The new CMS IPPS/LTCH PPS rule requires hospitals to make public a list of their standard changes online in a machine-readable format. Burnett Medical Center (BMC) supports the intent of these new regulations to educate patients on the cost of health care and patient financial responsibilities. Below is a listing of those charges.
| Charge# | Description | | Cost |
| 3905325 | PROTIME | $ | 56.00 |
| 3908675 | ANTICOAGULATION CLINIC | $ | 51.00 |
| 3908677 | ANTICOAGULATION CLINIC | $ | 51.00 |
| 3909192 | COLLECT, CAPILLARY SPEC | $ | 6.00 |
| 3291000 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291001 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291002 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291003 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291004 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291005 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291006 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291007 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291008 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291009 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291010 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291011 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291012 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291013 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291014 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291015 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291016 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291017 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291018 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291019 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291020 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291021 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291022 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291023 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291024 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291026 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291027 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291028 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291029 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291030 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291031 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291032 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291033 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291034 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291035 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291036 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291037 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291038 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291039 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291040 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291041 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291042 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291043 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291044 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291045 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291046 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291047 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291048 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291049 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291050 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291051 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291052 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291053 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291054 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291055 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291056 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291057 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291058 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291059 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291060 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291061 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291062 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291063 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291064 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291065 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291066 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291067 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291068 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291069 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291070 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291071 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291072 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291073 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291074 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291075 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291076 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291077 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291078 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291079 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291080 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291081 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291082 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291083 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291084 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291085 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291086 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291087 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291088 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291089 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291090 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291091 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291092 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291093 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291094 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291095 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291096 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291097 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291098 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291099 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291100 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291101 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291102 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291103 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291105 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291106 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291107 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291108 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291109 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291110 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291111 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291112 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291113 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3291204 | ANESTHESIA PRO FEE | $ | 14.00 |
| 3292000 | ANES PRO FEE | $ | 208.00 |
| 3292001 | ANES PRO FEE | $ | 208.00 |
| 3292002 | ANES PRO FEE | $ | 208.00 |
| 3292003 | ANES PRO FEE | $ | 208.00 |
| 3292004 | ANES PRO FEE | $ | 208.00 |
| 3292005 | ANES PRO FEE | $ | 208.00 |
| 3292006 | ANES PRO FEE | $ | 208.00 |
| 3292007 | ANES PRO FEE | $ | 208.00 |
| 3292008 | ANES PRO FEE | $ | 208.00 |
| 3292009 | ANES PRO FEE | $ | 208.00 |
| 3292010 | ANES PRO FEE | $ | 208.00 |
| 3292011 | ANES PRO FEE | $ | 208.00 |
| 3292012 | ANES PRO FEE | $ | 208.00 |
| 3292013 | ANES PRO FEE | $ | 208.00 |
| 3292014 | ANES PRO FEE | $ | 208.00 |
| 3292015 | ANES PRO FEE | $ | 208.00 |
| 3292016 | ANES PRO FEE | $ | 208.00 |
| 3292017 | ANES PRO FEE | $ | 208.00 |
| 3292018 | ANES PRO FEE | $ | 208.00 |
| 3292019 | ANES PRO FEE | $ | 208.00 |
| 3292020 | ANES PRO FEE | $ | 208.00 |
| 3292021 | ANES PRO FEE | $ | 208.00 |
| 3292022 | ANES PRO FEE | $ | 208.00 |
| 3292023 | ANES PRO FEE | $ | 208.00 |
| 3292024 | ANES PRO FEE | $ | 208.00 |
| 3292026 | ANES PRO FEE | $ | 208.00 |
| 3292027 | ANES PRO FEE | $ | 208.00 |
| 3292028 | ANES PRO FEE | $ | 208.00 |
| 3292029 | ANES PRO FEE | $ | 208.00 |
| 3292030 | ANES PRO FEE | $ | 208.00 |
| 3292031 | ANES PRO FEE | $ | 208.00 |
| 3292032 | ANES PRO FEE | $ | 208.00 |
| 3292033 | ANES PRO FEE | $ | 208.00 |
| 3292034 | ANES PRO FEE | $ | 208.00 |
| 3292035 | ANES PRO FEE | $ | 208.00 |
| 3292036 | ANES PRO FEE | $ | 208.00 |
| 3292037 | ANES PRO FEE | $ | 208.00 |
| 3292038 | ANES PRO FEE | $ | 208.00 |
| 3292039 | ANES PRO FEE | $ | 208.00 |
| 3292040 | ANES PRO FEE | $ | 208.00 |
| 3292041 | ANES PRO FEE | $ | 208.00 |
| 3292042 | ANES PRO FEE | $ | 208.00 |
| 3292043 | ANES PRO FEE | $ | 208.00 |
| 3292044 | ANES PRO FEE | $ | 208.00 |
| 3292045 | ANES PRO FEE | $ | 208.00 |
| 3292046 | ANES PRO FEE | $ | 208.00 |
| 3292047 | ANES PRO FEE | $ | 208.00 |
| 3292048 | ANES PRO FEE | $ | 208.00 |
| 3292049 | ANES PRO FEE | $ | 208.00 |
| 3292050 | ANES PRO FEE | $ | 208.00 |
| 3292051 | ANES PRO FEE | $ | 208.00 |
| 3292052 | ANES PRO FEE | $ | 208.00 |
| 3292053 | ANES PRO FEE | $ | 208.00 |
| 3292054 | ANES PRO FEE | $ | 208.00 |
| 3292055 | ANES PRO FEE | $ | 208.00 |
| 3292056 | ANES PRO FEE | $ | 208.00 |
| 3292057 | ANES PRO FEE | $ | 208.00 |
| 3292058 | ANES PRO FEE | $ | 208.00 |
| 3292059 | ANES PRO FEE | $ | 208.00 |
| 3292060 | ANES PRO FEE | $ | 208.00 |
| 3292061 | ANES PRO FEE | $ | 208.00 |
| 3292062 | ANES PRO FEE | $ | 208.00 |
| 3292063 | ANES PRO FEE | $ | 208.00 |
| 3292064 | ANES PRO FEE | $ | 208.00 |
| 3292065 | ANES PRO FEE | $ | 208.00 |
| 3292066 | ANES PRO FEE | $ | 208.00 |
| 3292067 | ANES PRO FEE | $ | 208.00 |
| 3292068 | ANES PRO FEE | $ | 208.00 |
| 3292069 | ANES PRO FEE | $ | 208.00 |
| 3292070 | ANES PRO FEE | $ | 208.00 |
| 3292071 | ANES PRO FEE | $ | 208.00 |
| 3292072 | ANES PRO FEE | $ | 208.00 |
| 3292073 | ANES PRO FEE | $ | 208.00 |
| 3292074 | ANES PRO FEE | $ | 208.00 |
| 3292075 | ANES PRO FEE | $ | 208.00 |
| 3292076 | ANES PRO FEE | $ | 208.00 |
| 3292077 | ANES PRO FEE | $ | 208.00 |
| 3292078 | ANES PRO FEE | $ | 208.00 |
| 3292079 | ANES PRO FEE | $ | 208.00 |
| 3292080 | ANES PRO FEE | $ | 208.00 |
| 3292081 | ANES PRO FEE | $ | 208.00 |
| 3292082 | ANES PRO FEE | $ | 208.00 |
| 3292083 | ANES PRO FEE | $ | 208.00 |
| 3292084 | ANES PRO FEE | $ | 208.00 |
| 3292085 | ANES PRO FEE | $ | 208.00 |
| 3292086 | ANES PRO FEE | $ | 208.00 |
| 3292087 | ANES PRO FEE | $ | 208.00 |
| 3292088 | ANES PRO FEE | $ | 208.00 |
| 3292089 | ANES PRO FEE | $ | 208.00 |
| 3292090 | ANES PRO FEE | $ | 208.00 |
| 3292091 | ANES PRO FEE | $ | 208.00 |
| 3292092 | ANES PRO FEE | $ | 208.00 |
| 3292093 | ANES PRO FEE | $ | 208.00 |
| 3292094 | ANES PRO FEE | $ | 208.00 |
| 3292095 | ANES PRO FEE | $ | 208.00 |
| 3292096 | ANES PRO FEE | $ | 208.00 |
| 3292097 | ANES PRO FEE | $ | 208.00 |
| 3292098 | ANES PRO FEE | $ | 208.00 |
| 3292099 | ANES PRO FEE | $ | 208.00 |
| 3292100 | ANES PRO FEE | $ | 208.00 |
| 3292101 | ANES PRO FEE | $ | 208.00 |
| 3292102 | ANES PRO FEE | $ | 208.00 |
| 3292103 | ANES PRO FEE | $ | 208.00 |
| 3292105 | ANES PRO FEE | $ | 208.00 |
| 3292106 | ANES PRO FEE | $ | 208.00 |
| 3292107 | ANES PRO FEE | $ | 208.00 |
| 3292108 | ANES PRO FEE | $ | 208.00 |
| 3292109 | ANESTHESIA PRO FEE | $ | 208.00 |
| 3292110 | ANES PRO FEE | $ | 208.00 |
| 3292111 | ANES PRO FEE | $ | 208.00 |
| 3292112 | ANES PRO FEE | $ | 208.00 |
| 3292113 | ANES PRO FEE | $ | 208.00 |
| 3292204 | ANES PRO FEE | $ | 208.00 |
| 3293000 | TRIGGER POINT INJ 1-2 | $ | 247.00 |
| 3293001 | TRIGGER POINT INJ 1-2 | $ | 247.00 |
| 3293002 | TRIGGER POINT INJ 3+ | $ | 244.00 |
| 3293003 | SACROILIAC JOINT INJ | $ | 737.00 |
| 3293004 | SACROILIAC JOINT INJ | $ | 493.00 |
| 3293005 | SACROILIAC JOINT INJ | $ | 493.00 |
| 3293006 | INTUBATION/ EMERGENCY | $ | 932.00 |
| 3293007 | LARYNGOSCOPY W/FB | $ | 622.00 |
| 3293008 | INTRODUC/ NEEDLE PERIPHER | $ | 63.00 |
| 3293009 | VENIPUNCTURE UNDER 3YO | $ | 63.00 |
| 3293010 | VENIPUNCTURE 3YO & OLDER | $ | 63.00 |
| 3293011 | PICC LINE INSERTION | $ | 624.00 |
| 3293012 | PICC LINE INSERTION | $ | 624.00 |
| 3293013 | REPLACEMENT/ PICC LINE | $ | 896.00 |
| 3293014 | REMOVAL TUNNELED CV CATH | $ | 1,287.00 |
| 3293015 | N/G TUBE PLACEMENT | $ | 484.00 |
| 3293016 | LUMBAR PUNCTURE, DIAG | $ | 1,361.00 |
| 3293017 | LUMBAR PUUNCTURE /REDUCED | $ | 1,361.00 |
| 3293018 | LUMBAR PUNCTURE / DISCONT | $ | 476.00 |
| 3293019 | SPINAL PUNCTURE / THERAPE | $ | 1,430.00 |
| 3293020 | BLOOD PATCH | $ | 843.00 |
| 3293021 | INJECTION /SUBS/SUBARACHN | $ | 1,361.00 |
| 3293023 | CAUDAL STEROID INJECTION | $ | 593.00 |
| 3293024 | LUMBAR EPIDURAL SGLE DISC | $ | 164.00 |
| 3293025 | EPIDURAL / CATH PLACEMENT | $ | 792.00 |
| 3293026 | EPIDURAL / CATH PLACEMENT | $ | 792.00 |
| 3293027 | EPIDERMAL CONT INFUSION | $ | 727.00 |
| 3293028 | FEMORAL NREVE BLK SGL BIL | $ | 507.00 |
| 3293029 | FEMORLA NERVE BLK SGL LT | $ | 406.00 |
| 3293030 | FEMORAL NERVE BLK SGL RT | $ | 406.00 |
| 3293031 | TRANSFORAMEN EPIDURAL LUM | $ | 1,157.00 |
| 3293032 | TRANSFORAMEN EPIDURAL LUM | $ | 187.00 |
| 3293033 | TRANSFORAMEN EPIDURAL LUM | $ | 770.00 |
| 3293034 | TRANSFORAMEN EPIDURAL LUM | $ | 770.00 |
| 3293035 | TRANSFORAMEN EPID ADD BIL | $ | 727.00 |
| 3293036 | TRANSFORAMEN EPIDURAL ADD | $ | 484.00 |
| 3293037 | TRANSFORAMEN EPIDURAL ADD | $ | 484.00 |
| 3293038 | CARDIOPULMONARY RESUSCIT | $ | 1,353.00 |
| 3293039 | ANESTHESIA/ EXTREME AGE | $ | 0.00 |
| 3293040 | ANESTHESIA / EMERGENCY | $ | 0.00 |
| 3293041 | CONSCIOUS SEDATION < 5YRS | $ | 529.00 |
| 3293042 | CONSCIOUS SEDATION 5YRS + | $ | 351.00 |
| 3293043 | CONSCIOUS SEDATION EA 15M | $ | 351.00 |
| 3293046 | OUTPATIENT VISIT NEW 10MN | $ | 153.00 |
| 3293047 | OUTPATIENT VISIT NEW 20MN | $ | 299.00 |
| 3293048 | OUTPATIENT VISIT NEW 30MN | $ | 385.00 |
| 3293049 | OUTPATIENT VISIT NEW 45MN | $ | 764.00 |
| 3293050 | OUTPATIENT VISIT NEW 60MN | $ | 988.00 |
| 3293051 | OUTPATIENT VISIT EST 5MN | $ | 56.00 |
| 3293052 | OUTPATIENT VISIT EST 10MN | $ | 152.00 |
| 3293053 | OUTPATIENT VISIT EST 15MN | $ | 300.00 |
| 3293054 | OUTPATIENT VISIT EST 25MN | $ | 462.00 |
| 3293055 | OUTPATIENT VISIT EST 40MN | $ | 652.00 |
| 3293056 | ATTENDANCE / STABIL BIRTH | $ | 554.00 |
| 3293057 | RESUSCITATION/POS PRES VE | $ | 1,039.00 |
| 3293058 | FEMORAL NERVE PAIN MGMT | $ | 406.00 |
| 3293059 | FEMORAL NERVE PAIN MGMT | $ | 406.00 |
| 3293060 | ARTERIAL PUNCTURE | $ | 86.00 |
| 3293061 | ARTERIAL PUNCTURE | $ | 86.00 |
| 3293062 | INTUBATION / EMERGENCY | $ | 932.00 |
| 3293063 | US GUID VASCULAR ACCESS | $ | 267.00 |
| 3293064 | FEMORAL NERVE BLK SINGLE | $ | 585.00 |
| 3293065 | GASTRIC TUBE INSERTION | $ | 113.00 |
| 3293066 | PLACE CATH JUGULAR VEIN | $ | 901.00 |
| 3293067 | INTRODUC/ NEEDLE PERIPH | $ | 63.00 |
| 3293068 | LARYNGOSCOPY / ASPIRATION | $ | 628.00 |
| 3293069 | INTRODUC NEEDLE PERIPHER | $ | 63.00 |
| 3293071 | LUMBAR PUNCTURE DIAG | $ | 1,361.00 |
| 3293072 | SCIATIC NERVE INJECTION SNG LT | $ | 394.00 |
| 3293073 | SCIATIC NERVE INJECTION SNG RT | $ | 394.00 |
| 3293074 | INJECTION SUBST/ EPIDUR/SUBARACH | $ | 1,361.00 |
| 3293075 | INJECTION DIAG/THERAP EPIDUR/SUBARACH | $ | 593.00 |
| 3293076 | EPIDURAL/SUBARA CATH PLACEMENT | $ | 792.00 |
| 3293077 | EPIDURAL CONT INFUSION | $ | 727.00 |
| 3295000 | FLUORO GUIDANCE NEEDLE PL | $ | 211.00 |
| 3295001 | US GUIDE NEEDLE PLACEMENT | $ | 211.00 |
| 3295002 | FLUOROGUIDE SPINE INJEC | $ | 954.00 |
| 3295003 | FLUORO GUIDANCE NEEDLE PL | $ | 211.00 |
| 3295004 | US GUIDANCE NEEDLE PLACE | $ | 211.00 |
| 3295005 | VENIPUNCTURE NON ROUT JUGUL/FEMORAL <3YO | $ | 150.00 |
| 3303880 | VERSED 2MG/ ML ELIXIR | $ | 6.00 |
| 3305006 | ACETAMINOPHEN SUPP 120MG | $ | 9.00 |
| 3305007 | TYLENOL 325MG SUPP | $ | 9.00 |
| 3305008 | ACETAMINOPHEN SUPP 650MG | $ | 9.00 |
| 3305020 | TETRACAINE 1% AMP 2ML | $ | 40.00 |
| 3305027 | ADENOSINE SRN 6MG/2ML | $ | 55.00 |
| 3305029 | ALBUTEROL INHALER | $ | 67.00 |
| 3305031 | BETAMETHASONE SUSP 3MG | $ | 30.00 |
| 3305036 | SUCCINYLCHOLINE CHLOR 20M | $ | 29.00 |
| 3305049 | AMIODARONE VL 30MG X 5 | $ | 52.00 |
| 3305053 | ATROPINE INJ 0.4MG | $ | 27.00 |
| 3305100 | ATROPINE 0.01MG (1MG/10ML) | $ | 0.00 |
| 3305124 | ZEMURON 10MG | $ | 21.00 |
| 3305131 | BETAMETHASONE 3MG INJ | $ | 25.00 |
| 3305178 | CALCIUM CHLORIDE 1G/10ML | $ | 30.00 |
| 3305190 | DEXAMETHASONE INJ 1MG/ML | $ | 3.00 |
| 3305199 | HEMABATE 250 MCG/ML | $ | 186.00 |
| 3305213 | CEFOXITIN 1GM INJ | $ | 58.00 |
| 3305253 | CLINDAMYCIN 300MG/2ML X 3 | $ | 52.00 |
| 3305276 | DANTROLENE 20MG VIAL MH | $ | 138.00 |
| 3305283 | DOLASETRON 10 MG AMP | $ | 98.00 |
| 3305291 | EPHEDRINE SRN 50MG/ 5ML | $ | 36.00 |
| 3305316 | FENTANYL 2ML 100MCG | $ | 26.00 |
| 3305319 | FLUTHANE - HALATHANE1/2HR | $ | 60.00 |
| 3305320 | NITROUS OXIDE PER 30 MIN | $ | 29.00 |
| 3305329 | DIPHENHYDRAMINE 50MG/ML | $ | 25.00 |
| 3305350 | DOPAMINE 40MGX10/250ML | $ | 0.00 |
| 3305382 | EPHEDRINE VL 50MG/ML | $ | 25.00 |
| 3305383 | EPINEPHRINE 0.1MG VIAL X 10 | $ | 3.00 |
| 3305386 | EPINEPHRINE 0.1MG SYR X 10 | $ | 3.00 |
| 3305432 | DROPERIDOL 5MG | $ | 30.00 |
| 3305436 | ISOFLURANE 1/2 HR | $ | 131.00 |
| 3305475 | CEFAZOLIN 500MG | $ | 17.00 |
| 3305481 | KETAMINE 150MG/ML | $ | 30.00 |
| 3305482 | LABETALOL 5MG /ML 4ML | $ | 26.00 |
| 3305483 | GENTAMYCIN 80MG INJ | $ | 47.00 |
| 3305489 | LASIX 20MG | $ | 25.00 |
| 3305506 | TORADOL 15MG INJ | $ | 25.00 |
| 3305523 | HESPAN 500ML | $ | 42.00 |
| 3305529 | HYDRALAZINE 20MG/ML | $ | 41.00 |
| 3305535 | BUPIVECAINE /ML | $ | 21.00 |
| 3305536 | BUPIVACAINE .025%/ML | $ | 21.00 |
| 3305537 | MARCAINE PF SAB/EPID VL | $ | 25.00 |
| 3305539 | FLUMAZENIL 0.5MG/5ML VIAL | $ | 33.00 |
| 3305543 | MEPERIDINE 100MG | $ | 24.00 |
| 3305548 | HYDROMORPHONE 2MG/ML | $ | 26.00 |
| 3305561 | MORPHINE 10MG INJ | $ | 26.00 |
| 3305562 | ASTRAMORPH PF 10MG INJ | $ | 22.00 |
| 3305563 | SEVOFLURANE /ML | $ | 22.00 |
| 3305564 | MARCAINE .75AMP SPINAL | $ | 19.00 |
| 3305578 | INDIGO CARMINE | $ | 28.00 |
| 3305579 | NA PENTOTHAL 500MG SYR | $ | 44.00 |
| 3305580 | PROPOFOL 20ML/AMP | $ | 23.00 |
| 3305581 | NALOXONE 0.4MG/ML 1ML VL | $ | 29.00 |
| 3305582 | REMIFENTANIL VL 1MG | $ | 80.00 |
| 3305583 | SUFENTANIL 100MCG/2ML | $ | 31.00 |
| 3305584 | PROPOFOL 10MG (500MG VL) | $ | 1.00 |
| 3305586 | PHENYLEPHRINE SYN 1MG/10M | $ | 41.00 |
| 3305587 | PHENYLEPHRINE 10MG/ML VIAL | $ | 36.00 |
| 3305640 | PROMETHAZINE 50MG | $ | 23.00 |
| 3305645 | CAF SOD BENZ 500MG VIAL | $ | 29.00 |
| 3305648 | PITOCIN INJ. 10U | $ | 55.00 |
| 3305662 | LIDOCAINE DOSE 1% 10MG/ML | $ | 24.00 |
| 3305663 | LIDOCAINE 2% 20MG/ML DOSE MPF | $ | 24.00 |
| 3305701 | NEOSTIGMINE 0.5MG VL | $ | 24.00 |
| 3305717 | METOCLOPRAMIDE 10MG/2CC | $ | 25.00 |
| 3305723 | GLYCOPYROLATE 0.2MG/ML | $ | 21.00 |
| 3305750 | METHERGINE AMP 02.MG/ML | $ | 35.00 |
| 3305752 | METHYLPREDNS AC VL 40MG | $ | 16.00 |
| 3305754 | METHYLPREDNS SS 125MG | $ | 17.00 |
| 3305767 | METOPROLOL 5MG/5ML AMP | $ | 10.00 |
| 3305768 | DEPO MEDROL 80MG | $ | 91.00 |
| 3305769 | ESMOLOL 100MG /VIAL | $ | 51.00 |
| 3305778 | MIDAZOLAM 1MG (2MG/2ML) X2 | $ | 13.00 |
| 3305780 | MIDAZOLAM SRP DOS 2MG/ML | $ | 9.00 |
| 3305795 | SUFENTANIL 50MCG/ML AMP | $ | 30.00 |
| 3305797 | DES | $ | 227.00 |
| 3305820 | NUBAIN 10MG VL | $ | 26.00 |
| 3305844 | NITROGLYCERIN PASTE 2% 1 G | $ | 10.00 |
| 3305849 | NITRO 0.4MG SL | $ | 9.00 |
| 3305850 | NITROGLYCERIN 50MG/250ML | $ | 32.00 |
| 3305884 | VERSED 1MG | $ | 23.00 |
| 3305885 | MIDAZOLAM VL 1MG/ML X5 | $ | 5.00 |
| 3305915 | PHENYLEPHRINE SPR 0.5% | $ | 22.00 |
| 3305928 | ZOSYN 1.125GM (3.375) X 3 | $ | 25.00 |
| 3305943 | LIDOCAINE 100MG PER VIAL | $ | 25.00 |
| 3305944 | XYLOCAINE 0.5% 50CC | $ | 19.00 |
| 3305948 | XYLOCAINE 1% 50CC | $ | 19.00 |
| 3305997 | ZOFRAN 1MG IV | $ | 23.00 |
| 3306006 | ADRENALIN INJ.1ML | $ | 22.00 |
| 3306007 | VASOPRESSIN 20U VIAL | $ | 26.00 |
| 3306008 | RACEPINEPHRINE 2.25% INHA | $ | 10.00 |
| 3306014 | RANITIDINE 25MG (50MG) X 2 | $ | 27.00 |
| 3306069 | SOD BICARB 50MEQ/50ML SYR | $ | 32.00 |
| 3306073 | BICITRA 30ML PO | $ | 18.00 |
| 3306143 | TRIAMCINOLIN 10MG INJ | $ | 28.00 |
| 3306169 | VANCOMYCIN 500MG (1GM)X 2 | $ | 28.00 |
| 3306192 | SCOPOLAMINE 1.5MG PATCH | $ | 41.00 |
| 3306251 | SOLUCORTEF 100MG INJ | $ | 56.00 |
| 3306464 | ETOMIDATE 2MG/ML 10ML | $ | 35.00 |
| 3306476 | FAT EMULSION 20% 250ML BG | $ | 62.00 |
| 3306504 | HYDROMORPHONE 1MG/ML | $ | 27.00 |
| 3306513 | KETAMINE 50MG/ML | $ | 30.00 |
| 3306514 | PHENYLEPHRINE 1MG/10ML SYR | $ | 28.00 |
| 3306516 | LIDOCAINE LTA 360 KIT | $ | 25.00 |
| 3306517 | LEVONORGESTR TAB 0.75MGX2 | $ | 51.00 |
| 3306625 | EMLA CREAM | $ | 70.00 |
| 3306627 | NEOSTIGMINE MDV DOSE 0.5MG | $ | 11.00 |
| 3306661 | INTUBATION/EMERGENCY | $ | 893.00 |
| 3306702 | LUMBAR PUNCTURE | $ | 455.00 |
| 3306703 | BLOOD PATCH | $ | 465.00 |
| 3307117 | TRIGGER POINT INJ 1-2 | $ | 661.00 |
| 3307500 | ALPHA-STIM STIMULATOR | $ | 270.00 |
| 3307513 | TRANSFORAMINAL EPIDURAL W IMAG | $ | 1,813.00 |
| 3307532 | TRANSFORAMEN EPID EA ADD LEVEL | $ | 845.00 |
| 3307539 | INJECTION PARAVERTABRAL JNT L/S | $ | 1,813.00 |
| 3307540 | INJECTION, INTERLAMINAR,EPIDURAL, CERVIC | $ | 1,465.00 |
| 3308000 | ANES GENERAL 1ST HR | $ | 548.00 |
| 3308001 | ANES GENERAL ADD 15MN | $ | 138.00 |
| 3308112 | ALBUTEROL INH SOL 3ML | $ | 8.00 |
| 3308113 | NEOSTIGMINE DOSE 0.5MGX1 (J2710) | $ | 25.00 |
| 64484 | TRANSFORMINAL EPIDURAL W IMAG EA + LEVEL | $ | 146.00 |
| 0298T | EXT ELECTROCARDIOGRAPHIC INTERP 3/14 | $ | 68.00 |
| 10021 | FINE NEEDLE ASPIRATION | $ | 417.00 |
| 10040 | ACNE SURGERY | $ | 279.00 |
| 10060 | I & D, ABCESS | $ | 320.00 |
| 10061 | I & D ABCESS | $ | 564.00 |
| 10080 | I&D PILONIDAL CYST | $ | 501.00 |
| 10081 | DRAINAGE PILONIDAL CYST | $ | 756.00 |
| 10120 | F-BODY REMOVAL, SUBQ,SIMPLE | $ | 423.00 |
| 10121 | REMOVAL FOREIGN BODY | $ | 764.00 |
| 10140 | I & D OF HEMATOMA | $ | 452.00 |
| 10160 | ABCESS/PUNC ASPIRATION | $ | 362.00 |
| 10180 | PHYS / COMPL DRAIN WOUND | $ | 679.00 |
| 1022F | PNEUMOCOCCUS IMMUN STATUS | $ | 18.00 |
| 1030F | INFLUENZA IMMUN STATUS | $ | 18.00 |
| 1055F | VISUAL FUNCTIONAL STATUS | $ | 18.00 |
| 1090F | URINARY INCONT ASSESS | $ | 18.00 |
| 11000 | DEBRIDEMENT INFECTED SKIN | $ | 142.00 |
| 11005 | PHYS/ DEBRIDE ABDOM WALL | $ | 2,125.00 |
| 11008 | PHYS/ REMOVAL MESH | $ | 1,742.00 |
| 11010 | DEBRIDE SKIN / FX | $ | 1,369.00 |
| 11042 | DEBRIDEMENT SKIN,SUBCUT TISSUE | $ | 327.00 |
| 11043 | DEBRIDE MUSCLE/FASCIA 20SQ CM < | $ | 563.00 |
| 11055 | LESION,PARING,CUTTING HYPERK | $ | 134.00 |
| 11056 | PARING/CUTTING LESION 2-4 | $ | 161.00 |
| 11057 | PAIRING / CUTTING BENIGN LESION | $ | 189.00 |
| 11104 | PUNCH BIOPSY OF SKIN, SNG LESION | $ | 317.00 |
| 11105 | PUNCH BIOPSY SKIN EACH ADDITIONAL LESION | $ | 156.00 |
| 1111F | DISCH MEDS RECONCILED W CURRENT MED LIST | $ | 0.00 |
| 11200 | SKIN TAG REMOVAL 1-15 LESIONS | $ | 242.00 |
| 11201 | SKIN TAG REMOVAL EA ADD 10 LESIONS | $ | 52.00 |
| 1125F | PAIN SEVERITY QUANTIFIED; PAIN PRESENT | $ | 0.00 |
| 1126F | PAIN SEVERITY QUANTIFIED; NO PAIN | $ | 0.00 |
| 11300 | LESION,SHAVING 0.5 OR LESS | $ | 273.00 |
| 11301 | LESION, SHAVING 0.6-1.0 CM | $ | 335.00 |
| 11302 | LESION, SHAVING 1.1-2.0 CM | $ | 394.00 |
| 11303 | LESION, SHAVING OVER 2.0 CM | $ | 433.00 |
| 11305 | LESION, SHAVING <0.5CM | $ | 274.00 |
| 11306 | SHAVING LESION 0.6-1.0 | $ | 338.00 |
| 11307 | SHAVE SKIN LESION 1.1-2CM | $ | 398.00 |
| 11310 | LESION, SHAVING FAC <0.5CM | $ | 316.00 |
| 11311 | LESION, SHAVING FAC 0.6-1.0 | $ | 309.00 |
| 11312 | SHAVE SKIN LESION 1.1-2.0 | $ | 449.00 |
| 11313 | SHAVING DERMAL LESION FACIAL OVER 2.0CM | $ | 462.00 |
| 11400 | EXC. LESION 0.5 OR LESS | $ | 344.00 |
| 11401 | EXC. LESION 0.6-1.0CM | $ | 414.00 |
| 11402 | EXC LESION 1.1-2.0 CM | $ | 458.00 |
| 11403 | EXC. LESION 2.1-3.0 CM | $ | 528.00 |
| 11404 | EXC. LESION 3.1-4.0 CM | $ | 597.00 |
| 11406 | EXC. LESION OVER 4.0 CM | $ | 851.00 |
| 11420 | LESION,EXCISION <0.5CM | $ | 341.00 |
| 11421 | LESION, EXCISION 0.6-1.0 | $ | 436.00 |
| 11422 | LESION, EXCISION 1.1-2.0 | $ | 485.00 |
| 11423 | LESION, EXCISION 2.1-3.0 | $ | 557.00 |
| 11424 | LESION, EXCISION 3.1-4.0 | $ | 639.00 |
| 11426 | PHYS / EXC BENIGN LESION | $ | 903.00 |
| 11440 | LESION,EXCISION FAC <0.5CM | $ | 376.00 |
| 11441 | LESION, EXCISION FAC 0.6-1.0CM | $ | 465.00 |
| 11442 | LESION,EXCISION FAC 1.1-2.0CM | $ | 519.00 |
| 11443 | EXCISION LESION 2.1-3.0 | $ | 615.00 |
| 11444 | EXC LESION 3.1-4.0 BENIGN FACE | $ | 769.00 |
| 11450 | PHYS/ EXCISON SUBQ TISSUE | $ | 1,050.00 |
| 1159F | MEDICATION LIST DOCUMENTED IN MED REC | $ | 0.00 |
| 11600 | EXCISION, MALIGNANT LESION 0.5CM | $ | 533.00 |
| 11601 | EXC LESION 0.6-1.0,TRUNK,ARMS,LEGS | $ | 632.00 |
| 11602 | LESION,EXCISION 1.1-2.0 | $ | 686.00 |
| 11603 | EXC LESION 2.1-3.0,TRUNKS LEGS ARMS | $ | 778.00 |
| 11604 | EXC LESION 3.0-4.0,TUNK,LEGS,ARMS | $ | 866.00 |
| 11606 | EXCISION, MALIG LESION 4.0+ | $ | 1,231.00 |
| 1160F | REVIEW OF MEDS BY PRESCRIB PRACT/CL PHAR | $ | 0.00 |
| 11620 | EXC LSION 0.5, LESS, SCALP, NECK | $ | 541.00 |
| 11621 | LESION, EXCISION 0.6-1.0 | $ | 636.00 |
| 11622 | EXC LESION 1.1-2.0,SCALP,NECK,HANDS | $ | 709.00 |
| 11623 | EXC LESION 2.1-3.0,SCALP,NECKS,HANDS | $ | 827.00 |
| 11624 | EXCIS MALIGNANT LESION 3+ | $ | 928.00 |
| 11626 | PHYS/ EXCIS MALIG LES >4CM | $ | 1,119.00 |
| 11640 | LESION, EXCISION FAC 1.5 < | $ | 558.00 |
| 11641 | LESION, EXCISION FAC 0.6-1.0 | $ | 657.00 |
| 11642 | LESION, EXCISION 1.1-2.0357 | $ | 751.00 |
| 11643 | LESION, EXCISION 2.1-3.0 | $ | 881.00 |
| 11644 | EXCISION LESION FACE 3.1-4 | $ | 1,043.00 |
| 11646 | EXCISION, MALIGNANT LES FACIAL OVER 4CM | $ | 1,405.00 |
| 1170F | FUNCTIONAL STATUS ASSESSED | $ | 0.00 |
| 11719 | TOE NAILS/TRIMMING | $ | 59.00 |
| 11720 | DEBRIDEMENT NAIL/S 1 -5 | $ | 80.00 |
| 11721 | DEBRIDEMENT NAILS 6+ | $ | 119.00 |
| 11730 | AVULSION OF NAIL PLATE | $ | 273.00 |
| 11740 | SUBUNGUAL HEMATOMA | $ | 137.00 |
| 11750 | EXCISION OF NAIL/MATRIX | $ | 617.00 |
| 11765 | WEDGE EXCISION/SKIN NAIL FOLD | $ | 465.00 |
| 11770 | PHYS / PILONIDAL CYST | $ | 797.00 |
| 11771 | PHYS/PILONIDAL CYST/ EXT | $ | 1,561.00 |
| 11772 | PHYS/PILONIDAL CYST COMPLI | $ | 1,901.00 |
| 11900 | INJECTION, INTRALESIONAL | $ | 154.00 |
| 11901 | INTRALESIONAL INJECTION >7 | $ | 191.00 |
| 11976 | REMOVAL CONTRACEPTIVE CAPSULE | $ | 395.00 |
| 11981 | INSERTION CONTRACEPTIVE | $ | 373.00 |
| 11982 | REMOVAL DRUG IMPLANT DEVICE | $ | 407.00 |
| 11983 | REMOVAL / REINSERT DRUG DELIVERY IMPLANT | $ | 558.00 |
| 12001 | LAC. REPAIR SIMPLE 2.5CM OR LESS | $ | 356.00 |
| 12002 | LAC. REPAIR SIMPLE 2.6-7.5CM | $ | 376.00 |
| 12004 | LAC. REPAIR SIMPLE 7.6-12.5CM | $ | 443.00 |
| 12005 | LAC REPAIR SIMPLE 12.6-20.0CM | $ | 551.00 |
| 12006 | LAC REPAIR 20.1-30.0CM | $ | 684.00 |
| 12007 | LAC REPAIR SIMPLE OVER 30.0CM | $ | 768.00 |
| 12011 | LAC. REPAIR SIMPLE FAC 2.5CM OR LESS | $ | 376.00 |
| 12013 | LAC. REPAIR SIMPLE FAC 2.6-5.0CM | $ | 414.00 |
| 12014 | LAC. REPAIR SIMPLE FAC 5.1-7.5CM | $ | 488.00 |
| 12015 | LAC REPAIR SIMPLE FAC 7.6-12.0CM | $ | 612.00 |
| 12016 | LAC REPAIR SIMPLE FAC 1.6-20. | $ | 730.00 |
| 12017 | LAC REPAIR SIMPLE FAC 20.1-30. | $ | 641.00 |
| 12018 | LAC REPAIR SIMPLE FAC OVER 30. | $ | 773.00 |
| 12020 | TX SUPERFICIAL WOUND DEHISCENCE | $ | 777.00 |
| 12031 | LAC. REPAIR INTERMED 2.5CM OR LESS | $ | 659.00 |
| 12032 | LAC REPAIR INTERMED 2.6-7.5CM | $ | 844.00 |
| 12034 | LAC REPAIR INTERMED 7.6-12.5 | $ | 862.00 |
| 12035 | LAC REPAIR INTERMED 12.6-20.0 | $ | 1,071.00 |
| 12036 | LAC REAPIR INTERMED 20.1-30.0CM | $ | 1,165.00 |
| 12037 | LAC REPAIR OVER 30.0CM | $ | 1,280.00 |
| 12041 | LAC REPAIR INTER EXTRM 2.5 OR LESS | $ | 678.00 |
| 12042 | LAC REPAIR INTER EXTR 2.6-7.5CM | $ | 797.00 |
| 12044 | LAC REPAIR INTER EXTR 7.6-12. | $ | 995.00 |
| 12045 | LAC REPAIR INTER EXTR 12.6-20. | $ | 1,110.00 |
| 12046 | LAC REPAIR INTER EXTR 20.1 -30. | $ | 1,478.00 |
| 12047 | LAC REPAIR INTER EXTR OVER 30 | $ | 1,621.00 |
| 12051 | LAC REPAIR INTER FAC 2.5CM OR LESS | $ | 717.00 |
| 12052 | LAC REPAIR INTER FAC 2.6-5.0CM | $ | 819.00 |
| 12053 | LAC REPAIR INTR FAC 5.1-7.5CM | $ | 959.00 |
| 12054 | LAC REPAIR INTER FAC 7.6-12.5CM | $ | 1,021.00 |
| 12055 | LAC REPAIR INTER FAC 12.6-20.0 | $ | 1,306.00 |
| 12056 | LAC REPAIR INTER FAC 20.1-30.0 | $ | 1,517.00 |
| 12057 | LAC REPAIR INTER FAAC OVER 30.0 | $ | 1,672.00 |
| 13121 | REPAIR COMPLEX 2.6-735CM | $ | 1,182.00 |
| 13122 | REPAIR COMPLEX EA ADD 5CM | $ | 367.00 |
| 13132 | REPAIR COMPLEX 2.6-7.5 CM | $ | 1,315.00 |
| 13160 | PHYS/ CLOSURE SURG WOUND | $ | 2,192.00 |
| 15100 | PHYS/ SKIN AUTOGRAFT | $ | 2,349.00 |
| 16000 | INITIAL TX 1ST DEGREE BURN | $ | 189.00 |
| 16020 | BURN/DRESSING,DEBRIDEMENT | $ | 226.00 |
| 17000 | DESTR. LESION 1 | $ | 226.00 |
| 17003 | DESTR. LESION 1-14 | $ | 22.00 |
| 17004 | LESION,DESCTRUC ANY METHOD 15+ | $ | 468.00 |
| 17106 | DESTR CUTANEOUS VASCULAR LESION | $ | 928.00 |
| 17110 | DESTR./CRYO,FLAT WARTS<15 | $ | 311.00 |
| 17111 | DESTR/CRYO,FLAT WARTS >15 | $ | 368.00 |
| 17250 | CHEMICAL CAUTER/GRANU | $ | 222.00 |
| 17260 | DESTRUC MALIGNANT LESION | $ | 260.00 |
| 17261 | DESTRUC MALIGNANT LESION | $ | 376.00 |
| 17263 | DESTRUCTION MALIG LESION 2.1-3.0CM | $ | 509.00 |
| 17280 | DEST MALIGNANT LESION164 | $ | 392.00 |
| 17282 | DEST MALIGNANT LESION | $ | 563.00 |
| 17999 | SKIN TISSUE PROCEDURE | $ | 222.00 |
| 19000 | DRAINAGE OF BREAST LESION | $ | 310.00 |
| 19001 | BREAST / CYST PUNC ASPIR | $ | 73.00 |
| 19020 | PHYS/ INCISION BREAST LESION | $ | 1,318.00 |
| 19100 | PHYS/ BREAST BIOPSY | $ | 419.00 |
| 19101 | BREAST BIOPSY | $ | 944.00 |
| 19120 | REMOVAL BREAST LESION | $ | 1,339.00 |
| 19301 | PHYS / PARTIAL MASTECTOMY | $ | 1,738.00 |
| 19318 | PHYS/ BREAST REDUCTION | $ | 3,060.00 |
| 2014F | MENTAL STATUS ASSESS | $ | 18.00 |
| 20520 | PHYS/ REMOV FOREIGN BODY | $ | 563.00 |
| 20526 | INJECTION, THERAPEUTIC CARPAL TUNNEL | $ | 204.00 |
| 20527 | INJECTION / DUPUY CONTRACT | $ | 206.00 |
| 20550 | INJ TENDON SHEATH, OR LIGAMENT | $ | 159.00 |
| 20550H | INJ TENDON SHEATH, OR LIGAMENT | $ | 159.00 |
| 20551 | INJECTION / TENDON | $ | 164.00 |
| 20551H | INJECTION / TENDON | $ | 164.00 |
| 20552 | INJECTION SING MULTI TRIGGER POINT | $ | 152.00 |
| 20553 | TRIGGER POINT INJECTION | $ | 177.00 |
| 20600 | ARTHROCENTESIS/ASPIRATION INJ | $ | 146.00 |
| 20600H | ARTHROCENTESIS /ASPIRATION INJ | $ | 146.00 |
| 20605 | ARTHROCENTESIS/INJ, INTERM JOINT | $ | 178.00 |
| 20605H | ARTHROCENTESIS / INJ, INTERM JOINT | $ | 178.00 |
| 20610 | ARTHROCENTESIS/INJ, MAJOR | $ | 209.00 |
| 20610H | ARTHROCENTESIS / INJ, MAJOR | $ | 209.00 |
| 20612 | ASPIRATION/INJECTION GANGLION CYST | $ | 164.00 |
| 20680H | REMOVAL IMPLANT DEEP | $ | 1,643.00 |
| 21013 | PHYS / EXCIS TUMOR FACE | $ | 1,437.00 |
| 21014 | EXCISION TUMOR FACE / SCALP >2CM | $ | 1,360.00 |
| 21310 | FRACTURE/ NASAL WO MANIP | $ | 377.00 |
| 21315 | FRACTURE/ NASAL W/O STABILIZ | $ | 798.00 |
| 21320 | FRACTURE/ NASAL W STABILIZ | $ | 731.00 |
| 21325 | OPEN TX NOSE FX UMCOMPLIC | $ | 1,311.00 |
| 21330 | OPEN TX NOSE FX W FIXATION | $ | 1,581.00 |
| 21337 | CLOSED TX NASAL SEPTAL FX W /WO STABIL | $ | 758.00 |
| 21400 | FRACTURE/ ORBIT WP MANIP | $ | 546.00 |
| 21480 | FRACTURE/ TEMPORMANDIBULA | $ | 278.00 |
| 21501 | I&D NECK/ CHEST LESION | $ | 1,274.00 |
| 21550 | BIOPSY NECK/CHEST LESION | $ | 733.00 |
| 21552 | EXCISION, TUMOR, SOFT TISSUE NECK 3CM+ | $ | 1,157.00 |
| 21800 | FRACTURE/ RIB CLOSED | $ | 316.00 |
| 21820 | FRACURE/ STERNUM CLOSED | $ | 394.00 |
| 21930 | PHYS / EXC BACK LESION <3CM | $ | 1,306.00 |
| 21931 | EXCISIN, TUMOR BACK / FLANK | $ | 1,266.00 |
| 21932 | PHYS / EXC BACK TUMOR | $ | 1,775.00 |
| 21933 | EXCIS TUMOR BACK >5CM | $ | 2,023.00 |
| 22305 | FRACTURE/ VERTEBRAL | $ | 528.00 |
| 22310 | FRACTURE/ VERTEBRAL WO MANIP | $ | 831.00 |
| 23500 | FRACTURE/ CLAVICULAR | $ | 605.00 |
| 23505 | FRACTURE/ CLAVIC W MANIP | $ | 965.00 |
| 23520 | FRACTURE/ STERNOCLAV WO MANIP | $ | 632.00 |
| 23525 | FRACTURE/ STERNOCLAV W MANIP | $ | 1,035.00 |
| 23540 | FRACTURE/ ACROMIOCLAVICLE | $ | 617.00 |
| 23545 | FRACTURE/ ACROMIOCLAV W MANIP | $ | 960.00 |
| 23570 | FRACTURE/ SCAPULAR WO MANIP | $ | 636.00 |
| 23600 | FRACTURE/PROX HUMERAL | $ | 904.00 |
| 23605 | FRACTURE/ PROX HUMER W MANIP | $ | 1,271.00 |
| 23620 | FRACTURE/ TUBEROSITY WO MANIP | $ | 744.00 |
| 23625 | FRACTURE/ TUBEROSITY W MANIP | $ | 1,043.00 |
| 23650 | FRACTURE/SHOULDER W/O MAN | $ | 868.00 |
| 23655 | FRACTURE/SHOULDER W ANES | $ | 1,090.00 |
| 23700H | MANIPULATION SHOULDER JOINT W ANESTHESIA | $ | 763.00 |
| 24076 | PHYS / EXC TUMOR ARM/ELBOW | $ | 1,468.00 |
| 24500 | FRACTURE/HUMERAL SHAFT | $ | 986.00 |
| 24505 | FRCTURE/ HUMERUS W MANIP | $ | 1,370.00 |
| 24530 | TREATMENT HUMERUS FRACTURE | $ | 1,047.00 |
| 24560 | FRACTURE/ EPICONDYL LAT | $ | 891.00 |
| 24600 | FRACTURE/ DISLOC ELBOW | $ | 1,006.00 |
| 24605 | FRACTURE/ DISLOC ELBOW W ANES | $ | 1,279.00 |
| 24620 | FRACTURE/ MONTEGGIA ELBOW | $ | 1,502.00 |
| 24640 | FRACTURE/RADIAL HEAD CHILD | $ | 395.00 |
| 24650 | FRACTURE/ RADIAL HEAD/NECK | $ | 727.00 |
| 24655 | FRACTURE/ RADIAL HEAD W MAN | $ | 1,204.00 |
| 24670 | FRACTURE/ ULNAR PROX WO MAN | $ | 805.00 |
| 24675 | FRACTURE/ ULNAR W MANIP | $ | 1,249.00 |
| 25000H | INCISION EXTENSOR TENDON SHEATH WRIST | $ | 829.00 |
| 25111 | PHYS / EXC GANGLION WRIST | $ | 1,031.00 |
| 25111H | EXCISION GANGLION WRIST PRIMARY | $ | 1,242.00 |
| 25112 | PHYS / EXC GANGLION WRIST | $ | 1,050.00 |
| 25112H | EXCISION GANGLION WRIST RECURRENT | $ | 1,500.00 |
| 25500 | FRACTURE/RADIAL SHAFT WO | $ | 751.00 |
| 25505 | FRACTURE/ RADIAL SHAFT W MANIP | $ | 1,379.00 |
| 25520 | FRACTURE/ GALEAZZI RADIAL | $ | 1,541.00 |
| 25530 | FRACTURE/ ULNAR SHAFT | $ | 727.00 |
| 25535 | FRACTURE/ ULNAR SHAFT W MANIP | $ | 1,340.00 |
| 25560 | FRACTURE/ RADIAL ULNAR SHAFT | $ | 770.00 |
| 25565 | FRACTURE/RADIAL ULNAR W MANIP | $ | 1,426.00 |
| 25600 | FRACTURE/DIATAL RADIAL | $ | 910.00 |
| 25605 | FRACTURE/DISTAL RADIAL W MANIP | $ | 1,634.00 |
| 25622 | FRACTURE/CARPAL SCAPHOID | $ | 843.00 |
| 25624 | FRACTURE/ CARPAL SCAPHOID W MAN | $ | 1,308.00 |
| 25630 | FRACTURE/CARPAL BONE | $ | 839.00 |
| 25635 | FRACTURE/ CARPAL BONE W MANIP | $ | 1,244.00 |
| 25650 | FRACTURE/ULNAR STYLOID | $ | 884.00 |
| 25660 | FRACTURE/ RADIO-INTERCARPAL | $ | 1,120.00 |
| 25675 | FRACTURE/ DISTAL RADIOULNA | $ | 1,217.00 |
| 25680 | FRACTURE/ TRANS SCAPHOPERIULNA | $ | 1,304.00 |
| 25690 | FRACTURE/ LUNATE DISLOCATION | $ | 1,305.00 |
| 26011H | DAINAGE FINGER ABSCESS COMPLICATED | $ | 717.00 |
| 26055H | TENSON SHEATH INCISION (TRIGGER FINGER) | $ | 1,202.00 |
| 26113 | EXCISION TUMOR SOFT TISS HAND/FINGER | $ | 1,354.00 |
| 26115H | EXCISION OF TUMOR, SOFT TISSUE HAND FING | $ | 1,292.00 |
| 26123H | FASCIECTOMY, PART PALMER RELEASE | $ | 3,239.00 |
| 26125 | FASCIECTOMY PARTIAL PALMAR RELEASE | $ | 711.00 |
| 26160 | PHYS / REM TENDON SH LESION | $ | 1,603.00 |
| 26236 | PARTIAL EXCISION BONE DISTAL PHAL/FINGER | $ | 1,141.00 |
| 26567 | OSTEOTOMY PHALANX/ FINGER | $ | 1,765.00 |
| 26600 | FRACTURE/METACARPAL WO MANIP | $ | 814.00 |
| 26605 | FRACTURE/METACARPAL W MANIP | $ | 887.00 |
| 26641 | FRACTURE/THUMB W MANIP | $ | 1,010.00 |
| 26650 | FRACTURE/ THUMB BENNETT | $ | 1,298.00 |
| 26650H | CARPOMETACARPAL FX DISLOC THUMB SKEL FIX | $ | 1,844.00 |
| 26670 | FRACTURE/CARPOMETACARPAL | $ | 907.00 |
| 26700 | CLOSED TX METACARPOPHALANGEAL | $ | 891.00 |
| 26720 | FRACTURE/ PHALANGEAL SHAFT | $ | 549.00 |
| 26725 | FRACTURE PHALANGEAL MANIP | $ | 927.00 |
| 26740 | FRACTURE/ ARTICULAR CLOSED | $ | 632.00 |
| 26750 | FRACTURE/ DISTAL PHALANGEAL | $ | 509.00 |
| 26755 | FRACTURE/ DISTAL PHALANGEAL W MAN | $ | 867.00 |
| 26770 | FRACTURE/DISLO INTERPHALANGE JOINT | $ | 763.00 |
| 27043 | EXCISION TUMOR SOFT TISSUE PLEVIS / HIP | $ | 1,149.00 |
| 27096 | INJECT SACROILIAC JOINT | $ | 500.00 |
| 27130 | TOTAL HIP ASSIST | $ | 3,874.00 |
| 27200 | FRACTURE/ COCCYX | $ | 494.00 |
| 27230 | FRACTURE/ FEMUR | $ | 1,293.00 |
| 27246 | FRACTURE/ GREATER TROCHANTER | $ | 1,045.00 |
| 27250 | FRACTURE/HIP DISLOCATION | $ | 1,131.00 |
| 27252 | FRACTURE/HIP W ANES | $ | 2,050.00 |
| 27266 | FRACTURE POST HIP ARTHRO/ANES | $ | 1,571.00 |
| 27301 | I&D DEEP ABSCESS, HEMATOMA | $ | 1,848.00 |
| 27301H | I & D, DEEP ABSC,BURSA,HEMAT THIGH- KNEE | $ | 1,956.00 |
| 27340H | EXCISION PREPATELLAR BURSA | $ | 914.00 |
| 27347H | REMOVAL KNEE CYST | $ | 1,300.00 |
| 27447 | TOTAL KNEE ASSIST | $ | 4,137.00 |
| 27447H | TOTAL KNEE ARTHROPLASTY | $ | 5,283.00 |
| 27520 | FRACTURE/ PATELLA WO MANIP | $ | 896.00 |
| 27530 | FRACTURE/TIBIA WO MANIP | $ | 1,038.00 |
| 27532 | FRACTURE/ TIBIA W MANIP | $ | 1,673.00 |
| 27550 | FRACTURE/ KNEE DISLOCATION | $ | 1,364.00 |
| 27552 | FRACTURE/ KNEE W ANES | $ | 1,696.00 |
| 27560 | FRACTURE/ PATELLA WO ANES | $ | 1,014.00 |
| 27570 | MANIPULATION KNEE JOINT/ ANESTHESIA | $ | 585.00 |
| 27603 | I & D LEG, ANKLE, ABSCESS, HEMATOMA | $ | 1,432.00 |
| 27760 | FRACTURE MEDIAL MALLEOLUS WO MAN | $ | 927.00 |
| 27780 | FRACTURE/FIBULA | $ | 850.00 |
| 27786 | FRACTURE/ LAT MALLEOLUS | $ | 878.00 |
| 27808 | FRACTURE/ ANKLE | $ | 928.00 |
| 27810 | FRACTURE/ BIMALLEOLAR ANKLE W MAN | $ | 1,292.00 |
| 27814H | BIMALLEOLAR ANKLE FRACTURE OPEN | $ | 2,995.00 |
| 27816 | FRACTURE/ TRIMALLEOLAR ANKLE WO | $ | 883.00 |
| 27824 | FRACTURE/ CLOSED DISTAL TIBIA | $ | 860.00 |
| 27840 | FRACTURE/ ANKLE DISLOCATION | $ | 1,025.00 |
| 27842 | FRACTURE/ ANKLE DISLOC W ANES | $ | 1,349.00 |
| 28043 | EXC TUMOR, SOFT TISSUE FOOT OR TOE SIMPL | $ | 1,035.00 |
| 28045H | EXC TUMOR SOFTI TSSUE FOOT/TOE SUBFASCIA | $ | 1,354.00 |
| 28090H | EXCISION, TENDON/SHEATH, CAPSULE FOOT | $ | 1,272.00 |
| 28173 | PHYS/ RESEC METATAR TUMOR | $ | 2,115.00 |
| 28190 | REMOVAL FB/ FOOT | $ | 730.00 |
| 28400 | FRACTURE/ CALCANEAL | $ | 700.00 |
| 28430 | FRACTURE/TALUS | $ | 657.00 |
| 28450 | FRACTURE/ TARSAL BONE | $ | 605.00 |
| 28455 | FRACTURE/ TARSAL W MANIP | $ | 778.00 |
| 28470 | FRACTURE/METATARSAL WO MANIP | $ | 616.00 |
| 28475 | FRACTURE/ METATARSAL W MANIP | $ | 707.00 |
| 28495 | FRACTURE/ GREAT TOE W MANIP | $ | 500.00 |
| 28510 | FRACTURE/ PHALANGE | $ | 346.00 |
| 28515 | FRACTURE/ PHALANGE W MANIP | $ | 453.00 |
| 28540 | FRACTURE/ TARSAL BONE DISLOC | $ | 547.00 |
| 28660 | FRACTURE INTERPHALANGEAL JOINT DISLOC | $ | 324.00 |
| 28740H | ARTHRODESIS, MIDTARSAL OR TARSOMETATARSA | $ | 2,421.00 |
| 29065 | CAST SHOULDER TO HAND | $ | 268.00 |
| 29075 | CAST ELBOW TO FINGER | $ | 242.00 |
| 29085 | CAST/HAND,FOREARM GAUNTLET | $ | 264.00 |
| 29105 | SPLINT, LONG ARM | $ | 244.00 |
| 29125 | SPLINT SHORT ARM | $ | 182.00 |
| 29130 | APPLICATION FINGER SPLINT | $ | 113.00 |
| 29345 | CAST LONG LEG | $ | 376.00 |
| 29405 | CAST SHORT LEG | $ | 232.00 |
| 29425 | APPLICATION WALKING CAST | $ | 246.00 |
| 29505 | SPLINT LONG LEG | $ | 234.00 |
| 29515 | SPLINT SHORT LEG | $ | 201.00 |
| 29580 | APPLIC. UNNA BOOT | $ | 147.00 |
| 29876H | ARTHROSOCPY, KNEE SYNOVECTOMY | $ | 2,558.00 |
| 29879H | ARTHROSCOPY, KNEE/ ABRASION ARTHROPLASTY | $ | 2,577.00 |
| 29880H | ARTHROSCOPY, KNEE MENISECTO PARTIAL/LAT | $ | 2,188.00 |
| 29881H | KNEE ARTHROSCOPY W MENISECTOMY | $ | 2,106.00 |
| 3008F | BMI , DOCUMENTED | $ | 10.00 |
| 30100 | INTRANASAL BIOPSY | $ | 406.00 |
| 30110 | EXCISION NASAL POLYP SIMPLE | $ | 657.00 |
| 30115 | REMOVAL NASAL POLYP | $ | 1,207.00 |
| 30125 | REMOVAL NOSE LESION | $ | 1,691.00 |
| 30130 | EXCISE INFERIOR TURBINATE | $ | 1,069.00 |
| 30140 | RESECT INFERIOR TURBINATE | $ | 1,248.00 |
| 30300 | REMOVE NASAL FOREIGN BODY | $ | 672.00 |
| 30310 | REMOVE NASAL FB W ANES | $ | 579.00 |
| 3044F | MOST RECENT HbA1c LEVEL<7.0% | $ | 0.00 |
| 3045F | MOST RECENT HbA1c LEVEL 7.0-9.0% | $ | 0.00 |
| 30465 | REPAIR NASAL STENOSIS | $ | 2,612.00 |
| 3046F | MOST RECENT HbA1c LEVEL >9.0%** | $ | 0.00 |
| 30520 | REPAIR NASAL SEPTUM | $ | 1,744.00 |
| 3060F | POSITIVE MICROALBUMIN TEST | $ | 0.00 |
| 3061F | NEGATIVE MICROALBUMINURIA TEST | $ | 0.00 |
| 3062F | POSITIVE MICROALBUMINURIA TEST | $ | 0.00 |
| 30630 | REPAIR NASAL SEPTUM DEFECT | $ | 1,744.00 |
| 3066F | DOCUMENTATION OF TREATMENT NEPHROPATHY | $ | 0.00 |
| 3072F | LOW RISK RETINOPATHY | $ | 0.00 |
| 3074F | SYSTOLIC <140mmHG | $ | 0.00 |
| 3075F | SYSTOLIC <140mmHG | $ | 0.00 |
| 3077F | SYSTOLIC > 140 mmHg | $ | 0.00 |
| 3078F | DIASTOLIC <80 mmHg | $ | 0.00 |
| 3079f | DIASTOLIC 80-89 mmHg | $ | 0.00 |
| 3080F | DIASTOLIC > 90 mmHg | $ | 0.00 |
| 30901 | NASAL HEMORRHAGE,SIMPLE | $ | 265.00 |
| 30903 | CONTROL NOSEBLEED ANTERIOR | $ | 586.00 |
| 30905 | CONTROL NOSEBLEED POSTER | $ | 730.00 |
| 30906 | CONTROL NOSEBLEED SUBSEQ | $ | 797.00 |
| 30930 | FX NASAL INFERIOR TURBINATES | $ | 334.00 |
| 31000 | IRRIG MAXILLARY SINUS | $ | 518.00 |
| 31020 | EXPLOR MAXILLARY SINUS | $ | 1,378.00 |
| 31231 | NASAL ENDOSCOPY DX | $ | 595.00 |
| 31231F | NASAL ENDOSCOPY DX - (FROY) | $ | 595.00 |
| 31237 | NASAL/SINUS ENDOSCOPY BX POLYP | $ | 912.00 |
| 31238 | NASAL ENDOSCOPY/ HEMORRHAGE | $ | 932.00 |
| 31254 | REVISION ETHMOID SINUS | $ | 743.00 |
| 31255 | REM ETHMOID SINUS ANT/ POST | $ | 1,087.00 |
| 31256 | EXPLORATORY MAXILLARY SINUS | $ | 541.00 |
| 31267 | NASAL/ SINUS ENDOSCOPY MAXILLARY ANTROS | $ | 832.00 |
| 31500 | INTUBATION | $ | 299.00 |
| 31511 | ENDOSCOPY/ REMOVAL FOREIGN BODY | $ | 604.00 |
| 31515 | LARYNGOSCOPY / ASPIRATION | $ | 589.00 |
| 31525 | PHYS / LARYNGOSCOPY | $ | 706.00 |
| 31526 | LARYNGOSCOPY W SCOPE DX | $ | 433.00 |
| 31530 | LARYNGOSCOPY W FB REMOVAL | $ | 541.00 |
| 31531 | LARYNGOSCOPY W FB REMOV SCOPE | $ | 582.00 |
| 31535 | LARYNGOSCOPY W BIOPSY | $ | 521.00 |
| 31536 | LARYNGOSCOPY BIOPSY DIRECT | $ | 579.00 |
| 31575 | LARYNGOSCOPY, FLEXIBLE | $ | 320.00 |
| 31576 | LARYNGOSCOPY W BIOPSY | $ | 632.00 |
| 31622 | BRONCHOSCOPY DIAGNOSTIC | $ | 887.00 |
| 31625 | BRONCHOSCOPY W BIOPSY | $ | 948.00 |
| 32551 | THORACOSTOMY TUBE INSERT | $ | 474.00 |
| 32554 | THORACENTESIS W/O IMAG | $ | 257.00 |
| 32555 | THORACENTESIS W IMAG | $ | 320.00 |
| 35840 | PHYS/ EXPLORATION ABDOMEN | $ | 4,600.00 |
| 36000 | NEEDLE, INTRODUCTION VEIN | $ | 72.00 |
| 36415 | VENIPUNCTURE | $ | 13.00 |
| 36489 | CENTRAL VENOUS CATH PLACEMENT | $ | 477.00 |
| 36510 | CATHETER UMBILICAL | $ | 391.00 |
| 36556 | PHYS / CV CATHETER INSERT | $ | 653.00 |
| 36561 | INSERT TUNNELED CV CATH 5YRS> | $ | 3,391.00 |
| 36569 | PHYS/ INSERT PICC CATH | $ | 705.00 |
| 36576 | PHYS / REP TUN CV CATH | $ | 1,085.00 |
| 36590 | PHYS / REM TUNNEL CV CATH | $ | 814.00 |
| 37609 | PHYS/ TEMPORAL ARTERY BIOPSY | $ | 878.00 |
| 37718 | PHYS / LIGATION SAPH VEIN | $ | 1,237.00 |
| 38100 | REMOVAL OF SPLEEN, TOTAL | $ | 3,088.00 |
| 38220 | BONE MARROW ASPIRATION | $ | 432.00 |
| 38221 | PHYS / BONE MARROW BIOPSY | $ | 458.00 |
| 38500 | EXCISION LYMPH NODE | $ | 911.00 |
| 38510 | EXC LYMPH NODE DEEP | $ | 1,426.00 |
| 4010F | DOCUMENTATION TREATMENT NEPHROPATHY | $ | 0.00 |
| 40490 | BIOPSY LIP | $ | 362.00 |
| 40806 | INCISION LABIAL FRENUM | $ | 407.00 |
| 40808 | BIOPSY VESTIBULE MOUTH | $ | 542.00 |
| 40810 | EXCISION MOUTH LESION | $ | 595.00 |
| 40819 | FRENULECTOMY | $ | 883.00 |
| 41010 | FRENULOTOMY | $ | 596.00 |
| 41100 | PHYS/ BIOPSY TONGUE 2/3 | $ | 481.00 |
| 41108 | BIOPSY FLOOR OF MOUTH | $ | 433.00 |
| 41599 | PHYS / REM TONGUE JEWELRY | $ | 98.00 |
| 42100 | BIOPSY UVULA, PALATE | $ | 428.00 |
| 42104 | EXC LESION MOUTH/ WO CLOS | $ | 620.00 |
| 42106 | EXC LESION MOUTH W CLOS | $ | 780.00 |
| 42140 | UVULECTOMY | $ | 739.00 |
| 42440 | EXC SUBMANDIBULAR GLAND | $ | 1,144.00 |
| 42450 | EXC SUBLINGUAL GLAND | $ | 1,289.00 |
| 42700 | I & D TONSIL | $ | 546.00 |
| 42809 | REM FOREIGN BODY PHARYNX | $ | 490.00 |
| 42820 | TONSILLECTOMY/ ADENOID <12 | $ | 809.00 |
| 42821 | TONSILLECTOMY / ADENOID >12 | $ | 841.00 |
| 42825 | TONSILLECTOMY <12 YO | $ | 735.00 |
| 42826 | TONSILLECTOMY >12 YO | $ | 705.00 |
| 42830 | REMOVAL ADENOIDS <12 YO | $ | 585.00 |
| 42831 | REMOVAL ADENOID >12 YO | $ | 631.00 |
| 42835 | REM ADENOIDS 2ND <12 YO | $ | 545.00 |
| 42836 | REMOVAL ADENOIDS 2ND >12 YO | $ | 676.00 |
| 42860 | EXCISION TONSIL TAG | $ | 512.00 |
| 42960 | POST TONSIL HEMOR SIMPLE | $ | 475.00 |
| 42970 | POST ADENOID HEMOR SIMPLE | $ | 1,140.00 |
| 43200 | ESOPHAGUS ENDOSCOPY | $ | 608.00 |
| 43202 | ESOPHAGUS ENDOSCOPY BIOPSY | $ | 817.00 |
| 43215 | ESOPHAGUS ENDOSCOPY FB REM | $ | 421.00 |
| 43216 | ESOPHAGUS ENDOS/ LESION | $ | 626.00 |
| 43235 | PHYS / EGD | $ | 844.00 |
| 43239 | PHYS / EGD BIOPSY | $ | 973.00 |
| 43246 | PHYS / GASTROSTOMY TUBE PLACE | $ | 696.00 |
| 43247 | PHYS/ EGD FOREIGN BODY | $ | 792.00 |
| 43251 | PHYS / EGD / POLYP | $ | 604.00 |
| 43752 | PHYS / NASAL TUBE PLACE | $ | 163.00 |
| 43761 | REPOSITION GASTRIC TUBE | $ | 328.00 |
| 44005 | ENTEROLYSIS | $ | 2,941.00 |
| 44020 | PHYS/ EXP SM INTESTINE | $ | 2,614.00 |
| 44110 | PHYS/ EXCIS INTESTINE LESION | $ | 2,283.00 |
| 44120 | PHYS/ REMOV SM INTESTINE | $ | 3,284.00 |
| 44140 | COLECTOMY, PARTIAL | $ | 3,607.00 |
| 44388 | PHYS / COLONOSCOPY STOMA | $ | 1,009.00 |
| 44680 | REVISION OF INTESTINE | $ | 2,892.00 |
| 44799 | INTESTINE/ UNLISTED PROCED | $ | 296.00 |
| 44950 | APPENDECTOMY | $ | 1,726.00 |
| 44955 | PHYS / APPENDECTOMY ADD | $ | 226.00 |
| 44960 | APPENDIX/RUPTURED | $ | 2,347.00 |
| 44970 | APPENDECTOMY, LAPROSCOPIC | $ | 1,608.00 |
| 45005 | PHYS/ I & D ABCESS, RECTUM | $ | 765.00 |
| 45110 | PROCTECTOMY/COMPLETE | $ | 4,994.00 |
| 45300 | PROCTOSIGMOIDOSCOPY RIGID DIAGNOSTIC | $ | 306.00 |
| 45330 | SIGMOIDOSCOPY | $ | 394.00 |
| 45331 | SIGMOIDOSCOPY/BIOPSY | $ | 474.00 |
| 45378 | PHYS / COLONOSCOPY | $ | 1,246.00 |
| 45380 | PHYS / COLONOSCOPY BIOPSY | $ | 1,820.00 |
| 45381 | PHYS/ COLONOSCOPY SUBMUC INJ | $ | 1,334.00 |
| 45385 | PHYS / COLONOSCOPY POLYP | $ | 1,820.00 |
| 45560 | REPAIR RECTOCELE | $ | 1,819.00 |
| 45990 | PHYS/ ANORECTAL EXAM | $ | 289.00 |
| 46040 | I&D PERIRECTAL ABCESS | $ | 1,477.00 |
| 46050 | PHYS/ INCIS ANAL ABSC | $ | 575.00 |
| 46060 | PHYS / INCIS RECTAL ABSCE | $ | 1,304.00 |
| 46080 | PHYS/ SPHINCTEROTOMY | $ | 693.00 |
| 46083 | INCIS THROMBOSED HEMORRHOID | $ | 495.00 |
| 46220 | PHYS/ EXCIS ANAL TAG | $ | 582.00 |
| 46230 | EXCISION EXTERNAL SKIN TAG | $ | 737.00 |
| 46250 | HEMORRHOIDECTOMY,EXT | $ | 1,286.00 |
| 46255 | PHYS / HEMORRHOIDECTOMY | $ | 1,611.00 |
| 46257 | PHYS/ HEMORRHOIDECTOMY INT /EXT | $ | 1,151.00 |
| 46260 | PHYS / HEMORRHOIDECTOMY | $ | 1,293.00 |
| 46275 | PHYS/ REMOV ANAL FISTULA | $ | 1,496.00 |
| 46320 | PHYS/ HEMORRHOID THROM EXT | $ | 515.00 |
| 46600 | ANOSCOPY | $ | 253.00 |
| 46922 | PHYS / LES DESTRUC ANUS | $ | 757.00 |
| 46930 | PHYS / DESTROY INT HEMORRHOID | $ | 577.00 |
| 46945 | PHYS/ HEMORRHOIDECTOMY/ LIGATION | $ | 869.00 |
| 46946 | PHYS/ LIGATION HEMORRHOID | $ | 878.00 |
| 46999 | PHYS / ANUS SURGERY PROCED | $ | 520.00 |
| 47100 | BIOPSY LIVER WEDGE | $ | 2,063.00 |
| 47562 | PHYS / LAP CHOLE | $ | 3,258.00 |
| 47600 | CHOLECYSTECTOMY | $ | 2,903.00 |
| 49000 | EXPLORATORY LAPAROTOMY | $ | 2,072.00 |
| 49020 | PHYS/ DRAIN PERITONEAL ABCESS | $ | 4,271.00 |
| 49082 | PHYS / PARACENTESIS ABD | $ | 492.00 |
| 49084 | PHYS / PERITONEAL LAVAGE | $ | 279.00 |
| 49203 | PHYS / EXC ABD TUMOR 5CM | $ | 3,213.00 |
| 49320 | LAPAROSCOPY DIAGNOSTIC | $ | 848.00 |
| 49505 | PHYS / REP ING HERNIA | $ | 2,056.00 |
| 49507 | PHYS/ INGUINAL HERNIA | $ | 2,108.00 |
| 49520 | PHYS/ INGUINAL HERNIA REP | $ | 2,260.00 |
| 49521 | PHYS/INGUINAL HERNIA INCAR | $ | 2,034.00 |
| 49555 | PHYS / FEMORLA HERNIA REP | $ | 1,596.00 |
| 49560 | PHYS/ VENTRAL HERNIA | $ | 2,497.00 |
| 49561 | PHYS / HERNIA REP, VENTRAL | $ | 2,495.00 |
| 49565 | PHYS / INCIS HERNIA REPAIR | $ | 2,767.00 |
| 49566 | VENTRAL HERNIA INCAR/STRANG | $ | 2,524.00 |
| 49568 | PHYS / HERNIA REP, MESH | $ | 723.00 |
| 49585 | UMBILICAL HERNIA REPAIR | $ | 1,196.00 |
| 49587 | PHYS / UMB HERNIA REP INCAR/STRAN | $ | 1,384.00 |
| 49590 | REPAIR SPIGELIAN HERNIA | $ | 1,534.00 |
| 49653 | PHYS / LAP REP UMB HERNIA | $ | 3,070.00 |
| 49999 | UNLISTED PROCEDURE | $ | 323.00 |
| 51102 | ASPIRATION BLADDER/INSERT SUPRA CATH | $ | 814.00 |
| 51500 | EXC URACHAL CYST/SINUS W W/O UB HERNIA | $ | 1,609.00 |
| 51700 | IRRIGATION OF BLADDER | $ | 315.00 |
| 51701 | INSERTI0N FOLEY/RESIDUAL | $ | 178.00 |
| 51702 | INSERTION INDWELLING CATH | $ | 220.00 |
| 51703 | INSERT BLADDER CATH, COMPLEX | $ | 377.00 |
| 51705 | CHANGE CYSTOSTOMY TUBE, SIMPLE | $ | 241.00 |
| 51865 | CYSTORRHAPHY, SUTURE BLADDER WOUND INJUR | $ | 2,245.00 |
| 52000 | CYSTOSCOPY | $ | 578.00 |
| 52310 | CYSTO, REMOVAL FB | $ | 687.00 |
| 53200 | BIOPSY / URETHRA | $ | 403.00 |
| 54050 | DESTRUCTION LESION/MALE218 | $ | 365.00 |
| 54150 | CIRCUMCISION/CLAMP OR DEVICE | $ | 239.00 |
| 54160 | CIRCUMCISION NEWBORN | $ | 338.00 |
| 54162 | LYSIS PENILE LESION | $ | 743.00 |
| 55000 | PHYS / DRAINAGE HYDROCELE | $ | 335.00 |
| 55040 | PHYS / EXCIS HYDROCELE | $ | 926.00 |
| 55100 | PHYS/ DRAINAGE SCROTUM ABSCESS | $ | 595.00 |
| 55250 | VASECTOMY | $ | 1,258.00 |
| 56405 | I & D VULVA / PERINEAL ABSCESS | $ | 416.00 |
| 56420 | DRAINAGE GLAND ABSCESS | $ | 337.00 |
| 56501 | LESION, DESTRUCTION/VULVA SIMPLE | $ | 361.00 |
| 56605 | BIOPSY VULVA/ PERINEUM | $ | 246.00 |
| 56606 | BIOPSY VULVA / PERINEUM | $ | 102.00 |
| 56700 | PARTIAL HYMENECTOMY/REVIS OF HYMEN RING | $ | 465.00 |
| 57061 | DESTRU VAGINAL LESION(S) | $ | 314.00 |
| 57100 | BIOPSY/VAGINAL MUCOSA | $ | 242.00 |
| 57160 | INSERTION PESSARY | $ | 211.00 |
| 57170 | DIAPHRAGM,INSERTION W INSTRUC | $ | 205.00 |
| 57240 | REPAIR BLADDER & VAGINA | $ | 1,822.00 |
| 57260 | REPAIR VAGINA | $ | 2,275.00 |
| 57265 | COMBINED ANTEROPOST COLP/ ENTEROCELE REP | $ | 2,381.00 |
| 57267 | PHYS/ INSERT MESH PELVIC | $ | 711.00 |
| 57268 | REPAIR ENTEROCELE / VAG APPROACH | $ | 1,266.00 |
| 57288 | SLING OPERATION STRESS INCONTINENCE | $ | 1,857.00 |
| 57410 | PELVIC EXAMINATION / ANESTHESIA | $ | 282.00 |
| 57452 | COLPOSCOPY | $ | 299.00 |
| 57454 | COLPOSCOPY/WITH BIOPSY | $ | 421.00 |
| 57455 | COLPOSCOPY WITH BIOPSY CERVIX | $ | 377.00 |
| 57456 | COLPOSCOPY CERVIX / ENDO CURRETAGE | $ | 356.00 |
| 57500 | BIOPSY,EXCISION LOCAL LESION | $ | 357.00 |
| 57505 | PHYS/ ENDOCERV CURETTAGE | $ | 282.00 |
| 57511 | CRYOCAUTERY | $ | 400.00 |
| 57520 | CONIZATION OF CERVIX | $ | 807.00 |
| 57522 | CONIZATION OF CERVIX | $ | 696.00 |
| 57800 | DILATION CERVICAL CANAL | $ | 165.00 |
| 58100 | ENDOMETRIAL BIOPSY | $ | 301.00 |
| 58120 | PHYS/ DILATION & CURETTAGE | $ | 708.00 |
| 58146 | PHYS/ MYOMECTOMY ABDOM COMPLEX | $ | 3,141.00 |
| 58150 | TOTAL HYSTERECTOMY | $ | 2,738.00 |
| 58180 | SUPRACERVICAL ABDOMINAL HYSTERECTOMY | $ | 2,378.00 |
| 58260 | VAGINAL HYSTERECTOMY | $ | 2,272.00 |
| 58262 | VAGINAL HYSTERECTOMY W REM TUBE | $ | 2,512.00 |
| 58300 | INSERTION OF INTRAUTERINE DEVICE | $ | 213.00 |
| 58301 | REMOVAL INTRAUTERINE DEVICE | $ | 262.00 |
| 58353 | ENDOMETRIAL ABLATION THERMAL | $ | 2,494.00 |
| 58541 | LAP SUPRACERV HYSTERECTOMY | $ | 2,357.00 |
| 58550 | VAGINAL HYSTERECTOMY | $ | 2,427.00 |
| 58552 | LAPAROSCOPY/TUBES & OVARY | $ | 2,695.00 |
| 58554 | LAPARO VAGINAL HYSTER W UTERUS >250 | $ | 3,584.00 |
| 58558 | HYSTEROSCOPY W BIOP/POLYP W W/O D&C | $ | 1,048.00 |
| 58561 | HYSTEROSCOPY WITH REMOVAL LEIOMYOMATA | $ | 925.00 |
| 58562 | HYSTEROSCOPY REMOVAL FB | $ | 1,086.00 |
| 58563 | HYSTEROSCOPY, ENDOMETRIAL ABLATION | $ | 4,529.00 |
| 58600 | PHYS / TUBAL LIGATION | $ | 1,819.00 |
| 58605 | TUBAL LIGATION POST PARTUM | $ | 904.00 |
| 58611 | TUBAL LIGATION | $ | 213.00 |
| 58661 | PHYS/ REM ADNEXAL STRUCT | $ | 1,766.00 |
| 58662 | LAPAROSCOPY EXCISE LESIONS | $ | 1,812.00 |
| 58670 | TUBAL LIGATION/ FULG OVIDUCTS | $ | 1,006.00 |
| 58671 | LAPAROSCOPY OCCLUSION OVIDUCTS/ DEVICE | $ | 959.00 |
| 58720 | REMOVAL OVARY/TUBES | $ | 1,981.00 |
| 58805 | PHYS / DRAIN OVARIAN CYST | $ | 1,106.00 |
| 58925 | PHYS/ OVARIAN CYSTECTOMY | $ | 2,411.00 |
| 58940 | REMOVAL OF OVARY (S) | $ | 1,420.00 |
| 58956 | INPT/ OMENTECTOMY | $ | 3,644.00 |
| 59120 | PHYS/ TREAT ECTOPIC PREGN | $ | 2,203.00 |
| 59151 | TREAT ECTOPIC PREGNANCY | $ | 1,999.00 |
| 59160 | CURRETAGE/POSTPARTUM | $ | 575.00 |
| 59300 | EPISIOTOMY/ VAGINAL REPAIR | $ | 532.00 |
| 59400 | ROUTINE OB ANTEPARTUM CARE | $ | 5,737.00 |
| 59409 | VAGINAL DELIVERY ONLY | $ | 2,256.00 |
| 59410 | VAGINAL DELIVERY/POSTPARTUM | $ | 2,866.00 |
| 59412 | CEPHALIC VERSION EXTERNAL | $ | 470.00 |
| 59414 | PHYS / DELIVER PLACENTA | $ | 254.00 |
| 59425 | ANTEPARTUM CARE ONLY | $ | 1,256.00 |
| 59426 | ANTEPARTUM 7+ VISITS | $ | 2,244.00 |
| 59430 | POSPARTUM CARE ONLY | $ | 501.00 |
| 59510 | CESAREAN DELIVERY/PRE & POST PARTUM | $ | 6,362.00 |
| 59514 | CESAREAN SECTION | $ | 2,548.00 |
| 59515 | CESAREAN DELV/POSTPARTUM | $ | 3,473.00 |
| 59812 | INCOMPLETE MISCARRIAGE | $ | 875.00 |
| 59820 | TREATMENT MISSED ABORTION | $ | 1,049.00 |
| 62270 | SPINAL PUNCTURE | $ | 442.00 |
| 62321 | EPIDURAL STEROID INJECTION W/IMAGING | $ | 277.00 |
| 64400 | INJECTION, ANES AGENT TRIGEMINAL NERVE | $ | 313.00 |
| 64405 | INJECTION/OCCICPITAL NERVE | $ | 305.00 |
| 64420 | INJECTION INTERCOSTAL NERVE, ANEST AGENT | $ | 277.00 |
| 64445 | INJECTION/ SCIATIC NERVE | $ | 377.00 |
| 64450 | INJECTION, PERIPHERAL BLOCK | $ | 285.00 |
| 64455 | INJECT ANESTHETIC AGENT | $ | 133.00 |
| 64483 | TRANSFORAMINAL EPIDURAL W IMAG | $ | 288.00 |
| 64493 | INJECTION PARAVERTABRAL JNT L/S | $ | 232.00 |
| 64718H | NEUROPLASTY/TRANSPOSIT, ULNAR NERVE ELBO | $ | 2,300.00 |
| 64721 | PHYS/ CARPAL TUNNEL REL | $ | 1,784.00 |
| 64721H | NEUROPLASTY/TRANSPOSITION MEDIAN NERVE | $ | 1,656.00 |
| 65205 | REMOVAL FB EXTERNAL EYE/SUPERFICIAL | $ | 157.00 |
| 65220 | FB REMOVAL CORNEAL,SLIT LAMP | $ | 160.00 |
| 67700 | BLEPHAROTOMY,ABCESS EYELID | $ | 762.00 |
| 69100 | BIOPSY EXTERNAL EAR | $ | 281.00 |
| 69105 | BIOPSY AUDITORY CANAL | $ | 403.00 |
| 69200 | REM FB AUDITORY CANAL | $ | 351.00 |
| 69205 | REMOVAL FB EAR CANAL / ANES | $ | 283.00 |
| 69209 | REMOVAL IMPACTED CERUMEN IRRIG/UNILAT | $ | 34.00 |
| 69210 | EAR LAVAGE, MD | $ | 143.00 |
| 69220 | DEBRIDEMENT MASTOID SIMPLE | $ | 397.00 |
| 69222 | DEBRIDEMENT MASTOID COMPLEX | $ | 632.00 |
| 69310 | REBUILD OUTER EAR CANAL | $ | 2,993.00 |
| 69420 | MYRINGOTOMY / ASPIRATION | $ | 548.00 |
| 69421 | MYRINGOTOMY NO TUBE ANES | $ | 419.00 |
| 69424 | REMOVAL VENTILATION TUBE | $ | 368.00 |
| 69433 | TYMPANOSTOMY W TUBES LOCAL | $ | 579.00 |
| 69436 | TYMPANOSOTMY W TUBE | $ | 450.00 |
| 69540 | EXCSION AURAL POLYP | $ | 603.00 |
| 69610 | TYMPANIC MEMBRANE REPAIR | $ | 1,034.00 |
| 69801 | LABYRINTHOTOMY | $ | 530.00 |
| 77002 | FLUORO GUIDANCE NEEDLE PLACE | $ | 67.00 |
| 81002 | URINALYSIS W/O MICROSCOPE | $ | 36.00 |
| 81003 | URINALYSIS AUTO /MICRO | $ | 33.00 |
| 82075 | BREATH ALCOHOL TEST | $ | 30.00 |
| 82948 | GLUCOSE TESTING (NONLAB) | $ | 45.00 |
| 86580 | PPD IMMUNIZATION | $ | 79.00 |
| 88164 | PAP SMEAR DIAG | $ | 40.00 |
| 90375 | RABIES IMMUNE GLOBULIN 2ML | $ | 1,097.00 |
| 903751 | Rabies Immune Globulin 1500 Unit/10ml | $ | 5,084.00 |
| 90471 | ADMINISTRATION OF IMMUNIZATION/SINGLE | $ | 10.00 |
| 90472 | ADMINISTRATION OF IMMUNIZATION-2 OR MORE | $ | 10.00 |
| 90473 | ADMIN IMMUNIZ INTRANASAL | $ | 10.00 |
| 90632 | HEPATITIS A VACCINE | $ | 131.00 |
| 906321 | Hepatitis A SDV Vaccine (1440u/ml) | $ | 139.00 |
| 90633 | HEPATITIS A/PED/ADOLESC | $ | 64.00 |
| 90636 | HEPATITIS A & B VACCINE | $ | 196.00 |
| 90647 | HIB VACCINE | $ | 57.00 |
| 90649 | H-PAPILLOMA VACC 3 DOSE IM | $ | 264.00 |
| 90649CL | GARDASIL 9 SYRINGE (0.5 ML) | $ | 264.00 |
| 90651 | HPV GARDASIL-9 IM 3 DOSE (0.5 ML) | $ | 336.00 |
| 90669 | PNEUMOCOCCAL CONJUGATE VACCINE | $ | 40.00 |
| 90670 | PNEUMOCOCCAL VAC 13 VAL | $ | 289.00 |
| 90675 | RABIES VACCINE | $ | 467.00 |
| 90680 | ROTAVIRUS VACCINE (ORAL) | $ | 157.00 |
| 90681 | ROTAVIRUS VACCINEEE (ORAL) | $ | 222.00 |
| 90685 | INFLUENZA VACCINE 0.25ML | $ | 30.00 |
| 90686 | INFLUENZA VACCINE 0.5ML | $ | 30.00 |
| 90691 | TYPHOID VACCINE | $ | 194.00 |
| 90696 | DTAP & IPV 4-6 YO | $ | 111.00 |
| 90700 | DTAP | $ | 54.00 |
| 90707 | MMR VACCINE | $ | 145.00 |
| 90713 | IPV POLIOVIRUS VACCINE | $ | 65.00 |
| 90715 | TDAP VACCINE >7YO | $ | 73.00 |
| 907151 | BOOSTRIX SDV (0.5ML) X1 | $ | 73.00 |
| 90716 | VARICELLA VACCINE | $ | 222.00 |
| 90723 | DTAP-HEPB-IPV VACCINE | $ | 142.00 |
| 90732 | PNEUMOVAX | $ | 135.00 |
| 90734 | MENINGOCOCCAL VACCINE IM | $ | 215.00 |
| 90736 | ZOSTER VACCINE SQ | $ | 306.00 |
| 90744 | HEPATITIS B AGE0-18YRS | $ | 53.00 |
| 90746 | HEPATITIS B AGE >19YRS | $ | 119.00 |
| 90748 | COMVAX | $ | 96.00 |
| 90792T | PYSCHIATRIC DIAG EVAL W MEDICAL SERVICE | $ | 388.00 |
| 92504 | EAR MICROSCOPY EXAM | $ | 86.00 |
| 92511 | NASOPHARYNGOSCOPY | $ | 433.00 |
| 92511F | NASOPHARYNGOSCOPY (FROY) | $ | 433.00 |
| 92551 | AUDIOGRAM, SCREEN | $ | 33.00 |
| 92567 | TYMPANOMETRY | $ | 53.00 |
| 92950 | CPR | $ | 809.00 |
| 92960 | CARDIOVERSION, ELECTIVE | $ | 731.00 |
| 93000 | EKG WITH INTERP & REPORT | $ | 60.00 |
| 93005 | EKG TRACING ONLY | $ | 36.00 |
| 93010 | EKG / PRO FEE | $ | 24.00 |
| 93016 | STRESS EKG SUPERVISION ONLY | $ | 62.00 |
| 93018 | STRESS EKG/INTERP & REPORT | $ | 41.00 |
| 93227 | EXT ELECTROCARDIOGRAPHIC INTERP 24/48HR | $ | 68.00 |
| 94010 | SPIROMETRY,W/GRAPH | $ | 80.00 |
| 94060 | SPIROMETRY, BRONCHOSPASM | $ | 140.00 |
| 94640 | NEBULIZER TREATMENT | $ | 46.00 |
| 94664 | NEBULIZER IPPB ETC DEMO/ EVAL | $ | 44.00 |
| 94760 | PULSE OXIMETRY | $ | 7.00 |
| 95028 | INTRACUT/INTRADER TESTS | $ | 38.00 |
| 95115 | ALLERGY INJECTION, SINGLE | $ | 31.00 |
| 95117 | ALLERGY INJECTION; 2 OR MORE | $ | 41.00 |
| 95250 | GLUCOSE MONITORING CONTINU | $ | 453.00 |
| 95251 | GLUCOSE MONITORING INTERP | $ | 117.00 |
| 95810 | POLYSOMNOGRAPHY | $ | 344.00 |
| 95811 | POLYSOMNOGRAPHY W CPAP | $ | 360.00 |
| 96110 | DEVELOPMENTAL SCREENING | $ | 24.00 |
| 96360 | IV INFUSION / HYDRATION | $ | 242.00 |
| 96372 | ADMIN / INJECTION | $ | 10.00 |
| 96523 | PORT FLUSH | $ | 62.00 |
| 97602 | REMOVAL DEVITALIZED TISSUE FROM WOUND | $ | 160.00 |
| 99000 | SPECIMEN HANDLING | $ | 26.00 |
| 99024 | POST OP VISIT | $ | 0.00 |
| 99075 | MEDICAL TESTIMONY / 15MN | $ | 150.00 |
| 99195 | PHLEBOTOMY | $ | 306.00 |
| 99201 | NEW VISIT-BRIEF | $ | 117.00 |
| 99202 | NEW VISIT-LIMITED | $ | 199.00 |
| 99202H | NEW VISIT - LIMITED | $ | 199.00 |
| 99203 | NEW VISIT-LOW | $ | 288.00 |
| 99203H | NEW VISIT - LOW | $ | 288.00 |
| 99203T | NEW VISIT - LOW | $ | 288.00 |
| 99204 | NEW VISIT-MODERATE | $ | 438.00 |
| 99204T | NEW VISIT - MODERATE | $ | 438.00 |
| 99205 | NEW VISIT-HIGH | $ | 545.00 |
| 99211 | EST. VISIT-BRIEF | $ | 55.00 |
| 99212 | EST. VISIT-LIMITED | $ | 117.00 |
| 99212F | EST. VISIT - LIMITED | $ | 129.00 |
| 99212H | EST VISIT- LIMITED | $ | 129.00 |
| 99212T | EST VISIT - LIMITED | $ | 129.00 |
| 99213 | EST. VISIT-LOW | $ | 150.00 |
| 99213F | EST. VISIT-LOW | $ | 183.00 |
| 99213H | EST. VISIT - LOW | $ | 183.00 |
| 99213T | EST VISIT - LIMITED | $ | 183.00 |
| 99214 | EST. VISIT-MODERATE | $ | 237.00 |
| 99214F | EST. VISIT-MODERATE | $ | 280.00 |
| 99214H | EST. VISIT - MODERATE | $ | 280.00 |
| 99214T | EST VISIT - MODERATE | $ | 280.00 |
| 99215 | EST. VISIT-HIGH | $ | 383.00 |
| 99215F | EST. VISIT - HIGH | $ | 383.00 |
| 99217 | OBSERVATION CARE DISCHARGE | $ | 190.00 |
| 99218 | OBSERVATION LEVEL I | $ | 259.00 |
| 99219 | OBSERVATION LEVEL II | $ | 356.00 |
| 99220 | OBSERVATION LEVEL III | $ | 485.00 |
| 99221 | INITIAL HOSP CARE | $ | 265.00 |
| 99222 | INITIAL HOSP CARE | $ | 361.00 |
| 99223 | INITIAL HOSP CARE | $ | 530.00 |
| 99224 | OBSERV CARE / SUBSEQ | $ | 104.00 |
| 99225 | OBSERV CARE / SUBSEQ | $ | 189.00 |
| 99226 | OBSERV CARE / SUBSEQ | $ | 274.00 |
| 99231 | SUBSEQ HOSP CARE | $ | 102.00 |
| 99232 | SUBSEQ HOSP CARE | $ | 189.00 |
| 99233 | SUBSEQ HOSP CARE | $ | 272.00 |
| 99234 | OBSERVATION HOSPITAL CARE | $ | 350.00 |
| 99235 | OBSERV/ IN PT CARE SA DAY | $ | 443.00 |
| 99236 | OBSERV/ IN PT CARE SA DAY | $ | 571.00 |
| 99238 | HOSPITAL DISCHARGE | $ | 191.00 |
| 99239 | HOSPITAL DISCHARGE DAY | $ | 282.00 |
| 99241 | OFFICE CONSULTATION VISIT | $ | 141.00 |
| 99242 | OFFICE CONSULT EXP PROB | $ | 234.00 |
| 99243 | OFFICE CONSULT DETAILED | $ | 318.00 |
| 99244 | OFFICE CONSULT COMPRE | $ | 474.00 |
| 99245 | OFFICE CONSULT COMP HIGH | $ | 579.00 |
| 99251 | INPT CONSULTATION VISIT | $ | 126.00 |
| 99252 | INPT CONSULTATION VISIT | $ | 195.00 |
| 99253 | INPT CONSULTATION VISIT | $ | 300.00 |
| 99254 | INPT CONSULTATION VISIT | $ | 431.00 |
| 99255 | INPT CONSULTATION VISIT | $ | 536.00 |
| 99291 | CRITICAL CARE FIRST HOUR | $ | 757.00 |
| 99304 | NURSING FACILITY CARE LOW | $ | 244.00 |
| 99305 | NURSING FACILITY CARE MOD | $ | 347.00 |
| 99306 | NURSING FACILITY CARE HIGH | $ | 440.00 |
| 99307 | NURS FAC CARE SUBSEQ | $ | 117.00 |
| 99308 | NURS FAC CARE SUBSEQ | $ | 182.00 |
| 99309 | NURS FAC CARE SUBSEQ | $ | 238.00 |
| 99310 | NURSING FAC CARE SUBSEQ | $ | 357.00 |
| 99315 | NURSING FAC DISCHARGE >30 | $ | 192.00 |
| 99316 | NURSING FAC DISCHARGE >30 | $ | 275.00 |
| 99335 | NURS HOME VISIT EST PT | $ | 249.00 |
| 99347 | HOME VISIT EST PATIENT | $ | 146.00 |
| 99356 | PROLONGED SERVICE INPATIENT | $ | 240.00 |
| 99357 | PROLONGED SERVICE INPATIENT | $ | 239.00 |
| 99358 | ATTORNEY CONSULT 1HR | $ | 285.00 |
| 99359 | ATTORNEY CONSULT 30MIN | $ | 139.00 |
| 99381 | NEW PREVENTATIVE VISIT; 0-1YR | $ | 294.00 |
| 99382 | NEW PREVENTATIVE VISIT; 1-4YR | $ | 308.00 |
| 99383 | NEW PREVENTATIVE VISIT; 5-11YR | $ | 319.00 |
| 99384 | NEW PREVENTATIVE VISIT; 12-17YRS | $ | 362.00 |
| 99385 | NEW PREVENTATIVE VISIT; 18-39YRS | $ | 349.00 |
| 99386 | NEW PREVENTATIVE VISIT; 40-64YRS | $ | 405.00 |
| 99387 | NEW PREVENTATIVE VISIT; 65+ | $ | 440.00 |
| 99391 | EST. PREVENTATIVE VISIT; 0-1YR | $ | 264.00 |
| 99392 | EST. PREVENTATIVE VISIT; 1-4YRS | $ | 282.00 |
| 99393 | EST. PREVENTATIVE VISIT; 5-11YRS | $ | 282.00 |
| 99394 | EST. PREVENTATIVE VISIT; 12-17YRS | $ | 309.00 |
| 99395 | EST. PREVENTATIVE VISIT; 18-39YRS | $ | 314.00 |
| 99396 | EST. PREVENTATIVE VISIT; 40-64YRS | $ | 336.00 |
| 99397 | EST. PREVENTATIVE VISIT; 65+ | $ | 362.00 |
| 99401 | PREVENT COUNSEL 15 MIN | $ | 96.00 |
| 99402 | PREVENT COUNSEL 30" | $ | 164.00 |
| 99406 | TOBACCO CESSATION COUNSEL | $ | 34.00 |
| 99407 | SMOKING CESSATION COUNSELING >10" | $ | 70.00 |
| 99411 | PREVENT VISIT GROUP | $ | 44.00 |
| 99455 | DOT PHYSICAL | $ | 135.00 |
| 99456 | DOT PHYSICIAL | $ | 135.00 |
| 99460 | NEWBORN H&P1 | $ | 240.00 |
| 99462 | IN PT VISIT/NEWBORN CARE | $ | 110.00 |
| 99463 | NEWBORN CARE | $ | 304.00 |
| 99464 | ATTENDANCE / DELIVERY | $ | 202.00 |
| 99465 | NEWBORN RESUSCITATION | $ | 384.00 |
| 9999947 | Hydrocodone/APAP 5-325 | $ | 0.00 |
| 9999955 | OXYCODONE IR 5 MG TABLET | $ | 0.00 |
| 9999956 | METOPROLOL SUCCINATE TABLET 100MG | $ | 0.00 |
| 9999961 | LIDOCAINE/EPINEPHRINE 1% DOSE | $ | 0.00 |
| A4284 | BREAST SHIELD | $ | 32.00 |
| A4310 | INSERTION TRAY,NO FOLEY,BAG | $ | 10.00 |
| A4314 | FOLEY CATH TRAY WITH CATH | $ | 29.00 |
| A4336 | SELF CATH 6" FEMALE | $ | 5.00 |
| A4344 | FOLEY CATHETER | $ | 17.00 |
| A4358 | URINARY DRAINAGE BAG LEG | $ | 9.00 |
| A4364 | DERMABOND, SKIN ADHESIVE | $ | 72.00 |
| A4463 | ABDOMINAL SUPPORT 12" | $ | 27.00 |
| A4550 | STERILE TRAY | $ | 18.00 |
| A4565 | SLING | $ | 22.00 |
| A4570 | SPLINT | $ | 0.00 |
| A4649 | STERILE SUPPLY | $ | 0.00 |
| A6207 | PROFORE COMPRESSION BANDAGE | $ | 12.00 |
| A6209 | DRESSING 16 SQ" < | $ | 16.00 |
| A6210 | POLYMEM MAX 4.5X4.5 | $ | 25.00 |
| A6441 | PROFORE PADDING BANDAGE | $ | 12.00 |
| A6443 | PROFORE CONFORMING BANDAGE | $ | 12.00 |
| A6449 | PROFORE LIGHT CMPRESS BANDAGE | $ | 12.00 |
| A6450 | ACE BANDAGE > 3" | $ | 8.00 |
| A6451 | ACE BANDAGE < 3" | $ | 6.00 |
| A6454 | PROFORE SELF-ADHER BANDAGE | $ | 12.00 |
| A7016 | NEBUMINST | $ | 6.00 |
| A9270 | POST OP SHOE | $ | 26.00 |
| A9284 | SPIROMETER | $ | 11.00 |
| AIC | AIC | $ | 0.00 |
| E0110 | CRUTCH | $ | 44.00 |
| E0112 | CRUTCHES | $ | 44.00 |
| E0114 | CRUTCH / METAL | $ | 42.00 |
| FAA99455 | FAA BASIC-MED | $ | 225.00 |
| G0008 | ADMIN INFLUENZA VIRUS VACCINE | $ | 10.00 |
| G0009 | ADMIN PNEUMOCOCCAL VACCINE | $ | 10.00 |
| G0010 | ADM HEPATITIS B VACCINE | $ | 10.00 |
| G0101 | PHYS/ PELVIC/ BREAST EXAM | $ | 104.00 |
| G0102 | PROSTATE DIGITAL EXAM SCREEN | $ | 55.00 |
| G0105 | PHYS / COLONOSCOPY SCREEN | $ | 1,246.00 |
| G0121 | PHYS / COLONOSCOPY SCREEN | $ | 1,246.00 |
| G0289 | ARTHROSCOPY / REMOVAL FB CHONDROPLASTY | $ | 214.00 |
| G0296 | COUNSELING VISIT / LUNG CA SCREEN LDCT | $ | 75.00 |
| G0364 | PHYS/ BONE MARROW ASPIRATE | $ | 40.00 |
| G0402 | INITIAL PREVEN PHYS EXAM | $ | 451.00 |
| G0403 | EKG / INTERP REPORT SCREEN | $ | 24.00 |
| G0405 | EKG INTERP REPORT ONLY | $ | 24.00 |
| G0438 | ANNUAL WELLNESS VISIT | $ | 456.00 |
| G0439 | ANNUAL WELLNES VISIT SUBS | $ | 304.00 |
| G0442 | ANNUAL MISUSE ALCOHOL SCREENING 15" | $ | 42.00 |
| G0443 | BRF FACE/FACE BEHAV COUNS MISUSE ALC 15" | $ | 61.00 |
| G0444 | ANNUAL DEPRESSION SCREENING 15MN | $ | 52.00 |
| G0447 | OBESITY COUNS F/F 15MN | $ | 68.00 |
| H0033 | ORAL MED ADMIN DIR OBSERV | $ | 11.00 |
| J0171 | ADRENALIN/ EPINEPHR 0.1MG INJ (J0171) | $ | 8.00 |
| J0171 CL | EPINEPHRINE 0.1MG INJ (J0171) | $ | 1.00 |
| J0171 RX | EPINEPHRINE INJ 0.3 MG DOSE (J0171) | $ | 14.00 |
| J0295 | AMPICIL/SULBACT 1.5GM (J0295) | $ | 30.00 |
| J0558 | PEN G CR 100,000U X12 (J0558) | $ | 118.00 |
| J0558 CL | PEN G/BENZ/PROC 100,000 UNITS INJ(J0558) | $ | 10.00 |
| J0561 | PEN G L-A 100,000 UNITS (J0561) | $ | 146.00 |
| J0561 CL | PEN G/BENZATHIN 100,000 UNITS INJ(J0561) | $ | 12.00 |
| J0561RX | BICILLIN L-A INJ (J056) | $ | 18.00 |
| J0570 | PROBUPHINE 74.2 MG | $ | 5,966.00 |
| J0690 | CEFAZOLIN 500MG IV (J0690) | $ | 9.00 |
| J0690 Cl | CEFAZOLIN 500MG INJ (J0690) | $ | 5.00 |
| J0696 | CEFTRIAXONE 250MG X1 (J0696) | $ | 26.00 |
| J0696 CL | CEFTRIAXONE 250MG X2 (J0696) | $ | 14.00 |
| J0696 CL1 | CEFTRIAXONE 250MG INJ (J0696) | $ | 7.00 |
| J0696 CL2 | CEFTRIAXONE 250MG INJ (J0696) | $ | 4.00 |
| J06962 | CEFTRIAXONE 250MG X2 (J0696) | $ | 9.00 |
| J0702 | CELESTONE 3MG INJ (J0702) | $ | 65.00 |
| J0702 CL | BETAMETHASONE 3MG INJ (J0702) | $ | 9.00 |
| J0725 | NOVAREL 1000U INJ (J0725) | $ | 312.00 |
| J0725 CL | CHORIONIC/GONADOTR 1000 UNITS INJ(J0725) | $ | 31.00 |
| J0780 | PROCHLORPERAZINE 10MG INJ (J0780) | $ | 37.00 |
| J0897 CL | DENOSUMAB INJ 1MGX 60(J0897) | $ | 28.00 |
| J1020 | METHYLPREDNISOLONE 20MG INJ (J1020) | $ | 22.00 |
| J1030 | DEPO-MEDROL 40MG INJ (J1030) | $ | 14.00 |
| J1050 CL | MEDROXYPROGESTERONE 1MG INJ (J1050) | $ | 1.00 |
| J1071 CL | TESTOSTERONE CYP 1MG X200 (J1071) | $ | 0.27 |
| J1100 | DEXAMETHOSONE 1 MG X4 (J1100) | $ | 10.00 |
| J1100 CL | DEXAMETHASONE 1MG INJ (J1100) | $ | 3.00 |
| J1160 | DIGOXIN 0.5MG INJ (J1160) | $ | 23.00 |
| J1170 | HYDROMORPHONE 1MG (J1170) | $ | 29.00 |
| J1200 | DIPHENHYDRAMINE 50MG INJ (J1200) | $ | 29.00 |
| J1335 | ERTAPENEM 500MG INJ (J1335) | $ | 149.00 |
| J1335 CL | ERTAPENEM 500MG INJ (J1335) | $ | 75.00 |
| J1580 | GENTAMYCIN 80MG INJ (J1580) | $ | 29.00 |
| J1610 | GLUCAGON HCL 1 MG INJ (J1610) | $ | 281.00 |
| J1630 | HALOPERIDOL 5MG INJ (J1630) | $ | 33.00 |
| J1650 | ENOXAPARIN 10MG X3 INJ (J1650) | $ | 40.00 |
| J1650 CL | ENOXAPARIN 10MG INJ (J1650) | $ | 17.00 |
| J1650 CL1 | ENOXAPARIN 10MG INJ (J1650) | $ | 15.00 |
| J1650 CL2 | ENOXAPARIN 10MG INJ (J1650) | $ | 12.00 |
| J1650 CL3 | ENOXAPARIN 10MG INJ (J1650) | $ | 5.00 |
| J1650 CL4 | ENOXAPARIN 10MG X10 (J1650) | $ | 4.00 |
| J1650 CL5 | ENOXAPARIN 10MG X15 (J1650) | $ | 10.00 |
| J1650 CL6 | ENOXAPARIN 10MG X12 (J1650) | $ | 12.00 |
| J1815 | INSULIN 5 UNITS INJ (J1815) | $ | 8.00 |
| J1885 | KETOROLAC 15MG X1 (J1885) | $ | 29.00 |
| J1885 CL | KETOROLAC 15MG INJ (J1885) | $ | 14.00 |
| J1885 CL1 | KETOROLAC 15MG INJ (J1885) | $ | 7.00 |
| J1940 | FUROSEMIDE 20 MG IM X1(J1940) | $ | 33.00 |
| J1940 CL | FUROSEMIDE 20MG INJ (J1940) | $ | 14.00 |
| J2060 | LORAZEPAM 2MG INJ (J2060) | $ | 27.00 |
| J2175 | MEPERDINE 100MG INJ (J2175) | $ | 23.00 |
| J2270 | MORPHINE 2MG X1 INJ (J2270) | $ | 23.00 |
| J2300 | NALBUPHINE INJ 10MG X2 (J2300) | $ | 14.00 |
| J2405 | ONDANSETRON 1MG X4 INJ (J2405) | $ | 8.00 |
| J2405 CL | ONDANSETRON 1MG INJ (J2405) | $ | 7.00 |
| J2550 | PROMETHAZINE 25 MG X1 INJ (J2550) | $ | 27.00 |
| J2790 | RHOGAM INJECTION 300MCG X1 (J2790) | $ | 202.00 |
| J2791 CL | RHO(D) IG HUMAN RHOPHYLAC 100IU | $ | 17.00 |
| J2920 | METHYLPREDNISOLONE 40MG X1 (J2920) | $ | 33.00 |
| J2930 | METHYLPREDNISOLONE 125MG X1 (J2930) | $ | 37.00 |
| J3010 | FENTANYL 100MCG X1 INJ (J3010) | $ | 27.00 |
| J3010 CL | FENTANYL CITRATE 0.1MG INJ (J3010) | $ | 4.00 |
| J3030 | SUMATRIPTAN 6MG X1 INJ (J3030) | $ | 87.00 |
| J3301 CL | TRIAMCINOLONE 10MG INJ (J3301) | $ | 9.00 |
| J3360 | DIAZEPAM 5MG X2 INJ (J3360) | $ | 23.00 |
| J3360 CL | DIAZEPAM 5MG INJ (J3360) | $ | 12.00 |
| J3410 | HYDROXYZINE 25MG INJ (J3410) | $ | 12.00 |
| | | $ | 11.00 |
| J3410 CL | HYDROXYZINE 25MG INJ (J3410) | $ | 6.00 |
| J3420 | B-12 INJECTION (1000mcg x 1) (J3420) | $ | 34.00 |
| J3430 RX | PHYTONADIONE 1MG X10 INJ (J3430) | $ | 11.00 |
| J3475 | MAGNESIUM SULF 500MG INJ (J3475) | $ | 0.00 |
| J7040 | NORMAL SALINE 500ML NFUSION | $ | 24.00 |
| J7050 | .9NS 250ML X1 | $ | 0.00 |
| J7120 | LACTATED RINGERS 500ML | $ | 25.00 |
| J7298 | LEVONORGESTEL CONTRACEP MIRENA J7298 | $ | 1,116.00 |
| J7300 | INTRAUTERINE COPPER CONTRACEP (J7298) | $ | 1,090.00 |
| J7301 | SKYLA CONTRACEPTIVE SYS X1 (J7301) | $ | 1,110.00 |
| J7307 | NEXPLANON IMPLANT (J7307) | $ | 1,018.00 |
| J7325 CL | SYNVISC 1MG INJ (J7325) | $ | 30.00 |
| J7506 | PREDNISONE 1MG X5 TAB (J7512) | $ | 8.00 |
| J7506 CL | PREDNISONE 1MG X10 (J7512) | $ | 1.00 |
| J7506 CL1 | PREDNISONE 1MG X20 (J7512) | $ | 0.00 |
| J7510 CL | PREDNISOLONE ORAL 5MG (J7510) | $ | 6.00 |
| J7512 CL | PREDNISONE 1MG X5(J7512) TABLET | $ | 2.00 |
| J9040 | BLEOMYCIN 15 UNITS X1 INJ (J9040) | $ | 99.00 |
| J9217 | LUPRON DEPOT 7.5MG KIT (J9217) | $ | 2,949.00 |
| J9250 | METHOTREXATE 0.1-5MG INJ (J9250) | $ | 10.00 |
| J9250 CL | METHOTREXATE 5MG INJ (J9250) | $ | 1.00 |
| L0120 | CERVICAL COLLAR | $ | 15.00 |
| L0220 | RIB BELT | $ | 29.00 |
| L0625 | PREGNANCY BELT | $ | 100.00 |
| L1810 | KNEE BRACE ELASTIC W JOINTS | $ | 67.00 |
| L1830 | KNEE IMMOBILIZER | $ | 69.00 |
| L1902 | ANKLE SUPPORT/ELASTIC | $ | 27.00 |
| L1906 | ANKLE TRAINING BRACE | $ | 112.00 |
| L2112 | CAM WALKER | $ | 309.00 |
| L2999 | KNEE SLEEVE | $ | 0.00 |
| L3260 | CAST BOOT | $ | 34.00 |
| L3480 | HEEL CUP | $ | 37.00 |
| L3485 | HEEL CUP | $ | 32.00 |
| L3650 | CLAVICLE BRACE | $ | 18.00 |
| L3670 | SHOULDER IMMOBILIZER | $ | 42.00 |
| L3702 | TENNIS ELBOW SPLINT | $ | 39.00 |
| L3807 | THUMB SPICA SPLINT UNIV | $ | 29.00 |
| L3908 | LAC C-UP WRIST SPLINT | $ | 24.00 |
| L3980 | BRACE, WRIST UNIV | $ | 60.00 |
| L3999 | TENNIS ELBOW SUPPORT GEL/AIR | $ | 38.00 |
| L4350 | ANKLE STIRRUP SPLINT AIRCAST | $ | 112.00 |
| L4386 | CAM WALKER, ANKLE | $ | 309.00 |
| MISC | MISC CLINIC CHARGE | $ | 0.00 |
| NO CHG | MISC NO CHARGE | $ | 0.00 |
| OB002 | OB VISIT | $ | 0.00 |
| P9612 | CATHERIZATION FOR COLLECTION | $ | 25.00 |
| PHARM | PHARMACY ORAL DRUG | $ | 0.00 |
| Q0162 | ONDANESTRON 8MG TAB | $ | 45.00 |
| Q3014 | TELEHEALTH ORIGINATING SITE FACILITY FEE | $ | 50.00 |
| Q4005 | CAST/ LONG ARM ADULT | $ | 44.00 |
| Q4006 | CAST,FIBER LONG ARM ADULT | $ | 140.00 |
| Q4007 | CAST / LONG ARM PED | $ | 31.00 |
| Q4008 | CAST,FIBER LONG ARM PEDIATRIC | $ | 93.00 |
| Q4009 | CAST/SHORT ARM ADULT | $ | 31.00 |
| Q4010 | CAST, FIBER SHORT ARM ADULT | $ | 93.00 |
| Q4011 | CAST/ SHORT ARM PED | $ | 17.00 |
| Q4012 | CAST, FIBER SHORT ARM PED | $ | 44.00 |
| Q4013 | CAST, PLAST GAUNTLET ADULT | $ | 39.00 |
| Q4014 | CAST, FIBER GAUNTLET ADULT | $ | 91.00 |
| Q4016 | CAST, FIBER GAUNTLET PED | $ | 86.00 |
| Q4017 | SPLINT / LONG ARM ADULT | $ | 33.00 |
| Q4018 | LONG ARM SPLINT/FIBER ADULT | $ | 34.00 |
| Q4019 | SPLINT / LONG ARM PED | $ | 20.00 |
| Q4020 | LONG ARM SPLINT PED FIBER | $ | 20.00 |
| Q4021 | SPLINT/SHORT ARM ADULT | $ | 26.00 |
| Q4022 | CAST/FIBER SHORT ARM ADULT | $ | 26.00 |
| Q4023 | SPLINT / SHORT ARM PED | $ | 26.00 |
| Q4024 | CAST,FIBER SHORT ARM PED | $ | 26.00 |
| Q4029 | CAST / LONG LEG ADULT | $ | 51.00 |
| Q4030 | CAST, FIBER LONG LEG ADULT | $ | 131.00 |
| Q4031 | CAST / LONG LEG PED | $ | 34.00 |
| Q4032 | CAST, FIBER LONG LEG PEDIATRIC | $ | 93.00 |
| Q4037 | CST / SHORT LEG ADULT | $ | 41.00 |
| Q4038 | CAST, FIBER SHORT LEG ADULT | $ | 93.00 |
| Q4039 | CAST / SHORT LEG PED | $ | 31.00 |
| Q4040 | CAST, FIBER SHORT LEG PED | $ | 93.00 |
| Q4041 | SPLINT / LONG LEG ADULT | $ | 41.00 |
| Q4043 | SPLINT / LONG LEG PED | $ | 33.00 |
| Q4045 | SPLINT/SHORT LEG ADULT | $ | 41.00 |
| Q4046 | SHORT LEG SPLINT ADULT FIBE | $ | 41.00 |
| Q4047 | SPLINT / SHORT LEG PED | $ | 30.00 |
| Q4048 | SPLINT/SHORT LEG PED FIBER | $ | 31.00 |
| S0020 | BUPIVACAINE DOSE 0.5% | $ | 0.00 |
| S0077 | CLINDAMYCIN 300MG INJ | $ | 31.00 |
| S0119 | ONDANESTRON HCL 4MG ORAL X1 | $ | 39.00 |
| S0183 | PROCHLORPERAZINE 5MG TAB | $ | 7.00 |
| S0302 | MN CHILD & TEEN CHECK UP | $ | 0.00 |
| S0303 | MN HEALTH CHECK UP | $ | 0.00 |
| S8096 | PEAK FLO METER | $ | 25.00 |
| X0100 | TRIM TOENAILS | $ | 25.00 |
| 3400001 | CARDIAC REHAB | $ | 564.00 |
| 3400002 | EKG MONITORING | $ | 439.00 |
| 3400005 | CARD REHAB DAY NO CHG | $ | 0.00 |
| 3327001 | CT UPPER EXT W RT | $ | 2,799.00 |
| 3327005 | CT UPPER EXT WO RT | $ | 2,236.00 |
| 3327006 | CT UPPER EXT W LT | $ | 2,799.00 |
| 3327007 | CT UPPER EXTR W/WO LT | $ | 3,735.00 |
| 3327012 | CT ABD WO | $ | 1,676.00 |
| 3327013 | CT ABD W | $ | 3,032.00 |
| 3327014 | CT ABD W/WO (3 PHASE) | $ | 3,532.00 |
| 3327015 | CT FACE/SINUSES WO | $ | 2,414.00 |
| 3327016 | CT MAXILLA FACIAL W/ | $ | 2,959.00 |
| 3327019 | CT ORBIT SELLA WO | $ | 3,007.00 |
| 3327020 | CT ORBIT SELLA W | $ | 3,552.00 |
| 3327021 | CT ORBIT SELLA W/WO | $ | 3,989.00 |
| 3327022 | CT C-SPINE WO | $ | 2,278.00 |
| 3327023 | CT C-SPINE W | $ | 2,838.00 |
| 3327024 | CT C-SPINE W/WO | $ | 3,522.00 |
| 3327028 | CT L-SPINE WO | $ | 2,255.00 |
| 3327029 | CT L-SPINE W | $ | 2,842.00 |
| 3327034 | CT L-SPINE W/WO | $ | 3,526.00 |
| 3327043 | CT PELVIS WO | $ | 1,701.00 |
| 3327052 | CT PELVIS W | $ | 3,043.00 |
| 3327053 | CT PELVIS W/WO | $ | 3,465.00 |
| 3327054 | CT NECK WO | $ | 2,240.00 |
| 3327055 | CT NECK W | $ | 2,808.00 |
| 3327056 | CT NECK W W/O | $ | 3,493.00 |
| 3327057 | CT T-SPINE WO | $ | 2,265.00 |
| 3327058 | CT T-SPINE W | $ | 2,852.00 |
| 3327059 | CT T-SPINE W/WO | $ | 3,548.00 |
| 3327060 | CT THORAX W/O | $ | 2,244.00 |
| 3327061 | CT THORAX W/MEDIA | $ | 2,822.00 |
| 3327062 | CT THORAX W/WO | $ | 3,514.00 |
| 3327065 | CT HEAD WO | $ | 1,735.00 |
| 3327066 | CT HEAD W | $ | 2,265.00 |
| 3327067 | CT HEAD W/WO | $ | 2,201.00 |
| 3327068 | CT EAR WO | $ | 3,007.00 |
| 3327070 | CT THORAX WO LIM | $ | 2,244.00 |
| 3327073 | CT RENDERING W/POSTPRO 3D | $ | 606.00 |
| 3327081 | CT C-SPINE WO | $ | 2,278.00 |
| 3327082 | CT ANGIO PELVIS | $ | 4,378.00 |
| 3327083 | CT AB W LIM | $ | 3,032.00 |
| 3327095 | CT L-SPINE WO | $ | 2,255.00 |
| 3327101 | CT HEAD OR BRAIN WO | $ | 1,735.00 |
| 3327102 | CT HEAD OR BRAIN WO | $ | 1,735.00 |
| 3327103 | CT UPPER EXTR WO LT | $ | 2,236.00 |
| 3327105 | CT LWR EXT WO LT | $ | 2,244.00 |
| 3327106 | CT LWR EXT WO RT | $ | 2,244.00 |
| 3327107 | CT LWR EXT W/ LT | $ | 2,846.00 |
| 3327108 | CT LWR EXT W RT | $ | 2,846.00 |
| 3327109 | CT LWR EXT W/O LT | $ | 3,727.00 |
| 3327110 | CT LWR EXT W/WO RT | $ | 3,727.00 |
| 3327114 | CT ANGIO CHEST | $ | 4,342.00 |
| 3327115 | CT ANGIO HEAD | $ | 5,811.00 |
| 3327116 | CT ANGIO ABD | $ | 4,388.00 |
| 3327117 | CT PELVIS W/O LIMITED | $ | 1,701.00 |
| 3327118 | CT ABD PELVIS W/O | $ | 2,031.00 |
| 3327119 | CT ABD PELVIS W | $ | 3,590.00 |
| 3327120 | CT ABD PELVIS W & W/O | $ | 4,279.00 |
| 3327121 | CT THORAX W / MEDIA | $ | 2,822.00 |
| 3327122 | CT ANGIO LOWER EXTREM WITH / BILAT | $ | 4,930.00 |
| 3327142 | CT ABD WO LIMI | $ | 1,676.00 |
| 3327143 | CT ESI | $ | 1,010.00 |
| 3327154 | CT UPPER EXT W W/O RT | $ | 3,735.00 |
| 3327155 | CTANGIO ABD BIL RUN OFF | $ | 4,666.00 |
| 3327156 | CT C-SPINE W/O | $ | 2,278.00 |
| 3327157 | CT ANGIO ABD PELVIS W | $ | 5,490.00 |
| 3327158 | CT ANGIO NECK W CONT 3D | $ | 6,050.00 |
| 3327159 | CT LOW-DOSE LUNG CANCER SCREENING | $ | 2,244.00 |
| 3476111 | ECHO/STRESS TEST | $ | 1,912.00 |
| 3476112 | ECHO/TECH COMPONENT | $ | 1,697.00 |
| 3476127 | DOPPLER/TECH COMPONENT | $ | 615.00 |
| 3476128 | COLOR FLOW MAP/TECH COMP | $ | 650.00 |
| 3476129 | ECHOCARDIOGRAM | $ | 3,287.00 |
| 3476130 | ECHOCARDIOGRAM / LIMITED | $ | 1,366.00 |
| 3476132 | DOPPLER ECHO / LIMITED | $ | 358.00 |
| 3476133 | DOPPLER ECHO / LIMITED | $ | 358.00 |
| 3476134 | ECHO/ STRESS TEST | $ | 1,912.00 |
| 3476150 | DEFINITY INJECTION PER ML | $ | 493.00 |
| 3476300 | DUAL PACEMAKER ANALAYSIS | $ | 323.00 |
| 3476301 | DUAL PACEMAKER REPROGRAM | $ | 227.00 |
| 3476302 | PACER ANALYSIS | $ | 323.00 |
| 3476303 | SINGLE PACEMAKER REPROGRA | $ | 227.00 |
| 3476305 | ICD F/U SINGLE W REPROGRA | $ | 342.00 |
| 3476307 | ICD F/U DUAL W REPROGRAM | $ | 342.00 |
| 3476308 | ILR ANALYSIS | $ | 227.00 |
| 3476309 | ICD ANALYSIS | $ | 342.00 |
| 3476310 | PACER REPROGRAM BIV | $ | 227.00 |
| 3476311 | ICD REPROGRAM BIV | $ | 342.00 |
| 3805002 | ER INSERTION FOLEY CATH | $ | 174.00 |
| 3805003 | ER PELVIC EXAM ANES | $ | 319.00 |
| 3805004 | ER INSERT BALDDER CATH | $ | 122.00 |
| 3805005 | MODERATE SEDATION 15" 5YRS > | $ | 462.00 |
| 3805006 | MODERATE SEDATION EA + 15" | $ | 129.00 |
| 3805007 | URINARY CATHETER COMPLICATED | $ | 331.00 |
| 3805008 | INTRA ARTERIAL INJECTION | $ | 185.00 |
| 3805010 | BIRTHING ROOM | $ | 2,313.00 |
| 3805011 | REMOVAL DEEP FOREIGN BODY THIGH KNEE | $ | 3,500.00 |
| 3805500 | ER ABCESS/COMPLEX I&D | $ | 531.00 |
| 3805501 | ER/ABCESS/PUNC ASPIRATION | $ | 163.00 |
| 3805502 | ER ABCESS/SIMP I&D | $ | 328.00 |
| 3805503 | ER BURN/1ST DEGREE INITIA | $ | 274.00 |
| 3805504 | ER DRESS/DEBRIDE PARTIAL THICK BURN MED | $ | 477.00 |
| 3805507 | ER BURN / SM DEBRIDE / NO ANES | $ | 214.00 |
| 3805508 | DRAINAGE FINGER ABSCESS | $ | 825.00 |
| 3805509 | ER DRESSING/ DEBRIDE PART THICK BURNS | $ | 434.00 |
| 3805521 | ER CYST/COMPLEX PILON ID | $ | 531.00 |
| 3805522 | ER CYST/SIMP PILON ID | $ | 398.00 |
| 3805523 | ER DEBRI (10% BODY) | $ | 77.00 |
| 3805524 | ER DEDBRI EA ADD 10 | $ | 41.00 |
| 3805527 | ER DEBRIDEMENT, SUBCUT | $ | 158.00 |
| 3805528 | ER EAR IRRIGATION/LAVAGE | $ | 84.00 |
| 3805529 | ER EAR/COMPLEX DRAIN EXT | $ | 647.00 |
| 3805530 | ER EAR/DRAIN EXT AUD CANA | $ | 711.00 |
| 3805531 | ER EAR/DRAIN ABCESS EXT | $ | 488.00 |
| 3805532 | ER EAR/REMOVFB | $ | 203.00 |
| 3805534 | ER EXCISION/FB COMP | $ | 660.00 |
| 3805535 | ER EXCISION/REMOV FM SIMP | $ | 143.00 |
| 3805536 | ER EYE/CORNEA FB W SLIT L | $ | 93.00 |
| 3805537 | ER EAY/DRAIN LACRIMAL GLA | $ | 712.00 |
| 3805539 | ER EYE/LACERATION SCLERA | $ | 784.00 |
| 3805540 | ER EYE/REMOVFB EYELID | $ | 199.00 |
| 3805541 | ER EYE/REMOVIMBEDDER F | $ | 108.00 |
| 3805543 | ER FX ACROMIOC WO M | $ | 1,183.00 |
| 3805544 | ER FRACT/ACROMIOCLAVICLE | $ | 859.00 |
| 3805545 | ER FX/ANKLE | $ | 1,261.00 |
| 3805546 | ER FX ANKLE DISLO W ANES | $ | 1,777.00 |
| 3805547 | ER FX ANKLE DISLOCA | $ | 1,359.00 |
| 3805548 | ER FX/CALCANEAL | $ | 1,044.00 |
| 3805549 | ER FX/CARPAL BO W MAN | $ | 1,359.00 |
| 3805550 | ER FX/CARPAL BONE | $ | 1,030.00 |
| 3805551 | ER FX/CARPAL SCAP W MA | $ | 1,716.00 |
| 3805552 | ER FX/CARPAL SCAPHOID | $ | 1,093.00 |
| 3805553 | ER FX/CARPOMETACARPAL | $ | 1,059.00 |
| 3805554 | ER FX/CLAVIC W MANIP | $ | 1,316.00 |
| 3805556 | ER FX/CLAVICULAR | $ | 900.00 |
| 3805557 | ER FX/COCCYX | $ | 759.00 |
| 3805558 | ER FX/DIS ELBOW W ANES | $ | 2,082.00 |
| 3805559 | ER FX/DISLO ELBOW | $ | 1,232.00 |
| 3805560 | ER/FX/DIST PHALAN W MANI | $ | 1,067.00 |
| 3805561 | ER/FX DISTAL PHALANGE | $ | 903.00 |
| 3805562 | ER FX DISTAL RAD W MANIP | $ | 2,105.00 |
| 3805563 | ER FX/DISTAL RADIAL | $ | 1,030.00 |
| 3805564 | ER FX/DISTAL RADIOULNA | $ | 1,614.00 |
| 3805565 | ER FX FEMORAL | $ | 1,764.00 |
| 3805566 | ER FX FIBULA | $ | 1,127.00 |
| 3805567 | ER FX/GALEAZZI RADIAL | $ | 2,054.00 |
| 3805568 | ER FX/GREAT TOE W MAN | $ | 721.00 |
| 3805569 | ER FX PHALANGES | $ | 594.00 |
| 3805570 | ER FX/GREATER TROCHANT | $ | 1,543.00 |
| 3805571 | ER FX HIP DISLOCATION | $ | 1,673.00 |
| 3805572 | ER FX HUMERAL SHAFT | $ | 1,264.00 |
| 3805573 | ER FX HUMERUS W MAN | $ | 1,848.00 |
| 3805574 | ER FX KNEE DISLOCATION | $ | 1,725.00 |
| 3805575 | ER FX/KNEE W ANES | $ | 2,399.00 |
| 3805576 | ER FX/LAT. EPICONDYL | $ | 1,127.00 |
| 3805577 | ER FX LAT. MALLEOUS | $ | 1,290.00 |
| 3805578 | ER DX LUNATE DISLOCATION | $ | 1,888.00 |
| 3805579 | ER FX/METACARPAL | $ | 1,246.00 |
| 3805580 | ER FX/METACARPAL W MAN | $ | 1,254.00 |
| 3805581 | ER FX METATARS W MAN | $ | 1,114.00 |
| 3805582 | ER FX/METATARSAL WO MANI | $ | 869.00 |
| 3805583 | ER FX MONTEGGIA ELBOW | $ | 2,137.00 |
| 3805584 | ER FX/NASAL W STABILIZ | $ | 644.00 |
| 3805585 | ER FX/NASAL WO MANI | $ | 172.00 |
| 3805586 | ER FX/NASAL WO STABILIZ | $ | 447.00 |
| 3805587 | ER FX/ORBIT WO MANIP | $ | 734.00 |
| 3805589 | FX /MEDIAL MALLEOLUS | $ | 1,170.00 |
| 3805590 | FX PATELLA WO ANES | $ | 1,152.00 |
| 3805591 | ER FX PATELLA WO MANIP | $ | 1,193.00 |
| 3805592 | ER FX/PHALAN/OPEN | $ | 2,051.00 |
| 3805594 | ER FX/PHALANGES W MAMINP | $ | 696.00 |
| 3805595 | ER FX/PROX HUMER W MANIP | $ | 1,734.00 |
| 3805596 | ER FX/PROX HUMERAL | $ | 1,338.00 |
| 3805597 | ER FX RAD HEAD CHILD | $ | 304.00 |
| 3805598 | ER FX RAD SHAFT W MAN | $ | 1,838.00 |
| 3805599 | ER FX/RAD ULNAR SHAFT | $ | 1,131.00 |
| 3805600 | ER FX/RAD ULNAR W MANI | $ | 1,863.00 |
| 3805601 | ER FX/RADIAL HEAD W MANI | $ | 1,640.00 |
| 3805602 | ER FX RADIAL HEAD NECK | $ | 956.00 |
| 3805603 | ER FX/RADIAL SHAFT WO | $ | 1,120.00 |
| 3805604 | ER FX/RADIO-INTERCARAPAL | $ | 1,634.00 |
| 3805605 | ER FX/RIB CLOSED | $ | 491.00 |
| 3805606 | ER FX/SCAPULAR WO MANIP | $ | 1,005.00 |
| 3805607 | ER CLOSED TX SHOULDER DISLOC MANIP/ANES | $ | 3,206.00 |
| 3805608 | ER CLOSED TX SHOULDER DISLOC W MANIP | $ | 1,008.00 |
| 3805609 | ER FX/STERNOCLAV W MAN | $ | 1,356.00 |
| 3805610 | ER FX/STERNOCLAV WO MANI | $ | 947.00 |
| 3805611 | ER FX/STERNUM CLOSED | $ | 643.00 |
| 3805612 | ER FX/TALUS | $ | 915.00 |
| 3805613 | ER FX/TARSAL BONE | $ | 882.00 |
| 3805614 | ER TARSAL BONE DISLOCATION | $ | 937.00 |
| 3805615 | ER FX/TARSAL BONE W MANIP | $ | 1,193.00 |
| 3805616 | ER FX/TEMPOROMANDIBULA | $ | 188.00 |
| 3805617 | ER FX/THUMB W MANIP | $ | 1,254.00 |
| 3805618 | ER FX/THUMB BENNETT | $ | 2,366.00 |
| 3805619 | ER FX/TIBIA W MANIP | $ | 2,190.00 |
| 3805620 | ER FX/TIBIA WO MANIP | $ | 1,491.00 |
| 3805621 | ER FX/TRANS-SCAPHOPERI | $ | 1,662.00 |
| 3805622 | ER FX/TUBEROSITY W MANI | $ | 1,593.00 |
| 3805623 | ER FX/TUBEROSITY WO MA | $ | 1,131.00 |
| 3805624 | ER FX/ULNAR PROX WO MAN | $ | 1,055.00 |
| 3805625 | ER FX/ULNAR SHAFT | $ | 980.00 |
| 3805626 | ER FX/ULNAR SHAFT W MAN | $ | 1,811.00 |
| 3805627 | ER FX/ULNAR STYLOID | $ | 1,129.00 |
| 3805628 | ER FX/ULNAR W MANI | $ | 1,683.00 |
| 3805629 | ER FX/VERTEBRAL | $ | 233.00 |
| 3805630 | ER FX/VERTEBRAL WO MAN | $ | 1,437.00 |
| 3805631 | ER HEMATOMA/INCISION DRAI | $ | 322.00 |
| 3805633 | ER NAIL REP OF NAIL BE | $ | 428.00 |
| 3805634 | ER NAIL/AVULSION OF PLATE | $ | 153.00 |
| 3805635 | ER NAIL DEBRI | $ | 48.00 |
| 3805637 | ER NAIL/EXCISION OF | $ | 601.00 |
| 3805638 | ER NAIL/WEDGE EXCISION | $ | 182.00 |
| 3805639 | ER NASAL DRAINAGE/ABCES | $ | 496.00 |
| 3805641 | ER NASAL HEM/COMPLEX | $ | 174.00 |
| 3805642 | ER NASAL HEM/PACK/CAUT | $ | 266.00 |
| 3805643 | ER NASAL SEPTUM/DRAIN ABS | $ | 521.00 |
| 3805644 | ER NASAL/REMOVFB | $ | 684.00 |
| 3805648 | ER PERICARDIOCENTESIS INITIAL | $ | 636.00 |
| 3805649 | ER PHARYNX REMOVFB | $ | 477.00 |
| 3805651 | ER PINCH GRAFT/SNG/MUL | $ | 1,658.00 |
| 3805653 | ER REMOV FB FOOT | $ | 668.00 |
| 3805655 | ER REP SIMP 2.5CM | $ | 357.00 |
| 3805656 | ER REP COMPLEX EXT 7.5 | $ | 1,189.00 |
| 3805657 | ER REP COMPLE EXT 2.5 | $ | 1,055.00 |
| 3805658 | ER REP/COMPLEX FAC 2.5 | $ | 1,113.00 |
| 3805659 | ER REP/COMPL FAC 7.5 | $ | 1,400.00 |
| 3805660 | ER REP / COMPL TRUNK 2.5 | $ | 914.00 |
| 3805661 | ER REP/COMPL TRUNK 7.5 | $ | 1,134.00 |
| 3805662 | ER REP/INTER EXT 7-6-12.5 | $ | 954.00 |
| 3805663 | ER REP/INTER EXTR 12.6-20 | $ | 1,208.00 |
| 3805664 | ER REP/INTER EXT 2.5CM | $ | 814.00 |
| 3805665 | ER REP/INTER EXTR 2.6-7.5 | $ | 897.00 |
| 3805666 | ER REP/INTER EXTR 20.1-30 | $ | 1,504.00 |
| 3805667 | ER REP/INTER EXTR OVER 30 | $ | 1,615.00 |
| 3805668 | ER REP/INTER FACE 12.6-20 | $ | 1,335.00 |
| 3805669 | ER REP INTER 20.1-30CM | $ | 1,235.00 |
| 3805670 | ER REP INTER 7.6-12.5 | $ | 919.00 |
| 3805671 | ER REP INTER OVER 30CM | $ | 1,426.00 |
| 3805672 | ER REP SIMP FACE 2.6-5.0 | $ | 405.00 |
| 3805673 | ER REP/SIMP FACE 5.1-7.5 | $ | 475.00 |
| 3805674 | ER REP/SIMP FACE 7.6-12.5 | $ | 578.00 |
| 3805675 | ER REP SIMP 12.6-20.0 | $ | 528.00 |
| 3805676 | ER REP SIMP 2.6-7.5CM | $ | 391.00 |
| 3805677 | ER REP SIMP 20.1-30.0 | $ | 642.00 |
| 3805678 | ER REP SIMP 7.6-12.5CM | $ | 451.00 |
| 3805679 | ER REP SIMP FACIAL 2.5 | $ | 354.00 |
| 3805681 | ER REP SIMP 30.0CM | $ | 706.00 |
| 3805682 | ER SKIN TAGS/ANY AREA -15 | $ | 271.00 |
| 3805683 | ER DESTRUCTION PENILE LESIONS | $ | 390.00 |
| 3805684 | TREATMENT DISLOCATION FOOT | $ | 1,481.00 |
| 3805685 | APPLICATION PASTE BOOT | $ | 160.00 |
| 3805688 | ER REPAIR FINGER TENDON | $ | 2,380.00 |
| 3805690 | ER REP / SIMP FACE 12.6-20.0 CM | $ | 649.00 |
| 3805695 | ER REP INTER 2.5CM | $ | 688.00 |
| 3805696 | ER REP INTER 2.6-7.5CM | $ | 875.00 |
| 3805697 | ER REP INTER 12.6-20CM | $ | 1,073.00 |
| 3805698 | ER REP INTER FACIAL 2.5CM | $ | 769.00 |
| 3805699 | ER REP INTER FAC 2.6-5.0 | $ | 909.00 |
| 3805700 | ER REP INTER FACE 5.1-7.5 | $ | 965.00 |
| 3805701 | ER REP INTER FACE 7.6-12 | $ | 1,045.00 |
| 3805702 | ER REP INTER FACE 20.1-30 | $ | 1,686.00 |
| 3805703 | ER REP INTER FACE OVER 30 | $ | 1,675.00 |
| 3805705 | ER REMOVFB DEEP | $ | 927.00 |
| 3805706 | ER FX POSTERIOR PELVIC RING CLOSED TX | $ | 2,562.00 |
| 3805707 | INTRAVENOUS START/SAL LOC | $ | 46.00 |
| 3805708 | ER SHAVING LESION 1.0CM - 2 CM | $ | 282.00 |
| 3805709 | ER DRAINAGE TONSIL ABSCESS | $ | 428.00 |
| 3805714 | ER ART PUNCTURE | $ | 116.00 |
| 3805717 | NASAL HEM/ANY METHOD | $ | 75.00 |
| 3805720 | ER FX PHALANX | $ | 911.00 |
| 3805723 | ER FX HIP DISLO ARTHRO | $ | 1,995.00 |
| 3805724 | ER FX DISTAL TIBIA | $ | 1,316.00 |
| 3805725 | ER DISLO FINGER | $ | 1,039.00 |
| 3805726 | ER FX DISLO THUMB | $ | 1,492.00 |
| 3805727 | ER DISLO HIP ANESTH | $ | 2,602.00 |
| 3805729 | ER ANAL ABCESS | $ | 466.00 |
| 3805730 | ER REP COMPLEX EACH AD | $ | 386.00 |
| 3805731 | ER REP COMPLEX EA ADD | $ | 356.00 |
| 3805737 | ER FX PHALANGE ARTICUL | $ | 596.00 |
| 3805738 | ER CARDIOVERSION | $ | 259.00 |
| 3805739 | ER FX ANKLE TRIMALL | $ | 1,707.00 |
| 3805742 | ER FX TRIMALLEOLAR | $ | 1,036.00 |
| 3805743 | ER FX GREAT TOE W/O MANIP | $ | 436.00 |
| 3805744 | ER ANOSCOPY DIAGNOSTIC | $ | 199.00 |
| 3805746 | ER APP SHORT LEG SPL | $ | 281.00 |
| 3805749 | ER FX METATARSAL OPEN | $ | 1,615.00 |
| 3805750 | ER I & D BARTHOLINS CYST | $ | 573.00 |
| 3805753 | ER SPINAL TAP DIAGNOSTIC | $ | 124.00 |
| 3805754 | ER FX PHALANG MANIP | $ | 1,615.00 |
| 3805755 | ER FX SUPRACONDYLAR | $ | 1,754.00 |
| 3805757 | ER DISLOC MCP JOINT | $ | 1,521.00 |
| 3805761 | ER REP/ COMPLEX 1.1-2.5CM | $ | 901.00 |
| 3805763 | ER INCISE EXTER HEMORRH | $ | 545.00 |
| 3805764 | ER FX NASAL SEPTAL | $ | 1,995.00 |
| 3805765 | ER REMOVTUNNELED CV CATH | $ | 861.00 |
| 3805768 | ER FX PELVIC RING | $ | 2,562.00 |
| 3805769 | ER DISLO PATELLA | $ | 2,538.00 |
| 3805775 | ER FX DISTAL FIBULA | $ | 2,171.00 |
| 3805782 | ER FX METATARSAL W O MA | $ | 869.00 |
| 3805787 | ER FX TIBIA W W/O FIB FX | $ | 1,678.00 |
| 3805788 | ER EXCIS LESION FACE 0.5 | $ | 244.00 |
| 3805789 | ER DISLO FINGER W ANES | $ | 1,780.00 |
| 3805791 | ER MEDIAL MALLEOLUS FX /M | $ | 2,427.00 |
| 3805794 | ER DISLO POST HIP ARTHRO | $ | 2,225.00 |
| 3805798 | ER FX LOWER JAW | $ | 1,564.00 |
| 3805800 | ER THORA | $ | 465.00 |
| 3805802 | ER THORA TUBE INSER | $ | 748.00 |
| 3805804 | ER FX /BIMALLEOLAR W MA | $ | 2,369.00 |
| 3805807 | ER DISLO FX SHOULDER | $ | 2,111.00 |
| 3805809 | ER CYSTOSTOMY TUBE CHANGE | $ | 352.00 |
| 3805810 | ER EXCIS BENIGN LES 0.5CM | $ | 388.00 |
| 3805813 | ER REP LAC TONGUE 2.6 | $ | 1,055.00 |
| 3805814 | ER INJ JOINT, BURSA | $ | 385.00 |
| 3805815 | REMOVAL INTRAUTERINE DEV | $ | 352.00 |
| 3805816 | REPAIR OF VAGINA | $ | 1,492.00 |
| 3805818 | REMOVAL FOREIGN BODY SIMP | $ | 677.00 |
| 3805819 | ER EYE FB CORNEA W/O SLIT | $ | 225.00 |
| 3805820 | INJECTION SCIATIC NERVE | $ | 392.00 |
| 3805822 | ER / DISLOCATION TOE | $ | 152.00 |
| 3805823 | INJECT, EDIURAL PATCH | $ | 124.00 |
| 3805824 | ER TRIGGER POINT INJ | $ | 181.00 |
| 3805825 | ER / REPAIR TENDON TOE | $ | 1,260.00 |
| 3805826 | REPAIR LEG TENDON | $ | 1,095.00 |
| 3805829 | NASAL GAST TUBE PLACEMENT | $ | 209.00 |
| 3805830 | BLOCK INJ/ PERIPHERAL | $ | 202.00 |
| 3805834 | ER/ FX TIBIA DISLOC/ MANI | $ | 2,442.00 |
| 3805838 | ER POST MALLEOLUS FX W MA | $ | 2,087.00 |
| 3805839 | ER ET / INTUBATION | $ | 339.00 |
| 3805840 | INJECTION/ OCCIPITAL NERV | $ | 399.00 |
| 3805841 | ER NERVE BLOCK INJECTION | $ | 365.00 |
| 3805843 | ER FX TALUS W MANIP | $ | 792.00 |
| 3805844 | ER FX HUMERUS | $ | 1,607.00 |
| 3805845 | ER REPAIR FINGER /TENDON | $ | 3,485.00 |
| 3805846 | ER FX/ FEMORAL | $ | 3,437.00 |
| 3805848 | ER FX DISTAL TIBIA MANIP | $ | 1,515.00 |
| 3805849 | INTRAOSSEOUS LINE INSERT | $ | 167.00 |
| 3805850 | GASTRIC TUBE INSERTION | $ | 57.00 |
| 3805851 | ER / FX FIBULA | $ | 1,787.00 |
| 3805855 | ER EXCIS BENIGN LES 0.6-1 | $ | 466.00 |
| 3805857 | REPAIR TONGUE LACERATION 2.5> | $ | 797.00 |
| 3805858 | CPAP INIT/MGMT | $ | 162.00 |
| 3805859 | OSTEOTOMY PHALANX OR FINGER EA | $ | 1,726.00 |
| 3805865 | ER REMOV FOREIGN BODY ARM | $ | 1,655.00 |
| 3805868 | ER INJ / JOINT BURSA | $ | 390.00 |
| 3805869 | ER DRAIN ABSCESS PALATE | $ | 530.00 |
| 3805870 | NAIL / EVAC SUB HEMATOMA | $ | 144.00 |
| 3805871 | AMPUTATION FINGER/ THUMB | $ | 2,737.00 |
| 3805876 | ER INSERTION CHEST TUBE | $ | 734.00 |
| 3805878 | FULL THICKNESS GRAFT/ CLOSURE | $ | 1,674.00 |
| 3805879 | CATHERIZATION FOR URINE SAMPLE | $ | 24.00 |
| 3805880 | SHAVE SKIN LESION 0.6-1.0CM | $ | 228.00 |
| 3805881 | ER EXCISION HAND/FINGER LESION <1.5CM | $ | 723.00 |
| 3805882 | ER EAR IRRIGATION / LAVAGE | $ | 51.00 |
| 3805883 | ER CLOSED TX METATARSOPHALANGEAL JNT DIS | $ | 1,306.00 |
| 3805884 | ER REMOVAL FB INTRANASAL / ANES | $ | 1,976.00 |
| 3805885 | ER DISLOCATED FINGER W ANES | $ | 3,205.00 |
| 3805886 | CLOSED TX FEMORAL SHAFT FX / REDUC W/O M | $ | 1,995.00 |
| 3805887 | ER CLOSED REDUC TX FEMORAL FX DISTAL W/O | $ | 1,995.00 |
| 3805888 | ER DISLOCATED TOE REDUCTION - INTERPHAL | $ | 1,283.00 |
| 3805889 | ER INJ PARAVETEBRAL FACET W IMAGE GUID | $ | 1,596.00 |
| 3805890 | ER INJECTION SINGLE TENDON W/O US GUID | $ | 581.00 |
| 3805961 | FOREIGN BODY REM EYE | $ | 110.00 |
| 3805985 | DIRECT ADM HOSP OBSV CARE | $ | 205.00 |
| 3805988 | PHLEBOTOMY | $ | 360.00 |
| 3805998 | ER SHORT LEG METAL SPLINT | $ | 80.00 |
| 3806004 | TRACHEOTOMY | $ | 973.00 |
| 3806021 | REP FOREARM TENDON/MUSCLE | $ | 1,176.00 |
| 3806022 | I & D VULVA/PERINEUM | $ | 501.00 |
| 3806024 | INCISION RECTAL ABSCESS | $ | 1,859.00 |
| 3806032 | DEBRIDEMENT MUSCLE/ FASCIA <20CM OR LES | $ | 658.00 |
| 3806033 | DEBRIDEMENT BONE < 20CM | $ | 972.00 |
| 3806034 | DEBRIDEMENT ADDITIONAL 20CM SUBCUTANEOUS | $ | 109.00 |
| 3806035 | DEBRIDEMENT ADDITIONAL 20CM MUSCLE | $ | 235.00 |
| 3806036 | DEBRIDEMENT ADDITIONAL 20CM BONE | $ | 416.00 |
| 3806037 | AVULSION NAIL PLATE EA ADDITIONAL | $ | 77.00 |
| 3806038 | ER REPAIR SIMPLE FACIAL 20.1 - 30.0 CM | $ | 720.00 |
| 3806039 | ER REPAIR SIMPLE FACIAL OVER 30.0CM | $ | 798.00 |
| 3806041 | ER REPAIR COMPLEX EYELIDS EA ADD 5CM < | $ | 391.00 |
| 3806042 | DRESSING / DEBRIDEMENT PART THICK >10% | $ | 563.00 |
| 3806043 | ER TRIGGER POINT INJ 3+ MUSCLES | $ | 184.00 |
| 3806044 | ER REMOV FOREIGN BODY SHOULDER SUBCUT | $ | 650.00 |
| 3806045 | ER REMOV FOREIGN BODY SHOULDER DEEP | $ | 1,896.00 |
| 3806046 | ER REMOVAL FOREIGN BODY UPPER ARM/ELBOW | $ | 588.00 |
| 3806047 | ER FX SUPRACONDYLAR W MANIP | $ | 2,366.00 |
| 3806048 | ER DRAINAGE FINGER ABSCESS SIMPLE | $ | 579.00 |
| 3806049 | ER REP EXTENSOR TENDON W/O GRAFT EA TEND | $ | 2,344.00 |
| 3806050 | ER REMOVAL FOREIGN BODY PELVIS/ HIP | $ | 675.00 |
| 3806051 | ER REMOV FOREIGN BODY PELVIS / HIP DEEP | $ | 2,583.00 |
| 3806052 | ER TX SPONTANEOUS HIP DISLOCATION | $ | 982.00 |
| 3806053 | ER FX FEMORAL SHAFT W MANIP | $ | 3,183.00 |
| 3806054 | ER FX SUPRACONDYLAR FEMORAL W MANIP | $ | 3,342.00 |
| 3806055 | ER REMOVAL FOREIGN BODY FOOT DEEP | $ | 1,347.00 |
| 3806056 | ER REMOVAL FOREIGN BODY FOOT COMPLICATED | $ | 1,591.00 |
| 3806057 | DISLOCATION METATARSOPHALANGEAL JOINT | $ | 471.00 |
| 3806058 | ER APPLICATION CAST LONG ARM | $ | 288.00 |
| 3806059 | ER APPLICATION CAST SHORT ARM | $ | 263.00 |
| 3806060 | ER APPLICATION SPLINT LONG ARM | $ | 252.00 |
| 3806061 | ER APPLICATION SPLINT SHORT ARM | $ | 167.00 |
| 3806062 | ER APPLICATION SPLINT FINGERS | $ | 121.00 |
| 3806063 | ER STRAPPING THORAX | $ | 78.00 |
| 3806064 | ER STRAPPING SHOULDER | $ | 78.00 |
| 3806065 | ER STRAPPING ELBOW WRIST | $ | 67.00 |
| 3806066 | ER STRAPPING HAND / FINGER | $ | 85.00 |
| 3806067 | ER CAST LONG LEG | $ | 424.00 |
| 3806068 | ER CAST SHORT LEG | $ | 255.00 |
| 3806069 | ER SPLINT LONG LEG | $ | 211.00 |
| 3806070 | ER STRAPPING KNEE | $ | 129.00 |
| 3806071 | ER STRAPPING ANKLE / FOOT | $ | 296.00 |
| 3806072 | ER STRAPPING TOES | $ | 50.00 |
| 3806073 | ER TRACHEOSTOMY ER PROCEDURE | $ | 770.00 |
| 3806074 | THORACOTOMY | $ | 3,358.00 |
| 3806075 | THORACOTOMY W /CONTROL TRAUMATIC HEMORR | $ | 6,060.00 |
| 3806076 | THORACOTOMY W CARDIAC MASSAGE | $ | 3,284.00 |
| 3806077 | VENIPUNCTURE < 3 YEARS | $ | 80.00 |
| 3806078 | VENIPUNCTURE > 3 YEARS | $ | 41.00 |
| 3806079 | VENIPUNCTURE CUTDOWN < 1 YEAR | $ | 228.00 |
| 3806080 | VENIPUNCTURE CUTDOWN > 1 YEAR | $ | 171.00 |
| 3806081 | CENTRAL LINE LESS THAN 5 YEARS | $ | 462.00 |
| 3806082 | CENTRAL LINE 5 YEARS OLDER | $ | 515.00 |
| 3806083 | ARTERIAL LINE | $ | 220.00 |
| 3806084 | REMOV FOREIGN BODY EAR/AN | $ | 465.00 |
| 3806085 | ER CEREBRAL THROMBOLYSIS | $ | 0.00 |
| 3806086 | REMOVAL FB SOFT TISSUE VESTIBULE MOUTH | $ | 490.00 |
| 3806087 | REMOVAL FB SOFT TISSUE VESTIBULE COMPLIC | $ | 1,001.00 |
| 3806088 | ER REPAIR LACERATION TONGUE < 2.5 CM | $ | 660.00 |
| 3806090 | TRAUMA ACTIVATION | $ | 2,554.00 |
| 3806092 | ER CARE I | $ | 378.00 |
| 3806093 | ER CARE II | $ | 717.00 |
| 3806094 | ER CARE III | $ | 1,211.00 |
| 3806095 | ER CARE IV | $ | 1,606.00 |
| 3806096 | ER CARE V | $ | 1,986.00 |
| 3806097 | CRITICAL CARE 1ST HR | $ | 2,565.00 |
| 3806098 | CRITICAL CARE EA ADD 1/2H | $ | 596.00 |
| 3806100 | HEMORRHOID THROMBECTOMY | $ | 466.00 |
| 3806101 | ANOSCOPY W REMOVAL FB | $ | 348.00 |
| 3806102 | ABDOMINAL PARACENTSIS W IMAGING GUIDANCE | $ | 471.00 |
| 3806103 | ER TRANS, BLOOD 0-2HR | $ | 352.00 |
| 3806105 | ER CARDIOPULMONARY RESUS | $ | 345.00 |
| 3806106 | ER TRANS, BLOOD 0-4HR | $ | 444.00 |
| 3806107 | ER TRANS, BLOOD 0-6HR | $ | 760.00 |
| 3806108 | ER TRANS, BLOOD 0-8HR | $ | 1,018.00 |
| 3806109 | TRANSFUSION,BLOOD > 8HR | $ | 1,271.00 |
| 3806112 | PERITONEAL LAVAGE | $ | 450.00 |
| 3806113 | BLADDER SCAN | $ | 85.00 |
| 3806114 | INCISION DRAINAGE SCROTAL ABSCESS | $ | 708.00 |
| 3806115 | VAGINAL DELIVERY | $ | 3,361.00 |
| 3806116 | DELIVERY PLACENTA | $ | 377.00 |
| 3806117 | NERVE BLOCK, DENTAL BLOCK | $ | 295.00 |
| 3806118 | TEMPORARY TRANSCUTANEOUS PACING | $ | 3.00 |
| 3806119 | CORONARY THROMBOLYSIS | $ | 286.00 |
| 3806120 | MODERATE SEDATION < 5 YEARS | $ | 100.00 |
| 3806121 | ARTHROCENTESIS SM JOINT FINGER TOES | $ | 392.00 |
| 3806122 | ARTHROCENTESIS SM JOINT W US GUIDANCE | $ | 582.00 |
| 3806123 | ARTHROCENTESIS WRIST ELBOW W US GUID REP | $ | 580.00 |
| 3806124 | ARTHROCENTESIS SHOULDER HIP W US GUID RE | $ | 575.00 |
| 3806125 | MODERATE SEDATION < 5 YEARS | $ | 392.00 |
| 3806126 | MODERATE SEDATION 5 YEARS OLDER | $ | 321.00 |
| 3806127 | MODERATE SEDATION EA ADD 15 MN | $ | 244.00 |
| 3806128 | REMOVAL CORNEA EPITHELIUM W W/O CHEMOCAU | $ | 190.00 |
| 3806129 | REPLACEMENT GASTROSTOMY TUBE | $ | 513.00 |
| 3806167 | ER ONE TOUCH | $ | 43.00 |
| 3806171 | PARACENTESIS ABD W/O GUID | $ | 455.00 |
| 3806173 | STRAPPING HIP | $ | 129.00 |
| 3806187 | CRITICAL CARE 1ST HR | $ | 2,565.00 |
| 3806190 | PEDIATRIC CRIT CARE | $ | 1,261.00 |
| 3806192 | ER CARE 1 | $ | 378.00 |
| 3806193 | ER CARE II | $ | 717.00 |
| 3806194 | ER CARE III | $ | 1,211.00 |
| 3806195 | ER CARE IV | $ | 1,606.00 |
| 3806196 | ER CARE V | $ | 1,986.00 |
| 3806300 | THORACENTESIS W/O IMAG | $ | 1,382.00 |
| 3806301 | THORACENTESIS W IMAG | $ | 1,582.00 |
| 3806401 | IV INFUSION / HYDRATION 31" TO 1HR | $ | 91.00 |
| 3806402 | IV INFUSION / HYDRATION EA ADD HOUR | $ | 32.00 |
| 3806403 | IV THERAPY INITIAL UP TO 1 HOUR | $ | 172.00 |
| 3806404 | IV THERAPY EA ADD HOUR | $ | 52.00 |
| 3806405 | IV THERAPY ADD SEQ INFUSION | $ | 52.00 |
| 3806406 | IM INJECTION / THERAPEUTIC | $ | 143.00 |
| 3806407 | IV PUSH | $ | 95.00 |
| 3806408 | IV PUSH EA ADD | $ | 41.00 |
| 3806409 | IV PORT FLUSH | $ | 186.00 |
| 3806410 | IMMUNIZATION | $ | 29.00 |
| 3806411 | IMMUNIZATION EA ADD VACCINE | $ | 25.00 |
| 3806412 | IV PUSH / SAME SUBSTANCE | $ | 41.00 |
| 3806413 | INFUSION THERAPY | $ | 172.00 |
| 3806414 | IV THERAPY SEQ CONCURRENT INFUSION | $ | 52.00 |
| 3807121 | ER LONG LEG SPLINT-ADULT | $ | 42.00 |
| 3807122 | ER SHORT LEG SPLINT-ADULT | $ | 42.00 |
| 3807123 | ER LONG ARM SPLINT-ADULT | $ | 33.00 |
| 3807124 | ER SHORT ARM SPLINT-ADULT | $ | 26.00 |
| 3807125 | ER LONG LEG SPLINT-CHILD | $ | 33.00 |
| 3807126 | ER SHORT LEG SPLINT-CHILD | $ | 30.00 |
| 3807127 | ER LONG ARM SPLINT-CHILD | $ | 20.00 |
| 3807128 | ER SHORT ARM SPLINT-CHILD | $ | 26.00 |
| 3807200 | ER CAST LONGARM ADULT FIB | $ | 142.00 |
| 3807201 | ER CAST LONGARM PED FIB | $ | 93.00 |
| 3807202 | ER CAST SHRTARM ADULT FIB | $ | 93.00 |
| 3807203 | ER CAST SHRTARM PED FIB | $ | 45.00 |
| 3807204 | ER CAST GAUNTLETADULT FIB | $ | 91.00 |
| 3807205 | ER CAST GAUNTLETPED FIB | $ | 87.00 |
| 3807206 | ER CAST LONGLEG ADULT FIB | $ | 133.00 |
| 3807207 | ER CAST LONGLEG PED FIB | $ | 93.00 |
| 3807208 | ER CAST/SHORT LEG ADULT | $ | 93.00 |
| 3807209 | ER CAST SHORTLEG PED FIB | $ | 93.00 |
| 3807211 | ER INJECTION JOINT, BURSA | $ | 238.00 |
| 3807212 | WOUND CLOSURE ADHESIVE | $ | 44.00 |
| 3808601 | ER SKIN TAG REMOVEA ADD L | $ | 45.00 |
| 3808602 | ER REP COMPLEX 2.6-7.5CM | $ | 1,209.00 |
| 3808650 | SANE EXAM | $ | 469.00 |
| 3808655 | SANE EXAM SUSPECT | $ | 201.00 |
| 3802274 | VENIPUNCTURE CUTDOWN < 1 YEAR | $ | 228.00 |
| 3806040 | ER REPAIR COMPLEX TRUNK EA ADD 5CM OR < | $ | 314.00 |
| 3821000 | ER PHYSICIAN I | $ | 151.00 |
| 3821005 | ER PHYSICIAN I | $ | 151.00 |
| 3821008 | ER PHYSICIAN I | $ | 151.00 |
| 3821100 | ER PHYSICIAN II | $ | 280.00 |
| 3821105 | ER PHYSICIAN II | $ | 280.00 |
| 3821108 | ER PHYSICIAN II | $ | 280.00 |
| 3821200 | ER PHYSICIAN III | $ | 375.00 |
| 3821205 | ER PHYSICIAN III | $ | 375.00 |
| 3821208 | ER PHYSICIAN III | $ | 375.00 |
| 3821300 | ER PHYSICIAN IV | $ | 527.00 |
| 3821305 | ER PHYSICIAN IV | $ | 527.00 |
| 3821308 | ER PHYSICIAN IV | $ | 527.00 |
| 3821400 | ER PHYSICIAN V | $ | 694.00 |
| 3821405 | ER PHYSICIAN V | $ | 694.00 |
| 3821408 | ER PHYSICIAN V | $ | 694.00 |
| 3821450 | PEDIATRIC CRIT CARE | $ | 1,056.00 |
| 3821500 | CRITICAL CARE/PHYS 1ST HR | $ | 869.00 |
| 3821505 | CRITICAL CARE/PHYS 1ST HR | $ | 869.00 |
| 3821508 | CRITICAL CARE/PHYS 1ST HR | $ | 869.00 |
| 3821510 | CRITICAL CARE / PHYS EA 1/2 HR | $ | 523.00 |
| 3821525 | CRIT CARE/PHYS EA 1/2 HR | $ | 523.00 |
| 3821530 | PROLONGED SERVICE 1ST HR | $ | 376.00 |
| 3821605 | CARDIOVERSION | $ | 537.00 |
| 3821606 | INTRAOSSEOUS LINE INSERT | $ | 260.00 |
| 3821607 | EKG INTERP AND REPORT | $ | 36.00 |
| 3821611 | ARTERIAL PUNCTURE | $ | 69.00 |
| 3821616 | ET / INTUBATION | $ | 485.00 |
| 3821617 | PERICARDIOCENTESIS INITIAL | $ | 512.00 |
| 3821618 | THORACOTOMY/CONTROL TRAUM | $ | 6,404.00 |
| 3821619 | TRACHEOSTOMY | $ | 979.00 |
| 3821622 | VENIPUNCTURE <3YO | $ | 43.00 |
| 3821623 | VENIPUNCTURE > 3YO | $ | 41.00 |
| 3821624 | CPR | $ | 818.00 |
| 3821625 | THORACOSTOMY,TUBE,HEM,ABC | $ | 763.00 |
| 3821626 | VEIN CUT DOWN > 1YO | $ | 176.00 |
| 3821627 | GASTRIC INTUB / ASPIR / LAVAGE | $ | 117.00 |
| 3821631 | ET / INTUBATION | $ | 485.00 |
| 3821632 | BIOPSY ENDOMETRIAL SAMPLI | $ | 390.00 |
| 3821633 | THORACOSTOMY, TUBE, HEM | $ | 388.00 |
| 3821637 | NAIL/ AVULSION OF PLATE | $ | 223.00 |
| 3821638 | REMOV TUNNEL CENT CATHETER | $ | 861.00 |
| 3821639 | CLOSED TX METATARSOPHALANGEAL JNT DISLOC | $ | 328.00 |
| 3821640 | DISLOCATED FINGER REDUCTION W ANES | $ | 935.00 |
| 3821641 | CLOSED TX FEMORAL SHAFT FX W/O MANIP | $ | 1,178.00 |
| 3821642 | CLOSED FX REDUC TX FEMORAL DISTAL W/O MA | $ | 1,212.00 |
| 3821643 | DISLOCATED TOE REDUCTION - INTERPHAL | $ | 322.00 |
| 3821644 | INJ PARAVETEBRAL FACET W IMAGE GUID | $ | 259.00 |
| 3821645 | INJECTION SINGLE TENDON W/O US GUID | $ | 99.00 |
| 3821754 | FRACTURE / ANKLE DISLOC W ANES | $ | 2,198.00 |
| 3821759 | ABCESS / SIMPLE I & D | $ | 433.00 |
| 3821761 | ABCESS/COMPLEX I & D | $ | 801.00 |
| 3821764 | BREAST CYST ASPIRATION | $ | 189.00 |
| 3821765 | CYST/COMPLEX PILONIDAL ID | $ | 765.00 |
| 3821766 | CYST/SIMPLE PILONIDAL I&D | $ | 464.00 |
| 3821770 | CYST/SIMPLE PILONIDAL I&D | $ | 464.00 |
| 3821771 | REMOVAL FB / FOOT | $ | 603.00 |
| 3821772 | REP FOREARM TENDON/MUSCLE | $ | 1,093.00 |
| 3821773 | I & D VULVA/ PERINEUM | $ | 488.00 |
| 3821774 | ABSCESS / COMPLEX I&D | $ | 801.00 |
| 3821775 | PHYS /DESTRUCTION PENILE LESIONS | $ | 389.00 |
| 3821776 | NAIL / AVULSION OF PLATE | $ | 223.00 |
| 3821780 | CYST / COMPLEX PILONIDAL ID | $ | 765.00 |
| 3821781 | I & D BARTHOLINS CYST | $ | 409.00 |
| 3821782 | SPLINT / SHORT ARM | $ | 178.00 |
| 3821788 | HEMATOMA/ INCISION-DRAIN | $ | 530.00 |
| 3821789 | DEBRIDEMENT 10% BODY | $ | 63.00 |
| 3821790 | REMOVAL FB/SUBCUTANEOUS | $ | 466.00 |
| 3821791 | REMOVAL FB/COMPLEX SUBCUT | $ | 829.00 |
| 3821792 | HEMATOMA/INCISION-DRAIN | $ | 530.00 |
| 3821793 | ABSCESS/PUNC ASPIRATION | $ | 429.00 |
| 3821794 | DEBRIDEMENT <10% BODY | $ | 126.00 |
| 3821796 | REMOVAL FB / COMPLEX | $ | 829.00 |
| 3821798 | DEBRIDEMENT SUBCUTANEOUS | $ | 274.00 |
| 3821801 | SKIN TAGS/ANY AREA(TO 15) | $ | 329.00 |
| 3821827 | EXCISION.REMOVAL FB SIMPL | $ | 466.00 |
| 3821845 | EYE/REMOVAL SUPERFIC FB | $ | 200.00 |
| 3821846 | FRACTURE/ACROMIPCLAV W MA | $ | 1,414.00 |
| 3821847 | FRACTURE/ACROMIOCLAVICLE | $ | 1,027.00 |
| 3821848 | FRACTURE/ANKLE | $ | 738.00 |
| 3821849 | FRACTURE/ANKLE DISLO W AN | $ | 2,198.00 |
| 3821850 | FRACTURE/ANKLE DISLOCATIO | $ | 1,671.00 |
| 3821851 | FRACTURE/ CALCANEAL | $ | 1,039.00 |
| 3821852 | FRACTURE/CARPAL BGO W MAN | $ | 1,790.00 |
| 3821853 | EYE/CORNEA FB W SLIT LAMP | $ | 241.00 |
| 3821854 | EYE/DRAIN LACRIMAL GLAND | $ | 609.00 |
| 3821855 | EYE / FB CORNEA W/O SLIT LAMP | $ | 189.00 |
| 3821856 | EYE/LACERATION SCLERA | $ | 642.00 |
| 3821857 | EYE/REMOVAL FB EYE LID | $ | 532.00 |
| 3821858 | EYE/REMOVAL IMBEDDED FB | $ | 242.00 |
| 3821859 | FRACTURE/CARPAL BONE | $ | 1,254.00 |
| 3821860 | FRACTURE/CARPAL SCAP W MA | $ | 1,931.00 |
| 3821861 | FRACTURE/CARPAL SCAPHOID | $ | 1,245.00 |
| 3821862 | FRACTURE/CARPOMETACARPAL | $ | 1,338.00 |
| 3821863 | FRACTURE/CLAVICLE W MANIP | $ | 1,483.00 |
| 3821865 | FRACTURE/CLAVICULAR | $ | 999.00 |
| 3821866 | FRACTURE/DIS ELBOW W ANES | $ | 1,163.00 |
| 3821867 | FRACTURE/DISLOC ELBOW | $ | 1,496.00 |
| 3821869 | FRACTURE/DIST PHALAN W MA | $ | 1,222.00 |
| 3821870 | FRACTURE/DIST PHALAN W MA | $ | 1,222.00 |
| 3821877 | FRACTURE/DISTAL PHALANGE | $ | 452.00 |
| 3821878 | FRACUTRE/DISTAL PHALANG | $ | 832.00 |
| 3821887 | FRACTURE/DISTAL RADIAL | $ | 1,401.00 |
| 3821888 | FRACTURE/DISTAL RADIOULNA | $ | 1,805.00 |
| 3821889 | FRACTURE/FEMUR | $ | 2,096.00 |
| 3821890 | FRACTURE/FIBULA | $ | 683.00 |
| 3821891 | FRACTURE/GALEAZZI RADIAL | $ | 2,377.00 |
| 3821892 | FRACUTRE/GREAT TOE W MANI | $ | 681.00 |
| 3821893 | FRACTURE/DREAT TOE W/O MA | $ | 294.00 |
| 3821894 | FRACTURE/GREATER TROCHANT | $ | 1,712.00 |
| 3821895 | FRACTURE / HIP DISLOCATION | $ | 790.00 |
| 3821896 | FRACTURE/HUMERAL SHAFT | $ | 800.00 |
| 3821897 | FRACTURE/HUMERUS W MAN | $ | 2,011.00 |
| 3821898 | FRACTURE/KNEE DISLOCATION | $ | 2,050.00 |
| 3821899 | FRACTURE/KNEE W ANES | $ | 1,545.00 |
| 3821900 | FRACTURE/ LAT EPICONDYL | $ | 1,293.00 |
| 3821901 | FRACTURE/ LAT MALLEOLUS | $ | 699.00 |
| 3821902 | FRACTURE/LUNATE DISLOCATI | $ | 2,127.00 |
| 3821903 | FRACTURE/METACARPAL | $ | 679.00 |
| 3821908 | FRACTURE/METACARPAL | $ | 1,246.00 |
| 3821912 | FRACTURE/METACARPAL W MAN | $ | 1,314.00 |
| 3821913 | FRACTURE/MEATACARPAL W MA | $ | 1,314.00 |
| 3821921 | FRACTURE / METATARSAL W MANIP | $ | 1,017.00 |
| 3821928 | FRACTURE/METATARSAL W MAN | $ | 1,017.00 |
| 3821930 | FRACTURE/METATARSAL WO MA | $ | 500.00 |
| 3821938 | FRACTURE/METATARSAL WO MA | $ | 936.00 |
| 3821939 | FRACTURE/MONTEGGIA ELBOW | $ | 2,448.00 |
| 3821940 | FRACTURE/PATELLA W ANES | $ | 2,766.00 |
| 3821941 | DISLOCAT/PATELLA WO ANES | $ | 1,508.00 |
| 3821942 | FRACTURE/PATELLA WO MANI | $ | 1,326.00 |
| 3821943 | FRACTURE/PHALAN/OPEN | $ | 2,637.00 |
| 3821944 | FRACTURE/PHALAN/OPEN | $ | 2,637.00 |
| 3821945 | FRACTURE/DISTAL RADIAL | $ | 1,401.00 |
| 3821949 | FRACTURE/MEDIAL MALLEOLUS | $ | 747.00 |
| 3821951 | DISLOCATION/ FINGER | $ | 1,147.00 |
| 3821952 | FRACTURE / PHALANGE | $ | 548.00 |
| 3821961 | FRACTURE/PHALANGES W MANI | $ | 650.00 |
| 3821968 | FRACTURE/PHALANGE W MAN | $ | 650.00 |
| 3821970 | FRACTURE/PROX HUMER W MAN | $ | 1,892.00 |
| 3821971 | FRACTURE/PROX HUMERAL | $ | 1,384.00 |
| 3821972 | FRACTURE/RAD HEAD CHILD | $ | 427.00 |
| 3821973 | FRACTURE/RAD SHAFT W MANI | $ | 2,048.00 |
| 3821974 | FRACTURE/RAD ULNAR SHAFT | $ | 618.00 |
| 3821975 | FRACTURE/RAD ULNA W MAN | $ | 2,099.00 |
| 3821976 | FRACTURE / RADIAL HEAD W MANIP | $ | 1,779.00 |
| 3821977 | FRACTURE/RADIAL HEAD NECK | $ | 590.00 |
| 3821979 | FRACTURE/RADIO-INTERCARPA | $ | 1,824.00 |
| 3821981 | FRACTURE/SCAPULAR WO MAN | $ | 1,073.00 |
| 3821982 | CLOSED TX SHOULDER DISLOC MANIP/ANES | $ | 990.00 |
| 3821983 | CLOSED TX SHOULDER DISLOCATION W MAN | $ | 1,293.00 |
| 3821984 | FRACTURE / STERNOCLAV W MANIP | $ | 1,556.00 |
| 3821985 | FRACTURE/STERNOCLAV WO MA | $ | 1,049.00 |
| 3821986 | FRACTURE/TALUS | $ | 948.00 |
| 3821987 | FRACTURE/TARSAL BONE | $ | 871.00 |
| 3821988 | FRACTURE/TARSAL BONE | $ | 794.00 |
| 3821989 | FRACTURE/TARSAL W MANIP | $ | 1,059.00 |
| 3821990 | FRACTURE/ THUMB W MANIP | $ | 1,497.00 |
| 3821991 | FRACTURE/ THUMB BENNETT | $ | 2,117.00 |
| 3821992 | FRACTURE/TIBIA W MANIP | $ | 2,547.00 |
| 3821993 | FRACTURE/ TIBIA WO MANIP | $ | 1,263.00 |
| 3821994 | FRACTURE / SCAPHOPERI | $ | 2,126.00 |
| 3821995 | FRACTURE/ TUBEROSITY W MA | $ | 1,577.00 |
| 3821996 | FRACTURE / PHALANGEAL MANIP | $ | 1,356.00 |
| 3821997 | FRACTURE DISTAL TIBIA | $ | 746.00 |
| 3821998 | DISLOC / FINGER | $ | 1,147.00 |
| 3822000 | REPAIR SIMPLE 2.5CM | $ | 157.00 |
| 3822002 | REPAIR SIMPLE 2.5CM | $ | 157.00 |
| 3822036 | FRACTURE/ ANKLE TRIMALL | $ | 1,936.00 |
| 3822039 | FRACTURE/ PHALANX | $ | 450.00 |
| 3822040 | FX/ TRIMALLEOLAR | $ | 1,284.00 |
| 3822041 | FRACTURE/ ULNAR STYLOID | $ | 1,345.00 |
| 3822045 | FRACTURE PHALANGE | $ | 832.00 |
| 3822049 | FRACTURE CALCANEAL | $ | 1,039.00 |
| 3822052 | FRACTURE/ LAT MALLEOLUS | $ | 1,290.00 |
| 3822060 | FRACTURE PHALANGE MANIP | $ | 1,356.00 |
| 3822063 | DISLOC MCP JOINT | $ | 1,360.00 |
| 3822073 | FRACTURE/ DISTAL FIBULA | $ | 1,725.00 |
| 3822076 | FRACTURE/ ORBIT W/O MANIP | $ | 718.00 |
| 3822077 | FRACTURE/BIMALLEOLAR W MA | $ | 2,100.00 |
| 3822078 | FRACTURE GREAT TOE | $ | 575.00 |
| 3822079 | FRACTURE / PROX HUMERAL | $ | 755.00 |
| 3822082 | FRACTURE/SCAPULA W/O MANI | $ | 1,073.00 |
| 3822083 | STRAPPING OF SHOULDER | $ | 47.00 |
| 3822084 | APPLIC LOWER LEG SPLINT | $ | 223.00 |
| 3822089 | DEBRIDE SKIN/ FX | $ | 1,232.00 |
| 3822091 | STRAPPING / KNEE | $ | 47.00 |
| 3822092 | STRAPPING / KNEE | $ | 47.00 |
| 3822093 | DISLOCATION/ THUMB | $ | 1,360.00 |
| 3822094 | DISLOCATION / FX SHOULDER | $ | 1,760.00 |
| 3822096 | FRACTURE/ DISTAL FIBULA | $ | 1,725.00 |
| 3822097 | DISLOCATION / FX SHOULDER | $ | 1,760.00 |
| 3822098 | FRACTURE/ ULNAR STYLOID | $ | 1,345.00 |
| 3822100 | REPAIR SIMPLE 2.6-7.5CM | $ | 190.00 |
| 3822102 | REPAIR SIMPLE 2.6-7.5CM | $ | 190.00 |
| 3822127 | REPAIR SIMPLE 7.6-12.5 | $ | 226.00 |
| 3822129 | DISLOC POST HIP PROS/ANES | $ | 2,560.00 |
| 3822131 | REMOVAL FB FOOT | $ | 603.00 |
| 3822132 | REMOVAL FOREIGN BODY SIMP | $ | 653.00 |
| 3822133 | REMOVAL FOREIGN BODY | $ | 653.00 |
| 3822137 | FRACTURE/ ANKLE TRIMALLEO | $ | 1,936.00 |
| 3822141 | REPAIR TENDON TOE | $ | 1,386.00 |
| 3822143 | FRACTURE/ CLAVICLE W MANI | $ | 1,483.00 |
| 3822144 | FRACTURE/ KNEE DISLOCATIO | $ | 2,050.00 |
| 3822148 | DRAINAGE ABSCESS PALATE | $ | 528.00 |
| 3822155 | FRACTURE/ THUMB W MANIP | $ | 1,497.00 |
| 3822156 | INJECTION/ OCCIPITAL NERV | $ | 276.00 |
| 3822157 | NERVE BLOCK INJECTION | $ | 338.00 |
| 3822158 | DISLOC / SHOULDER W ANES | $ | 1,778.00 |
| 3822159 | FX / TRIMALLEOLAR | $ | 709.00 |
| 3822162 | FRACTURE MEDIAL MALLEOLUS | $ | 1,374.00 |
| 3822163 | FRACTURE / FEMORAL | $ | 3,020.00 |
| 3822181 | FRACTURE/ TARSAL W MANIP | $ | 1,059.00 |
| 3822182 | REPAIR FINGER TENDON | $ | 2,373.00 |
| 3822186 | BLOCK INJ / PERIPHERAL NERVE | $ | 109.00 |
| 3822188 | ABSCESS / PUNCTURE ASPIRATION | $ | 429.00 |
| 3822190 | SHAVING LESION 1.1CM - 2CM | $ | 281.00 |
| 3822191 | NASAL / REMOVAL FOREIGN BODY | $ | 587.00 |
| 3822192 | DRAINAGE OF TONSIL ABSCESS | $ | 579.00 |
| 3822193 | SHAVE SKIN LESION 0.6-1.0CM | $ | 228.00 |
| 3822194 | REPAIR FINGER TENDON | $ | 2,373.00 |
| 3822195 | DEBRIDEMENT MUSCLE FASCIA <20CM OR LESS | $ | 658.00 |
| 3822196 | DEBRIDEMENT BONE <20CM | $ | 972.00 |
| 3822197 | DEBRIDEMENT ADDITIONAL 20CM SUBCUTANEOUS | $ | 109.00 |
| 3822198 | DEBRIDEMENT ADDITIONAL 20CM MUSCLE | $ | 235.00 |
| 3822199 | DEBRIDEMENT ADDITIONAL 20CM BONE | $ | 416.00 |
| 3822200 | REPAIR SIMPLE 7.6-12.5CM | $ | 226.00 |
| 3822224 | FRACTURE/ DISTAL RAD W MA | $ | 1,246.00 |
| 3822225 | REPAIR/INTER EXTR 7.6-12. | $ | 576.00 |
| 3822226 | FRACTURE/ SHOULDER W MAN | $ | 1,293.00 |
| 3822229 | FRACTURE/ DISTAL RAD W MA | $ | 2,294.00 |
| 3822233 | FRACTURE / HUMERUS W MAN | $ | 2,011.00 |
| 3822234 | NAIL / EVAC SUB HEMATOMA | $ | 146.00 |
| 3822235 | INJECTION JOINT BURSA | $ | 92.00 |
| 3822237 | FRACTURE / DISLOCATION ELBOW | $ | 2,082.00 |
| 3822241 | FRACTURE / STERNOCLAV W MANIP | $ | 1,556.00 |
| 3822242 | FULL THICKNESS GRAFT,CLOSURE | $ | 3,320.00 |
| 3822244 | EXCISION LESION HAND/FINGER <1.5 CM | $ | 1,395.00 |
| 3822245 | BLOCK INJ PERIPHERAL | $ | 202.00 |
| 3822246 | EAR IRRIGATION / LAVAGE | $ | 34.00 |
| 3822247 | AVULSION NAIL PLATE EA ADDITIONAL | $ | 77.00 |
| 3822248 | REPAIR SIMPLE FACIAL 20.1 - 30.0CM | $ | 419.00 |
| 3822249 | REPAIR SIMPLE FACIAL OVER 30.0CM | $ | 468.00 |
| 3822250 | TRIGGER POINT INJECT 3+ MUSCLES | $ | 184.00 |
| 3822251 | REMOVAL FOREIGN BODY SHOULDER SUBCUT | $ | 650.00 |
| 3822252 | REMOVAL FOREIGN BODY SHOULDER DEEP | $ | 1,896.00 |
| 3822253 | FRACTURE/ SUPRACONDYLAR W MANIP | $ | 2,366.00 |
| 3822254 | DRAINAGE FINGER ABSCESS SIMPLE | $ | 579.00 |
| 3822255 | REPAIR EXTENSOR TENDON W/O GRAFT EA TEND | $ | 2,344.00 |
| 3822256 | REMOVAL FOREIGN BODY PELVIS / HIP | $ | 675.00 |
| 3822257 | REMOVAL FOREIGN BODY PELVIS / HIP DEEP | $ | 2,583.00 |
| 3822258 | TX SPONTANEOUS HIP DISLOCATION | $ | 982.00 |
| 3822259 | FRACTURE FEMORAL SHAFT W MANIP | $ | 3,183.00 |
| 3822260 | FX SUPRACONDYLAR FEMORAL W MANIP | $ | 3,342.00 |
| 3822261 | REMOVAL FOREIGN BODY FOOT DEEP | $ | 1,347.00 |
| 3822262 | REMOVAL FOREIGN BODY FOOT COMPLICATED | $ | 1,591.00 |
| 3822263 | DISLOCATION METATARSOPHALANGEAL | $ | 471.00 |
| 3822264 | STRAPPING THORAX | $ | 47.00 |
| 3822265 | STRAPPING ELBOW /WRIST | $ | 48.00 |
| 3822266 | STRAPPING HAND / FINGER | $ | 50.00 |
| 3822267 | STRAPPING ANKLE / FOOT | $ | 45.00 |
| 3822268 | STRAPPING TOES | $ | 29.00 |
| 3822269 | TRACHEOSTOMY ER PROCEDURE | $ | 770.00 |
| 3822270 | THORACOTOMY | $ | 3,358.00 |
| 3822271 | THORACOTOMY W CARDIAC MASSAGE | $ | 3,284.00 |
| 3822272 | PERIPHERAL IV PLACEMENT, EJ LINE PLACEME | $ | 41.00 |
| 3822273 | VENIPUNCTURE < 3 YEARS | $ | 77.00 |
| 3822275 | CENTRAL LINE LESS THAN 5 YEARS | $ | 462.00 |
| 3822276 | CENTRAL LINE 5 YEARS OLDER | $ | 515.00 |
| 3822277 | ARTERIAL LINE | $ | 220.00 |
| 3822278 | CEREBRAL THROMBOLYSIS | $ | 0.00 |
| 3822279 | REMOVAL FB SOFT TISSUE VESTIBULE MOUTH | $ | 490.00 |
| 3822280 | REMOVAL FB SOFT TISSUE VESTIBULE COMPLIC | $ | 1,001.00 |
| 3822282 | HEMORRHOID THROMBECTOMY | $ | 466.00 |
| 3822283 | ANOSCOPY W REMOVAL FB | $ | 348.00 |
| 3822284 | ABDOMINAL PARACENTESIS W IMAGING GUIDANC | $ | 471.00 |
| 3822285 | PERITONEAL LAVAGE | $ | 450.00 |
| 3822286 | INCISON DRAINAGE SCROTAL ABSCESS | $ | 708.00 |
| 3822287 | VAGINAL DELIVERY | $ | 3,361.00 |
| 3822288 | DELIVERY PLACENTA | $ | 377.00 |
| 3822289 | STRAPPING HIP | $ | 47.00 |
| 3822290 | CORONARY THROMBOLYSIS | $ | 286.00 |
| 3822291 | MODERATE SEDATION < 5 YEARS | $ | 100.00 |
| 3822292 | MODERATE SEDATON 5 YEARS > | $ | 53.00 |
| 3822293 | MODERATE SEDATION EA ADD 15 MN | $ | 46.00 |
| 3822294 | ARTHROCENTESIS SM JOINT FING TOES | $ | 88.00 |
| 3822295 | ARTHROCENTESIS SM JOINT W US GUIDANCE | $ | 114.00 |
| 3822296 | ARTHROCENTESIS WRIST ELBOW W US GUID REP | $ | 131.00 |
| 3822297 | ARTHROCENTESIS SHOULDER HIP W US GUID RE | $ | 150.00 |
| 3822298 | MODERATE SEDATION < 5 YEARS | $ | 392.00 |
| 3822299 | MODERATE SEDATION 5 YEARS OLDER | $ | 321.00 |
| 3822300 | REPAIR SIMPLE 12.6-20.0CM | $ | 279.00 |
| 3822301 | REPAIR SIMPLE 12.6-20.0CM | $ | 279.00 |
| 3822325 | SPLINT / FINGER | $ | 126.00 |
| 3822332 | REMOVAL INTRAUTERINE DEV | $ | 300.00 |
| 3822334 | INCISE EXTER HEMORRHOID | $ | 476.00 |
| 3822337 | DISLOCAT/PATELLA W/O ANES | $ | 1,508.00 |
| 3822341 | REMOVAL INTRAUTERINE DEVICE | $ | 300.00 |
| 3822345 | NAIL / REPAIR NAIL BED | $ | 599.00 |
| 3822346 | NAIL / REPAIR NAIL BED | $ | 599.00 |
| 3822354 | MODERATE SEDATION EA ADD 15 MN | $ | 244.00 |
| 3822355 | REMOVAL CORNEA EPITHELIUM W W/O CHEMOCAU | $ | 297.00 |
| 3822356 | REPLACEMENT GASTROSTOMY TUBE | $ | 95.00 |
| 3822401 | REPAIR SIMPLE 20.1-30.0CM | $ | 333.00 |
| 3822402 | REPAIR SIMPLE 20.1-30.0CM | $ | 333.00 |
| 3822500 | REPAIR SIMPLE OVER 30.0CM | $ | 403.00 |
| 3822502 | REPAIR SIMPLE OVER 30.0CM | $ | 403.00 |
| 3822524 | REPAIR OF VAGINA | $ | 1,337.00 |
| 3822526 | INJECTION JOINT, BURSA | $ | 202.00 |
| 3822527 | ABSCESS/ SIMPLE I & D | $ | 433.00 |
| 3822532 | INJECTION JOINT BURSA | $ | 350.00 |
| 3822536 | INJECTION JOINT, BURSA | $ | 202.00 |
| 3822537 | DRAINAGE FINGER ABSCESS | $ | 822.00 |
| 3822538 | INJECTION SCIATIC NERVE | $ | 293.00 |
| 3822539 | INJECTION JOINT, BURSA | $ | 202.00 |
| 3822540 | FRACTURE / TALUS W MANIP | $ | 1,436.00 |
| 3822541 | NAIL / EVAC SUBUNG HEMATOMA | $ | 146.00 |
| 3822600 | REPAIR SIMPLE FACIAL 2.5 | $ | 181.00 |
| 3822608 | REPAIR/SIMPLE FACIAL 2.5C | $ | 181.00 |
| 3822700 | REPAIR SIMPLE FAC 2.6-5.0 | $ | 190.00 |
| 3822712 | REPAIR COMPLEX 2.6- 7.5CM | $ | 821.00 |
| 3822800 | REPAIR SIMPLE FACIAL 5.1-7.5 | $ | 231.00 |
| 382289 | NERVE BLOCK, DENTAL BLOCK | $ | 295.00 |
| 3822900 | REPAIR SIMPLE FAC 7.6-12. | $ | 277.00 |
| 3822907 | REPAIR SIMPLE FACIAL 12.6-20 | $ | 362.00 |
| 3822908 | REPAIR SIMPLE FACIAL 1.6-20.0CM | $ | 362.00 |
| 3823000 | REPAIR INTERMED 2.5CM | $ | 424.00 |
| 3823008 | REPAIR INTERMED 2.5CM | $ | 424.00 |
| 3823100 | REPAIR INTERMED 2.6-7.5CM | $ | 525.00 |
| 3823108 | REPAIR INTERMED 2.6-7.5CM | $ | 525.00 |
| 3823200 | REPAIR INTERMED 7.6-12.5C | $ | 558.00 |
| 3823208 | REPAIR INTERMED 7.6-12.5C | $ | 558.00 |
| 3823300 | REPAIR INTERMED 12.6-20CM | $ | 639.00 |
| 3823308 | REPAIR INTERMED 12.6-20. CM | $ | 639.00 |
| 3823400 | REPAIR INTERMED 20.1-30.CM | $ | 736.00 |
| 3823408 | REPAIR INTERMED 20.1-30CM | $ | 736.00 |
| 3823500 | REPAIR INTERMED OVER 30CM | $ | 853.00 |
| 3823508 | REPAIR INTERMED OVER 30CM | $ | 853.00 |
| 3823600 | REPAIR INTER EXTR 2.5CM | $ | 415.00 |
| 3823608 | REPAIR INTER EXTR 2.5CM | $ | 415.00 |
| 3823623 | FRACTURE/ DISTAL RADIOULN | $ | 1,805.00 |
| 3823700 | REPAIR INTE EXT 2.6-7.5CM | $ | 540.00 |
| 3823708 | REPAIR INTE EXTR 2.6-7.5C | $ | 540.00 |
| 3823724 | FRACTURE GREAT TOE | $ | 306.00 |
| 3823800 | REPAIR/INTER EXT 7.6-12.5 | $ | 576.00 |
| 3823900 | REPAIR/INTER EXTR 12.6-20 | $ | 708.00 |
| 3823901 | REPAIR / INTER EXTR 12.6-20CM | $ | 708.00 |
| 3823910 | REPAIR INTER EXTR 20.1-30 | $ | 815.00 |
| 3823920 | REPAIR/INTER EXTR OVER 30 | $ | 903.00 |
| 3824000 | REPAIR/INTER FACIAL 2.5CM | $ | 468.00 |
| 3824001 | REPAIR INTERMED FACE 2.5C | $ | 468.00 |
| 3824100 | REPAIR/INTER FACE 2.6-7.5 | $ | 548.00 |
| 3824101 | REPAIR/INTER FACE 2.6-7.5 | $ | 548.00 |
| 3824200 | REPAIR/INTER FACE 5.1-7.5 | $ | 583.00 |
| 3824201 | REPAIR/INTER FACE 5.1-7.5 | $ | 583.00 |
| 3824300 | REPAIR INTER FACIAL 7.6-12 | $ | 593.00 |
| 3824400 | REPAIR/INTER FACE 12.6-20 | $ | 789.00 |
| 3824500 | REPAIR INTER FACEIAL 20.1-30 | $ | 989.00 |
| 3824600 | REPAIR/INTER FACE OVER 30 | $ | 1,093.00 |
| 3824610 | PINCH GRAFT SGL MULT | $ | 2,005.00 |
| 3824700 | REPAIR/COMPLEX TRUNK 2.5C | $ | 553.00 |
| 3824701 | REPAIR/COMPLEX TRUNK 2.5C | $ | 553.00 |
| 3824708 | REPAIR COMPLEX EXTR 2.5CM | $ | 628.00 |
| 3824710 | REPIAR COMPLEX TRUNK 7.5CM | $ | 1,134.00 |
| 3824712 | REPAIR COMP EA +5CM | $ | 259.00 |
| 3824720 | REPAIR COMPLEX EXTR 2.5 | $ | 628.00 |
| 3824730 | REPAIR/COMPLEX EXTR 7.5C | $ | 704.00 |
| 3824740 | REPAIR/COMPLEX FACIAL 2.5 | $ | 661.00 |
| 3824743 | REPAIR/ COMPLEX 1.1- 2.5 | $ | 661.00 |
| 3824744 | REPAIR COMPLEX EXT 7.5CM | $ | 704.00 |
| 3824750 | REPAIR/COMPLEX FACIAL 7.5 | $ | 821.00 |
| 3824760 | EA ADD 5CM OR LESS TRUNK | $ | 325.00 |
| 3824762 | REPAIR SIMPLE FACIAL 2.6- | $ | 190.00 |
| 3824770 | REPAIR COM EA 5CM OR LESS | $ | 259.00 |
| 3824771 | REPAIR COMPLEX TRUNK 7.5C | $ | 670.00 |
| 3824772 | REPAIR COMPLEX 1.1-2.5CM | $ | 753.00 |
| 3824773 | REPAIR COMPLEX 1.1-2.5CM | $ | 753.00 |
| 3824780 | REPAIR COMPL 5CM OR LESS | $ | 371.00 |
| 3824781 | REPAIR COMPL 2.6-7.5 | $ | 903.00 |
| 3824784 | REPAIR COMPL 5CM OR LESS | $ | 371.00 |
| 3824790 | REPAIR COMP 5CM OR LESS | $ | 396.00 |
| 3824791 | REPAIR LAC 2.5 TONGUE | $ | 713.00 |
| 3824793 | REPAIR TONGUE LACERATION 2.5> | $ | 842.00 |
| 3824800 | WOUND CLOSURE ADHESIVE | $ | 122.00 |
| 3824801 | WOUND CLOSURE ADHESIVE | $ | 122.00 |
| 3825000 | BURN/1ST DEGREE INITIAL | $ | 203.00 |
| 3825001 | FRACTURE / PELVIC RING CLOSED TX | $ | 2,110.00 |
| 3825300 | BURN SM DEBRIDEMENT NO ANES | $ | 242.00 |
| 3825400 | BURN MED DEBRIDEMENT NO ANES | $ | 494.00 |
| 3825401 | DRESS/ DEBRIDE PARTIAL THICK BURN MED | $ | 475.00 |
| 3825402 | FRACTURE / TALUS W MANIP | $ | 1,436.00 |
| 3825500 | BURN/LG DEBRIDE/NO ANES | $ | 587.00 |
| 3825501 | INJECTION,JOINT,BURSA | $ | 113.00 |
| 3825502 | PELVIC EXAM/ ANESTHESIA | $ | 176.00 |
| 3825530 | AMPUTATION FINGER/ THUMB | $ | 2,894.00 |
| 3825531 | AMPUTATION FINGER/ THUMB | $ | 2,894.00 |
| 3825533 | FRACTURE/CARPAL SCAPHOID | $ | 1,245.00 |
| 3825540 | FRACTURE / RAD ULNAR W MANIP | $ | 2,099.00 |
| 3825582 | INCISE EXTER HEMORRHOID | $ | 476.00 |
| 3825586 | REPAIR SIMPLE FAC 7.6-12 | $ | 277.00 |
| 3825595 | FRACTURE / NASAL | $ | 119.00 |
| 3825597 | FRACTURE/ ULNAR SHAFT | $ | 581.00 |
| 3825600 | FRACTURE/CLAVICLE WO MAN | $ | 544.00 |
| 3825601 | FRACTURE VERTEBRAL | $ | 775.00 |
| 3825602 | FRACTURE/VERTEBRAL WO MAN | $ | 1,241.00 |
| 3825606 | FRACTURE / ACROMIOCLAVICLE | $ | 1,027.00 |
| 3825607 | FRACTURE / ACROMICLAVICLE W MANIP | $ | 1,414.00 |
| 3825610 | FRACTURE/NASAL WO MANIPU | $ | 119.00 |
| 3825611 | FRACTURE / PROX HUMERAL W MAN | $ | 1,892.00 |
| 3825612 | FRACTURE/TUBEROSITY WO MA | $ | 1,153.00 |
| 3825613 | FRACTURE/TUBEROSITY W MAN | $ | 1,577.00 |
| 3825616 | FRACTURE/HUMERAL SHAFT | $ | 1,459.00 |
| 3825618 | FRACTURE/DISLOC ELBOW | $ | 1,496.00 |
| 3825620 | FRACTURE/NASAL WO STABLIZ | $ | 693.00 |
| 3825621 | FRACTURE/MONTEGGIA ELBOW | $ | 2,448.00 |
| 3825622 | FRACTURE/RAD HEAD CHILD | $ | 427.00 |
| 3825623 | FRACTURE/RADIAL HEAD-NECK | $ | 1,081.00 |
| 3825624 | FRACTURE / RADIAL HEAD W MANIP | $ | 1,779.00 |
| 3825625 | FRACTURE/ULNAR PROX WO MA | $ | 644.00 |
| 3825626 | FRACTURE/ULNAR W MAN | $ | 1,851.00 |
| 3825627 | FRACTURE / RADIAL SHAFT WO | $ | 613.00 |
| 3825629 | FRACTURE/GALEAZZI RADIAL | $ | 2,377.00 |
| 3825630 | FRACTURE/NASAL W STABILIZ | $ | 608.00 |
| 3825631 | FRACTURE/ULNAR SHAFT | $ | 1,065.00 |
| 3825632 | FRACTURE/ULNAR SHAFT W MA | $ | 2,015.00 |
| 3825633 | FRACTURE/RAD ULNAR SHAFT | $ | 1,131.00 |
| 3825638 | FRACTURE/CARPAL SCAP W MA | $ | 1,931.00 |
| 3825639 | FRACTURE/CARPAL BONE | $ | 1,254.00 |
| 3825641 | FRACTURE/CARPAL BO W MAN | $ | 1,790.00 |
| 3825643 | FRACTURE/RADIO-INTERCARPA | $ | 1,824.00 |
| 3825645 | FRACTURE / TRANS- SCAPHOPERI | $ | 2,123.00 |
| 3825646 | FRACTURE/LUNATE DISLOCAT | $ | 2,127.00 |
| 3825650 | FRACTURE/STERNUM CLOSED | $ | 659.00 |
| 3825651 | FRACTURE/THUMB-BENNETT | $ | 2,117.00 |
| 3825652 | FRACTURE / CARPOMETACARPAL | $ | 1,338.00 |
| 3825655 | FRACTURE/COCCYX | $ | 841.00 |
| 3825656 | FRACTURE/FEMORAL | $ | 2,096.00 |
| 3825657 | FRACTURE / GREATER TROCHANTER | $ | 1,712.00 |
| 3825658 | FRACTURE / HIP DISLOCATION | $ | 790.00 |
| 3825659 | FRACTURE/PATELLA WO MANIP | $ | 1,326.00 |
| 3825661 | FRACTURER / TIBIA WO MANIP | $ | 1,263.00 |
| 3825666 | FRACTURE/ANKLE | $ | 1,356.00 |
| 3825667 | FRACTURE/ANKLE DISLOCATIO | $ | 1,671.00 |
| 3825669 | FRACTURE/TALUS | $ | 948.00 |
| 3825671 | FRACTURE/TARSAL BONE | $ | 871.00 |
| 3825676 | FRACTURE/GREAT TOE W MANI | $ | 681.00 |
| 3825679 | FRACTURE/TARSAL BONE | $ | 794.00 |
| 3825680 | FRACTURE / ORBIT WO MANIP | $ | 718.00 |
| 3825681 | CAST/SHOULDER TO HAND | $ | 304.00 |
| 3825682 | CAST/ELBOW TO FINGER | $ | 278.00 |
| 3825683 | CAST/HAND & FOREARM | $ | 300.00 |
| 3825684 | CAST/HIP SPICA-ONE LEG | $ | 707.00 |
| 3825686 | CAST/LONG WALKING | $ | 473.00 |
| 3825687 | CAST/CYLINDER | $ | 390.00 |
| 3825688 | CAST/SHORT LEG | $ | 132.00 |
| 3825689 | CAST/SHORT WALKING | $ | 254.00 |
| 3825690 | FRACTURE/TEMPOROMANDIBULA | $ | 143.00 |
| 3825691 | SPLINT/LONG ARM | $ | 266.00 |
| 3825692 | SPLINT/SHORT ARM | $ | 178.00 |
| 3825694 | UNNA BOOT,REMOVAL/REPAIR | $ | 147.00 |
| 3825695 | UNNA BOOT APPLICATION | $ | 158.00 |
| 3825696 | SPLINT/LONG LEG | $ | 223.00 |
| 3825697 | SPLINT/ SHORT LEG | $ | 223.00 |
| 3825698 | CAST, FULL ARM/REMOVAL | $ | 206.00 |
| 3825700 | NAIL/DEBRIDEMENT | $ | 64.00 |
| 3825701 | CAST/HAND & FOREARM | $ | 300.00 |
| 3825704 | FRACTURE / LAT EPICONDYL | $ | 1,293.00 |
| 3825705 | FRACTURE / TIBIA W MANIP | $ | 2,547.00 |
| 3825708 | REMOVAL FB DEEP/FINGER | $ | 1,103.00 |
| 3825709 | DISLOCATION/HIP/ANESTHESI | $ | 3,336.00 |
| 3825711 | CAST,FULL ARM/REMOVAL | $ | 206.00 |
| 3825713 | CAST CYLINDER | $ | 390.00 |
| 3825714 | CAST/ELBOW-FINGER | $ | 278.00 |
| 3825715 | CAST/HIP SPICA,ONE LEG | $ | 707.00 |
| 3825716 | CAST/LONG LEG | $ | 447.00 |
| 3825717 | CAST/LONG WALKING | $ | 473.00 |
| 3825719 | CAST/SHORT WALKING | $ | 254.00 |
| 3825730 | NAIL / EXCISION OF | $ | 779.00 |
| 3825734 | FRACTURE SUPRACONDYLAR | $ | 847.00 |
| 3825736 | DISLOCATION POST HIP ARTH | $ | 1,795.00 |
| 3825737 | DISLOC POST HIP ARTH/ANES | $ | 2,560.00 |
| 3825744 | FRACTURE/ METATARSAL OPEN | $ | 2,362.00 |
| 3825750 | NAIL / WEDGE EXCISION | $ | 420.00 |
| 3825752 | FRACTURE/TIBIA/FIBULA | $ | 780.00 |
| 3825753 | FRACTURE/NASAL SEPTAL | $ | 720.00 |
| 3825756 | FRACTURE/ULNAR PROXIMAL | $ | 1,179.00 |
| 3825760 | FRACTURE/DISTAL TIBIA | $ | 1,361.00 |
| 3825766 | REPAIR/ INTER FACE 7.6-12 | $ | 593.00 |
| 3825778 | FRACTURE / PELVIC RING | $ | 2,110.00 |
| 3825781 | FRACTURE / ARTICULAR CLOSED | $ | 964.00 |
| 3825782 | FRACTURE SUPRACONDYLAR | $ | 1,537.00 |
| 3825783 | FRACTURE/PHALANGE ARTICUL | $ | 964.00 |
| 3825784 | SPLINT/ LONG LEG | $ | 223.00 |
| 3825785 | EXCISION LESION FACE 0.5C | $ | 561.00 |
| 3825786 | DISLOCATION / FINGER W AN | $ | 1,555.00 |
| 3825788 | FX PELVIC RING | $ | 2,110.00 |
| 3825789 | REMOVAL NASAL FOREIGN BOD | $ | 944.00 |
| 3825791 | MEDIAL MALLEOLUS FX / MAN | $ | 1,935.00 |
| 3825798 | DISLOCATION POST HIP ARTH | $ | 1,795.00 |
| 3825804 | FRACTURE/DISLO PATELLA AN | $ | 1,188.00 |
| 3825805 | FRACTURE/DISLO PATELLA AN | $ | 2,136.00 |
| 3825806 | REPAIR SIMPLE FAC 5.1-7.5 | $ | 231.00 |
| 3825810 | FRACTURE /NASAL W/O STABI | $ | 759.00 |
| 3825811 | FRACTURE/ LOWER JAW | $ | 2,266.00 |
| 3825818 | REPAIR/ COMPLEX 2.5-5.0 | $ | 903.00 |
| 3825824 | SPLINT / LONG ARM | $ | 266.00 |
| 3825827 | SPLINT / FINGER | $ | 126.00 |
| 3825828 | BIOPSY/REMOV LYMPH NODE | $ | 1,114.00 |
| 3825829 | STRAPPING OF SHOULDER | $ | 47.00 |
| 3825831 | CASTING STRAPPING PROCED | $ | 133.00 |
| 3825832 | EXCIS BENIGN LESION 0.5CM | $ | 368.00 |
| 3825834 | EXTERNAL PACING | $ | 48.00 |
| 3825835 | CYSTOSTOMY TUBE/ CHANGE | $ | 227.00 |
| 3825836 | INSERTION FOLEY CATHETER | $ | 132.00 |
| 3825837 | FRACTURE/BIMALLEOLAR W MA | $ | 1,904.00 |
| 3825839 | TRIGGER POINT INJECT 1-2 | $ | 168.00 |
| 3825841 | REPAIR LAC TONGUE 2.6 | $ | 958.00 |
| 3825843 | REMOVAL FB DEEP | $ | 1,103.00 |
| 3825844 | FRACTURE COCCYX | $ | 841.00 |
| 3825847 | DISLOCATION / TOE | $ | 180.00 |
| 3825849 | TRIGGER POINT INJECTION | $ | 168.00 |
| 3825850 | REPAIR LEG TENDON | $ | 1,687.00 |
| 3825852 | FRACTURE / STERNUM CLOSED | $ | 659.00 |
| 3825853 | FX / TIBIA DISLOC MANIP | $ | 2,199.00 |
| 3825854 | INSERTION FOLEY CATHETER | $ | 132.00 |
| 3825855 | FX / POST MALLEOLUS W MAN | $ | 1,954.00 |
| 3825859 | FRACTURE / HUMERUS | $ | 2,219.00 |
| 3825860 | REPAIR FINGER/ TENDON | $ | 3,170.00 |
| 3825862 | FRACTURE DISTAL TIBIA MAN | $ | 2,176.00 |
| 3825864 | THORACENTESIS W/O IMAG | $ | 400.00 |
| 3825865 | THORACENTESIS W IMAG | $ | 496.00 |
| 3825866 | FRACTURE FIBULA | $ | 1,726.00 |
| 3825868 | FRACTURE/ RAD SHAFT W MAN | $ | 2,048.00 |
| 3825871 | TREATMENT DISLOCATION TALOTARSAL | $ | 1,477.00 |
| 3825875 | FRACTURE DISTAL TIBIA | $ | 2,176.00 |
| 3825881 | DISLOCATION TOE | $ | 180.00 |
| 3825972 | EAR IRRIGATION/LAVAGE | $ | 144.00 |
| 3825999 | FRACTURE/FIBULA | $ | 1,258.00 |
| 3826000 | NASAL DRAINAGE/ABCESS | $ | 537.00 |
| 3826100 | NASAL SEPTUM/DRAIN ABSCES | $ | 540.00 |
| 3827029 | DISLOCATION HIP ANES | $ | 3,336.00 |
| 3827031 | EAR IRRIGATION/LAVAGE | $ | 144.00 |
| 3827032 | EAR/COMPLEX DRAIN EXT | $ | 713.00 |
| 3827101 | NASAL HEM / ANY METHOD | $ | 246.00 |
| 3827102 | NASAL HEM / ANY METHOD | $ | 246.00 |
| 3827200 | NASAL HEM/COMPLEX | $ | 350.00 |
| 3827400 | NASAL HEM / NASAL PACK / CAUT | $ | 442.00 |
| 3827401 | NASAL HEMOR/ PACK CAUT | $ | 442.00 |
| 3827500 | EAR/DRAINAGE ABSCESS EXT | $ | 544.00 |
| 3827501 | EAR/DRAINAGE ABCESS EXT | $ | 544.00 |
| 3827600 | EAR/COMPLEX DRAINAGE EXT | $ | 713.00 |
| 3827700 | EAR/DRAIN EXT AUD CANAL | $ | 654.00 |
| 3827701 | EAR/DRAIN EXT AUD CANAL | $ | 654.00 |
| 3827800 | EAR/REMOVAL FOREIGN BODY | $ | 263.00 |
| 3827801 | EAR/REMOVAL FOREIGN BODY | $ | 116.00 |
| 3827802 | REMOVAL FB/ARM DEEP | $ | 1,615.00 |
| 3827803 | REMOVAL FB SUBCUT | $ | 621.00 |
| 3827805 | REMOV FOREIGN BODY EAR/AN | $ | 464.00 |
| 3827902 | APPLICATION SHORT ARM | $ | 219.00 |
| 3828101 | ANOSCOPY | $ | 195.00 |
| 3828105 | BREAST CYST ASPIRATION | $ | 189.00 |
| 3828107 | NORPLANT REMOVAL | $ | 420.00 |
| 3828108 | LUMBAR PUNCTURE | $ | 345.00 |
| 3828111 | PHLEBOTOMY | $ | 453.00 |
| 3828113 | ABD PARACENTESIS W/O IMAG | $ | 322.00 |
| 3828115 | ANAL ABCESS | $ | 440.00 |
| 3828116 | INCISION RECTAL ABSCESS | $ | 1,842.00 |
| 3828117 | ANAL ABSCESS | $ | 440.00 |
| 3828201 | NASAL HEM/COMPLEX | $ | 350.00 |
| 3828742 | FX/DISLOC THUMB | $ | 1,733.00 |
| 3829001 | PHARYNX / REMOVAL / FB | $ | 607.00 |
| 3829002 | EYE / REMOVAL FB SUPERFICIAL | $ | 200.00 |
| 3829003 | PHARYNX / REMOVAL FB | $ | 607.00 |
| 3829100 | EYE / REMOVAL IMBEDDED FB | $ | 242.00 |
| 3829202 | EYE / CORNEA FB W/O SLIT LAMP | $ | 189.00 |
| 3829300 | EYE / CORNEA FB W SLIT LAMP | $ | 241.00 |
| 3829400 | EYE/LACERATION SCLERA | $ | 642.00 |
| 3829600 | EYE / REMOVAL FB EYELID | $ | 532.00 |
| 3829700 | EYE/DRAIN LACRIMAL GLAND | $ | 609.00 |
| 385557 | ARTHROCENTESIS SM JOINT FINER TOES | $ | 152.00 |
| 3450219 | EKC ROUTINE | $ | 204.00 |
| 3450220 | EKG TRACING W/O I&R | $ | 265.00 |
| 3450221 | EKG TRACING W/O I&R | $ | 265.00 |
| 3450222 | EKG TRACING W/O I&R | $ | 265.00 |
| 3450225 | EKG | $ | 265.00 |
| 3450226 | EKG | $ | 265.00 |
| 3450233 | EKG RHYTHM | $ | 32.00 |
| 3450234 | EKG RHYTHM | $ | 32.00 |
| 3450278 | EKG STRESS | $ | 859.00 |
| 3450279 | EKG STRESS / DISCONTINUED | $ | 859.00 |
| 3450280 | EKG STRESS / REDUCED | $ | 859.00 |
| 3450347 | ECG MONITOR / REPORT 48HR | $ | 425.00 |
| 3450348 | EVENT MONITOR 30 DAY SET/ | $ | 197.00 |
| 3450500 | ZIOPATCH 24-48 HRS ELECTROCARDIO MONITOR | $ | 286.00 |
| 3450501 | ZIOPATCH 3-14 DAYS ELECTROCARDIO MONITOR | $ | 286.00 |
| 3452000 | EMG/ 1 EXTREMITY | $ | 143.00 |
| 3452001 | EMG/ 2 EXTREMITY | $ | 174.00 |
| 3452005 | NEUROMUSCULAR JUNCTION | $ | 80.00 |
| 3452006 | EMG/ 3 EXTREMITY | $ | 232.00 |
| 3453000 | EEG/ AWAKE & DROWSY | $ | 546.00 |
| 3453001 | EEG/ ASLEEP | $ | 455.00 |
| 3453002 | EEG/AWAKE & ASLEEP RECORD | $ | 627.00 |
| 3453003 | EEG/EXT 1HR MONITORING | $ | 594.00 |
| 3453004 | EEG / RXT MORE THAN 1 HR | $ | 754.00 |
| 3453005 | MONITORING 24HR AMBULATOR | $ | 945.00 |
| 3453006 | MONITORING 24HR RECORD | $ | 4,050.00 |
| 3453007 | SSER,UPPER LIMBS | $ | 216.00 |
| 3453008 | SSER,LOWER LIMBS | $ | 216.00 |
| 3456221 | TC-99M SESTAMIBI PER ST | $ | 300.00 |
| 3456223 | MYOCARDIAL PERF/SINGLE | $ | 1,996.00 |
| 3456224 | MYOCARDIAL PERFUS IMAG | $ | 3,342.00 |
| 3456225 | MYOCARDIAL PERFUSION IMAG | $ | 3,342.00 |
| 3105652 | ALLERGY INJECTIONS | $ | 31.00 |
| 3105653 | ALLERGY INJECTIONS 2 + INJECT | $ | 41.00 |
| 3105655 | THERAPEUTIC INJECTION | $ | 150.00 |
| 3105683 | IM INJECTION/THERAPEUTIC | $ | 150.00 |
| 3105686 | IV THERAPY/ 1 HR | $ | 795.00 |
| 3105687 | IV THERAPY, ADD HR | $ | 152.00 |
| 3105693 | IV THERAPY 1 HR | $ | 181.00 |
| 3105694 | IV THERAPY ADD HR | $ | 55.00 |
| 3105700 | THERAPEUTIC INJECTION | $ | 150.00 |
| 3602001 | D5W 250ML GLASS | $ | 25.00 |
| 3602002 | NITRO/D5W 250MG 50MG | $ | 23.00 |
| 3602003 | KCL/H20 100ML | $ | 13.00 |
| 3602005 | D5W 1000CC | $ | 29.00 |
| 3602056 | D5 .45NS 20KCL | $ | 42.00 |
| 3602065 | D5%-.9NS 1000CC | $ | 30.00 |
| 3602085 | .9NS 1000CC | $ | 26.00 |
| 3602095 | .9NS 250ML | $ | 22.00 |
| 3602100 | .9NS 100CC | $ | 32.00 |
| 3602110 | .45NS-WATER 1000CC | $ | 29.00 |
| 3602135 | AMINOSYN 7% 500CC | $ | 146.00 |
| 3602140 | LIPIDS 10% FAT EMULS | $ | 149.00 |
| 3602145 | MANNITOL 20% 500CC | $ | 148.00 |
| 3602160 | .9NS 100ML MINI BAG | $ | 30.00 |
| 3602305 | LIDOCAINE 2GMS-250ML D5W | $ | 25.00 |
| 3602307 | MAG SULFATE 40MG/ML 1000M | $ | 32.00 |
| 3602308 | MAG SULFATE 40MG/ML 100ML | $ | 28.00 |
| 3602310 | HYPERALIMENTATION (TPN)1L | $ | 233.00 |
| 3602312 | NORMAL SALINE IRRIG 3L | $ | 41.00 |
| 3602313 | STERILE WATER IRRIG 3L | $ | 41.00 |
| 3602315 | 500ML NS | $ | 28.00 |
| 3602317 | GLYCINE 1.5% IRRIG. 3L | $ | 51.00 |
| 3602400 | HEPARIN 25MU IN 500ML D5W | $ | 18.00 |
| 3602401 | HESPAN 6% 500ML | $ | 36.00 |
| 3602405 | DOPAMINE 400MG-D5W 250ML | $ | 83.00 |
| 3602406 | EVAC. CONTAINER 2000ML | $ | 58.00 |
| 3602414 | .9NS 20KCL 1L | $ | 44.00 |
| 3602999 | IV MISC | $ | 0.00 |
| 3350001 | HEALTH FAIR PANEL | $ | 31.00 |
| 3350002 | HEALTH FAIR PANEL EMP/SPO | $ | 19.00 |
| 3350998 | PATERNITY | $ | 30.00 |
| 3351001 | OVA AND PARASITES | $ | 88.00 |
| 3351004 | TRICHROME STAIN | $ | 88.00 |
| 3351006 | OVA AND PARASITE #2 | $ | 88.00 |
| 3351007 | OVA AND PARASITE #3 | $ | 88.00 |
| 3351042 | CITRIC ACID, URINE ARUP | $ | 70.00 |
| 3351043 | OXALATE, URINE ARUP | $ | 73.00 |
| 3351044 | VOLUME MEASUREMENT | $ | 51.00 |
| 3351045 | ALDOSTERONE, URINE ARUP | $ | 84.00 |
| 3351046 | URINE CULTURE | $ | 109.00 |
| 3351047 | VOLUME MEASUREMENT | $ | 51.00 |
| 3351050 | WBC STOOL/ LACTOFERRIN | $ | 158.00 |
| 3351051 | EXTERNAL PARASITE ID | $ | 71.00 |
| 3351052 | WBC STOOL | $ | 71.00 |
| 3351053 | WBC STOOL/ LACTOFERRIN #2 | $ | 158.00 |
| 3351054 | WBC STOOL/ LACTOFERRIN #3 | $ | 158.00 |
| 3351055 | BABESIA SPECIES ARUP | $ | 832.00 |
| 3351056 | BABESIA MICROTI ARUP | $ | 277.00 |
| 3351900 | B CELLS, TOTAL COUNT | $ | 80.00 |
| 3351901 | NK CELLS, TOTAL COUNT | $ | 80.00 |
| 3351902 | T CELLS, TOTAL COUNT | $ | 80.00 |
| 3351903 | MONONUCLEAR CELL ANTIGEN, EA ANTIGEN | $ | 80.00 |
| 3351904 | MONONUCLEAR CELL ANTIGEN, EA ANTIGEN | $ | 80.00 |
| 3351905 | T CELLS; ABSOLUTE CD4 & CD8 COUNT/ RATIO | $ | 80.00 |
| 3352000 | OCCULT BLOOD FECES 1-3 TE | $ | 42.00 |
| 3352001 | OCCULT BLOOD | $ | 42.00 |
| 3352003 | STOOL ADD PATHOGENS | $ | 68.00 |
| 3352008 | OCCULT BLOOD TRI CARD | $ | 42.00 |
| 3352009 | PROTEIN; ELECT FRACT(URIN | $ | 337.00 |
| 3352010 | HYDROXYPREGNENOLONE 17 AS | $ | 386.00 |
| 3352011 | PROTEIN;ELECT FRACT (URIN | $ | 337.00 |
| 3352012 | DNA SEQ BACT ID ARUP | $ | 738.00 |
| 3352013 | ALLERGEN SINGLE SPECIFIC IgG | $ | 56.00 |
| 3352014 | ALLERGEN SINGLE SPECIFIC IgG | $ | 56.00 |
| 3352015 | CHROMOSOME ANALYSIS 20-25 | $ | 558.00 |
| 3352017 | GIARDIA AG , EIA | $ | 99.00 |
| 3352018 | STOOL ADD PATHOGENS ADDIT | $ | 68.00 |
| 3352019 | C DIFF TOXIN #2 | $ | 93.00 |
| 3352020 | GC/ CHL - URINE | $ | 247.00 |
| 3352021 | PHENYTOIN, FREE | $ | 199.00 |
| 3352022 | HEP B SURF AG (REFLEX)I | $ | 146.00 |
| 3352024 | NEPHELOMETRY | $ | 233.00 |
| 3352026 | BK VIRUS QUANT PCR | $ | 1,519.00 |
| 3352027 | MYCOPLASMA IGG/ IGM | $ | 133.00 |
| 3352028 | IP STAIN / HERP CULT | $ | 147.00 |
| 3352029 | PROTEIN ASSAY | $ | 73.00 |
| 3352030 | TEGRETOL (CARBAMAZ) FREE | $ | 183.00 |
| 3352031 | IGG 2 | $ | 70.00 |
| 3352033 | CREATINE / ASSAY | $ | 378.00 |
| 3352036 | PARVOVIRUS IGM | $ | 93.00 |
| 3352037 | PARVOVIRUS IgM | $ | 93.00 |
| 3352039 | OPIATES / CONF SERUM | $ | 216.00 |
| 3352040 | HERPES SIMPLEX 2,AG,IF | $ | 203.00 |
| 3352041 | ENTEROVIRUS / ANTIBODY | $ | 98.00 |
| 3352042 | BARTONELLA, DNA, AMP PROB | $ | 591.00 |
| 3352043 | ASSAY ADP / AMP | $ | 306.00 |
| 3352044 | CALCIUM, TOTAL IONIZED | $ | 229.00 |
| 3352046 | PROTEIN - FLUIDS | $ | 39.00 |
| 3352047 | CYTOMEGALOVIRUS, DNA,QUAN | $ | 723.00 |
| 3352048 | D-DIMER | $ | 88.00 |
| 3352049 | MYELOPEROXIDASE | $ | 226.00 |
| 3352050 | OSMOLALITY / URINE | $ | 51.00 |
| 3352051 | IMMUNOFLUOR STUDY INDIR | $ | 129.00 |
| 3352052 | IMMUNOFLOUR STDY INDIR | $ | 129.00 |
| 3352053 | SEX HORMONE BINDING GLOBU | $ | 256.00 |
| 3352054 | FIBRIN DEGRADATION | $ | 252.00 |
| 3352055 | MASS SPECTROMETRY QUANT | $ | 71.00 |
| 3352056 | MACROSCOPIC EXAM ARTHROPO | $ | 93.00 |
| 3352057 | ENDOMYSIAL AB A TITER | $ | 293.00 |
| 3352058 | DNAse AB | $ | 59.00 |
| 3352060 | ALBUMIN / FLUID | $ | 37.00 |
| 3352061 | BICARBONATE (HCO3) | $ | 84.00 |
| 3352063 | PARVOVIRUS IgG | $ | 93.00 |
| 3352064 | PARVOVIRUS IgG | $ | 93.00 |
| 3352065 | H PYLORI ANTIBODY IgG ARU | $ | 67.00 |
| 3352066 | H PYLORI ANTIBODY IgM ARU | $ | 67.00 |
| 3352067 | MITOCHONDRAIL ANTI ARUP | $ | 131.00 |
| 3352068 | TSH, W / REF 2 FREE T4 | $ | 146.00 |
| 3352069 | FACTOR XI, ACTIVITY | $ | 275.00 |
| 3352070 | INHIBIN B ARUP | $ | 544.00 |
| 3352071 | GLUCOSE TOLER 3HR | $ | 168.00 |
| 3352072 | CHOLESTEROL, FLUID ARUP | $ | 39.00 |
| 3352073 | LACOSAMIDE ARUP | $ | 192.00 |
| 3352074 | G-6-PD ARUP | $ | 84.00 |
| 3352075 | BILIRUBIN, TOTAL BF ARUP | $ | 37.00 |
| 3352076 | SPECIFIC GRAVITY ARUP | $ | 42.00 |
| 3352077 | GANGLIOSIDE ANTI GM,GD,GQ | $ | 131.00 |
| 3352078 | RUBELLA ANTIBODY IgG ARUP | $ | 51.00 |
| 3352079 | TISSUE CULTURE | $ | 327.00 |
| 3352080 | FETAL MATERNAL SCREEN AHL | $ | 202.00 |
| 3352081 | KLEIHAUER-BETKE STAIN AHL | $ | 286.00 |
| 3352082 | LACTATE | $ | 145.00 |
| 3352083 | NOROVIRUS GRP 1&2 ARUP | $ | 551.00 |
| 3352084 | CHROMOGRANIN A ARUP | $ | 255.00 |
| 3352085 | NOROVIRUS GRP 1&2 ARUP | $ | 551.00 |
| 3352086 | METHAMPHETAMINE / MEDTOX | $ | 216.00 |
| 3352087 | MYELIN ASSOC GLYCOPROTEIN | $ | 131.00 |
| 3352088 | MYELOPEROXIDASE AB-ARUP | $ | 131.00 |
| 3352089 | SERINE PROTEASE 3- ARUP | $ | 131.00 |
| 3352090 | ISLET CELL ANTI, IgG-ARUP | $ | 118.00 |
| 3352091 | GLUTA ACID DECAR ANTI -AR | $ | 131.00 |
| 3352092 | ARIPIPRAZOLE - ARUP | $ | 891.00 |
| 3352093 | OLANZAPINE - ARUP | $ | 388.00 |
| 3352094 | BPERT - ARUP | $ | 363.00 |
| 3352095 | GBM-AbIgA - ARUP | $ | 337.00 |
| 3352096 | GBM-AbIgG - ARUP | $ | 337.00 |
| 3352097 | INFLUENZA ASSAY W/ OPTIC | $ | 133.00 |
| 3352098 | PROSTATE SPEC ANTIG | $ | 315.00 |
| 3352099 | GLUCOSE | $ | 31.00 |
| 3352100 | GLUCOSE | $ | 31.00 |
| 3352101 | CALCIUM | $ | 80.00 |
| 3352102 | KETONES - SERUM | $ | 74.00 |
| 3352103 | ARTERIAL BLOOD GASES | $ | 315.00 |
| 3352104 | ACETAMINOPHEN/ INITIAL | $ | 268.00 |
| 3352105 | CALCIUM | $ | 80.00 |
| 3352106 | AMMONIA | $ | 245.00 |
| 3352107 | GLUCOSE TOLER 3HR | $ | 168.00 |
| 3352108 | ARTERIAL BG ADDITIONAL | $ | 315.00 |
| 3352111 | HBsAg | $ | 32.00 |
| 3352112 | ALBUMIN | $ | 84.00 |
| 3352113 | BUN,UREA NITROGEN | $ | 73.00 |
| 3352114 | HBcAb | $ | 35.00 |
| 3352115 | SODIUM | $ | 71.00 |
| 3352116 | SODIUM | $ | 71.00 |
| 3352117 | HBsAB | $ | 51.00 |
| 3352118 | HEP A AB | $ | 51.00 |
| 3352119 | HIV | $ | 141.00 |
| 3352120 | POTASSIUM | $ | 76.00 |
| 3352121 | CARBON MONOXIDE | $ | 208.00 |
| 3352122 | VIRAL CULTURE NON-RESP | $ | 327.00 |
| 3352123 | BUN, ADDITIONAL | $ | 73.00 |
| 3352124 | PROSTATE SPEC ANTIGEN | $ | 315.00 |
| 3352125 | POTASSIUM | $ | 76.00 |
| 3352126 | CHLORIDE | $ | 76.00 |
| 3352127 | CHLORIDE | $ | 76.00 |
| 3352128 | H PYLORI | $ | 67.00 |
| 3352130 | CHOLESTEROL | $ | 65.00 |
| 3352131 | TRIGLYCERIDE | $ | 97.00 |
| 3352132 | HDL CHOLESTEROL | $ | 139.00 |
| 3352134 | IGM ANTIBODY | $ | 76.00 |
| 3352135 | PSA MC SCREEN | $ | 315.00 |
| 3352136 | ALLERGEN EA ARUP | $ | 28.00 |
| 3352138 | MYCOPLASMA PNEUMONIAE PCR ARUP | $ | 409.00 |
| 3352139 | IGF BINDING PROTEIN -1 ARUP | $ | 575.00 |
| 3352141 | MMA | $ | 133.00 |
| 3352143 | BLADDER TUMOR AG | $ | 269.00 |
| 3352144 | ROHIPNOL ARUP | $ | 21.00 |
| 3352146 | TOBRAMYCIN NCL | $ | 272.00 |
| 3352147 | TOTAL PROTEIN | $ | 73.00 |
| 3352148 | BILI DIRECT | $ | 140.00 |
| 3352149 | VIRUS ISOL/ID | $ | 572.00 |
| 3352150 | ELECTROLYTE PANEL | $ | 46.00 |
| 3352151 | URIC ACID | $ | 74.00 |
| 3352152 | HEPATITIS PANEL | $ | 233.00 |
| 3352153 | HEPATITIS C ANTIBODY | $ | 67.00 |
| 3352154 | ELECTROLYTE PANEL | $ | 46.00 |
| 3352156 | APOLIPOPROTEIN | $ | 219.00 |
| 3352158 | CELIAC TTG-IgG | $ | 131.00 |
| 3352159 | BETA 2 GLYCOPROTEIN IGG | $ | 109.00 |
| 3352160 | BILI TOTAL | $ | 37.00 |
| 3352161 | PCP CONFIRMATION | $ | 249.00 |
| 3352162 | METADONE CONFIRMATION | $ | 276.00 |
| 3352164 | ZINC | $ | 59.00 |
| 3352166 | DHEA-S | $ | 51.00 |
| 3352167 | HYDROXYPROGESTERONE | $ | 84.00 |
| 3352169 | CELIAC GLIADIN-IgA | $ | 131.00 |
| 3352170 | BETA 2 GLYCOPROTEIN IGM | $ | 109.00 |
| 3352171 | PLATELET NEUTRALIZATION | $ | 221.00 |
| 3352172 | PLATELET NEUTRALIZTION | $ | 221.00 |
| 3352173 | THYROID STIM IMMUNE GLOBU | $ | 332.00 |
| 3352174 | POTASSIUM FECAL ARUP | $ | 62.00 |
| 3352175 | OSMOLATLITY FECAL ARUP | $ | 62.00 |
| 3352176 | HERPES I AB | $ | 113.00 |
| 3352177 | HERPES II AB | $ | 113.00 |
| 3352178 | LIPOPROTEIN A | $ | 219.00 |
| 3352179 | CALCITONIN | $ | 453.00 |
| 3352181 | CELIAC GLIADIN IgG | $ | 131.00 |
| 3352182 | SEROTONIN | $ | 383.00 |
| 3352183 | ZINC PROTOPORPHYIN ARUP | $ | 73.00 |
| 3352184 | IG - A NCL | $ | 56.00 |
| 3352185 | CELIAC TTG-IgA | $ | 131.00 |
| 3352186 | INHIBIN A | $ | 183.00 |
| 3352187 | BABESIA IGG | $ | 99.00 |
| 3352189 | SHIGA-LIKE TOXIN AG | $ | 80.00 |
| 3352190 | SHIGA-LIKE TOXIN AG ADDIT | $ | 80.00 |
| 3352191 | BLASTOMYCES ANTIBODY | $ | 98.00 |
| 3352195 | CREATININE | $ | 86.00 |
| 3352196 | CREATININE | $ | 86.00 |
| 3352199 | VITAMIN B6 | $ | 95.00 |
| 3352200 | HIV RNA QUAN REALTIME PCR | $ | 1,435.00 |
| 3352201 | VITAMIN D 25OH | $ | 76.00 |
| 3352202 | SOLU TRANSFERRIN REC ARUP | $ | 99.00 |
| 3352203 | T CELLS, TOTAL COUNT | $ | 637.00 |
| 3352204 | NK CELLS, TOTAL COUNT | $ | 637.00 |
| 3352205 | T CELL, ABSOLUTE COUNT RA | $ | 792.00 |
| 3352206 | PROTEIN C ANTIGEN | $ | 203.00 |
| 3352207 | LACOSAMIDE ARUP | $ | 192.00 |
| 3352208 | TOXOPLASMA IGG | $ | 51.00 |
| 3352209 | BILI DIRECT | $ | 140.00 |
| 3352210 | VENOUS BLOOD GASES | $ | 315.00 |
| 3352211 | VENOUS BLOOD GASES | $ | 315.00 |
| 3352212 | BORDETELLA PERTU/PARA PCR | $ | 247.00 |
| 3352213 | OXYCARB | $ | 192.00 |
| 3352214 | NON DESIGNATED DRUG | $ | 192.00 |
| 3352215 | LAMICTAL (LAMOTRIGENE_ | $ | 91.00 |
| 3352216 | MYCOPHENOLIC ACID (MPA) | $ | 118.00 |
| 3352217 | ZONISAMIDE | $ | 192.00 |
| 3352218 | KEPPRA (LEVETIRACETAM) | $ | 192.00 |
| 3352219 | SEROQUEL (QUETIAPINE) | $ | 192.00 |
| 3352220 | TOTAL PROTEIN (PART OF BJ | $ | 45.00 |
| 3352221 | BILI NEONATE | $ | 140.00 |
| 3352222 | ANCA | $ | 128.00 |
| 3352223 | STOOL CULTURE YERSINIA | $ | 188.00 |
| 3352224 | GLUCOSE CSF | $ | 30.00 |
| 3352225 | PROTEIN CSF | $ | 39.00 |
| 3352226 | TRICHROME STAIN #2 | $ | 88.00 |
| 3352227 | TRICHROME STAIN #3 | $ | 88.00 |
| 3352228 | C DIFF TOXIN #3 | $ | 93.00 |
| 3352229 | STRIATED MUSCLE AB REFLEX | $ | 293.00 |
| 3352230 | ESTROGENS / FRACTIONATED | $ | 208.00 |
| 3352231 | HUMAN GROWTH HORMONE | $ | 84.00 |
| 3352232 | THYROGLOBULIN ARUP | $ | 201.00 |
| 3352233 | KOH WET PREP | $ | 71.00 |
| 3352236 | MICRO STREP PANEL | $ | 124.00 |
| 3352237 | SHIGA-LIKE TOXIN AG #3 | $ | 80.00 |
| 3352238 | STOOL ADD PATHOGENS #3 | $ | 68.00 |
| 3352239 | PROTEIN/ CREAT URINE ARUP | $ | 39.00 |
| 3352240 | MMA / SERUM | $ | 133.00 |
| 3352241 | HERPES SIMPLEX TYPE I | $ | 100.00 |
| 3352242 | THYROID PEROXIDASE AB | $ | 51.00 |
| 3352247 | OPIATES/ CONF URINE ARUP | $ | 191.00 |
| 3352248 | MYCO TUBERCULO DNA AMP PR | $ | 1,080.00 |
| 3352249 | ALLERGEN EA ADDITIONAL | $ | 28.00 |
| 3352250 | PH, VENOUS BLOOD | $ | 142.00 |
| 3352251 | LEISHMANIA ANTI, IgG | $ | 213.00 |
| 3352252 | THIOPURINE METHYLTRANSFER | $ | 1,510.00 |
| 3352253 | STREP TEST, RAPID | $ | 38.00 |
| 3352254 | INFLUENZA VIRUS | $ | 100.00 |
| 3352255 | HCG URINE | $ | 35.00 |
| 3352256 | HETEROPHILE ANTIBODY | $ | 51.00 |
| 3352257 | HETEROPHILE TITER | $ | 110.00 |
| 3352258 | EHRLICHIA / ANAPLASMA ARU | $ | 832.00 |
| 3352259 | VITAMIN K1/ SERUM ARUP | $ | 308.00 |
| 3352260 | CHLAMYDIA TRACH AMP ARUP | $ | 119.00 |
| 3352261 | CHLAMYDIA TRACH DNA ARUP | $ | 60.00 |
| 3352262 | ACETONE QUAN ARUP | $ | 140.00 |
| 3352263 | POLYCHLOR BIPHENYLS ARUP | $ | 604.00 |
| 3352264 | CHOLINESTERASE,RBC ARUP | $ | 93.00 |
| 3352265 | IG-A NCL | $ | 56.00 |
| 3352266 | VARICELLA ZOSTER,AG IF | $ | 203.00 |
| 3352267 | HERPES SIMPLEX 1,AG, IF | $ | 203.00 |
| 3352268 | VIRAL CULTURE | $ | 327.00 |
| 3352269 | VIRUS INOCULATION,SHELL | $ | 329.00 |
| 3352270 | STREPTOCOCCL AG UA ARUP | $ | 203.00 |
| 3352271 | RICKETTSIA ANTI | $ | 86.00 |
| 3352272 | VIRUS ANTIBODY NOS | $ | 210.00 |
| 3352273 | VIRUS ANTIBODY NOS | $ | 210.00 |
| 3352274 | IG-G NCL | $ | 56.00 |
| 3352275 | CLOSTRIDIUM DIFF TOXIN B | $ | 236.00 |
| 3352276 | MICROSPORIDIA DFA | $ | 332.00 |
| 3352277 | ARUP- SUSCEP MECA GENE DE | $ | 256.00 |
| 3352278 | ESTRONE ARUP | $ | 422.00 |
| 3352279 | 5-A DIHYDROTESTOSTERONE | $ | 306.00 |
| 3352280 | RABIES ANTIBODY, IgG ARUP | $ | 210.00 |
| 3352281 | KEPPRA ARUP | $ | 233.00 |
| 3352282 | LAMBDA ARUP | $ | 233.00 |
| 3352283 | ENCEPHALITIS, CA ARUP | $ | 111.00 |
| 3352284 | ENCEPHALITIS, EAST EQ IgG | $ | 111.00 |
| 3352285 | ENCEPHALITIS, ST LOU ARUP | $ | 111.00 |
| 3352286 | ENCEPHALITIS, WEST EQ IgG | $ | 111.00 |
| 3352287 | KETONES-SERUM | $ | 74.00 |
| 3352288 | ARGININE VASO HORMON ARUP | $ | 133.00 |
| 3352289 | DNA MYCOBACTERIUM ARUP | $ | 338.00 |
| 3352290 | GLYCOPHORIN - ARUP | $ | 453.00 |
| 3352291 | CD59 - ARUP | $ | 453.00 |
| 3352292 | GENERAL HEALTH PANEL | $ | 418.00 |
| 3352293 | GFR / ARUP | $ | 42.00 |
| 3352294 | HEP B CORE IGM - ARUP | $ | 76.00 |
| 3352295 | LEPTIN - ARUP | $ | 544.00 |
| 3352296 | PYRUVATE KINASE - ARUP | $ | 219.00 |
| 3352297 | KYPHOSCOLIOTIC FORM, TYPE | $ | 2,802.00 |
| 3352298 | CA 15-3 | $ | 76.00 |
| 3352300 | CHEM 12 (CMP) | $ | 181.00 |
| 3352301 | CHEM 12 (CMP) ADDITIONAL | $ | 181.00 |
| 3352302 | CHEM 8 (BMP) | $ | 142.00 |
| 3352303 | CHEM 8 (BMP) ADDITIONAL | $ | 142.00 |
| 3352304 | STRIATED MUSCLE AB | $ | 128.00 |
| 3352305 | RHEUMATOID FACTOR,QUAL | $ | 96.00 |
| 3352306 | CALPROTECTIN, FECAL | $ | 715.00 |
| 3352307 | ESTRADIOL BY TMS ARUP | $ | 156.00 |
| 3352308 | PROTEIN/ CREAT URINE | $ | 39.00 |
| 3352309 | OCCULT BLOOD-IMMUNO ASS-ARUP | $ | 141.00 |
| 3352310 | SODIUM STOOL | $ | 82.00 |
| 3352311 | INSULIN LIKE GROWTH FACT | $ | 88.00 |
| 3352312 | FACTOR VIII ACTIVITY | $ | 109.00 |
| 3352313 | RISTOCETIN COFACTOR | $ | 388.00 |
| 3352314 | VON WILLEBRAND MULT | $ | 388.00 |
| 3352315 | VON WILLEBRAND FACTOR | $ | 544.00 |
| 3352316 | VITAMIN A | $ | 80.00 |
| 3352317 | CARNITINE FREE / TOTAL | $ | 249.00 |
| 3352318 | RENAL FUNCTION PANEL | $ | 150.00 |
| 3352319 | IMMUNODIFFSUION/ IMMUNO | $ | 31.00 |
| 3352320 | ASSAY OF CITRATE | $ | 468.00 |
| 3352321 | ASSAY OF OXALATE | $ | 217.00 |
| 3352322 | ASSAY OF URINE PHOSPHOROU | $ | 87.00 |
| 3352324 | HERPES SIMPLEX VIRUS PCR | $ | 304.00 |
| 3352326 | BORDETELLA ANTIBODY SERUM | $ | 99.00 |
| 3352328 | ACETYLCHOLINE BLOCK RCPT | $ | 203.00 |
| 3352329 | PHOSPHOLIPID ANTIBODY | $ | 422.00 |
| 3352330 | PHOSPHOLIPID ANTIBODY | $ | 422.00 |
| 3352331 | ENTEROVIRUS, DETECT PCR | $ | 591.00 |
| 3352332 | GC / CHL -PROBE | $ | 111.00 |
| 3352333 | T3 REVERSE | $ | 119.00 |
| 3352334 | HEPATITIS B DNA QUANT | $ | 723.00 |
| 3352339 | NEURONAL ANTIBODIES ARUP | $ | 794.00 |
| 3352340 | OCCULT BLOOD IMMUNOLOGY | $ | 141.00 |
| 3352341 | C DIFF TOXIN | $ | 93.00 |
| 3352342 | VOLTAGE-GATED POTAS CHANN | $ | 1,000.00 |
| 3352343 | ACETAMINOPHEN ADDITIONAL | $ | 268.00 |
| 3352345 | COMPLIMENT COMPONENT ADDI | $ | 76.00 |
| 3352347 | BNP | $ | 574.00 |
| 3352348 | NICOTINE & METAB URINE | $ | 374.00 |
| 3352349 | FACTOR V LEIDEN MUTA ARUP | $ | 315.00 |
| 3352350 | WEST NILE VIRUS AB IGG | $ | 170.00 |
| 3352351 | IMMUNODIFFUSION/ IMMUNO | $ | 31.00 |
| 3352352 | BACTERIUM ANTIBODY | $ | 304.00 |
| 3352355 | EPSTEIN-BARR ANTIBODY | $ | 53.00 |
| 3352356 | HIV-1 | $ | 42.00 |
| 3352357 | CCP ANTIBODY | $ | 100.00 |
| 3352358 | HOMOVANILLIC ACID | $ | 236.00 |
| 3352359 | HERPES VIRUS-6 PCR | $ | 1,098.00 |
| 3352360 | FACTOR VII, ACTIVITY | $ | 301.00 |
| 3352361 | CORTISOL, SALIVA ARUP | $ | 51.00 |
| 3352362 | GLUCAGON - ARUP | $ | 101.00 |
| 3352363 | DIPTHERIA ANTIB IgG ARUP | $ | 51.00 |
| 3352364 | FUNGAL DNA PROBE ARUP | $ | 338.00 |
| 3352365 | FUNGAL CULTURE ARUP | $ | 210.00 |
| 3352366 | CHROMOGENIC FACTOR X ALLI | $ | 357.00 |
| 3352367 | ACETYLCHOLINE BLOCK | $ | 203.00 |
| 3352368 | VOLTAGE-GATED POTAS CHANN | $ | 1,000.00 |
| 3352369 | ACETYLCHOLINE BINDIN RCPT | $ | 203.00 |
| 3352370 | SUBOXONE | $ | 84.00 |
| 3352371 | DRUGS ABUSE CONFIRM ARUP | $ | 219.00 |
| 3352372 | SUSCEPTIBILITY-AFB/NOCARD | $ | 370.00 |
| 3352373 | HEPATITIS Be VIRUS ANTI | $ | 69.00 |
| 3352374 | HEPATITIS B VIRUS DNA QUA | $ | 440.00 |
| 3352375 | CYSTIC FIBROSIS 32 MUT AR | $ | 715.00 |
| 3352376 | HEMOCHROMATOSIS (HFE) ARU | $ | 453.00 |
| 3352377 | RUFINAMIDE BANZEL-ARUP | $ | 817.00 |
| 3352378 | BENZODIAZEPINES, URINE QUANT ARUP | $ | 179.00 |
| 3352379 | WEST NILE VIRUS AB IGM | $ | 129.00 |
| 3352380 | CANDIDA AB BY ID | $ | 98.00 |
| 3352381 | CBC / BLD MORPH | $ | 136.00 |
| 3352382 | TSH RECEPTOR AB - ARUP | $ | 544.00 |
| 3352383 | ANNA -ARUP | $ | 128.00 |
| 3352384 | PURKINJE CELL SCREEN-ARUP | $ | 128.00 |
| 3352385 | ANTI-ADRENAL ANTIBOD ARUP | $ | 128.00 |
| 3352386 | INTRIN FAC BLOCK ANTIB AR | $ | 172.00 |
| 3352389 | QUANITIATION OF DRUG | $ | 192.00 |
| 3352390 | TSH, W / REF 2 FREE T4 | $ | 136.00 |
| 3352391 | XYLOSE ABSORPTION TEST AR | $ | 99.00 |
| 3352392 | INFLUENZA ASSAY W/ OPTIC | $ | 133.00 |
| 3352393 | LDH BODY FLUID ARUP | $ | 41.00 |
| 3352394 | PROTEIN ASSAY | $ | 73.00 |
| 3352395 | D-DIMER QUANTITATIVE | $ | 252.00 |
| 3352397 | PANCREATIC ELAST, FECAL ARUP | $ | 576.00 |
| 3352398 | GFR / ARUP | $ | 42.00 |
| 3352400 | CHEM 8, i-STAT | $ | 142.00 |
| 3352401 | CHEM 8, i-STAT | $ | 142.00 |
| 3352402 | GLUCOSE, i- STAT | $ | 31.00 |
| 3352403 | GLUCOSE, i-STAT | $ | 31.00 |
| 3352404 | POTASSIUM, i-STAT | $ | 76.00 |
| 3352405 | POTASSIUM, i-STAT | $ | 76.00 |
| 3352406 | CREATININE, i-STAT | $ | 86.00 |
| 3352407 | CREATININE, i-STAT | $ | 86.00 |
| 3352408 | IONIZED CALCIUM, i-STAT | $ | 229.00 |
| 3352409 | IONIZED CALCIUM, i-STAT | $ | 229.00 |
| 3352410 | ARTERIAL BLOOD GAS, i-STAT | $ | 315.00 |
| 3352411 | ARTERIAL BLOOD GAS, i-STAT | $ | 315.00 |
| 3352412 | VENOUS BLOOD GAS, i-STAT | $ | 315.00 |
| 3352413 | VENOUS BLOOD GAS, i-STAT | $ | 315.00 |
| 3352414 | PH, ARTERIAL, i-STAT | $ | 142.00 |
| 3352415 | PH, ARTERIAL, i-STAT | $ | 142.00 |
| 3352416 | PH, VENOUS, i-STAT | $ | 142.00 |
| 3352417 | PH, VENOUS, i-STAT | $ | 142.00 |
| 3352418 | SULFATE, URINE | $ | 97.00 |
| 3352419 | BETA-HYDROXYBUTYRIC ACID | $ | 88.00 |
| 3352420 | SMOOTH MUSCLE AB IgG-ARUP | $ | 71.00 |
| 3352421 | ERYTHRO PORPHYRIN ARUP | $ | 285.00 |
| 3352422 | AFB CULTURE | $ | 255.00 |
| 3352423 | FUNGAL DNA PROBE ARUP | $ | 338.00 |
| 3352424 | DNA SEQ BACT ID ARUP | $ | 738.00 |
| 3352425 | DNA MYCOBACTERIUM ARUP | $ | 338.00 |
| 3352426 | 21-HYDROXYLASE AB -ARUP | $ | 238.00 |
| 3352427 | HIV-1 2 COMBO ANTIGEN-ARUP | $ | 124.00 |
| 3352428 | HISTOPLASMA ANTI CF-ARUP | $ | 56.00 |
| 3352429 | HISTOPLASMA ANTI CF-ARUP | $ | 56.00 |
| 3352430 | HIV 1 ANTI CONF,WEST BLOT | $ | 250.00 |
| 3352431 | DS DNA (CRITHID LUCIL)Ab IgG | $ | 107.00 |
| 3352432 | BETHESDA QUANT FACTOR 8 BILL | $ | 408.00 |
| 3352433 | ACID Hgb ELECTROPHORESIS BILL | $ | 84.00 |
| 3352434 | ALK Hgb ELECTROPHORESIS BILL | $ | 40.00 |
| 3352435 | ACETYLCHOLINE RECEP MOD ANTI | $ | 187.00 |
| 3352436 | OXYCODONE/OXYMORPHONE SCRE REFLEX UA ARU | $ | 70.00 |
| 3352437 | FACTOR XII, ACTIVITY ARUP | $ | 257.00 |
| 3352438 | OXCARBA METABOLITE ARUP | $ | 124.00 |
| 3352439 | KEPPRA ARUP | $ | 181.00 |
| 3352440 | LAMOTRIGINE ARUP | $ | 72.00 |
| 3352441 | HIV-1 ANTIBODY ARUP | $ | 268.00 |
| 3352442 | HIV-2 ANTIBODY ARUP | $ | 268.00 |
| 3352443 | ACETYLCHOLINE RECEPT ARUP | $ | 187.00 |
| 3352444 | BORDETELLA PERTUS ARUP | $ | 187.00 |
| 3352445 | BORDETELLA PERTUS ARUP | $ | 187.00 |
| 3352446 | ZONISAMIDE ARUP | $ | 281.00 |
| 3352447 | GABAPENTIN ARUP | $ | 101.00 |
| 3352448 | A1C ARUP | $ | 60.00 |
| 3352449 | VITAMIN B 7 (BIOTIN) ARUP | $ | 547.00 |
| 3352450 | FELBAMATE ARUP | $ | 101.00 |
| 3352451 | HEMOGLOBIN, PLASMA ARUP | $ | 80.00 |
| 3352452 | CARNITINE, TOTAL ARUP | $ | 63.00 |
| 3352453 | CARNITINE, FREE ARUP | $ | 63.00 |
| 3352454 | VIRAL CULTURE,RESPIRATORY ARUP | $ | 308.00 |
| 3352455 | PEMPHIGOID ANTI PANEL ARUP | $ | 505.00 |
| 3352456 | PEMPHIGOID ANTI PANEL ARUP | $ | 505.00 |
| 3352457 | PEMPHIGOID ANTI PANEL ARUP | $ | 505.00 |
| 3352458 | PEMPHIGOID ANTI PANEL ARUP | $ | 505.00 |
| 3352459 | MUMPS-PCR BUCCAL SWAB | $ | 1,608.00 |
| 3352460 | AMP- CONFIRM- URINE-ARUP | $ | 191.00 |
| 3352461 | OPI- CONFIRM- URINE-ARUP | $ | 191.00 |
| 3352462 | DRUGS ABUSE CONFIRM | $ | 219.00 |
| 3352463 | COCAINE / METABOLITE | $ | 216.00 |
| 3352464 | METHADONE CONFIRM | $ | 276.00 |
| 3352465 | NICTOTINE & METAB URINE | $ | 374.00 |
| 3352466 | OPIATES CONF SERUM | $ | 216.00 |
| 3352467 | OPIATES CONF URINE | $ | 216.00 |
| 3352469 | METHAMPHETAMINE MEDTOX | $ | 216.00 |
| 3352470 | AMPHET METHAMPHET CONFIRM | $ | 216.00 |
| 3352471 | SALICYLATES ADDITIONAL | $ | 119.00 |
| 3352473 | IMIPRAMINE /ANTIDEPRESSENTS | $ | 291.00 |
| 3352474 | BENZODIAZEPINES | $ | 216.00 |
| 3352475 | AMITRIPTYLINE | $ | 301.00 |
| 3352476 | BLOOD ALCOHOL | $ | 183.00 |
| 3352477 | ACETAMINOPHEN / INITIAL | $ | 268.00 |
| 3352478 | DRUG SCREEN PANEL | $ | 252.00 |
| 3352479 | PARECHOVIRUS PCR - ARUP | $ | 850.00 |
| 3352480 | PROTHROMBIN (F2) MUTATION - ARUP | $ | 244.00 |
| 3352481 | FYCOMPA -ARUP | $ | 981.00 |
| 3352482 | MRSA - REFLEX LATEX ARUP | $ | 67.00 |
| 3352483 | SUSCEPTIBILITY-SINGLE DRUG/ETEST ARUP | $ | 259.00 |
| 3352484 | SELENIUM, SERUM/PLASMA - ARUP | $ | 70.00 |
| 3352485 | HISTOPLASMA ANTI EIA, SERUM ARUP | $ | 579.00 |
| 3352486 | HISTOPLASMA GALACTO ANTI QUAN EIA UA ARU | $ | 353.00 |
| 3352487 | ANTIPHOS HS Ab IgG | $ | 183.00 |
| 3352488 | ANTIPHOS HS Ab IgM | $ | 183.00 |
| 3352489 | ASPERGILLUS / HYPERSENSITIVITY PANEL ARU | $ | 28.00 |
| 3352490 | ASPERGILLUS/ HYPERSENSIT PANEL ADD ARUP | $ | 28.00 |
| 3352491 | ALLERGEN SPECIFIC IgE QUAL - ARUP | $ | 28.00 |
| 3352492 | SMA CARRIER SCREENING | $ | 742.00 |
| 3352493 | ANKYLOSING SPONDYLITIS HLA-B27 GENO | $ | 637.00 |
| 3352494 | LYSOZYME, SERUM ARUP | $ | 73.00 |
| 3352495 | TOXOPLASMA ANTIBODY IgG ARUP | $ | 49.00 |
| 3352496 | SUSCEPTIBILITY ARUP PEN PROTEIN 2A | $ | 62.00 |
| 3352497 | SUSCEPTIBILITY ARUP PEN PROTEIN 2A (2ND) | $ | 62.00 |
| 3352498 | HMGCR ANTIBODY ARUP | $ | 451.00 |
| 3352500 | PROSTATIC ACID PHOSPHOTASE | $ | 164.00 |
| 3352501 | ARUP MALDI - TOF - ANAEROBIC | $ | 308.00 |
| 3352502 | TETANUS ANTIBODY | $ | 168.00 |
| 3352503 | IODINE, SERUM ARUP | $ | 751.00 |
| 3352504 | ANTI-MULLERIAN HORMONE ARUP | $ | 448.00 |
| 3352505 | RHEUMATOID ARTHRITIS PANEL | $ | 74.00 |
| 3352506 | RHEUMATOID FACTOR IgA ARUP | $ | 167.00 |
| 3352507 | RA IgG ARUP | $ | 180.00 |
| 3352508 | RHEUMATOID FACTORS IgM ARUP | $ | 167.00 |
| 3352510 | GGT | $ | 122.00 |
| 3352511 | SIROLIMUS TANDEM MASS SPECTRO ARUP | $ | 182.00 |
| 3352512 | AMYLASE | $ | 110.00 |
| 3352513 | AMYLASE | $ | 110.00 |
| 3352514 | OSMOTIC FRAGILITY, RBC | $ | 112.00 |
| 3352515 | METANEPHRINES, PLASMA | $ | 304.00 |
| 3352516 | CATECHOLAMINES, PLASMA | $ | 150.00 |
| 3352519 | LDH BODY FLUID ARUP | $ | 41.00 |
| 3352520 | PH BODY FLUID ARUP | $ | 28.00 |
| 3352521 | AMYLASE BODY FLUID ARUP | $ | 110.00 |
| 3352522 | PHOSPHORUS | $ | 32.00 |
| 3352523 | ACID PHOSPHATASE SER ARUP | $ | 124.00 |
| 3352524 | MYOGLOBULIN, URINE ARUP | $ | 71.00 |
| 3352525 | HEPARIN ANTI - Xa LMWt | $ | 440.00 |
| 3352526 | AMPHETAMINES 1 OR 2 | $ | 94.00 |
| 3352527 | METHYLENEDIOXYAMPHETAMINES (MDA,MDEA,MDM | $ | 94.00 |
| 3352528 | MYOSITIS-SPECIFIC ANTIBODY PANEL ARUP | $ | 163.00 |
| 3352529 | MYOSITIS-SPECIFIC ANTI PANEL PLUS ARUP | $ | 163.00 |
| 3352530 | BABESIA SPECIES BY PCR ARUP | $ | 626.00 |
| 3352531 | BABESIA SPECIES BY PCR / 2ND TEST | $ | 342.00 |
| 3352532 | ANAPLASMA IgG ARUP | $ | 175.00 |
| 3352533 | ANAPLASMA IgM ARUP | $ | 175.00 |
| 3352534 | STOOL CULTURE, VIBRIO | $ | 188.00 |
| 3352535 | GASTROINTESTINAL VIRAL PANEL / PCR | $ | 1,139.00 |
| 3352536 | OPIATES, URINE, QUANTITATIVE | $ | 90.00 |
| 3352537 | OPIATES, URINE, QUANTITATIVE | $ | 90.00 |
| 3352538 | THC METABO URINE QNT | $ | 179.00 |
| 3352539 | ALKALINE PHOSPHATASE | $ | 87.00 |
| 3352540 | ADENOSINE DEAMINASE,PLEURAL FLUID ARUP | $ | 137.00 |
| 3352541 | POLIO VIRUS Ab1 ARUP | $ | 195.00 |
| 3352542 | POLIO VIRUS Ab2 ARUP | $ | 195.00 |
| 3352543 | POLIO VIRUS Ab3 ARUP | $ | 195.00 |
| 3352545 | BONE SPECIFIC ALK PHOS-AR | $ | 250.00 |
| 3352546 | DRUG SCREEN PANEL CARD | $ | 252.00 |
| 3352547 | DRUG SCREEN PANEL CARD / 59 | $ | 252.00 |
| 3352548 | OXYCODONE/OXYMORPHONE SCRE REFLEX UA ARU | $ | 70.00 |
| 3352549 | MICROALBUMIN / DIRECT TESTING | $ | 27.00 |
| 3352550 | SMOOTH MUSCLE AB, IgG TITER ARUP | $ | 183.00 |
| 3352551 | IFOB IMMUNO 1-3 TESTS | $ | 60.00 |
| 3352552 | LDH | $ | 41.00 |
| 3352553 | IFOB TEST SCREENING 1-3 TEST | $ | 60.00 |
| 3352554 | FRUCTOSAMINE - ARUP | $ | 51.00 |
| 3352555 | QUANTIFERON-TB GOLD ARUP | $ | 273.00 |
| 3352556 | PROTEIN, TOTAL / URINE / REFRAC ARUP | $ | 135.00 |
| 3352557 | IMMUNOFIX ELECTROPHOR URINE ARUP | $ | 135.00 |
| 3352558 | NEPHELOMETRY / ANALYTE ARUP | $ | 135.00 |
| 3352559 | NEPHELOMETRY / ANALYTE ARUP | $ | 135.00 |
| 3352562 | NEISSERIA GONORRHOEAE AHL | $ | 119.00 |
| 3352563 | FUNGUS ANITBODY (IBD) | $ | 117.00 |
| 3352564 | FUNGAL ANITI ADDTL (IBD) | $ | 117.00 |
| 3352565 | CPK | $ | 110.00 |
| 3352566 | CPK ADDITONAL | $ | 110.00 |
| 3352567 | FETAL CONGENITAL ABNORMALITIES ARUP | $ | 275.00 |
| 3352568 | LYSOSOMAL ACID LIPASE ACTIVITY, DBS ARUP | $ | 1,075.00 |
| 3352569 | COPPER | $ | 73.00 |
| 3352570 | CPK - MB | $ | 118.00 |
| 3352571 | CPK - MB ADDTIONAL | $ | 118.00 |
| 3352572 | TROPONIN I | $ | 160.00 |
| 3352573 | MYOGLOBIN | $ | 194.00 |
| 3352574 | TROPONIN I ADDITIONAL | $ | 160.00 |
| 3352575 | AST (SGOT) | $ | 87.00 |
| 3352576 | MYOGLOBIN ADDITIONAL | $ | 194.00 |
| 3352577 | CPK-MB (3RD SET) | $ | 118.00 |
| 3352578 | TROPONIN I (3RD SET) | $ | 160.00 |
| 3352579 | CLOBAZAM QUANT, SERUM /PLASMA | $ | 618.00 |
| 3352580 | DRUG SCREEN PANEL CARD /59 | $ | 252.00 |
| 3352581 | RA - IgA ARUP | $ | 180.00 |
| 3352582 | RA - IgM ARUP | $ | 180.00 |
| 3352583 | RHEUMATOID FACTOR - ARUP | $ | 63.00 |
| 3352584 | BLOOD CULTURE DNA/RNA AMP PROBE ALLINA | $ | 91.00 |
| 3352585 | CRP HS | $ | 133.00 |
| 3352586 | ALT (SGPT) | $ | 88.00 |
| 3352587 | BLOOD CULTURE DNA/RNA AMP PROBE ALLINA | $ | 91.00 |
| 3352588 | CHEMILUMINESCENT ASSAY | $ | 812.00 |
| 3352589 | PROTEIN S TOTAL AG | $ | 158.00 |
| 3352590 | ANTITHROMBIN | $ | 141.00 |
| 3352591 | PLASMINOGEN ACTIVITY | $ | 111.00 |
| 3352592 | ANTITHROMBIN ADDITIONAL | $ | 141.00 |
| 3352593 | PROTEIN C, FUNCT ADDITION | $ | 133.00 |
| 3352594 | PROTEIN S,FUNC ADDITIONAL | $ | 216.00 |
| 3352595 | ACTIVATED PROTEIN C | $ | 241.00 |
| 3352596 | SPECIFIC GRAVITY BF ALLINA | $ | 24.00 |
| 3352597 | HOMOCYSTINE ADDITIONAL | $ | 84.00 |
| 3352601 | FLUORIDE ASSAY | $ | 313.00 |
| 3352609 | THROMBIN TIME-REFLEX | $ | 82.00 |
| 3352610 | PTT 1:1 MIX- REFLEX | $ | 59.00 |
| 3352611 | DRVVT 1:1 MIX- REFLEX | $ | 109.00 |
| 3352612 | HEX PHOS REFLEX | $ | 221.00 |
| 3352613 | ENCEPHALITIS, EAST EQ IgM | $ | 250.00 |
| 3352614 | ENCEPHALITIS, WEST EQ IgM | $ | 250.00 |
| 3352615 | EPSTEIN-BARR VIRUS PCR | $ | 397.00 |
| 3352616 | VARICELLA-ZOSTER VIRUS | $ | 422.00 |
| 3352617 | CYTOMEGALOVIRUS PCR | $ | 505.00 |
| 3352618 | HERPES SIMPLEX VIRUS CULT | $ | 73.00 |
| 3352619 | HERPES SIMPLEX VIRUS CULT | $ | 73.00 |
| 3352620 | WEST NILE VIRUS ANTI IgG | $ | 94.00 |
| 3352621 | WEST NILE VIRUS ANTI IgM | $ | 94.00 |
| 3352622 | ANTI - JO-1 IgG | $ | 135.00 |
| 3352623 | ALT (SGPT) | $ | 88.00 |
| 3352624 | AST (SGOT) | $ | 87.00 |
| 3352625 | BILL CAPILLARY ELECTROPHORESIS ARUP | $ | 129.00 |
| 3352626 | ALPHA GLOBIN HBA1 & HBA2 ARUP | $ | 2,051.00 |
| 3352627 | GHST ALPHA GLOBIN HBA1 & HBA2 ARUP | $ | 68.00 |
| 3352628 | HEMOGLOBIN EVAL REFLEX CASCADE ARUP | $ | 68.00 |
| 3352629 | C-DIFF CULTURE ARUP | $ | 189.00 |
| 3352630 | C-DIFF CYTOTOXIN REFLUX | $ | 124.00 |
| 3352631 | FUNGI-BY MALDI-ARUP | $ | 308.00 |
| 3352632 | AMIKACIN, PEAK LEVEL ARUP | $ | 60.00 |
| 3352633 | EPSTEIN-BARR VIRUS ANTI PANEL 1 ARUP | $ | 55.00 |
| 3352634 | THYROGLOBULIN SERUM ARUP | $ | 365.00 |
| 3352635 | IG-G NCL ARUP ADD | $ | 56.00 |
| 3352636 | IG-M NCL ARUP ADD | $ | 56.00 |
| 3352637 | IMMUNOFIX ELECTROPHORESIS ARUP ADD | $ | 111.00 |
| 3352638 | STREPTOCOCCUS GROUP B AMP PROBE ARUP | $ | 448.00 |
| 3352639 | REFLEX DBL-STRANDED DNA | $ | 136.00 |
| 3352640 | ALLERGEN SPECIFIC IgE ARUP | $ | 220.00 |
| 3352641 | ALLERGEN SPECIFIC IgE ARUP ADDIT | $ | 220.00 |
| 3352642 | TISSUE TRANSGLUTAMINASE tTG ANTI IgA AR | $ | 45.00 |
| 3352643 | JAK2 EXON 12 MUTATION ANAL BY PCR ARUP | $ | 1,512.00 |
| 3352644 | C DIFFICILE TOXIN B GENE RT-PCR ARUP | $ | 507.00 |
| 3352645 | TISSUE TRANSGLUTAMINASE ANTIB IgG ARUP | $ | 110.00 |
| 3352646 | BRUCELLA ANTIBODY ARUP | $ | 63.00 |
| 3352647 | BLOOD ALCOHOL | $ | 183.00 |
| 3352648 | EHLERS DANLOS SCREEN ARUP | $ | 806.00 |
| 3352649 | LACOSAMIDE SERUM PLASMA ARUP | $ | 475.00 |
| 3352650 | AMIODARONE / METABOLITE | $ | 91.00 |
| 3352651 | PNEUMOCOCCAL ABS, IgG 23 | $ | 14.00 |
| 3352652 | PNEUMOCOCCAL ABS, IgG 23 | $ | 14.00 |
| 3352653 | H. INFLUENZA B Ab, IgG | $ | 56.00 |
| 3352654 | ARSENIC / HEAVY METAL PANEL ARUP | $ | 56.00 |
| 3352655 | LEAD / HEAVY METAL PANEL ARUP | $ | 56.00 |
| 3352656 | CADMIUM / HEAVY METAL PANEL ARUP | $ | 56.00 |
| 3352657 | CHLAMYDIA TRACHOMATIS TMA ARUP | $ | 183.00 |
| 3352658 | RENIN / ARUP | $ | 244.00 |
| 3352659 | rHEUMATOID FACTOR / LUPUS PANEL ARUP | $ | 31.00 |
| 3352660 | RHEUMATOID FACTOR / LUPUS PANEL ARUP | $ | 31.00 |
| 3352661 | COMPLEMENT ANTIGEN EA COMP LUPUS PANEL A | $ | 51.00 |
| 3352662 | COMPLEMENT ANTIGEN EA COMP LUPUS PANEL A | $ | 51.00 |
| 3352663 | TOTAL PSA W FREE PSA EFLEX ARUP | $ | 50.00 |
| 3352664 | REPTILASE TIME REFLEX | $ | 125.00 |
| 3352665 | HEPARIN NEUTRALIZATION | $ | 95.00 |
| 3352666 | PHOSPHOLIPID NEUTRALIZATION | $ | 332.00 |
| 3352667 | NICOTINE & METS S/P QUANT ARUP | $ | 164.00 |
| 3352668 | LIPOPROTEIN -ARUP | $ | 76.00 |
| 3352669 | LIPID PANEL ARUP | $ | 76.00 |
| 3352670 | PTT REFLEX ARUP | $ | 95.00 |
| 3352671 | PLATELET NEUTRALIZATION REFLEX ARUP | $ | 147.00 |
| 3352672 | DILUTE RUSSELL VIPER VENOM REFLEX ARUP | $ | 59.00 |
| 3352673 | DULUTE RUSSELL VIPER VENOM CONFIRM ARUP | $ | 103.00 |
| 3352770 | CARBON DIOXIDE | $ | 84.00 |
| 3352771 | ANAEROB ORG ID / MALDI-TOF ARUP | $ | 319.00 |
| 3352772 | THYROID STIMULATING IMMUNOGLOBULINS ARUP | $ | 202.00 |
| 3352773 | INSULIN-LIKE GROWTH FACTOR 2 ARUP | $ | 397.00 |
| 3352774 | THYROID STIMULATING HORMONE ARUP | $ | 168.00 |
| 3352775 | BUPRENORPHINE, URN, QUANT ARUP | $ | 180.00 |
| 3352776 | FENTANYL & METABOLIC, URN, QUANT ARUP | $ | 351.00 |
| 3352777 | JC VIRUS BY PCR | $ | 421.00 |
| 3352909 | GLUCOSE, BODY FLUID | $ | 30.00 |
| 3352914 | FLUID PROTEIN | $ | 39.00 |
| 3353011 | HOMOCYSTINE | $ | 84.00 |
| 3353012 | ALDOLASE | $ | 40.00 |
| 3353013 | FACTOR IX ACTIVITY | $ | 201.00 |
| 3353014 | THROMBIN TIME, PLASMA | $ | 82.00 |
| 3353024 | ALDOSTERONE ARUP | $ | 244.00 |
| 3353048 | AFP | $ | 73.00 |
| 3353049 | HCG / QUANT | $ | 71.00 |
| 3353050 | B-HCG-ARUP | $ | 71.00 |
| 3353060 | ALPHA 1 ANTITRYPSIN TOTA | $ | 41.00 |
| 3353061 | ALPHA-ANTITRYPSIN,PHENO | $ | 166.00 |
| 3353072 | ANA ARUP | $ | 72.00 |
| 3353073 | DBL STRANDED DNA | $ | 67.00 |
| 3353074 | ANTI ENA | $ | 73.00 |
| 3353075 | ANTI ENA | $ | 73.00 |
| 3353076 | ANTI SSA | $ | 73.00 |
| 3353077 | ANTI SSB | $ | 73.00 |
| 3353078 | ANTI RNP | $ | 73.00 |
| 3353079 | ANTI SCLER | $ | 73.00 |
| 3353080 | ANTI SMITH | $ | 73.00 |
| 3353084 | ASO (STREPTOLYSIN) AB | $ | 123.00 |
| 3353096 | VITAMIN B12 | $ | 41.00 |
| 3353108 | BENCE JONES | $ | 375.00 |
| 3353109 | BABESIA IGM | $ | 99.00 |
| 3353120 | CAROTENE | $ | 155.00 |
| 3353121 | SOMATOSTATIN | $ | 160.00 |
| 3353144 | CEA | $ | 71.00 |
| 3353156 | COLD AGGLUTINIIN | $ | 88.00 |
| 3353180 | CORTISOL TOTAL/SERUM | $ | 51.00 |
| 3353181 | CORTISOL TOTAL/SERUM | $ | 51.00 |
| 3353192 | C-REACTIVE PROTEIN | $ | 46.00 |
| 3353204 | CRYOGLOBULINS | $ | 41.00 |
| 3353276 | DIGOXIN | $ | 73.00 |
| 3353288 | DILANTIN | $ | 223.00 |
| 3353312 | ESTRIOL | $ | 85.00 |
| 3353313 | ESTROGENS TOTAL | $ | 366.00 |
| 3353314 | T PALLIDUM FTA IgG ARUP | $ | 86.00 |
| 3353315 | T PALLIDUM FTA IgM ARUP | $ | 86.00 |
| 3353316 | T PALLIDUM TP-PA ARUP | $ | 86.00 |
| 3353317 | BORDETELLA PERTUSIS ARUP | $ | 196.00 |
| 3353336 | FEBRILE AGG | $ | 118.00 |
| 3353348 | FERRITIN | $ | 187.00 |
| 3353352 | CRYSTAL FLUID | $ | 62.00 |
| 3353360 | FOLATE | $ | 42.00 |
| 3353372 | FSH SERUM | $ | 46.00 |
| 3353408 | GASTRIN | $ | 73.00 |
| 3353409 | GASTROCCULT | $ | 56.00 |
| 3353420 | GENTAMICIN PEAK | $ | 277.00 |
| 3353421 | GENTANICIN TROUGH | $ | 277.00 |
| 3353447 | HERPES SIMPLEX TYPE II | $ | 100.00 |
| 3353452 | STREP SCREEN | $ | 147.00 |
| 3353486 | A1C | $ | 114.00 |
| 3353516 | IRON | $ | 67.00 |
| 3353518 | IRON BINDING | $ | 56.00 |
| 3353520 | LACTATE | $ | 145.00 |
| 3353540 | LDH ISO | $ | 216.00 |
| 3353546 | LEAD | $ | 41.00 |
| 3353550 | LH (LUTENIZING HORMONE) | $ | 59.00 |
| 3353552 | LIPASE | $ | 114.00 |
| 3353553 | PEPTIDE/ VASO INTESTI ARU | $ | 214.00 |
| 3353554 | ANTIDIURETIC HORMONE AVH | $ | 133.00 |
| 3353576 | LITHIUM | $ | 51.00 |
| 3353577 | MICROSOMAL ANTIBODIES | $ | 51.00 |
| 3353584 | MAGNESIUM / URINE ARUP | $ | 55.00 |
| 3353585 | DILANTIN (SEND OUT) | $ | 223.00 |
| 3353586 | TACROLIMUS | $ | 250.00 |
| 3353587 | MAGNESIUM | $ | 113.00 |
| 3353588 | MAGNESIUM | $ | 113.00 |
| 3353589 | LYMES DISEASE | $ | 191.00 |
| 3353590 | LYME CONFIRM | $ | 117.00 |
| 3353591 | EHRLICHIA | $ | 58.00 |
| 3353592 | LYME CONFIRM | $ | 117.00 |
| 3353593 | EHRLICHIA | $ | 58.00 |
| 3353594 | PROCALCITONIN - ARUP | $ | 934.00 |
| 3353600 | METANEPHRINE | $ | 304.00 |
| 3353610 | OSMOLALITY SERUM/PLASMA | $ | 51.00 |
| 3353636 | PHENOBARB | $ | 67.00 |
| 3353648 | PHOSPHORUS | $ | 32.00 |
| 3353657 | PROCAINAMIDE / NAPA | $ | 283.00 |
| 3353659 | RUBELLA ANTIBODY | $ | 47.00 |
| 3353660 | PROTEIN ELECT | $ | 67.00 |
| 3353684 | QUINIDINE | $ | 247.00 |
| 3353695 | SALICYLATES ADDITIONAL | $ | 119.00 |
| 3353697 | SALICYLATES | $ | 119.00 |
| 3353698 | TESTOSTERONE FREE/TOTAL FEMALE/CHILD ARU | $ | 126.00 |
| 3353699 | RPR (VDRL) | $ | 32.00 |
| 3353702 | TEGRETOL (CARBAMAZEPINE) | $ | 69.00 |
| 3353707 | THYROID HORMONE | $ | 110.00 |
| 3353709 | T4 - ARUP | $ | 37.00 |
| 3353710 | HEMOGLOBIN / CHROMATOGRAP | $ | 51.00 |
| 3353711 | ROTAVIRUS AG EIA | $ | 47.00 |
| 3353712 | N-TELOPEPTIDE, C-L UA ARU | $ | 159.00 |
| 3353713 | CANDIDA SPECIES BY PCR | $ | 556.00 |
| 3353719 | DIRECT LDL | $ | 59.00 |
| 3353720 | THEOPHYLLINE | $ | 95.00 |
| 3353721 | VANCOMYCIN, TROUGH | $ | 126.00 |
| 3353722 | TOPIRAMATE | $ | 235.00 |
| 3353723 | YEAST IDENTIFICATION/ ARU | $ | 175.00 |
| 3353724 | YEAST SUCEPTIBILITY/ARUP | $ | 124.00 |
| 3353725 | MALARIA ANTIBODY, IgG | $ | 489.00 |
| 3353726 | HGB EVAL/ELECTOPHORESIS | $ | 76.00 |
| 3353727 | PHENOLPHTHAL, FECAL ARUP | $ | 41.00 |
| 3353728 | SENSIVITY-DISK DIFF ARUP | $ | 201.00 |
| 3353731 | ANTIHISTAMINE AB - ARUP | $ | 728.00 |
| 3353732 | CLOZAPINE & METABOLITES S/P, QUANT | $ | 106.00 |
| 3353743 | TRANSFERRIN | $ | 51.00 |
| 3353744 | TSH | $ | 146.00 |
| 3353745 | CYCLOSPORINE (CSA) | $ | 128.00 |
| 3353746 | D-DIMER, PLASMA | $ | 88.00 |
| 3353747 | INFLUENZA VIRUS/ANTIBODY | $ | 166.00 |
| 3353748 | T4 FREE | $ | 51.00 |
| 3353749 | RSV | $ | 147.00 |
| 3353750 | T3 TOTAL | $ | 32.00 |
| 3353751 | PARATHORMONE | $ | 67.00 |
| 3353752 | ARSENIC | $ | 320.00 |
| 3353753 | MERCURY | $ | 59.00 |
| 3353754 | CADMIUM | $ | 84.00 |
| 3353755 | MICROALBUMIN CREATININE | $ | 87.00 |
| 3353756 | RBC, FOLATE ARUP | $ | 196.00 |
| 3353757 | ORGANIC ACIDS | $ | 277.00 |
| 3353758 | CRYOGLOBULINS,SE QUANT | $ | 41.00 |
| 3353759 | IgM ANTIBODY | $ | 59.00 |
| 3353765 | PROGESTERONE ARUP | $ | 136.00 |
| 3353766 | BORRELIA SPECIA BY PCR | $ | 437.00 |
| 3353767 | CULTURE/ YEAST | $ | 210.00 |
| 3353768 | YEAST CULTURE | $ | 175.00 |
| 3353769 | ASPERGILLUS | $ | 98.00 |
| 3353770 | CLOTTING FACTOR VIII | $ | 388.00 |
| 3353771 | GABAPENTIN (NEURONTIN) | $ | 91.00 |
| 3353772 | VITAMIN B1 THIAMINE | $ | 111.00 |
| 3353773 | MEASLES RUBEOLA ABS IgG IgM ARUP | $ | 57.00 |
| 3353775 | PROSTATE SPC ANTI FREE | $ | 124.00 |
| 3353776 | HEPATITIS BE ANTIBODY | $ | 194.00 |
| 3353777 | HEPATITIS BE ANTIGEN | $ | 193.00 |
| 3353779 | OLIGOCLONAL BANDS | $ | 326.00 |
| 3353780 | NEPHELOMETRY | $ | 233.00 |
| 3353781 | CARDIOLIPIN | $ | 69.00 |
| 3353782 | CARDIOLIPIN | $ | 69.00 |
| 3353783 | LUPUS ANTICOAGULANT | $ | 109.00 |
| 3353784 | LEGIONELLA AB IGM | $ | 168.00 |
| 3353786 | PREALBUMIN | $ | 51.00 |
| 3353787 | NMP 22 | $ | 255.00 |
| 3353789 | FIBRINOGEN | $ | 71.00 |
| 3353791 | PTT/LUPUS ANTI | $ | 109.00 |
| 3353792 | TISSUE THROMBOPLAST INHIB | $ | 88.00 |
| 3353793 | ANA REFLEX | $ | 73.00 |
| 3353794 | RECEPTOR ASSAY, ESTROGEN | $ | 812.00 |
| 3353795 | RECEPTOR ASSAY, PROGESTERONE | $ | 812.00 |
| 3353796 | TESTOSTERONE,FREE | $ | 238.00 |
| 3353798 | ERYTHROPOIETIN | $ | 84.00 |
| 3353799 | RUBEOLA | $ | 57.00 |
| 3353800 | VARICELLA-ZOSTER IgG | $ | 59.00 |
| 3353801 | BNP | $ | 574.00 |
| 3353802 | PROLACTIN | $ | 59.00 |
| 3353803 | VANCOMYCIN, PEAK | $ | 126.00 |
| 3353804 | LYME AG / URINE | $ | 84.00 |
| 3353806 | CERULOPLASMIN | $ | 51.00 |
| 3353807 | PROTEIN C, FUNCTIONAL | $ | 133.00 |
| 3353808 | PROTEIN S,FUNCTIONAL | $ | 216.00 |
| 3353809 | HOMOCYSTENE QUANT | $ | 363.00 |
| 3353810 | OBSTETRIC PANEL | $ | 250.00 |
| 3353811 | NEUTRALIZATION TEST | $ | 285.00 |
| 3353813 | TREPONEMA PALLIDUM | $ | 119.00 |
| 3353814 | NEUTROPHIL ASSOC AB | $ | 254.00 |
| 3353815 | HEP C CONFIRM (REFLEX) | $ | 527.00 |
| 3353816 | BILE CHOLYLGLYCINE | $ | 365.00 |
| 3353817 | NUCLEOTIDASE 5 | $ | 188.00 |
| 3353818 | CMV AB IGG | $ | 158.00 |
| 3353819 | HIV-1 | $ | 298.00 |
| 3353820 | EBV AB IGM | $ | 53.00 |
| 3353822 | HAPTOGLOBIN,QUANTATIVE | $ | 56.00 |
| 3353823 | DIRECT LDL | $ | 59.00 |
| 3353824 | EBV AB IGG | $ | 53.00 |
| 3353825 | RENIN | $ | 73.00 |
| 3353826 | BONE MARROW SMEAR | $ | 245.00 |
| 3353829 | PATH LEVEL IV | $ | 227.00 |
| 3353830 | IRON STAINS | $ | 174.00 |
| 3353831 | IMMUNOFIXATION,ELECTROPHO | $ | 111.00 |
| 3353832 | IMMUNOFIXATION, URINE | $ | 111.00 |
| 3353833 | HLA TYPING | $ | 180.00 |
| 3353834 | FECAL FAT / QUAL | $ | 42.00 |
| 3353835 | IgE | $ | 51.00 |
| 3353836 | CHLORIDE OTHER THAN BLOOD | $ | 84.00 |
| 3353838 | HEPATITIS PANEL ACUTE | $ | 233.00 |
| 3353840 | HEP C RNA, PCR | $ | 591.00 |
| 3353842 | AMITRIPTYLINE | $ | 301.00 |
| 3353843 | CHLAMYDIA TRACHOMATIS | $ | 60.00 |
| 3353844 | NEISSERIA GONORRHOEAE,DIR | $ | 338.00 |
| 3353845 | CRYPTOSPORIDIUM GIARDIA | $ | 203.00 |
| 3353846 | CRYPTOSPORIDIUM AG EIA | $ | 99.00 |
| 3353847 | T3 FREE | $ | 56.00 |
| 3353848 | HEP C QUAN NAAT | $ | 523.00 |
| 3353849 | PARSITE SMEAR | $ | 99.00 |
| 3353850 | BORDETELLA PERTUSIS | $ | 203.00 |
| 3353851 | IMIPRAMINE | $ | 291.00 |
| 3353852 | BREATH ALCOHOL TEST | $ | 35.00 |
| 3353853 | GLUCOSE 1 HR OB | $ | 80.00 |
| 3353855 | HCG SERUM QUAL | $ | 128.00 |
| 3353856 | HCT | $ | 40.00 |
| 3353857 | CBC W AUTO DIFF | $ | 136.00 |
| 3353858 | CBC W/O DIFF | $ | 122.00 |
| 3353859 | CA 27.29 | $ | 76.00 |
| 3353860 | CA 125 | $ | 67.00 |
| 3353862 | HIV ABY SCREEN | $ | 150.00 |
| 3353863 | ANTIBODY SCREEN | $ | 88.00 |
| 3353864 | GROUP B STREP CULTURE | $ | 172.00 |
| 3353865 | PINWORM EXAM | $ | 71.00 |
| 3353866 | KOH / SKIN SCRAPING | $ | 88.00 |
| 3353867 | STREP TEST; RAPID | $ | 38.00 |
| 3353869 | POST VASECTOMY SPERM EXAM | $ | 145.00 |
| 3353870 | SEMEN ANALYSIS | $ | 205.00 |
| 3353871 | HPV TYPING | $ | 186.00 |
| 3353872 | HEP C VIRUS - GENOTYPE | $ | 554.00 |
| 3353873 | DHEA | $ | 84.00 |
| 3353874 | ANTITHROMBIN III AG | $ | 132.00 |
| 3353876 | LYMES DISEASE | $ | 191.00 |
| 3353877 | PAPILLOMAC HUMAN DIR PROB | $ | 145.00 |
| 3353878 | PAPILLOMAV HUMAN QUAN | $ | 304.00 |
| 3353879 | SICKLING OF RBC, REDUCTION | $ | 155.00 |
| 3353881 | TOXOCARA ANTI IgG-ARUP | $ | 98.00 |
| 3353882 | BARTONELLA HENSELAE IgG | $ | 98.00 |
| 3353883 | URINALYSIS,NON AUTO/W/O M | $ | 42.00 |
| 3353884 | ACETYLCHOLINE RECEPTOR BINDING ARUP | $ | 187.00 |
| 3353885 | PAPILLOMAVIRUS HUMAN APL | $ | 186.00 |
| 3353886 | COCCIDIOIDES | $ | 98.00 |
| 3353887 | COCCIDIOIDES | $ | 98.00 |
| 3353888 | H PYLORI STOOL | $ | 243.00 |
| 3353889 | ADRENOCORTICOTROPIC HORMO | $ | 117.00 |
| 3353890 | ACETYLCHOLINE RECEP NON-E | $ | 99.00 |
| 3353891 | FIBRIN / FIBRINOGEN DEGRA | $ | 117.00 |
| 3353892 | COLUMN CHROMATO,QUAN | $ | 216.00 |
| 3353893 | HEP C RNA QUAN REAL TIME | $ | 509.00 |
| 3353896 | INSULIN FREE | $ | 67.00 |
| 3353898 | INFLUENZA VIRUS | $ | 100.00 |
| 3353899 | FETAL FIBRONECTIN | $ | 503.00 |
| 3353900 | CH50 | $ | 63.00 |
| 3353901 | FACTOR II ACTIVITY | $ | 233.00 |
| 3353902 | OSTEOCALCIN | $ | 166.00 |
| 3353904 | PLATELET IMMUNOGLOB ASSAY | $ | 210.00 |
| 3353905 | TOXOPLASMA, IGM | $ | 168.00 |
| 3353906 | URTICARIA-INDUCING ACTIVITY ARUP | $ | 424.00 |
| 3353907 | FRAGILE X (FMR1) ARUP | $ | 479.00 |
| 3353908 | CORTISOL, FREE | $ | 93.00 |
| 3353909 | FRAGILE X (FMR1) REFLEX METHYLATION ANAL | $ | 2,163.00 |
| 3353910 | FECAL FAT, TIMED QUANT | $ | 459.00 |
| 3353913 | MUMPS IGG | $ | 51.00 |
| 3353915 | ANA REFLEX | $ | 73.00 |
| 3353916 | INSULIN TOTAL | $ | 51.00 |
| 3353917 | INSULIN ANTIBODIES | $ | 363.00 |
| 3353919 | AMPHET METHAMPHET CONFIRM | $ | 216.00 |
| 3353920 | PORPHYRINS QUANT $ FRACT | $ | 249.00 |
| 3353921 | HERPES SIMPLEX TYPE 2 | $ | 189.00 |
| 3353922 | DIHYDROXYVITAMIN D I25 | $ | 133.00 |
| 3353923 | ACTIVATED PROTEIN C | $ | 241.00 |
| 3353925 | ANGIOTENSIN I | $ | 56.00 |
| 3353926 | ASPERGILLUS AB ADDITIONAL | $ | 98.00 |
| 3353927 | FACTOR X ACTIVITY | $ | 1,192.00 |
| 3353929 | INFLUENZA VIRUS | $ | 100.00 |
| 3353930 | TCELL,ABSOLUTE COUNT | $ | 241.00 |
| 3353931 | AMMONIA ADDITIONAL | $ | 245.00 |
| 3353933 | GROUP B STREP CULTURE | $ | 172.00 |
| 3353934 | GC CULTURE | $ | 172.00 |
| 3353935 | KOH / SKIN SCRAPING | $ | 88.00 |
| 3353936 | LIPASE | $ | 114.00 |
| 3353937 | CRYPTOCOCCUS ANTI,CSF ARU | $ | 107.00 |
| 3353938 | LYME DISEASE (CSF) ARUP | $ | 90.00 |
| 3353940 | Manual Cell Count-BF | $ | 71.00 |
| 3353942 | ACETYLCHOLINE RECEPTOR BLOCKING ARUP | $ | 187.00 |
| 3353943 | ACETYLCHOLINE MODULATING RECEPTOR ARUP | $ | 187.00 |
| 3353988 | 5HIAA | $ | 94.00 |
| 3353989 | BARTONELLA HENSELAE IgM | $ | 98.00 |
| 3354014 | CULTURE WOUND, ADD SITE | $ | 109.00 |
| 3354015 | CULTURE, Wnd or Sputum or Misc | $ | 109.00 |
| 3354016 | BLOOD CULTURE ADDITIONAL | $ | 136.00 |
| 3354017 | BLOOD CULTURE | $ | 136.00 |
| 3354020 | CULTURE COMPLETE | $ | 109.00 |
| 3354066 | STOOL CULTURE | $ | 207.00 |
| 3354067 | STOOL CULTURE ADDITIONAL | $ | 207.00 |
| 3354068 | STOOL CULTURE #3 | $ | 207.00 |
| 3354100 | GRAM STAIN | $ | 71.00 |
| 3354101 | ANAEROBE CULTURE | $ | 277.00 |
| 3354102 | MRSA SURVEILLANCE/ ARUP | $ | 172.00 |
| 3354103 | ANAEROBE CULTURE ADDITION | $ | 277.00 |
| 3354140 | WET SMEAR | $ | 65.00 |
| 3354187 | STREP A CULTURE | $ | 172.00 |
| 3354189 | CLO TEST | $ | 187.00 |
| 3354201 | SENSITIVITY | $ | 124.00 |
| 3354202 | CULTURE, WOUNDSPUTUM,MS | $ | 109.00 |
| 3354203 | CULTURE I.D. | $ | 136.00 |
| 3354204 | BETA-LACTAMASE ARUP | $ | 80.00 |
| 3354205 | CULTURE I.D. | $ | 132.00 |
| 3354206 | SENSITIVITY | $ | 124.00 |
| 3354207 | CULTURE I.D. | $ | 136.00 |
| 3354208 | SENSITIVITY | $ | 124.00 |
| 3354209 | COMPLEMENT;ANITGEN EA | $ | 76.00 |
| 3354211 | CONCENTRATION,INF AGENT | $ | 114.00 |
| 3354212 | AFB CULTURE ARUP | $ | 182.00 |
| 3354213 | AFB SMEAR ONLY | $ | 97.00 |
| 3354214 | ETHOSUXIMIDE | $ | 67.00 |
| 3354215 | FUNGAL MOLD ID ARUP | $ | 582.00 |
| 3354216 | FUNGAL CULTURE,HAIR,SKIN, | $ | 233.00 |
| 3354218 | CA 19-9 | $ | 72.00 |
| 3354219 | STOOL CULTURE ADDITIONAL | $ | 207.00 |
| 3354221 | VITAMIN E ASSAY | $ | 240.00 |
| 3354222 | DETECT AGENT NOS DNA AMP | $ | 1,436.00 |
| 3354223 | CMV ANTIBODY, IGM | $ | 119.00 |
| 3354224 | SENSITIVITY - ARUP | $ | 145.00 |
| 3354225 | VITAMIN B-2 ASSAY | $ | 340.00 |
| 3354226 | CULTURE I.D. - ARUP | $ | 136.00 |
| 3354227 | CONCENTRATION, INF AGENT | $ | 63.00 |
| 3354228 | CULTURE, BACT W ISOLAT/ID / ISOL ARUP | $ | 166.00 |
| 3354229 | STOOL CULTURE ID ARUP | $ | 350.00 |
| 3354230 | STOOL CULTURE ID ARUP | $ | 350.00 |
| 3355080 | WBC | $ | 42.00 |
| 3355081 | WBC | $ | 42.00 |
| 3355093 | RBC | $ | 52.00 |
| 3355117 | RETIC | $ | 71.00 |
| 3355125 | HGB /HEMOGLOBULIN | $ | 40.00 |
| 3355126 | HGB /HEMOGLOBIN ADDITIONA | $ | 40.00 |
| 3355127 | HEMOGLOBIN (BY HEMOCUE) | $ | 40.00 |
| 3355129 | PLATELET ADDITIONAL | $ | 73.00 |
| 3355130 | PLATELET | $ | 73.00 |
| 3355132 | LIVER PANEL (HEPATIC) | $ | 183.00 |
| 3355134 | CBC NO DIFF ADD | $ | 122.00 |
| 3355135 | LIVER PANEL (HEPATIC) | $ | 183.00 |
| 3355136 | DEPAKOTE ( VALPROIC ACID) | $ | 88.00 |
| 3355138 | HCT / HEMATOCRIT | $ | 40.00 |
| 3355141 | HCT / HEMATOCRIT ADDITION | $ | 40.00 |
| 3355150 | MANUAL DIFFERENTIAL | $ | 44.00 |
| 3355151 | MANUAL DIFFERENTIAL ADDIT | $ | 44.00 |
| 3355152 | QUANITATION OF DRUG | $ | 192.00 |
| 3355153 | VALPROIC ACID TOTAL ARUP | $ | 155.00 |
| 3355154 | VALPROIC ACID FREE ARUP | $ | 155.00 |
| 3355155 | MANUAL DIFF NO CHG | $ | 0.00 |
| 3355182 | SED RATE / ESR | $ | 65.00 |
| 3355325 | PROTIME/ INR | $ | 66.00 |
| 3355326 | PROTIME / INR ADDITIONAL | $ | 66.00 |
| 3355352 | CBC W AUTO DIFF ADDITION | $ | 136.00 |
| 3355353 | CBC W AUTO DIFF | $ | 136.00 |
| 3355482 | CELL COUNT , FLUID | $ | 79.00 |
| 3355831 | PTT | $ | 80.00 |
| 3355833 | PTT | $ | 80.00 |
| 3355850 | DRUG HAIRSTAT 5 REFLEX PANEL ARUP | $ | 316.00 |
| 3356000 | URINALYSIS | $ | 55.00 |
| 3356003 | CHLORIDE URINE | $ | 46.00 |
| 3356004 | METANEPHRINE FRACTIONATED URINE ARUP | $ | 136.00 |
| 3356007 | URINE MICRO | $ | 52.00 |
| 3356010 | CORTISOL-URINE 24'-RANDOM | $ | 93.00 |
| 3356011 | CADMIUM / URINE | $ | 84.00 |
| 3356012 | BETA-2 MICROGLOBULIN/URIN | $ | 67.00 |
| 3356013 | COPPER, URINE ARUP | $ | 73.00 |
| 3356014 | BARIUM QUANTITATIVE URINE | $ | 533.00 |
| 3356015 | CHROMIUM URINE | $ | 69.00 |
| 3356016 | PHENOL EXPOSURE QUANT URINE | $ | 196.00 |
| 3356017 | SILVER QUANTITATIVE URINE/ SERUM | $ | 420.00 |
| 3356018 | PORPHOBILINOGEN, RANDOM URINE ARUP | $ | 160.00 |
| 3356023 | LEGIONELLA AG, URINE | $ | 84.00 |
| 3356025 | URINALYSIS / QUALITATIVE - ARUP | $ | 59.00 |
| 3356040 | URINE OCCULT | $ | 42.00 |
| 3356043 | URINE ALBUMIN | $ | 37.00 |
| 3356045 | MICRO ALBUMIN URINE | $ | 97.00 |
| 3356060 | URINE KETONES | $ | 42.00 |
| 3356068 | AMYLASE, URINE | $ | 110.00 |
| 3356100 | CREATININE UA RANDOM ARUP | $ | 87.00 |
| 3356101 | CREATININE UA 24HR ARUP | $ | 87.00 |
| 3356127 | URINE CALCIUM | $ | 100.00 |
| 3356128 | THALLIUM, URINE | $ | 110.00 |
| 3356150 | URIC ACID/ BODY FLUID | $ | 80.00 |
| 3356160 | CREATIN CLEARANCE TIMED | $ | 67.00 |
| 3356162 | CULTURE TYPING, IMMUNO | $ | 76.00 |
| 3356163 | IMMUNOFIX/ E-PHORSIS URIN | $ | 398.00 |
| 3356164 | CREATIN CLEARANCE TIMED | $ | 67.00 |
| 3356208 | VMA TIMED URINE | $ | 94.00 |
| 3356224 | PROTEIN TIMED URINE | $ | 73.00 |
| 3356243 | CATECHOLAMINES URINE | $ | 156.00 |
| 3356377 | SODIUM URINE | $ | 41.00 |
| 3356389 | POTASSIUM URINE | $ | 41.00 |
| 3356402 | HCG URINE | $ | 35.00 |
| 3356502 | RH | $ | 107.00 |
| 3356503 | THYROGLOBULIN ANTIBODY | $ | 58.00 |
| 3356504 | ANTIBODY ID,RBC ANTI | $ | 124.00 |
| 3356810 | LIPID PANEL | $ | 216.00 |
| 3357061 | RHEUMATOID FACTOR | $ | 51.00 |
| 3357062 | BRAC1 BRAC2 GENE ANALYSIS | $ | 2,222.00 |
| 3357088 | MONO TEST | $ | 51.00 |
| 3357856 | CELIAC PANEL | $ | 56.00 |
| 3357868 | IG-G NCL | $ | 56.00 |
| 3357880 | IG-M NCL | $ | 56.00 |
| 3358000 | TROPONIN I,i-STAT | $ | 164.00 |
| 3358001 | TROPONIN I, i STAT ADDIT | $ | 164.00 |
| 3358002 | CK-MB, i-STAT | $ | 128.00 |
| 3358003 | CK-MB, i-STAT ADDIT | $ | 128.00 |
| 3358011 | BLOOD TYPE ABO | $ | 107.00 |
| 3358012 | RH | $ | 107.00 |
| 3358013 | TYPE COMPLETE | $ | 107.00 |
| 3358014 | TYPE COMPLETE-2 | $ | 107.00 |
| 3358022 | INFANT BLOOD TYPE ABO | $ | 107.00 |
| 3358023 | INFANT RH | $ | 107.00 |
| 3358025 | DU LAB | $ | 66.00 |
| 3358050 | RH ONLY | $ | 107.00 |
| 3358108 | DAT | $ | 97.00 |
| 3358109 | ANTIBODY IDENTIFICATION | $ | 124.00 |
| 3358110 | ANITBODY ELUTION | $ | 332.00 |
| 3358111 | ANTIBODY ELUTION(RBC) | $ | 332.00 |
| 3358112 | DAT | $ | 97.00 |
| 3358113 | ANTIGEN SCREENING | $ | 154.00 |
| 3358114 | ANTIGEN SCREENING | $ | 154.00 |
| 3358115 | RH PHENOTYPING,COMPLETE | $ | 131.00 |
| 3358116 | RH ANTIGEN SCREEN | $ | 145.00 |
| 3358117 | RH ANTIGEN SCREENING | $ | 145.00 |
| 3358120 | ANTIBODY SCREEN / ARC | $ | 109.00 |
| 3358123 | ANTIHUMAN GLOBULIN TEST COOMBS | $ | 88.00 |
| 3358124 | ANTIHUMAN GLOBULIN TEST COOMBS | $ | 88.00 |
| 3358125 | PRETREATMENT RBC'S | $ | 213.00 |
| 3358126 | PRETREATMENT OF SERUM RBC'S | $ | 219.00 |
| 3358127 | INFECT AGENT DETECT NUCLEIC ACID STREPTO | $ | 281.00 |
| 3358201 | CROSSMATCH-1 | $ | 291.00 |
| 3358202 | CROSSMATCH-2 | $ | 291.00 |
| 3358203 | CROSSMATCH-3 | $ | 291.00 |
| 3358205 | ANTIGEN SCREENING | $ | 66.00 |
| 3358206 | RARE TYPING | $ | 371.00 |
| 3358207 | CROSSMATCH-1 | $ | 291.00 |
| 3358208 | CROSSMATCH-2 | $ | 291.00 |
| 3358209 | CROSSMATCH-3 | $ | 291.00 |
| 3358210 | ANTIGEN SCREENING | $ | 66.00 |
| 3358530 | STRIATED MUSCLE REFLEX | $ | 293.00 |
| 3358531 | ANCA TITER REFLEX | $ | 293.00 |
| 3358532 | FACTOR V ACTIVITY | $ | 133.00 |
| 3358533 | C-PEPTIDE | $ | 67.00 |
| 3358534 | RICKETTSIA | $ | 86.00 |
| 3358535 | URINALYSIS COMPLETE | $ | 68.00 |
| 3358536 | URINALYSIS W/O MICRO | $ | 39.00 |
| 3358537 | URINALYSIS AUTO | $ | 68.00 |
| 3358538 | URINALYSIS COMPLETE /59 | $ | 68.00 |
| 3359000 | PATH/LEVEL I GROSS ONLY | $ | 76.00 |
| 3359001 | PATH/LEVEL II GROSS & MIC | $ | 159.00 |
| 3359003 | PATH/LEVEL III GROSS/MICR | $ | 166.00 |
| 3359004 | PATH/LEVEL IV GROSS/MICRO | $ | 227.00 |
| 3359005 | PATH/LEVEL V GROSS/MICRO | $ | 505.00 |
| 3359006 | PATH/LEVEL VI GROSS/MICRO | $ | 702.00 |
| 3359008 | PATH/SPECIAL STAIN #1 | $ | 261.00 |
| 3359009 | PATH/SPECIAL STAIN #2 | $ | 174.00 |
| 3359010 | PATH/CYTOL,VAGINA,CERVIX | $ | 46.00 |
| 3359011 | PATH/CYTOL,FLUIDS,WASH,BR | $ | 147.00 |
| 3359012 | PATH/ESTROGEN EVAL | $ | 27.00 |
| 3359013 | PATH/DECALCIFICATION PROC | $ | 26.00 |
| 3359014 | PATH/SPECIAL STAIN (ENZY) | $ | 188.00 |
| 3359015 | PATH/IMMUNOPEROXIDASE/ANT | $ | 228.00 |
| 3359016 | PATH/CYTOLOGY FLUIDS | $ | 178.00 |
| 3359017 | PATH/CYTOLOGY,SCR & INTER | $ | 118.00 |
| 3359019 | PATH/CYTOLGY NEEDLE ASPIR | $ | 250.00 |
| 3359020 | CYTOL, CERVI | $ | 118.00 |
| 3359021 | PERIPHERAL SMEAR AHL | $ | 86.00 |
| 3359022 | DECALCIFICAT | $ | 26.00 |
| 3359023 | STONE ANAL. W | $ | 217.00 |
| 3359024 | PATH / PROGESTE | $ | 119.00 |
| 3359030 | HEMOGRAM PLATELET COUNT | $ | 122.00 |
| 3359031 | PAP SMEAR THIN PREP | $ | 94.00 |
| 3359032 | CYTOLOGY SMEAR, OTHER | $ | 112.00 |
| 3359033 | HER 2-FISH | $ | 228.00 |
| 3359034 | CYTO FLUID THI PREPSMEAR | $ | 147.00 |
| 3359036 | TISSUE CULTURE SOLID TUMOR | $ | 223.00 |
| 3359037 | CHROMOSOME COUNT 15-20 CE | $ | 558.00 |
| 3359038 | PAP SMEAR ROUTINE | $ | 118.00 |
| 3359039 | FACTOR X CHROMOGE | $ | 202.00 |
| 3359040 | CYTOGENETICS/MOLECULAR | $ | 96.00 |
| 3359041 | TISSUE CULTURE/NONNEOPLAS | $ | 223.00 |
| 3359042 | STONE ANAL | $ | 111.00 |
| 3359043 | CULTURE SKIN/TISSUE BIOPS | $ | 223.00 |
| 3359044 | CYTOPATHOLOGY,CERVICAL VA | $ | 99.00 |
| 3359046 | CYTOPATHOLOGY,SELE CELLUL | $ | 160.00 |
| 3359047 | MOLECULAR CYTOGENETICS | $ | 66.00 |
| 3359048 | MOLECULAR CYTOGENETICS | $ | 66.00 |
| 3359049 | INTERPHASE IN SITU HYBRID | $ | 180.00 |
| 3359050 | CTYOGENOMIC SNP MICRO REFLEX ARUP | $ | 5,813.00 |
| 3359053 | MORPHOMETRIC ANALYSIS COM | $ | 1,170.00 |
| 3359054 | INSITU HYDRIDIZATION MANU | $ | 2,009.00 |
| 3359055 | PHYSICIAN BLOOD BANK | $ | 593.00 |
| 3359056 | AUTO DIFF / WBC COUNT | $ | 110.00 |
| 3359057 | TISSUE CULT/ BONE MARROW | $ | 223.00 |
| 3359061 | FLOWCYTOMETRY/ TC 1 MARKE | $ | 277.00 |
| 3359062 | FLOWCYTOMETRY/TC ADD ON | $ | 167.00 |
| 3359063 | FLOWCYTOMETRY/TC ADD ON | $ | 167.00 |
| 3359064 | FLOWCYTOMETRY/READ 16 > | $ | 337.00 |
| 3359065 | CELL MARKER STUDY | $ | 229.00 |
| 3359066 | PAP SMEAR AUTO/THIN PREP | $ | 96.00 |
| 3359067 | RETICULOCYTE BLOOD COUNT | $ | 68.00 |
| 3359068 | FLOWCYTOMETRY INTERP | $ | 217.00 |
| 3359069 | PATH/CYTO CERVIX VAGINAL | $ | 167.00 |
| 3359070 | PATH/ LEVEL II GROSS & MI | $ | 159.00 |
| 3359071 | PATH LEVEL III GROSS MICR | $ | 166.00 |
| 3359072 | CHROMOSOME KAROTYPE | $ | 112.00 |
| 3359073 | CHROMOSOME KAROTYPE | $ | 112.00 |
| 3359074 | PATH/ SPECIAL STAIN #1 | $ | 261.00 |
| 3359075 | FLOW CYTOMETRY/ READ 9-15 | $ | 277.00 |
| 3359076 | MORPHOMETRIC ANALYSIS COM | $ | 1,170.00 |
| 3359077 | INSTU HYRIDIZATION MANU | $ | 2,009.00 |
| 3359078 | PATH/LEVEL V GROSS/ MICRO | $ | 505.00 |
| 3359079 | PAP SMEAR SCREENING/ HAND | $ | 156.00 |
| 3359080 | INSITU HYBRIDIZATION(FISH | $ | 1,416.00 |
| 3359081 | INTERPHASE IN SITU HYBRID | $ | 180.00 |
| 3359082 | TRANSFUSION RX / PHYS SER | $ | 593.00 |
| 3359083 | CYTOGENICS, 10-30 | $ | 144.00 |
| 3359084 | PATH/LEVEL VI GROSS/MICRO | $ | 948.00 |
| 3359085 | TUMOR IMMUNOHISTO/ MANUAL | $ | 883.00 |
| 3359086 | PATH/CYTOLOGY NEEDLE ASPI | $ | 250.00 |
| 3359087 | PATH/LEVEL I GROSS ONLY | $ | 76.00 |
| 3359088 | PATH/ IMMUNOFLUOR STUDY | $ | 210.00 |
| 3359089 | PATH/ IMMUNOFLUOR STUDY | $ | 210.00 |
| 3359090 | MONOCYTIC EHR DNA ALLINA | $ | 1,436.00 |
| 3359091 | PATH/LEVEL IV GROSS/MICRO | $ | 227.00 |
| 3359092 | JAK2 GENE MUTATION | $ | 693.00 |
| 3359093 | CHROMOSOME ANAL, ADD CELL | $ | 85.00 |
| 3359095 | CYTOPATH URINE 3-5 PROBES | $ | 2,487.00 |
| 3359096 | DECALCIFICAT | $ | 26.00 |
| 3359100 | PATH/ IMMUNOPEROXIDASE / ANT | $ | 228.00 |
| 3359101 | IHC STAIN ADDL | $ | 228.00 |
| 3359102 | HPV HIGH RISK | $ | 141.00 |
| 3359103 | PROSTATE SATURATION BIOPSY | $ | 4,482.00 |
| 3359104 | IHC STAIN MULTIPLEX | $ | 327.00 |
| 3359105 | IHC STAIN MUTIPLEX | $ | 327.00 |
| 3359106 | TUMOR IMMUNOHISTO/ MANUAL | $ | 883.00 |
| 3359107 | CYG-GENERAL MORPH | $ | 2,050.00 |
| 3359108 | CYG-GENERAL MORPH | $ | 2,050.00 |
| 3359109 | CHROMOSOME COUNT 15-20 CLL ARUP | $ | 684.00 |
| 3359110 | TISSUE CULTURE NON NEO ARUP | $ | 684.00 |
| 3359111 | CYTOGENETICS MOLECULAR CTYO ARUP | $ | 684.00 |
| 3359112 | CALR, GENE ANALYSIS | $ | 1,252.00 |
| 3359113 | BRAF V600 MUTATION ASSAY ALLINA | $ | 918.00 |
| 3359114 | EGFR MUTATION ANALYSIS ALLINA | $ | 1,683.00 |
| 3359115 | MPL CODON 515 MUTATION DETEC, QUANT ARUP | $ | 1,814.00 |
| 3359116 | EPOR MUTATION DETEC, SEQUENCING ARUP | $ | 1,814.00 |
| 3359117 | BETA LACTAMASE - ALLINA | $ | 37.00 |
| 3359118 | KB SUSCEPTIBILITY - ALLINA | $ | 54.00 |
| 3359119 | E TEST - ALLINA | $ | 37.00 |
| 3359120 | KB SUSCEPTIBILTY -ALLINA 2ND | $ | 54.00 |
| 3359121 | T CELL PCR 1 | $ | 732.00 |
| 3359122 | T CELL PCR 2 | $ | 706.00 |
| 3359123 | TISSUE HOMOGENIZATION | $ | 42.00 |
| 3359124 | EOSINOPHIL SMEAR | $ | 37.00 |
| 3359125 | DNA EXTRACTION, SEQUENCING | $ | 216.00 |
| 3359190 | VENIPUNCTURE | $ | 13.00 |
| 3359191 | VENIPUNCTURE ADDITIONAL | $ | 13.00 |
| 3359192 | CAPILLARY COLLECTION | $ | 6.00 |
| 3359193 | COLLECTION BLOOD/ VENOUS | $ | 131.00 |
| 3359194 | COLLECTION BLOOD/ VENOUS | $ | 131.00 |
| 3359195 | SPECIMEN HANDLING | $ | 37.00 |
| 3359196 | SPECIMEN HANDLING | $ | 37.00 |
| 3359198 | CAPILLARY COLLECTION ADDI | $ | 6.00 |
| 3359201 | ARTERIAL PUNCTURE | $ | 85.00 |
| 3359202 | ARTERIAL PUNCTURE ADDITI | $ | 85.00 |
| 3359203 | ARUP - PROCESS FEE | $ | 109.00 |
| 3359204 | ARTERIAL PUNCTURE | $ | 86.00 |
| 3359205 | ARUP - PROCESS FEE | $ | 109.00 |
| 3359206 | VENIPUNCTURE (NO CHG) | $ | 0.00 |
| 3359210 | MEDICAL NECESSITY TEST 0 CHARGE | $ | 0.00 |
| 3359382 | TRAVEL LAB | $ | 27.00 |
| 3359393 | PKU | $ | 604.00 |
| 3359395 | PH FECAL | $ | 28.00 |
| 3359406 | MECONIUM DRUG PANEL 10 | $ | 907.00 |
| 3359407 | MECONIUM DRUG PANEL 9 | $ | 818.00 |
| 3359408 | MECONIUM DRUG PANEL 8 | $ | 706.00 |
| 3359409 | SEROGROUPING - ALLINA | $ | 40.00 |
| 3359509 | FLUNITRAZEPAM & METABOLITES W/RFLX, U | $ | 669.00 |
| 3359510 | GAMMA-HYDROXYBUTYRIC ACID SCREEN | $ | 712.00 |
| 3359600 | MEDTOX TESTING | $ | 40.00 |
| 3359601 | SPECIMEN HANDLING MEDTOX | $ | 30.00 |
| 3359602 | DDC SPECIMEN HANDLING | $ | 23.00 |
| 3359880 | DRUG TEST/S 1-7 DRUG TESTING | $ | 416.00 |
| 3359881 | DRUG TEST 15-21 DRUG CLASSES | $ | 822.00 |
| 3359882 | DRUG TEST 8-14 DRUG CLASSES | $ | 252.00 |
| 3359885 | CONSULT REPORT REFERRED SLIDE PREP ELSEW | $ | 456.00 |
| 3368536 | URINALYSIS W/O MICRO | $ | 39.00 |
| 3369010 | PATH/CYTOL,VAGINA,CERVIX | $ | 46.00 |
| 3369196 | SPECIMEN HANDLING | $ | 27.00 |
| 3370067 | RHOPHYLAC 300MCG / 1500IU(RHOGAM) X15 | $ | 21.00 |
| LAB | LAB Conversion | $ | 0.00 |
| 3339026 | MRI PROHANCE/GADOLIN 50ML | $ | 263.00 |
| 3339500 | MRI TMJ JNT | $ | 3,622.00 |
| 3339501 | MRI ORBIT,FACE,NECK | $ | 3,622.00 |
| 3339502 | MRI BRAIN W/O | $ | 3,622.00 |
| 3339503 | MRI BRAIN W | $ | 3,622.00 |
| 3339504 | MRI BRAIN W W/O | $ | 3,622.00 |
| 3339505 | MRI CHEST W/O | $ | 3,622.00 |
| 3339506 | MRI C-SPINE W/O | $ | 3,622.00 |
| 3339507 | MRI C-SPINE W | $ | 3,622.00 |
| 3339508 | MRI T-SPINE | $ | 3,622.00 |
| 3339509 | MRI T-SPINE W | $ | 3,622.00 |
| 3339510 | MRI L-SPINE W/O | $ | 3,622.00 |
| 3339511 | MRI L-SPINE W | $ | 3,622.00 |
| 3339512 | MRI C-SPINE W W/O | $ | 3,622.00 |
| 3339513 | MRI T-SPINE W W/O | $ | 3,622.00 |
| 3339514 | MRI L-SPINE W W/O | $ | 3,622.00 |
| 3339515 | MRI PELVIS W | $ | 3,622.00 |
| 3339516 | MRI UPPER EXT W W/O LT | $ | 3,622.00 |
| 3339518 | MRI LWR EXTR NON JNT LT W W/O | $ | 3,622.00 |
| 3339519 | MRI LWR EXT JNT W/O RT | $ | 3,622.00 |
| 3339520 | MRI ABD W/O | $ | 3,622.00 |
| 3339521 | MRI ABD W W/O | $ | 3,622.00 |
| 3339524 | MRA NECK W/O | $ | 3,622.00 |
| 3339525 | MRA NECK W W/O | $ | 3,622.00 |
| 3339526 | MRA HEAD W/O | $ | 3,622.00 |
| 3339527 | MRI PELVIS / HIP W/O | $ | 3,622.00 |
| 3339528 | MRI LWR EXT JNT W/O LT | $ | 3,622.00 |
| 3339529 | MRI T-SPINE LIM | $ | 3,622.00 |
| 3339530 | MRI UPPER EXT JNT RT | $ | 3,622.00 |
| 3339531 | MRI UPPER EXT JNT LT | $ | 3,622.00 |
| 3339532 | MRA UPPER EXT LT | $ | 3,622.00 |
| 3339533 | MRA CHEST W W/O | $ | 3,622.00 |
| 3339534 | MRA ABD W W/O | $ | 3,622.00 |
| 3339535 | MRA NECK W | $ | 3,622.00 |
| 3339536 | MRI LWR EXT NOT JNT RT WO | $ | 3,622.00 |
| 3339537 | MRI C-SPINE LIM W/O | $ | 3,622.00 |
| 3339538 | MRA SPINAL CANAL | $ | 3,622.00 |
| 3339539 | MRI ORBIT,FACE,NECK W W/O | $ | 3,622.00 |
| 3339540 | MRI LWR EXT NOT JNT LT WO | $ | 3,622.00 |
| 3339541 | MRI LWR EXT JNT W W/O RT | $ | 3,622.00 |
| 3339542 | MRA LWR EXT LT | $ | 3,622.00 |
| 3339543 | MRI UPPER EXT NOT JNT RT | $ | 3,622.00 |
| 3339546 | MRI LWR EXTR NON JNT RT W W/O | $ | 3,622.00 |
| 3339547 | MRI LWR EXT JNT W W/O LT | $ | 3,622.00 |
| 3339548 | MRI LWR EXT JNT W RT | $ | 3,622.00 |
| 3339549 | MRA LWR EXT RT | $ | 3,622.00 |
| 3339550 | MRA HEAD W W/O | $ | 3,622.00 |
| 3339551 | MRI BRAIN / NEURO FUNC | $ | 3,622.00 |
| 3339552 | MRI UPPER EXT NOT JNT LT | $ | 3,622.00 |
| 3339553 | MRI BRAIN FUNCTION | $ | 3,622.00 |
| 3339554 | MRI LWR EXT JNT W/O RT | $ | 3,622.00 |
| 3339555 | MRA UPPER EXT RT | $ | 3,622.00 |
| 3339556 | MRI IAC W W/O | $ | 3,622.00 |
| 3339557 | MRI UPPER EXT JNT W | $ | 3,622.00 |
| 3339558 | MRI UPPER EXT JNT W | $ | 3,622.00 |
| 3339559 | MRI UPPER EXT W W/O RT | $ | 3,622.00 |
| 3339560 | MRI LWR EXT W LT | $ | 3,622.00 |
| 3339561 | MRI PELVIS / HIP W W/O | $ | 3,622.00 |
| 3339562 | MRI ABD W | $ | 3,622.00 |
| 3339563 | MRI UPPER EXT JNT W/WO RT | $ | 3,622.00 |
| 3339564 | MRI UPPER EXT JNT W/WO LT | $ | 3,622.00 |
| 3339565 | MRI CHEST W W/O CONTRAST | $ | 3,622.00 |
| 3339566 | MRI BRAIN W | $ | 3,622.00 |
| 3339567 | MRA HEAD W/O | $ | 3,622.00 |
| 3339568 | MRI LWR EXT NO /JNT W RT | $ | 3,622.00 |
| | | $ | 3,622.00 |
| 3328608 | NM RENOGRAM LT | $ | 1,989.00 |
| 3328618 | NM MI WORK UP/PYP SCAN | $ | 1,739.00 |
| 3328619 | NM GI BLEED & SULPHUR | $ | 3,230.00 |
| 3328620 | NM MECKLES | $ | 3,238.00 |
| 3328621 | NM BONE/JNT SCAN LIM | $ | 1,608.00 |
| 3328622 | NM BONE SCAN MULT AREA | $ | 2,115.00 |
| 3328623 | NM BONE SCAN TOTAL BODY | $ | 2,249.00 |
| 3328624 | NM 3 PHASE BONE SCAN | $ | 3,209.00 |
| 3328627 | NM LIVER & SPLEEN IMAGE | $ | 1,835.00 |
| 3328631 | NM MUGA GAITED CARDIAC | $ | 1,985.00 |
| 3328632 | NM GASTRIC EMPTYING STUDY | $ | 2,680.00 |
| 3328633 | NM PY BREATH TEST | $ | 973.00 |
| 3328634 | NM SPLEEN SCAN | $ | 2,059.00 |
| 3328638 | NM RENAL SCAN LT | $ | 1,659.00 |
| 3328642 | NM RENAL STUDY,SINGLE LT | $ | 1,226.00 |
| 3328644 | NM PULM PERFUSION IMAG,PA | $ | 2,047.00 |
| 3328645 | NM PARATHYROID | $ | 1,317.00 |
| 3328648 | NM RENAL SCAN RT | $ | 1,659.00 |
| 3328649 | NM RENOGRAM RT | $ | 1,989.00 |
| 3328650 | NM RENAL STUDY SINGLE RT | $ | 1,226.00 |
| 3328651 | NM HIDA SCAN | $ | 3,162.00 |
| 3328652 | NM HIDA EF | $ | 4,390.00 |
| 3328653 | NM ORAL RADIOPHARM THERAP | $ | 513.00 |
| 3328654 | NM INDIUM BONE SCAN LIMIT | $ | 1,582.00 |
| 3328655 | NM THYROID IMAGING VAS FL | $ | 2,262.00 |
| 3328656 | NM KIDNEY IMAG W / MORPH LT | $ | 2,030.00 |
| 3328657 | NM KIDNEY IMAG W / MORPH RT | $ | 2,030.00 |
| 3328658 | NM KIDNEY IMAG W MORPH BILAT | $ | 2,536.00 |
| 3328659 | NM RENAL STUDY BILATERAL | $ | 1,532.00 |
| 3328660 | NM RENOGRAM BILATERAL | $ | 2,488.00 |
| 3328661 | NM BSGI | $ | 2,244.00 |
| 3328663 | NM PULMONARY VENTILATION PERFUSION IMAG | $ | 2,251.00 |
| 3050002 | RM/BOARD SEMI PRIVATE | $ | 2,572.00 |
| 3050004 | RM/BOARD OBSTETRIC | $ | 2,300.00 |
| 3050005 | RM/BOARD SWING BED PRIV | $ | 950.00 |
| 3050006 | RM/BOARD SWING LOA | $ | 0.00 |
| 3105651 | GLUCOSE TESTING (NONLAB) | $ | 45.00 |
| 3105682 | THERAPEUTIC INJ INTR ARTE | $ | 120.00 |
| 3105685 | BLADDER IRRIGATION | $ | 310.00 |
| 3105688 | COLLECTION/BLOOD VENOUS | $ | 81.00 |
| 3105689 | ADMINISTRATION/HEP B VACC | $ | 53.00 |
| 3105690 | IMMUNIZATION | $ | 31.00 |
| 3105691 | COLLECTION/BLOOD VENOUS | $ | 81.00 |
| 3105692 | IMMUNIZATION VACCINE | $ | 26.00 |
| 3105695 | IV INFUS/HYDRATION EA 1HR | $ | 34.00 |
| 3105696 | IV INFUS/HYDRATION | $ | 96.00 |
| 3105697 | IV PUSH EA ADD | $ | 234.00 |
| 3105698 | IV PUSH | $ | 234.00 |
| 3105699 | IV THERAPY ADD SEQ INF | $ | 234.00 |
| 3105701 | PORT FLUSH | $ | 196.00 |
| 3105702 | IV PUSH | $ | 234.00 |
| 3105704 | IMMUNIZATION ADMIN/ INFLU | $ | 10.00 |
| 3105705 | IMMUNIZATION / ADMIN PNEU | $ | 10.00 |
| 3105706 | BLADDER IRRIG/ CHEMO | $ | 477.00 |
| 3105707 | GLUCOSE TESTING (NONLAB) | $ | 45.00 |
| 3105709 | IV PUSH EA ADD | $ | 234.00 |
| 3105712 | IV INFUSION / HYDRATION | $ | 96.00 |
| 3105800 | IMPLANTABLE PUMP/PROGRA | $ | 464.00 |
| 3105801 | INSERTION OF NEEDLE | $ | 54.00 |
| 3105802 | ARTERIAL PUNCTURE | $ | 122.00 |
| 3105803 | INSERT NON-TUNNEL CV CATH | $ | 789.00 |
| 3105804 | INSERT PIC CATH 5YRS> | $ | 1,720.00 |
| 3105805 | REPOSITION VENOUS CATH | $ | 351.00 |
| 3105806 | NASAL GASTRIC TUBE INSERT | $ | 207.00 |
| 3105807 | INJECTION JOINT/ BURSA | $ | 151.00 |
| 3105808 | SHAVE SKIN LESION | $ | 281.00 |
| 3105811 | PICC LINE INSERTION | $ | 500.00 |
| 3105812 | PICC LINE INSERTION | $ | 500.00 |
| 3105813 | REMOVAL CENT VENOUS CATH | $ | 1,100.00 |
| 3105814 | REMOVAL CENT VENOUS CATH | $ | 1,100.00 |
| 3105816 | DRAINAGE HYDROCELE | $ | 460.00 |
| 3105817 | PICC LINE INSERTION | $ | 500.00 |
| 3105818 | THORACENTESIS W/O IMAG | $ | 1,457.00 |
| 3105819 | INSERT NON-TUNNEL CV CATH | $ | 789.00 |
| 3105820 | REMOVAL TUNNELED CV CATH | $ | 776.00 |
| 3105821 | THORACENTESIS W IMAGING | $ | 1,667.00 |
| 3105822 | NEGATIVE PRESSURE WOUND THERAPY | $ | 360.00 |
| 3105823 | PHLEBOTOMY | $ | 379.00 |
| 3106110 | INTUBATION | $ | 703.00 |
| 3107020 | NASOPHARYNGOSCOPY | $ | 369.00 |
| 3107021 | DEBRIDE,SUBQ 1ST 20SQ CM | $ | 509.00 |
| 3107022 | NEG PRESS THER 50 CM | $ | 160.00 |
| 3107023 | DEBRD SEL 1ST 20SQCM | $ | 159.00 |
| 3107024 | NEG PRESS THER >50CM | $ | 209.00 |
| 3805986 | ER OBSERVATION EA.1HR | $ | 150.00 |
| 3806400 | OBSERVATION HOURS | $ | 0.00 |
| 3650001 | OT CONTRACT PRE-EMP EVAL | $ | 22.00 |
| 3650002 | OT CCC SCREEN | $ | 0.00 |
| 3658003 | OT EVAL LOW COMPLEXITY | $ | 230.00 |
| 3658004 | OT TRAIN IN ADL 15 | $ | 259.00 |
| 3658005 | OT EVAL MOD COMPLEXITY | $ | 252.00 |
| 3658006 | OT ADLS 15 | $ | 259.00 |
| 3658007 | OT THER EX 15 | $ | 259.00 |
| 3658008 | OT COG/SENS INT 15 | $ | 259.00 |
| 3658009 | OT THER ACT 15" | $ | 259.00 |
| 3658010 | OT EVAL HIGH COMPLEXITY | $ | 274.00 |
| 3658011 | OT NEURO RE-ED 15 | $ | 259.00 |
| 3658013 | OT RE-EVALUATION | $ | 153.00 |
| 3658014 | OT ORTHOTICS FIT/TRN 15 | $ | 240.00 |
| 3658015 | OT W/C MGT FIT 15 | $ | 227.00 |
| 3658016 | OT SENSORY SKILLS 15 | $ | 259.00 |
| 3658018 | OT ULTRASOUND 15 | $ | 195.00 |
| 3658019 | OT PHYS PERF TEST 15 | $ | 191.00 |
| 3658020 | OT ORTHOTIC MGMT/TRAINING 15 | $ | 240.00 |
| 3658021 | OT IONTOPHORESIS 15 | $ | 132.00 |
| 3658023 | OT COG/SENS INT 15" 59 | $ | 259.00 |
| 3658024 | OT ADLS 15" 59 | $ | 259.00 |
| 3658027 | OT E-STIM MANUAL 15 | $ | 124.00 |
| 3658028 | OT PARAFFIN BATH | $ | 0.00 |
| 3658029 | OT CONTRACT GOOD SAM HC /VISIT OT | $ | 99.00 |
| 3658030 | OT E-STIM ATTENDED 15 | $ | 124.00 |
| 3658031 | OT THER EX 15 59 | $ | 259.00 |
| 3658032 | OT THER ACT 15" 59 | $ | 259.00 |
| 3658033 | OT NEURO RE-ED 15" 59 | $ | 259.00 |
| 3658034 | OT COG/SENS INT 15 59 | $ | 259.00 |
| 3658035 | OT CROSSBOW EVAL | $ | 64.00 |
| 3658036 | OT TRAIN IN ADL 15MN 59 | $ | 259.00 |
| 3658037 | THERAPEUTIC INTERVEN COG FUNC | $ | 107.00 |
| 3658038 | ORTHOTIC PROSTHETIC MGMT / TRAIN 15MN | $ | 194.00 |
| 3659020 | OT MOBILITY CURRENT G8978CH | $ | 0.00 |
| 3659021 | OT MOBILITY CURRENT G8978CI | $ | 0.00 |
| 3659022 | OT MOBILITY CURRENT G8978CJ | $ | 0.00 |
| 3659023 | OT MOBILITY CURRENT G8978CK | $ | 0.00 |
| 3659024 | OT MOBILITY CURRENT G8978CL | $ | 0.00 |
| 3659025 | OT MOBILITY CURRENT G8978CM | $ | 0.00 |
| 3659026 | OT MOBILITY CURRENT G8978CN | $ | 0.00 |
| 3659027 | OT MOBILITY GOAL G8979CH | $ | 0.00 |
| 3659028 | OT MOBILITY GOAL G8979CI | $ | 0.00 |
| 3659029 | OT MOBILITY GOAL G8979CJ | $ | 0.00 |
| 3659030 | OT MOBILITY GOAL G8979CK | $ | 0.00 |
| 3659031 | OT MOBILITY GOAL G8979CL | $ | 0.00 |
| 3659032 | OT MOBILITY GOAL G8979CM | $ | 0.00 |
| 3659033 | OT MOBILITY GOAL G8979CN | $ | 0.00 |
| 3659034 | OT MOBILITY D/C G8980CH | $ | 0.00 |
| 3659035 | OT MOBILITY D/C G8980CI | $ | 0.00 |
| 3659036 | OT MOBILITY D/C G8980CJ | $ | 0.00 |
| 3659037 | OT MOBILITY D/C G8980CK | $ | 0.00 |
| 3659038 | OT MOBILITY D/C G8980CL | $ | 0.00 |
| 3659039 | OT MOBILITY D/C G8980CM | $ | 0.00 |
| 3659040 | OT MOBILITY D/C G8980CN | $ | 0.00 |
| 3659041 | OT BODY POSITION CURRENT G8981CH | $ | 0.00 |
| 3659042 | OT BODY POSITION CURRENT G8981CI | $ | 0.00 |
| 3659043 | OT BODY POSITION CURRENT G8981CJ | $ | 0.00 |
| 3659044 | OT BODY POSITION CURRENT G8981CK | $ | 0.00 |
| 3659045 | OT BODY POSITION CURRENT G8981CL | $ | 0.00 |
| 3659046 | OT BODY POSITION CURRENT G8981CM | $ | 0.00 |
| 3659047 | OT BODY POSITION CURRENT G8981CN | $ | 0.00 |
| 3659048 | OT BODY POSITION GOAL G8982CH | $ | 0.00 |
| 3659049 | OT BODY POSITION GOAL G8982CI | $ | 0.00 |
| 3659050 | OT BODY POSITION GOAL G8982CJ | $ | 0.00 |
| 3659051 | OT BODY POSITION GOALG8982CK | $ | 0.00 |
| 3659052 | OT BODY POSITION GOAL G8982CL | $ | 0.00 |
| 3659053 | OT BODY POSITION GOAL G8982CM | $ | 0.00 |
| 3659054 | OT BODY POSITION GOAL G8982CN | $ | 0.00 |
| 3659055 | OT BODY POSITION D/C G8983CH | $ | 0.00 |
| 3659056 | OT BODY POSITION D/C G8983CI | $ | 0.00 |
| 3659057 | OT BODY POSITION D/C G8983CJ | $ | 0.00 |
| 3659058 | OT BODY POSITION D/C G8983CK | $ | 0.00 |
| 3659059 | OT BODY POSITION D/C G8983CL | $ | 0.00 |
| 3659060 | OT BODY POSITION D/C G8983CM | $ | 0.00 |
| 3659061 | OT BODY POSITION D/C G8983CN | $ | 0.00 |
| 3659062 | OT CARRYING CURRENT G8984CH | $ | 0.00 |
| 3659063 | OT CARRYING CURRENT G8984CI | $ | 0.00 |
| 3659064 | OT CARRYING CURRENT G8984CJ | $ | 0.00 |
| 3659065 | OT CARRYING CURRENT G8984CK | $ | 0.00 |
| 3659066 | OT CARRYING CURRENT G8984CL | $ | 0.00 |
| 3659067 | OT CARRYING CURRENT G8984CM | $ | 0.00 |
| 3659068 | OT CARRYING CURRENT G8984CN | $ | 0.00 |
| 3659069 | OT CARRYING GOAL G8985CH | $ | 0.00 |
| 3659070 | OT CARRYING GOAL G8985CI | $ | 0.00 |
| 3659071 | OT CARRYING GOAL G8985CJ | $ | 0.00 |
| 3659072 | OT CARRYING GOAL G8985CK | $ | 0.00 |
| 3659073 | OT CARRYING GOAL G8985CL | $ | 0.00 |
| 3659074 | OT CARRYING GOAL G8985CM | $ | 0.00 |
| 3659075 | OT CARRYING GOAL G8985CN | $ | 0.00 |
| 3659076 | OT CARRYING D/C G8986CH | $ | 0.00 |
| 3659077 | OT CARRYING D/C G8986CI | $ | 0.00 |
| 3659078 | OT CARRYING D/C G8986CJ | $ | 0.00 |
| 3659079 | OT CARRYING D/C G8986CK | $ | 0.00 |
| 3659080 | OT CARRYING D/C G8986CL | $ | 0.00 |
| 3659081 | OT CARRYING D/C G8986CM | $ | 0.00 |
| 3659082 | OT CARRYING D/C G8986CN | $ | 0.00 |
| 3659083 | OT SELF CARE CURRENT G8987CH | $ | 0.00 |
| 3659084 | OT SELF CARE CURRENT G8987CI | $ | 0.00 |
| 3659085 | OT SELF CARE CURRENT G8987CJ | $ | 0.00 |
| 3659086 | OT SELF CARE CURRENT G8987CK | $ | 0.00 |
| 3659087 | OT SELF CARE CURRENT G8987CL | $ | 0.00 |
| 3659088 | OT SELF CARE CURRENT G8987CM | $ | 0.00 |
| 3659089 | OT SELF CARE CURRENT G8987CN | $ | 0.00 |
| 3659090 | OT SELF CARE GOAL G8988CH | $ | 0.00 |
| 3659091 | OT SELF CARE GOAL G8988CI | $ | 0.00 |
| 3659092 | OT SELF CARE GOAL G8988CJ | $ | 0.00 |
| 3659093 | OT SELF CARE GOAL G8988CK | $ | 0.00 |
| 3659094 | OT SELFCARE GOAL G8988CL | $ | 0.00 |
| 3659095 | OT SELF CARE GOAL G8988CM | $ | 0.00 |
| 3659096 | OT SELF CARE GOAL G8988CN | $ | 0.00 |
| 3659097 | OT SELF CARE D/C G8989CH | $ | 0.00 |
| 3659098 | OT SELF CARE D/C G8989CI | $ | 0.00 |
| 3659099 | OT SELF CARE D/C G8989CJ | $ | 0.00 |
| 3659100 | OT SELF CARE D/C G8989CK | $ | 0.00 |
| 3659101 | OT SELF CARE D/C G8989CL | $ | 0.00 |
| 3659102 | OT SELF CARE D/C G8989CM | $ | 0.00 |
| 3659103 | OT SELF CARE D/C G8989CN | $ | 0.00 |
| 3659104 | OT OTHER PRIMARY CURRENT G8990CH | $ | 0.00 |
| 3659105 | OT OTHER PRIMARY CURRENT G8990CI | $ | 0.00 |
| 3659106 | OT OTHER PRIMARY CURRENT G8990CJ | $ | 0.00 |
| 3659107 | OT OTHER PRIMARY CURRENT G8990CK | $ | 0.00 |
| 3659108 | OT OTHER PRIMARY CURRENT G8990CL | $ | 0.00 |
| 3659109 | OT OTHER PRIMARY CURRENT G8990CM | $ | 0.00 |
| 3659110 | OT OTHER PRIMARY CURRENT G8990CN | $ | 0.00 |
| 3659111 | OT OTHER PRIMARY GOAL G8991CH | $ | 0.00 |
| 3659112 | OT OTHER PRIMARY GOAL G8991CI | $ | 0.00 |
| 3659113 | OT OTHER PRIMARY GOAL G8991CJ | $ | 0.00 |
| 3659114 | OT OTHER PRIMARY GOAL G8991CK | $ | 0.00 |
| 3659115 | OT OTHER PRIMARY GOAL G8991CL | $ | 0.00 |
| 3659116 | OT OTHER PRIMARY GOAL G8991CM | $ | 0.00 |
| 3659117 | OT OTHER PRIMARY GOAL G8991CN | $ | 0.00 |
| 3659118 | OT OTHER PRIMARY D/C G8992CH | $ | 0.00 |
| 3659119 | OT OTHER PRIMARY D/C G8992CI | $ | 0.00 |
| 3659120 | OT OTHER PRIMARY D/C G8992CJ | $ | 0.00 |
| 3659121 | OT OTHER PRIMARY D/C G8992CK | $ | 0.00 |
| 3659122 | OT OTHER PRIMARY D/C G8992CL | $ | 0.00 |
| 3659123 | OT OTHER PRIMARY D/C G8992CM | $ | 0.00 |
| 3659124 | OT OTHER PRIMARY D/C G8992CN | $ | 0.00 |
| 3659125 | OT OTHER SUBSEQUE CURRENT G8993CH | $ | 0.00 |
| 3659126 | OT OTHER SUBSEQUE CURRENT G8993CI | $ | 0.00 |
| 3659127 | OT OTHER SUBSEQUE CURRENT G8993CJ | $ | 0.00 |
| 3659128 | OT OTHER SUBSEQUE CURRENT G8993CK | $ | 0.00 |
| 3659129 | OT OTHER SUBSEQUE CURRENT G8993CL | $ | 0.00 |
| 3659130 | OT OTHER SUBSEQUE CURRENT G8993CM | $ | 0.00 |
| 3659131 | OT OTHER SUBSEQUE CURRENT G8993CN | $ | 0.00 |
| 3659132 | OT OTHER SUBSEQUE GOAL G8994CH | $ | 0.00 |
| 3659133 | OT OTHER SUBSEQUE GOAL G8994CI | $ | 0.00 |
| 3659134 | OT OTHER SUBSEQUE GOAL G8994CJ | $ | 0.00 |
| 3659135 | OT OTHER SUBSEQUE GOAL G8994CK | $ | 0.00 |
| 3659136 | OT OTHER SUBSEQUE GOAL G8994CL | $ | 0.00 |
| 3659137 | OT OTHER SUBSEQUE GOAL G8994CM | $ | 0.00 |
| 3659138 | OT OTHER SUBSEQUE D/C G8995CH | $ | 0.00 |
| 3659139 | OT OTHER SUBSEQUE D/C G8995CI | $ | 0.00 |
| 3659140 | OT OTHER SUBSEQUE D/C G8995CJ | $ | 0.00 |
| 3659141 | OT OTHER SUBSEQUE D/C G8995CK | $ | 0.00 |
| 3659142 | OT OTHER SUBSEQUE D/C G8995CL | $ | 0.00 |
| 3659143 | OT OTHER SUBSEQUE D/C STATUS G8995CM | $ | 0.00 |
| 3659144 | OT OTHER SUBSEQUE D/C G8995CN | $ | 0.00 |
| 3659163 | OT OTHER SUBSEQUE GOAL G8994CN | $ | 0.00 |
| 3316686 | RECOVERY ROOM FIRST 30 MN | $ | 1,005.00 |
| 3316687 | RECOVERY ROOM ADD 15MN | $ | 289.00 |
| 3511000 | DOCETAXEL 1MG INJ | $ | 25.82 |
| 3514500 | VANCOMYCIN VL 500MG | $ | 12.00 |
| 3515000 | APAP/ASA/CAFF TAB | $ | 8.00 |
| 3515001 | APAP/BUTAL/CAFF CAP | $ | 8.00 |
| 3515005 | ACETAMINPHN SUSP 160/5 | $ | 8.00 |
| 3515006 | ACETAMINPHN SUPP 120MG | $ | 8.00 |
| 3515007 | ACETAMINPHN SUPP 325MG | $ | 8.00 |
| 3515008 | ACETAMINPHN SUPP 650MG | $ | 8.00 |
| 3515009 | ACETAMINPHN TAB 325MG | $ | 8.00 |
| 3515010 | ACETAMINPHN TAB 500MG | $ | 8.00 |
| 3515011 | APAP/CODN ELIX 120-12/5ML | $ | 8.00 |
| 3515012 | APAP/CODEINE TB 300-30MG | $ | 8.00 |
| 3515014 | ACETAZOLAMIDE TAB 250MG | $ | 10.00 |
| 3515015 | ACETYLCHOLN KIT OPH 1:100 | $ | 0.00 |
| 3515016 | ACETLCYSTN 200MG/ML 30ML J7608 x 6 GM | $ | 41.00 |
| 3515017 | ACIDOPHILUS CAP 460MG | $ | 8.00 |
| 3515018 | ACT. CHARCOAL TAB 250MG | $ | 8.00 |
| 3515020 | ACT.CHARC/SORB LQD 25GM | $ | 32.00 |
| 3515021 | ACT.CHARC/SORB LQD 50GM | $ | 39.00 |
| 3515022 | ACYCLOVIR CAP 200MG | $ | 9.00 |
| 3515023 | ACYCLOVIR OINT 5% 15GM | $ | 500.00 |
| 3515024 | ACYCLOVIR TAB 800MG | $ | 11.00 |
| 3515027 | ADENOSIN SRN 6 MG/2 ML | $ | 33.00 |
| 3515028 | ALBUTERL NB 5MG/ML 20ML | $ | 31.50 |
| 3515029 | ALBUTEROL INHALER | $ | 110.00 |
| 3515030 | ALBUTEROL NEB 2.5MG/3ML | $ | 8.00 |
| 3515031 | ALBUTEROL 2MG/5ML 30ML | $ | 11.00 |
| 3515032 | IPRATROP/ALBU INHALER | $ | 439.00 |
| 3515033 | IPRA/ALBU NEB 2.5-0.5/3ML | $ | 10.00 |
| 3515034 | ALENDRONATE TAB 35MG | $ | 36.00 |
| 3515035 | ALENDRONATE TAB 70MG | $ | 36.00 |
| 3515036 | ALLOPURINOL TAB 100MG | $ | 8.00 |
| 3515038 | ALPRAZOLAM TAB 0.25MG | $ | 8.00 |
| 3515040 | ALPRAZOLAM XR TAB 3MG | $ | 14.00 |
| 3515041 | ALTEPLASE VL 1MG X100 | $ | 12,255.00 |
| 3515042 | ALTEPLASE VL 2 MG | $ | 252.00 |
| 3515043 | AMANTADINE CAP 100MG | $ | 10.00 |
| 3515044 | AMANTADIN SYR 100MG/10ML | $ | 9.00 |
| 3515045 | AMILORIDE TAB 5MG | $ | 8.25 |
| 3515046 | AA/DEXT5/LYTE TPN 2000ML | $ | 194.75 |
| 3515047 | AMINOCAPRC ACID 5GM/20ML | $ | 44.00 |
| 3515048 | AMINOPHYLLINE 250MG/10ML | $ | 59.00 |
| 3515049 | AMIODARONE VL 30MG X5 | $ | 48.00 |
| 3515050 | AMIODARONE TAB 100MG | $ | 32.00 |
| 3515051 | AMIODARONE TAB 200MG | $ | 8.00 |
| 3515052 | AMITRIPTYLINE TAB 10MG | $ | 8.00 |
| 3515053 | AMITRIPTYLINE TAB 25MG | $ | 8.00 |
| 3515054 | AMITRIPTYLINE TAB 50MG | $ | 9.00 |
| 3515055 | AMLODIPINE TAB 10MG | $ | 10.00 |
| 3515056 | AMLODIPINE TAB 2.5MG | $ | 9.00 |
| 3515057 | AMLODIPINE TAB 5MG | $ | 9.00 |
| 3515058 | AMLODIP/BENAZ CAP 5-10MG | $ | 10.00 |
| 3515059 | AMMONIA INH AMP INH | $ | 14.00 |
| 3515060 | AMMONIUM LACT LOT 12% | $ | 34.00 |
| 3515061 | AMOXICILLIN CHEW 250MG | $ | 8.00 |
| 3515062 | AMOXICILLIN CAP 250MG | $ | 8.00 |
| 3515063 | AMOXICILLIN CAP 500MG | $ | 8.00 |
| 3515064 | AMOXICILLIN 500 MG 6 CAPS | $ | 16.50 |
| 3515065 | AMOXICIL SUSP 125/5 100ML | $ | 11.00 |
| 3515066 | AMOXICIL SUSP 250/5 150ML | $ | 15.00 |
| 3515067 | AMOXICILLIN TAB 875MG | $ | 8.00 |
| 3515068 | AMOX/KCLAV 400-57/5 100ML | $ | 114.00 |
| 3515069 | AMOX/KCLAV 600-42/5 75ML | $ | 64.00 |
| 3515070 | AMOX/KCLAV TAB 875-125MG | $ | 12.00 |
| 3515071 | AMOX/KCLAV XR TAB 1000-62 | $ | 15.00 |
| 3515072 | AMPHOTERICIN B VL 50MG | $ | 67.25 |
| 3515073 | AMPICILLIN VL 500MG X2 (J0290) | $ | 51.00 |
| 3515074 | AMPICIL/SULBACT 1.5GM (J0295) | $ | 50.00 |
| 3515075 | AMPICIL/SULBACT 1.5GM X2 (J0295) | $ | 63.00 |
| 3515076 | AMYLAS/LYPS/PROT 10000U | $ | 10.00 |
| 3515077 | ANASTRAZOLE TAB 1MG | $ | 23.00 |
| 3515078 | ANTIHEMOPHL FCT 1U X1200 | $ | 1,220.50 |
| 3515079 | ANTIPY/BENZ/GLYC EAR DROP | $ | 22.00 |
| 3515080 | APRACLON OPH DROP 0.5% | $ | 0.00 |
| 3515081 | ASPIRIN TAB EC [81MG] | $ | 8.00 |
| 3515082 | ARFORMOT NEB 15MCG/2ML | $ | 14.75 |
| 3515083 | ARIPIPRAZOLE TAB 2MG | $ | 58.00 |
| 3515084 | ARIPIPRAZOLE TAB 5MG | $ | 58.00 |
| 3515085 | ARTIFICIAL TEARS OPH 1.4% | $ | 12.00 |
| 3515086 | ARTIFICIAL TEARS OPH OINT | $ | 15.00 |
| 3515087 | ASPIRIN CHEW TAB 81MG | $ | 8.00 |
| 3515088 | ASPIRIN SUPP 300MG | $ | 9.00 |
| 3515089 | ASPIRIN SUPP 600MG | $ | 9.00 |
| 3515090 | ASPIRIN TAB 325MG | $ | 8.00 |
| 3515091 | ASPIRIN TAB EC 325MG | $ | 0.00 |
| 3515092 | ASA/CA/MG/AL TAB 325MG | $ | 7.00 |
| 3515093 | ATENOLOL TAB 100MG | $ | 9.00 |
| 3515094 | ATENOLOL TAB 25MG | $ | 8.00 |
| 3515095 | ATENOLOL TAB 50MG | $ | 9.00 |
| 3515096 | ATORVASTATIN TAB 10MG | $ | 8.00 |
| 3515097 | ATORVASTATIN TAB 20MG | $ | 8.00 |
| 3515098 | ATORVASTATIN TAB 40MG | $ | 8.00 |
| 3515099 | ATORVASTATIN TAB 80MG | $ | 14.00 |
| 3515100 | ATROPIN SRN 0.01MG X100 | $ | 32.00 |
| 3515101 | ATROPINE OPH DROP 1% | $ | 84.00 |
| 3515102 | ATROPIN SRN 0.01MG X50 | $ | 35.00 |
| 3515103 | ATROPIN VL 0.01MG X100 | $ | 39.00 |
| 3515104 | AZACITIDINE VL 1MG X100 | $ | 703.00 |
| 3515105 | AZATHIOPRINE TAB 50MG | $ | 10.00 |
| 3515106 | AZELASTINE NASAL SPRAY | $ | 142.75 |
| 3515107 | AZITHROMYCIN SUSP 100/5 | $ | 60.00 |
| 3515108 | AZITHROMYCIN SUSP 200/5 | $ | 60.00 |
| 3515109 | AZITHROMYCIN SUSP 2GM | $ | 236.00 |
| 3515110 | AZITHROMYCIN VL 500MG | $ | 53.00 |
| 3515111 | AZITHROMYCIN TAB 250MG | $ | 16.00 |
| 3515113 | AZITHROMYCIN TAB 500MG | $ | 34.00 |
| 3515114 | BACITRACIN EYE OINT 3.5GM | $ | 138.00 |
| 3515115 | BACITRACIN OINT 30 GM | $ | 14.00 |
| 3515116 | BACITRACIN PKT 0.9 GM | $ | 12.00 |
| 3515117 | BACLOFEN TAB 10MG | $ | 8.00 |
| 3515118 | BACLOFEN TAB 20MG | $ | 9.00 |
| 3515119 | BELLADON/PB ELIXIR 30 ML | $ | 21.25 |
| 3515120 | BELLADON/PB TAB 16.2MG | $ | 7.00 |
| 3515121 | BENAZEPRIL TAB 10MG | $ | 8.00 |
| 3515122 | BENAZEPRIL TAB 5MG | $ | 9.00 |
| 3515123 | BENZOCAINE GEL 20% | $ | 23.00 |
| 3515124 | BENZOCN ORAL 20% /SPRAY | $ | 30.75 |
| 3515125 | BENZOCN/RESORC CREAM | $ | 11.00 |
| 3515126 | BENZCN/TETRCN/BUT /SPRAY | $ | 7.00 |
| 3515127 | BENZOIN COMPD TINCTURE | $ | 8.00 |
| 3515128 | BENZONATATE CAP 100MG | $ | 8.00 |
| 3515129 | BENZONATATE CAP 200MG | $ | 8.00 |
| 3515130 | BENZTROPINE TAB 0.5MG | $ | 9.00 |
| 3515131 | BETAMETH VL 6MG/ML | $ | 18.00 |
| 3515132 | BETAXOLOL OPH DROP 0.25% | $ | 460.00 |
| 3515133 | BICALUTAMIDE TAB 50MG | $ | 34.00 |
| 3515134 | ZZBIMATOPROST OPH DRP 0.0 | $ | 228.25 |
| 3515135 | BISACODYL SUPP 10MG | $ | 8.00 |
| 3515136 | BISACODYL TAB 5MG | $ | 8.00 |
| 3515137 | BISMUTH CHEW TAB 262MG | $ | 8.00 |
| 3515138 | BISMUTH SUSP 524MG/30ML | $ | 8.00 |
| 3515139 | BLEOMYCIN VL 15U | $ | 114.00 |
| 3515140 | BRIMONIDINE OPH DRP 0.10% | $ | 236.00 |
| 3515141 | BRIMONIDINE OPH DRP 0.15% | $ | 222.00 |
| 3515142 | BRIMONIDINE OPH DRP 0.20% | $ | 58.00 |
| 3515143 | BRINZOLAMIDE OPH DROP 1% | $ | 415.00 |
| 3515144 | BUDESONIDE INHALER | $ | 335.00 |
| 3515145 | BUDESONIDE NEB 0.25MG/2ML | $ | 18.00 |
| 3515146 | BUDESONIDE NEB 0.5MG/2ML | $ | 21.00 |
| 3515147 | BUDESONIDE NEB 1MG/2ML | $ | 40.00 |
| 3515148 | BUDES/FORMOT INHAL 80-4.5 | $ | 294.00 |
| 3515149 | BUMETANIDE SDV 0.5MG/2ML | $ | 27.00 |
| 3515150 | BUMETANIDE TAB 0.5MG | $ | 8.00 |
| 3515151 | BUMETANIDE TAB 1MG | $ | 9.00 |
| 3515152 | BUMETANIDE TAB 2MG | $ | 8.00 |
| 3515154 | BUPIVACN DOSE 0.5% 1ML | $ | 0.00 |
| 3515155 | BUPIVACN SDV 0.25% 30ML | $ | 12.00 |
| 3515156 | BUPIVACN SDV 0.25% 10ML | $ | 15.00 |
| 3515157 | BUPIVCN/EPI DOSE 0.5% 1ML | $ | 14.00 |
| 3515158 | BUPRENORPH SRN 0.1MG X3 | $ | 40.00 |
| 3515159 | BUPREN/NALOX TAB 2-0.5MG | $ | 12.75 |
| 3515160 | BUPROPION SR TAB 100MG | $ | 9.00 |
| 3515161 | BUPROPION SR TAB 150MG | $ | 9.00 |
| | | $ | 9.00 |
| 3515162 | BUPROPION TAB 75MG | $ | 9.00 |
| 3515163 | BUPROPION XL TAB 150MG | $ | 12.00 |
| 3515164 | BUSPIRONE TAB 10MG | $ | 9.00 |
| 3515165 | BUSPIRONE TAB 15MG | $ | 10.00 |
| 3515166 | BUSPIRONE TAB 5MG | $ | 8.00 |
| 3515167 | BUTORPHANOL NASAL SPRAY | $ | 152.00 |
| 3515168 | CADEXOMER IODN GEL 0.9% | $ | 82.50 |
| 3515169 | CAFF/SOD BENZ VL 250MG/ML | $ | 33.00 |
| 3515170 | CALAMINE TOP SUSP 118ML | $ | 8.00 |
| 3515171 | CALAMINE/ZINC OXIDE OINT | $ | 19.50 |
| 3515172 | CALC ACET GELCAP 667MG | $ | 9.00 |
| 3515173 | CALC CHEW 750MG =300MG | $ | 7.00 |
| 3515174 | CALC CHEW 500MG =200MG | $ | 8.00 |
| 3515175 | CALC SUSP 1250/5ML=500MG | $ | 8.00 |
| 3515176 | CALC/MAG CHEW 550-110MG | $ | 8.00 |
| 3515177 | CALC/VITS D+K CHEW 500MG | $ | 7.00 |
| 3515178 | CALC CL SRN 1 GM/10ML | $ | 36.00 |
| 3515179 | CALC CIT/VIT D TB 315-250 | $ | 8.00 |
| 3515180 | CALC GLUC VL 1GM/10ML | $ | 34.00 |
| 3515181 | CALC POLYCARB TAB 625MG | $ | 8.00 |
| 3515182 | CALC/VIT D TAB 500MG-200U | $ | 8.00 |
| 3515183 | CALCITONIN VL 200U/ML 2ML | $ | 37.75 |
| 3515184 | CALCITONIN NASAL SPRAY | $ | 117.50 |
| 3515185 | CALCITRIOL CAP 0.25MCG | $ | 9.00 |
| 3515186 | CANDESARTAN TAB 32MG | $ | 10.25 |
| 3515187 | CANDESARTAN TAB 4MG | $ | 9.50 |
| 3515188 | CANDESARTAN TAB 8MG | $ | 9.50 |
| 3515189 | CAPSAICIN CREAM 0.025% | $ | 24.50 |
| 3515190 | CAPTOPRIL TAB 12.5MG | $ | 9.00 |
| 3515191 | CARBAMAZEPINE TAB 200MG | $ | 9.00 |
| 3515192 | CARBAM PEROX EAR DROP | $ | 10.00 |
| 3515193 | CARB/LEVO CR TAB 50-200MG | $ | 9.00 |
| 3515194 | CARB/LEVO ER TAB 25-100MG | $ | 8.00 |
| 3515195 | CARB/LEVO TAB 10-100MG | $ | 10.00 |
| 3515196 | CARB/LEVO TAB 25-100MG | $ | 8.00 |
| 3515197 | CARB/LEVO TAB 25-250MG | $ | 8.00 |
| 3515198 | CARBOPLATN VL 50MG X3 | $ | 71.00 |
| 3515199 | CARBOPROST AMP 250MCG/ML | $ | 530.00 |
| 3515201 | CARISOPRODOL TAB 350MG | $ | 8.00 |
| 3515202 | CARTEOLOL DROP 1% OPH | $ | 36.00 |
| 3515203 | CARVEDILOL TAB 12.5MG | $ | 10.00 |
| 3515204 | CARVEDILOL TAB 25MG | $ | 10.00 |
| 3515205 | CARVEDILOL TAB 3.125MG | $ | 10.00 |
| 3515206 | CARVEDILOL TAB 6.25MG | $ | 10.00 |
| 3515208 | CEFAZOLIN VL 500 MG X2 (J0690) | $ | 27.00 |
| 3515209 | CEFAZOLIN PGBK 500 MG X2 (J0690) | $ | 51.00 |
| 3515210 | CEFDINIR CAP 300MG | $ | 14.00 |
| 3515211 | CEFIXIME SUSP 100/5 50ML | $ | 348.00 |
| 3515212 | CEFOTAXIME VL 1GM | $ | 45.75 |
| 3515213 | CEFOXITIN VL 1GM | $ | 53.00 |
| 3515214 | CEFOXITIN PGBK 1GM | $ | 59.00 |
| 3515215 | CEFOXITIN PGBK 1GM X2 | $ | 70.00 |
| 3515216 | CEFTAZIDIME VL 500 MG X2 | $ | 51.00 |
| 3515217 | CEFTRIAXON VL 250MG X4 (J0696) | $ | 27.00 |
| 3515218 | CEFTRIAXON VL 250MG (J0696) | $ | 40.00 |
| 3515219 | CEFTRIAXON VL 250MG X8 (J0696) | $ | 29.00 |
| 3515220 | CEFTRIAXON VL 250MG X2 (J0696) | $ | 27.00 |
| 3515221 | CEFTRIAXON PGBK 250MG X4 (J0696) | $ | 59.00 |
| 3515222 | CEFTRIAXON PGBK 250MG X8 (J0696) | $ | 68.00 |
| 3515223 | CEFUROXIME SP 250/5 100ML | $ | 372.00 |
| 3515224 | CEFUROXIME TAB 250MG | $ | 12.00 |
| 3515225 | CEFUROXIME TAB 500MG | $ | 16.00 |
| 3515226 | CELECOXIB CAP 100MG | $ | 12.00 |
| 3515227 | CELECOXIB CAP 200MG | $ | 23.00 |
| 3515228 | CEPHALEXIN CAP 250MG | $ | 8.00 |
| 3515229 | CEPHALEXIN CAP 500MG | $ | 9.00 |
| 3515230 | CEPHALEXIN 500 MG 6 CAPS | $ | 21.75 |
| 3515231 | CEPHALEXIN SP 250/5 100ML | $ | 8.00 |
| 3515232 | CETIRIZINE TAB 10MG | $ | 10.00 |
| 3515233 | CETIRIZINE TAB 5MG | $ | 10.00 |
| 3515234 | CHLORL HYDR SRP 100MG/1ML | $ | 7.00 |
| 3515235 | CHLORHEXIDINE GLUC LIQD | $ | 20.75 |
| 3515236 | CHLORPROMAZ AMP 25MG/ML | $ | 56.00 |
| 3515237 | CHLORPROMAZINE TAB 25MG | $ | 8.50 |
| 3515238 | CHLORTHALIDONE TAB 25MG | $ | 10.00 |
| 3515239 | CHOLESTYRAMINE PWD 4GM | $ | 82.75 |
| 3515240 | CHOLESTYRAMINE PKT 4GM | $ | 11.00 |
| 3515241 | CHOLIN/MG SALIC TAB 750MG | $ | 7.50 |
| 3515242 | CILOSTAZOL TAB 50MG | $ | 9.00 |
| 3515243 | CILOSTAZOL TABS 100MG | $ | 9.00 |
| 3515244 | CIPROFLX PGBK 200MG X2 | $ | 51.00 |
| 3515245 | CIPROFLOXACIN OPH DP 0.3% | $ | 39.75 |
| 3515246 | CIPROFLOXACIN TAB 250MG | $ | 14.00 |
| 3515247 | CIPROFLOXACIN TAB 500MG | $ | 14.00 |
| 3515248 | CITALOPRAM TAB 10MG | $ | 10.00 |
| 3515249 | CITALOPRAM TAB 20MG | $ | 10.00 |
| 3515250 | CITALOPRAM TAB 40MG | $ | 11.00 |
| 3515251 | CLARITHROMYCIN TAB 500MG | $ | 12.00 |
| 3515252 | CLINDAMYCIN CAP 150MG | $ | 8.00 |
| 3515253 | CLINDAMYCIN IV 300MG/2ML | $ | 31.00 |
| 3515254 | CLINDAMYCIN TOP SOLN 1% | $ | 134.00 |
| 3515255 | CLOBETASOL OINT 0.05% | $ | 335.00 |
| 3515256 | CLONAZEPAM TAB 0.5MG | $ | 8.00 |
| 3515257 | CLONAZEPAM TAB 1MG | $ | 8.00 |
| 3515258 | CLONIDIN PATCH 0.1MG/24HR | $ | 114.00 |
| 3515259 | CLONIDINE TAB 0.1MG | $ | 8.00 |
| 3515260 | CLONIDINE TAB 0.2MG | $ | 8.00 |
| 3515261 | CLOPIDOGREL TAB 75MG | $ | 12.00 |
| 3515262 | CLOTRIMAZOLE CRM 1% | $ | 17.00 |
| 3515263 | CLOTRIM/BETAMETH CRM | $ | 56.00 |
| 3515264 | COCAINE SOLN 4% 4ML | $ | 112.75 |
| 3515265 | COLCHICINE TAB 0.6MG | $ | 17.00 |
| 3515266 | CONIVAPTAN AMP 20MG/100ML | $ | 730.00 |
| 3515267 | COSYNTROPIN VL 0.25MG | $ | 203.00 |
| 3515268 | CRANBERRY CAP 140MG | $ | 8.00 |
| 3515269 | CROMOLYN DROP 4% OPH | $ | 63.00 |
| 3515270 | CYCLOBENZAPRINE TAB 10MG | $ | 9.00 |
| 3515271 | CYCLOBENZAPRIN 10MG 6 TAB | $ | 21.75 |
| 3515272 | CYCLOBENZAPRINE TAB 5MG | $ | 9.00 |
| 3515273 | CYCLOPENTOLATE OPH DRP 1% | $ | 0.00 |
| 3515275 | CYPROHEPTADINE TAB 4MG | $ | 8.00 |
| 3515276 | DANTROLENE VL 20MG | $ | 134.00 |
| 3515277 | DARBEPOETN NON 1MCG X100 | $ | 1,130.00 |
| 3515278 | DARBEPOETN NON 1MCG X200 | $ | 2,260.00 |
| 3515279 | DARBEPOETN NON 1MCG X300 | $ | 3,590.00 |
| 3515280 | DARBEPOETN NON 1MCG X40 | $ | 475.00 |
| 3515281 | DARBEPOETN NON 1MCG X500 | $ | 5,750.00 |
| 3515282 | DARBEPOETN NON 1MCG X60 | $ | 660.00 |
| 3515283 | DARIFENACIN TAB 15MG | $ | 14.50 |
| 3515284 | DARIFENACIN TAB 7.5MG | $ | 24.00 |
| 3515285 | DEFEROXAMINE VL 500MG | $ | 37.00 |
| 3515286 | DEMECLOCYCLINE TAB 300MG | $ | 24.00 |
| 3515287 | DESFLURANE LIQD INH | $ | 196.00 |
| 3515288 | DEXAMETHASON OPH DRP 0.1% | $ | 110.00 |
| 3515289 | DEXAMETHASON VL 1MG X10 (J1100) | $ | 27.00 |
| 3515290 | DEXAMETHASON VL 1MG X4 (J1100) | $ | 28.00 |
| 3515291 | DEXAMETHSN TAB 0.25MG X4 (J8540) | $ | 8.00 |
| 3515292 | DEXAMETHSN TAB 0.25MG X16 (J8540) | $ | 8.00 |
| 3515293 | DEXTROMETHR SRP 7.5MG/5ML | $ | 19.75 |
| 3515294 | D5W 250ML | $ | 18.00 |
| 3515295 | DEXTROSE 50% SYN 50ML | $ | 35.00 |
| 3515296 | DEXTROSE CHEW TAB | $ | 7.00 |
| 3515297 | DIAZEPAM RCTL GEL 10MG | $ | 505.00 |
| 3515298 | DIAZEPAM RCTL GEL 2.5MG | $ | 357.00 |
| 3515299 | DIAZEPAM SRN 5MG X2 (J3360) | $ | 58.00 |
| 3515300 | DIAZEPAM TAB 2MG | $ | 8.00 |
| 3515301 | DIAZEPAM TAB 5MG | $ | 8.00 |
| 3515302 | DICLOFENAC OPH DROP 0.1% | $ | 119.00 |
| 3515303 | DICLOFENAC GEL 1% 100GM | $ | 107.00 |
| 3515304 | DICLOFENAC TAB 75MG | $ | 9.00 |
| 3515305 | DICLOXACILLIN CAP 250MG | $ | 7.25 |
| 3515306 | DICYCLOMINE CAP 10MG | $ | 8.00 |
| 3515307 | DICYCLOMINE TAB 20MG | $ | 8.00 |
| 3515308 | DIGOXIN AMP 0.5MG INJ (J1160) | $ | 33.00 |
| 3515309 | DIGOX IMN FAB VL 40MG/4ML | $ | 2,412.75 |
| 3515310 | DIGOXIN SOLN 0.05MG/ML | $ | 107.00 |
| 3515311 | DIGOXIN TAB 0.125MG | $ | 10.00 |
| 3515312 | DIGOXIN TAB 0.25MG | $ | 9.00 |
| 3515313 | DIHYDROERGOT AMP 1MG/ML | $ | 260.00 |
| 3515314 | DILTIAZEM CAP CD 120MG | $ | 9.00 |
| 3515315 | DILTIAZEM CAP CD 180MG | $ | 8.00 |
| 3515316 | DILTIAZEM CAP CD 240MG | $ | 8.00 |
| 3515317 | DILTIAZEM CAP CD 300MG | $ | 10.00 |
| 3515318 | DILTIAZEM VL 125MG/25ML | $ | 57.00 |
| 3515319 | DILTIAZEM VL 25MG/5ML | $ | 28.00 |
| 3515320 | DILTIAZEM TAB 30MG | $ | 8.00 |
| 3515321 | DILTIAZEM TAB 60MG | $ | 8.00 |
| 3515322 | DILTIAZEM TAB 90MG | $ | 8.00 |
| 3515323 | DIMENHYDRINATE CHEW 50MG | $ | 8.00 |
| 3515324 | DINOPROSTONE SUPP 10MG | $ | 470.00 |
| 3515325 | DIPHENHYDRAMINE CAP 25MG | $ | 8.00 |
| 3515326 | DIPHENHYDRAMINE CAP 50MG | $ | 8.00 |
| 3515327 | DIPHENHYDRAMINE CRM 2% | $ | 12.00 |
| 3515328 | DIPHENHYDRAMN LIQD 12.5/5 | $ | 8.00 |
| 3515329 | DIPHENHYDRAMIN VL 50MG INJ (J1200) | $ | 29.00 |
| 3515330 | DIPHENOXYLAT/ATROPIN TAB | $ | 8.00 |
| 3515331 | DIP/TET/AP INFANRIX | $ | 54.00 |
| 3515332 | DIP/TET/AP TRIPEDIA | $ | 53.00 |
| 3515333 | DIP/TET/AP ADACEL | $ | 96.00 |
| 3515334 | DIP/TET/AP BOOSTRIX VL | $ | 70.00 |
| 3515335 | DIP/TET/AP BOOSTRIX SYR | $ | 72.00 |
| 3515336 | DIP/TET/AP/POLIO KINRIX | $ | 106.00 |
| 3515337 | DIPYRIDM/ASA CAP 200-25MG | $ | 18.00 |
| 3515338 | DIVALPROEX ER TAB 500MG | $ | 12.00 |
| 3515339 | DIVALPROEX SPRK CAP 125MG | $ | 9.00 |
| 3515340 | DIVALPROEX DR TAB 250MG | $ | 9.00 |
| 3515341 | DM/PSEU/BRM SRP 10-30-2/5 | $ | 38.00 |
| 3515342 | DOBUTAMINE VL 250MG/20ML | $ | 51.00 |
| 3515344 | DOCUSATE SOD CAP 100MG | $ | 8.00 |
| 3515345 | DOCUSATE SOD 100MG/10ML | $ | 8.00 |
| 3515346 | DOLASETRON VL 10MG X10 | $ | 121.00 |
| 3515347 | DONEPEZIL TAB 10MG | $ | 15.00 |
| 3515348 | DONEPEZIL TAB 5MG | $ | 16.00 |
| 3515349 | DOPAMINE VL 40MG/ML X5 | $ | 48.00 |
| 3515350 | DOPAMINE DRIP 40MG X10 | $ | 61.00 |
| 3515351 | DORZOL/TIMOLOL OPH DROP | $ | 113.00 |
| 3515352 | DOXAZOSIN TAB 1MG | $ | 9.00 |
| 3515353 | DOXAZOSIN TAB 2MG | $ | 9.00 |
| 3515354 | DOXAZOSIN TAB 4MG | $ | 9.00 |
| 3515355 | DOXEPIN CAP 25MG | $ | 8.00 |
| 3515356 | DOXEPIN CREAM 5% | $ | 302.00 |
| 3515357 | DOXYCYCLINE VL 100MG | $ | 74.00 |
| 3515358 | DOXYCYCLINE TAB 100MG | $ | 10.00 |
| 3515359 | DOXYLAMINE TAB 25MG | $ | 8.00 |
| 3515360 | DRONABINOL GELCAP 2.5MG | $ | 14.00 |
| 3515361 | DROPERIDOL AMP 5MG/2ML | $ | 28.00 |
| 3515362 | DULOXETINE CAP 30MG | $ | 14.00 |
| 3515363 | DULOXETINE CAP 60MG | $ | 14.00 |
| 3515364 | DUTASTERIDE GELCAP 0.5MG | $ | 15.00 |
| 3515365 | ECONAZOLE CREAM 1% | $ | 535.00 |
| 3515366 | ELECTROLYTE/PEGS PWD SOLN | $ | 32.00 |
| 3515367 | DRY MOUTH SPRAY 59ML | $ | 14.00 |
| 3515368 | ELETRIPTAN TAB 40MG | $ | 71.00 |
| 3515369 | DRY SKIN CREAM 16 OZ. | $ | 16.00 |
| 3515370 | PETROLTM/AQUAPHOR 3 OZ. | $ | 15.00 |
| 3515371 | DIAPER OINT ZINC OX 40% | $ | 12.00 |
| 3515372 | VITAMIN A & D OINT 454 GM | $ | 39.00 |
| 3515373 | ENALAPRIL TAB 10MG | $ | 9.00 |
| 3515374 | ENALAPRIL TAB 20 MG | $ | 10.00 |
| 3515376 | ENOXAPARIN SRN 10MG X10 (J1650) | $ | 150.00 |
| 3515377 | ENOXAPARIN SRN 10MG X3 (J1650) | $ | 29.00 |
| 3515378 | ENOXAPARIN SRN 10MG X4 (J1650) | $ | 30.00 |
| 3515379 | ENOXAPARIN SRN 10MG X6 (J1650) | $ | 104.00 |
| 3515380 | ENOXAPARIN SRN 10MG X8 (J1650) | $ | 35.00 |
| 3515381 | ENTACAPONE TAB 200MG | $ | 15.00 |
| 3515382 | EPHEDRINE VL 50MG/ML | $ | 78.00 |
| 3515383 | EPINEPHRINE INJ 0.1MG X10 (J0171) | $ | 31.00 |
| 3515384 | EPINEPHRN DOSE 0.1 MGX10 | $ | 9.00 |
| 3515385 | EPINEPHRIN PEN 0.1MG X1.5 | $ | 655.00 |
| 3515386 | EPINEPHRIN 10ML 0.1MG X10 (J0171) | $ | 33.00 |
| 3515387 | EPINEPHRIN PEN 0.1MG X6 | $ | 475.00 |
| 3515388 | EPOETIN NON 1000U X20 | $ | 416.00 |
| 3515389 | EPOETIN NON 1000U X10 | $ | 205.50 |
| 3515390 | EPOETIN NON 1000U X2 | $ | 57.50 |
| 3515391 | EPOETIN NON 1000U X40 | $ | 948.50 |
| 3515392 | ERTAPENEM VL 500MG X2 | $ | 216.00 |
| 3515393 | ERYTHROMYC OINT 3.5 GM | $ | 34.00 |
| 3515394 | ERYTHROMYC OINT 1 GM | $ | 22.00 |
| 3515395 | ERYTHROMYCIN TAB 333MG | $ | 17.00 |
| 3515396 | ESCITALOPRAM TAB 10MG | $ | 12.00 |
| 3515397 | ESCITALOPRAM TAB 20MG | $ | 12.00 |
| 3515398 | ESCITALOPRAM TAB 5MG | $ | 17.00 |
| 3515399 | ESMOLOL VL 100MG/10ML | $ | 63.00 |
| 3515400 | ESOMEPRAZOLE CAP 40MG | $ | 17.00 |
| 3515401 | ESTROGEN CONJ CREAM | $ | 249.00 |
| 3515402 | ESTROGEN CONJ TAB 0.3MG | $ | 12.00 |
| 3515403 | ESTROGEN CONJ TAB 0.625MG | $ | 12.00 |
| 3515404 | ESZOPICLONE TAB 2MG | $ | 14.50 |
| 3515405 | ESZOPICLONE TAB 3MG | $ | 14.50 |
| 3515406 | ETHACRYNIC ACID TAB 25MG | $ | 7.00 |
| 3515407 | ETHYL CL ANESTH /SPRAY | $ | 57.00 |
| 3515408 | ETOMIDATE AMP 40MG/20ML | $ | 38.00 |
| 3515409 | EXEMESTANE TAB 25MG | $ | 23.25 |
| 3515410 | EXENATIDE SYRN 10MCG | $ | 615.00 |
| 3515411 | ZZEYE ANTIOXDANT TAB | $ | 7.00 |
| 3515412 | EZETIMIBE TAB 10MG | $ | 22.00 |
| 3515413 | EZETIM/SIMVAS TAB 10-10MG | $ | 11.25 |
| 3515414 | EZETIM/SIMVAS TAB 10-20MG | $ | 12.00 |
| 3515415 | EZETIM/SIMVAS TAB 10-40MG | $ | 12.00 |
| 3515416 | FAMOTIDINE VL 20MG/2ML | $ | 9.00 |
| 3515417 | FAMOTIDINE TAB 20MG | $ | 9.00 |
| 3515418 | FAMOTIDINE CHEW 10MG | $ | 7.25 |
| 3515419 | FELODIPINE TAB 2.5MG | $ | 8.50 |
| 3515420 | FELODIPINE ER TAB 5MG | $ | 9.00 |
| 3515422 | FENOFIBRATE TAB 145MG | $ | 14.00 |
| 3515423 | FENTANYL AMP 100MCG/2ML | $ | 9.00 |
| 3515424 | FENTANYL SDV 100MCG X2.5 | $ | 9.00 |
| 3515426 | FENTANYL PAT 100MCG/HR | $ | 134.00 |
| 3515427 | FENTANYL PAT 12MCG/HR | $ | 36.00 |
| 3515428 | FENTANYL PAT 25MCG/HR | $ | 37.00 |
| 3515429 | FENTANYL PAT 50MCG/HR | $ | 52.00 |
| 3515430 | FENTANYL PAT 75MCG/HR | $ | 66.00 |
| 3515431 | FERRIC GLUC 12.5MG/ML X5 | $ | 64.00 |
| 3515432 | FERRIC SUBSULF SOLN | $ | 24.00 |
| 3515433 | FERROUS FUM TAB 324MG | $ | 8.00 |
| 3515434 | FERROUS GLUC TAB 324MG | $ | 8.00 |
| 3515435 | FERRO S04 ELX 325MG/7.4ML | $ | 8.00 |
| 3515436 | FERROUS SO4 TAB 325MG | $ | 8.00 |
| 3515437 | FILGRASTIM VL 1 MCG X480 | $ | 505.75 |
| 3515438 | FINASTERIDE TAB 5MG | $ | 11.00 |
| 3515439 | FISH OIL GELCAP 1000MG | $ | 8.00 |
| 3515440 | FLECAINIDE TAB 50MG | $ | 10.00 |
| 3515441 | FLUCONAZOLE TAB 50MG | $ | 14.00 |
| 3515442 | FLUCONAZL PB 200MG/100ML | $ | 20.00 |
| 3515443 | FLUDROCORTISONE TAB 0.1MG | $ | 8.00 |
| 3515444 | FLUMAZENIL VL 0.5MG/5ML | $ | 34.00 |
| 3515445 | FLUOCINONIDE CREAM 0.05% | $ | 71.00 |
| 3515446 | FLUORESCEIN STRIP 1MG | $ | 8.00 |
| 3515447 | FLUORESCEIN/BENOX OPH DRP | $ | 21.00 |
| 3515448 | FLUOXETINE CAP 10MG | $ | 10.00 |
| 3515449 | FLUOXETINE CAP 20MG | $ | 10.00 |
| 3515450 | FLUTIC/SALM DIS 500-50MCG | $ | 372.00 |
| 3515451 | FLUTIC/SALM INH 115-21MCG | $ | 475.00 |
| 3515452 | FLUTIC/SALM DIS 100-50MCG | $ | 258.00 |
| 3515453 | FLUTIC/SALM DIS 250-50MCG | $ | 258.00 |
| 3515454 | FLUTICASON INHALER 110MCG | $ | 367.00 |
| 3515455 | FLUTICASON INHALER 220MCG | $ | 555.00 |
| 3515456 | FLUTICASON NASL SPR 50MCG | $ | 111.00 |
| 3515457 | FLUVASTATIN CAP 20MG | $ | 14.00 |
| 3515458 | FLUVOXAMINE TAB 50MG | $ | 9.50 |
| 3515459 | FOLIC ACID DOSE 1MG/0.2ML | $ | 100.00 |
| 3515460 | FOLIC ACID TAB 400MCG | $ | 8.00 |
| 3515461 | FOLIC ACID TAB 1MG | $ | 8.00 |
| 3515462 | FORMOTEROL NEB 20MCG/2ML | $ | 14.50 |
| 3515463 | FOSINOPRIL TAB 10MG | $ | 9.00 |
| 3515464 | FOSINOPRIL TAB 20MG | $ | 9.00 |
| 3515465 | FULVESTRNT SRN 25 MG X10 | $ | 1,028.00 |
| 3515466 | FUROSEMIDE VL 20MG X5 (J1940) | $ | 31.00 |
| 3515467 | FUROSEMIDE VL 20MG X1 (J1940) | $ | 30.00 |
| 3515468 | FUROSEMIDE VL 20MG X2 (J1940) | $ | 29.00 |
| 3515469 | FUROSEMIDE ORAL 10MG/ML | $ | 36.00 |
| 3515470 | FUROSEMIDE TAB 20MG | $ | 8.00 |
| 3515471 | FUROSEMIDE TAB 40MG | $ | 8.00 |
| 3515472 | FUROSEMIDE TAB 80MG | $ | 8.00 |
| 3515473 | GABAPENTIN CAP 100MG | $ | 8.00 |
| 3515474 | GABAPENTIN CAP 300MG | $ | 8.00 |
| 3515475 | GABAPENTIN CAP 400MG | $ | 9.00 |
| 3515476 | GABAPENTIN TAB 600MG | $ | 10.00 |
| 3515477 | GALANTAMINE TAB 4MG | $ | 12.00 |
| 3515479 | GEMFIBROZIL TAB 600MG | $ | 10.00 |
| 3515480 | GENTAMICIN OPH DROP 0.3% | $ | 68.00 |
| 3515481 | SUFENTANIL AMP 50MCG/ML | $ | 14.00 |
| 3515482 | GENTAMICIN OPH OINT 0.3% | $ | 35.00 |
| 3515483 | GENTAMICIN IV 80MG/2ML | $ | 45.50 |
| 3515484 | GLIMEPIRIDE TAB 2MG | $ | 8.00 |
| 3515485 | GLIMEPIRIDE TAB 4MG | $ | 9.00 |
| 3515486 | GLIPIZIDE ER TAB 10MG | $ | 8.00 |
| 3515487 | GLIPIZIDE ER TAB 2.5MG | $ | 8.00 |
| 3515488 | GLIPIZIDE ER TAB 5MG | $ | 8.00 |
| 3515489 | GLIPIZIDE TAB 10MG | $ | 8.00 |
| 3515490 | GLIPIZIDE TAB 5MG | $ | 8.00 |
| 3515491 | GLUCAGON VL 1MG | $ | 310.00 |
| 3515492 | GLUCOSAMINE TAB 500MG | $ | 8.00 |
| 3515493 | GLUCOS/CHONDR TAB 500-400 | $ | 8.00 |
| 3515494 | GLUCOSE GEL (15GM SUGAR) | $ | 11.00 |
| 3515495 | GLYBURIDE TAB 5MG | $ | 8.00 |
| 3515496 | GLYCERIN SUPP ADULT | $ | 8.00 |
| 3515497 | GLYCERIN SUPP PED | $ | 8.00 |
| 3515498 | GLYCOPYRROL VL 0.4MG/2ML | $ | 53.00 |
| 3515499 | GUAIF/CODN SRP 100-10/5 | $ | 9.00 |
| 3515500 | GUAIF/DM SRP 100-10MG/5ML | $ | 8.00 |
| 3515501 | GUAIF/DM/PHEN 100-10-5/5 | $ | 12.00 |
| 3515502 | GUAIFENESIN ER TAB 600MG | $ | 8.00 |
| 3515503 | GUAIFENESIN SRP 100MG/5ML | $ | 8.00 |
| 3515504 | HAEMOPH B VACC PEDVAXHIB | $ | 53.00 |
| 3515505 | HALOPERIDOL VL 5MG/ML | $ | 33.00 |
| 3515506 | HALOPERIDOL TAB 0.5MG | $ | 8.00 |
| 3515507 | HALOPERIDOL TAB 1MG | $ | 8.00 |
| 3515509 | DTAP/HEPB/POLIO PEDIARIX | $ | 142.00 |
| 3515510 | HEPARIN FLUSH 10 UNT X50 | $ | 11.00 |
| 3515511 | HEPARIN SYN 1000 UNT X5 | $ | 29.00 |
| 3515512 | HEPARIN SYN 1000 UNT X5 | $ | 10.00 |
| 3515513 | HEPARIN DRIP 1000 UNT X25 | $ | 56.00 |
| 3515515 | HEPAT A VL 1440U HAVRIX | $ | 132.00 |
| 3515516 | HEPAT A VL 720U HAVRIX | $ | 60.00 |
| 3515517 | HEPAT A SRN 1440U HAVRIX | $ | 131.00 |
| 3515518 | HEPAT A SRN 720U HAVRIX | $ | 64.00 |
| 3515519 | HEPB/HEPA TWINRIX | $ | 193.00 |
| 3515520 | HEPAT B 10MCG PED ENGERIX | $ | 53.00 |
| 3515521 | HEPAT B 20MCG ADT ENGERIX | $ | 119.00 |
| 3515522 | HEPB/HAEMOPH COMVAX | $ | 97.00 |
| 3515523 | HETASTARCH DRIP 500ML | $ | 61.00 |
| 3515524 | HISTRELIN IMPLANT 50MG | $ | 4,700.50 |
| 3515525 | HOMATROPINE OPH DROP 2% | $ | 65.00 |
| 3515526 | HOMATROPINE OPH DROP 5% | $ | 72.00 |
| 3515527 | HUMAN PAPILLOMAVIRUS VL | $ | 252.00 |
| 3515528 | HYLAN GF SRN 1MG X16 | $ | 381.75 |
| 3515529 | HYDRALAZINE VL 20MG/ML | $ | 104.00 |
| 3515530 | HYDRALAZINE TAB 25MG | $ | 8.00 |
| 3515531 | HYDRALAZINE TAB 10MG | $ | 8.00 |
| 3515532 | HYDROCHLOROTHIZ CP 12.5MG | $ | 8.00 |
| 3515533 | HYDROCHLOROTHIZ TB 25MG | $ | 8.00 |
| 3515534 | HYDROCOD/AP ELX 2.5-167/5 | $ | 16.00 |
| 3515535 | HYDROCOD/APAP TAB 5-325MG | $ | 8.00 |
| 3515536 | HYDROCOD/APAP TAB 5-500MG | $ | 3.25 |
| 3515537 | HYDROCOD/APAP 5-500 6 TAB | $ | 14.50 |
| 3515538 | HYDROCORTISONE SUPP 25MG | $ | 38.00 |
| 3515539 | HYDROCORTISONE CREAM 1% | $ | 11.00 |
| 3515540 | HYDROCORTSN CRM RCTL 2.5% | $ | 143.00 |
| 3515541 | HYDROCORTISONE GEL 10% | $ | 181.00 |
| 3515542 | HYDROCORTISONE OINT 1% | $ | 12.00 |
| 3515543 | HYDROCORTISONE OINT 2.5% | $ | 20.00 |
| 3515545 | HYDROCORTISON 100MG X 3 | $ | 55.00 |
| 3515546 | HYDROCORTISONE TAB 10MG | $ | 9.00 |
| 3515547 | HYDROCORTISONE TAB 5MG | $ | 8.00 |
| 3515548 | HYDROMORPHONE SRN 2MG/ML | $ | 10.00 |
| 3515549 | HYDROMORPHONE TAB 2MG | $ | 8.00 |
| 3515550 | HYDROXYCHLOROQN TB 200MG | $ | 12.00 |
| 3515551 | HYDRXYPROPMETHC DRP 2.5% | $ | 25.75 |
| 3515552 | HYDROXYZINE VL 25MG X2 | $ | 52.00 |
| 3515553 | HYDROXYZINE TAB 25MG | $ | 8.00 |
| 3515554 | HYDROXYZINE PAM CAP 25MG | $ | 8.00 |
| 3515555 | HYDROXYZINE PAM CAP 50MG | $ | 8.00 |
| 3515556 | HYOSCYAMINE TAB 0.125MG | $ | 8.00 |
| 3515557 | HYPROMELOS DRP 0.3% OPH | $ | 17.00 |
| 3515558 | HYPROMELOS GEL 0.3% OPH | $ | 12.00 |
| 3515559 | IBANDRONATE VL 1MG X3 | $ | 400.00 |
| 3515560 | IBANDRONATE TAB 150MG | $ | 150.75 |
| 3515561 | IBUPROFEN CHEW TAB 100MG | $ | 8.00 |
| 3515562 | IBUPROFEN SUSP 100MG/5ML | $ | 8.00 |
| 3515563 | IBUPROFEN TAB 200MG | $ | 8.00 |
| 3515564 | IBUPROFEN TAB 400MG | $ | 8.00 |
| 3515565 | IBUPROFEN TAB 600MG | $ | 8.00 |
| 3515566 | IBUPROFEN TAB 800MG | $ | 8.00 |
| 3515567 | IMIPENEM/CILAST 250MG X2 | $ | 65.00 |
| | | $ | 65.00 |
| | | $ | 65.00 |
| 3515568 | IMIQUIMOD CREAM PKT 5% | $ | 16.00 |
| 3515569 | IMUN GLOB VL 500MG X24 | $ | 2,059.75 |
| 3515570 | IMUN GLOB VL 500MG X12 | $ | 1,033.75 |
| 3515572 | IMUN GLOB 10% 500MG X20G | $ | 1,690.00 |
| 3515573 | IMUN GLOB 10% 500MG X40 | $ | 3,375.00 |
| 3515574 | IMUN GLOB 10% 500MG X40P | $ | 3,405.50 |
| 3515575 | IMUN GLOB 10% 500MG X10P | $ | 858.50 |
| 3515576 | IMUN GLOB 10% 500MG X10 | $ | 845.00 |
| 3515577 | INDAPAMIDE TAB 1.25MG | $ | 9.00 |
| 3515578 | INDIGO CARMINE AMP | $ | 24.25 |
| 3515579 | INDINAVIR CAP 400MG | $ | 10.00 |
| 3515580 | INDOMETHACIN CAP 25MG | $ | 8.00 |
| 3515581 | INFLIXIMAB VL 10MG X10 | $ | 1,805.00 |
| 3515582 | INHALER-AEROCHAMBER PLUS | $ | 67.00 |
| 3515583 | INSULIN DETEMIR DOSE 5 UNITS (J1815) | $ | 9.00 |
| 3515584 | INSULIN GLARGINE DOSE 5 UNIT (J1815) | $ | 9.00 |
| 3515585 | INSULIN GLARGN PEN 5U X60 (J1815) | $ | 64.50 |
| 3515586 | INSULIN LISPRO DOSE 5 UNIT (J1815) | $ | 9.00 |
| 3515587 | INSULIN LISPRO PEN 5U X60 (J1815) | $ | 179.00 |
| 3515588 | INSULIN NPH DOSE 5 UNIT (J1815) | $ | 8.00 |
| 3515589 | INSULIN N/REG 70/30 DOSE 5 UNIT (J1815) | $ | 8.00 |
| 3515590 | INSULIN N/LISP 75/25 DOSE 5 UNIT (J1815) | $ | 9.00 |
| 3515591 | INSULIN REGULAR DOSE 5 UNIT (J1815) | $ | 8.00 |
| 3515592 | INTERFERON BETA-1A 30MCG | $ | 954.50 |
| 3515594 | IPECAC SYRUP 30ML | $ | 19.25 |
| 3515595 | IPRATROPM NEB 0.5MG/2.5ML | $ | 9.00 |
| 3515596 | IPRATROPIUM INHALER | $ | 425.00 |
| 3515597 | IRBESARTAN TAB 150MG | $ | 11.00 |
| 3515598 | IRBESARTAN TAB 300MG | $ | 12.00 |
| 3515599 | IRON DEXTRAN 50MG (J1750)X20 (1000MG) | $ | 405.00 |
| 3515600 | IRON SUCROSE VL 1MG X100 | $ | 105.00 |
| 3515601 | IRON/C/B12/SA TAB | $ | 8.00 |
| 3515602 | IRON/C/SA CAP | $ | 7.25 |
| 3515603 | IRON/FE FUM/C/B12/FA TB | $ | 8.00 |
| 3515604 | ISOSORBID DINITR TAB 10MG | $ | 9.00 |
| 3515605 | ISOSORBID DINITR TAB 20MG | $ | 9.00 |
| 3515606 | ISOSORBID MONO TAB 120MG | $ | 8.00 |
| 3515607 | ISOSORBID MONO TAB 20MG | $ | 8.00 |
| 3515608 | ISOSORBID MONO TAB 30MG | $ | 9.00 |
| 3515609 | ISOSORBID MONO TAB 60MG | $ | 10.00 |
| 3515610 | KETAMINE VL 100MG/ML 5ML | $ | 18.00 |
| 3515611 | KETAMINE VL 10MG/ML 20ML | $ | 37.00 |
| 3515612 | KETAMINE VL 50MG/ML 10ML | $ | 16.00 |
| 3515613 | KETOCONAZOLE CREAM 2% | $ | 284.00 |
| 3515614 | KETOCONAZOLE SHAMP00 2% | $ | 53.00 |
| 3515615 | KETOCONAZOLE TAB 200MG | $ | 15.00 |
| 3515616 | KETOROLAC OPH DROP 0.4% | $ | 332.00 |
| 3515617 | KETOROLAC VL 15MG X1 (J1885) | $ | 26.00 |
| 3515618 | KETOROLAC VL 15MG X2 (J1885) | $ | 27.00 |
| 3515619 | KETOROLAC VL 15MG X4 (J1885) | $ | 27.00 |
| 3515620 | KETOTIFEN OPH DROP 0.025% | $ | 17.00 |
| 3515621 | LABETALOL VL 5MG/ML 20ML | $ | 26.00 |
| 3515622 | LABETALOL TAB 100MG | $ | 8.00 |
| 3515623 | LACTASE TAB 3000 UNT | $ | 8.00 |
| 3515624 | LR 1000ML | $ | 18.00 |
| 3515625 | LACTULOSE SOLN 20GM/30ML | $ | 8.00 |
| 3515626 | LAMIVUDINE TAB 150MG | $ | 16.00 |
| 3515627 | LAMOTRIGINE TAB 100MG | $ | 10.00 |
| 3515628 | LANOLIN BREAST CREAM | $ | 9.00 |
| 3515629 | LANSOPRAZOLE TAB 15MG | $ | 32.00 |
| 3515630 | LANSOPRAZOLE CAP 30MG | $ | 14.00 |
| 3515631 | LATANOPROST OPH DRP 0.005 | $ | 150.00 |
| 3515632 | LEUCOVORIN VL 50MG X2 | $ | 140.00 |
| 3515633 | LEUPROLID DPT-3 7.5MG X3 | $ | 2,948.25 |
| 3515635 | LEUPROLID DPT-4 7.5MG X4 | $ | 6,805.00 |
| 3515636 | LEUPROLID ELI 7.5MG X6 | $ | 3,029.25 |
| 3515638 | LEVALBUTRL NEB 1.25MG/3ML | $ | 15.00 |
| 3515639 | LEVALBUTEROL INHALER | $ | 74.50 |
| 3515640 | LEVETIRACETAM TAB 250MG | $ | 8.00 |
| 3515641 | LEVETIRACETAM TAB 500MG | $ | 11.00 |
| 3515642 | LEVOFLOXACIN TAB 250MG | $ | 24.00 |
| 3515643 | LEVOFLOXACIN TAB 500MG | $ | 32.00 |
| 3515644 | LEVOFLOXACN PB 250MG X3 | $ | 53.00 |
| 3515645 | LEVOFLOXACN PB 250MG X2 | $ | 59.00 |
| 3515646 | LEVOTHYROXINE TAB 112MCG | $ | 8.00 |
| 3515647 | LEVOTHYROXINE TAB 125MCG | $ | 8.00 |
| 3515648 | LEVOTHYROXINE TAB 137MCG | $ | 8.00 |
| 3515649 | LEVOTHYROXINE TAB 150MCG | $ | 8.00 |
| 3515650 | LEVOTHYROXINE TAB 175MCG | $ | 8.00 |
| 3515651 | LEVOTHYROXINE TAB 200MCG | $ | 8.00 |
| 3515652 | LEVOTHYROXINE TAB 25MCG | $ | 8.00 |
| 3515653 | LEVOTHYROXINE TAB 300MCG | $ | 8.00 |
| 3515654 | LEVOTHYROXINE TAB 50MCG | $ | 8.00 |
| 3515655 | LEVOTHYROXINE TAB 75MCG | $ | 8.00 |
| 3515656 | LEVOTHYROXINE TAB 88MCG | $ | 8.00 |
| 3515657 | LEVOTHYROXINE TAB 100MCG | $ | 8.00 |
| 3515658 | LIDOCAINE CREAM 4% 15GM | $ | 17.00 |
| 3515659 | LIDOCAIN AMP 4% 5ML | $ | 0.00 |
| 3515660 | LIDOCAIN SRN 10MG X10 | $ | 11.00 |
| 3515661 | LIDOCAINE JELLY 2% 10ML | $ | 16.00 |
| 3515662 | LIDOCAIN DOSE 1% 1ML | $ | 0.00 |
| 3515663 | LIDOCAIN DOSE 2% 1ML | $ | 0.00 |
| 3515664 | LIDOCAIN AMP 1% 5ML | $ | 9.00 |
| 3515665 | LIDOCAIN SDV 0.5% 50ML | $ | 8.00 |
| 3515666 | LIDOCAN TOP 4% 50ML | $ | 48.00 |
| 3515667 | LIDOCAN VIS 2% 100ML | $ | 24.00 |
| 3515668 | LIDOCAIN DRIP 10MG X200 | $ | 15.00 |
| 3515669 | LIDOCAIN/DEX 5-7.5% AMP | $ | 20.00 |
| 3515670 | LIDOCAINE PATCH 5% | $ | 18.00 |
| 3515671 | LIDOCAN/EPI AMP 1.5% 5ML | $ | 23.50 |
| 3515672 | LIDOCAN/EPI DOSE 0.5% 1ML | $ | 20.75 |
| 3515674 | LIDOCAN/EPI DOSE 1% 1ML | $ | 10.00 |
| 3515675 | LIDOCAN/EPI DOSE 2% 1ML | $ | 9.00 |
| 3515676 | LIDOCN/PRILOCN CRM 30GM | $ | 59.50 |
| 3515677 | LINDANE LOT 1% 60ML | $ | 151.50 |
| 3515678 | LINEZOLID TAB 600MG | $ | 280.00 |
| 3515679 | LISINOPRIL TAB 10MG | $ | 8.00 |
| 3515680 | LISINOPRIL TAB 2.5MG | $ | 8.00 |
| 3515681 | LISINOPRIL TAB 20MG | $ | 9.00 |
| 3515682 | LISINOPRIL TAB 30MG | $ | 9.00 |
| 3515683 | LISINOPRIL TAB 40MG | $ | 8.00 |
| 3515684 | LISINOPRIL TAB 5MG | $ | 8.00 |
| 3515685 | LOPERAMIDE CAP 2MG | $ | 8.00 |
| 3515687 | LOPERAMIDE LIQD 1MG/5ML | $ | 14.00 |
| 3515688 | LOPERAMIDE LIQD 1MG/7.5ML | $ | 19.75 |
| 3515689 | LOPERAMIDE TAB 2MG-24 | $ | 20.00 |
| 3515690 | LORATADINE TAB 10MG | $ | 8.00 |
| 3515691 | LORAZEPM CONC 2MG/ML 30ML | $ | 74.00 |
| 3515692 | LORAZEPAM SDV 2MG X1 (J2060) | $ | 27.00 |
| 3515693 | LORAZEPAM TAB 0.5MG | $ | 8.00 |
| 3515694 | LORAZEPAM TAB 1MG | $ | 8.00 |
| 3515695 | LOSARTAN TAB 25MG | $ | 8.00 |
| 3515696 | LOSARTAN TAB 100MG | $ | 8.00 |
| 3515697 | LOTEPREDNOL OPH DROP 0.5% | $ | 302.00 |
| 3515698 | LOVASTATIN TAB 10MG | $ | 8.00 |
| 3515699 | LOVASTATIN TAB 20MG | $ | 10.00 |
| 3515700 | LUBIPROSTONE CAP 24MCG | $ | 15.00 |
| 3515701 | LUTEIN TAB 20MG | $ | 8.00 |
| 3515702 | MAG CITRATE SOLN | $ | 9.00 |
| 3515703 | MAG/AL HYDROX 30ML UD | $ | 9.00 |
| 3515705 | MAG/AL HYDROX/SIMTH DOSE | $ | 8.00 |
| 3515706 | MAG HYDROX 400/5 16OZ | $ | 16.25 |
| 3515707 | MAG HYDROX 400/5 30ML UD | $ | 9.00 |
| 3515709 | MAGNESIUM OXID TAB 400MG | $ | 8.00 |
| 3515710 | MAGNESIUM PGBK 4GM/100ML | $ | 17.00 |
| | | $ | 17.00 |
| 3515711 | MAGNESIUM VL 500MG X2 | $ | 9.00 |
| 3515712 | MAGNESIUM LVP 40GM/1000ML | $ | 46.00 |
| 3515713 | MANNITOL PGBK 500ML | $ | 68.00 |
| 3515714 | MANNITOL VL 25% 50ML | $ | 9.00 |
| 3515715 | MEASLES/MUMPS/RUBELLA | $ | 117.00 |
| 3515716 | MECLIZINE TAB 25MG | $ | 8.00 |
| 3515717 | MEDROXYPROGST VL 1MG X150 (J1050) | $ | 105.00 |
| 3515718 | MEDROXYPROGST TAB 2.5MG | $ | 8.00 |
| 3515719 | MEGESTROL DOSE 20MG X40 | $ | 18.75 |
| 3515720 | MELATONIN TAB 3MG | $ | 8.00 |
| 3515721 | MELOXICAM TAB 15MG | $ | 12.00 |
| 3515722 | MELOXICAM TAB 7.5MG | $ | 8.00 |
| 3515723 | MEMANTINE TAB 10MG | $ | 8.00 |
| 3515724 | MEMANTINE TAB 5MG | $ | 15.00 |
| 3515725 | MENINGOCOCC VL MENACTRA | $ | 215.00 |
| 3515726 | MENTHOL LOZENGE | $ | 8.00 |
| 3515727 | MENTHOL/CAMPHOR LOTION | $ | 12.00 |
| 3515728 | PHENOL LOZENGE | $ | 8.00 |
| 3515729 | MEPERIDINE SRN 100MG (J2175) | $ | 52.00 |
| 3515730 | MESALAMINE TAB 400MG | $ | 11.00 |
| 3515731 | MESNA VL 200MG X5 | $ | 266.25 |
| 3515732 | METAXALONE TAB 800MG | $ | 16.00 |
| 3515733 | METFORMIN TAB 1000MG | $ | 9.00 |
| 3515734 | METFORMIN TAB 500MG | $ | 8.00 |
| 3515735 | METFORMIN ER TAB 500MG | $ | 9.00 |
| 3515736 | METFORMIN ER TAB 750MG | $ | 9.00 |
| 3515737 | METHAZOLAMIDE TAB 50MG | $ | 16.00 |
| 3515738 | METHENAMINE HIPP TAB 1GM | $ | 10.00 |
| 3515740 | METHIMAZOLE TAB 10MG | $ | 8.00 |
| 3515741 | METHOCARBAMOL TAB 750MG | $ | 8.00 |
| 3515742 | METHOTREXATE DOSE 5MG X10 | $ | 24.50 |
| 3515743 | METHOTREXATE TAB 2.5MG | $ | 15.00 |
| 3515744 | METHYLSALC/MENTH CRM 4OZ | $ | 17.75 |
| 3515746 | METHYLCELLULOSE PWD 16OZ. | $ | 8.00 |
| 3515747 | METHYLCELLULOSE PWD/DOSE | $ | 8.00 |
| 3515748 | METHYLDOPA TAB 250MG | $ | 8.00 |
| 3515749 | METHYLEN BLU VL 1MG X100 | $ | 250.00 |
| 3515750 | METHYLERGONV AMP 0.2MG/ML | $ | 49.00 |
| 3515751 | METHYLERGONOV TAB 0.2MG | $ | 8.50 |
| 3515752 | METHYLPREDNS AC VL 40MG | $ | 17.00 |
| 3515753 | METHYLPREDNSLN 4MG-21TAB | $ | 60.00 |
| 3515754 | METHYLPREDNS SS 125MG | $ | 37.00 |
| 3515755 | METHYLPREDNS SS 125MG X8 | $ | 114.00 |
| 3515756 | METHYLPREDNS SS 40MG | $ | 33.00 |
| 3515757 | METHYLPREDNS SS 125MG X4 | $ | 73.00 |
| 3515758 | METHYLPREDNSLN TAB 4MG | $ | 10.00 |
| 3515759 | METOCLOPRAMID VL 10MG/2ML | $ | 27.00 |
| 3515760 | METOCLOPRAMIDE TAB 10MG | $ | 8.00 |
| 3515761 | METOCLOPRAMIDE TAB 5MG | $ | 8.00 |
| 3515762 | METOLAZONE TAB 2.5MG | $ | 10.00 |
| 3515763 | METOLAZONE TAB 5MG | $ | 10.00 |
| 3515764 | METOPROLOL SUCC TAB 100MG | $ | 9.00 |
| 3515765 | METOPROLOL SUCC TAB 25MG | $ | 9.00 |
| 3515766 | METOPROLOL SUCC TAB 50MG | $ | 9.00 |
| 3515767 | METOPROLOL AMP 5MG/5ML | $ | 27.00 |
| 3515768 | METOPROLOL TART TAB 25MG | $ | 8.00 |
| 3515769 | METOPROLOL TART TAB 50MG | $ | 8.00 |
| 3515770 | METOPROLOL TART TAB 100MG | $ | 8.00 |
| 3515771 | METRONIDZL GEL 1% 70GM | $ | 228.00 |
| 3515772 | METRONIDAZOLE TAB 250MG | $ | 8.00 |
| 3515773 | METRONIDAZOLE TAB 500MG | $ | 8.00 |
| 3515774 | METRONDZOL PB 500MG/100ML | $ | 48.00 |
| 3515775 | MICONAZOLE CREAM 2% 30GM | $ | 11.00 |
| 3515776 | MICONAZOLE-7 CREAM 2% | $ | 17.00 |
| 3515777 | MICONAZOLE POWDER 2% | $ | 16.00 |
| 3515778 | MIDAZOLAM VL 1MG/ML X2 | $ | 27.00 |
| 3515779 | MIDAZOLAM VL DOSE 1MG/ML | $ | 26.00 |
| 3515780 | MIDAZOLAM SRP DOS 2MG/ML | $ | 8.00 |
| 3515781 | MIDODRINE TAB 5MG | $ | 10.00 |
| 3515782 | MIGLITOL TAB 25MG | $ | 8.00 |
| 3515784 | MIRTAZAPINE TAB 15MG | $ | 10.00 |
| 3515785 | MIRTAZAPINE TAB 7.5MG | $ | 10.00 |
| 3515786 | MIRTAZAPINE TAB 30MG | $ | 29.00 |
| 3515787 | MISOPROSTOL TAB 100MCG | $ | 8.00 |
| 3515788 | MISOPROSTOL TAB 200MCG | $ | 9.00 |
| 3515790 | MOEXIPRIL TAB 15MG | $ | 9.50 |
| 3515791 | MOLD EXTRACT TEST CANDIDA | $ | 34.00 |
| 3515792 | MOMETASONE CRM 0.1% 45GM | $ | 74.00 |
| 3515793 | MOMETASONE NASAL SPRAY | $ | 141.75 |
| 3515794 | MONTELUKAST TAB 10MG | $ | 14.00 |
| 3515795 | MORPHINE INJ 10MG X1 (J2270) | $ | 28.00 |
| 3515796 | MORPHINE SRN 2MG X1 INJ (J2270) | $ | 28.00 |
| 3515797 | MORPHINE SRN 4MG X1 INJ (J2270) | $ | 28.00 |
| 3515799 | MORPHINE ER TAB 15MG | $ | 8.00 |
| 3515800 | MORPHINE ER TAB 30MG | $ | 8.00 |
| 3515801 | MORPHINE SOLN 10MG/5ML | $ | 68.00 |
| 3515802 | MORPHINE SUPP 5MG | $ | 12.00 |
| 3515804 | MOXIFLOXACN OPH DROP 0.5% | $ | 261.00 |
| 3515805 | MOXIFLOXACIN TAB 400MG | $ | 59.00 |
| 3515806 | MOXIFLOXACIN PB 100MG X4 | $ | 107.00 |
| 3515807 | MULTIVIT W/ IRON TAB | $ | 8.00 |
| 3515808 | MULTIVIT/FE/MIN LQD 15ML | $ | 8.00 |
| 3515809 | MULTIVIT/FE/MIN LQD 240ML | $ | 8.00 |
| 3515810 | MULTIVIT/MIN/LUTEIN CAP | $ | 8.00 |
| 3515811 | MULTIVIT/MIN/LUTEIN TAB | $ | 8.00 |
| 3515812 | MULTIVITAMIN VL 10ML/2 VIALS X1 J3490 | $ | 58.00 |
| 3515813 | MULTIVITAMIN TAB | $ | 8.00 |
| 3515814 | MUPIROCIN CREAM 2% 15GM | $ | 321.00 |
| 3515815 | MUPIROCIN OINT 2% 22GM | $ | 40.00 |
| 3515816 | MYCOPHENOLATE CAP 250MG | $ | 11.00 |
| 3515817 | MYCOPHENOLAT TB 250MG X2 | $ | 33.00 |
| 3515818 | NABUMETONE TAB 500MG | $ | 9.00 |
| 3515819 | NAFCILLIN VL 2GM | $ | 52.00 |
| 3515820 | NALBUPHINE AMP 10MG/ML | $ | 30.00 |
| 3515821 | NALOXONE AMP 0.4MG/ML | $ | 44.00 |
| 3515822 | NAPHAZOLN/PHENIR OPH DROP | $ | 11.00 |
| 3515823 | NAPROXEN TAB 220MG | $ | 8.00 |
| 3515824 | NAPROXEN TAB 275MG | $ | 7.75 |
| 3515825 | NAPROXEN TAB 375MG | $ | 9.00 |
| 3515826 | NAPROXEN TAB 500MG | $ | 9.00 |
| 3515827 | NATEGLINIDE TAB 120MG | $ | 11.00 |
| 3515828 | NEFAZODONE TAB 100MG | $ | 11.00 |
| 3515829 | NEFAZODONE TAB 50MG | $ | 8.75 |
| 3515830 | NEO/BAC/POLY OINT 30GM | $ | 11.00 |
| 3515831 | NEO/BAC/POLY OPH OINT | $ | 102.00 |
| 3515832 | NEO/POLY/DEX OP DROP 0.1% | $ | 35.00 |
| 3515833 | NEO/POLY/DEX OPHTH OINT 0.1% -OR | $ | 0.00 |
| 3515834 | NEO/POLY/HC OTIC DROP 1% | $ | 126.00 |
| 3515835 | NEOSTIGMINE VL DOSE 0.5MGX2 J2710 | $ | 16.00 |
| 3515836 | NESIRITIDE VL 0.1MG X15 | $ | 771.25 |
| 3515837 | NICOTINE PAT 14MG/24HR | $ | 10.00 |
| 3515838 | NICOTINE PAT 21MG/24HR | $ | 10.00 |
| 3515839 | VANCOMYCIN PGBK J3370 500MG X2 | $ | 73.00 |
| 3515840 | NICOTINE PAT 7MG/24HR | $ | 10.00 |
| 3515841 | NIFEDIPINE ER TAB 30MG | $ | 9.00 |
| 3515842 | NISOLDIPINE TAB 20MG | $ | 32.00 |
| 3515843 | NITROFUR MCROBID CP 100MG | $ | 11.00 |
| 3515844 | NITROGLYCRN ON 2% 1GM PKT | $ | 10.00 |
| 3515845 | NITROGLYCERN PAT 0.1MG/HR | $ | 9.00 |
| 3515846 | NITROGLYCERN PAT 0.2MG/HR | $ | 9.00 |
| 3515847 | NITROGLYCERN PAT 0.4MG/HR | $ | 9.00 |
| 3515848 | NITROGLYCERN SPRAY | $ | 440.00 |
| 3515849 | NITROGLYCERIN TAB 0.4MG | $ | 9.00 |
| 3515850 | NITROGLYCRN PB 50MG/250ML | $ | 67.00 |
| 3515851 | SOD NITROPRSS VL 50MG/2ML | $ | 465.00 |
| 3515852 | NFD NON-FORMULARY DRUG | $ | 0.00 |
| 3515853 | NOREPINEPHRIN AMP 4MG/4ML | $ | 56.00 |
| 3515854 | ZZNORGSTRL/ESTRADL 5 TABS | $ | 21.50 |
| 3515855 | NORTRIPTYLINE CAP 10MG | $ | 8.00 |
| 3515856 | NORTRIPTYLINE CAP 25MG | $ | 9.00 |
| 3515857 | NUTRITION DIGESTIVE CAP | $ | 7.00 |
| 3515858 | NYSTATIN CREAM 15GM | $ | 33.00 |
| 3515859 | NYSTATIN OINT 30GM | $ | 32.00 |
| 3515860 | NYSTATIN POWDER 15GM | $ | 63.00 |
| 3515861 | NYSTATN SUSP 100MU/ML-473 | $ | 191.00 |
| 3515862 | NYSTATIN SUSP 100MU/ML-60 | $ | 32.00 |
| 3515863 | NYSTATIN/TRIAMCN CRM 15GM | $ | 187.00 |
| 3515864 | OFLOXACIN OPH DROP 0.3% | $ | 70.00 |
| 3515865 | OFLOXACIN OTIC DROP 0.3% | $ | 119.00 |
| 3515866 | OLANZAPINE TAB 2.5MG | $ | 21.00 |
| 3515867 | OLANZAPINE TAB 5MG | $ | 20.00 |
| 3515868 | OLOPATADINE OPH DROP 0.2% | $ | 265.00 |
| 3515869 | OLOPATADINE OPH DROP 0.1% | $ | 360.00 |
| 3515870 | OMEPRAZOLE CAP 20MG | $ | 9.00 |
| 3515871 | ONDANSETRON VL 1 MG X4 | $ | 25.00 |
| 3515872 | ONDANSETRON ODT 4MG | $ | 39.00 |
| 3515873 | ONDANSETRON ODT 4MG X2 | $ | 63.00 |
| 3515874 | OPIUM/BELLADON SUPP 30MG | $ | 53.00 |
| 3515875 | OSELTAMIVIR CAP 75MG | $ | 34.00 |
| 3515876 | OSELTMVR SUSP 6MG/ML 60ML | $ | 135.50 |
| 3515877 | OXCARBAZEPINE TAB 300MG | $ | 10.00 |
| 3515878 | OXYBUTYNIN ER TAB 10MG | $ | 11.00 |
| 3515879 | OXYBUTYNIN ER TAB 15MG | $ | 11.00 |
| 3515880 | OXYBUTYNIN TAB 5MG | $ | 8.00 |
| 3515881 | OXYCODONE ER TAB 10MG | $ | 12.00 |
| 3515882 | OXYCODONE ER TAB 20MG | $ | 16.00 |
| 3515883 | OXYCODONE ER TAB 40MG | $ | 20.00 |
| 3515884 | OXYCODONE IR TAB 5MG | $ | 8.00 |
| 3515885 | OXYCODON/APAP TAB 5-325MG | $ | 9.00 |
| 3515886 | OXYCOD/APAP 5-325 6 TAB | $ | 15.50 |
| 3515887 | OXYMETAZOLN NAS SPY 0.05% | $ | 10.00 |
| 3515888 | OXYTOCIN VL 10U/ML | $ | 9.00 |
| 3515891 | PAMIDRONATE VL 30 MG X3 | $ | 177.50 |
| 3515892 | PANCURONIUM DOSE 1MG/ML | $ | 11.00 |
| 3515893 | PANTOPRAZOLE VL 40MG | $ | 30.00 |
| 3515894 | PANTOPRAZOLE TAB 20MG | $ | 11.00 |
| 3515895 | PANTOPRAZOLE TAB 40MG | $ | 12.00 |
| 3515896 | ONDANSETRON 8MG TAB | $ | 37.29 |
| 3515897 | PAROXETINE TAB 10MG | $ | 10.00 |
| 3515898 | PAROXETINE TAB 20MG | $ | 10.00 |
| 3515899 | PEGFILGRSTM SRN 6MG/0.6ML | $ | 8,010.00 |
| 3515900 | PEN G CR SRN 100,000UX12 (J0558) | $ | 230.00 |
| 3515901 | PEN G LA SRN 100,000UX12 (J0561) | $ | 210.00 |
| 3515902 | PENICILLIN GK 600000X8.4 (J2540) | $ | 61.00 |
| 3515903 | PEN V K 250MG/5ML 100ML | $ | 12.00 |
| 3515904 | PENICILLIN V K TAB 250MG | $ | 22.00 |
| 3515905 | PENICILLIN V K TAB 500MG | $ | 9.00 |
| 3515906 | PENTOBARB DOSE 50MG X1 | $ | 695.00 |
| 3515907 | PENTOXIFYLLINE TAB 400MG | $ | 9.00 |
| 3515908 | PHENAZOPYRIDINE TAB 100MG | $ | 10.00 |
| 3515909 | PHENOBARBITAL VL 130MG | $ | 75.00 |
| 3515910 | PHENOBARBITAL VL 65MG/ML | $ | 35.00 |
| 3515911 | PHENOL THROAT SPRAY | $ | 10.00 |
| 3515912 | PHENTOLAMINE VL 5MG | $ | 255.00 |
| 3515913 | PHENYLEPHRIN OP DROP 2.5% | $ | 138.00 |
| 3515914 | PHENYLEPH DOSE 10MG/ML | $ | 14.00 |
| 3515915 | PHENYLEPHRIN NSL SPR 0.5% | $ | 11.00 |
| 3515916 | PHENYLEPH VL 10MG/ML X5 | $ | 63.25 |
| 3515917 | PHENYTOIN AMP 50MG X5 - | $ | 45.75 |
| 3515918 | PHENYTOIN SRN 50MG X2 | $ | 10.00 |
| 3515919 | PHENYTOIN ER CAP 100MG | $ | 8.00 |
| 3515920 | PHENYTOIN ER CAP 300MG | $ | 10.00 |
| 3515921 | PHENYTOIN SUSP 125MG/5ML | $ | 60.00 |
| 3515922 | PHYSOSTIGMINE AMP 1MG/ML | $ | 70.00 |
| 3515923 | PILOCARPINE OPH DROP 1% | $ | 0.00 |
| 3515924 | PILOCARPINE OPH GEL 4% | $ | 185.00 |
| 3515925 | PIOGLITAZONE TAB 15MG | $ | 16.00 |
| 3515926 | PIOGLITAZONE TAB 30MG | $ | 20.00 |
| 3515927 | PIOGLITAZONE TAB 45MG | $ | 21.00 |
| 3515928 | PIPRCL/TAZ VL 1.125GM X3 | $ | 64.00 |
| 3515930 | PIROXICAM CAP 10MG | $ | 10.00 |
| 3515931 | PNEUMOC-23 VAC PNEUMOVAX | $ | 130.00 |
| 3515932 | PODOPHYLLUM LQD 25% TOP | $ | 198.00 |
| 3515933 | POLIO VAC IPOL | $ | 60.00 |
| 3515934 | POLYETHYLEN GLYCOL OP DRP | $ | 12.00 |
| 3515935 | POLYETHYLENE GLYCOL PKT | $ | 9.00 |
| 3515936 | POLYETHYLEN GLYCOL PWD | $ | 8.00 |
| 3515937 | POLY/TRIMETHOP OPH DROP | $ | 23.00 |
| 3515938 | D5-1/2NS KCL 20MEQ/1000ML | $ | 51.00 |
| 3515939 | POTAS GLUC TAB 99MG | $ | 8.00 |
| 3515940 | POTAS PHOS MONO-DIBS PKT | $ | 7.25 |
| 3515941 | POTAS BICRB/CIT TAB 25MEQ | $ | 9.00 |
| 3515942 | POTAS CL LQD 20MEQ/15ML | $ | 8.00 |
| 3515943 | POTAS CL PKT 20MEQ | $ | 20.00 |
| 3515944 | POTASSIUM CL VL 2MEQ X10 J3480 | $ | 46.00 |
| 3515945 | POTAS CL TAB 10MEQ | $ | 8.00 |
| 3515946 | POTAS CL TAB 20MEQ | $ | 8.00 |
| 3515947 | POTAS CL PGBK 2MEQ X5 | $ | 49.00 |
| 3515948 | POTAS IOD SLN 1GM/ML 30ML | $ | 38.00 |
| 3515949 | POVIDON-IODN OPH DROP 5% | $ | 0.00 |
| 3515950 | POVIDONE-IODINE OINT 10% | $ | 11.00 |
| 3515951 | PRAMIPEXOLE TAB 0.125MG | $ | 11.00 |
| 3515952 | PRAMIPEXOLE TAB 0.25MG | $ | 10.00 |
| 3515953 | PRAMIPEXOLE TAB 1.5MG | $ | 15.00 |
| 3515954 | PRAMOXINE/ZINC OX CREAM | $ | 15.00 |
| 3515955 | PRAMOXIN/MENTHOL CREAM | $ | 14.00 |
| 3515956 | PRAVASTATIN TAB 20MG | $ | 11.00 |
| 3515957 | PREDNISOLONE OPH DROP 1% | $ | 101.00 |
| 3515958 | PREDNISOLN LQD 5MG/5ML X6 | $ | 23.50 |
| 3515959 | PREDNISONE TAB 1MG X10 | $ | 8.00 |
| 3515960 | PREDNISONE TAB 1MG | $ | 8.00 |
| 3515961 | PREDNISONE TAB 2.5MG | $ | 8.00 |
| 3515962 | PREDNISONE TAB 1MG X20 | $ | 8.00 |
| 3515963 | PREDNISONE TAB 5MG X10 | $ | 9.00 |
| 3515964 | PREDNISONE TAB 1MG X5 | $ | 8.00 |
| 3515965 | PREGABALIN CAP 100MG | $ | 17.00 |
| 3515966 | PREGABALIN CAP 150MG | $ | 15.00 |
| 3515967 | PREGABALIN CAP 200MG | $ | 15.00 |
| 3515968 | PREGABALIN CAP 25MG | $ | 16.00 |
| 3515969 | PREGABALIN CAP 50MG | $ | 17.00 |
| 3515970 | PREGABALIN CAP 75MG | $ | 17.00 |
| 3515971 | PRENATAL/IRON/DSS/FA TAB | $ | 8.00 |
| 3515972 | PRIMIDONE TAB 50MG | $ | 8.00 |
| 3515973 | PROCAINAMD VL 1000MG/10ML | $ | 100.00 |
| 3515974 | PROCHLORPERAZ VL 10MG/2ML (J0780) | $ | 36.00 |
| 3515975 | PROCHLORPERZN TAB 5MG X2 | $ | 8.00 |
| 3515976 | PROCHLORPERAZINE TAB 5MG | $ | 8.00 |
| 3515977 | PROCHLORPERAZIN SUPP 25MG | $ | 22.00 |
| 3515978 | PROMETH/COD SRP 10-6.25/5 | $ | 8.00 |
| 3515979 | PROMETHAZINE VL 25MG/ML | $ | 28.00 |
| 3515980 | PROMETHAZINE SUPP 25MG | $ | 33.00 |
| 3515981 | PROMETHAZN SRP 6.25MG/5ML | $ | 16.00 |
| 3515982 | PROMETHAZINE TAB 25MG | $ | 8.00 |
| 3515983 | PROPAFENONE TAB 150MG | $ | 9.00 |
| 3515984 | PROPARACAINE OPHTH 0.5% DROP | $ | 69.00 |
| 3515985 | PROPOFOL VL 10MG/ML 20ML | $ | 33.00 |
| 3515986 | ZZPROPOXYPHENE HCL CAP 65 | $ | 7.25 |
| 3515987 | ZZPROPXNAP/APAP TAB 100-6 | $ | 7.50 |
| 3515988 | PROPRANOLOL ER CAP 80MG | $ | 10.00 |
| 3515989 | PROPRANOLOL TAB 20MG | $ | 8.00 |
| 3515990 | PROPYLTHIOURACIL TAB 50MG | $ | 8.00 |
| 3515991 | PROTAMINE VL 10MG/ML X25 | $ | 47.50 |
| 3515992 | PSEUD/BROM ELX 15-1MG/5ML | $ | 19.25 |
| 3515993 | PSEUDOEPHEDRINE TAB 30MG | $ | 8.00 |
| 3515994 | PSEUDOEPHEDRINE TAB 60MG | $ | 8.00 |
| 3515995 | PSYLLIUM POWDER PKT | $ | 8.00 |
| 3515996 | PSYLLIUM POWDER BULK | $ | 7.00 |
| 3515997 | PYRL/APAP/PAMBROM TAB | $ | 7.00 |
| 3515998 | ZN PYRITHN SHMP 1% 420ML | $ | 14.00 |
| 3515999 | QUETIAPINE TAB 100MG | $ | 15.00 |
| 3516000 | QUETIAPINE TAB 200MG | $ | 31.00 |
| 3516001 | QUETIAPINE TAB 25MG | $ | 8.00 |
| 3516002 | QUETIAPINE TAB 300MG | $ | 32.00 |
| 3516003 | QUETIAPINE TAB 50MG | $ | 15.00 |
| 3516004 | QUINAPRIL TAB 10MG | $ | 9.00 |
| 3516005 | QUININE SULF CAP 324MG | $ | 16.00 |
| 3516006 | RABIES IM GLB 150U/ML X10 | $ | 4,890.00 |
| 3516008 | RACEPINEPHRINE NEB 2.25% | $ | 9.00 |
| 3516009 | RALOXIFENE TAB 60MG | $ | 16.00 |
| 3516010 | RAMELTEON TAB 8MG | $ | 24.00 |
| 3516011 | RAMIPRIL CAP 10MG | $ | 10.00 |
| 3516012 | RAMIPRIL CAP 2.5MG | $ | 12.00 |
| 3516013 | RAMIPRIL CAP 5MG | $ | 9.00 |
| 3516014 | RANITIDINE VL 25MG/ML X2 | $ | 41.00 |
| 3516015 | RANITIDINE DOS 150MG/10ML | $ | 16.00 |
| 3516016 | RANITIDINE TAB 150MG | $ | 9.00 |
| 3516017 | RANITIDINE TAB 75MG | $ | 8.00 |
| 3516018 | RASAGILINE TAB 0.5MG | $ | 37.00 |
| 3516019 | RASAGILINE TAB 1MG | $ | 37.00 |
| 3516020 | REMIFENTANIL VL 1 MG | $ | 107.00 |
| 3516022 | RISEDRONATE TAB 35MG | $ | 114.00 |
| 3516023 | RISPERIDONE SOLN 1MG/ML | $ | 12.00 |
| 3516024 | RISPERIDONE TAB 0.25MG | $ | 10.00 |
| 3516025 | RISPERIDONE TAB 0.5MG | $ | 11.00 |
| 3516026 | RISPERIDONE TAB 1MG | $ | 12.00 |
| 3516027 | RIVASTIGMINE CAP 3MG | $ | 11.25 |
| 3516028 | ROCURONIUM DOSE 10MG/ML | $ | 31.00 |
| 3516029 | ROPINIROLE TAB 0.5MG | $ | 10.00 |
| 3516030 | ROPINIROLE TAB 1MG | $ | 8.00 |
| 3516031 | ROPINIROLE TAB 2MG | $ | 10.00 |
| 3516032 | ROPINIROLE TAB 3MG | $ | 14.00 |
| 3516033 | ROPIVACAINE VL 1MG X200 | $ | 8.00 |
| 3516034 | ROSIGLITAZONE TAB 2MG | $ | 11.00 |
| 3516035 | ROSIGLITAZONE TAB 4MG | $ | 12.00 |
| 3516036 | ROSIGLITAZONE TAB 8MG | $ | 17.00 |
| 3516037 | ROSUVASTATIN TAB 10MG | $ | 20.00 |
| 3516038 | ROSUVASTATIN TAB 20MG | $ | 17.00 |
| 3516039 | ROTAVIRUS VAC ROTATEQ | $ | 146.00 |
| 3516040 | SALMETEROL INHALR 50MCG | $ | 440.00 |
| 3516041 | SAW PALMETTO CAP 450MG | $ | 7.00 |
| 3516042 | SCOPOLAMINEPAT 1.5MG/72HR | $ | 51.00 |
| 3516043 | SECOBARBITAL CAP 100MG | $ | 62.00 |
| 3516044 | SELENIUM SULFD SHMP 2.25% | $ | 233.00 |
| 3516045 | SENNOSIDES SYRP 8.8MG/5ML | $ | 8.00 |
| 3516046 | SENNOSIDES TAB 15MG | $ | 8.00 |
| 3516047 | SENNOSIDES TAB 8.6MG | $ | 8.00 |
| 3516048 | SENNOSID/DOC TAB 8.6-50MG | $ | 8.00 |
| 3516049 | SERTRALINE CONC 20MG/ML | $ | 113.00 |
| 3516050 | SERTRALINE TAB 100MG | $ | 8.00 |
| 3516051 | SERTRALINE TAB 25MG | $ | 8.00 |
| 3516052 | SERTRALINE TAB 50MG | $ | 8.00 |
| 3516053 | SEVELAMER TAB 400MG | $ | 8.25 |
| 3516054 | SEVOFLURANE LIQUID | $ | 244.00 |
| 3516055 | SILDENAFIL TAB 20MG | $ | 25.75 |
| 3516056 | SILVER NITRATE STICK | $ | 8.00 |
| 3516057 | SILVER SULFADZN CRM 50GM | $ | 31.00 |
| 3516058 | SIMETHICONE CHEW 80MG | $ | 8.00 |
| 3516059 | SIMVASTATIN TAB 10MG | $ | 10.00 |
| 3516061 | SIMVASTATIN TAB 40MG | $ | 12.00 |
| 3516062 | SIMVASTATIN TAB 80MG | $ | 12.00 |
| 3516063 | SIMVASTATIN TAB 5MG | $ | 8.00 |
| 3516064 | SIROLIMUS TAB 1MG | $ | 20.00 |
| 3516065 | SITAGLIPTIN TAB 100MG | $ | 23.00 |
| 3516066 | SITAGLIPTIN TAB 25MG | $ | 15.00 |
| 3516067 | SITAGLIPTIN TAB 50MG | $ | 31.00 |
| 3516068 | SOD BICARB SRN 5MEQ/10ML | $ | 20.00 |
| 3516069 | SOD BICARB SRN 50MEQ/50ML | $ | 38.00 |
| 3516070 | SALINE NASAL SPRAY | $ | 11.00 |
| 3516071 | SODIUM CL NEB 0.9% | $ | 8.00 |
| 3516072 | SODIUM CL TABS 1GM | $ | 8.00 |
| 3516073 | SOD CIT/CIT ACID SLN 30ML | $ | 10.00 |
| 3516075 | SOD POLSTYR SSP 15GM/60ML | $ | 21.00 |
| 3516076 | EYE WASH OPH SOLN | $ | 11.00 |
| 3516077 | SOLIFENACIN TAB 5MG | $ | 18.00 |
| 3516078 | SORBITOL SOLN 70% DOSE | $ | 8.00 |
| 3516079 | SOTALOL TAB 80MG | $ | 10.00 |
| 3516080 | SPIRONOLACTON TAB 12.5 MG | $ | 8.00 |
| 3516081 | SPIRONOLACTONE TAB 25MG | $ | 8.00 |
| 3516082 | SUCCINYLCHLN DOSE 20MG/ML | $ | 25.00 |
| 3516083 | SUCRALFATE SUSP 1GM/10ML | $ | 250.00 |
| 3516084 | SUCRALFATE TAB 1GM | $ | 8.00 |
| 3516086 | SULFACETAMIDE OP DROP 10% | $ | 86.00 |
| 3516087 | SULFACETAMID/SULFUR EMUL | $ | 59.75 |
| 3516088 | SULFA/TMP 400-80MG/10ML | $ | 291.00 |
| 3516089 | SULFA/TMP TAB 400-80MG | $ | 8.00 |
| 3516090 | SULFA/TMP TAB 800-160MG | $ | 8.00 |
| 3516091 | SULINDAC TAB 150MG | $ | 8.00 |
| 3516092 | SULINDAC TAB 200MG | $ | 9.00 |
| 3516093 | SUMATRIPTAN VL 6MG/0.5ML | $ | 140.00 |
| 3516094 | TAMOXIFEN TAB 10MG | $ | 8.00 |
| 3516095 | TAMSULOSIN CAP 0.4MG | $ | 12.00 |
| 3516097 | TEMAZEPAM CAP 15MG | $ | 8.00 |
| 3516098 | TENECTEPLASE KIT 1MG X50 | $ | 7,862.00 |
| 3516099 | TERAZOSIN CAP 5MG | $ | 9.00 |
| 3516100 | TERBINAFINE CREAM 1% | $ | 22.00 |
| 3516101 | TERBINAFINE TAB 250MG | $ | 23.00 |
| 3516102 | TERBUTALINE VL 1MG/ML | $ | 37.00 |
| 3516103 | TERBUTALINE TAB 2.5MG | $ | 9.00 |
| 3516104 | TERCONAZOLE CREAM 45GM | $ | 70.00 |
| 3516106 | TETANUS/DIP VAC DECAVAC | $ | 51.00 |
| 3516107 | TETANUS IMM GLOB HYPTET | $ | 700.00 |
| 3516109 | TETRACAINE AMP 10MG/ML | $ | 14.00 |
| 3516110 | TETRACYCLINE CAP 250MG | $ | 16.00 |
| 3516111 | THEOPHYLLINE ER TAB 100MG | $ | 8.00 |
| 3516112 | THEOPHYLLINE ER TAB 300MG | $ | 8.00 |
| 3516114 | THYROID TAB 60MG | $ | 8.00 |
| 3516115 | TIMOLOL OPH DROP 0.25% | $ | 24.00 |
| 3516116 | TIMOLOL OPH DROP 0.5% | $ | 32.00 |
| 3516117 | TIOTROPIUM INHALER -5S | $ | 150.00 |
| 3516118 | TIOTROPIUM INHALER -30S | $ | 480.00 |
| 3516119 | TIZANIDINE TAB 2MG | $ | 9.00 |
| 3516120 | TIZANIDINE TAB 4MG | $ | 9.00 |
| 3516121 | TOBRAMYCIN OPH OINT 0.3% | $ | 105.25 |
| 3516122 | TOBRAMYCIN OPH DROP 0.3% | $ | 24.00 |
| 3516123 | TOBRAMYCIN/DEX OPH DROP | $ | 111.00 |
| 3516124 | TOBRAMYCIN/DEX OPH OINT | $ | 311.00 |
| 3516125 | TOBRAMYCIN/LOTEP OPH DROP | $ | 311.00 |
| 3516126 | TOLTERODINE LA CAP 2MG | $ | 23.00 |
| 3516127 | TOLTERODINE LA CAP 4MG | $ | 24.00 |
| 3516128 | TOLTERODINE TAB 1MG | $ | 15.00 |
| 3516129 | TOLTERODINE TAB 2MG | $ | 15.00 |
| 3516130 | TOPIRAMATE TAB 100MG | $ | 24.00 |
| 3516131 | TOPIRAMATE TAB 50MG | $ | 14.00 |
| 3516132 | TORSEMIDE TAB 10MG | $ | 8.00 |
| 3516133 | TORSEMIDE TAB 20MG | $ | 8.00 |
| 3516134 | TRACE ELEMENTS VL 1ML | $ | 18.00 |
| 3516135 | TRAMADOL TAB 50MG | $ | 8.00 |
| 3516137 | TRAVOPRST Z OP DRP 0.004% | $ | 222.00 |
| 3516138 | TRAZODONE TAB 100MG | $ | 8.00 |
| 3516139 | TRAZODONE TAB 150MG | $ | 9.00 |
| 3516140 | TRAZODONE TAB 50MG | $ | 8.00 |
| 3516141 | TRIAMCINLN CRM 0.1% 15GM | $ | 14.00 |
| 3516142 | TRIAMCINLN CRM 0.1% 80GM | $ | 23.00 |
| 3516143 | TRIAMCINOLN DOSE 10MG X4 | $ | 20.00 |
| 3516144 | TRIAMCINLN OINT 0.1% 15GM | $ | 14.00 |
| 3516145 | TRIAMCINLN OINT 0.1% 80GM | $ | 23.00 |
| 3516146 | TRIAM/HCTZ CAP 37.5-25MG | $ | 8.00 |
| 3516147 | TRIAM/HCTZ TAB 75-50MG | $ | 8.00 |
| 3516148 | TRIAZOLAM TAB 0.125MG | $ | 10.00 |
| 3516149 | TRIFLURIDINE OPH DROP 1% | $ | 361.00 |
| 3516150 | TRIMETHOBENZAM CAP 300MG | $ | 9.00 |
| 3516153 | TRIMETHOPRIM TAB 100MG | $ | 8.00 |
| 3516154 | TROLAMINE CREAM 10% | $ | 15.00 |
| 3516155 | TROPICAMIDE OPH DROP 0.5% | $ | 20.00 |
| 3516156 | TROPICAMIDE OPH DROP 1% | $ | 0.00 |
| 3516157 | TROSPIUM ER CAP 60MG | $ | 13.00 |
| 3516158 | TROSPIUM TAB 20MG | $ | 10.25 |
| 3516159 | TUBERCULIN DOSE 5TU/0.1ML | $ | 34.00 |
| 3516160 | TYPHOID VAC 25MCG TYPHIM | $ | 187.00 |
| 3516161 | URSODIOL CAP 300MG | $ | 16.00 |
| 3516162 | VALACYCLOVIR TAB 500MG | $ | 20.00 |
| 3516163 | VALGANCICLOVIR TAB 450MG | $ | 110.00 |
| 3516164 | VALPROATE SOD VL 100MG/ML | $ | 66.00 |
| 3516165 | VALSARTAN TAB 160MG | $ | 12.00 |
| 3516166 | VALSARTAN TAB 40MG | $ | 11.00 |
| 3516167 | VALSARTAN TAB 80MG | $ | 17.00 |
| 3516168 | VANCOMYCIN CAP 125MG | $ | 60.00 |
| 3516169 | VANCOMYCIN VL J3370 500MG X2 | $ | 65.00 |
| 3516170 | VARENICLINE TAB 0.5MG | $ | 16.00 |
| 3516171 | VARENICLINE TAB 1MG | $ | 14.00 |
| 3516172 | VARICELLA VAC VARIVAX | $ | 222.00 |
| 3516173 | VASOPRESSIN IV 20 UNITS | $ | 70.00 |
| 3516174 | VENLAFAXINE TAB 37.5MG | $ | 9.00 |
| 3516175 | VENLAFAXINE TAB 75MG | $ | 10.00 |
| 3516176 | VENLAFAXINE ER TAB 150MG | $ | 14.00 |
| 3516177 | VENLAFAXINE ER TAB 37.5MG | $ | 14.00 |
| 3516178 | VENLAFAXINE ER CAP 75MG | $ | 12.00 |
| 3516179 | VERAPAMIL SR TAB 180MG | $ | 8.00 |
| 3516180 | VERAPAMIL AMP 5MG/2ML | $ | 45.00 |
| 3516181 | VERAPAMIL SR TAB 120MG | $ | 10.00 |
| 3516182 | VERAPAMIL SR TAB 240MG | $ | 8.00 |
| 3516183 | VERAPAMIL TAB 120MG | $ | 8.00 |
| 3516184 | RENAL/NEPHRO CAP | $ | 8.00 |
| 3516185 | VIT B12/B6/FA TAB | $ | 8.00 |
| 3516186 | VIT B12/C/FE/FA CAP | $ | 8.00 |
| 3516187 | VITAMIN A CAP 8000UNT | $ | 8.00 |
| 3516188 | VIT B COMPLEX CAP | $ | 8.00 |
| 3516189 | THIAMN VIT B1 VL 100MG/ML | $ | 38.00 |
| 3516190 | THIAMINE VIT B1 TAB 100MG | $ | 8.00 |
| 3516191 | CYANOCOBAL B12 1000MCG/ML | $ | 34.00 |
| 3516192 | CYANOCOBL B12 TAB 1000MCG | $ | 8.00 |
| 3516193 | CYANOCOBAL B12 TAB 100MCG | $ | 8.00 |
| 3516194 | CYANOCOBAL B12 TAB 250MCG | $ | 8.00 |
| 3516195 | NIACIN VIT B3 TAB 500MG | $ | 15.00 |
| 3516196 | PYRIDOXIN VIT B6 TAB 50MG | $ | 8.00 |
| 3516197 | ASCORBIC ACID TAB 500MG | $ | 8.00 |
| 3516198 | VITAMIN D CAP 50,000U | $ | 9.00 |
| 3516199 | VITAMIN D TAB 1000U | $ | 8.00 |
| 3516200 | VITAMIN D TAB 400U | $ | 7.00 |
| 3516201 | VITAMIN E CAP (400 U) | $ | 8.00 |
| 3516202 | PHYTON VIT K AMP 1MG X10 | $ | 98.00 |
| 3516203 | PHYTON VIT K NEO AMP 1MG | $ | 14.00 |
| 3516204 | PHYTONADION VIT K TAB 5MG | $ | 116.00 |
| 3516205 | WARFARIN TAB 1MG | $ | 8.00 |
| 3516206 | WARFARIN TAB 2.5MG | $ | 10.00 |
| 3516207 | WARFARIN TAB 2MG | $ | 10.00 |
| 3516208 | WARFARIN TAB 3MG | $ | 8.00 |
| 3516209 | WARFARIN TAB 4MG | $ | 8.00 |
| 3516210 | WARFARIN TAB 5MG | $ | 8.00 |
| 3516211 | WARFARIN TAB 6MG | $ | 8.00 |
| 3516212 | WARFARIN TAB 7.5MG | $ | 8.00 |
| 3516214 | ZAFIRLUKAST TAB 20MG | $ | 10.00 |
| 3516215 | ZALEPLON CAP 5MG | $ | 11.00 |
| 3516216 | ZIDOVUDINE TAB 100MG X3 | $ | 15.00 |
| 3516217 | ZINC OXIDE OINT 20% 60GM | $ | 11.00 |
| 3516218 | ZINC SULF CAP 220MG | $ | 8.00 |
| 3516220 | ZOLEDRONIC ACD PB 1MG X5 | $ | 1,029.00 |
| 3516221 | ZOLPIDEM TAB 10MG | $ | 14.00 |
| 3516222 | ZOLPIDEM TAB 5MG | $ | 12.00 |
| 3516223 | ZONISAMIDE CAP 100MG | $ | 9.00 |
| 3516224 | ZONISAMIDE CAP 50MG | $ | 9.00 |
| 3516225 | ZOSTER VAC ZOSTAVAX | $ | 301.00 |
| 3516226 | PROTEINAS INHIB 10MG X50 | $ | 307.75 |
| 3516227 | PROTEINAS INHIB 10MG X100 | $ | 572.75 |
| 3516228 | 1/2 NS 1000 ML | $ | 18.00 |
| 3516229 | NS 250 ML | $ | 22.00 |
| 3516230 | NS 1000 ML | $ | 18.00 |
| 3516231 | NS 100 ML | $ | 17.00 |
| 3516232 | NS 100 ML MB+ | $ | 14.00 |
| 3516233 | NS KCL 20 MEQ/1000ML | $ | 48.00 |
| 3516234 | NS 500 ML | $ | 18.00 |
| 3516235 | NS 50 ML | $ | 17.00 |
| 3516236 | D10W 1000 ML | $ | 18.00 |
| 3516237 | D5-1/4NS KCL 20MEQ/1000ML | $ | 49.00 |
| 3516238 | D5-LR 1000 ML | $ | 22.00 |
| 3516239 | D5-1/4 NS 1000 ML | $ | 18.00 |
| 3516240 | D5-1/2 NS 1000 ML | $ | 18.00 |
| 3516241 | D5-NS 500 ML X2 | $ | 18.00 |
| 3516242 | D5W 1000 ML | $ | 18.00 |
| 3516243 | D5W 100 ML | $ | 17.00 |
| 3516244 | D5W 250 ML GLASS | $ | 17.00 |
| 3516245 | D5W 50 ML | $ | 17.00 |
| 3516246 | D5W 500 ML | $ | 18.00 |
| 3516247 | D10W 250 ML | $ | 18.00 |
| 3516248 | GLYCINE IRRIGATION 3L | $ | 32.00 |
| 3516249 | SODIUM CL 0.9% IRRIG 3L | $ | 18.00 |
| 3516250 | HYPERTON SALINE 3% 500ML | $ | 48.00 |
| 3516251 | HYDROCORTISON 100MG/2ML | $ | 37.00 |
| 3516252 | ALLOPURINOL TAB 300MG | $ | 8.00 |
| 3516253 | BUPIVACN DOSE 0.25% 1ML | $ | 15.00 |
| 3516254 | DEXTROSE 25% SYN 10ML | $ | 36.00 |
| 3516255 | RHO (D) IMM GLOB RHOGAM | $ | 202.00 |
| 3516256 | FENTANYL SDV 100MCG/2ML | $ | 27.00 |
| 3516257 | LIDOCAIN SDV 1% 30ML | $ | 11.00 |
| 3516258 | LUBIPROSTONE CAP 8MCG | $ | 15.00 |
| 3516259 | MINERAL OIL 30 ML | $ | 8.00 |
| 3516260 | METHYLPHENIDATE TAB 2.5MG | $ | 8.00 |
| 3516261 | NIFEDIPINE CAP 10MG | $ | 9.00 |
| 3516262 | RABIES VAC RABAVERT | $ | 467.00 |
| 3516263 | SIMVASTATIN TAB 20MG | $ | 12.00 |
| 3516264 | SODIUM CL OPH DROP | $ | 22.00 |
| 3516265 | SULFA/TMP SUSP 100ML BTL | $ | 12.00 |
| 3516266 | ZOLEDRONIC ACD VL 1MG X4 | $ | 1,135.50 |
| 3516267 | OPIUM/BELLADON SUPP 60MG | $ | 59.00 |
| 3516268 | HYDROMORPHONE TAB 4MG | $ | 8.00 |
| 3516269 | METHADONE TAB 10MG | $ | 8.00 |
| 3516270 | SODIUM CL FLUSH 5ML | $ | 8.00 |
| 3516271 | BENZOCN/MENTHOL SPRAY | $ | 14.00 |
| 3516272 | PHARMACY KEY | $ | 7.00 |
| | | $ | 7.00 |
| 3516273 | WITCH HAZEL PAD | $ | 14.00 |
| 3516274 | SEDATION KIT | $ | 0.00 |
| 3516275 | MAGNESIUM KIT | $ | 0.00 |
| 3516277 | PT SPECIFIC IV ACCESS | $ | 7.00 |
| | | $ | 7.00 |
| 3516278 | OXYBUTYNIN ER TAB 5MG | $ | 11.00 |
| 3516279 | LIDOCAN/EPI/TETRA TOP 3ML | $ | 12.00 |
| 3516280 | GI COCKTAIL 30ML | $ | 9.00 |
| 3516281 | CHLORZOXAZONE TAB 500MG | $ | 7.75 |
| 3516282 | DICLOFENAC PATCH 1.3% | $ | 21.50 |
| 3516283 | FLUPHENAZINE TAB 5MG | $ | 7.75 |
| 3516284 | BENZTROPINE TAB 1MG | $ | 8.00 |
| 3516285 | SULFASALAZINE TAB 500MG | $ | 8.00 |
| 3516286 | LECITHIN CAP 1200MG | $ | 7.00 |
| 3516287 | CYCLOSPORINE MOD CAP 25MG | $ | 9.00 |
| 3516288 | FELODIPINE ER TAB 2.5MG | $ | 8.50 |
| 3516289 | OCTREOTIDE SRN 1MG X30 | $ | 4,286.00 |
| 3516291 | TRASTUZUMAB VL 10MG X44 | $ | 3,549.25 |
| 3516292 | RABIES IM GLB 150U/ML X2 | $ | 1,072.00 |
| 3516293 | MAGIC MOUTH WASH 240 ML | $ | 25.00 |
| 3516294 | CEFDINIR SP 250/5 100ML | $ | 233.00 |
| 3516295 | OLMESARTAN 20MG TAB | $ | 14.00 |
| 3516296 | CARBAMAZEPINE XR 100MG | $ | 9.00 |
| 3516297 | SOD PHOS MON/DIB ENEMA | $ | 0.00 |
| 3516298 | ALPRAZOLAM TAB 0.5MG | $ | 8.00 |
| 3516299 | METHYLPHENIDATE TAB 5MG | $ | 8.00 |
| 3516300 | ESTROG/MEDROX 0.625/2.5MG | $ | 7.75 |
| 3516301 | HYDROCOD/IBU TAB 7.5-200M | $ | 8.00 |
| 3516302 | FERUMOXYTOL VL 1MG X510 | $ | 504.75 |
| 3516303 | OXYCOD/APAP TAB 10-325MG | $ | 11.00 |
| 3516304 | TETRIX CREAM KIT | $ | 253.00 |
| 3516305 | AMIKACIN INJ VL 100MG X1 | $ | 51.75 |
| 3516306 | TESTOSTERONE GEL 1% 5GM | $ | 35.00 |
| 3516307 | THALIDOMIDE CAP 100 MG | $ | 254.75 |
| 3516308 | THALIDOMIDE CAP 200 MG | $ | 289.00 |
| 3516309 | ZIPRASIDONE CAP 20 MG | $ | 32.00 |
| 3516312 | TERIPARATIDE INJ 10 MCG X | $ | 1,080.75 |
| 3516313 | ESOMEPRAZOLE CAP 20 MG | $ | 20.00 |
| 3516314 | COENZYME Q10 CAP 100MG | $ | 8.00 |
| 3516315 | MOMETASONE INH 220 MCG | $ | 311.00 |
| 3516316 | FORMOTEROL INH 12 MCG | $ | 187.50 |
| 3516317 | HYDROXYUREA CAP 500MG | $ | 8.25 |
| 3516318 | IMUN GLOB 10% 500MG X20P | $ | 1,352.50 |
| 3516319 | TRAND-VERAP CR TB 4-240MG | $ | 10.25 |
| 3516320 | INSULIN DETEMIR PEN 5U X60 (J1815) | $ | 68.00 |
| 3516321 | INSULIN ASPART PEN 5U X60 (J1815) | $ | 141.00 |
| 3516322 | PANCRELIPASE DR 12000UNIT | $ | 10.00 |
| 3516323 | AMLODIP/BENAZ CAP 10-20 M | $ | 18.00 |
| 3516324 | CARB/LEVO/ENTAC 150 TAB | $ | 10.75 |
| 3516325 | BUDES/FORMOT INHAL 160-4. | $ | 327.00 |
| 3516326 | MORPHINE VL DOSE 10MG X1 (J2274) | $ | 17.00 |
| 3516327 | DEMECLOCYCL TAB 150MG | $ | 16.25 |
| 3516328 | BETAMETH DIP CRE 0.05% | $ | 181.00 |
| 3516329 | TRIAM/HCTZ TAB 37.5-25 MG | $ | 8.00 |
| 3516330 | BRIMONIDINE-TIMOLOL OPH | $ | 252.00 |
| 3516331 | PREDNISOLN DOSE 5MG/5ML 30ml Dose | $ | 8.00 |
| 3516332 | PHARMACY CONSULT | $ | 0.00 |
| 3516333 | BUPIVCN/EPI DOSE 0.25% 1 | $ | 14.00 |
| 3516334 | GRANISETRON VL 1MG/ML | $ | 75.00 |
| 3516335 | HYDROCOD/APAP TAB 7.5-500 | $ | 7.25 |
| 3516336 | HYDROCOD/APAP TAB 7.5-325 | $ | 8.00 |
| 3516337 | CODEINE TAB 30MG | $ | 8.00 |
| 3516338 | HYDROMORPH VL DOSE 2MG/ML | $ | 27.00 |
| 3516339 | FAT EMULSION IV 20% 500ML | $ | 89.00 |
| 3516340 | ERYTHROMYCIN BS TAB 250MG | $ | 15.00 |
| 3516341 | NEOMYCIN TAB 500 MG | $ | 9.00 |
| 3516342 | CAPTOPRIL TAB 25MG | $ | 9.00 |
| 3516343 | CARB/LEVO TAB 37.5-150MG | $ | 8.00 |
| 3516344 | CITALOPRAM TAB 5MG | $ | 10.00 |
| 3516345 | MISOPROSTOL TAB 50 MCG | $ | 8.00 |
| 3516346 | MISOPROSTOL TAB 25 MCG | $ | 8.00 |
| 3516347 | DORZOLAMIDE OPH DRP 2% | $ | 71.00 |
| 3516348 | FERRO S04 ELX 220MG/5ML | $ | 8.00 |
| 3516349 | ESTROPIPATE TAB 1.5MG | $ | 7.50 |
| 3516350 | PYRIDOSTIG TAB 60MG | $ | 9.00 |
| 3516351 | PALIVIZUMAB VL 50 MG | $ | 3,213.00 |
| 3516352 | MORPHINE CNC 20MG/ML 30ML | $ | 51.00 |
| 3516353 | SODIUM BICARB TAB 325MG | $ | 8.00 |
| 3516354 | PANCRELIPASE DR 5000UNIT | $ | 9.00 |
| 3516355 | DONEPEZIL ODT 5MG | $ | 16.00 |
| 3516356 | PETRO/MINRL/LAN CRM 16OZ. | $ | 16.00 |
| 3516357 | PRAMIPEXOLE TAB 0.5 MG | $ | 11.00 |
| 3516358 | PALIVIZUMAB VL 100 MG | $ | 6,066.00 |
| 3516359 | WARFARIN DOSE MONITOR | $ | 0.00 |
| 3516361 | FENOFIBRATE TAB 160MG | $ | 9.25 |
| 3516362 | PHENYTOIN VL 50MG X5 | $ | 9.00 |
| 3516363 | PHENYTOIN VL 50MG X2 | $ | 9.00 |
| 3516364 | CEFUROXIME SP 250/5 50 ML | $ | 180.00 |
| 3516365 | METRONIDZL GEL 0.75% 45GM | $ | 246.00 |
| 3516366 | NALTREXONE ER IM INJ 1MG | $ | 1,384.75 |
| 3516367 | ARIPIPRAZOLE TAB 10MG | $ | 61.00 |
| 3516368 | MULTIVIT/MIN EYE CAP | $ | 8.00 |
| 3516369 | ESZOPICLONE TAB 1 MG | $ | 14.50 |
| 3516370 | 1/2 NS KCL 20 MEQ/1000 ML | $ | 52.00 |
| 3516371 | DIVALPROEX ER TAB 250MG | $ | 10.00 |
| 3516372 | ISOSORBID DINITR TAB 5MG | $ | 8.00 |
| 3516373 | LIDOCAINE PATCH REMOVE | $ | 0.00 |
| 3516374 | DONEPEZIL ODT 10MG | $ | 16.00 |
| 3516375 | VANCO SOLN 50MG/ML 40ML | $ | 83.75 |
| 3516376 | OMEGA-3 ESTER CAP 1GM | $ | 10.00 |
| 3516377 | DOXEPIN CAP 50MG | $ | 8.00 |
| 3516378 | METHYLPHENIDATE TAB 10MG | $ | 7.50 |
| 3516379 | D5-1/2NS KCL 10MEQ/1000ML | $ | 48.00 |
| 3516380 | DABIGATRAN CAP 75MG | $ | 15.00 |
| 3516382 | DOCETAXEL 4ML 1MG X80 | $ | 1,865.00 |
| 3516383 | PALONOSETRON VL 25MCG X10 | $ | 475.50 |
| 3516384 | SULFA/PREDNS OPH SOLN 5ML | $ | 32.00 |
| 3516385 | POT-NA PHOS MONO-DIBS PKT | $ | 7.25 |
| 3516386 | LOSARTAN TAB 50MG | $ | 8.00 |
| 3516387 | NITROGLYCRN ON 2% 60GM TB | $ | 9.00 |
| 3516388 | VORICONAZOLE TAB 50MG | $ | 18.50 |
| 3516389 | LR 500ML | $ | 18.00 |
| 3516390 | GLUCOSE CHW ORANGE 4GM | $ | 8.00 |
| 3516391 | ACIPHEX - MRF/HOME MED | $ | 0.00 |
| 3516392 | BENEFIBER 3GM SUBSTITUTE | $ | 0.00 |
| 3516393 | GENTAMICIN PBK 80MG/100ML | $ | 49.00 |
| 3516394 | NICOTINE PATCH REMOVE | $ | 0.00 |
| 3516395 | APAP/CODN SOLN 120ML | $ | 8.00 |
| 3516396 | OCTREOTIDE VL 25MCG X4 | $ | 23.00 |
| 3516397 | EXENATIDE SYRN 5MCG | $ | 615.00 |
| 3516398 | BCG LIVE INTRAVSCL 81MG | $ | 314.75 |
| 3516399 | D5-NS KCL 20 MEQ/1000ML | $ | 48.00 |
| 3516400 | HYDROCORTSN CRM TOP 2.5% | $ | 18.00 |
| 3516401 | LACOSAMIDE TAB 50MG | $ | 12.00 |
| 3516402 | FOMEPIZOLE IV 15MG X100 J1451 | $ | 1,690.00 |
| 3516403 | CLINDAMYCIN PGBK 600 MG | $ | 60.00 |
| 3516404 | ACETAMINPHN ER TAB 650MG | $ | 0.00 |
| 3516405 | NITROGLYCERIN TB 0.4MGX25 | $ | 23.75 |
| 3516406 | GLYCOPYRROLATE TAB 1MG | $ | 9.00 |
| 3516407 | DESVENLAFAXNE SR TB 100MG | $ | 12.25 |
| 3516408 | PATIENT TAKES NO MEDS | $ | 0.00 |
| 3516409 | AA/DEXT10/LYTE TPN 1000ML | $ | 166.75 |
| 3516410 | SUMATRIPTAN TAB 50MG | $ | 52.00 |
| 3516411 | ZIDOVUDINE 10MG/ML 240ML | $ | 62.75 |
| 3516412 | ZIDOVUDINE VL 10MG/ML X20 | $ | 76.25 |
| 3516413 | IMUN GLOB 10% 500MG X20M | $ | 922.25 |
| 3516414 | IMUN GLOB 10% 500MG X40M | $ | 1,823.75 |
| 3516415 | IMUN GLOB 10% 500MG X2M | $ | 110.75 |
| 3516416 | GATIFLOXACN OPH DROP 0.5% | $ | 118.00 |
| 3516417 | LINEZOLID PB 200MG X3 | $ | 263.00 |
| 3516418 | RIVASTIGMINE PATCH 4.6MG | $ | 34.00 |
| 3516419 | TRIAMCINLN OINT 0.5% 15GM | $ | 9.00 |
| 3516420 | MINOCYCLINE CAP 100MG | $ | 9.00 |
| 3516421 | NEBIVOLOL TAB 5MG | $ | 11.00 |
| 3516422 | HALOPERIDOL TAB 5MG | $ | 8.00 |
| 3516423 | LIDOCN/PRILOCN CRM 5GM | $ | 17.00 |
| 3516424 | KETOROLAC TAB 10MG | $ | 10.00 |
| 3516425 | PHENYLEPH VL 10MG/1ML | $ | 33.00 |
| 3516426 | IRON POLYSACC CAP 150MG | $ | 7.25 |
| 3516427 | FERROUS SO4 ER TAB 160MG | $ | 8.00 |
| 3516428 | VITAMIN A & D DOSE 6 GM | $ | 7.00 |
| 3516429 | TOBRAMYCIN NEB 80MG/2ML | $ | 12.00 |
| 3516430 | TOBRAMYCIN VL 80MG/2ML | $ | 12.00 |
| 3516431 | PROBENECID TAB 500MG | $ | 8.00 |
| 3516432 | ROFLUMILAST TAB 500MCG | $ | 18.00 |
| 3516433 | PYRIDOXIN VIT B6 100MG/ML | $ | 24.00 |
| 3516434 | CYCLOSPORINE NONMOD CAP 2 | $ | 11.00 |
| 3516435 | TOCILIZUMAB VL 80MG/4ML | $ | 361.50 |
| 3516436 | TOCILIZUMAB VL 400MG/20ML | $ | 1,636.50 |
| 3516437 | VALPROIC ACD SOLN 250/5ML | $ | 118.00 |
| 3516438 | INDAPAMIDE TAB 2.5MG | $ | 9.00 |
| 3516439 | ROPINIROLE TAB 0.25MG | $ | 8.00 |
| 3516440 | POTAS CL CAP 10MEQ | $ | 14.00 |
| 3516441 | AMOX/KCLAV TAB 500-125MG | $ | 11.00 |
| 3516442 | ELETRIPTAN TAB 20MG | $ | 71.00 |
| 3516443 | LAMOTRIGINE TAB 25MG | $ | 12.00 |
| 3516444 | PNEUMOC-13 VAC PREVNAR 13 | $ | 278.00 |
| 3516445 | ROTAVIRUS VAC ROTARIX | $ | 203.00 |
| 3516446 | INFLUENZA - FLUZONE VACCINE 0.5ML | $ | 30.00 |
| 3516448 | HYLAN GF SRN 1MG X 48 | $ | 1,104.25 |
| 3516449 | METHOTREXATE DOSE 0.1-5MG | $ | 12.00 |
| 3516450 | GENTAMICIN IM 80MG/2ML | $ | 49.00 |
| 3516451 | CLINDAMYCIN IM 300MG/2ML | $ | 25.00 |
| 3516452 | SOAP SUDS ENEMA | $ | 0.00 |
| 3516453 | LACT.ACDPH/BIFIDOBAC. CAP | $ | 8.00 |
| 3516454 | PAMIDRONATE VL 30 MG/10ML | $ | 32.00 |
| 3516455 | SODIUM CL GEL 20% | $ | 0.00 |
| 3516456 | CEFAZOLIN PGBK 500 MG X4 (J0690) | $ | 54.00 |
| 3516457 | SUMATRIPTAN TAB 100MG | $ | 51.00 |
| 3516458 | PACLITAXL PRT-BND 1MGX100 | $ | 1,185.00 |
| 3516459 | CRANBERRY CAP 200MG | $ | 8.00 |
| 3516460 | CEFEPIME VL 500MG X4 | $ | 57.00 |
| 3516461 | DAPTOMYCIN VL 1MG X500 | $ | 635.00 |
| 3516462 | TIGECYCLINE VL 1MG X50 | $ | 218.00 |
| 3516463 | ERIBULIN VL 0.1 MG X10 | $ | 1,071.75 |
| 3516464 | ETOMIDATE VL 20MG/10ML | $ | 35.00 |
| 3516465 | CARBXYMETH OPH DROP 0.5% | $ | 18.00 |
| 3516466 | MELATONIN TAB 1-10MG | $ | 8.00 |
| 3516467 | BCG LIVE INTRAVSCL 50 MG | $ | 303.00 |
| 3516468 | NALBUPHINE DOSE 10MG/ML X1 | $ | 11.00 |
| 3516469 | GANCICLOVIR VL 500MG | $ | 200.00 |
| 3516470 | ZIPRASIDONE CAP 60MG | $ | 20.00 |
| 3516472 | RHO (D) IMM GLOB RHOPHYLA | $ | 250.00 |
| 3516473 | HYDROXYPROGESTRN 1MG X250 | $ | 883.00 |
| 3516474 | PENTAMIDINE VL 300MG | $ | 139.00 |
| 3516475 | AA5%/DEXT15/LYTE 2000ML | $ | 207.00 |
| 3516476 | FAT EMULSION IV 20% 250ML | $ | 65.00 |
| 3516477 | GLIMEPIRIDE TAB 1MG | $ | 8.00 |
| 3516478 | HYDROXYZINE VL 25MG X4 | $ | 18.00 |
| 3516479 | BUMETANIDE SDV 1MG/4ML | $ | 28.00 |
| 3516480 | COCAINE SOL 4% DOSE | $ | 287.00 |
| 3516481 | MORPHINE IR TAB 15 MG | $ | 8.00 |
| 3516482 | DOBUTAMINE DRIP 250MG | $ | 55.00 |
| 3516483 | FENTANYL PATCH REMOVE | $ | 0.00 |
| 3516484 | METOPROLOL TART TB 12.5MG | $ | 8.00 |
| 3516485 | CLONAZEPAM ODTAB 0.25 MG | $ | 8.25 |
| 3516486 | MINOXIDIL TAB 10MG | $ | 8.25 |
| 3516487 | ESTRADIOL TAB 1MG | $ | 8.00 |
| 3516488 | SOTALOL TAB 40MG | $ | 8.00 |
| 3516489 | CALC/VIT D TAB 600MG-400U | $ | 8.00 |
| 3516490 | CEFEPIME VL 500MG X2 | $ | 53.00 |
| 3516491 | REGADENOSON SRN 0.1MG X4 | $ | 345.00 |
| 3516492 | LEFLUNOMIDE TAB 20MG | $ | 14.00 |
| 3516493 | SCOPOLAMINE PATCH REMOVE | $ | 0.00 |
| 3516494 | HYDROXYZINE VL 25MG | $ | 14.00 |
| 3516495 | MORPHINE CNC 20MG/ML 15ML | $ | 22.00 |
| 3516496 | DICLOFENAC PATCH REMOVE | $ | 0.00 |
| 3516497 | MIDAZOLAM VL 1MG X10 | $ | 27.00 |
| 3516498 | DOXORU LIPO VL 10MG/ML X5 | $ | 3,710.00 |
| 3516499 | FEBUXOSTAT TAB 40MG | $ | 22.00 |
| 3516500 | MULTIVIT/MIN CHEW TAB | $ | 8.00 |
| 3516501 | BIMATOPROST OPH DRP 0.01% | $ | 239.00 |
| 3516502 | FESOTERODINE TAB 8MG | $ | 22.00 |
| 3516503 | METFORMIN TAB 850MG | $ | 9.00 |
| 3516504 | HYDROMORPHONE SRN 1MG/ML | $ | 29.00 |
| 3516505 | FLUOCINONID TOP SLN 0.05% | $ | 116.00 |
| 3516506 | WARFARIN TAB 0.5MG | $ | 7.00 |
| 3516507 | ISOSORBID MONO TAB 15MG | $ | 8.00 |
| 3516508 | CAFFEINE TAB 200MG | $ | 8.00 |
| 3516509 | LABETALOL SRN 5MG/ML 4ML | $ | 34.00 |
| 3516510 | INSTYMEDS KEY | $ | 7.00 |
| | | $ | 7.00 |
| 3516511 | MORPHINE ER TAB 60MG | $ | 14.00 |
| 3516512 | METOPROLOL SUCC TB 12.5 M | $ | 8.00 |
| 3516513 | KETAMINE SRN 50 MG/ML | $ | 25.00 |
| | | $ | 25.00 |
| 3516514 | PHENYLEPH SRN 1 MG/10ML | $ | 25.00 |
| 3516515 | EPHEDRINE SRN 50MG/5ML | $ | 30.25 |
| 3516516 | LIDOCAIN LTA 360 KIT | $ | 21.00 |
| 3516517 | LEVONORGESTR TAB 0.75MGX2 | $ | 62.00 |
| 3516518 | ETOPOSIDE VL 10MG X10 | $ | 21.00 |
| 3516519 | SARGRAMOSTIM VL 50MCG X5 | $ | 373.00 |
| 3516520 | HALOPERIDOL DOSE 2MG/ML | $ | 8.00 |
| 3516521 | SELENIUM SULFD SHMP 1% | $ | 12.00 |
| 3516522 | LOPNVR-RITNVR TB 100-25MG | $ | 14.00 |
| 3516523 | ARIPIPRAZOLE TAB 15MG | $ | 61.00 |
| 3516524 | AZACITIDINE VL 100MG | $ | 726.75 |
| 3516525 | AMPHET /DEXTROAMP TAB 20MG | $ | 9.00 |
| 3516526 | AMPHET/DEXTROAMP TAB 5MG | $ | 7.25 |
| 3516527 | LUTEIN CAP 6MG | $ | 8.00 |
| 3516528 | DERMABOND PEN 6502020 | $ | 65.00 |
| 3516529 | TESTOST CYP VL 1MG (J1071) | $ | 54.00 |
| 3516530 | SODIUM CL VL 0.9% 20ML | $ | 0.00 |
| 3516531 | SODIUM CL VL 0.9% 10ML | $ | 0.00 |
| 3516532 | ENOXAPARIN SRN 10MG X15 (J1650) | $ | 44.00 |
| 3516533 | RIFAXIMIN TAB 550MG | $ | 59.00 |
| 3516534 | LIOTHYRONINE TAB 25MCG | $ | 9.00 |
| 3516535 | LIDOCAIN BUFF 1% 5ML | $ | 26.00 |
| 3516536 | TRIAMCINOLN 10MG X4 | $ | 36.00 |
| 3516538 | LORAZEPAM CARP 2MG X1 (J2060) | $ | 11.00 |
| 3516539 | FENTANYL CARP 100MCG/2ML | $ | 9.00 |
| 3516540 | FENTANYL CARP (50MCG/ML) | $ | 10.00 |
| 3516541 | VALACYCLOVIR TAB 1 GM | $ | 22.00 |
| 3516542 | HEPAT B VL 20MCG ADT | $ | 108.00 |
| 3516543 | ROPIVACAINE 5MG/ML | $ | 9.00 |
| 3516544 | ROPIVACANE 2MG/ML-20 | $ | 21.00 |
| 3516545 | DULOXETINE 20MG | $ | 17.00 |
| 3516546 | INSULIN DETEMIR PEN 5 UNIT X60(J1815) | $ | 135.00 |
| 3516547 | STERILE WATER INJ | $ | 0.00 |
| 3516548 | STERILE WATER 20 ML | $ | 0.00 |
| 3516549 | STERILE WATER 50 ML | $ | 2.50 |
| 3516550 | TRIAMCINOLONE ACE CREAM (0.025%) | $ | 12.00 |
| 3516551 | VANCO 600MG J3370 500MG X2 | $ | 61.00 |
| 3516552 | VANCO 750MG J3370 500MG X2 | $ | 61.00 |
| 3516553 | VANCO 1200 MG J3370 500MG X3 | $ | 77.00 |
| 3516554 | VANCO 1250 MG J3370 500MG X3 | $ | 77.00 |
| 3516555 | VANCO 1300 MG J3370 500MG X3 | $ | 55.00 |
| 3516556 | VANCO 1500 MG J3370 500MG X3 | $ | 77.00 |
| 3516557 | VANCO 500MG X1 J3370 | $ | 50.00 |
| 3516558 | VANCO 1600 MG J3370 500MG X4 | $ | 77.00 |
| 3516559 | VANCO 1700 MG J3370 500MG X4 | $ | 77.00 |
| 3516560 | VANCO 1750 MG J3370 500MG X4 | $ | 77.00 |
| 3516561 | VANCO 1800 MG J3370 500MG X4 | $ | 77.00 |
| 3516562 | VANCO 2000 MG J3370 500MG X4 | $ | 77.00 |
| 3516563 | VANCO 2200 MG J3370 500MG X5 | $ | 93.00 |
| 3516564 | VANCO 2400 MG J3370 500MG X5 | $ | 93.00 |
| 3516565 | MAGNESIUM SULF 1 GM PGBK J3475 500 X2 | $ | 46.00 |
| 3516566 | OMEPRAZOLE 40MG | $ | 10.00 |
| 3516567 | IBUPROFEN ORAL SUSP DOSE **ED ONLY** | $ | 0.00 |
| 3516568 | ACETAMINOPHEN DOSE SUSP **ED ONLY** | $ | 0.00 |
| 3516569 | DIPHENHYDRAMINE DOSE SUSP **ED ONLY** | $ | 0.00 |
| 3516570 | ADENOSINE IV 1MG X60 J0153 | $ | 337.00 |
| 3516571 | ADENOSINE IV 1MG X90 J0153 | $ | 495.00 |
| 3516572 | AMINOPHYLLINE IV 250MG X2 J0280 | $ | 73.00 |
| 3516573 | AMPICILLIN IV 500MG X2 J0290 | $ | 51.00 |
| 3516574 | AMPICILLIN IV 500 X4 J0290 | $ | 61.00 |
| 3516575 | AMPICILLIN IV 500MG X1 J0290 | $ | 53.00 |
| 3516576 | AMPICILLIN/SULBACTAM 1.5GM X1 J0295 | $ | 50.00 |
| 3516577 | AMPCILLIN/SULBACTAM 1.5GM X2 J0295 | $ | 53.00 |
| 3516578 | AZITHROMYCIN IV 500MG X1 J0456 | $ | 53.00 |
| 3516579 | BUMETANIDE IV 0.5MG X1 S0171 | $ | 46.00 |
| 3516580 | CALCIUM GLUC IV 10ML X1 J0610 | $ | 54.00 |
| 3516581 | CALCIUM GLUC 10ML X2 J0610 | $ | 62.00 |
| 3516582 | CEFAZOLIN IV 500MG X4 J0690 | $ | 55.00 |
| 3516583 | CEFEPIME/LIDO IV 500MG X2 J0692 | $ | 16.00 |
| 3516584 | CEFEPIME IV 500MG X2 J0692 | $ | 53.00 |
| 3516585 | CEFTAZIDIME IV 500MG X1 J0713 | $ | 50.00 |
| 3516586 | CEFEPIME IV 500MG X4 J0692 | $ | 86.00 |
| 3516587 | CEFTAZIDIME IV 500MG X2 J0713 | $ | 50.00 |
| 3516588 | CEFTAZIDIME IV 500MG X4 J0713 | $ | 56.00 |
| 3516589 | CEFTRIAXONE/LIDO IV 250MG X4 J0696 | $ | 9.00 |
| 3516590 | CEFTRIAXONE IM 250MGX8 J0696 | $ | 29.00 |
| 3516591 | CEFTRIAXONE IV 250MG X2 J0696 | $ | 47.00 |
| 3516592 | CLINDAMYCIN IV 300MGX4 S0077 | $ | 53.00 |
| 3516593 | CLINDAMYCIN IV 300MGX3 S0077 | $ | 49.00 |
| 3516594 | CYCLOPHOSPHAMIDE IV 100MGX10 J9070 | $ | 1,080.00 |
| 3516595 | DAPTOMYCIN IV 1MGX500 J0878 | $ | 635.00 |
| 3516596 | DILTIAZEM IV 125MG | $ | 57.00 |
| 3516597 | DEXAMETHASONE IV 1MGX10 J1100 | $ | 47.00 |
| 3516598 | DIPHENHYDRAMINE IV 50MGX1 J1200 | $ | 49.00 |
| 3516599 | DOBUTAMINE IV 250MGX1 J1250 | $ | 53.00 |
| 3516600 | DOCEAXEL IV 1MGX80 J9171 | $ | 4,655.00 |
| 3516601 | DOXORUBICIN IV 10MGX5 J9000 | $ | 3,710.00 |
| 3516602 | DOXYCYLINE IV 100MG | $ | 74.00 |
| 3516603 | ERTAPENEM/LIDO IVP 500MGX2 J1335 | $ | 144.00 |
| 3516604 | ERTAPENEM IV 500MGX2 J1335 | $ | 216.00 |
| 3516605 | ETOPOSIDE IV 10MGX10 J9181 | $ | 21.00 |
| 3516606 | FAMOTIDINE IV 20MGX1 S0028 | $ | 9.00 |
| 3516607 | FUROSEMIDE IV DRIP 20MGX5 J1940 | $ | 51.00 |
| 3516608 | FUROSEMIDE IV 20MGX5 J1940 | $ | 48.00 |
| 3516609 | GENTAMICIN IV 80MGX1 J1580 | $ | 49.00 |
| 3516610 | HYDROCORTISONE IV 100MGX1 J1720 | $ | 57.00 |
| 3516611 | HYDROCORTISONE IV 100MG 3 x J1720 | $ | 63.00 |
| 3516612 | HYDROMORPHONE PCA IV 4MGX10 J1170 | $ | 31.00 |
| 3516613 | IMIPENEM/CILASTIN IV 250MGX4 J0743 | $ | 65.00 |
| 3516614 | INIPENEM/CILASTIN IV 250MGX2 J0743 | $ | 85.00 |
| 3516615 | INFLIXIM IV 10MGX40 J1745 | $ | 1,515.00 |
| 3516616 | INFLIXIM IV 10MGX50 J1745 | $ | 1,515.00 |
| 3516617 | INSULIN R IV DRIP 5UNITSX20 J1815 | $ | 8.00 |
| 3516618 | IRON DEXTRAN IV 50MG X1 (100MG) | $ | 54.00 |
| 3516620 | IRON DEXTRAN TEST 25MGX1 J1750 | $ | 0.00 |
| 3516621 | IRON SCROSE IV 1MGX100 J1756 | $ | 105.00 |
| 3516622 | IRON SUCROSE IV 1MGX150 J1756 | $ | 195.00 |
| 3516623 | IRON SUCROSE IV 1MGX200 J1756 | $ | 195.00 |
| 3516624 | IRON SUCROSE 1MGX300 J1756 | $ | 255.00 |
| 3516625 | MAGNESIUM SULF 500MGX2 J3475 | $ | 9.00 |
| 3516626 | MAGNESIUM IV 500MGX4 J3475 | $ | 11.00 |
| 3516627 | NEOSTIGMINE MDV DOSE 0.5MG/ML J2710 | $ | 9.00 |
| 3516628 | METHYLPRED SUCC IV 125MGX4 J2930 | $ | 57.00 |
| 3516629 | MORPHINE IV 10MG X10 J2270 | $ | 50.50 |
| 3516630 | MORPHINE PCA 10MG X10 J2270 | $ | 16.00 |
| 3516631 | NAFCILLIN IV 2GM S0032 | $ | 54.00 |
| 3516632 | NOREPINEPHRINE 4MG/D5W 250ML | $ | 56.00 |
| 3516633 | ONDANSETRON IV 1MG X4 J2405 | $ | 47.00 |
| 3516634 | OCYTOCIN IV 10U X1 J2590 | $ | 47.00 |
| 3516635 | PAMIDRONATE IV 30MG X1 J2430 | $ | 59.00 |
| 3516636 | PANTOPRAZOLE 40MG X1 S0164 | $ | 51.00 |
| 3516637 | PANTOPRAZOLE 40MG X1 S0164 | $ | 14.00 |
| 3516638 | PENICILLIN G IV 2.5MIL.UN X8.4 J2540 | $ | 52.00 |
| 3516639 | PENICILLIN G IV 5MIL.U X8.4 J2540 | $ | 51.50 |
| 3516640 | PHENYTOIN IV (100-349MG)50MG X1 J1165 | $ | 8.00 |
| 3516641 | PHENYTOIN IV (350-699MG) 50MG X1 J1165 | $ | 8.00 |
| 3516642 | PHENYTOIN IV(700-1500MG) 50MGX1 J1165 | $ | 21.00 |
| 3516643 | PHYTONADIONE IV 1MG X1 J3430 | $ | 98.00 |
| 3516644 | RANITIDINE IV 25MG X2 J2780 | $ | 61.00 |
| 3516645 | SODIUM BICARB IV 150 MEQ/D5W 1000ML | $ | 21.00 |
| 3516646 | TERBUTALINE IV 1MG X20 J3105 | $ | 37.00 |
| 3516647 | TIGECYCLINE IV 1MG X50 J3243 | $ | 218.00 |
| 3516648 | TOBRAMYCIN IV 80MG X1 J3260 | $ | 12.00 |
| 3516649 | VALPROATE NA IV 1000MG/NS 100ML | $ | 62.00 |
| 3516650 | VALPROATE NA IV 500MG/ NS 50ML | $ | 66.00 |
| 3516651 | NOREPHINEPHRINE 4MG/D5W 1000ML | $ | 56.00 |
| 3516652 | NO CHARGE ORDER SET FLLER | $ | 0.00 |
| 3516653 | ENOXAPARIN 10MG X12 | $ | 47.00 |
| 3516654 | ACYCLOVIR 5MG X 100 | $ | 68.00 |
| 3516655 | FERUMOXYTOL 1MG X510 (Q0138) | $ | 1,503.00 |
| 3516656 | FERUMOXYTOL IV 1MGX 510 (Q0138) | $ | 1,503.00 |
| 3516657 | KETOROLAC CARP 15MG X4 (J1885) | $ | 11.00 |
| 3516658 | PHARMACIST CONSULTATION REQUEST | $ | 0.00 |
| 3516659 | VISCOUS LIDOCAINE 2% 15ML | $ | 9.00 |
| 3516660 | CEFOXITIN IV 1 GM (J0694) | $ | 53.00 |
| 3516661 | GENTAMICIN 80MG X2 J1580 | $ | 11.00 |
| 3516662 | LEVONORGESTREL TAB 1.5MG X1 | $ | 62.00 |
| 3516663 | NALTREXONE 1MG X380 | $ | 1,930.00 |
| 3516664 | IRON DEXTRAN 50MG X24 (J1750) | $ | 363.00 |
| 3516665 | TRANEXAMIC ACID 1000MG IV (J3490) | $ | 102.00 |
| 3516666 | GENTAMICIN 80MG X3 (J1580) | $ | 57.00 |
| 3516667 | SODIUM CL SYRN 0.9% 10 ML | $ | 8.00 |
| 3516668 | GENTAMICIN IV MOD 80MGX 5 J1580 | $ | 35.00 |
| 3516669 | GENTAMICIN IV MOD 80MG X6 J1580 | $ | 40.00 |
| 3516670 | CEFAZOLIN IV MOD 500MG X6 IV J0690 | $ | 50.00 |
| 3516671 | HYDROCOD/APAP SUSP DOSE 5/325MG-10ML | $ | 8.00 |
| 3516672 | PAMIDRONATE IV-MOD 30MG X1 (J2430) | $ | 32.00 |
| 3516673 | FOSFOMYCIN TROMETHAMINE PK 3 GM | $ | 293.00 |
| 3516674 | THIAMINE/MULTI VITAMIN/NS 1000ML IV MOD | $ | 56.00 |
| 3516675 | IMUN GLOB 10% 500MG X80G | $ | 5,175.00 |
| 3516676 | RIFAMPIN CAP 300 MG | $ | 10.00 |
| 3516677 | ACYCLOVIR 5MG X200 (1000MG) | $ | 91.00 |
| 3516678 | IRON DEXTRAN 50MG X2 | $ | 76.00 |
| 3516679 | CLINIMIX E 4.25 AMINO/5% DEXTROSE | $ | 113.00 |
| 3516680 | CLINIMIX E WITH MULTIVITS | $ | 113.00 |
| 3516681 | GENTAMICIN 80MG X2 J1580 | $ | 8.00 |
| 3516682 | GENTAMICIN 80MG X2 J1580 | $ | 53.00 |
| 3516683 | GENTAMYCIN 80MG X2 J1580 | $ | 11.00 |
| 3516684 | VANCOMYCIN ORAL LIQUID 125MG | $ | 4.00 |
| 3516685 | PHENYTOIN 50MG X J1165 x 16 (800MG) | $ | 15.00 |
| 3516686 | IRON DEXTRAN 50MG (J1750) X24 1155MG | $ | 450.00 |
| 3516687 | FOSPHENYTOIN 500MG INJECTION | $ | 195.00 |
| 3516688 | DENOSUMAB 1MG (J0897) x 60 | $ | 1,755.00 |
| 3516689 | FONDAPARINUX 0.5MG (J1652) X 5 | $ | 103.00 |
| 3516690 | PIPRCL/TAZ 1.125GM (J2543) X2 | $ | 32.00 |
| 3516691 | LIDOCAINE 1% 2ML VIAL | $ | 0.00 |
| 3516692 | INFLUENZA - FLUZONE VACCINE 0.5ML | $ | 30.00 |
| 3516693 | ONABOTULINUMTOXINA(BOTOX)1 UNIT X200 | $ | 1,845.00 |
| 3516696 | MEROPENEM 1 GM J2185 100MG X10 | $ | 80.00 |
| 3516697 | MEGESTROL ACE ORAL SUSP 40MG/ML | $ | 219.00 |
| 3516698 | LEVOFLOXACIN 250MG J1956 X1 | $ | 51.00 |
| 3516699 | CAPSAICIN CREAM 0.025 | $ | 15.00 |
| 3516700 | RISPERDAL CONSTA 0.5MG X50 | $ | 535.00 |
| 3516701 | ACETYLCYSTEINE J0132 100MG X 60 | $ | 310.00 |
| 3516702 | ACETYLCYSTEINE 12000MG J3490 | $ | 555.00 |
| 3516703 | ACETYLCYSTEINE 6000MG J3490 | $ | 301.00 |
| 3516704 | ACETYLCYSTEINE 100MG X97.5 J0132 | $ | 485.00 |
| 3516705 | GABAPENTIN 600MG COMP SOLN | $ | 11.00 |
| 3516706 | RISPERIDONE 2 MG COMP SOLN | $ | 20.00 |
| 3516707 | RISPERDAL CONSTA J2794 | $ | 1,070.00 |
| 3516708 | 1/2 NS 1000 W/SOD BICARB 8.4% 50 MEQ | $ | 20.00 |
| 3516709 | FLUCONAZOLE TAB (100MG) | $ | 17.00 |
| 3516710 | CIPROFLOXACIN 0.3% OPHTH SOLN | $ | 73.00 |
| 3516711 | PANTOPRAZOLE DRIP (80MG) | $ | 57.00 |
| 3516712 | BENZOCAINE ORAL ANESTHETIC (20%) | $ | 31.00 |
| 3516713 | CEFAZOLIN IV 500MG X1 J0690 | $ | 47.00 |
| 3516714 | INSULIN NOVOLOG 5 UNITS X1 J1815 | $ | 9.00 |
| 3516715 | MIDAZOLAM COMPOUNND ORAL DOSE | $ | 9.00 |
| 3516716 | MICRONIZED COLESTIPOL HCL | $ | 9.00 |
| 3516717 | GENTAMICIN IV 80MG x4 J1580 | $ | 61.00 |
| 3516718 | ACETYLCYSTEINE 100MGX 72.27 J0132 | $ | 336.00 |
| 3516719 | SODIUM CL NEB (3% - 4 ML) | $ | 8.00 |
| 3516720 | EPOETIN ALFA 1000 UNIT X20 | $ | 690.00 |
| 3516721 | MUSCLE RUB | $ | 10.00 |
| 3516722 | DAPTOMYCIN 1 MG X475 (J0878) | $ | 590.00 |
| 3516723 | RIVAROXABAN TAB 10MG | $ | 25.00 |
| 3516724 | CEFOXITIN IV 1 GM (J0694) (X2) | $ | 60.00 |
| 3516725 | FLUCONAZOLE IV 200MG X2 J1450 | $ | 42.00 |
| 3516726 | CLINIMIX E W MULTIVITAMINS | $ | 83.00 |
| 3516727 | CLINIMIX E W MINERALS | $ | 83.00 |
| 3516728 | TROSPIUM ER 60MG CAP | $ | 15.00 |
| 3516729 | CLOVE OIL 1ML | $ | 0.00 |
| 3516730 | LUGOLS SOLUTION 5% | $ | 53.00 |
| 3516731 | TETRACAINE OPHTH DROP 5% | $ | 0.00 |
| 3516732 | SIMETHICONE 40MG/0.6ML DROPS | $ | 8.00 |
| 3516733 | PRAZOSIN 1 MG CAPSULE | $ | 8.00 |
| 3516734 | FLUCONAZOLE IV 200MGX1 J1450 | $ | 53.00 |
| 3516735 | CEFTRIAXONE IV TEST DOSE (100 MG) | $ | 60.00 |
| 3516736 | GAMUNEX-C 500MG X190 J1561 | $ | 12,147.00 |
| 3516737 | METHIMAZOLE 5MG TAB | $ | 8.00 |
| 3516738 | MEROPENEM 500mg J2185 100MG X5 | $ | 80.00 |
| 3516739 | CHLORHEXIDINE 0.12% SOLUTION | $ | 20.00 |
| 3516740 | SLOW-MAG 71.5-119 TABLET | $ | 8.00 |
| 3516741 | CEFTRIAXONE 250MG X8 (J0696) | $ | 49.00 |
| 3516742 | CEFTRIAXONE IV 250 MG X4 (J0696) | $ | 47.00 |
| 3516743 | RITUXIMAB IV 10MG X100 (J9312) | $ | 13,279.00 |
| 3516744 | NAPROXEN TAB (250MG) | $ | 8.00 |
| 3516745 | SILDENAFIL TAB (20MG) | $ | 36.00 |
| 3516746 | KCENTRA 10U X50 J2724 | $ | 1,670.00 |
| 3516747 | LANREOTIDE SYR1 MG X120 J1930 | $ | 7,795.00 |
| 3516748 | ADVAIR DISKUS 500-50MCG/INH | $ | 590.00 |
| 3516749 | PROTAMINE SULFATE J2720 10MG X1 | $ | 27.00 |
| 3516750 | MESALAMINE CAP 0.375 GM | $ | 12.00 |
| 3516751 | MERCAPTOPURINE TAB 50MG | $ | 17.00 |
| 3516752 | BACTERIOSTATIC 0.9% SOLN | $ | 0.00 |
| 3516753 | PHOSPHA 250MG TAB | $ | 8.00 |
| 3516754 | VANCOMYCIN 500MG IV MOD J3370 | $ | 53.00 |
| 3516755 | TEMAZEPAM 7.5 MG CAPSULE | $ | 16.00 |
| 3516756 | CLINIMIX E 4.25%/5% 1000 ML | $ | 80.00 |
| 3516757 | LACOAMIDE 100 MG TABLET | $ | 21.00 |
| 3516758 | LIDOCAINE 5% OINTMENT | $ | 288.00 |
| 3516760 | ALBUMIN 25% 20 ML X5 (P9046) | $ | 148.00 |
| 3516761 | ALBUMIN 25% 20MLX2 (P0946) | $ | 151.00 |
| 3516762 | FILGRASTIM 1MCG X100 J1442 | $ | 505.00 |
| 3516764 | FEBXOSTAT 80 MG TABLET | $ | 22.00 |
| 3516765 | ORAGEL 20% 11.9 GM | $ | 14.00 |
| 3516766 | VANCOMYCIN 500MG X6 J3370 | $ | 115.00 |
| 3516767 | RITUXAN 100MG X5 J9310 | $ | 6,581.00 |
| 3516768 | CEPASTAT LOZENGE | $ | 8.00 |
| 3516769 | OSELTAMIVIR ORAL SUSP 6 MG/ML-60 ML | $ | 258.00 |
| 3516770 | VITAMIN K CAPSULE 1000MCG | $ | 7.00 |
| 3516771 | OSELTAMIVIR 30MG CAPSULE | $ | 24.00 |
| 3516772 | HYDROXOCOBALAMIN 5 GM /NS 200 ML | $ | 1,190.00 |
| 3516773 | OCTREOTIDE ACETATE INJ 25 MCGX2 J2354 | $ | 31.00 |
| 3516774 | DIGIFAB VIAL 40MGX1 J1162 | $ | 5,160.00 |
| 3516775 | METHYLENE BLUE INJ 0.5% | $ | 299.00 |
| 3516776 | OCTREOTIDE ACETATE INJ 25MCG X4 J2354 | $ | 37.00 |
| 3516777 | OCTREOTIDE ACETATE INJ 25MCG X20 J2354 | $ | 67.00 |
| 3516778 | GENTAMICIN SDV 80MG X1 J1580 | $ | 29.00 |
| 3516779 | BUMETANIDE 2MG IV-MOD X4 S0171 | $ | 51.00 |
| 3516780 | DEFEROXAMINE 500MG X2 IV J0895 | $ | 68.00 |
| 3516781 | AMIODARONE IV 150MG X5 J0282 | $ | 46.00 |
| 3516782 | AMIODARONE IV-MOD30 MG X30 J0282 | $ | 50.00 |
| 3516783 | FOSPHENYTOIN IV 50MG X20 Q2009 | $ | 314.00 |
| 3516784 | ACTIVATED CHARCOAL W/O SORB SUSP 25 GM | $ | 32.00 |
| 3516785 | EPINEPHRINE IV 0.1 MG X20 J0171 | $ | 51.00 |
| 3516786 | EPINEPHRINE IV 0.1 MG X10 J0171 | $ | 48.00 |
| 3516787 | DAPTOMYCIN IV1 MG X550 J0878 | $ | 1,410.00 |
| 3516788 | LAMIVUDINE 150MG TABLET | $ | 16.00 |
| 3516789 | ACETYLCSTEINE IV 100MG X60 JJ0132 | $ | 310.00 |
| 3516790 | ACETYLCSTEINE IV 100MG X40 J0132 | $ | 232.00 |
| 3516791 | ACETYLCYSTEINE IV 100MG X120 J0132 | $ | 570.00 |
| 3516792 | NITROGLYCERIN PATCH REMOVAL | $ | 0.00 |
| 3516793 | MORPHINE SULFATE ER 10 MG CAPSULE | $ | 12.00 |
| 3516794 | TRIAMCINOLONE 10MG X4 J3301-OR | $ | 0.00 |
| 3516795 | DEXAMETHASONE OPHTH DROP 0.1%- OR | $ | 0.00 |
| 3516796 | PREDNISOLONE OPHTH 1%- OR | $ | 0.00 |
| 3516797 | PROPARACAINE OPHTH 0.5% DROP- OR | $ | 0.00 |
| 3516798 | VISION BLUE 0.06% OPHTH SOLN- OR | $ | 0.00 |
| 3516799 | MOXIFLOXACIN OPHTH DROP 0.5%- OR | $ | 0.00 |
| 3516800 | DICLOFENAC OPHTH SOLN 0.1%- OR | $ | 0.00 |
| 3516801 | PHENYLEPHRINE OPHTH SOLN 2.5% | $ | 0.00 |
| 3516802 | BACITRACIN OPHTH OINT | $ | 0.00 |
| 3516803 | BRILINTA TABLET 90MG | $ | 15.00 |
| 3516804 | ZOSYN 1.125 GM X4 J2543 | $ | 61.00 |
| 3516805 | POTASSIUM CL VL 2 mEqX5 J3480 | $ | 46.00 |
| 3516806 | ZOLENDRONIC ACID 1MG X4 J3489 | $ | 292.00 |
| 3516807 | LITHIUM CAPSULE (300 MG) | $ | 8.00 |
| 3516808 | THIAMINE IV 100MG X1 J3411 | $ | 58.00 |
| 3516809 | PHENYLEPHRINE IV-DRIP 1MLX1 J2370 | $ | 53.00 |
| 3516810 | 0.9% SODIUM CHLORIDE 250 ML | $ | 0.00 |
| 3516811 | 0.9% SODIUM CHLORIDE 100 ML | $ | 0.00 |
| 3516812 | ONABOUTULINUMTOXINA(BOTOX) 1 UNIT X100 | $ | 925.00 |
| 3516813 | CIPRODEX OTIC SUSP 7.5 ML | $ | 316.00 |
| 3516814 | GENTAMICIN IV 80MG X6 | $ | 53.00 |
| 3516815 | OCTREOTIDE IV 25MCG J2354 25 X10 | $ | 87.00 |
| 3516816 | TRANEAMIC ACID 1% J3490 X1 | $ | 63.00 |
| 3516817 | DAPTOMYCIN IV 1MG X680 J0878 | $ | 1,410.00 |
| 3516818 | TRANEXAMIC ACID ADMIN J3490X1 | $ | 63.00 |
| 3516819 | TRANEXAMIC ACID 5% J3490 X 1 | $ | 63.00 |
| 3516820 | M.V.I 12 INFVITE INJ 10ML J3490 | $ | 38.00 |
| 3516821 | LITHIUM CARBONATE CAPSULE 150MG | $ | 8.00 |
| 3516822 | FENOFIBRATE TABLET 160 MG X1 | $ | 10.00 |
| 3516823 | KETOROLAC TROMETHAMINE 0.5% OPHTH DROPS | $ | 49.00 |
| 3516824 | DEPO LEPRON 3.75MG X3 J1950 | $ | 5,370.00 |
| 3516825 | LIOTHYRONINE SODIUM TABLET 5 MCG | $ | 8.00 |
| 3516826 | CINACALCET HCL TABLET 1MG X30 J0604 | $ | 58.00 |
| 3516827 | RYANODEX BOLUS INJ 250MG | $ | 3,911.00 |
| 3516828 | NEO/POLY/BAC/HC OPHTH OINT 3.5GM | $ | 111.00 |
| 3516829 | DIAZEPAM DOSE 5MG X1 J3360 | $ | 23.00 |
| 3516830 | POTASSIUM CHLORIDE 2 MEQX20 J3480 | $ | 47.00 |
| 3516831 | NALOXONE IV DRIP 1MG X4 | $ | 218.00 |
| 3516832 | NICOTINE GUM 2MG | $ | 8.00 |
| 3516833 | NITHIODOTE KIT J3490 X1 | $ | 309.00 |
| 3516834 | SUMATRIPTAN TABLET 25MG | $ | 53.00 |
| 3516835 | FERRIC CARBOXYMALTOSE IV 1MGX750 J1439 | $ | 1,750.00 |
| 3516836 | PERFLUTREN LIPID MIRCOSPHERE (6.52MG/ML) | $ | 250.00 |
| 3516837 | METHOTREXATE SODIUM 50MG/2ML VIAL | $ | 43.00 |
| 3516838 | SOD BICARB-CIT AC-SIM PK 4GM | $ | 27.00 |
| 3516839 | CETIRIZINE SYRUP DOSE 10 ML | $ | 11.00 |
| 3516840 | MYRBETRIQ TABLET X1 | $ | 9.00 |
| 3516841 | CALCITONIN SALMON NASAL SPRAY 3.7ML | $ | 193.00 |
| 3516842 | APIXABAN TABLET 2.5MG X1 | $ | 16.00 |
| 3516843 | VERAPAMIL TABLET 80MG | $ | 8.00 |
| 3516844 | DEXAMETHASONE ORAL DOSE 10MG X1 | $ | 10.00 |
| 3516845 | ACETYLCYSTEINE IV 100MGX 44 J0132 | $ | 248.00 |
| 3516846 | ACETYLCYSTEINE IV 100MG X130 | $ | 614.00 |
| 3516847 | TRANEXAMIC ACID 10 ML TOPICAL | $ | 63.00 |
| 3516848 | HALOPERIDOL ORAL CONCENTRATE 2MG/ML | $ | 52.00 |
| 3516849 | PHENOBARBITAL 100MG TABLET | $ | 8.00 |
| 3516850 | ZOLEDRONIC ACID IV MOD 1MGX4 J3489 | $ | 292.00 |
| 3516851 | GENTAMICIN IV 80MGX2 J1580 | $ | 53.00 |
| 3516852 | DEXAMETHASONE ORAL DOSE 4MGX1 | $ | 10.00 |
| 3516853 | DAPTOMYCIN IV 1MGX525 | $ | 1,410.00 |
| 3516854 | SIROLIMUS 1 MG (J7520) | $ | 32.00 |
| 3516855 | MYCOPHENOLATE MOFETIL 500 MG (J7517) | $ | 16.00 |
| 3516856 | LIDOCAINE IV DRIP J2001 10MGX100 | $ | 52.00 |
| 3516857 | MOXIFLOXACIN OPHTH INJ 5MG/ML | $ | 40.00 |
| 3519999 | pre-effective date drug | $ | 0.00 |
| 906801 | Rotari oral Susp (1 ml) x 1 | $ | 203.00 |
| 99999 | Clinic No Charge | $ | 0.00 |
| | | $ | 0.00 |
| | | $ | 0.00 |
| 999991 | Acetaminophen 120mg Rectal Suppository | $ | 0.00 |
| 9999910 | Benzoin Compound Tincture | $ | 0.00 |
| 9999911 | Flourescein Sodium 1mg strip | $ | 0.00 |
| 9999912 | Benzocain/tetracain/butaben spray | $ | 0.00 |
| 9999914 | Clonazepam 0.5mg Tablet | $ | 0.00 |
| 9999915 | Diazepam 5mg tablet | $ | 0.00 |
| 9999916 | Diphenydramine 25mg capsule | $ | 0.00 |
| 9999917 | Ear Wax Removal Drops | $ | 0.00 |
| 9999918 | Acarbose 10mg tablet | $ | 0.00 |
| 9999919 | Eye irrigation solution | $ | 0.00 |
| 999992 | Acetaminophen 325mg Suppository | $ | 0.00 |
| 9999920 | Gentamicin Ophthalmic Ointment 0.3% | $ | 0.00 |
| 9999921 | Ibuprofen 200mg tablet | $ | 0.00 |
| 9999922 | Homatropine 2% ophthalmic drop | $ | 0.00 |
| 9999923 | Lidocain 1% MDV | $ | 0.00 |
| 9999924 | Lidocain 2% MDV | $ | 0.00 |
| 9999925 | Lidocaine 2% Jelly | $ | 0.00 |
| 9999926 | Lidocaine 2% Viscous | $ | 0.00 |
| 9999927 | Lidocaine 4% cream | $ | 0.00 |
| 9999928 | Acetaminophen 160mg/5ml | $ | 0.00 |
| 9999929 | Acetaminophen 80mg chew | $ | 0.00 |
| 999993 | Activated Charcoal liquid 25GM | $ | 0.00 |
| 9999930 | Acetaminophen 500mg tablet | $ | 0.00 |
| 9999931 | Meclizine 25mg tablet | $ | 0.00 |
| 9999932 | Ferric Subsulfate Solution | $ | 0.00 |
| 9999933 | Nitroglycerin 0.4mg sublingual tab | $ | 0.00 |
| 9999934 | Podocon 25% Solution | $ | 0.00 |
| 9999935 | Prednisolone 1% Ophthalmic Drop | $ | 0.00 |
| 9999936 | Prochlorperazine 5mg tablet | $ | 0.00 |
| 9999937 | Proparacaine 0.5% opthalmic drops | $ | 0.00 |
| 9999938 | Propranolol 20mg tablet | $ | 0.00 |
| 9999939 | Diphenhydramine 12.5mg/5ml liquid | $ | 0.00 |
| 9999940 | Silver Nitrate Stick | $ | 0.00 |
| 9999941 | Silver Sulfadaine 1% Cream | $ | 0.00 |
| 9999942 | Sodium Chloride 0.9% Nebulizer Solution | $ | 0.00 |
| 9999943 | LUGOLS 5% SOLUTION | $ | 0.00 |
| 9999944 | MAG/ALU/SIMETH 200/200/20 - 30ML | $ | 0.00 |
| 9999945 | HYDROXYZINE PAMOATE 25MG CAP | $ | 0.00 |
| 9999946 | OMEPRAZOLE 20MG CAP | $ | 0.00 |
| 9999948 | Tramadol 50mg oral tablet | $ | 0.00 |
| 9999949 | Prednisolone 5mg/5ml - 30ml | $ | 0.00 |
| 999995 | Calcium Antacid Chew 500mg | $ | 0.00 |
| 9999950 | Lorazepam 1mg tablet | $ | 0.00 |
| 9999951 | LIDOCAINE OINTMENT DOSE (5%) | $ | 0.00 |
| 9999952 | MENTHOL SPRAY 10%-118ML | $ | 0.00 |
| 9999953 | LUBIPROSTONE CAPULE 24 MCG | $ | 0.00 |
| 9999954 | MAGNESIUM CITRATE SOLN 300ML | $ | 0.00 |
| 9999957 | EXCEDRIN 250-250-65 MG | $ | 0.00 |
| 9999958 | RACEPINEPHRINE NEB 2.25%- 0.5ML | $ | 0.00 |
| 999996 | Auralgan Ear Drop | $ | 0.00 |
| 9999962 | TROPICAMIDE OPHTH DROP 0.5% | $ | 0.00 |
| 9999963 | PHENYLEPHRINE OPHTH DROP 2.5% | $ | 0.00 |
| 9999964 | LIDO/PRILOCAINE CREAM 2.5%- 5 GM | $ | 0.00 |
| 999997 | Asprin 81mg chew tab | $ | 0.00 |
| 999998 | Asprin 325mg EC | $ | 0.00 |
| 999999 | Bacitracin 500U/GM Packet | $ | 0.00 |
| 99999913 | Ibuprofen 100mg/5ml Suspension | $ | 0.00 |
| GENCONV | General Conversion | $ | 0.00 |
| J0561 RX | PENICILLIN G LA SRN 100000UX12 | $ | 17.50 |
| J0690 RX | CEFAZOLIN PREMIX (J0690) 500MGX2 IV | $ | 25.50 |
| J0690 RX1 | CEFAZOLIN PREMIX IV (J0690) 500MG X4 | $ | 13.50 |
| J0696 RX | CEFTRIAXONE PREMIX (J0696) IV 250MG X4 | $ | 14.75 |
| J0696 RX1 | CEFTRIAXONE PREMIX (J0696) IV 250MG X8 | $ | 8.50 |
| J06963 | CEFTRIAONE 250MG X4 (J0696) | $ | 9.00 |
| J06964 | CEFTRIAXONE 250MG X8 (J0696) | $ | 11.00 |
| J1642 RX | HEPARIN FLUSH (J1642) 10 UNT X50 | $ | 0.22 |
| J1644 RX | HEPARIN SYRINGE (J1644) 1000 UNIT X5 | $ | 5.80 |
| J1644 RX1 | HEPARIN IV DRIP (J1644) 1000 UNT X25 | $ | 2.24 |
| J16501 | ENOXAPARIN 10MG X4 INJ (J1650) | $ | 58.00 |
| J16502 | ENOXAPARIN 10MG X6 INJ (J1650) | $ | 74.00 |
| J16503 | ENOXAPARIN 10MG X8 INJ (J1650) | $ | 111.00 |
| J1815 RX | INSULIN 5 UNITS INJ (J1815) LEVEMIR PEN | $ | 2.25 |
| J1815 RX1 | INSULIN 5 UNITS INJ (J1815) NOVOLOG | $ | 2.35 |
| | | $ | 2.35 |
| J1815 RX2 | INSULIN 5 UNITS PGBK (J1815) | $ | 2.00 |
| J1815 RX3 | INSULIN 5 UNITS INJ (J1815) LISPRO PEN | $ | 2.60 |
| J18151 | LEVEMIR FLEXPEN 5 UNITS X60 (J1815) | $ | 0.00 |
| J18152 | INSULIN REGULAR DOSE 5 UNIT (J1815) | $ | 8.00 |
| J1885 RX | KETOROLAC SDV (J1885) 15MG X2 | $ | 13.50 |
| J1885 RX1 | KETOROLAC SDV (J1885) 15MG X4 | $ | 6.75 |
| J18852 | KETOROLAC 15MG X2 (J1885) | $ | 9.00 |
| J18853 | KETOROLAC 15MG X4 (J1885) | $ | 10.00 |
| J1940 RX | FUROSEMIDE SDV(J1940) 20MG X2 | $ | 14.50 |
| J19401 | FUROSEMIDE 20 MG X2 IV (J1940) | $ | 14.50 |
| J1956 RX | LEVOFLOXACIN PREMIX (J1956) 250MGX2 | $ | 29.50 |
| J1956 RX1 | LEVOFLOXACIN PREMIX (J1956) 250MGX3 | $ | 18.00 |
| J22702 | MORPHINE 4MG X1 INJ (J2270) | $ | 28.00 |
| J22703 | MORPHINE 10 MG X1 INJ (J2270) | $ | 28.00 |
| J23002 | NALBUPHINE 10MG X1 (J2300) | $ | 29.00 |
| J2354 RX | OCTREOTIDE VL (J2354) 25MCGX2 | $ | 15.50 |
| J2354 RX1 | OCTREOTIDE VL (J2354) 25MCGX20 | $ | 3.35 |
| J2354 RX2 | OCTREOTIDE VL (J2354) 25MCGX4 | $ | 9.25 |
| J2405 RX | ONDANSETRON SDV (J2405) 1MG X4 | $ | 6.25 |
| J2543 RX | PIPERACILLIN/TAZOBAT SDV(J2543)1.125GMX3 | $ | 22.00 |
| J2543 RX1 | PIPERACILLIN/TAZOBAC SDV(J2543)1.125GMX4 | $ | 15.25 |
| J2597 RX | DESMOPRESSION 1MG J2597 | $ | 500.00 |
| J2765 | METOCLOPRAMIDE 10MG X1 J2765 | $ | 27.00 |
| J3430 RX1 | PHYTONADIONE AMP (J3430) 1MG X10 | $ | 9.80 |
| J3480 RX | POTASSIUM CHLORIDE PREMIX(J3480) 2MEQ X5 | $ | 9.80 |
| J3480 RX1 | POTASSIUM CHLORIDE SDV(J3480) 2MEQ X10 | $ | 4.60 |
| J3480 RX2 | POTASSIUM CHLORIDE SDV(J3480) 2MEQX20 | $ | 2.35 |
| J3490 | LEVENORGESTREL IUD (19.5 MG) J3490 | $ | 1,495.00 |
| J7187 RX | HUMATE-P 1 UNIT J7187 | $ | 1.33 |
| J7187 RX1 | HUMATE-P UNIT J7187 | $ | 1.00 |
| J7296 | LEVONORGETREL IUD (19.5MG/24HR) KYLEENA | $ | 1,430.00 |
| J7326 | GEL-ONE INJECTION J7326 X1 | $ | 1,720.00 |
| J7509 RX | METHYPREDNISOLONE 4MG TAB J7509 DOSE PAK | $ | 2.00 |
| J7512 RX | PREDNISONE TABLET (J7512) 1MG X10 | $ | 0.80 |
| J7512 RX2 | PREDNISONE TABLET (J7512) 1MG X20 | $ | 0.40 |
| J7512 RX3 | PREDNISONE TABLET (J7512) 1MG X5 | $ | 1.60 |
| J7620 | IPRATROPIUM/ALBUTEROL (J7620) | $ | 22.65 |
| J76201 | IPRA/ALBU 2.5-0.5MG NEB X1 (J7620) | $ | 10.00 |
| Q9984 | KYLEENA IUD | $ | 1,430.00 |
| VFC | VACCINES FOR CHILDREN | $ | 20.83 |
| VFC1 | Tdap age 7-18 SDV (0.5ML) 90715 | $ | 20.83 |
| VFC10 | INFLUENZA QUAD VACCINE IM (0.25ML) 90685 | $ | 20.83 |
| VFC11 | INFLUENZA QUAD VACCINE IM (0.5ML) 90686 | $ | 20.83 |
| VFC12 | MEASLES/MUMPS/RUBELLA VACCINE MDV 90707 | $ | 20.83 |
| VFC13 | MENINGOCOCCAL VACCINE SDV (4 MCG/0.5 ML | $ | 20.83 |
| VFC14 | PNEUMOC-13 VACCINE VL (0.5 ML) 90670 | $ | 20.83 |
| VFC15 | POLIO VACCINE MDV (0.5 ML/DOSE) 90713 | $ | 20.83 |
| VFC16 | ROTAVIRUS VACCINE ORAL SUSP (1 ML) 90681 | $ | 20.83 |
| VFC17 | VARICELLA VACCINE [CHICKEN POX] VIAL (0. | $ | 20.83 |
| VFC18 | HUMAN PAPIL VIRUS CERVARIX | $ | 20.83 |
| VFC19 | HPV SD (0.5ml) | $ | 20.83 |
| VFC2 | Tdap age 7-18 Syr (0.5ML) 90715 | $ | 20.83 |
| VFC3 | DIP/TET/AP VACCINE SDV (0.5ML) 90700 | $ | 20.83 |
| VFC4 | DIP/TET/AP/POLIO VACCINE SDV (0.5ML) | $ | 20.83 |
| VFC5 | DTAP/HEPB/POLIO PREFILL SYRN VACCINE (0 | $ | 20.83 |
| VFC6 | HAEMOPH B VACCINE (0.5ML) 90647 | $ | 20.83 |
| VFC7 | HEPATITIS A SYRINGE (720U/0.5ML) 90633 | $ | 20.83 |
| VFC8 | HEPATITIS B SDV VACCINE (10MCG/0.5ML) | $ | 20.83 |
| VFC9 | HUMAN PAPILLOMAVIRUSVACCINE SDV (0.5ML) | $ | 20.83 |
| 3700001 | PT CONTRACT PRE-EMP EVAL | $ | 22.00 |
| 3700003 | PT RE-EVALUATION | $ | 258.00 |
| 3700005 | PT CCC SCREEN | $ | 0.00 |
| 3700008 | PT EVAL LOW COMPLEXITY | $ | 257.00 |
| 3700009 | PT EVAL MOD COMPLEXITY | $ | 282.00 |
| 3700010 | PT EVAL HIGH COMPLEXITY | $ | 306.00 |
| 3700011 | PT RE-EVALUATION | $ | 175.00 |
| 3700014 | PT THER EXERCISE 15 | $ | 211.00 |
| 3700024 | PT GAIT TRAINING 15 | $ | 86.00 |
| 3700025 | PT THER ACTIVITY 15 | $ | 224.00 |
| 3700026 | PT AQUA THERAPY 15 | $ | 222.00 |
| 3700027 | PT GAIT TRAINING 15" 59 | $ | 86.00 |
| 3700028 | PT THER ACTIVITY 15 59 | $ | 224.00 |
| 3700072 | PT ULTRASOUND 15 | $ | 211.00 |
| 3700085 | PT IONTOPHORESIS 15 | $ | 250.00 |
| 3700090 | PT NEG PRES <50 | $ | 187.00 |
| 3700096 | PT MASSAGE | $ | 194.00 |
| 3700097 | PT PARAFFIN BATH | $ | 0.00 |
| 3700144 | PT MECHANICAL TRACTION | $ | 224.00 |
| 3700145 | PT CANALITH REPOSITIONING PROCEDURE/DAY | $ | 124.00 |
| 3700193 | PT E-STIM ATTENDED 15 | $ | 135.00 |
| 3700228 | PT HOME INSTRUCT 15 | $ | 224.00 |
| 3700252 | PT E-STIM MANUAL UNATTENDED | $ | 292.00 |
| 3700253 | PT E-STIM UNATTENDED | $ | 292.00 |
| 3700255 | PT E-STIM WOUND MANUAL | $ | 292.00 |
| 3700276 | PT FIT MEASURE 15 | $ | 88.00 |
| 3700300 | PT EQUIPMENT ADJ/REPAIR 15 | $ | 21.00 |
| 3700416 | PT DEBRIDE > 20CM ADD GP | $ | 316.00 |
| 3700417 | PT DEBRIDE <= 20CM | $ | 178.00 |
| 3700421 | PT MANUAL THERAPY 15 | $ | 220.00 |
| 3700422 | PT PHONOPHORESIS | $ | 211.00 |
| 3700429 | PT NEURO RE-EDUCATION 15 | $ | 201.00 |
| 3700431 | PT MANUAL THERAPY 15 59 | $ | 220.00 |
| 3700505 | PT HOUR CONSULT SIREN SCHOOL | $ | 128.00 |
| 3700516 | PT CONTRACT HEARTS OF GOLD 15" | $ | 19.00 |
| 3700517 | PT CON GOOD SAM HC /VISIT PT | $ | 81.00 |
| 3700518 | PT CON GOOD SAM HC /VISIT PTA | $ | 81.00 |
| 3700519 | PT CONTRACT BIRTH-3 YO | $ | 124.00 |
| 3700520 | PT CONTRACT NORTHERN BRIDGES | $ | 186.00 |
| 3700700 | PT CROSSBOW EVAL | $ | 69.00 |
| 3705001 | LUMBAR/SACRAL ORTHOSIS SUMMIT 631 | $ | 421.00 |
| 3709019 | PT MOBILITY CURRENT G8978CH | $ | 0.00 |
| 3709020 | PT MOBILITY CURRENT G8978CI | $ | 0.00 |
| 3709021 | PT MOBILITY CURRENT G8978CJ | $ | 0.00 |
| 3709022 | PT MOBILITY CURRENT G8978CK | $ | 0.00 |
| 3709023 | PT MOBILITY CURRENT G8978CL | $ | 0.00 |
| 3709024 | PT MOBILITY CURRENT G8978CM | $ | 0.00 |
| 3709025 | PT MOBILITY CURRENT G8978CN | $ | 0.00 |
| 3709026 | PT MOBILITY GOAL G8979CH | $ | 0.00 |
| 3709027 | PT MOBILITY GOAL G8979CI | $ | 0.00 |
| 3709028 | PT MOBILITY GOAL G8979CJ | $ | 0.00 |
| 3709029 | PT MOBILITY GOAL G8979CK | $ | 0.00 |
| 3709030 | PT MOBILITY GOAL G8979CL | $ | 0.00 |
| 3709031 | PT MOBILITY GOAL G8979CM | $ | 0.00 |
| 3709032 | PT MOBILITY GOAL G8979CN | $ | 0.00 |
| 3709033 | PT MOBILITY D/C G8980CH | $ | 0.00 |
| 3709034 | PT MOBILITY D/C G8980CI | $ | 0.00 |
| 3709035 | PT MOBILITY D/C G8980CJ | $ | 0.00 |
| 3709036 | PT MOBILITY D/C G8980CK | $ | 0.00 |
| 3709037 | PT MOBILITY D/C G8980CL | $ | 0.00 |
| 3709038 | PT MOBILITY D/C G8980CM | $ | 0.00 |
| 3709039 | PT MOBILITY D/C G8980CN | $ | 0.00 |
| 3709040 | PT BODY POSITION CURRENT G8981CH | $ | 0.00 |
| 3709041 | PT BODY POSITION CURRENT G8981CI | $ | 0.00 |
| 3709042 | PT BODY POSITION CURRENT G8981CJ | $ | 0.00 |
| 3709043 | PT BODY POSITION CURRENT G8981CK | $ | 0.00 |
| 3709044 | PT BODY POSITION CURRENT G8981CL | $ | 0.00 |
| 3709045 | PT BODY POSITION CURRENT G8981CM | $ | 0.00 |
| 3709046 | PT BODY POSITION CURRENT G8981CN | $ | 0.00 |
| 3709047 | PT BODY POSITION GOAL G8982CH | $ | 0.00 |
| 3709048 | PT BODY POSITION GOAL G8982CI | $ | 0.00 |
| 3709049 | PT BODY POSITION GOAL G8982CJ | $ | 0.00 |
| 3709050 | PT BODY POSITION GOAL G8982CK | $ | 0.00 |
| 3709051 | PT BODY POSITION GOAL G8982CL | $ | 0.00 |
| 3709052 | PT BODY POSITION GOAL G8982CM | $ | 0.00 |
| 3709053 | PT BODY POSITION GOAL G8982CN | $ | 0.00 |
| 3709054 | PT BODY POSITION D/C G8983CH | $ | 0.00 |
| 3709055 | PT BODY POSITION D/C G8983CI | $ | 0.00 |
| 3709056 | PT BODY POSITION D/C G8983CJ | $ | 0.00 |
| 3709057 | PT BODY POSITION D/C G8983CK | $ | 0.00 |
| 3709058 | PT BODY POSITION D/C G8983CL | $ | 0.00 |
| 3709059 | PT BODY POSITION D/C G8983CM | $ | 0.00 |
| 3709060 | PT BODY POSITION D/C G8983CN | $ | 0.00 |
| 3709061 | PT CARRYING CURRENT G8984CH | $ | 0.00 |
| 3709062 | PT CARRYING CURRENT G8984CI | $ | 0.00 |
| 3709063 | PT CARRYING CURRENT G8984CJ | $ | 0.00 |
| 3709064 | PT CARRYING CURRENT G8984CK | $ | 0.00 |
| 3709065 | PT CARRYING CURRENT G8984CL | $ | 0.00 |
| 3709066 | PT CARRYING CURRENT G8984CM | $ | 0.00 |
| 3709067 | PT CARRYING CURRENT G8984CN | $ | 0.00 |
| 3709068 | PT CARRYING GOAL G8985CH | $ | 0.00 |
| 3709069 | PT CARRYING GOAL G8985CI | $ | 0.00 |
| 3709070 | PT CARRYING GOAL G8985CJ | $ | 0.00 |
| 3709071 | PT CARRYING GOAL G8985CK | $ | 0.00 |
| 3709072 | PT CARRYING GOAL G8985CL | $ | 0.00 |
| 3709073 | PT CARRYING GOAL G8985CM | $ | 0.00 |
| 3709074 | PT CARRYING GOAL G8985CN | $ | 0.00 |
| 3709075 | PT CARRYING D/C G8986CH | $ | 0.00 |
| 3709076 | PT CARRYING D/C G8986CI | $ | 0.00 |
| 3709077 | PT CARRYING D/C G8986CJ | $ | 0.00 |
| 3709078 | PT CARRYING D/C G8986CK | $ | 0.00 |
| 3709079 | PT CARRYING D/C G8986CL | $ | 0.00 |
| 3709080 | PT CARRYING D/C G8986CM | $ | 0.00 |
| 3709081 | PT CARRYING D/C G8986CN | $ | 0.00 |
| 3709082 | PT SELF CARE CURRENT G8987CH | $ | 0.00 |
| 3709083 | PT SELF CARE CURRENT G8987CI | $ | 0.00 |
| 3709084 | PT SELF CARE CURRENT G8987CJ | $ | 0.00 |
| 3709085 | PT SELF CARE CURRENT G8987CK | $ | 0.00 |
| 3709086 | PT SELF CARE CURRENT G8987CL | $ | 0.00 |
| 3709087 | PT SELF CARE CURRENT G8987CM | $ | 0.00 |
| 3709088 | PT SELF CARE CURRENT G8987CN | $ | 0.00 |
| 3709089 | PT SELF CARE GOAL G8988CH | $ | 0.00 |
| 3709090 | PT SELF CARE GOAL G8988CI | $ | 0.00 |
| 3709091 | PT SELF CARE GOAL G8988CJ | $ | 0.00 |
| 3709092 | PT SELF CARE GOAL G8988CK | $ | 0.00 |
| 3709093 | PT SELF CARE GOAL G8988CL | $ | 0.00 |
| 3709094 | PT SELF CARE GOAL G8988CM | $ | 0.00 |
| 3709095 | PT SELF CARE GOAL G8988CN | $ | 0.00 |
| 3709096 | PT SELF CARE D/C G8989CH | $ | 0.00 |
| 3709097 | PT SELF CARE D/C G8989CI | $ | 0.00 |
| 3709098 | PT SELF CARE D/C G8989CJ | $ | 0.00 |
| 3709099 | PT SELF CARE D/C G8989CK | $ | 0.00 |
| 3709100 | PT SELF CARE D/C G8989CM | $ | 0.00 |
| 3709101 | PT SELF CARE D/C G8989CN | $ | 0.00 |
| 3709102 | PT OTHER PRIMARY CURRENT G8990CH | $ | 0.00 |
| 3709103 | PT OTHER PRIMARY CURRENT G8990CI | $ | 0.00 |
| 3709104 | PT OTHER PRIMARY CURRENT G8990CJ | $ | 0.00 |
| 3709105 | PT OTHER PRIMARY CURRENT G8990CK | $ | 0.00 |
| 3709106 | PT OTHER PRIMARY CURRENT G8990CL | $ | 0.00 |
| 3709107 | PT OTHER PRIMARY CURRENT G8990CM | $ | 0.00 |
| 3709108 | PT OTHER PRIMARY CURRENT G8990CN | $ | 0.00 |
| 3709109 | PT OTHER PRIMARY GOAL G8991CH | $ | 0.00 |
| 3709110 | PT OTHER PRIMARY GOAL G8991CI | $ | 0.00 |
| 3709111 | PT OTHER PRIMARY GOAL G8991CJ | $ | 0.00 |
| 3709112 | PT OTHER PRIMARY GOAL G8991CK | $ | 0.00 |
| 3709113 | PT OTHER PRIMARY GOAL G8991CL | $ | 0.00 |
| 3709114 | PT OTHER PRIMARY GOAL G8991CM | $ | 0.00 |
| 3709115 | PT OTHER PRIMARY GOAL G8991CN | $ | 0.00 |
| 3709116 | PT OTHER PRIMARY D/C G8992CH | $ | 0.00 |
| 3709117 | PT OTHER PRIMARY D/C G8992CI | $ | 0.00 |
| 3709118 | PT OTHER PRIMARY D/C G8992CJ | $ | 0.00 |
| 3709119 | PT OTHER PRIMARY D/C G8992CK | $ | 0.00 |
| 3709120 | PT OTHER PRIMARY D/C G8992CL | $ | 0.00 |
| 3709121 | PT OTHER PRIMARY D/C G8992CM | $ | 0.00 |
| 3709122 | PT OTHER PRIMARY D/C G8992CN | $ | 0.00 |
| 3709123 | PT OTHER SUBSEQUE CURRENT G8993CH | $ | 0.00 |
| 3709124 | PT OTHER SUBSEQUE CURRENT G8993CI | $ | 0.00 |
| 3709125 | PT OTHER SUBSEQUE CURRENT G8993CJ | $ | 0.00 |
| 3709126 | PT OTHER SUBSEQUE CURRENT G8993CK | $ | 0.00 |
| 3709127 | PT OTHER SUBSEQUE CURRENT G8993CL | $ | 0.00 |
| 3709128 | PT OTHER SUBSEQUE CURRENT G8993CM | $ | 0.00 |
| 3709129 | PT OTHER SUBSEQUE CURRENT G8993CN | $ | 0.00 |
| 3709130 | PT OTHER SUBSEQUE GOAL G8994CH | $ | 0.00 |
| 3709131 | PT OTHER SUBSEQUE GOAL G8994CI | $ | 0.00 |
| 3709132 | PT OTHER SUBSEQUE GOAL G8994CJ | $ | 0.00 |
| 3709133 | PT OTHER SUBSEQUE GOAL G8994CK | $ | 0.00 |
| 3709134 | PT OTHER SUBSEQUE GOAL G8994CL | $ | 0.00 |
| 3709135 | PT OTHER SUBSEQUE GOAL G8994CM | $ | 0.00 |
| 3709136 | PT OTHER SUBSEQUE GOAL G8994CN | $ | 0.00 |
| 3709137 | PT OTHER SUBSEQUE D/C G8995CH | $ | 0.00 |
| 3709138 | PT OTHER SUBSEQUE D/C G8995CI | $ | 0.00 |
| 3709139 | PT OTHER SUBSEQUE D/C G8995CJ | $ | 0.00 |
| 3709140 | PT OTHER SUBSEQUE D/C G8995CK | $ | 0.00 |
| 3709141 | PT OTHER SUBSEQUE D/C G8995CL | $ | 0.00 |
| 3709142 | PT OTHER SUBSEQUENT D/C G8995CM | $ | 0.00 |
| 3709143 | PT OTHER SUBSEQUENT D/C G8995CN | $ | 0.00 |
| 3709144 | PT SELF CARE D/C G8989CL | $ | 0.00 |
| 3709999 | MISC | $ | 0.00 |
| 327219 | XR DIGITAL BREAST TOMOSYNTHESIS UNILAT | $ | 121.00 |
| 3320001 | XR FINGER 2 V RT | $ | 709.00 |
| 3320002 | XR FINGER 2 V LT | $ | 709.00 |
| 3320005 | XR HAND 2 V RT | $ | 510.00 |
| 3320006 | XR HAND 2 V LT | $ | 510.00 |
| 3320011 | XR HAND OBLIQUE 3 V RT | $ | 637.00 |
| 3320016 | XR FOREARM 2 V RT | $ | 521.00 |
| 3320017 | XR FOREARM 2 V LT | $ | 521.00 |
| 3320026 | XR WRIST 2 V RT | $ | 611.00 |
| 3320029 | XR C-ARM 0-1HR | $ | 1,123.00 |
| 3320030 | XR WRIST 3 V RT | $ | 771.00 |
| 3320033 | XR HAND 2 V LT | $ | 510.00 |
| 3320035 | XR HAND OBLIQUE 3 V LT | $ | 637.00 |
| 3320036 | XR ELBOW 2 V RT | $ | 548.00 |
| 3320037 | XR ELBOW 2 V LT | $ | 548.00 |
| 3320038 | XR ELBOW 2 VIEWS | $ | 548.00 |
| 3320040 | XR WRIST 2 V LT | $ | 611.00 |
| 3320041 | XR WRIST 3 V LT | $ | 771.00 |
| 3320042 | XR ELBOW OBLIQUE 3V RT | $ | 664.00 |
| 3320043 | XR ELBOW OBLIQUE 3 V LT | $ | 664.00 |
| 3320045 | XR HUMERUS 2 V LT | $ | 538.00 |
| 3320046 | XR HUMERUS 2 V RT | $ | 538.00 |
| 3320051 | XR SHDR 2 V LT | $ | 557.00 |
| 3320052 | XR SHDR 2 V RT | $ | 557.00 |
| 3320056 | XR CLAVICLE RT | $ | 548.00 |
| 3320057 | XR CLAVICLE LT | $ | 548.00 |
| 3320059 | XR SCAPULA COMPLETE LT | $ | 601.00 |
| 3320060 | XR SCAPULA COMPLETE RT | $ | 601.00 |
| 3320061 | XR STERNUM 2 V LIM | $ | 574.00 |
| 3320062 | XR PELVIS/HIPS INF-CHILD | $ | 899.00 |
| 3320064 | XR CHEST SINGLE VIEW | $ | 203.00 |
| 3320065 | XR CHEST 2 VIEW | $ | 277.00 |
| 3320066 | XR STERNUM 2 V | $ | 574.00 |
| 3320067 | XR CHEST 3 VIEWS | $ | 351.00 |
| 3320068 | XR HYSTEROSALPINGOGRAPHY | $ | 1,543.00 |
| 3320069 | XR STERNOCLAVIC MIN 3 V | $ | 691.00 |
| 3320070 | XR STRESS ANKLE | $ | 1,321.00 |
| 3320071 | XR RIBS 2 V LT | $ | 315.00 |
| 3320072 | XR RIBS 2 V RT | $ | 315.00 |
| 3320073 | XR UPPER EXTRM INFANT RT | $ | 646.00 |
| 3320074 | XR RIBS 4 V W CHEST | $ | 437.00 |
| 3320075 | XR UPPER EXTRM INFANT LT | $ | 646.00 |
| 3320076 | XR RIBS BILAT | $ | 385.00 |
| 3320077 | XR RIBS PA/CHEST TRAUMA | $ | 351.00 |
| 3320078 | XR RIBS PA CHEST TRAUMA | $ | 351.00 |
| 3320079 | XR WRIST 1 V LT | $ | 611.00 |
| 3320080 | XR WRIST 1 V RT | $ | 611.00 |
| 3320081 | XR ELBOW 2 V LT | $ | 548.00 |
| 3320083 | XR CHEST 4 VIEWS | $ | 391.00 |
| 3320085 | XR CLAVICLE LT 76 | $ | 548.00 |
| 3320087 | XR CLAVICLE RT 76 | $ | 548.00 |
| 3320091 | XR CHEST SINGLE VIEW REPEAT | $ | 203.00 |
| 3320092 | XR WRIST 3 V RT | $ | 771.00 |
| 3320093 | XR WRIST 3 V LT | $ | 771.00 |
| 3320094 | XR CHEST 3 V | $ | 855.00 |
| 3320095 | XR CHEST 2 VIEW REPEAT | $ | 289.00 |
| 3320098 | XR AC JTS W-WEIGHT | $ | 782.00 |
| 3320099 | XR SHDR 1 V RT | $ | 432.00 |
| 3320100 | XR SHDR 1 V LT | $ | 432.00 |
| 3320108 | XR TOE 2 V LT | $ | 637.00 |
| 3320112 | XR FOOT 2 V RT | $ | 531.00 |
| 3320113 | XR FOOT 2 V LT | $ | 531.00 |
| 3320114 | XR FEMUR 1VIEW LT | $ | 484.00 |
| 3320115 | XR FEMUR 1 VIEW RT | $ | 484.00 |
| 3320117 | XR FOOT OBLIQUE 3 V LT | $ | 620.00 |
| 3320118 | XR FOOT OBLIQUE 3 V RT | $ | 620.00 |
| 3320119 | XR TOE 2 V RT | $ | 637.00 |
| 3320122 | XR ANKLE 2 V RT | $ | 548.00 |
| 3320123 | XR ANKLE 2 V LT | $ | 548.00 |
| 3320127 | XR ANKLE 2 V | $ | 548.00 |
| 3320128 | XR ANKLE 3 V RT | $ | 664.00 |
| 3320129 | XR ANKLE MIN 3 V LT | $ | 664.00 |
| 3320131 | XR TIBIA/FIBULA 2 V LT | $ | 503.00 |
| 3320132 | XR TIBIA/FIBULA 2 V RT | $ | 503.00 |
| 3320141 | XR KNEE 1- 2 V LT | $ | 574.00 |
| 3320142 | XR KNEE 1-2 V RT | $ | 574.00 |
| 3320145 | XR KNEE 3 V LT | $ | 735.00 |
| 3320146 | XR KNEE 3 V RT | $ | 735.00 |
| 3320147 | XR KNEE 4 V RT | $ | 855.00 |
| 3320148 | XR KNEES AP STANDING | $ | 691.00 |
| 3320149 | XR KNEE 4 V LT | $ | 855.00 |
| 3320154 | XR FEMUR MIN 2V LT | $ | 510.00 |
| 3320155 | XR FEMUR MIN 2V RT | $ | 510.00 |
| 3320156 | XR CALCANEUS RT | $ | 548.00 |
| 3320157 | XR CALCANEUS LT | $ | 548.00 |
| 3320161 | XR CALCANEOUS RT | $ | 548.00 |
| 3320162 | XR CALCANEOUS LT | $ | 548.00 |
| 3320163 | XR ANKLE 2 V RT | $ | 548.00 |
| 3320164 | XR ANKLE 2 V LT | $ | 548.00 |
| 3320169 | XR KNEE 1-2 V LT | $ | 574.00 |
| 3320206 | XR TOE 2 V RT | $ | 637.00 |
| 3320220 | XR HUMERUS 2 V RT | $ | 538.00 |
| 3320221 | XR HUMERUS 2 V LT | $ | 538.00 |
| 3320225 | XR SHDR 1 V RT | $ | 432.00 |
| 3320227 | XR SHDR 1 LT | $ | 432.00 |
| 3320228 | XR HUMERUS 2 V LT | $ | 538.00 |
| 3320229 | XR STRESS ANKLE | $ | 1,321.00 |
| 3320230 | XR SHDR 2 V RT | $ | 557.00 |
| 3320231 | XR ELBOW 2 V RT | $ | 548.00 |
| 3320232 | XR WRIST 2 V LT | $ | 611.00 |
| 3320233 | XR HAND 1 V RT | $ | 510.00 |
| 3320234 | XR FOOT 1 V LT | $ | 531.00 |
| 3320235 | XR FOOT 1 V RT | $ | 531.00 |
| 3320237 | XR TIBIA/FIBULA 1 V LT | $ | 503.00 |
| 3320238 | XR TIBIA/FIBULA 1 V RT | $ | 503.00 |
| 3320239 | XR HAND 1 V LT | $ | 510.00 |
| 3320241 | XR WRIST 2 V RT | $ | 611.00 |
| 3320242 | XR ANKLE 2 V RT | $ | 548.00 |
| 3320243 | XR TIBIA/FIBULA 2 VIEW LT | $ | 503.00 |
| 3320244 | XR SHDR 2 V LT | $ | 557.00 |
| 3320245 | XR MASTOIDS 3 V OR LESS | $ | 709.00 |
| 3320246 | XR RIBS 2 VIEW RT | $ | 315.00 |
| 3320247 | XR HAND OBLIQUE 3 VIEW LT | $ | 637.00 |
| 3320248 | XR FOOT OBLIQUE 3 V RT | $ | 620.00 |
| 3320249 | XR RIBS 2 VIEW LT | $ | 315.00 |
| 3320250 | XR ANKLE 3 V LT | $ | 664.00 |
| 3320251 | XR ANKLE 3 V RT | $ | 664.00 |
| 3320252 | XR BONE AGE STUDY | $ | 368.00 |
| 3320254 | XR SHDR ARTHROGRAPHY | $ | 2,082.00 |
| 3320255 | XR LWR EXTREMITY/INFA LT | $ | 531.00 |
| 3320256 | XR ARTHROGRAPHY KNEE RT | $ | 2,693.00 |
| 3320257 | XR HUMERUS 2 V RT | $ | 538.00 |
| 3320258 | XR SHDR ARTHROGRAPHY | $ | 2,082.00 |
| 3320259 | XR HAND 2V RT | $ | 510.00 |
| 3320260 | XR ARTHROGRAPHY KNEE LT | $ | 2,693.00 |
| 3320261 | XR LWR EXTREMITY/ INFA RT | $ | 531.00 |
| 3320262 | XR TIBIA/FIBULA 2V RT | $ | 503.00 |
| 3320263 | XR TOE 2 V LT | $ | 637.00 |
| 3320264 | XR FOREARM 1 VIEW LT | $ | 521.00 |
| 3320265 | XR FOREARM 1 VIEW RT | $ | 521.00 |
| 3320266 | XR WRIST 1 V LT/RT REPEAT | $ | 611.00 |
| 3320267 | XR TIBIA/FIBULA 1 V LT/RT | $ | 503.00 |
| 3320268 | XR VIDEO SWALLOW | $ | 1,717.00 |
| 3320301 | XR T-SPINE 3 V | $ | 691.00 |
| 3320304 | XR FOOT OBLIQUE 3 VIEW LT | $ | 620.00 |
| 3320309 | XR NOSE 1+ V | $ | 664.00 |
| 3320313 | XR FINGER 2 V LT | $ | 709.00 |
| 3320314 | XR CALCANEOUS 1 VIEW RT | $ | 548.00 |
| 3320315 | XR KNEE 2 V RT | $ | 574.00 |
| 3320316 | XR ELBOW 2 LT | $ | 548.00 |
| 3320317 | XR FINGER 2 V RT | $ | 709.00 |
| 3320319 | XR FOREARM 2 V RT | $ | 521.00 |
| 3320320 | XR FOREARM 2 V LT | $ | 521.00 |
| 3320321 | XR LOOPOGRAM (URINARY) LT | $ | 585.00 |
| 3320322 | XR HAND OBLIQUE 3 V RT | $ | 637.00 |
| 3320323 | XR LOOPOGRAM (URINARY) RT | $ | 585.00 |
| 3320324 | XR ELBOW 2 V RT | $ | 548.00 |
| 3321001 | XR UPPER GI/AIR | $ | 2,495.00 |
| 3321002 | XR UGI/SM BFT/AIR | $ | 3,887.00 |
| 3321003 | XR ABD 2 V, CHEST 1V | $ | 879.00 |
| 3321004 | XR UGI | $ | 2,111.00 |
| 3321005 | XR UGI / SM BFT | $ | 3,510.00 |
| 3321006 | XR UGI SMBFT AIR / KUB | $ | 2,873.00 |
| 3321011 | XR ESOPHOGRAM | $ | 1,804.00 |
| 3321015 | XR BARIUM ENEMA | $ | 3,250.00 |
| 3321025 | XR AIR CONT COLON | $ | 4,525.00 |
| 3321031 | XR SMALL BOWEL | $ | 2,244.00 |
| 3321048 | XR ABDOMEN 1 VIEW | $ | 404.00 |
| 3321049 | XR ABDOMEN 2 VIEWS | $ | 719.00 |
| 3321050 | XR ABDOMEN 3 OR MORE VIEWS | $ | 719.00 |
| 3321051 | XR ABDOMEN 1 VIEW REPEAT | $ | 404.00 |
| 3321052 | XR ABDOMEN 2 VIEW REPEAT | $ | 719.00 |
| 3322001 | XR IVP | $ | 2,334.00 |
| 3322002 | XR UROGRAPHY,RETROGRADE | $ | 2,334.00 |
| 3322008 | XR UROGRAPHY LOOPOGRAM | $ | 585.00 |
| 3322016 | XR CYSTOGRAPHY MIN 3 VI | $ | 664.00 |
| 3322020 | XR VOIDING CYSTO | $ | 1,797.00 |
| 3322026 | XR VOIDING CYSTO W-FLUORO | $ | 1,797.00 |
| 3322030 | XR THORACENTESIS LT | $ | 463.00 |
| 3322031 | XR THORACENTESIS RT | $ | 463.00 |
| 3322032 | XR THORACENTESIS W GUIDE | $ | 596.00 |
| 3322033 | XR THORACENTESIS W GUIDE | $ | 596.00 |
| 3323001 | XR FACIAL BONE MIN 3 V | $ | 791.00 |
| 3323002 | XR FACIAL BONE LESS 3 V | $ | 531.00 |
| 3323005 | XR NOSE 3 V | $ | 664.00 |
| 3323006 | XR NOSE 3 V | $ | 664.00 |
| 3323010 | XR MANDIBLES LESS 4 V | $ | 674.00 |
| 3323018 | XR SINUSES MIN 3 V | $ | 701.00 |
| 3323020 | XR SINUSES LESS 3 V | $ | 592.00 |
| 3323043 | XR ORBIT FOREIGN BODY | $ | 548.00 |
| 3323044 | XR ORBIT 4 V | $ | 791.00 |
| 3324001 | XR C-SPINE 2-3 V | $ | 637.00 |
| 3324002 | XR LAT C-SPINE 2 V | $ | 637.00 |
| 3324005 | XR C-SPINE 4 V | $ | 861.00 |
| 3324008 | XR C-SPINE/FLEX | $ | 1,159.00 |
| 3324009 | XR T-SPINE 2 V | $ | 601.00 |
| 3324010 | XR LUMBOSACRAL BENDING | $ | 806.00 |
| 3324013 | XR L-SPINE 2-3 VIEW | $ | 646.00 |
| 3324014 | XR L-SPINE + BENDING | $ | 1,249.00 |
| 3324015 | XR THORACOLUMBAR 2 VIEW | $ | 664.00 |
| 3324017 | XR L-SPINE 4 V | $ | 879.00 |
| 3324022 | XR PELVIS 1-2 V | $ | 521.00 |
| 3324026 | XR PELVIS W BIL HIP | $ | 746.00 |
| 3324030 | XR PELVIS W LAT HIP | $ | 746.00 |
| 3324032 | XR PELVIS 3 V | $ | 855.00 |
| 3324042 | XR HIP UNI W PELVIS 1 VIEW LT | $ | 510.00 |
| 3324043 | XR HIP UNI W PELVIS 1 VIEW RT | $ | 510.00 |
| 3324044 | XR HIP UNI W PELVIS 2-3V LT | $ | 727.00 |
| 3324045 | XR HIP UNI W PELVIS 2-3V RT | $ | 727.00 |
| 3324047 | XR HIPS BIL W PELVIS 2 VIEW | $ | 684.00 |
| 3324048 | XR COCCYX SACRUM | $ | 538.00 |
| 3324049 | XR SACRUM/COCCYX | $ | 538.00 |
| 3324050 | XR HIP / CONTRAST | $ | 2,029.00 |
| 3324052 | XR SI JNT 1-2 V | $ | 557.00 |
| 3324054 | XR PELVIS 1-2 V | $ | 521.00 |
| 3324057 | XR HIP / CONTRAST | $ | 2,029.00 |
| 3324058 | XR L-SPINE 1 VIEW | $ | 646.00 |
| 3324059 | XR HIPS BIL W PELVIS 1 VIEW | $ | 684.00 |
| 3324100 | XR DORSAL SPINE 4 VIEW | $ | 879.00 |
| 3324108 | XR BONE SURVEY INFANT | $ | 1,886.00 |
| 3324109 | XR OSSEOUS SURVEY LIMITED | $ | 1,257.00 |
| 3324110 | CHOLANGIOGRAM OPERATIVE | $ | 541.00 |
| 3324112 | XR ORBIT 2 V | $ | 674.00 |
| 3324113 | XR SKULL LESS 4 VIEW | $ | 664.00 |
| 3324120 | XR BONE SURVEY COMPLETE | $ | 2,074.00 |
| 3324121 | XR ORBIT 1 V | $ | 791.00 |
| 3324122 | XR SKULL COMPLETE MIN 4VI | $ | 800.00 |
| 3324505 | XR NECK SOFT TISSUE | $ | 510.00 |
| 3324999 | XR SPINE 1 V | $ | 422.00 |
| 3326001 | XR FLOURO < 1HR | $ | 1,123.00 |
| 3326002 | XR FLUORO ESI | $ | 1,662.00 |
| 3326003 | FLUORO GUIDANCE/EPIDURAL | $ | 1,662.00 |
| 3326005 | FLUORO GUID NEEDLE PLACE | $ | 1,329.00 |
| 3326006 | FLUORO GUID NEEDLE PLACE | $ | 1,329.00 |
| 3326007 | PARACENTESIS W IMAGING | $ | 596.00 |
| 3327152 | COMP DIAG MAMMO ADD ON | $ | 53.00 |
| 3327153 | COMP SCRE MAMMO ADD ON | $ | 53.00 |
| 3327211 | XR MAMMO DIAG UNI | $ | 305.00 |
| 3327212 | XR MAMMO BIL SCREEN TO DIAG | $ | 318.00 |
| 3327213 | XR MAMMO DIAG BILATERAL | $ | 305.00 |
| 3327214 | XR MAMMO SCREEN TO DIAG BILATERAL | $ | 318.00 |
| 3327215 | XR MAMMO SCREENING BILATERAL | $ | 305.00 |
| 3327216 | XR MAMMO SCREENING UNI 52 MOD | $ | 305.00 |
| 3327217 | XR SCREENI DIGITAL BREAST TOMOSYNTHESIS | $ | 121.00 |
| 3327218 | XR DIAG DIGITAL BREAST TOMOSYNTHESIS | $ | 121.00 |
| 3327220 | XR DIAG DIGITAL BREAST TOMO BILAT | $ | 121.00 |
| 3327221 | XR DIAG DIGITAL BREAST TOMO UNILATERAL | $ | 121.00 |
| 3328475 | XR DEXA SCAN | $ | 602.00 |
| 3328662 | XR PET CT SKULL BASE TO MID-THIGH | $ | 3,172.00 |
| 3329013 | INJ GASTROGRAFIN | $ | 40.00 |
| 3329014 | INJ RETROGRADE | $ | 360.00 |
| 3329015 | INJ CYSTOGRAM | $ | 304.00 |
| 3329016 | INJ VOIDING CYST | $ | 304.00 |
| 3329017 | INJ VOIDING CYSTO FLURO | $ | 304.00 |
| 3329021 | INJ RENAL SCAN/DRUG | $ | 506.00 |
| 3329022 | INJ TC99M SESTAMIBI | $ | 140.00 |
| 3329023 | INJ ISOTOPE I-123 | $ | 177.00 |
| 3329024 | INJ ISOTOPE THALLIUM | $ | 436.00 |
| 3329026 | INJ PROHANCE/GADOLIN 50ML | $ | 263.00 |
| 3329027 | INJ MAG 3 TECHNESIUM | $ | 434.00 |
| 3329028 | INJ KINEVAC 5 MCG | $ | 314.00 |
| 3329029 | INJ ISOVUE 50CC | $ | 80.00 |
| 3329033 | INJ RENOGRAFIN 12CC | $ | 19.00 |
| 3329034 | INJ CYSTOGRAFIN | $ | 322.00 |
| 3329035 | INJ VISAPAQUE 100ML | $ | 268.00 |
| 3329036 | INJ HYPAQUE | $ | 19.00 |
| 3329037 | INJ OMNIPIAQUE 300 | $ | 83.00 |
| 3329038 | INJ TC 99M CHOLETEC 4.8MC | $ | 95.00 |
| 3329039 | INJ ISOVUE 370 100cc | $ | 49.00 |
| 3329040 | INJ TC99M MEDRONATE 20-30 | $ | 76.00 |
| 3329042 | INJ TC99M MAA 10MCI | $ | 508.00 |
| 3329043 | INJ TC99M SULFUR COLLOID | $ | 284.00 |
| 3329045 | INJ TC99M DTPA AEROSOL | $ | 508.00 |
| 3329046 | NM DOSE FDG 45MCI | $ | 725.00 |
| 3329049 | INJ CATHETER HYSTEROGRAPH | $ | 372.00 |
| 3329050 | INJ TC 99 TECHNETIUM | $ | 460.00 |
| 3329051 | INJ SHOULDER XRAY LT | $ | 231.00 |
| 3329052 | INJ SHOULDER XRAY RT | $ | 231.00 |
| 3329053 | THYROID ISOTOPE I 131 TH | $ | 58.00 |
| 3329054 | INJ PROCEDURE HIP LT | $ | 322.00 |
| 3329055 | INJ PROCEDURE HIP RT | $ | 322.00 |
| 3329056 | INJ LASIX 20MG INJ | $ | 13.00 |
| 3329057 | INJ OMNIPAQUE 300 MG | $ | 518.00 |
| 3668101 | ST EVALUATION FLUENCY | $ | 397.00 |
| 3668102 | ST EVALUATION SOUND | $ | 323.00 |
| 3668103 | ST EVALUATION WITH LANGUAGE | $ | 669.00 |
| 3668104 | ST SWALLOWING TX 59 | $ | 259.00 |
| 3668105 | ST SPEECH THERAPY | $ | 259.00 |
| 3668107 | ST SWALLOWING TX | $ | 259.00 |
| 3668109 | ST APHASIA EVAL | $ | 259.00 |
| 3668110 | ST SWALLOW EVAL | $ | 460.00 |
| 3668112 | ST THER EXERCISE 15" | $ | 172.00 |
| 3668113 | ST COGNITIVE SKILLS | $ | 259.00 |
| 3668116 | ST SPEECH THERAPY 15" 59 | $ | 259.00 |
| 3668117 | ST VIDEO SWALLOW STUDY | $ | 508.00 |
| 3668118 | ST BEHAVIORAL QUAL ANALYSIS | $ | 334.00 |
| 3669025 | ST SWALLOW CURRENT G8996CH | $ | 0.00 |
| 3669026 | ST SWALLOW CURRENT G8996CI | $ | 0.00 |
| 3669027 | ST SWALLOW CURRENT G8996CJ | $ | 0.00 |
| 3669028 | ST SWALLOW CURRENT G8996CK | $ | 0.00 |
| 3669029 | ST SWALLOW CURRENT G8996CL | $ | 0.00 |
| 3669030 | ST SWALLOW CURRENT G8996CM | $ | 0.00 |
| 3669031 | ST SWALLOW CURRENT G8996CN | $ | 0.00 |
| 3669032 | ST SWALLOW GOAL G8997CH | $ | 0.00 |
| 3669033 | ST SWALLOW GOAL G8997CI | $ | 0.00 |
| 3669034 | ST SWALLOW GOAL G8997CJ | $ | 0.00 |
| 3669035 | ST SWALLOW GOAL G8997CK | $ | 0.00 |
| 3669036 | ST SWALLOW GOAL G8997CL | $ | 0.00 |
| 3669037 | ST SWALLOW GOAL G8997CM | $ | 0.00 |
| 3669038 | ST SWALLOW GOAL G8997CN | $ | 0.00 |
| 3669039 | ST SWALLOW D/C G8998CH | $ | 0.00 |
| 3669040 | ST SWALLOW D/C G8998CI | $ | 0.00 |
| 3669041 | ST SWALLOW D/C G8998CJ | $ | 0.00 |
| 3669042 | ST SWALLOW D/C G8998CK | $ | 0.00 |
| 3669043 | ST SWALLOW D/C G8998CL | $ | 0.00 |
| 3669044 | ST SWALLOW D/C G8998CM | $ | 0.00 |
| 3669045 | ST SWALLOW D/C G8998CN | $ | 0.00 |
| 3669046 | ST MOTOR SPEECH CURRENT G8999CH | $ | 0.00 |
| 3669047 | ST MOTOR SPEECH CURRENT G8999CI | $ | 0.00 |
| 3669048 | ST MOTOR SPEECH CURRENT G8999CJ | $ | 0.00 |
| 3669049 | ST MOTOR SPEECH CURRENT G8999CK | $ | 0.00 |
| 3669050 | ST MOTOR SPEECH CURRENT G8999CL | $ | 0.00 |
| 3669051 | ST MOTOR SPEECH CURRENT G8999CM | $ | 0.00 |
| 3669052 | ST MOTOR SPEECH CURRENT G8999CN | $ | 0.00 |
| 3669053 | ST MOTOR SPEECH D/C G9158CH | $ | 0.00 |
| 3669054 | ST MOTOR SPEECH D/C G9158CI | $ | 0.00 |
| 3669055 | ST MOTOR SPEECH D/C G9158CJ | $ | 0.00 |
| 3669056 | ST MOTOR SPEECH D/C G9158CK | $ | 0.00 |
| 3669057 | ST MOTOR SPEECH D/C G9158CL | $ | 0.00 |
| 3669058 | ST MOTOR SPEECH D/C G9158CM | $ | 0.00 |
| 3669059 | ST MOTOR SPEECH D/C G9158CN | $ | 0.00 |
| 3669060 | ST LANGUAGE COMPRE CURRENT G9159CH | $ | 0.00 |
| 3669061 | ST LANGUAGE COMPRE CURRENT G9159CI | $ | 0.00 |
| 3669062 | ST LANGUAGE COMPRE CURRENT G9159CJ | $ | 0.00 |
| 3669063 | ST LANGUAGE COMPRE CURRENT G9159CK | $ | 0.00 |
| 3669064 | ST LANGUAGE COMPRE CURRENT G9159CL | $ | 0.00 |
| 3669065 | ST LANGUAGE COMPRE CURRENT G9159CM | $ | 0.00 |
| 3669066 | ST LANGUAGE COMPRE CURRENT G9159CN | $ | 0.00 |
| 3669067 | ST LANGUAGE COMPRE GOAL G9160CH | $ | 0.00 |
| 3669068 | ST LANGUAGE COMPRE GOAL G9160CI | $ | 0.00 |
| 3669069 | ST LANGUAGE COMPRE GOAL G9160CJ | $ | 0.00 |
| 3669070 | ST LANGUAGE COMPRE GOAL G9160CK | $ | 0.00 |
| 3669071 | ST LANGUAGE COMPRE GOAL G9160CL | $ | 0.00 |
| 3669072 | ST LANGUAGE COMPRE GOAL G9160CM | $ | 0.00 |
| 3669073 | ST LANGUAGE COMPRE GOAL G9160CN | $ | 0.00 |
| 3669074 | ST LANGUAGE COMPRE D/C G9161CH | $ | 0.00 |
| 3669075 | ST LANGUAGE COMPRE D/C G9161CI | $ | 0.00 |
| 3669076 | ST LANGUAGE COMPRE D/C G9161CJ | $ | 0.00 |
| 3669077 | ST LANGUAGE COMPRE D/C G9161CK | $ | 0.00 |
| 3669078 | ST LANGUAGE COMPRE D/C G9161CL | $ | 0.00 |
| 3669079 | ST LANGUAGE COMPRE D/C G9161CM | $ | 0.00 |
| 3669080 | ST LANGUAGE COMPRE D/C G9161CN | $ | 0.00 |
| 3669081 | ST LANGUAGE EXPRESS CURRENT G9162CH | $ | 0.00 |
| 3669082 | ST LANGUAGE EXPRESS CURRENT G9162CI | $ | 0.00 |
| 3669083 | ST LANGUAGE EXPRESS CURRENT G9162CJ | $ | 0.00 |
| 3669084 | ST LANGUAGE EXPRESS CURRENT G9162CK | $ | 0.00 |
| 3669085 | ST LANGUAGE EXPRESS CURRENT G9162CL | $ | 0.00 |
| 3669086 | ST LANGUAGE EXPRESS CURRENT G9162CM | $ | 0.00 |
| 3669087 | ST LANGUAGE EXPRESS CURRENT G9162CN | $ | 0.00 |
| 3669088 | ST LANGUAGE EXPRESS GOAL G9163CH | $ | 0.00 |
| 3669089 | ST LANGUAGE EXPRESS GOAL G9163CI | $ | 0.00 |
| 3669090 | ST LANGUAGE EXPRESS GOAL G9163CJ | $ | 0.00 |
| 3669091 | ST LANGUAGE EXPRESS GOAL G9163CK | $ | 0.00 |
| 3669092 | ST LANGUAGE EXPRESS GOAL G9163CL | $ | 0.00 |
| 3669093 | ST LANGUAGE EXPRESS GOAL G9163CM | $ | 0.00 |
| 3669094 | ST LANGUAGE EXPRESS GOAL G9163CN | $ | 0.00 |
| 3669095 | ST LANGUAGE EXPRESS D/C G9164CH | $ | 0.00 |
| 3669096 | ST LANGUAGE EXPRESS D/C G9164CI | $ | 0.00 |
| 3669097 | ST LANGUAGE EXPRESS D/C G9164CJ | $ | 0.00 |
| 3669098 | ST LANGUAGE EXPRESS D/C G9164CK | $ | 0.00 |
| 3669099 | ST LANGUAGE EXPRESS D/C G9164CL | $ | 0.00 |
| 3669100 | ST LANGUAGE EXPRESS D/C G9164CM | $ | 0.00 |
| 3669101 | ST LANGUAGE EXPRESS D/C G9164CN | $ | 0.00 |
| 3669102 | ST ATTENTION CURRENT G9165CH | $ | 0.00 |
| 3669103 | ST ATTENTION CURRENT G9165CI | $ | 0.00 |
| 3669104 | ST ATTENTION CURRENT G9165CJ | $ | 0.00 |
| 3669105 | ST ATTENTION CURRENT G9165CK | $ | 0.00 |
| 3669106 | ST ATTENTION CURRENT G9165CL | $ | 0.00 |
| 3669107 | ST ATTENTION CURRENT G9165CM | $ | 0.00 |
| 3669108 | ST ATTENTION CURRENT G9165CN | $ | 0.00 |
| 3669109 | ST ATTENTION GOAL G9166CH | $ | 0.00 |
| 3669110 | ST ATTENTION GOAL G9166CI | $ | 0.00 |
| 3669111 | ST ATTENTION GOAL G9166CJ | $ | 0.00 |
| 3669112 | ST ATTENTION GOAL G9166CK | $ | 0.00 |
| 3669113 | ST ATTENTION GOAL G9166CL | $ | 0.00 |
| 3669114 | ST ATTENTION GOAL G9166CM | $ | 0.00 |
| 3669115 | ST ATTENTION GOAL G9166CN | $ | 0.00 |
| 3669116 | ST ATTENTION D/C G9167CH | $ | 0.00 |
| 3669117 | ST ATTENTION D/C G9167CI | $ | 0.00 |
| 3669118 | ST ATTENTION D/C G9167CJ | $ | 0.00 |
| 3669119 | ST ATTENTION D/C G9167CK | $ | 0.00 |
| 3669120 | ST ATTENTION D/C G9167CL | $ | 0.00 |
| 3669121 | ST ATTENTION D/C G9167CM | $ | 0.00 |
| 3669122 | ST ATTENTION D/C G9167CN | $ | 0.00 |
| 3669123 | ST MEMORY CURRENT G9168CH | $ | 0.00 |
| 3669124 | ST MEMORY CURRENT G9168CI | $ | 0.00 |
| 3669125 | ST MEMORY CURRENT G9168CJ | $ | 0.00 |
| 3669126 | ST MEMORY CURRENT G9168CK | $ | 0.00 |
| 3669127 | ST MEMORY CURRENT G9168CL | $ | 0.00 |
| 3669128 | ST MEMORY CURRENT G9168CM | $ | 0.00 |
| 3669129 | ST MEMORY CURRENT G9168CN | $ | 0.00 |
| 3669130 | ST MEMORY GOAL G9169CH | $ | 0.00 |
| 3669131 | ST MEMORY GOAL G9169CI | $ | 0.00 |
| 3669132 | ST MEMORY GOAL G9169CJ | $ | 0.00 |
| 3669133 | ST MEMORY GOAL G9169CK | $ | 0.00 |
| 3669134 | ST MEMORY GOAL G9169CL | $ | 0.00 |
| 3669135 | ST MEMORY GOAL G9169CM | $ | 0.00 |
| 3669136 | ST MEMORY GOAL G9169CN | $ | 0.00 |
| 3669137 | ST MEMORY D/C G9170CH | $ | 0.00 |
| 3669138 | ST MEMORY D/C G9170CI | $ | 0.00 |
| 3669139 | ST MEMORY D/C G9170CJ | $ | 0.00 |
| 3669140 | ST MEMORY D/C G9170CK | $ | 0.00 |
| 3669141 | ST MEMORY D/C G9170CL | $ | 0.00 |
| 3669142 | ST MEMORY D/C G9170CM | $ | 0.00 |
| 3669143 | ST MEMORY D/C G9170CN | $ | 0.00 |
| 3669144 | ST VOICE CURRENT G9171CH | $ | 0.00 |
| 3669145 | ST VOICE CURRENT G9171CI | $ | 0.00 |
| 3669146 | ST VOICE CURRENT G9171CJ | $ | 0.00 |
| 3669147 | ST VOICE CURRENT G9171CK | $ | 0.00 |
| 3669148 | ST VOICE CURRENT G9171CL | $ | 0.00 |
| 3669149 | ST VOICE CURRENT G9171CM | $ | 0.00 |
| 3669150 | ST VOICE CURRENT G9171CN | $ | 0.00 |
| 3669151 | ST VOICE GOAL G9172CH | $ | 0.00 |
| 3669152 | ST VOICE GOAL G9172CI | $ | 0.00 |
| 3669153 | ST VOICE GOAL G9172CJ | $ | 0.00 |
| 3669154 | ST VOICE GOAL G9172CK | $ | 0.00 |
| 3669155 | ST VOICE GOAL G9172CL | $ | 0.00 |
| 3669156 | ST VOICE GOAL G9172CM | $ | 0.00 |
| 3669157 | ST VOICE GOAL G9172CN | $ | 0.00 |
| 3669158 | ST VOICE D/C G9173CH | $ | 0.00 |
| 3669159 | ST VOICE D/C G9173CI | $ | 0.00 |
| 3669160 | ST VOICE D/C G9173CJ | $ | 0.00 |
| 3669161 | ST VOICE D/C G9173CK | $ | 0.00 |
| 3669162 | ST VOICE D/C G9173CL | $ | 0.00 |
| 3669163 | ST VOICE D/C G9173CM | $ | 0.00 |
| 3669164 | ST VOICE D/C G9173CN | $ | 0.00 |
| 3669165 | ST OTHER LANGUAGE CURRENT G9174CH | $ | 0.00 |
| 3669166 | ST OTHER LANGUAGE CURRENT G9174CI | $ | 0.00 |
| 3669167 | ST OTHER LANGUAGE CURRENT G9174CJ | $ | 0.00 |
| 3669168 | ST OTHER LANGUAGE CURRENT G9174CK | $ | 0.00 |
| 3669169 | ST OTHER LANGUAGE CURRENT G9174CL | $ | 0.00 |
| 3669170 | ST OTHER LANGUAGE CURRENT G9174CM | $ | 0.00 |
| 3669171 | ST OTHER LANGUAGE CURRENT G9174CN | $ | 0.00 |
| 3669172 | ST OTHER LANGUAGE GOAL G9175CH | $ | 0.00 |
| 3669173 | ST OTHER LANGUAGE GOAL G9175CI | $ | 0.00 |
| 3669174 | ST OTHER LANGUAGE GOAL G9175CJ | $ | 0.00 |
| 3669175 | ST OTHER LANGUAGE GOAL G9175CK | $ | 0.00 |
| 3669176 | ST OTHER LANGUAGE GOAL G9175CL | $ | 0.00 |
| 3669177 | ST OTHER LANGUAGE GOAL G9175CM | $ | 0.00 |
| 3669178 | ST OTHER LANGUAGE GOAL G9175CN | $ | 0.00 |
| 3669179 | ST OTHER LANGUAGE D/C G9176CH | $ | 0.00 |
| 3669180 | ST OTHER LANGUAGE D/C G9176CI | $ | 0.00 |
| 3669181 | ST OTHER LANGUAGE D/C G9176CJ | $ | 0.00 |
| 3669182 | ST OTHER LANGUAGE D/C G9176CK | $ | 0.00 |
| 3669183 | ST OTHER LANGUAGE D/C G9176CL | $ | 0.00 |
| 3669184 | ST OTHER LANGUAGE D/C G9176CM | $ | 0.00 |
| 3669185 | ST OTHER LANGUAGE D/C G9176CN | $ | 0.00 |
| 3669186 | ST MOTOR SPEECH GOAL G9186CH | $ | 0.00 |
| 3669187 | ST MOTOR SPEECH GOAL G9186CI | $ | 0.00 |
| 3669188 | ST MOTOR SPEECH GOAL G9186CJ | $ | 0.00 |
| 3669189 | ST MOTOR SPEECH GOAL G9186CK | $ | 0.00 |
| 3669190 | ST MOTOR SPEECH GOAL G9186CL | $ | 0.00 |
| 3669191 | ST MOTOR SPEECH GOAL G9186CM | $ | 0.00 |
| 3669192 | ST MOTOR SPEECH GOAL G9186CN | $ | 0.00 |
| 26123 | FASCIECTOMY / PART PALMAR RELEASE | $ | 2,405.00 |
| 3206462 | REPAIR SPEGELIAN HERNIA | $ | 3,085.00 |
| 3206651 | BONE MARROW ASPIRATION | $ | 459.00 |
| 3207000 | CATARACT PHACO LT | $ | 5,405.00 |
| 3207002 | INTRACAPSULAR CATARACT EX | $ | 4,504.00 |
| 3207003 | YAG LASER RT | $ | 1,727.00 |
| 3207004 | YAG LASER LT | $ | 1,727.00 |
| 3207009 | YAG LASER BILATERAL | $ | 2,589.00 |
| 3207010 | A SCAN RT | $ | 311.00 |
| 3207011 | ARTHROSCOPY | $ | 4,695.00 |
| 3207012 | FX LAT MALLEOLOUS OPEN REDUC | $ | 5,066.00 |
| 3207013 | CATARACT PHACO BILATERAL | $ | 8,105.00 |
| 3207014 | D & C | $ | 1,645.00 |
| 3207015 | A SCAN LT | $ | 311.00 |
| 3207016 | INTRACAPSULAR CATARACT EX | $ | 4,504.00 |
| 3207017 | LAP CHOLE | $ | 5,354.00 |
| 3207018 | ARTHROSCOPY | $ | 4,695.00 |
| 3207019 | GANGLION CYST | $ | 3,096.00 |
| 3207020 | A SCAN BILATERAL | $ | 589.00 |
| 3207021 | GANGLION CYST | $ | 2,186.00 |
| 3207022 | BENIGN LESION 1.0 | $ | 976.00 |
| 3207023 | BENIGN LESION 1.0 | $ | 932.00 |
| 3207024 | MALIG LESION 1.0 | $ | 933.00 |
| 3207025 | CARPAL TUNNEL RELEASE | $ | 3,109.00 |
| 3207026 | INGUINAL HERNIA REPAIR | $ | 3,623.00 |
| 3207027 | DEPUYTRENS CONTRACTURE RT | $ | 86.00 |
| 3207028 | IMPLANTATION OF MESH | $ | 2,095.00 |
| 3207029 | EXCISION OF CYST/FINGER | $ | 2,186.00 |
| 3207030 | ARTHROSCOPY KNEE | $ | 5,068.00 |
| 3207031 | RELEASE TRIGGER FINGER | $ | 1,958.00 |
| 3207032 | CARPAL TUNNEL RELEASE | $ | 3,109.00 |
| 3207035 | SPERMATOCELE | $ | 2,587.00 |
| 3207036 | BUNIONECTOMY | $ | 4,666.00 |
| 3207037 | CHOLECYSTECTOMY | $ | 6,327.00 |
| 3207038 | ANTEROPOSTERIOR COLPORRAP | $ | 3,808.00 |
| 3207039 | VAGINAL HYSTERECTOMY | $ | 6,750.00 |
| 3207042 | IRIDOTOMY/IRIDECTOMY | $ | 3,759.00 |
| 3207043 | BONE BIOPSY | $ | 1,258.00 |
| 3207044 | ARTHROPLASTY / KNEE / PROSTHE | $ | 6,354.00 |
| 3207045 | OPEN TX OLECRANON | $ | 5,941.00 |
| 3207046 | CLOSED TX PROX HUMERAL MANIP | $ | 3,651.00 |
| 3207047 | REPAIR ANKLE LIGAMENT | $ | 6,024.00 |
| 3207048 | OPEN TX LATERAL MALLEOLUS | $ | 5,066.00 |
| 3207050 | INGUINAL HERNIA | $ | 4,671.00 |
| 3207052 | REPAIR ROTATOR CUFF CHRON | $ | 8,421.00 |
| 3207053 | ADENOIDECTOMY | $ | 1,531.00 |
| 3207054 | TONSILLECTOMY/ADNOIDECTOM | $ | 2,495.00 |
| 3207056 | TONSILLECTOMY/ADNOIDECTOM | $ | 2,603.00 |
| 3207057 | EXC INTERDIGIT NEUROMA | $ | 2,885.00 |
| 3207058 | TRIGGER FINGER RELEASE | $ | 1,958.00 |
| 3207059 | DEBRIDEMENT SKIN SUBQ TIS | $ | 497.00 |
| 3207060 | ING HERNIA REPAIR | $ | 4,076.00 |
| 3207061 | DESTRUC LESION, EXTENSIVE | $ | 1,533.00 |
| 3207062 | CATARACT PHACO RT | $ | 5,405.00 |
| 3207063 | ARTHROTOMY KNEE / EXPLORATION | $ | 6,190.00 |
| 3207064 | SUTURE INFRAPATELL TENDON | $ | 4,972.00 |
| 3207065 | D & C/INCOMPLETE MISCAR | $ | 2,103.00 |
| 3207066 | MYRINGOTOMY/TUBE PLACE | $ | 1,223.00 |
| 3207067 | REMOVAL OF IMPLANT/DEEP | $ | 2,715.00 |
| 3207068 | ARTHROSCOPY KNEE | $ | 5,068.00 |
| 3207069 | MYRINGOTOMY/TUEB PLACE | $ | 1,831.00 |
| 3207070 | MYRINGOTOMY/TUBE PLACE | $ | 1,223.00 |
| 3207071 | REMOVAL OF INPLANT/DEEP | $ | 2,715.00 |
| 3207072 | D&C SEPTIC MISCAR3 | $ | 3,295.00 |
| 3207073 | I&D SUBMUCOSL ABCESS | $ | 1,106.00 |
| 3207074 | EXCIS LESION 1.0 CM | $ | 709.00 |
| 3207075 | RECONST ROTATOR CUFF | $ | 8,711.00 |
| 3207076 | LIGATION OF FALLOPIAN TUB | $ | 2,741.00 |
| 3207077 | RELEASE OF TRIGGER FINGER | $ | 1,958.00 |
| 3207078 | RELEASE OF TRIGGER FINGER | $ | 1,958.00 |
| 3207079 | EXCISION LESION 1.1-2 CM | $ | 821.00 |
| 3207080 | TONSILLECTOMY 12+ | $ | 2,177.00 |
| 3207082 | VASECTOMY | $ | 1,898.00 |
| 3207083 | TONSILLECTOMY/UNDER 12 | $ | 2,176.00 |
| 3207084 | GANGLION CYST | $ | 3,096.00 |
| 3207085 | RELEASE ULNAR NERVE | $ | 3,592.00 |
| 3207086 | OPEN REDUCTION INT / ANKLE | $ | 5,672.00 |
| 3207087 | BREAST BIOPSY INCISIONAL | $ | 1,557.00 |
| 3207089 | RECONST POST TIBIAL TENDO | $ | 4,856.00 |
| 3207093 | TUBAL LIGATION | $ | 2,886.00 |
| 3207096 | EXCISION LESION 2.1-3. | $ | 1,084.00 |
| 3207099 | HAMMERTOE | $ | 3,574.00 |
| 3207100 | HAMMERTOE | $ | 3,574.00 |
| 3207101 | HAMMERTOE | $ | 3,574.00 |
| 3207102 | HAMMERTOE | $ | 3,574.00 |
| 3207103 | HAMMERTOE | $ | 3,574.00 |
| 3207104 | HAMMERTOE | $ | 3,574.00 |
| 3207105 | GANGLION CYST/RECURRENT | $ | 3,711.00 |
| 3207108 | INGUINAL HERNIA/INCAR STR | $ | 4,854.00 |
| 3207110 | EXCISION LESION OVER 4CM | $ | 1,389.00 |
| 3207111 | INGUINAL HERNIA | $ | 3,623.00 |
| 3207115 | DEBRIDE SKIN SUBUT TISSUE | $ | 497.00 |
| 3207124 | ADENOIDECTOMY | $ | 1,531.00 |
| 3207125 | CYSTOURETHROSCPY/FULGURAT | $ | 1,943.00 |
| 3207126 | ARTHOSCOPY | $ | 5,068.00 |
| 3207127 | HEMORRHOID,THROMBOSED EXT | $ | 972.00 |
| 3207128 | CLOSED/DISTAL RADIAL FX | $ | 3,813.00 |
| 3207129 | INCISONAL/VENTRAL HERNIA | $ | 6,501.00 |
| 3207130 | EXCISION LESION 1.0CM | $ | 709.00 |
| 3207131 | EXCIS LYMPH NODE,DEEP | $ | 3,612.00 |
| 3207132 | EXCISION LESION 4CM | $ | 1,389.00 |
| 3207134 | TRIGGER FINGER RELEASE | $ | 1,958.00 |
| 3207135 | CARPAL TUNNEL RELEASE | $ | 3,109.00 |
| 3207136 | EXCISION LESION OVER 4CM | $ | 1,389.00 |
| 3207137 | MYRINGOPLASTY | $ | 2,803.00 |
| 3207138 | SEPTOPLASTY | $ | 5,095.00 |
| 3207139 | ENDOSCOPIC ETHMOIDECTOMY | $ | 3,385.00 |
| 3207143 | PELVIC EXAM | $ | 868.00 |
| 3207144 | CYSTOURETHOSCOPY/TUMOR LG | $ | 4,041.00 |
| 3207146 | ORCHIOPEXY,ING APPROACH | $ | 3,346.00 |
| 3207147 | SLING OPERATION/INCONT | $ | 5,886.00 |
| 3207148 | CYSTOURETHROSCOPY | $ | 860.00 |
| 3207149 | GANGLION CYST | $ | 2,186.00 |
| 3207150 | RELEASE TRIGGER FINGER | $ | 1,958.00 |
| 3207157 | LAPAROSCOPY/LYSIS ADHESIO | $ | 4,859.00 |
| 3207158 | D & C | $ | 1,645.00 |
| 3207159 | CIRCUMCISION | $ | 1,594.00 |
| 3207160 | HEMORRHOIDECTOMY, INT,EXT | $ | 2,357.00 |
| 3207161 | SPHINCTEROTOMY | $ | 1,275.00 |
| 3207166 | AUSTIN BUNIONECTOMY | $ | 5,674.00 |
| 3207167 | HAMMERTOE | $ | 3,574.00 |
| 3207168 | UMBILICAL HERNIA | $ | 3,194.00 |
| 3207172 | SUBMUCOUS RESECT TURBIN | $ | 2,437.00 |
| 3207176 | GANGLION CYST | $ | 2,186.00 |
| 3207177 | INGUINAL HERNIA | $ | 5,435.00 |
| 3207178 | I & D PERIRECTAL ABCESS | $ | 2,508.00 |
| 3207179 | SPHINCTEROTOMY | $ | 1,275.00 |
| 3207181 | INCISIONAL HERNIA REPAIR | $ | 5,475.00 |
| 3207183 | AKIN OSTEOTOMY | $ | 5,163.00 |
| 3207184 | OSTECTOMY PARTIAL METATAR | $ | 3,443.00 |
| 3207185 | EXCISION LESION OVER 4CM | $ | 1,858.00 |
| 3207189 | RELEASE OF TRIIGER FINGER | $ | 1,958.00 |
| 3207191 | UMBILICAL HERNIA | $ | 2,177.00 |
| 3207202 | EXCISION MALIG LESION 4.0 | $ | 1,619.00 |
| 3207205 | TX OF TUBAL PREGNANCY | $ | 5,795.00 |
| 3207206 | AMPUTATION/TRANSMETATARSA | $ | 4,994.00 |
| 3207207 | RECUR/ING HERNIA | $ | 5,520.00 |
| 3207212 | INCISIONAL HERNIA/RECURRE | $ | 5,519.00 |
| 3207216 | UMBILICAL HERNIA/INCARCER | $ | 3,650.00 |
| 3207217 | REMOVAL SKIN TAGS | $ | 333.00 |
| 3207218 | HEMORRHOIDECTOMY/INTERNAL | $ | 2,176.00 |
| 3207221 | RELEASE TENDON WRIST | $ | 3,374.00 |
| 3207222 | GANGLION CYST WRIST | $ | 3,096.00 |
| 3207223 | BIOPSY UPPER EYE LID | $ | 905.00 |
| 3207225 | UMBILICAL HERNIA | $ | 3,194.00 |
| 3207226 | FRENULOTOMY | $ | 1,296.00 |
| 3207228 | MYRINGOTOMY/TUBE PLACE | $ | 1,223.00 |
| 3207236 | APPENDECTOMY, LAPROSCOPIC | $ | 4,076.00 |
| 3207238 | PILONIDAL CYST | $ | 1,207.00 |
| 3207239 | INCOMPLETE ABORTION | $ | 2,103.00 |
| 3207240 | ARTHROS DEBRIDEMENT/SHAVI | $ | 4,486.00 |
| 3207242 | CLOSED/DISTAL RADIAL FX | $ | 3,813.00 |
| 3207243 | COLONOSCOPY | $ | 5,138.00 |
| 3207244 | EXCISION CYST/FINGER | $ | 2,186.00 |
| 3207245 | EXCISON/CYST FINGER | $ | 2,186.00 |
| 3207247 | ENTROPIAN REPAIR | $ | 3,415.00 |
| 3207249 | NASALPHARYNGOSCOPY | $ | 377.00 |
| 3207252 | HAMMERTOE | $ | 3,574.00 |
| 3207254 | PILONIDAL CYST/EXTENSIVE | $ | 3,021.00 |
| 3207256 | REMOVAL OF IMPLANT DEEP | $ | 2,715.00 |
| 3207260 | EXCISION CYST/BREAST | $ | 2,718.00 |
| 3207262 | INCISIONAL VENTRAL HERNIA | $ | 6,501.00 |
| 3207263 | DEBRIDEMENT SKIN SUBQ TIS | $ | 497.00 |
| 3207266 | CLOSED REDUCTION SHOULDER | $ | 2,802.00 |
| 3207267 | EXCIS MALIGNANT LESION 2. | $ | 1,095.00 |
| 3207272 | NEUROPLASTY ULNAR NERVE | $ | 3,592.00 |
| 3207277 | HAMMER TOE | $ | 3,574.00 |
| 3207279 | I & D OF ABCESS | $ | 564.00 |
| 3207282 | BONE MARROW BIOPSY NEEDLE | $ | 575.00 |
| 3207284 | LAPAROSCOPY | $ | 3,575.00 |
| 3207285 | EXCIS TUMOR,TISSUE/ELBOW | $ | 2,139.00 |
| 3207286 | EXCISION, OLECRANON BURSA | $ | 2,803.00 |
| 3207287 | TRANSURETHRAL RESECTION | $ | 5,417.00 |
| 3207288 | AUSTIN BUNIONECTOMY | $ | 5,674.00 |
| 3207292 | CAPSULOTOMY | $ | 2,628.00 |
| 3207297 | EGD | $ | 2,715.00 |
| 3207298 | OSTECTOMY FOR SPUR | $ | 3,650.00 |
| 3207304 | EXCISION LESION, TENDON | $ | 3,166.00 |
| 3207305 | FEMORAL HERNIA/INCARCERA | $ | 4,468.00 |
| 3207310 | I & D HEMATOMA,SEROMA,FLU | $ | 820.00 |
| 3207314 | REMOVAL OF IMPLANT/DEEP | $ | 2,715.00 |
| 3207316 | PALATOPHARYNGOPLASTY | $ | 4,757.00 |
| 3207317 | REPAIR OF BLEPHAROPLASTY | $ | 3,797.00 |
| 3207321 | EXCISION LESION 4.0 OVER | $ | 2,093.00 |
| 3207323 | CLOSED TX DISTAL RADIAL F | $ | 1,801.00 |
| 3207325 | INGUINAL HERNIA/INCAR | $ | 4,854.00 |
| 3207327 | MICROSURGICAL TECHNIQUE | $ | 1,732.00 |
| 3207332 | EXCISION LESION,TENDON | $ | 3,166.00 |
| 3207333 | UMBILECTOMY,EXCIS UMBIL | $ | 4,219.00 |
| 3207334 | INGUINAL HERNIA | $ | 4,671.00 |
| 3207337 | CYSTOURETHROSCOPY/CALIBRA | $ | 1,206.00 |
| 3207340 | EXC INTERDIGIT NEUROMA | $ | 2,885.00 |
| 3207341 | EXCISION OF LESION 1.1-2 | $ | 821.00 |
| 3207342 | ESCISION OF LESION 1.1-2 | $ | 821.00 |
| 3207343 | EXCISION OF LESION 3.1-4 | $ | 1,083.00 |
| 3207344 | UMBILICAL HERNIA/INCARERA | $ | 3,650.00 |
| 3207345 | METACARPAL FX/SKELETON FI | $ | 4,482.00 |
| 3207346 | SUBMUCOUS RESECT TURBIN | $ | 3,657.00 |
| 3207347 | APPENDECTOMY | $ | 4,543.00 |
| 3207352 | EGD/FOREIGN BODY REMOV | $ | 2,986.00 |
| 3207354 | TYMPANOSOTMY/LOCAL,TOP | $ | 1,098.00 |
| 3207358 | RETINA/COAGULATION | $ | 4,108.00 |
| 3207359 | BIOPSY/EXCIS LYMPH NODE | $ | 1,711.00 |
| 3207360 | TYMPANOSTOMY/LOCAL OR TOP | $ | 733.00 |
| 3207362 | D & C POSTPARTUM | $ | 1,582.00 |
| 3207363 | EXCISION TUMOR, DEEP | $ | 4,236.00 |
| 3207365 | D & C/ 1ST TRIMESTER | $ | 2,184.00 |
| 3207366 | HYSTEROSCOPY/BIOPSY | $ | 2,177.00 |
| 3207374 | EXCISION, TUMOR, FOOT | $ | 2,716.00 |
| 3207375 | ADENOIDECTOMY | $ | 1,609.00 |
| 3207377 | EXCISION NAIL/NAIL MATRIX | $ | 1,019.00 |
| 3207378 | UMBILICAL HERNIA/INCARCER | $ | 3,574.00 |
| 3207382 | LAP VAG HYS/TUBES/OVARIES | $ | 6,853.00 |
| 3207383 | TUBAL LIGATION/POST PARTU | $ | 2,497.00 |
| 3207384 | PHOTOCOAGULATION | $ | 6,043.00 |
| 3207385 | CESAREAN SECTION | $ | 7,445.00 |
| 3207386 | APPENDECTOMY | $ | 5,600.00 |
| 3207388 | TEMPORAL ARTERY BIOPSY | $ | 1,694.00 |
| 3207390 | AMPUTATION TOE/METARSOPHA | $ | 2,450.00 |
| 3207391 | EXCISION OF LESION 1.1-2. | $ | 1,041.00 |
| 3207392 | ADENOIDECTOMY/SECONDARY | $ | 1,664.00 |
| 3207393 | EXCISION CYST/BREAST | $ | 2,718.00 |
| 3207396 | BIOPSY,TISSUE NECK/THORAX | $ | 1,009.00 |
| 3207399 | EXC HYPERPLASTIC ALVEOLAR | $ | 1,692.00 |
| 3207405 | DISLOC ATHROPLASTY HIP | $ | 4,796.00 |
| 3207406 | VENTRAL HERNIA INCAR/RECU | $ | 6,575.00 |
| 3207408 | REP RUPTOR ACHILLES TEND | $ | 6,154.00 |
| 3207409 | HEMORRHOIDECTOMY EXT/INT | $ | 3,240.00 |
| 3207410 | LIGATION VARICOSE VEIN | $ | 2,095.00 |
| 3207411 | AUSTIN BUNIONECTOMY | $ | 5,674.00 |
| 3207416 | GASTRORRHAPHY | $ | 7,026.00 |
| 3207417 | EXPLORATORY LAP | $ | 5,588.00 |
| 3207418 | I & D/HEMATOMA | $ | 2,723.00 |
| 3207419 | OCCLUSION OF FALLOPIAN TU | $ | 2,190.00 |
| 3207420 | ARTHROSCOPY,SHOULDER/DECO | $ | 6,697.00 |
| 3207423 | LAPAROSCOPY,SALPIN-OOPHOR | $ | 4,079.00 |
| 3207424 | LAPAROSCOPY OVARIAN CYST | $ | 2,552.00 |
| 3207425 | TOTAL ABDOMINAL HYSTER | $ | 7,294.00 |
| 3207426 | ENTEROLYSIS | $ | 7,334.00 |
| 3207428 | EXCISION/CYST/FINGER | $ | 2,186.00 |
| 3207432 | ARTHROPLASTY,TOTAL HIP | $ | 10,790.00 |
| 3207433 | TUBAL LIGATION/C SECTION | $ | 624.00 |
| 3207437 | ARTHROPLASTY,TOTAL HIP | $ | 10,790.00 |
| 3207438 | ARTHROPLASTY/METATARSAL | $ | 3,974.00 |
| 3207440 | EXCIS MALIG LESION 0.6-1. | $ | 932.00 |
| 3207441 | ENDOCERVICAL CURETTAGE | $ | 643.00 |
| 3207442 | ENDOMETRIAL BIOPSY | $ | 696.00 |
| 3207444 | CYSTOMETROGRAM/SIMPLE | $ | 2,014.00 |
| 3207446 | CLAVICULECTOMY/PARTIAL | $ | 5,344.00 |
| 3207450 | CYSTOURETHROSCOPY/DIAG | $ | 2,489.00 |
| 3207457 | CYSTOSCOPY & URETER CATHE | $ | 1,019.00 |
| 3207458 | CYSTOGRAM/SIMPLE | $ | 2,014.00 |
| 3207459 | BIOPSY OF PROSTATE | $ | 709.00 |
| 3207460 | DIAG LARYNGOSCOPY | $ | 1,267.00 |
| 3207461 | PROSTATECTOMY 1ST STAGE | $ | 5,417.00 |
| 3207462 | INCISION OF PROSTATE | $ | 3,471.00 |
| 3207463 | ING HERNIA/RECURRENT | $ | 5,520.00 |
| 3207464 | CYSTOSCOPY & URETER CATH | $ | 1,019.00 |
| 3207467 | EXCISION LESION 0.6-1.0CM | $ | 797.00 |
| 3207469 | INCISION/REMOVAL FB | $ | 628.00 |
| 3207470 | TEMPORAL ARTERY BIOPSY | $ | 1,694.00 |
| 3207472 | AMPUTAION METATARSAL | $ | 4,392.00 |
| 3207475 | REVISION OF ILEOSTOMY | $ | 3,739.00 |
| 3207480 | MALIG LESION -1.0 | $ | 1,083.00 |
| 3207483 | MALIG LESION -1.0 | $ | 1,083.00 |
| 3207489 | CYSTOURETHROSCOPY/DILATIO | $ | 1,159.00 |
| 3207490 | CYSTOURETHROSCOPY,FULG,ME | $ | 2,285.00 |
| 3207491 | ENDOSCOPIC INJECTION | $ | 1,543.00 |
| 3207492 | ORCHIECTOMY,SIMPLE | $ | 3,898.00 |
| 3207494 | EXCISION LESION 1.1- 2CM | $ | 821.00 |
| 3207501 | I&D RECTAL ABCESS | $ | 2,931.00 |
| 3207503 | ARTHROSCOPY,DEBRIDE/SHAV | $ | 4,486.00 |
| 3207504 | ARTHROSCOPY/REMOVAL FB | $ | 1,275.00 |
| 3207505 | CYSTOURETHROSCOPY/REM FB | $ | 1,192.00 |
| 3207507 | BIOPSY/EXCIS LYMPH NODE | $ | 1,711.00 |
| 3207514 | EXCISION LESION 4CM | $ | 1,389.00 |
| 3207516 | EXCISION OF LESION 3.1-4C | $ | 1,266.00 |
| 3207517 | EXCISON OF LESION 1.1-2CM | $ | 821.00 |
| 3207526 | TENOTOMY | $ | 1,940.00 |
| 3207532 | ARTHROSCOPY SHOULDER/DECO | $ | 6,697.00 |
| 3207533 | EXCISION,TUMOR FOOT DEEP | $ | 2,470.00 |
| 3207534 | EXCISON,TUMOR,FOOT,DEEP | $ | 2,470.00 |
| 3207536 | AVULSION OF NAIL | $ | 490.00 |
| 3207537 | EXCISION OF LESION | $ | 611.00 |
| 3207538 | AUSTIN BUNIONECTOMY | $ | 5,674.00 |
| 3207539 | EXCISON,TUMOR,FOOT | $ | 2,716.00 |
| 3207541 | OPEN TX METATARSAL FX | $ | 3,294.00 |
| 3207545 | PROSTATECTOMY/LYMPHADENEC | $ | 9,176.00 |
| 3207546 | EXCISION/FULGUR URE POLYP | $ | 1,366.00 |
| 3207550 | REPAIR LOWER LEG TENDON | $ | 3,822.00 |
| 3207551 | REMOVAL PIN/SIMPLE | $ | 1,634.00 |
| 3207552 | REMOVAL TOE LESIONS | $ | 2,099.00 |
| 3207553 | REDUCTION MAMMAPLASTY | $ | 12,870.00 |
| 3207554 | CHOLECYSTECTOMY/EXP DUCT | $ | 7,746.00 |
| 3207555 | CHOLECYSTECTOMY/CHOLANGIO | $ | 6,130.00 |
| 3207557 | RECONST POST TIBIAL TENDO | $ | 4,856.00 |
| 3207560 | INCISIONAL HERNIA REPAIR | $ | 5,475.00 |
| 3207561 | VAGINAL HYSTERECTOMY | $ | 6,736.00 |
| 3207562 | REPAIR BLADDER & VAGINA | $ | 2,844.00 |
| 3207563 | REMOVAL BLADDER LESION | $ | 5,185.00 |
| 3207564 | MYRINGOTOMY/TUBE PLACE | $ | 1,831.00 |
| 3207566 | ESCISION TONGUE FOLD | $ | 1,206.00 |
| 3207567 | COLOPEXY INTRA PERITONEAL | $ | 4,103.00 |
| 3207568 | COLONOSCOPY/BIOPSY | $ | 4,536.00 |
| 3207569 | TOTAL KNEE ARTHROPLASTY | $ | 10,661.00 |
| 3207570 | REPAIR HALLUX RIGIDUS W/O IMPLANT | $ | 3,887.00 |
| 3207571 | FX GREAT TOE TREATMENT | $ | 1,005.00 |
| 3207572 | EXCISION OF PENIS LESION | $ | 953.00 |
| 3207574 | CYSTOURETHROSCOPY/TUMOR L | $ | 4,041.00 |
| 3207575 | EXCISION,LESION 1.0 | $ | 797.00 |
| 3207576 | AUSTIN BUNIONECTOMY | $ | 5,674.00 |
| 3207577 | CYSTOSCOPY/FULGURATION | $ | 1,217.00 |
| 3207578 | BIOPSY OF PROSTATE | $ | 709.00 |
| 3207579 | LAPAROSCOPY/BIOPSY | $ | 2,339.00 |
| 3207580 | REMOVAL OF SKIN TAG | $ | 333.00 |
| 3207581 | CAPSULOTOMY | $ | 2,628.00 |
| 3207582 | HAMMERTOE | $ | 3,574.00 |
| 3207583 | CAPSULOTOMY/INTERPHAL JT | $ | 2,940.00 |
| 3207584 | TENOTOMY | $ | 1,940.00 |
| 3207585 | BIOPSY/EXCIS LYMPH NODE | $ | 1,711.00 |
| 3207587 | LYSIS PENILE LESION | $ | 1,412.00 |
| 3207588 | PARTIAL REMOVAL OF COLON | $ | 8,695.00 |
| 3207589 | OSTECTOMY, CALCANEOUS | $ | 3,083.00 |
| 3207590 | TUBAL LIGATION/POST PARTU | $ | 2,497.00 |
| 3207591 | REMOVAL ABD WALL LESION | $ | 2,634.00 |
| 3207592 | EXPLORATION/ABD,FLANK,BAC | $ | 1,663.00 |
| 3207593 | LITHOTRIPSY,EXTRACORPOREA | $ | 5,130.00 |
| 3207594 | LYMPHADENECTOMY/PELVIC | $ | 4,713.00 |
| 3207595 | TENOTOMY/GEN ANESTH | $ | 2,221.00 |
| 3207596 | PARTIAL EXCIS CALCANEOUS | $ | 3,050.00 |
| 3207597 | EXTRACAPSULAR CATARACT | $ | 6,495.00 |
| 3207598 | EXCIS LESION UVULA | $ | 900.00 |
| 3207599 | EXCISION NAIL/NAIL MATRIX | $ | 1,019.00 |
| 3207600 | CAPSULOTOMY | $ | 2,628.00 |
| 3207601 | CAPSULOTOMY | $ | 2,628.00 |
| 3207602 | OSTECTOMY,PARTIAL | $ | 2,917.00 |
| 3207603 | AMPUTATION LOWER LEG | $ | 5,649.00 |
| 3207604 | ARTHROSCOPIC ROTATOR CUFF | $ | 7,791.00 |
| 3207605 | TENOTOMY SHOULDER | $ | 4,513.00 |
| 3207606 | INSERT PERIPHER CENT VEIN 5YRS> | $ | 2,295.00 |
| 3207607 | EXCIS LESION 1.0 CM | $ | 709.00 |
| 3207608 | BENIGN LESION 1.0 CM | $ | 976.00 |
| 3207609 | ORCHIECTOMY/RADICAL | $ | 3,647.00 |
| 3207610 | CYSTOSCOPY/STENT | $ | 1,106.00 |
| 3207611 | CYSTOURETHROSCOPY/FULGURA | $ | 1,943.00 |
| 3207612 | LAPAROSCOPY/LYSIS ADHESIO | $ | 4,859.00 |
| 3207613 | CONIZATION OF CERVIX | $ | 2,002.00 |
| 3207614 | ENDOCERVICAL CURRETAGE | $ | 643.00 |
| 3207615 | ARTHRODESIS/TOE | $ | 4,076.00 |
| 3207616 | SALPINGO-OOPHORECTOMY | $ | 4,995.00 |
| 3207617 | BIOPSY/EXCISION LESION | $ | 424.00 |
| 3207618 | OPEN REDUCTION INT/ANKLE | $ | 5,672.00 |
| 3207619 | REVISION URINARY ANASTOMO | $ | 3,768.00 |
| 3207620 | REMOVAL FB DEEP/COMPLICA | $ | 1,786.00 |
| 3207621 | ENTERECTOMY/RESEC SM INTE | $ | 6,972.00 |
| 3207622 | INSERT CENTRAL VENOUS CAT | $ | 901.00 |
| 3207623 | REVISION OF ILEOSTOMY | $ | 6,154.00 |
| 3207624 | REMOVAL FB DEEP/COMPLICA | $ | 1,786.00 |
| 3207625 | EXCISION NAIL/MATRIX | $ | 1,019.00 |
| 3207626 | EXCISION OF NAIL/MATRIX | $ | 1,019.00 |
| 3207627 | EXCISION OF NAIL/MATRIX | $ | 1,019.00 |
| 3207628 | RETINA/COAGULATION | $ | 4,108.00 |
| 3207629 | PROCTECTOMY/COMPLETE | $ | 11,649.00 |
| 3207630 | ORCHIECTOMY/RADICAL | $ | 3,647.00 |
| 3207631 | LITHOTRIPSY/EXTRACORPOREA | $ | 4,755.00 |
| 3207632 | EXCISION HYDROCELE | $ | 2,354.00 |
| 3207633 | REMOVAL FB DEEP/COMPLICAT | $ | 1,786.00 |
| 3207634 | INCISION TOE TENDON | $ | 2,448.00 |
| 3207635 | SALPINGECTOMY | $ | 5,058.00 |
| 3207636 | CYSTOSTOMY | $ | 2,044.00 |
| 3207637 | REPAIR BLADDER WOUND | $ | 5,119.00 |
| 3207638 | CYSTOSCOPY/ STENT | $ | 1,106.00 |
| 3207639 | AMPUTATION/ IP JOINT | $ | 2,051.00 |
| 3207640 | REMOVAL SHOULDER LESION | $ | 3,874.00 |
| 3207641 | EXCISION LESION 1.1-2CM | $ | 821.00 |
| 3207642 | IRRIGATION OF BLADDER | $ | 333.00 |
| 3207643 | LAPAROSCOPY, TUBAL BLOCK | $ | 3,618.00 |
| 3207644 | CONIZATION OF CERVIX | $ | 2,002.00 |
| 3207645 | OSTECTOMY FOR SPUR | $ | 3,650.00 |
| 3207646 | INCISION / PYLORIC MUSCLE | $ | 4,492.00 |
| 3207647 | OPEN REDUCTION ANKLE FX | $ | 4,614.00 |
| 3207648 | REPAIR BLADDER AND VAGINA | $ | 2,844.00 |
| 3207649 | DISLOC ARTHROPLASTY HIP | $ | 4,796.00 |
| 3207650 | REMOVAL PROSTATE REGROWTH | $ | 2,969.00 |
| 3207651 | INGUINAL HERNIA/INCARCER | $ | 4,854.00 |
| 3207652 | CYSTOSTOMY | $ | 2,044.00 |
| 3207653 | CYSTOSCOPY & URTETER CATH | $ | 1,019.00 |
| 3207654 | REMOVAL/IMPACTED CERUMEN | $ | 263.00 |
| 3207655 | COLONOSCOPY/POLYP/SNARE | $ | 555.00 |
| 3207656 | SERVERING/VITREOUS STRAND | $ | 2,032.00 |
| 3207657 | INTESTINAL PLICATION | $ | 6,438.00 |
| 3207659 | I& D/APPENDICEAL ABSCESS | $ | 4,370.00 |
| 3207660 | APPENDECTOMY/ ADD ON | $ | 4,234.00 |
| 3207661 | LAPARO/SLING OPERATION | $ | 5,863.00 |
| 3207662 | EXCISION LESION 2.1-3. | $ | 1,084.00 |
| 3207663 | BIOPSY OVARY | $ | 969.00 |
| 3207664 | COLONOSCOPY/COLOSTOMY | $ | 1,296.00 |
| 3207665 | LITHOLAPAXY | $ | 3,505.00 |
| 3207666 | CYSTOSCOPY/STENT | $ | 1,106.00 |
| 3207667 | EXCISION INTESTINE LESION | $ | 5,032.00 |
| 3207668 | BUNIONECTOMY/DBL OSTEOTOM | $ | 4,886.00 |
| 3207669 | BUNIONECTOMY/DBL OSTEOTOM | $ | 4,886.00 |
| 3207670 | OSTEOTOMY OF METATARSAL | $ | 2,623.00 |
| 3207671 | DRAINAGE/ HYDROCELE | $ | 592.00 |
| 3207672 | INGUINAL HERNIA 6MOS-5YO | $ | 3,842.00 |
| 3207673 | FLEX SIGMOID/ POLYPECTOMY | $ | 743.00 |
| 3207674 | MARSUPIALIZATION/BARTHOLI | $ | 1,329.00 |
| 3207675 | REMOVAL HYDROCELE | $ | 2,502.00 |
| 3207676 | VASECTOMY | $ | 1,898.00 |
| 3207677 | CYSTOURETHROSCOPY/STONE M | $ | 1,937.00 |
| 3207678 | CYSTOSCOPY / STENT | $ | 1,106.00 |
| 3207679 | EVACUATE MOLE OF UTERUS | $ | 3,234.00 |
| 3207680 | BUNION/ CORRECTION | $ | 4,666.00 |
| 3207681 | BONE MARROW/ASPIRATION | $ | 459.00 |
| 3207682 | EXCISION OF LESION | $ | 557.00 |
| 3207683 | FEMORAL HERNIA REPAIR | $ | 4,770.00 |
| 3207684 | RECTOCELE REPAIR | $ | 4,543.00 |
| 3207685 | CIRCUMCISION | $ | 1,594.00 |
| 3207686 | CYSTOURETHROSCOPY | $ | 860.00 |
| 3207687 | CYSTOSCOPY/BIOP/FULGURATI | $ | 2,858.00 |
| 3207688 | REVISON LOWER LEG TENDON | $ | 3,505.00 |
| 3207689 | UNLISTED PROCEDURE | $ | 0.00 |
| 3207690 | ARTHROTOMY ANKLE | $ | 4,694.00 |
| 3207691 | TRANSFER SINGLE TENDON | $ | 6,715.00 |
| 3207695 | AMPUTATION / IP JOINT | $ | 2,051.00 |
| 3207696 | TENOTOMY / TOE | $ | 1,937.00 |
| 3207697 | TENOTOMY / TOE | $ | 1,937.00 |
| 3207699 | ANTEROPOSTERIOR COLPORRAP | $ | 3,808.00 |
| 3207700 | PARTIAL EXCISION TOE | $ | 3,941.00 |
| 3207701 | REVISION OF TOE | $ | 2,624.00 |
| 3207702 | PARTIAL REMOVAL BONE/FOOT | $ | 3,665.00 |
| 3207703 | REMOVAL IMPLANT / DEEP | $ | 2,715.00 |
| 3207704 | OSTEOTOMY / METATARSAL | $ | 2,623.00 |
| 3207705 | CYSTOURETHROSCOPY/REM FB | $ | 1,192.00 |
| 3207706 | EXCISION HYDROCELE | $ | 2,354.00 |
| 3207707 | CYSTOSCOPY/ DILATION | $ | 1,521.00 |
| 3207708 | ANORECTAL EXAM ANESTHESIA | $ | 746.00 |
| 3207709 | BUNIONECTOMY/ DBI OSTEOTO | $ | 4,886.00 |
| 3207710 | LAPARO/ SLING OPERATION | $ | 5,863.00 |
| 3207711 | EXCISION/TUMOR/FOOT/DEEP | $ | 2,470.00 |
| 3207712 | OPEN TX METATARSAL FX | $ | 3,294.00 |
| 3207713 | EXC INTERDIGIT NEUROMA | $ | 2,885.00 |
| 3207714 | RECONSTRUC EXTERNAL CANAL | $ | 7,579.00 |
| 3207715 | COLONOSCOPY/COLOS/LESION | $ | 1,929.00 |
| 3207716 | CAPSULOTOMY | $ | 2,628.00 |
| 3207717 | METACARPAL FX/SKELETON FI | $ | 4,482.00 |
| 3207718 | BREAST BIOPSY | $ | 1,557.00 |
| 3207719 | REMOVAL OF OVARYS | $ | 3,109.00 |
| 3207720 | BIL-SALP-OOPHOR ABD HYSTE | $ | 9,471.00 |
| 3207721 | EXC INTERDIGIT NEUROMA | $ | 2,885.00 |
| 3207722 | EXC INTERDIGIT NEUROMA | $ | 2,885.00 |
| 3207723 | CAPUSLOTOMY | $ | 2,628.00 |
| 3207724 | CYSTOURETHROSCOPY/ STONE | $ | 1,937.00 |
| 3207725 | REPAIR BOWEL OPENING | $ | 6,287.00 |
| 3207726 | INCISE/GRACFT MIDFOOT BON | $ | 5,017.00 |
| 3207727 | EXOSTECTOMY HALLUX | $ | 2,917.00 |
| 3207728 | CYSTOSCOPY/ TREATMENT | $ | 1,408.00 |
| 3207729 | ARTHODESIS/INTERPHAL JT | $ | 3,592.00 |
| 3207730 | INCISE/GRAFT MIDFT BONES | $ | 5,017.00 |
| 3207731 | INCISION METATARSAL | $ | 2,623.00 |
| 3207732 | ARTHROSCOPY/ LAT RELEASE | $ | 3,689.00 |
| 3207733 | ARTHROSCOPY/REMOVAL FB | $ | 1,275.00 |
| 3207734 | TIBIA FRACTURE TREATMENT | $ | 3,905.00 |
| 3207735 | RECTUM/ BIOPSY | $ | 1,753.00 |
| 3207736 | ANORECTAL EXAM | $ | 746.00 |
| 3207737 | BUNION/ CORRECTION | $ | 4,666.00 |
| 3207739 | BUNION / CORRECTION | $ | 4,543.00 |
| 3207741 | EXCISION TUMOR/DEEP KNEE | $ | 3,993.00 |
| 3207742 | ARTHROSCOPY/ REMOVAL FB | $ | 1,275.00 |
| 3207743 | COLONOSCOPY, SUBMUCOUS IN | $ | 450.00 |
| 3207744 | CAUTERIZATION OF CERVIX | $ | 281.00 |
| 3207745 | PROCTOSIGMOIDOSCOPY/BIOPSY | $ | 438.00 |
| 3207746 | GASTROSTOMY TUBE PLACEMEN | $ | 1,725.00 |
| 3207747 | ELBOW DISLOCATION | $ | 3,158.00 |
| 3207748 | RELEASE ULNAR NERVE | $ | 3,592.00 |
| 3207749 | PERCUT PIN FIXATION FING | $ | 3,333.00 |
| 3207750 | VAGINAL SEPTUM | $ | 422.00 |
| 3207751 | HYMENECTOMY / PARTIAL | $ | 1,266.00 |
| 3207752 | REMOVAL FB EAR | $ | 841.00 |
| 3207753 | UNLISTED PRCEDURE FOOT | $ | 786.00 |
| 3207754 | RETINAL PHOTO COAG/ LASER | $ | 2,868.00 |
| 3207755 | EXCIS BENIGN LESION 0.5CM | $ | 760.00 |
| 3207756 | CERVICAL CERCLAGE | $ | 1,165.00 |
| 3207757 | TURBINOPLASTY | $ | 841.00 |
| 3207758 | OSTECTOMY/ PARTIAL METATA | $ | 3,443.00 |
| 3207759 | INCISON OF METATARSAL | $ | 2,486.00 |
| 3207760 | AMPUTATION TOE | $ | 2,450.00 |
| 3207761 | INCISION OF TOE TENDON | $ | 1,937.00 |
| 3207762 | INSICION OF TOE TENDON | $ | 1,937.00 |
| 3207763 | TENOTOMY | $ | 1,940.00 |
| 3207765 | REMOVAL EPIDIDYMIS | $ | 2,731.00 |
| 3207766 | REMOVAL EPIDIDYMIS LESION | $ | 820.00 |
| 3207767 | DESTRUCTION PENIS LESION | $ | 333.00 |
| 3207768 | REPAIR WOUND OR LESION | $ | 727.00 |
| 3207769 | REMOVAL DIGIT NERVE LESIO | $ | 2,587.00 |
| 3207770 | DIGIT NERVE ADD-ON | $ | 1,369.00 |
| 3207771 | INSERT URETERAL SUPPORT | $ | 6,416.00 |
| 3207772 | CYSTOURETHROSCOPY/ FULGUR | $ | 1,943.00 |
| 3207773 | PROSTATECTOMY/RADICAL/LYM | $ | 9,734.00 |
| 3207774 | TONSILLECTIOMY/ADENOID | $ | 2,495.00 |
| 3207775 | I & D OF ABCESS | $ | 254.00 |
| 3207776 | TENOTOMY / TOE | $ | 1,937.00 |
| 3207778 | HAMMERTOE | $ | 3,574.00 |
| 3207779 | TENOTOMY | $ | 1,937.00 |
| 3207780 | TENOTOMY | $ | 1,937.00 |
| 3207781 | BUNION / CORRECTION | $ | 4,666.00 |
| 3207782 | BUNION/ CORRECTION | $ | 4,543.00 |
| 3207783 | TENOTOMY | $ | 1,937.00 |
| 3207784 | VAGINAL HYSTERECOTMY T/O | $ | 6,496.00 |
| 3207785 | MARSUPIALIZATION/BARTHOLN | $ | 1,329.00 |
| 3207786 | LAPAROSCOPY | $ | 3,575.00 |
| 3207787 | LAPAROSCOPY/EXCISE LESION | $ | 5,161.00 |
| 3207788 | BONE MARROW ASPIRATION | $ | 459.00 |
| 3207789 | RESECTION TUMOR FOOT | $ | 4,887.00 |
| 3207790 | HEMORRHOIDECTOMY EXT/INTE | $ | 3,240.00 |
| 3207791 | PHOTOCOAGULATION | $ | 6,043.00 |
| 3207792 | EXCISION / TUMOR MPJ | $ | 2,470.00 |
| 3207793 | EXCISION / TUMOR MPJ | $ | 2,470.00 |
| 3207794 | INCISE BLADDER/ DRAIN URE | $ | 3,050.00 |
| 3207795 | CYSTOGRAM / SIMPLE | $ | 2,014.00 |
| 3207796 | REMOVAL OF METATARSAL | $ | 3,419.00 |
| 3207797 | PARTIAL REMOVAL OF TOE | $ | 814.00 |
| 3207798 | FIXATION OF KNEE JOINT | $ | 1,039.00 |
| 3207799 | DEBRIDE ABDOMINAL WALL | $ | 5,509.00 |
| 3207800 | REMOVAL MESH | $ | 2,071.00 |
| 3207801 | INGUINAL HERNIA 6MOS-5YR | $ | 2,525.00 |
| 3207803 | HYSTEROSCOPY, ABLATION | $ | 2,205.00 |
| 3207804 | HYSTEROSCOPY, BIOPSY | $ | 2,177.00 |
| 3207805 | EXCISION OF UVULA | $ | 1,506.00 |
| 3207806 | AKIN OSTEOTOMY | $ | 5,163.00 |
| 3207807 | REDUCE TESTIS TORSION | $ | 4,505.00 |
| 3207809 | EXCISION OF UVULA | $ | 1,506.00 |
| 3207810 | LAPAROSCOPY,TUBAL BLOCK | $ | 3,618.00 |
| 3207811 | REPAIR DETACHED RETINA / PHOTOCOAG | $ | 3,786.00 |
| 3207812 | HAMMERTOE | $ | 3,574.00 |
| 3207813 | FUSION / FOOT BONES | $ | 5,417.00 |
| 3207814 | REMOVAL FB / DEEP | $ | 3,177.00 |
| 3207815 | INCISION OF METATARSALS | $ | 2,623.00 |
| 3207816 | COLONOSCOPY | $ | 1,106.00 |
| 3207817 | HEMORRHOID TAG REMOVAL | $ | 1,312.00 |
| 3207818 | DESTRUCTION ANAL LESION | $ | 289.00 |
| 3207819 | ENDOMETRIAL ABLATION/THER | $ | 1,637.00 |
| 3207820 | EXCHANGE LENS PROSTHESIS | $ | 5,993.00 |
| 3207821 | SEPTOPLASTY | $ | 5,095.00 |
| 3207822 | LAPRO-VAG HYST COMPLEX | $ | 8,205.00 |
| 3207823 | REMOV LESION BACK/FLANK | $ | 2,461.00 |
| 3207824 | EXCISION CYST / BREAST | $ | 2,718.00 |
| 3207825 | BREAST BIOPSY INCISIONAL | $ | 1,557.00 |
| 3207826 | SUBMUCOUS RESECTION TURBI | $ | 3,657.00 |
| 3207827 | ADENOIDECTOMY | $ | 1,609.00 |
| 3207828 | MYRINGOTOMY / TUBE PLACE | $ | 1,223.00 |
| 3207829 | HEMORRHOIDECTOMY/INTERNAL | $ | 1,211.00 |
| 3207830 | REMOVAL IMPLANT / DEEP | $ | 2,715.00 |
| 3207831 | BUNIONECTOMY/ DBL OSTEOTO | $ | 4,886.00 |
| 3207832 | EXCISION / TUMOR MPJ | $ | 2,470.00 |
| 3207833 | CAPSULOTOMY/ INTERPHAL JT | $ | 2,940.00 |
| 3207834 | REMOVAL OF VITREOUS | $ | 2,536.00 |
| 3207835 | EXPLORATORY LAP | $ | 5,588.00 |
| 3207836 | RELEASE TRIGGER FINGER | $ | 1,958.00 |
| 3207837 | ENDOSCOPIC INJECTION | $ | 1,543.00 |
| 3207838 | REMOVAL OF SPLEEN | $ | 6,130.00 |
| 3207839 | CYSTOSCOPY / DILATION | $ | 1,521.00 |
| 3207840 | YAG LASER | $ | 1,727.00 |
| 3207841 | INCISIONAL HERNIA/RECURRE | $ | 5,519.00 |
| 3207842 | EXCISION LESION 1.0 | $ | 797.00 |
| 3207844 | HAMMERTOE | $ | 3,574.00 |
| 3207845 | CYSTOURETORO W/ LITHOTRIP | $ | 3,095.00 |
| 3207846 | REVISION OF BIG TOE | $ | 2,624.00 |
| 3207847 | INCISE/GRAFT MIDFOOT BONE | $ | 5,017.00 |
| 3207848 | HAMMERTOE | $ | 3,574.00 |
| 3207849 | TENOTOMY | $ | 1,940.00 |
| 3207850 | UNLISTED PROCEDURE FOOT | $ | 786.00 |
| 3207851 | EXCHANGE LENS PROSTHESIS | $ | 5,993.00 |
| 3207852 | EXCISION MALIG LESION 4.0 | $ | 1,619.00 |
| 3207853 | AMPUTATION METATARSAL | $ | 4,392.00 |
| 3207854 | GANGLION CYST/ RECURRENT | $ | 3,711.00 |
| 3207855 | PLACE GASTROSTOMY TUBE | $ | 1,725.00 |
| 3207856 | EXC INTERDIGIT NEUROMA | $ | 2,885.00 |
| 3207857 | FIXATION SHOULDER | $ | 1,397.00 |
| 3207858 | BUINION / CORRECTION | $ | 4,543.00 |
| 3207859 | TENOTOMY | $ | 1,940.00 |
| 3207860 | TENOTOMY | $ | 1,937.00 |
| 3207862 | SURG PREP RECIP SITE | $ | 534.00 |
| 3207863 | D & C 2ND TRIMESTER | $ | 2,422.00 |
| 3207864 | EXCISION OF LESION 1.1-2. | $ | 1,041.00 |
| 3207865 | HAMMERTOE | $ | 3,574.00 |
| 3207866 | HAMMERTOE | $ | 3,574.00 |
| 3207867 | EXCIS. TUMOR,TISSUE/ELBOW | $ | 2,139.00 |
| 3207868 | REPAIR ABDOMINAL WALL | $ | 5,463.00 |
| 3207869 | YAG LASER | $ | 1,727.00 |
| 3207870 | OSTECTOMY / PARTIAL METAT | $ | 3,443.00 |
| 3207871 | INCISION METATARSAL | $ | 2,623.00 |
| 3207872 | ENDOMETRIAL ABLATION/ THE | $ | 1,637.00 |
| 3207873 | LYSIS PENILE CIRCUM LES | $ | 1,412.00 |
| 3207874 | RELEASE TRIGGER FINGER | $ | 1,958.00 |
| 3207875 | MALIG LESION 1.0 | $ | 933.00 |
| 3207876 | I & D OF ABCESS | $ | 1,131.00 |
| 3207877 | EXCISION, TUMOR FOOT | $ | 2,716.00 |
| 3207878 | UNLISTED PROCEDURE FOOT | $ | 2,595.00 |
| 3207879 | ILEOSCOPY | $ | 459.00 |
| 3207880 | EXCIS MALIG LESION 3.1-4. | $ | 1,389.00 |
| 3207881 | LAYER CLOSURE WOUND | $ | 397.00 |
| 3207882 | INCISION OF FOOT FASCIA | $ | 2,232.00 |
| 3207883 | DILATE URETHRA STRICTURE | $ | 468.00 |
| 3207884 | LITHOTRIPSY/EXTRACORPOREA | $ | 7,757.00 |
| 3207885 | EGD/FOREIGN BODY REMOVAL | $ | 2,986.00 |
| 3207886 | MASTECTOMY/ MOD RADICAL | $ | 7,717.00 |
| 3207887 | KNEE ARTHROSCOPY / DX | $ | 2,935.00 |
| 3207888 | PANNICULECTOMY | $ | 8,141.00 |
| 3207889 | REMOVAL NASAL FOREIGN BOD | $ | 1,420.00 |
| 3207890 | REMOVAL TUNNELED CV CATH | $ | 1,451.00 |
| 3207891 | MASTOID CAVITY DEBRIDE | $ | 928.00 |
| 3207892 | SKIN PINCH GRAFT | $ | 2,924.00 |
| 3207893 | AMPUTATION OF TOE | $ | 2,450.00 |
| 3207894 | CYSTOSCOPY/ STENT IMPLANT | $ | 2,501.00 |
| 3207895 | CYSTOSCOPY / FULG | $ | 2,285.00 |
| 3207896 | REVISE ULNAR NERVE/WRIST | $ | 1,137.00 |
| 3207897 | HEMORRHOIDECTOMY/ EXTERNA | $ | 2,062.00 |
| 3207898 | INSERT DRUG IMPLANT DEVIC | $ | 606.00 |
| 3207899 | CESAREAN SECTION | $ | 7,445.00 |
| 3207900 | REMOVAL SWEAT GLAND LES | $ | 1,489.00 |
| 3207901 | REMOVAL TAILBONE | $ | 3,328.00 |
| 3207902 | EXCISON LESION FACE 1.1-2 | $ | 1,206.00 |
| 3207903 | REMOVAL BREAST TISSUE | $ | 3,744.00 |
| 3207904 | COLONOSCOPY | $ | 393.00 |
| 3207905 | GASTROSTOMY TUBE PLACE | $ | 4,037.00 |
| 3207906 | CYSTOSCOPY / TREATMENT | $ | 1,969.00 |
| 3207907 | REVISE ULNAR NERVE/ WRIST | $ | 1,137.00 |
| 3207908 | REMOVAL ANAL FISTULA | $ | 2,229.00 |
| 3207909 | AMPUTATION OF TOE | $ | 2,450.00 |
| 3207910 | TREAT TOE DISLOCATION | $ | 835.00 |
| 3207911 | EXCISION THROMBOSED VEIN | $ | 8,368.00 |
| 3207912 | HYSTEROSCOPY WITH LYSIS | $ | 2,531.00 |
| 3207913 | LAPAROSCOPIC PROCEDURE | $ | 1,906.00 |
| 3207914 | REMOVAL INTRANASAL LESION | $ | 2,128.00 |
| 3207915 | REMOVAL LESION SUBCUT | $ | 2,409.00 |
| 3207916 | CHANGE BLADDER TUBE | $ | 473.00 |
| 3207917 | EXCISION OF LESION 1.0-2. | $ | 1,041.00 |
| 3207918 | REPAIR NASAL STENOSIS | $ | 6,594.00 |
| 3207919 | PARTIAL EXCISON PHAL/TOE | $ | 3,941.00 |
| 3207920 | BENIGN LESION 1.0 | $ | 932.00 |
| 3207921 | EXCIS LESION FACE 3.1-4 | $ | 1,902.00 |
| 3207922 | CYSTOURETORO W/ LITHOTRIP | $ | 804.00 |
| 3207923 | REPAIR VAGINA/ PERINEUM | $ | 871.00 |
| 3207924 | AKIN OSTEOTOMY | $ | 5,163.00 |
| 3207925 | CAPSULOTOMY | $ | 2,628.00 |
| 3207926 | CYSTOURETHROSCOPY / CALIB | $ | 1,206.00 |
| 3207927 | EXC MALIG LESION 0.6-1CM | $ | 1,151.00 |
| 3207928 | LAYER CLOSURE OF WOUND | $ | 1,138.00 |
| 3207929 | REMOVAL OVARIAN CYST | $ | 4,556.00 |
| 3207930 | OMENTECTOMY | $ | 5,539.00 |
| 3207931 | POSTERIOR COLPORRHAPHY RE | $ | 1,009.00 |
| 3207932 | TREATMENT NOSE FRACTURE | $ | 3,168.00 |
| 3207933 | ARTHROSCOPY KNEE, SYNOVEC | $ | 3,450.00 |
| 3207934 | ARTHROSCOPY KNEE, SYNOVEC | $ | 3,450.00 |
| 3207935 | TREATMENT OF NOSE FRACTUR | $ | 953.00 |
| 3207936 | EXCISION LESION 2.1-3.0 | $ | 976.00 |
| 3207937 | ARTHROSCOPY, DEBRIDE/SHAV | $ | 4,486.00 |
| 3207938 | AMPUTATION TOE | $ | 2,450.00 |
| 3207939 | THYROID LOBECTOMY/ TOTAL | $ | 5,235.00 |
| 3207940 | TONSILLECTOMY | $ | 2,177.00 |
| 3207941 | REPAIR DEFORMITY / TOE | $ | 1,165.00 |
| 3207942 | CYSTOSCOPY / TREATMENT | $ | 1,217.00 |
| 3207943 | DESTRUCT BENIGN LESION | $ | 392.00 |
| 3207944 | ASPIR BLADDER/SUPRAPUB CA | $ | 1,927.00 |
| 3207945 | EXCIS MALIG LESION 0.5 | $ | 721.00 |
| 3207947 | EXCISION FACE LESION | $ | 1,501.00 |
| 3207948 | EXCIS/ FULGUR URETH POLYP | $ | 1,366.00 |
| 3207950 | REMOVAL BREAST TISSUE | $ | 2,495.00 |
| 3207951 | REMOVAL LESION SUBCUTAN | $ | 2,409.00 |
| 3207952 | CHANGE OF BLADDER TUBE | $ | 473.00 |
| 3207953 | EGD | $ | 2,715.00 |
| 3207954 | REVISION URETHRAL | $ | 2,892.00 |
| 3207955 | DESTRUCTION PENIS LESION | $ | 593.00 |
| 3207956 | INJECTION OF BLADDER | $ | 329.00 |
| 3207957 | FIXATION OF SHOULDER | $ | 1,397.00 |
| 3207958 | INJ/ DRAIN JOINT/BURSA | $ | 351.00 |
| 3207959 | EXCISION LESION WRIST | $ | 3,410.00 |
| 3207960 | INCISION TENDON SHEATH | $ | 3,374.00 |
| 3207961 | REPAIR BLADDER NECK | $ | 4,264.00 |
| 3207962 | DRAINAGE BLADDER ABCESS | $ | 957.00 |
| 3207963 | DRAINAGE URETHRAL ABCESS | $ | 2,852.00 |
| 3207964 | OVARIAN CYST RUPTURE | $ | 2,806.00 |
| 3207965 | RADICAL RESECT METATARSAL | $ | 3,576.00 |
| 3207966 | AMPUTATION TOE | $ | 2,450.00 |
| 3207967 | DEBRIDEMENT SKIN SUBQ TIS | $ | 497.00 |
| 3207968 | LAPAROSCOPY, SALPING-OOPH | $ | 4,079.00 |
| 3207970 | EXCISION / VARICOCELE | $ | 2,297.00 |
| 3207971 | BIOPSY / TESTIS | $ | 1,403.00 |
| 3207972 | EGD / POLYP / SNARE | $ | 1,348.00 |
| 3207973 | DRAIN ABDOMINAL ABSCESS | $ | 9,334.00 |
| 3207974 | RADICAL RESECT METATARSAL | $ | 3,576.00 |
| 3207975 | EXCISON MALIGNANT LESION | $ | 1,194.00 |
| 3207976 | REVISION UPPER EYELID | $ | 3,264.00 |
| 3207977 | BENIGN LESION 1.0 | $ | 932.00 |
| 3207978 | CYSTOSCOPY/STONE REMOVAL | $ | 2,454.00 |
| 3207979 | REPAIR COMPLEX 2.6-7.5CM | $ | 1,859.00 |
| 3207980 | REPAIR COMPLEX ADD 5.0CM | $ | 521.00 |
| 3207981 | CYSTOSCOPY / TREATMENT | $ | 1,627.00 |
| 3207982 | CYSTOSCOPY / TREATMENT | $ | 1,312.00 |
| 3207983 | CYSTOSCOPY / BIOPSY | $ | 927.00 |
| 3207984 | REMOV/INSERT DRUG IMPLANT | $ | 1,167.00 |
| 3207985 | INCIS BLADDER CONTRACTURE | $ | 2,621.00 |
| 3207986 | IMPLANT HORMONE PELLETS | $ | 502.00 |
| 3207987 | REM INTRAUTERINE DEVICE | $ | 434.00 |
| 3207988 | CHEMICAL CAUTERY, TISSUE | $ | 220.00 |
| 3207989 | LAPAROSCOPY/SALPING-OOPH | $ | 4,079.00 |
| 3207990 | EXCIS MALIG LESION 1.1-2C | $ | 903.00 |
| 3207991 | OOPHORECTOMY UNI/BILATER | $ | 3,109.00 |
| 3207992 | SHAVING LESION 0.5CM/LESS | $ | 231.00 |
| 3207993 | REPAIR BLOOD VESSEL LESIO | $ | 6,247.00 |
| 3207994 | EXCISION LESION 2.1-3.CM | $ | 1,084.00 |
| 3207995 | COLONOSCOPY | $ | 3,822.00 |
| 3207996 | DRAINAGE OVARIAN ABCESS | $ | 4,285.00 |
| 3207997 | REMOVAL/ SWEAT GLAND LES | $ | 1,299.00 |
| 3207998 | C-SECTION/ATTEMP NOR DELI | $ | 6,495.00 |
| 3207999 | SLING OPERATION/ INCONTIN | $ | 5,886.00 |
| 3208000 | COLONOSCOPY | $ | 3,822.00 |
| 3208001 | COLONOSCOPY | $ | 3,822.00 |
| 3208002 | COLONOSCOPY | $ | 3,822.00 |
| 3208003 | COLONOSCOPY | $ | 3,822.00 |
| 3208005 | COLONOSCOPY/BIOPSY | $ | 4,536.00 |
| 3208006 | COLONOSCOPY/BIOPSY | $ | 4,536.00 |
| 3208008 | COLONOSCOPY/POLYP/CAUTERY | $ | 4,643.00 |
| 3208009 | COLONOSCOPY/POLYP/SNARE | $ | 4,904.00 |
| 3208010 | ESOPHAGOSCOPY | $ | 2,286.00 |
| 3208012 | ESOPHAGEAL DILAT/FB REMOV | $ | 3,021.00 |
| 3208016 | EGD | $ | 2,715.00 |
| 3208017 | EGD | $ | 2,715.00 |
| 3208018 | EGD | $ | 2,715.00 |
| 3208019 | GASTROSCOPY/BIOPSY | $ | 2,768.00 |
| 3208020 | UGD/BIOPSY | $ | 2,768.00 |
| 3208021 | EGD/CLO TEST/BIOPSY | $ | 2,768.00 |
| 3208022 | GASTROSCOPY/BIOPSY | $ | 2,768.00 |
| 3208025 | FLEX SIGMOID | $ | 1,106.00 |
| 3208026 | CARDIOVERSION | $ | 935.00 |
| 3208027 | ESOPHAGEAL DILAT/BIOPSY | $ | 2,768.00 |
| 3208032 | COLONOSCOPY | $ | 3,822.00 |
| 3208034 | EXCIS BENIGN LESION 0.5CM | $ | 611.00 |
| 3208035 | EXCIS BENIGN LESION 0.5CM | $ | 760.00 |
| 3208036 | EXCISION LESION 3-1-4 | $ | 1,083.00 |
| 3208037 | COLONOSCOPY/POLYP/SNARE | $ | 4,904.00 |
| 3208039 | FLEX SIGMOID/BIOPSY | $ | 1,151.00 |
| 3208041 | EXCISION OF LESION 1.0 | $ | 976.00 |
| 3208043 | HEMORRHOIDECTOMY EXTERNAL | $ | 2,062.00 |
| 3208045 | PORTAL CATHETER FLUSH | $ | 229.00 |
| 3208046 | FLEX SIGMOID | $ | 1,106.00 |
| 3208048 | FLEX SIGMOID/BIOSPY | $ | 1,151.00 |
| 3208049 | TYMPANOSTOMY/LOCAL OR TOP | $ | 733.00 |
| 3208051 | CYSTOURETHROSCOPY | $ | 860.00 |
| 3208052 | SIGMOIDOSCOPY | $ | 1,106.00 |
| 3208053 | COLONOSCOPY/BIOPSY | $ | 468.00 |
| 3208054 | COLONOSCOPY/POLYP/CAUTERY | $ | 496.00 |
| 3208062 | SIGMOID/POLYP | $ | 1,649.00 |
| 3208063 | FLEX SIGMOID | $ | 1,106.00 |
| 3208065 | SIGMOIDOSCOPY/POLYP REMOV | $ | 1,534.00 |
| 3208068 | SUBMUCOUS RESECT TURBINAT | $ | 2,437.00 |
| 3208070 | COLONOSCOPY | $ | 3,822.00 |
| 3208071 | EGD BIOPSY | $ | 2,768.00 |
| 3208073 | COLONOSCOPY | $ | 3,822.00 |
| 3208085 | COLONOSCOPY | $ | 604.00 |
| 3208087 | HEMORRHOID / FISTULA REM | $ | 2,229.00 |
| 3208088 | PLACEMENT SETON | $ | 1,270.00 |
| 3208089 | LAP CHOLE | $ | 5,354.00 |
| 3208090 | CAST / SHOULDER TO HAND | $ | 412.00 |
| 3208091 | CYSTOSCOPY / STENT | $ | 1,543.00 |
| 3208093 | INJECTION / JOINT | $ | 351.00 |
| 3208094 | INJECTION / JOINT | $ | 351.00 |
| 3208095 | INJECTION JOINT | $ | 254.00 |
| 3208096 | GASTROSTOMY TUBE PLACEMEN | $ | 4,037.00 |
| 3208098 | INJECTION / JOINT | $ | 261.00 |
| 3208100 | REOPENING / ABDOMEN | $ | 5,841.00 |
| 3208101 | PART REMOV METATARSAL | $ | 2,031.00 |
| 3208102 | HYSTEROSCOPY, ABLATION | $ | 2,205.00 |
| 3208103 | EXCISION LESION 1.1-2. | $ | 1,041.00 |
| 3208104 | CIRCUMCISION / REGIONAL | $ | 661.00 |
| 3208105 | CYSTOSCOPY & URETH CATH | $ | 1,019.00 |
| 3208106 | REMOVAL SHOULDER LESION | $ | 3,874.00 |
| 3208107 | REMOVE CARTILAGE / GRAFT | $ | 2,961.00 |
| 3208108 | AUSTIN BUNIONECTOMY | $ | 5,674.00 |
| 3208109 | TREAT FX DISTAL RADIAL | $ | 4,079.00 |
| 3208110 | PARTIAL REMOVAL COLON | $ | 9,767.00 |
| 3208111 | SURGICAL COLONOSCOPY | $ | 351.00 |
| 3208112 | INSERT PERITONEAL CATH | $ | 2,313.00 |
| 3208113 | INSERT BLADDER CATH/COMPL | $ | 533.00 |
| 3208114 | REMOVAL ABD WALL LESION | $ | 2,634.00 |
| 3208115 | REMOVAL ABD/OVARIAN CYST | $ | 4,556.00 |
| 3208116 | I & D OF ABCESS | $ | 1,131.00 |
| 3208117 | REPAIR EYELID DEFECT | $ | 2,494.00 |
| 3208118 | TREAT FX DISTAL RADIAL | $ | 4,079.00 |
| 3208119 | SUTURE LARGE INTESTINE | $ | 6,271.00 |
| 3208120 | LIGATE/STRIP LONG VEIN | $ | 4,624.00 |
| 3208121 | REMOVAL ETHMOID SINUS | $ | 4,856.00 |
| 3208122 | EXPLORE MAXILLARY SINUS | $ | 1,927.00 |
| 3208123 | OPEN TX METACARPAL FX | $ | 4,289.00 |
| 3208124 | REMOVAL TUNNELED CV CATH | $ | 905.00 |
| 3208125 | EXCISION PENIS LESION (S) | $ | 953.00 |
| 3208126 | ENDOSCOPY, MAXILLARY SINU | $ | 652.00 |
| 3208130 | OPEN TX METATARSAL FX | $ | 3,294.00 |
| 3208131 | DEBRIDE SKIN,MUSC/BONE FX | $ | 2,590.00 |
| 3208132 | EXCIS/REP MOUTH LESION | $ | 1,173.00 |
| 3208133 | CYSTOSCOPY W / TREATMENT | $ | 2,172.00 |
| 3208134 | LAPAROSCOPY/ EXCIS LESION | $ | 4,079.00 |
| 3208135 | REPAIR SIMPLE FACIAL 2.6- | $ | 736.00 |
| 3208137 | VULVECTOMY / PARTIAL | $ | 3,305.00 |
| 3208138 | RELEASE TRIGGER FINGER | $ | 1,958.00 |
| 3208139 | LAPAROSCOPY HERNIA REPAIR | $ | 5,884.00 |
| 3208140 | UNLISTED PROCEDURE | $ | 455.00 |
| 3208141 | REPAIR RECTOCELE | $ | 4,543.00 |
| 3208142 | FRACTURE NASAL TURBINATES | $ | 1,040.00 |
| 3208143 | CHOLECYSTECTOMY | $ | 5,354.00 |
| 3208144 | EXCISION LESION 1.1-2.CM | $ | 821.00 |
| 3208145 | EXCISION TUMOR MPJ | $ | 2,470.00 |
| 3208146 | LIGATE OVIDUCTS | $ | 624.00 |
| 3208147 | LIGATION / STRIP VEIN | $ | 2,599.00 |
| 3208148 | EXCISION ANAL LESION | $ | 764.00 |
| 3208149 | EXCISION LESION 1.0CM | $ | 797.00 |
| 3208150 | REMOVAL KNEE BURSA | $ | 2,195.00 |
| 3208151 | EXCISION TUMOR DEEP | $ | 4,236.00 |
| 3208152 | DIAG LARYNGOSCOPY | $ | 1,267.00 |
| 3208153 | REVISION FALLOPIAN TUBES | $ | 5,313.00 |
| 3208154 | I&D HEMATOMA,SEROMA,FLUID | $ | 820.00 |
| 3208155 | REMOVAL FOOT FASCIA | $ | 2,599.00 |
| 3208156 | PREPUTIAL STRETCHING | $ | 395.00 |
| 3208157 | CAPSULOTOMY | $ | 2,628.00 |
| 3208158 | CAPSULOTOMY | $ | 2,628.00 |
| 3208159 | CAPSULOTOMY | $ | 2,628.00 |
| 3208160 | CORRECT/ HALLUX VALGUS | $ | 2,460.00 |
| 3208161 | PART REMOV METATARSAL | $ | 2,031.00 |
| 3208162 | EXPLORE ABDOMINAL VESSEL | $ | 4,097.00 |
| 3208163 | REMOVAL FOREIGN BODY | $ | 833.00 |
| 3208164 | INCISION & DRAINAGE ELBOW | $ | 912.00 |
| 3208165 | APPLIC BONE FIXATION | $ | 1,040.00 |
| 3208166 | COLONOSCOPY/ POLYP/ SNARE | $ | 4,904.00 |
| 3208167 | SURGICAL WOUND CLO 2NDARY | $ | 4,747.00 |
| 3208168 | SPERMATOCELE | $ | 2,662.00 |
| 3208169 | CYSTOSCOPY/ STONE REMOVAL | $ | 2,454.00 |
| 3208170 | CYSTOSCOPY/STENT IMPLANT | $ | 2,501.00 |
| 3208171 | FIXATION KNEE JOINT | $ | 1,039.00 |
| 3208172 | CIRCUMCISON / REGIONAL | $ | 661.00 |
| 3208173 | EXTENSIVE REP VAGINA | $ | 5,471.00 |
| 3208174 | INSERT MESH / PELVIC | $ | 1,667.00 |
| 3208175 | REVISION ETHMOID SINUS | $ | 778.00 |
| 3208176 | OSTEOTOMY / METATARSAL | $ | 2,486.00 |
| 3208177 | HAMMERTOE | $ | 3,574.00 |
| 3208178 | EXPLORE MAXILLARY SINUS | $ | 1,927.00 |
| 3208179 | EXCISION LESION OVER 4CM | $ | 1,389.00 |
| 3208180 | AMPUTATION TOE | $ | 2,450.00 |
| 3208181 | REPAIR ANKLE LIGAMENTS | $ | 3,520.00 |
| 3208182 | EXCISION LESION / FACE | $ | 1,582.00 |
| 3208183 | EXCISION LESION / FACE | $ | 1,206.00 |
| 3208184 | REPAIR HYDROCELE | $ | 2,481.00 |
| 3208185 | I&D FOOT | $ | 1,095.00 |
| 3208186 | PAR REMOV, FOOT FASCIA | $ | 2,215.00 |
| 3208187 | ARTHROSCOPY KNEE,CHONDRO | $ | 1,524.00 |
| 3208188 | EGD | $ | 2,715.00 |
| 3208189 | COMPLEX DRAINAGE/ WOUND | $ | 1,033.00 |
| 3208190 | REMOVAL FOREIGN BODY | $ | 1,087.00 |
| 3208191 | EXCISION LESION 3.1-4.0CM | $ | 1,083.00 |
| 3208192 | RELEASE PALM CONTRACTURE | $ | 2,698.00 |
| 3208193 | GANGLION CYST | $ | 2,186.00 |
| 3208194 | LAPAROSCOPY/EXCIS LESION | $ | 5,161.00 |
| 3208195 | EXCIS MALIG LESION 3.1-4 | $ | 1,198.00 |
| 3208196 | PART REMOV FASCIA FOOT | $ | 2,215.00 |
| 3208197 | EXPLORE SM INTESTINE | $ | 5,582.00 |
| 3208198 | COLONOSCOPY/POLYP/SNARE | $ | 4,904.00 |
| 3208202 | REMOVE FEMUR LESION/BURSA | $ | 2,634.00 |
| 3208203 | EXC INTERDIGIT NEUROMA | $ | 2,885.00 |
| 3208204 | EXC LESION TENDON | $ | 2,130.00 |
| 3208205 | REMOVAL SM INTESTINE | $ | 6,972.00 |
| 3208206 | EXCIS TUMOR FOOT | $ | 2,044.00 |
| 3208207 | ORCHIDOPEXY | $ | 2,982.00 |
| 3208208 | EXCISION, TUMOR TOE | $ | 2,716.00 |
| 3208209 | REMOVAL BLADDER STONE | $ | 2,241.00 |
| 3208210 | ENDOSCOPY, MAXILLARY SINU | $ | 652.00 |
| 3208211 | AMPUTATION TOE | $ | 2,450.00 |
| 3208212 | CONIZATION CERVIX | $ | 1,451.00 |
| 3208213 | BENIGN LESION 1.0 | $ | 932.00 |
| 3208214 | FRACTURE/ FINGER / PIN | $ | 2,336.00 |
| 3208215 | CYSTOSCOPY / STONE | $ | 1,583.00 |
| 3208216 | CYSTOSCOPY / URETER CATH | $ | 1,019.00 |
| 3208217 | REMOV PROSTATE GROWTH | $ | 2,969.00 |
| 3208218 | CYSTOSCOPY / STENT | $ | 1,543.00 |
| 3208219 | REM GANGLION CYST FINGER | $ | 2,186.00 |
| 3208220 | REM INTRAUTERINE DEVICE | $ | 434.00 |
| 3208221 | LAP SUPRACERV HYSTERECTOM | $ | 5,772.00 |
| 3208222 | PELVIC EXAM / ANES | $ | 868.00 |
| 3208223 | HYSTERECTOMY/ SUPRACERV | $ | 5,351.00 |
| 3208266 | CYSTOSCOPY STONE REMOVAL | $ | 2,591.00 |
| 3208284 | LAPAROSCOPY PROCED UNLIS | $ | 1,131.00 |
| 3208285 | CYSTOSTOMY TYBE PLACEMENT | $ | 628.00 |
| 3208286 | EXCIS MALIGNANT LESION 2. | $ | 1,095.00 |
| 3208287 | DRAINAGE OF OVARIAN CYST | $ | 2,453.00 |
| 3208288 | LIGATION HEMORRHOIDS | $ | 1,186.00 |
| 3208289 | ARTHRSCOPY, DEBRIDE/SHAV | $ | 4,486.00 |
| 3208290 | EXCISE INFERIOR TURBINATE | $ | 2,693.00 |
| 3208291 | TONSILLECTOMY/ADNOIDECTOM | $ | 2,495.00 |
| 3208292 | ARTHROSCOPY/REMOVAL FB | $ | 1,275.00 |
| 3208293 | REPAIR / INTER FAC 2.5 | $ | 1,138.00 |
| 3208294 | DILATION URETHRA STRICT | $ | 587.00 |
| 3208295 | SWANSON TOTAL IMPLANT | $ | 2,595.00 |
| 3208296 | GLAUCOMA FISTULIZATION | $ | 2,092.00 |
| 3208297 | REVISION CALF TENDON | $ | 1,087.00 |
| 3208298 | REVISION CALF TENDON | $ | 1,087.00 |
| 3208299 | INCISION BREAST LESION | $ | 1,684.00 |
| 3208300 | ENDOSCOPY URETER | $ | 1,977.00 |
| 3208301 | I & D OF ABCESS | $ | 1,131.00 |
| 3208302 | ENDOSCOPY,MAXILLARY SINUS | $ | 1,215.00 |
| 3208303 | CYSTOSCOPY / TREATMENT | $ | 530.00 |
| 3208304 | DRAINAGE FINGER ABSCESS | $ | 1,044.00 |
| 3208305 | TENDON SHEATH INJECTION | $ | 245.00 |
| 3208306 | INGUINAL HERNIA | $ | 3,623.00 |
| 3208307 | REMOVAL SWEAT GLAND LESIO | $ | 1,489.00 |
| 3208308 | MYRINGOTOMY | $ | 1,108.00 |
| 3208309 | TONSILLECTOMY/ ADNOIDECTO | $ | 2,603.00 |
| 3208310 | INFERIOR TUBINOPLASTY | $ | 1,485.00 |
| 3208311 | REMOVAL IMPACTED CERUMEN | $ | 263.00 |
| 3208312 | TOTAL KNEE ARTHROPLASTY | $ | 10,661.00 |
| 3208313 | OPEN TX METATARSAL FX | $ | 3,294.00 |
| 3208314 | OPEN TX METATARSAL FX | $ | 3,294.00 |
| 3208315 | LAP/ ENTEROLYSIS | $ | 5,372.00 |
| 3208316 | COLPOPEXY/ EXTRAPERITONEA | $ | 1,055.00 |
| 3208317 | REMOVAL ELBOW LESION | $ | 2,996.00 |
| 3208318 | EXCISION, OLECRANON BURSA | $ | 2,803.00 |
| 3208319 | COLONOSCOPY / BIOPSY | $ | 4,536.00 |
| 3208320 | COLONOSCOPY/POLYP/SNARE | $ | 4,904.00 |
| 3208321 | COLONOSCOPY/SUBMUCOUS INJ | $ | 450.00 |
| 3208322 | ARTHROSCOPY/ LAT RELEASE | $ | 3,689.00 |
| 3208323 | HEMORRHOID/ LIGATION | $ | 1,254.00 |
| 3208324 | DEBRIDEMENT TIS/MUSC/BONE | $ | 1,923.00 |
| 3208325 | EXCISION LESION 3.1-4 | $ | 1,083.00 |
| 3208326 | EXCISION TUMOR FING/HAND | $ | 2,478.00 |
| 3208327 | PARTIAL EXCISION PHAL/TOE | $ | 3,941.00 |
| 3208328 | LAPARO PROCED UTERUS | $ | 262.00 |
| 3208329 | INCISION & DRAINAGE FOOT | $ | 2,810.00 |
| 3208330 | OSTEOTOMY / METATARSAL | $ | 2,623.00 |
| 3208331 | INSERTION PICC LINE | $ | 585.00 |
| 3208332 | REPAIR CIRCUMCISION | $ | 1,380.00 |
| 3208333 | EXTRACAPSULAR CATARACT | $ | 6,495.00 |
| 3208334 | COLONOSCOPY/ BIOPSY | $ | 468.00 |
| 3208335 | REPAIR COMPLEX 2.5-7.5CM | $ | 2,756.00 |
| 3208336 | DEBRIDEMENT 20 SQ CM | $ | 188.00 |
| 3208337 | OSTEOTOMY / METATARSAL | $ | 2,623.00 |
| 3208338 | EXCISION TUMOR FACE | $ | 2,379.00 |
| 3208339 | REPAIR TUNNELED CV CATH | $ | 1,194.00 |
| 3208340 | BIOPSY TOE JOINT LINING | $ | 1,466.00 |
| 3208341 | GASTROSTOMY TUBE REPOSIT | $ | 650.00 |
| 3208342 | KNEE ARTHROSCOPY/MENISCUS | $ | 4,028.00 |
| 3208343 | SPERMATOCELE | $ | 2,587.00 |
| 3208344 | I&D NECK/CHEST LESION | $ | 1,963.00 |
| 3208345 | MYOMECTOMY ABD COMPLETE | $ | 7,203.00 |
| 3208346 | EXCISION BOWEL POUCH | $ | 4,614.00 |
| 3208347 | EXCIS TUMOR BACK >5CM | $ | 4,605.00 |
| 3208348 | CORRECT/HALLUX VALGUS | $ | 2,460.00 |
| 3208349 | EXCISION LESION 2.1-3. | $ | 1,084.00 |
| 3208350 | EXCIS MALIGNANT LESION 2. | $ | 1,095.00 |
| 3208352 | ARTHROSCOPY, KNEE CHONDRO | $ | 4,046.00 |
| 3208353 | EXCIS PILONIDAL CYST COMP | $ | 3,363.00 |
| 3208354 | EXTERNAL HEMORRHOIDS | $ | 644.00 |
| 3208355 | CYSTO / URETHRAL STRICTUR | $ | 1,858.00 |
| 3208356 | GANGLION CYST | $ | 3,870.00 |
| 3208359 | EXCISION MALIGNANT LESION | $ | 1,194.00 |
| 3208360 | BIOPSY VULVA / PERINEUM | $ | 377.00 |
| 3208362 | COLONOSCOPY | $ | 3,822.00 |
| 3208363 | APPLIC BONE FIXATION | $ | 1,040.00 |
| 3208364 | COLONOSCOPY | $ | 3,822.00 |
| 3208365 | COLONOSCOPY SUBMUC INJ | $ | 3,822.00 |
| 3208366 | CYSTOURETHROSCOPY/REM FB | $ | 1,192.00 |
| 3208367 | AMPUTATION TOE | $ | 2,450.00 |
| 3208368 | COLONOSCOPY SUBMUC INJ | $ | 3,822.00 |
| 3208369 | EXCISION VAGINAL CYST | $ | 1,497.00 |
| 3208370 | REMOV ANAL FISTULA INTER | $ | 2,426.00 |
| 3208371 | BENIGN LEISON 1.0 | $ | 932.00 |
| 3208372 | PERITONEAL LAVAGE | $ | 605.00 |
| 3208373 | EXCISION LESION 1.0 CM | $ | 797.00 |
| 3208374 | EXCISION LESION 4.0 OVER | $ | 2,093.00 |
| 3208375 | CYSTO REMOVAL CLOTS | $ | 1,835.00 |
| 3208376 | CYSTOMETROGRAM COMPLEX | $ | 1,353.00 |
| 3208377 | EAR/THROAT EXAM / ANEST | $ | 597.00 |
| 3208378 | REPAIR ELBOW / DEBRIDE | $ | 3,992.00 |
| 3208379 | HYSTEROSCOPY/BIOPSY | $ | 2,177.00 |
| 3208380 | DEBRIDEMENT/ MUSC FASCIA | $ | 756.00 |
| 3208381 | CYSTOURETERO/ LITHOTRIPSY | $ | 2,712.00 |
| 3208382 | ANUS PROCEDURE | $ | 948.00 |
| 3208383 | SIGMOIDOSCOPY W SUBMUC IN | $ | 575.00 |
| 3208384 | BENIGN LESION 1.0 | $ | 932.00 |
| 3208385 | EXCISION LESION 0.6-1.0CM | $ | 935.00 |
| 3208386 | TREATMENT WRIST FRACTURE | $ | 2,780.00 |
| 3208387 | CYSTOSCOPY & URETH CATH | $ | 1,019.00 |
| 3208388 | PARTIAL REMOVAL COLON | $ | 8,695.00 |
| 3208389 | INDUCED ABORTION D &C | $ | 1,296.00 |
| 3208390 | WOUND EXPLORATION | $ | 2,626.00 |
| 3208391 | REPAIR COMPLEX 2.6-7.5CM | $ | 1,859.00 |
| 3208392 | MARSHALL MARCHETTI COMPLI | $ | 4,955.00 |
| 3208393 | METATARSAL FRACTURE | $ | 2,081.00 |
| 3208394 | DELIVERY PLACENTA | $ | 525.00 |
| 3208395 | EXCISION SKIN TAG/ ANUS | $ | 670.00 |
| 3208396 | REMOVAL METATARSAL | $ | 973.00 |
| 3208397 | REPAIR FOOT TENDON | $ | 1,722.00 |
| 3208398 | DEBRID MUSCLE TISSUE BONE | $ | 1,923.00 |
| 3208399 | INJECTION JOINT | $ | 254.00 |
| 3208400 | INJECTION JOINT | $ | 529.00 |
| 3208402 | CYSTOMETROGRAM W/ VP & UP | $ | 1,174.00 |
| 3208403 | REMOVAL ELBOW LESION | $ | 2,996.00 |
| 3208404 | TENDON SHEATH INJECTION | $ | 245.00 |
| 3208405 | EXCIS WRIST TENDON SHEATH | $ | 2,134.00 |
| 3208406 | AUTOGRAFT SKIN SPLIT | $ | 4,059.00 |
| 3208407 | REMOVAL CERCLAGE SUTURE | $ | 769.00 |
| 3208408 | PARTIAL HYSTERECTOMY | $ | 5,437.00 |
| 3208409 | INGUINAL HERNIA INCARCERA | $ | 7,279.00 |
| 3208410 | EXCISION LESION 1.0CM | $ | 709.00 |
| 3208411 | BENIGN LESION 1.0 | $ | 932.00 |
| 3208412 | DESTRUCT BENIGN LESION | $ | 392.00 |
| 3208413 | REMOVAL TONGUE JEWELRY | $ | 191.00 |
| 3208414 | INJECTION / JOINT | $ | 351.00 |
| 3208415 | BIOPSY VAGINA | $ | 710.00 |
| 3208416 | PARITAL MASTECTOMY | $ | 3,581.00 |
| 3208417 | GANGLION CYST | $ | 2,186.00 |
| 3208418 | EXCIS MALIG LESION 3.1-4. | $ | 1,198.00 |
| 3208419 | ORCHIOPEXY | $ | 4,001.00 |
| 3208420 | ENTROPIAN REP BILATERAL | $ | 5,122.00 |
| 3208421 | NASAL ENDOSCOPY | $ | 436.00 |
| 3208422 | EXC BENIGN LESION 0.5CM < | $ | 611.00 |
| 3208423 | LAPAROSCOPY, SALPIN-OOPHO | $ | 5,095.00 |
| 3208424 | REM INT/EXT HEMORRHOID | $ | 2,326.00 |
| 3208425 | COLONOSCOPY | $ | 3,822.00 |
| 3208426 | EXCIS INTRA-ABDTUMOR | $ | 6,644.00 |
| 3208427 | EXCIS MALIG LESION 3.1-4C | $ | 1,198.00 |
| 3208428 | REMOVAL FOOT LESION | $ | 1,940.00 |
| 3208430 | INJECTION JOINT | $ | 380.00 |
| 3208431 | EXCISION GUM LESION | $ | 1,188.00 |
| 3208432 | COLONOSCOPY STOMA BIOPSY | $ | 1,052.00 |
| 3208433 | EXCISE EXCESS SKIN TISSUE | $ | 4,131.00 |
| 3208434 | DRAINAGE SCROTUM ABSCESS | $ | 941.00 |
| 3208435 | REMOVAL ETHMOID SINUS | $ | 2,852.00 |
| 3208436 | REMOVAL RESIDUAL CERVIX | $ | 2,322.00 |
| 3208437 | REMOVAL FOREIGN BODY FOOT | $ | 1,157.00 |
| 3208438 | BIOPSY, BONE OPEN | $ | 1,214.00 |
| 3208439 | EXCISION BACK TUMOR <5CM | $ | 3,570.00 |
| 3208440 | BENIGN LESION 1.0 | $ | 932.00 |
| 3208441 | EXCISON LESION 2.1 - 3.0 | $ | 1,084.00 |
| 3208442 | TREATMENT TOE FRACTURE | $ | 2,756.00 |
| 3208443 | TREATMENT TOE FRACTURE | $ | 2,220.00 |
| 3208444 | REM CERVIX /REP VAGINA | $ | 3,301.00 |
| 3208445 | CARPAL TUNNEL RELEASE | $ | 3,109.00 |
| 3208446 | CARDIOVERSION | $ | 935.00 |
| 3208447 | DELIVERY PLACENTA | $ | 525.00 |
| 3208448 | EXTERNAL HEMORRHOIDS | $ | 644.00 |
| 3208449 | AMPUTATION METATARASL | $ | 4,392.00 |
| 3208450 | EXPLORATION FOOT JOINT | $ | 1,806.00 |
| 3208451 | EXCISION LESION 1.1-2CM | $ | 821.00 |
| 3208452 | FLEX SIGMOID/ BIOPSY | $ | 1,151.00 |
| 3208453 | EXC TUMOR SOFT TIS FOOT | $ | 2,562.00 |
| 3208454 | ARTHROSCOPY, DEBRIDE/SHAV | $ | 4,486.00 |
| 3208455 | HEMORRHOIDECTOMY, INT,EXT | $ | 2,357.00 |
| 3208456 | INSERT TUNNELED CV CATH 5YRS> | $ | 1,945.00 |
| 3208457 | ARTHROSCOPY KNEE, SYNOVEC | $ | 3,450.00 |
| 3208458 | HEMORRHOIDECTOMY/INTERNAL | $ | 2,176.00 |
| 3208459 | EXCIS TUMOR FINGER/ HAND | $ | 2,478.00 |
| 3208460 | HEMORRHOID,THROMBOSED EXT | $ | 972.00 |
| 3208461 | REMOVAL SKIN TAG | $ | 333.00 |
| 3208462 | REPAIR SPEGELIAN HERNIA | $ | 3,085.00 |
| 3208463 | REPAIR FEMORAL HERNIA | $ | 3,208.00 |
| 3208464 | DRAINAGE PELVIC ABSCESS | $ | 2,392.00 |
| 3208467 | EXCISION LESION 4.0 OVER | $ | 2,093.00 |
| 3208468 | INCISION BONE CORTEX FOOT | $ | 3,200.00 |
| 3208469 | AMPUTATION METATARSAL | $ | 4,392.00 |
| 3208470 | COLONOSCOPY / BIOPSY | $ | 4,536.00 |
| 3208471 | FASCIECTOMY / PALMAR | $ | 3,241.00 |
| 3208472 | EXCISION TUMOR SOFT TISSUE | $ | 2,979.00 |
| 3208473 | REPAIR COMPLEX EXTR 2.6 - | $ | 1,859.00 |
| 3208474 | REPAIR COMPLEX EXTR OVER | $ | 521.00 |
| 3208475 | HYSTERECTOMY / DIAGNOSTIC | $ | 1,039.00 |
| 3208476 | RELEASE ULNAR NERVE ELBOW | $ | 1,672.00 |
| 3208477 | PERCUT PIN FIXATION FINGER | $ | 3,333.00 |
| 3208478 | ARTHROTOMY ANKLE | $ | 3,546.00 |
| 3208479 | EXCIS TUMOR ANKLE / LEG | $ | 2,609.00 |
| 3208480 | CHROMOTUBATION OVIDUCT | $ | 436.00 |
| 3208481 | INJECTION / JOINT | $ | 261.00 |
| 3208482 | OPEN REDUCTION ANKLE FX | $ | 4,614.00 |
| 3208483 | AMPUTATION TOE/ METATARSAL | $ | 2,450.00 |
| 3208484 | LIGATION HEMORRHOIDS | $ | 1,186.00 |
| 3208485 | AUSITN BUNIONECTOMY | $ | 5,674.00 |
| 3208486 | REVISION ETHOMOID SINUS | $ | 1,869.00 |
| 3208487 | EXPLORE MAXILLARY SINUS | $ | 2,410.00 |
| 3208488 | TREATMENT TOE FRACTURE | $ | 2,756.00 |
| 3208489 | REPAIR TENDON / LEG | $ | 2,007.00 |
| 3208490 | REPAIR TENDON / LEG | $ | 2,007.00 |
| 3208491 | DISLOCATION FINGER / PIN | $ | 2,422.00 |
| 3208492 | REPAIR ELBOW / DEBRIDEMENT | $ | 2,854.00 |
| 3208493 | EXCISION LESION BACK FLANK 3CM> | $ | 2,403.00 |
| 3208494 | REMOVAL SPERM CORD LESION | $ | 2,319.00 |
| 3208495 | I & D BARTHOLINS GLAND ABSCESS | $ | 476.00 |
| 3208496 | INSERT TUNNELED CV CATH 5YRS> | $ | 1,834.00 |
| 3208497 | EXCISION LESION MALIGNANT OVER 4.0CM | $ | 2,154.00 |
| 3208498 | REPAIR METATARSAL W OR W/O BONE GRAFT | $ | 3,172.00 |
| 3208499 | LAPARO VAGINAL HYSTER W UTERUS>250 | $ | 7,203.00 |
| 3208500 | AMPUTATION / IP JOINT | $ | 2,051.00 |
| 3208501 | FASCIECTOMY / PALMAR | $ | 3,241.00 |
| 3208502 | RELEASE TRIGGER FINGER | $ | 1,958.00 |
| 3208503 | THORACENTESIS W/O IMAGING | $ | 1,701.00 |
| 3208504 | SUTURE INFRAPATELLAR TENDON | $ | 4,972.00 |
| 3208505 | EXCIS BONE CYST,TUMOR, PHALANGE,FOOT | $ | 1,599.00 |
| 3208506 | UNLISTED PROCEDURE FOOT / TOES | $ | 786.00 |
| 3208507 | OSTECTOMY, PARTIAL | $ | 2,917.00 |
| 3208508 | TREAT ECTOPIC PREGNANCY | $ | 4,017.00 |
| 3208509 | CATARACT PHACO (2ND) LT | $ | 5,405.00 |
| 3208510 | CATARACT PHACO (2ND) RT | $ | 5,405.00 |
| 3208511 | YAG LASER (2ND) | $ | 1,727.00 |
| 3208512 | YAG LASER (2ND) | $ | 1,727.00 |
| 3208513 | INCISIONAL HERNIA / RECURRENT | $ | 5,519.00 |
| 3208514 | LARYNGOSCOPY /BIOSPY | $ | 1,048.00 |
| 3208515 | REMOVAL NOSE LESION | $ | 3,398.00 |
| 3208516 | INJECTION TREATMENT EYE | $ | 728.00 |
| 3208517 | PARTIAL REMOVAL TIBIA | $ | 4,544.00 |
| 3208518 | REMOVAL KNEE CAP | $ | 3,549.00 |
| 3208519 | AMPUTATION / IP JOINT TOE | $ | 2,051.00 |
| 3208520 | COLONOSCOPY | $ | 3,822.00 |
| 3208521 | REMOVAL KNEE CYST | $ | 1,303.00 |
| 3208522 | REVISION ETHOMOID SINUS | $ | 778.00 |
| 3208523 | HEMORRHOIDECTOMY INT/ EXT | $ | 3,240.00 |
| 3208524 | CYSTOSCOPY CHEMODENERVATION | $ | 1,270.00 |
| 3208525 | KNEE ARTHROSCOPY LOOSE BODY REM | $ | 4,129.00 |
| 3208526 | REPAIR ELBOW / DEBRIDEMENT | $ | 2,854.00 |
| 3208527 | FRACTURE/ FINGER PIN FIXATION | $ | 2,336.00 |
| 3208528 | FUSION FOOT BONES | $ | 4,763.00 |
| 3208529 | EXCISION TONSIL TAG/S | $ | 1,507.00 |
| 3208530 | ARTHRODESIS / TOE | $ | 4,076.00 |
| 3208531 | ANUS PROCEDURE | $ | 948.00 |
| 3208532 | ARTHROSCOPY KNEE SYNOVEC | $ | 3,450.00 |
| 3208533 | EXCISION / CYST / FINGER | $ | 2,186.00 |
| 3208534 | ARTHROSCOPY KNEE, DRILLING | $ | 4,046.00 |
| 3208535 | SEPTOPLASTY | $ | 5,095.00 |
| 3208536 | IMPLANTATION OF MESH | $ | 2,095.00 |
| 3208537 | HYSTEROSCOPY / REMOVAL FB | $ | 2,177.00 |
| 3208538 | CYSTO REMOVAL CLOTS | $ | 1,835.00 |
| 3208539 | REPAIR INTERMED 12.6-20.0 CM | $ | 1,320.00 |
| 3208540 | REMOVAL LENS MATERIAL | $ | 4,086.00 |
| 3208541 | IRIDOTOMY / IRIDECTOMY BY LASER | $ | 1,224.00 |
| 3208542 | INSERT INTRAOCULAR LENS SECONDAR IMPLANT | $ | 3,972.00 |
| 3208543 | PARACENTESIS ANTERIOR CHAMBER | $ | 2,406.00 |
| 3208544 | REMOVAL FB EAR | $ | 312.00 |
| 3208545 | LARYNGOSCOPY / FLEXIBLE DIAG | $ | 407.00 |
| 3208546 | RELEASE PALMAR CONTRACTURE | $ | 2,698.00 |
| 3208547 | CARPAL TUNNEL RELEASE BILATERAL | $ | 4,483.00 |
| 3208548 | INSERT INTRAOCULAR LENS SECONDARY IMPLAN | $ | 3,972.00 |
| 3208549 | REMOVAL OF VITREOUS | $ | 2,536.00 |
| 3208550 | ARTHRODESIS / TOE | $ | 4,076.00 |
| 3208551 | REMOVAL SESAMOID BONE | $ | 1,747.00 |
| 3208552 | PARTIAL REMOVAL METATARSAL | $ | 2,284.00 |
| 3208553 | DEBRIDEMENT SUBCUT TISSUE | $ | 497.00 |
| 3208554 | JOINT INJECTION WITH ULTRASOUND | $ | 366.00 |
| 3208555 | JOINT INJECTION WITH ULTRASOUND | $ | 366.00 |
| 3208556 | EXCIS TUMOR FOOT | $ | 2,044.00 |
| 3208557 | EXC TUMOR SOFT TISSUE FOOT | $ | 2,562.00 |
| 3208558 | COLONOSCOPY / BIOPSY | $ | 4,536.00 |
| 3208559 | REMOVAL LESION SUBCUT | $ | 2,409.00 |
| 3208560 | ARTHROSCOPY KNEE | $ | 4,695.00 |
| 3208561 | ENDOSCOPY, MAXILLARY ANTROSTOMY | $ | 652.00 |
| 3208562 | EXCISION TUMOR SOFT TISSUE NECK 3CM> | $ | 2,322.00 |
| 3208563 | COLONOSCOPY / POLYP / SNARE | $ | 4,904.00 |
| 3208564 | COLONOSCOPY , SUBMUCOUS INJ | $ | 450.00 |
| 3208565 | COLONOSCOPY / BIOPSY | $ | 468.00 |
| 3208566 | INJECTION / JOINT | $ | 351.00 |
| 3208567 | INJECTION / JOINT | $ | 261.00 |
| 3208568 | LAPAROSCOPY/ EXCIS LESION | $ | 4,079.00 |
| 3208569 | CYSTOGRAM / SIMPLE | $ | 2,014.00 |
| 3208570 | JOINT INJECTION WITH ULTRASOUND BILAT | $ | 548.00 |
| 3208571 | TYMPANIC MEMBRANE REPAIR | $ | 1,551.00 |
| 3208572 | LABYRINTHOTOMY | $ | 667.00 |
| 3208573 | OPEN TX METACAPAL FX | $ | 4,289.00 |
| 3208574 | ABDOMINAL HYSTERECTOMY | $ | 1,723.00 |
| 3208575 | REMOV LESION BACK/FLANK | $ | 890.00 |
| 3208576 | INGUINAL HERNIA BILAT | $ | 7,006.00 |
| 3208577 | CYSTOURETHOSCOPY W LITHO/ STENT | $ | 2,284.00 |
| 3208578 | OSTEOTOMY / METATARSAL | $ | 2,623.00 |
| 3208579 | EXCISION TUMOR FACE/ SCALP >2CM | $ | 2,732.00 |
| 3208580 | EXCISION OLECRANON BURSA | $ | 2,803.00 |
| 3208581 | REMOVAL LESION SUBCUT | $ | 2,409.00 |
| 3208582 | REPAIR OF ENTEROCELE /VAGINAL APPROACH | $ | 2,546.00 |
| 3208583 | EXC TUMOR SOFT TISSUE FOOT | $ | 2,562.00 |
| 3208584 | EXCISION LESION 1.1-2.0CM | $ | 1,041.00 |
| 3208585 | EGD / FOREIGN BODY REMOVAL | $ | 2,986.00 |
| 3208586 | WOUND DEHISCENCE SIMPLE REPAIR | $ | 1,201.00 |
| 3208587 | FINE NEEDLE ASPIRATION W/O IMAGING | $ | 518.00 |
| 3208588 | REPAIR HALLUX RIGIDUS/ CHEILECTOMY | $ | 3,887.00 |
| 3208589 | COLONOSCOPY | $ | 3,822.00 |
| 3208590 | DILATE URETHRA STRICTURE | $ | 370.00 |
| 3208591 | EXCISION BONE CYST/BENIGN TUMOR FINGER | $ | 2,218.00 |
| 3208592 | DILATION URETHRAL STRICTURE | $ | 482.00 |
| 3208593 | GANGLION CYST | $ | 2,186.00 |
| 3208594 | INJECTION / JOINT | $ | 261.00 |
| 3208595 | MANIPULATION / ELBOW W ANESTHESIA | $ | 2,139.00 |
| 3208596 | TX TIBIAL FX W MANIP W/WO SKELETAL TRACT | $ | 2,543.00 |
| 3208597 | HALLUX RIGIDUS W CHEILECTOMY W IMPLANT | $ | 2,540.00 |
| 3208598 | EXC URACHAL CYST/SINUS W W/O UMB HERNIA | $ | 3,364.00 |
| 3208599 | CYSTORRHAPHY, SUTURE BLADDER WOUND/INJUR | $ | 4,694.00 |
| 3208600 | EXCIS WRIST TENDON SHEATH | $ | 2,134.00 |
| 3208601 | BIOPSY LIVER, WEDGE | $ | 4,316.00 |
| 3208602 | OSTECTOMY, PARTIAL | $ | 2,917.00 |
| 3208603 | TEMPORAL ARTERY BIOPSY BILATERAL | $ | 2,542.00 |
| 3208604 | REMOVAL LESION SUBCUT | $ | 2,409.00 |
| 3208605 | FASCIECTOMY/ PART PALMAR RELEASE | $ | 4,304.00 |
| 3208606 | PROCTOSIGMOIDOSCOPY RIGID DIAGBOSTIC | $ | 283.00 |
| 3208607 | EXCISION TUMOR SOFT TISSUE PELVIS / HIP | $ | 2,403.00 |
| 3208608 | ORCHIECTOMY SIMPLE | $ | 1,996.00 |
| 3208609 | EXCISION TUMOR SOFT TISSUE FINGER HAND | $ | 2,979.00 |
| 3208610 | TOTAL KNEE ARTHROPLASTY BILATERAL | $ | 10,661.00 |
| 3208611 | DESTRUCT VAGINAL LESIONS SIMPLE | $ | 470.00 |
| 3208612 | PARTIAL EXCISION BONE DISTAL PHAL/FINGER | $ | 3,642.00 |
| 3208613 | FLEXIBLE CYSTO OFFICE | $ | 1,527.00 |
| 3208614 | SIMPLE CYSTOMETROGRAM OFFICE | $ | 620.00 |
| 3208615 | HYSTEROSCOPY W REMOVAL LEIOMYOMATA | $ | 3,992.00 |
| 3208616 | CLOSED TX NASAL SEPTAL FX W W/O STABIL | $ | 2,266.00 |
| 3208617 | FASCIECTOMY, PARTIAL PALMAR RELEASE | $ | 1,400.00 |
| 3328502 | US ABDOMEN / SINGLE ORGAN | $ | 910.00 |
| 3328503 | US GUIDE NEEDLE PLACE (THERA/PARA/BIOP | $ | 1,953.00 |
| 3328506 | US COMPLETE ABDOMEN | $ | 1,153.00 |
| 3328507 | US THYROID, NECK, PAROTID | $ | 1,082.00 |
| 3328512 | US SEGMENTAL PRESSURE | $ | 248.00 |
| 3328513 | US CHEST MEDIASTINUM | $ | 701.00 |
| 3328514 | US UNLISTED PROCEDURE | $ | 1,289.00 |
| 3328515 | US NON-VASCULAR EXTREMITY (COMPLETE) | $ | 1,039.00 |
| 3328517 | US ABDOMINAL DOPPLER (COMPLETE) | $ | 3,127.00 |
| 3328518 | US LIMITED OB (HEART MOTION, PLACENTAL | $ | 673.00 |
| 3328521 | US OB BPP | $ | 822.00 |
| 3328522 | US INTRAVAGINAL (NON OBSTETRICAL) | $ | 554.00 |
| 3328523 | US COMPLETE OB 2ND/3RD TRIMESTER (> 14WK | $ | 820.00 |
| 3328524 | US COMPLETE OB 2ND/3RD TRIMESTER (>14WKS | $ | 820.00 |
| 3328525 | US BILATERAL VENOUS | $ | 1,766.00 |
| 3328526 | US OB 1ST TRIMESTER (<14 WKS) | $ | 897.00 |
| 3328527 | US OB TWINS 1ST TRIMESTER (USE + 76801) | $ | 291.00 |
| 3328529 | US OB TWINS 2ND/3RD TRIMEST (USE +76805) | $ | 563.00 |
| 3328531 | US PELVIS | $ | 1,042.00 |
| 3328533 | US FOLLOW UP PELVIS / LIMIT BLADDER ONLY | $ | 846.00 |
| 3328535 | US AORTA / KIDNEYS ONLY/ TRANSPLANT LIMI | $ | 920.00 |
| 3328536 | US THYROID, NECK, PAROTID | $ | 1,082.00 |
| 3328537 | US RUQ,SINGLE ORGAN, FU, LIMITED ABD | $ | 910.00 |
| 3328538 | US CAROTID | $ | 1,944.00 |
| 3328539 | US SCROTUM AND CONTENTS | $ | 1,061.00 |
| 3328540 | US DOPPLER COLOR FLOW | $ | 704.00 |
| 3328543 | US BREAST, COMPLETE LEFT UNILAT | $ | 554.00 |
| 3328544 | US BREAST, COMPLETE RIGHT UNILAT | $ | 554.00 |
| 3328545 | US BREAST, COMPLETE BILAT | $ | 832.00 |
| 3328546 | US BREAST, LIMITED LEFT UNILAT | $ | 413.00 |
| 3328547 | US BREAST, LIMITED RIGHT UNILAT | $ | 413.00 |
| 3328548 | US BREAST, LIMITED BILAT | $ | 620.00 |
| 3328551 | US LWR/ UPP EXTREMITY VENOUS (UNILAT) | $ | 1,480.00 |
| 3328552 | US LWR/ UPP EXTREMITY VENOUS (UNIL) LIMI | $ | 1,480.00 |
| 3328555 | US FOLLOW UP OB (GROWTH,AFI,ORGAN RE-EVA | $ | 874.00 |
| 3328556 | US IVT OB | $ | 748.00 |
| 3328559 | US NON-VASCULAR EXTRMIETY (LIMITED) | $ | 687.00 |
| 3328560 | US COMPLETE ABDOMEN LIMITED | $ | 1,153.00 |
| 3328562 | US UPPER EXTREMITY ATERIAL DUPLEX BILAT | $ | 1,502.00 |
| 3328563 | US LWR EXTREM ARTERIAL DUPLEX BILAT | $ | 1,868.00 |
| 3328565 | US KIDNEY / BLADDER | $ | 1,102.00 |
| 3328566 | US OB BIO-PHYSICAL PROFILE | $ | 595.00 |
| 3328567 | US KIDNEY TRANSPLANT (WITH DUPLEX) | $ | 1,331.00 |
| 3328568 | US ABDOMINAL DOPPLER (COMPLETE) MULT TES | $ | 3,127.00 |
| 3328569 | US OB BIO-PHYSICAL PROFILE-TWINS(+76819) | $ | 595.00 |
| 3328571 | US LWR EXTREMITY ARTERIAL DULEX UNILAT | $ | 1,214.00 |
| 3328572 | US KIDNEY TRANSPLANT (WITH DUPLEX) LIMIT | $ | 1,331.00 |
| 3328573 | US ABI / SEGMENTAL PRESSURE UNILATERAL | $ | 433.00 |
| 3328574 | US ABI / SEGMENTAL PRESSURE UNILAT LIMIT | $ | 433.00 |
| 3328575 | US OB TWINS FOLLOW UP (GROWTH ETC) | $ | 874.00 |
| 3328576 | US ABDOMINAL DOPPLER (LIMITED) | $ | 1,727.00 |
| 3328577 | US AORTA/IVC/ILLIAC DUPLEX/ ABDOMINAL BY | $ | 1,586.00 |
| 3328578 | US HEMODIALYSIS ACCESS | $ | 2,235.00 |
| 3328579 | US FETAL UMBILICAL ARTERY DOPPLER | $ | 192.00 |
| 3328580 | US UPPER EXTREMITY ARTERIAL DUPLEX UNILA | $ | 1,100.00 |
| 3328581 | US ABDOMINAL AORTA SCREENING | $ | 920.00 |
