Charge Avg Price CPT/HCPCS/Modifiers 00000 - PLASTIC OPERATION OF PENIS FOR INJURY 7219.05 54440 00001 - NECK W/O CONTRAST 2430.1 70490TCCT 00002 - NECK W/CONTRAST 2550.75 70491TCCT 00003 - FINE NEEDLE ASPIRATION 407.55 88173TC 00004 - SCAN CT CERVICAL SPINE W/O CO 3085.6 72125TCCT 00005 - THORACIC SPINE W/O CONTRAST 3085.6 72128TCCT 00006 - SCAN LUMBAR SPINE CT W/O CONT 3085.6 72131TCCT 00007 - SCAN THORAX W/O CONTRAST 3085.6 71250TCCT 00009 - SCAN THORAX W/CONTRAST 3268.95 71260TCCT 00015 - SCAN THORAX W/O & W/CONTRAST 3427.6 71270TCCT 00016 - FACIAL BONES/SINUSES W/O CONT 3085.6 70486TCCT 00017 - FACIAL BONES/SINUSES W/CONTRA 3210.05 70487TCCT 00018 - 2E ROOM & CARE - MED/SURG SEMI 1520 00019 - ABDOMEN W/O CONTRAST 3085.6 74150TCCT 00020 - E/R LEVEL 2 361.95 99282 00021 - SCAN CT ABDOMEN W/CONTRAST 3210.05 74160TCCT 00022 - ABDOMEN W/O AND W/CONTRAST 3427.6 74170TCCT 00023 - SCAN TEMPORL EAR BONE W/O CON 3085.6 70480TCCT 00024 - TEMPORAL EAR BONE W/CONTRAST 3210.05 70481TCCT 00025 - 2E ROOM & CARE - Level II 3037.15 00026 - PELVIS W/O CONTRAST 3085.6 72192TCCT 00027 - PELVIS W/CONTRAST 3210.05 72193TCCT 00028 - PELVIS W/O AND W/CONTRAST 3427.6 72194TCCT 00030 - 2E ROOM & CARE - MED/SURG PRIV 2206.85 00032 - 2E ROOM & CARE - MED/SURG TRIAGE 1248.3 00033 - US BIO PHYSICAL PROFILE 478.8 76815 00034 - GRAFT/IMPLANT BONE 0.8CC 294.5 C1713 00035 - GRAFT/IMPLANT BONE 7.5CC 3100.8 C1713 00036 - GRAFT/IMPLANT BONE 4CC 1815.45 C1713 00037 - KIT GRAFT/IMPLANT BONE DISP 198.55 C1713 00038 - GRAFT/IMPLANT BONE 15CC 1739.45 C1713 00039 - XR OSSEOUS SURVEY COMP CHILD 423.7 77076TC 00040 - 3E ROOM & CARE - MED/SURG PRIV 2206.85 00042 - WALKER ADJUSTABLE 88.35 00043 - OB CURRETTE/TUBING 50.35 00047 - KIT HEMODIALYSIS 28.5 C1752 00050 - 3N ROOM & CARE - MED/SURG PRIV 2206.85 00056 - PLATE 8 HOLE SUPRACONDYLAR 1010.8 C1713 00057 - PLATE 6 HOLE SUPRACONDYLAR 1010.8 C1713 00058 - SCREW 32MM HEX HEAD COMP 1010.8 C1713 00059 - SCREW 38/44/51MM HEX HEAD COM 1010.8 C1713 00060 - 43 ROOM & CARE - PSYCH SEMI 1248.3 00061 - SUTURE MAXON 2/0 AND 0 T-19 311.6 00062 - SUTURE TICRON 24.7 00063 - POWDER WOUND CARE 12.35 00066 - DRESSING WOUND COLL 4IN X 5IN 13.3 00067 - 2E ROOM & CARE - HOSPICE SEMI 1107.7 00068 - 2E ROOM & CARE - PEDS SEMI 2206.85 00069 - 2 E ROOM & CARE - PSYCH SEMI 1248.3 00070 - OB ROOM & CARE - OB/GYN PRIV 2206.85 00072 - 3E ROOM & CARE - MED/SURG SEMI 1520 00073 - MESH MARLEX 6X6 595.65 C1781 00074 - MESH MARLEX 3X6 595.65 C1781 00075 - MESH MARLEX 2X4 595.65 C1781 00076 - FORCEPS DISPOSABLE BIOPSY 198.55 00081 - 3E ROOM & CARE - MED/SURG SEMI 2001.65 00082 - GORTEX GRAFT SEG 6MM X 100MM 2960.2 C1768 00083 - CATHETER VASCULAR TEMPORARY 237.5 C1751 00084 - TRAY KNEE ORTHO MINOR 55.1 00087 - BRUSH CYTOLOGY 28.5 00091 - TROCAR ENDOPATH 5MM DISP 307.8 00092 - TROCAR ENDOPATH 10-11MM DISP 342.95 00096 - 3E ROOM & CARE - HOSPICE SEMI 1107.7 00097 - SCREW CORTICAL 6.5MM 10-22MM 1010.8 C1713 00098 - CANISTER SUCTION 5.7 00099 - T-TUBE MODIFIED 85.5 00107 - BANDAGE ELASTIC ACE 4 INCHES 70.3 00111 - PLATE TUBULAR 1/3 510 C1713 00112 - ACETABULAR CUP 1400.3 C1776 00113 - SUTURES NYLON 19 00114 - SUTURES SPECIAL 174.8 00115 - SCREW CANCELLOUS 6.5 512.78 C1713 00116 - SCREW COMP 1010.8 C1713 00117 - PLATE BROAD 5-10 1010.8 C1713 00118 - SCREW CORTICAL 4.5 1010.8 C1713 00119 - CONNECTOR SAF T 49.5 00120 - BANDAGE ELASTIC ACE 3 INCHES 64.6 00123 - PACEMAKER ELECTRODE LEADS 3204.35 C1779 00124 - SPLINT CLAVICLE RESTRAINER 145.35 L3650 00130 - ICU ROOM & CARE - I C U 3448.5 00132 - LUBRICANT KY PER OZ. 1.1 A4402 00139 - TUBE CANNTOR 262.2 00140 - BANDAGE ELASTIC ROLL 6IN ACE 76.95 00142 - CATH FOLEY INDWELL SILICONE 194.75 C1729 00144 - TUBE RECTAL 54.15 00145 - VAGINAL CURETTE DISPOSABLE 36.1 00146 - FEEDING TUBE 95 00147 - BAG URINARY DRAINAGE BEDSIDE 127.3 A4357 00149 - VACUTAINER 17.1 00150 - BAG AMBU DISPOSABLE 96.9 00151 - TUBE NASO/GASTRIC W/O STYLET 127.3 00152 - HEMOVAC 480.7 C1729 00154 - PUMP BREAST DISPOSABLE 121.6 00157 - WATER HUMIDIFIER 19 00158 - CATHETER RADIAL ARTERY 504.45 C1751 00160 - 4M ROOM & CARE - PSYCH SEMI 1248.3 00161 - CATHETER IMPLANTABLE ACCESS 339.15 C1751 00162 - CATHETER VAS DOUBLE LUMEN 1584.6 C1751 00163 - INTRODUCERPERCUT SHEATH 190 C1894 00165 - SYRINGES ASEPTO 48.45 00180 - 4S ROOM & CARE - PSYCH SEMI 1248.3 00184 - 3E ROOM & CARE - PSYCH SEMI 1248.3 00186 - 3N ROOM & CARE - MED/SURG SEMI 1520 001898 - ANGIOPLASTY VENOUS BALLOON TRANS RADIO 3708.8 01898 00193 - NEEDLE LIVER BIOPSY 90.25 00194 - 3N ROOM & CARE - MED/SURG SEMI 2001.65 00199 - SUPPORT FOOT 127.3 00200 - WARMER RADIANT/DAILY 74.1 00207 - DISP CATH TIPS FOR HEMODIALYS PER 10 167.2 A4860 00209 - S G P T ALANINE AMINO 145.35 84460 00210 - ALKALINE PHOSPHATASE 147.25 84075 00212 - C P K ENZYME 252.7 82550QW 00213 - CPK-MB FRACTION 297.35 82553 00214 - LACTATE DEHYDROGENASE 145.35 83615 00215 - SGO-T 145.35 84450 00216 - BILIRUBUN TOTAL 152 82247 00217 - BUN UREA-N 159.6 84540 00218 - CHLORIDE URINE 159.6 82436 00219 - CREATININE CLEARANCE 155.8 82575 00220 - BASIC METABOLIC PROFILE 358.15 80048 00221 - SODIUM SERUM 133 84295 00223 - GLUCOSE TOLERANCE 3 HR 51.3 82952 00224 - ANTI THROMBIN III 215.65 85300 00225 - DIGOXTIN 201.4 80162 00227 - HEPATITIS PANEL ACUTE 431.3 80074 00228 - B12 VITAMIN REF LAB 277.4 82607 00229 - DRUG PANEL MULTIPLE URINE 230.85 80307 00233 - NSY ROOM & CARE - LEVEL I 831.25 00234 - ROOM & CARE - OB 2001.65 00235 - CPK ISOENZYMES 272.65 82552 00236 - ALK PHOS ISOENZYME 376.2 84080 00237 - LEAD LEVEL 91.2 83655 00238 - MYCOPLASMA ANTIBODY 237.5 86738 00239 - ESTRIOL REF LAB 374.3 82670 00240 - OB ROOM & CARE - OB/GYN TRIAGE 1248.3 00241 - FSH GONADOTROPIN 272.65 83001 00242 - OB ROOM & CARE - OB/GYN SEMI 1520 00243 - LIVER PROFILE 302.1 80076 00245 - GLYCOHEMOGLOBIN 136.8 83036 00246 - PROLACTIN 330.6 84146 00247 - STONE ANALYSIS REF LAB 209.95 82355 00248 - 2N ROOM & CARE - Level II 3037.15 "00249 - SYPHLLIS TESTING QUALIT(VDRL,RPR,ART)." 65.55 86592 00250 - C REACTIVE PROTEIN 112.1 86140 00251 - MONO TEST SCREEN 86.45 86308QW 00252 - HETEROPHIL ANTIBODY( MONO TEST) 86.45 86308QW 00253 - COLD AGGLUTININ 115.9 86156 00257 - SEDIMENTATION RATE 97.85 85651QW 00258 - PARTIAL PROTHROMBIN TIME 218.5 85730 00259 - CULTURE URINE 190.95 87086 00261 - CULTURE WOUND ( AEROBIC) 262.2 87070 00262 - OCCULT BLOOD 71.25 82270QW 00263 - GRAM STAIN SMEAR 91.2 87205 00265 - STOOL WBC 84.55 89055 00266 - STOOL FAT 84.55 82705 00267 - ROOM & CARE - 2 NORTH 3172.05 00268 - SMEAR CELL BLOCK CYSTOPATH 285.95 88305 00269 - PAP SMEAR PHYSICIAN CYTOPATH 97.85 88141TC 00270 - PAP SMEAR CYTOPATHOLOGY 141.55 88150TC 00271 - SMEAR BODY FLUIDS C.P.FIL.ME. 184.3 88106TC 00273 - SMEAR BRUSHING/INTER CYT PATH 285.95 88305TC 00274 - 3E ROOM & CARE - MED/SURG TRIAGE 1248.3 00277 - BLOOD SMEAR INTERPRETATION 141.55 85007 00278 - GROSS ONLY LEVEL I 110.2 88300TC 00281 - GROSS MICRO LEVEL II 225.15 88302TC 00282 - GROSS MICRO LEVEL III 444.6 88304TC 00283 - FROZEN SECTION 1 SPEC 435.1 88331TC 00284 - FROZEN SECTION ADDTL SPECS 727.7 88332TC 00285 - 2E ROOM & CARE - MED/SURG SEMI 2001.65 00287 - IMMUNO HISTO CHEMISTRY 245.1 88342TC 00289 - PROSTATIC SPECIFIC ANTIGEN 225.15 84153 00297 - TIBIA EXTERNAL FIXATOR 2889.58 C1713 00302 - DECALCIFICATION 136.8 88311TC 00303 - XR FACIAL BONES MIN 3V 447.45 70150TC 00305 - XR SCAPULA COMP RT 310.65 73010TCRT 00306 - XR ELBOW COMP MIN 3V LT 331.55 73080TC 00307 - XR ELBOW COMP MIN 3V RT 331.55 73080TC 00308 - XR FOREARM ANT/ LAT 2V LT 275.5 73090TC 00309 - XR WRIST COMP MIN 3V LT 315.4 73110TC 00310 - XR HAND MIN 3V LT 323 73130TC 00312 - XR FOOT COMP MIN 3V RT 315.4 73630TC 00313 - XR COLON FLUR BAR W/WO KUB 465.5 74270TC 00314 - XR COLON FOSTER W/WO GLUC 593.75 74280TC 00315 - UROGRAPHY W/NEPHROTOMOGRAM 852.15 74415TC 00316 - XR CHEST FRONT 1V 569.05 71010TC 00323 - XR HYSTEROSALPINGOGRAM 690.65 74740TC 00324 - DRUG PANEL 10 URINE ROUTINE 159.62 80307 00337 - ADRIAMYCIN 10MG 828.4 00338 - ADRIAMYCIN 50MG 3764.85 00354 - NM SCAN WHOLE BODY GALLIUM 1981.7 78802 00357 - NM SCAN BONE/JOINT WHOLE BODY 1598.85 78306 00358 - NM SCAN BONE/JOINT LTD 991.8 78300 00360 - SCAN BRAIN 1714.75 78606 00366 - NM SCAN LUNG PERFUSION 1335.7 78580 00367 - NM SCAN PULMONARY VENTILATION 1692.9 78579 00368 - NM SCAN MYOCARDIAL PERFUSION 2622 78451 00371 - NM SCAN GI BLOOD LOSS 1371.8 78278 00372 - NM SCAN LIVER STATIC 1175.15 78201 00373 - NM SCAN HEPATOBILIARY 1580.8 78226 00374 - SCAN RENAL 1640.65 78707 00375 - NM SCAN TESTICULAR W/FLOW 996.55 78761 00376 - NM SCAN THYROID IMAGING 789.45 78010 00377 - NM SCAN THYROID IMAGE W/UPTAKE 1080.15 78012 00380 - CISTERNOGRAPHY 1606.45 78630 00383 - SCAN HEAD W/O CONTRAST 2430.1 70450TCCT 00384 - SCAN HEAD W/CONTRAST 2550.75 70460TCCT 00387 - SURGERY INPT 1 HR 3288.9 00388 - SURGERY INPT 3 HRS 9861 00389 - SURGERY INPT 5 HRS 16430.25 00390 - SURGERY INPT 6 1/2 HRS 21359.8 00391 - SURGERY INPT OVER 8 HRS 26287.45 00392 - SURGERY AMB 1/2 HR 1645.4 00393 - SURGERY AMB 3 HRS 9861 00394 - SURGERY OUTPT 1/2 HR 1645.4 00404 - EMERGENCY O.R. 330PM-700AM 525.8 00406 - ANESTHESIA LOCAL 495.9 00407 - ANESTHESIA INPT 1/2 HR 495.9 00408 - ANESTHESIA INPT 1 HR 990.85 00410 - ANESTHESIA INPT 1 1/2 HRS 1484.85 00411 - ANESTHESIA INPT 2 HRS 1979.8 00412 - ANESTHESIA INPT 2 1/2 HRS 2470 00413 - ANESTHESIA INPT 3 HRS 2964.95 00414 - ANESTHESIA INPT 3 1/2 HRS 3458.95 00415 - ANESTHESIA INPT 4 HRS 3952.95 00416 - ANESTHESIA INPT 4 1/2 HRS 4444.1 00417 - ANESTHESIA INPT 5 HRS 4939.05 00418 - ANESTHESIA INPT 5 1/2 HRS 5433.05 00419 - ANESTHESIA INPT 6 HRS 5927.05 00420 - ANESTHESIA INPT 6 1/2 HRS 6420.1 00421 - ANESTHESIA INPT 7 HRS 6913.15 00422 - ANESTHESIA INPT 7 1/2 HRS 7407.15 00423 - ANESTHESIA INPT 8 HRS 7900.2 00424 - ANESTHESIA INPT OVER 8 HRS 8887.25 00425 - ANESTHESIA OUTPT 1 HR 990.85 00426 - ANESTHESIA OUTPT 1 1/2 HRS 1484.85 00427 - ANESTHESIA OUTPT 2 HRS 1979.8 00428 - ANESTHESIA OUTPT 3 1/2 HRS 3458.95 00429 - ANESTHESIA OUTPT 4 HRS 3952.95 00430 - ANESTHESIA AMB 1/2 HR 495.9 00435 - ANESTHESIA AMB 1 HR 990.85 00436 - ANESTHESIA AMB 1 1/2 HRS 1484.85 00437 - ANESTHESIA AMB 2 HRS 1979.8 00438 - ANESTHESIA AMB 2 1/2 HRS 2470 00439 - ANESTHESIA AMB 3 HRS 2964.95 00440 - ANESTHESIA AMB 3 1/2 HRS 3458.95 00441 - ANESTHESIA AMB 4 HRS 3952.95 00445 - LABOR/DELIVERY EPIDURAL 1697.65 00448 - PACKED RED BLOOD CELLS EACH UNIT 248.9 P9021 00451 - TRANS OF BLOOD / BLOOD COMPONENT I UNIT 1467.75 36430 00452 - FRESH FROZEN PLASMA EACH UNIT 209.95 P9017 00453 - PLATELET CONCENTRATE 90.25 P9019BL 00454 - CRYOPRECIPITATE 141.55 P9012 00455 - PACKED CELLS WASHED 575.7 P9022 00457 - RHOGAM 441.75 J2790 00458 - BLOOD PROCESSING 423.7 00459 - TRANS BOOD / BLOOD COMPONENT- I UNIT 1467.75 36430 00460 - TYPE/CROSSMATCH PER UNIT 323 00461 - BLOOD TYPING ABO 102.6 86900 00462 - COOMBS TEST DIRECT 190.95 86880 00463 - RBC ANTIBODY SCREENING FOR EACH SERUM 247 86870 00464 - PRENATAL STUDIES 218.5 80055 00468 - ALDOMET TAB 125MG 4 00472 - BREAST SURGICAL SPECIMEN 253.65 76098TC 00475 - US PELVIC NON-OB 761.9 76856 00476 - US BREAST(S) 517.75 76641 00477 - US GUIDED AMNIOCENTESIS 612.75 76946 "00478 - US SOFT TISSUES- HEAD & NCK-THYROID,PARA" 662.15 76536 00480 - US ABDOMINAL AORTA 804.65 76770 00481 - US ONE ORGAN OR FOLLOW UP 684 76705 00482 - US PANCREAS LTD 684 76705 00483 - US RENAL 771.4 76775 00485 - US LIVER 684 76705 00486 - US SPLEEN 684 76705 00489 - E.R. OXYGEN 163.4 00490 - MEDICATED NEBULIZER 143.45 94640 00492 - ARTERIAL BLOOD GASES 451.25 82805 00494 - ABO/RH SECOND SAMPLE 102.6 86900 00497 - ABO/RH SECOND SAMPLE-NEONATAL 102.6 86900 00499 - ABO/RH and ANTIBODY SCREEN-NEONATAL 247 86900 00501 - CHEST PHYSICIAL THERAPY 97.85 97124 00502 - PT IONTOPHORESISEACH EA 15 MIN 122.55 97033GP 00503 - PT THERAPEUTIC PROCEDURE EA 15MN 115.9 97110GP 00504 - PT PHONOPHORESIS 103.55 97039GP 00507 - PT HOT PACKS 75.05 97010GP 00508 - PT HOME MGMT TRAIN EA 15 MIN 108.3 97535 00515 - PT PARAFFIN ROUTINE 85.5 97018GP 00520 - NM SCAN MYOCARDIAL 1641.6 78466 00531 - OT HOME MANAGEMENT TRAINING 108.3 97535GO 00538 - OT HOME MANAGEMENT TRAINING 108.3 97535GO 00545 - ST VIDEOFLUROSCOPY TEST 537.7 92611GN 00547 - ST SPEECH THERAPY TREAT 1 UNITS 289.75 92507GN 00549 - ST SPEECH THERAPY TREATMENT 289.75 92507GN 00551 - ST SPEECH EVALUATION LANGUAGE 1 UNIT 311.6 92523GN 00553 - E/R LEVEL 3 571.9 99283 00554 - E/R LEVEL 4 894.9 99284 00555 - E/R LEVEL 5 1340.45 99285 00556 - ER CRITICAL CARE 1st HR 1857.25 99291 00557 - ER CRITICAL EXT EA ADDL 30 MIN 709.65 99292 00560 - SCAN MUGA 1577.95 78472 00561 - E/R LEVEL 1 271.7 99281 00568 - SPIROMETRY W/GRAPHIC RECORD 349.6 94010 00569 - CARDIAC STRESS T / DOBUTAMIN STRESS TEST 1658.7 93017 00573 - CARDIOPULMONARY RESUSCITATION 1030.75 92950 00575 - AMBULANCE D.M.H. 857.85 00576 - ER APPL SPICA DBL LEG ADULT 1815.45 00577 - ER APPL SPICA DBL LEG CHILD 1349 00578 - ER APPL SPICA SGL LEG ADULT 1620.7 00587 - ER APPL SPICA SGL LEG CHILD 1162.8 00593 - SPLINT ANATOMICAL TOE 51.3 00594 - CAST SHORT ARM/ADULT 277.4 A4580 00595 - CAST SHORT ARM/CHILD 277.4 A4580 00596 - CAST LONG ARM/ADULT 277.4 Q4006 00597 - CAST LONG ARM/CHILD 277.4 Q4007 00605 - CAST SHORT LEG NWB/ADULT 277.4 A4580 00606 - CAST LONG LEG NWB/ADULT 611.8 29345 00615 - CAST SHORT LEG PLASTER/ADULT 277.4 Q4037 00616 - SPLINT SHORT LEG PLASTER/CHIL 192.85 00617 - SPLINT 277.4 A4580 00618 - DRESSING VALPEAU/ADULT 560.5 00619 - DRESSING VALPEAU/CHILD 385.7 00621 - DRESSING ARM COMPRESS/ADULT 179.55 00622 - DRESSING ARM COMPRESS/CHILD 145.35 00623 - DRESSING LEG COMPRESS/CHILD 174.8 00624 - DRESSING UNNA BOOT/CHILD 192.85 00625 - RECOVERY INPT 1/2 HR 319.2 00626 - RECOVERY INPT 1 HR 637.45 00627 - RECOVERY INPT 1 1/2 HRS 955.7 00628 - RECOVERY INPT 2 HRS 1273 00629 - RECOVERY INPT 3 HRS 1906.65 00630 - RECOVERY INPT 4 HRS 2543.15 00631 - RECOVERY INPT 5 HRS 3176.8 00632 - RECOVERY INPT 6 HRS 3812.35 00633 - RECOVERY INPT 7 HRS 4444.1 00634 - RECOVERY INPT 8 HRS 5080.6 00635 - RECOVERY OUTPT 1/2 HR 319.2 00636 - RECOVERY OUTPT 1 HR 637.45 00637 - RECOVERY OUTPT 1 1/2 HRS 955.7 00640 - RECOVERY OUTPT 2 HRS 1273 00641 - RECOVERY OUTPT 3 HRS 1906.65 00643 - RECOVERY OUTPT 4 HRS 2543.15 00644 - RECOVERY AMB 1/2 HR 319.2 00645 - RECOVERY AMB 1 HR 637.45 00646 - RECOVERY AMB 1 1/2 HRS 955.7 00647 - RECOVERY AMB 2 HRS 1273 00648 - RECOVERY AMB 3 HRS 1906.65 00649 - RECOVERY AMB 4 HRS 2543.15 00650 - 2 E ROOM ISOLATION M&S/DAILY 2188.8 00652 - MONITOR FETAL 197.6 00653 - L&D PUMP VACUUM BREAST 99.75 00655 - LABOR ROOM 1 HR 201.4 00656 - LABOR ROOM 2 HRS 398.05 00657 - LABOR ROOM 3 HRS 596.6 00658 - LABOR ROOM 5 HRS 990.85 00659 - LABOR ROOM 6 HRS 1188.45 00660 - LABOR ROOM 7 HRS 1385.1 00661 - LABOR ROOM 8 HRS 1582.7 00663 - LABOR ROOM 9 HRS 1781.25 00664 - LABOR ROOM 10 HRS 1979.8 00665 - LABOR ROOM 11 HRS 2174.55 00666 - LABOR ROOM 12 HRS 2372.15 00667 - LABOR ROOM 13 HRS 2570.7 00669 - LABOR ROOM 14 HRS 2766.4 00670 - LABOR ROOM 15 HRS 2979.2 00671 - LABOR ROOM 16 HRS 3162.55 00672 - LABOR ROOM 17 HRS 3359.2 00673 - LABOR ROOM 18 HRS 3557.75 00674 - LABOR ROOM 19 HRS 3755.35 00675 - LABOR ROOM 20 HRS 3952.95 00676 - LABOR ROOM 21 HRS 4148.65 00677 - LABOR ROOM 22 HRS 4346.25 00678 - LABOR ROOM 23 HRS 4544.8 00679 - LABOR ROOM 24 HRS (MAX) 4741.45 00680 - XR BONE AGE STUDIES 311.6 77072TC 00681 - DELIVERY ROOM-NORMAL DELIVERY 701.1 00682 - FETAL NON-STRESS TEST 447.45 59025 00684 - EEG AWAKE AND DROWSY 839.8 95816 00686 - INITAL OBS CARE 152 G0379 00687 - OBSERVATION ROOM 192 G0378 00688 - DIALYSIS HEMO REGULAR 4608.45 G0257 00688 - DIALYSIS HEMO REGULAR 4608.45 G0257 00691 - DIALYSIS HEMO ACUTE 4608.45 G0257 00709 - VASC DUPLEX CAROTID BILATERAL 1330.95 93880 00717 - VASC DOPPLER UE ART MULT BILAT 769.5 93923 00718 - VASC DOPPLER LE ART MULT BILAT 769.5 93923 00720 - CODEINE TAB 60MG 7 00729 - VASC DUPLEX UE VENOUS BILAT 1176.1 93970 00730 - VASC DUPLEX LE VENOUS BILAT 1176.1 93970 00731 - CARE CONTINUITY/MONTH 127.3 00732 - CARE CONTINUITY/DAY 9.5 00733 - CLOSE COMPANION/MONTH 90.25 00734 - CLOSE COMPANION/DAY 8.55 00736 - INSTALLATION/CC 192.85 00739 - TELEPHONE/TAKE HOME 51.3 00800 - NEONATAL TRANS ISOLATION 38 00880 - NM SCAN LIVER & SPLEEN STATIC 1251.15 78215 00900 - CATHETER URETERAL 159.6 C1758 00960 - DRESSING WOUND COLL 4X6 11.4 00961 - SPECULUM VAGINAL 11.4 00964 - TUBE SHEA PARASOL VENT 63.65 00965 - BLANKET PATIENT WARMING 43.7 00966 - BUTTON GOLD COLLAR 64.6 00967 - NEEDLE UV120 VERASS DISP 1523.8 00968 - ENDO GIA EZ35W 2971.6 00970 - DRESSING WOUND COLL 4X4 8.55 00971 - RELOAD GIA EVU35 5196.5 00972 - GRAFT VASCULAR 2960.2 C1768 00973 - CLIPS LIGATION TITANIUM 102.6 00977 - NEEDLE VERRES DISP. 133 00978 - INSERTER EZ LOAD T-TUBE 668.8 00986 - NM DOBUT STRESS MYO PERF MULT 2622 78451 00988 - TRANESOPHAGEAL 2D ECHO 2273.35 93312 00991 - OBSERVATION ROOM 2-3 HOURS 152 00992 - CATH DBL LUMEN DIALYSIS 292.6 C1752 00993 - GUIDE MALLEABLE CATHETER 156.75 C1769 00994 - KIT CATH ROUND TIP CHOLANGIO 230.85 00995 - TROCAR W/SLIDING REDUC 10-11M 256.5 00996 - WHIRLPOOL LIMB REGULAR O.T. 141.55 97022GO 01000 - XR SKULL MIN 4V 423.7 70260TC 01001 - 2N ROOM & CARE - MED/SURG SEMI 3242.35 01002 - GRAFT VASCULAR SYNTHETIC 2960.2 C1768 01003 - RESECTOR CONCEPT FULL RADIUS 247 01004 - EYE CONFORMER/SPHERE 141.55 01005 - GRAFT PRO-OSTEON BONE10X10X40 1815.45 C1713 01010 - EKG 12 Tracing only 349.6 93005 01011 - ROD HUMERAL FIXATION 2671.4 C1776 01015 - KIT BONE GRAFT 198.55 01016 - GRAFT PRO OSTEONBONE(12X25X25 3100.8 C1713 01018 - GRAFT PRO OSTEON BONE (15cc) 1739.45 C1713 01021 - GRAFT PRO-OSTEON BONE (0.8)cc 1544.7 C1713 01022 - SCREW CORTICAL 3.5mm X(24-36) 19 C1713 01023 - SCREW CORTICAL 3.5mmX(10-22) 1010.8 C1713 01024 - SCREW CANCELLOUS 4.0mmx(10-22 1010.8 C1713 01025 - SCREW CORTIAL 2.7 X(6-24) 19 C1713 01026 - SCREW CORTICAL 6.5mm(24m-36mm 19 C1713 01027 - SCREW CANCELLOUS 4.0mmX(30-50 35.15 C1713 01028 - SCREW MALLOLAR 4.5mmX(25-70) 1010.8 C1713 01029 - SCREW CANCELLOUS 6.5mmX(14-25 1010.8 C1713 01033 - SCREW CORTICAL 4.5 X (30-48) 1010.8 C1713 01034 - SCREW CORTICAL 4.5 X(52-64mm) 19 C1713 01035 - SCREW CORTICAL 4.5mm X(14-30) 1010.8 C1713 01036 - SCREW CANCELLOUS 3.5mmX(14-16 19 C1713 01037 - ADAPTOR SWIVEL (BRON.CONNEC) 48.45 01039 - WIRE GUIDE SPRING 105.45 C1769 01040 - XR SKULL LIMITED < 4V 294.5 70250TC 01043 - CAP HUMERAL ROD 1036.45 C1776 01044 - BLADE ARTHROSCOPY 237.5 01046 - CATHETER FORGARTY WITH TWIST 1238.8 C1757 01050 - SURGERY INPT 1/2 HR 1645.4 01053 - ALBUMIN SERUM PROTEIN TOTAL 90.25 84155 01060 - XR SINUSES MIN 3V 210.9 70240TC 01062 - IMP ACCESS CATHETER- VENOUS/ ARTERIAL 396.15 C1751 01080 - VASC DUPLEX UE VENOUS UNI RT 782.8 93971 01081 - VASC DUPLEX LE VENOUS UNI RT 782.8 93971 01087 - NON-INVASIVE VENTILATOR 913.9 94660 01088 - INFLUENZA ADMIN FEE 93.1 G0008 01092 - DISP CATH TIP FOR PERITO DIALYSIS PER 10 28.5 A4860 "01098 - PACEMAKER, SINGLE CHAMBER, RATE-RESPO" 15492.6 C1786 01100 - CATHETER FRENCH INTERMITTENT 79.8 C1729 01107 - THERMO TEMP A DOT 7.6 01108 - CATH CHOLANGIOGRAM 229.9 C1887 01117 - STOCKING GLOVE COMPRESSION 38.95 01120 - XR SINUSES MIN 3V 318.25 70220TC 01130 - SINOGRAM 556.7 76080TC 01131 - SERVICES TRAINING & EDUCATION 123.5 G0177 011350 - RADIOLOGIC EXAMINATION CHEST SINGLE 569.05 71045 01136 - XR THUMB MIN 2V LT 244.15 73140FATC 011370 - RADIOLOGIC EXAM CHEST 2 VIEWS 316.35 71046 01138 - XR FINGER 2ND DIG MIN 2V LT 244.15 73140F1TC 01139 - XR FINGER 2ND DIGIT MIN 2V RT 244.15 73140F6TC 01140 - XR NASAL BONES MIN 3V 273.6 70160TC 01141 - XR FINGER 3 RD DIG MIN 2V LT 244.15 73140F2TC 01142 - XR FINGER 3RD DIGIT MIN 2V RT 244.15 73140F7TC 01143 - XR FINGER 4TH DIG MIN 2V LT 244.15 73140F3TC 01144 - XR FINGER 4TH DIGIT MIN 2V RT 244.15 73140F8TC 01145 - XR FINGER 5TH DIGIT MIN 2V LT 244.15 73140TC 01146 - XR FINGER 5TH DIGIT MIN 2V RT 244.15 73140TC 01147 - XR GREAT TOE MIN 2V LT 241.3 73660TATC 01148 - XR GREAT TOE MIN 2V RT 241.3 73660T5TC 01149 - XR TOE 2ND DIGIT MIN 2V LT 241.3 73660T1TC 01150 - SURGERY INPT 1 1/2 HRS 4932.4 01151 - XR TOE 2ND DIGIT MIN 2V RT 241.3 73660T6TC 01152 - XR TOE 3RD DIGIT MIN 2V LT 241.3 73660T2TC 01153 - XR TOE 3RD DIGIT MIN 2V RT 241.3 73660T7TC 01154 - XR TOE 4TH DIGIT MIN 2V LT 241.3 73660T3TC 01155 - XR TOE 4TH DIGIT MIN 2V RT 241.3 73660T8TC 01156 - XR TOE 5TH DIGIT MIN 2V LT 241.3 73660T4TC 01157 - XR TOE 5TH DIGIT MIN 2V RT 241.3 73660T9TC 01160 - XR MANDIBLE MIN 4V 386.65 70110TC 01164 - CAPD/COMPOSITE TRAINING 1064.95 90989 01165 - CAPD/COMPOSITE TREATMENT 534.85 90945 011656 - NM TC-99 HEPATOLITE 8.0 MCI 427.5 A9510 01166 - CCPD/COMPOSITE TRAINING 1064.95 90989 01167 - CCPD/COMPOSITE TREATMENT 534.85 90945 01168 - CARBAMAZEPINE 162.45 80156 01176 - PUL STRESS TEST COMPLEX 1212.2 94621 01179 - EDU 2-4 PTS EA 30 MIN 46.55 98961 01180 - XR ORBIT MIN 4V 298.3 70200TC 01181 - EDU 5-8 PTS EA 30 MIN 32.3 98962 01182 - OMNIPAGQUE 300-399 MG/ML 446.5 Q9962 01183 - PULMONARY STRESS TEST MEASURE HEART 1212.2 94618 01184 - ECHO TRANS THOR 2D 1238.8 93307 01188 - URINALYSIS COMPLETE W/MIC 97.85 81000 01191 - HAPTOGLOBIN QUANTITATIVE 147.25 83010 01192 - URINE OSMOLALITY 110.2 83935 01193 - ESTRADIOL 395.2 82670 01194 - TESTOSTERONE TOTAL 395.2 84403 01195 - HIV-1 AB BY WESTERN BLOT 235.6 86689 01196 - VIRAL LOAD HIV-1 QUANT. 860.7 87536 01198 - ACID VALPROIC 161.5 80164 01199 - PLATELET ANTIBODIES 423.7 86022 01200 - SURGERY INPT 2 HRS 6574 01201 - HEMOVAC LARGE 63.65 01204 - SENSORS TEMPERATURE 8.55 01207 - SOLUTION II/SC PERINEAL 9.5 01208 - CREAM/SC ALOE VESTRA 11.4 01209 - DRESSING/SC DUODERM 4IN X 5IN 19 01210 - X-RAY INTERNAL AUDIT CANAL 273.6 70134TC 01211 - T-3 FREE 362.9 84481 01212 - POTASSIUM URINE 71.25 84133 01213 - ALDOLASE 83.6 82085 01215 - IMMUNOFIXATION 417.05 86334 01216 - MIC BACTERIAL SENSITIVITY 149.15 87186 01217 - TOXIN C DIFFICILE 202.35 87230 01218 - ORGANISM ADDITIONAL ID 84.55 87077 01219 - ORGANISM MULTIPLE 95 87081 01220 - X-RAY MASTOIDS MIN 3V PER SDE 356.25 70130TC 01221 - DRESSING/SC DUODERM 6IN X 8IN 35.15 01222 - DRESSING/SC DUODERM 6IN X 7IN 48.45 01223 - ROLL KERLIX/SC 4 1/2IN X 6IN 13.3 01224 - DRESSING/SC TELFA 8IN X 10IN 58.9 01225 - PACK/SC ABD PAD 102.6 01226 - TRAY/SC BASIC LACERATION 28.5 01227 - SCALPEL/SC BLADE #10 9.5 01228 - PADS/SC BLUE EACH 11.4 01230 - DRESSING/SC HYDRSRB 4IN X 8IN 11.4 01232 - TUBE/SC SAF-GEL 46.55 01233 - SYRINGE/SC BULB DISPOSABLE 34.2 01234 - DRESSING/SC DUODERM 4IN X 6IN 19 01235 - DRESSING/SC DUODERM 4IN X 4IN 13.3 01240 - XR TMJ BILATERAL 451.25 70330TC 01246 - B-NATRIURETIC PEPTIDE 676.4 83880 01247 - VENIPUNCTURE 33.25 36415 01249 - C-PEPTIDE 556.7 84681 01250 - SURGERY INPT 2 1/2 HRS 8215.6 "01251 - LOCM 100-199 MG/ML IODINE, 1 ML" 64 Q9965 01253 - CALCIUM IONIZES 366.7 82330 "01254 - LOCM 200-299 MG/ML IODINE, 1 ML" 74 Q9966 01255 - ETHYLENE GLYCOL 400.9 80320 01256 - ANTIBODY MUMPS 351.5 86735 "01257 - LOCM 300-399 MG/ML IODINE, 1 ML" 84 Q9967 01259 - ISOVUE 300-399 MG/ML 446.5 Q9967 01261 - FLUID AMNIOTIC 164.35 82106 01262 - CULTURE VIRUS 722 87252 01263 - ACETYLCHOLINESTERASE 218.5 82013 01264 - AMNIOTIC FLUID CHROMOSOME ANALYSIS 2818.65 88267TC 01265 - ANTIBODY H. PYLORI 190.95 86677 01267 - TROPONIN-I 337.25 84484 01271 - METABOLITES COCAINE DRUG SCRN 98.8 80353 01272 - SEROTONIN 416.1 84260 01273 - LEVEL OPIATES DRUG SCREEN 98.8 G0479 01275 - OT RE-EVALUATION O.T. 176.7 97004GO 01277 - VENTILATOR 1ST DAY 1330.95 94002 01280 - SERUM HERPES SIMPLEX 225.15 87274 01281 - PT MGMT WHEELCHAIR EA 15 MIN 102.6 97542GP 01282 - X-RAY MASTOIDS FACIAL LIMITED 272.65 70120TC 01284 - XR FACIAL BONES <3V 298.3 70140TC 01285 - CT NEEDLE BIOPSY 1999.75 77012 01287 - XR EXAM FOREIGN BODY 1V CHILD 272.65 76010TC 01288 - CARDIAC STRESS TEST 1330.95 93015 01289 - XR BONE SURVEY LIMITED FOR METASTASIS 494 77074TC 01290 - FILIFORM 42.75 01292 - XR LUMBAR SPINE COMP 383.8 72114TC 01295 - PT NEUROMUSC RE-ED EA 15 MIN 114 97112GP 01298 - EKG 12 LEAD TRACING ONLY 235.6 93005 01301 - MONITOR HOLTER RECORDING 574.75 93225 01303 - PT ACTIVITIES THERAP EA 15 MIN 114 97530GP 01304 - PT TRNG HOME MGMT/ADL EA 15 MIN 108.3 97535GP 01305 - PT DEV COGNITIVE SKILLS 15 MIN 112.1 97532GP 01306 - PT E STIM ATTEND EA 15 MIN 112.1 97032GP 01308 - PT PROS TRNG EA 15 MIN 108.3 97761GP 01310 - CATHETER 5 FRENCH URETHERAL 95 C1758 01311 - PT PROCEDURE THERAP UNLISTED 93.1 97139GP 01312 - PT MANUAL THERAPY EA 15 MIN 121.6 97140GP 01313 - FRC NITROGEN 442.7 94726 01315 - NASAL CANULA 62.7 A4615 01316 - AIRFLOW RESISTANT DETERMI 267.9 94728 01318 - PULMONARY COMPLIANCE 350.55 94750 01319 - URINALYSIS MICROSCOPIC ONLY 57 81015 01321 - PULSE OXIMETRY OVERNIGHT 288.8 94762 01322 - GC DNA PROBE 169.1 87591 01324 - RESPIRATORY FLOW VOLUME 401.85 94375 01325 - FFP THAWING EACH EACH UNIT 86.45 86927 01327 - BLOOD COUNT HEMATOCRIT 65.55 85014 01329 - MAXIMUM VOLUNTATION 355.3 94200 01330 - CO/MEMBANE DIFFUSE CAPACITY 397.1 94729 01331 - THERAPY GROUP PSYCHO. 127.3 G0410 01332 - THERAPY GROUP PSYCHO. 287.85 G0410 01333 - DIABETES SELF MANAGEMENT TRAINNING 214.7 G0108 01334 - DIABETES SELF MGMT TRAINING 30MIN GROUP 68.4 G0109 01335 - GRP 3 MONTH F/UP 2 UNITS 68.4 G0109 01336 - GRP BEHAV CHANGE AND CORE 6UT 68.4 G0109 01337 - GRP MEAL PLANNING 2 UNITS 68.4 G0109 01338 - GRP MONITORING 2 UNITS 68.4 G0109 01340 - GRP 12 MONTH F/UP 2 UNITS 68.4 G0109 01342 - IND TRAINING EDUCATION 2 UNIT 214.7 G0108 01350 - SURGERY INPT 3 1/2 HRS 11502.6 01400 - SURGERY INPT 4 HRS 13145.15 01403 - CT 3D RECONST W/O POST PROCESS 165.3 76376 01404 - CT EAR TEMPORAL BONE WO/W CONT 2388.3 70482 01405 - CTA LOWER EXTREM WO/W CONTRAST 1845 73706 01410 - DRESSING APPLICATION FINGER 97.85 01412 - CT LOWER EXTREM WO/W CONTRAST 2473.8 73702CT 01413 - CT UPPER EXTREM WO/W CONTRAST 2217.3 73202CT 01420 - SPLINT ANATOMICAL FINGER 51.3 01421 - CTA ABDOMINAL AORTA WO/W CONT 3612.85 75635 01422 - CT 3D RECONST W/POST PROCESS 426.55 76377 01423 - CTA ABDOMEN WO/W CONTRAST 2915.55 74175CT 01424 - CTA PELVIS WO/W CONTRAST 2769.25 72191CT 01425 - CTA CHEST WO/W CONTRAST 2875.65 71275CT 01426 - CTA HEAD WO/W CONTRAST 2635.3 70496CT 01427 - CTA NECK WO/W CONTRAST 2485.2 70498CT 01428 - CT NECK WO/W CONTRAST 2495.65 70492CT 01430 - ARTANE TAB 2MG 4 01432 - PATELLAR IMPLANT 9808.75 C1776 01450 - SURGERY INPT 4 1/2 HRS 14788.65 01471 - TREATMENT IPPB 143.45 94640 01475 - IOP ADMISSION ASSESSMENT INITIAL (2.5hr) 227.05 01476 - IOP ADMISSION ASSESSEMENT ADDL (.25hr) 25.65 01477 - PROSTATE SPECIFIC ANTIGEN- FREE 493.05 84154 01479 - IOP LEVEL II GROUP INTENSIVE OP(2.0hr) 69.35 01481 - IOP LEVEL I & II ADDL TIME (.25hr) 11.4 01483 - IOP LEVEL I GROUP BASIC OP(1.5hr) 51.3 01484 - CATCHECHOLAMINES TOTAL - URINE 461.7 82382 01485 - IOP LEVEL I & II INDIVIDUAL SESSION(1hr) 88.35 01486 - IOP INDIVIDUAL SESS ADDL TIME(.25hr) 24.7 01487 - BLOOD-WBC 172.9 85048 01488 - G6PD QUANTITATIVE 262.2 82955 01490 - IOP DISCHARGE ASSESSMENT(1.25hr) 114.95 01496 - CATECHOLAMINE 392.35 82383 01499 - OLIGO CLONAL IMMUNE 537.7 83916 01500 - IMMUNO ASSAY CA 19-9 199.5 86301 01505 - BLOOD SMEAR MANUAL DIFFERENTIAL 58.9 85007 01513 - CATH TRANSL ANGIO DRUG COATED NON LASER 2050 C2623 01515 - INTRODUCER PERCUT SHEATH 159.6 C1894 01533 - CATHETER GUIDING 1153.75 C1887 01534 - SWALLOW/DYSPHAGIA TREATMENT 211.85 92526GN 01536 - THIN PREPERATION CYTOLOGY 402.8 88143TC 01550 - SURGERY INPT 5 1/2 HRS 18072.8 01552 - 2E INFU THER DIAG TO 1 HR 197.6 96365 01553 - 2E TRANS BLOOD / BLOOD COMPONENT- 1UNIT 1467.75 36430 01558 - 2E INJ IV PUSH 88.35 96374 01559 - L& D INFU THER DIAG ADD HR 197.6 96366 01560 - L& D INFU THERA UP TO 1HR 197.6 96365 01564 - L & D INJ SUB CUT/ IM 350.55 96372 01566 - L & D INJ IV PUSH 713.45 96374 01567 - EXTERNAL VERSION 917.7 59412 01569 - INJECTION EPIDURAL BLOOD CLOT PATCH 1033.6 62273 01577 - CRYO PRECIPATATE REDUCED PLASMA 154 P9044 01585 - PLATELET PHERESIS EA UNIT 1558.95 P9019 01591 - PT STRAP ELBOW/ WRIST LT 225.15 29260GP 01596 - PT STRAP ANKLE/ FOOT LT 205.2 29540GP 01597 - PT STRAP ANKLE FOOT RT 205.2 29540GP 01598 - PT STRAP SHOULDER LT 247 29240GP 01599 - PT STRAP SHOULDER RT 247 29240GP 01600 - SURGERY INPT 6 HRS 19716.3 01602 - PT STRAP LOW BACK 164.35 29799 01603 - PT STRAP KNEE LT 237.5 29530GP 01604 - PT STRAP KNEE RT 237.5 29530GP 01605 - PT STRAPP TOES LT 420.85 29550GP 01606 - PT STRAP TOES RT 420.85 29550GP 01607 - STRAPPING HIP LT 190 29520GP 01608 - PT STRAP HIP RT 190 29520GP 01609 - PT STRAP ELBOW/WRIST RT 247.95 29260GP 01610 - CATHETER MUSHROOM INDWELLING 96.9 C1729 01613 - PROXIMAL FINGER STATIC SPLINT 247.95 29130GO 01616 - ER IV INF THERAPEAUTIC EA ADDL HR 269.8 96366 01617 - ER IV INF THER/ DIAG UP TO 1HR 339.15 96365 01625 - ER IPECAC ADMINISTRATION 214.7 99175 01627 - ER INJECTION SUB-Q/IM 269.8 96372 01628 - ER IV PUSH INITIAL DRUG 191.9 96374 01638 - XR VENOGRAPHY EXTREMITY UNI LAT LT 1614.05 75820TC 01641 - VISIPAQUE 300-399 MG / ML 381.9 Q9967 01644 - HYPAQUE 60% 1ML 875.9 01645 - SINOGRAFFIN 1ML 397.1 01652 - NM TC SUPLHER COLOID 8MCI 392.35 A9541 01653 - NM MYOCARDIAL PERFUSION SPECT 3533.05 78451 01654 - NM TC-99M MACRO ALBUMIN 5 MCI 194.75 A9540 01658 - VASC DUPLEX UE VENOUS UN LT 845.5 93971 01659 - NM TC-99 MERITIADE (MAG-3) 15 MCI 701.1 01660 - NM TC- 99 M PYRO PHOSPHA 25 MCI 675.45 A9538 01661 - NM TC-99 TETROFOSMN 40 MCI 677.35 A9502 01662 - NM BRAIN VASCUL FLOW ONLY 404.7 78610 01663 - NM TC-99 M MEDRONATE 25 MCI 194.75 A9503 01664 - NM TC-99 PERTECHNT 1MCI 214.7 A9512 01666 - NM THALLIUM- 201 1 MCI 366.7 A9505 01667 - NM 123 CAP DX 100 UCI 509.2 A9516 01669 - NM KIDNEY W & W/O PHRMA 1984.55 78709 01670 - ACTIVITY THERAPY PER EDUCATION 114.95 G0176 01672 - OT GROUP THERAPY 104.5 G0129 01673 - PACE MAKER DUAL RATE RESPONSE 22287.95 C1785 01674 - PACE MAKER OTHER THAN SINLE / DUAL CHAMB 39768.9 C2621 01675 - DIALYSIS ACESS SYS IMPLANTABLE 2080.5 C1881 01677 - PACE MAKER DUAL NON RATE RSPNV 6703.2 C2619 01678 - PACE MAKER SGL RATE RESPONSIVE 5747.5 C1786 01680 - CATHETER HICKMAN 9.6 SGL LUMEN 1728.05 C1751 01681 - CATHER HICKMAN HEMODIALYSIS 1005.1 C1752 01682 - PLUS MESH HERNIA REPAIR LARGE 1013.65 C1781 01683 - CATH CENTRAL VENOUS 7FR 2 X 20 1728.05 C1751 01686 - MESH PLUG HERNIA REPAIR MED 1013.65 C1781 01687 - GLIDE WIRE 3 X 150 STRAIGHT 336.3 C1769 01688 - GRAFT VASCULAR BAR 22X10 2960.2 C1768 01689 - GRAFT VASCULAR BARD 22 X 11 2960.2 C1768 01691 - GLIDE WIRE 3 X 150 ANGLED 336.3 C1769 01693 - GRAFT GORTEX VASC 70 X 10 2960.2 C1768 01694 - CATHETER DIALYSIS 32 FR 1005.1 C1752 01695 - CATHETER KI HEMO 12 FR 1005.1 C1752 01696 - CATH EMB FOGARTY 10 FR 1238.8 C1757 01697 - GRAFT PATCH GORTEX VASC 5 CM 2960.2 C1768 01698 - CATH EMB FOGARTY 3FR 1238.8 C1757 01699 - CATH EMB FOGARTY 4 FR 1238.8 C1757 01700 - SURGERY INPT 7 HRS 23001.4 01701 - CATH EMB FOGARTY 8 FR 1238.8 C1757 01702 - RETRIVER STONE 8 MM 663.1 C1773 01703 - GUIDE WIRE 8 X 150 376.6 C1769 01704 - GRAFT IMPRA 45 CM 2960.2 C1768 01705 - FEMORAL HEAD IMPLANT 11 X 180 125 4627.45 C1776 01706 - NAIL GAMMA 11X 180 125 DEG 1406.91 C1713 01708 - SCREW CANELLOUS 4.0 X 10 1010.8 C1713 01709 - CATHETER INTRAVASCULAR US 2688.5 C1753 01710 - GRAFT GORTEX VASC 80 X 10 2960.2 C1768 01711 - TRANS ESOPHAGEAL 2D ECHO 1984.55 93318 01712 - ECHO TRANSTHORACIC 2D FU LTD 1546.6 93308 01713 - DOPPLER ECHO FOLLOW UP 367.65 93321 01714 - DOPPLER ECHO CARDIOGRAPHY 573.8 93320 01722 - 3E OBSERVATION PER HR 166.01 G0378 01723 - 3E INJ IV PUSH 88.35 96374 01725 - NON-STERILE/PLAIN WP 98.8 97022 01726 - DEBRIDE STERILE WP <20 SQ CM 64.6 97597 01728 - DEBRIDEMENT STERILE W P >20 SQCM 82.65 97598 "01729 - BREATH EXER CUPPIN, PERCU, VIBRA" 99.75 94667 01733 - ELECTRIC STIMULATION- UNATTENDED 74.1 G0283 01743 - AIRWAY ORAL 60MM ADOLESCENT 42.75 01747 - STERILE WATER IRRI 1000ML 51.3 01750 - SURGERY INPT 7 1/2 HRS 24643.95 01755 - AIRWAY ORAL 43 MM INFANT 32.3 01758 - AIRWAY ORAL 80MM ADULT 29.45 01765 - BAG PEDS / INFANT AMBU 418 01767 - TUBE SUCTION YANKAUER 21.85 01768 - AIRWAY GUEDEL 100ML 212.8 01774 - TUBE CUFFED ET 3.0 202080 114.95 01775 - TUBE CUFFED ET 4.0 202075 114.95 01776 - TUBE CUFFED ET 5.0 202070 93.1 01777 - TUBE CUFFED ET 6.0 202065 93.1 01779 - TUBE CUFFED ET 7.5 226.1 01780 - TUBE CUFFED ET 8.0 226.1 01784 - TUBE CUFFED ET 7.0 226.1 01785 - TUBE CUFFED ET 9.0 202045 93.1 01800 - SURGERY INPT 8 HRS 26287.45 01801 - ICU CATHETER DBL LUMEN BUNDLE 1584.6 C1751 01802 - 2E CATHETER DBL LUMEN BUNDLE 1584.6 C1751 01807 - ANTIBODY ID LEUKOCYTE 303 86021 "01809 - HEPATITIS C, QAUNTIFICATION" 971.85 87522 01810 - PROGESTRONE 637.45 84144 "01842 - PACEMAKER, DUAL CHAMBER, RATE-RESPONSIVE" 25639.55 C1785 01848 - USSPINAL CANAL AND CONTENTS 589.95 76800 01850 - FEMORAL ARTERY CATH 96.9 C1751 01871 - EXTERNAL FIXATOR 1424.05 C1713 01872 - APEX PIN FOR EXTERNAL FIXATOR 1424.05 C1713 01873 - PIN TRANSFIX FOR EXTERNAL FIXATOR 1424.05 C1713 01874 - 10 HOLE PUNCH CLAMP FOR EXTERNAL FIXATOR 1424.05 C1713 01875 - PIN TO BAR COULPLING FOR EXTERNAL FIX 1424.05 C1713 01876 - BAR TO BAR COUPLING FOR EXTERNAL FIX 1424.05 C1713 01877 - TRANSFIX CARBON FIBER ROD FOR EXTERN FIX 1424.05 C1713 01878 - STRAIGHT POST FOR EXTERNAL FIXATOR 1424.05 C1713 01879 - ANGLED POST FOR EXTERNAL FIXATOR 1424.05 C1713 01880 - ESTROGEN RECEPTOR ASSAY 455.05 84233 01881 - PLATE 8 HOLE 3.5 / PROX. TIBIA 1499.18 C1713 01882 - SCREW 3.5 X 36 CORTICAL 1424.05 C1713 01883 - SCREW 3.5 X 32 CORTICAL 1424.05 C1713 01884 - SCREW 3.5 X 38 CORTICAL 1424.05 C1713 01885 - SCREW 4.0 X 4.0 CANCELLOUS 48.9 C1713 01886 - SCREW 4.0 X 55 CANCELLOUS 1424.05 C1713 01887 - SCREW 4.0 X 60 CANCELLOUS 1424.05 C1713 01889 - CANCELLOUS CRUNCH 5CC 1424.05 C1713 01895 - CATHETER PLACE SUPERIOR/INFERIOR VENA CA 2372.15 36010 "01897 - STENT PLACEMENT INTRAVASCULAR, VESSEL" 9404.05 37205 01898 - ANGIOPLASTY;VENOUS BALLOON TRANS. RADIO 2823.15 75978TC "01900 - VENOGRAPHY;CAVAL,SUPERIOR W/SERIALOGRAPH" 2917.45 75827TC 01903 - BONE SCREW 417.5 C1713 "01923 - BLOOD, OCCULT BY FECAL HEMOGLOBIN" 75.05 82274QW 01952 - STRAPPING; RIGHT ELBOW OR WRIST 228 29260GO 01953 - STAPPRING; LEFT ELBOW OR WRIST 228 29260GO 01954 - STRAPPING; RIGHT HAND OR FINGER 209 29280GO 01955 - STRAPPING; LEFT HAND OR FINGER 209 29280GO 01958 - DUPLEX SCAN OF EXTREMITY 1166.6 G0365 01959 - DUPLEX SCAN EXTREMITY 1166.6 G0365 01961 - LENS INTROCULAR ANTER CHAMBER 746.7 V2630 01963 - SONOHYSTEROGRAPHY 625.1 76831 "01964 - LEAD, PACEMAKER, OTHER THAN TRANSVENOUS" 969 C1898 01965 - XR FINGER 2ND DIGITMIN 2V RT 241.3 73140TC 01966 - DUPLEX SCAN EXTREMITY 1166.6 G0365 01967 - DUPLEX SCAN EXTREMITY 1166.6 G0365 01975 - EEG AWAKE AND ASLEEP 869.25 95819 01985 - RH FACTOR 61.75 86901 02050 - ANESTHESIA OUTPT 1/2 HR 495.9 02100 - XR NECK SOFT TISSUE 294.5 70360TC 02110 - XR CERVICAL SPINE 1V 244.15 72020TC 02130 - XR CERV SPINE ANT/LAT 383.8 72040TC "02131 - BRAIN IMAGING, TOMOGRAPHIC (SPECT)" 2491.85 78607 02132 - LYPHOSCINTGRAPHY 1927.55 78195 02133 - LIVER IMAGING SPEC 2161.25 78205 02134 - KIDNEY SCAN SPEC 1863.9 78710 02135 - KIDNEY FUNCTION 2014.95 78708 02136 - GASTRIC EMPTYING IMAGING STUDY 1907.6 78264 02137 - BONE SCAN-THREE PHASE 2238.2 78315 02138 - INFRACT PLANAR SNGLE STDY IMAGE W/TL-201 1910.45 78453 02139 - MYOCARDIAL SINGLE TL-201 2372.15 78451 02140 - MYOCARDIAL PERFUSION/E.F. 1019.35 78451 02141 - MYOCARDIAL PYP SPECT 1932.3 78451 02146 - MYOCARD PERF WALL MOUTION 1050.7 78451 02148 - ISO TC99 SESTAMIBI 1 DOSE 754.3 A9500 02150 - XR CERVICAL SPINE COMPLETE 432.25 72052TC 02152 - ISO TC 99M CERETEC<25MC 3007.7 A9521 02153 - ISO-IN III LEUKOCY (WBC) 3064.7 A9547 02154 - ISO TC99 DTPA PER MCI 303.05 A9539 02155 - NM BONE SCAN SPECT 2220.15 78320 02156 - NM TUMOR IMAG-WHOLE BODY 2 DAY 3264.2 78804 02157 - ISO TC 99MAG-3 OOS<15 MIL 895.85 A9562 02158 - NM PARATHYROID IMAGING SESTAMIBI 1657.75 78070 02159 - ABCESS LOC WHOLE BODY 2703.7 78806 02160 - ABCESS LOCALIZATION SPECT 2459.55 78807 02161 - CHEST ULTRASOUND 760.95 76604 02200 - XR THORACIC SPINE 3V 319.2 72072TC 02250 - ANESTHESIA OUTPT 2 1/2 HRS 2470 02279 - CATH TRANSL ATHERECTOMY DIRECTIONAL 3846.75 C1714 02280 - CATH TRANSL ANGIOPLASTY NON LASER 815 C1725 02287 - ANGIOGRAPHIC CATHERER / ANGIOPLASTY 1795.5 C1725 02288 - PTA BALLOON DIALATION CATHETER FOR FISTU 1795.5 C1726 02289 - ZIMMER TOTAL KNEE 7999 C1776 02300 - ANESTHESIA OUTPT 3 HRS 2964.95 "02301 - LAG SCREW, TIBIA 10.5X95MM" 873.66 C1713 "02302 - LOCKING SCREW, FULL THREAD 5X47,5MM" 1424.05 C1713 "02303 - LONG NAIL KIT R2.0, TIBIA" 600.24 C1713 02304 - CANCELLOUS CRUNCH 15CC 1424.05 C1713 02330 - XR LUMBOSACRAL SPINE AN /LAT 342.95 72100TC 02350 - XR LUMBOSACRAL SPINE 4V W/OBL 475 72110TC "02383 - TECHNETIUM TC-99M GLUCOHEPT, <25ML" 334.4 A9550 02495 - FEMORAL IMPLANT 9808.75 C1776 02497 - HIP ORTHOSIS 3835.15 L1686 02500 - XR SACRUM & COCCYX SPINE MIN 2V 264.1 72220TC 02600 - XR PELVIS ONE/ TWO VIEWS RT 301.15 72170TC 02620 - XR PELVIS ONE / TWO VIEWS LT 301.15 72170TC 02650 - XR SACROILIAC JOINT 3V+ 287.85 72202TC 02700 - CAST SHORT ARM PLASTER/ADULT 277.4 A4580 02710 - CAST SHORT ARM PLASTER/CHILD 277.4 A4580 02755 - UNIPOLAR 47MM 9808.75 C1776 02756 - UNIPOLAR 12/14 TAPER SLV. 4MM IMPLANT 9808.75 C1776 02800 - SPLINT LONG ARM/ADULT 277.4 A4580 02801 - VARICELLA 169.1 86787 02802 - CARDIOLIPIN ANTIBODY 529.15 86147 02810 - SPLINT 84.55 A4570 02820 - SPLINT SUGAR TONG/ADULT 237.5 02830 - SPLINT SUGAR TONG/CHILD 198.55 02890 - PROSTATIC SPECIFIC ANTIGEN 225.15 84153 03010 - XR SHOULDER COMP MIN 2V LT 367.65 73030TC 03020 - XR SHOULDER COMP MIN 2V RT 367.65 73030TC 03100 - SURGERY AMB 1 HR 3288.9 03110 - XR CLAVICLE COMPLETE LT 288.8 73000TC 03120 - XR CLAVICLE COMPLETE RT 288.8 73000TC 03150 - SURGERY AMB 1 1/2 HRS 4932.4 03200 - SURGERY AMB 2 HRS 6574 03210 - XR SCAPULA COMPLETE LT 310.65 73010LTTC 03240 - SPLINT LONG LEG/ADULT 277.4 A4580 03250 - SURGERY AMB 2 1/2 HRS 8215.6 03310 - XR HUMERUS MIN 2V LT 305.9 73060TC 03320 - XR HUMERUS MIN 2V RT 305.9 73060TC 03350 - SURGERY AMB 3 1/2 HRS 11502.6 03400 - SURGERY AMB 4 HRS 13145.15 03418 - VASOTEC INJ 1.25MG 111 03520 - XR FOREARM ANT/LAT 2V RT 275.5 73090TC 03600 - DRESSING LEG COMPRESS/ADULT 192.85 03620 - XR WRIST COMP MIN 3V RT 315.4 73110TC 03720 - XR HAND MIN 3V RT 323 73130TC 03810 - XR FINGER(S) MIN 2V LT 175.75 73140TC 03820 - XR FINGER(S) MIN 2V RT 175.75 73140TC 03940 - XR ACROMIOCLAVICULAR JOINT 247 73050TC 03960 - XR STERNOCLACULAR JNT MIN 3V 247 71130TC 04210 - XR KNEE COMPLETE 4V+ LT 426.55 73564TC 04220 - XR KNEE COMPLETE 4V+ RT 426.55 73564TC 04250 - COLCHICINE TAB 0.5MG 2 04310 - XR TIBIA & FIBULA 2V LT 270.75 73590TC 04320 - XR TIBIA & FIBULA 2V RT 270.75 73590TC 04410 - XR ANKLE COMPLETE MIN 3V LT 277.4 73610TC 04420 - XR ANKLE COMPLETE MIN 3V RT 277.4 73610TC 04510 - XR FOOT COMP MIN 3V LT 315.4 73630TC 04610 - XR CALCANEUS MIN 2V LT 316.35 73650TC 04620 - XR CALCANEOUS MIN 2V RT 316.35 73650TC 05010 - XR ESOPHAGUS 363.85 74220TC 05021 - INVEGA 3 MG TABLET 13.94 05022 - INVEGA 6 MG TABLET 13.94 05110 - X-RAY ABDOMINAL 1 AP VIEW 289.75 74000TC 05120 - XR ABD COMP DECUBITUS AND /OR ERECT VIEW 378.1 74020TC 05130 - XR ABD COMP DECU AND/ OR ERECT VIEW 378.1 74020TC 05200 - XR UPPER GI DELAY W / KUB 451.25 74241TC 05223 - NM XE 133 GAS 10 MCI 476.9 A9558 05224 - NM KIDNEY W/O PHARM 1640.65 78707 05227 - NM MUGA MULTIPLE 2111.85 78473 05228 - NM MUGA SINGLE 1577.95 78472 05230 - US PREGNANT UTERUS ADD'L GEST 253.65 76802 05231 - OB US 0-14 WEEKS 812.25 76801 05234 - US PREGNANT UTERUS TRANSVAG 736.25 76817 05235 - US UNLISTED US PROCEDURE 429.4 05236 - US INFANT HIPS DYNAMIC 318.25 76885 05239 - US INFANT HEAD 513.95 76506TC 05241 - NM TC-99M CHOLETEC 596.6 05243 - C4 COMPLEMENT 323 86160 05244 - HIV GENOTYPE 1117.2 87901 05245 - HEPATITIS C GENOTYPE 1717.6 87902 05246 - LEGIONELLA ANTIGEN DETECTION 323 87278 05247 - LEGIONELLA ANTIGEN -URINE 323 87449 05250 - CONTRAST XR UPPER GI TRACT 548.15 74247TCCT 05252 - INHIBIN -A 310.65 86336 05253 - TOXOPLASM ANTIBODY-Ig G 287.85 86777 05254 - TOXOPLASMA ANTIBODY Ig A 287.85 86777 05255 - TOXOPLASMA ANTIBODY-Ig M 287.85 86778 05257 - THYROID PEROXIDASE AUTO ANTI BODY 151.05 86376 05260 - SEX HORMONE BINDING GLOBULIN 117.8 84270 05262 - TOXOCOLOGY SCREEN -SERUM 444.6 G0479 05263 - ANTI DNA -DOUBLE STRAND 356.25 86225 "05267 - RNP/SMITH / SJOGRN'S SYN A,B ANTI BODY" 637.45 86235 05272 - Ga 67(GALLIUM CITRATE) 516.8 A9556 05284 - BLOOD COMPATIBILITY SPIN TECH / UNIT 172.9 86920 05285 - BLOOD COMP INCUB TECH / UNIT 94.05 86921 05286 - BLOOD COMP ANTI GLOBULIN TECH / UNIT 192.85 86922 05287 - HIV-1 & 2 SINGLE RESUTL 151.05 86703 05300 - XR EXAM OF SMALL BOWEL 505.4 74250TCCT 05305 - GLUCOSE TOLERANCE TEST 1 HOUR 154.85 82951 05306 - PROTEIN PLEURAL FLUID 106.4 84157 05307 - GLUCOSE TOLERANCE TEST 2 HOUR 51.3 82952 05308 - CREATININE URINE / OTHER SOURCES 81.7 82570 05314 - ANEROBIC CULTURE(EXCEPT BLOOD) 202.35 87075 05315 - PROTEIN C ANTIGEN 265.05 85302 05317 - PROTEIN S TOTAL 273.6 85305 05319 - AM FLUID/ CHRO VILLE CHROM ANALYSIS 637.45 88235TC 05320 - AMNIO FLUID /CHRO VILLE CHROM KARYOTYPE 1015.55 05321 - AMNIO FLUID/ CHRO VILLE ADD KARYOTYPES 225.15 88280TC 05322 - CHROMOSOME EXAM INTER & RESULT 169.1 88291TC 05323 - PROD OF CONCEPT KARYO W/ BANDING 906.3 88262TC 05324 - BONE MARROW CHROMOSOME ANALYSIS 686.85 05325 - BONE MARROW CHROM DNA PROBE 270.75 88271TC 05326 - BONE MARROW CHROM HYBRID ANALYSIS 403.75 88275TC 05327 - URINE ANALYSIS AUTOMATED W/ MICRO 86.45 81001 053277 - MARROW ASPIRATION ONLY 686.85 38220 05328 - GROSS & MICRO LEVEL 6 569.05 88309TC 053288 - BONE MARROW BIOPSY AND ASPIRATIONS 686.85 38222 053299 - BONE MARROW BIOPSY NEEDLE/TROCAR 686.85 38221 05330 - CONTINOUS NEBULIZER 124.45 94644 05331 - CONTINOUS NEBULIZER ADDTIONAL EACH HOUR 124.45 05332 - PROD OF CONC TISSUE CHROM ANALYSIS 756.2 88233TC 05334 - EKG 1-3 LEAD RHYTHM STRIP ONLY 196.65 93041 05335 - EDUCATION AND TRAINNING 88.35 98960 05336 - TOXOPLASMA ANTIBODIES 82.65 86777 05339 - ER NASO / ORO GASTRIC INTUBATION 431.3 43752 05342 - PT NON-SELECT DEBRIDEMENT 154.85 97602GP 05344 - ER HEP- LOCK 16.15 J1642 05345 - TRIPLE LUMEN -SWAN GANZ CATHETER 644.1 A4300 05368 - FIBER GLASS CAST 145.35 A4590 05370 - ER CRUTCHES 139.65 E0116 05373 - OT EDUCATION AND TRAINING 88.35 98960GO 05376 - OB IV HYDRATION UP TP 1 HOUR 151.05 96360 05377 - OB IV HYDRATION ADD 1 HOUR 35.15 96361 05378 - OB PULSE OXY MULTI DETERMINATION 205.2 94761 05379 - OB PULSE OXY CONTI OVER NIGHT 288.8 94762 05380 - OB OBSERVATION / HOUR 593.75 G0378 05381 - OB OBSERVATION DIRECT ADMIT / HOUR 70.3 G0379 05382 - OB PULSE OXY SINGLE DETERMINATION 124.45 94760 05383 - FETAL SCALP BLOOD SAMPLING 161.5 59030 05384 - NEW BORN CIRCUMCISION 2077.65 54150-52 05388 - XR MANDIBLE 1-3 VIEWS 337.25 70100TC 05389 - XR PARANASAL SINUSES 1-3 VIEWS 259.35 70210TC "05392 - XR CHEST PA, LAT W / OBLIQUE PROJECTION" 341.05 71022TC 05396 - XR CHEST 4V WITH FLUOROSCOPY 836 71034TC 05397 - XR RIBS UNI MINI 3V INCLU PA VIEW 446.5 71101 05398 - XR RIBS BILATERAL 4 V INCLU PA VIEW 563.35 71111TC 05399 - XR CERVICAL SPINE 4 VIEW 523.45 72050TC 05401 - XR THORACIC SPINE 2 VIEWS 372.4 72070TC 05402 - XR THORACIC SPINE 4 VIEWS 460.75 72074TC 05403 - XR THORACO LUMBER JUNCTION MIN OF 378.1 72080TC 05405 - XR ELBOW 2 VIEWS 272.65 73070 05406 - XR UPPER EXT INFANT 2 VIEWS 146.3 73092TC 05407 - XR WRIST 2 VIEWS 258.4 73100TC 05408 - XR HAND 2 VIEWS 259.35 73120TC 05412 - XR KNEES 1 / 2VIEWS 285.95 73560TC 05413 - XR KNEE 3 VIEWS 358.15 73562TC 05414 - XR LOWER EXT INFANT 2 VIEWS 238.45 73592TC 05415 - XR SHOULDER 1VIEW 262.2 73020TC 05416 - XR ANKLE 2 VIEWS 262.2 73600TC 05417 - XR FOOT 2 VIEWS 264.1 73620 "05419 - XR ABD COMP SUPINE, ERECT, DECU W XCHEST" 517.75 74022TC 05420 - XR UPPER GI W/O DELAYED WO KUB 676.4 74240TC 05421 - CONTRAST XR UPPER GI TRACT 707.75 74246TC 05422 - XR W MANU STRESS BY DR. INCL OPP JOINT 58.9 77071TC 05423 - XR BONE LENTH STUDY 57 77073TC 05425 - SLEEVE FOR LIMB COMPRESSION 290.7 05446 - MISCELLANEOUS 1877.2 C1750 05500 - X-RAY GALLBLADDER 377.15 74290TC 05520 - X-RAY GALLBLADDER REPEAT 141.55 74291TC 05560 - XR CHOLANGIOGRAPHY INTRA-OP 723.9 74300TC 06000 - BRACE POLYCENTRIC FRACTURE 1815.45 06010 - BRACE TAYLOR BACK 3705 06080 - CLOSING VOLUMES 225.15 94727 06090 - BRONCHO BEFORE/AFTER EVAL 999.4 94060TC 06100 - XR ABDOMEN AP 1V/ KUB 289.75 74000TC 06101 - RADIOLOGIC EXAMINATION ABDOMEN 1 VIEW 289.75 74018 06102 - RADIOLOGIC EXAMINATION ABDOMEN 2 VIEWS 289.75 74019 06103 - RADIOLOGIC EXAM ABDOMEN 3 OR MORE VIEWS 378.1 74021 06110 - PULMONARY FUNCTION TESTING 999.4 94060 06130 - PEAK EXPIRATORY FLOW 162.45 94150 06150 - POST BRONCHODILATOR 999.4 94060 06200 - XR PYELOGRAM IV 725.8 74400TC 06250 - DRIP IVP 668.8 74410TC 06270 - NEPHROSTOGRAM 671.65 74425TC 06300 - XR CYSTOGRAPHY MIN 3V 342.95 74430TC 06350 - XR URETHROCYSTOGRAPHY VOIDING 730.55 74455TC 06400 - XR UROGRAPHY RETROGRADE 725.8 74420TC 07011 - PULMONARY REHABILITATION W/EXERCISE 509.2 G0424 08767 - GELFOAM SPONGE-50 41.4 09111 - HALDOL CONC 2MG 194.05 09950 - NM ISOTOPE RETURN 281.2 09980 - ISOTOPE ONLY 281.2 10020 - RESTRAINT VEST 206.15 10022 - WARMER INFANT HEEL 8.55 10030 - AMYLASE SERUM 152 82150 10035 - CALCIUM SERUM 133.95 82310 10040 - LABOR ROOM 4 HRS 990.85 10050 - LIPASE 145.35 83690 10060 - ALCOHOL LEVEL 170.07 80320 10070 - SUTURES PLAIN 18.05 10080 - SUTURES CHROMIC 18.05 10090 - SUTURES SILK 18.05 10100 - SUTURES TEVDEK 24.7 10101 - MICROALBUMIN URINE 130.15 82043 10102 - TACROLIMUS 458.85 80197 10103 - CA-125 181.45 86304 10104 - TRILEPTAL LEVEL 184.3 82491 10105 - ERYTHROPOIETIN 256.5 82668 10106 - PHOSPHOLIPID ANTIBODIES 529.15 86147 10110 - SUTURES ETHIBOND 38 10120 - SUTURES DEXON 38 10130 - SUTURES VICRYL 38 10170 - SPUTUM CYTOPATHOLOGY 184.3 88161 10210 - SET IIUP SUCTION 70.3 10260 - WALKER 294.5 10290 - STOCKING ANTI-EMBOLISM KNEE-HI 64.6 "10307 - SMEAR INDIA INK,KOH,TRICHO,BAC,FUNGUS" 102.6 87210 10310 - CANE QUAD 167.2 10320 - CATH OROPHARYNGEAL SUCTION 48.45 A4628 10380 - ACID PHOSPHATASE 152 84060 10500 - TUBEGAUZE/SR P/LYD 16IN OR LS 96.9 A6266 10510 - CANE WALKING 49.4 10600 - SCREW CANCELLOUS 4.0 496.85 C1713 10700 - WEBRIL 6X4 & 4X4 33.25 10800 - SCREW COMP LAG 1013.65 C1713 11000 - COMP TUBE AND PLATE 1109.6 11001 - SUTURE VASCUFIL ETHICON 4 & 5 106.4 11002 - GRAFT IMPRA VENAFLOW VASCULAR 2272.4 C1768 11003 - IMPLANT PRO OSTEON 500 2952.6 C1713 11007 - CATHETER INTRAUTERINE 112.1 C1729 11010 - HOLTER MONITOR RECORDING 574.75 93225 11016 - XR JOINT SURV LEAD POISONING 203.3 77077TC 11017 - CONTRAST NON-IONIC 272.65 96379 11018 - ULTRASOUND EXTREMITIES 631.75 76881 11023 - APPENDIX RT LOWER QUANDRANT 684 76705 11031 - US GUIDANCE BIOPSY 895.85 76942 11032 - VALVE TRACHEOSTOMY SPEAKING 508.25 L8501 11038 - E-HEALTH BLD/BODY FLD EXP-EMP 20 11039 - E-HEALTH BLD/BODY FLD EXP-PT. 20 11050 - PLATE SCP BROAD 14 HOLES 779.95 C1713 11090 - SALICYLATE 145.35 G0479 11165 - BREVIBLOC INJ 250MG 399 11170 - DIRECT BILLIRUBIN 152 82248 11195 - CATHETER SUCTION 4.75 11196 - SET SUCTION 33.25 11250 - IRON SERUM 262.2 83540 11280 - TOTAL IRON BINDING CAPACITY 249.85 83550 11400 - SCREW WOODRUFF 4.2 79.8 C1713 11500 - SCREW CORTICAL 2.7 79.8 C1713 11630 - PHOSPHORUS SERUM INORGANIC 115.9 84100 11650 - URIC ACID SERUM 145.35 84550 11680 - MAGNESIUM 178.6 83735 11700 - SCREW CORTICAL 3.5 79.8 C1713 11810 - CHOLESTEROL TOTAL 147.25 82465 11840 - TRIGLYCERIDES 192.85 84478 11900 - DRILL/SAW ZIMMER AIR 313.5 11910 - AMMONIA LEVEL 328.7 82140 11950 - LACTIC ACID 159.6 83605 11980 - PLATE BROAD 12-18 663.1 C1713 12011 - URINE 24 HOUR MEASUREMENT 34.2 81050 12022 - XR UPPER GI W / AIR W / SM BOWEL 832.2 74249TC 12023 - XR UPPER GI & SMALL INTEST 874.95 74245TC 12024 - H D L 57 83718 12026 - US OBSTETRIC MULT GESTATION 1006.05 76810 12027 - US MULTI ORG-UPPER QU AB 863.55 76700 12028 - LOWER EXTREMITY W/O CONTRAST 2430.1 73700 12029 - LOWER EXTREMITY W/CONTRAST 2550.75 73701 12032 - CT SCAN UPPER EXTREMITY W / O CONTRAS LT 2430.1 73200LT 12034 - UPPER EXTREMITY W/CONTRAST 2108.05 73201 12050 - URINE CALCIUM QUANT. 159.6 82340 12070 - URINE PHOSPHORUS 159.6 84105 12090 - URIC ACID OTHER SOURCE 159.6 84560 12110 - PLATE NARROW 2-6 210.9 C1713 12150 - PROTEIN TOTAL URINE 166.25 84156 12170 - PLATE NARROW 7-10 345.8 C1713 12200 - SURGERY OUTPT 2 HRS 6574 12230 - PLATE NARROW 11-18 520.6 C1713 12240 - SERUM CREATININ 152 82565 12310 - PLATE SEMI TUBU 2-6 178.6 C1713 12340 - PLATE SEMI TUBU 7-12 1010.8 C1713 12400 - URINE ELECTROLYTES PANEL 342 80051 12420 - SODIUM URINE 159.6 84300 12500 - PLATE EPIPHYSIS 145.35 C1713 12700 - CUP GILBERTY 2956.4 12760 - LENS INTRA-OCULAR 1172.3 13000 - PINS KNOWLES 203.3 C1713 13030 - FBS GLUCOSE QUANTITATIVE 133.95 82951 13050 - GLUCOSE 2 HR PP 247 82952 13100 - BUN 133.95 84520 13200 - SCREW MALLEOLAR 4.5 106.4 C1713 13210 - ELECTROLYTES SERUM PANEL 235.6 80051 13220 - POTASSIUM SERUM 133.95 84132 13240 - C02 CONTENT 133.95 82374 13280 - TORADOL INJ 30MG 27 J1885 13349 - MVI-12 INJ 10ML 65 13356 - MYAMBUTOL TAB 400MG 13 13437 - MYCOSTATIN POWDER 374 13439 - MYCOSTATIN SUSP 60ML 190 13560 - KETONE SERUM 84.55 82009 13800 - WIRE KIRSCHNER 045 298.15 C1713 13890 - WIRE THREADED 045 1010.8 C1769 13900 - PIN STEINMAN THREADED 90.25 C1713 14000 - PIN STEINMAN 1010.8 C1713 14030 - T3 TEST 337.25 84480 14090 - T4 TEST 201.4 84436 14110 - PIN CALIBRATED 95 C1713 14200 - PLATE SMALL FRAGMENT 178.6 C1713 14260 - PLATE SMALL STRAIGHT 1010.8 C1713 14310 - DILANTIN PHENYTOIN 198.55 80185 14350 - PHENOBARBITAL LEVEL 133.95 80184 14400 - THEOPHYLLINE 245.1 80198 14610 - QUINADINE 183.35 80194 14660 - PROCAINAMIDE LEVEL 272.65 80190 14760 - GENTAMICIN 272.65 80170 14790 - IGA GAMMAGLOBULIN 304 82784 14800 - IGG REF LAB 304 82784 14830 - IGM REF LAB 304 82784 14850 - IGE REF LAB 249.85 82785 15010 - CEMENT BONE 1791.37 C1713 15030 - HGB ELECTRORESIS FRAC & QUANT 330.6 83020 15050 - PROTEIN ELECTROPHORESIS FRAC 330.6 84165 15216 - LIPID PROFILE 389.5 80061 15667 - PERIACTIN TAB 4MG 11.9 16010 - NAILS KUNTSCHLER 458.85 C1713 16040 - PROFILE METABOLIC COMPREH 742.9 80053 16110 - STAPLE EPIPHYSEAL 51.3 16210 - SUTURE WIRE 81.7 16230 - HEPATITIS B SURFACE ANTIGEN 183.35 87340 16250 - HEPATITIS B SURFACE ANTIBODY 183.35 86706 16270 - HEPATITIS B CORE ANTIBODY 215.65 86704 16290 - HEPATITIS A IGM ANTIBODY 402.8 86709 16350 - LITHIUM LEVEL 166.25 80178 16490 - LUTEINIZING HORMONE LH 230.85 83002 16530 - FERRITIN 276.45 82728 16550 - TRANSFERRIN 169.1 84466 1656 - NM TC-99 HEPATOLITE 8.0 MCI 427.5 A9510 16570 - FOLIC ACID SERUM 294.5 82746 16770 - DRUG SCREEN URINE MINI 117.8 80102 17010 - PIN RUSH 3/32 133 C1713 17150 - SCAN HEAD W/O AND W/CONTRAST 2768.3 70470 17199 - PHYSIOSOL IRRIGATION 1000ML 314 17330 - LDH ISOENZYME REF LAB 311.6 83625 17510 - PIN RUSH 1/8 153.9 C1713 17630 - TRAY ORTHO MINOR 56.05 17720 - ALPHA FETOPROTEIN SERUM 365.75 82105 17810 - OSMOLALITY BLOOD 159.6 83930 18010 - PIN RUSH 3/16 206.15 C1713 18050 - CORTISOL TOTAL 251.75 82533 18090 - INSULIN LEVEL TOTAL 356.25 83525 18150 - TSH BY RIA REF LAB 323 84443 18250 - SERUM PREGNANCY QUAL BETAQ 178.6 84703 18290 - RENIN RIA REF LAB 383.8 84244 18310 - PARATHORMONE HORMONE C 842.65 83970 18360 - CEA BLOOD 311.6 82378 18510 - PIN RUSH 1/4 256.5 C1713 18550 - PKU - NEO NATAL SCREEN 129.2 84030 18630 - IMMUNO ELECTPHORESIS 374.3 86320 18650 - FLUID ELECTROPHORESIS 272.65 86325 18800 - PROGESTRONE ASSAY 455.05 84234 18810 - ESTROGEN RECEPTOR ASSAY 455.05 84233 18859 - TRAY EPIDURAL ANESTHESIA 131.8 18926 - STERILE WATER F/INJ UP TO 5CC 8 19010 - C1 COMPLEMENT REF LAB 141.55 86160 19030 - C2 COMPLEMENT REF LAB 141.55 86160 19050 - C3 COMPLEMENT REF LAB 141.55 86160 19070 - TOTAL COMPLEMENT 294.5 86162 19081 - DROPERIDOL UP TO 5MG 27 J1790 19180 - ASPERGILLUS ANTIBODY 197.6 86606 19210 - HERPES CULTURE 249.85 87255 19260 - ANGIOTENSION CONVERTING ENZ 183.35 82164 19370 - CHLAMYDIA CULTURE 294.5 87110 19560 - HEMOGOBIN FA2 CHROM 311.6 83021 19760 - CYTOMEGLOVIRUS 356.25 87495 19810 - GASTRIC ANALYSIS 71.25 82271 20001 - OT STIMULATION ELECT UNATTENDED 112.1 G0283 20005 - CANULA HYDRODISECTION (EYE) 19.95 20006 - KNIFE 3.2 SLIT (EYE) 76 20008 - CYSTOME IRRIGATING 11.4 20009 - TRAY FOLEY CATH SUPRA-PUBIC 121.6 C2627 20011 - SYRINGE VISCOAT (EYE) 228 20012 - KNIFE EYE 15 DEGREE 24.7 20014 - CORD BIPOLAR DISPOSABLE 137.75 20050 - US OBSTETRIC SINGLE GESTATION 729.6 76805 20110 - BOTTLE PERI 8.55 20120 - NEEDLE BIOPSY(TRUCUT) 122.55 20169 - ARGINAID 17.85 20230 - GROSS MICRO LEVEL IV 664.05 88305TC 20231 - BOTTLE CHEST DRAINAGE REPLACE 83.6 20240 - GROSS MICRO LEVEL V 518.7 88307 20340 - RHEUMATOID FACTOR QUAL 127.3 86430 20350 - TUBE BLAKEMORE NASAL GASTRIC 893 20370 - ASO TITER ANTISTREPTOLYSIN 169.1 86060 20520 - COLLAR CERVICAL SOFT 71.25 L0120 20540 - THERMOMETER RECTAL 22.8 C1729 20570 - TOBREX 0.3% OPTH SOLN 5ML 84 20600 - GRAFT VASCULAR 4320.6 C1768 20610 - PCMKR DUAL CHMB RATE RESPONS IMPLANT 179192.8 C1785 20630 - WIRE V-PACE PACER 535.8 20640 - RESTRAINT ARM/LEG 104.5 20760 - SPECIAL STAINS GROUP-II 141.55 88313TC 20800 - SPONGE SURG PATIE 1IN X 1IN 11.4 20810 - IMMOBILIZER SHOULDER 311.6 L3670 21000 - SHOE WALKING CAST AMBULATORY 97.85 21100 - SUPPORT LUMBARSACRAL FULL COR 323 L0976 21120 - DRESSING TELFA 8IN X 3IN 32.3 21130 - DRESSING TELFA 8IN X 10IN 48.45 21160 - US TRANSVAGINAL 664.05 76830 21180 - US TRANSRECTAL 740.05 76872 21300 - IMMOBILIZER KNEE 594.7 L1830 21350 - STABILIZER PATELLAR 166.25 L1810 21410 - KIT PEDS SKIN TRACTION 100.1 21510 - KIT BLOOD GLUCOSE STRIP 17.1 82948 21618 - VALIUM TAB 5MG 4 21630 - 4 X 4 GAUGE SPONGES (10) (STERILE) 10.45 A6222 21650 - OWENS SILK PACK 43.7 21800 - COLLAR CERVICAL HARD 185.25 21838 - PENICILLIN-VK TAB 500MG 2 21900 - PT CONTRAST BATH EA 15 MIN 102.6 97034GP 22040 - STRESS ECHO REGULAR 2122.3 93350 22100 - PT COLD PACK 75.05 97010 22410 - PACK ICE COLLAR 41.8 22440 - PROSTIGMIN INJ 1:1000 9 J2710 22450 - STETHOSCOPE DISPOSABLE 10.45 22510 - OT ORTHOTICS EA 15 MIN 145.35 97760GO 22522 - OT APPLIC SPLINT FOREARM RT 290.7 29125GO 22585 - PEPCID INJ 10MG 33 S0028 22600 - ZANTAC TAB 150MG 13 22620 - OT ELECTRIC STIMULATION 112.1 97032GO 22642 - HIV B&B FLUID EXPOSURE 971.85 22922 - RPR B&B EXPOSURE 350 23100 - NASAL CANNULA 52.25 A4615 23170 - PHACO CATARACT PROCEDURE 304 23190 - PHACO SPEC CUSTOM PACK 1197 23220 - PT GAIT TRAINING 1 UNIT 15 MIN 108.3 97116GP 23230 - LENS INTROCULAR POSTERIOR CHA 746.7 V2632 23280 - TUBING OXYGEN 47 A4616 23300 - MASK OXYGEN 43.7 A4620 23330 - SURGERY AMB 1/2 HR 1645.4 23350 - SURGERY AMB 1 HR 3288.9 23370 - SURGERY AMB 1 1/2 HRS 4932.4 23380 - SURGERY AMB 2 HRS 6574 23390 - SURGERY AMB 2 1/2 HRS 8215.6 23410 - SURGERY AMB 3 HRS 9861 23430 - SURGERY AMB 3 1/2 HRS 11502.6 23450 - SURGERY AMB 4 HRS 13145.15 23610 - VENTURI MASK 101.65 23710 - PT IMMERSION TANK EA 15 MIN 159.6 97036GP 23850 - END TIDAL CO2 MEASUREMENT 203.3 94770 23900 - PT MASSAGE EA 15 MIN 97.85 97124GP 24153 - TYLENOL W/CODEINE ELIXIR 106 24520 - DEEP SPUTUM INDUCTION INITIAL 143.45 94640 24590 - VENTOLIN INHALER 17GM 251 J7611 24610 - PT ELECTRICAL STIMULATION 110.2 G0283GP 24640 - INCENT BREATHING EXERCISE 133.95 24680 - INCENT SPIRO THERAPY 247 94200 24900 - PT TRACTION ROUTINE 110.2 97012 25100 - PT ULTRASOUND EA 15 MIN 133.95 97035 25550 - PT WHIRLPOOL LIMB DEB<20 SQCM 266 97597 25710 - PT WHIRLPOOL BODY 141.55 97022 25750 - PT WHIRLPOOL BODY DEB>20 SQCM 349.6 97598 26228 - LOPRESSOR TAB 50MG 5 26350 - FTA 169.1 86780 26352 - TRICHOMONAS VAGINALIS RT/PCR 284 87661 26355 - TREPONEMA PALLIDIUM WITH REFLEX 169.1 86780 26420 - ANTI NUCLEAR ANTIBODY 223.25 86038 26440 - ANTI DNA REF LAB 226.1 86225 26960 - RUBELLA ANTIBODY 133 86762 27500 - LUMBER SPINE WITHOUT CONTRAST 328.51 72131 27700 - C.P.A.P. NASAL 913.9 94660 28010 - OT SENS MOTOR CRD EXER 15 MIN 114 97112GO 28510 - SM TREATMENT MMT/END 1 80 97110GO 29010 - OT SENS MTR PERCEP/COG 15 MIN 112.1 97532GO 29400 - HUMIDIFER BOTTLE 19 30009 - ACETATE 66MEQ 18 30050 - BAG U (PEDIATRICS) 8.55 30100 - PADS HEEL/ELBOW PROTECTOR 33.25 30180 - NEEDLE SILVERMAN BIOPSY 68.4 30190 - NEEDLE CHOLANGIOGRAM 68.4 30200 - TUBING EMERSON PUMP 163.4 30300 - SPLINT HAND UNIVERSAL 301.15 3030000 - 2E 2 EAST OBSERVATION 160.84 G0378 3030005 - 2N RESPIRATORY CARE OBSERVATION 192 G0378 3030010 - Hospital Discharge < 30min 190 99238 3030015 - Hospital Discharge > 30min 259 99239 "3030020 - Chemo, Anti-Neopl,SQ/IM" 464 96401 "3030025 - Chemo, Hormonal Anti-Neo" 440 96402 "3030030 - Chemo, Intralesional, up to 7" 1702 96405 "3030035 - Chemo, Intralesional over 7" 724 96406 "3030040 - Chemo, IV Push, Sngl / Initial Drug" 724 96409 "3030045 - Chemo, IV Push, EA Addl Drug" 563 96411 "3030050 - Chemo, IV Infusion, Up to 1HR" 1100 96413 "3030055 - Chemo, IV Infusion EA Addl HR" 519 96415 "3030060 - Chemo, Prolong Infuse w/Pump" 1222 96416 "3030065 - Chemo, IV Infusion EA Addl Seq Inf" 622 96417 "3030070 - Chemo, IA Push Technique" 1761 96420 "3030075 - Chemo, IA Infusion up to 1HR" 1538 96422 30390 - PLASTIBELL 19 30400 - SPLINT ARM METAL 192.85 30410 - MOLD POSTERIOR 90.25 30420 - TUBE TROCAR CHEST DRAINAGE 194.75 30500 - TAPE WATERPROOF 1 INCH 11.4 3050000 - 3N 3 NORTH OBSERVATION 192 G0378 3050005 - 3N NB ROOM & CARE LEVEL I 831.25 30510 - TAPE NON ALLERGIC 51.3 30550 - RETAINER VISCERA 117.8 3060005 - Hospital Discharge < 30min 190 99238 3060010 - Hospital Discharge > 30min 259 99239 30610 - MASKS HEPA-N95 83.6 30700 - DRAIN SUMP 185.25 3070000 - HIV-1 & 2 SINGLE RESULT 178.6 86703 30800 - HIP LGT POST TIB FI 272.65 C1776 3080000 - OUTPATIENT VISIT EST COMPREHENSIVE/MODIF 408.5 9921525 3080005 - OUTPATIENT VISIT EST COMPREHENSIVE/MODIF 408.5 99215 3080010 - OUTPATIENT VISIT EST EXTENDED/MODIFIER 332.5 9921425 3080015 - OUTPATIENT VISIT EST EXTENDED 332.5 99214 3080020 - OUTPATIENT VISIT EST INTERMEDIATE/MODIFI 258.4 9921325 3080025 - OUTPATIENT VISIT EST INTERMEDIATE 258.4 99213 3080030 - OUTPATIENT VISIT EST MODERATE/MODIFIER 214.7 9921225 3080035 - OUTPATIENT VISIT EST MODERATE 214.7 99212 3080040 - OUTPATIENT VISIT EST BRIEF/MODIFIER 174.8 9921125 3080045 - OUTPATIENT VISIT EST BRIEF 174.8 99211 3080050 - OUTPATIENT VISITNEW COMPREHENSIVE/MODIF 511.1 9920525 3080055 - OUTPATIENT VISIT NEW COMPREHENSIVE 511.1 99205 3080060 - OUTPATIENT VISIT NEW EXTENDED/MODIFIER 406.6 9920425 3080065 - OUTPATIENT VISIT NEW EXTENDED 406.6 99204 3080070 - OUTPATIENT VISIT NEW INTERMEDIATE/MODIF 323.95 9920325 3080075 - OUTPATIENT VISIT NEW INTERMEDIATE 323.95 99203 3080080 - OUTPATIENT VISIT NEW MODERATE//MODIF 230.85 9920225 3080085 - OUTPATIENT VISIT NEW MODERATE 230.85 99202 3080090 - OUTPATIENT VISIT NEW BRIEF//MODIFIER 237.5 9920125 3080095 - OUTPATIENT VISIT NEW BRIEF 237.5 99201 3080100 - FETAL BIOPHYS PROFIL W/O NST 687.8 76819 3080105 - FETAL BIOPHYS PROFIL W/ NST 890.15 76818 "3080110 - OB US, FOLLOW-UP PER FETUS" 597.55 76816 "3080115 - OB US, LIMITED, FETUS(S)" 589.95 76815 "3080120 - OB US, DETAILED,ADDL FETUS" 654.55 76812 "3080125 - OB US, DETAILED,SNGL FETUS" 1015.55 76811 "3080130 - OB US, >/= 14 WKS, ADDL FETUS" 786.6 76810 "3080135 - OB US, >/= 14 WKS, SNGL FETUS" 923.4 76805 "3080140 - OB US, < 14 WKS, ADDL FETUS" 641.25 76802 "3080145 - OB US, < 14 WKS, SNGL FETUS" 836 76801 3080150 - REMOVE CERCLAGE SUTURE UNDER ANESTHESIA 269.8 59871 3080155 - REVISION OF CERVIX 4165.75 59320 3080160 - EPISIOTOMY OR VAGINAL REPAIR 269.8 59300 3080165 - TRANSABDOM AMNIOINFUS W/US 263.15 59070 3080170 - FETAL MONITOR W/REPORT 935.75 59050 3080175 - CHORIONIC VILLUS SAMPLING ANY METHOD 722.95 59015 3080180 - Cesarean Delivery 2373 59510 3080185 - Insert Cervical Dilator 1900 59200 30910 - SWABS GLYCERINE LEMON 19 31000 - SERVICE UTILIZATION REVIEW 128.25 31010 - HOOK AMNIO 8.8 31020 - TUBING GASTROSTOMY JEJU 215.65 3130000 - ICU OBSERVATION 192 G0378 3160000 - 4M 4MAIN OBSERVATION 192 G0378 3170000 - 5M 5 MAIN OBSERVATION 192 G0378 3180000 - 4S 4 SOUTH OBSERVATION 192 G0378 3180005 - Hospital Discharge < 30min 190 99238 3180010 - Hospital Discharge > 30min 259 99239 3220000 - 3S 3 SOUTH OBSERVATION 167.98 G0378 3220025 - 3S ROOM & CARE - Level II 3037.15 3220050 - 3S ROOM & CARE - MED/SURG PRIV 2206.85 3220186 - 3S ROOM & CARE - MED/SURG SEMI 1520 3220194 - 3S ROOM & CARE - MED/SURG SEMI 2001.65 3240000 - 3E ROOM & CARE - Level II 3037.15 3240005 - Hospital Discharge < 30min 190 99238 3240010 - Hospital Discharge > 30min 259 99239 33050 - COCKUP WRIST SPLINT 90.25 L3908 3500000 - EPIDURAL TRAY SINGLE DOSE 52.25 3500005 - Arthrodesis (correction flatfoot) 12603.65 28735 3500010 - Heel Spur 6158.85 28119 3500015 - Ossforce Staples 1485.8 C1713 3500020 - Arthrex Suture Bridge Anchor 2117.55 C1713 3500025 - Subtalar Arthrosis Implant 9348.95 C1776 3500030 - FLIXENE VASCULAR GRAFT 4-7mmX35mm 3595.75 C1768 3500035 - FLIXENE VASCULAR GRAFT 4-7mmX45mm 3595.75 C1768 3500040 - ACCORD CABLE WITH CLAMP 1504.8 C1713 3500045 - 3 HOLE LINER 46mm 3236.65 C1776 3500050 - REFLECTION HEAD SCREWS 1424.05 C1713 3500100 - FINE NEEDLE ASPIRATION W/O IMAGING 375.25 10021 3500102 - FINE NEEDLE ASPIRATION W/ IMAGING 1140.95 10022 3500104 - I&D OF ABSCESS SIMPLE 585.2 10060 3500106 - I&D OF ABSCESS COMPLICATED 1116.25 10061 3500108 - I&D OF PILONDIAL CYST SIMPLE 1255.9 10080 3500110 - REMOVE FOREIGN BODY SIMPLE 1831.6 10120 3500112 - I&D OF HEMATOME FLUID 3317.4 10140 3500114 - I&D OF COMPLEX 4519.15 10180 3500116 - DEBRIDEMENT INFECTED SKIN 2352.2 11000 3500120 - DEBRIDEMENT OF ABDOMINAL WALL 3957.7 11005 3500124 - REMVL MESH FROM ABDOMINAL WALL 4199.95 11008 3500126 - DEBRDMENT FB OPEN FX OR DISCL SKIN 2177.4 11010 3500128 - DEBRDMENT SKIN MUSLE FASCIA AT SITE 2878.5 11011 3500130 - DEBRDMENT SKIN BONE AT SITE 2457.65 11012 3500132 - DEBRDMENT SUBQ TISSUE 1ST <20SQ CM 1308.15 11042 3500134 - DEBRDMENT SUBQ TISSUE EA ADDL <20SQ CM 38 "3500136 - DEBRDMENT, BONE 1ST 20SQ CM OR LESS" 2990.6 11044 3500138 - PARING/CUTTING BENIGN LESION SNGL 279.3 11055 3500140 - PARING/CUTTING BENIGN LESION 2-4 311.6 11056 3500142 - PARING/CUTTING BENIGN LESION >4 333.45 11057 3500144 - BIOPSY SKIN LESION SNGL 810.35 11100 3500146 - BIOPSY SKIN LESION ADDL 438.9 11101 3500148 - RMVL SKIN TAGS MULTIPLE UP TO 15 1082.05 11200 3500150 - RMVL SKIN TAGS EA ADDL 10 LESIONS 997.5 11201 "3500152 - SHAVE SKIN LESION,/SNLTRK/ARM/LEG <0.5CM" 299.25 11300 "3500154 - SHVE SKN LESION,/SNLTRK/ARM/LEG 0.6-1.0" 301.15 11301 "3500156 - SHVE SKN LESION,/SNLTRK/ARM/LEG 1.1-2.0" 429.4 11302 "3500158 - SHVE SKN LESION,/SNLTRK/ARM/LEG >2.0CM" 698.25 11303 "3500160 - SHVE SKN LESION,/SNL SCLP/NK/HAND/FT<0.5" 361.95 11305 "3500162 - SHVESKNLESION,/SNLSCLP/NK/HND/FT 0.6-1.0" 417.05 11306 "3500164 - SHVESKNLESION,/SNLSCLP/NK/HND/FT 1.1-2CM" 581.4 11307 "3500166 - SHVESKNLESION,/SNLSCLP/NK/HND/FT 2.0CM" 1122.9 11308 "3500168 - SHAVE SKIN SNLFACE, EARS, EYELIDS, <0.5" 672.6 11310 3500170 - SHAVE SKIN SNLFACE/EARS/EYELIDS 1.1-2.0 501.6 11311 3500171 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 1390.57 23071 3500172 - SHAVE SKIN SNLFACE/EARS/EYELIDS >2.0CM 1083.95 11313 3500174 - EXCISION LIPOMAS 2687.55 11400 3500176 - EXCISION BENIGN CYST 1982.65 11401 3500178 - EXCISION BENIGN CYST 2-3 CM 3009.6 11403 3500180 - EXCISION BENIGN CYST 3-4CM 3742.05 11404 3500182 - EXC LIPOMA 4275.95 11406 3500184 - EXC CYST LESION .5CM/NECK 2864.25 11420 3500186 - EXCISION BENIGN LESION/1-2CM 3079.9 11422 3500187 - EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2 3079.9 11423 3500188 - EXCISION BENIGN LESION-LESION >4.0CM 4835.5 11426 3500190 - EXCISION BENIGN LESION-LESION <0.5CM 2082.4 11440 3500192 - EXCISION BENIGN FACIAL LESION EXT:1-2CM 2843.35 11442 3500194 - EXCISION FACE-LESION DIAMETER 2.0-3.0CM 3260.4 11443 "3500196 - EXCISION/SKIN,TISSUE/HIDRADENITIS" 5439.7 11450 3500198 - EVACUATION OF SUBUNGUAL HEMATOMA 322.05 11740 3500200 - EXCISION OF PILONDAL CYST OR SINUS SIMPL 5169.9 11770 3500202 - TX SIMPLE SUPERFICIAL WOUND SIMPLE CLOSE 2985.85 12020 3500204 - TX SMPLE SPRFICIAL WND SMPLE CLSR W/PK 912 12021 3500206 - HARVEST CLTRD SKIN AUTOGRAFT 100SQ CM < 1289.15 15040 3500208 - RMVL OF SUTURES UNDER ANESTHESIA 3968.15 15850 3500210 - DRESSING CHANGE NOT FOR BURNS 3439.95 15852 3500212 - DRESSING CHANGE W/O ANESTHESIA SMALL 430.35 16020 3500214 - BENIGN LESION DESTRUCTION UP TO 14 809.4 17110 3500216 - MASTOTOMY/EXPLORATION/DRAINAGE ABSCESS 3579.6 19020 3500218 - BIOPSY OF BRST PERCTM NEEDLE CORE 2238.2 19100 3500220 - BIOPSY OF BRST OPEN INCISIONAL 4616.05 19101 3500222 - BXY BRST PERQ/NEEDLE IMAGING GUIDANCE 1563.7 19102 3500224 - REMOVAL BREAST LESION 5019.8 19120 3500226 - EXCISION OF BREAST LESION 5154.7 19125 3500228 - EXCISION CHEST WALL TUMOR INCLUDING RIBS 4938.1 19260 3500232 - MASTECTOMY OF GYNECOMASTIA 6399.2 19300 3500234 - MASTECTOMY PARTIAL W/LYMPHADENECTOMY 9609.25 19302 "3500236 - MASTECTOMY, RADIAL" 7699.75 19305 3500238 - INJECTION(S) TRIGGER PTS 1 OR 2 MUSCLES 862.6 20552 3500240 - REMOVAL OF IMPLANT; SUPERFICIAL 4900.1 20670 3500242 - REMOVAL OF IMPLANT; DEEP 5521.4 20680 3500244 - REVISION EXT. FIXATOR 5816.85 20690 3500246 - APPLY BONE FIXATION DEVICE 6399.2 20692 3500248 - ADJUST BONE FIXATION DEVICE 6496.1 20693 3500250 - RMVL EXT FIXATOR WRIST 4827.9 20694 3500252 - CLOSED TX NASAL BONE FX W/O MANIP 1367.05 21310 3500254 - CLSD TX OF NASAL FX WO STABILIZATION 3253.75 21315 3500256 - CLSD TX OF NASAL FX W STABILIZATION 3619.5 21320 3500258 - CLSD TX OF MANDIBULAR FX WO MANIP 4043.2 21450 3500260 - CLSD TX OF MANDIBULAR FX W MANIP 2201.15 21451 3500262 - EXCISION NECK THORAX SUBQ<3CM 5059.7 21555 3500264 - EXCISION ABDOMINAL WALL TUMOR 5069.2 22900 3500266 - I&D SHOULDER AREA;DEEPABSCESS OR HEMATOM 6976.8 23030 3500268 - EXCISION SHOULDER SUBQ 3CM> 329.65 23030 3500270 - OPEN REPAIR ROTATOR CUFF 7648.45 23410 3500272 - SHLDER ROTATOR CUFF REPR W/ACROMIOPLASTY 9358.45 23420 3500274 - CLSD TX CLAVICULAR FX WO MANIP 666.9 23500 3500276 - CLSD TX CLAVICULAR FX W MANIP 3090.35 23505 3500278 - CLAVICAL DISLOCATION 937.65 23545 3500280 - CLSD REDUCTN PROX HUMERUS 2888.95 23605 3500282 - ORIF HUMERUS 12421.25 23615 3500284 - MANIPULATION SHOULDER-NO ANESTHESIA 884.45 23650 3500286 - RX SHOULDER-GENERAL ANES 2390.2 23665 3500288 - REMOVAL OF FOREIGN BODY:SUBCUTANEOUS 2658.1 24200 3500290 - MANIPULATION ELBOW- ANESTHESIA 3485.55 24300 3500292 - CLSD TX HUMERAL SHAFT FX WO MANIP 665.95 24500 3500294 - CLSD TX HUMERAL SHAFT FX W MANIP 1482 24505 3500296 - OPEN TX HUMERAL SHAFT FX 12583.7 24515 3500298 - TX HUMERAL SHAFT FX W/INSERTION IMPLANT 11347.75 24516 3500300 - CLSD TX SUPRACONDYLAR WO MANIP 801.8 24530 3500302 - CLSD TX SUPRACONDYLAR W MANIP 4187.6 24535 3500304 - PERCUTANEOUS FIXATION SUPCONDLYL FX 5373.2 24538 3500306 - ORIF DISTAL HUMERUS 940.5 24545 3500308 - TX CLSD ELBOW DISLOCTION 857.85 24600 3500310 - CLSD RX-ELBOW WI ANESTH 2649.55 24605 3500312 - OPEN TX ACUTE CHRONIC ELBOW DISLOCATION 8547.15 24615 3500314 - CLSD TX RADIAL HEAD SUBLUXATION W MANIP 501.6 24640 3500316 - CLSD TX RADIAL HEAD OR NECK FX WO MANIP 701.1 24650 3500318 - CLSD TX RADIAL HEAD OR NECK FX W MANIP 1266.35 24655 3500320 - CLSD TX ULNA FX PROXIMAL END WO MANIP 667.85 24670 3500322 - CLSD TX ULNA FX PROXIMAL END W MANIP 1412.65 24675 3500324 - OPEN TX ULNAR FX 9788.8 24685 3500326 - UNLISTED PROCEDURE 6410.6 24999 3500328 - I&D FOREARM /WRIST DEEP ABSCESS 3284.15 25028 3500330 - I&D BURSA 316.35 25031 3500332 - BIOPSY FOREARM/WRIST SUPERFICIAL 3800.95 25065 3500334 - BX SOFT TISSUE FOREARM/WRIST DEEP 3770.55 25066 3500336 - EXCISION OF MASS-FOREARM SUBQ 4120.15 25075 3500338 - EXCISION OF MASS-FOREARM DEEP 5338.05 25076 "3500340 - EXCISE TENDON, FOREARM WRIST FLEXOR EA" 4143.9 25109 3500342 - EXCISION WRIST GANGLION 4541 25111 3500344 - REMOVAL DEEP FB FOREARM/WRIST 4987.5 25248 3500346 - WRIST MANIP 1650.15 25259 3500348 - REPAIR FOREARM TENDON/ MUSCLE 5355.15 25260 3500350 - REPAIR FOREARM TENDON/ MUSCLE PRIMARY 4845.95 25270 3500352 - REPAIR TENDON OR MUSCLE EXT 2ND SNL 3202.45 25272 3500354 - CLSD TX RADIAL /ULNAR SHAFT WO MANIP 604.2 25560 3500356 - CLSD TX RADIAL ULNAR SHAFT FX W MANIP 1240.7 25565 3500358 - ORIC FOREARM 11241.35 25575 3500360 - CLSED TRTMT DISTAL RADIUS FX 778.05 25600 3500361 - OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP 1615 25607 3500362 - CLSD REDUCTION DISTAL RADIUS 1615 25605 3500364 - PERCUTANEOUS RADIAL FX OR SEPARATION 5317.15 25606 3500366 - UNLISTED PROCEDURE 6221.55 25999 3500368 - I&D ABSCESS FINGER SIMPLE 2432 26010 3500370 - I&D ABSCESS FINGER COMPLICATED 2636.25 26011 3500372 - DRAINAGE OF PALMAR BURSA 2636.25 26025 "3500374 - SYNOVECTOMY, CARPOMETACARPAL JOINT" 3330.7 26130 3500376 - REMOVAL IMPLANT FROM FINGER/HAND 3965.3 26320 3500378 - FINGER/JOINT MANIP 1083 26340 3500380 - REPAIR FNGR HAND TENDON 4961.85 26350 3500382 - REVISE FINGER HAND TENDON 8286.85 26390 3500384 - REPAIR GRAFT HAND TENDON 8378.05 26392 "3500386 - REPAIR, HAND TENDON" 3496.95 26410 3500388 - CLOSED TX METACARPAL FX W/O MANIP 554.8 26600 3500390 - CLOSED TX METACARPAL FX W/ MANIP 1000.35 26605 3500391 - OPEN TX METACARPAL FRACTURE SINGLE EA BO 2728.71 26615 3500392 - CLOSED TX METACARPAL FX W/MANIP EX FIX 3822.8 26607 3500396 - I&D PELVIS JOINT AREA; DEEP ABSCESS 5336.15 26990 3500398 - I&D PELVIS JOINT AREA INFECTED BURSA 3254.7 26991 3500402 - BIOPSY SOFT TISSUE PELVIS SUPERFICIAL 2413 27040 3500404 - EXCISION ISCHIAL BURSA 5855.8 27060 3500406 - EXCISION FEMUR LESION BURSA 5601.2 27062 3500410 - Partial Hip Replacement w/ or w/o Bipola 13146 27125 3500412 - TOTAL HIP REPLACEMENT 13100.58 27130 3500416 - REVISE TOTAL HIP ARTHRO WWO ALLOGRAFT 8393.25 27486 3500420 - REVISE TOTAL HIP ARTHRO WWO ALLOGRAFT 8393.25 27486 3500424 - CLOSED TX OF PELVIC RING FX WO MANIP 851.2 27193 3500426 - CLOSED TX OF PELVIC RING FX W/ MANIP 214.7 27194 3500428 - CLOSED TX OF ACETABULUM W/O MANIP 513 27220 3500434 - CLOSED TX OF FEMORAL FX W/O MANIP 567.15 27230 3500438 - PERQ FIXATION OF FEMORAL 8289.7 27235 3500440 - CLOSED TX OF FEMORAL FX; W/O MANIP 1903.8 27238 3500454 - TX SPONTNEOUS HIP DISLOCATION W/O MANIP 803.7 27256 3500456 - TX SPONTNEOUS HIP DISLOCATION W/ MANIP 2483.3 27257 3500462 - OPEN TX FEMORAL FX W INTERNAL FIXATION 6252.2 27269 3500464 - MANIPULATION HIP JOINT 4252.2 27275 3500468 - KNEE W/EXPLOR DRAINAGE REMVL FB 6335.55 27310 3500469 - EXCISION LESION MENISCUS/CAPSULE KNEE 588.75 27347 3500470 - BX SOFT TISSUE THIGH / KNEE SUPERFICIAL 4389 27323 3500472 - REPAIR KNEE TENDON PRIMANU 6630.05 27380 3500474 - REPAIR THIGH MUSCLE PRIMARY 7855.55 27385 3500476 - REPAIR THIGH MUSCLE SECONDARY 5713.3 27386 3500478 - TENETOMY SINGLE TENDON 4053.65 27390 3500480 - TENETOMY MULTIPLE TENDONS 4192.35 27391 "3500482 - TENETOMY MULTILE TENDONS, BILATERAL" 3254.7 27392 3500484 - ARTHROPLASTY KNEE TIBIAL PLATEAU 5562.25 27440 3500486 - REVISE TOTAL HIP ARTHRO WWO ALLOGRAFT 1 8393.25 27486 3500494 - CLOSED TX TIBIAL FX W/O MANIP 905.35 27530 3500496 - CLOSED TX KNEE DISLOCATION W/O ANES 799.9 27550 3500498 - CLOSED TX KNEE DISLOCATION W ANES 3109.35 27552 3500502 - MANIPULATION KNEE JOINT 3657.5 27570 3500504 - I&D LEG OR ANKLE DEEP 4159.1 27603 3500506 - I&D LEG OR ANKLE INFECTED BURSA 3254.7 27604 3500510 - BX LOWER LEG ANKLE DEEP 4931.45 27614 3500512 - REPAIR PRIMARY RUPTURED ACHILLES TENDON 7891.65 27650 3500514 - REPAIR PRMRY RPTRD ACHILLES TENDN W GRFT 9460.1 27652 3500516 - OPEN TX ANKLE FX 8943.3 27814 3500518 - CLOSED TX ANKLE DISLOCATION WO ANES 926.25 27840 3500520 - CLOSED TX ANKLE DISLOCATION W ANES 2693.25 27842 3500522 - OPEN TX ANKLE DISLOC W REPAIR INT/EXT 5071.1 27860 3500528 - I&D BURSA FOOT 3420 28001 3500529 - CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PRO 4269.3 28292 3500530 - REMOVAL FB FOOT SUBQ 2768.3 28190 3500531 - HALLUX RIGIDUS W/CHEILECTORY 1ST MP JT W 10818 28291 3500532 - REMOVAL FB FOOT DEEP 4269.3 28192 3500534 - REMOVAL FB FOOT COMPLICATED 5266.8 28193 3500538 - AMPUTATION METATARSAL W/TOE SINGLE 5219.3 28810 "3500540 - AMPUTATION, TOE METATARSOPHALANGEAL JNT" 4816.5 28820 3500546 - APPLICATION OF LONG ARM SPLINT (SHOULDER 405.65 29105 3500548 - APP SHORT ARM SPLINT FOREARM-HAND STATIC 372.4 29125 3500550 - APPLICATION OF FINGER SPLINT; STATIC 342 29130 3500552 - STRAPPING; THORAX 380.95 29240 3500554 - ELBOW OR WRIST 324.9 29260 3500556 - HAND OR FINGER 287.85 29280 3500558 - APPLICATION OF LONG LEG CAST (THIGHS-TOE 630.8 29345 3500560 - WALKER OR AMBULATORY TYPE 505.4 29355 3500562 - APP OF SHORT LEG CAST BELOW KNEE-TOES 470.25 29405 3500564 - WALKER OR AMBULATROY TYPE 466.45 29425 3500566 - APP OF SHORT LEG SPLINT (CALF-FOOT) 399 29515 3500570 - ARTHROSCOPY TEMPOROMANDUBULAR JOINT SURG 8740.95 29804 3500576 - OSTEOCHNODRAL ALLOGRAFT 8893.9 29867 3500578 - MENISCAL TRANSPLATATION MEDIAL OR LATERA 666.9 29868 3500582 - ARTHROSCOPY KNEE LAVAGE DRAINAGE 6725.05 29871 3500584 - W/ LATERAL RELEASE 5703.8 29873 3500586 - RMVL FOREIGN BODY 6198.75 29874 3500588 - SYNOVECTOMY LIMITED 5401.7 29875 3500590 - SYNOVECTOMY MAJOR 2 OR MORE 5401.7 29876 3500592 - DEBRIDEMENT SHAVING ARTICULAR CARTILAGE 6502.75 29877 3500594 - ARTHROSCOPY KNEE SURGICAL 4719.6 29879 3500596 - ARTHROSCOPY KNEE SURGICAL W MENISCECTOMY 6717.45 29880 3500598 - ARTHROSCOPY KNEE SURG W/MENISCECTOMY M/L 6311.8 29881 3500600 - ARTHROSCOPY KNEE W/MENISCUS REPAIR 6059.1 29882 3500602 - ARTHROSCOPY KNEE W/MENISCUS REPAIR M&L 5927.05 29883 3500604 - ARTHROSCOPY KNEE W W/O MANIP 6948.3 29884 3500606 - EXCISION NASAL POLYPS SIMPLE 3118.85 30110 3500608 - REMOVAL FOREIGN BODY INTRANASAL 354.35 30300 3500610 - REQUIRING GENERAL ANESTHESIA 4020.4 30310 "3500612 - CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMP" 468.35 30901 3500616 - CONTROL NOSE BLEED W/PACKS INITIAL 620.35 30905 "3500618 - INTUBATION, ENDOTRACHEAL" 920.55 31500 "3500620 - LARYNGOSCOPY, INDIRECT DIAGNOSTIC" 542.45 31505 3500624 - LARYNGOSCOPY W/REMOVAL FB 521.55 31511 3500626 - LARYNGOSCOPY W/REMOVAL LESION 5155.65 31512 3500628 - LARYNGOSCOPY DIRECT ASPIRATION 3374.4 31515 3500630 - LARYNGOSCOPY DIRECT EXCEPT NEWBORN 3797.15 31525 3500632 - LARYNGOSCOPY DIRECT W/FB REMOVAL 4313.95 31530 3500634 - LARYNGOSCOPY W/FB & OP SCOPE 4867.8 31531 3500636 - LARYNGOSCOPY DIRECT OPERATIVE W/BX 5242.1 31535 3500638 - TRACHEOSTOMY FENESTRATION W/SKIN FLAPS 4955.2 31610 3500640 - VISULATION OF WINDPIPE 2641.95 31615 3500642 - BRNCHSC BRUSHING OR PROTECTED BRUSHINGS 2820.55 31623 3500643 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+S 2820.55 31625 3500644 - BX LUNG OR MEDIASTINUM PERCUTANEOUS NDLE 1695.75 32405 3500646 - THORACENTESIS INITIAL OR SUBSEQUENT 1187.5 32421 3500648 - THORACENTESIS W/TUBE INSERT 1328.1 32422 3500650 - INSERTING CHEST TUBE 1620.7 32551 3500652 - INSERT CARDIAC ELECTRODE 8075.95 33210 3500654 - INSERTION PULSE GENERATOR 11569.1 33212 3500658 - THROMBOENDARTERECTOMY 8646.9 35302 3500662 - INSERT NON-TUNNELED CV CATHETER >AGE 5YR 2351.25 36556 3500664 - INSERT TUNNELED CV W/ PORT OR PUMP 4283.55 36558 3500666 - INSERT TUNNELED CV W/SUBQ PORT 5674.35 36561 3500668 - BIOPSY REMOVAL LYMPH NODES 5493.85 38500 3500670 - REPAIR TUNNELED CV CATH 1675.8 36575 3500672 - REPAIR CV DEVISE W/SUBQ PORT OR PUMP 4025.15 36576 3500674 - REPLACEMENT TUNNELED CV CATH 4513.45 36578 3500676 - REPLACEMENT TUNLD CV W/O SUBQ PORT/PUMP 3896.9 36581 3500678 - RVL TUNNELED CV CATHE W/O SUBQ PORT/PUMP 2527.95 36589 3500680 - REPOSITION CV CATHETER 2644.8 36597 3500682 - ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT 10211.55 36821 3500688 - BIOPSY REMOVAL LYMPH NODES 5493.85 38500 3500690 - BIOPSY REMOVAL LYMPH NODES OPEN DEEP 5868.15 38525 3500692 - EXCISION SALIVARY CYST 6754.5 42408 3500694 - EXCISE SUBLINGUAL GLAND 6681.35 42450 3500696 - TONSILLECTOMY AND ADENOIDECTOMY >12 4389 42821 3500698 - ADENOIDECTOMY SECONDARY > AGE 12 3966.25 42831 3500702 - ESOPHAGOSCOPY DIAGNOSTIC 2109 43200 3500704 - ESOPHAGOSCOPY W/DIRECTED SUBMUCOSAL INJ 3709.75 43201 3500706 - ESOPHAGOSCOPY W LESION 5001.75 43216 3500708 - ESOPHAGOSCOPY W LESION SNARE 3560.6 43217 3500710 - REPAIR ESOPHAGOSCOPY W LESION 2575.45 43227 3500712 - UPPR GI ENDOSCOPY SIMPLE 2345.55 43234 3500714 - UPPR GI ENDOSCOPY DIAGNOSIS 2231.55 43235 3500716 - UPPR GASTROINTESINAL ENDOSCOPY DIRECT 2550.75 43236 3500718 - UPPR GI ENDOSCOPY BIOPSY 2451.95 43239 3500720 - UPPR GI ENDOSCOPY & INJECT 2470.95 43243 3500722 - UPPR GI ENDOSCOPY W REMOVAL FB 2530.8 43247 3500724 - UPPR GI ENDOSCOPY TUMOR 2373.1 43250 3500726 - UPPR GI ENDOSCOPY W SNARE 2417.75 43251 3500728 - UPPR GI ENDOSCOPY CNTRL BLEEDING 2787.3 43255 3500732 - NASO- OR ORO GASTRIC W STENT 737.2 43752 3500734 - CHANGE GASTRO TUBE 901.55 43760 3500736 - REPOSITION GASTROSTOMY TUBE 1432.6 43761 "3500744 - COLECTOMY, PARTIAL W/ANASTOMOSIS" 9386.95 44204 3500746 - APPENDECTOMY 5186.05 44950 3500748 - APPENDECTOMY ADD ON 364.8 44955 3500752 - PROCTOSIGMOIDOSCOPY DIAGNOSTIC 2465.25 45300 3500754 - PROCTOSIGMOIDOSCOPY REMOVAL 5346.6 45308 3500756 - PROCTOSIGMOIDOSCOPY REMOVAL W/SNARE 4140.1 45309 3500758 - PROCTOSIGMOIDOSCOPY REMOVAL CAUTERY 3803.8 45315 3500760 - PROCTOSIGMOIDOSCOPY CNTRL BLEED 4189.5 45317 3500762 - SIGMOIDOSCOPY DIAGNOSTIC 1966.5 45330 3500764 - SIGMOIDOSCOPY AND BIOPSY 2230.6 45331 3500766 - SIGMOIDOSCOPY W/SUBMUCOSAL INJ 1879.1 45335 3500768 - COLONOSCOPY DIAGNOSTIC 2720.8 45378 3500770 - COLONOSCOPY AND BIOPSY 2954.5 45380 3500771 - COLSC FLX W/REMOVAL LESION BY HOT BIOPSY 965.94 45384 3500772 - COLONOSCOPY CONTROL BLEEDING 2909.85 45382 3500774 - COLONOSCOPY LESION REMOVAL 2747.4 45385 3500776 - COLONOSCOPY with ABLATION 2747.4 45388 3500778 - HEMORRHOIDECTOMY 1901.9 46221 3500780 - HEMORRHOIDECTOMY EXTERNAL COMPLETE 4930.5 46250 3500782 - HEMORRHOIDECTOMY W FISTULECTOMY 5564.15 46262 3500784 - REMOVAL OF ANNUAL FISTULA 4483.05 46270 3500786 - REPAIR ANAL FISTULA 5940.35 46288 3500788 - HEMORRHOIDECTOMY BY LIGAT INTERNAL 2774.95 46945 3500790 - NEEDLE BIOPSY OF LIVER 1711.9 47000 3500792 - LAPAROSCOPIC CHOLECSTECTOMY 9125.7 47562 3500794 - LAPARO CHOLECSTECTOMY W GRAPH 9775.5 47563 3500796 - LAPARO CHOLECSTECTOMY W/EXPLORATION 12720.5 47564 3500798 - CHOLECYSTECOMY 8754.25 47600 3500800 - CHOLECSTECTOMY W GRAPH 8626.95 47605 3500804 - LAPARO EXPLORATION ABDOMEN 8987.95 49000 3500806 - LAPAROSCOPY ABDOMEN 6840 49320 3500808 - REPAIR INIT INGUINAL HERNIA 5 Y/0 OR OLD 7345.4 49505 3500810 - INCARCERATED OR STRANGULATED 7726.35 49507 3500812 - REPAIR RECURRENT INGUINAL HERNIA ANY AGE 7501.2 49520 3500814 - INCARCERATED OR STRANGULATED 7559.15 49521 3500816 - REPAIR RECUR INCISIONAL/VENTRAL HERNIA 5651.55 49560 3500820 - REPAIR RECUR INCISIONAL/VENTRAL HERNIA 5823.5 49565 3500822 - REPAIR RECUR HERNIA INCARCERATED/STRANG 6004.95 49566 3500824 - HERNIA REPAIR W MESH 3088.45 49568 3500826 - REPAIR UMB HERNIA >5YRS REDUCIBLE 5370.35 49585 3500828 - REPAIR UMBIL HERNIA INCAR/STRANG >5 6186.4 49587 3500830 - REPAIR OF ABDOMINAL WALL DEHISCENCE 4884.9 49900 3500834 - RENAL ABSCESS OPEN DRAIN 4519.15 50020 3500840 - INTRODUCE INTRACATH INTO RENAL PELVIS 3166.35 50392 3500843 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPHY 1618.8 51600 3500844 - INJECTION RETROGRADE URETHROCYSTOGRAPHY 1618.8 51610 "3500846 - BLADDER IRRIGATION SPL, LAVAGE" 552.9 51700 3500848 - PROSTATECTOMY (TURP) 8048.4 52601 "350085 - ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINA" 66623.5 54522 3500850 - CIRCUMSION W/REGIONAL BLOCK 5189.85 54150 3500852 - CIRCUMSION >28DAYS OF AGE 5117.65 54161 3500854 - ORCHIECTOMY SIMPLE 5639.2 54520 3500890 - TOTAL ABDOMINAL HYSTERECTOMY 6714 58150 3500898 - DILATION & CURETTAGE DX &/THER NONOBSTET 2344.5 58120 3500910 - DRAINAGE OF OVARY CYST UNI OR BI VAG APP 5095.8 58800 3500912 - ABDOMINAL APPROACH 491.15 58805 3500914 - RTNE OB CARE INC ANTE VAG DEL & POST 1883 59400 3500926 - TX OF INCOMP ABORT ANY TRIMSTR COMP SURG 4189.5 59812 3500928 - TX OF MISSED ABORTION COMP SURG 1ST TRI 4123 59820 3500930 - SECOND TRIMESTER 5212.65 59821 3500935 - CATARACT REMOVAL INSERTION OF LENS 1981.72 66984 3500936 - REMVL FOREIGN BDY EXT EYE; CONJUC SPRFIC 433.2 65205 3500941 - RMVL LENS MATERIAL INTRACAPSULAR 1981.72 66920 3500942 - W/GENERAL ANESTHESIA 4285.45 69205 3500944 - RMVL IMPACTED CERIMEN ONE OR BOTH EARS 325.85 69210 3500946 - MYRINGOTOMY W/ASPIRATION EUST TUBE INFLA 1472.5 69420 3500948 - MYRINGOTOMY W/ASPIRATION EUST TUBE 3952.95 69421 3500950 - TYPANOSTOMY 3796.2 69436 3500952 - MICROSURGICAL TECH W/USE OF OPER MICROSC 4801.3 69990 3500954 - LENS IMPLANT MA30AC 1788 C1780 3500956 - LENS IMPLANT MN60AC 1788 C1780 3500958 - LENS IMPLANT MTA4UO 1788 C1780 3500960 - LENS IMPLANT SN60WF 1788 C1780 3500962 - LENS IMPLANT SN6CWS 1788 C1780 3500964 - PRQ Vertbral Augmnt Thoracic 6448 22513 3500966 - PRQ Vertbral Augmnt Lumbar 6448 22514 3500968 - PRQ Vertbral Augmnt Ea Addl 3224 22515 3500970 - Injection for Knee X-ray 1239 27370 3500972 - Transcath Stent CCA w/EP 19327 37215 3500974 - Transcath Stent CCA w/o EP 12067 37216 3500976 - Stent Placement Ante Carotid 7500 37218 3500978 - Open/Perq Place Stent 1st 9818 37236 3500980 - Esophagoscopy Rigid TRNSO 1985 43180 3500982 - Esophagoscopy Rig TRNSO Rem FB 1086 43194 3500984 - Esophagoscopy Flex Dx Brush 761 43197 3500986 - Esophagoscopy Flex Rem FB 5735 43215 3500988 - Esophagoscopy Lesion Rem 6048 43216 3500990 - EGD Rem FB 4035 43247 3500992 - EGD Cautery Tumor/Polyp 3935 43250 3500994 - Small Bowel Endoscopy 4737 44360 3500996 - Small Bowel Endoscopy Rem FB 3840 44363 3500998 - Small Bowel Endoscopy BR/WA 3203 44380 35010 - TUBING CYSTO 49.4 3501000 - Small Bowel Endoscopy BR/WA TRES 1740 44381 3501002 - Small Bowel Endo w/stent 1740 44384 3501004 - Endo of Bowel Pouch 4370 44385 3501006 - Endo of Bowel Pouch Biop 3310 44386 3501008 - Colonscopy through Stoma SPX 3996 44388 3501010 - Colonscopy for FB 3996 44390 3501012 - Colonscopy for Bleeding 3550 44391 3501014 - Colonscopy & Polypectomy 3900 44392 3501016 - Colonscopy w/Ablation 3550 44401 3501018 - Colonscopy w/stent placement 3550 44402 3501020 - Colonscopy w/resection 3550 44403 3501022 - Colonscopy w/injection 3550 44404 3501024 - Colonscopy w/dilation 3550 44405 3501026 - Colonscopy w/ultrasound 3550 44406 3501028 - Colonscopy w/NDL Aspire /BX 3550 44407 3501030 - Colonscopy w/Decompression 3550 44408 3501032 - PX Small Intestine 5105 44799 3501034 - Sigmoidscopy w/ FB rem 5114 45332 3501036 - Sigmoidscopy & Polypectomy 3687 45333 3501038 - Sigmoidscopy for Bleeding 4575 45334 3501040 - Sigmoidscopy & Decompression 3621 45337 3501042 - Sigmoidscopy w/TNDSC Bal Dilation 4080 45340 3501044 - Sigmoidscopy w/Band Ligation 4080 45350 3501048 - Colonscopy flex w/stent plcmt 4080 45389 3501050 - Colonscopy flex w/Resection 4080 45390 3501052 - Cystourethro w/implant 4080 52441 3501054 - Cystourethro w/ addl implant 5040 52442 3501056 - Injection for myelogram 1935 62284 3501059 - NJX/DX/THER SBST INTRLMNR LMBR/SAC W/IMG 560.53 62323 3501060 - Skin SPLT GRFT TRNK/ARM/LEG 8591 15100 3501062 - Skin SPLT GRFT TRNK/ARM/LEG ADD'L 4554 15101 3501064 - ViperSlide Lubricant 450 3501066 - Embosphere microsphere 300-500 625 3501068 - Embosphere microsphere 500-700 625 3501070 - Embosphere microsphere 700-900 625 3501071 - Embolization Coil 7cm-12mm 410 3501072 - Embolization Coil 7cm-12mm 410 3501074 - Embolization Coil 14cm-10mm 410 3501076 - VCF Catheter 5.0Fr 812 C1725 3501078 - PTA Ballon Catheter 605.01 C1725 3501079 - METACROSS 387.5 C1725 3501080 - Stealth Classic Crown 145 cm Shaft 4244 C1769 3501082 - ViperWire Guide Wire 0.017 tip 1188 C1769 3501084 - MicroCatheter 798 C1894 3501085 - DIAMONDBACKS 3904.25 C1724 3501086 - Optitorque 5Fr Jacky Radial 110cm 688 C1725 3501088 - Optitorque 6Fr Sarah Radial 110cm 688 C1725 3501090 - Glidesheath Slender SS 0.025 6Fr 10cm 875 C1894 3501092 - Glidesheath Slender SS 0.025 5Fr 16cm 875 C1894 "3501094 - Guide Wire GT 0.018"" Dbl Angle" 550 C1894 "3501096 - Guide Wire 25cm,035, 260cm" 613 C1894 "3501098 - Standard, 1.55mm J-tip 260cm cath" 820 C1894 3501100 - KMP 5F 100cm CATH 615 C1757 3501102 - MIK 5f 80cm cath 615 C1757 3501104 - Placement soft tissue local device 3754 10035 3501106 - Placement soft tissue; ea addl 1877 10036 3501108 - Bronch EBUS Sampling 1/2 nod 2641 31652 "350111 - Inj for Cholangiogram, new access" 9200 3501110 - Bronch EBUS Sampling 3/> nod 2821 31653 3501112 - Bronch EBUS IVNTJ Perph Les 3000 31654 3501114 - EGD Esophagogastic Transoral:fundopolast 5700 43210 "3501116 - Inj for Cholangiogram,existing access" 9000 47531 "3501118 - Inj for Cholangiogram, new access" 9200 47532 3501120 - Plmt Biliary Drainage cath:external 5000 3501122 - Plmt Biliary Drainage cath:inter-extern 7000 47534 3501124 - Conversion Ext Bil Drain. Cath 7500 47535 3501126 - Exchange Biliary Drg Cath 8500 47536 3501128 - Removal Biliary Drainage Cath 8500 47537 3501130 - Perq Plmt Bile Duct Stent exist.access 2775 47538 3501132 - Perq Plmt Bile Duct Stent new access 3500 47539 3501134 - Perq Plmt Bile Stent new accessbw/plm 4780 47540 3501136 - Plmt Access Biliary Tree Sm Bowel 9170 47541 3501138 - Inj Antegrade Nephro &/or ureter;new acc 7685 50430 3501140 - Inj Antegrade Nephro &/or ureter;existg 6000 50431 3501142 - Plmt Nephrostomy Catheter 6500 50432 3501144 - Plmt Nephrostomy Catheter; new 7000 50433 3501146 - Endoluminal Bx Urtr Renal Pelvis 7000 50606 3501148 - Plmt ureteral stent /preexist tract 4080 50693 3501150 - Plmt ureteral stent new access w/o sep. 10100 50694 3501152 - Plmt ureteral stent new access w/sep ca. 10400 50695 3501154 - Uteral Embolization /OCCl 11000 50705 3501156 - Balloon Dilate Ureteral Stricture 10000 50706 3501158 - Endovascular Intracranial Prl Adm 9000 61650 3501159 - PRQ TRLUML CORONARY ANGIO ONE ARTERY 587.5 92920 3501160 - Endovascular ea. addl vas territory 500 61651 3501162 - Paravertebral Block Sng 2000 64461 3501164 - Paravertebral Block 2nd & addl site 500 64462 3501166 - Paravertebral Block continuous Inf 3500 64463 3501168 - Implantation Intrastromal Corneal ring 400 65785 3501180 - TRTMNT TRIMALLEOLAR FX W/MNP 548.15 27818RT 3520000 - SPINAL ANESTHESIA TRAY 39.9 3520005 - EPIDURAL TRAY CLR DRAPE 72.2 3540045 - ARTERIOGRAM OF EXTREMITY 3866.5 75710 3540050 - SELECTIVE ARTERIAL CATH PLACEMNT 1ST ORD 2923.15 36215 3540055 - SELECTIVE ARTERIAL CATH PLACEMNT 2ND ORD 3180.6 36216 3540060 - CATH ART EA 1ST ORD 3660.35 36245 3540065 - INTRO NEEDLE ARTERY RETRO 3269.9 36120 3540075 - ANGIO EXTREMITY UNILAT S&I 3866.5 75710 3540085 - SECONDARY MECHANICAL THROMBECTOMY 5153.75 37186 3540090 - SECONDARY MECHANICAL THROMBECTOMY 5153.75 37186-59 3540095 - VESSEL MAPPING OF VESSELS 1415.5 G0365 3540100 - ULTRASOUND ARTERY BIL 1389.85 93930 3540105 - ULTRASOUND ARTERY UNI 934.8 93931 3540110 - ULTRASOUND VEIN BIL 1469.65 93970 3540115 - ULTRASOUND VEIN UNI 987.05 93971 3540120 - CANNULATION VEIN INJECTION OF CONTRAST 1971.25 36005 3540125 - CANNULATION VEIN INJ OF CONTRAST EA ADDL 1971.25 36005-59 3540130 - VENOGRAPHY EXTREMITY UNI S&I 1548.5 75820 3540135 - VENOGRAPHY EXTREMITY BIL S&I 2018.75 75822 3540140 - VENOGRAPHY SVC W/SERIAL S&I 3031.45 75827 3540145 - LIGATION 6641.45 37607 3540150 - SELECTIVE VENOUS CATH PLACEMENT 1ST ORD 2903.2 36011 3540155 - SELECTIVE VENOUS CATH PLACEMENT 2ND ORD 2820.55 36012 3540160 - PLACEMENT OF COIL 6395.4 37204 3540165 - TRANSCATH THERAPY EMBOLIZATION S&I 5311.45 75894 3540170 - POST COIL ANGIOGRAM VIA CATH 1773.65 75898 3540175 - ULTRASOUND GUIDANCE 837.9 76937 3540180 - FLUORO GUIDANCE PLACEMENT 912.95 77001 3540182 - FLUORO GUIDANCE NEEDLE PLACEMENT 912.95 77002 3540184 - FLUORO GUIDANCE PLACEMENT FOR INJECTION 912.95 77003 "3540185 - INSERT TUNNEL, NO PORT" 4546.7 36558 3540190 - DUAL CATH INSERTION SEPARATE SITE 5814.95 36565 "3540200 - TUNNELED, NO PORT NO PUMP REPLACEMENT" 4534.35 36581 3540205 - INSERT PERITONEAL CATH W/O PERTONEOSCOPY 7079.4 49421 3540210 - PERITONEOSCOPY W CATH INSERTION 8501.55 49324 3540215 - INJECTION OF AIR OR CONTRAST 1152.35 49400 3540220 - PERITONEOGRAM S & I 950.95 74190 "3540225 - ULTRASOUND GUIDANCE, INTRAOPERATIVE" 1102.95 76998 3540230 - PRESTERNAL SUBCUTANEOUS EXTENSION 1600.75 49435 3540235 - DELAYED CREATION OF EXIT SITE 3748.7 49436 3540240 - CREATION AV FISTULA 10665.65 36821 3540245 - TRANSPOSITION CEPHALIC VEIN UPPER ARM 11644.15 36818 3540250 - TRANSPOSITION BASILIC VEIN UPPER ARM 13714.2 36819 3540255 - TRANSPOSITION FOREARM VEIN 11673.6 36820 3540260 - REVISION AVF/AVG 11041.85 36832 3540265 - REVISION AVF/AVG W THROMBECTOMY 12455.45 36833 3540270 - REVISION AVF/AVG REPAIR ANEURYSM 12455.45 36832 3540275 - LIGATION AVG/AVF RUPTURE OR TRAUMA 8353.35 37618 3540280 - DIRECT REPAIR VESSEL UPPER EXTREMITY 5299.1 35206 3540285 - REPAIR VESSEL UPPER EXT W PROST GRAFT 8307.75 35266 3540290 - REPAIR VESSEL UPPER EXT W VEIN GRAFT 7540.15 35236 3540294 - Vascular embolizaton/occlusion 11072 37243 3550000 - FINE NEEDLE ASPIRATION 228.95 10021 3550005 - FINE NEEDLE ASPIRATION W GUIDANCE 690.65 10022 3550010 - INJECTION SINUS TRACT 806.55 20501 3550015 - ABLATION 6969.2 20982 3550025 - THORACENTESIS ASPARATION INIT 834.1 32421 3550030 - THORACENTESIS W/TUBE INSERT 834.1 32422 3550035 - INSERT INDWELL TUNNELED PLEURAL CATH 4559.05 32550 3550040 - INSERT CHEST TUBE 834.1 32551 3550045 - REMOVE LUNG CATH 213.75 32552 3550050 - LYSE CHEST FIBRIN SUBQ DAY 834.1 32562 3550055 - PERC RX ABLATE TX TUMOR 7685.5 32998 3550060 - PTA TIBIOPERONEAL TRN/BRN EA 7108.85 37228 3550075 - PTA ILIAC ARTERY 6866.6 37220 3550080 - PTA FEMORAL-POPLITERAL ARTERIES 6670.9 37221 3550095 - INJ EXTREM VENOGRAM 1971.25 36005 3550100 - INTRO SVC/IVC CATH 2546.95 36010 3550105 - SELECTIVE VENOUS CATH PLACEMNT 1ST ORD 2903.2 36011 3550110 - SELECTIVE VENOUS CATH PLACEMNT 2ND ORD 2896.55 36012 3550115 - INTRO CATH 2096.65 36013 3550120 - CATH PULMONARY SELECT UNILAT 2882.3 36014 3550125 - SELECTIVE CATH PLACEMNT SEGMENTAL 2401.6 36015 3550130 - INTRO NEEDLE/INTRACATH 4726.25 36100 3550140 - INTRO NEEDLE EXTREMITY ARTERY 3128.35 36140 3550155 - INTRO NEEDLE/INTRA CATH AORTIC 2624.85 36160 3550160 - INTRO CATHETER AORTA 2986.8 36200 3550165 - SELECTIVE ARTERIAL CATH PLACEMNT 1ST ORD 2923.15 36215 3550170 - SELECTIVE ARTERIAL CATH PLACEMNT 2ND ORD 3180.6 36216 3550175 - SELECTIVE ARTERIAL CATH PLACEMNT 3RD ORD 3270.85 36217 3550180 - SELECTIVE ARTERIAL CATH PLACEMENT ADD'L 1755.6 36218 3550185 - CATH EA 1ST ORD ABDOM/PEL/LE 3660.35 36245 3550190 - CATH ART INIT 2ND ORD ABD/PEL/LE 3505.5 36246 3550195 - CATH ART INIT 3RD ORD ABD/PEL/LE 3727.8 36247 3550200 - CATH ART ADD 2ND 3RD ORD AB/PEL/LE 2325.6 36248 3550205 - PERCUTANEOUS PORTAL VEIN CATH 3240.45 36481 3550210 - INSERT NON-TUNNEL CV CATH >5YR 2697.05 36556 3550215 - INSERT NON-TUNNEL CV W/O PORT/PUMP 4546.7 36558 3550220 - INSERT TUNNEL PORT 5999.25 36561 3550225 - INSERT TUNNELED PUMP 6056.25 36563 3550230 - INSERTION NON TUNNELED PICC 2467.15 36569 3550235 - PICC >=5 2337 36569 3550240 - PICC W/PORT >= 5 5799.75 36571 3550245 - PICC REPLACEMENT W/PORT OR PUMP 5063.5 36578 3550250 - NON TUNNELED REPLACEMENT 3450.4 36580 3550255 - TUNNELED REPLACEMENT 4534.35 36581 3550260 - TUNNELED PORT REPLACEMENT 5914.7 36582 3550265 - TUNNELED PUMP REPLACEMENT 8241.25 36583 3550270 - PICC REPLACEMENT 2544.1 36584 3550275 - PICC W/PORT REPLACEMENT 5339 36585 "3550280 - REMOVAL TUNNELED NO PORT, NO PUMP" 2956.4 36589 3550285 - REMOVAL TUNNELED W/PORT/PUMP 3639.45 36590 3550290 - THROMBOLYTIC DECLOTTING VASCULAR ACCESS 1085.85 36593 3550295 - CVA MAINT FIBRIN STRIPPING 3250.9 36595 3550300 - CVA MAINT LUMEN BRUSHING 2518.45 36596 3550305 - REPOSITION CV CATH W/FLUORO 2362.65 36597 3550310 - CONTRAST INJ EVAL CVA DEVICE W/FLUORO 1091.55 36598 3550315 - INTRAVASC PRESSURE MEASUREMENT 1604.55 36620 3550325 - THROMBECTOMY ARTERIAL INITIAL VESSEL 7568.65 37184 3550330 - THROMBECTOMY ARTERIAL ADD'L VESSEL 3735.4 37185 3550335 - VENOUS MECH THROMBECTOMY 7171.55 37187 3550340 - VENOUS MECH THROMBECTOMY REPEAT 6119.9 37188 "3550345 - TRANSCTH RETRIEVAL, PERC FOREIGN BODY" 3680.3 37203 3550350 - INTRAVASCULAR STENT INIT VESSEL 10120.35 37205 3550355 - INTRAVASCULAR STENT EA ADD'L 8893.9 37206 "3550360 - TRNSCATH PLACEMNT INTVASCULAR STENT, INI" 7353 37207 3550365 - TRNSCATH PLACEMNT INTVASCULAR EA ADD'L 4707.25 37208 3550370 - INTERRUP IVC LIGATION 5478.65 37191 3550385 - UNLISTED LIVER 690.65 47399 3550410 - PERITONEAL LAVAGE INIT 834.1 49082 3550415 - PERITONEAL LAVAGE SUB 834.1 49083 3550420 - INJ OF AIR/CONTRAST PERITONEAL CAV 1152.35 49400 3550425 - INTRAPERITONEAL CANNULA / CATH TEMP 4559.05 49421 3550430 - INTRAPERITONEAL CANNULA / CATH PERM 7079.4 49421 3550435 - EXCHANGE CATH 2288.55 49423 3550450 - ABLATION RENAL TUMOR PERC UNI CRYOTHERAP 7685.5 50593 3550460 - BIOPSY THYROID 690.65 60100 3550465 - PERITONEOGRAM S & I 950.95 74190 3550470 - ABD & BIL ILIOFEM LE ANGIO S&I 4356.7 75630 3550480 - CAROTID EXTERNAL ANGIO LT S & I 6865.65 75660 3550485 - CAROTID EXTERNAL ANGIO BIL S & I 6865.65 75662 3550490 - ANGIO CAROTID CEREBRAL UNI S&I 4356.7 75665 3550495 - CAROTID/CERE ANGIOGRAM BIL S & I 4356.7 75671 3550500 - CAROTID CERVICAL ANGIO UNI S & I 4356.7 75676 3550505 - ANGIO CAROTID CERVICAL BIL S & I 4356.7 75680 3550510 - VERTEBRAL ANGIOGRAPHY S&I 4356.7 75685 3550515 - ANGIO EXTREMITY UNILAT S&I 4356.7 75710 3550520 - ANGIO LOWER EXTREMITY BIL S&I 4356.7 75716 3550525 - ANGIO RENAL UNIL S&I 4356.7 36251 3550530 - ANGIO RENAL SELECTIVE BIL S&I 4356.7 36252 3550535 - ANGIO VISCERAL SELECTIVE S&I 4356.7 75726 3550540 - ANGIO ADRENAL SELECTIVE UNI S&I 4356.7 75731 3550545 - ANGIO ADRENAL SELECTIVE BIL S&I 4356.7 75733 3550546 - REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI 3708.8 37224 3550547 - REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM 10842.17 37225 3550548 - REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM V 3708.8 37226 3550549 - REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM 10842.17 37229 3550550 - ANGIO PELVIC SELECTIVE S&I 4356.7 75736 3550555 - ANGIO PULMONARY SELECTIVE UNI S&I 4356.7 75741 3550560 - ANGIO PULMONARY SELECTIVE BILI S&I 4356.7 75743 3550565 - ANGIO PULMONARY NONSELECT S&I 1543.75 75746 3550570 - ANGIO INTERNAL MAMMARY S&I 1543.75 75756 3550575 - ANGIO SELECTIVE EA ADD'L VESSEL S&I 1543.75 75774 3550585 - LYMPHANGIOGRAM EXTREMITY BIL S&I 840.75 75803 3550590 - LYMPHANGIOGRAM PELVIC UNI S&I 840.75 75805 3550595 - LYMPHANGIOGRAM PELVIC BIL S&I 840.75 75807 "3550600 - VENOGRAPHY, EXTREMITY UNI S&I" 1548.5 75820 "3550605 - VENOGRAPHY, IVC W/SERIAL S&I" 3059.95 75825 "3550610 - VENOGRAPHY, CVA W/SERIAL S&I" 3031.45 75827 "3550615 - RENAL, UNI" 4356.7 75831 "3550620 - RENAL, BIL" 4356.7 75833 "3550625 - ADRENAL, UNI" 4356.7 75840 "3550630 - ADRENAL, BIL" 4356.7 75842 3550635 - SINUS OR JUNGULAR 1543.75 75860 3550640 - SUPERIOR SAGITTAL SINUS 1543.75 75870 3550645 - EPIDURAL 1543.75 75872 3550650 - ORBITAL 1543.75 75880 3550655 - HEPATIC W HEMODYNAMIC EVAL 4356.7 75889 3550660 - VENOUS CATH SAMPLING S&I 2650.5 75893 3550665 - CVA MAINTENANCE FIBRIN STRIPPING 1415.5 75901 3550670 - CVA MAINTENANCE LUMEN BRUSHING 1628.3 75902 3550675 - INS ENDOVAS VENA CAVA 3598.6 37191 "3550685 - TRANSCATH RETREIVAL, PERC" 3963.4 75961 3550710 - FLUOROSCOPY 791.35 76000 3550715 - ULTRASOUND GUIDANCE 837.9 76937 "3550720 - FLUORO GUIDANCE CVA PLCMNT, REMVL" 912.95 77001 3550725 - VESSEL MAPPING OF VESSELS 1415.5 G0365 3550730 - GORE STENT 7mmx5mx75-120cm 3267.05 C1874 3550735 - GORE STENT 7mmx10mx75-120cm 3803.8 C1874 3550740 - GORE STENT 7mmx15mx75-120cm 4439.35 C1874 3550745 - GORE STENT 8mmx5mx85-120cm 3267.05 C1874 "3550746 - STENT, NON-COAT/COV W/O DEL" 3603.8 C1877 "3550747 - STENT, NON-COAT/COV WITH DEL SYS" 1243.75 C1876 3550750 - GORE STENT 8mmx10mx85-120cm 3803.8 C1874 3550755 - GORE STENT 8mmx15mx85-120cm 4439.35 C1874 3550780 - ENDOVENOUS MCHNCHEM 1ST VEIN 8893 36473 3600005 - ED ADMIN IMMUNIZATION 1 VACCINE 108.3 90471 3600010 - ED IV INF HYDRATION UP TO 1HR 374.3 96360 3600015 - ED IV INF HYDRATION EA ADDL HR 259.35 96361 3600020 - ED IV INF SEQUENTIAL UP TO 1HR 327.75 96367 3600025 - ED IV INF CONCURRENT THERAPEUTIC 259.35 96368 3600030 - ED IV PUSH EA ADDL DRUG 185.25 96375 3600035 - ED IV PUSH EA SEQUENTIAL DRUG 185.25 96376 3600040 - ED PREGNANCY TEST 36.1 81025 3600061 - E/R LEVEL 2 361.95 99282 3600062 - ER LEVEL 2w/modifier 361.95 9928225 3600063 - E/R LEVEL 3 571.9 99283 3600064 - ER LEVEL 3w/modifier 571.9 9928325 3600065 - ER LEVEL 1w/modifier 271.7 9928125 3600066 - LEVEL 2 TYPE B ED VISIT 272.88 G0381 3600067 - LEVEL 3 TYPE B ED VISIT 362.24 G0382 3600069 - LEVEL 1 TYPE B ED VISIT 229.75 G0380 3600070 - ER LEVEL 2w/modifier 361.95 9928225 3600071 - E/R LEVEL 1 271.7 99281 3600072 - ER LEVEL 1w/modifier 271.7 9928125 3600075 - ER LEVEL 3w/modifier 571.9 9928325 3600080 - ER LEVEL 4 w/modifier 894.9 9928425 3600085 - ER LEVEL 5 w/modifier 1340.45 9928525 3600090 - ER CRITICAL CARE 1ST HR W MOD 1857.25 9929125 40000 - TUBE CIRCLE NEPHROSTOMY 613.7 40020 - BREATH CIR W/BAG PEDIATRICS 228.95 40030 - NASAL PACKING 58.9 4010000 - CYCLIC CITRULLINATED PEPTITE AB 190 86200 4010005 - CREATININE RANDOM URINE 107.35 82570 4010010 - KEPPRA 230.85 80177 4010015 - LAMICTAL 230.85 82542 4010020 - LEUKOCYTE ALKALINE PHOS 170.05 85540 4010025 - LYME DISEASE 529.15 87476 "4010028 - LYME DISEASE ANTIBODIES (IgG,IgM) IMMUNO" 529.15 86617x2 4010030 - MUMPS AB 169.1 86735 4010035 - T3 FREE 264.1 84481 4010040 - T4 FREE 182.4 84439 4010045 - TACROLIMUS 458.85 80197 4010050 - THIOCYANATE 152 84430 4010055 - THYROID BINDING GLOBULIN 182.4 84442 4010060 - TOBRAMYCIN 250.8 80200 4010065 - TOBRAMYCIN TROUGH 250.8 80200 4010070 - TOBRAMYCIN PEAK 250.8 80200 4010075 - VANCOMYCIN TROUGH 250.8 80202 4010080 - VANCOMYCIN PEAK 250.8 80202 4010085 - VITAMIN B1 (THIAMIN) 250.8 84425 4010090 - VITAMIN D 25 HYDROXY 342.95 82306 4010095 - VMA 24 HOUR URINE 205.2 84585 4010100 - VMA RANDOM URINE 205.2 84585 4010110 - H1N1 PCR 475 87798 4010115 - TB GOLD 314.45 86480 "4010120 - ACETONE, URINE" 150.1 82010 4010125 - ANTIDIURECTIC HORMONE 318.25 84588 4010130 - ANGIOTENSION CONV ENZY (ACE) 203.3 82164 "4010135 - AMYLASE, PERITONEAL FLD" 174.8 82150 "4010140 - AMYLASE, SYNOVIAL FLUID" 172.9 83615 4010145 - BENCE JONES 262.2 86334 4010150 - BETA-2-MICROGLOBULIN 199.5 82232 4010160 - ISOLATION/EXTRACTION 198.55 83891 4010165 - SEPARATION/ID 170.05 83909 4010170 - ENZYMATIC DIGESTION 134.9 83892 4010180 - AMPLIFICATION/TARGET 237.5 83898 4010190 - AMPLIFICATION/TARGET 237.5 4010200 - MUTATION ID 237.5 83904 4010220 - INTERPRETATION & REPORT 147.25 83912 4010225 - CA 19/9 232.75 86301 4010235 - CD8 375.25 86360 4010240 - TOTAL TCELL 247 86359 4010245 - NATURAL KILLER CELLS 193.8 86357 4010250 - B CELL 194.75 86355 "4010255 - CHLORIDE, BODY FLUID" 136.8 82438 "4010260 - CHLORIDE, SYNOVIAL FL" 136.8 82438 "4010265 - CHOLESTEROL, ABD FLD" 98.8 82465 4010270 - CITRATE 294.5 82507 "4010275 - COCCIDIODES, AB CF" 149.15 86635 4010280 - CYCLOSPORINE 293.55 80158 4010290 - ISOLATION OR EXTRACTION 198.55 83891 4010295 - ID BY HIGH RESOLUTION 170.05 83909 4010300 - MUTATION ID BY ENZYMATIC 144.4 83914 4010305 - AMPLIFICATION TARGET 214.7 83900 4010310 - EACH ADDITION NUCLIE 190.95 83901 4010315 - INTERPRETATION/REPORT 147.25 83912 4010325 - CHLAMYDIA PROBE TECH 215.65 87491 4010330 - GONNORHEA PROBE TECH 205.2 87591 "4010335 - CMV PCR, CSF" 567.15 87497 "4010340 - CMV, DNA, PCR, URINE" 445.55 87496 4010345 - ECHOVIRUS AB 259.35 86658 4010355 - NA 259.35 84300 4010360 - K 110.2 84133 4010365 - CL 110.2 82436 4010370 - ENDOMYSIAL AB SCREEN 238.45 86255 4010375 - ETHYLEENE GLYCOL 303.05 82693 4010385 - ESTRONE 212.8 82679 4010390 - ESTRIODIAL 290.7 82670 4010395 - ESTRIOL 181.45 82677 "4010400 - ESTROGEN, TOTAL" 267.9 82672 4010405 - EPSTEIN BARR VIRUS 189.05 86665 4010415 - F5 AMPLIFICATION 348.65 85220 4010420 - F5 MUTATION ID 143.45 83914 4010425 - F5 INTERP/REPORT 237.5 83898 4010430 - FACTOR VIII 353.4 85240 4010435 - FACTOR V 348.65 85220 4010440 - FETAL FIBRONECTIN 612.75 82731 4010450 - FLOW CYTO 323 88184TC 4010455 - ADDN MAKER 184.3 88185TC "4010460 - FOLATE, RBC" 216.6 82747 4010465 - FUNGUS CULTURE 230.85 87102 4010470 - GLUCOSE BODY FLUID 122.55 82945 4010475 - GLUCOSE SYNOVIAL FLUID 122.55 82945 4010485 - GLOMERULAR BASEMENT MEMBRANE 289.75 83520 4010490 - HAPTOGLOBIN 185.25 83010 4010495 - HEPATITIS B SURFACE AG 162.45 87340 4010500 - HEPATITIS B SURFACE AB 163.4 86706 4010505 - HEPATITIS BE ANTIGEN 146.3 87350 4010510 - HEPATITIS B VIRUS DNA 500.65 87517 4010520 - HEPATITIS E AB IGG 223.25 86790 4010525 - HEPATITIS E AB 223.25 86790 "4010530 - HIAA, 24 HR URINE" 107.35 82570 4010535 - HLA B-27 331.55 86812 4010540 - HOMOCYSTEINE 309.7 83090 4010545 - HOMOCYSTEIN RANDOM URINE 309.7 83090 4010550 - HERPES PCR (CSF) 337.25 87530 4010560 - HSV 1 IGG AB 153.9 86695 4010565 - HSV 2 IGG AB 151.05 86696 "4010590 - PROTEIN, TOTAL URINE" 98.8 84155 "4010595 - PROTEIN ELECTROPHORESIS, URINE" 197.6 84165 4010600 - IMMUNOFIXATION ELECTROPHORESIS 284.05 86335 "4010605 - IMMUNOFIXATION, SERUM" 262.2 86334 "4010610 - IMMUNOFIXATION, URINE" 284.05 86335 4010615 - INFLUENZA A 129.2 87140 4010620 - INFLUENZA B 129.2 87140 4010625 - ISPROPHYL ALCOHOL 216.6 84600 4010630 - LUPUS 193.8 85613 4010635 - DVVRT 137.75 85730 "4010640 - LDH, ABDOMINAL ABCESS" 121.6 83615 4010645 - LDH-SPINAL FLUID 121.6 83615 4010650 - LDH-PERITONEAL FLUID 121.6 83615 4010660 - LUPUS 193.8 85613 4010665 - DVVRT 137.75 85730 4010670 - MAGNESIUM RBC 129.2 83735 "4010675 - METANEPHRINE, FRAC 24 HR UR" 168.15 83825 "4010680 - METANEPHRINES, 24 HR URINE" 168.15 83835 4010685 - METHYL ALCOHOL 216.6 84600 4010690 - METHYLMALONIC ACID 321.1 83921 "4010695 - MICRO ALBUMIN, URINE" 136.8 82043 4010700 - MICROALBUMIN 24 HR 136.8 82043 "4010705 - MYCOPLASMA, AG" 429.4 87581 4010710 - MYELIN BASIC PROTEIN (MBP) CSF 247.95 83873 4010715 - MYELIN BASIC PROTEIN (MBP) SER 289.75 83520 4010720 - NEOMYCIN 230.85 80299 4010725 - OLIGOCLONAL BANDS/ CSF/SERUM 269.8 83916 4010735 - OXALIC ACID 152 83945 4010740 - CREAT URINE 107.35 82570 4010745 - PH PERITONEAL FLD 88.35 83986 "4010750 - POTASSIUM, URINE" 115.9 84156 "4010755 - PROTEIN, URINE RANDOM" 115.9 84156 "4010765 - PROTEIN, TOTAL" 98.8 84155 "4010770 - PROTEIN, ELECTROPHORESIS" 197.6 84165 4010780 - CREAT URINE 107.35 82570 "4010785 - PROTEIN, URINE" 115.9 84156 4010790 - URINE ELECTROPHORESIS 210.9 84166 4010795 - PROTEIN ABDOMINAL ABCESS 122.55 82945 "4010800 - PROTEIN, PERITONEAL FLUID" 133.95 84157 "4010805 - PROTEIN, SYNOVIAL FLD" 133.95 84157 4010815 - PT AMPLIFICATION 237.5 83898 4010820 - MUTATION ID 144.4 83914 4010825 - INTERPRETATION & REPORT 147.25 83912 4010830 - RESPIRATORY SYNCYTIAL VIRUS (RSV) 232.75 87420 "4010835 - SODIUM, URINE" 106.4 84300 4010840 - SYNOVIAL FLUID CELL COUNT 172.9 89051TC 4010845 - THYROGLOBULIN AB 184.3 86800 4010855 - THYROGLOBULIN AB 184.3 86800 4010860 - THYROID PEROXIDASE 174.8 86376 "4010865 - TRIGLYCERIDE, BODY FLUID" 127.3 84478 4010870 - TRYSPIN 331.55 83519 4010875 - URIC ACID 24 HR URINE 95 84560 4010880 - ZONISAMIDE 230.85 80299 4010890 - D1 DERATOPHAGOIDES PTERONYSSINUS 116.85 86003 4010895 - D2 DERTMATOPHAGOIDES FARINAE 116.85 86003 4010900 - M2 CLADOSPORIUM HERBARUM 116.85 86003 4010905 - M3 ASPERILLUS FUMIGATUS 116.85 86003 4010906 - A. ALTERNATA MOLD 95.95 86003 4010910 - M4 MUCOR RACEMOSUS 116.85 86003 4010915 - M5 CANDIDA ALBICANS 116.85 86003 4010920 - M6 ALTERNARIA TENUIS 116.85 86003 4010925 - I 16 COCKROACH 116.85 86003 4010930 - ACETYL CHOLINE RECEPTOR BINDING AB 314.45 83519 4010935 - ACETYL CHOLINE RECEPTOR BLOCKING AB 314.45 83519 4010940 - ACETYL CHOLINE RECEPTOR MODULATING AB 314.45 83519 4010945 - ANCA SCREEN 285 86021 4010950 - P ANCA 285 86021 4010955 - C. ANCA 285 86021 4010960 - AMIODARONE 274.55 82492 "4010965 - ALDOSTERONE, SERUM" 380.95 82088 4010970 - BETA HYDROXYBUTYRATE 142.5 82010 4010975 - BENZO CONFIRMATION 182.4 80102 "4010980 - CARDIOLIPIN, AB IgG" 246.05 86147 "4010985 - CARDIOLIPIN, AB IgM" 246.05 86147 "4010990 - CARDIOLIPIN, AB IgA" 246.05 86147 4010995 - CA15-3 209.95 86300 4011000 - CENTROMERE B ANTIBODY 176.7 86038 4011005 - SCL-70 SCLERODERMA AB 193.8 86235 4011010 - CLOZAPINE (CLOZARIL) 274.55 82492 "4011015 - COPPER, SERUM" 153.9 82525 4011020 - DHEA-SULPHATE 246.05 82627 4011025 - DHEA LCMSMS 283.1 82626 4011030 - GAMMA GLUTAMYL TRANSFERASE 124.45 82977 "4011035 - GLUCOSE, PLUERAL FLUID" 127.3 84157 "4011040 - H. PYLORI, IGA" 204.25 86677 "4011045 - H. PYLORI, IGM" 204.25 86677 4011050 - HIV-1 ULTRA QUANT [bdna] 575.7 87536 4011055 - HSV IGM AB 169.1 86694 4011060 - HEP C VIRUS RIBA 353.4 86804 4011065 - HEP E Ab IGG 353.4 86790 4011070 - HEP E Ab IGM 211.85 86790 4011075 - HEP INDUCED THROMBOCYTOPENIA AB 433.2 86022 "4011080 - HISTOPLASMA AB, CF" 141.55 86698 4011085 - JO-1 ANTIBODY 193.8 86235 4011090 - MITOCHONDRIAL AB w/REFLEX 227.05 86255 4011095 - MYCOPHENOLIC ACID 330.6 83789 4011100 - MYELIN ASSOCIATED GLYCOPROTEIN IgG 227.05 86255 4011105 - MYELIN ASSOCIATED GLYCOPROTEIN IgM 275.5 83520 4011110 - OPIATES CONFIRMATION 213.75 83925 4011115 - PARIETAL CELL AB 185 83516 "4011120 - PHENCYCLIDINE, URINE" 164.35 83992 "4011125 - PHENCYCLIDINE, URINE CONFIRMATION" 164.35 83992 "4011130 - 17, OH PROGESTRONE" 245.1 83498 4011135 - RENAL PANEL 283.1 80069 4011140 - SCL-70 SCLERODERMA AB 193.8 86235 4011145 - SMOOTH MUSCLE (SM) AB (IgG) 190 86225 4011150 - STRIATED MUSCLE AB w/REFLEX 190 86255 4011156 - TB PCR CSF 522.5 87556 4011160 - THIAMINE 230.85 84425 4011170 - TTG IGG 191.9 83625 4011175 - TTG IGA 191.9 83625 4011180 - TOPAMAX (TOPIRAMATE) 179.55 80201 4011185 - URINE EOS 58.9 81015 "4011190 - VIT D1, 25 DIHYDROXY" 391.4 82652 4011255 - HEPARIN INDUCED PLT AGREGATION 444.6 86022 4011260 - HEPARIN /PF4/PLATE AB (ELISA) 444.6 86022 "4011270 - COXSAKIE B (1-6) Antibodies, Serum" 208.05 86658 "4011280 - EOS SMEAR, FECES" 179.55 85999 4011285 - EOS URINE 179.55 85999 4011290 - HERPES SIMPLEX VIRUS IGM TITER 158.65 86694 4011295 - HISTOPLASMA 137.75 86698 4011300 - HISTOPLASMA ANTIGEN URINE 137.75 86698 4011310 - INTRINSIC FACTOR AB 175.75 86340 4011315 - LETOSPIRA SCREEN W/ REFLEX 155.8 86720 4011320 - LDH SYNOVIAL FLUID 106.4 83615 4011325 - LIVER KIDNEY MICROSOME IGG AB 162.45 86376 4011330 - LYZOSYME W/ INTERP 353.4 88342TC "4011335 - PORPHYRINS, FRACT 24HR UR" 208.05 84120 4011340 - PRO-INSILIN 286.9 84206 4011345 - PROTEIN-C ANTIGEN 313.5 85302 "4011350 - QUETIAPINE/SEROQUEL, BLOOD" 225.15 80299 4011355 - SULFONURIA (HYPOGLYCEMIA) PANEL 666.9 G0479 4011360 - TOXOPLASMA GONDII DNA QUAL PCR 424.65 87798 4011370 - WEST NILE VIRUS AB IGG 142.5 86788 4011375 - WEST NILE VIRUS AB IGM 142.5 86789 4011385 - MRSA SCREEN 208.05 87070 4011415 - GLUCOSE; GESTATIONAL DIABETES 99.75 82950 "4011420 - GLUCOSE, RANDOM" 75.05 82947 4011430 - CREATININE 24HR URINE 99.75 82570 4011435 - CHLORIDE RANDOM URINE 104.5 82436 4011440 - LDH BODY FLUID 114 83615 4011445 - METHADONE SCREEN 205.2 G0479 4011450 - OSMOLALITY URINE 133.95 83935 4011455 - PROTEIN BODY FLUID 126.35 84157 4011460 - PROTEIN URINE 24HR URINE 103.55 84156 4011465 - STOOL PH 81.7 83986 4011470 - UA COMPLETE NO REFLEX 97.85 81001 4011475 - UA W/O MICRO W/REFLEX 97.85 81001 4011480 - UA W/O MICRO NO REFLEX 97.85 81001 "4011485 - CULTURE, FOLEY CATH URINE" 133.95 87088 "4011490 - CULTURE, VAGINAL" 208.05 87070 "4011495 - CULTURE, URETHRAL" 208.05 87070 "4011500 - CULTURE, PENLE" 208.05 87070 4011505 - STREP SCREENING 137.75 87081 4011515 - PENICILLIUM NOTATUS 95.95 86003 4011520 - ALTERNATA ALTERNATA 95.95 86003 4011525 - HELMINTHOSPORIUM HALODES 95.95 86003 4011530 - HISTONE AB 179.55 80346 4011535 - LIDOCAINE 173.85 80176 4011540 - ANTI PLATELET DIRECT AB 310.65 86022 4011545 - AMPHOTERICIN B 225.15 80299 4011550 - CLONAZEPAM 178.6 83625 "4011555 - MAGNESIUM, URINE RANDOM" 122.55 83735 "4011560 - PHOSPHORUS, URINE RANDOM" 91.2 84105 4011570 - CAT DANDER 95.95 86003 4011575 - HORSE DANDER 95.95 86003 4011580 - COW DANDER 95.95 86003 4011585 - DOG DANDER 95.95 86003 4011586 - FEATHER MIX 95.95 86003 4011587 - HOUSE DUST 95.95 86003 4011600 - BERMUDA GRASS 95.95 86003 4011605 - TIMOTHY GRASS 95.95 86003 4011610 - MAPLE 95.95 86003 4011611 - CORN 95.95 86003 4011612 - SESAME SEED 95.95 86003 4011615 - MOUNTAIN CEDAR 95.95 86003 4011620 - OAK 95.95 86003 4011625 - ELM 95.95 86003 4011630 - WALNUT 95.95 86003 4011635 - MAPLE LEAF 95.95 86003 4011640 - COTTONWOOD 95.95 86003 4011645 - WHITE ASH 95.95 86003 4011650 - PECAN 95.95 86003 4011651 - PEANUT 95.95 86003 4011655 - MULBERRY 95.95 86003 4011660 - COMMON RAGWEED 95.95 86003 4011665 - RUSSIAN TISTLE 95.95 86003 4011670 - ROUGH PIGWEED 95.95 86003 4011675 - ROUGH MARSH ELDER 95.95 86003 4011685 - CODFISH 95.95 86003 4011686 - SCALLOP 95.95 86003 4011687 - SOYBEAN 95.95 86003 4011690 - CRAB 95.95 86003 4011691 - MOUSE 95.95 86003 4011695 - SHRIMP 95.95 86003 4011696 - EGG WHITE 95.95 86003 4011697 - CLAM 95.95 86003 4011700 - TUNA 95.95 86003 4011701 - MILK 95.95 86003 4011702 - WHEAT 95.95 86003 4011705 - LOBSTER 95.95 86003 4011715 - ALMOND NUT TREE 95.95 86003 4011720 - BRAZIL NUT TREE 95.95 86003 4011725 - CASHEW NUT TREE 95.95 86003 4011730 - HAZEL NUT TREE 95.95 86003 4011735 - PECAN NUT TREE 95.95 86003 4011740 - PISTACHIO NUT TREE 95.95 86003 4011745 - WALNUT NUT TREE 95.95 86003 4011750 - ZINC LEVEL-BLD 95.95 84630 4011755 - ZINC LEVEL UR 95.95 86003 4011775 - ASSAY OF PRIMIDONE 58.9 80188 4011780 - ACTH PLASMA 135.85 82024 4011785 - HAPATITIS B SURFACE AB QUAN 53.2 86317 "4011790 - TESTOSTERONE, FREE" 90.25 84402 4011795 - CMV ANTIBODY IGM 59.85 86645 4011800 - VIRUS INOCULATION TISSUE 92.15 87252 4011805 - VIRUS INOCULATION SHELL VIAL 69.35 87254 4011815 - HIV-1 DNA QUANT 299.25 87536 4011820 - RISPERIDONE LEVEL 64.6 83789 4011825 - MOLECULE NUCLEIC AMPLI EA 58.9 83898 4011830 - MOLECULE MUTATION IDENTIFY 58.9 83904 4011835 - MOLECULE ISOLATE NUCLEIC 15.2 83891 4011840 - MOLECULAR DIAGNOSTICS 50.35 83902 4011845 - MOLECULAR NUCLEIC AMPLI 2 SEQ 117.8 83900 4011850 - MOLECULAR DIAGNOSTICS 15.2 83896 4011855 - GENETIC EXAMINATION 15.2 83912 4011865 - VON WILLEBRAND FACTOR 318.25 85245 4011870 - GLIADIN AB IGG 172.9 83625 4011875 - SUBOXON 95.95 83925 4011880 - ALPRAZOLAM 58.9 83625 4011895 - PARAVOVIRUS BIG AB 74.1 86747 4011900 - SEROQUEL 68.4 80299 4011905 - Barbitarates 191.9 G0479 4011910 - PCP Phencyclidine 196.65 G0479 4011915 - Marijuana 230.85 G0479 4011920 - Test for Acetone/Ketones 114 82009 4011925 - Immediate eval. of specimen adequacy 321.1 88172TC 4011975 - Madden 5 Panel Drug Screen 97 80307 4011980 - Buprenorphine Screen 171 80307 4011985 - HPV High Risk 16/18 Geno 94 87624 4011996 - Drug Screen Quantalcohols 118 80320 4011998 - Alcohols biomarkers; 1 or 2 234 80321 4012000 - Alcohols biomarkers; 3 or42 234 80322 4012002 - alkaloids NOS 234 80323 4012004 - Drug Screen Amphetamines 1/2 203 G0479 4012006 - Anabolic steroids; 1 or 2 203 80327 "4012008 - Analgesics, non-opiod; 1 or 2" 218 80329 "4012010 - Antidepressants, serotonergic class; 1/2" 234 80332 "4012012 - Antidepressants, tricyclic 1/2" 234 G0479 "4012014 - Antidepressants, NOS" 234 80338 "4012016 - Antiepileptics, NOS 1-3" 234 80339 "4012018 - Antipsychotic, NOS 1-3" 234 80342 "4012032 - Gabapentin, non-blood" 234 80171 4012054 - Wet Mount 234 87210 4012056 - Procalcitonin 360 84145 4012058 - H.Pylori Breath 486 83013 4012060 - H.Pylori Stool 281 87338 4012077 - PROCALCITONIN 427 84145 4012078 - FLURORESCENT ANTIBODY SCREEN 292 86255 4012079 - FLURORESCENT ANTIBODY TITER 256 86256 4012080 - PNEUMOCOCCAL URINE ATIGEN 234 86403 4012081 - STREP A 174 87880 40211 - FACIAL BONES/SINUSES W&W/O DYE 3427.6 70488 40510 - OT EVALUATION O.T. 304 97003GO 41000 - SLING CAMP MOBILE ARM SUPPORT 54.15 41030 - XR CHEST DECUB SPECIAL VIEW 272.65 71035TC 41031 - RADIOLOGIC EXAMINATION CHEST SINGLE VIEW 569.05 71045 41032 - RADIOLOGIC EXAMINATION CHEST 2 VIEW 316.35 71046 41033 - RADEX CHEST +3 VIEWS FRONTAL LAT OBLIQ 341.05 71047 41034 - RADEX CHEST +4 VIEWS W/F 836 71048 41035 - RADEX CHEST DECUB SPECIAL VIEW 272.65 71046 41036 - RADEX CHEST FRONT LAT 2 VIEW 316.35 71046 41040 - VENA CAVA FILTER 3845.6 C1880 41050 - XR CHEST PA / LAT 2V 316.35 71020TC 41060 - XR CHEST FRONT / LAT 2 VIEW 316.35 71020TC 41110 - XR RIBS UNI LAT 2V LT 330.6 71100TC 41120 - XR RIBS UNI LAT 2V RT 330.6 71100TC 41130 - XR RIBS BILAT 3V 465.5 71110TC 41200 - XR STERNUM MIN 2V 259.35 71120TC 41710 - SET DEODER 70.3 41810 - MATTRESS WATER PRESSURE 234.65 E0186 4200000 - MRI AUDITORY CANAL WO CONTRAST 3185.35 70551 4200005 - MRI BRAIN WO CONTRAST 3185.35 70551 4200010 - MRI PITUITARY WO CONTRAST 3185.35 70551 4200015 - MRI AUDITORY CANAL W CONTRAST 3619.5 70552 4200020 - MRI BRAIN W CONTRAST 3619.5 70552 4200025 - MRI PITUITARY W CONTRAST 3619.5 70552 4200030 - MRI AUDITORY CANAL WO W CONTRAST 4667.35 70553 4200035 - MRI BRAIN WO W CONTRAST 4667.35 70553 4200040 - MRI PITUITARY WO W CONTRAST 4667.35 70553 4200045 - MRI FACE WO CONTRAST 3123.6 70540 4200050 - MRI NECK WO CONTRAST 3123.6 70540 4200055 - MRI ORBIT (S) WO CONTRAST 3185.35 70540 4200060 - MRI FACE W CONTRAST 3585.3 70542 4200065 - MRI NECK W CONTRAST 3585.3 70542 4200070 - MRI ORBIT(S) W CONTRAST 3585.3 70542 4200075 - MRI FACE WO W CONTRAST 4276.9 70543 4200080 - MRI NECK WO W CONTRAST 4276.9 70543 4200085 - MRI ORBIT(S) WO W CONTRAST 4276.9 70543 4200090 - MRI TMJ(S) W CONTRAST 3100.8 70336 4200095 - MRI TMJ(S) WO CONTRAST 3100.8 70336 4200100 - MRI TMJ(S) WO W CONTRAST 3100.8 70336 4200105 - MRI BRACHIAL PLEXUS WO CONTRAST 3116.95 71550 4200110 - MRI CHEST WO CONTRAST 3116.95 71550 4200120 - MRI CHEST W CONTRAST 3591 71551 4200125 - MRI BRACHIAL PLEXUS WO W CONTRAST 4365.25 71552 4200130 - MRI CHEST WO W CONTRAST 4365.25 71552 4200135 - MRI CERVICAL SPINE WO CONTRAST 3196.75 72141 4200140 - MRI CERVICAL SPINE W CONTRAST 3662.25 72142 4200145 - MRI THORACIC SPINE WO CONTRAST 3208.15 72146 4200150 - MRI THORACIC SPINE W CONTRAST 3554.9 72147 4200155 - MRI LUMBAR PLEXUS WO CONTRAST 3269.9 72148 4200160 - MRI LUMBAR SPINE WO CONTRAST 3269.9 72148 4200165 - MRI LUMBAR PLEXUS W CONTRAST 3546.35 72149 4200170 - MRI LUMBAR SPINE W CONTRAST 3546.35 72149 4200175 - MRI CERVICAL SPINE WO W CONTRAST 4570.45 72156 4200180 - MRI THORACIC SPINE WO W CONTRAST 4655 72157 4200185 - MRI LUMBAR PLEXUS WO W CONTRAST 4654.05 72158 4200190 - MRI LUMBAR SPINE WO W CONTRAST 4654.05 72158 4200195 - MRI PELVIS WO CONTRAST 2985.85 72195 4200200 - MRI PELVIS W CONTRAST 3619.5 72196 4200205 - MRI PELVIS WO W CONTRAST 4333.9 72197 4200210 - MRI FOREARM LT WO CONTRAST 2977.3 73218 4200215 - MRI FOREARM RT WO CONTRAST 2977.3 73218 4200220 - MRI HAND LT WO CONTRAST 2977.3 73218 4200225 - MRI HAND RT WO CONTRAST 2977.3 73218 4200230 - MRI HUMERUS LT WO CONTRAST 2977.3 73218 4200235 - MRI HUMERUS RT WO CONTRAST 2977.3 73218 4200240 - MRI FOREARM LT W CONTRAST 3387.7 73219 4200245 - MRI FOREARM RT W CONTRAST 3387.7 73219 4200250 - MRI HAND LT W CONTRAST 3387.7 73219 4200255 - MRI HAND RT W CONTRAST 3387.7 73219 4200260 - MRI HUMERUS LT W CONTRAST 3387.7 73219 4200265 - MRI HUMERUS RT W CONTRAST 3387.7 73219 4200270 - MRI FOREARM LT WO W CONTRAST 3875.05 73220 4200275 - MRI FOREARM RT WO W CONTRAST 3875.05 73220 4200280 - MRI HAND LT WO W CONTRAST 3875.05 73220 4200285 - MRI HAND RT WO W CONTRAST 3875.05 73220 4200290 - MRI HUMERUS LT WO W CONTRAST 3875.05 73220 4200295 - MRI HUMERUS RT WO W CONTRAST 3875.05 73220 4200300 - MRI ELBOW LT WO CONTRAST 3022.9 73221 4200305 - MRI ELBOW RT WO CONTRAST 3022.9 73221 4200310 - MRI SHOULDER LT WO CONTRAST 3022.9 73221 4200315 - MRI SHOULDER RT WO CONTRAST 3022.9 73221 4200320 - MRI WRIST LT WO CONTRAST 3022.9 73221 4200325 - MRI WRIST RT WO CONTRAST 3022.9 73221 4200330 - MRI ELBOW LT W CONTRAST 3196.75 73222 4200335 - MRI ELBOW RT W CONTRAST 3196.75 73222 4200340 - MRI SHOULDER LT W CONTRAST 3196.75 73222 4200345 - MRI SHOULDER RT W CONTRAST 3196.75 73222 4200350 - MRI WRIST LT W CONTRAST 3196.75 73222 4200355 - MRI WRIST RT W CONTRAST 3196.75 73222 4200360 - MRI ELBOW LT WO W CONTRAST 4055.55 73223 4200365 - MRI ELBOW RT WO W CONTRAST 4055.55 73223 4200370 - MRI SHOULDER LT WO W CONTRAST 4055.55 73223 4200375 - MRI SHOULDER RT WO W CONTRAST 4055.55 73223 4200380 - MRI WRIST LT WO W CONTRAST 4055.55 73223 4200385 - MRI WRIST RT WO W CONTRAST 4055.55 73223 4200390 - MRI FEMUR LT WO CONTRAST 2965.9 73718 4200395 - MRI FEMUR RT WO CONTRAST 2965.9 73718 4200400 - MRI FOOT LT WO CONTRAST 2965.9 73718 4200405 - MRI FOOT RT WO CONTRAST 2965.9 73718 4200410 - MRI TIBIA/FIBULA LT WO CONTRAST 2965.9 73718 4200415 - MRI TIBIA/FIBULA RT WO CONTRAST 2965.9 73718 4200420 - MRI FEMUR LT W CONTRAST 3507.4 73719 4200425 - MRI FEMUR RT W CONTRAST 3507.4 73719 4200430 - MRI FOOT LT W CONTRAST 3507.4 73719 4200435 - MRI FOOT RT W CONTRAST 3507.4 73719 4200440 - MRI TIBIA/FIBULA LT W CONTRAST 3507.4 73719 4200445 - MRI TIBIA/RIBULA RT W CONTRAST 3507.4 73719 4200450 - MRI FEMUR LT WO W CONTRAST 3875.05 73720 4200455 - MRI FEMUR RT WO W CONTRAST 3875.05 73720 4200460 - MRI FOOT LT WO W CONTRAST 3875.05 73720 4200465 - MRI FOOT RT WO W CONTRAST 3875.05 73720 4200470 - MRI TIBIA/FIBULA LT WO W CONTRAST 3875.05 73720 4200475 - MRI TIBIA/FIBULA RT WO W CONTRAST 3875.05 73720 4200480 - MRI HIP LT WO CONTRAST 3058.05 73721 4200485 - MRI HIP RT WO CONTRAST 3058.05 73721 4200490 - MRI HIPS BIL WO CONTRAST 3058.05 73721 4200495 - MRI KNEE LT WO CONTRAST 3058.05 73721 4200500 - MRI KNEE RT LT WO CONTRAST 3058.05 73721 4200505 - MRI ANKLE LT WO CONTRAST 3058.05 73721 4200510 - MRI ANKLE RT WO CONTRAST 3058.05 73721 4200515 - MRI ANKLE LT W CONTRAST 3161.6 73722 4200520 - MRI ANKLE RT W CONTRAST 3161.6 73722 4200525 - MRI HIP LT W CONTRAST 3161.6 73722 4200530 - MRI HIP RT W CONTRAST 3161.6 73722 4200535 - MRI HIPS BIL W CONTRAST 3161.6 73722 4200540 - MRI KNEE LT W CONTRAST 3161.6 73722 4200545 - MRI KNEE RT W CONTRAST 3161.6 73722 4200550 - MRI ANKLE LT WO W CONTRAST 4181.9 73723 4200555 - MRI ANKLE RT WO W CONTRAST 4181.9 73723 4200560 - MRI HIP LT WO W CONTRAST 4181.9 73723 4200565 - MRI HIP RT WO W CONTRAST 4181.9 73723 4200570 - MRI HIPS BIL WO W CONTRAST 4181.9 73723 4200575 - MRI KNEE LT WO W CONTRAST 4181.9 73723 4200580 - MRI KNEE RT WO W CONTRAST 4181.9 73723 4200585 - MRI ABDOMEN WO CONTRAST 3196.75 74181 4200590 - MRI ABDOMEN W CONTRAST 3707.85 74182 4200600 - MRI ABDOMEN WO W CONTRAST 4386.15 74183 4200605 - MRI BREAST LT WO W CONTRAST 969 77058 4200610 - MRI BREAST RT WO W CONTRAST 969 77058 4200615 - MRI BREAST BIL WO W CONTRAST 2238.2 77059 4200620 - MRA HEAD WO CONTRAST 2965.9 70544 4200625 - MRA HEAD W CONTRAST 3123.6 70545 4200630 - MRA HEAD WO W CONTRAST 4216.1 70546 4200635 - MRA CAROTIDS WO CONTRAST 2927.9 70547 4200640 - MRA NECK WO CONTRAST 2927.9 70547 4200645 - MRA CAROTIDS W CONTRAST 3034.3 70548 4200650 - MRA NECK W CONTRAST 3034.3 70548 4200655 - MRA CAROTIDS WO W CONTRAST 4044.15 70549 4200660 - MRA NECK WO W CONTRAST 4044.15 70549 4200665 - MRA CHEST W CONTRAST 2213.5 71555 4200670 - MRA CHEST WO CONTRAST 2213.5 71555 4200675 - MRA CHECT WO W CONTRAST 2213.5 71555 4200680 - MRA CERVICAL W CONTRAST 2942.15 72159 4200685 - MRA CERVICAL WO CONTRAST 2942.15 72159 4200690 - MRA CERVICAL SPINE WO W CONTRAST 2942.15 72159 4200695 - MRA LUMBAR SPINE WO W CONTRAST 2942.15 72159 4200700 - MRA LUMBAR W CONTRAST 2942.15 72159 4200705 - MRA LUMBAR WO CONTRAST 2942.15 72159 4200710 - MRA THORACIC SPINE WO W CONTRAST 2942.15 72159 4200715 - MRA THORACIC W CONTRAST 2942.15 72159 4200720 - MRA THORACIC WO CONTRAST 2942.15 72159 4200725 - MRA EXTRM UPPER BIL W CONTRAST 3382 73225 4200730 - MRA EXTRM UPPER BIL WO CONTRAST 3382 73225 4200735 - MRA EXTRM UPPER BIL WO W CONTRAST 3382 73225 4200740 - MRA EXTRM UPPER LT W CONTRAST 3382 73225 4200745 - MRA EXTRM UPPER LT WO CONTRAST 3382 73225 4200750 - MRA EXTRM UPPER LT WO W CONTRAST 3382 73225 4200755 - MRA EXTRM UPPER RT W CONTRAST 3382 73225 4200760 - MRA EXTRM UPPER RT WO CONTRAST 3382 73225 4200765 - MRA EXTRM UPPER RT WO W CONTRAST 3382 73225 4200770 - MRA PELVIS W CONTRAST 3170.15 C8918 4200775 - MRA PELVIS WO CONTRAST 2938.35 C8919 4200780 - MRA EXTRM LOWR BIL W CONTRAST 3748.7 C8912 4200785 - MRA EXTRM LOWER BIL WO CONTRAST 3390.55 C8913 4200790 - MRA EXTRM LOWR BIL WO W CONTRAST 4132.5 C8914 4200800 - MRA EXTRM LOWR LT WO CONTRAST 3390.55 C8913 4200805 - MRA EXTRM LOWR LT WO W CONTRAST 4132.5 C8914 4200810 - MRA EXTRM LOWR RT W CONTRAST 3748.7 C8912 4200815 - MRA EXTRM LOWR RT WO CONTRAST 3390.55 C8913 4200820 - MRA EXTRM LOWR RT WO W CONTRAST 4132.5 C8914 4200825 - MRA ABDOMEN W CONTRAST 3145.45 C8900 4200830 - MRA ABDOMEN WO CONTRAST 3096.05 C8901 4200835 - MRA ABDOMEN WO W CONTRAST 3656.55 C8902 4200845 - Mammo Screening Diagnostic CAD 37.5 77052TC 4200882 - Angio Lower Extremity Bil S&I 4357 75716TC 4200900 - XR Exam Entire Spine 1 view 344 72081TCCT 4200902 - XR Exam Entire Spine 2/3 view 687 72082CT 4200904 - XR Exam Cervical 2-3 v 687 72082TCCT 4200906 - XR Exam Thoracic 2-3 v 687 72082TCCT 4200908 - XR Exam Lumbar 2-3 v 687 72082TCCT 4200910 - XR Exam Sacral/Cocygeal 2-3 view 687 72082TCCT 4200912 - XR Exam Entire Spine 4/5 v 826 72083TCCT 4200914 - XR Exam Cerival 4/5 v 826 72083TCCT 4200916 - XR Exam Thoracic 4/5 views 826 72083TCCT 4200918 - XR Exam Lumbar 4/5 views 826 72083TCCT 4200920 - XR Exam Sacral/Cocygeal 4/5 view 826 72083TCCT 4200922 - XR Exam Entire Spine 6/> views 965 72084TCCT 4200924 - XR Exam Cervical 6/> views 965 72084TCCT 4200926 - XR Exam Thoracic 6/> views 965 72084TCCT 4200928 - XR Exam Lumbar 6/> views 965 72084TCCT 4200930 - XR Exam Sacral/Cocygeal 6/> views 4726 72084TCCT 4200932 - XR Exam Hip UNI 1 view 489 73501TCCT 4200934 - XR Exam Hip UNI 2-3 view 601 73502TCCT 4200936 - XR Exam Hip UNI 4/> view 712 73503TCCT 4200938 - XR Exam Hip BIL 2 views 903 73521TCCT 4200940 - XR Exam Hip BIL 3-4 views 1042 73522TCCT 4200942 - XR Exam Hip BIL 5/> views 1200 73523TCCT 4200944 - XR Exam of Femur 1 view 466 73551TCCT 4200946 - XR Exam of Femur 2/> views 653 73552TCCT 4200962 - DXA BONE DENSITY AXIAL SKELETON 833 77080 "4200964 - DX MAMMO, INCL CAD UNI" 578 77065 "4200966 - DX MAMMO, INCL CAD BI" 798 77066 4200967 - SCREEMING MAMM UNILATERAL 542 77057 4200968 - SCR MAMMO BI INCL CAD 667 77067 4200969 - SCREENING DIGITAL BREAST TOMOSYNTHESIS 667 77063 4200970 - DXA BONE DENSITY FX ASSESSMENT 833 77085 4200971 - SCR MAMMO BI INCL CAD 665.78 77067 4200972 - DXA BONE DENSITY / PERPHERAL 527 77081 4200974 - FRACTURE ASSESSMENT VIA DXA 527 77086 4210000 - CT ABDOMEN & PELVIS WO CONTRAST 3087.5 74176 4210005 - CT ABDOMEN & PELVIS W CONTRAST 3582.45 74177 4210008 - LOW DOSE CT LUNG SCREENING 2100 S8032 4210010 - CT ABDOMEN & PELVIS W/WO CONTRAST 4237.95 74178 4210015 - Stroke Protocol 2431 70450 4210020 - CTA ABDOMEN & PELVIS WO/W CONTRAST 7785 74174 4210025 - CTA HEART W/3D IMAGE 3990 75574 4210030 - CT CERVICAL SPINE W/CONTRAST 3085.6 72126 4210040 - CTA -ABDOMEN W/CONTRAST 4787 74175 4210045 - CTA -CHEST W/CONTRAST 4677 71275 4210050 - CTA -HEAD W/CONTRAST 4563 70496 4210055 - CTA -NECK W/CONTRAST 4517 70498 4230001 - US BREAST LIMITED 93.5 76642 4230005 - Limited Fetal Ultrasound 821 76815 4300000 - ERYTHROMYCIN WITH ETHANOL 2% 60ML TOPL 77.4 4300001 - URINE hCG 36 4300005 - UROKINASE 250000 UNIT INJ 2358.05 J3365 4300010 - ARIPIPRAZOLE 5MG ORAL 94.5 J0400 4300015 - ARIPIPRAZOLE 10MG ORAL 94.5 4300020 - ARIPIPRAZOLE 15MG ORAL 94.5 4300025 - ARIPIPRAZOLE 20 MG ORAL 129.45 4300030 - ARIPIPRAZOLE 30MG ORAL 129.45 4300036 - PREGABALIN 25MG 23.45 4300037 - PREGABALIN 75MG 23.45 4300038 - PREGABALIN 300MG 23.45 4300040 - ACETAZOLAMIDE 250MG ORAL 12.4 4300045 - ACETAZOLAMIDE SODIUM 500MG IV 242.4 J1120 4300050 - ACTIVATED CHARCOAL-SORB 25GM/120ML ORAL 80.85 4300051 - FERRIC SUBSULFATE SOLUTION 8ML 39.5 4300055 - ACTIVATED CHARCOAL 25GM/120ML ORAL 77.95 4300060 - ALTEPLASE 100MG IV 9734.43 J2997 4300065 - PIOGLITAZONE 15MG ORAL 38.1 4300070 - KETOROLAC TROMETHAMINE 0.5% 5ML OPTH 428.25 4300075 - ACYCLOVIR 200MG ORAL 14.35 4300080 - ACYCLOVIR 800MG ORAL 25.45 4300081 - ACYCLOVIR ORAL SUSPENSION 200MG/5ML 162 4300085 - ACYCLOVIR SODIUM 1000MG IV 0.57 J0133 4300090 - ADENOSINE 3MG/ML 2ML IV 172.4 J0153 4300092 - Lexiscan 888.05 J2785 4300095 - DOXORUBICIN 2MG/ML 5ML IV 72.45 J9000 4300100 - FLUOROURACIL 50MG/ML 1ML IV 50 J9190 4300105 - OXYMETAZOLINE 15ML NASL 0.05% 25 4300115 - ALBUTEROL SULFATE 4MG ORAL 12.1 4300120 - AZITHROMYCIN 500MG IV 39.3 J0456 4300125 - SPIRONOLACTONE 100MG ORAL 16.45 4300130 - SPIRONOLACTONE 25MG ORAL 11.9 4300135 - METHYLDOPATE 250MG/5ML IV 218.8 J0210 4300140 - METHYLDOPA 250MG ORAL 11.6 4300145 - METHYLDOPA 500MG ORAL 12.95 4300150 - MELPHALAN 2MG ORAL 50 J8600 4300155 - ALLOPURINOL 100MG ORAL 11.65 4300160 - ALLOPURINOL 300MG ORAL 13.1 4300165 - BRIMONIDINE .1% 5ML OPTH 343.85 4300170 - ALUMINUM HYDROXIDE GEL 400GM ORAL 10 4300175 - ALUMINUM 454GM TOPL 10 4300180 - METAPROTERENOL 0.6% 2.5ML INHAL 25 J7669 4300185 - METAPROTERENOL 10MG/5ML 5ML ORAL 11.45 4300190 - METAPROTERENOL 10MG ORAL 14.35 4300195 - METAPROTERENOL 20MG ORAL 16.1 4300200 - METAPROTERENOL 650 MCG/ACT 14GM INHAL 203.35 4300205 - AMANTADINE 100MG ORAL 13.25 4300210 - GLIMEPIRIDE 1MG ORAL 12.85 4300215 - GLIMEPIRIDE 2MG ORAL 14.6 4300220 - ZOLPIDEM 5MG ORAL 30.25 4300225 - BENZOCAINE 20% 60GM TOPL 25 4300230 - ZINC ACETATE 28.3GM TOPL 89.2 4300235 - AMINOCAPROIC ACID 250MG/ML 20ML IV 25 J3490 4300240 - AMINOCAPROIC ACID 500MG ORAL 22 4300245 - AMINOCAPROIC ACID 25% 5ML 36.85 4300250 - ETOMIDATE 2MG/ML 10ML IV 84.05 4300255 - ETOMIDATE 2MG/ML 1 ML INJ 25 4300260 - AMIKACIN 250MG/ML 2ML INJ 19.46 J0278 4300265 - AMIKACIN 250MG/ML 2ML INHAL 42.9 4300270 - AMINOPHYLLINE 500MG/20ML 20ML IV 12.5 J0280 4300275 - AMINOPHYLLINE 100MG ORAL 10.35 4300280 - AMINOPHYLLINE 200MG ORAL 10.4 4300285 - AMINO ACID INFUSION 8.5% 14.5 4300290 - AMITRIPTYLINE 25MG ORAL 12.15 4300295 - AMITRIPTYLINE 10MG ORAL 10.8 4300300 - AMITRIPTYLINE 50MG ORAL 12.85 4300305 - AMITRIPTYLINE 75MG ORAL 13.9 4300310 - AMITRIPTYLINE 100MG ORAL 14.85 4300315 - AMMONIA AROMATIC 15%/0.33ML 1ML INHAL 25 4300320 - AMOXICILLIN 50MG/ML 1ML ORAL 10.05 4300325 - AMOXICILLIN 125MG/5ML 5ML ORAL 11.15 4300330 - AMOXICILLIN 250MG/5ML 5ML ORAL 11.35 4300335 - AMOXICILLIN 250MG ORAL 11.15 4300340 - AMOXICILLIN 500MG ORAL 12.15 4300345 - ALUMINUM HYDROXIDE GEL 320MG/5ML 5ML ORA 10.35 4300350 - AMPICILLIN 250MG ORAL 11.05 4300355 - AMPICILLIN 500MG ORAL 13.15 4300360 - AMPICILLIN 125MG/5ML 5ML ORAL 12.1 4300365 - AMPICILLIN 250MG/5ML 5ML ORAL 11.65 4300370 - AMPICILLIN SODIUM 250MG IV 23.1 J0290 4300375 - AMPICILLIN SODIUM 500MG IV 20.35 J0290 4300380 - AMPICILLIN SODIUM 2GM IV 12.25 J0290 4300385 - AMPICILLIN SODIUM 1 GM IV 19.15 J0290 4300390 - AMOBARBITAL 500MG INJ 269.85 J0300 4300395 - METHYL SALICYLATE-MENTHOL 28GM TOPL 13.6 4300400 - CEFAZOLIN 500MG IV 21.6 J0690 4300405 - CEFAZOLIN 1GM IV 5.01 J0690 4300410 - DISULFIRAM 250MG ORAL 25.55 4300415 - DISULFIRAM 500MG ORAL 34.85 4300420 - DIPHENHYDRAMINE HCL 2% 30GM TOPL 24 4300425 - MECLIZINE 25MG ORAL 11.75 4300430 - MECLIZINE 12.5MG ORAL 10.7 4300435 - FOMEPIZOLE 1 GRAM/ML 1ML IV 5374.45 J1451 4300440 - HYDROCORTISONE ACETATE 25MG RECTAL 10.15 4300445 - HYDROCORTISONE 2.5% 30GM RECTAL 456 4300450 - TUBERCULIN PPD 5 UNIT/0.1ML 0.1ML IDERMA 27.5 4300455 - HYDRALAZINE 20MG/ML 1ML INJ 74.49 J0360 4300460 - HYDRALAZINE 25MG ORAL 11.55 4300465 - HYDRALAZINE 10MG ORAL 10.95 4300470 - HYDRALAZINE 100MG ORAL 14.45 4300475 - HYDRALAZINE 50MG ORAL 11.95 4300480 - PAMIDRONATE 3MG/ML 1ML IV 218.8 J2430 4300485 - DONEPEZIL 5MG ORAL 55.6 4300520 - TRIAMCINOLONE 20MG/ML 1ML INJ 71.75 J3303 4300525 - THYROID 30MG ORAL 11.15 4300530 - THYROID 60MG ORAL 11.2 4300535 - MESALAMINE 400MG ORAL 19.5 4300540 - ASCORBIC ACID 500MG/ML 50ML INJ 64.4 J3490 4300550 - AMOXAPINE 50MG ORAL 14.35 4300555 - ASPIRIN 325MG ORAL 10 4300560 - ASPIRIN 81MG ORAL CHEWABLE 10 4300565 - ASPIRIN 300MG RECTAL 10 4300570 - ASPIRIN 600MG RECTAL 15.1 4300575 - ASPIRIN 81MG ORAL EC 10.25 4300580 - HYDROXYZINE HCL 25MG ORAL 14 4300585 - HYDROXYZINE HCL 10MG ORAL 12.75 4300590 - HYDROXYZINE HCL 50MG ORAL 14.9 4300595 - TOLNAFTATE 1% 15GM TOPL 19.95 4300600 - LORAZEPAM 2MG/ML INJ 25.06 J2060 4300605 - LORAZEPAM 0.5MG ORAL 25 4300610 - LORAZEPAM 1MG ORAL 25 4300615 - LORAZEPAM 2MG ORAL 25 4300620 - EFAVIR-EMTRIC TENOFOV 600-200-300 ORAL 276.95 4300625 - ATROPINE 0.05MG/ML 5ML INJ 79.4 J0461 4300630 - ATROPINE 0.4MG/ML 1ML INJ 15 J0461 4300635 - ATROPINE 0.1MG/ML 10 ML INJ 14.67 J0461 4300640 - ATROPINE 1% 3.5GM OPTH 16 4300645 - IPRATROPIUM BROMIDE 0.02% 2.5ML INHAL 47.62 J7644 4300650 - IPRATROPIUM BROMIDE 17 MCG/ACT 12.9GM IN 856.35 4300655 - AMOXICILLIN-POT CLAV 125MG/5ML 5ML ORAL 11.95 4300660 - AMOXICILLIN-POT CLAV 250MG/5ML 5ML ORAL 13.7 4300665 - AMOXICILLIN-POT CLAVUL 250MG ORAL 35.75 4300670 - AMOXICILLIN-POT CLAVUL 500MG ORAL 26.5 4300675 - AMOXICILLIN-POT CLAVUL 875MG ORAL 33.05 4300680 - ACETIC AC-APY-BENZO-POLICOS-AL 5.4-1.4% 783.35 4300685 - SULFANILAMIDE 15% 120GM VAG 392.15 4300690 - AZTREONAM 1GM IV 184.9 4300695 - AZTREONAM 2 GRAM IV 361.6 4300700 - TRIAMCINOLONE ACETONIDE 63GM TOPL 311.35 4300705 - SULFASALAZINE 500MG ORAL 12.4 4300710 - BACITRACIN 50000 UNIT INJ 871.3 4300715 - BACITRACIN 500 UNIT/G TOPL 10 4300720 - BACLOFEN 10MG ORAL 12.4 4300725 - TRIMETHOPRIM-SULFAMETH 80MG/5ML 10ML INJ 75.5 4300730 - TRIMETH-SULFAMETH 80-400MG ORAL 12.9 4300735 - TRIMETH-SULFAMETHOX 160-800MG ORAL 10 4300740 - MUPIROCIN 2% 22GM TOPL 328.15 4300745 - MUPIROCIN CALCIUM 2% 1GM NASL 52.25 4300750 - DIPHENHYDRAMINE HCL 50MG ORAL 10 4300755 - DIPHENHYDRAMINE HCL 50MG/ML 1ML INJ 25.61 J1200 4300760 - DIPHENHYDRAMINE HCL 25MG ORAL 10.55 4300765 - PROBENECID 500MG ORAL 14.3 4300770 - DICYCLOMINE 10MG/ML 2ML INJ 87.8 J0500 4300775 - DICYCLOMINE 10MG/5ML 5ML ORAL 12.1 4300780 - DICYCLOMINE 10MG ORAL 11.2 4300785 - DICYCLOMINE 20MG ORAL 11.55 4300790 - POVIDONE-IODINE 5% 30ML OPTH 59.9 4300795 - POVIDONE-IODINE 5% 88.7GM TOPL 48.1 4300800 - BETAMETHASONE VALERATE 0.1% 15GM TOPL 80.45 4300805 - TIMOLOL 0.25% 5ML OPTH 21.7 4300810 - CLARITHROMYCIN 500MG ORAL 36.95 4300815 - PENICILLIN G BENZATHINE +PROC 1200000 UN 209.8 J0558 4300820 - PENICILLIN G BENZATHINE 600000 UNIT/ML 145.5 J0561 4300825 - PENICILLIN G BENZATHINE 1200000 UNIT/2ML 278.1 J0561 4300830 - PENICILLIN G BENZATHINE 2400000 UNIT/4ML 490.7 J0561 4300835 - SODIUM CITRATE-CITRIC ACID 500-334MG/ML 12.7 4300840 - BLEOMYCIN 15 UNIT INJ 195.1 J9040 4300845 - SULFACETAMID-PREDNISOL 10-0.2%5ML OPTH 257.1 4300850 - SULFACETAMID-PREDNISOL 10-0.2% 3.5GM OPT 252.65 4300855 - TERBUTALINE 1MG/ML 1ML SUBCUT 100.24 J3105 4300860 - TERBUTALINE 5MG ORAL 12.75 4300865 - TERBUTALINE 2.5MG ORAL 11.9 4300870 - ESMOLOL 250MG/ML 10ML IV 1149.36 4300871 - ESMOLOL 100MG/10/ML INJ 64.85 4300875 - BALANCED SALT IRRIG SOLN COMB2 15ML OPTH 36.35 4300880 - BALANCED SALT IRRIG SOLN COMB1 500ML OPT 156.05 4300890 - ERGOTAMINE-CAFFEINE ORAL 15.3 4300895 - CAFFEINE-SOD BENZOATE 250MG/ML 2ML INJ 62.2 4300900 - PRAMOXINE-CALAMINE 1-8% 180ML TOPL 10 4300905 - CALAMINE 120ML TOPL 12.85 4300910 - VERAPAMIL 80MG ORAL 12.5 4300915 - VERAPAMIL 240MG ORAL SR 15.35 4300920 - VERAPAMIL 120MG ORAL SR 14.1 4300925 - VERAPAMIL 180MG ORAL SR 15.25 4300930 - CALCIUM CHLORIDE 100MG/ML 10ML IV 50.95 4300935 - EDETATE CALCIUM DISODIUM 200MG/ML 5ML IN 430.7 J0600 4300940 - CALCIUM GLUCONATE 100MG/ML 10ML IV 25 J0610 4300945 - CALCIUM GLUCONATE 500MG ORAL 11.1 4300950 - CAMPHOR-PHENOL 45ML TOPL 10 4300955 - IRINOTECAN 40MG/2ML 2ML IV 108.1 J9206 4300960 - CASPOFUNGIN 70MG IV 1839.15 J0637 4300961 - MICAFUNGIN 50MG INJ 495.6 4300965 - CAPTOPRIL 100MG ORAL 16.55 4300970 - CAPTOPRIL 50MG ORAL 15.7 4300975 - CAPTOPRIL 25MG ORAL 13.4 4300980 - CAPTOPRIL 12.5MG ORAL 12.55 4300985 - SUCRALFATE 100MG/ML 10ML ORAL 156.7 4300990 - SUCRALFATE 1GM ORAL 13.4 4300995 - MEPIVACAINE 1% 50ML INJ 83.3 J0670 4301000 - DILTIAZEM HCL 5MG/ML 10ML IV 30.9 4301005 - DILTIAZEM HCL 90MG ORAL 14.15 4301010 - DILTIAZEM HCL 180MG ORAL 15.25 4301015 - DILTIAZEM HCL 240MG ORAL 15.65 4301020 - DILTIAZEM HCL 120MG ORAL SR 15.2 4301025 - DILTIAZEM HCL 300MG ORAL CD 21.75 4301030 - DILTIAZEM HCL 60MG ORAL SR 13.65 4301035 - DILTIAZEM HCL 120MG ORAL CD 15.4 4301040 - DOXAZOSIN 1MG ORAL 14.05 4301045 - DOXAZOSIN 4MG ORAL 14.35 4301050 - IMMUNE GLOBULIN (HUMAN) (IGG) 12 G IV 5282.2 4301060 - UREA 20% 85GM TOPL 60.4 4301065 - DICLOFENAC POTASSIUM 50MG ORAL 16.85 4301070 - CLONIDINE 0.1MG ORAL 10 4301075 - CLONIDINE0.2MG ORAL 11.45 4301080 - CLONIDINE 0.1MG/24 HR TOPL 166.3 4301085 - CLONIDINE 0.2MG/24 HR TOPL 275.85 4301090 - CLONIDINE 0.3MG/24 HR TOPL 380.35 4301095 - ALTEPLASE 2MG INJ 264.53 J2997 4301100 - CEFACLOR 250MG ORAL 18.65 4301105 - CEFACLOR 125MG/5ML 5ML ORAL 10.7 4301110 - CEFACLOR 250/MG/5ML 5ML ORAL 11.4 4301115 - LOMUSTINE 10MG ORAL 53.6 4301120 - MULTIVITAMIN STRESS FORMULA ORAL 10.45 4301125 - CEFUROXIME AXETIL 250MG ORAL 29.1 4301130 - BETAMETHASONE ACET +SOD PHOS 6MG/ML 5ML 47.19 J0702 4301135 - BETAMETHASONE ACET+SOD PHOS 6MG/ML 10ML 378.55 J0702 4301140 - BETAMETHASONE ACET+SOD PHOS 6MG/ML 15ML 562.8 J0702 4301145 - MYCOPHENOLATE MOFETIL 500MG ORAL 54.5 4301150 - MENTHOL-CETYLPYRIDINIUM 3MG TOPL 12.15 4301155 - DINOPROSTONE 10MG VAG 1119.2 4301160 - BUTAMBEN-TETRACAINE-BENZOCAINE 56ML TOPL 274.05 4301165 - ACTIVATED CHARCOAL 260MG ORAL 10.4 4301170 - LEVOTHYROXINE 112MCG TABLET 10.8 4301175 - PHENOL 0.014 1MM TOPL 10.15 4301180 - CHLORPHENIRAMINE MALEATE 4MG ORAL 10.3 4301185 - CHLORPHENIRAMINE MALEATE 12MG ORAL 10.95 4301190 - CHLORPHENIRAMINE MALEATE 8MG ORAL 10.9 4301195 - CHROMIUM CHLORIDE 4MCG/ML 10ML IV 25 4301200 - CIPROFLOXACIN 250MG ORAL 10 4301205 - CIPROFLOXACIN 500MG ORAL 33.5 4301210 - CIPROFLOXACIN IN D5W 200MG/100ML 100ML I 50 J0744 4301215 - CIPROOFLOXACIN IN D5W 400MG/200ML 200ML 25 J0744 4301220 - MAGNESIUM CITRATE 296ML ORAL 17.8 4301225 - LORATADINE 10MG ORAL 13.75 4301230 - CLINDAMYCIN PHOSPHATE 300MG/ML 2ML IV 23.5 4301235 - CLINDAMYCIN PHOSPHATE 600MG/4ML 4ML IV 29.65 4301240 - CLINDAMYCIN PHOSPHATE 900MG/6ML 6ML IV 25 4301245 - CLINDAMYCIN HCL 150MG ORAL 15.05 4301250 - CLINDAMYCIN PALMITATE 75MG/5ML 5ML ORAL 23.95 4301255 - AMINO ACID INFUSION 2.75% 44.4 4301260 - AMINO ACID INFUSION 5% IN D15W 50.55 4301265 - OSELTAMIVIR 75MG TABLET 52.5 4301266 - OXALIPLATIN 100 mg vial 1051.5 4301270 - SULINDAC 200MG ORAL 15.45 4301275 - SULINDAC 150MG ORAL 14.4 4301280 - CLOMIPHENE CITRATE 50MG ORAL 81 4301285 - CLOZAPINE 25MG ORAL 22.5 4301290 - CLOZAPINE 100MG ORAL 42.35 4301295 - CODEINE SULFATE 15MG ORAL 25 4301300 - CODEINE SULFATE 30MG ORAL 25 4301305 - CODEINE SULFATE 60MG ORAL 25 4301310 - BENZTROPINE 1MG/ML 2ML INJ 336.25 J0515 4301315 - BENZTROPINE 0.5MG ORAL 10.95 4301320 - BENZTROPINE 2MG ORAL 10 4301325 - BENZTROPINE 1MG ORAL 10 4301326 - BUSPIRONE 5MG TAB 13.4 4301327 - BUSPIRONE 10MG TABL 15.55 4301328 - BUSPIRONE 15MG TAB 19.25 4301330 - DOCUSATE SODIUM 100MG ORAL 10.65 4301335 - DOCUSATE SODIUM 50MG ORAL 11.2 4301345 - DOCUSATE SODIUM 50MG/5ML 120ML ORAL 25.45 4301350 - COLCHICINE 0.6MG ORAL 13.9 4301355 - HYDROCORTISONE 100MG/60ML 60ML RECTAL 58.75 4301360 - COLCHICINE-PROBENECID 0.5-500MG ORAL 13.7 4301365 - COLISTIMETHATE SODIUM 150MG INHAL 325 4301370 - NEOMYCIN-COLIST-HC-THONZONIUM 5ML OTIC 203.45 4301375 - LAMIVUDINE-ZIDOVUDIN 150-300MG ORAL 81.05 4301380 - PROCHLORPERAZINE MALEATE 5MG ORAL 12.5 4301385 - PROCHLORPERAZINE MALEATE 10MG ORAL 14.25 4301390 - PROCHLORPERAZINE EDISYLATE 5MG/ML 2ML IN 27.05 J0780 4301395 - PROCHLORPERAZINE 25MG RECTAL 21.15 4301400 - AMIODARONE 50MG/ML 3ML IV 5 J0282 4301405 - FLURANDRENOLIDE 0.0005 15GM TOPL 299.65 4301410 - CARVEDILOL 3.125MG ORAL 20.75 4301415 - CARVEDILOL 6.25MG ORAL 20.75 4301420 - CARVEDILOL 12.5MG ORAL 20.75 4301425 - NADOLOL 80MG ORAL 16.2 4301430 - NADOLOL 40MG ORAL 41.45 4301445 - HYDROCORTISONE 20MG ORAL 14.75 4301450 - NEOMYCIN-POLYMYXIN-HC3.5-10000-10MG-UNI 312.05 4301455 - HYDROCORTISONE 0.01% 28.35 GM TOPL 37.35 4301460 - COSYNTROPIN 0.25MG IV 566.4 J0833 4301470 - WARFARIN 1MG ORAL 15.75 4301475 - WARFARIN 2MG ORAL 16 4301476 - WARFARIN 3MG Tablet 10.2 4301477 - WARFARIN 4mg tablet 10 4301478 - WARFARIN 6MG Tablet 10.25 4301480 - WARFARIN 5MG ORAL 10 4301485 - WARFARIN 7.5MG ORAL 10 4301490 - WARFARIN 10MG ORAL 10 4301495 - WARFARIN 2.5MG ORAL 16.2 4301500 - LOSARTAN 50 MG ORAL 22.6 4301505 - INDINAVIR 200MG ORAL 50 4301510 - INDINAVIR 400MG ORAL 50 4301515 - HYOSCYAMINE 0.15MG ORAL 11.7 4301520 - LIOTHYRONINE 5MCG ORAL 10.35 4301525 - LIOTHYRONINE 25 MCG ORAL 10.25 4301530 - MISOPROSTOL 100 MCG ORAL 10 4301535 - MISOPROSTOL 200 MCG ORAL 15.25 4301540 - GANCICLOVIR SODIUM 500MG IV 394.4 J1570 4301545 - GANCICLOVIR 250MG ORAL 30.55 4301550 - CYCLOPHOSPHAMIDE 500MG IV 409.9 J9070 4301555 - CYCLOPHOSPHAMIDE 1GM IV 3599.7 J9070 4301560 - CYCLOPHOSPHAMIDE 25MG ORAL 50 J8530 4301565 - CYCLOPHOSPHAMIDE 50MG ORAL 50 J8530 4301570 - SODIUM HYPOCHLORITE 0.25% 1000ML IRRIG 83.8 4301575 - FLURAZEPAM 15MG ORAL 25 4301580 - FLURAZEPAM 30MG ORAL 25 4301585 - DANAZOL 200MG ORAL 30.8 4301590 - DANTROLENE 20MG IV 2546.95 4301595 - DANTROLENE 25MG ORAL 14.7 4301600 - DANTROLENE 100MG ORAL 20.25 4301605 - DAPSONE 25MG ORAL 10.9 4301610 - PYRIMETHAMINE 25MG ORAL 10 4301635 - DESMOPRESSIN 4MCG/ML 1ML INJ 52.32 J2597 4301640 - DESMOPRESSIN 10MCG/SPRAY 5ML NASL 631.3 4301645 - CARBAMIDE PEROXIDE 6.5% 15ML OTIC 10 4301650 - DEXAMETHASONE SODIUM PHOSPHATE 4MG/ML 1M 7.3 J1100 4301655 - DEXAMETHASONE 4MG ORAL 12.55 4301660 - DEXAMETHASONE 0.5MG ORAL 11.1 4301665 - DEXAMETHASONE 0.75MG ORAL 11.5 4301670 - DEXAMETHASONE 1.5MG ORAL 11.7 4301675 - DEXAMETHASONE 0.5MG/5ML 5ML ORAL 11.05 4301680 - DEMECLOCYCLINE 300MG ORAL 93.7 4301685 - CHLORPHENIRAMINE-PSEUDOEPHED 8-120MG ORA 24.9 4301690 - TESTOSTERONE ENANTHATE 200MG/ML 5ML IM 460.1 J3121 4301695 - ESTRADIOL VALERATE 40MG/ML 5ML IM 784.8 J1380 4301700 - MEPERIDINE 50MG ORAL 25 4301705 - MEPERIDINE (PF) 25MG/ML INJ 25 J2175 4301710 - MEPERIDINE (PF) 50MG/ML INJ 25 J2175 4301715 - MEPERIDINE (PF) 75MG/ML INJ 25 J2175 4301720 - MEPERIDINE (PF) 100MG/ML INJ 25 J2175 4301725 - VALPROATE SODIUM 250MG/5ML 5ML ORAL 90.05 4301730 - VALPROIC ACID 250MG ORAL 10 4301750 - DIVALPROEX ER 500MG ORAL 10 4301755 - DIVALPROEX ER 250MG ORAL 19.85 4301765 - ESTRADIOL CYPIONATE 5MG/ML 5ML INJ 181.6 J1000 4301770 - METHYLPREDNISOLONE ACETATE 40MG/ML INJ 53.25 J1030 4301775 - MEDROXYPROGESTERONE(CONTRACEP) 150MG/ML 213.6 J1055 4301780 - TESTOSTERONE CYPIONATE 100MG/ML 10ML INJ 25 J1071 4301785 - DEFEROXAMINE 500MG INJ 58.9 J0895 4301790 - ZINC OXIDE-COD LIVER OIL 40% 57GM TOPL 21.25 4301800 - TRAZODONE 50MG ORAL 10.65 4301805 - DEXAMETHASONE SODIUM PHOSPHATE 0.1% 5ML 80.3 4301810 - DEXTROSE 10% IN WATER (D10W)250ML IV 63.95 4301815 - DEXTROSE 10% IN WATER (D10W) 500ML IV 60 4301820 - DEXTROSE 10% IN WATER (D10W) 1000ML IV 60 4301825 - DEXTROSE 10%-1/2 NS 1000ML IV 60 4301830 - DEXTROSE 10%-1/4 NORMAL SALINE 250ML IV 60 4301835 - DEXTROSE 10%-NORMAL SALINE 1000ML IV 60 4301840 - DEXTROSE 20% IN WATER (D20W) 500ML IV 81.6 4301845 - DEXTROSE 5% IN NORMAL SALINE 500ML IV 60 J7042 4301846 - Dextrose 5%/0.9% SOD Chloride 1000ml 60 J7042 4301850 - DEXTROSE 5% IN WATER (D5W) 150ML IV 50 4301851 - DEXTROSE 5% WATER 250ML IV 50 4301855 - DEXTROSE 5% IN WATER (D5W) 100ML IV 50 4301860 - DEXTROSE 5% IN WATER (D5W) 500ML IV 50 J7060 4301865 - DEXTROSE 5% IN WATER (D5W) 1000ML IV 60 J7070 4301870 - DEXTROSE 5%-1/2 NORMAL SALINE 250ML IV 50 4301875 - DEXTROSE 5%-1/2 NORMAL SALINE 500ML IV 60 J7042 4301880 - DEXTROSE 5%-1/4 NORMAL SALINE 500ML IV 60 J7042 4301881 - DEXTROSE 5% NaCl 0.2% 1000ML IV 30 J7042 4301885 - DEXTROSE 5%-LACTATED RINGERS 1000ML IV 60 4301890 - DEXTROSE 50% IN WATER (D50W) 50ML IV 36.75 4301895 - DEXTROSE 70% IN WATER (D70W) 500ML IV 10.45 4301900 - DEXTROSE IN RINGERS 5% 1000ML IV 60 4301905 - ACETAZOLAMIDE 500MG ORAL 31.8 4301910 - PERIT. DIALYSIS 4 & DEX 1.5% 2000ML 150.4 A4722 4301915 - PERIT. DIALYSIS 13 & DEX 2.5% 2000ML 143.8 A4722 4301920 - PERIT. DIALYSIS 3 + DEX 4.25% 2000ML 167.45 A4722 4301925 - DIBUCAINE 1% 30GM TOPL 16.2 4301930 - DICLOXACILLIN 250MG ORAL 12.9 4301935 - ETIDRONATE DISODIUM 200MG ORAL 27.75 4301940 - FLUCONAZOLE 50MG ORAL 33.15 4301945 - FLUCONAZOLE 100MG ORAL 10 4301950 - FLUCONAZOLE 200MG ORAL 69.3 4301955 - FLUCONAZOLE IN DEXTROSE 400MG/200 ML 33.65 J1450 4301956 - FLUCONAZOLE 100MG/DEXTROSE 5%50ML IV PIG 59.7 J1450 4301960 - FLUCONAZOLE IN DEXTROSE 200MG/100ML 61.05 J1450 4301965 - DIGOXIN MMNUNE FAB 38MG IV 13247.2 J1162 4301970 - PHENYTOIN SODIUM 50MG/ML 2ML INJ 12.59 J1165 4301975 - PHENYTOIN SODIUM 50MG/ML 5ML INJ 5.33 J1165 4301980 - PHENYTOIN 100MG/4ML 4ML ORAL 10 4301985 - PHENYTOIN SODIUM EXTENDED 100MG ORAL 10 4301990 - PHENYTOIN 50MG ORAL 12.65 4301995 - PHENYTOIN SODIUM EXTENDED 30MG ORAL 11.7 4302000 - HYDROMORPHONE (PF) 4MG/ML 1ML INJ 25 J1170 4302002 - HYDROMORPHONE 2MG/ML INJ 25.82 J1170 4302005 - HYDROMORPHONE 2MG ORAL 25 4302010 - HYDROMORPHONE 4MG ORAL 25 4302015 - DILTIAZEM HCL 30MG ORAL 12 4302020 - DIPHENHYDRAMINE HCL 12.5/5ML 120ML ORAL 26.45 Q0163 4302025 - DIPIVEFRIN 0.1% 5ML OPTH 10 4302030 - PROPOFOL 10MG/ML 20ML IV 25 4302035 - PROPOFOL 10MG/ML 100ML IV 50 4302040 - OXYBUTYNIN CHLORIDE 5MG ORAL 12.7 4302045 - DOBUTAMINE 12.5MG/ML 20ML IV 27.15 J1250 4302050 - DOBUTAMINE IN D5W (PMX) 250ML IV 189.2 J1250 4302055 - ALUMINUM-CALCIUM TOPL 10 4302060 - PHENOBARB-BELLAD ALKALOIDS 16.2MG/5ML 73.45 4302070 - PHENOBARB-BELLAD ALKALOIDS 16.2MG ORAL 12.1 4302075 - DOPAMINE 40MG/ML 10ML IV 2.5 J1265 4302085 - DOPAMINE IN D5W (PMX) 1.6MG/ML 250ML IV 11.04 J1265 4302086 - MILRINONE PREMIX 20MG/100ML 93.85 4302090 - DOXAPRAM 20MG/ML 20ML IV 416.65 4302095 - ERGOCALCIFEROL (VITAMIN D2) 60ML ORAL 605.15 4302100 - BISACODYL 5MG ORAL EC 10.4 4302105 - BISACODYL 10MG RECTAL 10 4302110 - FENTANYL 25 MCG/HR TOPL 30.6 4302115 - FENTANYL 50 MCG/HR TOPL 47.6 4302120 - FENTANYL 75 MCG/HR TOPL 45 4302125 - ERYTHROMYCIN ETHYLSUCCINATE 400MG ORAL 11.15 4302130 - ERYTHROMYCIN ETHYLSUCCINATE 400MG/5ML 11.9 4302135 - NAPROXEN 500MG ORAL 15.45 4302140 - ASPIRIN 325MG ORAL 10.1 4302145 - VENLAFAXINE 75MG ORAL 21.8 4302150 - VENLAFAXINE 37.5MG ORAL 20.8 4302155 - VENLAFAXINE 75MG ER ORAL 33.9 4302160 - HYDROQUINONE WITH SUNSCREEN 4% 28.35GM 263.9 4302165 - HYDROQUINONE 2% 28.35GM TOPL 131.75 4302170 - CALCIUM CARBONATE 1250MG ORAL 10.5 4302175 - PERMETHRIN 5% 60 GM TOPL 133.25 4302180 - THEOPHYLLINE 80MG/15ML 15ML ORAL 10 4302185 - PHOSPHORATED CARBOHYDRATE 118ML ORAL 37.7 4302190 - LIDOCAINE-PRILOCAINE 2.5-2.5% 5GM TOPL 173.05 4302200 - EMTRICITABINE 200MG ORAL 75.3 4302205 - ERYTHROMYCIN 250MG ORAL 13.5 4302210 - HEPATITIS B VIRUS VACCINE (PF) 20 MCG/ML 277.65 90746 4302215 - EPHEDRINE SULFATE 50MG/ML 1ML INJ 25 4302220 - EPINEPHRINE 1MG/ML 1ML INJ 28.3 J0171 4302225 - EPINEPHRINE HCL 0.1MG/ML 10ML INJ 3.45 J0171 4302230 - LAMIVUDINE 150MG ORAL 50 4302235 - LAMIVUDINE 10MG/ML 60ML ORAL 140.35 4302240 - LAMIVUDINE 10MG/ML 120ML ORAL 273.2 4302245 - EPOETIN ALFA 2000 UNIT/ML 1ML SUBCUT 74.34 J0885 4302250 - EPOETIN ALFA 10000 UNIT/ML 1ML SUBCUT 72.81 J0885 4302255 - EPOETIN ALFA 4000 UNIT/ML 1ML SUBCUT 78.5 J0885 4302260 - EPOETIN ALFA 3000 UNIT/ML 1ML SUBCUT 79.23 J0885 4302265 - EPOETIN ALFA 40000 UNIT/ML 1ML SUBCUT 1275.35 J0885 4302270 - ABACAVIR-LAMIVUDINE 600-300MG ORAL 163.15 4302275 - ERYTHROMYCIN ETHYLSUCCINATE 50ML ORAL 41.3 4302280 - ERYTHROMYCIN ETHYLSUCCINATE 200MG/5ML OR 12 4302285 - ERYTHROMYCIN 500MG ORAL 15.15 4302290 - ERYTHROMYCIN LACTOBIONATE 1000MG IV 125.95 J1364 4302295 - ERYTHROMYCIN LACTOBIONATE 500MG IV 73.6 J1364 4302300 - LITHIUM CARBONATE 450MG ORAL 12.35 4302305 - ETHANOL (ETHYL ALCOHOL) 98% 1ML IV 62.2 4302310 - ETOPOSIDE 20MG/ML 5ML IV 7 J9181 4302315 - WHITE PETROLATUM-MINERAL OIL 120GM TOPL 31.65 4302320 - FLUTAMIDE 125MG ORAL 19.1 4302325 - FERROUS SULFATE 220MG/5ML 5ML ORAL 17.85 4302330 - FERROUS SULFATE 325MG ORAL 10.75 4302335 - FERROUS GLUCONATE 240MG ORAL 10.3 4302340 - FERROUS SULFATE 75MG/0.6ML 50ML ORAL 52 4302345 - NA FERRIC GLUC CPLX IN SUCROSE 12.5MG/ML 176 4302350 - BUTALBITAL-ASPIRIN-CAFFEINE 50-325-40MG 25 4302355 - CODEINE-BUTALBITAL-ASA-CAFF ORAL 25 4302360 - METRONIDAZOLE IN NACL 500MG/100ML 50 4302365 - METRONIDAZOLE 250MG ORAL 10 4302366 - METRONIDAZOLE 500MG TABLET 12.05 4302370 - SODIUM PHOSPHATES 133ML RECTAL 10.7 4302375 - MINERAL OIL 133ML RECTAL 14.4 4302380 - SODIUM PHOSPHATES 66.6ML RECTAL 12.1 4302385 - SODIUM PHOSPHATES 45ML ORAL 22.05 4302390 - BISACODYL-SOD BIPHOS-SOD PHOS RECTAL 51.15 4302395 - ALBUMIN HUMAN 25% 50ML IV 223.17 P9047 4302400 - CYCLOBENZAPRINE 10MG ORAL 10 4302405 - TAMSULOSIN 0.4MG ORAL 30.4 4302410 - FLUDROCORTISONE 0.1MG ORAL 13.5 4302415 - FLUTICASONE 110 MCG/ACT 12GM INHAL 551.45 4302420 - FLUTICASONE 44 MCG/ACT 10.6GM INHAL 542.9 4302425 - FLUNISOLIDE 25MCG (0.25%) 25ML NASL 209.75 4302430 - FLUOCINOLONE 0.025% 15GM CREAM 40 4302435 - FLUOCINOLONE 0.025% 15GM OINT 40 4302440 - FLUOCINOLONE 0.01% 15GM CREAM 50.85 4302445 - FLUOCINOLONE 0.25% 60GM TOPL 108 4302450 - FLUOCINONIDE 0.05%15GM TOPL 22.35 4302455 - FLUORESCEIN 1MG OPTH 25 4302461 - INFLUEN TR-SPLIT 2010-2011 0.5ml syringe 137.74 90656 4302465 - FLUOROMETHOLONE 0.1% 5ML OPTH 127.75 4302470 - FOLIC ACID 5MG/ML 10ML INJ 25 4302475 - ISOFLURANE 5ML INHAL 91.35 4302480 - ALENDRONATE 10MG ORAL 24.55 4302482 - Bicalutamide 50mg Tablet 12.95 4302483 - Anastrozole 1 mg Tablet 11.5 4302485 - PEDIATRIC MULTIVITAMINS-IRON 18MG ORAL 10.25 4302490 - AMPHOTERICIN B 50MG IV 114.1 J0285 4302495 - GENTAMICIN 40MG/ML 2ML INJ 25 J1580 4302496 - GENTAMICIN INJ 20MG/2ML 25 J1580 4302500 - GENTAMICIN 0.1% 15GM CREAM 21.7 4302505 - GENTAMICIN 0.1% 15GM OINT 21.7 4302510 - GENTAMICIN 0.3% 3.5GM OPTH 90.6 4302515 - SIMETHICONE 80MG ORAL 10.7 4302520 - ALUM HYDROX-MAG CARB 5ML 160-105 MG ORAL 10.1 4302525 - ALUM HYDROX-MAG CARB 5ML ORAL 10 4302530 - FLUTICASONE/SALMETEROL 250/50 INHALER 446.35 4302531 - Advair 100/50 446.35 4302532 - Advair 500/50 722.85 "4302535 - AMYLASE, LIPASE, PROTEASE CPDR 10000-300" 15.8 4302540 - GENTAMICIN 0.3% 5ML OPTH 46.5 4302545 - GENTAMICIN IN SALINE 60MG/50ML 50 J1580 4302550 - GENTAMICIN IN SALINE 120MG/100ML 25 J1580 4302555 - GENTAMICIN IN NS 80MG/50ML 50ML 50 J1580 4302560 - DEXTRAN 40 IN D5W 10-5% 500ML IV 60 J7100 4302565 - DEXTRAN 40 IN SALINE 10% 500ML IV 60 J7100 4302570 - DEXTRAN 75 IN SALINE 6% 500ML IV 60 J7110 4302575 - ZIPRASIDONE MESYLATE 20MG IM 44.88 J3486 4302580 - ZIPRASIDONE HCL 20MG ORAL 46.5 4302585 - ZIPRASIDONE HCL 40MG ORAL 46.5 4302590 - ZIPRASIDONE HCL 60MG ORAL 10 4302595 - ZIPRASIDONE HCL 80MG ORAL 10 4302600 - GLUCAGON (HUMAN RECOMBINANT) 1MG INJ 1134.65 J1610 4302610 - METFORMIN 500MG ORAL 10 4302615 - METFORMIN 850MG ORAL 15.8 4302620 - GLIPIZIDE 5MG ORAL 10 4302625 - GLIPIZIDE 10MG ORAL 13.3 4302630 - GLIPIZIDE 5MG ORAL XL 12.8 4302635 - GLIPIZIDE 2.5MG ORAL XL 12.75 4302640 - GLIPIZIDE 10MG ORAL XL 13.55 4302645 - GLYCINE 1.5% 3000ML IRRIGATION 69.7 4302650 - CARBAMIDE PEROXIDE 10% 15ML TOPL 10 4302655 - PEG 3350-ELECTROLYTES 4000ML ORAL 110.05 4302660 - TRYPSIN-BALSAM-CASTOR OIL 0.12-87MG/G 11 90.45 4302665 - GRISEOFULVIN MICROSIZE 125MG/5ML ORAL 23.2 4302670 - GRISEOFULVIN ULTRAMICROSIZE 125MG ORAL 18.65 4302675 - GRISEOFULVIN ULTRAMICROSIZE 250MG ORAL 22 4302685 - CLOTRIMAZOLE 1% 45GM VAGINAL 36.35 4302690 - HALOPERIDOL LACTATE 5MG/ML 1ML INJ 25.1 J1630 4302695 - HALOPERIDOL 5MG ORAL 10 4302700 - HALOPERIDOL 0.5MG ORAL 11.3 4302705 - HALOPERIDOL 1MG ORAL 12 4302710 - HALOPERIDOL 2MG ORAL 12.1 4302715 - HALOPERIDOL DECANOATE 50MG/ML 1ML IM 122.8 J1631 4302720 - HALOPERIDOL DECANOATE 100MG/ML 1ML IM 109.78 J1631 4302725 - HALCINONIDE 0.1% 30GM TOPL 229.55 4302730 - HALCINONIDE 0.1% 60 GM TOPL 386.15 4302735 - CARBOPROST TROMETHAMINE 250 MCG/ML 1ML I 538.05 4302740 - HEPARIN (PORCINE) 1000 UNIT/ML 1ML INJ 30.27 J1644 4302745 - HEPARIN (PORCINE) 1000 UNIT/ML 10ML INJ 5.94 J1644 4302750 - HEPARIN (PORCINE) 5000 UNIT/ML 1ML INJ 5.01 J1644 4302755 - HEPARIN IN D5W (PMX) 100UNIT/ML 250ML IV 2 J1644 4302760 - HEPARIN LOCK FLUSH 100 UNIT/ML 1ML IV 2.72 J1642 4302765 - HEPARIN PORCINE ((PF) 5000 UNIT/0.5ML 5 J1644 4302770 - AMINO ACID INFUSION 8% 439.65 4302775 - HETASTARCH IN NORMAL SALINE 6% 500ML IV 93.3 4302780 - METHENAMINE HIPPURATE 1 GRAM ORAL 20.15 4302785 - BENZOCAINE 20% 60ML TOPL 141.5 4302790 - HYDROCODONE-HOMATROPINE 5-1.5MG/5ML 5ML 25 4302795 - HYALURONIDASE 150 UNIT/ML 1ML INJ 144.2 J3470 4302800 - HYDROXYUREA 500MG ORAL 15.6 4302805 - HYDROCORTISONE 2.5% 28.35GM TOPL 23.25 4302810 - HYDROCHLOROTHIAZIDE 25MG ORAL 10.6 4302811 - HYDROCHLOROTHIAZIDE 12.5MG ORAL 10 4302815 - HYDROCHLOROTHIAZIDE 50MG ORAL 10.8 4302820 - HYOSCYAMINE SULFATE 0.375MG ORAL 15.15 4302825 - TETANUS IMMUNE GLOBULIN (PF) 250 UNIT IM 1417.95 J1670 4302830 - HYDROCORTISONE 0.5% 28.35GM TOPL 20.1 4302835 - HYDROCORTISONE 0.5% 28.35 GM TOPL 23.25 4302840 - HYDROCORTISONE 1% 28.35 GM TOPL 37.35 4302845 - HYDROCORTISONE 2.5% 28.4GM TOPL 23.25 4302850 - TERAZOSIN 1GM 1 ORAL 17 4302855 - TERAZOSIN 5MG 1 ORAL 17 4302860 - FERROUS SULFATE-B COMP WITH C 525 (105)- 15.1 4302865 - ICHTHAMIMOL 20% 30GM TOPL 21.25 4302866 - LURASIDONE 40MG TAB 90.35 4302867 - LURASIDONE 20MG TAB 90.35 4302868 - LURASIDONE 60MG TAB 136.65 4302870 - ERYTHROMYCIN 0.5M% 3.5 GM OPTH 59 4302875 - ISOSORBIDE MONONITRATE 60MG ORAL 10 4302880 - ISOSORBIDE MONONITRATE 10MG ORAL 12.25 4302885 - ISOSORBIDE MONONITRATE 30MG ORAL 15.8 4302890 - LOPERAMIDE 2MG ORAL 10 4302895 - LOPERAMIDE 1MG/5ML 5ML ORAL 10 4302900 - AZATHIOPRINE 50MG ORAL 16.3 J7500 4302905 - DROPERIDOL 2.5MG/ML 2ML INJ 34.95 J1790 4302910 - PROPRANOLOL 1MG/ML 1ML IV 54.4 J1800 4302915 - PROPRANOLOL 10MG ORAL 10 4302925 - PROPRANOLOL 40MG ORAL 11.8 4302930 - PROPRANOLOL 80MG ORAL 12.15 4302935 - PROPRANOLOL 60MG ORAL 11.4 4302940 - PROPRANOLOL 80MG ORAL LA 11.9 4302945 - PROPRANOLOL 120MG ORAL 12.35 4302950 - PROPRANOLOL 160MG ORAL 22.55 4302955 - PROPRANOLOL-HYDROCHLOROTHIAZID 80-25MG 12.15 4302960 - INDIGOTINDISULFONATE SODIUM 8MG//ML 5ML 41.35 4302965 - INDOMETHACIN 25MG ORAL 11.75 4302970 - INDOMETHACIN 50MG ORAL 13 4302975 - INDOMETHACIN 75MG ORAL 10.95 4302985 - CROMOLYN 800 MCG/ACTUATION 14.2GM INHAL 572.25 4302990 - FAT EMULSION 10% 70.55 4302995 - FAT EMULSION 20% 313.6 4303000 - SAQUINAVIR MESYLATE 200MG ORAL 50 4303005 - IPECAC 5ML ORAL 11.75 4303010 - IRON DEXTRAN 50MG/ML 2ML INJ 135.6 J1750 4303011 - IRON SUCROSE INJECTION 260.6 4303015 - RALTEGRAVIR 400MG ORAL 94.95 4303020 - ISOSORBIDE MONONITRATE 20MG ORAL 13.15 4303025 - ISONIAZID 50MG/5ML 5ML ORAL 20.05 4303030 - ISONIAZID 300MG ORAL 10.7 4303035 - ISONIAZID 100MG ORAL 10.3 4303040 - ATROPINE 1% 15ML OPTH 145.1 4303045 - PILOCARPINE HCL 4% 15ML OPTH 56.75 4303050 - HOMATROP HBR 5% 5ML OPTH 144.4 4303060 - SCOPOLAMINE HBR 0.25% 5ML OPTH 139.2 4303065 - ARTIFIC TEAR HYPROMELLOSE 0.05% 15ML OPT 91.4 4303070 - ISOSORBIDE DINITRATE 2.5MG SL 10.9 4303075 - ISOSORBIDE DINITRATE 5MG SL 10.9 4303085 - ISOSORBIDE DINITRATE 40MG ORAL 16.85 4303090 - ISOSORBIDE DINITRATE 10MG ORAL 10 4303095 - ISOSORBIDE DINITRATE 5MG ORAL 10.65 4303100 - ISOPROTERENOL HCL 0.2MG/ML 5ML IV 119.7 4303106 - Lactobacillus Packets 13.75 4303110 - LOPINAV-RITONAV 400-100MG/5ML 5ML ORAL 64.75 4303115 - LOPINAV-RITONAV 400-100MG/5ML 60ML ORAL 694.2 4303120 - LOPINAVIR-RITONAVIR 200-50MG ORAL 50 4303125 - KANAMYCIN 333MG/ML 3ML IV 85.7 J1840 4303130 - BISMUTH SUBSALICYLATE 262MG/15ML ORAL 11.2 4303140 - SODIUM POLYSTYRENE SULFONATE 15GM/60ML 47.65 4303145 - POTASSIUM CHLORIDE 20 MEQ ORAL 10 4303150 - CEPHALEXIN 125MG/5ML 5ML ORAL 11.95 4303155 - CEPHALEXIN 250MG/5ML 5ML ORAL 14.15 4303160 - CEPHALEXIN 250MG ORAL 13.05 4303165 - CEPHALEXIN 500MG ORAL 17.55 4303170 - PROCYCLIDINE 5MG ORAL 14.3 4303175 - TRIAMCINOLONE ACETONIDE 0.1% 15GM TOPL 66.65 4303180 - TRIAMCINOLONE ACETONIDE 0.1% 15GM TOPL 66.65 4303185 - TRIAMCINOLONE ACETONIDE 40MG/ML 1ML INJ 6.25 J3301 4303190 - TRIAMCINOLONE ACETONIDE 40MG/ML 5ML INJ 25 J3301 4303195 - TRIAMCINOLONE ACETONIDE 0.1% 5GM DENTAL 10 4303200 - LEVETIRACETAM 250MG ORAL 10 4303201 - LEVETIRACETAM ORAL SOLUTION 23.9 4303202 - LEVETIRACETAM 1000MG/100ML 0.51 J1953 4303205 - KETAMINE 50MG/ML 10ML IV 36.9 4303210 - KETOCONAZOLE 2% 15GM TOPL 67.6 4303215 - CLOZAPINE TBDL 25MG TABLET 20.5 4303220 - CLONAZEPAM 0.5MG ORAL 25 4303225 - POTASSIUM CHLORIDE 20 MEQ ORAL 14.5 4303230 - POTASSIUM CHLORIDE 10 MEQ ORAL 10 4303235 - POTASSIUM CHLORIDE 8 MEQ ORAL 10.8 4303240 - POTASSIUM BICARB-CITRIC ACID 25 MEQ ORAL 11.45 4303245 - POTASSIUM PHOSPHATE MONOBASIC 500MG ORAL 10.95 4303250 - GRANISETRON 1MG ORAL 266.75 4303255 - GRANISETRON 1MG/ML 1ML IV 145.9 J1626 4303260 - LABETALOL 5MG/ML 20ML IV 24.99 4303265 - ARTIFICIAL TEAR WITH LANOLIN 3.5GM OPTH 49.3 4303270 - LACTATED RINGERS 500ML IV 62.85 J7120 4303275 - LACTATED RINGERS 1000ML IV 60 J7120 4303280 - LACTULOSE 10MG/15ML 30ML ORAL 10 4303285 - LAMOTRIGINE 100MG ORAL 36.65 4303290 - LAMOTRIGINE 25MG ORAL 34.7 4303295 - TERBINAFINE 250MG ORAL 83.3 4303300 - DIGOXIN 250 MCG/ML 2ML INJ 25.38 J1160 4303305 - DIGOXIN 50 MCG/ML 60ML ORAL 161.35 4303310 - DIGOXIN 125 MCG ORAL 11.2 4303315 - DIGOXIN 250 MCG ORAL 11.2 4303320 - INSULIN GLARGINE 100 UNIT/ML 10ML SUBCUT 23.29 J1817 4303325 - FUROSEMIDE 10MG/ML 2ML INJ 25 J1940 4303330 - FUROSEMIDE 10MG/ML 60ML ORAL 55.25 4303335 - FUROSEMIDE 20MG ORAL 10 4303340 - FUROSEMIDE 8MG/ML 5ML ORAL 17.05 4303345 - FUROSEMIDE 40MG ORAL 10 4303350 - FUROSEMIDE 80MG ORAL 11.2 4303355 - CHLORAMBUCIL 2MG ORAL 50 4303360 - LEVOFLOXACIN 25MG/ML 20ML IV 175.57 J1956 4303365 - LEVOFLOXACIN 250MG ORAL 91.35 4303370 - LEVOFLOXACIN 500MG ORAL 10 4303371 - LEVOFLOXACIN 750MG ORAL 184.6 4303375 - LEVOFLOXACIN 250MG IN D5W 250MG/50ML 50M 50 J1956 4303380 - LEVOFLOXACIN 500MG IN D5W 250MG/100ML IV 25.01 J1956 4303385 - LEVOFLOXACIN 750MG IN D5W 750MG/150ML 15 77.62 J1956 4303390 - INSULIN DETERMIR 100 UNIT/ML 10ML SUBCUT 150.45 J1817 4303395 - LEVORPHANOL TARTRATE 2MG ORAL 25 4303400 - NOREPINEPHRINE BITARTRATE 1MG/ML 4ML IV 26.75 4303405 - ESCITALOPRAM 10MG/ORAL 10 4303410 - FOSAMPRENAVIR 700MG ORAL 70.55 4303420 - CHLORDIAZEPOXIDE HCL 25MG 25 4303425 - CHLORDIAZEPOXIDE HCL 5MG ORAL 25 4303430 - CHLORDIAZEPOXIDE HCL 10MG ORAL 25 4303435 - FLUOCINONIDE 0.05% 15GM TOPL 92.65 4303440 - FLUOCINONIDE 0.05% 30GM TOPL 133 4303445 - FLUOCINONIDE 0.05% 60GM TOPL 219.15 4303450 - LIDOCAINE IN D5W (PF) 4MG/ML 250 ML IV 50 J2001 4303455 - LIDOCAINE 5% (700MG/PATCH) 1 TOPL 41.4 4303460 - LIDOCAINE 5% (700MG/PATCH) 30 TOPL 1067.75 4303465 - LINDANE 1% 60ML LOTION 601.35 4303470 - LINDANE 1% 60ML SHAMPOO 601.35 4303475 - LITHIUM CITRATE 8 MEQ/5ML 5ML ORAL 13.05 4303480 - LITHIUM CARBONATE 300MG ORAL 10 4303485 - DIPHENOXYL-ATR 2.5-.025MG/5ML 5ML ORAL 98.3 4303490 - DIPHENOXYL-ATROP 2.5-0.025MG ORAL 25 4303495 - GEMFIBROZIL 600MG ORAL 14.8 4303500 - METOPROLOL TARTRATE 5MG/5ML 5ML IV 25 4303505 - METOPROLOL TARTRATE 50MG ORAL 12.5 4303510 - METOPROLOL TARTRATE 100MG ORAL 13.6 4303515 - METOPROLOL TARTRATE 25MG ORAL 10 4303520 - BENAZEPRIL 5MG ORAL 14.6 4303525 - BENAZEPRIL 10MG ORAL 13.65 4303530 - AMLODIPINE-BENAZEPRIL 2.5-10MG ORAL 26.35 4303535 - CLOTRIMAZOLE 1% 30 GM TOPL 53.85 4303540 - CLOTRIMAZOLE-BETHAMETHASONE 1-0.05% 15GM 131.15 4303545 - ENOXAPARIN 100MG/ML 1ML SUBCUT 36.96 J1650 4303550 - ENOXAPARIN 30MG/0.3ML 0.3ML SUBCUT 36.18 J1650 4303555 - ENOXAPARIN 40MG/0.4ML 0.4ML SUBCUT 35.2 J1650 4303560 - ENOXAPARIN 60MG/0.6ML 0.6ML SUBCUT 206.45 J1650 4303565 - ENOXAPARIN 80MG/0.8ML 0.8ML SUBCUT 33.99 J1650 4303570 - ENOXAPARIN 120MG/0.8ML 0.8ML SUBCUT 41.01 J1650 4303575 - LOXAPINE SUCCINATE 50MG ORAL 21.2 4303580 - LOXAPINE SUCCINATE 10MG ORAL 15.55 4303585 - LOXAPINE SUCCINATE 25MG ORAL 10 4303590 - DYPHYLLINE 200MG ORAL 23.7 4303595 - IODINE STRONG (LUGOLS) 5% 480ML ORAL 162.45 4303605 - TRACE ELEMENTS CR-CU-MN-SE-ZN 0.01-1-.5- 37.45 4303610 - MVI ADULT NO1 WITH VIT K 1-5-10-200MG-MC 25 4303615 - ALUMINUM-MAGNESIUM HYDROXIDE 30ML ORAL 13.1 4303620 - NITROFURANTOIN(MACROCRYST25%) 100MG ORAL 18.9 4303625 - NITROFURANTOIN MACROCRYSTAL 50MG ORAL 22.05 4303635 - MAGNESIUM SULFATE 500MG/ML 2ML INJ 25 4303640 - MAGNESIUM SULFATE 500MG/ML 10ML INJ 49.25 J3475 4303643 - MAGNESIUM 2GM/STERILE WATER 50ML 50 4303644 - MAGNESIUM 4GM/STERILE WATER 100ML 50 4303645 - MAGNESIUM SULFATE 20 GRAM/500ML 500ML IV 2.19 J3475 4303650 - MAGNESIUM OXIDE 400MG ORAL 10.4 4303655 - MANGANESE SULFATE 4MEQ/ML 10ML IV 25 4303660 - MANNITOL 25% 50ML IV 25 J2150 4303665 - BUPIVACAINE (PF) 0.25% 30ML INJ 25 4303670 - BUPIVACAINE (PF) 0.5% 30ML INJ 25 4303675 - BUPIVACAINE (PF) 0.75% 30ML INJ 31.75 4303680 - BUPIVACAINE-EPI 0.5%-1:200000 50ML INJ 42.45 4303681 - BUPIVACAINE-EPI 0.25%-1:200000 10ML INJ 25 4303685 - DRONABINOL 2.5MG ORAL 47.25 4303690 - DRONABINOL 5MG ORAL 84.35 4303695 - DRONABINOL 10MG ORAL 128.7 4303700 - PROCARBAZINE 50MG ORAL 249.75 4303705 - TRANDOLAPRIL 2MG ORAL 16.2 4303710 - TRANDOLAPRIL 4MG ORAL 16.2 4303715 - CEFEPIME 2GM IV 49.58 J0692 4303720 - CEFEPIME 1GM IV 48.41 J0692 4303725 - NEOMYCIN-POLYMYXIN-DEXAMETH 5ML OPTH 12.2 4303730 - TRIAMTERENE-HCTZ 75-50MG ORAL 13.75 4303735 - TRIAMTERENE-HCTZ 37.5-25MG ORAL 11.9 4303740 - METHYLPREDNISOLONE 4MG ORAL 12.15 J7509 4303745 - CEFOXITIN 1 GRAM IV 40.85 J0694 4303750 - CEFOXITIN 2 GRAM IV 5 J0694 4303755 - MEGESTROL 40MG ORAL 50 4303760 - MEGESTROL 20MG ORAL 50 4303765 - MEGESTROL 40MG/ML 10ML ORAL 320.6 4303770 - ESTERIFIED ESTROGENS 1.25MG ORAL 16 4303775 - ESTERIFIED ESTROGENS 2.5MG ORAL 21.2 4303780 - MEPHOBARBITAL 32MG ORAL 25 4303785 - MEPHOBARBITAL 50MG ORAL 25 4303790 - MEPHOBARBITAL 100MG ORAL 25 4303795 - PHYTONADIONE 5MG ORAL 46.85 4303800 - MEROPENEM 500MG IV 36.54 J2185 4303805 - PYRIDOSTIGMINE BROMIDE 60MG ORAL 10 4303810 - PSYLLIUM ORAL 11.25 4303815 - METHADONE 10MG/5ML 5ML ORAL 35 4303820 - METHADONE 10MG/5ML 10ML ORAL 35 4303825 - METHADONE 10MG/5ML 15ML ORAL 35 4303835 - METHYLERGONOVINE MALEATE 0.2MG/ML INJ 47.4 J2210 4303840 - METHYLERGONOVINE MALEATE 0.2MG ORAL 88.9 4303845 - METHOTREXATE NA (PF) 25MG/ML 2ML INJ 50 J9260 4303850 - METHYLENE BLUE (ANTIDOTE) 1% 10ML INJ 3.33 Q9968 4303855 - METRONIDAZOLE 0.75% 70GM VAG 151.65 4303860 - MEXILETINE 150MG ORAL 13.95 4303865 - MEXILETINE 200MG ORAL 15.8 4303870 - CALCITONIN (SALMON) 200 UNIT/ML 2ML INJ 7250.03 J0630 4303875 - MICONAZOLE NITRATE 2% 30GM TOPL 14.35 4303880 - GLYBURIDE 2.5MG ORAL 11.35 4303885 - GLYBURIDE 5MG ORAL 12.3 4303890 - MAGNESIUM HYDROXIDE 400MG/5ML 30ML ORAL 11.85 4303895 - MINERAL OIL 480ML ORAL 39.4 4303900 - MINERAL OIL 472ML TOPL 25.35 4303905 - PRAZOSIN 1MG ORAL 11.3 4303910 - PRAZOSIN 2MG ORAL 11.7 4303915 - PRAZOSIN 5MG ORAL 12.85 4303920 - MINOXIDIL 10MG ORAL 15.65 4303925 - MINOXIDIL 2.5MG ORAL 17.4 4303930 - ACETYLCHOLINE CHLORIDE 20MG/2ML 2ML OPTH 444.9 4303935 - MITOMYCIN 5MG IV 307.35 J9280 4303940 - MIVACURIUM CHLORIDE 2MG/ML 1ML INJ 26.85 4303945 - MICONAZOLE NITRATE 200MG VAG 76.4 4303950 - MICONAZOLE NITRATE 100MG VAG 10 4303955 - MICONAZOLE NITRATE 2% 45GM VAG 52.8 4303960 - MORPHINE 10MG/ML 10ML IV 35 J2270 4303965 - MORPHINE 10MG/ML 1ML INJ 25 J2270 4303966 - MORPHINE 8MG/ML INJ 25 J2270 4303970 - MORPHINE 2MG/ML 1ML INJ 25.38 J2270 4303975 - MORPHINE 4MG/ML 1ML INJ 25.12 J2270 4303977 - MORPHINE 5MG/ML 1ML INJ 25 J2270 4303980 - MORPHINE 10MG/5ML 5ML ORAL 35 4303985 - MORPHINE (PF) 30MG/30ML1ML INJ 8.41 J2274 4303990 - MORRHUATE SODIUM 5% 30ML IV 375.4 4303995 - IBUPROFEN 400MG ORAL 10 4304000 - IBUPROFEN 600MG ORAL 11.31 4304005 - IBUPROFEN 100MG/5ML 5ML ORAL 10 4304010 - IBUPROFEN 800MG ORAL 10 4304015 - MORPHINE 30MG ORAL 25 4304020 - MORPHINE 15MG ORAL 25 4304025 - ACETYLCYSTEINE 200MG/ML 30ML ORAL 40.8 4304030 - ACETYLCYSTEINE 10% (100MG/ML) 4ML ORAL 32.2 4304035 - PEDIATRIC MULTIVITAMINS-FL 0.25MG ORAL 11.55 4304040 - MUMPS VIRUS VACCINE LIVE SUBCUT 119.7 90707 4304045 - SODIUM CHLORIDE 5% 15ML OPTH 85 4304050 - MECHLORETHAMINE 10MG INJ 53.9 J9230 4304055 - ETHAMBUTOL 100MG ORAL 12.7 4304060 - ETHAMBUTOL 400MG ORAL 17.85 4304065 - CLOTRIMAZOLE 10MG TOPL 17.5 4304070 - PHENYLEPHRINE HCL 0.25% 5ML OPTH 10 4304075 - TROPICAMIDE 15ML OPTH 74.5 4304076 - TROPICAMIDE 1% 15ML OPTH 10 4304080 - ALUMINUM-MAGNESIUM HYDROXIDE 30ML ORAL 13.35 4304085 - BUSULFAN 2MG ORAL 29.45 4304090 - PRIMIDONE 50MG ORAL 12.2 4304095 - PRIMIDONE 250MG ORAL 14.35 4304100 - HEPATITIS B IMMUNE GLOBULIN 1ML IM 774.6 90371 4304105 - NAFCILLIN 1GM IV 72.35 4304110 - NAFCILLIN 2 GRAM IV 112.25 4304115 - MEMANTINE 10MG ORAL 28.05 4304116 - MEMANTINE 5MG ORAL 28.05 4304120 - NAPHAZOL-PHENIRAM 0.025-0.3% 15ML OPT 42.6 4304125 - NAPROXEN 375MG ORAL 14.9 4304130 - NAPROXEN 250MG ORAL 13.5 4304135 - NAPROXEN 500MG ORAL 15.85 4304140 - NALOXONE 0.4MG/ML 1ML INJ 88.89 J2310 4304141 - Naloxone 1mg/ml 2ml 26.64 J2310 4304145 - ROPIVACAINE 2MG/ML 20ML INJ 1.25 J2795 4304150 - ARTIFIC TEAR HYPROMELLOSE 0.4% 15ML OPTH 23.95 4304155 - THIOTHIXENE 20MG ORAL 22.8 4304160 - THIOTHIXENE 1MG ORAL 11.05 4304165 - THIOTHIXENE 2MG ORAL 11.4 4304170 - THIOTHIXENE 5MG ORAL 12.1 4304175 - THIOTHIXENE 10MG ORAL 12.95 4304180 - VINORELBINE 10MG/ML 1ML IV 123.85 J9390 4304185 - PENTOBARBITAL SODIUM 50MG/ML 1ML 70.6 J2515 4304190 - NEOMYCIN 500MG ORAL 15.95 4304195 - NEOMYCIN-POLYMYXIN-DEXAMETH 3.5GM OPTH 37.55 4304200 - NEOMYCIN-POLYMYXIN-HC 3.5-10000-1MG UNIT 140 4304205 - NEOMYCIN-BACITRACIN-POLYMYXIN TOPL 10 4304210 - NEOSTIGMINE METHYLSULFATE 1MG/ML 1ML INJ 13.13 J2710 4304215 - NEOSTIGMINE METHYLSULFATE 0.5MG/ML 10ML 4.01 J2710 4304220 - PHENYLEPHRINE HCL 0.5% 15ML DROP 10 4304225 - PHENYLEPHRINE HCL 0.5% 15ML SPRAY 25 4304230 - PHENYLEPHRINE HCL 10MG/ML 1ML INJ 25 J2370 4304235 - PHENYLEPHRINE HCL 0.25% 15ML NASL 25 4304240 - PHENYLEPHRINE HCL 10% 5ML OPTH 34.3 4304245 - B COMPLEX-VITAMIN C-FOLIC ACID 1MG ORAL 11 4304255 - FILGRASTIM 300 MCG/ML 1ML INJ 1313.7 J1442 4304260 - GABAPENTIN 400MG ORAL 17.05 4304265 - GABAPENTIN 100MG ORAL 12.55 4304270 - GABAPENTIN 300MG ORAL 16 4304275 - POTASSIUM+NA PHOS 278-164-250 ORAL 11.35 4304281 - PROTONIX IV 72.65 4304282 - PANTOPRAZOLE 40MG 32.95 4304283 - Pantoprazole 20mg tab 10 4304290 - NIACIN 100MG ORAL 10.15 4304295 - NIACIN 500MG ORAL 10.28 4304300 - NICOTINE 14MG/24 HR TOPL 10 4304305 - NICOTINE 21MG/24 HR TOPL 9.99 4304315 - NIMODIPINE 30MG ORAL 51.7 4304320 - DULOXETINE CPDR 30 MG TABLET 36.55 4304325 - NITROGLYCERIN 2% 1 GM TOPL 10 4304335 - NITROGLYCERIN 0.1MG/HR TOPL 19.45 4304340 - NITROGLYCERIN 0.2MG/HR TOPL 13.05 4304345 - NITROGLYCERIN 0.3MG/HR TOPL 24.9 4304350 - NITROGLYCERIN 0.4MG/HR TOPL 14.05 4304355 - NITROGLYCERIN 5MG/ML 10ML IV 39.25 4304360 - NITROGLYCERIN/ D5W (PMX)200 MCG/ML 250ML 99.2 4304370 - NITROPRUSSIDE 25MG/ML 1ML IV 80.5 4304375 - NITROGLYCERIN 0.3MG SL 10.4 4304380 - NITROGLYCERIN 0.4MG SL 13.2 4304385 - NITROGLYCERIN 0.6MG SL 10.4 4304390 - NITROGLYCERIN 2.5MG ORAL 10.95 4304395 - NITROGLYCERIN 6.5MG ORAL 11.05 4304400 - NITROGLYCERIN 9MG ORAL 12.2 4304405 - KETOCONAZOLE 200MG ORAL 23.7 4304415 - TAMOXIFEN 10MG ORAL 50 4304425 - NON FORMULARY MED 1 EA 103.27 4304435 - ORPHENADRINE CITRATE 30MG/ML 2ML INJ 97 J2360 4304440 - ORPHENADRINE CITRATE 100MG ORAL 19.05 4304445 - DISOPYRAMIDE 100MG ORAL 13.05 4304450 - DISOPYRAMIDE 150MG ORAL 10.3 4304455 - DISOPYRAMIDE 100MG ORAL SR 18.95 4304460 - DISOPYRAMIDE 150MG ORAL SR 19.35 4304465 - DESIPRAMINE 10MG ORAL 14.2 4304470 - DESIPRAMINE 25MG ORAL 15.05 4304475 - DESIPRAMINE 50MG ORAL 19.5 4304480 - DESIPRAMINE 100MG ORAL 25.9 4304485 - AMLODIPINE 2.5MG ORAL 17.55 4304490 - AMLODIPINE 5MG ORAL 10 4304495 - RITONAVIR 100MG ORAL 52.25 4304500 - INSULIN NPH+REGULAR HUM 100 UNIT/ML 10ML 0.38 J1815 4304505 - INSULIN NPH HUM RECOMB 100 UNIT/ML 10ML 1.53 J1815 4304510 - INSULIN REGULAR HUMAN 100 UNIT/ML 10ML 0.75 J1815 4304515 - INSULIN ASPART 100 UNIT/ML 10ML 1299.76 J1817 4304516 - INSULIN ASPART PROTAMINE ASPART 70/30 138.2 J1817 4304520 - NALBUPHINE 10MG/ML 1ML INJ 25 J2300 4304525 - NALBUPHINE 20MG/ML 1ML INJ 25 J2300 "4304535 - INFANT FORMULA, SPEC. METABOLIC" 10.3 4304545 - NYSTATIN 500000 UNIT ORAL 13 4304550 - NYSTATIN 50000000 UNIT 1GM ORAL 175.65 4304555 - NYSTATIN 100000 UNIT VAG 23.7 4304560 - NYSTATIN 100000 UNIT/ML 5ML ORAL 138.1 4304565 - NYSTATIN 100000 UNIT/G 30GM TOPL 20.1 4304570 - NYSTATIN 100000 UNIT/G 30GM TOPL 120.2 4304575 - SODIUM CHLORIDE 0.65% 45ML NASL 20.15 4304580 - IOHEXOL 180MG/ML 1ML ITHECAL 219.1 Q9965 4304581 - CHLORHEXIDINE GLUCONATE 4% SOL 25.5 4304582 - CHLORHEXIDINE GLUCONATE ORAL RINSE 10 4304590 - CALCIUM-CHOLECALCIFEROL(D3) 500 (1250)-4 10.55 4304595 - MANNITOL 20% 500ML IV 106.15 4304610 - CALCIUM CARBONATE 1250MG ORAL 10.5 4304611 - CALCIUM CARBONATE 5000MG CHEWABLE TAB 10.15 4304615 - AMIODARONE 200MG ORAL 24.35 4304616 - PACERONE 100MG TABLET 82.75 4304620 - AMYLASE-LIPASE-PROTEA 12000-40000-12000 12.5 4304625 - CARBOPLATIN 10MG/ML 15ML IV 17.68 J9045 4304630 - PAREGORIC 2MG/5ML 5ML ORAL 197.55 4304635 - BROMOCRIPTINE 2.5MG ORAL 19.55 4304640 - PANCURONIUM 2MG/ML 1ML IV 25 4304645 - PAROXETINE HCL 30MG ORAL 11.55 4304650 - PAROXETINE HCL 20MG ORAL 10 4304655 - PAROXETINE HCL 10MG ORAL 21.65 4304660 - ORAL ELECTROLYTES 237ML ORAL 40.45 4304665 - PEDIATRIC MULTIVITAMINS-FL 50ML ORAL 61.35 4304670 - PENICILLIN V POTASSIUM 125MG/5ML ORAL 10.55 4304675 - PENICILLIN V POTASSIUM 250MG/5ML ORAL 10.95 4304680 - PENTAMIDINE 300MG INJ 437.1 4304685 - THIOPENTAL SODIUM 1 GRAM IV 247.6 4304690 - FAMOTIDINE (PF) 20MG/2ML 2ML INJ 25 4304695 - FAMOTIDINE 20MG ORAL 10 4304700 - BISMUTH SUBSALICYLATE 262MG ORAL 10.55 4304705 - PERI-COLACE 8.6-50MG ORAL 11.5 4304715 - PERMETHRIN 1% 59ML TOPL 41.65 4304720 - PERPHENAZINE 2MG ORAL 14.05 4304725 - PERPHENAZINE 4MG ORAL 15.55 4304730 - DIPYRIDAMOLE 25MG ORAL 11.7 4304735 - DIPYRIDAMOLE 50MG ORAL 12.9 4304740 - MINERAL OIL-HYDROPHIL PETROLAT 454GM TOP 51.9 4304745 - PENICILLIN G POTASSIUM 5000000 UNIT IV 35.46 J2540 4304750 - PROMETHAZINE 12.5MG ORAL 12.45 4304755 - PROMETHAZINE 25MG/ML 1ML INJ 25 J2550 4304760 - PROMETHAZINE 25MG ORAL 12.45 4304765 - PROMETH-PHENYLEPH 6.25-5MG/5ML 5ML ORAL 11.9 4304770 - PROMETHAZIN-COD 6.25-10MG/5ML 5ML ORAL 124.85 4304775 - PROMETHAZINE-DM 6.25-15MG/5ML 5ML ORAL 14.27 4304780 - PROMETHAZINE 6.25MG/5ML 118ML ORAL 42 4304785 - PHENOBARBITAL 20MG/5ML 5ML ORAL 55.95 4304790 - PHENOBARBITAL 100MG ORAL 25 4304800 - PHENOBARBITAL 30MG ORAL 25 4304805 - PHENOBARBITAL 60MG ORAL 25 4304810 - PHENOBARBITAL 15MG ORAL 25 4304815 - PHENOBARBITAL SODIUM 130MG/ML 1ML INJ 143.76 J2560 4304820 - PHENOBARBITAL SODIUM 65MG/ML 1ML INJ 66.85 J2560 4304825 - PHENYLEPH-PROMETHAZINE-COD 5ML ORAL 71 4304830 - PHENYLEPHRINE HCL 2.5% 15ML OPTH 147.35 4304835 - HEXACHLOROPHENE 3% 148ML TOPL 122.25 4304840 - CALCIUM ACETATE 667MG ORAL 13.7 4304845 - PHYSOSTIGMINE SALICYLATE 1MG/ML 2ML INJ 31.15 4304850 - PILOCARPINE HCL 2% 15ML OPTH 246 4304855 - PINDOLOL 5MG ORAL 13.2 4304860 - PINDOLOL 10MG ORAL 14.35 4304865 - OXYTOCIN 10 UNIT/ML 1ML INJ 25 J2590 4304870 - VASOPRESSIN 20 UNIT/ML 1ML INJ 33.5 4304875 - LEVONORGESTREL 0.75MG ORAL 98.35 4304880 - HYDROXYCHLOROQUINE 200MG ORAL 15.4 4304885 - ELECTROLYTE-A 1000EA IV 94.35 4304890 - CISPLATIN 1MG/ML 50ML IV 109.25 J9060 4304895 - CLOPIDOGREL 75MG ORAL 10 4304900 - FELODIPINE 5MG ORAL 16.6 4304905 - PNEUMOCOCCAL 23-VALPS VACCINE 25 MCG/0.5 419.4 90732 4304910 - NEOMYCIN-POLYMYX-PREDNIS 0.5% 5ML OPTH 129.2 4304915 - BACITRACIN-POLYMYXIN B 28.35GM TOPL 11.03 4304920 - BACITRACIN-POLYMYXIN B 3.5GM OPTH 81.2 4304925 - PEDIATRIC MULTIVITAMINS 50ML ORAL 32.8 4304930 - PEDIATRIC MULTIVITAMINS-IRON 50ML ORAL 32.8 4304935 - MISC NATURAL PRODUCT NASAL 30ML NASL 64.1 4304940 - TETRACAINE HCL 2% 30ML TOPL 93.3 4304945 - POTASSIUM ACETATE 2 MEQ/ML 20ML IV 25 4304950 - POTASSIUM CHLORIDE 20 MEQ/100ML IV 50 J3480 4304951 - Potassium 40 meq/100ml 50 J3480 4304955 - POTASSIUM CHLORIDE 2 MEQ/ML 10ML IV 2.65 J3480 4304975 - POTASSIUM CHLOR 10%20MEQ/15ML 15ML ORAL 11.8 4304990 - POTASSIUM CHLOR 10% 40MEQ/30ML 15ML ORAL 11.95 4305000 - POTASSIUM PHOSPHATE DIBASIC 3 MM/ML 25 4305005 - POTASSIUM PHOSPHATE DIBASIC 3 MM/ML 1 25 4305010 - POVIDONE-IODINE 10% 240ML TOPL 21.2 4305015 - PREDNISOLONE SOD PHOSPHATE 1% 5ML OPTH 76.2 4305020 - PREDNISONE 1MG ORAL x20 2.51 J7512 4305025 - PREDNISONE 1MG ORAL x 50 1.14 J7512 4305030 - PREDNISONE 1MG/15ML 1ML ORAL x 5 13.7 J7512 4305035 - PREDNISONE 1MG ORAL x 5 10.4 J7512 4305040 - PREDNISONE 1MG ORAL x10 5.22 J7512 4305045 - PREDNISOLONE 15MG/5ML 5ML ORAL 5.36 J7510 4305050 - CONJUGATED ESTROGENS 25MG INJ 540.35 J1410 4305055 - CONJUGATED ESTROGENS 0.625MG/ 42.5GM VAG 641.65 4305060 - CONJUGATED ESTROGENS 0.3MG TAB ORAL 19.6 4305065 - CONJUGATED ESTROGENS 0.65MG TAB ORAL 19.6 4305070 - PRENATAL VIT-IRON FUM-FA 27-0.8MG ORAL 10.3 4305075 - PE-SHARK LIVER OIL-COCOA BUTT RECTAL 10 4305080 - PHENYLEPH-SHARK LIV OIL-MO-PET 28GM RECT 31.8 4305086 - DARUNAVIR 400MG ORAL 87.45 4305100 - MIDODRINE 2.5MG ORAL 15.3 4305101 - MIDODRINE 5MG TAB 10 4305105 - PROCAINAMIDE 100ML/ML 10ML INJ 76.05 J2690 4305110 - PROCAINAMIDE 500MG/ML 2ML INJ 76.25 J2690 4305115 - NIFEDIPINE 30MG ORAL XL 15.8 4305120 - NIFEDIPINE 60MG ORAL XL 20 4305125 - NIFEDIPINE 90MG ORAL XL 21.15 4305130 - HYDROCORTISONE PRAMOXINE 1-1% 10GM RECTA 315.15 4305135 - TACROLIMUS 1MG 1ORAL 31.19 J7507 4305140 - FLUPHENAZINE HCL 2.5MG/ML 1ML INJ 52.55 4305145 - FLUPHENAZINE HCL 2.5MG/5ML 5ML ORAL 138.45 4305150 - FLUPHENAZINE HCL 2.5MG ORAL 13.65 4305155 - FLUPHENAZINE HCL 1MG ORAL 12.55 4305160 - FLUPHENAZINE HCL 5MG ORAL 13.5 4305165 - FLUPHENAZINE HCL 10MG ORAL 14 4305170 - FLUPHENAZINE DECANOATE 25MG/ML 1ML INJ 82.35 J2680 4305175 - TRIMETHOPRIM 100MG ORAL 13 4305185 - PROCAINAMIDE 250MG ORAL 10 4305190 - PROPYLTHIOURACIL 50MG ORAL 10.7 4305195 - FINASTERIDE 5MG ORAL 23.55 4305200 - DINOPROSTONE 20MG VAG 5125.15 4305205 - PROTAMINE 10MG/ML 5ML IV 9.52 J2720 4305210 - MEDROXYPROGESTERONE 10MG ORAL 12.05 4305215 - FLUOXETINE 20MG/5ML 120ML ORAL 525.45 4305220 - FLUOXETINE 20MG ORAL 21.95 4305225 - FLUOXETINE 10MG ORAL 21.35 4305230 - PSEUDOEPHEDRINE HCL 60MG ORAL 10.25 4305235 - PSEUDOEPHEDRINE HCL 30MG/5ML 5ML ORAL 10.45 4305245 - MERCAPTOPURINE 50MG ORAL 50 4305250 - PYRAZINAMIDE 500MG ORAL 15.5 4305260 - PHENAZOPYRIDINE 200MG ORAL 14.1 4305265 - PHENAZOPYRIDINE-BUTABARB-HYOSC ORAL 15.45 4305270 - PYRIDOXINE 100MG/ML 1ML INJ 56.95 J3415 4305275 - QUININE SULFATE 324MG ORAL 38.75 4305280 - SUCCINYLCHOL CHLORIDE 20MG/ML 10ML INJ 5.24 J0330 4305285 - CHOLESTYRAMINE-ASPARTAME 4GM ORAL 24.6 4305290 - QUINIDINE GLUCONATE 80MG/ML 10ML INJ 103.8 4305295 - QUINIDINE GLUCONATE 324MG ORAL 16 4305300 - QUINIDINE SULFATE 300MG ORAL 13.8 4305305 - QUINIDINE SULFATE 200MG ORAL 10.9 4305310 - QUINIDINE SULFATE 300MG ORAL 11.7 4305315 - QUINIDINE SULFATE 200MG ORAL 12.45 4305320 - QUININE SULFATE 260MG ORAL 13.8 4305326 - Fluticasone Nasal Spray 334.95 4305330 - RABIES VACCINE PCEC (PF) 2.5 UNIT IM 1337.35 90675 4305335 - PHENTOLAMINE 5MG INJ 793 J2760 4305340 - METOCLOPRAMIDE 5MG/ML 2ML INJ 25.2 J2765 4305345 - METOCLOPRAMIDE 5ML/5ML 5ML ORAL 31.3 4305350 - METOCLOPRAMIDE 10MG ORAL 11.4 4305355 - PYRIDOSTIGMINE BROMIDE 5MG/ML 2ML INJ 177.05 4305360 - MIRTAZAPINE 15MG ORAL 21.85 4305365 - SEVELAMER HCL 400MG ORAL 16.95 4305380 - DELAVIRDINE 200MG ORAL 50 4305390 - TRETINOIN 0.5% 20GM TOPL 224.75 4305395 - TRETINOIN 0.1% 20GM TOPL 261.35 4305400 - ZIDOVUDINE 10MG/ML 1ML IV 2.5 J3485 4305405 - ZIDOVUDINE 10MG/ML 1ML ORAL 50 4305410 - ZIDOVUDINE 100MG ORAL 50 4305415 - NALMEFENE 1MG/ML 2ML INJ 281.55 4305420 - NALMEFENE 100 MCG/ML 1ML INJ 30.2 4305425 - ATAZANAVIR 100MG ORAL 89.5 4305430 - ATAZANAVIR 150MG ORAL 89.5 4305435 - ATAZANAVIR 200MG ORAL 89.5 4305440 - METHOTREXATE SODIUM 2.5MG ORAL 50 J8610 4305445 - RIFAMPIN 600MG IV 615.55 4305450 - RIFAMPIN 300MG ORAL 18.3 4305455 - RINGERS 1000ML IV 60 J7120 4305460 - RISPERIDONE 1MG ORAL 10 4305465 - RISPERIDONE 1MG/ML 30ML ORAL 747.4 4305470 - RISPERIDONE 2MG ORAL 56.85 4305475 - RISPERIDONE 3MG ORAL 55.6 4305480 - RISPERIDONE 0.5MG ORAL 10 4305481 - RISPERIDONE 0.25MG ORAL TABLET 10 4305485 - METHYLPHENIDATE 10MG ORAL 25 4305490 - METHYLPHENIDATE 20MG ORAL 25 4305495 - METHYLPHENIDATE 5MG ORAL 25 4305500 - MORPHINE 10MG RECTAL 26.5 4305505 - METHOCARBAMOL 100MG/ML 1ML INJ 374.9 J2800 4305510 - METHOCARBAMOL 500MG ORAL 11.9 4305515 - METHOCARBAMOL 750 ORAL 12.6 4305520 - GLYCOPYRROLATE 0.2MG/ML 2ML INJ 25 4305525 - GLYCOPYRROLATE 1MG ORAL 15.75 4305530 - GLYCOPYRROLATE 2MG ORAL 19.6 4305535 - GUAIFENESIN 100MG/5ML 5ML ORAL 10 4305540 - CODEINE-GUAIFENESIN 10-100MG/5ML 5ML ORA 25 4305550 - DEXTROMETHORPHAN-GUAIFENESIN 10-100MG/5M 31.05 4305555 - CALCITRIOL 0.25MCG ORAL 15.6 4305560 - CEFTRIAXONE 250MG INJ 13.75 J0696 4305565 - CEFTRIAXONE 1GM IV 2.51 J0696 4305570 - CEFTRIAXONE 2 GRAM IV 7.87 J0696 4305575 - FLUMAZENIL 0.1MG/ML 5ML IV 24.66 4305580 - MAGALDRATE 540MG/5ML 5ML ORAL 10.3 4305585 - CHLORPHENIRAMINE-PHENYLEPHRINE 30ML ORAL 239.95 4305590 - CHLORPHENIRAMINE-PHENYLEPH-DM 30ML ORAL 326.9 4305595 - CHLORPHENIRAMINE-PHENYLEPHRINE 5ML ORAL 12.85 4305600 - CHLORPHENIRAMINE-PHENYLEPH-DM 5ML ORAL 14.4 4305605 - RACEPINEPHRINE HCL 2.25% INHAL 170.65 4305610 - SODIUM CHLORIDE 0.9% 10ML INJ 35.05 4305615 - SALSALATE 500MG ORAL 11.45 4305620 - ATROPINE 0.4MG ORAL 11.6 4305625 - CYCLOSPORINE 100MG/ML 5ML ORAL 140.35 J7502 4305630 - CYCLOSPORINE 100MG ORAL 39 J7502 4305635 - CYCLOSPORINE 25MG ORAL 20.8 J7515 4305640 - OCTREOTIDE ACETATE 1000 MCG/ML 1ML INJ 1030.05 J2354 4305645 - OCTREOTIDE ACETATE 50 MCG/ML 1ML INJ 30.95 J2354 4305650 - GLYCERIN (ADULT) RECTAL 10 4305655 - GLYCERIN (CHILD) 1.5GM RECTAL 10 4305660 - COLLAGENASE 250 UNIT/G 30GM TOPL 975.75 4305665 - SCOPOLAMINE HBR 0.4MG/ML 1ML INJ 51.5 4305670 - SALICYLIC ACID-SULFUR 2% 200ML TOPL 50.45 4305675 - SELENIUM SULFIDE 2.5% 118ML TOPL 55.6 4305680 - SELENIUM SULFIDE-MENTHL 1-0.5% 210ML TOP 21.1 4305685 - SENNOSIDES 8.6MG ORAL 10.25 4305690 - SENNOSIDES-DOCUSATE SODIUM 8.6-50MG ORAL 11.75 4305695 - CINACALCET 30MG ORAL 80.85 4305700 - OXAZEPAM 10MG ORAL 25 4305705 - OXAZEPAM 15MG ORAL 25 4305710 - OXAZEPAM 30MG ORAL 25 4305715 - QUETIAPINE 100MG ORAL 9.98 4305720 - QUETIAPINE 200MG ORAL 10 4305725 - QUETIAPINE 25MG ORAL 26.8 4305730 - QUETIAPINE 200MG ORAL 59.2 4305735 - QUETIAPINE 300MG ORAL 74.5 4305740 - QUETIAPINE 400MG ORAL 85.8 4305741 - SEROQUEL XR 50MG TABLET 34.9 4305745 - NEFAZODONE 100MG ORAL 16.7 4305750 - NEFAZODONE 200MG ORAL 16.95 4305755 - NEFAZODONE 250MG ORAL 17.1 4305760 - NEFAZODONE 150MG ORAL 16.85 4305765 - NEFAZODONE 50MG ORAL 16.55 4305770 - SILVER NITRATE APPLICATORS TOPL 10 4305775 - SIMETHICONE 40MG/0.6ML 30ML ORAL 40.9 4305780 - CARBIDOPA-LEVODOPA 10-100MG ORAL 13.15 4305785 - CARBIDOPA-LEVODOPA 25-100MG ORAL 10 4305790 - CARBIDOPA-LEVODOPA 25-250MG ORAL 10 4305795 - DOXEPIN 10MG ORAL 11.45 4305800 - DOXEPIN 25MG ORAL 11.9 4305805 - DOXEPIN 50MG ORAL 12.5 4305810 - MONTELUKAST 10MG ORAL 34.9 4305815 - SODIUM ACETATE 2 MEQ/ML 20ML IV 25 4305825 - SODIUM BICARBONATE 0.5 MEQ/ML 10ML IV 38.9 4305830 - SODIUM BICARBONATE 1 MEQ/ML 50ML IV 39.45 4305835 - SODIUM BICARBONATE 325MG ORAL 10.1 4305840 - SODIUM BICARBONATE 650MG ORAL 10.1 4305845 - SODIUM CHLORIDE 0.9% 1000ML IRRIG 22.23 4305850 - SODIUM CHLORIDE 4 MEQ/ML 5ML IV 25 4305855 - SODIUM CHLORIDE 0.9% 20ML INJ 25 4305860 - SODIUM CHLORIDE 0.9% 3000ML IRRIG 57.2 4305865 - SODIUM CHLORIDE 0.9% 250ML IV 50 J7050 4305870 - SODIUM CHLORIDE 1GM ORAL 10.45 4305875 - SODIUM CHLORIDE 0.9% 3ML INHAL 25 4305880 - SODIUM CHLORIDE 0.45% 250 250ML IV 50 J7050 4305885 - SODIUM CHLORIDE 0.45% 500ML IV 30 J7040 4305890 - SODIUM CHLORIDE 0.45% 1000ML IV 60 J7030 4305895 - SODIUM CHLORIDE 0.45% 0.45% 50 IV 50 4305900 - SODIUM CHLORIDE 0.45% 0.45% 100IV 50 4305905 - SODIUM CHLORIDE 0.9% 500ML IV 60 J7040 4305910 - SODIUM CHLORIDE 0.9% 50ML IV 50 4305915 - SODIUM CHLORIDE 0.9% 100ML IV 50 4305920 - SODIUM CHLORIDE 0.9% 150ML IV 50 4305925 - SODIUM CHLORIDE 0.9% 1000ML IV 60 4305930 - SODIUM CHLORIDE 3% 500ML IV 60 4305935 - SODIUM CHLORIDE 5% 500ML IV 60 4305940 - SODIUM PHOSPHATE 3MM/ML 15ML IV 25 4305945 - HYDROCORTISONE SOD SUCCINATE 250MG/2ML 12.5 J1720 4305950 - HYDROCORTISONE SOD SUCCINATE 100MG/2ML 53.49 J1720 4305955 - HYDROCORTISONE SOD SUCCINATE 500MG/4ML 5.04 J1720 4305960 - HYDROCORTISONE SOD SUCCINATE 1000MG/8ML 38.55 J1720 4305965 - METHYLPREDNISOLONE SODIUM SUCC 40MG/ML 25.56 J2920 4305970 - METHYLPREDNISOLONE SODIUM SUCC 125MG/2ML 25.38 J2930 4305975 - CARISOPRODOL 350MG ORAL 35.3 4305985 - SORBITOL 70% 473ML SOLN 40.2 4305990 - TIOTROPIUM BROMIDE 18 MCG INHAL 330.9 4305995 - ITRACONAZOLE 100MG ORAL 50.4 4306000 - SILVER SULFADIAZINE 1% 50GM TOPL 41.8 4306005 - SILVER SULFADIAZINE 1% 400GM TOPL 158.6 4306010 - POTASSIUM IODIDE 1GM/ML 30ML ORAL 62.65 4306015 - BUTORPHANOL TARTRATE 2MG/ML 1ML INJ 12.5 J0595 4306020 - BUTORPHANOL TARTRATE 1MG/ML 1ML INJ 25 J0595 4306025 - STREPTOMYCIN 1GM INJ 71.25 J3000 4306030 - FENTANYL CITRATE (PF) 0.05MG/ML 2ML INJ 25 J3010 4306031 - FENTANYL INJ 500mcg/10ml 43.5 J3010 4306035 - BUPRENORPHINE-NALOXONE 2-0.5MG SL 31.3 4306040 - BUPRENORPHINE-NALOXONE 8-2MG SL 48.15 4306045 - PSEUDOEPHEDRINE HCL 30MG ORAL 10.2 4306050 - SULFACETAMIDE SODIUM 10% 15ML OPTH 76.95 4306055 - SULFADIAZINE 500MG ORAL 23.05 4306060 - TRIMETH-SULFAMET 40-200MG/5ML 5ML ORAL 12.7 4306070 - DESFLURANE 5ML INHAL 4662.1 4306075 - DOCUSATE CALCIUM 240MG ORAL 10.65 4306080 - BERACTANT (IN SALINE) 25MG/ML 8ML INJ 3548.6 4306085 - EFAVIRENZ 100MG ORAL 50 4306090 - EFAVIRENZ 200MG ORAL 50 4306095 - PALIVIZUMAB 50MG/0.5ML 1ML INJ 9975.6 90378 4306100 - LEVOTHYROXINE 200 MCG INJ 114.4 4306105 - LEVOTHYROXINE 500 MCG INJ 118.75 4306110 - LEVOTHYROXINE 300 MCG ORAL 13.25 4306115 - LEVOTHYROXINE 100 MCG ORAL 11.7 4306120 - LEVOTHYROXINE 25 MCG ORAL 11.05 4306125 - LEVOTHYROXINE 50 MCG ORAL 11.2 4306126 - LEVOTHYROXINE 88 MCG ORAL 11.65 4306130 - LEVOTHYROXINE 125 MCG ORAL 11.6 4306135 - LEVOTHYROXINE 150 MCG ORAL 10 4306140 - CIMETIDINE 150MG/ML 2ML INJ 25 4306145 - CIMETIDINE 300MG ORAL 14.15 4306150 - CIMETIDINE 400MG ORAL 16.75 4306155 - CIMETIDINE 300MG/5ML 5ML ORAL 18.3 4306160 - CIMETIDINE 200MG ORAL 13.6 4306165 - METHIMAZOLE 5MG ORAL 11.95 4306170 - METHIMAZOLE 10MG ORAL 13.35 4306175 - PACLITAXEL 6MG/ML 1ML IV 50 J9267 4306180 - DOCETAXEL 20MG/0.5ML IV 1983.6 J9171 4306190 - CARBAMAZEPINE 100MG ORAL 11.35 4306195 - CARBAMAZEPINE 200MG ORAL 11.6 4306200 - CARBAMAZEPINE 100MG/5ML 5ML ORAL 96.75 4306205 - ATENOLOL 50MG ORAL 13.9 4306207 - ATOVASTATIN 10 mg tablet 11.65 4306208 - ATOVASTATIN 20 mg tablet 12.3 4306209 - ATOVASTATIN 40 mg tablet 12.3 4306215 - TETANUS-DIPHTERIA TOXOIDS-TD 103.45 90714 4306216 - TDAP 40 90715 4306217 - Measles-Mumps-Rubella Vaccine 261.7 90710 4306220 - TETRACAINE HCL 0.5% 2ML OPTH 474.8 4306230 - THEOPHYLLINE 100MG ORAL 11.05 4306235 - THEOPHYLLINE 200MG ORAL 11.6 4306240 - THEOPHYLLINE 300MG ORAL 11.4 4306245 - THERAPEUTIC MULTIVITAMIN ORAL 10.5 4306250 - B COMPLEX-C-CALCIUM ORAL 10 4306255 - THERAPEUTIC MULTIVITAMIN 5ML ORAL 28.7 4306260 - MULTIVIT IRON MIN NO. 8 FA 9-0.4MG ORAL 10.25 4306265 - THIAMINE HCL 100MG/ML 2ML INJ 59.84 J3411 4306270 - CHLORPROMAZINE 50MG ORAL 19.05 4306275 - CHLORPROMAZINE 100MG ORAL 24.2 4306280 - CHLORPROMAZINE 200MG ORAL 27.05 4306285 - CHLORPROMAZINE 10MG ORAL 11.55 4306290 - CHLORPROMAZINE 25MG ORAL 16.35 4306295 - CHLORPROMAZINE 25MG/ML 1ML INJ 93.55 J3230 4306300 - CHLORPROMAZINE 50MG/2ML 2ML INJ 25 J3230 4306305 - THROMBIN (BOVINE) 20000 UNIT TOPL 1483.5 4306310 - LIOTRIX 30MG ORAL 12.8 4306315 - TRIMETHOBENZAMIDE 100MG/ML 2ML INJ 33.33 J3250 4306320 - TRIMETHOBENZAMIDE 300MG ORAL 16.5 4306325 - TIMOLOL MALEATE 20MG ORAL 14.05 4306330 - TIMOLOL MALEATE 0.5% 5ML OPTH 11.2 4306335 - TOLNAFTATE 1% 45GM TOPL 21.25 4306340 - BENZOIN 120MG TOPL 38.25 4306345 - RINGERS 1000ML IRRIGATION 10 4306350 - TENECTEPLASE 50MG IV 16748.75 J3101 4306355 - TOBRAMYCIN-DEXAMETHASONE 5ML OPTH 424.2 4306360 - TOBRAMYCIN-DEXAMETHASONE 0.3-0.1% 2.5EA 271 4306365 - TOBRAMYCIN SULFATE 40MG/ML 2ML INJ 25 J3260 4306370 - TOBRAMYCIN SULFATE 0.3% 5GM OPTH 152.9 4306375 - TOBRAMYCIN SULFATE 0.3% 3.5GM OPTH 398.55 4306380 - IMIPRAMINE HCL 25MG ORAL 13.8 4306385 - IMIPRAMINE HCL 50MG ORAL 16.4 4306390 - IMIPRAMINE HCL 10MG ORAL 11.9 4306395 - IMIPRAMINE PAMOATE 75MG ORAL 88.15 4306400 - IMIPRAMINE PAMOATE 100MG ORAL 88.15 4306405 - IMIPRAMINE PAMOATE 125MG ORAL 84.4 4306410 - IMIPRAMINE PAMOATE 150MG ORAL 84.4 4306415 - TOLNAFTATE 1% 10ML TOPL 26.05 4306420 - TOPIRAMATE 50MG ORAL 32.45 4306425 - TOPIRAMATE 100MG ORAL 10 4306430 - DESOXIMETASONE 0.25% 15GM TOPL 294.45 4306435 - DESOXIMETASONE 0.25% 15GM TOPL 256.7 4306440 - METOPROLOL SUCCINATE XL 50MG ORAL 13.95 4306445 - METOPROLOL SUCCINATE XL 100MG ORAL 15.9 4306450 - METOPROLOL SUCCINATE XL 25MG ORAL 14.6 4306455 - KETOROLAC TROMETHAMINE 60MG/2ML 2ML IV 6.45 J1885 4306456 - KETOROLAC 15 mg 25 J1885 4306460 - KETOROLAC TROMETHAMINE 30MG/ML 1ML IV 12.74 J1885 4306465 - ATRACURIUM 10MG/ML 5ML IV 51.8 4306470 - LABETALOL 200MG ORAL 13 4306471 - LABETALOL 100MG tab 12.1 4306475 - SCOPOLAMINE BASE 1.5MG TOPL 72 4306480 - TRAVOPROST 0.004% 2.5 OPTH 723.05 4306485 - PENTOXIFYLLINE 400MG ORAL 12.7 4306490 - TRIFLUOPERAZINE 1MG ORAL 12.55 4306495 - TRIFLUOPERAZINE 2MG ORAL 13.75 4306500 - TRIFLUOPERAZINE 5MG ORAL 14.75 4306505 - TRIFLUOPERAZINE 10MG ORAL 17.1 4306510 - TRIHEXYPHENIDYL 5MG ORAL 11.6 4306515 - TRIHEXYPHENIDYL 2MG ORAL 10 4306520 - OXCARBAZEPINE 150MG ORAL 19.45 4306525 - OXCARBAZEPINE 300MG ORAL 27.2 4306530 - OXCARBAZEPINE 600MG ORAL 38.75 4306535 - NEOMYCIN-BACITRACNZN-POLYMYXIN 28.4GM TO 31.9 4306540 - NEOMYCIN-POLYMYXIN-GRAMICIDIN 10ML OPTH 135.65 4306545 - ABACAVIR-LAMIVUDINE-ZIDOVUDINE ORAL 124.15 4306550 - DORZOLAMIDE 2% 0.5ML OPTH 157.5 4306555 - EMTRICITABINE-TENOFOVIR 200-300MG ORAL 180.8 4306565 - TIGECYCLINE 50MG IV 6.99 J3243 4306570 - ACETAMINOPHEN 160MG/5ML 5ML ORAL 10 4306575 - ACETAMINOPHEN 325MG ORAL 10 4306580 - ACETAMINOPHEN 80MG/0.8ML 15ML ORAL 23.75 4306585 - ACETAMINOPHEN 120MG RECTAL 10 4306590 - ACETAMINOPHEN 650MG RECTAL 10 4306595 - ACETAMINOPHEN 325MG RECTAL 10 4306600 - ACETAMIN-CODEINE 120-12MG/5ML 5ML ORAL 45.5 4306605 - ACETAMIN-CODEINE 300-15MG ORAL 25 4306610 - ACETAMINOPHEN 500MG ORAL 10 4306615 - ACETAMINOPHEN-CODEINE 300-30MG ORAL 25 4306620 - ACETAMIN-CODEINE 300-60MG ORAL 25 4306625 - TETRAHYDROZOLINE 0.1% 30ML NASL 298.95 4306630 - SEVOFLURANE 5ML INHAL 717.45 4306635 - TRAMADOL 50MG ORAL 10 4306640 - AMPICILLIN-SULBACTAM 3 GM IV 22.48 J0295 4306645 - AMPICILLIN-SULBACTAM 1.5 GM IV 27.95 J0295 "4306650 - ZINC OXIDE 4 X 10"" -YARD 1 TOPL" 10.85 4306655 - BETHANECHOL CHLORIDE 5MG ORAL 13.15 4306660 - BETHANECHOL CHLORIDE 10MG ORAL 17 4306665 - BETHANECHOL CHLORIDE 25MG ORAL 17.8 4306670 - FLAVOXATE 100MG ORAL 18 4306675 - VALGANCICLOVIR 450MG ORAL 243.25 4306680 - BETAMETHASONE VALERATE 0.1% 60ML TOPL 55.85 4306685 - BETAMETHASONE VALERATE 0.1% 45GM TOPL 132.65 4306690 - DIAZEPAM 5MG/ML 2ML INJ 15 J3360 4306695 - DIAZEPAM 2MG ORAL 25 4306700 - DIAZEPAM 5MG ORAL 25 4306705 - VALACYCLOVIR 500MG ORAL 10 4306715 - VANCOMYCIN 1000MG/10ML 10ML IV 5.97 J3370 4306716 - Vancomycin Premix 1000mg 157.85 J3370 4306717 - Vancomycin Premix 500mg 50.6 J3370 4306720 - VANCOMYCIN 500MG IV 26.25 J3370 4306725 - WHITE PETROLATUM-MINERAL OIL 120GM TOPL 32.65 4306730 - ISOXSUPRINE 10MG ORAL 15.05 4306735 - ISOXSUPRINE 20MG ORAL 18.15 4306740 - ENALAPRILAT 1.25MG/ML 1ML IV 25.7 4306745 - ENALAPRIL MALEATE 2.5MG ORAL 10 4306750 - ENALAPRIL MALEATE 5MG ORAL 10 4306755 - ENALAPRIL MALEATE 10MG ORAL 14.7 4306760 - VECURONIUM BROMIDE 10MG IV 25.8 4306765 - PENICILLIN V POTASSIUM 250MG ORAL 10 4306770 - PENICILLIN V POTASSIUM 500MG ORAL 10 4306775 - ALBUTEROL SULFATE 0.083% 3ML INHAL 25 4306780 - ALBUTEROL 90 MCG/ACTUATION 17GM INHAL 25 4306785 - ALBUTEROL SULFATE 2MG/5ML 5ML ORAL 35.5 4306790 - ALBUTEROL SULFATE 2MG ORAL 11.4 4306795 - VERAPAMIL 2.5MG/ML 2ML IV 25 4306800 - VERAPAMIL 120MG ORAL 13.3 4306805 - MIDAZOLAM 1MG/ML 2ML 12.51 J2250 4306810 - MIDAZOLAM 5MG/ML 10ML IV 0.5 J2250 4306815 - MIDAZOLAM 5MG/ML 2ML INJ 2.53 J2250 4306820 - VORICONAZOLE 200MG ORAL 237 4306825 - VORICONAZOLE 200MG IV 675.4 J3465 4306830 - DOXYCYCLINE HYCLATE 100MG IV 69.1 4306835 - DOXYCYCLINE HYCLATE 50MG ORAL 13.6 4306840 - DOXYCYCLINE HYCLATE 100MG ORAL 16.15 4306845 - HYDROCODONE-ACETAMIN 5-500MG ORAL 25 4306846 - HYDROCODONE-ACETAMIN 10/325MG TAB 25 4306850 - DIDANOSINE 400MG ORAL 69.2 4306855 - DIDANOSINE 250MG ORAL 50 4306860 - DIDANOSINE 200MG ORAL 50 4306865 - DIDANOSINE 125MG ORAL 50 4306870 - VINBLASTINE 1MG/ML 10ML IV 50 J9360 4306875 - VINCRISTINE 1MG/ML 2ML IV 102 J9370 4306880 - NELFINAVIR 250MG ORAL 50 4306885 - NEVIRAPINE 200MG ORAL 55.6 4306890 - NEVIRAPINE 50MG/5ML 60ML ORAL 163.75 4306895 - NEVIRAPINE 50ML/5ML 120ML ORAL 320 4306900 - TENOFOVIR DISOPROXIL FUMARATE 300MG ORAL 134.15 4306905 - TETRAHYDROZOLINE 0.05% 15ML OPTH 14.15 4306910 - HYDROXYZINE HCL 25MG/ML 1ML IM 25.7 J3410 4306915 - HYDROXYZINE HCL 10MG/5ML 5ML ORAL 13.7 4306920 - VITAMIN A + D 120GM TOPL 17.8 4306921 - VITAMIN B-12 100mcg TABLET 10.1 4306922 - CYANOCOBALAMIN 100MCG TABLET 10.25 4306923 - VITAMIN D 50000IU CAP 16.35 4306925 - THIAMINE HCL 100MG ORAL 10.25 4306930 - THIAMINE HCL 50MG ORAL 10.1 4306935 - CYANOCOBALAMIN 1000 MCG/ML 1ML IM 25 J3420 4306940 - PYRIDOXINE 25MG ORAL 10.15 4306945 - PYRIDOXINE 50MG ORAL 10.15 4306950 - ASCORBIC ACID 250MG ORAL 10.15 4306955 - ASCORBIC ACID 500MG ORAL 10.3 4306960 - PHYTONADIONE 10MG/ML 1ML INJ 40.39 J3430 4306965 - PHYTONADIONE 2MG/ML 0.5ML INJ 30.9 J3430 4306970 - PROTRIPTYLINE 5MG ORAL 20.25 4306975 - PROTRIPTYLINE 10MG ORAL 24.85 4306980 - DICLOFENAC SODIUM 50MG ORAL 10.7 4306985 - DICLOFENAC SODIUM 25MG ORAL 16.2 4306990 - ACETIC ACID 2% 15ML OTIC 180 4307000 - WATER FOR INJECTION STERILE 1000ML IV 60 4307010 - BUPROPION 100MG ORAL 10 4307015 - BUPROPION 150MG ORAL 18.45 4307020 - PENICILLIN G PROCAINE 600000 UNIT 1ML IM 72.15 J2510 4307025 - PENICILLIN G PROCAINE 1200000 UNIT 2ML 133.95 J2510 4307030 - GUANABENZ 4MG ORAL 14.3 4307035 - LATANOPROST 0.005% 2.5ML OPTH 82.65 4307040 - ALPRAZOLAM 0.5MG ORAL 25 4307045 - ALPRAZOLAM 1MG ORAL 25 4307050 - ALPRAZOLAM 2MG ORAL 25 4307055 - ALPRAZOLAM 0.25MG ORAL 25 4307060 - TRYPSIN-BALSAM-CASTOROIL 90-87-788 UNIT- 244.2 4307065 - LEVALBUTEROL HCL 1.25MG/3ML 3ML INHAL 50.25 4307070 - LIDOCAINE HCL 1% 20ML INJ 1.3 J2001 4307075 - LIDOCAINE HCL 2% 20ML INJ 0.67 J2001 4307080 - LIDOCAINE HCL 4% 50ML TOPL 45.85 4307085 - LIDOCAINE HCL 5% 35.44GM TOPL 58.2 4307090 - LIDOCAINE (PF) 20MG/ML 5ML IV 30.9 4307095 - LIDOCAINE HCL 2% 30ML TOPL 78.55 4307100 - LIDOCAINE HCL 2% 20ML TOPL 10 4307105 - LIDOCAINE-EPI 1%-1:100000 20ML INJ 25 4307110 - LIDOCAINE-EPI 2%-1:100000 20ML INJ 25 4307115 - LIDOCAINE (PF) 1% (10MG/ML) 5ML INJ 5.16 J2001 4307120 - RANITIDINE HCL 25MG/ML 2ML INJ 27.4 J2780 4307125 - RANITIDINE HCL 15MG/ML 1ML ORAL 396.3 4307130 - RANITIDINE HCL 150MG ORAL 16.8 4307135 - RANITIDINE IN 1/2 NS 50MG/50ML 50ML IV 50 J2780 4307140 - METOLAZONE 2.5MG ORAL 16.45 4307145 - METOLAZONE 5MG ORAL 17.35 4307150 - ROCURONIUM 10MG/ML 1ML INJ 32.15 4307155 - STAVUDINE 15MG ORAL 50 4307160 - STAVUDINE 20MG ORAL 50 4307165 - STAVUDINE 30MG ORAL 50 4307170 - STAVUDINE 40MG ORAL 50 4307175 - COAL TAR 177ML TOPL 83.35 4307180 - ABACAVIR 300MG ORAL 53.1 4307195 - ABACAVIR 20MG/ML 120ML ORAL 366.8 4307205 - CEFUROXIME SODIUM 1.5GM IV 10 J0697 4307220 - ZINC OXIDE 20% 30GM TOPL 19.5 4307225 - ZINC SULFATE 5MG/ML 1ML IV 25 4307230 - ZINC SULFATE 220MG ORAL 10.2 4307235 - AZITHROMYCIN 250MG ORAL 10 4307240 - AZITHROMYCIN 200MG/5ML 5ML ORAL 57.75 4307245 - AZITHROMYCIN 100MG/5ML 15ML ORAL 153.25 4307250 - SIMVASTATIN 10MG ORAL 22.15 4307255 - SIMVASTATIN 20MG ORAL 10 4307260 - SIMVASTATIN 5MG ORAL 18.7 4307265 - SIMVASTATIN 40MG ORAL 10 4307270 - ONDANSETRON HCL 4MG ORAL 79.35 4307271 - Odansetron 4mg ODT Tablet 106.8 4307275 - ONDANSETRON HCL (PF) 4MG/2ML 1ML INJ 6.26 J2405 4307280 - GOSERELIN 3.6MG SUBCUT 2059.5 J9202 4307285 - SERTRALINE 50MG ORAL 11.75 4307290 - SERTRALINE 100MG ORAL 9.99 4307295 - PIPERACILLIN-TAZOBACTAM 2.25GM IV 36.96 J2543 4307300 - PIPERACILLIN-TAZOBACTAM 3.375GM IV 35.73 J2543 4307305 - PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV 33.41 J2543 4307310 - ACYCLOVIR 5% 15GM TOPL 879.35 4307315 - OLANZAPINE 2.5MG ORAL 59.69 4307320 - OLANZAPINE 5MG ORAL 73.9 4307325 - OLANZAPINE 7.5MG ORAL 10 4307330 - OLANZAPINE 10MG ORAL 106.3 4307335 - LINEZOLID 200MG/100ML 100ML IV 256.3 J2020 4307340 - LINEZOLID 600MG/300ML 300ML IV 141.7 J2020 4307345 - LINEZOLID 600MG ORAL 438.1 4307346 - LINEZOLID SUSP 100MG/5ML 150ML 24.3 4307355 - DEXTROSE 5% IN WATER (D5W) 50ML IV 50 4307360 - LEUCOVORIN CALCIUM 50MG INJ 10 J0640 4307365 - CORTISONE 25MG ORAL 12 4307370 - FOLIC ACID 1MG ORAL 11 4307375 - LEUCOVORIN CALCIUM 5MG ORAL 18.95 4307380 - DEXTROSE 5%/ 1/2 NS 1000ML 60 4307385 - AMINO ACIDS 10% 500ML 1407.85 45000 - TUBE ENDO W/POS AIRWAY DEVICE 49.4 A7037 45001 - CLOSED TREATMENT HIP ARTHR DISLOCATION 3385.8 27266 45002 - TREATMENT TIBIAL SHAFT FX 2470.95 27752 45003 - NON TUNNELED CV CATH <5 YRS 2040.6 36555 45004 - NON TUNNELED CV CATH >5 YRS 2030.15 36556 45005 - ER ESOPHAGOSCOPY RMV FB 1043.1 43215 45006 - UPPER GI ENDOSCOPY W/FB REM 877.8 43247 45007 - ID VULVA/PERINEAL ABSCESS 588.05 56405 45010 - TUBE HOLDER ENDOTRACHEAL 14.25 45011 - FACILITY OBS NURSE ASSESS 8.55 G0379 45100 - DRAINAGE SKIN ABSCESS SIMPLE 594.7 10060 45101 - DRAINAGE SKIN ABSCESS COMPL 472.15 10061 45102 - DRAINAGE PILONIDAL CYST SIMPL 472.15 10080 45103 - REMOVE FOREIGN BODY SIMPLE 711.55 10120 45104 - REMOVE FOREIGN BODY COMPL 1824.95 10121 45105 - DRAINAGE HEMATOMA FLUID 1818.3 10140 45106 - PUNCTURE DRAINAGE OF LESION 229.9 10160 45107 - DEBRIDE INFECTED SKIN 451.25 11000 45108 - RMVL DEVITAL TIS 20CM/< 429.4 97597 45109 - RMVL DEVITAL TIS ADD; 20CM< 451.25 97598 45110 - TRUNK/ARMS/LEGS 0.6-1.0CM 913.9 11401 45111 - EX SKIN TAGTRUNK/ARMS/LEGS/GENT 2.1-3.CM 1633.05 11403 45112 - EX SKIN TAG SCLP/NCK/HNDS/FT/GENT 2.1-3C 1454.45 11421 45113 - EX SKIN FC/EAR/ELID/NOSE/LPS/MM1.1-20 1117.2 11442 45114 - REMOVAL OF NAIL PLATE 1140 11730 45116 - REMOVAL NAIL BED 1022.2 11750 45117 - EXCISION NAIL BED/FINGER TUFT 3004.85 11752 45118 - REPAIR NAIL BED 891.1 11760 45119 - RECONSTRUCT NAIL BED W/GRAFT 3538.75 11762 45120 - WEDGE EXCISION NAIL FOLD 451.25 11765 45121 - SC/NE/AX/EX/GE/TR <2.5CM 494 12001 45122 - SC/NE/AX/EX/GE/TR 2.6-7.5CM 482.6 12002 45123 - SC/NE/AX/EX/GE/TR 7.6-12.5CM 583.3 12004 45124 - SC/NE/AX/EX/GE/TR 12.6-20.0CM 508.25 12005 45125 - SC/NE/AX/EX/GE/TR 20.1-30.0CM 494 12006 45126 - SC/NE/AX/EX/GE/TR >30.0CM 494 12007 45127 - FACE/ER/EYLDS/N/L/MM <2.5CM 494 12011 45128 - SUPER FICIAL WOUND REPAIR 2.5CM OR LESS 494 12013 45129 - FACE/ER/EYLDS/N/L/MM 5.1-7.5C 494 12014 45130 - FAC/ER/EYLDS/N/L/MM 7.6-12.5C 772.35 12015 45131 - FAC/ER/EYLDS/N/L/MM 12.6-20.0 494 12016 45132 - FAC/ER/EYLDS/N/L/MM 20.1-30.0 494 12017 45133 - FAC/ER/EYLDS/N/L/MM >30.0CM 494 12018 45134 - CLOSURE SPLIT WOUND SIMPLE 494 12020 45135 - SC/AX/TR/EXTM/EX-HF <2.5CM 494 12031 45136 - SC/AX/TR/EXTM/EX-HF 2.6-7.5CM 494 12032 45137 - SC/AX/TR/EXTM/EX-HF 7.6-12.5C 494 12034 45138 - SC/AX/TR/EXTM/EX-HF 12.6-20.0 494 12035 45139 - SC/AX/TR/EXTM/EX-HF 20.1-30.0 494 12036 45140 - SC/AX/TR/EXTM/EX-HF >30CM 2727.45 12037 45141 - NEC/HDS/FT/EXT GEN <2.5CM 494 12041 45142 - NEX/HDS/FT/EXT GEN 2.6-7.5CM 1015.55 12042 45143 - NEC/HDS/FT/EXT/GEN 7.6-12.5CM 494 12044 45144 - NEC/HDS/FT/EX GEN 12.6-20.0CM 494 12045 45145 - NEC/HDS/FT/EXT GEN 20.1-30.0C 494 12046 45146 - NEC/HDS/FT/EXT GEN >30.0CM 2727.45 12047 45147 - FAC/ER/EYLDS/NS/LP/MM <2.5CM 494 12051 45148 - FAC/ER/EYLDS/NS/LP/MM 2.6-5.0 494 12052 45149 - FAC/ER/EYLDS/NS/LP/MM 5.4-7.5 494 12053 45150 - FAC/ER/EYLD/NS/LP/MM 7.6-12.5 494 12054 45151 - FAC/ER/EYLD/NS/LP/MM12.6-20.0 494 12055 45152 - FAC/ER/EYLD/NS/LP/MM20.1-30.0 494 12056 45153 - FAC/ER/EYLDS/NS/LP/MM >30.0CM 2727.45 12057 45154 - RPR WND/LS CMPLX TRUNK1.1-2.5 740.05 13100 45155 - RPR WND/LS CMPLX TRUNK2.6-7.5 740.05 13101 45156 - WOUND REP EA 5CM TRUNK ETC 740.05 13102 45157 - RPR WND/LS CPX SC/A/L1.1-2.5C 740.05 13120 45158 - RPR WND/LS CPX SC/A/L 2.6-7.5 740.05 13121 45159 - REPAIR WOUND/LESION ADD-ON 740.05 13122 45160 - RPR WND/LS CPX FH/CH/C/M/NECK 740.05 13131 45161 - RPR WND/LS CPX FH/CH/C/M/NECK 740.05 13132 45162 - WOUND REPAIR EA 5CM FACE ETC 740.05 13133 45163 - RPR WND/LS CPX EL/N/E/L <1.0C 2727.45 13150 45164 - RPR WND/LS CX EL/N/E/L1.1-2.5 740.05 13151 45165 - RPR WND/LS CX EL/N/E/L2.6-7.5 740.05 13152 45168 - REMOVE SUTURES UNDER ANES 298.3 15851 45169 - ER TREAT BURN(S) 1ST DEG LOCAL 355.3 16000 45170 - ER TREATMENT BURN(S)<5% BSA 345.8 16020 45171 - ER TREATMENT BURN(S) 5-10% BSA 298.3 16025 45172 - ER TREATMENT BURN(S)> 10% BSA 451.25 16030 45173 - CHEMICAL CAUTER GRANUL TISSUE 298.3 17250 45174 - ID BREAST ABSCESS 2362.65 19020 45175 - BIOPSY OF BREAST INCISIONAL 3023.85 19101 45176 - INJ TENDON/LIGAMENT/CYST 486.4 20550 45177 - ARTHROCENTESIS (SMALL JOINT) 486.4 20600 45178 - ARTHROCENTESIS (INTERM JOINT) 486.4 20605 45179 - ARTHROCENTESIS (MAJOR JOINT) 460.75 20610 45180 - TREATMENT NOSE FRACTURE 185.25 21310 45181 - TREATMENT OPEN NASAL FRACTURE 3750.6 21325 45182 - TREATMENT LOWER JAW FRACTURE 529.15 21450 45183 - RESET DISLOCATED JAW 529.15 21480 45184 - TREATMENT RIB FX CLOSED UNCOM 877.8 21800 45185 - TREATMENT STERNUM FRACTURE 548.15 21820 45186 - TREATMENT CLAVICLE FRACTURE 877.8 23500 45187 - REPAIR FINGER FRACTURE EACH 7504.05 26765 45188 - CLS RX CLAVICL DISLO (A-C JOINT) W/O MAN 548.15 23540 45189 - TREATMENT CLAVICLE DISLOCATN 548.15 23540 45190 - REDUCE AC DISLOCATION 877.8 23545 45191 - TREATMENT SHOULDER BLADE FX 877.8 23570 45192 - TRTMNT CLSD PROX HUM W/O MANP 548.15 23600 45193 - TREATMENT HUMERUS FRACTURE 3282.25 23605 45194 - CLSD RX HUM GRT TUB FX W/O MANIPULATION 548.15 23620 45195 - TRTMNT CLSD HUM GRT TUB FX W 3407.65 23625 45196 - TREATMENT SHOULDER DISLOCTION 1049.75 23650 45197 - TRTMNT SHLDR DISLOCTN W/ANES 2524.15 23655 45198 - RED CLSD SHLDR DIS FX GR TUB 548.15 23665 45199 - TRTMNT HUM FX CLSED W/O MANIP 548.15 24500 45200 - TRTMNT HUM FX CLSED W/MANIP 548.15 24505 4520000 - TEE W/DOPPLER COMPLETE 1623 93306 4520015 - ECHO TRANSTHORACIC 2483 93303 45201 - TX HUM FX CLSED SUP/TRN W/O M 548.15 24530 45202 - TREATMENT HUMERAL FX W/MANIP 548.15 24535 45203 - TRTMNT HUM FX CLS EPI WO MANI 548.15 24560 45204 - TRTMNT ELBOW DIS CLSD WO ANES 1172.3 24600 45205 - TREATMENT ELBOW DISLOCATION 2524.15 24605 45206 - TRTMNT NURSEMD ELBOW DIS W/MA 548.15 24640 45207 - TREATMENT RADIUS FRACTURE 548.15 24650 45208 - TREATMENT OF ULNA FX W/O MANI 548.15 24670 45209 - TREATMENT FX RADIUS W/O MANIP 548.15 25500 45210 - TREATMENT FX RADIUS W/MANIP 548.15 25505 45211 - TRTMNT FX ULNA CLSD W/O MANIP 548.15 25530 45212 - TRTMNT FX RADIUS ULNA W/O MAN 548.15 25560 45213 - TRTMNT FX RADIUS ULNA W/MANIP 548.15 25565 45214 - TREATMENT FX RADIUS/ULNA 883.5 25600 45215 - TRTMNT FX RADIUS/ULNA W/O MNP 1451.6 25605 45216 - TRTMNT WRIST BONE FX W/O MANP 548.15 25622 45217 - TRTMNT WRIST BONE FX WO MNP E 548.15 25630 45218 - REPAIR WRIST BONE FX CL UL S 548.15 25650 45219 - TRTMNT CL DIS RADI DISL W MNP 548.15 25675 45220 - ID FINGER ABSCESS SIMPLE 472.15 26010 45221 - ID FELON 1461.1 26011 45222 - REPAIR HAND TENDON 2527.95 26410 45223 - REPAIR FINGER TENDON 2527.95 26418 45224 - REPAIR EXT TENDON/FINGER SPLT 2527.95 26432 45225 - TRTMNT METACARPAL FX W/O MANP 548.15 26600 45226 - TRTMNT METACARPAL FX W/MANIP 548.15 26605 45227 - RED CLSD METACARPAL FX DISLC 548.15 26645 45228 - TREATMENT HAND DISLOCATION 548.15 26670 45229 - REDUCE CMC DISLCTION W/ANES 548.15 26675 45230 - TREATMENT KNUCKLE DISLOCATION 877.8 26700 45231 - REDUCE MCP DISLCTION W/ANES 548.15 26705 45232 - TRTMNT FINGER FX W/O MANIP EA 877.8 26720 45233 - TRTMNT FINGER FX W/MANIP EA 877.8 26725 45234 - TRTMNT DISTAL PHAL FX WO MANP 877.8 26750 45235 - TRTMNT DISTAL PHAL FX W/MANIP 877.8 26755 45236 - TREATMENT FINGER DISLOCATION 883.5 26770 45237 - REDUCE IPJ DISLOCATION W/ANES 2524.15 26775 45238 - AMPUTATION FINGER OR THUMB 3862.7 26951 45239 - TREATMENT TAIL BONE FRACTURE 548.15 27200 45240 - TREATMENT THIGH FRACTURE 548.15 27230 45241 - TREATMENT HIP DISLOCATION 548.15 27250 45243 - TREATMENT FEMORAL SHAFT FX 548.15 27500 45244 - TRTMNT CL SUPRACOND FX NO RED 548.15 27501 45245 - TREATMENT CONDYLAR FX NO RED 548.15 27508 45246 - TREATMENT KNEECAP FRACTURE 548.15 27520 45247 - TREATMENT KNEE FRACTURE 548.15 27530 45248 - TRTMNT KNEECAP DISLC W/ ANES 548.15 27560 45249 - CLOSED TRTMNT PATTELA DISLC W/ANES 2524.15 27562 45250 - TREATMENT TIBIA FX W/O MANIP 548.15 27750 452502 - REPAIR FIBULA NONUNION/MALUNION W/INT FI 16365 27726 45251 - TRTMNT MEDIAL MAL FX W/O MANP 548.15 27760 45252 - TRTMNT MEDIAL MAL FX W/MANIP 3075.15 27762 45253 - TREATMENT FIBULA FX W/O MANIP 548.15 27780 45254 - TRTMNT DISTAL FIBULA FX WO MN 548.15 27786 45255 - TRTMNT DISTAL FIBULA FX W/MNP 548.15 27788 45256 - TRTMNT BIMALLEOLAR FX WO MANP 548.15 27808 45257 - TRTMNT BIMALLEOLAR FX W/MANIP 548.15 27810 45258 - TRTMNT TRIMALLEOLAR FX WO MNP 548.15 27816 45259 - TRTMNT TRIMALLEOLAR FX W/MNP 548.15 27818 452590 - OPEN TX TRIMALLEOLAR ANKLE FX W/O FIX J 5783.36 27822 45260 - TREATMENT ANKLE DISLOCATION 548.15 27840 45261 - REDUCE ANKLE DISLOC W/ANES 2524.15 27842 45262 - REMOVAL FOREIGN BODY FOOT 913.9 28190 45263 - TREATMENT HEEL FRACTURE 548.15 28400 45264 - TRTMNT ANKLE FX TALUS W/O MNP 548.15 28430 45265 - TRTMNT MIDFOOT FX W/O MNP EA 548.15 28450 45266 - TRTMNT METATARSAL FX W/O MNP 548.15 28470 45267 - REDUCE METATARSAL FRACTURE 548.15 28475 452670 - OPEN TREATMENT METATARSAL FRACTURE EACH 5783.36 28485 45268 - TREATMENT BIG TOE FX W/O MANP 548.15 28490 45269 - TREATMENT BIG TOE FX W/MANIP 548.15 28495 45270 - TREATMENT TOE FX W/O MANP EA 877.8 28510 45271 - TREATMENT TOE FX W/MANIP EA 877.8 28515 45272 - TREATMENT SESAMOID FRACTURE 548.15 28530 45273 - TREATMENT FOOT DISL W/O ANES 548.15 28630 45274 - TEARTMENT FOOT DISL W/ANES 877.8 28660 45275 - REDUCE TOE IP DISL W/ANES 2524.15 28665 45276 - APPLY ELBOW/FINGER CAST 379.05 29075 45277 - APPLY HAND/WRIST CAST 379.05 29085 45278 - APPLY LONG SPLINT 267.9 29105 45279 - APPLY FOREARM SPLINT 290.7 29125 45280 - APPLY FINGER SPLINT 247.95 29130 45281 - STRAPPING THORAX 277.4 29200 45283 - APPLY ELBOW/WRIST STRAP 277.4 29260 45284 - STRAPPING HAND/FINGER 277.4 29280 45285 - APPLY KNEE/FOOT THIGH CAST 485.45 29365 45286 - APPLY SHORT LEG CAST 257.45 29405 45287 - APPLY WALKING LEG CAST 485.45 29425 45288 - APPLY LONG LEG SPLINT 485.45 29505 45289 - APPLY LOWER LEG SPLINT 485.45 29515 45290 - STRAPPING KNEE 237.5 29530 45291 - STRAPPING ANKLE 205.2 29540 45292 - STRAPPING TOES 462.65 29550 45294 - REMOVAL/REVISION OF CAST 277.4 29705 45295 - WINDOWING OF CAST 277.4 29730 45296 - WEDGING OF CAST 277.4 29740 45297 - REMOVAL NASAL POLYPS SIMPLE 2664.75 30110 45298 - REMOVAL NASAL FOREIGN BODY 185.25 30300 45299 - CONTROL NOSEBLEED ANTER SIMPL 457.9 30901 45300 - CONTROL NOSEBLEED ANTER COMPL 457.9 30903 45301 - CONTROL NOSEBLEED POSTER INI 457.9 30905 45302 - ER INSERT EMERGENCY AIRWAY 1316.7 31500 45303 - CHANGE WINDPIPE AIRWAY 551 31502 45304 - INDIRECT LARYNGOS DIAGNOSTIC 267.9 31505 45305 - REMOVAL FOREIGN BODY LARYNX 267.9 31511 45306 - DIRECT LARYNGOS DIAGNOSTIC 3072.3 31525 45307 - ER EMERGENCY TRACHEOSTOMY 1290.1 45308 - INCISION WINDPIPE CRIC MEMB 2664.75 31605 45309 - DRAINAGE OF CHEST 925.3 32421 45310 - THORACENTESIS W/TUBE INSERT 993.7 32422 45311 - INSERTATION OF CHEST TUBE 993.7 32551 45312 - ER THORACOTOMY MAJOR TRAUMA 6024.9 45313 - THORACOTOMY MAJOR MASSAGE 6024.9 32160 45314 - PERICARDIOCENTESIS 993.7 33010 45315 - ER INS TEMP TRANSVENOUS PACER 6024.9 33210 45316 - ER INTRO NEEDLE EXTREM ARTERY 4871.6 36140 45317 - ER VENIPUNCTURE 163.4 36415 45318 - VENIPUNCTURE SCALP <3YRS 163.4 36405 45320 - VENOUS CUTDOWN 0-1 YR OLD 163.4 36420 45321 - ER VENIPUNCTURE CUTDOWN 163.4 36425 45322 - TRANS BLOOD / BLOOD COMPONENT I UNIT 1467.75 36430 45323 - NON TUNNELED CV CATH > 5YRS 2030.15 36556 45324 - NON TUNNELED CVCATH < 5YRS 2040.6 36555 45325 - INSERT NEEDLE BONE CAVITY 668.8 36680 45326 - ID LYMPH NODE ABSCESS 2362.65 38300 45327 - REP TONGUE LAC <2.5CM ANT 2/3 529.15 41250 45328 - REP TONGUE LAC >2.6CM OR COMP 1290.1 41252 45329 - DRAINAGE GUM LESION 529.15 41800 45330 - SIALOLITHOTOMY UNCOMPLICATED 1290.1 42330 45331 - DRAINAGE TONSIL ABSCESS 529.15 42700 45332 - ID PHARYNX ABSCESS INTRAORAL 2664.75 42720 45333 - ID PHARYNX ABSCESS EXTERNAL 5747.5 42725 45334 - REMOVE PHARYNX FOREIGN BODY 185.25 42809 45335 - CONTROL OROPHARYNGEAL HEMORRH 457.9 42960 45336 - UPPER GI ENDOSCOPY SIMPLE 1559.9 43234 45337 - PLACE GASTROSTOMY TUBE 1559.9 43246 45338 - ER CHANGE GASTROSTOMY TUBE 551 43760 45339 - PROCTOSIGMOIDOSCOPY 594.7 45300 45340 - PROCTOPLASTY PROLAPSE RECTAL MUCOUS MEMB 3906.4 45505 45341 - REMOVE RECTAL FB /FECAL IMPA W/ANAES 3477 45915 45342 - INCISION RECTAL ABSCESS 3588.15 46040 45343 - INCISION ANAL ABSCESS 2743.6 46050 45344 - INCISE EXTERNAL HEMORRHOID 520.6 46083 45345 - REMOVAL HEMORRHOID CLOT 3048.55 46320 45346 - DIAGNOSTIC ANOSCOPY 511.1 46600 45347 - ANOSCOPY/REMOVE FOREIGN BODY 960.45 46608 45348 - ABD PARACENTESIS 1203.65 49082 45350 - ASPIRATION BLADDER BY NEEDLE 1132.4 51100 45351 - ASPIRATION BLADDER BY TROCHAR 532.95 51101 45352 - ASPIRATION BLADDER W/CATHETER 3601.45 51102 45353 - BLADDER IRRIGATION SIMPLE 532.95 51700 45354 - CHANGE BLADDER TUBE 551 51705 45355 - DILATION URETHRAL STRICTURE 3278.45 53620 45356 - ER INSERT URINARY CATHETER 427.5 51702 45357 - DRAINAGE SCROTAL WALL ABCESS 1390.57 55100 45358 - SLITTING OF PREPUSE 2636.25 54001 45359 - DRAINAGE SCROTUM 4075.5 54700 45360 - I&D VULVA/PERINEUM 588.05 56405 45361 - DRAINAGE GLAND ABSCESS 545.3 56420 45362 - COLPOCENTESIS 2413 57020 45363 - INTRO-AGENT VAGINAL BLEED 545.3 57180 45364 - VAGINAL DELIVERY ONLY 3936.8 59409 45366 - DELIVERY OF PLACENTA 1100.1 59414 45367 - ER TX MISSED ABORTION 1ST TRI 3099.85 59820 45368 - ER SPINAL PUNCTURE LUMBAR DX 779.95 62270 45370 - INJECTION TRIGEMINAL NERVE 486.4 64400 45371 - INJECTION NERVE BLOCK 486.4 64402 45372 - INTERCOSTAL NERVE BLOCK SINGL 1162.8 64421 45373 - INJECTION FOR NERVE BLOCK 486.4 64450 45374 - REMOVE FB EYE EXTERIOR 444.6 65205 45375 - REMOVE FB EYE EMBEDDED 444.6 65210 45376 - REMOVE FOREIGN BODY EYE CORNE 444.6 65220 45377 - REMOVE FOREIGN BODY CORNEA EM 444.6 65222 45378 - REMOVE FB CORNEA DEEP 2344.6 65235 45379 - DRAIN EXTERNAL EAR LESION SIM 472.15 69000 45380 - I&D EXT AUDITORY CANAL ABSCES 472.15 69020 45381 - CLEAR OUTER EAR CANAL 178.6 69200 45382 - ER REMOVE IMPACTED EAR WAX 176.7 69210 45387 - TX GASTRO INTUB W/ASP 704.9 43753 45388 - HEART/LUNG RESUSCITATION CPR 1607.4 92950 45389 - ER TEMPORARY EXTERNAL PACING 1472.5 92953 45390 - ER HEART ELECTROCONVERSION 1316.7 92960 45391 - ER SWAN-GANZ CATH PLACEMENT 3444.7 93503 45393 - FACILITY TRIAGE ONLY 175.75 46167 - PINCH SKIN GRAFT 2CM 2727.45 15050 4740000 - Psychiatric Diagnostic Evaluation 199.5 90791 4740005 - Psychotherapy Complex Interactive 249.85 90785 "4740010 - Psychotherapy, 30 min. w/ pt &/ Family" 225.15 90832 "4740015 - Psychotherapy, 45 min. w/ pt &/ Family" 299.25 90834 "4740020 - Psychotherapy, 60 min. w/ Pt &/ Family" 299.25 90837 "4740025 - Psychotherapy, for crisis initial 60 min" 299.25 90839 4740030 - Group Psychotherapy 317.3 90853 4740032 - Group Psychotherapy 317.3 90837 4740035 - OT>=45 350 G0129 "4740040 - Activity Therapy, Music>=45" 346 G0176 4740045 - Group Psychotherapy 45-50 min 350 G0410 4740050 - Interactive Group Therapy 297 G0411 4740055 - Psych Daignostic Evaluation 200 90791 4740060 - Psychotherapy 30 min w/pt 7 or family 225 90832 4740065 - Psychotherapy 60 min. w/pt/or family 297 90837 4770000 - OT GROUP THERAPY PER DAY 883.5 G0129 4770005 - ACTIVITY THERAPHY PER EDUCATION 916.75 G0176 4770015 - SERVICES TRAINING & EDUCATION 323 G0177 4770020 - THERAPY GROUP PSYCHO 287.85 G0410 4780015 - Psychotherapy 45 min w/pt & or family 300 90834 50060 - COMPLETE BLOOD COUNT AUTO. 127.3 85025 50061 - D-DIMER 301.15 85379 50062 - PROTEIN C 469.3 85303 50063 - PROTEIN S 496.85 85306 50064 - CULTURE TYPING NUCLEIC ACID PROBE DIR EA 27.51 87149 50065 - BLOOD CULTURE GRAM N ATIRE OR ID 27.51 87149 50090 - KIT PERICARDIOCENTESIS 346.75 5011001 - OMNIPAGQUE 300MG 1ML 1973.15 Q9967 50130 - KIT SINGLE C.V.P.IMPL.ACC.CAT 504.45 C1751 50200 - MESH MARLEX 1013.65 C1781 50230 - CATHETER SWAN GANZ 7 INCHES 746.7 C1751 50240 - INTRACATH 24 1728.05 C1751 50300 - PLATELET COUNT AUTOMATIC 91.2 85049 50340 - REGLAN 10MG/2ML AMPS 37.05 J2765 50360 - REGLAN 150MG/30ML VIAL 422.75 J2765 50390 - RED CELL SICKLING 121.6 85660 50500 - INFUS-A-PORT 1774.6 C1788 50501 - EMBOLIZATION PROTECTIVE SYSTEM 1188.75 C1884 50520 - RECORDER CARDIAC IMPLANTABLE 352.45 C1764 50590 - RETICULOCYTE COUNT MANUAL 102.6 85044 50610 - CATHETER FOGARTY 3 FR 80CM 1238.8 C1757 51040 - CATHETER DOUBLE TRANSDUCER 455.05 C1751 51050 - PROTHROMBIN TIME 198.55 85610QW 51100 - BOOT CAST 147.25 51140 - BLEEDING TIME 155.8 85002 51180 - CLOTTING TIME LEE WHITE 121.6 85345 52010 - BLOOD SMEAR INTERPRETATION 230.85 85060 5218 - CT-ANGIO UPPER EXT RT 2532.7 73206 5220 - CT-ANGIO LOWER EXT RT 4143.9 73706 5221 - CT-ANGIO LOWER EXT LT 4143.9 73706 52250 - SPECIAL STAINS GROUP II 141.55 88313TC 52260 - BONE MARROW 485.45 85097 52320 - SPECIAL STAINS GROUP I 183.35 88312TC 52410 - FIBRIN SPLIT PROD 159.6 85362 52460 - FIBRINOGEN ACTIVITY 133.95 85384 52570 - MIXING STUDIES PROTH TIME 272.65 85611 52630 - HEPARIN INDUCED ANTIBODIES 183.35 85520 53020 - CS-F GLUCOSE ASSAY QUANTITATV 127.3 82945 53040 - CS-F PROTEIN TOTAL 133.95 84157 53060 - CSF CELL COUNT WITH/DIFF 151.05 89051TC 53070 - CSF CHLORIDE 117.8 82438 53080 - CELL COUNT FLUIDS W/DIFF 151.05 89051TC 55555 - NACL 23.4% SOLN 30ML 9 55557 - EULEXIN CAP 125MG 9 S0175 55558 - TUBE STOMACH LEVINE TYPE 164.35 60010 - SUTURES AUTO GIA 534.85 60020 - SHIELD EYE 21.85 60050 - BAG URINARY LEG W/WO TUBE 21.85 A4358 60100 - SUTURES AUTO EEA 993.7 60110 - BELT COLOSTOMY 85.5 A4367 60150 - CULTURE THROAT 218.5 87070 60200 - SUTURES AUTO TA 488.3 60240 - CULTURE SPUTUM 218.5 87070 60250 - SET INJECTION CLOSED ROOM/ICE 116.85 60280 - CULTURE BLOOD (AEROBIC & ANEROBIC) 218.5 87040 60300 - HEMOCLIPS 125.4 60330 - NEEDLE SPINAL 54.15 60350 - GENITAL CULTURE 218.5 87070 60390 - CULTURE STOOL 172.9 87045 6040000 - 3S ROOM & CARE - MED/SURG PRIV 2137 6040002 - 3S ROOM & CARE - HOSPICE SEMI 1072 6040004 - 3S ROOM & CARE - TELEMETRY 2137 6040006 - 3S ROOM & CARE - PSYCH SEMI 1208 6040008 - 3S ROOM & CARE - DETOX SEMI 1938 6040010 - 3S ROOM ISOLATION M&S/DAILY 2119 60450 - CULTURE GONORRHEA 95 87081 60650 - CULTURE FLUID BODY(AEROBIC) 262.2 87070 60700 - CULTURE CSF(AEROBIC) 262.2 87070 60720 - TRAY PUDENDAL BLOCK 76 60750 - CULTURE BACTERIA STREP SCREEN 95 87081 60900 - RETRIEVER STONE DISPOSABLE 560.5 61220 - KIT C.V.P. CATHETER 79.8 C1751 61280 - TRICHO/ BACT/.FUNGUS/INDIA INDIA INK/KOH 102.6 87210 61530 - COLOPLAST COLOSTOMY POWDER 19.95 61540 - SKIN BARRIER FLANGE 19.95 61550 - PREMIUM PASTE COLOSTOMY 48.45 A4364 61560 - UROSTOMY POUCHES (10) 137.75 61570 - 2 PC COLOSTOMY POUCHES (10) 61.75 61580 - 1 PC COLOSTOMY POUCHES (10) 79.8 61770 - ANALYSIS SEMEN COMPLETE 65.55 89320 61810 - SET ENEMA 43.7 61820 - MALARIA SMEAR 81.7 87207 61900 - CATH URETERAL 35.15 C1758 61910 - FRENCH CATH INTERMITTENT W/SUPPLIES 226.1 C1729 61920 - KIT UMBILICAL CATHETER 24.7 C1751 62010 - BAG BILE 79.8 63010 - TRAY FOLEY CATH INDWELLING 330.6 C1729 63310 - CULTURE MTB CONC AND ISOL 318.25 87116 63340 - MTB STAIN ACID FAST 121.6 87206 63460 - FUNGUS CULTURE 192.85 87106 63510 - OVA AND PARASITES 164.35 87177 66666 - BANDAGE 2IN ELASTOPLAST TAPE 10.45 66667 - BANDAGE ELASTIC PER ROLL 110.2 66668 - STOPCOCK 4 WAY 4.75 66669 - BANDAGE 4IN ELASTOPLAST TAPE 14.25 66670 - BANDAGE 6IN ELASTOPLAST TAPE 25.65 66673 - CATHETER UMBILICAL VESSEL 38.95 C1751 66679 - TUBE ENDOTRACH (INFANT) 9.5 66685 - EYE PROCTECTOR-POSEY PHOTO 8.55 66686 - ENDO PATH 1692.9 66687 - 4 X 4 EACH POST OP SPONGE (STERILE) 9.5 A6222 66690 - BOWL MIXING 14.25 66691 - SUTURE BONE WAX 13.3 66694 - SUTURE AUTO-TLC 55/75/OR 90 842.65 66695 - SUTURE AUTO EEA (CDH) 1390.8 66697 - SUTURE AUTO PDS 19.95 66698 - SUTURE AUTO TRT 75 (RELOAD) 374.3 66699 - SUTURE AUTO PLC RU 198.55 66700 - GAUZE VASELN 4X4 16IN OR LESS 9.5 A6222 66702 - GRAFT VAS IMPLANTABLE 2960.2 C1768 66706 - PIN ASSEMBLY - STANDARD 326.26 C1713 66710 - BANDAGE ESMARK 4IN OR 6IN 23.75 66712 - TAPE ADAPTIC 3 X 8 (ER) 18.05 "66713 - TAPE NON-ALLERGIC 3""/2""(ER)" 11.4 66714 - COMPRESSION HEX HEAD 91.2 C1713 66715 - SCREW MAGNA FIX 444.6 C1713 66716 - GRAFT THINWALL V. (STRAIGHT) 2323.7 C1768 66717 - GRAFT CENTER FLEX VASCULAR 2960.2 C1768 66719 - PIN COMPRESSION GUIDE 256.5 C1713 66720 - GAUZE VASELINE 16 SQ IN OR > 13.3 A6222 66723 - BLADE-OSCILLATING SAW 21.85 66724 - SUTURE SURGICAL STEEL 9.5 66726 - COBAN (SELF ADH. WRAP) 8.55 66728 - BAG BOWEL-ISOLATION 8.55 66735 - CANNULA AIR INJE 48.45 66736 - ACTIVE CORD DISP FOR T.U.R. 38 66737 - SUTURE PROLENE 68.4 66738 - KIT PROSTATE BIOPSY 95 66739 - DRILL TIP-BIT FREE LOCK 96.9 66740 - CATH CHOLANG 4.5FR X 18IN 99.75 C1887 66741 - WIRES GUIDE (UROLOGICAL) 336.3 C1769 66742 - TUBE HORIZONTAL DRAIN(COLOST) 122.55 66743 - LOOP ENDO 128.25 66744 - SUTURE MERSILENE 5MM 133 66745 - SCREW LUHR CORTICAL 136.8 C1713 66746 - SPLINT DENVER NASAL 141.55 66747 - KNIFE MICRO SURGICAL 141.55 66749 - PERCUTANEOUS INTRODUC. 12FR. 164.35 C1892 66750 - FORCEP DISP LAP CHOLE GAST 110.2 66753 - TAP FREE LOCK/ECT 192.85 66754 - BAG ENDO 230.85 66755 - ELECTRODE CUTTING LOOP 237.5 66756 - CATHETER DI-QUN.MAH 19.5-13.5 1005.1 C1752 66757 - DRILL BIT MANDIBULAR 787.63 66760 - SCREW LAG (FREELOCK) 451.25 C1713 66761 - PLATE T. 8 HOLES 1196.27 C1713 66763 - CATHETER PERM DBL LUMEN 929.1 C1750 66765 - URETHERAL STENT DBL J. 627.95 C2617 66766 - PLATE LUH ST/CRVD 647.9 C1713 66767 - STAPLER LINEAR CUTTER (INTER) 780.9 66768 - STENT URETHERAL PIGTAIL 857.85 C2625 66769 - PLATE SUPRA CONDYLAR TUBE 6 HOLE 927.2 C1713 66770 - COMPRESSION SYS.HOW.MANDIBULA 977.18 C1713 66771 - PLATE SUPRA CONDYLAR TUBE 8 HOLE 1240.7 C1713 66772 - VASCULAR GRAFT SYNTHETIC 2611.55 C1768 66774 - GREENFIELD VENA CAVA FIL.INTR 3762.95 C1880 66776 - SERUM PREGNANCY QUANTITATIVE 304 84702 66778 - CULTURE NOSE 218.5 87070 66779 - STENT CUSTOM. STRAIGHT STOMA 432.25 C2625 66780 - KIT FLEXXICON II DUAL LUMEN 304 66892 - LUMEN-MULTI LARGE BORE 288.8 68001 - ACETAMINOPHEN (LEVEL) 209.95 G0480 69000 - BOOT AMBULATORY SURG SINGLE 133 70000 - CATHETER SUBCLAVIAN 337.25 C1751 70160 - URINALYSIS COMPLETE W/MIC 97.85 8100159 70440 - URINE PREGNANCY QUALITATIVE 76 81025QW 70650 - PH FLUIDS 76 83986 70680 - CRYSTAL FLUIDS 91.2 89060 7110000 - PT OTHER LIMIT D/C STATUS CH 0.01 G8992CHGP 7110005 - PT OTHER LIMIT D/C STATUS CI 0.01 G8992CIGP 7110010 - PT OTHER LIMIT D/C STATUS CJ 0.01 G8992CJGP 7110015 - PT OTHER LIMIT D/C STATUS CK 0.01 G8992CKGP 7110020 - PT OTHER LIMIT D/C STATUS CL 0.01 G8992CLGP 7110025 - PT OTHER LIMIT D/C STATUS CM 0.01 G8992CMGP 7110030 - PT OTHER LIMIT D/C STATUS CN 0.01 G8992CNGP 7110035 - PT OTHER LIMIT GOAL STATUS CH 0.01 G8991CHGP 7110040 - PT OTHER LIMIT GOAL STATUS CI 0.01 G8991CIGP 7110045 - PT OTHER LIMIT GOAL STATUS CJ 0.01 G8994CJGP 7110050 - PT OTHER LIMIT GOAL STATUS CK 0.01 G8991CKGP 7110055 - PT OTHER LIMIT GOAL STATUS CL 0.01 G8991CLGP 7110060 - PT OTHER LIMIT GOAL STATUS CM 0.01 G8991CMGP 7110065 - PT OTHER LIMIT GOAL STATUS CN 0.01 G8991CNGP 7110070 - PT OTHER SUBS CURRENT STATUS CH 0.01 G8993CHGP 7110075 - PT OTHER SUBS CURRENT STATUS CI 0.01 G8993CIGP 7110080 - PT OTHER SUBS CURRENT STATUS CJ 0.01 G8993CJGP 7110085 - PT OTHER SUBS CURRENT STATUS CK 0.01 G8993CKGP 7110090 - PT OTHER SUBS CURRENT STATUS CL 0.01 G8993CLGP 7110095 - PT OTHER SUBS CURRENT STATUS CM 0.01 G8993CMGP 7110100 - PT OTHER SUBS CURRENT STATUS CN 0.01 G8993CNGP 7110105 - PT OTHER SUBS D/C STATUS CH 0.01 G8993CHGP 7110110 - PT OTHER SUBS D/C STATUS CI 0.01 G8995CIGP 7110115 - PT OTHER SUBS D/C STATUS CJ 0.01 G8995CJGP 7110120 - PT OTHER SUBS D/C STATUS CK 0.01 G8995CKGP 7110125 - PT OTHER SUBS D/C STATUS CL 0.01 G8995CLGP 7110130 - PT OTHER SUBS D/C STATUS CM 0.01 G8995CMGP 7110135 - PT OTHER SUBS D/C STATUS CN 0.01 G8995CNGP 7110140 - PT OTHER SUBS GOAL STATUS CH 0.01 G8994CHGP 7110145 - PT OTHER SUBS GOAL STATUS CI 0.01 G8994CIGP 7110150 - PT OTHER SUBS GOAL STATUS CJ 0.01 G8994CJGP 7110155 - PT OTHER SUBS GOAL STATUS CK 0.01 G8994CKGP 7110160 - PT OTHER SUBS GOAL STATUS CL 0.01 G8994CLGP 7110165 - PT OTHER SUBS GOAL STATUS CM 0.01 G8994CMGP 7110170 - PT OTHER SUBS GOAL STATUS CN 0.01 G8994CNGP 7110175 - PT-BODY POS CURRENT STATUS CH 0.01 G8981CHGP 7110180 - PT-BODY POS CURRENT STATUS CI 0.01 G8981CIGP 7110185 - PT-BODY POS CURRENT STATUS CJ 0.01 G8981CJGP 7110190 - PT-BODY POS CURRENT STATUS CK 0.01 G8981CKGP 7110195 - PT-BODY POS CURRENT STATUS CL 0.01 G8981CLGP 7110200 - PT-BODY POS CURRENT STATUS CM 0.01 G8981CMGP 7110205 - PT-BODY POS CURRENT STATUS CN 0.01 G8981CNGP 7110210 - PT-BODY POSITION D/C STATUS CH 0.01 G8983CHGP 7110215 - PT-BODY POSITION D/C STATUS CI 0.01 G8983CIGP 7110220 - PT-BODY POSITION D/C STATUS CJ 0.01 G8983CJGP 7110225 - PT-BODY POSITION D/C STATUS CK 0.01 G8983CKGP 7110230 - PT-BODY POSITION D/C STATUS CL 0.01 G8983CLGP 7110235 - PT-BODY POSITION D/C STATUS CM 0.01 G8983CMGP 7110240 - PT-BODY POSITION D/C STATUS CN 0.01 G8983CNGP 7110245 - PT-BODY POSITION GOAL STATUS CH 0.01 G8982CHGP 7110250 - PT-BODY POSITION GOAL STATUS CI 0.01 G8982CIGP 7110255 - PT-BODY POSITION GOAL STATUS CJ 0.01 G8982CJGP 7110260 - PT-BODY POSITION GOAL STATUS CK 0.01 G8982CKGP 7110265 - PT-BODY POSITION GOAL STATUS CL 0.01 G8982CLGP 7110270 - PT-BODY POSITION GOAL STATUS CM 0.01 G8982CMGP 7110275 - PT-BODY POSITION GOAL STATUS CN 0.01 G8982CNGP 7110280 - PT-CARRY CURRENT STATUS CH 0.01 G8984CHGP 7110285 - PT-CARRY CURRENT STATUS CI 0.01 G8984CIGP 7110290 - PT-CARRY CURRENT STATUS CJ 0.01 G8984CJGP 7110295 - PT-CARRY CURRENT STATUS CK 0.01 G8984CKGP 7110300 - PT-CARRY CURRENT STATUS CL 0.01 G8984CLGP 7110305 - PT-CARRY CURRENT STATUS CM 0.01 G8984CMGP 7110310 - PT-CARRY CURRENT STATUS CN 0.01 G8984CNGP 7110315 - PT-CARRY D/C STATUS CH 0.01 G8986CHGP 7110320 - PT-CARRY D/C STATUS CI 0.01 G8986CIGP 7110325 - PT-CARRY D/C STATUS CJ 0.01 G8986CJGP 7110330 - PT-CARRY D/C STATUS CK 0.01 G8986CKGP 7110335 - PT-CARRY D/C STATUS CL 0.01 G8986CLGP 7110340 - PT-CARRY D/C STATUS CM 0.01 G8986CMGP 7110345 - PT-CARRY D/C STATUS CN 0.01 G8986CNGP 7110350 - PT-CARRY GOAL STATUS CH 0.01 G8985CHGP 7110355 - PT-CARRY GOAL STATUS CI 0.01 G8985CIGP 7110360 - PT-CARRY GOAL STATUS CJ 0.01 G8985CJGP 7110365 - PT-CARRY GOAL STATUS CK 0.01 G8985CKGP 7110370 - PT-CARRY GOAL STATUS CL 0.01 G8985CLGP 7110375 - PT-CARRY GOAL STATUS CM 0.01 G8985CMGP 7110380 - PT-CARRY GOAL STATUS CN 0.01 G8985CNGP 7110385 - PT-MOBILITY CURRENT STATUS CH 0.01 G8978CHGP 7110390 - PT-MOBILITY CURRENT STATUS CI 0.01 G8978CIGP 7110395 - PT-MOBILITY CURRENT STATUS CJ 0.01 G8978CJGP 7110400 - PT-MOBILITY CURRENT STATUS CK 0.01 G8978CKGP 7110405 - PT-MOBILITY CURRENT STATUS CL 0.01 G8978CLGP 7110410 - PT-MOBILITY CURRENT STATUS CM 0.01 G8978CMGP 7110415 - PT-MOBILITY CURRENT STATUS CN 0.01 G8978CNGP 7110420 - PT-MOBILITY D/C STATUS CH 0.01 G8980CHGP 7110425 - PT-MOBILITY D/C STATUS CI 0.01 G8980CIGP 7110430 - PT-MOBILITY D/C STATUS CJ 0.01 G8980CJGP 7110435 - PT-MOBILITY D/C STATUS CK 0.01 G8980CKGP 7110440 - PT-MOBILITY D/C STATUS CL 0.01 G8980CLGP 7110445 - PT-MOBILITY D/C STATUS CM 0.01 G8980CMGP 7110450 - PT-MOBILITY D/C STATUS CN 0.01 G8980CNGP 7110455 - PT-MOBILITY GOAL STATUS CH 0.01 G8979CHGP 7110460 - PT-MOBILITY GOAL STATUS CI 0.01 G8979CIGP 7110465 - PT-MOBILITY GOAL STATUS CJ 0.01 G8979CJGP 7110470 - PT-MOBILITY GOAL STATUS CK 0.01 G8979CKGP 7110475 - PT-MOBILITY GOAL STATUS CL 0.01 G8979CLGP 7110480 - PT-MOBILITY GOAL STATUS CM 0.01 G8979CMGP 7110485 - PT-MOBILITY GOAL STATUS CN 0.01 G8979CNGP 7110490 - PT-OTHER LIMIT CURRENT STATUS CH 0.01 G8990CHGP 7110495 - PT-OTHER LIMIT CURRENT STATUS CI 0.01 G8990CIGP 7110500 - PT-OTHER LIMIT CURRENT STATUS CJ 0.01 G8990CJGP 7110505 - PT-OTHER LIMIT CURRENT STATUS CK 0.01 G8990CKGP 7110510 - PT-OTHER LIMIT CURRENT STATUS CL 0.01 G8990CLGP 7110515 - PT-OTHER LIMIT CURRENT STATUS CM 0.01 G8990CMGP 7110520 - PT-OTHER LIMIT CURRENT STATUS CN 0.01 G8990CNGP 7110525 - PT-SELF CARE CURRENT STATUS CH 0.01 G8987CHGP 7110530 - PT-SELF CARE CURRENT STATUS CI 0.01 G8987CIGP 7110535 - PT-SELF CARE CURRENT STATUS CJ 0.01 G8987CJGP 7110540 - PT-SELF CARE CURRENT STATUS CK 0.01 G8987CKGP 7110545 - PT-SELF CARE CURRENT STATUS CL 0.01 G8987CLGP 7110550 - PT-SELF CARE CURRENT STATUS CM 0.01 G8987CMGP 7110555 - PT-SELF CARE CURRENT STATUS CN 0.01 G8987CNGP 7110560 - PT-SELF CARE D/C STATUS CH 0.01 G8989CHGP 7110565 - PT-SELF CARE D/C STATUS CI 0.01 G8989CIGP 7110570 - PT-SELF CARE D/C STATUS CJ 0.01 G8989CJGP 7110575 - PT-SELF CARE D/C STATUS CK 0.01 G8989CKGP 7110580 - PT-SELF CARE D/C STATUS CL 0.01 G8989CLGP 7110585 - PT-SELF CARE D/C STATUS CM 0.01 G8989CMGP 7110590 - PT-SELF CARE D/C STATUS CN 0.01 G8989CNGP 7110595 - PT-SELF CARE GOAL STATUS CH 0.01 G8988CHGP 7110600 - PT-SELF CARE GOAL STATUS CI 0.01 G8988CIGP 7110605 - PT-SELF CARE GOAL STATUS CJ 0.01 G8988CJGP 7110610 - PT-SELF CARE GOAL STATUS CK 0.01 G8988CKGP 7110615 - PT-SELF CARE GOAL STATUS CL 0.01 G8988CLGP 7110620 - PT-SELF CARE GOAL STATUS CM 0.01 G8988CMGP 7110625 - PT-SELF CARE GOAL STATUS CN 0.01 G8988CNGP 7110630 - PHYSICAL THERAPY-I/P LATE CHARGE 0.01 7110635 - PHYSICAL THERAPY-O/P LATE CHARGE 0.01 7110640 - PT EVAL LOW COMPLEX 20 MIN 287 97161GP 7110645 - PT EVAL MOD COMPLEX 30 MIN 317 97162GP 7110650 - PT EVAL HIGH COMPLEX 45 MIN 362 97163GP 7110655 - PT RE-EVAL EST PLAN 260 97164 7120000 - OT- BODY POS CURRENT STATUS CH 0.01 G8981CHGO 7120005 - OT- BODY POS CURRENT STATUS CI 0.01 G8981CIGO 7120010 - OT- BODY POS CURRENT STATUS CJ 0.01 G8981CJGO 7120015 - OT- BODY POS CURRENT STATUS CK 0.01 G8981CKGO 7120020 - OT- BODY POS CURRENT STATUS CL 0.01 G8981CLGO 7120025 - OT- BODY POS CURRENT STATUS CM 0.01 G8981CMGO 7120030 - OT- BODY POS CURRENT STATUS CN 0.01 G8981CNGO 7120035 - OT- BODY POSITION D/C STATUS CH 0.01 G8983CHGO 7120040 - OT- BODY POSITION D/C STATUS CI 0.01 G8983CIGO 7120045 - OT- BODY POSITION D/C STATUS CJ 0.01 G8983CJGO 7120050 - OT- BODY POSITION D/C STATUS CK 0.01 G8983CKGO 7120055 - OT- BODY POSITION D/C STATUS CL 0.01 G8983CLGO 7120060 - OT- BODY POSITION D/C STATUS CM 0.01 G8983CMGO 7120065 - OT- BODY POSITION D/C STATUS CN 0.01 G8983CNGO 7120070 - OT- BODY POSITION GOAL STATUS CH 0.01 G8982CHGO 7120075 - OT- BODY POSITION GOAL STATUS CI 0.01 G8982CIGO 7120080 - OT- BODY POSITION GOAL STATUS CJ 0.01 G8982CJGO 7120085 - OT- BODY POSITION GOAL STATUS CK 0.01 G8982CKGO 7120090 - OT- BODY POSITION GOAL STATUS CL 0.01 G8982CLGO 7120095 - OT- BODY POSITION GOAL STATUS CM 0.01 G8982CMGO 7120100 - OT- BODY POSITION GOAL STATUS CN 0.01 G8982CNGO 7120105 - OT- CARRY CURRENT STATUS CH 0.01 G8984CHGO 7120110 - OT- CARRY CURRENT STATUS CI 0.01 G8984CIGO 7120115 - OT- CARRY CURRENT STATUS CJ 0.01 G8984CJGO 7120120 - OT- CARRY CURRENT STATUS CK 0.01 G8984CKGO 7120125 - OT- CARRY CURRENT STATUS CL 0.01 G8984CLGO 7120130 - OT- CARRY CURRENT STATUS CM 0.01 G8984CMGO 7120135 - OT- CARRY CURRENT STATUS CN 0.01 G8984CNGO 7120140 - OT- CARRY D/C STATUS CH 0.01 G8986CHGO 7120145 - OT- CARRY D/C STATUS CI 0.01 G8986CIGO 7120150 - OT- CARRY D/C STATUS CJ 0.01 G8986CJGO 7120155 - OT- CARRY D/C STATUS CK 0.01 G8986CKGO 7120160 - OT- CARRY D/C STATUS CL 0.01 G8986CLGO 7120165 - OT- CARRY D/C STATUS CM 0.01 G8986CMGO 7120170 - OT- CARRY D/C STATUS CN 0.01 G8986CNGO 7120175 - OT- CARRY GOAL STATUS CH 0.01 G8985CHGO 7120180 - OT- CARRY GOAL STATUS CI 0.01 G8985CIGO 7120185 - OT- CARRY GOAL STATUS CJ 0.01 G8985CJGO 7120190 - OT- CARRY GOAL STATUS CK 0.01 G8985CKGO 7120195 - OT- CARRY GOAL STATUS CL 0.01 G8985CLGO 7120200 - OT- CARRY GOAL STATUS CM 0.01 G8985CMGO 7120205 - OT- CARRY GOAL STATUS CN 0.01 G8985CNGO 7120210 - OT- MOBILITY CURRENT STATUS CH 0.01 G8978CHGO 7120215 - OT- MOBILITY CURRENT STATUS CI 0.01 G8978CIGO 7120220 - OT- MOBILITY CURRENT STATUS CJ 0.01 G8978CJGO 7120225 - OT- MOBILITY CURRENT STATUS CK 0.01 G8978CKGO 7120230 - OT- MOBILITY CURRENT STATUS CL 0.01 G8978CLGO 7120235 - OT- MOBILITY CURRENT STATUS CM 0.01 G8978CMGO 7120240 - OT- MOBILITY CURRENT STATUS CN 0.01 G8978CNGO 7120245 - OT- MOBILITY D/C STATUS CH 0.01 G8980CHGO 7120250 - OT- MOBILITY D/C STATUS CI 0.01 G8980CIGO 7120255 - OT- MOBILITY D/C STATUS CJ 0.01 G8980CJGO 7120260 - OT- MOBILITY D/C STATUS CK 0.01 G8980CKGO 7120265 - OT- MOBILITY D/C STATUS CL 0.01 G8980CLGO 7120270 - OT- MOBILITY D/C STATUS CM 0.01 G8980CMGO 7120275 - OT- MOBILITY D/C STATUS CN 0.01 G8980CNGO 7120280 - OT- MOBILITY GOAL STATUS CH 0.01 G8979CHGO 7120285 - OT- MOBILITY GOAL STATUS CI 0.01 G8979CIGO 7120290 - OT- MOBILITY GOAL STATUS CJ 0.01 G8979CJGO 7120295 - OT- MOBILITY GOAL STATUS CK 0.01 G8979CKGO 7120300 - OT- MOBILITY GOAL STATUS CL 0.01 G8979CLGO 7120305 - OT- MOBILITY GOAL STATUS CM 0.01 G8979CMGO 7120310 - OT- MOBILITY GOAL STATUS CN 0.01 G8979CNGO 7120315 - OT- OTHER LIMIT CURRENT STATUS CH 0.01 G8990CHGO 7120320 - OT- OTHER LIMIT CURRENT STATUS CI 0.01 G8990CIGO 7120325 - OT- OTHER LIMIT CURRENT STATUS CJ 0.01 G8990CJGO 7120330 - OT- OTHER LIMIT CURRENT STATUS CK 0.01 G8990CKGO 7120335 - OT- OTHER LIMIT CURRENT STATUS CL 0.01 G8990CLGO 7120340 - OT- OTHER LIMIT CURRENT STATUS CM 0.01 G8990CMGO 7120345 - OT- OTHER LIMIT CURRENT STATUS CN 0.01 G8990CNGO 7120350 - OT- OTHER LIMIT D/C STATUS CH 0.01 G8992CHGO 7120355 - OT- OTHER LIMIT D/C STATUS CI 0.01 G8992CIGO 7120360 - OT- OTHER LIMIT D/C STATUS CJ 0.01 G8992CJGO 7120365 - OT- OTHER LIMIT D/C STATUS CK 0.01 G8992CKGO 7120370 - OT- OTHER LIMIT D/C STATUS CL 0.01 G8992CLGO 7120375 - OT- OTHER LIMIT D/C STATUS CM 0.01 G8992CMGO 7120380 - OT- OTHER LIMIT D/C STATUS CN 0.01 G8992CNGO 7120385 - OT- OTHER LIMIT GOAL STATUS CH 0.01 G8991CHGO 7120390 - OT- OTHER LIMIT GOAL STATUS CI 0.01 G8991CIGO 7120395 - OT- OTHER LIMIT GOAL STATUS CJ 0.01 G8991CJGO 7120400 - OT- OTHER LIMIT GOAL STATUS CK 0.01 G8991CKGO 7120405 - OT- OTHER LIMIT GOAL STATUS CL 0.01 G8991CLGO 7120410 - OT- OTHER LIMIT GOAL STATUS CM 0.01 G8991CMGO 7120415 - OT- OTHER LIMIT GOAL STATUS CN 0.01 G8991CNGO 7120420 - OT- OTHER SUBS CURRENT STATUS CH 0.01 G8993CHGO 7120425 - OT- OTHER SUBS CURRENT STATUS CI 0.01 G8993CIGO 7120430 - OT- OTHER SUBS CURRENT STATUS CJ 0.01 G8993CJGO 7120435 - OT- OTHER SUBS CURRENT STATUS CK 0.01 G8993CKGO 7120440 - OT- OTHER SUBS CURRENT STATUS CL 0.01 G8993CLGO 7120445 - OT- OTHER SUBS CURRENT STATUS CM 0.01 G8993CMGO 7120450 - OT- OTHER SUBS CURRENT STATUS CN 0.01 G8993CNGO 7120455 - OT- OTHER SUBS D/C STATUS CH 0.01 G8995CHGO 7120460 - OT- OTHER SUBS D/C STATUS CI 0.01 G8995CIGO 7120465 - OT- OTHER SUBS D/C STATUS CJ 0.01 G8995CJGO 7120470 - OT- OTHER SUBS D/C STATUS CK 0.01 G8995CKGO 7120475 - OT- OTHER SUBS D/C STATUS CL 0.01 G8995CLGO 7120480 - OT- OTHER SUBS D/C STATUS CM 0.01 G8995CMGO 7120485 - OT- OTHER SUBS D/C STATUS CN 0.01 G8995CNGO 7120490 - OT- OTHER SUBS GOAL STATUS CH 0.01 G8994CHGO 7120495 - OT- OTHER SUBS GOAL STATUS CI 0.01 G8994CIGO 7120500 - OT- OTHER SUBS GOAL STATUS CJ 0.01 G8994CJGO 7120505 - OT- OTHER SUBS GOAL STATUS CK 0.01 G8994CKGO 7120510 - OT- OTHER SUBS GOAL STATUS CL 0.01 G8994CLGO 7120515 - OT- OTHER SUBS GOAL STATUS CM 0.01 G8994CMGO 7120520 - OT- OTHER SUBS GOAL STATUS CN 0.01 G8994CNGO 7120525 - OT- SELF CARE CURRENT STATUS CH 0.01 G8987CHGO 7120530 - OT- SELF CARE CURRENT STATUS CI 0.01 G8987CIGO 7120535 - OT- SELF CARE CURRENT STATUS CJ 0.01 G8987CJGO 7120540 - OT- SELF CARE CURRENT STATUS CK 0.01 G8987CKGO 7120545 - OT- SELF CARE CURRENT STATUS CL 0.01 G8987CLGO 7120550 - OT- SELF CARE CURRENT STATUS CM 0.01 G8987CMGO 7120555 - OT- SELF CARE CURRENT STATUS CN 0.01 G8987CNGO 7120560 - OT- SELF CARE D/C STATUS CH 0.01 G8989CHGO 7120565 - OT- SELF CARE D/C STATUS CI 0.01 G8989CIGO 7120570 - OT- SELF CARE D/C STATUS CJ 0.01 G8989CJGO 7120575 - OT- SELF CARE D/C STATUS CK 0.01 G8989CKGO 7120580 - OT- SELF CARE D/C STATUS CL 0.01 G8989CLGO 7120585 - OT- SELF CARE D/C STATUS CM 0.01 G8989CMGO 7120590 - OT- SELF CARE D/C STATUS CN 0.01 G8989CNGO 7120595 - OT- SELF CARE GOAL STATUS CH 0.01 G8988CHGO 7120600 - OT- SELF CARE GOAL STATUS CI 0.01 G8988CIGO 7120605 - OT- SELF CARE GOAL STATUS CJ 0.01 G8988CJGO 7120610 - OT- SELF CARE GOAL STATUS CK 0.01 G8988CKGO 7120615 - OT- SELF CARE GOAL STATUS CL 0.01 G8988CLGO 7120620 - OT- SELF CARE GOAL STATUS CM 0.01 G8988CMGO 7120625 - OT- SELF CARE GOAL STATUS CN 0.01 G8988CNGO 7120630 - OT-I/P LATE CHARGE 0.01 7120635 - OT-O/P LATE CHARGE 0.01 7120640 - OT EVAL LOW COMPLEX 30 MIN 304 97165GO 7120645 - OT EVAL MOD COMPLEX 45 MIN 349 97165GO 7120650 - OT EVAL HIGH COMPLEX 60 MIN 409 97167GO 7130000 - ST-ATTENTION CURRENT STATUS CH 0.01 G9165CHGN 7130005 - ST-ATTENTION CURRENT STATUS CI 0.01 G9165CIGN 7130010 - ST-ATTENTION CURRENT STATUS CJ 0.01 G9165CJGN 7130015 - ST-ATTENTION CURRENT STATUS CK 0.01 G9165CKGN 7130020 - ST-ATTENTION CURRENT STATUS CL 0.01 G9165CLGN 7130025 - ST-ATTENTION CURRENT STATUS CM 0.01 G9165CMGN 7130030 - ST-ATTENTION CURRENT STATUS CN 0.01 G9165CNGN 7130035 - ST-ATTENTION D/C STATUS CH 0.01 G9167CHGN 7130040 - ST-ATTENTION D/C STATUS CI 0.01 G9167CIGN 7130045 - ST-ATTENTION D/C STATUS CJ 0.01 G9167CJGN 7130050 - ST-ATTENTION D/C STATUS CK 0.01 G9167CKGN 7130055 - ST-ATTENTION D/C STATUS CL 0.01 G9167CLGN 7130060 - ST-ATTENTION D/C STATUS CM 0.01 G9167CMGN 7130065 - ST-COMPREHENSIVE D/C STATUS CM 0.01 G9167CNGN 7130070 - ST-ATTENTION GOAL STATUS CH 0.01 G9166CHGN 7130075 - ST-ATTENTION GOAL STATUS 0.01 G9166CIGN 7130080 - ST-ATTENTION GOAL STATUS CJ 0.01 G9166CJGN 7130085 - ST-ATTENTION GOAL STATUS CKJ 0.01 G9166CKGN 7130090 - ST-ATTENTION GOAL STATUS CL 0.01 G9166CLGN 7130100 - ST-ATTENTION GOAL STATUS CN 0.01 G9166CNGN 7130105 - ST COMPREHEN CURRENT STATUS CH 0.01 G9159CHGN 7130110 - ST COMPREHEN CURRENT STATUSCI 0.01 G9159CI 7130115 - ST COMPREHEN CURRENT STATUS CJ 0.01 G9159CJGN 7130120 - ST COMPREHEN CURRENT STATUS CK 0.01 G9159CKGN 7130130 - ST COMPREHEN CURRENT STATUS CM 0.01 G9159CMGN 7130135 - ST COMPREHEN CURRENT STATUS CN 0.01 G9159CNGN 7130140 - ST COMPREHEN CURRENT D/C STATUS CH 0.01 G9161CHGN 7130145 - ST COMPREHEN CURRENT D/C STATUS CI 0.01 G9161CIGN 7130150 - ST COMPREHEN CURRENT D/C STATUS CJ 0.01 G9161CJGN 7130155 - ST COMPREHEN CURRENT D/C STATUS CK 0.01 G9161CKGN 7130160 - ST COMPREHEN CURRENT D/C STATUS CL 0.01 G9161CLGN 7130165 - ST COMPREHEN CURRENT D/C STATUS CM 0.01 G9161CMGN 7130170 - ST COMPREHEN CURRENT D/C STATUS CN 0.01 G9161CNGN 7130175 - ST-COMPREHENSIVE GOAL STATUS CH 0.01 G9160CHGN 7130180 - ST-COMPREHENSIVE GOAL STATUS CI 0.01 G9160CIGN 7130185 - ST-COMPREHENSIVE GOAL STATUS CJ 0.01 G9160CJGN 7130190 - ST-COMPREHENSIVE GOAL STATUS CK 0.01 G9160CKGN 7130195 - ST-COMPREHENSIVE GOAL STATUS CL 0.01 G9160CLGN 7130200 - ST-COMPREHENSIVE GOAL STATUS CM 0.01 G9160CMGN 7130205 - ST-COMPREHENSIVE GOAL STATUS CN 0.01 G9160CNGN 7130210 - ST-EXPRESSION CURRENT STATUS CH 0.01 G9162CHGN 7130215 - ST-EXPRESSION CURRENT STATUS CI 0.01 G9162CIGN 7130220 - ST-EXPRESSION CURRENT STATUS CJ 0.01 G9162CJCN 7130225 - ST-EXPRESSION CURRENT STATUS CK 0.01 G9162CKGN 7130230 - ST-EXPRESSION CURRENT STATUS CL 0.01 G9162CLGN 7130235 - ST-EXPRESSION CURRENT STATUS CM 0.01 G9162CMGN 7130240 - ST-EXPRESSION CURRENT STATUS CN 0.01 G9162CNGN 7130245 - ST-EXPRESSION D/C STATUS CH 0.01 G9164CHGN 713025 - ST-MEMORY CURRENT STATUS CJ 0.01 G9168CJGN 7130250 - ST-EXPRESSION D/C STATUS CI 0.01 G9164CIGN 7130255 - ST-EXPRESSION D/C STATUS CJ 0.01 G9164CJGN 7130260 - ST- EXPRESSION D/C STATUS CK 0.01 G9164CKGN 7130265 - ST-EXPRESSION D/C STATUS CL 0.01 G9164CLGN 7130270 - ST-EXPRESSION D/C STATUS CM 0.01 G9164CMGN 7130275 - ST-EXPRESSION D/C STATUS CN 0.01 G9164CNGN 7130280 - ST-EXPRESSION GOAL STATUS CH 0.01 G9163CHGN 7130285 - ST-EXPRESSION GOAL STATUS CI 0.01 G9163CIGN 7130290 - ST-EXPRESSION GOAL STATUS CJ 0.01 G9163CJGN 7130295 - ST-EXPRESSION GOAL STATUS CK 0.01 G9163CKGN 7130300 - ST-EXPRESSION GOAL STATUS CL 0.01 G9163CLGN 7130305 - ST-EXPRESSION GOAL STATUS CM 0.01 G9163CMGN 7130310 - ST-EXPRESSION GOAL STATUS CN 0.01 G9163CNGN 7130315 - ST-MEMORY CURRENT STATUS CH 0.01 G9168CHGN 7130320 - ST-MEMORY CURRENT STATUS CI 0.01 G9168CIGN 7130330 - ST-MEMORY CURRENT STATUS CK 0.01 G9168CKGN 7130335 - ST-MEMORY CURRENT STATUS CL 0.01 G9168CLGN 7130340 - ST-MEMORY CURRENT STATUS CM 0.01 G9168CMGN 7130345 - ST-MEMORY CURRENT STATUS CN 0.01 G9168CNGN 7130360 - ST-MEMORY D/C STATUS CJ 0.01 G9170CJGN 7130365 - ST-MEMORY D/C STATUS CK 0.01 G9170CKGN 7130370 - ST-MEMORY D/C STATUS CL 0.01 G9170CLGN 7130375 - ST-MEMORY D/C STATUS CK 0.01 G9170CMGN 7130380 - ST-MEMORY D/C STATUS CN 0.01 G9170CNGN 7130385 - ST-MEMORY GOAL STATUS CH 0.01 G9169CHGN 7130390 - ST-MEMORY GOAL STATUS CI 0.01 G9169CIGN 7130395 - ST-MEMORY GOAL STATUS CJ 0.01 G9169CJGN 7130400 - ST-MEMORY GOAL STATUS CK 0.01 G9169CKGN 7130405 - ST-MEMORY GOAL STATUS CL 0.01 G9169CLGN 7130410 - ST-MEMORY GOAL STATUS CM 0.01 G9169CMGN 7130415 - ST-MEMORY GOAL STATUS CH 0.01 G9169CNGN 7130420 - ST-MOTOR SPEECH D/C STATUS CH 0.01 G9158CHGN 7130425 - ST-MEMORY GOAL STATUS CI 0.01 G9158CIGN 7130430 - ST-MEMORY GOAL STATUS CJ 0.01 G9158CJGN 7130435 - ST-MEMORY GOAL STATUS CK 0.01 G9158CKGN 7130440 - ST-MEMORY GOAL STATUS CL 0.01 G9158CLGN 7130445 - ST-MEMORY GOAL STATUS CM 0.01 G9158CMGN 7130455 - ST-MEMORY GOAL GOAL STATUS CH 0.01 G9157CHGN 7130460 - ST-MOTOR SPEECH GOAL STATUS CI 0.01 G9186CIGN 7130465 - ST-MEMORY GOAL GOAL STATUS CH 0.01 G9157CJGN 7130470 - ST-MEMORY GOAL GOAL STATUS CK 0.01 G9157CKGN 7130475 - ST-MEMORY GOAL GOAL STATUS CL 0.01 G9157CLGN 7130480 - ST-MEMORY GOAL GOAL STATUS CM 0.01 G9157CMGN 7130490 - ST-MTR SPEECH CURRENT STATUS CH 0.01 G8999CHGN 7130495 - ST-MTR SPEECH CURRENT STATUS CI 0.01 G8999CIGN 7130500 - ST-MTR SPEECH CURRENT STATUS CJ 0.01 G8999CJGN 7130505 - ST-MOTOR SPEECH CURRENT STATUS CK 0.01 G8999CKGN 7130510 - ST-MTR SPEECH CURRENT STATUS CL 0.01 G8999CLGN 7130515 - ST-MTR SPEECH CURRENT STATUS CM 0.01 G8999CMGN 7130520 - ST-MTR SPEECH CURRENT STATUS CN 0.01 G8999CNGN 7130525 - ST-OTHER PATH CURRENT STATUS CH 0.01 G9174CHGN 7130530 - ST-OTHER PATH CURRENT STATUS CI 0.01 G9174CIGN 7130535 - ST-OTHER PATH CURRENT STATUS CJ 0.01 G9174CJGN 7130545 - ST-OTHER PATH CURRENT STATUS CL 0.01 G9174CLGN 7130550 - ST-OTHER PATH CURRENT STATUS CM 0.01 G9174CMGN 7130555 - ST-OTHER PATH CURRENT STATUS CN 0.01 G9174CNGN 7130560 - ST-OTHER PATH D/C STATUS CK 0.01 G9176CKGN 7130565 - ST-OTHER PATH D/C STATUS CK 0.01 G9176CHGN 7130570 - ST-OTHER PATH D/C STATUS CJ 0.01 G9176CJGN 7130580 - ST-OTHER PATH D/C STATUS CL 0.01 G9176CLGN 7130585 - ST-OTHER PATH D/C STATUS CM 0.01 G9176CMGN 7130590 - ST-OTHER PATH D/C STATUS CN 0.01 G9176CNGN 7130595 - ST-OTHER PATH GOAL STATUS CH 0.01 G9175CHGN 7130600 - ST-OTHER PATH GOAL STATUS CI 0.01 G9175CIGN 7130605 - ST-OTHER PATH GOAL STATUS CJ 0.01 G9175CJGN 7130610 - ST-OTHER PATH D/C STATUS CK 0.01 G9175CKGN 7130615 - ST-OTHER PATH GOAL STATUS CL 0.01 G9175CLGN 7130620 - ST-OTHER PATH GOAL STATUS CM 0.01 G9175CMGN 7130625 - ST-OTHER PATH GOAL STATUS CN 0.01 G9175CNGN 7130630 - ST-SWALLOW CURRENT STATUS CH 0.01 G8996CHGN 7130635 - ST-SWALLOW CURRENT STATUS CI 0.01 G8996CIGN 7130640 - ST-SWALLOW CURRENT STATUS CJ 0.01 G8996CJGN 7130645 - ST-SWALLOW CURRENT STATUS CK 0.01 G8996CKCN 7130650 - ST-SWALLOW CURRENT STATUS CL 0.01 G8996CLGN 7130655 - ST-SWALLOW CURRENT STATUS CM 0.01 G8996CMGN 7130660 - ST-SWALLOW CURRENT STATUS CH 0.01 G8996CNGN 7130665 - ST-SWALLOW D/C STATUS CH 0.01 G8998CHGN 7130670 - ST-SWALLOW D/C STATUS CI 0.01 G8998CIGN 7130675 - ST-SWALLOW D/C STATUS CJ 0.01 G8998CJGN 7130680 - ST-SWALLOW D/C STATUS CN 0.01 G8998CKGN 7130685 - ST-SWALLOW D/C STATUS CL 0.01 G8998CLGN 7130690 - ST-SWALLOW D/C STATUS CN 0.01 G8998CMGN 7130695 - ST-SWALLOW D/C STATUS CN 0.01 G8998CNGN 7130700 - ST-SWALLOW GOAL STATUS CH 0.01 G8997CHGN 7130705 - ST-SWALLOW GOAL STATUS CI 0.01 G8997CIGN 7130710 - ST-SWALLOW GOAL STATUS CCJ 0.01 G8997CJGN 7130715 - ST-SWALLOW GOAL STATUS CK 0.01 G8997CKGN 7130720 - ST-SWALLOW GOAL STATUS CL 0.01 G8997CLGN 7130725 - ST-SWALLOW GOAL STATUS CM 0.01 G8997CMGN 7130730 - ST-SWALLOW GOAL STATUS CN 0.01 G8997CNGN 7130735 - ST-VOICE CURRENT STATUS CH 0.01 G9171CHGN 7130740 - ST-VOICE CURRENT STATUS CI 0.01 G9171CIGN 7130745 - ST-VOICE CURRENT STATUS CJ 0.01 G9171CJGN 7130750 - ST-VOICE CURRENT STATUS CK 0.01 G9171CKGN 7130755 - ST-VOICE CURRENT STATUS CL 0.01 G9171CLGN 7130760 - ST-VOICE CURRENT STATUS CM 0.01 G9171CMGN 7130765 - ST-VOICE CURRENT STATUS CN 0.01 G9171CNGN 7130770 - ST-VOICE D/C STATUS CH 0.01 G9173CHGN 7130775 - ST-VOICE D/C STATUS CI 0.01 G9173CIGN 7130780 - ST-VOICE D/C STATUS CJ 0.01 G9173CJGN 7130785 - ST-VOICE D/C STATUS CK 0.01 G9173CKGN 7130790 - ST-VOICE D/C STATUS CL 0.01 G9173CLGN 7130795 - ST-VOICE D/C STATUS CM 0.01 G9173CMGN 7130800 - ST-VOICE D/C STATUS CN 0.01 G9173CNGN 7130805 - ST-VOICE GOAL STATUS CH 0.01 G9172CHGN 7130810 - ST-VOICE GOAL STATUS CI 0.01 G9172CIGN 7130815 - ST-VOICE GOAL STATUS CJ 0.01 G9172CJGN 7130820 - ST-VOICE GOAL STATUS CK 0.01 G9172CKGN 7130825 - ST-VOICE GOAL STATUS CL 0.01 G9172CLGN 7130830 - ST-VOICE GOAL STATUS CM 0.01 G9172CMGN 7130835 - ST-VOICE GOAL STATUS CN 0.01 G9172CNGN 7130840 - ST-SPEECH SOUND LANG COMPREH 632 92523GN 7130845 - ST-EVAL SPEECH PRODUCTION 632 92522GN 7130850 - ST-EVAL SPEECH FLUENCY 632 92521GN 7130855 - ST-I/P LATE CHARGE 0.01 7130860 - ST-O/P LATE CHARGE 0.01 73140 - XR THUMB MIN 2V RT 244.15 73140TC 74000 - MYOGLOBIN BLOOD 190 83874 74001 - AMIKACIN 164.35 80150 74002 - CD4 LYMPHOCYTES 256.5 86361 74003 - DRUG PANEL BLOOD 241.3 G0479 74004 - HEPATITIS C ANTIBODY 178.6 86803 74005 - HEPATITIS DELTA AGENT 178.6 87380 74006 - HIV I SCREENING 133 87389 74007 - SYPHYLLIS TEST QUANTI TATIVE 125.4 86593 74008 - VANCOMYCIN 156.75 80202 74009 - CRYPTOCOCCUS ANTIGN INF AGENT 145.35 87327 74010 - GC CHLAMYDIA AmpDNA PROBE 169.1 87491 74011 - LEGIONELLA ANTIBODY 153.9 86713 74012 - MENINGITIS CIE 169.1 86185 74013 - PNEUMOCYSTIS 256.5 87281 74015 - CT/GC/TV COMBINED 658.3 87491 77711 - US SCROTUM 674.5 76870 77712 - XR VIDEOFLUOROSCOPY 456.95 74230TC 77713 - X-RAY FACL BONES ZYGOMA 3VWS 447.45 70150TC 80001 - D-5-W 150ML 51 80002 - DEXTROSE 50% OR LESS 500ML 1U 66.1 80003 - DEXTROSE > THAN 50% 500ML=1U 82 80017 - SODIUM CHLO NACL 0.9% 250 CC 51 J7050 80020 - NACL 0.9% 200ML 10 J7050 80024 - SODIUM LACTATE 500ML 76 80035 - MANNITOL 20%/WATER 500ML 364 80036 - STERILE WATER 1000ML 21.15 80037 - NACL 1000 ML STERILE 0.9% 53 J7030 80041 - SODIUM BICARBONATE 5% 239 80042 - PLASMA-LYTE/5% DEX 1000ML 101 80043 - DEXTRAN 75 INJ 500ML 381 J7110 80044 - DEXTRAN 40/NS INJ 500ML 0.9% 514 J7100 80045 - DEXTRAN 40/D-5-W INJ 500ML 514 J7100 80046 - DIANEAL W/1.5% DEXTROSE 76 80047 - DIANEAL W/4.25% DEXTROSE 86 80048 - AMINO ACID 3.5% 500ML= 1 UNIT 145 80049 - AMINO ACID 7% TO-8.5% 500ML1U 398 80050 - CORD TUR CAUTERY 35.15 80051 - GLYCINE 1.5% IRRIGATION SOL 86 80052 - STERILE WATER FOR IRRIG 000ML 223 80053 - NACL IRRIGATION 3000ML 89 80054 - AMINO ACID 5.5% TO 7%-500ML1U 205 80056 - DIANEAL W/2.5% DEXTROSE 98 80064 - IV SET PEDIATRIC 8 INCHES 15 80070 - TRAY DIALYSIS 123 80200 - TUBE TRACHEOTOMY-LARYNGECTOMY 428.45 A4623 80305 - NACL 0.45% 50ML 28 80306 - 0.45% NACL 100ML 30 80310 - 0.225% NACL 500ML 30 80397 - D-5-HNS 1000ML 33 80403 - DEXTROSE 5% 500ML= 1 UNIT 42 J7042 80405 - D-5-0.45% NACL 250ML 72 80452 - D-5-NACL 0.3% 250CC 8 80494 - D-5-LACT RING 1000ML 38 80495 - D-5-LR 1000ML 95 80545 - D-5-0.9% NACL 250ML INJ 33 J7042 80559 - DEXTROSE 5% NACL-500ML=1 UNIT 42 J7042 80648 - D-5-W 1000CC 76 J7070 80656 - D-5-W 500ML 39 J7060 80664 - D-5-W 250ML 69 80672 - D-5-W 100ML 69 80680 - D-5-W 50ML 69 80690 - D-20-W 500ML 107 80729 - D-10-0.9% NACL 1000ML 78 80730 - D-10-NACL 0.45% 1000ML 68 80731 - D-10-0.225% NACL 1000ML 68 80761 - D-10-W 1000ML 89 80765 - D-10-W 500ML 56 80770 - D-10-0.225% NACL 250ML 30 80775 - DEXTROSE 5% NACL 500 ML=1 U 42 J7042 80777 - D-10-0.45% NACL 1000ML 68 81010 - BLADE MICRO EYE 121.6 81030 - DERMATOME DISPOSABLE 112.1 81034 - LACTATED RINGERS UP TO 1000CC 86 J7120 81042 - LACTATED RINGERS UP TO 1000CC 46 J7120 81113 - RC CARDIAC DOBUTAMIN STRESS TEST 2111.85 78473 81212 - NACL 1000CC 53 J7030 81220 - NACL STERILE-500ML= 1 UNIT 38 J7040 81238 - SODIUM CHOL NACL 0.9% 250 CC 26 J7050 81246 - SODIUM CHOL NACL 0.9% 250CC 69 J7050 81254 - SODIUM CHL NACL 0.9% 250CC 69 J7050 81262 - NACL 0.9% 500CC 26 J7040 81300 - NACL 0.45% 100ML 28 81301 - D-5-NACL 0.45% 1000CC 77 J7030 81302 - SODIUM CHL 0.225% 1000CC 59 J7030 81303 - SODIUM CHL 0.45% 250CC 34 J7050 81305 - NACL STERILE 500ML = 1 UNIT 40 J7040 81306 - SODIUM CHL 0.225% 250CC 28 J7050 81318 - NACL 3.0% 500ML 59 81319 - NACL 5% 500ML 63 81351 - RINGERS 1000ML 68 J7120 88113 - 02 MASK 0-24 HOURS 337.25 88115 - AEROSOL TREAT NON PRESSURIZED 143.45 94640 88116 - OXYGEN 0-24 HOURS 247 E0424 88117 - CROUPETTE 0-24 HRS. 315.4 88125 - CULTURE EYE ( AEROBIC & ANEROBIC) 262.2 87070 8855 - armband 486.4 88810 - MEASLES - RUBEOLA TITER 237.5 86765 88819 - ST SWALLOW EVAL DYSPHAGIA 311.6 92610GN 88820 - VENTILATOR SUBSEQUENT DAY 1330.95 94003 88823 - MASK TRACH 43.7 88825 - MASK TRACH 0-24 HRS 246.05 88833 - RBC FOLATE 323 82747 88836 - BLADES CAUTERY 5.7 88837 - ARCH BARS 11.4 88839 - URINE BETA STREPT 136.8 87880QW 88840 - HIP PROSTHESIS-INTERMEDIC 15250.35 C1776 88856 - MEASLES - RUBEOLA TITER 125.4 88890 - HOT PACK ROUTINE 75.05 97010GO 88892 - NEEDLE INFUSAID 23.75 88894 - OT ULTRASOUND EA 15 MIN 133.95 97035GO 88896 - OT PARAFFIN EA 15 MIN 95 97018GO 88897 - COLD PACK 75.05 97010GO 88999 - WARMER BLOOD FLUID CUFF 29.45 89112 - OT MASSAGE ROUTINE EA 15 MIN 97.85 97124GO 90020 - L&D TEST CONTRACT STRESS FETAL 538.65 59020 90100 - VESSEL PAW 24.7 90140 - TYPE SCREEN 225.15 86920 90141 - NB EVOKED AUDITORY TEST LMT 184.3 92587 90200 - VESSEL LOOP 18.05 90244 - BLOOD TYPING SEROLOGIC RH PHENOTYPING CO 44 86906 90280 - BLOOD TYPING ABO 69.35 86900 90285 - POOLING PLATELETS/OTHER BLOOD PRODUCTS 133.26 86965 90286 - HGB/RBCS FETAL FETOMATERNAL HEMRRG DIF 149.4 85460 90287 - ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM 190.95 86880 90288 - BLOOD TYPING SEROLOGIC ABO 69.35 86900 90440 - ANTIBODY SCREENING 206.15 86850 90500 - COOMB'S TEST INDIRECT TITER 267.9 86886 90520 - NEEDLE INTRAOSSEOUS 71.25 90530 - SET PNEUMOTHORAX 323 90610 - MANIPULATOR UTERINE 169.1 90700 - VENOUS PRESSURE CLAMP 68.4 A4918 90710 - CORD BLOOD 615.6 91010 - UNLISTED TRANSF MEDICINE PROCEDURE 753.35 86999 91125 - PELVIC EXAM W/ANESTHESIA OTHER THAN LOCA 2344.5 57410 91300 - BIT ORTHO DRILL 58.9 91310 - DRILL NAIL 38 91500 - SAW GIGLI DISPOSABLE 96.9 91510 - STIMULATOR NERVE 137.75 91550 - ARTHOGRAM KNEE I&S 349.6 73580TC 91600 - SAW/BLADES POWER 323.95 91630 - XR VENOGRAPHY EXTREMITY UNI LAT RT 1614.05 75820TC 91700 - DRILL WIRE PASS 311.6 91710 - BURR CARBIDE DISPOSABLE 113.05 92000 - AIRWAY 36.1 92100 - NM THALLIUM MYOCARD PERF MULT 2622 78451 92360 - 2D ECHOCARDIOGRAM 1675.8 93307 93010 - TRANSDUCER DISPOSABLE 423.7 93250 - DOPPLER COLOR FLOW VELOCTY MA 506.35 93325 94010 - BRUSH BRONCH DISPOSABLE 92.15 94029 - 5M ROOM & CARE - PSYCH SEMI 1248.3 94031 - NSYROOM & CARE - LEVEL III 1383.2 94032 - US ABD DOPPLER COMPLETE 1423.1 93975 94033 - ABD DOPPLER LIMITED 979.45 93976 96020 - BLOOD GASES W/ O2 SATURATION 310.65 82805 97180 - RESP RECORDING 430.35 94015 97460 - END TIDAL C02 THERAPY SETUP 322.05 98000 - DIALYSIS ACUTE HEMO 4608.45 G0257 98021 - DIALYSIS HEMO ACUTE 4608.45 G0257 98022 - DIALYSIS ACUTE HEMO 4608.45 G0257 98023 - DIALYSIS ACUTE HEMO ICU 4608.45 G0257 98024 - DIALYSIS ACUTE HEMO EMER.ROOM 4608.45 G0257 99010 - XR OSSEOUS SURVEY BONE METASTACIS 683.05 77075TC 99110 - TOMOGRAPHY 455.05 76100TC 99200 - SIALOGRAM S & I 436.05 70390TC