLD PERITONEAL CATH FOR DRNG 15,072.00 1511633 SP REMOVAL OF NEPH TUBE W FLUORO 3,617.00 1511641 SP RENAL UNILATERAL 2ND ORDER 13,574.00 1511658 SP RENAL BILATERAL 2ND ORDER 13,574.00 1511674 CROSSER CATHETER 11,743.00 1511682 USHER CROSSER SUPPORT 2,187.00 1511690 EKKOS CATHETER 14,475.00 1511708 SP IVC FILTER REMOVAL 13,814.00 1511716 SP IVC FILTER REPOSITION 13,814.00 1511724 SP RFA LUMBAR/SACRAL EA ADDL JNT 3,400.00 1511732 SP RFA CERVICAL/THORACIC EA ADDL 1,189.00 1511757 PARACENTESIS W/O GUIDANCE 2,507.00 1511765 SP NASO OR ORO GASTRIC TUBE PL 574.00 1511773 SP INSERTION OF INDWELLING TN CATH 14,012.00 1511781 SP PERCUT CHOLECYSTOSTOMY 13,274.00 1511799 SP PERCUT CYSTOSTOMY 7,442.00 1511807 SP EMBOLIZATION OF ABSCESS/FISTULA 2,418.00 1511815 SP PL NEPHRO URET CATH I/E,NEW ACCE 7,397.00 1511823 SP PERITONEOGRAM 1,759.00 1511831 SP INSTALL VIA CHEST/CATH PLEURODES 2,228.00 1511849 SP SECONDARY THROMBECTOMY 11,150.00 1511856 EMP CHEST IV 739.00 1511864 SP TIPS REVISION 52,665.00 1511872 SP PERINEOGRAM 1,059.00 1511880 SP BILIARY DUCT BIOPSY 13,286.00 1511898 CT ABLATION RENAL TUMOR UNILAT 29,265.00 1511906 SP PLEURAL DRAINAGE W/INDWLLNG CATH 2,475.00 1511914 SP ARTERIAL INFUSION 4,782.00 1511922 SP THROMBOLYSIS VENOUS INFUSION 4,782.00 1511930 SP THROMBOLYSIS CONTINUED TREATMENT 10,669.00 1511948 SP THROMBOLYSIS CESSATION OF TRTMNT 10,669.00 1511955 SP CAROTID CEREBRAL INTERNAL UNILAT 22,082.00 1511963 SP VERTEBRAL SELECTIVE UNILATERAL 22,082.00 1511971 SP INTRACRANIAL BR OF CAROT OR VERT 1,070.00 1511989 SP DECLOG JEJUNOSTOMY OR OTHER TUBE 2,675.00 1511997 SP EXTREMITY ANGIO UNI W INTERVNTN 8,891.00 1512003 SP INTRO OF CATH TO URTER,EPL,RENAL 11,610.00 1512011 SP SELECTIVE ADDED VESSEL 4,778.00 1512029 SP VENOGRAM BILATERAL EXT 2,929.00 1512045 SP EXTREMITY ANGIO BILATERAL WI 8,891.00 1512052 FLOURO GUIDE FOR NEEDLE PLACEMENT 2,796.00 1512060 FLUORO GUIDE FOR NDLE PL NON SPINE 2,257.00 1512078 SP RECONSTRUCTION IMAGES 1,061.00 1512086 SP RECONSTRUCTION IMAGES SP WK 1,061.00 1512102 SP VISERAL SUPRASEL ANGIO ADDTL 8,891.00 1512128 US INFANT HIPS DYNAMIC 393.00 1512136 US INFANT HIPS, LIMITED STATIC 393.00 1512144 SP STENT PLCMNT INTRAV PERCUT ARTRL 51,828.00 1512151 SP ADDTNL STENT PLCMNT INTRAV PERCU 25,065.00 1512169 SP STENT PLCMNT INTRAV PRCT-VENOUS 51,828.00 1512177 SP ADDTNL STENT PLCMNT -VENOUS 25,065.00 1512185 SP EMBOLIZATION NON NEURO 56,855.00 1512193 US GUIDANCE FOR VASCULAR ACCESS 768.00 1512201 SP IMAGE GUIDE FL CL DRN BY CATH 7,025.00 1512227 SP POWER GLIDE INSERTION 2,800.00 1512235 SP PSEUDOANEURYSM TRT DRT PNCT 1,096.00 1512243 SP IVAS EACH ADD'L LEVEL 324.00 1512250 BC-INTERVENTIONAL LOC 3 5,856.00 1512268 BC-INTERVENTIONAL LOC 3 ADD'L SITE 5,856.00 1512276 BC-BREAST TOMO SCREENING 230.00 1512284 BC-BREAST TOMO DIAGNOSTIC UNILAT 230.00 1512292 BC-BREAST TOMO DIAGNOSTIC BILAT 230.00 1512300 BC-BREAST U/S COMPLETE RIGHT 1,139.00 1512318 BC-BREAST U/S COMPLETE LEFT 1,139.00 1512326 BC-BREAST U/S LIMITED RIGHT 1,139.00 1512334 BC-BREAST U/S LIMITED LEFT 1,139.00 1512342 BC-BREAST U/S LIMITED-BILAT 2,278.00 1512359 BC-BREAST U/S COMPLETE-BILAT 2,278.00 1512367 EMBOL PARTICLES 1,197.00 1512375 CATHETER ATHERECTOMY SILVERHAWK 18,115.00 1512383 SHEATH BALKIN 525.00 1512391 SHEATH RENAL 1,096.00 1512409 SHEATH FLEX CL07800 8F 100CM 949.00 1512417 TRAY THORACENTISE 643.00 1512425 GI FASTENERS/ANCHORS 1,003.00 1512433 NEEDLE HOLDER SHORT STOP 64.00 1512441 SCAPEL DISP #11 48.00 1512458 KYPHX XPANDER INFLATION SYRINGE 1,158.00 1512466 CATHETER QUICK CROSS 4FR 5,550.00 1512474 SHEATH PEELAWAY 540.00 1512482 KIT CENTRAL VEIN 1,027.00 1512490 CONTINU-FLO W/3 118.00 1512508 TRAY HYSTERO-SALPINGO 470.00 1512516 TRAY MYELOGRAM PH4320 790.00 1512615 WINGSPAN STENT SYSTEM 32,425.00 1512623 GATEWAY BALLOON CATHETER 5,375.00 1512631 ANGIOGUARD RX FILTER 7,750.00 1512649 PRECISE PRO RX STENT 8,250.00 1512656 GUIDEWIRE ANGLED ADVANTAGE 975.00 1512664 AVIATOR PLUS BALLOON CATHETER 1,085.65 1512672 TR BAND REGULAR TERUMO 225.00 1512680 SLENDER GLIDE SHEATH TERUMO 350.00 1512698 STENT COPE NEPHROURETEROSTOMY 610.00 1512706 STARBURST TALON SERIUM-FLEXELE 14,129.00 1512714 SHEATH GUIDING SHUITTLE SELECT 648.00 1512722 BALLOON HYPERFORM 7,120.00 1512730 CATHETER ECHELON 3,230.00 1512748 INJECTOR CADENCE PRECISION 2,440.00 1512755 BALLOON ECHELON 3,230.00 1512763 CATHETER MARATHON FLOW DIR 13,585.00 1512771 CATHETER MARKSMAN STENT 4,725.00 1512789 CATHETER ULTRAFLOW MICRO DIR 3,030.00 1512797 GUIDEWIRE MIRAGE 2,100.00 1512805 GUIDEWIRE AVIGO 1,935.00 1512813 GUIDEWIRE X-CELERATOR 1,380.00 1512821 KIT ONYX 12,439.00 1512839 DEVICE ALLIGATOR RETRIEVAL 11,535.00 1512847 NAVIEN DSC 5,120.00 1512854 BALLOON HYPERGLIDE 5,815.00 1512862 CATHETER ORION 4,480.00 1512870 CATHETER SLIP-CATH BEACON TIP 401.00 1512888 CATHETER CELLO BALLOON GUIDE 4,785.00 1512896 DX SLIM DELIVERY CATHETER 4,650.00 1512904 NEURON MAX DELIVERY CATHETER 1,975.00 1512912 NEURON DELIVERY CATHETER 2,975.00 1512920 REPERFUSION CATHETER 6,900.00 1512938 MAX SEPARATOR 14,850.00 1512946 VELOCITY DELIVERY MICROCATHETER 4,650.00 1512953 MAX ASPIRATION TUBINS 1,980.00 1512961 SEPARATOR 13,000.00 1512979 BARE AXIUM COIL 5,500.00 1512987 AXIUM 3D COIL 7,000.00 1512995 BARE AXIUM 3D COIL 5,500.00 1513001 BARE AXIUM PRIME 3D COIL 5,500.00 1513019 COIL RELEASE 1,250.00 1513027 CONCERTO HELIX COIL 2,975.00 1513035 COIL RELEASE HANDLE 1,338.00 1513043 COIL 400 COMPLEX EXTRA SOFT 12,500.00 1513050 COIL 400 CURVE EXTRA SOFT 10,500.00 1513068 J COIL 12,500.00 1513076 COIL 400 SOFT COIL 12,500.00 1513084 COIL 400 STANDARD COIL 12,500.00 1513092 AXIUM HELIX COIL 6,000.00 1513100 CANISTER KIT 1,850.00 1513118 BARE AXIUM HELIX COIL 5,000.00 1513126 CATHETER POWERGLIDE BASIC 262.50 1513142 CATHETER POWERGLIDE FULL 422.50 1513159 GATEWAY PTA BALLOON 5,366.00 1513167 DAC CATHETER 4,975.00 1513175 WINGSPAN STENT SYSTEM 30,215.00 1513183 TARGET DETACHABLE COILS ULTRA 9,096.00 1513191 TARGET DETACHABLE COILS HELICAL 5,760.00 1513209 TRANSEND GUIDEWIRE SOFT/PLATINUM 2,111.00 1513217 TRANSEND 300 GUIDEWIRE 2,520.00 1513225 EXCELSOR SL-10 MICRO CATHETER 4,296.00 1513241 EXCELSIOR XT-27 MICRO CATHETER 4,560.00 1513258 SYNCHRO GUIDEWIRE 2,424.00 1513266 INZONE DETACHABLE SYSTEM 1,002.00 1513274 IZDS CONNECTING CABLE 257.00 1513282 BALLOON GUIDE CATHETER 4,375.00 1513290 TREVO PRO VUE SYSTEM 36,475.00 1513308 SOLITAIRE FR DEVICE 31,685.00 1513316 ACCUSTICK INTRODUCER SYSTEM 1,526.00 1513324 BAG LEG DISP 124.00 1513332 BAG-A-JET 330.00 1513340 CANNULA OXYGEN 107.00 1513357 CATHETER HIGH FLOW 5FR PIG 664.00 1513365 CATH REG NON GLIDE 551.00 1513373 CATHETER HNBR5.038100PWMSSIM2 546.00 1513381 CATHETER HNBR5.038100PWNSH1 546.00 1513399 BILIARY EXT TUBE 1,755.00 1513407 CATHETER P5.0B3850M450 578.00 1513415 BALLOON SMALL VESSEL 4,881.00 1513423 CONNECTING TUBE HPCT8.880PFM 471.00 1513431 DILATORS 282.00 1513449 DRAPE FEMORAL ADULT 591.00 1513456 DRESSING GAUZE 29.00 1513464 DRESSING TEGADERM 10X12 71.00 1513472 SNARES 3,755.00 1513480 GOOSE-NECK SNARE GN1500 3,755.00 1513498 WIRE .035 EXCHANGE 524.00 1513506 WIRE GLIDE 895.00 1513514 WIRE REG 0.35 482.00 1513522 EMBOL .018 COILS 1,483.00 1513530 IV STARTER KIT 152.00 1513548 SPINAL NEEDLE LONG 330.00 1513555 SPINAL NEEDLE REG 100.00 1513563 NEPHROSTOMY SYSTEM 8F 1,526.00 1513571 RAZOR DISP 16.00 1513589 ROTATING HEMOSTATIC VALVE 958.00 1513605 SCISSORS SHAFT DISP MINI MET2 5M 289.00 1513613 INFUSION CATH 1,630.00 1513621 GI KIT 3,191.00 1513639 INFUSION WIRE 11,985.00 1513647 SET SUTURE REMOVAL 152.00 1513654 DRESSING STERILE 94.00 1513662 STOPCOCKS(3-WAY) 104.00 1513670 STOPCOCKS FLOSWITCH 273.00 1513688 TRAY ARTHROGRAM 677.00 1513696 TRAY MYELOGRAM PH4324A 594.00 1513704 TUBE EXTENSION K-50 52.00 1513712 WIRE COIL PUSHER 16 175CM 2,156.00 1513720 WIRE DEFLECT TIP 38 100 10 BH 1,057.00 1513738 CANISTER SUCTION 1200CC 210.00 1513746 CATH SUCTION 14FR 61.00 1513753 STERILE DRAPE COVER 156.00 1513761 TRAY ARTERIOGRAM 993.00 1513779 STERILE IV TUBING 193.00 1513787 NEPH CONNECTING TUBING 55.00 1513795 BIO-GUN 18G 7.5CM 889.00 1513803 CATHETER DRAINAGE 10FR 1,241.00 1513811 SHEATH REG 658.00 1513829 SHEATH LONG 549.00 1513837 IV CATHETER QUICK 22X1 57.00 1513845 IV CATHLON #20 128.00 1513852 IV INFUSION ST BTRFLY 21 16.00 1513860 STOPCOCKS 3-WAY NYLON 117.00 1513878 WIRE .018 COPE 667.00 1513886 SYRINGE DISP 200MI MED-RAD 273.00 1513894 MONARCH SYRINGE IN2001 2,021.00 1513902 CATH GLIDE/SLIP 1,027.00 1513910 DEVICE TORQUE OTD-100 243.00 1513928 CATHETER PICS 501 MPIS 1,331.00 1513936 LIVER BX SET 3,011.00 1513944 INTRODUCER MPIS-501-NT 786.00 1513951 GUIDEWIRE V-18 150CM 1,513.00 1513969 GUIDEWIRE TRANSEND .014 182CM 2,479.00 1513977 TRAY ANESTHESIA EPIDURAL 807.00 1513985 KYPHX INFLATABLE BONE TAMP 10,489.00 1513993 KYPHX OSTEO INTRODUCER 10,472.00 1514009 KYPHX BONE FILLER DEVICE 1,081.00 1514017 KYPHX CEMENT & MIXER 1,708.00 1514025 NEEDLE BONE BIOPSY 355.00 1514033 CEMENT DELIVERY SYSTEM EZ 3,806.00 1514041 SYRINGE DISCOGRAM PRESSURE 710.00 1514058 EMBOL 0.35 COILS 1,026.00 1514066 THROMBO CLOT BUSTER 7,700.00 1514231 TUNNELED DIALYSIS CATHETER 1,569.00 1514249 WIRE FILTER SPIDER 6,500.00 1514256 BALLOON REGULAR 4,038.00 1514265 STENT SELF EXPANDING 13,269.00 1514272 WIRE COIL PUSHER 16 175CM 2,156.00 1514280 IVC FILTER PERMAMENT 7,900.00 1514298 IVC FILTER REMOVABLE 7,900.00 1514306 ACUSTICK INTRODUCER SYSTEM 1,526.00 1514314 INFUSION WIRE 2,500.00 1514322 BILIARY CATH 1,755.00 1514330 INFUSION CATH 1,630.00 1514348 NEPHROSTOMY SYSTEM 8F 1,526.00 1514355 NEPH URETER INT STENT 2,516.00 1514363 GUIDEWIRE TRANSEND .014 2,479.00 1514371 GUIDEWIRE V-18 150CM 1,513.00 1514405 US POST THYROIDETOMY HEAD/NECK 2,278.00 1514413 SHEATH GUIDING SHUTTLE SELECT 648.00 1514421 CATHETER MARATHON FLOW DIR 13,585.00 1514439 TRANSEND GUIDEWIRE SOFT/PLATINUM 2,111.00 1514447 GUIDEWIRE MIRAGE 2,100.00 1514454 GUIDEWIRE AVIGO 1,935.00 1514462 SNARES 3,755.00 1514470 INTRODUCER MPSIS-NT 786.00 1514488 BALLOON SM3 OR LESS 4,881.00 1514496 SHEATH CONTRALATERAL 525.00 1514504 CATH GLIDE/SLIP 1,027.00 1514512 CATH REG NON GLIDE 551.00 1514520 ARC STROKE SUPPORT CATHETER 11,000.00 1514538 SP BONE TUMOR ABLATION 22,000.00 1514553 XR SHUNT SERIES 580.00 1514579 XR PELVIS AND HIPS 2V 595.00 1514587 XR FEMUR RIGHT 1V 590.00 1514629 XR PEDIATRIC CHEST 2V 914.00 1514926 SP CONV NEPHROSTOMY TO NEPHROURETER 2,622.00 1514934 SP ENDOLUMIN BX URETER RENAL PELVIS 7,532.00 1514942 URETERAL EMBOLIZATION OR OCCLUSION 7,532.00 1514959 SP REMOVE BILIARY TUBE W/FLUORO 2,235.00 1514967 SP PLACE ACCESS THRU BILIARY TREE 16,690.00 1514975 SP REMOVAL CALCULUS FROM BILE OR GB 4,175.00 1515006 SP PARVERTEBRAL BLOCK,THORACIC 3,672.00 1515048 SP SHUNT WITH PERIPHERAL PTA 28,125.00 1515055 SP SHUNT WITH STENT INSERTION 56,850.00 1515063 SP SHUNT WITH THROMBECTOMY 28,125.00 1515071 XR FEMUR LEFT 1V 590.00 1515089 SP COILING CAROTID CEREBRL INT UNIL 22,082.00 1515121 SP SHUNT W/THOMBECT & PERIPH PTA 56,850.00 1515139 SP SHUNT W/THROMB & PERIPH STENT 86,175.00 1515147 SP PTA OF CENTRAL DIALYSIS SECTION 7,030.00 1515154 SP STENT PLD IN CENT DIALY SEGMENT 7,030.00 1515162 SP DIALYSIS CIRCUIT EMBOLIZATION 7,030.00 1515204 MOD SEDAT-INITIAL 15MIN,< 5 YR OLD 130.00 1515212 MOD SEDAT-INITIAL 15MIN,> 5 YR OLD 70.00 1515220 MOD SEDAT-EA ADD'D 15MIN 65.00 1515238 MOD SEDAT OTHER PHY-INIT 15MIN <5YR 500.00 1515246 MOD SEDAT OTHER PHY-INIT 15MIN >5YR 410.00 1515253 MOD SEDAT OTHER PHY-EA ADD'D 15MIN 310.00 1515261 SP REM AND REP EXT ACC NEPH CATH 9,588.00 1515279 COIL TARGET ULTRA 360 10,750.00 1515287 COIL AXIUM BARE PRIME 8,975.00 1515295 PIPELINE EMBO DEVICE 71,500.00 1515311 LIFESTREAM BALLOON COVERED STENT 12,250.00 1515345 NAV 6 EMBO FILTER 8,475.00 1515352 NEURO GLUE EMBOLIC 19,635.00 1515360 KIT ONYX EMBOLIC 12,500.00 1515394 NEURO ENTERPRISE Z STENT 30,666.00 1515402 NEURO CODMAN COIL 9,998.00 1515410 STRYKER TREVO STROKE PACK 49,825.00 1515444 CATD INDIGO CATHETER 13,950.00 1515451 LANTERN MICROCATHETER 3,250.00 1515469 CATD SEPATATOR 8,400.00 1515501 VERTEBROPLASTY CEMENT 3,188.00 1515519 SP CHANGE URETERAL STENT THRU ILEAL 4,603.00 1515535 DRUG COATED BALLOON PTA CATHETER 7,000.00 1515543 BARRICADE COIL 2,975.00 1515550 ENDOCARE AMICA MICROWAVE PROBE 11,000.00 1515568 PULSE RIDER DEVICE 62,500.00 1515600 TURBO ELITE LASER CATHETER 16,000.00 1515634 XR ELBOW LT 2V(POST REDUCTION) 295.00 1515642 XR ELBOW RT 2V(POST REDUCTION) 295.00 1515659 XR ELBOW LT 2V(SURGERY ONLY) 295.00 1515667 XR ELBOW RT 2V(SURGERY ONLY) 295.00 1515675 AXIUM DETACHABLE COIL 7,000.00 1515683 XR HAND LT 2V(POST REDUCTION) 540.00 1515691 XR HAND RT 2V(POST REDUCTION) 540.00 1515709 XR HAND LT 2V(SURGERY ONLY) 540.00 1515717 XR HAND RT 2V(SURGERY ONLY) 540.00 1515733 XR SHOULDER LT 2V(POST REDUCTION) 295.00 1515741 XR SHOULDER RT 2V(POST REDUCTION) 295.00 1515758 XR SHOULDER LT 1V(SURGERY ONLY) 295.00 1515766 XR SHOULDER RT 1V(SURGERY ONLY) 295.00 1515782 XR WRIST LT 2V(POST REDUCTION) 295.00 1515790 XR WRIST RT 2V(POST REDUCTION) 295.00 1515808 XR WRIST LT 2V(SURGERY ONLY) 295.00 1515816 XR WRIST RT 2V(SURGERY ONLY) 295.00 1515832 VALIENT CAPTIVIA STENT GRAFT 76,595.00 1515840 EDURANT BIFURCATED GRAFT 47,380.00 1515857 EDURANT CONTRA LIMB GRAFT 23,632.00 1515865 EDURANT ILIAC EXTENSION GRAFT 23,632.00 1515881 EDURANT AORTIC EXTENSION GRAFT 35,510.00 1515899 APTUS ENDO ANCHOR 2,125.00 1515907 TALENT OCCLUDER 12,875.00 1515915 SENTRANT INTRO SHEATH 1,125.00 1515931 US SCLEROTHERAPHY FLUID COLLECTION 2,700.00 1515949 SP ANGIO W/LASER ARTHERECTOMY 49,505.00 1515956 SP ANGIO,LASER ATHER & STENT PLACEM 75,455.00 1515964 SP TIBIAL/PERO ANGIO W/LASER ATHERE 75,455.00 1515980 SP TIBIAL/PERO ANGIO LASER ATH/STEN 75,455.00 1515992 POWER LASER CATHETER 18,475.00 1515998 POD OCCLUSION DEVICE 8,950.00 1516004 POD PACKING COIL 8,950.00 1516012 NEUROFORM ATLAS STENT 36,250.00 1516020 XR ANKLE LT 2V(SURGERY ONLY) 360.00 1516038 XR ANKLE RT 2V(SURGERY ONLY) 360.00 1516046 XR ANKLE LT 2V(POST REDUCTION) 360.00 1516053 XR ANKLE RT 2V(POST REDUCTION) 360.00 1516087 XR FOOT LT 2V(SURGERY ONLY) 360.00 1516095 XR FOOT RT 2V(SURGERY ONLY) 360.00 1516103 XR FOOT LT 2V(POST REDUCTION) 360.00 1516111 XR FOOT RT 2V(POST REDUCTION) 360.00 1516129 XR KNEE LT 2V(SURGERY ONLY) 360.00 1516137 XR KNEE RT 2V(SURGERY ONLY) 360.00 1516145 XR KNEE LT 2V(POST REDUCTION) 360.00 1516152 XR KNEE RT 2V(POST REDUCTION) 360.00 1516160 XR TIBIA-FIBULA LT(SURGERY) 849.00 1516178 XR TIBIA-FIBULA RT(SURGERY) 360.00 1516186 XR TIBIA-FIBULA LT(POST REDUCTION) 360.00 1516194 XR TIBIA-FIBULA RT(POST REDUCTION) 360.00 1516228 XR KNEE LT 2V WEIGHT BEARING ONLY 360.00 1516236 XR KNEE RT 2V WEIGHT BEARING ONLY 360.00 1516244 PROTEGE CAROTID STENT 10,875.00 1516251 SPIDER EMBOLIC PROTECTION DEVICE 7,975.00 1516269 OPTIMA COIL 7,975.00 1516277 LUTONIX DRUG BALLOON .018 7,250.00 1516285 JET-7 REPERFUSION CATHETER 14,175.00 1516293 REVASCULARIZATION DEVICE 3D 26,950.00 1516301 REACT CATHETER 9,750.00 1516319 REACT CATHETER - 71 9,750.00 1516327 SNIPER OCCLUSION MICROCATHETER 6,000.00 1516335 PWR MIDLINE PROVENA 3FR SNGLE LUMEN 715.00 1516343 PWR MIDLINE PROVENA 4FR SINGL LUMEN 666.00 1516350 COVERA COVERED STENT 13,250.00 1516368 VENOVO STENT 8,500.00 1516376 EMBROTRAP STOKE RETRIEVER 32,000.00 1516384 JET D ASPIRATION CATHETER 14,175.00 1516392 PRESSURE SENSING SHEATH 8FRX25CM 4,250.00 1516400 JET D REPERFUSION CATHETER 13,975.00 1516418 SWIFT NINJA MICRO CATHETER 8,000.00 1516426 SP CAROTID ARTERY STENT PLACEMENT 30,955.00 1516434 XR UGI AND SMALL BOWEL FOLLOW THRU 2,909.00 1516442 SP PROSTATE ARTERY EMBOLIZATION 56,855.00 1516459 SP SELECTIVE ADDED VESSEL-XU 4,778.00 1516467 SP CHEMICAL ABLATION-SINGLE VEIN 5,868.00 1516483 VENASEAL CLOSURE SYSTEM CATHETER 9,195.00 1516491 CLOT TRIEVER CATHETER 40,000.00 1516509 CLOT TREIVER SHEATH 10,000.00 1516517 TRIEVER24 60,000.00 1516525 FLOW TRIEVER CATHETER 0.05 1520006 HH-MOTHERS DAY SCREENING MAMMO 65.00 1520030 HH-SCREENING MAMMO DIGITAL 734.00 1520048 HH-SCREENING MAMMO W/IMP DIGITAL 734.00 1520055 HH-MOTHERS DAY MAMMO W/IMPLANTS 65.00 1520063 BC US AXILLA UNILATERAL 660.00 1520071 BC US AXILLA BILATERAL 1,320.00 1530021 U/S GUIDED NEEDLE PLACEMENT 3,782.00 1530112 ART/VEIN MAPPING DIALYSIS ACCESS 2,725.00 1550086 XR HIP BILAT AP 4 VIEW 1,236.00 1560242 GASTROJEJUNOSTOMY TUBE STD 1,235.00 1590173 BP MASTECTOMY BRA 502.00 1590223 BP EXTERNAL BREAST PROS GARMENT 555.00 1590488 BC US GUIDED CORE BX 1,734.00 1590496 BP GRADIENT PRESSURE SLEEVE 502.00 1590520 BP GRADIENT COMP STK 18-30MMHG 502.00 1590538 BP GRADIENT COMP STK BN 30-40MMHG 502.00 1590546 BP GRADIENT COMP STKBN 40-50MMHG 502.00 1590553 BP GRADIENT COMP STK TH 18-30MMHG 502.00 1590561 BP GRADIENT COMP STK TH 30-40MMHG 502.00 1590579 BP GRADIENT COMPRESN TL 40-50MM 502.00 1590587 BP GRADIENT COMP STK WH 18-30MM 502.00 1590645 BP GRADIENT COMP STK WH30-40MMH 502.00 1590652 BP GRADIENT COMP STK WH40-50MMH 502.00 1590686 BP GRADIENT COMP GLOVE RTW 502.00 1590694 BP GRADIENT COMP ARM SLEEVE RTW 502.00 1590710 BP THORACIC COMPRESSION GARMENT 508.00 1590728 BP BREAST PROSTHESIS & FORM 895.00 1590736 BP BREAST PROSTHESIS FORM LEFT 1,985.00 1590744 BP BREAST PROSTHESIS FORM RIGHT 1,985.00 1590751 BP BREAST PROSTHESIS FORM BILATERAL 1,895.00 1590769 BP MASTECTOMY FORM LEFT 1,195.00 1590777 BP MASTECTOMY FORM RIGHT 1,195.00 1590785 BP MASTECTOMY FORM BILATERAL 1,195.00 1590793 BP CUSTOM BREAST PROSTHESIS LT 7,000.00 1590801 BP CUSTOM BREAST PROSTHESIS RT 7,000.00 1590819 BP CUSTOM BREAST PROSTHESIS BIL 7,000.00 1590827 BP PROSTHETIC NIPPLE REUSEABLE 502.00 1595271 INTERVENTIONAL BIOPSY 2 8,714.00 1595289 INT BIOPSY 2 ADD'L SITE 6,980.00 1595297 BC INTERVENTIAL RADIOLOGY 1 1,911.00 1595305 BC INTERVENTIAL RADIOLOGY 3 4,463.00 1595313 BC SURGICAL SPECIMEN EXAM 606.00 1595321 BC US VACUUM ASSISTED BX 1,734.00 1595347 BC GUIDANCE FLUID ASPIRATION 1,734.00 1595461 PERITONEAL CATH KIT 2,729.00 1595479 BP REDUCTION KIT A6545 502.00 1595489 MIDLINE INSERTION - OP 2,800.00 1600154 PTCA SINGLE VESSEL 24,471.00 1600337 CL THORACIC AORTOGRAM 8,891.00 1600717 LOW OSMOLAR CONTRAST 300-399MG/ML 2.00 1600725 IMAG SUPERVISION INJECT CATH ANGIO 569.00 1600733 IMAG SUPERVISION CORONARY ANGIO 569.00 1600766 EP EVAL ICD GEN&LEAD NEW IMPLANT 3,846.00 1600774 ANGIO RENAL UNILAT SEL S&I 13,574.00 1600782 ANGIO RENAL BILAT SEL S&I 13,574.00 1600816 SP ANGIOPLASTY INITIAL ARTERY 28,125.00 1600865 RIGHT HEART CATH ONLY 19,244.00 1600873 SELECTIVE CORONARY ONLY 23,862.00 1600881 SELECTIVE CORONARY W/GRAFTS 32,757.00 1600899 SELECTIVE CORONARY W/RT HEART CATH 47,725.00 1600907 SLCTV CRNRY W/GRFTS & RT HRT CATH 45,661.00 1600915 SELECTIVE CORONARY W/LT HEART CATH 28,452.00 1600923 SELECTIVE CRNRY W/GRFTS< HRT CATH 37,345.00 1600931 SELECTIVE CORONARY W/RT< HRT CATH 52,314.00 1600949 SLCT CRNRY W/RT< HRT CTH W/GRFTS 49,361.00 1600956 LT HEART CATH W/TRASSEPTAL PUNCTUR 17,823.00 1600964 AORTIC ROOT W/93460 & 93461 569.00 1600998 INTRACORONARY STENT PLCMNT NODES 44,634.00 1601004 AORTOGRAPHY INJECTION 3,496.00 1601012 ARTERIAL CONDUIT INJECTION 3,417.00 1601020 BIOPSY FORCEPS 1,627.00 1601038 BIOPSY SHEATHS 299.00 1601046 CARDIAC OUTPUT SEPARATE PROCEDURE 1,428.00 1601053 CORONORY STENT PLCEMNT EA ADDL DES 44,634.00 1601087 DIAGNOSTIC LONG SHEATH 310.00 1601103 GRAFTS INJECTION 3,757.00 1601129 IABP INSERTION 26,562.00 1601145 INTRACRNRY STNT PLCMNT DES 44,634.00 1601160 LT HEART CATHETERIZATION 12,526.00 1601194 LV ANGIOGRAPHY 3,132.00 1601251 PERMANENT PACEMAKER REMOVAL 3,259.00 1601269 PERMANENT PACER INSERT ATRIAL 4,022.00 1601277 PERMANENT PACER INSERT BOTH LEADS 5,375.00 1601285 PERMANENT PACER INSERT VENTRICULR 4,022.00 1601301 PTCA ADDITIONAL VESSEL 24,471.00 1601335 PTCA GUIDING CATHETER 666.00 1601368 PULMONARY ANGIO 4,067.00 1601376 RIGHT HEART CATHETERIZATION 6,564.00 1601384 RT & LT HEART CATHETERIZATION 15,498.00 1601426 SELECTIVE CORONARY ANGIOGRAPHY 3,883.00 1601434 SWAN GANZ INSERTION 1,170.00 1601442 TEMP PACEMAKER INSERT 1,329.00 1601459 TEMP PACEMAKER WIRE 997.00 1601541 PHARM AGENT ADMIN NITRIC OXIDE 535.00 1601574 STENT CORONARY MAGIC WALL LONG 12,354.00 1601590 STENT CORONARY MAGIC WALL SHORT 8,361.00 1601616 CORONARY STENT PL EA ADD NODES 44,634.00 1601640 CANCELLED CATH LAB PROCEDURE 1,911.00 1602754 INTRAVAS STENT ILIAC UNILATERAL 24,475.00 1602762 INSERT BIVENT PACER GEN ONLY 46,925.00 1602770 INSERT SC PACER GEN ONLY 40,220.00 1602796 TRANSCATH AORTIC VALVE REPLACE 30,757.00 1603000 PERCUTANEOUS CORONARY THROMBECTOMY 2,004.00 1603034 ANGIO-SEAL PLACEMENT 430.00 1603208 FFR HEART FLOW RESERVE MEASURE 1,447.00 1603216 EXTERNAL ELECTRICAL CARDIOVERSION 2,557.00 1603224 FLUOROSCOPY UP TO 1 HOUR 1,462.00 1603232 COR ATHER W PTCA SINGLE VESSEL 44,634.00 1603240 COR ATHER W PTCA ADD VESSELS 44,634.00 1603257 PERC ATHER W STENT DES 44,634.00 1603265 PERC ATHER W STENT NO DES 44,634.00 1603281 PERC ATHER W STENT DES ADD VES 44,634.00 1603299 REVASC COR GRAFT W DES 44,634.00 1603307 REVASC COR GRAFT W NO DES 44,634.00 1603315 REVAS COR ADD GRAFT W DES 44,634.00 1603323 REVAS COR ADD GRAFT W NO DES 44,634.00 1603349 REVAS STEMI W DES 44,634.00 1603356 REVAS STEMI W NO DES 44,634.00 1603364 REVAS CTO W DES 44,634.00 1603372 REVAS CTO W NO DES 44,634.00 1603380 REVAS CTO W DES ADD VES 44,634.00 1603398 REVAS CTO W NO DES ADD VES 44,634.00 1603638 IMPELLA INSERTION 47,027.00 1604230 EP ABL THERMOCOOL BIDIR SF NAV 13,720.00 1604248 EP ABL THERMOCOOL UNIDIR SF NAV 13,720.00 1604255 EP ABL THERMO SMART BIDIR 13,720.00 1604263 EP ABL THERMO SMART UNIDIR 13,720.00 1604271 EP ABL NAVISTAR 4MM BIDIR 13,720.00 1604289 EP ABL NAVISTAR 4MM UNIDIR 13,720.00 1604297 EP ABL NAVISTAR 8MM BIDIR 13,720.00 1604305 EP ABL NAVISTAR 8MM UNIDIR 13,720.00 1604313 LEADLESS PACEMAKER INSERT/REPLACE 89,795.00 1610609 PERCLOSE VASCULAR CLOSURE DEVICE 1,648.00 1610815 INSERT/REPL SUB-Q SYSTEM 143,862.00 1610823 INSERT SUB-Q LEAD ONLY 26,430.00 1610831 REPLACE SUB-Q GENERATOR ONLY 143,682.00 1610849 REMOVE SUB-Q GENERATOR ONLY 13,311.00 1610864 REVISE SUB-Q GENERATOR OR LEAD 13,311.00 1610872 EVALUATION OF SUB-Q GENERATOR 500.00 1612936 AORTOGRAPHY ABDOMINAL W/ILIOFEM 16,050.00 1612944 GUIDELINER CATHETER 2,304.00 1612969 VENOGRAM,UNILAT EXTREMITY 3,945.00 1612977 VENOGRAM,BILATERAL EXTREMITY 2,929.00 1612985 SUPERIOR VENA CAVAL 6,136.00 1612993 ABDOMINAL AORTOGRAM 4,693.00 1613009 ABDOMINAL AORTOGRAM W RUN-OFF 16,050.00 1613017 ANGIOGRAPHY EXTREM UNILATERAL 8,891.00 1613025 ANGIOGRAPHY EXTREM BIALTERAL 8,891.00 1613033 RENAL SELECTIVE BILATERAL 5,628.00 1613066 VENOGRAPHY,SINUS OR JUGLAR 8,921.00 1613140 ANGIO,EA ADD SELECT VESSEL AFTR 4,778.00 1613157 THORACIC AORTOGRAM 8,891.00 1613264 ANGIO,VISCERAL SELECT EA VESSEL 8,891.00 1613306 ANGIO,PULMONARY SELECT UNILATERAL 4,982.00 1613314 ANGIO,PULMONARY SELECT BILATERAL 8,891.00 1613322 ANGIO,PULMONARY NON-SELECTIVE 4,982.00 1613371 RENAL SELECTIVE UNILATERAL 4,738.00 1613389 PTA TIBIOPERONEAL ARTERY & BRANCH 20,384.00 1613397 STENT ARTERY RENAL 12,681.00 1613413 PTA,ILIAC ARTERY 20,384.00 1613421 PTA,FEMORAL POPLITEAL 20,384.00 1613504 STENT ARTERY ADD'L (RENAL) 12,681.00 1613512 VISIPAQUE 300-399MG/ML 33.00 1613546 EP RIGHT VENTRICULAR RECORDING 19,012.00 1613553 EP MAP TACHYCARDIA,ADD-ON 19,012.00 1613561 EP INTRA-ATRIAL PACING 19,012.00 1613579 EP INTRAVENTRICULAR PACING 19,012.00 1613587 EP ELECTROPHYS MAP,3D,ADD-ON 19,012.00 1613595 EP ESOPHAGEAL RECORDING 19,012.00 1613603 EP ESOPHAGEAL RECORDING W/PACING 19,012.00 1613629 EP COMPREHENSIVE EP W/O INDUCTN 19,811.00 1613637 EP COMPREHENSIVE EP W INDUCTION 19,811.00 1613645 EP LA RECORDING & PACING FRM COR 19,811.00 1613652 EP LV RECORDING AND PACING 19,811.00 1613660 EP STIMULATION POST IV DRUG INF 19,012.00 1613678 EP F/U TESTING (NIPS) 19,811.00 1613686 EP EVAL PREV PLACED ICD (NIPS) 7,089.00 1613694 EP ABLATION AV NODE 27,446.00 1613702 COMP EPS W/ SVT ABLATION 67,794.00 1613710 COMP EPS W/ VT ABLATION & 3D MAP 67,794.00 1613728 EP TILT TABLE EVALUATION 3,064.00 1613736 TRANSEPTAL HEART CATH 21,419.00 1613751 EP EVAL ICD LEAD ONLY 636.00 1613769 EP BUNDLE OF HIS RECORDING 19,012.00 1613777 EP INTRA-ATRIAL RECORDING 19,012.00 1613785 EP INTRACARDIAC ECG (ICE) 23,136.00 1613793 AFIB ABLATION (W) TRANSEPTAL 67,794.00 1613801 INTERVENTIONAL CARDIOLOGY 1 1,911.00 1613835 INTERVENTIONAL CARDIOLOGY 4 10,144.00 1613843 INTERVENTIONAL CARDIOLOGY 5 14,201.00 1613850 INSERT NEW SC PACER RA SYSTEM 26,825.00 1613868 INSERT NEW RV SC PACER SYSTEM 26,825.00 1613876 INSERT NEW DC PACER SYSTEM 26,825.00 1613900 INSERT SC PACER GEN ONLY 26,825.00 1613926 UPGRADE PACER SC TO DC 26,825.00 1613934 REPOSITION ELECTRODE PACER/AICD 8,959.00 1613942 INSERT SINGLE ELECTRODE ANY DEV 25,984.00 1613959 INSERT TWO ELECTRODES ANY DEV 25,984.00 1613967 REPAIR SINGLE ELECTRODE ANY DEV 8,959.00 1613975 REPAIR TWO ELECTRODES ANY DEV 8,959.00 1613983 REVISE/RELOCATE POCKET - PACER 5,206.00 1613991 REVISE/RELOCATE POCKET - ICD 5,622.00 1614007 INSERT LV LEAD TO EXISTING DEVICE 26,825.00 1614015 INSERT LV LEAD TO NEW IMPLANT 26,825.00 1614023 REPOSITION LV LEAD TO RMV/RPL AICD 8,959.00 1614031 REMOVE PACER GENERATOR 26,825.00 1614049 REMOVE LEAD FROM SC PACEMAKER 26,825.00 1614056 REMOVE LEAD FROM DC PACEMAKER 26,825.00 1614064 INSERT SC ICD GEN ONLY 26,825.00 1614072 REMOVE LEAD(S) ICD 8,959.00 1614080 INSERT NEW SC-DC ICD SYSTEM 33,531.00 1614098 REMOVE ICD GEN. ONLY SC OR DC 33,531.00 1614106 IMPLANT CARDIAC RECORDER 26,828.00 1614114 REMOVE CARDIAC RECORDER 3,301.00 1614122 REPLACE BIVENT ICD GENERATOR 53,500.00 1614130 REPLACE SC ICD GENERATOR ONLY 53,500.00 1614148 REPLACE DC ICD GENERATOR 53,500.00 1614155 INSERT DC ICD GEN ONLY 53,500.00 1614163 INSERT BIVENT ICD GEN ONLY 53,500.00 1614171 REPLACE DC PACER GEN 47,027.00 1614189 REPLACE BIVENT PACER GEN 47,027.00 1614197 INSERT DC PACER GEN ONLY 47,027.00 1614205 REPLACE SC PACER GEN ONLY 42,908.00 1614213 FLUTTER ABL W/AFIB ABL 535.00 1614221 SECOND ARRHYTHMIA W/AFIB ABL 535.00 1614452 DEFLECTABLE D-TYPE CATH DECA EP 3,256.00 1614460 3EFLECTABLE D-TYPE CATH QUAD EP 2,258.00 1614478 QUAD CATH FIXED EP 799.00 1614486 1EFLEXION SPIRAL DUO-DECA EP 8,477.00 1614494 LIVEWIRE DUO-DECA LG CURVE EP 5,486.00 1614502 OPTIMA LASSO EP 8,477.00 1614510 QUAD SUPREME FIXED EP 1,695.00 1614528 DEFLECTABLE DECA EP 3,491.00 1614536 ARRAY CATHETER EP 25,614.00 1614544 NAV X SURFACE ELECTRODE KIT 8,112.00 1614551 LBL ABLATION EP 7,973.00 1614569 SAFIRE ABLATION EP 6,584.00 1614577 DECAPOLAR FIXED LSL W LUMEN EP 3,592.00 1614585 COOLPATH ABLATION EP 13,022.00 1614593 TRANSSEPTAL NEEDLE EP 2,049.00 1614601 AGILIS NXT INTRODUCER EP 8,531.00 1614619 TRANSSEPTAL SHEATH INTRODUCER EP 1,538.00 1614627 ABL LIVEWIRE TC LG 7FR 4MM TIP 5,078.00 1614635 BW HEX D CRV 6FR 222 4,236.00 1614643 BW HEX FIX 6FR 222 1,793.00 1614668 INTRO SEPT 8FR 1,592.00 1614676 INTRO SAFL 8FR 60CM 1,437.00 1614684 TRIO INTRO 12FR 320.00 1614692 INTRO RAMP 8FR 60CM 1,397.00 1614700 DECA LIVEWIRE MED 3,445.00 1614718 DECA LIVEWIRE XL 3,445.00 1614726 DECA CSL 6FR 282 2,866.00 1614734 DECA CSL 7 FR 120CM 2,902.00 1614742 ABL COOLPATH BR MD 11,838.00 1614759 ABL COOLPATH BR XL 11,838.00 1614767 ABL COOLPATH BD LG 11,838.00 1614775 DUPLEX SCAN EXTREMITY VEINS LMT 1,413.00 1614809 WHOLEY WIRE 175CM 761.00 1614817 WRENCH KIT PACER 350.00 1614825 WORLEY GUIDE CSG 1,260.00 1614833 COPILOT 381.00 1614841 SAFE SHEATH 567.00 1614882 CATH TORNUS 963.00 1614924 PM NO ADJUSTMENT 308.00 1614932 PM TRANSTELEPHONIC 308.00 1614940 PM REP SINGLE W/ADJUSTMENT 431.00 1614957 PM REP DUAL W/ADJUSTMENT 431.00 1614965 CW NUC ISOTOPE STRESS TEST 2,035.00 1614973 CW EVENT MONITORING 1,061.00 1614981 CW EVENT RECORDING-HOOK UP 706.00 1614999 CW LOWER EXT ART DOPPLER 1,167.00 1615004 CW LOWER EXT VENOUS DOPPLER 2,389.00 1615012 CW UPPER EXT VENOUS DOPPLER 2,389.00 1615020 CW UPPER EXT ARTERIAL DOPPLER 1,167.00 1615038 CW UPPER EXTREMITY DUPLEX 2,389.00 1615046 CW LOWER ART DUPLEX SCAN 2,389.00 1615053 CW CAROTID ULTRASOUND (DUPLEX) 2,477.00 1615079 CW SECTOR ECHOCARDIOGRAM 5,307.00 1615129 CW DOPPLER ECHOCARDIOGRAPH 1,769.00 1615137 CW DOPPLER COLOR FLOW 1,769.00 1615145 CW HOLTER MONITOR SCANNING & REPORT 3,304.00 1615152 CW HOLTER MONITOR HOOKUP & RECRDNG 1,171.00 1615160 CW ECHOCARDIOGRAM/EX TEST 1,769.00 1615178 CW PHARM STRESS TEST 2,035.00 1615194 CW NUC ISOTOPE PHARMACOLOGICAL 2,035.00 1615202 CW STRESS TEST 2,035.00 1615210 CW STRESS TEST W/ECHO 2,035.00 1615228 CW AICD OR BIIV INTERROGATION 270.00 1615244 CW AICD PROGRAMMING DUAL LEAD 270.00 1615277 PRESSURE WIRE 3,718.00 1615285 US INTRAVASCULAR CORONARY VESSEL 642.00 1615293 US INTRAVASCULAR EA ADD'L VESSEL 250.00 1615301 CW LWR EXT ART DOPPLER W/TREADMILL 1,061.00 1615319 CW UPPER EXT ART DOPPLER LIMITED 1,052.00 1615327 CW LWR EXT ART DOPPLER,LIMITED 1,052.00 1615335 VENOUS ABLATION CLOSURE SURGERY 11,556.00 1615343 BW DECA F-CURVE UNIDIR 858.00 1615350 CARTO REF PATCH 2,060.00 1615368 BW ABL THERMO F-CURVE UNIDIR 13,720.00 1615376 BW LASSO D-CURVE ECO 4,410.00 1615384 COOLFLOW TUBING 440.00 1615392 PACEMAKER DEFIB INTERROGATION 270.00 1615400 PACEMAKER DEFIB SYS DEV EVALUATION 208.00 1615715 CW HOLTER MONITOR HOOK UP & REC(52) 1,171.00 1615723 ADULT NASAL CANNULA 14FT 35.00 1615962 SP VENOPLASTY INITIAL VEIN 28,125.00 1616002 PERC DRUG ELUTING CORONARY STENT 48,140.00 1616168 CW-DOBUTAMINE CARDIOLITE STRESS TES 2,035.00 1616176 ELECTIVE CARDIOVERSION EXTERNAL 2,557.00 1616184 PM REP MULTI-BIVI W/ADJUSTMENT 180.00 1616291 LEFT HEART CATH ONLY 16,436.00 1616317 CL PTA, RENAL OR VISCERAL ARTERY 28,125.00 1616325 CL AV DIALYSIS SHUNT ANGIOGRAPHY 5,936.00 1616333 CL PTA, EA ADD'L PERIPHERAL VESSEL 7,030.00 1616341 CL PTA VENOUS INITIAL AND ADD'L 7,030.00 1616358 CL STENT PLCMNT FIRST VESSEL-ARTRL 51,828.00 1616366 CL ADDITIONAL STENT PLCMNT-ARTERIAL 25,065.00 1616374 CL STENT PLCMNT FIRST VESSEL-VENOUS 51,828.00 1616382 CL ADD'L STENT PLACEMENT - VENOUS 25,065.00 1616390 CL SHUNT WITH PERIPHERAL PTA 28,125.00 1616408 CL SHUNT WITH STENT INSERTION 56,850.00 1616416 CL SHUNT WITH THROMBECTOMY 28,125.00 1616424 CL SHUNT W/THROMBCTMY&PERIPHRL PTA 56,850.00 1616432 CL SHUNT W/THROMBCTMY&PERPHRL STENT 86,175.00 1616440 CL PTA OF CENTRAL DIALYSIS SECTION 7,030.00 1616457 CL STENT PLCD IN CNTRL DLYSIS SGMNT 7,030.00 1616465 CL DIALYSIS CIRCUIT EMBOLIZATION 7,030.00 1616473 XR FISTULA SINOGRAM 1,086.00 1616475 SP CHEMICAL ABLATION-MULTIPLE VEIN 5,868.00 1616481 CL EXTREMITY ANGIO UNILAT W/INTRVNT 8,891.00 1616499 CL PTA ILIAC ARTERY ADDITIONAL LVL 20,384.00 1616507 CL PTA TIBIOPERONEAL ADD'L LEVEL 20,384.00 1616515 INTRAVSCLR STENT ILIAC UNILT EA ADD 24,475.00 1616523 CL INTRVSC STNT FMRL/POP W/WO PLSTY 56,546.00 1616531 CL INTRVSC STENT TBOPRNL W/WO PLSTY 24,475.00 1616549 CL INTRAVSCLR STENT TBOPRNL EA ADD 24,475.00 1616556 CL INTRVSLR STNT FMRL/POP&ARTHRCTMY 24,475.00 1616564 CL INTRVSCLR STNT TBOPRNL&ARTHRCTMY 24,475.00 1616572 CL INTVSC STN TBOPRNLATHRCTMY EA AD 24,475.00 1616580 CL ATHERECTOMY PERIPHERAL 18,559.00 1616598 CL ATHERECTOMY RENAL 18,559.00 1616606 CL ATHERECTOMY VISCERAL 18,559.00 1616614 CL ATHERECTOMY PERIPH EA ADDL 16,380.00 1616622 CL ATHERECTOMY ILIAC EACH VESSEL 16,380.00 1616630 CL ATHRCTMY TIB/PERONEAL W/WO PLSTY 18,559.00 1616648 CL ATHRCTMY ADD TIB/PRNL W/WO PLSTY 16,380.00 1616655 CL ATHERECTOMY ABDOMINAL AORTA 18,559.00 1616663 CL ATHERECTOMY BRACHIOCEPHALIC 18,559.00 1616671 CL EXTREMITY ANGIO BILATERAL 8,891.00 1616689 CL RENAL UNILATERAL ANGIOGRAM 13,574.00 1616697 CL RENAL UNILATERAL 2ND ORDER 13,574.00 1616705 CL RENAL BILAT 1ST ORDER 13,574.00 1616713 CL RENAL BILATERAL 2ND ORDER 13,574.00 1616721 CL THROMBOLYSIS ARTERIAL INFUSION 4,782.00 1616739 CL THROMBOLYSIS CESSATION OF TRTMNT 10,669.00 1616747 CL CINERADIOGRAPHY 1,424.00 1700038 RT PHYSICS SUP SIMPL 1,574.00 1700137 RT TREAT DEVICE COMP 3,764.00 1700152 RT TREATMENT DEVICE INTERMEDIATE 2,016.00 1700160 BRACHY ISODOSE SIMP-77316 2,986.00 1700178 BRACHYTHERAPY ISODOSE INTERM 3,192.00 1700186 BRACHY ISODOSE COMP-77318 3,842.00 1700194 RT SPECIAL DOSIMETRY 1,270.00 1700236 RT SPECIAL MEDICAL PHYSICS 2,788.00 1700244 RT RAD DOSIMETRY 2,638.00 1700343 INTERSTITIAL,COMPX W/SUP&LOADING 5,586.00 1700475 LOADING RADIOELMT 1,043.00 1700491 RT TELETHE ISOD SIM 1,652.00 1700509 RT TELETHER ISOD COMP>2 3,467.00 1700517 RT TUMOR SIMULATION-SIMPLE 2,437.00 1700525 RT TUMOR SIMULATION-IN 3,424.00 1700533 RT TUMOR SIMULATION CMPLX 5,095.00 1700541 PORT VERIFICATION FILMS 1-2 1,304.00 1700558 RT FOLLOW UP COMPLEX 99214 999.00 1700699 LARYNGOSCOPY 1,569.00 1700871 INTRAFRACTION TRACKING OF TARGET 1,304.00 1700947 CT GUIDANCE RAD THERAPY FIELDS-59 6,967.00 1701077 RT TREATMENT DEVICE SIMPLE 1,928.00 1701093 RT SPEC PORT PLAN 3,842.00 1701101 BRACHY SOURCE STRAND I 125 EA 213.00 1701226 RT TUMOR SIMULATION-3D 9,958.00 1701242 RT FOLLOW-UP INTERMED-99212 719.00 1701259 RT FOLLOW UP COMPREH-99213 897.00 1701317 RT FOLLOW UP-SIMP-99211 511.00 1701333 RT COMPREH 99213 25 897.00 1701341 RT INTERMEDIATE 99212 25 719.00 1701358 RT COMPLEX 99214 25 999.00 1701374 RT IMRT TREATMENT PLAN 22,195.00 1701390 RT BRACHY SOURCE PER SOURCE 556.00 1701424 RT SPEC TX PROC 6,199.00 1701432 MEGAVOLTAGE COMP 6-10MEV 1,902.00 1701440 MEGAVOLTAGE COMP 11-19MEV 1,902.00 1701457 MEGAVOLTAGE COMP 20-22MEV 1,902.00 1701465 MEGAVOLTAGE SIMP 20-22MEV 1,437.00 1701473 MEGAVOLTAGE SIMP 11-19MEV 1,437.00 1701481 MEGAVOLTAGE SIMP 6-10MEV 1,437.00 1701499 MEGAVOLTAGE INTER 6-10MEV 1,488.00 1701515 MEGAVOLTAGE INTER 11-19MEV 1,488.00 1701523 SUR APPLIC LOW RATE NUCLIDE 1,135.00 1701531 RT VOLUME STUDY 1,019.00 1701549 RT FLUOROSCOPY UP TO ONE HR 1,462.00 1701564 RT 3D RECONSTRUTION INDP WKST 1,061.00 1701572 RT US GUIDANCE INTERSTITIAL RAD APP 827.00 1701580 RT MINIMAL 99211 25 511.00 1701598 RT HIGH COMPLEX 99215 25 1,034.00 1701614 PLACEMENT-TANDEMS/OVOIDS 9,549.00 1701671 BRACHY SOURCE HDR IR-192 3,934.00 1701788 TUMOR SIMULATION SIMPLE-59 2,437.00 1701796 TUMOR SIMULATION COMPLEX-59 5,095.00 1701804 IMRT TREATMENT PLAN-59 22,195.00 1701879 PHYSICS SUP SIMPLE-59 1,574.00 1701887 PORT VERIFICATION FILMS-59 1,304.00 1701895 BASIC RADIATION DOSIMETRY CALCU 2,638.00 1701903 CT GUIDANCE RAD THERAPY FIELDS 6,967.00 1701911 RT MINIMAL 99211 511.00 1701952 3D RENDERING W/POSTPROCESS 1,061.00 1702000 OFFICE VISIT COMPLEX 1,426.00 1702026 OFFICE VISIT COMPREHENSIVE 847.00 1702034 INITIAL HIGH COMPLEX 99215 1,034.00 1702075 US GUIDANCE NEEDLE PLACEMENT 1,734.00 1702083 FIDUCIAL MARKER SUPPLY CODE 1,980.00 1702141 RT FOLLOW UP COMPREHENSIVE 99213 25 897.00 1702158 RT FOLLOW UP COMPLEX - 99214 25 999.00 1702182 CONE BEAM CT 6,967.00 1702190 MEGAVOLTAGE C =>1MEV MOD59 1,902.00 1702208 STEREOTACTIC THERAPY ONE SESSION 37,333.00 1702216 STEREOTACTIC THERAPY 1-5 SESSIONS 9,349.00 1702232 MULTILEAF COLLIMATOR DEVICE (MLC) 1,690.00 1702240 RT TRNSPRNL PLCMNT OF NDL OR CATH 13,753.00 1702257 HDR INSERTION AFTER LOADER DEVICE 1,890.00 1702273 MULTILEAF COLLIMATOR DEVICE (MLC)59 1,690.00 1702281 TREATMENT DEVIDE COMPLEX - 59 3,764.00 1702307 RT >1MEV TREATMENT COMPLEX 1,902.00 1702315 RT IMRT TREATMENT SIMPLE 6,199.00 1702323 RT TELETHERAPY ISODOSE SIMPLE 1,652.00 1702331 RT TELETHERAPY ISODOSE COMPLEX 3,467.00 1702349 RT BRACHYTHERAPY ISODOSE CPL 77318 3,842.00 1702356 RT BRACHYTHERAPY ISODOSE INTERMED 3,192.00 1702364 RT BRACHYTHERAPY ISODOSE SIMP 77316 2,986.00 1702372 RT IMRT TREATMENT COMPLEX 6,199.00 1702380 RT TREATMENT IMAGE GUIDANCE 1,304.00 1702398 RT GUIDANCE FOR LOCALZTN TRGT VLM 1,304.00 1702406 RT >1MEV TREATMENT SIMPLE 1,437.00 1702414 RT >1MEV TREATMENT INTERMEDIATE 1,488.00 1702422 HDR 1 CHANNEL 8,090.00 1702430 HDR 2-12 CHANNELS 8,090.00 1702448 HDR OVER>12 CHANNELS 8,090.00 1702455 TELEMED CONSULT 99204 847.00 1702463 TELEMED CONSULT 99205 1,426.00 1702471 TELEMED CONSULT 99215 1,034.00 1702489 TELEMED CONSULT 99211 25 511.00 1702497 TELEMED CONSULT 99215 25 1,034.00 1702505 TELEMED FOLLOW UP SIMPLE 99211 511.00 1702513 TELEMED FOLLOW UP INTERMED-99212 719.00 1702521 TELEMED FOLLOW UP COMPREHENSV-99213 897.00 1702539 TELEMED FOLLOW UP COMPLEX 99214 999.00 1702547 TELEMED INTERMEDIAT F/U-25 99212 25 719.00 1702554 TELEMED COMPREHENSV F/U-25 9921325 897.00 1702562 TELEPHONE EVAL 10-15 MIN 99441 67.00 1702570 TELEPHONE EVALUATN 15-20 MIN 99442 134.00 1702588 TELEPHONE EVAL 20-30 MIN 99443 198.00 1710094 LEVEL5 99215 FACILITY FEE 1,034.00 1720010 LEVEL3 99213 FACILITY FEE 897.00 1720028 INTERVENTIONAL PROCEDURE 1,107.00 1720036 LEVEL4 99214 FACILITY FEE 999.00 1720044 LEVEL1 99211 FACILITY FEE 511.00 1720051 LEVEL2 99212 FACILITY FEE 719.00 1720069 LEVEL 5 99205 FACILITY FEE 1,426.00 1720077 LEVEL 3 99203 FACILITY FEE 728.00 1720085 LEVEL 4 99204 FACILITY FEE 847.00 1720093 LEVEL 1 99201 FACILITY FEE 1,425.00 1720101 LEVEL 2 99202 FACILITY FEE 575.00 1720143 HDR RADIONUCLIDE SKIN SURFACE 1CH 8,090.00 1720150 HDR LESION >2CM OR 2 CHANNELS 8,090.00 1720168 SIMPLE TREATMENT DEVICE-59 1,928.00 1720176 INTERMEDIATE TX DEVICE-59 2,016.00 1720184 XOFIGO RADIUM-RA223 PER UCI 635.00 1720192 ADMINISTRATION XOFIGO RA-233 1,265.00 1720200 TELEHEALTH ORIGINATING SITE FEE 70.00 1800010 CT HEAD W/C 15 SL 4,243.00 1800051 CT SPINE LUMB 3LVL W/O 7,725.00 1800069 CT SPINE THOR 3LVL W/O 7,725.00 1800077 CT SPINE CERV 3LVL W/O 7,725.00 1800085 CT CHEST WITH IV CONTRAST 6,564.00 1800093 CT ORBITS W/O CONTRAST MEDIA 5,593.00 1800119 CT ORBITS WITH CONTRAST 3,976.00 1800135 CT TEMPORAL BONELIC W/O 5,593.00 1800143 CT GUIDE FOR NEEDLE PLACEMENT 6,700.00 1800168 CT RT LOWER EXTREMITY W/O CONTRAST 5,514.00 1800226 CT HEAD NO CONTRAST 15SL 5,697.00 1800234 CT HEAD W/WO CONT 5,145.00 1800259 CT TEMPORAL BONE NO IV CONTRAST 5,593.00 1800267 MRI TEMPOROMANDIBULAR JOINT 6,995.00 1800291 CT SELLA/PITUITRY W/O 5,593.00 1800317 CT SINUSES W/O 2,464.00 1800325 CT FACIAL BONES W/O 2,464.00 1800341 MRI ORBIT W/O CONTRAST 6,995.00 1800366 MRI NECK W/O CONTRAST 6,995.00 1800374 MRI HEAD W/O CONT 6,995.00 1800382 MRI HEAD W/CONTRAST 6,995.00 1800408 MRI CHEST W/O CONTRAST 6,995.00 1800416 CT COR SAG OBC AND OR RECONSTR 1,061.00 1800432 MRI LUMBAR SPINE W/O CONTRAST 6,995.00 1800440 MRI CERVICAL SPINE W/O CONT 6,995.00 1800457 MRI CERVICAL SPINE W/CONTRAST 6,995.00 1800465 MRI THORACIC SPINE W/O CONTRAS 6,995.00 1800481 MRI LUMBAR SPINE W/CONTRAST 6,995.00 1800515 CT RT UPPER EXT W/O CONTRAST 5,290.00 1800523 CT RT UPPER EXT W/W/O CONTRAST 5,290.00 1800531 CT RT UPPER EXT W/CONTRAST 5,290.00 1800549 MRI RT UPPER EXT NO JOINT WO&W 6,995.00 1800564 CT RT LOW EXT W/CONTRAST 5,514.00 1800572 CT RT LOW EXT W&W/O CONTRAST 5,514.00 1800606 MRI ABDOMEN W/O CONTRAST 6,995.00 1800622 CT PELVIS, 30 SL W/CONTRAST 5,696.00 1800630 CT NECK NO CONTRAST 5,290.00 1800655 CT NECK WITH IV CONTRAST 5,290.00 1800663 CT GUIDE CYST ASPIRATION 6,700.00 1800705 CT ABDOMEN NO IV CONTRAST 6,069.00 1800713 CT ABDOMEN W/O & W IV CONTRAST 6,069.00 1800804 CT ABD WITH IV CONTRAST 6,069.00 1800812 CT PELVIS W/O 5,696.00 1800820 CT CHEST NO IV CONTRAST 6,564.00 1800838 CT NEEDLE LOCALIZATION 6,700.00 1800853 CT PERCUT ABCESS DRAIN WITH CATH 6,236.00 1800861 CT FACIAL BONES W/CONTRAST 2,464.00 1800879 CT FACIAL BONES W&WO CONTRAST 5,593.00 1800895 CT VERTEBROPLASTY UNDER CT 1,906.00 1800903 CT CHEST W/O & W CONTRAST 6,564.00 1800929 CT SPINE LUMB W/CONTRAST 7,725.00 1800937 CT SPINE LUMB W/O & W CONTRAST 6,437.00 1800945 CT NERVE BLOCK LUMBAR OR SACRAL 3,847.00 1800978 CT ANGIO HEAD W/WO IV CNTRST VIZ 5,145.00 1800986 CT LUNG SCREENING-LDCT 4,000.00 1800994 CT ANGIOGRAPHY NECK W/O & W CONT 4,407.00 1801000 CT ANGIOGRAPHY CHEST W/O & W CONT 6,564.00 1801018 CT ANGIOGRAPHY LWR EXT W/O& W CONT 4,591.00 1801026 CT ANGIOGRAPHY HEAD W/O & W CONT 5,145.00 1801034 CT ANGIOGRAPHY,ABD W/O & W CONT 6,069.00 1801042 CTA ABD AORTA-BILAT LOW EXT RUN OFF 11,209.00 1801059 CT ANGIOGRAPHY PELVIS W/O & W CONT 5,696.00 1801067 CT ANGIO LEFT UPR EXT W/O & W CONT 4,407.00 1801075 CT PELVIS W/O & W CONTRAST 5,696.00 1801083 CT NECK W & W/O CONTRAST 5,593.00 1801091 CT ORBIT W & W/O CONTRAST 5,593.00 1801109 CT SPINE CERV W/CONTRAST 7,725.00 1801117 CT SPINE CERV W&W/O CONTRAST 6,437.00 1801125 CT SPINE THORACIC W/CONTRAST 7,725.00 1801133 CT SPINE THORACIC W/O & W CONTRAST 6,437.00 1801141 CT SINUS W/CONTRAST 2,464.00 1801158 CT LT LOWER EXTREMITY W/O CONTRAST 5,514.00 1801166 CT LT LOWER EXT W&WO CONTRAST 5,514.00 1801174 CT LT LOWER EXT W/CONTRAST 5,514.00 1801182 CT GUIDANCE FOR TISSUE ABLATION 783.00 1801257 CT LT UPPER EXT W/O&W CONTRAST 5,290.00 1801265 CT LT UPPER EXT W/O CONTRAST 5,290.00 1801273 CT LT UPPER EXT W/CONTRAST 5,290.00 1801315 CT RECONSTRUCT ON SEP WORKSTATN 1,061.00 1801323 CT HEAD W/O (STROKE) 5,697.00 1801331 CT TEMPORAL BONE WITH IV CONTRAST 3,976.00 1801349 CT SINUS W/WO 5,593.00 1801356 CT TEMPOROMANDIBULAR JOINT W*WO 5,593.00 1801364 CT TEMPOROMANDIBULAR JOINT W CNT 2,464.00 1801372 CT CHEST W/O CON HIGH RES 6,564.00 1801398 CT SACROILIAC JOINT NO CONT 5,696.00 1801406 CT THORACOLUMBAR SPINE NO CONT 7,725.00 1801430 LOW OSMOLAR CONT 300-399MG P/ML 14.00 1801448 LOW OSMOLAR CONTRAST 300-399MG P/ML 22.00 1801455 GASTROVIEW 367 MG/ML PER ML 1.00 1801463 CT LEFT SHOULDER NO IV CONT 5,290.00 1801471 CT LEFT SHOULDER WO/W IV CONT 5,290.00 1801489 CT LEFT SHOULDER WITH IV CONT 5,290.00 1801497 CT RIGHT SHOULDER NO IV CONT 5,290.00 1801505 CT RIGHT SHOULDER WO/W IV CONT 5,290.00 1801513 CT RIGHT SHOULDER WITH IV CONT 5,290.00 1801521 CT LEFT HIP NO IV CONT 5,514.00 1801539 CT LEFT HIP WO/W IV CONT 5,514.00 1801547 CT LEFT HIP WITH IV CONT 5,514.00 1801554 CT LEFT ANKLE NO IV CONT 5,514.00 1801562 CT LEFT ANKLE WO/W IV CONT 5,514.00 1801588 CT LEFT KNEE NO IV CONT 5,514.00 1801596 CT LEFT KNEE WO/W IV CONT 5,514.00 1801604 CT LEFT KNEE WITH IV CONT 5,514.00 1801612 CT LEFT FOOT NO IV CONT 5,514.00 1801620 CT LEFT FOOT WO/W IV CONT 5,514.00 1801638 CT LEFT FOOT WITH IV CONT 4,771.00 1801646 CT RIGHT HIP NO IV CONT 5,514.00 1801653 CT RIGHT HIP WO/W IV CONT 5,514.00 1801661 CT RIGHT HIP WITH IV CONT 5,514.00 1801679 CT RIGHT KNEE NO IV CONT 5,514.00 1801687 CT RIGHT KNEE WO/W IV CONT 5,514.00 1801695 CT RIGHT KNEE WITH IV CONT 5,514.00 1801703 CT RIGHT ANKLE NO IV CONT 5,514.00 1801711 CT RIGHT ANKLE WO/W IV CONT 5,514.00 1801737 CT RIGHT FOOT NO IV CONT 5,514.00 1801794 CT RIGHT FOOT WO/W IV CONT 5,514.00 1801802 CT RIGHT FOOT WITH IV CONT 4,771.00 1801810 CTLOW EXT (BOTH)WITH IV CONTRAST 5,514.00 1801836 CT TEMPORAL BONE W/WO IV CONTRAST 5,593.00 1801851 CT HEART WITH IV CONT (CHD) 6,564.00 1801869 CT ANGIO HRT W/WO IV CON (CRN ART) 6,564.00 1801893 CT HEART NO IV CONTRAST (COR CA) 6,564.00 1801901 CT HEART WITH IV CONTRAST (PULUN) 6,564.00 1801935 CT CEREBRAL PERFUSION WITH CONTRAST 5,697.00 1801943 CT ABD/PELVIS W/WO CONT (UROGRAM) 10,695.00 1801950 CT ABDOMEN/PELVIS WC (ENTEROGRAPHY) 10,695.00 1801984 CTA ABD-PELVIS W/WO IV CONTRAST 6,069.00 1801992 CT SACROILIAC INJECTION 4,157.00 1802008 CT ANGIO RIGHT UPR EXT W/O & W CONT 4,407.00 1802016 CT GUIDE FOR RENAL TISSUE ABLATION 783.00 1802024 CT THORACOLUMBAR SPINE W CONTRAST 7,725.00 1802057 CT ANGIO CHEST W/WO IV CNTRST AORTA 6,564.00 1802065 CT LEFT UPPER EXT ARTHROGRAM W/C 5,290.00 1802073 CT RIGHT LOWER EXT ARTHROGRAM W/C 5,514.00 1802081 CT LEFT LOWER EXT ARTHROGRAM W/C 5,514.00 1802099 ENDOCARE CRYOPROBE,PERC SLIMLINE 12,375.00 1802123 CT RIGHT THORACENTESIS 2,787.00 1802131 CT LEFT THORACENTESIS 2,787.00 1802149 CT RIGHT UPPER EXT ARTHROGRAM W/C 5,290.00 1802156 CT CHEST NO IV CONT(INIT LDCT(NCCN) 4,000.00 1802164 CT CHEST NO IV CONT(SUBSEQ LDCT NCC 4,000.00 1802172 CT CHEST NO IV CONT(NOD F/U LDCT NC 4,000.00 1802180 CT VENOGRAM ABD/PELVIS W/IV CONT 6,069.00 1802198 CT VENOGRAM LOWER EXT W/IV CONTRAST 4,591.00 1802206 CTA HEART FLOW DATA PREP TRANSMIT 1,000.00 1802214 CTA HEART FLOW ANALYSIS 5,600.00 1802248 CT VENOGRAM PELVIS W/IV CONTRAST 5,696.00 1802354 MRA CHEST WO/W CONTRAST 6,995.00 1802362 MRA ABDOMEN WO/W CONTRAST 6,995.00 1802370 MRA PELVIS W/WO CONTRAST 6,995.00 1802388 MRA RT UPPER EXT W/WO CONTRAS 6,995.00 1802404 MRA HEAD W/O CONTRAST 6,995.00 1802412 MRA HEAD W/CONTRAST 6,995.00 1802420 MRA HEAD W/WO CONTRAST 6,995.00 1802438 MRA NECK W/O CONTRAST 6,995.00 1802453 MRA NECK W/WO CONTRAST 6,995.00 1802487 MRA ABDOMEN W/CONTRAST 6,995.00 1802495 MRA ABDOMEN W/O CONTRAST 6,995.00 1802503 MRI HEAD W&W/O CONTRAST 6,995.00 1802511 MRI LUMBAR SPINE WO/W CONTRAST 6,995.00 1802529 MRI THORACIC SPINE WO/W CONTRAST 6,995.00 1802537 MRI PELVIS WO/W CONTRAST 6,995.00 1802545 MRI CERVICAL SPINE WO/W CONTRAST 6,995.00 1802578 MRI ABD WO/W CONTRAST 6,995.00 1802586 MRI PELVIS W/O CONTRAST 6,995.00 1802594 MRI CHEST WO/W CONTRAST 6,995.00 1802602 MRI RT SHOULDER W/O CONTRAST 6,995.00 1802628 MRI RT SHOULDER W/O&W CONTRAST 6,995.00 1802636 MRI FACE W/O CONTRAST 6,995.00 1802651 MRI FACE W/O & W 6,995.00 1802669 MRI NECK W/O & W 6,995.00 1802693 MRI ORBIT W/O & W 6,995.00 1802735 MRI RT UPPER EXT ANY JNT W/O&W 6,995.00 1802792 BC MRI RT BRST UNILAT W/O &W CNTRT 6,995.00 1802800 BC MRI BREAST BILAT WO&W CONTRAST 6,995.00 1802826 MRI PROSTATE NO IV CONTRAST 6,995.00 1802834 MRI PROSTATE W/W/O IV CONTRAST 6,995.00 1802842 MRI LT SHOULDER W/O CONTRAST 6,995.00 1802867 MRI LT SHOULDER W/O & W CONTRAST 6,995.00 1802875 MRI CARD F/MORPHOLOGY & FNCTN W/WO 6,995.00 1802933 BC MRI BREAST BILATERAL WO/C 6,995.00 1802941 BC MRI LT BREAST UNILAT WO CONTRAST 6,995.00 1802958 BC MRI RT BREAST UNILAT WO CNTRST 6,995.00 1802974 BC MRI LT BREAST UNILAT WO&W CNTRST 6,995.00 1802982 MRA PELVIS W/O CONTRAST 6,995.00 1802990 MRA PELVIS W/WO IV CONTRAST 6,995.00 1803006 MRA CHEST W/O CONTRAST 6,995.00 1803055 MRA LT UPPER EXT W/WO CONTRAST 6,995.00 1803162 MRI LT UPPER EXT NO JOINT W/O&W 9,668.00 1803188 GADOLINIUM PER ML 30.00 1803279 MRV ABDOMEN W/WO IV CONSTRAST 6,995.00 1803287 MRV PELVIS W/WO IV CONTRAST 6,995.00 1803295 MRI & MRCP ABDOMEN NO IV CONTRAST 6,995.00 1803303 MRV HEAD W/O CONTRAST 6,995.00 1803311 MRI RECONSTRUCTION IMAGES 1,061.00 1803329 MRV HEAD WITH IV CONTRAST 6,995.00 1803337 MRV HEAD WO&W IV CONTRAST 6,995.00 1803345 MRI SPECTROSCOPY 6,995.00 1803410 MRI RECONSTRUCTION IMAGES SP WS 1,061.00 1803428 BC MRI GUIDANCE FOR NEEDLE PLACEMT 2,706.00 1803444 MRI LEFT ANKLE WO/W IV CONTRAST 6,995.00 1803469 MRI LEFT KNEE NO IV CONTRAST 6,995.00 1803477 MRI LEFT ANKLE NO IV CONTRAST 6,995.00 1803493 MRI LEFT HIP NO IV CONTRAST 6,995.00 1803501 MRI LEFT HIP W/WO IV CONTRAST 6,995.00 1803527 MRI LEFT FOOT NO IV CONTRAST 6,995.00 1803535 MRI LEFT FOOT WO/W IV CONTRAST 6,995.00 1803550 MRI LEFT THIGH NO IV CONTRAST 6,995.00 1803568 MRI LEFT THIGH WO/W IV CONTRAST 6,995.00 1803584 MRI LEFT CALF NO IV CONTRAST 6,995.00 1803592 MRI LEFT CALF WO/W IV CONTRAST 6,995.00 1803618 MRI LEFT ELBOW NO IV CONTRAST 6,995.00 1803626 MRI LEFT ELBOW WO/W CONTRAST 6,995.00 1803642 MRI LEFT WRIST NO IV CONTRAST 6,995.00 1803659 MRI LEFT WRIST WO/W IV CONTRAST 6,995.00 1803667 MRI LEFT WRIST WITH IV CONTRAST 6,995.00 1803675 MRI LEFT HAND NO IV CONTRAST 6,995.00 1803683 MRI LEFT HAND WO/W IV CONTRAST 6,995.00 1803709 MRI LEFT HUMERUS NO IV CONTRAST 6,995.00 1803717 MRI LEFT HUMERUS WO/W IV CONTRAST 6,995.00 1803733 MRI LEFT FOREARM NO IV CONTRAST 6,995.00 1803741 MRI LEFT FOREARM WO/W IV CONTRAST 6,995.00 1803766 MRI RIGHT ANKLE NO IV CONTRAST 6,995.00 1803774 MRI RIGHT ANKLE WO/W IV CONTRAST 6,995.00 1803790 MRI RIGHT KNEE NO IV CONTRAST 6,995.00 1803808 MRI RIGHT KNEE WO/W IV CONTRAST 6,995.00 1803824 MRI RIGHT HIP NO IV CONTRAST 6,995.00 1803832 MRI RIGHT HIP WO/W IV CONTRAST 6,995.00 1803857 MRI RIGHT FOOT NO IV CONTRAST 6,995.00 1803865 MRI RIGHT FOOT WO/W IV CONTRAST 6,995.00 1803881 MRI RIGHT THIGH NO IV CONTRAST 6,995.00 1803899 MRI RIGHT THIGH WO/W IV CONTRAST 6,995.00 1803915 MRI RIGHT CALF NO IV CONTRAST 6,995.00 1803923 MRI RIGHT CALF WO/W IV CONTRAST 6,995.00 1803949 MRI RIGHT ELBOW NO IV CONTRAST 6,995.00 1803956 MRI RIGHT ELBOW WO/W IV CONTRAST 6,995.00 1803972 MRI RIGHT WRIST NO IV CONTRAST 6,995.00 1803980 MRI RIGHT WRIST WO/W IV CONTRAST 6,995.00 1804004 MRI RIGHT HAND NO IV CONTRAST 6,995.00 1804012 MRI RIGHT HAND WO/W IV CONTRAST 6,995.00 1804038 MRI RIGHT HUMERUS NO IV CONTRAST 6,995.00 1804046 MRI RIGHT HUMERUS WO/W IV CONTRAST 6,995.00 1804061 MRI RIGHT FOREARM NO IV CONTRAST 6,995.00 1804079 MRI RIGHT FOREARM WO/W IV CONTRAST 6,995.00 1804095 MRA LOWER EXTREMITY BILAT W/WO 6,995.00 1804103 MRI INTERVENTIONAL RADIOLOGY 1 1,623.00 1804111 BC MRI INTERVENTIONAL RADIOLOGY 2 1,834.00 1804129 MRI PITUITARY WO/W IV CONTRAST 6,995.00 1804137 MRI PITUITARY NO IV CONTRAST 6,995.00 1804145 MRI IAC WO/W IV CONTRAST 6,995.00 1804152 MRI IAC NO IV CONTRAST 6,995.00 1804228 CT BONE LENGTH 892.00 1804269 MRI SINUS NO IV CONTRAST 6,995.00 1804277 MRI SINUS WO/W IV CONTRAST 6,995.00 1804285 MRI LOWER EXT NO JOINT W/O & W BL 6,995.00 1804293 MRI LOWER EXT NO JOINT W/O BLT 6,995.00 1804301 MRI & MRCP ABDOMEN W/WO IV CONTRAST 6,995.00 1804335 CT ABD & PELVIS NO IV CONTRAST 10,695.00 1804343 CT ABD & PELVIS WITH IV CONTRAST 10,695.00 1804350 CT ABD&PELVIS W/WO IV CONTRAST 10,695.00 1804376 MRV RT UPPER EXTRMTY W/WO IV CONTRS 6,995.00 1804384 MRV LT UPPER EXTRMTY W/WO IV CONTR 6,995.00 1804400 M MRI HEAD AND IAC W/WO IV CONT 6,995.00 1804418 M MRI HEAD AND IAC NO IV CONTRAST 6,995.00 1804426 MRI TMJ WITH CONTRAST PER PROTOCOL 6,995.00 1804434 MRV BILAT LOWER EXTREMITY W/WO 6,995.00 1804459 MRI AND MRCP SS ABDOMEN NO IV CON 6,995.00 1804491 MRI HEAD AND IAC W/WO IV CONT 6,995.00 1804509 MRI HEAD AND IAC NO IV CONTRAST 6,995.00 1804517 MRI RIGHT ELBOW ARTHROGRAM W/C 6,995.00 1804525 MRI LEFT ELBOW ARTHROGRAM W/CON 6,995.00 1804533 MRI RIGHT SHOULDER ANTHROGRAM W/C 6,995.00 1804541 MRI LEFT SHOULDER ARTHROGRAM W/C 6,995.00 1804558 MRI RIGHT HIP ARTHROGRAM W/CONT 6,995.00 1804566 MRI LEFT HIP ARTHROGRAM W/CON 6,995.00 1804574 MRI RIGHT KNEE ARTHROGRAM W/C 6,995.00 1804582 MRI LEFT KNEE ARTHROGRAM W/CONT 6,995.00 1804590 MRI RIGHT ANKLE ARHTROGRAM W/C 6,995.00 1804608 MRI LEFT ANKLE ARTHROGRAM W/C 6,995.00 1804616 MRI CARDIAC FOR MORPHOLOGY&FUN W/WO 6,995.00 1804624 MRI RIGHT WRIST ARTHROGRAM W/CON 6,995.00 1804632 MRI LEFT WRIST ARTHROGRAM W/CON 6,995.00 1804640 MRI HEAD & PITUITARY W/WO IV CNTRST 6,995.00 1804657 MRI HEAD & PITUITARY NO IV CNTRST 6,995.00 1804665 MRI HEAD & CSF FLOW NO IV CONT 6,995.00 1804673 MRI HEAD & CSF FLOW W/WO IV CON 6,995.00 1804681 MRI CSF FLOW STUDY NO IV CONT 6,995.00 1804707 MRI BREAST CORE BIOPSY 6,353.00 1804715 MRI BREAST CORE BIOPSY EA ADD'L 3,457.00 1804723 MRI NEEDLE LOCALIZATION 4,729.00 1804731 MRI NEEDLE LOCALIZATION EA ADD'L 1,834.00 1804749 MRI SACRUM NO IV CONTRAST 6,995.00 1804756 MRI SACRUM W/WO IV CONTRAST 6,995.00 1804764 MRI CLAVICLE NO IV CONTRAST-RT 6,995.00 1804772 MRI CLAVICLE W/WO IV CONTRAST-RT 6,995.00 1804780 MRI CSF FLOW STUDY W/WO IV CONT 6,995.00 1804798 MRI CLAVICLE NO IV CONTRAST-LT 6,995.00 1804814 CT CHEST NO IV CONTRAST (LDCT) 4,000.00 1804822 CT IMAGE GUIDE FL CL DRN BY CATH 7,025.00 1804863 MRI THORACIC WITH CONTRAST 6,995.00 1804897 MRI CLAVICLE W/WO CONTRAST-LT 6,995.00 1804913 RS-MRI LEFT HIP NO IV CONTRAST 6,995.00 1804921 RS-MRI RIGHT HIP NO IV CONTRAST 6,995.00 1804939 MRV NECK W/WO IV CONTRAST 6,995.00 1804947 CT CHEST NO IV CONTRAST-TVAR 4,000.00 1804954 CT ABD/PELVIS NO IV CONTRAST-TAVR 10,695.00 1804962 CT NECK NO IV CONTRAST-TAVR 5,290.00 1804970 CTA CHEST W/WO IV CONTRAST-TAVR 6,564.00 1804988 CTA ABD/PELVIS W/WO IV CONTRST-TAVR 6,069.00 1804996 CTA NECK W/WO IV CONTRAST-TAVR 4,407.00 1805001 CTA HEART W/WO IV CONTRAST - TAVR 6,564.00 1805019 CTA HEART W/WO IV CONTRAST - TAVR 6,564.00 1880004 M MRI CERVICAL SPINE W/CONTRAST 6,995.00 1880012 M MRI CERVICAL SPINE W/O CONT 6,995.00 1880020 M MRI CERVICAL SPINE WO/W CONTRAST 6,995.00 1880038 M MRI HEAD W&W/O CONTRAST 6,995.00 1880053 M MRI HEAD W/O CONT 6,995.00 1880061 M MRI IAC NO IV CONTRAST 6,995.00 1880079 M MRI IAC WO/W IV CONTRAST 6,995.00 1880087 M MRI LEFT ANKLE NO IV CONTRAST 6,995.00 1880103 M MRI LEFT ANKLE WO/W IV CONTRAST 6,995.00 1880111 M MRI LEFT CALF NO IV CONTRAST 6,995.00 1880137 M MRI LEFT CALF WO/W IV CONTRAST 6,995.00 1880145 M MRI LEFT ELBOW NO IV CONTRAST 6,995.00 1880160 M MRI LEFT ELBOW WO/W CONTRAST 6,995.00 1880194 M MRI LEFT FOREARM WO/W IV CONTRAST 6,995.00 1880202 M MRI LEFT HIP NO IV CONTRAST 6,995.00 1880210 M MRI LEFT HIP VIEW W/WO IV CONT 6,995.00 1880228 M MRI LEFT HIP WITH IV CONTRAST 6,995.00 1880236 M MRI LEFT HUMERUS NO IV CONTRAST 6,995.00 1880251 M MRI LEFT HUMERUS WO/W IV CONTRAST 6,995.00 1880269 M MRI LEFT KNEE NO IV CONTRAST 6,995.00 1880277 M MRI LEFT KNEE WITH IV CONTRAST 6,995.00 1880285 M MRI LEFT KNEE WO/W IV CONTRAST 6,995.00 1880293 M MRI LEFT THIGH NO IV CONTRAST 6,995.00 1880327 M MRI LEFT WRIST NO IV CONTRAST 6,995.00 1880426 M MRI LT LOWER EXT NO JOINT W/O 6,995.00 1880434 M MRI LT SHOULDER W/CONTRAST 6,995.00 1880442 M MRI LT SHOULDER W/O CONTRAST 6,995.00 1880459 M MRI LT SHOULDER W/O&W CONTRAST 6,995.00 1880483 M MRI LT UPPER EXT ANY JOINT W/O 6,995.00 1880491 M MRI LT UPPER EXT NO JOINT W/O CON 6,995.00 1880525 M MRI LUMBAR SPINE W/CONTRAST 6,995.00 1880533 M MRI LUMBAR SPINE W/O CONTRAST 6,995.00 1880541 M MRI LUMBAR SPINE WO/W CONTRAST 6,995.00 1880574 M MRI ORBIT W/O&W 6,995.00 1880582 M MRI PELVIS W/CONTRAST 6,995.00 1880590 M MRI PELVIS W/O CONTRAST 6,995.00 1880608 M MRI PELVIS WO/W CONTRAST 6,995.00 1880616 M MRI PITUITARY NO IV CONTRAST 6,995.00 1880624 M MRI PITUITARY WO/W IV CONTRAST 6,995.00 1880632 M MRI RIGHT ANKLE NO IV CONTRAST 6,995.00 1880665 M MRI RIGHT CALF NO IV CONTRAST 6,995.00 1880699 M MRI RIGHT ELBOW NO IV CONTRAST 6,995.00 1880723 M MRI RIGHT FOREARM NO IV CONTRAST 6,995.00 1880756 M MRI RIGHT HIP NO IV CONTRAST 6,995.00 1880764 M MRI RIGHT HIP WITH IV CONTRAST 6,995.00 1880772 M MRI RIGHT HIP WO/W IV CONTRAST 6,995.00 1880780 M MRI RIGHT HUMERUS NO IV CONTRAST 6,995.00 1880806 M MRI RIGHT HUMERUS WO/W IV CONT 6,995.00 1880814 M MRI RIGHT KNEE NO IV CONTRAST 6,995.00 1880822 M MRI RIGHT KNEE WITH IV CONTRAST 6,995.00 1880830 M MRI RIGHT KNEE WO/W IV CONTRAST 6,995.00 1880863 M MRI RIGHT THIGH WO/W IV CONTRAST 6,995.00 1880871 M MRI RIGHT WRIST NO IV CONTRAST 6,995.00 1880889 M MRI RIGHT WRIST WITH IV CONTRAST 6,995.00 1880897 M MRI RIGHT WRIST WO/W IV CONTRAST 6,995.00 1880921 M MRI RT LOWER EXT ANY JOINT W/O 6,995.00 1880954 M MRI RT LOWER EXT NO JOINT W/O 6,995.00 1880962 M MRI RT SHOULDER W/CONTRAST 6,995.00 1880970 M MRI RT SHOULDER W/O CONTRAST 6,995.00 1880988 M MRI RT SHOULDER W/O&W CONTRAST 6,995.00 1881036 M MRI RT UPPER EXT NO JOINT W/O CON 6,995.00 1881044 M MRI RT UPPER EXT NO JOINT WO&W 6,995.00 1881051 M MRI SINUS NO IV CONTRAST 6,995.00 1881069 M MRI SINUS WO/W IV CONTRAST 6,995.00 1881077 M MRI TEMPOROMANDIBULAR JOINT 6,995.00 1881085 M MRI THORACIC SPINE W/O CONTRAST 6,995.00 1881093 M MRI THORACIC SPINE WO/W CONTRAST 6,995.00 1881119 M MRCP W/O CONTRAST 6,995.00 1881127 M MRV HEAD W/O CONTRAST 6,995.00 1881135 M MRA HEAD W/O CONTRAST 6,995.00 1881143 M MRA ABDOMEN WITH IV CONTRAST 6,995.00 1881150 M MRA ABDOMEN WO&W IV CONTRAST 6,995.00 1881192 M MRA CHEST WITH IV CONTRAST 6,995.00 1881218 M MRA CHEST WO&W IV CONTRAST 6,995.00 1881242 M MRA LT LWR EXTRM W IV CONT BILAT 6,995.00 1881259 M MRA LT UPR EXT WO&W IV CONTRAST 6,995.00 1881275 M MRA NECK WITH IV CONTRAST 6,995.00 1881283 M MRA NECK NO IV CONTRAST 6,995.00 1881291 M MRA PELVIS WITH IV CONTRAST 6,995.00 1881317 M MRA RENAL ARTERY W IV CONTRAST 6,995.00 1881325 M MRA RT LOWER EXT WITH IV CONTRST 6,995.00 1881341 M MRA UPPER EXT WO&W IV CONTRAST 6,995.00 1881416 M MRCP WITH IV CONTRAST 6,995.00 1881424 M MRI CHEST WITH IV CONTRAST 6,995.00 1881432 M MRI CHEST NO IV CONTRAST 6,995.00 1881440 M MRI CHEST WO&W IV CONTRAST 6,995.00 1881465 M MRI FACE NO IV CONTRAST 6,995.00 1881473 M MRI FACE WO&W IV CONTRAST 6,995.00 1881481 M MRI LEFT FOOT NO IV CONTRAST 6,995.00 1881499 M MRI LEFT FOOT WITH IV CONTRAST 6,995.00 1881507 M MRI LEFT FOOT WO&W IV CONTRAST 6,995.00 1881515 M MRI LEFT HAND NO IV CONTRAST 6,995.00 1881531 M MRI LEFT HAND WO&W IV CONTRAST 6,995.00 1881549 M MRI NECK NO IV CONTRAST 6,995.00 1881556 M MRI NECK WO&W IV CONTRAST 6,995.00 1881564 M MRI RIGHT FOOT NO IV CONTRAST 6,995.00 1881572 M MRI RIGHT FOOT WITH IV CONTRAST 6,995.00 1881580 M MRI RIGHT FOOT WO&W IV CONTRAST 6,995.00 1881598 M MRI RIGHT HAND NO IV CONTRAST 6,995.00 1881614 M MRI RIGHT HAND WO&W IV CONTRAST 6,995.00 1881622 M MRV ABDOMEN WITH IV CONTRAST 6,995.00 1881648 M MRV AORTAL ILIAC VEIN WO&W CONT 6,995.00 1881655 M MRV SMV/IMV WO&W IV CONTRAST 6,995.00 1881663 M MRI ABDOMEN NO IV CONTRAST 6,995.00 1881689 M MRI ABDOMEN W/WO IV CONTRAST 6,995.00 1881697 M MRI CARDIAC FOR MORPHOLOGY WO 6,995.00 1881705 M MRI CARDIAC FOR MORPHOLOGY WO/W 6,995.00 1881713 M MRI SPRECTROSCOPY 6,995.00 1881739 M MRV HEAD WO&W IV CONTRAST 6,995.00 1900059 NM THYROID UPTAKE MULT W/O IMAGING 693.00 1900091 NM THYROID IMAGING W MULT UPTAKE 1,417.00 1900141 NM THYROID CA MET IMAGE WB 3,625.00 1900257 NM SENTINEL NODE INJECTN W/IMAGING 3,363.00 1900281 NM LIVER W/VASC FLOW 2,047.00 1900299 NM LIVER IMAGING (SPECT) 4,071.00 1900307 NM LIVER-SPLEEN SCAN 3,476.00 1900315 NM LIVER &SPLEEN W/VASC FLOW 2,451.00 1900349 NM HEPATOBIL IMAGE 1,908.00 1900422 NM GASTRIC EMPTYING STUDY 2,494.00 1900463 NM MECKELS 2,366.00 1900471 NM PERITONEAL-VENOUS SHUNT 2,213.00 1900497 NM BONE-LIMITED 1,782.00 1900505 NM BONE-MULTIPLE 2,817.00 1900521 NM BONE SCAN WHOLE BODY 4,538.00 1900539 NM BONE 3 PHASE 4,071.00 1900695 NM MYOCARD PERF SPECT SINGLE 5,195.00 1900703 NM MYOCARD PERF SPECT MULTIPLE 6,791.00 1900745 NM MUGA REST CARD BLOOD SINGLE 2,951.00 1900828 NM PERFUSION IMAGING ONLY 1,317.00 1900869 NM PULM VENT IMAG GASEOUS SGL 1,317.00 1900927 NM BRAIN W/VASC FLOW 4+VIEWS 2,664.00 1900935 NM BRAIN IMAGING TOMO GRAPHIC 3,972.00 1900950 NM CEREBRAL VASCULAR FLOW ONLY 2,569.00 1900968 NM CISTERNOGRAM 3,440.00 1900984 NM CSF SHUNT,FLOW 2,865.00 1900992 NM CSF-LEAK-FLOW (30) 2,458.00 1901032 NM RENOGRAM W/FLOW&FUNC W/O RX 2,702.00 1901123 NM URETERAL CYSTOGRAM 1,826.00 1901131 NM TESTICULAR IMAG W/VASC FLOW 2,569.00 1901206 NM MUGA REST ONLY 2,951.00 1901222 NM MUGA REST-STRESS 1,602.00 1901289 NM GALLIUM IMAGING WB 2ORMORE D 5,665.00 1901297 WHOLE BODY SINGLE DAY IMAGE(SPECT) 5,470.00 1901305 NM INDIUM LEUKOYT WB 3,067.00 1901354 WHOLE BODY SINGLE DAY IMAGING 5,470.00 1901362 NM RADIOPHARM THERAPY ORAL ADM 698.00 1901404 NM THYROID CA THP ORAL ADMIN 698.00 1901552 NM GI BLOOD LOSS 2,060.00 1901578 NM HEPATOBIL IMAGE W/EF 1,908.00 1901610 NM LIVER IMAGING STATIC ONLY 2,633.00 1901636 NM TC99M MEDRONATE UP TO 30 MCI 294.00 1901644 NM TC99M SESTAMIBI PER DOSE 1,008.00 1901651 NM TC99M SULFUR COLLOID UP TO 20MCI 702.00 1901677 NM TC99M MAA STUDY DS TO 10MCI 263.00 1901685 NM XENON 133 PER 10 MCI 164.00 1901693 NM GA 67 PER MCI 244.00 1901701 NM I123 PER 100 UCI CAPSULE 31.00 1901719 NM TL 201 PER MCI 388.00 1901768 NM I-131 SOD IOD CAP PER MCI TX 135.00 1901776 NM IN 111 OXYQUIN DX PER 0.5 MCI 3,190.00 1901784 NM TC99M MERTIATIDE DS TO 15MCI 914.00 1901800 NM TC99M EXAMETAZ DS TO 25 MCI 3,222.00 1901859 NM IN 111 PENTETATE PER 0.5MCI 4,000.00 1901883 NM TC99M DISOFENIN DS TO 15MCI 4,000.00 1901891 NM TC99M LABEL RBC DS TO 30 MCI 299.00 1901933 NM TC99M MEBROFENIN,UP TO 15MCI 202.00 1902014 NM RENOGRAM W/RX INTERV SINGLE 2,702.00 1902501 NM TUMOR LOCALIZATION-BREAST 2,340.00 1902543 NM BONE DENSITY DEXA AXIAL SKEL 1,449.00 1902550 NM MYOCARD PERF TOM,EX-THALLIUM 6,791.00 1902568 NM MYOCARDD PERF TOM,REST-THALLIUM 5,195.00 1902576 NM BONE MARROW WHOLE BODY 2,850.00 1902592 NM ISO OCTREOSCAN STUDY DOSE 7,337.00 1902634 NM SM 153 LEXIDRONAM UPTO 150MCI 13,993.00 1902642 NM TC99M SULF COLLOID TO 25 MCI 168.00 1902725 NM TC99M BICISATE TO 25 MCI 3,212.00 1902741 NM IN111 PENTETREOTIDE UP TO 6 MCI 14,377.00 1902808 NM I131 MIBG IOBEN-SUFATE 0.5MCI 8,764.00 1902832 NM TC99M TETROFOSMIN PER DOSE 1,053.00 1902923 NM PHYSICIAN CONSULTATION 511.00 1902931 NM PHYSICIAN F/U W/TESTS/PROC 511.00 1903053 NM PARATHYROID IMAGING 1,978.00 1903178 NM WHOLE BODY SCAN 2OR MORE DAYS 5,665.00 1903186 NM LIVER IMG SPECT W/VASC FLOW 4,071.00 1903202 NM MYOCARD REST ONLY VIAB SPECT 5,195.00 1903244 NM PULMONARY QUANTITATIVE PERFUSION 2,040.00 1903269 NM TC 99M DTPA AEROSOL UP TO 75MCI 85.00 1903293 NM DEXA FOREARM 1,264.00 1903301 NM DEXA VERTEBRAL FX ASSESSMENT 1,664.00 1903392 NM FDG F-18 UP TO 45 MCI 1,342.00 1903400 NM TC99M PERTECHNETATE PER MCI 3.00 1903418 PET IMAGING LIMITED INITIAL 6,287.00 1903426 PET IMAGING LIMITED SUBS 6,287.00 1903434 PET IMAGING LIMITED INT NOPR 6,287.00 1903442 NM 18F NAF PER STUDY DOSE 1,259.00 1903459 PET IMAGING LIMITED SUBS NOPR 6,287.00 1903467 PET IMAGING SKULL-MID THIGH INT 5,071.00 1903475 PET IMAGING SKULL-MID THIGH SUBS 5,071.00 1903483 PET IMAGNG SKULL-MID THIGH INT NOPR 5,071.00 1903491 PET IMAGNG SKULL-MID THIGH SUB NOPR 5,071.00 1903509 PET CT BONE IMG WHOLE BODY INITIAL 11,163.00 1903517 PET CT NAF BONE IMG WHOLE BODY SQ 11,163.00 1903525 PET CT NAF BONE IMG WH BDY NOPR 11,163.00 1903533 PET CT NAF BONE IMG WH BDY SB NOPR 11,163.00 1903541 PET CT FDG WHOLE BODY INT NOPR 11,163.00 1903558 PET CT FDG SB-MID THIGH INT NOPR 11,163.00 1903566 PET CT FDG LIMITED INITIAL NOPR 11,163.00 1903574 PET CT FDG LIMITED SUBSEQUENT 11,163.00 1903582 PET CT FDG LIMITED SUBSQ NOPR 11,163.00 1903590 PET CT NAF BONE IMAGING LIM INITIAL 11,163.00 1903608 PET CT BONE IMAGING LT IN NOPR 11,163.00 1903616 PET CT NAF BONE IMAGING LMT SUBSQNT 11,163.00 1903624 PET CT NAF BONE IMAGING LT SQ NOPR 11,163.00 1903632 PET CT NAF BONE IMG SB-MID TH INT 11,163.00 1903640 PET CT NAF BN IMG SB-MDTH INTL NOPR 11,163.00 1903657 PET CT NAF BONE IMG SB-MD TH SQ 11,163.00 1903665 PET CT NAF BNE IMG SB-MD TH SQ NOPR 11,163.00 1903673 NM PULM QUANT VENT/PERF 491.00 1903681 NM PULMONARY VENT & PERFUSION 2,058.00 1903707 NM SENTINEL NODE INJECTION 1,070.00 1903715 NM I123 MIBG 16,050.00 1903723 NM PARATHYROID IMAGING W SPECT 1,959.00 1903731 NM I 125 SEED MARKER EA 1,000.00 1903780 NM GASTROINTESTINAL PROCEDURE 1,469.00 1903897 NM SENTINEL NODE LEFT INJ W IMAGING 3,363.00 1903905 NM SENTINEL NODE RT INJ W IMAGING 3,363.00 1903913 NM SENTINAL NODE LT INJ W/O IMAGING 1,070.00 1903921 NM SENTINEL NODE RT INJ W/O IMAGING 1,070.00 1903939 NM RADIOPHARMACY THERAPY,INTRA-ART 1,470.00 1903947 NM BASIC DOSIMETRY 2,638.00 1903954 NM SPEC MED RAD PHYSICS CONSULT 2,788.00 1903962 NM RENOGRAM W/WO PHARM INTERVENTION 2,702.00 1903970 TECHNECTIUM TC-99M PYROPHOSPHATE 370.00 1903988 NM I131 SOD IODIDE CAP(S) DIAG/MCI 135.00 1903996 NM TC99M DTPCA TO 25MCI 85.00 1904077 SIR-SPHERES Y90 80,105.00 1904085 TC99M CERETEC PER DOSE 7,032.00 1950005 PET CT FDG SB TO MID THIGH INT 11,163.00 1950013 PET CT FDG WHOLE BODY INITIAL 11,163.00 1950021 PET MYOCARDIAL METABOLIC EVAL 6,627.00 1950039 PET MYOCARDIAL SNG REST OR STRESS 6,627.00 1950047 PET MYOCARDIAL MLT REST OR STRESS 6,627.00 1950054 PET BRAIN IMAGING METABOLIC EVAL 6,627.00 1950062 PET CT FDG SB TO MID THIGH SUBS 11,163.00 1950070 PET CT FDG WHOLE BODY SUBS 11,163.00 1950088 PET CT FDG SB-MID THIGH SQ NOPR 11,163.00 1950096 PET CT FDG WHOLE BODY SUBQ NOPR 11,163.00 1950104 PET CT FDG LIMITED INITIAL 11,163.00 2101509 GI LAB REGULAR 1ST HOUR 5,600.00 2101517 GI LAB MINOR 3,913.00 2101525 GI LAB REGULAR WITH HIGH TECH 13,411.00 2101533 GI LAB EACH ADD'L 30 MINUTES 2,800.00 2101541 FACILITY FEE - LEVEL 2 (99212) 719.00 2101616 GI OUTPT LAB REGULAR 1ST HOUR 5,600.00 2101624 GI OUTPT LAB MINOR 3,913.00 2101632 GI OUTPT LAB REGULAR WITH HIGH TECH 13,411.00 2101640 GI OUTPT LAB EACH ADD'L 30 MINUTES 2,800.00 2101657 GI OUTPT FACILITY FEE-LEVEL2(99211) 511.00 2101665 GI BRAVO RECORDER READING 2,395.00 2300036 BONE MARROW BIOPSY 401.00 2300051 CYTOLOGY - SMEARS 154.00 2300127 SPECIAL STAIN-TRICHROME 120.00 2300267 BONE MARROW IRON STAIN 120.00 2300317 SPECIAL STAIN-ELASTIC 120.00 2300457 SPECIAL STAIN-DIFF QUICK 144.00 2300564 CYTOSPIN PREP 439.00 2300622 ASP BX-SMEARS 273.00 2300630 ASP BX-CELL BLOCK 520.00 2300721 RETICULUM /GMS 144.00 2300739 DECAL,BONE 75.00 2300796 SPECIAL STAIN-GMS 144.00 2300846 IRON STAIN 120.00 2300861 GRAM STAIN-TISSUE 144.00 2300887 SPECIAL STAIN-PAS 120.00 2300895 MUCIKERATIN STAIN 120.00 2300903 ACID FAST STAIN - TISSUE 144.00 2300937 FROZEN SECTION 835.00 2300945 FRZN SXN, ADD'L 244.00 2301356 GROSS & MICROSCOPIC LEVLE 1 277.00 2301364 GROSS & MICROSCOPIC LEVEL 2 308.00 2301372 GROSS & MICROSCOPIC LEVEL 3 421.00 2301380 GROSS & MICROSCOPIC LEVEL 4 520.00 2301398 GROSS & MICROSCOPIC LEVEL 5 700.00 2301406 GROSS & MICROSCOPIC LEVEL 6 728.00 2301422 BONE MARROW ASPIRATION ONLY 4,132.90 2301430 FNA,SUPERFICIAL TISSUE 297.00 2301455 CYTOPATHOLOGY FOR SPEC ADEQUACY 209.00 2301471 BONE MARROW SM,INTERP 2,040.00 2301521 SPECIAL STAIN,CONGO RED 120.00 2301547 SPECIAL STAIN,PAS/DIASTASE 120.00 2301570 BONE MARROW ASPIRATE 1,612.00 2301596 RETRIEVAL FOR MOLECULAR ANALYSIS 70.00 2301604 T PREP EXAM DURING SURGERY 60.00 2301612 T PREP EXAM DURING SURGERY EA ADDL 60.00 2301620 PATH CONSULT,REFERRED BLOCK 140.00 2400000 VENIPUNCTURE 90.00 2400018 VENIPUNCTURE CHARGE 90.00 2400026 MOB1 VENIPUNCTURE 90.00 2400034 WHITWOOD VENIPUNCTURE CHG 90.00 2400042 VENIPUNCTURE CHARGE EWMOB 90.00 2400059 CAPILLARY BLOOD COLLECTION 90.00 2501542 XR HYPAQUE SM BOWEL FOLLOW THR 1,777.00 3000015 UREA NITROGEN, URINE RANDOM 170.00 3000049 SALICYLATE 234.00 3000056 RHEUMATOID FACTOR QUANT 209.00 3000064 PROTEIN, 24 HR URINE 141.00 3000072 PROTEIN, TOTAL 144.00 3000080 PROTEIN, CSF 140.00 3000122 ALBUMIN FLUID 122.00 3000130 IGM 178.00 3000148 , URINE 26.00 3000189 DILANTIN, FREE 238.00 3000205 WET MOUNT 156.00 3000213 URIC ACID, 24 HR URINE 117.00 3000221 GLUCOSE, CSF 194.00 3000239 GLUCOSE 194.00 3000247 GLUCOMETER GLUCOSE 98.00 3000254 GLUCOSE 2 HR PP 194.00 3000262 ANA 294.00 3000320 MAGNESIUM, 24 HR URINE 229.00 3000338 SODIUM, 24 HR URINE 209.00 3000353 PREGNANCY, URINE (HCG, QUAL) 186.00 3000361 PREGNANCY, BLOOD 186.00 3000387 POTASSIUM, 24 HR URINE 189.00 3000478 KLEIHAUER-BETHE STAIN 397.00 3000528 CRYOPRECIPITATE X 1 96.00 3000585 FFP X1 131.00 3001013 CULTURE, WOUND 607.00 3001021 CULTURE SPUTUM/BRONCH WASHING 607.00 3001047 CULTURE, CATHETER TIPS 607.00 3001054 CULTURE, ANAEROBIC 437.00 3001062 CREATININE, RANDOM URINE 154.00 3001070 CORTISOL P.M. 210.00 3001088 CORTISOL A.M.-W 210.00 3001104 CHLORIDE, URINE RANDOM 209.00 3001120 ELUTION 250.00 3001153 SENSITIVITY 349.00 3001203 CRYPTOSPORIDIUM SMEAR 258.00 3001237 T4 (THYROXINE) 114.00 3001252 WET-MOUNT INDIA INK 156.00 3001294 ACETAMINOPHEN 454.00 3001310 PROPOXYPHENE, URINE 26.00 3001328 PROTEIN, AMNIOTIC FLUID 116.00 3001336 AMMONIA 323.00 3001351 , URINE 26.00 3001369 BASIC METABOLIC PANEL 618.00 3001385 CULTURE, G.C.SCREEN 170.00 3001393 CULTURE, BLOOD 610.00 3001401 FLUID CELL COUNT 215.00 3001443 OPIATES, URINE 26.00 3001450 PHENCYCLIDINE, URINE 26.00 3001468 PROSTATIC SPECIFIC ANTIGEN (PSA) 286.00 3001484 ACID-FAST CULTURE 299.00 3001500 CBC 131.00 3001534 METHAQUALINE, URINE 26.00 3001542 PRIMIDONE 259.00 3004991 (ETHYL) 114.00 3008257 SODIUM, URINE RANDOM 209.00 3008281 COMPLEMENT, C3 323.00 3008299 AMYLASE, FLUID 364.00 3008323 POTASSIUM, URINE RANDOM 228.00 3008349 AMYLASE, URINE RANDOM 364.00 3008356 URINE FOR EOSINOPHILS 60.00 3008372 CULTURE, JOINT REPLACEMENT 607.00 3008448 GLUCOSE, FLUID 194.00 3008463 LDH, FLUID 187.00 3009347 D-DIMER 247.00 3009404 -W 234.00 3009495 SPECIFIC GRAVITY 39.00 3009594 RESPIRATORY SYNCITIAL VIRUS EI 349.00 3009958 ASO TITER 209.00 3010709 OCCULT BLOOD 60.00 3011400 DRUG SCREEN, URINE 150.00 3011715 CULTURE, CSF 607.00 3011723 CULTURE, JOINT FLUID 607.00 3011731 CULTURE, MRSA SCREEN 239.00 3011749 SPLIT BLOOD PRODUCTS 217.00 3011756 AUTO WHOLE BLOOD UNIT 1,104.00 3011871 HEPATITIS C VIRUS -W 308.00 3011889 CARDIAC RISK PANEL 286.00 3011939 PREALBUMIN 293.00 3011988 PLATELETS X 1, REDUCED VOLUME 104.00 3012002 BACTERIAL ANTIGENS PANEL 509.00 3012051 CREATINE KINASE / CKMB (REFLEX 238.00 3012069 CKMB QUANTITATIVE 385.00 3012119 ELECTROLYTE PANEL 509.00 3012135 VALPROIC ACID 277.00 3012143 LIVER PROFILE 829.00 3012218 CATH/TAP URINALYSIS 213.00 3012275 ACETONE, SEMI-QNT,SERUM 335.00 3012333 ALBUMIN 122.00 3012408 AMIKACIN (AMIKIN)-W 335.00 3012465 AMPHETAMINES, URINE 26.00 3012473 AMYLASE 364.00 3012523 PHENOBARBITAL 229.00 3012614 CALCIUM 282.00 3012648 CALCIUM, 24 HR URINE 194.00 3012671 CARBAMZEPINE (TEGRETOL) 299.00 3012689 CARBON DIOXIDE (CO2) 173.00 3012788 CHLORIDE, BLOOD 173.00 3012838 169.00 3012895 COCAINE, URINE 26.00 3012952 CPK 238.00 3012986 CREATININE,BLOOD 209.00 3013000 CREAT.CLEARANCE 294.00 3013018 CRYOGLOBULINS 277.00 3013042 VITAMIN B12 279.00 3013091 DIGOXIN 593.00 3013265 FAT,QUALITATIVE 75.00 3013281 FIBRINOGEN 321.00 3013299 FOLATE, (SERUM) 279.00 3013307 FOLATE, RBC 56.00 3013414 GLUC TOLERANCE PRENATAL 209.00 3013463 GGTP 173.00 3013489 BETA HCG, QUANT 437.00 3013547 -W 310.00 3013570 FETAL HEMOGLOBIN (APT) 47.00 3013588 HEMOGLOBIN A1C 210.00 3013729 IRON (TOTAL ONLY) 117.00 3013810 LACTIC ACID (LACTATE) 376.00 3013828 LDH 187.00 3013869 LIDOCAINE 243.00 3013877 LIPASE 220.00 3013919 LITHIUM, LAB-W 294.00 3013935 MAGNESIUM 235.00 3014032 OSMOLALITY, BLOOD 197.00 3014040 OSMOLALITY, URINE 197.00 3014123 DILANTIN (PHENYTOIN) 423.00 3014164 ALK. PHOSPHATASE 235.00 3014172 PHOSPHORUS 209.00 3014180 PHOSPHORUS,24 HR URINE 170.00 3014214 POTASSIUM 209.00 3014305 FLUID PROTEIN 140.00 3014420 SODIUM 209.00 3014537 CANNABINOIDS, URINE 26.00 3014545 THEOPHYLLINE 319.00 3014628 TSH 245.00 3014644 SGOT (AST) 257.00 3014651 SGPT (ALT) 257.00 3014669 TRIGLYCERIDES 220.00 3014677 T3,TOTAL-W 250.00 3014701 BUN (UREA NITROGEN) 209.00 3014719 URIC ACID 144.00 3014735 VANCOMYCIN 400.00 3014800 GENTAMICIN 400.00 3014818 TOBRAMYCIN 400.00 3014891 EOSINOPHILE COUNT 76.00 3014909 HEMATOCRIT 65.00 3014933 CBC WITH DIFF 325.00 3014966 RETICULOCYTE COUNT 116.00 3015229 PLATELET COUNT 234.00 3015237 PROTHROMBIN TIME 257.00 3015260 SEDIMENTATION RATE 166.00 3015278 SICKLE CELL PREPARATION 76.00 3015294 PTT 319.00 3015385 CRP QUANTITATIVE (HS) 323.00 3015468 ANTIBODY SCREEN 184.00 3015492 ANTIBODY IDENTIFICATION 531.00 3015518 DIRECT,COOMBS 186.00 3015526 ANTIBODY TITER 531.00 3015575 COMPATIBILITY TESTING, AHG 194.00 3015666 ANTIGEN TYPING-DIRECT 207.00 3015765 CEA-W 345.00 3015773 FERRITIN 181.00 3016045 ANA, QUANTITATIVE 277.00 3016284 RUBELLA AB SCREEN-W 247.00 3016300 COLD AGGLUTININS 217.00 3016318 HEPATITIS B SURFACE ANTIGEN-W 308.00 3016342 HEP SURFACE AB-W 308.00 3016391 HEP A VIRUS IGM-W 308.00 3016409 HETEROPHILE SCREEN 220.00 3016466 IMMUNOGLOBULIN PANEL-Q.I.G. 437.00 3016490 CRYPTOCCOCCUS ANTIGEN 220.00 3016789 ACID FAST SMEAR CONCENTRATE 258.00 3016805 CULTURE, STOOL 630.00 3016821 CULTURE,EYE/EAR/NOSE/THROAT 607.00 3016839 CULTURE,BODY FLUIDS 607.00 3016870 STREP GROUP A SCREEN 239.00 3016888 CULTURE URINE 505.00 3016920 CULTURE FUNGUS 307.00 3016946 ACID FAST CULTURE, BLOOD 299.00 3017035 DIFFICILE TOXIN 324.00 3017043 OVA & PARASITES 432.00 3017092 GRAM STAIN 184.00 3017100 ACID FAST SMEAR, DIRECT 258.00 3017126 MALARIA SMEAR 156.00 3017597 NEWBORN ADDITIONAL UNIT 217.00 3017639 SPERM EXAM - PRESENCE/ABSENCE 144.00 3017647 ABO TYPING 166.00 3017654 RH TYPING 144.00 3017662 RBC COUNT 120.00 3017670 WBC COUNT 120.00 3017688 IRON BINDING CAPACITY,DIRECT 120.00 3017696 GTT SPECIMENS, FIRST THREE 209.00 3017704 GTT SPECIMENS, FOURTH SPECIMEN 125.00 3017712 GTT SPECIMENS, FIFTH SPECIMEN 125.00 3017720 IGG, QUANTITATIVE 228.00 3017738 IGA, QUANTITATIVE 178.00 3017779 COMPREHENSIVE METABOLIC PANEL 766.00 3017860 GROUP B STREP SCREEN 239.00 3017902 CARDIAC TROPONIN I 384.00 3017910 MYOGLOBIN, SERUM 203.00 3017928 CULTURE, VRE SCREEN 239.00 3017936 RPR SEROLOGY 128.00 3017985 RAPID GROUP B STREP SCREEN 334.00 3018009 PRENATAL PANEL 1,339.00 3018017 HIV 1/2 ANTIBODY-EIA 441.00 3018140 COMPLEMENT, C4 323.00 3018157 FREE T4 (FT4) 184.00 3018165 FREE T3 (FT3)-W 189.00 3018173 CAFFEINE 299.00 3018181 BILIRUBIN, TOTAL 139.00 3018199 BILIRUBIN, DIRECT 139.00 3018207 OCCULT BLOOD, URINE 60.00 3018223 CORTISOL TOTAL-W 210.00 3018231 FETAL ASSAY-W 933.00 3018264 ACUTE HEPATITIS PANEL 1,358.00 3018272 GTT SPECIMENS, SIXTH SPECIMEN 125.00 3018298 COMPATIBILITY TEST, EACH UNIT 672.00 3018314 RENAL FUNCTION PANEL 661.00 3018322 HDL CHOLESTEROL 104.00 3018330 LDL CHOLESTEROL 104.00 3018363 MICROALBUMIN-W 361.00 3018371 PROTEIN, URINE RANDOM 141.00 3018389 CALCIUM, URINE RANDOM 282.00 3018405 METHADONE, URINE 26.00 3018488 BNP, B NATRIURETIC 397.00 3018496 LEGIONELLA ANTIGEN,URINE 210.00 3018504 STREP PNEUMONIAE AG,URINE 210.00 3018512 E.D. URINE HCG 164.00 3018520 RUBEOLA AB SCREEN-W 247.00 3018538 VARICELLA ZOSTER AB SCREEN 247.00 3018553 BILIRUBIN, NURSERY/NICU 116.00 3018561 PLATELET FUNCTION TEST 333.00 3018579 HEPATITIS B CORE AB,IGM-W 286.00 3018587 FLUID CHOLESTEROL 169.00 3018595 FLUID TRIGLYCERIDES 220.00 3018603 INFLUENZA A&B TEST 294.00 3018611 CULTURE, VAP,QUANTITATIVE 607.00 3018629 ALPHA FETO PROTEIN-W 287.00 3018637 CA 15-5-W 287.00 3018645 CA 125-W 287.00 3018652 CA 19-9-W 287.00 3018678 CULTURE,GENITAL,OB/GYN 607.00 3018686 E COLI 0157 H7 SCREEN 205.00 3018694 METHEMOGLOBIN ABG 67.00 3018702 HEMOGLOBIN ANG 67.00 3018710 LACTATE ABG 67.00 3018728 CALCIUM,IONIZED,ABG 67.00 3018736 GLUCOSE,ABG 67.00 3018744 BILIRUBIN,ABG 67.00 3018751 ELECTROLYTES,ABG 509.00 3018769 PPD SKIN TEST 62.00 3018777 PTH INTACT-W 290.00 3018884 RAPID MRSA SCREEN 479.00 3018900 FLUID CELL COUNT, NO DIFF 203.00 3018918 URIC ACID,FLUID 144.00 3018926 URINE PH 33.00 3018934 FLUID SPECIFIC GRAVITY 33.00 3018942 SKIN TEST FOR CANDIDA 62.00 3018959 CDIFF TOXIN DNA BY PCR 334.00 3018967 CLOSTRIDIUM DIFFICILE AG, EIA 321.00 3018975 URINE DRUG SCREEN 257.00 3018983 PROCALCITONIN 413.00 3018991 VITAMIN D,25-HYDROXY-W 280.00 3019007 VALPROIC ACID,NON PROTEIN BOUND 269.00 3019015 POOLED BLOOD PRODUCT PROC CHG 118.00 3019023 BETAHYDROXY BUTYRATE 194.00 3019031 NICU DRUG RESISTANT ORG SCREEN 239.00 3019056 OCCULT BLOOD-ON SINGLE COLLECTION 60.00 3019064 HEMOGLOBIN 65.00 3019072 SHIGA TOXIN TEST 192.00 3019080 SHIGA TOXIN 1 DETECTION 98.00 3019098 SHIGA TOXIN 2 DETECTION 98.00 3019106 PROSTATIC SPECIFIC ANTIGEN(PSA)SCRN 286.00 3019114 OCCULT BLD,STL,1-3 BY IMMUNOASSAY 60.00 3019122 HEP B SURFACE AG CONFIRM 500.00 3019130 URINE DRUG SCREEN-EMPHEALTH 35.00 3019148 T-4 FREE DLAB 4.00 3019155 HEP C AB-DLAB 10.00 3019163 HEP B SURF AG W/REFLEX TO CONF-DLAB 6.18 3019171 HEP B SURF CONFIRM-DLAB 33.86 3019189 HEP A IGM AB-DLAB 11.00 3019197 HEP B CORE IGM AB-DLAB 12.00 3019205 HEP B SURF AB QL-DLAB 9.00 3019213 CEA-DLAB 7.00 3019221 VIT D 250H LC/MS/MS-DLAB 81.89 3019239 PTH,INTACT & CALCIUM-DLAB 25.00 3019247 T-3, FREE D-LAB 50.88 3019254 T-3, TOTAL-DLAB 5.00 3019262 CORISTOL, TOTAL-DLAB 7.00 3019270 HAPTOGLOBIN-DLAB 10.00 3019288 MICROALBUMIN RAND UR-DLAB 20.72 3019296 RUBELLA IMMUNE-DLAB 5.00 3019304 TRANSFERRIN-DLAB 13.68 3019312 LITHIUM-DLAB 10.07 3019320 -DLAB 210.00 3019338 AFP,TUMOR-DLAB 10.00 3019346 CA125-DLAB 10.00 3019353 CA 15-3-DLAB 14.00 3019361 CA 19-9-DLAB 13.00 3019379 AMIKACIN-DLAB 22.64 3019387 ACUTE HEPATITIS PANEL-DLAB 39.18 3019395 HIV 1/2 ANTIBODY, SCREENING 240.00 3019403 VARICELLA-W 63.25 3019411 MUMPS IGG-DLAB 53.20 3019429 RUBEOLA IGG-DLAB 33.29 3019437 ANA W/RFX-DLAB 8.78 3019445 ANA RFX-DLAB 14.00 3019452 MUMPS IGG AB-W 247.00 3019460 URINALYSIS WITH MICROSCOPY 255.00 3019478 URINALYSIS WITHOUT MICROSCOPY 213.00 3019486 CCP -W 277.00 3019502 SYPHILIS AB 128.00 3019510 CPEPTIDE 210.00 3019528 RPR TITER 128.00 3019536 ANA ANTIBODY,EIA SCRN 240.00 3019544 DS DNA ANTIBODY,EIA 180.00 3019551 SSA ANTIBODY 180.00 3019569 SSB ANTIBODY 180.00 3019577 SM ANTIBODY 180.00 3019585 SM/RNP ANTIBODY 180.00 3019593 JO1 ANTIBODY 180.00 3019601 SC170 ANTIBODY 180.00 3019619 CENTROMERE ANTIBODIES 180.00 3019627 HIV1 AB, HIV2 AB, P24AG SCREEN 280.00 3019635 POCT INR 257.00 3019650 AMIKACIN PEAK 335.00 3019668 AMIKACIN TROUGH 335.00 3019676 AMPLIF RNA 200.00 3019684 NEISSERIA GONORRHOEAE AMPLIF RNA 200.00 3019734 EVAL OF SPERM ABSENCE/PRESENCE 156.00 3019742 CANDIDA AURIS SCREEN 239.00 3019759 PATHOLOGIST PERIPHRL BLOOD SMR RVW 64.33 3019767 PATHOLOGIST BODY FLUID SMEAR REVIEW 160.69 3019775 INFLUENZA A/B VIRUS BY PCR 450.00 3019783 SARS-COV-2 RNA, QUALITATIVE RT PCR 250.00 3019791 SARS-COV-2 IGG ANTIBODY QUALITATIVE 150.00 3019809 SARS-COV-2 IGM ANTIBODY QUALITATIVE 75.00 3019817 VERIFYNOW - ASPIRIN 175.00 3019825 VERIFYNOW - PRU 175.00 3019833 SARS-COV-2 TOTAL ANTIBODY QUALITATV 75.00 3019841 RP2 MULTI RESP PCR PNL-12-25 TARGTS 416.00 3019858 RP2 MULTI RESP PCR PANEL-C.PNEUMO 35.00 3019866 RP2 MULTI RESP PCR PANEL-M.PNEUMO 35.00 3019874 RP2 MULTI RESP PCR PANEL-SARS-COV-2 51.00 3019882 SARS-COV2-ANTIGEN BY FIA 91.00 3020195 SARS-COV-2 RT PCR-ABBOTT IDKNOW 250.00 3020203 WESTPAC SPECIAL HNDLNG FEE-WEST PAC 50.00 3020211 LYRA SARSCOV2 PCR HI THRU INST ADD 25.00 3020229 LYRA SARS-COV-2 PCR HI THRUPUT INST 475.00 3020237 SLVA DRCT COV2 PCR HI THRU INST ADD 25.00 3020245 SALIVA DIRCT COV2 PCR HI THRU INST 475.00 3020252 RSV DNA/RNA AMPLIFIED PROBE 140.84 3900008 WHOLE BLOOD, ONE UNIT 1,240.00 3900016 RED BLOOD CELLS,ONE UNIT 1,311.00 3900024 CRYOPRECIPITATE,ONE UNIT 413.00 3900040 FRESH FROZEN PLASMA,ONE UNIT 413.00 3900123 SPECIAL SCREEN,PER ANTIGEN 184.00 3900156 RH IG PRODUCT 475.00 3900255 PLATELETPHERESIS UNIT 2,583.00 3900263 THERAPEUTIC PHLEBOTOMY 439.00 3900321 AUTOLOGOUS ADMINISTRATIVE PROC 186.00 3900412 RH IMM GLOB ADMIN 531.00 3900578 ARC AUTO RBC UNIT 1,311.00 3900891 APHERESIS,THERAPEUTIC,PLASMA 7,820.00 3900909 APHERESIS,THERAPEUTIC,PLATELETS 7,820.00 3900917 APHERESIS, THERAPEUTIC,WBC 7,820.00 3900925 BLOOD TRANSFUSION/HIM 3,050.00 3900933 BLOOD TRANSFUSION 3,050.00 3900941 CRYOPRECIPITATE POOLED X5 ARC UNIT 70.00 3900982 ARC FROZEN PLASMA UNIT 40.00 3900990 PLATELET ANTIBODY PER TEST,HLA-ARC 700.00 3901006 PLATELET ANTIGEN TYPING-ARC 400.00 3901022 CRYOPRECIP ARC 70.00 3930376 IHC,ADDNL STAIN PROC-NG 93.16 4012001 NUTRITION COUNSELING EA 15 MIN 143.00 4013009 NUTRITION COUNS FOLLOW UP-EA15M 143.00 4900106 SEROTONIN, BLOOD -NI 92.34 4900189 ANTI PARIETAL AB-MAYO 24.69 4900197 ANTI CARDIOLIPIN AB -MAYO 12.65 4900221 IGG SUBCLASS-NI 104.00 4900239 CMV, IGG + IGM AB -MAYO 9.08 4900254 LIPIDS, TOTAL,FECAL, -MAYO 30.00 4900262 DHEA S-MAYO 14.55 4900296 ESTRADIOL, 17 BETA-MAYO 13.22 4900320 G6PDH -MAYO 17.07 4900346 FTA ABS -MAYO 18.94 4900379 ARSENIC, BLOOD-NI 33.10 4900411 , TOTAL, BLOOD-NI 40.55 4900437 PORPHYRINS 24 HR QUANT -MAYO 37.86 4900445 CELL BOUND PLATELET AB-MAYO 75.00 4900478 COCCI AB, CF -MAYO 9.47 4900486 CMV CULTURE-MAYO 66.89 4900536 ARSENIC, URINE-NI 51.00 4900593 FREE T4-MAYO 16.06 4900619 ALDOSTERONE SERUM -MAYO 15.31 4900627 -MAYO 17.96 4900635 CATECHOLAMINES, URINE-MAYO 30.00 4900668 ANTI MITOCHONDRIAL AB -MAYO 10.82 4900684 MICROALBUMIN -MAYO 16.13 4900783 MARIJUANA(THC)QUANTITATIVE-NI 43.69 4900791 (QUAALUDE)-NI 49.00 4900817 PCP (QUALITATIVE),GCMS CONF-NI 49.00 4900833 B PERTUSSIS CULTURE-NI 46.00 4900874 SJOGRENS SSA,SSB AB-NI 36.11 4900924 HIV WESTERN BLOT-MAYO 19.75 4900999 COXACKIE B ANTIBODIES -NI 55.30 4901021 EPSTEIN BARR PANEL-MAYO 13.61 4901088 ANTI SMOOTH MUSCLE AB-MAYO 12.90 4901104 SENDOUT PROCESSING CHARGE 23.00 4901112 LEAD, BLOOD -MAYO 9.56 4901161 CALCULUS ANALYSIS-ARAWAK 41.00 4901187 RISTOCETIN -QUEST 69.00 4901203 TOXOPLASMA AB, IGM-MAYO 19.48 4901211 T3 REVERSE - MAYO 31.22 4901229 CA 15 3-MAYO 16.20 4901302 PROINSULIN -NI 78.03 4901336 INSULIN LEVEL-MAYO 9.99 4901344 ANTI PLATELET AB-MAYO 50.00 4901351 C1 ESTERASE INHIBITOR -MAYO 22.60 4901369 R CHROMOSOME STUDY,TISSUE-MAYO 625.00 4901385 -MAYO 77.50 4901393 PROTEIN S ANTIGEN-MAYO 22.75 4901419 CHLAMYDIA AB PANEL, IFA TWAR -MRL 198.90 4901468 HISTOPLASMA AB,CSF-MAYO 44.72 4901526 R HYPERSEN PNEUMONITIS PNL-MAYO 40.36 4901534 ASPERGILLUS AB, CF -MAYO 33.10 4901542 PREGNENOLONE -NI 77.35 4901559 AMIODARONE -MAYO 21.90 4901708 B.BURGDORF.(LYMES) AB,CSF-MRL 67.50 4901765 CHROMOGRANIN A -NI 87.55 4901856 R PARVOVIRUS B19, ANTIBODY-MAYO 11.23 4901930 IGF I (SOMATOMEDIN C)-NI 60.86 4901997 -MAYO 9.50 4902045 TOXIC SHOCK SYNROME PNL-MRL 200.70 4902060 A1 ANTITRYPSIN +PHENOTP-MAYO 23.22 4902110 ALLERGY PANEL FOOD PRO 1-NI 92.00 4902268 CARNITINE LEVEL-MAYO 30.67 4902326 R RUBEOLA IGG & IGM AB -MAYO 12.50 4902342 COCCI AB, CSF-MAYO 55.30 4902375 RUBELLA AB,IGM-NI 38.59 4902409 THYROID STIMULATING IG-MAYO 50.03 4902425 CORTISOL, URINARY FREE-MAYO 22.00 4902466 DRUG SCREEN, BLOOD-MAYO 124.00 4902508 HEPATITIS A AB TOTAL-NI 62.40 4902516 HEPATITIS B CORE AB IGM-MAYO 15.00 4902532 -MAYO 38.74 4902680 IRON, QUANT, TISSUE-MAYO 62.87 4902706 ETHYLENE GLYCOL-MAYO 71.45 4902755 GMI ANTIBODY PANEL-MAYO 30.00 4902847 COMPLEMENT CH50 -MAYO 13.89 4902862 TREPONEMA PALLIDUM DFA -NI 18.08 4902870 JO 1 ANTIBODY-NI 30.80 4902995 HIV2 EIA SCREEN/WB REFLEX-NI 24.30 4903019 VITAMIN D, 1,25 DIHYDROXY-MAYO 16.67 4903043 ALPHA 1 ANTITRYPSIN QNT-MAYO 20.00 4903084 HERPES VIRUS 6, HUMAN-MRL 162.00 4903092 R HEMOGLOBIN ELECTROPHORESIS-MAYO 35.58 4903142 ACTH -MAYO 15.06 4903183 ALUMINUM-MAYO 21.00 4903191 DELTA AMINOLEVOLINIC ACID-NI 41.00 4903217 ANDROSTENEDIONE-MAYO 32.66 4903225 ANGIOTENSIN CONV ENZ -MAYO 10.00 4903258 CALCITONIN-NI 49.20 4903308 CATECHOLAMINES, SERUM -QUEST 47.55 4903324 -MAYO 65.41 4903340 LIBRIUM(CHLORDIAZEPOXIDE)-NI 26.24 4903357 TORCH PANEL IGM 86645-MAYO 18.00 4903365 ACETYLCHOLINE RECEPTOR AB-MAYO 52.38 4903381 COPPER, SERUM -MAYO 15.00 4903407 C PEPTIDE-MAYO 16.54 4903423 CYANIDE -MAYO 89.00 4903456 DIAZEPAM NORDIAZEPAM-MAYO 58.60 4903563 ESTRIOL, SERUM-NI 8.50 4903597 IGD-MAYO 38.75 4903605 IGE -MAYO 10.64 4903639 FSH, BLOOD -MAYO 9.73 4903654 -MAYO 15.85 4903696 17-OH -NI 44.00 4903704 5 HIAA (SEROTONIN METAB) -MAYO 20.00 4903720 IMIPRAMINE -MAYO 20.35 4903787 METANEPHRINES,24 HR URINE -MAYO 22.50 4903803 R -MAYO 101.00 4903837 5 NUCLEOTIDASE-MAYO 233.38 4903845 , URINE -MAYO 21.01 4903860 PORPHOBILINOGREN 24HR UR-MAYO 30.31 4903894 PROGESTERONE, SERUM -MAYO 10.12 4903902 17 OH PROGESTERONE-MAYO 22.84 4903944 RENIN (PLASMA) -MAYO 12.07 4903977 TUMOR MARKER-MAYO 10.96 4903993 VMA, URINE -MAYO 22.34 4904017 ZINC-MAYO 12.22 4904033 ANTI THROMBIN III-MAYO 17.00 4904058 VISCOSITY, SERUM -MAYO 25.00 4904066 TRICHINELLA AB-MAYO 47.29 4904082 INTRINSIC FACTOR AB-NI 26.25 4904090 INSULIN AB-NI 58.50 4904108 ANCA CYTOPLASMIC NEUT AP,SER-MAYO 20.96 4904116 ANTI STRIATED MUSCLE AB -MAYO 23.00 4904140 ADENOVIRUS AB-MAYO 90.43 4904157 R EPSTEIN BARR VIRUS PANEL -MAYO 7.00 4904199 POLIO AB -NI 67.90 4904215 R Q FEVER AB -MAYO 30.00 4904223 TOXOPLASMA AB IGG-MAYO 19.98 4904231 ECHOVIRUS AB-NI 123.30 4904249 R V ZOSTER AB,IGG/IGM -MAYO 12.50 4904256 ANTI CENTROMERE AB-MAYO 10.73 4904280 GLOMERULAR BASMNT.MEMB.AB-MAYO 10.88 4904298 BETA-2 -MAYO 26.00 4904330 R CHLAMYDIA GROUP AB -MAYO 12.77 4904355 ERYTHROPOETIN-NI 24.03 4904397 HISTONE AUTOANTIBODIES-QUEST 49.05 4904413 BETA GLUCURONIDASE -NI 64.00 4904496 HISTOPLASMA AB,SERUM-MAYO 31.32 4904546 HLA B 27-MAYO 38.73 4904561 ANTI THYROGLOBULIN AB-NI 14.88 4904595 MYCOPLASMA CULTURE -MAYO 79.93 4904603 LEGIONELLA CULTURE-MAYO 13.01 4904694 LEGIONELLA AB(COMPLETE) -MAYO 23.41 4904801 SENS & MOTOR NEUROPATHY PNL-MRL 928.80 4904868 ANTI GLIADIN ANTIBODIES,IGG,IGA-NI 79.27 4904926 STOOL FOR ALPHA1 ANTITRYPSIN-SKB 20.00 4904975 TESTOSTERONE,TOTAL-MAYO 12.24 4905014 R COAG FACTOR II-MAYO 60.00 4905105 LYMES AB,EARLY,NONREFLEXED-NI 59.00 4905113 PLASMA HEMOGLOBIN-MAYO 39.74 4905147 AFB ID, CONVENTIONAL-MRL 79.00 4905170 TYPHUS FEVER ANTIBODY-MAYO 49.70 4905238 LYME DISEASE AB,REFLEXED-NI 23.60 4905246 GIARDIA LAMBLIA ANTIGEN-MAYO 20.99 4905253 AB-MAYO 14.51 4905295 LYME'S DISEASE AB, W BLOT-MAYO 30.00 4905303 BRUCELLA AB-MAYO 34.84 4905436 ALCOHOL PROFILE(METHANOL)-NI 23.33 4905444 COAG FACTOR VIII - MAYO 49.30 4905493 PROSTATIC ACID PHOS BY RIA-MAYO 21.80 4905519 VITAMIN D 25 HYDROXY-MAYO 8.00 4905535 METHOTREXATE-MAYO 50.56 4905550 HEPATITIS BE AG & AB-MAYO 30.94 4905584 -NI 44.07 4905634 HEPATITIS BE AB-MAYO 15.95 4905667 CALCIUM IONIZED -MAYO 15.80 4905725 R RICKETTSIAL DISEASE PANEL-QUEST 34.05 4905741 BORRELIA BURGDORFERI DNA,PCR-MAYO 86.28 4905782 VITAMIN A-MAYO 14.05 4905865 LUPUS(PHOSPHOLIPID)AB REFLX-MAYO 36.50 4905873 R ALK PHOS ISOENZYMES-MAYO 13.00 4905964 FK506 (TACROLIMUS)-MAYO 24.06 4905972 ISLET CELL AB (IA-2)-MAYO 27.37 4906061 SEX HORMONE BINDING GLOBULIN-NI 37.50 4906194 THYROPEROXIDASE (TPO)AB-MAYO 9.88 4906335 BETA GLUCURONIDASE,CSF-MAYO 55.29 4906343 PSEUDOCHOLINESTERASE-MAYO 29.04 4906426 DEOXYCORTICOSTERONE-MAYO 36.67 4906467 BENZODIAZEPINES URINE-MAYO 76.60 4906509 POC CHROMOSOMAL ANALYSIS CHG2-MAYO 160.00 4906566 ALDOLASE -MAYO 9.00 4906582 R T & B CELL ANALYSIS-MAYO 18.17 4906608 MYCOPL PNEUM IGM & TOTAL-MAYO 21.87 4906624 ANTI ENA-MAYO 3.00 4906632 VIRAL CULTURE-MAYO 30.66 4906723 ALDOSTERONE URINE-MAYO 55.00 4906731 CANDIDA ANTIBODY -NI 97.85 4906749 VDRL, CSF -MAYO 7.50 4906814 CLONAZEPAM -MAYO 28.91 4906822 AFB PRIMARY DRUG SUSCEPT PNL-MRL 141.30 4906855 LEPTOSPIRA ANTIBODY -MAYO 50.00 4906871 PENTOBARBITAL-NI 50.58 4906889 THYROID PEROXIDASE AB(TPO AB)-NI 38.50 4906954 -MAYO 10.13 4907028 ALLERGY PNL, ADULT-NI 262.00 4907135 COAG FACTOR IX-MAYO 60.00 4907150 MYOGLOBIN, SERUM-NI 45.50 4907234 MYOGLOBIN, URINE-NI 35.00 4907366 LEGIONELLA ANTIGEN,DFA-MAYO 75.00 4907457 LUTEINIZING HORMONE-MAYO 9.84 4907499 NEISSERIA GONORRHOEAE PROBE-NI 27.32 4907515 HEPATITIS B VIRUS, DNA QNT-NI 107.61 4907564 COUMADIN LEVEL-NI 78.00 4907689 AEROBIC MIC CUSTOM 3 DRUGS -MRL 163.80 4907762 MAG ANTIBODY -MRL 225.90 4907861 MYELOPEROXIDASE AB-MAYO 31.70 4907887 ALPHA GALACTOSIDASE-MAYO 119.58 4907952 CK ISOENZYMES-MAYO 30.19 4907986 CA 27.29-MAYO 15.50 4907994 HEPARIN THROMBOCYTOPENIA-MAYO 35.03 4908026 LAMOTRIGINE-MAYO 15.00 4908034 GABAPENTIN-MAYO 21.70 4908067 HOMOCYSTEINE, TOTAL PLASMA-MAYO 16.85 4908075 HEPARIN ASSAY-MAYO 55.00 4908083 STREP SEROTYPING-MRL 157.00 4908091 CELIAC DISEASE FULL PNL FOCUS A-MRL 84.29 4908125 AEROBIC MIC/MBC,3 DRUGS-MRL 216.00 4908232 CRYPTOCOCCUS AG-MAYO 31.91 4908240 HOMOCYSTEINE,URINE-MAYO 68.47 4908265 CHOMOSOME ANAL,BLD,HEMAT-MAYO 576.84 4908273 AMINO ACID QN ION EXC, UR -MAYO 100.00 4908349 HCV QUANT, CHIRON RNA-MAYO 119.87 4908364 ALLERGEN,INDIVIDUAL-NI 18.44 4908430 R PSA FREE & TOTAL -MAYO 10.00 4908489 ANTI DNA,DOUBLESTRANDED-MAYO 11.89 4908497 INFLUENZA VIRUS DIR AG DETECT-NI 36.31 4908547 TISSUE PROCESSING-MAYO 43.86 4908562 LAMBERT EATON AUTOANTIBODY-MAYO 13.67 4908570 HISTOPLASMA ANTIGEN,URINE-MAYO 79.56 4908620 PI LINKED ANTIGEN,PNH-MAYO 99.88 4908679 INTERFERON, ALPHA-MAYO 60.00 4908711 R COAG FACTOR VII-MAYO 25.00 4908729 CITRATE,24 HR URINE-MAYO 35.09 4908737 ACETYLCHOLINE RECP MOD AB-MAYO 79.56 4908745 RUBELLA AB,IGG-MAYO 21.02 4908786 SOMATOMEDIN C,PLASMA-MAYO 28.69 4908828 CAFFEINE,SERUM-MAYO 21.07 4908836 ANTIFUNGAL SUSCEPT PANEL-MRL 369.90 4908851 AUTOANTIBODIES SSA-MAYO 19.49 4908869 AUTOANTIBODIES SSB-MAYO 19.49 4908877 AUTOANTIBODIES SM-MAYO 20.09 4908885 AUTOANTIBODIES SCL 70-MAYO 18.26 4908893 AUTOANTIBODIES U1 RNP-MAYO 20.09 4908927 MAGNESIU, RBC & PLASMA-NI 20.75 4908950 CHROMIUM-MAYO 25.38 4908984 METANEPHRINE/NORMETANEPH-NI 99.53 4909024 IGG,IGM,IGA-MAYO 25.64 4909057 D/L AMPHETAMINE-NI 47.59 4909099 ELECTRON MICROSCOPY-MAYO 501.69 4909123 HCV BY RIBA-MAYO 106.34 4909131 DRUG SCREEN, SERUM-NI 72.14 4909180 R TESTOSTERONE, TOTAL & FREE-MAYO 14.33 4909263 AMITRIPTYLINE-MAYO 24.52 4909271 HERPES SIMPLEX PCR,CSF-MAYO 45.00 4909305 FRUCTOSAMINE-NI 17.09 4909321 COAG,VON WILLEBRAND DIS.-MAYO 372.42 4909339 VITAMIN C, ASCORBIC ACID-MAYO 10.08 4909396 AEROBIC MIC, CUSTOM, 2 DRUGS-MRL 150.30 4909404 AEROBIC MIC, CUST,4 DRUGS-MRL 233.10 4909461 SPECIAL STAINS GROUP 11-CS 72.00 4909511 PATHOLOGY CONSULTATION-MAYO 190.19 4909552 ACTIVATED PROTEIN C RESIST-MAYO 40.00 4909586 ESTRONE, SERUM-MAYO 28.87 4909602 APOLIPOPROTEIN A 1,B-MAYO 21.58 4909628 R BARTONELLA AB PANEL-MAYO 10.00 4909636 VITAMIN B1-NI 56.30 4909644 VITAMIN E-MAYO 9.93 4909651 R HEAVY METALS,WHOLE BLOOD-MAYO 11.82 4909669 IGF BP3-MAYO 13.21 4909677 R TRYPANOSOMA CRUZI ABS-MAYO 47.62 4909701 TOPIRAMATE (TOPAMAX)-MAYO 31.34 4909743 GLUCAGON,PLASMA-MAYO 43.96 4909768 DOXEPIN-MAYO 20.74 4909792 ARYLSULFATASE A, LEUK.-MAYO 90.63 4909842 MERCURY-MAYO 24.24 4909867 E HISTOLYTICA (AMEBIC)AB-MAYO 35.40 4909883 PORPHYRINS,FECES-MAYO 166.54 4909917 ANTI SPERM AB-NI 54.50 4909925 METHYLMALONIC ACID, SERUM-MAYO 20.24 4909933 HEMOGLOBIN S SCREEN-MAYO 43.39 4909941 AFB ID,DNA PROBE-MRL 80.10 4909958 AFB MAI MIC SENSITIVITIES-MRL 186.30 4909966 AFB PRIMARY SENSITIVITIES-MRL 112.50 4909974 AFB RAPID GROWER SENSI-MRL 115.20 4909990 AFB MTB COMPLEX DNA,PCR-MRL 233.81 4910006 VOLATILE SCREEN, BLOOD-MAYO 41.03 4910022 -MAYO 44.90 4910048 ANAEROBIC BACTERIAL ID-MRL 90.90 4910055 ANAEROBE SUSCEPT MIC-MRL 95.40 4910063 ANTINUCLEAR ANTIBODIES-MAYO 8.90 4910097 AEROBIC BACTERIAL ID-MRL 78.30 4910147 MYCOBACTERIA,PCR,MISC-NI 95.40 4910170 R COAG FACTOR V-MAYO 60.00 4910188 R COAG -MAYO 60.00 4910212 MANGANESE-MAYO 289.00 4910220 HEPATITIS B SURFACE AB,QNT-NI 38.50 4910261 IGF 1 SOMATOMEDIN C-MAYO 19.94 4910303 CYSTICERCUS IGG AB-MAYO 74.60 4910311 CYSTICERCUS AB CSF -MAYO 78.00 4910360 MICROSPORIDIA SPORE DETECT-MRL 94.50 4910394 FUNGAL SUSCEPTIBILITY MIC-1-MRL 130.00 4910410 VITAMIN B2,RIBOFLAVIN-MAYO 23.19 4910444 VITAMIN B6-MAYO 143.51 4910469 PEROXISOMAL PANEL(VLCFA(-MAYO 57.04 4910527 METHYLMALONIC ACID,URINE-MAYO 25.00 4910535 INHIBIN-NI 73.50 4910584 CARNITINE LEVEL, URINE-MAYO 62.46 4910659 CMV DNA,PCR-MRL 149.35 4910766 PNL ADULT-MAYO 40.00 4910790 LIPOPROTEIN A-MAYO 37.14 4910832 LEUKOCYTE ALKALINE PHOS-MAYO 86.60 4910865 FACTOR VIII ACTIVITY-UCI 57.00 4910873 FACTOR VIII INHIBITOR-UCI 110.00 4910899 FACTOR VIII INHIBITOR PANEL-MAYO 373.46 4910915 HCV DNA GENOTYPING-MAYO 136.59 4910980 FLECANIDE-MAYO 66.71 4911046 HCV RNA DECT/QUANT,S-MAYO 88.50 4911079 GQ1B IGG ANTIBODY-MRL 148.50 4911087 ASCA, ANCA AB-PROM 415.00 4911095 SPECIAL STAINS, GROUP II-CS 37.10 4911129 SKELETAL MUSCLE BX ANALYSIS-LBM 564.75 4911145 PROFILE-MAYO 91.62 4911228 ALDOSTERONE,SERUM-NI 81.50 4911236 RENIN ACTIVITY,PLASMA-NI 49.00 4911293 R FERRITIN-MAYO 53.55 4911319 BCR/ABL RN QT-MAYO 90.00 4911327 HEXAGONAL PHOSPHOLIPID PTT-NI 42.04 4911335 DRVVT CONFIRMATION-NI 42.04 4911350 ORGANIC ACIDS QNT,URINE-NI 569.34 4911400 BETA 2 1 AB-MAYO 50.00 4911442 FUNGAL SUSCEPT CUST MIC 2-MRL 167.11 4911459 M AVIUM-INTRAC MIC PANEL-MRL 140.40 4911467 STREP PNEUMO ANTIGEN,LA-MRL 74.70 4911475 NEURON SPECIFIC ENOLASE,CSF-MAYO 42.43 4911483 JC VIRUS DNA-MAYO 74.68 4911525 COCAINE QNT,CONFIRM-NI 43.57 4911533 METHADONE CONFIRMATION-NI 49.00 4911541 PROPOXYPHENE CONFIRMATION-NI 49.00 4911574 BENZODIAZEPINES,URINE QT-NI 52.43 4911756 BARBITURATES,U,QL,CONF-NI 44.40 4911764 AMPHETAMINES,UR,QNT-NI 124.06 4911798 OPIATES,U,QL,CONF-NI 44.70 4911871 IN SITU HYBRIDIZATION-MAYO 50.00 4911897 CYTOGENETICS REPORT-MAYO 50.00 4911947 MTHF REDUCTASE-QUEST 153.50 4911962 BILE ACIDS-NI 150.00 4911988 VON WILLEBRANDS MULTIMER 33.00 4912028 MEM VIRAL AB EVAL CSF-MRL 278.25 4912044 COBALT-NI 101.15 4912051 CADMIUM-MAYO 37.50 4912077 RISTOCETIN COFACTOR-MAYO 40.00 4912085 VON WILLEBRAND FACTOR AG-MAYO 30.00 4912200 CRP-HIGH SENSITIVITY-MAYO 23.25 4912218 ANGIOTENSIN CONV ENZ,CSF-MAYO 76.50 4912226 CMV BY PCR,URINE-MAYO 65.78 4912259 E COLI 0157 H7 SEROTYPING-MRL 60.30 4912317 FUNGAL SUSCEPT CUST MIC,3-MRL 320.40 4912358 VARICELLA ZOSTER AB-MAYO 16.80 4912366 R PROTEIN ELECTROPHORESIS-MAYO 14.21 4912374 HEMOGLOBIN A1C-MAYO 9.41 4912408 LEUK/LYMPHOMA CONSULT-MAYO 48.95 4912416 LEUK/LYPHM FLOW/C-MAYO 37.15 4912432 LEUKEMIA PHENOTYPE ACUTE-MAYO 128.80 4912465 HYPERCOAG PANEL-MAYO 789.42 4912473 SYPHILIS,IGG-MAYO 18.94 4912499 H PYLORI AG,FECE-QUEST 102.30 4912507 SELENIUM-MAYO 12.10 4912549 BORON - NI 71.00 4912564 R ECHOVIRUS AB PANEL-MRL 25.38 4912580 PTH RELATED PEPTIDE-MAYO 10.73 4912606 PROT.ELECTROPH,URINE-MAYO 33.94 4912614 MYCOPLASMA PNEUMO,CULTURE-MRL 99.00 4912648 LEVETIRACETAM(KEPPRA)-MAYO 12.91 4912655 CMV QUANT BY PCR,PLASMA-MAYO 354.20 4912689 HEPARIN PF4 AB-MAYO 42.48 4912713 B BURGDORFER DNA,PCR-MRL 268.20 4912739 14-3-3 PROTEIN-MAYO 106.08 4912754 FOLATE,RBC-MAYO 52.50 4912762 FUNGAL IDENTIFICATION-MRL 91.80 4912788 LYMPHOCYTE CHROMOSOMES A-GCTR 245.00 4912796 LYMPHOCYTE CHROMOSOMES B-GCTR 166.00 4912804 LYMPHOCYTE CHROMOSOMES C-GCTR 37.00 4912812 LYMPHOCYTE CHROMOSOMES D-GCTR 28.00 4912838 CMV PCR, SERUM-MAYO 62.00 4912846 TRILEPTAL (OXYCARB)-MAYO 21.23 4912887 HLA CLASS II TYPING-MAYO 132.17 4912911 MYCOBACTERIA PCR,CSF-NI 144.41 4912937 FTA-ABS IGG AND TPI-MAYO 72.85 4912945 IMMUNE COMPLEX PNL-MRL 277.20 4912952 HSV 1/2 DNA,PCR-MRL 292.50 4912960 E COLI SHIGA LIKE TOX-MRL 118.80 4912978 HSV 1/2 TYPING,IGG-MRL 186.30 4912986 BARTONELLA AB PNL-MRL 206.10 4913018 IBD P_ANCA_IFA PERINUCLR-PROM 41.00 4913026 83520 PROMETHEUS-PROM 63.75 4913109 VWD VON WILLEBRAND PANEL-MAYO 70.00 4913166 DIHYDROHDMN MYRISTATE ACETATE-MAYO 111.63 4913190 BABESIA MICROTI IGG-MAYO 40.35 4913216 COXIELLA BURNETII AB-MRL 129.60 4913240 FEBRILE AGGLUTININS-QUEST 29.29 4913257 IGF II-NI 98.60 4913265 IBD SG1 DIAGNOSTIC-PROM 35.00 4913273 IBD P_ANCA_DNASE-PROM 41.00 4913299 J AB-NI 58.43 4913323 MOTOR NEUROPATHY PANEL-MRL 236.85 4913349 FUNGUS ANTIBODY PANEL,SERUM-NI 312.30 4913364 SENSORY NEUROPATHY PNL-MRL 471.60 4913422 ECHNIOCOCCUS IGG AB-MRL 153.00 4913430 ECHOVIRUS AB PANEL-MRL 123.30 4913471 HANTA VIRUS AB(IGG,IGM)-MAYO 86.86 4913489 MYCOPLASMA DNA,PCR-QUEST 161.50 4913505 EPSTEIN BARR(EBV)DNA,PCR-MRL 268.20 4913521 BETA 2 MICROGLOBULIN,CSF-MRL 94.50 4913547 ANTI NEURONAL AB,SERUM,CSF-MRL 159.30 4913570 B 2 MICROBLOGULIN,SERUM-MAYO 10.61 4913596 THYROTROP RECEPT AB-MAYO 26.00 4913638 PARAINFLUENZA VIRUS AG-DFA-QUEST 75.00 4913653 ASPERGILLUS AB-MRL 41.00 4913661 BLASTOMYCES AB-MRL 25.33 4913679 COCCIDIOIDES AB-MRL 40.80 4913687 CRYPTOCOCCUS AB-MRL 84.27 4913695 HISTOPLASMA AB-MRL 40.80 4913703 CRYPTOCOCCUS AB, EIA-MRL 24.00 4913729 VIRAL CULTURE,COMPREHENS-MRL 232.20 4913778 AFB,M.AV/INTRACELL MIC X7-MRL 352.80 4913786 CHROMOSOMES SPECIAL BANDING-GCTR 15.00 4913794 MYCOPHENOLIC ACID-MAYO 28.35 4913828 IMMUNOHISTOCHEMISTRY-USLABS 58.00 4913877 HEMOSIDERIN,URINE-MAYO 36.67 4913885 CYLIC CITRULLINATED PEPTD-MAYO 13.80 4913893 COMPLEMENT C1Q-MAYO 40.47 4913901 RAJI CELL IMMUN COMPLEX-MAYO 61.01 4913919 N-TELOPEPTIDE,SERUM-MAYO 70.00 4913943 METHYL ALCOHOL-MAYO 70.09 4913950 GAMMAHYDROXY BUTYRATE-MAYO 98.50 4914057 ANTI SS DNA-QUEST 130.25 4914073 CUTANEOUS IMMUNOFLUORSNCE-MAYO 64.46 4914081 COAG FACTOR XIII-MAYO 64.60 4914107 PLASMINOGEN ACTIVITY-MAYO 59.37 4914115 ALPHA 2 ANTIPLASMIN-MAYO 71.65 4914123 FRANCISELLA ANTIBODY-MAYO 125.00 4914172 AMNIOTIC L/S RATIO-UCI 50.00 4914180 AMNIOTIC FLUID P/G-UCI 46.00 4914198 AMNIOTIC FLM-UCI 39.00 4914214 FACTOR II ASSAY-UCI 65.00 4914222 FACTOR IX ASSAY-UCI 52.00 4914248 FACTOR VII ASSAY-UCI 88.00 4914255 FACTOR VIII ASSAY-UCI 52.00 4914271 FACTOR XI ASSAY-UCI 88.00 4914289 FACTOR XII ASSAY-UCI 88.00 4914297 FACTOR XIII QUALITATIVE-UCI 30.00 4914305 BARBITURATES CONFIRM-UCI 18.00 4914313 BENZODIAZEPINES CONFIRM-UCI 63.95 4914321 COCAINE METABOLITE CONFIRM-UCI 18.00 4914339 PROPOXYPHENE CONFIRM-UCI 18.00 4914347 OPIATES CONFIRM-UCI 63.95 4914354 THC CONFIRM-UCI 63.95 4914362 PHENCYCLIDINE CONFIRM-UCI 18.00 4914388 METHOTREXATE-UCI 17.00 4914396 POTASSIUM,FECES-MAYO 36.14 4914404 SODIUM,FECES-MAYO 36.17 4914412 CRYPOPORIDIUM,ISOSPORA DFA-MRL 126.90 4914438 TISSUE CULTURE-MAYO 280.49 4914446 DNA PROBE-MAYO 312.22 4914453 IN SITU HYBRIDIZATION-MAYO 312.22 4914461 INTERPRETATION,REPORT-MAYO 312.22 4914479 ELECTROLYTES,FECES-MAYO 16.20 4914495 HSV & VZV DNA,PCR,DERMAL-MAYO 115.81 4914511 ZONISAMIDE-MAYO 54.30 4914537 RUBEOLA AB SCREEN,IGG-MAYO 21.22 4914545 AMPHETAMINE CONFIRMATION-UCI 63.95 4914552 METHADONE CONFIRMATION-UCI 18.00 4914560 HIV P24 ANTIGEN-MAYO 247.78 4914586 CMV RAPID PCR,URINE-MAYO 66.89 4914594 GUADIN,IGA ANTIBODIES-MAYO 29.74 4914602 ENDOMYSIAL IGA AB-MAYO 20.00 4914628 LEAD WITH DEMOGRAPHICS-MAYO 8.00 4914636 PROCAINAMIDE PLUS NAPA-MAYO 26.91 4914651 AMIKACIN-UCI 18.00 4914669 COXSACKIE&ENTERO CSF PCR-MAYO 65.59 4914677 EPSTEIN BARR PCR-MAYO 50.00 4914693 COXSACKIE A ANTIBODY-MAYO 94.00 4914719 STRONGYLOIDES IGG AB-MAYO 40.25 4914727 COAG FACTOR XI-MAYO 60.00 4914735 COAG FACTOR XII-MAYO 60.00 4914750 DNASE ANTIBODIES-NI 34.00 4914776 HEPATITIS E IGG,IGM AB-NI 88.50 4914784 RENAL BX LIGHT MICROSCOPY-CS 52.15 4914792 RENAL BX ELECTRON MICROS-CS 631.13 4914800 RENAL BX IMMUNOFLUORESCENCE-CS 248.00 4914818 ROTAVIRUS ANTIGEN-NI 49.50 4914826 SERUM-MAYO 15.76 4914834 AMINO ACID QN ION EXC,P-MAYO 100.00 4914842 COLORADO TICK FEVER AB-MAYO 78.40 4914859 DNA PROBE,MOLECULAR CYTOGEN-GCTR 122.00 4914891 IMMUNOHISTOCHEM STAIN-LABC 38.00 4914909 IMAGE ANALYSIS-ADPL 55.00 4914941 FTA IGM AB-MAYO 50.31 4915047 STREPTOCOCCAL ANTIBODIES-MAYO 21.98 4915062 HYPOGLYCEMIC SCREEN-MAYO 90.00 4915070 HTLV I/II AB-MAYO 20.03 4915088 ENTEROVIRUS DETECT,PCR-MRL 250.29 4915096 HERPES VIRUS 6 DNA,PCR-MRL 268.20 4915104 V ZOSTER DNA,PCR-MRL 268.20 4915153 ENTEROVIRUS AB PANEL 2-MAYO 247.85 4915161 WEST NILE VIRUS RNA,PCR-MAYO 268.20 4915187 MYCOPLASMA AB,CF,CSF-MRL 72.90 4915195 IMMUNE COMPLEX DETECTION 1-NI 118.50 4915229 VITAMIN K1-NI 105.00 4915237 ANTI SM/RNP AB-NI 26.00 4915260 KAPPA/LAMBDA LT CHAINS-MAYO 14.95 4915286 COPPER,URINE-MAYO 12.66 4915302 AB(PR3)-MAYO 37.90 4915328 PAP CYTOLOGY-ADPL 22.00 4915351 MONOCLONAL PROTEIN STUDY-MAYO 16.00 4915401 DRUG SCREEN, COMPREHENSIVE-UCI 104.00 4915435 WEST NILE VIRUS AB,S IGG-MRL 32.47 4915443 WEST NILE VIRUS AB,CSF IGM-MRL 35.02 4915468 COMP C1 ESTERASE INHIB-MAYO 43.98 4915526 CHROMATIN AB-NI 44.50 4915567 RIBOSOMAL P ANTIBODY-NI 53.00 4915609 HEPATITIS BE AG-MAYO 17.04 4915617 CSF IGG INDEX-MAYO 9.64 4915625 MYELIN BASIC PROTEIN-MAYO 60.75 4915633 OLIGOCLONAL BANDS-MAYO 23.00 4915641 PLASMA METANEPHRINES-MAYO 13.61 4915658 HSV AB SCRN,IGM,EIA CHG1-MAYO 7.61 4915724 HEAVY METALS, URINE-MAYO 11.79 4915732 ACYLCANRITINES,QNT-MAYO 53.03 4915740 ACYLGLYCINES,QNT-MAYO 141.84 4915955 HSV AB,IGM,S BY IFA(CONFIRM)-MAYO 15.99 4915963 PROTEIN C ACTIVITY-MAYO 25.09 4915971 FLOW CYTOMETRY,FIRST MARKER-MAYO 24.54 4915989 FLOW CYTOMETRY,ADDED MARKERS-MAYO 21.46 4916037 CHLAMYDIA,GC RAPID PCR-MAYO 17.35 4916045 TORCH PANEL,IGG-MAYO 91.61 4916102 NB SCREEN COLLECTION-LB 7.00 4916136 TOXOPLASMA DNA,PCR-MRL 268.20 4916151 CYLCOSPORINE-UCI 45.00 4916169 PYRUVIC ACID-MAYO 62.96 4916177 H PYLORI IGG,IGM,IGA AB-MAYO 62.30 4916185 INFLUENZA A/B, PCR-MAYO 72.05 4916201 ARGININE VASOPRESSIN-MAYO 51.04 4916227 HIV DETECTION PANEL,CSF-MRL 280.80 4916235 GAD65 ANTIBODY-MAYO 22.75 4916276 PATH VIS,MORPH ANALYSIS-USLABS 112.50 4916284 HIV 1 GENOTYPING-MAYO 543.78 4916334 RETICULIN AB-MAYO 18.07 4916375 TISSUE CULTURE-MAYO 423.24 4916383 CHROMOSOME ANALYS E KARYOTYPES-MAYO 423.24 4916391 CHROMOSOMES INTERP/RPT-MAYO 41.48 4916417 MUSCLE BX SPECIAL STAINS-LBM 97.75 4916508 COCCI ID IGG & IGM-UCDAVIS 36.00 4916516 COCCIDIOIDES CF-UCDAVIS 44.00 4916672 INFLUENZA A IGG,IGM AB-MAYO 16.02 4916680 INFLUENZA B IGG,IGM AB-MAYO 14.34 4916698 B PERTUSSIS RAPID PCR-MAYO 35.00 4916706 SIROLIMUS B-MAYO 21.18 4916797 IN SITU HYBRD 10:30 CELLS-GCTR 122.00 4916805 CYTOGENETICS INTERPRET-GCTR 40.00 4916821 NICOTINE & METABOLITE,U -MAYO 26.04 4916839 17 HYDROXY PREGNENOLONE-MAYO 69.59 4916953 TISSUE TRANSGLUTAMASE IGG AB-MAYO 15.00 4916995 DENGUE FEVER IGG,IGM AB-MAYO 102.75 4917019 MULTIPLE SCLEROSIS PANEL-MAYO 104.01 4917076 PRO PREDICT METABOLITES-PROM 270.00 4917134 RBC FRAGILITY-MAYO 85.00 4917159 ENTEROVIRUS RAPID PCR-MAYO 69.53 4917183 PROTEIN S ACTIVITY-MAYO 33.24 4917191 MENIGITIS,ASEPTIC,CSF-MRL 733.50 4917225 VASOACT INT POLYPETIDE-MAYO 50.00 4917241 DRUG SCREEN ON MECONIUM-MAYO 30.93 4917258 CYSTATIN C-MAYO 41.46 4917290 ADENOVIRUS DFA-MRL 95.40 4917308 MORPHOMETRIC ANALYSIS,EA AB-USLABS 73.00 4917316 ADENOSINE DEAMINASE,FL-MAYO 120.00 4917324 BK VIRUS DNA,PCR-MAYO 55.99 4917332 CHLAMYDIA/GC DNA PROBE-MAYO 39.00 4917340 THYROGLOBULIN ANTIBODY-MAYO 19.25 4917357 HIV 1 AB IFA ASSAY-MAYO 19.75 4917365 HIV AB TYPE 2 EIA-MAYO 59.36 4917373 INTERLUKIN 5-MAYO 54.80 4917399 MS PROFILE-MAYO 10.00 4917415 TESTOSTERONE-ESTRX 41.00 4917464 T3 UPTAKE-MAYO 12.89 4917472 HEPATITIS A AB,IGG,IGG-MAYO 15.90 4917522 MUMPS AB,IGG,IGM-MAYO 25.00 4917563 LYMES DISEASE AB,RFLX WB-NI 23.60 4917589 SERTRALINE (ZOLOFT)-MAYO 70.84 4917621 HER 2/NEU QUANTITATIVE-MAYO 156.81 4917647 TISSUE TRANSGLUTAMINASE IGA AB-MAYO 15.00 4917688 TOXOPLASMA DNA,PCR,CSF-MAYO 89.51 4917696 ALPHA GLOBIN GENE ANALYSIS-MAYO 319.86 4917753 LATEX ALLERGEN,IGE-MAYO 4.50 4917829 PATH CONSULT,REPORT-MAYO 190.19 4917845 PNEUMOCOCCAL IGG AB-MAYO 11.12 4917852 NEUROMYELITIS OPTICAL AB-MAYO 169.70 4917860 CORTISOL LEVEL-ESTRX 37.00 4917902 MUMPS AB,IGG/IGA,IFA-MRL 133.20 4917936 NB METABOLIC SCREENING PANEL-LBM 141.25 4917951 HIV P24 (ICD) ANTIGEN-MRL 198.00 4918025 A1 ANTITRYPSIN GENOTYPE-MAYO 239.98 4918041 BILE ACIDS,TOTAL-MAYO 40.28 4918082 CRMP 5IGG WESTERN BLOT-MAYO 120.30 4918090 HEMOCHROMATOSIS HFE GENE-MAYO 70.00 4918116 HEP B VIRAL DNA,QUANT-MAYO 142.00 4918124 NIACIN-MAYO 85.00 4918132 PARANEOPLASTIC EVAL-MAYO 26.75 4918173 LUPUS PNL 83516-NI 36.00 4918215 MYCOPLASMA DNA,PCR-MAYO 186.01 4918223 LUPUS PNL 83520-NI 36.00 4918231 LUPUS PNL 86038-NI 36.50 4918249 LUPUS PNL 86160-NI 36.00 4918256 LUPUS PNL 86235-NI 36.00 4918264 LUPUS PNL 86255-NI 36.00 4918330 CHOLESTEROL, VAP-MAYO 27.50 4918348 LP-PLA2-PAYO 150.00 4918355 HIV1 PROVIRAL DNA BY PCR-MAYO 50.00 4918363 ALLERGEN,INDIVIDUAL,ICG-NI 18.50 4918439 DETECTION,FECAL-MAYO 91.22 4918454 THIOPURINE METHYLTRANSFERATE-MAYO 73.02 4918488 VARICELLA ZOSTER,RAPID PCR-MAYO 60.00 4918496 PARAINFLUENZA DFA-MRL 145.00 4918504 APOLIPOPROTEIN B-MAYO 17.00 4918538 HEP B DNA PCR, QNT,SERUM-MAYO 85.00 4918611 JC VIRUS DNA BY PCR-MAYO 75.00 4918629 FLOW CYTOMETRY AT-NGLABS 91.00 4918637 FLOW CYTOMET,ADDL MARKERS-NGLABS 15.00 4918645 FLOW INTERP 2-8 MARKERS-MAYO 76.00 4918652 FLOW INTERP 9-15 MARKERS-MAYO 121.00 4918660 FLOW INTERP 16+ MARKERS-NGLABS 145.70 4918678 TISSUE CULT AT-NGLABS 120.00 4918686 CYTOGENETICS AT-NGLABS 160.00 4918694 ADDED KARYOTYPES AT-NGLABS 35.00 4918702 ADDED CELL CT AT-NGLABS 33.00 4918710 TISSUE CULT NO GROWTH-NGLABS 90.00 4918728 CONSULT-NGLABS 188.00 4918736 IHC STAINS TC AT-NGLABS 35.00 4918744 INITIAL KARYOTYPES AT-NGLABS 70.00 4918777 LYME DISEASE ABS (IGG,IGM)-MAYO 100.00 4918785 T3 UPTAKE-MAYO 11.00 4918793 ORGANIC ACID SCREEN URINE-MAYO 52.54 4918819 ANCA VASCULITIDES-MAYO 9.47 4918835 ACETYLCHOLINE RCPT MOD AB-MAYO 107.00 4918850 VALPORIC ACID, FREE & TOTAL-MAYO 54.28 4918868 ACTIN ANTIBODY IGG 34.20 4918876 ADENOVIRUS DNA QNT PCR-MAYO 65.00 4918918 PNEUMOCCAL ANTIBODY TITER-MAYO 123.78 4918934 COXSACKIE B AB PANEL,CSF-MRL 134.10 4918942 ECHOVIRUS AB,CSF-MRL 132.30 4918975 CALIF ENCEPHALITIS AB,IFA,CSF-MRL 81.00 4918983 EAST EQUINE ENCHPHLTS AB,IFA,CS-MRL 144.00 4918991 ST LS ENCEPHALITIS AB,IFA,CSF-MRL 159.30 4919007 WEST EQUINE ENCHEPH IGG/IGM,CSF-MRL 172.80 4919023 FLOW CYTOMETRY ADDL MARKERS A-MAYO 24.00 4919049 FLOW CYTOMETRY ADDL MARKERS C-MAYO 14.37 4919056 FLUORES NONINFECTIOUS AGENT AB-MAYO 95.40 4919064 IMMUNOASSAY QNT NOT SPECIFIED-MAYO 112.95 4919072 PLASMINOGEN ACT INHIB AG-MAYO 150.85 4919114 PORPHYRIN PROFILE PLASMA-MAYO 32.30 4919122 SOLUBLE TRANSFERRIN RECPT-MAYO 29.00 4919130 HEPARIN LOW MOLECULAR WT-UCI 60.00 4919148 PROTEIN S AG,TOTAL-MAYO 22.06 4919155 TOXOCARA CANIS AB-MRL 137.20 4919163 HIV1 RNA QUANT RT PCR-NI 291.00 4919171 BETA-2 TRANSFERRIN,FLD-MAYO 81.97 4919189 -MAYO 155.38 4919213 FISH PROBE-NGLABS 191.00 4919221 RNA RT PCR,QL-MRL 250.29 4919239 HSV 1/2 DNA,RT PCR-MRL 292.50 4919346 ADAM TS13 ACT INHIBIT-MAYO 132.60 4919353 CORTISOL,SALIVA-MAYO 53.47 4919361 PROTNHEMADSORPTION/HEMAGLUTIN-MAYO 42.33 4919379 VIRAL SMEAR,SHELL VIAL-MAYO 46.90 4919395 VWFACTOR BIND-MAYO 110.00 4919411 VORICONAZOLE-MAYO 64.05 4919429 DIPHTHERIA IGG AB-MAYO 30.38 4919437 TETANUS IGG AB-MAYO 31.38 4919445 SEROTONIN,24HR URINE-MAYO 30.00 4919452 TOTAL T4-MAYO 54.60 4919460 ALPHA FETOPROTEIN L3% - MAYO 90.00 4919510 ANTITHROMBIN AG,PLASMA-MAYO 33.67 4919544 CALPROTECTIN,STOOL-MAYO 100.00 4919569 MUSK AB-MAYO 550.00 4919577 ANA, FLUID-MAYO 85.00 4919585 -MAYO 12.00 4919619 QUANTIFERON TB GOLD-NI 240.00 4919627 GONADOTROPIN RELEASING HORMONE-MAYO 250.00 4919643 TPMT,QNT HPLC-PROM 110.00 4919650 TPMT, ACTIVITY-PROM 110.00 4919668 T.PALLIDUM DNA,PCR-MRL 268.20 4919676 FUNGITELL ASSAY1,3 B D GLUCANS-MAYO 143.00 4919684 PROCOLLAGEN TYPE 1-MAYO 200.41 4919700 INTERLUKIN 6-MAYO 130.00 4919783 IBD SGI PANEL CHGO1-MAYO 203.00 4919791 IBD SGI PANEL EIA-MAYO 50.00 4919809 ANTITHROMBIN ACTIVITY-MAYO 21.22 4919817 LEGIONELLA PCR-MAYO 91.00 4919825 ASPERGILLUS AG GALACTOMANNAN-MAYO 50.00 4919833 COENZ Q10 REDUCED & TOT-MAYO 136.68 4919874 HSV CULTURE RAPID METHOD-NI 33.50 4919882 IMMUNE CELL FUNCTION-NI 275.00 4919890 CIC PANEL IMMUNE COMPLEX-MAYO 120.00 4919908 CIC PANEL CHG2-MAYO 31.09 4919916 ASCEPT MENINIGITIS PHL CHG1-MRL 38.60 4919924 ASCEPT MENINIGITIS PNL CHG2-MRL 38.61 4919932 ASCEPT MENINIGITIS PNL CHG3-MRL 38.61 4919940 ASCEPT MENINIGITIS PNL CHG4-MRL 38.61 4919957 ASCEPT MENINIGITIS PNL CHG5-MRL 38.63 4919965 DILANTIN FREE & TOTAL-MAYO CHG 1 12.65 4919973 MENINGOENCAPHALITIS CSF CHG1-MRL 23.17 4919981 MENINGOENCEPHALITIS CSF CHG2-MRL 22.54 4919999 MENINGOENCEPHALITIS CSF CHG3-MRL 23.53 4920005 MENINGOENCEPHALITIS CSF CHG4-MRL 23.53 4920013 MENINGOENCEPHALITIS CSF CHG5-MRL 23.53 4920021 MENINGOENCEPHALITIS CSF CHG6-MRL 23.54 4920039 MENINGOENCEPHALITIS CSF CHG7-MRL 23.54 4920047 MENINGOENCEPHALITIS CSF CHG8-MRL 23.54 4920054 MENINGOENCAEPHALITIS CSF CHG9-MRL 23.54 4920070 R LAMBERT EATON AUTOANTIBODY-MAYO 13.66 4920088 MYASTHENIA GRAVIS ADULT-MAYO 41.92 4920096 ARSENIC,URINE-MAYO 35.63 4920112 CMV IGG/IGM CHARGES-MAYO 9.08 4920120 TOXOPLASMA A GONDII PCR,CSF-MAYO 104.40 4920138 DOXEPIN/NORDOXEPIN-MAYO 20.74 4920153 RNP IGG AB 81357-MAYO 18.26 4920161 FCL CHLORIDE,FECES-MAYO 35.90 4920179 CELIAC DISEASE ANTIBODY,FOCUS B-MRL 84.29 4920187 82524-MAYO 54.02 4920195 HYPERSENSITIVE PNEUMO IGG-MAYO 13.45 4920203 HIV 2 AB IBL-MAYO 101.69 4920211 MS PROFILE CHARGE1-MAYO 10.00 4920229 MS PROFILE CHARGES2-MAYO 15.00 4920237 MS PROFILE CHARGE3-MAYO 15.00 4920245 SENSORY AND MOTOR NEUROP 01-MAYO 50.10 4920252 SENSORY AND MOTOR NEUROP 02-MAYO 50.09 4920260 SEROTONIN RELEASE, UF HEPARIN-MAYO 295.00 4920278 SEROTONIN RLS, LLMW HEPARIN-MAYO 295.00 4920302 IMMUNOHISTO AB-CLARIENT 57.58 4920310 IMMUNOHIST TUMOR-CLARIENT 92.75 4920351 LYSE CELLS-CLARIENT 15.60 4920385 MICRODISSECT,MAN-CLARIENT 205.87 4920393 PATH CON,OUT SLIDE-MAYO 190.19 4920401 MICRO CONSULT,PROF-NGLABS 102.60 4920419 MICRO CONSULT,TECH-NGLABS 68.40 4920427 CONSULT,NOSLIDE-NGLABS 85.00 4920435 5 CELLS, 1 KAROTYPE-NGLABS 209.00 4920443 THIAMINE,VITAMIN B1-MAYO 32.00 4920450 MYCOPLASM PNEUM CULT-QUEST 45.23 4920468 ROTAVIRUS AG,FECES-MAYO 45.79 4920476 PROINSULIN,PLASMA-MAYO 30.00 4920484 INTRINSIC FAC BLK AB-MAYO 21.21 4920492 BK VIRUS DNA PCR,U -MAYO 35.80 4920500 SEROTONIN,S-MAYO 47.38 4920518 ENTEROVIRUS,PCR-MAYO 65.59 4920526 WARFARIN,SERUM-MAYO 38.00 4920534 EBVIRUS,DNA,QNT,PCR-MAYO 84.68 4920542 BARTONELLA,PCR,BLD-MAYO 144.08 4920559 ERYTHROPOIETIN,S-MAYO 14.62 4920567 HSV,RAPID,PCR-MAYO 46.10 4920575 INSULIN AB,S-MAYO 43.07 4920591 FUNGAL AB PANEL 86606-MRL 41.00 4920609 FUNGAL AB PANEL 86612-MRL 40.80 4920617 FUNGAL AB PANEL 86628-MRL 40.80 4920625 FUNGAL AB PANEL 86635-MRL 40.80 4920633 FUNGAL AB PANEL 86698-MRL 40.80 4920641 COAG CONSULT PROTIME-MAYO 40.00 4920658 COAG CONSULT PTT-MAYO 40.00 4920666 COAG CONSULT DRVV-MAYO 40.00 4920674 COAG CONSULT THROMBIN TIME-MAYO 40.00 4920682 COAG CONSULT FIBRINOGEN-MAYO 40.00 4920690 COAG CONSULT D DIMER-MAYO 40.00 4920708 COAG CONSULT PROT C ACTIVITY-MAYO 40.00 4920716 COAG CONSULT PROT S AG,FREE-MAYO 40.00 4920724 COAG CONSULT AT III ACTIVITY-MAYO 40.00 4920781 COAG CONSULT ACTPROT RESIST V-MAYO 40.00 4920799 CMV PCR, FLUIDS-MAYO 60.00 4920807 PYRIDINIUM COLL XLINK, UR-MAYO 122.35 4920815 HIV 1 QUANTITATIVE PCR-MAYO 85.00 4920823 T SPOT TB TEST-OXFORD 52.00 4920831 PAP SMEAR LIQUID PREP-ADPL 24.50 4920849 JO 1 ANTIBODIES, IGG-MAYO 18.26 4920856 COAG FACTOR II ACTIVITY-MAYO 64.62 4920864 COAG FCTR VIII ACTVTY ASSY, PL-MAYO 50.00 4920906 SPINAL FLUID INDEX CHG-MAYO 6.13 4920922 ZONIZAMIDE-MAYO 51.36 4920948 SEX HORMONE BINDING GLOBULIN-MAYO 20.00 4920955 COXSACKIE A AB PANEL,SERUM-QUEST 6.83 4920963 COXSACKIE A AB PANEL,SERUM-QUEST 6.83 4920971 COXSACKIE B AB PANEL,SERUM-QUEST 9.17 4920989 COXSACKIE B AB PANEL,SERUM-MAYO 9.17 4920997 ADRENAL ANTBDY(21 HYDROXYLS AB-MAYO 55.00 4921003 DRUG SCR PRESCRIPT OTC,PLASMA-MAYO 61.35 4921011 POLIOVIRUS AB,NEUTRALIZATION-NI 74.12 4921029 TORCH PROFILE IGG CMV-MAYO 11.00 4921037 TORCH PROFILE IGG HSV1-MAYO 11.00 4921045 TORCH PROFILE IGG HSV2-MAYO 11.00 4921052 TORCH PROFILE IGG RUBELLA-MAYO 11.00 4921060 TORCH PROFILE IGG TOXO-MAYO 11.00 4921078 HIV GENOTYPE DRUG RESISTANCE-MAYO 400.00 4921086 HCV FIBROSURE CHG1-MAYO 322.81 4921094 HCV FIBROSURE CHG2-MAYO 40.00 4921102 HCV FIBROSURE CHG3-MAYO 40.00 4921110 HCV FIBROSURE CHG4-MAYO 40.00 4921128 HCV FIBROSURE CHG5-MAYO 40.00 4921136 HCV FIBROSURE CHG6-MAYO 40.00 4921144 BCR/ABL FISH STUDY 88271-MAYO 87.03 4921151 BCR/ABL FISH STUDY 88275-MAYO 88.00 4921169 BONE ALKALINE PHOSPH,S-MAYO 14.90 4921177 PROPHYRINS, 24 HR QUANT-MAYO 8.61 4921185 AMINOLEVULONIC ACID, UR-MAYO 70.24 4921193 HISTAMINE-MAYO 130.00 4921201 TOXOPLASMA IGG IGM ANTIBODY-MAYO 15.36 4921219 PREGNENOLONE,SERUM-MAYO 65.83 4921227 CHLAMYDIA GROUP AB-MAYO 12.78 4921235 EBV AB PROFILE-MAYO 5.00 4921243 PARANEOPLASTIC AUTO1-MAYO 34.00 4921250 PARANEOPLASTIC AUTO2-MAYO 34.00 4921268 MYCOPLASMA PCR-MAYO 150.00 4921276 HSV TYPE 1AB,IGG CHG2-MAYO 7.00 4921284 HSV TYPE 2AB,IGG CHG3-MAYO 7.00 4921292 WEST NILE VIRUS BY PCR,CSF-MAYO 60.00 4921300 NEURON SPECIFIC ENOLASE, SERUM-MAYO 25.00 4921318 HANTAVIRUS ANTIBODY-MAYO 59.12 4921326 BILE ACIDS, TOTAL, SERUM-MAYO 40.00 4921334 VAP CHOLESTEROL CHG1-MAYO 27.50 4921342 BETA HYDROXYBUTYRATE DEHYROGEN-MAYO 32.28 4921359 PARANEOPLASTIC AB EVAL-MAYO 35.00 4921367 FCLL CHRONIC LYMPH LEUKEMIA-MAYO 34.59 4921375 FCLL CLL FISH PANEL 1-MAYO 34.59 4921383 HEAVY METALS SCREEN,B CHG1-MAYO 15.67 4921391 HEAVY METALS SCREEN,B CHG2-MAYO 15.66 4921409 HEAVY METALS SCREEN,B CHG3-MAYO 15.66 4921417 POC CHROMOSOMAL ANALYSIS CHG1-MAYO 160.00 4921425 ACID FAST (MTB) PCR-MAYO 145.00 4921433 HSVP 1/2 PCR 57126-MAYO 45.00 4921441 ARBOVIRUS ANTIBODY PANEL, SERUM-MRL 78.08 4921458 ARBOVIRUS ANTIBODY PANEL,1-MRL 78.08 4921466 ARBOVIRUS ANTIBODY PANEL 2-MRL 78.08 4921474 ARBOVIRUS ANTIBODY PANEL,3-MRL 78.08 4921482 STREPTOZYME-MAYO 62.00 4921490 WEST NILE VIRUSAB,S IGM-MRL 32.47 4921508 WEST NILE VIRUS AB CSF IGG-MRL 35.02 4921524 ENDOMYCELIAL AB IGG A-MAYO 38.59 4921532 ARBOVIRUS AB PANEL,CSF CHG1-MRL 78.08 4921540 ARBOVIRUS AB PANEL,CSF CHG2-MRL 78.08 4921557 ARBOVIRUS AB PANEL,CSF CHG3-MRL 78.08 4921565 ARBOVIRUS AB PANEL,CSF CHG4-MRL 78.08 4921573 WESTERN EQUINE ENCEP,CSF-QUEST 84.15 4921581 HGB ELECTROPHORESIS-MAYO 17.79 4921599 HEPATITIS B VIRUS QT-MAYO 142.04 4921623 HEAVY METALS SCREEN,01-MAYO 11.79 4921631 HEAVY METALS SCREEN,02-MAYO 11.79 4921644 N GONORRHOEA,RNA-MAYO 17.35 4921649 HEAVY METALS SCREEN,3-MAYO 11.79 4921656 LEAD URINE-MAYO 30.89 4921664 NEISERRIA GC PCR CHARGE-MAYO 17.35 4921672 LACTOFERIN DETECTION STOOL-MAYO 100.00 4921680 ANCA VASCULIT 83876-MAYO 9.48 4921698 MEXILETINE-MAYO 86.47 4921706 RIBISOME P AB IGG-MAYO 10.73 4921714 INTRINSIC FACTOR BLOCKING AB,S-MAYO 22.48 4921722 IBD SGI 88350-MAYO 196.00 4921730 FREE LIGHT CHAIN,URINE-MAYO 29.17 4921763 CHROMATIN ANTIBODIES ELISA-MAYO 92.75 4921771 CHROMOGRANIN A,SERUM-MAYO 20.00 4921797 IMIPRAMINE-MAYO 19.00 4921805 IGG SUBCLASS PANEL-MAYO 8.20 4921813 IGG SUBCLASS PANEL 2-MAYO 10.14 4921854 FEBRILE AB PANEL CHARGE1-QUEST 29.29 4921862 FEBRILE AB PANEL CHARGE2-QUEST 29.29 4921912 SEROTONIN, SERUM-MAYO 30.00 4921920 ELECTROLYTES,FECAL 82438-MAYO 16.20 4921938 ELECTROLYTES,FECAL 83735-MAYO 16.20 4921946 ELECTROLYTES,FECAL 84302-MAYO 16.20 4921953 EHRLICHIA AB IGG/IGM-MRL 91.35 4921961 HIV2 AB 86702-MAYO 59.36 4921979 ALPHA 1 ANTITRYPSIN,FECES-MAYO 33.05 4921987 SS A, SS B IGG ANTIBODIES-MAYO 15.00 4921995 TORCH PANEL IGM 86694-MAYO 18.00 4922001 ASP FUMIGATUS IGG AB-MAYO 30.30 4922019 ARSENIC BLOOD-MAYO 203.70 4922027 TORCH PANEL IGM 86778-MAYO 19.00 4922035 MONOCLONAL PROTEIN STUDY 84155-MAYO 18.99 4922043 MONOCLONAL PROTEIN STUDY 84165-MAYO 15.76 4922050 CHROMOSOME ANALYSIS 88230-MAYO 65.00 4922068 CHROMOSOME ANALYSIS 88262-MAYO 55.00 4922076 CHROMOSOME ANALYSIS 88291-MAYO 55.00 4922084 MONOCLONAL PRTN URINE 84156-MAYO 17.00 4922092 MONOCLONAL PROTEIN URINE 84166-MAYO 17.00 4922100 CALCITONIN,SERUM-MAYO 20.00 4922118 EPSTEIN BARR VIRUS,PCR-MAYO 33.20 4922126 TACROLIMUS LEVEL -UCI 40.00 4922134 H1N1 VIRAL DNA BY PCR-MRL 268.20 4922142 H1N1 VIRAL DNA,PCR,CHG2-MRL 97.50 4922175 BK VIRUS PCR-MAYO 55.99 4922183 COBALT,SERUM-MAYO 61.28 4922191 CHLORDIAZEPOXIDE (LIBRIUM)-MAYO 68.46 4922209 CHROMOSOME STUDY TISSUE-MAYO 326.31 4922217 EAST EQUINE ENCEPH VRS AB,CSF-MAYO 69.30 4922241 HEPATITIS BE AG CHARGE-MAYO 18.06 4922266 VIRAL CULTURE NONRESPIRATORY-MAYO 44.45 4922274 THIAMIN VITB1-MAYO 9.93 4922282 VON WILLEBRAND CHG1-MAYO 70.00 4922290 VON WILLEBRAND CHG2-MAYO 60.00 4922308 THYROGLOBULIN TUMOR MKR CHG1-MAYO 10.67 4922316 TESTOSTERONE FREE/TOTAL-MAYO 14.20 4922324 T AND B CELL QT CHG1-MAYO 14.53 4922332 T AND B CELL QT CHG2-MAYO 18.16 4922340 T AND B CELL QT CHG3-MAYO 18.16 4922357 T AND B CELL QT CHG4-MAYO 18.16 4922365 ST.LOUIS ENCEPH VIRUS AB,S-MRL 59.04 4922373 ST.LOUIS ENCEPH VIRUS AB,CSF-MRL 77.40 4922381 SPINAL FLUID INDEX CHG2-MAYO 11.53 4922399 PSA FREE/TOTAL CHG1-MAYO 10.00 4922449 PROTEIN ELECTROPHORESIS S CHG-MAYO 12.63 4922456 PENTOBARBITAL SERUM-MAYO 50.58 4922464 PARIETAL CELL ANTIBODY-MAYO 26.18 4922472 MUMPS IGG/M AB CSF-MRL 68.40 4922480 MENINGOENCEPHALITIS PANEL S-MRL 70.38 4922498 MENINGOENCEPHALITIS PNL S CHG1-MRL 70.38 4922506 MENINGOENCEPHALITIS PNL S CHG2-MRL 70.38 4922514 MENINGOENCEPHALITIS PNL S CHG3-MRL 35.19 4922522 MENINGOENCEPHALITIS PNL S CHG4-MRL 35.19 4922530 MENINGOENCEPHALITIS PNL S CHG5-MRL 35.19 4922548 MENINGOENCEPHALITIS PNL S CHG6-MRL 35.19 4922555 MEM PNL SERUM CHG7-MRL 35.19 4922563 MENINGOENCEPHALITIS PNL S CHG8-MRL 35.19 4922597 PORPHYRINS PROFILE CHARGE-MAYO 71.05 4922605 ALDOSTERONE CORTISOL RATIO-NI 47.49 4922613 ALDOSTERONE CORTISOL RATIO CHG2-NI 47.49 4922621 KIDNEY STONE ANALYSIS-MAYO 11.79 4922639 IN SITU COMP ASSISTED-CLARIENT 230.53 4922647 IN SITU MANUAL ASSISTED-CLARIENT 200.92 4922654 HEMOGLOBIN AIC-UCI 18.00 4922662 STRONGYLOIDES AB,IGG 35.00 4922670 PLASMINOGEN INHIB ACTIVITY 1-MAYO 150.00 4922688 QUANTIFERON TB GOLD PLUS,BLOOD-MAYO 85.00 4922696 VITAMIN K1 LEVEL-MAYO 76.00 4922787 URINE SUPERSAT,SODIUM-MAYO 9.86 4922795 URINE SUPERSAT,POTASSIUM-MAYO 8.72 4922803 URINE SUPERSAT,CALCIUM-MAYO 12.22 4922811 URINE SUPERSAT,MAGNESIUM-MAYO 13.58 4922829 URINE SUPERSAT,CHLORIDE-MAYO 10.18 4922837 URINE SUPERSAT PHOS-MAYO 10.48 4922845 URINE SUPERSAT SULFATE-MAYO 9.62 4922852 URINE SUPERSAT CITRATE-MAYO 50.96 4922860 URINE SUPERSAT OXALATE-MAYO 26.09 4922878 URINE SUPERSAT PH-MAYO 7.26 4922886 URINE SUPERSAT URIC ACID-MAYO 9.62 4922894 URINE SUPERSAT CREATININE-MAYO 10.40 4922902 URINE SUPERSAT OSMOLALITY-MAYO 13.20 4922936 DIHYDROTESTERON-MAYO 45.23 4922944 LYME DISEASE PCR,BLOOD-MAYO 86.28 4922969 LYME DISEASE AB,EIA,SERUM-MAYO 20.10 4922977 LYME DISEASE AB,EIA,CSF-MAYO 35.00 4922985 LYME DISEASE AB WB,CSF-MAYO 31.59 4923009 THROMBOPHILIA,FIBRINOLYSIN-MAYO 11.37 4923017 THROMBOPHILIA,SOLUBLE FIBRIN-MAYO 40.00 4923025 MYOGLOBIN,URINE-MAYO 19.64 4923033 HEMOGLOBIN A2 AND F-MAYO 70.90 4923041 RNA POYMERASAE III AB,IGG-MAYO 44.11 4923058 HISTOPLASMA AG,SERUM-MAYO 119.00 4923066 BETA CROSSLAPS (B-CTX)-MAYO 60.00 4923074 ENDOMYSIAL AB, IGG-MAYO 97.00 4923082 SM ,IGG - MAYO 18.26 4923090 CYSTICERSOSIS,IGG AB,S-MAYO 70.00 4923108 BK VIRUS PCR,QUAN,PLASMA-MAYO 83.68 4923116 JC POLYOMA DNA,QN PCR,PLASMA-MAYO 311.34 4923124 C ALBICANS AB IGG,IGA,IGM-MAYO 97.85 4923140 TESTOSTERONE BIOAVAILALBE-MAYO 57.69 4923181 PROTHROMBIN FRAGMENT 1+2-MAYO 169.00 4923215 -MAYO 113.00 4923256 STREP PNEUMO IGG AB-MAYO 63.71 4923264 SPECIMEN TRANSPORT-UCI 23.00 4923272 SPECIMEN TRANSPORT-CS 70.00 4923280 PERIODIC FEVER PANEL CHG1-GENEDX 275.00 4923298 PERIODIC FEVER PANEL CH2-GENEDX 275.00 4923306 PERIODIC FEVER PANEL CHG3-GENEDX 1,650.00 4923363 ANTIMULLERIAN HORMONE-MAYO 60.75 4923371 AMPHETAMINE CONFIRMATION-MAYO 50.00 4923421 PARANEOPLASTIC AB EVAL,CSF-MAYO 55.00 4923439 PARANEOPLASTIC AB CHG1,CSF-MAYO 60.00 4923447 ANFLUENZA A/B & RSV,PCR,NP SWAP-MAY 76.72 4923454 RSV PCR DETECTION-MAYO 110.02 4923462 CERVICAL VAGINAL CYTOLOGY-PATHINC 30.00 4923470 HPV NAAT FRM CRVCL CYTOLOGY-PATHINC 39.00 4923488 CHLAMYDIA BY PCR-PATHINC 39.00 4923496 GONORRHEA BY PCR-PATHINC 39.00 4923629 MONOCLONAL PROTEIN STDY RAND U-MAYO 25.00 4923637 MONOCLONAL PRTN STDY,RAND U1-MAYO 25.00 4923645 GANGLIOSIDE ANTIBODY PNL - MAYO 30.00 4923678 MAG ANTIBODY-MAYO 140.00 4923686 MAG-SGPG AB-MAYO 105.00 4923694 MAG-IGM AB TITER-MAYO 115.00 4923702 HU ANTIBODY-MAYO 185.00 4923710 HU AB WESTERN BLOT-MAYO 105.00 4923728 HU AB TITER-MAYO 182.50 4923736 HIV1 SUSCEPTABILITY ANALYSIS-MAYO 120.00 4923744 HIV1 RT BASED DRUG ANALYSIS-MAYO 125.00 4923751 HIV1 DRUG RESISTANCE 1-10-MAYO 553.00 4923769 HIV1 DRUG RESIST EA ADDED DRUG-MAYO 55.00 4923835 THC CONFIRMATION,MECONIUM-MAYO 96.01 4923843 AMPHETAMINE/METHAMPH,MECONIUM-MAYO 46.01 4923850 VAGINITIS PCR SCREEN CHG1-PATH INC 25.00 4923868 VAGINITIS PCR SCREEN CHG2-PATH INC 25.00 4923876 VAGINITIS PCR SCREEN CHG3-PATH INC 25.00 4923884 FETAL LUNG MATURITY-LBC-UCI 39.00 4923892 N TERMINAL PRO-BNP-MAYO 71.77 4923942 CGH MORPHOMETRIC - GCTR 200.00 4923959 CGH INTERP - GCTR 200.00 4924007 MITOCHONDRIA INTERP-GCTR 60.00 4924015 COCAINE CONF ON MECONIUM-MAYO 96.01 4924023 FLOW CYTOMETRY 16+MARKERS-MAYO 141.30 4924031 PCP CONFIRMATION,MECONIUM-MAYO 146.48 4924049 CARBOHYDRATE DEF TRANSFERIN-MAYO 45.73 4924098 ESCITALOPRAM (LEXPRO)-MAYO 52.95 4924106 NEUTROPHIL SPECIFIC ANTIBODIES-MAYO 71.10 4924114 SACCHAROMYCES(IBD) ANTIBODIES-MAYO 70.00 4924122 ACANTHAMOEBA CULTURE-MRL 162.00 4924130 CHROMOSOME ANALYSIS CULTURE-MAYO 100.00 4924148 CHROMOSOME ANALYSIS CVS-MAYO 450.62 4924155 CHROMOSOME ANALYSIS IN SITU-MAYO 67.91 4924163 CHROMOSOME ADDL KARYOTYPES-MAYO 26.00 4924171 CHROMOSOME INTERP-MAYO 30.00 4924189 CHROMOSOME CYTOGENETICS-MAYO 100.00 4924221 HLA B5701 NA PROBE AMP-MAYO 517.73 4924247 RBC ENZYME EVAL CHG1-MAYO 71.69 4924254 RBC ENZYME EVAL CHG2-MAYO 69.80 4924262 RBC ENZYME EVAL CHG3 - MAYO 76.32 4924270 RBC ENZYME EVAL CHG4 - MAYO 133.51 4924288 RBC ENZYME EVAL CHG5 - MAYO 197.80 4924296 FLOW CYT BONE MARROW 1ST M-GEMINI 86.69 4924304 FLOW CYT BONE MARROW SUBS M-GEMINI 64.00 4924320 FLOW CYT SUBS M -GEMINI 34.00 4924338 FLOW CYT 1ST MARKER - GEMINI 55.14 4924346 FLOW CYT ADDED MARKERS-GEMINI 33.31 4924353 IHC STAIN TC-GEMINI 40.00 4924361 ACGH WHOLE GENOME CONSIT-MAYO 1,535.10 4924411 COXSACKIE B ANTINODY PANEL-QUEST 12.66 4924429 COXSACKIE B ANTIBODY_PANEL-QUEST 12.66 4924437 COXSACKIE A ANTIBODY PANEL-MAYO 18.14 4924445 COXSACKIE A ANTIBODY_PANE-MAYO 18.13 4924452 TCD4 T CELL COUNT - MAYO 21.60 4924460 TCD4 CD4/CD8 COUNT - MAYO 23.05 4924478 PSA ULTRASENSATIVE - MAYO 123.40 4924486 FIBRINOGEN ANTIGEN-NI 35.50 4924494 HE-4 OVARIAN TUMOR MARKER-MAYO 145.00 4924502 NMO EVALUATION W REFLEX-MAYO 169.70 4924510 C DIFFICILE CULTURE-MAYO 81.48 4924528 HEMOPHILUS MIC PANEL-MRL 80.10 4924536 OXCARBAZEPINE METABOLITE-MAYO 21.31 4924551 FREE THYROXINE INDEX CHG2-MAYO 25.69 4924569 NOVOVIRUS ANTIGEN EIA-MAYO 123.00 4924577 LIPOPROTEIN A-SERUM-MAYO 15.39 4924585 HUMAN HERPES VIRUS 6 PCR-MAYO 116.50 4924593 HUMAN HERPES VIRUS 8 IGG-MAYO 156.44 4924601 GRANULOCYTE AB,SERUM-MAYO 72.89 4924619 UPG DECARBOXYLASE-MAYO 189.80 4924627 FACTOR VII INHIBITOR SCREEN-MAYO 54.45 4924635 FACTOR VII ASSAY-MAYO 88.85 4924668 FCTR V LEIDEN GENE MUTTN F5DNA-MAYO 50.00 4924676 CYTOCHORME P450 2C19,2C19S-MAYO 733.84 4924684 BCR/ABL P210,QNT,BCRAB-MAYO 350.06 4924692 CHRONIC GRAN DISEASE MUT PNL-GENEDX 2,860.00 4924700 CHRONIC GRAN DZ MUT PNLB-GENEDX 2,035.00 4924718 CYSTIC FBRSS GENE CAR PNL,CFPB-MAYO 121.31 4924726 FRGL X CHROMOSOME MUT PNL,FXPB-MAYO 290.99 4924734 HLA-B 5701 GENOTYPE,ABACAVIR,BLD-MA 597.00 4924742 HEREDITARY HFE GENE ANL,HHEMO-MAYO 150.00 4924759 JAK2 V617F MUT DETECT, JAK2B-MAYO 200.00 4924767 KIT ASP816VAL MUT ANL Q ,KITAS-MAYO 438.90 4924775 MITOCHONRIAL DNA ANALYSIS-GCTR 600.00 4924791 PROTHROMBIN G20210A MUTTN,PTNP-MAYO 48.63 4924809 SMA GENE CARRIER PNL,SMAGEN-MAYO 623.50 4924817 TPMT GENETC ANALYS PCR ,FPRTG-MAYO 380.50 4924825 HLA CLS 1 MOL TYP DISEASE,DISI-MAYO 29.37 4924833 RESPIRATORY ALLERGY PNL 10655X1-N1 9.60 4924841 RESPIRATORY ALLERGY PNL 10655X2-NI 7.20 4924858 RESPIRATORY ALLERGY PNL 10655X3-NI 48.00 4924866 FOOD ALLERGY PROFILE (10715X)A-NI 10.80 4924874 FOOD ALLERGY PROFILE (10715X)B-NI 9.60 4924882 NMDA RECEPTOR AB SERUM-MAYO 445.32 4924890 NMDA RECEPTOR AB,CSF-MAYO 450.00 4924908 LMP CHOLESTEROL-MAYO 10.00 4924916 LMP TRIGLYCERIDES-MAYO 10.00 4924924 LMP APOLIPOPROTIEN B-MAYO 15.00 4924932 LMP HDL CHOLESTEROL-MAYO 10.00 4924940 LMP LP (A) CHOLESTEROL-MAYO 25.07 4924957 CREATINE DISORDERS 01-MAYO 20.00 4924965 CREATINE DISORDERS 02-MAYO 20.00 4924973 CREATINE DISORDERS 03-MAYO 71.66 4924981 CHLAMYDIA TRACHOMATIS CULTURE-MAYO 89.38 4924999 C1 ESTERASE INHIBITOR,FUNCT-MAYO 43.98 4925004 MI-2 AB-MAYO 80.00 4925012 SRP ANTIBODIES-MAYO 80.00 4925020 FLUOXETINE,SERUM-MAYO 56.89 4925038 VITAMIN B12 BINDING UNSATUREATE-NI 39.50 4925046 CHROMOSOMES ADDL HIGH RES STDY-GCTR 27.00 4925053 URINE PROTEIN ELECTROPHORESIS-MAYO 30.00 4925061 URINE IMMUNOFXTN EL PHORESIS-MAYO 131.50 4925079 SEROTNN REL.ASSAY,UNFRCT-HEPRN-MAYO 367.00 4925087 TPMT GENOTYPE-MAYO 390.00 4925095 D-LACTATE,PLASMA-MAYO 56.58 4925103 INSULIN-LIKE GROWTH FACT PROT3-MAYO 22.00 4925111 EGFR GENE MUTATION ANALYSS-CLARIENT 1,291.64 4925129 KRAS GENE-CLARIENT 327.16 4925137 LEVETIRACETAM (KEPRA) LEVEL-UCI 60.40 4925145 SYPHILIS IGG AB W REFLEX-MAYO 12.75 4925152 HEAVY METAL SCREEN CHG4 - MAYO 15.66 4925160 R RICKETTSIAL DISEASE PNL CHG2-QUES 34.05 4925178 CELIAC DISEASE IGA-MAYO 12.00 4925186 CELIAC DISEASE HLA-DQ-MAYO 80.62 4925194 GLIADIN DEAMINATED IGA AB-MAYO 23.13 4925202 GLIADIN DEAMINATED IGG AB-MAYO 10.00 4925210 SYPHILIS AB BY TP-PA,S-MAYO 37.51 4925228 IN SITU HYBRIDIZATION-PATH INC 130.00 4925236 THROMBIN CLOTTING TIME-NI 37.18 4925244 PMLR RAR QUANT,PCR-MAYO 437.12 4925251 IBD SGI DIAGNOSTIC CHG4-PROM 41.00 4925269 IBD SGI DIAGNOSTIC CHG2-PROM 41.00 4925277 IBD SGI DIAGNOSTIC CHG3-PROM 41.00 4925319 BONE MARROW CHROMSM ANALYSS CHG1-GI 180.00 4925327 BONE MARROW CHRMSME ANALSS CHG2-GI 250.00 4925335 BONE MARROW CHRMSME ANALYSS CHG3-GI 20.00 4925343 6MAMU,6-MAM,U-MAYO 153.50 4925350 ACYCLOVIR-MAYO 146.00 4925368 REDUCING SUBSTANCES,STOOL-MAYO 20.00 4925376 COLLAGEN TYPE I C-TELOPEPTIDE-NI 69.50 4925384 ALPHA-GLOBIN COMMON MUT ANAL-CHG1 Q 299.00 4925434 COLOVANTAGE - QUEST-NI 355.00 4925442 ALDOSTERONE/PLSM RENIN RATION-NI 70.75 4925459 ALDOSTERONE/PLSM RENIN RATIO 1-NI 70.75 4925467 LEGIONELLA ANTIGEN DFA-FOCUS 86.40 4925475 DNA ANALYSIS FOR METHYLTN STDY-GCTR 500.00 4925483 DNA ANALYSIS CGH MICROARRAY-GCTR 1,100.00 4925491 HISTAMINE RLS(CHRONIC URTICARIA)-NI 150.00 4925509 DHEA ()-NI 89.00 4925517 HEPATITIS B VRS DNA QNT RLTM APT-NI 110.00 4925525 HEPATITIS B VRS DNA QNT RLTM PCR-NI 259.44 4925533 TREPONEMA PALLIDUM AB IFA(CSF)-NI 43.50 4925541 OROTIC ACID,URINE MAYO 61.89 4925558 HTLV I,II DNA,RT,PCR-MAYO 249.67 4925566 CHILDHD ALLRGY PRFL 10659X CHG1-NI 40.80 4925574 PANCREATIC ELAST IN STOOL-MAYO 91.65 4925582 HEPATITIS BC AB IGG & M-MAYO 16.60 4925590 FRUCTOSAMINE,SERUM-MAYO 18.00 4925608 FLT3(ITD)&D835 VARNT DET CHG1-MAYO 162.50 4925616 FLT3(ITD)&D835 VARIANT DET CH2-MAYO 162.50 4925624 CEBRA MUTATION ANALYSIS-MAYO 413.00 4925632 KIT ASP816VAL MUTTN ANALYSIS,V-MAYO 380.24 4925640 NUCLEOPHOSMIN MUTATN ANALYSIS-MAYO 556.70 4925657 GANGLIOSIDE GQ1B AB(IGG)-MAYO 136.70 4925665 NICOTINE & METABOLITES, S - MAYO 53.47 4925673 DHEA-MAYO 21.90 4925681 HEPARIN,LOW MOLEC WT ANTI-XA-UCI 60.00 4925699 CORTISOL, TOTAL, LC/MS/MS-NI 97.78 4925707 HE4, OVARIAN CA MONITORING-MAYO 41.93 4925715 SSDNA (SNGL STRANDED DNA) IGG AB-NI 65.12 4925723 NEUROMYLTS OPTICA IGG ATOANTBDY-NI 295.00 4925731 HIV1 GENOSURE PRIME-M-BIOSCIENCE 300.00 4925749 HIV1 GENOSURE PRIME2-M-BIOSCIENCE 290.00 4925756 HIV1 GENOSURE PRIME3-M-BIOSCIENCE 300.00 4925764 HIV1 PHENSNS INTEGRACE-M-BIOSCIENCE 725.00 4925772 HIV1 PHNSNS ADDL DRGS-M-BIOSCIENCE 95.50 4925780 CA 19-9 CARBOHYDRATE AG-MAYO 18.21 4925798 NOROVIRUS RNA,RT PCR-MAYO 95.00 4925806 HSV TYPES 1&2 DNA,RT PCR-MRL 141.35 4925814 VON WILLEBRAND FACTOR ACTIVITY-MAYO 75.00 4925830 TSH ANTIBODY-NI 106.20 4925848 LACOSAMIDE (VIMPAT)-MAYO 96.00 4925855 CHROMIUM,SERUM-MAYO 26.92 4925863 HEMOSIDERIN-URINE-MAYO 34.59 4925871 RASPBERRY IGG-MAYO 39.80 4925889 SOYBEAN IGG-MAYO 39.80 4925897 PECAN FOOD IGG-MAYO 39.80 4925905 BETA-2 TRANSFERRIN BF-MAYO 88.64 4925913 MICROSPORIDIA STAIN CHRG1-MAYO 24.54 4925921 MICROSPORIDIA STAIN CHRG2-MAYO 24.54 4925939 CO-SEN NEURO PROFILE CHRG1-MAYO 1,256.92 4925947 CO-SEN NEURO PROFILE CHRG2-MAYO 1,256.92 4925954 DRVVT 1:1 MIX-NI 22.50 4925962 QUANTIFERON-TB GOLD-NI 258.30 4925970 ANTIMCRBRL SSCP,HMPHLS,MICPNL-FOCUS 80.10 4925988 MEFV GENE ANALYSIS FMF-MAYO 675.00 4926002 RBC FOLATE-NI 56.20 4926010 HEPATITIS A IGG ANTIBODY-MAYO 16.87 4926028 DPD GENE MUTATION-MAYO 287.50 4926036 NERVE BX PNL,LVL4 G&M-UCI 300.00 4926044 INFLXMB&ANTI-INFLXMB AB CHRG1-MAYO 212.50 4926051 INFLXMB&ANTI-INFLXMB AB CHRG2-MAYO 212.50 4926069 MUCOPLYSCCHRDS (MPS)QN,U-MAYO 58.35 4926077 HELICOBACTER PYLORI AB,19M,S-MAYO 675.00 4926085 DES-GAMMA-CARBOXY PROTHRMBN,S-MAYO 150.00 4926093 H.PYLORI C UREA BREATH.T-MAYO 64.24 4926101 CEA,PERITONEAL FLUID-MAYO 186.90 4926119 INFLUENZA A&B,PCR-UCI 185.00 4926127 RESP VIRUS PCR PANEL III-FOCUS 1,386.90 4926135 CELIAC HLA DQ TYPING ALPHA-MAYO 101.50 4926143 CELIAC HLA DQ TYPING BETA-MAYO 101.50 4926168 IGE QUANTITATIVE-MAYO 10.64 4926176 ALLERGEN SPECIFIC IGE-MAYO 4.50 4926184 HSV AND VZV,PCR CHRG1-MAYO 45.00 4926192 HSV AND VZV,PCR CHRG2-MAYO 45.00 4926200 INTERLEUKIN 1-ALPHA-MAYO 260.00 4926218 INTERLEUKIN 1-BETA-MAYO 260.00 4926226 IL-6,SERUM-MAYO 164.60 4926234 MYOSITIS ANTIBODY PANEL-MAYO 310.00 4926242 HSV1/2(IGG),TYPE-SPEC AB CHG1-NI 43.00 4926259 HSV1/2(IGG) TYPE SPCFC AB CHG2-NI 43.00 4926267 BORDTLLA P/PARAPER DNA,QL RT PCR-NI 170.00 4926275 ETHANOL,U-MAYO 53.70 4926283 ANA, HEP-2 SUBSTATE-MAYO 18.12 4926291 ANA REFLEX TO TITER-MAYO 24.96 4926325 HUNTINGTON DISEASE ANALYSIS-MAYO 250.00 4926358 CLOBAZAM (ONFI) - MAYO 71.60 4926408 DRUG SCREEN BLOOD CHG 1 - MAYO 83.96 4926432 HIV-1/2-2 AG AND AB SCREEN,S-MAYO 25.00 4926440 HIV-1/2-2 AB DIFF,S CHRG 1-MAYO 20.00 4926457 HIV-1/2-2 AB DIFF,S CHRG2-MAYO 27.12 4926465 HIV-1 AB CONFIRM BY WB,S-MAYO 19.75 4926473 HIV-2 AB CONFIRMATION,S-MAYO 57.80 4926481 ANT SUS,GRAM-POS RDS,MIC PNL-FOCUS 82.80 4926499 HSV CX W/RFLX TO TYPING-FOCUS 60.30 4926507 HSV 1 AND 2 AG,DFA CHRG 1-FOCUS 40.50 4926515 HSV 1 AND 2 AG DFA CHRG2-FOCUS 40.50 4926523 CHLAMYDIA TRACHOMATIS AG,DFA-FOCUS 81.00 4926531 MYCOPLASMA IGG IGM AB-MAYO 17.33 4926549 MYOSITIS AB 2 PANEL CHRG 1 - MAYO 162.50 4926556 MYOSITIS AB 2 PANEL CHRG 2 - MAYO 162.50 4926564 INFLXMB & ANTI-INFLIX AB CHRG1-MAYO 212.50 4926572 INFLXMB & ANTI-INFLIX AB CHRG2-MAYO 212.50 4926580 RAJI CELL IMMUNE COMPLEX ASSAY-MAYO 295.60 4926705 UGT1A1 GENE SEQ IRINOTECAN-MAYO 953.80 4926713 TRICHOMONAS VAGINALIS PCR-PATHINC 38.30 4926721 CEA PLEURAL FLUID-MAYO 186.90 4926739 FACTOR X CHROMOGENIC ACT ASSY-MAYO 193.85 4926747 VON WILLEBRAND PROF CHGI-MAYO 30.00 4926754 VON WILLEBRAND PROF CHG2-MAYO 30.00 4926762 VON WILLEBRAND PROF CHG3-MAYO 30.00 4926770 BETHESDA UNITS RX-MAYO 145.60 4926788 COAG FACTOR VII INHIB SC RX -MAYO 296.60 4926796 RISTOCETIN CO-FACTOR-PL RX-MAYO 33.00 4926804 SPECIAL COAGULATION INTERP RX-MAYO 36.00 4926812 CTRACH/N GNONORR AMPLIFIED RNA-MAYO 43.83 4926820 BILE ACIDS FRACTNTD AND TOT-MAYO 84.86 4926838 HSV(NEONATES) CULTURE-MAYO 301.00 4926846 DRUGS SCREEN BLD 10 WB-MAYO 123.00 4926853 HSV TYPES 1&2 AB IGG-CHG1-MAYO 8.87 4926861 HSV TYPES 1&2 AB IGG CHG2-MAYO 9.00 4926879 FACOTR V(LEIDEN) MUT W/RX HR2-QUEST 192.18 4926887 FACTOR V REFLEX TO HR2CHG-QUEST 230.00 4926895 YEAST SUSCEPTIBILITY COMP PNL-FOCUS 497.23 4926903 SPECIAL STAIN, GRP2-ADPL-PATHINC 40.00 4926911 HPV LOW RISK DNA ISH-MAYO 565.10 4926929 AUTOIMM HEP DX CHG1-QUEST 61.00 4926937 AUTOIMM HEP DX CHG2-QUEST 61.00 4926945 AUTOIMM HEP DX CHG3-QUEST 61.00 4926952 AUTOIMM HEP DX CHG4-QUEST 61.00 4926960 IMAGE ANALYSIS(ASPERIO) PATHINC 177.33 4926978 OSTEOCALCIN-MAYO 62.95 4926986 THERMOACTIN VULGARIS IGG-MAYO 59.23 4926994 MICROPOLYSPORA FAENI-IGG-MAYO 44.25 4927000 URIC ACID-MAYOQ 25.65 4927018 NERVE BX PNL,SPECIAL STAIN&RPT-UCI 285.00 4927034 CARBOHYDRATE, URINE - MAYO 49.45 4927042 THYROXINE BIND GLOBULIN-MAYO 30.68 4927059 CORTISONE SERUM - NI 132.30 4927067 ALLERGEN SPECIFIC IGG(8)-MAYO 17.92 4927075 HISTOPLASMA AG URINE-MAYO 92.80 4927091 BUPROPION (WELLBUTRIN)-MAYO 89.68 4927109 FLOWCYTOMETRY/TC 1 MARKER-CLARIENT 62.00 4927117 FLOWCYTOMETRY/TC,ADD-ON-CLARIENT 12.00 4927158 LIVER/KIDNEY MICROSOM AB - MAYO 22.87 4927216 ESTRIOL,UNCONJUGATED-MAYO 18.94 4927224 -MAYO 93.64 4927232 FIBROGEN ANTIGEN-MAYO 95.00 4927240 C1 EST INHIB FUNCTIONAL-MAYO 12.25 4927257 BETA-GLOBIN COMPLETE-NI 349.00 4927281 RA DGNSTC PNL W/14-3-3 ETA CHG1-NI 108.00 4927299 RA DGNSTC PNL W/14-3-3 ETA CHG2-NI 85.75 4927307 RA DGNSTC PNL W/14-3-3 ETA CHG 3-NI 85.75 4927315 ZINC, RBC-MAYO 81.84 4927323 BRAF MUT ANAL PCR-CLARIENT 78.12 4927331 BRAF MUT FDA MELANOMA-CLARIENT 78.12 4927349 ALK REAMNT,FISH-CLARIENT 401.84 4927356 MSI BY PCR - CLARIENT 275.52 4927364 HEV IGM AB SCRN-MAYO 81.65 4927372 CYSTINURIA PRF,QN,24HRS-MAYO 107.34 4927380 KAPPA/LAMDA LT CHN,UR CHG2-MAYO 47.75 4927398 KAPPA/LAMDA LT CHN,UR CHG3-MAYO 47.75 4927406 KAPPA/LAMDA LT CHN,UR CHG1-MAYO 47.75 4927414 HCV RNA NS3 GENOTYPE-NI 700.00 4927422 IHC AB STAIN,ADDL - PATHINC 40.00 4927430 IHC AB STAIN, ADDL - CLARIENT 57.58 4927448 CALPROTECTIN,STOOL-NI 140.00 4927463 PAN ANCA PLUS W/REFLEX CHG 1-NI 131.95 4927471 PAN ANCA PLUS W/REFLEX CHG 2-NI 131.95 4927489 PAN ANCA PLUS W/REFLEX CHG3-NI 131.95 4927497 LACTOFERRIN,QUAL,STOOL-NI 185.00 4927505 PAN ANCA PLUS W/REFLEX CHG4-NI 13.12 4927539 HLA TYPING(A,B,&C) SEROLOGICAL-MAYO 353.00 4927620 RPR-MAYO 30.00 4927638 DILANTIN FREE & TOTAL-MAYO CHG 2 12.66 4927646 DNA ANNALY CGH MICROARRAY 180K-GENE 1,100.00 4927653 NRAS MUTATION ANALYSIS-CLARIENT 542.40 4927661 CHROMOSOMES,CONGENITAL-MAYO 191.32 4927679 ACH RECEPT(MUSCLE)BINDING AB-MAYO 19.00 4927687 CASR GENE,FULL GENE ANALYSIS-MAYO 1,300.00 4927695 NOTCH3 DNA SEQUENCING-MAYO 2,525.00 4927703 WEST NILE VIRUS PCR(PLASMA)-MAYO 35.80 4927711 FREE THYROXINE INDEX(FTI)CHG 2-MAYO 10.29 4927729 AEROBIC BACTERIAL ID(7925)-FOCUS 78.30 4927737 AEROBIC MIC ROUTINE(7429)-FOCUS 51.00 4927745 AFB SUSCEPTIBILITY MTB(7235)-FOCUS 112.50 4927752 AFB SLOW GROW MIC SUSCEPT(92522)-MR 140.40 4927760 AFB RAPID GROW MIC SUSCEPT(7913)-MR 109.80 4927778 ANAEROBIC MIC PANEL(7921)-FOCUS 214.40 4927786 FUNGAL ID,MOLD(8028)-FOCUS 85.24 4927802 VANILLYLMANDELIC ACD-MAYO 22.34 4927810 YERSINIA AB IG(A,G,M)-MAYO 224.64 4927828 QUINIDINE-MAYO 41.52 4927836 PNEUMOCYSTIS JIROVEC-QUEST 42.00 4927844 PARAINFLU(TYPES1,2,3)-MAYO 77.50 4927851 HLA CLASS I MOL TYPE-MAYO 29.37 4927869 IMMUNOGLOBULIN D-MAYO 41.07 4927885 PHENYLALANINE&TYRSN CHG1-MAYO 53.55 4927893 PHENYLALANINE&TYRSN CHG2-MAYO 47.79 4927901 INHIBIN A,B CHG1-MAYO 40.00 4927919 INHIBIN A,B CHG2-MAYO 40.00 4927927 FAT STAIN(CHYLURIA)CHG1-MAYO 20.68 4927935 FAT STAIN(CHYLURIA)CHG2-MAYO 20.68 4927943 FAT STAIN(CHYLURIA)CHG3-MAYO 20.68 4927950 BRAZIL NUT,IGE-MAYO 4.50 4927968 MAGNESIUM,RBC-MAYO 47.80 4927976 PREGABALIN(LYRICA)-MAYO 70.00 4927984 FATTY ACID PROFILE COMP(C8-26)-MAYO 125.07 4927992 OVA & PARASITIC EXAM-MAYO 27.76 4928008 BACTERIAL VAGINOSIS-LABC 75.00 4928016 BACTERIAL VAGINOSIS PNL CHRG 1-LABC 24.15 4928024 BACTERIAL VAGINOSIS PNL CHRG 2-LABC 24.15 4928032 BACTERIAL VAGINOSIS PNL CHRG 3-LABC 55.10 4928040 BACTERIAL VAGINOSIS PNL CHRG 4-LABC 55.10 4928057 TACROLIMUS-MAYO 25.00 4928065 ER/PR ESTRGN/PRGSTRNE RCPTR IMAGE-C 185.62 4928081 ZIKA VIRUS REAL-TIME RT-PCR,URINE-M 220.00 4928099 SUSCEPTIBILITY YEAST PANEL-MAYO 150.00 4928107 SULFAMETHOXAZOLE-MAYO 50.89 4928115 NMO/AQP4 FACS TITER-MAYO 150.00 4928123 JC PLYMA VRS DNA,QL,RT PCR PLSM-NI 161.50 4928131 DCP-QUEST 137.50 4928149 VON WILLEBRAND DIS TYPE-QUEST 220.00 4928156 NEOENCEPH PARANEO W/REFLEX-QUEST 3,780.00 4928164 IMMUNOFIXATION,SERUM-MAYO 55.00 4928172 IMMUNOGLOBULIN G-MAYO 12.00 4928180 IMMUNOGLOBULIN M-MAYO 12.00 4928198 IMMUNOGLOBULIN A-MAYO 12.00 4928206 HSV CSF-MAYO 45.00 4928214 MP STUDY,IFE-MAYO 57.80 4928222 MP STUDY,PEL-MAYO 29.82 4928230 FLOW PROFILE PNH TECH 1ST M-CL 134.00 4928248 FLOW PROFILE PNH EA ADDL M-CL 134.00 4928255 CYTOGENETIC STUDY(SET UP)-CL 175.00 4928263 CYTOGENETICS CELL ANALYSIS-CL 175.00 4928271 CYTOGENETICS INTERPRETATION 30.00 4928289 FISH-GLOBL EA MULT PROBE STAIN-CL 401.84 4928297 FISH AUTO-GLB EA PROBE STAIN-CL 461.04 4928305 EGFR MUTATION-BIDIR.SEQ-CL 443.00 4928313 PROFESSIONAL CONSULT-CL 310.00 4928321 IHC QUAL EA SPEC,INIT AB GLBL-CL 93.16 4928339 IHC QUAL EA SPEC,INIT AB TC-CL 57.58 4928347 IHC QUAL EA MPLEX AB TC-CL 172.72 4928354 IHC QUANT GLOBAL-CL 111.94 4928362 IHC MORPHOMETRIC QUANT TC-CL 92.81 4928370 IHC IN SITU HYBRID TC-CLARIENT 98.23 4928388 IHC IN SITU HYB,ADDL TC-CL 98.23 4928396 ANTIBODY SCREEN, EA MEDIA-ARC 45.00 4928404 ABID/EACH PANEL & MEDIA-ARC 34.00 4928412 DAT,EACH ANTISERA-ARC 25.00 4928420 ABO TYPE-ARC 25.00 4928438 RBC AG,OTHER THAN ABO OR D,EACH-ARC 40.00 4928446 RH PENOTYPING,COMP-ARC 60.00 4928453 PRE-RX RBCS W/CHEMI/DRUGS-ARC 50.00 4928461 PRE-TREATMENT W/-ARC 20.00 4928479 ELUTION-ARC 80.00 4928487 1RBC AG NEG/UNIT-ARC 80.00 4928495 ANTI-CMV TEST-ARC 50.00 4928503 SHP-UNSCHEDULED(STAT FEE)-ARC 40.00 4928511 UNIT W/4 EMPTY BAG-EMP4(EDS BAG)ARC 80.00 4928529 IRRADIATION-ARC 42.00 4928537 OFF HOUR CONSULT/HR-ARC 158.00 4928545 SAMPLE TRANSPORTATION-ARC 35.00 4928552 ZIKA VIRUS TESTING-ARC 7.00 4928560 SODIUM,FECES-QUEST 27.00 4928578 POTASSIUM,FECES-QUEST 26.00 4928586 LEVEL IV BIOPSY,NERVE OR MUSCLE-UCI 300.00 4928594 IHC STAIN,INITIAL ANTIBODY-UCI 150.00 4928602 IHC STAIN,ADD AB-UCI 114.00 4928610 ELECTRON MICROSCOPY-UCI 750.00 4928628 TRANSPORT SPECIMEN-UCI 10.00 4928636 BLOOD TYPING FOR RH(D)-ARC 20.00 4928644 DIFFERENTIAL RBC ABSORBTION-ARC 39.00 4928651 AMIKACIN PEAK-UCI 18.00 4928669 AMIKACIN TROUGH-UCI 18.00 4928677 PRIMIDONE-MAYO 25.00 4928685 PHENOBARBITAL-MAYO 25.00 4928693 PLT AG NEG/OTHER COMP HLA-ARC 400.00 4928701 PT SERA AG SCREEN/UNIT-ARC 60.00 4928719 THAWING RARE REAGENT CELLS-ARC 40.00 4928727 DILUTION OF SERUM,PER ALIQUOT-ARC 30.00 4928735 INDIRECT TITER,PER ANIBODY-ARC 80.00 4928743 SPECIAL ANTIGLOBULIN TEST-ARC 1,000.00 4928750 RENAL BX IHC STAIN-CS 251.34 4928768 RENAL BX SPCL STAIN-CS 37.10 4928776 HLA ANTIBODY ID,CLASS 1,IGG-ARC 800.00 4928784 HLA MOLECULAR AB TYPING-ARC 900.00 4928792 PLT ASSOC IGG,IGM TESTING DIR-ARC 242.00 4928800 GENITAL HSV1,2 BY PCR-QUEST 358.75 4928818 N-ACETYLPROCAINAMIDE-MAYO 26.91 4928826 FLOW INTERPRETATION(2-8)-CL 55.82 4928834 FLOW INTERPRETATION(9-15)-CL 68.59 4928842 FLOW INTERPRETATION(16+MARKERS)-CL 75.00 4928859 FISH AUTO-TECH-CL 355.04 4928867 BLADDER CANCER FISH GLOBAL-CL 700.00 4928875 KRAS GENE ANALYSIS-CL 303.00 4928883 KRAS GENE ANALYSIS_-CL 130.00 4928891 CEBPA MUTATION ANALYSIS-CL 358.00 4928909 IDH1,IDH2 MUTATIONS ANALYSIS-CL 265.00 4928917 MICROSATELLITE INSTABILITY ANAL-CL 536.00 4928925 NPM1 MUTATION ANAL-LIQUID BX-CL 300.00 4928933 IHC QUALITATIVE;ADDN'L STAIN-CL 57.58 4928941 IHC QUANTITATIVE TECH-CL 65.64 4928958 INSULIN-LIKE GRWTH FACTOR-BIND PRO3 18.21 4928966 CORTISOL,S,LC-MS/MS-MAYO 53.27 4928974 CORTISOL,FREE,SERUM-MAYO 76.00 4928982 PANCREATIC ESTERASE,STOOL 224.00 4928990 IGF-1 LC/MS 29.91 4929006 PLATELET GLYCOPROTEIN FLOW 1 MARKER 172.85 4929014 PLATELET GLYCOPROTEIN FLOW ADDON 63.87 4929022 PLATELET BLYCOPROTEIN FLOW READ 2-8 97.46 4929048 CHROMOSOME CONGENTIAL CLTRE 01-MAYO 243.17 4929055 CYTO/MOLECULAR REPORT-MAYO 63.09 4929063 ADD'L SPECIALIZED BANDING-MAYO 10.00 4929071 LD ISOENZYMES-MAYO 7.20 4929089 PHOSPHLIPASE A2 REC ANTIBODY SCREEN 213.35 4929097 PHOSPHOLIPASE A2 REC ANTIBODY TITER 185.00 4929113 RANDOM URINE FRACTIONATED CATECHOL 75.50 4929121 TREE NUT ALLERGY PANEL 94.00 4929139 CARDIO IQ APOLIPOPROTEIN B 28.50 4929147 CARDIO IQ LIPOPROTEIN FRACTIONATION 50.00 4929154 CARDIO IQ OMEGA-3,6 FATTY ACID 50.00 4929162 HCV RNA GENOTYPE 3 NSSA DRUG RESIST 563.71 4929170 JC POLYOMA VIRUS DNA 301.34 4929188 SCHISTOSOMA IGG ANTIBODY 66.20 4929196 T3 FREE,QUEST 50.00 4929204 T3 TOTAL,QUEST 50.00 4929212 AEROBIC MIC CUSTOM,1 DRUG MRL 74.70 4929220 METHYLENEDIOXY AMPHETAMINE CONFIRM 43.97 4929238 CHC 4Q12 GENE DELETION-MAYO 82.93 4929246 CHIC GENE DELETION REPORT-MAYO 128.31 4929253 FATTY ACID PROFILE,ESSENTIAL-MAYO 82.93 4929261 HEP E VIRUS IGM AB-MAYO 94.10 4929279 HEP E VIRUS IGM AB CONFIRM-MAYO 143.70 4929287 LD ISOENZYMES INTERP-MAYO 15.25 4929295 PHOSPHOLIPASE A2 RECEP.IFA-MAYO 185.00 4929303 FIBROTEST-HAPTOCLOBIN-MAYO 70.75 4929311 FIBROTEST-APO-A1-MAYO 78.34 4929329 FIBROTEST-BILIRUBIN-MAYO 12.47 4929337 FIBROTEST-GGTP-MAYO 12.47 4929345 FIBROTEST-ALT-MAYO 12.47 4929352 IGG4-MAYO 125.40 4929360 SOLUBLE LIVER AG AUTOAB-MAYO 77.97 4929378 24 HR MICROALBUMIN NO CREAT-MAYO 5.90 4929386 TOPHERYMA WHIPPLEI PCR-MAYO 119.06 4929394 IGA TOTAL-MAYO 124.11 4929402 IGA SUBCLASS 1-MAYO 106.99 4929410 IGA SUBCLASS 2-MAYO 107.00 4929428 E HISTOLYTICA AG-MAYO 106.26 4929436 PROLACTIN,TOTAL-MAYO 30.20 4929444 PROLACTIN,UNPRECIPITATED-MAYO 30.20 4929451 ESTROGEN FRACTIONATION-MAYO 25.01 4929469 ADDED TESTING,VIRAL ID-MAYO 55.20 4929477 AFB NUCLEIC ACID SEQUENCE-MAYO 442.80 4929485 MIC,EACH MULTIMICROBIAL-MAYO 157.50 4929519 NEURONAL(V-G)K+CHANNEL AB,S-MAYO 120.92 4929527 ACH RECEPTOR(MUSCLE)BINDING AB-MAYO 120.92 4929535 N-TYPE CALCIUM CHANNEL AB-MAYO 120.92 4929543 P/Q-TYPE CALCIUM CHANNEL AB-MAYO 120.92 4929550 GAD65 ANTIBODY ASSAY-MAYO 177.11 4929568 PURKINUE CEL CYTOPLAMC AP TYPE TR-M 107.86 4929576 CRMP-5-IGG,S-MAYO 107.87 4929584 ANTI-NEURONAL AB,TYPE 3-MAYO 107.87 4929592 PURKINUE CEL CYTOPLASMC AP TYPE 2-M 107.87 4929600 ACHR GANGLIONIC NEURONAL AB,S-MAYO 120.92 4929618 ANTI-NEURONAL NUCLEAR AB,TYPE 1-MAY 107.87 4929626 ANTI-NEURONAL NUCLEAR AB,TYPE 2-MAY 107.87 4929634 AMPHYIPHYSIN AB,S-MAYO 107.87 4929642 ANTI-GLIAL NUCLEAR AB,TYPE 1-MAYO 107.87 4929659 NMDA-R AB CBA,SERUM-MAYO 107.86 4929667 AMPA-R AB CBA,SERUM-MAYO 107.87 4929675 GABA-B-R AB CBA,SERUM-MAYO 107.87 4929683 LGI1-IGG CBA,S-MAYO 107.87 4929691 CASPR2-IGG CBA,S-MAYO 107.87 4929709 CANCER ID GENOMIC ID-BIOTHERAN 4,750.00 4929717 THYROID RFLX,FT3-NI 69.50 4929725 THYROID RFLX,FT4-NI 41.00 4929733 THYROID RFLX,TSH-NI 38.00 4929741 FIBROBLAST CULT FOR GENE CHG1-MAYO 250.00 4929758 FIBROBLAST CULT FOR GENE CHG2-MAYO 42.27 4929766 MATERNAL CELL CONT,B-MAYO 426.66 4929774 AMNIOTIC FLUID CUL/GENE CHG1-MAYO 690.27 4929782 AMNIOTIC FLUID CUL/GENE CHG2-MAYO 60.03 4929790 OVAPARASITES NONSTOOL CONCTRICHRM-M 99.60 4929808 14.3.3 ETA PROTEIN-QUEST 127.92 4929816 ALKALINE PHOSPHATASE,TOTAL-MAYO 29.30 4929824 ISOPROPANOL-MAYO 46.17 4929832 TRANSFERRIN-MAYO 16.23 4929840 BRCA1/BRCA2 FULL GENE ANALYSIS-MAYO 1,795.20 4929857 PRADER-WILLI/ANGELMAN SYNDROM-MAYO 328.39 4929865 ALLERGY-ICE-QUEST 10.00 4929873 MYOGLOBIN SERUM-MAYO 71.55 4929881 ANA LUPUS PANEL-QUEST 407.58 4929899 NTX-TELOPEPTIDE,CREAT URINE CHG1-MA 16.13 4929907 NTX-TELOPEPTIDE,URINE CHG2-MAYO 13.13 4929915 ALPHA-1-ANTITRYPSIN,SERUM CHG1-MAYO 17.50 4929923 ALPHA-1-ANTITRYPSIN,PHENO CHG2-MAYO 17.50 4929931 MYELOPEROXIDASE AB,MPO-MAYO 6.24 4929949 ANCA PANEL FOR VASCULITIS(PR3,MPO)M 18.95 4929956 DIPHTHERIA TOXOID IGG AB,S-MAYO 35.79 4929964 B.PERTUSSIS AB,IGG,S-MAYO 80.00 4929972 CREATININE BODY FLUID-MAYO 28.37 4929980 ANGIOTENSIN CONVERTING ENZY,CSF-MAY 64.70 4929998 LYSOZUME,SERUM-MAYO 76.60 4930004 C.TRACH,MISC,RNA-MAYO 50.17 4930012 CAMPLYLOBACTER JEJUNI ANTIBODY-MAYO 99.83 4930020 PANCREASTATIN-MAYO 165.00 4930038 HEPATITIS A TOTAL ANTIBODY-MAYO 10.57 4930046 RHEUMATOID ARTHRITIS PANEL3 CHG1-QU 25.25 4930053 RHEUMATOID ARTHRTIS PANEL3 CHG2-QUE 25.25 4930061 RHEUMATOID ARTHRTIS PANEL3 CHG3-QUE 25.25 4930079 FSH,PEDIATRICS-QUEST 93.63 4930087 LH,PEDIATRICS-QUEST 93.64 4930095 CYP2C19 GENOTYPE,B-MAYO 801.40 4930111 MVISTA HISTOPLASMA ANTIGENT-MAYO 119.00 4930129 BCR/ABL1 CYTOGENETICS DNA PROBE-MAY 84.11 4930137 BCR/ABL1 CYTOMOLECULRE REPORT-MAYO 46.89 4930145 ANTI-DNASE B TITER,S-MAYO 122.90 4930152 SRY YP11.3 CYTOGENETICS DNA PROBE-M 161.96 4930160 SRY YP11.3 CYTOGENETICS REPORT-MAYO 90.29 4930178 CHLAMYDIA RNA,RECTAL-QUEST 60.00 4930186 LIVER FIBROSIS TEST PANEL-MAYO 250.00 4930194 MOTOR & SENSORY NEUROPATHY PANEL-MA 2,500.00 4930202 HLA-B 5801 GENOTYPE ALLOPURINOL-MAY 218.10 4930210 BILIRUBIN,BODY FLUID-MAYO 117.50 4930228 RHEUMATOID FACTOR,BODY FLUID-QUEST 22.50 4930236 CORTISOL,FREE-QUEST 62.50 4930244 ACID FAST BACILLI ID-JEWISH HEALTH 304.50 4930251 M.ABSCESSUS DIFFERNTIATION-JEW HEAL 108.77 4930269 MIC 20 DRUG COMO-JEW HEALTH 389.62 4930277 PDL-1 BY ICHC-IO 340.00 4930285 ROS1 BY FISH-IO 550.00 4930293 FREE FATTY ACIDS,TOTAL SERUM-MAYO 42.52 4930301 PNH,PL-LINKED AG1 MARKER-MAYO 31.76 4930319 PNH,PL-LINKED AG ADD-ON-MAYO 68.12 4930327 TRICHOPHYTON RUBRUM IGE-QUEST 10.00 4930335 ROCKY MOUNTAIN SPOTTED FEVER IGG-MA 22.78 4930343 ROCKY MOUNTAIN SPOTTED FEVER IGM-MA 22.79 4930350 CYTOGENETICS ADD KARYOTYPES-NG 45.00 4930368 CYTOGENETICS ADD CULTURE-NG 90.00 4930376 IHC,ADDNL STAIN PROC-NG 93.16 4930384 IHC BY ISH-NEOGENOMICS 147.92 4930392 TSH RECEPTOR ANTIBODY-MAYO 13.78 4930400 BETA CAROTENE-MAYO 122.75 4930418 HLA SELECT XMATCHED PLATELETS-ARC 1,000.00 4930426 RED CELLS LUERED AUTOLOGOUS-ARC 345.00 4930434 MUTATION ANALY BIDIRECT SEQ-NEOGEN 200.00 4930442 T.VAGINALIS RNA,QUAL TMA,MALES-QUES 75.34 4930459 COLLOIDAL IRON STAIN-LABCROP 20.00 4930467 SMMHC STAIN,FIRST ANTIBODY-LABCROP 40.00 4930475 SMMHC STAIN,EA ADDNL AB-LABCORP 40.00 4930483 AMPHETAMINES CONFIRMATION,URINE-MAY 23.91 4930491 MDA CONFIRMATION,URINE-MAYO 23.91 4930509 BCR/ABL,P190,QUANT MONITOR-MAYO 350.06 4930517 COLLAGEN CROSSLNKD N-TELOPEP,URI-QU 58.50 4930525 HEREDTRY HEMOCHROM DNA MUT ANALY-QU 196.50 4930533 ANA MULTIPLEX W/REFLUX-QUEST 14.47 4930541 LIVER KIDNEY MICROSOMAL ANTBDY-MAYO 24.28 4930566 THYROID FUNCTION CASCADAE-MAYO 10.04 4930574 BETA GLOBIN GENE SEQNCNG BLOOD-MAYO 600.00 4930582 CYP2D6 GENOTYPE CASCADE-MAYO 561.90 4930590 MVISTA COCCIDIOIDES ANTGN URN-MAYO 119.00 4930608 HLA TYPING FOR CELIAC DISEASE-QUEST 220.63 4930616 ALAKALINE PHOSPHATE BONE SPEC-QUEST 61.00 4930624 MORPH ANA TUMOR IMMUNO-LABCORP 388.00 4930632 IHC MULTIPLEX X1 TECHNICAL-LABCORP 114.00 4930640 APHERESIS PLTS IRRAD LEUKORED-ARC 502.00 4930657 CUTANEOUS IMMFLUOR STAIN-MAYO 49.76 4930665 IHC-EACH ADDITIONAL STAIN-LABC 38.00 4930673 HERPES SMPLX VRS PCR (NON-BLD)-MAYO 46.10 4930681 MDS PANEL - INTEGRATED 80.00 4930699 MDS PANEL 88275 - INTEGRATED 80.00 4930707 STRATIFY JCV ANTIBODY W REFLEX-QUES 1,511.08 4930715 GONAD RELEASING HORMONE-MAYO 260.00 4930723 BCL-2 TRANSLOCATION T(14:18)-NG 315.00 4930731 BRAF MUTATION ANALYSIS-NEOGENOMICS 200.00 4930749 UNLISTED MOLECULAR PATHOLOGY - MAYO 110.00 4930756 MOPATH PROCEDURE LEVEL 2 - MAYO 110.00 4930764 MOPATH PROCEDURE LEVEL 5 - MAYO 110.00 4930772 MOPATH PROCEDURE LEVEL 6 - MAYO 110.00 4930780 MOPATH PROCEDURE LEVEL 7 - MAYO 110.00 4930798 MOPATH PROCEDURE LEVEL 8 - MAYO 110.00 4930806 MOPATH PROCEDURE LEVEL 9 - MAYO 110.00 4930814 THROMBIN TIME-MAYO 41.40 4930822 RHEUMATOID FACTOR,BODY FLUID-MAYO 79.00 4930830 CARDIO IQ LIPOPROTEIN(A)-MAYO 25.00 4930848 HEPATITIS C VIRL RNA GENO LIPA-QUES 193.00 4930855 AEROBIC BACTERIA SUSPECTIBILITY-QUE 133.67 4930863 AFB SEQUENCING 1-QUEST 442.80 4930871 POLIOVIRUS(TYPES 1,3)AB NEUT-MAYO 180.52 4930889 ALPHA-SUB OF PIT GLYCO-MAYO 35.00 4930897 IN SITU HYBRIDIZATION-1ST-LABCORP 125.00 4930905 IN SITU HYBRIDIZATION-EA ADDNL-LABC 125.00 4930913 3 RBC AG NEG UNIT-ARC 220.00 4930921 MACPROBE-FOCUS 221.40 4930939 MAC MIC SUSCEPTIBILITY-FOCUS 161.50 4930947 RESPIRATORY VIRAL PANEL-MAYO 521.80 4930954 PNEUMOCYSTIS JEROVECII,DFA-MAYO 121.40 4930962 GANGLIOSIDE GM1,GM2,GD1A,GD1B,GQ1BM 310.40 4930970 AVOCADO,IGE-MAYO 5.33 4930988 INHIBIN A-QUEST 83.38 4930996 INHIBIN B-QUEST 135.00 4931002 KIT(C-KIT)MUTATION ANALY-NEOGENOMIC 304.00 4931010 FLT3(INCL D385)MUTATION ANALY-NEO 300.00 4931028 STAT3 MUTATION ANALY-NEO 490.00 4931036 TP53 MUTATION ANALY BI-DIRECT-NEO 900.00 4931044 NEOTYPE AML PROGNOSTIC PROFILE-NEO 1,630.00 4931051 ALCOHOL,METHYL-QUEST 68.25 4931069 BRUCELLA TOTAL AB,AGGLUT(CONF)-MAYO 20.45 4931077 14.3.3 ETA PROTEIN-MAYO 159.80 4931085 FECAL LEUKOCYTES-MAYO 45.76 4931093 UGT1A1 FULL GENE SEQUENCING-MAYO 1,000.00 4931101 MALDO-TOF ID-QUEST 221.40 4931119 PNEUMOCYSTIS JIROVECII,DFA-QUEST 42.00 4931127 ABL T3151 MUTATION IN CML-QUEST 500.00 4931135 PD--NEOGENOMICS 150.00 4931143 MUMPS IGM ANTIBODY-MAYO 161.50 4931150 HSV IGM AB BY EIA-MAYO 7.64 4931168 DNA ANALY SKELTAL DYSPLSIA-GEN CNTR 495.00 4931176 C3A LEVEL - MAYO 126.86 4931184 C4A LEVEL - MAYO 126.86 4931192 PANCREATIC AMYLASE, SERUM - MAYO 42.76 4931200 FETOMTNL BLD,FLW CYTO-MAYO 538.80 4931218 COMPLEMENT COMP C3,BODY FLUIDS-NI 23.68 4931226 COMPLEMENT COMP C4,BODY FLUIDS-NI 23.68 4931234 OPIATE MECONIUM CONF CHG1-MAYO 59.89 4931242 OPIATE MECONIUM CONF CHG2-MAYO 49.95 4931267 CRYPTOCOCCUS AG TITER,LFA,CSF-MAYO 19.36 4931275 QUETIAPINE(SEROQUEL),S-MAYO 76.16 4931309 MDM2 GENE AMP FISH-INTEGRATED 540.00 4931317 MICRODISSECTION GLOBAL-INTEGRATED 55.00 4931325 ESTROGEN RECEPT IMAGE ANALY-INTEGRA 97.00 4931333 PROGEST RECEPT IMAGE-IOALY-INTEGRAT 97.00 4931341 K167 IMAGE ANALYSIS-IOTEGRATED 97.00 4931358 HER2 IMAGE ANALYSIS-INTEGRATED 97.00 4931366 PI-LINKED AG 1ST MARKRS-MAYO 15.00 4931374 PLINKED AG ADDL MARKRS-MAYO 10.00 4931382 TESTOSTERONE,FREE-MAYO 9.44 4931390 TESTOSTERONE,FREE-MAYO 9.56 4931408 TESTOSTERONE,FREE---MAYO 10.34 4931416 TESTOSTERONE,BIOAVAILALE-MAYO 20.55 4931424 CYTOGENITICS DNA PROBE,IMRGF-MAYO 192.36 4931432 CYTO/MOLECULAR REPORT,IMRGF-MAYO 121.87 4931440 ,BLOOD-MAYO 41.42 4931457 APOLIPOPROTEIN E GENO-MAYO 318.24 4931473 F-ACTIN AB,IGG,SERUM-MAYO 51.59 4931481 CHIKUNGUNYA IGM AB,SERUM-MAYO 90.00 4931499 CHIKUNGUNYA IGG AB,SERUM-MAYO 90.00 4931507 ZIKA VIRUS MAC-ELISA,IGM SERUM-MAYO 90.00 4931515 CASHEW NUT,IGE-MAYO 4.50 4931523 MOG FACS,SERUM-MAYO 525.00 4931531 CHICKEN IGG-MAYO 49.80 4931549 LETTUCE IGG-MAYO 49.80 4931556 SHRIMP IGG-MAYO 49.80 4931564 TRANSFORMING GROWTH FACTOR BETA-MAY 195.00 4931572 UGT1A1 GENE POLYMORPHISM-QUEST 210.00 4931580 QUANTITAT THYROGLOBUL W/O AB-QUEST 15.86 4931598 PAIN MGMT,ALCOHOL METAB QUANT-QUEST 85.00 4931606 IGF BINDIN PROTEIN-3,QUEST 80.51 4931614 STONE ANALYSIS-QUEST 36.00 4931622 CLL PROGNOSTIC PANEL COMPRENS-QUEST 2,120.01 4931630 BK VIRUS DNA QUANT PCR-QUEST 234.40 4931648 TOTAL GLUTATHIONE-QUEST 61.00 4931655 COTTONWOOD(T13)IGE-QUEST 10.07 4931663 DOG DANDER(E5)IGE-QUEST 10.07 4931671 ACACIA(T19)IGE-QUEST 10.07 4931689 WHITE ASH(T15)IGE-QUEST 10.07 4931697 CAT DANDER(E1)IGE-QUEST 18.44 4931705 MITOCHONDRIAL ANTIBODY TITIER-QUEST 19.72 4931713 MITOCHONDRIAL ANTIBODY TITIER-QUEST 18.20 4931721 HEPATITIS B SURFACE AB,QUANT-QUEST 43.16 4931739 LYMPHOCYTE SUBSET PANEL 5-QUEST 44.96 4931747 SURESWAB BACTERIAL VAGINOSIS-QUEST 650.00 4931754 LP-PLA2 ACTIVITY-QUEST 50.00 4931762 TPMT ACTIVITY PROFILE,RBC-MAYO 135.00 4931770 DHR FLOW FMLP ENZYME ACT-MAYO 66.94 4931788 DHR FLOW FMLP FLOWCYTOM/MARKER-MAYO 205.16 4931796 T CELL RECEPTOR GENE-PRB REARRAN-MA 257.75 4931804 T CELL RECEPTOR GENE-TRG REARRANG-M 248.59 4931812 -MAYO 260.00 4931820 PARVO VIRUS B19,PCR-MAYO 119.87 4931832 TESTOSTERONE,TOTAL-MAYO 9.44 4931838 FLT3 MUTATION-INTEG 1,642.50 4931846 CEBPA MUTATION-INTEG 390.00 4931853 NPM1 MUTATION-INTEG 374.00 4931861 IGG SUBCLASS PANEL-QUEST 104.00 4931879 ALPHA-GLOBULIN MUTATION ANALY-QUEST 299.00 4931887 XSENSE,FRAGILE X SCREEN-QUEST 269.00 4931895 XSENSE,FRAGILE X REFLEX-QUEST 75.00 4931903 AUSTRAILAN PARROT DROPPINS IGE-QUES 10.00 4931911 HERPESVIRUS 8 IGG ANTIBODY-QUEST 45.60 4931929 HUMAN METAPNEU(HMPV)RNA-MAYO 335.00 4931978 MONOCLONAL GAMMPTHY MNTR CHG1-MAYO 3.62 4931986 MONOCLONAL GMMPTHY MNTR CHG2-MAYO 10.59 4931994 5-FLUCYSTONE,SERUM-MAYO 73.28 4932000 IODINE SERUM/PLASMA-QUEST 72.96 4932018 MPN,CALR GENE MUT,EXON9-MAYO 689.80 4932026 T4 FREE,DIRECT DIALYSIS-QUEST 21.80 4932034 ENCEPHALPTHY-AUTOIMMNE EVL CSF-MAYO 850.00 4932042 MPL EXON 10 MUT DETECT-MAYO 291.72 4932059 OXYCODONE-FREE(UNCONJUGATED)-MAYO 120.00 4932067 OXYCODONE W/METABOLIC CONF URN-MAYO 43.04 4932075 MPSEX CHG1-IMMUNOFIXATION,S-MAYO 50.97 4932083 MPSEX CHG2-TOTAL PROTEIN,S-MAYO 8.36 4932091 MPSEX CHG3-PROTN ELECTRPHRSS,S-MAYO 24.49 4932109 MPSEX CHG4-KAPPA/LAMBDA FREELT-MAYO 62.04 4932117 GHRELIN, TOTAL-QUEST 275.00 4932125 MUSCLE BIOPSY CHARGE 1 - LGB 625.00 4932133 MUSCLE BIOPSY CAHRGE 2 - LGB 625.00 4932141 MUSCLE BIOPSY CHARGE 3 - LGB 625.00 4932158 MUSCLE BIOPSY CHARGE 4 - LGB 625.00 4932166 CHROMOSOMAL MICROARRAY,POC-MAYO 1,300.00 4932174 CHROMOSOMES,HEMATOLOGIC,BLD,CHG1 159.11 4932182 CHROMOSOMES,HEMATOLOGIC,BLD,CHG2 37.17 4932190 NOTCHB DNA SEQ MOPATH PRCDR L7-MAYO 2,525.00 4932208 CRYPTOSPORIDIUM ANTIGEN,FECES-MAYO 49.95 4932216 CYCLOSPORA SPECIAL STAIN-MAYO 22.16 4932224 CYCLOSPORA STAIN CONCENTRATION-MAYO 24.69 4932232 HERPES SIMPLX VIRUS PCR, BLOOD-MAYO 59.84 4932240 FLU A&B W/SUBTYPE,RT-PCR CHG1-QUEST 379.95 4932257 FLU A&B W/SUBTYPE,RT-PCR CHG2-QUEST 379.95 4932265 SACCHAROMYCES CER AB,IGG-MAYO 74.63 4932273 COCCIDNS IMMTS ID, DNA PROBE-QUEST 75.00 4932281 DRUG ABUSE PNL 9,W/CONFIM SRM-QUEST 143.00 4932299 ANTIPHSPHLPD SYNDRM DX PNL C1-QUEST 80.86 4932307 ANTIPHSPHLPD SYNDRM DX PNL C2-QUEST 80.86 4932315 ANTIPHSPHLPD SYNDRM DX PNL C3-QUEST 80.86 4932323 ANTIPHSPHLPD SYNDRM DX PNL C4-QUEST 80.86 4932331 BIRD FANCIER PRECIPITIN PNL I-MAYO 132.50 4932349 DRD3 GENOTYPE-MAYO 600.00 4932356 PROLACTIN,PITUITARY MACROADNMA-MAYO 51.16 4932364 COCCIDIOIDES DNA PROBE-QUEST 167.18 4932372 MYOSITIS ANTBDY PNL CHG 84182-QUEST 519.22 4932380 MYOSITIS ANTBDY PNL CHG 86235-QUEST 432.69 4932398 ANTI-HMGCR ANTIBODY IGG-QUEST 190.00 4932406 ADAMS TS13 ANTIBODY-LABCORP 287.75 4932414 MYCOPLASMA HOMINIS PCR-MAYO 115.25 4932422 HBS ANTIBODY,S-MAYO 14.08 4932430 ASPERIGILLUS PRECIP,ID,S-MAYO 108.45 4932448 MEASLES(RUBEOLA)AB,IGM,S-MAYO 24.04 4932455 INHIBIN B,S-MAYO 61.30 4932463 C3 NEPHRITIC FACTOR(C3NEF)-QUEST 72.06 4932471 HLA-B51 DETERMINATION-QUEST 80.00 4932489 ASPERGILLUS FUMIGATUS(M3)IGE-QUEST 10.07 4932497 ACETYLCHOLIN RCPTR BINDING AB-QUEST 100.00 4932505 MOG ANTIBDY W REFLEX TO TITER-QUEST 528.00 4932513 NEUTROPHIL ANTIBODY,FLOW CYT-QUEST 142.04 4932521 FONDAPARINUX SODIUM(XA INHIB)-QUEST 152.00 4932539 MICROSPORIDIA EXAM-QUEST 60.30 4932547 STONE RISK DIAGNOSTIC PROFILE-QUEST 100.00 4932554 LIPASE,BODY FLUID-MAYO 10.13 4932562 COLLAGEN TYPE II ANTIBODIES-QUEST 78.60 4932570 BACTERIAL MENNINGITIS AG PNL-QUEST 98.50 4932588 SUSCEPTIBILITY,MIC,AEROBIC XI-QUEST 89.25 4932596 TPMT GENOTYPE-QUEST 420.00 4932604 PHOSPHOLIPASE A2 RECPT AB,SRM-QUEST 227.05 4932612 PHOSPHOLIPASE A2 RCPT AB(IFA)-QUEST 227.05 4932620 TPMT ACTIVITY-QUEST 285.03 4932638 MUSCLE BX-HISTO SPCL STN HSPST2-UCI 95.00 4932646 MUSCLE BX-HISTO SPCL STN HSPST3-UCI 206.34 4932653 STONE ANALYSIS PROCESSING CHRG-MAYO 10.00 4932661 LIVER FIBRSS TST ACTTST PNL-QUEST 288.75 4932679 OXALATE,SERUM-QUEST 107.00 4932687 MYOMARKER IMMUNOASSY NONANTBDY-MAYO 151.58 4932695 MYOMAKER ANTIGEN ANTIBODY-MAYO 183.42 4932703 HMG-COA ELISA,SERUM-MAYO 200.00 4932711 ASPERGILLUS FUMIGATUS,IGE-MAYO 4.50 4932729 BUPRENORPHINE SCREEN WREFLEX,U-MAYO 116.40 4932737 BUPRENORPHINE METABOLITES,U-MAYO 98.24 4932851 DSDNA AB BY CRITHIDIA IFA,IGG-MAYO 138.50 4932869 IODINE,SERUM - MAYO 45.74 4932877 NMDA RECPTR NR1-SUBUNT AUTOAB-QUEST 500.00 4932885 LIVER CYTOSOL(LC-1)AUTOAB - QUEST 138.00 4932893 H PYLORIA UREA BREATH TEST - QUEST 160.00 4932901 B PERTUSSIS TOXIN AB-IGG,IGA-QUEST 175.00 4932919 SURESWAB HSV 1-2 MRNA-QUEST 200.00 4932927 LYMPHOCYTE SUBSET PANEL 3- QUEST 134.88 4932935 HEPATITIS C VIRAN RNA,QUALTTV-QUEST 149.00 4932943 JC POLYOMA VRS DNA QL PCR CSF-QUEST 311.34 4932950 SNP MICROARRAY(REVL)PRODCNDP-LACORP 1,400.00 4932968 POMPE DISEASE, BS-MAYO 225.00 4932976 FENTANYL W/METAB CONF, U - MAYO 96.46 4932984 NK/NKT SUBST PNL NK CELL TCNT-MAYO 177.50 4932992 NK/NKT SUBSET MONONUC CELL AG-MAYO 377.90 4933008 NK/NKT SUBST PNL TCELL TCOUNT-MAYO 177.50 4933032 ANTIMICRO SUSECPT,AERO CUST MIC3-NI 201.26 4933040 FACTOR X ACTIVITY CHROMOGENIC-QUEST 145.00 4933057 ENTEROVIRUS CULTURE-QUEST 62.00 4933065 CORTISOL FREE URINE-MAYO 21.08 4933073 CORTISOL COL CHROMOTOGRPHY URN-MAYO 27.34 4933099 PARANEOPLASTIC PEMPHIGS,IGG AB-MAYO 330.90 4933107 IL-2 RECEPTOR(SOUBLE) BY MAFD-MAYO 130.00 4933115 TRICHOMONAS VAGINALIS AMP RNA-MAYO 61.30 4933123 RESPIRATORY PATHOLGN PNLS PCR-MAYO 500.00 4933131 METANEPHRINES,FRCTNTD,RNDM URN-MAYO 22.50 4933149 MLTPL MYELOMA MMRD BY FLW MRK1-MAYO 353.72 4933156 MLTPL MYELOMA MMRD BY FLW ADMK-MAYO 130.72 4933164 MLTPL MYELOMA MMRD BYFLW INTRP-MAYO 336.93 4933172 HER2 BREAST (MO) - INTEGRATED 794.00 4933180 MG/LES EVALUATION - MAYO 375.00 4933198 HCV ANTBDY W RFLX TO HCV PCR S-MAYO 28.31 4933206 MICROSPORIDIA PCR - MAYO 60.00 4933214 ETHYL GLUCURONIDE SCREEN,URINE-MAYO 116.40 4933222 CENTROMERE B ANTIBODY - QUEST 36.00 4933230 TRAMADOL AND METABOLIE,URINE-MAYO 40.00 4933248 ECHINOCOCCUS AB IGG,SERUM-MAYO 30.00 4933255 COCCIDIODES COMP FIX IMMUNODIF-MAYO 54.90 4933263 CHROMOSOMES,HEMA BMARROW,CULT-MAYO 141.86 4933271 CHROMOSOMES,HEMA BMARRW MOLRPT-MAYO 33.14 4933289 CHROMO HEMA BMRRW METAPHAS1-19-MAYO 175.00 4933297 CHROMO HEMA BMRRW METAPHS20-25-MAYO 175.00 4933313 CHROMO HEMA BMRRW AGNOR/CBLSTN-MAYO 11.60 4933321 TISSUE TRANSGLUTAMINASE IGG AB-MAYO 15.00 4933339 SARS-COV-2-RNA,QUALITTV RTPCR-QUEST 100.00 4933347 SARS-COV-2 BY RT-PCR-WESTPAC 70.00 4933354 SARS-COV-2 IGG ANTIBODY-MAYO 43.00 4933362 ANTISTREP-O TITER,S(ASO)-MAYO 19.50 4933370 SARS-COV-2 BY RT-PCR-PANGEA 80.00 4933388 SARS-COV2 BY RT-PCR-NEXTGEN 70.00 4933420 BRCA1/2 MUTA DD ANALYSIS-NEO 295.00 4933438 CEBPA MUTATION ANALYSIS-NEO 322.00 4933446 CALR MUTATION ANALYSIS-NEO 280.00 4933453 IGVH MUTATION ANALYSIS-NEO 417.00 4933461 JAK2 V617F MUTA ANALYSIS-NEO 250.00 4933479 KIT (C-KIT) MUTA ANALYSIS-NEO 274.00 4933487 MYD88 MUTATION ANALYSIS-NEO 290.00 4933495 NPM1 MUTATION ANALYSIS-NEO 270.00 4933503 T-CELL RECEPT BETA RRNGMNT-NEO 500.00 4933511 T-CELL RECEP GAMMA RRNGMNT-NEO 256.00 4933529 MPL MUTATION ANALYSIS-NEO 221.00 4933537 JAK2 EXON MUTA ANALYSIS-NEO 316.00 4933545 STAT3 MUTATION ANALYSIS-NEO 442.00 4933552 TP53 MUTATION ANALYSIS-NEO 810.00 4933560 NEOTYPE MDS/CML PROF-NEO 2,400.00 4933578 NEOTYPE MYELOID PROF-NEO 2,600.00 4933586 IDH1/IDH2 MUTA ANALYSIS-NEO 265.00 4933594 FLT3 MUTATION ANALYSIS-NEO 300.00 4933602 BCR-ABL1 STD P210,P190-NEO 388.00 4933610 B-CELL GENE RRNGMNT-NEO 492.00 4933628 MPN EXTENDED RFLX PNL-NEO 1,067.00 4933636 NEOTYPE CLL P PROFILE-NEO 420.00 4933644 STD LEUK/LYMPH FLO/CYT-NEO 168.00 4933651 CLL MRD FLOW CYTOMETRY-NEO 25.00 4933669 PNH FLOW CYTOMETRY-NEO 25.00 4933677 BCR/ABL1 FISH 88374-NEO 200.00 4933686 CCND1 IGH FISH 88374-NEO 200.00 4933693 PML RARA FISH 88374-NEO 200.00 4933701 AML FAVORABLE RISK 88374-NEO 200.00 4933719 CLL FISH PANEL 88374-NEO 200.00 4933727 EOSIOPHILIA FISH 88374-NEO 200.00 4933735 LG SML CELL LYMPH 88374-NEO 200.00 4933743 AML NONFVRABLE RISK 88374-NEO 400.00 4933750 MDS EXTENDED FISH PNL 88374-NEO 400.00 4933768 NEOTYPE CLL P PROFILE 88374-NEO 400.00 4933776 STD LEUK/LYMPH FLO/C 88185-NEO 35.00 4933784 CLL MRD FLOW CYTOMETRY 88185-NEO 28.00 4933792 PNH FLOW CYTOMETRY 88185-NEO 28.00 4933800 BCR/ABL1 FISH 88377-NEO 180.00 4933818 CCND1 IGH FISH 88377-NEO 180.00 4933826 PML RARA FISH 88377-NEO 180.00 4933834 AML FAVORABLE RISK 88377-NEO 180.00 4933842 CLL FISH PANEL 88377-NEO 180.00 4933859 EOSINOPHILA FISH 88377-NEO 180.00 4933867 LG SML CELL LYMPH 88377-NEO 180.00 4933875 AML NONFVRABLE RISK 88377-NEO 360.00 4933883 MDS EXTENDED FISH PNL 88377-NEO 360.00 4933891 CHLAMYDIA TRACHOMATS AMPLFD RNA-WPL 23.38 4933909 NEISSERIA GONRRHOEAE AMPLFD RNA-WPL 23.38 4933917 IBUPROFEN-QUEST 15.00 4933925 LIPOPROTEIN FRACTIONATN ULTRA-QUEST 113.00 4933933 CHLAMYDIA TRACHOMATIS RNA TMA-QUEST 60.00 4933941 NEISSERIA GONRRHOEAE RNA TIMA-QUEST 60.00 4933958 C TRACHOMATIS RNA ALT TARGET-QUEST 60.00 4933966 N GONNORRHOEAE RNA ALT TARGET-QUEST 60.00 4933990 (XCOPRI) PLASMA-LABCORP 135.00 4934006 H PYLORI C UREA BREATH TEST-MAYO 64.24 4934022 ALZHMR DISEASE EVALUATION,CSF-MAYO 1,200.00 4934030 ISONIAZID (INH)-MAYO 77.69 4934048 BETA-GLOBIN COMPLETE-QUEST 349.00 4934055 NMR LIPROPTEIN PROFILE,2-MAYO 55.80 4934063 INFLUENZA A ANTIBODY-QUEST 26.45 4934071 NMS1 - SRP IFA SCREEN-MAYO 170.37 4934089 NMS1-HMG-COA REDUCTASE ANTIBDY-MAYO 199.63 4934097 FENTANYL SCREEN,U-MAYO 135.70 4934105 HONEY BEE IGG AB-MAYO 57.50 4934113 HB VARIANT,A2 AND F QUANT-MAYO 154.63 4934121 HPLC HB VARIANT-MAYO 216.98 4934139 FERRITIN-MAYO 163.76 4934147 ENCEPHALOPATHY GAS65 AB-MAYO 88.67 4934154 ENCEPHALOPATHY EVAL IFA AB-MAYO 45.33 4934162 HMG-COA REDUCTASE ANTIBODY-MAYO 222.90 4934170 ANTI-CN-1A NT5C1A IBM-MAYO 165.00 4934188 HIV 12 AG/AB 4TH GENERATION-QUEST 60.00 4934196 HIV 12 AG/AB REFLEX-QUEST 82.29 4934204 PNH WITH FLAER (HI SENSTVTY)-QUEST 350.00 4934220 HEMOGLOBINOPATHY EVAL-QUEST 30.00 4934238 FISH CML/ALL BCR/ABL TRAS9,22-QUEST 299.00 4934246 SEX HORMONONE BINDNG GLOBULIN-QUEST 37.50 4934253 BILE ACIDS, PREGNANCY-QUEST 120.61 4934261 ADRENAL AB SCREEN - QUEST 27.14 4934279 ANA SCREEN IFA WITH REFLEX-QUEST 309.48 4934295 SMOOTH MUSCLE ANTIBODY TITER-MAYO 15.00 4996088 CRYPTOCOCCAL ANTIGEN-QUEST 27.84 4996963 MUSK ANTIBODY TEST-QUEST 1,065.00 4997425 NOROVIRUS,STOOL-QUEST 98.00 4997433 PYRUVATE KINASE-QUEST 127.65 4997607 DELTA AMINOLEVELINIC ACID URINE-QUE 80.54 4997615 W/CONFIRMATION-QUEST 124.00 4997623 OPIATES SCREEN W/CONFIRMATION-QUEST 65.23 5100862 TRANSCRANIAL MOTOR E/P UPPER 1,245.00 5100870 TRANSCRANIAL MOTOR E/P LOWER EX 1,245.00 5100938 VER VISUAL EVOKE RESPONSE 1,734.00 5101720 SER IN UPPER LIMBS 1,511.00 5101738 SER IN THE TRUNK OR HEAD 1,260.00 5101746 SER IN LOWER LIMBS 1,511.00 5105044 ABER AUDITORY LEVEL 350.00 5105051 EMG-1 807.00 5105069 EMG-2 999.00 5105085 EMG-3 841.00 5105093 EMG-4 1,049.00 5105184 EMG CRANIAL NERVE MUSC UNILAT RT 1,430.00 5105192 EMG CRANIAL NERVE MUSCLES BILAT 1,430.00 5105200 EMG CRANIAL NERVE MUSC UNILAT LT 1,430.00 5105234 EMG NON EXT W/NERVE CONDUCTION 331.00 5105242 SER IN UPPER AND LOWER LIMBS 1,511.00 5105259 EMG LIMITED W/NERVE CONDUCTION 628.00 5105267 EMG COMPLETE W/NERVE CONDUCTION 628.00 5105275 TRANSCRANIAL MOTOR UPPER & LOWER 628.00 5105283 NERVE CONDUCTION STUDIES 9-10 465.00 5105291 NERVE CONDUCTION STUDIES 11-12 465.00 5105309 NERVE CONDUCTION STUDIES 5-6 1,364.00 5105317 NERVE CONDUCTION STUDIES 7-8 1,364.00 5105325 NERVE CONDUCTION STUDY 1-2 257.00 5105333 NERVE CONDUCTION STUDIES 3-4 257.00 5105335 NEUROMUSCULAR TESTING 600.00 5105341 INTRA OP NEURO MONITOR EA 15 MIN 268.00 5300272 UP EXTREM ARTERIAL DUPLEX COMP 2,389.00 5300280 LOWER EXT VENOUS DUPLEX COMP 2,389.00 5300447 UP EXTREM ARTERIAL DUPLEX LTD 1,413.00 5300702 UPPER EXT ARTERIAL DOPPLER,LMTD 1,052.00 5300710 LOWER EXT ARTERIAL DOPPLER,LMTD 1,052.00 5300728 LWR EXT ART DOPPLER W/TREADMILL 1,061.00 5300736 UPPER EXT VENOUS DOPPLER RIGHT 1,413.00 5300744 UPPER EXT VENOUS DOPPLER LEFT 1,413.00 5301080 LOWER EXT VENOUS DOPPLER RIGHT 1,413.00 5301098 LOWER EXT VENOUS DOPPLER LEFT 1,413.00 5301130 INTRAOP T E E 3,782.00 5301148 STRESS ECHOCARDIOGRAM 5,676.00 5301163 STAT PARTIAL ECHOCARDIOGRAM 1,812.00 5301569 UP EXTREM VENOUS DUPLEX COMP 2,389.00 5301577 UPPER EXTREM ARTERIAL DOPPLER COMP 1,167.00 5301635 HOLTER MONITOR HOOKUP & RECORDING 1,171.00 5304969 EKG/ECG TELEMETRY 308.00 5306774 HOLTER MONITOR RECORDING 1,171.00 5306790 LOWER EXT ART DOPPLER 1,589.00 5306808 ECHOCARDIOGRAPHY F/U 768.00 5306816 EP EVAL PACING-DEFIB POST IMPLANT 7,089.00 5306824 DOPPLER ECHOCARDIOGRAM F/U 931.00 5306832 ECHOCARDIOGRAM CONGEN ABN COMPL 1,769.00 5306840 ECHOCARDIOGRAM CONGENITAL ABN F/U 931.00 5306857 DUPLEX SCAN ACCESS 1,624.00 5308085 TRANSCRANIAL ULTRASOUND 1,291.00 5309646 ECG - OUTPATIENT 595.00 5309653 VENIPUNCTURE FEE-OUTPATIENT 90.00 5309679 SECTOR ECHOCARD W/ CONTRAST 1,769.00 5309687 ECHOCARDIOGRAM W/EX TEST W/CONTRAST 1,769.00 5310230 ECHOCARDIOGRAM/EX TEST 1,769.00 5310248 ECHOCARDIOGRAPHY TRANSESO 2,477.00 5310255 EVENT MONITORING 1,061.00 5310263 EVENT RECORDING-HOOK UP 706.00 5310305 HOLTER MONITOR SCANNING & REPORT 3,304.00 5310321 LOW EXTREM ARTERIAL DUPLEX COMP 2,389.00 5310339 LOWER EXT ART LIMIT DUPL 1,413.00 5310347 NUC ISOTOPE STRESS TEST 2,035.00 5310396 PENILE PETHYSMOGRAPHY 736.00 5310404 PHARM STRESS TEST 2,035.00 5310412 SECTOR ECHOCARDIOGRAM 5,307.00 5310420 STRESS TEST TRACING ONLY 2,035.00 5310438 NUC ISOTOPE PHARMACOLOGICAL 2,035.00 5310446 STRESS TEST W/ECHO 2,035.00 5310453 STRESS TEST 2,035.00 5310487 ARTERIAL DOPPLER EXAM 1,167.00 5310586 BARLOW LOWER EXT VENOUS DOPPLER 2,389.00 5310628 CAROTID ULTRASOUND(DUPLX) 2,477.00 5310636 DOPPLER COLOR FLOW MAPPING 1,769.00 5310644 DOPPLER COLOR FLOW 1,769.00 5310651 DOPPLER ECHOCARDIOGRAPHY 1,769.00 5310677 ECG RHYTHM STRIP 397.00 5310693 ECG ROUTINE 595.00 5310719 ECG STAT 595.00 5310743 UPPER EXTREM VENOUS DUPLEX UNI 1,413.00 5310750 LOWER EXTREM VENOUS DUPLEX UNI 1,413.00 5310768 STAT CAROTID DUPLEX 2,470.00 5310792 STAT LE ARTERIAL DUPLEX - BILAT 2,272.00 5310800 STAT LE ARTERIAL DUPLEX - UNI 1,359.00 5370069 ECG PEDIATRIC 15 LEAD 595.00 5390141 AICD OR BIIV INTERROGATION 270.00 5390166 AICD PROGRAMMING DUAL LEAD 270.00 5390182 PM REMOTE DATA INTEROGATION 255.00 5390190 UPPER EXTREMITY DOPPLER WITH 2,389.00 5390208 HOLTER MONITOR HOOK UP & RECORD(52) 1,171.00 5390216 DUPLEX SCAN EXT VEINS LIMITED 1,413.00 5390224 LOWER VENOUS UNILATERAL 1,413.00 5390232 UPPER VENOUS UNILATERAL 1,413.00 5390240 U/S GUIDED CATH INSERTION 1,394.00 5390257 ART/VEIN MAPPING DIALYSIS ACCESS 1,069.00 5390265 DUPLEX CAROTID LIMITED 1,279.00 5390273 PSEUDO ANEURSYM INJECTION 653.00 5390281 LINQ 2019 IMPLANTABLE DEVICE 217.00 5390299 IN-PERSON INTERO PHYSIO MONITOR 217.00 5390315 UPPER EXTREMITY ARTERIAL DUPLEX LT 1,413.00 5390323 UPPER EXTREMITY ARTERIAL DUPLEX RT 1,413.00 5390356 LOWER EXTREMITY ARTERIAL DUPLEX LT 1,413.00 5390364 LOWER EXTREMITY ARTERIAL DULEX RT 1,413.00 5390398 ART/VEIN MAPPING DIALYSIS-UNILATERA 514.00 5390414 LINQ2020-IMPLANTABLE DEVICE 271.00 5390422 DEFIBRILLATOR/AICD SINGLE LEAD 213.00 5390430 INTRVNT ECHO TRANSESOPHGL GUIDANCE 5,000.00 5500848 EEG CONT REC SETUP,ED, TAKEDOWN 1,480.00 5500855 EEG W/O VID REV DATA 2-12HR UNATTND 1,480.00 5500863 EEG W/O VID REV DATA 2-12HR INTRMIT 1,480.00 5500871 EEG W/O VID REV DATA 12-26HR UNMNTR 2,840.00 5500889 EEG W/O VID REV DATA 12-26HR INTRMT 2,840.00 5500897 EEG W VID REV DATA 2-12HR INTRMT 1,480.00 5500905 EEG W VID REV DATA 12-26HR INTRMT 2,840.00 5501259 EEG RECORDING IN COMA OR SLEEP 1,488.00 5501275 EEG EXTENDED MONITORING 41-60MIN 1,988.00 5501283 EEG EXTENDED MONITOR GREAT 1HR 1,988.00 5502018 EEG AWAKE/SLEEP 1,988.00 5502026 EEG CEREBRAL SILENCE 1,869.00 5502034 EEG ROUTINE 1,798.00 5502042 EEG STAT 1,798.00 5502059 EEG NON-INTRACRANIAL SURG MONITOR 3,262.00 5502109 DIGITAL ANALYSIS OF EEG 678.00 5700042 CR-INIT EVAL OP>36 475.00 5700133 CR-O/P MONITOR EX CONTINOUS>36 475.00 5700158 CR-MONITOR CV EXERCISE THERA 475.00 5700562 REVISE POCKET, PACEMAKER 4,194.00 5701008 CR HISTORY & PHYSICAL 511.00 5701016 CR-GROUP EXERCISE 12 SESSIONS 199.00 5701024 CR-GROUP EXERCISE 26 SESSIONS 403.00 5701032 CR-GROUP EXERCISE 52 SESSIONS 791.00 5701040 CR-I/P MONITOR EX 1/DAY 345.00 5701057 CR-INIT EVAL OP 475.00 5701065 CR-INITIAL EVAL I/P 385.00 5701099 CR-O/P MONITOR EX CONTINOUS 475.00 5701115 SUPERVISED EXERCISE THERAPY PAD 255.00 5701172 PUL FUNCTION SCRN 1,107.00 5900006 PT AQUATIC THERAPY 225.00 5900220 PT ULTRASOUND 107.00 5900246 PT TRACTION - MECHANICAL 107.00 5900329 PT ELECT-STIM UNATTENDED 107.00 5900345 PT ELECT-STIM ATTENDED 225.00 5900444 PT THERAPEUTIC EXERCISE 225.00 5900477 PT GAIT TRAINING 225.00 5900857 BURN DEBRIDEMENT 225.00 5901137 PT PED DEV TESTING EXTENDED 449.00 5901145 PT PED DEV TESTING LIMITED 449.00 5901327 PT WHIRLPOOL 107.00 5901392 PT ADL TRAINING 225.00 5901632 PT IONTOPHORESIS 225.00 5901657 PT MANUAL THERAPY 225.00 5901673 PT OP DRESSING CHANGE ONLY 511.00 5901681 M/CAL PT EVALUATION-INITIAL 225.00 5901699 M/CAL PT EVALUATION ADD'L 112.00 5901707 M/CAL PT TREATMENT ADD'L 225.00 5901715 M/CAL PT TREATMENT INITIAL 449.00 5901780 PT DEBRIDEMENT NON-SELECTIVE 30 MIN 449.00 5901798 PT DEBRIDEMENT SELECT>=20CM-120MIN 449.00 5901806 PT DEBRIDEMENT SELECT>OR=20CM-90MIN 449.00 5901814 PT DEBRIDEMENT SELECT <=20CM-60 MIN 449.00 5901822 PT DEBRIDEMENT SELECT20CM 30 MIN 449.00 5901996 PT DEBRIDEMENT SELECT >20CM 45 MIN 449.00 5902002 PT DEBRIDEMENT SEL>OR=20CM-60MIN 449.00 5902010 PT GROUP EXERCISE 15 MIN EA 225.00 5902135 BARLOW PT WOUND DEBRIDEMENT>20CM 225.00 5902143 PT EVALUATION-120 MIN 449.00 5902150 PT THERAPEUTIC ACTIVITIES-15MIN 225.00 5902168 BARLOW PT THERAPEUTIC ACTIVITY-EA15 225.00 5902242 PT PED DEV TESTING INITAL 1ST HR 449.00 5902259 PT PED DEV TEST EACH ADDTL 30 MIN 225.00 5902267 GA-PT PED DEV TEST EACH ADD 30 MIN 225.00 5902275 GY-PT PED DEV TEST EACH ADD 30 MIN 225.00 5902283 KX-PT PED DEV TEST EACH ADD 30 MIN 225.00 5902291 PT TRACTION-MECHANICAL-CQ 107.00 5902309 PT ELECT-STIM UNATTENDED-CQ 107.00 5902317 PT VASOPNEUMATIC DEVICE-CQ 107.00 5902325 PT ELECT-STIM ATTENDED-CQ 225.00 5902333 PT IONTOPHORESIS-CQ 225.00 5902341 PT ULTRASOUND-CQ 107.00 5902358 PT THERAPEUTIC EXERCISE-CQ 225.00 5902366 PT GAIT TRAINING-CQ 225.00 5902374 PT MANUAL THERAPY -CQ 225.00 5902382 PT THERAPEUTIC ACTIVITIES 15 MIN-CQ 225.00 5902390 PT ADL TRAINING -CQ 225.00 5902408 PT CANALITH REPOSITIONING-CQ 449.00 5905013 PT RE-EVALUATION 225.00 5905021 BARLOW PT EVALUATION - 45 MIN 449.00 5905039 BARLOW PT EVALUATION - 60 MIN 449.00 5905047 BARLOW PT EVALUATION - 75 MIN 449.00 5905054 BARLOW PT EVALUATION - 90 MIN 449.00 5905062 BARLOW PT GAIT TRAINING-EA 15 MIN 225.00 5905070 BARLOW PT THER EX-EA 15 MIN 225.00 5905088 BARLOW PT ADL TRAINING-EA 15 MIN 225.00 5905096 BARLOW PT PRP/GROUP EXERCISE-15 MIN 225.00 5905146 BARLOW PT RE-EVAL 449.00 5905153 BARLOW PT EVAL 120 MIN 449.00 5905161 BARLOW PT WOUND DEBRIDE >20CM 60MIN 449.00 5905179 BARLOW PT WOUND DEBRIDE >20CM 45MIN 449.00 5905187 BARLOW PT WOUND DEBRIDE <20CM 60MIN 449.00 5905195 BARLOW PT WOUND DEBRIDE <20CM 30MIN 449.00 5905203 BARLOW PT WOUND DEBRIDE <20CM 45MIN 449.00 5907001 GY-PT AQUATIC THERAPY 225.00 5907019 GY-PT ULTRASOUND 107.00 5907027 GY-PT TRACTION - MECHANICAL 107.00 5907035 GY-PT ELCT-STIM UNATTENDED 107.00 5907043 GY-PT ELECT-STIM ATTENDED 225.00 5907050 GY-PT THERAPEUTIC EXERCISE 225.00 5907068 GY-PT GAIT TRAINING 225.00 5907076 GY-PT BURN DEBRIDEMENT 225.00 5907084 GY-PT WHIRLPOOL 107.00 5907092 GY-PT ADL TRAINING 225.00 5907100 GY-PT IONTOPHORESIS 225.00 5907118 GY-PT MANUAL THERAPY 225.00 5907126 GY-PT OP DRESSING CHANGE ONLY 511.00 5907134 GY-PT DEBRIDEMENT NON-SELECTIVE 30M 449.00 5907142 GY-PT DEBRIDEMENT NON-SELECTIVE 45M 449.00 5907159 GY-PT DEBRIDEMENT NON-SELECTIVE 60M 449.00 5907167 GY-PT DEBRIDEMENT NON-SELECTIVE 90M 449.00 5907175 GY-PT DEBRIDEMENT SELECT>=20CM-120M 449.00 5907183 GY-PT DEBRIDEMENT SELECT>OR=20CM90M 449.00 5907191 GY-PT DEBRIDEMENT SELECT<=20CM-60M 449.00 5907209 GY-PT DEBRIDEMENT SELECT<=20CM45MIN 449.00 5907217 GY-PT DEBRIDEMENT SELECT<=20CM30MIN 449.00 5907225 GY-PT THERAPEUTIC ACTIVITIES-15MIN 225.00 5907233 GY-PT DEBRIDEMENT SELECT>=20CM60MIN 449.00 5907241 GY-PT CANALITH REPOSITIONING 449.00 5907258 GY-PT VASOPNEUMATIC DEVICE 107.00 5907266 GY-PT PED DEV TESTING EXTENDED 449.00 5907274 GY-PT PED DEV TESTING LIMITED 449.00 5907282 GY-PT EVALUATION 75 MIN 449.00 5907290 GY-PT EVALUATION 90 MIN 449.00 5907308 GY-PT EVALUATION 45 MIN 449.00 5907316 GY-PT EVALUATION 60 MIN 449.00 5907324 GY-PT EVALUATION 120 MIN 449.00 5907332 GY-PT RE-EVALUATION 225.00 5908009 KX-PT AQUATIC THERAPY 225.00 5908017 KX-PT ULTRASOUND 107.00 5908025 KX-PT TRACTION MECHANICAL 107.00 5908033 KX-PT ELECT-STIM UNATTENDED 107.00 5908041 KX-PT ELECT-STIM ATTENDED 225.00 5908058 KX-PT THERAPEUTIC EXERCISE 225.00 5908066 KX-PT GAIT TRAINING 225.00 5908074 KX-BURN DEBRIDEMENT 225.00 5908082 KX-PT WHIRLPOOL 107.00 5908090 KX-PT ADL TRAINING 225.00 5908108 KX-PT IONTOPHORESIS 225.00 5908116 KX-PT MANUAL THERAPY 225.00 5908124 KX-PT OP DRESSING CHANGE ONLY 511.00 5908132 KX-PT DEBRIDEMENT NON-SLCTV 30 MIN 449.00 5908140 KX-PT DEBRIDEMENT NON-SLCTV 45 MIN 449.00 5908157 KX-PT DEBRIDEMENT NON-SLCTV 60 MIN 449.00 5908165 KX-PT DEBRIDEMENT NON-SELECTIVE 90M 449.00 5908173 KX-PT DBRDMNT SELECT>=20CM-120MIN 449.00 5908181 KX-PT DEBRIDEMENT >=20CM 90MIN 449.00 5908199 KX-PT DEBRIDEMENT <=20CM 60 MIN 449.00 5908207 KX-PT DEBRIDEMENT SELECT <=20CM 45M 449.00 5908215 KX-PT DEBRIDEMENT SELECT<=20CM 30M 449.00 5908223 KX-PT THERAPEUTIC ACTIVITIES-15MIN 225.00 5908231 KX-PT DEBRIDEMENT SELECT >=20CM 60M 449.00 5908249 KX-PT CANALITH REPOSITIONING 449.00 5908256 KX-PT PED DEV TESTING EXTENDED 449.00 5908264 KX-PT PED DEV TESTING LIMITED 449.00 5908272 KX-PT EVALUATION 75 MIN 449.00 5908280 KX-PT EVALUATION 90 MIN 449.00 5908298 KX-PT EVALUATION 45 MIN 449.00 5908306 KX-PT EVALUATION 60 MIN 449.00 5908314 KX-PT EVALUATION 120 MIN 449.00 5908322 KX-PT RE-EVALUATION 225.00 5908330 KX-PT ADL TRAINING-CQ 225.00 5908348 KX-PT CANALITH REPOSITIONING-CQ 449.00 5908355 KX-PT ELECT-STIM ATTENDED-CQ 225.00 5908366 KX-PT ELECT-STIM UNATTENDED-CQ 107.00 5908371 KX-PT GAIT TRAINING-CQ 225.00 5908389 KX-PT IONTOPHORESIS-CQ 225.00 5908397 KX-PT MANUAL THERAPY-CQ 225.00 5908405 KX-PT THERAPEUTIC ACTIVITIES 15M-CQ 225.00 5908413 KX-PT THERAPEUTIC EXERCISE-CQ 225.00 5908421 KX-PT TRACTION MECHANICAL-CQ 107.00 5908439 KX-PT ULTRASOUND-CQ 225.00 5909007 GA-PT AQUATIC THERAPY 225.00 5909015 GA-PT ULTRASOUND 107.00 5909023 GA-PT TRACTION - MECHANICAL 107.00 5909031 GA-PT ELECT-STIM UNATTENDED 107.00 5909049 GA-PT ELECT-STIM ATTENDED 225.00 5909056 GA-PT THERAPEUTIC EXERCISE 225.00 5909064 GA-PT GAIT TRAINING 225.00 5909072 GA-PT BURN DEBRIDEMENT 225.00 5909080 GA-PT WHIRLPOOL 107.00 5909098 GA-PT ADL TRAINING 225.00 5909106 GA-PT IONTOPHORESIS 225.00 5909114 GA-PT MANUAL THERAPY 225.00 5909122 GA-PT OP DRESSING CHANGE ONLY 511.00 5909130 GA-PT DEBRIDEMENT NON-SELECTIVE 30M 449.00 5909148 GA-PT DEBRIDEMENT NON-SELECT 45 MIN 449.00 5909155 GA-PT DEBRIDEMENT NON-SELECTIVE 60M 449.00 5909163 GA-PT DEBRIDEMENT NON-SELECT 90MIN 449.00 5909171 GA-PT DEBRIDEMENT SELECT>=20CM-120M 449.00 5909189 GA-PT DEBRIDEMENT SELECT>=20CM 90M 449.00 5909197 GA-PT DEBRIDEMENT SELECT<=20CM 60M 449.00 5909205 GA-PT DEBRIDEMENT SELECT<=20CM 45M 449.00 5909213 GA-PT DEBRIDEMENT SELECT<=20CM-30M 449.00 5909221 GA-PT THERAPEUTIC ACTIVITIES-15M 225.00 5909239 GA-PT DEBRIDEMENT SELECT>=20CM 60M 449.00 5909247 GA-PT CANALITH REPOSITIONING 449.00 5909254 GA-PT PED DEV TESTING EXTENDED 449.00 5909262 GA-PT PED DEV TESTING LIMITED 449.00 5909270 GA-PT EVALUATION 75 MIN 449.00 5909288 GA-PT EVALUATION 90 MIN 449.00 5909296 GA-PT EVALUATION 45 MIN 449.00 5909304 GA-PT EVALUATION 60 MIN 449.00 5909312 GA-PT EVALUATION 120 MIN 449.00 5909320 GA-PT RE-EVALUATION 225.00 5909338 GA-PT ADL TRAINING - CQ 225.00 5909346 GA-PT CANALITH REPOSITIONING-CQ 449.00 5909353 GA-PT ELECT-STIM ATTENDED-CQ 225.00 5909361 GA-PT ELECT-STIM UNATTENDED-CQ 107.00 5909379 GA-PT GAIT TRAINING - CQ 225.00 5909387 GA-PT OINTOPHORESIS - CQ 225.00 5909395 GA-PT MANUAL THERAPY - CQ 225.00 5909403 GA-PT THERAPEUTIC ACTIVITIES 15M-CQ 225.00 5909411 GA-PT THERAPEUTIC EXERCISE-CQ 225.00 5909429 GA-PT TRACTION-MECHANICAL-CQ 107.00 5909437 GA-PT ULTRASOUND-CQ 107.00 5993068 CK-PT GOAL MOBILITY: WLK&MOVE ARND 0.01 5996004 CN-PT EVAL MOBILITY:WLK&MVE AROUND 0.01 5996186 PT EVAL LOW COMPLEXITY 409.00 5996194 PT EVAL OBS LOW COMPLEXITY 409.00 5996202 KX PT EVAL LOW COMPLEXITY 409.00 5996210 PT EVAL MOD COMPLEXITY 449.00 5996228 PT EVAL OBS MOD COMPLEXITY 449.00 5996236 KX PT EVAL MOD COMPLEXITY 449.00 5996244 PT EVAL HIGH COMPLEXITY 489.00 5996251 PT EVAL OBS HIGH COMPLEXITY 489.00 5996269 KX PT EVAL HIGH COMPLEXITY 489.00 5996277 PT REEVAL 225.00 5996285 PT REEVAL OBS 225.00 5996293 KX PT REEVAL 225.00 5996384 NICU PT EVAL LOW COMPLEXITY 409.00 5996400 NICU PT EVAL MED COMPLEXITY 449.00 5996426 NICU PT EVAL HIGH COMPLEXITY 489.00 5996442 NICU PT REEVAL 225.00 6000012 FACILITY FEE-LEVEL 1 511.00 6001549 FACILITY FEE-LEVEL 5 1,034.00 6001556 FACILITY FEE-LEVEL 3 897.00 6001788 FACILITY FEE-LEVEL 1 -25 511.00 6001796 FACILITY FEE-LEVEL 3 -25 897.00 6001804 FACILITY FEE-LEVEL 5 -25 1,034.00 6012652 FACILITY FEE-LEVEL 2 719.00 6012660 FACILITY FEE-LEVEL 2 -25 719.00 6012678 FACILITY FEE-LEVEL 4 999.00 6012686 FACILITY FEE-LEVEL 4 -25 999.00 6100051 OT THERAPEUTIC EXERCISE-15 MINUTE 225.00 6100168 OT SPLINT CHECKOUT 15 MIN 225.00 6100804 OT PED DEV TESTING EXTENDED 449.00 6100812 OT PED DEV TESTING LIMITED 449.00 6100820 FLUIDOTHERAPY 107.00 6100846 OT PED DEV TESTING EACH ADD 30 MIN 225.00 6100853 OT PED DEV TESTING EACH ADD 30 MIN 225.00 6101190 OT THERAPEUTIC ACTIVITIES-15MIN 225.00 6101216 OT SPLINT FITTING/TRAINING-15 MIN 225.00 6101224 OT ADL/SELF MGMT TRAINING 15 MIN 225.00 6101364 OT EVALUATION 60 MIN 449.00 6101372 M/CAL OT EVALUATION-INITIAL 30 MIN 225.00 6101380 OT EVALUATION 45 MIN 449.00 6101398 OT EVALUATION 75 MIN 449.00 6101414 M/CAL OT TREATMENT INITIAL 30 MIN 449.00 6101422 M/CAL OT TREATMENT ADD'L 15MIN 225.00 6101430 M/CAL OT EVALUATION ADD 15 MIN 112.00 6101505 OT EVALUATION-120 MIN 449.00 6101521 OT VASOPNEUMATIC DEVICE 107.00 6101539 OT PARAFFIN BATH 107.00 6101547 OT COGNITIVE TRAINING INTL 15 MIN 129.00 6101554 OT COGNITIVE TRAINING EA ADD 15 MIN 125.00 6101810 OT ELECTRICAL STIM UNATTENDED 107.00 6101828 OT ELECTRICAL STIM ATTENDED 225.00 6101836 OT ULTRASOUND 15 MIN 107.00 6101851 OT IONTOPHORESIS 15 MIN 225.00 6101919 OT MANUAL THERAPY-15 MIN 225.00 6101927 PEDIATRIC DEVELOPMENTAL TESTING 449.00 6101943 OT CONTRAST BATH 107.00 6101968 OT RE-EVALUATION 30 MIN 225.00 6101976 OT PED DEV TESTING 1ST HR 449.00 6101984 OT IONTOPHORESIS 15MIN - CO 225.00 6101992 OT MANUAL THERAPY-15MIN-CO 225.00 6102008 OT PARAFFIN BATH - CO 107.00 6102016 OT SPLINT CHECKOUT 15MIN - CO 225.00 6102024 OT SPLINT FITTING/TRAINING 15MIN-CO 225.00 6102032 OT THERAPEUTIC ACTIVITIES-15M-CO 225.00 6102040 OT THERAPEUTIC EXERCISE 15M-CO 225.00 6102057 OT ULTRASOUND 15 MIN-CO 107.00 6102065 OT VASOPNEUMATIC DEVICE - CO 107.00 6102073 OT ELECTRICAL STIM ATTENDED-CO 225.00 6102081 OT ELECTRICAL STIM UNATTENDED-CO 107.00 6102099 OT CONTRAST BATH - CO 107.00 6102107 OT FLUIDOTHERAPY - CO 107.00 6102115 OT ADL/SLF MGMT TRAINING 15MIN - CO 225.00 6102123 OT COGNITIVE TRAINING INTL 15MIN-CO 129.00 6102131 OT COGNITIVE TRN EA ADD 15 MIN-CO 125.00 6105001 KX-OT THERAPEUTIC EXERCISE 15 MIN 225.00 6105019 KX-OT SPLINT CHECKOUT 15MIN 225.00 6105027 KX-FLUIDOTHERAPY 107.00 6105035 KX-OT THERAPEUTIC ACTIVITIES 15MIN 225.00 6105043 KX-OT SPLINT FITTING/TRAINING 15MIN 225.00 6105050 KX-OT ADL/SELF MGMT TRAINING 15 MIN 225.00 6105076 KX-OT VASOPNEUMATIC DEVICE 107.00 6105084 KX-OT PARAFFIN BATH 107.00 6105092 KX-OT ELECTRICAL STIM UNATTENDED 107.00 6105100 KX-OT ELECTRICAL STIM ATTENDED 225.00 6105118 KX-OT ULTRASOUND 15 MIN 107.00 6105126 KX-OT IONTOPHORESIS 15 MIN 225.00 6105134 KX-OT MANUAL THERAPY 15 MIN 225.00 6105142 KX-OT CONTRAST BATH 107.00 6105159 KX-OT EVALUATION 45 MIN 449.00 6105167 KX-OT EVALUATION 60 MIN 449.00 6105175 KX-OT EVALUATION 75 MIN 449.00 6105183 KX-OT EVALUATION 120 MIN 449.00 6105191 KX-OT PED DEV TESTING 449.00 6105209 KX-OT PED DEV TESTING EXTENDED 449.00 6105217 KX-OT PED DEV TESTING LIMITED 449.00 6105225 KX-OT RE-EVALUATION 30 MINS 449.00 6105233 KX-OT PED DEV TESTING 1ST HR 449.00 6105241 KX-OT PED DEV TESTING EA ADD 30 MIN 225.00 6105258 KX-OT FLUIDOTHERAPY-CO 107.00 6105266 KX-OT ADL/SELF MGMT TRAINING 15M-CO 225.00 6105282 KX-OT CONTRAST BATH-CO 107.00 6105290 KX-OT ELECTRICAL STIM ATTENDED-CO 225.00 6105308 KX-OT ELECTRICAL STIM UNATTNDED-CO 107.00 6105316 KX-OT IONTOPHORESIS 15 MIN-CO 225.00 6105324 KX-OT MANUAL THERAPY 15 MIN-CO 225.00 6105332 KX-OT PARAFFIN BATH-CO 107.00 6105340 KX-OT SPLINT CHECKOUT 15 MIN-CO 225.00 6105357 KX-OT SPLINT FIT/TRAINING 15M-CO 225.00 6105365 KX-OT THERAPEUTIC ACTIVITIES 15M-CO 225.00 6105373 KX-OT THERAPEUTIC EXERCISE 15MIN-CO 225.00 6105381 KX-OT ULTRASOUND 15 MIN-CO 107.00 6105399 KX-OT VASOPNEUMATIC DEVICE-CO 107.00 6106009 GY-OT THERAPEUTIC EXERCISE-15 MIN 225.00 6106017 GY-OT SPLINT CHECKOUT 15 MIN 225.00 6106025 GY-OT FLUIDOTHERAPY 107.00 6106033 GY-OT THERAPEUTIC ACTVITIES 15 MIN 225.00 6106041 GY-OT SPLINT FITTING/TRAINING 15MIN 225.00 6106058 GY-OT ADL/SELF MGMT TRAINING 15 MIN 225.00 6106074 GY-OT VASOPNEUMATIC DEVICE 107.00 6106082 GY-OT PARAFFIN BATH 107.00 6106090 GY-OT ELECTRICAL STIM UNATTENDED 107.00 6106108 GY-OT ELECTRICAL STIM ATTENDED 225.00 6106116 GY-OT ULTRASOUND 15 MIN 107.00 6106124 GY-OT IONTOPHORESIS 15 MIN 225.00 6106132 GY-OT MANUAL THERAPY 15 MIN 225.00 6106140 GY-OT CONTRAST BATH 107.00 6106157 GY-OT EVALUATION 45 MIN 449.00 6106165 GY-OT EVALUATION 60 MIN 449.00 6106173 GY-OT EVALUATION 75 MIN 449.00 6106181 GY-OT EVALUATION 120 MIN 449.00 6106199 GY-OT PED DEV TESTING 449.00 6106207 GY-OT PED DEV TESTING EXTENDED 449.00 6106215 GY-OT PED DEV TESTING LIMITED 449.00 6106223 GY-OT RE-EVALUATION 30 MIN 449.00 6106231 GY-OT PED DEV TESTING 1ST HR 449.00 6106249 GY-OT PED DEV TESTING EA ADD 30 MIN 225.00 6107007 GA-OT THERAPEUTIC EXERCISE 15 MIN 225.00 6107015 GA-OT SPLINT CHECKOUT 15 MIN 225.00 6107023 GA-OT FLUIDOTHERAPY 107.00 6107031 GA-OT THERAPEUTIC ACTIVITY-15 MIN 225.00 6107049 GA-OT SPLINT FITTING/TRAINING 15MIN 225.00 6107056 GA-OT ADL/SELF MGMT TRAINING 15 M 225.00 6107072 GA-OT VASOPNEUMATIC DEVICE 107.00 6107080 GA-OT PARAFFIN BATH 107.00 6107098 GA-OT ELECTRICAL STIM UNATTENDED 107.00 6107106 GA-OT ELECTRICAL STIM ATTENDED 225.00 6107114 GA-OT ULTRASOUND 15 MIN 107.00 6107122 GA-OT IONTOPHORESIS 15 MIN 225.00 6107130 GA-OT MANUAL THERAPY 15 MIN 225.00 6107148 GA-OT CONTRAST BATH 107.00 6107155 GA-OT EVALUATION 45 MIN 449.00 6107163 GA-OT EVALUATION 60 MIN 449.00 6107171 GA-OT EVALUATION 75 MIN 449.00 6107189 GA-OT EVALUATION 120 MIN 449.00 6107197 GA-OT PED DEV TESTING 449.00 6107205 GA-OT PED DEV TESTING EXTENDED 449.00 6107213 GA-OT PED DEV TESTING LIMITED 449.00 6107221 GA-OT RE-EVALUATION 449.00 6107239 GA-OT PED DEV TESTING 1ST HR 449.00 6107247 GA-OT PED DEV TESTING EA ADD 30 MIN 225.00 6107254 GA-OT ADL/SELF MGMT TRAINING 15M-CO 225.00 6107270 GA-OT CONTRAST BATH - CO 107.00 6107288 GA-OT ELECTRICAL STIM ATTENDED-CO 225.00 6107296 GA-OT ELECTRICAL STIM UNATTENDED-CO 107.00 6107304 GA-OT FLUIDTHERAPY-CO 107.00 6107312 GA-OT IONTOPHORESIS 15 MIN-CO 225.00 6107320 GA-OT MANUAL THERAPY 15MIN-CO 225.00 6107338 GA-OT PARAFFIN BATH - CO 107.00 6107346 GA-OT SPLINT CHECKOUT 15MIN-CO 225.00 6107353 GA-OT SPLINT FITTING/TRN 15M-CO 225.00 6107361 GA-OT THEREAPEUTIC ACTIVITY 15M-CO 225.00 6107379 GA-OT THERAPEUTIC EXERCISE 15M-CO 225.00 6107387 GA-OT ULTRASOUND 15 MIN-CO 107.00 6107395 GA-OT VASOPNEUMATIC DEVICE-CO 107.00 6196182 OT EVAL LOW COMPLEXITY 409.00 6196190 OT EVAL OBS LOW COMPLEXITY 409.00 6196208 KX OT EVAL LOW COMPLEXITY 409.00 6196216 OT EVAL MOD COMPLEXITY 449.00 6196224 OT EVAL OBS MOD COMPLEXITY 449.00 6196232 KX OT EVAL MOD COMPLEXITY 449.00 6196240 OT EVAL HIGH COMPLEXITY 489.00 6196257 OT EVAL OBS HIGH COMPLEXITY 489.00 6196265 KX OT EVAL HIGH COMPLEXITY 489.00 6196273 OT REEVAL 225.00 6196281 OT REEVAL OBS 225.00 6196299 KX OT REEVAL 225.00 6300016 ED DEPT LEVEL 1 99281 321.00 6300024 ED DEPT LEVEL 2 99282 966.00 6300032 ED DEPT LEVEL 4 99284 2,513.00 6300073 ED DEPT LEVEL 5 99285 4,236.00 6300156 ED DEPT LEVEL 1 99281 321.00 6300172 SUTURE GENERAL/EA 61.00 6300198 ED DEPT LEVEL 3 99283 1,511.00 6300347 EMERGNCY DEPT MEDICAL TRIAGE A 321.00 6301097 CLSD TX ANKLE DISLOC W/ANESTH 1,927.00 6301105 CLSD TX TRIMALLEOLAR FX W/OMANIP 2,268.00 6301154 FX SCAPULA CLSD W/O RED-23570 1,134.00 6301162 LEVEL 1 PROCEDURE-ER 615.00 6301170 LEVEL 2 PROCEDURE-ER 1,233.00 6301188 LEVEL 3 PROCEDURE-ER 3,075.00 6301196 LEVEL 4 PROCEDURE-ER 7,379.00 6301204 ED MINOR W/PROCEDURE-TEST-25 321.00 6301212 ED REGULAR W/PROCEDURE TEST-25 966.00 6301220 ED INTERMEDIATE W/PROCEDURE-25 1,511.00 6301238 ED ADVANCED CARE W/PROCEDURE 4,236.00 6301246 ED MAJOR W/PROCEDURE-TEST-25 2,513.00 6301253 ED CRITICAL CARE W/PROCEDURE-25 7,064.00 6301261 OPEN TX IP JOINT DISLOCATION 2,157.00 6301287 FX ORBIT CLOSED W/O RED 21400 1,890.00 6301295 CLOSED FEMUR FX 27508 3,061.00 6301311 CLSD PHALANX FX W/ MANIPULTION 824.00 6301329 AMPUTATION OF FINGER/THUMB 3,970.00 6301337 CLSD FX TIBIA W/ANESTH&MANIP 5,395.00 6301345 INTERMED REPAIR SCALP 12.5-20CM 1,589.00 6301352 CAUTERY NASAL HEMORRHAGE 1 NARES 677.00 6301360 CLSD TX PROX FIBULA W/O MANIP 1,798.00 6301386 ED DEPT LEVEL 4 99284 2,513.00 6301394 ED DEPT LEVEL 5 >12 HRS 99285 7,048.00 6301402 PHH-D ED BLOOD ADMIN (PER DAY) 1,201.00 6301410 PHH-D ED CARDIOVRSN, ELECTRIC EXT 2,557.00 6301428 PHH-D ED RYTHM ECG,TRACING 397.00 6301436 PHH-D STOCKINET BIAS X 4 114.00 6301444 PHH-D STOCKINET BIAS X 5 114.00 6301451 PHH-D STOCKINETTE TUBE 47.00 6301469 PHH-D STOCKINET BIAS X2 52.00 6301477 PHH-D STOCKINETTE TUB X 2 47.00 6301485 PHH-D STOCKINETTE TUB X3 70.00 6301493 PHH-D STOCKINETTE TUB X 4 70.00 6301501 PHH-D STOCKINET BIAS X 3 52.00 6301519 ER VISIT LEVEL III SAME DAY-9928327 1,972.00 6301527 ER VISIT LEVEL IV SAME DAY-9928427 2,513.00 6301543 UA DIPSTICK OR TABLET REAGENT 99.00 6301550 ED DEBRIDEMENT <=20CM 449.00 6302004 PHALANX FX W/MANIP 1,248.00 6302012 PHALANX FX CLS TX 794.00 6302020 CLSD TX ACROMIOCLAV DISLOC 1,134.00 6302038 CLSD TX KNEE DIS W/ANESTH 2,268.00 6302053 ED MAJOR W/PROC >12 HRS 2,513.00 6302061 ED ADVANCED W/PROC >12 HRS 7,048.00 6302079 ED CRITICAL CARE-25 >12 HRS 11,431.00 6302517 URINALYSIS W/O MICROSCOPY 30.00 6302558 BURN MEDIUM WHOLE FACE/EXTREMITY 482.00 6308852 ED DEPT CRITIC CARE 99291 2,444.00 6308860 CRITICAL CARE ADD'L 30 MIN ER 1,221.00 6308878 INTUBATION ENDOTRACH ER 1,349.00 6308886 BURNS LARGE W/O ANESTHESIA ER 1,134.00 6308910 IP JOINT DISLOC W/MANIP W/ANESTH 1,222.00 6309140 ED DEPT CRITIC CARE 99291 7,064.00 6309157 PHALANX FX PHALANGES W/O RED 718.00 6309173 TROCHANTER FX 1,701.00 6309181 CLSD TX MED MALLELOUS FX WO MANI 1,589.00 6309199 CLSD HUMERAL CONDYLAR FX W/O MANI 1,871.00 6309223 ED LAC REPAIR 2.6-7.5CM-12002 1,233.00 6309231 ED IMMUNIZATION ADMIN-90471 569.00 6309256 ED PLACE NEEDLE IN VEIN 615.00 6309264 ED LAC REPAIR FACE-<2.5 12011 1,233.00 6309272 ED LAC REPAIR <2.5-12001 1,233.00 6309280 ED APPLY ST F/ARM SPLINT 29125 594.00 6309298 ED CASTING/STRAPPING UNLIS29799 496.00 6309306 ED APPLY DYN F/ARM SPLINT-29126 496.00 6309314 ED APPLY SHORT LEG SPLINT 29515 1,190.00 6309322 ED LAC REP-LYR-FACE 2.6-5 12052 1,233.00 6309330 ED LAC REPAIR FACE 2.6-5 12013 1,233.00 6309348 ED LAC REP-LYR-<2.5-FACE-12051 1,233.00 6309355 ED APPLY FINGER SPLINT-DYN29131 491.00 6309363 ED APPLY LONG ARM SPLINT 29105 594.00 6309371 ED REMOVE NAIL PLATE-11730 1,233.00 6309397 ED NOSEBLEED CONTROL-30901 615.00 6309405 ED SPINAL TAP-62270 1,233.00 6309413 ED BURN TX NO ANEST SMALL-16020 1,190.00 6309421 ED DRAIN ABCESS SPL-10060 1,233.00 6309439 ED DRAIN ABCESS-COMP-MULTI-10061 1,233.00 6309447 ED APPLY FINGER SPLINT-STA29130 594.00 6309454 ED INSERT CATHETER-51702 594.00 6309470 EXTENSOR TENDON REPAIR 3,394.00 6309504 FX DISTAL PHALANX CLSD W/O MANIP 664.00 6309512 INCISION & REMOVAL FB COMPLICATED 1,363.00 6309520 THUMB SPICA SPLINT 594.00 6309538 ARTHROCENTESIS 339.00 6309561 FX GREAT TOE CLSD W/MANIPULATION 1,363.00 6309587 INTERMEDIATE REPAIR FACE 5.1-7.5 1,589.00 6309595 I&D ABSCESS MULTIPLE/COMPLICATED 1,248.00 6309603 CLSD TX IP JOINT DISLOCATION 339.00 6309611 INTERMEDIATE REPAIR NECK,HANDS,FEET 1,927.00 6309645 SIMPLE REPAIR FACE 7.6-12.5CM 1,589.00 6309660 INTERMED REPAIR FACE 20.1-30CM 3,855.00 6309678 INTERMED REPAIR FACE 12.6-20CM 3,742.00 6309686 INTERMED REPAIR FACE 5.1 -7.5CM 1,589.00 6309694 SIMPLE REPAIR FACE 20.1-30CM 3,855.00 6309702 SIMPLE REPAIR FACE 12.6-20CM 2,495.00 6309710 SIMPLE REPAIR FACE 7.6-12.5CM 1,589.00 6309728 COMPLEX REPAIR SCALP/ARM 1.1-2.5CM 1,701.00 6309736 COMPLEX RPR EYELID/NOSE 2.6-7.5CM 4,764.00 6309744 COMPLEX REPAIR EYELID/NOSE 1.1-25CM 2,268.00 6309769 INTERMED RPR NECK/HAND 7.6-12.5CM 1,473.00 6309777 INTERMED REPAIR NECK/HAND 20.1-30CM 2,609.00 6309801 INTERMED RPR SCALP/TRUNK 20.1-30CM 2,042.00 6309819 INTERMED RPR SCALP/TRNK <2.5CM 679.00 6309827 SIMPLE REPAIR 12.6-20CM 1,134.00 6309835 SIMPLE REPAIR 20.1-30CM 1,589.00 6309876 IP JOINT DISLOC W/MANIP WO ANES 679.00 6309975 DEBRIDEMENT FOREIGN W/OPEN FX 1,363.00 6309983 EXCISION OF NAIL PARTIAL/COMPL 1,589.00 6309991 ED IV INFUSN 16-60M 96365 1,510.00 6310007 ED IV INFUSION EA ADDL HR 137.00 6310015 ED IV INF SEQUENTIAL 16-60M 96367 137.00 6310023 ED INFUSION CONCURRENT 96368 137.00 6310031 ED IV INF HYDRATION ADD HR 96361 200.00 6310049 ED INJECTION IV PUSH 96374 980.00 6310056 ED INJ ADDL PUSH NEW DRUG 96375 735.00 6310064 ED IV INF HYDRATION 31-60M 96360 1,167.00 6310072 ED INJECTION NOT IV PUSH 96372 531.00 6310080 ED INSERT BLADDER CATHETER-51701 357.00 6310098 ED IV INFUSN 16-60M 9636559 1,510.00 6310106 ED IV INFUS EA ADDL 59 137.00 6310114 ED IV INF SEQ 16-60M 96367-59 137.00 6310122 ED INFUSION CONCURRENT 96368-59 137.00 6310148 ED IV INF HYDRATION 31-60 96360-59 1,167.00 6310155 ED IV INF HYDRATION ADD HR 96361-59 200.00 6310163 ED INJ NOT IV PUSH 96372-59 531.00 6310171 ED INJECTION IV PUSH 96374-59 980.00 6310189 ED INJ ADDL PUSH NEW DRUG 96375-59 735.00 6310197 ED IMMUN ADMIN EA ADDL VAC-90472 243.00 6310205 ED CARDIOPUL RESUSICITATION-92950 1,522.00 6310213 BURN MEDIUM WHOLE FACE/EXTREMIT 482.00 6310221 ED VENIPUNCTURE 90.00 6310239 ED CRITICAL CARE 1ST HOUR-25 7,064.00 6310247 ED CRITICAL CARE EA ADD'L 30 MIN 211.00 6310254 ED INSERT PICC CAT 6,032.00 6310262 ED LAC REP-INT < 2.5 - 12041 706.00 6310270 ED LAC REP - 2.6-7.5 - 12042 706.00 6310296 ED APPLY LONG LEG SPLINT -29505 682.00 6310304 ED LAC REP - INT <2.5 - 12031 694.00 6310312 ED LAC REP-INT 2.6-7.5 12032 706.00 6310320 ED ET INSERTION 31500 1,275.00 6310338 ED CENTRAL LINE INSERTION 36556 3,465.00 6310346 ED ADMINISTRATN PNEUMOCCAL VACCINE 569.00 6310353 ED ADMIN INFLUENZA VIRUS VACCCINE 569.00 6310361 ED ADMINISTRATION HEPATITIS B VACCN 569.00 6310379 ED ADMIN HI DS INFLUENZA VIRUS VACC 569.00 6310387 BAMLANIVIMAB INFUSION & MONITORING 1,548.00 6310395 CASIRIVIMAB & IMDEVIMAB INFS & MNTR 1,548.00 6330450 FOREIGN BODY REMOVAL SKIN 1,335.00 6330468 INTERMEDIATE RPR FACE 2.6-5CM-12052 1,231.00 6330492 DEBRIDEMENT-11000 ER 336.00 6330500 NAIL PLATE AVULSION-11730 ER 445.00 6330518 EVAC SUBUNGUAL HEMATOMA-11740 ER 336.00 6330526 LAC SIMP RPR TO 2.5CM-12001 ER 445.00 6330534 LAC SIMP RPR 2.5-7.5CM-12002 ER 567.00 6330542 LAC SIMP RPR 7.5 TO 12.5CM-12004 ER 907.00 6330559 LAC SIMP RPR TO 2.5CM FACE-12011 ER 679.00 6330567 LAC INTERMED 2.5-7.5CM-12032 ER 892.00 6330575 LAC INTERMED RPR 7.5-12.5CM-12034ER 1,231.00 6330583 LAC INTERMED RPR TO 2.5CM-12041 ER 794.00 6330591 INTERMED 2.5-7.5CM NE/HA/FE-12042ER 1,118.00 6330609 LAC COMPLX REPAIR 1-2.5CM-13131 ER 1,779.00 6330617 LAC COMPLX RPR 2.5-7.5CM-13132 ER 4,337.00 6330633 ARTHROCENTESISS-SML JNTS-20600 ER 336.00 6330682 FOREIGN BODY REMV SIMP EYE-65205 ER 229.00 6330690 FOREIGN BDY-CONJUNCT EMBED-65210 ER 338.00 6330708 FOREIGN BDY-CORNL W/S LAMP-65222 ER 445.00 6330716 FB CORNEAL W/RUST RING REM-65435 ER 3,508.30 6330724 FOREIGN BODY EAR-69200 ER 679.00 6330757 EKG INTERPRETATION-93010 ER 179.00 6330765 NON-PRESSURIZED INHALETION-94640 ER 823.15 6330807 SPECIAL REPORTS-99080 ER 285.00 6330815 ED DEPT LEVEL 1 99281 321.00 6330872 LAC SIMP RPR 5.1-7.5CM FAC-12014 ER 1,231.00 6330898 FOREIGN BODY REMOVAL-10120 ER 1,335.00 6330906 COMPLEX REPAIR >7.5CM-13353 ER 7,123.00 6330922 INTERMED RPR FACE 2.6-5CM-12052 ER 1,231.00 6330948 I&D INFECTED ABSCESS-10060 ER 336.00 6330955 PUNC/ASPIR ABSCSS,HEMAT,CYS-10160ER 336.00 6330963 COMPLEX REPAIR 2.5-7.5CM LAC 2,896.00 6330971 DISLOC SHOULD W/RED W/O ANES-ER 2,440.00 6330997 METATARSAL FRACTURE-ED 1,134.00 6331003 ULNAR FX W/O MANIPULATION 24670 1,134.00 6331011 RADIAL HEAD FX W/O REDUC 24650 1,363.00 6331029 FX CLAVICLE CLOSED W/O RED 23500 1,134.00 6331060 FX NASAL BONE W/P RED 21310 1,134.00 6331078 ELBOW DISLOC W/REDUC&ANES 24605 1,927.00 6331086 TIBIA FX CLOSED 2,609.00 6331102 RIB FX 21800 854.00 6331110 FX CARPAL SCAPHOID CLSD W/O RED 2,268.00 6331128 HUMERAL NECK FX 1,589.00 6331136 ACETABULAR FX 3,372.00 6331144 FX DISTAL RADIUS CLSD W/O RED 2,268.00 6331151 VERTEBRAL CMPSN FX W/O MANIP 3,641.00 6331169 OBSERVATION DISCHARGE-99217 576.00 6331185 OBS INITIAL MOD SEVERITY-99219 2,157.00 6331193 OBS INITIAL HIGH SEVERITY-99220 1,331.00 6331201 META CARPAL FX W/O RED 26600 1,248.00 6331227 CLOSED TX HIP DISLOC W/ANESTH 3,629.00 6331235 DISLOC ANKLE W/O ANESTH 27840 1,134.00 6331243 CLSD TX HUMERAL SHAFT FX W/OMANP 1,473.00 6331250 INTERMED REPAIR FACE 7.6-12.5CM 2,456.00 6331268 FX CALCANEUS CLSD W/O RED 28400 1,134.00 6331276 REPAIR OF NAILBED 11760 1,701.00 6331300 INTERMED REPAIR FACE UP TO 2.5CM 892.00 6331318 CMPLX REP EYELIDS/NOSE/LIP2.6-7.5 4,764.00 6331326 COCCYX FX 907.00 6331334 CLSD TX BIMALLEOLAR FX W/O MANIPUL 1,701.00 6331342 PATELLA FX CLSD W/O MANIP 27520 1,701.00 6331367 SIMPLE REPAIR LAC 30.0+CM 12007 2,007.00 6331474 CLSD TX HUMERAL FX W/MANIP 3,742.00 6331623 HEPATITIS B VACCINE-WC 393.00 6331631 DIPTHERIA/TETANUS VACCINE-WC 132.00 6332514 WRIST SPLINT 502.00 6390785 INTERMED REPAIR NECK/HAND >30CM 2,834.00 6390793 INTERMED REPAIR SCALP/TRUNK >30CM 2,495.00 6390801 CLSDELBOWDISLOCATION W/REDUCTION 445.00 6390819 ED SUB INF TXPROP IN 16-90M96369-59 1,018.00 6390827 ED SUB INF TXPROP EA ADD HR-9637059 225.00 6390843 ED SUB INF TXPPROP ADD PUMP 9637159 455.00 6390850 ED TX PROPH/DX INJ EA ADDL 96376-59 162.00 6390900 ED SUBC INFSN TX/PROP INTL 16-60M 1,018.00 6390918 ED SUBC INFSN TX/PROP EA ADDL HR 225.00 6390926 ED SUBC INFSN TX/PROP ADDL PUMP 455.00 6390934 DISLOC SHOULDER W/O ANES ER - 23605 2,218.00 6390942 ED TX PROPH OR DX INJ EA ADD SEQ 162.00 6500508 INITIAL INFANT IP HEARING SCREEN 350.00 6500516 INFANT HEARING OP RESCREENING 350.00 6500524 INITIAL INFANT OP HEARING SCREENING 350.00 6500532 THER ACT EA 15 MIN 1:1 NICU OT 297.00 6500540 OT EVALUATION NICU 1,316.00 6505028 NICU OT EVAL LOW COMPLEXITY 409.00 6505044 NICU OT EVAL MED COMPLEXITY 449.00 6505069 NICU OT EVAL HIGH COMPLEXITY 489.00 6505085 NICU OT REEVAL 225.00 6601470 LD ULTRASOUND 1,160.00 6601561 BIOPHYSICAL PROFILE W/NS TEST 1,912.00 6601579 ULTRASOUND, LIMITED OB 1,160.00 6601611 OB OBS IV PUSH ADDL SAME DRUG 162.00 6601637 OB OBS THERAPEUTIC INF INITIAL 1,510.00 6601645 OB OBS THERAPEUTIC INF ADDL HR >31M 137.00 6601702 L&D VERSION 2,082.00 6601710 L&D MAJOR SURG 1 HR 13,188.00 6601728 L&D MAJOR SURG 1/4 HR 3,297.00 6601744 LD DELIVERY OF PLACENTA ONLY 1,283.00 6601751 LD LACTATION EDUCATION PER HR 27.00 6601769 BLOOD TRANSFUSION-MATERNAL 3,050.00 6800866 JOINT INJECT SM 20600 1,036.00 6905046 CARDIOVERSION ELECTIVE 92960 2,557.00 6905079 TRANSFUSION 3,050.00 6905095 TRANSFUSION OUTPATIENT 3,050.00 6907001 OBSERVATION PER HOUR-ED 300.00 6907002 OBSERVATION PER HOUR-1T 300.00 6907003 OBSERVATION PER HOUR-2T 300.00 6907004 OBSERVATION PER HOUR-3T 300.00 6907005 OBSERVATION PER HOUR-4T 300.00 6907006 OBSERVATION PER HOUR-3P 300.00 6907007 OBSERVATION PER HOUR-4P 300.00 6907008 OBSERVATION PER HOUR-ED(25) 300.00 6907009 OBSERVATION PER HOUR-1T(25) 300.00 6907010 OBSERVATION PER HOUR-2T(25) 300.00 6907011 OBSERVATION PER HOUR-3T(25) 300.00 6907012 OBSERVATION PER HOUR-4T(25) 300.00 6907013 OBSERVATION PER HOUR-3P(25) 300.00 6907014 OBSERVATION PER HOUR-4P(25) 300.00 6907015 ED BED OCCUPANCY 1,291.00 6907016 OBSERVATION PER HOUR-2S 300.00 6907017 OBSERVATION PER HOUR-2S(25) 300.00 7000235 solution with 1 252.80 7000243 peritoneal dialysis solution with 1 316.00 7000250 peritoneal dialysis solution with 1 1,386.00 7000268 peritoneal dialysis solution with 2 252.80 7000276 peritoneal dialysis solution with 2 252.80 7000284 peritoneal dialysis solution with 2 1,386.00 7000292 peritoneal dialysis solution with 4 252.80 7000300 peritoneal dialysis solution with 4 330.00 7000318 Dialysate - BiBag Bicarbonate Powde 245.35 7000326 Dialysate - Calcium Chloride 0.5 mE 8.60 7000334 Dialysate - CENTRISOL Bicarbonate 89.10 7000342 Dialysate - Naturalyte - 1.0 K 0 Ca 176.90 7000359 Dialysate - Naturalyte - 1.0 K 2.5 176.90 7000367 Dialysate - Naturalyte - 2.0 K 2.5 176.90 7000375 Dialysate - Naturalyte - 3.0 K 2.5 176.90 7000383 Dialysate - Potassium Chloride 0.5 7.50 7100027 WHC WOUND BIOPSY ADDITIONAL LESION 445.00 7100035 WHC WOUND BIOPSY SINGLE LESION 781.00 7100076 WHC TCP02 MULTI 1,167.00 7100084 WHC TCP02 SINGLE 1,052.00 7100191 WHC FOLLOW-UP VISIT LEVEL 5 99215 1,034.00 7100209 WHC FOLLOW-UP VISIT LEVEL 4 99214 999.00 7100217 WHC FOLLOW-UP VISIT LEVEL 3 99213 897.00 7100225 WHC FOLLOW-UP VISIT LEVEL 2 99212 719.00 7100233 WHC FOLLOW-UP VISIT LEVEL 1 99211 511.00 7100258 WHC NEW PATIENT VISIT 99204 847.00 7100274 WHC NAIL DEBRIDEMENT 1-5 337.00 7100282 WHC NAIL DEBRIDEMENT 6+ DIFF SITE 534.00 7100399 WHC FOLLOW-UP VISIT 99211-25 511.00 7100407 WHC NEW PATIENT VISIT 99202 575.00 7100415 WHC NEW PATIENT VISIT 99203 728.00 7100423 WHC NEW PATIENT VISIT 99205 1,426.00 7100563 WHC NEW PATIENT VISIT 99202-25 575.00 7100571 WHC NEW PATIENT VISIT 99203-25 728.00 7100589 NEW PATIENT VISIT 99204-25 847.00 7100597 WHC NEW PATIENT VISIT 99205-25 1,426.00 7100605 FOLLOW-UP VISIT 99212-25 719.00 7100613 WHC FOLLOW-UP VISIT 99213-25 897.00 7100621 WHC FOLLOW-UP VISIT 99214-25 999.00 7100639 WHC FOLLOW-UP VISIT 99215-25 1,034.00 7100662 WHC I&D ABSCESS SIMP/SGL 1,082.00 7100688 WHC TOTAL CONTACT CAST APPLICATION 892.00 7100704 WHC EXCISION OF ULCER & CLOSURE 6,288.00 7100811 WHC APP WOUND VAC <50CM 553.00 7100829 WHC APP WOUND VAC >50CM 692.00 7100944 WHC AVULSION OF NAIL PLATE 1,082.00 7100993 WHC SIM REPAIR SUPER WD 2.6CM-7.5CM 730.00 7101009 WHC PUNCTURE ABSCESS, BULLA,HEMATOM 503.00 7101017 WHC ACTIVE WOUND CARE <20CM 812.00 7101025 WHC ACTIVE WOUND CARE EA ADD>20 812.00 7101033 WHC UNNABOOT APPLICATION - RT 370.00 7101041 WHC UNNABOOT APPLICATION - LT 370.00 7101066 WHC APP MULTILAYER WRAP RT 370.00 7101074 WHC APP MULTILAYER WRAP BIL 605.00 7101082 WHC APP MULTILAYER WRAP LT 370.00 7101090 WHC INCISION AND REMOVAL FOREIGN 1,338.00 7101108 WHC DEBRIDEMENT SUBQ<20 SQ CM 1,580.00 7101116 WHC DEBRIDEMENT SUBQ EA ADD >20 CM 1,580.00 7101124 WHC DEBRIDEMENT MUSCLE <20CM 1,824.00 7101132 WHC DEBRDMT-MUSCLE EA ADD 20SQ CM 1,824.00 7101140 WHC DEBRIDE BONE <20 CM 2,432.00 7101157 WHC DEBRIDEMENT BONE EA ADD 20CM 2,432.00 7101181 WHC NON-SELECTIVE DEBRIDEMENT 487.00 7101199 WHC UNNABOOT APPLICATION - BIL 605.00 7101207 WHC APP LOW COST SKIN SUB FT 1ST 25 2,351.00 7101215 WHC APP LW COST SKIN SUB FT EA 25 2,351.00 7101223 WHC APP LOW COST SKIN SUB EXT1ST 25 2,351.00 7101231 WHC APP LOW COST SKIN SUB ADD 25 2,351.00 7101256 WHC SURG PREP TRUNK ARMS LEGS 2,351.00 7101260 WHC SURG PREP SCALP,HANDS,FEET 2,351.00 7101264 WHC SURG PREP EA ADD 100SQ CM T,A,L 2,351.00 7102023 WHC APP SKIN SUB ANK/LEG 1ST 25SQCM 4,676.00 7102031 WHC APP SKIN SUB ANK/LEG EA AD 25SQ 630.00 7102049 WHC APP SKIN SUB LEGS 1ST 100 SQ CM 7,708.00 7102056 WHC APP SKIN SUB LEGS EA ADD 100 SQ 1,692.00 7102064 WHC APP SKIN SUB FEET 1ST 25 SQ CM 4,676.00 7102072 WHC APP SKIN SUB FEET EA ADD 25 SQ 630.00 7102080 WHC APP SKIN SUB FEET 1ST 100 SQ CM 4,676.00 7102098 WHC APP SKIN SUB FEET EA ADD 100 SQ 1,692.00 7102106 I&D COMPLEX POSTOP WD INFECTION 9,358.00 7102114 I&D FOREIGN BODY SUBQ TISSUE SIMPLE 1,335.00 7102122 WHC I & D HEMATOMA/SEROMA 6,570.00 7102130 WHC PARING CALLUS SINGLE 435.00 7102148 WHC PARING CALLUS 2-4 LESIONS 435.00 7102155 WHC PARING CALLUS >4 LESIONS 651.00 7102189 WHC NEGATIVE PRES DISP 1ST 50 SQ CM 1,332.00 7102197 WHC NEGATIVE PRES DISP > 50 SQ CM 533.00 7102205 APPL SKIN SUB TRUNK FIRST 25SQ 8,325.00 7102213 APPL SKIN SUB TRUNK EA ADDL 25SQ 2,080.00 7102221 APPL SKIN SUB TRUNK FIRST 100SQ 14,600.00 7102239 APPL SKIN SUB TRUNK EA ADDL 100SQ 3,650.00 7102247 APPL SKIN SUB HEAD FIRST 25SQ 8,325.00 7102254 APPL SKIN SUB HEAD EA ADDL 25SQ 2,080.00 7102262 APPL SKIN SUB HEAD FIRST 100SQ 8,325.00 7102270 APPL SKIN SUB HEAD EA ADDL 100SQ 2,080.00 7102288 WHC PURAPLY PER SQ CM FIRST 128 600.00 7102296 WHC PURAPLY/SQ CM WASTED 600.00 7102304 WHC APLIGRAF PER SQ CM 217.00 7102312 WHC APLIGRAF WASTED 217.00 7102320 WHC BANDAGE ACE 2" 15.00 7102338 WHC BANDAGE ACE 4" 16.00 7102346 WHC BANDAGE ACE 6" 22.00 7102353 WHC BANDAGE COBAN 2 LAYER 150.00 7102361 WHC BANDAGE KERLIX RL STER 75.00 7102379 WHC BANDAGE KLING 3" 15.00 7102387 WHC BANDAGE KLING 4" 16.00 7102395 WHC BANDAGE KLING 6" 20.00 7102403 WHC BANDAGE PACK SYS PROFORE 437.00 7102411 WHC BANDAGE SURE PRESS COMPR 295.00 7102437 WHC DERMAGRAFT PER SQ CM 282.00 7102445 WHC DERMAGRAFT WASTED 282.00 7102452 WHC DRESS 1 X 8 XEROFOAM 55.00 7102460 WHC DRESS 5 X 9 XEROGOAM 94.00 7102478 WHC DRESS ACTICOAT ABDSO 465.00 7102486 WHC DRESS ACTICOTE 4X4 SILVER 282.00 7102494 WHC DRESS ACTICOTE 7 BURN 4X4 341.00 7102502 WHC DRESS ACTISORB 2X4 98.00 7102510 WHC DRESS ADAPTIC 3X3 29.00 7102528 WHC DRESS ADAPTIC 3X8 104.00 7102536 WHC DRESS ALGISITE M 229.00 7102544 WHC DRESS ALLDRESS ABS FILM 4X4 295.00 7102551 WHC DRESS ALLDRESS ABS FILM 6X6 304.00 7102569 WHC DRESS ALLEVYN 6X6 60.00 7102577 WHC DRESS ALLEVYN ADH 3X3 81.00 7102585 WHC DRESS ALLEVYN ADH 5X5 165.00 7102593 WHC DRESS AQUACEL 2X2 87.00 7102601 WHC DRESS AQUACEL 4X4 152.00 7102619 WHC DRESS BIATAIN 4X4 170.00 7102627 WHC DRESS COVERSITE 4X4 15.00 7102643 WHC DRESS CURADERM 4X4 117.00 7102668 WHC DRESS CUTIMED SORBACT 4X6 84.00 7102676 WHC DRESS FIBRACOL PLUS 4X4 235.00 7102684 WHC DRESS FOAM CONTRE/BIAT AG 4X4 199.00 7102692 WHC DRESS MEPILEX 4X4 FOAM 74.00 7102700 WHC DRESS MEPILEX LITE 62.00 7102718 WHC DRESS POLYMAX 114.00 7102726 WHC DRESS POLYMEM 4X12 449.00 7102734 WHC DRESS POLYMEM PAD 4X4 182.00 7102742 WHC DRESS POLYU HYDRO ALLEVYN 4 156.00 7102759 WHC DRESS PRISMA 476.00 7102767 WHC DRESS PROMOGRAM 4.34 SQ 170.00 7102775 WHC DRESS SURGIPAD 5X9 22.00 7102783 WHC DRESS TEGADERM 10X12 71.00 7102791 WHC DRESS TEGADERM SM 33.00 7102809 WHC DRESS TELFA 2 X 3 EACH 22.00 7102817 WHC DRESS TELFA 3 X 8 EACH 22.00 7102825 WHC DRESS TRIACT CONTACT LAYER 30.00 7102841 WHC DRESS WOUND VEIL 4X4 29.00 7102858 WHC DUODERM 4X4EA OP 37.00 7102866 WHC DUODERM 6X6BX OP 330.00 7102874 WHC EPIFIX GRAFT/SQ CM 1,495.00 7102882 WHC EPIFIX GRAFT/SQ CM WASTED 1,495.00 7102890 WHC GAUZE 2X2 OP EA 20.00 7102908 WHC GAUZE VASELINE 1 X 8 37.00 7102916 WHC GAUZE VASELINE 3 X 18 61.00 7102924 WHC GELOCAST 3 61.00 7102932 WHC GRAFIX PRIME/SQ CM 625.00 7102965 WHC MEDIHONEY ALGINATE 2X2 26.00 7102973 WHC MEDIHONEY ALGINATE 4X4 58.00 7102999 WHC NEOX SKIN WOUND MATRIX/SQ CM 880.00 7103005 WHC NEOX SKIN WND MA/SQ CM WASTED 880.00 7103039 WHC PACKING NU GAUZE 1" 156.00 7103047 WHC PACKING NU GAUZE 1/4" 203.00 7103054 WHC PACKING NU GAUZE 2" 210.00 7103062 WHC REM0VER ER STAPLE 243.00 7103070 WHC ROLL COBAN 3"-4" 80.00 7103088 WHC SCISSORS STERILE DISP 289.00 7103096 WHC SET SUTURE REMOVAL 152.00 7103104 WHC SHOE MILLO PEDIC LG 311.00 7103112 WHC SHOE MILLO PEDIC M 311.00 7103120 WHC SHOE POST-OP DARCO 106.00 7103153 WHC SPENCO LINER 453.00 7103161 WHC SPONGE 4 X 4 RAY-TEC 67.00 7103179 WHC SPONGE FLUFF STERILE TRAY/10 231.00 7103187 WHC WOUND LAYER/SILICONE 2X3 203.00 7103195 WHC WOUND LAYER/SILICONE 4X8 399.00 7103211 WHC PURAPLY PER SQ CM OVER 128 600.00 7103229 WHC ORTHOWEDGE BLACK POST-OP XS 502.00 7103237 WHC ORTHOWEDGE BLACK POST-OP S 502.00 7103245 WHC ORTHOWEDGE BLACK POST-OP M 502.00 7103252 WHC ORTHOWEDGE BLACK POST-OP L 502.00 7103260 WHC ORTHOWEDGE BLACK POST-OP XL 502.00 7103278 WHC MEN SEMI-RIGID POST-OP SHOE L 502.00 7103286 WHC MEN SEMI-RIGID POST-OP SHOE M 502.00 7103294 WHC MEN SEMI-RIGID POST-OP SHOE S 502.00 7103302 WHC MEN SEMI-RIGID POST-OP SHOE XL 502.00 7103310 WHC WOMEN SEMI-RIGID POST-OP SHOE L 502.00 7103328 WHC WOMEN SEMI-RIGID POST-OP SHOE M 502.00 7103336 WHC WOMEN SEMI-RIGID POST-OP SHOE S 502.00 7103344 WHC WOMEN SEMI-RIGID POST-OP SHOEXS 502.00 7103351 WHC MEPILEX AG (SILVER) 4X4 67.00 7103369 WHC MEXTRA SUPERABSORB 7X9 67.00 7103377 WHC FOAM HUDROFERA BLUE CLASSIC 4X4 67.00 7103385 WHC MEPILEX BORDER 4X4 67.00 7103393 WHC MEPILEX TRANSFER 6X8 67.00 7103401 WHC CAST SHOE ROCKER 9.75X4.50 SM 502.00 7103419 WHC CAST SHOE ROCKER 10.5X5 MED 502.00 7103427 WHC CAST SHOE ROCKER 12.5X5.5 LG 502.00 7103435 WHC CAST SHOE ROCKER 13.5X5.75 SM 502.00 7103443 WHC MELGISORB ALGIANTE DRESSING 4X4 67.00 7103450 STERILE IODOFORM GAUZE 1/4"X 5 YD 10.00 7103468 STERILE IODOFORM GAUZE 1/2" X 5 YD 10.00 7103476 MELGISORB AG ANTIMICRBL DRESS 4"X4" 67.00 7103484 DRESSING RESTORE CONTACT 6X8 50.00 7103492 TUBE PASTE MEDIHNY HYDROCLLD 1.5 OZ 56.00 7103500 MEPITEL ONE NON-ADHRNT WND LYR 3X4 22.00 7103518 WHC DRESSING HYDROFERA 4X5 67.00 7103526 WHC DRSSNG MEPITEL W/SAFETC 3X4 1EA 67.00 7103534 WHC KIT,CUMITED,OFFLOADER,TCC 1EA 76.00 7103542 WHC DRSSNG HYDROFR BLUE NO FLM BCK 67.00 7103559 WHC STRAVIX/SQ CM 1,418.00 7103567 WHC AMPUTATION TOE 16,630.00 7103575 WHC AMPUTATION PARTIAL TOE 16,630.00 7200058 PN NON STRESS TEST 1,220.00 7200066 PN US BIOPHYSICAL PROFILE W/NST 1,912.00 7200090 PN US COMPLETE FETAL SURVEY 2,735.00 7200108 PN U/S LIMITED OB 1,160.00 7200116 PN U/S FOLLOW-UP OR REPEAT 1,491.00 7200124 PN FETAL ECHOCARDIOGRAM 4,721.00 7200132 PN AMNIOCENTESIS 1,424.00 7200140 PN US GUIDANCE AMNIO 2,367.00 7200264 PN US TRANSVAGINAL-OB 1,491.00 7200595 PN US BIOPHYSICAL PROFILE W/O NST 1,072.00 7200603 PN US DOPPLER ECHO FETAL 3,152.00 7200611 PN US DOPPLER ECHO F/U FETAL 3,152.00 7200629 PN US FETAL ECHOCARDIOGRAM F/U 3,152.00 7200637 PN US 1ST TRIMESTER <14WKS TRANSABD 2,517.00 7200645 PN US 1ST TRIM-EACH ADD'L GEST 870.00 7200652 PN US OB PLUS DETAILED FETAL EXAM 2,735.00 7200660 PN US OB+ DETL FETAL-EA ADD'L GESTN 2,653.00 7200678 PN US FOLLOW UP/REPEAT-EA ADD GESTN 1,491.00 7200686 PN US COLOR MAPPING 1,769.00 7200694 1ST TRIM NUCHAL TRANSLUCENCY 2,517.00 7200702 PN 1ST TRIM NUCHAL TRANSLUCNCY AD'L 870.00 7200710 RAD US COMPLETE FETAL SUR 2,735.00 7200728 RAD US LIMITED OB 1,160.00 7200736 RAD US FOLLOW UP OR REPEAT 1,491.00 7200744 RAD US TRANSVAGINAL-OB 1,491.00 7200751 RAD US 1ST TRIMESTER <14 WEEKS 2,517.00 7200769 RAD US 1ST TRIMESTER EACH ADD'L 870.00 7200777 RAD US OB PLUS DETAILED F/U 2,735.00 7200785 RAD US OB+DETAILED FETAL - EA 2,653.00 7200793 RAD US COMPLETE MULTIPLE 2,653.00 7200801 PN MCA DOPPLER VELOCIMETRY 557.00 7200819 PN UA DOPPLER VELOCIMETRY 557.00 7200827 PN INJECTION SUBQ OR IM 531.00 7200835 OFFICE OUTPATIENT VISIT NEW 99201 1,425.00 7200843 OFFICE OUTPATIENT VISIT NEW 99202 575.00 7200850 OFFICE OUTPATIENT VISIT NEW 99203 728.00 7200868 OFFICE OUTPATIENT VISIT NEW 99204 847.00 7200876 OFFICE OUTPATIENT VISIT NEW 99205 1,426.00 7200900 PN US COM EA ADDL GESTATION 2,653.00 7200918 OFFICE OUTPATIENT VISIT EST 99211 511.00 7200926 OFFICE OUTPATIENT VISIT EST 99212 719.00 7200934 OFFICE OUTPATIENT VISIT EST 99213 897.00 7200942 OFFICE OUTPATIENT VISIT EST 99214 999.00 7200959 OFFICE OUTPATIENT VISIT EST 99215 1,034.00 7201015 PN GENETIC COUNSELING - 30 MIN 736.00 7300064 SPEECH/LANG IND TX 15MIN 225.00 7300163 SPEECH LANG SWALLOW TREATMNT 15 MIN 225.00 7300171 SPEECH LANG SWALLOW EVAL 449.00 7300197 ST VIDEOFLUOROSCOPIC SWALLOW 60 MIN 449.00 7300254 SPEECH/LANG IND TX 30MIN 449.00 7300262 SPEECH/LANG IND TX 45MIN 449.00 7300270 SPEECH/LANG IND TX 60MIN 449.00 7300288 ST DYSPHAGIA EVAL 45 MIN 449.00 7300296 ST DYSPHAGIA EVAL 60 MIN 449.00 7300304 SPEECH/LANG SWALLOW TREAT 30MIN 449.00 7300312 SPEECH/LANG SWALLOW TREAT 45MIN 449.00 7300320 SPEECH/LANG SWALLOW TREAT 60MIN 449.00 7300338 ST VIDEO FLUOROSCOPIC SWALLOW 75MIN 449.00 7300346 ST VIDEOFLUOROSCOPIC SWALLOW 90MIN 449.00 7300379 ST AUDIO METRIC SCRN PURE TONE AIR 449.00 7300387 M/CAL SPEECH EVALUATION 449.00 7300395 M/CAL SPEECH/LANG THERAPY 60MIN 449.00 7300403 ST DYSPHAGIA EVAL 75 MIN 449.00 7300411 ST DYSPHAGIA EVAL 90 MIN 449.00 7300429 M/CAL SPEECH/LANG THERAPY 30 MIN 449.00 7300437 SPCH FLUENCY EVAL 75 MIN 450.00 7300445 SPCH FLUENCY EVAL 90 MIN 450.00 7300452 SPCH FLUENCY EVAL 120 MIN 450.00 7300460 SPCH SOUND PROD EVAL 75 MIN 450.00 7300478 SPCH SOUND PROD EVAL 90 MIN 450.00 7300486 SPCH SND PROD EVAL 120 MIN 450.00 7300494 BARLOW ST SWALLOWING EVAL 60 MIN 449.00 7300528 BARLOW ST VIDEOFLUORO STUDY 90 MIN 449.00 7300536 BARLOW ST DYSPHAGIA THERAPY 15 MIN 225.00 7300544 BARLOW ST DYSPHAGIA THERAPY 30 MIN 449.00 7300551 BARLOW ST DYSPHAGIA THERAPY 45 MIN 449.00 7300569 BARLOW ST DYSPHAGIA THERAPY 60 MIN 449.00 7300577 BARLOW ST SPEECH/LANG THERAPY 15MIN 225.00 7300585 BARLOW ST SPEECH/LANG THERAPY 30MIN 449.00 7300593 BARLOW ST SPEECH/LANG THERAPY 45MIN 449.00 7300601 BARLOW ST SPEECH/LANG THERAPY 60MIN 449.00 7300627 BARLOW SPCH FLUENCY EVAL 75 MIN 450.00 7300635 BARLOW SPCH FLUENCY EVAL 90 MIN 450.00 7300643 BARLOW SPCH FLUENCY EVAL 120 MIN 450.00 7300650 BARLOW SPCH SOUND PROD EVAL 75 MIN 450.00 7300668 BARLOW SPCH SOUND PROD EVAL 90 MIN 450.00 7300676 BARLOW SPCH SOUND PROD EVAL 120 MIN 450.00 7300684 BARLOW LANG COMP/EXP EVAL 75 MIN 450.00 7300692 BARLOW LANG COMP/EXP EVAL 90 MIN 450.00 7300700 BARLOW LANG COMP/EXP EVAL 120 MIN 450.00 7300718 BARLOW VCE/RSNC ANLYS EVAL 75 MIN 450.00 7300726 BARLOW VCE/RSNC ANLYS EVAL 90 MIN 450.00 7300734 BARLOW VCE/RSNC ANLYS EVAL 120 MIN 450.00 7300742 BARLOW SPCH FLUENCY EVAL 30 MIN 450.00 7300759 BARLOW SPCH FLUENCY EVAL 45 MIN 450.00 7300767 BARLOW SPCH FLUENCY EVAL 60 MIN 450.00 7300775 BARLOW SPCH SOUND PROD EVAL 30 MIN 450.00 7300783 BARLOW SPCH SOUND PROD EVAL 45 MIN 450.00 7300791 BARLOW SPCH SOUND PROD EVAL 60 MIN 450.00 7300809 BARLOW LANG COMP/EXP EVAL 30 MIN 450.00 7300817 BARLOW LANG COMP/EXP EVAL 45 MIN 450.00 7300825 BARLOW LANG COMP/EXP EVAL 60 MIN 450.00 7300833 BARLOW VCE/RESNC ANALYS EVL 30 MIN 450.00 7300841 BARLOW VCE/RESONANCE ANALYS EVAL 45 450.00 7300858 BARLOW VCE/RESONANCE ANALYS EVL60MN 450.00 7301005 LANG COMP/EXP EVAL 75 MIN 450.00 7301013 LANG COMP/EXP EVAL 90 MIN 450.00 7301021 LANG COMP/EXP EVAL 120 MIN 450.00 7301039 VOICE/RESNNC ANALYS EVAL 75 MIN 450.00 7301047 VOICE/RESNNC ANALYS EVAL 90 MIN 450.00 7301054 VOICE/RESNNC ANALYS EVAL 120 MIN 450.00 7301062 SPCH FLUENCY EVAL 30 MIN 450.00 7301070 SPCH FLUENCY EVAL 45 MIN 450.00 7301088 SPCH FLUENCY EVAL 60 MIN 450.00 7301096 SPCH SOUND PROD EVAL 30 MIN 450.00 7301104 SPCH SOUND PROD EVAL 45 MIN 450.00 7301112 SPCH SOUND PROD EVAL 60 MIN 450.00 7301120 LANG COMP/EXP EVAL 30 MIN 450.00 7301138 LANG COMP/EXP EVAL 45 MIN 450.00 7301146 LANG COMP/EXP EVAL 60 MIN 450.00 7301153 VOICE/RESONANCE ANALYS EVAL 30 MIN 450.00 7301161 VOICE/RESONANCE ANALYS EVAL 45 MIN 450.00 7301179 VOICE/RESONANCE ANALYS EVAL 60 MIN 450.00 7301294 SPEECH TX COGNITIVE TR INTL 15 MIN 129.00 7301302 SPEECH COGNITIVE TR EA ADD 15 MIN 125.00 7302003 KX-SPEECH/LANG IND TX 15 MIN 225.00 7302029 KX-SPEECH LANG SWALLOW TRTMNT 15MIN 225.00 7302037 KX-SPEECH/LANG IND TX 30 MIN 449.00 7302045 KX-SPEECH/LANG IND TX 45 MIN 449.00 7302052 KX-SPEECH/LANG IND TX 60 MIN 449.00 7302060 KX-SPEECH/LANG SWALLOW TREAT 30 MIN 449.00 7302078 KX-SPEECH/LANG SWALLOW TREAT 45 MIN 449.00 7302086 KX-SPEECH/LANG SWALLOW TREAT 60 MIN 449.00 7302094 KX-ST DYSPHAGIA EVAL 60 MIN 449.00 7302102 KX-ST DYSPHAGIA EVAL 75 MIN 449.00 7302110 KX-ST DYSPHAGIA EVAL 90MIN 449.00 7302128 KX-ST DYSPHAGIA EVAL 30 MIN 449.00 7302185 KX-ST VIDEO FLUOROSCPC SWLLW 75 MIN 449.00 7302193 KX-ST VIDEO FLUORSCPC SWLLW 60 MIN 449.00 7302201 KX-ST VIDEO FLOURSCPC SWLLW 90 MIN 449.00 7302219 KX-ST DYSPHAGIA EVAL 45 MIN 449.00 7302227 KX-ST SPCH FLUENCY EVAL 75 MIN 450.00 7302235 KX-ST SPCH FLUENCY EVAL 90 MIN 450.00 7302243 KX-ST SPCH FLUENCY EVAL 120 MIN 450.00 7302250 KX-ST SPCH SOUND PROD EVAL 75 MIN 450.00 7302268 KX-ST SPCH SOUND PROD EVAL 90 MIN 450.00 7302276 KX-ST SPCH SOUND PROD EVAL 120 MIN 450.00 7302284 KX-ST LANG COMP/EXP EVAL 75 MIN 450.00 7302292 KX-ST LANG COMP/EXP EVAL 90 MIN 450.00 7302300 KX-ST LANG COMP/EXP EVAL 120 MIN 450.00 7302318 KX-ST VCE/RSNC ANLYS EVAL 75 MIN 450.00 7302326 KX-ST VCE/RSNC ANLYS EVAL 90 MIN 450.00 7302334 KX-ST VCE/RSNC ANLYS EVAL 120 MIN 450.00 7302425 KX-SPEECH TX COGNITIVE TR INTL 15 M 129.00 7302433 KX-SPEECH TX COGNITVE TR EA ADD 15M 125.00 7303001 GY-SPEECH/LANG IN TX 15 MIN 225.00 7303027 GY-SPEECH LANG SWALLOW TRTMNT 15 MI 225.00 7303035 GY-SPEECH/LANG IND TX 30 MIN 449.00 7303043 GY-SPEECH/LANG IND TX 45 MIN 449.00 7303050 GY-SPEECH/LANG IND TX 60 MIN 449.00 7303068 GY-SPEECH/LANG SWALLOW TREAT 30 MIN 449.00 7303076 GY-SPEECH/LANG SWALLOW TREAT 45 MIN 449.00 7303084 GY-SPEECH/LANG SWALLOW TREAT 60 MIN 449.00 7303092 GY-ST DYSPHAGIA EVAL 45 MIN 449.00 7303100 GY-ST DYSPHAGIA EVAL 60 MIN 449.00 7303118 GY-ST DYSPHAGIA EVAL 75 MIN 449.00 7303126 GY-ST DYSPHAGIA EVAL 90 MIN 449.00 7303134 GY-ST DYSPHAGIA EVAL 30 MIN 449.00 7303191 GY-ST VIDEO FLUOROSCPC SWALLOW 75 M 449.00 7303209 GY-ST VIDEO FLUOROSCPC SWALLOW 60 M 449.00 7303217 GY-ST VIDEO FLUOROSCPC SWALLOW 90 M 449.00 7303225 GY-ST SPCH FLUENCY EVAL 75 MIN 450.00 7303233 GY-ST SPCH FLUENCY EVAL 90 MIN 450.00 7303241 GY-ST SPCH FLUENCY EVAL 120 MIN 450.00 7303258 GY-ST SPCH SOUND PROD EVAL 75 MIN 450.00 7303266 GY-ST SPCH SOUND PROD EVAL 90 MIN 450.00 7303274 GY-ST SPCH SOUND PROD EVAL 120 MIN 450.00 7303282 GY-ST LANG COMP/EXP EVAL 75 MIN 450.00 7303290 GY-ST LANG COMP/EXP EVAL 90 MIN 450.00 7303308 GY-ST LANG COMP/EXP EVAL 120 MIN 450.00 7303316 GY-ST VCE/RSNC ANLYS EVAL 75 MIN 450.00 7303324 GY-ST VCE/RSNC ANLYS EVAL 90 MIN 450.00 7303332 GY-ST VCE/RSNC ANLYS EVAL 120 MIN 450.00 7304009 GA-SPEECH/LANG IND.TX 15 MIN 225.00 7304025 GA-SPEECH LANG SWALLOW TREATMNT 15M 225.00 7304033 GA-SPEECH/LANG IND TX 30MIN 449.00 7304041 GA-SPEECH/LANG IND TX 45 MIN 449.00 7304058 GA-SPEECH/LANG IND TX 60MIN 449.00 7304066 GA-SPEECH/LANG SWALLOW TREAT 30 MIN 449.00 7304074 GA-SPEECH/LANG SWALLOW TREAT 45MIN 449.00 7304082 GA-SPEECH/LANG SWALLOW TREAT 60MIN 449.00 7304090 GA-ST DYSPHAGIA EVAL 45 MIN 449.00 7304108 GA-ST DYSPHAGIA EVAL 60 MIN 449.00 7304116 GA-ST DYSPHAGIA EVAL 75 MIN 449.00 7304124 GA-ST DYSPHAGIA EVAL 90 MIN 449.00 7304132 GA-ST DYSPHAGIA EVAL 30 MIN 449.00 7304199 GA-ST VIDEO FLUOROSCPC SWALLOW 75 M 449.00 7304207 GA-ST VIDEO FLOUROSCPC SWALLOW 60 M 449.00 7304215 GA-ST VIDEO FLOUROSCPC SWALLOW 90 M 449.00 7304223 GA-ST SPCH FLUENCY EVAL 75 MIN 450.00 7304231 GA-ST SPCH FLUENCY EVAL 90 MIN 450.00 7304249 GA-ST SPCH FLUENCY EVAL 120 MIN 450.00 7304256 GA-ST SPCH SOUND PROD EVAL 75 MIN 450.00 7304264 GA-ST SPCH SOUND PROD EVAL 90 MIN 450.00 7304272 GA-ST SPCH SOUND PROD EVAL 120 MIN 450.00 7304280 GA-ST LANG COMP/EXP EVAL 75 MIN 450.00 7304298 GA-ST LANG COMP/EXP EVAL 90 MIN 450.00 7304306 GA-ST LANG COMP/EXP EVAL 120 MIN 450.00 7304314 GA-ST VCE/RSNC ANLYS EVAL 75 MIN 450.00 7304322 GA-ST VCE/RSNC ANLYS EVAL 90 MIN 450.00 7304330 GA-ST VCE/RSNC ANLYS EVAL 120 MIN 450.00 7900004 CHEMO ANTI-NEOL SQ/IM 319.00 7900012 CHEMO HORMON ANTINEOPL SQ/IM 319.00 7900020 CHEMO IV PUSH SINGLE DRUG 1,138.00 7900038 CHEMO IV PUSH ADDL DRUG 653.00 7900046 CHEMO IV INFUSION 1 HR 1,858.00 7900053 CHEMO IV INFUSION ADDL HR 319.00 7900061 CHEMO PROLONG INFUSE W/PUMP 1,562.00 7900079 CHEMO IV INFUS EACH ADDL SEQ 549.00 7900087 CHEMO IA PUSH TECHNIQUE 653.00 7900095 CHEMO IA INFUSION UP TO 1 HR 1,858.00 7900103 CHEMO IA INFUSE EACH ADDL HR 653.00 7900111 CHEMOTHERAPY INFUSION METHOD 1,858.00 7900129 CHEMOTHERAPY INTRACAVITARY 1,138.00 7900137 CHEMOTX ADMN PRTNL CAVITY 1,138.00 7900145 CHEMOTHERAPY INTO CNS 1,858.00 7900152 CHEMOTHERAPY INJECTION 653.00 7900160 BLOOD TRANSFUSION 3,050.00 7900178 IV INF HYDRATION 31-60 96360 1,167.00 7900186 IV INF HYDRATION 31-60 96360-59 1,167.00 7900194 IV INF HYDRATION ADD HR 96361 200.00 7900202 IV INF HYDRATION ADD HR 96361-59 200.00 7900210 IV INFUSION 16-60M 96365 1,510.00 7900228 IV INFUSION 16-60M 96365-59 1,510.00 7900236 IV INFUSION EA ADDL HR 96366 137.00 7900244 IV INFUSION EA ADDL HR 96366-59 137.00 7900251 IV INFUSION SEQ 16-60M 96367 137.00 7900269 IV INFUSION SEQ 16-60M 96367-59 137.00 7900277 IV INFUSION CONCURRENT 96368 137.00 7900285 INFUSION CONCURRENT 96368-59 137.00 7900293 INJECTION NOT IV PUSH 96372 531.00 7900301 INJ NOT IV PUSH 96372-59 531.00 7900319 INJECTION IV PUSH 96374 980.00 7900327 INJECTION IV PUSH 96374-59 980.00 7900335 INJ ADDL PUSH NEW DRUG 96375 735.00 7900343 INJ ADDL PUSH NEW DRUG 96375-59 735.00 7900350 IV PUSH ADDL SAME DRUG 96376 162.00 7900368 IV PUSH ADDL SAME DRUG 96376-59 162.00 7900376 INFUSION CTR E&M 511.00 7900384 INFUSION CTR E&M - 25 511.00 7900392 IRRIGATION ACCESS DEVICE-FLUSH 396.00 7900400 CHEMO ANTI-NEOL SQ/IM - 9640159 319.00 7900418 CHEMO HORMON ANTINEOP SQ/IM 9640259 319.00 7900426 DECLOTTING BY THROMBOLYTIC AGENT 1,050.00 7900434 SALINE LOCK INSERTION 615.00 7900442 UNLISTED CHEMOTHERAPY PROCEDURE 222.00 7900624 HIB VACCINATION 248.00 7900632 THERAPEUTIC PHLEBOTOMY IC 439.00 7900640 APHERESIS,THERAPEUTIC,PLASMA 7,820.00 8300162 OUTPATIENT OBS HR ONE - 4T 300.00 8300170 OUTPATIENT OBS HR ONE - P2 300.00 8300212 OUTPATIENT OBS EA ADD'L HR-P2 300.00 8300238 OUTPATIENT OBS EA ADD'L HR-4T 300.00 8300261 OUTPATIENT OBS EA ADD'L HR-1T 300.00 8300311 OUTPATIENT OBS HR ONE - 3T 3T 300.00 8300329 OUTPATIENT OBS EA ADD'L HR-3T 300.00 8300394 DIRECT ADMIT OBS - 3PZ 6,923.00 8300410 DIRECT ADMIT OBS-1T 6,923.00 8300428 DIRECT ADMIT OBS-2W 6,923.00 8300444 DIRECT ADMIT OBS-4PZ 6,923.00 8300451 DIRECT ADMIT OBS 6,923.00 8300469 DIRECT ADMIT OBS-4T 6,923.00 8300477 DIRECT ADMIT OBS-P2 5,792.00 8300485 DIRECT ADMIT OBS-3T 6,923.00 8300501 OBS INSERT PICC CAT 2N 5,092.00 8300519 DIRECT ADMIT OBS-2N 6,923.00 8300520 DIRECT ADMIT OBS-1T(25) 6,923.00 8300521 DIRECT ADMIT OBS-2W(25) 6,923.00 8300522 DIRECT ADMIT OBS-2T(25) 6,923.00 8300523 DIRECT ADMIT OBS-4T(25) 6,923.00 8300524 DIRECT ADMIT OBS-P2(25) 5,792.00 8300525 DIRECT ADMIT OBS-3T(25) 6,923.00 8300526 DIRECT ADMIT OBS-2N(25) 6,923.00 8300528 DIRECT ADMIT OBS 3PZ(25) 6,923.00 8300529 DIRECT ADMIT OBS-4PZ(25) 6,923.00 8300535 ADMIN PNEUMOCCAL VACCINE - 1T 569.00 8300543 ADMIN INFLUENZA VIRUS VACCINE-1T 569.00 8300550 IMMUNIZATION ADMIN-1T 569.00 8300568 ADMIN HEPATITIS B VACCINE -1T 569.00 8300642 IV PUSH SINGLE OR INIT DRUG - OBS 980.00 8300683 IRRIGATE IMPL VASC ACCESS DV - OBS 396.00 8300691 CHEMO ADMIN INTRATHECAL - OBS 1,858.00 8300717 IV INFUS HYDRATE INIT HR - OBS 1,167.00 8300741 UNCODEABLE OUTPATIENT OBS EA HR-3PZ 300.00 8300782 UNCODEABLE OUTPATIENT OBS EA HR-4PZ 300.00 8300808 OBS INSERT PICC CAT 5,092.00 8300816 OBS SUB INFSN/TX/PRP INTL 16-60M 1,018.00 8300824 OBS SUBC INFS TX/PROP 16-60M 1,018.00 8300832 OBS SUBC INFSN TX/PROP EA ADD HR 225.00 8300840 OBS SUBC INFS TX/PROP ADDL PUMP 455.00 8300873 OBSERVATION PROCEDURE 839.00 8300881 OBS SUBC INFSN TX/PROP EA ADD HR 225.00 8300899 OBS SUBC INFSN/TX/PROP ADDL PUMP 455.00 8300907 OBSERVATION DEBRIDEMENT 2,594.00 8300931 ADMIN INFLUENZA VIRUS VAC 569.00 8301038 IMMUNIZATION ADMIN 569.00 8301046 ADMINISTRATION HEPATITIS B VAC 569.00 8301053 ADMIN PNEUMOCCAL VACCINE-3T 569.00 8301061 ADMIN INFLUENZA VIRUS VACCINE-3T 569.00 8301079 IMMUNIZATION ADMIN-3T 569.00 8301087 ADMIN HEPATITIS B VACCINE-3T 569.00 8301095 IMMUNIZATION EA ADD'L-90472-3T 243.00 8301103 OP IV INFUSION 16-60M 96365 1,510.00 8301111 OP IV INFUSION 16-60M 96365-59 1,510.00 8301129 OP IV INFUSION EA ADD'L HR 137.00 8301137 OP IV INFUSION EA ADDL MOD 59 137.00 8301145 OP INF SEQUENTIAL 16-60M 96367 137.00 8301152 OP IV INF SEQ 16-60M 96367-59 137.00 8301160 OP INFUSION CONCURRENT 96368 137.00 8301178 OP INFUSION CONCURRENT 96368-59 137.00 8301186 OP IV INF HYDRATION ADD HR 96361 200.00 8301194 OP IV HYDRATION ADD HR 96361-59 137.00 8301202 OP INJECTION IV PUSH 96374 980.00 8301210 OP INJECTION IV PUSH 96374-59 980.00 8301228 OP INJ ADDL PUSH NEW DRUG 96375 735.00 8301236 OP INJ ADDL PUSH NEW DRUG 96375-59 735.00 8301244 OP IV INF HYDRATION 31-60M 96360 1,167.00 8301251 OP IV INF HYDRATION 31-60M 96360-59 1,167.00 8301269 OP INJECTION NOT IV PUSH 96372 531.00 8301277 OP INJ NOT IV PUSH 96372-59 531.00 8301285 OP IMMUN ADMIN FIRST VAC 90471 569.00 8301293 OP IMMUN ADMIN EACH ADDL VAC 90472 243.00 8301301 OP ADMIN INFLUENZA VACCINE 569.00 8301319 OP ADMIN PNEUMOCCAL VACCINE 569.00 8301327 OP ADMIN HEPATITIS B VACCINE 569.00 8301335 OP PLACE NEEDLE IN VEIN 615.00 8301343 OP PLACE NEEDLE IN VEIN MOD 59 615.00 8301350 OP IV PUSH ADDL SAME DRUG 96376 162.00 8301368 OP IV PUSH ADDL SAME DRUG 96376-59 162.00 8301376 ADMIN PNEUMOCCAL VACCINE-CCC 569.00 8301384 ADMIN INFLUENZA VIRUS VACCINE-CCC 569.00 8301392 IMMUNIZATION ADMIN-CCC 569.00 8301400 ADMIN HEPATITIS B VACCINE-CCC 569.00 8301418 ADMIN PNEUMOCCAL VACCINE-3PZ 569.00 8301426 ADMIN INFLUENZA VIRUS VACCINE-3PZ 569.00 8301434 IMMUNIZATION ADMIN-3PZ 569.00 8301442 ADMIN HEPATITIS B VACCINE-3PZ 569.00 8301459 ADMIN PNEUMOCCAL VACCINE-4PZ 569.00 8301467 ADMIN INFLUENZA VIRUS VACCINE-4PZ 569.00 8301475 IMMUNIZATION ADMIN-4PZ 569.00 8301483 ADMIN HEPATITIS B VACCINE-4PZ 569.00 8301491 ADMIN PNEUMOCCAL VACCINE - P2 569.00 8301509 ADMIN INFLUENZA VIRUS VACCINE-P2 569.00 8301517 IMMUNIZATION ADMIN-P2 569.00 8301525 ADMIN HEPATITIS B VACCINE-P2 569.00 8301533 ADMIN PNEUMOCCAL VACCINE-P3 569.00 8301541 ADMIN INFLUENZA VIRUS VACCINE-P3 569.00 8301558 IMMUNIZATION EA ADD'L-90472-P3 243.00 8301566 IMMUNIZATION ADMIN-P3 569.00 8301574 ADMIN HEPATITIS B VACCINE-P3 569.00 8301582 ADMIN PNEUMOCCAL VACCINE-NSY 569.00 8301590 ADMIN INFLUENZA VIRUS VACCINE-NSY 569.00 8301608 IMMUNIZATION ADMIN-NSY 569.00 8301616 ADMIN HEPATITIS B VACCINE-NSY 569.00 8301624 IMMUNIZATION EA ADD'L-90472-1T 243.00 8301632 IMMUNIZATION EA ADD'L-90472-CCC 243.00 8301640 IMMUNIZATION EA ADD'L-90472-3PZ 243.00 8301657 IMMUNIZATION EA ADD'L-90472-4PZ 243.00 8301665 IMMUNIZATION EA ADD'L-90472-P2 243.00 8301699 PROCEDURE O/P 4PZ 1,401.00 8301707 I&O STRAIGHT CATH FOR RETAINED URIN 357.00 8301715 I&O STRGHT CATH RTND URINE MOD 59 357.00 8301723 FOLEY INSERTION SIMPLE 594.00 8301731 FOLEY INSERTION SIMPLE MOD 59 594.00 8301749 FOLEY INSERTION COMPLICATED 594.00 8301756 FOLEY INSERTION COMPLICATED MOD 59 594.00 8301764 OP DECLOTTING BY THROMBOLYTIC AGENT 1,050.00 8302002 UNCODEABLE OUTPATIENT OBS EA HR-1T 300.00 8302044 UNCODEABLE OUTPATIENT OBS EA HR-4T 300.00 8302085 UNCODEABLE OUTPATIENT OBS EA HR-2N 300.00 8302101 UNCODEABLE OUTPATIENT OBS EA HR-3T 300.00 8302127 UNCODEABLE OUTPATIENT OBS EA HR 300.00 8302143 UNCODEABLE OUTPATIENT OBS EA HR-P2 300.00 8302150 UNCODEABLE OUTPT OBS EA ADD'L HR-P2 201.00 8302168 UNCODEABLE OUTPATIENT OBS EA HR-2W 300.00 8302176 UNCODEABLE OUTPT OBS EA ADD HR-2W 201.00 8302218 LEVEL 1 PROCEDURE-OBS 615.00 8302226 LEVEL 2 PROCEDURE-OBS 1,233.00 8302234 LEVEL 3 PROCEDURE-OBS 3,075.00 8302242 LEVEL 4 PROCEDURE-OBS 7,379.00 8302259 ADMIN PNEUMOCCAL VACCINE - 4T 569.00 8302267 ADMIN INFLUENZA VIRUS VACCINE - 4T 569.00 8302275 IMMUNIZATION ADMIN-4T 569.00 8302283 ADMIN HEPATITIS B VACCINE -4T 569.00 8302291 ADMIN PNEUMOCCAL VACCINE - 1N 569.00 8302309 ADMIN INFLUENZA VIRUS VACCINE-1N 569.00 8302317 IMMUNIZATION ADMIN -1N 569.00 8302325 ADMIN HEPATITIS B VACCINE-1N 569.00 8302333 ADMIN PNEUMOCCAL VACCINE - 1S 569.00 8302341 ADMIN INFLUENZA VIRUS VACCINE-1S 569.00 8302358 IMMUNIZATION ADMIN-1S 569.00 8302366 ADMIN HEPATITIS B VACCINE-1S 569.00 8302374 ADMIN HI DS INFLUENZA VIRUS VAC-1T 569.00 8302390 ADMIN HI DS INFLUENZA VIRUS VAC 569.00 8302408 ADMIN HI DS INFLUENZA VIRUS VAC-3T 569.00 8302416 OP ADMIN HI DS INFLUENZA VIRUS VACC 569.00 8302424 ADMIN HI DS INFLUENZA VRS VAC-CCC 569.00 8302432 ADMIN HI DS INFLUENZA VRS VAC-3PZ 569.00 8302440 ADMIN HI DS INFLUENZA VRS VAC-4PZ 569.00 8302457 ADMIN HI DS INFLUENZA VRS VAC-P2 569.00 8302465 ADMIN HI DS INFLUENZA VRS VAC-P3 569.00 8302473 ADMIN HI DS INFLUENZA VRS VAC-NSY 569.00 8302481 ADMIN HI DS INFLUENZA VRS VAC-4T 569.00 8302499 ADMIN HI DS INFLUENZA VRS VAC-1N 569.00 8302507 ADMIN HI DS INFLUENZA VRS VAC-1S 569.00 8302515 ADMIN HI DS INFLUENZA VIRUS VAC-2N 569.00 8302523 ADMIN HI DS INFLUENZA VIRUS VAC-OBS 569.00 8302531 ADMIN HI DS INFLUENZA VIRUS VAC-2W 569.00 8302606 BAMLANIVIMAB INFUSION AND MONITOR 1,548.00 8305005 CHEMO IV INFUSION INITIAL HR - 2N 1,858.00 8305021 PROCEDURE O/P 2N 1,401.00 8305047 CARDIOVERSION SSS UNIT 2,557.00 8305088 CARDIOVERSION - 1T- OP ONLY 2,557.00 8305096 CHEMO IV INFUSION EA ADDL HR - 2N 319.00 8305286 SSS INTERVENTIONAL PROCEDURE LEVEL1 2,259.00 8305310 SSS CHEMO PROLONG INF W/ PUMP 1,562.00 8305328 SSS CHEMO IV INF EA SEQ 653.00 8305344 IV PUSH SINGLE OR INIT DRUG - 2N 980.00 8305385 IRRIGATE IMPL VASC ACCESS DV - 2N 396.00 8305393 IV PUSH CHEMOSGL/INITIAL - 2N 1,138.00 8305401 OBS SUB INFSN/TXPROP INTL 16-60M-2N 1,018.00 8305419 IV PUSH CHEMO EA ADDL - 2N 653.00 8305427 CHEMO ADMIN INTRATHECAL - 2N 1,858.00 8305443 OBS SUB INFSN TX/PROP INL 16-60M 2N 1,018.00 8305450 OBS SUB INFSN TX/PROP EA ADDL HR 2N 225.00 8305468 OBS SUB INFSN TX/PROP ADDL PUMP 2N 455.00 8305476 IV INFUS HYDRAT INIT HOUR - 2N 1,167.00 8305518 OBSERVATION PROCEDURE 2N 839.00 8305534 IV INFUS CHEMO EA AD SEQ INFUS - 2N 549.00 8305575 OBS SUB INFSN/TXPROP INTL 16-60M-2S 1,018.00 8305583 OBS SUBC INFSN/TXPROP INL 16-60M-2S 1,018.00 8305591 OBS SUB INFSN/TXPROP EA ADD'L HR-2S 225.00 8305609 OBS SUBC INFSN TX/PROP ADDL PUMP-2S 455.00 8305658 ADMIN PNEUMOCCAL VACCINE-2W 569.00 8306003 ADMIN SARSCOV2 30MCG/0.3ML 1ST 85.00 8306011 ADMIN SARSCOV2 30MCG/0.3ML 2ND 142.00 8306029 ADM SARSCOV2 100MCG/0.5ML 1ST 85.00 8306037 ADM SARSCOV2 100MCG/0.5ML 2ND 142.00 8306045 ADMIN SARSCOV2 0.5ML SINGLE DOSE 235.00 8320004 ELECTIVE CARDIOVERSION-92960 (2S) 2,557.00 8350381 ADMINISTRATION HEPATITS B VACCN-2N 569.00 8350399 IMMUNIZATION ADMIN - 2N 569.00 8350407 ADMIN INFLUENZA VIRUS VAC-2N 569.00 8350415 OBS SUB INFSN TX/PROP EA ADDL HR 2N 225.00 8350423 OBS SUBC INFSN/TXPROP ADDL PUMP 2N 455.00 8350449 OBSERVATION DEBRIDEMENT 2N 2,594.00 8350456 IMMUNIZATION EA ADDL-90472 - 2N 243.00 8350464 ADMINISTRATION PNEUMOCCAL VACCN 2N 569.00 8350480 OBS SUBC INFSN TX/PROP EA ADD HR-2S 225.00 8350498 OBS SUBC INFSN TX/PROP ADD PUMP-2S 455.00 8350514 IMMUNIZATION EA ADD'L - 90472 - 2S 243.00 8350522 ADMIN PNEUMOCCAL VACCNE-OBS 569.00 8350530 ADMIN INFLUENZA VIRUS VACCINE-OBS 569.00 8350548 IMMUNIZATION ADMIN - OBS 569.00 8350555 ADMIN HEPATITIS B VACCINE-OBS 569.00 8350563 OP BLOOD TRANSFUSION - 36430 3,050.00 8350571 OP BLOOD TRANSFUSION - 3643059 3,050.00 8350589 ADMIN ON-BODY INJ FOR TIMED SEQ-IC 569.00 8350597 ADMIN ON-BODY INJ FOR TIMED SEQ-4T 569.00 8350605 DIRECT ADMIT OBS-2S 6,923.00 8350613 DIRECT ADMIT OBS-2S(25) 6,923.00 8350621 ADMINISTRATION HEPATITS B VACCN-2W 569.00 8350639 IMMUNIZATION ADMIN - 2W 569.00 8350647 ADMIN INFLUENZA VIRUS VAC-2W 569.00 8450009 REHAB PT THERAPY EXERC.15MIN 225.00 8450017 REHAB PT EVALUATION 60 MIN 449.00 8450090 REHAB SPEECH/LANG IND. TX 15 MIN 225.00 8450132 REHAB OT EVALUATION 60 MIN 449.00 8450140 REHAB OT THER.ACTIVITY 15 MIN 225.00 8450165 REHAB OT ORTH FITTING/TRAIN 15 MIN 225.00 8450272 REHAB DYSPHAGIA EVAL 30 MIN 449.00 8450306 REHAB DYSPHAGIA TX 15 MIN 225.00 8450314 REHAB PT GAIT/STR TRAIN EA 15 MIN 225.00 8450322 REHAB PT NEUROMUS RE-ED EA 15 MIN 225.00 8450330 REHAB OT NEUROMUS RE-ED 15 MIN 225.00 8450355 REHAB OT THERAPEUTIC EXERCISE 15MIN 225.00 8450363 REHAB PT WHEELCHAIR MOBILITY TRN 15 225.00 8450371 REHAB OT ADL TRAINING 15 MIN 225.00 8450389 REHAB VIDEOFLUOROSCOPIC STUDY 60 MN 449.00 8450413 REHAB AUDIOMETRIC SCREEN 449.00 8450447 REHAB VIDEOFLUOROSCOPIC STUDY 75 MN 449.00 8450454 REHAB VIDEOFLUOROSCOPIC STUDY 90MIN 449.00 8450462 REHAB DYSPHAGIA TX 45MIN 449.00 8450470 REHAB DYSPHAGIA 60 MIN 449.00 8450488 REHAB OT EVAL 75 MIN 449.00 8450496 REHAB SPEECH/LANG IND TX 60 MIN 449.00 8450504 REHAB DYSPHAGIA EVAL 45 MIN 449.00 8450512 REHAB SPEECH/LANG IND TX 30 MIN 449.00 8450520 REHAB SPEECH/LANG IND TX 45 MIN 449.00 8450579 REHAB DYSPHAGIA EVAL 60 MIN 449.00 8450587 REHAB DYSPHAGIA TX 30 MIN 449.00 8450595 REHAB PT EVALUATION 75 MIN 449.00 8450629 REHAB DYSPHAGIA EVAL 75 MIN 449.00 8450637 REHAB DYSPHAGIA EVAL 90 MIN 449.00 8450645 REHAB PT ADL TRAINING 15 MIN 225.00 8450652 REHAB SPCH FLUENCY EVAL 75 MIN 450.00 8450660 REHAB SPCH FLUENCY EVAL 90 MIN 450.00 8450678 REHAB SPCH FLUENCY EVAL 120 MIN 450.00 8450686 REHAB SPCH SOUND PROD EVAL 75 MIN 450.00 8450694 REHAB SPCH SOUND PROD EVAL 90 MIN 450.00 8450702 REHAB SPCH SOUND PROD EVAL 120 MIN 450.00 8450710 REHAB LANG COMP/EXP EVAL 75 MIN 450.00 8450728 REHAB LANG COMP/EXP EVAL 90 MIN 450.00 8450736 REHAB LANG COMP/EXP EVAL 120 MIN 450.00 8450744 REHAB VCE/RSNC ANLYS EVAL 75 MIN 450.00 8450751 REHAB THER ACTIVITY 15 MIN 225.00 8450769 REHAB VCE/RSNC ANLYS EVAL 90 MIN 450.00 8450777 REHAB VCE/RSNC ANLYS EVAL 120 MIN 450.00 8450785 REHAB OT COGNITIVE TRAIN INTL 15MIN 129.00 8450793 REHAB OT COGNITIVE TRN EA ADD 15MIN 125.00 8450827 REHAB SPCH FLUENCY EVAL 30 MIN 450.00 8450835 REHAB SPCH FLUENCY EVAL 45 MIN 450.00 8450843 REHAB SPCH FLUENCY EVAL 60 MIN 450.00 8450850 REHAB SPCH SOUND PROD EVAL 30 MIN 450.00 8450868 REHAB SPCH SOUND PROD EVAL 45 MIN 450.00 8450876 REHAB SPCH SOUND PROD EVAL 60 MIN 450.00 8450884 REHAB LANG COMP/EXP EVL 30 MIN 450.00 8450892 REHAB LANG COMP/EXP EVAL 45 MIN 450.00 8450900 REHAB LANG COMP/EXP EVAL 60 MIN 450.00 8450918 REHAB VOICE/RSNCE ANALYS EVL 30 MIN 450.00 8450926 REHAB VOICE/RESNC ANALYS EVL 45 MIN 450.00 8450934 REHAB VOICE/RESNC ANALYS EVAL 60MIN 450.00 8450942 REHAB SPEECH COGNTV TR INTL 15 MIN 129.00 8450959 REHAB SPEECH COGNTV TR EA ADD15 MIN 125.00 8600025 TCU SPEECH/LANG TX 15 MIN 225.00 8600041 TCU ST SPEECH/LANG GROUP TX 225.00 8600066 TCU VIDEOFLUOROSCOPIC STUDY 60 MIN 449.00 8600082 TCU SPCH FLUENCY EVAL 75 MIN 450.00 8600090 TCU SPCH FLUENCY EVAL 90 MIN 450.00 8600108 TCU SPCH FLUENCY EVAL 120 MIN 450.00 8600116 TCU SPCH SOUND PROD EVAL 75 MIN 450.00 8600124 TCU SPCH SOUND PROD EVAL 90 MIN 450.00 8600132 TCU SPCH SOUND PROD EVAL 120 MIN 450.00 8600140 TCU LANG COMP/EXP EVAL 75 MIN 450.00 8600157 TCU LANG COMP/EXP EVAL 90 MIN 450.00 8600165 TCU LANG COMP/EXP EVAL 120 MIN 450.00 8600173 TCU VCE/RSNC ANLYS EVAL 75 MIN 450.00 8600181 TCU VCE/RSNC ANLYS EVAL 90 MIN 450.00 8600199 TCU VCE/RSNC ANLYS EVAL 120 MIN 450.00 8600207 TCU SPCH FLUENCY EVAL 30 MIN 450.00 8600215 TCU SPCH FLUENCY EVAL 45 MIN 450.00 8600223 TCU SPCH FLUENCY EVAL 60 MIN 450.00 8600231 TCU SPCH SOUND PROD EVAL 30 MIN 450.00 8600249 TCU SPCH SOUND PROD EVAL 45 MIN 450.00 8600256 TCU SPCH SOUND PROD AVEL 60 MIN 450.00 8600264 TCU LANG COMP/EXP EVAL 30 MIN 450.00 8600272 TCU LANG COMP/EXP EVAL 45 MIN 450.00 8600280 TCU LANG COMP/EXP EVAL 60 MIN 450.00 8600298 TCU VOICE/RESONANCE ANALYS EVAL 30M 450.00 8600306 TCU VOICE/RESONANCE ANALYS EVL 45 M 450.00 8600314 TCU VOICE/RESONANCE ANALYS EVAL 60M 450.00 8600512 TCU DYSPHAGIA TX 15 MIN 225.00 8600520 TCU DYSPHAGIA EVAL 30 MIN 449.00 8600538 TCU DYSPHAGIA EVAL 75 MIN 449.00 8600546 TCU DYSPHAGIA EVAL 90 MIN 449.00 8600553 TCU SPEECH COGNITIVE TR INTL 15 MIN 129.00 8600561 TCU SPEECH COGNITIVE TR INTL 15 MIN 129.00 8600991 TCU PT DEBRDMNT SELECT >20CM 60MIN 449.00 8601015 TCU PT DEBRDMNT SELECT >20CM 45 MIN 449.00 8601023 TCU PT DEBRIDEMENT SLCT >20CM 120M 449.00 8601031 TCU PT DEBRIDEMENT SELECT >20CM 90M 449.00 8601049 TCU PT DEBRIDEMENT SELECT >20CM 30M 449.00 8601056 TCU PT EVALUATION 60 MIN 449.00 8601197 TCU PT THERAPEUTIC EX 15 MIN 225.00 8601213 TCU PT GAIT TRN EA 15 MIN 225.00 8601262 TCU PT WHIRLPOOL 107.00 8601296 TCU PT ADL TRAINING EA 15 MIN 225.00 8601304 TCU PT WHLCHR MOBILITY TRNG 15 MIN 225.00 8601312 TCU PT GROUP EXERCISE 15 MIN EA 225.00 8601338 TCU PT DEBRIDE SELECT L=20CM 90 MIN 449.00 8601346 TCU PT DEBRIDE SELECT L=20CM 45 MIN 449.00 8601353 TCU PT DEBRIDE SELECT L=20CM 60 MIN 449.00 8601361 TCU PT DEBRIDEMENT NONSELECT 90 MIN 449.00 8601379 TCU PT DEBRIDE SELECT L=20CM 30 MIN 449.00 8601387 TCU PT DEBRIDEMENT NONSELECT 60 MIN 449.00 8601395 TCU PT DEBRIDE NONSELECT 45 MIN 449.00 8601403 TCU PT DEBRIDE NONSELECT 30 MIN 449.00 8601437 TCU PT EVALUATION 30 MIN 449.00 8601452 TCU PT EVALUATION 45 MIN 449.00 8601460 TCU PT EVALUATION 75 MIN 449.00 8601478 TCU OT EVALUATION 45 MIN 449.00 8601486 TCU OT EVALUATION 15 MIN 449.00 8601494 TCU OT EVALUATION 30 MIN 449.00 8601502 TCU OT EVALUATION 75 MIN 449.00 8603003 TCU OT EVALUATION 60 MIN 449.00 8603144 TCU OT THERAPEUTIC EXCERCISE 15 MIN 225.00 8603169 TCU OT GROUP EXERCISE 15 MIN EA 225.00 8603177 TCU OT ORTHOTICS FIT/TRAIN 15 MIN 225.00 8603185 TCU OT ADL TRAINING 15 MIN 225.00 8603235 TCU OT THER ACTIVITIES 15 MIN 225.00 8603243 TCU OT NEUROMUSC RE-ED 15 MIN 225.00 8603250 TCU PT NEUROMUSCULAR REED 15 MIN 225.00 8604092 TCU AUDIOMETRIC SCREEN 449.00 8604126 TCU VIDEOFLUOROSCOPIC STUDY 75 MIN 449.00 8604134 VIDEOFLUOROSCOPIC SWALLOW 90 MIN 449.00 8604142 TCU DYSPHAGIA TX 45 MIN 449.00 8604159 TCU DYSPHAGIA TX 60 MIN 449.00 8604167 TCU DYSPHAGIA EVAL 60 MIN 449.00 8604175 TCU DYSPHAGIA TX 30 MIN 449.00 8604183 TCU SPEECH/LANG TX 60 MIN 449.00 8604191 TCU DYSPHAGIA EVAL 45 MIN 449.00 8604241 TCU SPEECH/LANG TX 30 MIN 449.00 8604258 TCU SPEECH/LANG TX 45 MIN 449.00 8604266 TCU PT THERAPEUTIC ACTIVITY 15 MIN 225.00 8610420 TCU PT EVALUATION 15 MIN 225.00 8620015 RUG - RUX07 0.01 8620023 RUG - RUX11 0.01 8620072 RUG - RVL07 0.01 8620080 RUG - RVL11 0.01 8620098 RUG - RHX07 0.01 8620106 RUG - RHX11 0.01 8620114 RUG - RHL07 0.01 8620122 RUG - RHL11 0.01 8620130 RUG - RMX07 0.01 8620148 RUG - RMX11 0.01 8620155 RUG - RML07 0.01 8620171 RUG - RLX07 0.01 8620189 RUG - RLX11 0.01 8620197 RUG - RMX17 0.01 8620205 RUG - RUX17 0.01 8620213 RUG - RML10 0.01 8620221 RUG - RVL10 0.01 8620239 RUG - RUX10 0.01 8620247 RUG - RUA30 0.01 8620254 RUG - RMX15 0.01 8620262 RUG - RHL10 0.01 8620270 RUG - RMC60 0.01 8620296 RUG - RMB30 0.01 8620312 RUG - CD130 0.01 8620320 RUG - RUAX 0.01 8620338 RUG - RVBX 0.01 8620353 RUG - RHX10 0.01 8620551 RUG - RHL20 0.01 8620564 RUG - RHL30 0.01 8620809 RUG - RVL20 0.01 8620813 RUG - RVL60 0.01 8621203 RUG - RMX20 0.01 8621211 RUG - RHL60 0.01 8621215 RUG - RMX60 0.01 8629743 CMG - B1501 0.01 8690000 RUG - AAA00 0.01 8690018 RUG - CA111 0.01 8690026 RUG - CB111 0.01 8690034 RUG - PA111 0.01 8690042 RUG - RHA11 0.01 8690059 RUG - RHB11 0.01 8690067 RUG - RHC10 0.01 8690075 RUG - RMA11 0.01 8690083 RUG - RMB11 0.01 8690091 RUG - RMC11 0.01 8690109 RUG - RUA11 0.01 8690117 RUG - RUB11 0.01 8690125 RUG - RUC11 0.01 8690133 RUG - RVA11 0.01 8690141 RUG - RVB11 0.01 8690158 RUG - RVC11 0.01 8690166 RUG - SE111 0.01 8690174 RUG - SE211 0.01 8690182 RUG - SE311 0.01 8690190 RUG - SSA11 0.01 8690208 RUG - SSB11 0.01 8690216 RUG - SSC11 0.01 8690224 RUG - RHA07 0.01 8690232 RUG - RHB07 0.01 8690240 RUG - RHC07 0.01 8690257 RUG - RMA07 0.01 8690265 RUG - RMB07 0.01 8690273 RUG - RMC07 0.01 8690281 RUG - RUA07 0.01 8690299 RUG - RUB07 0.01 8690307 RUG - RUC07 0.01 8690315 RUG - RVA07 0.01 8690323 RUG - RVB07 0.01 8690331 RUG - RVC07 0.01 8690349 RUG - SE107 0.01 8690356 RUG - SE207 0.01 8690364 RUG - SE307 0.01 8690372 RUG - SSA07 0.01 8690380 RUG - SSB07 0.01 8690398 RUG - SSC07 0.01 8690406 RUG - RHA02 0.01 8690414 RUG - RHB02 0.01 8690422 RUG - RHC02 0.01 8690430 RUG - RMA02 0.01 8690448 RUG - RMB02 0.01 8690455 RUG - RMC02 0.01 8690463 RUG - RUA02 0.01 8690471 RUG - RUB02 0.01 8690489 RUG - RUC02 0.01 8690497 RUG - RVA02 0.01 8690505 RUG - RVB02 0.01 8690521 RUG - SE202 0.01 8690539 RUG - SE302 0.01 8690547 RUG - SSA02 0.01 8690554 RUG - SSC02 0.01 8690562 RUG - RVB03 0.01 8690570 RUG - SE203 0.01 8690588 RUG - SE303 0.01 8690596 RUG - SSA03 0.01 8690604 RUG - CA107 0.01 8690612 RUG - SE208 0.01 8690620 RUG - SE308 0.01 8690638 RUG - SSA08 0.01 8690646 RUG - SSB08 0.01 8690653 RUG - PD111 0.01 8690655 RUG - PD130 0.01 8690661 RUG - PD107 0.01 8690679 RUG - PO111 0.01 8690687 RUG - PO107 0.01 8690695 RUG - SSB02 0.01 8690703 RUG - CA211 0.01 8690711 RUG - CA207 0.01 8690729 RUG - CA108 0.01 8690737 RUG - RHC03 0.01 8690745 RUG - RMAO8 0.01 8690752 RUG - CA103 0.01 8690760 RUG - RML11 0.01 8690778 RUG - RUX02 0.01 8690794 RUG - PB111 0.01 8690802 RUG - CA117 0.01 8690810 RUG - RXV02 0.01 8690828 RUG - CA114 0.01 8690836 RUG - RVL02 0.01 8690844 RUG - RVX20 0.01 8690851 RUG - RHX02 0.01 8690857 RUG - RVX60 0.01 8690869 RUG - SE301 0.01 8690877 RUG - RHL02 0.01 8690885 RUG - RUC17 0.01 8690893 RUG - RMX02 0.01 8690901 RUG - SE217 0.01 8690919 RUG - RML02 0.01 8690927 RUG - SSCO1 0.01 8690935 RUG - RLX02 0.01 8690976 RUG - RMX03 0.01 8690984 RUG - RMX08 0.01 8691008 RUG - RMX04 0.01 8691016 RUG - RUL07 0.01 8691024 RUG - RUL02 0.01 8691032 RUG - RUL03 0.01 8691040 RUG - RUL08 0.01 8691057 RUG - RUL11 0.01 8691065 RUG - RUL04 0.01 8691073 RUG - RVX07 0.01 8691081 RUG - RVX02 0.01 8691099 RUG - RVX03 0.01 8691107 RUG - RVX08 0.01 8691110 RUG - RVX10 0.01 8691115 RUG - RVX11 0.01 8691123 RUG - RVX04 0.01 8691131 RUG - RUG07 0.01 8691149 RUG - RUG02 0.01 8691156 RUG - RUG03 0.01 8691164 RUG - RUG08 0.01 8691172 RUG - RUG11 0.01 8691180 RUG - RUG04 0.01 8691198 RUG - PE111 0.01 8691206 RUG - SE328 0.01 8691214 RUG - SE201 0.01 8691222 RUG - RMX05 0.01 8691230 RUG - SE101 0.01 8691248 RUG - RVX01 0.01 8691255 RUG - RUL17 0.01 8691263 RUG - RHC17 0.01 8691271 RUG - CB101 0.01 8691289 RUG - SSA17 0.01 8691297 RUG - SSB01 0.01 8691305 RUG - RVX17 0.01 8691313 RUG - RMB17 0.01 8691321 RUG - RUL01 0.01 8691339 RUG - RMA10 0.01 8691347 RUG - CA110 0.01 8691354 RUG - RVB10 0.01 8691362 RUG - CB104 0.01 8691370 RUG - RHA10 0.01 8691388 RUG - RUA10 0.01 8691396 RUG - RMX10 0.01 8691404 RUG - RVC01 0.01 8691412 RUG - RHC11 0.01 8691420 RUG - RVCOD 0.01 8691438 CMG - D1101 0.01 8691446 RUG - RUL10 0.01 8691453 RUG - CCA10 0.01 8691461 RUG - LC120 0.01 8691475 RUG - LC160 0.01 8691479 RUG - LB130 0.01 8691482 RUG - LB160 0.01 8691487 RUG - CC110 0.01 8691495 CMG - D1203 0.01 8691503 RUG - RUC20 0.01 8691506 RUG - RVC04 0.01 8691511 RUG - RHC20 0.01 8691517 RUG - RUC60 0.01 8691527 RUG - RHC60 0.01 8691529 RUG - RHC0D 0.01 8691537 RUG - RMB20 0.01 8691541 RUG - RMB60 0.01 8691545 RUG-PA160 0.01 8691552 RUG - CB110 0.01 8691560 CMG - A0103 0.01 8691578 RUG - RMC10 0.01 8691586 RUG - CC120 0.01 8691594 RUG - RHB10 0.01 8691602 RUG - RMB04 0.01 8691610 RUG - LB120 0.01 8691628 RUG - RHX20 0.01 8691634 RUG - RHX60 0.01 8691636 CMG - C0301 0.01 8691644 CMG - A0201 0.01 8691651 CMG - A0202 0.01 8691669 CMG - A0203 0.01 8691677 CMG - A0401 0.01 8691685 CMG - A0404 0.01 8691693 CMG - A0405 0.01 8691701 CMG - A0501 0.01 8691719 CMG - A0601 0.01 8691727 CMG - A0603 0.01 8691735 CMG - A0801 0.01 8691743 CMG - A0901 0.01 8691750 CMG - A1101 0.01 8691768 CMG - A1201 0.01 8691776 CMG - A1202 0.01 8691784 CMG - A1301 0.01 8691792 CMG - A1302 0.01 8691800 CMG - C0506 0.01 8691818 CMG - A1401 0.01 8691826 CMG - A1402 0.01 8691834 CMG - A1501 0.01 8691842 CMG - A1502 0.01 8691859 RUG - HC110 0.01 8691867 RUG - HB120 0.01 8691869 RUG - HB130 0.01 8691872 RUG - HB160 0.01 8691883 CMG - A1801 0.01 8691891 CMG - A1802 0.01 8691909 RUG - HD110 0.01 8691917 CMG - A1901 0.01 8691925 CMG - A1902 0.01 8691933 RUG - SE230 0.01 8691941 RUG - HD114 0.01 8691950 RUG - LD101 0.01 8691958 RUG - LD110 0.01 8691966 RUG - LD120 0.01 8691974 RUG - PC110 0.01 8691982 RUG - SSA10 0.01 8691990 RUG - HD120 0.01 8691992 RUG - HD130 0.01 8692006 RUG - SSB17 0.01 8692014 CMG - D0206 0.01 8692022 CMG - D0207 0.01 8692030 RUG - SE310 0.01 8692048 RUG - RUB20 0.01 8692052 RUG - RUB30 0.01 8692055 RUG - HB110 0.01 8692056 RUG - RUB60 0.01 8692063 RUG - RVC10 0.01 8692071 RUG - CB120 0.01 8692089 RUG - HB10D 0.01 8692097 RUG - SE317 0.01 8692105 RUG - RVA08 0.01 8692113 CMG - A1903 0.01 8692121 RUG - PB120 0.01 8692137 RUG - PB130 0.01 8692139 RUG - LC110 0.01 8692147 RUG - LB110 0.01 8692154 RUG - RMA17 0.01 8692162 RUG - HE110 0.01 8692170 RUG - LC104 0.01 8692188 RUG - PC120 0.01 8692190 RUG - PC130 0.01 8692193 RUG - PC160 0.01 8692204 RUG - PB110 0.01 8692212 RUG - LC130 0.01 8692220 CMG - A2001 0.01 8692238 CMG - A2002 0.01 8692246 CMG - A2101 0.01 8692253 RUG - RMA20 0.01 8692261 RUG - RMA30 0.01 8692279 RUG - RMA60 0.01 8692287 CMG - B0101 0.01 8692295 CMG - B0102 0.01 8692303 RUG - SE110 0.01 8692311 CMG - B0103 0.01 8692329 CMG - B0105 0.01 8692337 CMG - B0201 0.01 8692345 CMG - B0202 0.01 8692352 CMG - B0203 0.01 8692360 CMG - B0204 0.01 8692378 CMG - B0205 0.01 8692386 CMG - B0206 0.01 8692394 CMG - B0301 0.01 8692402 CMG - B0302 0.01 8692410 CMG - B0303 0.01 8692428 CMG - B0401 0.01 8692436 CMG - B0402 0.01 8692444 CMG - B0403 0.01 8692451 CMG - B0404 0.01 8692469 CMG - B0405 0.01 8692477 CMG - B0501 0.01 8692485 CMG - B0502 0.01 8692493 CMG - B0503 0.01 8692501 RUG - RMB10 0.01 8692519 CMG - B0504 0.01 8692527 CMG - B0505 0.01 8692535 CMG - B0601 0.01 8692543 CMG - B0602 0.01 8692550 CMG - B0603 0.01 8692568 CMG - B0604 0.01 8692576 CMG - B0701 0.01 8692584 CMG - B0703 0.01 8692592 CMG - B0801 0.01 8692600 CMG - B0802 0.01 8692618 CMG - B0803 0.01 8692626 CMG - B0805 0.01 8692634 CMG - B0902 0.01 8692642 CMG - B0904 0.01 8692659 CMG - B1101 0.01 8692667 CMG - B1201 0.01 8692675 CMG - B1202 0.01 8692683 CMG - B1203 0.01 8692691 CMG - B1301 0.01 8692709 RUG - RVA10 0.01 8692717 CMG - B1302 0.01 8692725 CMG - B1303 0.01 8692733 CMG - B1401 0.01 8692741 RUG - HD160 0.01 8692758 CMG - B1502 0.01 8692766 CMG - B1601 0.01 8692774 CMG - B1602 0.01 8692782 CMG - B1603 0.01 8692790 CMG - B1701 0.01 8692808 CMG - B1702 0.01 8692816 CMG - B1703 0.01 8692824 CMG - B1704 0.01 8692832 CMG - B1801 0.01 8692840 CMG - B1802 0.01 8692857 CMG - B1803 0.01 8692865 CMG - B1901 0.01 8692873 CMG - B1902 0.01 8692881 RUG - PD110 0.01 8692899 CMG - B1903 0.01 8692907 CMG - B2001 0.01 8692915 CMG - B2003 0.01 8692923 CMG - B2101 0.01 8692931 CMG - C0101 0.01 8692949 CMG - C0103 0.01 8692956 CMG - C0104 0.01 8692964 CMG - C0105 0.01 8692972 CMG - C0107 0.01 8692980 RUG - RUB10 0.01 8692998 RUG - PD140 0.01 8693004 RUG - SE210 0.01 8693012 RUG - RVA12 0.01 8693020 RUG - PA110 0.01 8693038 RUG - RUAOD 0.01 8693046 RUG - PA120 0.01 8693053 CMG - C0108 0.01 8693061 CMG - C0201 0.01 8693079 CMG - C0202 0.01 8693087 CMG - C0203 0.01 8693095 CMG - C0204 0.01 8693103 CMG - C0205 0.01 8693111 CMG - C0302 0.01 8693129 CMG - C0401 0.01 8693137 CMG - C0402 0.01 8693145 CMG - C0404 0.01 8693152 CMG - C0405 0.01 8693160 CMG - C0501 0.01 8693178 CMG - C0502 0.01 8693186 CMG - C0601 0.01 8693194 CMG - C0603 0.01 8693202 CMG - C0701 0.01 8693210 CMG - C0801 0.01 8693228 CMG - C0802 0.01 8693236 CMG - C0803 0.01 8693244 CMG - C0805 0.01 8693251 CMG - C0901 0.01 8693269 CMG - C0902 0.01 8693277 CMG - C0904 0.01 8693285 CMG - C1001 0.01 8693293 CMG - C1002 0.01 8693301 CMG - C1101 0.01 8693319 CMG - C1201 0.01 8693327 CMG - C1202 0.01 8693335 CMG - C1203 0.01 8693343 CMG - C1301 0.01 8693350 CMG - C1302 0.01 8693368 CMG - C1303 0.01 8693376 CMG - C1401 0.01 8693384 CMG - C1403 0.01 8693392 RUG - RUC10 0.01 8693400 CMG - C1501 0.01 8693418 CMG - C1502 0.01 8693426 CMG - C1503 0.01 8693434 CMG - C1601 0.01 8693442 CMG - C1602 0.01 8693459 CMG - C1702 0.01 8693467 CMG - C1703 0.01 8693475 CMG - C1801 0.01 8693483 CMG - C1803 0.01 8693491 CMG - C1901 0.01 8693509 CMG - C1902 0.01 8693517 CMG - C1903 0.01 8693525 CMG - C2001 0.01 8693533 CMG - C2101 0.01 8693541 CMG - D0101 0.01 8693558 CMG - D0102 0.01 8693566 CMG - D0103 0.01 8693574 CMG - D0201 0.01 8693582 CMG - D0203 0.01 8693590 CMG - D0401 0.01 8693608 CMG - D0402 0.01 8693616 CMG - D0403 0.01 8693624 CMG - D0404 0.01 8693632 CMG - D0405 0.01 8693640 CMG - D0501 0.01 8693657 CMG - D0506 0.01 8693665 CMG - D0601 0.01 8693673 CMG - D0801 0.01 8693681 CMG - D0902 0.01 8693699 CMG - D1001 0.01 8693707 CMG - D1102 0.01 8693715 CMG - D1201 0.01 8693723 CMG - D1301 0.01 8693731 CMG - D1302 0.01 8693749 CMG - D1303 0.01 8693756 CMG - D1401 0.01 8693764 CMG - D1501 0.01 8693772 CMG - D1503 0.01 8693780 CMG - D1701 0.01 8693798 CMG - D1702 0.01 8693806 CMG - D1703 0.01 8693814 CMG - D1801 0.01 8693822 CMG - D1802 0.01 8693830 CMG - D1803 0.01 8693848 CMG - D1901 0.01 8693855 CMG - D1903 0.01 8693863 CMG - D2001 0.01 8693871 CMG - D2101 0.01 8693889 CMG - B2002 0.01 8693897 CMG - A1102 0.01 8693905 CMG - B1004 0.01 8694549 CMG - D1002 0.01 8694556 CMG - A0301 0.01 8694564 CMG - D0904 0.01 8694572 CMG - D0903 0.01 8694580 CMG - D0901 0.01 8695009 CMG - A0104 0.01 8695017 CMG - A0105 0.01 8695025 CMG - A0106 0.01 8695033 CMG - A0107 0.01 8695041 CMG - A0108 0.01 8695058 CMG - A0109 0.01 8695066 CMG - A0110 0.01 8695074 CMG - A0111 0.01 8695082 CMG - A0112 0.01 8695090 CMG - A0113 0.01 8695108 CMG - A0114 0.01 8695116 CMG - A0303 0.01 8695124 CMG - A0503 0.01 8695132 CMG - A0504 0.01 8695140 CMG - A0505 0.01 8695157 CMG - A0702 0.01 8695165 CMG - A0704 0.01 8695173 CMG - A0705 0.01 8695181 CMG - A0803 0.01 8695199 CMG - A0804 0.01 8695207 CMG - A0806 0.01 8695215 CMG - A0904 0.01 8695223 CMG - A1003 0.01 8695231 CMG - A1303 0.01 8695249 CMG - A1601 0.01 8695256 CMG - A1602 0.01 8695264 CMG - A1701 0.01 8695272 CMG - A1703 0.01 8695280 CMG - B0113 0.01 8695298 CMG - C0114 0.01 8695306 CMG - C0503 0.01 8695314 CMG - C0505 0.01 8695322 CMG - C0705 0.01 8695330 CMG - D0106 0.01 8695348 CMG - D0109 0.01 8695355 CMG - D0303 0.01 8695363 CMG - D0705 0.01 8695371 CMG - D0803 0.01 8695378 CMG - D0802 0.01 8695389 CMG - A0304 0.01 8695397 CMG - C0704 0.01 8695405 CMG - A0205 0.01 8695413 CMG - C0113 0.01 8695421 CMG - A0802 0.01 8695439 CMG - D0804 0.01 8695447 CMG - D0107 0.01 8695454 CMG - C0109 0.01 8695462 CMG - A0903 0.01 8695470 CMG - A0604 0.01 8695488 CMG - B1003 0.01 8695496 CMG - A0703 0.01 8695504 CMG - A0604 0.01 8695512 CMG - A0805 0.01 8695520 CMG - D0701 0.01 8695538 CMG - D2004 0.01 8695546 CMG - D0604 0.01 8695553 CMG - A0302 0.01 8695561 CMG - D0304 0.01 8695579 CMG - A0403 0.01 8695587 CMG - B0704 0.01 8695595 CMG - A0506 0.01 8695603 CMG - D1704 0.01 8695611 CMG - D0104 0.01 8695629 CMG - A0102 0.01 8695637 CMG - A0206 0.01 8695645 CMG - D1602 0.01 8695652 CMG - B0110 0.01 8695660 CMG - A0402 0.01 8695678 CMG - A1803 0.01 8695686 CMG - B0104 0.01 8695694 CMG - D1003 0.01 8695702 CMG - D0704 0.01 8695710 CMG - D0702 0.01 8695728 CMG - D0805 0.01 8695736 CMG - A0207 0.01 8695744 CMG - D0302 0.01 8695751 CMG - D0806 0.01 8695769 CMG - B0107 0.01 8695777 CMG - A1403 0.01 8695785 CMG - B0207 0.01 8695793 CMG - A1404 0.01 8695801 CMG - D0110 0.01 8695819 CMG - A1603 0.01 8695827 CMG - A1704 0.01 8695835 CMG - A1002 0.01 8695843 CMG - A1001 0.01 8695850 CMG - C0303 0.01 8695868 CMG - C0304 0.01 8695876 CMG - D2003 0.01 8695884 CMG - A0902 0.01 8695892 CMG - A0602 0.01 8695900 CMG - D1404 0.01 8695918 CMG - A1503 0.01 8695926 CMG - D0602 0.01 8695934 CMG - A2004 0.01 8695942 CMG - D0105 0.01 8695959 CMG - D1502 0.01 8695967 CMG - D2002 0.01 8695975 CMG - D1902 0.01 8695983 CMG - C1404 0.01 8695991 RUG - PA101 0.01 8696007 CMG - C1102 0.01 8696015 CMG - C1802 0.01 8696023 CMG - C0504 0.01 8696031 CMG - D0108 0.01 8696049 CMG - C0602 0.01 8696056 CMG - C0403 0.01 8696064 CMG - A1203 0.01 8696072 CMG - D0105 0.01 8696080 CMG - C0110 0.01 8696098 CMG - B0903 0.01 8696106 CMG - A0502 0.01 8696114 CMG - C0206 0.01 8696122 CMG - D1202 0.01 8696130 RUG - ESI10 0.01 8696148 CMG - A0101 0.01 8696155 CMG - C2004 0.01 8696163 CMG - C2002 0.01 8696171 CMG - B0806 0.01 8696189 CMG - C1504 0.01 8696197 CMG - C2003 0.01 8696205 RUG - CA120 0.01 8696213 RUG - RUL20 0.01 8696221 RUG - CA124 0.01 8696225 RUG - RUL60 0.01 8696239 CMG - D0502 0.01 8696247 RUG - ES114 0.01 8696254 RUG - RULOD 0.01 8696262 RUG - CA130 0.01 8696270 CMG - A0701 0.01 8696276 RUG - CA160 0.01 8696288 CMG - D0603 0.01 8696296 CMG - C0106 0.01 8696304 CMG - D1403 0.01 8696312 CMG - B0804 0.01 8696320 RUG - CA104 0.01 8696338 CMG - C1402 0.01 8696346 CMG - D1402 0.01 8696387 CMG - D1603 0.01 8696395 CMG - C1701 0.01 8696403 CMG - A0204 0.01 8696411 CMG - C1704 0.01 8696429 CMG - A1504 0.01 8696437 CMG - B0106 0.01 8696445 CMG - C0102 0.01 8696452 RUG - ES130 0.01 8696454 RUG - ES160 0.01 8696460 CMG - C1603 0.01 8696478 CMG - CO102 0.01 8696486 CMG - D0301 0.01 8696502 RUG - ES110 0.01 8696510 CMG - C0604 0.01 8696528 RUG - RMC20 0.01 8696536 CMG - C0703 0.01 8696544 CMG - C0207 0.01 8696546 CMG - C0702 0.01 8696551 RUG - ES120 0.01 8696569 CMG - C0806 0.01 8696577 CMG - B1002 0.01 8696585 CMG - B1001 0.01 8696593 CMG - C0804 0.01 8696601 CMG - A1702 0.01 8696619 CMG - D1601 0.01 8696627 CMG - C0903 0.01 8696635 CMG - B0901 0.01 8696643 CMG - D1504 0.01 8696650 CMG - C0603 0.01 8696809 CMG - C1003 0.01 8696817 CMG - A2003 0.01 8696841 CMG - D0205 0.01 8696858 CMG - D0204 0.01 8696866 CMG - D0202 0.01 8697005 CMG - B0109 0.01 8697013 RUG - RVC20 0.01 8697021 CMG - B0108 0.01 8697027 RUG - RVC60 0.01 8697039 RUG - RVC30 0.01 8697278 RUG - RUA20 0.01 8697281 RUG - RUA40 0.01 8697286 RUG - RUA60 0.01 8697294 RUG - RHA20 0.01 8697302 CMG - D0506 0.01 8697310 CMG - D0703 0.01 8697328 RUG - 1B111 0.01 8697336 CMG - A0207 0.01 8697344 CMG - B2004 0.01 8697369 RUG - RMB01 0.01 8697377 RUG - RMX01 0.01 8697385 RUG - RML17 0.01 8697393 RUG - RHA17 0.01 8697401 RUG - CA102 0.01 8697419 RUG - RHB17 0.01 8697427 RUG - RVL05 0.01 8697435 RUG - RHB01 0.01 8697443 RUG - RVL17 0.01 8697450 RUG - RMA01 0.01 8697468 RUG - RML01 0.01 8697476 RUG - SSA01 0.01 8697484 RUG - RHA01 0.01 8697492 RUG - RVA17 0.01 8697500 RUG - RVB01 0.01 8697518 RUG - RVB17 0.01 8697526 RUG - RHC01 0.01 8697534 RUG - RMC01 0.01 8697542 RUG - RML05 0.01 8697559 RUG - CA101 0.01 8697567 RUG - RUA17 0.01 8697583 RUG - RVA01 0.01 8697591 RUG - RVL01 0.01 8697609 CMG - D0505 0.01 8697617 RUG - RMA05 0.01 8697625 RUG - RHA30 0.01 8697633 RUG - RUB17 0.01 8697641 RUG - RHB20 0.01 8697658 CMG - B0304 0.01 8697666 RUG - RML20 0.01 8697668 RUG - RML30 0.01 8697672 RUG - RML60 0.01 8697674 RUG - RHB05 0.01 8697682 RUG - RHA0D 0.01 8697690 RUG - RVA30 0.01 8697691 RUG - RVA60 0.01 8697716 RUG - CD120 0.01 8697724 RUG - CD140 0.01 8697732 RUG - CD150 0.01 8697740 CMG - B1102 0.01 8697747 RUG - CD160 0.01 8697757 RUG - RHA60 0.01 8697807 RUG - RVB20 0.01 8697815 RUG - RVB60 0.01 8697856 RUG - CD110 0.01 8697864 RUG - CB130 0.01 8697872 RUG - BA130 0.01 8697878 RUG - CB160 0.01 8697880 CMG - D0504 0.01 8697898 CMG - D0503 0.01 8697906 RUG - RVA20 0.01 8697914 CMG - B0702 0.01 8697922 CMG - D0505 0.01 8697930 RUG - BB110 0.01 8697948 RUG - BA110 0.01 8697955 RUG - CC130 0.01 8697963 CMG - B0506 0.01 8697973 RUG - CC160 0.01 8697989 RUG - PA130 0.01 8698003 RUG - RMCOD 0.01 8698508 RUG - CE110 0.01 8698557 RUG - RHB30 0.01 8698565 CMG - B1504 0.01 8698573 RUG - RHB60 0.01 8698854 CMG - B1503 0.01 8698862 CMG - B1404 0.01 8698870 CMG - B1403 0.01 8698888 CMG - B1402 0.01 8698896 RUG - CE120 0.01 8700007 PDPM - CAPE0 0.01 8700015 PDPM - GAXE0 0.01 8700023 PDPM - LAQC0 0.01 8700031 PDPM - KAPC0 0.01 8700049 PDPM - CAPD0 0.01 8700056 PDPM - CAKB0 0.01 8700064 PDPM - KCCC0 0.01 8700072 PDPM - CAQD0 0.01 8700080 PDPM - KFPC0 0.01 8700098 PDPM - BACC1 0.01 8700106 PDPM - GAPF1 0.01 8700114 PDPM - CAPE1 0.01 8700122 PDPM - ODKD1 0.01 8700130 PDPM - GAPC1 0.01 8700148 PDPM - CDPF1 0.01 8700155 PDPM - IEUF1 0.01 8700163 PDPM - KAPF1 0.01 8700171 PDPM - GAPD1 0.01 8700189 PDPM - CAPD1 0.01 8700197 PDPM - BDIE1 0.01 8700205 PDPM - KAPC1 0.01 8700213 PDPM - KBXF1 0.01 8700221 PDPM - KAQC1 0.01 8700239 PDPM - KDPD1 0.01 8700247 PDPM - LAQC1 0.01 8700254 PDPM - KAGD1 0.01 8700262 PDPM - CAPF1 0.01 8700270 PDPM - GBCC1 0.01 8700288 PDPM - ZZZZZ 0.01 8700296 PDPM - KDKD1 0.01 8700304 PDPM - KAGC1 0.01 8700312 PDPM - GACB1 0.01 8700320 PDPM - KCXF1 0.01 8700338 PDPM - KDPC1 0.01 8700346 PDPM - PGYF1 0.01 8700353 PDPM - CDPC1 0.01 8700361 PDPM - GAXD1 0.01 8700379 PDPM - FAMF1 0.01 8700387 PDPM - GAPE1 0.01 8700395 PDPM - KAPD1 0.01 8700403 PDPM - KEPE1 0.01 8700411 PDPM - GAXF1 0.01 8700429 PDPM - KBPF1 0.01 8700437 PDPM - CDPE1 0.01 8700445 PDPM - JBMD1 0.01 8700452 PDPM - FACC1 0.01 8700460 PDPM - GDCE1 0.01 8700478 PDPM - MJMD1 0.01 8700486 PDPM - ODPF1 0.01 8700494 PDPM - OEKE1 0.01 8700502 PDPM - KACC1 0.01 8700510 PDPM - KDPF1 0.01 8700528 PDPM - KCKC1 0.01 8700536 PDPM - KDXF1 0.01 8700544 PDPM - GCXF1 0.01 8700551 PDPM - FAXF1 0.01 8700569 PDPM - FEPD1 0.01 8700577 PDPM - CAPC1 0.01 8700585 PDPM - IDEA1 0.01 8700593 PDPM - IDEB1 0.01 8700601 PDPM - KAXF1 0.01 8700619 PDPM - GDXF1 0.01 8700627 PDPM - OGPF1 0.01 8700635 PDPM - CBPD1 0.01 8700643 PDPM - KCCC1 0.01 8700650 PDPM - KAGA1 0.01 8700668 PDPM - KEXF1 0.01 8700676 PDPM - GBGE1 0.01 8700684 PDPM - HAQB1 0.01 8700692 PDPM - BAMD1 0.01 8700700 PDPM - KBGD1 0.01 8700718 PDPM - IDIC1 0.01 8700726 PDPM - KAKC1 0.01 8700734 PDPM - KAKD1 0.01 8700742 PDPM - JBKF1 0.01 8700759 PDPM - KACB1 0.01 8700767 PDPM - FCIE1 0.01 8700775 PDPM - BBPE1 0.01 8700783 PDPM - KCKD1 0.01 8700791 PDPM - KFKE1 0.01 8700809 PDPM - ABME1 0.01 8700817 PDPM - OLGC1 0.01 8700825 PDPM - KAKB1 0.01 8700833 PDPM - KAGE1 0.01 8700841 PDPM - JBGC1 0.01 8700858 PDPM - CFPD1 0.01 8700866 PDPM - AFMF1 0.01 8700874 PDPM - KBPB1 0.01 8700882 PDPM - IGMC1 0.01 8700890 PDPM - FAND1 0.01 8700908 PDPM - IEUE1 0.01 8700916 PDPM - KDPE1 0.01 8700924 PDPM - JFIC1 0.01 8700932 PDPM - GAGE1 0.01 8700940 PDPM - KAGB1 0.01 8700957 PDPM - GECD1 0.01 8700965 PDPM - KAPE1 0.01 8700973 PDPM - JECD0 0.01 8700981 PDPM - KEGA1 0.01 8700999 PDPM - KACD1 0.01 8701005 PDPM - MHCB1 0.01 8701013 PDPM - OGXF1 0.01 8701021 PDPM - JAEB1 0.01 8701047 PDPM - IHCC1 0.01 8701054 PDPM - KAKE1 0.01 8701062 PDPM - KECC1 0.01 8701070 PDPM - IAMB1 0.01 8701088 PDPM - IFCC1 0.01 8701096 PDPM - KFPD1 0.01 8701104 PDPM - KBPE1 0.01 8701112 PDPM - KDKF1 0.01 8701120 PDPM - JAED1 0.01 8701138 PDPM - ICCB1 0.01 8701146 PDPM - KDCE1 0.01 8701153 PDPM - OEPE1 0.01 8701161 PDPM - GFXF1 0.01 8701179 PDPM - KDCC1 0.01 8701187 PDPM - FDMF1 0.01 8701195 PDPM - KDGA1 0.01 8701203 PDPM - KAXD1 0.01 8701211 PDPM - FAUF1 0.01 8701229 PDPM - NGCE1 0.01 8701237 PDPM - JBPE1 0.01 8701245 PDPM - CDPD1 0.01 8701252 PDPM - CAGC1 0.01 8701260 PDPM - AFMD1 0.01 8701278 PDPM - OECC1 0.01 8701286 PDPM - KCKE1 0.01 8701294 PDPM - KDKC1 0.01 8701302 PDPM - JGEC1 0.01 8701310 PDPM - CCPE1 0.01 8701328 PDPM - FAEC1 0.01 8701336 PDPM - GBPD1 0.01 8701344 PDPM - IEMD1 0.01 8701351 PDPM - KEPC1 0.01 8701369 PDPM - IBID1 0.01 8701377 PDPM - GCPF1 0.01 8701385 PDPM - FDPF1 0.01 8701393 PDPM - KFKC1 0.01 8701401 PDPM - KAXE1 0.01 8701419 PDPM - KCCB1 0.01 8701427 PDPM - CDCE1 0.01 8701435 PDPM - MLMF1 0.01 8701443 PDPM - JAMF1 0.01 8701450 PDPM - ODGE1 0.01 8701468 PDPM - JFMF1 0.01 8701476 PDPM - GEPF1 0.01 8710485 PDPM - AEMF1 0.01 8710493 PDPM - EDIE1 0.01 8710501 PDPM - GAGC1 0.01 8710519 PDPM - JFKE1 0.01 8710527 PDPM - NDEC1 0.01 8710535 PDPM - NEXE1 0.01 8710543 PDPM - MLMD1 0.01 8710550 PDPM - IFIE1 0.01 8710568 PDPM - GDGE1 0.01 8710576 PDPM - NLED1 0.01 8710584 PDPM - OHCC1 0.01 8710592 PDPM - BDPC1 0.01 8710600 PDPM - GASF1 0.01 8710618 PDPM - KDGC1 0.01 8710626 PDPM - OIXF1 0.01 8710634 PDPM - KFGE1 0.01 8710642 PDPM - IECB1 0.01 8710659 PDPM - BAIE1 0.01 8710667 PDPM - KEKE1 0.01 8710675 PDPM - KCPC1 0.01 8710683 PDPM - GBPF1 0.01 8710691 PDPM - NGPD1 0.01 8710709 PDPM - IEMC1 0.01 8710717 PDPM - JDMD1 0.01 8710725 PDPM - IFIE1 0.01 8710733 PDPM - KEKF1 0.01 8710741 PDPM - GACC1 0.01 8710758 PDPM - NEKD1 0.01 8710766 PDPM - KBQC1 0.01 8710774 PDPM - CBPE1 0.01 8710782 PDPM - GDPC1 0.01 8710790 PDPM - JAPD1 0.01 8710808 PDPM - FAME1 0.01 8710816 PDPM - KEPD1 0.01 8710824 PDPM - IDMD1 0.01 8710832 PDPM - GBXF1 0.01 8710840 PDPM - KBKE1 0.01 8710857 PDPM - BCMD1 0.01 8710865 PDPM - FDPC1 0.01 8710873 PDPM - KBCC1 0.01 8710881 PDPM - JACC1 0.01 8710899 PDPM - KBGC1 0.01 8710907 PDPM - KBPD1 0.01 8710915 PDPM - FDEE1 0.01 8710923 PDPM - JFID1 0.01 8710931 PDPM - NKMC1 0.01 8710949 PDPM - KFCB1 0.01 8710956 PDPM - FAPD1 0.01 8710964 PDPM - NDCC1 0.01 8710972 PDPM - LBQC1 0.01 8710980 PDPM - JACE1 0.01 8710998 PDPM - LESF1 0.01 8711004 PDPM - JBKE1 0.01 8711012 PDPM - OAXE1 0.01 8711020 PDPM - JEUF1 0.01 8711038 PDPM - KDPB1 0.01 8711046 PDPM - FEPE1 0.01 8711053 PDPM - NICC1 0.01 8711061 PDPM - KBKF1 0.01 8711079 PDPM - IFIF1 0.01 8711087 PDPM - PDQD1 0.01 8711095 PDPM - JFXE1 0.01 8711103 PDPM - CAXF1 0.01 8711111 PDPM - MJIE1 0.01 8711129 PDPM - GFPF1 0.01 8711137 PDPM - ODPD1 0.01 8711145 PDPM - KDGD1 0.01 8711152 PDPM - JDED1 0.01 8711160 PDPM - KIPD1 0.01 8711178 PDPM - KAPB1 0.01 8711186 PDPM - ODXF1 0.01 8711194 PDPM - IEID1 0.01 8711202 PDPM - FFMD1 0.01 8711210 PDPM - KEPB1 0.01 8711228 PDPM - OEXF1 0.01 8711236 PDPM - IDME1 0.01 8711244 PDPM - KAYE1 0.01 8711251 PDPM - OHPC1 0.01 8711269 PDPM - JFPD1 0.01 8711277 PDPM - JBGB1 0.01 8711285 PDPM - OLPD1 0.01 8711293 PDPM - GAGB1 0.01 8711301 PDPM - OEGC1 0.01 8711319 PDPM - EEMD1 0.01 8711327 PDPM - BDPE1 0.01 8711335 PDPM - KEKD1 0.01 8711343 PDPM - JDME1 0.01 8711350 PDPM - GACE1 0.01 8711368 PDPM - IFMB1 0.01 8711376 PDPM - KAQB1 0.01 8711384 PDPM - OGGD1 0.01 8711392 PDPM - KCGB1 0.01 8711400 PDPM - GAPB1 0.01 8711418 PDPM - JFCE1 0.01 8711426 PDPM - KCPD1 0.01 8711434 PDPM - KFPC1 0.01 8711442 PDPM - GDSE1 0.01 8711459 PDPM - JFMD1 0.01 8711467 PDPM - KAKF1 0.01 8711475 PDPM - KBKC1 0.01 8711483 PDPM - JACA1 0.01 8711491 PDPM - OHGE1 0.01 8711509 PDPM - MLEC1 0.01 8711517 PDPM - FECB1 0.01 8711525 PDPM - JFMC1 0.01 8711533 PDPM - NGCC1 0.01 8711541 PDPM - KBPC1 0.01 8711558 PDPM - EEUF1 0.01 8711566 PDPM - JDIS1 0.01 8711574 PDPM - JDIF1 0.01 8711582 PDPM - JIMD1 0.01 8711590 PDPM - JBCB1 0.01 8711608 PDPM - CAPB1 0.01 8711616 PDPM - JACD1 0.01 8711624 PDPM - OGKC1 0.01 8711632 PDPM - JAME1 0.01 8711640 PDPM - OKPD1 0.01 8711657 PDPM - IDCB1 0.01 8711665 PDPM - GBGC1 0.01 8711673 PDPM - KHKE1 0.01 8711681 PDPM - GACD1 0.01 8711699 PDPM - KDGE1 0.01 8711707 PDPM - OJSE1 0.01 8711715 PDPM - FDPE1 0.01 8711723 PDPM - KCKB1 0.01 8711731 PDPM - CCCD1 0.01 8711749 PDPM - ODKB1 0.01 8711756 PDPM - JAGD1 0.01 8711764 PDPM - KAQE1 0.01 8711772 PDPM - FAPC1 0.01 8711780 PDPM - ODXE1 0.01 8711798 PDPM - FDKF1 0.01 8711806 PDPM - KGGC1 0.01 8711814 PDPM - GEKE1 0.01 8711822 PDPM - JAKD1 0.01 8711830 PDPM - GAXE1 0.01 8711848 PDPM - FACD1 0.01 8711855 PDPM - KBCD1 0.01 8711863 PDPM - KDXE1 0.01 8711871 PDPM - NDKF1 0.01 8711889 PDPM - CACD1 0.01 8711897 PDPM - IFHE1 0.01 8711905 PDPM - OEGD1 0.01 8711913 PDPM - JAPB1 0.01 8711921 PDPM - FBKC1 0.01 8711939 PDPM - JAXF1 0.01 8711947 PDPM - OHPF1 0.01 8711954 PDPM - FAIE1 0.01 8711962 PDPM - LAQD1 0.01 8711970 PDPM - FDMD1 0.01 8711988 PDPM - MKMB1 0.01 8711996 PDPM - AAMF1 0.01 8712002 PDPM - OLPF1 0.01 8712010 PDPM - ODKF1 0.01 8712028 PDPM - FBGA1 0.01 8712036 PDPM - KBXD1 0.01 8712044 PDPM - FCPC1 0.01 8712051 PDPM - IECC1 0.01 8712069 PDPM - IDCC1 0.01 8712077 PDPM - FCPC1 0.01 8712085 PDPM - JEPE1 0.01 8712093 PDPM - JAPC1 0.01 8712101 PDPM - KEKB1 0.01 8712119 PDPM - FAKB1 0.01 8712127 PDPM - GDCB1 0.01 8712135 PDPM - FDCE1 0.01 8712143 PDPM - JAUE1 0.01 8712150 PDPM - OEXD1 0.01 8712168 PDPM - GDXE1 0.01 8712176 PDPM - CDXF1 0.01 8712184 PDPM - GCPC1 0.01 8712192 PDPM - JCKD1 0.01 8712200 PDPM - JDUE1 0.01 8712218 PDPM - GDPE1 0.01 8712226 PDPM - OGPD1 0.01 8712234 PDPM - CDPF1 0.01 8712242 PDPM - KACE1 0.01 8712259 PDPM - KDGB1 0.01 8712267 PDPM - GAKC1 0.01 8712275 PDPM - FEUD1 0.01 8712283 PDPM - NLMF1 0.01 8712291 PDPM - ODPE1 0.01 8712309 PDPM - JAMB1 0.01 8712317 PDPM - KFCC1 0.01 8712333 PDPM - JFKB1 0.01 8712341 PDPM - OGPE1 0.01 8712358 PDPM - JEMB1 0.01 8712366 PDPM - KFPF1 0.01 8712374 PDPM - OIPF1 0.01 8712382 PDPM - JAGB1 0.01 8712390 PDPM - NIIF1 0.01 8712408 PDPM - JCCC1 0.01 8712416 PDPM - JDPC1 0.01 8712424 PDPM - FEUE1 0.01 8712432 PDPM - AEMC1 0.01 8712440 PDPM - KDKE1 0.01 8712457 PDPM - MHID1 0.01 8712465 PDPM - OIKE1 0.01 8712473 PDPM - IDIB1 0.01 8712481 PDPM - JEGB1 0.01 8712499 PDPM - FDMC1 0.01 8712507 PDPM - NDKC1 0.01 8712515 PDPM - JFKD1 0.01 8712523 PDPM - KAKA1 0.01 8712531 PDPM - JBCD1 0.01 8712549 PDPM - FAMD1 0.01 8712556 PDPM - EFMC1 0.01 8712564 PDPM - GDGB1 0.01 8712572 PDPM - GDPD1 0.01 8712580 PDPM - GDPF1 0.01 8712598 PDPM - BDEE1 0.01 8712606 PDPM - GBGB1 0.01 8712614 PDPM - JDIC1 0.01 8712622 PDPM - BAPF1 0.01 8712630 PDPM - AFIE1 0.01 8712648 PDPM - KECD1 0.01 8712655 PDPM - OHXE1 0.01 8712663 PDPM - GDCD1 0.01 8712671 PDPM - GDKD1 0.01 8712689 PDPM - MIMC1 0.01 8712697 PDPM - GAKD1 0.01 8712705 PDPM - OCPF1 0.01 8712713 PDPM - MLIB1 0.01 8712721 PDPM - KFGB1 0.01 8712739 PDPM - BAMF1 0.01 8712747 PDPM - OAPF1 0.01 8712754 PDPM - OAPC1 0.01 8712762 PDPM - FBCC1 0.01 8712770 PDPM - ADMD1 0.01 8712788 PDPM - JFUE1 0.01 8712796 PDPM - JDKC1 0.01 8712804 PDPM - BFMC1 0.01 8712812 PDPM - JBKB1 0.01 8712820 PDPM - KDCB1 0.01 8712838 PDPM - JDXF1 0.01 8712846 PDPM - JDKD1 0.01 8712853 PDPM - JAEC1 0.01 8712861 PDPM - NKMF1 0.01 8712879 PDPM - JECC1 0.01 8712887 PDPM - FBID1 0.01 8712895 PDPM - FBIB1 0.01 8712903 PDPM - IFMC1 0.01 8712911 PDPM - FAGA1 0.01 8712929 PDPM - FEME1 0.01 8712937 PDPM - JEPD1 0.01 8712945 PDPM - NHMC1 0.01 8712952 PDPM - JAMC1 0.01 8712960 PDPM - JFUF1 0.01 8712978 PDPM - JEXE1 0.01 8712986 PDPM - IGCB1 0.01 8712994 PDPM - OHXD1 0.01 8713000 PDPM - AEMB1 0.01 8713018 PDPM - CBCD1 0.01 8713026 PDPM - OEPC1 0.01 8713034 PDPM - KDCD1 0.01 8713042 PDPM - EDIF1 0.01 8713059 PDPM - IEEF1 0.01 8713067 PDPM - GEXF1 0.01 8713075 PDPM - MKMD1 0.01 8713083 PDPM - OHKD1 0.01 8713091 PDPM - OKGC1 0.01 8713109 PDPM - KECE1 0.01 8713117 PDPM - FDCD1 0.01 8713125 PDPM - MJIC1 0.01 8713133 PDPM - JAMD1 0.01 8713141 PDPM - JDMC1 0.01 8713158 PDPM - FDIE1 0.01 8713166 PDPM - KDBA1 0.01 8713174 PDPM - MGBC1 0.01 8713182 PDPM - MKMC1 0.01 8713190 PDPM - JECE1 0.01 8713208 PDPM - NHCD1 0.01 8713216 PDPM - IDID1 0.01 8713224 PDPM - NHCC1 0.01 8713232 PDPM - JDCB1 0.01 8713240 PDPM - JDCE1 0.01 8713257 PDPM - IDCA1 0.01 8713265 PDPM - CACC1 0.01 8713273 PDPM - NKCE1 0.01 8713281 PDPM - NHPE1 0.01 8713299 PDPM - KBXE1 0.01 8713307 PDPM - KHCE1 0.01 8713315 PDPM - EDCE1 0.01 8713323 PDPM - IBMD1 0.01 8713331 PDPM - BEEB1 0.01 8713349 PDPM - FAMC1 0.01 8713356 PDPM - JDCC1 0.01 8713364 PDPM - JBME1 0.01 8713372 PDPM - JBMC1 0.01 8713380 PDPM - OHPD1 0.01 8713398 PDPM - KEGD1 0.01 8713406 PDPM - OKKE1 0.01 8713414 PDPM - NJMD1 0.01 8713422 PDPM - OACE1 0.01 8713430 PDPM - CBPF1 0.01 8713448 PDPM - MKMF1 0.01 8713455 PDPM - OAPD1 0.01 8713463 PDPM - KEXE1 0.01 8713471 PDPM - FDKD1 0.01 8713489 PDPM - OGPC1 0.01 8713497 PDPM - JEIC1 0.01 8713505 PDPM - IAIA1 0.01 8713513 PDPM - IACD1 0.01 8713521 PDPM - NKXF1 0.01 8713539 PDPM - OHCB1 0.01 8713547 PDPM - JEMC1 0.01 8713554 PDPM - JDPB1 0.01 8713562 PDPM - IHMD1 0.01 8713570 PDPM - FDMB1 0.01 8713588 PDPM - IEEB1 0.01 8713596 PDPM - NAMB1 0.01 8713604 PDPM - JECB1 0.01 8713612 PDPM - IEMB1 0.01 8713620 PDPM - FDKC1 0.01 8713638 PDPM - BAME1 0.01 8713646 PDPM - JBPB1 0.01 8713653 PDPM - BDID1 0.01 8713661 PDPM - JDPD1 0.01 8713679 PDPM - JAIC1 0.01 8713687 PDPM - JDMB1 0.01 8713695 PDPM - CAGE1 0.01 8713703 PDPM - GDKC1 0.01 8713711 PDPM - FAMB1 0.01 8713729 PDPM - JBEB1 0.01 8713737 PDPM - MJED1 0.01 8713745 PDPM - IECE1 0.01 8713752 PDPM - OHSF1 0.01 8713760 PDPM - JAIE1 0.01 8713778 PDPM - MKEB1 0.01 8713786 PDPM - JEID1 0.01 8713794 PDPM - FACE1 0.01 8713802 PDPM - FAPB1 0.01 8713810 PDPM - GDPB1 0.01 8713828 PDPM - IGEC1 0.01 8713836 PDPM - EEIC1 0.01 8713844 PDPM - NKME1 0.01 8713851 PDPM - OBCC1 0.01 8713869 PDPM - CDGC1 0.01 8713877 PDPM - OHXF1 0.01 8713885 PDPM - JACB1 0.01 8713893 PDPM - OEPD1 0.01 8713901 PDPM - JECD1 0.01 8713919 PDPM - JAKE1 0.01 8713927 PDPM - BDME1 0.01 8713935 PDPM - OAPE1 0.01 8713943 PDPM - CACE1 0.01 8713950 PDPM - ODKC1 0.01 8713968 PDPM - OEPF1 0.01 8713976 PDPM - JDID1 0.01 8713984 PDPM - EEIE1 0.01 8713992 PDPM - NEUE1 0.01 8714008 PDPM - GECC1 0.01 8714016 PDPM - FBME1 0.01 8714024 PDPM - JDIE1 0.01 8714032 PDPM - OKXF1 0.01 8714040 PDPM - ODPC1 0.01 8714057 PDPM - OEKD1 0.01 8714065 PDPM - NAME1 0.01 8714073 PDPM - OGGE1 0.01 8714081 PDPM - OBCB1 0.01 8714099 PDPM - JHCB1 0.01 8714107 PDPM - OKPC1 0.01 8714115 PDPM - JBMF1 0.01 8714123 PDPM - GAGD1 0.01 8714131 PDPM - IBIC1 0.01 8714149 PDPM - MKID1 0.01 8714156 PDPM - MHIC1 0.01 8714164 PDPM - GBXE1 0.01 8714172 PDPM - NHXF1 0.01 8714180 PDPM - MHMD1 0.01 8714198 PDPM - OKPB1 0.01 8714206 PDPM - ODPB1 0.01 8714214 PDPM - OBPE1 0.01 8714222 PDPM - GDKB1 0.01 8714230 PDPM - FDUF1 0.01 8714248 PDPM - CDXD1 0.01 8714255 PDPM - EDMC1 0.01 8714263 PDPM - JBPF1 0.01 9000001 ADMINISTRATION PNEUMOCCAL VACCINE 569.00 9000027 IMMUNIZATION ADMIN 569.00 9000035 ADMINISTRATION HEPATITIS B VACCINE 569.00 9400003 LM A-C JOINTS, BILATERAL 1,126.00 9400011 LM ABDOMEN 1 VIEW 360.00 9400029 LM ABDOMEN 2 VIEWS 1,083.00 9400037 LM ABDOMEN, 3 VIEWS 1,623.00 9400052 LM ANKLE, 2V LIMITED, RIGHT 625.00 9400060 LM ANKLE, 2V LIMITED, LEFT 625.00 9400078 LM ANKLE, COMPLETE, RIGHT 849.00 9400086 LM ANKLE, COMPLETE, LEFT 849.00 9400094 LM BONE AGE 439.00 9400102 LM BONE LENGTH (SCANOGRAM) 892.00 9400110 LM BONE SURVEY, COMPLETE >1YEAR 3,198.00 9400128 LM BONE SURVEY, INFANT <1 YEAR 2,061.00 9400136 LM CHEST, 1V (PA) 739.00 9400144 LM CHEST, 2V 914.00 9400151 LM CHEST, COMPLETE MIN OF 4 VIEWS 764.00 9400169 LM CLAVICLE, RIGHT 739.00 9400177 LM CLAVICLE, LEFT 739.00 9400201 LM ELBOW, 2V LIMITED, RIGHT 625.00 9400219 LM ELBOW, 2V LIMITED, LEFT 625.00 9400227 LM ELBOW, COMPLETE, RIGHT 827.00 9400235 LM ELBOW, COMPLETE, LEFT 827.00 9400243 LM EYE FOR FOREIGN BODY, RIGHT 1,010.00 9400250 LM EYE FOR FOREIGN BODY, LEFT 1,010.00 9400268 LM FACIAL BONES, 2V LIMITED 1,294.00 9400276 LM FACIAL BONES, COMPLETE 1,626.00 9400284 LM FACIAL W NASAL BONES 1,626.00 9400292 LM FEMUR, 2V COMPLETE,RIGHT 948.00 9400300 LM FEMUR, 2V COMPLETE, LEFT 948.00 9400318 LM FINGERS LEFT 582.00 9400326 LM FOOT, 2V LIMITED, RIGHT 625.00 9400334 LM FOOT, 2V LIMITED, LEFT 625.00 9400342 LM FOOT, COMPLETE, RIGHT 849.00 9400359 LM FOOT, COMPLETE, LEFT 849.00 9400367 LM FOREARM, COMPLETE, RIGHT 827.00 9400375 LM FOREARM, COMPLETE, LEFT 827.00 9400383 LM FOREIGN BODY, IV INFANT <1 YEAR 888.00 9400391 LM HAND, 2V LIMITED, RIGHT 625.00 9400409 LM HAND, 2V LIMITED, LEFT 625.00 9400417 LM HAND, COMPLETE, RIGHT 849.00 9400425 LM HAND, COMPLETE, LEFT 849.00 9400433 LM HEEL, 2V, RIGHT 827.00 9400441 LM HEEL, 2V, LEFT 827.00 9400458 LM HIP, UNILATERAL,2V RIGHT 503.00 9400466 LM HIP, UNILATERAL,2V,LEFT 503.00 9400474 LM HIP, BILATERAL 2-3 VIEW 503.00 9400482 LM HUMERUS AP & LAT, RIGHT 827.00 9400490 LM HUMERUS AP & LAT, LEFT 827.00 9400508 LM KNEE, 2V LIMITED, RIGHT 613.00 9400516 LM KNEE, 2V LIMITED, LEFT 613.00 9400524 LM KNEE, 4V COMPLETE, RIGHT 939.00 9400532 LM KNEE, 4V COMPLETE, LEFT 939.00 9400540 LM KNEES, BOTH STANDING 939.00 9400557 LM LWR EXTREMITY 2V, INFANT <1 YR 360.00 9400565 LM MANDIBLE 2V LIMITED 884.00 9400573 LM MASTOID, 3-5 VIEWS 595.00 9400581 LM NASAL BONES 995.00 9400599 LM NECK WITH SOFT TISSUE 646.00 9400607 LM ORBITS BILATERAL 1,593.00 9400615 LM PELVIS, 1OR 2V 927.00 9400623 LM PELVIS, 3V 995.00 9400631 LM PELVIS & HIPS 2V, INFANT <1YEAR 503.00 9400649 LM RIBS, BILATERAL 1,086.00 9400656 LM RIBS, UNILATERAL, RIGHT 1,086.00 9400664 LM RIBS, UNILATERAL, LEFT 1,086.00 9400672 LM SACROILIAC MIN 3V 962.00 9400680 LM SACRUM & COCCYX 1,064.00 9400698 LM SCAPULA , RIGHT 915.00 9400706 LM SCAPULA , LEFT 915.00 9400714 LM SHOULDER, 1V, LIMITED, RIGHT 625.00 9400722 LM SHOULDER, 1V, LIMITED, LEFT 625.00 9400730 LM SHOULDER, 4V COMPLETE, RIGHT 827.00 9400748 LM SHOULDER, 4V COMPLETE, LEFT 827.00 9400755 LM SINUS, 2V, LIMITED 724.00 9400763 LM SINUS, COMPLETE 1,695.00 9400771 LM SKULL, 1V LIMITED 995.00 9400789 LM SKULL, 3V COMPLETE 1,767.00 9400797 LM SPINE, LS BENDING VIEWS ONLY 1,360.00 9400805 LM SPINE LS COMPLETE INC BENDING 1,754.00 9400813 LM SPN LMBSCRL CMPLT MIN 4 VIEWS 1,754.00 9400821 LM SPINE 1V ANY LEVEL 608.00 9400839 LM SPINE, CERVICAL 2V LIMITED 906.00 9400847 LM SPINE CERVICAL, COMPLETE 1,271.00 9400854 LM SPINE CERVICAL W/FLEXION 1,571.00 9400862 LM SPINE, CERVICAL W/OBLIQUE 1,271.00 9400870 LM SPINE, LUMBAR 3V 1,648.00 9400888 LM SPINE, THORACIC 3V 1,069.00 9400896 LM SPINE,THORACOLUMBAR JUNCTION 2V 914.00 9400912 LM SPINE (SCOLIOSIS) SUP&ERECT 1,417.00 9400920 LM STERNOCLAVICULAR JNT(S) MIN 3 VW 842.00 9400938 LM STERNUM 2V 914.00 9400946 LM TIBIA/FIBULA 2V, RIGHT 849.00 9400953 LM TIBIA/FIBULA 2V, LEFT 849.00 9400961 LM TMJ BILATERAL 1,417.00 9400979 LM TOES, RIGHT 625.00 9400987 LM TOES, LEFT 625.00 9400995 LM UPR EXTRM,2V,INFNT<1YR+C78 550.00 9401001 LM WRIST, 2V LIMITED, RIGHT 625.00 9401019 LM WRIST, 2V LIMITED, LEFT 625.00 9401027 LM WRIST, COMPLETE, RIGHT 849.00 9401035 LM WRIST, COMPLETE, LEFT 849.00 9401043 LM FINGERS RIGHT 582.00 9401050 LM MANDIBLE 595.00 9401068 LM RIBS UNILAT RT W CHEST PA 1,396.00 9401076 LM RIBS UNILAT LT W CHEST PA 1,396.00 9401084 LM MANDIBLE COMPLETE 595.00 9471285 LM-PT MEDI-CAL TRTMNT ADD'L 15 MIN 225.00 9480989 LM-PT PED DEV TESTING EXTENDED 449.00 9480997 LM-PT PED DEV TESTING LIMITED 449.00 9481011 LM-PT MANUAL THERAPY 15 MINS 225.00 9481029 LM-PT WC EVALUATION - COMPREHENSIVE 449.00 9481037 LM-PT WC EVLTN - EXTENDED 449.00 9481045 LM-PT WC EVALUATION - INTERMEDIATE 449.00 9481052 LM-PT WC ERGNMC EVAL AT JOB SITE 449.00 9481060 LM-PT WC RE-EVAL - EXTENDED 449.00 9481078 LM-PT WC RE-EVAL - INTERMEDIATE 449.00 9481086 LM-PT WC RE-EVAL - LIMITED 449.00 9481094 LM-PT WC ELCTRCL STIM - UNATTND 107.00 9481102 LM-PT WC TRACTION - MECHANICAL 107.00 9481110 LM-PT WC THERPTC EXRCS-INTL 30 MIN 449.00 9481128 LM-PT WC THERP EXER ADD 15MIN 225.00 9481136 3M-PT WC GAIT TRN-INTL 30 MIN 449.00 9481144 LM-PT WC GAIT TRN-ADD 15MIN 225.00 9481151 LM-PT WC ULTRASOUND UP TO 30 MIN 107.00 9481177 LM-PT WC TRACTION MANUAL UP TO 30 M 449.00 9481185 LM-PT WC SOFT TISS MOBILIZATION 449.00 9481193 LM-PT WC INDIV INST/TRN UP TO 30MIN 449.00 9481201 LM-PT WC IONTOPHORESIS UP TO 30 MIN 225.00 9481219 LM-PT WC E-STIM MANUAL 15M EA 449.00 9481227 LM-PT WC CONTRAST BATH UP TO 30 MIN 449.00 9481250 LM-PT MEDI-CAL EVAL INIT 30 MIN 225.00 9481268 LM-PT MEDI-CAL EVAL ADD'L 15 MIN 112.00 9481276 LM-PT MEDI-CAL TRTMNT INIT 30 MIN 449.00 9481284 LM-PT WC JT MOBLIZATION 449.00 9481292 LM-OT EVALUATION 45 MIN 449.00 9481300 LM-OT EVALUATION 60 MIN 449.00 9481318 LM-OT EVALUATION 75 MIN 449.00 9481326 LM-OT SPLINT CHECKOUT EA 15 MIN 225.00 9481334 LM-OT RE-EVALUATION 225.00 9481342 LM-OT ADL/SELF MNGMNT TRAIN 15 MIN 225.00 9481359 LM-OT THERAPEUTIC EXRCSE 15 MIN 225.00 9481367 LM-OT MANUAL THERAPY EA 15 MIN 225.00 9481383 LM-OT SPLNT FIT & TRN EA 15 MIN 225.00 9481391 LM-OT THERAPEUTIC ACTIVITY EA15MIN 225.00 9481409 LM-OT CONTRAST BATH EA 15 MIN 107.00 9481417 LM-OT ELECTRICAL STIM-UNATTENDED 107.00 9481425 LM-OT E-STIM MANUAL EA 15 MIN 225.00 9481433 LM-OT PARAFFIN 107.00 9481441 LM-OT ULTRASOUND EA 15 MIN 107.00 9481458 LM-OT IONTOPHORESIS EA 15 MIN 225.00 9481508 LM-OT WC ERGONOMIC EVAL AT JOB SITE 449.00 9481516 LM-OT WC SPLINT EVALUATION 30 MIN 449.00 9481524 LM-OT WC SPLINT EVAL ADD'L 15 MINS 225.00 9481565 LM-OT WC PARAFFIN 107.00 9481573 LM-OT WC ELECTRICAL STIM - UNATTND 107.00 9481581 LM-OT WC CONTRAST BATH UP TO 30 MIN 107.00 9481599 LM-OT WC THEREX 30 MINS 449.00 9481607 LM-OT WC THEREX ADD'L 15 MIN 225.00 9481615 LM-OT WC ADL/SELF MGMT TRAIN 30 MIN 449.00 9481623 LM-OT WC ADL/SLF MGMT TRN ADD 15MIN 225.00 9481631 LM-OT WC SPLINT FITTING & TRAINING 449.00 9481649 LM-OT WC ULTRASOUND UP TO 30 MIN 107.00 9481656 LM-OT WC IONTOPHORESIS UP TO 30 MIN 225.00 9481664 LM-OT WC E-STIM MAN UP TO 15M EA 449.00 9481672 LM-OT WC INDIVIDUALIZED INST 30MIN 449.00 9481706 LM-OT MEDI-CAL OT EVAL-INIT 30 MIN 225.00 9481714 LM-OT MEDI-CAL OT EVAL-ADD'L 15 MIN 112.00 9481722 LM-OT MEDI-CAL OT TRTMNT-INIT 30MIN 449.00 9481730 LM-OT MEDI-CAL OT TRTMNT-ADD'L15MIN 225.00 9481748 LM-OT PED DEV TESTING EXTENDED 449.00 9481755 LM-OT PED DEV TESTING LIMITED 449.00 9481763 LM-WC OT CHECK OUT INIT 30 MIN 449.00 9481771 LM-WC OT CHECK OUT ADD 15 MIN 225.00 9481789 LM-OT WC STND PHYS PERF TST 30 MIN 449.00 9481797 LM-OT WC STND PHYS PERF TST AD 15 M 225.00 9481805 LM-OT FLUIDTHERAPY 107.00 9481813 LM-PT WC FLUIDTHERAPY 107.00 9481821 LM CANALITH REPOSITIONING 449.00 9481839 LM-PT GROUP EXERCISE 15 MIN EA 225.00 9481847 LM PT EVAL LOW COMPLEXITY 409.00 9481854 LM KX PT EVAL LOW COMPLEXITY 409.00 9481862 LM PT EVAL MOD COMPLEXITY 449.00 9481870 LM KX PT EVAL MOD COMPLEXITY 449.00 9481888 LM PT EVAL HIGH COMPLEXITY 489.00 9481896 LM KX PT EVAL HIGH COMPLEXITY 489.00 9481904 LM PT REEVAL 225.00 9481912 LM KX PT REEVAL 225.00 9481920 LM OT EVAL LOW COMPLEXITY 409.00 9481938 LM KX OT EVAL LOW COMPLEXITY 409.00 9481946 LM OT EVAL MOD COMPLEXITY 449.00 9481953 LM KX OT EVAL MOD COMPLEXITY 449.00 9481961 LM OT EVAL HIGH COMPLEXITY 489.00 9481979 LM KX OT EVAL HIGH COMPLEXITY 489.00 9481987 LM OT REEVAL 225.00 9481995 LM KX OT REEVAL 225.00 9482001 LM-PT DEV TESTING 1ST HR 449.00 9482019 LM-PT DEV TESTING EACH ADD 30 MIN 250.00 9482027 LM-PT MANUAL THERAPY 15 MIN-CQ 225.00 9482035 LM-PT E-DTIM UNATTENDED - CQ 107.00 9482043 LM-PT TRACTION-CQ 107.00 9482050 LM-PT ULTRASOUND 15 MIN EA-CQ 107.00 9482068 LM-PT IONTOPHORESIS 15M-CQ 225.00 9482076 LM-PT CONTRAST BATH 15M-CQ 107.00 9482084 LM-PT ELECT-STIM-PNT/PROBE 15M-CQ 225.00 9482092 LM-PT THERAPEUTIC EXERCISE 15M-CQ 225.00 9482100 LM-PT GAIT TRAINING 15MIN-CQ 225.00 9482118 LM-PT ADL TRAINING 15MIN-CQ 225.00 9482126 LM-PT THERAPEUTIC ACTIVITY-CQ 225.00 9482134 LM-CANALITH REPOSITIONING-CQ 449.00 9482142 LM-OT SPLINT CHECKOUT EA 15 MIN-CO 225.00 9482159 LM-OT ADL/SELF MNGMNT TRAIN 15M-CO 225.00 9482167 LM-OT THERAPEUTIC EXERCISE 15M-CO 225.00 9482175 LM-OT MANUAL THERAPY EA 15 MIN-CO 225.00 9482191 LM-OT SPLINT FIT & TRN EA 15MIN-CO 225.00 9482209 LM-OT THERAPEUTIC ACTVTY EA 15M-CO 225.00 9482217 LM-OT CONTRAST BATH EA 15 MIN-CO 107.00 9482225 LM-OT ELECTRICAL-STIM-UNATTENDED-CO 107.00 9482233 LM-OT E-STIM MANUAL EA 15MIN-CO 225.00 9482241 LM-OT PARAFFIN-CQ 107.00 9482258 LM-OT ULTRASOUND EA 15MIN-CO 107.00 9482266 LM-OT IONTOPHORESIS EA 15MIN-CO 225.00 9482274 LM-OT FLUIDTHERAPY-CO 107.00 9486002 LM-KX PT MANUAL THERAPY 15 MIN 225.00 9486010 LM-KX OT SPLINT CHECKOUT EA 15 MIN 225.00 9486028 LM-KX OT ADL/SELF MNGMNT TRAIN 15 M 225.00 9486036 LM-KX OT THERAPEUTIC EXRCSE 15 MIN 225.00 9486044 LM-KX OT MANUAL THERAPY EA 15 MIN 225.00 9486069 LM-KX OT SPLINT FIT&TRN EA 15 MIN 225.00 9486077 LM-KX OT THERAPEUTIC ACTVTY EA 15 M 225.00 9486085 LM-KX OT CONTRAST BATH EA 15 MIN 107.00 9486093 LM-KX OT ELECTRICAL STIM-UNATTENDED 107.00 9486101 LM-KX OT E-STIM MANUAL EA 15 MIN 225.00 9486119 LM-KX OT PARAFFIN 107.00 9486127 LM-KX OT ULTRASOUND EA 15 MIN 107.00 9486135 LM-KX OT IONTOPHORESIS EA 15 MIN 225.00 9486143 LM-KX OT FLUIDTHERAPY 107.00 9486150 LM-KX CANALITH REPOSITIONING 449.00 9486168 LM-KX PT E-STIM UNATTENDED 107.00 9486176 LM-KX PT TRACTION 107.00 9486184 LM-KX PT ULTRASOUND 15 MIN EA 107.00 9486192 LM-KX PT IONTOPHORESIS 15 MIN 225.00 9486200 LM-KX PT CONTRAST BATH 15 MIN 107.00 9486218 LM-KX PT ELCTRCL STIM-PNT/PROBE 15M 225.00 9486226 LM-KX PT THRPETC EXERCISE 15 MIN 225.00 9486234 LM-KX PT GAIT TRAINING 15 MIN 225.00 9486242 LM-KX PT ADL TRAINING 15 MIN 225.00 9486259 LM-KX PT THERAPEUTIC ACTIVITY 225.00 9486267 KX-LM-OT EVALUATION 45 MIN 449.00 9486275 KX-LM-OT EVALUATION 60 MIN 449.00 9486283 KX-LM-OT EVALUATION 75 MIN 449.00 9486291 KX-LM-OT PED DEV TESTING EXTENDED 449.00 9486309 KX-LM-OT PED DEV TESTING LIMITED 449.00 9486317 KX-LM-OT RE-EVALUATION 225.00 9486325 KX-LM-PT EVALUATION 120 MINS 449.00 9486333 KX-LM-PT EVALUATION 45 MIN 449.00 9486341 KX-LM-PT EVALUATION 60 MIN 449.00 9486358 KX-LM-PT EVALUATION 75 MIN 449.00 9486366 KX-LM-PT EVALUATION 90 MIN 449.00 9486374 KX-LM-PT PED DEV TESTING EXTENDED 449.00 9486382 KX-LM-PT PED DEV TESTING LIMITED 449.00 9486390 KX-LM-PT RE-EVALUATION 225.00 9486408 LM-KX CANALITH REPOSITIONING-CQ 449.00 9486416 LM-KX PT ADL TRAINING 15M-CQ 225.00 9486424 LM-KX PT CONTRAST BATH 15 MIN-CQ 107.00 9486432 LM-KX PT E-STIM-PNT/PROBE 15 MIN-CQ 225.00 9486440 LM-KX PT E-STIM UNATTENDED-CQ 107.00 9486457 LM-KX PT GAIT TRAINING 15 MIN-CQ 225.00 9486465 LM-KX PT IONTOPHORESIS 15 MIN-CQ 225.00 9486473 LM-KX PT MANUAL THERAPY 15MIN-CQ 225.00 9486481 LM-KX PT THERAPEUTIC ACTIVITY-CQ 225.00 9486499 LM-KX PT THERAPEUTIC EXERCS 15M-CQ 225.00 9486507 LM-KX PT TRACTION-CQ 107.00 9486515 LM-KX PT ULTRASOUND 15MIN EA-CQ 107.00 9486523 LM-KX OT ADL/SELF MNGMNT TRN 15M-CO 225.00 9486549 LM-KX OT CONTRAST BATH EA 15MIN-CO 107.00 9486556 LM-KX OT ELECTRC-STIM UNATTENED-CO 107.00 9486564 LM-KX OT E-STIM MANUAL EA 15 MIN-CO 225.00 9486572 LM-KX OT FLUIDTHERAPY-CO 107.00 9486580 LM-KX OT IONTOPHORESIS EA 15MIN-CO 225.00 9486598 LM-KX OT MANUAL THERAPY EA 15 M-CO 225.00 9486606 LM-KX OT PARAFFIN-CO 107.00 9486614 LM-KX OT SPLINT CHECKOUT EA 15M-CO 225.00 9486622 LM-KX OT SPLINT FIT & TRN EA15M-CO 225.00 9486630 LM-KX OT THERAPTC ACTIVITY EA15M-CO 225.00 9486648 LM-KX OT THERAPEUTIC EXERCS 15M-CO 225.00 9486655 LM-KX OT ULTRASOUND EA 15 MIN-CO 107.00 9487000 LM-GY-PT MANUAL THERAPY 15 MIN 225.00 9487018 LM-GY-OT SPLINT CHECKOUT 15MIN 225.00 9487026 LM-GY-OT ADL/SELF MNGMNT TRAIN 15 M 225.00 9487034 LM-GY-OT THERAPEUTIC EXERCISE 15MIN 225.00 9487042 LM-GY-OT MANUAL THERAPY EA 15 MIN 225.00 9487067 LM-GY-OT SPLNT FIT&TRN EA 15MIN 225.00 9487075 LM-GY-OT THERAPEUTIC ACTVTY EA 15 M 225.00 9487083 LM-GY-OT CONTRAST BATH EA 15M 107.00 9487091 LM-GY-OT ELECTRICAL STIM-UNATTENDED 107.00 9487109 LM-GY-OT E-STIM MANUAL EA 15 MIN 225.00 9487117 LM-GY-OT PARAFFIN 107.00 9487125 LM-GY-OT ULTRASOUND EA 15 MIN 107.00 9487133 LM-GY-OT IONTOPHORESIS EA 15 MIN 225.00 9487141 LM-GY-OT FLUIDTHERAPY 107.00 9487158 LM-GY-PT CANALITH REPOSITIONING 449.00 9487166 LM-GY-PT E-STIM UNATTENDED 107.00 9487174 LM-GY-PT TRACTION 107.00 9487182 LM-GY-PT ULTRASOUND 15 MIN EA 107.00 9487190 LM-GY-PT IONTOPHORESIS 15 MINS 225.00 9487208 LM-GY-PT CONTRAST BATH 15 MINS 107.00 9487216 LM-GY-PT ELCTRCL STIM-PNT/PROBE 15M 225.00 9487224 LM-GY-PT THRPETC EXERCISE 15 MINS 225.00 9487232 LM-GY-PT GAIT TRAINING 15 MINS 225.00 9487240 LM-GY-PT ADL TRAINING 15 MINS 225.00 9487257 LM-GY-PT THERAPEUTIC ACTIVITY 225.00 9487265 GY-LM OT EVALUATION 45 MIN 449.00 9487273 GY-LM OT EVALUATION 60 MIN 449.00 9487281 GY-LM OT EVALUATION 75 MIN 449.00 9487299 GY-LM OT PED DEV TESTING EXTENDED 449.00 9487307 GY-LM OT PED DEV TESTING LIMITED 449.00 9487315 GY-LM OT RE-EVALUATION 225.00 9487323 GY-LM PT EVALUATION 120 MIN 449.00 9487331 GY-LM PT EVALUATION 45 MIN 449.00 9487349 GY-LM PT EVALUATION 60 MIN 449.00 9487356 GY-LM PT EVALUATION 75 MIN 449.00 9487364 GY-LM PT EVALUATION 90 MIN 449.00 9487372 GY-LM PT PED DEV TESTING EXTENDED 449.00 9487380 GY-LM PT PED DEV TESTING LIMITED 449.00 9487398 GY-LM PT RE-EVALUATION 225.00 9488008 LM-GA PT MANUAL THERAPY 15 MIN 225.00 9488016 LM-GA OT SPLINT CHECKOUT EA 15 MIN 225.00 9488024 LM-GA OT ADL/SELF MGNMNT TRAIN 15M 225.00 9488032 LM-GA OT THERAPEUTIC EXERCISE 15MIN 225.00 9488040 LM-GA OT MANUAL THERAPY EA 15 MIN 225.00 9488065 LM-GA OT SPLINT FIT & TRN EA 15 MIN 225.00 9488073 LM-GA OT THERAPEUTIC ACTIVITY EA15M 225.00 9488081 LM-GA OT CONTRAST BATH EA 15 MIN 107.00 9488099 LM-GA OT ELECTRICAL STIM-UNATTENDED 107.00 9488107 LM-GA OT E-STIM MANUAL EA 15 MIN 225.00 9488115 LM-GA OT PARAFFIN 107.00 9488123 LM-GA OT ULTRASOUND EA 15 MIN 107.00 9488131 LM-GA OT IONTOPHORESIS EA 15 MIN 225.00 9488149 LM-GA OT FLUIDTHERAPY 107.00 9488156 LM-GA CANALITH REPOSITIONING 449.00 9488164 LM-GA PT E-STIM UNATTENDED 107.00 9488172 LM-GA PT TRACTION 107.00 9488180 LM-GA PT ULTRASOUND 15 MIN EA 107.00 9488198 LM-GA PT IONTOPHORESIS 15 MIN 225.00 9488206 LM-GA PT CONTRAST BATH 15 MINS 107.00 9488214 LM-GA-PT ELCTRCL STIM-PNT/PROBE 15M 225.00 9488222 LM-GA PT THRPETC EXERCISE 15 MIN 225.00 9488230 LM-GA PT GAIT TRAINING 15 MINS 225.00 9488248 LM-GA PT ADL TRAINING 15 MINS 225.00 9488255 LM-GA PT THERAPEUTIC ACTIVITY 225.00 9488263 GA-LM-OT EVALUATION 45 MIN 449.00 9488271 GA-LM OT EVALUATION 60 MIN 449.00 9488289 GA-LM OT EVALUATION 75 MIN 449.00 9488297 GA-LM OT PED DEV TESTING EXTENDED 449.00 9488305 GA-LM OT PED DEV TESTING LIMITED 449.00 9488313 GA-LM OT RE-EVALUATION 225.00 9488321 GA-LM PT EVALUATION 120 MIN 449.00 9488339 GA-LM PT EVALUATION 45 MIN 449.00 9488347 GA-LM PT EVALUATION 60 MINS 449.00 9488354 GA-LM PT EVALUATION 75 MIN 449.00 9488362 GA-LM PT EVALUATION 90 MIN 449.00 9488370 GA-LM PT PED DEV TESTING EXTENDED 449.00 9488388 GA-LM PT DEV TESTING LIMITED 449.00 9488396 GA-LM PT RE-EVALUATION 225.00 9488404 LM-GA CANALITH REPOSITIONING-CQ 449.00 9488412 LM-GA PT ADL TRAINING 15MIN-CQ 225.00 9488420 LM-GA PT CONTRAST BATH 15M-CQ 107.00 9488438 LM-GA PT E-STIM UNATTENDED-CQ 107.00 9488446 LM-GA PT GAIT TRAINING 15M-CQ 225.00 9488453 LM-GA PT IONTOPHORESIS 15M-CQ 225.00 9488461 LM-GA PT MANUAL THERAPY 15MIN-CQ 225.00 9488479 LM-GA PT THERAPEUTIC ACTIVITY-CQ 225.00 9488487 LM-GA PT THERAPEUTIC EXRCS 15M-CQ 225.00 9488495 LM-GA PT TRACTION-CQ 107.00 9488503 LM-GA PT ULTRASOUND 15M EA-CQ 225.00 9488511 LM-GA PT ELECT-STIM-PNT/PRB 15M-CQ 225.00 9488529 LM-GA OT ADL/SELF MNG TRN 15M-CO 225.00 9488545 LM-GA OT CONTRAST BATH EA 15M-CO 107.00 9488552 LM-GA OT ELECTRC STIM-UNATTENDD-CO 107.00 9488560 LM-GA OT E-STIM MANUAL EA 15 MIN-CO 225.00 9488578 LM-GA OT FLUIDTHERAPY-CO 107.00 9488586 LM-GA OT IONTOPHORESIS EA 15 MIN-CO 225.00 9488594 LM-GA OT MANUAL THERAPY EA 15MIN-CO 225.00 9488602 LM-GA OT PARAFFIN-CO 107.00 9488610 LM-GA OT SPLINT CHECKOUT EA 15M-CO 225.00 9488628 LM-GA OT SPLINT FIT & TRN EA 15M-CO 225.00 9488636 LM-GA OT THERAPTC ACTVTY EA 15M-CO 225.00 9488644 LM-GA OT THERAPEUTIC EXERCS 15M-CO 225.00 9488651 LM-GA OT ULTRASOUND EA 15 MIN-CO 107.00 9489824 LM-PT EVALUATION 45 MIN 449.00 9489832 LM-PT EVALUATION 60 MINS 449.00 9489840 LM-PT EVALUATION 75 MINS 449.00 9489857 LM-PT EVALUATION 90 MINS 449.00 9489865 LM-PT EVALUATION 120 MINS 449.00 9489873 LM-PT RE-EVALUATION 225.00 9489881 LM-PT E-STIM UNATTENDED 107.00 9489899 LM-PT TRACTION 107.00 9489907 LM-PT ULTRASOUND 15 MIN EA 107.00 9489923 LM-PT IONTOPHORESIS 15 MINS 225.00 9489931 LM-PT CONTRAST BATH 15 MINS 107.00 9489949 LM-PT ELCTRCL STIM-PNT/PROBE 15 MIN 225.00 9489956 LM-PT THRPETC EXERCISE 15 MINS 225.00 9489964 LM-PT GAIT TRAINING 15 MINS 225.00 9489972 LM-PT ADL TRAINING 15 MINS 225.00 9489980 LM-PT THERAPEUTC ACTVTY 225.00 9490004 LM-SP/LANG IND TX 15MIN 225.00 9490020 LM-SP/LANG SWALLOW TREATMNT 15 MIN 225.00 9490038 LM-ST DYSPHAGIA EVAL 30MIN 449.00 9490046 LM-SP/LANG IND TX 30MIN 449.00 9490053 LM-SP/LANG IND TX 45MIN 449.00 9490061 LM-SP/LANG IND TX 60MIN 449.00 9490079 LM-ST DYSPHAGIA EVAL 45 MIN 449.00 9490087 LM-ST DYSPHAGIA EVAL 60MIN 449.00 9490095 LM-SP/LANG SWALLOW TREAT 30MIN 449.00 9490103 LM-SP/LANG SWALLOW TREAT 45MIN 449.00 9490111 LM-SP/LANG SWALLOW TREAT 60MIN 449.00 9490145 LM-ST DYSPHAGIA EVAL 75MIN 449.00 9490152 LM-ST DYSPHAGIA EVAL 90MIN 449.00 9490160 LM-SPCH FLUENCY EVAL 75MIN 450.00 9490178 LM-SPCH FLUENCY EVAL 90MIN 450.00 9490186 LM-SPCH FLUENCY EVAL 120MIN 450.00 9490194 LM-SPCH SOUND PROD EVAL 75MIN 450.00 9490202 LM-SP SOUND PROD EVAL 90MIN 450.00 9490210 LM-SP SOUND PROD EVAL 120MIN 450.00 9490228 LM-LANG COMP/EXP EVAL 75MIN 450.00 9490236 LM-LANG COMP/EXP EVAL 90MIN 450.00 9490244 LM-LANG COMP/EXP EVAL 120MIN 450.00 9490251 LM-VOICE/RESNNC ANALYS EVAL 75MIN 450.00 9490269 LM-VOICE/RESNNC ANALYS EVAL 90MIN 450.00 9490277 LM-VOICE/RESNNC ANALYS EVAL 120MIN 450.00 9490285 LM-KX-SPEECH/LANG IND TX 15 MIN 225.00 9490301 LM-KX-SP/LANG SWAL TRT 15MIN 225.00 9490319 LM-KX-SPEECH/LANG IND TX 30MIN 449.00 9490327 LM-KX-SP/LANG IND TX 30MIN 449.00 9490335 LM-KX-SP/LANG IND TX 60MIN 449.00 9490343 LM-KX-SP/LANG SWALLOW TREAT 30MIN 449.00 9490350 LM-KX-SP/LANG SWALLOW TREAT 45MIN 449.00 9490368 LM-KX-SP/LANG SWALLOW TREAT 60MIN 449.00 9490376 LM-KX-ST DYSPHAGIA EVAL 60MIN 449.00 9490384 LM-KX-ST DYSPHAGIA EVAL 75MIN 449.00 9490392 LM-KX-ST DYSPHAGIA EVAL 90MIN 449.00 9490400 LM-KX-ST DYSPHAGIA EVAL 30MIN 449.00 9490418 LM-KX-ST VIDEO FLUORO SWLLW 75MIN 449.00 9490426 LM-KX-ST VIDEO FLUOR SWLLW 60MIN 449.00 9490434 LM-KX-ST VIDEO FLUORO SWLLW 90MIN 449.00 9490442 LM-KX-ST DYSPHAGIA EVAL 45MIN 449.00 9490459 LM-KX-SOUND PROD EVAL(75MIN) 500.00 9490467 LM-KX-SOUND PROD EVAL(90MIN) 525.00 9490475 LM-KX-SOUND PROD EVAL(120MIN) 600.00 9490483 LM-KX-LANG COMPR/EXPRES EVAL(75MIN) 1,000.00 9490491 LM-KX-LANG COMPR/EXPRES EVAL(90MIN) 1,100.00 9490509 LM-KX-LANG COMPR/EXPRES EVAL(120MIN 1,250.00 9490517 LM-KX-BEH & VOICE RESONANCE(75MIN) 450.00 9490525 LM-KX-BEH & VOICE RESONANCE(90MIN) 475.00 9490533 LM-KX-BEH & VOICE RESONANCE(120MIN) 525.00 9490541 LM-KX-AUDIO SCREENING(30MIN) 500.00 9491119 LM GOAL SWALLOWING CJ 0.01 9492232 LM-SP/TX COGNITIVE TR INTL 15 MIN 129.00 9492240 LM-SP/TX COGNITIVE TR EA ADD 15 MIN 125.00 9492257 LM-KX-SP/TX COGNITIVE TR INTL 15MIN 129.00 9492265 LM-KX-SP/TX COGNITIVE TR EA ADD 15M 125.00