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| ITEMNUM
105906 |
ITEMDESC
OBSERVATION – TELE 1ST HOUR |
ITEMPRICE
515.00 |
| 105953 | OBSERVATION – TELE EA ADDL HR | 112.25 |
| 109630 | IV HYDRATION INITIAL | 22.25 |
| 163049 | ZIKA VIRUS IGM (163049) | 75.00 |
| 164125 | GLUTEN SENSITIVITY ANTIBODIES (164125) | 220.00 |
| 400653 | HEP B SURF AB QUANT (006530) | 23.00 |
| 401417 | INSULIN-LIKE GROWTH FAC IGF-2(141770) | 71.46 |
| 506102 | RIBS BILATERAL NO CXR | 545.50 |
| 674174 | CTA HEAD (COW) | 5,117.00 |
| 800593 | WRIST SPLINT MEDIUM LEFT | 79.25 |
| 823239 | PORPHYRINS PLASMA (823239) | 171.25 |
| 823248 | PORPHYRINS FECAL (823248) | 181.00 |
| 1005905 | OBSERVATION – MED-SURG 1ST HOUR | 330.75 |
| 1005906 | OBSERVATION – TELE 1ST HOUR | 515.00 |
| 1005907 | OBSERVATION – TELE EA ADDL HR | 112.25 |
| 1005953 | OBSERVATION – MED-SURG EA ADDL HR | 75.25 |
| 1010061 | DRAINAGE OF SKIN ABSCESS | 464.00 |
| 1010080 | INCIS DRAIN PILONIDAL CYST SIMPLE | 282.00 |
| 1010120 | REM FB SUBQ SIMPLE | 332.75 |
| 1010160 | PUNCTURE DRAINAGE OF LESION | 465.00 |
| 1011042 | DEBRIDE 20 SQ CM | 780.00 |
| 1011740 | EVACUATION OF SUBUNGUAL HEMATOMA | 197.00 |
| 1011760 | REPAIR OF NAIL BED | 500.00 |
| 1012002 | REPAIR SUPERFICIAL WOUND | 560.75 |
| 1012004 | REPAIR SUPERFICIAL WOUND – PROF | 929.00 |
| 1012005 | LAC REPAIR CALF – PROF | 1,121.00 |
| 1012011 | LAC REPAIR SIMPLE | 359.50 |
| 1012013 | SUPERF WOUNDS FACE, EARS 2.6CM TO 5.0CM | 405.00 |
| 1012014 | SUPERF WOUND FACE, EARS 5.1CM TO 7.5CM | 428.00 |
| 1012015 | 7.6 CM TO 12.5 CM | 600.00 |
| 1012032 | LAYER CLOSURE OF WOUNDS | 475.75 |
| 1012034 | PROF REPAIR INT WOUNDS SCALP TRUNK | 978.00 |
| 1012035 | INTERMED WOUNDS SCALP 12.6-20.0 | 522.00 |
| 1012041 | INTERME OF NECK HANDS FEET 2.5CM OR LESS | 508.00 |
| 1012042 | 2.6 CM TO 7.5 CM | 367.00 |
| 1012051 | INTERM FACE EARS TO 2.5 CM | 508.00 |
| 1012052 | 2.6CM TO 5.0CM | 478.00 |
| 1012053 | 5.1 CM TO 7.5 CM | 610.00 |
| 1012054 | 7.6 CM TO 12.5 CM | 794.00 |
| 1013120 | COMPLEX SCALP ARMS LEGS 1.1CM TO 2.5CM | 705.00 |
| 1013121 | COMPLEX REPAIR PROF FEE | 1,600.00 |
| 1013122 | EACH ADDL 5CM OR LESS | 375.00 |
| 1013131 | COMPLEX FOREHEAD CHEEKS MOUTH 1.1-2.5CM | 793.00 |
| 1013132 | COMPLEX FOREHEAD CHEEKS MOUTH 2.6-7.5CM | 1,243.00 |
| 1013133 | EACH ADD 5CM OR LESS | 567.00 |
| 1013151 | COMPLEX EYELIDS NOSE EARS 1.1-2.5CM | 828.00 |
| 1013152 | COMPLEX EYELIDS NOSE EARS 2.6 – 7.5CM | 1,418.00 |
| 1016000 | INITIAL TREATMENT OF BURN(S) | 410.00 |
| 1016020 | TREATMENT OF BURN | 410.00 |
| 1018470 | DERMABOND | 241.50 |
| 1020000 | INCISION OF ABSCESS | 459.50 |
| 1020520 | REMOVAL OF FOREIGN BODY | 1,200.00 |
| 1020600 | SM JOINT INJ | 330.00 |
| 1020605 | INT JOINT INJ | 271.00 |
| 1020610 | ASPIRATION OF JOINT | 491.25 |
| 1021480 | RESET DISLOCATED JAW | 391.50 |
| 1023650 | TREAT SHOULDER DISLOCATION | 504.75 |
| 1024505 | HUMERAL SHAFT FRACT W MANIPULATION | 1,212.00 |
| 1024600 | TREAT ELBOW DISLOCATION | 526.75 |
| 1024640 | ELBOW NURSE MAID | 241.50 |
| 1024655 | RADIAL HEAD NECK FRACT W MANIPULATION | 1,296.00 |
| 1024670 | TREAT ULNAR FRACTURE | 526.75 |
| 1024675 | ULNAR FRACT PROX W MANIPULATION | 1,296.00 |
| 1025505 | RADIAL SHAFT FRACT W MANIPULATION | 1,163.00 |
| 1025535 | ULNAR SHAFT FRACT W MANIPULATION | 733.00 |
| 1025565 | RADIAL&ULNAR SHAFT FRACT W MANIPULATION | 1,394.00 |
| 1025605 | TREAT WRIST FRACTURE | 1,296.00 |
| 1025622 | TREAT WRIST BONE FRACTURE | 526.75 |
| 1026010 | DRAINAGE OF FINGER ABSCESS SIM | 263.25 |
| 1026605 | METACARPAL FRACT SING W MANIPULATION | 586.00 |
| 1026725 | PHALANGEAL SHAFT FRACT W MANIP | 838.00 |
| 1026755 | DISTAL PHALANGEAL FRACT W MANIP | 702.00 |
| 1026770 | TREAT FINGER DISLOCATION | 322.00 |
| 1027550 | TREAT KNEE/TIBIA FRACTURE | 546.50 |
| 1027560 | TREAT KNEECAP DISLOCATION | 425.50 |
| 1027788 | DISTAL FIBULAR FRAC W MANIP | 1,029.00 |
| 1027818 | TRIMALLEOLAR ANKLE FRACT W MANIPULATION | 1,548.00 |
| 1027840 | TREAT ANKLE DISLOCATION | 504.75 |
| 1028515 | NON GREAT TOE FRACT W MANIPULATION | 386.00 |
| 1029075 | CAST SHORT ARM | 593.00 |
| 1029105 | APPLY LONG ARM SPLINT | 422.25 |
| 1029125 | APPLY SHORT ARM SPLINT | 422.25 |
| 1029130 | APPLICATION OF FINGER SPLINT | 404.25 |
| 1029240 | STRAPPING OF SHOULDER | 5.00 |
| 1029260 | STRAPPING ELBOW OR WRIST | 5.00 |
| 1029280 | STRAPPING HAND OR FINGER | 5.00 |
| 1029505 | SPLINT LONG LEG APPLICATION | 253.50 |
| 1029515 | SPLINT LOWER LEG APPLICATION | 253.50 |
| 1029530 | STRAPPING KNEE LEG THIGH | 5.00 |
| 1029540 | STRAPPING ANKLE AND OR FOOT | 5.00 |
| 1029550 | STRAPPING OF TOES | 5.00 |
| 1029580 | UNNA BOOT STRAPPING | 420.00 |
| 1030901 | CONTROL OF NOSEBLEED | 511.50 |
| 1030903 | NASAL HEMMOR ANTER COMPLEX ANY METHOD | 297.00 |
| 1030905 | NASAL HEMORRHAGE POSTERIOR | 465.00 |
| 1031500 | INSERT EMERGENCY AIRWAY | 1,115.50 |
| 1031605 | TRACH EMERG PROCED CRICOTHYROID MEMBRANE | 1,834.00 |
| 1032002 | PNEUMOTHORAX | 841.00 |
| 1032551 | TUBE THORACOSTOMY INCL CONNEC TO DRAIN | 3,044.00 |
| 1036420 | CENTRAL LINE INSERT/JUGULAR | 1,250.00 |
| 1036430 | BLOOD TRANSFUSION O/P | 1,166.00 |
| 1036680 | PLACEMENT OF NEEDLE TRAOUSSEOUS INFUSION | 424.00 |
| 1037195 | THROMBOLYSIS CEREBRAL INTRAVENOUS INFUS | 1,177.00 |
| 1043760 | CHANGE GASTROSTOMY TUBE | 549.00 |
| 1046050 | INCIS DRAIN PERIANAL ABCESS SUPERFICIAL | 464.00 |
| 1046600 | ANOSCOPY | 123.50 |
| 1049080 | PUNCTURE PERITONEAL CAVITY | 1,042.25 |
| 1049083 | PARACENTESIS PERITONEAL CAVITY W/US GUID | 1,042.25 |
| 1051701 | BLADDER IRRIGATION | 358.50 |
| 1051702 | INSERT FOLEY CATH | 233.75 |
| 1051703 | COMPLICATED INDWELLING BLADDER CATHETER | 309.00 |
| 1056420 | DRAINAGE OF GLAND ABCESS | 552.00 |
| 1059409 | VAGINAL DELIVERY NORMAL | 3,930.00 |
| 1062270 | LUMBAR PUNCTURE | 1,069.25 |
| 1064405 | INJ – OCCIPITAL NERVE | 296.75 |
| 1064450 | INJECTION FOR NERVE BLOCK | 649.00 |
| 1065205 | FOREIGN BODY EXTERNAL EYE CONJUNC SUPERF | 145.00 |
| 1065220 | REM FOREIGN BODY EYE | 500.50 |
| 1065222 | FOREIGN BODY CORNEAL W SLIT LAMP | 201.00 |
| 1065435 | CORNEAL EPITHELIUM CHEMOCAUTERIZATION | 900.00 |
| 1069200 | EAR LAVAGE | 241.50 |
| 1069201 | FOREIGN BDY EXTERN AUDITORY CANAL WO GEN | 434.00 |
| 1069210 | IMPACTED EAR WAX REMOVAL W/ INSTRUMENTS | 241.50 |
| 1088001 | ER MANAGEMENT LEVEL 1 | 176.25 |
| 1088002 | ER MANAGEMENT LEVEL 2 | 606.25 |
| 1088003 | ER MANAGEMENT LEVEL 3 | 992.00 |
| 1088004 | ER MANAGEMENT LEVEL 4 | 1,322.50 |
| 1088005 | ER MANAGEMENT LEVEL 5 | 1,983.75 |
| 1088200 | LACERATION REPAIR SIMPLE | 359.50 |
| 1088201 | LACERATION REPAIR INTERMEDIATE | 410.00 |
| 1088202 | LACERATION REPAIR COMPLEX | 1,600.00 |
| 1088888 | IV THERAPY | 324.00 |
| 1090471 | ADMIN IMMUN > 8YR | 154.00 |
| 1090472 | ADMIN IMMUN + ADDITIONAL > 8 YRS | 23.00 |
| 1092950 | CPR HEART/LUNG RESUSCITATION | 1,520.75 |
| 1092960 | CARDIOVERSION ELECTRIC EXT | 1,045.00 |
| 1092961 | CARDIOVERS ELECT CONV OF ARRHYTHMIA | 700.00 |
| 1096360 | IV HYDRATION INITIAL | 165.25 |
| 1096361 | IV HYDRATION SUB | 48.50 |
| 1096366 | DRIP ADDITIONAL HR | 96.00 |
| 1096367 | DRIP ADDITIONAL SEQ | 158.00 |
| 1096368 | DRIP CONCURRENT | 97.00 |
| 1096372 | INJ ADMIN OF THERAPEUTIC | 61.75 |
| 1096374 | IV PUSH INITIAL | 165.25 |
| 1096375 | IV PUSH SUB | 70.50 |
| 1096376 | IVP-PUSH ADDL SEQ | 171.25 |
| 1096523 | PICC LINE IRRIGATION | 35.00 |
| 1099144 | 5 YR > 1ST 30 MIN INTRA SERVICE | 356.00 |
| 1099195 | PHLEBATOMY-THERAPEUTIC | 132.25 |
| 1099291 | CRITICAL CARE | 2,942.75 |
| 1099435 | NEWBORN CARE | 1,284.00 |
| 1500002 | DEPO-PROVERA | 182.00 |
| 1500396 | ALCOHOL ABUSE SCREEN 15-30 MIN | 125.00 |
| 1500434 | TOXCUP DRUG SCREEN CUP-5 PANEL | 20.83 |
| 1501055 | MEDROXYPROG (DEPO-PROVERA) 150MG VL | 182.00 |
| 1501100 | DEXAMETHASONE(DECADRON) 4MG/ML VL | 28.00 |
| 1503420 | CYANOCOBALAMIN(B-12) 1MG/1ML VL | 39.50 |
| 1503940 | MARCAINE | 29.00 |
| 1504315 | FOLEY TRAY W/CATH | 79.25 |
| 1507120 | RHOGAM | – |
| 1507611 | ALBUTEROL(VENTOLIN) 0.5% NEB SOL | 16.00 |
| 1507644 | IPRATROPIUM(ATROVENT) NEB UDV | 16.00 |
| 1510061 | DRAIN SKIN ABSCESS (CLINIC) | 148.09 |
| 1511100 | BIOPSY SKIN LESION | 97.74 |
| 1511101 | SHAVE BIOPSY 1ST | 97.74 |
| 1511102 | SHAVE BIOPSY EA ADD | 63.55 |
| 1511200 | REMOVAL SKIN TAGS | 90.36 |
| 1511765 | TOE NAIL REMOVAL | 398.00 |
| 1514565 | ARM SLING MEDIUM | 61.75 |
| 1517110 | CRYOTHERAPY | 101.35 |
| 1520550 | INJECTION TENDON SHEATH/LIGAMENT | 275.00 |
| 1520551 | INJECTION TENDON ORIGIN/INSERTION | 275.00 |
| 1520552 | TRIGGER POINT INJECTION 1-2 SITES | 490.25 |
| 1520600 | SM JOINT INJ | 70.76 |
| 1520605 | INT JOINT INJ | 71.97 |
| 1520610 | LG JOINT INJ | 76.95 |
| 1525375 | LIDOCAINE 2% | 22.50 |
| 1529065 | CAST LONG ARM | 94.82 |
| 1529075 | CAST SHORT ARM | 90.18 |
| 1529105 | SPLINT LONG ARM | 90.70 |
| 1529125 | SPLINT SHORT ARM | 79.19 |
| 1529425 | CAST SHORT LEG | 86.23 |
| 1569200 | EAR WAX LAVAGE ONLY | 73.00 |
| 1569210 | EAR WAX REMOVAL W/ INTRUMENTATION | 73.00 |
| 1586580 | TUBERCULIN PPD(TUBERSOL) 5U/0.1ML | 28.00 |
| 1590465 | ADMIN IMMUN 1-18YRS | 19.50 |
| 1590466 | ADMIN IMMUN THRU 18 YRS EA ADD’T | 13.00 |
| 1590471 | ADMIN IMMUN > 8YR | 19.50 |
| 1590472 | ADMIN IMMUN + ADDITIONAL > 8 YRS | 13.00 |
| 1590657 | INFLUENZA IMMUN.CHILD | 17.00 |
| 1590707 | MMR VIRUS IMMUN. | 71.50 |
| 1590716 | VARICELLA | 201.00 |
| 1590791 | INITIAL PSYCHIATRIC EVALUATION | 275.00 |
| 1590792 | INITIAL PSYCHIATRIC W MED SERV | 275.00 |
| 1590805 | PSYCHIACTRIC 20-30 MIN W/ MED E/M | 210.00 |
| 1590832 | PSYCHOTHERAPY 30 MINS | 125.00 |
| 1590834 | PSYCHOTHERAPY | 134.00 |
| 1590837 | PSYCHOTHERAPY 60 MIN | 160.50 |
| 1597810 | ACUPUNTURE NO ELECT STEM INITIAL 15 MIN | 135.00 |
| 1597811 | ACUPUNCTURE NO ELECT STEM EACH ADD 15 MI | 70.00 |
| 1598941 | CHIROPRACTIC 3-4 REGIONS | 155.00 |
| 1599202 | NEW PT LEVEL 2 | 170.00 |
| 1599203 | NEW PT LEVEL 3 | 210.00 |
| 1599204 | NEW PT LEVEL 4 | 245.00 |
| 1599211 | NURSE VISIT | 44.00 |
| 1599212 | ESTB PT LEVEL 2 | 135.00 |
| 1599213 | ESTB PT LEVEL 3 | 175.00 |
| 1599214 | ESTB PT LEVEL 4 | 210.00 |
| 1599215 | ESTB PT LEVEL 5 (40 MIN ONE ON ONE) | 225.00 |
| 1599243 | CONSULT – MODERATE | 160.50 |
| 1599244 | CONSULT – HIGH | 187.50 |
| 1599381 | WELL CHILD NEW INFANT-12 MON | 120.50 |
| 1599382 | WELL CHILD NEW 1-4 YRS | 130.00 |
| 1599383 | WELL CHILD NEW-WCE 5-11 YRS | 139.50 |
| 1599384 | WELL CHILD NEW 12-17 YRS | 142.00 |
| 1599385 | NEW PT WELL EXAM | 142.00 |
| 1599386 | NEW PT WELL EXAM 40-64 YO | 121.29 |
| 1599391 | WELL CHILD EST INFANT-12 MON | 96.50 |
| 1599392 | WELL CHILD EST 1-4 | 107.00 |
| 1599393 | WELL CHILD EST 5-11 YRS | 116.50 |
| 1599394 | WELL CHILD EST 12-17 | 125.00 |
| 1599395 | EST PT WELL EXAM | 119.00 |
| 1599396 | EST PT WELL EXAM 40-64YO | 108.57 |
| 1599397 | EST PT WELL EXAM 65+ YR | 113.21 |
| 1599408 | ALCOHOL/SUBSTANCE ABUSE SCREEN 15-30 MIN | 125.00 |
| 1599409 | ALCOHOL/SUBSTANCE ABUSE SCREEN 15-30 MIN | 150.00 |
| 1599410 | ALCOHOL ABUSE SCREEN 30+ MINUTES | 150.00 |
| 1599998 | EST PT WELL EXAM | 119.00 |
| 1599999 | NEW PT WELL EXAM | 142.00 |
| 2000120 | ORAL EVAL PERIODIC | 48.00 |
| 2000148 | COMPLETE PRAL EVAL | 80.50 |
| 2000210 | INTRAORAL – COMPLETE SERIES | 128.50 |
| 2000220 | INTRAORAL – PERIAPICAL 1ST | 32.00 |
| 2000230 | INTRORAL – PERIAPICAL EACH ADDTL | 9.50 |
| 2000240 | INTRAORAL – OCCLUSAL | 32.00 |
| 2000270 | BITEWING- SINGLE | 17.00 |
| 2000272 | BITEWING – 2 FILMS | 34.00 |
| 2000274 | BITEWING – 4 FILMS | 61.00 |
| 2002330 | RESIN – 1 SURFACE ANT | 176.50 |
| 2002331 | RESIN – 2 SURFACES ANT | 192.50 |
| 2002332 | RESIN – 3 SURFACES ANT | 208.50 |
| 2002335 | RESIN – 4+ VIN INCISION | 273.00 |
| 2002391 | RESIN COMP 1 SURFACE POST | 125.00 |
| 2002392 | RESIN COMP – 2 SURF POST | 154.00 |
| 2002393 | RESIN COMP – 3 SURF POST | 183.00 |
| 2002394 | RESIN COMP 4+ SURF POST | 192.50 |
| 2002920 | RECEMENT CROWN | 96.50 |
| 2002931 | CROWN STAINLESS PERM | 304.00 |
| 2002940 | PROTECTIVE RESTORATION | 135.00 |
| 2002954 | PREFABRICATED POST & CORE ADDTL TO CROWN | 225.00 |
| 2002999 | UNSPECIFIED RESTORATIVE PROC BY REPORT | 150.00 |
| 2003220 | THERAPEUTIC PULPOTOMY | 239.50 |
| 2003221 | PULPAL DEBRIDEMENT PRIMARY PERM TEETH | 135.00 |
| 2003310 | ENDODONIC THERAPY ANTERIOR TOOTH EXC FIN | 648.00 |
| 2003320 | ENDODONIC THERAPY BICUSPID TOOTH | 783.00 |
| 2004341 | PERI SCALING/ROOT PLANING 4+ PER QUAD | 150.00 |
| 2004342 | PERI SCALING/ROOT PLANING 1-3 PER QUAD | 150.00 |
| 2005411 | ADJUST COMPLETE DENTURE MANDIBULAR | 75.00 |
| 2007111 | EXTRACTION CORONAL REMNANTS DECID TOOTH | 123.00 |
| 2007140 | EXTRACTION ERUPTED TOOTH | 138.00 |
| 2007210 | SURG REMOVAL ERUPTED TOOTH | 273.00 |
| 2007250 | SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS | 300.00 |
| 2007971 | EXCISION PERICORONAL GINGIVA | 50.00 |
| 2007999 | ORAL SURGERY UNSPECIFIED BY REPORT | 205.50 |
| 2009110 | PALLIATIVE TX EMER OF DENTAL PAIN (MINOR | 135.00 |
| 2009430 | OFFICE VISIT FOR OBS NO OTHER SERVICES | 60.00 |
| 2011034 | ANTEPARTUM MEDICAL VISITS | 176.50 |
| 2011038 | POSTPARTUM MEDICAL VISIT | 176.50 |
| 2016200 | INITIAL NUTRITION ASSESSMENT | 176.50 |
| 2016201 | NUTRITION ASSESSMENT | 176.50 |
| 2016202 | INITIAL NUT ASSESS SUB 15 MIN | 176.50 |
| 2016204 | FOLLOW UP NUTRITION INDIVIDUAL | 176.50 |
| 2016208 | POSTPARTUM NUTRITION ASSESMENT | 176.50 |
| 2016300 | INITIAL PSYCHOSOCIAL ASSESS | 176.50 |
| 2016302 | PSYCHOSOCIAL ASSESSMENT | 176.50 |
| 2016304 | FOLLOW-UP PSYCHOSOCAIL IND | 176.50 |
| 2016308 | POSTPARTUM PSYCHOSOCIAL ASSE | 176.50 |
| 2016400 | INDIVIDUAL CLIENT ORIENTATION | 176.50 |
| 2016402 | HEALTH ED ASSESSMENT | 176.50 |
| 2016404 | INITIAL HEALTH ED EA 15MIN | 176.50 |
| 2016406 | FOLLOW UP HEALTH ED IND | 176.50 |
| 2016410 | PERINATAL ED | 176.50 |
| 2016414 | POSTPARTUM HEALTH ED ASSES | 176.50 |
| 2026402 | INITIAL HEALTH ED ASSE CARE PL | 176.50 |
| 2057452 | COLPOSCOPY | 121.00 |
| 2057500 | CERIX BX | 262.00 |
| 2058100 | ENDIMETRAL BIOPSY | 99.50 |
| 2059025 | FETAL NST | 52.50 |
| 2076815 | LIMITCOL ULTRA SOUND/AFI | 147.50 |
| 2081003 | URINALYSIS W/O SCOPE | 37.50 |
| 2081025 | URINE PREG TEST | 30.00 |
| 2082948 | GLUCOSE BLOOD REAGENT | 15.00 |
| 2085013 | HEMOGLOBIN | 30.00 |
| 2087430 | RAPID STREP | 60.00 |
| 2088136 | ANKLE STIRRUP | 189.50 |
| 2500003 | ORTHO SURGERY MAJOR 1ST HR | 5,800.00 |
| 2500004 | ORTHO SURGERY MINOR 1ST HR | 2,300.00 |
| 2501000 | ALCON IOC IMPLANT(NOT RESTORE) | 265.75 |
| 2504789 | RECOVER RM PROCDURE + 1/4HR | 38.75 |
| 2504790 | RECOVERY ROOM 1 HR | 84.00 |
| 2512113 | ORTHO SURGERY MAJOR EA ADDT 15 MIN | 550.00 |
| 2512114 | ORTHO SURGERY MINOR EA ADDT 15 MIN | 350.00 |
| 2512875 | RECOVERY ROOM PROCEDURE | 551.00 |
| 2520552 | TRIGGER POINT 1-2 MUSCLES | 225.00 |
| 2520553 | TRIGGER POINT 3 OR MORE MUSCLES | 225.00 |
| 2525236 | JURGANS BALLS | 39.75 |
| 2525260 | REP TENDON/FOREARM MUSCLE PROF | 1,236.50 |
| 2525333 | SKIN STAPLE RICHARD ALLEN | 69.50 |
| 2525387 | SURGICAL PROCEDURE MINOR | 1,875.75 |
| 2525511 | ETH 3-0 VICRYL TIES | 99.50 |
| 2525514 | ETH 6-0 VICRYL S29 | 75.25 |
| 2525516 | ETH VICRYL SINGLE (ALL OTHER) | 16.50 |
| 2525527 | ETHIBOND SINGLE (ALL OTHER) | 16.50 |
| 2525529 | ETH 4-0 MERSILENE P3 | 29.75 |
| 2525536 | 3-0 MONOCRYL PS2 | 33.00 |
| 2525537 | ETH MONOCRYL/BIOSYN SINGLE AL | 16.50 |
| 2525538 | ETHILON 3-0 FSI | 40.75 |
| 2525539 | ETH ETHILON/MOMOSOFT SINGLE | 12.25 |
| 2525597 | K WIRE SMITH/NEPHEW | 37.50 |
| 2546040 | I & D PERIRECTAL ABSCESS | 1,150.50 |
| 2562311 | PROF- INJECT SPINE L/S | 463.00 |
| 2564470 | PROF- INJ PARAVERTBAL C/T | 473.75 |
| 2564483 | PROF – EPIDURAL LUMBAR/SACRAL | 473.75 |
| 2564490 | PROF – INJ THERAPEUTIC | 534.50 |
| 2588888 | IV THERAPY | 303.25 |
| 2596372 | THERAPUTIC INJECTION IM/SC | 61.75 |
| 2599195 | THEURAPEUTIC PHLEBOTOMY | 132.25 |
| 3000140 | ANES – CATARACT | 142.25 |
| 3000190 | ANES – FACIAL BONES/SKULL | 142.25 |
| 3000450 | ANES CLAVICLE | 142.25 |
| 3000520 | ANES – CLOSED CHEST PROCEDURE | 142.25 |
| 3000524 | PNEUMOCENTESIS | 142.25 |
| 3000532 | ANES CENTRAL VENOUS | 142.25 |
| 3000635 | ANES – EPIDURAL | 142.25 |
| 3000640 | ANES-SPINE LESI | 142.25 |
| 3001200 | ANES – CLOSED HIP | 142.25 |
| 3001320 | ANES ALL PROC NERVES MUSCLES | 142.25 |
| 3001462 | ANES-CLOSED ANKLE/LEG/FOOT | 142.25 |
| 3001480 | ANES – OPEN PROC LOWER EXT | 142.25 |
| 3001610 | ANES-NERVES/MUSCLES | 142.25 |
| 3001620 | ANES-CLOSED HEAD/NECK/SHOULDER | 142.25 |
| 3001630 | ANES OPEN HUMERAL NECK ETC | 142.25 |
| 3001730 | ANES-CLOSED ELBOW/HUMERUS | 142.25 |
| 3001740 | ANES OPEN HUMERUS/ELBOW | 142.25 |
| 3001810 | ANES -NERVES MUSCLES TENDONS | 142.25 |
| 3001820 | ANES – WRIST | 142.25 |
| 3001830 | ANES – OPEN RADIU/ULNA | 142.25 |
| 3001991 | ANES-LESI | 142.25 |
| 3001995 | REGIONAL IV FOR PAIN MGMT | 142.25 |
| 3001999 | ANES UNLISTED PROCEDURE | 142.25 |
| 3020550 | INJECTION SINGLE TENDON SHEATH LIGAMENT | 490.25 |
| 3020552 | TRIGGER POINT ONE/TWO MUSCLES | 490.25 |
| 3020553 | TRIGGER POINT THREE OR MORE | 735.00 |
| 3053166 | ANESTHESIA BIER BLOCK ADD 15 | 92.75 |
| 3053171 | ANESTHESIA REGIONAL 1ST HR | 478.50 |
| 3053172 | MONITORED ANESTHESIA CARE | 239.00 |
| 3053306 | ANESTHESIA GENERAL + 1/4H99 | 185.50 |
| 3053322 | ANESTHESIA GENERAL 1 3/4 99 | 572.25 |
| 3053637 | ANESTHESIA LOCAL 1/2HR 99 | 44.25 |
| 3062270 | ANES SPINAL TAP | 142.25 |
| 3062273 | ANES BLOOD PATCH | 142.25 |
| 3062289 | EDIDURAL PAIN CONTROL TRAY | 248.25 |
| 3064447 | FEMORAL BLOCK | 650.00 |
| 3064450 | SCIATIC/POPLITEAL BLOCK | 650.00 |
| 3079996 | ANESTHESIA GENERAL 1 HR 99 | 896.00 |
| 3079997 | ANESTHESIA EA ADDTL 15 MIN | 60.75 |
| 3099156 | ANES 5YRS+ MOD SEDATION | 239.00 |
| 3099157 | ANES 5YRS+ EACH ADD 15 MIN | 239.00 |
| 3511034 | TUBING IV BLOOD Y TYPE | 10.75 |
| 3512082 | ENEMA OIL MINERAL OIL | 22.25 |
| 3512095 | THUMB SPICA MEDIUM RIGHT | 146.75 |
| 3512124 | SHOULDER IMMOBILIZER PREMIUM | 89.00 |
| 3512331 | KLING BANDAGE 6 | 10.75 |
| 3512467 | TRAY CHEST TUBE | 1,080.00 |
| 3513290 | SOD CHLOR 0.9% 100ML | 85.00 |
| 3514563 | ARM SLING X SMALL | 61.75 |
| 3514565 | ARM SLING MEDIUM | 61.75 |
| 3514568 | ARM SLING LARGE | 61.75 |
| 3514570 | KNEE IMMOBILIZER 24 | 205.00 |
| 3514571 | KNEE IMMOBILIZER 16 | 181.75 |
| 3514617 | ACE BANDAGE 6 | 12.25 |
| 3514633 | ACE BANDAGE 3 | 12.25 |
| 3514647 | ACE BANDAGE 2 | 12.25 |
| 3514666 | FOLEY CATH KIT | 23.25 |
| 3516968 | FOLEY TRAY | 27.75 |
| 3517959 | KLING BANDAGE 2 | 10.75 |
| 3518071 | ABD PADS 8X10 | 10.75 |
| 3518271 | SCAPELS DISPOSABLE # 11 | 7.75 |
| 3518301 | IV NON PUMP | 10.25 |
| 3518449 | IV TUBING 15GTT NON-PUMP | 10.00 |
| 3518537 | KNEE IMMOBILIZER 20 | 205.00 |
| 3518667 | IV PUMP TUBING | 10.25 |
| 3519392 | PLEUR-E-VAC | 575.25 |
| 3519805 | WRIST SPLINT LARGE LEFT | 79.25 |
| 3519806 | WRIST SPLINT MEDIUM RIGHT | 79.25 |
| 3519807 | WRIST SPLINT SMALL LEFT | 79.25 |
| 3519811 | WRIST SPLINT SMALL RIGHT | 79.25 |
| 3519812 | WRIST SPLINT LARGE RIGHT | 79.25 |
| 3519818 | THUMB SPICA MEDIUM LEFT | 146.75 |
| 3519819 | THUMB SPICA LARGE LEFT | 146.75 |
| 3519822 | THUMB SPICA LARGE RIGHT | 146.75 |
| 3519830 | SPLINT FINGER STRIP 1/2X 18 | 18.50 |
| 3519831 | SPLINT FINGER STRIP 3/4 X 18 | 18.50 |
| 3519832 | SPLINT FINGER STRIP 1X 18 | 18.50 |
| 3519970 | STERI-STRIP 1/8 | 12.25 |
| 3519971 | STERI-STRIP 1/4 | 10.75 |
| 3519972 | STERI-STRIP 1/2 | 12.25 |
| 3520168 | SURGICEL | 138.00 |
| 3520420 | STOCKINETTE BIAS 2 | 12.25 |
| 3520421 | STOCKINETTE 3 BIAS | 12.25 |
| 3520422 | STOCKINETTE BIAS 4 | 17.50 |
| 3524569 | ARM SLING X LARGE | 61.75 |
| 3534001 | ORTHO GLASS 2 | 9.75 |
| 3534002 | ORTHO GLASS 3 | 9.75 |
| 3534003 | ORTHO GLASS 4 | 9.75 |
| 3534005 | ORTHO GLASS 6 | 9.75 |
| 3534568 | ARM SLING SMALL | 61.75 |
| 3540133 | EKG PADS ADULT DFIB | 10.75 |
| 3540633 | SUTURES MONO PDSII O 6-0 TP-1 | 165.25 |
| 3553072 | STAPLES SKIN ALL | 241.50 |
| 3558117 | FIBERGLASS CAST ROLL 2 | 47.50 |
| 3558118 | FIBERGLASS CASTING ROLL 3 | 49.50 |
| 3558119 | FIBERGLASS CASTING ROLL 4 | 49.50 |
| 3560259 | D5W (DEXTROSE 5%) 500ML | 85.00 |
| 3560564 | D5W + LACT RINGERS 1000ML | 85.00 |
| 3560689 | D5W+ NS 0.45% 1000ML LVP | 85.00 |
| 3560713 | D5W + 0.9% NS 1000ML | 84.00 |
| 3560754 | D5W (DEXTROSE 5%) 250ML | 85.00 |
| 3560903 | RINGERS LACTATE 1000ML | 85.00 |
| 3560945 | SOD CHLOR (SALINE) 0.9% 250ML | 85.00 |
| 3561109 | SOD CHLOR (SALINE) 0.9% 500ML | 85.00 |
| 3561117 | SOD CHLOR 0.9% 1000ML | 85.00 |
| 3561257 | SOD CHLOR 0.45% 1000ML | 85.00 |
| 3561695 | D5W (DEXTROSE 5%) 50ML | 85.00 |
| 3561729 | SOD CHLOR (SALINE) 0.9%50ML | 85.00 |
| 3561745 | D5W (DEXTROSE 5%) 100ML | 85.00 |
| 3564053 | KLING BANDAGE 3 | 10.75 |
| 3564056 | KLING BANDAGE 4 IN | 10.75 |
| 3579855 | FLUSH NS 0.9% | 17.50 |
| 3588135 | ACE BANDAGE 4 | 12.25 |
| 3588136 | AIR CAST ANKLE STIRRUP UNIVERSAL | 195.25 |
| 4000455 | THYROID PANEL (000455) | 11.94 |
| 4000540 | THYROGLOBULIN COMP PANEL (500540) | 57.00 |
| 4000633 | ANTI-EXTRACT NUCLEAR ANTIGEN (006338) | 38.25 |
| 4000904 | URINALYSIS | – |
| 4000905 | OCCULT BLOOD FECAL IMMUNOASSAY(182949) | 66.30 |
| 4001768 | IMMUNOGLOBULINS A/G/M QN (001768) | 29.72 |
| 4001870 | ANTI-SCLERODERMA 70 ABS (018705) | 18.00 |
| 4002103 | URINE PROTEIN (24 HR) (003277) | 6.00 |
| 4003129 | PROT+CREAT (RANDOM) (003129) | 12.71 |
| 4003277 | PROTEIN TOTAL, QN 24HR URINE (003277) | 6.00 |
| 4004176 | CATECHOLAMINES FRAC UR FREE 24HR (004176 | 27.00 |
| 4005223 | HEMOGLOBIN HB (005223) | 22.00 |
| 4006668 | ANTI-SMOOTH MUSCLE M2 AB (006668) | 37.93 |
| 4007441 | SOLUBLE LIVER ANTIGEN (007441) | 140.50 |
| 4008352 | GQ1B AB IGG (808602) | 17.08 |
| 4011173 | ANTI-CCP IGG/IGA (164914) | 20.20 |
| 4013914 | CMV QUANT PCR (139149) | 323.50 |
| 4014033 | NEOPTERIN (140335) | 84.92 |
| 4016195 | CARDIOLIPIN AB PANEL (161950) | 39.28 |
| 4016204 | IBD EXPANDED PANEL (162045) | 243.00 |
| 4016369 | TETANUS ANTITOXOID AB (163691) | 22.64 |
| 4016486 | ANA W/RFLX IF POSITIVE (164868) | 21.75 |
| 4016488 | ANA W/ REFLEX CASCADE (164880) | 457.25 |
| 4018083 | H. PYLORI BREATH TEST (180836) | 225.00 |
| 4019560 | BB BLOOD FFP | 60.75 |
| 4020061 | IHC 1ST AB STAIN X1 GLBL (W20061) | 84.25 |
| 4020532 | IHC EA ADDL AB STAIN X3 GLBL (W20532) | 252.75 |
| 4021140 | NEONATAL BILIRUBIN PANEL | 38.75 |
| 4030000 | HEP B VIRUS QUANT PCR (551610) | 204.00 |
| 4030180 | PLATELET COUNT | 21.00 |
| 4030551 | ANTI-MULLERIAN HORMONE AMH (500183) | 78.54 |
| 4033214 | EOSINOPHIL COUNT | 13.50 |
| 4036415 | VENIPUNCTURE | 35.00 |
| 4036417 | LAB CORP VENIPUNCTURE | 35.00 |
| 4039490 | EBV PCR QUANT(138230) | 306.00 |
| 4039998 | IGA HEAVY LIGHT CHAINS (HLC) (123540) | 270.00 |
| 4039999 | IGM HEAVY LIGHT CHAINS (123560) | 270.00 |
| 4040250 | OCCULT BLOOD #2 | 49.50 |
| 4040260 | OCCULT BLOOD #3 | 49.50 |
| 4040560 | URIC ACID URINE (012898) | 6.89 |
| 4042045 | THYROGLOBULIN TUMOR MARKER (042045) | 10.00 |
| 4048920 | JAK2 MUTATION ANALYSIS, QUAL (489200) | 204.00 |
| 4050123 | HEP C FIBROSURE (550123) | 163.20 |
| 4050200 | BB CROSSMATCH #2 | 123.50 |
| 4050210 | BB CROSSMATCH #3 | 123.50 |
| 4050220 | BB CROSSMATCH #4 | 123.50 |
| 4050411 | VITAMIN D 25-HYDROXY LCMS D2+D3 (504115) | 173.40 |
| 4053173 | LITHIUM | 27.21 |
| 4055007 | HEP C RT-PCR QUANT (550080) | 132.60 |
| 4055009 | HEP C RNA PCR QN RFX GENO (550090) | 172.99 |
| 4055042 | HIV 1 RNA BY PCR (550420) | 153.00 |
| 4055084 | HEP C RNA QUAL RFX TO QUANT (550840) | 114.75 |
| 4055088 | HIV 1 QUANT, RNA REAL TIME (550880) | 439.50 |
| 4055130 | HEP C REALTIME ABBOTT (551300) | 647.75 |
| 4060183 | ALLERGEN PROFILE VEGETABLE I (601831) | 96.31 |
| 4060185 | ALLERGEN PR MILK (601856) | 91.25 |
| 4060247 | M003-IGE ASPERGILLUS FUMIGATUS (602471) | 14.25 |
| 4060264 | ALLERGENS IGE AREA 13 (602643) | 687.50 |
| 4060290 | MOLD/DUST ALLERGY PANEL, IGE (602904) | 121.25 |
| 4060298 | ALLERGEN CHILDHOOD IGE (602988) | 93.18 |
| 4062255 | STREP A SCREEN | 60.75 |
| 4062263 | DRUG (DOA)SCR, URINE I/H | 134.50 |
| 4070112 | CA 125 (002303) | 13.25 |
| 4070113 | CA 19-9 (002261) | 15.06 |
| 4070227 | RETICULOCYTE COUNT | 80.25 |
| 4070235 | SED RATE (ESR) | 49.50 |
| 4070326 | AMYLASE | 93.75 |
| 4070359 | CALCIUM | 20.00 |
| 4070417 | POTASSIUM | 20.00 |
| 4070441 | SODIUM | 20.00 |
| 4070573 | BUN | 20.00 |
| 4070599 | CHOLESTEROL | 80.25 |
| 4070620 | CREATININE | 20.00 |
| 4070672 | DIGOXIN | 136.50 |
| 4070755 | ALBUMIN | 20.00 |
| 4070789 | QUANTIFERON TB GOLD (182873) | 61.20 |
| 4070847 | LD (LDH) (001115) | 3.75 |
| 4070870 | ALKALINE PHOSPHATASE | 20.00 |
| 4071001 | URIC ACID | 59.75 |
| 4071035 | TRIGLYCERIDES | 79.25 |
| 4071076 | PT INR (PT) | 101.50 |
| 4071258 | CULTURE BLOOD #1 | 168.50 |
| 4071621 | BB ANTIBODY SCREEN | 62.75 |
| 4071738 | GRAM STAIN | 39.75 |
| 4071746 | OCCULT BLOOD #1 | 49.50 |
| 4071749 | CULTURE EYE | 157.50 |
| 4071750 | CULTURE EAR | 157.50 |
| 4071751 | CULTURE BODY FLUID | 157.50 |
| 4071753 | CULTURE STOOL | 157.50 |
| 4071755 | CULTURE CSF | 157.50 |
| 4071845 | GLUCOSE TOL 2HR. | 189.50 |
| 4072579 | PROTEIN TOTAL SERUM | 20.00 |
| 4073783 | MAGNESIUM | 80.25 |
| 4073874 | THYROID STIM HORM (TSH) | 221.50 |
| 4073980 | BB BLOOD PROCESSING FEE | 28.75 |
| 4073981 | BB RH(D) TYPING | 60.75 |
| 4073988 | BB ABO TYPE | 60.75 |
| 4074492 | DILANTIN | 171.00 |
| 4074980 | CO2 | 20.00 |
| 4075044 | ALCOHOL(ETHANOL) SERUM | 141.00 |
| 4075234 | HDL | 79.25 |
| 4075250 | HEP C AB W/RFLX (144065) | 14.00 |
| 4076372 | BILIRUBIN TOTAL | 20.00 |
| 4076706 | LIPID PANEL CHL TRG HDL LDL | 217.25 |
| 4076927 | APTT | 101.50 |
| 4076928 | STOOL CULTURE YESINIA ONLY (182410) | 56.25 |
| 4076929 | STOOL CULTURE VIBRIO ONLY (182311) | 56.25 |
| 4076935 | HCG QUAL | 107.00 |
| 4077012 | CELL CT, NON CSF | 77.25 |
| 4077015 | CELL CT, CSF | 93.75 |
| 4077057 | CULTURE URINE SCREEN | 135.50 |
| 4077061 | CULTURE BETA STREP B | 60.75 |
| 4077081 | HEMOGRAM & PLATLET COUNT AUTO | 103.50 |
| 4077085 | HEMOGRAM | 77.25 |
| 4077099 | KETONES, SERUM | 15.50 |
| 4077115 | MONO SCREEN | 62.75 |
| 4077172 | PHENOBARBITAL SERUM | 35.00 |
| 4077271 | WET MOUNT | 60.75 |
| 4077321 | ACETAMINOPHEN | 168.50 |
| 4077347 | GLUCOSE TOL 1HR. | 126.75 |
| 4077350 | GLUCOSE | 20.00 |
| 4077404 | CEREBRO SPINAL FLUID PROTEIN | 60.75 |
| 4077481 | CULTURE GENITAL | 157.50 |
| 4077484 | CULTURE WOUND | 157.50 |
| 4077567 | T4 FREE | 86.00 |
| 4077628 | KOH SLIDE PREP | 32.00 |
| 4077636 | PHOSPHORUS | 20.00 |
| 4077644 | SALICYLATE | 84.00 |
| 4077696 | GAMMA GT (GGT) (001958) | 12.25 |
| 4077701 | REPEAT BASIC METABOLIC PANEL | 151.00 |
| 4077711 | REPEAT CBC | 96.75 |
| 4077712 | REPEAT POTASSIUM | 20.00 |
| 4077718 | REPEAT HEPATIC PANEL | 135.50 |
| 4077719 | REPEAT COMP METABOLIC PANEL | 260.00 |
| 4077720 | RPR (006072) | 2.50 |
| 4077721 | VITAMIN B12 (001503) | 9.75 |
| 4077725 | COMPLEMENT C4 (001834) | 29.25 |
| 4077726 | VITAMIN B12 & FOLATE (000810) | 30.81 |
| 4077727 | CULT ID AERO 1 | 135.50 |
| 4077729 | PROTEIN ELECTRO. RANDOM URINE (354928) | 18.05 |
| 4077750 | OVA & PARASITE EXAM. ROUTINE(008623) | 10.92 |
| 4079262 | TITANIUM WB (792620) | 37.25 |
| 4079335 | URINE SODIUM 24 HOUR (003178) | 4.59 |
| 4079670 | CULTURE ANAEROBIC I/H | 172.00 |
| 4079674 | DRUG PROFILE BLOOD (SEVEN DRUGS) (766477 | 319.25 |
| 4079676 | GLUCOSE TOL 3HR. | 208.00 |
| 4079681 | ELECTROLYTES | 77.25 |
| 4079682 | AMMONIA | 138.00 |
| 4079683 | TROPONIN I | 174.00 |
| 4079684 | CBC WITH AUTOMATED DIFFERENTIAL | 96.75 |
| 4079685 | MYOGLOBIN | 174.00 |
| 4079686 | COMPREHENSIVE METABOLIC PANEL | 260.00 |
| 4079687 | BASIC METABOLIC PANEL | 151.00 |
| 4079689 | RENAL FUNCTION PANEL | 193.25 |
| 4079690 | LIVER FUNCTION PANEL | 135.50 |
| 4079691 | BILIRUBIN DIRECT | 20.00 |
| 4079696 | IgA SERUM (001784) | 6.25 |
| 4079697 | IgM SERUM (001792) | 6.25 |
| 4079880 | APOLIPOPROTEIN B (167015) | 24.75 |
| 4079882 | ANTI-NUCLEAR ANTIBODIES (ANA) (164947) | 33.50 |
| 4079884 | ALLERGEN PR MINI (649749) | 294.00 |
| 4079885 | CELIAC DISEASE PANEL (165142) | 288.50 |
| 4079888 | CELIAC DISEASE COMP PANEL (165126) | 336.75 |
| 4079894 | CMV (PCR) QUAL (138693) | 321.25 |
| 4079895 | TESTOSTERONE FREE & TOT 36170 (140103) | 37.50 |
| 4079897 | LEVETIRACETAM (KEPPRA) (716936) | 84.15 |
| 4079903 | ALLERGEN PINE TREE (062489) | 143.82 |
| 4079904 | CRYPTOCOCCAL AG (006551) | 35.00 |
| 4079908 | HEP C RNA PCR QUANT (550080) | 132.60 |
| 4079909 | GLUTAMIC ACID (GAD) AUTOANTIBODY (143008 | 52.50 |
| 4079910 | MICROALBUMIN/CREAT RATIO RANDOM (140285) | 13.69 |
| 4079916 | ANCA SCN WITH REFLEX (162388) | 45.75 |
| 4079919 | A1-ANTITRYPSIN PHENOTYPING (095653) | 28.00 |
| 4079920 | CHROMIUM, PLASMA (071522) | 71.40 |
| 4079924 | ALLERGEN PR ZONE 19 (650820) | 359.55 |
| 4079925 | ALLERGEN MOLD GRP (062448) | 347.75 |
| 4079927 | LUPUS ANTICOAGULANT (117054) | 291.98 |
| 4079929 | GLUCOSE, BODY FLUID (019497) | 5.01 |
| 4079930 | PROTEIN, TOTAL, BODY FLUID (019588) | 6.00 |
| 4079934 | ALLERGEN W/TOTAL IGE AREA 12 (603719) | 639.00 |
| 4079938 | VITAMIN D 1 25 DI-HYDROXY (081091) | 49.50 |
| 4079944 | GLUTEN (069781) | 26.75 |
| 4079946 | EBV QUAL PCR (138289) | 328.95 |
| 4079948 | IMMUNO-FECAL OCCULT BLOOD (182949) | 66.30 |
| 4079950 | METHYLMALONIC ACID SERUM (706961) | 48.75 |
| 4079952 | TISSUE TRANSGLUTAM ANTI IGG (164988) | 108.75 |
| 4079953 | STOOL FOR WBC | 53.50 |
| 4079954 | EST GLOM FILTRATION RATE | 12.25 |
| 4079958 | PTH INTACT (015610) | 61.25 |
| 4079959 | ANTI-EXTRACTABLE NUCLEAR AG (006338) | 34.00 |
| 4079960 | LIVER KIDNEY MICROSOMAL AB (163980) | 31.00 |
| 4079961 | D DIMER | 174.00 |
| 4079967 | KAPPA-LAMBDA LIGHT CHAIN (121137) | 61.20 |
| 4079968 | LIPASE | 80.25 |
| 4079972 | REPEAT LIPASE | 80.25 |
| 4079973 | REPEAT D-DIMER | 174.00 |
| 4079985 | PHOSPHORUS 24 HR URINE (003251) | 11.25 |
| 4079986 | BHCG QUANT. | 220.50 |
| 4079987 | RUBEOLA IGM (160218) | 15.00 |
| 4079989 | TISSUE TRANSGLUTAM ANTI IGA (164640) | 35.00 |
| 4079990 | H. PYLORI ANTIBODIES(IGM IGG & IGA) (163 | 6.83 |
| 4079992 | LEAD BLOOD (PEDIATRIC) (717009) | 26.25 |
| 4079993 | ANTI-JO-1 (161455) | 40.00 |
| 4079995 | PORPHOBILINOGEN QUARAND URINE(003053) | 32.50 |
| 4079996 | ANDROSTENEDIONE SERUM(004705) | 223.00 |
| 4079997 | C-TELOPEPTIDE SERUM(500089) | 126.00 |
| 4079998 | PAP W REFLEX TO HPV (192630) | 81.25 |
| 4079999 | MTHFR (511238) | 127.50 |
| 4080002 | VITAMIN K1 SERUM (121200) | 178.50 |
| 4080003 | PAP ONLY (192005) | 61.71 |
| 4080004 | FECAL REDUCING SUBSTANCES (016766) | 21.00 |
| 4080005 | URINE CYTOLOGY (009068) | 86.96 |
| 4080006 | BABESIA MICROTI ANTIBODIES IGG AND IGM ( | 275.00 |
| 4080008 | CORTISOL FREE & TOTAL(500440) | 80.58 |
| 4080009 | T & B LYMPHOCYTE DIFF. PANEL (096917) | 506.25 |
| 4080011 | NATURAL KILLER CELL SURFACE ANTIGEN (CD3 | 214.25 |
| 4080014 | BETA 2 GLYC AB IGA IGG IGM (163915) | 41.31 |
| 4080015 | BK VIRUS DNA BY PCR(138962) | 370.26 |
| 4080017 | TRYPTASE (826008) | 37.50 |
| 4080020 | CREATININE URINE (013672) | 16.00 |
| 4080022 | HTLV I & II ANTIBODY (164277) | 49.98 |
| 4080026 | LYME DISEASE AB W/REFLEX TO WESTERN (258 | 97.25 |
| 4080028 | ANA COMPREHENSIVE PANEL (165092) | 364.42 |
| 4080031 | TESTOSTERONE FREE & WEAKLY BOUND (143255 | 337.25 |
| 4080034 | MRSA SCREEN | 60.75 |
| 4080035 | ALLERGEN BASIC FOOD (660423) | 267.25 |
| 4080036 | HOUSE DUST QUANT. IGE (069450) | 26.75 |
| 4080037 | COPPER PLASMA (001586) | 61.20 |
| 4080038 | ANCA PROFILE (163873) | 72.50 |
| 4080040 | PROTEIN, TOTAL, URINE (013664) | 13.00 |
| 4080042 | INFLAMMATORY BOWEL DISEASE (IBD) PROFILE | 461.00 |
| 4080044 | 17-HYDROXPROGESTERONE(070085) | 29.60 |
| 4080045 | PROINSULIN (140533) | 153.00 |
| 4080047 | URINE SODIUM RANDOM(013326) | 5.82 |
| 4080048 | URINE POTASSIUM RANDOM(013334) | 10.75 |
| 4080049 | CHROMOGRANIN A (140848) | 123.42 |
| 4080058 | LD (LDH) BODY FLUID (100156) | 6.00 |
| 4080062 | IMMUNOFIXATION(IFE) AND PROTEIN ELECTROP | 116.00 |
| 4080063 | IMMUNOFIXATION(IFE) SERUM AND PROTEIN EL | 109.25 |
| 4080064 | IgG SUBCLASSES (209601) | 195.25 |
| 4080065 | ETHANOL URINE (007237) | 15.91 |
| 4080067 | ACTIN (SMOOTH MUSCLE) ANTIBODY (006643) | 5.29 |
| 4080068 | CANDIDA ANTIBODIES IGG IGA IGM (163135) | 171.00 |
| 4080074 | HEPATITIS PANEL ACUTE (322744) | 82.13 |
| 4080156 | CARBAMAZEPINE | 83.00 |
| 4080158 | CYCLOSPORIN (706556) | 54.50 |
| 4080159 | CLOZAPINE (CLOZARIL) SERUM (706440) | 71.40 |
| 4080162 | REPEAT DIGOXIN | 136.50 |
| 4080164 | VALPROIC ACID (007260) | 11.50 |
| 4080197 | TACROLIMUS (PROGRAF) (700248) | 101.25 |
| 4080201 | TOPIRAMATE (TOPAMAX) (716285) | 27.75 |
| 4080202 | VANCOMYCIN | 18.00 |
| 4080203 | ZONISAMIDE (ZONEGRAN) (007915) | 91.80 |
| 4080211 | ADALIMUMAB CONCENTRATION W/ SB (504575) | 400.00 |
| 4080377 | DRUG SCREEN 9 ALC (733002) | 82.50 |
| 4081001 | URINALYSIS AUTO W MICRO | 11.76 |
| 4081015 | URINALYSIS MICRO ONLY | 37.50 |
| 4081105 | HPA 1A PLATELET ANTIGEN (500314) | 282.25 |
| 4081206 | BCR-ABLI CML/ALL PCR QUANT (480481) | 433.50 |
| 4081217 | BRCA2 TARGETED ANALYSIS (252250) | 417.00 |
| 4081404 | TRANSTHYRETIN (252810) | 529.00 |
| 4081405 | GENESEQ CARDIO FAMILIAL AORTOPA (48003) | 2,750.00 |
| 4082024 | ACTH PLASMA (004440) | 5.75 |
| 4082026 | PLASMA IODINE (070034) | 61.50 |
| 4082043 | MICROALBUMIN 24 HR URINE (140050) | 10.65 |
| 4082085 | ALDOLASE (002030) | 28.25 |
| 4082103 | ALPHA 1 ANTITRYPSIN SCREEN (001982) | 27.75 |
| 4082104 | ALPHA1 ANTITRYPSIN STOOL QUANT (123010) | 189.50 |
| 4082105 | ALPHA-FETO PROTEIN SERUM TUMOR MARKER (0 | 4.07 |
| 4082131 | HOMOCYSTEINE SERUM OR PLASMA (706994) | 102.00 |
| 4082150 | REPEAT AMYLASE | 93.75 |
| 4082164 | ANGIOTENSIN-1-CONVERTING ENZYME (010116) | 40.25 |
| 4082172 | LIPOPROTEIN A (120188) | 18.05 |
| 4082232 | BETA 2 MICROGLOBULIN SERUM (010181) | 115.25 |
| 4082273 | GASTROCCULT | 50.50 |
| 4082306 | VITAMIN D 25-HYDROXY | 122.00 |
| 4082330 | CALCIUM IONIZED (004804) | 35.00 |
| 4082340 | URINE CALCIUM (24 HR) (003269) | 7.14 |
| 4082360 | CALCULI URINARY W/PHOTO (120691) | 20.81 |
| 4082375 | CARBOXYHEMOGLOBIN (007187) | 36.00 |
| 4082378 | CEA (002139) | 13.50 |
| 4082383 | CATECHOLAMINES PLASMA (084152) | 70.00 |
| 4082384 | CATECHOLAMINES FRAC. RANDOM URINE (3162 | 37.94 |
| 4082390 | CERULOPLASMIN (001560) | 25.75 |
| 4082399 | PTHRP(503380) | 33.66 |
| 4082435 | CHLORIDE | 20.00 |
| 4082436 | URINE CHLORIDE RANDOM (013656) | 13.00 |
| 4082530 | CORTISOL 24HR URINE FREE (004432) | 22.56 |
| 4082533 | CORTISOL (004051) | 11.44 |
| 4082535 | CORTISOL, AM (104018) | 11.44 |
| 4082536 | CORTISOL W/ REFLX DEXAMETHASONE (503990) | 93.50 |
| 4082542 | BILE ACIDS FRACT (503640) | 281.25 |
| 4082550 | CK TOTAL | 77.25 |
| 4082552 | CK ISOENZYMES SERUM (002154) | 19.74 |
| 4082553 | CKMB | 174.00 |
| 4082570 | URINECREATININE (24 HR) (003012) | 6.90 |
| 4082575 | CREATININE CLEARANCE (003004) | 9.25 |
| 4082595 | CRYOGLOBULIN (001594) | 12.25 |
| 4082626 | DHEA (00401) | 41.25 |
| 4082627 | DHEA SULFATE (004020) | 25.75 |
| 4082652 | THYROID ABS (006684) | 69.00 |
| 4082668 | ERYTHROPOIETIN (EPO) SERUM (140277) | 23.94 |
| 4082670 | ESTRADIOL (004515) | 25.75 |
| 4082672 | ESTROGEN TOTAL (004549) | 23.25 |
| 4082677 | ESTRIOL SERUM (004614) | 116.00 |
| 4082679 | ESTRONE SERUM (004564) | 179.75 |
| 4082705 | FECAL FAT QL (001677) | 33.00 |
| 4082710 | FECAL FAT QN (001354) | 54.50 |
| 4082728 | FERRITIN SERUM (004598) | 9.25 |
| 4082746 | FOLATE SERUM (002014) | 8.75 |
| 4082747 | FOLATE RBC (266015) | 54.50 |
| 4082755 | ALLERGEN W/ TOTAL IGE AREA 19 (602987) | 614.75 |
| 4082784 | IgG SERUM (001776) | 6.25 |
| 4082785 | IgE TOTAL (002170) | 14.31 |
| 4082786 | IMMUNOGLOBULIN AEGM (002295) | 45.25 |
| 4082945 | GLUCOSE, CSF | 20.00 |
| 4082995 | G-6PD QN 500 (001917) | 17.52 |
| 4083001 | FOLLICLE-STIMULATING HORMONE (FSH)(00430 | 12.25 |
| 4083002 | LUTEINIZING HORMONE (LH) (004283) | 12.25 |
| 4083003 | GROWTH HORMONE SERUM (004275) | 21.04 |
| 4083005 | FSH AND LH (028480) | 35.39 |
| 4083010 | HAPTOGLOBIN (001628) | 31.00 |
| 4083015 | HEAVY METALS PROFILE 1 BLOOD (042580) | 151.39 |
| 4083018 | CHROMIUM AND COBALT WB (MOM)(738770) | 105.75 |
| 4083021 | HEMOGLOBINOPATHY PROFILE (121679) | 41.16 |
| 4083036 | HEMOGLOBIN A1C | 68.50 |
| 4083088 | HISTAMINE DETERMINATION WHOLE B (081315) | 226.44 |
| 4083497 | 5-HIAA 24-HR URINE (004069) | 32.50 |
| 4083499 | ANEMIA PROFILE A (030577) | 22.25 |
| 4083502 | HANTAVIRUS ANTIBODIES (835027) | 143.25 |
| 4083516 | PHOSPHOLIPIDS SERUM (001727) | 23.75 |
| 4083517 | TRANSGLUTAMINASE IGA AB (164640) | 32.00 |
| 4083518 | PHOSPHOLIPASE A2 RECEPTOR AUTO (141330) | 200.00 |
| 4083519 | INSULIN-LIKE PROTEIN3 (IGFBP-3) (140152) | 33.00 |
| 4083520 | GLIADEN IGG & IGA ANTIBODY PANEL (163402 | 76.25 |
| 4083521 | INTERLEUKIN-6 (140816) | 125.50 |
| 4083522 | INSULIN LIKE GROWTH FCTR BINDIN (140822) | 63.24 |
| 4083525 | INSULIN (004333) | 29.25 |
| 4083526 | INSULIN ANTIBODIES (141598) | 26.01 |
| 4083540 | IRON SERUM TOTAL (001339) | 4.59 |
| 4083550 | IRON & TIBC W/%SAT.(001321) | 8.75 |
| 4083631 | LACTOFERRIN FECAL QUANT (123016) | 132.75 |
| 4083655 | LEAD BLOOD (ADULT) (007625) | 10.75 |
| 4083727 | GONADOTROPIN-RELEASING HORMONE (502421) | 241.00 |
| 4083789 | IODINE LEVEL (070034) | 61.50 |
| 4083790 | ESTRONE SULFATE (501049) | 175.00 |
| 4083833 | IGG HEAVY LIGHT CHAINS (123550) | 270.00 |
| 4083835 | METANEPH 24HR URINE (004234) | 31.48 |
| 4083883 | FREE KAPPA LAMBDA LIGHT CHAINS (121137) | 61.20 |
| 4083896 | FACTOR V LEIDEN MUTATION ANALYSIS (51115 | 122.00 |
| 4083901 | CYSTIC FIBRO DNA (480533) | 114.75 |
| 4083915 | 5′ NUCLROTIDASE (001701) | 37.00 |
| 4083930 | OSMOLALITY SERUM (002071) | 23.25 |
| 4083935 | OSMOLALITY URINE (003442) | 23.25 |
| 4083987 | STOOL, PH (010991) | 6.25 |
| 4084075 | ALK PHOS BONE (513002) | 62.99 |
| 4084080 | ALK PHOS ISO (001612) | 36.50 |
| 4084134 | PREALBUMIN (016931) | 12.00 |
| 4084144 | PROGESTERONE (004317) | 14.00 |
| 4084146 | PROLACTIN SERUM (004465) | 15.00 |
| 4084153 | PSA TOTAL | 37.50 |
| 4084154 | PSA FREE & TOTAL (480947) | 146.25 |
| 4084156 | UPEP 24 HOUR (003368) | 18.05 |
| 4084157 | PROTEIN, CSF | 58.25 |
| 4084165 | PROTEIN ELECTROPHORESES W/ INT (225920) | 11.00 |
| 4084207 | VITAMIN B6 PLASMA (004655) | 25.50 |
| 4084235 | THYROTROPIN RECEP. AB SERUM (010314) | 149.25 |
| 4084244 | RENIN ACTIVITY (002006) | 27.15 |
| 4084246 | RENIN ACTIVITY & ALDOSTERONE (000703) | 72.00 |
| 4084252 | VITAMIN B2, WHOLE BLOOD (123220) | 67.50 |
| 4084255 | SELENIUM SERUM (716910) | 71.40 |
| 4084260 | SEROTONIN (120204) | 61.20 |
| 4084270 | SEX HORM BIND GLOB (082016) | 123.50 |
| 4084305 | INSULIN LIKE GROWTH FACTOR1 PED (503660) | 71.40 |
| 4084402 | TESTOSTERONE FREE (144980) | 182.75 |
| 4084403 | TESTOSTERONE (004226) | 12.50 |
| 4084425 | VITAMIN B1 THIAMINE (121186) | 75.00 |
| 4084432 | THYROGLOBULIN QUANT. (042100) | 28.75 |
| 4084436 | T4 TOTAL | 28.26 |
| 4084445 | THYROID STIM IMMUNOGLOB (140749) | 257.00 |
| 4084446 | VITAMIN E SERUM (081000) | 38.00 |
| 4084450 | AST | 20.00 |
| 4084460 | ALT (SGPT) | 20.00 |
| 4084466 | TRANSFERRIN (004937) | 32.00 |
| 4084479 | T3 UPTAKE (T3U) (001156) | 4.00 |
| 4084480 | T3 TOTAL (002188) | 12.00 |
| 4084481 | T3 FREE SERUM (010389) | 23.00 |
| 4084482 | T3 REVERSE (002212) | 196.50 |
| 4084503 | TESTOSTERONE TOTAL WOMEN & CHIL (070001) | 22.75 |
| 4084560 | URINE URIC ACID (003418) | 3.75 |
| 4084586 | VASOACTIVE INTESTINAL POLY(010397) | 55.45 |
| 4084588 | ANTI-DIURETIC HORMONE (046557) | 182.22 |
| 4084590 | VITAMIN A (017509) | 22.25 |
| 4084591 | VITAMIN B3 (070115) | 310.00 |
| 4084630 | ZINC (001800) | 29.75 |
| 4084681 | C-PEPTIDE (010108) | 18.25 |
| 4084987 | PROTEIN ELECTROPHORESES (001487) | 16.30 |
| 4085007 | MANUAL DIFFERENTIAL | 52.00 |
| 4085014 | HEMATOCRIT | 21.00 |
| 4085018 | HEMOGLOBIN | 21.00 |
| 4085220 | FACTOR V ACTIVITY (086249) | 160.75 |
| 4085240 | FACTOR VIII ACTIVITY (086264) | 135.92 |
| 4085246 | VON WILLEBRAND FACTOR ANTIGEN (086280) | 92.75 |
| 4085260 | FACTOR X ACTIVITY (086306) | 131.07 |
| 4085300 | ANTI-THROMBIN ACTIVITY (015040) | 30.59 |
| 4085302 | PROTEIN C ANTIGEN (080465) | 123.17 |
| 4085303 | PROTEIN C ACTIVITY (CHROMOGENIC) (500463 | 88.00 |
| 4085305 | PROTEIN S ANTIGEN (164517) | 68.80 |
| 4085306 | PROTEIN S FUNCTIONAL (164525) | 65.50 |
| 4085384 | FIBRINOGEN ACTIVITY (001610) | 25.75 |
| 4085385 | FIBRINOGEN AG (117052) | 174.50 |
| 4085597 | ANTI-PHOSPHOLIPID SYNDROME (117079) | 820.25 |
| 4085705 | LUPUS ANTICOAGULANT REFLEX (117892) | 51.50 |
| 4085730 | PTT-LUPUS ANTICOAGULANT (117002) | 99.00 |
| 4085933 | ACHR MODULATING ABS (085933) | 201.96 |
| 4086003 | SJOGREN’S ANTI-SS-B (012690) | 11.75 |
| 4086007 | ACETYLCHOLINE RECPT AB,ALL (086007) | 580.00 |
| 4086014 | SMOOTH MUSCLE MITOCHOND (006668) | 11.27 |
| 4086031 | ALLERGEN PROFILE NUTS (671926) | 96.39 |
| 4086038 | ANA (164855) | 16.00 |
| 4086039 | ANA, IFA (164947) | 9.36 |
| 4086113 | ALLERGEN PROFILE FOOD W/ REFLEX (603857) | 19.56 |
| 4086133 | LATEX (602669) | 3.26 |
| 4086141 | CRP-CARDIAC (120766) | 13.77 |
| 4086157 | COLD AGGLUTININS (006353) | 28.25 |
| 4086160 | COMPLEMENT C3 (006452) | 29.25 |
| 4086171 | COCCIDIODAL SEROLOGY (807048) | 80.00 |
| 4086223 | ALLERGEN PROFILE FOOD (602989) | 39.12 |
| 4086225 | ANTI-DNA DBL. STRANDED (096339) | 16.00 |
| 4086235 | ANTI-SMITH (016360) | 61.20 |
| 4086253 | CULTURE BLOOD #3 | 168.50 |
| 4086255 | ANTI-CHROMATIN ANTIBODIES (012580) | 130.25 |
| 4086295 | ANA W/REFLEX TO MULTIPLE (164863) | 9.36 |
| 4086300 | CA 15.3 (143404) | 23.63 |
| 4086316 | CA 27.29 (140293) | 15.00 |
| 4086317 | SJOGREN’S ANTI-SS-A (012682) | 61.20 |
| 4086333 | ALLERGEN MILK (602753) | 3.26 |
| 4086334 | IMMUNOFIXATION (IFE) SERUM (001685) | 37.75 |
| 4086341 | IA2 AUTOANTIBODIES (141531) | 79.56 |
| 4086356 | HNK1 (CD57) PANEL (505026) | 85.17 |
| 4086376 | THYROID PEROXIDASE AB (006676) | 8.75 |
| 4086431 | RHEUMATOID FACTOR (006502) | 7.99 |
| 4086443 | ALLERGEN WHEAT (602459) | 3.26 |
| 4086553 | ALLERGEN SOYBEAN (602457) | 3.26 |
| 4086592 | RPR W/ RELX TO QUANT (012005) | 4.00 |
| 4086603 | ALLERGENS 5 (602904) | 121.25 |
| 4086606 | ASPERGILLUS AB IGG (164285) | 83.50 |
| 4086615 | B. PERTUSSIS AB IGG (161745) | 19.28 |
| 4086617 | LYME DISEASE IGM (160333) | 24.09 |
| 4086644 | CMV AB IGG (006494) | 42.25 |
| 4086645 | CMV AB IGM (096727) | 22.95 |
| 4086648 | DIPTHERIA ANTITOX AB (163709) | 22.65 |
| 4086658 | PORPHYRINS QUANT. RANDOM URINE (120980) | 24.48 |
| 4086664 | EBV ACUTE ANTIBODIES (216655) | 52.02 |
| 4086665 | EPSTEIN BARR CAPSID IGM (096735) | 17.50 |
| 4086667 | LYME WESTERN BLOT (163601) | 103.02 |
| 4086677 | H. PYLORI IGG AB (I/H) | 118.00 |
| 4086694 | HERPES SIMPLEX VIRUS 1/2 IGM (164806) | 32.00 |
| 4086696 | HERPES SIMPLEX VIRUS (HSV) TYPES 1-/2-SP | 73.75 |
| 4086702 | HIV SCR 4TH GEN RFX (083935) | 20.50 |
| 4086704 | HEP B CORE AB,TOTAL (006718) | 34.00 |
| 4086705 | HEP B CORE AB IGM (016881) | 11.00 |
| 4086706 | HEP B SURF AB QUAL (006395) | 22.28 |
| 4086707 | HEP BE ANTIBODY (006635) | 16.00 |
| 4086708 | HEP A AB TOTAL (006726) | 28.25 |
| 4086709 | HEP A AB IGM (006734) | 12.25 |
| 4086710 | INFLUNZA A&B AB QUANT (096487) | 14.10 |
| 4086711 | STRATIFY JC VIRUS AB W/TITER (819372) | 22.00 |
| 4086712 | STRATIFY JCV AB ELISA W/ RFLX (90257) | 0.01 |
| 4086738 | MYCOPLASMA IGG IGM (163758) | 80.75 |
| 4086747 | PARVOVIRUS B19 (HUMAN) IGG IGM (163303) | 206.00 |
| 4086756 | RSV TEST | 31.00 |
| 4086762 | RUBELLA IGG AB (006197) | 5.50 |
| 4086765 | RUBEOLA IGG (096560) | 13.75 |
| 4086773 | ALLERGEN RICE (716530) | 3.26 |
| 4086777 | TOXOPLASMOSIS IGG (006478) | 32.50 |
| 4086787 | VARICELLA IGG (096206) | 12.25 |
| 4086800 | THYROGLOBULIN Ab (006685) | 10.75 |
| 4086801 | COMPREHENSIVE THYROGLOBULIN (500540) | 186.50 |
| 4086803 | HEP C AB (140659) | 20.01 |
| 4086812 | HLA B27 DISEASE ASSOC (006924) | 59.84 |
| 4086813 | RAPID PLASMA REAGIN QUANTITAT (06460) | 10.75 |
| 4086850 | ANTIBODY SCREEN (006015) | 7.00 |
| 4086880 | BB DIRECT ANTIGLOBULIN TEST | 62.75 |
| 4086883 | ALLERGEN CHEESE CHEDDAR (602732) | 3.26 |
| 4086901 | LS RH | 20.00 |
| 4086920 | BB CROSSMATCH #1 | 123.50 |
| 4086927 | BB BLOOD FFP THW UNIT | 43.00 |
| 4086993 | ALLERGEN TOMATO (602468) | 3.26 |
| 4087072 | CULTURE UPPER RESPIRATORY | 157.50 |
| 4087073 | CULTURE LOWER RESPIRATORY | 157.50 |
| 4087100 | CULT SENSI 1 | 163.25 |
| 4087101 | CULTURE FUNGUS I/H | 103.50 |
| 4087103 | METANEPHRINES PLASMA (121806) | 178.50 |
| 4087104 | MITOCHONDRIAL ANTIBODY (006650) | 38.00 |
| 4087108 | N-TELOPEPTIDE URINE (141093) | 59.93 |
| 4087114 | IMMUNOFIXATION (IFE) URINE (123034) | 65.00 |
| 4087116 | AFB CULTURE WITH SMEAR (183764) | 38.75 |
| 4087118 | ANTI-CENTROMERE B ANTIBODIES (164814) | 113.75 |
| 4087119 | SCLERODERMA DIAGNOSTIC PROFILE (052373) | 73.75 |
| 4087120 | BB BLOOD PRBC LEUCO RED | 303.25 |
| 4087123 | LAMICTAL(LAMOTRIGINE SERUM (716944) | 42.75 |
| 4087125 | URINALYSIS AUTO W/O MICRO | 8.31 |
| 4087127 | CT/GC AMP NAA (183194) | 63.24 |
| 4087129 | DRUG ABUSE PROFILE, URINE (SEVEN DRUGS + | 76.75 |
| 4087130 | DRUG PROFILE, URINE (NINE DRUGS), IMMUNO | 94.75 |
| 4087134 | BNP (B TYPE NATRIURETIC PEPTIDE | 176.25 |
| 4087144 | ACETYLCHOLINE RECEPTOR BLOCKING (085926) | 179.52 |
| 4087145 | INSULIN-LIKE GROWTH FAC IGF-1 (010363) | 29.00 |
| 4087146 | SJOGRENS ABS SSA/SSB (012708) | 122.40 |
| 4087147 | CULTURE BLOOD #2 | 168.50 |
| 4087148 | OXCARBAZEPINE (TRILEPTAL) SERUM (716928) | 47.50 |
| 4087150 | ABSOLUTE CD4 AND CD8 COUNT INC RATION | 262.75 |
| 4087151 | CULT ID AERO >1 | 135.50 |
| 4087152 | CULT UA ID PRESUMPTIVE | 163.25 |
| 4087153 | CULT SENSI >1 | 163.25 |
| 4087154 | HEAVY METAL PROFILE UR (007492) | 91.80 |
| 4087159 | CRP QT. | 77.25 |
| 4087162 | HEP C RNA QUAL (550713) | 108.34 |
| 4087164 | ENDOMYSIAL AB IGA (164996) | 111.25 |
| 4087165 | RBC MAGNESIUM (080283) | 9.97 |
| 4087176 | WEST NILE AB SERUM (138842) | 117.30 |
| 4087177 | HERPES SIMPLEX TYPE II IGG (163147) | 25.75 |
| 4087182 | HERPES (HSV) CULTURE & TYPING (008250) | 30.50 |
| 4087185 | BETA LACTAMASE | 36.00 |
| 4087189 | ALLERGEN PR PERENNIAL (062497) | 215.73 |
| 4087192 | HEMATOPATHOLOGY CONSULTATION, PERIPHERAL | 27.25 |
| 4087193 | LYME DISEASE ANTIBODIES, TOTAL IMMUNOGLO | 49.00 |
| 4087194 | ANTI-CARDIOLIPIN AB (ACA), QUANT | 48.00 |
| 4087195 | MUMPS AB IGG (096552) | 12.00 |
| 4087198 | SIROLIMUS (716712) | 42.75 |
| 4087203 | ALLERGEN PEDS 3-6 (671934) | 160.25 |
| 4087205 | H. PYLORI IGM AB (163204) | 22.00 |
| 4087207 | PARASITE EXAM. BLOOD (008185) | 22.75 |
| 4087253 | POLIOVIRUS 1 3 AB (186542) | 322.50 |
| 4087324 | C. DIFFICILE TOXIN A & B (086207) | 15.00 |
| 4087328 | GIARDIA LAMBLIA DIRECT EIA (182204) | 35.19 |
| 4087329 | GIARDIA CRYPTOSPORIDIUM EIA STL (183558) | 135.15 |
| 4087338 | H. PYLORI STOOL ANTIGEN (180764) | 129.29 |
| 4087340 | HEP B SURFACE ANTIGEN (006510) | 8.00 |
| 4087350 | HEP BE AG (006619) | 10.25 |
| 4087400 | INFLUENZA A+B SWAB | 46.25 |
| 4087521 | HEP C NAA QUAL RFLX GENO (550825) | 102.00 |
| 4087522 | HEP C RNA QNT REF GENO (550100) | 153.00 |
| 4087535 | HIV RNA QUAL (139350) | 143.00 |
| 4087536 | HIV 1 QUANT RT PCR (550430) NONGRAPHICAL | 112.20 |
| 4087624 | PAP W HPV (195050) | 132.25 |
| 4087768 | PARASITE IDENTFY ARTHROPOD (188664) | 47.75 |
| 4087799 | EBV QUANT DNA PCR (139490) | 454.25 |
| 4087811 | STREPTOCOCCUS PNEUMONIAE AG (018788) | 19.50 |
| 4087902 | HEP C GENO NONRFLX (550475) | 245.00 |
| 4088108 | LACTIC ACID | 135.50 |
| 4088140 | SPINAL MUS ATROPHY SMA CARRIER (450010) | 858.33 |
| 4088164 | PANCREATIC ELASTASE FECAL (123234) | 245.00 |
| 4088165 | PANCREATIC ISLET CELLS (160721) | 26.93 |
| 4088188 | SPUTUM CYTOLOGY (009076) | 86.36 |
| 4088304 | SURG PATH L III (88304) | 74.46 |
| 4088305 | SURG PATH L IV 1ST SITE (88305) | 58.75 |
| 4088307 | SURG PATH L V (88307) | 110.25 |
| 4088312 | SPECIAL STAINS (883121) | 58.25 |
| 4088313 | GROUP II STAIN (88313) | 79.82 |
| 4088321 | ALLERGEN PR FOOD-SHELLFISH (062695) | 160.25 |
| 4088341 | IHC EA ADD AB STAIN X1 (W20530) | 84.25 |
| 4089060 | CRYSTALS FLUID (005355) | 27.25 |
| 4093446 | SYSTEMIC LUPUS (SLE) PROFILE A (056499) | 276.50 |
| 4096230 | EBV-VCA ANTIBODIES, IGG (096230) | 16.99 |
| 4096776 | VARICELLA IGM (096776) | 20.11 |
| 4099999 | CALPROTECTIN FECAL (123255) | 220.50 |
| 4119819 | THUMB SPICA | 146.75 |
| 4551032 | RHYTHM STRIP | 29.75 |
| 4581008 | EKG INITIAL | 354.75 |
| 4581012 | EKG SUBSEQUENT | 354.75 |
| 5001170 | MAMMOGRAM 2D SCREENING | 519.00 |
| 5014724 | MAMMOGRAM 2D BILAT DIAGN | 587.50 |
| 5014731 | MAMMOGRAM 2D UNIL LT | 396.50 |
| 5014732 | MAMMOGRAM 2D UNIL RT | 396.50 |
| 5014733 | MAMMOGRAM 3D SCREENING | 650.00 |
| 5014734 | MAMMOGRAM DIAGNOSTIC 3D UNI LT | 285.00 |
| 5014735 | MAMMOGRAM DIAGNOSTIC 3D UNI RT | 94.00 |
| 5014736 | MAMMOGRAM DIAGNOSTIC 3D BILAT | 363.00 |
| 5014737 | 3D DIAG CHARGE UNI/BILAT | 76.44 |
| 5060000 | SINUS COMPLETE | 359.50 |
| 5060012 | ABDOMEN 2V | 477.50 |
| 5060020 | ABDOMEN SERIES ACUTE | 672.00 |
| 5060046 | CHEST SINGLE VIEW | 228.25 |
| 5060053 | CHEST TWO VIEWS | 368.25 |
| 5060054 | CHEST 2v INS/EXP | 368.25 |
| 5060061 | CHEST FOUR VIEWS | 459.50 |
| 5060062 | CHEST I v Port | 228.25 |
| 5060094 | RIBS UNI W/1VW CXR LT | 393.50 |
| 5060095 | RIBS UNI W/1VW CXR RT | 393.50 |
| 5060096 | RIBS RT UNI – NO CXR | 336.25 |
| 5060097 | RIBS UNI – NO CXR LT | 393.50 |
| 5060102 | RIBS BILATERAL NO CXR | 545.50 |
| 5060103 | RIBS BILATERALW/1VW CXR | 545.50 |
| 5060111 | STERNUM | 331.75 |
| 5060152 | ACROMIOCLAVICUL. JTS BIL | 388.75 |
| 5060179 | CLAVICLE COMPLETE LT | 336.25 |
| 5060180 | CLAVICLE COMPLETE RT | 336.25 |
| 5060187 | ELBOW 1-2 VWS LT | 257.00 |
| 5060188 | ELBOW 1-2 VWS RT | 257.00 |
| 5060195 | ELBOW COMPLETE 3+V LT | 329.50 |
| 5060196 | ELBOW COMPLETE 3+V RT | 329.50 |
| 5060202 | FINGERS LT | 231.25 |
| 5060204 | FINGERS RT | 231.25 |
| 5060211 | FOREARM LT | 316.25 |
| 5060212 | FOREARM RT | 316.25 |
| 5060228 | HAND 1-2 VWS LT | 228.25 |
| 5060229 | BOTH HANDS AP (ARTHRITIS) | 228.25 |
| 5060230 | HAND 1-2 VWS RT | 228.25 |
| 5060237 | HAND 3+VWS LT | 357.00 |
| 5060238 | HAND 3+VWS RT | 357.00 |
| 5060252 | HUMERUS LT | 324.00 |
| 5060253 | HUMERUS RT | 324.00 |
| 5060270 | SCAPULA LT | 331.75 |
| 5060271 | SCAPULA RT | 331.75 |
| 5060278 | SHOULDER COMPLETE LT | 368.25 |
| 5060279 | SHOULDER COMPLETE RT | 368.25 |
| 5060286 | SHOULDER LIMITED LT | 249.25 |
| 5060287 | SHOULDER LIMITED RT | 249.25 |
| 5060288 | SHOULDER POST REDUCTION LEFT | 368.25 |
| 5060289 | SHOULDER POST REDUCTION RIGHT | 368.25 |
| 5060294 | WRIST 3+VWS LT | 368.25 |
| 5060295 | WRIST 3+VWS RT | 368.25 |
| 5060302 | WRIST 1-2VWS LT | 281.25 |
| 5060303 | WRIST 1-2VWS RT | 281.25 |
| 5060320 | ANKLE 3+VIEWS LT | 368.25 |
| 5060321 | ANKLE 3+VIEWS RT | 368.25 |
| 5060328 | ANKLE PLAIN 1-2 VWS LT | 264.75 |
| 5060329 | ANKLE PLAIN 1-2 VWS RT | 264.75 |
| 5060344 | FEMUR LT | 373.50 |
| 5060345 | FEMUR RT | 373.50 |
| 5060369 | FOOT 3+VWS LT | 336.25 |
| 5060370 | FOOT 3+VWS RT | 336.25 |
| 5060377 | FOOT 1-2 VWS LT | 249.25 |
| 5060378 | FOOT 1-2 VWS RT | 249.25 |
| 5060385 | HIP COMPLETE 2V LT | 402.25 |
| 5060386 | HIP COMPLETE 2V RT | 402.25 |
| 5060393 | HIP UNILATERAL LIMITED LT | 280.25 |
| 5060394 | HIP UNILATERAL LIMITED RT | 280.25 |
| 5060402 | HIP PELVIS INFANT/CHILD RT | 338.25 |
| 5060435 | KNEE COMP 3-4 VWS LT | 413.50 |
| 5060436 | KNEE COMP 3-4 VWS RT | 413.50 |
| 5060443 | KNEE 1-2 VWS LT | 291.00 |
| 5060444 | KNEE 1-2 VWS RT | 291.00 |
| 5060460 | TIBIA FIBULA LT +1 JT | 308.50 |
| 5060461 | TIBIA FIBULA RT +1 JT | 308.50 |
| 5060468 | OS CALCIS CALCANEUS HEEL LT | 280.25 |
| 5060469 | OS CALCIS CALCANEUS HEEL RT | 280.25 |
| 5060476 | TOES LT | 249.25 |
| 5060477 | TOES RT | 249.25 |
| 5060558 | BARIUM ENEMA | 780.25 |
| 5060582 | ESOPHAGUS | 477.50 |
| 5060632 | UGI WITH SM BOWEL W/AIR | 1,088.75 |
| 5060715 | FACIAL BONES 3+VWS | 569.50 |
| 5060749 | MANDIBLE 4+VWS | 373.50 |
| 5060780 | NASAL BONES | 359.50 |
| 5060806 | ORBITS BIL | 545.50 |
| 5060814 | NECK SOFT TISSUE | 280.25 |
| 5060897 | SKULL COMPLETE 4+VWS | 664.25 |
| 5060905 | SKULL LIMITED 2-3 VIEWS | 329.50 |
| 5060954 | TEMPOROMANDIBULR JTS BIL | 545.50 |
| 5061028 | CERVICAL SPINE LIMITED 2-3V | 402.25 |
| 5061036 | C-SPINE COMP MIN 4V | 597.50 |
| 5061069 | COCCYX SACRUM 2+VWS | 376.00 |
| 5061085 | LUMBAR SPINE 1V | 228.25 |
| 5061093 | LUMBAR SPINE 2-3VWS | 373.50 |
| 5061101 | LUMBAR SPINE COMPLETE 5V | 753.00 |
| 5061119 | L SPINE BEND/F E ONLY 2V | 423.25 |
| 5061127 | L SPINE COMP W F E/BD | 824.50 |
| 5061135 | PELVIS ROUTINE EXAM AP VIEW | 291.00 |
| 5061168 | SACRO ILIAC JOINTS 3+V | 424.25 |
| 5061192 | THORACIC SPINE 2V LIMITED | 376.00 |
| 5061200 | THORACO LUMBAR REGION | 376.00 |
| 5061283 | IVP WITH TOMOGRAMS | 1,027.00 |
| 5061531 | FLUORO UNDER 1HR | 242.50 |
| 5061616 | MAMMO 2D SPECIAL SCREENING | 83.00 |
| 5061619 | SINUSES < 3 VIEWS | 240.50 |
| 5061633 | KNEE BILATERAL STANDING 1 VW | 435.75 |
| 5061634 | BVCH EMP CXR | 188.50 |
| 5062190 | C SPINE 1V LAT | 228.25 |
| 5062802 | INFANT BONE SURVEY | 619.50 |
| 5062810 | FACIAL BONES 1-2 VWS | 266.75 |
| 5062836 | CERVICAL COMP W/FLEX EXT 7V | 839.00 |
| 5062851 | SCOLIOSIS STUDY | 385.75 |
| 5062869 | HIP BILATERAL COMPLETE | 525.75 |
| 5063354 | CHEST 3V | 388.75 |
| 5063818 | UGI W/AIR CONTRAST | 970.75 |
| 5064139 | PELVIS EXTENDED EXAM 3V | 413.50 |
| 5064162 | ABDOMEN ONE VIEW | 243.50 |
| 5067676 | 3V LSS EMP. PHYS SPECIAL | 206.00 |
| 5077063 | 3D SCREEN CHARGE | 650.00 |
| 5077067 | MAMMOGRAM 2D SCREENING | 519.00 |
| 5077072 | BONE AGE STUDY | 120.00 |
| 5077777 | BONE SURVEY COMPLETE | 1,422.00 |
| 5079814 | THORACIC SPINE 3V | 423.25 |
| 5079823 | KNEE EXTENDED 4+ LT | 423.25 |
| 5079824 | KNEE EXTENDED 4+ RT | 423.25 |
| 5561619 | US OB U/S <14WKS | 672.00 |
| 5561621 | US BREAST UNI SPECIAL LT COMPL | 88.00 |
| 5561622 | US BREAST UNI SPECIAL RT COMPL | 88.00 |
| 5561717 | US SINGLE QUAD/ORGAN LOW BACK | 664.25 |
| 5561721 | US NON VASCULAR EXT RIGHT | 672.00 |
| 5561747 | US LIVER ONLY | 672.00 |
| 5561754 | US GALLBLADDER ONLY | 583.00 |
| 5561762 | US SPLEEN ONLY | 672.00 |
| 5561788 | US AORTA | 672.00 |
| 5561796 | US KIDNEYS BILAT | 672.00 |
| 5561804 | US BLADDER | 672.00 |
| 5561853 | US ABDOMEN COMPLETE | 1,096.50 |
| 5561911 | US NON OB PELV-COMP | 672.00 |
| 5561929 | US ABSCESS LOCAL SCAN | 672.00 |
| 5561978 | US CHEST | 672.00 |
| 5561986 | US THYROID/NECK U SCAN | 494.00 |
| 5562174 | US IUD LOCALIZATION | 672.00 |
| 5562919 | US CAROTID DUP BILAT | 747.25 |
| 5562943 | US GUIDED NEEDLE INJ/BIOPSY | 583.00 |
| 5564154 | US PAROTID | 494.00 |
| 5564220 | US BREAST BILATERAL | 375.00 |
| 5564428 | US OB COMP >14 WEEKS | 672.00 |
| 5564642 | US EXT. VEN DOP BILAT | 672.00 |
| 5564643 | US EXT VEN DOP UNI/LMT LT | 583.00 |
| 5564644 | US EXT VEN DOP UNI/LMT RT | 583.00 |
| 5564659 | US ART BIL LOWER EXT SCAN | 672.00 |
| 5564660 | US ART LOWER EXT LEFT | 533.50 |
| 5564690 | US BREAST UNI LT COMPL | 346.00 |
| 5564691 | US SCROTUM U SCAN | 672.00 |
| 5564692 | US BREAST UNI RT COMPL | 346.00 |
| 5564693 | US TRANSVAGINAL | 375.00 |
| 5564694 | US KIDNEY UNILAT LEFT | 672.00 |
| 5564695 | US BREAST UNI LT LIMITED | 242.50 |
| 5564696 | US BREAST UNI RT LIMITED | 242.50 |
| 5567176 | US LIMITED ABDOMEN | 583.00 |
| 5576775 | US KIDNEY UNILAT RIGHT | 672.00 |
| 5576881 | US NON VASCULAR EXT LEFT | 672.00 |
| 5576883 | US NON VASCULAR EXT RIGHT SPECIFIC | 572.00 |
| 5593926 | US ART LOWER EXT RIGHT | 533.50 |
| 5593930 | US ART BIL UPPER EXT SCAN | 672.00 |
| 5593931 | US ART UPPER EXT RIGHT | 533.50 |
| 5593932 | US ART UPPER EXT LEFT | 533.50 |
| 6061629 | CT ABD/PEL W-WO/CONTRAST (ORAL) | 4,000.50 |
| 6061630 | CT ABD/PEL W-WO/CONTRAST | 4,000.50 |
| 6061631 | CT ABD/PEL WO/CONTRAST | 3,273.25 |
| 6061632 | CT ABD/PEL W/CONTRAST | 3,531.00 |
| 6061633 | CT ABD/PEL W/CONTRAST (ORAL) | 3,531.00 |
| 6061634 | CT ABD/PEL WO/CONTRAST (ORAL) | 3,273.25 |
| 6061636 | CT MAX/FACIAL W/WO CONTRAST | 2,183.75 |
| 6061637 | CT MAX/FACIAL W/O CONTRAST | 1,786.50 |
| 6062968 | CT ABDOMEN W/CONTRAST | 3,016.25 |
| 6062969 | CT ABDOMEN W/CONTRAST (ORAL) | 3,016.25 |
| 6062976 | CT CHEST W/O CONTRAST | 2,488.50 |
| 6063008 | CT HEAD W/CONTRAST | 1,930.75 |
| 6063111 | CT L-SPINE W CONTRAST | 2,744.50 |
| 6063537 | CT C-SPINE W/CONTRAST | 2,744.50 |
| 6063552 | CT C-SPINE W/O CONTRAST | 2,561.00 |
| 6063560 | CT SOFT TISSUE NECK W+W/O | 1,910.25 |
| 6063578 | CT ABDOMEN W/O CONT | 2,818.00 |
| 6063594 | CT ABDOMEN W & W/O CONT | 3,154.50 |
| 6063595 | CT ABDOMEN W & W/O CONT (+ ORAL) | 3,154.50 |
| 6063602 | CT CHEST W & W/O CONT | 2,796.00 |
| 6063610 | CT CHEST W/CONTRAST | 2,667.25 |
| 6063611 | CT BONE MINERAL DENSITY STUDY | 402.25 |
| 6063636 | CT UPPER EXT W/CONTRAST LEFT | 1,395.50 |
| 6063644 | CT T-SPINE W/O CONTRAST | 2,250.00 |
| 6063651 | CT ORBIT/IAC W CONTRAST | 1,786.50 |
| 6063669 | CT ORBIT/IAC W/O CONTRAST | 1,638.75 |
| 6063685 | CT L-SPINE W/O CONTRAST | 2,561.00 |
| 6063701 | CT HEAD W/O CONTRAST | 1,678.50 |
| 6063792 | CT LOWER EXT W/O CONT | 1,113.00 |
| 6063834 | CT PELVIS W/WO CONT | 1,560.00 |
| 6063835 | CT PELVIS W/WO CONT (ORAL) | 1,560.00 |
| 6063859 | CT PELVIS W/CONTRAST | 1,392.00 |
| 6063958 | CT HEAD W & W/O CONT | 2,061.00 |
| 6065789 | CT PELVIS W/O CONT | 1,343.75 |
| 6065797 | CT UPPER EXT W/O CONT LEFT | 1,113.00 |
| 6065920 | CT SOFT TISSUE NECK W/ | 1,786.50 |
| 6065938 | CT SOFT TISSUE NECK W/O | 1,638.75 |
| 6066102 | CT MAXILLOFACIAL/SINUS W | 1,983.75 |
| 6070486 | CT SINUS W/O CONTRAST | 1,786.50 |
| 6070487 | CT SINUS W/CONTRAST | 1,983.75 |
| 6070498 | CTA CAROTID/NECK | 2,882.00 |
| 6071275 | CTA CHEST | 3,410.00 |
| 6073200 | CT UPPER EXT W/O CONT RIGHT | 1,113.00 |
| 6073201 | CT UPPER EXT W/CONTRAST RIGHT | 1,295.25 |
| 6073700 | CT LOWER EXT W/O CONT LEFT | 1,113.00 |
| 6073701 | CT LOWER EXT LEFT W/CONTRAST | 1,295.25 |
| 6073702 | CT LOWER EXT RIGHT W/CONTRAST | 1,295.25 |
| 6073704 | CT LOWER EXT LEFT W/WO CONTRAST | 1,400.75 |
| 6073705 | CT LOWER EXT W/O CONT RIGHT | 1,113.00 |
| 6073706 | CT HIP L W/O CONT | 1,113.00 |
| 6073707 | CT HIP R W/O CONT | 1,113.00 |
| 6074170 | CT LIVER 3 PHASE | 1,883.00 |
| 6074175 | CT ANGIO/AAA | 2,728.00 |
| 6074178 | CT UROGRAM | 2,824.00 |
| 6075635 | CTA PELVIS RUNOFF | 2,586.00 |
| 6500003 | TETANUS-DIPHTHERIA (DECAVAC) VL | 63.75 |
| 6500022 | RISPERIDONE(RISPERDAL) 0.5MG TAB | 20.00 |
| 6500032 | MUPIROCIN(BACTROBAN) 2% OINT | 35.00 |
| 6500061 | DOPAMINE(INTROPIN) 800MG/250ML IVPB | 203.00 |
| 6500070 | FLUORESCEIN (FUL-GLO) EYE STRIP | 14.50 |
| 6500078 | HYDROCORTISONE 2.5% CREAM | 42.75 |
| 6500089 | ACETAMINOPHEN(TYLENOL) 325MG SUPP | 9.75 |
| 6500094 | TROPICAMIDE(MYDRIACYL) 1% EYE DROP | 52.00 |
| 6500097 | ACETAMINOPHEN(TYLENOL) 650MG SUPP | 9.75 |
| 6500102 | TUBERCULIN PPD(TUBERSOL) 5U/0.1ML | 28.75 |
| 6500124 | MIDAZOLAM(VERSED) 2MG/2ML SDV | 29.75 |
| 6500126 | LISINOPRIL (ZESTRIL) 10MG TAB | 7.75 |
| 6500128 | FLUOXETINE(PROZAC) 20MG CAP | 12.25 |
| 6500145 | CEPHALEXIN(KEFLEX) 500MG CAP | 7.75 |
| 6500360 | OXYMETAZOLINE(AFRIN)NASAL SOL 0.05% | 27.75 |
| 6500444 | SPIRONOLACTONE(ALDACTONE) 25MG TAB | 7.75 |
| 6500899 | AMOXICILLIN(AMOXIL) 250MG CAP | 7.75 |
| 6500948 | AMOXICILLIN(AMOXIL) 250MG/5ML SUSP | 27.75 |
| 6501061 | AMPICILLIN(PENBRITIN) 500MG VL | 56.25 |
| 6501204 | ENALAPRILAT(VASOTEC)2.5 MG/2ML VL | 54.00 |
| 6501267 | CLONIDINE(CATAPRESS) TD 0.1MG/24H | 63.75 |
| 6501285 | SUCCINYLCHOLINE(QUELICIN)200MG/10ML | 35.00 |
| 6501343 | PHYSOSTIGMINE(ANTILIRIUM) 1MG/ML VL | 40.75 |
| 6501368 | MECLIZINE (ANTIVERT) 25MG TAB | 17.50 |
| 6501481 | D50W (DEXTROSE 50%) 50ML PFS | 84.00 |
| 6501483 | HYDRALAZINE (APRESOLINE) 25MG TAB | 7.75 |
| 6501509 | HYDRALAZINE(APRESOLINE) 20MG/ML VL | 17.50 |
| 6501525 | PHYTONADIONE(VIT-K3) 10MG/ML SDV | 110.25 |
| 6501855 | ASPIRIN(ECOTRIN) 325MG TAB | 7.75 |
| 6501970 | ATROPINE 1MG/10ML ADULT PFS | 46.25 |
| 6502002 | ATROPINE 1MG/ML VL | 32.00 |
| 6502267 | SULFASALAZINE(AZULFIDINE) 500MG TAB | 9.75 |
| 6502273 | HEPARIN 25 000 UNITS/250 ML IVPB | 23.25 |
| 6502580 | DIPHENHYDRAMINE(BENADRYL)50MG/ML | 28.75 |
| 6502606 | DIPHENHYDRAMINE(BENADRYL) 25MG CAP | 7.75 |
| 6502622 | DIPHENHYDRAMINE(BENADRYL)12.5/5 SYR | 13.50 |
| 6502646 | GLYCERIN ADULT SUPP | 13.50 |
| 6502648 | DICYCLOMINE(BENTYL) 20MG/2ML VL | 128.92 |
| 6502663 | DICYCLOMINE(BENTYL) 10MG CAP | 7.75 |
| 6502676 | SULFA-TRIMETH DS (BACTRIM DS) TAB | 7.75 |
| 6502897 | MAGNESIUM CL(SLOW MAG) 70 MG TB | 7.75 |
| 6502903 | PEN BENZATHINE(BICILLIN LA)IM 1.2MU | 206.00 |
| 6503455 | CALCIUM GLUCONATE INJ 10% 10ML VL | 38.75 |
| 6503495 | POT CHLOR(KLOR-CON) ER 10MEQ TAB | 7.75 |
| 6503505 | CALCIUM CHLORIDE INJ 10% 10ML PFS | 35.00 |
| 6503877 | CLONIDINE (CATAPRESS) 0.1MG TAB | 7.75 |
| 6503950 | CEFAZOLIN (ANCEF) 1GM/50ML IVPB | 52.00 |
| 6504495 | MAGNESIUM CITRATE SOLN 296ML | 18.50 |
| 6504545 | CLINDAMYCIN(CLEOCIN) 150MG CAP | 7.75 |
| 6504733 | IBUPROFEN(MOTRIN) 800MG TAB | 7.75 |
| 6504832 | IBUPROFEN(MOTRIN) 200 MG TAB | 7.75 |
| 6504834 | COLCHICINE (COLCRYS)0.6MG TAB | 31.00 |
| 6504933 | PROCHLORPERAZINE(COMPAZINE)10MG/2ML | 28.75 |
| 6504964 | HEPATITIS B VACCINE (ENGERIX) | 298.75 |
| 6505128 | ALBUTEROL(VENTOLIN) 2.5MG/3ML UDV | 16.50 |
| 6505193 | ACETAMINO(TYLENOL#3)+COD SYRUP 5ML | 14.50 |
| 6505575 | NEO-POLY-HC(CORTISPORIN) OTIC SUSP | 83.00 |
| 6505623 | LOVASTATIN (MEVACOR) 20MG TAB | 7.75 |
| 6505631 | CEFTRIAXONE (ROCEPHIN) 250MG VL | 35.00 |
| 6505668 | ADENOSINE(ADENOCARD) 6MG/2ML | 147.75 |
| 6505676 | NITRO (TRIDIL) 50MG/250ML IVPB | 114.75 |
| 6505722 | AMPI & SULB(UNASYN) 1-0.5GM VL | 48.50 |
| 6505730 | AMPI & SULB(UNASYN) 2-1GM VL | 68.50 |
| 6505760 | WARFARIN(COUMADIN) 1MG TAB | 14.50 |
| 6505765 | WARFARIN(COUMADIN) 2 MG TAB | 14.50 |
| 6505773 | WARFARIN(COUMADIN) 2.5 MG TAB | 14.50 |
| 6505781 | WARFARIN(COUMADIN) 5 MG TAB | 14.50 |
| 6505896 | CIPROFLOXACIN(CIPRO) 500MG TAB | 9.75 |
| 6505898 | CYCLOPENTOLATE(CYCLOGYL) 1% EYE DRP | 41.75 |
| 6505997 | EYE WASH (DACRIOSE) 30ML | 60.75 |
| 6506268 | CARBAMIDE PERO(DEBROX) OTIC DR 15ML | 24.25 |
| 6506334 | DEXAMETHASONE(DECADRON) 0.5MG/5 SYR | 26.25 |
| 6506755 | METHYLPRED (DEPO-MEDROL)40MG/ML VL | 78.25 |
| 6506789 | MEDROXYPROG (DEPO-PROVERA) 150MG VL | 187.50 |
| 6507144 | PROPOFOL (DIPRIVAN) 200MG/20ML SDV | 84.00 |
| 6507167 | ACETAZOLAMIDE (DIAMOX) 250MG TAB | 13.50 |
| 6507456 | PHENYTOIN(DILANTIN) 100MG CAPS | 7.75 |
| 6507514 | PHENYTOIN (DILANTIN) 250MG/5ML SDV | 84.00 |
| 6507837 | BELLADO-PHENO(DONNATAL) ELIX 10ML | 85.00 |
| 6507936 | DOCUSATE(COLACE) 100MG CAP | 7.75 |
| 6507971 | METFORMIN(GLUCOPHAGE) 500MG TAB | 7.75 |
| 6508082 | BISACODYL(DULCOLAX) 10MG SUPP | 13.50 |
| 6508090 | BISACODYL(DULCOLAX) DR 5MG TAB | 7.75 |
| 6508140 | TRIAM/HCTZ (DYAZIDE) 37.5/25 CP | 7.75 |
| 6508314 | AMITRIPTYLINE(ELAVIL) 25MG TAB | 7.75 |
| 6508611 | EPHEDRINE 50MG/1ML VL | 45.25 |
| 6508627 | ACETAMINOPHEN(TYLENOL) 160/5 SYR | 7.75 |
| 6509262 | FERROUS SULF (FEOSOL) 325MG TAB | 7.75 |
| 6509338 | METRONIDAZOLE (FLAGYL) 250MG TAB | 7.75 |
| 6509452 | FOLIC ACID 1MG TAB | 7.75 |
| 6509486 | FOLIC ACID 50MG/10ML MDV | 60.75 |
| 6509833 | GENTAMICIN(GARAMYCIN) 80MG/2ML VL | 127.75 |
| 6509866 | GENTAMICIN(GARAMYCIN) 0.3% EYE DRP | 49.50 |
| 6509874 | GENTAMICIN(GARAMYCIN) 0.3% EYE OINT | 77.25 |
| 6509878 | TRAMADOL 50MG TAB ER-4-PK | 27.75 |
| 6509902 | VALSARTAN(DIOVAN) 80MG TAB | 10.75 |
| 6510112 | GLUCAGON (GLUCAGEN) 1MG VL | 356.25 |
| 6510252 | HALOPERIDOL (HALDOL) 0.5MG TAB | 7.75 |
| 6510286 | HALOPERIDOL (HALDOL) 5MG/ML VL | 28.75 |
| 6510427 | HEPARIN 10 000 UNITS/1ML VL | 7.75 |
| 6510831 | HYDROMORPHONE(DILAUDID) 2MG/ML | 17.50 |
| 6511185 | PROPRANOLOL (INDERAL) 10 MG TAB | 7.75 |
| 6511201 | INDOMETHACIN (INDOCIN) 25MG CAP | 7.75 |
| 6511235 | INFLUENZA VACC ADULT 0.5ML | 33.00 |
| 6511888 | SOD POLYSTYRENE (KAYEXALATE) | 28.75 |
| 6512019 | CEPHALEXIN (KEFLEX) 250MG CAP | 7.75 |
| 6512100 | TRIAMCINOLONE(KENALOG) 40MG/ML VL | 40.75 |
| 6512340 | DIGOXIN (LANOXIN) 0.5MG/2ML VL | 78.25 |
| 6512357 | DIGOXIN (LANOXIN) 0.125MG TAB | 7.75 |
| 6512365 | DIGOXIN (LANOXIN) 0.25MG TAB | 7.75 |
| 6512407 | FUROSEMIDE (LASIX) 20MG/2ML VL | 28.75 |
| 6512415 | FUROSEMIDE (LASIX) 20MG TAB | 7.75 |
| 6512423 | FUROSEMIDE (LASIX) 100MG/10ML VL | 36.00 |
| 6512431 | FUROSEMIDE (LASIX) 40MG TAB | 7.75 |
| 6512506 | NOREPINEPHRINE(LEVOPHED)4MG/4ML VL | 50.50 |
| 6512530 | CHLORDIAZEPOXIDE(LIBRIUM) 25MG CAP | 14.50 |
| 6512647 | LIDOCAINE IV 100MG/5ML ADULT PFS | 81.25 |
| 6512852 | DIPHENOX+ATROPINE(LOMOTIL) TAB | 10.75 |
| 6513025 | MAGNESIUM SULFATE INJ 1GM/2ML SDV | 32.00 |
| 6513132 | MANNITOL 20% 500ML IVPB | 57.25 |
| 6514031 | MAGNESIUM HYDROX (MOM) 30ML SUSP | 13.50 |
| 6514155 | ACETYLCHOLINE(MIOCHOL) 0.001% EYE | 138.00 |
| 6514296 | IBUPROFEN(MOTRIN) 400 MG TAB | 7.75 |
| 6514692 | SIMETHICONE (GAS-X) 80MG CHEW TAB | 7.75 |
| 6514858 | NALOXONE(NARCAN) 0.4 MG/ML SDV | 63.93 |
| 6515327 | NEO-POLY-BACI (NEOSPORIN) TOP 0.9G | 9.75 |
| 6515368 | NEO-POLY-GRAMI(NEOSPORIN) EYE DRP | 97.75 |
| 6515434 | PHENYLEPHRINE(NEO-SYNEPH)10MG/ML VL | 46.25 |
| 6516208 | ISOFLURANE(FORANE) PER MIN | 2.00 |
| 6516216 | ENFLURANE(ETHRANE) 250ML PER MIN | 2.00 |
| 6517166 | PROMETHAZINE(PHENERGAN) 25MG/ML VL | 84.00 |
| 6517190 | PROMETH+COD(PHENERGAN) SYRUP 10ML | 8.25 |
| 6517240 | PROMETHAZINE(PHENERGAN) 25MG SUPP | 14.50 |
| 6517273 | PROMETHAZINE(PHENERGAN) 25MG TAB | 7.75 |
| 6517513 | OXYTOCIN(PITOCIN) 10 UNIT/ML VL | 44.25 |
| 6517547 | VASOPRESSIN(VASOSTRICT) 20U/1ML | 165.25 |
| 6517927 | PREDNISONE (METICORTEN) 5MG TAB | 7.75 |
| 6517935 | PREDNISONE (METICORTEN) 20MG TAB | 7.75 |
| 6518818 | PHENAZOPYRIDINE(PYRIDIUM) 100MG TAB | 9.75 |
| 6519337 | METHOCARBAMOL(ROBAXIN) 500MG TAB | 7.75 |
| 6519428 | GUAIFENESIN(ROBITUSSIN)200MG/10 SYRUP | 10.75 |
| 6519451 | GUAIFEN-DM(ROBITUSSIN DM) SYR 10ML | 13.50 |
| 6519576 | RIFAMPIN(RIMACTANE) 300MG CAP | 9.75 |
| 6520046 | SOD BICARBONATE 8.4% 50MEQ AD PFS | 73.75 |
| 6520509 | PSEUDOEPHEDRINE(SUDAFED) 30MG TAB | 10.75 |
| 6520525 | SULFACETAMIDE(BLEH-10)EYE DROPS 10% | 42.75 |
| 6520616 | METHYLPRED (SOLU-MEDROL) 40MG VL | 84.00 |
| 6520624 | HYDROCORTISONE(SOLU-CORTEF)250MG VL | 56.25 |
| 6520632 | METHYLPRED (SOLU-MEDROL) 125MG VL | 84.00 |
| 6520673 | METHYLPRED (SOLU-MEDROL) 1000MG VL | 93.75 |
| 6520715 | FENTANYL(SUBLIMAZE)100MCG/2ML AMP | 42.75 |
| 6520723 | CARISOPRODOL(SOMA) 350MG TAB | 13.50 |
| 6520731 | FENTANYL(SUBLIMAZE)250MCG/5ML AMP | 42.75 |
| 6521036 | LEVOTHYROXINE(LEVOXYL) 50MCG TAB | 7.75 |
| 6521044 | LEVOTHYROXINE(LEVOXYL) 100 MCG TAB | 7.75 |
| 6522222 | PENICILLIN VK 250MG/5ML PED SUSP | 14.50 |
| 6522240 | CARBAMAZEPINE(TEGRETOL) 200MG TAB | 7.75 |
| 6522489 | BENZONATATE(TESSALON) 100MG CAP | 7.75 |
| 6522524 | BUPIVACAINE(MARCAINE)INJ 0.5% 50ML | 41.75 |
| 6522554 | TETANUS IMM GLOB (HYTERTET) PFS | 1,093.25 |
| 6522557 | BUPIV 0.5% + EPI(MARCAINE) PF | 35.00 |
| 6522626 | TETRACAINE 0.5% EYE DROPS | 31.00 |
| 6522760 | MULTIVITS + MIN (THERA M) TABS | 7.75 |
| 6522786 | THIAMINE(VIT-B1) 200MG/2ML SDV | 70.50 |
| 6522794 | THIAMINE(VITA-B1) 100MG TAB | 9.75 |
| 6522885 | CHLORPROMAZINE(LARGACTIL)50MG/2MLVL | 57.25 |
| 6523859 | ACETAMINOPHEN(TYLENOL) 80/0.8 DROP | 22.25 |
| 6523867 | ACETAMINOPHEN(TYLENOL) 325MG TAB | 7.75 |
| 6523870 | ACETAMINOPHEN(TYLENOL) 500MG TAB | 7.75 |
| 6523883 | ACETAMINOPHEN(TYLENOL#3)+COD TAB | 9.75 |
| 6524255 | KETAMINE(KETALAR) 500MG/10ML MDV | 24.25 |
| 6524329 | DIAZEPAM (VALIUM) 5MG TAB | 9.75 |
| 6524345 | DIAZEPAM (VALIUM) INJ 10MG/2ML CJ | 84.00 |
| 6524428 | VANCOMYCIN(VANCOCIN) INJ 500 MG VL | 84.00 |
| 6524550 | PENICILLIN VK 500MG TAB | 7.75 |
| 6524667 | DOXYCYCLINE(VIBRAMYCIN) 100MG TAB | 7.75 |
| 6524931 | HYDROXYZINE(ATARAX) 50MG/ML VL | 14.50 |
| 6525078 | PHYTONADIONE(VITA-K3) 1MG/0.5ML VL | 63.75 |
| 6525110 | CYANOCOBALAMIN(B-12) 1MG/1ML VL | 40.75 |
| 6525300 | LIDOCAINE(UROJECT) GEL 2% 10ML PFS | 60.75 |
| 6525359 | LIDOCAINE TOPICAL 4% SOLN 40ML | 27.75 |
| 6525367 | LIDOCAINE(XYLOCAINE) 1% LOCAL MDV | 25.00 |
| 6525375 | LIDOCAINE(XYLOCAINE) 2% MDV | 23.25 |
| 6525383 | LIDOCAINE 2%+EPI(XYLOCAINE+EPI)20ML | 49.50 |
| 6525433 | ZINC OXIDE(DESITIN) 20% OINTMENT | 10.75 |
| 6525490 | ALLOPURINOL(ZYLOPRIM) 100MG TAB | 8.25 |
| 6525722 | RACEPINEPRINE 2.25% NEB UDV | 17.50 |
| 6526530 | DEXAMETHASONE(DECADRON) 4MG/ML VL | 28.75 |
| 6526597 | DEXAMETHASONE(DECADRON) 4MG TAB | 7.75 |
| 6527769 | NAPROXEN (NAPROSYN) 250MG TAB | 7.75 |
| 6528791 | LIDOCAINE 2% + EPI (XYLOCAINE+EPI) | 55.00 |
| 6528841 | METOLAZONE (ZAROXYLIN) 5MG TAB | 7.75 |
| 6529013 | TERBUTALINE(BRETHINE) 1MG/ML SDV | 24.25 |
| 6529401 | ACETAMINOPHEN(TYLENOL) 120MG SUPP | 7.75 |
| 6529427 | OXYBUTYNIN(DITROPAN) 5MG TAB | 7.75 |
| 6529658 | NITRO (NITRO-BID) 2% OINT | 46.25 |
| 6529732 | LACTULOSE(KRISTALOSE) 10GM/15ML CUP | 10.75 |
| 6529781 | GLYCOPYRROLATE(ROBINUL)0.4MG/2ML VL | 77.25 |
| 6529880 | PREDNISOLONE(PRED-FORTE) 1% EYE DRP | 85.25 |
| 6529930 | ERYTHROMYCIN(ILOTYCIN)EYE OINT 3.5G | 88.00 |
| 6530045 | CIMETIDINE(TAGAMET) 300MG TAB | 7.75 |
| 6530144 | LOPERAMIDE (IMODIUM) 2MG CAP | 9.75 |
| 6530193 | HYDROCORTISONE 1% CREAM | 8.75 |
| 6530474 | LORAZEPAM (ATIVAN) 1MG TAB | 10.75 |
| 6530516 | OXYCODONE-APAP (PERCOCET) 5-325 TAB | 9.75 |
| 6530540 | CYCLOBENZAPRINE(FLEXERIL) 10MG TAB | 7.75 |
| 6530599 | PHENYTOIN(DILANTIN) 100MG/4ML ORAL SUSP | 52.00 |
| 6531308 | PROCAINAMIDE(PRONESTYL) 1GM/10ML SDV | 60.75 |
| 6531894 | HYDROMORPHONE(DILAUDID) 2MG TAB | 9.75 |
| 6531969 | POT CHLOR(MICRO-K) 20MEQ PWD PKT | 9.75 |
| 6531977 | METOPROLOL (LOPRESSOR) 50MG TAB | 7.75 |
| 6532124 | FUROSEMIDE (LASIX) 40MG/4ML VL | 28.75 |
| 6532520 | IBUPROFEN(MOTRIN) 600MG TAB | 7.75 |
| 6532553 | GUAIFEN-COD (ROBITUSSIN AC)5ML | 9.75 |
| 6532686 | PNEUMOCOCCAL(PNEUMOVAX-23) 0.5ML | 200.25 |
| 6533080 | LORAZEPAM (ATIVAN) 0.5MG TAB | 10.75 |
| 6533296 | METOCLOPRAMIDE(REGLAN) 10MG/2ML SDV | 33.00 |
| 6533445 | LIDOCAINE VISCOUS 2% SOLN 15 ML | 14.50 |
| 6533452 | CEFOXITIN(MEFOXIN) 1GM IVPB | 84.00 |
| 6533585 | LORAZEPAM (ATIVAN) 2MG/ML SDV | 27.75 |
| 6534385 | CEFOTAXIME(CLAFORAN) 1GM VL | 37.50 |
| 6534476 | CARBI-LEVODOPA(SINEMET) 25-100 TAB | 7.75 |
| 6534559 | ACETYLCYSTEINE(MUCOMYST) 20% 30ML | 93.75 |
| 6534641 | METOCLOPRAMIDE (REGLAN) 10MG TAB | 7.75 |
| 6534674 | TEMAZEPAM(RESTORIL) 15MG CAP | 9.75 |
| 6535093 | VITAMINS A & D OINT | 9.75 |
| 6535432 | ATENOLOL (TENORMIN) 50MG TAB | 7.75 |
| 6535481 | METRONIDAZOLE (FLAGYL) 500 MG IVPB | 84.00 |
| 6535499 | CAPTOPRIL(CAPOTEN) 25MG TAB | 7.75 |
| 6535804 | SUCRALFATE (CARAFATE) 1000MG TAB | 7.75 |
| 6535853 | ALPRAZOLAM(XANAX) 0.25MG TAB | 9.75 |
| 6535960 | VERAPAMIL (CALAN) 80MG TAB | 7.75 |
| 6535978 | VERAPAMIL (ISOPTIN) SR 120MG TAB | 7.75 |
| 6536000 | TRAZODONE(DESERYL) 50MG TAB | 7.75 |
| 6536208 | ALUM-MGOH-SI(MYLANTA)SUSP 30ML | 13.50 |
| 6536448 | AMPICILLIN(PENBRITIN) 1000MG VL | 54.00 |
| 6536737 | DILTIAZEM(CARDIZEM) 30MG TAB | 7.75 |
| 6537271 | PEG3350-KCL-BICARB(GOLYTELY) 4L | 63.75 |
| 6537339 | RANITIDINE (ZANTAC) 150MG TAB | 7.75 |
| 6537651 | METHADONE(METHADOSE) 10MG TAB | 14.50 |
| 6537792 | MORPHINE SULFATE INJ 4 MG/ML | 42.75 |
| 6538162 | GLIPIZIDE(GLUCOTROL) 5MG TAB | 7.75 |
| 6538204 | GLYBURIDE(MICRONASE)5MG TAB | 7.75 |
| 6538535 | METOPROLOL (LOPRESSOR) 5MG/5ML SDV | 84.00 |
| 6538618 | AMOX/CLAV(AUGMENTIN) 500MG TAB | 14.85 |
| 6538659 | LABETALOL(TRANDATE) 100MG/20ML MDV | 58.25 |
| 6539004 | CEFAZOLIN (ANCEF) 1GM VL | 37.50 |
| 6539194 | MORPHINE(MS CONTIN) 12HR 30MG TAB | 14.50 |
| 6539418 | CEFTRIAXONE (ROCEPHIN) 1GM VL | 84.00 |
| 6539939 | AMIODARONE(CORDARONE) 200MG TAB | 12.25 |
| 6540121 | NIFEDIPINE(ADALAT) ER 30 MG TAB | 14.50 |
| 6540133 | NITRO (NITRO-STAT) SL 0.4MG TAB | 8.75 |
| 6561406 | D5W + NS 0.45% + 20K 1000ML | 84.00 |
| 6561430 | NS 0.9% + 40K 1000ML | 84.00 |
| 6574262 | MORPHINE SULFATE INJ 10 MG/ML CJ | 60.75 |
| 6578659 | AMOX/CLAV(AUGMENTIN) 250/5ML SUSP | 178.75 |
| 6578967 | CLONAZEPAM(KLONOPIN) 0.5MG TAB | 9.75 |
| 6578969 | FENTANYL(DURAGESIC) TD 50MCG/HR PAT | 87.00 |
| 6578970 | CELECOXIB(CELEBREX) 100MG CAP | 18.00 |
| 6578971 | SENNOSIDES (SENOKOT) 8.6MG TAB | 7.75 |
| 6578973 | GABAPENTIN (NEURONTIN) 100MG CAP | 7.75 |
| 6578974 | MONTELUKAST (SINGULAIR) 10MG TAB | 16.50 |
| 6578975 | ETOMIDATE(AMIDATE) IV 20MG/10ML MDV | 84.00 |
| 6578992 | LANSOPRAZOLE(PREVACID)DR 30MG CAP | 22.25 |
| 6578994 | ALBUMIN HUMAN 25% 50ML VL | 457.25 |
| 6578996 | ATORVASTATIN(LIPITOR)10MG TAB | 17.50 |
| 6578999 | TAMSULOSIN(FLOMAX) 0.4MG CAP | 9.75 |
| 6579000 | GABAPENTIN (NEURONTIN) 300MG CAP | 8.50 |
| 6579004 | OCTREOTIDE(SANDOSTATIN) 50MCG/ML | 55.00 |
| 6579005 | PREDNISOLONE(ORAPRED) 30MG/10ML SYRUP | 17.50 |
| 6579008 | ENOXAPARIN(LOVENOX)80MG/0.8ML SYR | 276.50 |
| 6579010 | PROPARACAINE 0.5% EYE DROPS | 29.75 |
| 6579100 | ZOLPIDEM (AMBIEM) 5MG TAB | 9.75 |
| 6579103 | AZITHROMYCIN(ZITHROMAX) 250MG TAB | 27.75 |
| 6579588 | KETOROLAC(TORADOL) 60MG/2ML SDV | 84.00 |
| 6579592 | FLUMAZENIL(RAMAZICON) 0.5MG/5ML VL | 61.75 |
| 6579593 | KETOROLAC(TORADOL) 30MG/ML SDV | 84.00 |
| 6579595 | NITROFURANTOIN (MACRODANTIN) 50 MG CP | 9.50 |
| 6579598 | KETOROLAC(TORADOL) 15MG/ML SDV | 29.75 |
| 6579600 | CEFTRIAXONE (ROCEPHIN) 500MG VL | 40.75 |
| 6579606 | TOBRA-DEXA (TOBRADEX) EYE OINT 3.5G | 459.50 |
| 6579609 | NICOTINE(NICODERM) 21 MG/24HR PATCH | 17.00 |
| 6579622 | SUMATRIPTAN(IMITREX) 6MG/0.5ML SDV | 364.50 |
| 6579654 | DIVALPROEX(DEPAKOTE) DR 250MG TAB | 7.75 |
| 6579662 | ASPIRIN(ECOTRIN) 81MG CHEW TAB | 7.75 |
| 6579665 | RANITIDINE (ZANTAC) 50MG/2ML SDV | 42.75 |
| 6579667 | RHOD IMM GLOBULIN(RHOGAM)300MCG PFS | 329.50 |
| 6579669 | IBUPROFEN(MOTRIN) 100MG/5ML SUSP | 13.50 |
| 6579672 | HYDROCHLOROTHIAZIDE (HCTZ) 25MG TAB | 7.75 |
| 6579676 | CEPHALEXIN(KEFLEX) 250MG/5ML SUSP | 97.75 |
| 6579680 | IPRATROPIUM (ATROVENT) 0.02% NEB | 16.50 |
| 6579686 | CLARITHROMYCIN(BIAXIN) 250MG TAB | 16.50 |
| 6579689 | DILTIAZEM(CARDIZEM) 25MG/5ML SDV | 115.25 |
| 6579691 | VENLAFAXINE (EFFEXOR) XR 75 MG CAP | 18.50 |
| 6579692 | FAMOTIDINE (PEPCID) 20MG TAB | 7.75 |
| 6579698 | DILTIAZEM(CARDIZEM)24HR 120 MG CAP | 8.95 |
| 6579706 | POT CHLOR(MICRO-K) CR 20MEQ TAB | 9.75 |
| 6579708 | SERTRALINE (ZOLOFT) 50MG TAB | 9.75 |
| 6579709 | BENAZEPRIL(LOTENSIN) 10MG TAB | 7.75 |
| 6579710 | BACLOFEN(LIORESAL)10MG TAB | 7.75 |
| 6579714 | ENOXAPARIN(LOVENOX)30MG/0.3ML SYR | 110.25 |
| 6579715 | FENTANYL(DURAGESIC) TD 25MCG/HR PAT | 47.50 |
| 6579717 | DILTIAZEM(CARDIZEM)24HR 180 MG CAP | 7.75 |
| 6579720 | AMLODIPINE(NORVASC) 5MG TAB | 7.75 |
| 6579722 | ISOSORBIDE MONO (IMDUR)ER 60 MG TAB | 9.75 |
| 6579727 | BUMETANIDE(BUMEX) 1MG TAB | 7.75 |
| 6579728 | DOXAZOSIN(CARDURA) 2MG TAB | 7.75 |
| 6579732 | CLINDAMYCIN(CLEOCIN) 600MG/4ML VL | 87.00 |
| 6579736 | MIDAZOLAM(VERSED) 5MG/5ML SDV | 40.75 |
| 6579746 | PAROXETINE (PAXIL) 20 MG TAB | 9.75 |
| 6579752 | FAMOTIDINE (PEPCID) 20MG/2ML SDV | 29.75 |
| 6579756 | AZITHROMYCIN(ZITHROMAX) 500MG VL | 100.50 |
| 6579758 | NICOTINE(NICODERM) 14MG/24HR PATCH | 16.00 |
| 6579762 | CARVEDILOL (COREG) 3.125MG TAB | 7.75 |
| 6579763 | CHARCOAL ACT-SORB(ACTIDOSE) SUSP | 60.75 |
| 6579772 | LOSARTAN (COZAAR) 50MG TAB | 7.75 |
| 6579773 | ALBUTEROL(VENTOLIN) 0.5% NEB SOL | 68.50 |
| 6579775 | ROCURONIUM (ZEMURON) 50MG/5ML MDV | 113.25 |
| 6579776 | ESMOLOL(BREVIBLOC) 100MG/10ML VL | 96.75 |
| 6579780 | POT CHLOR(KRIDER)20 MEQ/100 ML IVPB | 52.00 |
| 6579781 | LEVOFLOXACIN(LEVAQUIN) 500MG IVPB | 211.75 |
| 6579785 | CLOPIDOGREL(PLAVIX) 75MG TAB | 21.00 |
| 6579792 | HEPATITIS A VACCINE(HAVRIX) | 277.50 |
| 6579803 | LEVOFLOXACIN(LEVAQUIN) 250MG IVPB | 211.75 |
| 6579820 | LEVOFLOXACIN(LEVAQUIN) 500MG TAB | 50.50 |
| 6579837 | AMIODARONE(CORDARONE)150MG/3ML | 35.00 |
| 6579838 | TENECTEPLASE (TNKASE) IV 50MG -340B | 12,985.00 |
| 6579839 | TRAMADOL (ULTRAM) 50MG TAB | 7.75 |
| 6579841 | NALOXONE(NARCAN) 2MG/2ML PFS | 102.50 |
| 6579848 | LABETALOL(TRANDATE) 20MG/4ML PFS | 44.25 |
| 6579851 | BUPIVACAINE(MARCAINE)INJ 0.25% 50ML | 35.00 |
| 6579856 | ONDANSETRON (ZOFRAN) 4MG/2ML SDV | 23.75 |
| 6579857 | OXYCODONE(OXYCONTIN) SR 10MG TAB | 9.75 |
| 6579863 | PHENYLEPHRINE(AK-DILATE)2.5% EYE DR | 54.50 |
| 6579864 | CIPROFLOXACIN(CIPRO) 0.3% EYE DROPS | 166.25 |
| 6579869 | SEVOFLURANE(ULTANE) PER MIN | 2.00 |
| 6579871 | ONDANSETRON (ZOFRAN) 4MG TAB | 14.00 |
| 6579872 | MIRTAZAPINE (REMERON) 15MG TAB | 9.75 |
| 6579873 | ATENOLOL (TENORMIN) 25MG TAB | 7.75 |
| 6579875 | ENOXAPARIN(LOVENOX)60MG/0.6ML SYR | 190.50 |
| 6579884 | LEVALBUTEROL(XOPENEX)1.25MG/3ML UDV | 27.75 |
| 6579888 | MORPHINE SULF CONC 20 MG/ML PO LIQ | 67.25 |
| 6579892 | METOPROLOL (LOPRESSOR) 25MG TAB | 7.75 |
| 6579893 | ENOXAPARIN(LOVENOX)100MG/1ML SYR | 300.75 |
| 6579894 | PREGABALIN(LYRICA) 50MG CAP | 20.00 |
| 6579895 | ENOXAPARIN(LOVENOX)40MG/0.4ML SYR | 136.50 |
| 6579896 | DILTIAZEM(CARDIZEM) 125MG/25ML SDV | 192.00 |
| 6579899 | ZIPRASIDONE(GEODON) 20MG CAP | 87.00 |
| 6579900 | CARVEDILOL (COREG) 12.5MG TAB | 7.75 |
| 6579901 | PILOCARPINE(ISOPTO-CARPINE) 2% DRP | 144.25 |
| 6579902 | HYDROXYZINE(ATARAX) 25MG TAB | 9.75 |
| 6579904 | CLINDAMYCIN 150MG CAP ER 4PK | 24.25 |
| 6579905 | CLINDAMYCIN(CLEOCIN) 900MG/50 IVPB | 104.50 |
| 6579908 | D5W + NS 0.9% + 20K 1000ML | 84.00 |
| 6579909 | CITALOPRAM(CELEXA) 20MG TAB | 9.75 |
| 6579910 | NS 0.9% + 20K 1000ML | 84.00 |
| 6579911 | MAGNESIUM SULFATE 2GM/50ML IVPB | 72.50 |
| 6579913 | NS 0.45% + 20K 1000ML | 84.00 |
| 6579917 | QUETIAPINE(SEROQUEL) 25MG TAB | 9.75 |
| 6579918 | INSULIN-REG (HUMULIN-R) 100U/ML MDV | 9.75 |
| 6579919 | INSULIN GLARNINE (LANTUS) 100U/ML | 14.50 |
| 6579920 | INSULIN-NPH (NOVOLIN-N) 100U/ML MDV | 9.75 |
| 6579922 | INSULIN LISPRO (HUMALOG) 100U/ML | 23.25 |
| 6579926 | VANCOMYCIN(VANCOCIN) INJ 1000 MG VL | 84.00 |
| 6579927 | ENALAPRIL(VASOTEC) 10MG TAB | 7.75 |
| 6579929 | FENTANYL(DURAGESIC) TD 100MCG/HR PAT | 234.75 |
| 6579932 | DONEPEZIL(ARICEPT) 10MG TAB | 31.00 |
| 6579934 | GUAIFENESIN(MUCINEX) 12HR 600MG TAB | 13.50 |
| 6579935 | HYDROCODONE-APAP(NORCO) 10-325 TAB | 10.75 |
| 6579936 | DIAZEPAM (VALIUM) INJ 50MG/10ML MDV | 144.25 |
| 6579937 | PANTOPRAZOLE(PROTONIX) 40MG SDV | 81.25 |
| 6579939 | ALBUTEROL(VENTOLIN) 90MCG/PUFF MDI | 128.75 |
| 6579947 | VALPROATE(DEPAKOTE) 500 MG/5ML VL | 54.00 |
| 6579949 | OSELTAMIVIR(TAMIFLU) 75MG CAP | 42.00 |
| 6579950 | SIMVASTATIN (ZOCOR) 20MG TAB | 9.75 |
| 6579951 | VANCOMYCIN(VANCOCIN) 125MG CAP | 69.50 |
| 6579961 | DULOXETINE(CYMBALTA) 30MG CAP | 17.50 |
| 6579962 | CEFEPIME (MAXIPIME) 1GM VL | 52.00 |
| 6579963 | ONDANSETRON (ZOFRAN) 4MG ODT TAB | 14.50 |
| 6579964 | LEVALBUTEROL(XOPENEX)0.63MG/3ML UDV | 27.75 |
| 6579965 | PANTOPRAZOLE(PROTONIX) EC 40MG TAB | 14.50 |
| 6579966 | HYDROMORPHONE(DILAUDID) 1MG/ML AMP | 18.50 |
| 6579968 | PIPERA-TAZO(ZOSYN) 3.375GM VL | 96.75 |
| 6579975 | ZIPRASIDONE(GEODON) 20MG/ML VL | 546.50 |
| 6579976 | VECURONIUM (NORCURON) 20MG SDV | 66.00 |
| 6579979 | METHYLPRED (DEPO-MEDROL)80MG/ML VL | 78.25 |
| 6579980 | MIDAZOLAM(VERSED) 10MG/10ML SDV | 73.75 |
| 6579981 | BUPIV(MARCAINE)INJ 0.25% PF 30ML | 36.50 |
| 6579983 | ACYCLOVIR(ZOVIRAX) 400MG TAB | 7.75 |
| 6579984 | ACYCLOVIR 400MG TAB ER 4 PK | 23.25 |
| 6579986 | LIDOCAINE(XYLOCAINE) 1% PF | 26.25 |
| 6579987 | TOPIRAMATE(TOPAMAX) 25MG TAB | 9.75 |
| 6579988 | HEPARIN LOCK FLUSH 500 UNITS/5 ML MDV | 14.00 |
| 6579989 | MORPHINE SULFATE INJ 2 MG/ML CJ | 42.75 |
| 6579991 | FLUTIC-SALMET(ADVAIR) 250-50 DISKUS | 375.00 |
| 6580002 | AMOXICILLIN 250MG CAP ER 4PK | 7.75 |
| 6580013 | SULFA-TRIMETH 200-40 MG/5ML PO SUSP | 50.50 |
| 6580014 | SULFAMETHOX-TRIMETH DS TAB ER 4PK | 26.25 |
| 6580016 | DIPHENHYDRAMINE 25MG CAP 4PK | 16.50 |
| 6580021 | CLONIDINE 0.1MG TAB ER 4PK | 24.25 |
| 6580026 | CIPROFLOXACIN 500MG TAB ER 4PK | 24.25 |
| 6580027 | PROCHLORPERAZINE 5MG TAB ER 4PK | 26.25 |
| 6580032 | DEXAMETHASONE 4MG TAB ER 4PK | 24.25 |
| 6580044 | METRONIDAZOLE 250MG TAB ER 4PK | 26.25 |
| 6580045 | CYCLOBENZAPRINE 10MG TAB ER 4PK | 24.25 |
| 6580050 | GLYCERIN PED SUPP | 13.50 |
| 6580056 | CEPHALEXIN 250MG CAP ER 4PK | 23.25 |
| 6580057 | CEPHALEXIN 500MG CAP ER 4PK | 24.25 |
| 6580066 | IBUPROFEN 600 MG TAB ER 4PK | 24.25 |
| 6580067 | IBUPROFEN 800MG TAB ER 4PK | 24.25 |
| 6580073 | PHENYLEPHRINEN(NEO-SYNEPH) NASAL SP | 14.50 |
| 6580074 | PHENYLEPHRINE(AK-DILATE) 10% EYE DR | 35.00 |
| 6580075 | NITRO SL 0.4MG TAB ER 25PK | 26.25 |
| 6580079 | PENICILLIN VK 500MG TAB ER 4PK | 26.25 |
| 6580081 | PROMETHAZINE 25MG SUPP ER 4 PK | 26.25 |
| 6580086 | PREDNISONE 20MG TAB ER 4PK | 28.00 |
| 6580094 | SILVER SULFA (SILVADENE)1% CRM 50G | 83.00 |
| 6580106 | ACETAMINOPHEN #3 +COD TAB ER 4PK | 26.25 |
| 6580114 | DOXYCYCLINE 100MG CAP ER 4PK | 7.75 |
| 6581015 | EPINEPHRINE 30MG/30ML MDV | 258.95 |
| 6588038 | EPINEPHRINE 1 MG/1ML AMP | 35.50 |
| 6588039 | EPINEPHRINE 1MG/10ML PFS | 93.75 |
| 6588042 | NYSTATIN(MYCOSTATIN) 500KU/5ML SUSP | 9.75 |
| 6588044 | GENTAMICIN(GARAMYCIN) 100MG IVPB | 84.00 |
| 6588047 | MIDAZOLAM(VERSED)10MG/5ML ORAL SYR | 31.00 |
| 6588048 | OXY-APAP (PERCOCET) 5-325 TAB ER-4-PK | 26.25 |
| 6588051 | ACETYLCYSTEINE (MUCOMYST) 10% 4ML | 35.00 |
| 6588052 | RABIES VIRUS VACCINE(RABAVERT) PFS | 989.75 |
| 6588055 | HYDROCODONE-APAP(NORCO) 5-325 TAB | 10.75 |
| 6588057 | HEPARIN 1000 UNITS/1ML VL | 14.50 |
| 6588060 | ONDANSETRON 4MG TAB ER 4PK | 40.75 |
| 6588062 | FENTANYL(DURAGESIC) TD 75MCG/HR PAT | 144.25 |
| 6588065 | MULTIVITAMIN(INFUVITE) INJ 10ML | 58.25 |
| 6588070 | AZITHROMYCIN(ZITHROMAX)200MG/5 SUSP | 49.50 |
| 6588071 | LEVOFLOXACIN(LEVAQUIN) 750MG IVPB | 211.75 |
| 6588072 | AMOX/CLAV 875MG TAB ER 4PK | 57.25 |
| 6588073 | IPRATROPIUM-ALBUTEROL(DUOneb) UDV | 7.75 |
| 6588075 | LIDO-PRILO (EMLA) CREAM 2.5-2.5% | 52.00 |
| 6588077 | FLUCONAZOLE(DIFLUCAN) 150MG TAB | 31.00 |
| 6588078 | LEVETIRACETAM(KEPPRA) 500MG/5ML VL | 71.50 |
| 6588082 | LOSARTAN/HCTZ (HYZAAR) 100/25 TAB | 7.75 |
| 6588083 | AMLODIPINE(NORVASC) 10MG TAB | 7.75 |
| 6588085 | AMOX/CLAV(AUGMENTIN) 875MG TAB | 17.50 |
| 6588099 | BUPIVACAINE(MARCAINE)INJ 0.25% 10ML | 35.00 |
| 6588100 | CALCIUM CARB(TUMS) 500MG CHEW TAB | 7.75 |
| 6588101 | CALCIUM CARB(TUMS) 750MG CHEW TAB | 7.75 |
| 6588107 | GLUCOSE(GLUTOSE) GEL 40% 37.5GM | 22.25 |
| 6588117 | LORATADINE (CLARITIN) 10MG TAB | 7.50 |
| 6588119 | PROPOFOL (DIPRIVAN) 1000MG/100ML SDV | 128.75 |
| 6588125 | WATER FOR IRRIGATION 1000ML | 11.00 |
| 6588128 | INFLUENZA VACCINE HD 0.5ML | 70.00 |
| 6588129 | NEO-POLY-BACI (NEOSPORIN) TOP 30G | 14.50 |
| 6588132 | SOD CHLOR 0.9% NEB SOLN 3ML UDV | 16.50 |
| 6588900 | POLYVINYL ALC (TEARS NATURALE) 1.4% DRPS | 16.50 |
| 6588910 | SODIUM CHLORIDE (SALT) 1000MG TAB | 9.75 |
| 6588918 | SOD BICARBONATE SDV 2.5MEQ/5ML | 14.50 |
| 6588921 | RABIES (HYPERRAB) IMM GLOB 300 UNITS | 1,628.00 |
| 6588929 | LEVOTHYROXINE(LEVOXYL) 75 MCG TAB | 7.75 |
| 6588932 | SALINE 0.9% WARMED 1000ML | 85.00 |
| 6588940 | CHLORDIAZEPOX(LIBRIUM)25MG 4 PAK | 24.25 |
| 6588950 | OMEPRAZOLE(PRILOSEC) 20MG CAP | 16.50 |
| 6589000 | TIOTROPIUM (SPIRIVA) 18MCG INH | 485.00 |
| 6589069 | METOPROLOL XL(TOPROL) 50MG TABS | 7.75 |
| 6589080 | DEXTROSE 10% (D10W) 1000ML | 85.00 |
| 6589120 | CIPROFLOXACIN(CILOXAN) EYE OINT 0.3% | 315.10 |
| 6589139 | BUPROPION (WELLBUTRIN) SR 150MG | 7.75 |
| 6589261 | ASPIRIN 300MG SUPP | 20.00 |
| 6589268 | HYDROCO/APAP(NORCO) 5/325 ER-4-PK | 27.75 |
| 6589354 | CEFTRIAXONE/D5W IVPB : 1GM/50ML | 133.50 |
| 6589357 | NF-GLIPIZIDE 10MG ORAL TABLET | 2.00 |
| 6589416 | NF-ADVAIR DISKUS 500/50 0.5MG/ACTUATION- | 15.00 |
| 6589469 | LIDO/EPI/TETRACAINE TOP SOLN | 25.95 |
| 6589655 | SALINE (OCEAN) NASAL SPRAY 0.65% | 9.00 |
| 6589700 | WOUND GEL (SOLOSITE) | 22.25 |
| 6589710 | RIVAROXABAN(XARELTO) 10MG TAB | 43.75 |
| 6589752 | FOSPHENYTOIN(CEREBYX) 500MG/10ML | 275.50 |
| 6589792 | ALTEPLASE (ACTIVASE) 100MG | 11,294.25 |
| 6589794 | NICARDIPINE(CARDENE) 25MG/10ML | 98.25 |
| 6589845 | CIPROFLOXACIN(CIPRO) 400MG/200ML IVPB | 67.00 |
| 6589846 | PIPER-TAZO (ZOSYN) 4.5GM VL | 99.00 |
| 6590059 | MORPHINE SULFATE ER 15 MG | 52.23 |
| 6590075 | MELOXICAM(MOBIC)15MG TAB | 13.40 |
| 6590151 | CHLORPROMAZINE HCL 50 MG/ 2 ML | 57.25 |
| 6590191 | ERYTHROMYCIN OPHTHALMIC 0.5 % 5MG/G 1 G | 45.00 |
| 6590203 | HALOPERIDOL 1 MG TAB | 7.50 |
| 6590224 | MIDAZOLAM 5 MG/ML 50 MG | 47.50 |
| 6590248 | LAMOTRIGINE 100 MG TABLET | 7.50 |
| 6590289 | IRON DEXTRAN 100 MG/2 ML | 180.17 |
| 6590298 | ATORVASTATIN (LIPITOR) 40MG TAB | 22.39 |
| 6590300 | HEPATITIS A VACCINE 25 UNITS/0.5 ML VIAL | 290.88 |
| 6590301 | NF-BUSPIRONE (BUSPAR) 10MG TABS | 3.63 |
| 6590308 | MAGNESIUM SULFATE 1 G IN D5W 100 ML | 39.41 |
| 6590333 | LORAZEPAM(ATIVAN) 1MG 4PAK ER | 25.85 |
| 6590344 | PROPOFOL (DIPRIVAN) 500MG/50ML SDV | 98.00 |
| 6590347 | BUDESONIDE(PULMICORT) 0.5MG/2ML UDV | 46.25 |
| 6590357 | ACETAMINOPHEN(OFIRMEV) 1000MG/100ML | 155.10 |
| 6590362 | HYDROCODONE-APAP(NORCO) 10-325 ER-4-PK | 36.00 |
| 6590378 | LEVETIRACETAM(KEPPRA) 500MG TABS | 12.00 |
| 6590379 | PNEUMOCOCCAL(PREVNAR 13) VACC 0.5ML | 289.00 |
| 6590382 | AMOXICILLIN(AMOXIL) 500MG CAP | 7.95 |
| 6590391 | ALPRAZOLAM(XANAX) 0.5MG TAB | 8.85 |
| 6590399 | FLUORESCEIN/BENOX EYE DROPS | 5.00 |
| 6590403 | QUETIAPINE(SEROQUEL) 100MG TAB | 10.85 |
| 6590439 | NF-Depakote Delayed-Release Tablet 125MG | 5.00 |
| 6590441 | NF-Lyrica Oral Capsule 25MG | 24.00 |
| 6590448 | ONDANSETRON (ZOFRAN) 4MG TABS | 8.95 |
| 6590455 | BENZOCAINE(HURRICAINE)SPRAY 20% | 42.20 |
| 6590471 | ADMIN VACCINE 65+ | 27.75 |
| 6590688 | ADMIN VACCINE UNDER 65 | 27.75 |
| 6599926 | DEXAMETHASONE(DECADRON) 10MG/ML VL | 35.00 |
| 6599997 | MUMP-MEASLES-RUB (MMR II) VACCINE | 168.50 |
| 6599999 | TDAP (BOOSTRIX) VACCINE 0.5ML | 159.75 |
| 7001002 | VENTILATOR | 440.75 |
| 7001212 | CARBOXYHEMOGLOBIN CHECK | 94.75 |
| 7031500 | AIRWAY INTUBATION | 903.25 |
| 7036600 | ARTERIAL BLOOD GAS COLLECTION | 70.00 |
| 7062511 | ABG INITAL | 392.50 |
| 7062512 | ABG SUBSEQUENT | 392.50 |
| 7062628 | SPIROMETRY | 185.50 |
| 7062875 | SPIROMETRY BRONCHODILATOR B&A | 394.50 |
| 7062876 | TAKE HOME OXYGEN | 162.25 |
| 7065191 | AEROSOL INITIAL FFN | 255.50 |
| 7065192 | AEROSOL SUB FFN | 94.75 |
| 7065266 | CHEST PT 1ST TX | 111.25 |
| 7065399 | VOL VENT S/U-FIRST DAY | 361.50 |
| 7065456 | IS DAILY INPT | 134.50 |
| 7065912 | MASK CPAP INIATION FIRST DAY | 887.25 |
| 7069337 | CHEST PT SUBSEQ | 90.25 |
| 7069349 | MASK CPAP SUBSEQUENT | 582.00 |
| 7069352 | CONT BRONCHODILATION SETUP | 583.00 |
| 7089350 | SPUTUM COLLECTION | 47.50 |
| 7094640 | INHALATION AIRWAY TREATMENT MEDICATED | 305.00 |
| 7094664 | AEROSOL ADMIN | 156.00 |
| 7094760 | SINGLE PULSE OX CHECK | 27.75 |
| 7094762 | CONTINUOUS OVERNIGHT SPO2 | 322.00 |
| 7094770 | END TIDAL CO2 | 235.00 |
| 7505541 | PT GAIT TRAINING (NON CRUTCH) 97116 | 135.50 |
| 7505581 | PT ELECTRICL STIM 97014 | 105.50 |
| 7505584 | PT PARAFFIN BATH 97018 | 89.00 |
| 7505609 | PT EVAL 97163 HIGH COMPLEXITY | 243.50 |
| 7505612 | PT RE EVAL 97164 | 197.25 |
| 7505616 | PT ADL SELF CARE/HOME MGNT 97535 | 99.50 |
| 7505617 | PT PROPULSION WC TRAIN 97542 | 83.00 |
| 7505656 | PT TRACTION (MECHANICAL) 97012 | 101.50 |
| 7505707 | PT MCR ELEC STIM G0283 | 105.50 |
| 7505771 | PT SKILLED GAIT TRAINING 97116 | 135.50 |
| 7505804 | PT TENS INSTRUCT 64550 | 130.25 |
| 7505813 | PT THERAPEUTIC EXERISE 97110 | 83.00 |
| 7505839 | PT FUNCTIONAL ACTIVITIES 97530 | 70.50 |
| 7505854 | PT ULTRASOUND 97035 | 61.75 |
| 7505860 | PT MANUAL THERAPY 97140 | 70.50 |
| 7505862 | PT NEUROMUSCULAR RE-ED BALANCE 97112 | 83.00 |
| 7577145 | GCPT MOBILITY GOAL G8979CH | – |
| 7577148 | GCPT BODY POS GOAL G8982CH | – |
| 7577151 | GCPT CARRY GOAL G8985CH | – |
| 7577152 | GCPT CARRY DC G8986CH | – |
| 7577163 | GCPT MOBILITY CURRENT G8978CI | – |
| 7577164 | GCPT MOBILITY CURRENT G8978CJ | – |
| 7577165 | GCPT MOBILITY CURRENT G8978CK | – |
| 7577166 | GCPT MOBILITY CURRENT G8978CL | – |
| 7577167 | GCPT MOBILITY CURRENT G8978CM | – |
| 7577168 | GCPT MOBILITY CURRENT G8978CN | – |
| 7577169 | GCPT MOBILITY GOAL G8979CI | – |
| 7577170 | GCPT MOBILITY GOAL G8979CJ | – |
| 7577171 | GCPT MOBILITY GOAL G8979CK | – |
| 7577172 | GCPT MOBILITY GOAL G8979CL | – |
| 7577173 | GCPT MOBILITY GOAL G8979CM | – |
| 7577175 | GCPT MOBILITY DC G8980CI | – |
| 7577176 | GCPT MOBILITY DC G8980CJ | – |
| 7577177 | GCPT MOBILITY DC G8980CK | – |
| 7577178 | GCPT MOBILITY DC G8980CL | – |
| 7577179 | GCPT MOBILITY DC G8980CM | – |
| 7577181 | GCPT BODY POS CURRENT G8981CI | – |
| 7577182 | GCPT BODY POS CURRENT G8981CJ | – |
| 7577183 | GCPT BODY POS CURRENT G8981CK | – |
| 7577185 | GCPT BODY POS CURRENT G8981CM | – |
| 7577187 | GCPT BODY POS GOAL G8982CI | – |
| 7577188 | GCPT BODY POS GOAL G8982CJ | – |
| 7577190 | GCPT BODY POS GOAL G8982CL | – |
| 7577193 | GCPT BODY POS DC G8983CI | – |
| 7577194 | GCPT BODY POS DC G8983CJ | – |
| 7577199 | GCPT CARRY CURRENT G8984CI | – |
| 7577200 | GCPT CARRY CURRENT G8984CJ | – |
| 7577201 | GCPT CARRY CURRENT G8984CK | – |
| 7577202 | GCPT CARRY CURRENT G8984CL | – |
| 7577203 | GCPT CARRY CURRENT G8984CM | – |
| 7577205 | GCPT CARRY GOAL G8985CI | – |
| 7577206 | GCPT CARRY GOAL G8985CJ | – |
| 7577207 | GCPT CARRY GOAL G8985CK | – |
| 7577208 | GCPT CARRY GOAL G8985CL | – |
| 7577211 | GCPT CARRY DC G8986CI | – |
| 7577212 | GCPT CARRY DC G8986CJ | – |
| 7577213 | GCPT CARRY DC G8986CK | – |
| 7577214 | GCPT CARRY DC G8986CL | – |
| 7597003 | PT IONTOPHORESIS 97033 | 114.75 |
| 7597161 | PT EVAL LOW COMPLEXITY | 168.50 |
| 7597162 | PT EVAL MODERATE COMPLEXITY | 243.50 |
| 7597163 | PT EVAL HIGH COMPLEXITY | 318.50 |
| 8000421 | SODIUM IRRIGATION 0.9% 1000ML | 13.00 |
| 8000596 | EPIDURAL TRAY | 62.95 |
| 8000599 | HUBER NEEDLE | 1.00 |
| 8000622 | BITRAC LARGE NIV FULL FACE BIPAP | 329.00 |
| 8000627 | FEM CATH 8FR | 9.75 |
| 8000629 | SUTURE MONOSOF BLACK 5/0 P-13 | 165.25 |
| 8000632 | CERVICAL COLLAR MEDIUM SOFT | 10.75 |
| 8000633 | STAPLE REMOVER HAND PLIER | 10.75 |
| 8000643 | LUMBAR PUNCTURE TRAY ADULT | 62.75 |
| 8000645 | DIAL A FLOW | 16.75 |
| 8000684 | TRAY PARACENTESIS | 275.50 |
| 8000697 | GASTRIC SUMP TUBE 14FR | 8.75 |
| 8000698 | GASTRIC SUMP TUBE 12 FR | 8.75 |
| 8000707 | WALKER BOOT SHORT LEG LARGE | 118.23 |
| 8000708 | WALKER BOOT SHORT LEG MEDIUM | 118.23 |
| 8000709 | WALKER BOOT SHORT LEG SMALL | 118.23 |
| 8000711 | THUMB SPICA SMALL RIGHT | 146.75 |
| 8000712 | THUMB SPICA SMALL LEFT | 146.75 |
| 8000713 | CAST SHOE LARGE | 20.19 |
| 8000714 | CAST SHOE SMALL | 20.19 |
| 8000715 | CAST SHOE MEDIUM | 20.19 |
| 8000721 | ADAPTIC 3X8 OIL DRESSING | 33.00 |
| 8000725 | STERILE WATER IRRIGATION 500ML | 10.75 |
| 8000726 | SALINE IRRIGATION 500ML | 11.75 |
| 8000901 | TRAY WRIST ORTHO SURGERY | 5,000.00 |
| 8000902 | TRAY LARGE FRAG ORTHO SURGERY | 3,000.00 |
| 8000903 | TRAY SMALL FRAG ORTHO SURGERY | 2,000.00 |
| 8000904 | TRAY EYE | 700.00 |
| 15800000 | CHIROPRACTIC 1-2 REGIONS | 130.00 |
| 20000250 | EXTRAORAL-FIRST RADIOGRAPHIC IMAGE | 66.00 |
| 20000260 | EXTRAORAL-EACH ADDTL RADIOGRAPHIC IMAGE | 15.00 |
| 20001110 | PROPHYLAXIS-ADULT | 128.50 |
| 20001120 | PROPHYLAXIS-CHILC | 96.50 |
| 20001203 | TOPICAL FLUORIDE – CHILD | 54.00 |
| 20001204 | TOPICAL FLUORIDE – ADULT | 54.00 |
| 20001206 | TOPICAL APP OF FLUORIDE VARNISH | 54.00 |
| 20001351 | SEALANT – PER TOOTH | 70.50 |
| 20001515 | SPACE MAINTAINER FIXED BILATERAL | 600.00 |
| 20002140 | AMALGAM – 1 SURFACE | 125.00 |
| 20002150 | AMALGAM – 2 SURFACES | 154.00 |
| 20002160 | AMALGAM – 3 SURFACES | 183.00 |
| 20002161 | AMALGAM – 4+ SURFACES | 192.50 |
| 40003376 | GLUCOSE QUANT URINE (003376) | 6.90 |
| 40086007 | ACETYLCHOLINE RECEPTOR AB (086007) | 563.17 |
| 40140640 | VGCC ANTIBODY (140640) | 178.50 |
| 40160184 | STRIATIONAL ABS (160184) | 80.00 |
| 40808968 | PARANEOPLASTIC PROFILE 1 (808968) | 774.00 |
| 75772230 | COOL AEROSOL | 160.75 |
| 80000031 | KERLEX | 2.00 |
| 80000080 | TRAY SUTURE REMOVAL w FCP LITT SCIS | 10.75 |
| 80000103 | STERILE 4X4 | 1.00 |
| 80000537 | GASTRIC TUBE SUMP 16FR 48IN DUAL LUMEN | 8.75 |
| 80000539 | TRAY LACERATION CLOTH TOWELS/DRAPE | 27.75 |
| 80000543 | ADAPTIC 3X3 STRL | 2.00 |
| 80000576 | CRUTCHES ADULT TALL | 40.75 |
| 80000579 | CVP TRAY ADULT | 226.00 |
| 80000595 | CERVICAL COLLAR LARGE SOFT | 10.75 |
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Infection Preventionist: Heather Loose - 909.866.6501
Bear Valley Community Hospital
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