AUDUBON COUNTY MEMORIAL HOSPITAL ,,,
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Charge Master Report- Price List,,,
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,,Charge Code Description,Rate
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,,INJECT CARPAL TUNNEL,175
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,,INJECT TENDON/ LIGAMENT,140
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,,TRIGGER POINT INJECTION 1/2 MUSCL,135
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,,INJECT TRIGGER POINT 3/>,150
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,,INJECT JOINT/ BURSA,145
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,,INJECT JOINT BURSA INT,145
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,,INJECT JOINT/ BURSA LARGE,155
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,,ARTHROCENTIESIS ASPIR/ INJ MAJOR JT,240
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,,ARTHRO INJECTION MAJOR JT/BURSA-BILATERA,315
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,,SPINAL FLUID TAP DIAGNOSTIC,350
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,,EPIDURAL PATCH INJECT,400
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,,INJECT SPINE CERVICAL/ THORACIC,650
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,,INJECT SPINE LUMBAR/ SACRAL,500
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,,NERVE BLOCK OCCIPITAL INJ,215
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,,NERVE BLOCK INTERCOST INJ SNG,235
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,,NERVE BLOCK INTERCOST INJ MLT,375
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,,NERVE BLOCK ILIO/HYPGASTRIC INJ,275
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,,NERVE BLOCK SCIATIC INJ SNG,350
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,,NERVE BLOCK FEMORAL INJ SNG,340
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,,NERVE BLOCK OTHER PERIPHERAL,250
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,,INJECTION AA/STRD GENICULAR,550
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,,LUMBAR/ SACRAL INJECTION,495
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,,LUMBAR/ SACRAL JOINT INJECTION EACH LEV,225
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,,CERVICAL/ THORACIC INJ 1 LEVEL,600
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,,INJ PARAVERT F JNT C/T 2 LEVEL,250
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,,INJ PARAVERT F JNT C/T 3 LEVEL,250
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,,LUMBAR/ SACRAL INJ 1 LEVEL,500
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,,INJ PARAVERT F JNT L/S 2 LEVEL-SINGLE,230
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,,INJ PARAVERT F JNT L/S 3 LEVEL,230
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,,NERVE BLOCK SPENOPALATINE GANGL,275
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,,NERVE BLOCK LUMBAR/THORACIC,540
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,,INJECT CELIA PLEXUS W/WO RAD MONITORING,550
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,,RF ABLATION NERVES NRVTG SI JOINT,"1,175.00"
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,,CERVICAL/ THORACIC,995
,,DESTRUCT NROLYTC AGENT PARV FCT ADD C/T,475
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,,LUMBAR/ SACRAL FACET,"1,075.00"
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,,DISTRUCT NROLYTC AGENT PARVERTB EA ADD,440
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,,INJECTION TREATMENT OF NERVE,640
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,,INJECT SACROILIAC JOINT- BILATERAL,875
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,,INJECTION AA/STRD GENICULAR BILATERAL,"1,000.00"
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,,NERVE BLOCK OTHER PERI- BILATERAL,475
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,,BILATERAL- SPHENOPALTINE INJ,150
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,,LUMBAAR/SACRAL TRANSACTION-BILATERAL,900
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,,INJ PARAVERT F JNT L/S 1 LEVEL-BILATERAL,975
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,,INJ PARAVERT F JNT L/S 2 LEVEL-BILATERAL,425
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,,INJ PARAVERT F JNT L/S 3 LEVEL-BILATERAL,425
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,,FLOURO GUIDANCE NEEDLE PLACEMENT ADD ON,100
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,,SACROILIAC JOINT INJECT,450
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,,PAIN CLINIC NEW PROB FOCUSED,75
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,,PAIN CLINIC NEW EXP PROBLEM,120
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,,PAIN CLINIC NEW DETAILED VISIT,185
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,,OFFICE OUTPATIENT NEW 45 MIN,275
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,,PAIN CLINIC EST LEVEL 2,70
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,,PAIN CLINIC EST LEVEL 3,115
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,,PAIN CLINIC EST LEVEL 4,165
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,,PAIN CLINIC EST LEVEL 4,210
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,,INITIAL INPATIENT CONSULT,200
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,,EXCISION DESTRUCT INTRANASAL LESION,"2,205.00"
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,,EXCISION MUS VEST COMPLEX,"1,020.00"
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,,PUNCH BIOPSY SKIN SINGLE LESION,300
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,,2ND- BIOPSY EA ADD,75
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,,INCISIONAL BIOPSY SKIN LESION,350
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,,INCISIONAL BIOPSY EA ADD,175
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,,EACH ADDITIONAL PUNCH BIOPSY,50
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,,SHAVING SKIN LESION 0.5CM/<,295
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,,2ND- REPAIR COMPLEX 1.1-2.5CM,492
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,,2ND- REPAIR COMPLEX ENEL 1.1-2.5CM,535
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,,EXCISION B9 LESION MARGIN 1.1-2.0 CM,440
,,EXC B9 LESION 2.1-3.0CM,498
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,,EXCISION B9 LESION MRGN  0.5CM/<,330
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,,EXCISION B9 LESION XCP SK TG .6-1.0CM,415
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,,EXCISION B9 LESION 1.1-2.0CM,465
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,,2ND- FTH GFT FREE W/DIRECT CLOSURE 20 SQ,"1,185.00"
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,,EXCISION MALIGNANT >4.0CM,"1,000.00"
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,,EXCISION MALIGNANT LESION 0.5 CM/<,495
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,,EXCISION MALIGNANT LESION 1.1-2.0 CM,305
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,,EXCISION MALIGNANT LESION >4 CM,"1,265.00"
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,,IMMED RECONS BREAST- BILATERAL,"3,500.00"
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,,2ND- EXCISION DESTRUCT INTRANASAL LESION,"1,102.00"
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,,REPAIR COMPLEX SCALP 1.1-2.5 CM,900
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,,2ND- REPAIR COMPLEX 2.6-7.5CM,500
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,,2ND- EXCISION LESION MUCOSA,490
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,,INECTION BOTOX,100
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,,BILATERAL- EXCISION LESION EYELID,"1,000.00"
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,,POST OP VISIT,0
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,,NEW PATIENT LEVEL 1,80
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,,NEW PATIENT LEVEL 2,135
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,,NEW PATIENT LEVEL 3,190
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,,NEW PATIENT LEVEL 4,290
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,,EST PATIENT LEVEL 1,40
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,,EST PATIENT LEVEL 2,80
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,,EST PATIENT LEVEL 3,130
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,,EST PATIENT LEVEL 4,190
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,,REMOVAL OF BREAST IMPLANT,"1,266.00"
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,,PROBLEM FOCUSED NEW PT,74.32
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,,EXP PROBLEM FOCUS NEW,141.34
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,,DETAILED NEW PT,214.43
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,,COMPREHENSIVE-MOD NEW PT,364.15
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,,COMPREHENSIVE-HIGH NEW PT,468.41
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,,"O/P VISIT, EST PT LVL 1",26.72
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,,OFFICE VISIT LEVEL 2,72.47
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,,OFFICE VISIT LVL 3,143.64
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,,DETAILED OFFICE VISIT L4,220.87
,,COMPREHENSIVE OFFICE VIST,310.63
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,,DETAILED HOSP CARE-INITIA,282.5
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,,COMP MOD INITIAL HOSP CA,383.4
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,,COMP HIGH INITIAL HOSP CA,564.66
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,,SUBS OBS CARE LVL 1,111.96
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,,SUBS OBSER CARE LEVEL 2,204.24
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,,SUBS OBSER CARE LEVEL 3,293.09
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,,CARDIOVERSION ELECTRIC EXT,344.48
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,,"NF CARE, INIT LEVEL 1",257.82
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,,"NF CARE , INIT LEVEL 2",364.54
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,,"NF CARE , INIT LEVEL 3",460.43
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,,FACE TO FACE/1ST HOUR,259.78
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,,FACE TO FACE EA ADD 30 MI,255.13
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,,EST PT/DISABILITY EXAM,274.01
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,,NEW PT/DISABLILTY EXAM,269.74
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,,BONE MARROW ASPIRATE,36.85
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,,BONE MARROW ASPIRATION,249.25
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,,BONE MARROW BIOPSY,310.95
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,,DIAGNOSTIC BONE MARROW ASPIRATIONS/ BIOP,385
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,,"OFFICE/OP VISIT, NEW LV1",107.18
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,,"OFFICE/OP VISIT, NEW LV2",203.85
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,,"OFFICE/OP VISIT, NEW LV3",309.26
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,,"OFFICE/OP VISIT, NEW LV4",525.21
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,,"OFFICE/OP VISIT, NEW LV5",675.6
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,,"OFFICE/OP VISIT, EST LV1",38.53
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,,"OFFICE /OP VISIT, EST LV2",104.52
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,,"OFFICE/OP VISIT, EST LV3",207.19
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,,"OFFICE/OP VISIT, EST LV4",318.57
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,,"OFFICE/OP VISIT, EST LV5",448.02
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,,"INPT E/M, INIT. LEVEL 1",407.44
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,,"INPT E/M, INIT. LEVEL 2",552.98
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,,"INPT E/M, INIT. LEVEL 3",814.4
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,,SUBS OBS CARE LVL 1,161.48
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,,SUBS OBSER CARE LEVEL 2,294.55
,,SUBS OBSER CARE LEVEL 3,422.73
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,,REMOVE FOREIGN BODY,380
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,,CARPAL TUNNEL TX INJ,198.37
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,,INJ SGL TENDON SHTH OR LI,145
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,,INJECTION SINGLE TENDON ORIGIN,135
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,,DRAIN/INJECT SM JNT/BURSA,150
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,,DRAIN/INJ INTERM JNT/BURS,150
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,,ASPIRATE/INJ GANGLION CYS,160
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,,2ND- AVULSION NAIL PLATE PARTIAL/COMPLET,145
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,,2ND-REPAIR NAIL BED,240
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,,EXCISION B9 LESION .5CM/<,305
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,,EXCISION B9 LESION MRGN 06-1.0CM,392
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,,BILATERAL- CARPAL TUNNEL,290
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,,BILATERAL- INJECTION 1 TENDON SHEATH,220
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,,BILATERAL-ATHROCENTESIS ASPIR SMALL JT,210
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,,2ND- TENOTOMY ELBOX LAT MED PERCUT,500
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,,2ND-EXCISION GANGLION WRIST DORSAL,420
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,,2ND- EXCISION CYST TUMOR CARPAL,570
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,,BILATERAL- INJECTION SINGLE TENDON ORIGI,215
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,,2ND- ARTH WRIST LTD W/ AUTOGRAFT,890
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,,BILATERAL FASCIOTOMY PALMAR OPEN PARTIAL,"1,690.00"
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,,BILATERAL- ARTHROCENTESIS ASPIR/ W/O US,250
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,,2ND- PARTIAL EXCISION DISTAL PHALANX FIN,577
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,,2ND- TENDON SHEATH INCISION,655
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,,BILATERAL WRIST SURG W RLS TRANSVRD CARP,"1,725.00"
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,,2ND-NDSC WRIST SURG WRLS TRANS,520
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,,2ND-JOINT ARTHROSCOPY,500
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,,PARTIAL EXCISION BONE HUMERUS,"1,690.00"
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,,TENOTOMY ELBOX LATERAL/ MEDIAL PERCUT,"1,060.00"
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,,TNOT ELBOX LATERAL MEDIAL DEBRIDE,"1,545.00"
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,,2ND-  NEUROPLASTY ULNAR NERVE ELBOW,690
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,,NEUROPLASTY; MEDIAN NERVE,"1,104.00"
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,,INCISION EXTERNSOR TENDON SHEATH WRIST,860
,,REPAIR REVISE WRIST JOINT OPEN CARPAL,"2,300.00"
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,,ARTH WRIST W/WO INTERPOS,"1,885.00"
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,,ARTHRO INTERPOS INTERCARPAL JOINTS,"1,855.00"
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,,TENDON SHEATH INCISION,"1,315.00"
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,,EXCISION TISSUE HAND FINGER 1.5SM/>,"1,060.00"
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,,EXCI TUM/VASC MAL SOFT TISS HAND 1.5CM/>,"1,275.00"
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,,REPAIR FLXR TENDON,"1,630.00"
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,,2ND-NEUROPLASTY ULNAR NERVE WRIST,470
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,,2ND-NEUROPLASTY TRANSPOS MEDIAN NRV CARP,505
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,,ARTHRP MTCARPHLING JT W/ PROSTC,"1,410.00"
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,,FINGER FRACTURE,"1,200.00"
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,,POST OP FOLLOWUP VISIT,0
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,,APPLICATION CAST SHORT ARM,215.56
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,,APPLY CAST HAND LOWER FOREARM,250
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,,THUMB SPICA,201
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,,SHORT ARM SPLINT,150
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,,"OFFICE/OP VISIT, NEW LV1",84
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,,"OFFICE/OP VISIT, NEW LV2",140
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,,"OFFICE/OP VISIT, NEW LV3",200
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,,"OFFICE/OP VISIT, NEW LV4",303
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,,"OFFICE/OP VISIT, EST LV1",42
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,,"OFFICE/OP VISIT, EST LV2",84
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,,"OFFICE/OP VISIT, EST LV3",136
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,,"OFFICE/OP VISIT, EST LV4",201
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,,WRIST SURG W/RLS TRANSVRS CARPL,"1,200.00"
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,,JOINT ARTHROSCOPY,"1,000.00"
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,,2ND SURG-CYSTOSCOPY,"1,430.00"
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,,O.R. 1ST 30 MIN,915.28
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,,2ND SURG-DECOMPRESS FOREARM 1 SPACE,"2,905.50"
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,,2ND SURG-COLOREC CANCR SCR;COLNSCPY NOT,"1,430.50"
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,,O.R. EACH ADD 15 MIN,302
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,,TIS TRNFR F/C/C/M/N/A/G/H/F,"5,691.00"
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,,INCISION DRAINAGE ABSCESS SIMPLE/SINGLE,"1,844.00"
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,,INCISION DRAINAGE ABSCESS COMPLEX/MULT,"1,844.00"
,,2ND- REMOVAL IMPLANT SUPERFICIAL SEP PRO,"1,830.00"
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,,2ND SURG-FRACTURE NASAL INFERIOR TURBINA,"2,167.50"
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,,COLOREC CANCER SCR;COLONSCPY INDIV HI RI,"2,383.00"
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,,EXCISION DESTRUCT INTRANASAL LESION,"2,205.00"
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,,ANTERIOR SEGMENT INSERT DRAIN,500
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,,2ND SURG-REPAIR OF FOOT TENDON,"2,086.50"
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,,2ND SURG-HEMORRHOIDECTOMY INT RUBBER BAN,950.5
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,,2ND SURG-EGD DIAGNOSTIC,"1,346.00"
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,,2ND SURG-PARTIAL EXCISION DISTAL PHALANX,"1,975.00"
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,,2ND SURG-EGD TRANSORAL BIOPSY SINGLE/MUL,"1,346.00"
,,,
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,,2ND SURG-VASECTOMY UNI/BI SPX W/POSTOP S,"2,776.00"
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,,2ND SURG-NASAL/SINUS ENDOSCOPY W/ETHMOID,"2,893.00"
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,,2ND SURG-COMBINED ANTERPOSTERIOR COLPO,"3,359.00"
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,,2ND SURG-INSERT MESH/ PELVIC FLOOR,"2,096.00"
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,,2ND SURG -SURG TX ANAL FISTULA SUBQ,"2,665.00"
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,,2ND SURG-COLPOPEXTY VAG EXTRAPERITONEAL,"3,359.00"
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,,2ND SURG-SLING OPER STRESS INCONTINENCE,"4,022.50"
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,,2ND SURG-CYSTO W/SIMPLE REMOVAL STONE ST,"1,430.50"
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,,2ND SURG-LAPAROSCOPY ASPIRATION,"3,862.00"
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,,2ND SURG -LAP INSERT TUNNEL IP CATH,"3,862.00"
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,,2ND SURG-SIGMOIDOSCOPY FLX DX W/COLLJ,950.5
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,,2ND SURG-SIGNOIDOSCOPY AND BIOPSY,"1,042.00"
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,,2ND SURG-CYSTO W/INSERT URETERAL STENT,"1,430.50"
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,,CYSTOURETERO W/ LYTHOTRIPSY,"4,870.00"
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,,2ND SURG- CYSTO/URETERO W/LITHOTRIPSY,"4,990.00"
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,,2ND SURG-REMOVAL OF FOREIGN BODY,"2,200.50"
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,,2ND SURG-DIAGNOSTIC COLONOSCOPY FLEX,"1,430.50"
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,,2ND SURG-COLONOSCOPY W/BIOPSY SINGLE/MUL,"1,430.50"
,,,
,,2ND SURG-COLONOSCOPY W/ LESION REMOVAL,"1,662.00"
,,,
,,2ND SURG-COLSC FLX W/RMVL OF TUMOR POLY,"1,662.00"
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,,NEPHR INJ VIA INDWELLING,679
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,,2ND SURG-SUSPENSION OF UTERUS,"2,096.00"
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,,2ND SURG-VENTILATING TUBE RMVL REQUIRING,"2,320.50"
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,,2ND-SURG-TYPANOSTOMY GENERAL ANESTH,"2,167.50"
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,,2ND SURG-EXC FACE-MM B9+MARG 1.1-2 CM,955
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,,EXC FACE-MM +MARG2.1-3CM,"3,665.00"
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,,2ND SURG-REPAIR WRIST JOINTS,"5,295.00"
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,,2ND SURG-DILATION ESOPH UNGUIDED SOUND/B,"1,207.50"
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,,2ND SURG-RPR 1ST INGUN HRNA AGE 5YRS/> R,"3,536.00"
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,,2ND SURG-HYSTER BX ENDOMET/POLYPC W /WO,"3,439.00"
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,,2ND SURG-BIOPSY OF UTERUS LINING,163.5
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,,2ND SURG-RPR UMBIL HERN REDUC>5 YR,"3,536.00"
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,,LITHOTRIPSY XTRCORP SHOCK WAVE,"11,808.00"
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,,2ND SURG-DILATE URETHRA STRICTURE,"1,399.00"
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,,TIS TRNFR E/N/E/L 10 SQ CM/<,"5,691.00"
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,,ARTHROCENTESIS ASPRI W/O US,710
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,,INCISE FINGER TENDON SHEATH,"3,950.00"
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,,2ND-SUTURE 1 NERVE ULNAR MOTOR,"1,700.00"
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,,2ND SURG-LAPAROSCOPY EXCISE LESIONS,"6,091.50"
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,,2NS SURG-LAPAROSCOPY TUBAL CAUTERY,"5,317.00"
,,,
,,REMOVAL IMPLANT DEEP,"3,665.00"
,,,
,,2ND SURG-IRRIGATION OF BLADDER,308
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,,2ND SURG-CHANGE OF BLADDER TUBE,602.5
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,,BILATERAL CARPAL TUNNEL SURGERY,"8,100.00"
,,,
,,BIOPSY OF MOUTH LESION,"1,591.00"
,,,
,,EXCISION MUC VESTIBULE COMPLEX,"3,865.00"
,,,
,,2ND SURG- REMOVE EPIDIDYMIS LESION,"2,310.00"
,,,
,,2ND SURG- WRIST ENDOSCOPY/ SURGERY,"2,715.00"
,,,
,,2ND SURG-KNEE ARTHROSCOPY/SURGERY,"3,260.50"
,,,
,,2ND SURG-KNEE ARTHROSCOPY/SURGERY,"3,260.50"
,,,
,,2ND SURG-ARTHROSC KNEE; W MEN REP-MED&LA,"3,260.50"
,,,
,,,
,,2ND SURG-DILATION OF ANAL SPHINCTER,"2,382.50"
,,,
,,2ND SURG-EXCISION OF ANAL LESION,"1,647.50"
,,,
,,2ND SURG-DESTRUCT INTRL HEMORRHOID THERM,"2,382.50"
,,,
,,,
,,2ND SURG-HRHC NTRNL LIG OTHE THAN RUBBR,"2,382.50"
,,,
,,2ND SURG-LAP APPENDECTOMY,"5,317.00"
,,,
,,2ND SURG-ARTHROSCOPY OF JOINT,"3,260.50"
,,,
,,CATARACT REMOVAL INSERTION OF LENS,"4,585.00"
,,,
,,REMOVE MESH FROM ABD WALL,"1,012.00"
,,,
,,EXC FACE LESION SC <2CM,"3,610.00"
,,,
,,EXCISION TUMOR SOFT TISS FACE/SCALP 2CM/,"3,610.00"
,,,
,,DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM,572
,,,
,,,
,,DEBRIDEMENT MUSCLE FASCIA 20 SQ CM,"2,744.00"
,,,
,,DEBRIDEMENT SUBCUT TISSUE EA ADD 20 SQ C,572
,,,
,,DEBRIDE ABDOM WALL,"3,691.00"
,,,
,,DRAIN BLADDER INSERT SUPRAPUBIC,"5,848.00"
,,,
,,2ND- DEBRID SUBCUT TISSUE EA ADDL 20 SQ,285
,,,
,,2ND- PARING BENIGN HYPER LESION 2-4,285
,,,
,,2ND- PUNCH BIOPSY SKIN LESION,505
,,,
,,REMOVE FOREIGN BODY,"1,535.00"
,,,
,,"COLOREC CANCR SCR, PT NOT HI RISK","2,861.00"
,,,
,,2ND SURG-EXCISION TR EXT B9+MARG 2.1-3CM,950
,,,
,,2ND SURG- EXCISION TR EXT B9 1.1-2CM,950
,,,
,,2ND-  EXC B9 LESION MRGN SKN TAG 2.1-3.0,800
,,,
,,2ND- EXCISION B9 LESION 3.1-4.0,795
,,,
,,2ND- EXCSION B9 XCP SK TAG >4.0CM,"1,832.00"
,,,
,,2ND-EXCISION MALIGNANT LES >4.0CM,"1,832.50"
,,,
,,2ND- AVULSION NAIL PLATE PARTIAL/COMPLET,300
,,,
,,2ND- REPAIR NAIL BED,302
,,,
,,2ND-REMOVAL OF SKIN TAGS,285
,,,
,,2ND SURG- INTMD REPAIR S/A/T/EXT 2.6-7.5,360
,,,
,,2ND SURG- INTMED RPR S/A/T/EXT 2.5CM<,360
,,2ND-REPAIR INTERMED 7.6-12.5CM,530
,,,
,,SHAVE SKIN LESION > 2.0CM,572
,,,
,,2ND-REPAIR COMPLEX TRUNK 2.6-7.5 CM,650
,,,
,,2ND-REPAIR COMPLEX TRUNK 1.1-2.5CM,535
,,,
,,2ND-REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5,302
,,,
,,REPAIR COMPLEXT F/C/C/M 2.6.-7.5 CM,603
,,,
,,2ND SURG- COMPLEX REPAIR E/N/E/L 2.6-7.5,812
,,,
,,2ND-REPAIR COMPLEX 1.1-2.5CM,301
,,,
,,TISSUE TRANSFER TRUNK 10 SQ CM/<,"1,254.00"
,,,
,,EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2,"1,910.00"
,,,
,,EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3,"1,910.00"
,,,
,,EXC TR EXT B9+MARG 3.1-4CM,"1,591.00"
,,,
,,EXC B9 LESION MRGN XCP SK TG T/A/L>4.0 C,"4,401.00"
,,,
,,EXCISION B9 LESION 0.5CM/<,"1,591.00"
,,,
,,EXCISION H-F-NK-SP B9+MARG 1.1-2,"1,591.00"
,,,
,,EXCISION B9 LESION MRGN XCP SK TG 2.1-3.,"1,591.00"
,,,
,,EXCISION B9 LESION XCP SK TG 3.1-4.0CM,"3,665.00"
,,,
,,EXC H-F-NK SP B9+MARG>4CM,"1,500.00"
,,,
,,EXC FACE-MM B9+MARG 0.5 CM/<,"1,910.00"
,,,
,,2ND SURG-EXC FACE-MM B9+MARG 0.6-1CM,955
,,,
,,EXC B9LES MEGN XCP SK TG F/E/E/N/L/M 1.1,"1,910.00"
,,,
,,PARTIAL EXCISION OF LIP,"4,335.00"
,,,
,,2ND-SPLIT AGRFT F/S/N/H/F/G/M/D 1ST 100,"2,845.00"
,,,
,,LARYNGOSCOPY W/WO TRACH EXCEPT NEWBORN,421
,,,
,,,
,,2ND- SKIN SUB GRAFT FACE/ NECK/ HF/G,750
,,,
,,BIOPSY OF NECK/ CHEST,"1,591.00"
,,,
,,EXC NECK LES SC 3CM/>,"2,025.00"
,,,
,,EXCISION NECK LES SC<3 CM,"3,665.00"
,,,
,,EXC TR-EXT MAL 1.1-2CM,345
,,,
,,EXCISION MAL LESION TRUNK/ARM 2.1-3.0,"1,591.00"
,,,
,,EXCISION MAL LESION TRUCH 3.1-4.0CM,"1,591.00"
,,,
,,EXC MALIGNANT LESION TRUNK/ARM/LEG>4.0 C,"4,401.00"
,,,
,,,
,,EXCISION MALIGNT LESION S/N/H/F/G 1.1-2.,"1,910.00"
,,EXCISION S/N/H/F/G/ MAL 2.1-3,"1,591.00"
,,,
,,EXCIS MALGNT LESION S/N/H/F/G>4.0CM,"4,401.00"
,,,
,,EXCISION MALIGNANT LESION 0.5 CM/<,"1,591.00"
,,,
,,EXC F/E/E/N/L MAL+MRG 0.6-1,"1,910.00"
,,,
,,EXCISION MALIGNANT LESION F/E/E 1.1-2.0C,"1,591.00"
,,,
,,EXCISION F/E/E/N/L MAL+MRG 2.1-3,"3,665.00"
,,,
,,EXC F/E/E/N/L MAL+MRG 3.1-4,"4,401.00"
,,,
,,EXC F/E/E/N/L/ MAL+MRG >4 CM,"3,665.00"
,,,
,,CHANGE OF BLADDER TUBE,"1,205.00"
,,,
,,CHANGE CYSTOSTOMY TUBE COMPLICATED,"1,205.00"
,,,
,,2ND SURG- REMOVAL OF NAIL PLATE,300
,,,
,,BIOSPY NAIL UNIT,"1,591.00"
,,,
,,REMOVE PILONIDAL CYST EXTEN,"4,401.00"
,,,
,,REMOVAL OF BREAST LESION,"3,646.00"
,,,
,,MASECTOMY SIMPLE COMPLETE-BILATERAL,"8,550.00"
,,,
,,EXC BACK LES SC 3 CM/>,"3,665.00"
,,,
,,EXCISION TUMOR SOFT TISS BACK/ FLANK 5CM,"3,665.00"
,,,
,,IMMEDIATE RECON BREAST- BILATERAL,"8,550.00"
,,,
,,2ND SURG- REMOVE CONTRACEPTIVE CAPSULE,"1,012.00"
,,,
,,CYSTOSCOPY,"2,861.00"
,,,
,,CYSTO W/IRRIG EVAC MULTIPLE OBST CLOTS,"4,870.00"
,,,
,,CYSTOSCOPY URETER CATHETER,"2,861.00"
,,,
,,INTMD REPAIR S/A/T/EXT 2.5 CM/<,603
,,,
,,REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,724
,,,
,,INTMD RPR S/TR/EXT 7.6-12.5,"1,276.00"
,,,
,,2ND- REPAIR INTERMED GENT 2.6-7.5,325
,,,
,,REPAIR INTERMED N/H/H/XTRNL GENT 7.6-12.,724
,,,
,,REPAIR INTMD F/E/E/N/L/MUC 2.6-5.0CM,724
,,,
,,ARTHROCENTESIS ASPIR/INJ SM JT/BURSA,710
,,,
,,2ND- ARTHROCENTESIS ASPR MAJOR JT,355
,,,
,,REMOVAL IMPLANT SUPER SEPARATE PROC,"3,665.00"
,,,
,,2ND SURG-REMOVAL OF FOOT LESION,"3,086.50"
,,,
,,EXC FACE LESION SC <2CM- 2ND SURG,"1,805.00"
,,,
,,EXCISION TUMOR SOFT TISSUE <3CM,"3,665.00"
,,,
,,2ND- EXC B9 LESION 1.1-2.0CM,795
,,YAG LASER PROCEDURE,"1,074.00"
,,,
,,CYSTOSCOPY W/BIOPSY(S),"2,861.00"
,,,
,,CYSTOSCOPY AND TREATMENT,"2,383.00"
,,,
,,CYSTO W/REMOVAL OF LESIONS MINOR,"2,861.00"
,,,
,,CYSTO W/REMOVAL OF TUMORS SMALL,"2,861.00"
,,,
,,CYSTO W//REMOVAL BLADDER TUMOR,"2,861.00"
,,,
,,CYSTO W//REMOVAL TUMOR LARGE,"5,848.00"
,,,
,,2ND- PER VERT AGMNTJ CAVITY CRTJ,"2,096.00"
,,,
,,SPINAL PUNCTURE LUMBAR DIAGNOSTIC,"1,152.00"
,,,
,,CYSTO W/INTERNAL URETHROTOMY,"4,870.00"
,,,
,,CYSTO CALIBRATION DILAT URTL STRIX/STEN,"2,383.00"
,,,
,,CYSTOURETHROSCOPY INJ CHEMODENERVATION B,"2,861.00"
,,,
,,,
,,CYSTO W/SIMPLE REMOVAL STONE STENT,"2,861.00"
,,,
,,2ND- LITHOLAPAXY SMP/SM<2.5cm,"4,870.00"
,,,
,,2ND SURG-CYSTOSCOPY REMOV URETERAL STONE,"2,924.00"
,,,
,,,
,,CYSTOSCOPY STONE REMOVAL,"4,870.00"
,,,
,,CYSTO W/INSERT URETERAL STENT,"2,861.00"
,,,
,,CYSTO W/URETEROSCOPY W/RMVL,"4,870.00"
,,,
,,2ND-CYSTOURETERO W/ LITHOTRIPSY,"2,435.00"
,,,
,,CYSTO/ URETERO W/ LITHOTRIPSY,"9,981.00"
,,,
,,2ND SURG-EXCISON ARM/ ELBOW LES SC 3 CM>,800
,,,
,,2ND-TNOT ELBOW LAT/MED DEBRIDE OPEN TDN,"3,050.00"
,,,
,,EXC FACE-MM B9+MARG .6-1CM,"1,591.00"
,,,
,,2ND-TENOTOMY ELBOW LATAERAL/MEDIAL PERC,"3,056.00"
,,,
,,,
,,INCISION EXTENSOR TENDON SHEATH WRIST,"4,839.00"
,,,
,,2nd- EAR AND THROAT EXAM,"1,932.00"
,,,
,,2ND-TRANSURETHRAL RESECTION BLADDER NECK,"3,700.00"
,,,
,,,
,,2ND- EXCISION GANGLION WRIST DORSAL,"1,650.00"
,,,
,,2ND-EXC CYST TUMOR CARPAL BONES,"3,056.00"
,,,
,,2ND- CARPECTOMY 1 BONE,"1,645.00"
,,,
,,2ND SURG-TRANSPLANT FOREARM TENDON,"4,630.00"
,,EXCISION NECK LESION SC<3 CM,"1,500.00"
,,,
,,2ND- ARTHRODESIS WRIST LTD W/AUTOGRAFT,"2,711.00"
,,,
,,2ND- ARTHROCENTESIS ASPIR/INJ SMALL JT,305
,,,
,,PROSTATECTOMY (TURP),"8,957.00"
,,,
,,BILATERAL FASCIOTOMY PALMAR OPEN PARTIAL,"4,933.00"
,,,
,,,
,,2ND- ARTHRO ASPIR/INJ INTERIM JT/BURS WO,355
,,,
,,2ND- TENOTOMY EXTENSOR HAND/FINGER OPEN,"1,500.00"
,,,
,,,
,,LASER VAPORIZATION OF PROSTATE,"8,957.00"
,,,
,,2ND SURG- HAND TENDON RECONSTRUCTION,"2,711.00"
,,,
,,2ND SURG- EXC THIGH/ KNEE LES SC<3CM,"1,800.00"
,,,
,,2ND-RPR FLEXOR TENDON LEG PRIMARY,"2,420.00"
,,,
,,2ND- REPAIR DISRUPTED LIGAMENT ANKLE,"3,056.00"
,,,
,,2ND SURG-INCISION OF FOOT FASCIA,"3,086.50"
,,,
,,2ND-OSTECTOMY PRTL 5TH METAR HEAD SPX,"2,450.00"
,,,
,,TONSILLECTOMY ADENOIDECTOMY<AGE 12,"4,580.00"
,,,
,,TONSILLECTOMY ADENOIDECTOMY AGE 12/>,"4,580.00"
,,,
,,2ND-TX OPEM TENDON FLEXOR TOE 1 TENDON,"1,400.00"
,,,
,,TONSILLECTOMY <AGE12,"4,580.00"
,,,
,,TONSELLECTOMY ONE-HALF AGE 12/>,"4,580.00"
,,,
,,2ND- CORRECTION OF HAMMER TOE,"2,570.00"
,,,
,,HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT,"7,351.00"
,,,
,,REMOVAL OF ADENIODS,"4,580.00"
,,,
,,ADENOIDECTOMY PRIMARY 12/>,"3,814.00"
,,,
,,ARTHROSCOPY KNEE LATERAL RELEASE,"6,521.00"
,,,
,,BILATERAL CARPAL TUNNEL RELEASE,"9,781.00"
,,,
,,ARTHROSCOPY OF JOINT,"6,521.00"
,,,
,,2ND- EXCISION DESTRUCT INTRANASAL LESION,"1,805.00"
,,,
,,SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/,"4,335.00"
,,,
,,MEATOTOMY CUTTING MEATUS SPX EXCPT INFAN,"4,007.00"
,,,
,,,
,,LAMNOTMY INCL W/ DCMMPRSN ROOT 1,"9,134.00"
,,,
,,LAMINOTOMY REEXPL 1 NTRSPC LUMBAR,"9,134.00"
,,,
,,SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTIL,"6,788.00"
,,,
,,,
,,FRACTURE NASAL INFERIOR TURBINATE THERAP,"4,335.00"
,,,
,,,
,,REPAIR COMPLEX TRUNK 1.1-2.5 CM,"1,200.00"
,,,
,,CMPLX RPR TRUNK 2.6-7.5CM,"1,314.00"
,,,
,,2ND-CMPLX RPR TRUNK ADDL 5CM/<,"1,314.00"
,,,
,,2ND- REPAIR COMPLEX E/N/E/L 1.1-2.5CM,550
,,,
,,REPAIR COMPLEX SCAP/ARM/LEG 1.1-2.5CM,603
,,,
,,COMPLEX REPAIR S/A/L 2.6-7.5 CM,779
,,,
,,PARTIAL RPR OR REMOVAL OF SHOULDER BONE,"6,113.00"
,,,
,,COMPLEX REPAIR F/C/C/M/N/AX/G/H/F,603
,,,
,,2ND SURG-COMPLEX REPAIR F/C/C/M/N,300
,,,
,,REPAIR COMPLEX EYELID/NOSE 1.1-2.5CM,"1,062.00"
,,,
,,COMPLEX REPAIR E/N/E/L 2.6-7.5 CM,"1,623.00"
,,,
,,ESOPHAGOSCOPY RIGID BALLOON,"2,350.00"
,,,
,,ESOPHAGOGASTRODUODENOSCOPY TRNASORAL DIA,"2,692.00"
,,,
,,,
,,EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,"2,692.00"
,,,
,,EGD PLACE GASROSTOMY TUBE,"2,822.00"
,,,
,,EGD REMOVE FOREGN BODY,"2,822.00"
,,,
,,EGD REMOVAL TUMOR POLY/OTHER LESION,"1,200.00"
,,,
,,EGD CONTROL BLEEDING ANY,"2,350.00"
,,,
,,REPAIR ROTATOR CUFF,"11,120.00"
,,,
,,OPEN REPAIR OF ROTATOR CUFF CHRONIC,"10,401.00"
,,,
,,DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/M,"2,415.00"
,,,
,,,
,,DILATE URETHRA STRICTURE,"2,678.00"
,,,
,,EXCISION LIP FULL RCNSTJ W/LOCAL FLAP,"9,455.00"
,,,
,,TISSUE TRNFR E/N/E/L/10.1-30SQCM,"5,691.00"
,,,
,,EXC ARM/ELBOW LES SC 3CM/>,"1,600.00"
,,,
,,EXC ARM/ELBOW LES SC<3 CM,"4,401.00"
,,,
,,2ND-EXCISION LESION MUCOSA,"1,932.00"
,,,
,,EXCISION OLECTRANON BURSA,"4,839.00"
,,,
,,TIS TRNFR S/A/L 10 SQ CM/<,"1,623.00"
,,PARTIAL EXCISION BONE HUMERUS,"6,113.00"
,,,
,,REMOVAL FOREIGN BODY UPPER ARM,"1,591.00"
,,,
,,REMOVAL FOREIGN BODY UPPER ARM/ELBOW,"3,665.00"
,,,
,,LAPAROSCOPE PROC INTESTINE,"12,183.00"
,,,
,,2ND- EGD PERCUT PLACEMENT GASTRO TUBE,"1,175.00"
,,,
,,2ND- EGD TRANSORAL CONTROL BLEEDING,"1,175.00"
,,,
,,2ND- TONSILLECTOMY  <AGE 12,"2,300.00"
,,,
,,2ND SURG-REMOVAL OF ADENOIDS.,"2,290.00"
,,,
,,2ND- ADENOIDECTOMY SECOND <AGE 12,"1,907.00"
,,,
,,2ND-EGD FLEX REMOVAL LESIONS BIOP FORCEP,"1,175.00"
,,,
,,REPAIR ELBOW PERC,"6,113.00"
,,,
,,2ND-TNOT ELBOW LATERAL/MED DEBRIDE OPEN,"3,000.00"
,,,
,,,
,,TNOT ELBOX LATERAL MEDICAL DEBRIDE,"6,113.00"
,,,
,,ENTEROSCOPY>2ND PRTN W/PLMT PRQ TUBE,"2,350.00"
,,,
,,COLONOSCOPY THRU STOMA,"1,724.00"
,,,
,,INSJ MULTIOCOMPNT INFATABEL PENILE PROST,"21,044.00"
,,,
,,,
,,REMOVE MUTI-COMP PENIS PROS,"6,960.00"
,,,
,,REMOVAL REPLACEMENT INFLAT PENILE PROST,"29,345.00"
,,,
,,SINGLE NERVE BLOCK INJ ARM NERVE,"1,710.00"
,,,
,,FORESKIN MANJ W/LSS PREPUTIAL,"5,796.00"
,,,
,,2ND SURG- APPENDECTOMY ADD ON,"3,264.00"
,,,
,,ORCHIECTOMY SIMPLE SCROTAL/INGUINAL,"4,623.00"
,,,
,,INJECT CELIAC PLEXUS W/WO RAD MONITORING,"1,424.00"
,,,
,,,
,,INSERT GASTR STIMUL,"13,240.00"
,,,
,,2ND SURG- REMOVAL OF ANAL TAGS,"1,984.00"
,,,
,,2ND SURG- REMOV HEMORRHOID CLOT,"1,984.00"
,,,
,,2ND- LAP SURG RPR INITIAL INGUINAL HERN,"4,425.00"
,,,
,,2ND- LAP SURG REPAIR RECURRENT ING HERNI,"4,425.00"
,,,
,,2ND-LAP RPR HRNA XCPT INCAL/INGUN STRANG,"4,427.00"
,,,
,,,
,,2ND- ANOSCOPY W/DILATION,200
,,,
,,REMOVE BY LIGAT INT HEM GROUP,"3,968.00"
,,REVISE FINGER/TOE NERVE,"3,398.00"
,,,
,,2ND- NEURP MAJOR PRPH NRB ARM/LEG OPEN,"1,600.00"
,,,
,,REVISE ULNAR NERVE AT ELBOW,"3,398.00"
,,,
,,NEUROPLASTY/TRANS ULNAR WRIST,"3,398.00"
,,,
,,NEUROPLASTY/TRANSPOS MEDIAN NRV CARPAL T,"4,080.00"
,,,
,,,
,,2ND- LAPAROSCOPICE PROC LIVER,"3,200.00"
,,,
,,REPAIR OF DIGIT NERVE,"3,398.00"
,,,
,,2ND SURG REPAIR OF HAND OR FOOT NERVE,"1,699.00"
,,,
,,SUTURE 1 NERVE ULNAR MOTOR,"3,398.00"
,,,
,,2ND-REMOVAL PERITONEAL FOR BODY,"2,400.00"
,,,
,,2ND- IMPLANT MES OPEN HERNIA RPR/DEBRR,"2,944.00"
,,,
,,2ND- REPAIR EPIG HERNIA INCARCERATED,"2,945.00"
,,,
,,2ND- HERNI A REPAIR 5 YRS/>,825
,,,
,,BILATERAL LAPARSCOPY SURG RPR HERNIA,"12,000.00"
,,,
,,LAPAROSCOPIC APPENDECTOMY,"10,634.00"
,,,
,,WOUND PREP TRK/ARM/ LEG,"3,665.00"
,,,
,,ID SUBMUOCSAL ABSCESS RECTUM,"3,968.00"
,,,
,,REMOVAL OF HYDROCELE,"7,072.00"
,,,
,,BILATERAL LITHROTRIPSY XTRCORP SHOCK WAV,"17,712.00"
,,,
,,,
,,REMOVE WRIST JOINT LINING- 2ND SURG,"2,420.00"
,,,
,,REMOVE WRIST TENDON LESION,"3,289.00"
,,,
,,REREMOVE WRIST TENDON LESION,"3,289.00"
,,,
,,SPLIT AGRFT F/S/N/H/F GT EA 100CM,"5,691.00"
,,,
,,REMOVAL OF WRIST LESION,"6,113.00"
,,,
,,2ND- INSJ TEMP NDWELLG BLADDER CATH,170
,,,
,,SKIN FULL GRAFT TRUNK,"1,623.00"
,,,
,,2ND SURG-CYSTOSCOPY URETER CATHETER,"1,430.50"
,,,
,,CARPECTOMY 1 BONE,"3,289.00"
,,,
,,2ND-CYSTO W/DIL BLADDER GEN ANESTH,"2,435.00"
,,,
,,VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAM,"5,552.00"
,,,
,,,
,,TRANSURETHAL RESECTION BLADDER NECK,"7,459.00"
,,,
,,2ND- FTH/GFT FREE W/DIRECT CLOSURE N/E/E,"2,800.00"
,,SKIN SUB GRAFT TRUNK/ARM/LEG,"1,623.00"
,,,
,,2ND-TNOT FLXR/XTNSR TEND FOREARM/ WRIST,"2,195.00"
,,,
,,2ND-BIOPSY URETHA,"1,668.00"
,,,
,,REPAIR REVISE WRIST JOINT OPEN CARPAL,"9,260.00"
,,,
,,SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA,"1,901.00"
,,,
,,SIGMOIDOSCOPY AND BIOPSY,"1,736.00"
,,,
,,ARTHRP WRIST W/WO INTERPOS,"10,490.00"
,,,
,,2ND- DILATION OF URETHRA,"1,115.00"
,,,
,,DIAGNOSTIC COLONOSCOPY FLEX,"2,861.00"
,,,
,,COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,"2,861.00"
,,,
,,COLSC FLX W/REMOVAL LESION BY HOT BX FOR,"3,324.00"
,,,
,,COLONOSCOPY W/ LESION REMOVAL,"3,324.00"
,,,
,,REPAIR WRIST JOINTS,"12,597.00"
,,,
,,2ND SURG-REMOVAL OF HYDROCELE,"2,311.00"
,,,
,,OPEN TREATMENT RADIAL SHAFT FRACTURE,"8,558.00"
,,,
,,2ND SURG-EXC LESION SPERMATIC CORD,"2,776.00"
,,,
,,REVISE SPREMATIC CORD VEINS,"4,623.00"
,,,
,,REAMER AND DRILL BITS,"1,975.00"
,,,
,,CLTX DSTL RDL FX/EPIPHYSL SEP,"2,829.00"
,,,
,,OPTX DISTAL RADL X-ARTIC FX,"8,558.00"
,,,
,,OPTX DISTAL RAD IARTIC FX,"8,558.00"
,,,
,,2ND- DELIAT FEMALE URETHA W/SUPP,"1,115.00"
,,,
,,PROSTATE NEEDLE BIOPSY ANY APPROACH,"4,137.00"
,,,
,,PROSTATE SATURATION SAMPLING,"3,445.00"
,,,
,,2ND-POST COLPORRHAPHY RECT W WO PERINEOR,"2,800.00"
,,,
,,,
,,2ND- REPAIR ENTEROCELE VAGINAL,"2,800.00"
,,,
,,2ND- PARAVAGINAL DEFECT RPR VAG APP,"3,350.00"
,,,
,,FUSE HAND BONES WITH GRAFT,"5,423.00"
,,,
,,2ND- REMOVAL INTRAUTERINE DEVICE IUD,140
,,,
,,2ND- LAPROSCOPY W/LISIS ADHESIONS,"4,427.00"
,,,
,,DILAT RECTAL STRIX SPX UNDER ANES,"3,968.00"
,,,
,,ANALYZE NEUROSTIM COMPLEX,158
,,,
,,2ND SURG-DRAINAGE OF SKIN ABSCESS,922
,,,
,,RELEASE PALM CONTRACTU;RE,"3,950.00"
,,2ND SURG-INCISION OF ANAL SPHINCTER,"2,382.50"
,,,
,,EXCISION SOFT TISSUE HAND 1.5CM/>,"3,289.00"
,,,
,,EXC TUM MAL SOFT TISS HAND 1.5CM/>,"3,289.00"
,,,
,,RELEASE PAM CONTRACTURE,"5,423.00"
,,,
,,2ND SURG INCISE FINGER TENDON SHEATH,"1,645.00"
,,,
,,EXC LESION TDN SHTH/JT CAPSL HAND/FNGR,"3,950.00"
,,,
,,EXCISION/ CURETTEAGE CYST/TUMORE PHALANX,"3,289.00"
,,,
,,,
,,2ND SURG-EXCISION SINGLE EXTERNAL PAPILL,950.5
,,,
,,HEMMORRHOIDECTOMY INT RUBBER BANK LIGATI,"1,910.00"
,,,
,,,
,,PARTIAL EXCISION DISTAL PHALANX FINGER,"3,950.00"
,,,
,,2ND SURG-REMOVE EXT HEM GROUPS 2+,"2,665.00"
,,,
,,HEMORRHOIDECTOMY NTRNL XTRNL 1 COL/GR,"4,438.00"
,,,
,,HEMORRHOIDECTOMY INT XTRNL 2/> COL/GR,"4,438.00"
,,,
,,SURG TX ANAL FISTULA SUBQ,"5,330.00"
,,,
,,2ND-LAMNOTMY W/DCMPRSN NRV EA ADD,"4,567.00"
,,,
,,REMOVAL OF HEMORRHOID CLOT,"3,968.00"
,,,
,,REPAIR FLXR TENDON,"3,289.00"
,,,
,,REVISE HAND/ FINGER TENDON,"5,423.00"
,,,
,,EXCISION HAND/ FINGER TENDON,"5,423.00"
,,,
,,GRAFT HAND OR FINGER TENDON,"5,423.00"
,,,
,,REPAIR FINGER TENDON,"3,289.00"
,,,
,,RELEASE PALM/ FINGER TENDON,"3,289.00"
,,,
,,TENOTOMY FLEXOR PALM OPEN EA TENDON,"2,995.00"
,,,
,,INCISION OF FINGER TENDON,"2,995.00"
,,,
,,TENOTOMY EXTENSOR HAND/FINGER OP EA TEND,"2,995.00"
,,,
,,,
,,2ND-NEUROPLASTY/TRANSPOSITION ULNAR NRVE,"1,700.00"
,,,
,,,
,,2ND-NEUROPLASTY TRANS MEDIAN NRV CARPAL,"1,700.00"
,,,
,,,
,,2ND- NEUROPLASTY/ TRANS ULNAR NERVE WRIS,"1,700.00"
,,,
,,,
,,TRANSPLANT/ GRAFT HAND TENDON,"5,423.00"
,,TRANSPLANT PALM TENDON,"7,134.00"
,,,
,,INJECT FACET JT 1 LEVEL- BILATERAL,"2,136.00"
,,,
,,INJECT FACET 2ND LEVEL- BILATERAL,"2,136.00"
,,,
,,INJECT FACET 3 LEVEL- BILATERAL,"2,136.00"
,,,
,,HAND TENDON RECONSTRUCTION,"5,423.00"
,,,
,,RCNST TENDON PULLEY EA TND W/TDN/FSCAL G,"5,423.00"
,,,
,,,
,,ARTHRP MT CARPHLNG JT W PROSTC,"10,490.00"
,,,
,,RECONSTRUCT J COLTRL LIGM,"5,423.00"
,,,
,,INSJ TUNNELED CTR VAD W/SUBQ PORT 5 YR/>,"4,863.00"
,,,
,,OSTEOTOMY PHALANX FINGER EACH,"5,423.00"
,,,
,,RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRP,"4,401.00"
,,,
,,,
,,ANOSCOPY AND BIOPSY,"1,583.00"
,,,
,,OPEN TREATMENT METACARPAL FRACTURE SINGL,"8,558.00"
,,,
,,,
,,VULVECTOMY SIMPLE PARTIAL,"5,595.00"
,,,
,,ARTHRODESIS INTERPHALANGEAL JT W/WO INT,"3,289.00"
,,,
,,,
,,DSTRJ LESION ANUS SIMPLE SURG EXCISION,"3,295.00"
,,,
,,DESTRUCTION INTERNAL HEMORRHOID THERMAL,"4,765.00"
,,,
,,,
,,TYMPANOSTOMY GEN ANES-BILATERAL,"6,500.00"
,,,
,,HRHC NTRNL LIG OTH THAN RBBR BAND 1COL/G,"4,765.00"
,,,
,,AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL,"5,423.00"
,,,
,,CATARACT REMOVAL INSER LENS COMPLEX,"4,585.00"
,,,
,,DESTRUCTION VAGINAL LESIONS SIMPLE,"3,491.00"
,,,
,,BIOPSY VAGINAL MUCOSA SIMPLE,"4,192.00"
,,,
,,DESTRUCT B9 LESION 1-14,687
,,,
,,REPAIR RECTUM VAGINA,"6,718.00"
,,,
,,COMBINED ANTERPOSTERIOR COLPORRHAPHY,"6,718.00"
,,,
,,EXTENSIVE REPAIR OF VAGINA,"8,045.00"
,,,
,,INSJ MESH/PORSTH PELVIC FLOOR DEFECT EA,"4,192.00"
,,,
,,COLPOPEXY VAG EXTRAPERITONEAL APPROACH,"6,718.00"
,,,
,,SLING OPERATION STRESS INCONTINENCE,"6,295.00"
,,,
,,EXCESION THIGH/KNEE LESION SC<3CM,"3,665.00"
,,,
,,EXC TUMOR SOFT TISSUE THIGH SUB <5CM,"3,665.00"
,,,
,,EXC THIGH/KNEE LES SC 3 CM/>,"7,341.00"
,,,
,,EXCISE SOFT TUMOR THIGH KNEE 5 CM/>,"6,113.00"
,,,
,,REMOVAL OF FOREIGN BODY,"4,401.00"
,,,
,,COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERV,"1,360.00"
,,,
,,CONIZATION OF CERVIX,"3,491.00"
,,,
,,EXCISION CERIVAL STUMP VAG APPROACH,"5,595.00"
,,,
,,LAPAROSCOPY CHOLECTYSTECTOMY,"10,634.00"
,,,
,,LAPS CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,"12,183.00"
,,,
,,,
,,FIXATION OF KNEE JOINT,"2,515.00"
,,,
,,LIGATION/BIOPSY TEMP ARTERY,"1,591.00"
,,,
,,REPAIR PRIMARY DISRUPTED LIGAMENT,"6,113.00"
,,,
,,BILATERAL-EXCISION LESION EYELID,"2,480.00"
,,,
,,EXC FOOT/TOE TUM SC 1.5CM/>,"5,141.00"
,,,
,,REMOVAL OF FOOT LESION,"6,173.00"
,,,
,,OSTECTOMY PRTL 5TH METAR HEAD,"7,351.00"
,,,
,,REMOVAL OF HEEL SPUR,"6,173.00"
,,,
,,PARTIAL EXCISION BONE PHALANX TOE,"5,141.00"
,,,
,,REPAIR OF FOOT TENDON,"6,173.00"
,,,
,,RPR TENDON FLXR FOOT SEC W/ GRAFT,"8,405.00"
,,,
,,RECONSTRUCT TIBL TENDON W/EXC ACCESSORY,"8,405.00"
,,,
,,,
,,VAG HYSTERECTOMY UTERUS 250 GM/<,"8,045.00"
,,,
,,VAG HYST 250 GM/< W.RMVL  TUBE/OVARY,"8,045.00"
,,,
,,VAG HYST 250 GM W/ RMVL TUBE OVARY,"6,699.00"
,,,
,,VAG HYSTER 250 GM/<W/RPR ENTEROCELE,"8,045.00"
,,,
,,VAG HYSTERECTOMY UTERUS >250GM,"8,045.00"
,,,
,,VAG HYST>250 GM RMVL TUBE/OVARY,"8,045.00"
,,,
,,CORRECT HALLUX VALGUS W/SESMDC W/DIST ME,"7,351.00"
,,,
,,,
,,CORRECT BUNION W/SESMDC,"7,351.00"
,,,
,,INCISION OF METATARSAL,"6,173.00"
,,RECONSTRUCT J ANGULAR DFRM SOFT TISS,"5,141.00"
,,,
,,OPEN TREATMENT CALC FRACTURE,"8,558.00"
,,,
,,TREAT METATARSAL FRACTURE,"8,558.00"
,,,
,,2ND- BIOPSY/ EXC LYMPH NODE OPEN SUPER,"2,447.00"
,,,
,,BIOPSY LYMPH NODE/ EXCISION CERVICAL NOD,"5,878.00"
,,,
,,BIOPSY/ EXC LYMPH NODE OPEN DEEP AX NODE,"4,895.00"
,,,
,,LSH W/T/O UT 250 G OR LESS,"10,145.00"
,,,
,,LAPS VAG HYSTERECTOMY UTERUS 250 GM/<,"12,183.00"
,,,
,,LAPS W/VAG HYSTERECT 250 GM/RMVL TUBE/OV,"12,183.00"
,,,
,,,
,,LAPS W/VAGINAL HYSTER >250 GRAMS,"16,384.00"
,,,
,,LAPS VAG HYSTERECT>250 GM RMVL TUBE/OVAR,"16,384.00"
,,,
,,,
,,HYSTER BX ENTOMETRIUM/POLYPC W/WO DC,"6,878.00"
,,,
,,HYSTEROSCOPY ENDOMETRIAL ABLATION,"6,878.00"
,,,
,,HYSTER BI TUBE OCCLUSION W/PERM IMPLTS,"6,878.00"
,,,
,,LAPAROSCOPY LYSIS,"10,634.00"
,,,
,,LAPROSCOPY W/REMOVAL ADNEXAL STRUC,"8,855.00"
,,,
,,LAPS FULG/EXC OVARY VISCERA/PER SURFACE,"10,145.00"
,,,
,,LAPAROSCOPY FULGURATION OVIDUCTS,"10,634.00"
,,,
,,REMOVAL OF OVARY/TUBES(S),"8,045.00"
,,,
,,FUSION OF BIG TOE JOINT,"10,093.00"
,,,
,,REMOVE GROIN LYMPH NODES,"4,895.00"
,,,
,,AMPUTATION TOE METATARSOP JOINT,"5,141.00"
,,,
,,2ND SURG-DRAIN BLADDER INSERT SUPRAPUBIC,"2,924.00"
,,,
,,,
,,REMOVE EXTERNAL EAR PARTIAL,"1,591.00"
,,,
,,2ND SURG-PARTIAL REMOVAL COLLAR BONE,"3,670.50"
,,,
,,2ND SURG-PARTIAL REPAIR OR REMOVAL OF SH,"3,670.50"
,,,
,,2ND SURG- RESECT INFERIOR TURBINATE,"2,167.50"
,,,
,,2ND SURG-REMOVE TENDON SHEATH LESION,"1,975.00"
,,,
,,CARDIOVERSION ELECTRIC EXT,"1,497.00"
,,,
,,MASTECTOMY PARTIAL,"6,842.00"
,,,
,,MASTECTOMY PARTIAL W/AXILLARY LYMOH,"6,842.00"
,,,
,,MASTECTOMY SIMPLE COMPLETE,"6,842.00"
,,LAPAROSCOPY ASPIRATION,"7,724.00"
,,,
,,VENTILATING TUBE RMVL REQUIRING GNL ANES,"4,641.00"
,,,
,,CREATE EARDRUM OPENING,"4,335.00"
,,,
,,TYMPANOSTOMY GENERAL ANESTH,"4,335.00"
,,,
,,HRHC NTRNL LIG OTHER RBBR BANK 2/>,"3,968.00"
,,,
,,RPR 1ST INGUN HRNA AGE 5YRS/> REDUC OPEN,"6,077.00"
,,,
,,REPAIR 1ST INCAL/VNT HERNIA INC,"7,500.00"
,,,
,,REPAIR UMBIL HERNIA REDUC < 5 YR,589
,,,
,,REPAIR UMB HERNIA <5 YRS INCARCERATED,"5,889.00"
,,,
,,RPR UMBIL HERN REDUC>5 YR,"7,072.00"
,,,
,,RPR UMBILICAL HERNIA 5 YRS/>,"5,889.00"
,,,
,,LAP SURG RPR INITIAL INGUINAL HERNIA,"10,634.00"
,,,
,,LAPS SURG RPR RECURRENT ING HERNIA,"8,855.00"
,,,
,,LAPS REPAIR HERNIA EXCEPT INCAL.INGUN RE,"10,075.00"
,,,
,,LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRA,"9,359.00"
,,,
,,LAP REPAIR INCISIONAL HERNIA,"8,855.00"
,,,
,,2ND-ARTHROSCOPY SHOULDER SURG SYN PA,"2,715.00"
,,,
,,ARTROSCOPY SHOULDER SURG DEBRIDEMENT LTD,"5,431.00"
,,,
,,,
,,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EX,"5,431.00"
,,,
,,,
,,2ND-ARTHROSCOPY ELBOW SURG DEBRIDE LTD,"2,700.00"
,,,
,,ENDOSCOPIC CARPAL TUNNEL RELEASE,"6,521.00"
,,,
,,KNEE ARTHROSCOPY/SURGERY,"6,521.00"
,,,
,,ARTHROSCOPY KNEE SYNOV LTD,"5,431.00"
,,,
,,KNEE ARTHROSCOPY/SURGERY,"6,521.00"
,,,
,,ARTHROSCOP KNEE W/MENISCECTOMY,"5,431.00"
,,,
,,ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W,"6,521.00"
,,,
,,,
,,KNEE ARTHROSCOPY/ SURGERY,"6,521.00"
,,,
,,ARTHROSC KNEE; W MEN REP-MED&LAT,"6,521.00"
,,,
,,ADDITIONAL LIPOMA REMOVAL,900
,,,
,,3RD ADDITIONAL CLOSURES,200
,,,
,,3RD SURG- ADDITIONAL LESIONS,400
,,,
,,3RD SURG-ADDITIONAL LESIONS,636.66
,,HARDWIRE ROOM,"1,105.00"
,,,
,,SKILLED NURSING FACILITY,707
,,,
,,DIRECT ADMIT TO SNF,0
,,,
,,FHM NOT IN LABOR,139.13
,,,
,,NON-STRESS TST FHM-IP,292.9
,,,
,,NON-STRESS TEST FHM-OP,292.9
,,,
,,STRESS TEST FHM,371.01
,,,
,,CHEMO-SQ/IM ;NON-HORMONAL,138.2
,,,
,,"CHEMO, PUSH TECHNIQUE",138.2
,,,
,,OBSERVATION ROOM 1ST HOUR,240
,,,
,,CHEMO -INFUSION 0-1 HRS,265.38
,,,
,,CHEMO- SQ/IM,138.2
,,,
,,OUTPATIENT VISIT,132.88
,,,
,,MED/SURG SEMI-PRIVATE,917
,,,
,,HOSPICE ROOM CHARGE,917
,,,
,,RESPITE ROOM CHARGE,450
,,,
,,MED/SURG PRIVATE,917
,,,
,,OBS ROOM EA ADD HOUR,29.44
,,,
,,DIRECT ADMINT HOSP OBSERV,0.01
,,,
,,CHEMO-INFUSION EA ADD HR,69.1
,,,
,,CHEMO-INFUSION OVER 8 HRS,345.45
,,,
,,OBSERVATION HYDRATION,39.37
,,,
,,CHEMO IV INFUS EACH ADDL,140
,,,
,,ADMIN PRQ ID SUBQ/IM,18
,,,
,,"IV PUSH, SEQ SAME DRUG",33.43
,,,
,,DC ACUTE TO SWB,0
,,,
,,INSERT BLADDER CATHETER,49.58
,,,
,,IV INFUSION HYDRATION EA ADD HR,28.82
,,,
,,IV INFUSION 1ST HOUR IN OBS,63.2
,,,
,,IV INFUSION ADD HR IN OBS,40
,,,
,,IV INFUSION SEQ+ IN OBS,35.35
,,,
,,THER/DIAG CONCURRENT INF,38.25
,,,
,,TX/PRO/DX INJ NEW DRUG AD,68.37
,,,
,,"IV PUSH, SEQ SAME DRUG IN OBS",16.2
,,,
,,CHEMO IV PUSH ADDL DRUG,104.47
,,IRR DRUG DELIVERY DEVICE,65
,,,
,,IV CONCURRENT INUFISON IN OBS,21.42
,,,
,,TX/PRO/DX INJ NEW DRUG AD IN OBS,40.81
,,,
,,OBSERVATION BED TYPE,0
,,,
,,2ND-COLOREC CANCER SCR HI RISK,450
,,,
,,2ND- COLOREC CANCER SCR NOT HI RISK,440
,,,
,,INCISION DRAINAGE ABSCESS SIMPLE,280
,,,
,,INCISION DRAINAGE ABCESS COMPLICATED/ MU,505
,,,
,,,
,,INCISION DRAINAGE PILONDIAL CYST,460
,,,
,,INCISION DRAINAGE PILONIDAL CYST,694
,,,
,,COLOREC CANCER SCR- PRO FEE,915
,,,
,,INCISION REMOVAL FOREIGN BODY SUBQ TISS,375
,,,
,,COLOREC CANCER SCR;NOT HIGH RISK,900
,,,
,,PUNCTURE ASPIRATION ABSCESS HEMOTOMA,325
,,,
,,ASPIRATION AND/OR INJECTION THRYOID CYST,280
,,,
,,2ND- BIOPSY/ EXC LYMPH NODE OPEN SUPER,425
,,,
,,2ND- RPR UMBILICAL HERNIA 5 YRS/> INCAR,590
,,,
,,REPAIR LIP,"1,150.00"
,,,
,,FINE NEEDLE ASPIRATION BX W/US,315
,,,
,,DEBRIDEMENT SKN SUBQ T/M/F NECRO INFCTJ,"1,575.00"
,,,
,,INCISION REMOVAL FOREIGN BODY SUBQ,670
,,,
,,EXCISION TUMOR SOFT TISS FACE/SCALP 2CM/,"1,200.00"
,,,
,,DEB SUBQ TISSUE SQ CM/<,240
,,,
,,DEBRIDEMENT MUSCLE FASCIA 20 SQ CM,585
,,,
,,DEBRIDEMENT SUBCUT TISSUE EA ADD 20 SQ C,100
,,,
,,BIOPSY SKIN SUBQ EA ADD LESION,80
,,,
,,ASPRATION BLADDER INSERT SUPRAPUBIC CATH,515
,,,
,,,
,,PUNCH BIOPSY SKIN SINGLE LESION,255
,,,
,,2ND- DEBRID SUBCUT TISSUE EA ADD 20SQ,55
,,,
,,2ND-PARING BENIGN HYPER LESION 2-4,85
,,,
,,3RD- INCISION BIOPSY SKIN EA ADD,60
,,,
,,2ND- PUNCH BIOPSY EA ADD,65
,,,
,,3RD- PUNCH BIOPSY EA ADD,50
,,INCISIONAL BIOPSY SKIN LESION,360
,,,
,,2ND-INCISION BIOPSY SKIN EA ADD,85
,,,
,,2ND-REMOVAL OF SKIN TAGS <W/15,100
,,,
,,2ND- EXCISION B9 XCP SK TAG 1.1-2.0CM,200
,,,
,,POST OP CHECK,0
,,,
,,2ND- EXC B9 LESION MARGIN XCP SK TG 3.1-,240
,,,
,,2ND- EXC B9 LESION MARGIN XCP SK TG 2.1-,250
,,,
,,2ND- EXC B9 MARGIN SK TG 3.1-4.0,280
,,,
,,2ND- EXCISION B9 XCP SK TAG >4.0CM,390
,,,
,,EXCISION MAL LESION TRUNK ARM 2.1-3.0CM,695
,,,
,,2ND- AVULSION NAIL PLATE PARTIAL/COMPL,120
,,,
,,REMOVAL SKIN TAGS,175
,,,
,,2ND-REPAIR INTERM S/A/T/E/2.6-7.5 CM,375
,,,
,,2ND- REPAIR INTERMED N/H/F 2.5/<,250
,,,
,,2ND- REPAIR INTERMED 7.6-12.5CM,420
,,,
,,2ND- REPAIR INTERM GENT 2.6-7.5 CM,350
,,,
,,2ND- REPAIR COMPLEX TRUNK 2.6-7.5CM,475
,,,
,,2ND-REPAIR COMPLEX TRUNK 1.1-2.5CM,440
,,,
,,2ND-  REPAIR COMPLEX SCALP ARM 2.6-7.5CM,500
,,,
,,EXCISION B9 LESION MRGN 0.5CM/<,305
,,,
,,EXCISION TR-EXT B9+MARG 1.1-2CM,360
,,,
,,EXCISION B9 LESION MRGN XCP SK TAB 2.1-3,220
,,,
,,EXCISION TR-EXT B9+MARG 3.1-4CM,480
,,,
,,EXCISON B9 LESION MRGN XCP,725
,,,
,,EXCISION B9 LESION 0.6-1.0CM,390
,,,
,,EXCISION H-F-NK-SP B9+MARG 1.1-2,375
,,,
,,EXCISION B9 LESION REMOVAL XCP SK TAG 2.,450
,,,
,,EXCISION B9 LESION XCP SK TG 3.1-4.0CM,575
,,,
,,EXCISION B9 LESION MARGIN XCP SK TAG >4.,740
,,,
,,EXCISION B9 LESION F/E/E/N/L/M 1.1-2.0CM,465
,,,
,,EXCISION B9 LESION MARGIN 2.1-3.0CM,550
,,,
,,INTUBATION ENDOTRACHEAL ER PROCEDURE,340
,,,
,,EXC TUMOR SOFT TISSUE NECK/ANT THORAX,"1,100.00"
,,,
,,EXCISION TUMOR SOFT TISSUE NECK/ANT THOR,"5,180.00"
,,,
,,TRACHESOTOMY EMERGENCY PROCEDURE TRANS,515
,,,
,,,
,,EXCISION MALIGNANT LESION TR/ARM LEG>4,"1,000.00"
,,,
,,EXCISION MALIGNANT LESION F/E/N/L 2.1-3,780
,,,
,,CHANGE CYSTOMSTOMY TUBE SIMPLE,210
,,,
,,AVULSION NAIL PLATE PARTIAL/COMPLETE,155
,,,
,,REPAIR NAIL BED,475
,,,
,,EXCISION PILONIDAL CYST,700
,,,
,,MASECTOMY COMPLETE- BILATERAL,"3,375.00"
,,,
,,EXCISION TUMOR SOFT TISS BACK/ FLANK 5CM,"1,700.00"
,,,
,,SIMPLE LAC REPAIR SCALP/ NECK 2.5CM/<,130.49
,,,
,,SIMPLE REPAIR SCALP/NECK 2.6-7.5CM,250
,,,
,,SIMPLE REPAIR 2.5CM/<,275
,,,
,,REPAIR INTERMEDIATE S/A/T/E 7.6-12.5CM,700
,,,
,,REPAIR INTERMEDIATE S/A/T/E/12.6 20CM,700
,,,
,,EXCISION TUMOR SOFT TISSUES <3CM,"1,215.00"
,,,
,,CYSTOURETHROSCOPY WITH BIOPSY,"2,383.00"
,,,
,,TUBE THORACOSTOMY INC WATER SEAL,400
,,,
,,REMOVE TUNNELED PLEURAL CATHETER,450
,,,
,,THORACENTESIS NEEDLE/CATH PLEURA,725
,,,
,,2ND- REMOVAL IMPLANT SUPER SEP PROC,460
,,,
,,REPAIR COMPLEX TRUNK 2.6-7.5CM,985
,,,
,,2ND-REPAIR COMPLEX TRUNK EA ADD 5 CM,152
,,,
,,REPAIR COMPLEX SCAP/ARM/ LEG 2.6-7.5,960
,,,
,,REPAIR COMPLEX SCALP/ ARM LEG ADD 5CM,300
,,,
,,EGD TRANSORAL DIAGNOSTIC,630
,,,
,,EGD BIOPSY SINGLE/ MULTIPLE,961
,,,
,,EGD PERCUTANEOUS PLACEMENT GASTO TUBE,550
,,,
,,EGD REMOVAL TUMOR POLYP/OTHER LESION,"1,100.00"
,,,
,,PERQ REPLACEMENT G TUBE NOT REQ GSTRST,559
,,,
,,PERQ REPLACEMENT GTUBE REQ REVJ,875
,,,
,,2ND- BIOPSY/ EXC LYMPH NODE NEEDLE,140
,,,
,,2ND- EXC B9 LESION XCP SKIN TAG 1.1-2.0C,200
,,,
,,2ND-EXC B9 LESION MRGN XCP SKIN TAG 2.1-,240
,,,
,,EXCISION TUMOR SOFT TISS UPPER ARM,"1,100.00"
,,REMOVAL OF FOREIGN BODY UPPER ARM,520
,,,
,,REMOVAL FOREIGN BODY UPPER ARM/ELBOW,"1,250.00"
,,,
,,2ND-EGD PERCUT PLACEMENT GASTRO TUBE,260
,,,
,,2ND- EGD TRANSORAL CONTROL BLEEDING,830
,,,
,,2ND-EGD BIOPSY SINGLE/MULTIPLE,480
,,,
,,EGD INTRALUMINAL TUBE/CATH INSERT,185
,,,
,,2ND- EGD REMOVAL LESIONS BIOPSY FORCEPS,500
,,,
,,2ND- EGD DIAGNOSTIC BRUSH WASH,375
,,,
,,2ND- DILATION ESOPH UNGUIDED SOUND,185
,,,
,,ENTEROSCOPY> 2ND PRTN W/ PLMT PRQ TUBE,630
,,,
,,COLONOSCOPY STOMA DX INCL COLLJ,650
,,,
,,ENTRC RESCJ SMALL INTESTINE,"1,500.00"
,,,
,,2ND-LAPARO PARTIAL COLECTOMY,"1,900.00"
,,,
,,FORESKIN MANJ W/LSS PREPUTIAL,175
,,,
,,2ND- COLONOSCOPY FLEX DX W/COLLJ SPEC,408
,,,
,,2ND - COLONOSCOPY W/ LESION REMOVAL,640
,,,
,,2ND-COLONOSCOPY AND BIOPSY,585
,,,
,,2ND-COLONOSCOPY W/ LESION REMOVAL,295
,,,
,,2ND-EXCISION SINGLE EXT PAPILLA/TAG,270
,,,
,,2ND-HEMORRHOIDECTOMY XTRNL 2/>,580
,,,
,,2ND- LAP RPR INITIAL ING HERNIA,490
,,,
,,2ND- LAP SURG REPAIR INCURRENT ING HERNI,705
,,,
,,2ND- LAP RPR HERNIA XCPT INCAL/INGUN STR,"1,100.00"
,,,
,,2ND-ANOSCOPY W/ DILATION,650
,,,
,,HRHC NTRNL LIG OTHER RBBR BAND 2/>,790
,,,
,,2ND- LAPARASCOPIC PROC LIVER,800
,,,
,,ABDOM PARACENTESIS W/IMAGING,745
,,,
,,2ND-REMOVAL PERITONEAL FOR BODY,"1,100.00"
,,,
,,2ND- HRHC NTRNL LIG OTHER THAN RBBR BAND,435
,,,
,,2ND-APPENDEC INDICATED PURPOSE OTHER,100
,,,
,,2ND-IMPLANT MESH OPEN HERNIA REPAIR,300
,,,
,,2ND- REPAIR EPIG HERNIA INCARCERATED,600
,,,
,,2ND-RPR UMBILICAL HRNA 5 YRS/>REDUCIBLE,475
,,,
,,BILATERAL LAP SURG RPR INITIAL ING HERNI,"1,600.00"
,,,
,,LAPROSCOPY APPENDECTOMY,"1,475.00"
,,ID SUBMUCOSAL ABSCESS RECTUM,690
,,,
,,2ND- INSJ TEMP NDWELLG BLADDER CATHETER,75
,,,
,,REMOVAL OF SPERM DUCT(S),850
,,,
,,SIGMOIDOSCOPY FLX DX W/ COLLJ,425
,,,
,,SIGMOIDOSCOPY FLX W/BIOPSY SING/MULT,645
,,,
,,COLONSCOPY FLX DX W/COLL SPEC,775
,,,
,,COLONOSCOPY AND BIOPSY,"1,200.00"
,,,
,,COLONOSCOPY W/CONTROL BLEEDING,"1,800.00"
,,,
,,COLONOSCOPY W/LESION REMOVAL,"1,050.00"
,,,
,,COLONSCOPY W/ LESION REMOVAL,"1,250.00"
,,,
,,2ND-REMOVAL INTRAUTERINE DEVICE,120
,,,
,,VENOGRAPHY VENOUS SINUS/JUGULAR CATH,350
,,,
,,2ND-LAPROSCOPY FULGURATION OVIDUCTS,450
,,,
,,DILAT RCT STRIX SPX,485
,,,
,,DEBRIDEMENT BURNS 1ST SUBSQ SMALL,200
,,,
,,ID PERIANAL ABSCESS SUPERFICIAL,510
,,,
,,INCISION THROMBOSED HEMORRHOID EXT,415
,,,
,,HEMORRHOIDECTOMY INT XTNL 2//> COL/GRP,"1,100.00"
,,,
,,ID VULVA/PERINEAL ABSCESS,275
,,,
,,2ND- INJECT ANES OTHER PERIPH,100
,,,
,,INSERT TUNNELED CV CATH,"2,620.00"
,,,
,,REMOVAL TUN CTR VAD W/SUBQ PORT/PMP,500
,,,
,,DESTRUCT BENIGN LESION UP TO 14,270
,,,
,,CHEMICAL CAUTERIZATION OF GRAN TISSUE,208
,,,
,,EXC TUMOR SOFT TISSUE THIGH SUBF <5CM,"1,425.00"
,,,
,,EXC THIGH/KNEE LES SC 3 CM/>,"1,025.00"
,,,
,,EXCISE TUMOR SOFT TISSUE THIGH KNEE 5CM/,"1,750.00"
,,,
,,LAPROSCOPY SURG CHOLECYSTECTOMY,"1,450.00"
,,,
,,LAP SURG CHOLECTYSTECTOMY W/CHOLANG,"1,600.00"
,,,
,,DEBRIDEMENT OPEN WOUND 20 SQ CM/<,121
,,,
,,REMOVAL DEVITAL TISSUE N SLCTV DBDMT,95
,,,
,,LIGATION/BIOPSY TEMP ARTERY,700
,,,
,,BIOPSY SOFT TISSUE LEG/ANKLE SUPERFICIAL,570
,,,
,,EXC TUMOR SOFT TISSUE LEG/ANKLE <3CM,"1,025.00"
,,,
,,CLOSED TIBIAL SHAFT FX W/O MANIPULATION,800
,,CLOSED TX TIBIAL SHAFT FX W/MANJ,"1,350.00"
,,,
,,BIOPSY/EXC LYPMH NODE NEEDLE SUPER,280
,,,
,,BX/EXC LYMPH NODE OPEN DEEP CERVICAL,"1,370.00"
,,,
,,BIOPSY/ EXC LYMPH NODE OPEN DEEP AX NODE,"1,000.00"
,,,
,,BIOPSY BREAST W/DEVICE 1ST LESION US GUI,"1,530.00"
,,,
,,EXC SYST/ABERRANT BREAST TISSUES 1/>,"1,135.00"
,,,
,,MOD SED SAME PHYS INITIAL 15 MIN <5 YRS,60
,,,
,,NEW OFFICE VISIT LEVEL 1,75
,,,
,,NEW OFFICE VISIT LEVEL 2,130
,,,
,,NEW OFFICE VISIT LEVEL 3,185
,,,
,,NEW OFFICE VISIT LEVEL 4,275
,,,
,,NEW OFFICE VISIT LEVEL 5,360
,,,
,,OFFICE VISIT LEVEL 1,40
,,,
,,OFFICE VISIT LEVEL 2,75
,,,
,,OFFICE VISIT LEVEL 3,130
,,,
,,OFFICE VISIT LEVEL 4,185
,,,
,,OFFICE VISIT LEVEL 5,250
,,,
,,OBSERVATION CARE DISCH MGMT,158.72
,,,
,,INTIAL OBSERVATION CARE/,175
,,,
,,INITIAL OBSERVATION CARE/ DAY,404.54
,,,
,,INITIAL IP VISIT LEVEL 1,160
,,,
,,INITIAL INPATIENT LEVEL 2,210
,,,
,,INITIAL IP LEVEL 3,300
,,,
,,SUBSEQUENT OBSERVATION/ 25 MIN,130
,,,
,,SUBS HOSPITAL CARE/ DAY15 MIN,80
,,,
,,SUBSQ HOSPITAL CARE/ DAY 25 MIN,125
,,,
,,SUBSQ HOSPITAL CARE/ DAY 35 MIN,227.92
,,,
,,OBSERVATION/ INPATIENT HOSPITAL CARE 40,300.58
,,,
,,OBSERVATION/INPATIENT HOSP CARE 50 MIN,373.94
,,,
,,OBSERV/ INPATIENT HOSPITAL CARE 55 MIN,480.47
,,,
,,HOSPITAL DISCHARGE DAY MGMT 30 MIN/<,158.35
,,,
,,HOSPITAL DISCHARGE DAY MGMT >30 MIN,190
,,,
,,ER VISIT/ MINOR,100
,,,
,,ER VISIT/ LIMITED,125
,,,
,,ER VISIT/ MODERATE,150
,,ER VISIT/ HIGH,175
,,,
,,INPATIENT CONSULTATION,70
,,,
,,PARTIAL MASTECTOMY,"1,525.00"
,,,
,,MASTECTOMY PARTIAL W/ AUX LYMP,"2,200.00"
,,,
,,MASTECTOMY SIMPLE COMPLETE,"2,300.00"
,,,
,,INITIAL NF CARE LEVEL 1,150
,,,
,,INITIAL NF LEVEL 2,200
,,,
,,INITIAL NF LEVEL 3,250
,,,
,,SUBSQ NF CARE/DAY E/M STABLE 10 MIN,96.47
,,,
,,SUBSQ NF CARE/DAY MINOR COMPL 15 MIN,149.26
,,,
,,SUBSQ NF CARE/ DAY NEW PROB 25 MIN,196.84
,,,
,,NF DISCHARGE MGMT 30 MIN,157.99
,,,
,,SNF DISCHARGE 30 MIN,227.69
,,,
,,REMOVAL OF BREAST IMPLANT,"6,842.00"
,,,
,,PROLONGED VISIT,240
,,,
,,REPLACE DUODENOSTOMY TUBE,"1,660.00"
,,,
,,REPAIR 1ST INCAL/VNT HERNIA INC,"2,300.00"
,,,
,,REPAIR UMB HERNIA <5 YRS INCAR,"1,200.00"
,,,
,,REPAIR UMBILICAL HERNIA 5 YRS/>REDUCIBLE,"1,050.00"
,,,
,,RPR UMBILICAL HERNIA AGE 5 YRS/> INCAR,"1,180.00"
,,,
,,LAPROSCOPY RPR INITIAL INGUINAL HERNIA,985
,,,
,,LAP SURG RPR RECURRENT ING HERNIA,"1,350.00"
,,,
,,LAPS RPR HERNIA EXCEPT INCAL/ING REDUC,"1,700.00"
,,,
,,LAP RPR HERNIA XCPT INCAL/INGUN,"2,130.00"
,,,
,,LAP REPAIR INCISIONAL HERNIA,"2,370.00"
,,,
,,I&D ABSC; SMPL OR SGL,245
,,,
,,I&D ABSC; COMPL OR MULTI,450
,,,
,,EXPLORATION PENETRATING WOUND SPX EXTREM,775
,,,
,,,
,,REMOVAL OF FOREIGN BODY; SIMPLE,260
,,,
,,PUNCTURE DRAINAGE OF LESION,240
,,,
,,REMOVE NASAL FOREIGN BODY,150.77
,,,
,,IMMUNIZATION ADMIN,19
,,,
,,"IMMUNIZATION ADMIN, EA AD",24
,,,
,,INJECT TRIGGER POINTS3/>,105
,,ARTHROCENTESIS ASPR/INJ INTERM,100
,,,
,,REPAIR LIP,775
,,,
,,"HYDRATION IV INFUSION, IN",106.87
,,,
,,"HYDRATE IV INFUSION, ADD",28.82
,,,
,,"THER/PROPH/DIAG IV INF, I",175
,,,
,,"THER/PROPH/DG IV INF, ADD",33.43
,,,
,,TX/PROPH/DG ADDL SEQ IV I,57.74
,,,
,,THER/DIAG CONCURRENT INF,38.25
,,,
,,"THER/PROPH/DIAG INJ, SC/I",55
,,,
,,"THER/PROPH/DIAG INJ, IV P",106.01
,,,
,,THER/PROPH/DIAG INJ ADD-O,42.13
,,,
,,"IV PUSH, SEQ SAME DRUG",33.43
,,,
,,ANTERIOR EPISTAXIS CONTRO,140
,,,
,,"CONTROL OF NOSE BLEED,ANT",263.85
,,,
,,CONTROL OF NOSE BLEED,308.16
,,,
,,PLACE IN OBSERVATION,35.38
,,,
,,EXCISION MALIGNANT LESION REM 1.1-2.0CM,450
,,,
,,BLADDER IRRIGATE LAVAGE/I,69.8
,,,
,,INSJ NON-NDWELLG BLADDER CATHETER,49.58
,,,
,,INSERT TEMP BLADDER CATH,75.67
,,,
,,INSERT BLADDER CATH COMPLEX,195
,,,
,,CHANGE OF BLADDER TUBE,130
,,,
,,CHANGE OF CYSTOSTOMY TUBE; COMPLICATED,200
,,,
,,REMOVAL OF NAIL PLATE SINGLE,140
,,,
,,EVACUATION SUBUNGUAL HEMATOMA,85
,,,
,,REPAIR OF NAILBED,285
,,,
,,US URINE CAPACITY MEASURE,31.61
,,,
,,DRAINAGE OF GUM LESION,237.91
,,,
,,DRAINAGE ABSCESS PALATE UVULA,260
,,,
,,SIMPLE REPAIR SCALP/NECK 2.5 CM/<,115
,,,
,,SIMPLE REPAIR SCALP/NECK 7.6- 12.5CM,185
,,,
,,SIMPLE REPAIR SCALP/NECK 12.6-20CM,235
,,,
,,SIMPLE REPAIR SCALP/NECK 20.1-30.CM,295
,,,
,,SIMPLE REPAIR SCALP/NECK >30CM,365
,,,
,,SIMPLE REPAIR R/E/E/N 2.5/<,135
,,SIMPLE REPAIR F/E/E/ 2.6-5.0 CM,145
,,,
,,SIMPLE REPAIR F/E/E/ 5.1-7.5CM,185
,,,
,,SIMPLE REPAIR F/E/E 7.6-12.5CM,235
,,,
,,SIMPLE REPAIR F/E/E 12.6-20.0 CM,320
,,,
,,SIMPLE REPAIR F/E/E/ 20.1 -30 CM,385
,,,
,,SIMPLE REPAIR F/E/E/ >30 CM,430
,,,
,,SIMPLE REPAIR SCAP/NECK 2.6-7.5CM,145
,,,
,,REPAIR INTERMED 2.5 CM/<,400
,,,
,,INT MD RPR S/A/T/EXT 2.6-7.5,490
,,,
,,INTMD WND REPAIR S/TR/EXT,600
,,,
,,LAY CLOS FACE LAC 0-2.5CM,430
,,,
,,"TUBE THORA, INCL WATER SE",400
,,,
,,BILATERAL-CONTROL NASAL HEMORRHAGE,215
,,,
,,COMPLEX RPR S/A/L 2.6-7.5 CM,675
,,,
,,REPAIR COMPLEX 1.1-2.5 CM,625
,,,
,,REPAIR COMPLEX,725
,,,
,,PERQ REPLACEMENT GTUBE NOT REQ REVJ,95
,,,
,,IRRIGATION CORPORA CAVERNOSA PRIAPISM,340
,,,
,,INJECT ANES OTHER PERIPHERAL NERVE/BRANC,115
,,,
,,DRAINAGE OF SCROTUM ABCESS,420
,,,
,,,400
,,,
,,REMOVE FOREIGN BODY -EYE,110
,,,
,,REMOVE FOREIGN BODY -EYE,130
,,,
,,REMOVE FOREIGN BODY -EYE,105
,,,
,,REMOVE FOREIGN BODY -EYE,130
,,,
,,ADMIT TO ACUTE,0
,,,
,,CLOSED TX RADIAL ULNAR SHAFT FRAC,"1,075.00"
,,,
,,DRESSING & DEBRID OF BURN,135
,,,
,,ID PERIANAL ABSCESS SUPERFICIAL,250
,,,
,,REMOVAL IMPACTED CERUMEN,35
,,,
,,ID VULVA/PERINEAL ABSCESS,315
,,,
,,IRRIG DRUG DELIVERY SYSTEM,68
,,,
,,PICC INSERTON5 YRS OR LESS,743.67
,,,
,,PICC INSERTON AGE 5 YRS/>,215
,,,
,,REPAIR CVA CATHETER,100
,,TB INTRADERMAL TEST,14.26
,,,
,,DRAW BLOOD OFF VENOUS DEVICE,56
,,,
,,TREAT FINGER DISLOCATION,500
,,,
,,BILATERAL REMOVAL IMPACTED CERUMEN,55
,,,
,,"THROMBOLYSIS, CEREBRAL, B",339.54
,,,
,,TREAT KNEECAP DISLOCATION,750
,,,
,,LIGATION/BIOPSY TEMPORAL ARTERY,500
,,,
,,CLOSED TIBIAL SHAFT FX W/O MANIPULATION,725
,,,
,,CLOSED TX TIBIAL SHAFT FX W/MANJ,"1,135.00"
,,,
,,REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,234.28
,,,
,,,
,,REMOVAL FOREIGN BODY FOOT DEEP,700
,,,
,,APPLICATION CAST ELBOW FINGER SHORT ARM,150
,,,
,,,
,,ABDOM PARACENTESIS W/IMAGING,275
,,,
,,APPLICAATION CAST HAND LOWER FOREARM,200
,,,
,,APPLICATION LONG ARM SPLINT,125
,,,
,,APPLICATION OF ARM SPLINT,100
,,,
,,APPLICATION FINGER SPLINT,75
,,,
,,MOD SED SAME PHYS INTIAL 15 MIN <5 YEARS,40
,,,
,,CLEAR OUTER EAR CANAL,200
,,,
,,STRAPPING SHOULDER,50
,,,
,,E.R. VISIT - LEVEL 1,97.19
,,,
,,E.R. VISIT - LEVEL 2,150.51
,,,
,,E.R. VISIT-LEVEL 3,225
,,,
,,E.R. VISIT-LEVEL 4,354
,,,
,,E.R. VISIT - LEVEL 5,425
,,,
,,CRITICAL CARE-FIRST HOUR,440
,,,
,,CRITICAL CARE-ADDL 30 MIN,95
,,,
,,APPLICATION SHORT LEG CAST BELOW KNEE,150
,,,
,,APPLY SHORT LEG CAST,160
,,,
,,APPLICATION LONG LEG SPLINT THIGH ANKLE/,215
,,,
,,APPLICATION OF LOWER LEG SPLINT,125
,,,
,,STRAPPING KNEE,45
,,,
,,STRAPPING ANKLE/FOOT,45
,,CPR,425
,,,
,,DISP KIT DX SWIVELOCK SL 3.5X8.5MM,412.5
,,,
,,DX SWIVELOCK SL 3.5X8.5MM W/FORK EYELET,637.5
,,,
,,15G HYDROMARK COIL 3 TITANIUM,143.67
,,,
,,MAMMOSTAR 14G,138.03
,,,
,,GLAUKOS TRABECULAR STENT (EYE),"3,562.50"
,,,
,,DuraGen Plus Dural Regeneration Matrix,736.5
,,,
,,CORTIVA TAILORED SMALL,"2,600.00"
,,,
,,LOCKING SCREW,255
,,,
,,CORTIVA TAILORED MEDIUM,"4,200.00"
,,,
,,BONE CEMENT,270
,,,
,,WRIST FUSION PLATE,"3,750.00"
,,,
,,MEMORY GEL XTRA BREAST IMPLANT,"1,350.00"
,,,
,,CORTEX SCREW,103
,,,
,,ROTATION CORRECTION PLATE,"1,325.00"
,,,
,,AVIVE SOFT TISSUE MEMBRANCE 3X4 CM,"3,350.00"
,,,
,,ARTHREX MICRO SUTURE ANCHOR,656.25
,,,
,,SHOULDER SUTURE ANCHOR w/SUTURE(ARTHREX),532.5
,,,
,,,
,,SHOULDER SUTURE ANCHORS w/ SUTURE&NEEDLE,502.5
,,,
,,,
,,LIGA CLIPS-OPEN BOWEL,97.36
,,,
,,ZCB00 LENS,231.75
,,,
,,3 PIECE LENS ZA9003,231.75
,,,
,,NERVE PROTECTOR 10MM X 40MM,"2,400.00"
,,,
,,APPLIER LIGAMAX 5MM,234.21
,,,
,,ENDOCLIP 5mm,661.2
,,,
,,ENDOCLIP 10MM,447.53
,,,
,,MESH PERFIX LIGHT PLUG-XL,784.5
,,,
,,HERNIA MESH 8X12,"1,511.25"
,,,
,,ULTRA PRO HERNIA OVAL,843.57
,,,
,,TVT ABBREVO,"2,006.65"
,,,
,,EASY CLIP-BICORTICAL FIX DEVICE 10X15X13,"1,700.00"
,,,
,,2.4X8.55MM SUTURE ANCHOR,700
,,,
,,PLATE REDUCTION WIRES,375
,,BONE SCREWS CREOSS PIN SELFTAPPING,210
,,,
,,DISTAL RAD PLATE,"1,925.00"
,,,
,,6X3 HOLE DISTAL RADIUS PLATE,"2,015.00"
,,,
,,SHOULDER SUTURE ANCHOR,850
,,,
,,ARTHROFLEX 15X140 1.5MM,"2,325.00"
,,,
,,CS MISC IMPLANTABLE,0
,,,
,,LOCKING SCREW,289
,,,
,,9.5MM TAPER POST,525
,,,
,,15MM DF 2.5X3.5,"2,780.00"
,,,
,,2.0 MM GUIDE PIN,115
,,,
,,HERNIA PATCH MED CIRCLE 6.4CM,"1,263.75"
,,,
,,COMPOSIX CIRCLE 2X4,840
,,,
,,COMPOSIX MESH 6X8,"1,981.25"
,,,
,,COMPOSIX CIRCLE 4.5,"1,453.75"
,,,
,,COMPOSIX MESH 7X9,"2,625.00"
,,,
,,COMPOSIX MESH 8X10,"3,388.75"
,,,
,,METALLIC URETERAL STENT RESONANCE,"1,285.81"
,,,
,,STENT 6X24-COOK,207.38
,,,
,,"COMPR FT SCRW, 2.5 MICRO, 14MM LGTH",505
,,,
,,"COMPR FT SCREW, 3.5 MINI 16MM LENGTH",505
,,,
,,PENILE IMPLANT ASSEMBLY KIT,"1,000.00"
,,,
,,HUNTER TENDON ROD 3MMX24.5CM,"2,200.00"
,,,
,,QUICKSET KIT 5CC,"2,300.00"
,,,
,,GRAFIX PRIME 1.5 X 2,"1,000.00"
,,,
,,STRAIGHT PLATE,"1,100.00"
,,,
,,ESSURE,"1,937.50"
,,,
,,4FUSION FIXATION DEVICE,"3,896.00"
,,,
,,PENILE PROSTHESIS,"11,425.00"
,,,
,,INTERSTIM NEURO STIM-STAGE 2,"15,714.00"
,,,
,,INTERSTIM STAGE 1 LEAD,"4,268.75"
,,,
,,VENTRALEX ST HERNIA PATCH 0380,720
,,,
,,PATCH 7.6 ROUND-KUGEL,528.14
,,,
,,KUGEL MESH 10.2 ROUND,558.65
,,,
,,PATCH 8.0X12-KUGEL,720.18
,,,
,,KUGEL MESH 9.5X13,880.2
,,MESH PLUG-SMALL,596.25
,,,
,,MESH PLUG-MED,601.5
,,,
,,MESH PLUG-LARGE,608.25
,,,
,,MESH PLUG X-LRG,709.5
,,,
,,"MINI TIGHTROPE, 1.1 MM",787.5
,,,
,,PICC ARROW 6FR 3LUMEN,177.26
,,,
,,POWER PORT VAD,777
,,,
,,PROSIMA-COMPLETE,"3,012.50"
,,,
,,PENILE IMPLANT RESERVIOR,"2,812.50"
,,,
,,SOFTMESH 12X12 / 30cm X 30cm,724.5
,,,
,,"PROSTOP GUIDE WIRE 0.54""",142.5
,,,
,,STENT-BOST SCIEN,167.58
,,,
,,PATCH 5.4X7.0-VERTRIO,"2,661.25"
,,,
,,PATCH 3.1X4.7-VENTRIO,"1,425.00"
,,,
,,VENTRIO 11X14 CIRCLE,"1,617.50"
,,,
,,VENTRIO 11x14-OVAL,"2,101.25"
,,,
,,NERVE PROTECTOR 10MMX20MM,"2,900.00"
,,,
,,NERVE PROTECTOR 7MM X 40MM,"2,900.00"
,,,
,,SOFT TISSUE MEMBRANE 3X4CM,"3,400.00"
,,,
,,PESSARY,84
,,,
,,TRIUNE VENT EAR TUBE,135
,,,
,,2.3 M PROFYLE HAND LOCK PLATE ST BAR 4H,800
,,,
,,ECHO PS MESH 6X8,"2,400.00"
,,,
,,SILICONE MCP METACARPOPHAL IMPLANT,"1,820.00"
,,,
,,HERNIA MESH 7X9,"2,950.00"
,,,
,,MINI SCORPION IMPLANT SYSTEM,"1,495.00"
,,,
,,3.2MM IMPLANT PACKAGE,"1,625.00"
,,,
,,COMPR FT SCREW 5.0 LG 60MM,810
,,,
,,LAPIPLASTY SYSTEM 2,"5,115.00"
,,,
,,2.4X16MM VAL SCREW,225
,,,
,,LOW PROFILE SCREW 2.4X16MM,185
,,,
,,2.4X12MM VAL SCREW,225
,,,
,,2.4X 18MM VAL SCREW,225
,,,
,,COMPR FT SCREW 5.0 LG 44MM,810
,,,
,,LO-PRO LOCK SCREW 3.5 X 12MM,140
,,VOLAR DISTAL RAD PLATE,"1,315.00"
,,,
,,LO-PRO SCREW 3.5MM X 13MM,95
,,,
,,FIBERTAK DX SUTURE ANCHOR,750
,,,
,,DURASEAL,"1,450.00"
,,,
,,ADMIN PREVNAR (PNEU 2) VACCINE,21.42
,,,
,,CARDIO CLINIC NEW PT,44.01
,,,
,,CARDIO CLINIC EST PT,44.01
,,,
,,ENT CLINIC VISIT-EST PT,26.96
,,,
,,ENT CLINIC VISIT -NEW PT,26.96
,,,
,,CIRCUMSION,349.04
,,,
,,CLINIC-EST PT,44.01
,,,
,,CLINIC-NEW PT,44.01
,,,
,,OP VISITING DR-EST PT,55
,,,
,,OP VISITING DR- NEW PT,55
,,,
,,OPTHAMOLOGY CLINIC-EST PT,70
,,,
,,OPTHAMOLOGY CLINIC-NEW PT,70
,,,
,,ORTHOPEDIC CLINIC-EST,44.01
,,,
,,ORTHOPEDIC CLINIC-NEW PT,44.01
,,,
,,UROLOGY CLININC-NEW PT,44.01
,,,
,,PULMONOLOGY CLINIC-NEW PT,55
,,,
,,PULMONOLOGY CLINIC-EST PT,55
,,,
,,OB/GYN CLINIC -NEW PT,44.01
,,,
,,UROLOGY CLINIC EST PT,44.01
,,,
,,OB/GYN CLINIC-EST PT,44.01
,,,
,,IV INFUSION 1ST HR-CLINIC,189.56
,,,
,,INJECTION,26.41
,,,
,,IV INFUSION 1ST HR-THERAP,189.56
,,,
,,IV INFUSION ADD HR-THERAP,94.77
,,,
,,"IV INFUSION, SEQ+ -THERA",94.77
,,,
,,IV INFUSION ADD HR-CLINIC,94.77
,,,
,,IV INFUSION SEQ+ - CLINIC,94.77
,,,
,,PAIN CONTROL CLINIC-NEW PT,44
,,,
,,PAIN CONTROL CLINIC-EST PT,44
,,,
,,"INSERTION, DRUG INPLANT",238.53
,,,
,,REMOVAL OF DRUG IMPLANT,290.45
,,REMOVE & REINSERT DRUG IMPLANT,526.47
,,,
,,INCISION DRAINAGE PILONIDAL CYST SIMPLE,260
,,,
,,"IV PUSH, INITIAL CLINIC",68.37
,,,
,,"IV PUSH, INITIAL THERAPEU",68.37
,,,
,,"IV PUSH, ADD DRUG-CLINIC",68.37
,,,
,,"IV PUSH, ADD DRUG-THERAPU",68.37
,,,
,,"INC & REM FB, SQ; SMPL",80.35
,,,
,,INCISION REMOVAL FOREIGN BODY SUBQ TISS,460
,,,
,,POST OP  CLINC VISIT,0
,,,
,,OP VISIT- EST,10
,,,
,,OP VISIT- NEW,10
,,,
,,PUNCT ASP - ABSC HEMAT CYST,57.14
,,,
,,IV HYDRATION 1ST HR-CLINI,189.56
,,,
,,IV HYDRATION 1ST HR-THERA,322.44
,,,
,,IV HYDRATION ADD HR-CLINI,94.77
,,,
,,IV HYDRATION ADD HR-THERA,94.77
,,,
,,OUTPATIENT VISIT-CLINIC,132.88
,,,
,,IMMUNIZATION ADMIN,18.78
,,,
,,THER INJECTION CARP TUNNEL,140
,,,
,,INJ SGL TENDON SHEATH/ LIGAMENT,102
,,,
,,INJECTIN SINGLE TENDON ORIGIN,100
,,,
,,INJ TRIGGER POINT 1/2 MUSCL,92
,,,
,,"INJECT TRIGGER POINTS, =/",150
,,,
,,ARTHROCENTESIS ASPIR/INJ SMALL JT/BURSA,86
,,,
,,DRAIN/INJ INTERM JNT/BURSA,91
,,,
,,DRAIN/INJ MAJOR JNT/BURSA,112
,,,
,,ARTHROCENTESIS ASPRIN/IINJ MAJ JT/BURSA,155
,,,
,,ASPIRATE/INJ GANGLION CYST,30.94
,,,
,,"IV PUSH, SEQ SAME DRUG",33.43
,,,
,,NASAL HEMORRHAGE ANTERIOR SIMPLE,145
,,,
,,ACNE SURGERY,140
,,,
,,FINE NEEDLE ASPIRATION BX W/US,175
,,,
,,DEBRIDEMENT SKIN SUBQ T/M/F NECRO INFCTJ,"1,500.00"
,,,
,,UA DIPSTICK RGNT NON-AUTO W/O MICRO,16.03
,,,
,,DEB SUBQ TISSUE 20 SQ CM/<,91.66
,,DRAINAGE OF SKIN ABSCESS; SIMPLE,37.43
,,,
,,DRAINAGE OF SKIN ABCESS,41.58
,,,
,,TANGENTIAL BIOPSY SKIN LESION,95
,,,
,,TANGENTIAL BIOPSY SKIN EA ADD,50
,,,
,,PUNCH BIOPSY SKIN SINGLE LESION,125
,,,
,,INCISIONAL BIOPSY EA ADD,80
,,,
,,SHAVE SKIN LESION 1.1-2.0 CM,195
,,,
,,INCISIONAL BIOPSY SINGLE LESION,150
,,,
,,2ND-SHAVE SKIN LESION .5CM/<,65
,,,
,,2ND- EXCISION B9 XCP SK TAG 1.1-2.0CM,150
,,,
,,DEBRIDEMENT NAIL ANY METHOD 1-5,50
,,,
,,EXCISION NAIL MATRIX PERM REMOVAL,225
,,,
,,REMOVAL OF SKIN TAGS <W/15,23.8
,,,
,,2ND- REPAIR INTERMED 2.5CM/<,200
,,,
,,2ND-  REPAIR INTERMED N/H/F 2.5CM/<,150
,,,
,,NASAL ENDOSCOPY DIAG,165
,,,
,,SHAVING SKIN LESION 1 TRUNK/ ARM LEG 0.5,90
,,,
,,SHAVE SKIN LESION 1 TRUNK ARM LEG .6-1.0,135
,,,
,,SHAVE LESION TRUNK/ARM 1.1-2.0,145
,,,
,,SHAVE SKIN LESION 0.5CM/<,96.44
,,,
,,SHAVING SKIN LESIN 0.6-1.0CM,135
,,,
,,SHAVE SKIN LESION 0.5CM/<,130
,,,
,,SHAVE LESION 0.6-1.0 CM,167
,,,
,,2ND- REPAIR COMPLEX SCALP 2.6-7.5 CM,315
,,,
,,EXCISION BENIGN LESION 0.5CM<,269.38
,,,
,,EXCISION B9 LESION 0.6-1.0CM,250
,,,
,,EXC TR-EXT B9+MARG 1.1-2CM,395
,,,
,,EXC B9 LESION XCP SK TAG T/A/L 2.1-3 CM,350
,,,
,,EXCISION TR-EXT B9+ MARG 3.1-4CM,350
,,,
,,EXC B9 LESION MRGN XCP SK TG T/A/L/>4.0,450
,,,
,,EXC H-F-NK-SP B9 0.5/<,290
,,,
,,"EXC, BLES,  S/N/H/F/G .6-1.0CM",245
,,,
,,EXCISION H-F-NK-SP B9+MARG 1.1-2,307
,,,
,,EXCESION B9 LESION 2.1-3.0CM,385
,,,
,,EXCISION BP LESION  XCP SK TG 3.1-4.0CM,440
,,EXCISION B9 LESION SNHFG>4.0CM,630
,,,
,,EXC B9 LESION MARGIN XCP SK TG F/E/E/N/L,400
,,,
,,EXCISION B9 LESION F/E/E/N/L/M 1.1-2.0,335
,,,
,,DRAIN NECK/CHEST LESION,"1,100.00"
,,,
,,LARYNGOSCOPY FLEX DIAG,165
,,,
,,EXC TR-EXT MAL 1.1-2CM,345
,,,
,,EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.,445
,,,
,,EXCISION MALIGNANT LESION TRUNK/ ARM/,725
,,,
,,EXCISION MALIGNANT LESION 1.1-2.0CM,400
,,,
,,EXC S//N/H/F/G/MAL +MRG 2.1-3,643.34
,,,
,,EXCISION MALIGNANT > 4.0 CM,650
,,,
,,EXCISION MALIGNANT LESION 0.5 CM/<,310
,,,
,,EXCISION MALIGNANT LESION F/E/N/L .6-.1.,375
,,,
,,EXC MALIGNANT LESION 1.1-2.0CM,300
,,,
,,EXCISION MALIGNANT LESION F/E/N/L 2.1-3.,575
,,,
,,BLDR IRRIGATION SMPL LAVAGE/INSTLJ,61.91
,,,
,,INSERT TEMP BLADDER CATH,67.25
,,,
,,CHANGE OF CYSTOSTOMY TUBE,125
,,,
,,TREATMENT OF BLADDER LESION,47.02
,,,
,,AVULSION NAIL PLATE PARTIAL/COMPLETE,140
,,,
,,AVULSION NAIL PLATE PARTIAL/COM SIMPLE,55
,,,
,,EXCISION NAIL MATRIX PERM REMOVAL-BILAT,500
,,,
,,EXCISION PILONIDAL CYST,450
,,,
,,US URINE CAPACITY MEASURE,45
,,,
,,INJECTION INTRALESIONAL UP TO 7 LESIONS,75
,,,
,,INJECTION INTRALESIONAL>7 LESIONS,158
,,,
,,REMOVE CONTRACEPTIVE CAPSULE,80.95
,,,
,,SIMPLE REPAIR SCALP/NECK 2.5CM/<,102
,,,
,,SIMPLE REPAIR SCALP/NECK 2.6-7.5CM,145
,,,
,,SIMPLE REPAIR 2.5CM/<,140
,,,
,,REPAIR INTERMED 2.6-7.5CM,494
,,,
,,2ND- REPAIR INTERMED 2.6-7.5 CM,250
,,,
,,BILATERAL- INJECTION 1 TENDON SHEATH,150
,,,
,,DRAIN/ IN JOINT W/O US-BILATERAL,180
,,,
,,DRAIN/ INJ JOINT W/O US- BILATERAL,220
,,BIOPSY PALATE UVULA,240
,,,
,,SPINAL FLUID TAP DIAGNOSTIC,192
,,,
,,INJ EPIDURAL BLOOD OR CLO,279
,,,
,,ESI-CERVICAL,280
,,,
,,ESI-LUMBER,225.58
,,,
,,BILATERAL-INJECTION SINGLE TENDON ORIGIN,150
,,,
,,REMOVE TUNNELED PLEURAL CATHETER,370
,,,
,,ASPIRATE PLEURA W/O IMAGING,480
,,,
,,ARTHOCENTESIS INJ SMALL JT/BURSA-BILATER,160
,,,
,,CLOSED TRT METACARPAL FX W/ MAN,615
,,,
,,REPAIR COMPLEX TRUNK 2.6-7.5 CM,635
,,,
,,2ND-REPAIR COMPLEX TRUNK EA ADD 5 CM,95
,,,
,,REMOVAL OF URETHRA GLAND,200
,,,
,,DILATE URETHR STRICT SOUND; MALE INITIAL,35.94
,,,
,,DILAT URETHRAL STRIX DILATOR MALE SBSQ,45.24
,,,
,,DILATE FEMALE URETHRA W/SUPPOSITORY,106
,,,
,,REPLACE GTUBE NO REVJ,98
,,,
,,PERQ REPLACEMENT GTUBE REQ REVJ,222
,,,
,,2ND- BIOPSY/ EXCISION LYMPH NODE NEEDLE,80
,,,
,,PERQ REPLACEMENT GTUBE REQ REVJ,222
,,,
,,NERVE BLOCK INJECT OCCIPITAL,154
,,,
,,NERVE BLOCK INJECT INTERCOST SNG,166
,,,
,,NERVE BLOCK INJECT INTERCOST MLT,224
,,,
,,N BLOCK INJ ILIO-ING/HYPOGI,225
,,,
,,NERVE BLOCK INJECT SCIATIC SNG,177
,,,
,,NERVE BLOCK INJECT FEMORAL SNG,162
,,,
,,N BLOCK OTHER PERIPHERAL,111
,,,
,,INJECTION AA/STRD GENICULAR,215
,,,
,,INJECT EPIDURAL LUMBAR/SACRAL,277
,,,
,,LUMBAR/ SACRAL INJECTION EACH,110
,,,
,,INJ CERVICAL/ THORACIC FACET,261
,,,
,,INJ PARAVERT F JNT C/T 2 LEVEL,145
,,,
,,INJ PARAVERT F JNT C/T 3 LEVEL,150
,,,
,,FACET INJ JNT L/S 1 LEV,224
,,,
,,INJ PARAVERT F JNT L/S 2 LEVEL,200
,,INJ PARAVERT F JNT L/S 3 LEVEL,215
,,,
,,NERVE BLOCK SPENOPALATINE GANGL,275
,,,
,,NERVE BLOCK LUMBAR/ THORACIC,198
,,,
,,RF ABLATION NERVES NRVTG SI JOINT,525
,,,
,,CERVICAL/THORACIC,580
,,,
,,DESTRUCT NROLYTC AGENT PARV FCT ADD C/T,200
,,,
,,LUMBAR/ SACRAL FACET,575
,,,
,,DESTRUCT NROLTYC AGENT PARV FCT ADD L/S,155
,,,
,,INJECTION TREATMENT OF NERVE,350
,,,
,,ABDOM PARACENTESIS W/IMAGING,275
,,,
,,PUNCT ASP HYDROCELE TUNIC,53.56
,,,
,,EXCISE HYDROCELE; UNILATERAL,596.97
,,,
,,EXCISION GANGLION WRIST DORSAL/ VOL PRIM,550
,,,
,,IMMUNOTHERAPY 2+ INJECTIONS,17.01
,,,
,,VASECTOMY UNI/BI SPX W/ POSTOP SEMEN EX,575
,,,
,,CLOSED TX ULNAR SHAFT FRACTURE W/O MANIP,475
,,,
,,,
,,PROSTATE NEEDLE BIOPSY ANY APPROACH,129.17
,,,
,,TELEHEALTH FACILITY FEE,44.01
,,,
,,DEBRIDEMENT BURNS 1ST SUBSQ,140
,,,
,,ASPIR/INJ THYROID CYST,114.88
,,,
,,ID PERIANAL ABSCESS SUPERFICIAL,225
,,,
,,INCISION THROMBOSED HEMORRHOID EXT,250
,,,
,,EXCESION HAND LESION SC<1.5CM,"1,200.00"
,,,
,,EXCISION SINGLE EXTERNAL PAPILLA OR TAG,300
,,,
,,REMOVAL IMPLANT FROM FINGER/HAND,780
,,,
,,THER/DIAG CONCURRENT INF,38.25
,,,
,,TX/PRO/DX INJ NEW DRUG AD,68.37
,,,
,,ID VULVA/PERINEAL ABSCESS,245
,,,
,,2ND- INJECTION ANES OTHER PERIP,55
,,,
,,REFILLING MAINT PORTABLE PUMP,365
,,,
,,IRRIG DRUG DELIVERY DEVIC,75
,,,
,,PICC INSERTON5 YRS OR LESS,743.67
,,,
,,PICC INSERTON AGE 5 YRS/>,225
,,,
,,PICC LINE WITH IMAGING >5 YRS,375
,,TB INTRADERMAL TEST,16.81
,,,
,,REMOVAL TUNNELED CV CATH,44.01
,,,
,,REMOVAL TUN CTR VAD W/SUBQ PORT/PUMP,450
,,,
,,DRAW BLOOD OFF VENOUS DEV,39.01
,,,
,,COLLECT BLOOD FROM PICC,43.78
,,,
,,DECLOT VASCULAR DEVICE,307.69
,,,
,,BIOPSY OF VULVA,36.3
,,,
,,BIOPSY OF VULVA/ PERINEUM,20
,,,
,,FINGER FRACTURE,"1,100.00"
,,,
,,TYMPANOSTOMY LOCAL/TOP ANES- BILAT,750
,,,
,,DESTRUCTION PREMALIGNANT LESION 1ST,120
,,,
,,DESTRUCT LESION PREMALIG LESION 2-14 EA,10
,,,
,,DESTRUCT PREMALIGNANT LESION 15/>,245
,,,
,,DESTROY VAG LESIONS SIMPLE,25.59
,,,
,,INJECT SACROILIAC JOINT,207
,,,
,,BIOPSY OF VAGINA,39.81
,,,
,,"DESTRUCT B9 LESION, 1-14",67.86
,,,
,,DESTRUCT BENGN LESIONS 15/>,200
,,,
,,CHEMICAL CAUTERY GRANULATION TISSUE,70.82
,,,
,,EXAM/BIOPSY VAGINA &/OR CERVIX W/SCOPE,55.36
,,,
,,COLPOSCOPY W BIOPSIES,27.2
,,,
,,COLPOSCOPY CERVIS UPPR/ADJCT VAG W/CERVI,275
,,,
,,COLPOSCOPY CERVIX ENDOCERVICAL CURRETAGE,255
,,,
,,,
,,BIOPSY CERVIX SINGLE/MULT EXC OF LESION,190
,,,
,,ENDOCERVICAL CURETTAGE/PAP,17.82
,,,
,,REMOVAL DEVITAL TISSUE N SLCTV DEBRIDE,95
,,,
,,NEG PRESS WOUND TX </50 SQ CM,35
,,,
,,BIOPSY SOFT TISSUE LEG/ANKLE SUPERFICIAL,350
,,,
,,EXCISE TUMOR SOFT TISSUE LEG/ANKLE<3CM,700
,,,
,,ENDOMETRIAL BX WH/WP ENDOCREVIX BX W/O D,35.71
,,,
,,,
,,DIAGNOSTIC BONE MARROW BIOPSIES ASPIRAT,204
,,,
,,INSERTION INTRA-UTERINE D,56.87
,,,
,,REMOVE INTRAUTERINE DEVICE,45.2
,,BIOPSY/ EXC LYMPH NODE NEEDLE SUPER,175
,,,
,,DRAINAGE OF BREAST LESION,116.06
,,,
,,APPLICATION CAST HAND LOWER FOREARM,170
,,,
,,APPLICATION OF FOREARM CAST,95
,,,
,,BIOPSY BREAST W/DEVICE 1ST LESION US GUI,400
,,,
,,APPLICATION CAST FINGER,131
,,,
,,APPLICATION SHORT ARM SPLINT FOREARM-HAN,100
,,,
,,,
,,REMOVAL IMPACTED CERUMEN INTRUSTENTATION,85
,,,
,,,
,,DEBRIDEMENT MAST CAVITY SIMPLE,130
,,,
,,TYMPANOSTOMY LOCAL/ TOP ANES,400
,,,
,,TYMPANOSTOMY GENERAL ANESTHESIA,400
,,,
,,REPLACE DUODENOSTOMY TUBE,225
,,,
,,LAP SURG RPR RECURRRENT ING HERNIA,"1,275.00"
,,,
,,REMOVE FULL ARM OR LEG CA,33.33
,,,
,,AVULSION NAIL PLATE - BILATERAL,210
,,,
,,JUVADERM PLUS,600
,,,
,,MIRENA,"1,050.00"
,,,
,,ER PATIENT E/M LEVEL 1,62.27
,,,
,,ER PATIENT E/M LEVEL 2,121.91
,,,
,,ER PATIENT E/M LEVEL 3,183.41
,,,
,,ER PATIENT E/M LEVEL 4,348.61
,,,
,,ER PATIENT E/M LEVEL 5,515.22
,,,
,,DRAINAGE OF SKIN ABSCESS; SIMPLE OR SGL,281.79
,,,
,,DRAINAGE OF SKIN ABSCESS; COMPL OR MULTI,522.75
,,,
,,"INC & REM FB, SQ; SMPL",325
,,,
,,PUNCTURE DRAINAGE OF LESION,278.29
,,,
,,REMOVE FOREIGN BODY FROM NOSE,362.85
,,,
,,TRIGGER POINT INJECTION,135
,,,
,,INJECT TRIGGER POINTS 3/>,133.1
,,,
,,DRAIN/INJ MAJOR JNT/BURSA,134
,,,
,,REMOVAL OF SUPPORT IMPLAN,427.05
,,,
,,ANTERIOR EPISTAXIS CONTRL,166.88
,,,
,,"CONTRL NASAL HEMRG,ANT",233.06
,,CONT POSTERIOR NASAL BLEE,294.27
,,,
,,"INTUB,ENDOTRACHEAL PROC",327.85
,,,
,,EXCISION MALIGNANT LESION 1.1-2.0 CM,660
,,,
,,BLADDER IRRIGATE LAVAGE/I,133.42
,,,
,,INSERT TEMP BLADDER CATH SIMPLE,89.36
,,,
,,INSERT BLADDER CAH COMPLEX,310
,,,
,,CHANGE OF BLADDER TUBE,155.1
,,,
,,CHANGE OF CYSTOSTOMY TUBE; COMPLICATED,236.87
,,,
,,REMOVAL OF NAIL PLATE,152.04
,,,
,,DRAIN BLOOD FROM UNDER NAIL,95.08
,,,
,,REPAIR OF NAILBED,380.63
,,,
,,DRAINAGE OF GUM LESION,430.16
,,,
,,DRAINAGE ABSCESS PALATE UVULA,305.91
,,,
,,SIMPLE LAC REP 0-2.5 CM,130.49
,,,
,,SIMPLE LAC REP 2.6-7.5 CM,225
,,,
,,SIMPLE LAC 7.6-12.5 CM,215.11
,,,
,,SIMPLE LAC 12.6-20.0 CM,290.97
,,,
,,SIMPLE LAC 20.1-30.0 CM,353.51
,,,
,,SIMPLE LAC 30.1 CM & OVER,438
,,,
,,SIMPLE FACE LAC 0-2.5 CM,162.36
,,,
,,SIMPLE FACE LAC 2.6-5.0CM,182.72
,,,
,,SIMPLE FACE LAC 5.1-7.5CM,231.61
,,,
,,SIMPLE FACE LAC 7.6-12.5CM,289.11
,,,
,,LAYERED LAC 0-2.5 CM,443.31
,,,
,,LAYERED LAC 2.6-7.5CM,565.37
,,,
,,"LAY NCK,HND,FT LAC 0-2.5",455.02
,,,
,,"LAY NK,HND,FT LAC 2.6-7.5",582.08
,,,
,,"LAY NCK,HEAD,FT LAC 20.1& UP",889.63
,,,
,,LAY CLOS FACE LAC 0-2.5CM,498.17
,,,
,,LAY CLOS FACE LAC 2.6-5.0,583
,,,
,,FOREIGN BODY REMOVAL FROM PHARYX,395.57
,,,
,,CPR,559.07
,,,
,,CARDIOVERSION,364.52
,,,
,,CREP S/A/L; 2.6-7.5CM,779.01
,,,
,,COMPLEX  REPAIR S/A/L; EA ADD 5 CM/,250.02
,,COMPLEX REPAIR FACE 1.1-2.5CM,836.68
,,,
,,TREAT CLAVICLE FRACTURE,631.13
,,,
,,ARTERIAL PUNCTURE,46.38
,,,
,,TREAT SHOULDER DISLOCATIO,824.82
,,,
,,TREAT SHOULDER DISLOCATION W/MAINIP,"1,150.01"
,,,
,,NASAL/OROGASTRIC W/TUBE PLMT,119.16
,,,
,,IRRIGATION CORPORA CAVERNOSA PRIAPISM,520
,,,
,,INJ ANETH;TRIGEMINAL NERVE,325
,,,
,,INJ ANESTH; OTHR PERIPHER,135.25
,,,
,,TREAT ELBOX DISLOCAITON  WO ANES,957.65
,,,
,,REDUCTION OF REDIAL SUBLU,271.51
,,,
,,DRAINABE OF SCROTUM ABCESS,525
,,,
,,EYE PROC-REM FB CONJ LOOS,130.03
,,,
,,REMOVE FOREIGN BODY FROM EYE,122.87
,,,
,,REMOVE FOREIGN BODY FROM EYE,153.76
,,,
,,TREAT FRACTURE RADIUS/ULN,"1,470.46"
,,,
,,IV START,50
,,,
,,THER/PRHOP/DIAG INJ SC/IM,65
,,,
,,VENIPUNCTURE < 3 YRS,57.95
,,,
,,ID VULVA/PERINEAL ABSCESS,335
,,,
,,TREAT METACARPAL FRACTURE,787.48
,,,
,,TREAT METACARPAL FRACTURE,834.9
,,,
,,TREAT FINGER FRACTURE EACH,866.71
,,,
,,TREAT FINGER FRACTURE EACH W/O MANIP,525.14
,,,
,,TREAT FINGER DISLOCATION,730.49
,,,
,,CLOSED TX PATELLAR DISLOC,952.89
,,,
,,TREAT LOWER LEG FRACTURE,868.64
,,,
,,REMOVAL OF FOOT FOREIGN BODY,396.09
,,,
,,OBSERV/ INPATIENT HOSPITAL CARE 55 MIN,480.47
,,,
,,LONG ARM SPLINT MOLDED,174.18
,,,
,,,174.18
,,,
,,SHORT ARM SPLINT,114.04
,,,
,,,114.04
,,,
,,APPLICATION OF FINGER SPLINT,90
,,,
,,CLEAR OUTER EAR CANAL,168.71
,,O/P E/M NEW PT LEVEL 1,78.06
,,,
,,O/P E/M NEW PT LEVEL 2,147.22
,,,
,,O/P E/M NEW PT LEVEL 3,224.61
,,,
,,O/P E/M NEW PT LEVEL 4,381.7
,,,
,,O/P E/M NEW PT LEVEL 5,496.24
,,,
,,O/P E/M EST PT LEVEL 1,27.34
,,,
,,O/P E/M EST PT LEVEL 2,75.02
,,,
,,O/P E/M EST PT LEVEL 3,150.11
,,,
,,O/P E/M EST PT LEVEL 4,231.73
,,,
,,O/P E/M EST PT LEVEL 5,328.28
,,,
,,DISCH FROM OBSERVATION,213.86
,,,
,,INITIAL OBS/DAY LEVEL 1,295.37
,,,
,,INITIAL OBS/DAY LEVEL 2,401.34
,,,
,,INITIAL OBS/DAY LEVEL 3,404.54
,,,
,,I/P E/M INIT LEVEL 1,298.01
,,,
,,I/P E/M INIT LEVEL 2,404.11
,,,
,,I/P E/M INIT LEVEL 3,598.68
,,,
,,I/P E/M SUBS LEVEL 1,115.47
,,,
,,I/P E/M SUBS LEVEL 2,214.14
,,,
,,I/P E/M SUBS LEVEL 3,308.15
,,,
,,OBSERV/INPATIENT HOSPITAL CARE 55 MIN,480.47
,,,
,,I/P E/M DISCH MGMT,214.91
,,,
,,CRITICAL CARE-FIRST HOUR,661.03
,,,
,,"NURSING FAC CARE, INIT LO",202.09
,,,
,,SNF DISCHARGE MGMT 30 MINUTES,157.99
,,,
,,PROLONG SERV-FIRST HOUR,273.62
,,,
,,PROLONG SRV EA ADD 30 MIN,264.53
,,,
,,"AUDIT/DAST, 15-30 MIN",100.8
,,,
,,"AUDIT/DAST, OVER 30 MIN",199.88
,,,
,,SHORT LEG CAST,166.08
,,,
,,APPLICAT LONG LEG SPLINT,144.94
,,,
,,APPLIC SHORT LEG SPLINT,145.06
,,,
,,STRAPPING OF KNEE,54.99
,,,
,,STRAPPING ANKLE &/OR FOOT,53.17
,,,
,,"CRITICAL CARE, ADD -30MIN",330.43
,,ER PATIENT E/M LEVEL 1,62.27
,,,
,,ER PATIENT E/M LEVEL 2,121.91
,,,
,,ER PATIENT E/M LEVEL 3,183.41
,,,
,,ER PATIENT E/M LEVEL 4,348.61
,,,
,,ER PATIENT E/M LEVEL 5,515.22
,,,
,,DRAINAGE OF SKIN ABSCESS; SMPL OR SGL,281.79
,,,
,,DRAINAGE OF SKIN ABSCESS; COMPL OR MULTI,522.75
,,,
,,EXPLORATION PENETRATING WOUND SPX EXTREM,"1,300.00"
,,,
,,,
,,REMOVAL OF FOREIGN BODY SIMPLE,325
,,,
,,"PUNCT ASP - ABSC,HEMAT,CY",278.29
,,,
,,WOUND CLOSURE UTILIZING TISSUE ADHESIVE,250
,,,
,,REMOVE NASAL FOREIGN BODY,362.85
,,,
,,TRIGGER POINT INJECTION,135
,,,
,,INJECT TRIGGER POINTS 3/>,133.1
,,,
,,ARTHROCENTESIS ASPR/INJ INTERM,140
,,,
,,DRAIN/INJ MAJOR JNT/BURSA,134
,,,
,,REMOVAL OF SUPPORT IMPLANT,427.05
,,,
,,ANTERIOR EPISTAXIS CONTRO,335
,,,
,,"CONTRL NASAL HEMRG,ANT",233.06
,,,
,,CONT POSTERIOR NASAL BLEE,294.27
,,,
,,INSERT EMERGENCY AIRWAY,327.85
,,,
,,EXCISION MALIGNANT LESION 1.1-2.0 CM,660
,,,
,,BLADDER IRRIGATE LAVAGE/I,185
,,,
,,INSERT TEMP BLADDER CATH SIMPLE,89.36
,,,
,,INS BLADDER CATH COMPLEX,310
,,,
,,CHANGE OF BLADDER TUBE,155.1
,,,
,,CHANGE OF CYSTOSTOMY TUBE; COMPLICATED,325
,,,
,,REMOVAL OF NAIL PLATE SINGLE,260
,,,
,,2ND- AVULSION NAIL PLAT PARTIAL/COM SIMP,70
,,,
,,DRAIN BLOOD FROM UNDER NAIL,125
,,,
,,REPAIR OF NAILBED,465
,,,
,,DRAINAGE OF GUM LESION,430.16
,,,
,,DRAINAGE ABSCESS PALATE UVULA,380
,,,
,,SIMPLE LAC REP 0-2.5 CM,225
,,SIMPLE LAC REP 2.6-7.5 CM,275
,,,
,,SIMPLE LAC 7.6-12.5 CM,320
,,,
,,SIMPLE LAC 12.6-20.0 CM,400
,,,
,,SIMPLE LAC 20.1-30.0 CM,475
,,,
,,SIMPLE LAC 30.1 CM & OVER,550
,,,
,,SIMPLE FACE LAC 0-2.5 CM,275
,,,
,,SIMPLE FACE LAC 2.6-5.0CM,290
,,,
,,SIMPLE FACE LAC 5.1-7.5CM,335
,,,
,,SIMPL FACE LAC 7.6-12.5CM,400
,,,
,,,400
,,,
,,LAYERED LAC 0-2.5 CM,443.31
,,,
,,LAYERED LAC 2.6-7.5CM,750
,,,
,,"LAY NCK,HND,FT LAC 0-2.5",455.02
,,,
,,"LAY NK,HND,FT LAC 2.6-7.5",582.08
,,,
,,"LAY NK,HD,FT LAC 20.1&UP",889.63
,,,
,,LAY CLOS FACE LAC 0-2.5CM,645
,,,
,,LAY CLOS FACE LAC 2.6-5.0,583
,,,
,,TUBE THORACOSTOMY INCL WATER SEAL,360
,,,
,,FOREIGN BODY REMOVAL FROM PHARYX,395.57
,,,
,,CPR,559.07
,,,
,,CARDIOVERSION,364.52
,,,
,,BILATERAL- CONTROL NASAL HEMORRHAGE,550
,,,
,,CREP S/A/L; 2.6-7.5CM,"1,050.00"
,,,
,,COMPLEX REPAIR S/A/L; EA ADD 5 CM/,250.02
,,,
,,REPAIR COMPLEX FACE 1.1-2.5CM,"1,050.00"
,,,
,,TREAT CLAVICLE FRACTURE,631.13
,,,
,,ARTERIAL PUNCTURE,46.38
,,,
,,TREAT SHOULDER DISLOCATIO,824.82
,,,
,,NASAL/OROGASTRIC W/TUBE PLMT,119.16
,,,
,,PERQ REPLACMENT GTUBE NOT REQ REVJ,550
,,,
,,INJ. ANESTH;TRIGEMINAL NERVE,325
,,,
,,INJ ANESTH; OTHR PERIPHER,200
,,,
,,TREAT ELBOW DISLOCATION WO ANES,957.65
,,,
,,TREAT ELBOW DISLOCATION,271.51
,,,
,,DRAINAGE OF SCROTUM ABCESS,525
,,REMOVE FOREIGN BODY FROM EYE,140
,,,
,,REMOVE FOREIGN BODY FROM EYE,145
,,,
,,REMOVE FOREIGN BODY FROM EYE,170
,,,
,,TREAT FRACTUE RADUS/ULNA,"1,470.46"
,,,
,,IV START,50
,,,
,,DRESS/DEBRID P-THICK BURN S,163.89
,,,
,,THER/PROPH/DIAG INJ SC/IM,65
,,,
,,VENIPUNCTURE < 3 YRS,57.95
,,,
,,ID VULVA/PERINEAL ABSCESS,270
,,,
,,VENIPUNCTURE > 3 YRS,27.91
,,,
,,REMOVE TUNNELED CV CATH,574.8
,,,
,,TREAT METACARPAL FRACTURE,787.48
,,,
,,TREAT METACARPAL FRACTURE,834.9
,,,
,,TREAT FINGER FRACTURE EACH,866.71
,,,
,,TREAT FINGER FRACTURE EACH W/O MANIP,525.14
,,,
,,TREAT FINGER DISLOCATION,730.49
,,,
,,BILATERAL- REMOVAL OF IMPACTED CERUMEN,185
,,,
,,TREAT KNEECAP DISLOCATION,952.89
,,,
,,,952.89
,,,
,,REMOVAL OF FOOT FOREIGN BODY,640
,,,
,,REMOVAL FOREIGN BODY FOOT DEEP,"1,065.00"
,,,
,,APPLICATION CAST ELBOW FINGER SHORT ARM,220
,,,
,,,
,,APPLICATION CAST HAND LOWER FOREARM,250
,,,
,,LONG ARM SPLINT MOLDED,174.18
,,,
,,SHORT ARM SPLINT,114.04
,,,
,,APPLICATION OF FINGER SPLINT,90
,,,
,,MOD SEDATION INITIAL 15 MIN 5/>YRS,80
,,,
,,CLEAR OUTER EAR CANAL,168.71
,,,
,,O/P E/M NEW PT LEVEL 1,78.06
,,,
,,O/P E/M NEW PT LEVEL 2,147.22
,,,
,,O/P E/M NEW PT LEVEL 3,224.61
,,,
,,O/P E/M NEW PT LEVEL 4,381.7
,,,
,,O/P E/M NEW PT LEVEL 5,496.24
,,,
,,REMOVE IMPACTED EAR WAX UNI,97.09
,,O/P E/M EEST PT LEVEL 1,27.34
,,,
,,O/P E/M EST PT LEVEL 2,75.02
,,,
,,O/P E/M EST PT LEVEL 3,150.11
,,,
,,O/P E/M EST PT LEVEL 4,231.73
,,,
,,O/P E/M EST PT LEVEL 5,328.28
,,,
,,DISCH FROM OBSERVATION,213.86
,,,
,,INITIAL OBS/DAY LEVEL 1,295.37
,,,
,,INITIAL OBS/DAY LEVEL 2,401.34
,,,
,,INITIAL OBS/DAY LEVEL 3,404.54
,,,
,,I/P E/M INIT LEVEL 3,587.12
,,,
,,SUBS OBSERVATION CARE,118.47
,,,
,,OBSER/HOSP SAME DATE,405.78
,,,
,,OBSERV/ HOSP SAME DATE,373.94
,,,
,,OBSERV/HOSPITAL SAME DATE,480.47
,,,
,,I/P E/M DISCH MGMT,214.91
,,,
,,CRITICAL CARE-FIRST HOUR,661.03
,,,
,,CRIT CARE-EA ADD 30 MIN,330.43
,,,
,,SNF DISCHARGE DAY; 30 MINUTES,214.54
,,,
,,APPLICATION SHORT CAST BELOW KNEE,205
,,,
,,"AUDIT/DAST, 15-30 MIN",100.8
,,,
,,"AUDIT/DAST, OVER 30 MIN",199.88
,,,
,,SHORT LEG CAST,166.08
,,,
,,APPLICAT LONG LEG SPLINT,144.94
,,,
,,APPLIC SHORT LEG SPLINT,180
,,,
,,STRAPPING OF KNEE,75
,,,
,,STRAPPING ANKLE &/OR FOOT,65
,,,
,,REPAIR COMPLEX 1.1-2.5CM,900
,,,
,,CARDIAC REHAB W ECG MONIT,222.81
,,,
,,AEROCHAMBER SPACER,28.95
,,,
,,GROUNDING PADS,90
,,,
,,RETROGRADE LIG KNIFE,592.5
,,,
,,ANTEGRADE LIG KNIFE,742.5
,,,
,,TENEX KIT,"1,147.50"
,,,
,,FLOSEAL KIT,299.31
,,,
,,BALLOON DILATOR,71.42
,,DIALATION CATHETER,259.08
,,,
,,CORE BIOPSY NEEDLE 10ga,401.48
,,,
,,CORE BIOPSY NEEDLE 13ga,388.32
,,,
,,SUTURE TAPE 1.33MM W/TAILS,70
,,,
,,POCKET MASK (FOR ALL),35
,,,
,,IVAC MULTI-CHANL PUMP TBG,45.01
,,,
,,WARM AND FORM BRACE,80
,,,
,,PICCLINE TRAY,207.69
,,,
,,ROSIDAL K 8CM X 5M,29.13
,,,
,,ROSIDAL K 10CM X 5M,32.75
,,,
,,ROSIDAL K 12CM X 5M,39.13
,,,
,,ROSIDAL K 12CM X 10M,58.5
,,,
,,K-WIRE W/LENGHT MARKINGS,55
,,,
,,TWIST DRILL,235
,,,
,,OXYGEN ER/OR,27.6
,,,
,,CHROMIC 1 CC01,53.16
,,,
,,ANGIO CATH 12G,43.72
,,,
,,VENOM NEEDLE 100mm 20g,113.15
,,,
,,VENOM NEEDLE 150mm 20g,113.13
,,,
,,CHOLANGIO-NASHVILLE,69.8
,,,
,,ENDOLOOP PDS II LIGATURE 0 18,81.73
,,,
,,PROSTATE BX NEEDLE GUIDE,41.78
,,,
,,QUICK CLIP (ENDO),217.5
,,,
,,EGIA HANDLE STANDARD,377.9
,,,
,,GIA 12MM SMALL,413.6
,,,
,,ENDO GIA 12MM STAPLER,459.55
,,,
,,ENDO NEEDLE 25g 5mm (Olympus),64.29
,,,
,,ENDO POUCH 10 MM,105.1
,,,
,,ENDOKITNER 5MM,25.98
,,,
,,ENDO POUCH,93.23
,,,
,,ENDO CATCH 15MM,349.61
,,,
,,ENDO CATCH 10MM GOLD,80
,,,
,,ENDOCLOSE,100.66
,,,
,,SYSTEM POS AIRWAY PRESSURE EZPAP,48.74
,,,
,,ACCU PAP MANOMETER,44.73
,,ENDO SUTURE ENDO LOOP,41.74
,,,
,,LIGASURE LAP 5MM BLUNT TIP,814.67
,,,
,,LINEAR CUTTER 55-OPEN BOWEL,114.2
,,,
,,LINEAR RELOAD 55-OPEN BOWEL,90.58
,,,
,,LINEAR CUTTER 75-OPEN BOWEL,178.74
,,,
,,LINEAR RELOAD 75-OPEN BOWEL,111.2
,,,
,,SCISSORS CURVED W/ MONOPOLAR CAUTERY 5mm,109.77
,,,
,,,
,,ECHELON FLEX POWERED PLUS STAPLER,581.56
,,,
,,STAPLER BLUE RELOAD 45mm,298.97
,,,
,,STAPLER RELOAD 45mm ENDOPATH ECHELON,298.97
,,,
,,TROCAR 5MM LONG,157.76
,,,
,,BLADELESS TROCAR 5mm SLEEVE,94.64
,,,
,,BLADELESS TROCAR 12mm SLEEVE,125.25
,,,
,,TROCAR 12MM LONG,194.37
,,,
,,TROCAR 15MM,194.54
,,,
,,VARESS INSUFFLATION NEEDLE,71.42
,,,
,,INSUFFLATION NDL LONG,69.32
,,,
,,FRACTURETRAY,"2,950.00"
,,,
,,INTERNALBRACE LIGAMENT REPAIR KIT,"2,500.00"
,,,
,,NB300 NERVE BLOCK TRAY,44.79
,,,
,,NERVE BLOCK TRAY,25.2
,,,
,,SPINAL EPIDURAL TRAY,44.1
,,,
,,CONTINUOUS EPIDURAL TRAY,60.52
,,,
,,SPINAL TRAY W/MARCAINE,36.69
,,,
,,RESTORE SILVER DRESSING 4x5,28.88
,,,
,,RESTRAINT ARM WITH LOCK,86.18
,,,
,,RESTRAINT LEG WITH LOCK,93.66
,,,
,,OMEGA3 WOUND 3 X 3.5 cm,551.25
,,,
,,OMEGA3 WOUND 3 X 7 cm,"1,102.50"
,,,
,,"CHIBA NEEDLE 22gx6""",38.17
,,,
,,TRAY ADDITIONAL FRACTURE,"2,200.00"
,,,
,,ACAPELLA,89.25
,,,
,,AMPLATZ RENAL DILATORS,335.1
,,,
,,THORACENTESIS TRAY,25.1
,,SAFE-T-CENTESIS TRAY,95.78
,,,
,,PHENOL APPLICATORS,35
,,,
,,ARTHROSCOPY PACK (MANNING),280.58
,,,
,,KNEE ARTHRO PACK,90.55
,,,
,,ARTHROSCOPY PACK,129.68
,,,
,,ARTH SHAVER 3.5 TOMCAT,74
,,,
,,ARTH SHAVER 4.0 TOMCAT,89.43
,,,
,,ARTH SHAVER 4.0 AGG PLUS,74
,,,
,,ARTH SHAVER 5.5 AGG PLUS,129.79
,,,
,,KNEE ARTHRO PACK KIMBERLY CLARK,64.58
,,,
,,ENDO GIA 45-2.5MM RELOAD,535.45
,,,
,,PICC TRAY 5 FR TRIPLE LUMEN,613.37
,,,
,,BAIR PAWS - FLEX GOWN,45.15
,,,
,,URETERAL SHEATH 16X30,154.43
,,,
,,BELLY BAG,48.65
,,,
,,HOT BIOPSY FORCEPS (SINGLE USE),48.65
,,,
,,BIPAP MASK SMALL (TRI-ANIM),80.58
,,,
,,BIPAP MASK MED (TRI-ANIM),49.9
,,,
,,BIPAP MASK LARGE (TRI-ANIM),75.2
,,,
,,BIS SENSOR,48.75
,,,
,,AQUASHIELD TUBING,23.75
,,,
,,PROSTATE BX GUN 20CM,64.02
,,,
,,BREAST BX NDL 14GX15CM,48.23
,,,
,,BLADDER EVACUATOR,49
,,,
,,HET BIPOLAR FORCEPS,"2,975.00"
,,,
,,BLAKE DRAIN 10FR,125.6
,,,
,,BLAKE DRAIN 15FR,32.4
,,,
,,BLAKE DRAIN 19FR,125.6
,,,
,,BONE MARROW BX TRAY,127.19
,,,
,,BONE MARROW BX-JAMSHIDI,48.24
,,,
,,18G ILLINOIS BONE MARROW NDLE,31.38
,,,
,,15G ILLINOIS BONE MARROW NDLE,56.04
,,,
,,STR CHEST TUBE INSERTION TRAY,34.55
,,,
,,BUGBEE CAUTERY,122.21
,,,
,,C SECTION PACK,72.64
,,CS MISC STERILE BILLABLE,0
,,,
,,GELPORT,905.63
,,,
,,CENTRAL LINE DRSG KIT,45.05
,,,
,,BREVI-KATH,127.42
,,,
,,FOLEY CATH TRAY 16FR,44.91
,,,
,,FOLEY CATH TRAY 18FR,45.35
,,,
,,3-WAY CATH 24FR COUDE TIP,45.5
,,,
,,TRAY SUPERPUBIC FOLEY,116.69
,,,
,,SP CATH-16FR,23.03
,,,
,,SP CATH-18FR,45.03
,,,
,,SP CATH-20FR,45.03
,,,
,,SP CATH-22FR,28.75
,,,
,,SP CATH-24FR,31.18
,,,
,,FILIFORM 4FR STRAIGHT,25.04
,,,
,,FILIFORM 3FR STRAIGHT,30.05
,,,
,,FILIFORM 4 FR SPIRAL,29.38
,,,
,,FILIFORM 5FR STRAIGHT,25.04
,,,
,,FOLLOWERS 16FR,48.98
,,,
,,PHIL CATH FOLLOWER 18FR,48.98
,,,
,,FOLLOWERS 26FR,48.98
,,,
,,FOLLOWERS 10FR,48.98
,,,
,,FOLLOWERS 14FR,48.98
,,,
,,SILICONE CATH 24FR 5CC,19.68
,,,
,,SILICONE CATH 24FR 30CC,34.25
,,,
,,SILICONE CATH 22FR 30CC,34.25
,,,
,,CATH 3-WAY 24FR,45.44
,,,
,,SILICONE CATH 22FR 5CC,34.25
,,,
,,SPECIALTY 16FR SILICONE COUDE TIP,89.46
,,,
,,CATH-COUDE 14 FR,38.33
,,,
,,HSG CATHETER,60
,,,
,,CATH UMBILICAL 3.5 FR,27.2
,,,
,,CATH UMBILICAL 5.0 FR,27.2
,,,
,,COLORADO CAUTERY TIP,147
,,,
,,HANDHELD DISP CAUTERY,22.13
,,,
,,CHEST TROCAR 12FR,30.1
,,PLEURA GUIDE,192.28
,,,
,,CHEST TUBE TROCAR 24FR,33.5
,,,
,,CHOLANGIO-TAUT,76.3
,,,
,,CIRCUIT (PASSIVE),39
,,,
,,"CHOLANGIOGRAM CATH 18""",47.94
,,,
,,"CHOLANG CATH 4.5 FR 18""",119.66
,,,
,,ADULT CO2 TUBING,34.7
,,,
,,EVAC COBLATOR 2,391.5
,,,
,,LG PA STOCKINGS,96.69
,,,
,,SCD STOCKING-MEDIUM,84.22
,,,
,,MED PA STOCKINGS,88.42
,,,
,,VAPOTHERM CIRCUITS,153
,,,
,,COBLATOR EVAC 70 Xtra HP,453
,,,
,,ARTHRO CASSETTE TUBING,127.37
,,,
,,SINGLE CASSETTE TUBING (BLUE),96
,,,
,,SCD STOCKING-LARGE,92.09
,,,
,,CHEEK RETRACTOR-CHILD/SMALL CLEAR,47.37
,,,
,,CHEEK RETRACTOR-ADULT/LARGE CLEAR,47.14
,,,
,,CT FRONT LOAD SYRINGE,46.35
,,,
,,CTR KIT,255.62
,,,
,,CUTTING LOOP 26FR,127.17
,,,
,,CYSTO PACK,22.02
,,,
,,BOTOX BLADDER NEEDLE,121.03
,,,
,,BOTOX BLADDER NEEDLE W/ SHEATH,735
,,,
,,CYTOLOGY BRUSH DISP,31.98
,,,
,,GONIOL PRISM,87.5
,,,
,,DERMABOND PRINEO,137.84
,,,
,,DERMATOME BLADE,55.41
,,,
,,DERMABOND-ER,42.57
,,,
,,OPHTHALMOLOGY PACK,374.88
,,,
,,7.0 MALYUGIN RING 2.0 SYSTEM,199.75
,,,
,,0.3 mm INTREPID I/A HAND PIECE,37.5
,,,
,,SHILEY TRACH SIZE 7,56.2
,,,
,,SHILEY TRACH SIZE 10,57.24
,,,
,,JUHN TYM-TAP MIDDLE EAR FLUID COLLECTOR,92.2
,,EAR TUBES 1.27MM (Grace Medidal),48
,,,
,,DUETTE 16FR,32.5
,,,
,,DUETTE 18FR,32.5
,,,
,,GLASSCOCK EAR DRESSING,38.75
,,,
,,DURAVENT EAR TUBE 1.27MM,71.67
,,,
,,EAR TUBE-RICH.ARMST. DUAL,48.25
,,,
,,PAPARELLA EAR TUBE 1.2,56.67
,,,
,,PAPARELLA EAR TUBE,46.34
,,,
,,ARMSTRONG EAR TUBE,45.18
,,,
,,EEA CIRC STAPLER 25MM,"1,483.31"
,,,
,,EEA CIRC STAPLER 31MM,"1,483.31"
,,,
,,EEA CIRC STAPLER 28MM,"1,483.31"
,,,
,,ROLLER BALL ELECTRODE,168.43
,,,
,,MEGA FINE NEEDLE ELECTRODE 2-inch,43.78
,,,
,,THORACENTIESIS BOTTLE,47.94
,,,
,,ENDO TATOO INK,76
,,,
,,ENDOSTITCH SUTURE 10MM,423.7
,,,
,,ENDOSTITCH SUTURE RELOAD,99.22
,,,
,,EPIDURAL KIT FLEX TIP,104.81
,,,
,,ENTRADA COLONIC OVER TUBE,247.5
,,,
,,EPIDURAL TRAY,41.73
,,,
,,EPIDURAL ANESTH TRAY,45
,,,
,,ENTRADA OVERTUBE 50CM,337.5
,,,
,,IO NEEDLE 25mm Blue,204.9
,,,
,,IO NEEDLE 15mm Red (Pedi),204.9
,,,
,,IO NEEDLE 45mm Yellow,204.9
,,,
,,EXTERNAL NERO STIM,600
,,,
,,TRAXTION HEX SNARE,70
,,,
,,EXACTO COLD SNARE,50
,,,
,,LMA FAST TRACK SZ 3,223.26
,,,
,,LMA FAST TRACK SZ 4,121.5
,,,
,,LMA FAST TRACK SZ 5,223.26
,,,
,,FEED TUBE LP GAST 14FR2.3,135.17
,,,
,,FEEDING TUBE 24FR,98.44
,,,
,,"FEEDING TUBE NASOGASTRIC 12 FR X 43""",42.95
,,AMT Button-Boxed Kit 24FR 5.4 cm,269.25
,,,
,,BUTTON FS-24F STR,26.63
,,,
,,CAUTERY CORD DISP,43.7
,,,
,,SURGIFOAM 100CM,78.4
,,,
,,GLIDESCOPE SZ 1,40.96
,,,
,,GLIDESCOPE SZ 2,40.96
,,,
,,GLIDESCOPE SZ 3,45
,,,
,,SAFETY NEEDLE 25GX2,35.72
,,,
,,GLIDESCOPE SZ 4,45
,,,
,,GLYCINE 3000ML,10.11
,,,
,,GASTROSTOMY TUBE KIT,63.2
,,,
,,GYNE PACK,22.09
,,,
,,ENT HEAD NECK PACK,39.73
,,,
,,ENDO CLIPPER,240
,,,
,,JP DRAIN 100ML,163.52
,,,
,,SWIFTSET SKIN ADHESIVE,61.5
,,,
,,INTERCEED,348.08
,,,
,,INTERSTIM & TEST CABLE,180
,,,
,,COFLEX TLC CALAMINE TWO LAYER STAN,25.32
,,,
,,"IOBAN 23""X33""",25.53
,,,
,,INSUFFLATION TUBING,49.74
,,,
,,TORRENT IRRIGAT TUBING,25
,,,
,,"IRRIGATION, EYE",26.76
,,,
,,IRRISEPT (wound debridement),113.57
,,,
,,ISOBAND 15CM X 5M,45.38
,,,
,,"K-WIRE W/DBL TRCR TIP .045 x 6.84""",40
,,,
,,KING LTS-D AIRWAY SIZE 3 (ER),81.08
,,,
,,KING LTS-D AIRWAY SIZE 4 (ER),114
,,,
,,KING LTS-D AIRWAY SIZE 2 (ER),110.06
,,,
,,KING LTS-D AIRWAY SIZE 5 (ER),99.17
,,,
,,KING LTS-D AIRWAY SIZE 2.5 (ER),110.06
,,,
,,LAP CHOLE PACK III,90.14
,,,
,,KOPANS 20g 9cm,55.56
,,,
,,KOPAN NEEDLE 7cm,55.56
,,,
,,LAPAROTOMY PACK,47.43
,,TPOD PELVIC STABILIZER DEVICE,223.5
,,,
,,LAP CHOLE II PACK-ACMH,93.56
,,,
,,LAP-PELVIC DRAPE,28.02
,,,
,,LAP SCISSORS-DISP,60.66
,,,
,,LIGASURE IMPACT,"1,126.13"
,,,
,,LEAD INTRODUCER KIT,420
,,,
,,LIGASURE 37CM TISSUE FUSION,566.36
,,,
,,LEEP ELECTRODES R1007,31.43
,,,
,,LEEP ELECTRODE R2010,42.36
,,,
,,LINEAR STAP RELOAD 60,89.14
,,,
,,LINEAR STAPLER 60MM,82.16
,,,
,,LITHOTRIPTER  PROBES 2FR,422.53
,,,
,,LITHOTRIPTER  PROBES 9FR,422.53
,,,
,,LIGASURE IMPACT 13.5MM,"1,335.69"
,,,
,,LUMBAR PUNCT KIT-ADULT,36.65
,,,
,,LONG FILTERLINE CO2,25.75
,,,
,,PED CO2 TUBING,34.85
,,,
,,MAXON 0 - 341LOOP,41.1
,,,
,,MAXON 0 - 6319-62,35.98
,,,
,,MAXON 1 - 6319-72,34.98
,,,
,,MITIVAC EXTRACTOR,116.66
,,,
,,MORGAN LENSES,45.8
,,,
,,CVC KIT 7 FR TRIPLE LUMEN,234.36
,,,
,,MYRINGOTOMY KNIFE,45
,,,
,,NASAL STENT-MEROCEL,41
,,,
,,MULTI CVC KIT,390.6
,,,
,,NOZ-STOP KIT,112.5
,,,
,,NEUROTHERM EPIDURAL CATH,122.5
,,,
,,COIL STONE BASKET-BOS SCI,355.59
,,,
,,NS  3000 CC BAG,31.51
,,,
,,NASOPORE,393.98
,,,
,,CRICOTHYROTOMY CATH SET-ADULT,390
,,,
,,NU-TRAKE PED,237.68
,,,
,,NU-TRAKE ADULT,288.68
,,,
,,LITHOTOMY PACK,41.93
,,CASE SUPPLIES,33.46
,,,
,,ORTHO PACK,99.48
,,,
,,OXI-SENSOR FOREHEAD,48
,,,
,,LITHO UNDERBODY BLANKET,45.55
,,,
,,PHILLIPS CATH FOLLOWER 20FR,48.98
,,,
,,PHILLIPS CATH FOLLOWER 22FR,48.98
,,,
,,EndoVive PEG Kit,136.5
,,,
,,DISP. SUCTION IRRIGATOR,124.55
,,,
,,LAP SPATULA PISTOL,61.38
,,,
,,LMA PAIN PUMP (OR),925.62
,,,
,,POWERLOC 22G KIT,46.56
,,,
,,ARROW PICC 6 FR TRIPLE LUMEN,476.59
,,,
,,SPO2 SENSOR (ADULT),56.88
,,,
,,PEG TRAY,118.13
,,,
,,PENILE CLAMP-LARGE,67.52
,,,
,,PENILE CLAMP-REGULAR,68.4
,,,
,,POWERLOC 19G KIT,32.75
,,,
,,LAP PLUME FILTER DEVICE,77.02
,,,
,,PORTED ELBOW FOR BIPAP,73
,,,
,,PROBE PLUS II IRRIGATION,77.22
,,,
,,PROBE PLUS 5MM HOOK,128.59
,,,
,,PROBE PLUS PISTOL HANDLE,245.9
,,,
,,PRESSURE BAG 1000CC,47.95
,,,
,,PRESSURE BAG 3000CC,97.02
,,,
,,POWERLOC 20G KIT,46.56
,,,
,,PLEUR-VAC CHEST TUBE,80.5
,,,
,,POLYP SNARES 15mm (Olympus),35
,,,
,,"18"" SINGLE BLADDER",40.32
,,,
,,POLYP TRAPS,20.4
,,,
,,QUANTUM DILATOR 16MM,163.13
,,,
,,QUANTUM INFLATION DEVICE,183.83
,,,
,,RAPID RHINO NASAL PACKING,74.2
,,,
,,WILSON RETRACTOR,132
,,,
,,LONESTAR RETRACTOR,145.53
,,,
,,ROTICULAR STAPLER 55MM,866.91
,,RIGID CYSTO BOTOX NEEDLE,59.04
,,,
,,ROTH NET-3.0,141
,,,
,,QUANTUM DILATOR 14MM,163.13
,,,
,,QUANTUM DILATOR 18MM,163.13
,,,
,,"24"" SINGLE BLADDER",43.44
,,,
,,"34"" SINGLE BLADDER",49.27
,,,
,,KALTOSTAT DRESSING,29.25
,,,
,,SCLERO NEEDLE-5MMX25G,52
,,,
,,"18"" DUAL BLADDER",49.27
,,,
,,SORBAFIX,735
,,,
,,URETERAL ACCESS SHEATH SET 13F/15F,335.74
,,,
,,HOT POLYP SNARE 25MM,58
,,,
,,PACK SHOULDER ARTHROSCOPY (MANNING),121.1
,,,
,,DR DONS SLING,77
,,,
,,SAW BLADE 40X9.5X0.6,50
,,,
,,SAW BLADE 25X9.4X0.6,50
,,,
,,SAW BLADE 25X5.5X0.6,50
,,,
,,SAW BALDE 25X9.4X0.7,50
,,,
,,THD SLIDE ONE,747
,,,
,,BED CUSHION,62.04
,,,
,,NEXIVA CLOSED IV 20Gx1,16.8
,,,
,,STIMU QUIK NEEDLE 21G 150mm,25.18
,,,
,,ENDOFORM 2x2,28.57
,,,
,,STERILE SHOULDER DRAPE PACK W/POUCH,36.05
,,,
,,STERILE UNIVERSAL SPINE DRAPE 99x135,31.1
,,,
,,CLOSESURE SYSTEM-CARTER THOMASOM,169.2
,,,
,,CLOSED SUCTION SYSTEM 12FR,66.98
,,,
,,"TRACHCARE, 14FR, 72HR, TEE",72
,,,
,,ORTHO-LONG/MED BLADE25X9,119.16
,,,
,,ORTHO-LONG/MED BLADE31X9,119.16
,,,
,,ORTHO-LONG NARROW BLADE25X5.5,119.16
,,,
,,ORTHO-AVG-MED BLADE 25X9MM,137.64
,,,
,,ORTHO-LONG NARROW THIN BLADE,40.5
,,,
,,SP CATH INTRODUCER,142.23
,,,
,,SURGICEL 2x3,130.57
,,FLOOR PAD -YELLOW,28.35
,,,
,,SUTURE 10-0 12in,79.95
,,,
,,SUTURE PROLENE 6-0,25.4
,,,
,,TALON GRASPER,214.5
,,,
,,THORACIC TROCAR 28FR,39.9
,,,
,,THORACENTESIS TRAY,92.56
,,,
,,TOUMA T-TYPE EAR TUBE,47.2
,,,
,,TRIANGLE HOOK BLADE-STERI,165
,,,
,,ET TUBE 6.0 UNCUFFED,103.08
,,,
,,TUR DRAPE-LINGEMAN,120.42
,,,
,,TRU CUTTING KNIFE,172.78
,,,
,,TUR TUBING,44.1
,,,
,,HEYMAN TRAY,335.69
,,,
,,URO-JET (XYLOCAINE),19.98
,,,
,,UROLOCK  II ADAPTER,52.41
,,,
,,HTA HYDRO THERMAL ABALATION,"1,656.25"
,,,
,,URETERAL DILATOR SYSTEM,417.15
,,,
,,ABALATION CATH,"1,494.20"
,,,
,,VR1 VENT CIRCUIT,45.55
,,,
,,ORTHO OVAL,42.14
,,,
,,ORTHO-EGG BURR,173.51
,,,
,,VERSASTEP SLEEVE,114.75
,,,
,,ACELL MATRISTEM MICRO MATRIX MM1000,"3,632.50"
,,,
,,ACELL MATRISTEM MICRO MATRIX MM0100,541.5
,,,
,,ACELL MATRISTEM SURGICAL MATRIX PSMX0710,"2,756.25"
,,,
,,,
,,ACELL MICROMATRIX MM0200,590
,,,
,,ACELL MATRIX WSX0505,"1,485.00"
,,,
,,ACELL MATRIX WSX0710,"3,330.00"
,,,
,,WOUND WASH SALINE 0.9%,15.5
,,,
,,LIGASURE- BOWEL RESECTION,"1,092.00"
,,,
,,STRATAFIX SYMMETRIC 45cm VIOLET,47.93
,,,
,,4-0 FIBER LOOP BLUE,87.5
,,,
,,2-0 FIBERWIRE,44
,,,
,,ETHIBOND 2-0 CX46D,25.6
,,MICRO COMP DRILL AND 2.00MM BIT,517.5
,,,
,,HERNIA TACKER,"1,367.50"
,,,
,,"PROSTOP GUIDE WIRE .054""",142.5
,,,
,,0.86MM GUIDE WIRE TROCAR TIP,63
,,,
,,"0.062"" GUIDE WIRE TROCAR TIP",37.5
,,,
,,".45"" GUIDE WIRE TROCAR",95
,,,
,,DRILL BIT,215
,,,
,,"THREADED G-WIRE .062"" W/TOCAR TIP",44
,,,
,,STOPCOCK 3 PORT ANESTHESIA,30.08
,,,
,,"12"" SINGLE BLADDER",33.49
,,,
,,ADULT AMBU BAG,18.83
,,,
,,MANUAL RESUSCITATOR BVM ADULT MASK,52.6
,,,
,,STRYKER ABLATION WAND,237.06
,,,
,,ORTHO-BENT FINE BLADE,63.14
,,,
,,ORTHO-LONG WIDE THIN BLADE,24.6
,,,
,,HAND WRIST INTERNAL BRACE LIG AUG REPAIR,"1,600.00"
,,,
,,ETHIBOND-0 CX45D,25.6
,,,
,,OXYGEN PER DAY,89.97
,,,
,,YUEH CENTESIS NEEDLE,39.98
,,,
,,GLIDE WIRE BOSTON SCI,162.98
,,,
,,RESECTR-BOST SCI,953.22
,,,
,,RESECTOR 4.0MM,129.79
,,,
,,HYDROFERA BLUE READY,41.39
,,,
,,STONE BASKET 1.9,238.14
,,,
,,URO PASS SHEATH,179.75
,,,
,,STONE BASKET URO,302.57
,,,
,,LUMEN CATH URO,82.8
,,,
,,IRRI FLOW,68
,,,
,,"ARGYLE TROCAR CATH 24FR X 16""",43.56
,,,
,,"ARGYLE TROCAR CATH 28FR X 16""",43.56
,,,
,,"ARGYLE TROCAR CATH 32FR X 16""",43.56
,,,
,,CASTING SUPPLIES,35
,,,
,,THORACENTESIS TRAY,75
,,,
,,SIMPLE EPISTAXIS CONTROL,340
,,,
,,COMPLEX EPISTAXIS CONTROL,540
,,INCISION LINGUAL FRENUM,520
,,,
,,NASAL ENDOSCOPY,500
,,,
,,POSTOPERATIVE SINUS DEBRIDE,640
,,,
,,LARYNGOSCOPY W/W/O TRACH DX EXCEPT NEWBO,650
,,,
,,,
,,FLEXIBLE LARYNGOSCOPY,295
,,,
,,BIOPSY PALATE UVULA,370
,,,
,,NASOPHARYNGOSCOPY W/ENDOSCOPE,275
,,,
,,TONSILLECTOMY PRIMARY/ SECOND AGE 12/>,650
,,,
,,ADENDOIDECTOMY PRIMARY <AGE 12,540
,,,
,,ADENOIDECTOMY PRIM 12/>,585
,,,
,,BILATERAL POSTOP SINUS DEBRIDE,950
,,,
,,BILATERAL-MYRINGOTOMOY,560
,,,
,,BILATERAL MYRING AND TUBE PLACEMENT,600
,,,
,,FOLLOW UP VISIT,0
,,,
,,OP VISIT- NEW LEVEL 1,84
,,,
,,OP VISIT- NEW LEVEL 2,140
,,,
,,OP VISIT- NEW LEVEL 3,200
,,,
,,OP VISIT- NEW LEVEL 4,303
,,,
,,REMOVAL OF CERUMENT,115
,,,
,,OP VISIT- ESTAB LEVEL 1,42
,,,
,,OP VISIT- ESTABL LEVEL 2,84
,,,
,,OP VISIT- ESTABL LEVEL 3,136
,,,
,,OP VISIT- ESTAB LEVEL 4,201
,,,
,,DEBRIDEMENT MAST CAVITY SIMPLE,200
,,,
,,MYRINGOTOMOY,370
,,,
,,TYMPANOSTOMY LOCAL/TOPICAL ANES,400
,,,
,,MYRING AND TUBE PLACEMENT,400
,,,
,,TYMPANOSTOMY LOCAL/TOP ANES-BILATER,750
,,,
,,SODIUM CHLORIDE BAG 0.45% 1000 ML,27.1
,,,
,,DEXTROSE 10% IN WATER BAG 1000ML,22.14
,,,
,,D5W 250ML bag,22.87
,,,
,,DEXTROSE 5%/LACT RINGER'S 1000ML,17.45
,,,
,,DEXTROSE 5%/LACT RINGER'S 500ML,27.85
,,,
,,DEXTROSE 5% 0.45% SODIUM 1000ML,21.35
,,DEXTROSE 5%/0.20 SOD CH  1000ml,27.85
,,,
,,DEXTROSE 5%/0.9% SODIUM C 1000ML,21.25
,,,
,,D5W 1000 ML BAG,27.85
,,,
,,DEXTROSE 5% IN WATER BAG 100ML,21.2
,,,
,,DEXTROSE 5% IN WATER BAG 500ML,24.1
,,,
,,DEXTROSE 5% IN WATER BAG 500ML,20.89
,,,
,,LACTATED RINGER'S 1000ML,27.85
,,,
,,SODIUM CHLORIDE ADD-V BAG 100ML,21.7
,,,
,,SODIUM CHLORIDE ADD-V BAG 50ML,21.75
,,,
,,D RX SODIUM CHLORIDE INJ 0.9% USP 1000ML,29.1
,,,
,,D RX SODIUM CHLORIDE INJ 0.9% 50ML,21.05
,,,
,,SODIUM CHLORIDE BAG 0.9% 100CC,3.25
,,,
,,,16.55
,,,
,,0.9% NS 250ML BAG,27.85
,,,
,,SODIUM CHLORIDE BAG 0.9% 500 CC,25.2
,,,
,,TPN HOME INFUSION THERAPY,278.46
,,,
,,STOP SMOKING CLASS,57.88
,,,
,,VENT MGMT INPAT INIT DAY,409.16
,,,
,,VENT MGMT INPAT SUBQ DAY,294.28
,,,
,,INITIAL USN EVAL,71.33
,,,
,,USN TREATMENT,75.84
,,,
,,NEBULIZER CONT TREATMENT,75.84
,,,
,,ACAPELLA TRAINING,105.85
,,,
,,ACAPELLA SUBS,122.36
,,,
,,OXIMETRY,12.81
,,,
,,"OXIMETRY, EXERCISE",20.29
,,,
,,TREND OXIMETRY,102.88
,,,
,,SUBS NEBULIZER CONT.,75.84
,,,
,,SUBS USN TREATMENT,75.84
,,,
,,EVALUATE PT USE OF NEBULIZER- INITIAL,96.2
,,,
,,SUBS MDI TREATMENT,75.84
,,,
,,SUBS INHALATION TREATMENT,75.84
,,,
,,NEBULIZER TREATMENT,75.84
,,,
,,MDI INITIAL EVAL,96.2
,,,
,,MDI TREATMENT,75.84
,,INITIAL IPPB EVAL,96.2
,,,
,,IPPB TREATMENT,75.84
,,,
,,INIT CHEST PHY THERAPY,105.85
,,,
,,SUBS CHEST PHY THERAPY,131.72
,,,
,,SUBS IPPB TREATMENT,75.84
,,,
,,SPIROMETRY,271.33
,,,
,,MVV,171.94
,,,
,,PFT-PRE & POST BRONO,441.51
,,,
,,PFT BY GAS,297.19
,,,
,,CO/MEMBRANE DIFFUSE CAPAC,392.4
,,,
,,MIPS/MEPS,194.16
,,,
,,OB ROOM CHARGE,640
,,,
,,NURSERY,566.55
,,,
,,COV 19 - PATH LABS,60
,,,
,,JAK2 EXON 12-15- MOLDX,185
,,,
,,VALPROIC ACID,141.41
,,,
,,CHEM 7 (BASIC METABOLIC),45
,,,
,,ELECTROLYTES,73.22
,,,
,,CHEM 12(COMP METABOLIC),52
,,,
,,LIVER PROFILE,85.34
,,,
,,LIPID PROFILE,139.84
,,,
,,RENAL FUNCTION PANEL,90.65
,,,
,,ACUTE HEPATITS PANEL,440.17
,,,
,,NEONATAL SCREEN,102.04
,,,
,,"BARBITURATES, SERUM",758.93
,,,
,,PATERNITY TEST SWAB,25
,,,
,,DRUG SCREENING BENZODIAZEPINES 1 OR 2,193.03
,,,
,,CLOZAPINE,142.91
,,,
,,CYCLOSPORIN,188.47
,,,
,,DRUG SCREEN QUANTITATIVE OXCARBAZEPINE,30
,,,
,,PHENYTOIN; FREE,143.51
,,,
,,DRUG SCREEN ANALGENSICS NON-OPOID 1 OR 2,74.14
,,,
,,TACROLIMUS,143.19
,,,
,,TOPAMAX LEVEL,124.47
,,,
,,SOLUBLE TRANSFERRIN RECEPTOR,62
,,ZONEGRAN,142.91
,,,
,,GABAPENTIN/NEURONTIN,142.91
,,,
,,CAFFEINE,142.91
,,,
,,ASSAY OF OPIATES,204.23
,,,
,,SIROLIMUS,142.91
,,,
,,VANCOMYCIN,141.41
,,,
,,DRUG SCREEN QUAT AMPHETAMINES 1 OR 2,25
,,,
,,DRUG SCREEN AMPHETAMINES 3 OR 4,70
,,,
,,LAMOTRIGINE,142.91
,,,
,,DRUG SCREEN NON-OPOID 3-5,100
,,,
,,DRUG SCREENING METHODONE,41
,,,
,,PROSTATE BX'S 1-20 SPC,788
,,,
,,MEDICARE DRUG SCREEN 1-7,125
,,,
,,DRUG TEST-SIMPLE-ALL CLASSES,0
,,,
,,RESPIRATORY PANEL,875
,,,
,,URINALYSIS-ROUTINE,33.08
,,,
,,URINE-DIPSTICK ONLY,23.47
,,,
,,24 HR UA MET.NORMET. PANEL,31.3
,,,
,,BCR-ABL GENE REARRAGNEMENT-MOLDX,581.75
,,,
,,CALRETICULIN MUTATION,185
,,,
,,PT 20210 GENE MUTATION-MOLDX,517.39
,,,
,,FACTOR V LEIDEN- MOLDX,637.65
,,,
,,HEMOCHROMATOSIS GENOTYPE-MOLDX,115
,,,
,,JAK2 V617F MUTATION-MOLDX,300.46
,,,
,,GROSS MICRO LEVEL III,100
,,,
,,MTHFR GENE ANALYSIS,120
,,,
,,BONE MARROW NDL BIO,80.77
,,,
,,CYTO OTHER SOURCE,176.51
,,,
,,FROZEN SECTION,100.77
,,,
,,PML/RARA QUANTITATIVE,"1,100.00"
,,,
,,SURGICAL GROSS LEVEL I,86.68
,,,
,,TRG GENE REEARRANGMENT ANALYSIS,325
,,,
,,GROSS MICRO LEVEL II,75
,,,
,,GROSS MICRO LEVEL IV,155
,,,
,,HLA II TYPING 1 LOCUS LR,399.47
,,HLA-B5701,987.17
,,,
,,MOLECULAR PATH PROC LEVEL 4- MOLDX,207
,,,
,,ONCO (OVAR) FIVE PROTEINS,0
,,,
,,HCV FIBRO SURE,145
,,,
,,ACETONE-QUAL,47.14
,,,
,,ACETONE ASSAY,83.67
,,,
,,ACTH,403.17
,,,
,,URINARY CYCLICAMP,141.89
,,,
,,ALBUMIN,51.7
,,,
,,ASSAY OF URINE ALBUMIN,25
,,,
,,"MICROALBUMIN, URINE",60.44
,,,
,,"ETHANOL, EXCEPT BREATH",112.82
,,,
,,ALDOLASE,101.31
,,,
,,ALDOSTERONE,425.35
,,,
,,ALPHA I ANTITRYPSIN TOTAL,140.21
,,,
,,ALPHA I ANTITRYPSIN PHENO,150.91
,,,
,,"CYSTINE, URINE",176.09
,,,
,,"ALA AMINOLEVULINIC ACID,D",171.8
,,,
,,AMINO ACID,176.09
,,,
,,AMMONIA,152.11
,,,
,,AMYLASE,67.7
,,,
,,ANDROSTENEDIONE,290.92
,,,
,,RENIN,229.59
,,,
,,ANGIOTENSIN CONV ENZ -ACE,152.35
,,,
,,ASSAY OF APOLIPOPROTEIN,75
,,,
,,ARSENIC,100
,,,
,,ASCORBIC ACID (VITAMIN C),103.16
,,,
,,PHENOBARBITAL,119.59
,,,
,,B2 MICROGLOBULIN SERUM,141.89
,,,
,,"BILE ACIDS, TOTAL",88.03
,,,
,,"BILIRUBIN, TOTAL",52.48
,,,
,,"BILIRUBIN, DIRECT",52.48
,,,
,,OCCULT BLOOD-EMESIS,33.95
,,,
,,CADMIUM,140
,,,
,,VIT-D (25 HYDROXY),308.99
,,CALCITONIN,279.46
,,,
,,CALCIUM,53.78
,,,
,,IONIZED CALCIUM,142.58
,,,
,,"CALCIUM, URINE,QUANT",63
,,,
,,STONE ANALYSIS,130.78
,,,
,,CARBAMAZEPINE,151.93
,,,
,,CARBON DIOXIDE (CO2),51.03
,,,
,,CARBOXYHEMOGLOBIN,128.65
,,,
,,CARNITINE,176.09
,,,
,,CAROTENE,96.31
,,,
,,ASSAY THREE CATECHOLAMINES,263.56
,,,
,,CERULOPLASMIN,112.16
,,,
,,DECALCIFICATION,39.53
,,,
,,INHIBIN B,140.37
,,,
,,CHLOROMYCETIN,132.21
,,,
,,CHLORIDE,47.97
,,,
,,CHLORIDE-URINE,52.48
,,,
,,CHOLESTROL,43.25
,,,
,,CHOLINESTERASE-S,82.25
,,,
,,RBC CHOLINESTERASE,80.23
,,,
,,QUANTITATIVE ASSAY DRUG,142.91
,,,
,,CANNABINOIDS CONFIRMATION,142.91
,,,
,,MYCOPHENOLIC ACID,142.88
,,,
,,KEPPRA,142.91
,,,
,,CHROMIUM SERUM,54.45
,,,
,,CITRATE,290.21
,,,
,,BETA-CTX,65
,,,
,,COPPER,129.55
,,,
,,"CORTISOL, FREE",174.44
,,,
,,CORTISOL S OR U,170.2
,,,
,,CREATINE,48.4
,,,
,,COLUMN CHROMOTOGRAPHY,188.5
,,,
,,CPK,68
,,,
,,CPK ISOENZYMES (3),139.77
,,,
,,CK-MB,55
,,CREATININE,53.51
,,,
,,FROZEN SECTION ADDITIONAL,38.41
,,,
,,URINE CREATININE,54.02
,,,
,,CREAT CLEARANCE,98.63
,,,
,,CRYOGLOBULIN,67.53
,,,
,,B 12 (VITAMIN),58
,,,
,,B-12 BINDING CAPACITY,149.41
,,,
,,GROSS/MICRO LEVEL V,550
,,,
,,DHEA-S,150
,,,
,,FROZEN SECTION WITH STAIN,107.21
,,,
,,CONSULT & REPORT ON SLIDE,31.48
,,,
,,DIGOXIN,138.6
,,,
,,"VIT D,1,25 HYDROXY",401.73
,,,
,,"PANCREATIC ELASTASE, FECA",120.42
,,,
,,FROZEN SECTION (CONSULT),50.94
,,,
,,"DRUG SCREEN, SGL CLASS",117.35
,,,
,,ERYTHROPOIETIN,196.16
,,,
,,ESTRADIOL,100
,,,
,,ESTROGEN-TOTAL,226.36
,,,
,,UNCONJUGATED ESTRIOL,224.33
,,,
,,ESTRONE,260.56
,,,
,,FECAL FAT-SCREEN,45.05
,,,
,,GROSS MICRO LEVEL VI,840
,,,
,,FECAL FAT QUANTITATIVE,142.79
,,,
,,FERRITIN,142.16
,,,
,,FIBRINOGEN QUANT,88.66
,,,
,,FOLATE (FOLIC ACID),153.44
,,,
,,GENTAMYCIN,171.09
,,,
,,IGA,50
,,,
,,IGE,171.89
,,,
,,IgG SUBCLASS,36.31
,,,
,,BLOOD PH,84.49
,,,
,,BLOOD GASES ANY COMBINATION,28
,,,
,,ARTERIAL BLOOD GAS,205.4
,,,
,,OXYGEN SATURATION ONLY,40.1
,,SPEC STAIN-MICROGRAN,265.02
,,,
,,GASTRIC ANALYSIS,68.38
,,,
,,GASTRIN,184.03
,,,
,,"GLUCOSE, BODY FLUID",39.21
,,,
,,"GLUCOSE, BLOOD",39.21
,,,
,,GLUCOSE CHALLENGE0,49.63
,,,
,,GLUCOSE TOLERANCE 3 SPEC,106.77
,,,
,,GTT - EACH ADD HOUR,40.94
,,,
,,G 6-P D SCREEN,72.98
,,,
,,SPEC STAIN-TISSUES,109.78
,,,
,,GGTP,75.15
,,,
,,FRUCTOSAMINE,149.4
,,,
,,FSH,194.04
,,,
,,LUTEINIZING HORMONE,193.32
,,,
,,HUMAN GROWTH HORMONE,174.01
,,,
,,RBC FOLATE,180.79
,,,
,,HAPTOGLOBIN,131.34
,,,
,,HEAVY MTL SCN-UR,196.58
,,,
,,HEMOGLOBIN ELECTRO,54.39
,,,
,,FETAL HEMOGLOBIN,86.27
,,,
,,HGB A1C (GLYC HGB),50
,,,
,,METHEMOGLOBIN,30.64
,,,
,,"PLASMA, FREE HEMOGLOBIN",76.29
,,,
,,"HEMOSIDERIN, QUANT",34.37
,,,
,,HISTAMINE,308.22
,,,
,,HVA-UR,202.01
,,,
,,17-HYDROXYCORTICOSTERIODS,180.18
,,,
,,5-HIAA URINE,72.98
,,,
,,17 OH PROGESTERONE,283.49
,,,
,,FETAL LUNG MATURITY,197.47
,,,
,,TROPONIN QUANT.,102.74
,,,
,,BNP,175
,,,
,,ANALYTE QUANT NOS,135.01
,,,
,,INSULIN-SERUM,119.4
,,,
,,IRON,67.59
,,TIBC,78.67
,,,
,,IMMUNOASSAY NONANTIBODY,120.42
,,,
,,17-KETOSTERIODS,133.65
,,,
,,LACTIC ACID,111.47
,,,
,,LDH,63.04
,,,
,,LDH ISOENZYMES,133.6
,,,
,,FECAL LACTOFERRIN,204.84
,,,
,,LEAD,90
,,,
,,L/S RATIO,229.4
,,,
,,LIBRIUM0URN,193.03
,,,
,,LIPASE,71.84
,,,
,,LIPOPROTEIN BLD BY NMR,329.19
,,,
,,NMR LIPO PROFILE,259.14
,,,
,,HDL CHOLESTROL,85.49
,,,
,,"LDL, DIRECT",79.8
,,,
,,LITHIUM,69.03
,,,
,,MAGNESIUM,69.93
,,,
,,MASS SPECTROMETRY QUANT,188.47
,,,
,,ASSAY OF MERCURY,90
,,,
,,METANEPHRINES,176.85
,,,
,,MYELIN BASIC PROTEIN,179.59
,,,
,,MYOGLOBIN - S/U,134.79
,,,
,,ASSAY MYELOPEROXIDASE,354.38
,,,
,,ANTIDEPRESSANTS TRYCYCLIC 1 OR 2,141.41
,,,
,,ASSAY NEPHELOMETRY,60
,,,
,,NICOTINE/COTININE,247.33
,,,
,,5 NUCLEOTIDASE,116.5
,,,
,,OLIGOCLONAL BANDS-CSF,75
,,,
,,"ORGANIC ACIDS, URINE",171.81
,,,
,,METHYLMALONIC ACID,171.86
,,,
,,OSMOLALITY,71.15
,,,
,,OSMOLALITY-URINE,71.11
,,,
,,OXALATE - URINE,134.38
,,,
,,PARATHYROID HORMONE,430.8
,,,
,,ASSAY PH BODY FLUID NOS,37.34
,,"CALPROTECTIN, STOOL",204.83
,,,
,,DILANTIN-PHENYTOIN,138.35
,,,
,,ACID PHOS - TOTAL,77.1
,,,
,,PROSTATIC ACID PHOS,100.84
,,,
,,ALKALINE PHOSPHATASE,54.02
,,,
,,ALK PHOS ISOENZYME,154.35
,,,
,,PHOSPHATIDYLGLYCEROL,172.5
,,,
,,PHOSPHOROUS,49.56
,,,
,,"PHOSPHORUS, URINE",54.02
,,,
,,"PORPHOBILINOGEN, URINE; Q",88.03
,,,
,,PORPHYRIN- QUANT FRACTION,153.52
,,,
,,PORPHYRIN SCREEN,89.88
,,,
,,POTASSIUM,47.97
,,,
,,POTASSIUM - URINE,44.91
,,,
,,PREGNENOLONE,143.5
,,,
,,MYSOLINE (PRIMIDONE),173.16
,,,
,,PROGESTERONE,95
,,,
,,PROCALCITONIN,279.47
,,,
,,PROLACTIN,202.3
,,,
,,FREE PSA,192
,,,
,,"TOTAL PROTEIN,SERUM OR BO",38.27
,,,
,,"TOTAL PROTEIN, URINE",38.27
,,,
,,TOT PROTEIN-NON URINE/SER,38.27
,,,
,,"PROTEIN ELP, SERUM",112.16
,,,
,,"PROTEIN ELP, URINE",186.21
,,,
,,PRE-ALBUMIN,152.27
,,,
,,PROTOPORPHYRIN RBC,149.77
,,,
,,ASSAY OF PROINSULIN,84
,,,
,,VITAMIN B-6,293.17
,,,
,,QUINIDINE,152.35
,,,
,,ESTROGEN RECEPTOR,295.17
,,,
,,PROGESTERONE RECEPTOR,295.17
,,,
,,SELENIUM,113.56
,,,
,,SEROTONIN,323.3
,,,
,,SICKLE CELL TEST,57.59
,,SEX HORMONE BINDING GLOBU,226.89
,,,
,,SODIUM,50.22
,,,
,,SODIUM-URINE,30.07
,,,
,,IGF-1,221.83
,,,
,,SPECTROPHOTOMETRY ANALYTE NES,35
,,,
,,SP GR NOT URINE,26.14
,,,
,,URINE SULFATE,49.61
,,,
,,FREE TESTOSTERONE,265.73
,,,
,,TESTOSTERONE LAB,150
,,,
,,THEOPHYLLINE,147.71
,,,
,,THIAMINE (VIT B),221.63
,,,
,,THYROGLOBULIN,167.64
,,,
,,T-4,71.78
,,,
,,NEONATAL T4,67.53
,,,
,,FREE T4,78.67
,,,
,,THYROXIN BIND. GLOBULI,154.35
,,,
,,TSH,75
,,,
,,THYROID STIMULATING IMMUN,400
,,,
,,VITAMIN E,148
,,,
,,SGOT/AST,53.91
,,,
,,SGPT/ALT,55.3
,,,
,,TRANSFERRIN,133.26
,,,
,,TRIGLYCERIDE,60.08
,,,
,,T3 UPTAKE,67.53
,,,
,,T-3 RIA,133.06
,,,
,,FREE T3,176.85
,,,
,,REVERSE T3,164.5
,,,
,,BLOOD UREA NITROGEN,41.16
,,,
,,URINE BUN,49.62
,,,
,,URIC ACID,47.14
,,,
,,URIC ACID URINE,49.63
,,,
,,VMA-URINE,161.81
,,,
,,VIP,62.23
,,,
,,VASOPRESSIN (ADH),354.31
,,,
,,VISCOSITY,108.95
,,VITAMIN A,121.03
,,,
,,VITAMIN K,143.12
,,,
,,D-XYLOSE TOLERANCE,123.63
,,,
,,"ZINC, SERUM",118.85
,,,
,,C-PEPTIDE INSULIN,217.13
,,,
,,"HCG, QUANT",97
,,,
,,PREGNANCY QUAL,78.36
,,,
,,TOBRAMYCIN,168.24
,,,
,,FECAL REDUCING SUBSTANCE,57.48
,,,
,,BLEEDING TIME - IVY/DUKES,47
,,,
,,WBC WITH AUTO DIFF,67.53
,,,
,,DIFFERENTIAL-MANUAL,35.94
,,,
,,HEMATOCRIT,22.26
,,,
,,HEMOGLOBIN,22.26
,,,
,,CBC W/O DIFF (HEMOGRAM),67.53
,,,
,,CBC W/ DIFF,81.14
,,,
,,RED BLOOD CELL COUNT,31.38
,,,
,,RETICULOCYTE COUNT,44.91
,,,
,,WHITE BLOOD CELL CNT,26.51
,,,
,,SMEAR TO PATHOLOGIST,80.62
,,,
,,CLOT RETRACTION,34.9
,,,
,,FACTOR V ACTIVITY,141.89
,,,
,,FACTOR VIII,141.89
,,,
,,FACTOR VIII RELATED AG,239.5
,,,
,,VON WILLEBRAND FACTOR,239.5
,,,
,,FACTOR 8 VWF MULTIMRC,239.5
,,,
,,FACTOR IX ACTIVITY,141.91
,,,
,,FACTOR X,142.73
,,,
,,CLOTTING FACTOR XI PTA,40
,,,
,,FACTOR XII  ASSAY,89.38
,,,
,,ANTITHROMBIN III,61.13
,,,
,,"PROTEIN C, FUNCTIONAL",135.87
,,,
,,"PROTEIN S, FUNCTIONAL",121.03
,,,
,,PROTEIN S FREE,159.95
,,,
,,APC RESISTANCE PROFILE,159.98
,,FACTOR  INHIBITOR TEST,61.13
,,,
,,LEE-WHITE COAG,37.8
,,,
,,COAG-OTHER,38.85
,,,
,,FIBRIN SPLIT PRODUCT,71.84
,,,
,,"D-DIMER, QUALITATIVE",74.49
,,,
,,"D-DIMER, QUANTITATIVE",84.59
,,,
,,ALPHA II ANTIPLASMIN,80.45
,,,
,,PLASMINOGEN ACTIVITY,68.05
,,,
,,RBC FRAGILITY,92.62
,,,
,,LEUKOCYTE ALK PHOS,89.78
,,,
,,OSMOTIC FRAGILITY RBC INCUBATED,25
,,,
,,PLATELET COUNT -AUTO,46.73
,,,
,,PLATELET EST/SMEAR REVIEW,35.94
,,,
,,PROTHROMBIN TIME,36.56
,,,
,,PT SUBSTITUITON PLASMA,36.56
,,,
,,SEDIMENTATION RATE,37.05
,,,
,,PTT,54.39
,,,
,,CIRCULATING ANTICOAGULANS,67.54
,,,
,,FEBRILE AGGLUTININS,72.83
,,,
,,ALLERGEN SPECIFIC IGE,25
,,,
,,COLD AGGLUTININS,84.16
,,,
,,ANTIBODY IDENTIFICATION PLATELET ANTIBOD,191.68
,,,
,,,
,,IMMUNOGLOBIN ASSAY,85
,,,
,,ASO SCREEN,60.28
,,,
,,C-REACTIVE PROTEIN,54.02
,,,
,,HIGH SENSITIVITY CRP,135.16
,,,
,,BETA 2 GLYCOPROTEIN I AB,265.52
,,,
,,CEA,198.05
,,,
,,"COMPLEMENT, TOTAL",212.09
,,,
,,COMPLEMENT ANTIGEN,125.36
,,,
,,HERPES SIMPLEX TYPE I,137.71
,,,
,,INFLUENZA A OR B,125.24
,,,
,,CYCLIC CITRULLINATED PEPT,135.16
,,,
,,ASO ANTIDNASE B,133.04
,,ANTI-DNA,143.45
,,,
,,ANTI SS DNA,125.84
,,,
,,NUCLEAR ANTIGEN ANTIBODY,48
,,,
,,ALPHA FETO PROTEIN,175.12
,,,
,,LYME SEROLOGY,177.79
,,,
,,ANCA,125.82
,,,
,,MUMPS IGG TITER,137.67
,,,
,,ANA,126.19
,,,
,,FLUORESCENT ANITBODY SCREEN,125.82
,,,
,,RUBEOLA SCRN,134.49
,,,
,,ROTAVIRUS SCREEN AG,125.24
,,,
,,RUBELLA SCREEN,150.23
,,,
,,HEP. B SURF AG,100.99
,,,
,,HEP B CORE AB,125.82
,,,
,,HEPATITIS B CORE IGM,69.93
,,,
,,HEPATITIS B SURF AB,112.16
,,,
,,HEP. C AB (HCV),148.95
,,,
,,HEP BE AG,120.28
,,,
,,HEP BE AB,120.73
,,,
,,HEP. A ANTIBODY,129.34
,,,
,,HEP A AB (IGM),117.53
,,,
,,MONONUCLEOSIS TEST,54.02
,,,
,,HETEROPHILE TITER (EBV),67.53
,,,
,,HIV AB,69.93
,,,
,,CHROMOGRANIN A,217.26
,,,
,,CA15-3,217.13
,,,
,,CA 125,217.13
,,,
,,RSV AG,125.24
,,,
,,THYROTROPIN RECEPTOR,40
,,,
,,HEPATITIS DELTA ANTIBODY,179.15
,,,
,,IMMUNO ELP - SERUM,233.39
,,,
,,IMMUNO ELP - URINE,233.39
,,,
,,HYPERSENS PNEUMO PANEL,125.12
,,,
,,HYPE PHEUMO PANEL-ACTINOM,66.59
,,,
,,HYPE PNEUMO PANEL-PROTOZO,61.13
,,IMMUNOFIXATON URINE,306.25
,,,
,,INHIBIN A,135.18
,,,
,,INSULIN ANTIBODIES,223.5
,,,
,,INTRINSIC FACTOR ANTIBODY,153.24
,,,
,,ISLET CELL ANITBODY,119.5
,,,
,,CLL/LYMPHOMA-1,191.38
,,,
,,CLL/LYMPHOMA-2,191.38
,,,
,,PSA PROST. SPEC. ANTG,192
,,,
,,CA 19-9,217.13
,,,
,,SCREENING PSA,192.04
,,,
,,SCREENING HEMOCULT,33.95
,,,
,,MICROSOMAL ANTIBODY,151.85
,,,
,,SPECIMEN COLLECTION,19.99
,,,
,,RA (Rheumatoid Factor- Quantitative),59.25
,,,
,,FINE NEEDLE ASPR.,491.2
,,,
,,TB TEST CELL IMMUN MEASURE,95
,,,
,,RPR (STS),44.52
,,,
,,ARTERIAL PUNCTURE,119.11
,,,
,,ROCKY MT SPOTTED FEVER,71.3
,,,
,,CAT SCRATCH DISEASE Ab,66.59
,,,
,,BLASTOMYCES ANTIBODY,65
,,,
,,LYME WB IgM,161.65
,,,
,,AB; CANDIDA,124.36
,,,
,,CHLAMYDIA ANTIBODIES,132.52
,,,
,,COCCIDIODES ANITBODY,55
,,,
,,Q FEVER ABY,36.91
,,,
,,CRYPTOCOCCUS ANTIGEN,106.4
,,,
,,CMV-IgG,150.23
,,,
,,CMV-IgM,175.86
,,,
,,ENTEROVIRUS AB,135.95
,,,
,,"EBV, EARLY ANITGEN",136.95
,,,
,,"EBV, NUCLEAR ANTIGEN",159.74
,,,
,,EBV ACUTE PROFILE,80
,,,
,,FUNGUS ANTIBODY,84.8
,,,
,,"GIARDIA Ab, TOTAL SERUM",153.58
,,ACETYLCHOLINE RECEPT,141.07
,,,
,,HERPES SIMPLEX TYPE II,71.26
,,,
,,HISTOPLASMA ANITBODY,60
,,,
,,INFLUENZA IGG OR IGM SERU,141.5
,,,
,,LEGIONELLA,159.49
,,,
,,LEPTOSPIRA ABY,137.67
,,,
,,ROTAVIRUS ANTIBODY,137.67
,,,
,,SARS COVID IgG ANTIBODY,40
,,,
,,TOXOPLASMA ANTIBODY,150.23
,,,
,,TREPONEMA PALLIDUM ABY,138.33
,,,
,,TRICHINELLA ANTIBODY,66.58
,,,
,,VARICELLA ZOSTER AB.,134.49
,,,
,,ANTIBODY WEST NILE VIRUS IGM,35
,,,
,,ANTIBODY WEST NILE VIRUS,30
,,,
,,"HEPATITIS E VIRUS, IGM",134.49
,,,
,,THYROGLOBULIN ABY,165.99
,,,
,,HEP C RIBA,161.7
,,,
,,HLA-B27,200
,,,
,,ANTIGEN SCREEN,92.7
,,,
,,BLOOD CULTURE,107.72
,,,
,,STOOL CULTURE,98.49
,,,
,,YERSINIA CULTURE,98.49
,,,
,,MRSA SCREENING CULURE,89.88
,,,
,,CULTURE OTHER SOURCE,89.88
,,,
,,CLO TEST,75.75
,,,
,,ANAEROBIC CULTURE,61.13
,,,
,,URINE CULTURE W/CC,84.28
,,,
,,"FUNGUS CULTURE, SKIN",80.45
,,,
,,"FUNGUS CULTURE,OTHER SOUR",61.13
,,,
,,"FUNGUS CULTURE, BLOOD",94.17
,,,
,,FUNGUS DEFINITIVE I.D.,107.72
,,,
,,MYCOPLASMA0UREA PLASMA,51.5
,,,
,,AFB CULTURE,69.68
,,,
,,CULTYP NUC ACID AMP PRB,44
,,,
,,"CULTURE, ADD'L ID",75.75
,,PARASITE EXAM STOOL/SPUTU,92.88
,,,
,,"CHLAMYDIA SCREEN, DNA",143.88
,,,
,,"GC, GENPROBE, DNA",143.88
,,,
,,NITROCEQIN TEST,49.6
,,,
,,SENSITIVITY,90.26
,,,
,,BONE MARROW-SMEAR INTERPR,71.05
,,,
,,MICROSPORIDIA,36.91
,,,
,,MICRO EXAM ANY SOURCE,44.52
,,,
,,"BORDETELLA PERTUSSIS, IgG",137.68
,,,
,,PINWORM EXAM,44.52
,,,
,,"SMEAR, COMPLEX STAIN",111.06
,,,
,,INDIA INK PREP.,44.52
,,,
,,KOH PREP,44.52
,,,
,,"CLOSTRIDUM TOXINS, EIA(C-",125.24
,,,
,,CHLAMYDIA CULTURE,204.43
,,,
,,"VIRAL CULTURE, GENERAL",272.09
,,,
,,BORDETELLA PERTUSSIS SMEA,125.24
,,,
,,CYTOMEGALOVIRUS ANTIBODY,124.21
,,,
,,HELICOBACTER PYLORI-STOOL,125.24
,,,
,,URINE HISTOPLASMOSIS AG,125.22
,,,
,,SHIGA-TOXIN,125.22
,,,
,,"RAPID STREP SCREEN, EIA",125.24
,,,
,,LEGIONELLA ANTIGEN,125.24
,,,
,,IADNA BORRELIA BURG AMP PROBE,140
,,,
,,IADNA CANDIDA SPECIES DIRECT PROBE,40
,,,
,,CNS DNA/RNA AMP PROBE MUL 12-25,550
,,,
,,IADNA CHLAMYDIA PNEU AMPLIFIED PROBE,150
,,,
,,C DIFF AMPLIFIED PROBE,60
,,,
,,CYTOMEGALOVIRUS NA QUAN,447.11
,,,
,,STOOL FILMARRY PANEL- MOLDX,375
,,,
,,IADNA GARDNERELLA VAGINALIS DIRECT PROBE,40
,,,
,,,
,,HEPATITIS B VIRUS PCR,447.05
,,,
,,HEPATITIS C-GENOTYPE,475
,,,
,,HEP C RNA QUANT,447.2
,,HERPES S AMPLIF NA PROBE,366.43
,,,
,,HIV 1 RNA PCR,475
,,,
,,VIRAL LOAD HIV-1,475
,,,
,,MYCOPLASMA PNEUMONIA,158
,,,
,,ANIT-CARDIOLIPIN ANITBODY,265.52
,,,
,,IADNA RESPIRATORY PROBE 12-25 TARGET,525
,,,
,,COV 19,60
,,,
,,IADNA TRICHOMONAS VAGINALIS DIRECT PROBE,40
,,,
,,,
,,TRICHOMONAS VAGINALIS AMPLIF,55
,,,
,,NOS AMPLIFIED PROBE,190
,,,
,,BK VIRUS QUANTITATIVE,447.05
,,,
,,CAMPYLOBACTER ANTIGEN,120.36
,,,
,,DRUG TEST PRSMV CHEM ANALYZER,95
,,,
,,AUTOPSY/GROSS-MICRO,"1,279.23"
,,,
,,"CYTOPATHOLOGY,FLUIDS,SMEA",210.5
,,,
,,"CYTOPATHOLOGY,FLUIDS,CONC",218.47
,,,
,,NON GYN THIN PREP,405.39
,,,
,,HOMOCYSTINE CPT,176.09
,,,
,,PAP SMEAR,54.39
,,,
,,CLL/LYMPHOMA 3,249.13
,,,
,,FLOW CYTOMETRY EA ADDTL M,100
,,,
,,"TISSUE CULTURE, LYMPHOCYT",525
,,,
,,MYCOPLASMA,138.3
,,,
,,CHROMOSOME ANALYSIS,750
,,,
,,"CYTOGENETICS, 100-300",419.24
,,,
,,FISH,716.32
,,,
,,CYTOGNETICS INTREP & RPT,45.25
,,,
,,DRUG TESTS READ BY OBSERVATION,0
,,,
,,E  COLI 0157,125.24
,,,
,,IMHISTOCHEM/SYTCMH EA ADD ANTIBODY,140
,,,
,,IMMUNOCYTOCHEMISTRY,295.17
,,,
,,HER-2-NEW,411.62
,,,
,,GLIADIN IGA,120.42
,,,
,,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY,190
,,,
,,,
,,M/PHMTRC ALYS ISH QUANT/SEMIA MNL EA MUL,725
,,,
,,,
,,BIOAVAILABLE TESTOSTERONE,265.73
,,,
,,PARATHYROID HORMONE-RELAT,141.07
,,,
,,ANALYTE QUANT RADIOIMMUNOASSAY,141.07
,,,
,,IADNA STREPTOCOCCUS GROUP B AMP,95
,,,
,,CD4 (HELPER SUPPRESSOR PANEL),150
,,,
,,"CYTOGENETIC, DNA PROBE",223.62
,,,
,,IMMUNOFLUORESCENT STUDY-I,276.63
,,,
,,SPECIMEN HANDLING-COVID,22.95
,,,
,,DOT CUSTODY HANDLING,42.8
,,,
,,BREATH ALCOHOL TESTING,42.8
,,,
,,CELL COUNT NON-BLOOD,49.34
,,,
,,CELL COUNT-CSF/FLUID,57.54
,,,
,,WBC STOOL,44.52
,,,
,,CRYSTAL ID - JOINT FLD,74.62
,,,
,,EOSINOPHIL-NASAL SM,34.9
,,,
,,THERAPEUTIC PHLEBOTOMY,50.15
,,,
,,"PREPARE & CONSULT, TISSUE",125.91
,,,
,,SPERM COUNT,89.88
,,,
,,SPERM ANALYSIS,125.82
,,,
,,SEMEN ANALYSIS STRICT MORPHOLOGIC,52.5
,,,
,,SPECIMEN HANDLING- REGULAR,22.95
,,,
,,PACKED RED CELLS,407.65
,,,
,,PLATELET CONCENTRATE,183.2
,,,
,,FRESH FROZEN PLASMA,133.87
,,,
,,WASHED RED CELLS,561.81
,,,
,,AUTOLOGOUS BLOOD,186.97
,,,
,,PLATELETS PHERESIS,"1,095.23"
,,,
,,IRRADIATION OF CELLS,103.65
,,,
,,PLATELET CROSSMATCH,463.1
,,,
,,RBC ANITOBDY INDENT,103.65
,,,
,,DIRECT COOMBS TEST,52.79
,,ANITBODY SCREEN,59.81
,,,
,,"CROSSMATCH, COMBS",107.67
,,,
,,ABO BLOOD TYPING,59.81
,,,
,,DU TYPING,33.97
,,,
,,RH BLOOD TYPING,35.79
,,,
,,BLOOD TYPIE ANTIGEN DONOR,27.08
,,,
,,BLOOD ADMIN FEE 0-2 HOURS,155.85
,,,
,,BLOOD ADMIN FEE 2-4 HOURS,207.77
,,,
,,BLOOD ADMIN FEE 4-6 HOURS,311.63
,,,
,,BLOOD ADMIN FEE 6 HR & UP,415.49
,,,
,,ANTIBODY SCREEN RBC,50
,,,
,,ANTIBODY ID RBC,87.5
,,,
,,ANTIHUMAN GLOBULIN DIRECT EACH,37.5
,,,
,,BLOOD TYPING SEROLOGIC,37.5
,,,
,,BLOOD TYPE ANTIGEN,87.5
,,,
,,BLOOD TYPING ANTIGEN SCREEN,20
,,,
,,"CROSSMATCH,IMMEDIATE SPIN",56.1
,,,
,,"CROSSMATCH, 37 DEGREES",56.1
,,,
,,COMPATIBILITY EACH UNIT,81.25
,,,
,,"FRESH FROZEN PLASMA, THAW",33.67
,,,
,,POOLING OF PLATELETS,58.07
,,,
,,CARDIOVERSION,794.41
,,,
,,CARDIAC STRESS TEST,587.97
,,,
,,MEDICATION TREADMILL,587.97
,,,
,,IPPE EKG,260.26
,,,
,,EKG,146.98
,,,
,,SUBSEQUENT EKG,146.98
,,,
,,RHYTHM STRIP,98.02
,,,
,,HOLTER MONITOR RECORDING,294.29
,,,
,,HOLTER MONITOR SCANNING,786.09
,,,
,,EEG-AWAKE & DROWSEY,607.77
,,,
,,EEG-AWAKE & ASLEEP,607.77
,,,
,,SLEEP STUDY- UNATTENDED,360
,,,
,,POLYSOMNOGRAPHY,"2,244.85"
,,,
,,POLYSOMNOGRAPHY W/CPAP,"2,342.53"
,,EYE FOR FOREIGN BODY,64.52
,,,
,,PF MANDIBLE PARTIAL,70.2
,,,
,,"MANDIBLE, COMPLETE",94.79
,,,
,,SOLITARY PULMONARY NODULE,739
,,,
,,"MASTOIDS, COMPLETE",129.09
,,,
,,"FACIAL BONES, LTD",75.48
,,,
,,"FACIAL BONES, COMPLETE",99.56
,,,
,,"NASAL BONES, COMPLETE",64.52
,,,
,,XRAY EXAM OF EYE SOCKETS,107.45
,,,
,,"SINUSES, LIMITED",67.56
,,,
,,"SINUSES, COMPLETE",94.29
,,,
,,"SKULL, LIMITED",94.14
,,,
,,"SKULL, COMPLETE",128.85
,,,
,,TEMP.MANDIB.JTS. COMPLETE,94.14
,,,
,,"NECK, SOFT TISSUES",64.52
,,,
,,ULTRASOUND EXAM AAA SCREE,222.91
,,,
,,CT-BRAIN W/O CONTRAST,323.81
,,,
,,"CT BRAIN, W/CONTRAST",432.25
,,,
,,"HEAD, W&W/O CONTRAST",485.75
,,,
,,"CT ORBIT,SELLA, POST.FOSS",488.57
,,,
,,"CT ORBIT, SELLA,POST.FOSS",551.93
,,,
,,CT SINUS W/O CONTRAST,436.54
,,,
,,CT MAX FACIAL W/O CONTRST,436.54
,,,
,,CT MAX FACIAL (SINUS) W,499.21
,,,
,,CT MAX FACIAL(SINUS)BOTH,540.86
,,,
,,CT NECK TISSUES W/O,489.5
,,,
,,CT NECK TISSUE WITH,531.84
,,,
,,CT NECK TISSUE BOTH,551.93
,,,
,,CT ANGIOGRAPHY HEAD,670.31
,,,
,,CT ANGIOGRAPHY NECK,669.95
,,,
,,"MRI-FACE, NECK OR ORBTSWO",513.46
,,,
,,"MRI-FACE, NECK OR ORBTS W",621.09
,,,
,,"MRI-FACE,NECK,ORBTS W/WO",821.02
,,,
,,MRI-ANGIOGRAPHY HEAD W/O,457.14
,,,
,,MRA HEAD W/CONTRAST,457.14
,,MRA NECK W/O CONTRAST,457.14
,,,
,,MRA-NECK WITH CONTRAST,457.14
,,,
,,MRA-NECK W & W/O CONTRAST,689.5
,,,
,,MRI-BRAIN,566.39
,,,
,,MRI-BRAIN W,685.12
,,,
,,MRI-BRAIN W/WO W/ADD SEQU,905.54
,,,
,,"RIBS, UNILATERAL(2VIEWS)L",83.75
,,,
,,"RIBS, UNILATER(2VIEWS)RT",83.75
,,,
,,"CHEST, SINGLE VIEW",67.39
,,,
,,"SUBSEQUENT CHEST, SINGLE",69.8
,,,
,,"CHEST, TWO VIEWS",83.75
,,,
,,"CHEST, 2 VIEWS +LORDO",102.2
,,,
,,CHEST SPECIAL VIEWS,69.86
,,,
,,"WRIST, PARTIAL LFT",67.26
,,,
,,"WRIST, PARTIAL RIGHT",67.26
,,,
,,"RIBS, UNI(3 VIEWS)PA LFT",102.2
,,,
,,RIBS UNI (3VIEWS)PA RT,102.2
,,,
,,"RIBS, BILATERAL, 3 VIEWS",102.2
,,,
,,"RIBS, BIL (4VIEWS)INCL PA",119.69
,,,
,,STERNUM,73.24
,,,
,,STERNOCLAVICULAR JTS,83.75
,,,
,,CT CHEST W/O,390.98
,,,
,,"CT CHEST, W",477.2
,,,
,,CT CHEST BOTH,529.35
,,,
,,"CT ANGIOGRAPHY, CHEST",737.24
,,,
,,MRI CHEST W/O DYE,554.78
,,,
,,MRI-CHEST W/WO CONTRAST,867.18
,,,
,,MRA CHEST W OR W/O,697.31
,,,
,,VENOUS DUPLEX UNI LEFT,171.57
,,,
,,VENOUS DUPLEX UNI RIGHT,171.57
,,,
,,DOP ART.WAVE UPER&LWR,93.53
,,,
,,"SPINE, SINGLE VIEW",58.87
,,,
,,C SPINE (AP/LAT),88.55
,,,
,,C SPINE (4 VIEWS),120.54
,,,
,,C SPINE COMPLETE W/EXT &,139.14
,,"THORACIC SPINE,LTD 2 VIEW",86.16
,,,
,,"THORACIC SPINE,W/SWIMMER",83.75
,,,
,,SPINE-COLOSIS STUDY,113.6
,,,
,,"LUMBAR SPINE, LTD",88.55
,,,
,,"LUMBAR SPINE, COMP INCLUD",120.54
,,,
,,LS SPINE COMP W BENDING,128.82
,,,
,,CT SPINE CERV W/O,411.55
,,,
,,CERV SPINE W CONTR,461.88
,,,
,,CT SPINE THOR W/O,380.52
,,,
,,CT SPINE THOR WITH,469.08
,,,
,,CT SPINE LUMBAR W/O,380.52
,,,
,,CT SPINE LUMBAR WITH,469.08
,,,
,,MRI-CERVICAL SPINE,615.45
,,,
,,MRI-CERVICAL SPINE W,733.61
,,,
,,MRI-DORAL SPINE,615.45
,,,
,,MRI-DORSAL SPINE WITH,739.75
,,,
,,MRI-LUMBAR SPINE,567.61
,,,
,,MRI-LUMBAR W,687.61
,,,
,,MRI-CERIVAL SPINE W/WO,987.48
,,,
,,MRI-THORACIC SPINE W/WO,987.48
,,,
,,MRI-LUMBAR SPINE W/WO,912.24
,,,
,,"PELVIS, AP",69.96
,,,
,,CT PELVIS W/O CONT,415.39
,,,
,,CT PELVIS W/CONT,443.24
,,,
,,CT PELVIS BOTH,465.26
,,,
,,MRI-PELVIS W/O CONTRAST,559.63
,,,
,,MRI-PELVIS W,667.18
,,,
,,MRI -PELVIS W & W/O DYE,864.7
,,,
,,MRI PELVIS WITHOUT,689.5
,,,
,,"PF SACROILIAC JTS, PART",64.52
,,,
,,SACRUM/COCCYX,64.52
,,,
,,MRI UPPER JT W/ BOTH,"1,247.18"
,,,
,,UPPER JT W/ LEFT,623.58
,,,
,,MRI UPPER JT W/ RIGHT,623.58
,,,
,,MRI UPPER JOINT LT W & WO,826.08
,,MRI UPPER JOINT RT W &W/O,826.08
,,,
,,EPIDUROGRAM+,223.68
,,,
,,PF CLAVICLE BILATERAL,123.36
,,,
,,"CLAVICLE, LEFT",61.68
,,,
,,"CLAVICLE, RIGHT",61.68
,,,
,,"SCAPULA, BILATERAL",71.03
,,,
,,"SCAPULA, LEFT",69.96
,,,
,,"SCAPULA, RIGHT",69.96
,,,
,,"SHOULDER, PARTIAL LEFT",56.41
,,,
,,"SHOULDER, PARTIAL RIGHT",56.41
,,,
,,"SHOULDER, COMPLETE BILATR",73.71
,,,
,,"SHOULDER, COMPLETE LEFT",75.15
,,,
,,"SHOULDER, COMPLETE RIGHT",75.15
,,,
,,SHOULDER ARTHROGRAM,209.42
,,,
,,SHOULDER ARTHROGRAM RT,209.42
,,,
,,XRAY EXAM OF SHOULDERS,83.12
,,,
,,"HUMERUS, LEFT",67.56
,,,
,,"HUMERUS, RIGHT",67.56
,,,
,,"ELBOW, PARTIAL LEFT",59.59
,,,
,,"ELBOW, PARTIAL RIGHT",59.59
,,,
,,"ELBOW, COMPLETE BILATERAL",133.11
,,,
,,"ELBOW, COMPLETE LEFT",64.52
,,,
,,"ELBOW, COMPLETE RIGHT",64.52
,,,
,,FOREARM LEFT,62.32
,,,
,,FOREARM RIGHT,62.32
,,,
,,"WRIST, COMPLETE BILATERAL",135.15
,,,
,,"WRIST, COMPLETE LEFT",67.56
,,,
,,"WRIST, COMPLETE RIGHT",67.56
,,,
,,"HAND, PARTIAL LEFT",62.32
,,,
,,"HAND, PARTIAL RIGHT",62.32
,,,
,,"HAND, COMPLETE BILATERAL",130.04
,,,
,,"HAND, COMPLETE LEFT",64.52
,,,
,,"HAND, COMPLETE RIGHT",64.52
,,,
,,FINGER-LEFT THUMB,50.63
,,,
,,FINGER-LEFT 2,50.63
,,FINGER-LEFT 3,50.63
,,,
,,FINGER-LEFT 4,50.63
,,,
,,FINGER-LEFT 5,50.63
,,,
,,FINGER-RIGHT THUMB,50.63
,,,
,,FINGER-RIGHT 2,50.63
,,,
,,FINGER-RIGHT 3,50.63
,,,
,,FINGER-RIGHT 4,50.63
,,,
,,FINGER-RIGHT 5,50.63
,,,
,,CT UPPER EXT LT W/O,388.33
,,,
,,"CT UPPER EXTREM, W/O RTVA",388.33
,,,
,,MRI UPPER EXTREM W/O,516.07
,,,
,,MRI UPPER EXTREM WITH,623.58
,,,
,,CT UP EXT BILATERAL W/WO,894.16
,,,
,,MRI-UPPER JOINTS LEFT,522.2
,,,
,,MRI-UPPER JOINTS RIGHT,522.2
,,,
,,MRI- UPPER EXT T- W/ WO CONT BOTH,"1,652.16"
,,,
,,MRI-UPPER EXT LT-W/WO CONTR,826.08
,,,
,,MRI- UPPER EXT T W/ WO CONT,826.08
,,,
,,CT UPPER EXTREM. W RT,443.24
,,,
,,"CARDIAC M-MODE, DOPPLER C",512.91
,,,
,,M-MODE & REAL TIME,358.54
,,,
,,CARDIAC DOPPLER,149.73
,,,
,,DOPPLER COLOR FLOW,28.58
,,,
,,STRESS ECHO,576.93
,,,
,,"HIP, SINGLE VIEW LEFT",69.96
,,,
,,"HIP, SINGLE VIEW RIGHT",69.96
,,,
,,"HIP, COMPLETE, BILAERAL",103.37
,,,
,,"HIP, COMPLETE LEFT",85.83
,,,
,,"HIP, COMPLETE RIGHT",85.83
,,,
,,AP PELVIS + BOTH HIPS,101.96
,,,
,,KNEE (MIN 3 VIEW) BILATER,150.3
,,,
,,KNEE (MIN. 3 VIEWS) LEFT,75.15
,,,
,,KNEE (MIN. 3 VIEWS) RIGHT,75.15
,,,
,,"HIP, O.R.I.F",112.58
,,,
,,KNEE (4 OR MORE VIEW) LFT,88.55
,,KNEE (4 OR MORE VIEW)RT,88.55
,,,
,,"PF FEMUR, BILATERAL",134.81
,,,
,,"FEMUR, LEFT",67.41
,,,
,,"FEMUR, RIGHT",67.41
,,,
,,AP STANDING KNEES,72.44
,,,
,,KNEE 1 OR 2 VWS BILATERAL,139.91
,,,
,,KNEE 1 OR 2 VIEWS LEFT,69.96
,,,
,,KNEE 1 OR 2 VIEWS RIGHT,69.96
,,,
,,"ANKLE, PARTIAL LEFT",62.32
,,,
,,"ANKLE, PARTIAL RIGHT",62.32
,,,
,,"ANKLE, COMPLETER BILATERA",36.16
,,,
,,"ANKLE, COMPLETE LEFT",64.52
,,,
,,"ANKLE, COMPLETE RIGHT",64.52
,,,
,,"FOOT, PARTIAL BILATERAL",118.51
,,,
,,"FOOT, PARTIAL LEFT",59.25
,,,
,,"FOOT, PARTIAL RIGHT",59.25
,,,
,,"FOOT, COMPLETE BILATERAL",129.05
,,,
,,"FOOT, COMPLETE LEFT",64.52
,,,
,,"FOOT, COMPLETE RIGHT",64.52
,,,
,,"XRAY OF HEEL, LEFT",62.32
,,,
,,"XRAY OF HEEL,  RT",62.32
,,,
,,TOE-LEFT 1,48.18
,,,
,,TOE-LEFT 2,48.18
,,,
,,TOE-LEFT 3,48.18
,,,
,,TOE-LEFT 5,48.18
,,,
,,TOE- RIGHT 1,48.18
,,,
,,TOE-RIGHT 2,48.18
,,,
,,TOE-RIGHT 3,48.18
,,,
,,TOE RT 4TH,48.18
,,,
,,TOE- RIGHT 5,48.18
,,,
,,"CT LOWER EXTREM, W/O LT",380.63
,,,
,,CT LOWER EXT. W/O RT,380.63
,,,
,,MRI-LOWER JOINTS LT-WO CO,519.67
,,,
,,MRI-LOWER JOINTS RT-WO CO,519.67
,,,
,,MRI-LOWER JNT OR ET W/CON,627.39
,,MRA-LWR EXTREM W/WO CONTR,697.65
,,,
,,MRI-LOWER EXT LT WO CONST,513.46
,,,
,,MRI-LOWER EXT RT WO CONTR,513.46
,,,
,,MRI-LOWER EXT BILAT W CON,"1,263.79"
,,,
,,MRI-LOWER EXT LT W CONTRA,631.88
,,,
,,MRI-LOWER EXT RT WI CONTR,631.88
,,,
,,EXTRACRANIAL DUPLEX,230.41
,,,
,,TIBIA/FIBULA BILATERAL,129.04
,,,
,,TIBIA/FIBULA LEFT,64.52
,,,
,,TIBIA/FIBULA RIGHT,64.52
,,,
,,ANKLE/ARM INDEX BILATERAL,94.29
,,,
,,LWR. EXT. DUPLEX BILATERA,219.75
,,,
,,LTD LWR EXT DUPLEX BILAT,146.71
,,,
,,LTD LWR EXT DUPLEX LEFT,149.66
,,,
,,LTD LWR EXT DUPLEX RIGHT,149.66
,,,
,,UPPER EXT DUPL BILATERAL,175.69
,,,
,,LTD UPR EXT DUPLEX LEFT,116.82
,,,
,,LTD UPR EXT DUPLEX RIGHT_,116.82
,,,
,,VENOUS DUPLEX-BIL STUDY,261.12
,,,
,,VASC DUPLEX SCAN OF AB VE,694.65
,,,
,,VASCULAR STUDY,465.01
,,,
,,DUPLEX OF AORTA,250.4
,,,
,,"DUPLEX A, IVC, IL/BPG; UN",166.28
,,,
,,LTD VENOUS DUPLEX-UNI STU,171.57
,,,
,,LTD VENOUS SUPLEX-UNI STU,171.57
,,,
,,"ABDOMEN, SINGLE VIEW",67.39
,,,
,,ABDOMEN SUPINE & OBLIQUE,86.58
,,,
,,ACUTE ABD SERIES (MAY INC,122.12
,,,
,,CT UPPER ABDOMEN W/O,454.28
,,,
,,CT UPPER ABDMN WITH,488.26
,,,
,,CT UPPER ABDMN BOTH,535.18
,,,
,,CTA ABD/PELVIS,617.34
,,,
,,CT ABD & PELVIS W/O CONTR,657.47
,,,
,,CT ABDOMEN & PELVIS W/CON,687.61
,,,
,,CT ABD & PELVIS 1+ SECTIO,761.41
,,MRI-ADDOMEN W/O CONTRAST,557.23
,,,
,,MRI-ABDOMEN W & W/O CONTR,864.7
,,,
,,MRA-RENAL ARTERY,689.5
,,,
,,"FLOUROSCOPU, ESOPHAG",175.69
,,,
,,"FLUORO, SWALLOWING/",203.02
,,,
,,"FLUORO, UGI WITHOUT KUB",264.7
,,,
,,"FLUORO, UGI W/KUB OR DELA",262.26
,,,
,,"FLUOROSCOPY, UGI/SB",348.51
,,,
,,"FLURO, DBL CONT UGI",264.7
,,,
,,DBL CONT. UGI/SB-FLUO,348.51
,,,
,,SMALL BOWEL FOLLOW THRU,178.54
,,,
,,"FLOUROSCOPY, BARIUM",264.7
,,,
,,"FLOURO,AIR CON BARIUM",378.68
,,,
,,XRAY OF BILE DUCT/ PANCREAS,139.14
,,,
,,CHOLE ADDITIONAL SET,83.29
,,,
,,"UROGRAM, ROUTINE EXAM",186.66
,,,
,,"UROGRAM, ROUT +TOMO'S",186.66
,,,
,,"UROGRAM, RETROGRADE",139.74
,,,
,,CYSTOGRAM +,120.87
,,,
,,VOIDING CYSTOGRAM,126.13
,,,
,,HYSTEROSALPINGPGRAM,145.45
,,,
,,CT ANGIO ABDOMINAL ARTERI,924.29
,,,
,,VENOGTAM-EXT UNI-RT,270.51
,,,
,,FLUOROGUIDE FOR VEIN DEVI,147.12
,,,
,,"FLUOROSCOPY,SEP.PROC.<1HR",64.52
,,,
,,FLUOROSCOPE EXAM EXTENSIVE,255.8
,,,
,,BONE AGE STUDY,72.75
,,,
,,BONE LENGTH STUDY,110.89
,,,
,,"X-RAYS, BONE SURVEY, LIMI",172.83
,,,
,,"BONE SURVEY, COMPLETE",205.86
,,,
,,BONE DENSITY STUDY,86.35
,,,
,,MAMMO UNILATERAL SCREEN,267.97
,,,
,,MAMMO SCREEN,267.97
,,,
,,"BREAST, SPECIMEN",61.68
,,,
,,VENOUS DUPLEX UNI LEFT,171.57
,,CT MULTIPLANNAR/3D RECONS,79.32
,,,
,,CT LIMITED OR LOCALIIZED,373.4
,,,
,,THYROID TISSUE,213.64
,,,
,,"BREAST, BILATERAL",205.86
,,,
,,"BREAST, UNILATERAL LEFT",205.86
,,,
,,"BREAST, UNILATERAL RIGHT",205.86
,,,
,,"UPPER ABD, COMPLETE",307.59
,,,
,,ORGAN SPECIFIC ABD,224.24
,,,
,,RETROPERIT/AORTA,281.46
,,,
,,"RETROPERITONEAL, LTD",224.09
,,,
,,OB FIRST TRIMESTER,379.63
,,,
,,"US- OB. COMPLETE, >/= 14 WKS",378.31
,,,
,,US- OB. LIMITED,245.71
,,,
,,US-OB. FOLLOWUP,330.26
,,,
,,BIOPHYSICAL PROFILE,413.38
,,,
,,TRANS-VAGINAL ULTRASOUND,264.06
,,,
,,PELVIS COMPLETE,264.06
,,,
,,PELVIS LTD. OR F/U,149.66
,,,
,,"TESTICLES, ULTRASOUND",245.53
,,,
,,TRANSRECTAL,263.56
,,,
,,US EXAM OF EXTREMITY-LT,234.26
,,,
,,US EXAM OF EXTREMITY-RT,234.26
,,,
,,NEEDLE BIOPSY W/S GUIDED+,256.56
,,,
,,"PREOP NEEDLE PLMNT, BRST",214.08
,,,
,,"PREOP NDL PLMNT, BRST ADD",214.08
,,,
,,NEEDLE LOC(LEASON SPEC)LT,214.08
,,,
,,NEEDLE LOC(LEASON SPEC)RT,214.08
,,,
,,"DXA BONE DENSITY, VERT FX",50.56
,,,
,,MRI -LOWER JTS W/WO BILAT,"1,647.18"
,,,
,,MRI-LOWER JOINTS LT W/WO,823.58
,,,
,,MRI-LOWER JTS W/WO CONT,823.58
,,,
,,MRI-LOWER EXT BIL-W/WO C,"1,647.18"
,,,
,,MRI LOWER EXT LT W/WO CON,823.58
,,,
,,MRI-LOWER EXT RT W/WO CON,823.58
,,,
,,MRI-LOWER EXT BIL W/WO CO,"1,647.18"
,,CT LOWER EXTREM W/ LEFT,444.33
,,,
,,CT LOWER EXT W/ CONTRAST,444.33
,,,
,,THYR W/UPTAKE (SINGLE)__,186.66
,,,
,,THYR W/UPTAKE (MULTI),189.8
,,,
,,TECH. THYROID,144.86
,,,
,,THYROID IMAGING ONLY,172.83
,,,
,,PARATHYROID IMAGING,310.58
,,,
,,LIVER IMAGING WITH FLOW,185
,,,
,,LIVER/SPLEEN SCAN W/FLOW,213.79
,,,
,,HEPATOBILIARY SYS W/O CCK,328.9
,,,
,,HEPATOBIL SYS IMAGE W/CCK,276.97
,,,
,,GASTRIC MUCOSA IMAGING,264.7
,,,
,,GASTRIC EMPTYING OF STOMA,303.95
,,,
,,GI BLEED,375.57
,,,
,,MECKELS DIVERT EXAM,259.99
,,,
,,BONE IMAGING;LIMITED AREA,237.36
,,,
,,"BONE IMAGING, MULT AREAS",313.28
,,,
,,BONE IMAGING;WHOLE BODY,326.52
,,,
,,BONE IMAGING;3 PHASE,386.27
,,,
,,PF BONE IMAG SPECT,390.53
,,,
,,THALLIUM STRESS REST,495.81
,,,
,,SPECT STRESS/REDIST,609.65
,,,
,,RESTING MUGA,371.21
,,,
,,MYOCARDIAL PERFUSION STUD,609.65
,,,
,,MYOCARD PERFS ST W/EJECTI,609.65
,,,
,,LUNG VENTILATION IMAGING,179.26
,,,
,,PERFUSION LUNG SCAN,280.1
,,,
,,LUNG VENTILAT&PERFUS IMAG,396.5
,,,
,,PET/CT BRAIN IMAGING-INIT,563.4
,,,
,,PET/CT BRAIN IMAGING-SUBS,563.4
,,,
,,RENAL STATIC IMAGES W FUN,361.22
,,,
,,GALLIUM STUDY,299.97
,,,
,,PET/CT SKULL-THIGH-SUBS,935.92
,,,
,,PET/CT SKULL-THIGH-INIT,935.92
,,,
,,PET/CT WHOLE BODY-INITIAL,945.4
,,PET/CT WHOLE BODY-SUBS,945.4
,,,
,,EYE FOR FOREIGN BODY,166.69
,,,
,,"MANDIBLE, PARTIAL",207.31
,,,
,,"MANDIBLE, COMPLETE",223.65
,,,
,,"MASTOIDS, > 3 VIEWS",220.93
,,,
,,"MASTOIDS, COMPLETE",329.29
,,,
,,"FACIAL BONES, LTD",166.91
,,,
,,"FACIAL BONES, COMPLETE",243.25
,,,
,,"NASAL BONES, COMPLETE",201.98
,,,
,,ORBITS,246.4
,,,
,,"SINUSES, LIMITED",182.91
,,,
,,"SINUSES, COMPLETE",220.93
,,,
,,"SKULL, LIMITED",204.7
,,,
,,"SKULL, COMPLETE",249.54
,,,
,,"TEMP.MADIB.JTS, LTD UNIL",180.31
,,,
,,"TEMP.MADIB.JTS, LTS UNIL",180.31
,,,
,,TEMP.MANDIB.JTS. COMPLETE,296.97
,,,
,,"NECK, SOFT TISSUES",153.2
,,,
,,"RIBS, UNILATERAL(2VIEWS)L",176.42
,,,
,,"RIBS, UNILATER(2VIEWS)RT",176.42
,,,
,,"CHEST, SINGLE VIEW",122.43
,,,
,,"SUBSEQUENT CHEST, SINGLE",122.43
,,,
,,"SUBSEQUENT CHEST, 2 VIEWS",166.91
,,,
,,"CHEST, TWO VIEWS",166.91
,,,
,,"CHEST, 2 VIEWS +LORDO",201.85
,,,
,,"CHEST, 2 VIEWS + OBLIQ",261.56
,,,
,,"CHEST, 2 VIEWS + FLOUR",402.25
,,,
,,"WRIST, PARTIAL BILATERAL",371.27
,,,
,,"WRIST, PARTIAL LFT",185.63
,,,
,,"WRIST, PARTIAL RIGHT",185.63
,,,
,,"RIBS, BILATERAL, PA CXR",429.21
,,,
,,"RIBS, UNI(3 VIEWS)PA LFT",214.6
,,,
,,RIBS UNI(3VIEWS)P/A RT,214.6
,,,
,,"RIBS, BILATERAL, 3 VIEWS",224.11
,,,
,,"RIBS, BIL(4 VIEWS)INCL PA",305.32
,,STERNUM,182.8
,,,
,,STERNOCLAVICULAR JTS,217.73
,,,
,,"SPINE, SINGLE VIEW",131.96
,,,
,,C SPINE (AP/LAT),228.97
,,,
,,C SPINE (4 VIEWS),307.62
,,,
,,C SPINE COMPLETE W/EXT &,407.92
,,,
,,"THORACIC SPINE,LTD 2 VIEW",185.95
,,,
,,"THORACIC SPINE,W/SWIMMER",220.98
,,,
,,"SPINE, THORA JUNCTION",204.7
,,,
,,SPINE-SCOLOSIS STUDY,291.39
,,,
,,"LUMBAR SPINE, LTD",207.2
,,,
,,"LUMBAR SPINE, COMP INCLUD",283.05
,,,
,,LS SPINE COMP W BENDING V,396.81
,,,
,,SPINE LUMBOSACRAL ONLY BEND 2-3 VIEWS,100
,,,
,,"PELVIS, AP",144.62
,,,
,,"SACROILIAC JTS, PART",174.86
,,,
,,"SACROILIAC JTS, COMP",205.08
,,,
,,SACRUM/COCCYX,170.13
,,,
,,CERVICAL MYELOGRAM +,757.11
,,,
,,THORAIS MYELOGRAM +,702.89
,,,
,,LUMBAR MYELOGRAM +,746.19
,,,
,,INJECTION FOR MYELOGRAM,"1,015.61"
,,,
,,"CLAVICLE, BILATERAL",337.34
,,,
,,"CLAVICLE, LEFT",169.4
,,,
,,"CLAVICLE, RIGHT",169.4
,,,
,,"SCAPULA, BILATERAL",360.63
,,,
,,SCAPULA LEFT,180.31
,,,
,,"SCAPULA, RIGHT",180.31
,,,
,,"SHOULDER, PARTIAL BILATER",268.49
,,,
,,"SHOULDER, PARTIAL LEFT",131.96
,,,
,,"SHOULDER, PARTIAL RIGHT",131.96
,,,
,,"SHOULDER, COMPLETE BILATR",342.95
,,,
,,"SHOULDER, COMPLETE LEFT",172.14
,,,
,,"SHOULDER, COMPLETE RIGHT",172.14
,,,
,,INJECT FOR SHOULDER X-RAY,412.03
,,SHOULDER ARTHROGRAM BILAT,"1,324.65"
,,,
,,SHOULDER ARTHROGRAM+,662.32
,,,
,,SHOULDER ARTHROGRAM +,662.32
,,,
,,XAY EXAM OF SHOULDERS,237.16
,,,
,,"HUMERUS, BILATERAL",338.83
,,,
,,"HUMERUS, LEFT",169.32
,,,
,,"HUMERUS, RIGHT",169.32
,,,
,,"ELBOW, PARTIAL BILATERAL",337.33
,,,
,,"ELBOW, PARTIAL LEFT",169.4
,,,
,,"ELBOW, PARTIAL RIGHT",169.4
,,,
,,"ELBOW, COMPLETE BILATERAL",414.37
,,,
,,"ELBOW, COMPLETE LEFT",207.2
,,,
,,"ELBOW, COMPLETE RIGHT",207.2
,,,
,,"FOREARM, BILATERAL",321.03
,,,
,,FOREARM LEFT,160.53
,,,
,,FOREARM RIGHT,160.53
,,,
,,"WRIST, COMPLETE BILATERAL",468.86
,,,
,,"WRIST, COMPLETE LEFT",234.43
,,,
,,"WRIST, COMPLETE RIGHT",234.43
,,,
,,"HAND, PARTIAL BILATERAL",322.47
,,,
,,"HAND, PARTIAL LEFT",161.25
,,,
,,"HAND, PARTIAL RIGHT",161.25
,,,
,,"HAND, RIGHT & LEFT",387.59
,,,
,,"HAND, COMPLETE LEFT",193.83
,,,
,,"HAND, COMPLETE RIGHT",193.83
,,,
,,FINGER-LEFT THUMB,212.77
,,,
,,FINGER-LEFT 2,212.77
,,,
,,FINGER-LEFT 3,212.77
,,,
,,FINGER-LEFT 4,212.77
,,,
,,FINGER-LEFT 5,212.77
,,,
,,FINGER-RIGHT THUMB,212.77
,,,
,,FINGER-RIGHT 2,212.77
,,,
,,FINGER-RIGHT 3,212.77
,,,
,,FINGER-RIGHT 4,212.77
,,,
,,FINGER-RIGHT 5,212.77
,,HIP XRAY BILATERAL,295.49
,,,
,,"HIP, SINGLE VIEW LEFT",147.74
,,,
,,"HIP, SINGLE VIEW RIGHT",147.74
,,,
,,"HIP, COMPLETE LEFT 2-3 VIEWS",228.97
,,,
,,"HIP, COMPLETE RIGHT 2-3 VIEWS",228.97
,,,
,,XRAY EXAM HIPS BI 2 VIEWS,130
,,,
,,XRAY EXAM HIPS BI 3-4 VIEWS,160
,,,
,,KNEE (MIN 3 VIEW) LEFT AND RIGHT,447.32
,,,
,,KNEE (MIN. 3 VIEWS) LEFT,223.65
,,,
,,KNEE (MIN. 3 VIEWS) RIGHT,223.65
,,,
,,KNEE (4 OR MORE VIEW) LEFT & RIGHT,517.65
,,,
,,KNEE (4 OR MORE VIEW) LFT,258.84
,,,
,,KNEE (4 OR MORE VIEW)RT,258.84
,,,
,,"FEMUR, BILATERAL",316.86
,,,
,,"FEMUR, LEFT",158.42
,,,
,,"FEMUR, RIGHT",160.53
,,,
,,XRAY EXAM OF KNEES,210.03
,,,
,,KNEE 1 OR 2 VWS BILATERAL,354.98
,,,
,,KNEE 1 OR 2 VIEWS LEFT,177.59
,,,
,,KNEE 1 OR 2 VIEWS RIGHT,177.59
,,,
,,"LOWER EXTREM., PEDS BILAT",393.06
,,,
,,"LOWER EXTREM., PEDS LEFT",196.55
,,,
,,"LOWER EXTREM., PEDS RIGHT",196.55
,,,
,,"ANKLE, PARTIAL BILATERAL",338.83
,,,
,,"ANKLE, PARTIAL LEFT",169.4
,,,
,,"ANKLE, PARTIAL RIGHT",169.4
,,,
,,"ANKLE, COMPLETE BILATERAL",403.98
,,,
,,"ANKLE, COMPLETE LEFT",201.98
,,,
,,"ANKLE, COMPLETE RIGHT",201.98
,,,
,,"FOOT, PARTIAL BILATERAL",320.61
,,,
,,"FOOT, PARTIAL LEFT",161.25
,,,
,,"FOOT, PARTIAL RIGHT",161.25
,,,
,,"FOOT, COMPLETE BILATERAL",382.17
,,,
,,"FOOT, COMPLETE LEFT",191.08
,,,
,,"FOOT, COMPLETE RIGHT",191.08
,,"CALCANEUS, BILATERAL",333.39
,,,
,,"CALCANEUS, LEFT",166.59
,,,
,,"CALCANEUS, RIGHT",166.69
,,,
,,TOE-LEFT 1,191.08
,,,
,,TOE-LEFT 2,191.08
,,,
,,TOE-LEFT 3,191.08
,,,
,,TOE-LEFT 4,191.08
,,,
,,TOE-LEFT 5,191.08
,,,
,,TOE-RIGHT 1,191.08
,,,
,,TOE-RIGHT 2,191.08
,,,
,,TOE-RIGHT 3,191.08
,,,
,,TOE-RIGHT 4,191.08
,,,
,,TOE-RIGHT 5,191.08
,,,
,,TIBIA/FIBULA BILATERAL,311.81
,,,
,,TIBIA/FIBULA LEFT,154.23
,,,
,,TIBIA/FIBULA RIGHT,154.23
,,,
,,"UPPER EXT., PEDS BILATERL",327.75
,,,
,,"UPPER EXT., PED LEFT",163.88
,,,
,,"UPPER EXT., PEDS RIGHT",163.88
,,,
,,"ABDOMEN, SINGLE VIEW",128.72
,,,
,,,128.72
,,,
,,"SUBSEQUENT ABDOMEN, SINGL",128.72
,,,
,,ABDOMEN 2 VIEWS,221.67
,,,
,,XRAY EXAM SERIES ABDOMEN,265.43
,,,
,,"FLOUROSCOPY, ESOPHAGUS",323.59
,,,
,,"FLUORO, SWALLOWING/",313.83
,,,
,,"FLUORO, UPPER GI WITHOUT KUB",382.24
,,,
,,"FLUORO, UPPER GI W/KUB",408.42
,,,
,,"FLUOROSCOPY, UGI/SB",635.07
,,,
,,FLURO UPPER GI TRACT,450.05
,,,
,,"FLURO,UPPER GI TRACTI W/KUB",517.81
,,,
,,DBL CONT.UGI/SB-FLUO,705.38
,,,
,,SMALL BOWEL FOLLOW THRU,695.11
,,,
,,"FLOUROSCOPY, BARIUM",544.62
,,,
,,"FLOURO,AIR CON BARIUM",798.37
,,O.C.G. (GALLBLADDER),440.37
,,,
,,"CHOLANGIOGRAM, OPERA,",276.78
,,,
,,"UROGRAM, ROUTINE EXAM",720.87
,,,
,,"UROGRAM, ROUT +TOMO'S",921.7
,,,
,,"UROGRAM, RETROGRADE",906.13
,,,
,,CYSTOGRAM +,285.77
,,,
,,INJECTION CYCTOGRAM/VCU,360.67
,,,
,,XRAY URETHRA/ BLADDER,589.14
,,,
,,PELVIMETRY,174.77
,,,
,,HYSTEROSALPINGOGRAPHY +,497.81
,,,
,,INJECTION FOR HYSTEROSALP,469.08
,,,
,,"VENOGRAM, EXT BIALTERAL++",846.95
,,,
,,INJ. PROC. VENOGRAM,394.95
,,,
,,"VENOGRAM, EXT UNI LEFT",749.36
,,,
,,"VENOGRAM, EXT UNI RIGHT",749.36
,,,
,,FLUOROGUIDE FOR VEIN DEVICE,465.81
,,,
,,"FLUOROSCOPY,SEP.PROC.<1HR",91.5
,,,
,,FLUOROSCOPE,0
,,,
,,NEEDLE LOCALIZATION BY XRAY,200
,,,
,,BONE AGE STUDY,112.83
,,,
,,BONE LENGTH STUDY,195.55
,,,
,,"BONE SURVEY, LIMITED",386.25
,,,
,,"BONE SURVEY, COMPLETE",629.11
,,,
,,JOINT SURVEY,204.59
,,,
,,"TOMOGRAPHY, PER PLANE",659.94
,,,
,,CT PROCEDURE,48.99
,,,
,,FILM PREP CHARGE-PER FILM,5.64
,,,
,,FLURO GUIDANCE NEEDLE PLACE ADD ON,156
,,,
,,INJECT SACROILIAC JOINT,250.41
,,,
,,"PERC ABSCESS DRAIN, ABD","6,564.29"
,,,
,,CONTRAST INJ PERQ RADIOLOGIC EVAL GI TUB,80
,,,
,,CHEST VIEW -PORT PLACE,0
,,,
,,ULTRASOUND EXAM AAA SCREE,865.81
,,,
,,ASPIRATE PLEURA W/O IMAGE,"1,043.88"
,,,
,,ASPIRATE PLEURA W/IMAGING,"1,301.30"
,,"DUPLEX A, IVC, IL/BPG; UN",245.79
,,,
,,THYROID TISSUE,320.69
,,,
,,US EXAM CHEST,250
,,,
,,"US BREAST, BILATERAL",310.39
,,,
,,"BREAST, UNILATERAL LEFT",310.39
,,,
,,"BREAST, UNILATERAL RIGHT",310.39
,,,
,,"US ABDOMEN, COMPLETE",461.68
,,,
,,ORGAN SPECIFIC ABD,333.33
,,,
,,US ABDOMINAL AORTA SCREENING,865
,,,
,,US EXAM ABDOM BACK WALL,421
,,,
,,"RETROPERITONEAL, LTD",329.11
,,,
,,US RENAL TRANSPLANT W/ DOPPLER,300
,,,
,,OB FIRST TRIMESTER,888.86
,,,
,,OBSTET. COMPLETE,573.15
,,,
,,"OBSTETICAL U/S, MULTIGEST",565.22
,,,
,,OBSTET. LIMITED,369.66
,,,
,,OBSTET. FOLLOW UP,495.4
,,,
,,BIOPHYSICAL PROFILE,613.46
,,,
,,TRANS-VAGINAL ULTRASOUND,397.94
,,,
,,US PELVIS COMPLETE,390.49
,,,
,,PELVIS LTD. OR F/U,218.49
,,,
,,"TESTICLES, ULTRASOUND",363.83
,,,
,,US TRANSRECTAL,388.63
,,,
,,US EXAM OF JOINT-LT,363.33
,,,
,,US EXAM OF JOINT-RT,363.33
,,,
,,SUBS BREAST CYST ASP LT,234.25
,,,
,,SUBS BREAST CYST ASP RT,234.25
,,,
,,ABD PARACENTESIS,836.16
,,,
,,NEEDLE BIOPSY U/S GUIDED+,333.35
,,,
,,NEEDLE BIOPSY PROSTRATE,"1,848.81"
,,,
,,US GUIDANCE AMNIOCENTESIS,222.09
,,,
,,NEEDLE BIOPSY BREAST LT,772.92
,,,
,,NEEDLE BIOPSY BREAST RT,772.92
,,,
,,NEEDLE BIOP OF THYROID LT,905.99
,,,
,,NEEDLE BIOP OF THYROID RT,905.99
,,ULTRASOUND GUIDANCE,410
,,,
,,INIT BREAST CYST ASPR. LT,491.56
,,,
,,INIT BREST CYCST ASPR. RT,491.56
,,,
,,US GUIDE VASCULAR ACCESS,91.27
,,,
,,US BREAST IMAGING FOR BIOPSY,0
,,,
,,LOW DOSE CT SCAN,565
,,,
,,CT-BRAIN W/O CONTRAST,926.89
,,,
,,"CT BRAIN, W/CONTRAST","1,211.28"
,,,
,,"CT HEAD, W&W/O CONTRAST","1,176.40"
,,,
,,"CT ORBIT,SELLA,POST.FOSSA","1,271.14"
,,,
,,"CT ORBIT,SELLA,POST.FOSSA","1,899.84"
,,,
,,"CT ORBIT, SELLA, POST FOS","2,134.37"
,,,
,,CT SINUS W/O CONTRAST,"1,271.14"
,,,
,,CT MAX FACIAL W/O CONTRST,"1,271.14"
,,,
,,CT MAX FACIAL(SINUS) W,"1,583.04"
,,,
,,CT NECK TISSUES W/O,"1,198.79"
,,,
,,CT NECK TISSUE WITH,"1,503.18"
,,,
,,CT NECK TISSUE BOTH,"1,867.43"
,,,
,,CT ANGIOGRAPHY HEAD,"2,486.14"
,,,
,,CT ANGIOGRAPHY NECK,"2,486.14"
,,,
,,CT CHEST W/O,"1,201.28"
,,,
,,"CT CHEST, W","1,510.63"
,,,
,,CT CHEST BOTH,"1,879.92"
,,,
,,"CT ANGIOGRAPHY, CHEST","2,324.01"
,,,
,,CT SPINE CERV W/O,970.8
,,,
,,CT SPINE CERV WITH,"1,518.15"
,,,
,,"CT CERSPINE, BOTH","1,884.87"
,,,
,,CT SPINE THOR W/O,"1,211.28"
,,,
,,CT SPINE THOR WITH,"1,525.67"
,,,
,,"CT THOR SPINE, BOTH","1,897.36"
,,,
,,CT SPINE LUMBAR W/O,"1,206.33"
,,,
,,CT SPINE LUMBAR WITH,"1,520.63"
,,,
,,"CT LUMBAR SPINE, BOTH","1,887.36"
,,,
,,CT PELVIS W/O CONT,909.38
,,,
,,CT PELVIS W/CONT,"1,625.46"
,,CT PELVIS BOTH,"1,852.47"
,,,
,,CT UPPER EXTREM W/O BILTL,"2,392.63"
,,,
,,"CT UPPER EXTREM, W/O LEFT","1,196.31"
,,,
,,"CT UPPER EXTREM, W/O RT","1,196.31"
,,,
,,"CT UPPER EXTREM, W/ BILAT","2,991.33"
,,,
,,"CT UPPER EXTREM, W LEFT","1,495.66"
,,,
,,"CT UPPER EXTREM, W RT","1,495.66"
,,,
,,"CT LOWER EXTREM, W/O BILT","2,402.55"
,,,
,,"CT LOWER EXTREM, W/O LT","1,201.28"
,,,
,,"CT LOWER EXTREM, W/O RT","1,201.28"
,,,
,,CT LOWER EXTREM W/ BILAT,"3,046.23"
,,,
,,CT LOWER EXTREM W/ LEFT,"1,523.11"
,,,
,,CT LOWER EXTREM W/ RIGHT,"1,523.11"
,,,
,,CT LOWER EXTREM W&WO BILT,"3,984.36"
,,,
,,CT LOWER EXTREM W&WO LEFT,"1,992.18"
,,,
,,CT LOWER EXTREM W&WO RGHT,"1,992.18"
,,,
,,CT UPPER ABDOMEN W/O,896.97
,,,
,,CT UPPER ABDMN WITH,"1,620.41"
,,,
,,CT UPPER ABDMN BOTH,"1,889.91"
,,,
,,CTA ABD/PELVIS,"2,327.75"
,,,
,,CT ANGIO ABDOMENT W/CONTRAST/NONCONTRAST,815
,,,
,,,
,,CT ABD & PELVIS W/O CONTR,"1,086.53"
,,,
,,CT ABDOMEN & PELVIS W/CON,"1,919.85"
,,,
,,CT ABD & PELVIS 1+ SECTIO,"2,289.05"
,,,
,,CT ANGIO ABDOMINAL ARTERI,"2,483.73"
,,,
,,CT GUIDED NEEDLE BIOPSY+,540.16
,,,
,,LUNG/MEDIASTINUM BIOPSY,795.45
,,,
,,LIVER BIOPSY,797.12
,,,
,,BONE BIOPSY-DEEP,839.85
,,,
,,BONE BIOSPY-SUPERFICIAL,555.96
,,,
,,CT MULTIPLANNAR/3D RECON,370.53
,,,
,,CT LIMITED OR LOCALIZED F,724.77
,,,
,,OPTIRAY 300,70.65
,,,
,,SINCALIDE INJECTION 5MCG,0
,,THYROID UPTAKE MEASUREMEN,325.06
,,,
,,THYROID IMAGING W/BLOOD F,798.73
,,,
,,THYROID IMAGING W/BLOOD F,"1,006.09"
,,,
,,PARATHYROID IMAGING,"1,214.10"
,,,
,,LIVER IMAGING WITH FLOW,822.01
,,,
,,LIVER SPECT,919
,,,
,,LIVER/SPLEEN,790.04
,,,
,,LIVER/SPLEEN SCAN W/FLOW,453.94
,,,
,,HEPATOBILIARY SYS W/O CCK,"1,370.96"
,,,
,,HEPATOBIL SYS IMAGE W/CCK,"1,667.90"
,,,
,,GI TRACT SCAN,"1,014.09"
,,,
,,GASTRIC EMPTYING STOMACH,"1,162.90"
,,,
,,GI BLEED,"1,395.85"
,,,
,,MECKELS DIVERT EXAM,"1,389.45"
,,,
,,BONE IMAGING;LIMITED AREA,693.13
,,,
,,BONE IMAGING;MULITPLE ARE,882.85
,,,
,,BONE IMAGING;WHOLE BODY,975.67
,,,
,,BONE IMAG;VASCLR FLO ONLY,724.4
,,,
,,BONE IMAGING;3 PHASE,"1,381.46"
,,,
,,3 PHASE EXTENDED EXAM,"1,381.46"
,,,
,,BONE IMAGING;SPECT,826.85
,,,
,,"HT MUSCLE IMAGE SPECT, MU","1,832.00"
,,,
,,RESTING MUGA,847.64
,,,
,,LUNG VENTILATION IMAGING,749.13
,,,
,,PERFUSION LUNG SCAN ONLY,941.2
,,,
,,LUNG VENTILAT&PERFUS IMAG,"1,313.36"
,,,
,,BRAIN IMAGING SPECT,"1,365.42"
,,,
,,RENAL STATIC IMAGES,"1,144.00"
,,,
,,RENAL STATIC IMAGES W/VAS,866.82
,,,
,,RENAL STATIC IMAGES W FUN,"1,285.00"
,,,
,,RENAL STAT FUN W/DRUG,"1,285.00"
,,,
,,RENAL STATIC IMAGES;SPECT,"1,180.00"
,,,
,,TESTICULAR IMAGING,812.42
,,,
,,GALLIUM STUDY,"1,025.27"
,,,
,,123-I CAPSULE,369.59
,,MEBROPHENIN,298.6
,,,
,,99MTC-RC-MUGA,639.8
,,,
,,TC 99M (THYROID SCAN ONLY,193.13
,,,
,,"99M-TC SUL COL (LIVER,SPL",440.33
,,,
,,99M-TC MAA,262.65
,,,
,,TC MAG 3 (RENAL IMAGING),386.25
,,,
,,TECHNESIUM,235.37
,,,
,,99M-TC CHOLE TEC (HEPATO,247.2
,,,
,,TECHNESIUM W. COLD VL PYP,306.2
,,,
,,99M-TC DTPA,386.25
,,,
,,KENOVAC,153.7
,,,
,,131-I CAPSULE,369.59
,,,
,,"ISOTOPES, 99M-TC (BONE)",169.95
,,,
,,"TC 99M SULFUR COLLOID, VL",440.33
,,,
,,133-XE GS,345.54
,,,
,,CARDIO LITE (FOR 4438464),864.57
,,,
,,"CARDIO LITE(FOR 8465,8461",602.55
,,,
,,CARDIO LITE(PARATHY IMAG),864.57
,,,
,,"ISOTOPES, 201-THALLIUM",622.52
,,,
,,TC-99M NATCOY (ISOTOPE),208.18
,,,
,,TC 99M W/RBC,298.49
,,,
,,ADD/REPEAT VIEW,0
,,,
,,DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS+,50
,,,
,,,
,,"BREAST, SPECIMEN",34.59
,,,
,,"PREOP NEEDLE PLMNT, BRST",511.87
,,,
,,"PREOP NEEDLE PLMNT, BRST",511.87
,,,
,,"PREOP NEEDLE PLMNT, BRST",355.3
,,,
,,NEEDLE LOC(LEASON SPEC)RT,511.87
,,,
,,BREAST TOMOSYNTHESIS BI,50
,,,
,,DIAGNOSTIC MAMMO UNILATERAL,335
,,,
,,DIAGNOSTIC MAMMO BILATERAL,425
,,,
,,SCREENING MAMMO BILATERAL,355
,,,
,,MRI TEMPOROMANDIBULAR JOINT,785
,,,
,,"MRI-FACE,NECK OR ORBTS-WO","3,083.75"
,,MRI-FACE NECK OR ORBTS W,"3,533.35"
,,,
,,"MRI-FACE,NECK,ORBTS W/WO","4,274.38"
,,,
,,MR-ANGIOGRAPHY HEAD W/O,"3,083.75"
,,,
,,MRI ANGIO HEAD W/CONTRAST,"3,654.30"
,,,
,,MRI ANGIO NECK W/O CONTRAST,"3,083.75"
,,,
,,MRI ANGIO NECK WITH CONTRAST,"3,970.56"
,,,
,,MRI ANGIO-NECK W & W/O CONTRAST,"5,006.14"
,,,
,,MRI-BRAIN W/O CONTRAST,"3,083.75"
,,,
,,MRI-BRAIN W,"3,660.46"
,,,
,,MRI-BRAIN W/WO W/ADD SEQU,"4,172.04"
,,,
,,MRI-CHEST WO CONTRAST,"3,083.75"
,,,
,,MRI-CHEST W,"4,075.97"
,,,
,,MRI-CHEST W/WO CONTRAST,"5,006.14"
,,,
,,MRI ANGIO CHEST W OR W/O DYE,"3,496.17"
,,,
,,MRI-CERVICAL SPINE W/O,"2,820.20"
,,,
,,MRI-CERVICAL SPINE W,"3,688.42"
,,,
,,MRI-DORSAL SPINE W/O,"2,826.36"
,,,
,,MRI-DORSAL SPINE W,"3,161.21"
,,,
,,MRI-LUMBAR SPINE W/O,"2,823.29"
,,,
,,MRI-LUMBAR W,"3,598.40"
,,,
,,MRI-CERIVAL SPINE W/WO,"4,079.06"
,,,
,,MRI-THORACIC SPINE W/WO,"3,710.08"
,,,
,,MRI-LUMBAR SPINE W/WO,"4,054.29"
,,,
,,MRI PELVIS W/O CONTRAST,"3,083.75"
,,,
,,MRI-PELVIS W,"3,610.83"
,,,
,,MRI PELVIS W & W/O DYE,"4,348.86"
,,,
,,MRI ANGIO PELVIS W/O DYE,"3,539.52"
,,,
,,MRI UPPER JT W/ BOTH,"6,632.51"
,,,
,,MRI UPPER JT W/ LEFT,"3,316.25"
,,,
,,MRI UPPER JT W/ RIGHT,"3,316.25"
,,,
,,MRI UPPER JOINT LT W &W/O,"4,048.02"
,,,
,,MRI UPPER JOINT RT W &W/O,"4,048.02"
,,,
,,MRI UPPER EXTREM W/O-RIGHT,"3,083.75"
,,,
,,MRI UPPER EXTEM W,"3,579.82"
,,,
,,MRI-UPPER JOINTS BIL W/O,"3,922.47"
,,MRI-UPPER JOINTS LFT W/O,"1,961.24"
,,,
,,MRI-UPPER JOINTS RT W/O,"1,961.24"
,,,
,,MRI-UPPER EXTREMITY BILAT W/WO,"8,703.88"
,,,
,,MRI-UPPER EXT LT-W/WO CONTR,"4,351.95"
,,,
,,MRI-UPPER EXT RT-W/WO CONTR,"4,351.95"
,,,
,,MRI-LOWER JOINTS BI W/O,"3,922.47"
,,,
,,MRI-LOWER JOINTS LT-WO CO,"1,961.24"
,,,
,,MRI-LOWER JOINTS RT-WO CO,"1,961.24"
,,,
,,MRI ANGIO-LOWER EXTREM W/WO CONTR,"3,558.13"
,,,
,,MRI-LOWER EXTREMITY BILAT,"6,167.48"
,,,
,,MRI-LOWER EXT LT-WO CONTR,"3,083.75"
,,,
,,MRI-LOWER EXT RT-WO CONTR,"3,083.75"
,,,
,,MRI-LOWER EXTR W CONTRAST,"7,302.22"
,,,
,,MRI-LOWER EXTR W CONTRAST,"3,651.12"
,,,
,,MRI-LOWER EXT W CONRAST,"3,651.12"
,,,
,,MRI-ABDOMEN WO CONTRAST,"2,844.95"
,,,
,,MRI-ABDOMEN W & W/O CONTR,"4,367.47"
,,,
,,MRI  ANGIO ABDOMEN,"3,536.44"
,,,
,,MRI-LOWER JOINTS BI W/WO,"8,089.88"
,,,
,,MRI-LOWER JTS W/WO CONTRA,"4,044.93"
,,,
,,MRI-LOWER JTS W/WO CONTRA,"4,044.93"
,,,
,,MRI UPPER EXTREM W/O-LEFT,"3,083.75"
,,,
,,MRI-LOWER EXT BIL-W/WO C,"8,778.28"
,,,
,,MRI-LOWER EXT LT W/WO CON,"4,389.15"
,,,
,,MRI-LOWER EXT RT W/WO CON,"4,389.15"
,,,
,,VENOUS DUPLEX-BIL-IN DEPT,"1,129.79"
,,,
,,VENOUS DUPLEX UNI LEFT,731.55
,,,
,,VENOUS DUPLEX UNI RIGHT,731.55
,,,
,,DOP ART.WAVE UPER&LWR,570.21
,,,
,,"CARDIAC M-MODE, DOPPLER C","1,219.69"
,,,
,,M-MODE & REAL TIME,631.02
,,,
,,"CARDIAC M-MODE, DOPPLER LIMITED",734.18
,,,
,,CARDIAC DOPPLER,267.14
,,,
,,ECHO DOPLER LIMITED,148.16
,,,
,,DOPPLER COLOR FLOW,166.61
,,STRESS ECHO,"1,259.40"
,,,
,,CAROTID DUPLEX SCAN; BILAT,"1,129.79"
,,,
,,LTD. EXTRACRANIAL,779.17
,,,
,,SEG. PRESS. UPR. BILATERA,865.28
,,,
,,DOP. ART. WAVE UPR.,570.21
,,,
,,SEG. PRESS. LWR. BILATERA,865.28
,,,
,,ANKLE/ARM INDEX BILATERAL,570.21
,,,
,,LWR. EXT. DUPLEX BILATERA,"1,128.30"
,,,
,,LTD LWR EXT DUPLEX BILAT,"1,926.18"
,,,
,,LTD LWR EXT DUPLEX LEFT,963.09
,,,
,,LTD LWR EXT DUPLEX RIGHT,963.09
,,,
,,UPR. EXT. DUPLEX BILATERA,"1,129.79"
,,,
,,LTD UPR EXT DUPLEX BILAT,"1,552.91"
,,,
,,LTD UPR EXT DUPLEX LEFT,776.46
,,,
,,LTD UPR EXT DUPLEX RIGHT,776.46
,,,
,,VENOUS DUPLEX-BIL STUDY,"1,129.79"
,,,
,,VASC DUPLEX SCAN OF AB VE,"1,128.30"
,,,
,,VASCULAR STUDY,921.97
,,,
,,DUPLEX OF AORTA,"1,129.79"
,,,
,,DUP-SCAN AORTA IVC ILIAC VAS UNI/LMTD,710.37
,,,
,,LTD VENOUS DUPLEX-UNI STU,731.55
,,,
,,LTD VENOUS DUPLEX-UNI STU,731.55
,,,
,,BONE DENSITY STUDY,367.53
,,,
,,DXA BONE DENSITY STUDY 1/> SITES,65
,,,
,,"DXA BONE DENSITY, VERT FX",181.46
,,,
,,DXA BONE DENSITY STUDY AXIAL SKELETON,102
,,,
,,F18FDG=<45MCI,369.67
,,,
,,PET/CT BRAIN IMAGING-INIT,"6,571.69"
,,,
,,PET/CT BRAIN IMAGING-SUBS,"6,571.69"
,,,
,,PET/CT SKULL-THIGH-SUBSEQ,"6,571.69"
,,,
,,PET/CT SKULL-THIGH-INITIA,"6,571.69"
,,,
,,PET/CT WHOLE BODY-INITIAL,"6,571.69"
,,,
,,PET/CT WHOLE BODY-SUBSEQ,"6,571.69"
,,,
,,OPIUM TINCTURE 10 MG / ML,18.3
,,,
,,MILNACIPRAN TAB  50 MG [N,17.95
,,ROPIVACAINE VIAL 0.5% - 5,63.4
,,,
,,CLOBETASOL CREAM 0.05% 30 GM,316.75
,,,
,,CONTRST ORAL UGI LOW DENS,25.05
,,,
,,CIPROFLOXICIN 250MG TAB,13.35
,,,
,,DOXORUBICIN LIPOSOMAL VIA,"1,422.85"
,,,
,,FOSPHENYTOIN VIAL 500 MG,65.1
,,,
,,CLOPIDOGREL TAB 75MG [*],3.75
,,,
,,LEVOFLOXACIN TAB 500MG [*,33.8
,,,
,,DIATRIZ- MEGL/ SOD 37% CO,55.75
,,,
,,TORSEMIDE TAB 10MG  [*],4.8
,,,
,,CO Q 10 CAP 100MG,4.4
,,,
,,MIRTAZAPINE  TAB 15MG  [*,5.4
,,,
,,RAMIPRIL CAP  2.5MG  [*],3.85
,,,
,,MINERAL OIL STERILE,9.25
,,,
,,MONTELUKAST  TAB 10MG  [*,13.45
,,,
,,NISOLDIPINE ER TAB  20MG,26.7
,,,
,,DILTIAZEM CD CAP 240MG,4.95
,,,
,,CYSTOGRAFIN 300 ML,63.09
,,,
,,IOPAMIDOL VIAL 61% 100ML,0
,,,
,,SORBITOL 70% 30ML SOLN,9.25
,,,
,,IOPAMIDOL VIAL 61% 150ML,293.8
,,,
,,"CONTRAST, RUO CYSTO",59.42
,,,
,,MAGNESIUM SULF,32.05
,,,
,,"INJ, FILGRASTIM G0CSF 1MCG",732.3
,,,
,,CICLOPRIOX 0.77% CREAM 15,12
,,,
,,CEFPODOXIME ORAL SUSP,12.05
,,,
,,HYDROXYZINE TAB 50 MG [NO,4.35
,,,
,,DARBEPOETIN 500MCG NOT DUE TO CHEMO,"8,370.70"
,,,
,,HETASTARCH 6% 500ML,48.95
,,,
,,MULTIQ 400MG TAB,27.2
,,,
,,BENDAMUSTINE 45MG VIAL,"1,402.05"
,,,
,,GEMCITABINE VIAL  200MG [,336.6
,,,
,,HEMORRHOID OINTMENT TUBE,21.25
,,,
,,SODIUM BICARBONATE TAB  6,3.6
,,,
,,INDIGO CARMINE AMP 8MG/ML,33.75
,,TICAGRELOR 90MG,17.4
,,,
,,AMIFOSTINE VIAL 500MG [NO,"1,107.10"
,,,
,,ROCURONIUM MDV 50 MG/ 5ML,18
,,,
,,NYSTATIN SUSPENSION BOTTL,34
,,,
,,MITOXANTRONE INJ 2MG/ML 1,63.3
,,,
,,MITOMYCIN 40MG VIAL,"2,559.65"
,,,
,,BYSTOLIC 10mg,14.35
,,,
,,MAGNESIUM SULF 1GM IN 100ML D5W,32.5
,,,
,,CEFAZOLIN VIAL 1GM [*],21.2
,,,
,,CEFTRIAXONE ADD-V VIAL 1G,48
,,,
,,KETOROLAC VIAL/PFS 30MG/M,27.3
,,,
,,ENOXAPARIN SYRINGE  40MG/,69.95
,,,
,,GLYCERIN SOLN,52.75
,,,
,,METHYLPREDNISOLONE VIAL 5,66.45
,,,
,,GRANISETRON 1MG VIAL,58.95
,,,
,,NITROGLYCERIN BOTTLE 50MG,58.25
,,,
,,GANCICLOVIR 500MG VIAL,226.6
,,,
,,ATROPINE SYRINGE 1 MG/10,38.4
,,,
,,NEFAZODONE 200MG TAB,12.5
,,,
,,CLONIDINE PATCH TTS-1,63.2
,,,
,,FOSINOPRIL TAB 10MG,5.65
,,,
,,NEOM/POLY/HC OPHTH SUSP B,315.5
,,,
,,NEOM/POLY/DEX OPHTH OINT,88.25
,,,
,,M-M-R II W/DILUENT SDV [*,120.03
,,,
,,DONEPIZIL TAB 10MG [*],4.9
,,,
,,VALSARTAN TAB 80MG  [*],20.5
,,,
,,ROFLUMILAST TAB 500 MCG,22.1
,,,
,,NEOM/POLY/DEX OPHTH SUSP,88.25
,,,
,,BUPROPRION-SR TAB 150MG,4.85
,,,
,,PSEUDOEPHEDRINE CAPLET SR,4.25
,,,
,,ISOSORBIDE DINITRATE TAB,5.45
,,,
,,FLUDROCORTISONE TAB 0.1 M,5.4
,,,
,,METHYLPHENIDATE HCL TAB 5,4.85
,,,
,,GABAPENTIN CAP 100MG [*],4.75
,,,
,,GABAPENTIN CAP 300MG [*],5.9
,,ISOSORBIDE DINITRATE  TAB,5.45
,,,
,,ISOSORBIDE MONONITRATE ER,6.55
,,,
,,TRANDOLAPRIL TAB 2MG,5.7
,,,
,,EYEVITAMIN TAB,3.7
,,,
,,ATRACURIUM VIAL 100MG/10ML,19.95
,,,
,,PRAVASTATIN TAB 20MG [NOT,9.4
,,,
,,IRBESARTAN TAB 75MG [NOT,9.65
,,,
,,METAXALONE TAB 800MG [*],12.3
,,,
,,ALENDRONATE TAB 70MG,40.35
,,,
,,MISC NONRX DRUG,26.15
,,,
,,DOCETAXEL VIAL 20MG/ML,"1,259.80"
,,,
,,MIDAZOLAM MDV 10 MG /10ML,8.4
,,,
,,NFD,3
,,,
,,LIDOCAINE TOPICAL AMP 4%,18.5
,,,
,,OFLOXACIN 0.3% OTIC SOLN,142.25
,,,
,,NFB,3
,,,
,,MISC IV DRUG,0
,,,
,,MISC-INCIDENT TO RADIOLOG,0
,,,
,,VENLAFAXINE XR CAP 37.5MG,9.65
,,,
,,NALOXONE  VIAL/PFS 0.4MG/,50.7
,,,
,,MUPIROCIN NASAL OINT 2%,46
,,,
,,POTASSIUM 10MEQ CAP,10.7
,,,
,,CLONAZEPAM TAB 1MG,5.05
,,,
,,KETOROLAC LS OPHTH SOLN 0,47.5
,,,
,,HEPARIN LOCK PFS 500 UNIT,17.8
,,,
,,SOLIFENACIN TAB 5 MG,31.3
,,,
,,HEPARIN LOCK PFS 300 UNIT,4.85
,,,
,,LEVOTHYROXINE TAB 175 MCG,5.1
,,,
,,POTASSIUM 20MEQ- 0.9% SOD,21.6
,,,
,,POTASSIUM 20MEQ- D5W-1/2,21.05
,,,
,,POTASSIUM 40MEQ- 0.9% SOD,35.05
,,,
,,ETOMIDATE VIAL 20 MG/ 10,36.5
,,,
,,SODIUM CHLORIDE ADD-V BAG,23.3
,,,
,,OMEGA-3-ACID ETHYL ESTERS,6.25
,,,
,,VANCOMYCIN ADDV VIAL 1GM,61.1
,,REGADENOSON IV PFS  0.4 M,541.3
,,,
,,CHLORHEXIDINE 4%  ANTISEP,15
,,,
,,ZOLPIDEM CR TAB 12.5 MG N,16.85
,,,
,,DEXTROSE 5% IN WATER EXCE,20.05
,,,
,,MODAFINIL TAB 200 MG,83.4
,,,
,,DEXTROSE 5% IN WATER EXCE,20.19
,,,
,,IOPAMIDOL VIAL 61%  50 ML,0
,,,
,,AMLODIPINE TAB 10MG,11.65
,,,
,,ZAFIRLUKAST 20MG TAB,7.4
,,,
,,ESOMEPRAZOLE CAP 20MG (NO,21.6
,,,
,,BUDESONIDE MDI 180 MCG,519.75
,,,
,,VECURONIUM  VIAL 20MG / 2,54.75
,,,
,,DULOXETINE CAP 30 MG,17.4
,,,
,,HYLAN  ONE  SYRINGE 48 MG,"2,969.90"
,,,
,,TRIAMCINOLONE ACET 0.1% O,34.25
,,,
,,CROMOLYN NASAL AEROSOL SO,9.25
,,,
,,SODIUM CHLORIDE MINIBAG PLUS 100ML,27.25
,,,
,,ZANAMIVIR 10 DOSE BOX  5,15.5
,,,
,,BUDESONIDE-FORMOMDI 80-4.,56.25
,,,
,,CYPROHEPTADINE TAB 4 MG [,5.45
,,,
,,BUDESONIDE-FORMO MDI 160-,533.5
,,,
,,NITROGLYCERIN PATCH 0.1MG,12.5
,,,
,,FINASTERIDE TAB 5MG,5.45
,,,
,,PRAVASTATIN TAB 40MG,12.1
,,,
,,ZOLPIDEM CR TAB  6.25 MG,16.85
,,,
,,DICLOFENAC GEL 1% 100GM,125.75
,,,
,,ACETAMINOPHEN IV VIAL 1000,118.85
,,,
,,CHLORPHEN-HYDROCOD ORAL S,5
,,,
,,VARICELLA ZOSTER VACCINE,493.45
,,,
,,LEVALBUTEROL AEROSOL MDI,156.5
,,,
,,ETONOG-ETHINYL ESTRA V,275.15
,,,
,,HYALGAN VIAL 20MG/2ML,297.3
,,,
,,CEFEPIME VIAL 2 GM,37.7
,,,
,,METHOCARBAMOL  TAB 750 MG,4.6
,,,
,,ESTRADIOL TD PAT BIWEEKLY,42
,,ETODOLAC TAB 400MG,6.55
,,,
,,BUTAL-ASA-CAFF CAP 50-325,6.6
,,,
,,CITALOPRAM TAB 20 MG (*),8.1
,,,
,,TESTOSTERONE CYP SDV 200,54.7
,,,
,,KETOCONAZOLE SHAMPOO 2% 4,9.5
,,,
,,EST ESTROGEN/METHYLTES TA,6.35
,,,
,,BEVACIZUMAB VL 100 MG/4ML,"1,737.90"
,,,
,,UREA CREAM 40% - 85 GM TU,132.25
,,,
,,ALVIMOPAN CAP 12 MG,185.25
,,,
,,BUTAL-APAP-CAFF TAB 50-32,6.55
,,,
,,ENALAPRILAT VIAL 1.25 MG,26
,,,
,,CELECOXIB CAP  50 MG [NOT,11.7
,,,
,,DICLOFENAC PATCH 1.3% [NO,20.25
,,,
,,RIFAMPIN CAP 300MG,5.95
,,,
,,SITAGLIPTIN TAB 100 MG,37.6
,,,
,,LEVETIRACETAM 500MG VIAL,32.4
,,,
,,LEVETIRACETAM TAB 250 MG,8.25
,,,
,,ER-ONDANSETRON 4MG ODT,143.8
,,,
,,BECLOMETHASONE INHALER 40,290.75
,,,
,,BECLOMETHASONE 80MCG INH,386.25
,,,
,,TRIAMCIN AQ  NASAL INHALE,24
,,,
,,CROMOLYN  AEROSOL MDI [NO,25.5
,,,
,,INFLIXIMAB VIAL 100MG,"2,188.65"
,,,
,,PALIPERIDONE 1MG ER SYRINGE,"6,071.10"
,,,
,,Paliperidone 156mg ER Syringe,"4,051.35"
,,,
,,Paliperidone 117 MG ER SYRINGE,"3,041.25"
,,,
,,PHENYLEPHRINE 1%  VIAL 10,24.25
,,,
,,SUMATRIPTAN STAT DOSE VIA,164.5
,,,
,,VITAMIN B-COMPLEX TAB [NO,3
,,,
,,VITAMIN B-12 TAB 100 MCG,3.13
,,,
,,AZELASTINE NASAL SPRAY 137,9.25
,,,
,,VITAMIN B-12 TAB 1000 MCG,4.15
,,,
,,FONDAPARINUX SYRINGE 2.5,131.65
,,,
,,ACETAMINOPHEN CR CAPLET 6,5.35
,,,
,,PROMETHAZINE  SUPP  50MG,67.9
,,FEROCON CAP [NOT STOCKED],4.3
,,,
,,HYDROCOD/ACET TAB 10MG/65,5.6
,,,
,,MIDODRINE TAB 5MG,7.2
,,,
,,ATORVASTATIN TAB 10MG,4.2
,,,
,,CARVEDILOL TAB 12.5MG,7.3
,,,
,,SITAGLIPTIN-METFORMIN TAB,20.55
,,,
,,GLUCOS/CHOND CAP 500-400,4.1
,,,
,,MILNACIPRAN TAB 100 MG [N,17.95
,,,
,,AMYL NITRITE INHALANT AMP,10.25
,,,
,,CLINDAMYCIN ADD-V VIAL 30,31.8
,,,
,,ASPIRIN-ACETAMIN-CAFF TAB,3.7
,,,
,,LIDOCAINE LARYNGOTRACHEAL,26
,,,
,,DIMENHYDRINATE TAB 50 MG,3.95
,,,
,,FISH OIL CAP 1000 MG (*),3.65
,,,
,,SODIUM HYPOCHLORITE 0.25%,9.25
,,,
,,DARIFENACIN SR TAB 24-HR,30.95
,,,
,,SCOPOLAMINE TD PATCH 72HR,47.75
,,,
,,BUPROPION XL TAB 150 MG,11.9
,,,
,,MESALAMINE TAB DELAYED RE,23.85
,,,
,,TORSEMIDE TAB 20 MG,5.05
,,,
,,BUPIVACAINE IN DEX PF SPI,21.15
,,,
,,DILTIAZEM  VIAL 125MG/25M,41.1
,,,
,,ESTRADIOL TAB 2 MG NOT ST,5.2
,,,
,,HEPATITIS A VACCINE 1440,165.95
,,,
,,PERFLUTREN LIPID MICROSPH,590.3
,,,
,,DARBEPOETIN 60MCG NOT DUE TO CHEMO,"1,014.60"
,,,
,,ROSUVASTATIN TAB 20 MG,22.3
,,,
,,LEVOTHYROXINE TAB 200 MCG,6.3
,,,
,,AZELASTINE NASAL SPRAY 0.,18.5
,,,
,,ESTRADIOL TD PATCH BIWEEK,41.75
,,,
,,PYRIDOSTIGMINE TAB 60 MG,6.2
,,,
,,INSULIN NOVOLOG (ASPART),62.6
,,,
,,INSULIN LANTUS (GLARGINE),45
,,,
,,INSULIN NPH  PEN 100 UNIT,47.54
,,,
,,INSULIN 70/30 PEN 100 UNI,45
,,INSULIN LEVEMIR (DETEMIR),41
,,,
,,MENTHOL THROAT LOZENGES B,10.85
,,,
,,OXYCODONE ER TAB 30 MG,27.8
,,,
,,DENOSUMAB PFS 60 MG/ML,"2,773.70"
,,,
,,POTASSIUM 40MEQ- D5W-1/2,21.6
,,,
,,FAT EMULSION 20% 250ML,91.35
,,,
,,BENDAMUSTINE VIAL  100 MG,"3,922.80"
,,,
,,ESMOLOL VIAL 10MG/ML 10ML,39.2
,,,
,,GUAIFENESIN/PSEUDOEPHEDRI,4.9
,,,
,,ESTROGEN-MEDROXYPROG TAB,19.15
,,,
,,DABIGATRA CAP 75 MG [NOT,11.4
,,,
,,DABIGATRAN CAP 150 MG [NO,17.95
,,,
,,OCTREOTIDE 200 MCG/ML (0.,91.02
,,,
,,DALTEPARIN PFS 5000 UNIT/,100.15
,,,
,,HYDROCOD/ACET TAB 5MG/325,4.65
,,,
,,MAGIC MOUTHWASH,32.8
,,,
,,FOSAPREPITANT VIAL 150 MG,708.2
,,,
,,VITAMIN D TAB 1000 IU,3.55
,,,
,,HYPOCHLOROUS ACID BOTTLE,50.5
,,,
,,DENOSUMAB SDV 120 MG/1.7M,"5,092.40"
,,,
,,BACITRACIN VIAL IM 50000,35.45
,,,
,,CISATRACURIUM IV MDV 2 MG,5
,,,
,,TRIPTORELIN PFS 22.5 MG [,"10,551.10"
,,,
,,LEVOFLOXACIN TAB 250 MG[*,30.05
,,,
,,FEBUXOSTAT TAB 40 MG,21.65
,,,
,,RIVAROXABAN TAB 10 MG,37.35
,,,
,,PENTOSAN CAPS 100 MG,23.8
,,,
,,FENTANYL SDV 0.05MG/ML 10,17.2
,,,
,,RIVASTIGMINE PATCH 24HR 4,58.5
,,,
,,FENTANYL AMP 250 MCG/ 5ML,20.75
,,,
,,DIATRIZOATE URETHRAL,78.1
,,,
,,CALCITRIOL CAP 0.25MCG,4.9
,,,
,,HYDROCHLOROTHIAZIDE CAP 1,4.3
,,,
,,LEUPROLIDE (6 MONTH)  KIT,"21,580.70"
,,,
,,FERUMOXYTOL VIAL 510 MG/17 ML,"2,009.35"
,,LEUPROLIDE  IM KIT 7.5 MG,"3,606.35"
,,,
,,HYDRALAZINE TAB 10MG,3.75
,,,
,,ACETAMIN CODEINE UD CUP 1,3.7
,,,
,,DICLOFENAC W/ MISOPRTAB 7,21.25
,,,
,,LEUPROLIDE ACETATE (3 MON,"10,795.95"
,,,
,,OLMESARTAN MEDOXOMIL TAB,14.8
,,,
,,FERRIC GLUC CMPLX IN SUCR,85.2
,,,
,,"INJ, BUPIVACAINE LIPOSOME",733.35
,,,
,,ER-CLINDAMYCIN 150MG CAP #28,43.35
,,,
,,DULOXETINE CAP 20 MG,20
,,,
,,GLIPIZIDE XL TAB 2.5MG,5.95
,,,
,,DEXILANT 60MG CAP,21
,,,
,,IOPAMIDOL VIAL 41% 200ML,0
,,,
,,ZOLEDRONIC ACID 1MG,168.65
,,,
,,PREGABALIN  CAP 50 MG  [*,5.15
,,,
,,TELMISARTAN TAB 40 MG,13.55
,,,
,,MEMANTINE TAB 5 MG,5.25
,,,
,,PAROXETINE 10MG TAB [NOT,8.6
,,,
,,CONJUGATED ESTROGEN TAB 0,16.25
,,,
,,ROPINIROLE  TAB 0.25 MG,4.85
,,,
,,ROPINIROLE TAB 1 MG,8.05
,,,
,,CARISOPRODOL TAB 350MG,3.95
,,,
,,BUDESONIDE  MDI 90 MCG,390.5
,,,
,,TIOTROPIUM 18 MCG / CAP I,203.75
,,,
,,AMMONIUM LAC LOTION TUBE,77.5
,,,
,,DILTIAZEM ADD-V VIAL 100M,45.1
,,,
,,BETAMETHASONE ACET & SOD,33.75
,,,
,,DANTROLENE VIAL 20MG,191.5
,,,
,,SODIUM CHLORIDE BAG 3%  5,27.15
,,,
,,NOREPINEPHRINE DRIP,60.2
,,,
,,PHENTOLAMINE MESYLATE FOR,242.8
,,,
,,SODIUM THIOSULFATE VIAL 2,55.4
,,,
,,HYDROXYZINE VIAL 50 MG/ML,59.6
,,,
,,TETRACAINE 1% SPINAL PF,180.55
,,,
,,LORAZEPAM ORAL CONC 2MG/M,11.4
,,NS FLUSH 10ML SYRINGE,5.35
,,,
,,OXYCODONE CONCENTRATE  20,402.75
,,,
,,"RABIES VIRUS VACCINE, HDC",819.7
,,,
,,RABIES IMMUNE GLOB 150 UN,"8,045.30"
,,,
,,FENTANYL PATCH  12 MCG/HR,45.75
,,,
,,ALENDRONATE TAB 35MG [NOT,40.4
,,,
,,MOMETASONE 220 MCG/INH TW,168.75
,,,
,,FLUOXETINE CAP 10MG [NOT,7.85
,,,
,,ENOXAPARIN SYRINGE 150 MG,60.1
,,,
,,NAFCILLIN ADD-V-VIAL  1 G,48.05
,,,
,,TRIFLURIDINE 1% OPHTH SOL,52
,,,
,,SERTRALINE TAB 50MG,4.25
,,,
,,PIROXICAM CAP 10MG,8.2
,,,
,,AZATHIOPRINE TAB 50MG,7.75
,,,
,,FLUOCINONIDE GEL 0.05% 15,152
,,,
,,FLUTICASONE HFA MDI  44 M,48.5
,,,
,,FORMOTEROL MDI 12MCG/CAP-,138.75
,,,
,,IMMUNIZATION ADMIN- RABIES,54
,,,
,,ACETAZOLAMIDE TAB 250MG,11.05
,,,
,,VITAMIN A&D OINT TUBE 45G,13.5
,,,
,,ACETAMINOPHEN SUPP  120MG,4.6
,,,
,,ACETAMINOPHEN SUPP 325MG,4.7
,,,
,,ACETAMINOPHEN SUPP 650MG,4.6
,,,
,,ACTIVATED CHARCOAL W/SORB,62.45
,,,
,,ACTIVATED CHARCOAL TUBE 2,62.45
,,,
,,NIFEDIPINE ER TAB  30MG,5.8
,,,
,,ADENOSINE SCAN VIAL 3MG/M,375.95
,,,
,,ADENSOINE 1 MG INJECTION,94.35
,,,
,,ALBUMIN VIAL 5% (12.5GM/2,166.2
,,,
,,SPIRONOLACTONE TAB  25MG,3.95
,,,
,,TEMSIROLIMUS VIAL KIT  25,"3,307.95"
,,,
,,ALBUTEROL  SVN  UD VIAL 0,4.95
,,,
,,ER-TOBRAMYCIN OPHTH 5ML S,32.85
,,,
,,ER-ERYTHROMYCIN OPH OINT,20
,,,
,,ALLOPURINOL TAB 300MG,5.2
,,ALLOPURINOL TAB 100MG,4.4
,,,
,,ALFENTANIL AMP 1 MG/ 2 ML,21.05
,,,
,,ALPRAZOLAM TAB 0.25MG [*],4.65
,,,
,,ALUMINUM HYDROX GEL BO 32,9.05
,,,
,,ALPRAZOLAM TAB 0.5MG [*],4.95
,,,
,,METAPROTERENOL UD VIAL 0.,5.21
,,,
,,ZOLPIDEM  TAB 5MG [*],3.7
,,,
,,AMINOCAPROIC ACID VIAL 25,32
,,,
,,AMINOPHYLLINE VIAL 25MG/M,43.4
,,,
,,AMITRIPTYLINE TAB 10MG,4.1
,,,
,,AMITRIPTYLINE TAB 25MG [*,4.45
,,,
,,AMMONIA AROMATIC INHALANT,5.95
,,,
,,AMOXICILLIN TAB 875MG,5.1
,,,
,,AMOXICILLIN CAP 250MG  [*,4
,,,
,,AMOXICILLIN/CLAV ORAL SUS,9.95
,,,
,,AMOXICILLIN ORAL SUSP 200,17.3
,,,
,,AMOXICILLIN ORAL SUSP 400,26.7
,,,
,,AMOXICILLIN CAP 500MG,4.4
,,,
,,AMPICILLIN  VIAL (IV/IM),29.25
,,,
,,AMPICILLIN ADD-VIAL (IV),79.05
,,,
,,AMPICILLIN ORAL SUSP 250M,59.4
,,,
,,AMPICILLIN CAP 500MG,4.7
,,,
,,SUCCINYLCHOLINE (10ML MDV,65.45
,,,
,,PHYSOSTIGMINE AMP 1MG/ML,185.6
,,,
,,NEOM/POLY/HC OTIC SUSPENS,198
,,,
,,HYDROCORTISONE SUPP 25MG,42.25
,,,
,,ACETAMIN/CODEINE TAB 300M,4.15
,,,
,,ACETAMIN/CODEINE UD CUP 1,6.2
,,,
,,ACETAMINOPHEN DROPS 80MG/,16.9
,,,
,,ACETAMIN/DIPHEN (PM) TAB,3.7
,,,
,,ACETAMINOPHEN TAB 500MG [,1.5
,,,
,,HYDRALAZINE VIAL 20MG/ML,246.45
,,,
,,SANDOSTATIN LAR DEPOT,"7,148.00"
,,,
,,COLLAGENASE 250 U/GM OINT,451.5
,,,
,,AQUAPHILIC OINTMENT TUBE,22.5
,,FLUTICASONE NASAL SPRAY 5,162.5
,,,
,,ARTIFICIAL TEARS OPHTH SO,16
,,,
,,ARTHRITIS CREAM TUBE 35 G,21.5
,,,
,,ARIPIPRAZOLE 10MG TAB,67.75
,,,
,,ASPIRIN EC TAB 81 MG [*],3.6
,,,
,,ASPIRIN CHEW TAB 81 MG [*,1.25
,,,
,,LORATADINE/PSEUDOEPHEDRIN,5.3
,,,
,,ASPIRIN EC TAB 325MG [*],3.6
,,,
,,ASPIRIN TAB 325MG (*),3.6
,,,
,,ASPIRIN SUPP 600MG [*],6.25
,,,
,,ATENOLOL TAB 25MG,4.85
,,,
,,ATENOLOL TAB 50MG [*],5.55
,,,
,,ALTEPLASE (TPA) 100MG [NO,"16,385.20"
,,,
,,LORAZEPAM VIAL/PFS 2MG/ML,18.65
,,,
,,FENTANYL PATCH  25MCG/HR,47.5
,,,
,,SULFACETAMIDE 10% OPHTH,119
,,,
,,FLUCONAZOLE BAG IN NS 200,16.65
,,,
,,NITROGLYCERIN TOPICAL OIN,14
,,,
,,ATROPINE VIAL 0.4MG/ML 1M,33.15
,,,
,,IPRATROPIUM MDI 17 MCG/AC,897.75
,,,
,,IPRATROPIUM BROMIDE UD VI,5.9
,,,
,,ATROPINE VIAL 1MG/ML 1ML,42.6
,,,
,,ATROPINE SULFATE   OPHTH,49.5
,,,
,,AMOXICILLIN/CLAV ORAL SUS,76.95
,,,
,,AMOXICILLIN/CLAV TAB 500M,10.35
,,,
,,AMOXICILLIN/CLAV TAB 875M,12.6
,,,
,,AMOXICILLIN/CLAV   1000MG,10.95
,,,
,,ANTIPYRINE/BENZOCAINE OTI,29.5
,,,
,,CELECOXIB CAP 100MG,11.85
,,,
,,SULFASALAZINE DR TAB  500,4.3
,,,
,,TRIAMCINOLONE ACETONIDE I,24
,,,
,,VITAMIN B-6 TAB 100 MG,4.05
,,,
,,BACITRACIN 15 GM OINTMENTS,16
,,,
,,BACTERIOSTATIC WATER FOR,3.6
,,,
,,BCG INTRAVESICAL VIAL,348.5
,,SULFAMETH/TRIMET 200MG/40,9.45
,,,
,,DICYCLOMINE CAP 10MG,4.7
,,,
,,METFORMIN TAB 850MG,5.7
,,,
,,OXYCODONE ORAL SOLN  5MG/,19.05
,,,
,,PRAMIPEXOLE TAB 0.25MG,8.75
,,,
,,OXYCODONE ER TAB 10MG  [*,12.9
,,,
,,OXYCODONE TAB  5MG  [*],4.5
,,,
,,PEN G BENZ/PEN G PROC C-R,307.95
,,,
,,BISACODYL EC TAB 5MG[*],3.65
,,,
,,BISACODYL SUPP 10MG [*],4
,,,
,,BISOPROLOL/HCTZ TAB  2.5M,5.55
,,,
,,BISOPROLOL/HCTZ TAB  5MG/,9.6
,,,
,,BISOPROLOL/HCTZ TAB 10MG/,9.6
,,,
,,PINK BISMUTH LIQUID  262M,9.4
,,,
,,BOTULINUM TOXIN VIAL,0
,,,
,,BISMUTH SUBSALICYLATE CHE,3.75
,,,
,,TERBUTALINE  INJ 1MG/ML,55.4
,,,
,,TERBUTALINE TAB  2.5MG,6.4
,,,
,,BRIMONIDINE OPHTH SOL 0.1,396
,,,
,,BISOPROLOL TABLET 5MG,5.95
,,,
,,BUMETANIDE VIAL 1 MG/ 4ML,21.05
,,,
,,BUMETANIDE TAB 1MG [*],5.5
,,,
,,BUSPIRONE TAB 5MG,4.9
,,,
,,VITAMIN C TAB 500MG [*],3.65
,,,
,,VITAMIN D TAB 400 IU,4.05
,,,
,,VERAPAMIL TAB  80MG  (PLA,4.55
,,,
,,VERAPAMIL TAB 180MG ER,7.6
,,,
,,VERAPAMIL  ER TAB 240MG,6.45
,,,
,,CALCIUM CHLORIDE SYRINGE,36.7
,,,
,,CAPTOPRIL TAB 25MG,6.85
,,,
,,SUCRALFATE TAB 1GM  [*],4.65
,,,
,,SUCRALFATE ORAL SUSP UD C,23.85
,,,
,,CARBACHOL OPHTH SOLN 0.01,53
,,,
,,CARBAMIDE PEROXIDE EAR WA,17.5
,,,
,,CARBIDOPA/LEVODOPA TAB 25,5.2
,,DILTIAZEM  VIAL 25 MG/ 5,21.1
,,,
,,DILTIAZEM TAB 30MG [*],5.3
,,,
,,ofloxacin ophth solution 0.3%,33.25
,,,
,,CEFUROXIME TAB 250MG,13.7
,,,
,,MULTIVITAMIN LIQUID,9.75
,,,
,,MUPIROCIN 2% OINTMENT 22,12.5
,,,
,,MENTHOL/BENZOCAINE LOZENG,3.85
,,,
,,PHENOL LOZENGE CHERRY,3.55
,,,
,,CEPHALEXIN ORAL SUSP 250M,60.75
,,,
,,CEPHALEXIN CAP 250MG [NOT,5.05
,,,
,,CEPHALEXIN CAP 500MG,5.7
,,,
,,CETACAINE SPRAY [NOT STOC,11.75
,,,
,,PHENOL THROAT SPRAY,17.25
,,,
,,QUINAPRIL TAB  10MG,5.7
,,,
,,ACETAMINOPHEN CHEW TAB 80,3.65
,,,
,,CHLORAL HYDRATE ORAL SYRU,4.7
,,,
,,CHLORDIAZEPOXIDE CAP 10MG,4.65
,,,
,,CHLORHEXIDINE ORAL RINSE,27.9
,,,
,,CIPROFLOXACIN BAG 400MG/2,22.9
,,,
,,CIPROFLOXACIN 0.3% OPH,29.25
,,,
,,CILOSTAZOL TAB 100MG [*],6.8
,,,
,,MAGNESIUM CITRATE ORAL SO,14.4
,,,
,,Mitomycin 20mg vial,"1,290.60"
,,,
,,CEFOTAXIME VIAL 1GM,28.2
,,,
,,CEFTRIAXONE VIAL 1GM [*],43
,,,
,,CLINDAMYCIN CAP 150MG [*],4.65
,,,
,,CLINDAMYCIN ADD-V VIAL 60,18.65
,,,
,,CLINDAMYCIN 150MG/ML 6ML,28.85
,,,
,,CLINDAMYCIN IV 900MG/50ML,17.1
,,,
,,CLONIDINE TAB 0.1MG [*],3.95
,,,
,,CLOTRIMAZOLE 1% CREAM 30,29
,,,
,,CYCLOSPORIN OPH 4ML,430.75
,,,
,,COCAINE 4% 4ML,135.8
,,,
,,PROBENECID 500MG TAB [NOT,5.6
,,,
,,COLCHICINE TAB 0.6MG [*],19.05
,,PROCHLORPERAZINE SUPP 25M,26.15
,,,
,,PROCHLORPERAZINE VIAL  10,56.5
,,,
,,PROCHLORPERAZINE  TAB  5M,4.6
,,,
,,HYDROCORTISONE ACETATE TA,5.5
,,,
,,AMIODARONE VIAL 450MG / 9,26
,,,
,,AMIODARONE TAB 200MG [*],4.6
,,,
,,NADOLOL TAB  40MG,16.55
,,,
,,NEOM/POLY/BAC/HC OPHTH OI,126.25
,,,
,,CIPROFLOX/DEXAMETH OTIC S,547.25
,,,
,,WARFARIN TAB  1MG,4.65
,,,
,,WARFARIN TAB 2.5MG,4.7
,,,
,,WARFARIN TAB  2MG [*],4.65
,,,
,,WARFARIN TAB 3MG,4.7
,,,
,,WARFARIN TAB 4MG,4.7
,,,
,,WARFARIN TAB 5MG [*],4.75
,,,
,,CYCLOPENTOLATE OPHTH SOLN,39.25
,,,
,,VITAMIN B-12 VIAL 1000MCG,27.25
,,,
,,CYCLOBENZAPRINE TAB 10MG,3.65
,,,
,,MISOPROSTOL TAB  100MCG,5
,,,
,,EYE WASH IRRIGATING SOLN,15.25
,,,
,,CYCLOPHOSPHAMIDE LYOPH  V,887
,,,
,,ETOPOSIDE MDV 100MG/5ML,34.45
,,,
,,DOXORUBICIN HCL VIAL 50 M,81.3
,,,
,,TOPOTECAN VIAL 4MG/4ML  [,"2,169.45"
,,,
,,DIVALPROEX  ER TAB 500MG,7.95
,,,
,,VALPROIC ACID 250MG/5ML S,3.8
,,,
,,DIVALPROEX TAB 250MG,6.7
,,,
,,VALPROATE VIAL 500 MG/ 5M,31
,,,
,,ESTRADIOL TAB 0.5MG,4.55
,,,
,,DEPOMETHYLPRED 40mg,34.35
,,,
,,DOXAZOSIN TAB 2MG [*],5.35
,,,
,,DEPOMETHYLPRED 80 mg,51.15
,,,
,,DEXAMETHASONE TAB 0.5MG,3.9
,,,
,,DEXAMETHASONE TAB 4MG,5.7
,,,
,,DEXAMETHASONE SDV 4MG/ML,19.25
,,DEXTROSE SYRINGE 50% - 50,35.85
,,,
,,GLYBURIDE TAB 2.5MG [NOT,4.35
,,,
,,GLYBURIDE TAB 5MG [*],3.95
,,,
,,DIAZEPAM SYRINGE 10 MG /,75.6
,,,
,,DIAZEPAM MDV 5MG/ML 10 ML,102.7
,,,
,,DIAZEPAM TAB 2MG NOT STOC,3.75
,,,
,,DIAZEPAM TAB 5MG [*],4.1
,,,
,,FLUCONAZOLE TAB 100MG,46.7
,,,
,,DILTIAZEM CD CAP 120MG [*,4.3
,,,
,,DILTIAZEM CD CAP 180MG [*,4.45
,,,
,,PHENYTOIN  CAP 100MG  [*],4.7
,,,
,,PHENYTOIN  INFATABS 50MG,6.75
,,,
,,DIPHENHYDRAMINE ORAL LIQU,7
,,,
,,DIPHENHYDRAMINE TAB 25MG,3.6
,,,
,,DIPHENHYDRA 2% CREAM,16.25
,,,
,,DIPHENOXY/ATROPINE TAB 2.,5.1
,,,
,,DIPHENHYDRAMINE VIAL  50M,22.45
,,,
,,DARBEPOETIN 300MCG NOT DUE TO CHEMO,"5,027.05"
,,,
,,PROPOFOL   VIAL IV  200 M,21.7
,,,
,,DARBEPOETIN 200MCG NOT DUE TO CHEMO,"3,355.20"
,,,
,,FEXOFENADINE TAB 60 MG (N,6.25
,,,
,,Melatonin 3mg tablet,4
,,,
,,DIPYRIDAMOLE TAB 50MG,5.2
,,,
,,ASPIRIN/DIPYRIDAMOLE CAP,26.2
,,,
,,FIBER-LAX  TAB 625 MG,3.95
,,,
,,INDAPAMIDE 1.25MG TAB,4.22
,,,
,,FULVESTRANT 250MG/5ML (2,"1,745.45"
,,,
,,OXYBUTYNIN XL TAB  5MG  [,9.8
,,,
,,OXYBUTYNIN TAB  5MG  [*],4.4
,,,
,,DISOPYRAMIDE CAP 100MG,8.65
,,,
,,DOBUTAMINE VIAL 250MG/20M,28.5
,,,
,,DOCUSATE SODIUM CAP 100MG,3.6
,,,
,,DIFLUNISAL TAB 500MG,7.25
,,,
,,BELLADONNA ALK/PHENOBARB,21.5
,,,
,,DOPAMINE BAG 400 MG D5W 2,42.85
,,DOPAMINE 400 MG/10 ML VIAL,20.95
,,,
,,DOXEPIN CAP 25MG[*],5.05
,,,
,,DOXEPIN CAP 10MG [*],4.65
,,,
,,DOXYCYCLINE TAB 100MG [*],11.7
,,,
,,DOXYCYCLINE MDV 100MG/10M,70.9
,,,
,,DONEPEZIL 5MG TAB,4.9
,,,
,,LOSARTAN TAB 25MG [*],6.55
,,,
,,TRIAMTER/HCTZ  CAP 37.5/2,4.35
,,,
,,VITAMIN E CAP 200IU,3.1
,,,
,,VITAMIN E CAP 400IU  [*],3.7
,,,
,,MONSEL'S SOLUTION 1 OZ,12.93
,,,
,,LIDOCAINE/PRILOCAINE CREA,12
,,,
,,HEPATITIS-B VACC ADULT SD,144.85
,,,
,,EPHEDRINE VIAL 50MG/ML,118.65
,,,
,,EPINEPHRINE AMP 1:1000 1M,14.47
,,,
,,EPINEPHRINE SYRINGE 1:100,27.3
,,,
,,ERYTHROMYCIN DR TAB 250MG,4.75
,,,
,,ERYTHROMYCIN OPHTH OINT T,42.75
,,,
,,CALCIUM ACETATE CAP 667MG,5.05
,,,
,,FENTANYL PATCH 100MCG/HR,150.75
,,,
,,FENTANYL PATCH  50MCG/HR,56.5
,,,
,,FENTANYL PATCH  75MCG/HR,92.75
,,,
,,FERROUS SULF TAB 325MG (5,3.65
,,,
,,METRONIDAZOLE TAB  250MG,4.55
,,,
,,GLYCERIN SUPP ADULT [*],3.85
,,,
,,FLUTICASONE/SALMETEROL DI,336.75
,,,
,,LOSARTAN TAB 50MG,7.6
,,,
,,FLUTICASONE/SALMETEROL DI,195.75
,,,
,,FLUVASTATIN XL TAB 80MG [,26.75
,,,
,,FLUVASTATIN CAP 20MG [NOT,14.55
,,,
,,FLUDARABINE VIAL 50MG [NO,677.15
,,,
,,FLUORESCEIN SODIUM A.T OP,9.5
,,,
,,FLUOROURACIL VIAL 1GM/20M,29.5
,,,
,,FLURAZEPAM CAP 15MG,4.85
,,,
,,FOLIC ACID  TAB 1MG [*],3.85
,,FOLIC ACID MDV 5MG/ML  10,5
,,,
,,FOLIC ACID TAB  400MCG,4
,,,
,,FLUOXETINE CAP 20MG [*],8.05
,,,
,,ISOFLURANEFOR INHALATION,9.5
,,,
,,CEFTAZIDIME VIAL 1GM,25.6
,,,
,,FLURBIPROFEN 0.03% OPTH S,"1,046.00"
,,,
,,CEFTAZIDIME VIAL 2GM,31.25
,,,
,,POLYETHYLENE GLYCOL 17 GM,6.9
,,,
,,GENTAMICIN OPHTH OINT  0.,73
,,,
,,GENTAMICIN CREAM  0.1% [N,9.5
,,,
,,GENTAMICIN OPHTH SOLN 3MG,43.75
,,,
,,GEMFIBROZIL TAB 600MG,7.7
,,,
,,GENTAMICIN  VIAL 80 MG/ 2,18.25
,,,
,,CORTROSYN 0.25MG VIAL,241.7
,,,
,,GLIMEPIRIDE TAB 2MG,5.1
,,,
,,GLUCAGEN VIAL 1MG,382.2
,,,
,,GLIPIZIDE TAB 5MG [*],4.2
,,,
,,METFORMIN TAB 500MG [*],4.8
,,,
,,GLUCOSE GEL 45 TUBE [NOT,3.7
,,,
,,GLIPIZIDE XL TAB 5MG [*],4.8
,,,
,,GLUCOSE GEL 15 TUBE,10.65
,,,
,,GUAIFENESIN/CODEINE SYRUP,4.55
,,,
,,GUAIFENESIN CUP 200MG/10M,4.65
,,,
,,GUAIFENESIN/CODEINE/PSEUD,3.7
,,,
,,GUAIFENESIN/DEXTROMETH CU,8
,,,
,,HALOPERIDOL TAB 1MG,4.4
,,,
,,HALOPERIDOL VIAL 5MG/ML [,14.1
,,,
,,SIMVASTATIN TAB 20MG [*],12.4
,,,
,,CARVEDILOL TAB  3.125MG [,7.3
,,,
,,CEFPODOXIME TAB 200MG [NO,18.75
,,,
,,HEPARIN LOCK FLUSH MDV 10,8
,,,
,,SIMVASTATIN TAB  5MG,3.95
,,,
,,HEPARIN  BAG 25000 UNITS/,34.6
,,,
,,"HEPARIN MDV 10,000 UNITS/",33
,,,
,,EUCERIN (HYDROUCERIN) CRE,17.75
,,HYDRALAZINE TAB 25MG,4
,,,
,,HYDROCHLOROTHIAZIDE TAB 2,3.65
,,,
,,HYDROCOD/ACET TAB  5MG/50,3.8
,,,
,,HYDROCOD/ACET ELIX 7.5MG/,11.2
,,,
,,HYDROCHLOROTHIAZIDE 12.5,4.3
,,,
,,HYDROCORTISONE CREAM 1% 3,14
,,,
,,HYDROCORTISONE CREAM 2.5%,166.25
,,,
,,HYDROMORPHONE TAB 2MG [*],4.8
,,,
,,HYDROMORPHONE VIAL/AMP 2M,25.85
,,,
,,SIMVASTATIN TAB 40MG [*],12.4
,,,
,,HYDROXYZINE TAB 10MG,4
,,,
,,QUINAPRIL 20MG TAB,5.85
,,,
,,HYDROXYZINE TAB  25MG [*],4.25
,,,
,,HYDROXYZINE CAP 25MG [*],4.05
,,,
,,TERAZOSIN HCL  CAP 1MG,6.4
,,,
,,TERAZOSIN HCL CAP 5MG,6.1
,,,
,,DIBUCAINE 1% OINTMENT TUB,20
,,,
,,HYOSCYAMINE SL TAB 0.125M,5.05
,,,
,,IMIPRAMINE TAB 25 MG,4.8
,,,
,,LOPERAMIDE CAP 2MG [*],5.1
,,,
,,LOPERAMIDE ORAL SOLN 1MG/,3.6
,,,
,,DROPERIDOL VIAL 5 MG/ 2 M,32.65
,,,
,,PROPRANOLOL  VIAL 1MG/ML,38.25
,,,
,,PROPRANOLOL LA CAP  80MG,7.95
,,,
,,INDOMETHACIN CAP 25MG,4.3
,,,
,,IRON DEXTRAN VIAL 100MG/2,74.6
,,,
,,FAT EMULSION 10% 500ML [B,16.6
,,,
,,IOPAMIDOL VIAL 61%  30 ML,0
,,,
,,dorzolamide-timolol 2%-0.5% 10 mL,130.5
,,,
,,LMD 10%  BAG IN 0.9% SOD,75.5
,,,
,,POTASSIUM TAB 10 MEQ [*],4.6
,,,
,,POTASSIUM TAB 20 MEQ [*],4.75
,,,
,,POTASSIUM EFFERV TAB 25 M,4.1
,,,
,,INSULIN NOVOLOG (ASPAR,43
,,,
,,INSULIN 70/30 MDV - 100 U,31
,,INSULIN NPH MDV 100 UN,31
,,,
,,INSULIN REGULAR MDV 100 U,31
,,,
,,TRIAMCINOLONE ACET 0.1% I,154.25
,,,
,,KETAMINE 500mg/5mL vial,22.3
,,,
,,CLONAZEPAM TAB 0.5MG [*],4.85
,,,
,,KETAMINE 200 MG/20 ML,59.25
,,,
,,KETOPROFEN CAP 50MG [NOT,5.55
,,,
,,KETOCONAZOLE CREAM 2% 15G,10.75
,,,
,,LABETALOL MDV 100 MG/ 20,12.4
,,,
,,LUBRIFRESH OPH OINT,20.75
,,,
,,LACTOBACILLUS CAPSULE,4
,,,
,,LACTULOSE SYRUP 10 GM/15,5
,,,
,,LANOLIN HYDROUS 28 GM TUB,13
,,,
,,DIGOXIN ELIXIR 0.05MG/ML,8.55
,,,
,,DIGOXIN IMMUNE FAB VIAL 4,"7,123.60"
,,,
,,DIGOXIN TAB 0.125MG [*],6.55
,,,
,,DIGOXIN TAB 0.25MG [NOT S,5.5
,,,
,,DIGOXIN AMP 0.5 MG/ 2 ML,30
,,,
,,FUROSEMIDE TAB 20MG (*),3.8
,,,
,,FUROSEMIDE VIAL 20MG/2ML,25.4
,,,
,,FUROSEMIDE TAB 40MG [*],3.9
,,,
,,LEUCOVORIN VIAL  50MG/10M,62
,,,
,,FUROSEMIDE VIAL/PFS 40MG/,24.15
,,,
,,CHLORDIAZEPOX-CLIDINIUM,12.8
,,,
,,LIDOCAINE BAG 0.4% IN D5W,29.1
,,,
,,LITHIUM CARBONATE CAP 150,3.85
,,,
,,METOPROLOL TAB 50MG  [*],3.75
,,,
,,LORAZEPAM TAB 0.5MG [*],4.2
,,,
,,BENAZEPRIL TAB 10MG [*],5.2
,,,
,,ENOXAPARIN SYRINGE  30MG/,55.35
,,,
,,CLOTRIM/BETAMETH CREAM 15,45.5
,,,
,,LEUPROLIDE ACETATE FOR IN,"1,302.05"
,,,
,,LEVALBUTEROL UD INH SOLN,9.55
,,,
,,LEVOFLOXACIN BAG 250MG IN,26.45
,,,
,,LEVOFLOXACIN BAG 500MG IN,29.05
,,"PROCRIT 20,000 UNITS/ML- due to chemo","1,166.05"
,,,
,,KETOTIFEN EYE DROP,83.75
,,,
,,CALCIUM CITRATE + D3,3.9
,,,
,,HYDROCOD/IBUP TAB 7.5MG/2,5.6
,,,
,,LEVOFLOXACIN 750MG/ 5%,32.6
,,,
,,NITROFURANTOIN MACRO CAP,9.85
,,,
,,NITROFURANTOIN CAP 50MG,8.5
,,,
,,MAGNESIUM SULF VIAL 50% 1,16.55
,,,
,,MAGNESIUM OXIDE TAB 400MG,3.8
,,,
,,MANNITOL VIAL 25% - 12.5,21.25
,,,
,,BUPIVACAINE/ EPI MPF VIAL,23.25
,,,
,,BUPIVACAINE MPF VIAL 0.5%,19.85
,,,
,,BUPIVACAINE MPF VIAL 0.25,15
,,,
,,BUPIVACAINE/ EPI MPF VIAL,19.3
,,,
,,CALCITONIN SALMON NASAL S,194.25
,,,
,,MECLIZINE TAB 25MG [*],5.05
,,,
,,METHYLPREDNISOLONE 4MG TAB,7.4
,,,
,,MEGESTROL TAB 40MG,6
,,,
,,MEGESTROL ACETATE ORAL SO,8.9
,,,
,,THIORIDAZINE 10MG TAB [NO,4.2
,,,
,,MENTHOLATUM OINTMENT 1OZ,31
,,,
,,MEPERIDINE VIAL 50 MG/ML [,22.25
,,,
,,MESALAMINE CAP 500MG,16.65
,,,
,,PSYLLIUM SMTH TEXTURE S/F,3.95
,,,
,,TENECTEPLASE KIT 50MG,"11,583.60"
,,,
,,BENZONATATE CAP 100MG,4.85
,,,
,,METHENAMINE TAB 1GM [NOT,3.95
,,,
,,METHOTREXATE TAB 2.5MG,14.75
,,,
,,CEFEPIME 1 GM IV BAG,50.95
,,,
,,METHYLENE BLUE 1%  VIAL 1,396.64
,,,
,,METHYLERGONOVINE AMP  0.2,31.95
,,,
,,METHOCARBAMOL TAB 500MG,4.45
,,,
,,METHOCARBAMOL VIAL 1000 M,225.3
,,,
,,METHYLDOPA TAB 250MG,4.2
,,,
,,METRONIDAZOLE PREMIX BAG,20.45
,,METOPROLOL TARTRATE VIAL,18.8
,,,
,,ENOXAPARIN SYRINGE  60MG/,30.95
,,,
,,ENOXAPARIN SYRINGE  80MG/,37.45
,,,
,,ENOXAPARIN SYRINGE 120MG/,50.4
,,,
,,ENOXAPARIN SYRINGE 100MG/,54.45
,,,
,,MILK OF MAGNESIA CUP 30ML,7.75
,,,
,,MINERAL OIL (ORAL) 30ML,9.45
,,,
,,MOEXIPRIL TAB  7.5MG  [NO,6
,,,
,,MICONAZOLE NITRATE 2% CRE,21.75
,,,
,,FUROSEMIDE ORAL SOLN 10MG,3.85
,,,
,,MORPHINE ORAL SOLN BTL 20,9.3
,,,
,,MORPHINE SULFATE TABLET 1,6.85
,,,
,,MORPHINE SULFATE TAB 15MG,5.15
,,,
,,MORPHINE SULFATE VIAL/CAR,20.6
,,,
,,IBUPROFEN UD CUP 100MG/5M,5.1
,,,
,,IBUPROFEN TAB 200MG [*],1.25
,,,
,,IBUPROFEN TAB 400MG [*],1.5
,,,
,,IBUPROFEN TAB 600MG [*],1.5
,,,
,,IBUPROFEN TAB 800MG [*],1.5
,,,
,,MORPHINE SULFATE VIAL/CAR,20.95
,,,
,,MORPHINE SULFATE TABLET 3,9.5
,,,
,,ACETYLCYSTINE SOLN 20% (2,18.5
,,,
,,MOXIFLOXACIN TAB 400MG  [,69.3
,,,
,,MULTIVITAMIN TABLET [*],3.65
,,,
,,MULTIVITAMIN WITH MINERAL,3.7
,,,
,,MULTIVITAMINS (IV) (2 X 5,38.35
,,,
,,CLOTRIMAZOLE TROCHE TAB 1,9.3
,,,
,,NYSTATIN/TRIAMCINOLONE CR,210.5
,,,
,,"NYSTATIN CREAM 100,000 UN",40.5
,,,
,,"NYSTATIN POWDER 100,000 U",12.3
,,,
,,SIMETHICONE CHEWABLE TAB,3.7
,,,
,,SIMETHICONE 80MG/1.2ML OR,9.45
,,,
,,PRIMIDONE 250MG TAB,5.25
,,,
,,NAPROXEN 375MG TAB [NOT S,5.5
,,,
,,NAPROXEN 500MG TAB,5.95
,,NICARDIPINE PREMIX 20MG/200ML BAG,221.7
,,,
,,NALOXONE 0.4MG/ML (IV),21.26
,,,
,,NEOM/POLY/BAC OPHTH OINT,111.75
,,,
,,NEOSTIGMINE MDV  1:1000 1,5
,,,
,,PHENYLEPHRINE EX STR 1% NASAL,16.75
,,,
,,PHENYLEPHRINE OPHTH  BOTT,23.75
,,,
,,PHENYLEPHRINE 2.5% 3ML OP,22.25
,,,
,,INJ. FILGRASTIM G-CSF 1 MCG,"1,159.40"
,,,
,,BUPIVACAINE 0.5% 50ML VIAl,5
,,,
,,NICOTINE PATCH 14MG (*),7.4
,,,
,,NICOTINE PATCH 21MG [*],7.4
,,,
,,NIFEDIPINE CAP  10MG,2.5
,,,
,,POLYSACCHARIDE IRON COMPL,4
,,,
,,NITROGLYCERIN CAP 2.5MG,5.15
,,,
,,NITROGLYCERIN CAP 6.5MG,5.3
,,,
,,NITROGLYCERIN PATCH 0.2MG,12
,,,
,,NITROGLYCERIN PATCH 0.4MG,12.5
,,,
,,NITROGLYCERIN PATCH 0.3MG,21.25
,,,
,,NITROGLYCERIN SUBLINGUAL,6.35
,,,
,,NITROPRUSSIDE VIAL 25MG/M,102.9
,,,
,,TAMSULOSIN CAP 0.4MG  [*],11.1
,,,
,,ORPHENADRINE VIAL 60 MG/,42.45
,,,
,,LABETALOL TAB 100MG [*],4.5
,,,
,,AMLODIPINE TAB  5MG [*],4.25
,,,
,,NAFCILLIN  2 GM VIAL [NOT,67.5
,,,
,,NALBUPHINE MDV 10 MG / ML,12.8
,,,
,,NULYTELY ORAL SOLN 4 LITE,66.7
,,,
,,NALBUPHINE 10MG/ML 1ML,19.35
,,,
,,SALINE NASAL SPRAY [*],16.75
,,,
,,OPIUM - BELLADONNA 16A SU,63.75
,,,
,,GUAIFENESIN LA TAB 600MG,5.3
,,,
,,GUAIFENESIN/DEXTROMETH TA,4.65
,,,
,,CALCIUM/ VIT D TAB 600 MG,4.7
,,,
,,COMBIGAN 0.2 - 0.5% 5mL,409
,,,
,,NORTRIPTYLINE CAP 10MG,4.3
,,PANTOPRAZOLE TAB  40MG  [,4.35
,,,
,,NORTRIPTYLINE SOLN 10MG/5,3.75
,,,
,,NORTRIPTYLINE CAP 25MG,5.1
,,,
,,CANDESARTAN TAB 16MG,13.2
,,,
,,PACLITAXEL  VIAL 300MG/50,295.8
,,,
,,Eliquis 5mg,15
,,,
,,morphine vial 4mg/mL,16.4
,,,
,,TRANYLCYPROMINE TAB  10MG,10
,,,
,,PROPAFENONE TAB 150MG,5.2
,,,
,,TRASTUZUMAB VIAL 21MG/ML 150mL VIAL,"2,915.20"
,,,
,,LATANOPROST 0.005% OPHTH,36
,,,
,,PROPARACAINE OPHTH SOLN,19.25
,,,
,,ALBUTEROL/IPRATROP MDI 14,930.25
,,,
,,ALBUTEROL/ IPRATROP NEBUL,7.5
,,,
,,PREDNISOLONE ORAL SOLN  5,10.9
,,,
,,ZOLEDRONIC ACID VIAL 1MG,78.56
,,,
,,PENICILLIN VK TAB 250MG,3.95
,,,
,,PENICILLIN VK 250MG/5ML O,9.15
,,,
,,PENICILLIN G POT  VIAL 5,43.85
,,,
,,PEGFILGRASTIM INJ 6 MG/ 0,"13,470.60"
,,,
,,FAMOTIDINE TAB 20MG [*],3.7
,,,
,,FAMOTIDINE BAG 20MG/50ML,26.9
,,,
,,FELODOPINE TAB 5MG,6.25
,,,
,,OXYCODONE/APAP  TAB  5MG/,6
,,,
,,SULFAMETH/TRIMETHO SS,4.7
,,,
,,PHENAZOPYRIDINE TAB 100MG,5.45
,,,
,,PROMETHAZINE 6.25MG/5ML O,3.65
,,,
,,PROMETHAZINE  SUPP 25MG,35.4
,,,
,,PROMETHAZINE TAB 25MG [*],4.5
,,,
,,PROMETHAZINE AMP  25MG/M,20.5
,,,
,,PROMETH/COD SYRUP  6.25MG,4.25
,,,
,,PROMETHAZINE SUPP 12.5MG,35.4
,,,
,,PHENOBARBITAL TAB  64.8MG,5.05
,,,
,,PHENOBARB 32.4 MG,4.35
,,,
,,TRAMADOL/ACETAMIN 37.5MG/,5.45
,,PHENOBARBITAL ELIXIR 4MG/,3.85
,,,
,,Ferric Carboxymaltose 750mg/15mL,"2,074.60"
,,,
,,PHENYTOIN VIAL 100MG/2 ML,19.25
,,,
,,PIPERACILLIN/TAZO 4.5G,44.7
,,,
,,PIPERACILLIN/TAZOBACTAM V,34.9
,,,
,,PIOGLITAZONE TAB 15MG,16.15
,,,
,,PIPERACILLIN/TAZOBACTAM V,42.3
,,,
,,PNEUMOCOCCAL 23 VACCINE 0,20.6
,,,
,,OXYTOCIN 10U/ML 1ML MDV 1,24.3
,,,
,,"POLYMIXIN-B MDV 500,000 U",48
,,,
,,POTASSIUM CHLORIDE VIAL 2,20.3
,,,
,,POTASSIUM CHLORIDE VIAL 4,20.85
,,,
,,PREDNISOLONE ACET 1% OPHT,108.75
,,,
,,PREDNISONE TAB 1MG,4
,,,
,,PREDNISONE TAB  5MG,3.95
,,,
,,PREDNISONE TAB 10MG  [*],4
,,,
,,PREDNISONE TAB  20MG,3.8
,,,
,,CONJUGATED ESTROGEN TAB 0,16.25
,,,
,,ESTRACE 0.01% VAGINAL CREAM,16.5
,,,
,,OMEPRAZOLE CAP 20MG  [*],11.05
,,,
,,LISINOPRIL TAB 10MG [*],3.8
,,,
,,LISINOPRIL TAB  5MG,5.1
,,,
,,PROCALAMINE BOTTLE 1000ML,90.5
,,,
,,EPSOM SALT (TOPICAL) 4 LB,38.53
,,,
,,PRAMOXINE FOAM 1%,118
,,,
,,PRAMOXINE/HYDROCORT CREAM,30
,,,
,,PROPRANOLOL TAB  20MG,5.6
,,,
,,PROTAMINE VIAL 50 MG/ 5ML,43.05
,,,
,,PANTOPRAZOLE (IV) VIAL 40,47.1
,,,
,,ALBUTEROL  MDI 90MCG [*],62.25
,,,
,,Opdivo 40mg/4mL,"1,826.90"
,,,
,,ALBUTEROL ORAL LIQ 2MG/5M,3.65
,,,
,,MEDROXYPROGESTERONE TAB 1,4.4
,,,
,,PSEUDOEPHEDRINE SYRUP 30M,3.55
,,,
,,PSEUDOEPHEDRINE TAB 30MG,3.09
,,QUINIDINE GLUC  ER  TAB,6
,,,
,,QUINIDINE SULF ER TAB 300,5.4
,,,
,,QUINIDINE MDV 80 MG/ML -,7.05
,,,
,,QUINIDINE TAB 200MG,3.9
,,,
,,RABEPRAZOLE  TAB 20MG [NO,41.3
,,,
,,RACEPINEPHRINE UD VIAL 2.,12.25
,,,
,,METOCLOPRAMIDE TAB 5MG,5.15
,,,
,,METOCLOPRAMIDE TAB 10MG,4.4
,,,
,,METOCLOPRAMIDE VIAL 10 MG,20.15
,,,
,,METOCLOPRAMIDE 5MG/5ML OR,3.65
,,,
,,NABUMETONE TAB  500MG,5.9
,,,
,,REPAGLINIDE  TAB 1MG,10.25
,,,
,,RHO D IMMUNE GLOBULIN (HU,183.2
,,,
,,DIMETHYL SULFOXIDE-50 VIA,"1,345.25"
,,,
,,BENEFIBER POWDER 1.5 GM F,4
,,,
,,RISPERIDONE TAB  0.5MG  [,11.2
,,,
,,RITUXIMAB VIAL 500 MG/ 50,"6,200.85"
,,,
,,RIVASTIGMINE  CAP 1.5MG,11.9
,,,
,,SODIUM CHLORIDE TABLET 1G,3.65
,,,
,,ROSIGLITAZONE 4MG TABLET,11.95
,,,
,,GLYCOPYRROLATE VIAL 1 MG/,23.45
,,,
,,GOSERELIN SYRINGE 10.8MG,"3,931.90"
,,,
,,CEFTRIAXONE VIAL 2GM [*],17.7
,,,
,,FLUMAZENIL MDV 0.5 MG / 5,5.6
,,,
,,SODIUM CHLORIDE UD VIAL 0,3.8
,,,
,,SODIUM CHLORIDE SYRINGE 0,4.8
,,,
,,SENNA TAB  8.6MG  [*],3.65
,,,
,,SENNA/DOCUSATE SOD TAB  8,3.75
,,,
,,SULFAMETH/TRIMETH (IV) MD,43.6
,,,
,,BENDAMUSTINE 25MG,980.7
,,,
,,SODIUM CHLORIDE VIAL 0.9% 10 mL,6.1
,,,
,,SALSALATE TAB 750MG,4.95
,,,
,,SALMETEROL 50MCG DISKUS,23.5
,,,
,,SILVER SULFADIAZINE 1% CR,9.5
,,,
,,SILVER NITRATE APPLICATOR,10.25
,,CARBIDOPA/LEVODOPA TAB 25,5
,,,
,,CARBIDOPA/LEVODOPA TAB CR,5.2
,,,
,,MAG-DELAY TAB 64MG,3.8
,,,
,,SULFAMETH/TRIMET  DS TAB,4.05
,,,
,,SODIUM BICARB SYRINGE 4.2,39.85
,,,
,,ROSUVASTATIN TAB 5MG,22.3
,,,
,,SODIUM BICARB SYRINGE 8.4,34.35
,,,
,,SOD CIT/ CITRIC ACID SOLN,5.45
,,,
,,SODIUM POLYSTYRENE  SUSP,23.75
,,,
,,METHYLPREDNISOLONE  VIAL 125 mg,37.45
,,,
,,METHYLPREDNISOLONE VIAL 4,29.5
,,,
,,METHYLPREDNISOLONE VIAL,139.2
,,,
,,SOTALOL  TAB  80MG  [*],7.7
,,,
,,SILVER SULFADIAZINE 1% CR,36
,,,
,,calmoseptine ointment,9.25
,,,
,,ER-calmoseptine,20
,,,
,,BUTORPHANOL VIAL 2MG/ML (,23.05
,,,
,,CALCIUM GLUCONATE VIAL  1,16.65
,,,
,,FENTANYL SDV /AMP/PFS 100,19.25
,,,
,,SULINDAC TAB  150MG,5.3
,,,
,,SULINDAC  TAB 200MG,6.25
,,,
,,SEVOFLURANE/15 MIN,10.75
,,,
,,AMANTADINE CAP 100MG [*],9.8
,,,
,,LEVOTHYROXINE TAB 100 MCG,4.6
,,,
,,LEVOTHYROXINE TAB  50 MCG,4.5
,,,
,,LEVOTHYROXINE TAB  75 MCG,4.6
,,,
,,LEVOTHYROXINE TAB 125 MCG,4.8
,,,
,,LEVOTHYROXINE TAB 112 MCG,4.8
,,,
,,LEVOTHYROXINE TAB  88 MCG,4.6
,,,
,,CARBAMAZEPINE CHEW TAB 10,4.65
,,,
,,TEMAZEPAM CAP 15MG  [*],4.85
,,,
,,TETANUS/DIPHTHERIA ADSORB,67.45
,,,
,,TETRACAINE HCL 0.5% OPHTH,29
,,,
,,THEOPHYLLINE TAB 200MG,4.8
,,,
,,THEOPHYLLINE TAB 300MG,4.75
,,THIAMINE  TAB 100MG,4.1
,,,
,,THIAMINE MDV 100MG/ML [*],15.95
,,,
,,CHLORPROMAZINE AMP 25MG/M,73.9
,,,
,,CHLORTHALIDONE TAB 25MG [,5.7
,,,
,,CHOLESTYRAMINE PACKET 4GM,12.7
,,,
,,TICLOPIDINE 250MG TAB [NO,7
,,,
,,TIMOLOL MAL 0.5% OPHTH SO,20
,,,
,,TOBRAMYCIN/DEXAMETH 0.3%/,502
,,,
,,TOBRAMYCIN/DEXAMETH 0.3%/,228.25
,,,
,,TOBRAMYCIN MDV 80 MG / 2M,6.7
,,,
,,TOLTERODINE LA CAP 2MG,27.9
,,,
,,TRIAMCINOLONE VIAL 40MG,29.9
,,,
,,TOLTERODINE LA CAP 4MG [N,29.8
,,,
,,METOPROLOL SUCCINATE XL T,5.55
,,,
,,TIMOLOL MAL 0.5% OPHTH GE,400.25
,,,
,,KETOROLAC TAB 10MG,7.4
,,,
,,KETOROLAC VIAL 60 MG/ 2 M,25
,,,
,,ATRACURIUM MDV 10MG/ML (1,44.6
,,,
,,TRAZODONE HCL TAB  50MG,3.8
,,,
,,PENTOXIFYLLINE TAB 400MG,6.2
,,,
,,TROPICAMIDE 1% OPHTH SOLN,34.25
,,,
,,TRIAMCINOLONE ACET 0.1% C,26.25
,,,
,,TRIAMTER/HCTZ  TAB 75/50M,5.5
,,,
,,TUBERSOL MANTOUX MDV  [*],30
,,,
,,WITCH HAZEL PADS,18.75
,,,
,,CALCIUM CARB CHEW TAB 500,4
,,,
,,ACETAMINOPHEN TAB 325MG [,1.5
,,,
,,ACETAMINOPHEN ELIXIR UD C,10
,,,
,,ARTIFICIAL TEARS PG 5ML,16.5
,,,
,,TRAMADOL TAB 50MG  [*],4.95
,,,
,,AMIODARONE 150MG/3ML VIAL,21
,,,
,,AMPICILLIN/SULBAC ADD-V V,30.45
,,,
,,AMPICILLIN/SULBACTAM VIAL,33.15
,,,
,,ESCITALOPRAM TAB 10MG [*],11.3
,,,
,,ESOMEPRAZOLE CAP 40MG [*],19.75
,,BETHANECHOL TAB 25MG,8.35
,,,
,,BIMATOPROST 0.01% OPHT,455.75
,,,
,,TOBRAMYCIN 0.3% OPHTH SOL,35.25
,,,
,,METOPROLOL SUCCINATE XL T,5.55
,,,
,,OXCARBAZEPINE TAB  150MG,13.85
,,,
,,VANCOMYCIN VIAL 1000 MG [,29.45
,,,
,,VANCOMYCIN VIAL  500 MG,31.65
,,,
,,ENALAPRIL TAB 5MG [*],6.3
,,,
,,VASOPRESSIN MDV 20U/ML,25.75
,,,
,,VERAPAMIL VIAL (IV) 2.5MG,55.45
,,,
,,MIDAZOLAM VIAL 2 MG/ 2ML,18.5
,,,
,,VINORELBINE VIAL 10MG/ML,59.7
,,,
,,CHONDROITIN/ HYAL OPHTH S,680.5
,,,
,,QUETIAPINE TAB  25MG  [*],10.2
,,,
,,VITAMIN K1 SYRINGE 1MG/0.,21.1
,,,
,,VITAMIN K1 AMP 10MG/ML [*,103.9
,,,
,,DICLOFENAC TAB 50MG,5.2
,,,
,,DICLOFENAC 0.1% OPHTH SOL,72
,,,
,,DICLOFENAC TAB 75MG,6.7
,,,
,,TOPIRAMATE 25MG TABLET [N,7.95
,,,
,,LANSOPRAZOLE CAP 30MG (*),13.7
,,,
,,LIDOCAINE MDV 1% 10ML [*],0
,,,
,,LIDOCAINE/EPINEPH MDV 1%,0
,,,
,,LIDOCAINE MDV 2 % 10 ML,0
,,,
,,LIDOCAINE/EPINEPH MDV 2%,0
,,,
,,LIDOCAINE MPF VIAL 0.5 %,0
,,,
,,LIDOCAINE/EPINEPH MDV 0.5,0
,,,
,,LIDOCAINE MPF VIAL 1% 5ML,0
,,,
,,LIDOCAINE MPF VIAL 2%  5M,0
,,,
,,LIDOCAINE/EPINEPH MPF VIA,21.3
,,,
,,LIDOCAINE SYRINGE 2% 100M,23.8
,,,
,,LIDOCAINE PATCH 5%,52.25
,,,
,,LIDOCAINE URO-JET GEL 2%,23
,,,
,,LIDOCAINE VISCOUS CUP 2%,10
,,,
,,LIDOCAINE JELLY OPH TUBE,0
,,LIDOCAINE JELLY TUBE 2% 5,12.25
,,,
,,ONDANSETRON  ODT 4MG,6.5
,,,
,,LIDOCAINE JELLY 2% 30ML T,174.25
,,,
,,Procrit 40000 units/mL- due to chemo,"2,320.55"
,,,
,,RANITIDINE TAB  150MG  [*,6.4
,,,
,,RANITIDINE ORAL SOLN 15MG,4.85
,,,
,,AZTREONAM VIAL [2 GM],161.15
,,,
,,ISOVUE-M300,188.08
,,,
,,ER-AZITHROMYCIN 250MG PAK,56.65
,,,
,,METOLAZONE TABLET 2.5MG [,7.25
,,,
,,AZITHROMYCIN VIAL 500MG [,32.55
,,,
,,AZITHROMYCIN ORAL SUSP 20,71.8
,,,
,,AZITHROMYCIN  TAB 250MG [,6.2
,,,
,,AZTREONAM VIAL 1 GM,87.7
,,,
,,ZINC OXIDE OINTMENT TUBE,9.25
,,,
,,ZINC SULF CAP 220MG,3.75
,,,
,,ACYCLOVIR CAP 200MG,5.9
,,,
,,ACYCLOVIR TAB 800MG,10.15
,,,
,,ACYCLOVIR CREAM TUBE  5%,"1,326.75"
,,,
,,ACYCLOVIR VIAL,70.5
,,,
,,ONDANSETRON  PFS/VIAL 4 M,18.55
,,,
,,AZITHROMYCIN ORAL SUSP 10,71.8
,,,
,,ROSUVASTATIN TAB 10MG  [*,16.4
,,,
,,OSELTAMIVIR 12MG/ML SUSP,12.7
,,,
,,OSELTAMIVIR  CAP 75MG,31.35
,,,
,,INJECTION I/M - OR,75
,,,
,,INJECTION I/M - ER,75
,,,
,,INJECTION I/M - CLINIC,75
,,,
,,INJECTION IM-OTHER DIAGNO,75
,,,
,,INJECTION IM-OTHER THERAP,75
,,,
,,CALCIUM/ VIT D TAB 500 MG,3.6
,,,
,,METFORMIN XR TAB 500MG [N,6.1
,,,
,,LEUPROLIDE DEPOT SYRINGE,"14,390.75"
,,,
,,NEOM/POLY/GRAMICIDIN OPHT,54.75
,,,
,,HYDROCOD/ACET TAB 10MG/50,4.5
,,OLANZEPINE TAB  2.5MG  [*,23.65
,,,
,,IRINOTECAN VIAL 100MG/5ML,151.5
,,,
,,BUPROPRION-SR / ER TAB 10,6.55
,,,
,,BUDESONIDE SVN VIAL 0.5 M,23.6
,,,
,,MONTELUKAST CHEWABLE TAB,14.85
,,,
,,DORZOLAMIDE OPHTH SOLN 2%,132.5
,,,
,,LEVOTHYROXINE TAB 137 MCG,5.05
,,,
,,MINOCYCLINE 100MG CAP (NO,6.55
,,,
,,ESTRADIOL TDPATCH WEEKLY,78.25
,,,
,,LANSOPRAZOLE SOLU-TAB 15M,33.4
,,,
,,CETIRIZINE ORAL SYRUP 1 M,4.05
,,,
,,FEXOFEN-PSEUDOEPHED 12 HR,6.85
,,,
,,FEXOFENADINE TAB 180 MG,4.45
,,,
,,MOMETASONE 50 MCG/ACT NAS,41
,,,
,,EPOGEN VIAL 10000/ML- due to chemo,588.8
,,,
,,LEVOTHYROXINE TAB  25 MCG,4.4
,,,
,,CELECOXIB CAP 200 MG,7.9
,,,
,,ZOLMITRIPTAN TAB 5 MG,61.8
,,,
,,LUTEIN CAP 6MG,3.75
,,,
,,PAROXETINE TAB 20MG,8.55
,,,
,,RISEDRONATE SODIUM 35MG T,63.1
,,,
,,RIZATRIPTAN 10MG TABLET [,70
,,,
,,MUSCLE RUB CREAM 3 OZ TUB,17.5
,,,
,,CITALOPRAM TAB 10 MG,8
,,,
,,TOPIRAMATE TAB  50 MG,4.4
,,,
,,SUMATRIPTAN SUCCINATE TAB,48.75
,,,
,,PROPOFOL 1% 50ML VIAL,48.9
,,,
,,VALACYCLOVIR HCL 500 MG T,16.5
,,,
,,VENLAFAXINE ER CAP 75MG,11.05
,,,
,,NIACIN ER CAP 500 MG,14.7
,,,
,,AMLODIPINE/BENAZEPRIL CAP,8.65
,,,
,,CETIRIZINE TAB 10MG [*] [,8
,,,
,,BENAZEPRIL TAB 20MG [NOT,5.25
,,,
,,ESCITALOPRAM TAB 20MG,11.8
,,,
,,AMLODIPINE/BENAZEPRIL CAP,8.65
,,ATORVASTATIN TAB 20MG (*),5.05
,,,
,,CIPROFLOXACIN TAB 500MG [,9.25
,,,
,,GEMCITABINE VIAL 1GM [NOT,112.95
,,,
,,LOVASTATIN TAB 20MG,5.8
,,,
,,WARFARIN TAB 6MG [NOT STO,8.05
,,,
,,LEVOTHYROXINE TAB 150 MCG,4.85
,,,
,,TERBINAFINE TAB  250 MG,27.05
,,,
,,FLUTICASONE HFA MDI 110MC,566.75
,,,
,,EZETIMIBE TAB 10MG [*],28.35
,,,
,,AMLODIPINE/BENAZEPRIL CAP,8.6
,,,
,,ATORVASTATIN TAB 40MG [NO,19.2
,,,
,,PRENATAL RX 1 TAB [NOT ST,4.15
,,,
,,LORATADINE TAB 10MG [*],4.8
,,,
,,MINOCYCLINE 50MG CAP [NOT,6.6
,,,
,,SODIUM CHLORIDE 0.9% 50ML MINIBAG PLUS,27.25
,,,
,,HYDROCORTISONE VIAL 100 M,48.25
,,,
,,INSULIN LISPRO PEN 100 UN,113.9
,,,
,,CLARITHROMYCIN TAB 500MG,14.55
,,,
,,RIVAXIMIN 550 MG,95.5
,,,
,,SIMVASTATIN TAB 80MG [NOT,12.35
,,,
,,METRONIDAZOLE GEL 45 GM T,9
,,,
,,PROPRANOLOL LA 120MG CAPS,7
,,,
,,PIROXICAM CAP 20MG [NOT S,11.6
,,,
,,METHOTREXATE  VIAL 50 MG/,20
,,,
,,TANNATE SUSP 5MG/4.5MG 5M,4.3
,,,
,,PIOGLITAZONE 30 MG TABLET,46.25
,,,
,,LETROZOLE TAB 2.5 MG,36.15
,,,
,,CIMETIDINE TAB 400MG [NOT,6.15
,,,
,,METOPROLOL SUCCINATE XL T,6.55
,,,
,,LISINOPRIL TAB 20MG,3.8
,,,
,,ATORVASTATIN TAB 80MG [NO,19.2
,,,
,,TRAVAPROST 0.004% OPHTH S,428
,,,
,,FENOFIBRATE 134MG,11.45
,,,
,,HALFLYTELY BWL-PREP KIT [,100.81
,,,
,,RITUXIMAB VIAL 100 MG/ 10,"1,240.20"
,,INFLUENZA VIRUS VACCINE S,83.65
,,,
,,FLUCONAZOLE TAB 150MG,28.75
,,,
,,STERILE WATER INJ 10ML,6.4
,,,
,,MAG-AL PLUS UD LIQ 30ML [,10
,,,
,,METHADONE TAB 10 MG [*],4.45
,,,
,,LINEZOLID IV PREMIX 600MG,118.85
,,,
,,CARBOPLATIN VIAL 600MG/60,249.8
,,,
,,CARBOPLATIN VIAL 50MG/5ML,34.35
,,,
,,BORTEZOMIB VIAL 3.5 MG/3.,"2,998.10"
,,,
,,MICONAZOLE 100MG VAG SUPP,10.75
,,,
,,ER-ACETAMIN/CODEINE ELX 1,23.95
,,,
,,ER-AMOXICILLIN 250MG PAK,20
,,,
,,ER-AMOXICILLIN 875MG PAK,20
,,,
,,ER-AMOXICILLIN 200MG/5ML,20
,,,
,,ER-AMOXICILLIN 400MG/5ML,20
,,,
,,ER-AMOX/CLAVULANATE 500/1,27.85
,,,
,,ER-AMOX/CLAVULANATE 875/1,33.8
,,,
,,ER-AMOX/CLAV 400MG/5ML OR,47.75
,,,
,,ER-SULFAMETH/TRIMETH DS 8,24.55
,,,
,,ER-CEFUROXIME 250MG PAK #,36.4
,,,
,,ER-CIPROFLOXACIN 500MG PA,31.5
,,,
,,ER-NEOM/POLY/HCT OTIC SUS,30.15
,,,
,,ER-METRONIDAZOLE 250MG PA,20
,,,
,,ER-CYCLOBENZAPRINE 10MG P,22.2
,,,
,,ER-GENTAMICIN 0.3% OPHTH,28.95
,,,
,,ER-GENTAMICIN 0.3% OPHTH,31
,,,
,,ER-CEPHALEXIN 500MG PAK #,36.65
,,,
,,ER-CEPHALEXIN 250MG/5ML O,61.25
,,,
,,ER-LEVOFLOXACIN 500MG PAK,48.55
,,,
,,ER-NITROFURANTN MACRO 100,31.2
,,,
,,ER-METHYLPREDNISOLONE 4MG,40.05
,,,
,,ER-IBUPROFEN 400MG PAK #6,20
,,,
,,ER-PREDNISOLONE 5MG/5ML O,108.1
,,,
,,ER-PENICILLN VK 250MG PAK,45.7
,,,
,,ER-PROMETHAZINE 25MG PAK,20
,,ER-PROMETHAZINE 12.5MG SU,20
,,,
,,ER-PROMETHAZINE 25MG SUPP,20
,,,
,,ER-PREDNISONE 10MG PAK #1,20
,,,
,,ER-ALBUTEROL 2.5MG/3ML IN,20
,,,
,,ER-ALBUTEROL 90MCG INHALE,36.5
,,,
,,ER-PHENAZOPYRIDINE 100MG,24.35
,,,
,,ER-METHOCARBAMOL 500MG PA,26
,,,
,,ER-METAXALONE 800MG PAK #,73.4
,,,
,,ER-ACETAMINOPHEN/CODEINE,20
,,,
,,ER-TRAMADOL 50MG PAK #20,35
,,,
,,ER-DOXYCYCLINE 100MG PAK,20
,,,
,,ER-HYDROCODONE/APAP 5/325,20
,,,
,,ER-HYDROXYZINE PAMOATE 25,20
,,,
,,ER-AZITHROMYCIN 200MG/5ML,44.9
,,,
,,MONTELUKAST CHEW TAB 4MG,14.85
,,,
,,PHENYLHIST DH LIQUID (DIH,9.25
,,,
,,EZETIMIBE-SIMVASTATIN TAB,28.1
,,,
,,DAPTOMYCIN VIAL 500MG/10ML,203.5
,,,
,,ESTRADIOL ACETAT VAG RING,967.5
,,,
,,MELOXICAM TAB  7.5 MG,3.85
,,,
,,IMMUNE GLOBULIN IV SOL 5 gm,"1,513.60"
,,,
,,METRONIDAZOLE 0.75% CREAM,12.5
,,,
,,BUPROPION XL TAB 300 MG [,12.1
,,,
,,IMIPENEM-CILASTATIN ADD-V,70.5
,,,
,,LORATADINE SYRUP 5MG/5ML,4.75
,,,
,,VINCRISTINE VIAL 2MG/2ML,39.6
,,,
,,CAPSAICIN 0.025% CREAM 60,27
,,,
,,KCL 10MEQ/100 ML,27.05
,,,
,,EZETIMIBE-SIMVASTATIN TAB,28.1
,,,
,,eliquis 2.5 mg,15
,,,
,,IRON SUCROSE VIAL 100MG/5,124.5
,,,
,,METOPROLOL SUCCINATE XL,9.7
,,,
,,APAP / CODEINE SUSP BOTTL,9.6
,,,
,,MIGQUIN CAPSULE [NOT STOC,5.05
,,,
,,DULOXETINE CAP 60 MG,17.4
,,FLUOCINONIDE CREAM 0.05%,95.75
,,,
,,FERROUS SULFATE CR TAB  4,3.85
,,,
,,MELOXICAM TAB 15MG,11.9
,,,
,,IBANDRONATE TAB 150MG [NO,415.95
,,,
,,PACLITAXEL VIAL  100 MG,20.85
,,,
,,CISPLATIN MDV 200MG/200ML,176.35
,,,
,,OXALIPLATIN  VIAL 100MG/2,232.5
,,,
,,METFORMIN TAB 1000MG,6.25
,,,
,,CEFAZOLIN 2GM BAG,41.25
,,,
,,FLUNISOLIDE MDI 250 MCG/A,34.25
,,,
,,PEMETREXED DISODIUM VIAL,"6,794.65"
,,,
,,CHLORZOXAZONE TAB 500MG,5.45
,,,
,,PREGABALIN CAP 75 MG,6.45
,,,
,,FENOFIBRATE TAB 145 MG,12.8
,,,
,,FENOFIBRATE TAB 160MG,7.8
,,,
,,OXALIPLATIN VIAL  50MG/10,"2,486.00"
,,,
,,LEUCOVORIN VIAL  350MG /,186.55
,,,
,,FLUTICASONE/SALMETEROL DI,543.25
,,,
,,FOMEPIZOLE VIAL 1 GM/ML,"2,132.05"
,,,
,,GLIMEPIRIDE TAB 4MG,5.7
,,,
,,DARBEPOETIN 100MCG NOT DUE TO CHEMO,"1,683.35"
,,,
,,ONDANSETRON  ODT 8MG [NOT,70.35
,,,
,,DOCETAXEL VIAL 80MG/4ML,"4,298.90"
,,,
,,PREGABALIN CAP 25 MG [NOT,21.2
,,,
,,NABUMETONE 750MG TABLET [,6.3
,,,
,,HYDROXYCHLOROQUINE TAB 20,11.4
,,,
,,RAMIPRIL CAP  5MG,3.9
,,,
,,CARVEDILOL TAB  6.25MG,7.3
,,,
,,TRAMADOL ER 200MG TABLET,18.05
,,,
,,TRAMADOL ER 100MG TABLET,11.5
,,,
,,ESZOPICLONE TAB 2 MG [NOT,37.4
,,,
,,VARENICLINE TAB 1 MG,9.6
,,,
,,ALTEPLASE FOR CATHETER  V,347.15
,,,
,,DARBEPOETIN 40 MCG Not due to chemo,680.25
,,,
,,HISTRELIN ACETATE IMPLANT,"10,052.10"
,,SIMVASTATIN TAB 10MG [NOT,8.55
,,,
,,BLEOMYCIN VIAL 15 UNITS/5,123.9
,,,
,,VINBLASTINE VIAL 1MG/ML [,109.55
,,,
,,DACARBAZINE VIAL 200MG/20,42.45
,,,
,,OLMESARTAN/HCTZ 40/25 TAB,25.55
,,,
,,TETANUS/DIPTHERIA/PERTUSS,106.25
,,,
,,VECURONIUM BROMIDE VIAL,35.65
,,,
,,TAMOXIFEN TAB  20MG  [NOT,10.35
,,,
,,OLOPATADINE 0.2% OPHTH SO,170.5
,,,
,,IMMUNE GLOBULIN VIAL 10 G,"2,594.85"
,,,
,,Prevnar Pnuemococcal vac,461.2
,,,
,,ALENDRONATE TAB 70MG + D,72.6
,,,
,,DESOXIMETASONE CREAM 0.25,37
,,,
,,PANCRLIPASE  (ZENPEP) CAP,8.2
,,,
,,NICOTINE PATCH  7MG/24HR,13
,,,
,,GRANULEX SPRAY,9.8
,,,
,,WOUND WASH SALINE CAN,9.15
,,,
,,MOXIFLOXACIN 0.5% OPHTH S,210
,,,
,,PALONOSETRON VIAL  0.25MG,79.8
,,,
,,CEFTRIAXONE ADD-V 2 GM,33.5
,,,
,,TORSEMIDE 100MG TABLET,8.75
,,,
,,HUMATE P 952,19.45
,,,
,,IRBESARTAN  TAB 150 MG,9.05
,,,
,,MORPHINE SULFATE PCA 30MG,42.45
,,,
,,METOPROLOL TAB 25 MG,3.95
,,,
,,VITAMIN K1 TAB 5 MG,130.45
,,,
,,GADOBENATE MRI 15ML,0
,,,
,,HEPARIN CARPUJECT 5000 UN,14.35
,,,
,,ESTRADIOL VAG TAB 25MCG [,15.7
,,,
,,BETAMETHASONE OINT 0.05%,14.5
,,,
,,CISPLATIN 50MG/50ML,17.3
,,,
,,MAG SULFATE 2GM/50ML,17.15
,,,
,,NATEGLINIDE 120 MG,7.25
,,,
,,HUMATE-P 1798 IU,19.45
,,,
,,INVANZ 1 GM VIAL,269.4
,,EPINEPHRINE 0.3MG AUTO-INJ,349
,,,
,,EPINEPHRINE 0.15MG AUTO-INJECTOR,456.1
,,,
,,sensipar 30 mg tablet,61.6
,,,
,,Immune globuline 2.5gm,765.05
,,,
,,Immune Globulin 1 gm,315.95
,,,
,,Immune Globulin 20 gm,"5,173.20"
,,,
,,Immune Globulin 30 gm,"7,751.50"
,,,
,,NPLATE 250 MCG,"4,222.75"
,,,
,,SANDOSTATIN LAR DEPOT 30 MG,"13,805.60"
,,,
,,NYSTATIN SUSP 5 ML CUP,5.97
,,,
,,GEMCITABINE 2GM/52.6ML,"3,172.50"
,,,
,,nplate 500 mcg,"8,434.00"
,,,
,,PEG BOTTLE 255 GM,3.6
,,,
,,DIAZEPAM RECTAL GEL 2.5 MG,561.5
,,,
,,DIAZEPAM RECTAL GEL 10 MG,610.5
,,,
,,GAMUNEX-C 40 GM,42.25
,,,
,,GAMUNEX-C 2.5GM,42.25
,,,
,,DEXAMETHASONE PF 10MG/ML,25.05
,,,
,,SYSTANE EYE DROP 0.4%,10.5
,,,
,,gamunex-c 10 gm/100mL,42.25
,,,
,,stubbs magic mouthwash,3.85
,,,
,,ISOVUE 61% 75mL BOTTLE,16.55
,,,
,,XOLAIR 150 MG VIAL,"2,449.05"
,,,
,,NEXPLANON 68 MG IMPLANT,"2,030.70"
,,,
,,temozolomide 100 mg cap,458.15
,,,
,,temozolomide 20 mg cap,107.1
,,,
,,temozolomide 5 mg cap,29.55
,,,
,,"FLUZONE HIGH DOSE, IM",223.75
,,,
,,TRANEXAMIC ACID 1000MG/10ML,23
,,,
,,STELARA 90 MG SQ INJECTION,"49,870.45"
,,,
,,MEROPENEM 1 GM VIAL,110.1
,,,
,,SODIUM CHLORIDE 0.9% VIAL 50 ML,5.27
,,,
,,ENTACAPONE 200 MG TAB,11.95
,,,
,,BACLOFEN 20 MG TAB,5.7
,,,
,,LYRICA 200 MG CAP,18.7
,,OSELTAMAVIR 30 MG,18.55
,,,
,,RITUXAN HYCELA INJ,"14,216.95"
,,,
,,EOVIST 0.25MOL 10 ML,294.84
,,,
,,CEFOXITIN 1 GM VIAL,29.5
,,,
,,CEFAZOLIN ADD-V VIAL 1 GM,22.35
,,,
,,INFLECTRA 100 MG VIAL,"1,776.60"
,,,
,,DRONABINOL 2.5MG CAP,13.05
,,,
,,PANCRELIPASE 5000/17000/24000 CAP,7.35
,,,
,,JEVITY 1.5KCAL/ML 1000 ML BAG,23.56
,,,
,,SKYLA 14MCG/24 HR IUD,"1,452.80"
,,,
,,SOD CHLORIDE 3% NEB,3.5
,,,
,,CINVANTI 130MG INJ,810.25
,,,
,,OXYMETAZOLINE NASAL SPRAY 0.05%,15.25
,,,
,,SOD BICARB VIAL 8.4%,18.5
,,,
,,PACLITAXEL 150MG/25ML VIAL,22.2
,,,
,,XOLAIR PFS 150MG,"2,449.05"
,,,
,,XOLAIR PFS 75 MG,"2,449.05"
,,,
,,ANORO 62.5/25 INHALER,165.58
,,,
,,Lamotrigine 100 mg tablet,3.95
,,,
,,DEFEROXAMINE 500 MG VIAL,38.5
,,,
,,KEYTRUDA 100 MG VIAL,"9,059.90"
,,,
,,FASENRA 30MG SYRINGE,"10,744.95"
,,,
,,PACKED RED BLOOD CELLS 1 UNIT,0
,,,
,,Platelet Infusion,0
,,,
,,SOMATULINE DEPOT INJ 120 MG,"15,296.32"
,,,
,,OMNIPAQUE 300 100ML BOTTLE,0
,,,
,,LEUCOVORIN 350 MG VIAL,67.66
,,,
,,KYLEENA 19.5 MG IUD,"1,825.94"
,,,
,,"PERJETA 420 MG VIAL, IV","10,276.48"
,,,
,,ESOMEPRAZOLE 40 MG VIAL,124.5
,,,
,,VANCOMYCIN ORAL 125 MG CAP,59.85
,,,
,,VALACYCLOVIR 1000MG TAB,14.65
,,,
,,"PROCRIT10,000 UNIT- NOT DUE TO CHEMO",588.8
,,,
,,"PROCRIT 20,000UNIT- NOT due to chemo","1,166.05"
,,,
,,"PROCRIT 40,000UNITS- NOT due to chemo","2,320.55"
,,PREMARIN CREAM 30 GM TUBE,632.87
,,,
,,BSS Plus for cataracts,33.5
,,,
,,DEX-MOXI INTRAOCULAR SOLN,32.48
,,,
,,BSS irrigating drops,10.5
,,,
,,DUOVISC,195.8
,,,
,,PROVISC,78.95
,,,
,,MIOCHOL-E INTRAOCULAR,86.28
,,,
,,MYXREDLIN 100 UNIT/100ML,88
,,,
,,DEXAMETHASONE OPHTH SUSP,90
,,,
,,SPIRIVA RESPIMAT INH,75
,,,
,,DARZALEX 100MG/5ML VIAL,"1,066.91"
,,,
,,DARZALEX 400MG/20ML VIAL,"4,267.20"
,,,
,,DEXTROMETHORPHAN SUSP 30MG/5ML,8.98
,,,
,,SALINE 7% INH VIAL,5.36
,,,
,,ACETYLCYSTEINE 20% 4ML VIAL,9.65
,,,
,,EPINEPHRINE DRIP 4mg/254mL,58.63
,,,
,,PROPOFOL DRIP 1000MG/100ML,78.98
,,,
,,Aranesp 40mcg due to chemo,680.25
,,,
,,ARANESP 60 MCG DUE TO CHEMO,"1,014.60"
,,,
,,ARANESP 100MCG DUE TO CHEMO,"1,638.35"
,,,
,,ARANESP 200MCG DUE TO CHEMO,"3,355.20"
,,,
,,ARANESP 300MCG DUE TO CHEMO,"5,027.05"
,,,
,,ARANESP 500MCG DUE TO CHEMO,"8,370.70"
,,,
,,MIRENA IUD 52MG,"1,487.95"
,,,
,,BENAZEPRIL 20MG TAB,5.25
,,,
,,QUETIAPINE 100MG TAB,15.2
,,,
,,HALOPERIDOL 5MG TAB,5.5
,,,
,,SUGAMMADEX 200MG/2ML VIAL INJ,129.6
,,,
,,Dalvance 500mg Vial,"3,033.60"
,,,
,,DOPAMINE 200MG/5ML VIAL,18.56
,,,
,,OPTIRAY 320 VIAL 20ML,22.68
,,,
,,NALOXONE 4MG NASAL,0
,,,
,,BLACK WIDOW ANTIVENIN,70.85
,,,
,,CEFEPIME 1 GM VIAL,34.58
,,,
,,ENTYVIO 300 MG VIAL,"12,529.95"
,,TIZANIDINE 4 MG TABLET,8.1
,,,
,,DARZALEX FASPRO 1800MG,"14,542.08"
,,,
,,NALOXONE 2MG/2ML SYRINGE,78.77
,,,
,,ESI ANESTHESIA,940.39
,,,
,,INTUBATION ENDOTRACHEAL EMERGENCY,355
,,,
,,SPNIAL FLUID TAP DIAGNOSTIC,350
,,,
,,INTRASCALENE NERVE BLOCK,435.51
,,,
,,NERVE BLOCK INJ SUPRASCAPULAR,360
,,,
,,NERVE BLOCK ILIOHYPOGASTRIC,325
,,,
,,INJECTION ANESTHETIC AGENT SCIATIC NERVE,305
,,,
,,NERVE BLOCK OTHER PERIPHERAL,250
,,,
,,IV START,75
,,,
,,BILATERAL- NERVE BLOCK,375
,,,
,,PICC LINE INSERTION >5 YRS,743.67
,,,
,,INJECT SACROILIAC JOINT,589.16
,,,
,,ANESTHESIA FIRST MINUTE,651.03
,,,
,,ANESTHESIA ADD'L MINUTES,9.75
,,,
,,CONCIOUS SEDATION-30 MIN,282.67
,,,
,,CONCIOUS SEDATION-ADD 15M,141.34
,,,
,,OT THER EXER-EA 15 MIN,117.13
,,,
,,OT ORTHOTIC FIT-EA 15 MIN,138.09
,,,
,,OT NUEROMUSCLE RE-ED,122.01
,,,
,,OT PARAFFIN BATH,37.2
,,,
,,OT WHEELCHAIR MGMT & TRAI,113.43
,,,
,,OT LOW COMPLEX EVAL,310
,,,
,,OT MODERATE COMPLEX EVAL,440
,,,
,,OT HIGH COMPLEX EVAL,570
,,,
,,OT REEVALUATION,105
,,,
,,THERAPEUTIC ACTIVITY - EA 15 MIN,128.04
,,,
,,OT SELF CARE ADL-EA 15 MI,126.93
,,,
,,PARE BENIGN LES; SGL,92.47
,,,
,,"DEBRIDE NAIL, 1-5",68.42
,,,
,,"DEBRIDE NAIL, 6 OR MORE",115.83
,,,
,,Attention current status 0%,0.01
,,,
,,Attention current status 1-19%,0.01
,,Attention current status 20-39%,0.01
,,,
,,Attention current status 40-59%,0.01
,,,
,,Attention current status 60-79%,0.01
,,,
,,Attention current status 80-99%,0.01
,,,
,,Attention current status 100%,0.01
,,,
,,Attention goal status 0%,0.01
,,,
,,Attention goal status 1-19%,0.01
,,,
,,Attention goal status 20-39%,0.01
,,,
,,Attention goal status 40-59%,0.01
,,,
,,Attention goal status 60-79%,0.01
,,,
,,Attention goal stataus 80-99%,0.01
,,,
,,Attention goal status 100%,0.01
,,,
,,Attention @DC 0%,0.01
,,,
,,Attention @ DC 1-19%,0.01
,,,
,,Attention @ DC 20-39%,0.01
,,,
,,Attention @ DC 40-59%,0.01
,,,
,,Attention @ DC 60-79%,0.01
,,,
,,Attention @ DC 80-99%,0.01
,,,
,,Attention @ DC 100%,0.01
,,,
,,Memory current status 0%,0.01
,,,
,,Memory current status 1-19%,0.01
,,,
,,Memory current status 20-39%,0.01
,,,
,,Memory current status 40-59%,0.01
,,,
,,Memory current status 60-79%,0.01
,,,
,,Memory current status 80-99%,0.01
,,,
,,Memory current status 100%,0.01
,,,
,,Memory goal status 0%,0.01
,,,
,,Memory goal status 1-19%,0.01
,,,
,,Memory goall status 20-39%,0.01
,,,
,,Memory goal status 40-59%,0.01
,,,
,,Memory goal status 60-79%,0.01
,,,
,,Memory goal status 80-99%,0.01
,,,
,,Memory goal status 100%,0.01
,,,
,,MECHANICAL TRACTION THERA,59.92
,,,
,,ELECTRICAL STIM-UNATTENDE,50.18
,,WHIRLPOOL THERAPY,81.97
,,,
,,INFARED THERAPY,21.26
,,,
,,OT IONTOPHORESIS-EA 15 MIN,90.66
,,,
,,CONTRAST BATH THERAPY,64.2
,,,
,,ULTRASOUND THER-EA 15 MIN,46.94
,,,
,,Memory @ DC 0%,0
,,,
,,Memory @ DC 1-19%,0.01
,,,
,,Memory  @ DC 20-39%,0.01
,,,
,,Memory @ DC 40-59%,0.01
,,,
,,Memory @ DC 60-79%,0.01
,,,
,,Memory @ DC 80-99%,0.01
,,,
,,Memory @ DC 100%,0.01
,,,
,,MANUAL THERAPY-EA 15 MIN,109.45
,,,
,,MYOFASCIAL REL-EA 15 MIN,109.45
,,,
,,CHEMICAL CAUTERIZATION GR,161.33
,,,
,,ORTHOTIC TR/15 MIN,138.09
,,,
,,PROSTHETIC TR /15 MIN,120.85
,,,
,,COGNITIVE SKILLS DEVELOPMENT,78
,,,
,,NEG PRESS WOUND TX<50CM,104.55
,,,
,,ORTHOTICS/ PROSTH MGMT/ TRAIN 15 MIN,163.16
,,,
,,Mobility current 0%,0.01
,,,
,,Mobility  current 1-19%,0.01
,,,
,,Mobility current 20-39%,0.01
,,,
,,Mobility current 40-59%,0.01
,,,
,,Mobility current 60-79%,0.01
,,,
,,Mobility current 80-99%,0.01
,,,
,,Mobility current 100%,0.01
,,,
,,Mobility goal 0%,0.01
,,,
,,Mobility goal 1-19%,0.01
,,,
,,Mobility goal 20-39%,0.01
,,,
,,Mobility goal 40-59%,0.01
,,,
,,Mobility goal 60-79%,0.01
,,,
,,Mobility goal 80-99%,0.01
,,,
,,Mobility goal 100%,0.01
,,,
,,Mobility @ DC 0%,0.01
,,Mobility @ DC 1-19%,0.01
,,,
,,Mobility @ DC 20-39%,0.01
,,,
,,Mobility @ DC 40-59%,0.01
,,,
,,Mobility @ DC 60-79%,0.01
,,,
,,Mobility @ DC 80-99%,0.01
,,,
,,Mobility @ DC 100%,0.01
,,,
,,UNNA BOOT APPLICATION-LEF,222.32
,,,
,,UNNA BOOT APPLICATION-RT,222.32
,,,
,,Body pos current 0%,0.01
,,,
,,Body pos current 1-19%,0.01
,,,
,,Body pos current 20-39%,0.01
,,,
,,Body pos current 40-59%,0.01
,,,
,,Body pos current 60-79%,0.01
,,,
,,Body pos current 80-99%,0.01
,,,
,,Body pos current 100%,0.01
,,,
,,Body pos goal status 0%,0.01
,,,
,,Body pos goal status 1-19%,0.01
,,,
,,Body pos goal status 20-39%,0.01
,,,
,,Body pos goal status 40-59%,0.01
,,,
,,Body pos goal status 60-79%,0.01
,,,
,,Body pos goal status 80-99%,0.01
,,,
,,Body pos goal status 100%,0.01
,,,
,,Body pos @ DC 0%,0.01
,,,
,,Body pos @ DC 1-19%,0.01
,,,
,,Body pos @ DC 20-39%,0.01
,,,
,,Body pos @ DC 40-59%,0.01
,,,
,,Body pos @ DC 60-79%,0.01
,,,
,,Body pos @ DC 80-99%,0.01
,,,
,,Body pos @ DC 100%,0.01
,,,
,,Carrying objects current status 0%,0.01
,,,
,,Carrying objects current status 1-19%,0.01
,,,
,,Carrying objects current status 20-39%,0.01
,,,
,,Carrying objects current status 40-59%,0.01
,,,
,,Carrying objects current status 60-79%,0.01
,,,
,,Carrying objects current status 80-99%,0.01
,,Carrying objects current status 100%,0.01
,,,
,,Carrying objects goal status 0%,0.01
,,,
,,Carrying objects goal status 1-19%,0.01
,,,
,,Carrying objects goal status 20-39%,0.01
,,,
,,Carrying objects goal status 40-59%,0.01
,,,
,,Carrying objects goal status 60-79%,0.01
,,,
,,Carrrying objects goal status 80-99%,0.01
,,,
,,Carrying objects goal status 100%,0.01
,,,
,,Carrying objects @ DC 0%,0.01
,,,
,,Carrying objects @ DC 1-19%,0.01
,,,
,,Carrying objects @ DC 20-39%,0.01
,,,
,,Carrying objects @ DC 40-59%,0.01
,,,
,,Carrying objects @ DC 60-79%,0.01
,,,
,,Carrying objects @ DC 80-99%,0.01
,,,
,,Carrying objects @ DC 100%,0.01
,,,
,,Self-care current status 0%,0.01
,,,
,,Self-care current status 1-19%,0.01
,,,
,,Self-care current status 20-39%,0.01
,,,
,,Self-care current status 40-59%,0.01
,,,
,,Self-care current status 60-79%,0.01
,,,
,,Self-care current status 80-99%,0.01
,,,
,,Self-care current status 100%,0.01
,,,
,,Self-care goal status 0%,0.01
,,,
,,Self-care goal status 1-19%,0.01
,,,
,,Self-care goal status 20-39%,0.01
,,,
,,Self-care goal status 40-59%,0.01
,,,
,,Self-care goal status 60-79%,0.01
,,,
,,Self-care goal status 80-99%,0.01
,,,
,,Self-care goal status 100%,0.01
,,,
,,Self-care @ DC 0%,0.01
,,,
,,Self-care @ DC 1-19%,0.01
,,,
,,Self-care @ DC 20-39%,0.01
,,,
,,Self-care @ DC 40-59%,0.01
,,,
,,Self-care @ DC 60-79%,0.01
,,,
,,Self-care @ DC 80-99%,0.01
,,Self-care @ DC 100%,0.01
,,,
,,Other primary current status 0%,0.01
,,,
,,Other primary current status 1-19%,0.01
,,,
,,Other primary current status 20-39%,0.01
,,,
,,Other primary current status 40-59%,0.01
,,,
,,Other primary current status 60-79%,0.01
,,,
,,Other primary current status 80-99%,0.01
,,,
,,Other primary current status 100%,0.01
,,,
,,Other primary goal status 0%,0.01
,,,
,,Other primary goal status 1-19%,0.01
,,,
,,Other primary goal status 20-39%,0.01
,,,
,,Other primary goal status 40-59%,0.01
,,,
,,Other primary goal status 60-79%,0.01
,,,
,,Other primary goal status 80-99%,0.01
,,,
,,Other primary goal status 100%,0.01
,,,
,,"BRIEF VISIT, NEW PT",117.61
,,,
,,"LIMITED VISIT, NEW PT",223.69
,,,
,,"INTERMED VISIT,NEW PT",339.35
,,,
,,"EXTENDED VISIT, NEW PT",576.3
,,,
,,WOC EST PT-BRIEF W/PROCED,42.3
,,,
,,"BRIEF VISIT, EST PT",114.68
,,,
,,"LIMITED VISIT, EST PT",227.35
,,,
,,"INTERMEDIATE VISIT, EST P",349.53
,,,
,,Other primary @ DC 0%,0.01
,,,
,,Other primary @ DC 1-19%,0.01
,,,
,,Other primary @ DC 20-39%,0.01
,,,
,,Other primary @ DC 40-59%,0.01
,,,
,,Other primary @ DC 60-79%,0.01
,,,
,,Other primary @ DC 80-99%,0.01
,,,
,,Other primary @ DC 100%,0.01
,,,
,,Subsequent PT/OT current status 0%,0.01
,,,
,,Subsequent PT/OT current status 1-19%,0.01
,,,
,,Subsequent PT/OT current  status 20-39%,0.01
,,,
,,Subsequent PT/OT current  status 40-59%,0.01
,,,
,,Subsequent PT/OT current status 60-79%,0.01
,,Subsequent PT/OT current status 80-99%,0.01
,,,
,,Subsequent PT/OT current status 100%,0.01
,,,
,,Subsequent PT/OT goal status 0%,0.01
,,,
,,Subsequent PT/OT goal status 1-19%,0.01
,,,
,,Subsequent PT/OT goal status 20-39%,0.01
,,,
,,Subsequent PT/OT goal status 40-59%,0.01
,,,
,,Subsequent PT/OT goal status 60-79%,0.01
,,,
,,Subsequent PT/OT goal status 80-99%,0.01
,,,
,,Subsequent PT/OTgoal status 100%,0.01
,,,
,,Subsequent PT/OT @ DC 0%,0.01
,,,
,,Subsequent PT/OT @ DC 1-19%,0.01
,,,
,,Subsequent PT/OT @ DC 20-39%,0.01
,,,
,,Subsequent PT/OT @ DC 40-59%,0.01
,,,
,,Subsequent PT/OT @ DC 60-79%,0.01
,,,
,,Subsequent PT/OT @ DC 80-99%,0.01
,,,
,,PT LOW COMPLEXITY EVAL,230
,,,
,,PT MODERATE COMPLEX EVAL,312
,,,
,,PT HIGH COMPLEX EVAL,390
,,,
,,PT REEVALUATION,100
,,,
,,NEEDLE INJ W/O INJECTIONS 1 OR 2 MUSCLES,40
,,,
,,NEEDLE INSJ W/O INJECTIONS 3 OR MORE MUS,55
,,,
,,MEDCOSOUND,59.38
,,,
,,APPLY MULTILAYER LEG-BILATERAL,105
,,,
,,APPLY MULTILAYER COMPRESS ARM-BILATERAL,75
,,,
,,,
,,CANALITH REPOSITIONING PR,132.93
,,,
,,HOT/COLD PACKS,38.52
,,,
,,MECHANICAL TRACTION THERA,59.92
,,,
,,ELECTRICAL STIM THERAPY,69.71
,,,
,,ELECTRICAL STIM-UNATTENDE,50.18
,,,
,,VASOPNEAUMATIC DEVICE THE,68.63
,,,
,,PARAFFIN BATH THERAPY,37.2
,,,
,,WHIRLPOOL THERAPY,81.97
,,,
,,WHIRLPOOL W/WOUND CARE &,81.97
,,,
,,INFARED THERAPY,21.26
,,PT IONTOPHORESIS-EA 15 MIN,114.13
,,,
,,CONTRAST BATH THERAPY,64.2
,,,
,,ULTRASOUND THER-EA 15 MIN,46.94
,,,
,,THERAPEUTIC EX-EA 15 MIN,117.13
,,,
,,NEUROMUSCLE REED-EA 15 MI,122.01
,,,
,,GAIT TRAINING-EA 15 MIN,104
,,,
,,MANUAL THERAPY-EA 15 MIN,109.45
,,,
,,MASSAGE THERAPY-EA 15 MIN,95.84
,,,
,,MYOFASCIAL REL-EA 15 MIN,109.45
,,,
,,ORTHOTIC TR/15 MIN,138.09
,,,
,,PROSTHETIC TR /15 MIN,120.85
,,,
,,THERAPEUTIC ACTIVITY- EA 15 MIN,128.04
,,,
,,SELF CARE MGMT TRAIN-15 M,126.93
,,,
,,PT WHEELCHAIR MGMT & TRAI,113.43
,,,
,,ACTIV WOUND CARE/20CM OR<,91.07
,,,
,,ACTIVE WOUND CARE>20CM,42.57
,,,
,,PHYS PERFORM TEST OR MEAS,122.06
,,,
,,ASSESTIVE TECH ASSESS,134.58
,,,
,,C/O FOR ORTHOTIC/PROSTH 15 min,163.16
,,,
,,Mobility current 0%,0.01
,,,
,,Mobility  current 1-19%,0.01
,,,
,,Mobility current 20-39%,0.01
,,,
,,Mobility current 40-59%,0.01
,,,
,,Mobility current 60-79%,0.01
,,,
,,Mobility current 80-99%,0.01
,,,
,,Mobility current 100%,0.01
,,,
,,Mobility goal 0%,0.01
,,,
,,Mobility goal 1-19%,0.01
,,,
,,Mobility goal 20-39%,0.01
,,,
,,Mobility goal 40-59%,0.01
,,,
,,Mobility goal 60-79%,0.01
,,,
,,Mobility goal 80-99%,0.01
,,,
,,Mobility goal 100%,0.01
,,,
,,Mobility @ DC 0%,0.01
,,,
,,Mobility @ DC 1-19%,0.01
,,Mobility @ DC 20-39%,0.01
,,,
,,Mobility @ DC 40-59%,0.01
,,,
,,Mobility @ DC 60-79%,0.01
,,,
,,Mobility @ DC 80-99%,0.01
,,,
,,Mobility @ DC 100%,0.01
,,,
,,Body pos current 0%,0.01
,,,
,,Body pos current 1-19%,0.01
,,,
,,Body pos current 20-39%,0.01
,,,
,,Body pos current 40-59%,0.01
,,,
,,Body pos current 60-79%,0.01
,,,
,,Body pos current 80-99%,0.01
,,,
,,Body pos current 100%,0.01
,,,
,,Body pos goal status 0%,0.01
,,,
,,Body pos goal status 1-19%,0.01
,,,
,,Body pos goal status 20-39%,0.01
,,,
,,Body pos goal status 40-59%,0.01
,,,
,,Body pos goal status 60-79%,0.01
,,,
,,Body pos goal status 80-99%,0.01
,,,
,,Body pos goal status 100%,0.01
,,,
,,Body pos @ DC 0%,0.01
,,,
,,Body pos @ DC 1-19%,0.01
,,,
,,Body pos @ DC 20-39%,0.01
,,,
,,Body pos @ DC 40-59%,0.01
,,,
,,Body pos @ DC 60-79%,0.01
,,,
,,Body pos @ DC 80-99%,0.01
,,,
,,Body pos @ DC 100%,0.01
,,,
,,Carrying objects current status 0%,0.01
,,,
,,Carrying objects current status 1-19%,0.01
,,,
,,Carrying objects current status 20-39%,0.01
,,,
,,Carrying objects current status 40-59%,0.01
,,,
,,Carrying objects current status 60-79%,0.01
,,,
,,Carrying objects current status 80-99%,0.01
,,,
,,Carrying objects current status 100%,0.01
,,,
,,Carrying objects goal status 0%,0.01
,,,
,,Carrying objects goal status 1-19%,0.01
,,Carrying objects goal status 20-39%,0.01
,,,
,,Carrying objects goal status 40-59%,0.01
,,,
,,Carrying objects goal status 60-79%,0.01
,,,
,,Carrrying objects goal status 80-99%,0.01
,,,
,,Carrying objects goal status 100%,0.01
,,,
,,Carrying objects @ DC 0%,0.01
,,,
,,Carrying objects @ DC 1-19%,0.01
,,,
,,Carrying objects @ DC 20-39%,0.01
,,,
,,Carrying objects @ DC 40-59%,0.01
,,,
,,Carrying objects @ DC 60-79%,0.01
,,,
,,Carrying objects @ DC 80-99%,0.01
,,,
,,Carrying objects @ DC 100%,0.01
,,,
,,Self-care current status 0%,0.01
,,,
,,Self-care current status 1-19%,0.01
,,,
,,Self-care current status 20-39%,0.01
,,,
,,Self-care current status 40-59%,0.01
,,,
,,Self-care current status 60-79%,0.01
,,,
,,Self-care current status 80-99%,0.01
,,,
,,Self-care current status 100%,0.01
,,,
,,Self-care goal status 0%,0.01
,,,
,,Self-care goal status 1-19%,0.01
,,,
,,Self-care goal status 20-39%,0.01
,,,
,,Self-care goal status 40-59%,0.01
,,,
,,Self-care goal status 60-79%,0.01
,,,
,,Self-care goal status 80-99%,0.01
,,,
,,Self-care goal status 100%,0.01
,,,
,,Self-care @ DC 0%,0.01
,,,
,,Self-care @ DC 1-19%,0.01
,,,
,,Self-care @ DC 20-39%,0.01
,,,
,,Self-care @ DC 40-59%,0.01
,,,
,,Self-care @ DC 60-79%,0.01
,,,
,,Self-care @ DC 80-99%,0.01
,,,
,,Self-care @ DC 100%,0.01
,,,
,,Other primary current status 0%,0.01
,,,
,,Other primary current status 1-19%,0.01
,,Other primary current status 20-39%,0.01
,,,
,,Other primary current status 40-59%,0.01
,,,
,,Other primary current status 60-79%,0.01
,,,
,,Other primary current status 80-99%,0.01
,,,
,,Other primary current status 100%,0.01
,,,
,,Other primary goal status 0%,0.01
,,,
,,Other primary goal status 1-19%,0.01
,,,
,,Other primary goal status 20-39%,0.01
,,,
,,Other primary goal status 40-59%,0.01
,,,
,,Other primary goal status 60-79%,0.01
,,,
,,Other primary goal status 80-99%,0.01
,,,
,,Other primary goal status 100%,0.01
,,,
,,Other primary @ DC 0%,0.01
,,,
,,Other primary @ DC 1-19%,0.01
,,,
,,Other primary @ DC 20-39%,0.01
,,,
,,Other primary @ DC 40-59%,0.01
,,,
,,Other primary @ DC 60-79%,0.01
,,,
,,Other primary @ DC 80-99%,0.01
,,,
,,Other primary @ DC 100%,0.01
,,,
,,Subsequent PT/OT current status 0%,0.01
,,,
,,Subsequent PT/OT current status 1-19%,0.01
,,,
,,Subsequent PT/OT current  status 20-39%,0.01
,,,
,,Subsequent PT/OT current  status 40-59%,0.01
,,,
,,Subsequent PT/OT current status 60-79%,0.01
,,,
,,Subsequent PT/OT current status 80-99%,0.01
,,,
,,Subsequent PT/OT current status 100%,0.01
,,,
,,Subsequent PT/OT goal status 0%,0.01
,,,
,,Subsequent PT/OT goal status 1-19%,0.01
,,,
,,Subsequent PT/OT goal status 20-39%,0.01
,,,
,,Subsequent PT/OT goal status 40-59%,0.01
,,,
,,Subsequent PT/OT goal status 60-79%,0.01
,,,
,,Subsequent PT/OT goal status 80-99%,0.01
,,,
,,Subsequent PT/OTgoal status 100%,0.01
,,,
,,APPLY MULTILAYER COMPRESS LEG BELOW KNEE,70
,,,
,,APPLY MULTILAYER COMPRESS ARM,50
,,,
,,Subsequent PT/OT @ DC 0%,0.01
,,,
,,Subsequent PT/OT @ DC 1-19%,0.01
,,,
,,Subsequent PT/OT @ DC 20-39%,0.01
,,,
,,Subsequent PT/OT @ DC 40-59%,0.01
,,,
,,Subsequent PT/OT @ DC 60-79%,0.01
,,,
,,Subsequent PT/OT @ DC 80-99%,0.01
,,,
,,SPEECH THERAPY-EA 15 MIN,72.12
,,,
,,SPEECH THERAPY - 30 MIN,144.21
,,,
,,SPEECH THERAPY - 45 MIN,216.31
,,,
,,SPEECH THERAPY - 1 HR,288.41
,,,
,,SPEECH THERAPY-1HR 15 MIN,360.5
,,,
,,EVALUATION OF SPEECH FLUENCY,317.93
,,,
,,EVALUATION OF SPEECH PRODUCTION,271.95
,,,
,,VIDEO SWALLOW 45 MIN,634.21
,,,
,,VIDEO SWALLOW 30 MIN,422.81
,,,
,,VIDEO SWALLOW 15 MIN,155.75
,,,
,,SWALLOWING TREAT-15 MIN,75.23
,,,
,,SWALLOWING TREAT -30 MIN,150.51
,,,
,,SWALLOWING TREAT-45 MIN,225.75
,,,
,,SWALLOWING TREAT- 1 HR,301.01
,,,
,,CLINICAL SWALLOW EVAL-15M,194.03
,,,
,,CLINICAL SWALLOW EVAL-30,388.04
,,,
,,CLINICA SWALLOW EVAL-45,582.06
,,,
,,CLINICAL SWALLOW EVAL-60,776.1
,,,
,,TRAINING FOR USE OF SGD'S,324.3
,,,
,,EX / SPEECH DEVICE RX-1HR,363.72
,,,
,,EX/SPEECH DEVICE RX-ADD30,155.64
,,,
,,VOICE PROSTHETIC TRAINING,367.49
,,,
,,Motor speech @ DC 0%,0.01
,,,
,,Motor speech @ DC 1-19%,0.01
,,,
,,Motor speech @ DC 20-39%,0.01
,,,
,,Motor speech @ DC 40-59%,0.01
,,,
,,Motor speech @ DC 60-79%,0.01
,,,
,,Motor speech @ DC 80-99%,0.01
,,Motor speech @ DC 100%,0.01
,,,
,,Comprehension current status 0%,0.01
,,,
,,Comprehension current status 1-19%,0.01
,,,
,,Comprehension current status 20-39%,0.01
,,,
,,Comprehension current status 40-59%,0.01
,,,
,,Comprehension current status 60-79%,0.01
,,,
,,Comprehension current status 80-99%,0.01
,,,
,,Comprehension current status 100%,0.01
,,,
,,Comprehension goal status 0%,0.01
,,,
,,Comprehension goal status 1-19%,0.01
,,,
,,Comprehension goal status 20-39%,0.01
,,,
,,Comprehension goal status 40-59%,0.01
,,,
,,Comprehension goal status 60-79%,0.01
,,,
,,Comprehension goal status 80-99%,0.01
,,,
,,Comprehension goal status 100%,0.01
,,,
,,ASSESSMENT OF APHASIA,307.02
,,,
,,Comprehension @ DC 0%,0.01
,,,
,,Comprehension @ DC 1-19%,0.01
,,,
,,Comprehension @ DC 20-39%,0.01
,,,
,,Comprehension @ DC 40-59%,0.01
,,,
,,Comprehension @ DC 60-79%,0.01
,,,
,,Comprehension @ DC 80-99%,0.01
,,,
,,Comprehension @ DC 100%,0.01
,,,
,,Expression current status 0%,0.01
,,,
,,Expression current status 1-19%,0.01
,,,
,,Expression current status 20-39%,0.01
,,,
,,Expression current status 40-59%,0.01
,,,
,,Expression current status 60-79%,0.01
,,,
,,Expression current status 80-99%,0.01
,,,
,,Expression current status 100%,0.01
,,,
,,Expression goal status 0%,0.01
,,,
,,Expression goal status 1-19%,0.01
,,,
,,Expression goal status 20-39%,0.01
,,,
,,Expression goal status 40-59%,0.01
,,,
,,Expression goal status 60-79%,0.01
,,Expression goal status 80-99%,0.01
,,,
,,Expression goal status 100%,0.01
,,,
,,Expression @ DC 0%,0.01
,,,
,,Expression @ DC 1-19%,0.01
,,,
,,Expression @ DC 20-39%,0.01
,,,
,,Expression @ DC 40-59%,0.01
,,,
,,Expression @ DC 60-79%,0.01
,,,
,,Expression @ DC 80-99%,0.01
,,,
,,Expression @ DC 100%,0.01
,,,
,,Attention current status 0%,0.01
,,,
,,Attention current status 1-19%,0.01
,,,
,,Attention current status 20-39%,0.01
,,,
,,Attention current status 40-59%,0.01
,,,
,,Attention current status 60-79%,0.01
,,,
,,Attention current status 80-99%,0.01
,,,
,,Attention current status 100%,0.01
,,,
,,Attention goal status 0%,0.01
,,,
,,Attention goal status 1-19%,0.01
,,,
,,Attention goal status 20-39%,0.01
,,,
,,Attention goal status 40-59%,0.01
,,,
,,Attention goal status 60-79%,0.01
,,,
,,Attention goal status 80-99%,0.01
,,,
,,Attention goal status 100%,0.01
,,,
,,Attention @ DC 0%,0.01
,,,
,,Attention @ DC 1-19%,0.01
,,,
,,Attention @ DC 20-39%,0.01
,,,
,,Attention @ DC 40-59%,0.01
,,,
,,Attention @ DC 60-79%,0.01
,,,
,,Attention @ DC 80-99%,0.01
,,,
,,Attention @ DC 100%,0.01
,,,
,,Memory current status 0%,0.01
,,,
,,Memory current status 1-19%,0.01
,,,
,,Memory current status 20-39%,0.01
,,,
,,Memory current status 40-59%,0.01
,,,
,,Memory current status 60-79%,0.01
,,Memory current status 80-99%,0.01
,,,
,,Memory current status 100%,0.01
,,,
,,Memory goal status 0%,0.01
,,,
,,Memory goal status 1-19%,0.01
,,,
,,Memory goal status 20-39%,0.01
,,,
,,Memory goal status 40-59%,0.01
,,,
,,Memory goal status 60-79%,0.01
,,,
,,Memory goal status 80-99%,0.01
,,,
,,Memory goal status 100%,0.01
,,,
,,Memory @ DC 0%,0.01
,,,
,,Memory @ DC 1-19%,0.01
,,,
,,Memory @ DC 20-39%,0.01
,,,
,,Memory @ DC 40-59%,0.01
,,,
,,Memory @ DC 60-79%,0.01
,,,
,,Memory @ DC 80-99%,0.01
,,,
,,Memory @ DC 100%,0.01
,,,
,,Voice current status 0%,0.01
,,,
,,Voice current status 1-19%,0.01
,,,
,,Voice current status 20-39%,0.01
,,,
,,voice current status 40-59%,0.01
,,,
,,Voice current status 60-79%,0.01
,,,
,,Voice current status 80-99%,0.01
,,,
,,Voice current status 100%,0.01
,,,
,,Voice goal status 0%,0.01
,,,
,,Voice goal status 1-19%,0.01
,,,
,,Voice goal status 20-39%,0.01
,,,
,,Voice goal status 40-59%,0.01
,,,
,,Voice goal status 60-79%,0.01
,,,
,,Voice goal status 80-99%,0.01
,,,
,,Voice goal status 100%,0.01
,,,
,,Voice @ DC 0%,0.01
,,,
,,Voice @ DC 1-19%,0.01
,,,
,,Voice @ DC 20-39%,0.01
,,,
,,Voice @ DC 40-59%,0.01
,,,
,,Voice @ DC 60-79%,0.01
,,Voice @ DC 80-99%,0.01
,,,
,,Voice @ DC 100%,0.01
,,,
,,Other S/L current status 0%,0.01
,,,
,,Other S/L current status 1-19%,0.01
,,,
,,Other S/L current status 20-39%,0.01
,,,
,,Other S/L current status 40-59%,0.01
,,,
,,Other S/L current status 60-79%,0.01
,,,
,,Other S/L current status 80-99%,0.01
,,,
,,Other S/L current status 100%,0.01
,,,
,,Other S/L goal status 0%,0.01
,,,
,,Other S/L goal status 1-19%,0.01
,,,
,,Other S/L goal status 20-39%,0.01
,,,
,,Other S/L goal status 40-59%,0.01
,,,
,,Other S/L goal status 60-79%,0.01
,,,
,,Other S/L goal status 80-99%,0.01
,,,
,,Other S/L goal status 100%,0.01
,,,
,,Other S/L @ DC 0%,0.01
,,,
,,Other S/L @ DC 1-19%,0.01
,,,
,,Other S/L @ DC 20-39%,0.01
,,,
,,Other S/L @ DC 40-59%,0.01
,,,
,,Other S/L @ DC 60-79%,0.01
,,,
,,Other S/L @ DC 80-99%,0.01
,,,
,,Other S/L @ DC 100%,0.01
,,,
,,COGNITIVE SKILLS DEVELOPM,78.86
,,,
,,Motor speech goal status 0%,0.01
,,,
,,Motor speech goal status 1-19%,0.01
,,,
,,Motor speech goal status 20-39%,0.01
,,,
,,Motor speech goal status 40-59%,0.01
,,,
,,Motor speech goal status 60-79%,0.01
,,,
,,Motor speech goal status 80-99%,0.01
,,,
,,Motor speech goal status 100%,0.01
,,,
,,SPEECH SOUND LANG COMPREHEN,552.46
,,,
,,BEHAVRAL QUALIT ANALYS VOICE,263.76
,,,
,,Swallowing current status 0%,0.01
,,,
,,Swallowing current status 1-19%,0.01
,,Swallowing current status 20-39%,0.01
,,,
,,Swallowing current status 40-59%,0.01
,,,
,,Swallowing current status 60-79%,0.01
,,,
,,Swallowing current status 80-99%,0.01
,,,
,,Swallowing current status 100%,0.01
,,,
,,Swallowing goal status 0%,0.01
,,,
,,Swallowing goal status 1-19%,0.01
,,,
,,Swallowing goal status 20-39%,0.01
,,,
,,Swallowing goal status 40-59%,0.01
,,,
,,Swallowing goal status 60-79%,0.01
,,,
,,Swallowing goal status 80-99%,0.01
,,,
,,Swallowing goal status 100%,0.01
,,,
,,Swallowing @ DC 0%,0.01
,,,
,,Swallowing @ DC 1-19%,0.01
,,,
,,Swallowing @ DC 20-39%,0.01
,,,
,,Swallowing @ DC 40-59%,0.01
,,,
,,Swallowing @ DC 60-79%,0.01
,,,
,,Swallowing @ DC 80-99%,0.01
,,,
,,Swallowing @ DC 100%,0.01
,,,
,,Motor speech current status 0%,0.01
,,,
,,Motor speech current status 1-19%,0.01
,,,
,,Motor speech current status 20-39%,0.01
,,,
,,Motor speech current status 40-59%,0.01
,,,
,,Motor speech current status 60-79%,0.01
,,,
,,Motor speech current status 80-99%,0.01
,,,
,,Motor speech current status 100%,0.01
,,,
,,DIABETES TEACHING-EA 30MN,34.72
,,,
,,DIETARY CONSULT,34.72
,,,
,,"MNT,INIT ASSESS-EA 15 MIN",26.78
,,,
,,"MNT, REASSES, EA 15 MIN",26.78
,,,
,,MNT REASSES 2ND REF-EA 15,57.92
,,,
,,WEIGHT LOSS VISIT PER 30 MIN,40
,,,
,,BOOKLETS,5.12
,,,
,,SPEECH BOOKLET,8.79
,,,
,,TELEPHONE,2.91
,,MEDICARE RHC OFFICE VISIT,0
,,,
,,MEDICARE PREVENTATIVE OFFICE VISIT,0
,,,
,,ADMIN FLU VIRUS VACCINE,18
,,,
,,ADMIN PNEUMONIA VACCINE,52.49
,,,
,,FINE NEEDLE ASPIRATION W/O IMAGING,297
,,,
,,ACNE SURGERY MILIA CYSTS,212.1
,,,
,,I&D ABSC; SMPLE OR SGL,252.34
,,,
,,I&D ABSC; COMP OR MULTIPL,445.15
,,,
,,OBTAINING PAP SMEAR,97.55
,,,
,,"CA SCRNING, PELV & BRST E",83.72
,,,
,,"INC & REM FB, SQ; SMPL",317.08
,,,
,,WELCOME MEDICARE VISIT,351.09
,,,
,,PPPS INITIAL VISIT,373.61
,,,
,,PPPS SUSEQ VISIT,249.73
,,,
,,ANNUAL DEPRESSION SCREENI,30.27
,,,
,,IMADM ANY ROUTE 1ST VAC/T,54.56
,,,
,,INADMIN ADD'L VAC <=18 YR,27.04
,,,
,,IMMUNIZATION ADM; 1 VACCI,18.78
,,,
,,IMMUNIZATION ADM; EA ADDT,26.24
,,,
,,IMMUNE ADMIN ORAL/NASAL,18.78
,,,
,,INJ SGL TENDON SHTH OR LI,130.29
,,,
,,TPI (S) - 1/2 MUSCLE(S),121.33
,,,
,,TPI(S) - 3/>MUSCLE(S),137.5
,,,
,,DRAIN/INJECT SM JNT/BURSA,104.08
,,,
,,DRAIN/INJ INTERM JNT/BURS,109.09
,,,
,,DRAIN/INJ MAJOR JNT/BURSA,130.19
,,,
,,THER/PROPH/DIAG INJ. SC/I,53.77
,,,
,,CONTROL NASAL HEMORRH. AN,205.6
,,,
,,CONTROL NASAL HEMORRH. AN,457.68
,,,
,,BACK TO SCHOOL PHYSICAL,25
,,,
,,URINALYSIS NONAUTO W/O SCOPE,16.03
,,,
,,URINE PREG. VISUAL COLOR,18.5
,,,
,,DEB SUBQ TISSUE 20 SQ CM/,244.23
,,,
,,PARE BENIGN LES; SGL,111.55
,,,
,,"TRIM SKIN LESIONS, 2-4",125.83
,,"TRIM SKIN LESIONS, OVER 4",142.01
,,,
,,REM SKIN TAGS; TO 15,192.6
,,,
,,REMOVE SKIN TAGS ADD-ON,43.02
,,,
,,"SHAVE LES, T/A/L; 0.5CM/<",200.31
,,,
,,"SHAVE LES, T/A/L; 0.6-1.0",246.38
,,,
,,"SHAVE LES, T/A/L; 1.1-2.0",290.3
,,,
,,SHAVE LES S/N/F/G;0.5C,204.6
,,,
,,"SHAVE LES, S/N/H/F/G DIAM .6-1.0CM",251.73
,,,
,,SHAVE LESIONS S/N/H/F/G 1.1-2.0 CM,296.72
,,,
,,SHAVE SKIN LESION F/E/E/N/L/M 0.5CM/<,234.59
,,,
,,SHAVE SKIN LESION 1.1-2.0 CM,331
,,,
,,EXC TR-EXT B9+MARG 0.5 <,269.38
,,,
,,"EXC, BEN LES,T/A/L; 0.6-1",316.48
,,,
,,"EXC, BEN LES T/A/L; 1.1-2",352.17
,,,
,,"EXC, BEN LES, T/A/L;2.1-3",406.6
,,,
,,"EXC, BEN LES, T/A/L;3.1-4",462.13
,,,
,,"EXC, BLES,S/N/EX,G;0.5CM/",269.32
,,,
,,"EXC, BLES, S/N/EX,G;0.6-1",334.08
,,,
,,"EXC, BLS,S/N/EX, G;1.1-2.",373.49
,,,
,,"EXC, BLES, S/N/EX,G;2.1-3",430.37
,,,
,,"EXC, BLES, S/N/EX,G;3.1-4",497.65
,,,
,,EXC FACE-MM B9+MARG 0.5<,295.96
,,,
,,EXC FACE-MM B9+MARG 0.6-1,357.64
,,,
,,EXC FACE-MM B9+MARG 1.1-2,401.41
,,,
,,EXC FACE-MM B9+MARG 2.1-3,479.25
,,,
,,EXC FACE-MM B9+MARG 3.1-4,602.62
,,,
,,CHANGE OF WINDPIPE AIRWAY,85
,,,
,,EXC MLES T/A/L;1.1-2.0CM,528.12
,,,
,,EXC TREAT EXT MAL+MARB 3.1-4CM,650
,,,
,,REMOVAL OF NAIL PLATE,213.43
,,,
,,DRAIN BLOOD FROM UNDER TO,105.72
,,,
,,EXCISON NAIL PERMANENT REMOVAL,387.31
,,,
,,WEDGE EXCISION SKIN NAIL FOLD,358.85
,,,
,,SIMPLE LAC REP 0-2.5CM,190.21
,,,
,,SIMPLE LAC REP 2.6-7.5 CM,232.17
,,SIMPLE LAC 7.6-A12.5CM,273.85
,,,
,,SIMPLE LAC 12..6-20.0CM,346.08
,,,
,,SIMPLE FACE LAC 0-2.5CM,233.07
,,,
,,SIMPLE FACE LAC 2.6-5.0CM,244.06
,,,
,,SIMPLE FACE LAC 5.1-7.5CM,286.13
,,,
,,LAYERED LAC 0-2.5CM,504.59
,,,
,,INTMD REPAIR EXT 7.6-12.5,750
,,,
,,"OCCULT BLOOD, FECES",14.88
,,,
,,TYMPANOGRAM,35.93
,,,
,,GLUCOSE BLD BY MONITOR,6.86
,,,
,,"DIL URETH STRICT, SOUND;M",181.71
,,,
,,HEMOGLOBIN,19.82
,,,
,,ALLERGY SINGLE INJECTION,22.51
,,,
,,ALLGERY TWO OR MORE INJEC,27.85
,,,
,,"REM FB, CONJUNCTIVA; SUPE",123.5
,,,
,,"REM FB, EXT EYE; CORNEAL,",127.01
,,,
,,I & D OF VULVA OR PERINEAL ABSCESS,236.08
,,,
,,ROUTINE VENIPUNCTURE,19.99
,,,
,,IRRIG DRUG DELIVERY DEVIC,65
,,,
,,"SKIN TEST;TB, ID",16.81
,,,
,,STREP TEST,35.08
,,,
,,REMOVE IMPACTED EAR WAX- BILATERAL,52.5
,,,
,,REMOVE IMPACTED EAR WAX- BILATERAL,231
,,,
,,DESTRUCT PREMALG LESION,142.24
,,,
,,"DESTRUCT PREMLG LES, 2-1",21.42
,,,
,,"DESTRUCT B9 LESION, 1-14",235.59
,,,
,,"DESTRUCT LESION, 15 OR MO",279.54
,,,
,,CLOSED TR MEDIAL MALL FRACTURE W/O MANIP,700
,,,
,,,
,,RAPID FLU TEST,49.07
,,,
,,ENDOMETRIAL BX WO CERVICAL DILATION,234.59
,,,
,,REMOVAL-FB-FOOT-SUBCUTA,561.1
,,,
,,FOLLOW UP VISIT,0
,,,
,,LONG ARM SPLINT MOLDED,190.1
,,,
,,APPLY SHORT ARM SPLINT,141.88
,,REM FB EXT AUDITORY CANAL,212.88
,,,
,,NEW PT OFFICE VISIT LVL 1,82.38
,,,
,,NEW PT OFFICE VISIT LVL 2,142.63
,,,
,,NEW PT OFFICE VISIT LVL 3,205.24
,,,
,,NEW PT CLINIC VISIT LVL 4,316
,,,
,,NEW PT CLINIC VISIT LVL 5,394.56
,,,
,,REMOVE IMPACTED EAR WAS UNI,26.33
,,,
,,REMOVAL IMPACTED CERUMEN,115.59
,,,
,,EST PT CLINIC VISIT LVL 1,39.74
,,,
,,EST PT CLINIC VISIT LVL 2,83.07
,,,
,,EST PT CLINIC VISIT LVL 3,138.72
,,,
,,EST PT CLINIC VISIT LVL 4,206.1
,,,
,,EST PT CLINIC VISIT LVL 5,277.44
,,,
,,DISCH FROM OBSERVATION,158.72
,,,
,,INITIAL OBS/DA LEVEL 1,214.83
,,,
,,INITIAL OBS/DAY LEVEL 2,294.95
,,,
,,INITIAL OBS/DAY LEVEL 3,404.54
,,,
,,INPATIENT E/M INIT LEVEL1,221.44
,,,
,,INPT E/M INIT LEVEL 2,300.53
,,,
,,INPT E/M INIT LEVEL 3,442.63
,,,
,,"SUBS OBSERV, LEVEL 1",87.76
,,,
,,"SUBS OBSERV, LEVEL 2",160.09
,,,
,,"SUBS OBSERV, LEVEL 3",229.74
,,,
,,INPT E/M SUBS LEVEL 1,86.65
,,,
,,INPT E/M SUBS LEVEL 2,159.01
,,,
,,INPT E/M SUBS LEVEL 3,227.92
,,,
,,INPT E/M SUBS LEVEL 4,300.58
,,,
,,INPT E/M SUBS LEVEL 5,373.94
,,,
,,INPT E/M DISCH MGMT,158.35
,,,
,,DISCHARGE MGMT +30 MIN,233.88
,,,
,,"NURSING FAC CARE, INIT LO",202.09
,,,
,,"NURSING FAC CARE,INIT MED",285.75
,,,
,,"NURSING FAC CARE, INIT HI",363.94
,,,
,,"NURSING FAC CARE, SUBS LO",96.47
,,,
,,"NURSING FAC CARE, SUBSSQ",149.26
,,"NURSING FAC CARE, SUBSEQ",196.84
,,,
,,"NURSING FAC CARE, SUBSEQ",292.23
,,,
,,SNF DISCHARGE < 30 MIN,157.99
,,,
,,SNF DISCHARGE >30 MIN,227.69
,,,
,,"HOME VISIT, EST PATIENT",123.08
,,,
,,PROLONGED SERVICE,219.78
,,,
,,"PREV MED, NEW PT  <1YR",194.42
,,,
,,"PREV MED, NEW PT, 1-4 YRS",205.14
,,,
,,"PREV MED, NEW PT, 5-11 YR",211.46
,,,
,,"PREV MED, NEW PT, 12-17 Y",239.9
,,,
,,"PREV MED, NEW PT, 18-39 Y",232.72
,,,
,,"PREV MED, NEW PT, 40-64 Y",269.19
,,,
,,"PREV MED, NEW PT+65 YRS",292.07
,,,
,,"PREV MED, EST PT, < 1YR",174.66
,,,
,,"PREV MED, EST PT, 1-4 YRS",186.82
,,,
,,"PREV MED, EST PT, 5-11 YR",186.22
,,,
,,"PREV MED, EST PT, 12-17 Y",204.7
,,,
,,"PREV MED, EST PT, 18-39YR",209.26
,,,
,,"PREV MED, EST PT, 40-64 Y",223.24
,,,
,,"PREV MED, EST PT, >=65YRS",239.9
,,,
,,APP OF SHORT LEG  CAST,176.94
,,,
,,HEALTH RISK ASSESSMENT,26.78
,,,
,,NEBULIZER TX,38.86
,,,
,,TRANS CARE MGMT 14 DAY DISCH,200
,,,
,,TRANSITIONAL CARE MGMT 7 DAY DISCHARGE,275
,,,
,,ADVANCE CARE PLAN 30 MINUTES,85
,,,
,,ADVANCE CARE PLAN ADDITIONAL 30 MIN,75
,,,
,,APPLY LOWER LEG SPLINT,159.66
,,,
,,STRAPPING:UNNA BOOT,57.18
,,,
,,NURSING HOME/ EMPLOY EXAM,58.92
,,,
,,SPORT PHYSICAL-EST PT,15
,,,
,,DOT EXAM,58.97
,,,
,,SPORTS PHYSICAL-NEW PT,15
,,,
,,DAYCARE CHILD PHYSICAL,25
,,,
,,EMPLOYMENT PHYSICAL,75
,,AFHC MEDICAID/MCO RHC VISIT,0
,,,
,,MEDICARE RHC OFFICE VISIT,0
,,,
,,MEDICARE PREVENTATIVE VISIT,0
,,,
,,DESTRUCT PREMALIGNANT LESION 15/>,325
,,,
,,ADMIN FLU VIRUS VACCINE,18
,,,
,,ADMIN PNEUMONIA VACCINE,52.49
,,,
,,FNA W/O IMAGE,297
,,,
,,ACNE SURGERY MILIA CYSTS,212.1
,,,
,,I&D ABSC; SMPLE OR SGL,252.34
,,,
,,I&D ABSC; COMP OR MULTIPL,445.15
,,,
,,OBTAINING PAP SMEAR,97.55
,,,
,,"CA SCRNING, PELV & BRST E",83.72
,,,
,,"INC & REM FB, SQ; SMPL",317.08
,,,
,,"I&D HEMATOMA, SEROMA, FLUID COLLECTION",340.64
,,,
,,REMOVE FOREIGN BODY INTRANASAL,397.99
,,,
,,WELCOME MEDICARE VISIT,351.09
,,,
,,PPPS INITIAL VISIT,373.61
,,,
,,PPPS SUBSEQ VISIT,249.73
,,,
,,ANNUAL DEPRESSION SCREENI,30.27
,,,
,,INADMIN 1ST VAC <=18 YRS,54.56
,,,
,,INADMIN ADD'L VAC <=18 YR,27.04
,,,
,,IMMUNIZATION ADM; 1 VACCI,18.78
,,,
,,IMMUNIZATION ADM; EA ADDT,26.24
,,,
,,IMMUNE ADMIN ORAL/NASAL,18.78
,,,
,,INJ SGL TENDON SHTH OR LI,130.29
,,,
,,TPI (S) - 1/2 MUSCLE(S),121.33
,,,
,,TPI(S) - 3/>MUSCLE(S),137.5
,,,
,,DRAIN/INJECT SM JNT/BURSA,104.08
,,,
,,DRAIN/INJ INTERM JNT/BURS,109.09
,,,
,,DRAIN/INJ MAJOR JNT/BURSA,130.19
,,,
,,"THER/PROPH/DIAG INJ, SC/I",53.77
,,,
,,CONTROL NASAL HEMORRH. AN,205.6
,,,
,,CONTROL NASAL HEMORRH. AN,457.68
,,,
,,BACK TO SCHOOL PHYSICAL,25
,,,
,,DEBR EXZ/INF SKIN; 10% BS,116.58
,,DEB SUBQ TISSUE 20 SQ CM/,244.23
,,,
,,PARE BENIGN LES; SGL,111.55
,,,
,,"TRIM SKIN LESIONS, 2-4",125.83
,,,
,,"TRIM SKIN LESIONS, OVER 4",142.01
,,,
,,TANGENTIAL BIOPSY SKIN SINGLE LESION,240
,,,
,,PUNCH BIOPSY SKIN LESION,210
,,,
,,PUNCH BIOPSY SKIN EACH ADDITIONAL,145
,,,
,,REM SKIN TAGS; TO 15,192.6
,,,
,,REMOVE SKIN TAGS ADD-ON,43.02
,,,
,,"SHAVE LES, T/A/L; 0.5CM/<",200.31
,,,
,,"SHAVE LES, T/A/L; 0.6-1.0",246.38
,,,
,,"SHAVE LES, T/A/L; 1.1-2.0",290.3
,,,
,,SHAVE LES T/A/L; > 2.0CM,321.36
,,,
,,SHAVE LES S/N/F/G;0.5C,204.6
,,,
,,"SHAVE LES,S/N/H/F/G;0.6-1",251.73
,,,
,,SHAVE LESIONS 1 S/N/F/G 1.1-2.0 CM,296.72
,,,
,,SHAVE SKIN LESION 0.5CM/<,234.59
,,,
,,"SHAVE LES,F/E/N/L;0.6-1.0",242.74
,,,
,,SHAVE SKIN LESION 1.1-2.0 CM,331
,,,
,,SHAVE LESION F/E/E/N/ > 2.0 CM,396.45
,,,
,,EXC TR-EXT B9+MARG 0.5 <,269.38
,,,
,,"EXC, BEN LES,T/A/L; 0.6-1",316.48
,,,
,,"EXC, BEN LES T/A/L; 1.1-2",352.17
,,,
,,"EXC, BEN LES, T/A/L;2.1-3",406.6
,,,
,,"EXC, BEN LES, T/A/L;3.1-4",462.13
,,,
,,"EXC, BLES,S/N/EX,G;0.5CM/",269.32
,,,
,,"EXC, BLES, S/N/EX,G;0.6-1",334.08
,,,
,,"EXC, BLS,S/N/EX, G;1.1-2.",373.49
,,,
,,"EXC, BLES, S/N/EX,G;2.1-3",430.37
,,,
,,"EXC, BLES, S/N/EX,G;3.1-4",497.65
,,,
,,EXC FACE-MM B9+MARG 0.5<,295.96
,,,
,,EXC FACE-MM B9+MARG 0.6-1,357.64
,,,
,,EXC FACE-MM B9+MARG 1.1-2,401.41
,,,
,,EXC FACE-MM B9+MARG 2.1-3,479.25
,,,
,,EXC FACE-MM B9+MARG 3.1-4,602.62
,,CHANGE OF WINDPIPE AIRWAY,85
,,,
,,EXCISION MAL LESION TRUNK/ARM .5CM/<,417.96
,,,
,,"EXC MLES,T/A/L;0.6-1.0CM",485.92
,,,
,,EXC MLES T/A/L;1.1-2.0CM,528.12
,,,
,,"EXC MLES, T/A/L;2.1-3.0CM",604.74
,,,
,,EXC TREAT EXT MAL +MARG 3.1-4CM,650
,,,
,,EXCISION MAL LESION S/N/F/G/ 0.5CM/<,412.39
,,,
,,"EXC MLES,S/N/EXT/G;0.6-1.",489.38
,,,
,,"EXC MLES, S/N/EXT/G;1.1-2",546.85
,,,
,,"EXC MLES, S/N/EXT/G;2.1-3",643.34
,,,
,,EXC S/N/H/F/G MAL+MRG 3.1-4,725.12
,,,
,,EXCISION MALIGNANT LESION >4.0,920
,,,
,,"EXC MLES,F/E/E/N/L;0.5CM/",425.98
,,,
,,"EXC MLES,F/E/E/N/L;0.6-1.",506.87
,,,
,,"EXC MLES,F/E/E/N/L;1.1-2.",579.91
,,,
,,INSERT BLADDER CATHETER,117.09
,,,
,,INS TEMP BLADDER CATH,150.43
,,,
,,INSERT BLADDER CATH COMPLEX,310
,,,
,,CHANGE OF CYSTOSTOMY TUBE,199.71
,,,
,,AVULSION NAIL PLATE,213.43
,,,
,,DRAIN BLOOD FROM UNDER TO,105.72
,,,
,,REMOVAL OF NAIL BED,387.31
,,,
,,WEDGE EXCISION SKIN NAIL FOLD,358.85
,,,
,,INSERT NON-BIODEGRADABLE DRUG,350
,,,
,,REMOVAL OF DRUG DELIVERY IMPLANT,290.45
,,,
,,SIMPLE LAC REP 0-2.5CM,190.21
,,,
,,SIMPLE LAC REP 2.6-7.5 CM,232.17
,,,
,,SIMPLE LAC 7.6-A12.5CM,273.85
,,,
,,SIMPLE LAC 12..6-20.0CM,346.08
,,,
,,SIMPLE FACE LAC 0-2.5CM,233.07
,,,
,,SIMPLE FACE LAC 2.6-5.0CM,244.06
,,,
,,SIMPLE FACE LAC 5.1-7.5CM,286.13
,,,
,,AUDIO OR TELEHEALTH VISIT,110.9
,,,
,,LAYERED LAC 0-2.5 CM,504.59
,,,
,,REPAIR INTERMED 2.6-7.5 CM,750
,,INTMD REPAIR EXT 7.6-12.5,750
,,,
,,REPAIR INT N/H/F GENT 2.6-7.5CM,617.34
,,,
,,OCCULT BLD FECES 1-3 TESTS,14.88
,,,
,,SIALOLITHOTOMY; SM UNCOMPLICATED,509.87
,,,
,,ASPIRATE PLEURA W/ IMAGING,735
,,,
,,TYMPANOGRAM,35.93
,,,
,,"DIL URETH STRICT, SOUND;M",181.71
,,,
,,DILATE FEMALE URETHRA; INITIAL,145.06
,,,
,,DILATE FEMALE URETHRA; FU,148.7
,,,
,,NASAL /OROGASTRIC W/TUBE PLMT,92.19
,,,
,,INJ ANES TRIGEMINAL NERVE,315
,,,
,,TSH,49.17
,,,
,,ALLERGY SINGLE INJECTION,22.51
,,,
,,ALLGERY TWO OR MORE INJEC,27.85
,,,
,,"REM FB, CONJUNCTIVA; SUPE",123.5
,,,
,,"REM FB, EXT EYE; CORNEAL,",127.01
,,,
,,INCISE THROMBOSED HEMORRHOID EXT,375.74
,,,
,,REMOVAL OF HEMORROID CLOT,391.46
,,,
,,IRRIG DRUG DELIVERY DEVIC,65
,,,
,,STREP TEST,35.08
,,,
,,REMOVE IMPACTED EAR WAX- BILATERAL,52.5
,,,
,,REMOVE IMPACTED EAR WAX-BILATERAL,231
,,,
,,DESTRUCT PREMALG LESION,142.24
,,,
,,"DESTRUCT PREMLG LES, 2-1",21.42
,,,
,,"DESTRUCT B9 LESION, 1-14",235.59
,,,
,,"DESTRUCT LESION, 15 OR MO",279.54
,,,
,,DESTR MLES T/A/L; 0.5 CM/,216.47
,,,
,,DESTRUCTION MALIGNANT LESION F/E/E/N/L/M,300.01
,,,
,,CLOSED TR MEDAL MALL FRACTURE W/O MANIP,700
,,,
,,,
,,ACUPUNCTURE,71.99
,,,
,,REMOVE EYELID FOREIGN BODY,580
,,,
,,CORONER'S CALL LEV 2,370.08
,,,
,,ENDOMETRIAL BX WO CERVICAL DILATION,234.59
,,,
,,REMOVAL-FB-FOOT-SUBCUTA,561.1
,,INSERT INTRAUTERINE DEVICE,175
,,,
,,OMT AREA 1-2,61.68
,,,
,,OMT AREA 3-4,82.16
,,,
,,OMT AREA 5-6,120.86
,,,
,,FOLLOW UP VISIT,0
,,,
,,APPLY LONG ARM CAST,208.84
,,,
,,APPLY SHORT ARM CAST,195
,,,
,,LONG ARM SPLINT MOLDED,190.1
,,,
,,APPLY SHORT ARM SPLINT; S,141.88
,,,
,,REM FB EXT AUDITORY CANAL,212.88
,,,
,,NEW PT OFFICE VISIT LVL 1,82.38
,,,
,,NEW PT OFFICE VISIT LVL 2,142.63
,,,
,,NEW PT OFFICE VISIT LVL 3,205.24
,,,
,,NEW PT CLINIC VISIT LVL 4,316
,,,
,,NEW PT CLINIC VISIT LVL 5,394.56
,,,
,,REMOVE IMPACTED EAR WAX UNI,26.33
,,,
,,REMOVAL IMPACTED CERUMEN,115.59
,,,
,,EST PT CLINIC VISIT LVL 1,39.74
,,,
,,EST PT CLINIC VISIT LVL 2,83.07
,,,
,,EST PT CLINIC VISIT LVL 3,138.72
,,,
,,EST PT CLINIC VISIT LVL 4,206.1
,,,
,,EST PT CLINIC VISIT LVL 5,277.44
,,,
,,DISCH FROM OBSERVATION,158.72
,,,
,,INITIAL OBS/DA LEVEL 1,214.83
,,,
,,INITIAL OBS/DAY LEVEL 2,294.95
,,,
,,INITIAL OBS/DAY LEVEL 3,404.54
,,,
,,INPATIENT E/M INIT LEVEL1,221.44
,,,
,,INPT E/M INIT LEVEL 2,300.53
,,,
,,INPT E/M INIT LEVEL 3,442.63
,,,
,,"SUBS OBSERV, LEVEL 1",87.76
,,,
,,"SUBS OBSERV, LEVEL 2",160.09
,,,
,,"SUBS OBSERV, LEVEL 3",229.74
,,,
,,INPT E/M SUBS LEVEL 1,86.65
,,,
,,INPT E/M SUBS LEVEL 2,159.01
,,,
,,INPT E/M SUBS LEVEL 3,227.92
,,INPT E/M SUBS LEVEL 4,300.58
,,,
,,INPT E/M SUBS LEVEL 5,373.94
,,,
,,OBSERV/HOSP SAME DATE,480.47
,,,
,,INPT E/M DISCH MGMT,158.35
,,,
,,DISCHARGE MGMT +30 MIN,233.88
,,,
,,"NURSING FAC CARE, INIT LO",202.09
,,,
,,"NURSING FAC CARE,INIT MED",285.75
,,,
,,"NURSING FAC CARE, INIT HI",363.94
,,,
,,"NURSING FAC CARE, SUBS LO",96.47
,,,
,,"NURSING FAC CARE, SUBSSQ",149.26
,,,
,,"NURSING FAC CARE, SUBSEQ",196.84
,,,
,,"NURSING FAC CARE, SUBSEQ",292.23
,,,
,,SNF DISCHARGE < 30 MIN,157.99
,,,
,,SNF DISCHARGE >30 MIN,227.69
,,,
,,"HOME VISIT, EST PATIENT",123.08
,,,
,,HOME VISIT EST PATIENT,186.03
,,,
,,PROLONGED SERVICE,219.78
,,,
,,PROLONGED E/M SVC BEFORE/AFTER DIR PT CA,195
,,,
,,"PREV MED, NEW PT < 1YR",194.42
,,,
,,"PREV MED, NEW PT, 1-4 YRS",205.14
,,,
,,"PREV MED, NEW PT, 5-11 YR",211.46
,,,
,,"PREV MED, NEW PT, 12-17 Y",239.9
,,,
,,"PREV MED, NEW PT, 18-39 Y",232.72
,,,
,,"PREV MED, NEW PT, 40-64 Y",269.19
,,,
,,"PREV MED, NEW PT+65 YRS",292.07
,,,
,,"PREV MED, EST PT, < 1YR",174.66
,,,
,,"PREV MED, EST PT, 1-4 YRS",186.82
,,,
,,"PREV MED, EST PT, 5-11 YR",186.22
,,,
,,"PREV MED, EST PT, 12-17 Y",204.7
,,,
,,"PREV MED, EST PT, 18-39YR",209.26
,,,
,,"PREV MED, EST PT, 40-64 Y",223.24
,,,
,,"PREV MED, EST PT, >=65YRS",239.9
,,,
,,APP OF SHORT LEG  CAST,176.94
,,,
,,HEALTH RISK ASSESSMENT,26.78
,,,
,,NEBULIZER TX,39.94
,,TRANS CARE MGMT 14 DAY DISCH,200
,,,
,,TRANS CARE MGMT 7 DAY DISCH,275
,,,
,,,275
,,,
,,ADVANCED CARE PLAN 30 MINUTES,85
,,,
,,ADVANCE CARE PLAN ADDITIONAL 30 MIN,75
,,,
,,APPLY LOWER LEG SPLINT,159.66
,,,
,,STRAPPING:UNNA BOOT,117.61
,,,
,,NURSING HOME AGE 40-64,58.92
,,,
,,SPORT PHYSICAL-EST PT,15
,,,
,,DOT EXAM,58.97
,,,
,,SPORT  PHYSICAL-NEW PT,15
,,,
,,DAYCARE CHILD PHYSICAL,25
,,,
,,EMPLOYMENT PHYSICAL,75
,,,
,,DRIVERS LICENSE EXAM,75
,,,
,,AFHC MEDICAID/MCO RHC VISIT,0
,,,
,,"TDAP, ADACEL, IM",60.18
,,,
,,"HIB PRP-T, ACTHIB, IM",20
,,,
,,ALBUTEROL NON-COMP UNIT 1,2.41
,,,
,,NITROSTAT SL TAB 0.4MG,5
,,,
,,BETAMETHASONE ACET&SOD PHOSP 3MG,21.42
,,,
,,DEXAMETHASONE 4MG/ML VIAL,3.75
,,,
,,DIAZEPAM 10MG/2ML SYRINGE,43.16
,,,
,,CEFTRIAXONE 1 GM VIAL,33.99
,,,
,,"RABIES VIRUS VACCINE, HDC INJ",615
,,,
,,DEPO T INJECTION 1MG,0.11
,,,
,,DIPHENHYDAMINE 50 MG,17.45
,,,
,,DEPO MEDROL 80 MG VIAL,42.3
,,,
,,DEPO-MEDROL 40 MG VIAL,29.1
,,,
,,"VFC HEP A PEDS, HAVRIX, IM",0
,,,
,,VFC HEP B,0
,,,
,,"MENINGITIS B, TRUMENBA, IM",181.15
,,,
,,"HEP-A VACCINE ADULT, HAVRIX, IM",90.87
,,,
,,"PEDIATRIC HEP A VACCINE, HAVRIX, IM",90.87
,,,
,,FUROSEMIDE 40 MG VIAL,16.25
,,,
,,FLU VAC NO PRSV 3 VAL 6-35 M,25
,,"FLU VACCINE, 3 YRS & >",25
,,,
,,"FLU VACCINE HIGH DOSE, FLUZONE HD, IM",82.5
,,,
,,FLU VACCINE 3 YRS & > IM,25
,,,
,,"PNEUMOCOCCAL VACCINE 13, PREVNAR, IM",315
,,,
,,INFLUENZA VIRUS VAC QUAD LIVE INTRANASAL,31.62
,,,
,,,
,,VFC FLU VACCINE 4 VALENT NASAL,0
,,,
,,"ROTOVIRUS VACCINE, ROTATEQ, PO",133.9
,,,
,,"FLU VAC 6-35M, FLUZONE, IM",25
,,,
,,"FLU VACCINE QUAD, FLUZONE/FLULAVAL, IM",25
,,,
,,"DTAP-IPV VACCINE 4-6 YRS, KINRIX,  IM",73.11
,,,
,,"DTAP VACCINE, DAPTACEL, IM",40
,,,
,,"MMR VACCINE, SQ",88.91
,,,
,,"POLIOVIRUS IPV, IPOL, SC/IM",50.3
,,,
,,"LIVE VARICELLA VACCINE, VARIVAX, SQ",160.5
,,,
,,"TD VACCINE, IM",33.55
,,,
,,"DTAP-HEPB-IPV, PEDIARIX, IM",130.42
,,,
,,"PNEUMOCOCCAL VACCINE 23, PNEUMOVAX, IM",275
,,,
,,SQ MPV VACCINE,180.71
,,,
,,"MENACWY VACCINE, MENACTRA, IM",125.5
,,,
,,HEPB VACC ILL PAT 3 DOSE,202.62
,,,
,,"HPV IMMUNIZATION, GARDASIL, IM",259.5
,,,
,,"HEP B ADULT, ENGERIX, IM",101.6
,,,
,,HYDROXYZINE 25MG,11.42
,,,
,,KENALOG 40 MG VIAL,16.7
,,,
,,ORPHENADRINE INJ TO 60MG,63.56
,,,
,,PHENERGAN 25 MG,8.75
,,,
,,PEN BENZATHINE/PROCAINE,188.53
,,,
,,METOCLOPRAMIDE 10MG/2ML,22.94
,,,
,,ROCEPHIN INJECTION 250ML,28.01
,,,
,,SOLU-MEDROL 40 MG VIAL,19.16
,,,
,,SOLUMEDROL 125 MG,25.21
,,,
,,SILVADENE CREAM,12.52
,,,
,,KETOROLAC 30 MG VIAL,6.56
,,,
,,KETOROLAC 60MG IM,8.45
,,VITAMIN B-12,11.98
,,,
,,ZOFRAN INJ PER 1 MG,10.24
,,,
,,SILVER NITRATE APPLICATOR,4.38
,,,
,,DEXTROSE 50% SYRINGE,12.65
,,,
,,EPINEPHRINE 0.1MG/ML SYRINGE,6.86
,,,
,,ATROPINE 1MG/10ML SYRINGE,7.96
,,,
,,CALCIUM CHLORIDE 10% SYRINGE,15.74
,,,
,,LIDOCAINE 2% SYRINGE,6.76
,,,
,,EPINPEHRINE 1MG/ML AMPULE,2.4
,,,
,,NALOXONE 0.4MG/ML VIAL,24.28
,,,
,,OXYTOCIN 10UNIT/ML VIAL,0.92
,,,
,,AMMONIA INHALANT AMPULE,0.52
,,,
,,NIFEDIPINE 10MG TABLET,2
,,,
,,METOPROLOL TART 5MG/5ML VIAL,1
,,,
,,SODIUM CHLORIDE 1000ML BAG,3.32
,,,
,,INDOMETHACIN,1
,,,
,,XYLOCAINE 1% VIAL,0
,,,
,,XYLOCAINE 1% WITH EPI VIAL,0
,,,
,,XYLOCAINE 2% VIAL,0
,,,
,,XYLOCAINE 2% WITH EPI VIAL,0
,,,
,,MARCAINE 0.25% VIAL,0
,,,
,,MARCAINE 0.5% VIAL,0
,,,
,,ACTIVATED CHARCOAL 25 GM,29.08
,,,
,,ASPIRIN 81 MG CHEWABLE,1.25
,,,
,,BENZOIN TINCTURE SWAB,0
,,,
,,GENTIAN VIOLET,0
,,,
,,EMLA CREAM,0
,,,
,,PHENYLEPHRINE 1% NASAL SPRAY,7.84
,,,
,,ETHYL CHLORIDE WOUND SPRAY,0
,,,
,,MAG-AL SUSPENSION 30 ML,2.75
,,,
,,LEVALBUTEROL 1.25MG/0.5ML,3.28
,,,
,,IPRATROPIUM/ALBUTEROL SVN,1.25
,,,
,,EPINEPHRINE AUTO-INJECTOR ADULT,262.4
,,,
,,EPINEPHRINE AUTO-INJECTOR PEDS,262.4
,,,
,,GLUCOSE GEL,0
,,TRIPLE ANTIBIOTIC PACK,0
,,,
,,ONDANSETRON 4MG/2ML VIAL,2.25
,,,
,,TB TEST TUBERSOL,16.81
,,,
,,ACETAMIN 160MG/5L UD CUP,2.25
,,,
,,CLONIDINE 0.1 MG TAB,2.5
,,,
,,CEFTRIAXONE 2 GM VIAL,6.5
,,,
,,SOD CHL 10ML FLUSH,2
,,,
,,LIDOCAINE 2% VISCOUS ORAL,4.25
,,,
,,DONNATAL ELIXIR,14.75
,,,
,,OXYMETAZOLINE 0.05% NASAL SRAY AFHC,15.25
,,,
,,MECLIZINE 25 MG TAB AFHC,2
,,,
,,KYLEENA IUD 19.5 MG AFHC,"1,716.23"
,,,
,,SKYLA 13.5 MG IUD,"1,465.87"
,,,
,,"VFC ROTAVIRUS, ROTARIX, PO",0
,,,
,,"VFCHIB, ACTHIB, IM",0
,,,
,,"VFC TD, IM",0
,,,
,,"VFC HPV, GARDASIL-9, IM",0
,,,
,,"VFC FLU VAC QUAD 6-35M, FLUZONE, IM",0
,,,
,,"VFC FLU VACCINE QUAD, FLUZONE, IM",0
,,,
,,VFC INFLUENZA,0
,,,
,,"VFC DTAP, DAPTACEL, IM",0
,,,
,,"VFC VARICELLA LIVE, VARIVAX, SQ",0
,,,
,,"VFC POLIO, IPOL, SC/IM",0
,,,
,,"VFC DTAP-HEPB-IPV, PEDIARIX, IM",0
,,,
,,"VFC PNEUMONIA 13 VACCINE, PREVNAR, IM",0
,,,
,,"VFC TDAP, ADACEL, IM",0
,,,
,,"VFC MMR, SQ",0
,,,
,,"VFC MENIGOCOCCOL A, MENACTRA, IM",0
,,,
,,VFC H1N1 INJECTABLE,0
,,,
,,VFC-H1N1 NASAL,0
,,,
,,"VFC-DTAP IPV VACCINE 4-6 YRS, KINRIX, IM",0
,,,
,,VFC- MMRV VACCINE SC,0
,,,
,,"VFC TDAP, BOOSTRIX, IM",0
,,,
,,"VFC HIB, PEDVAXHIB, IM",0
,,,
,,"VFC DTAP/IPV/HIB, PENTACEL, IM",0
,,"VFC MMR/VARICELLA, PROQUAD, SQ",0
,,,
,,"VFC MENINGITIS B, TRUMENBA, IM",0
,,,
,,"VFC ROTOVIRUS, ROTARIX, PO",0
,,,
,,"VFC ROTOVIRUS, ROTATEQ, PO",0
,,,
,,"FLU VAC QUAD, FLUZONE, IM, MEDICARE",0
,,,
,,"FLU VAC HD, FLUZONE HD, IM, MEDICARE",0
,,,
,,"TYPHOID VACCINE, IM, PRIVATE",115
,,,
,,"HEPATITIS B VAC, PEDS, IM, PRIVATE",35
,,,
,,"VFC HEP B, PEDS,ENGERIX,  IM",0
,,,
,,"MMRV, PRIVATE, SUBQ",290
,,,
,,"SHINGRIX, IM, PRIVATE",350
,,,
,,"MEN B, BEXSERO, IM, PRIVATE",228.6
,,,
,,"INFLUENZA, FLUBLOK, PRIVATE, IM",82.5
,,,
,,"INFLUENZA, FLUBLOK, MEDICARE, IM",0
,,,
,,"PNEUMOCOCCAL, PREVNAR, IM, MEDICARE",0
,,,
,,"PNEUMOCOCCAL, PNEUMOVAX, IM, MEDICARE",0
,,,
,,"MEN B, BEXSERO, IM, VFC",0
,,,
,,VFC ADMIN FEE,19.68
,,,
,,DERMABOND,25.42
,,,
,,SMALL VOLUME NEBULIZER,2.45
,,,
,,SILVER SULFADIAZINE CREAM 1% 25 GM TUBE,18.54
,,,
,,DUODERM CGF 4X4 (AFHC,7.87
,,,
,,AQUACELL AG RIBBON,24.12
,,,
,,EXERCISER VOLUMETRIC VOLDYNE 500,8.23
,,,
,,CHRONIC CARE MANAGEMENT,63
,,,
,,SPORTS PHYSICAL,15
,,,
,,ADMIN FLU VIRUS VACCINE,18
,,,
,,ADMIN PNEUMONIA VACCINE,52.49
,,,
,,EMC MEDICARE OFFICE VISIT,0
,,,
,,EMC MEDICARE PREV EXAM,0
,,,
,,FINE NEEDLE ASPIRATION W/O IMAGING GUID,297
,,,
,,I&D ABSC; SMPL OR SGL,252.34
,,,
,,OBTAINING PAP SMEAR,97.55
,,,
,,"CA SCRNING, PELV & BRST E",83.72
,,,
,,"INC & REM FB, SQ; SMPL",317.08
,,"INC & REM FB, SQ; COMPL",588.34
,,,
,,PUNCT ASP - ABSC HEMAT CY,272.09
,,,
,,"REM FB, INTRANASAL; OFFIC",397.99
,,,
,,"BLOOD OCCULT TEST,COLOREC",14.88
,,,
,,WELCOME MEDICARE VISIT,351.09
,,,
,,PPPS INITIAL VISIT,373.61
,,,
,,PPPS SUBSEQ VISIT,249.73
,,,
,,ANNUAL DEPRESSION SCREENI,30.27
,,,
,,INADMIN 1ST VAC <=18 YRS,54.56
,,,
,,INADMIN ADD'L VAC <=18 YR,27.04
,,,
,,IMMUNIZATION ADM; 1 VACCI,18.78
,,,
,,IMMUNIZATION ADM; EA ADDT,26.24
,,,
,,IMMUNE ADMIN ORAL/NASAL,18.78
,,,
,,INJ SGL TENDON SHTH OR LI,130.29
,,,
,,TPI(S) - 1/2 MUSCLE(S,121.33
,,,
,,TPI(S) - 3/> MUSCLE(S),137.5
,,,
,,DRAIN/INJECT SM JNT/BURSA,104.08
,,,
,,DRAIN/INJ INTERM JNT/BURS,109.09
,,,
,,DRAIN/INJ MAJOR JNT/BURSA,130.19
,,,
,,ASPIRATE/INJ GANGLION CYS,132.9
,,,
,,INTRANASAL LIVE FLU VACCI,34.11
,,,
,,"THER/PROPH/DIAG INJ, SC/I",53.77
,,,
,,"CONTROL NASAL HEMORRH, AN",220.29
,,,
,,"CONTROL NASAL HEMORRH, AN",457.68
,,,
,,BACK TO SCHOOL PHYSICAL,25
,,,
,,URINALYSIS NONAUTO W/O SCOPE,16.03
,,,
,,"URINE PREG, VISUAL COLOR",18.5
,,,
,,DEB SUBQ TISSUE 20 SQ CM/,244.23
,,,
,,PARE BENIGN LES; SGL,111.55
,,,
,,"TRIM SKIN LESIONS, 2 TO 4",125.83
,,,
,,"TRIM SKIN LESIONS, OVER 4",142.01
,,,
,,TANGENTIAL BIOPSY SKIN SINGLE LESION,240
,,,
,,PUNCH BIOPSY SKIN SINGLE LESION,210
,,,
,,REM SKIN TAGS; TO 15,192.6
,,,
,,REMOVE SKIN TAGS ADD-ON,43.02
,,"SHAVE LES,T/A/L; 0.5CM/<",200.31
,,,
,,"SHAVE LES,T/A/L; 0.6-1.0C",246.38
,,,
,,"SHAVE LES,T/A/L;1.1-2.0CM",290.3
,,,
,,"SHAVE LES,T/A/L; > 2.0CM",321.36
,,,
,,"SHAVE LES,S/N/H/F/G;0.5CM",204.6
,,,
,,"SHAVE LES,S/N/H/F/G;0.6-1",251.73
,,,
,,"SHAVE LES,S/N/H/F/G;1.1-2",296.72
,,,
,,"SHAVE LES,S/N/H/F/G;> 2.0",324.14
,,,
,,"SHAVE LES,F/E/N/L; 0.5CM/",234.59
,,,
,,"SHAVE LES,F/E/N/L;0.6-1.0",242.74
,,,
,,"SHAVE LES,F/E/N/L; 1.1-2.",331
,,,
,,"SHAVE LES,F/E/N/L;>2.0CM",396.45
,,,
,,EXC TR-EXT B9+MARG 0.5 <,269.38
,,,
,,"EXC, BEN LES,T/A/L; 0.6-1",316.48
,,,
,,"EXC, BEN LES,T/A/L; 1.1-2",352.17
,,,
,,"EXC, BEN LES,T/A/L; 2.1-3",406.6
,,,
,,"EXC, BLES,S/N/EX,G;0.5CM/",269.32
,,,
,,"EXC, BLES,S/N/EX,G;0.6-1.",334.08
,,,
,,"EXC, BLES,S/N/EX,G;1.1-2.",373.49
,,,
,,"EXC, BLES,S/N/EX,G;2.1-3.",430.37
,,,
,,EXC FACE-MM B9+MARG 0.5 <,295.96
,,,
,,EXC FACE-MM B9+MARG 0.6-1,357.64
,,,
,,EXC FACE-MM B9+MARG 1.1-2,401.41
,,,
,,"INTUB, ENDOTRACHEAL PROC",253.79
,,,
,,CHANGE OF WINDPIPE AIRWAY,85
,,,
,,"EXC MLES,T/A/L;0.5CM/<",417.96
,,,
,,"EXC MLES,T/A/L;0.6-1.0CM",485.92
,,,
,,"EXC MLES,T/A/L;1.1-2.0CM",528.12
,,,
,,"EXC MLES,T/A/L;2.1-3.0CM",604.74
,,,
,,EXC TREAT EXT MAL +MARG 3.1-4CM,650
,,,
,,"EXC MLES,S/N/EXT/G; 0.5CM",412.39
,,,
,,"EXC MLES,S/N/EXT/G;0.6-1.",489.38
,,,
,,"EXC MLES,S/N/EXT/G;1.1-2.",546.85
,,,
,,"EXC MLES,S/N/EXT/G;2.1-3.",643.34
,,,
,,"EXC MLES,F/E/E/N/L;0.5CM/",425.98
,,"EXC MLES,F/E/E/N/L;0.6-1.",506.87
,,,
,,"EXC MLES,F/E/E/N/L;1.1-2.",579.91
,,,
,,INSERT BLADDER CATHETER,117.09
,,,
,,AVULSION NAIL PLATE,213.43
,,,
,,EXCISION NAIL PERMANENT REMOVAL,387.31
,,,
,,WEDGE EXC NAIL FOLD,358.85
,,,
,,REMOVAL OF DRUG IMPLANT,290.45
,,,
,,REMOVAL W/INSERT NON-BIO DRUG DLVR IMPLA,526.47
,,,
,,,
,,SIMPLE LAC REP  0-2.5CM,190.21
,,,
,,SIMPLE LAC REP 2.6-7.5 CM,232.17
,,,
,,SIMPLE LAC 7.6-12.5 CM,273.85
,,,
,,SIMPLE LAC 12.6-20.0 CM,346.08
,,,
,,SIMPLE LAC 20.1-30.0 CM,410.31
,,,
,,SIMPLE LAC 30.1 CM & OVER,478.84
,,,
,,SIMPLE FACE LAC 0-2.5CM,233.07
,,,
,,SIMPLE FACE LAC 2.6-5.0CM,244.06
,,,
,,SIMPLE FACE LAC 5.1-7.5CM,286.13
,,,
,,SIMPL FACE LAC 7.6-12.5CM,346.91
,,,
,,LAYERED LAC 0-2.5 CM,504.59
,,,
,,LAYERED LAC 2.6-7.5CM,645.98
,,,
,,INTMD REPAIR EXT 7.6-12.5,750
,,,
,,"LAY NCK,HN, FT LAC 0-2.5",505.44
,,,
,,"LAY NK,HND,FT LAC 2.6-7.5",617.34
,,,
,,"LAY NK,HD,FT LAC 20.1 &UP","1,009.94"
,,,
,,LAY CLOS FACE LAC 0-2.5CM,551.68
,,,
,,LAY CLOS FACE LAC 2.6-5.0,629.55
,,,
,,"OCCULT BLOOD, FECES",14.88
,,,
,,TREAT METACARPAL FRACTURE,638.94
,,,
,,CPR,659.36
,,,
,,CARDIOVERSION,444.67
,,,
,,"GLUCOSE, BLD BY MONITOR",6.86
,,,
,,"DIL URETH STRICT, SOUND;M",181.71
,,,
,,"DILATE URETHR STRICTR, SU",175.53
,,,
,,TREAT SHOULDER DISLOCATIO,678.07
,,"CL TX SHLDR DISL, W/MANIP",866.22
,,,
,,DILATE FEMALE URETHRA; IN,151.52
,,,
,,DILATE FEMALE URETHRA; FU,148.7
,,,
,,REDUCTION OF REDIAL SUBLU,297.76
,,,
,,HEMOGLOBIN,19.82
,,,
,,ALLERGY SINGLE INJECTION,22.51
,,,
,,ALLGERY TWO OR MORE INJEC,27.85
,,,
,,"REM FB, CONJUNCTIVA; SUPE",123.5
,,,
,,"REM FB, EXT EYE; CORNEAL,",127.01
,,,
,,REM B CORNL W/SLIP LAMP,144.8
,,,
,,NON AUTO ERYTHROCYTE SED,21.64
,,,
,,DRESS/DEBRID P-THICK BURN S,174.19
,,,
,,DRESSING/DEBRIDEMENT THICK BURN,350
,,,
,,QUAL HETEROPHILE AB,15.16
,,,
,,"IA INFECTIOUS AGENT, SGL",37.86
,,,
,,ROUTINE VENIPUNCTURE,19.99
,,,
,,"SKIN TEST;TB, ID",16.81
,,,
,,STREP TEST,35.08
,,,
,,REMOVE IMPACTED EAR WAX- BILATERAL,52.5
,,,
,,REMOVE IMPACTED EAR WAX- BILATERAL,231
,,,
,,DESTRUCT PREMALG LESION,142.24
,,,
,,"DESTRUCT PREMALG LES, 2-1",21.42
,,,
,,"DESTRUCT B9 LESION, 1-14",235.59
,,,
,,"DESTRUCT LESION, 15 OR MO",279.54
,,,
,,CHEM CAUT GRANULATION TIS,172.13
,,,
,,DESTR MLES T/A/L; 0.5 CM/,202.83
,,,
,,DESTR MLES T/A/L; 0.6-1.0,305.93
,,,
,,DESTR MLES T/A/L; 2.1-3.0,408.26
,,,
,,DESTR MLES F/E/E/N/L/MM;,379.83
,,,
,,CLOSED TR MEDIAL MALL FRACTURE W/O MANIP,700
,,,
,,,
,,RAPID FLU TEST,49.07
,,,
,,CLOSED FRACTURE REDUCTION,675.45
,,,
,,REMOVAL-FB-FOOT-SUBCUTA,561.1
,,,
,,SPECIM TRNSF-PHY TO LAB,19.86
,,FOLLOW UP VISIT,0
,,,
,,LONG ARM SPLINT MOLDED,190.1
,,,
,,SHORT ARM SPLINT,141.88
,,,
,,APPLY FINGER SPLINT; STAT,89.93
,,,
,,REM FB EXT AUDITORY CANAL,212.88
,,,
,,NEW PT OFFICE VISIT LVL 1,82.38
,,,
,,NEW PT OFFICE VISIT LVL 2,142.63
,,,
,,NEW PT OFFICE VISIT LVL 3,205.24
,,,
,,NEW PT CLINIC VISIT LVL 4,316
,,,
,,NEW PT CLINIC VISIT LVL 5,394.56
,,,
,,REMOVE IMPACTED EAR WAS UNI,26.33
,,,
,,REMOVAL IMPACTED CERUMEN,115.59
,,,
,,EST PT CLNIC VISIT LVL 1,39.74
,,,
,,EST PT CLINIC VISIT LVL 2,83.07
,,,
,,EST PT CLINIC VISIT LVL 3,138.72
,,,
,,EST PT CLINIC VISIT LVL 4,206.1
,,,
,,EST PT CLINIC VISIT LVL 5,277.44
,,,
,,DISCH FROM OBSERVATION,158.72
,,,
,,INITIAL OBS/DA LEVEL 1,214.83
,,,
,,INITIAL OBS/DAY LEVEL 2,294.95
,,,
,,INITIAL OBS/DAY LEVEL 3,404.54
,,,
,,INPATIENT E/M INIT LEVEL1,221.44
,,,
,,INPT E/M INIT LEVEL 2,300.53
,,,
,,INPT E/M INIT LEVEL 3,442.63
,,,
,,"SUBS OBSERV, LEVEL 1",87.76
,,,
,,"SUBS OBSERV, LEVEL 2",160.09
,,,
,,"SUBS OBSERV, LEVEL 3",229.74
,,,
,,INPT E/M SUBS LEVEL 1,86.65
,,,
,,INPT E/M SUBS LEVEL 2,159.01
,,,
,,INPT E/M SUBS LEVEL 3,227.92
,,,
,,OBSERV/HOSP SAME DATE,373.94
,,,
,,INPT E/M DISCH MGMT,158.35
,,,
,,DISCHARGE MGMT +30 MIN,233.88
,,,
,,"NURSING FAC CARE, INIT LO",202.09
,,,
,,"NURSING FAC CARE,INIT MED",285.75
,,"NURSING FAC CARE, INIT HI",363.94
,,,
,,"NURSING FAC CARE, SUBS LO",96.47
,,,
,,"NURSING FAC CARE, SUBSSQ",149.26
,,,
,,"NURSING FAC CARE, SUBSEQ",196.84
,,,
,,"NURSING FAC CARE, SUBSEQ",292.23
,,,
,,SNF DISCHARGE < 30 MIN,157.99
,,,
,,SNF DISCHARGE >30 MIN,227.69
,,,
,,ASSISTED LIVING VISIT 15 MIN,115
,,,
,,ASSISTED LIVING VISIT 25 MIN,165
,,,
,,"HOME VISIT, EST PATIENT",123.08
,,,
,,HOME VISIT EST PATIENT 25 MIN,186.03
,,,
,,PROLONGED SERVICE,219.78
,,,
,,PROLONG SERVICE ADD 30 MI,214.54
,,,
,,"PREV MED, NEW PT < 1 YR",194.42
,,,
,,"PREV MED, NEW PT, 1-4 YRS",205.14
,,,
,,"PREV MED, NEW PT, 5-11 YR",211.46
,,,
,,"PREV MED, NEW PT, 12-17YR",239.9
,,,
,,"PREV MED, NEW PT, 18-39YR",232.72
,,,
,,"PREV MED, NEW PT, 40-64YR",269.19
,,,
,,"PREV MED, NEW PT + 65 YRS",292.07
,,,
,,"PREV MED, EST PT, > 1 YR",174.66
,,,
,,"PREV MED, EST PT, 1-4 YRS",186.82
,,,
,,"PREV MED, EST PT, 5-11 YR",186.22
,,,
,,"PREV MED, EST PT, 12-17YR",204.7
,,,
,,"PREV MED, EST PT, 18-39YR",209.26
,,,
,,"PREV MED, EST PT, 40-64YR",223.24
,,,
,,"PREV MED, EST PT, >=65 YRS",239.9
,,,
,,FIREMAN'S PHYSICAL,48.2
,,,
,,"AUDIT/DAST, 15-30 MIN",70.16
,,,
,,"AUDIT/DAST, OVER 30 MIN",136.21
,,,
,,HEALTH RISK ASSESSMENT,26.78
,,,
,,SHORT LEG CAST,178.28
,,,
,,NEBULIZER TX,38.86
,,,
,,TRANS CARE MGMT 14 DAY DISCH,200
,,,
,,TRANSITIONAL CARE MGMT 7 DAY DISCHARGE,275
,,ADVANCE CARE PLAN 30 MINUTES,85
,,,
,,ADVANCE CARE PLAN ADDITIONAL 30 MIN,75
,,,
,,APPLICAT LONG LEG SPLINT,178.36
,,,
,,APPLIC SHORT LEG SPLINT,159.66
,,,
,,KNEE STRAPPING,63.08
,,,
,,STRAPPING ANKLE &/OR FOOT,57.18
,,,
,,NURSING HOME/EMPLOY EXAM,58.92
,,,
,,SPORT PHYSICAL-EST PT,15
,,,
,,DOT EXAM,58.97
,,,
,,SPORTS PHYSICAL-NEW PT,15
,,,
,,DAYCARE CHILD PHYSICAL,25
,,,
,,EMPLOYMENT PHYSICAL,75
,,,
,,DRIVERS LICENSE EXAM,75
,,,
,,DUAL ELIGIBLE T CHARGE,0.01
,,,
,,EMC MEDICAID RHC VISIT,0
,,,
,,ADMIN FLU VIRUS VACCINE,18
,,,
,,EMC MEDICARE OFFICE VISIT,0
,,,
,,EMC MEDICARE PREV VISIT,0
,,,
,,FINE NEEDLE ASP W/O IMAGING,297
,,,
,,I&D ABSC; SMPLE OR SGL,252.34
,,,
,,I&D ABSC; COMP OR MULTIPL,445.15
,,,
,,OBTAINING PAP SMEAR,97.55
,,,
,,"CA SCRNING, PELV & BRST E",83.72
,,,
,,"INC & REM FB, AQ; SMPL",317.08
,,,
,,"INC & REM FB, SQ; COMPL",588.34
,,,
,,PUNCT ASP - ABSC HEMAT CY,272.09
,,,
,,"REM FB, INTRANASAL; OFFIC",397.99
,,,
,,"BLOOD OCCULT TEST, COLORE",14.88
,,,
,,WELCOME MEDICARE VISIT,351.09
,,,
,,PPPS INITIAL VISIT,373.61
,,,
,,PPPS SUBSEQ VISIT,249.73
,,,
,,ANNUAL DEPRESSION SCREENI,30.27
,,,
,,IMMUNIZATION ADM; 1,18.78
,,,
,,IMMUNIZATION ADM; EA ADD,26.24
,,,
,,HEMOGLOBIN,19.82
,,INJ SGL TENDON SHTH OR LI,130.29
,,,
,,TPI (S) - 1/2 MUSCLE(S),121.33
,,,
,,TPI(S) - 3/>MUSCLE(S),137.5
,,,
,,DRAIN/INJECT SM JNT/BURSA,104.08
,,,
,,DRAIN/INJ INTERM JNT/BURS,109.09
,,,
,,DRAIN/INJ MAJOR JNT/BURSA,130.19
,,,
,,ASPIRATE/INJ GANGLION CYS,132.9
,,,
,,"THER/PROPH/DIAG INJ, SC/I",53.77
,,,
,,CONTROL NASAL HEMORRH. AN,205.6
,,,
,,CONTROL NASAL HEMORRH. AN,457.68
,,,
,,BACK TO SCHOOL PHYSICAL,25
,,,
,,DEB SUBQ TISSUE 20 SQ CM/,244.23
,,,
,,PARE BENIGN LES; SGL,111.55
,,,
,,"TRIM SKIN LESIONS, 2-4",125.83
,,,
,,"TRIM SKIN LESIONS, OVER 4",142.01
,,,
,,REM SKIN TAGS; TO 15,192.6
,,,
,,REMOVE SKIN TAGS ADD-ON,43.02
,,,
,,"SHAVE LES, T/A/L; 0.5CM/<",200.31
,,,
,,"SHAVE LES, T/A/L; 0.6-1.0",246.38
,,,
,,"SHAVE LES, T/A/L; 1.1-2.0",290.3
,,,
,,"SHAVE LES,T/A/L;> 2.0CM",321.36
,,,
,,"SHAVE LES, S/N/H/F/G;0.5C",204.6
,,,
,,"SHAVE LES,S/N/H/F/G;0.6-1",251.73
,,,
,,"SHAVE LES, S/N/H/F/G;1.1-",296.72
,,,
,,"SHAVE LES, S/N/H/F/G;>2.0",324.14
,,,
,,"SHAVE LES, F/E/N/L;0.5CM/",234.59
,,,
,,"SHAVE LES,F/E/N/L;0.6-1.0",242.74
,,,
,,"SHAVE LES, F/E/N/L 1.1-2.",331
,,,
,,"SHAVE LES, F/E/N/L;>2.0CM",396.45
,,,
,,EXC TR-EXT B9+MARG 0.5 <,269.38
,,,
,,"EXC, BEN LES,T/A/L; 0.6-1",316.48
,,,
,,"EXC, BEN LES T/A/L; 1.1-2",352.17
,,,
,,"EXC, BEN LES, T/A/L;2.1-3",406.2
,,,
,,EXC B9 LESION MRGN SCP SK TG T/A/L 3.1-4,462.13
,,,
,,"EXC, BLES,S/N/EX,G;0.5CM/",269.32
,,"EXC, BLES, S/N/EX,G;0.6-1",334.08
,,,
,,"EXC, BLS,S/N/EX, G;1.1-2.",373.49
,,,
,,"EXC, BLES, S/N/EX,G;2.1-3",430.37
,,,
,,"EXC, BLES, S/N/EX,G;3.1-4",497.65
,,,
,,EXC FACE-MM B9+MARG 0.5<,295.96
,,,
,,EXC FACE-MM B9+MARG 0.6-1,357.64
,,,
,,EXC FACE-MM B9+MARG 1.1-2,401.41
,,,
,,"INTUB, ENDOTRACHEAL PROC",253.79
,,,
,,CHANGE OF WINDPIPE AIRWAY,85
,,,
,,"EXC MLES, T/A/L;0.5CM/<",417.96
,,,
,,"EXC MLES,T/A/L;0.6-1.0CM",485.92
,,,
,,EXC MLES T/A/L;1.1-2.0CM,528.12
,,,
,,"EXC MLES, T/A/L;2.1-3.0CM",604.74
,,,
,,EXC TREAT EXT MAL +MARG 3.1-4CM,650
,,,
,,"EXC MLES, S/N/EXT/G; 0.5C",412.39
,,,
,,"EXC MLES,S/N/EXT/G;0.6-1.",489.38
,,,
,,"EXC MLES, S/N/EXT/G;1.1-2",546.85
,,,
,,"EXC MLES, S/N/EXT/G;2.1-3",643.34
,,,
,,"EXC MLES, F/E/E/N/L;0.5CM",425.98
,,,
,,"EXC MLES,F/E/E/N/L;0.6-1.",506.87
,,,
,,"EXC MLES, F/E/E/N/L;1.1-2",579.91
,,,
,,INSERT BLADDER CATHETER,117.09
,,,
,,AVULSION NAIL PLATE PARTIAL/COMPLETE,213.43
,,,
,,DRAIN BLOOD FROM UNDER NAIL,105.72
,,,
,,EXCISION NAIL PERMANENT REMOVAL,387.31
,,,
,,WEDGE EXC NAIL FOLD,358.85
,,,
,,INJECTION INTO SKIN LESIO,121.53
,,,
,,SIMPLE LAC REP 0-2.5CM,190.21
,,,
,,SIMPLE LAC REP 2.6-7.5 CM,232.17
,,,
,,SIMPLE LAC 7.6-A12.5CM,273.85
,,,
,,SIMPLE LAC 12..6-20.0CM,346.08
,,,
,,SIMPLE LAC 20.1-30.0CM,410.31
,,,
,,SIMPLE LAC 30.1 CM & OVER,478.84
,,,
,,SIMPLE FACE LAC 0-2.5CM,233.07
,,,
,,SIMPLE FACE LAC 2.6-5.0CM,244.06
,,SIMPLE FACE LAC 5.1-7.5CM,286.13
,,,
,,SIMPLE FACE LAC 7.6-12.5C,346.91
,,,
,,LAYERED LAC 0-2.5CM,504.59
,,,
,,LAYERED LAC 2.6-7.5CM,645.98
,,,
,,INTMD REPAIR EXT 7.6-12.5,750
,,,
,,"LAY NCK,HN,FT LAC 0-2.5",505.44
,,,
,,"LAY NK,HND,FT LAC 2.6-7.5",617.34
,,,
,,"LAY NK, HD,FT LAC 20.1&UP","1,009.94"
,,,
,,LAY CLOS FACE LAC 0-2.5CM,551.68
,,,
,,LAY CLOS FACE LAC 2.6-5.0,629.55
,,,
,,OCCULT BLD FECES 1-3 TESTS,14.88
,,,
,,TREAT METACARPAL FRACTURE,638.94
,,,
,,STRAPPING; THORAX,64.9
,,,
,,CPR,659.36
,,,
,,CARDIOVERSION,444.67
,,,
,,"DIL URETH STRICT, SOUND;M",181.71
,,,
,,"DILATE URETHR STRICTR, SU",175.53
,,,
,,TREAT SHOULDER DISLOCATIO,678.07
,,,
,,"CL TX SHLDR DISL, W/MANIP",866.22
,,,
,,DILATE FEMALE URETHRA; IN,151.52
,,,
,,DILATE FEMALE URETHRA; FU,148.7
,,,
,,REDUCTIONA OF REDIAL SUBL,297.76
,,,
,,ALLERGY SINGLE INJECTION,22.51
,,,
,,ALLGERY TWO OR MORE INJEC,27.85
,,,
,,"REM FB, CONJUNCTIVA; SUPE",123.5
,,,
,,"REM FB, EXT EYE; CORNEAL,",127.01
,,,
,,REM B CORNL W/SLIP LAMP,144.8
,,,
,,DRAIN FINGER ABSC; SIMPLE,562.25
,,,
,,REMOVE IMPACTED EAR WAX-BILATERAL,52.5
,,,
,,REMOVE IMPACTED EAR WAX-BILATERAL,231
,,,
,,DESTRUCT PREMALG LESION,142.24
,,,
,,"DESTRUCT PREMLG LES, 2-1",21.42
,,,
,,"DESTRUCT B9 LESION, 1-14",235.59
,,,
,,"DESTRUCT LESION, 15 OR MO",279.54
,,,
,,CHEM CAUT GRANULATION TIS,172.13
,,DESTR MLES T/A/L; 0.5 CM/,202.83
,,,
,,DESTR MLES T/A/L; 0.6-1.0,305.93
,,,
,,DESTR MLES T/A/L; 1.1-2.0,373.38
,,,
,,DESTR MLES T/A/L; 2.1-3.0,408.26
,,,
,,DESTR MLES S/N/H/F/G; 0.6 - 1,348.09
,,,
,,DESTRUCTION MALIGNANT LESION F/E/E/N/L/M,300.01
,,,
,,DESTR MLES F/E/E/N/L/MM;,379.83
,,,
,,DESTR MLES F/E/E/N/L/MM;,437.21
,,,
,,DESTR MLES F/E/E/N/L/MM;,524.15
,,,
,,CLOSED TR MEDIAL MALL FRACTURE W/O MANIP,700
,,,
,,,
,,CLOSED FRACTURE REDUCTION,675.45
,,,
,,CORONER'S CALL LEVEL 1,240.7
,,,
,,CORONER'S CALL LEV 2,361.05
,,,
,,CORONER'S CALL LEEL 3,481.4
,,,
,,REMOVAL-FB-FOOT-SBCUTA,561.1
,,,
,,INSERTION INTRAUTERINE DEVICE IUD,175
,,,
,,REMOVAL INTRAUTERINE DEVICE IUD,215
,,,
,,OMT AREA 1-2,61.68
,,,
,,OMT AREA 3-4,82.16
,,,
,,OMT AREA 5-6,120.86
,,,
,,FOLLOW UP VISIT,0
,,,
,,LONG AREM SLPINT MOLDED,190.1
,,,
,,SHORT AREM SPLINT,141.88
,,,
,,APPLY FINGER SPLINT; STAT,89.93
,,,
,,REM FB EXT AUDITORY CANAL,212.88
,,,
,,NEW PT OFFICE VISIT LVL 1,82.38
,,,
,,NEW PT OFFICE VISIT LVL 2,142.63
,,,
,,NEW PT OFFICE VISIT LVL 3,205.24
,,,
,,NEW PT CLINIC VISIT LVL 4,316
,,,
,,NEW PT CLINIC VISIT LVL 5,394.56
,,,
,,REMOVE IMPACTED CERUMEN IRRIGATION UNILA,26.33
,,,
,,,
,,REMOVAL IMPACTED CERUMEN UNILAT,115.59
,,,
,,EST PT CLINIC VISIT LVL 1,39.74
,,EST PT CLINIC VISIT LVL 2,83.07
,,,
,,EST PT CLINIC VISIT LVL 3,138.72
,,,
,,EST PT CLINIC VISIT LVL 4,206.1
,,,
,,EST PT CLINIC VISIT LVL 5,277.44
,,,
,,DISCH FROM OBSERVATION,158.72
,,,
,,INITIAL OBS/DAY LVL 1,214.83
,,,
,,INITIAL OBS/DAY LVL 2,294.95
,,,
,,INITIAL OBS/DAY LVL 3,404.54
,,,
,,INPATIENT E/M INIT LVL 1,221.44
,,,
,,INPT E/M INIT LEVEL 2,300.53
,,,
,,INPT E/M INIT LEVEL 3,442.63
,,,
,,"SUBS OBSERV, LEVEL 1",87.76
,,,
,,"SUBS OBSERV, LEVEL 2",160.09
,,,
,,"SUBS OBSERV, LEVEL 3",229.74
,,,
,,INPT E/M SUBS LEVEL 1,86.65
,,,
,,INPT E/M SUBS LVL 2,159.01
,,,
,,INPT E/M SUBS LEVEL 3,227.92
,,,
,,OBSERV/HOSP SAME DATE,300.58
,,,
,,OBSERV/HOSP SAME DATE,373.94
,,,
,,OBSERV/HOSP SAME DATE,480.47
,,,
,,INPT E/M DISCH MGMT,158.35
,,,
,,DISCHARGE MGMT + 30 MIN,233.88
,,,
,,STRAPPING; SHOULDER,63.43
,,,
,,STRAPPING; ELBOW OR WRIST,63.49
,,,
,,"NURSING FAC CARE, INIT LO",202.09
,,,
,,"NURSING FAC CARE,INIT MED",285.75
,,,
,,"NURSING FAC CARE, INIT HI",363.94
,,,
,,"NURSING FAC CARE, SUBS ME",96.47
,,,
,,NURSING FAC CARE SUBSEQ,149.26
,,,
,,"NURSING FAC CARE, SUBSEQ",196.84
,,,
,,"NURSING FAC CARE, SUBSEQ",292.23
,,,
,,SNF DISCHARGE < 30 MIN,157.99
,,,
,,SNF DISCHARGE >30 MIN,227.69
,,,
,,ASSISTED LIVING VISIT 45 MIN NEW PT,250
,,,
,,ASSIST LIVING VISIT 60 MIN NEW PT,330
,,ASSISTED LIVING 15 MIN,115
,,,
,,ASSISTED LIVING VISIT 25 MIN,165
,,,
,,"HOME VISIT, EST PATIENT",123.08
,,,
,,PROLONGED SERVICE,219.78
,,,
,,PROLONG SERVICE ADD 30 MI,214.54
,,,
,,"PREV MED, NEW PT < 1YR",194.42
,,,
,,"PREV MED, NEW PT, 1-4 YRS",205.14
,,,
,,"PREV MED, NEW PT, 5-11 YR",211.46
,,,
,,"PREV MED, NEW PT, 12-17 Y",239.9
,,,
,,"PREV MED, NEW PT, 18-39 Y",232.72
,,,
,,"PREV MED, NEW PT, 40-64 Y",269.19
,,,
,,"PREV MED, NEW PT+65 YRS",292.07
,,,
,,"PREV MED, EST PT, < 1YR",174.66
,,,
,,"PREV MED, EST PT, 1-4 YRS",186.82
,,,
,,"PREV MED, EST PT, 5-11 YR",186.22
,,,
,,"PREV MED, EST PT, 12-17 Y",204.7
,,,
,,"PREV MED, EST PT, 18-39YR",209.26
,,,
,,"PREV MED, EST PT, 40-64YR",223.24
,,,
,,"PREV MED, EST PT, >=65YRS",239.9
,,,
,,FIREMAN'S PHYSICAL,48.2
,,,
,,BEHAV CHNG SMOKING 3-10 M,30.94
,,,
,,BEHAV CHNG SMOKING > 10 M,60.25
,,,
,,"AUDIT/DAST, 15-30 MIN",70.16
,,,
,,"AUDIT/DAST, OVER 30 MIN",136.21
,,,
,,HEALTH RISK ASSESSMENT,25.75
,,,
,,SHORT LEG CAST,178.28
,,,
,,NEBULIZER TX,39.94
,,,
,,TRANS CARE MGMT 14 DAY DISCH,200
,,,
,,TRANS CARE MGMT 7 DAY DISCH,275
,,,
,,ADVANCE CARE PLAN 30 MINUTES,85
,,,
,,ADVANCE CARE PLAN ADDITIONAL 30 MIN,75
,,,
,,APPLICAT LONG LEG SPLINT,178.36
,,,
,,APPLIC SHORT LEG SPLINT,159.66
,,,
,,KNEE STRAPPING,63.08
,,,
,,STRAPPING ANKLE &/OR FOOT,57.18
,,NURSING HOME/ EMPLOY EXAM,58.92
,,,
,,SPORT PHSICAL-EST PT,15
,,,
,,DOT EXAM,58.97
,,,
,,SPORTS PHYSICAL-NEW PT,15
,,,
,,DAYCARE CHILD PHYSICAL,25
,,,
,,EMPLOYMENT PHYSICAL,75
,,,
,,DRIVERS LICENSE EXAM,75
,,,
,,EMC MEDICAID RHC VISIT,0
,,,
,,"TDAP, ADACEL IM",60.18
,,,
,,"HIB PRP-T, ACTHIB, IM",20
,,,
,,ALBUTEROL NON-COMP UNIT 1,2.41
,,,
,,NITROGLYCERIN SUBLINGUAL 0.4MG TAB,5
,,,
,,CEFTRIAXONE 1 GM VIAL,33.99
,,,
,,COMPAZINE INJ UP TO 10 MG,15.05
,,,
,,DEPO T INJECTION,0.11
,,,
,,DECAVAC VACCINE SYR 10X.0,102.58
,,,
,,DIPHENHYDAMINE 50 MG,26.49
,,,
,,DEPOMEDRAL 80MG,42.3
,,,
,,DEPO-MEDROL 40MG/ML VIAL,29.1
,,,
,,DIAZEPAM 10MG/2ML SYRINGE,25.5
,,,
,,"VFC HEP A PEDS, HAVRIX, IM",0
,,,
,,VFC  HEP-B,0
,,,
,,"MENINGITIS B, TRUMENBA, IM",181.15
,,,
,,EPINEPHRINE AMP1:1000,1.61
,,,
,,"ADULT HEP A VACCINE, HAVRIX, IM",90.87
,,,
,,"HEP A VACCINE PEDS, HAVRIX, IM",90.87
,,,
,,"IM 4 DOSE HIB, PRP-T",47.5
,,,
,,FUROSEMIDE 40 MG VIAL,16.25
,,,
,,FLU VAC NO PRSV 3 VAL 6-35 M,25
,,,
,,"FLU VACCINE, 3 YRS & >",25
,,,
,,"FLU VAC HIGH DOSE, FLUZONE, IM",82.5
,,,
,,"PNEUMOCOCCAL VACCINE 13, PREVNAR, IM",315
,,,
,,PNEUMOCOCCAL 23 VACCINE,465.95
,,,
,,VFC FLU VACCINE 4 VALENT NASAL,0
,,,
,,"ROTOVIRUS VACC, ROTATEQ, PO",133.9
,,"FLU VAC QUAD 6-35 M, FLUZONE, IM",25
,,,
,,"FLU VACCINE QUAD, FLUZONE/FLULAVAL, IM",25
,,,
,,"DTAP AND IPV 4-6 YRS, KINRIX, IM",73.11
,,,
,,"DTAP VACCINE,DAPTACEL, IM",40
,,,
,,"MMR VACCINE, SQ",88.91
,,,
,,"POLIOVIRUS, IPOL, SC/IM",50.3
,,,
,,"LIVE VARICELLA VACCINE, VARIVAX, SQ",160.5
,,,
,,"TD VACCINE, IM",33.55
,,,
,,"DTAP-HEPB-IPV, PEDIARIX, IM",130.42
,,,
,,"PNEUMOCOCCAL VACCINE 23, PNEUMOVAX, IM",275
,,,
,,SQ MPV VACCINE,180.71
,,,
,,"MENACWY VACCINE, MENACTRA, IM",125.5
,,,
,,IM 3D PEDI/ADOL HEP-B VAC,32.14
,,,
,,"HPV IMMUNIZATION, GARDASIL, IM",259.5
,,,
,,"HEP B ADULT, ENGERIX, IM",101.6
,,,
,,HYDROXYZINE 25MG,11.42
,,,
,,"HEP A VACCINE ADULT, HAVRIX, IM",90.87
,,,
,,KENALOG 40 MG VIAL,16.7
,,,
,,LIDOCAINE 2% 1.5CC,5
,,,
,,NORFLEX 60MG,63.56
,,,
,,PHENERGAN 25 MG,8.75
,,,
,,PEDIARIX,130.42
,,,
,,REGLAN 10ML,22.94
,,,
,,ROCEPHIN INJECTION PER 25,28.01
,,,
,,SOLUMEDROL 40 MG,19.16
,,,
,,SOLUMEDROL 125MG,25.21
,,,
,,SILVADENE 50 GM,12.52
,,,
,,KETOROLAC 30 MG VIAL,6.56
,,,
,,KETOROLAC 60 MG IM,8.45
,,,
,,"VANCOMYCIN HCL, 500 MG IN",29.6
,,,
,,VITAMIN B-12,11.98
,,,
,,LEVALBUTEROL 0.5 MG,9.2
,,,
,,SILVER NITRATE APPLICATOR,4.38
,,,
,,DEXTROSE 50% SYRINGE,12.65
,,,
,,EPINEPHRINE 0.1MG/ML SYRINGE,6.86
,,ATROPINE 1MG/10ML SYRINGE,7.96
,,,
,,CALCIUM CHLORIDE 10% SYRINGE,15.74
,,,
,,LIDOCAINE 2% SYRINGE,6.76
,,,
,,EPINEPHRINE 1MG/ML AMPULE,2.4
,,,
,,NALOXONE 0.4MG/ML VIAL,24.28
,,,
,,OXYTOCIN 10UNITS/ML VIAL,0.92
,,,
,,AMMONIA INHALANT AMPULE,0.52
,,,
,,NIFEDIPINE 10MG TABLET,2
,,,
,,METOPROLOL TART 5MG/5ML VIAL,1
,,,
,,SODIUM CHLORIDE 1000ML BAG,3.32
,,,
,,INDOMETHACIN 25 MG CAPSULE,1
,,,
,,DIAZEPAM 10MG/2ML CARPUJECT,43.16
,,,
,,XYLOCAINE 1% VIAL,0
,,,
,,XYLOCAINE 1% WITH EPI VIAL,0
,,,
,,XYLOCAINE 2% VIAL,0
,,,
,,XYLOCAINE 2% WITH EPI VIAL,0
,,,
,,MARCAINE 0.25% VIAL,0
,,,
,,MARCAINE 0.5% VIAL,0
,,,
,,ACTIVATED CHARCOAL 25 GM,29.08
,,,
,,ASPIRIN 81 MG CHEWABLE,1.25
,,,
,,BENZOIN TINCTURE SWAB,0
,,,
,,GENTIAN  VIOLET,0
,,,
,,EMLA CREAM,0
,,,
,,PHENYLEPHRINE 1% NASAL SPRAY,7.84
,,,
,,ETHYL CHLORIDE WOUND SPRAY,0
,,,
,,MAG-AL SUSPENSION 30 ML,2.75
,,,
,,LEVALBUTEROL 1.25MG/0.5ML,3.28
,,,
,,IPRATROPIUM/ALBUTEROL SVN,1.25
,,,
,,EPINEPHRINE AUTO-INJECTOR ADULT,262.4
,,,
,,EPINEPHRINE AUTO-INJECTOR PEDS,262.4
,,,
,,GLUCOSE GEL,0
,,,
,,TRIPLE ANTIBIOTIC OINT PACK,0
,,,
,,ONDANSETRON 4MG/2ML,2.25
,,,
,,TB TEST TUBERSOL,16.81
,,,
,,CLONIDINE 0.1MG TAB,0
,,OXYMETAZOLINE 0.05% NASAL SPRAY EMC,15.25
,,,
,,"VFC ROTAVIRUS, ROTARIX, PO",0
,,,
,,"VFCHIB, ACTHIB, IM",0
,,,
,,"VFC TD, TETANUS, IM",0
,,,
,,"VFC HPV, GARDASIL-9, IM",0
,,,
,,"VFC FLU VAC QUAD 6-35 M, FLUZONE, IM",0
,,,
,,"VFC FLU VACCINE QUAD, FLUZONE, IM",0
,,,
,,VFC INFLUENZA,0
,,,
,,"VFC DTAP, DAPTACEL, IM",0
,,,
,,"VFC VARICELLA LIVE, VARIVAX, SQ",0
,,,
,,"VFC POLIO, IPOL, SC/IM",0
,,,
,,"VFC DTAP-HEPB-IPV, PEDIARIX, IM",0
,,,
,,"VFC  PNEUMONIA 13 VACCINE, PREVNAR ADMIN",0
,,,
,,"VFC TDAP, ADACEL, IM",0
,,,
,,"VFC MMR, SQ",0
,,,
,,"VFC MENIGOCOCCOL, MENACTRA, IM",0
,,,
,,"VFC- DTAP IPV VACCINE 4-6 YRS, KINRIX IM",0
,,,
,,VFC- MMRV VACCINE SC,0
,,,
,,"VFC HIB, PEDVAXHIB, IM",0
,,,
,,"VFC MENINGITIS B, TRUMENBA, IM",0
,,,
,,"FLU VAC HD, FLUZONE HD, IM, MEDICARE",0
,,,
,,"FLU VAC QUAD, FLUZONE, IM, MEDICARE",0
,,,
,,"VFC ROTOVIRUS, ROTATEQ, PO",0
,,,
,,"MEN B, BEXSERO, IM, PRIVATE",228.6
,,,
,,"INFLUENZA, FLUBLOK, IM, PRIVATE",82.5
,,,
,,"INFLUENZA, FLUBLOK, IM, MEDICARE",0
,,,
,,"PNEUMOCOCCAL, PREVNAR, IM, MEDICARE",0
,,,
,,"PNEUMOCOCCAL, PNEUMOVAX, IM, MEDICARE",0
,,,
,,"MMRV, PROQUAD, SUBQ, VFC",0
,,,
,,VFC ADMIN FEE,19.68
,,,
,,DERMABOND,25.42
,,,
,,3-0  663G ETHILON SUTURE,5.77
,,,
,,LACERATION TRAY,4.56
,,,
,,WOUND WASH SALINE,5.69
,,,
,,SMALL VOLUME NEBULIZER,2.45
,,"COBAN 4""",7.13
,,,
,,"KLING 4""-STERILE",2.41
,,,
,,MEPILEX BORDER 4X4,9.76