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Patient Estimator/Master Charge List

Please use this estimator for your upcoming clinic or hospital services.

Scroll down for the Master List of Charges.


Charge CodeDescriptionDepartmentUB RevenueCodeProcedure CodeRate
30354014.45 NACL 1000CCCS25811.80
3035402310% DEXTROSE 1000CCCS636J349012.40
3025835014-3-3 ETA PROTEINLAB30283520138.16
3025351321-HYDROXYLASE ANTIBODYLAB30283516147.20
3025410524 HOUR URINE PHOSPHORUSLAB3018410546.69
305200624" ROCK TAPECS2701.00
303049494IN LONG COMPRILANCS270A644998.44
302583495 HIAA 24 H URINELAB30283497103.20
303540545% Dex .45 NaCl / K10MEQCS636J349042.42
303540085% DEX .45 NACL 1000MLCS25812.50
303540555% DEX .45 NACL W/ POTAS. 1000MLCS25813.20
303540065% DEX .9 NACL per 500ml - 1000ML bagCS258J704212.50
303540565% DEX .9 NACL W/ POTAS. 1000MLCS258J704213.20
303540005% DEX 1000MLCS636J707011.20
303540045% DEX 100MLCS636J349010.10
303540205% DEX 250MLCS636J34906.80
303540025% DEX 500MLCS636J70605.90
30354518A & D OINTMENT 5GM PKTRX2592.50
30300639ABD PAD 5 X 9CS270A62522.50
30300640ABD PAD 7.5 X 8CS270A62182.50
30204000ABDOMEN (KUB) SINGLE VIEWRAD32074018195.00
30204022ABDOMEN 2 VIEW AND PA CHESTRAD32074022353.52
30204002ABDOMEN ACUTE SERIES READINGRADP9727402265.40
30204020ABDOMEN COMPLETERAD32074019278.94
30204021ABDOMEN COMPLETE READINGRADP9727401948.08
30204001ABDOMEN READINGRADP9727401837.96
30352101ABILIFY 10MG TABRX25167.90
30350613ABILIFY 2MG TABRX2597.60
30350713ABILIFY 5MG TABRX25978.70
30256900ABO GROUPLAB3008690045.50
30251235ABO/RH GROUPING PATIENTLAB3008690059.50
30256903ABO/RH TYPE UNITLAB3008690278.35
30203050AC JOINTSRAD32073050184.00
30203051AC JOINTS READINGRADP9727305039.40
30350272ACCOLATE 20MG TABRX2596.70
30300198ACE WRAP 2"CS270A64488.20
30300199ACE WRAP 3"CS271A64489.90
30300680ACE WRAP 4 LONGCS271A645032.40
30300200ACE WRAP 4"CS271A644917.91
30300202ACE WRAP 6"CS27030.05
30300280ACE WRAP 6in LONGCS27030.05
30350001ACETAMINOPHEN 120MG SUPPRX2592.70
30350811ACETAMINOPHEN 325MG SUPPRX2592.90
30350156ACETAMINOPHEN 325MG TABRX2592.50
30350649ACETAMINOPHEN 500MG TABRX2592.50
30350812ACETAMINOPHEN 650MG SUPPRX2592.50
30350193ACETAMINOPHEN ELIXIR 160mg/5mlRX2592.50
30252003ACETAMINOPHEN LEVELLAB30180307300.00
30350821ACETAMINOPHEN W/COD 120/12MG/5MLRX2592.50
30350434ACETAMINOPHEN/COD 300MG/30MG TABRX2592.50
30350422ACETYLCYSTIENE SOLN PER GRAMRX259J760823.10
30350315ACIPHEX 20MG TABRX2593.30
30359980ACT DRY MOUTH LOZENGERX2592.50
30350194ACTIDOSE AQUA TUBE 50GM 240MLRX25952.40
30300989ACTISORB SLIVER 4X4CS27044.80
30355979ACTIVASE PER 1MG INJ - 100MG VIALRX636J299713386.10
30350732ACTIVASE PER 1MG INJ - 50mg vialRX636J29976698.10
30350517ACTOS 15MG TABRX2592.50
30350250ACTOS 45MG TABRX25937.80
30350457ACYCLOVIR 400 MG TABRX2592.50
30354701ACYCLOVIR 800MG TABLETRX2592.50
30352520ACYCLOVIR PER 5MG INJRX636J013327.30
30350702ADACEL VACCINERX63690715128.70
30250231ADALIMUMAB AB AND CONCENTRATIONLAB301545.00
30300994ADAPTIC 3X16CS270A622219.20
30300559ADAPTIC 3X3CS270A62225.80
30300959ADAPTIC 3X8CS270A622218.65
30354202ADENOSINE INJECTION PER 1MGRX636J015331.10
30160234ADMIT/DISC SAME DAY I OBS/INPTOBSP98299234357.40
30160235ADMIT/DISC SAME DAY II OBS/INPTOBSP98299235399.95
30160236ADMIT/DISC SAME DAY III OBS/INPTOBSP98299236458.40
34100120ADULT DAY CARE- 12 HRS TO 18HRSLTC119160.00
34100080ADULT DAY CARE- 6 HRS TO 12 HRSLTC119110.00
34100040ADULT DAY CARE- UP TO 6 HOURSLTC11975.00
30359600ADVAIR DISKUS 250/50MCG PER INHALERRX259229.60
30350619ADVAIR DISKUS 500/50 PER INHALERRX259374.30
30350890ADVAIR DSK 100/50MCG INH-14 DOSERX259229.40
30353503ADVAIR DSK 250/50MCG INH-14 DOSERX259180.50
30350326ADVAIR HFA 115/21MCG INHALERRX259241.80
30350529ADVAIR HFA 230/21MCG - 120DOSE INHRX259419.40
30160300ADVANCE CARE PLAN INITIAL 30 MIN - INPTNURP9879949786.80
35059497ADVANCE CARE PLAN INITIAL 30MIN - ClinicCLNC5219949786.80
35059498ADVANCE CARE PLAN SUBSEQ 30MIN - ClinicCLNC5219949875.60
30160301ADVANCE CARE PLAN SUBSEQ 30MIN - INPTNURP9879949875.60
30350404AFRIN NASAL SPRAYRX2598.70
30300968AFTERSHAVECS2708.10
30350669AGGRENOX 200/25MG CAPRX25922.30
3505AICAIC MedicareCLNC5210.00
35054644AIRWAY INHALATION TREATMENTCLNC4109464027.20
30252040ALBUMINLAB3018204045.60
30350880ALBUTEROL HFA-60DOSE INHRX25996.30
30358703ALBUTEROL PER 1MG (.63MG VIAL)RX294J76102.50
30350004ALBUTEROL PER 1MG INH SOLNRX294J76102.50
30252055ALCOHOLLAB3018032078.80
30301329ALCOHOL SALIVA TESTCS27048.55
30252085ALDOLASELAB3018208577.70
30252088ALDOSTERONELAB30182088287.10
30350650ALENDRONATE SOD 70MG TABRX2592.90
30254080ALK.PHOS ISOENZYMESLAB30084080118.24
30254075ALKALINE PHOSPHATASELAB3008407548.30
30256003ALLERGEN MULTI RAST MAYLAB3028600341.76
30256007ALLERGEN ROCKY MOUNTAIN PROFILELAB3028600389.76
30301129Allevyn 3x3 Foam DressingCS279A62125.54
30300827ALLEVYN DRESSING 5X5CS27031.85
30300348ALLEVYN DRESSING SACRUMCS27028.10
30305051ALLEVYN HEEL DRESSING 5 3/4 X 5 3/4CS272A621313.64
30350198ALLOPURINOL 100MG TABRX2592.50
30354210ALLOPURINOL 300MG TABLETRX2592.50
30252103ALPHA 1 ANTITRYPSINLAB30182103122.55
30252105ALPHA FETOPROTEINLAB30182105109.60
30352860ALPHA LIPOIC ACID 200MG CAPSULERX2592.50
30352105ALPHAGAN P 0.1% PER 5ML BTLRX259190.00
30351011ALPHAGAN-P OPH SOL .15% PER 5ML BTRX259161.60
30350280ALPRAZOLAM 0.25MG TABRX2592.50
30357901ALPRAZOLAM 1MG TABLETRX2592.50
30254460ALT / SGPTLAB3018446048.30
30350495AMANTADINE 100MG CAPRX2597.20
30354616AMANTADINE OS 50MG/5MLRX2512.50
30300484AMBU RESUSCITATOR ADULTCS27090.80
30300496AMBU RESUSCITATOR PEDCS27090.80
30300497AMBU SPUR NEONATECS27090.80
30359501AMIDATE(ETOMIDATE) UP TO 20MG INJRX25924.10
30350962AMILORIDE 5MG TABRX2597.10
30350245AMIODARONE 200MG TABRX2592.50
30350738AMIODARONE 30MG INJ - 150mg IVPRX636J028216.10
30351738AMIODARONE 30MG INJ - 900MG INFUSIONRX636J028226.80
30350975AMITIZA (LUBIPROSTONE) 24MCG CAPRX25921.80
30358040AMITIZA 8MCG CAPRX25221.80
30350653AMITRIPTYLINE 100 MG TABRX2596.10
30350281AMITRIPTYLINE 10MG TABRX2592.50
30350651AMITRIPTYLINE 25MG TABRX2592.50
30355509AMLODIPINE 2.5MG TABRX2512.50
30350089AMLODIPINE 5MG TABRX2592.50
30252140AMMONIALAB30182140116.60
30350918AMMONIA INHALANTRX2597.50
30350172AMOXICIL/CLV 400/57MG/5ML - 100ML BTLRX25132.20
30359401AMOXICIL/CLV 600/43MG/5ML - 125ML BTLRX25143.60
30354511AMOXICILLIN 250MG CAPRX2592.50
30350214AMOXICILLIN 500MG CAPRX2592.50
30351203AMOXICILLIN OS 250MG/5ML - 1 BTLRX25911.70
30350225AMOXICILLIN OS 400MG/5ML-50ML BTLRX2597.20
30350012AMOXICILLIN/CLAV 500/125MG TABRX2592.90
30350013AMOXICILLIN/CLAV 875/125MG TABRX2593.90
30351114AMOXICILLIN/CLAV XR 1000/62.5MG TABRX25119.80
30250325AMPHETAMINES URINE QUANTLAB30280325377.64
30350545AMPICILLIN SOD 500MG INJRX636J029023.10
30350551AMPICILLIN/SULBACTAM PER 1.5GM INJ(3GM)RX636J029528.80
30351383AMPICILLIN/SULBACTAM PER 1.5GM(1.5GM VL)RX636J029523.40
30257798AMPLIFIED PROBE EACH ORGANISMLAB30287798185.91
30252150AMYLASELAB3018215070.00
30256038ANA SCREENLAB30286038122.35
30256039ANA TITERLAB3028603978.10
30350654ANASTROZOLE 1MG TABRX2592.50
30256044ANCA IGALAB3028625548.60
30203600ANKLE AP AND LATERALRAD32073600179.00
30203601ANKLE AP/LAT READINGRADP9727360035.08
30203610ANKLE COMPLETERAD32073610209.86
30203611ANKLE COMPLETE READINGRADP9727361036.52
30356910ANORO ELLIPTA 62.5/25MCG INHRX259202.80
30350083ANTACID/ANTIGAS OS PER DOSERX2592.50
30252000ANTI CCPLAB30186200103.60
30256002ANTI GLIADIN Ab IgA & IgGLAB3028351692.24
30256850ANTIBODY GELLAB3008685078.35
30256870ANTIBODY IDENTIFICATIONLAB30086870106.20
30254999ANTIMITOCHONDRIAL A.B.LAB3028351692.24
30253521ANTI-MULLERIAN HORMONELAB30283520151.00
30350503ANTIPYRINE/BENZOCAINE OTIC 15ML BTLRX25919.20
30350515ANUCORT HC RECTAL SUPPRX25916.10
30169125APP OF SHORT ARM SPLINT, STATICEDP9812912591.75
30302258AQUACEL 6X6CS272A621044.85
30301375AQUACEL AG 4X4 DRESSINGCS270A621244.85
30300763AQUAPAK STERILE WATERCS272A421816.30
30457113AQUATIC THERAPY W/THER EXER EACH 15 MINPT4209711359.88
30350102ARANESP (DARBEPOETIN) PER 1MCG INJRX636J08812234.50
30352005ARIXTRA PER 0.5MG INJ - 2.5mg syrRX636J1652106.90
30351652ARIXTRA PER 0.5MG INJ - 7.5MG SYRRX636J1652191.00
30355604ARMOUR THYROID 90MG TABRX2517.40
30256600ARTERIAL COLLECTIONLAB4503660064.85
30252803ARTERIAL/VENOUS BLOOD GASLAB30082803175.95
30352500ASACOL D/R 400MG TABRX25914.80
30350966ASMANEX TWISTHALER 220MCG per inhalerRX259427.60
35050612ASPIRATE GANGLION CYSTCLNC5212061265.10
30350006ASPIRIN 300MG SUPPRX2596.40
30350005ASPIRIN 325MG TABRX2592.50
30350007ASPIRIN 81MG CHEWABLE TABRX2592.50
30350655ASPIRIN EC 325MG TABRX2592.50
30350629ASPIRIN EC 81MG TABRX2592.50
30253882ASSAY NEPHELOMETRY NOT SPEC.LAB30183883108.80
30254450AST / SGOTLAB3018445048.30
30350164ATACAND 32 MG TABRX25917.40
30350009ATENOLOL 50MG TABRX2592.50
30355060ATROPINE SULF OPTH SOLN 1% per BTLRX259116.80
30350213ATROPINE UP TO 0.1MG INJRX636J046127.60
30350011ATROVENT HFA 17MCG INHALER - 200 INHRX259302.90
30300207ATTEND BRIEF BARIATRICCS270A452015.39
30301999ATTEND CHUCK PADCS272A45542.90
30300069ATTEND WIPESCS270A433529.70
30300781ATTENDS BRIEFS LARGECS270A45204.60
30300751ATTENDS BRIEFS MEDIUMCS270A45206.70
30300520ATTENDS BRIEFS XLARGECS270A45205.50
30300638ATTENDS PANT LINERCS270A45203.00
30301650ATTENDS PULL UP XXLGCS270A45208.10
30300787ATTENDS PULL UP YOUTH X SMALLCS270T45348.00
30300521ATTENDS PULLUP LARGECS270A45205.30
30300577ATTENDS PULLUP MEDIUMCS270A45205.30
30300522ATTENDS PULLUP XLARGECS270A45206.70
30301998ATTENDS PULLUP YOUTHCS270A45205.30
35052552AUDIOMETRY PURE TONE AIR THRESHOLDCLNC5219255230.00
30350930AVALIDE 300MG/12.5MG TABRX25917.10
30350319AVAPRO 300MG TABRX25920.10
30353005AVODART 0.5MG CAPRX25917.80
30351004AZATHIOPRINE 50MG TABRX636J75002.50
30358335AZELASTINE NASAL SOLUTION PER BTLRX25962.10
30350147AZITHROMYCIN 250MG TABRX2592.70
30350240AZITHROMYCIN 500MG INJRX636J045624.40
30350146AZITHROMYCIN OS 100MG/5ML -15MLRX25942.10
30350014AZITHROMYCIN OS 200MG/5ML - 15MLRX25929.90
30350162AZITHROMYCIN OS 200MG/5ML -30CC BTRX25928.30
30350770AZOPT OPTH DROPS PER 10ML BTLRX259263.70
30258388B NATRIURETIC PEPTIDELAB30183880314.08
30350395BACITRACIN OINTMENT PER 1OZ TUBERX2599.90
30350016BACITRACIN PKTRX2593.80
30357104BACLOFEN 10MG TABLETRX2592.50
30350154BACLOFEN 20MG TABRX2592.50
30301804BAIR HUGGER BLANKET FULL BODYCS27080.00
30300349BANDAID 2X3.75CS270A64131.00
30259004BASIC EXAM LIFE INSURANCELAB3009900058.80
30250048BASIC METABOLIC PANELLAB30180048112.70
30256902BB UNIT 1T&RH
30256904BB UNIT 2 T&RH
30256907BB UNIT 3 T&RH
30256908BB UNIT 4 T&RH
30350196BELLADONNA ALK W/PHEN PER 5MLRX25932.50
30355050BELSOMRA 5MG TABLETRX25936.90
30353500BENAZEPRIL 10MG TABRX2592.50
30350148BENAZEPRIL 40MG TABRX2592.50
30351603BENEFIBER PER DOSERX2572.50
30350469BENICAR 20MG TABRX2592.50
30351511BENZONATATE 100MG CAPRX2592.50
30353832BENZTROPINE 1MG TABRX2512.50
30350045BENZTROPINE 2MG TABRX2592.50
30252232BETA 2 MICROGLOBULINLAB30282232129.44
30252011BETA-HYDROXYBUTYRIC ACIDLAB3018201055.40
30354610BETOPTIC S OPHTH 0.25% PER 10MLRX259260.40
30356003BEVESPI AEROSPHERE PER INHALERRX252153.60
35059484BHI GENERAL > 20 MINUTES/MONTHCLNC52199484100.50
30351102BICALUTAMIDE 50MG TABRX2592.50
30203523BILATERAL HIP 3-4 VIEW READINGRADP9727352261.08
30203522BILATERAL HIPS 3-4 VIEWSRAD32073522250.00
30203567BILATERAL WT BEARING KNEE READINGRADP9727356536.52
30203565BILATERAL WT BEARING KNEESRAD32073565162.94
30300495BILE BAGCS27045.35
30256682BILHARZIASISLAB30286682104.08
30252248BILIRUBIN DIRECTLAB3018224845.60
30252247BILIRUBIN TOTALLAB3018224745.60
30304975BIOPATCH 1CS27236.05
35051100BIOPSY SKIN PUNCH (SINGLE LESION)CLNC52111104113.40
35051101BIOPSY SKIN PUNCH EACH ADD LESIONCLNC5211110539.90
30300253BIOPSY FORCEPS DISPCS270100.40
30300720BIOPSY PUNCH SZ 2 DISPCS27221.70
30300817BIOPSY PUNCH SZ 3 DISPCS27021.70
30300724BIOPSY PUNCH SZ 4 DISPCS27021.70
30301124BIOPSY PUNCH SZ 5 DISPCS27015.39
30300723BIOPSY PUNCH SZ 6 DISPCS27021.70
30450001BIOTHOTIC ORTHOTICSPT274129.00
30357715BIOTIN 5000MCG TABRX2592.50
30301365BIPAP CIRCUT TUBINGCS270137.40
30301133BIPAP HEAD GEARCS27145.15
30304918BiPap Heated Circut TubingCS270117.60
30301347BIPAP MASK LARGECS270120.00
30301539BIPAP MASK MEDIUMCS270120.00
30301540BIPAP MASK SMALLCS270120.00
30350017BISACODYL 10 MG SUPPRX2592.50
30350632BISACODYL EC 5MG TABRX2592.50
30357430BISOPROLOL 10MG TABRX2592.70
30350659BISOPROLOL 5MG TABRX2513.80
30257799BK VIRUS BY PCRLAB30287799331.10
37080101BLADDER SCAN/MEASURE PVRNUR4025179868.50
30259003BLOOD UNIT SEARCHLAB30099001195.30
30300762BODY LOTION 4 OZCS2701.30
30300302BONE MARROW BIOPSY TRAYCS270158.40
30257801BORDETELLA PERTUSSIS BY PCRLAB30287798184.80
30256617BORRELIA BURGDORFERI ANTIBODY PANELAB30286618201.00
30450035BRACE MEASUREMENT AND TRAINING 15 MINPT4209776096.00
30355914BREO ELLIPTA 100MCG/25MCG PER INHALERRX252278.80
30358214BREO ELLIPTA 200MCG/25MCG PER INHALERRX252278.80
30357760BRILINTA 90MG TABRX25219.60
30350456BROVANA SOLN INH 15MCG/MLRX259J760525.90
30350572BUDESONIDE INHAL PER 0.5mgRX294J76265.60
30300051BULB SYRINGE 1 OZCS2706.55
30351118BUMETANIDE (BUMEX) 0.5MG INJRX636J349019.80
30350431BUMETANIDE 1MG TABRX2593.10
30357991BUMETANIDE 2MG TABRX25111.70
30254520BUNLAB3018452038.60
30350069BUPIVACAINE 0.5% 5MG/ML PER 30ML INJRX636S002013.00
30350218BUPROPION 100MG TABRX2592.50
30354522BUPROPION SR 100MG/12H TABRX2592.50
30354521BUPROPION SR 150MG/12H TABRX2592.50
30350142BUPROPION XL 150MG/24HR TABRX2593.60
30350256BUSPAR 10MG TABRX2592.50
30356591BUSPIRONE 15MG TABLETRX2592.50
30351552BUTALBITAL/ASA/CAFFEINE 50/325/40MG CAPRX2595.40
30359036BUTORPHANOL NASAL SPRAY 2.5ML BTLRX25937.50
30350189BUTORPHANOL TARTRATE UP TO 1MG INJRX636J059528.80
30354523BUTRANS TRANS PATCH - 10MCG/HRRX259146.20
30355804BUTRANS TRANS PATCH - 15MCG/HRRX259168.60
30354524BUTRANS TRANS PATCH - 20MCG/HRRX259206.60
30350531BUTRANS TRANS PATCH - 5MCG/HRRX259113.40
30350711BYETTA PEN INJRX259710.30
30354525BYSTOLIC 10MG TABRX25910.30
30351116BYSTOLIC 5MG TABRX25913.90
30257493C DIFF TOXIN GENELAB30287493121.54
30256140C REACTIVE PROTEINLAB3028614055.00
30202040C SPINE AP AND LATERALRAD32072040228.00
30202052C SPINE COMPLETERAD32072052340.60
30202053C SPINE READINGRADP9727205262.52
30256160C3/C4 COMPLEMENTLAB3018616090.80
30256304CA 125LAB30186304166.50
30256300CA 27-29LAB30286300166.48
34009993CABLE TV - MONTHLYLTC99420.00
30252308CALCITONINLAB30182308126.00
30350990CALCITONIN NS 200IU/SPRAY - 30 DOSERX259139.90
30353002CALCITRIOL 0.25MCG CAPRX2593.10
30252310CALCIUMLAB3018231045.60
30350018CALCIUM +D 600MG/400IU TABRX2592.50
30353252CALCIUM 600MG TABRX2592.50
30354991CALCIUM ALGINATE ROPE 3/4" X 12CS272A619983.60
30350129CALCIUM CARBONATE 500MG CHEW TABRX2592.50
30350705CALCIUM CHL 10% UP TO 1000MG/10ML INJRX636J349033.60
30359000CALCIUM CITRATE W/ VIT D TABLETRX2592.50
30350327CALCIUM GLUC 10% PER 10ML INJRX636J061039.30
30252330CALCIUM IONIZEDLAB30182330109.44
30252340CALCIUM URINELAB3018234058.00
30301010CALGISWABCS2704.60
30356876CALMOSEPTINE OINT 4OZ TUBERX25117.00
30300024CANNULA INFANTCS27010.17
30301575CANNULA EAR PROTECTORCS27010.26
30357990CAPTOPRIL 12.5MG TABLETRX2593.10
30353041CAPTOPRIL 50MG TABRX2592.50
30350019CARAFATE OS PER DOSERX25914.10
30350472CARBAMAZEPINE 200 MG TABRX2592.50
30356541CARBAMAZEPINE ER 100MG CAPRX25111.40
30350120CARBIDOPA/LEVODOPA 10/100MG TABRX2592.50
30350235CARBIDOPA/LEVODOPA 25/100MG TABRX2592.50
30350910CARBODOPA-LEVODOPA 25/250MG TABRX2512.50
30252374CARBON DIOXIDELAB3018237445.60
30255049CARBON MONOXIDE LEVELLAB3018237559.60
30352203CARDENE(NICARDIPINE) PER 20MGRX259182.30
30218332CARDIAC DOPPLER COMPLETEUS40293320357.00
30219331CARDIAC DOPPLER LIMITEDUS40293321241.00
30256143CARDIAC PANEL
30350582CARISOPRODOL 350MG TABRX2592.50
30350623CARVEDILOL 12.5MG TABRX2592.50
30350625CARVEDILOL 25MG TABRX2512.50
30350167CARVEDILOL 3.125MG TABRX2592.50
30350624CARVEDILOL 6.25MG TABRX2592.50
30300621CAST PADDING 1 ROLLCS2704.60
30301103CATCH POLYPCS27032.50
30252526CATECHOLAMINE FRACTIONATION URINELAB30182384152.85
30300447CATH KIT FEMALE FAST CATHCS270A927023.05
30300449CATH KIT FEMALE MINICS27023.05
30300584CATH MINI FEMALECS27023.05
30300107CATH PLUGCS2704.70
30300390CATH SECURECS27227.96
30300019CATH SELF 16FRCS27014.60
30300111CATH TRAY URETHRALCS272A431019.05
30300333CATHETER MALE TEXASCS274A432621.44
30300847CATHETER SELF FEM 14FRCS2702.50
30300332CATHETER TUBE HOLDERCS274A433327.96
30354164CATHFLO ACTIVASE(ALTEPLASE) PER 1MG-2MGRX636J2997242.70
30255027CBCLAB3058502767.60
30255028CBC NO DIFFLAB3058502784.90
30255024CBC WITH AUTO DIFFLAB3058502584.90
30255023CBC WITH MANUAL DIFFLAB3058500754.10
35059490CCMCLNC521G0511100.50
30252378CEALAB30182378155.90
30350291CEFAZOLIN PER 500MG INJRX636J069021.70
30350583CEFDINIR 300MG CAPRX2596.40
30355000CEFDINIR OS 250/5ML - 60ML BTLRX259101.30
30354021CEFEPIME PER 500MG INJRX636J069229.20
30353920CEFOPODOXIME PROXETIL 200MG TABLETRX25921.20
30350704CEFOTAXIME PER 1GM INJRX636J069821.50
30358510CEFOTETAN 1GM INJRX636J349042.40
30350111CEFTRIAXONE PER 250MG INJ - 1GM VIALRX636J069617.20
30352501CEFTRIAXONE PER 250MG INJ - 500MG VIALRX636J069615.70
30357140CEFUROXIME 250MG TABRX2516.50
30356714CEFUROXIME 500MG TABRX25113.20
30350210CELEBREX 100MG TABRX2526.70
30350209CELEBREX 200MG TABRX2599.00
30258352CELIAC DISEASE DUAL ANTIGENLAB3028351692.24
30259050CELL COUNT BODY FLUIDLAB3058905039.65
30350478CENESTIN 1.25MG TABRX25914.40
30305000CENTRAL LINE DRESSING TRAYCS272A422128.80
30300549CENTRAL LINE KIT ADULTCS270194.50
30300530CENTRAL LINE KIT PEDSCS270178.30
30350020CEPACOL THROAT LOZ EACHRX2592.50
30357773CEPHALEXIN 250MG/5ML PER 100ml BTLRX25144.90
30350153CEPHALEXIN 500MG CAPRX2592.50
30252390CERULOPLASMINLAB3018239085.92
30300842CERVICAL COLLAR ACECS27046.75
30300279CERVICAL COLLAR ACE MINICS27029.95
30350361CETIRIZINE 10MG TABRX2592.50
30350670CHANTIX 1 MG TABRX2592.50
30201022CHEST 2 VIEW READINGRADP9727104645.20
30201020CHEST 2 VIEWSRAD32471046248.75
30201010CHEST ONE VIEWRAD32471045198.83
30201011CHEST ONE VIEW READINGRADP9727104537.96
30309373CHEST TUBE 12FRCS27278.50
30300379CHEST TUBE 24FRCS27278.50
30300277CHEST TUBE 28FRCS27078.50
30300383CHEST TUBE 32FRCS27278.50
30300306CHEST TUBE TRAYCS27041.85
30257486CHLAMYDIA PNEUMONIALAB30287486280.72
30257491CHLAMYDIA DNA PROBE CULTLAB30687491280.72
30301132CHLORAPREP 10.5MLCS270A424833.85
30350535CHLORDIAZEPOXIDE 25MG CAPSULERX2592.50
30350663CHLORDIAZEPOXIDE/CLIDIN 5/2.5MG CAPRX2593.60
30252435CHLORIDELAB3018243545.60
30356710CHLORPHENIRAMINE 4MG TABRX2592.50
30352201CHLORTHALIDONE 25MG TABRX2592.50
30252465CHOLESTEROLLAB3018246551.05
30350937CHOLESTYRAN OS 4GMS DOSERX2597.00
30351400CILOSTAZOL (PLETAL) 100MG TABRX2592.50
30353302CIPRODEX OTIC PER BTLRX259303.40
30350349CIPROFLOXACIN 200MG INJRX636J074421.80
30357010CIPROFLOXACIN 250MG TABLETRX2592.50
30350274CIPROFLOXACIN 500MG CAPRX2592.50
30350491CIPROFLOXACIN OPH DRP 0.3% -2.5ML BTLRX25920.80
30350464CITALOPRAM 10MG TABRX2592.50
30358010CITALOPRAM 20MG TABLETRX2592.50
30350179CITALOPRAM 40MG TABRX2592.50
30252507CITRATE URINE 24 HOURLAB30182507215.70
30252553CKMBLAB30182553100.00
30203000CLAVICLE COMPLETERAD32073000215.17
30203001CLAVICLE READINGRADP9727300035.08
30305001CLC 2000 EXTENSIONCS27219.20
30350448CLINDAMYCIN 150MG CAPRX2592.50
30353032CLINDAMYCIN PER 300MG INJ - 300MG VLRX636J349022.40
30350237CLINDAMYCIN PER 300MG INJ - 600MG VLRX636S007721.40
30352581CLOBETASOL 0.05% CREAM 15GMRX259253.90
30350022CLONAZEPAM 1MG TABRX2592.50
30350533CLONIDINE 0.1MG TABRX2592.50
30350994CLOPIDOGREL BISULFATE 75MG TABRX2592.50
30350484CLOTRIMAZOLE 1% CREAM PER 1OZ TUBERX25910.80
30359815CLOTRIMAZOLE/BETAMETHASONE 1%/0.05% TUBERX25975.20
30300567CO2 DETECTOR EASY CAP IICS27066.10
30300644CO2 DETECTOR PEDSCS27066.10
30301831COBAN 1 LATEX FREECS270A64536.80
30301832COBAN 2 LATEX FREECS270A645312.25
30301833COBAN 3 LATEX FREECS270A645415.22
30350585COCAINE 4% TOPICAL SOLN 4ML BTLRX259334.40
30256636COCCIDIOIDES ANTIBODIES TEST
35059492COCM 1st psyc mgmt 1st 70 minCLNC52199492158.20
35059494COCM 1ST/SUB EACH ADDL 30 MINSCLNC5219949464.43
35059493COCM SUBSEQUENT 1ST 60 MINCLNC52199493127.30
30350547COENZYME Q10 100MG CAPRX2592.50
30305081COFLEX 2 LAYER COMPRESION DRESSINGCS272A645467.14
30350264COLCHICINE (COLRYS) 0.6MG TABRX25119.40
30300888COLD PACK CERVICAL/ NECCS27087.50
30300486COLD PACK OVERSIZECS27099.80
30300480COLD PAK DISPCS27021.40
30352045COLESTIPOL 1GM TABLETRX2594.30
30300245COLLAGENASE OINTMENT SANTYLSRX270224.48
30350548COMBIGAN OPTH SOLN 5ML BTLRX259279.80
30350296COMBIVENT INHALERRX259551.00
34000001COMMUNITY BATHLTC11915.00
30250053COMPREHENSIVE METABOLICLAB30180053128.30
30304841COMPRILAN ELASTIC BANDAGE 3inCS270A644929.34
30350951COMTAN 200MG TABRX25916.80
30300835CONFORM STRETCH 1CS270A64455.60
30300777CONFORM STRETCH 2"CS270A64455.60
30300837CONFORM STRETCH 3"CS270A64468.00
30300779CONFORM STRETCH 4CS270A64468.00
30300838CONFORM STRETCH 6CS270A644711.70
30300186CONNECTING TUBINGCS2707.90
31109145CONSCIOUS SEDATION EACH ADD 15 MINOBS7629914575.10
31109143CONSCIOUS SEDATION FIRST 30 MINOBS76299143171.20
30300103CONTROL SYRINGECS2708.00
99999999CONV CHARGE NUMBERZZ9990.00
30256880COOMBS DIRECTLAB3008688049.70
30252525COPPERLAB3018252599.28
888888888CORRECTING CHARGECS2700.00
888888887CORRECTING PAY/ADJCS2700.00
30252533CORTISOLLAB30182533138.15
30350409CORTISONE 25MG TABRX2595.80
30257081CORYNEBACTERIUM DIPHTHERIAELAB30286317100.00
30300542COTTON BADDING PER FTCS2709.81
30309999COTTON BALLS PER BAGCS27013.77
30301128COTTON TIP APP 6IN STERILECS2792.91
35050296COUNSELING FOR LUNG SCREENINGCLNC521G0296157.50
30257636COVID 19 ID NOWLAB30687635146.25
30256328COVID 19 IgG AbLAB30286769150.00
30256329COVID 19 IgM AbLAB30286769150.00
30257635COVID-19LAB306876350.00
30254681C-PEPTIDELAB30184681156.15
30252550CPKLAB3018255091.30
30355812CRANBERRY 425MG CAPSULERX2592.50
30252565CREATININELAB3018256545.60
30252575CREATININE CLEARANCELAB3018257593.10
30252570CREATININE URINELAB3018257041.44
30356071CREON 6000UNIT CAPSULERX2597.00
30352401CREON PANCRELIPASE 24000 CAPRX25221.90
30350589CRESTOR 10MG TABRX2592.50
30160292CRITICAL CARE EA. ADD. 30 MINEDP98199292395.00
30160291CRITICAL CARE FIRST 30-74MINEDP98199291795.00
30256920CROSSMATCH GELLAB30086922130.55
30256923CROSSMATCH PANEL
30202041C-SPINE READINGRADP9727204046.64
30204151CT ABDOMEN READINGCTP97274150184.95
30204160CT ABDOMEN W/ CONTRASTCT350741601448.30
30207416CT ABDOMEN W/ CONTRAST READINGCTP97274160197.94
30204150CT ABDOMEN W/O CONTRASTCT350741501240.05
30204170CT ABDOMEN W/WO CONTRASTCT350741701597.40
30207417CT ABDOMEN W/WO CONTRAST READINGCTP97274170218.10
30201252CT ABDOMEN/PELVIS W/ CONTRASTCT350741771841.20
30201255CT ABDOMEN/PELVIS W/ CONTRAST READINGCTP97274177283.38
30201256CT ABDOMEN/PELVIS W/ WO CONTRAST READINGCTP97274178310.44
30201251CT ABDOMEN/PELVIS W/O CONTRASTCT350741761553.50
30201254CT ABDOMEN/PELVIS W/O CONTRAST READINGCTP97274176270.39
30201253CT ABDOMEN/PELVIS W/WO CONTRASTCT350741781962.50
30202125CT C SPINE W/O CONTRASTCT350721251332.25
30201250CT CHEST READINGCTP97271250179.22
30203457CT CHEST W/ & W/O CONTRASTCT350712701584.00
30201271CT CHEST W/ & W/O CONTRAST READINGCTP97271270213.09
30203456CT CHEST W/ CONTRASTCT350712601462.30
30201261CT CHEST W/ CONTRAST READINGCTP97271260193.62
30203455CT CHEST W/O CONTRASTCT350712501256.40
30207217CT C-SPINE READINGCTP97272125155.40
30207320CT EXTREMITIES UPPER READINGCTP97273200155.40
30200486CT FACIAL BONES READINGCTP97270486133.74
30200451CT HEAD READINGCTP97270450132.66
30200471CT HEAD W/ & W/O CONTRAST READINGCTP97270470196.86
30207046CT HEAD W/ CONTRAST READINGCTP97270460174.87
30200470CT HEAD WITH AND WITHOUT CONTRASTCT351704701370.00
30200460CT HEAD WITH CONTRASTCT351704601270.00
30200450CT HEAD WITHOUT CONTRASTCT351704501067.80
30203480CT IAC W/O CONTRASTCT351704801165.60
30207370CT LOWER EXTREMITIES READINGCTP97273700155.40
30203463CT LOWER EXTREMITY W/ COCT350737011406.00
30203462CT LOWER EXTREMITY W/O CCT350737001253.00
30207213CT L-SPINE READINGCTP97272131155.40
30203458CT L-SPINE W/O CONTRASTCT350721311230.00
30202133CT L-SPINE W/WO CONTRASTCT350721331530.00
30203547CT MAXILLOFACIAL W/O CONCT350704861100.00
30202199CT PELVIS READINGCTP97272192168.39
30202193CT PELVIS W/ CONTRASTCT350721931439.20
30207219CT PELVIS W/ CONTRAST READINGCTP97272193179.22
30202192CT PELVIS W/O CONTRASTCT350721921272.40
30207220CT PELVIS W/WO CONTRAST READINGCTP97272194189.27
30203543CT SINUS/MAXILOFACIAL W/O CONTRASTCT351704861100.00
30206380CT SINUSES READINGCTP97270486149.97
30203454CT SOFT TISSUE NECK W/ & W/O CONTRCT350704921430.00
30203452CT SOFT TISSUE NECK W/ CCT350704911328.10
30200491CT SOFT TISSUE NECK W/ CONTRAST READINGCTP97270491214.17
30203451CT SOFT TISSUE NECK W/OCT350704901105.10
30200490CT SOFT TISSUE NECK W/O CONTRAST READINGCTP97270490199.02
30202128CT T SPINE W/O CONTRASTCT350721281300.00
30207218CT T-SPINE READINGCTP97272128155.40
30203460CT UPPER EXTREMITY W/CT350732011300.00
30203459CT UPPER EXTREMITY W/OCT350732001150.00
30205635CTA AORTA W/ RUNOFFS LOWER EXT.CT350737061562.00
30205636CTA AORTA W/RUNOFFS LOWER EXT. READINGCTP97273706290.97
30200498CTA CAROTIDSCT350704981872.00
30200005CTA CAROTIDS READINGCTP97270498271.47
30201276CTA CHEST PE PROTOCOLCT350712751706.20
30201262CTA CHEST PE READINGCTP97271275282.30
30200004CTA HEAD READINGCTP97270496271.47
30200496CTA HEAD/BRAINCT350704961659.80
30201263CTA THORACIC AORTA READINGCTP97274175282.30
30201277CTA THORACIC AORTA W AND W/O CONTRASTCT350741751738.10
30203207CTA UPPER EXTREMITY RUNOFF READINGCTP97273206289.95
30203206CTA UPPER EXTREMITY RUNOFFSCT350732061411.80
30257040CULTURE BLOODLAB30687040102.10
30257077CULTURE ORGANISM IDENTIFLAB3068707798.55
30257186CULTURE ORGANISM SENSITILAB3068718678.10
30257070CULTURE OTHER SOURCELAB30687070104.55
30257046CULTURE STOOLLAB30687046104.55
30257088CULTURE URINELAB3068708862.50
30300736CURETTES BLUE INFANTCS27010.53
30300737CURETTES WHITE FLEXHOOPCS27010.53
30301100CURETTES YELLOWCS27010.53
30350733CYANIDE ANTIDOTE PKGRX636J3490542.40
30350205CYANOCOBALAMIN UP TO 1000MCG INJRX636J342021.70
30350239CYCLOBENZAPRINE 10MG TABRX2592.50
30250158CYCLOSPORINLAB30180158144.40
30354065CYCLOSPORINE 25MG CAPRX2597.70
30350508CYMBALTA 20MG CAPRX2592.50
30350675CYMBALTA 30MG CAPRX2592.50
30352095CYMBALTA 60MG CAPRX2592.50
30350645CYPROHEPTADINE 4 MG TABRX2592.60
30258343CYTOLOGY (PLEURAL FLUID)LAB31188112201.83
30255380D DIMERLAB30585380111.15
30359530DALIRESP 500MCG TABLETRX25934.20
30354110DANTROLENE 25MG CAPRX2514.20
30301800DEFIB PADSCS27022.96
30350593DELSYM COUGH LIQ PER 5MLRX2592.50
30304301DEMECLOCYCLINE 150MG TABRX2516.90
30350550DEMECLOCYCLINE 300MG TABRX25930.80
30350453DEMEROL PER 100MG INJ - 100MG SYRRX636J217527.80
30350450DEMEROL PER 100MG INJ - 50MG SYRRX636J217529.10
30350452DEMEROL PER 100MG INJ - 75MG SYRRX636J217527.70
30300479DEODORANT SPRAYCS2703.20
30300590DEODORANT STICK LADYCS2703.20
30300478DEODORANT STICK MENCS2693.20
30350158DEPO MEDROL PER 20MG INJRX636J103026.40
30354493DERMABOND SKIN ADHESIVECS279G016876.05
30353034DERMAGRAN OINT TUBE 4OZRX25922.90
35057003DESTRUCTION BENIGN 2 THROUGH 14CLNC5211700318.90
35057000DESTRUCTION BENIGN LESIONCLNC5211700090.30
30300655DETACHOL PKTCS27013.00
30350429DETROL 2MG TABRX2592.60
30350477DETROL LA 4MG CAPRX25910.10
30352034DEXAMETHASONE 4MG TABRX2595.10
30350924DEXAMETHASONE ORAL PER 0.25MGRX636J85405.90
30350561DEXAMETHASONE SOD PHOS PER 1MG INJRX636J110017.70
30350475DEXILANT 60MG CAPRX25921.50
30356103DEXTROAMPHETAMINE 10MG TABLETRX25915.20
30354010DEXTROSE 50% INJRX25934.40
30354001DEXTROSE SOL. 10% 1000CCRX25820.25
30251658DHEA-SULFATELAB30082627105.00
30300740DIAPER 0-6 LBSCS2702.50
30301997DIAPER 16-28 lbsCS2702.50
30300742DIAPER 35LBS SIZE 6CS2702.50
30300741DIAPER 6-14 LBSCS2702.50
30300839DIAPERSCS27027.40
30352760DIAZEPAM 10MG TABLETRX2592.50
30359603DIAZEPAM 2MG TABRX2512.50
30350025DIAZEPAM 5MG TABRX2592.50
30350204DIAZEPAM UP TO 5MG INJRX636J336083.40
30353306DICLOFENAC TOPICAL GEL 1% TUBERX259101.00
30350026DICYCLOMINE 20MG TABRX2592.50
37357804DIETARY CNSL GROUP PER 30 MINDIET9429780425.00
37357802DIETARY CNSL INITIAL PER 15 MINDIET9429780225.00
37357803DIETARY CNSL SUBSEQ PER 15 MINDIET9429780325.00
30250298DIGITOXINLAB30180299149.12
30250162DIGOXIN LEVELLAB30180162167.00
30350263DIGOXIN UP TO 0.5MG INJRX636J116031.30
30350288DILANTIN 100MG CAPRX2592.50
30350285DILTIAZEM 120MG TABRX2592.50
30350034DILTIAZEM 30MG TABRX2592.50
30359303DILTIAZEM 60MG TABRX2512.50
30351310DILTIAZEM DRIP 125MG INFUSIONRX25952.00
30350335DILTIAZEM ER 120MG CAPLETRX2513.30
30350471DILTIAZEM ER 180MG CAPRX2592.50
30350667DILTIAZEM ER 300 MG CAPRX25910.30
30350708DILTIAZEM PER 25MG INJRX259J349022.00
30350118DIOVAN 160MG TABRX25916.70
30350269DIOVAN 320MG TABRX2592.50
30356730DIOVAN 40MG TABRX2592.50
30350516DIOVAN 80MG TABRX25914.30
30350184DIPHENHYDRAMINE 25MG CAPRX2592.50
30350027DIPHENHYDRAMINE LIQ 12.5MG/5MLRX2592.50
30350307DIPHENHYDRAMINE UP TO 50MG INJRX636J120013.60
30351052DIPTHERIA, TETANUS, PERTUSSIS (DTaP)RX6369070073.20
PT3G8986DISCHARGE CARRY/MOVE/HANDLE OBJ D/CPT420G89860.01
PT3G8985DISCHARGE CARRY/MOVE/HANDLE OBJ GOALPT420G89850.01
PT3G8983DISCHARGE CHANGE/MAINTAIN BODY POS D/CPT420G89830.01
PT3G8982DISCHARGE CHANGE/MAINTAIN BODY POS GOALPT420G89820.01
PT3G8980DISCHARGE MOBILITY WALK/MOVE D/CPT420G89800.01
PT3G8979DISCHARGE MOBILITY WALK/MOVE GOALPT420G89790.01
PT3G8992DISCHARGE OTHER PRIMARY D/CPT420G89920.01
PT3G8991DISCHARGE OTHER PRIMARY GOALPT420G89910.01
PT3G8995DISCHARGE OTHER SUBSEQUENT D/CPT420G89950.01
PT3G8994DISCHARGE OTHER SUBSEQUENT GOALPT420G89940.01
PT38989DISCHARGE SELF CARE D/CPT420G89890.01
PT3G8988DISCHARGE SELF CARE GOALPT420G89880.01
30350522DIVALPROEX 125MG CAPRX2593.20
30350301DIVALPROEX 250MG TABRX25910.90
30350999DIVALPROEX SOD 500MG TABRX25918.00
30350451DOBUTAMINE PER 250MG INJRX636J125026.80
30350029DOCUSATE SOD 100MG CAPRX2592.50
30350300DONEPEZIL 10MG TABRX2512.50
30350668DONEPEZIL 5MG TABRX2592.50
30350332DOPAMINE PER 40MG INJRX636J126535.30
30351113DORZOLAM/TIMOLOL 2/0.5% OPTH-10ML BTLRX25936.30
35050214DOT PHYSICALCLNC52199214150.00
30350402DOXAZOSIN 2MG TABRX2593.30
30350426DOXAZOSIN 4MG TABRX2594.30
30350514DOXEPIN 100MG CAPRX2592.50
30354901DOXEPIN 10MG CAPSULERX2592.50
30350673DOXEPIN 25MG CAPRX2592.60
30350253DOXYCYCLINE 100MG CAPRX2592.50
30301118DRAIN SPONGE 2X2CS2700.68
30301101DRAIN SPONGE 4X4CS2704.20
30300738DRAIN SPONGE PLAINCS270A64024.20
30300978DRAIN TUBE ATTACHMENT 9780CS27064.40
30300970DRAIN TUBE ATTACHMENT NHCS27080.40
30300696DRAPE STERILECS27018.95
30300508DRESSING TEGADERM 4X5 TCS27010.00
30300708DRESSING TEGADERM 4X5 TCS2705.05
30300819DRESSING 2 LAYER COMPRESSION 4"CS27055.00
30300784DRESSING ALGINATE 2X2CS27024.64
30304077DRESSING ALGINATE 2X2CS272A619620.32
30304945DRESSING CALCIUM ALIGNATECS270A619626.46
30300546DRESSING FOAM HEEL BIATAINCS27039.75
30300761DRESSING HUMIFIBER 2X2CS270A619633.75
3030773DRESSING HUMIFIBER 4X4CS270A619639.50
30300804DRESSING HUMIFIBER 6X6CS270A619783.50
30300785DRESSING MEPILEX AG 4X4CS27094.85
30301973DRESSING THERA HONEY 1.5CS27281.65
30300124DRESSING THERAHONEY GAUZE 4X5CS272A464946.77
30300343DRILL BIT PENDRILCS27067.60
30250101DRUGS OF ABUSE DRUG SCREENLAB30180305100.80
30301522DRY WIPESCS270A433511.52
30256226ds DNA AbLAB30286225109.92
30354602DULERA 200MCG/5MCG INHALERRX259441.60
30300677DUO DERM 4X4CS27029.65
30300123DUODERM HEELCS27077.80
30300904DUODERM THIN 4X4CS27017.20
30351192DYRENIUM 100MG TABRX25911.40
30350128DYRENIUM 50MG CAPRX25917.40
30300561EAR IRRIGATIONCS2706.50
37089210EAR IRRIGATION / CLEANINGPROC7696921069.30
30300682EAR WICKCS27015.60
30520059EAR WICKCS2705.00
30219330ECHOCARDIOLOGY COMPLETEUS483933061360.00
37080102ED - INSERT NON-INDWELLING FOLEY CATHED4505170147.30
30151702ED - INSERTION OF FOLEY CATHETERED45051702159.00
30160120ED FOREIGN BODY INCISION & REMOVALEDP98110120157.50
30160060ED I&D ABCESS (SIMPLE OR SINGLE)EDP98110060139.70
30150471ED INJECTION, IMMUNIZATION ADMINISTRATIOED4509047179.75
30150003ED INJECTION, SQ OR IMED4509637279.76
30156361ED IV INFUS HYDRATION, EACH ADD HOURED4509636197.00
30156360ED IV INFUS HYDRATION, INITIAL, 31M-1HED45096360269.66
30156367ED IV INFUSION, INITIAL, UP TO 1 HRED45096365269.66
30156375ED IV PUSH EACH ADDITIONAL DRUGED4509637558.20
30156374ED IV PUSH, SINGLE/INITIAL DRUGED45096374168.00
30162001ED LAC REPR SCALP/NECK//EXTREMI <= 2.5EDP98112001172.00
30162002ED LAC REPR SCALP/NECK//EXTREMI 2.5-7.5CEDP98112002185.00
30162013ED LACERAT SIMPL FACE/EAR 2.6CM TO 7.5CMEDP98112013139.78
30162011ED LACERAT SIMPLE FACE/EARS 2.5CM OR LESEDP98112011132.25
30160901ED SIMPLE CONTROL OF NOSE BLEEDEDP98130901104.30
30352330EFFIENT 10MG TABLETRX25949.80
30300635EGGCRATE CHAIR PADCS27031.15
30300694EGGCRATE MATTRESS PADCS27039.20
30603005EKGRAD73093005139.00
30203080ELBOW COMPLETE 3 VIEWRAD32073080217.00
30203081ELBOW COMPLETE 3 VIEW READINGRADP9727308036.52
30203071ELBOW LIMITED 2 VIEW READINGRADP9727307035.08
30203070ELBOW LIMITED 2 VIEWSRAD32073070214.57
30300068ELECTRODES 4 PKCS271A455623.38
30359421ELIQUIS 5MG TABLETRX25919.70
30359801ELMIRON 100MG CAPSULERX25924.10
30450005EMPLOYEE FUNCTIONAL TESTINGPT4200.00
30350641ENABLEX 7.5MG TABRX25918.00
30350923ENALAPRIL 10MG TABRX2592.50
30350925ENALAPRIL 20MG TABRX2592.50
30350165ENDOCET 5/325 MG TABRX2592.50
30256347ENDOMYSIAL ANTIBODIESLAB3028625696.40
30300189ENEMA BUCKETCS27011.15
30300187ENEMA FLEETCS2709.85
30355002ENLUXTRA ROLLCS272A6198156.00
30354950EPI PEN 0.3MG/0.3ML PER PENRX251215.40
30352031EPINEPHRINE 0.1MG INJRX636J017141.80
30353031EPINEPHRINE 0.1MG INJRX636J017136.60
30357810EPOGEN per 1000unitsRX635507.40
30256665EPSTEIN BARR PANELLAB30286665145.12
30153015ER CRITICAL CARE 1ST HOUED450992911340.00
30153016ER CRITICAL CARE AD 30 MED45099292375.00
30153010ER DEPARTMENT LEVEL IED45099281144.00
30153011ER DEPARTMENT LEVEL IIED45099282250.00
30153012ER DEPARTMENT LEVEL IIIED45099283384.00
30153013ER DEPARTMENT LEVEL IVED45099284624.00
30153014ER DEPARTMENT LEVEL VED45099285840.00
30160281ER VISIT IEDP98199281127.10
30160282ER VISIT IIEDP98199282145.45
30160283ER VISIT IIIEDP98199283205.00
30160284ER VISIT IVEDP98199284313.00
30160285ER VISIT VEDP98199285488.00
30350672ERYTHROMYCIN OPTH OINT 0.5%/3.5GMTRX25937.60
30251290ERYTHROPOIETIN LEVELLAB30182668152.50
30357280ESCITALOPRAM 5MG TABRX2512.50
35059394EST PATIENT WELLNESS AGE 12-17 YRSCLNC52199394157.50
35059392EST PATIENT WELLNESS AGE 1-4 YRSCLNC52199392157.50
35059395EST PATIENT WELLNESS AGE 18-39 YRSCLNC52199395157.50
35059396EST PATIENT WELLNESS AGE 40-64 YRSCLNC52199396157.50
35059393EST PATIENT WELLNESS AGE 5-11 YRSCLNC52199393157.50
35059391EST PATIENT WELLNESS UNDER AGE 1CLNC52199391157.50
35059211EST. PATIENT LEVEL ICLNC5219921158.80
35059212EST. PATIENT LEVEL IICLNC5219921291.94
35059213EST. PATIENT LEVEL IIICLNC52199213135.67
35059214EST. PATIENT LEVEL IVCLNC52199214189.02
35059215EST. PATIENT LEVEL VCLNC52199215204.80
30450006E-STIM MANUAL PER 15 MINPT4219703270.00
30252670ESTRADIOLLAB30182670229.45
30353505ESTRADIOL 1MG TABRX2592.50
30252671ESTROGENS (FRACTIONATED)LAB30182671168.55
30252679ESTRONELAB30082679199.60
30300040ET TUBE HOLDER ADULTCS27024.60
30300055ET TUBE HOLDER PEDSCS27224.60
30301125ET TUBE SZ 2.5CS27018.10
30300009ET TUBE SZ 3.0CS27218.10
30300013ET TUBE SZ 4.0CS27218.10
30300015ET TUBE SZ 4.5CS27218.10
30300016ET TUBE SZ 5.0CS27218.10
30300026ET TUBE SZ 5.5CS27218.10
30300039ET TUBE SZ 6CS27018.10
30300027ET TUBE SZ 6.5CS27218.10
30300028ET TUBE SZ 7CS27218.10
30300030ET TUBE SZ 7.5CS27218.10
30300031ET TUBE SZ 8.0CS27218.10
30300035ET TUBE SZ 8.5CS27218.10
30300036ET TUBE SZ 9CS27218.10
30300037ET TUBE SZ 9.5CS27218.10
30354517ETODALAC 500MG TABRX2594.70
PT1G8984EVAL CARRY/MOVE/HANDLE OBJ CURRENTPT424G89840.01
PT1G8986EVAL CARRY/MOVE/HANDLE OBJ D/CPT424G89860.01
PT1G8985EVAL CARRY/MOVE/HANDLE OBJ GOALPT424G89850.01
PT1G8981EVAL CHANGE/MAINTAIN BODY POS CURRENTPT424G89810.01
PT1G8983EVAL CHANGE/MAINTAIN BODY POS D/CPT424G89830.01
PT1G8982EVAL CHANGE/MAINTAIN BODY POS GOALPT424G89820.01
PT1G8978EVAL MOBILITY WALK/MOVE CURRENTPT424G89780.01
PT1G8980EVAL MOBILITY WALK/MOVE D/CPT424G89800.01
PT1G8979EVAL MOBILITY WALK/MOVE GOALPT424G89790.01
PT1G8990EVAL OTHER PRIMARY CURRENTPT424G89900.01
PT1G8992EVAL OTHER PRIMARY D/CPT424G89920.01
PT1G8991EVAL OTHER PRIMARY GOALPT424G89910.01
PT1G8993EVAL OTHER SUBSEQUENT CURRENTPT424G89930.01
PT1G8995EVAL OTHER SUBSEQUENT D/CPT424G89950.01
PT1G8994EVAL OTHER SUBSEQUENT GOALPT424G89940.01
PT1G8987EVAL SELF CARE CURRENTPT424G89870.01
PT1G8989EVAL SELF CARE D/CPT424G89890.01
PT1G8988EVAL SELF CARE GOALPT424G89880.01
30350195EVISTA 60MG TABRX2592.50
30304997EW BRIEF LARGECS270A452013.32
30304998EW BRIEFS MEDIUMCS270A45208.00
30304999EW BRIEFS XLARGECS270A45209.70
35051440EXCISION BENIGN LESION .5CM OR LECLNC52111440148.10
35051402EXCISION BENIGN LESION 1.1-2.0 CMCLNC52111402186.90
35051403EXCISION BENIGN LESION 2.1-3.0 CMCLNC52111403214.20
35051423EXCISION BENIGN LESION 2.1-3.0 CMCLNC52111423204.80
35051442EXCISION LESION HEAD 1.1-2.0CLNC52111442212.10
35051441EXCISION LESION-FACIAL 0.6-CLNC52111441192.20
35051640EXCISION MALIG LESION .5CM OR LESCLNC52111640207.90
35051641EXCISION MALIGNANT LESION 1.1-CLNC52111641237.30
35051623EXCISION MALIGNANT LESION 2.1-3CLNC52111623268.80
35051730EXCISION TOENAILCLNC52111730114.50
35051765EXCISION TOENAIL (WEDGE EXCISION)CLNC52111765139.70
35051400EXCISION BENIGN LESION 0.5 CM OR LCLNC52111400134.40
35051421EXCISION BENIGN LESION 0.6 -1.0 CMCLNC52111421170.10
35051401EXCISION BENIGN LESION 0.6-1.0 CMCLNC52111401159.60
35051404EXCISION BENIGN LESION 3.1 TO 4.0CCLNC52111404228.90
35051604EXCISION MALIG LESION 3.1 - 4.0 CMCLNC52111604320.30
35051642EXCISION MALIG.LESION 1.1-2.0 CMCLNC52111642289.80
35051750EXCISION NAIL AND MATRIXCLNC52111750159.51
30354686EXELON 3MG TABRX2595.50
30350284EXELON 6MG CAPSULERX25915.30
30350424EXELON PATCH 9.5MG/24HRRX25938.00
30300813EXTENSION SET W/ VALVE &CS27027.50
30300662EXU-DRY DRESSINGCS272A625115.65
30300564EYE COVER PADSCS2707.30
30300292EYE EXAM TRAYCS2706.50
30252544F2 - ISOPROSTANELAB30182542192.72
30200150FACIAL BONES COMPLETE 3RAD32070150198.60
30200151FACIAL BONES COMPLETE 3 READINGRADP9727015055.28
30200140FACIAL BONES LIMITEDRAD32070140171.00
30200141FACIAL BONES LIMITED READINGRADP9727014042.32
30253093FACTOR V LIEDEN - MUTATION SCREENINGLAB30085307122.72
30300739FALL RISK KIT LG YLWCS27023.44
30301725FALL RISK KIT XLG YLWCS27023.44
30350346FAMOTIDINE 20MG TABRX2592.50
30352225FAMOTIDINE INJ 20MG/2MLRX25114.70
30352010FASLODEX PER 25MG INJECTIONRX636J93951404.90
30256672FECAL CALPROTECTINLAB30183993191.00
30300668FEEDING TUBE 12FRCS27063.15
30356901FELODIPINE ER 5MG TABLETRX2592.80
30203550FEMUR 2 VIEWSRAD32073552211.74
30203551FEMUR READINGRADP9727355237.96
30355511FENOFIBRATE 54MG TABRX2592.50
30354551FENOFIBRATE 67MG CAPRX2594.40
30357888FENTANYL IV DRIP 2000MCGRX636J301045.30
30350030FENTANYL PATCH 100MCG/HRRX25984.80
30350299FENTANYL PATCH 12MCG/HRRX25916.00
30350343FENTANYL PATCH 25MCG/HRRX25911.60
30350031FENTANYL PATCH 50MCG/HRRX25915.40
30350596FENTANYL PATCH 75 MCG/HRRX25961.90
30350586FENTANYL UP TO 0.1MG INJRX636J301014.60
30252728FERRITINLAB30182728115.35
30354036FERROUS GLUCONATE 27MG TABRX2592.50
30350208FERROUS SULFATE 160MG TABRX2592.50
30350626FERROUS SULFATE 325MG TABRX2592.50
30358581FERROUS SULFATE SLOW REL 45MG TABRX2592.50
30350316FEXOFENADINE 180MG TABRX2592.50
30350690FIBER LAXATIVE CAPSULERX2592.50
30306022FIBRACOL 4" x 4.375"CS272A602236.93
30300373FILTERLINE SETCS27056.00
30350389FINASTERIDE 5MG TABRX2592.50
30207210FINGER 2 VIEW READINGRADP9727314029.32
30300159FINGER SPLINT SZ 1staxxCS27016.47
30300267FINGER SPLINT SZ 2 staxxCS27016.47
30300268FINGER SPLINT SZ 3 staxxCS27016.47
30300269FINGER SPLINT SZ 4 staxxCS27016.47
30300270FINGER SPLINT SZ 5 staxxCS27016.47
30300271FINGER SPLINT SZ 5.5 staxxCS27016.47
30300272FINGER SPLINT SZ 6 staxxCS27016.47
30300273FINGER SPLINT SZ 7 staxxCS27016.47
30203140FINGERS 2 VIEWSRAD32073140189.00
30350581FISH OIL 1000MG CAPRX2592.50
30353456FISH OIL 1200MG CAPRX2592.50
30350382FLAX SEED OIL 1000MG SOFTGELRX2592.50
30353052FLECAINIDE 100MG TABRX2592.50
30350126FLECAINIDE 50MG TABRX2592.50
30350199FLOMAX 0.4MG CAPRX2592.50
30354048FLORAJEN3 460MG CAPSULERX2592.50
30350988FLORASTOR 250MG CAPSULERX2593.60
30350202FLOVENT 100MCG DISCUSRX259272.60
30351920FLOVENT HFA 110MCG PER INHALERRX252390.70
30352200FLOVENT HFA 220MCG - 120 DOSE INHALERRX259425.10
30350033FLOVENT HFA 44MCG - 120DOSE INHALERRX259272.60
30350845FLUCONAZOLE 150MG TABLETRX25910.50
30350927FLUDROCORTISONE 0.1MG TABRX2514.80
30251234FLUID CRYSTALSLAB3008906043.30
30301102FLUID SOLIDIFERCS27011.25
30350425FLUMAZENIL PER 0.1MG INJRX25926.00
30256254FLUORESCENT ANTIBODY SCREENLAB3028625596.40
30350227FLUOXETINE 10MG CAPRX2592.50
30350763FLUOXETINE 20MG CAPRX2592.50
30350724FLUTICASONE NS 50MCG - 120 SPRAYSRX25938.90
30252746FOLATELAB30182746108.10
30300318FOLEY CATH 10FRCS27014.35
30300319FOLEY CATH 12FRCS27014.35
30300320FOLEY CATH 14FRCS270A433814.35
30300631FOLEY CATH 16FRCS27026.85
30300317FOLEY CATH 18FRCS274A433820.55
30300018FOLEY CATH 18FR 3WAYCS27024.35
30300628FOLEY CATH 20FRCS27016.35
30300315FOLEY CATH 22FRCS27015.39
30300322FOLEY CATH 24FRCS270A433817.01
30304887Foley Cath 24FR Latex FreeCS270A434428.35
30300323FOLEY CATH 26FRCS27014.35
30300661FOLEY CATH 28FRCS27014.35
30300335FOLEY CATH 28FR 30CCCS27014.35
30300336FOLEY CATH 30FRCS27014.35
30300337FOLEY CATH 30FR 30CCCS27014.35
30300313FOLEY CATH 6FRCS27014.35
30300314FOLEY CATH 8FRCS27014.35
30300083FOLEY CATH IC 20FRCS27038.90
30301789FOLEY COUDE CATH 14FR 5CCCS27018.00
30301790FOLEY COUDE CATH 16FR 5CCCS27018.00
30301791FOLEY COUDE CATH 18FR 5CCCS27018.00
30300446FOLEY TRAY PEDIATRICCS270A431570.95
30300532FOLEY TRAY ADULT 16FRCS270A431394.60
30350662FOLIC ACID 1MG TABRX2592.50
30203620FOOT AP AND LATERALRAD32073620178.00
30203621FOOT AP AND LATERAL READINGRADP9727362032.20
30203630FOOT COMPLETE 3 VIEWSRAD32073630208.55
30203631FOOT COMPLETE READINGRADP9727363035.08
30203090FOREARM 2 VIEWRAD32073090183.41
30200003FOREARM READINGRADP9727309035.08
35050120FOREIGN BODY INCISION & REMOVALCLNC52110120157.50
30354709FOSINOPRIL 40MG TABRX2593.00
30300671FRACTURE PANCS27010.00
30254481FREE T3LAB30184481135.52
30254439FREE T4LAB3018443972.16
30300540FREE-UP MASSAGE CREAM JCS27023.35
30253001FSH FOLLICLE STIMULATINGLAB30183001148.64
30257102FUNGAL BIOPSY (CULTURE)LAB30687102133.20
30350036FUROSEMIDE 20MG TABRX2592.50
30350765FUROSEMIDE 40MG TABRX2592.50
30350766FUROSEMIDE 80MG TABRX2592.50
30350430FUROSEMIDE UP TO 20MG INJRX636J194014.20
30350347FUROSEMIDE UP TO 20MG INJ (40MG VLRX636J194014.40
30300050G LAVAGE KIT PEDCS27020.20
30350286GABAPENTIN 100MG CAPRX2512.50
30350767GABAPENTIN 300MG CAPRX2592.50
30350768GABAPENTIN 400MG CAPRX2592.50
30300483GAIT BELTCS27030.25
30450008GAIT TRAINING PER 15 MINPT4209711683.00
35051903GARDASIL 9 VACCINERX63690651356.50
35059064GARDASIL-HPVRX63690649280.00
30300727GASTRIC LAVAGE KIT 18FRCS270103.55
30300963GASTRIC LAVAGE SETCS270103.55
30300048GASTRIC LAVAGE TUBE ADULCS27025.90
30257507GASTROINTESTINAL MOLECULAR PANELLAB306875071800.00
30301111GAUZE PACKING 1/4 IN NHCS27012.80
30300240GAUZE 2X2 STERILECS272A64022.50
30300308GAUZE 4X4 STERILECS272A64026.30
30300345GAUZE 4X4 STERILE TRAYCS272A64023.65
30300004GAUZE 8X4 STERILECS272A64031.55
30300307GAVAGE SETCS27029.55
30350470GEMFIBROZIL 600MG TABRX2592.50
30350254GENTAMICIN UP TO 80MG INJRX636J158015.20
30350411GENTAMYCIN OPTH SOL 0.3%/ 5ML BTLRX25918.30
30301131GERI LEG SLEEVECS27039.95
30300585GERI SLEEVE LGCS27039.75
30300619GERI SLEEVE MEDCS27039.95
30300620GERI SLEEVE SMCS27039.95
30300595GERIGLOVE ARM COVERINGCS27039.15
30258297GGTLAB3018297774.40
30305068GLIDESCOPE LOPRO SZ 1CS272120.00
30305066GLIDESCOPE LOPRO SZ 3CS272120.00
30305067GLIDESCOPE LOPRO SZ 4CS272120.00
30301693GLIDESCOPE SZ 4CS27071.50
30301692GLIDESCOPE SZ3CS27071.50
30350507GLIMEPIRIDE 2MG TABRX2592.50
30350781GLIPIZIDE 10MG TABRX2592.50
30359003GLIPIZIDE 2.5MG ER TABLETRX2592.50
30350928GLIPIZIDE 5MG TABRX2512.50
30350935GLIPIZIDE ER 10MG TABRX2592.50
30357450GLIPIZIDE ER 5MG TABRX2512.50
30300991GLOVE ISOTONER EDEMACS27045.00
30300052GLOVE STERILE LF SZ 6.5CS270A49303.90
30300058GLOVE STERILE LF SZ 7CS272A49303.90
30300059GLOVE STERILE LF SZ 7.5CS272A49303.90
30300056GLOVE STERILE LF SZ 8CS272A49303.90
30300060GLOVE STERILE LF SZ 8.5CS272A49303.90
30350336GLUCAGON PER 1MG INJRX636J1610436.80
30250556GLUCOMETERNUR3008296222.90
30150001GLUCOMETER EDED3008296222.90
30350783GLUCOSAMINE/CHONDDROITIN CAPSULERX2592.50
30252947GLUCOSE FASTINGLAB3018294731.20
30252950GLUCOSE POSTLAB3018295037.90
30252952GLUCOSE TOLERANCE EACH ADDITIONALLAB3018295231.36
30252951GLUCOSE TOLERANCE FASTINLAB30182951102.96
30252945GLUCOSE, BODY FLUID, OTHERLAB3018294531.21
30350595GLUTOSE 37.5GM TUBERX25914.40
30350038GLYBURIDE 5MG TABRX2592.50
30353059GOLYTELY PER 4 LITER BOTTLERX25942.00
30257591GONORRHEA DNA PROBELAB30687591171.75
30300695GOWN STERILECS27026.70
30300637GOWN PROTECTION YELLOWCS27039.50
30257205GRAM STAIN / FECAL WBCLAB3068720545.60
30300889GROUNDING PADSCS27047.85
30252956GTT 1HR
30252953GTT 3HR
30252954GTT2HR
37085865GUAIAC EMESIS (FOR EACH THREE)RX9298227134.30
37085864GUAIAC STOOLS (FOR EACH THREE)RX9298227034.30
30350568GUAIFENESIN 400MG TABRX2592.50
30350046GUAIFENESIN/COD OS 100/10MG/5MLRX2592.50
30256316H.INFLUENZAE B ANTIBODY IgGLAB30286317119.92
30351201HALOPERIDOL 1MG TABRX2592.50
30354520HALOPERIDOL 5MG TABRX2593.00
30350567HALOPERIDOL UP TO 5MG INJRX636J163029.90
30203131HAND 2 VIEW READINGRADP9727312035.08
30203120HAND 2 VIEWSRAD32073120169.00
30203132HAND 3 VIEW READINGRADP9727313036.52
30203130HAND 3 VIEWSRAD32073130212.00
30454968HAND EXERCISERPT27337.50
30253010HAPTOGLOBINLAB30083010246.25
30254703HCG QUALITATIVELAB3028470360.16
30254702HCG QUANTITATIVELAB30184702120.40
30253718HDLLAB3018371864.85
30200002HEEL / CALCANEUS READINGRADP9727365033.64
30203650HEEL 2 VIEWSRAD32073650168.00
30300184HEEL PROTECTORCS270108.10
30301390HEEL WARMER INFANTCS27013.86
30300034HEELBO PROTECTOR LARGECS27029.30
30257338HELICOBACTER PYLORI STOOL ANTIGENLAB30687338115.04
30255014HEMATOCRITLAB3058501431.10
30258898HEMOCHROMOTOSIS MUTATIONLAB30181256308.22
30255018HEMOGLOBINLAB3058501831.10
30256709HEP A AB IGMLAB3028670990.08
30256704HEP B CORE ANTIBODY TOTLAB3028670496.45
30256706HEP B SABLAB3028670685.92
30257340HEP B SURFACE ANTIGEN HBLAB3028734082.64
30257521HEP C VIRUS RNA BY PCRLAB30087521280.72
30257522HEP C VIRUS RNA CHIRONLAB30087522342.72
30250074HEP PANEL ACUTELAB30080074258.20
30357000HEPARIN LK FLUSH PER 10UNITRX636J164217.80
30350041HEPARIN PER 1000 UNITSRX636J164416.50
30356332HEPARIN PER 1000UNITS (1000UNITS/ML)RX636J164419.40
35059063HEPATITIS A VACCINE-PEDIATRIC/ADOLESCENTCLNC6369063396.60
30350728HEPATITIS B VACCINE INJRX63690746141.70
35059074HEPATITIS B VACCINE-PEDIATRIC/ADOLESCENTRX6369074463.00
30257902HEPATITIS C VIRUS GENOTYPELAB30287902809.33
30256694HERPES SIMPLEX 1 & 2 ABS IGG & IGLAB30687529280.72
30252563HERPES SIMPLEX VIRUSLAB30286694115.12
30253036HGB A1CLAB3018303678.10
30300718HIBICLENS 4OZCS272A424831.05
30203510HIP AP AND LATERALRAD32073502228.13
30203511HIP AP AND LATERAL READINGRADP9727350246.64
30203520HIP BILATERAL WITH PELVISRAD32073521299.82
30203521HIP BILATERAL WITH PELVIS READINGRADP9727352146.64
30203500HIP ONE VIEW UNILATERALRAD32073501198.99
30203541HIP READINGRADP9727350139.40
30256703HIV 1 & 2LAB30286703109.68
30257389HIV BY CIALAB30687389192.64
30256711HIV BY CIA CONFIRMATION
30258681HLA B27LAB30986812206.48
30253518HMGCRLAB3018351692.24
30603226HOLTER EXTENDED MONITORRAD73193270319.00
30603225HOLTER MONITORRAD73193225319.00
35059348HOME VISIT LEVEL II ESTABLISHED PTCLNC5229934896.60
30253090HOMOCYSTINELAB30183090143.36
30160238HOSP DISCHARGE LEVEL INURP98799238172.85
30160239HOSP DISCHARGE LEVEL IINURP98799239217.25
30160221HOSP INPATIENT INITIAL LEVEL INURP98799221178.15
30160222HOSP INPATIENT INITIAL LEVEL IINURP98799222272.75
30160223HOSP INPATIENT INITIAL LEVEL IIINURP98799223351.00
30160231HOSP SUBSEQUENT CARE LEVEL INURP98799231101.90
30160232HOSP SUBSEQUENT CARE LEVEL IINURP98799232134.95
30160233HOSP SUBSEQUENT CARE LEVEL IIINURP98799233178.15
30300482HOT PACK DISP.CS27021.40
30300597HOT/COLD PACKCS27021.40
30256789HTLVLAB30286790103.04
30300743HUGGIES MED 16-28 LBSCS2702.50
30203061HUMERUS 2 VIEW READINGRADP9727306035.08
30203060HUMERUS 2 VIEWSRAD32073060198.00
30353401hydrALAZINE 20mg injRX636J036025.40
30352701HYDRALAZINE 25MG TABRX2593.10
30350310HYDROCERIN CREAM 160Z TUBRX25916.20
30352051HYDROCHLORATHIAZIDE 12.5MG CAPRX2512.50
30350039HYDROCHLOROTHIAZIDE 25MG TABRX2592.50
30350182HYDROCODONE/ACET 10/650MG TABRX2592.50
30350432HYDROCODONE/ACET 5/500MG TABRX2592.50
30351127HYDROCODONE/ACET 7.5/325MG TABRX2592.50
30350932HYDROCODONE/ACET 7.5MG/500MG TABRX2592.50
30350933HYDROCODONE/APAP 5/325MG TABRX2512.50
30350785HYDROCORTISONE 20MG TABRX2595.10
30350929HYDROCORTISONE 5MG TABRX2592.50
30354519HYDROCORTISONE CM 1% .9GM PKTRX2596.80
30300326HYDROGEN PEROXIDE 16ozCS270A42449.30
30300388HYDROGEN PEROXIDE 4ozCS2709.30
30351500HYDROMORPHONE 4MG TABRX2592.50
30351303HYDROMORPHONE DRIP 50MGRX636J117055.50
30353033HYDROMORPHONE UP TO 4MG INJRX636J117018.00
30350604HYDROXYCHLOROQUINE 200MG TABRX25911.10
30350982HYDROXYUREA 500MG CAPSULERX2592.60
30350496HYDROXYZINE 10MG TABRX2512.50
30350330HYDROXYZINE PAM 25MG CAPRX636Q01772.50
30350042HYDROXYZINE UP TO 25MG INJ - 25MG VLRX636J341061.40
30350331HYDROXYZINE UP TO 25MG INJ-50MG VLRX636J341024.00
30353091HYOSCYAMINE 0.125MG TABLETRX2592.50
30301119HYPAFIX TAPE 2CS2702.00
30350753HYZAAR 50/12.5MG TABRX2592.50
35056083I & D HEMORROID THROMBOSED EXTCLNC5214608390.30
35050061I & D ABCESS (COMPLICATED/MULTIPLECLNC52110061216.30
35050060I & D ABCESS (SIMPLE OR SINGLE)CLNC52110060139.70
35050140I & D OF HEMATOMA OR FLUID COLLECTCLNC52110140172.20
35050080I & D PILONIDAL CYST (SIMPLE)CLNC52110080190.10
30350157IBUPROFEN 200MG TABRX2592.50
30350338IBUPROFEN SUSP 100MG/5MLRX2592.50
30300814ICE BAG DISPOSABLECS2708.70
30253519IGF BINDING PROTEIN-1LAB30183519147.20
30351601IMIPRAMINE 25MG TABRX2592.50
30350790IMITREX 100MG TABRX2596.00
30253514IMMUNOASSAY NONANTIBODYLAB3028351692.24
30256320IMMUNOELECTROPHORESISLAB30286320239.36
30252784IMMUNOGLOBLIN G A D M ELAB3018278474.40
30301819IN LINE FILTERED EXT SETCS27022.05
30520025INCENTIVE SPIROMETER TREATMENTRX27013.50
30357310INCRUSE ELLIPTA 62.5MG INHALERRX252369.50
30350722INDAPAMIDE 2.5MG TABLETRX2592.50
30350171INDOMETHACIN 25MG CAPRX2592.50
30257804INFLUENZA RAPID TEST A &LAB30687502146.25
35051695INFLUENZA VACCINE ADMIN - MEDICARECLNC771G00080.00
30353001INFLUENZA VACCINE LIVE, INTRANASALRX6369066065.10
30351425INFLUENZA VACCINE PED <35 monthsRX6369068572.60
30350658INFLUENZA VIRUS VACCINERX6369068675.20
35050460INJ IMMUN ADMIN 1 COMP <18 W COUNSELCLNC7719046021.00
35050461INJ IMMUN ADMIN EA ADDL <18 W COUNSELCLNC7719046121.00
35050471INJ IMMUN 1 ADMIN W/O COUNSELCLNC7719047126.30
35050472INJ IMMUN ADMIN EA ADD W/O COUNSELCLNC7719047226.30
35050610INJECT / ASPIRATION MAJOR JOINT OR BURSACLNC52120610126.00
35050605INJECT / ASPIRATION MEDIUM JOINT/ BURSACLNC5212060593.50
35050600INJECT / ASPIRATION SMALL JOINT / BURSACLNC5212060067.20
35055115INJECTION ALLERGYCLNC5219511521.00
35050526INJECTION CARPAL TUNNELCLNC5212052697.70
35054405INJECTION GREATER OCCIPITAL NERVECLNC52164405142.80
35050772INJECTION SUBQ OR INTERMUSCULARCLNC5219637221.00
35050550INJECTION TENDON SHEATH/LIGAMENTCLNC5212055097.70
35050553INJECTION TRIGGER POINTS 3 OR MORCLNC5212055384.00
35050552INJECTION TRIGGERPOINTS 1-2 MUSCLCLNC5212055271.40
35055117INJECTION ALLERGY SHOT- 2 OR MORECLNC5219511726.30
30300328INJECTION SITECS27014.15
37083010INJECTION, IMMUNIZATION ADMIN ONE VACCINNUR7719047179.75
37083011INJECTION, IMMUNIZATION, EACH ADDITIONALNUR7719047237.25
37083008INJECTION, SUBQ OR INTRAMUSCULARNUR2609637279.76
30359619INSULIN - HUMALOG 70/30 PEN - 3MLRX259149.80
30356903INSULIN - TOUJEO PENRX252230.20
30256337INSULIN ANTIBODYLAB30286337171.28
30255151INSULIN ASSAYLAB3018352591.44
30357155INSULIN BASAGLAR PER PEN 100U/MLRX252170.40
30355101INSULIN HUMALOG 75/25 PER 5 UNITSRX250J18156.20
30351223INSULIN HUMALOG PEN 100U/ML - 3MLRX259139.40
30350380INSULIN HUMALOG PER 5 UNITSRX250J18151.30
30350969INSULIN HUMULIN 70/30 PER 5 UNIT INJRX250J18158.70
30350414INSULIN HUMULIN NPH PER 5 UNIT INJRX250J18158.70
30350413INSULIN HUMULIN REGULAR PER 5 UNIT INJRX250J18158.70
30352550INSULIN LANTUS PEN 100U/ML - 3MLRX259159.10
30358000INSULIN LEVEMIR 100UNIT/ML - 3MLRX259163.30
30358215INSULIN REGULAR 100UNIT DRIPRX250J181547.00
30355013INSULIN TRESIBA PEN 200U/ML - 3MLRX252235.50
30354801INSULIN VICTOZA PEN 18MG/3MLRX259383.80
35059127INTEGRATED BEHAVIORAL HEALTH SCREENINGCLNC900961277.74
30350616INTEGRILIN PER 5MG INJRX636J1327388.00
30253522INTERLEUKIN 6LAB30183520138.16
30300557INTRASITE GELCS270A624825.65
37083014INTRAVENOUS PUSH, EACH ADDITIONAL DRUGNUR2609637552.28
37083013INTRAVENOUS PUSH, SINGLE/INITIAL DRUGNUR26096374168.00
30300505INTUBATING STYLET 10FRCS27018.45
30300626INTUBATING STYLET 14FRCS27018.45
30300506INTUBATING STYLET 6FRCS27018.45
30301001INV. CIRCUIT ASSEMBLY DISPOSABLECS27098.40
35056010IPOL INACTIVATED POLIO VACCINECLNC5219071397.50
30352100IPRATROP/ALBUT 0.5/3MG/3ML INH SOLNRX2592.50
30350048IPRATROPIUM INHAL SOLN PER MGRX636J76452.50
30350742IRBESARTAN/HCTZ 150/12.5 MG TABRX25116.80
30258354IRONLAB3018354051.76
30253550IRON BINDING CAPACITYLAB3018355070.90
31106523IRRIGATION OF IMPLANTED VENOUS DEVICENUR7619652383.94
30300964IRRIGATION SYRINGE 60CCCS27014.80
30300113IRRIGATION TRAYCS270A432014.70
30350648ISOSORBIDE MONO ER 30MG TABRX2592.50
30350391ISOSORBIDE MONO ER 60MG TABRX2592.50
30357123ISOSORBITE DINITRATE 5MG TABRX2596.00
30309730ISOVUE 300MG/100ML BTLRAD254Q996710.59
30200001ISOVUE 370MG/100ML BTLRAD254Q996710.59
30350714ISUPREL PER 1MG INJRX636J7658106.40
35058300IUD INSERTIONCLNC52158300227.40
30300247IV ADMIN CONTINU-FLO IV ADMIN SETCS272A422256.05
30300248IV ADMIN SECONDARY SETCS272A422214.94
30300250IV ADMIN SET MINI DRIPCS27225.75
30300331IV BLOOD SETCS27249.75
30300249IV BURETROL SETCS27239.05
30301122IV CATH 14GCS27216.47
30300527IV CATH 16GCS272A421517.98
30300526IV CATH 18GCS272A421517.98
30300525IV CATH 20GCS272A421517.98
30300523IV CATH 22GCS272A421517.98
30300254IV CATH 24GCS272A421517.98
30300355IV CATH EXTENSION SETCS27225.14
30300252IV EXTENSION TUBINGCS2705.25
30300535IV NITROGLYCERIN SETCS27241.15
30253891JAK-2 QUALITATIVELAB30981270547.50
30357731JANUVIA (SITAGLIPTIN) 100MG TABRX25253.30
30350131JANUVIA 25MG TABRX25926.50
30351231JANUVIA 50MG TABLETRX25939.10
30355330JARDIANCE 25MG TABRX25265.50
30450011JOBST MEASUREMENT PER 15 MINPT4209713969.40
30355102K PHOS ORIGINAL 500MG TABRX2592.50
30300648KANGAROO PUMP SETCS270B403523.20
30253883KAPPA / LAMBDA FREE LIGHT CHAINLAB30183520277.35
30350054KENALOG PER 10MG INJRX636J330113.00
30259920KEPPRALAB30180177150.76
30300641KERLIX 1 ROLLCS270A458012.42
30353810KETAMINE UP TO 500MG INJRX25923.90
30350462KETOCONAZOLE CREAM 2% - 60GM TUBERX25926.60
30350259KETOROLAC TROM 10MG TABRX2599.90
30350511KETOROLAC TROM PER 15MG INJ - 60MG VLRX636J188515.90
30350500KETOROLAC TROM PER 15MG INJ-30MG VLRX636J188515.00
30450012KINETIC ACT PER 15 MINPT4209753098.00
30300206KING AIRWAY LTD 2CS270127.50
3030207KING AIRWAY LTD 2.5CS270127.50
30300208KING AIRWAY LTSD 3CS270140.85
30300210KING AIRWAY LTSD 4CS270140.85
30300242KING AIRWAY LTSD 5CS270140.85
35059069KINRIX DTAP-IPVRX63690696130.50
30203562KNEE 3 VIEW COMPLETERAD32073562240.50
30203560KNEE AP AND LATERAL 2 VIEWRAD32073560211.20
30203563KNEE AP AND LATERAL 2 VIEW READINGRADP9727356035.08
30203561KNEE READINGRADP9727356239.40
30257210KOH PREP / WET PREPLAB3068721046.56
30356948KRILL OIL 1000MG CAPSULERX2592.50
30202100L SPINE 2-3 VIEWRAD32072100231.00
30207211L SPINE 2-3 VIEW READINGRADP9727210046.64
30202110L SPINE 4 VIEWRAD32072110325.00
30202111L SPINE 4 VIEW READINGRADP9727211053.84
30356050LABETALOL 100MG TABLETRX2592.50
30356720LABETALOL INFUSION 200MGRX25928.00
30350710LABETALOL PER 20MG INJRX25912.70
35053132LACERATION COMPLEX 2.6-7.5CMCLNC52113132593.30
35052051LACERATION MODERATE FACE >2.5CMCLNC52112051275.10
35052001LACERATION SIMPLE >2.5CMCLNC52112001171.20
35053006LACERATION SIMPLE 12.6-20.0CMCLNC52112005243.60
35052002LACERATION SIMPLE 2.6-7.5CMCLNC52112002184.80
35052004LACERATION SIMPLE 7.6-12.5CMCLNC52112004214.20
35052011LACERATION SIMPLE ON FACE >2.5CLNC52112011171.20
30250295LACOSAMIDELAB30180299192.00
30354015LACTATED RINGERS 1000MLCS258J712017.00
30253607LACTIC ACIDLAB3018360592.56
30350823LACTULOSE SOLN 10GM/15MLRX2592.50
30350598LAMOTRIGINE (LAMICTAL) 25MG TABRX2592.50
30350229LAMOTRIGINE 100MG TABRX2592.50
30256853LAMOTRIGINE LEVELLAB30180175150.75
30350627LANOXIN 0.125MG TABRX2593.30
30351115LANOXIN 0.25MG TABRX2592.50
30350101LANSOPRAZOLE 30MG CAPRX2592.50
30300264LARYNGEAL MASK SIZE 5CS27069.75
30200297LDCT CHEST SCREENINGCT35271271340.00
30200298LDCT CHEST SCREENING READINGCTP97271271158.64
30201149LDCT CHEST SURVEILLANCECT35271250340.00
30201257LDCT CHEST SURVEILLANCE READINGCTP97271250179.22
30253615LDHLAB3018361548.30
30253721LDL DIRECTLAB3018372184.00
30253655LEADLAB3018365598.70
30351901LEFLUNOMIDE 20MG TABRX25915.70
30301109LEG BAG STRAPCS27022.96
30257542LEGIONELLA BY PCR
35051311LESION REMOVAL .6 TO 1.0CM DIAMETECLNC52111311119.70
30355933LETROZOLE 2.5MG TABRX2512.50
30350534LEVALBUTEROL INH PER O.5MGRX25922.10
30350743LEVETIRACETAM 500MG TABRX2592.50
30354512LEVETIRACETAM OS 100MG/ML PER 5MLRX25911.00
30351953LEVETIRACETAM PER 10MG INJRX636J195323.60
30350481LEVOCETIRIZINE 5MG TABRX2592.50
30350056LEVOFLOXACIN 500MG TABRX2592.50
30356001LEVOFLOXACIN PER 250MG INJ - 250MG VLRX636J195615.70
30350306LEVOFLOXACIN PER 250MG INJ - 500MGRX636J195666.50
30356000LEVOFLOXACIN PER 250MG INJ - 750MG VLRX636J195670.50
30350730LEVOPHED (NOREPHINEPHRINE) 4MG/4ML INJRX25924.00
30350058LEVOTHROID 50MCG TABRX2592.50
30350059LEVOTHYROXINE (LEVOXYL) 125MCG TABRX2593.00
30350057LEVOTHYROXINE 100MCG TABRX2512.50
30350744LEVOTHYROXINE 112MCG TABRX2592.50
30350745LEVOTHYROXINE 137MCG TABRX2596.90
30350369LEVOTHYROXINE 150MCG TABRX2592.50
30350040LEVOTHYROXINE 25MCG TABRX2592.50
30358182LEVOTHYROXINE 300MCG TABLETRX2594.00
30350991LEVOTHYROXINE 75MCG TABRX2596.90
30350746LEVOTHYROXINE 88MCG TABRX2596.90
30350419LEXAPRO 10MG TABRX2592.50
30350676LEXAPRO 20MG TABRX2592.50
30253002LH LEUTENIZING HORMONELAB30183002148.16
30356062LIDOCAIN 1%/EPINEPHRINE PER 5MLRX2591.90
30350819LIDOCAINE 2% JELLY 5ML TUBERX25921.30
30356550LIDOCAINE 4% TOPICAL SOLN PER DOSERX2592.50
30350138LIDOCAINE ORAL SOL 2% PER DOSERX2592.50
30350060LIDOCAINE PER 10MG INJ / per MLRX636J200111.10
30356033LIDOCAINE PER 10MG INJ-100MG SYRINRX636J200122.80
30350818LIDOCAINE/PRILOCAINE CRM (EMLA CRMRX25917.40
30358701LIDODERM 5% TRANSDERMAL PATCHRX25916.10
87000002LIFELINE MOBILE UNIT SET UP FEEPALS99999.00
87000000LIFELINE MONTHLYPALS99935.00
87000001LIFELINE MONTHLY- WITH FALL DETECTIONPALS99945.00
30300854Lighted Curette 4mmCS27013.77
30352301LIOTHYRONINE 50MCG TABRX2519.20
30253690LIPASELAB3018369073.30
30250061LIPID PANELLAB30180061118.00
30350305LIPITOR 10MG TABRX2592.50
30351117LIPITOR 20MG TABRX2512.50
30350114LIPITOR 40MG TABRX2592.50
30350748LISINOPRIL 10MG TABRX2512.50
30350747LISINOPRIL 2.5MG TABRX2592.50
30350064LISINOPRIL 20MG TABRX2512.50
30350750LISINOPRIL 40MG TABRX2592.50
30350103LISINOPRIL 5MG TABLETRX2592.50
30350751LITHIUM CARB 300MG CAPRX2592.50
30250178LITHIUM LEVELLAB3018017852.00
30253884LIVER FIBROSIS
30250076LIVER PANELLAB3018007699.70
30300283LOCAL ANESTHETIC TRAYCS27050.00
35050283LOCAL ANESTHETIC TRAYCLNC521A464952.50
30300427LONGITUDINAL ARCH PADCS274L301025.30
30300976LOOP BRIDGE 7767CS270A442126.05
30350628LOPERAMIDE 2MG CAPRX2592.50
30300832LOPEZ VALVECS27018.20
30350776LORATADINE 10MG TABRX2592.50
30350814LORATADINE SYRUP 5MG/5MLRX25910.10
30350778LORAZEPAM 0.5MG TABRX2592.50
30354721LORAZEPAM 1MG TABLETRX2592.50
30350437LORAZEPAM 2MG TABRX2592.50
30350010LORAZEPAM UP TO 2MG INJRX636J206014.30
30352065LOSARTAN 100MG TABRX2592.50
30350518LOSARTAN 25MG TABRX2592.50
30350368LOSARTAN 50MG TABRX2592.50
30352008LOVASTATIN 20MG TABRX2592.50
30353506LOVAZA 1GM CAPSULERX2598.50
30350504LOVENOX UP TO 10MG INJ - 100MG SYRRX636J1650149.40
30351268LOVENOX UP TO 10MG INJ - 120MG SYRRX636J165074.30
30355569LOVENOX UP TO 10MG INJ - 150MG SYRRX636J165059.30
30350445LOVENOX UP TO 10MG INJ - 30MG SYRRX636J165024.00
30350449LOVENOX UP TO 10MG INJ - 40MG SYRRX636J165031.10
30350502LOVENOX UP TO 10MG INJ - 60MG SYRRX636J165029.20
30350246LOVENOX UP TO 10MG INJ - 80MG SYRRX636J1650121.50
30300316LUMBAR PUNC. KIT ADUCS27093.35
30300442LUMBAR PUNC. KIT PEDSCS27072.55
30300173LUMBOSACRAL SUPPORTCS270L062173.00
30300408LUMBOSACRAL SUPPORT SMCS27081.65
30355003LUMIGAN EYE DROPS 0.01% - 2.5ML BTLRX259248.50
30359030LUNESTA 1MG TABRX2592.90
30350679LUNESTA 2 MG TABRX25911.60
30352009LUNESTA 3 MG TABRX25923.90
30357303LUPRON DEPOT PER 7.5MG INJRX636J92179324.40
30258863LUPUS PANELLAB3058561376.64
30350691LUTEIN 20MG SOFTGELRX2592.50
30350685LYRICA (PREGABALIN) 75MG CAPRX2512.50
30350612LYRICA 50MG TABRX2522.50
30352115LYSINE 500MG TABLETRX2592.50
30250051LYTESLAB30180051104.55
30350072MAGNESIUM 250MG TABRX2592.50
30350482MAGNESIUM CHLORIDE 64MG TABRX2592.50
30350741MAGNESIUM CITRATE PER 300CC BTLRX2595.20
30350399MAGNESIUM SULF PER 500MG INJRX636J347516.50
30253735MAGNESIUM, SERUMLAB3018373553.60
30350066MAG-OX 400MG TABRX2592.50
30257207MALARIA SMEARLAB3068720747.92
30200100MANDIBLE 2-3 VIEWRAD32070100170.20
30450013MANUAL THERAPY PER 15 MIPT4209714089.00
30255007MANUAL WBC DIFFERENTIALLAB3058500741.10
30300082MASIMO SPO2 ADULTCS27077.50
30300818MASIMO SPO2 NEONATALCS27083.85
30300594MASIMO SPO2 SENSOR PEDSCS27061.45
30300645MASK NON REBREATHERCS270A70159.60
30300834MASK O2 PEDCS2708.00
30300754MASK AEROSOLCS2706.75
30520012MASK AEROSOL DRAGONCS27011.30
30301778MASK INFANT NONREBREATHERCS27022.68
30520007MASK O2 ADULTCS2706.75
30301775MASK O2 INFANTCS27022.68
30301777MASK PEDI NON REBREATHERCS27017.91
30301123MASK PROCEDURECS27023.52
30450014MASSAGE PER 15 MINPT4209712469.00
30300656MASTISOL PKTCS27014.00
30301437MATTRESS OVERLAY WAFFLECS270144.44
30350807MAXALT MLT 10MG TABRX25910.00
30256765MEASLES IGGLAB30286765103.04
30350276MECLIZINE 25MG TABRX2592.50
30354492MEDI HONEY ROPE DRESSING 3/4" X 12CS272A619947.60
30450337MEDICAL EXERCISE PER MONTHPT42040.00
35050438MEDICARE ANNUAL WELLNESS- INITIALCLNC521G0438165.00
35050439MEDICARE ANNUAL WELLNESS- SUBSEQCLNC521G0439136.50
35050402MEDICARE WELLNESS IPPECLNC521G0402136.50
30300855MEDIPORE H TAPECS27010.80
30352001MEDROXYPROGESTERONE 10MG TABRX2592.50
30355371MEDROXYPROGESTERONE 1MG INJRX636J1050114.80
30350355MEDROXYPROGESTERONE 2.5MG TABRX2592.50
30350321MEGESTROL ORAL SUSP 400MG/10MLRX25961.20
30351111MELATONIN 3MG TABRX2592.50
30355745MELATONIN 5MG CAPSULERX2592.50
30359701MELOXICAM 7.5MG TABRX2592.50
35059073MENACTRA-MCV4 MENINGOCOCCALRX63690734270.40
30306212MEPILEX 3X3 SILVERCS272A621232.80
30304957MEPILEX SACRUM 9X9CS272A621386.05
30304989MEPITAL DRESSING 2"X3"CS272A619736.41
30350601MEROPENEM PER 100MG INJRX636J218597.70
30304988MESALT DRESSING 3/4"X39"CS270A619719.87
30350073METAMUCIL PER DOSERX2592.50
30252527METANEPHRINES FRACTIONATION URINELAB30183835135.52
30253836METANEPHRINES, PLASMALAB30183835135.52
30350037METFORMIN 500MG TABRX2592.50
30352099METFORMIN 850MG TABRX2592.50
30350378METFORMIN ER 750MG TABRX2592.50
30350779METFORMIN XR 500MG TABRX2592.50
30350536METHADONE 10MG TABRX2592.50
30350377METHAZOLAMIDE 50MG TABRX25910.20
30350953METHOCARBAMOL 500MG TABRX2592.50
30350693METHOTREXATE 2.5MG TABRX636J861013.40
30355041METHYLENE BLUE 1% per 10MGRX25962.50
30252543METHYLMALONIC ACIDLAB30183921169.68
30355401METHYLPHENIDATE SR 20MG BIDRX2595.10
30350487METHYLPREDNISOLONE 4MG - 21 TABSRX25965.40
30350224METHYLPREDNISOLONE PER 4MG TABRX636J75092.50
30350074METOCLOPRAMIDE 10MG TABRX2592.50
30350075METOCLOPRAMIDE UP TO 10MG INJRX636J276515.80
30350379METOCLOPROMIDE 5MG TABRX2592.50
30350215METOLAZONE 2.5MG TABRX2599.30
30350077METOPROLOL 25MG TABRX2592.50
30350076METOPROLOL 50MG TABRX2592.50
30350901METOPROLOL ER (TOPROL XL) 25MG TABRX2592.50
30350356METOPROLOL ER (TOPROL XL) 50MG TABRX2592.50
30356801METOPROLOL ER 100MG TABLETRX2593.00
30350183METOPROLOL PER 5MG INJRX636J349013.10
30350410METRONIDAZOLE 250MG TABRX2592.50
30350476METRONIDAZOLE 500MG TABRX2593.40
30350244METRONIDAZOLE UP TO 500MG INJRX636J349018.80
30351410MICARDIS 40MG TABRX2593.50
30350914MICARDIS 80MG TABRX25916.20
30252043MICROALBUMIN URINELAB3018204363.00
30350401MIDAZOLAM PER 1MG INJRX636J225015.00
30354301MIDODRINE 10MG TABRX25911.50
30350079MILK OF MAGNESIA PER 30CCRX2592.50
30300852Mindray SpO2 AdultCS27059.00
30300851Mindray SpO2 PedsCS27066.45
30350528MIRTAZAPINE 15MG TABRX2592.50
30259326MISC LABLAB300862560.00
30354499MISC PHARMACYRX2590.00
35059080Misc/ Disability DeterminationCLNC52199080215.00
35050707MMR MEASLES, MUMPS, RUBELLARX63690707171.50
30300524MOLESKIN PER FOOTCS27021.68
30300491MOLESKIN PER INCHCS2702.20
30300492MOLESKIN PER YARDCS27041.55
30253608MONO TESTLAB3028630841.44
30300726MORGAN DELIVERY SETCS270122.40
30300954MORGAN LENSCS270122.40
30359222MORPHINE IV DRIP 100MGRX636J227046.00
30355785MORPHINE OS 10MG/5MLRX2518.60
30350303MORPHINE OS 20MG/ML PER DOSERX2512.50
30350084MORPHINE SULF UP TO 10MG INJ - 10MG VLRX636J227022.70
30350080MORPHINE SULF UP TO 10MG INJ - 2MG SYRRX636J227019.10
30350028MORPHINE SULF UP TO 10MG INJ - 4MG SYRRX636J227019.00
30350802MORPHINE SULFATE ER 100MG TABRX25914.10
30350081MORPHINE SULFATE ER 15MG TABRX2593.50
30350344MORPHINE SULFATE ER 30MG TABRX2592.60
30350800MORPHINE SULFATE ER 60MG TABRX2595.80
30350801MORPHINE SULFATE IR 15MG TABRX2592.50
30350970MOXIFLOXACIN 400MG TABRX25963.60
30356382MUCINEX ER 600MG TABRX2592.50
30256735MUMPS IGGLAB30286735104.40
30350590MUPIROCIN OINTMENT 2% PER TUBERX25921.80
30352027MYCOPHENOLIC ACID 360MG DR TABRX25126.00
30257581MYCOPLASMA PNEUMONIALAB30687581185.91
30253874MYOGLOBIN, SERUMLAB30183874146.60
30356013MYRBETRIA ER 25MG TABRX25238.90
30351501NABUMETONE 500MG TABRX2592.50
30350393NABUMETONE 750MG TABRX2593.10
30353201NADOLOL 80MG TABLETRX25917.70
30350493NAFCILLIN UP TO 2 GRAM INJRX636S003276.90
30350420NALOXONE HCL PER 1MG INJRX636J231028.40
30350563NAMENDA 10MG TABRX2592.50
30354143NAMENDA XR 14MG CAPSULERX25240.10
30352833NAMENDA XR 28MG TABLETRX25955.00
30359004NAPROXEN 220MG TABRX2592.50
30350644NAPROXEN 500MG TABRX2592.50
30520008NASAL CANNULA 14'CS271A461511.50
30520013NASAL CANNULA PEDATRICCS27020.10
30300297NASAL EXAM TRAYCS27017.95
30304210NASAL PACKING RHINO ROCCS270A421061.65
30300299NASAL PACKING LRGECS27046.60
30301130NASAL PACKING SMLLCS27911.05
30300038NASAL RAE 6.5CS27218.10
30300042NASAL RAE 7CS27218.10
30300043NASAL RAE 7.5CS27218.10
30300826NASAL RAE 8.0CS27228.25
30352102NASONEX NASAL SPRAY 50MCG - 17GMRX259366.60
30300843NASOPH AIRWAY 20FRCS27028.15
30300844NASOPH AIRWAY 22FRCS27028.15
30300845NASOPH AIRWAY 24frCS27028.15
30300450NASOPH AIRWAY 26FRCS27028.15
30300451NASOPH AIRWAY 28FRCS27028.15
30300452NASOPH AIRWAY 30FRCS27028.15
30300587NASOPH AIRWAY 32FRCS27028.15
30300846NASOPH AIRWAY 34FRCS27028.15
30300601NASOSTATCS270118.75
30350562NATEGLINIDE 120MG TABRX2593.90
30300380NEBULIZER MASK ADULTCS27011.90
30300706NEBULIZER SET UPCS271A700312.65
30520027NEBULIZER TREATMENTRX4109466437.75
30200360NECK SOFT TISSUERAD32070360174.00
30200361NECK SOFT TISSUE READINGRADP9727036037.96
30300550NEEDLE HUBER 20GCS27031.50
30305034NEEDLE HUBER 19G X 1IN.CS27231.47
30300440NEEDLE HUBER 19G X 3/4 in.CS27231.50
30300605NEEDLE INTRAOSSEOUS 16GCS270153.70
30301893NEEDLE IO EZ ADULT 25MMCS270220.00
30301894NEEDLE IO EZ BARIATRIC 45MMCS270250.00
30301892NEEDLE IO EZ PEDS 15MMCS270220.00
30300808NEEDLE SPINAL 14GCS27088.50
30300384NEEDLE SPINAL 18GCS27213.60
30300385NEEDLE SPINAL 20GCS27213.60
30300321NEEDLE SPINAL 22GCS27013.60
30300386NEEDLE SPINAL 25GCS27213.60
30300551NEEDLE SPINAL 27GCS27213.60
37087605NEG PRESSURE WOUND THER <50CMPROC94097605466.20
37087606NEG PRESSURE WOUND THER >50CMPROC94097606466.20
30305071NEGATIVE PRESSURE MASKCS27035.00
30300607NELLCOR SPO2 ADULTCS27089.20
30300602NELLCOR SPO2 PEDSCS27089.20
30350538NEOMYCIN/POLY B OTIC SUSP 10ML BTLRX259116.80
30353136NEOMYCIN/POLY B/DEXAMETHAZONE OPTH OINTMRX25934.80
30353562NEOMYCIN/POLYMYXIN/HYROCORTISONE 10MLRX251160.20
30350729NEOSTIGMINE METHYL UP TO 0.5MG INJRX636J271028.10
30355360NEO-SYNEPHRINE NASAL SPRAY 15ML BTLRX25916.30
30350501NEULASTA(PEGFILGRASTIM) 6MG INJRX636J25058633.30
30350712NEUPOGEN PER 1mcgRX636J1442817.80
30450123NEUROMUSCULAR REEDUCATIONPT4209711297.00
35059201NEW PATIENT LEVEL ICLNC52199202113.92
35059202NEW PATIENT LEVEL IICLNC52199202157.53
35059203NEW PATIENT LEVEL IIICLNC52199203197.80
35059204NEW PATIENT LEVEL IVCLNC52199204191.10
35059205NEW PATIENT LEVEL VCLNC52199205235.20
35059384NEW PATIENT-WELLNESS AGE 12-17YRSCLNC52199384157.50
35059382NEW PATIENT-WELLNESS AGE 1-4YRSCLNC52199382157.50
35059385NEW PATIENT-WELLNESS AGE 18-39YRSCLNC52199385157.50
35059386NEW PATIENT-WELLNESS AGE 40-64YRSCLNC52199386157.50
35059383NEW PATIENT-WELLNESS AGE 5-11YRSCLNC52199383157.50
35059381NEW PATIENT-WELLNESS UNDER AGE 1CLNC52199381157.50
30350397NEXIUM 40MG CAPRX2593.40
30355243NEXPLANON 68MG IMPLANTRX636J7307651.80
35051981NEXPLANON INSERTIONCLNC52111981210.00
35051982NEXPLANON REMOVALCLNC52111982495.00
35051983NEXPLANON REMOVAL AND REINSERTIONCLNC52111983495.00
35059309NH VISITCLNC52199309102.90
30354405NIACIN 500MG TABRX2592.50
30350530NIASPAN ER 500MG TABRX25911.00
30354529NICOTINE 14MG PATCHRX2599.80
30350085NICOTINE 21MG PATCHRX25910.00
30354515NICOTINE 4MG LOZENGERX2592.80
30354526NICOTINE 7MG PATCHRX25910.70
30250102NICOTINE AND METABOLITESLAB3018032384.00
30350320NICOTINE GUM 4MGRX2592.50
30351103NIFEDIPINE 10MG TABRX2593.80
30350277NIFEDIPINE ER 30MG TABRX2592.50
30359104NITRO TD PATCH 0.2MG/HRRX2592.80
30353153NITRO TD PATCH 0.3MG/HRRX25917.60
30350304NITRO TD PATCH 0.4MG/HRRX2594.00
30350087NITRO-BID 1GM (2%) OINTRX25910.20
30351125NITROFURANTOIN 50MG CAPRX25914.60
30358103NITROFURATOIN 100MG CAPRX2516.10
30350499NITROGLYCERINE PER 5MG INJRX636J349028.60
30350324NITROPRESS UP TO 50MG INJRX636J3490116.50
30350238NITROQUICK 0.4MG SL TABRX2593.10
9999999NO-CHARGE - CONVIENCE ITEMZZ9990.00
30250016NON CHEMNET URINE/DRUG SCREENLAB3009900198.00
30450003Norco Shoulder PulleyPT27479.75
30300342NORMAL SALINE FOR IRRCS27016.95
30354012NORMAL SALINE IV 250MLCS636J70505.60
30354009NORMAL SALINE IV 1000MLCS258J703011.40
30354013NORMAL SALINE IV 100MLCS636J349010.60
30354019NORMAL SALINE IV 500MLCS636J70405.70
30354018NORMAL SALINE IV 50MLCS636J34908.10
30355167NORTRIPTYLINE 10MG CAPSULERX2512.50
30357801NORTRIPTYLINE 25MG CAPSULERX2592.50
30350757NORTRIPTYLINE 50MG CAPRX2592.50
30350132NORTRIPTYLINE 75MG CAPRX2592.50
30200160NOSE 3 VIEWRAD32070160185.00
30200161NOSE 3 VIEW READINGRADP9727016036.52
35059315NURSING FACILITY DISCHARGE SERVICECLNC52199315152.30
35059308NURSING FACILITY DR VISITCLNC5219930885.10
35059307NURSING FACILITY DR VISIT (ROUNDS)CLNC5219930758.80
35059306NURSING FACILITY INITIAL ADMITCLNC52199306290.99
35059318NURSING FACILITY YEARLY ASSESSCLNC5219931895.60
30350415NYSTATIN OS 100,000U/ML - 5MLRX25910.20
30350015NYSTATIN POWDER 15GM BOTTLERX25919.60
30520058O2 CONNECTING TUBINGCS2704.05
30300850O2 EXTENSION TUBING 14'CS271A461610.20
30300358OB PACK EMERGENCYCS27085.55
350221OBS ICU HOURS 2-6OBS762G0378105.00
350222OBS ICU HOURS 6-24OBS762G037872.50
350220OBS ICU INTIALOBS762G0378840.00
30160226OBS SUBSEQENT CARE LEVEL IIIOBSP98299226178.15
30160224OBS SUBSEQUENT CARE LEVEL IOBSP98299224100.00
30169216OBS SUBSEQUENT CARE LEVEL IIOBSP98299225130.00
30169217OBS. DISCHARGE IOBSP98299217172.85
30160218OBS. INITIAL VISIT IOBSP98299218175.20
30160219OBS. INITIAL VISIT IIOBSP98299219271.55
30160220OBS. INITIAL VISIT IIIOBSP98299220351.00
31100026OBSERVATION DIRECT ADMISSIONOBS762G0379525.30
350215OBSERVATION HOURS 2-6OBS762G037887.20
350216OBSERVATION HOURS 7-24OBS762G037872.50
350214OBSERVATION HOURS INITIALOBS762G0378658.40
30252270OCCULT BLOODLAB3018227491.40
30300971ODOR ELIMINATING DROPS 7CS270A439422.05
30357056OLANZAPINE 10MG TABRX2592.50
30355972OLANZAPINE 10MG/2ML INJRX25175.00
30350243OLANZAPINE 2.5MG TABRX2592.50
30350892OLANZAPINE 20MG TABRX2513.00
30356381OLANZAPINE DISINTEGRATING 10MG TABRX2529.10
30252542Omega 3LAB30182542192.72
30350163OMEPRAZOLE 20MG CAPRX2592.50
30351616ONDANSETRON (ZOFRAN 4MG TAB)RX2592.60
30350279ONDANSETRON HCL PER 1MG INJRX636J240512.80
30353864ONDANSETRON ODT 4MG TABRX2592.50
30353140ONFI 10MG TABLET(S)RX25965.90
30350497ONGLYZA 5MG TABRX25944.80
35059422ONLINE E/M UP TO 7 DAYS 11-20 MINCLNC5219942231.59
35059423ONLINE E/M UP TO 7 DAYS 21+ MINCLNC5219942351.04
35059421ONLINE E/M UP TO 7 DAYS 5-10 MINCLNC5219942115.74
30300008OPHTHALMIC BURLCS27035.55
30305079OPTICELL AG GEL FIBER 2X2CS272A619617.54
30305078OPTICELL AG GEL FIBER 4X5CS272A619732.24
30305080OPTICELL AG GEL FIBER 8X12CS272A619890.90
30305076OPTILOCK NON-ADHESIVE 3X3CS272A619616.52
30305075OPTILOCK NON-ADHESIVE 5X5.5CS272A619715.89
30305077OPTILOCK NON-ADHESIVE 6.5X10CS272A619823.73
30300391ORAL AIRWAY 100MM ADULTCS27011.40
30300392ORAL AIRWAY 110MM LG ADULTCS27011.40
30300395ORAL AIRWAY 120MM LG ADULTCS27011.40
30300118ORAL AIRWAY 30MMCS27011.40
30300127ORAL AIRWAY 40 MMCS27011.40
30300397ORAL AIRWAY 50MM PEDCS27011.40
30300398ORAL AIRWAY 60MM PEDCS27011.40
30300128ORAL AIRWAY 70 MMCS27011.40
30300387ORAL AIRWAY 80MMCS27011.40
30300399ORAL AIRWAY 90MM MED ADULTCS27011.40
30300044ORAL RAE 3.0CS27218.10
30300045ORAL RAE 3.5CS27218.10
30300047ORAL RAE 4CS27218.10
30300053ORAL RAE 4.5CS27218.10
30300054ORAL RAE 5.5CS27218.10
30450015ORTHO CST/SPL/TRN PER 15PT4209776072.80
30450297ORTHOTIC CASTING OR STRAPPINGPT4202979972.80
30450036ORTHOTIC TRAINING PER 15 MINPT4209776070.60
30253930OSMOLALITY SERUMLAB3018393052.88
30253935OSMOLALITY URINELAB3018393554.60
30207075OSSEOUS SURVEY COMPLETERAD32077075415.00
30300370OSTOMY CLAMPSCS270A436323.66
30300613OSTOMY FLANGE 2 1/4CS270A441493.00
30300920OSTOMY FLANGE 2 3/4CS270A441596.60
30300913OSTOMY FLANGE BXCS270A441489.56
30300924OSTOMY FLANGE BX 5CS270A440993.00
30300560OSTOMY POUCH 2 3/4 BXCS27093.85
30300914OSTOMY POUCH BXCS270A506394.90
30300614OSTOMY POUCH BX 10CS270A506393.85
30300823OSTOMY POWDERCS27013.10
30300824OSTOMY SKIN CREAMCS270A437712.15
37082000OUTPATIENT VISIT LEVEL 1NUR4509921278.80
37083001OUTPATIENT, PROVIDERPROC9829920292.00
31100113OUTPT IV INF, SEQUENTIAL INF OF NEW DRUGOBS2609636779.76
31100110OUTPT IV INFUS HYDRAT EACH ADD HROBS2609636152.17
31100109OUTPT IV INFUS HYDRAT, INITIAL, 31M-1HOBS26096360269.66
31100111OUTPT IV INFUS INITIAL UP TO 1 HROBS26096365269.66
31100112OUTPT IV INFUS EACH ADDITIONAL HROBS2609636652.17
30257177OVA AND PARASITELAB3068717771.20
30253945OXALATE URINELAB30183945114.15
30359301OXCARBAZEPINE 300MG TABRX2592.50
30259512OXCARBAZEPINE METABOLITELAB30180183106.00
35054760OXIMETERCLNC5219476011.60
30350761OXYBUTYNIN 5MG TABRX2592.50
30357137Oxybutynin ER 10MG TABRX2595.70
30350275OXYBUTYNIN ER 5MG TABRX2514.50
30350181OXYCODONE ER 10MG TABRX25916.10
30350328OXYCODONE ER 20MG TABRX25922.90
30350351OXYCODONE IR 15MG TABRX2592.50
30350509OXYCODONE IR 30MG TABRX2592.50
30350381OXYCODONE IR 5MG TABRX2592.50
30350325OXYCODONE/ASPIRIN 5/325MG TABRX2592.70
30351510OXYCONTIN 15MG TABRX25915.00
30353010OXYCONTIN 30MG TABRX25919.80
34000002OXYGEN CONCENTRATOR MONTHLYLTC270143.80
34000003OXYGEN E-TANKLTC2709.20
30520028OXYGEN/HOURLYRX2709.45
30350939OXYTOCIN UP TO 10UNITS INJRX636J259015.90
30259016PACKED RED BLOOD CELLSLAB381P9021309.34
30300674PACKING IODOFORM 1CS272A640727.30
30300675PACKING IODOFORM 1/2CS27227.30
30300715PACKING IODOFORM 1/4CS272A640727.30
30300101PACKING STRIP PLAIN 1CS272A640719.10
30300100PACKING STRIP PLAIN 1/2CS272A640725.55
30300099PACKING STRIP PLAIN 1/4CS272A640727.30
30300716PACKING STRIP PLAIN 2CS272A640712.75
30300088PAD FEMALE MAXICS2701.90
30301864PAD FEMALE MODERATECS270A45201.30
30300087PAD FEMALE THINCS270A45202.50
37361019PALS ATTENDANT 15 MINPALS580T10195.49
37365126PALS COMMUNITY INTEGRATIONPALS580S51265.78
37362001PALS MEDICAL ESCORT PER 15 MINPALS580T20015.67
37360080PALS MEDICAL ESCORT/SHOPPING/MILEPALS990T20010.33
37360000PALS MEDICAL SUPPLIESPALS5800.00
37361008PALS PRIVATE ATT. PER 15 MN WEEKENDPALS580T10198.51
37361020PALS PRIVATE ATTENDANT PER 15 MINPALS580T10195.49
37360003PALS PRIVATE MILEAGE PER MILEPALS580A00800.55
37360002PALS PRIVATE NURSE PER 15MINPALS580T10199.00
37361006PALS VA ATTENDANT PER 15 MINPALS580G01565.75
37361007PALS VA RESPITE PER 15 MINPALS580S91255.55
37360006PALS WAIVER HOMEMAKING PER 15 MINPALS580S51304.52
37360007PALS WAIVER NURSE SERVICE PER 15MIPALS580T100211.59
37361005PALS WAIVER RESPITE CAREPALS580T10053.76
37360005PALS WAIVER SOCIAL TRANSPRT PR MILPALS580S02150.33
37360004PALS WAIVER SOCIAL/SUPER PER 15MINPALS580T10195.78
30253525PANCREATIC ELASTASE FECALLAB3018265692.24
30350236PANTOPRAZOLE 40MG TABRX2592.50
30352355PANTOPRAZOLE PER 40MG INJ - BOLUS/INFRX636J349044.60
30353507PANTOPRAZOLE PER 40MG INJ - IVPRX636J349029.80
35050091PAP SMEARCLNC770Q009136.80
30300304PARACENTISIS TRAYCS27056.35
30256253PARANEOPLASTIC PANEL
35051055PARING OR CUTTING OF BENIGN LESIONCLNC5211105560.90
30355430PAROXETINE 10MG TABLETRX2592.50
30350091PAROXETINE 20MG TABRX2592.50
30350842PAROXETINE 30MG TABLETRX2592.50
30354552PAROXETINE ER 37.5MG TABRX25917.80
30300793PASTE FLANGE 79300CS270A440649.85
30258305PATH. SURGICAL GROSS & MLAB31088305141.92
30255060PATHOLOGIST REVIEW OF SLLAB9718506087.70
30300049PEAK FLOW METERCS270A461471.35
35059072PEDIARIX DTAP-HEPB-IPVCLNC52190723152.00
35050647PEDVAXHIB-MENINGOCOCCALCLNC5219064775.90
30202170PELVIS 1-2 VIEWRAD32072170175.00
30202171PELVIS 1-2 VIEW READINGRADP9727217036.52
30307350PELVIS HIP UNILATERALRAD32073501173.00
30203501PELVIS HIP UNILATERAL READINGRADP9727350139.40
30350258PENICILLIN VK 500MG TABRX2592.50
30354527PENICILLIN VK OS 250MG/5ML - 100ML BTLRX25914.00
30300443PENROSE TUBING 1/2 X 12CS2702.60
30300578PENROSE TUBING 1/4CS2702.60
30300445PENROSE TUBING 1X18CS2702.60
30350473PENTASA CR 500MG CAPSULERX25917.40
30354516PENTOXIFYLLINE ER 400MG TABRX2592.50
30520034PERCUSSION & POSTURAL DRRX27037.75
30357606PERFOROMIST INH SOLN PER 20MCGRX636J760618.10
30300057PERINAL IRRIGATION KITCS2705.25
30354260PERMETHRIN CREAM 5% 2.2 OZ TUBERX259169.10
30356021PERPHENAZINE 2MG TABRX2515.30
37360009PERS INSTALLATION AND TESTINGPALS580S5160102.76
37360010PERS RENTALPALS580S516170.90
37360011PERS RENTAL SELF DIRECTPALS580S516145.00
30305052PESSARY RING SZ 4CS271A4562117.95
30305055PESSARY RING SZ 6CS271A4562119.75
30305056PESSARY RING SZ 8CS271A4562119.75
30300062PETROLATUM 6X36CS27013.50
30300346PETROLATUM GAUZE 3X9CS27012.60
30300084PETROLATUM GZE STRP 1/2X72CS27013.50
30300205PETROLATUM GZE STRP 1X36CS27013.50
30358001PHENAZOPYRIDINE 200MG TABRX2596.00
30350458PHENAZOPYRIDINE 97.5MG TABRX2592.50
30250184PHENOBARBLAB30180184122.40
30350618PHENOBARBITAL 30MG TABRX2592.50
30350954PHENTERMINE 37.5MG TABRX2592.50
30351001PHENYTOIN 50MG CHEWABLE TABLETRX2593.90
30258018PHENYTOIN SOD LEVELLAB30180185106.00
30354226PHENYTOIN SOD OS 125mg/5mlRX25910.90
30350920PHENYTOIN SOD PER 50MG INJRX636J116517.40
30259195PHLEBOTOMY THERAPEUTICLAB94099195130.95
30350615PHOS-NAK PER PACKETRX2523.40
30254100PHOSPHOROUSLAB3018410045.60
30252804PH-VENOUS BLOODLAB3018280088.00
30450018PHYS THER EVAL PER 20 MINPT42497161199.00
30450004PHYS THER EVAL PER 30 MINPT42497162229.00
30450007PHYS THER EVAL PER 45 MINPT42497163249.00
30450019PHYS THER RE-EVAL PER 15PT42497164117.75
30355223PIPERACIL/TAZO 1/0.125GM INJ (3.37gm vl)RX636J254324.90
30354534PIPERACILLIN/TAZO 1/0.125GM INJ (4gm vl)RX636J254375.60
30255595PLATELET COUNTLAB3058504970.35
30300364PLEUR-EVACCS270172.65
35051699PNEUMOCOCCAL VACCINE ADMIN-MEDICARECLNC771G00090.00
30300801PNEUMOTHORAX KITCS270180.60
30350417PNEUMOVAX 23 VACCINERX63690732232.70
30256356PNH BY FLOW CYTOMETRYLAB30286356214.20
30300543POLAR FROST 5/PKTCS27013.00
30350621POLYETHELENE GLYCOL PER 17GM DOSERX2512.50
30254132POTASSIUMLAB3018413245.60
30351110POTASSIUM 99MG TABRX2592.50
30350078POTASSIUM CHL ER 10MEQ TABRX2592.50
30350052POTASSIUM CHL ER 20MEQ TABRX2592.50
30350666POTASSIUM CHL PER 2MEQ INJ - 40MEQ VLRX636J34800.50
30354078POTASSIUM CHL PER 2MEQ INJ - PREMIXRX636J34800.00
30350051POTASSIUM CHLORIDE ER 8MEQ TABRX2592.50
30350053POTASSIUM OS 20MEQ/15MLRX2592.50
30356810POTASSIUM PHOS/SODIUM PHOS 250MG TABRX2512.50
30254133POTASSIUM URINELAB3018413345.60
30300815POVIDONE IODINE PREP SOLUTIONCS2709.36
30300352POVIDONE IODINE SWABSTICKCS2702.30
30354800PRADAXA 150MG CAPSULERX25923.00
30359616PRAMIPEXOLE 0.125MG TABRX2592.50
30354203PRAMIPEXOLE 0.5MG TABRX2512.50
30350510PRAVASTATIN 20MG TABRX2592.50
30351709PRAVASTATIN 40MG TABRX2592.50
30354528PRAVASTATIN 80MG TABRX25912.60
30354600PRAZOSIN 1MG TABRX2592.50
30356802PRAZOSIN 2MG CAPRX2513.60
30350479PRED FORTE OPHTH SUSP PER BTLRX251110.70
30354248PREDNISOLONE 15MG/5ML PER DOSERX2595.00
30350092PREDNISOLONE OS 5MG/5MLRX636J751015.90
30350908PREDNISONE 10MG TABRX2512.50
30350099PREDNISONE 1MG TABRX2512.50
30359802PREDNISONE 20MG TABRX2512.50
30359800PREDNISONE 5MG TABRX2512.50
30251025PREGNANCY TEST URINELAB3078102540.20
30351119PREMARIN 0.3MG TABRX25916.60
30350175PREMARIN 0.625 TABRX25916.60
30300291PREP BASINCS2703.80
30300786PRESSURE INFUSER BAGCS27084.08
35059067PREVNAR13-PNEUMOCOCCAL 13RX63690670248.30
30350617PRIMAXIN PER 250MG INJRX636J074340.40
30250188PRIMIDONELAB30180188132.72
30350808PRIMIDONE 50MG TABRX2592.50
30354501PRISTIQ SR 100MG TABRX25927.10
30359001PROBIOTIC CAPSULERX2592.90
30350735PROCAINAMIDE HCL UP TO 1GM INJRX636J2690118.10
30254145PROCALCITONINLAB30184145217.76
30350150PROCHLORPERAZINE 25MG SUPPRX25923.80
30300990PROFORE LITECS27053.00
30254144PROGESTERONELAB30184144166.88
PT28984PROGRESS CARRY/MOVE/HANDLE OBJ CURRENTPT420G89840.01
PT28985PROGRESS CARRY/MOVE/HANDLE OBJ GOALPT420G89850.01
PT28981PROGRESS CHANGE/MAINTAIN BODY POS CURRENPT420G89810.01
PT28982PROGRESS CHANGE/MAINTAIN BODY POS GOALPT420G89820.01
PT28978PROGRESS MOBILITY WALK/MOVE CURRENTPT420G89780.01
PT28979PROGRESS MOBILITY WALK/MOVE GOALPT420G89790.01
PT28993PROGRESS OTHER SUBSEQUENT CURRENTPT420G89930.01
PT28994PROGRESS OTHER SUBSEQUENT GOALPT420G89940.01
PT28990PROGRESS PRIMARY CURRENTPT420G89900.01
PT28991PROGRESS PRIMARY GOALPT420G89910.01
PT28987PROGRESS SELF CARE CURRENTPT420G89870.01
PT28988PROGRESS SELF CARE GOALPT420G89880.01
30254206PROINSULINLAB30184206171.00
30254146PROLACTINLAB30184146155.04
30357100PROLIA PER 1 MG INJRX636J08972041.40
30350110PROMETHAZINE 12.5MG SUPPRX25933.60
30350342PROMETHAZINE 12.5MG TABRX2592.50
30350329PROMETHAZINE 25MG SUPPRX25923.10
30350394PROMETHAZINE 25MG TABRX2592.50
30350107PROMETHAZINE UP TO 50MG INJ - 25mg/mlRX636J217514.70
30355201PROPAFENONE 225MG TABLETRX2593.00
30350151PROPARACAINE 0.5% EYE DROPS PER DOSERX2592.50
30350200PROPRANOLOL 10MG TABRX2512.50
30350440PROPRANOLOL 20MG TABRX2592.50
30358421PROPRANOLOL 40MG TABRX2512.50
30352763PROPRANOLOL ER 20MG/ML PER DOSERX2592.50
30350736PROPRANOLOL UP TO 1MG INJRX636J180042.40
30350544PROPYLTHIOURACIL 50MG TABRX2593.90
35056409PROQUAD VACCINECLNC52190710286.20
30450020PROSTHETIC TRAIN PER 15PT4209776170.60
30254155PROTEIN TOTALLAB3018415585.30
30251008PROTEIN BODY FLUIDLAB3018415732.00
30254156PROTEIN URINELAB3018415629.36
30255610PROTIMELAB3058561058.90
30350903PROVIGIL 200MG TABRX25920.20
30351211PRUCLAIR NON STEROIDAL CREAM PER TUBERX259144.90
30254153PSA TOTALLAB30184153157.12
30350688PSEUDOEPHEDRINE 30MG TABRX2592.50
35059791PSYCHIATRIC DIAGNOSTIC EVALCLNC90090791189.39
35059832PSYCHOTHERAPY 16-30 MINSCLNC9009083294.77
35059834PSYCHOTHERAPY 38-52 MINSCLNC90090834126.36
61059837PSYCHOTHERAPY 52+ MIN SBSBP90090837188.85
35059837PSYCHOTHERAPY 52+ MINSCLNC90090837188.85
35059847PSYCHOTHERAPY FAMILY W/PATIENT 50 MINCLNC91690847158.34
35059840PSYCHOTHERAPY FOR CRISIS EA ADDL 30 MINCLNC9009084094.77
35059839PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINSCLNC90090839197.33
30450009PT ANNUAL ASSESSMENTPT42150.00
30457750PT PHYSICAL PERFORMANCE TEST PER 15 MINPT4209775075.00
30253970PTH PARATHYROID HORMONELAB30183970319.50
30255730PTTLAB3058573078.08
30350247PULMICORT INHLER 90MCG - 120 DOSERX259227.00
30300617PVP SOLUTIONCS2708.55
30351671QUETIAPINE 200MG TABRX2592.50
30300259QUICK COMBO ADULTCS270182.80
30300258QUICK COMBO PEDSCS270159.60
30300513QUICK TRACH 2.0CS270434.60
30300312QUICK TRACH 4.0CS270434.60
30356990QUINAPRIL 20MG TABRX2592.50
30352098QUINAPRIL 40 MG TABRX2593.00
30350373RABIES VACCINE HYPERRAB 150IU/1MLRX636903751216.20
30350372RABIES VACCINE RABAVERTRX63690675519.50
30350293RACEPINEPHRINE 2.25% 0.5ML INHRX2595.10
30350520RAMIPRIL 2.5MG CAPRX2592.50
30350262RAMIPRIL 5MG CAPRX2592.50
30357500RANEXA 500MG ER TABLETRX25219.80
30350295RANITIDINE 150MG TABRX2592.50
30350144RANITIDINE HCL 25MG INJRX636J278020.70
30350447RANITIDINE ORAL LIQUID PER DOSERX2595.90
30304929RAPID RHINO 5.5CS270151.50
30304928RAPID RHINO 7.5CS270148.53
30454724Rear Foot Post 4PT27023.33
30450002REAR FOOT POST 5PT27423.33
30350136RECLAST (ZOLEDRONIC ACID) 1MG INJRX636J3489142.30
30358451RED YEAST RICE 600MG CAPRX2512.50
30350097REFRESH CLASSIC OPHTH DROPETTERX2592.50
30359010REMDESIVIR PER 100MG VIALRX252790.00
35059454REMOTE PAT. MONT. DEVICE READING FEECLNC5219945464.38
35059457REMOTE PATIENT MONITORING SERVICECLNC5219945752.45
35059453REMOTE PATIENT MONITORING SET UP FEECLNC5219945319.69
35059209REMOVAL IMPACTED CERUMEN / IRRIGATECLNC5216920921.80
35059210REMOVAL IMPACTED CERUMEN W/ INSTRUMENTCLNC5216921069.30
35057938REMOVAL OF FOREIGN BODY EYECLNC52165222267.80
35056320REMOVAL OF IMPLANT FINGER OR HANDCLNC51026320373.80
35051200REMOVAL OF SKIN TAG(S)CLNC5211120094.50
30250069RENAL FUNCTION PANELLAB30180069121.20
30254244RENIN PLASMALAB30184244136.30
35053131REPAIR COMPLEX 1.1-2.5 CMCLNC52113131378.00
35052032REPAIR INTERMEDIATE 2.6-7.5 CMCLNC51012032308.70
35052031REPAIR-INTERMEDIATE 2.5CM OR LESSCLNC51012031234.20
35050123RESPIRATOR PHYSICAL-CITY OF FORSYTCLNC5219921263.00
30257634RESPIRATORY PANEL
30257633RESPIRATORY VIRUSLAB306876331032.27
30350560RESTASIS 0.05% OPTH PER DROPETTERX25927.40
30300122RESTON SHEETCS270E139920.05
30300610RESUSCITATOR AMBU PED NEOCS27090.80
30300510RETAINER GAUZE SZ 1 PER INCHCS270A64572.50
30300406RETAINER GAUZE SZ 10 PER INCHCS270A64572.50
30300418RETAINER GAUZE SZ 2 PER INCHCS270A64572.50
30300411RETAINER GAUZE SZ 3 PER INCHCS270A64572.50
30300412RETAINER GAUZE SZ 4 PER INCHCS270A64572.50
30300714RETAINER GAUZE SZ 5 PER INCHCS270A64572.50
30300413RETAINER GAUZE SZ 5.5 PER INCHCS270A64572.50
30300414RETAINER GAUZE SZ 6 PER INCHCS270A64572.50
30300415RETAINER GAUZE SZ 7 PER INCHCS270A64572.50
30300416RETAINER GAUZE SZ 8 PER INCHCS270A64572.50
30300417RETAINER GAUZE SZ 9 PER INCHCS270A64572.50
30255045RETICULOCYTE COUNTLAB3058504536.00
30253523RF By EIALAB3018351692.24
30256901RH TYPELAB3008690145.50
30256430RHEUMATOID FACTORLAB3028643049.12
30600006RHYTHM STRIP 1-3 LEADSRAD7309304183.85
30256234RIBONUCLEIC PROTEINLAB30286235143.44
30201112RIBS BILATERAL 3 VIEW READINGRADP9727111061.08
30201110RIBS BILATERAL 3 VIEWSRAD32071110239.00
30201103RIBS UNILAT, AND PA CHEST READINGRADP9727110155.28
30201101RIBS UNILATERAL & PA CHESTRAD32071101226.00
30201100RIBS UNILATERAL 2 VIEWSRAD32071100213.00
30201102RIBS UNILATERAL READINGRADP9727110046.64
30352006RIFAMPIN 150MG CAPRX2595.30
30350740RISAMINE OINT 4OZ TUBERX25914.80
30350180RISPERIDONE 0.25MG TABRX2592.50
30350435RISPERIDONE 0.5MG TABRX2592.50
30350297RISPERIDONE 1MG TABRX2592.50
30356006RISPERIDONE 4MG TABRX2512.50
34003211ROOM CHARGE BED HOLDLTC1200.00
31007100ROOM HOSPITAL RESPITENUR120195.00
31204100ROOM ICUNUR2001513.00
31002100ROOM MEDICAL SEMIPRIVATENUR1201263.00
34002200ROOM NH PRIVATELTC120195.00
34009700ROOM NH PRIVATE & HALFLTC120257.00
34007100ROOM NH RESPITE CARELTC120195.00
34003200ROOM NH SEMIPRIVATELTC120195.00
34059700ROOM NH SWG PRIVATE & HALFNHSB120257.00
34053200ROOM NH SWG SEMIPRIVATENHSB120195.00
34004300ROOM NH VA HEAVY REHABLTC120598.79
34004200ROOM NH VA REDUCED FUNCTIONLTC120250.54
34004400ROOM NH VA SPECIAL CARELTC120375.81
34052200ROOM SKILLED PRIVATELTC120160.00
31056100ROOM SWING BEDSB120986.00
30350353ROPINIROLE 0.25MG TABRX2592.50
30350135ROPINIROLE 2MG TABRX2592.50
35054502ROSUVASTATINRX2512.50
30256592RPRLAB3028659234.16
30257420RSVLAB30687420111.28
30256762RUBELLALAB30286762115.12
30202202S/I JOINTS 3 VIEWRAD32072202217.00
30202220SACRUM/COCCYX 1-2 VIEWRAD32072220192.00
30202221SACRUM/COCCYX 1-2 VIEWS READINGRADP9727222036.52
30300710SALEM SUMP 10FRCS2708.35
30300673SALEM SUMP 12FRCS27023.60
30300711SALEM SUMP 14FRCS2708.35
30300712SALEM SUMP 16FRCS2708.35
30300713SALEM SUMP 18FRCS2708.35
30300338SALEM SUMP 6FRCS2708.35
30300707SALEM SUMP 8FRCS2708.35
30250196SALICYLATELAB30180307300.00
30350112SALINE FLUSHRX25813.00
30358280SALINE NASAL SPRAY PER BTLRX2594.60
30252075SALIVA ALCOHOL TESTLAB3018207551.00
30300191SCALPEL DISP SZ 10CS27024.99
30300190SCALPEL DISP SZ 11CS27022.80
30300196SCALPEL DISP SZ 15CS270A464922.80
30203010SCAPULA COMPLETERAD32073010184.03
30203011SCAPULA READINGRADP9727301037.96
30300757SCD LEG CUFFCS27087.20
30202091SCOLIOSIS SERIES READINGRADP9727208267.28
30202090SCOLIOSIS STUDY 2 VIEWRAD32072082251.00
30300969SCOPE SPIDER NET RETRIEVAL DEVICECS270150.00
30301003Scotch Cast Glow IN the Dark 3"CS27021.42
30300939SCOTCH CAST N PINK 3CS270Q405048.70
30300809SCOTCH CAST SPLINT 3X12CS27042.15
30300810SCOTCH CAST SPLINT 4X30CS27092.45
30300811SCOTCH CAST SPLINT 5X30CS270101.25
30300237SCOTCH CAST WHITE 2CS270Q405030.10
30300238SCOTCH CAST WHITE 3CS270Q405030.75
30300239SCOTCH CAST WHITE 4CS270Q405040.15
30305050SCOTCHCAST 3 X 35CS27071.85
30300281SCOTCHCAST BLACK 2CS27030.10
30300290SCOTCHCAST BLACK 3CS27030.10
30301004SCOTCHCAST GLOW IN THE DARK 2"CS27018.80
30300204SCOTCHCAST N GREEN 2CS27030.75
30300201SCOTCHCAST N ORANGE 2CS27030.75
30300203SCOTCHCAST N PINK 2CS27030.75
30300282SCOTCHCAST N. GREEN 3CS27030.10
30300296SCOTCHCAST N. ORANGE 3CS27030.75
30300284SCOTCHCAST PURPLE 2CS27030.10
30300293SCOTCHCAST PURPLE 3CS27030.75
30300298SCOTCHCAST PURPLE 4CS27040.15
30300286SCOTCHCAST RED 2CS27030.10
30300295SCOTCHCAST RED 3CS27030.75
30300926SCOTCHCAST REINFORCE STRIPS 4X36CS27035.25
35052111SCOUT PHYSICALCLNC9990.00
30255651SED RATELAB3058565258.90
30450021SELF CARE/HOME VISIT PER 15 MINPT4209753599.00
90009999SELF PAY BALANCE FORWARDCS9990.00
30259300SEMEN ANALYSIS POST VASELAB3098930082.90
30359888SENNA 8.6MG TABRX2512.50
30350113SENNA/DOCUSATE 8.6/50MG TABRX2592.50
30350302SEROQUEL 100MG TABRX2592.50
30350265SEROQUEL 25MG TABRX2592.50
30350810SEROQUEL 300MG TABRX25955.00
30350363SERTRALINE 100MG TABRX2592.50
30352030SERTRALINE 50 MG TABRX2592.50
30252010SERUM KETONESLAB3018200960.00
35051301SHAVING DERMAL LESION 0.6-1.0 CMCLNC52111301101.90
30203020SHOULDER 1 VIEWRAD32073020208.68
30201023SHOULDER 1 VIEW READINGRADP9727302032.20
30203021SHOULDER 2 VIEW READINGRADP9727303039.40
30203030SHOULDER COMPLETE 2 VIEWRAD32073030250.04
30300493SHOULDER PULLEY SETCS274L365049.20
30354530SILVADENE CRM 1% 400GM TUBRX259105.20
30350174SILVADENE CRM 1% 50GM TUBRX25914.30
30352052SILVER NITRATE STICKSRX2595.20
30358912SIMETHICONE 180MG CAPRX2592.50
30354504SIMETHICONE 80MG CHEWABLE TABRX2592.50
30352050SIMVASTATIN 10 MG TABRX2592.50
30350149SIMVASTATIN 20MG TABRX2592.50
30350490SIMVASTATIN 40MG TABRX2592.50
30350439SINGULAIR 10MG TABRX2592.50
30353000SITAGLIPTIN 100 MG TABRX25939.10
30350643SKELAXIN 800MG TABRX25915.20
30300849Skin Barrier Ring 2inCS27025.25
30300828SKIN GEL PROTECTIVE WIPESCS270A437738.75
30300866SKIN SCRIBE PENSCS27024.15
30300778SKIN STAPLER (LACERATIONS)CS27040.65
30200261SKULL COMPLETE 4 VIEW READINGRADP9727026059.64
30200260SKULL COMPLETE 4 VIEWSRAD32070260273.00
30200251SKULL LIMITED 1-3 VIEW READINGRADP9727025042.32
30200250SKULL LIMITED 1-3 VIEWSRAD32070250179.00
37085800SLEEP STUDY UNATTENDED, SIMULT RECORDNUR92095800255.30
30300097SLIPPERS LARGECS27016.92
30300096SLIPPERS XLARGECS27016.92
30300095SLIPPERS XXLARGECS27016.92
30300098SLIPPERS YOUTHCS27016.92
30257523SMOOTH MUSCLE ANIT-BODYLAB3018351692.24
30300017SNARE HOT POLYPECTOMYCS270120.60
30300086SOAP BARCS2701.90
30351508SOD BICARB 8.4% INJ - 50MEQ ABBOJCRX636J349029.50
30254295SODIUMLAB3018429545.60
30350913SODIUM BICARB 650MG TABRX2592.50
30350334SODIUM POLY SULF O/S PER 15GM/60CCRX25922.40
30254300SODIUM URINELAB3018430045.60
30300574SOFROL 2 PER ROLLCS27011.34
30300571SOFROL 3 PER ROLLCS270Q40508.50
30300572SOFROL 4 PER ROLLCS2709.99
30300616SOFROL 6 PER ROLLCS27016.35
30350117SOLU-CORTEF UP TO 100MG INJRX636J172049.10
30357580SOLUMEDROL UP TO 125MG ING-500MG VLRX63679.60
30350360SOLUMEDROL UP TO 125MG INJRX636J293035.20
30350359SOLUMEDROL UP TO 125MG INJ-1GM VLRX636J2930107.50
30350824SOTALOL 80MG TABRX2592.50
30350418SPACER FOR INHALERRX25987.70
35051594SPECULA VAGINACLNC521A990015.40
30300734SPECULUM VAGINA LGCS27014.67
30300735SPECULUM VAGINA MEDCS27014.67
30301039SPECULUM VAGINA SMCS27014.67
30255165SPEPLAB3018416585.92
30353504SPIRIVA HANDIHALER WITH 5 CAPSRX259115.50
30356215SPIRIVA RESPIMAT 2.5MCG PER INHALERRX259113.50
30520024SPIROMETER SETUPNUR27038.00
30350455SPIRONALACTONE 25MG TABRX2592.50
30357536SPIRONALACTONE 50MG TABRX2512.50
30300747SPLINT SAMCS27051.15
35050211SPORTS PHYSICALCLNC5219921140.00
30256323SSA (RO) ABIGGLAB30286235178.60
30256324SSB(LA) AB IGGLAB30286235143.44
30300831STABILIZER IO EZCS27250.00
30300288STAPLE REMOVER SKINCS27018.80
30300212STERI STRIP 1/2CS27010.85
30300211STERI STRIP 1/4CS2707.60
30300672STERILE FIELD 18x26CS27218.95
30300340STERILE WATER FOR IRRIGATIONCS272A421717.30
30201130STERNO-CLAVICULAR JOINTRAD32071130187.00
30201120STERNUM 2 VIEWRAD32071120187.00
30201125STERNUM READINGRADP9727112042.32
30300228STOCKENETT PER FOOT 6CS2703.65
30300226STOCKINET 2 PER FTCS270Q40502.50
30300225STOCKINET 3 PER FTCS2702.50
30300227STOCKINET 4 PER FTCS2702.75
30252335STONE ANALYSISLAB30182365103.20
30253630STOOL WBC'S (LACTOFERRIN)LAB30183630132.45
30300686STOPCOCKCS2703.05
30300589STOPCOCK 3 WAYCS27031.45
30300106STRAIGHT CATH 10FRCS270A43519.55
30300108STRAIGHT CATH 12FRCS270A43519.55
30300109STRAIGHT CATH 14FRCS270A43519.55
30300110STRAIGHT CATH 16FRCS270A43519.55
30300115STRAIGHT CATH 18FRCS270A43519.55
30300841STRAIGHT CATH 22FRCS270A43519.33
30300102STRAIGHT CATH 6FRCS270A43519.55
30300104STRAIGHT CATH 8FRCS270A43519.55
30300596STRAP MONTOGOMERYCS27019.36
30256317STREP PNEUM ANTIBODIES 23 SEROTYPESLAB30286317119.92
30257880STREP SCREEN RAPIDLAB3068765178.10
30300840STRIGHT CATH 20FRCS270A43519.93
30350995SUCCINYLCHOLINE UP TO 20MG INJRX636J033076.00
30350416SUCRALFATE 1GM TABRX2592.50
30300393SUCTION CANISTERCS27015.66
30300583SUCTION CATH 10FRCS2704.35
30300664SUCTION CATH 12FRCS2704.35
30300670SUCTION CATH 14FRCS2704.35
30300025SUCTION CATH 16FRCS2704.35
30300006SUCTION CATH 18FRCS2704.35
30300582SUCTION CATH 6FRCS2704.35
30300007SUCTION CATH 8FRCS2724.35
30300545SUCTION CONNECTING TUBINGCS270A70029.60
30300702SUCTION KIT 10FRCS27012.55
30300703SUCTION KIT 14FRCS27012.55
30300704SUCTION KIT 18FRCS27012.55
30300709SUCTION KIT 5/6FRCS27012.55
30300701SUCTION KIT 8FRCS27012.55
30300021SUCTION NON-COND TUBECS2703.90
30300303SUCTION TIP YANKAUERCS27014.58
30300394SUCTION TUBINGCS2708.30
30300003SUCTION YANKAUER TUBINGCS270A700210.35
30350223SULFAMETHOXAZ/TRIM OS 200/40MG/5MLRX25914.10
30350642SULFAMETHOXAZOL/TRIM 800/160MG TABRX2592.50
30350789SULFASALAZINE 500MG TABRX2592.50
30350044SUMATRIPTAN 6MG INJRX636J3030167.40
30255095SURGE/PATH SPECIMENLAB31288305196.54
30300909SURGI LUBE TUBECS2709.10
30300334SURGICAL CAUTERYCS27040.30
30300116SUTURE C GUT 634GCS27052.45
30300117SUTURE C GUT 635GCS27052.45
30300396SUTURE ETHILON 2-0 664GCS27033.30
30300400SUTURE ETHILON 3-0 663GCS27230.30
30300402SUTURE ETHILON 4-0 662GCS27230.30
30300404SUTURE ETHILON 5-0 661GCS27230.30
30300403SUTURE ETHILON 5-0 698GCS27230.30
30300405SUTURE ETHILON 6-0 667GCS27230.30
30300246SUTURE ETHILON 6-0 697GCS27019.45
35051255SUTURE REMOVAL PLACED IN FACILITYCLNC521992110.00
35051254SUTURE REMOVAL SUTURED ELSEWHERECLNC5219921226.30
30300287SUTURE SETCS27028.40
30304946SUTURE SET SMALLCS27228.40
30300357SUTURE SILK 0 678gCS27245.60
30300244SUTURE SILK 2-0 K833HCS27045.60
30300366SUTURE SILK 3.0 k832hCS27245.60
30300363SUTURE SILK 3-0CS27245.60
30300356SUTURE SILK 3-0 684gCS27245.60
30300588SUTURE TOWEL DISPCS2703.20
30300243SUTURE VICRYL 2-0 J317HCS27049.95
30300301SUTURE VICRYL 3-0 j316hCS27249.95
30300339SUTURE VICRYL 3-0 j423hCS27249.95
30300775SUTURE VICRYL 3-0 J497GCS27049.95
30300350SUTURE VICRYL 4-0 j310hCS27249.95
30300351SUTURE VICRYL 4-0 j494gCS27249.95
30300354SUTURE VICRYL 4-0 j496gCS27249.95
30300305SUTURE VICRYL 5-0 j511gCS27249.95
30300309SUTURE VICRYL 6-0 j510gCS27249.95
30300241SUTURES C GUT 3-0 636GCS27019.45
30300353SWAB LEMON GLCCS2701.30
61059315SWB DISCHARGE LEVEL ISBP98799315162.00
61059316SWB DISCHARGE LEVEL IISBP98799316190.00
61059304SWB INITIAL ADMISSION LEVEL ISBP98799304105.00
61059305SWB INITIAL ADMISSION LEVEL IISBP98799305180.00
61059306SWB INITIAL ADMISSION LEVEL IIISBP98799306258.00
61059307SWB SUBSEQUENT CARE LEVEL ISBP9879930780.40
61059308SWB SUBSEQUENT CARE LEVEL IISBP98799308110.00
61059309SWB SUBSEQUENT CARE LEVEL IIISBP98799309145.00
61059310SWB SUBSEQUENT CARE LEVEL IVSBP98799310175.00
30354550SYMBICORT MDI 160/4.5MCG - 60 DOSERX259257.40
30350314SYMBICORT MDI 80/4.5MCG - inhalerRX259259.90
30357325SYNVISC-ONE PER 1MG INTRA-ARTICULAR INJRX636J73251045.30
30202070T SPINE 2 VIEWRAD32072070196.05
30202072T SPINE 2 VIEW + SWIMMERRAD32072072238.60
30202073T SPINE 2 VIEW + SWIMMER READINGRADP9727207248.08
30202071T SPINE 2 VIEW READINGRADP9727207042.32
30254480T3 TOTALLAB30184480113.44
30254479T3 UPTAKELAB3018447951.76
30254436T4 THYROXINELAB3018443658.90
30250197TACROLIMUS (FK 506)LAB30180197109.80
30354567TACROLIMUS 0.5MG CAPRX2513.00
30350468TAMIFLU 75 MG CAPRX25923.20
30350177TAMIFLU OS 6MG/ML - 60ML BTLRX259256.20
30350095TAMOXIFEN 20MG TABRX2594.10
30350460TAZICEF PER 500MG INJRX636J071332.00
30256743TB GOLDLAB30286480368.00
35050443TB INTRADERMAL TESTNUR3028658030.60
30300409TED HOSE KNEE LGCS270A653151.65
30300789TED HOSE KNEE LG CLOSE TOECS270A6531152.80
30300489TED HOSE KNEE MEDCS270A653133.25
30300120TED HOSE KNEE SMCS270A653122.65
30300410TED HOSE KNEE XLCS270A653151.65
30300692TED HOSE THIGH LGCS270A653457.25
30300065TED HOSE THIGH LG SHORTCS27022.65
30300807TED HOSE THIGH MEDCS270A653457.25
30300119TED HOSE THIGH SMCS270A653438.50
30300693TED HOSE THIGH XLGCS270A653457.25
30520060TED HOSE XXLCS270A653125.14
30304909Tegaderm + PadCS27017.46
30301000TEGADERM 2X3CS272A62584.10
30300988TEGADERM 4X4CS270A62586.70
30300987TEGADERM 6X8CS270A625917.37
30304510TEGADERM IVCS272A62573.80
30300681TEGADERM WITH PADCS2704.10
30250156TEGRETOLLAB30180156123.70
30351605TEKTURNA (ALISKIREN) 300MG TABRX25917.10
35059999TELEMEDICINE ORIGINATING SITE FEECLNC780Q301426.65
35059990TELEMEDICINE ORIGINATION SITERAD780Q301426.65
31000001TELEMETRYRX73293268280.00
30300192TELFA 2X3CS270A64022.50
30301591TELFA 3X4CS2702.50
30301590TELFA 3X4 ADHESIVECS2702.50
30300193TELFA 3X8CS270A64032.50
30301899TELFA 4X8 ISLAND ADHCS270A622010.62
30300341TELFA 8X10 STERILECS270A64022.20
30300194TELFA ADHESIVE PADS 4X8CS2706.45
30301595TELFA MINI ISLANDCS270A62192.50
30350122TEMAZEPAM 15MG CAPRX2592.50
30354502TENECTEPLASE 1MG INJRX636J31019420.40
30350441TERAZOSIN 10MG CAPRX2592.50
30355501TERAZOSIN 1MG CAPSULERX2592.50
30350123TERAZOSIN 5MG CAPRX2592.50
30254402TESTOSTERONE FREELAB30184402192.20
30254403TESTOSTERONE TOTALLAB30184403206.48
30350124TETANUS/DIPTHERIA INJRX6369071480.20
30350574THEOPHYLLINE ER 300MG TABRX2594.80
30456666THERA PUTTYCS27023.22
30458666THERA PUTTY BLACKCS27026.91
30452666THERA PUTTY LEVEL 0 TANCS27017.68
30453666THERA PUTTY LEVEL 1 YELLOWCS27017.68
30301607THERA TUBE LEVEL 3CS27014.13
30301608THERA TUBE LEVEL 4CS270A930015.12
30300717THERABAND LEVEL 0CS27012.60
30300518THERABAND LEVEL 1CS270A930010.53
30300514THERABAND LEVEL 2CS270A930011.16
30300515THERABAND LEVEL 3CS270A930012.15
30300539THERABAND LEVEL 4CS270A930014.04
30300517THERABAND LEVEL 5CS270A930015.21
30300519THERABAND LEVEL 7CS270A930017.64
30301500THERACANECS270124.11
30302666THERA-PUTTY (SUPER SOFT TAN)CS27010.00
30454666THERAPUTTY LEVEL 2 REDCS27017.68
30455666THERAPUTTY LEVEL 3 GREENCS27017.68
30457666THERAPUTTY LEVEL 4 BLUECS27017.68
30450022THERAPY EXERCISE PER 15PT4209711097.00
30350701THIAMINE HCL 100MG INJRX636J341129.10
30254425THIAMINE VITAMIN B-1LAB30184425105.00
30258175Thin Prep Screened by Automated SystemLAB3118817560.70
30258142ThinPrep PAP ManualLAB3118814246.43
30250183THIOPURINE METABOLITESLAB30180299474.00
30350566THIORIDAZINE 25MG TABRX2592.60
30202080THORA-COLUMBAR 2 VIEWRAD32072080266.27
30202081THORACOLUMBAR READINGRADP9727208042.32
30300324THOROCENTESIS TRAY DISP.CS270163.50
30254432THYROGLOBULINLAB30184432122.55
30256376THYROID PEROXIDASE ANTIBLAB30286376116.40
30203591TIB/FIB LOWER EXTREMITY READINGRADP9727359033.64
30203590TIBIA/FIBULA 2 VIEWRAD32073590217.07
30256757TICK BORNE DISEASE (RICKETTSIAL)LAB30286757154.80
30350483TIMOLOL OPH SOL 0.5% - 5ML BTLRX259240.50
30253516TISSUE TRANSGLUTAMINASE IGALAB3028351692.24
30350771TIZANIDINE (ZANAFLEX) 4MG TABRX2592.50
30355103TIZANIDINE 2MG TABRX2592.50
30354725TOBRAMYC/DEXAMETH 0.3/0.1% OPHTH PER BTLRX251105.80
30350556TOBRAMYCIN OPTH 0.3% PER 5ML BTTLRX25128.60
30203661TOE READINGRADP9727366027.88
30203660TOES 2 VIEWSRAD32073660164.00
30302550TOOTHETTESCS2700.00
30300764TOOTHPASTE 3.OZCS2701.85
30351186TOPIRAMATE 100MG TABLETRX2592.50
30351213TOPIRAMATE 200MG TABRX2592.50
30350600TOPIRAMATE 25MG TABRX2592.50
30350998TORSEMIDE 100MG TABRX2592.50
30359160TORSEMIDE 10MG TABRX2512.50
30350365TORSEMIDE 20MG TABRX2592.50
30354430Toviaz 8mg tabRX25919.70
30354230TOVIAZ ER 4MG TABRX25924.80
30300311TRACHEOSTOMY CARE KITCS27056.35
30301002TRACHEOTOMY TUBE HOLDERCS27010.00
30450023TRACTION MECHANICAL PER 15 MINPT4209701253.45
30354030TRADJENTA 5MG TABRX25946.40
30350178TRAMADOL 50MG TABRX2592.50
30356004TRANEXAMIC ACID PER 1000MG/10MLRX25126.20
30354509TRANSDERM SCOP 1.5MG PATCHRX25961.00
30254466TRANSFERRIN LEVELLAB30184466102.08
310536430TRANSFUSION BLOOD, SKSB39136430650.00
30150104TRANSFUSION, BLOOD - EDED39136430650.00
31016430TRANSFUSION, BLOOD - INPTNUR39136430650.00
31100200TRANSFUSION, BLOOD - OUTPTOBS39136430650.00
30160390TRAUMA RESPONSE TEAM W/HOSP CRITICED689G03901308.11
30350203TRAVATAN OPTH SOLN 0.004%-2.5ML BTRX259235.80
30300629TRAY IRRIGATIONCS2706.25
30300407TRAY TRACHEATOMYCS270164.70
30350916TRAZODONE 150MG TABRX2592.50
30351124TRAZODONE 50MG TABRX2592.50
30358710TRELEGY ELLIPTA PER INHALERRX252403.90
30256780TREPONEMA PALLIDUM BY TP-PALAB30286780105.92
30350465TRIAMCINOLONE CRM 1% 15GM TUBERX25916.60
30352035TRIAMTERENE/HCTZ 37.5/25MG TABRX2592.50
30350358TRIAMTERENE/HCTZ 75/50MG TABRX2593.60
30350540TRICOR 145MG TABRX2595.60
30256200TRIFLURIDINE 1% OPHTH SOLN 7.5ML BTLRX259262.60
30254478TRIGLYCERIDELAB3018447851.05
30350793TRIHEXYPHENIDYL 2MG TABRX2592.50
30350206TRIMETHSULF/POLY OPH B/L 10MLRX25917.30
30254484TROPONIN ILAB3018448499.76
30353380TRULICITY 0.75MG/0.5ML INJRX252266.90
30254443TSH THYROID STIMULATINGLAB30184443141.00
30300014TUBE GASTROSTOMY REPLACEMENTCS270245.25
30300419TUBE GAUZE SZ 1.5CS2702.50
30300420TUBE GAUZE SZ 5/8 PER INCHCS2702.50
30300421TUBE GAUZE SZ 7/8 PER INCHCS2702.50
30354200TUBERCULIN 0.1MLRX25939.20
30300422TUBULAR ELASTICCS2702.50
30350130TUSSIONEX ER SUSP PER 5CC DOSERX2592.50
30251240TYPE & SCREEN
30251241TYPE & SCREEN - PANEL
30226942U/S GUIDANCE FOR NEEDLE PLACEMENTUS40276942596.00
30350474ULORIC 40MG TABRX25938.70
30450024ULTRASOUND PER 15 MINPT4209703570.00
30301120UMBILICAL CORD CLAMPCS27020.88
30300092UNDER PAD 30X30CS2702.10
30300776UNNA BOOT 3CS270A645630.65
30300690UNNA BOOT 3 CALAMINECS272A645630.65
30300691UNNA BOOT 4CS272A645630.65
30450034UNNA BOOT TREATMENTPT4202958063.65
30300433URETHRAL MEATAL DILATORCS27034.80
30300816URI DRAIN CONNECT EXCS27011.20
30254550URIC ACIDLAB3018455036.16
30254560URIC ACID URINELAB3018456046.85
30251000URINALYSIS COMPLETELAB3078100139.65
30300064URINARY BAGCS27047.00
30300993URINARY LEG BAGCS270A510515.15
30300634URINE COLLECTER PEDSCS27012.96
30251002URINE DIP ONLYLAB3078100227.84
35058102URINE DIPSTICKCLNC521810028.40
30300114URINE DRAIN BAGCS270A435747.00
30256335URINE IMMUNOELECTROPHORESISLAB30086335234.80
30258415URINE MALB/CREATININE RATIOLAB30182043132.40
30251015URINE MICROSCOPICLAB3078101539.65
30254166URINE PROTEIN ELECTROPHORESISLAB30284166142.64
30300548URINE STRAINERCS2702.60
30259002URINE/BLOOD COLLECTION AFTER HOURLAB9909900190.05
30259001URINE/BLOOD COLLECTION FOR SEND OUTLAB3099900048.05
30350230UROXATRAL ER 10MG TABRX2592.50
30217670US ABDOMEN COMPLETEUS40276700496.06
302171669US ABDOMEN COMPLETE READINGUS97276700126.00
30217671US ABDOMEN LIMITEDUS40276705483.00
30217656US ABDOMEN LIMITED READINGUS9727670598.00
30219388US CAROTID BILATERALUS921938801028.70
30219389US CAROTID BILATERAL READINGUS97293880115.00
30217660US CHESTUS40276604365.00
30217688US EXTREMITY NONVASCULARUS40276881472.62
30219395US EXTREMITY VENOUS COMPLETEUS92193970525.00
30210057US EXTREMITY VENOUS COMPLETE READINGUS9729397087.00
30217681US FETAL BIOPHYSICAL PROFILEUS40276818529.00
30217680US OB >14 WEEKSUS40276805506.00
3027680US OB >14 WEEKS READINGUS97276805107.00
30216810US OB >14WKS ADD FETUSUS40276810365.00
30216802US OB 1ST TRI ADD FETUSUS40276802303.00
30206801US OB 1ST TRIMESTERUS40276801436.00
30217682US OB LIMITEDUS40276815314.00
30217683US OB REPEATUS40276816332.00
30217685US PELVIC GYN COMPLETEUS40276856530.00
30217686US PELVIC LIMITEDUS40276857343.00
30216857US PELVIC LIMITED READINGUS9727685774.00
30217684US PELVIC TRANSVAGINALUS40276830512.00
30210058US PELVIC TRANSVAGINAL READINGUS97276830121.00
30217677US RETROPERITONEAL COMPLETEUS40276770542.32
30217678US RETROPERITONEAL COMPLETE READINGUS97276770128.00
30217676US RETROPERITONEAL LIMITEDUS40276775450.00
30217687US SCROTUMUS40276870498.00
30217655US SCROTUM READINGUS97276870110.00
30217653US THYROIDUS40276536466.00
30217654US THYROID READINGUS9727653694.00
30206817US TVS OBUS40276817475.00
30219393US UNILAT VENOUS DOPPLER READINGUS9729397197.00
30219394US UNILATERAL VENOUS DOPPLERUS92193971729.85
30301126VACUUM BOTTLE KITCS270171.00
30304020VACUUM BOTTLE KIT 1000MLCS270144.00
30350603VALACYCLOVIR 1000MG TABRX2594.50
30356980VALACYCLOVIR 500MG TABRX2512.80
30355920VALIUM RECTAL GEL 20MGRX259224.40
30258016VALPROIC ACIDLAB30180164108.30
30250202VANCOMYCINLAB30180202108.32
30350446VANCOMYCIN 125MG CAPRX25918.40
30355515VANCOMYCIN 125MG ORAL SUSPENSIONRX2512.50
30350318VANCOMYCIN 500MG INJRX636J337024.20
30305073VAPOTHERM HI-VN NASAL CANNULACS27047.35
30305074VAPOTHERM HI-VN PED NASAL CANNULACS27047.25
30305072VAPOTHERM PATIENT CIRCUT HIGH FLOWCS270212.80
30257797VARCELLA ZOSTER BY PCRLAB30687798171.95
35059071VARICELLA VACCINERX63690716191.40
30257251VARICELLA VIRAL CULTURELAB30687252208.56
30256787VARICELLA ZOSTER ABLAB30286787103.04
37084568VASECTOMY PROCEDURE ROOMRX76155250100.00
30300361VASECTOMY TRAYCS270210.00
30301696VASEINE 1OZCS2707.20
303000406VASELINE 0.6OZCS2705.40
30350739VASOPRESSIN 20U/ML INJRX259275.10
30350421VECURONIUM BROMIDE PER 20mg INJRX25940.80
30353144VECURONIUM PER 10MG INJRX25931.40
30250001VENIPUNCTURELAB3003641522.85
30353110VENLAFAXINE 25MG TABRX2592.50
30350032VENLAFAXINE XR 37.5MG CAPRX2592.50
30350386VENLAFOXINE XR 75MG CAPRX2592.50
30350716VENOFER PER 1MG INJ -100MG VIALRX636J1756247.10
30350463VERAPAMIL 120MG TABRX2592.50
30352601VERAPAMIL 80MG TABRX2512.50
30350383VERAPAMIL ER 180MG TABRX2592.50
30350384VERAPAMIL ER 240MG TABRX2592.50
30350436VERAPAMIL SR 120MG TABRX2592.50
30350370VERAPAMIL UP TO 10MG INJRX636J349027.30
30350968VESICARE 5MG TABRX25945.60
30354561VIIBYRD 40MG TABRX25922.10
30357735VIMPAT 50MG TABLETRX25923.70
35050071VIRTUAL MEDICARE CHECK-IN FOR RHCCLNC521G007124.76
37082499VIS FUNCTION SCREENINGNUR7699917214.03
35050003VISION TEST ISHIHARA 14 PLATECLNC5199228315.00
35050004VISION TEST PERIPHERALCLNC519920817.50
30252541VIT D 25 HYDROXY D2LAB30182306236.80
35050005VITAL SIGNS W/O PHYSICAL EXAMCLNC521992117.50
30350798VITAMIN - OCUVITE PRESERVISION TABRX2592.50
30355921VITAMIN A 10,000IU CAPSULERX2592.50
30351338VITAMIN B COMPLEX PER TABLETRX2592.50
30350125VITAMIN B1 100MG TABRX2592.50
30356780VITAMIN B1 50MG TABRX2512.50
30252607VITAMIN B12LAB30182607124.90
30350392VITAMIN B12 1000MCG SUBLINGUAL TABRX2592.50
30355186VITAMIN B6 100MG TABRX2512.50
30350796VITAMIN C 250MG CHEWABLE TABRX2592.50
30354532VITAMIN D 1000IU TABRX2592.50
30350140VITAMIN D 400IU CAPRX2592.50
30350960VITAMIN D 50 000 UNIT CAPRX2592.50
30350526VITAMIN D 5000IU TABRX2592.50
30350390VITAMIN E 400IU CAPRX2592.50
30350141VITAMIN K PER 1MG INJRX636J343081.90
30354531VITAMIN, CHILDREN'S CHEWABLERX2592.50
30354508VITAMIN, MULTIVITAMINRX2592.50
30350631VITAMIN, PRENATAL PLUS TABRX2592.50
30300821VOMIT BAG DISPOSABLECS27010.71
37082500VSL FUNC SCRNGNUR7699249914.03
30301457WAFFLE CHAIR PADCS270123.36
30300005WANDERGUARD 1 YEARCS270199.90
30301916WANDERGUARD 90 DAYCS270127.80
30301571WANDERGUARD BANDCS27013.41
30350405WARFARIN 2.5MG TABRX2592.50
30350403WARFARIN 2MG TABRX2592.50
30350220WARFARIN 3MG TABRX2592.50
30357402WARFARIN 4MG TABRX2592.50
30350312WARFARIN 5MG TABRX2512.50
30300883WARMING FLUID SETCS27069.25
35057110WART REMOVALCLNC52117110114.50
30300344WATER DISTILLED GALLONCS272A42188.75
30353565WELCHOL 625MG TABRX2598.60
30253181WEST NILE AB IGG AND IGMLAB30086788134.80
34100030WHIRLPOOL BATHPALS11940.00
30450030WHIRLPOOL PER 15 MINPT4209702291.05
35050001WORK COMP SPECIAL SERVICESCLNC5219945566.60
30450032WORK COND INTIAL 2 HOURSPT42097545150.05
30203101WRIST 3 VIEW READINGRADP9727311036.52
30203110WRIST COMPLETE 3 VIEWRAD32073110210.00
30203100WRIST LIMITED 2 VIEWRAD32073100182.00
30203102WRIST LIMITED 2 VIEW READINGRADP9727310035.08
30350388XALATAN EYE GTT 0.005 - 2.5ML BTLRX25930.80
30355001XANAX 0.5MG TABRX2592.50
30357830XARELTO 15MG TABLETRX25933.20
30357930XARELTO 20MG TABLETRX25937.20
30300905XEROFORM 1X8CS2707.90
30301127XEROFORM 2X2CS2723.40
30300010XEROFORM 4X3YRDSCS27030.75
30300833XEROFORM 5X9CS2705.30
30350488XGEVA (DENOSUMAB) PER 1MG INJRX636J08973192.80
30354678XIFAXAN 550MG TABRX252111.30
30356402XOPENEX HFA 45MCG INHALERRX259157.40
30356540ZADITOR 0.025% PER BOTTLERX25234.60
30353550ZETIA 10MG TABRX25910.60
30350565ZINC 50MG TABRX2592.50
30356760ZIPRASIDONE 60MG CAPSULERX2592.50
30359054ZOLEDRONIC ACID 4MG/5ML INJRX636J348952.10
30359776ZOLMITRIPTAN 2.5MG TABRX25162.40
30352020ZOLPIDEM 5MG TABRX2592.50
30250203ZONISAMIDELAB30180203106.00
30352801ZONISAMIDE 100MG CAPSULERX2592.50