Please use this estimator for your upcoming clinic or hospital services.
Scroll down for the Master List of Charges.
Charge Code | Description | Department | UB RevenueCode | Procedure Code | Rate |
---|---|---|---|---|---|
30354014 | .45 NACL 1000CC | CS | 258 | 11.80 | |
30354023 | 10% DEXTROSE 1000CC | CS | 636 | J3490 | 12.40 |
30258350 | 14-3-3 ETA PROTEIN | LAB | 302 | 83520 | 138.16 |
30253513 | 21-HYDROXYLASE ANTIBODY | LAB | 302 | 83516 | 147.20 |
30254105 | 24 HOUR URINE PHOSPHORUS | LAB | 301 | 84105 | 46.69 |
30520062 | 4" ROCK TAPE | CS | 270 | 1.00 | |
30304949 | 4IN LONG COMPRILAN | CS | 270 | A6449 | 98.44 |
30258349 | 5 HIAA 24 H URINE | LAB | 302 | 83497 | 103.20 |
30354054 | 5% Dex .45 NaCl / K10MEQ | CS | 636 | J3490 | 42.42 |
30354008 | 5% DEX .45 NACL 1000ML | CS | 258 | 12.50 | |
30354055 | 5% DEX .45 NACL W/ POTAS. 1000ML | CS | 258 | 13.20 | |
30354006 | 5% DEX .9 NACL per 500ml - 1000ML bag | CS | 258 | J7042 | 12.50 |
30354056 | 5% DEX .9 NACL W/ POTAS. 1000ML | CS | 258 | J7042 | 13.20 |
30354000 | 5% DEX 1000ML | CS | 636 | J7070 | 11.20 |
30354004 | 5% DEX 100ML | CS | 636 | J3490 | 10.10 |
30354020 | 5% DEX 250ML | CS | 636 | J3490 | 6.80 |
30354002 | 5% DEX 500ML | CS | 636 | J7060 | 5.90 |
30354518 | A & D OINTMENT 5GM PKT | RX | 259 | 2.50 | |
30300639 | ABD PAD 5 X 9 | CS | 270 | A6252 | 2.50 |
30300640 | ABD PAD 7.5 X 8 | CS | 270 | A6218 | 2.50 |
30204000 | ABDOMEN (KUB) SINGLE VIEW | RAD | 320 | 74018 | 195.00 |
30204022 | ABDOMEN 2 VIEW AND PA CHEST | RAD | 320 | 74022 | 353.52 |
30204002 | ABDOMEN ACUTE SERIES READING | RADP | 972 | 74022 | 65.40 |
30204020 | ABDOMEN COMPLETE | RAD | 320 | 74019 | 278.94 |
30204021 | ABDOMEN COMPLETE READING | RADP | 972 | 74019 | 48.08 |
30204001 | ABDOMEN READING | RADP | 972 | 74018 | 37.96 |
30352101 | ABILIFY 10MG TAB | RX | 251 | 67.90 | |
30350613 | ABILIFY 2MG TAB | RX | 259 | 7.60 | |
30350713 | ABILIFY 5MG TAB | RX | 259 | 78.70 | |
30256900 | ABO GROUP | LAB | 300 | 86900 | 45.50 |
30251235 | ABO/RH GROUPING PATIENT | LAB | 300 | 86900 | 59.50 |
30256903 | ABO/RH TYPE UNIT | LAB | 300 | 86902 | 78.35 |
30203050 | AC JOINTS | RAD | 320 | 73050 | 184.00 |
30203051 | AC JOINTS READING | RADP | 972 | 73050 | 39.40 |
30350272 | ACCOLATE 20MG TAB | RX | 259 | 6.70 | |
30300198 | ACE WRAP 2" | CS | 270 | A6448 | 8.20 |
30300199 | ACE WRAP 3" | CS | 271 | A6448 | 9.90 |
30300680 | ACE WRAP 4 LONG | CS | 271 | A6450 | 32.40 |
30300200 | ACE WRAP 4" | CS | 271 | A6449 | 17.91 |
30300202 | ACE WRAP 6" | CS | 270 | 30.05 | |
30300280 | ACE WRAP 6in LONG | CS | 270 | 30.05 | |
30350001 | ACETAMINOPHEN 120MG SUPP | RX | 259 | 2.70 | |
30350811 | ACETAMINOPHEN 325MG SUPP | RX | 259 | 2.90 | |
30350156 | ACETAMINOPHEN 325MG TAB | RX | 259 | 2.50 | |
30350649 | ACETAMINOPHEN 500MG TAB | RX | 259 | 2.50 | |
30350812 | ACETAMINOPHEN 650MG SUPP | RX | 259 | 2.50 | |
30350193 | ACETAMINOPHEN ELIXIR 160mg/5ml | RX | 259 | 2.50 | |
30252003 | ACETAMINOPHEN LEVEL | LAB | 301 | 80307 | 300.00 |
30350821 | ACETAMINOPHEN W/COD 120/12MG/5ML | RX | 259 | 2.50 | |
30350434 | ACETAMINOPHEN/COD 300MG/30MG TAB | RX | 259 | 2.50 | |
30350422 | ACETYLCYSTIENE SOLN PER GRAM | RX | 259 | J7608 | 23.10 |
30350315 | ACIPHEX 20MG TAB | RX | 259 | 3.30 | |
30359980 | ACT DRY MOUTH LOZENGE | RX | 259 | 2.50 | |
30350194 | ACTIDOSE AQUA TUBE 50GM 240ML | RX | 259 | 52.40 | |
30300989 | ACTISORB SLIVER 4X4 | CS | 270 | 44.80 | |
30355979 | ACTIVASE PER 1MG INJ - 100MG VIAL | RX | 636 | J2997 | 13386.10 |
30350732 | ACTIVASE PER 1MG INJ - 50mg vial | RX | 636 | J2997 | 6698.10 |
30350517 | ACTOS 15MG TAB | RX | 259 | 2.50 | |
30350250 | ACTOS 45MG TAB | RX | 259 | 37.80 | |
30350457 | ACYCLOVIR 400 MG TAB | RX | 259 | 2.50 | |
30354701 | ACYCLOVIR 800MG TABLET | RX | 259 | 2.50 | |
30352520 | ACYCLOVIR PER 5MG INJ | RX | 636 | J0133 | 27.30 |
30350702 | ADACEL VACCINE | RX | 636 | 90715 | 128.70 |
30250231 | ADALIMUMAB AB AND CONCENTRATION | LAB | 301 | 545.00 | |
30300994 | ADAPTIC 3X16 | CS | 270 | A6222 | 19.20 |
30300559 | ADAPTIC 3X3 | CS | 270 | A6222 | 5.80 |
30300959 | ADAPTIC 3X8 | CS | 270 | A6222 | 18.65 |
30354202 | ADENOSINE INJECTION PER 1MG | RX | 636 | J0153 | 31.10 |
30160234 | ADMIT/DISC SAME DAY I OBS/INPT | OBSP | 982 | 99234 | 357.40 |
30160235 | ADMIT/DISC SAME DAY II OBS/INPT | OBSP | 982 | 99235 | 399.95 |
30160236 | ADMIT/DISC SAME DAY III OBS/INPT | OBSP | 982 | 99236 | 458.40 |
34100120 | ADULT DAY CARE- 12 HRS TO 18HRS | LTC | 119 | 160.00 | |
34100080 | ADULT DAY CARE- 6 HRS TO 12 HRS | LTC | 119 | 110.00 | |
34100040 | ADULT DAY CARE- UP TO 6 HOURS | LTC | 119 | 75.00 | |
30359600 | ADVAIR DISKUS 250/50MCG PER INHALER | RX | 259 | 229.60 | |
30350619 | ADVAIR DISKUS 500/50 PER INHALER | RX | 259 | 374.30 | |
30350890 | ADVAIR DSK 100/50MCG INH-14 DOSE | RX | 259 | 229.40 | |
30353503 | ADVAIR DSK 250/50MCG INH-14 DOSE | RX | 259 | 180.50 | |
30350326 | ADVAIR HFA 115/21MCG INHALER | RX | 259 | 241.80 | |
30350529 | ADVAIR HFA 230/21MCG - 120DOSE INH | RX | 259 | 419.40 | |
30160300 | ADVANCE CARE PLAN INITIAL 30 MIN - INPT | NURP | 987 | 99497 | 86.80 |
35059497 | ADVANCE CARE PLAN INITIAL 30MIN - Clinic | CLNC | 521 | 99497 | 86.80 |
35059498 | ADVANCE CARE PLAN SUBSEQ 30MIN - Clinic | CLNC | 521 | 99498 | 75.60 |
30160301 | ADVANCE CARE PLAN SUBSEQ 30MIN - INPT | NURP | 987 | 99498 | 75.60 |
30350404 | AFRIN NASAL SPRAY | RX | 259 | 8.70 | |
30300968 | AFTERSHAVE | CS | 270 | 8.10 | |
30350669 | AGGRENOX 200/25MG CAP | RX | 259 | 22.30 | |
3505AIC | AIC Medicare | CLNC | 521 | 0.00 | |
35054644 | AIRWAY INHALATION TREATMENT | CLNC | 410 | 94640 | 27.20 |
30252040 | ALBUMIN | LAB | 301 | 82040 | 45.60 |
30350880 | ALBUTEROL HFA-60DOSE INH | RX | 259 | 96.30 | |
30358703 | ALBUTEROL PER 1MG (.63MG VIAL) | RX | 294 | J7610 | 2.50 |
30350004 | ALBUTEROL PER 1MG INH SOLN | RX | 294 | J7610 | 2.50 |
30252055 | ALCOHOL | LAB | 301 | 80320 | 78.80 |
30301329 | ALCOHOL SALIVA TEST | CS | 270 | 48.55 | |
30252085 | ALDOLASE | LAB | 301 | 82085 | 77.70 |
30252088 | ALDOSTERONE | LAB | 301 | 82088 | 287.10 |
30350650 | ALENDRONATE SOD 70MG TAB | RX | 259 | 2.90 | |
30254080 | ALK.PHOS ISOENZYMES | LAB | 300 | 84080 | 118.24 |
30254075 | ALKALINE PHOSPHATASE | LAB | 300 | 84075 | 48.30 |
30256003 | ALLERGEN MULTI RAST MAY | LAB | 302 | 86003 | 41.76 |
30256007 | ALLERGEN ROCKY MOUNTAIN PROFILE | LAB | 302 | 86003 | 89.76 |
30301129 | Allevyn 3x3 Foam Dressing | CS | 279 | A6212 | 5.54 |
30300827 | ALLEVYN DRESSING 5X5 | CS | 270 | 31.85 | |
30300348 | ALLEVYN DRESSING SACRUM | CS | 270 | 28.10 | |
30305051 | ALLEVYN HEEL DRESSING 5 3/4 X 5 3/4 | CS | 272 | A6213 | 13.64 |
30350198 | ALLOPURINOL 100MG TAB | RX | 259 | 2.50 | |
30354210 | ALLOPURINOL 300MG TABLET | RX | 259 | 2.50 | |
30252103 | ALPHA 1 ANTITRYPSIN | LAB | 301 | 82103 | 122.55 |
30252105 | ALPHA FETOPROTEIN | LAB | 301 | 82105 | 109.60 |
30352860 | ALPHA LIPOIC ACID 200MG CAPSULE | RX | 259 | 2.50 | |
30352105 | ALPHAGAN P 0.1% PER 5ML BTL | RX | 259 | 190.00 | |
30351011 | ALPHAGAN-P OPH SOL .15% PER 5ML BT | RX | 259 | 161.60 | |
30350280 | ALPRAZOLAM 0.25MG TAB | RX | 259 | 2.50 | |
30357901 | ALPRAZOLAM 1MG TABLET | RX | 259 | 2.50 | |
30254460 | ALT / SGPT | LAB | 301 | 84460 | 48.30 |
30350495 | AMANTADINE 100MG CAP | RX | 259 | 7.20 | |
30354616 | AMANTADINE OS 50MG/5ML | RX | 251 | 2.50 | |
30300484 | AMBU RESUSCITATOR ADULT | CS | 270 | 90.80 | |
30300496 | AMBU RESUSCITATOR PED | CS | 270 | 90.80 | |
30300497 | AMBU SPUR NEONATE | CS | 270 | 90.80 | |
30359501 | AMIDATE(ETOMIDATE) UP TO 20MG INJ | RX | 259 | 24.10 | |
30350962 | AMILORIDE 5MG TAB | RX | 259 | 7.10 | |
30350245 | AMIODARONE 200MG TAB | RX | 259 | 2.50 | |
30350738 | AMIODARONE 30MG INJ - 150mg IVP | RX | 636 | J0282 | 16.10 |
30351738 | AMIODARONE 30MG INJ - 900MG INFUSION | RX | 636 | J0282 | 26.80 |
30350975 | AMITIZA (LUBIPROSTONE) 24MCG CAP | RX | 259 | 21.80 | |
30358040 | AMITIZA 8MCG CAP | RX | 252 | 21.80 | |
30350653 | AMITRIPTYLINE 100 MG TAB | RX | 259 | 6.10 | |
30350281 | AMITRIPTYLINE 10MG TAB | RX | 259 | 2.50 | |
30350651 | AMITRIPTYLINE 25MG TAB | RX | 259 | 2.50 | |
30355509 | AMLODIPINE 2.5MG TAB | RX | 251 | 2.50 | |
30350089 | AMLODIPINE 5MG TAB | RX | 259 | 2.50 | |
30252140 | AMMONIA | LAB | 301 | 82140 | 116.60 |
30350918 | AMMONIA INHALANT | RX | 259 | 7.50 | |
30350172 | AMOXICIL/CLV 400/57MG/5ML - 100ML BTL | RX | 251 | 32.20 | |
30359401 | AMOXICIL/CLV 600/43MG/5ML - 125ML BTL | RX | 251 | 43.60 | |
30354511 | AMOXICILLIN 250MG CAP | RX | 259 | 2.50 | |
30350214 | AMOXICILLIN 500MG CAP | RX | 259 | 2.50 | |
30351203 | AMOXICILLIN OS 250MG/5ML - 1 BTL | RX | 259 | 11.70 | |
30350225 | AMOXICILLIN OS 400MG/5ML-50ML BTL | RX | 259 | 7.20 | |
30350012 | AMOXICILLIN/CLAV 500/125MG TAB | RX | 259 | 2.90 | |
30350013 | AMOXICILLIN/CLAV 875/125MG TAB | RX | 259 | 3.90 | |
30351114 | AMOXICILLIN/CLAV XR 1000/62.5MG TAB | RX | 251 | 19.80 | |
30250325 | AMPHETAMINES URINE QUANT | LAB | 302 | 80325 | 377.64 |
30350545 | AMPICILLIN SOD 500MG INJ | RX | 636 | J0290 | 23.10 |
30350551 | AMPICILLIN/SULBACTAM PER 1.5GM INJ(3GM) | RX | 636 | J0295 | 28.80 |
30351383 | AMPICILLIN/SULBACTAM PER 1.5GM(1.5GM VL) | RX | 636 | J0295 | 23.40 |
30257798 | AMPLIFIED PROBE EACH ORGANISM | LAB | 302 | 87798 | 185.91 |
30252150 | AMYLASE | LAB | 301 | 82150 | 70.00 |
30256038 | ANA SCREEN | LAB | 302 | 86038 | 122.35 |
30256039 | ANA TITER | LAB | 302 | 86039 | 78.10 |
30350654 | ANASTROZOLE 1MG TAB | RX | 259 | 2.50 | |
30256044 | ANCA IGA | LAB | 302 | 86255 | 48.60 |
30203600 | ANKLE AP AND LATERAL | RAD | 320 | 73600 | 179.00 |
30203601 | ANKLE AP/LAT READING | RADP | 972 | 73600 | 35.08 |
30203610 | ANKLE COMPLETE | RAD | 320 | 73610 | 209.86 |
30203611 | ANKLE COMPLETE READING | RADP | 972 | 73610 | 36.52 |
30356910 | ANORO ELLIPTA 62.5/25MCG INH | RX | 259 | 202.80 | |
30350083 | ANTACID/ANTIGAS OS PER DOSE | RX | 259 | 2.50 | |
30252000 | ANTI CCP | LAB | 301 | 86200 | 103.60 |
30256002 | ANTI GLIADIN Ab IgA & IgG | LAB | 302 | 83516 | 92.24 |
30256850 | ANTIBODY GEL | LAB | 300 | 86850 | 78.35 |
30256870 | ANTIBODY IDENTIFICATION | LAB | 300 | 86870 | 106.20 |
30254999 | ANTIMITOCHONDRIAL A.B. | LAB | 302 | 83516 | 92.24 |
30253521 | ANTI-MULLERIAN HORMONE | LAB | 302 | 83520 | 151.00 |
30350503 | ANTIPYRINE/BENZOCAINE OTIC 15ML BTL | RX | 259 | 19.20 | |
30350515 | ANUCORT HC RECTAL SUPP | RX | 259 | 16.10 | |
30169125 | APP OF SHORT ARM SPLINT, STATIC | EDP | 981 | 29125 | 91.75 |
30302258 | AQUACEL 6X6 | CS | 272 | A6210 | 44.85 |
30301375 | AQUACEL AG 4X4 DRESSING | CS | 270 | A6212 | 44.85 |
30300763 | AQUAPAK STERILE WATER | CS | 272 | A4218 | 16.30 |
30457113 | AQUATIC THERAPY W/THER EXER EACH 15 MIN | PT | 420 | 97113 | 59.88 |
30350102 | ARANESP (DARBEPOETIN) PER 1MCG INJ | RX | 636 | J0881 | 2234.50 |
30352005 | ARIXTRA PER 0.5MG INJ - 2.5mg syr | RX | 636 | J1652 | 106.90 |
30351652 | ARIXTRA PER 0.5MG INJ - 7.5MG SYR | RX | 636 | J1652 | 191.00 |
30355604 | ARMOUR THYROID 90MG TAB | RX | 251 | 7.40 | |
30256600 | ARTERIAL COLLECTION | LAB | 450 | 36600 | 64.85 |
30252803 | ARTERIAL/VENOUS BLOOD GAS | LAB | 300 | 82803 | 175.95 |
30352500 | ASACOL D/R 400MG TAB | RX | 259 | 14.80 | |
30350966 | ASMANEX TWISTHALER 220MCG per inhaler | RX | 259 | 427.60 | |
35050612 | ASPIRATE GANGLION CYST | CLNC | 521 | 20612 | 65.10 |
30350006 | ASPIRIN 300MG SUPP | RX | 259 | 6.40 | |
30350005 | ASPIRIN 325MG TAB | RX | 259 | 2.50 | |
30350007 | ASPIRIN 81MG CHEWABLE TAB | RX | 259 | 2.50 | |
30350655 | ASPIRIN EC 325MG TAB | RX | 259 | 2.50 | |
30350629 | ASPIRIN EC 81MG TAB | RX | 259 | 2.50 | |
30253882 | ASSAY NEPHELOMETRY NOT SPEC. | LAB | 301 | 83883 | 108.80 |
30254450 | AST / SGOT | LAB | 301 | 84450 | 48.30 |
30350164 | ATACAND 32 MG TAB | RX | 259 | 17.40 | |
30350009 | ATENOLOL 50MG TAB | RX | 259 | 2.50 | |
30355060 | ATROPINE SULF OPTH SOLN 1% per BTL | RX | 259 | 116.80 | |
30350213 | ATROPINE UP TO 0.1MG INJ | RX | 636 | J0461 | 27.60 |
30350011 | ATROVENT HFA 17MCG INHALER - 200 INH | RX | 259 | 302.90 | |
30300207 | ATTEND BRIEF BARIATRIC | CS | 270 | A4520 | 15.39 |
30301999 | ATTEND CHUCK PAD | CS | 272 | A4554 | 2.90 |
30300069 | ATTEND WIPES | CS | 270 | A4335 | 29.70 |
30300781 | ATTENDS BRIEFS LARGE | CS | 270 | A4520 | 4.60 |
30300751 | ATTENDS BRIEFS MEDIUM | CS | 270 | A4520 | 6.70 |
30300520 | ATTENDS BRIEFS XLARGE | CS | 270 | A4520 | 5.50 |
30300638 | ATTENDS PANT LINER | CS | 270 | A4520 | 3.00 |
30301650 | ATTENDS PULL UP XXLG | CS | 270 | A4520 | 8.10 |
30300787 | ATTENDS PULL UP YOUTH X SMALL | CS | 270 | T4534 | 8.00 |
30300521 | ATTENDS PULLUP LARGE | CS | 270 | A4520 | 5.30 |
30300577 | ATTENDS PULLUP MEDIUM | CS | 270 | A4520 | 5.30 |
30300522 | ATTENDS PULLUP XLARGE | CS | 270 | A4520 | 6.70 |
30301998 | ATTENDS PULLUP YOUTH | CS | 270 | A4520 | 5.30 |
35052552 | AUDIOMETRY PURE TONE AIR THRESHOLD | CLNC | 521 | 92552 | 30.00 |
30350930 | AVALIDE 300MG/12.5MG TAB | RX | 259 | 17.10 | |
30350319 | AVAPRO 300MG TAB | RX | 259 | 20.10 | |
30353005 | AVODART 0.5MG CAP | RX | 259 | 17.80 | |
30351004 | AZATHIOPRINE 50MG TAB | RX | 636 | J7500 | 2.50 |
30358335 | AZELASTINE NASAL SOLUTION PER BTL | RX | 259 | 62.10 | |
30350147 | AZITHROMYCIN 250MG TAB | RX | 259 | 2.70 | |
30350240 | AZITHROMYCIN 500MG INJ | RX | 636 | J0456 | 24.40 |
30350146 | AZITHROMYCIN OS 100MG/5ML -15ML | RX | 259 | 42.10 | |
30350014 | AZITHROMYCIN OS 200MG/5ML - 15ML | RX | 259 | 29.90 | |
30350162 | AZITHROMYCIN OS 200MG/5ML -30CC BT | RX | 259 | 28.30 | |
30350770 | AZOPT OPTH DROPS PER 10ML BTL | RX | 259 | 263.70 | |
30258388 | B NATRIURETIC PEPTIDE | LAB | 301 | 83880 | 314.08 |
30350395 | BACITRACIN OINTMENT PER 1OZ TUBE | RX | 259 | 9.90 | |
30350016 | BACITRACIN PKT | RX | 259 | 3.80 | |
30357104 | BACLOFEN 10MG TABLET | RX | 259 | 2.50 | |
30350154 | BACLOFEN 20MG TAB | RX | 259 | 2.50 | |
30301804 | BAIR HUGGER BLANKET FULL BODY | CS | 270 | 80.00 | |
30300349 | BANDAID 2X3.75 | CS | 270 | A6413 | 1.00 |
30259004 | BASIC EXAM LIFE INSURANCE | LAB | 300 | 99000 | 58.80 |
30250048 | BASIC METABOLIC PANEL | LAB | 301 | 80048 | 112.70 |
30256902 | BB UNIT 1T&RH | ||||
30256904 | BB UNIT 2 T&RH | ||||
30256907 | BB UNIT 3 T&RH | ||||
30256908 | BB UNIT 4 T&RH | ||||
30350196 | BELLADONNA ALK W/PHEN PER 5ML | RX | 259 | 32.50 | |
30355050 | BELSOMRA 5MG TABLET | RX | 259 | 36.90 | |
30353500 | BENAZEPRIL 10MG TAB | RX | 259 | 2.50 | |
30350148 | BENAZEPRIL 40MG TAB | RX | 259 | 2.50 | |
30351603 | BENEFIBER PER DOSE | RX | 257 | 2.50 | |
30350469 | BENICAR 20MG TAB | RX | 259 | 2.50 | |
30351511 | BENZONATATE 100MG CAP | RX | 259 | 2.50 | |
30353832 | BENZTROPINE 1MG TAB | RX | 251 | 2.50 | |
30350045 | BENZTROPINE 2MG TAB | RX | 259 | 2.50 | |
30252232 | BETA 2 MICROGLOBULIN | LAB | 302 | 82232 | 129.44 |
30252011 | BETA-HYDROXYBUTYRIC ACID | LAB | 301 | 82010 | 55.40 |
30354610 | BETOPTIC S OPHTH 0.25% PER 10ML | RX | 259 | 260.40 | |
30356003 | BEVESPI AEROSPHERE PER INHALER | RX | 252 | 153.60 | |
35059484 | BHI GENERAL > 20 MINUTES/MONTH | CLNC | 521 | 99484 | 100.50 |
30351102 | BICALUTAMIDE 50MG TAB | RX | 259 | 2.50 | |
30203523 | BILATERAL HIP 3-4 VIEW READING | RADP | 972 | 73522 | 61.08 |
30203522 | BILATERAL HIPS 3-4 VIEWS | RAD | 320 | 73522 | 250.00 |
30203567 | BILATERAL WT BEARING KNEE READING | RADP | 972 | 73565 | 36.52 |
30203565 | BILATERAL WT BEARING KNEES | RAD | 320 | 73565 | 162.94 |
30300495 | BILE BAG | CS | 270 | 45.35 | |
30256682 | BILHARZIASIS | LAB | 302 | 86682 | 104.08 |
30252248 | BILIRUBIN DIRECT | LAB | 301 | 82248 | 45.60 |
30252247 | BILIRUBIN TOTAL | LAB | 301 | 82247 | 45.60 |
30304975 | BIOPATCH 1 | CS | 272 | 36.05 | |
35051100 | BIOPSY SKIN PUNCH (SINGLE LESION) | CLNC | 521 | 11104 | 113.40 |
35051101 | BIOPSY SKIN PUNCH EACH ADD LESION | CLNC | 521 | 11105 | 39.90 |
30300253 | BIOPSY FORCEPS DISP | CS | 270 | 100.40 | |
30300720 | BIOPSY PUNCH SZ 2 DISP | CS | 272 | 21.70 | |
30300817 | BIOPSY PUNCH SZ 3 DISP | CS | 270 | 21.70 | |
30300724 | BIOPSY PUNCH SZ 4 DISP | CS | 270 | 21.70 | |
30301124 | BIOPSY PUNCH SZ 5 DISP | CS | 270 | 15.39 | |
30300723 | BIOPSY PUNCH SZ 6 DISP | CS | 270 | 21.70 | |
30450001 | BIOTHOTIC ORTHOTICS | PT | 274 | 129.00 | |
30357715 | BIOTIN 5000MCG TAB | RX | 259 | 2.50 | |
30301365 | BIPAP CIRCUT TUBING | CS | 270 | 137.40 | |
30301133 | BIPAP HEAD GEAR | CS | 271 | 45.15 | |
30304918 | BiPap Heated Circut Tubing | CS | 270 | 117.60 | |
30301347 | BIPAP MASK LARGE | CS | 270 | 120.00 | |
30301539 | BIPAP MASK MEDIUM | CS | 270 | 120.00 | |
30301540 | BIPAP MASK SMALL | CS | 270 | 120.00 | |
30350017 | BISACODYL 10 MG SUPP | RX | 259 | 2.50 | |
30350632 | BISACODYL EC 5MG TAB | RX | 259 | 2.50 | |
30357430 | BISOPROLOL 10MG TAB | RX | 259 | 2.70 | |
30350659 | BISOPROLOL 5MG TAB | RX | 251 | 3.80 | |
30257799 | BK VIRUS BY PCR | LAB | 302 | 87799 | 331.10 |
37080101 | BLADDER SCAN/MEASURE PVR | NUR | 402 | 51798 | 68.50 |
30259003 | BLOOD UNIT SEARCH | LAB | 300 | 99001 | 195.30 |
30300762 | BODY LOTION 4 OZ | CS | 270 | 1.30 | |
30300302 | BONE MARROW BIOPSY TRAY | CS | 270 | 158.40 | |
30257801 | BORDETELLA PERTUSSIS BY PCR | LAB | 302 | 87798 | 184.80 |
30256617 | BORRELIA BURGDORFERI ANTIBODY PANE | LAB | 302 | 86618 | 201.00 |
30450035 | BRACE MEASUREMENT AND TRAINING 15 MIN | PT | 420 | 97760 | 96.00 |
30355914 | BREO ELLIPTA 100MCG/25MCG PER INHALER | RX | 252 | 278.80 | |
30358214 | BREO ELLIPTA 200MCG/25MCG PER INHALER | RX | 252 | 278.80 | |
30357760 | BRILINTA 90MG TAB | RX | 252 | 19.60 | |
30350456 | BROVANA SOLN INH 15MCG/ML | RX | 259 | J7605 | 25.90 |
30350572 | BUDESONIDE INHAL PER 0.5mg | RX | 294 | J7626 | 5.60 |
30300051 | BULB SYRINGE 1 OZ | CS | 270 | 6.55 | |
30351118 | BUMETANIDE (BUMEX) 0.5MG INJ | RX | 636 | J3490 | 19.80 |
30350431 | BUMETANIDE 1MG TAB | RX | 259 | 3.10 | |
30357991 | BUMETANIDE 2MG TAB | RX | 251 | 11.70 | |
30254520 | BUN | LAB | 301 | 84520 | 38.60 |
30350069 | BUPIVACAINE 0.5% 5MG/ML PER 30ML INJ | RX | 636 | S0020 | 13.00 |
30350218 | BUPROPION 100MG TAB | RX | 259 | 2.50 | |
30354522 | BUPROPION SR 100MG/12H TAB | RX | 259 | 2.50 | |
30354521 | BUPROPION SR 150MG/12H TAB | RX | 259 | 2.50 | |
30350142 | BUPROPION XL 150MG/24HR TAB | RX | 259 | 3.60 | |
30350256 | BUSPAR 10MG TAB | RX | 259 | 2.50 | |
30356591 | BUSPIRONE 15MG TABLET | RX | 259 | 2.50 | |
30351552 | BUTALBITAL/ASA/CAFFEINE 50/325/40MG CAP | RX | 259 | 5.40 | |
30359036 | BUTORPHANOL NASAL SPRAY 2.5ML BTL | RX | 259 | 37.50 | |
30350189 | BUTORPHANOL TARTRATE UP TO 1MG INJ | RX | 636 | J0595 | 28.80 |
30354523 | BUTRANS TRANS PATCH - 10MCG/HR | RX | 259 | 146.20 | |
30355804 | BUTRANS TRANS PATCH - 15MCG/HR | RX | 259 | 168.60 | |
30354524 | BUTRANS TRANS PATCH - 20MCG/HR | RX | 259 | 206.60 | |
30350531 | BUTRANS TRANS PATCH - 5MCG/HR | RX | 259 | 113.40 | |
30350711 | BYETTA PEN INJ | RX | 259 | 710.30 | |
30354525 | BYSTOLIC 10MG TAB | RX | 259 | 10.30 | |
30351116 | BYSTOLIC 5MG TAB | RX | 259 | 13.90 | |
30257493 | C DIFF TOXIN GENE | LAB | 302 | 87493 | 121.54 |
30256140 | C REACTIVE PROTEIN | LAB | 302 | 86140 | 55.00 |
30202040 | C SPINE AP AND LATERAL | RAD | 320 | 72040 | 228.00 |
30202052 | C SPINE COMPLETE | RAD | 320 | 72052 | 340.60 |
30202053 | C SPINE READING | RADP | 972 | 72052 | 62.52 |
30256160 | C3/C4 COMPLEMENT | LAB | 301 | 86160 | 90.80 |
30256304 | CA 125 | LAB | 301 | 86304 | 166.50 |
30256300 | CA 27-29 | LAB | 302 | 86300 | 166.48 |
34009993 | CABLE TV - MONTHLY | LTC | 994 | 20.00 | |
30252308 | CALCITONIN | LAB | 301 | 82308 | 126.00 |
30350990 | CALCITONIN NS 200IU/SPRAY - 30 DOSE | RX | 259 | 139.90 | |
30353002 | CALCITRIOL 0.25MCG CAP | RX | 259 | 3.10 | |
30252310 | CALCIUM | LAB | 301 | 82310 | 45.60 |
30350018 | CALCIUM +D 600MG/400IU TAB | RX | 259 | 2.50 | |
30353252 | CALCIUM 600MG TAB | RX | 259 | 2.50 | |
30354991 | CALCIUM ALGINATE ROPE 3/4" X 12 | CS | 272 | A6199 | 83.60 |
30350129 | CALCIUM CARBONATE 500MG CHEW TAB | RX | 259 | 2.50 | |
30350705 | CALCIUM CHL 10% UP TO 1000MG/10ML INJ | RX | 636 | J3490 | 33.60 |
30359000 | CALCIUM CITRATE W/ VIT D TABLET | RX | 259 | 2.50 | |
30350327 | CALCIUM GLUC 10% PER 10ML INJ | RX | 636 | J0610 | 39.30 |
30252330 | CALCIUM IONIZED | LAB | 301 | 82330 | 109.44 |
30252340 | CALCIUM URINE | LAB | 301 | 82340 | 58.00 |
30301010 | CALGISWAB | CS | 270 | 4.60 | |
30356876 | CALMOSEPTINE OINT 4OZ TUBE | RX | 251 | 17.00 | |
30300024 | CANNULA INFANT | CS | 270 | 10.17 | |
30301575 | CANNULA EAR PROTECTOR | CS | 270 | 10.26 | |
30357990 | CAPTOPRIL 12.5MG TABLET | RX | 259 | 3.10 | |
30353041 | CAPTOPRIL 50MG TAB | RX | 259 | 2.50 | |
30350019 | CARAFATE OS PER DOSE | RX | 259 | 14.10 | |
30350472 | CARBAMAZEPINE 200 MG TAB | RX | 259 | 2.50 | |
30356541 | CARBAMAZEPINE ER 100MG CAP | RX | 251 | 11.40 | |
30350120 | CARBIDOPA/LEVODOPA 10/100MG TAB | RX | 259 | 2.50 | |
30350235 | CARBIDOPA/LEVODOPA 25/100MG TAB | RX | 259 | 2.50 | |
30350910 | CARBODOPA-LEVODOPA 25/250MG TAB | RX | 251 | 2.50 | |
30252374 | CARBON DIOXIDE | LAB | 301 | 82374 | 45.60 |
30255049 | CARBON MONOXIDE LEVEL | LAB | 301 | 82375 | 59.60 |
30352203 | CARDENE(NICARDIPINE) PER 20MG | RX | 259 | 182.30 | |
30218332 | CARDIAC DOPPLER COMPLETE | US | 402 | 93320 | 357.00 |
30219331 | CARDIAC DOPPLER LIMITED | US | 402 | 93321 | 241.00 |
30256143 | CARDIAC PANEL | ||||
30350582 | CARISOPRODOL 350MG TAB | RX | 259 | 2.50 | |
30350623 | CARVEDILOL 12.5MG TAB | RX | 259 | 2.50 | |
30350625 | CARVEDILOL 25MG TAB | RX | 251 | 2.50 | |
30350167 | CARVEDILOL 3.125MG TAB | RX | 259 | 2.50 | |
30350624 | CARVEDILOL 6.25MG TAB | RX | 259 | 2.50 | |
30300621 | CAST PADDING 1 ROLL | CS | 270 | 4.60 | |
30301103 | CATCH POLYP | CS | 270 | 32.50 | |
30252526 | CATECHOLAMINE FRACTIONATION URINE | LAB | 301 | 82384 | 152.85 |
30300447 | CATH KIT FEMALE FAST CATH | CS | 270 | A9270 | 23.05 |
30300449 | CATH KIT FEMALE MINI | CS | 270 | 23.05 | |
30300584 | CATH MINI FEMALE | CS | 270 | 23.05 | |
30300107 | CATH PLUG | CS | 270 | 4.70 | |
30300390 | CATH SECURE | CS | 272 | 27.96 | |
30300019 | CATH SELF 16FR | CS | 270 | 14.60 | |
30300111 | CATH TRAY URETHRAL | CS | 272 | A4310 | 19.05 |
30300333 | CATHETER MALE TEXAS | CS | 274 | A4326 | 21.44 |
30300847 | CATHETER SELF FEM 14FR | CS | 270 | 2.50 | |
30300332 | CATHETER TUBE HOLDER | CS | 274 | A4333 | 27.96 |
30354164 | CATHFLO ACTIVASE(ALTEPLASE) PER 1MG-2MG | RX | 636 | J2997 | 242.70 |
30255027 | CBC | LAB | 305 | 85027 | 67.60 |
30255028 | CBC NO DIFF | LAB | 305 | 85027 | 84.90 |
30255024 | CBC WITH AUTO DIFF | LAB | 305 | 85025 | 84.90 |
30255023 | CBC WITH MANUAL DIFF | LAB | 305 | 85007 | 54.10 |
35059490 | CCM | CLNC | 521 | G0511 | 100.50 |
30252378 | CEA | LAB | 301 | 82378 | 155.90 |
30350291 | CEFAZOLIN PER 500MG INJ | RX | 636 | J0690 | 21.70 |
30350583 | CEFDINIR 300MG CAP | RX | 259 | 6.40 | |
30355000 | CEFDINIR OS 250/5ML - 60ML BTL | RX | 259 | 101.30 | |
30354021 | CEFEPIME PER 500MG INJ | RX | 636 | J0692 | 29.20 |
30353920 | CEFOPODOXIME PROXETIL 200MG TABLET | RX | 259 | 21.20 | |
30350704 | CEFOTAXIME PER 1GM INJ | RX | 636 | J0698 | 21.50 |
30358510 | CEFOTETAN 1GM INJ | RX | 636 | J3490 | 42.40 |
30350111 | CEFTRIAXONE PER 250MG INJ - 1GM VIAL | RX | 636 | J0696 | 17.20 |
30352501 | CEFTRIAXONE PER 250MG INJ - 500MG VIAL | RX | 636 | J0696 | 15.70 |
30357140 | CEFUROXIME 250MG TAB | RX | 251 | 6.50 | |
30356714 | CEFUROXIME 500MG TAB | RX | 251 | 13.20 | |
30350210 | CELEBREX 100MG TAB | RX | 252 | 6.70 | |
30350209 | CELEBREX 200MG TAB | RX | 259 | 9.00 | |
30258352 | CELIAC DISEASE DUAL ANTIGEN | LAB | 302 | 83516 | 92.24 |
30259050 | CELL COUNT BODY FLUID | LAB | 305 | 89050 | 39.65 |
30350478 | CENESTIN 1.25MG TAB | RX | 259 | 14.40 | |
30305000 | CENTRAL LINE DRESSING TRAY | CS | 272 | A4221 | 28.80 |
30300549 | CENTRAL LINE KIT ADULT | CS | 270 | 194.50 | |
30300530 | CENTRAL LINE KIT PEDS | CS | 270 | 178.30 | |
30350020 | CEPACOL THROAT LOZ EACH | RX | 259 | 2.50 | |
30357773 | CEPHALEXIN 250MG/5ML PER 100ml BTL | RX | 251 | 44.90 | |
30350153 | CEPHALEXIN 500MG CAP | RX | 259 | 2.50 | |
30252390 | CERULOPLASMIN | LAB | 301 | 82390 | 85.92 |
30300842 | CERVICAL COLLAR ACE | CS | 270 | 46.75 | |
30300279 | CERVICAL COLLAR ACE MINI | CS | 270 | 29.95 | |
30350361 | CETIRIZINE 10MG TAB | RX | 259 | 2.50 | |
30350670 | CHANTIX 1 MG TAB | RX | 259 | 2.50 | |
30201022 | CHEST 2 VIEW READING | RADP | 972 | 71046 | 45.20 |
30201020 | CHEST 2 VIEWS | RAD | 324 | 71046 | 248.75 |
30201010 | CHEST ONE VIEW | RAD | 324 | 71045 | 198.83 |
30201011 | CHEST ONE VIEW READING | RADP | 972 | 71045 | 37.96 |
30309373 | CHEST TUBE 12FR | CS | 272 | 78.50 | |
30300379 | CHEST TUBE 24FR | CS | 272 | 78.50 | |
30300277 | CHEST TUBE 28FR | CS | 270 | 78.50 | |
30300383 | CHEST TUBE 32FR | CS | 272 | 78.50 | |
30300306 | CHEST TUBE TRAY | CS | 270 | 41.85 | |
30257486 | CHLAMYDIA PNEUMONIA | LAB | 302 | 87486 | 280.72 |
30257491 | CHLAMYDIA DNA PROBE CULT | LAB | 306 | 87491 | 280.72 |
30301132 | CHLORAPREP 10.5ML | CS | 270 | A4248 | 33.85 |
30350535 | CHLORDIAZEPOXIDE 25MG CAPSULE | RX | 259 | 2.50 | |
30350663 | CHLORDIAZEPOXIDE/CLIDIN 5/2.5MG CAP | RX | 259 | 3.60 | |
30252435 | CHLORIDE | LAB | 301 | 82435 | 45.60 |
30356710 | CHLORPHENIRAMINE 4MG TAB | RX | 259 | 2.50 | |
30352201 | CHLORTHALIDONE 25MG TAB | RX | 259 | 2.50 | |
30252465 | CHOLESTEROL | LAB | 301 | 82465 | 51.05 |
30350937 | CHOLESTYRAN OS 4GMS DOSE | RX | 259 | 7.00 | |
30351400 | CILOSTAZOL (PLETAL) 100MG TAB | RX | 259 | 2.50 | |
30353302 | CIPRODEX OTIC PER BTL | RX | 259 | 303.40 | |
30350349 | CIPROFLOXACIN 200MG INJ | RX | 636 | J0744 | 21.80 |
30357010 | CIPROFLOXACIN 250MG TABLET | RX | 259 | 2.50 | |
30350274 | CIPROFLOXACIN 500MG CAP | RX | 259 | 2.50 | |
30350491 | CIPROFLOXACIN OPH DRP 0.3% -2.5ML BTL | RX | 259 | 20.80 | |
30350464 | CITALOPRAM 10MG TAB | RX | 259 | 2.50 | |
30358010 | CITALOPRAM 20MG TABLET | RX | 259 | 2.50 | |
30350179 | CITALOPRAM 40MG TAB | RX | 259 | 2.50 | |
30252507 | CITRATE URINE 24 HOUR | LAB | 301 | 82507 | 215.70 |
30252553 | CKMB | LAB | 301 | 82553 | 100.00 |
30203000 | CLAVICLE COMPLETE | RAD | 320 | 73000 | 215.17 |
30203001 | CLAVICLE READING | RADP | 972 | 73000 | 35.08 |
30305001 | CLC 2000 EXTENSION | CS | 272 | 19.20 | |
30350448 | CLINDAMYCIN 150MG CAP | RX | 259 | 2.50 | |
30353032 | CLINDAMYCIN PER 300MG INJ - 300MG VL | RX | 636 | J3490 | 22.40 |
30350237 | CLINDAMYCIN PER 300MG INJ - 600MG VL | RX | 636 | S0077 | 21.40 |
30352581 | CLOBETASOL 0.05% CREAM 15GM | RX | 259 | 253.90 | |
30350022 | CLONAZEPAM 1MG TAB | RX | 259 | 2.50 | |
30350533 | CLONIDINE 0.1MG TAB | RX | 259 | 2.50 | |
30350994 | CLOPIDOGREL BISULFATE 75MG TAB | RX | 259 | 2.50 | |
30350484 | CLOTRIMAZOLE 1% CREAM PER 1OZ TUBE | RX | 259 | 10.80 | |
30359815 | CLOTRIMAZOLE/BETAMETHASONE 1%/0.05% TUBE | RX | 259 | 75.20 | |
30300567 | CO2 DETECTOR EASY CAP II | CS | 270 | 66.10 | |
30300644 | CO2 DETECTOR PEDS | CS | 270 | 66.10 | |
30301831 | COBAN 1 LATEX FREE | CS | 270 | A6453 | 6.80 |
30301832 | COBAN 2 LATEX FREE | CS | 270 | A6453 | 12.25 |
30301833 | COBAN 3 LATEX FREE | CS | 270 | A6454 | 15.22 |
30350585 | COCAINE 4% TOPICAL SOLN 4ML BTL | RX | 259 | 334.40 | |
30256636 | COCCIDIOIDES ANTIBODIES TEST | ||||
35059492 | COCM 1st psyc mgmt 1st 70 min | CLNC | 521 | 99492 | 158.20 |
35059494 | COCM 1ST/SUB EACH ADDL 30 MINS | CLNC | 521 | 99494 | 64.43 |
35059493 | COCM SUBSEQUENT 1ST 60 MIN | CLNC | 521 | 99493 | 127.30 |
30350547 | COENZYME Q10 100MG CAP | RX | 259 | 2.50 | |
30305081 | COFLEX 2 LAYER COMPRESION DRESSING | CS | 272 | A6454 | 67.14 |
30350264 | COLCHICINE (COLRYS) 0.6MG TAB | RX | 251 | 19.40 | |
30300888 | COLD PACK CERVICAL/ NEC | CS | 270 | 87.50 | |
30300486 | COLD PACK OVERSIZE | CS | 270 | 99.80 | |
30300480 | COLD PAK DISP | CS | 270 | 21.40 | |
30352045 | COLESTIPOL 1GM TABLET | RX | 259 | 4.30 | |
30300245 | COLLAGENASE OINTMENT SANTYLS | RX | 270 | 224.48 | |
30350548 | COMBIGAN OPTH SOLN 5ML BTL | RX | 259 | 279.80 | |
30350296 | COMBIVENT INHALER | RX | 259 | 551.00 | |
34000001 | COMMUNITY BATH | LTC | 119 | 15.00 | |
30250053 | COMPREHENSIVE METABOLIC | LAB | 301 | 80053 | 128.30 |
30304841 | COMPRILAN ELASTIC BANDAGE 3in | CS | 270 | A6449 | 29.34 |
30350951 | COMTAN 200MG TAB | RX | 259 | 16.80 | |
30300835 | CONFORM STRETCH 1 | CS | 270 | A6445 | 5.60 |
30300777 | CONFORM STRETCH 2" | CS | 270 | A6445 | 5.60 |
30300837 | CONFORM STRETCH 3" | CS | 270 | A6446 | 8.00 |
30300779 | CONFORM STRETCH 4 | CS | 270 | A6446 | 8.00 |
30300838 | CONFORM STRETCH 6 | CS | 270 | A6447 | 11.70 |
30300186 | CONNECTING TUBING | CS | 270 | 7.90 | |
31109145 | CONSCIOUS SEDATION EACH ADD 15 MIN | OBS | 762 | 99145 | 75.10 |
31109143 | CONSCIOUS SEDATION FIRST 30 MIN | OBS | 762 | 99143 | 171.20 |
30300103 | CONTROL SYRINGE | CS | 270 | 8.00 | |
99999999 | CONV CHARGE NUMBER | ZZ | 999 | 0.00 | |
30256880 | COOMBS DIRECT | LAB | 300 | 86880 | 49.70 |
30252525 | COPPER | LAB | 301 | 82525 | 99.28 |
888888888 | CORRECTING CHARGE | CS | 270 | 0.00 | |
888888887 | CORRECTING PAY/ADJ | CS | 270 | 0.00 | |
30252533 | CORTISOL | LAB | 301 | 82533 | 138.15 |
30350409 | CORTISONE 25MG TAB | RX | 259 | 5.80 | |
30257081 | CORYNEBACTERIUM DIPHTHERIAE | LAB | 302 | 86317 | 100.00 |
30300542 | COTTON BADDING PER FT | CS | 270 | 9.81 | |
30309999 | COTTON BALLS PER BAG | CS | 270 | 13.77 | |
30301128 | COTTON TIP APP 6IN STERILE | CS | 279 | 2.91 | |
35050296 | COUNSELING FOR LUNG SCREENING | CLNC | 521 | G0296 | 157.50 |
30257636 | COVID 19 ID NOW | LAB | 306 | 87635 | 146.25 |
30256328 | COVID 19 IgG Ab | LAB | 302 | 86769 | 150.00 |
30256329 | COVID 19 IgM Ab | LAB | 302 | 86769 | 150.00 |
30257635 | COVID-19 | LAB | 306 | 87635 | 0.00 |
30254681 | C-PEPTIDE | LAB | 301 | 84681 | 156.15 |
30252550 | CPK | LAB | 301 | 82550 | 91.30 |
30355812 | CRANBERRY 425MG CAPSULE | RX | 259 | 2.50 | |
30252565 | CREATININE | LAB | 301 | 82565 | 45.60 |
30252575 | CREATININE CLEARANCE | LAB | 301 | 82575 | 93.10 |
30252570 | CREATININE URINE | LAB | 301 | 82570 | 41.44 |
30356071 | CREON 6000UNIT CAPSULE | RX | 259 | 7.00 | |
30352401 | CREON PANCRELIPASE 24000 CAP | RX | 252 | 21.90 | |
30350589 | CRESTOR 10MG TAB | RX | 259 | 2.50 | |
30160292 | CRITICAL CARE EA. ADD. 30 MIN | EDP | 981 | 99292 | 395.00 |
30160291 | CRITICAL CARE FIRST 30-74MIN | EDP | 981 | 99291 | 795.00 |
30256920 | CROSSMATCH GEL | LAB | 300 | 86922 | 130.55 |
30256923 | CROSSMATCH PANEL | ||||
30202041 | C-SPINE READING | RADP | 972 | 72040 | 46.64 |
30204151 | CT ABDOMEN READING | CTP | 972 | 74150 | 184.95 |
30204160 | CT ABDOMEN W/ CONTRAST | CT | 350 | 74160 | 1448.30 |
30207416 | CT ABDOMEN W/ CONTRAST READING | CTP | 972 | 74160 | 197.94 |
30204150 | CT ABDOMEN W/O CONTRAST | CT | 350 | 74150 | 1240.05 |
30204170 | CT ABDOMEN W/WO CONTRAST | CT | 350 | 74170 | 1597.40 |
30207417 | CT ABDOMEN W/WO CONTRAST READING | CTP | 972 | 74170 | 218.10 |
30201252 | CT ABDOMEN/PELVIS W/ CONTRAST | CT | 350 | 74177 | 1841.20 |
30201255 | CT ABDOMEN/PELVIS W/ CONTRAST READING | CTP | 972 | 74177 | 283.38 |
30201256 | CT ABDOMEN/PELVIS W/ WO CONTRAST READING | CTP | 972 | 74178 | 310.44 |
30201251 | CT ABDOMEN/PELVIS W/O CONTRAST | CT | 350 | 74176 | 1553.50 |
30201254 | CT ABDOMEN/PELVIS W/O CONTRAST READING | CTP | 972 | 74176 | 270.39 |
30201253 | CT ABDOMEN/PELVIS W/WO CONTRAST | CT | 350 | 74178 | 1962.50 |
30202125 | CT C SPINE W/O CONTRAST | CT | 350 | 72125 | 1332.25 |
30201250 | CT CHEST READING | CTP | 972 | 71250 | 179.22 |
30203457 | CT CHEST W/ & W/O CONTRAST | CT | 350 | 71270 | 1584.00 |
30201271 | CT CHEST W/ & W/O CONTRAST READING | CTP | 972 | 71270 | 213.09 |
30203456 | CT CHEST W/ CONTRAST | CT | 350 | 71260 | 1462.30 |
30201261 | CT CHEST W/ CONTRAST READING | CTP | 972 | 71260 | 193.62 |
30203455 | CT CHEST W/O CONTRAST | CT | 350 | 71250 | 1256.40 |
30207217 | CT C-SPINE READING | CTP | 972 | 72125 | 155.40 |
30207320 | CT EXTREMITIES UPPER READING | CTP | 972 | 73200 | 155.40 |
30200486 | CT FACIAL BONES READING | CTP | 972 | 70486 | 133.74 |
30200451 | CT HEAD READING | CTP | 972 | 70450 | 132.66 |
30200471 | CT HEAD W/ & W/O CONTRAST READING | CTP | 972 | 70470 | 196.86 |
30207046 | CT HEAD W/ CONTRAST READING | CTP | 972 | 70460 | 174.87 |
30200470 | CT HEAD WITH AND WITHOUT CONTRAST | CT | 351 | 70470 | 1370.00 |
30200460 | CT HEAD WITH CONTRAST | CT | 351 | 70460 | 1270.00 |
30200450 | CT HEAD WITHOUT CONTRAST | CT | 351 | 70450 | 1067.80 |
30203480 | CT IAC W/O CONTRAST | CT | 351 | 70480 | 1165.60 |
30207370 | CT LOWER EXTREMITIES READING | CTP | 972 | 73700 | 155.40 |
30203463 | CT LOWER EXTREMITY W/ CO | CT | 350 | 73701 | 1406.00 |
30203462 | CT LOWER EXTREMITY W/O C | CT | 350 | 73700 | 1253.00 |
30207213 | CT L-SPINE READING | CTP | 972 | 72131 | 155.40 |
30203458 | CT L-SPINE W/O CONTRAST | CT | 350 | 72131 | 1230.00 |
30202133 | CT L-SPINE W/WO CONTRAST | CT | 350 | 72133 | 1530.00 |
30203547 | CT MAXILLOFACIAL W/O CON | CT | 350 | 70486 | 1100.00 |
30202199 | CT PELVIS READING | CTP | 972 | 72192 | 168.39 |
30202193 | CT PELVIS W/ CONTRAST | CT | 350 | 72193 | 1439.20 |
30207219 | CT PELVIS W/ CONTRAST READING | CTP | 972 | 72193 | 179.22 |
30202192 | CT PELVIS W/O CONTRAST | CT | 350 | 72192 | 1272.40 |
30207220 | CT PELVIS W/WO CONTRAST READING | CTP | 972 | 72194 | 189.27 |
30203543 | CT SINUS/MAXILOFACIAL W/O CONTRAST | CT | 351 | 70486 | 1100.00 |
30206380 | CT SINUSES READING | CTP | 972 | 70486 | 149.97 |
30203454 | CT SOFT TISSUE NECK W/ & W/O CONTR | CT | 350 | 70492 | 1430.00 |
30203452 | CT SOFT TISSUE NECK W/ C | CT | 350 | 70491 | 1328.10 |
30200491 | CT SOFT TISSUE NECK W/ CONTRAST READING | CTP | 972 | 70491 | 214.17 |
30203451 | CT SOFT TISSUE NECK W/O | CT | 350 | 70490 | 1105.10 |
30200490 | CT SOFT TISSUE NECK W/O CONTRAST READING | CTP | 972 | 70490 | 199.02 |
30202128 | CT T SPINE W/O CONTRAST | CT | 350 | 72128 | 1300.00 |
30207218 | CT T-SPINE READING | CTP | 972 | 72128 | 155.40 |
30203460 | CT UPPER EXTREMITY W/ | CT | 350 | 73201 | 1300.00 |
30203459 | CT UPPER EXTREMITY W/O | CT | 350 | 73200 | 1150.00 |
30205635 | CTA AORTA W/ RUNOFFS LOWER EXT. | CT | 350 | 73706 | 1562.00 |
30205636 | CTA AORTA W/RUNOFFS LOWER EXT. READING | CTP | 972 | 73706 | 290.97 |
30200498 | CTA CAROTIDS | CT | 350 | 70498 | 1872.00 |
30200005 | CTA CAROTIDS READING | CTP | 972 | 70498 | 271.47 |
30201276 | CTA CHEST PE PROTOCOL | CT | 350 | 71275 | 1706.20 |
30201262 | CTA CHEST PE READING | CTP | 972 | 71275 | 282.30 |
30200004 | CTA HEAD READING | CTP | 972 | 70496 | 271.47 |
30200496 | CTA HEAD/BRAIN | CT | 350 | 70496 | 1659.80 |
30201263 | CTA THORACIC AORTA READING | CTP | 972 | 74175 | 282.30 |
30201277 | CTA THORACIC AORTA W AND W/O CONTRAST | CT | 350 | 74175 | 1738.10 |
30203207 | CTA UPPER EXTREMITY RUNOFF READING | CTP | 972 | 73206 | 289.95 |
30203206 | CTA UPPER EXTREMITY RUNOFFS | CT | 350 | 73206 | 1411.80 |
30257040 | CULTURE BLOOD | LAB | 306 | 87040 | 102.10 |
30257077 | CULTURE ORGANISM IDENTIF | LAB | 306 | 87077 | 98.55 |
30257186 | CULTURE ORGANISM SENSITI | LAB | 306 | 87186 | 78.10 |
30257070 | CULTURE OTHER SOURCE | LAB | 306 | 87070 | 104.55 |
30257046 | CULTURE STOOL | LAB | 306 | 87046 | 104.55 |
30257088 | CULTURE URINE | LAB | 306 | 87088 | 62.50 |
30300736 | CURETTES BLUE INFANT | CS | 270 | 10.53 | |
30300737 | CURETTES WHITE FLEXHOOP | CS | 270 | 10.53 | |
30301100 | CURETTES YELLOW | CS | 270 | 10.53 | |
30350733 | CYANIDE ANTIDOTE PKG | RX | 636 | J3490 | 542.40 |
30350205 | CYANOCOBALAMIN UP TO 1000MCG INJ | RX | 636 | J3420 | 21.70 |
30350239 | CYCLOBENZAPRINE 10MG TAB | RX | 259 | 2.50 | |
30250158 | CYCLOSPORIN | LAB | 301 | 80158 | 144.40 |
30354065 | CYCLOSPORINE 25MG CAP | RX | 259 | 7.70 | |
30350508 | CYMBALTA 20MG CAP | RX | 259 | 2.50 | |
30350675 | CYMBALTA 30MG CAP | RX | 259 | 2.50 | |
30352095 | CYMBALTA 60MG CAP | RX | 259 | 2.50 | |
30350645 | CYPROHEPTADINE 4 MG TAB | RX | 259 | 2.60 | |
30258343 | CYTOLOGY (PLEURAL FLUID) | LAB | 311 | 88112 | 201.83 |
30255380 | D DIMER | LAB | 305 | 85380 | 111.15 |
30359530 | DALIRESP 500MCG TABLET | RX | 259 | 34.20 | |
30354110 | DANTROLENE 25MG CAP | RX | 251 | 4.20 | |
30301800 | DEFIB PADS | CS | 270 | 22.96 | |
30350593 | DELSYM COUGH LIQ PER 5ML | RX | 259 | 2.50 | |
30304301 | DEMECLOCYCLINE 150MG TAB | RX | 251 | 6.90 | |
30350550 | DEMECLOCYCLINE 300MG TAB | RX | 259 | 30.80 | |
30350453 | DEMEROL PER 100MG INJ - 100MG SYR | RX | 636 | J2175 | 27.80 |
30350450 | DEMEROL PER 100MG INJ - 50MG SYR | RX | 636 | J2175 | 29.10 |
30350452 | DEMEROL PER 100MG INJ - 75MG SYR | RX | 636 | J2175 | 27.70 |
30300479 | DEODORANT SPRAY | CS | 270 | 3.20 | |
30300590 | DEODORANT STICK LADY | CS | 270 | 3.20 | |
30300478 | DEODORANT STICK MEN | CS | 269 | 3.20 | |
30350158 | DEPO MEDROL PER 20MG INJ | RX | 636 | J1030 | 26.40 |
30354493 | DERMABOND SKIN ADHESIVE | CS | 279 | G0168 | 76.05 |
30353034 | DERMAGRAN OINT TUBE 4OZ | RX | 259 | 22.90 | |
35057003 | DESTRUCTION BENIGN 2 THROUGH 14 | CLNC | 521 | 17003 | 18.90 |
35057000 | DESTRUCTION BENIGN LESION | CLNC | 521 | 17000 | 90.30 |
30300655 | DETACHOL PKT | CS | 270 | 13.00 | |
30350429 | DETROL 2MG TAB | RX | 259 | 2.60 | |
30350477 | DETROL LA 4MG CAP | RX | 259 | 10.10 | |
30352034 | DEXAMETHASONE 4MG TAB | RX | 259 | 5.10 | |
30350924 | DEXAMETHASONE ORAL PER 0.25MG | RX | 636 | J8540 | 5.90 |
30350561 | DEXAMETHASONE SOD PHOS PER 1MG INJ | RX | 636 | J1100 | 17.70 |
30350475 | DEXILANT 60MG CAP | RX | 259 | 21.50 | |
30356103 | DEXTROAMPHETAMINE 10MG TABLET | RX | 259 | 15.20 | |
30354010 | DEXTROSE 50% INJ | RX | 259 | 34.40 | |
30354001 | DEXTROSE SOL. 10% 1000CC | RX | 258 | 20.25 | |
30251658 | DHEA-SULFATE | LAB | 300 | 82627 | 105.00 |
30300740 | DIAPER 0-6 LBS | CS | 270 | 2.50 | |
30301997 | DIAPER 16-28 lbs | CS | 270 | 2.50 | |
30300742 | DIAPER 35LBS SIZE 6 | CS | 270 | 2.50 | |
30300741 | DIAPER 6-14 LBS | CS | 270 | 2.50 | |
30300839 | DIAPERS | CS | 270 | 27.40 | |
30352760 | DIAZEPAM 10MG TABLET | RX | 259 | 2.50 | |
30359603 | DIAZEPAM 2MG TAB | RX | 251 | 2.50 | |
30350025 | DIAZEPAM 5MG TAB | RX | 259 | 2.50 | |
30350204 | DIAZEPAM UP TO 5MG INJ | RX | 636 | J3360 | 83.40 |
30353306 | DICLOFENAC TOPICAL GEL 1% TUBE | RX | 259 | 101.00 | |
30350026 | DICYCLOMINE 20MG TAB | RX | 259 | 2.50 | |
37357804 | DIETARY CNSL GROUP PER 30 MIN | DIET | 942 | 97804 | 25.00 |
37357802 | DIETARY CNSL INITIAL PER 15 MIN | DIET | 942 | 97802 | 25.00 |
37357803 | DIETARY CNSL SUBSEQ PER 15 MIN | DIET | 942 | 97803 | 25.00 |
30250298 | DIGITOXIN | LAB | 301 | 80299 | 149.12 |
30250162 | DIGOXIN LEVEL | LAB | 301 | 80162 | 167.00 |
30350263 | DIGOXIN UP TO 0.5MG INJ | RX | 636 | J1160 | 31.30 |
30350288 | DILANTIN 100MG CAP | RX | 259 | 2.50 | |
30350285 | DILTIAZEM 120MG TAB | RX | 259 | 2.50 | |
30350034 | DILTIAZEM 30MG TAB | RX | 259 | 2.50 | |
30359303 | DILTIAZEM 60MG TAB | RX | 251 | 2.50 | |
30351310 | DILTIAZEM DRIP 125MG INFUSION | RX | 259 | 52.00 | |
30350335 | DILTIAZEM ER 120MG CAPLET | RX | 251 | 3.30 | |
30350471 | DILTIAZEM ER 180MG CAP | RX | 259 | 2.50 | |
30350667 | DILTIAZEM ER 300 MG CAP | RX | 259 | 10.30 | |
30350708 | DILTIAZEM PER 25MG INJ | RX | 259 | J3490 | 22.00 |
30350118 | DIOVAN 160MG TAB | RX | 259 | 16.70 | |
30350269 | DIOVAN 320MG TAB | RX | 259 | 2.50 | |
30356730 | DIOVAN 40MG TAB | RX | 259 | 2.50 | |
30350516 | DIOVAN 80MG TAB | RX | 259 | 14.30 | |
30350184 | DIPHENHYDRAMINE 25MG CAP | RX | 259 | 2.50 | |
30350027 | DIPHENHYDRAMINE LIQ 12.5MG/5ML | RX | 259 | 2.50 | |
30350307 | DIPHENHYDRAMINE UP TO 50MG INJ | RX | 636 | J1200 | 13.60 |
30351052 | DIPTHERIA, TETANUS, PERTUSSIS (DTaP) | RX | 636 | 90700 | 73.20 |
PT3G8986 | DISCHARGE CARRY/MOVE/HANDLE OBJ D/C | PT | 420 | G8986 | 0.01 |
PT3G8985 | DISCHARGE CARRY/MOVE/HANDLE OBJ GOAL | PT | 420 | G8985 | 0.01 |
PT3G8983 | DISCHARGE CHANGE/MAINTAIN BODY POS D/C | PT | 420 | G8983 | 0.01 |
PT3G8982 | DISCHARGE CHANGE/MAINTAIN BODY POS GOAL | PT | 420 | G8982 | 0.01 |
PT3G8980 | DISCHARGE MOBILITY WALK/MOVE D/C | PT | 420 | G8980 | 0.01 |
PT3G8979 | DISCHARGE MOBILITY WALK/MOVE GOAL | PT | 420 | G8979 | 0.01 |
PT3G8992 | DISCHARGE OTHER PRIMARY D/C | PT | 420 | G8992 | 0.01 |
PT3G8991 | DISCHARGE OTHER PRIMARY GOAL | PT | 420 | G8991 | 0.01 |
PT3G8995 | DISCHARGE OTHER SUBSEQUENT D/C | PT | 420 | G8995 | 0.01 |
PT3G8994 | DISCHARGE OTHER SUBSEQUENT GOAL | PT | 420 | G8994 | 0.01 |
PT38989 | DISCHARGE SELF CARE D/C | PT | 420 | G8989 | 0.01 |
PT3G8988 | DISCHARGE SELF CARE GOAL | PT | 420 | G8988 | 0.01 |
30350522 | DIVALPROEX 125MG CAP | RX | 259 | 3.20 | |
30350301 | DIVALPROEX 250MG TAB | RX | 259 | 10.90 | |
30350999 | DIVALPROEX SOD 500MG TAB | RX | 259 | 18.00 | |
30350451 | DOBUTAMINE PER 250MG INJ | RX | 636 | J1250 | 26.80 |
30350029 | DOCUSATE SOD 100MG CAP | RX | 259 | 2.50 | |
30350300 | DONEPEZIL 10MG TAB | RX | 251 | 2.50 | |
30350668 | DONEPEZIL 5MG TAB | RX | 259 | 2.50 | |
30350332 | DOPAMINE PER 40MG INJ | RX | 636 | J1265 | 35.30 |
30351113 | DORZOLAM/TIMOLOL 2/0.5% OPTH-10ML BTL | RX | 259 | 36.30 | |
35050214 | DOT PHYSICAL | CLNC | 521 | 99214 | 150.00 |
30350402 | DOXAZOSIN 2MG TAB | RX | 259 | 3.30 | |
30350426 | DOXAZOSIN 4MG TAB | RX | 259 | 4.30 | |
30350514 | DOXEPIN 100MG CAP | RX | 259 | 2.50 | |
30354901 | DOXEPIN 10MG CAPSULE | RX | 259 | 2.50 | |
30350673 | DOXEPIN 25MG CAP | RX | 259 | 2.60 | |
30350253 | DOXYCYCLINE 100MG CAP | RX | 259 | 2.50 | |
30301118 | DRAIN SPONGE 2X2 | CS | 270 | 0.68 | |
30301101 | DRAIN SPONGE 4X4 | CS | 270 | 4.20 | |
30300738 | DRAIN SPONGE PLAIN | CS | 270 | A6402 | 4.20 |
30300978 | DRAIN TUBE ATTACHMENT 9780 | CS | 270 | 64.40 | |
30300970 | DRAIN TUBE ATTACHMENT NH | CS | 270 | 80.40 | |
30300696 | DRAPE STERILE | CS | 270 | 18.95 | |
30300508 | DRESSING TEGADERM 4X5 T | CS | 270 | 10.00 | |
30300708 | DRESSING TEGADERM 4X5 T | CS | 270 | 5.05 | |
30300819 | DRESSING 2 LAYER COMPRESSION 4" | CS | 270 | 55.00 | |
30300784 | DRESSING ALGINATE 2X2 | CS | 270 | 24.64 | |
30304077 | DRESSING ALGINATE 2X2 | CS | 272 | A6196 | 20.32 |
30304945 | DRESSING CALCIUM ALIGNATE | CS | 270 | A6196 | 26.46 |
30300546 | DRESSING FOAM HEEL BIATAIN | CS | 270 | 39.75 | |
30300761 | DRESSING HUMIFIBER 2X2 | CS | 270 | A6196 | 33.75 |
3030773 | DRESSING HUMIFIBER 4X4 | CS | 270 | A6196 | 39.50 |
30300804 | DRESSING HUMIFIBER 6X6 | CS | 270 | A6197 | 83.50 |
30300785 | DRESSING MEPILEX AG 4X4 | CS | 270 | 94.85 | |
30301973 | DRESSING THERA HONEY 1.5 | CS | 272 | 81.65 | |
30300124 | DRESSING THERAHONEY GAUZE 4X5 | CS | 272 | A4649 | 46.77 |
30300343 | DRILL BIT PENDRIL | CS | 270 | 67.60 | |
30250101 | DRUGS OF ABUSE DRUG SCREEN | LAB | 301 | 80305 | 100.80 |
30301522 | DRY WIPES | CS | 270 | A4335 | 11.52 |
30256226 | ds DNA Ab | LAB | 302 | 86225 | 109.92 |
30354602 | DULERA 200MCG/5MCG INHALER | RX | 259 | 441.60 | |
30300677 | DUO DERM 4X4 | CS | 270 | 29.65 | |
30300123 | DUODERM HEEL | CS | 270 | 77.80 | |
30300904 | DUODERM THIN 4X4 | CS | 270 | 17.20 | |
30351192 | DYRENIUM 100MG TAB | RX | 259 | 11.40 | |
30350128 | DYRENIUM 50MG CAP | RX | 259 | 17.40 | |
30300561 | EAR IRRIGATION | CS | 270 | 6.50 | |
37089210 | EAR IRRIGATION / CLEANING | PROC | 769 | 69210 | 69.30 |
30300682 | EAR WICK | CS | 270 | 15.60 | |
30520059 | EAR WICK | CS | 270 | 5.00 | |
30219330 | ECHOCARDIOLOGY COMPLETE | US | 483 | 93306 | 1360.00 |
37080102 | ED - INSERT NON-INDWELLING FOLEY CATH | ED | 450 | 51701 | 47.30 |
30151702 | ED - INSERTION OF FOLEY CATHETER | ED | 450 | 51702 | 159.00 |
30160120 | ED FOREIGN BODY INCISION & REMOVAL | EDP | 981 | 10120 | 157.50 |
30160060 | ED I&D ABCESS (SIMPLE OR SINGLE) | EDP | 981 | 10060 | 139.70 |
30150471 | ED INJECTION, IMMUNIZATION ADMINISTRATIO | ED | 450 | 90471 | 79.75 |
30150003 | ED INJECTION, SQ OR IM | ED | 450 | 96372 | 79.76 |
30156361 | ED IV INFUS HYDRATION, EACH ADD HOUR | ED | 450 | 96361 | 97.00 |
30156360 | ED IV INFUS HYDRATION, INITIAL, 31M-1H | ED | 450 | 96360 | 269.66 |
30156367 | ED IV INFUSION, INITIAL, UP TO 1 HR | ED | 450 | 96365 | 269.66 |
30156375 | ED IV PUSH EACH ADDITIONAL DRUG | ED | 450 | 96375 | 58.20 |
30156374 | ED IV PUSH, SINGLE/INITIAL DRUG | ED | 450 | 96374 | 168.00 |
30162001 | ED LAC REPR SCALP/NECK//EXTREMI <= 2.5 | EDP | 981 | 12001 | 172.00 |
30162002 | ED LAC REPR SCALP/NECK//EXTREMI 2.5-7.5C | EDP | 981 | 12002 | 185.00 |
30162013 | ED LACERAT SIMPL FACE/EAR 2.6CM TO 7.5CM | EDP | 981 | 12013 | 139.78 |
30162011 | ED LACERAT SIMPLE FACE/EARS 2.5CM OR LES | EDP | 981 | 12011 | 132.25 |
30160901 | ED SIMPLE CONTROL OF NOSE BLEED | EDP | 981 | 30901 | 104.30 |
30352330 | EFFIENT 10MG TABLET | RX | 259 | 49.80 | |
30300635 | EGGCRATE CHAIR PAD | CS | 270 | 31.15 | |
30300694 | EGGCRATE MATTRESS PAD | CS | 270 | 39.20 | |
30603005 | EKG | RAD | 730 | 93005 | 139.00 |
30203080 | ELBOW COMPLETE 3 VIEW | RAD | 320 | 73080 | 217.00 |
30203081 | ELBOW COMPLETE 3 VIEW READING | RADP | 972 | 73080 | 36.52 |
30203071 | ELBOW LIMITED 2 VIEW READING | RADP | 972 | 73070 | 35.08 |
30203070 | ELBOW LIMITED 2 VIEWS | RAD | 320 | 73070 | 214.57 |
30300068 | ELECTRODES 4 PK | CS | 271 | A4556 | 23.38 |
30359421 | ELIQUIS 5MG TABLET | RX | 259 | 19.70 | |
30359801 | ELMIRON 100MG CAPSULE | RX | 259 | 24.10 | |
30450005 | EMPLOYEE FUNCTIONAL TESTING | PT | 420 | 0.00 | |
30350641 | ENABLEX 7.5MG TAB | RX | 259 | 18.00 | |
30350923 | ENALAPRIL 10MG TAB | RX | 259 | 2.50 | |
30350925 | ENALAPRIL 20MG TAB | RX | 259 | 2.50 | |
30350165 | ENDOCET 5/325 MG TAB | RX | 259 | 2.50 | |
30256347 | ENDOMYSIAL ANTIBODIES | LAB | 302 | 86256 | 96.40 |
30300189 | ENEMA BUCKET | CS | 270 | 11.15 | |
30300187 | ENEMA FLEET | CS | 270 | 9.85 | |
30355002 | ENLUXTRA ROLL | CS | 272 | A6198 | 156.00 |
30354950 | EPI PEN 0.3MG/0.3ML PER PEN | RX | 251 | 215.40 | |
30352031 | EPINEPHRINE 0.1MG INJ | RX | 636 | J0171 | 41.80 |
30353031 | EPINEPHRINE 0.1MG INJ | RX | 636 | J0171 | 36.60 |
30357810 | EPOGEN per 1000units | RX | 635 | 507.40 | |
30256665 | EPSTEIN BARR PANEL | LAB | 302 | 86665 | 145.12 |
30153015 | ER CRITICAL CARE 1ST HOU | ED | 450 | 99291 | 1340.00 |
30153016 | ER CRITICAL CARE AD 30 M | ED | 450 | 99292 | 375.00 |
30153010 | ER DEPARTMENT LEVEL I | ED | 450 | 99281 | 144.00 |
30153011 | ER DEPARTMENT LEVEL II | ED | 450 | 99282 | 250.00 |
30153012 | ER DEPARTMENT LEVEL III | ED | 450 | 99283 | 384.00 |
30153013 | ER DEPARTMENT LEVEL IV | ED | 450 | 99284 | 624.00 |
30153014 | ER DEPARTMENT LEVEL V | ED | 450 | 99285 | 840.00 |
30160281 | ER VISIT I | EDP | 981 | 99281 | 127.10 |
30160282 | ER VISIT II | EDP | 981 | 99282 | 145.45 |
30160283 | ER VISIT III | EDP | 981 | 99283 | 205.00 |
30160284 | ER VISIT IV | EDP | 981 | 99284 | 313.00 |
30160285 | ER VISIT V | EDP | 981 | 99285 | 488.00 |
30350672 | ERYTHROMYCIN OPTH OINT 0.5%/3.5GMT | RX | 259 | 37.60 | |
30251290 | ERYTHROPOIETIN LEVEL | LAB | 301 | 82668 | 152.50 |
30357280 | ESCITALOPRAM 5MG TAB | RX | 251 | 2.50 | |
35059394 | EST PATIENT WELLNESS AGE 12-17 YRS | CLNC | 521 | 99394 | 157.50 |
35059392 | EST PATIENT WELLNESS AGE 1-4 YRS | CLNC | 521 | 99392 | 157.50 |
35059395 | EST PATIENT WELLNESS AGE 18-39 YRS | CLNC | 521 | 99395 | 157.50 |
35059396 | EST PATIENT WELLNESS AGE 40-64 YRS | CLNC | 521 | 99396 | 157.50 |
35059393 | EST PATIENT WELLNESS AGE 5-11 YRS | CLNC | 521 | 99393 | 157.50 |
35059391 | EST PATIENT WELLNESS UNDER AGE 1 | CLNC | 521 | 99391 | 157.50 |
35059211 | EST. PATIENT LEVEL I | CLNC | 521 | 99211 | 58.80 |
35059212 | EST. PATIENT LEVEL II | CLNC | 521 | 99212 | 91.94 |
35059213 | EST. PATIENT LEVEL III | CLNC | 521 | 99213 | 135.67 |
35059214 | EST. PATIENT LEVEL IV | CLNC | 521 | 99214 | 189.02 |
35059215 | EST. PATIENT LEVEL V | CLNC | 521 | 99215 | 204.80 |
30450006 | E-STIM MANUAL PER 15 MIN | PT | 421 | 97032 | 70.00 |
30252670 | ESTRADIOL | LAB | 301 | 82670 | 229.45 |
30353505 | ESTRADIOL 1MG TAB | RX | 259 | 2.50 | |
30252671 | ESTROGENS (FRACTIONATED) | LAB | 301 | 82671 | 168.55 |
30252679 | ESTRONE | LAB | 300 | 82679 | 199.60 |
30300040 | ET TUBE HOLDER ADULT | CS | 270 | 24.60 | |
30300055 | ET TUBE HOLDER PEDS | CS | 272 | 24.60 | |
30301125 | ET TUBE SZ 2.5 | CS | 270 | 18.10 | |
30300009 | ET TUBE SZ 3.0 | CS | 272 | 18.10 | |
30300013 | ET TUBE SZ 4.0 | CS | 272 | 18.10 | |
30300015 | ET TUBE SZ 4.5 | CS | 272 | 18.10 | |
30300016 | ET TUBE SZ 5.0 | CS | 272 | 18.10 | |
30300026 | ET TUBE SZ 5.5 | CS | 272 | 18.10 | |
30300039 | ET TUBE SZ 6 | CS | 270 | 18.10 | |
30300027 | ET TUBE SZ 6.5 | CS | 272 | 18.10 | |
30300028 | ET TUBE SZ 7 | CS | 272 | 18.10 | |
30300030 | ET TUBE SZ 7.5 | CS | 272 | 18.10 | |
30300031 | ET TUBE SZ 8.0 | CS | 272 | 18.10 | |
30300035 | ET TUBE SZ 8.5 | CS | 272 | 18.10 | |
30300036 | ET TUBE SZ 9 | CS | 272 | 18.10 | |
30300037 | ET TUBE SZ 9.5 | CS | 272 | 18.10 | |
30354517 | ETODALAC 500MG TAB | RX | 259 | 4.70 | |
PT1G8984 | EVAL CARRY/MOVE/HANDLE OBJ CURRENT | PT | 424 | G8984 | 0.01 |
PT1G8986 | EVAL CARRY/MOVE/HANDLE OBJ D/C | PT | 424 | G8986 | 0.01 |
PT1G8985 | EVAL CARRY/MOVE/HANDLE OBJ GOAL | PT | 424 | G8985 | 0.01 |
PT1G8981 | EVAL CHANGE/MAINTAIN BODY POS CURRENT | PT | 424 | G8981 | 0.01 |
PT1G8983 | EVAL CHANGE/MAINTAIN BODY POS D/C | PT | 424 | G8983 | 0.01 |
PT1G8982 | EVAL CHANGE/MAINTAIN BODY POS GOAL | PT | 424 | G8982 | 0.01 |
PT1G8978 | EVAL MOBILITY WALK/MOVE CURRENT | PT | 424 | G8978 | 0.01 |
PT1G8980 | EVAL MOBILITY WALK/MOVE D/C | PT | 424 | G8980 | 0.01 |
PT1G8979 | EVAL MOBILITY WALK/MOVE GOAL | PT | 424 | G8979 | 0.01 |
PT1G8990 | EVAL OTHER PRIMARY CURRENT | PT | 424 | G8990 | 0.01 |
PT1G8992 | EVAL OTHER PRIMARY D/C | PT | 424 | G8992 | 0.01 |
PT1G8991 | EVAL OTHER PRIMARY GOAL | PT | 424 | G8991 | 0.01 |
PT1G8993 | EVAL OTHER SUBSEQUENT CURRENT | PT | 424 | G8993 | 0.01 |
PT1G8995 | EVAL OTHER SUBSEQUENT D/C | PT | 424 | G8995 | 0.01 |
PT1G8994 | EVAL OTHER SUBSEQUENT GOAL | PT | 424 | G8994 | 0.01 |
PT1G8987 | EVAL SELF CARE CURRENT | PT | 424 | G8987 | 0.01 |
PT1G8989 | EVAL SELF CARE D/C | PT | 424 | G8989 | 0.01 |
PT1G8988 | EVAL SELF CARE GOAL | PT | 424 | G8988 | 0.01 |
30350195 | EVISTA 60MG TAB | RX | 259 | 2.50 | |
30304997 | EW BRIEF LARGE | CS | 270 | A4520 | 13.32 |
30304998 | EW BRIEFS MEDIUM | CS | 270 | A4520 | 8.00 |
30304999 | EW BRIEFS XLARGE | CS | 270 | A4520 | 9.70 |
35051440 | EXCISION BENIGN LESION .5CM OR LE | CLNC | 521 | 11440 | 148.10 |
35051402 | EXCISION BENIGN LESION 1.1-2.0 CM | CLNC | 521 | 11402 | 186.90 |
35051403 | EXCISION BENIGN LESION 2.1-3.0 CM | CLNC | 521 | 11403 | 214.20 |
35051423 | EXCISION BENIGN LESION 2.1-3.0 CM | CLNC | 521 | 11423 | 204.80 |
35051442 | EXCISION LESION HEAD 1.1-2.0 | CLNC | 521 | 11442 | 212.10 |
35051441 | EXCISION LESION-FACIAL 0.6- | CLNC | 521 | 11441 | 192.20 |
35051640 | EXCISION MALIG LESION .5CM OR LES | CLNC | 521 | 11640 | 207.90 |
35051641 | EXCISION MALIGNANT LESION 1.1- | CLNC | 521 | 11641 | 237.30 |
35051623 | EXCISION MALIGNANT LESION 2.1-3 | CLNC | 521 | 11623 | 268.80 |
35051730 | EXCISION TOENAIL | CLNC | 521 | 11730 | 114.50 |
35051765 | EXCISION TOENAIL (WEDGE EXCISION) | CLNC | 521 | 11765 | 139.70 |
35051400 | EXCISION BENIGN LESION 0.5 CM OR L | CLNC | 521 | 11400 | 134.40 |
35051421 | EXCISION BENIGN LESION 0.6 -1.0 CM | CLNC | 521 | 11421 | 170.10 |
35051401 | EXCISION BENIGN LESION 0.6-1.0 CM | CLNC | 521 | 11401 | 159.60 |
35051404 | EXCISION BENIGN LESION 3.1 TO 4.0C | CLNC | 521 | 11404 | 228.90 |
35051604 | EXCISION MALIG LESION 3.1 - 4.0 CM | CLNC | 521 | 11604 | 320.30 |
35051642 | EXCISION MALIG.LESION 1.1-2.0 CM | CLNC | 521 | 11642 | 289.80 |
35051750 | EXCISION NAIL AND MATRIX | CLNC | 521 | 11750 | 159.51 |
30354686 | EXELON 3MG TAB | RX | 259 | 5.50 | |
30350284 | EXELON 6MG CAPSULE | RX | 259 | 15.30 | |
30350424 | EXELON PATCH 9.5MG/24HR | RX | 259 | 38.00 | |
30300813 | EXTENSION SET W/ VALVE & | CS | 270 | 27.50 | |
30300662 | EXU-DRY DRESSING | CS | 272 | A6251 | 15.65 |
30300564 | EYE COVER PADS | CS | 270 | 7.30 | |
30300292 | EYE EXAM TRAY | CS | 270 | 6.50 | |
30252544 | F2 - ISOPROSTANE | LAB | 301 | 82542 | 192.72 |
30200150 | FACIAL BONES COMPLETE 3 | RAD | 320 | 70150 | 198.60 |
30200151 | FACIAL BONES COMPLETE 3 READING | RADP | 972 | 70150 | 55.28 |
30200140 | FACIAL BONES LIMITED | RAD | 320 | 70140 | 171.00 |
30200141 | FACIAL BONES LIMITED READING | RADP | 972 | 70140 | 42.32 |
30253093 | FACTOR V LIEDEN - MUTATION SCREENING | LAB | 300 | 85307 | 122.72 |
30300739 | FALL RISK KIT LG YLW | CS | 270 | 23.44 | |
30301725 | FALL RISK KIT XLG YLW | CS | 270 | 23.44 | |
30350346 | FAMOTIDINE 20MG TAB | RX | 259 | 2.50 | |
30352225 | FAMOTIDINE INJ 20MG/2ML | RX | 251 | 14.70 | |
30352010 | FASLODEX PER 25MG INJECTION | RX | 636 | J9395 | 1404.90 |
30256672 | FECAL CALPROTECTIN | LAB | 301 | 83993 | 191.00 |
30300668 | FEEDING TUBE 12FR | CS | 270 | 63.15 | |
30356901 | FELODIPINE ER 5MG TABLET | RX | 259 | 2.80 | |
30203550 | FEMUR 2 VIEWS | RAD | 320 | 73552 | 211.74 |
30203551 | FEMUR READING | RADP | 972 | 73552 | 37.96 |
30355511 | FENOFIBRATE 54MG TAB | RX | 259 | 2.50 | |
30354551 | FENOFIBRATE 67MG CAP | RX | 259 | 4.40 | |
30357888 | FENTANYL IV DRIP 2000MCG | RX | 636 | J3010 | 45.30 |
30350030 | FENTANYL PATCH 100MCG/HR | RX | 259 | 84.80 | |
30350299 | FENTANYL PATCH 12MCG/HR | RX | 259 | 16.00 | |
30350343 | FENTANYL PATCH 25MCG/HR | RX | 259 | 11.60 | |
30350031 | FENTANYL PATCH 50MCG/HR | RX | 259 | 15.40 | |
30350596 | FENTANYL PATCH 75 MCG/HR | RX | 259 | 61.90 | |
30350586 | FENTANYL UP TO 0.1MG INJ | RX | 636 | J3010 | 14.60 |
30252728 | FERRITIN | LAB | 301 | 82728 | 115.35 |
30354036 | FERROUS GLUCONATE 27MG TAB | RX | 259 | 2.50 | |
30350208 | FERROUS SULFATE 160MG TAB | RX | 259 | 2.50 | |
30350626 | FERROUS SULFATE 325MG TAB | RX | 259 | 2.50 | |
30358581 | FERROUS SULFATE SLOW REL 45MG TAB | RX | 259 | 2.50 | |
30350316 | FEXOFENADINE 180MG TAB | RX | 259 | 2.50 | |
30350690 | FIBER LAXATIVE CAPSULE | RX | 259 | 2.50 | |
30306022 | FIBRACOL 4" x 4.375" | CS | 272 | A6022 | 36.93 |
30300373 | FILTERLINE SET | CS | 270 | 56.00 | |
30350389 | FINASTERIDE 5MG TAB | RX | 259 | 2.50 | |
30207210 | FINGER 2 VIEW READING | RADP | 972 | 73140 | 29.32 |
30300159 | FINGER SPLINT SZ 1staxx | CS | 270 | 16.47 | |
30300267 | FINGER SPLINT SZ 2 staxx | CS | 270 | 16.47 | |
30300268 | FINGER SPLINT SZ 3 staxx | CS | 270 | 16.47 | |
30300269 | FINGER SPLINT SZ 4 staxx | CS | 270 | 16.47 | |
30300270 | FINGER SPLINT SZ 5 staxx | CS | 270 | 16.47 | |
30300271 | FINGER SPLINT SZ 5.5 staxx | CS | 270 | 16.47 | |
30300272 | FINGER SPLINT SZ 6 staxx | CS | 270 | 16.47 | |
30300273 | FINGER SPLINT SZ 7 staxx | CS | 270 | 16.47 | |
30203140 | FINGERS 2 VIEWS | RAD | 320 | 73140 | 189.00 |
30350581 | FISH OIL 1000MG CAP | RX | 259 | 2.50 | |
30353456 | FISH OIL 1200MG CAP | RX | 259 | 2.50 | |
30350382 | FLAX SEED OIL 1000MG SOFTGEL | RX | 259 | 2.50 | |
30353052 | FLECAINIDE 100MG TAB | RX | 259 | 2.50 | |
30350126 | FLECAINIDE 50MG TAB | RX | 259 | 2.50 | |
30350199 | FLOMAX 0.4MG CAP | RX | 259 | 2.50 | |
30354048 | FLORAJEN3 460MG CAPSULE | RX | 259 | 2.50 | |
30350988 | FLORASTOR 250MG CAPSULE | RX | 259 | 3.60 | |
30350202 | FLOVENT 100MCG DISCUS | RX | 259 | 272.60 | |
30351920 | FLOVENT HFA 110MCG PER INHALER | RX | 252 | 390.70 | |
30352200 | FLOVENT HFA 220MCG - 120 DOSE INHALER | RX | 259 | 425.10 | |
30350033 | FLOVENT HFA 44MCG - 120DOSE INHALER | RX | 259 | 272.60 | |
30350845 | FLUCONAZOLE 150MG TABLET | RX | 259 | 10.50 | |
30350927 | FLUDROCORTISONE 0.1MG TAB | RX | 251 | 4.80 | |
30251234 | FLUID CRYSTALS | LAB | 300 | 89060 | 43.30 |
30301102 | FLUID SOLIDIFER | CS | 270 | 11.25 | |
30350425 | FLUMAZENIL PER 0.1MG INJ | RX | 259 | 26.00 | |
30256254 | FLUORESCENT ANTIBODY SCREEN | LAB | 302 | 86255 | 96.40 |
30350227 | FLUOXETINE 10MG CAP | RX | 259 | 2.50 | |
30350763 | FLUOXETINE 20MG CAP | RX | 259 | 2.50 | |
30350724 | FLUTICASONE NS 50MCG - 120 SPRAYS | RX | 259 | 38.90 | |
30252746 | FOLATE | LAB | 301 | 82746 | 108.10 |
30300318 | FOLEY CATH 10FR | CS | 270 | 14.35 | |
30300319 | FOLEY CATH 12FR | CS | 270 | 14.35 | |
30300320 | FOLEY CATH 14FR | CS | 270 | A4338 | 14.35 |
30300631 | FOLEY CATH 16FR | CS | 270 | 26.85 | |
30300317 | FOLEY CATH 18FR | CS | 274 | A4338 | 20.55 |
30300018 | FOLEY CATH 18FR 3WAY | CS | 270 | 24.35 | |
30300628 | FOLEY CATH 20FR | CS | 270 | 16.35 | |
30300315 | FOLEY CATH 22FR | CS | 270 | 15.39 | |
30300322 | FOLEY CATH 24FR | CS | 270 | A4338 | 17.01 |
30304887 | Foley Cath 24FR Latex Free | CS | 270 | A4344 | 28.35 |
30300323 | FOLEY CATH 26FR | CS | 270 | 14.35 | |
30300661 | FOLEY CATH 28FR | CS | 270 | 14.35 | |
30300335 | FOLEY CATH 28FR 30CC | CS | 270 | 14.35 | |
30300336 | FOLEY CATH 30FR | CS | 270 | 14.35 | |
30300337 | FOLEY CATH 30FR 30CC | CS | 270 | 14.35 | |
30300313 | FOLEY CATH 6FR | CS | 270 | 14.35 | |
30300314 | FOLEY CATH 8FR | CS | 270 | 14.35 | |
30300083 | FOLEY CATH IC 20FR | CS | 270 | 38.90 | |
30301789 | FOLEY COUDE CATH 14FR 5CC | CS | 270 | 18.00 | |
30301790 | FOLEY COUDE CATH 16FR 5CC | CS | 270 | 18.00 | |
30301791 | FOLEY COUDE CATH 18FR 5CC | CS | 270 | 18.00 | |
30300446 | FOLEY TRAY PEDIATRIC | CS | 270 | A4315 | 70.95 |
30300532 | FOLEY TRAY ADULT 16FR | CS | 270 | A4313 | 94.60 |
30350662 | FOLIC ACID 1MG TAB | RX | 259 | 2.50 | |
30203620 | FOOT AP AND LATERAL | RAD | 320 | 73620 | 178.00 |
30203621 | FOOT AP AND LATERAL READING | RADP | 972 | 73620 | 32.20 |
30203630 | FOOT COMPLETE 3 VIEWS | RAD | 320 | 73630 | 208.55 |
30203631 | FOOT COMPLETE READING | RADP | 972 | 73630 | 35.08 |
30203090 | FOREARM 2 VIEW | RAD | 320 | 73090 | 183.41 |
30200003 | FOREARM READING | RADP | 972 | 73090 | 35.08 |
35050120 | FOREIGN BODY INCISION & REMOVAL | CLNC | 521 | 10120 | 157.50 |
30354709 | FOSINOPRIL 40MG TAB | RX | 259 | 3.00 | |
30300671 | FRACTURE PAN | CS | 270 | 10.00 | |
30254481 | FREE T3 | LAB | 301 | 84481 | 135.52 |
30254439 | FREE T4 | LAB | 301 | 84439 | 72.16 |
30300540 | FREE-UP MASSAGE CREAM J | CS | 270 | 23.35 | |
30253001 | FSH FOLLICLE STIMULATING | LAB | 301 | 83001 | 148.64 |
30257102 | FUNGAL BIOPSY (CULTURE) | LAB | 306 | 87102 | 133.20 |
30350036 | FUROSEMIDE 20MG TAB | RX | 259 | 2.50 | |
30350765 | FUROSEMIDE 40MG TAB | RX | 259 | 2.50 | |
30350766 | FUROSEMIDE 80MG TAB | RX | 259 | 2.50 | |
30350430 | FUROSEMIDE UP TO 20MG INJ | RX | 636 | J1940 | 14.20 |
30350347 | FUROSEMIDE UP TO 20MG INJ (40MG VL | RX | 636 | J1940 | 14.40 |
30300050 | G LAVAGE KIT PED | CS | 270 | 20.20 | |
30350286 | GABAPENTIN 100MG CAP | RX | 251 | 2.50 | |
30350767 | GABAPENTIN 300MG CAP | RX | 259 | 2.50 | |
30350768 | GABAPENTIN 400MG CAP | RX | 259 | 2.50 | |
30300483 | GAIT BELT | CS | 270 | 30.25 | |
30450008 | GAIT TRAINING PER 15 MIN | PT | 420 | 97116 | 83.00 |
35051903 | GARDASIL 9 VACCINE | RX | 636 | 90651 | 356.50 |
35059064 | GARDASIL-HPV | RX | 636 | 90649 | 280.00 |
30300727 | GASTRIC LAVAGE KIT 18FR | CS | 270 | 103.55 | |
30300963 | GASTRIC LAVAGE SET | CS | 270 | 103.55 | |
30300048 | GASTRIC LAVAGE TUBE ADUL | CS | 270 | 25.90 | |
30257507 | GASTROINTESTINAL MOLECULAR PANEL | LAB | 306 | 87507 | 1800.00 |
30301111 | GAUZE PACKING 1/4 IN NH | CS | 270 | 12.80 | |
30300240 | GAUZE 2X2 STERILE | CS | 272 | A6402 | 2.50 |
30300308 | GAUZE 4X4 STERILE | CS | 272 | A6402 | 6.30 |
30300345 | GAUZE 4X4 STERILE TRAY | CS | 272 | A6402 | 3.65 |
30300004 | GAUZE 8X4 STERILE | CS | 272 | A6403 | 1.55 |
30300307 | GAVAGE SET | CS | 270 | 29.55 | |
30350470 | GEMFIBROZIL 600MG TAB | RX | 259 | 2.50 | |
30350254 | GENTAMICIN UP TO 80MG INJ | RX | 636 | J1580 | 15.20 |
30350411 | GENTAMYCIN OPTH SOL 0.3%/ 5ML BTL | RX | 259 | 18.30 | |
30301131 | GERI LEG SLEEVE | CS | 270 | 39.95 | |
30300585 | GERI SLEEVE LG | CS | 270 | 39.75 | |
30300619 | GERI SLEEVE MED | CS | 270 | 39.95 | |
30300620 | GERI SLEEVE SM | CS | 270 | 39.95 | |
30300595 | GERIGLOVE ARM COVERING | CS | 270 | 39.15 | |
30258297 | GGT | LAB | 301 | 82977 | 74.40 |
30305068 | GLIDESCOPE LOPRO SZ 1 | CS | 272 | 120.00 | |
30305066 | GLIDESCOPE LOPRO SZ 3 | CS | 272 | 120.00 | |
30305067 | GLIDESCOPE LOPRO SZ 4 | CS | 272 | 120.00 | |
30301693 | GLIDESCOPE SZ 4 | CS | 270 | 71.50 | |
30301692 | GLIDESCOPE SZ3 | CS | 270 | 71.50 | |
30350507 | GLIMEPIRIDE 2MG TAB | RX | 259 | 2.50 | |
30350781 | GLIPIZIDE 10MG TAB | RX | 259 | 2.50 | |
30359003 | GLIPIZIDE 2.5MG ER TABLET | RX | 259 | 2.50 | |
30350928 | GLIPIZIDE 5MG TAB | RX | 251 | 2.50 | |
30350935 | GLIPIZIDE ER 10MG TAB | RX | 259 | 2.50 | |
30357450 | GLIPIZIDE ER 5MG TAB | RX | 251 | 2.50 | |
30300991 | GLOVE ISOTONER EDEMA | CS | 270 | 45.00 | |
30300052 | GLOVE STERILE LF SZ 6.5 | CS | 270 | A4930 | 3.90 |
30300058 | GLOVE STERILE LF SZ 7 | CS | 272 | A4930 | 3.90 |
30300059 | GLOVE STERILE LF SZ 7.5 | CS | 272 | A4930 | 3.90 |
30300056 | GLOVE STERILE LF SZ 8 | CS | 272 | A4930 | 3.90 |
30300060 | GLOVE STERILE LF SZ 8.5 | CS | 272 | A4930 | 3.90 |
30350336 | GLUCAGON PER 1MG INJ | RX | 636 | J1610 | 436.80 |
30250556 | GLUCOMETER | NUR | 300 | 82962 | 22.90 |
30150001 | GLUCOMETER ED | ED | 300 | 82962 | 22.90 |
30350783 | GLUCOSAMINE/CHONDDROITIN CAPSULE | RX | 259 | 2.50 | |
30252947 | GLUCOSE FASTING | LAB | 301 | 82947 | 31.20 |
30252950 | GLUCOSE POST | LAB | 301 | 82950 | 37.90 |
30252952 | GLUCOSE TOLERANCE EACH ADDITIONAL | LAB | 301 | 82952 | 31.36 |
30252951 | GLUCOSE TOLERANCE FASTIN | LAB | 301 | 82951 | 102.96 |
30252945 | GLUCOSE, BODY FLUID, OTHER | LAB | 301 | 82945 | 31.21 |
30350595 | GLUTOSE 37.5GM TUBE | RX | 259 | 14.40 | |
30350038 | GLYBURIDE 5MG TAB | RX | 259 | 2.50 | |
30353059 | GOLYTELY PER 4 LITER BOTTLE | RX | 259 | 42.00 | |
30257591 | GONORRHEA DNA PROBE | LAB | 306 | 87591 | 171.75 |
30300695 | GOWN STERILE | CS | 270 | 26.70 | |
30300637 | GOWN PROTECTION YELLOW | CS | 270 | 39.50 | |
30257205 | GRAM STAIN / FECAL WBC | LAB | 306 | 87205 | 45.60 |
30300889 | GROUNDING PADS | CS | 270 | 47.85 | |
30252956 | GTT 1HR | ||||
30252953 | GTT 3HR | ||||
30252954 | GTT2HR | ||||
37085865 | GUAIAC EMESIS (FOR EACH THREE) | RX | 929 | 82271 | 34.30 |
37085864 | GUAIAC STOOLS (FOR EACH THREE) | RX | 929 | 82270 | 34.30 |
30350568 | GUAIFENESIN 400MG TAB | RX | 259 | 2.50 | |
30350046 | GUAIFENESIN/COD OS 100/10MG/5ML | RX | 259 | 2.50 | |
30256316 | H.INFLUENZAE B ANTIBODY IgG | LAB | 302 | 86317 | 119.92 |
30351201 | HALOPERIDOL 1MG TAB | RX | 259 | 2.50 | |
30354520 | HALOPERIDOL 5MG TAB | RX | 259 | 3.00 | |
30350567 | HALOPERIDOL UP TO 5MG INJ | RX | 636 | J1630 | 29.90 |
30203131 | HAND 2 VIEW READING | RADP | 972 | 73120 | 35.08 |
30203120 | HAND 2 VIEWS | RAD | 320 | 73120 | 169.00 |
30203132 | HAND 3 VIEW READING | RADP | 972 | 73130 | 36.52 |
30203130 | HAND 3 VIEWS | RAD | 320 | 73130 | 212.00 |
30454968 | HAND EXERCISER | PT | 273 | 37.50 | |
30253010 | HAPTOGLOBIN | LAB | 300 | 83010 | 246.25 |
30254703 | HCG QUALITATIVE | LAB | 302 | 84703 | 60.16 |
30254702 | HCG QUANTITATIVE | LAB | 301 | 84702 | 120.40 |
30253718 | HDL | LAB | 301 | 83718 | 64.85 |
30200002 | HEEL / CALCANEUS READING | RADP | 972 | 73650 | 33.64 |
30203650 | HEEL 2 VIEWS | RAD | 320 | 73650 | 168.00 |
30300184 | HEEL PROTECTOR | CS | 270 | 108.10 | |
30301390 | HEEL WARMER INFANT | CS | 270 | 13.86 | |
30300034 | HEELBO PROTECTOR LARGE | CS | 270 | 29.30 | |
30257338 | HELICOBACTER PYLORI STOOL ANTIGEN | LAB | 306 | 87338 | 115.04 |
30255014 | HEMATOCRIT | LAB | 305 | 85014 | 31.10 |
30258898 | HEMOCHROMOTOSIS MUTATION | LAB | 301 | 81256 | 308.22 |
30255018 | HEMOGLOBIN | LAB | 305 | 85018 | 31.10 |
30256709 | HEP A AB IGM | LAB | 302 | 86709 | 90.08 |
30256704 | HEP B CORE ANTIBODY TOT | LAB | 302 | 86704 | 96.45 |
30256706 | HEP B SAB | LAB | 302 | 86706 | 85.92 |
30257340 | HEP B SURFACE ANTIGEN HB | LAB | 302 | 87340 | 82.64 |
30257521 | HEP C VIRUS RNA BY PCR | LAB | 300 | 87521 | 280.72 |
30257522 | HEP C VIRUS RNA CHIRON | LAB | 300 | 87522 | 342.72 |
30250074 | HEP PANEL ACUTE | LAB | 300 | 80074 | 258.20 |
30357000 | HEPARIN LK FLUSH PER 10UNIT | RX | 636 | J1642 | 17.80 |
30350041 | HEPARIN PER 1000 UNITS | RX | 636 | J1644 | 16.50 |
30356332 | HEPARIN PER 1000UNITS (1000UNITS/ML) | RX | 636 | J1644 | 19.40 |
35059063 | HEPATITIS A VACCINE-PEDIATRIC/ADOLESCENT | CLNC | 636 | 90633 | 96.60 |
30350728 | HEPATITIS B VACCINE INJ | RX | 636 | 90746 | 141.70 |
35059074 | HEPATITIS B VACCINE-PEDIATRIC/ADOLESCENT | RX | 636 | 90744 | 63.00 |
30257902 | HEPATITIS C VIRUS GENOTYPE | LAB | 302 | 87902 | 809.33 |
30256694 | HERPES SIMPLEX 1 & 2 ABS IGG & IG | LAB | 306 | 87529 | 280.72 |
30252563 | HERPES SIMPLEX VIRUS | LAB | 302 | 86694 | 115.12 |
30253036 | HGB A1C | LAB | 301 | 83036 | 78.10 |
30300718 | HIBICLENS 4OZ | CS | 272 | A4248 | 31.05 |
30203510 | HIP AP AND LATERAL | RAD | 320 | 73502 | 228.13 |
30203511 | HIP AP AND LATERAL READING | RADP | 972 | 73502 | 46.64 |
30203520 | HIP BILATERAL WITH PELVIS | RAD | 320 | 73521 | 299.82 |
30203521 | HIP BILATERAL WITH PELVIS READING | RADP | 972 | 73521 | 46.64 |
30203500 | HIP ONE VIEW UNILATERAL | RAD | 320 | 73501 | 198.99 |
30203541 | HIP READING | RADP | 972 | 73501 | 39.40 |
30256703 | HIV 1 & 2 | LAB | 302 | 86703 | 109.68 |
30257389 | HIV BY CIA | LAB | 306 | 87389 | 192.64 |
30256711 | HIV BY CIA CONFIRMATION | ||||
30258681 | HLA B27 | LAB | 309 | 86812 | 206.48 |
30253518 | HMGCR | LAB | 301 | 83516 | 92.24 |
30603226 | HOLTER EXTENDED MONITOR | RAD | 731 | 93270 | 319.00 |
30603225 | HOLTER MONITOR | RAD | 731 | 93225 | 319.00 |
35059348 | HOME VISIT LEVEL II ESTABLISHED PT | CLNC | 522 | 99348 | 96.60 |
30253090 | HOMOCYSTINE | LAB | 301 | 83090 | 143.36 |
30160238 | HOSP DISCHARGE LEVEL I | NURP | 987 | 99238 | 172.85 |
30160239 | HOSP DISCHARGE LEVEL II | NURP | 987 | 99239 | 217.25 |
30160221 | HOSP INPATIENT INITIAL LEVEL I | NURP | 987 | 99221 | 178.15 |
30160222 | HOSP INPATIENT INITIAL LEVEL II | NURP | 987 | 99222 | 272.75 |
30160223 | HOSP INPATIENT INITIAL LEVEL III | NURP | 987 | 99223 | 351.00 |
30160231 | HOSP SUBSEQUENT CARE LEVEL I | NURP | 987 | 99231 | 101.90 |
30160232 | HOSP SUBSEQUENT CARE LEVEL II | NURP | 987 | 99232 | 134.95 |
30160233 | HOSP SUBSEQUENT CARE LEVEL III | NURP | 987 | 99233 | 178.15 |
30300482 | HOT PACK DISP. | CS | 270 | 21.40 | |
30300597 | HOT/COLD PACK | CS | 270 | 21.40 | |
30256789 | HTLV | LAB | 302 | 86790 | 103.04 |
30300743 | HUGGIES MED 16-28 LBS | CS | 270 | 2.50 | |
30203061 | HUMERUS 2 VIEW READING | RADP | 972 | 73060 | 35.08 |
30203060 | HUMERUS 2 VIEWS | RAD | 320 | 73060 | 198.00 |
30353401 | hydrALAZINE 20mg inj | RX | 636 | J0360 | 25.40 |
30352701 | HYDRALAZINE 25MG TAB | RX | 259 | 3.10 | |
30350310 | HYDROCERIN CREAM 160Z TUB | RX | 259 | 16.20 | |
30352051 | HYDROCHLORATHIAZIDE 12.5MG CAP | RX | 251 | 2.50 | |
30350039 | HYDROCHLOROTHIAZIDE 25MG TAB | RX | 259 | 2.50 | |
30350182 | HYDROCODONE/ACET 10/650MG TAB | RX | 259 | 2.50 | |
30350432 | HYDROCODONE/ACET 5/500MG TAB | RX | 259 | 2.50 | |
30351127 | HYDROCODONE/ACET 7.5/325MG TAB | RX | 259 | 2.50 | |
30350932 | HYDROCODONE/ACET 7.5MG/500MG TAB | RX | 259 | 2.50 | |
30350933 | HYDROCODONE/APAP 5/325MG TAB | RX | 251 | 2.50 | |
30350785 | HYDROCORTISONE 20MG TAB | RX | 259 | 5.10 | |
30350929 | HYDROCORTISONE 5MG TAB | RX | 259 | 2.50 | |
30354519 | HYDROCORTISONE CM 1% .9GM PKT | RX | 259 | 6.80 | |
30300326 | HYDROGEN PEROXIDE 16oz | CS | 270 | A4244 | 9.30 |
30300388 | HYDROGEN PEROXIDE 4oz | CS | 270 | 9.30 | |
30351500 | HYDROMORPHONE 4MG TAB | RX | 259 | 2.50 | |
30351303 | HYDROMORPHONE DRIP 50MG | RX | 636 | J1170 | 55.50 |
30353033 | HYDROMORPHONE UP TO 4MG INJ | RX | 636 | J1170 | 18.00 |
30350604 | HYDROXYCHLOROQUINE 200MG TAB | RX | 259 | 11.10 | |
30350982 | HYDROXYUREA 500MG CAPSULE | RX | 259 | 2.60 | |
30350496 | HYDROXYZINE 10MG TAB | RX | 251 | 2.50 | |
30350330 | HYDROXYZINE PAM 25MG CAP | RX | 636 | Q0177 | 2.50 |
30350042 | HYDROXYZINE UP TO 25MG INJ - 25MG VL | RX | 636 | J3410 | 61.40 |
30350331 | HYDROXYZINE UP TO 25MG INJ-50MG VL | RX | 636 | J3410 | 24.00 |
30353091 | HYOSCYAMINE 0.125MG TABLET | RX | 259 | 2.50 | |
30301119 | HYPAFIX TAPE 2 | CS | 270 | 2.00 | |
30350753 | HYZAAR 50/12.5MG TAB | RX | 259 | 2.50 | |
35056083 | I & D HEMORROID THROMBOSED EXT | CLNC | 521 | 46083 | 90.30 |
35050061 | I & D ABCESS (COMPLICATED/MULTIPLE | CLNC | 521 | 10061 | 216.30 |
35050060 | I & D ABCESS (SIMPLE OR SINGLE) | CLNC | 521 | 10060 | 139.70 |
35050140 | I & D OF HEMATOMA OR FLUID COLLECT | CLNC | 521 | 10140 | 172.20 |
35050080 | I & D PILONIDAL CYST (SIMPLE) | CLNC | 521 | 10080 | 190.10 |
30350157 | IBUPROFEN 200MG TAB | RX | 259 | 2.50 | |
30350338 | IBUPROFEN SUSP 100MG/5ML | RX | 259 | 2.50 | |
30300814 | ICE BAG DISPOSABLE | CS | 270 | 8.70 | |
30253519 | IGF BINDING PROTEIN-1 | LAB | 301 | 83519 | 147.20 |
30351601 | IMIPRAMINE 25MG TAB | RX | 259 | 2.50 | |
30350790 | IMITREX 100MG TAB | RX | 259 | 6.00 | |
30253514 | IMMUNOASSAY NONANTIBODY | LAB | 302 | 83516 | 92.24 |
30256320 | IMMUNOELECTROPHORESIS | LAB | 302 | 86320 | 239.36 |
30252784 | IMMUNOGLOBLIN G A D M E | LAB | 301 | 82784 | 74.40 |
30301819 | IN LINE FILTERED EXT SET | CS | 270 | 22.05 | |
30520025 | INCENTIVE SPIROMETER TREATMENT | RX | 270 | 13.50 | |
30357310 | INCRUSE ELLIPTA 62.5MG INHALER | RX | 252 | 369.50 | |
30350722 | INDAPAMIDE 2.5MG TABLET | RX | 259 | 2.50 | |
30350171 | INDOMETHACIN 25MG CAP | RX | 259 | 2.50 | |
30257804 | INFLUENZA RAPID TEST A & | LAB | 306 | 87502 | 146.25 |
35051695 | INFLUENZA VACCINE ADMIN - MEDICARE | CLNC | 771 | G0008 | 0.00 |
30353001 | INFLUENZA VACCINE LIVE, INTRANASAL | RX | 636 | 90660 | 65.10 |
30351425 | INFLUENZA VACCINE PED <35 months | RX | 636 | 90685 | 72.60 |
30350658 | INFLUENZA VIRUS VACCINE | RX | 636 | 90686 | 75.20 |
35050460 | INJ IMMUN ADMIN 1 COMP <18 W COUNSEL | CLNC | 771 | 90460 | 21.00 |
35050461 | INJ IMMUN ADMIN EA ADDL <18 W COUNSEL | CLNC | 771 | 90461 | 21.00 |
35050471 | INJ IMMUN 1 ADMIN W/O COUNSEL | CLNC | 771 | 90471 | 26.30 |
35050472 | INJ IMMUN ADMIN EA ADD W/O COUNSEL | CLNC | 771 | 90472 | 26.30 |
35050610 | INJECT / ASPIRATION MAJOR JOINT OR BURSA | CLNC | 521 | 20610 | 126.00 |
35050605 | INJECT / ASPIRATION MEDIUM JOINT/ BURSA | CLNC | 521 | 20605 | 93.50 |
35050600 | INJECT / ASPIRATION SMALL JOINT / BURSA | CLNC | 521 | 20600 | 67.20 |
35055115 | INJECTION ALLERGY | CLNC | 521 | 95115 | 21.00 |
35050526 | INJECTION CARPAL TUNNEL | CLNC | 521 | 20526 | 97.70 |
35054405 | INJECTION GREATER OCCIPITAL NERVE | CLNC | 521 | 64405 | 142.80 |
35050772 | INJECTION SUBQ OR INTERMUSCULAR | CLNC | 521 | 96372 | 21.00 |
35050550 | INJECTION TENDON SHEATH/LIGAMENT | CLNC | 521 | 20550 | 97.70 |
35050553 | INJECTION TRIGGER POINTS 3 OR MOR | CLNC | 521 | 20553 | 84.00 |
35050552 | INJECTION TRIGGERPOINTS 1-2 MUSCL | CLNC | 521 | 20552 | 71.40 |
35055117 | INJECTION ALLERGY SHOT- 2 OR MORE | CLNC | 521 | 95117 | 26.30 |
30300328 | INJECTION SITE | CS | 270 | 14.15 | |
37083010 | INJECTION, IMMUNIZATION ADMIN ONE VACCIN | NUR | 771 | 90471 | 79.75 |
37083011 | INJECTION, IMMUNIZATION, EACH ADDITIONAL | NUR | 771 | 90472 | 37.25 |
37083008 | INJECTION, SUBQ OR INTRAMUSCULAR | NUR | 260 | 96372 | 79.76 |
30359619 | INSULIN - HUMALOG 70/30 PEN - 3ML | RX | 259 | 149.80 | |
30356903 | INSULIN - TOUJEO PEN | RX | 252 | 230.20 | |
30256337 | INSULIN ANTIBODY | LAB | 302 | 86337 | 171.28 |
30255151 | INSULIN ASSAY | LAB | 301 | 83525 | 91.44 |
30357155 | INSULIN BASAGLAR PER PEN 100U/ML | RX | 252 | 170.40 | |
30355101 | INSULIN HUMALOG 75/25 PER 5 UNITS | RX | 250 | J1815 | 6.20 |
30351223 | INSULIN HUMALOG PEN 100U/ML - 3ML | RX | 259 | 139.40 | |
30350380 | INSULIN HUMALOG PER 5 UNITS | RX | 250 | J1815 | 1.30 |
30350969 | INSULIN HUMULIN 70/30 PER 5 UNIT INJ | RX | 250 | J1815 | 8.70 |
30350414 | INSULIN HUMULIN NPH PER 5 UNIT INJ | RX | 250 | J1815 | 8.70 |
30350413 | INSULIN HUMULIN REGULAR PER 5 UNIT INJ | RX | 250 | J1815 | 8.70 |
30352550 | INSULIN LANTUS PEN 100U/ML - 3ML | RX | 259 | 159.10 | |
30358000 | INSULIN LEVEMIR 100UNIT/ML - 3ML | RX | 259 | 163.30 | |
30358215 | INSULIN REGULAR 100UNIT DRIP | RX | 250 | J1815 | 47.00 |
30355013 | INSULIN TRESIBA PEN 200U/ML - 3ML | RX | 252 | 235.50 | |
30354801 | INSULIN VICTOZA PEN 18MG/3ML | RX | 259 | 383.80 | |
35059127 | INTEGRATED BEHAVIORAL HEALTH SCREENING | CLNC | 900 | 96127 | 7.74 |
30350616 | INTEGRILIN PER 5MG INJ | RX | 636 | J1327 | 388.00 |
30253522 | INTERLEUKIN 6 | LAB | 301 | 83520 | 138.16 |
30300557 | INTRASITE GEL | CS | 270 | A6248 | 25.65 |
37083014 | INTRAVENOUS PUSH, EACH ADDITIONAL DRUG | NUR | 260 | 96375 | 52.28 |
37083013 | INTRAVENOUS PUSH, SINGLE/INITIAL DRUG | NUR | 260 | 96374 | 168.00 |
30300505 | INTUBATING STYLET 10FR | CS | 270 | 18.45 | |
30300626 | INTUBATING STYLET 14FR | CS | 270 | 18.45 | |
30300506 | INTUBATING STYLET 6FR | CS | 270 | 18.45 | |
30301001 | INV. CIRCUIT ASSEMBLY DISPOSABLE | CS | 270 | 98.40 | |
35056010 | IPOL INACTIVATED POLIO VACCINE | CLNC | 521 | 90713 | 97.50 |
30352100 | IPRATROP/ALBUT 0.5/3MG/3ML INH SOLN | RX | 259 | 2.50 | |
30350048 | IPRATROPIUM INHAL SOLN PER MG | RX | 636 | J7645 | 2.50 |
30350742 | IRBESARTAN/HCTZ 150/12.5 MG TAB | RX | 251 | 16.80 | |
30258354 | IRON | LAB | 301 | 83540 | 51.76 |
30253550 | IRON BINDING CAPACITY | LAB | 301 | 83550 | 70.90 |
31106523 | IRRIGATION OF IMPLANTED VENOUS DEVICE | NUR | 761 | 96523 | 83.94 |
30300964 | IRRIGATION SYRINGE 60CC | CS | 270 | 14.80 | |
30300113 | IRRIGATION TRAY | CS | 270 | A4320 | 14.70 |
30350648 | ISOSORBIDE MONO ER 30MG TAB | RX | 259 | 2.50 | |
30350391 | ISOSORBIDE MONO ER 60MG TAB | RX | 259 | 2.50 | |
30357123 | ISOSORBITE DINITRATE 5MG TAB | RX | 259 | 6.00 | |
30309730 | ISOVUE 300MG/100ML BTL | RAD | 254 | Q9967 | 10.59 |
30200001 | ISOVUE 370MG/100ML BTL | RAD | 254 | Q9967 | 10.59 |
30350714 | ISUPREL PER 1MG INJ | RX | 636 | J7658 | 106.40 |
35058300 | IUD INSERTION | CLNC | 521 | 58300 | 227.40 |
30300247 | IV ADMIN CONTINU-FLO IV ADMIN SET | CS | 272 | A4222 | 56.05 |
30300248 | IV ADMIN SECONDARY SET | CS | 272 | A4222 | 14.94 |
30300250 | IV ADMIN SET MINI DRIP | CS | 272 | 25.75 | |
30300331 | IV BLOOD SET | CS | 272 | 49.75 | |
30300249 | IV BURETROL SET | CS | 272 | 39.05 | |
30301122 | IV CATH 14G | CS | 272 | 16.47 | |
30300527 | IV CATH 16G | CS | 272 | A4215 | 17.98 |
30300526 | IV CATH 18G | CS | 272 | A4215 | 17.98 |
30300525 | IV CATH 20G | CS | 272 | A4215 | 17.98 |
30300523 | IV CATH 22G | CS | 272 | A4215 | 17.98 |
30300254 | IV CATH 24G | CS | 272 | A4215 | 17.98 |
30300355 | IV CATH EXTENSION SET | CS | 272 | 25.14 | |
30300252 | IV EXTENSION TUBING | CS | 270 | 5.25 | |
30300535 | IV NITROGLYCERIN SET | CS | 272 | 41.15 | |
30253891 | JAK-2 QUALITATIVE | LAB | 309 | 81270 | 547.50 |
30357731 | JANUVIA (SITAGLIPTIN) 100MG TAB | RX | 252 | 53.30 | |
30350131 | JANUVIA 25MG TAB | RX | 259 | 26.50 | |
30351231 | JANUVIA 50MG TABLET | RX | 259 | 39.10 | |
30355330 | JARDIANCE 25MG TAB | RX | 252 | 65.50 | |
30450011 | JOBST MEASUREMENT PER 15 MIN | PT | 420 | 97139 | 69.40 |
30355102 | K PHOS ORIGINAL 500MG TAB | RX | 259 | 2.50 | |
30300648 | KANGAROO PUMP SET | CS | 270 | B4035 | 23.20 |
30253883 | KAPPA / LAMBDA FREE LIGHT CHAIN | LAB | 301 | 83520 | 277.35 |
30350054 | KENALOG PER 10MG INJ | RX | 636 | J3301 | 13.00 |
30259920 | KEPPRA | LAB | 301 | 80177 | 150.76 |
30300641 | KERLIX 1 ROLL | CS | 270 | A4580 | 12.42 |
30353810 | KETAMINE UP TO 500MG INJ | RX | 259 | 23.90 | |
30350462 | KETOCONAZOLE CREAM 2% - 60GM TUBE | RX | 259 | 26.60 | |
30350259 | KETOROLAC TROM 10MG TAB | RX | 259 | 9.90 | |
30350511 | KETOROLAC TROM PER 15MG INJ - 60MG VL | RX | 636 | J1885 | 15.90 |
30350500 | KETOROLAC TROM PER 15MG INJ-30MG VL | RX | 636 | J1885 | 15.00 |
30450012 | KINETIC ACT PER 15 MIN | PT | 420 | 97530 | 98.00 |
30300206 | KING AIRWAY LTD 2 | CS | 270 | 127.50 | |
3030207 | KING AIRWAY LTD 2.5 | CS | 270 | 127.50 | |
30300208 | KING AIRWAY LTSD 3 | CS | 270 | 140.85 | |
30300210 | KING AIRWAY LTSD 4 | CS | 270 | 140.85 | |
30300242 | KING AIRWAY LTSD 5 | CS | 270 | 140.85 | |
35059069 | KINRIX DTAP-IPV | RX | 636 | 90696 | 130.50 |
30203562 | KNEE 3 VIEW COMPLETE | RAD | 320 | 73562 | 240.50 |
30203560 | KNEE AP AND LATERAL 2 VIEW | RAD | 320 | 73560 | 211.20 |
30203563 | KNEE AP AND LATERAL 2 VIEW READING | RADP | 972 | 73560 | 35.08 |
30203561 | KNEE READING | RADP | 972 | 73562 | 39.40 |
30257210 | KOH PREP / WET PREP | LAB | 306 | 87210 | 46.56 |
30356948 | KRILL OIL 1000MG CAPSULE | RX | 259 | 2.50 | |
30202100 | L SPINE 2-3 VIEW | RAD | 320 | 72100 | 231.00 |
30207211 | L SPINE 2-3 VIEW READING | RADP | 972 | 72100 | 46.64 |
30202110 | L SPINE 4 VIEW | RAD | 320 | 72110 | 325.00 |
30202111 | L SPINE 4 VIEW READING | RADP | 972 | 72110 | 53.84 |
30356050 | LABETALOL 100MG TABLET | RX | 259 | 2.50 | |
30356720 | LABETALOL INFUSION 200MG | RX | 259 | 28.00 | |
30350710 | LABETALOL PER 20MG INJ | RX | 259 | 12.70 | |
35053132 | LACERATION COMPLEX 2.6-7.5CM | CLNC | 521 | 13132 | 593.30 |
35052051 | LACERATION MODERATE FACE >2.5CM | CLNC | 521 | 12051 | 275.10 |
35052001 | LACERATION SIMPLE >2.5CM | CLNC | 521 | 12001 | 171.20 |
35053006 | LACERATION SIMPLE 12.6-20.0CM | CLNC | 521 | 12005 | 243.60 |
35052002 | LACERATION SIMPLE 2.6-7.5CM | CLNC | 521 | 12002 | 184.80 |
35052004 | LACERATION SIMPLE 7.6-12.5CM | CLNC | 521 | 12004 | 214.20 |
35052011 | LACERATION SIMPLE ON FACE >2.5 | CLNC | 521 | 12011 | 171.20 |
30250295 | LACOSAMIDE | LAB | 301 | 80299 | 192.00 |
30354015 | LACTATED RINGERS 1000ML | CS | 258 | J7120 | 17.00 |
30253607 | LACTIC ACID | LAB | 301 | 83605 | 92.56 |
30350823 | LACTULOSE SOLN 10GM/15ML | RX | 259 | 2.50 | |
30350598 | LAMOTRIGINE (LAMICTAL) 25MG TAB | RX | 259 | 2.50 | |
30350229 | LAMOTRIGINE 100MG TAB | RX | 259 | 2.50 | |
30256853 | LAMOTRIGINE LEVEL | LAB | 301 | 80175 | 150.75 |
30350627 | LANOXIN 0.125MG TAB | RX | 259 | 3.30 | |
30351115 | LANOXIN 0.25MG TAB | RX | 259 | 2.50 | |
30350101 | LANSOPRAZOLE 30MG CAP | RX | 259 | 2.50 | |
30300264 | LARYNGEAL MASK SIZE 5 | CS | 270 | 69.75 | |
30200297 | LDCT CHEST SCREENING | CT | 352 | 71271 | 340.00 |
30200298 | LDCT CHEST SCREENING READING | CTP | 972 | 71271 | 158.64 |
30201149 | LDCT CHEST SURVEILLANCE | CT | 352 | 71250 | 340.00 |
30201257 | LDCT CHEST SURVEILLANCE READING | CTP | 972 | 71250 | 179.22 |
30253615 | LDH | LAB | 301 | 83615 | 48.30 |
30253721 | LDL DIRECT | LAB | 301 | 83721 | 84.00 |
30253655 | LEAD | LAB | 301 | 83655 | 98.70 |
30351901 | LEFLUNOMIDE 20MG TAB | RX | 259 | 15.70 | |
30301109 | LEG BAG STRAP | CS | 270 | 22.96 | |
30257542 | LEGIONELLA BY PCR | ||||
35051311 | LESION REMOVAL .6 TO 1.0CM DIAMETE | CLNC | 521 | 11311 | 119.70 |
30355933 | LETROZOLE 2.5MG TAB | RX | 251 | 2.50 | |
30350534 | LEVALBUTEROL INH PER O.5MG | RX | 259 | 22.10 | |
30350743 | LEVETIRACETAM 500MG TAB | RX | 259 | 2.50 | |
30354512 | LEVETIRACETAM OS 100MG/ML PER 5ML | RX | 259 | 11.00 | |
30351953 | LEVETIRACETAM PER 10MG INJ | RX | 636 | J1953 | 23.60 |
30350481 | LEVOCETIRIZINE 5MG TAB | RX | 259 | 2.50 | |
30350056 | LEVOFLOXACIN 500MG TAB | RX | 259 | 2.50 | |
30356001 | LEVOFLOXACIN PER 250MG INJ - 250MG VL | RX | 636 | J1956 | 15.70 |
30350306 | LEVOFLOXACIN PER 250MG INJ - 500MG | RX | 636 | J1956 | 66.50 |
30356000 | LEVOFLOXACIN PER 250MG INJ - 750MG VL | RX | 636 | J1956 | 70.50 |
30350730 | LEVOPHED (NOREPHINEPHRINE) 4MG/4ML INJ | RX | 259 | 24.00 | |
30350058 | LEVOTHROID 50MCG TAB | RX | 259 | 2.50 | |
30350059 | LEVOTHYROXINE (LEVOXYL) 125MCG TAB | RX | 259 | 3.00 | |
30350057 | LEVOTHYROXINE 100MCG TAB | RX | 251 | 2.50 | |
30350744 | LEVOTHYROXINE 112MCG TAB | RX | 259 | 2.50 | |
30350745 | LEVOTHYROXINE 137MCG TAB | RX | 259 | 6.90 | |
30350369 | LEVOTHYROXINE 150MCG TAB | RX | 259 | 2.50 | |
30350040 | LEVOTHYROXINE 25MCG TAB | RX | 259 | 2.50 | |
30358182 | LEVOTHYROXINE 300MCG TABLET | RX | 259 | 4.00 | |
30350991 | LEVOTHYROXINE 75MCG TAB | RX | 259 | 6.90 | |
30350746 | LEVOTHYROXINE 88MCG TAB | RX | 259 | 6.90 | |
30350419 | LEXAPRO 10MG TAB | RX | 259 | 2.50 | |
30350676 | LEXAPRO 20MG TAB | RX | 259 | 2.50 | |
30253002 | LH LEUTENIZING HORMONE | LAB | 301 | 83002 | 148.16 |
30356062 | LIDOCAIN 1%/EPINEPHRINE PER 5ML | RX | 259 | 1.90 | |
30350819 | LIDOCAINE 2% JELLY 5ML TUBE | RX | 259 | 21.30 | |
30356550 | LIDOCAINE 4% TOPICAL SOLN PER DOSE | RX | 259 | 2.50 | |
30350138 | LIDOCAINE ORAL SOL 2% PER DOSE | RX | 259 | 2.50 | |
30350060 | LIDOCAINE PER 10MG INJ / per ML | RX | 636 | J2001 | 11.10 |
30356033 | LIDOCAINE PER 10MG INJ-100MG SYRIN | RX | 636 | J2001 | 22.80 |
30350818 | LIDOCAINE/PRILOCAINE CRM (EMLA CRM | RX | 259 | 17.40 | |
30358701 | LIDODERM 5% TRANSDERMAL PATCH | RX | 259 | 16.10 | |
87000002 | LIFELINE MOBILE UNIT SET UP FEE | PALS | 999 | 99.00 | |
87000000 | LIFELINE MONTHLY | PALS | 999 | 35.00 | |
87000001 | LIFELINE MONTHLY- WITH FALL DETECTION | PALS | 999 | 45.00 | |
30300854 | Lighted Curette 4mm | CS | 270 | 13.77 | |
30352301 | LIOTHYRONINE 50MCG TAB | RX | 251 | 9.20 | |
30253690 | LIPASE | LAB | 301 | 83690 | 73.30 |
30250061 | LIPID PANEL | LAB | 301 | 80061 | 118.00 |
30350305 | LIPITOR 10MG TAB | RX | 259 | 2.50 | |
30351117 | LIPITOR 20MG TAB | RX | 251 | 2.50 | |
30350114 | LIPITOR 40MG TAB | RX | 259 | 2.50 | |
30350748 | LISINOPRIL 10MG TAB | RX | 251 | 2.50 | |
30350747 | LISINOPRIL 2.5MG TAB | RX | 259 | 2.50 | |
30350064 | LISINOPRIL 20MG TAB | RX | 251 | 2.50 | |
30350750 | LISINOPRIL 40MG TAB | RX | 259 | 2.50 | |
30350103 | LISINOPRIL 5MG TABLET | RX | 259 | 2.50 | |
30350751 | LITHIUM CARB 300MG CAP | RX | 259 | 2.50 | |
30250178 | LITHIUM LEVEL | LAB | 301 | 80178 | 52.00 |
30253884 | LIVER FIBROSIS | ||||
30250076 | LIVER PANEL | LAB | 301 | 80076 | 99.70 |
30300283 | LOCAL ANESTHETIC TRAY | CS | 270 | 50.00 | |
35050283 | LOCAL ANESTHETIC TRAY | CLNC | 521 | A4649 | 52.50 |
30300427 | LONGITUDINAL ARCH PAD | CS | 274 | L3010 | 25.30 |
30300976 | LOOP BRIDGE 7767 | CS | 270 | A4421 | 26.05 |
30350628 | LOPERAMIDE 2MG CAP | RX | 259 | 2.50 | |
30300832 | LOPEZ VALVE | CS | 270 | 18.20 | |
30350776 | LORATADINE 10MG TAB | RX | 259 | 2.50 | |
30350814 | LORATADINE SYRUP 5MG/5ML | RX | 259 | 10.10 | |
30350778 | LORAZEPAM 0.5MG TAB | RX | 259 | 2.50 | |
30354721 | LORAZEPAM 1MG TABLET | RX | 259 | 2.50 | |
30350437 | LORAZEPAM 2MG TAB | RX | 259 | 2.50 | |
30350010 | LORAZEPAM UP TO 2MG INJ | RX | 636 | J2060 | 14.30 |
30352065 | LOSARTAN 100MG TAB | RX | 259 | 2.50 | |
30350518 | LOSARTAN 25MG TAB | RX | 259 | 2.50 | |
30350368 | LOSARTAN 50MG TAB | RX | 259 | 2.50 | |
30352008 | LOVASTATIN 20MG TAB | RX | 259 | 2.50 | |
30353506 | LOVAZA 1GM CAPSULE | RX | 259 | 8.50 | |
30350504 | LOVENOX UP TO 10MG INJ - 100MG SYR | RX | 636 | J1650 | 149.40 |
30351268 | LOVENOX UP TO 10MG INJ - 120MG SYR | RX | 636 | J1650 | 74.30 |
30355569 | LOVENOX UP TO 10MG INJ - 150MG SYR | RX | 636 | J1650 | 59.30 |
30350445 | LOVENOX UP TO 10MG INJ - 30MG SYR | RX | 636 | J1650 | 24.00 |
30350449 | LOVENOX UP TO 10MG INJ - 40MG SYR | RX | 636 | J1650 | 31.10 |
30350502 | LOVENOX UP TO 10MG INJ - 60MG SYR | RX | 636 | J1650 | 29.20 |
30350246 | LOVENOX UP TO 10MG INJ - 80MG SYR | RX | 636 | J1650 | 121.50 |
30300316 | LUMBAR PUNC. KIT ADU | CS | 270 | 93.35 | |
30300442 | LUMBAR PUNC. KIT PEDS | CS | 270 | 72.55 | |
30300173 | LUMBOSACRAL SUPPORT | CS | 270 | L0621 | 73.00 |
30300408 | LUMBOSACRAL SUPPORT SM | CS | 270 | 81.65 | |
30355003 | LUMIGAN EYE DROPS 0.01% - 2.5ML BTL | RX | 259 | 248.50 | |
30359030 | LUNESTA 1MG TAB | RX | 259 | 2.90 | |
30350679 | LUNESTA 2 MG TAB | RX | 259 | 11.60 | |
30352009 | LUNESTA 3 MG TAB | RX | 259 | 23.90 | |
30357303 | LUPRON DEPOT PER 7.5MG INJ | RX | 636 | J9217 | 9324.40 |
30258863 | LUPUS PANEL | LAB | 305 | 85613 | 76.64 |
30350691 | LUTEIN 20MG SOFTGEL | RX | 259 | 2.50 | |
30350685 | LYRICA (PREGABALIN) 75MG CAP | RX | 251 | 2.50 | |
30350612 | LYRICA 50MG TAB | RX | 252 | 2.50 | |
30352115 | LYSINE 500MG TABLET | RX | 259 | 2.50 | |
30250051 | LYTES | LAB | 301 | 80051 | 104.55 |
30350072 | MAGNESIUM 250MG TAB | RX | 259 | 2.50 | |
30350482 | MAGNESIUM CHLORIDE 64MG TAB | RX | 259 | 2.50 | |
30350741 | MAGNESIUM CITRATE PER 300CC BTL | RX | 259 | 5.20 | |
30350399 | MAGNESIUM SULF PER 500MG INJ | RX | 636 | J3475 | 16.50 |
30253735 | MAGNESIUM, SERUM | LAB | 301 | 83735 | 53.60 |
30350066 | MAG-OX 400MG TAB | RX | 259 | 2.50 | |
30257207 | MALARIA SMEAR | LAB | 306 | 87207 | 47.92 |
30200100 | MANDIBLE 2-3 VIEW | RAD | 320 | 70100 | 170.20 |
30450013 | MANUAL THERAPY PER 15 MI | PT | 420 | 97140 | 89.00 |
30255007 | MANUAL WBC DIFFERENTIAL | LAB | 305 | 85007 | 41.10 |
30300082 | MASIMO SPO2 ADULT | CS | 270 | 77.50 | |
30300818 | MASIMO SPO2 NEONATAL | CS | 270 | 83.85 | |
30300594 | MASIMO SPO2 SENSOR PEDS | CS | 270 | 61.45 | |
30300645 | MASK NON REBREATHER | CS | 270 | A7015 | 9.60 |
30300834 | MASK O2 PED | CS | 270 | 8.00 | |
30300754 | MASK AEROSOL | CS | 270 | 6.75 | |
30520012 | MASK AEROSOL DRAGON | CS | 270 | 11.30 | |
30301778 | MASK INFANT NONREBREATHER | CS | 270 | 22.68 | |
30520007 | MASK O2 ADULT | CS | 270 | 6.75 | |
30301775 | MASK O2 INFANT | CS | 270 | 22.68 | |
30301777 | MASK PEDI NON REBREATHER | CS | 270 | 17.91 | |
30301123 | MASK PROCEDURE | CS | 270 | 23.52 | |
30450014 | MASSAGE PER 15 MIN | PT | 420 | 97124 | 69.00 |
30300656 | MASTISOL PKT | CS | 270 | 14.00 | |
30301437 | MATTRESS OVERLAY WAFFLE | CS | 270 | 144.44 | |
30350807 | MAXALT MLT 10MG TAB | RX | 259 | 10.00 | |
30256765 | MEASLES IGG | LAB | 302 | 86765 | 103.04 |
30350276 | MECLIZINE 25MG TAB | RX | 259 | 2.50 | |
30354492 | MEDI HONEY ROPE DRESSING 3/4" X 12 | CS | 272 | A6199 | 47.60 |
30450337 | MEDICAL EXERCISE PER MONTH | PT | 420 | 40.00 | |
35050438 | MEDICARE ANNUAL WELLNESS- INITIAL | CLNC | 521 | G0438 | 165.00 |
35050439 | MEDICARE ANNUAL WELLNESS- SUBSEQ | CLNC | 521 | G0439 | 136.50 |
35050402 | MEDICARE WELLNESS IPPE | CLNC | 521 | G0402 | 136.50 |
30300855 | MEDIPORE H TAPE | CS | 270 | 10.80 | |
30352001 | MEDROXYPROGESTERONE 10MG TAB | RX | 259 | 2.50 | |
30355371 | MEDROXYPROGESTERONE 1MG INJ | RX | 636 | J1050 | 114.80 |
30350355 | MEDROXYPROGESTERONE 2.5MG TAB | RX | 259 | 2.50 | |
30350321 | MEGESTROL ORAL SUSP 400MG/10ML | RX | 259 | 61.20 | |
30351111 | MELATONIN 3MG TAB | RX | 259 | 2.50 | |
30355745 | MELATONIN 5MG CAPSULE | RX | 259 | 2.50 | |
30359701 | MELOXICAM 7.5MG TAB | RX | 259 | 2.50 | |
35059073 | MENACTRA-MCV4 MENINGOCOCCAL | RX | 636 | 90734 | 270.40 |
30306212 | MEPILEX 3X3 SILVER | CS | 272 | A6212 | 32.80 |
30304957 | MEPILEX SACRUM 9X9 | CS | 272 | A6213 | 86.05 |
30304989 | MEPITAL DRESSING 2"X3" | CS | 272 | A6197 | 36.41 |
30350601 | MEROPENEM PER 100MG INJ | RX | 636 | J2185 | 97.70 |
30304988 | MESALT DRESSING 3/4"X39" | CS | 270 | A6197 | 19.87 |
30350073 | METAMUCIL PER DOSE | RX | 259 | 2.50 | |
30252527 | METANEPHRINES FRACTIONATION URINE | LAB | 301 | 83835 | 135.52 |
30253836 | METANEPHRINES, PLASMA | LAB | 301 | 83835 | 135.52 |
30350037 | METFORMIN 500MG TAB | RX | 259 | 2.50 | |
30352099 | METFORMIN 850MG TAB | RX | 259 | 2.50 | |
30350378 | METFORMIN ER 750MG TAB | RX | 259 | 2.50 | |
30350779 | METFORMIN XR 500MG TAB | RX | 259 | 2.50 | |
30350536 | METHADONE 10MG TAB | RX | 259 | 2.50 | |
30350377 | METHAZOLAMIDE 50MG TAB | RX | 259 | 10.20 | |
30350953 | METHOCARBAMOL 500MG TAB | RX | 259 | 2.50 | |
30350693 | METHOTREXATE 2.5MG TAB | RX | 636 | J8610 | 13.40 |
30355041 | METHYLENE BLUE 1% per 10MG | RX | 259 | 62.50 | |
30252543 | METHYLMALONIC ACID | LAB | 301 | 83921 | 169.68 |
30355401 | METHYLPHENIDATE SR 20MG BID | RX | 259 | 5.10 | |
30350487 | METHYLPREDNISOLONE 4MG - 21 TABS | RX | 259 | 65.40 | |
30350224 | METHYLPREDNISOLONE PER 4MG TAB | RX | 636 | J7509 | 2.50 |
30350074 | METOCLOPRAMIDE 10MG TAB | RX | 259 | 2.50 | |
30350075 | METOCLOPRAMIDE UP TO 10MG INJ | RX | 636 | J2765 | 15.80 |
30350379 | METOCLOPROMIDE 5MG TAB | RX | 259 | 2.50 | |
30350215 | METOLAZONE 2.5MG TAB | RX | 259 | 9.30 | |
30350077 | METOPROLOL 25MG TAB | RX | 259 | 2.50 | |
30350076 | METOPROLOL 50MG TAB | RX | 259 | 2.50 | |
30350901 | METOPROLOL ER (TOPROL XL) 25MG TAB | RX | 259 | 2.50 | |
30350356 | METOPROLOL ER (TOPROL XL) 50MG TAB | RX | 259 | 2.50 | |
30356801 | METOPROLOL ER 100MG TABLET | RX | 259 | 3.00 | |
30350183 | METOPROLOL PER 5MG INJ | RX | 636 | J3490 | 13.10 |
30350410 | METRONIDAZOLE 250MG TAB | RX | 259 | 2.50 | |
30350476 | METRONIDAZOLE 500MG TAB | RX | 259 | 3.40 | |
30350244 | METRONIDAZOLE UP TO 500MG INJ | RX | 636 | J3490 | 18.80 |
30351410 | MICARDIS 40MG TAB | RX | 259 | 3.50 | |
30350914 | MICARDIS 80MG TAB | RX | 259 | 16.20 | |
30252043 | MICROALBUMIN URINE | LAB | 301 | 82043 | 63.00 |
30350401 | MIDAZOLAM PER 1MG INJ | RX | 636 | J2250 | 15.00 |
30354301 | MIDODRINE 10MG TAB | RX | 259 | 11.50 | |
30350079 | MILK OF MAGNESIA PER 30CC | RX | 259 | 2.50 | |
30300852 | Mindray SpO2 Adult | CS | 270 | 59.00 | |
30300851 | Mindray SpO2 Peds | CS | 270 | 66.45 | |
30350528 | MIRTAZAPINE 15MG TAB | RX | 259 | 2.50 | |
30259326 | MISC LAB | LAB | 300 | 86256 | 0.00 |
30354499 | MISC PHARMACY | RX | 259 | 0.00 | |
35059080 | Misc/ Disability Determination | CLNC | 521 | 99080 | 215.00 |
35050707 | MMR MEASLES, MUMPS, RUBELLA | RX | 636 | 90707 | 171.50 |
30300524 | MOLESKIN PER FOOT | CS | 270 | 21.68 | |
30300491 | MOLESKIN PER INCH | CS | 270 | 2.20 | |
30300492 | MOLESKIN PER YARD | CS | 270 | 41.55 | |
30253608 | MONO TEST | LAB | 302 | 86308 | 41.44 |
30300726 | MORGAN DELIVERY SET | CS | 270 | 122.40 | |
30300954 | MORGAN LENS | CS | 270 | 122.40 | |
30359222 | MORPHINE IV DRIP 100MG | RX | 636 | J2270 | 46.00 |
30355785 | MORPHINE OS 10MG/5ML | RX | 251 | 8.60 | |
30350303 | MORPHINE OS 20MG/ML PER DOSE | RX | 251 | 2.50 | |
30350084 | MORPHINE SULF UP TO 10MG INJ - 10MG VL | RX | 636 | J2270 | 22.70 |
30350080 | MORPHINE SULF UP TO 10MG INJ - 2MG SYR | RX | 636 | J2270 | 19.10 |
30350028 | MORPHINE SULF UP TO 10MG INJ - 4MG SYR | RX | 636 | J2270 | 19.00 |
30350802 | MORPHINE SULFATE ER 100MG TAB | RX | 259 | 14.10 | |
30350081 | MORPHINE SULFATE ER 15MG TAB | RX | 259 | 3.50 | |
30350344 | MORPHINE SULFATE ER 30MG TAB | RX | 259 | 2.60 | |
30350800 | MORPHINE SULFATE ER 60MG TAB | RX | 259 | 5.80 | |
30350801 | MORPHINE SULFATE IR 15MG TAB | RX | 259 | 2.50 | |
30350970 | MOXIFLOXACIN 400MG TAB | RX | 259 | 63.60 | |
30356382 | MUCINEX ER 600MG TAB | RX | 259 | 2.50 | |
30256735 | MUMPS IGG | LAB | 302 | 86735 | 104.40 |
30350590 | MUPIROCIN OINTMENT 2% PER TUBE | RX | 259 | 21.80 | |
30352027 | MYCOPHENOLIC ACID 360MG DR TAB | RX | 251 | 26.00 | |
30257581 | MYCOPLASMA PNEUMONIA | LAB | 306 | 87581 | 185.91 |
30253874 | MYOGLOBIN, SERUM | LAB | 301 | 83874 | 146.60 |
30356013 | MYRBETRIA ER 25MG TAB | RX | 252 | 38.90 | |
30351501 | NABUMETONE 500MG TAB | RX | 259 | 2.50 | |
30350393 | NABUMETONE 750MG TAB | RX | 259 | 3.10 | |
30353201 | NADOLOL 80MG TABLET | RX | 259 | 17.70 | |
30350493 | NAFCILLIN UP TO 2 GRAM INJ | RX | 636 | S0032 | 76.90 |
30350420 | NALOXONE HCL PER 1MG INJ | RX | 636 | J2310 | 28.40 |
30350563 | NAMENDA 10MG TAB | RX | 259 | 2.50 | |
30354143 | NAMENDA XR 14MG CAPSULE | RX | 252 | 40.10 | |
30352833 | NAMENDA XR 28MG TABLET | RX | 259 | 55.00 | |
30359004 | NAPROXEN 220MG TAB | RX | 259 | 2.50 | |
30350644 | NAPROXEN 500MG TAB | RX | 259 | 2.50 | |
30520008 | NASAL CANNULA 14' | CS | 271 | A4615 | 11.50 |
30520013 | NASAL CANNULA PEDATRIC | CS | 270 | 20.10 | |
30300297 | NASAL EXAM TRAY | CS | 270 | 17.95 | |
30304210 | NASAL PACKING RHINO ROC | CS | 270 | A4210 | 61.65 |
30300299 | NASAL PACKING LRGE | CS | 270 | 46.60 | |
30301130 | NASAL PACKING SMLL | CS | 279 | 11.05 | |
30300038 | NASAL RAE 6.5 | CS | 272 | 18.10 | |
30300042 | NASAL RAE 7 | CS | 272 | 18.10 | |
30300043 | NASAL RAE 7.5 | CS | 272 | 18.10 | |
30300826 | NASAL RAE 8.0 | CS | 272 | 28.25 | |
30352102 | NASONEX NASAL SPRAY 50MCG - 17GM | RX | 259 | 366.60 | |
30300843 | NASOPH AIRWAY 20FR | CS | 270 | 28.15 | |
30300844 | NASOPH AIRWAY 22FR | CS | 270 | 28.15 | |
30300845 | NASOPH AIRWAY 24fr | CS | 270 | 28.15 | |
30300450 | NASOPH AIRWAY 26FR | CS | 270 | 28.15 | |
30300451 | NASOPH AIRWAY 28FR | CS | 270 | 28.15 | |
30300452 | NASOPH AIRWAY 30FR | CS | 270 | 28.15 | |
30300587 | NASOPH AIRWAY 32FR | CS | 270 | 28.15 | |
30300846 | NASOPH AIRWAY 34FR | CS | 270 | 28.15 | |
30300601 | NASOSTAT | CS | 270 | 118.75 | |
30350562 | NATEGLINIDE 120MG TAB | RX | 259 | 3.90 | |
30300380 | NEBULIZER MASK ADULT | CS | 270 | 11.90 | |
30300706 | NEBULIZER SET UP | CS | 271 | A7003 | 12.65 |
30520027 | NEBULIZER TREATMENT | RX | 410 | 94664 | 37.75 |
30200360 | NECK SOFT TISSUE | RAD | 320 | 70360 | 174.00 |
30200361 | NECK SOFT TISSUE READING | RADP | 972 | 70360 | 37.96 |
30300550 | NEEDLE HUBER 20G | CS | 270 | 31.50 | |
30305034 | NEEDLE HUBER 19G X 1IN. | CS | 272 | 31.47 | |
30300440 | NEEDLE HUBER 19G X 3/4 in. | CS | 272 | 31.50 | |
30300605 | NEEDLE INTRAOSSEOUS 16G | CS | 270 | 153.70 | |
30301893 | NEEDLE IO EZ ADULT 25MM | CS | 270 | 220.00 | |
30301894 | NEEDLE IO EZ BARIATRIC 45MM | CS | 270 | 250.00 | |
30301892 | NEEDLE IO EZ PEDS 15MM | CS | 270 | 220.00 | |
30300808 | NEEDLE SPINAL 14G | CS | 270 | 88.50 | |
30300384 | NEEDLE SPINAL 18G | CS | 272 | 13.60 | |
30300385 | NEEDLE SPINAL 20G | CS | 272 | 13.60 | |
30300321 | NEEDLE SPINAL 22G | CS | 270 | 13.60 | |
30300386 | NEEDLE SPINAL 25G | CS | 272 | 13.60 | |
30300551 | NEEDLE SPINAL 27G | CS | 272 | 13.60 | |
37087605 | NEG PRESSURE WOUND THER <50CM | PROC | 940 | 97605 | 466.20 |
37087606 | NEG PRESSURE WOUND THER >50CM | PROC | 940 | 97606 | 466.20 |
30305071 | NEGATIVE PRESSURE MASK | CS | 270 | 35.00 | |
30300607 | NELLCOR SPO2 ADULT | CS | 270 | 89.20 | |
30300602 | NELLCOR SPO2 PEDS | CS | 270 | 89.20 | |
30350538 | NEOMYCIN/POLY B OTIC SUSP 10ML BTL | RX | 259 | 116.80 | |
30353136 | NEOMYCIN/POLY B/DEXAMETHAZONE OPTH OINTM | RX | 259 | 34.80 | |
30353562 | NEOMYCIN/POLYMYXIN/HYROCORTISONE 10ML | RX | 251 | 160.20 | |
30350729 | NEOSTIGMINE METHYL UP TO 0.5MG INJ | RX | 636 | J2710 | 28.10 |
30355360 | NEO-SYNEPHRINE NASAL SPRAY 15ML BTL | RX | 259 | 16.30 | |
30350501 | NEULASTA(PEGFILGRASTIM) 6MG INJ | RX | 636 | J2505 | 8633.30 |
30350712 | NEUPOGEN PER 1mcg | RX | 636 | J1442 | 817.80 |
30450123 | NEUROMUSCULAR REEDUCATION | PT | 420 | 97112 | 97.00 |
35059201 | NEW PATIENT LEVEL I | CLNC | 521 | 99202 | 113.92 |
35059202 | NEW PATIENT LEVEL II | CLNC | 521 | 99202 | 157.53 |
35059203 | NEW PATIENT LEVEL III | CLNC | 521 | 99203 | 197.80 |
35059204 | NEW PATIENT LEVEL IV | CLNC | 521 | 99204 | 191.10 |
35059205 | NEW PATIENT LEVEL V | CLNC | 521 | 99205 | 235.20 |
35059384 | NEW PATIENT-WELLNESS AGE 12-17YRS | CLNC | 521 | 99384 | 157.50 |
35059382 | NEW PATIENT-WELLNESS AGE 1-4YRS | CLNC | 521 | 99382 | 157.50 |
35059385 | NEW PATIENT-WELLNESS AGE 18-39YRS | CLNC | 521 | 99385 | 157.50 |
35059386 | NEW PATIENT-WELLNESS AGE 40-64YRS | CLNC | 521 | 99386 | 157.50 |
35059383 | NEW PATIENT-WELLNESS AGE 5-11YRS | CLNC | 521 | 99383 | 157.50 |
35059381 | NEW PATIENT-WELLNESS UNDER AGE 1 | CLNC | 521 | 99381 | 157.50 |
30350397 | NEXIUM 40MG CAP | RX | 259 | 3.40 | |
30355243 | NEXPLANON 68MG IMPLANT | RX | 636 | J7307 | 651.80 |
35051981 | NEXPLANON INSERTION | CLNC | 521 | 11981 | 210.00 |
35051982 | NEXPLANON REMOVAL | CLNC | 521 | 11982 | 495.00 |
35051983 | NEXPLANON REMOVAL AND REINSERTION | CLNC | 521 | 11983 | 495.00 |
35059309 | NH VISIT | CLNC | 521 | 99309 | 102.90 |
30354405 | NIACIN 500MG TAB | RX | 259 | 2.50 | |
30350530 | NIASPAN ER 500MG TAB | RX | 259 | 11.00 | |
30354529 | NICOTINE 14MG PATCH | RX | 259 | 9.80 | |
30350085 | NICOTINE 21MG PATCH | RX | 259 | 10.00 | |
30354515 | NICOTINE 4MG LOZENGE | RX | 259 | 2.80 | |
30354526 | NICOTINE 7MG PATCH | RX | 259 | 10.70 | |
30250102 | NICOTINE AND METABOLITES | LAB | 301 | 80323 | 84.00 |
30350320 | NICOTINE GUM 4MG | RX | 259 | 2.50 | |
30351103 | NIFEDIPINE 10MG TAB | RX | 259 | 3.80 | |
30350277 | NIFEDIPINE ER 30MG TAB | RX | 259 | 2.50 | |
30359104 | NITRO TD PATCH 0.2MG/HR | RX | 259 | 2.80 | |
30353153 | NITRO TD PATCH 0.3MG/HR | RX | 259 | 17.60 | |
30350304 | NITRO TD PATCH 0.4MG/HR | RX | 259 | 4.00 | |
30350087 | NITRO-BID 1GM (2%) OINT | RX | 259 | 10.20 | |
30351125 | NITROFURANTOIN 50MG CAP | RX | 259 | 14.60 | |
30358103 | NITROFURATOIN 100MG CAP | RX | 251 | 6.10 | |
30350499 | NITROGLYCERINE PER 5MG INJ | RX | 636 | J3490 | 28.60 |
30350324 | NITROPRESS UP TO 50MG INJ | RX | 636 | J3490 | 116.50 |
30350238 | NITROQUICK 0.4MG SL TAB | RX | 259 | 3.10 | |
9999999 | NO-CHARGE - CONVIENCE ITEM | ZZ | 999 | 0.00 | |
30250016 | NON CHEMNET URINE/DRUG SCREEN | LAB | 300 | 99001 | 98.00 |
30450003 | Norco Shoulder Pulley | PT | 274 | 79.75 | |
30300342 | NORMAL SALINE FOR IRR | CS | 270 | 16.95 | |
30354012 | NORMAL SALINE IV 250ML | CS | 636 | J7050 | 5.60 |
30354009 | NORMAL SALINE IV 1000ML | CS | 258 | J7030 | 11.40 |
30354013 | NORMAL SALINE IV 100ML | CS | 636 | J3490 | 10.60 |
30354019 | NORMAL SALINE IV 500ML | CS | 636 | J7040 | 5.70 |
30354018 | NORMAL SALINE IV 50ML | CS | 636 | J3490 | 8.10 |
30355167 | NORTRIPTYLINE 10MG CAPSULE | RX | 251 | 2.50 | |
30357801 | NORTRIPTYLINE 25MG CAPSULE | RX | 259 | 2.50 | |
30350757 | NORTRIPTYLINE 50MG CAP | RX | 259 | 2.50 | |
30350132 | NORTRIPTYLINE 75MG CAP | RX | 259 | 2.50 | |
30200160 | NOSE 3 VIEW | RAD | 320 | 70160 | 185.00 |
30200161 | NOSE 3 VIEW READING | RADP | 972 | 70160 | 36.52 |
35059315 | NURSING FACILITY DISCHARGE SERVICE | CLNC | 521 | 99315 | 152.30 |
35059308 | NURSING FACILITY DR VISIT | CLNC | 521 | 99308 | 85.10 |
35059307 | NURSING FACILITY DR VISIT (ROUNDS) | CLNC | 521 | 99307 | 58.80 |
35059306 | NURSING FACILITY INITIAL ADMIT | CLNC | 521 | 99306 | 290.99 |
35059318 | NURSING FACILITY YEARLY ASSESS | CLNC | 521 | 99318 | 95.60 |
30350415 | NYSTATIN OS 100,000U/ML - 5ML | RX | 259 | 10.20 | |
30350015 | NYSTATIN POWDER 15GM BOTTLE | RX | 259 | 19.60 | |
30520058 | O2 CONNECTING TUBING | CS | 270 | 4.05 | |
30300850 | O2 EXTENSION TUBING 14' | CS | 271 | A4616 | 10.20 |
30300358 | OB PACK EMERGENCY | CS | 270 | 85.55 | |
350221 | OBS ICU HOURS 2-6 | OBS | 762 | G0378 | 105.00 |
350222 | OBS ICU HOURS 6-24 | OBS | 762 | G0378 | 72.50 |
350220 | OBS ICU INTIAL | OBS | 762 | G0378 | 840.00 |
30160226 | OBS SUBSEQENT CARE LEVEL III | OBSP | 982 | 99226 | 178.15 |
30160224 | OBS SUBSEQUENT CARE LEVEL I | OBSP | 982 | 99224 | 100.00 |
30169216 | OBS SUBSEQUENT CARE LEVEL II | OBSP | 982 | 99225 | 130.00 |
30169217 | OBS. DISCHARGE I | OBSP | 982 | 99217 | 172.85 |
30160218 | OBS. INITIAL VISIT I | OBSP | 982 | 99218 | 175.20 |
30160219 | OBS. INITIAL VISIT II | OBSP | 982 | 99219 | 271.55 |
30160220 | OBS. INITIAL VISIT III | OBSP | 982 | 99220 | 351.00 |
31100026 | OBSERVATION DIRECT ADMISSION | OBS | 762 | G0379 | 525.30 |
350215 | OBSERVATION HOURS 2-6 | OBS | 762 | G0378 | 87.20 |
350216 | OBSERVATION HOURS 7-24 | OBS | 762 | G0378 | 72.50 |
350214 | OBSERVATION HOURS INITIAL | OBS | 762 | G0378 | 658.40 |
30252270 | OCCULT BLOOD | LAB | 301 | 82274 | 91.40 |
30300971 | ODOR ELIMINATING DROPS 7 | CS | 270 | A4394 | 22.05 |
30357056 | OLANZAPINE 10MG TAB | RX | 259 | 2.50 | |
30355972 | OLANZAPINE 10MG/2ML INJ | RX | 251 | 75.00 | |
30350243 | OLANZAPINE 2.5MG TAB | RX | 259 | 2.50 | |
30350892 | OLANZAPINE 20MG TAB | RX | 251 | 3.00 | |
30356381 | OLANZAPINE DISINTEGRATING 10MG TAB | RX | 252 | 9.10 | |
30252542 | Omega 3 | LAB | 301 | 82542 | 192.72 |
30350163 | OMEPRAZOLE 20MG CAP | RX | 259 | 2.50 | |
30351616 | ONDANSETRON (ZOFRAN 4MG TAB) | RX | 259 | 2.60 | |
30350279 | ONDANSETRON HCL PER 1MG INJ | RX | 636 | J2405 | 12.80 |
30353864 | ONDANSETRON ODT 4MG TAB | RX | 259 | 2.50 | |
30353140 | ONFI 10MG TABLET(S) | RX | 259 | 65.90 | |
30350497 | ONGLYZA 5MG TAB | RX | 259 | 44.80 | |
35059422 | ONLINE E/M UP TO 7 DAYS 11-20 MIN | CLNC | 521 | 99422 | 31.59 |
35059423 | ONLINE E/M UP TO 7 DAYS 21+ MIN | CLNC | 521 | 99423 | 51.04 |
35059421 | ONLINE E/M UP TO 7 DAYS 5-10 MIN | CLNC | 521 | 99421 | 15.74 |
30300008 | OPHTHALMIC BURL | CS | 270 | 35.55 | |
30305079 | OPTICELL AG GEL FIBER 2X2 | CS | 272 | A6196 | 17.54 |
30305078 | OPTICELL AG GEL FIBER 4X5 | CS | 272 | A6197 | 32.24 |
30305080 | OPTICELL AG GEL FIBER 8X12 | CS | 272 | A6198 | 90.90 |
30305076 | OPTILOCK NON-ADHESIVE 3X3 | CS | 272 | A6196 | 16.52 |
30305075 | OPTILOCK NON-ADHESIVE 5X5.5 | CS | 272 | A6197 | 15.89 |
30305077 | OPTILOCK NON-ADHESIVE 6.5X10 | CS | 272 | A6198 | 23.73 |
30300391 | ORAL AIRWAY 100MM ADULT | CS | 270 | 11.40 | |
30300392 | ORAL AIRWAY 110MM LG ADULT | CS | 270 | 11.40 | |
30300395 | ORAL AIRWAY 120MM LG ADULT | CS | 270 | 11.40 | |
30300118 | ORAL AIRWAY 30MM | CS | 270 | 11.40 | |
30300127 | ORAL AIRWAY 40 MM | CS | 270 | 11.40 | |
30300397 | ORAL AIRWAY 50MM PED | CS | 270 | 11.40 | |
30300398 | ORAL AIRWAY 60MM PED | CS | 270 | 11.40 | |
30300128 | ORAL AIRWAY 70 MM | CS | 270 | 11.40 | |
30300387 | ORAL AIRWAY 80MM | CS | 270 | 11.40 | |
30300399 | ORAL AIRWAY 90MM MED ADULT | CS | 270 | 11.40 | |
30300044 | ORAL RAE 3.0 | CS | 272 | 18.10 | |
30300045 | ORAL RAE 3.5 | CS | 272 | 18.10 | |
30300047 | ORAL RAE 4 | CS | 272 | 18.10 | |
30300053 | ORAL RAE 4.5 | CS | 272 | 18.10 | |
30300054 | ORAL RAE 5.5 | CS | 272 | 18.10 | |
30450015 | ORTHO CST/SPL/TRN PER 15 | PT | 420 | 97760 | 72.80 |
30450297 | ORTHOTIC CASTING OR STRAPPING | PT | 420 | 29799 | 72.80 |
30450036 | ORTHOTIC TRAINING PER 15 MIN | PT | 420 | 97760 | 70.60 |
30253930 | OSMOLALITY SERUM | LAB | 301 | 83930 | 52.88 |
30253935 | OSMOLALITY URINE | LAB | 301 | 83935 | 54.60 |
30207075 | OSSEOUS SURVEY COMPLETE | RAD | 320 | 77075 | 415.00 |
30300370 | OSTOMY CLAMPS | CS | 270 | A4363 | 23.66 |
30300613 | OSTOMY FLANGE 2 1/4 | CS | 270 | A4414 | 93.00 |
30300920 | OSTOMY FLANGE 2 3/4 | CS | 270 | A4415 | 96.60 |
30300913 | OSTOMY FLANGE BX | CS | 270 | A4414 | 89.56 |
30300924 | OSTOMY FLANGE BX 5 | CS | 270 | A4409 | 93.00 |
30300560 | OSTOMY POUCH 2 3/4 BX | CS | 270 | 93.85 | |
30300914 | OSTOMY POUCH BX | CS | 270 | A5063 | 94.90 |
30300614 | OSTOMY POUCH BX 10 | CS | 270 | A5063 | 93.85 |
30300823 | OSTOMY POWDER | CS | 270 | 13.10 | |
30300824 | OSTOMY SKIN CREAM | CS | 270 | A4377 | 12.15 |
37082000 | OUTPATIENT VISIT LEVEL 1 | NUR | 450 | 99212 | 78.80 |
37083001 | OUTPATIENT, PROVIDER | PROC | 982 | 99202 | 92.00 |
31100113 | OUTPT IV INF, SEQUENTIAL INF OF NEW DRUG | OBS | 260 | 96367 | 79.76 |
31100110 | OUTPT IV INFUS HYDRAT EACH ADD HR | OBS | 260 | 96361 | 52.17 |
31100109 | OUTPT IV INFUS HYDRAT, INITIAL, 31M-1H | OBS | 260 | 96360 | 269.66 |
31100111 | OUTPT IV INFUS INITIAL UP TO 1 HR | OBS | 260 | 96365 | 269.66 |
31100112 | OUTPT IV INFUS EACH ADDITIONAL HR | OBS | 260 | 96366 | 52.17 |
30257177 | OVA AND PARASITE | LAB | 306 | 87177 | 71.20 |
30253945 | OXALATE URINE | LAB | 301 | 83945 | 114.15 |
30359301 | OXCARBAZEPINE 300MG TAB | RX | 259 | 2.50 | |
30259512 | OXCARBAZEPINE METABOLITE | LAB | 301 | 80183 | 106.00 |
35054760 | OXIMETER | CLNC | 521 | 94760 | 11.60 |
30350761 | OXYBUTYNIN 5MG TAB | RX | 259 | 2.50 | |
30357137 | Oxybutynin ER 10MG TAB | RX | 259 | 5.70 | |
30350275 | OXYBUTYNIN ER 5MG TAB | RX | 251 | 4.50 | |
30350181 | OXYCODONE ER 10MG TAB | RX | 259 | 16.10 | |
30350328 | OXYCODONE ER 20MG TAB | RX | 259 | 22.90 | |
30350351 | OXYCODONE IR 15MG TAB | RX | 259 | 2.50 | |
30350509 | OXYCODONE IR 30MG TAB | RX | 259 | 2.50 | |
30350381 | OXYCODONE IR 5MG TAB | RX | 259 | 2.50 | |
30350325 | OXYCODONE/ASPIRIN 5/325MG TAB | RX | 259 | 2.70 | |
30351510 | OXYCONTIN 15MG TAB | RX | 259 | 15.00 | |
30353010 | OXYCONTIN 30MG TAB | RX | 259 | 19.80 | |
34000002 | OXYGEN CONCENTRATOR MONTHLY | LTC | 270 | 143.80 | |
34000003 | OXYGEN E-TANK | LTC | 270 | 9.20 | |
30520028 | OXYGEN/HOURLY | RX | 270 | 9.45 | |
30350939 | OXYTOCIN UP TO 10UNITS INJ | RX | 636 | J2590 | 15.90 |
30259016 | PACKED RED BLOOD CELLS | LAB | 381 | P9021 | 309.34 |
30300674 | PACKING IODOFORM 1 | CS | 272 | A6407 | 27.30 |
30300675 | PACKING IODOFORM 1/2 | CS | 272 | 27.30 | |
30300715 | PACKING IODOFORM 1/4 | CS | 272 | A6407 | 27.30 |
30300101 | PACKING STRIP PLAIN 1 | CS | 272 | A6407 | 19.10 |
30300100 | PACKING STRIP PLAIN 1/2 | CS | 272 | A6407 | 25.55 |
30300099 | PACKING STRIP PLAIN 1/4 | CS | 272 | A6407 | 27.30 |
30300716 | PACKING STRIP PLAIN 2 | CS | 272 | A6407 | 12.75 |
30300088 | PAD FEMALE MAXI | CS | 270 | 1.90 | |
30301864 | PAD FEMALE MODERATE | CS | 270 | A4520 | 1.30 |
30300087 | PAD FEMALE THIN | CS | 270 | A4520 | 2.50 |
37361019 | PALS ATTENDANT 15 MIN | PALS | 580 | T1019 | 5.49 |
37365126 | PALS COMMUNITY INTEGRATION | PALS | 580 | S5126 | 5.78 |
37362001 | PALS MEDICAL ESCORT PER 15 MIN | PALS | 580 | T2001 | 5.67 |
37360080 | PALS MEDICAL ESCORT/SHOPPING/MILE | PALS | 990 | T2001 | 0.33 |
37360000 | PALS MEDICAL SUPPLIES | PALS | 580 | 0.00 | |
37361008 | PALS PRIVATE ATT. PER 15 MN WEEKEND | PALS | 580 | T1019 | 8.51 |
37361020 | PALS PRIVATE ATTENDANT PER 15 MIN | PALS | 580 | T1019 | 5.49 |
37360003 | PALS PRIVATE MILEAGE PER MILE | PALS | 580 | A0080 | 0.55 |
37360002 | PALS PRIVATE NURSE PER 15MIN | PALS | 580 | T1019 | 9.00 |
37361006 | PALS VA ATTENDANT PER 15 MIN | PALS | 580 | G0156 | 5.75 |
37361007 | PALS VA RESPITE PER 15 MIN | PALS | 580 | S9125 | 5.55 |
37360006 | PALS WAIVER HOMEMAKING PER 15 MIN | PALS | 580 | S5130 | 4.52 |
37360007 | PALS WAIVER NURSE SERVICE PER 15MI | PALS | 580 | T1002 | 11.59 |
37361005 | PALS WAIVER RESPITE CARE | PALS | 580 | T1005 | 3.76 |
37360005 | PALS WAIVER SOCIAL TRANSPRT PR MIL | PALS | 580 | S0215 | 0.33 |
37360004 | PALS WAIVER SOCIAL/SUPER PER 15MIN | PALS | 580 | T1019 | 5.78 |
30253525 | PANCREATIC ELASTASE FECAL | LAB | 301 | 82656 | 92.24 |
30350236 | PANTOPRAZOLE 40MG TAB | RX | 259 | 2.50 | |
30352355 | PANTOPRAZOLE PER 40MG INJ - BOLUS/INF | RX | 636 | J3490 | 44.60 |
30353507 | PANTOPRAZOLE PER 40MG INJ - IVP | RX | 636 | J3490 | 29.80 |
35050091 | PAP SMEAR | CLNC | 770 | Q0091 | 36.80 |
30300304 | PARACENTISIS TRAY | CS | 270 | 56.35 | |
30256253 | PARANEOPLASTIC PANEL | ||||
35051055 | PARING OR CUTTING OF BENIGN LESION | CLNC | 521 | 11055 | 60.90 |
30355430 | PAROXETINE 10MG TABLET | RX | 259 | 2.50 | |
30350091 | PAROXETINE 20MG TAB | RX | 259 | 2.50 | |
30350842 | PAROXETINE 30MG TABLET | RX | 259 | 2.50 | |
30354552 | PAROXETINE ER 37.5MG TAB | RX | 259 | 17.80 | |
30300793 | PASTE FLANGE 79300 | CS | 270 | A4406 | 49.85 |
30258305 | PATH. SURGICAL GROSS & M | LAB | 310 | 88305 | 141.92 |
30255060 | PATHOLOGIST REVIEW OF SL | LAB | 971 | 85060 | 87.70 |
30300049 | PEAK FLOW METER | CS | 270 | A4614 | 71.35 |
35059072 | PEDIARIX DTAP-HEPB-IPV | CLNC | 521 | 90723 | 152.00 |
35050647 | PEDVAXHIB-MENINGOCOCCAL | CLNC | 521 | 90647 | 75.90 |
30202170 | PELVIS 1-2 VIEW | RAD | 320 | 72170 | 175.00 |
30202171 | PELVIS 1-2 VIEW READING | RADP | 972 | 72170 | 36.52 |
30307350 | PELVIS HIP UNILATERAL | RAD | 320 | 73501 | 173.00 |
30203501 | PELVIS HIP UNILATERAL READING | RADP | 972 | 73501 | 39.40 |
30350258 | PENICILLIN VK 500MG TAB | RX | 259 | 2.50 | |
30354527 | PENICILLIN VK OS 250MG/5ML - 100ML BTL | RX | 259 | 14.00 | |
30300443 | PENROSE TUBING 1/2 X 12 | CS | 270 | 2.60 | |
30300578 | PENROSE TUBING 1/4 | CS | 270 | 2.60 | |
30300445 | PENROSE TUBING 1X18 | CS | 270 | 2.60 | |
30350473 | PENTASA CR 500MG CAPSULE | RX | 259 | 17.40 | |
30354516 | PENTOXIFYLLINE ER 400MG TAB | RX | 259 | 2.50 | |
30520034 | PERCUSSION & POSTURAL DR | RX | 270 | 37.75 | |
30357606 | PERFOROMIST INH SOLN PER 20MCG | RX | 636 | J7606 | 18.10 |
30300057 | PERINAL IRRIGATION KIT | CS | 270 | 5.25 | |
30354260 | PERMETHRIN CREAM 5% 2.2 OZ TUBE | RX | 259 | 169.10 | |
30356021 | PERPHENAZINE 2MG TAB | RX | 251 | 5.30 | |
37360009 | PERS INSTALLATION AND TESTING | PALS | 580 | S5160 | 102.76 |
37360010 | PERS RENTAL | PALS | 580 | S5161 | 70.90 |
37360011 | PERS RENTAL SELF DIRECT | PALS | 580 | S5161 | 45.00 |
30305052 | PESSARY RING SZ 4 | CS | 271 | A4562 | 117.95 |
30305055 | PESSARY RING SZ 6 | CS | 271 | A4562 | 119.75 |
30305056 | PESSARY RING SZ 8 | CS | 271 | A4562 | 119.75 |
30300062 | PETROLATUM 6X36 | CS | 270 | 13.50 | |
30300346 | PETROLATUM GAUZE 3X9 | CS | 270 | 12.60 | |
30300084 | PETROLATUM GZE STRP 1/2X72 | CS | 270 | 13.50 | |
30300205 | PETROLATUM GZE STRP 1X36 | CS | 270 | 13.50 | |
30358001 | PHENAZOPYRIDINE 200MG TAB | RX | 259 | 6.00 | |
30350458 | PHENAZOPYRIDINE 97.5MG TAB | RX | 259 | 2.50 | |
30250184 | PHENOBARB | LAB | 301 | 80184 | 122.40 |
30350618 | PHENOBARBITAL 30MG TAB | RX | 259 | 2.50 | |
30350954 | PHENTERMINE 37.5MG TAB | RX | 259 | 2.50 | |
30351001 | PHENYTOIN 50MG CHEWABLE TABLET | RX | 259 | 3.90 | |
30258018 | PHENYTOIN SOD LEVEL | LAB | 301 | 80185 | 106.00 |
30354226 | PHENYTOIN SOD OS 125mg/5ml | RX | 259 | 10.90 | |
30350920 | PHENYTOIN SOD PER 50MG INJ | RX | 636 | J1165 | 17.40 |
30259195 | PHLEBOTOMY THERAPEUTIC | LAB | 940 | 99195 | 130.95 |
30350615 | PHOS-NAK PER PACKET | RX | 252 | 3.40 | |
30254100 | PHOSPHOROUS | LAB | 301 | 84100 | 45.60 |
30252804 | PH-VENOUS BLOOD | LAB | 301 | 82800 | 88.00 |
30450018 | PHYS THER EVAL PER 20 MIN | PT | 424 | 97161 | 199.00 |
30450004 | PHYS THER EVAL PER 30 MIN | PT | 424 | 97162 | 229.00 |
30450007 | PHYS THER EVAL PER 45 MIN | PT | 424 | 97163 | 249.00 |
30450019 | PHYS THER RE-EVAL PER 15 | PT | 424 | 97164 | 117.75 |
30355223 | PIPERACIL/TAZO 1/0.125GM INJ (3.37gm vl) | RX | 636 | J2543 | 24.90 |
30354534 | PIPERACILLIN/TAZO 1/0.125GM INJ (4gm vl) | RX | 636 | J2543 | 75.60 |
30255595 | PLATELET COUNT | LAB | 305 | 85049 | 70.35 |
30300364 | PLEUR-EVAC | CS | 270 | 172.65 | |
35051699 | PNEUMOCOCCAL VACCINE ADMIN-MEDICARE | CLNC | 771 | G0009 | 0.00 |
30300801 | PNEUMOTHORAX KIT | CS | 270 | 180.60 | |
30350417 | PNEUMOVAX 23 VACCINE | RX | 636 | 90732 | 232.70 |
30256356 | PNH BY FLOW CYTOMETRY | LAB | 302 | 86356 | 214.20 |
30300543 | POLAR FROST 5/PKT | CS | 270 | 13.00 | |
30350621 | POLYETHELENE GLYCOL PER 17GM DOSE | RX | 251 | 2.50 | |
30254132 | POTASSIUM | LAB | 301 | 84132 | 45.60 |
30351110 | POTASSIUM 99MG TAB | RX | 259 | 2.50 | |
30350078 | POTASSIUM CHL ER 10MEQ TAB | RX | 259 | 2.50 | |
30350052 | POTASSIUM CHL ER 20MEQ TAB | RX | 259 | 2.50 | |
30350666 | POTASSIUM CHL PER 2MEQ INJ - 40MEQ VL | RX | 636 | J3480 | 0.50 |
30354078 | POTASSIUM CHL PER 2MEQ INJ - PREMIX | RX | 636 | J3480 | 0.00 |
30350051 | POTASSIUM CHLORIDE ER 8MEQ TAB | RX | 259 | 2.50 | |
30350053 | POTASSIUM OS 20MEQ/15ML | RX | 259 | 2.50 | |
30356810 | POTASSIUM PHOS/SODIUM PHOS 250MG TAB | RX | 251 | 2.50 | |
30254133 | POTASSIUM URINE | LAB | 301 | 84133 | 45.60 |
30300815 | POVIDONE IODINE PREP SOLUTION | CS | 270 | 9.36 | |
30300352 | POVIDONE IODINE SWABSTICK | CS | 270 | 2.30 | |
30354800 | PRADAXA 150MG CAPSULE | RX | 259 | 23.00 | |
30359616 | PRAMIPEXOLE 0.125MG TAB | RX | 259 | 2.50 | |
30354203 | PRAMIPEXOLE 0.5MG TAB | RX | 251 | 2.50 | |
30350510 | PRAVASTATIN 20MG TAB | RX | 259 | 2.50 | |
30351709 | PRAVASTATIN 40MG TAB | RX | 259 | 2.50 | |
30354528 | PRAVASTATIN 80MG TAB | RX | 259 | 12.60 | |
30354600 | PRAZOSIN 1MG TAB | RX | 259 | 2.50 | |
30356802 | PRAZOSIN 2MG CAP | RX | 251 | 3.60 | |
30350479 | PRED FORTE OPHTH SUSP PER BTL | RX | 251 | 110.70 | |
30354248 | PREDNISOLONE 15MG/5ML PER DOSE | RX | 259 | 5.00 | |
30350092 | PREDNISOLONE OS 5MG/5ML | RX | 636 | J7510 | 15.90 |
30350908 | PREDNISONE 10MG TAB | RX | 251 | 2.50 | |
30350099 | PREDNISONE 1MG TAB | RX | 251 | 2.50 | |
30359802 | PREDNISONE 20MG TAB | RX | 251 | 2.50 | |
30359800 | PREDNISONE 5MG TAB | RX | 251 | 2.50 | |
30251025 | PREGNANCY TEST URINE | LAB | 307 | 81025 | 40.20 |
30351119 | PREMARIN 0.3MG TAB | RX | 259 | 16.60 | |
30350175 | PREMARIN 0.625 TAB | RX | 259 | 16.60 | |
30300291 | PREP BASIN | CS | 270 | 3.80 | |
30300786 | PRESSURE INFUSER BAG | CS | 270 | 84.08 | |
35059067 | PREVNAR13-PNEUMOCOCCAL 13 | RX | 636 | 90670 | 248.30 |
30350617 | PRIMAXIN PER 250MG INJ | RX | 636 | J0743 | 40.40 |
30250188 | PRIMIDONE | LAB | 301 | 80188 | 132.72 |
30350808 | PRIMIDONE 50MG TAB | RX | 259 | 2.50 | |
30354501 | PRISTIQ SR 100MG TAB | RX | 259 | 27.10 | |
30359001 | PROBIOTIC CAPSULE | RX | 259 | 2.90 | |
30350735 | PROCAINAMIDE HCL UP TO 1GM INJ | RX | 636 | J2690 | 118.10 |
30254145 | PROCALCITONIN | LAB | 301 | 84145 | 217.76 |
30350150 | PROCHLORPERAZINE 25MG SUPP | RX | 259 | 23.80 | |
30300990 | PROFORE LITE | CS | 270 | 53.00 | |
30254144 | PROGESTERONE | LAB | 301 | 84144 | 166.88 |
PT28984 | PROGRESS CARRY/MOVE/HANDLE OBJ CURRENT | PT | 420 | G8984 | 0.01 |
PT28985 | PROGRESS CARRY/MOVE/HANDLE OBJ GOAL | PT | 420 | G8985 | 0.01 |
PT28981 | PROGRESS CHANGE/MAINTAIN BODY POS CURREN | PT | 420 | G8981 | 0.01 |
PT28982 | PROGRESS CHANGE/MAINTAIN BODY POS GOAL | PT | 420 | G8982 | 0.01 |
PT28978 | PROGRESS MOBILITY WALK/MOVE CURRENT | PT | 420 | G8978 | 0.01 |
PT28979 | PROGRESS MOBILITY WALK/MOVE GOAL | PT | 420 | G8979 | 0.01 |
PT28993 | PROGRESS OTHER SUBSEQUENT CURRENT | PT | 420 | G8993 | 0.01 |
PT28994 | PROGRESS OTHER SUBSEQUENT GOAL | PT | 420 | G8994 | 0.01 |
PT28990 | PROGRESS PRIMARY CURRENT | PT | 420 | G8990 | 0.01 |
PT28991 | PROGRESS PRIMARY GOAL | PT | 420 | G8991 | 0.01 |
PT28987 | PROGRESS SELF CARE CURRENT | PT | 420 | G8987 | 0.01 |
PT28988 | PROGRESS SELF CARE GOAL | PT | 420 | G8988 | 0.01 |
30254206 | PROINSULIN | LAB | 301 | 84206 | 171.00 |
30254146 | PROLACTIN | LAB | 301 | 84146 | 155.04 |
30357100 | PROLIA PER 1 MG INJ | RX | 636 | J0897 | 2041.40 |
30350110 | PROMETHAZINE 12.5MG SUPP | RX | 259 | 33.60 | |
30350342 | PROMETHAZINE 12.5MG TAB | RX | 259 | 2.50 | |
30350329 | PROMETHAZINE 25MG SUPP | RX | 259 | 23.10 | |
30350394 | PROMETHAZINE 25MG TAB | RX | 259 | 2.50 | |
30350107 | PROMETHAZINE UP TO 50MG INJ - 25mg/ml | RX | 636 | J2175 | 14.70 |
30355201 | PROPAFENONE 225MG TABLET | RX | 259 | 3.00 | |
30350151 | PROPARACAINE 0.5% EYE DROPS PER DOSE | RX | 259 | 2.50 | |
30350200 | PROPRANOLOL 10MG TAB | RX | 251 | 2.50 | |
30350440 | PROPRANOLOL 20MG TAB | RX | 259 | 2.50 | |
30358421 | PROPRANOLOL 40MG TAB | RX | 251 | 2.50 | |
30352763 | PROPRANOLOL ER 20MG/ML PER DOSE | RX | 259 | 2.50 | |
30350736 | PROPRANOLOL UP TO 1MG INJ | RX | 636 | J1800 | 42.40 |
30350544 | PROPYLTHIOURACIL 50MG TAB | RX | 259 | 3.90 | |
35056409 | PROQUAD VACCINE | CLNC | 521 | 90710 | 286.20 |
30450020 | PROSTHETIC TRAIN PER 15 | PT | 420 | 97761 | 70.60 |
30254155 | PROTEIN TOTAL | LAB | 301 | 84155 | 85.30 |
30251008 | PROTEIN BODY FLUID | LAB | 301 | 84157 | 32.00 |
30254156 | PROTEIN URINE | LAB | 301 | 84156 | 29.36 |
30255610 | PROTIME | LAB | 305 | 85610 | 58.90 |
30350903 | PROVIGIL 200MG TAB | RX | 259 | 20.20 | |
30351211 | PRUCLAIR NON STEROIDAL CREAM PER TUBE | RX | 259 | 144.90 | |
30254153 | PSA TOTAL | LAB | 301 | 84153 | 157.12 |
30350688 | PSEUDOEPHEDRINE 30MG TAB | RX | 259 | 2.50 | |
35059791 | PSYCHIATRIC DIAGNOSTIC EVAL | CLNC | 900 | 90791 | 189.39 |
35059832 | PSYCHOTHERAPY 16-30 MINS | CLNC | 900 | 90832 | 94.77 |
35059834 | PSYCHOTHERAPY 38-52 MINS | CLNC | 900 | 90834 | 126.36 |
61059837 | PSYCHOTHERAPY 52+ MIN SB | SBP | 900 | 90837 | 188.85 |
35059837 | PSYCHOTHERAPY 52+ MINS | CLNC | 900 | 90837 | 188.85 |
35059847 | PSYCHOTHERAPY FAMILY W/PATIENT 50 MIN | CLNC | 916 | 90847 | 158.34 |
35059840 | PSYCHOTHERAPY FOR CRISIS EA ADDL 30 MIN | CLNC | 900 | 90840 | 94.77 |
35059839 | PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINS | CLNC | 900 | 90839 | 197.33 |
30450009 | PT ANNUAL ASSESSMENT | PT | 421 | 50.00 | |
30457750 | PT PHYSICAL PERFORMANCE TEST PER 15 MIN | PT | 420 | 97750 | 75.00 |
30253970 | PTH PARATHYROID HORMONE | LAB | 301 | 83970 | 319.50 |
30255730 | PTT | LAB | 305 | 85730 | 78.08 |
30350247 | PULMICORT INHLER 90MCG - 120 DOSE | RX | 259 | 227.00 | |
30300617 | PVP SOLUTION | CS | 270 | 8.55 | |
30351671 | QUETIAPINE 200MG TAB | RX | 259 | 2.50 | |
30300259 | QUICK COMBO ADULT | CS | 270 | 182.80 | |
30300258 | QUICK COMBO PEDS | CS | 270 | 159.60 | |
30300513 | QUICK TRACH 2.0 | CS | 270 | 434.60 | |
30300312 | QUICK TRACH 4.0 | CS | 270 | 434.60 | |
30356990 | QUINAPRIL 20MG TAB | RX | 259 | 2.50 | |
30352098 | QUINAPRIL 40 MG TAB | RX | 259 | 3.00 | |
30350373 | RABIES VACCINE HYPERRAB 150IU/1ML | RX | 636 | 90375 | 1216.20 |
30350372 | RABIES VACCINE RABAVERT | RX | 636 | 90675 | 519.50 |
30350293 | RACEPINEPHRINE 2.25% 0.5ML INH | RX | 259 | 5.10 | |
30350520 | RAMIPRIL 2.5MG CAP | RX | 259 | 2.50 | |
30350262 | RAMIPRIL 5MG CAP | RX | 259 | 2.50 | |
30357500 | RANEXA 500MG ER TABLET | RX | 252 | 19.80 | |
30350295 | RANITIDINE 150MG TAB | RX | 259 | 2.50 | |
30350144 | RANITIDINE HCL 25MG INJ | RX | 636 | J2780 | 20.70 |
30350447 | RANITIDINE ORAL LIQUID PER DOSE | RX | 259 | 5.90 | |
30304929 | RAPID RHINO 5.5 | CS | 270 | 151.50 | |
30304928 | RAPID RHINO 7.5 | CS | 270 | 148.53 | |
30454724 | Rear Foot Post 4 | PT | 270 | 23.33 | |
30450002 | REAR FOOT POST 5 | PT | 274 | 23.33 | |
30350136 | RECLAST (ZOLEDRONIC ACID) 1MG INJ | RX | 636 | J3489 | 142.30 |
30358451 | RED YEAST RICE 600MG CAP | RX | 251 | 2.50 | |
30350097 | REFRESH CLASSIC OPHTH DROPETTE | RX | 259 | 2.50 | |
30359010 | REMDESIVIR PER 100MG VIAL | RX | 252 | 790.00 | |
35059454 | REMOTE PAT. MONT. DEVICE READING FEE | CLNC | 521 | 99454 | 64.38 |
35059457 | REMOTE PATIENT MONITORING SERVICE | CLNC | 521 | 99457 | 52.45 |
35059453 | REMOTE PATIENT MONITORING SET UP FEE | CLNC | 521 | 99453 | 19.69 |
35059209 | REMOVAL IMPACTED CERUMEN / IRRIGATE | CLNC | 521 | 69209 | 21.80 |
35059210 | REMOVAL IMPACTED CERUMEN W/ INSTRUMENT | CLNC | 521 | 69210 | 69.30 |
35057938 | REMOVAL OF FOREIGN BODY EYE | CLNC | 521 | 65222 | 267.80 |
35056320 | REMOVAL OF IMPLANT FINGER OR HAND | CLNC | 510 | 26320 | 373.80 |
35051200 | REMOVAL OF SKIN TAG(S) | CLNC | 521 | 11200 | 94.50 |
30250069 | RENAL FUNCTION PANEL | LAB | 301 | 80069 | 121.20 |
30254244 | RENIN PLASMA | LAB | 301 | 84244 | 136.30 |
35053131 | REPAIR COMPLEX 1.1-2.5 CM | CLNC | 521 | 13131 | 378.00 |
35052032 | REPAIR INTERMEDIATE 2.6-7.5 CM | CLNC | 510 | 12032 | 308.70 |
35052031 | REPAIR-INTERMEDIATE 2.5CM OR LESS | CLNC | 510 | 12031 | 234.20 |
35050123 | RESPIRATOR PHYSICAL-CITY OF FORSYT | CLNC | 521 | 99212 | 63.00 |
30257634 | RESPIRATORY PANEL | ||||
30257633 | RESPIRATORY VIRUS | LAB | 306 | 87633 | 1032.27 |
30350560 | RESTASIS 0.05% OPTH PER DROPETTE | RX | 259 | 27.40 | |
30300122 | RESTON SHEET | CS | 270 | E1399 | 20.05 |
30300610 | RESUSCITATOR AMBU PED NEO | CS | 270 | 90.80 | |
30300510 | RETAINER GAUZE SZ 1 PER INCH | CS | 270 | A6457 | 2.50 |
30300406 | RETAINER GAUZE SZ 10 PER INCH | CS | 270 | A6457 | 2.50 |
30300418 | RETAINER GAUZE SZ 2 PER INCH | CS | 270 | A6457 | 2.50 |
30300411 | RETAINER GAUZE SZ 3 PER INCH | CS | 270 | A6457 | 2.50 |
30300412 | RETAINER GAUZE SZ 4 PER INCH | CS | 270 | A6457 | 2.50 |
30300714 | RETAINER GAUZE SZ 5 PER INCH | CS | 270 | A6457 | 2.50 |
30300413 | RETAINER GAUZE SZ 5.5 PER INCH | CS | 270 | A6457 | 2.50 |
30300414 | RETAINER GAUZE SZ 6 PER INCH | CS | 270 | A6457 | 2.50 |
30300415 | RETAINER GAUZE SZ 7 PER INCH | CS | 270 | A6457 | 2.50 |
30300416 | RETAINER GAUZE SZ 8 PER INCH | CS | 270 | A6457 | 2.50 |
30300417 | RETAINER GAUZE SZ 9 PER INCH | CS | 270 | A6457 | 2.50 |
30255045 | RETICULOCYTE COUNT | LAB | 305 | 85045 | 36.00 |
30253523 | RF By EIA | LAB | 301 | 83516 | 92.24 |
30256901 | RH TYPE | LAB | 300 | 86901 | 45.50 |
30256430 | RHEUMATOID FACTOR | LAB | 302 | 86430 | 49.12 |
30600006 | RHYTHM STRIP 1-3 LEADS | RAD | 730 | 93041 | 83.85 |
30256234 | RIBONUCLEIC PROTEIN | LAB | 302 | 86235 | 143.44 |
30201112 | RIBS BILATERAL 3 VIEW READING | RADP | 972 | 71110 | 61.08 |
30201110 | RIBS BILATERAL 3 VIEWS | RAD | 320 | 71110 | 239.00 |
30201103 | RIBS UNILAT, AND PA CHEST READING | RADP | 972 | 71101 | 55.28 |
30201101 | RIBS UNILATERAL & PA CHEST | RAD | 320 | 71101 | 226.00 |
30201100 | RIBS UNILATERAL 2 VIEWS | RAD | 320 | 71100 | 213.00 |
30201102 | RIBS UNILATERAL READING | RADP | 972 | 71100 | 46.64 |
30352006 | RIFAMPIN 150MG CAP | RX | 259 | 5.30 | |
30350740 | RISAMINE OINT 4OZ TUBE | RX | 259 | 14.80 | |
30350180 | RISPERIDONE 0.25MG TAB | RX | 259 | 2.50 | |
30350435 | RISPERIDONE 0.5MG TAB | RX | 259 | 2.50 | |
30350297 | RISPERIDONE 1MG TAB | RX | 259 | 2.50 | |
30356006 | RISPERIDONE 4MG TAB | RX | 251 | 2.50 | |
34003211 | ROOM CHARGE BED HOLD | LTC | 120 | 0.00 | |
31007100 | ROOM HOSPITAL RESPITE | NUR | 120 | 195.00 | |
31204100 | ROOM ICU | NUR | 200 | 1513.00 | |
31002100 | ROOM MEDICAL SEMIPRIVATE | NUR | 120 | 1263.00 | |
34002200 | ROOM NH PRIVATE | LTC | 120 | 195.00 | |
34009700 | ROOM NH PRIVATE & HALF | LTC | 120 | 257.00 | |
34007100 | ROOM NH RESPITE CARE | LTC | 120 | 195.00 | |
34003200 | ROOM NH SEMIPRIVATE | LTC | 120 | 195.00 | |
34059700 | ROOM NH SWG PRIVATE & HALF | NHSB | 120 | 257.00 | |
34053200 | ROOM NH SWG SEMIPRIVATE | NHSB | 120 | 195.00 | |
34004300 | ROOM NH VA HEAVY REHAB | LTC | 120 | 598.79 | |
34004200 | ROOM NH VA REDUCED FUNCTION | LTC | 120 | 250.54 | |
34004400 | ROOM NH VA SPECIAL CARE | LTC | 120 | 375.81 | |
34052200 | ROOM SKILLED PRIVATE | LTC | 120 | 160.00 | |
31056100 | ROOM SWING BED | SB | 120 | 986.00 | |
30350353 | ROPINIROLE 0.25MG TAB | RX | 259 | 2.50 | |
30350135 | ROPINIROLE 2MG TAB | RX | 259 | 2.50 | |
35054502 | ROSUVASTATIN | RX | 251 | 2.50 | |
30256592 | RPR | LAB | 302 | 86592 | 34.16 |
30257420 | RSV | LAB | 306 | 87420 | 111.28 |
30256762 | RUBELLA | LAB | 302 | 86762 | 115.12 |
30202202 | S/I JOINTS 3 VIEW | RAD | 320 | 72202 | 217.00 |
30202220 | SACRUM/COCCYX 1-2 VIEW | RAD | 320 | 72220 | 192.00 |
30202221 | SACRUM/COCCYX 1-2 VIEWS READING | RADP | 972 | 72220 | 36.52 |
30300710 | SALEM SUMP 10FR | CS | 270 | 8.35 | |
30300673 | SALEM SUMP 12FR | CS | 270 | 23.60 | |
30300711 | SALEM SUMP 14FR | CS | 270 | 8.35 | |
30300712 | SALEM SUMP 16FR | CS | 270 | 8.35 | |
30300713 | SALEM SUMP 18FR | CS | 270 | 8.35 | |
30300338 | SALEM SUMP 6FR | CS | 270 | 8.35 | |
30300707 | SALEM SUMP 8FR | CS | 270 | 8.35 | |
30250196 | SALICYLATE | LAB | 301 | 80307 | 300.00 |
30350112 | SALINE FLUSH | RX | 258 | 13.00 | |
30358280 | SALINE NASAL SPRAY PER BTL | RX | 259 | 4.60 | |
30252075 | SALIVA ALCOHOL TEST | LAB | 301 | 82075 | 51.00 |
30300191 | SCALPEL DISP SZ 10 | CS | 270 | 24.99 | |
30300190 | SCALPEL DISP SZ 11 | CS | 270 | 22.80 | |
30300196 | SCALPEL DISP SZ 15 | CS | 270 | A4649 | 22.80 |
30203010 | SCAPULA COMPLETE | RAD | 320 | 73010 | 184.03 |
30203011 | SCAPULA READING | RADP | 972 | 73010 | 37.96 |
30300757 | SCD LEG CUFF | CS | 270 | 87.20 | |
30202091 | SCOLIOSIS SERIES READING | RADP | 972 | 72082 | 67.28 |
30202090 | SCOLIOSIS STUDY 2 VIEW | RAD | 320 | 72082 | 251.00 |
30300969 | SCOPE SPIDER NET RETRIEVAL DEVICE | CS | 270 | 150.00 | |
30301003 | Scotch Cast Glow IN the Dark 3" | CS | 270 | 21.42 | |
30300939 | SCOTCH CAST N PINK 3 | CS | 270 | Q4050 | 48.70 |
30300809 | SCOTCH CAST SPLINT 3X12 | CS | 270 | 42.15 | |
30300810 | SCOTCH CAST SPLINT 4X30 | CS | 270 | 92.45 | |
30300811 | SCOTCH CAST SPLINT 5X30 | CS | 270 | 101.25 | |
30300237 | SCOTCH CAST WHITE 2 | CS | 270 | Q4050 | 30.10 |
30300238 | SCOTCH CAST WHITE 3 | CS | 270 | Q4050 | 30.75 |
30300239 | SCOTCH CAST WHITE 4 | CS | 270 | Q4050 | 40.15 |
30305050 | SCOTCHCAST 3 X 35 | CS | 270 | 71.85 | |
30300281 | SCOTCHCAST BLACK 2 | CS | 270 | 30.10 | |
30300290 | SCOTCHCAST BLACK 3 | CS | 270 | 30.10 | |
30301004 | SCOTCHCAST GLOW IN THE DARK 2" | CS | 270 | 18.80 | |
30300204 | SCOTCHCAST N GREEN 2 | CS | 270 | 30.75 | |
30300201 | SCOTCHCAST N ORANGE 2 | CS | 270 | 30.75 | |
30300203 | SCOTCHCAST N PINK 2 | CS | 270 | 30.75 | |
30300282 | SCOTCHCAST N. GREEN 3 | CS | 270 | 30.10 | |
30300296 | SCOTCHCAST N. ORANGE 3 | CS | 270 | 30.75 | |
30300284 | SCOTCHCAST PURPLE 2 | CS | 270 | 30.10 | |
30300293 | SCOTCHCAST PURPLE 3 | CS | 270 | 30.75 | |
30300298 | SCOTCHCAST PURPLE 4 | CS | 270 | 40.15 | |
30300286 | SCOTCHCAST RED 2 | CS | 270 | 30.10 | |
30300295 | SCOTCHCAST RED 3 | CS | 270 | 30.75 | |
30300926 | SCOTCHCAST REINFORCE STRIPS 4X36 | CS | 270 | 35.25 | |
35052111 | SCOUT PHYSICAL | CLNC | 999 | 0.00 | |
30255651 | SED RATE | LAB | 305 | 85652 | 58.90 |
30450021 | SELF CARE/HOME VISIT PER 15 MIN | PT | 420 | 97535 | 99.00 |
90009999 | SELF PAY BALANCE FORWARD | CS | 999 | 0.00 | |
30259300 | SEMEN ANALYSIS POST VASE | LAB | 309 | 89300 | 82.90 |
30359888 | SENNA 8.6MG TAB | RX | 251 | 2.50 | |
30350113 | SENNA/DOCUSATE 8.6/50MG TAB | RX | 259 | 2.50 | |
30350302 | SEROQUEL 100MG TAB | RX | 259 | 2.50 | |
30350265 | SEROQUEL 25MG TAB | RX | 259 | 2.50 | |
30350810 | SEROQUEL 300MG TAB | RX | 259 | 55.00 | |
30350363 | SERTRALINE 100MG TAB | RX | 259 | 2.50 | |
30352030 | SERTRALINE 50 MG TAB | RX | 259 | 2.50 | |
30252010 | SERUM KETONES | LAB | 301 | 82009 | 60.00 |
35051301 | SHAVING DERMAL LESION 0.6-1.0 CM | CLNC | 521 | 11301 | 101.90 |
30203020 | SHOULDER 1 VIEW | RAD | 320 | 73020 | 208.68 |
30201023 | SHOULDER 1 VIEW READING | RADP | 972 | 73020 | 32.20 |
30203021 | SHOULDER 2 VIEW READING | RADP | 972 | 73030 | 39.40 |
30203030 | SHOULDER COMPLETE 2 VIEW | RAD | 320 | 73030 | 250.04 |
30300493 | SHOULDER PULLEY SET | CS | 274 | L3650 | 49.20 |
30354530 | SILVADENE CRM 1% 400GM TUB | RX | 259 | 105.20 | |
30350174 | SILVADENE CRM 1% 50GM TUB | RX | 259 | 14.30 | |
30352052 | SILVER NITRATE STICKS | RX | 259 | 5.20 | |
30358912 | SIMETHICONE 180MG CAP | RX | 259 | 2.50 | |
30354504 | SIMETHICONE 80MG CHEWABLE TAB | RX | 259 | 2.50 | |
30352050 | SIMVASTATIN 10 MG TAB | RX | 259 | 2.50 | |
30350149 | SIMVASTATIN 20MG TAB | RX | 259 | 2.50 | |
30350490 | SIMVASTATIN 40MG TAB | RX | 259 | 2.50 | |
30350439 | SINGULAIR 10MG TAB | RX | 259 | 2.50 | |
30353000 | SITAGLIPTIN 100 MG TAB | RX | 259 | 39.10 | |
30350643 | SKELAXIN 800MG TAB | RX | 259 | 15.20 | |
30300849 | Skin Barrier Ring 2in | CS | 270 | 25.25 | |
30300828 | SKIN GEL PROTECTIVE WIPES | CS | 270 | A4377 | 38.75 |
30300866 | SKIN SCRIBE PENS | CS | 270 | 24.15 | |
30300778 | SKIN STAPLER (LACERATIONS) | CS | 270 | 40.65 | |
30200261 | SKULL COMPLETE 4 VIEW READING | RADP | 972 | 70260 | 59.64 |
30200260 | SKULL COMPLETE 4 VIEWS | RAD | 320 | 70260 | 273.00 |
30200251 | SKULL LIMITED 1-3 VIEW READING | RADP | 972 | 70250 | 42.32 |
30200250 | SKULL LIMITED 1-3 VIEWS | RAD | 320 | 70250 | 179.00 |
37085800 | SLEEP STUDY UNATTENDED, SIMULT RECORD | NUR | 920 | 95800 | 255.30 |
30300097 | SLIPPERS LARGE | CS | 270 | 16.92 | |
30300096 | SLIPPERS XLARGE | CS | 270 | 16.92 | |
30300095 | SLIPPERS XXLARGE | CS | 270 | 16.92 | |
30300098 | SLIPPERS YOUTH | CS | 270 | 16.92 | |
30257523 | SMOOTH MUSCLE ANIT-BODY | LAB | 301 | 83516 | 92.24 |
30300017 | SNARE HOT POLYPECTOMY | CS | 270 | 120.60 | |
30300086 | SOAP BAR | CS | 270 | 1.90 | |
30351508 | SOD BICARB 8.4% INJ - 50MEQ ABBOJC | RX | 636 | J3490 | 29.50 |
30254295 | SODIUM | LAB | 301 | 84295 | 45.60 |
30350913 | SODIUM BICARB 650MG TAB | RX | 259 | 2.50 | |
30350334 | SODIUM POLY SULF O/S PER 15GM/60CC | RX | 259 | 22.40 | |
30254300 | SODIUM URINE | LAB | 301 | 84300 | 45.60 |
30300574 | SOFROL 2 PER ROLL | CS | 270 | 11.34 | |
30300571 | SOFROL 3 PER ROLL | CS | 270 | Q4050 | 8.50 |
30300572 | SOFROL 4 PER ROLL | CS | 270 | 9.99 | |
30300616 | SOFROL 6 PER ROLL | CS | 270 | 16.35 | |
30350117 | SOLU-CORTEF UP TO 100MG INJ | RX | 636 | J1720 | 49.10 |
30357580 | SOLUMEDROL UP TO 125MG ING-500MG VL | RX | 636 | 79.60 | |
30350360 | SOLUMEDROL UP TO 125MG INJ | RX | 636 | J2930 | 35.20 |
30350359 | SOLUMEDROL UP TO 125MG INJ-1GM VL | RX | 636 | J2930 | 107.50 |
30350824 | SOTALOL 80MG TAB | RX | 259 | 2.50 | |
30350418 | SPACER FOR INHALER | RX | 259 | 87.70 | |
35051594 | SPECULA VAGINA | CLNC | 521 | A9900 | 15.40 |
30300734 | SPECULUM VAGINA LG | CS | 270 | 14.67 | |
30300735 | SPECULUM VAGINA MED | CS | 270 | 14.67 | |
30301039 | SPECULUM VAGINA SM | CS | 270 | 14.67 | |
30255165 | SPEP | LAB | 301 | 84165 | 85.92 |
30353504 | SPIRIVA HANDIHALER WITH 5 CAPS | RX | 259 | 115.50 | |
30356215 | SPIRIVA RESPIMAT 2.5MCG PER INHALER | RX | 259 | 113.50 | |
30520024 | SPIROMETER SETUP | NUR | 270 | 38.00 | |
30350455 | SPIRONALACTONE 25MG TAB | RX | 259 | 2.50 | |
30357536 | SPIRONALACTONE 50MG TAB | RX | 251 | 2.50 | |
30300747 | SPLINT SAM | CS | 270 | 51.15 | |
35050211 | SPORTS PHYSICAL | CLNC | 521 | 99211 | 40.00 |
30256323 | SSA (RO) ABIGG | LAB | 302 | 86235 | 178.60 |
30256324 | SSB(LA) AB IGG | LAB | 302 | 86235 | 143.44 |
30300831 | STABILIZER IO EZ | CS | 272 | 50.00 | |
30300288 | STAPLE REMOVER SKIN | CS | 270 | 18.80 | |
30300212 | STERI STRIP 1/2 | CS | 270 | 10.85 | |
30300211 | STERI STRIP 1/4 | CS | 270 | 7.60 | |
30300672 | STERILE FIELD 18x26 | CS | 272 | 18.95 | |
30300340 | STERILE WATER FOR IRRIGATION | CS | 272 | A4217 | 17.30 |
30201130 | STERNO-CLAVICULAR JOINT | RAD | 320 | 71130 | 187.00 |
30201120 | STERNUM 2 VIEW | RAD | 320 | 71120 | 187.00 |
30201125 | STERNUM READING | RADP | 972 | 71120 | 42.32 |
30300228 | STOCKENETT PER FOOT 6 | CS | 270 | 3.65 | |
30300226 | STOCKINET 2 PER FT | CS | 270 | Q4050 | 2.50 |
30300225 | STOCKINET 3 PER FT | CS | 270 | 2.50 | |
30300227 | STOCKINET 4 PER FT | CS | 270 | 2.75 | |
30252335 | STONE ANALYSIS | LAB | 301 | 82365 | 103.20 |
30253630 | STOOL WBC'S (LACTOFERRIN) | LAB | 301 | 83630 | 132.45 |
30300686 | STOPCOCK | CS | 270 | 3.05 | |
30300589 | STOPCOCK 3 WAY | CS | 270 | 31.45 | |
30300106 | STRAIGHT CATH 10FR | CS | 270 | A4351 | 9.55 |
30300108 | STRAIGHT CATH 12FR | CS | 270 | A4351 | 9.55 |
30300109 | STRAIGHT CATH 14FR | CS | 270 | A4351 | 9.55 |
30300110 | STRAIGHT CATH 16FR | CS | 270 | A4351 | 9.55 |
30300115 | STRAIGHT CATH 18FR | CS | 270 | A4351 | 9.55 |
30300841 | STRAIGHT CATH 22FR | CS | 270 | A4351 | 9.33 |
30300102 | STRAIGHT CATH 6FR | CS | 270 | A4351 | 9.55 |
30300104 | STRAIGHT CATH 8FR | CS | 270 | A4351 | 9.55 |
30300596 | STRAP MONTOGOMERY | CS | 270 | 19.36 | |
30256317 | STREP PNEUM ANTIBODIES 23 SEROTYPES | LAB | 302 | 86317 | 119.92 |
30257880 | STREP SCREEN RAPID | LAB | 306 | 87651 | 78.10 |
30300840 | STRIGHT CATH 20FR | CS | 270 | A4351 | 9.93 |
30350995 | SUCCINYLCHOLINE UP TO 20MG INJ | RX | 636 | J0330 | 76.00 |
30350416 | SUCRALFATE 1GM TAB | RX | 259 | 2.50 | |
30300393 | SUCTION CANISTER | CS | 270 | 15.66 | |
30300583 | SUCTION CATH 10FR | CS | 270 | 4.35 | |
30300664 | SUCTION CATH 12FR | CS | 270 | 4.35 | |
30300670 | SUCTION CATH 14FR | CS | 270 | 4.35 | |
30300025 | SUCTION CATH 16FR | CS | 270 | 4.35 | |
30300006 | SUCTION CATH 18FR | CS | 270 | 4.35 | |
30300582 | SUCTION CATH 6FR | CS | 270 | 4.35 | |
30300007 | SUCTION CATH 8FR | CS | 272 | 4.35 | |
30300545 | SUCTION CONNECTING TUBING | CS | 270 | A7002 | 9.60 |
30300702 | SUCTION KIT 10FR | CS | 270 | 12.55 | |
30300703 | SUCTION KIT 14FR | CS | 270 | 12.55 | |
30300704 | SUCTION KIT 18FR | CS | 270 | 12.55 | |
30300709 | SUCTION KIT 5/6FR | CS | 270 | 12.55 | |
30300701 | SUCTION KIT 8FR | CS | 270 | 12.55 | |
30300021 | SUCTION NON-COND TUBE | CS | 270 | 3.90 | |
30300303 | SUCTION TIP YANKAUER | CS | 270 | 14.58 | |
30300394 | SUCTION TUBING | CS | 270 | 8.30 | |
30300003 | SUCTION YANKAUER TUBING | CS | 270 | A7002 | 10.35 |
30350223 | SULFAMETHOXAZ/TRIM OS 200/40MG/5ML | RX | 259 | 14.10 | |
30350642 | SULFAMETHOXAZOL/TRIM 800/160MG TAB | RX | 259 | 2.50 | |
30350789 | SULFASALAZINE 500MG TAB | RX | 259 | 2.50 | |
30350044 | SUMATRIPTAN 6MG INJ | RX | 636 | J3030 | 167.40 |
30255095 | SURGE/PATH SPECIMEN | LAB | 312 | 88305 | 196.54 |
30300909 | SURGI LUBE TUBE | CS | 270 | 9.10 | |
30300334 | SURGICAL CAUTERY | CS | 270 | 40.30 | |
30300116 | SUTURE C GUT 634G | CS | 270 | 52.45 | |
30300117 | SUTURE C GUT 635G | CS | 270 | 52.45 | |
30300396 | SUTURE ETHILON 2-0 664G | CS | 270 | 33.30 | |
30300400 | SUTURE ETHILON 3-0 663G | CS | 272 | 30.30 | |
30300402 | SUTURE ETHILON 4-0 662G | CS | 272 | 30.30 | |
30300404 | SUTURE ETHILON 5-0 661G | CS | 272 | 30.30 | |
30300403 | SUTURE ETHILON 5-0 698G | CS | 272 | 30.30 | |
30300405 | SUTURE ETHILON 6-0 667G | CS | 272 | 30.30 | |
30300246 | SUTURE ETHILON 6-0 697G | CS | 270 | 19.45 | |
35051255 | SUTURE REMOVAL PLACED IN FACILITY | CLNC | 521 | 99211 | 0.00 |
35051254 | SUTURE REMOVAL SUTURED ELSEWHERE | CLNC | 521 | 99212 | 26.30 |
30300287 | SUTURE SET | CS | 270 | 28.40 | |
30304946 | SUTURE SET SMALL | CS | 272 | 28.40 | |
30300357 | SUTURE SILK 0 678g | CS | 272 | 45.60 | |
30300244 | SUTURE SILK 2-0 K833H | CS | 270 | 45.60 | |
30300366 | SUTURE SILK 3.0 k832h | CS | 272 | 45.60 | |
30300363 | SUTURE SILK 3-0 | CS | 272 | 45.60 | |
30300356 | SUTURE SILK 3-0 684g | CS | 272 | 45.60 | |
30300588 | SUTURE TOWEL DISP | CS | 270 | 3.20 | |
30300243 | SUTURE VICRYL 2-0 J317H | CS | 270 | 49.95 | |
30300301 | SUTURE VICRYL 3-0 j316h | CS | 272 | 49.95 | |
30300339 | SUTURE VICRYL 3-0 j423h | CS | 272 | 49.95 | |
30300775 | SUTURE VICRYL 3-0 J497G | CS | 270 | 49.95 | |
30300350 | SUTURE VICRYL 4-0 j310h | CS | 272 | 49.95 | |
30300351 | SUTURE VICRYL 4-0 j494g | CS | 272 | 49.95 | |
30300354 | SUTURE VICRYL 4-0 j496g | CS | 272 | 49.95 | |
30300305 | SUTURE VICRYL 5-0 j511g | CS | 272 | 49.95 | |
30300309 | SUTURE VICRYL 6-0 j510g | CS | 272 | 49.95 | |
30300241 | SUTURES C GUT 3-0 636G | CS | 270 | 19.45 | |
30300353 | SWAB LEMON GLC | CS | 270 | 1.30 | |
61059315 | SWB DISCHARGE LEVEL I | SBP | 987 | 99315 | 162.00 |
61059316 | SWB DISCHARGE LEVEL II | SBP | 987 | 99316 | 190.00 |
61059304 | SWB INITIAL ADMISSION LEVEL I | SBP | 987 | 99304 | 105.00 |
61059305 | SWB INITIAL ADMISSION LEVEL II | SBP | 987 | 99305 | 180.00 |
61059306 | SWB INITIAL ADMISSION LEVEL III | SBP | 987 | 99306 | 258.00 |
61059307 | SWB SUBSEQUENT CARE LEVEL I | SBP | 987 | 99307 | 80.40 |
61059308 | SWB SUBSEQUENT CARE LEVEL II | SBP | 987 | 99308 | 110.00 |
61059309 | SWB SUBSEQUENT CARE LEVEL III | SBP | 987 | 99309 | 145.00 |
61059310 | SWB SUBSEQUENT CARE LEVEL IV | SBP | 987 | 99310 | 175.00 |
30354550 | SYMBICORT MDI 160/4.5MCG - 60 DOSE | RX | 259 | 257.40 | |
30350314 | SYMBICORT MDI 80/4.5MCG - inhaler | RX | 259 | 259.90 | |
30357325 | SYNVISC-ONE PER 1MG INTRA-ARTICULAR INJ | RX | 636 | J7325 | 1045.30 |
30202070 | T SPINE 2 VIEW | RAD | 320 | 72070 | 196.05 |
30202072 | T SPINE 2 VIEW + SWIMMER | RAD | 320 | 72072 | 238.60 |
30202073 | T SPINE 2 VIEW + SWIMMER READING | RADP | 972 | 72072 | 48.08 |
30202071 | T SPINE 2 VIEW READING | RADP | 972 | 72070 | 42.32 |
30254480 | T3 TOTAL | LAB | 301 | 84480 | 113.44 |
30254479 | T3 UPTAKE | LAB | 301 | 84479 | 51.76 |
30254436 | T4 THYROXINE | LAB | 301 | 84436 | 58.90 |
30250197 | TACROLIMUS (FK 506) | LAB | 301 | 80197 | 109.80 |
30354567 | TACROLIMUS 0.5MG CAP | RX | 251 | 3.00 | |
30350468 | TAMIFLU 75 MG CAP | RX | 259 | 23.20 | |
30350177 | TAMIFLU OS 6MG/ML - 60ML BTL | RX | 259 | 256.20 | |
30350095 | TAMOXIFEN 20MG TAB | RX | 259 | 4.10 | |
30350460 | TAZICEF PER 500MG INJ | RX | 636 | J0713 | 32.00 |
30256743 | TB GOLD | LAB | 302 | 86480 | 368.00 |
35050443 | TB INTRADERMAL TEST | NUR | 302 | 86580 | 30.60 |
30300409 | TED HOSE KNEE LG | CS | 270 | A6531 | 51.65 |
30300789 | TED HOSE KNEE LG CLOSE TOE | CS | 270 | A6531 | 152.80 |
30300489 | TED HOSE KNEE MED | CS | 270 | A6531 | 33.25 |
30300120 | TED HOSE KNEE SM | CS | 270 | A6531 | 22.65 |
30300410 | TED HOSE KNEE XL | CS | 270 | A6531 | 51.65 |
30300692 | TED HOSE THIGH LG | CS | 270 | A6534 | 57.25 |
30300065 | TED HOSE THIGH LG SHORT | CS | 270 | 22.65 | |
30300807 | TED HOSE THIGH MED | CS | 270 | A6534 | 57.25 |
30300119 | TED HOSE THIGH SM | CS | 270 | A6534 | 38.50 |
30300693 | TED HOSE THIGH XLG | CS | 270 | A6534 | 57.25 |
30520060 | TED HOSE XXL | CS | 270 | A6531 | 25.14 |
30304909 | Tegaderm + Pad | CS | 270 | 17.46 | |
30301000 | TEGADERM 2X3 | CS | 272 | A6258 | 4.10 |
30300988 | TEGADERM 4X4 | CS | 270 | A6258 | 6.70 |
30300987 | TEGADERM 6X8 | CS | 270 | A6259 | 17.37 |
30304510 | TEGADERM IV | CS | 272 | A6257 | 3.80 |
30300681 | TEGADERM WITH PAD | CS | 270 | 4.10 | |
30250156 | TEGRETOL | LAB | 301 | 80156 | 123.70 |
30351605 | TEKTURNA (ALISKIREN) 300MG TAB | RX | 259 | 17.10 | |
35059999 | TELEMEDICINE ORIGINATING SITE FEE | CLNC | 780 | Q3014 | 26.65 |
35059990 | TELEMEDICINE ORIGINATION SITE | RAD | 780 | Q3014 | 26.65 |
31000001 | TELEMETRY | RX | 732 | 93268 | 280.00 |
30300192 | TELFA 2X3 | CS | 270 | A6402 | 2.50 |
30301591 | TELFA 3X4 | CS | 270 | 2.50 | |
30301590 | TELFA 3X4 ADHESIVE | CS | 270 | 2.50 | |
30300193 | TELFA 3X8 | CS | 270 | A6403 | 2.50 |
30301899 | TELFA 4X8 ISLAND ADH | CS | 270 | A6220 | 10.62 |
30300341 | TELFA 8X10 STERILE | CS | 270 | A6402 | 2.20 |
30300194 | TELFA ADHESIVE PADS 4X8 | CS | 270 | 6.45 | |
30301595 | TELFA MINI ISLAND | CS | 270 | A6219 | 2.50 |
30350122 | TEMAZEPAM 15MG CAP | RX | 259 | 2.50 | |
30354502 | TENECTEPLASE 1MG INJ | RX | 636 | J3101 | 9420.40 |
30350441 | TERAZOSIN 10MG CAP | RX | 259 | 2.50 | |
30355501 | TERAZOSIN 1MG CAPSULE | RX | 259 | 2.50 | |
30350123 | TERAZOSIN 5MG CAP | RX | 259 | 2.50 | |
30254402 | TESTOSTERONE FREE | LAB | 301 | 84402 | 192.20 |
30254403 | TESTOSTERONE TOTAL | LAB | 301 | 84403 | 206.48 |
30350124 | TETANUS/DIPTHERIA INJ | RX | 636 | 90714 | 80.20 |
30350574 | THEOPHYLLINE ER 300MG TAB | RX | 259 | 4.80 | |
30456666 | THERA PUTTY | CS | 270 | 23.22 | |
30458666 | THERA PUTTY BLACK | CS | 270 | 26.91 | |
30452666 | THERA PUTTY LEVEL 0 TAN | CS | 270 | 17.68 | |
30453666 | THERA PUTTY LEVEL 1 YELLOW | CS | 270 | 17.68 | |
30301607 | THERA TUBE LEVEL 3 | CS | 270 | 14.13 | |
30301608 | THERA TUBE LEVEL 4 | CS | 270 | A9300 | 15.12 |
30300717 | THERABAND LEVEL 0 | CS | 270 | 12.60 | |
30300518 | THERABAND LEVEL 1 | CS | 270 | A9300 | 10.53 |
30300514 | THERABAND LEVEL 2 | CS | 270 | A9300 | 11.16 |
30300515 | THERABAND LEVEL 3 | CS | 270 | A9300 | 12.15 |
30300539 | THERABAND LEVEL 4 | CS | 270 | A9300 | 14.04 |
30300517 | THERABAND LEVEL 5 | CS | 270 | A9300 | 15.21 |
30300519 | THERABAND LEVEL 7 | CS | 270 | A9300 | 17.64 |
30301500 | THERACANE | CS | 270 | 124.11 | |
30302666 | THERA-PUTTY (SUPER SOFT TAN) | CS | 270 | 10.00 | |
30454666 | THERAPUTTY LEVEL 2 RED | CS | 270 | 17.68 | |
30455666 | THERAPUTTY LEVEL 3 GREEN | CS | 270 | 17.68 | |
30457666 | THERAPUTTY LEVEL 4 BLUE | CS | 270 | 17.68 | |
30450022 | THERAPY EXERCISE PER 15 | PT | 420 | 97110 | 97.00 |
30350701 | THIAMINE HCL 100MG INJ | RX | 636 | J3411 | 29.10 |
30254425 | THIAMINE VITAMIN B-1 | LAB | 301 | 84425 | 105.00 |
30258175 | Thin Prep Screened by Automated System | LAB | 311 | 88175 | 60.70 |
30258142 | ThinPrep PAP Manual | LAB | 311 | 88142 | 46.43 |
30250183 | THIOPURINE METABOLITES | LAB | 301 | 80299 | 474.00 |
30350566 | THIORIDAZINE 25MG TAB | RX | 259 | 2.60 | |
30202080 | THORA-COLUMBAR 2 VIEW | RAD | 320 | 72080 | 266.27 |
30202081 | THORACOLUMBAR READING | RADP | 972 | 72080 | 42.32 |
30300324 | THOROCENTESIS TRAY DISP. | CS | 270 | 163.50 | |
30254432 | THYROGLOBULIN | LAB | 301 | 84432 | 122.55 |
30256376 | THYROID PEROXIDASE ANTIB | LAB | 302 | 86376 | 116.40 |
30203591 | TIB/FIB LOWER EXTREMITY READING | RADP | 972 | 73590 | 33.64 |
30203590 | TIBIA/FIBULA 2 VIEW | RAD | 320 | 73590 | 217.07 |
30256757 | TICK BORNE DISEASE (RICKETTSIAL) | LAB | 302 | 86757 | 154.80 |
30350483 | TIMOLOL OPH SOL 0.5% - 5ML BTL | RX | 259 | 240.50 | |
30253516 | TISSUE TRANSGLUTAMINASE IGA | LAB | 302 | 83516 | 92.24 |
30350771 | TIZANIDINE (ZANAFLEX) 4MG TAB | RX | 259 | 2.50 | |
30355103 | TIZANIDINE 2MG TAB | RX | 259 | 2.50 | |
30354725 | TOBRAMYC/DEXAMETH 0.3/0.1% OPHTH PER BTL | RX | 251 | 105.80 | |
30350556 | TOBRAMYCIN OPTH 0.3% PER 5ML BTTL | RX | 251 | 28.60 | |
30203661 | TOE READING | RADP | 972 | 73660 | 27.88 |
30203660 | TOES 2 VIEWS | RAD | 320 | 73660 | 164.00 |
30302550 | TOOTHETTES | CS | 270 | 0.00 | |
30300764 | TOOTHPASTE 3.OZ | CS | 270 | 1.85 | |
30351186 | TOPIRAMATE 100MG TABLET | RX | 259 | 2.50 | |
30351213 | TOPIRAMATE 200MG TAB | RX | 259 | 2.50 | |
30350600 | TOPIRAMATE 25MG TAB | RX | 259 | 2.50 | |
30350998 | TORSEMIDE 100MG TAB | RX | 259 | 2.50 | |
30359160 | TORSEMIDE 10MG TAB | RX | 251 | 2.50 | |
30350365 | TORSEMIDE 20MG TAB | RX | 259 | 2.50 | |
30354430 | Toviaz 8mg tab | RX | 259 | 19.70 | |
30354230 | TOVIAZ ER 4MG TAB | RX | 259 | 24.80 | |
30300311 | TRACHEOSTOMY CARE KIT | CS | 270 | 56.35 | |
30301002 | TRACHEOTOMY TUBE HOLDER | CS | 270 | 10.00 | |
30450023 | TRACTION MECHANICAL PER 15 MIN | PT | 420 | 97012 | 53.45 |
30354030 | TRADJENTA 5MG TAB | RX | 259 | 46.40 | |
30350178 | TRAMADOL 50MG TAB | RX | 259 | 2.50 | |
30356004 | TRANEXAMIC ACID PER 1000MG/10ML | RX | 251 | 26.20 | |
30354509 | TRANSDERM SCOP 1.5MG PATCH | RX | 259 | 61.00 | |
30254466 | TRANSFERRIN LEVEL | LAB | 301 | 84466 | 102.08 |
310536430 | TRANSFUSION BLOOD, SK | SB | 391 | 36430 | 650.00 |
30150104 | TRANSFUSION, BLOOD - ED | ED | 391 | 36430 | 650.00 |
31016430 | TRANSFUSION, BLOOD - INPT | NUR | 391 | 36430 | 650.00 |
31100200 | TRANSFUSION, BLOOD - OUTPT | OBS | 391 | 36430 | 650.00 |
30160390 | TRAUMA RESPONSE TEAM W/HOSP CRITIC | ED | 689 | G0390 | 1308.11 |
30350203 | TRAVATAN OPTH SOLN 0.004%-2.5ML BT | RX | 259 | 235.80 | |
30300629 | TRAY IRRIGATION | CS | 270 | 6.25 | |
30300407 | TRAY TRACHEATOMY | CS | 270 | 164.70 | |
30350916 | TRAZODONE 150MG TAB | RX | 259 | 2.50 | |
30351124 | TRAZODONE 50MG TAB | RX | 259 | 2.50 | |
30358710 | TRELEGY ELLIPTA PER INHALER | RX | 252 | 403.90 | |
30256780 | TREPONEMA PALLIDUM BY TP-PA | LAB | 302 | 86780 | 105.92 |
30350465 | TRIAMCINOLONE CRM 1% 15GM TUBE | RX | 259 | 16.60 | |
30352035 | TRIAMTERENE/HCTZ 37.5/25MG TAB | RX | 259 | 2.50 | |
30350358 | TRIAMTERENE/HCTZ 75/50MG TAB | RX | 259 | 3.60 | |
30350540 | TRICOR 145MG TAB | RX | 259 | 5.60 | |
30256200 | TRIFLURIDINE 1% OPHTH SOLN 7.5ML BTL | RX | 259 | 262.60 | |
30254478 | TRIGLYCERIDE | LAB | 301 | 84478 | 51.05 |
30350793 | TRIHEXYPHENIDYL 2MG TAB | RX | 259 | 2.50 | |
30350206 | TRIMETHSULF/POLY OPH B/L 10ML | RX | 259 | 17.30 | |
30254484 | TROPONIN I | LAB | 301 | 84484 | 99.76 |
30353380 | TRULICITY 0.75MG/0.5ML INJ | RX | 252 | 266.90 | |
30254443 | TSH THYROID STIMULATING | LAB | 301 | 84443 | 141.00 |
30300014 | TUBE GASTROSTOMY REPLACEMENT | CS | 270 | 245.25 | |
30300419 | TUBE GAUZE SZ 1.5 | CS | 270 | 2.50 | |
30300420 | TUBE GAUZE SZ 5/8 PER INCH | CS | 270 | 2.50 | |
30300421 | TUBE GAUZE SZ 7/8 PER INCH | CS | 270 | 2.50 | |
30354200 | TUBERCULIN 0.1ML | RX | 259 | 39.20 | |
30300422 | TUBULAR ELASTIC | CS | 270 | 2.50 | |
30350130 | TUSSIONEX ER SUSP PER 5CC DOSE | RX | 259 | 2.50 | |
30251240 | TYPE & SCREEN | ||||
30251241 | TYPE & SCREEN - PANEL | ||||
30226942 | U/S GUIDANCE FOR NEEDLE PLACEMENT | US | 402 | 76942 | 596.00 |
30350474 | ULORIC 40MG TAB | RX | 259 | 38.70 | |
30450024 | ULTRASOUND PER 15 MIN | PT | 420 | 97035 | 70.00 |
30301120 | UMBILICAL CORD CLAMP | CS | 270 | 20.88 | |
30300092 | UNDER PAD 30X30 | CS | 270 | 2.10 | |
30300776 | UNNA BOOT 3 | CS | 270 | A6456 | 30.65 |
30300690 | UNNA BOOT 3 CALAMINE | CS | 272 | A6456 | 30.65 |
30300691 | UNNA BOOT 4 | CS | 272 | A6456 | 30.65 |
30450034 | UNNA BOOT TREATMENT | PT | 420 | 29580 | 63.65 |
30300433 | URETHRAL MEATAL DILATOR | CS | 270 | 34.80 | |
30300816 | URI DRAIN CONNECT EX | CS | 270 | 11.20 | |
30254550 | URIC ACID | LAB | 301 | 84550 | 36.16 |
30254560 | URIC ACID URINE | LAB | 301 | 84560 | 46.85 |
30251000 | URINALYSIS COMPLETE | LAB | 307 | 81001 | 39.65 |
30300064 | URINARY BAG | CS | 270 | 47.00 | |
30300993 | URINARY LEG BAG | CS | 270 | A5105 | 15.15 |
30300634 | URINE COLLECTER PEDS | CS | 270 | 12.96 | |
30251002 | URINE DIP ONLY | LAB | 307 | 81002 | 27.84 |
35058102 | URINE DIPSTICK | CLNC | 521 | 81002 | 8.40 |
30300114 | URINE DRAIN BAG | CS | 270 | A4357 | 47.00 |
30256335 | URINE IMMUNOELECTROPHORESIS | LAB | 300 | 86335 | 234.80 |
30258415 | URINE MALB/CREATININE RATIO | LAB | 301 | 82043 | 132.40 |
30251015 | URINE MICROSCOPIC | LAB | 307 | 81015 | 39.65 |
30254166 | URINE PROTEIN ELECTROPHORESIS | LAB | 302 | 84166 | 142.64 |
30300548 | URINE STRAINER | CS | 270 | 2.60 | |
30259002 | URINE/BLOOD COLLECTION AFTER HOUR | LAB | 990 | 99001 | 90.05 |
30259001 | URINE/BLOOD COLLECTION FOR SEND OUT | LAB | 309 | 99000 | 48.05 |
30350230 | UROXATRAL ER 10MG TAB | RX | 259 | 2.50 | |
30217670 | US ABDOMEN COMPLETE | US | 402 | 76700 | 496.06 |
302171669 | US ABDOMEN COMPLETE READING | US | 972 | 76700 | 126.00 |
30217671 | US ABDOMEN LIMITED | US | 402 | 76705 | 483.00 |
30217656 | US ABDOMEN LIMITED READING | US | 972 | 76705 | 98.00 |
30219388 | US CAROTID BILATERAL | US | 921 | 93880 | 1028.70 |
30219389 | US CAROTID BILATERAL READING | US | 972 | 93880 | 115.00 |
30217660 | US CHEST | US | 402 | 76604 | 365.00 |
30217688 | US EXTREMITY NONVASCULAR | US | 402 | 76881 | 472.62 |
30219395 | US EXTREMITY VENOUS COMPLETE | US | 921 | 93970 | 525.00 |
30210057 | US EXTREMITY VENOUS COMPLETE READING | US | 972 | 93970 | 87.00 |
30217681 | US FETAL BIOPHYSICAL PROFILE | US | 402 | 76818 | 529.00 |
30217680 | US OB >14 WEEKS | US | 402 | 76805 | 506.00 |
3027680 | US OB >14 WEEKS READING | US | 972 | 76805 | 107.00 |
30216810 | US OB >14WKS ADD FETUS | US | 402 | 76810 | 365.00 |
30216802 | US OB 1ST TRI ADD FETUS | US | 402 | 76802 | 303.00 |
30206801 | US OB 1ST TRIMESTER | US | 402 | 76801 | 436.00 |
30217682 | US OB LIMITED | US | 402 | 76815 | 314.00 |
30217683 | US OB REPEAT | US | 402 | 76816 | 332.00 |
30217685 | US PELVIC GYN COMPLETE | US | 402 | 76856 | 530.00 |
30217686 | US PELVIC LIMITED | US | 402 | 76857 | 343.00 |
30216857 | US PELVIC LIMITED READING | US | 972 | 76857 | 74.00 |
30217684 | US PELVIC TRANSVAGINAL | US | 402 | 76830 | 512.00 |
30210058 | US PELVIC TRANSVAGINAL READING | US | 972 | 76830 | 121.00 |
30217677 | US RETROPERITONEAL COMPLETE | US | 402 | 76770 | 542.32 |
30217678 | US RETROPERITONEAL COMPLETE READING | US | 972 | 76770 | 128.00 |
30217676 | US RETROPERITONEAL LIMITED | US | 402 | 76775 | 450.00 |
30217687 | US SCROTUM | US | 402 | 76870 | 498.00 |
30217655 | US SCROTUM READING | US | 972 | 76870 | 110.00 |
30217653 | US THYROID | US | 402 | 76536 | 466.00 |
30217654 | US THYROID READING | US | 972 | 76536 | 94.00 |
30206817 | US TVS OB | US | 402 | 76817 | 475.00 |
30219393 | US UNILAT VENOUS DOPPLER READING | US | 972 | 93971 | 97.00 |
30219394 | US UNILATERAL VENOUS DOPPLER | US | 921 | 93971 | 729.85 |
30301126 | VACUUM BOTTLE KIT | CS | 270 | 171.00 | |
30304020 | VACUUM BOTTLE KIT 1000ML | CS | 270 | 144.00 | |
30350603 | VALACYCLOVIR 1000MG TAB | RX | 259 | 4.50 | |
30356980 | VALACYCLOVIR 500MG TAB | RX | 251 | 2.80 | |
30355920 | VALIUM RECTAL GEL 20MG | RX | 259 | 224.40 | |
30258016 | VALPROIC ACID | LAB | 301 | 80164 | 108.30 |
30250202 | VANCOMYCIN | LAB | 301 | 80202 | 108.32 |
30350446 | VANCOMYCIN 125MG CAP | RX | 259 | 18.40 | |
30355515 | VANCOMYCIN 125MG ORAL SUSPENSION | RX | 251 | 2.50 | |
30350318 | VANCOMYCIN 500MG INJ | RX | 636 | J3370 | 24.20 |
30305073 | VAPOTHERM HI-VN NASAL CANNULA | CS | 270 | 47.35 | |
30305074 | VAPOTHERM HI-VN PED NASAL CANNULA | CS | 270 | 47.25 | |
30305072 | VAPOTHERM PATIENT CIRCUT HIGH FLOW | CS | 270 | 212.80 | |
30257797 | VARCELLA ZOSTER BY PCR | LAB | 306 | 87798 | 171.95 |
35059071 | VARICELLA VACCINE | RX | 636 | 90716 | 191.40 |
30257251 | VARICELLA VIRAL CULTURE | LAB | 306 | 87252 | 208.56 |
30256787 | VARICELLA ZOSTER AB | LAB | 302 | 86787 | 103.04 |
37084568 | VASECTOMY PROCEDURE ROOM | RX | 761 | 55250 | 100.00 |
30300361 | VASECTOMY TRAY | CS | 270 | 210.00 | |
30301696 | VASEINE 1OZ | CS | 270 | 7.20 | |
303000406 | VASELINE 0.6OZ | CS | 270 | 5.40 | |
30350739 | VASOPRESSIN 20U/ML INJ | RX | 259 | 275.10 | |
30350421 | VECURONIUM BROMIDE PER 20mg INJ | RX | 259 | 40.80 | |
30353144 | VECURONIUM PER 10MG INJ | RX | 259 | 31.40 | |
30250001 | VENIPUNCTURE | LAB | 300 | 36415 | 22.85 |
30353110 | VENLAFAXINE 25MG TAB | RX | 259 | 2.50 | |
30350032 | VENLAFAXINE XR 37.5MG CAP | RX | 259 | 2.50 | |
30350386 | VENLAFOXINE XR 75MG CAP | RX | 259 | 2.50 | |
30350716 | VENOFER PER 1MG INJ -100MG VIAL | RX | 636 | J1756 | 247.10 |
30350463 | VERAPAMIL 120MG TAB | RX | 259 | 2.50 | |
30352601 | VERAPAMIL 80MG TAB | RX | 251 | 2.50 | |
30350383 | VERAPAMIL ER 180MG TAB | RX | 259 | 2.50 | |
30350384 | VERAPAMIL ER 240MG TAB | RX | 259 | 2.50 | |
30350436 | VERAPAMIL SR 120MG TAB | RX | 259 | 2.50 | |
30350370 | VERAPAMIL UP TO 10MG INJ | RX | 636 | J3490 | 27.30 |
30350968 | VESICARE 5MG TAB | RX | 259 | 45.60 | |
30354561 | VIIBYRD 40MG TAB | RX | 259 | 22.10 | |
30357735 | VIMPAT 50MG TABLET | RX | 259 | 23.70 | |
35050071 | VIRTUAL MEDICARE CHECK-IN FOR RHC | CLNC | 521 | G0071 | 24.76 |
37082499 | VIS FUNCTION SCREENING | NUR | 769 | 99172 | 14.03 |
35050003 | VISION TEST ISHIHARA 14 PLATE | CLNC | 519 | 92283 | 15.00 |
35050004 | VISION TEST PERIPHERAL | CLNC | 519 | 92081 | 7.50 |
30252541 | VIT D 25 HYDROXY D2 | LAB | 301 | 82306 | 236.80 |
35050005 | VITAL SIGNS W/O PHYSICAL EXAM | CLNC | 521 | 99211 | 7.50 |
30350798 | VITAMIN - OCUVITE PRESERVISION TAB | RX | 259 | 2.50 | |
30355921 | VITAMIN A 10,000IU CAPSULE | RX | 259 | 2.50 | |
30351338 | VITAMIN B COMPLEX PER TABLET | RX | 259 | 2.50 | |
30350125 | VITAMIN B1 100MG TAB | RX | 259 | 2.50 | |
30356780 | VITAMIN B1 50MG TAB | RX | 251 | 2.50 | |
30252607 | VITAMIN B12 | LAB | 301 | 82607 | 124.90 |
30350392 | VITAMIN B12 1000MCG SUBLINGUAL TAB | RX | 259 | 2.50 | |
30355186 | VITAMIN B6 100MG TAB | RX | 251 | 2.50 | |
30350796 | VITAMIN C 250MG CHEWABLE TAB | RX | 259 | 2.50 | |
30354532 | VITAMIN D 1000IU TAB | RX | 259 | 2.50 | |
30350140 | VITAMIN D 400IU CAP | RX | 259 | 2.50 | |
30350960 | VITAMIN D 50 000 UNIT CAP | RX | 259 | 2.50 | |
30350526 | VITAMIN D 5000IU TAB | RX | 259 | 2.50 | |
30350390 | VITAMIN E 400IU CAP | RX | 259 | 2.50 | |
30350141 | VITAMIN K PER 1MG INJ | RX | 636 | J3430 | 81.90 |
30354531 | VITAMIN, CHILDREN'S CHEWABLE | RX | 259 | 2.50 | |
30354508 | VITAMIN, MULTIVITAMIN | RX | 259 | 2.50 | |
30350631 | VITAMIN, PRENATAL PLUS TAB | RX | 259 | 2.50 | |
30300821 | VOMIT BAG DISPOSABLE | CS | 270 | 10.71 | |
37082500 | VSL FUNC SCRNG | NUR | 769 | 92499 | 14.03 |
30301457 | WAFFLE CHAIR PAD | CS | 270 | 123.36 | |
30300005 | WANDERGUARD 1 YEAR | CS | 270 | 199.90 | |
30301916 | WANDERGUARD 90 DAY | CS | 270 | 127.80 | |
30301571 | WANDERGUARD BAND | CS | 270 | 13.41 | |
30350405 | WARFARIN 2.5MG TAB | RX | 259 | 2.50 | |
30350403 | WARFARIN 2MG TAB | RX | 259 | 2.50 | |
30350220 | WARFARIN 3MG TAB | RX | 259 | 2.50 | |
30357402 | WARFARIN 4MG TAB | RX | 259 | 2.50 | |
30350312 | WARFARIN 5MG TAB | RX | 251 | 2.50 | |
30300883 | WARMING FLUID SET | CS | 270 | 69.25 | |
35057110 | WART REMOVAL | CLNC | 521 | 17110 | 114.50 |
30300344 | WATER DISTILLED GALLON | CS | 272 | A4218 | 8.75 |
30353565 | WELCHOL 625MG TAB | RX | 259 | 8.60 | |
30253181 | WEST NILE AB IGG AND IGM | LAB | 300 | 86788 | 134.80 |
34100030 | WHIRLPOOL BATH | PALS | 119 | 40.00 | |
30450030 | WHIRLPOOL PER 15 MIN | PT | 420 | 97022 | 91.05 |
35050001 | WORK COMP SPECIAL SERVICES | CLNC | 521 | 99455 | 66.60 |
30450032 | WORK COND INTIAL 2 HOURS | PT | 420 | 97545 | 150.05 |
30203101 | WRIST 3 VIEW READING | RADP | 972 | 73110 | 36.52 |
30203110 | WRIST COMPLETE 3 VIEW | RAD | 320 | 73110 | 210.00 |
30203100 | WRIST LIMITED 2 VIEW | RAD | 320 | 73100 | 182.00 |
30203102 | WRIST LIMITED 2 VIEW READING | RADP | 972 | 73100 | 35.08 |
30350388 | XALATAN EYE GTT 0.005 - 2.5ML BTL | RX | 259 | 30.80 | |
30355001 | XANAX 0.5MG TAB | RX | 259 | 2.50 | |
30357830 | XARELTO 15MG TABLET | RX | 259 | 33.20 | |
30357930 | XARELTO 20MG TABLET | RX | 259 | 37.20 | |
30300905 | XEROFORM 1X8 | CS | 270 | 7.90 | |
30301127 | XEROFORM 2X2 | CS | 272 | 3.40 | |
30300010 | XEROFORM 4X3YRDS | CS | 270 | 30.75 | |
30300833 | XEROFORM 5X9 | CS | 270 | 5.30 | |
30350488 | XGEVA (DENOSUMAB) PER 1MG INJ | RX | 636 | J0897 | 3192.80 |
30354678 | XIFAXAN 550MG TAB | RX | 252 | 111.30 | |
30356402 | XOPENEX HFA 45MCG INHALER | RX | 259 | 157.40 | |
30356540 | ZADITOR 0.025% PER BOTTLE | RX | 252 | 34.60 | |
30353550 | ZETIA 10MG TAB | RX | 259 | 10.60 | |
30350565 | ZINC 50MG TAB | RX | 259 | 2.50 | |
30356760 | ZIPRASIDONE 60MG CAPSULE | RX | 259 | 2.50 | |
30359054 | ZOLEDRONIC ACID 4MG/5ML INJ | RX | 636 | J3489 | 52.10 |
30359776 | ZOLMITRIPTAN 2.5MG TAB | RX | 251 | 62.40 | |
30352020 | ZOLPIDEM 5MG TAB | RX | 259 | 2.50 | |
30250203 | ZONISAMIDE | LAB | 301 | 80203 | 106.00 |
30352801 | ZONISAMIDE 100MG CAPSULE | RX | 259 | 2.50 |