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 |