hospital_id cpt cpt_modifier hcpcs hcpcs_modifier DRG APR-DRG Severity APC APG rev_code item_category item_id item_name item_description item_setting gross_charge cash_price 330184 10005 5071 2 761 FNA BX W/US GDN 1ST LES-10005 O "$1,740.00 " "$1,131.00 " 330184 10006 2 761 FNA BX W/US GDN EA ADDL-10006 O $150.00 $97.50 330184 10007 5071 2 761 FNA BX W/FLUOR GDN 1ST LES-10007 O "$1,740.00 " "$1,131.00 " 330184 10008 2 761 FNA BX W/FLUOR GDN EA ADDL-10008 O $185.00 $120.25 330184 10009 5071 2 761 FNA BX W/CT GDN 1ST LES-10009 O "$1,740.00 " "$1,131.00 " 330184 10010 2 761 FNA BX W/CT GDN EA LES-10010 O $248.00 $161.20 330184 10011 5071 761 FNA BX W/MR GDN 1ST LES-10011 O "$1,740.00 " "$1,131.00 " 330184 10012 761 FNA BX W/MR GDN EA LES-10012 O $248.00 $161.20 330184 10021 5052 761 RAD SPEC FNA W/O GUID O $864.00 $561.60 330184 10021 5052 510 Fine needle asp. w/o imag O $864.00 $561.60 330184 10030 5071 4 761 "GUIDE CATH FLUID DRAINAGE,SOFT TISS" O "$1,631.00 " "$1,060.15 " 330184 10035 5071 334 761 PERQ DEV SOFT TISS 1ST IMAG O "$1,631.00 " "$1,060.15 " 330184 10036 334 761 PERQ DEV SOFT TISS ADD IMAG O $593.00 $385.45 330184 10060 5051 3 761 RAD SPEC SKIN ABSCSS DRNG O $486.15 $316.00 330184 10060 5051 3 361 I&D ABSCESS SMP/SINGLE O $486.15 $316.00 330184 10060 5051 3 361 I&D ABSCESS SMPL/SNGL O $486.15 $316.00 330184 10060 5051 3 450 I&D ABSCESS O $486.15 $316.00 330184 10061 5052 361 I&D ABSCESS MULTI/CMPLICA O $929.25 $604.01 330184 10061 5052 761 I&D ABSC; COMPL OR MULTI-10061 O $929.25 $604.01 330184 10061 5052 510 Drainage Of Skin Absces O $929.25 $604.01 330184 10061 5052 450 I&D ABSCESS MULTIP/COMPLX O $929.25 $604.01 330184 10080 5071 450 I&D OF PILONDIAL CYST SIM O "$1,366.00 " $887.90 330184 10080 5071 510 INC&DRNG PILONDAL CYS SIM O "$1,366.00 " $887.90 330184 10080 5071 510 Drainage Of Pilonidal Cys O "$1,366.00 " $887.90 330184 10081 5071 510 Drainage Of PilonidalCom O "$1,631.00 " "$1,060.15 " 330184 10081 5071 450 I&D PILONID CYST; CPLX-10081 O "$1,631.00 " "$1,060.15 " 330184 10120 5052 3 361 I&R SQ Foreign Body Smpl O $865.00 $562.25 330184 10120 5052 3 450 I&REMOVAL OF FBSUBTANEOU O $865.00 $562.25 330184 10121 5072 361 I&R SQ Foreign Body Com - O "$3,742.00 " "$2,432.30 " 330184 10121 5072 450 INC & REM FB SQ; COMPL-10121 O "$3,742.00 " "$2,432.30 " 330184 10140 5072 4 361 I&D HEMATOMA/SEROMA/FLUID O "$3,929.10 " "$2,553.92 " 330184 10140 5072 4 450 I&D HEMATOMA SEROMA/FLUID O "$3,929.10 " "$2,553.92 " 330184 10160 5052 3 761 RAD SPEC PUNC DRAIN LESIO O $929.25 $604.01 330184 10160 5052 3 361 PUNC ASP ABSC/HEMATOMA O $929.25 $604.01 330184 10160 5052 3 450 PUNC ASP ABSC/HEM/BUL/CYS O $929.25 $604.01 330184 11000 5053 17 361 DEBRIDE SKIN TO 10% BDY S O "$1,159.00 " $753.35 330184 11000 5053 17 450 DEBRIDE-INFECTED SKIN<10% O "$1,159.00 " $753.35 330184 11000 5053 17 510 Debride Infected Skin 10 O "$1,159.00 " $753.35 330184 11000 5053 17 510 DEBR EXZ/INF SKIN; 10% BS-11000 O "$1,159.00 " $753.35 330184 11001 510 Debride Infected Skin Add O $43.00 $27.95 330184 11001 450 DEBR INFC SKIN ADD-ON =<10% BS-11001 O $43.00 $27.95 330184 11010 5071 450 DEBRIDE OPN FX TO SUBQ O "$1,631.00 " "$1,060.15 " 330184 11012 5073 450 DEBRIDEMENT SKINSUBCNT T O "$6,502.00 " "$4,226.30 " 330184 11042 5052 17 361 Debride skin & SQ tissue O $929.25 $604.01 330184 11042 5052 17 450 DEBRIDE SKIN & SUB Q TISS O $929.25 $604.01 330184 11042 5052 17 450 DEBRIDEMENT-SKIN-PARTIAL O $929.25 $604.01 330184 11042 5052 17 510 Deb Subq Tissue 20 SqC O $929.25 $604.01 330184 11043 5053 17 510 Debride Tissue/muscle O "$1,439.55 " $935.71 330184 11043 5053 17 450 DEBRIDE SKINSUB Q & MUSC O "$1,439.55 " $935.71 330184 11044 5072 510 Debride Tissue/muscle/bon O "$3,224.00 " "$2,095.60 " 330184 11045 18 361 DEBRIDE SKIN FULL THICKNE O $313.00 $203.45 330184 11045 18 361 Exc.benign lesion/margin O $313.00 $203.45 330184 11045 18 510 Deb Subq Tissue Add-on O $313.00 $203.45 330184 11046 18 510 Deb Musc/fascia Add-on O $415.00 $269.75 330184 11047 510 Deb Bone Add-on O "$1,076.25 " $699.56 330184 11055 5051 510 CL-PARE BENIGN LES; SGL-11055 O $389.00 $252.85 330184 11056 5051 510 CL-TRIM SKIN LESIONS 2TO4-1105 O $422.00 $274.30 330184 11057 5051 510 CL-TRIM SKIN LESIONS >4-11057 O $331.00 $215.15 330184 11102 5051 761 TANGNTL BX SKIN SINGLE LES(rad)-11102 O $530.00 $344.50 330184 11102 5051 510 TANGNTL BX SKIN SINGLE LES(cln)-11102 O $530.00 $344.50 330184 11103 761 TANGNTL BX SKIN EA LES(rad)-11103 O $70.00 $45.50 330184 11103 510 TANGNTL BX SKIN EA LES(cln)-11103 O $70.00 $45.50 330184 11104 5051 761 PUNCH BX SKIN SINGLE LES(rad)-11104 O $424.00 $275.60 330184 11104 5051 510 PUNCH BX SKIN SINGLE LES(cln)-11104 O $424.00 $275.60 330184 11105 761 PUNCH BX SKIN EA LES(rad)-11105 O $83.00 $53.95 330184 11105 510 PUNCH BX SKIN EA LES(cln)-11105 O $83.00 $53.95 330184 11106 5052 761 INCAL BX SKN SINGLE LES(rad)-11106 O $943.00 $612.95 330184 11106 5052 510 INCAL BX SKN SINGLE LES(cln)-11106 O $943.00 $612.95 330184 11107 761 INCAL BX SKN EA LES(rad)-11107 O $100.00 $65.00 330184 11107 510 INCAL BX SKN EA LES(cln)-11107 O $100.00 $65.00 330184 11200 5051 361 REMOVE SKIN TAGS O $463.00 $300.95 330184 11200 5051 450 REMOVAL OF SKIN TAGS/AAGA O $463.00 $300.95 330184 11201 510 Remove Skin Tags Add-o O $53.00 $34.45 330184 11201 450 REM SKIN TAGS ADD-ON =<10 LESIONS-11201 O $53.00 $34.45 330184 11300 5051 510 Shave Skin Lesion<=0.5c O $463.00 $300.95 330184 11301 5051 510 Shave Skin Lesion 0.6to1 O $463.00 $300.95 330184 11302 5051 510 Shave Skin Lesion 1.1 to O $463.00 $300.95 330184 11303 5052 510 Shave Skin Lesion >2cm O $885.00 $575.25 330184 11305 5051 510 Shave Skin Lesion=0.5CM O $463.00 $300.95 330184 11306 5051 510 Shave Skin Lesion0.6 to1c O $463.00 $300.95 330184 11307 5051 510 Shave Skin Lesion1.1to2c O $463.00 $300.95 330184 11308 5052 510 Shave Skin Lesion 2cm O $885.00 $575.25 330184 11310 5051 510 Shave Skin Lesion< =0.5 O $463.00 $300.95 330184 11311 5051 510 Shave Skin Lesion0.6to1c O $463.00 $300.95 330184 11312 5052 510 Shave Skin Lesion 1.1to2 O $885.00 $575.25 330184 11313 5052 510 Shave Skin Lesion> 2cm O $885.00 $575.25 330184 11400 5071 361 EXC BNG LES TNKARMLEG<= O "$1,631.00 " "$1,060.15 " 330184 11400 5071 450 EXCISION BENIGN LESION 0. O "$1,631.00 " "$1,060.15 " 330184 11401 5052 361 Exc BNG LES Tnk Arm .6-1 O $885.00 $575.25 330184 11401 5052 510 Exc Tr-ext B9+marg0.6-1 O $885.00 $575.25 330184 11401 5052 450 EXC TR EXT B9+MARG .6-1CM O $885.00 $575.25 330184 11402 5071 510 Exc Tr-ext B9+marg 1.1-2 O "$1,631.00 " "$1,060.15 " 330184 11402 5071 510 Exc Tr-ext B9+marg1.1-2 O "$1,631.00 " "$1,060.15 " 330184 11402 5071 450 EXC TR EXT B9+MARG 1.1-2 O "$1,631.00 " "$1,060.15 " 330184 11403 5071 510 Exc Tr-ext B9+marg 2.1-3 O "$1,631.00 " "$1,060.15 " 330184 11403 5071 510 Exc Tr-ext B9+marg2.1-3 O "$1,631.00 " "$1,060.15 " 330184 11403 5071 450 EXC TR EXT B9+MARG 2.1-3 O "$1,631.00 " "$1,060.15 " 330184 11404 5072 450 DEBRIDE SKIN - FULL THICK O "$3,742.00 " "$2,432.30 " 330184 11404 5072 510 Exc Tr-ext B9+marg3.1-4 O "$3,742.00 " "$2,432.30 " 330184 11404 5072 450 EXC TR EXT B9+MARG 3.1-4 O "$3,742.00 " "$2,432.30 " 330184 11406 5072 510 Exc Tr-ext B9+marg > 4.0 O "$3,742.00 " "$2,432.30 " 330184 11406 5072 450 EXC TR EXT B9+MARG>4CM O "$3,742.00 " "$2,432.30 " 330184 11420 5072 361 Exc Bgn Les Sclp NK < 5cm O "$3,742.00 " "$2,432.30 " 330184 11420 5072 450 EXC HFNKSP B9+MARG 0.5/< O "$3,742.00 " "$2,432.30 " 330184 11420 5072 510 EXC BLES S/N/EX G; 0.5CM/<-11420 O "$3,742.00 " "$2,432.30 " 330184 11421 5071 361 EXC BN LES SCLPNK .6-1c O "$1,631.00 " "$1,060.15 " 330184 11421 5071 450 EXC HFNKSP B9+MARG 0.6-1 O "$1,631.00 " "$1,060.15 " 330184 11422 5072 510 Exc H-f-nk-sp B9+marg 1. O "$3,742.00 " "$2,432.30 " 330184 11422 5072 450 EXC HFNKSP B9+MARG 1.1-2 O "$3,742.00 " "$2,432.30 " 330184 11423 5072 510 Exc H-f-nk-sp B9+marg 2. O "$3,742.00 " "$2,432.30 " 330184 11423 5072 450 EXC HFNKSP B9+MARG 2.1-3 O "$3,742.00 " "$2,432.30 " 330184 11423 5072 510 EXC BLES S/N/EX G; 2.1-3.0CM-11423 O "$3,742.00 " "$2,432.30 " 330184 11424 5072 510 Exc H-f-nk-sp B9+marg 3. O "$3,742.00 " "$2,432.30 " 330184 11424 5072 450 EXC HFNKSP B9+MARG 3.1-4 O "$3,742.00 " "$2,432.30 " 330184 11424 5072 510 EXC BLES S/N/EX G; 3.1-4.0CM-11424 O "$3,742.00 " "$2,432.30 " 330184 11426 5073 510 Exc H-f-nk-sp B9+marg>4 O "$6,502.00 " "$4,226.30 " 330184 11426 5073 450 EXC HFNKSP B9+MARG > 4CM O "$6,502.00 " "$4,226.30 " 330184 11426 5073 510 EXC BLES S/N/EX G; > 4.0CM-11426 O "$6,502.00 " "$4,226.30 " 330184 11440 5071 510 Exc Bng Les Face <5cm -11 O "$1,631.00 " "$1,060.15 " 330184 11440 5071 450 EXC FACE MM B9+MARG .5/< O "$1,631.00 " "$1,060.15 " 330184 11441 5071 510 Exc Bng Les Face .6-1cm - O "$1,631.00 " "$1,060.15 " 330184 11441 5071 450 EXC FACE MM B9+MARG .6-1 O "$1,631.00 " "$1,060.15 " 330184 11442 5071 510 Exc Face-mm B9+marg1- O "$1,631.00 " "$1,060.15 " 330184 11442 5071 450 EXC FACE MM B9+MARG 1.1-2 O "$1,631.00 " "$1,060.15 " 330184 11443 5072 510 Exc Face-mm B9+marg 2 O "$3,742.00 " "$2,432.30 " 330184 11443 5072 450 EXC FACE MM B9+MARG 2.1-3 O "$3,742.00 " "$2,432.30 " 330184 11444 5072 510 Exc Face-mm B9+marg 3 O "$3,742.00 " "$2,432.30 " 330184 11444 5072 450 EXC FACE MM B9+MARG 3.1-4 O "$3,742.00 " "$2,432.30 " 330184 11446 5073 510 Exc Face-mmB9+marg>4 O "$6,502.00 " "$4,226.30 " 330184 11446 5073 450 EXC FACE MM B9+MARG >4CM O "$6,502.00 " "$4,226.30 " 330184 11450 5073 450 RMV SWT GLND LSNAXLR SIM O "$6,502.00 " "$4,226.30 " 330184 11450 50 5073 450 RMVL SWEAT GLND AXL LSN SMP-BIL O "$6,502.00 " "$4,226.30 " 330184 11450 LT 5073 450 RMVL SWEAT GLND AXL LSN SMP-LT O "$6,502.00 " "$4,226.30 " 330184 11450 RT 5073 450 RMVL SWEAT GLND AXL LSN SMP-RT O "$6,502.00 " "$4,226.30 " 330184 11451 5073 450 RMV SWT GLND LSNAXL COMP O "$6,502.00 " "$4,226.30 " 330184 11451 50 5073 450 RMVL SWEAT GLND AXL LSN CMPL-BIL O "$6,502.00 " "$4,226.30 " 330184 11451 LT 5073 450 RMVL SWEAT GLND AXLT LSN CMPL-LT O "$6,502.00 " "$4,226.30 " 330184 11451 RT 5073 450 RMVL SWEAT GLND AXL LSN CMPL-RT O "$6,502.00 " "$4,226.30 " 330184 11462 5073 450 RMV SWT GLND LSNING SIMP O "$6,502.00 " "$4,226.30 " 330184 11462 50 5073 450 RMVL SWEAT GLND ING LSN SMP-BIL O "$6,502.00 " "$4,226.30 " 330184 11462 LT 5073 450 RMVL SWEAT GLND ING LSN SMP-LT O "$6,502.00 " "$4,226.30 " 330184 11462 RT 5073 450 RMVL SWEAT GLND ING LSN SMP-RT O "$6,502.00 " "$4,226.30 " 330184 11463 5073 450 RMV SWT GLND LSNING COMP O "$6,502.00 " "$4,226.30 " 330184 11463 50 5073 450 RMVL SWEAT GLND ING LSN CMPL-BIL O "$6,502.00 " "$4,226.30 " 330184 11463 LT 5073 450 RMVL SWEAT GLND ING LSN CMPL-LT O "$6,502.00 " "$4,226.30 " 330184 11463 RT 5073 450 RMVL SWEAT GLND ING LSN CMPL-RT O "$6,502.00 " "$4,226.30 " 330184 11470 5073 450 RMV SWT GLND LSNPRNL SIM O "$6,502.00 " "$4,226.30 " 330184 11471 5073 450 RMV SWT GLND LSNPRNL COM O "$6,502.00 " "$4,226.30 " 330184 11600 5071 510 Exc Tr-ext Mal+marg 0.5 O "$1,631.00 " "$1,060.15 " 330184 11601 5071 510 Exc Tr-ext Mal+marg 0.6 O "$1,631.00 " "$1,060.15 " 330184 11602 5052 510 Exc Tr-ext Mal+marg 1.1 O $885.00 $575.25 330184 11603 5071 510 Exc Tr-ext Mal+marg 2.1 O "$1,631.00 " "$1,060.15 " 330184 11604 5071 510 EXC TR-EXT MAL+MARG 3.1-4 CM-11604 O "$1,723.00 " "$1,119.95 " 330184 11606 5072 510 EXC TR-EXT MAL+MARG > 4 CM-11606 O "$4,050.00 " "$2,632.50 " 330184 11620 5072 510 Exc H-f-nk-sp Mal+marg.5 O "$3,742.00 " "$2,432.30 " 330184 11621 5071 510 Exc S/n/h/f/g Mal+mrg.6 O "$1,631.00 " "$1,060.15 " 330184 11622 5071 510 Exc S/n/h/f/g Mal+mrg 1. O "$1,631.00 " "$1,060.15 " 330184 11623 5072 510 Exc S/n/h/f/g Mal+mrg 2. O "$3,742.00 " "$2,432.30 " 330184 11624 5072 510 EXC S/N/H/F/G MAL+MRG 3.1-4-11624 O "$4,050.00 " "$2,632.50 " 330184 11626 5073 510 EXC S/N/H/F/G MAL+MRG > 4 CM-11626 O "$6,988.00 " "$4,542.20 " 330184 11640 5071 510 Exc F/e/e/n/l Mal+mrg .5c O "$1,631.00 " "$1,060.15 " 330184 11641 5071 510 Exc F/e/e/n/l Mal+mrg0.6 O "$1,631.00 " "$1,060.15 " 330184 11642 5071 510 Exc F/e/e/n/l Mal+mrg1.1 O "$1,631.00 " "$1,060.15 " 330184 11643 5072 510 Exc F/e/e/n/l Mal+mrg 2.1 O "$3,742.00 " "$2,432.30 " 330184 11644 5072 510 EXC F/E/E/N/L MAL+MRG 3.1-4-11644 O "$4,050.00 " "$2,632.50 " 330184 11646 5073 510 EXC F/E/E/N/L MAL+MRG > 4 CM-11646 O "$6,988.00 " "$4,542.20 " 330184 11719 5733 510 CL-TRIM ND NAILS-11719 O $135.00 $87.75 330184 11720 5733 510 CL-DEBRIDE NAIL 1TO5-11720 O $172.00 $111.80 330184 11721 5733 510 CL-DEBRIDE NAIL 6+ 11721 O $176.40 $114.66 330184 11730 TA 5051 510 RMV NAIL PLATE LF GRT TOE-CLN O $463.05 $300.98 330184 11730 T1 5051 510 RMV NAIL PLATE LF 2ND DIG-CLN O $463.05 $300.98 330184 11730 T2 5051 510 RMV NAIL PLATE LF 3RD DIG-CLN O $463.05 $300.98 330184 11730 T3 5051 510 RMV NAIL PLATE LF 4TH DIG-CLN O $463.05 $300.98 330184 11730 T4 5051 510 RMV NAIL PLATE LF 5TH DIG-CLN O $463.05 $300.98 330184 11730 F1 5051 510 RMV NAIL PLATE LH 2ND DIG-CLN O $463.05 $300.98 330184 11730 F2 5051 510 RMV NAIL PLATE LH 3RD DIG-CLN O $463.05 $300.98 330184 11730 F3 5051 510 RMV NAIL PLATE LH 4TH DIG-CLN O $463.05 $300.98 330184 11730 F4 5051 510 RMV NAIL PLATE LH 5TH DIG-CLN O $463.05 $300.98 330184 11730 FA 5051 510 RMV NAIL PLATE LT THUMB-CLN O $463.05 $300.98 330184 11730 T5 5051 510 RMV NAIL PLATE RF GRT TOE-CLN O $463.05 $300.98 330184 11730 T6 5051 510 RMV NAIL PLATE RF 2ND DIG-CLN O $463.05 $300.98 330184 11730 T7 5051 510 RMV NAIL PLATE RF 3RD DIG-CLN O $463.05 $300.98 330184 11730 T8 5051 510 RMV NAIL PLATE RF 4TH DIG-CLN O $463.05 $300.98 330184 11730 T9 5051 510 RMV NAIL PLATE RF 5TH DIG-CLN O $463.05 $300.98 330184 11730 F6 5051 510 RMV NAIL PLATE RH 2ND DIG-CLN O $463.05 $300.98 330184 11730 F7 5051 510 RMV NAIL PLATE RH 3RD DIG-CLN O $463.05 $300.98 330184 11730 F8 5051 510 RMV NAIL PLATE RH 4TH DIG-CLN O $463.05 $300.98 330184 11730 F9 5051 510 RMV NAIL PLATE RH 5TH DIG-CLN O $463.05 $300.98 330184 11730 F5 5051 510 RMV NAIL PLATE RT THUMB-CLN O $463.05 $300.98 330184 11730 5051 450 REMOVAL OF NAIL PLATE O $463.05 $300.98 330184 11730 TA 5051 450 RMV NAIL PLATE LF GRT TOE-ER O $463.05 $300.98 330184 11730 T1 5051 450 RMV NAIL PLATE LF 2ND DIG-ER O $463.05 $300.98 330184 11730 T2 5051 450 RMV NAIL PLATE LF 3RD DIG-ER O $463.05 $300.98 330184 11730 T3 5051 450 RMV NAIL PLATE LF 4TH DIG-ER O $463.05 $300.98 330184 11730 T4 5051 450 RMV NAIL PLATE LF 5TH DIG-ER O $463.05 $300.98 330184 11730 F1 5051 450 RMV NAIL PLATE LH 2ND DIG-ER O $463.05 $300.98 330184 11730 F2 5051 450 RMV NAIL PLATE LH 3RD DIG-ER O $463.05 $300.98 330184 11730 F3 5051 450 RMV NAIL PLATE LH 4TH DIG-ER O $463.05 $300.98 330184 11730 F4 5051 450 RMV NAIL PLATE LH 5TH DIG-ER O $463.05 $300.98 330184 11730 FA 5051 450 RMV NAIL PLATE LT THUMB-ER O $463.05 $300.98 330184 11730 T5 5051 450 RMV NAIL PLATE RF GRT TOE-ER O $463.05 $300.98 330184 11730 T6 5051 450 RMV NAIL PLATE RF 2ND DIG-ER O $463.05 $300.98 330184 11730 T7 5051 450 RMV NAIL PLATE RF 3RD DIG-ER O $463.05 $300.98 330184 11730 T8 5051 450 RMV NAIL PLATE RF 4TH DIG-ER O $463.05 $300.98 330184 11730 T9 5051 450 RMV NAIL PLATE RF 5TH DIG-ER O $463.05 $300.98 330184 11730 F6 5051 450 RMV NAIL PLATE RH 2ND DIG-ER O $463.05 $300.98 330184 11730 F7 5051 450 RMV NAIL PLATE RH 3RD DIG-ER O $463.05 $300.98 330184 11730 F8 5051 450 RMV NAIL PLATE RH 4TH DIG-ER O $463.05 $300.98 330184 11730 F9 5051 450 RMV NAIL PLATE RH 5TH DIG-ER O $463.05 $300.98 330184 11730 F5 5051 450 RMV NAIL PLATE RT THUMB-ER O $463.05 $300.98 330184 11732 TA 510 RMV NAIL PLT LF GRT TOE ADDL-CLN O $51.45 $33.44 330184 11732 T1 510 RMV NAIL PLT LF 2ND DIG ADDL-CLN O $51.45 $33.44 330184 11732 T2 510 RMV NAIL PLT LF 3RD DIG ADDL-CLN O $51.45 $33.44 330184 11732 T3 510 RMV NAIL PLT LF 4TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 T4 510 RMV NAIL PLT LF 5TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 F1 510 RMV NAIL PLT LH 2ND DIG ADDL-CLN O $51.45 $33.44 330184 11732 F2 510 RMV NAIL PLT LH 3RD DIG ADDL-CLN O $51.45 $33.44 330184 11732 F3 510 RMV NAIL PLT LH 4TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 F4 510 RMV NAIL PLT LH 5TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 FA 510 RMV NAIL PLT LT THUMB ADDL-CLN O $51.45 $33.44 330184 11732 T5 510 RMV NAIL PLT RF GRT TOE ADDL-CLN O $51.45 $33.44 330184 11732 T6 510 RMV NAIL PLT RF 2ND DIG ADDL-CLN O $51.45 $33.44 330184 11732 T7 510 RMV NAIL PLT RF 3RD DIG ADDL-CLN O $51.45 $33.44 330184 11732 T8 510 RMV NAIL PLT RF 4TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 T9 510 RMV NAIL PLT RF 5TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 F6 510 RMV NAIL PLT RH 2ND DIG ADDL-CLN O $51.45 $33.44 330184 11732 F7 510 RMV NAIL PLT RH 3RD DIG ADDL-CLN O $51.45 $33.44 330184 11732 F8 510 RMV NAIL PLT RH 4TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 F9 510 RMV NAIL PLT RH 5TH DIG ADDL-CLN O $51.45 $33.44 330184 11732 F5 510 RMV NAIL PLT RT THUMB ADDL-CLN O $51.45 $33.44 330184 11732 450 SPL AVULSE NP; EA ADDTL-11732 O $51.45 $33.44 330184 11740 TA 5734 5 510 DRN BLD UND NAIL LF-GRT TOE-CLN O $197.40 $128.31 330184 11740 T1 5734 5 510 DRN BLD UND NAIL LF-2ND DIG-CLN O $197.40 $128.31 330184 11740 T2 5734 5 510 DRN BLD UND NAIL LF-3RD DIG-CLN O $197.40 $128.31 330184 11740 T3 5734 5 510 DRN BLD UND NAIL LF-4TH DIG-CLN O $197.40 $128.31 330184 11740 T4 5734 5 510 DRN BLD UND NAIL LF-5TH DIG-CLN O $197.40 $128.31 330184 11740 FA 5734 5 510 DRN BLD UND NAIL LH-THUMB-CLN O $197.40 $128.31 330184 11740 F1 5734 5 510 DRN BLD UND NAIL LH-2ND DIG-CLN O $197.40 $128.31 330184 11740 F2 5734 5 510 DRN BLD UND NAIL LH-3RD DIG-CLN O $197.40 $128.31 330184 11740 F3 5734 5 510 DRN BLD UND NAIL LH-4TH DIG-CLN O $197.40 $128.31 330184 11740 F4 5734 5 510 DRN BLD UND NAIL LH-5TH DIG-CLN O $197.40 $128.31 330184 11740 T5 5734 5 510 DRN BLD UND NAIL RF-GRT TOE-CLN O $197.40 $128.31 330184 11740 T6 5734 5 510 DRN BLD UND NAIL RF-2ND DIG-CLN O $197.40 $128.31 330184 11740 T7 5734 5 510 DRN BLD UND NAIL RF-3RD DIG-CLN O $197.40 $128.31 330184 11740 T8 5734 5 510 DRN BLD UND NAIL RF-4TH DIG-CLN O $197.40 $128.31 330184 11740 T9 5734 5 510 DRN BLD UND NAIL RF-5TH DIG-CLN O $197.40 $128.31 330184 11740 F5 5734 5 510 DRN BLD UND NAIL RH-THUMB-CLN O $197.40 $128.31 330184 11740 F6 5734 5 510 DRN BLD UND NAIL RH-2ND DIG-CLN O $197.40 $128.31 330184 11740 F7 5734 5 510 DRN BLD UND NAIL RH-3RD DIG-CLN O $197.40 $128.31 330184 11740 F8 5734 5 510 DRN BLD UND NAIL RH-4TH DIG-CLN O $197.40 $128.31 330184 11740 F9 5734 5 510 DRN BLD UND NAIL RH-5TH DIG-CLN O $197.40 $128.31 330184 11740 5734 5 450 DRAIN BLOOD FRM UNDR NAIL O $197.40 $128.31 330184 11740 TA 5734 5 450 DRN BLD UND NAIL LF-GRT TOE-ER O $197.40 $128.31 330184 11740 T1 5734 5 450 DRN BLD UND NAIL LF-2ND DIG-ER O $197.40 $128.31 330184 11740 T2 5734 5 450 DRN BLD UND NAIL LF-3RD DIG-ER O $197.40 $128.31 330184 11740 T3 5734 5 450 DRN BLD UND NAIL LF-4TH DIG-ER O $197.40 $128.31 330184 11740 T4 5734 5 450 DRN BLD UND NAIL LF-5TH DIG-ER O $197.40 $128.31 330184 11740 FA 5734 5 450 DRN BLD UND NAIL LH-THUMB-ER O $197.40 $128.31 330184 11740 F1 5734 5 450 DRN BLD UND NAIL LH-2ND DIG-ER O $197.40 $128.31 330184 11740 F2 5734 5 450 DRN BLD UND NAIL LH-3RD DIG-ER O $197.40 $128.31 330184 11740 F3 5734 5 450 DRN BLD UND NAIL LH-4TH DIG-ER O $197.40 $128.31 330184 11740 F4 5734 5 450 DRN BLD UND NAIL LH-5TH DIG-ER O $197.40 $128.31 330184 11740 T5 5734 5 450 DRN BLD UND NAIL RF-GRT TOE-ER O $197.40 $128.31 330184 11740 T6 5734 5 450 DRN BLD UND NAIL RF-2ND DIG-ER O $197.40 $128.31 330184 11740 T7 5734 5 450 DRN BLD UND NAIL RF-3RD DIG-ER O $197.40 $128.31 330184 11740 T8 5734 5 450 DRN BLD UND NAIL RF-4TH DIG-ER O $197.40 $128.31 330184 11740 T9 5734 5 450 DRN BLD UND NAIL RF-5TH DIG-ER O $197.40 $128.31 330184 11740 F5 5734 5 450 DRN BLD UND NAIL RH-THUMB-ER O $197.40 $128.31 330184 11740 F6 5734 5 450 DRN BLD UND NAIL RH-2ND DIG-ER O $197.40 $128.31 330184 11740 F7 5734 5 450 DRN BLD UND NAIL RH-3RD DIG-ER O $197.40 $128.31 330184 11740 F8 5734 5 450 DRN BLD UND NAIL RH-4TH DIG-ER O $197.40 $128.31 330184 11740 F9 5734 5 450 DRN BLD UND NAIL RH-5TH DIG-ER O $197.40 $128.31 330184 11750 5052 450 EXCISION NAIL/NAIL MATRIX O $857.85 $557.60 330184 11750 TA 5052 510 RMV NAIL BED LF GRT TOE ADL-CLN O $857.85 $557.60 330184 11750 T1 5052 510 RMV NAIL BED LF 2ND DIG ADL-CLN O $857.85 $557.60 330184 11750 T2 5052 510 RMV NAIL BED LF 3RD DIG ADL-CLN O $857.85 $557.60 330184 11750 T3 5052 510 RMV NAIL BED LF 4TH DIG ADL-CLN O $857.85 $557.60 330184 11750 T4 5052 510 RMV NAIL BED LF 5TH DIG ADL-CLN O $857.85 $557.60 330184 11750 F1 5052 510 RMV NAIL BED LH 2ND DIG ADL-CLN O $857.85 $557.60 330184 11750 F2 5052 510 RMV NAIL BED LH 3RD DIG ADL-CLN O $857.85 $557.60 330184 11750 F3 5052 510 RMV NAIL BED LH 4TH DIG ADL-CLN O $857.85 $557.60 330184 11750 F4 5052 510 RMV NAIL BED LH 5TH DIG ADL-CLN O $857.85 $557.60 330184 11750 FA 5052 510 RMV NAIL BED LT THUMB ADL-CLN O $857.85 $557.60 330184 11750 T5 5052 510 RMV NAIL BED RF GRT TOE ADL-CLN O $857.85 $557.60 330184 11750 T6 5052 510 RMV NAIL BED RF 2ND DIG ADL-CLN O $857.85 $557.60 330184 11750 T7 5052 510 RMV NAIL BED RF 3RD DIG ADL-CLN O $857.85 $557.60 330184 11750 T8 5052 510 RMV NAIL BED RF 4TH DIG ADL-CLN O $857.85 $557.60 330184 11750 T9 5052 510 RMV NAIL BED RF 5TH DIG ADL-CLN O $857.85 $557.60 330184 11750 F6 5052 510 RMV NAIL BED RH 2ND DIG ADL-CLN O $857.85 $557.60 330184 11750 F7 5052 510 RMV NAIL BED RH 3RD DIG ADL-CLN O $857.85 $557.60 330184 11750 F8 5052 510 RMV NAIL BED RH 4TH DIG ADL-CLN O $857.85 $557.60 330184 11750 F9 5052 510 RMV NAIL BED RH 5TH DIG ADL-CLN O $857.85 $557.60 330184 11750 F5 5052 510 RMV NAIL BED RT THUMB ADL-CLN O $857.85 $557.60 330184 11750 TA 5052 450 RMV NAIL BED LF GRT TOE ADL-ER O $857.85 $557.60 330184 11750 T1 5052 450 RMV NAIL BED LF 2ND DIG ADL-ER O $857.85 $557.60 330184 11750 T2 5052 450 RMV NAIL BED LF 3RD DIG ADL-ER O $857.85 $557.60 330184 11750 T3 5052 450 RMV NAIL BED LF 4TH DIG ADL-ER O $857.85 $557.60 330184 11750 T4 5052 450 RMV NAIL BED LF 5TH DIG ADL-ER O $857.85 $557.60 330184 11750 F1 5052 450 RMV NAIL BED LH 2ND DIG ADL-ER O $857.85 $557.60 330184 11750 F2 5052 450 RMV NAIL BED LH 3RD DIG ADL-ER O $857.85 $557.60 330184 11750 F3 5052 450 RMV NAIL BED LH 4TH DIG ADL-ER O $857.85 $557.60 330184 11750 F4 5052 450 RMV NAIL BED LH 5TH DIG ADL-ER O $857.85 $557.60 330184 11750 FA 5052 450 RMV NAIL BED LT THUMB ADL-ER O $857.85 $557.60 330184 11750 T5 5052 450 RMV NAIL BED RF GRT TOE ADL-ER O $857.85 $557.60 330184 11750 T6 5052 450 RMV NAIL BED RF 2ND DIG ADL-ER O $857.85 $557.60 330184 11750 T7 5052 450 RMV NAIL BED RF 3RD DIG ADL-ER O $857.85 $557.60 330184 11750 T8 5052 450 RMV NAIL BED RF 4TH DIG ADL-ER O $857.85 $557.60 330184 11750 T9 5052 450 RMV NAIL BED RF 5TH DIG ADL-ER O $857.85 $557.60 330184 11750 F6 5052 450 RMV NAIL BED RH 2ND DIG ADL-ER O $857.85 $557.60 330184 11750 F7 5052 450 RMV NAIL BED RH 3RD DIG ADL-ER O $857.85 $557.60 330184 11750 F8 5052 450 RMV NAIL BED RH 4TH DIG ADL-ER O $857.85 $557.60 330184 11750 F9 5052 450 RMV NAIL BED RH 5TH DIG ADL-ER O $857.85 $557.60 330184 11750 F5 5052 450 RMV NAIL BED RT THUMB ADL-ER O $857.85 $557.60 330184 11755 TA 5071 510 BX NAIL UNIT LF GRT TOE-11755 O "$1,366.00 " $887.90 330184 11755 T1 5071 510 BX NAIL UNIT LF 2ND DIG-11755 O "$1,366.00 " $887.90 330184 11755 T2 5071 510 BX NAIL UNIT LF 3RD DIG-11755 O "$1,366.00 " $887.90 330184 11755 T3 5071 510 BX NAIL UNIT LF 4TH DIG-11755 O "$1,366.00 " $887.90 330184 11755 T4 5071 510 BX NAIL UNIT LF 5TH DIG-11755 O "$1,366.00 " $887.90 330184 11755 FA 5071 510 BX NAIL UNIT LH THMB-11755 O "$1,366.00 " $887.90 330184 11755 F1 5071 510 BX NAIL UNIT LH 2ND DIG-11755 O "$1,366.00 " $887.90 330184 11755 F2 5071 510 BX NAIL UNIT LH 3RD DIG-11755 O "$1,366.00 " $887.90 330184 11755 F3 5071 510 BX NAIL UNIT LH 4TH DIG-11755 O "$1,366.00 " $887.90 330184 11755 F4 5071 510 BX NAIL UNIT LH 5TH DIG-11755 O "$1,366.00 " $887.90 330184 11755 T5 5071 510 BX NAIL UNIT RF GRT TOE-11755 O "$1,366.00 " $887.90 330184 11755 T6 5071 510 BX NAIL UNIT RF 2ND DIG-11755 O "$1,366.00 " $887.90 330184 11755 T7 5071 510 BX NAIL UNIT RF 3RD DIG-11755 O "$1,366.00 " $887.90 330184 11755 T8 5071 510 BX NAIL UNIT RF 4TH DIG-11755 O "$1,366.00 " $887.90 330184 11755 T9 5071 510 BX NAIL UNIT RF 5TH DIG-11755 O "$1,366.00 " $887.90 330184 11755 F5 5071 510 BX NAIL UNIT RH THMB-11755 O "$1,366.00 " $887.90 330184 11755 F6 5071 510 BX NAIL UNIT RH 2ND DIG-11755 O "$1,366.00 " $887.90 330184 11755 F7 5071 510 BX NAIL UNIT RH 3RD DIG-11755 O "$1,366.00 " $887.90 330184 11755 F8 5071 510 BX NAIL UNIT RH 4TH DIG-11755 O "$1,366.00 " $887.90 330184 11755 F9 5071 510 BX NAIL UNIT RH 5TH DIG-11755 O "$1,366.00 " $887.90 330184 11760 5053 5 450 REPAIR OF NAIL BED O $899.85 $584.90 330184 11760 TA 5053 5 450 REPAIR NAIL BED LF GRT TOE-ER O $899.85 $584.90 330184 11760 T1 5053 5 450 REPAIR NAIL BED LF 2ND DIG-ER O $899.85 $584.90 330184 11760 T2 5053 5 450 REPAIR NAIL BED LF 3RD DIG-ER O $899.85 $584.90 330184 11760 T3 5053 5 450 REPAIR NAIL BED LF 4TH DIG-ER O $899.85 $584.90 330184 11760 T4 5053 5 450 REPAIR NAIL BED LF 5TH DIG-ER O $899.85 $584.90 330184 11760 FA 5053 5 450 REPAIR NAIL BED LH THUMB-ER O $899.85 $584.90 330184 11760 F1 5053 5 450 REPAIR NAIL BED LH 2ND DIG-ER O $899.85 $584.90 330184 11760 F2 5053 5 450 REPAIR NAIL BED LH 3RD DIG-ER O $899.85 $584.90 330184 11760 F3 5053 5 450 REPAIR NAIL BED LH 4TH DIG-ER O $899.85 $584.90 330184 11760 F4 5053 5 450 REPAIR NAIL BED LH 5TH DIG-ER O $899.85 $584.90 330184 11760 T5 5053 5 450 REPAIR NAIL BED RF GRT TOE-ER O $899.85 $584.90 330184 11760 T6 5053 5 450 REPAIR NAIL BED RF 2ND DIG-ER O $899.85 $584.90 330184 11760 T7 5053 5 450 REPAIR NAIL BED RF 3RD DIG-ER O $899.85 $584.90 330184 11760 T8 5053 5 450 REPAIR NAIL BED RF 4TH DIG-ER O $899.85 $584.90 330184 11760 T9 5053 5 450 REPAIR NAIL BED RF 5TH DIG-ER O $899.85 $584.90 330184 11760 F5 5053 5 450 REPAIR NAIL BED RH THUMB-ER O $899.85 $584.90 330184 11760 F6 5053 5 450 REPAIR NAIL BED RH 2ND DIG-ER O $899.85 $584.90 330184 11760 F7 5053 5 450 REPAIR NAIL BED RH 3RD DIG-ER O $899.85 $584.90 330184 11760 F8 5053 5 450 REPAIR NAIL BED RH 4TH DIG-ER O $899.85 $584.90 330184 11760 F9 5053 5 450 REPAIR NAIL BED RH 5TH DIG-ER O $899.85 $584.90 330184 11762 TA 5054 510 RECONS NAIL BED LF GRT TOE-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T1 5054 510 RECONS NAIL BED LF 2ND DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T2 5054 510 RECONS NAIL BED LF 3RD DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T3 5054 510 RECONS NAIL BED LF 4TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T4 5054 510 RECONS NAIL BED LF 5TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 FA 5054 510 RECONS NAIL BED LH THUMB-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F1 5054 510 RECONS NAIL BED LH 2ND DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F2 5054 510 RECONS NAIL BED LH 3RD DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F3 5054 510 RECONS NAIL BED LH 4TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F4 5054 510 RECONS NAIL BED LH 5TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T5 5054 510 RECONS NAIL BED RF GRT TOE-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T6 5054 510 RECONS NAIL BED RF 2ND DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T7 5054 510 RECONS NAIL BED RF 3RD DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T8 5054 510 RECONS NAIL BED RF 4TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 T9 5054 510 RECONS NAIL BED RF 5TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F5 5054 510 RECONS NAIL BED RH THUMB-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F6 5054 510 RECONS NAIL BED RH 2ND DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F7 5054 510 RECONS NAIL BED RH 3RD DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F8 5054 510 RECONS NAIL BED RH 4TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11762 F9 5054 510 RECONS NAIL BED RH 5TH DIG-CLN O "$2,438.00 " "$1,584.70 " 330184 11765 TA 5052 510 EXCSN NAIL FOLD LF GRT TOE-CLN O $192.15 $124.90 330184 11765 T1 5052 510 EXCSN NAIL FOLD LF 2ND DIG-CLN O $192.15 $124.90 330184 11765 T2 5052 510 EXCSN NAIL FOLD LF 3RD DIG-CLN O $192.15 $124.90 330184 11765 T3 5052 510 EXCSN NAIL FOLD LF 4TH DIG-CLN O $192.15 $124.90 330184 11765 T4 5052 510 EXCSN NAIL FOLD LF 5TH DIG-CLN O $192.15 $124.90 330184 11765 FA 5052 510 EXCSN NAIL FOLD LH THUMB-CLN O $192.15 $124.90 330184 11765 F1 5052 510 EXCSN NAIL FOLD LH 2ND DIG-CLN O $192.15 $124.90 330184 11765 F2 5052 510 EXCSN NAIL FOLD LH 3RD DIG-CLN O $192.15 $124.90 330184 11765 F3 5052 510 EXCSN NAIL FOLD LH 4TH DIG-CLN O $192.15 $124.90 330184 11765 F4 5052 510 EXCSN NAIL FOLD LH 5TH DIG-CLN O $192.15 $124.90 330184 11765 T5 5052 510 EXCSN NAIL FOLD RF GRT TOE-CLN O $192.15 $124.90 330184 11765 T6 5052 510 EXCSN NAIL FOLD RF 2ND DIG-CLN O $192.15 $124.90 330184 11765 T7 5052 510 EXCSN NAIL FOLD RF 3RD DIG-CLN O $192.15 $124.90 330184 11765 T8 5052 510 EXCSN NAIL FOLD RF 4TH DIG-CLN O $192.15 $124.90 330184 11765 T9 5052 510 EXCSN NAIL FOLD RF 5TH DIG-CLN O $192.15 $124.90 330184 11765 F5 5052 510 EXCSN NAIL FOLD RH THUMB-CLN O $192.15 $124.90 330184 11765 F6 5052 510 EXCSN NAIL FOLD RH 2ND DIG-CLN O $192.15 $124.90 330184 11765 F7 5052 510 EXCSN NAIL FOLD RH 3RD DIG-CLN O $192.15 $124.90 330184 11765 F8 5052 510 EXCSN NAIL FOLD RH 4TH DIG-CLN O $192.15 $124.90 330184 11765 F9 5052 510 EXCSN NAIL FOLD RH 5TH DIG-CLN O $192.15 $124.90 330184 11765 5052 450 EXCISION OF NAIL FOLD TOE O $192.15 $124.90 330184 11765 TA 5052 450 EXCSN NAIL FOLD LF GRT TOE-ER O $192.15 $124.90 330184 11765 T1 5052 450 EXCSN NAIL FOLD LF 2ND DIG-ER O $192.15 $124.90 330184 11765 T2 5052 450 EXCSN NAIL FOLD LF 3RD DIG-ER O $192.15 $124.90 330184 11765 T3 5052 450 EXCSN NAIL FOLD LF 4TH DIG-ER O $192.15 $124.90 330184 11765 T4 5052 450 EXCSN NAIL FOLD LF 5TH DIG-ER O $192.15 $124.90 330184 11765 FA 5052 450 EXCSN NAIL FOLD LH THUMB-ER O $192.15 $124.90 330184 11765 F1 5052 450 EXCSN NAIL FOLD LH 2ND DIG-ER O $192.15 $124.90 330184 11765 F2 5052 450 EXCSN NAIL FOLD LH 3RD DIG-ER O $192.15 $124.90 330184 11765 F3 5052 450 EXCSN NAIL FOLD LH 4TH DIG-ER O $192.15 $124.90 330184 11765 F4 5052 450 EXCSN NAIL FOLD LH 5TH DIG-ER O $192.15 $124.90 330184 11765 T5 5052 450 EXCSN NAIL FOLD RF GRT TOE-ER O $192.15 $124.90 330184 11765 T6 5052 450 EXCSN NAIL FOLD RF 2ND DIG-ER O $192.15 $124.90 330184 11765 T7 5052 450 EXCSN NAIL FOLD RF 3RD DIG-ER O $192.15 $124.90 330184 11765 T8 5052 450 EXCSN NAIL FOLD RF 4TH DIG-ER O $192.15 $124.90 330184 11765 T9 5052 450 EXCSN NAIL FOLD RF 5TH DIG-ER O $192.15 $124.90 330184 11765 F5 5052 450 EXCSN NAIL FOLD RH THUMB-ER O $192.15 $124.90 330184 11765 F6 5052 450 EXCSN NAIL FOLD RH 2ND DIG-ER O $192.15 $124.90 330184 11765 F7 5052 450 EXCSN NAIL FOLD RH 3RD DIG-ER O $192.15 $124.90 330184 11765 F8 5052 450 EXCSN NAIL FOLD RH 4TH DIG-ER O $192.15 $124.90 330184 11765 F9 5052 450 EXCSN NAIL FOLD RH 5TH DIG-ER O $192.15 $124.90 330184 11900 5051 510 Injection Into Skin Lesio O $486.15 $316.00 330184 11901 5051 510 Added Skin Lesions Inj O $463.00 $300.95 330184 11976 5071 510 RMVL OF CONTRACEPTV CAP O "$1,366.00 " $887.90 330184 11980 5735 510 SQ HORMONE PELLET IMPL-11980 O "$1,101.00 " $715.65 330184 11981 5734 510 INSERT DRUG IMPLANT DEVICE O $318.15 $206.80 330184 11982 5735 510 REM DRUG IMPL-11982 O $993.00 $645.45 330184 11983 5735 510 REM W INS DRUG IMPL-11983 O $993.00 $645.45 330184 12001 5051 16 515 Repair Superficial Wound( O $486.15 $316.00 330184 12001 5051 16 361 SIMPLE REPAIR NON FACE-12 O $486.15 $316.00 330184 12001 5051 16 450 SMP RPR NON FACE<2.5 CM O $486.15 $316.00 330184 12002 5051 450 SMP REPR NON FACE 2.6-7.5 O $486.15 $316.00 330184 12002 5051 510 Repair Super Wound 2.6-7 O $486.15 $316.00 330184 12004 5051 450 SMP RPR NON FACE 7.6-12.5 O $486.47 $316.20 330184 12004 5051 510 Repair Super Wound7.6-1 O $486.47 $316.20 330184 12004 5051 510 SREP S/N/A/G/TR/E; 7.6-12.5CM-12004 O $486.47 $316.20 330184 12005 5052 450 SMP RPR NON FACE 12.6-20. O $929.25 $604.01 330184 12005 5052 510 Repair Super Wound2.6-2 O $929.25 $604.01 330184 12005 5052 510 SREP S/N/A/G/TR/E; 12.6-20.0CM-12005 O $929.25 $604.01 330184 12006 5052 450 SMP REPR NONFACE 20.1 30C O $929.25 $604.01 330184 12006 5052 510 Repair Super Wound20.1- O $929.25 $604.01 330184 12006 5052 510 SREP S/N/A/G/TR/E; 20.1-30.0CM-12006 O $929.25 $604.01 330184 12007 5051 450 SMP REPR NONFACE GT 30CM O $463.00 $300.95 330184 12007 5051 510 Repair Super Wound >30 O $463.00 $300.95 330184 12007 5051 510 SREP S/N/A/G/TR/E; > 30CM-12007 O $463.00 $300.95 330184 12011 5051 510 Simple Repair face - 1201 O $486.15 $316.00 330184 12011 5051 450 SMP RPR-FACE<2.5 CM O $486.15 $316.00 330184 12013 5051 450 SMP WND RPR-FACE-2.6-5.0 O $486.47 $316.20 330184 12013 5051 510 Repair SuperWoundFEEN O $486.47 $316.20 330184 12014 5051 450 SMP RPR-FACE-5.1-7.5 CM O $486.47 $316.20 330184 12014 5051 510 Repair SuperWound5.1-7. O $486.47 $316.20 330184 12015 5051 450 SMP RPR-FACE-7.6-12.5 CM O $486.15 $316.00 330184 12015 5051 510 Repair SuperWound7.6-12 O $486.15 $316.00 330184 12016 5052 450 SMP RPR-FACE-12.6-20.0 CM O $463.00 $300.95 330184 12016 5052 510 Repair Super Wound12.6- O $463.00 $300.95 330184 12017 5052 450 SMP REPR FACE 20.1 30CM O $885.00 $575.25 330184 12017 5052 510 RepairSuperWound20.1-3 O $885.00 $575.25 330184 12018 5051 450 SMP REPR FACE GT 30CM O $463.00 $300.95 330184 12018 5051 510 Repair SuperWound>30 O $463.00 $300.95 330184 12020 5053 450 SECOND WOUND CL SIMP/SUPE O "$1,371.00 " $891.15 330184 12020 5053 510 Close Of Split Wound sim O "$1,371.00 " $891.15 330184 12021 5052 450 SECOND WOUND CL SMPL C PA O $885.00 $575.25 330184 12021 5052 510 CloseOf Split Wound w/p O $885.00 $575.25 330184 12021 5052 510 TX S WND DEHIS; W PACK-12021 O $885.00 $575.25 330184 12031 5052 450 INT RPR S/A/T/EXT 2.5CM< O $929.25 $604.01 330184 12032 5052 450 LAYER CLOSURE WOUNDS OF S O $929.25 $604.01 330184 12032 5052 450 INT RPR S/A/T/EXT 2.6-7.5 O $929.25 $604.01 330184 12034 5052 450 INT RPR S/TR/EXT 7.6-12.5 O $929.25 $604.01 330184 12035 5052 450 INT RPR S/A/T/EXT 12.6-20 O $929.25 $604.01 330184 12035 5052 510 INTMD WND REPAIR S/A/T/EXT-12035 O $929.25 $604.01 330184 12036 5053 450 INT RPR S/A/T/EXT 20.1-30 O "$1,371.00 " $891.15 330184 12036 5053 510 INTMD WND REPAIR S/A/T/EXT-12036 O "$1,371.00 " $891.15 330184 12037 5054 450 INT RPR S/TR/EXT > 30 O "$7,579.00 " "$4,926.35 " 330184 12037 5054 510 INTMD WND REPAIR S/TR/EXT 30.0+ CM-12037 O "$7,579.00 " "$4,926.35 " 330184 12041 5052 450 INT RPR N-HF/GNT 2.5CM/< O $929.25 $604.01 330184 12042 5052 450 INT RPR N-HF/GNT 2.6-7.5 O $929.25 $604.01 330184 12044 5053 450 INT RPR N-HF/GNT 7.6-12.5 O "$1,371.00 " $891.15 330184 12045 5053 450 INT RPR N-HF/GNT 12.6-20 O "$1,371.00 " $891.15 330184 12046 5052 450 INT RPR N-HF/GNT 20.1-30 O $885.00 $575.25 330184 12047 5054 450 INT RPR N-HF/GNT > 30 O "$4,320.00 " "$2,808.00 " 330184 12051 5052 450 INT RP FACE/MM 2.5CM/< O $486.47 $316.20 330184 12051 5052 510 INTMD RPR FACE/MM 2.5 CM/<(CLINIC) O $486.47 $316.20 330184 12052 5052 450 LAYER CLOSURE OF WOUNDS O $929.25 $604.01 330184 12052 5052 450 INT RPR FACE/MM 2.6-5 CM O $929.25 $604.01 330184 12053 5052 450 INT RPR FACE/MM 5.1-7.5 O $885.00 $575.25 330184 12054 5052 450 INT RPR FACE/MM 7.6-12.5 O $929.25 $604.01 330184 12055 5052 450 INT RPR FACE/MM 12.6-20 O "$1,786.00 " "$1,160.90 " 330184 12056 5052 450 INT RPR FACE/MM 20.1-30 O $885.00 $575.25 330184 12057 5052 450 INT RPR FACE/MM > 30 O $463.00 $300.95 330184 13100 5053 450 CMP RPR TRNK 1.1-2.5CM O "$1,371.00 " $891.15 330184 13101 5053 450 CMP RPR TRNK 2.6-7.5CM O "$1,371.00 " $891.15 330184 13102 450 CMP RPR TRNK ADDL 5CM/< O $660.00 $429.00 330184 13120 5053 450 CMP RPR SAL 1.1-2.5 CM O "$1,439.55 " $935.71 330184 13120 5053 510 RPR CMPL S/A/L 1.1 TO 2.5 O "$1,439.55 " $935.71 330184 13121 5053 450 CMP RPR SAL 2.6-7.5CM O "$1,371.00 " $891.15 330184 13122 450 CMP RPR SAL ADDL 5 CM/> O $593.00 $385.45 330184 13131 5052 450 CMP RPR FCCMNAXGHF1.1-2.5 O $929.25 $604.01 330184 13132 5053 450 CMP RPR FCCMNAXGHF2.6-7.5 O "$1,439.55 " $935.71 330184 13133 450 CMP RPR FCCMNAXGHF ADDL 5 O $798.00 $518.70 330184 13151 5053 450 CMP RPR ENEL 1.1-2.5CM O "$1,371.00 " $891.15 330184 13152 5053 450 CMP RPR ENEL 2.6-7.5CM O "$1,439.55 " $935.71 330184 13153 450 CMP RPR ENEL ADDL 5CM/< O $910.35 $591.73 330184 13160 5054 450 SECONDARY WOUND COMPLEX/T O "$4,320.00 " "$2,808.00 " 330184 14040 5054 361 Adj Tissu Transfer to 10s O "$4,320.00 " "$2,808.00 " 330184 15851 5054 510 Removal Of Sutures O "$4,320.00 " "$2,808.00 " 330184 16000 5051 361 INIT LOCAL TX 1ST DEG BUR O $463.00 $300.95 330184 16000 5051 450 INITIAL BURN CARE-1ST DEG O $463.00 $300.95 330184 16020 5051 515 Dress/debrid P-thick Burn O $486.15 $316.00 330184 16020 5051 450 DRSG/DEBRIDE-SMALL BURN O $486.15 $316.00 330184 16025 5051 450 DRSG/DEBRIDE-MEDIUM BURN O $463.00 $300.95 330184 16025 5051 510 DRESS/DEBRID P-THICK BURN O $463.00 $300.95 330184 16030 5052 450 DRSG/DEBRIDE-LARGE BURN O $885.00 $575.25 330184 16030 5052 510 DRESS/DEBRID P-THICKBURNL O $885.00 $575.25 330184 17000 5051 510 DestructPremalgLesion1st O $463.00 $300.95 330184 17003 510 Destruct PremalgLes 2-14 O $7.00 $4.55 330184 17004 5052 510 Destroy Premal Les 15/> O $885.00 $575.25 330184 17106 5052 510 DestruOf CVPLesions<10 O $885.00 $575.25 330184 17110 5051 361 Destroy Flat Wart up to 1 O $486.15 $316.00 330184 17110 5051 361 DestrY lesions skin tags O $486.15 $316.00 330184 17111 5051 510 Destruct Lesion 15 Or Mo O $463.00 $300.95 330184 17250 5051 361 Chem Cautery Gran Tiss - O $486.15 $316.00 330184 17250 5051 450 CHEM CAUT GRANUL TISSUE O $486.15 $316.00 330184 17260 5051 510 Destruction Lesions<0.5c O $463.00 $300.95 330184 17261 5051 510 Destruction Lesions 0.6-1 O $463.00 $300.95 330184 17262 5051 510 Destruction Lesions 1.1-2 O $463.00 $300.95 330184 17263 5051 510 Destruction Lesions 2.1-3 O $463.00 $300.95 330184 17270 5051 510 DestructionOfLesions<0.5 O $463.00 $300.95 330184 17271 5051 510 DestructionLesions 0.6-1 O $463.00 $300.95 330184 17272 5051 510 Destruction Lesions1.1-2 O $463.00 $300.95 330184 17273 5052 510 Destruction Lesions 2.1-3 O $885.00 $575.25 330184 17280 5051 510 DestructionLesions <0.5c O $463.00 $300.95 330184 17281 5052 510 Destruction Lesions 0.6-1 O $885.00 $575.25 330184 17282 5052 510 Destruction Lesions 1.1-2 O $885.00 $575.25 330184 17283 5052 510 Destr Lesions 2.1-3 O $885.00 $575.25 330184 19000 LT 5071 2 761 BREAST CYST ASPIR LEFT O "$1,712.55 " "$1,113.16 " 330184 19000 5071 2 761 US BREAST CYST ASPIRATION O "$1,712.55 " "$1,113.16 " 330184 19000 LT 5071 2 761 MG US BRST CYST ASPIR LEFT O "$1,712.55 " "$1,113.16 " 330184 19000 RT 5071 2 761 MG US BRST CYST ASPIR RIGHT O "$1,712.55 " "$1,113.16 " 330184 19000 LT 5071 2 761 DRAINAGE BREAST LESION LT-RAD O "$1,712.55 " "$1,113.16 " 330184 19000 RT 5071 2 761 DRAINAGE BREAST LESION RT-RAD O "$1,712.55 " "$1,113.16 " 330184 19000 LT 5071 2 510 DRAIN BREAST LESION LT O "$1,712.55 " "$1,113.16 " 330184 19000 RT 5071 2 510 DRAIN BREAST LESION RT O "$1,712.55 " "$1,113.16 " 330184 19001 2 761 US BREAST CYST ASPIRATION O $287.70 $187.00 330184 19001 2 761 MG US BRST CYST ASPIR EA ADDL CYST O $287.70 $187.00 330184 19001 LT 2 361 DRAIN BREAST LESION ADD-ON LT-RAD O "$1,712.55 " "$1,113.16 " 330184 19001 RT 2 361 DRAIN BREAST LESION ADD-ON RT-RAD O $287.70 $187.00 330184 19081 5072 20 761 BX BREAST 1ST LESION STRTCTC O "$3,929.10 " "$2,553.92 " 330184 19081 50 5072 20 761 BX BRST 1ST LESION STRTCTC BIL-RAD O "$5,893.65 " "$3,830.87 " 330184 19081 LT 5072 20 761 BX BRST 1ST LESION STRTCTC LT-RAD O "$3,929.10 " "$2,553.92 " 330184 19081 RT 5072 20 761 BX BRST 1ST LESION STRTCTC RT-RAD O "$3,929.10 " "$2,553.92 " 330184 19082 20 761 BX BREAST ADD LESION STRTCTC O "$2,933.70 " "$1,906.91 " 330184 19083 LT 5072 20 761 BX LT BREAST 1ST LESION US IMAG O "$3,224.00 " "$2,095.60 " 330184 19083 50 5072 20 761 BX BIL BREAST 1ST LESION US IMAG O "$4,836.00 " "$3,143.40 " 330184 19083 RT 5072 20 761 BX RT BREAST 1ST LESION US IMAG O "$3,224.00 " "$2,095.60 " 330184 19083 LT 5072 20 761 MG US BRST BX 1ST LESION LEFT O "$3,224.00 " "$2,095.60 " 330184 19083 50 5072 20 761 MG US BRST BX 1ST LESION BILAT O "$4,836.00 " "$3,143.40 " 330184 19083 RT 5072 20 761 MG US BRST BX 1ST LESION RIGHT O "$3,224.00 " "$2,095.60 " 330184 19084 20 761 BX BREAST ADD LESION US IMAG O "$1,815.00 " "$1,179.75 " 330184 19084 20 761 MG US BRST BX ADD LESION O "$1,815.00 " "$1,179.75 " 330184 19085 5072 761 BX BREAST 1ST LESION MR IMAG O "$3,742.00 " "$2,432.30 " 330184 19085 50 5072 761 BX BREAST 1ST LESION MR IMAG BIL-RAD O "$5,613.00 " "$3,648.45 " 330184 19085 LT 5072 761 BX BREAST 1ST LESION MR IMAG LT-RAD O "$3,742.00 " "$2,432.30 " 330184 19085 RT 5072 761 BX BREAST 1ST LESION MR IMAG RT-RAD O "$3,742.00 " "$2,432.30 " 330184 19086 761 BX BREAST ADD LESION MR IMAG O "$4,140.00 " "$2,691.00 " 330184 19100 5072 20 761 IR SPEC PERCU BIOPSY BREA O "$3,742.00 " "$2,432.30 " 330184 19100 50 5072 20 761 BX BRST PERCUT W/O IMG BIL-RAD O "$5,613.00 " "$3,648.45 " 330184 19100 LT 5072 20 761 BX BRST PERCUT W/O IMG LT-RAD O "$3,742.00 " "$2,432.30 " 330184 19100 RT 5072 20 761 BX BRST PERCUT W/O IMG RT-RAD O "$3,742.00 " "$2,432.30 " 330184 19100 50 5072 20 510 BX BREAST PERCUT W/O IMG-BILAT O "$3,742.00 " "$2,432.30 " 330184 19100 RT 5072 20 510 BX BREAST PERCUT W/O IMG-RT O "$3,742.00 " "$2,432.30 " 330184 19100 LT 5072 20 510 BX BREAST PERCUT W/O IMG-LT O "$3,742.00 " "$2,432.30 " 330184 19281 LT 5071 334 761 PERQ DEVICE LT BREAST 1ST MAM IMAG O "$1,712.55 " "$1,113.16 " 330184 19281 50 5071 334 761 PERQ DEVICE BIL BREAST 1ST MAM IMAG O "$2,568.83 " "$1,669.74 " 330184 19281 RT 5071 334 761 PERQ DEVICE RT BREAST 1ST MAM IMAG O "$1,712.55 " "$1,113.16 " 330184 19282 334 761 PERQ DEVICE BREAST EA MAM IMAG O $558.00 $362.70 330184 19283 5071 334 761 PERQ DEV BREAST 1ST STRTCTC O "$1,631.00 " "$1,060.15 " 330184 19283 50 5071 334 761 PERQ DEV BRST 1ST STRTCTC BIL-RAD O "$2,446.50 " "$1,590.23 " 330184 19283 LT 5071 334 761 PERQ DEV BRST 1ST STRTCTC LT-RAD O "$1,631.00 " "$1,060.15 " 330184 19283 RT 5071 334 761 PERQ DEV BRST 1ST STRTCTC RT-RAD O "$1,631.00 " "$1,060.15 " 330184 19284 334 761 PERQ DEV BREAST ADD STRTCTC O "$1,022.00 " $664.30 330184 19285 LT 5071 334 761 PERQ DEV LT BREAST 1ST US IMAG O "$1,712.55 " "$1,113.16 " 330184 19285 50 5071 334 761 PERQ DEV BIL BREAST 1ST US IMAG O "$2,568.83 " "$1,669.74 " 330184 19285 RT 5071 334 761 PERQ DEV RT BREAST 1ST US IMAG O "$1,712.55 " "$1,113.16 " 330184 19285 LT 5071 334 761 MG US BRST LCLZTN 1ST LSN LEFT O "$1,712.55 " "$1,113.16 " 330184 19285 RT 5071 334 761 MG US BRST LCLZTN 1ST LSN RIGHT O "$1,712.55 " "$1,113.16 " 330184 19285 50 5071 334 761 MG US BRST LCLZTN 1ST LSN BILAT O "$2,568.83 " "$1,669.74 " 330184 19286 334 761 PERQ DEV LT BREAST ADD US IMAG O "$1,321.00 " $858.65 330184 19286 334 761 PERQ DEV RT BREAST ADD US IMAG O "$1,321.00 " $858.65 330184 19286 334 761 MG US BRST LCLZTN ADD LESION O "$1,321.00 " $858.65 330184 19287 5071 761 PERQ DEV BREAST 1ST MR GUIDE O "$1,631.00 " "$1,060.15 " 330184 19287 50 5071 761 PERQ DEV BRST 1ST MR GUIDE BIL-RAD O "$2,446.50 " "$1,590.23 " 330184 19287 LT 5071 761 PERQ DEV BRST 1ST MR GUIDE LT-RAD O "$1,631.00 " "$1,060.15 " 330184 19287 RT 5071 761 PERQ DEV BRST 1ST MR GUIDE RT-RAD O "$1,631.00 " "$1,060.15 " 330184 19288 761 PERQ DEV BREAST ADD MR GUIDE O "$3,536.00 " "$2,298.40 " 330184 20206 5072 2 761 IR BX MSCL PERCU O "$3,742.00 " "$2,432.30 " 330184 20220 5072 2 761 CT BIOPSY BONE SUPERFICIA O "$3,224.00 " "$2,095.60 " 330184 20225 5072 51 761 IR Spec Peritoneocentesis O "$3,929.10 " "$2,553.92 " 330184 20225 5072 51 761 CT BIOPSY BONE DEEP O "$3,929.10 " "$2,553.92 " 330184 20240 5073 761 CT BIOPSY BONE OPEN SUPER O "$6,502.00 " "$4,226.30 " 330184 20245 5073 761 CT BIOPSY BONE OPEN DEEP O "$6,502.00 " "$4,226.30 " 330184 20501 278 761 RAD SPEC DIAG SINOGRAM O $140.00 $91.00 330184 20501 278 320 INJECTION SINUS TRACT DIAG-20501 O $118.00 $76.70 330184 20526 50 5441 510 THER INJ CARP TUNNEL BIL-CLN O $595.00 $386.75 330184 20526 LT 5441 510 THER INJ CARP TUNNEL LT-CLN O $595.00 $386.75 330184 20526 RT 5441 510 THER INJ CARP TUNNEL RT-CLN O $595.00 $386.75 330184 20550 5441 49 510 CL-INJ SGL TEND SHTH OR LIGM-2 O $595.00 $386.75 330184 20551 5441 510 CL-INJ TENDON ORIGIN/INSERT-20 O $735.00 $477.75 330184 20552 5441 49 510 Inj Trigger Point 1/2 Mus O $699.00 $454.35 330184 20553 5441 510 INJECT TRIGGER POINTS 3/> 20553 O $793.00 $515.45 330184 20600 5441 49 450 JOINT ASPIRATION-SMALL(FI O $364.35 $236.83 330184 20600 50 5441 49 761 DRN-INJ SML JNT-BRSA W/O US BIL O $546.53 $355.24 330184 20600 LT 5441 49 761 DRN-INJ SML JNT-BRSA W/O US LT O $364.35 $236.83 330184 20600 RT 5441 49 761 DRN-INJ SML JNT-BRSA W/O US RT O $364.35 $236.83 330184 20600 F6 5441 49 510 DRN/INJ SMLL JNT/BURSA R HD 2ND DIG O $364.35 $236.83 330184 20600 F7 5441 49 510 DRN/INJ SMLL JNT/BURSA R HD 3RD DIG O $364.35 $236.83 330184 20600 F8 5441 49 510 DRN/INJ SMLL JNT/BURSA R HD 4TH DIG O $364.35 $236.83 330184 20600 F9 5441 49 510 DRN/INJ SMLL JNT/BURSA R HD 5TH DIG O $364.35 $236.83 330184 20600 T1 5441 49 510 DRN/INJ SMLL JNT/BURSA L FT 2ND DIG O $364.35 $236.83 330184 20600 T2 5441 49 510 DRN/INJ SMLL JNT/BURSA L FT 3RD DIG O $364.35 $236.83 330184 20600 T3 5441 49 510 DRN/INJ SMLL JNT/BURSA L FT 4TH DIG O $364.35 $236.83 330184 20600 T4 5441 49 510 DRN/INJ SMLL JNT/BURSA L FT 5TH DIG O $364.35 $236.83 330184 20600 T5 5441 49 510 DRN/INJ SMLL JNT/BURSA R FT GRT TOE O $364.35 $236.83 330184 20600 T6 5441 49 510 DRN/INJ SMLL JNT/BURSA R FT 2ND DIG O $364.35 $236.83 330184 20600 T7 5441 49 510 DRN/INJ SMLL JNT/BURSA R FT 3RD DIG O $364.35 $236.83 330184 20600 T8 5441 49 510 DRN/INJ SMLL JNT/BURSA R FT 4TH DIG O $364.35 $236.83 330184 20600 T9 5441 49 510 DRN/INJ SMLL JNT/BURSA R FT 5TH DIG O $364.35 $236.83 330184 20600 TA 5441 49 510 DRN/INJ SMLL JNT/BURSA L FT GRT TOE O $364.35 $236.83 330184 20600 F1 5441 49 510 DRN/INJ SMLL JNT/BRSA L HD 2ND DIG O $364.35 $236.83 330184 20600 F2 5441 49 510 DRN/INJ SMLL JNT/BRSA L HD 3RD DIG O $364.35 $236.83 330184 20600 F3 5441 49 510 DRN/INJ SMLL JNT/BRSA L HD 4TH DIG O $364.35 $236.83 330184 20600 F4 5441 49 510 DRN/INJ SMLL JNT/BRSA L HD 5TH DIG O $364.35 $236.83 330184 20600 F5 5441 49 510 DRN/INJ SMLL JNT/BURSA RT THMB O $364.35 $236.83 330184 20600 FA 5441 49 510 DRN/INJ SMLL JNT/BURSA LT THMB O $364.35 $236.83 330184 20600 TA 5441 49 450 DRN/INJ SMLL JNT/BRSA LF GRT TOE-ER O $364.35 $236.83 330184 20600 T1 5441 49 450 DRN/INJ SMLL JNT/BRSA LF 2ND DIG-ER O $364.35 $236.83 330184 20600 T2 5441 49 450 DRN/INJ SMLL JNT/BRSA LF 3RD DIG-ER O $364.35 $236.83 330184 20600 T3 5441 49 450 DRN/INJ SMLL JNT/BRSA LF 4TH DIG-ER O $364.35 $236.83 330184 20600 T4 5441 49 450 DRN/INJ SMLL JNT/BRSA LF 5TH DIG-ER O $364.35 $236.83 330184 20600 FA 5441 49 450 DRN/INJ SMLL JNT/BRSA LH THUMB-ER O $364.35 $236.83 330184 20600 F1 5441 49 450 DRN/INJ SMLL JNT/BRSA LH 2ND DIG-ER O $364.35 $236.83 330184 20600 F2 5441 49 450 DRN/INJ SMLL JNT/BRSA LH 3RD DIG-ER O $364.35 $236.83 330184 20600 F3 5441 49 450 DRN/INJ SMLL JNT/BRSA LH 4TH DIG-ER O $364.35 $236.83 330184 20600 F4 5441 49 450 DRN/INJ SMLL JNT/BRSA LH 5TH DIG-ER O $364.35 $236.83 330184 20600 T5 5441 49 450 DRN/INJ SMLL JNT/BRSA RF GRT TOE-ER O $364.35 $236.83 330184 20600 T6 5441 49 450 DRN/INJ SMLL JNT/BRSA RF 2ND DIG-ER O $364.35 $236.83 330184 20600 T7 5441 49 450 DRN/INJ SMLL JNT/BRSA RF 3RD DIG-ER O $364.35 $236.83 330184 20600 T8 5441 49 450 DRN/INJ SMLL JNT/BRSA RF 4TH DIG-ER O $364.35 $236.83 330184 20600 T9 5441 49 450 DRN/INJ SMLL JNT/BRSA RF 5TH DIG-ER O $364.35 $236.83 330184 20600 F5 5441 49 450 DRN/INJ SMLL JNT/BRSA RH THUMB-ER O $364.35 $236.83 330184 20600 F6 5441 49 450 DRN/INJ SMLL JNT/BRSA RH 2ND DIG-ER O $364.35 $236.83 330184 20600 F7 5441 49 450 DRN/INJ SMLL JNT/BRSA RH 3RD DIG-ER O $364.35 $236.83 330184 20600 F8 5441 49 450 DRN/INJ SMLL JNT/BRSA RH 4TH DIG-ER O $364.35 $236.83 330184 20600 F9 5441 49 450 DRN/INJ SMLL JNT/BRSA RH 5TH DIG-ER O $364.35 $236.83 330184 20604 50 5441 50 761 DRN-INJ SML JNT-BURSA W/US BIL O "$1,048.50 " $681.52 330184 20604 LT 5441 50 761 DRN-INJ SML JNT-BURSA W/US LT O $699.00 $454.35 330184 20604 RT 5441 50 761 DRN-INJ SML JNT-BURSA W/US RT O $699.00 $454.35 330184 20605 5441 49 450 JOINT ASPIRATION-MEDIUM(A O $733.95 $477.07 330184 20605 50 5441 49 761 DRN-INJ INT JNT-BRSA W/O US BIL O "$1,100.93 " $715.60 330184 20605 LT 5441 49 761 DRN-INJ INT JNT-BRSA W/O US LT O $733.95 $477.07 330184 20605 RT 5441 49 761 DRN-INJ INT JNT-BRSA W/O US RT O $733.95 $477.07 330184 20605 50 5441 49 510 DRN INT JNT/BRSA WO US BIL-CLN O $733.95 $477.07 330184 20605 LT 5441 49 510 DRN INT JNT/BRSA WO US LT-CLN O $733.95 $477.07 330184 20605 RT 5441 49 510 DRN INT JNT/BRSA WO US RT-CLN O $733.95 $477.07 330184 20605 50 5441 49 450 DRN INT JNT/BRSA WO US BIL-ER O $733.95 $477.07 330184 20605 LT 5441 49 450 DRN INT JNT/BRSA WO US LT-ER O $733.95 $477.07 330184 20605 RT 5441 49 450 DRN INT JNT/BRSA WO US RT-ER O $733.95 $477.07 330184 20606 50 5442 50 761 DRN-INJ INT JNT-BURSA W/US BIL O "$2,302.50 " "$1,496.62 " 330184 20606 LT 5442 50 761 DRN-INJ INT JNT-BURSA W/US LT O "$1,535.00 " $997.75 330184 20606 RT 5442 50 761 DRN-INJ INT JNT-BURSA W/US RT O "$1,535.00 " $997.75 330184 20610 5441 49 761 RAD SPEC ASPIR/INJ MAJOR O $733.95 $477.07 330184 20610 5441 49 510 Drain/inject Joint/bursa O $733.95 $477.07 330184 20610 5441 49 450 JOINT ASPIRATION-LG(KNEE) O $733.95 $477.07 330184 20610 50 5441 49 761 DRN-INJ MAJ JNT-BRSA W/O US BIL O "$1,100.93 " $715.60 330184 20610 LT 5441 49 761 DRN-INJ MAJ JNT-BRSA W/O US LT O $733.95 $477.07 330184 20610 RT 5441 49 761 DRN-INJ MAJ JNT-BRSA W/O US RT O $733.95 $477.07 330184 20610 5441 49 450 ARTHROCENTESIS O $733.95 $477.07 330184 20610 50 5441 49 450 DRN MJR JNT/BRSA W/O US BIL-ER O $733.95 $477.07 330184 20610 LT 5441 49 450 DRN MJR JNT/BRSA W/O US LT-ER O $733.95 $477.07 330184 20610 RT 5441 49 450 DRN MJR JNT/BRSA W/O US RT-ER O $733.95 $477.07 330184 20611 50 5441 50 761 DRN-INJ MAJ JNT-BURSA W/US BIL O "$1,048.50 " $681.52 330184 20611 LT 5441 50 761 DRN-INJ MAJ JNT-BURSA W/US LT O $699.00 $454.35 330184 20611 RT 5441 50 761 DRN-INJ MAJ JNT-BURSA W/US RT O $699.00 $454.35 330184 20612 5441 510 Aspirate/inj Ganglion Cys O $595.00 $386.75 330184 20615 5071 510 TREATMENT OF BONE CYST O "$1,631.00 " "$1,060.15 " 330184 20662 5112 361 APPLICATION-PELVIC HALO O "$3,684.00 " "$2,394.60 " 330184 20663 5113 361 APPLICATION-FEMORAL HALO O "$7,378.00 " "$4,795.70 " 330184 20663 50 5113 361 APPLCT THIGH BRACE BIL-ER O "$7,378.00 " "$4,795.70 " 330184 20663 LT 5113 361 APPLCT THIGH BRACE LT-ER O "$7,378.00 " "$4,795.70 " 330184 20663 RT 5113 361 APPLCT THIGH BRACE RT-ER O "$7,378.00 " "$4,795.70 " 330184 20670 5072 361 Remove/Implant/wire O "$3,742.00 " "$2,432.30 " 330184 20680 5073 510 REMOVAL IMPLANT DEEP-20680 O "$7,023.00 " "$4,564.95 " 330184 20690 5114 450 APPLICATION-EXT FIXATION- O "$15,799.00 " "$10,269.35 " 330184 20690 50 5114 450 APPLY BONE FIXATION DEVICE BIL-ER O "$15,799.00 " "$10,269.35 " 330184 20690 LT 5114 450 APPLY BONE FIXATION DEVICE LT-ER O "$15,799.00 " "$10,269.35 " 330184 20690 RT 5114 450 APPLY BONE FIXATION DEVICE RT-ER O "$15,799.00 " "$10,269.35 " 330184 20700 450 MNL PREP&INSJ DP RX DLVR DEV-20700 O $274.00 $178.10 330184 20701 450 RMVL DEEP RX DELIVERY DEVICE-20701 O $203.00 $131.95 330184 20702 450 MNL PREP&INSJ IMED RX DEV-20702 O $455.00 $295.75 330184 20703 450 RMVL IMED RX DELIVERY DEVICE-20703 O $325.00 $211.25 330184 20704 450 MNL PREP&INSJ I-ARTIC RX DEV-20704 O $475.00 $308.75 330184 20705 450 RMVL I-ARTIC RX DELIVERY DEV-20705 O $390.00 $253.50 330184 20974 510 Electrical Bone Stimulati O $182.00 $118.30 330184 21310 5111 450 CLSD TX NASAL FX W/O MANI O $635.25 $412.91 330184 21315 5163 450 CLSD TX NASAL FX W/O STAB O "$3,142.00 " "$2,042.30 " 330184 21320 5164 450 CLSD TX NASAL FX W/STABIL O "$6,577.00 " "$4,275.05 " 330184 21320 5164 450 CLOSED TREATMENT OF NASAL O "$6,577.00 " "$4,275.05 " 330184 21337 5164 450 CLSD TX SEPTAL FX W/WO ST O "$6,577.00 " "$4,275.05 " 330184 21400 5162 450 CLSD FX ORBIT W/O MANIPUL O "$1,339.00 " $870.35 330184 21400 50 5162 450 CLOSED TX ORBIT WO MANIP BIL-ER O "$1,339.00 " $870.35 330184 21400 LT 5162 450 CLOSED TX ORBIT WO MANIP LT-ER O "$1,339.00 " $870.35 330184 21400 RT 5162 450 CLOSED TX ORBIT WO MANIP RT-ER O "$1,339.00 " $870.35 330184 21401 5163 450 CLSD FX ORBIT W/MANIPULAT O "$3,142.00 " "$2,042.30 " 330184 21401 50 5163 450 CLOSED TX ORBIT W MANIP BIL-ER O "$3,142.00 " "$2,042.30 " 330184 21401 LT 5163 450 CLOSED TX ORBIT W MANIP LT-ER O "$3,142.00 " "$2,042.30 " 330184 21401 RT 5163 450 CLOSED TX ORBIT W MANIP RT-ER O "$3,142.00 " "$2,042.30 " 330184 21440 5164 450 CLSD FX ALVEOLAR RIDGE-SE O "$6,577.00 " "$4,275.05 " 330184 21450 5162 450 CLSD MANDIBULAR FX-W/O MA O "$1,339.00 " $870.35 330184 21451 5163 450 CLSD MANDIBULAR FX-W/MANI O "$3,299.10 " "$2,144.42 " 330184 21480 5111 450 CLSD TMPRMAND DSLO O $605.00 $393.25 330184 21480 50 5111 450 RESET DISLOCATED JAW BIL-ER O $605.00 $393.25 330184 21480 LT 5111 450 RESET DISLOCATED JAW LT-ER O $605.00 $393.25 330184 21480 RT 5111 450 RESET DISLOCATED JAW RT-ER O $605.00 $393.25 330184 21550 5072 761 RAD SPEC BX NCK/CHEST O "$3,742.00 " "$2,432.30 " 330184 21820 5111 450 CLSD TX STERNUM FX O $605.00 $393.25 330184 22310 5111 450 CLSD VRTBRAL BODY FX WO M O $605.00 $393.25 330184 23030 5073 761 RAD SPEC DRAIN SHLDR LESI O "$6,502.00 " "$4,226.30 " 330184 23030 50 5073 761 DRAIN SHOULDER LESION BIL-RAD O "$9,753.00 " "$6,339.45 " 330184 23030 LT 5073 761 DRAIN SHOULDER LESION LT-RAD O "$6,502.00 " "$4,226.30 " 330184 23030 RT 5073 761 DRAIN SHOULDER LESION RT-RAD O "$6,502.00 " "$4,226.30 " 330184 23500 5111 450 CLSD CLAVICLE FX W/O MANI O $635.25 $412.91 330184 23500 50 5111 510 TREAT CLAV FX WO MANIP BIL-CLN O $635.25 $412.91 330184 23500 LT 5111 510 TREAT CLAV FX WO MANIP LT-CLN O $635.25 $412.91 330184 23500 RT 5111 510 TREAT CLAV FX WO MANIP RT-CLN O $635.25 $412.91 330184 23500 50 5111 450 TREAT CLAV FX WO MANIP BIL-ER O $635.25 $412.91 330184 23500 LT 5111 450 TREAT CLAV FX WO MANIP LT-ER O $635.25 $412.91 330184 23500 RT 5111 450 TREAT CLAV FX WO MANIP RT-ER O $635.25 $412.91 330184 23505 5112 450 CLSD CLAVICLE FX W/MANIPU O "$3,684.00 " "$2,394.60 " 330184 23505 50 5112 450 TREAT CLAV FX W MANIP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 23505 LT 5112 450 TREAT CLAV FX W MANIP LT-ER O "$3,684.00 " "$2,394.60 " 330184 23505 RT 5112 450 TREAT CLAV FX W MANIP RT-ER O "$3,684.00 " "$2,394.60 " 330184 23520 5112 450 CLSD STRENOCLAV DSLO W/O O "$3,684.00 " "$2,394.60 " 330184 23520 50 5112 450 TREAT STRNCLAV DSLC WO MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 23520 LT 5112 450 TREAT STRNCLAV DSLC WO MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 23520 RT 5112 450 TREAT STRNCLAV DSLC WO MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 23525 5111 450 CLSD STRENOCLAV DSLO W/MA O $605.00 $393.25 330184 23525 50 5111 450 TREAT CLAV DSLC W MNP BIL-ER O $605.00 $393.25 330184 23525 LT 5111 450 TREAT CLAV DSLC W MNP LT-ER O $605.00 $393.25 330184 23525 RT 5111 450 TREAT CLAV DSLC W MNP RT-ER O $605.00 $393.25 330184 23540 5111 450 CLSD ACROM W/CLAV DSLOC W O $605.00 $393.25 330184 23540 50 5111 510 ACRO CLAV DSLC WO MNP BIL-CLN O $605.00 $393.25 330184 23540 LT 5111 510 ACRO CLAV DSLC WO MNP LT-CLN O $605.00 $393.25 330184 23540 RT 5111 510 ACRO CLAV DSLC WO MNP RT-CLN O $605.00 $393.25 330184 23540 50 5111 450 ACRO CLAV DSLC WO MNP BIL-ER O $605.00 $393.25 330184 23540 LT 5111 450 ACRO CLAV DSLC WO MNP LT-ER O $605.00 $393.25 330184 23540 RT 5111 450 ACRO CLAV DSLC WO MNP RT-ER O $605.00 $393.25 330184 23545 5111 450 CLSD ACROM/CLAV DSLOC W/M O $605.00 $393.25 330184 23545 50 5111 450 TREAT ACRO CLAV DSLC W MNP BIL-ER O $605.00 $393.25 330184 23545 LT 5111 450 TREAT ACRO CLAV DSLC W MNP LT-ER O $605.00 $393.25 330184 23545 RT 5111 450 TREAT ACRO CLAV DSLC W MNP RT-ER O $605.00 $393.25 330184 23570 5111 450 CLSD SCAPULAR FX W/O MANI O $605.00 $393.25 330184 23570 50 5111 450 SHLDR BLADE FX WO MANIP BIL-ER O $605.00 $393.25 330184 23570 LT 5111 450 SHLDR BLADE FX WO MANIP LT-ER O $605.00 $393.25 330184 23570 RT 5111 450 SHLDR BLADE FX WO MANIP RT-ER O $605.00 $393.25 330184 23575 5112 450 CLSD SCAP FX-W/MAN-W/W/O O "$3,144.00 " "$2,043.60 " 330184 23575 50 5112 450 TREAT SHLDR BLADE FX W MANIP BIL-ER O "$3,144.00 " "$2,043.60 " 330184 23575 LT 5112 450 TREAT SHLDR BLADE FX W MANIP LT-ER O "$3,144.00 " "$2,043.60 " 330184 23575 RT 5112 450 TREAT SHLDR BLADE FX W MANIP RT-ER O "$3,144.00 " "$2,043.60 " 330184 23600 5111 450 CLSD PRX HUM FX W/O MANIP O $634.86 $412.66 330184 23600 50 5111 450 TREAT PRX HUMRS FX WO MANIP BIL-ER O $634.86 $412.66 330184 23600 LT 5111 450 TREAT PRX HUMRS FX WO MANIP LT-ER O $634.86 $412.66 330184 23600 RT 5111 450 TREAT PRX HUMRS FX WO MANIP RT-ER O $634.86 $412.66 330184 23605 5112 450 CLSD PRX HUM FX W/MAN O "$3,684.00 " "$2,394.60 " 330184 23605 50 5112 450 TREAT PRX HUMRS FX W MANIP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 23605 LT 5112 450 TREAT PRX HUMRS FX W MANIP LT-ER O "$3,684.00 " "$2,394.60 " 330184 23605 RT 5112 450 TREAT PRX HUMRS FX W MANIP RT-ER O "$3,684.00 " "$2,394.60 " 330184 23620 5111 450 CLSD FX HUM TUBER W/O MAN O $634.86 $412.66 330184 23620 50 5111 510 GRTR HUMRS FX WO MANIP BIL-CLN O $634.86 $412.66 330184 23620 LT 5111 510 GRTR HUMRS FX WO MANIP LT-CLN O $634.86 $412.66 330184 23620 RT 5111 510 GRTR HUMRS FX WO MANIP RT-CLN O $634.86 $412.66 330184 23620 50 5111 450 GRTR HUMRS FX WO MANIP BIL-ER O $634.86 $412.66 330184 23620 LT 5111 450 GRTR HUMRS FX WO MANIP LT-ER O $634.86 $412.66 330184 23620 RT 5111 450 GRTR HUMRS FX WO MANIP RT-ER O $634.86 $412.66 330184 23625 5112 450 CLSD FX HUM TUBEROSITY W/ O "$3,684.00 " "$2,394.60 " 330184 23625 50 5112 510 GRT HUMRS FX W MANIP BIL-CLN O "$3,684.00 " "$2,394.60 " 330184 23625 LT 5112 510 GRT HUMRS FX W MANIP LT-CLN O "$3,684.00 " "$2,394.60 " 330184 23625 RT 5112 510 GRT HUMRS FX W MANIP RT-CLN O "$3,684.00 " "$2,394.60 " 330184 23625 50 5112 450 GRT HUMRS FX W MANIP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 23625 LT 5112 450 GRT HUMRS FX W MANIP LT-ER O "$3,684.00 " "$2,394.60 " 330184 23625 RT 5112 450 GRT HUMRS FX W MANIP RT-ER O "$3,684.00 " "$2,394.60 " 330184 23650 5111 450 23650 CLOSED TREATMENT OF O $634.86 $412.66 330184 23650 5111 450 CLSD SHLDR DSLOC W/MAN O $634.86 $412.66 330184 23650 50 5111 450 TRT SHLDR DISL W MAN WO ANS BIL-ER O $634.86 $412.66 330184 23650 LT 5111 450 TRT SHLDR DISL W MAN WO ANS LT-ER O $634.86 $412.66 330184 23650 RT 5111 450 TRT SHLDR DISL W MAN WO ANS RT-ER O $634.86 $412.66 330184 23655 5112 450 CLSD SHLDR DSLC W/MAN W/A O "$3,868.20 " "$2,514.33 " 330184 23655 50 5112 450 TRT SHLDR DISL W MAN W ANS BIL-ER O "$3,868.20 " "$2,514.33 " 330184 23655 LT 5112 450 TRT SHLDR DISL W MAN W ANS LT-ER O "$3,868.20 " "$2,514.33 " 330184 23655 RT 5112 450 TRT SHLDR DISL W MAN W ANS RT-ER O "$3,868.20 " "$2,514.33 " 330184 23665 5112 450 CLSD SHLDR DSLC W/HUM TUB O "$3,144.00 " "$2,043.60 " 330184 23665 5112 450 CLSD SHLD DSLC W/GRIR HUM O "$3,144.00 " "$2,043.60 " 330184 23665 50 5112 450 TRT SHLDR DISL FX W MANIP BIL-ER O "$3,144.00 " "$2,043.60 " 330184 23665 LT 5112 450 TRT SHLDR DISL FX W MANIP LT-ER O "$3,144.00 " "$2,043.60 " 330184 23665 RT 5112 450 TRT SHLDR DISL FX W MANIP RT-ER O "$3,144.00 " "$2,043.60 " 330184 23675 5112 450 CLSD SHLDR DSLC W/SUG NEC O "$3,684.00 " "$2,394.60 " 330184 23675 50 5112 450 SHLDR DISL NCK FX W MANIP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 23675 LT 5112 450 SHLDR DISL NCK FX W MANIP LT-ER O "$3,684.00 " "$2,394.60 " 330184 23675 RT 5112 450 SHLDR DISL NCK FX W MANIP RT-ER O "$3,684.00 " "$2,394.60 " 330184 24500 5111 450 CLSD HUM SHFT FX W/O MANI O $634.86 $412.66 330184 24500 50 5111 450 TREAT HMRS FRACT WO MNP BIL-ER O $634.86 $412.66 330184 24500 LT 5111 450 TREAT HMRS FRACT WO MNP LT-ER O $634.86 $412.66 330184 24500 RT 5111 450 TREAT HMRS FRACT WO MNP RT-ER O $634.86 $412.66 330184 24505 5112 450 CLSD HUM SHFT FX W/MAN O "$3,684.00 " "$2,394.60 " 330184 24505 50 5112 450 TREAT HMRS FRACT W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 24505 LT 5112 450 TREAT HMRS FRACT W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 24505 RT 5112 450 TREAT HMRS FRACT W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 24530 5111 450 CLSD SUPRCON FX W/O MANIP O $605.00 $393.25 330184 24530 50 5111 450 HMRS FX SUPRA TRNS WO MNP BIL-ER O $605.00 $393.25 330184 24530 LT 5111 450 HMRS FX SUPRA TRNS WO MNP LT-ER O $605.00 $393.25 330184 24530 RT 5111 450 HMRS FX SUPRA TRNS WO MNP RT-ER O $605.00 $393.25 330184 24535 5112 450 CLSD SUPRACON FX W/MAN O "$3,868.20 " "$2,514.33 " 330184 24535 50 5112 450 HMRS FX SUPRA TRNS W MNP BIL-ER O "$3,868.20 " "$2,514.33 " 330184 24535 LT 5112 450 HMRS FX SUPRA TRNS W MNP LT-ER O "$3,868.20 " "$2,514.33 " 330184 24535 RT 5112 450 HMRS FX SUPRA TRNS W MNP RT-ER O "$3,868.20 " "$2,514.33 " 330184 24560 5111 450 CLSD EPICON FX MED/LAT W/ O $605.00 $393.25 330184 24560 50 5111 450 HMRS FX EPICON WO MNP BIL-ER O $605.00 $393.25 330184 24560 LT 5111 450 HMRS FX EPICON WO MNP LT-ER O $605.00 $393.25 330184 24560 RT 5111 450 HMRS FX EPICON WO MNP RT-ER O $605.00 $393.25 330184 24565 5112 450 24565 CLOSED TREATMENT OF O "$3,684.00 " "$2,394.60 " 330184 24565 5112 450 CLSD EPICON FX MED/LAT W/ O "$3,684.00 " "$2,394.60 " 330184 24565 50 5112 450 HMRS FX EPICON W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 24565 LT 5112 450 HMRS FX EPICON W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 24565 RT 5112 450 HMRS FX EPICON W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 24576 5111 450 CLSD CONDYL FX MED/LAT W/ O $605.00 $393.25 330184 24576 50 5111 450 HMRS FX CONDYL WO MNP BIL-ER O $605.00 $393.25 330184 24576 LT 5111 450 HMRS FX CONDYL WO MNP LT-ER O $605.00 $393.25 330184 24576 RT 5111 450 HMRS FX CONDYL WO MNP RT-ER O $605.00 $393.25 330184 24577 5112 450 CLSD CONYL FX MED/LAT W/M O "$3,368.00 " "$2,189.20 " 330184 24577 50 5112 450 HMRS FX CONDYL W MNP BIL-ER O "$3,368.00 " "$2,189.20 " 330184 24577 LT 5112 450 HMRS FX CONDYL W MNP LT-ER O "$3,368.00 " "$2,189.20 " 330184 24577 RT 5112 450 HMRS FX CONDYL W MNP RT-ER O "$3,368.00 " "$2,189.20 " 330184 24600 5111 450 CLSD ELBOW DSLOC W/O ANES O $634.86 $412.66 330184 24600 50 5111 450 TRT ELBW DISLOC WO ANS BIL-ER O $634.86 $412.66 330184 24600 LT 5111 450 TRT ELBW DISLOC WO ANS LT-ER O $634.86 $412.66 330184 24600 RT 5111 450 TRT ELBW DISLOC WO ANS RT-ER O $634.86 $412.66 330184 24605 5112 450 CLSD ELBOW DSLOC W/ANESTH O "$3,868.20 " "$2,514.33 " 330184 24605 50 5112 450 TRT ELBW DISLOC W ANS BIL-ER O "$3,868.20 " "$2,514.33 " 330184 24605 LT 5112 450 TRT ELBW DISLOC W ANS LT-ER O "$3,868.20 " "$2,514.33 " 330184 24605 RT 5112 450 TRT ELBW DISLOC W ANS RT-ER O "$3,868.20 " "$2,514.33 " 330184 24620 5112 450 CLSD MONTEGGIA FX/DSLO EL O "$3,482.00 " "$2,263.30 " 330184 24620 50 5112 450 TREAT ELBW FRACT W MNP BIL-ER O "$3,482.00 " "$2,263.30 " 330184 24620 LT 5112 450 TREAT ELBW FRACT W MNP LT-ER O "$3,482.00 " "$2,263.30 " 330184 24620 RT 5112 450 TREAT ELBW FRACT W MNP RT-ER O "$3,482.00 " "$2,263.30 " 330184 24640 5111 41 450 CLSD RAD HD SUBLUX W/MANI O $635.25 $412.91 330184 24640 50 5111 41 510 ELBW DISLC RD HD W MNP BIL-CLN O $635.25 $412.91 330184 24640 LT 5111 41 510 ELBW DISLC RD HD W MNP LT-CLN O $635.25 $412.91 330184 24640 RT 5111 41 510 ELBW DISLC RD HD W MNP RT-CLN O $635.25 $412.91 330184 24640 50 5111 41 450 ELBW DISLC RD HD W MNP BIL-ER O $635.25 $412.91 330184 24640 LT 5111 41 450 ELBW DISLC RD HD W MNP LT-ER O $635.25 $412.91 330184 24640 RT 5111 41 450 ELBW DISLC RD HD W MNP RT-ER O $635.25 $412.91 330184 24650 5111 450 CLSD RAD HD/NECK FX W/O M O $635.00 $412.75 330184 24650 50 5111 510 RADIUS FRACT WO MNP BIL-CLN O $635.00 $412.75 330184 24650 LT 5111 510 RADIUS FRACT WO MNP LT-CLN O $635.00 $412.75 330184 24650 RT 5111 510 RADIUS FRACT WO MNP RT-CLN O $635.00 $412.75 330184 24650 50 5111 450 RADIUS FRACT WO MNP BIL-ER O $635.00 $412.75 330184 24650 LT 5111 450 RADIUS FRACT WO MNP LT-ER O $635.00 $412.75 330184 24650 RT 5111 450 RADIUS FRACT WO MNP RT-ER O $635.00 $412.75 330184 24655 5112 450 CLSD RAD HD/NECK FX W/MAN O "$3,144.00 " "$2,043.60 " 330184 24655 50 5112 450 TREAT RADIUS FRACT W MNP BIL-ER O "$3,144.00 " "$2,043.60 " 330184 24655 LT 5112 450 TREAT RADIUS FRACT W MNP LT-ER O "$3,144.00 " "$2,043.60 " 330184 24655 RT 5112 450 TREAT RADIUS FRACT W MNP RT-ER O "$3,144.00 " "$2,043.60 " 330184 24670 5111 450 CLSD OLECR.PROC FX W/O MA O $605.00 $393.25 330184 24670 50 5111 450 TREAT PROX ULNAR FRACT WO MNP BIL-ER O $605.00 $393.25 330184 24670 LT 5111 450 TREAT PROX ULNAR FRACT WO MNP LT-ER O $605.00 $393.25 330184 24670 RT 5111 450 TREAT PROX ULNAR FRACT WO MNP RT-ER O $605.00 $393.25 330184 24675 5112 450 CLSD OLECRANON PROC FX W/ O "$3,144.00 " "$2,043.60 " 330184 24675 50 5112 450 TREAT PROX ULNAR FRACT W MNP BIL-ER O "$3,144.00 " "$2,043.60 " 330184 24675 LT 5112 450 TREAT PROX ULNAR FRACT W MNP LT-ER O "$3,144.00 " "$2,043.60 " 330184 24675 RT 5112 450 TREAT PROX ULNAR FRACT W MNP RT-ER O "$3,144.00 " "$2,043.60 " 330184 25500 5111 450 CLSD RAD SHFT FX W/O MANI O $605.00 $393.25 330184 25500 50 5111 450 TREAT RADIUS FRACT WO MNP BIL-ER O $605.00 $393.25 330184 25500 LT 5111 450 TREAT RADIUS FRACT WO MNP LT-ER O $605.00 $393.25 330184 25500 RT 5111 450 TREAT RADIUS FRACT WO MNP RT-ER O $605.00 $393.25 330184 25520 5112 450 CLS RADSHFT FX W/DSLO RAD O "$3,655.00 " "$2,375.75 " 330184 25520 50 5112 450 TRT RADIUS FRCT DSLC RAD JT BIL-ER O "$3,655.00 " "$2,375.75 " 330184 25520 LT 5112 450 TRT RADIUS FRCT DSLC RAD JT LT-ER O "$3,655.00 " "$2,375.75 " 330184 25520 RT 5112 450 TRT RADIUS FRCT DSLC RAD JT RT-ER O "$3,655.00 " "$2,375.75 " 330184 25530 5111 450 CLSD ULNAR SHFT FX W/O MA O $635.25 $412.91 330184 25530 50 5111 450 TREAT ULNA FRACT WO MNP BIL-ER O $635.25 $412.91 330184 25530 LT 5111 450 TREAT ULNA FRACT WO MNP LT-ER O $635.25 $412.91 330184 25530 RT 5111 450 TREAT ULNA FRACT WO MNP RT-ER O $635.25 $412.91 330184 25535 5111 450 CLSD ULNAR SHFT FX W/MANI O $635.25 $412.91 330184 25535 50 5111 450 TREAT ULNA FRACT W MNP BIL-ER O $635.25 $412.91 330184 25535 LT 5111 450 TREAT ULNA FRACT W MNP LT-ER O $635.25 $412.91 330184 25535 RT 5111 450 TREAT ULNA FRACT W MNP RT-ER O $635.25 $412.91 330184 25560 5111 450 CLSD RAD/ULNAR SHFT FX W/ O $605.00 $393.25 330184 25560 50 5111 450 TRT FRCT RDS & ULNA WO MNP BIL-ER O $605.00 $393.25 330184 25560 LT 5111 450 TRT FRCT RDS & ULNA WO MNP LT-ER O $605.00 $393.25 330184 25560 RT 5111 450 TRT FRCT RDS & ULNA WO MNP RT-ER O $605.00 $393.25 330184 25565 5112 450 CLSD RAD/ULNAR SHFT FX W/ O "$3,257.00 " "$2,117.05 " 330184 25565 50 5112 450 TRT FRCT RDS & ULNA W MNP BIL-ER O "$3,257.00 " "$2,117.05 " 330184 25565 LT 5112 450 TRT FRCT RDS & ULNA W MNP LT-ER O "$3,257.00 " "$2,117.05 " 330184 25565 RT 5112 450 TRT FRCT RDS & ULNA W MNP RT-ER O "$3,257.00 " "$2,117.05 " 330184 25600 5111 450 CLSD DSTL RAD FX W/O MAN O $634.86 $412.66 330184 25600 50 5111 510 FX DST RDS/ULNA WO MNP BIL-CLN O $634.86 $412.66 330184 25600 LT 5111 510 FX DST RDS/ULNA WO MNP LT-CLN O $634.86 $412.66 330184 25600 RT 5111 510 FX DST RDS/ULNA WO MNP RT-CLN O $634.86 $412.66 330184 25600 50 5111 450 FX DST RDS/ULNA WO MNP BIL-ER O $634.86 $412.66 330184 25600 LT 5111 450 FX DST RDS/ULNA WO MNP LT-ER O $634.86 $412.66 330184 25600 RT 5111 450 FX DST RDS/ULNA WO MNP RT-ER O $634.86 $412.66 330184 25605 5112 450 CLSD DSTL RAD FX/EPIP SEP O "$3,788.00 " "$2,462.20 " 330184 25605 50 5112 510 FRACT DST RDS/ULNA W MNP BIL-CLN O "$3,788.00 " "$2,462.20 " 330184 25605 LT 5112 510 FRACT DST RDS/ULNA W MNP LT-CLN O "$3,788.00 " "$2,462.20 " 330184 25605 RT 5112 510 FRACT DST RDS/ULNA W MNP RT-CLN O "$3,788.00 " "$2,462.20 " 330184 25605 50 5112 450 FRACT DST RDS/ULNA W MNP BIL-ER O "$3,788.00 " "$2,462.20 " 330184 25605 LT 5112 450 FRACT DST RDS/ULNA W MNP LT-ER O "$3,788.00 " "$2,462.20 " 330184 25605 RT 5112 450 FRACT DST RDS/ULNA W MNP RT-ER O "$3,788.00 " "$2,462.20 " 330184 25622 5111 450 CLSD NAVICULAR FX W/O MAN O $605.00 $393.25 330184 25622 50 5111 510 SCAPHOID FRACT WO MNP BIL-CLN O $605.00 $393.25 330184 25622 LT 5111 510 SCAPHOID FRACT WO MNP LT-CLN O $605.00 $393.25 330184 25622 RT 5111 510 SCAPHOID FRACT WO MNP RT-CLN O $605.00 $393.25 330184 25622 50 5111 450 SCAPHOID FRACT WO MNP BIL-ER O $605.00 $393.25 330184 25622 LT 5111 450 SCAPHOID FRACT WO MNP LT-ER O $605.00 $393.25 330184 25622 RT 5111 450 SCAPHOID FRACT WO MNP RT-ER O $605.00 $393.25 330184 25624 5112 450 CLOSED TREATMENT NAVICULA O "$3,684.00 " "$2,394.60 " 330184 25624 50 5112 450 TRT SCAPHOID FRACT W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 25624 LT 5112 450 TRT SCAPHOID FRACT W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 25624 RT 5112 450 TRT SCAPHOID FRACT W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 25630 5111 450 CLSD CARPAL BONE FX W/O M O $605.00 $393.25 330184 25630 50 5111 450 TRT CRPAL FRACT WO MNP BIL-ER O $605.00 $393.25 330184 25630 LT 5111 450 TRT CRPAL FRACT WO MNP LT-ER O $605.00 $393.25 330184 25630 RT 5111 450 TRT CRPAL FRACT WO MNP RT-ER O $605.00 $393.25 330184 25635 5112 450 CLSD CARPAL BONE FX W/MAN O "$3,684.00 " "$2,394.60 " 330184 25635 50 5112 450 TRT CRPAL FRACT W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 25635 LT 5112 450 TRT CRPAL FRACT W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 25635 RT 5112 450 TRT CRPAL FRACT W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 25650 5111 450 CLSD ULNAR STYLOID FX O $635.25 $412.91 330184 25650 50 5111 450 TREAT ULNAR STYL FRACT BIL-ER O $635.25 $412.91 330184 25650 LT 5111 450 TREAT ULNAR STYL FRACT LT-ER O $635.25 $412.91 330184 25650 RT 5111 450 TREAT ULNAR STYL FRACT RT-ER O $635.25 $412.91 330184 25660 5111 450 CLSD RADCARP/INTCARP DSLO O $635.25 $412.91 330184 25660 50 5111 450 RAD/INT CARP DSLC W MNP BIL-ER O $635.25 $412.91 330184 25660 LT 5111 450 RAD/INT CARP DSLC W MNP LT-ER O $635.25 $412.91 330184 25660 RT 5111 450 RAD/INT CARP DSLC W MNP RT-ER O $635.25 $412.91 330184 25675 5111 450 CLSD DSTL RADULNR DSLO W/ O $605.00 $393.25 330184 25675 5111 450 CLS. RADIOULNAR DISLOC C O $605.00 $393.25 330184 25675 50 5111 450 DSTL RADULNR DISLC W MNP BIL-ER O $605.00 $393.25 330184 25675 LT 5111 450 DSTL RADULNR DISLC W MNP LT-ER O $605.00 $393.25 330184 25675 RT 5111 450 DSTL RADULNR DISLC W MNP RT-ER O $605.00 $393.25 330184 25680 5111 450 CLSD TRNS/SCAP FX/DSLO W/ O $605.00 $393.25 330184 25680 50 5111 450 TRNS SCPH FRCT DISLOC W MNP BIL-ER O $605.00 $393.25 330184 25680 LT 5111 450 TRNS SCPH FRCT DISLOC W MNP LT-ER O $605.00 $393.25 330184 25680 RT 5111 450 TRNS SCPH FRCT DISLOC W MNP RT-ER O $605.00 $393.25 330184 25690 5112 450 CLSD LUNATE DSLO W/MANIPU O "$3,684.00 " "$2,394.60 " 330184 25690 50 5112 450 LUNATE DISLOC W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 25690 LT 5112 450 LUNATE DISLOC W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 25690 RT 5112 450 LUNATE DISLOC W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 25999 5111 450 UNLISTED PROCEDURE FOREAR O $605.00 $393.25 330184 26236 F1 5112 510 PRTL EXC BONE; DTL PHLNX LH 2D O "$2,947.00 " "$1,915.55 " 330184 26236 F2 5112 510 PRTL EXC BONE; DTL PHLNX LH 3D O "$2,947.00 " "$1,915.55 " 330184 26236 F3 5112 510 PRTL EXC BONE; DTL PHLNX LH 4D O "$2,947.00 " "$1,915.55 " 330184 26236 F4 5112 510 PRTL EXC BONE; DTL PHLNX LH 5D O "$2,947.00 " "$1,915.55 " 330184 26236 FA 5112 510 PRTL EXC BONE; DTL PHLNX LT THUMB O "$2,947.00 " "$1,915.55 " 330184 26236 F6 5112 510 PRTL EXC BONE; DTL PHLNX RH 2D O "$2,947.00 " "$1,915.55 " 330184 26236 F7 5112 510 PRTL EXC BONE; DTL PHLNX RH 3D O "$2,947.00 " "$1,915.55 " 330184 26236 F8 5112 510 PRTL EXC BONE; DTL PHLNX RH 4D O "$2,947.00 " "$1,915.55 " 330184 26236 F9 5112 510 PRTL EXC BONE; DTL PHLNX RH 5D O "$2,947.00 " "$1,915.55 " 330184 26236 F5 5112 510 PRTL EXC BONE; DTL PHLNX RT THUMB O "$2,947.00 " "$1,915.55 " 330184 26410 5112 510 CL-REP ET HAND; WO FG EA TEND- O "$7,378.00 " "$4,795.70 " 330184 26410 5112 450 ESOTENSOR TENDON REPAIRH O "$7,378.00 " "$4,795.70 " 330184 26432 FA 5112 510 DISTAL EXTEN TENDON INSRT LH THUMB-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F1 5112 510 DISTAL EXTEN TENDON INSRT LH 2ND DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F2 5112 510 DISTAL EXTEN TENDON INSRT LH 3RD DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F3 5112 510 DISTAL EXTEN TENDON INSRT LH 4TH DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F4 5112 510 DISTAL EXTEN TENDON INSRT LH 5TH DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F5 5112 510 DISTAL EXTEN TENDON INSRT RH THUMB-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F6 5112 510 DISTAL EXTEN TENDON INSRT RH 2ND DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F7 5112 510 DISTAL EXTEN TENDON INSRT RH 3RD DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F8 5112 510 DISTAL EXTEN TENDON INSRT RH 4TH DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26432 F9 5112 510 DISTAL EXTEN TENDON INSRT RH 5TH DIG-CLN O "$2,678.00 " "$1,740.70 " 330184 26600 5111 450 CLSD METACRP FX W/O MAN-E O $634.86 $412.66 330184 26600 5111 450 METACARPAL FRACT WO MNP BIL-ER O $634.86 $412.66 330184 26600 LT 5111 450 METACARPAL FRACT WO MNP LT-ER O $634.86 $412.66 330184 26600 RT 5111 450 METACARPAL FRACT WO MNP RT-ER O $634.86 $412.66 330184 26605 5111 450 CLSD METACRP FX W/MAN-EA O $635.00 $412.75 330184 26605 5111 450 METACARPAL FRACT W MNP BIL-ER O $635.00 $412.75 330184 26605 LT 5111 450 METACARPAL FRACT W MNP LT-ER O $635.00 $412.75 330184 26605 RT 5111 450 METACARPAL FRACT W MNP RT-ER O $635.00 $412.75 330184 26607 5113 361 CLSD METACRP FX W MAN O "$7,746.90 " "$5,035.49 " 330184 26607 5113 361 METCRPL FRACT W MNP W FX BIL-ER O "$7,746.90 " "$5,035.49 " 330184 26607 LT 5113 361 METCRPL FRACT W MNP W FX LT-ER O "$7,746.90 " "$5,035.49 " 330184 26607 RT 5113 361 METCRPL FRACT W MNP W FX RT-ER O "$7,746.90 " "$5,035.49 " 330184 26641 5111 450 CLSD THUMB DSLOC W/MANIPU O $605.00 $393.25 330184 26641 50 5111 450 THUMB DISLOC W MNP BIL-ER O $605.00 $393.25 330184 26641 LT 5111 450 THUMB DISLOC W MNP LT-ER O $605.00 $393.25 330184 26641 RT 5111 450 THUMB DISLOC W MNP RT-ER O $605.00 $393.25 330184 26645 5112 450 CLSD THUMB FX/DSLOC W/MAN O "$3,684.00 " "$2,394.60 " 330184 26645 50 5112 450 THUMB FRACTURE W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 26645 LT 5112 450 THUMB FRACTURE W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 26645 RT 5112 450 THUMB FRACTURE W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 26670 5111 450 CLSD METCRP DSLO-NO THUMB O $605.00 $393.25 330184 26670 5111 450 HAND DISLOC W MNP WO ANS BIL-ER O $605.00 $393.25 330184 26670 5111 450 HAND DISLOC W MNP WO ANS LT-ER O $605.00 $393.25 330184 26670 5111 450 HAND DISLOC W MNP WO ANS RT-ER O $605.00 $393.25 330184 26700 5111 450 CLSD METACARPHAL DSL W/MA O $635.25 $412.91 330184 26700 50 5111 450 KNUCKLE DISLOC W MNP WO ANS BIL-ER O $635.25 $412.91 330184 26700 LT 5111 450 KNUCKLE DISLOC W MNP WO ANS LT-ER O $635.25 $412.91 330184 26700 RT 5111 450 KNUCKLE DISLOC W MNP WO ANS RT-ER O $635.25 $412.91 330184 26720 5111 450 CLSD PHALANG SHFT FX W/O O $953.40 $619.71 330184 26720 FA 5111 450 FINGER FRACT WO MNP LH THUMB DIG-ER O $953.40 $619.71 330184 26720 F1 5111 450 FINGER FRACT WO MNP LH 2ND DIG-ER O $953.40 $619.71 330184 26720 F2 5111 450 FINGER FRACT WO MNP LH 3RD DIG-ER O $953.40 $619.71 330184 26720 F3 5111 450 FINGER FRACT WO MNP LH 4TH DIG-ER O $953.40 $619.71 330184 26720 F4 5111 450 FINGER FRACT WO MNP LH 5TH DIG-ER O $953.40 $619.71 330184 26720 F5 5111 450 FINGER FRACT WO MNP RH THUMB DIG-ER O $953.40 $619.71 330184 26720 F6 5111 450 FINGER FRACT WO MNP RH 2ND DIG-ER O $953.40 $619.71 330184 26720 F7 5111 450 FINGER FRACT WO MNP RH 3RD DIG-ER O $953.40 $619.71 330184 26720 F8 5111 450 FINGER FRACT WO MNP RH 4TH DIG-ER O $953.40 $619.71 330184 26720 F9 5111 450 FINGER FRACT WO MNP RH 5TH DIG-ER O $953.40 $619.71 330184 26725 5111 450 CLSD PHLGSHFT FX W/MAN O "$1,755.60 " "$1,141.14 " 330184 26725 FA 5111 450 FINGER FRACT W MNP LH THUMB DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F1 5111 450 FINGER FRACT W MNP LH 2ND DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F2 5111 450 FINGER FRACT W MNP LH 3RD DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F3 5111 450 FINGER FRACT W MNP LH 4TH DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F4 5111 450 FINGER FRACT W MNP LH 5TH DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F5 5111 450 FINGER FRACT W MNP RH THUMB DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F6 5111 450 FINGER FRACT W MNP RH 2ND DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F7 5111 450 FINGER FRACT W MNP RH 3RD DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F8 5111 450 FINGER FRACT W MNP RH 4TH DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26725 F9 5111 450 FINGER FRACT W MNP RH 5TH DIG-ER O "$1,755.60 " "$1,141.14 " 330184 26740 5111 450 CLSD ARTIC FX MC/IP W/O M O $605.00 $393.25 330184 26740 FA 5111 450 ARTCLR FRACT LH THUMB WO MNP-ER O $605.00 $393.25 330184 26740 F1 5111 450 ARTCLR FRACT LH 2ND DIG WO MNP-ER O $605.00 $393.25 330184 26740 F2 5111 450 ARTCLR FRACT LH 3RD DIG WO MNP-ER O $605.00 $393.25 330184 26740 F3 5111 450 ARTCLR FRACT LH 4TH DIG WO MNP-ER O $605.00 $393.25 330184 26740 F4 5111 450 ARTCLR FRACT LH 5TH DIG WO MNP-ER O $605.00 $393.25 330184 26740 F5 5111 450 ARTCLR FRACT RH THUMB WO MNP-ER O $605.00 $393.25 330184 26740 F6 5111 450 ARTCLR FRACT RH 2ND DIG WO MNP-ER O $605.00 $393.25 330184 26740 F7 5111 450 ARTCLR FRACT RH 3RD DIG WO MNP-ER O $605.00 $393.25 330184 26740 F8 5111 450 ARTCLR FRACT RH 4TH DIG WO MNP-ER O $605.00 $393.25 330184 26740 F9 5111 450 ARTCLR FRACT RH 5TH DIG WO MNP-ER O $605.00 $393.25 330184 26742 5112 450 CLSD ARTIC FX W/JT W/MAN- O "$3,684.00 " "$2,394.60 " 330184 26742 FA 5112 450 ARTCLR FRACT LH THUMB W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F1 5112 450 ARTCLR FRACT LH 2ND DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F2 5112 450 ARTCLR FRACT LH 3RD DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F3 5112 450 ARTCLR FRACT LH 4TH DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F4 5112 450 ARTCLR FRACT LH 5TH DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F5 5112 450 ARTCLR FRACT RH THUMB W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F6 5112 450 ARTCLR FRACT RH 2ND DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F7 5112 450 ARTCLR FRACT RH 3RD DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F8 5112 450 ARTCLR FRACT RH 4TH DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26742 F9 5112 450 ARTCLR FRACT RH 5TH DIG W MNP-ER O "$3,684.00 " "$2,394.60 " 330184 26750 5111 450 CLSD DSTL PHALANG FX W/O O $893.55 $580.81 330184 26750 FA 5111 450 DSTL PHLNGL FX LH THUMB WO MNP-ER O $893.55 $580.81 330184 26750 F1 5111 450 DSTL PHLNGL FX LH 2ND DIG WO MNP-ER O $893.55 $580.81 330184 26750 F2 5111 450 DSTL PHLNGL FX LH 3RD DIG WO MNP-ER O $893.55 $580.81 330184 26750 F3 5111 450 DSTL PHLNGL FX LH 4TH DIG WO MNP-ER O $893.55 $580.81 330184 26750 F4 5111 450 DSTL PHLNGL FX LH 5TH DIG WO MNP-ER O $893.55 $580.81 330184 26750 F5 5111 450 DSTL PHLNGL FX RH THUMB WO MNP-ER O $893.55 $580.81 330184 26750 F6 5111 450 DSTL PHLNGL FX RH 2ND DIG WO MNP-ER O $893.55 $580.81 330184 26750 F7 5111 450 DSTL PHLNGL FX RH 3RD DIG WO MNP-ER O $893.55 $580.81 330184 26750 F8 5111 450 DSTL PHLNGL FX RH 4TH DIG WO MNP-ER O $893.55 $580.81 330184 26750 F9 5111 450 DSTL PHLNGL FX RH 5TH DIG WO MNP-ER O $893.55 $580.81 330184 26755 5111 450 CLSD DSTL PHALANG FX W/MA O "$1,612.80 " "$1,048.32 " 330184 26755 5111 450 CLOSED TREATMENT DISTPHAL O "$1,612.80 " "$1,048.32 " 330184 26755 FA 5111 450 DSTL PHLNGL FX LH THUMB W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F1 5111 450 DSTL PHLNGL FX LH 2ND DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F2 5111 450 DSTL PHLNGL FX LH 3RD DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F3 5111 450 DSTL PHLNGL FX LH 4TH DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F4 5111 450 DSTL PHLNGL FX LH 5TH DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F5 5111 450 DSTL PHLNGL FX RH THUMB W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F6 5111 450 DSTL PHLNGL FX RH 2ND DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F7 5111 450 DSTL PHLNGL FX RH 3RD DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F8 5111 450 DSTL PHLNGL FX RH 4TH DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26755 F9 5111 450 DSTL PHLNGL FX RH 5TH DIG W MNP-ER O "$1,612.80 " "$1,048.32 " 330184 26765 5113 450 OPN TRTMT DSTL PHLG FRCT INTRNL FXT-EA O "$7,378.00 " "$4,795.70 " 330184 26765 FA 5113 450 OPEN DSTL PHLNGL FX LH THUMB-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F1 5113 450 OPEN DSTL PHLNGL FX LH 2ND DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F2 5113 450 OPEN DSTL PHLNGL FX LH 3RD DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F3 5113 450 OPEN DSTL PHLNGL FX LH 4TH DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F4 5113 450 OPEN DSTL PHLNGL FX LH 5TH DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F5 5113 450 OPEN DSTL PHLNGL FX RH THUMB-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F6 5113 450 OPEN DSTL PHLNGL FX RH 2ND DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F7 5113 450 OPEN DSTL PHLNGL FX RH 3RD DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F8 5113 450 OPEN DSTL PHLNGL FX RH 4TH DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26765 F9 5113 450 OPEN DSTL PHLNGL FX RH 5TH DIG-ER O "$7,378.00 " "$4,795.70 " 330184 26770 5111 450 CLSD INTRPHAL JT DSLO W/M O "$1,352.40 " $879.06 330184 26770 FA 5111 450 INTRPH JT DISLOC W MNP LH THUMB-ER O "$1,352.40 " $879.06 330184 26770 F1 5111 450 INTRPH JT DISLOC W MNP LH 2ND DIG-ER O "$1,352.40 " $879.06 330184 26770 F2 5111 450 INTRPH JT DISLOC W MNP LH 3RD DIG-ER O "$1,352.40 " $879.06 330184 26770 F3 5111 450 INTRPH JT DISLOC W MNP LH 4TH DIG-ER O "$1,352.40 " $879.06 330184 26770 F4 5111 450 INTRPH JT DISLOC W MNP LH 5TH DIG-ER O "$1,352.40 " $879.06 330184 26770 F5 5111 450 INTRPH JT DISLOC W MNP RH THUMB-ER O "$1,352.40 " $879.06 330184 26770 F6 5111 450 INTRPH JT DISLOC W MNP RH 2ND DIG-ER O "$1,352.40 " $879.06 330184 26770 F7 5111 450 INTRPH JT DISLOC W MNP RH 3RD DIG-ER O "$1,352.40 " $879.06 330184 26770 F8 5111 450 INTRPH JT DISLOC W MNP RH 4TH DIG-ER O "$1,352.40 " $879.06 330184 26770 F9 5111 450 INTRPH JT DISLOC W MNP RH 5TH DIG-ER O "$1,352.40 " $879.06 330184 26989 5111 450 UNLISTED PROCEDURE HANDS O $605.00 $393.25 330184 27040 5072 761 CT BIOPSY SFT TISS PELVIS O "$3,742.00 " "$2,432.30 " 330184 27040 50 5072 761 BX ST TISS PELV/HIP SUPR BIL-RAD O "$5,613.00 " "$3,648.45 " 330184 27040 LT 5072 761 BX ST TISS PELV/HIP SUPR LT-RAD O "$3,742.00 " "$2,432.30 " 330184 27040 RT 5072 761 BX ST TISS PELV/HIP SUPR RT-RAD O "$3,742.00 " "$2,432.30 " 330184 27041 5072 761 CT BIOPSY SFT TISS PELVIS O "$3,742.00 " "$2,432.30 " 330184 27041 50 5072 761 BX ST TISS PELV/HIP DEEP BIL-RAD O "$5,613.00 " "$3,648.45 " 330184 27041 LT 5072 761 BX ST TISS PELV/HIP DEEP LT-RAD O "$3,742.00 " "$2,432.30 " 330184 27041 RT 5072 761 BX ST TISS PELV/HIP DEEP RT-RAD O "$3,742.00 " "$2,432.30 " 330184 27093 278 761 INJ FOR HIP ARTHROGRAPHY O $262.50 $170.62 330184 27093 50 278 761 INJ HIP ARTHRGRPHY WO ANS BIL-RAD O $393.75 $255.94 330184 27093 LT 278 761 INJ HIP ARTHRGRPHY WO ANS LT-RAD O $262.50 $170.62 330184 27093 RT 278 761 INJ HIP ARTHRGRPHY WO ANS RT-RAD O $262.50 $170.62 330184 27096 RT 50 761 IR ARTHRO SCRL JNT RT O "$1,535.00 " $997.75 330184 27096 LT 50 761 IR ARTHRO SACR JNT LT O "$1,535.00 " $997.75 330184 27096 50 761 INJ FOR SACROILIAC JT ANESTH BILAT O "$1,535.00 " $997.75 330184 27096 LT 50 761 INJ FOR SACROILIAC JT ANESTH LEFT O "$1,535.00 " $997.75 330184 27096 RT 50 761 INJ FOR SACROILIAC JT ANESTH RIGHT O "$1,535.00 " $997.75 330184 27096 50 761 INJECT FOR SACROILIAC JOINT BILAT O "$1,535.00 " $997.75 330184 27096 LT 50 761 INJECT FOR SACROILIAC JOINT LEFT O "$1,535.00 " $997.75 330184 27096 RT 50 761 INJECT FOR SACROILIAC JOINT RIGHT O "$1,535.00 " $997.75 330184 27197 5111 450 CLSD TX PELVIC RING FX WO MANIP O $605.00 $393.25 330184 27198 5111 450 CLSD TX PELVIC RING FX W MANIP O $605.00 $393.25 330184 27200 5111 450 CLSD COCCYGEAL FX O $605.00 $393.25 330184 27220 5111 450 CLSD ACETABULUM FX W/O MA O $605.00 $393.25 330184 27220 50 5111 450 HIP SOCKET FRACT WO MNP BIL-ER O $605.00 $393.25 330184 27220 LT 5111 450 HIP SOCKET FRACT WO MNP LT-ER O $605.00 $393.25 330184 27220 RT 5111 450 HIP SOCKET FRACT WO MNP RT-ER O $605.00 $393.25 330184 27222 450 CLSD ACETAB FX W/MAN O $414.00 $269.10 330184 27222 50 450 HIP SOCKET FRACT W MNP BIL-ER O $414.00 $269.10 330184 27222 LT 450 HIP SOCKET FRACT W MNP LT-ER O $414.00 $269.10 330184 27222 RT 450 HIP SOCKET FRACT W MNP RT-ER O $414.00 $269.10 330184 27230 5111 450 CLSD FEM FX-PRX NECK-W/O O $634.86 $412.66 330184 27230 50 5111 450 FEMORAL FX PRX NECK WO MNP BIL-ER O $634.86 $412.66 330184 27230 LT 5111 450 FEMORAL FX PRX NECK WO MNP LT-ER O $634.86 $412.66 330184 27230 RT 5111 450 FEMORAL FX PRX NECK WO MNP RT-ER O $634.86 $412.66 330184 27232 450 CLSD FEM FX-PRXNEC-W/MANI O "$2,209.00 " "$1,435.85 " 330184 27238 5112 450 CLSD INTR/PRTR/SUBTR FX W O "$3,684.00 " "$2,394.60 " 330184 27238 50 5112 450 INTR/PRTR/SUBTR FX WO MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 27238 LT 5112 450 INTR/PRTR/SUBTR FX WO MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 27238 RT 5112 450 INTR/PRTR/SUBTR FX WO MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 27240 450 CLSD INTR/PRTR/SUBTR FX W O "$1,243.00 " $807.95 330184 27246 5111 450 CLSD GRTR TROCHAN FX-W/O O $605.00 $393.25 330184 27246 50 5111 450 GRTR TROCHANTERIC FX WO MNP BIL-ER O $605.00 $393.25 330184 27246 LT 5111 450 GRTR TROCHANTERIC FX WO MNP LT-ER O $605.00 $393.25 330184 27246 RT 5111 450 GRTR TROCHANTERIC FX WO MNP RT-ER O $605.00 $393.25 330184 27250 5111 450 CLSD HIP DSLOC-TRAUMA W/O O $605.00 $393.25 330184 27250 50 5111 450 HIP DISLOC TRAUMATIC WO ANS BIL-ER O $605.00 $393.25 330184 27250 LT 5111 450 HIP DISLOC TRAUMATIC WO ANS LT-ER O $605.00 $393.25 330184 27250 RT 5111 450 HIP DISLOC TRAUMATIC WO ANS RT-ER O $605.00 $393.25 330184 27252 5112 450 CLSD HIP DSLOC-TRAUMA W/A O "$3,868.20 " "$2,514.33 " 330184 27252 50 5112 450 HIP DISLOC TRAUMATIC W ANS BIL-ER O "$3,868.20 " "$2,514.33 " 330184 27252 LT 5112 450 HIP DISLOC TRAUMATIC W ANS LT-ER O "$3,868.20 " "$2,514.33 " 330184 27252 RT 5112 450 HIP DISLOC TRAUMATIC W ANS RT-ER O "$3,868.20 " "$2,514.33 " 330184 27256 5111 450 SPONT HIP DSLO-W/O ANES O O $605.00 $393.25 330184 27256 50 5111 450 SPONT HIP DISLOC WO MNP BIL-ER O $605.00 $393.25 330184 27256 LT 5111 450 SPONT HIP DISLOC WO MNP LT-ER O $605.00 $393.25 330184 27256 RT 5111 450 SPONT HIP DISLOC WO MNP RT-ER O $605.00 $393.25 330184 27500 5111 450 CLSD FEM SHAFT FX W/O MAN O $605.00 $393.25 330184 27500 50 5111 450 FEMORAL SHAFT FRACT WO MNP BIL-ER O $605.00 $393.25 330184 27500 LT 5111 450 FEMORAL SHAFT FRACT WO MNP LT-ER O $605.00 $393.25 330184 27500 RT 5111 450 FEMORAL SHAFT FRACT WO MNP RT-ER O $605.00 $393.25 330184 27501 5111 450 CLSD SUPRA/TRAN FEM FX W/ O $605.00 $393.25 330184 27501 50 5111 450 SUPRA/TRANS FEM FX WO MNP BIL-ER O $605.00 $393.25 330184 27501 LT 5111 450 SUPRA/TRANS FEM FX WO MNP LT-ER O $605.00 $393.25 330184 27501 RT 5111 450 SUPRA/TRANS FEM FX WO MNP RT-ER O $605.00 $393.25 330184 27502 5112 450 CLSD FEM SHFT FX W/MAN O "$3,684.00 " "$2,394.60 " 330184 27502 50 5112 450 FEMORAL SHAFT FRACTURE W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 27502 LT 5112 450 FEMORAL SHAFT FRACTURE W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 27502 RT 5112 450 FEMORAL SHAFT FRACTURE W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 27503 5112 450 CLSD SUP/TRNS FEM FX W/MA O "$3,684.00 " "$2,394.60 " 330184 27503 50 5112 450 SPRTRNS CNDYLR FEM FX W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 27503 LT 5112 450 SPRTRNS CNDYLR FEM FX W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 27503 RT 5112 450 SPRTRNS CNDYLR FEM FX W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 27510 5112 450 CLSD DISTAL CNDYL FX W/MA O "$3,684.00 " "$2,394.60 " 330184 27510 50 5112 450 FEM FX DISTAL END W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 27510 LT 5112 450 FEM FX DISTAL END W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 27510 RT 5112 450 FEM FX DISTAL END W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 27516 5111 450 CLSD DSTL FEM EPIPH SEP W O $605.00 $393.25 330184 27516 50 5111 450 THIGH FX GRWTH PLATE WO MNP BIL-ER O $605.00 $393.25 330184 27516 LT 5111 450 THIGH FX GRWTH PLATE WO MNP LT-ER O $605.00 $393.25 330184 27516 RT 5111 450 THIGH FX GRWTH PLATE WO MNP RT-ER O $605.00 $393.25 330184 27517 5112 450 CLSD DSTL FEM EPIPH SEP W O "$3,684.00 " "$2,394.60 " 330184 27517 50 5112 450 THIGH FX GRWTH PLATE W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 27517 LT 5112 450 THIGH FX GRWTH PLATE W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 27517 RT 5112 450 THIGH FX GRWTH PLATE W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 27520 5111 450 CLSD PATELLAR FX W/O MANI O $605.00 $393.25 330184 27520 50 5111 510 PATELLAR FRACTURE WO MNP BIL-CLN O $605.00 $393.25 330184 27520 LT 5111 510 PATELLAR FRACTURE WO MNP LT-CLN O $605.00 $393.25 330184 27520 RT 5111 510 PATELLAR FRACTURE WO MNP RT-CLN O $605.00 $393.25 330184 27520 50 5111 450 PATELLAR FRACTURE WO MNP BIL-ER O $605.00 $393.25 330184 27520 LT 5111 450 PATELLAR FRACTURE WO MNP LT-ER O $605.00 $393.25 330184 27520 RT 5111 450 PATELLAR FRACTURE WO MNP RT-ER O $605.00 $393.25 330184 27530 5111 450 CLSD TIBIA PROX FX W/O MA O $635.25 $412.91 330184 27530 50 5111 510 TIBIAL FRACTURE WO MNP BIL-CLN O $635.25 $412.91 330184 27530 LT 5111 510 TIBIAL FRACTURE WO MNP LT-CLN O $635.25 $412.91 330184 27530 RT 5111 510 TIBIAL FRACTURE WO MNP RT-CLN O $635.25 $412.91 330184 27530 50 5111 450 TIBIAL FRACTURE WO MNP BIL-ER O $635.25 $412.91 330184 27530 LT 5111 450 TIBIAL FRACTURE WO MNP LT-ER O $635.25 $412.91 330184 27530 RT 5111 450 TIBIAL FRACTURE WO MNP RT-ER O $635.25 $412.91 330184 27532 5113 450 CLSD TIBIA PROX FX W/SKEL O "$7,378.00 " "$4,795.70 " 330184 27532 50 5113 510 TIBIAL FX W SKEL TRACT BIL-CLN O "$7,378.00 " "$4,795.70 " 330184 27532 LT 5113 510 TIBIAL FX W SKEL TRACT LT-CLN O "$7,378.00 " "$4,795.70 " 330184 27532 RT 5113 510 TIBIAL FX W SKEL TRACT RT-CLN O "$7,378.00 " "$4,795.70 " 330184 27532 50 5113 450 TIBIAL FX W SKEL TRACT BIL-ER O "$7,378.00 " "$4,795.70 " 330184 27532 LT 5113 450 TIBIAL FX W SKEL TRACT LT-ER O "$7,378.00 " "$4,795.70 " 330184 27532 RT 5113 450 TIBIAL FX W SKEL TRACT RT-ER O "$7,378.00 " "$4,795.70 " 330184 27538 5111 450 CLSD KNEE TUBEROS FX W/WO O $605.00 $393.25 330184 27538 50 5111 510 TREAT KNEE FRACTURE(S) BIL-CLN O $605.00 $393.25 330184 27538 LT 5111 510 TREAT KNEE FRACTURE(S) LT-CLN O $605.00 $393.25 330184 27538 RT 5111 510 TREAT KNEE FRACTURE(S) RT-CLN O $605.00 $393.25 330184 27538 50 5111 450 TREAT KNEE FRACTURE(S) BIL-ER O $605.00 $393.25 330184 27538 LT 5111 450 TREAT KNEE FRACTURE(S) LT-ER O $605.00 $393.25 330184 27538 RT 5111 450 TREAT KNEE FRACTURE(S) RT-ER O $605.00 $393.25 330184 27550 5111 450 CLSD KNEE DSLOC W/O ANEST O $635.25 $412.91 330184 27550 50 5111 450 KNEE DISLOCATION WO ANS BIL-ER O $635.25 $412.91 330184 27550 LT 5111 450 KNEE DISLOCATION WO ANS LT-ER O $635.25 $412.91 330184 27550 RT 5111 450 KNEE DISLOCATION WO ANS RT-ER O $635.25 $412.91 330184 27552 5112 450 CLSD KNEE DSLOC W/ANESTHE O "$3,684.00 " "$2,394.60 " 330184 27552 50 5112 450 KNEE DISLOCATION W ANS BIL-ER O "$3,684.00 " "$2,394.60 " 330184 27552 LT 5112 450 KNEE DISLOCATION W ANS LT-ER O "$3,684.00 " "$2,394.60 " 330184 27552 RT 5112 450 KNEE DISLOCATION W ANS RT-ER O "$3,684.00 " "$2,394.60 " 330184 27560 5111 450 CLSD PATELLAR DSLOC W/O A O $635.00 $412.75 330184 27560 50 5111 510 PATELLAR DISLOC WO ANS BIL-CLN O $635.00 $412.75 330184 27560 LT 5111 510 PATELLAR DISLOC WO ANS LT-CLN O $635.00 $412.75 330184 27560 RT 5111 510 PATELLAR DISLOC WO ANS RT-CLN O $635.00 $412.75 330184 27560 50 5111 450 PATELLAR DISLOC WO ANS BIL-ER O $635.00 $412.75 330184 27560 LT 5111 450 PATELLAR DISLOC WO ANS LT-ER O $635.00 $412.75 330184 27560 RT 5111 450 PATELLAR DISLOC WO ANS RT-ER O $635.00 $412.75 330184 27562 5111 450 CLSD PATELLAR DSLOC W/ANE O $635.25 $412.91 330184 27562 50 5111 450 PATELLAR DISLOC W ANS BIL-ER O $635.25 $412.91 330184 27562 LT 5111 450 PATELLAR DISLOC W ANS LT-ER O $635.25 $412.91 330184 27562 RT 5111 450 PATELLAR DISLOC W ANS RT-ER O $635.25 $412.91 330184 27750 5111 450 CLSD TIB FX W/WO FIB FX W O $605.00 $393.25 330184 27750 50 5111 510 TIBIAL SHAFT FX WO MNP BIL-CLN O $605.00 $393.25 330184 27750 LT 5111 510 TIBIAL SHAFT FX WO MNP LT-CLN O $605.00 $393.25 330184 27750 RT 5111 510 TIBIAL SHAFT FX WO MNP RT-CLN O $605.00 $393.25 330184 27750 50 5111 450 TIBIAL SHAFT FX WO MNP BIL-ER O $605.00 $393.25 330184 27750 LT 5111 450 TIBIAL SHAFT FX WO MNP LT-ER O $605.00 $393.25 330184 27750 RT 5111 450 TIBIAL SHAFT FX WO MNP RT-ER O $605.00 $393.25 330184 27752 5112 450 CLSD TIB FX W/WO FIB FX W O "$3,868.20 " "$2,514.33 " 330184 27752 50 5112 450 TIBIAL SHAFT FX W MNP BIL-ER O "$3,868.20 " "$2,514.33 " 330184 27752 LT 5112 450 TIBIAL SHAFT FX W MNP LT-ER O "$3,868.20 " "$2,514.33 " 330184 27752 RT 5112 450 TIBIAL SHAFT FX W MNP RT-ER O "$3,868.20 " "$2,514.33 " 330184 27760 5111 450 CLSD MED MALL FX W/O MAN O $635.25 $412.91 330184 27760 50 5111 510 MEDIAL ANKLE FX WO MNP BIL-CLN O $635.25 $412.91 330184 27760 LT 5111 510 MEDIAL ANKLE FX WO MNP LT-CLN O $635.25 $412.91 330184 27760 RT 5111 510 MEDIAL ANKLE FX WO MNP RT-CLN O $635.25 $412.91 330184 27760 50 5111 450 MEDIAL ANKLE FX WO MNP BIL-ER O $635.25 $412.91 330184 27760 LT 5111 450 MEDIAL ANKLE FX WO MNP LT-ER O $635.25 $412.91 330184 27760 RT 5111 450 MEDIAL ANKLE FX WO MNP RT-ER O $635.25 $412.91 330184 27762 5112 450 CLSD MED MALL FX W/MAN O "$3,144.00 " "$2,043.60 " 330184 27762 50 5112 510 MED ANKLE FX W/MNP BIL-CLN O "$3,144.00 " "$2,043.60 " 330184 27762 LT 5112 510 MED ANKLE FX W/MNP LT-CLN O "$3,144.00 " "$2,043.60 " 330184 27762 RT 5112 510 MED ANKLE FX W/MNP RT-CLN O "$3,144.00 " "$2,043.60 " 330184 27762 50 5112 450 MED ANKLE FX W/MNP BIL-ER O "$3,144.00 " "$2,043.60 " 330184 27762 LT 5112 450 MED ANKLE FX W/MNP LT-ER O "$3,144.00 " "$2,043.60 " 330184 27762 RT 5112 450 MED ANKLE FX W/MNP RT-ER O "$3,144.00 " "$2,043.60 " 330184 27780 5111 450 CLSD PROX FIB/SHFT FX WO O $635.00 $412.75 330184 27780 50 5111 510 PRX FIBULA FX WO MNP BIL-CLN O $635.00 $412.75 330184 27780 LT 5111 510 PRX FIBULA FX WO MNP LT-CLN O $635.00 $412.75 330184 27780 RT 5111 510 PRX FIBULA FX WO MNP RT-CLN O $635.00 $412.75 330184 27780 50 5111 450 PRX FIBULA FX WO MNP BIL-ER O $635.00 $412.75 330184 27780 LT 5111 450 PRX FIBULA FX WO MNP LT-ER O $635.00 $412.75 330184 27780 RT 5111 450 PRX FIBULA FX WO MNP RT-ER O $635.00 $412.75 330184 27781 5112 450 CLSD PROX FIB/SHFT FX W/M O "$3,684.00 " "$2,394.60 " 330184 27781 50 5112 450 PRX FIBULA FX W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 27781 LT 5112 450 PRX FIBULA FX W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 27781 RT 5112 450 PRX FIBULA FX W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 27786 5111 450 CLSD LAT MALLEOLUS FX WO O $634.86 $412.66 330184 27786 50 5111 450 DISTAL FIBULAR FX WO MNP BIL-ER O $634.86 $412.66 330184 27786 LT 5111 450 DISTAL FIBULAR FX WO MNP LT-ER O $634.86 $412.66 330184 27786 RT 5111 450 DISTAL FIBULAR FX WO MNP RT-ER O $634.86 $412.66 330184 27788 5111 450 CLSD LAT MALLEOLUS FX W/M O $634.86 $412.66 330184 27788 50 5111 510 DISTAL FIBULAR FX W MNP BIL-CLN O $634.86 $412.66 330184 27788 LT 5111 510 DISTAL FIBULAR FX W MNP LT-CLN O $634.86 $412.66 330184 27788 RT 5111 510 DISTAL FIBULAR FX W MNP RT-CLN O $634.86 $412.66 330184 27788 50 5111 450 DISTAL FIBULAR FX W MNP BIL-ER O $634.86 $412.66 330184 27788 LT 5111 450 DISTAL FIBULAR FX W MNP LT-ER O $634.86 $412.66 330184 27788 RT 5111 450 DISTAL FIBULAR FX W MNP RT-ER O $634.86 $412.66 330184 27808 5111 450 CLSD BIMALL ANKLE FX W/O O $605.00 $393.25 330184 27808 50 5111 510 BIMALLEOLR ANK FX WO MNP BIL-CLN O $605.00 $393.25 330184 27808 LT 5111 510 BIMALLEOLR ANK FX WO MNP LT-CLN O $605.00 $393.25 330184 27808 RT 5111 510 BIMALLEOLR ANK FX WO MNP RT-CLN O $605.00 $393.25 330184 27808 50 5111 450 BIMALLEOLR ANK FX WO MNP BIL-ER O $605.00 $393.25 330184 27808 LT 5111 450 BIMALLEOLR ANK FX WO MNP LT-ER O $605.00 $393.25 330184 27808 RT 5111 450 BIMALLEOLR ANK FX WO MNP RT-ER O $605.00 $393.25 330184 27810 5112 450 CLSD BIMALL ANKLE FX W/MA O "$3,144.00 " "$2,043.60 " 330184 27810 50 5112 510 BIMALLEOLAR ANK FX W MNP BIL-CLN O "$3,144.00 " "$2,043.60 " 330184 27810 LT 5112 510 BIMALLEOLAR ANK FX W MNP LT-CLN O "$3,144.00 " "$2,043.60 " 330184 27810 RT 5112 510 BIMALLEOLAR ANK FX W MNP RT-CLN O "$3,144.00 " "$2,043.60 " 330184 27810 50 5112 450 BIMALLEOLAR ANK FX W MNP BIL-ER O "$3,144.00 " "$2,043.60 " 330184 27810 LT 5112 450 BIMALLEOLAR ANK FX W MNP LT-ER O "$3,144.00 " "$2,043.60 " 330184 27810 RT 5112 450 BIMALLEOLAR ANK FX W MNP RT-ER O "$3,144.00 " "$2,043.60 " 330184 27818 5112 450 CL TX TRIMAL ANK FX W/MAN O "$3,144.00 " "$2,043.60 " 330184 27818 50 5112 450 TRIMALLEOLAR ANK FX W MNP BIL-ER O "$3,144.00 " "$2,043.60 " 330184 27818 LT 5112 450 TRIMALLEOLAR ANK FX W MNP LT-ER O "$3,144.00 " "$2,043.60 " 330184 27818 RT 5112 450 TRIMALLEOLAR ANK FX W MNP RT-ER O "$3,144.00 " "$2,043.60 " 330184 27824 5111 450 CLSD FX WT-BRG DISTL TIB O $634.86 $412.66 330184 27824 50 5111 450 LOWER LEG FX WO MNP BIL-ER O $634.86 $412.66 330184 27824 LT 5111 450 LOWER LEG FX WO MNP LT-ER O $634.86 $412.66 330184 27824 RT 5111 450 LOWER LEG FX WO MNP RT-ER O $634.86 $412.66 330184 27825 5112 450 CLSD FX WTBRG TIB W/TRX&M O "$3,868.20 " "$2,514.33 " 330184 27825 50 5112 450 LOWER LEG FX W MNP BIL-ER O "$3,868.20 " "$2,514.33 " 330184 27825 LT 5112 450 LOWER LEG FX W MNP LT-ER O "$3,868.20 " "$2,514.33 " 330184 27825 RT 5112 450 LOWER LEG FX W MNP RT-ER O "$3,868.20 " "$2,514.33 " 330184 27830 5111 450 CLSD PROX TIBFIB JT DSLO O $605.00 $393.25 330184 27830 50 5111 450 LOWER LEG DISLOC WO ANS BIL-ER O $605.00 $393.25 330184 27830 LT 5111 450 LOWER LEG DISLOC WO ANS LT-ER O $605.00 $393.25 330184 27830 RT 5111 450 LOWER LEG DISLOC WO ANS RT-ER O $605.00 $393.25 330184 27840 5111 450 CLSD ANKLE DISLOC W/O ANE O $605.00 $393.25 330184 27840 50 5111 450 ANKLE DISLOCATION WO ANS BIL-ER O $605.00 $393.25 330184 27840 LT 5111 450 ANKLE DISLOCATION WO ANS LT-ER O $605.00 $393.25 330184 27840 RT 5111 450 ANKLE DISLOCATION WO ANS RT-ER O $605.00 $393.25 330184 28001 50 5072 510 I & D BURSA FOOT BIL-CLN O "$3,742.00 " "$2,432.30 " 330184 28001 LT 5072 510 I & D BURSA FOOT LT-CLN O "$3,742.00 " "$2,432.30 " 330184 28001 RT 5072 510 I & D BURSA FOOT RT-CLN O "$3,742.00 " "$2,432.30 " 330184 28124 LT 5113 510 PRTL EXC PHALANX TOE BONE LT O "$7,378.00 " "$4,795.70 " 330184 28124 RT 5113 510 PRTL EXC PHALANX TOE BONE RT O "$7,378.00 " "$4,795.70 " 330184 28160 TA 5113 510 INTERPHALANG TOE JNT EXC LF GRT TOE O "$5,901.00 " "$3,835.65 " 330184 28160 T1 5113 510 INTERPHALANG TOE JNT EXC LF 2D O "$5,901.00 " "$3,835.65 " 330184 28160 T2 5113 510 INTERPHALANG TOE JNT EXC LF 3D O "$5,901.00 " "$3,835.65 " 330184 28160 T3 5113 510 INTERPHALANG TOE JNT EXC LF 4D O "$5,901.00 " "$3,835.65 " 330184 28160 T4 5113 510 INTERPHALANG TOE JNT EXC LF 5D O "$5,901.00 " "$3,835.65 " 330184 28160 T5 5113 510 INTERPHALANG TOE JNT EXC RF GRT TOE O "$5,901.00 " "$3,835.65 " 330184 28160 T6 5113 510 INTERPHALANG TOE JNT EXC RF 2D O "$5,901.00 " "$3,835.65 " 330184 28160 T7 5113 510 INTERPHALANG TOE JNT EXC RF 3D O "$5,901.00 " "$3,835.65 " 330184 28160 T8 5113 510 INTERPHALANG TOE JNT EXC RF 4D O "$5,901.00 " "$3,835.65 " 330184 28160 T9 5113 510 INTERPHALANG TOE JNT EXC RF 5D O "$5,901.00 " "$3,835.65 " 330184 28190 5071 9 450 REMOVAL FOREIGN BODYFOOT O "$1,712.55 " "$1,113.16 " 330184 28190 50 5071 9 510 RMVL FOOT FRGN BDY BIL-CLN O "$1,712.55 " "$1,113.16 " 330184 28190 LT 5071 9 510 RMVL FOOT FRGN BDY LT-CLN O "$1,712.55 " "$1,113.16 " 330184 28190 RT 5071 9 510 RMVL FOOT FRGN BDY RT-CLN O "$1,712.55 " "$1,113.16 " 330184 28190 50 5071 9 450 RMVL FOOT FRGN BDY BIL-ER O "$1,712.55 " "$1,113.16 " 330184 28190 LT 5071 9 450 RMVL FOOT FRGN BDY LT-ER O "$1,712.55 " "$1,113.16 " 330184 28190 RT 5071 9 450 RMVL FOOT FRGN BDY RT-ER O "$1,712.55 " "$1,113.16 " 330184 28192 5072 510 REM DEEP FB OF FOOT-28192 O "$4,158.00 " "$2,702.70 " 330184 28193 5072 510 COMPLIC REM FB FROM FOOT-28193 O "$4,158.00 " "$2,702.70 " 330184 28400 5111 450 CLSD CALCANEAL FX W/O MAN O $605.00 $393.25 330184 28400 50 5111 510 CALCANEAL FRACT WO MNP BIL-CLN O $605.00 $393.25 330184 28400 LT 5111 510 CALCANEAL FRACT WO MNP LT-CLN O $605.00 $393.25 330184 28400 RT 5111 510 CALCANEAL FRACT WO MNP RT-CLN O $605.00 $393.25 330184 28400 50 5111 450 CALCANEAL FRACT WO MNP BIL-ER O $605.00 $393.25 330184 28400 LT 5111 450 CALCANEAL FRACT WO MNP LT-ER O $605.00 $393.25 330184 28400 RT 5111 450 CALCANEAL FRACT WO MNP RT-ER O $605.00 $393.25 330184 28405 5111 450 CLSD CALCANEAL FX W/MANIP O $605.00 $393.25 330184 28405 50 5111 450 CALCANEAL FRACT W MNP BIL-ER O $605.00 $393.25 330184 28405 LT 5111 450 CALCANEAL FRACT W MNP LT-ER O $605.00 $393.25 330184 28405 RT 5111 450 CALCANEAL FRACT W MNP RT-ER O $605.00 $393.25 330184 28430 5111 450 CLSD TALUS FX W/O MANIPUL O $605.00 $393.25 330184 28430 50 5111 510 TALUS FRACTURE WO MNP BIL-CLN O $605.00 $393.25 330184 28430 LT 5111 510 TALUS FRACTURE WO MNP LT-CLN O $605.00 $393.25 330184 28430 RT 5111 510 TALUS FRACTURE WO MNP RT-CLN O $605.00 $393.25 330184 28430 50 5111 450 TALUS FRACTURE WO MNP BIL-ER O $605.00 $393.25 330184 28430 LT 5111 450 TALUS FRACTURE WO MNP LT-ER O $605.00 $393.25 330184 28430 RT 5111 450 TALUS FRACTURE WO MNP RT-ER O $605.00 $393.25 330184 28435 5112 450 CLSD TALUS FX W/MANIPULAT O "$3,684.00 " "$2,394.60 " 330184 28435 50 5112 450 TALUS FRACTURE W MNP BIL-ER O "$3,684.00 " "$2,394.60 " 330184 28435 LT 5112 450 TALUS FRACTURE W MNP LT-ER O "$3,684.00 " "$2,394.60 " 330184 28435 RT 5112 450 TALUS FRACTURE W MNP RT-ER O "$3,684.00 " "$2,394.60 " 330184 28450 5111 450 TARSAL BONE FX W/O MANIP- O $605.00 $393.25 330184 28450 50 5111 510 TARSAL BONE FRACT WO MNP BIL-CLN O $605.00 $393.25 330184 28450 LT 5111 510 TARSAL BONE FRACT WO MNP LT-CLN O $605.00 $393.25 330184 28450 RT 5111 510 TARSAL BONE FRACT WO MNP RT-CLN O $605.00 $393.25 330184 28450 50 5111 450 TARSAL BONE FRACT WO MNP BIL-ER O $605.00 $393.25 330184 28450 LT 5111 450 TARSAL BONE FRACT WO MNP LT-ER O $605.00 $393.25 330184 28450 RT 5111 450 TARSAL BONE FRACT WO MNP RT-ER O $605.00 $393.25 330184 28455 5112 450 TARSAL BONE FX W/MANIP-EA O "$7,378.00 " "$4,795.70 " 330184 28455 50 5112 450 TARSAL BONE FRACT W MNP BIL-ER O "$7,378.00 " "$4,795.70 " 330184 28455 LT 5112 450 TARSAL BONE FRACT W MNP LT-ER O "$7,378.00 " "$4,795.70 " 330184 28455 RT 5112 450 TARSAL BONE FRACT W MNP RT-ER O "$7,378.00 " "$4,795.70 " 330184 28470 5111 450 CLSD METATARSAL FX WO MAN O $634.86 $412.66 330184 28470 5111 510 METATARSAL FX WO MNP BIL-CLN O $634.86 $412.66 330184 28470 LT 5111 510 METATARSAL FX WO MNP LT-CLN O $634.86 $412.66 330184 28470 RT 5111 510 METATARSAL FX WO MNP RT-CLN O $634.86 $412.66 330184 28470 5111 450 METATARSAL FX WO MNP BIL-ER O $634.86 $412.66 330184 28470 LT 5111 450 METATARSAL FX WO MNP LT-ER O $634.86 $412.66 330184 28470 RT 5111 450 METATARSAL FX WO MNP RT-ER O $634.86 $412.66 330184 28475 5111 450 CLSD METATARSAL FX W/MANI O $605.00 $393.25 330184 28475 5111 510 METATARSAL FX W MNP BIL-CLN O $605.00 $393.25 330184 28475 LT 5111 510 METATARSAL FX W MNP LT-CLN O $605.00 $393.25 330184 28475 RT 5111 510 METATARSAL FX W MNP RT-CLN O $605.00 $393.25 330184 28475 5111 450 METATARSAL FX W MNP BIL-ER O $605.00 $393.25 330184 28475 LT 5111 450 METATARSAL FX W MNP LT-ER O $605.00 $393.25 330184 28475 RT 5111 450 METATARSAL FX W MNP RT-ER O $605.00 $393.25 330184 28490 5111 450 CLSD FX GREAT TOE/PHALANG O $635.25 $412.91 330184 28490 50 5111 510 BIG TOE FRACTURE WO MNP BIL-CLN O $635.25 $412.91 330184 28490 LT 5111 510 BIG TOE FRACTURE WO MNP LT-CLN O $635.25 $412.91 330184 28490 RT 5111 510 BIG TOE FRACTURE WO MNP RT-CLN O $635.25 $412.91 330184 28490 50 5111 450 BIG TOE FRACTURE WO MNP BIL-ER O $635.25 $412.91 330184 28490 LT 5111 450 BIG TOE FRACTURE WO MNP LT-ER O $635.25 $412.91 330184 28490 RT 5111 450 BIG TOE FRACTURE WO MNP RT-ER O $635.25 $412.91 330184 28495 5111 450 CLSD FX GREAT TOE/PHAL W/ O $605.00 $393.25 330184 28495 50 5111 510 BIG TOE FRACTURE W MNP BIL-CLN O $605.00 $393.25 330184 28495 LT 5111 510 BIG TOE FRACTURE W MNP LT-CLN O $605.00 $393.25 330184 28495 RT 5111 510 BIG TOE FRACTURE W MNP RT-CLN O $605.00 $393.25 330184 28495 50 5111 450 BIG TOE FRACTURE W MNP BIL-ER O $605.00 $393.25 330184 28495 LT 5111 450 BIG TOE FRACTURE W MNP LT-ER O $605.00 $393.25 330184 28495 RT 5111 450 BIG TOE FRACTURE W MNP RT-ER O $605.00 $393.25 330184 28510 5111 450 CLSD FX OTHR TOE W/O MAN O $559.65 $363.77 330184 28510 T1 5111 510 TOE FRACT WO MNP LF 2ND DIG-CLN O $559.65 $363.77 330184 28510 T2 5111 510 TOE FRACT WO MNP LF 3RD DIG-CLN O $559.65 $363.77 330184 28510 T3 5111 510 TOE FRACT WO MNP LF 4TH DIG-CLN O $559.65 $363.77 330184 28510 T4 5111 510 TOE FRACT WO MNP LF 5TH DIG-CLN O $559.65 $363.77 330184 28510 T6 5111 510 TOE FRACT WO MNP RF 2ND DIG-CLN O $559.65 $363.77 330184 28510 T7 5111 510 TOE FRACT WO MNP RF 3RD DIG-CLN O $559.65 $363.77 330184 28510 T8 5111 510 TOE FRACT WO MNP RF 4TH DIG-CLN O $559.65 $363.77 330184 28510 T9 5111 510 TOE FRACT WO MNP RF 5TH DIG-CLN O $559.65 $363.77 330184 28510 T1 5111 450 TOE FRACT WO MNP LF 2ND DIG-ER O $559.65 $363.77 330184 28510 T2 5111 450 TOE FRACT WO MNP LF 3RD DIG-ER O $559.65 $363.77 330184 28510 T3 5111 450 TOE FRACT WO MNP LF 4TH DIG-ER O $559.65 $363.77 330184 28510 T4 5111 450 TOE FRACT WO MNP LF 5TH DIG-ER O $559.65 $363.77 330184 28510 T6 5111 450 TOE FRACT WO MNP RF 2ND DIG-ER O $559.65 $363.77 330184 28510 T7 5111 450 TOE FRACT WO MNP RF 3RD DIG-ER O $559.65 $363.77 330184 28510 T8 5111 450 TOE FRACT WO MNP RF 4TH DIG-ER O $559.65 $363.77 330184 28510 T9 5111 450 TOE FRACT WO MNP RF 5TH DIG-ER O $559.65 $363.77 330184 28515 5111 450 CLSD FX OTHR TOE W/MAN EA O $717.15 $466.15 330184 28515 T1 5111 510 TOE FRACT W MNP LF 2ND DIG-CLN O $717.15 $466.15 330184 28515 T2 5111 510 TOE FRACT W MNP LF 3RD DIG-CLN O $717.15 $466.15 330184 28515 T3 5111 510 TOE FRACT W MNP LF 4TH DIG-CLN O $717.15 $466.15 330184 28515 T4 5111 510 TOE FRACT W MNP LF 5TH DIG-CLN O $717.15 $466.15 330184 28515 T6 5111 510 TOE FRACT W MNP RF 2ND DIG-CLN O $717.15 $466.15 330184 28515 T7 5111 510 TOE FRACT W MNP RF 3RD DIG-CLN O $717.15 $466.15 330184 28515 T8 5111 510 TOE FRACT W MNP RF 4TH DIG-CLN O $717.15 $466.15 330184 28515 T9 5111 510 TOE FRACT W MNP RF 5TH DIG-CLN O $717.15 $466.15 330184 28515 T1 5111 450 TOE FRACT W MNP LF 2ND DIG-ER O $717.15 $466.15 330184 28515 T2 5111 450 TOE FRACT W MNP LF 3RD DIG-ER O $717.15 $466.15 330184 28515 T3 5111 450 TOE FRACT W MNP LF 4TH DIG-ER O $717.15 $466.15 330184 28515 T4 5111 450 TOE FRACT W MNP LF 5TH DIG-ER O $717.15 $466.15 330184 28515 T6 5111 450 TOE FRACT W MNP RF 2ND DIG-ER O $717.15 $466.15 330184 28515 T7 5111 450 TOE FRACT W MNP RF 3RD DIG-ER O $717.15 $466.15 330184 28515 T8 5111 450 TOE FRACT W MNP RF 4TH DIG-ER O $717.15 $466.15 330184 28515 T9 5111 450 TOE FRACT W MNP RF 5TH DIG-ER O $717.15 $466.15 330184 28530 5111 450 CLSD SESAMOID FX TREATMEN O $605.00 $393.25 330184 28530 50 5111 510 SESAMOID BONE FRACTURE BIL-CLN O $605.00 $393.25 330184 28530 LT 5111 510 SESAMOID BONE FRACTURE LT-CLN O $605.00 $393.25 330184 28530 RT 5111 510 SESAMOID BONE FRACTURE RT-CLN O $605.00 $393.25 330184 28530 50 5111 450 SESAMOID BONE FRACTURE BIL-ER O $605.00 $393.25 330184 28530 LT 5111 450 SESAMOID BONE FRACTURE LT-ER O $605.00 $393.25 330184 28530 RT 5111 450 SESAMOID BONE FRACTURE RT-ER O $605.00 $393.25 330184 28540 5111 450 CLSD TARSAL DSLOC W/O ANE O $605.00 $393.25 330184 28540 50 5111 450 TARSAL BONE DISLOC WO ANS BIL-ER O $605.00 $393.25 330184 28540 LT 5111 450 TARSAL BONE DISLOC WO ANS LT-ER O $605.00 $393.25 330184 28540 RT 5111 450 TARSAL BONE DISLOC WO ANS RT-ER O $605.00 $393.25 330184 28570 5111 450 CLSD TALOTARSAL JT SLC WO O $605.00 $393.25 330184 28570 50 5111 450 TALOTARSAL JT DISLOC WO ANS BIL-ER O $605.00 $393.25 330184 28570 LT 5111 450 TALOTARSAL JT DISLOC WO ANS LT-ER O $605.00 $393.25 330184 28570 RT 5111 450 TALOTARSAL JT DISLOC WO ANS RT-ER O $605.00 $393.25 330184 28600 5111 450 CLSD METATARSAL JT DSLO W O $605.00 $393.25 330184 28600 50 5111 450 TARSOMTRSL JT DSLC WO ANS BIL-ER O $605.00 $393.25 330184 28600 LT 5111 450 TARSOMTRSL JT DSLC WO ANS LT-ER O $605.00 $393.25 330184 28600 RT 5111 450 TARSOMTRSL JT DSLC WO ANS RT-ER O $605.00 $393.25 330184 28630 5111 450 CLSD METATRSLPHALANG JT D O $695.10 $451.82 330184 28630 TA 5111 450 METAT JT DSLC WO ANS LF GRT TOE-ER O $695.10 $451.82 330184 28630 T1 5111 450 METAT JT DSLC WO ANS LF 2ND DIG-ER O $695.10 $451.82 330184 28630 T2 5111 450 METAT JT DSLC WO ANS LF 3RD DIG-ER O $695.10 $451.82 330184 28630 T3 5111 450 METAT JT DSLC WO ANS LF 4TH DIG-ER O $695.10 $451.82 330184 28630 T4 5111 450 METAT JT DSLC WO ANS LF 5TH DIG-ER O $695.10 $451.82 330184 28630 T5 5111 450 METAT JT DSLC WO ANS RF GRT TOE-ER O $695.10 $451.82 330184 28630 T6 5111 450 METAT JT DSLC WO ANS RF 2ND DIG-ER O $695.10 $451.82 330184 28630 T7 5111 450 METAT JT DSLC WO ANS RF 3RD DIG-ER O $695.10 $451.82 330184 28630 T8 5111 450 METAT JT DSLC WO ANS RF 4TH DIG-ER O $695.10 $451.82 330184 28630 T9 5111 450 METAT JT DSLC WO ANS RF 5TH DIG-ER O $695.10 $451.82 330184 28660 5111 450 CLSD INTERPHALANGEAL JT D O $527.10 $342.62 330184 28660 TA 5111 450 INTRPH JT DISLOC WO ANS LF GRT TOE-ER O $527.10 $342.62 330184 28660 T1 5111 450 INTRPH JT DISLOC WO ANS LF 2ND DIG-ER O $527.10 $342.62 330184 28660 T2 5111 450 INTRPH JT DISLOC WO ANS LF 3RD DIG-ER O $527.10 $342.62 330184 28660 T3 5111 450 INTRPH JT DISLOC WO ANS LF 4TH DIG-ER O $527.10 $342.62 330184 28660 T4 5111 450 INTRPH JT DISLOC WO ANS LF 5TH DIG-ER O $527.10 $342.62 330184 28660 T5 5111 450 INTRPH JT DISLOC WO ANS RF GRT TOE-ER O $527.10 $342.62 330184 28660 T6 5111 450 INTRPH JT DISLOC WO ANS RF 2ND DIG-ER O $527.10 $342.62 330184 28660 T7 5111 450 INTRPH JT DISLOC WO ANS RF 3RD DIG-ER O $527.10 $342.62 330184 28660 T8 5111 450 INTRPH JT DISLOC WO ANS RF 4TH DIG-ER O $527.10 $342.62 330184 28660 T9 5111 450 INTRPH JT DISLOC WO ANS RF 5TH DIG-ER O $527.10 $342.62 330184 29055 5102 510 Application Of Shoulder C O $668.00 $434.20 330184 29055 50 5102 450 APPLIC CAST SHOULDER SPICA BIL-ER O $668.00 $434.20 330184 29055 LT 5102 450 APPLIC CAST SHOULDER SPICA LT-ER O $668.00 $434.20 330184 29055 RT 5102 450 APPLIC CAST SHOULDER SPICA RT-ER O $668.00 $434.20 330184 29065 5102 450 29065 APPLICATION LONG AR O $581.00 $377.65 330184 29065 5102 450 CAST APPLICATION-SHLDR-HA O $581.00 $377.65 330184 29065 50 5102 510 APPLIC LONG ARM CAST BIL-CLN O $581.00 $377.65 330184 29065 LT 5102 510 APPLIC LONG ARM CAST LT-CLN O $581.00 $377.65 330184 29065 RT 5102 510 APPLIC LONG ARM CAST R-CLN O $581.00 $377.65 330184 29065 50 5102 450 APPLIC LONG ARM CAST BIL-ER O $581.00 $377.65 330184 29065 LT 5102 450 APPLIC LONG ARM CAST LT-ER O $581.00 $377.65 330184 29065 RT 5102 450 APPLIC LONG ARM CAST R-ER O $581.00 $377.65 330184 29075 5102 39 450 CAST APPLICATION-ELBOW-FI O $530.00 $344.50 330184 29075 50 5102 39 510 APPLIC FOREARM CAST BIL-CLN O $530.00 $344.50 330184 29075 LT 5102 39 510 APPLIC FOREARM CAST LT-CLN O $530.00 $344.50 330184 29075 RT 5102 39 510 APPLIC FOREARM CAST RT-CLN O $530.00 $344.50 330184 29075 50 5102 39 450 APPLIC FOREARM CAST BIL-ER O $530.00 $344.50 330184 29075 LT 5102 39 450 APPLIC FOREARM CAST LT-ER O $530.00 $344.50 330184 29075 RT 5102 39 450 APPLIC FOREARM CAST RT-ER O $530.00 $344.50 330184 29085 5101 450 CAST APPLICATION-HAND&FOR O $397.95 $258.67 330184 29085 50 5101 450 APPLY HAND/WRIST CAST BIL-ER O $397.95 $258.67 330184 29085 LT 5101 450 APPLY HAND/WRIST CAST LT-ER O $397.95 $258.67 330184 29085 RT 5101 450 APPLY HAND/WRIST CAST RT-ER O $397.95 $258.67 330184 29086 FA 5101 510 APPLY FINGER CAST LH THUMB-CLN O $185.00 $120.25 330184 29086 F1 5101 510 APPLY FINGER CAST LH 2ND DIG-CLN O $185.00 $120.25 330184 29086 F2 5101 510 APPLY FINGER CAST LH 3RD DIG-CLN O $185.00 $120.25 330184 29086 F3 5101 510 APPLY FINGER CAST LH 4TH DIG-CLN O $185.00 $120.25 330184 29086 F4 5101 510 APPLY FINGER CAST LH 5TH DIG-CLN O $185.00 $120.25 330184 29086 F5 5101 510 APPLY FINGER CAST RH THUMB-CLN O $185.00 $120.25 330184 29086 F6 5101 510 APPLY FINGER CAST RH 2ND DIG-CLN O $185.00 $120.25 330184 29086 F7 5101 510 APPLY FINGER CAST RH 3RD DIG-CLN O $185.00 $120.25 330184 29086 F8 5101 510 APPLY FINGER CAST RH 4TH DIG-CLN O $185.00 $120.25 330184 29086 F9 5101 510 APPLY FINGER CAST RH 5TH DIG-CLN O $185.00 $120.25 330184 29105 50 5101 40 510 APPLY LONG ARM SPLINT BIL-CLN O $397.95 $258.67 330184 29105 LT 5101 40 510 APPLY LONG ARM SPLINT LT-CLN O $397.95 $258.67 330184 29105 RT 5101 40 510 APPLY LONG ARM SPLINT RT-CLN O $397.95 $258.67 330184 29105 5101 40 450 APPLY LONG ARM SPLINT(ER) O $397.95 $258.67 330184 29105 50 5101 40 450 APPLY LONG ARM SPLINT BIL-ER O $397.95 $258.67 330184 29105 LT 5101 40 450 APPLY LONG ARM SPLINT LT-ER O $397.95 $258.67 330184 29105 RT 5101 40 450 APPLY LONG ARM SPLINT RT-ER O $397.95 $258.67 330184 29125 5734 40 450 APPLY SPLINT SHORT ARM(ST O $318.15 $206.80 330184 29125 5734 40 450 WRIST SPLINT APPLICATION O $318.15 $206.80 330184 29125 50 5734 40 510 APPLY FOREARM SPLINT BIL-CLN O $318.15 $206.80 330184 29125 LT 5734 40 510 APPLY FOREARM SPLINT LT-CLN O $318.15 $206.80 330184 29125 RT 5734 40 510 APPLY FOREARM SPLINT RT-CLN O $318.15 $206.80 330184 29125 50 5734 40 450 APPLY FOREARM SPLINT BIL-ER O $318.15 $206.80 330184 29125 LT 5734 40 450 APPLY FOREARM SPLINT LT-ER O $318.15 $206.80 330184 29125 RT 5734 40 450 APPLY FOREARM SPLINT RT-ER O $318.15 $206.80 330184 29130 5733 40 450 APPLICATION-FINGER SPLINT O $207.90 $135.14 330184 29130 FA 5733 40 510 APPLY FNGR SPLINT LH THUMB-CLN O $207.90 $135.14 330184 29130 F1 5733 40 510 APPLY FNGR SPLINT LH 2ND DIG-CLN O $207.90 $135.14 330184 29130 F2 5733 40 510 APPLY FNGR SPLINT LH 3RD DIG-CLN O $207.90 $135.14 330184 29130 F3 5733 40 510 APPLY FNGR SPLINT LH 4TH DIG-CLN O $207.90 $135.14 330184 29130 F4 5733 40 510 APPLY FNGR SPLINT LH 5TH DIG-CLN O $207.90 $135.14 330184 29130 F5 5733 40 510 APPLY FNGR SPLINT RH THUMB-CLN O $207.90 $135.14 330184 29130 F6 5733 40 510 APPLY FNGR SPLINT RH 2ND DIG-CLN O $207.90 $135.14 330184 29130 F7 5733 40 510 APPLY FNGR SPLINT RH 3RD DIG-CLN O $207.90 $135.14 330184 29130 F8 5733 40 510 APPLY FNGR SPLINT RH 4TH DIG-CLN O $207.90 $135.14 330184 29130 F9 5733 40 510 APPLY FNGR SPLINT RH 5TH DIG-CLN O $207.90 $135.14 330184 29130 FA 5733 40 450 APPLY FNGR SPLINT LH THUMB-ER O $207.90 $135.14 330184 29130 F1 5733 40 450 APPLY FNGR SPLINT LH 2ND DIG-ER O $207.90 $135.14 330184 29130 F2 5733 40 450 APPLY FNGR SPLINT LH 3RD DIG-ER O $207.90 $135.14 330184 29130 F3 5733 40 450 APPLY FNGR SPLINT LH 4TH DIG-ER O $207.90 $135.14 330184 29130 F4 5733 40 450 APPLY FNGR SPLINT LH 5TH DIG-ER O $207.90 $135.14 330184 29130 F5 5733 40 450 APPLY FNGR SPLINT RH THUMB-ER O $207.90 $135.14 330184 29130 F6 5733 40 450 APPLY FNGR SPLINT RH 2ND DIG-ER O $207.90 $135.14 330184 29130 F7 5733 40 450 APPLY FNGR SPLINT RH 3RD DIG-ER O $207.90 $135.14 330184 29130 F8 5733 40 450 APPLY FNGR SPLINT RH 4TH DIG-ER O $207.90 $135.14 330184 29130 F9 5733 40 450 APPLY FNGR SPLINT RH 5TH DIG-ER O $207.90 $135.14 330184 29131 5733 510 APPLY FINGER SPLINT; DYNAMIC-29131 O $168.00 $109.20 330184 29260 5732 450 STRAPPINGELBOW/WRIST O $86.00 $55.90 330184 29260 50 5732 450 STRAPPING ELBOW / WRIST BIL-ER O $86.00 $55.90 330184 29260 LT 5732 450 STRAPPING ELBOW / WRIST LT-ER O $86.00 $55.90 330184 29260 RT 5732 450 STRAPPING ELBOW / WRIST RT-ER O $86.00 $55.90 330184 29305 50 5102 510 APPLICATION HIP CAST BIL-CLN O $668.00 $434.20 330184 29305 LT 5102 510 APPLICATION HIP CAST LT-CLN O $668.00 $434.20 330184 29305 RT 5102 510 APPLICATION HIP CAST RT-CLN O $668.00 $434.20 330184 29325 5102 510 Application Of Hip Casts O $668.00 $434.20 330184 29345 5102 39 450 CAST APPLICATION-THIGH TO O $701.40 $455.91 330184 29345 50 5102 39 510 APPLIC LONG LEG CAST BIL-CLN O $701.40 $455.91 330184 29345 LT 5102 39 510 APPLIC LONG LEG CAST LT-CLN O $701.40 $455.91 330184 29345 RT 5102 39 510 APPLIC LONG LEG CAST RT-CLN O $701.40 $455.91 330184 29345 50 5102 39 450 APPLIC LONG LEG CAST BIL-ER O $701.40 $455.91 330184 29345 LT 5102 39 450 APPLIC LONG LEG CAST LT-ER O $701.40 $455.91 330184 29345 RT 5102 39 450 APPLIC LONG LEG CAST RT-ER O $701.40 $455.91 330184 29355 50 5102 510 APPLIC AMB LONG LEG CAST BIL-CLN O $668.00 $434.20 330184 29355 LT 5102 510 APPLIC AMB LONG LEG CAST LT-CLN O $668.00 $434.20 330184 29355 RT 5102 510 APPLIC AMB LONG LEG CAST RT-CLN O $668.00 $434.20 330184 29355 50 5102 450 APPLIC AMB LONG LEG CAST BIL-ER O $668.00 $434.20 330184 29355 LT 5102 450 APPLIC AMB LONG LEG CAST LT-ER O $668.00 $434.20 330184 29355 RT 5102 450 APPLIC AMB LONG LEG CAST RT-ER O $668.00 $434.20 330184 29365 5102 450 CAST APPLICATION-THIGH-AN O $668.00 $434.20 330184 29365 50 5102 510 APPLIC CYLINDCLN CAST BIL-CLN O $668.00 $434.20 330184 29365 LT 5102 510 APPLIC CYLINDCLN CAST LT-CLN O $668.00 $434.20 330184 29365 RT 5102 510 APPLIC CYLINDCLN CAST RT-CLN O $668.00 $434.20 330184 29365 50 5102 450 APPLIC CYLINDER CAST BIL-ER O $668.00 $434.20 330184 29365 LT 5102 450 APPLIC CYLINDER CAST LT-ER O $668.00 $434.20 330184 29365 RT 5102 450 APPLIC CYLINDER CAST RT-ER O $668.00 $434.20 330184 29405 5102 39 450 CAST APPLICATION-1 YR O $798.00 $518.70 330184 36430 5241 113 391 BLOOD TRANFUSION O "$1,316.44 " $855.68 330184 36430 5241 113 391 BLOOD TRANSFUSION NURSING O "$1,316.44 " $855.68 330184 36430 5241 113 391 BLOOD TRANSFUSION SERVICE O "$1,316.44 " $855.68 330184 36471 50 5052 510 INJECTION THERAPY VEINS BIL-CLN O $885.00 $575.25 330184 36471 LT 5052 510 INJECTION THERAPY VEINS LT-CLN O $885.00 $575.25 330184 36471 RT 5052 510 INJECTION THERAPY VEINS RT-CLN O $885.00 $575.25 330184 36500 423 761 RAD ANG VENOUS CATH SAMPL O $464.00 $301.60 330184 36500 50 423 761 INSERTION CATH VEIN BIL-RAD O $464.00 $301.60 330184 36500 LT 423 761 INSERTION CATH VEIN LT-RAD O $464.00 $301.60 330184 36500 RT 423 761 INSERTION CATH VEIN RT-RAD O $464.00 $301.60 330184 36555 5182 761 RAD SPEC CENTRAL PERC < 2 O "$2,070.00 " "$1,345.50 " 330184 36555 5182 450 CENT VEN CATH-PERC 2 O "$2,094.00 " "$1,361.10 " 330184 36556 5182 75 761 RAD PICC INSERT PERC>AGE O "$2,094.00 " "$1,361.10 " 330184 36556 5182 75 450 CENT VEN CATH-CUTDWN>2 O "$2,094.00 " "$1,361.10 " 330184 36556 5182 75 450 CENT VEN CATH-PERC>2 O "$2,094.00 " "$1,361.10 " 330184 36556 5182 75 369 INS NON TUNNELL SHILEY CA O "$2,094.00 " "$1,361.10 " 330184 36558 5183 83 761 INSERTION TUNNELED CNT CV O "$7,143.00 " "$4,642.95 " 330184 36558 50 5183 83 761 INS TUNN CV CTH WO PMP >5 BIL-RAD O "$10,714.50 " "$6,964.43 " 330184 36558 LT 5183 83 761 INS TUNN CV CTH WO PMP >5 LT-RAD O "$7,143.00 " "$4,642.95 " 330184 36558 RT 5183 83 761 INS TUNN CV CTH WO PMP >5 RT-RAD O "$7,143.00 " "$4,642.95 " 330184 36561 5183 83 761 RAD SPEC INSERT TUNN CV C O "$7,143.00 " "$4,642.95 " 330184 36561 5183 83 369 INS TRIPLE LUMEN PORT CAT O "$7,143.00 " "$4,642.95 " 330184 36561 50 5183 83 761 INS TUNN CV CTH W PMP >5 BIL-RAD O "$10,714.50 " "$6,964.43 " 330184 36561 LT 5183 83 761 INS TUNN CV CTH W PMP >5 LT-RAD O "$7,143.00 " "$4,642.95 " 330184 36561 RT 5183 83 761 INS TUNN CV CTH W PMP >5 RT-RAD O "$7,143.00 " "$4,642.95 " 330184 36565 5183 761 IR INS TNL CV ACS DVC W/2 O "$7,143.00 " "$4,642.95 " 330184 36565 50 5183 761 TUNN CV CTH 2 SITES WO PMP BIL-RAD O "$10,714.50 " "$6,964.43 " 330184 36565 LT 5183 761 TUNN CV CTH 2 SITES WO PMP LT-RAD O "$7,143.00 " "$4,642.95 " 330184 36565 RT 5183 761 TUNN CV CTH 2 SITES WO PMP RT-RAD O "$7,143.00 " "$4,642.95 " 330184 36569 5182 75 761 RAD SPEC INSERT PICC CATH O "$2,173.50 " "$1,412.78 " 330184 36569 5182 75 450 INS PICC CTH WO SUBCU 5> O "$2,173.50 " "$1,412.78 " 330184 36571 5183 75 761 RAD SPEC INSERT PICVAD CA O "$7,500.15 " "$4,875.10 " 330184 36571 5183 75 761 RAD SPEC PORTA-A-CATH INS O "$7,500.15 " "$4,875.10 " 330184 36571 50 5183 75 761 INS PICVAD CATH W PORT >5 BIL-RAD O "$11,250.23 " "$7,312.65 " 330184 36571 LT 5183 75 761 INS PICVAD CATH W PORT >5 LT-RAD O "$7,500.15 " "$4,875.10 " 330184 36571 RT 5183 75 761 INS PICVAD CATH W PORT >5 RT-RAD O "$7,500.15 " "$4,875.10 " 330184 36576 5182 76 761 IR RPR CV ACS DVC W/PRT/P O "$2,070.00 " "$1,345.50 " 330184 36578 5183 76 761 IR RPL CTH ONLY CV ACS DV O "$7,143.00 " "$4,642.95 " 330184 36580 5182 75 761 IR RPL CMP NONTNL CVC O "$2,070.00 " "$1,345.50 " 330184 36580 5182 75 761 RPL CMP NONTUN WO PRT/PMP O "$2,070.00 " "$1,345.50 " 330184 36581 5183 83 761 IR RPL CMP TNL CVC O "$7,143.00 " "$4,642.95 " 330184 36581 5183 83 761 RPL CMP TUN WO PRT/PMP MS O "$7,143.00 " "$4,642.95 " 330184 36582 5183 83 761 RPL CMP W SUB PRT MOD SED O "$7,143.00 " "$4,642.95 " 330184 36583 5184 761 RPL CMP W SUB PMP MOD SED O "$11,874.00 " "$7,718.10 " 330184 36584 5182 75 761 IR RPL CMP PRPH PICC O "$2,070.00 " "$1,345.50 " 330184 36584 5182 75 761 RPL CMP PRPH PICC WO PMP O "$2,070.00 " "$1,345.50 " 330184 36585 5183 75 761 RPL CMP PRPH W SBC PRT MS O "$7,143.00 " "$4,642.95 " 330184 36589 5181 76 761 RAD SPEC RMVL TUNN CV CAT O "$2,070.00 " "$1,345.50 " 330184 36590 5181 76 761 RAD SPEC PORT REMOVAL O "$2,070.00 " "$1,345.50 " 330184 36591 5734 494 510 DRAW BLOOD OFF VENOUS DEVICE O $303.00 $196.95 330184 36592 5734 510 COLLECT BLOOD FROM PICC O $257.00 $167.05 330184 36593 5694 111 761 RAD SPEC DECLOT VSCLR DEV O $745.00 $484.25 330184 36593 5694 111 450 DECLOTTING BY THROMBOLYTI O $745.00 $484.25 330184 36593 5694 111 369 PORT-A-CATH FLUSH O $745.00 $484.25 330184 36593 5694 111 510 DECLOT VASCULAR DEVICE O $745.00 $484.25 330184 36595 5183 76 761 RAD SPEC MECH RMVL TUNN C O "$7,143.00 " "$4,642.95 " 330184 36596 5182 76 761 IR RMV MCHNCL OBST MTR CV O "$2,070.00 " "$1,345.50 " 330184 36597 5182 76 761 RAD REPOSITION CVC W/FLUR O "$2,070.00 " "$1,345.50 " 330184 36598 5693 278 761 RAD SPEC PORT EVAL W/ CON O $571.20 $371.28 330184 36598 5693 278 761 RAD SPEC PORT EVAL W/CONT O $571.20 $371.28 330184 36598 50 5693 278 761 INJ W/FLUOR EVAL CV DEVICE BIL-RAD O $856.80 $556.92 330184 36598 LT 5693 278 761 INJ W/FLUOR EVAL CV DEVICE LT-RAD O $571.20 $371.28 330184 36598 RT 5693 278 761 INJ W/FLUOR EVAL CV DEVICE RT-RAD O $571.20 $371.28 330184 36600 5734 494 410 ARTERIAL PUNCTURE O $215.88 $140.32 330184 36600 5734 494 410 ARTERIAL PUNCTURE (ABG) O $215.88 $140.32 330184 36680 5735 49 450 INTRAOSSEOUS INFUSION O $798.00 $518.70 330184 36800 5184 361 36800 INSERTION OF CANNUL O "$11,874.00 " "$7,718.10 " 330184 36901 5182 279 761 INTRO CTH DLYS CIRCUIT-36901 O "$2,070.00 " "$1,345.50 " 330184 36902 5192 77 761 INTRO CTH DLYS CIRCUIT-W TRNS BLLN ANGIOP-36902 O "$14,600.00 " "$9,490.00 " 330184 36903 5193 85 761 INTRO CTH DLYS CIRCUIT-W INTRV STENT-36903 O "$29,508.00 " "$19,180.20 " 330184 36904 5192 77 761 THRMBC/NFS DLYS CIRCUIT-36904 O "$14,600.00 " "$9,490.00 " 330184 36905 5193 79 761 THRMBC/NFS DLYS CIRCUIT-W TRNS BLLN ANGIOP-36905 O "$29,508.00 " "$19,180.20 " 330184 36906 5194 85 761 THRMBC/NFS DLYS CIRCUIT-W INTRV STENT-36906 O "$44,727.00 " "$29,072.55 " 330184 36907 79 761 BALO ANGIOP CTR DLYS SEG-36907 O $0.00 $0.00 330184 36908 79 761 STENT PLMT CTR DLYS SEG-36908 O $0.00 $0.00 330184 36909 85 761 DLYS CIRCUIT EMBOLJ-36909 O $0.00 $0.00 330184 37191 5184 77 761 RAD ANG RVSN OF INFERIOR O "$11,874.00 " "$7,718.10 " 330184 37191 5184 77 761 RAD SPEC PERCU PLACE IVC O "$11,874.00 " "$7,718.10 " 330184 37195 5694 111 450 CEREBRAL THROMBOLYSIS O $846.00 $549.90 330184 37197 5183 77 761 RAD TRANSCATHETER RETR. O O "$7,143.00 " "$4,642.95 " 330184 37197 5183 77 761 RAD SPEC TRANS RETRIEVE F O "$7,143.00 " "$4,642.95 " 330184 37211 TC 5184 77 761 THROMBOLYTIC ART THERAPY-INIT TRMT DAY O "$11,874.00 " "$7,718.10 " 330184 37212 TC 5183 77 761 THROMBOLYTIC VENOUS THERAPY-INIT TRMT DAY O "$7,143.00 " "$4,642.95 " 330184 37213 TC 5182 77 761 THROMBLYTIC ART/VEN THERAPY O "$2,070.00 " "$1,345.50 " 330184 37214 TC 5182 77 761 CESSJ THERAPY CATH REMOVAL O "$2,070.00 " "$1,345.50 " 330184 37220 5192 79 761 RAD SPEC ANGIOPLASTY ILIA O "$14,600.00 " "$9,490.00 " 330184 37220 50 5192 79 761 ILIAC REVASC W ANGIOPL BIL-RAD O "$21,900.00 " "$14,235.00 " 330184 37220 LT 5192 79 761 ILIAC REVASC W ANGIOPL LT-RAD O "$14,600.00 " "$9,490.00 " 330184 37220 RT 5192 79 761 ILIAC REVASC W ANGIOPL RT-RAD O "$14,600.00 " "$9,490.00 " 330184 37224 5192 79 761 ANGIOPLASTY FEMORAL O "$14,600.00 " "$9,490.00 " 330184 37224 50 5192 79 761 FEM/POPL REVAS W TL ANGIOP BIL-RAD O "$21,900.00 " "$14,235.00 " 330184 37224 LT 5192 79 761 FEM/POPL REVAS W TL ANGIOP LT-RAD O "$14,600.00 " "$9,490.00 " 330184 37224 RT 5192 79 761 FEM/POPL REVAS W TL ANGIOP RT-RAD O "$14,600.00 " "$9,490.00 " 330184 37236 5193 85 761 OPEN/PERQ PLACE STENT 1ST O "$29,508.00 " "$19,180.20 " 330184 37236 50 5193 85 761 OPEN/PERQ PLACE STENT 1ST BIL-RAD O "$44,262.00 " "$28,770.30 " 330184 37236 LT 5193 85 761 OPEN/PERQ PLACE STENT 1ST LT-RAD O "$29,508.00 " "$19,180.20 " 330184 37236 RT 5193 85 761 OPEN/PERQ PLACE STENT 1ST RT-RAD O "$29,508.00 " "$19,180.20 " 330184 37237 85 761 OPEN/PERQ PLACE STENT EA ADD O "$4,235.00 " "$2,752.75 " 330184 37237 50 85 761 TRNS INTRV PLM STNT ADL ART BIL-RAD O "$4,235.00 " "$2,752.75 " 330184 37237 LT 85 761 TRNS INTRV PLM STNT ADL ART LT-RAD O "$4,235.00 " "$2,752.75 " 330184 37237 RT 85 761 TRNS INTRV PLM STNT ADL ART RT-RAD O "$4,235.00 " "$2,752.75 " 330184 37238 5193 85 761 OPEN/PERQ PLACE STENT SAME O "$29,508.00 " "$19,180.20 " 330184 37238 50 5193 85 761 TRNS PLM INTR STNT INTL VEIN BIL-RAD O "$44,262.00 " "$28,770.30 " 330184 37238 LT 5193 85 761 TRNS PLM INTR STNT INTL VEIN LT-RAD O "$29,508.00 " "$19,180.20 " 330184 37238 RT 5193 85 761 TRNS PLM INTR STNT INTL VEIN RT-RAD O "$29,508.00 " "$19,180.20 " 330184 37239 85 761 OPEN/PERQ PLACE STENT EA ADD O "$4,235.00 " "$2,752.75 " 330184 37239 50 85 761 TRNS INTRV PLM STNT ADL VEIN BIL-RAD O "$4,235.00 " "$2,752.75 " 330184 37239 LT 85 761 TRNS INTRV PLM STNT ADL VEIN LT-RAD O "$4,235.00 " "$2,752.75 " 330184 37239 RT 85 761 TRNS INTRV PLM STNT ADL VEIN RT-RAD O "$4,235.00 " "$2,752.75 " 330184 37241 5193 85 761 VASC EMBOLIZE/OCCLUDE VENOUS O "$29,508.00 " "$19,180.20 " 330184 37242 5193 85 761 VASC EMBOLIZE/OCCLUDE ARTERY O "$29,508.00 " "$19,180.20 " 330184 37243 5193 85 761 VASC EMBOLIZE/OCCLUDE ORGAN O "$29,508.00 " "$19,180.20 " 330184 37244 5193 85 761 VASC EMBOLIZE/OCCLUDE BLEED O "$30,983.40 " "$20,139.21 " 330184 38205 815 APHORESIS ALLOGENIC O "$3,044.00 " "$1,978.60 " 330184 38206 5242 369 APHORESIS AUTOLOGOUS O "$3,324.00 " "$2,160.60 " 330184 38220 5072 124 369 BONE MARROW ASPIRATION O "$3,929.10 " "$2,553.92 " 330184 38220 50 5072 124 510 BONE MARROW ASPIRATION BIL-CLN O "$3,929.10 " "$2,553.92 " 330184 38220 LT 5072 124 510 BONE MARROW ASPIRATION LT-CLN O "$3,929.10 " "$2,553.92 " 330184 38220 RT 5072 124 510 BONE MARROW ASPIRATION RT-CLN O "$3,929.10 " "$2,553.92 " 330184 38221 5072 124 361 BONE MARROW BIOPSY O "$3,929.10 " "$2,553.92 " 330184 38221 50 5072 124 510 BONE MARROW BIOPSY BIL-CLN O "$3,929.10 " "$2,553.92 " 330184 38221 LT 5072 124 510 BONE MARROW BIOPSY LT-CLN O "$3,929.10 " "$2,553.92 " 330184 38221 RT 5072 124 510 BONE MARROW BIOPSY RT-CLN O "$3,929.10 " "$2,553.92 " 330184 38505 5072 10 761 IR MAM LYMPH NODE BIOPSY O "$3,742.00 " "$2,432.30 " 330184 38505 50 5072 10 761 NEEDLE BX LYMPH NODES SUPERF BIL-RAD O "$5,613.00 " "$3,648.45 " 330184 38505 LT 5072 10 761 NEEDLE BX LYMPH NODES SUPERF LT-RAD O "$3,742.00 " "$2,432.30 " 330184 38505 RT 5072 10 761 NEEDLE BX LYMPH NODES SUPERF RT-RAD O "$3,742.00 " "$2,432.30 " 330184 38792 5591 331 761 NM LYMPHOSCINTIGRAPHY INJ O "$1,058.40 " $687.96 330184 38792 50 5591 331 761 RA TRACER ID SENTINL NODE BIL-RAD O "$1,587.60 " "$1,031.94 " 330184 38792 LT 5591 331 761 RA TRACER ID SENTINL NODE LT-RAD O "$1,058.40 " $687.96 330184 38792 RT 5591 331 761 RA TRACER ID SENTINL NODE RT-RAD O "$1,058.40 " $687.96 330184 41250 5734 450 LAC REPAIR-MOUTH/TONGU<2. O $798.00 $518.70 330184 42700 5161 450 Drainage Of Tonsil Absces O $562.80 $365.82 330184 42700 50 5161 510 DRAIN TONSIL ABSCESS BIL-CLN O $562.80 $365.82 330184 42700 LT 5161 510 DRAIN TONSIL ABSCESS LT-CLN O $562.80 $365.82 330184 42700 RT 5161 510 DRAIN TONSIL ABSCESS RT-CLN O $562.80 $365.82 330184 42700 50 5161 450 DRAIN TONSIL ABSCESS BIL-ER O $562.80 $365.82 330184 42700 LT 5161 450 DRAIN TONSIL ABSCESS LT-ER O $562.80 $365.82 330184 42700 RT 5161 450 DRAIN TONSIL ABSCESS RT-ER O $562.80 $365.82 330184 42809 5735 450 REMOVE PHARYNX FRGN BODY O $798.00 $518.70 330184 42999 5161 361 THROAT SURGERY PROCEDURE O $536.00 $348.40 330184 43243 5302 450 EGD W/INJ SCLEROSIS VARIC O "$4,039.00 " "$2,625.35 " 330184 43246 5302 761 RAD SPEC PERCU GASTRO TUB O "$4,039.00 " "$2,625.35 " 330184 43246 5302 450 WITH DIRECTED PLACEMENT O O "$4,039.00 " "$2,625.35 " 330184 43752 5735 130 450 NASAL/OROGASTIC W/STENT O $798.00 $518.70 330184 43753 5722 130 450 GASTRIC INTUBATION/AND AS O $703.00 $456.95 330184 43762 5371 421 510 RPLC GTUBE NO REVJ TRC(cln)-43762 O $567.00 $368.55 330184 43762 5371 421 450 RPLC GTUBE NO REVJ TRC(cln)-43762 O $567.00 $368.55 330184 43763 5371 421 510 RPLC GTUBE REVJ GSTRST TRC(cln)-43763 O $695.00 $451.75 330184 43763 5371 421 450 RPLC GTUBE REVJ GSTRST TRC(cln)-43763 O $695.00 $451.75 330184 44373 5302 761 SM INT ENDO CONV PERC GT O "$4,039.00 " "$2,625.35 " 330184 45020 5313 761 CT DRAIN OF RECTAL ABSCES O "$6,558.00 " "$4,262.70 " 330184 45300 5311 450 PROCTOSIGMOIDOSCOPY O "$2,020.00 " "$1,313.00 " 330184 45300 5311 510 PROCTOSIGMOIDOSCOPY O "$2,020.00 " "$1,313.00 " 330184 45330 5311 510 FLEXIBLE SIGMOIDOSCOPY W/ O "$2,020.00 " "$1,313.00 " 330184 45331 5311 510 FLEX SIG W/BX O "$2,020.00 " "$1,313.00 " 330184 45334 5312 450 SIGMOIDOSCOPY W/BLEED CON O "$2,655.00 " "$1,725.75 " 330184 45335 5311 510 SIGMDSCPY W/SUBMUC INJ O "$2,020.00 " "$1,313.00 " 330184 45999 5311 450 UNLISTED PROCEDURE RECTUM O "$2,020.00 " "$1,313.00 " 330184 46020 5313 510 BURN CARE O "$6,558.00 " "$4,262.70 " 330184 46020 5313 510 PLACEMENT OF SETON O "$6,558.00 " "$4,262.70 " 330184 46030 5312 510 REMOVAL OF RECTAL MARKER O "$2,655.00 " "$1,725.75 " 330184 46040 5312 141 450 I&D ISCHIORECTAL/PERIRECT O "$2,787.75 " "$1,812.04 " 330184 46050 5311 510 INCISION OF ANAL ABSCESS O "$2,020.00 " "$1,313.00 " 330184 46083 5371 450 INCISION OF THROMBOSED HE O $654.00 $425.10 330184 46220 5312 510 EXCISE ANAL EXT TAG/PAPIL O "$2,787.75 " "$1,812.04 " 330184 46221 5311 510 LIGATION OF HEMORRHOID O "$2,020.00 " "$1,313.00 " 330184 46320 5312 450 EXCISION OF THROMBOSED HE O "$2,655.00 " "$1,725.75 " 330184 46500 5311 510 "INJ SCLEROSING SOLUTION, HEMORRHOIDS" O "$1,789.00 " "$1,162.85 " 330184 46600 5734 510 DIAGNOSITIC ANOSCOPY O $318.15 $206.80 330184 46606 5312 510 ANOSCOPY AND BIOPSY O "$2,655.00 " "$1,725.75 " 330184 46900 5052 510 DESTRUCTION ANAL LESION O $929.25 $604.01 330184 47000 5072 150 761 CT PERCU LIVER BIOPSY O "$3,224.00 " "$2,095.60 " 330184 47000 5072 150 369 LIVER BIOPSY O "$3,224.00 " "$2,095.60 " 330184 47490 5341 151 761 RAD SPEC PERCU INCSN GALL O "$6,222.00 " "$4,044.30 " 330184 47531 TC 5341 279 761 INJ FOR CHOLANGIOGRAM-EXISTING ACCESS O "$6,222.00 " "$4,044.30 " 330184 47532 TC 5341 279 761 INJECTION FOR CHOLANGIOGRAM-NEW ACCESS O "$8,662.00 " "$5,630.30 " 330184 47533 TC 5341 151 761 PLMT BILIARY DRAINAGE CATH-EXTERNAL O "$8,662.00 " "$5,630.30 " 330184 47534 TC 5341 151 761 PLMT BILIARY DRAINAGE CATH: INT-EXT O "$8,662.00 " "$5,630.30 " 330184 47535 TC 5341 151 761 CNVRSN EXT BIL DRG CATH TO INT-EXT O "$8,662.00 " "$5,630.30 " 330184 47536 TC 5341 151 761 EXCHANGE BILIARY DRG CATH O "$6,222.00 " "$4,044.30 " 330184 47537 TC 5301 421 761 REMOVAL BILIARY DRG CATH O "$2,117.00 " "$1,376.05 " 330184 47538 TC 5361 151 761 PERQ PLMT BILE DUCT STENT-EXSTNG SITE O "$12,706.00 " "$8,258.90 " 330184 47539 TC 5361 151 761 PRQ PLMT BILE DUCT STENT-NEW ACCESS O "$12,706.00 " "$8,258.90 " 330184 47540 TC 5361 152 761 PRQ PLMT BILE DUCT STENT-NEW W DRG CTH O "$12,706.00 " "$8,258.90 " 330184 47544 TC 151 761 REMOVAL DUCT GLBLDR CALCULI O $532.00 $345.80 330184 47556 5361 153 761 IR ENDSCPY BLRY W/DLT DCT O "$12,706.00 " "$8,258.90 " 330184 48102 5072 150 761 CT NEEDLE BIOPSY PANCREAS O "$3,742.00 " "$2,432.30 " 330184 49060 369 CT DRAIN OPEN RETROP ABSC O "$1,454.25 " $945.26 330184 49060 761 US ABS DRNG PERC + GUID O "$1,454.25 " $945.26 330184 49082 5301 150 450 PARACENTESIS INITIAL O "$2,222.85 " "$1,444.85 " 330184 49082 5301 150 510 Abdominal paracentesis W/O imaging guid O "$2,222.85 " "$1,444.85 " 330184 49082 5301 150 450 ABD PARACENTESIS WO IMG O "$2,222.85 " "$1,444.85 " 330184 49082 5301 150 450 ABD PARAC WO IMG GUIDANCE O "$2,222.85 " "$1,444.85 " 330184 49083 5301 150 761 RAD SPEC PUNC PERTNL CVT O "$2,222.85 " "$1,444.85 " 330184 49083 5301 150 761 Peritoneocentesis O "$2,222.85 " "$1,444.85 " 330184 49083 5301 150 761 CT PERITONEOCENTESIS SUBS O "$2,222.85 " "$1,444.85 " 330184 49180 5072 150 761 CT BIOPSY ABDOM MASS O "$3,929.10 " "$2,553.92 " 330184 49405 5072 150 761 IMAGE CATH FLUID COLXN VISC O "$3,929.10 " "$2,553.92 " 330184 49406 5072 150 761 IMAGE-CT CATH FLUID PERI/RETRO O "$3,224.00 " "$2,095.60 " 330184 49422 5183 150 761 RAD SPEC REMOVAL INTRAPER O "$7,500.15 " "$4,875.10 " 330184 49423 5302 150 761 RAD SPEC EXCH PRE AB/CYST O "$4,039.00 " "$2,625.35 " 330184 49424 278 761 IR INJ CNT ASS ABS/CYST O $582.75 $378.79 330184 49440 5302 130 761 RAD GASTROSTOMY TUBE POSI O "$4,240.95 " "$2,756.62 " 330184 49440 5302 130 761 RAD SPEC PER PLACMNT GAST O "$4,240.95 " "$2,756.62 " 330184 49440 5302 130 761 RAD SPEC INSERT GAS TUBE O "$4,240.95 " "$2,756.62 " 330184 49440 5302 130 761 RAD SPEC RPLCMT DISL G-J O "$4,240.95 " "$2,756.62 " 330184 49450 5301 130 761 REPLACE G/C TUBE PERC W/FLURO O "$2,117.00 " "$1,376.05 " 330184 50040 761 IR RENAL ABSCESS PERCU DR O "$1,140.00 " $741.00 330184 50040 761 PERCU NEPHR W DRNG O "$1,140.00 " $741.00 330184 50040 50 369 DRAINAGE KIDNEY BIL-RAD O "$1,140.00 " $741.00 330184 50040 LT 369 DRAINAGE KIDNEY LT-RAD O "$1,140.00 " $741.00 330184 50040 RT 369 DRAINAGE KIDNEY RT-RAD O "$1,140.00 " $741.00 330184 50200 RT 5072 170 761 Percutaneous Renal Biopsy O "$3,224.00 " "$2,095.60 " 330184 50200 LT 5072 170 761 Percutaneous Renal Biopsy O "$3,224.00 " "$2,095.60 " 330184 50200 50 5072 170 761 RENAL BX PERCU NEEDL/TROCAR BIL-RAD O "$4,836.00 " "$3,143.40 " 330184 50382 5373 170 761 IR RMV & RPL IND URT STNT O "$4,976.00 " "$3,234.40 " 330184 50382 50 5373 170 761 CHANGE URETER STENT PERCUT BIL-RAD O "$7,464.00 " "$4,851.60 " 330184 50382 LT 5373 170 761 CHANGE URETER STENT PERCUT LT-RAD O "$4,976.00 " "$3,234.40 " 330184 50382 RT 5373 170 761 CHANGE URETER STENT PERCUT RT-RAD O "$4,976.00 " "$3,234.40 " 330184 50387 5373 170 761 IR RMV/RPL TRNSPHRC URTR O "$4,976.00 " "$3,234.40 " 330184 50387 50 5373 170 761 CHANGE EXT/INT URETER STENT BIL-RAD O "$7,464.00 " "$4,851.60 " 330184 50387 LT 5373 170 761 CHANGE EXT/INT URETER STENT LT-RAD O "$4,976.00 " "$3,234.40 " 330184 50387 RT 5373 170 761 CHANGE EXT/INT URETER STENT RT-RAD O "$4,976.00 " "$3,234.40 " 330184 50389 5372 161 761 IR RMV NPH TUBE W/FLUORO O "$1,662.00 " "$1,080.30 " 330184 50389 50 5372 161 761 REMOVE RENAL TUBE W FLUORO BIL-RAD O "$2,493.00 " "$1,620.45 " 330184 50389 LT 5372 161 761 REMOVE RENAL TUBE W FLUORO LT-RAD O "$1,662.00 " "$1,080.30 " 330184 50389 RT 5372 161 761 REMOVE RENAL TUBE W FLUORO RT-RAD O "$1,662.00 " "$1,080.30 " 330184 50390 5071 161 761 IR ASP/INJ RNL CYST/PLVS O "$1,631.00 " "$1,060.15 " 330184 50390 50 5071 161 761 DRAINAGE KIDNEY LESION BIL-RAD O "$2,446.50 " "$1,590.23 " 330184 50390 LT 5071 161 761 DRAINAGE KIDNEY LESION LT-RAD O "$1,631.00 " "$1,060.15 " 330184 50390 RT 5071 161 761 DRAINAGE KIDNEY LESION RT-RAD O "$1,631.00 " "$1,060.15 " 330184 50391 5371 761 IR INS THPY AGNT NPHRSTMY O $654.00 $425.10 330184 50391 50 5371 761 INSTLL RX AGNT INTO RNAL TUB BIL-RAD O $981.00 $637.65 330184 50391 LT 5371 761 INSTLL RX AGNT INTO RNAL TUB LT-RAD O $654.00 $425.10 330184 50391 RT 5371 761 INSTLL RX AGNT INTO RNAL TUB RT-RAD O $654.00 $425.10 330184 50396 5372 161 761 IR MSR KDNY PRSR W/CTH O "$1,662.00 " "$1,080.30 " 330184 50396 50 5372 161 761 MEASURE KIDNEY PRESSURE BIL-RAD O "$2,493.00 " "$1,620.45 " 330184 50396 LT 5372 161 761 MEASURE KIDNEY PRESSURE LT-RAD O "$1,662.00 " "$1,080.30 " 330184 50396 RT 5372 161 761 MEASURE KIDNEY PRESSURE RT-RAD O "$1,662.00 " "$1,080.30 " 330184 50430 5372 161 761 NJX PX NFROSGRM &/URTRGRM-NEW ACCESS O "$1,662.00 " "$1,080.30 " 330184 50431 5372 161 761 NJX PX NFROSGRM &/URTRGRM-EXISTING ACCESS O "$1,662.00 " "$1,080.30 " 330184 50432 LT 5373 170 761 PLMT NEPHROSTOMY CATHETER-LT O "$5,224.80 " "$3,396.12 " 330184 50432 RT 5373 170 761 PLMT NEPHROSTOMY CATHETER-RT O "$5,224.80 " "$3,396.12 " 330184 50433 LT 5374 171 761 PLMT NEPHROURETERAL CATH LT-NEW ACCESS O "$4,976.00 " "$3,234.40 " 330184 50433 RT 5374 171 761 PLMT NEPHROURETERAL CATH RT-NEW ACCESS O "$4,976.00 " "$3,234.40 " 330184 50434 LT 5373 170 761 CONVT NEPHROSTOMY CATHETER LT VIA NPH TRCT O "$2,127.00 " "$1,382.55 " 330184 50434 RT 5373 170 761 CONVT NEPHROSTOMY CATHETER RT VIA NPH TRCT O "$2,127.00 " "$1,382.55 " 330184 50435 LT 5373 170 761 EXCHANGE NEPHROSTOMY CATH-LT O "$3,756.90 " "$2,441.99 " 330184 50435 RT 5373 170 761 EXCHANGE NEPHROSTOMY CATH-RT O "$3,756.90 " "$2,441.99 " 330184 50436 LT 5373 170 761 DILAT XST TRC NDURLGC PX LEFT-50436 O "$5,222.00 " "$3,394.30 " 330184 50436 RT 5373 170 761 DILAT XST TRC NDURLGC PX RIGHT-50436 O "$5,222.00 " "$3,394.30 " 330184 50437 LT 5374 170 761 DILAT XST TRC NEW ACCESS RCS-LEFT-50437 O "$8,788.00 " "$5,712.20 " 330184 50437 RT 5374 170 761 DILAT XST TRC NEW ACCESS RCS-RIGHT-50437 O "$8,788.00 " "$5,712.20 " 330184 50593 5362 172 761 CT PERCUTANEOUS RENAL CRY O "$21,089.00 " "$13,707.85 " 330184 50593 50 5362 172 761 PERC CRYO ABLATE RENAL TUM BIL-RAD O "$31,633.50 " "$20,561.78 " 330184 50593 LT 5362 172 761 PERC CRYO ABLATE RENAL TUM LT-RAD O "$21,089.00 " "$13,707.85 " 330184 50593 RT 5362 172 761 PERC CRYO ABLATE RENAL TUM RT-RAD O "$21,089.00 " "$13,707.85 " 330184 50606 LT 172 761 ENDOLUMINAL BX URTR RNL PLVS-LT O $450.00 $292.50 330184 50606 RT 172 761 ENDOLUMINAL BX URTR RNL PLVS-RT O $450.00 $292.50 330184 50684 278 761 RAD SPEC INJ FOR URETER X O $788.00 $512.20 330184 50684 50 278 761 INJ FOR URETER X-RAY BIL-RAD O "$1,773.00 " "$1,152.45 " 330184 50684 LT 278 761 INJ FOR URETER X-RAY LT-RAD O $788.00 $512.20 330184 50684 RT 278 761 INJ FOR URETER X-RAY RT-RAD O $788.00 $512.20 330184 50688 5373 170 761 RAD SPEC CHANGE URETER TU O "$4,976.00 " "$3,234.40 " 330184 50688 50 5373 170 761 CHANGE URETER TUBE/STENT BIL-RAD O "$7,464.00 " "$4,851.60 " 330184 50688 LT 5373 170 761 CHANGE URETER TUBE/STENT LT-RAD O "$4,976.00 " "$3,234.40 " 330184 50688 RT 5373 170 761 CHANGE URETER TUBE/STENT RT-RAD O "$4,976.00 " "$3,234.40 " 330184 50693 LT 5374 171 761 PLMT LT URETERAL STENT PRQ VIA NPH TRCT O "$7,693.00 " "$5,000.45 " 330184 50693 RT 5374 171 761 PLMT RT URETERAL STENT PRQ VIA NPH TRCT O "$7,693.00 " "$5,000.45 " 330184 50694 LT 5374 171 761 PLM LT URTRL STNT PRQ NW ACCSS WO NPH CTH O "$7,693.00 " "$5,000.45 " 330184 50694 RT 5374 171 761 PLM RT URTRL STNT PRQ NW ACCSS WO NPH CTH O "$7,693.00 " "$5,000.45 " 330184 50695 LT 5374 171 761 PLM LT URTRL STNT PRQ NW ACCSS W NPH CTH O "$7,693.00 " "$5,000.45 " 330184 50695 RT 5374 171 761 PLM RT URTRL STNT PRQ NW ACCSS W NPH CTH O "$7,693.00 " "$5,000.45 " 330184 51102 5373 173 761 RAD BLDR ASPR W SUPR PUB O "$3,907.00 " "$2,539.55 " 330184 51600 278 761 IR INJ PRC CYS/VD URT CYS O "$2,423.00 " "$1,574.95 " 330184 51600 278 761 IR INJ CYSTGRPHY/VDNG O "$2,423.00 " "$1,574.95 " 330184 51605 761 RAD SPEC CHAIN URETHROCYS O "$2,449.00 " "$1,591.85 " 330184 51610 278 761 Urethrocystogram Inject O "$1,910.00 " "$1,241.50 " 330184 51610 278 761 Urethrocystogram InjwCon O "$1,910.00 " "$1,241.50 " 330184 51700 5371 450 BLADDER IRRIGATION-SMPL L O $654.00 $425.10 330184 51701 5734 159 510 Insert Bladder Catheter O $318.15 $206.80 330184 51701 5734 159 510 INSRT STRAIGHT CATH-RESID URINE(ONC) O $318.15 $206.80 330184 51701 5734 159 450 INSERTION OF BLADDER CATHETER O $318.15 $206.80 330184 51702 5734 159 510 CATHETERIZATIONURETHRAS O $318.15 $206.80 330184 51702 5734 159 450 CATHERIZATION URETHRA SIM O $318.15 $206.80 330184 51702 5734 159 450 INSERTION OF TEMP INDWELL O $318.15 $206.80 330184 51705 5371 421 450 CHANGE OF CYSTOSTOMY TUBE O $654.00 $425.10 330184 52000 5372 510 CYSTOSCOPY O "$1,662.00 " "$1,080.30 " 330184 53899 5371 170 361 UNLISTED PROCEDURE URINAR O $654.00 $425.10 330184 55100 5072 450 SCROTUM ABSCESS DRAINAGE O "$3,742.00 " "$2,432.30 " 330184 55700 5373 176 761 US BX PROSTATE ANY APPROACH O "$3,907.00 " "$2,539.55 " 330184 56405 5412 514 I & D of Vulva/perineum O $821.00 $533.65 330184 56420 5411 417 450 I&D BARTHOLIN'S ABSCESS O $484.05 $314.63 330184 56420 50 5411 417 510 DRAINAGE GLAND ABSCESS BIL-CLN O $484.05 $314.63 330184 56420 LT 5411 417 510 DRAINAGE GLAND ABSCESS LT-CLN O $484.05 $314.63 330184 56420 RT 5411 417 510 DRAINAGE GLAND ABSCESS RT-CLN O $484.05 $314.63 330184 56420 50 5411 417 450 DRAINAGE GLAND ABSCESS BIL-ER O $484.05 $314.63 330184 56420 LT 5411 417 450 DRAINAGE GLAND ABSCESS LT-ER O $484.05 $314.63 330184 56420 RT 5411 417 450 DRAINAGE GLAND ABSCESS RT-ER O $484.05 $314.63 330184 56440 50 5414 510 SURGERY FOR VULVA LESION BIL-CLN O "$6,310.00 " "$4,101.50 " 330184 56440 LT 5414 510 SURGERY FOR VULVA LESION LT-CLN O "$6,310.00 " "$4,101.50 " 330184 56440 RT 5414 510 SURGERY FOR VULVA LESION RT-CLN O "$6,310.00 " "$4,101.50 " 330184 56440 5414 450 MRSPLZTN BRTHLNS GLND CYS O "$6,310.00 " "$4,101.50 " 330184 56440 50 5414 450 SURGERY FOR VULVA LESION BIL-ER O "$6,310.00 " "$4,101.50 " 330184 56440 LT 5414 450 SURGERY FOR VULVA LESION LT-ER O "$6,310.00 " "$4,101.50 " 330184 56440 RT 5414 450 SURGERY FOR VULVA LESION RT-ER O "$6,310.00 " "$4,101.50 " 330184 56501 5054 510 DESTROY VULVA LESIONS SIM O "$3,711.00 " "$2,412.15 " 330184 56515 5054 510 DESTROY VULVA LESION/S COMPL O "$7,579.00 " "$4,926.35 " 330184 56605 5413 514 Biopsy Of Vulva/perineum O $834.00 $542.10 330184 56820 5411 510 EXAM VULVA W/SCOPE O $461.00 $299.65 330184 56821 5412 510 EXAM/BIOPSY VULVA W/SCOPE O $834.00 $542.10 330184 57020 5415 510 COLPOCENTESIS O "$6,310.00 " "$4,101.50 " 330184 57061 5414 510 DESTROY VAG LESIONS SIMPLE O "$6,310.00 " "$4,101.50 " 330184 57065 5414 510 DESTROY VAG LESIONS COMPLEX O "$6,310.00 " "$4,101.50 " 330184 57100 5413 514 Biopsy Of Vagina O "$2,015.00 " "$1,309.75 " 330184 57160 5411 510 PESSARY DEVICE INSERTION O $484.05 $314.63 330184 57170 5411 510 FITTING DIAPHRAGM/CAP O $461.00 $299.65 330184 57420 5412 510 EXAM VAGINA W/SCOPE O $834.00 $542.10 330184 57452 5411 361 COLPOSCOPY W/O BX O $484.05 $314.63 330184 57454 5412 361 COLPOSCOPY W/BX &/OR CUTT O $875.70 $569.21 330184 57455 5412 514 Biopsy Of Cervix W/scope O $875.70 $569.21 330184 57456 5412 514 Endocerv Curettage W/scop O $875.70 $569.21 330184 57460 5414 361 LEEP EXCISION O "$6,310.00 " "$4,101.50 " 330184 57461 5414 510 CONZ CERVIX W/SCOPE LEEP O "$6,310.00 " "$4,101.50 " 330184 57500 5413 514 Biopsy Of Cervix O "$1,341.00 " $871.65 330184 57505 5413 514 Endocervical Curettage O "$2,015.00 " "$1,309.75 " 330184 57511 5412 514 Cryocautery Of Cervix O $834.00 $542.10 330184 57513 5414 510 LASER SURGERY CERVIX O "$6,310.00 " "$4,101.50 " 330184 57520 5414 510 CERVICAL CONE BIOPSY O "$6,310.00 " "$4,101.50 " 330184 57522 5414 510 LEEP CONE BIOPSY O "$6,310.00 " "$4,101.50 " 330184 57800 5414 510 DILATION CERVICAL CANAL O "$6,310.00 " "$4,101.50 " 330184 58100 5411 510 ENDOMETRIAL BIOPSY O $484.05 $314.63 330184 58110 510 Bx Done W/colposcopy Add- O $103.00 $66.95 330184 58300 510 IUD INSERTION O $547.05 $355.58 330184 58301 5412 417 510 IUD REMOVAL O $668.00 $434.20 330184 58301 5412 417 450 REMOVAL OF INTRAUTERINE DEVICE O $668.00 $434.20 330184 58340 278 761 IR HYSTEROSALPINGOGRAM EX O "$1,118.25 " $726.86 330184 58555 5414 514 Hysteroscopy Dx Sep Pro O "$6,310.00 " "$4,101.50 " 330184 58999 5411 361 UNLISTED PROCEDURE FEMALE O $461.00 $299.65 330184 59000 5413 178 361 AMNIOCENTESIS SGL O "$1,341.00 " $871.65 330184 59000 5413 178 361 AMNIOCENTESIS MULTI O "$1,341.00 " $871.65 330184 59025 TC 5411 191 920 NON-STRESS TEST O $484.05 $314.63 330184 59025 TC 5411 191 514 Fetal non-stress test -59 O $484.05 $314.63 330184 59025 TC 5411 191 920 FETAL NONSTRESS TEST O $484.05 $314.63 330184 59025 TC 5411 191 920 FETAL NON-STRESS TEST(MUL O $484.05 $314.63 330184 59320 5414 761 RAD SPEC REVSN OF CERVIX O "$6,310.00 " "$4,101.50 " 330184 59409 5414 450 VAGINAL DELIVERY O "$6,310.00 " "$4,101.50 " 330184 59425 510 Follow Up 2-6 Prenat Vis O "$1,012.20 " $657.93 330184 59425 510 High Risk Follow Up 2-6 O "$1,012.20 " $657.93 330184 59425 510 FOLLOW UP 2ND -6TH PRENAT O "$1,012.20 " $657.93 330184 59425 514 Antepartum care only; 4-6 O "$1,012.20 " $657.93 330184 59425 510 HIGH RISK-FOLLOW UP 2ND-6 O "$1,012.20 " $657.93 330184 59426 510 FOLLOW UP 7TH+PRENATAL V O "$1,692.00 " "$1,099.80 " 330184 59426 510 FOLLOW UP 7TH+PRENATAL VI O "$1,692.00 " "$1,099.80 " 330184 59426 510 High Risk Follow 7Th Pre O "$1,692.00 " "$1,099.80 " 330184 59430 510 POST PARTUM VISIT O $392.70 $255.25 330184 60100 5071 252 761 US THYROID BIOPSY O "$1,366.00 " $887.90 330184 60540 761 CT ADRENAL BIOPSY W/GUID O "$1,261.00 " $819.65 330184 61250 369 BURR HOLES-EXPLORE-NO SUR O "$1,374.00 " $893.10 330184 61250 50 369 PIERCE SKULL & EXPLORE BIL-ER O "$1,374.00 " $893.10 330184 61250 LT 369 PIERCE SKULL & EXPLORE LT-ER O "$1,374.00 " $893.10 330184 61250 RT 369 PIERCE SKULL & EXPLORE RT-ER O "$1,374.00 " $893.10 330184 61650 77 761 EVASC PRLNG ADMN RX AGNT 1ST O "$1,439.00 " $935.35 330184 61651 79 761 EVASC PRLNG ADMN RX AGNT ADD O $614.00 $399.10 330184 62270 5442 53 761 SPINAL PUNCTURE LUMBAR DIAG O "$1,611.75 " "$1,047.64 " 330184 62270 5442 53 450 SPINAL TAP-DIAGNOSTIC O "$1,611.75 " "$1,047.64 " 330184 62270 5442 53 510 SPINAL FLUID TAP DIAGNOSTIC O "$1,611.75 " "$1,047.64 " 330184 62272 5442 53 510 DRAIN CEREBRO SPINAL FLUID O "$1,535.00 " $997.75 330184 62273 5442 53 450 INJECTION EPIDURAL OF BLO O "$1,535.00 " $997.75 330184 62284 278 320 IR INJ MYLGRPHY/CT SPNL O $301.00 $195.65 330184 62302 5573 761 MYELOGRAPHY LUMBAR INJ CRVCL O "$1,361.00 " $884.65 330184 62303 5573 761 MYELOGRAPHY LUMBAR INJ THORAC O "$1,361.00 " $884.65 330184 62304 5573 761 MYELOGRAPHY LUMBAR INJ LUMBSCRL O "$1,361.00 " $884.65 330184 62305 5573 761 MYLGRPHY LMBR INJ 2+ REGIONS O "$1,361.00 " $884.65 330184 62328 5442 53 450 DX LMBR SPI PNXR W/FLUOR/CT-62328 O "$1,893.00 " "$1,230.45 " 330184 62329 5442 53 450 THER SPI PNXR CSF FLUOR/CT-62329 O "$1,893.00 " "$1,230.45 " 330184 64405 5441 214 510 INJ ANS ; GREATER OCCPTL NERVE-64405 O $699.00 $454.35 330184 64450 50 5442 214 510 N BLOCK OTHER PERIPHERAL BIL-CLN O "$1,611.75 " "$1,047.64 " 330184 64450 LT 5442 214 510 N BLOCK OTHER PERIPHERAL LT-CLN O "$1,611.75 " "$1,047.64 " 330184 64450 RT 5442 214 510 N BLOCK OTHER PERIPHERAL RT-CLN O "$1,611.75 " "$1,047.64 " 330184 64640 50 5443 510 INJ TREATMENT NERVE BIL-CLN O "$1,933.00 " "$1,256.45 " 330184 64640 LT 5443 510 INJ TREATMENT NERVE LT-CLN O "$1,933.00 " "$1,256.45 " 330184 64640 RT 5443 510 INJ TREATMENT NERVE RT-CLN O "$1,933.00 " "$1,256.45 " 330184 65205 5734 450 FB REMOVAL-EXTL EYE-SUPER O $280.00 $182.00 330184 65205 50 5734 510 RMV FRGN BDY EYE SUPRF BIL-CLN O $280.00 $182.00 330184 65205 LT 5734 510 RMV FRGN BDY EYE SUPRF LT-CLN O $280.00 $182.00 330184 65205 RT 5734 510 RMV FRGN BDY EYE SUPRF RT-CLN O $280.00 $182.00 330184 65205 50 5734 450 RMV FRGN BDY EYE SUPRF BIL-ER O $280.00 $182.00 330184 65205 LT 5734 450 RMV FRGN BDY EYE SUPRF LT-ER O $280.00 $182.00 330184 65205 RT 5734 450 RMV FRGN BDY EYE SUPRF RT-ER O $280.00 $182.00 330184 65210 5735 450 FB REMOVAL-EYE-CONJUNC EM O $798.00 $518.70 330184 65210 50 5735 450 RMV FRGN BDY EYE EMBD BIL-ER O $798.00 $518.70 330184 65210 LT 5735 450 RMV FRGN BDY EYE EMBD LT-ER O $798.00 $518.70 330184 65210 RT 5735 450 RMV FRGN BDY EYE EMBD RT-ER O $798.00 $518.70 330184 65220 5735 450 FB REMVL-CORNEA-W/O SPLIT O $798.00 $518.70 330184 65220 50 5735 450 RMV FRGN BDY CORNEAL W SLT BIL-ER O $798.00 $518.70 330184 65220 LT 5735 450 RMV FRGN BDY CORNEAL W SLT LT-ER O $798.00 $518.70 330184 65220 RT 5735 450 RMV FRGN BDY CORNEAL W SLT RT-ER O $798.00 $518.70 330184 65222 5734 450 FB REMOVAL-CORNEAL-W/SPLI O $318.15 $206.80 330184 65222 50 5734 450 RMV FRGN BDY CRNL WO SLT BIL-ER O $318.15 $206.80 330184 65222 LT 5734 450 RMV FRGN BDY CRNL WO SLT LT-ER O $318.15 $206.80 330184 65222 RT 5734 450 RMV FRGN BDY CRNL WO SLT RT-ER O $318.15 $206.80 330184 66761 RT 5481 369 IRIDOTOMY RT O "$1,422.00 " $924.30 330184 66761 LT 5481 369 IRIDOTOMY LT O "$1,422.00 " $924.30 330184 66821 RT 5481 369 YAG POSTERIOR CAPSULOTOMY O "$1,422.00 " $924.30 330184 66821 LT 5481 369 YAG POSTERIOR CAPSULOTOMY O "$1,422.00 " $924.30 330184 67145 LT 5481 369 RETINAL PHOTOCOAG LT O "$1,422.00 " $924.30 330184 69000 50 5071 450 DRAIN EXT EAR ABSC-HEMA SIMP-BIL-69000 O "$1,740.00 " "$1,131.00 " 330184 69000 LT 5071 450 DRAIN EXT EAR ABSC-HEMA SIMP-LT-69000 O "$1,740.00 " "$1,131.00 " 330184 69000 RT 5071 450 DRAIN EXT EAR ABSC-HEMA SIMP-RT-69000 O "$1,740.00 " "$1,131.00 " 330184 69005 50 5072 450 DRAIN EXT EAR ABSC-HEMA COMP-BIL-69005 O "$4,130.00 " "$2,684.50 " 330184 69005 LT 5072 450 DRAIN EXT EAR ABSC-HEMA COMP-LT-69005 O "$4,130.00 " "$2,684.50 " 330184 69005 RT 5072 450 DRAIN EXT EAR ABSC-HEMA COMP-RT-69005 O "$4,130.00 " "$2,684.50 " 330184 69020 50 5071 510 DRN OUTER EAR CANAL LESION BIL-CLN O "$1,631.00 " "$1,060.15 " 330184 69020 LT 5071 510 DRN OUTER EAR CANAL LESION LT-CLN O "$1,631.00 " "$1,060.15 " 330184 69020 RT 5071 510 DRN OUTER EAR CANAL LESION RT-CLN O "$1,631.00 " "$1,060.15 " 330184 69200 5734 450 FB REMOVAL EXTERNAL AND C O $318.00 $206.70 330184 69200 50 5734 510 CLEAR OUTER EAR CANAL BIL-CLN O $318.00 $206.70 330184 69200 LT 5734 510 CLEAR OUTER EAR CANAL LT-CLN O $318.00 $206.70 330184 69200 RT 5734 510 CLEAR OUTER EAR CANAL RT-CLN O $318.00 $206.70 330184 69200 50 5734 450 CLEAR OUTER EAR CANAL BIL-ER O $318.00 $206.70 330184 69200 LT 5734 450 CLEAR OUTER EAR CANAL LT-ER O $318.00 $206.70 330184 69200 RT 5734 450 CLEAR OUTER EAR CANAL RT-ER O $318.00 $206.70 330184 69210 5733 249 510 CERUMEN REMOVAL O $173.25 $112.61 330184 69210 5733 249 510 EAR LAVAGE O $173.25 $112.61 330184 69210 5733 249 450 IMPACTED CERUMEN REMOVAL O $173.25 $112.61 330184 70110 TC 5522 471 320 RAD MANDIBLE MIN 4 VIEWS O $303.00 $196.95 330184 70150 TC 5522 471 320 RAD ZYGOMATIC ARCHES O $418.16 $271.81 330184 70150 TC 5522 471 320 RAD FACIAL BONES MIN 3 VI O $418.16 $271.81 330184 70160 TC 5521 471 320 RAD NASAL BONES MIN 3 VIE O $373.00 $242.45 330184 70200 TC 5522 471 320 XR ORBITS COMPLETE O $271.00 $176.15 330184 70220 TC 5521 471 320 RAD PARASINUSES CMPLT MIN O $351.49 $228.47 330184 70250 TC 5522 471 320 RAD SKULL 1-3 VIEWS O $397.00 $258.05 330184 70260 TC 5522 471 320 RAD SKULL COMPLETE O $341.00 $221.65 330184 70330 TC 5521 471 320 TMJ BILATERAL O $345.45 $224.54 330184 70336 5523 293 614 MRI TEMPOROMANDIBULAR JOINT(S)-70336 O $706.00 $458.90 330184 70360 TC 5521 471 320 RAD NECK SOFT TISSUE O $375.11 $243.82 330184 70450 TC 5522 300 351 CT HEAD WITHOUT CONTRAST O "$1,481.00 " $962.65 330184 70460 TC 5571 300 351 CT HEAD WITH CONTRAST O "$1,678.00 " "$1,090.70 " 330184 70470 TC 5571 300 351 CT HEAD WITH AND WITHOUT O "$1,485.49 " $965.57 330184 70480 TC 5522 299 351 CT ORBITS W/O CONTRAST O "$1,180.20 " $767.13 330184 70480 TC 5522 299 351 CT TEMPORAL BONES W/O CON O "$1,180.20 " $767.13 330184 70481 TC 5571 300 350 CT Temporal Bones w/ cont O $842.00 $547.30 330184 70481 TC 5571 300 351 CT ORB SELLA POS FOS EAR O $842.00 $547.30 330184 70482 TC 5571 300 350 CT Temporal Bones w/ and O $842.10 $547.37 330184 70486 TC 5522 299 351 CT MAXILLOFACIAL W/O CONT O "$1,717.01 " "$1,116.06 " 330184 70486 TC 5522 299 351 CT SINUSES NON CONT RECO O "$1,717.01 " "$1,116.06 " 330184 70487 TC 5571 300 351 CT MAX/FACIAL W/CON O "$2,730.00 " "$1,774.50 " 330184 70488 TC 5571 300 351 MXLFCL W/W/O CONT O "$3,917.00 " "$2,546.05 " 330184 70490 TC 5522 299 351 CT NECK SOFT TISSUE WITHO O "$1,365.53 " $887.59 330184 70491 TC 5571 300 351 CT NECK SOFT TISSUE WITH O "$1,615.42 " "$1,050.03 " 330184 70492 TC 5571 300 351 CT-ST NECK W&WO CONTR-70492 O $760.00 $494.00 330184 70496 TC 5571 302 351 CT ANGIO HEAD O "$2,493.22 " "$1,620.60 " 330184 70498 TC 5571 302 351 CT ANGIO NECK O "$1,732.50 " "$1,126.12 " 330184 70540 TC 5523 293 610 MRI FACE WITHOUT CONTRAST O $718.00 $466.70 330184 70540 TC 5523 293 610 MRI FACE/ORBIT W/O CONTRA O $718.00 $466.70 330184 70540 TC 5523 293 610 MRI NECK (SOFT TISSUE) W/ O $718.00 $466.70 330184 70542 TC 5572 295 610 MR Face/Orbits without Co O "$3,133.20 " "$2,036.58 " 330184 70543 TC 5572 295 610 MR Face/Orbits with + wit O "$4,308.68 " "$2,800.64 " 330184 70543 TC 5572 295 610 MRI FACE/ORBIT W & W/O CO O "$4,308.68 " "$2,800.64 " 330184 70543 TC 5572 295 610 MRI NECK (SOFT TISSUE) W O "$4,308.68 " "$2,800.64 " 330184 70544 TC 5523 282 615 Angio Brain COW Without C O "$3,660.56 " "$2,379.37 " 330184 70544 TC 5523 282 615 MRA BRAIN (C.O.W.) W/O CO O "$3,660.56 " "$2,379.37 " 330184 70545 TC 5572 282 610 ANG BRAIN COW W/CONTRST O "$4,067.00 " "$2,643.55 " 330184 70546 TC 5572 282 615 ANG BRN W/W/O CNT IF PERF O "$1,291.00 " $839.15 330184 70546 TC 5572 282 610 MRI MRA HEAD W & W/O CONT O "$1,291.00 " $839.15 330184 70547 TC 5523 282 610 MRA NECK/CAROTID W/O CONT O "$3,217.46 " "$2,091.35 " 330184 70548 TC 5572 282 610 MRA NECK WITH CONTRAST O "$3,484.00 " "$2,264.60 " 330184 70549 TC 5572 282 615 Angio Carotid With + With O "$4,993.54 " "$3,245.80 " 330184 70551 TC 5523 293 610 Angio Brain without contr O "$3,368.93 " "$2,189.80 " 330184 70551 TC 5523 293 610 MRI TMJ'S O "$3,368.93 " "$2,189.80 " 330184 70551 TC 5523 293 611 MRI BRAIN W/O CONTRAST O "$3,368.93 " "$2,189.80 " 330184 70551 TC 5523 293 610 MRI INTER AUDITORY CANAL O "$3,368.93 " "$2,189.80 " 330184 70551 TC 5523 293 611 MRI PITUITARY W/O CONTRAS O "$3,368.93 " "$2,189.80 " 330184 70552 5572 295 611 MRI BRAIN W CONTRAST-70552 O "$1,156.00 " $751.40 330184 70553 TC 5572 295 611 MRI BRAIN W/WO CONTRAST O "$4,244.62 " "$2,759.01 " 330184 70553 TC 5572 295 610 MRI INTER AUDITORY CANAL O "$4,244.62 " "$2,759.01 " 330184 70553 TC 5572 295 611 MRI PITUITARY W & W/O CON O "$4,244.62 " "$2,759.01 " 330184 71045 5521 471 324 X-RAY EXAM CHEST 1 VIEW-71045 O $150.00 $97.50 330184 71046 5521 471 324 X-RAY EXAM CHEST 2 VIEWS-71046 O $150.00 $97.50 330184 71047 5521 471 324 X-RAY EXAM CHEST 3 VIEWS-71047 O $150.00 $97.50 330184 71048 5522 471 324 X-RAY EXAM CHEST 4+ VIEWS-71048 O $285.00 $185.25 330184 71100 RT 5521 471 320 RAD RIBS RIGHT O $593.00 $385.45 330184 71100 LT 5521 471 320 RAD RIBS LEFT O $593.00 $385.45 330184 71101 LT 5522 471 320 CHEST AP & LT RIBS O $341.00 $221.65 330184 71101 RT 5522 471 320 CHEST AP & RT RIBS O $341.00 $221.65 330184 71101 LT 5522 471 320 CHEST PA & LT RIBS O $341.00 $221.65 330184 71101 RT 5522 471 320 CHEST PA & RT RIBS O $341.00 $221.65 330184 71110 TC 5522 471 320 RAD RIBS BILATERAL 3 VIEW O $668.85 $434.75 330184 71110 TC 5522 471 320 X-RAY EXAM RIBS BIL 3 VIEWS LT-RAD O $668.85 $434.75 330184 71110 TC 5522 471 320 X-RAY EXAM RIBS BIL 3 VIEWS RT-RAD O $668.85 $434.75 330184 71111 TC 5522 471 320 RAD RIBS BILAT & PA CHEST O $341.00 $221.65 330184 71120 TC 5521 471 320 RAD STERNUM MIN 2 VIEW O $219.00 $142.35 330184 71130 TC 5521 471 320 RAD STEROCLAV JNT MIN 3 V O $190.05 $123.53 330184 71250 TC 5522 299 350 CT Chest + Abdomen + Pelv O "$1,613.00 " "$1,048.45 " 330184 71250 TC 5522 299 350 CT CHEST HIGH RESOLUTION- O "$1,613.00 " "$1,048.45 " 330184 71250 TC 5522 299 352 CT CHEST WITHOUT CONTRAST O "$1,613.00 " "$1,048.45 " 330184 71250 TC 5522 299 352 CT Chest ABD/Pelvis w O O "$1,613.00 " "$1,048.45 " 330184 71260 TC 5571 300 352 CT CHEST WITH CONTRAST O "$2,026.50 " "$1,317.23 " 330184 71260 TC 5571 300 352 CT CHEST/ABD/PELVIS WITH O "$2,026.50 " "$1,317.23 " 330184 71260 TC 5571 300 352 CT Chest ABD/Pelvis IV O "$2,026.50 " "$1,317.23 " 330184 71270 TC 5571 300 350 CT Chest + Abdomen + Pelv O "$2,553.00 " "$1,659.45 " 330184 71270 TC 5571 300 352 CT CHEST WITH AND WITHOUT O "$2,553.00 " "$1,659.45 " 330184 71271 350 CT THORAX LUNG CANCER SCR NON CONT-71271 O $1.00 $0.65 330184 71275 TC 5571 302 352 CT Angio Pulmonary with Contrast O "$2,422.88 " "$1,574.87 " 330184 71275 TC 5571 302 352 CT ANGIO AORTIC ARCH PANE O "$2,422.88 " "$1,574.87 " 330184 71550 TC 5523 293 610 MRI CHEST W/O CONTRAST O $684.00 $444.60 330184 71550 5523 293 618 MRA W/CONT CHEST O $684.00 $444.60 330184 71550 5523 293 618 MRA W/O CONT CHEST O $684.00 $444.60 330184 71550 5523 293 618 MRA W/O FOL W/CONT CHEST O $684.00 $444.60 330184 71552 TC 5572 295 610 MRI CHEST W & W/O CONTRAS O "$4,812.15 " "$3,127.90 " 330184 71552 TC 5572 295 610 MRA THORACIC AORTA W&W/O O "$4,812.15 " "$3,127.90 " 330184 71555 TC 282 618 Angio Chest without + wit O "$1,056.00 " $686.40 330184 71555 TC 282 610 Angio Subclavian With + W O "$1,056.00 " $686.40 330184 71555 TC 282 610 MRA AORTIC ARCH ROOT W&W/ O "$1,056.00 " $686.40 330184 71555 TC 282 618 MRA SUB CLAVIAN W&W/O CON O "$1,056.00 " $686.40 330184 72020 TC 5521 471 320 RAD SPINE CERVICAL SINGLE O $201.00 $130.65 330184 72020 TC 5521 471 320 RAD SPINE THORACIC SINGLE O $201.00 $130.65 330184 72020 TC 5521 471 320 RAD SPINE LUMBAR SINGLE V O $201.00 $130.65 330184 72040 TC 5521 471 320 CERV SPINE 2 OR 3 VIEWS O $476.44 $309.68 330184 72050 TC 5522 471 320 RAD SPINE CERVICAL MIN 4 O $723.19 $470.07 330184 72052 TC 5522 471 320 RAD SPINE CERVICAL FLEX A O $683.55 $444.31 330184 72070 TC 5522 471 320 RAD SPINE THORACIC AP & L O $456.75 $296.89 330184 72081 TC 5521 471 320 X-RAY EXAM ENTIRE SPINE 1 VW O $181.00 $117.65 330184 72082 TC 5522 471 320 X-RAY EXAM ENTIRE SPINE 2/3 VW O $588.00 $382.20 330184 72083 TC 5522 471 320 X-RAY EXAM ENTIRE SPINE 4/5 VW O $718.20 $466.83 330184 72084 TC 5522 471 320 X-RAY EXAM ENTIRE SPINE 6/> VW O $718.20 $466.83 330184 72100 TC 5522 471 320 RAD SPINE L-S AP & LATERAL O $511.35 $332.38 330184 72100 TC 5522 471 320 RAD SPINE APLATFLEX-EX O $511.35 $332.38 330184 72110 TC 5522 471 320 RAD SPINE L-S CMPLT W/OBL O $752.85 $489.35 330184 72114 TC 5522 471 320 RAD SPINE LUMBOSAC COMP B O $882.79 $573.81 330184 72125 TC 5522 299 352 CT SPINE CERVICAL NON CON O "$1,444.80 " $939.12 330184 72126 TC 5572 300 352 CT SPINE CERVICAL WITH CO O "$1,355.55 " $881.11 330184 72128 TC 5522 299 352 CT SPINE THORACIC NON CON O "$1,613.00 " "$1,048.45 " 330184 72129 5571 300 352 CT THORACIC SPINE W CONTR O $802.00 $521.30 330184 72131 TC 5522 299 352 CT SPINE LUM/SAC NON CONT O "$1,578.94 " "$1,026.31 " 330184 72132 TC 5572 300 352 CT SPINE LUMBOSACRAL WITH O "$1,355.55 " $881.11 330184 72133 5571 300 352 CT-LUMBAR SPINE W & WO CONTRAST O $842.10 $547.37 330184 72141 TC 5523 293 612 MRI CERVICAL SPINE W/O CO O "$3,479.70 " "$2,261.80 " 330184 72142 TC 5572 295 612 MRI CERVICAL SPINE W/CONT O "$1,291.00 " $839.15 330184 72146 TC 5523 293 612 MRI THORACIC SPINE W/O CO O "$3,389.00 " "$2,202.85 " 330184 72147 TC 5572 295 610 MRI THORACIC SPINE WITH C O "$1,291.00 " $839.15 330184 72148 TC 5523 293 612 MRI LUMBAR/SACRAL SPINE W O "$3,389.00 " "$2,202.85 " 330184 72149 5572 295 612 MRI SPINE LUMBAR W CONTR-72149 O "$1,160.00 " $754.00 330184 72156 TC 5572 295 612 MRI CERVICAL SPINE O "$5,527.73 " "$3,593.02 " 330184 72157 TC 5572 295 612 MRI THORACIC SPINE W/WO C O "$5,398.00 " "$3,508.70 " 330184 72158 TC 5572 295 612 MRI LUMBAR/SACRAL SPINE W O "$5,553.98 " "$3,610.08 " 330184 72170 TC 5522 471 320 RAD PELVIS AP O $386.00 $250.90 330184 72190 TC 5522 471 320 RAD PELVIS COMPLETE MIN 3 O $358.05 $232.73 330184 72191 TC 5571 302 352 CT ANGIO PELVIS O "$1,331.00 " $865.15 330184 72192 LT 5522 299 350 CT HIP WO CONTRAST LEFT-72192 O "$1,307.25 " $849.71 330184 72192 RT 5522 299 350 CT HIP WO CONTRAST RIGHT-72192 O "$1,307.25 " $849.71 330184 72192 TC 5522 299 352 CT PELVIS WITHOUT CNT O "$1,307.25 " $849.71 330184 72193 TC 5571 300 352 CT PELVIS WITH CNT O $842.00 $547.30 330184 72193 TC 5571 300 352 Pelvis W IV and Oral O $842.00 $547.30 330184 72193 TC 5571 300 352 Pelvis w Oral Contr Only O $842.00 $547.30 330184 72193 TC 5571 300 352 CT PLV IV & GSTRG CNT + O $842.00 $547.30 330184 72193 TC 5571 300 352 CT PLV GSTRG CONT ONLY + O $842.00 $547.30 330184 72194 TC 5571 300 352 CT PELVIS W&WO CNT O "$1,840.65 " "$1,196.42 " 330184 72195 TC 5523 293 610 MRI PELVIS WITHOUT CONTRA O "$3,013.00 " "$1,958.45 " 330184 72195 TC 5523 293 610 MRI PROSTAT W/O CONTRAST O "$3,013.00 " "$1,958.45 " 330184 72197 TC 5572 295 610 MRI PELVIS W & W/O CONTRA O "$4,990.12 " "$3,243.58 " 330184 72198 TC 282 618 Angio Iliac/Pelvis With + O $842.10 $547.37 330184 72198 TC 282 618 MRA PELVIS/ILIAC W&W/O CO O $842.10 $547.37 330184 72198 282 618 MRA W/CONT PELVIS O "$1,156.00 " $751.40 330184 72198 282 618 MRA W/O CONT PELVIS O $706.00 $458.90 330184 72198 282 618 MRA W/O FOL W/CONT PELVIS O "$1,156.00 " $751.40 330184 72202 TC 5522 471 320 RAD SACROILIAC JNTS MIN 3 O $444.94 $289.21 330184 72220 TC 5521 471 320 RAD SACRUM/COCCYX MIN 2 V O $316.26 $205.57 330184 72265 TC 5573 320 IR MYLGRPHY LSS S&I O "$1,361.00 " $884.65 330184 72275 320 EPIDUROGRAPHY O $509.00 $330.85 330184 72275 59 320 EPIDUROGRAPHY (59 MDF) O $509.00 $330.85 330184 73000 RT 5521 471 320 RAD EXT CLAVICLE RIGHT O $344.66 $224.03 330184 73000 LT 5521 471 320 RAD EXT CLAVICLE LEFT O $344.66 $224.03 330184 73000 50 5521 471 320 RAD EXT CLAVICLE BILATERA O $516.99 $336.05 330184 73010 RT 5522 471 320 RAD EXT SCAPULA RIGHT O $508.20 $330.33 330184 73010 LT 5522 471 320 RAD EXT SCAPULA LEFT O $508.20 $330.33 330184 73010 50 5522 471 320 X-RAY EXAM SHOULDER BLADE BIL-RAD O $762.30 $495.50 330184 73020 RT 5521 471 320 RAD EXT SHOULDER 1 VIEW R O $299.25 $194.51 330184 73020 LT 5521 471 320 RAD EXT LT SHOULDER 1 VIE O $299.25 $194.51 330184 73020 50 5521 471 320 X-RAY EXAM SHOULDER BIL-RAD O $448.88 $291.77 330184 73030 RT 5521 471 320 RAD EXT SHOULDER MIN 2 VI O $431.69 $280.60 330184 73030 LT 5521 471 320 RAD EXT SHOULDER MIN 2 VI O $431.69 $280.60 330184 73030 76 5521 471 320 RAD EXT SHOULDER POST RED O $431.69 $280.60 330184 73030 76 5521 471 320 RAD EXT SHOULDER 2V POST O $431.69 $280.60 330184 73030 50 5521 471 320 SHOULDER 2 VWS PST REDUC BIL-RAD O $647.54 $420.90 330184 73030 50 5521 471 320 X-RAY EXAM SHOULDER 2 VWS BIL-RAD O $647.54 $420.90 330184 73040 RT 5572 322 IR ARTHRO SHLDR RT O $684.00 $444.60 330184 73040 LT 5572 322 IR ARTHRO SHLDR LT O $684.00 $444.60 330184 73040 50 5572 322 CONT X-RAY SHOULDER BIL-RAD O "$1,026.00 " $666.90 330184 73050 TC 5521 471 320 RAD ACROMIOCLAVICULAR JNT O $420.00 $273.00 330184 73060 RT 5521 471 320 RAD EXT HUMERUS MIN 2 VIE O $345.50 $224.58 330184 73060 LT 5521 471 320 RAD EXT HUMERUS MIN 2 VIE O $345.50 $224.58 330184 73060 76 5521 471 320 RAD EXT HUMERUS POST RED O $345.50 $224.58 330184 73060 76 5521 471 320 RAD HUMERUS 2V POST RED L O $345.50 $224.58 330184 73060 5521 471 320 HUMERUS 2 VIEWS BIL-RAD O $345.50 $224.58 330184 73060 76 5521 471 320 HUMERUS 2 VIEWS PST REDUC BIL-RAD O $345.50 $224.58 330184 73070 RT 5521 471 320 RAD EXT ELBOW AP & LAT RI O $325.50 $211.58 330184 73070 52 5521 471 320 RAD EXT ELBOW SINGLE VIEW O $325.50 $211.58 330184 73070 LT 5521 471 320 RAD EXT ELBOW AP & LAT LE O $325.50 $211.58 330184 73070 76 5521 471 320 RAD EXT ELBOW AP & LAT PO O $325.50 $211.58 330184 73070 76 5521 471 320 RAD EXT ELBOW AP/LAT POST O $325.50 $211.58 330184 73070 50 5521 471 320 ELBOW 2 VIEWS BIL-RAD O $488.25 $317.36 330184 73070 50 5521 471 320 ELBOW 2 VIEWS PST REDUC BIL-RAD O $488.25 $317.36 330184 73080 RT 5521 471 320 RAD EXT ELBOW MIN 3 VIEW O $477.23 $310.20 330184 73080 LT 5521 471 320 RAD EXT ELBOW MIN 3 VIEW O $477.23 $310.20 330184 73080 50 5521 471 320 ELBOW COMP 3 VIEWS BIL-RAD O $715.84 $465.29 330184 73090 RT 5521 471 320 RAD EXT FOREARM AP & LAT O $384.69 $250.05 330184 73090 LT 5521 471 320 RAD EXT FOREARM AP & LAT O $384.69 $250.05 330184 73090 76 5521 471 320 RAD EXT FOREARM AP & LAT O $384.69 $250.05 330184 73090 76 5521 471 320 RAD FOREARM AP/LAT POST R O $384.69 $250.05 330184 73090 50 5521 471 320 FOREARM 2 VIEWS BIL-RAD O $577.04 $375.08 330184 73090 50 5521 471 320 FOREARM 2 VWS PST REDUC BIL-RAD O $577.04 $375.08 330184 73092 RT 5522 471 320 RAD UP EXTRE INFANT MIN 2 O $358.05 $232.73 330184 73092 LT 5522 471 320 RAD EXT UP REVERSE INFANT O $358.05 $232.73 330184 73092 50 5522 471 320 RAD UP EXTRE INFANT BI MI O $358.05 $232.73 330184 73100 LT 5521 471 320 RAD EXT WRIST LT 2 VU FOL O $355.00 $230.75 330184 73100 RT 5521 471 320 RAD EXT WRIST RT 2 VU FOL O $355.00 $230.75 330184 73100 76 5521 471 320 RAD EXT WRIST LT POST RED O $355.00 $230.75 330184 73100 50 5521 471 320 WRIST 2 VIEWS BIL-RAD O $532.50 $346.12 330184 73100 50 5521 471 320 WRIST 2 VIEWS PST REDUC BIL-RAD O $532.50 $346.12 330184 73110 RT 5521 471 320 WRIST MIN 3 VIEWS RT O $556.24 $361.55 330184 73110 76 5521 471 320 RAD EXT WRIST AP&LAT POST O $556.24 $361.55 330184 73110 LT 5521 471 320 WRIST MIN 3 VIEWS LT O $556.24 $361.55 330184 73110 LT 5521 471 320 WRST 3VWS MIN PST RED LT O $556.24 $361.55 330184 73110 RT 5521 471 320 WRST 3VWS MIN PST RED RT O $556.24 $361.55 330184 73110 LT 5521 471 320 WRST 3VWS MIN F/U LT O $556.24 $361.55 330184 73110 RT 5521 471 320 WRST 3VWS MIN F/U RT O $556.24 $361.55 330184 73110 50 5521 471 320 WRIST COMP 3 VWS BIL-RAD O $834.36 $542.33 330184 73110 50 5521 471 320 WRIST COMP 3 VWS PST REDUC BIL-RAD O $834.36 $542.33 330184 73120 LT 5522 471 320 RAD EXT HAND LT 2 VU FOLL O $332.06 $215.84 330184 73120 76 5522 471 320 RAD EXT HAND 2 V POST RED O $332.06 $215.84 330184 73120 RT 5522 471 320 RAD EXT HAND RT 2 VU FOLL O $332.06 $215.84 330184 73120 76 5522 471 320 RAD EXT HAND 2 VIEW POST O $332.06 $215.84 330184 73120 50 5522 471 320 HAND 2 VIEWS PST REDUC BIL-RAD O $498.09 $323.76 330184 73120 50 5522 471 320 X-RAY EXAM HAND 2 VIEWS BIL-RAD O $498.09 $323.76 330184 73130 RT 5521 471 320 RAD EXT HAND MIN 3 VIEW R O $497.70 $323.51 330184 73130 LT 5521 471 320 RAD EXT HAND MIN 3 VIEW L O $497.70 $323.51 330184 73130 76 5521 471 320 RAD EXT HAND MIN 3V POST O $497.70 $323.51 330184 73130 50 5521 471 320 HAND 3 VIEW PST REDUC BIL-RAD O $746.55 $485.26 330184 73130 50 5521 471 320 X-RAY EXAM HAND 3 VIEW BIL-RAD O $746.55 $485.26 330184 73140 RT 5521 471 320 RAD EXT FINGERS MIN 2 VIE O $268.27 $174.38 330184 73140 LT 5521 471 320 RAD EXT FINGERS MIN 2 VIE O $268.27 $174.38 330184 73140 76 5521 471 320 RAD EXT FINGERS 2V POST R O $268.27 $174.38 330184 73140 76 5521 471 320 RAD EXT FINGERS MN 2V POS O $268.27 $174.38 330184 73140 50 5521 471 320 FINGER(S) 2 VIEWS BIL-RAD O $402.41 $261.57 330184 73140 50 5521 471 320 FINGER(S) 2 VIEWS PST REDUC BIL-RAD O $402.41 $261.57 330184 73200 LT 5522 299 350 CT UPP EXT WO CONT-LT-73200 O "$1,496.00 " $972.40 330184 73200 RT 5522 299 350 CT UPP EXT WO CONT-RT-73200 O "$1,496.00 " $972.40 330184 73200 RT 5522 299 350 CT Wrist w/o contrast rig O "$1,496.00 " $972.40 330184 73200 LT 5522 299 350 CT Wrist w/o contrast lef O "$1,496.00 " $972.40 330184 73200 LT 5522 299 350 CT Shoulder w/o contrast O "$1,496.00 " $972.40 330184 73200 RT 5522 299 350 CT Elbow w/o contrast rig O "$1,496.00 " $972.40 330184 73200 LT 5522 299 350 CT Elbow w/o contrast lef O "$1,496.00 " $972.40 330184 73200 RT 5522 299 350 CT Shoulder w/o contrast O "$1,496.00 " $972.40 330184 73200 50 5522 299 350 CT UPPER EXTR WO DYE BIL-RAD O "$2,244.00 " "$1,458.60 " 330184 73201 RT 5572 300 350 CT UE W CONT RT + RECONS O $842.10 $547.37 330184 73201 LT 5572 300 350 CT UE W CONT LT + RECONS O $842.10 $547.37 330184 73201 50 5572 300 350 CT UPPER EXTR W DYE BIL-RAD O "$1,263.15 " $821.05 330184 73202 LT 5571 300 350 CT HUMERUS W & WO IV CONT-LT-73202 O $842.10 $547.37 330184 73202 RT 5571 300 350 CT HUMERUS W & WO IV CONT-RT-73202 O $842.10 $547.37 330184 73202 LT 5571 300 350 CT UPPER EXT W & WO IV CONT-LT-73202 O $842.10 $547.37 330184 73202 RT 5571 300 350 CT UPPER EXT W & WO IV CONT-RT-73202 O $842.10 $547.37 330184 73206 LT 5571 302 350 CT ANGIO UPR EXTRM W/O&W/DYE-LEFT-73206 O $552.00 $358.80 330184 73206 RT 5571 302 350 CT ANGIO UPR EXTRM W/O&W/DYE-RIGHT-73206 O $552.00 $358.80 330184 73218 LT 5523 293 610 MRI UE NOT JNT WO CNT-LT-73218 O "$2,775.00 " "$1,803.75 " 330184 73218 RT 5523 293 610 MRI UE NOT JNT WO CNT-RT-73218 O "$2,775.00 " "$1,803.75 " 330184 73218 RT 5523 293 610 MRI HAND RT W/O CONTRAST O "$2,775.00 " "$1,803.75 " 330184 73218 LT 5523 293 610 MRI HAND LT W/O CONTRAST O "$2,775.00 " "$1,803.75 " 330184 73218 RT 5523 293 610 MRI SHOULDER RT W/O CONTR O "$2,775.00 " "$1,803.75 " 330184 73218 LT 5523 293 610 MRI SHOULDER LT W/O CONTR O "$2,775.00 " "$1,803.75 " 330184 73218 RT 5523 293 610 MRI RADIUS/FOREARM RT W/O O "$2,775.00 " "$1,803.75 " 330184 73218 LT 5523 293 610 MRI RADIUS/FORARM LT W/O O "$2,775.00 " "$1,803.75 " 330184 73218 50 5523 293 610 MRI UPPER EXTR WO DYE BIL-RAD O "$4,162.50 " "$2,705.62 " 330184 73219 LT 5572 295 610 MRI UE NOT JNT W CNT-LT-73219 O "$1,291.00 " $839.15 330184 73219 RT 5572 295 610 MRI UE NOT JNT W CNT-RT-73219 O "$1,291.00 " $839.15 330184 73220 LT 5572 295 610 MRI UE NOT JNT W/WO CNT-LT-73220 O "$1,355.55 " $881.11 330184 73220 RT 5572 295 610 MRI UE NOT JNT W/WO CNT-RT-73220 O "$1,355.55 " $881.11 330184 73220 RT 5572 295 610 MRI RADIUS/FOREARM RT W W O "$1,355.55 " $881.11 330184 73220 LT 5572 295 610 MRI ELBOW LT WITH & W/O C O "$1,355.55 " $881.11 330184 73220 RT 5572 295 610 MRI ELBOW RT W & W/O CON O "$1,355.55 " $881.11 330184 73220 RT 5572 295 610 MRI HAND RT W & W/O CONTR O "$1,355.55 " $881.11 330184 73220 LT 5572 295 610 MRI HAND LT W &W/O CONTRA O "$1,355.55 " $881.11 330184 73220 RT 5572 295 610 MRI SHOULDER RT W&W/O CON O "$1,355.55 " $881.11 330184 73220 LT 5572 295 610 MRI SHOULDER LT W&W/O CON O "$1,355.55 " $881.11 330184 73220 LT 5572 295 610 MRI RADIUS/FOREARM LT W&W O "$1,355.55 " $881.11 330184 73220 RT 5572 295 610 MRI HEMERUS/BICEPS RT W&W O "$1,355.55 " $881.11 330184 73220 LT 5572 295 610 MRI HUMERUS/BICEPS LT W & O "$1,355.55 " $881.11 330184 73220 50 5572 295 610 MRI UPPR EXTRM WO & W DYE BIL-RAD O "$2,033.32 " "$1,321.66 " 330184 73221 LT 5523 293 610 MRI UE JNT WO CNT-LT-73221 O "$2,995.00 " "$1,946.75 " 330184 73221 RT 5523 293 610 MRI UE JNT WO CNT-RT-73221 O "$2,995.00 " "$1,946.75 " 330184 73221 RT 5523 293 610 MRI WRIST RT W/O CONTRAST O "$2,995.00 " "$1,946.75 " 330184 73221 RT 5523 293 610 MRI ELBOW JOINT RT W/O CO O "$2,995.00 " "$1,946.75 " 330184 73221 LT 5523 293 610 MRI ELBOW JOINT LT W/O CO O "$2,995.00 " "$1,946.75 " 330184 73221 LT 5523 293 610 MRI WRIST LT W/O CONTRAST O "$2,995.00 " "$1,946.75 " 330184 73221 50 5523 293 610 MRI JNT UPR EXTREM WO DYE BIL-RAD O "$4,492.50 " "$2,920.12 " 330184 73222 LT 5573 295 610 MRI UE JNT W CNT-LT-73222 O "$1,988.00 " "$1,292.20 " 330184 73222 RT 5573 295 610 MRI UE JNT W CNT-RT-73222 O "$1,988.00 " "$1,292.20 " 330184 73223 LT 5572 295 610 MRI UE JNT W/WO CNT-LT-73223 O "$1,355.00 " $880.75 330184 73223 RT 5572 295 610 MRI UE JNT W/WO CNT-RT-73223 O "$1,355.00 " $880.75 330184 73223 LT 5572 295 610 MRI ELBOW JOINT W & W/O C O "$1,355.00 " $880.75 330184 73223 LT 5572 295 610 MRI ELBOW JOINT LT W&W/O O "$1,355.00 " $880.75 330184 73223 RT 5572 295 610 MRI WRIST RT W&W/O CONTRA O "$1,355.00 " $880.75 330184 73223 LT 5572 295 610 MRI WRIST LT W&W/O CONTRA O "$1,355.00 " $880.75 330184 73223 RT 5572 295 610 MRA UPR EXT RT W&W/O CNTR O "$1,355.00 " $880.75 330184 73223 50 5572 295 610 MRI JNT UPR EXTR WO & W DYE BIL-RAD O "$2,032.50 " "$1,321.12 " 330184 73225 LT 282 610 ANG UPR EXT LT W/W/OUT CO O "$4,434.00 " "$2,882.10 " 330184 73225 LT 282 618 MRA UPPER EXTREM LT W&W/O O "$4,434.00 " "$2,882.10 " 330184 73225 LT 282 618 MRA W/DYE UPPER EXTREMITY LEFT O $802.00 $521.30 330184 73225 RT 282 618 MRA W/DYE UPPER EXTREMITY RIGHT O $802.00 $521.30 330184 73225 LT 282 618 MRA W/O DYE UPPER EXTR LEFT O $684.00 $444.60 330184 73225 RT 282 618 MRA W/O DYE UPPER EXTR RIGHT O $684.00 $444.60 330184 73225 LT 282 618 MRA W/O&W/DYE UPPER EXTR LEFT O "$1,291.00 " $839.15 330184 73225 RT 282 618 MRA W/O&W/DYE UPPER EXTR RIGHT O "$1,291.00 " $839.15 330184 73501 LT 5521 471 320 X-RAY EXAM HIP UNI 1 VIEW LT O $274.00 $178.10 330184 73501 RT 5521 471 320 X-RAY EXAM HIP UNI 1 VIEW RT O $274.00 $178.10 330184 73502 LT 5521 471 320 X-RAY EXAM HIP UNI 2-3 VIEWS LT O $404.00 $262.60 330184 73502 RT 5521 471 320 X-RAY EXAM HIP UNI 2-3 VIEWS RT O $404.00 $262.60 330184 73503 LT 5522 471 320 X-RAY EXAM HIP UNI 4/> VIEWS LT O $358.05 $232.73 330184 73503 RT 5522 471 320 X-RAY EXAM HIP UNI 4/> VIEWS RT O $358.05 $232.73 330184 73521 TC 5522 471 320 X-RAY EXAM HIPS BI 2 VIEWS O $380.00 $247.00 330184 73522 TC 5522 471 320 X-RAY EXAM HIPS BI 3-4 VIEWS O $358.05 $232.73 330184 73523 TC 5522 471 320 X-RAY EXAM HIPS BI 5/> VIEWS O $549.00 $356.85 330184 73525 LT 5572 322 IR ARTHROGRAPHY HIP LT O "$1,361.00 " $884.65 330184 73525 RT 5572 322 IR ARTHRO HIP RT O "$1,361.00 " $884.65 330184 73525 50 5572 322 CONTRAST X-RAY HIP BIL-RAD O "$2,041.50 " "$1,326.98 " 330184 73551 LT 5521 471 320 X-RAY EXAM OF FEMUR 1 VIEW LT O $531.30 $345.35 330184 73551 RT 5521 471 320 X-RAY EXAM OF FEMUR 1 VIEW RT O $531.30 $345.35 330184 73552 RT 5521 471 320 X-RAY EXAM OF FEMUR 2+ VIEWS RT O $571.20 $371.28 330184 73552 LT 5521 471 320 X-RAY EXAM OF FEMUR 2+ VIEWS LT O $571.20 $371.28 330184 73560 RT 5521 471 320 RAD EXT KNEE 1 OR 2 VIEW O $371.81 $241.68 330184 73560 LT 5521 471 320 RAD EXT KNEE 1 OR 2 VIEW O $371.81 $241.68 330184 73560 50 5521 471 320 KNEE 1 OR 2 VIEWS BIL-RAD O $557.72 $362.51 330184 73562 RT 5521 471 320 RAD EXT KNEE 3 VIEW RIGHT O $465.41 $302.52 330184 73562 LT 5521 471 320 RAD EXT KNEE 3 VIEW LEFT O $465.41 $302.52 330184 73562 50 5521 471 320 X-RAY EXAM KNEE 3 VIEWS BIL-RAD O $698.12 $453.78 330184 73564 LT 5522 471 320 XR Patella ? left O $676.46 $439.70 330184 73564 RT 5522 471 320 XR Patella ? right O $676.46 $439.70 330184 73564 RT 5522 471 320 RAD EXT KNEE CMPLT MIN 4V O $676.46 $439.70 330184 73564 LT 5522 471 320 RAD EXT KNEE CMPLT MIN 4V O $676.46 $439.70 330184 73564 50 5522 471 320 X-RAY EXAM KNEE 4 OR MORE BIL-RAD O "$1,014.69 " $659.55 330184 73565 TC 5521 471 320 EXT RAD BOTH KNEES STAND O $542.00 $352.30 330184 73580 RT 5572 322 IR ARTHRO KNEE RT O "$1,361.00 " $884.65 330184 73580 LT 5572 322 IR ARTHRO KNEE LT O "$1,361.00 " $884.65 330184 73580 50 5572 322 CNTRST X-RAY KNEE JOINT BIL-RAD O "$2,041.50 " "$1,326.98 " 330184 73590 RT 5521 471 320 RAD EXT TIBIA-FIBULA AP & O $435.23 $282.90 330184 73590 LT 5521 471 320 RAD EXT TIBIA-FIBULA AP & O $435.23 $282.90 330184 73590 RT 5521 471 320 RAD TIB-FIB AP/LAT POST R O $435.23 $282.90 330184 73590 LT 5521 471 320 RAD SPACE TIB-FIB AP/LAT O $435.23 $282.90 330184 73590 50 5521 471 320 TIBIA/FIBULA 2 VIEWS BIL-RAD O $652.84 $424.34 330184 73590 50 5521 471 320 TIBIA/FIBULA 2 VWS PST REDUC BIL-RAD O $652.84 $424.34 330184 73592 RT 5521 471 320 RAD LWR EXTRE INFANT MIN O $190.05 $123.53 330184 73592 50 5521 471 320 RAD LOW EXTRE INFANT BI M O $190.05 $123.53 330184 73592 LT 5521 471 320 INFANT LWR EXT LT O $190.05 $123.53 330184 73600 LT 5521 471 320 RAD EXT ANKLE LT 2 VU FOL O $595.00 $386.75 330184 73600 RT 5521 471 320 RAD EXT ANKLE RT 2 VU FOL O $595.00 $386.75 330184 73600 50 5521 471 320 X-RAY EXAM ANKLE 2 VIEWS BIL-RAD O $892.50 $580.12 330184 73610 RT 5521 471 320 RAD EXT ANKLE MIN 3 VIEW O $432.34 $281.02 330184 73610 LT 5521 471 320 RAD EXT ANKLE MIN 3 VIEW O $432.34 $281.02 330184 73610 76 5521 471 320 RAD EXT ANKLE MIN 3 V POS O $432.34 $281.02 330184 73610 76 5521 471 320 RAD ANKLE MIN 3V POST RED O $432.34 $281.02 330184 73610 50 5521 471 320 ANKLE 3 VIEWS PST REDUC BIL-RAD O $648.51 $421.53 330184 73610 50 5521 471 320 X-RAY EXAM ANKLE 3 VIEWS BIL-RAD O $648.51 $421.53 330184 73615 RT 5572 322 IR ARTHRO ANKLE RT O "$1,361.00 " $884.65 330184 73615 LT 5572 322 IR ARTHRO ANKLE LT O "$1,361.00 " $884.65 330184 73615 50 5572 322 CONTRAST X-RAY OF ANKLE BIL-RAD O "$2,041.50 " "$1,326.98 " 330184 73620 LT 5521 471 320 RAD EXT FOOT LT 2 VU FOLL O $335.13 $217.83 330184 73620 RT 5521 471 320 RAD EXT FOOT RT 2 VU FOLL O $335.13 $217.83 330184 73620 50 5521 471 320 X-RAY EXAM FOOT 2 VIEWS BIL-RAD O $502.69 $326.75 330184 73630 RT 5521 471 320 RAD EXT FOOT MIN 3 VIEW R O $511.09 $332.21 330184 73630 LT 5521 471 320 RAD EXT FOOT MIN 3 VIEW L O $511.09 $332.21 330184 73630 RT 5521 471 320 RAD EXT FOOT MIN 3 POST R O $511.09 $332.21 330184 73630 76 5521 471 320 RAD EXT FOOT MIN 3V POST O $511.09 $332.21 330184 73630 50 5521 471 320 FOOT 3 VIEWS PST REDUC BIL-RAD O $766.63 $498.31 330184 73630 50 5521 471 320 X-RAY EXAM FOOT 3 VIEWS BIL-RAD O $766.63 $498.31 330184 73650 RT 5521 471 320 RAD EXT CALCAN RT MIN 2 V O $330.00 $214.50 330184 73650 LT 5521 471 320 RAD EXT CALCAN LT MIN 2 V O $330.00 $214.50 330184 73650 LT 5521 471 320 XR Calcaneous Post Reduct O $330.00 $214.50 330184 73650 76 5521 471 320 RAD EXT CALCAN RT POST RD O $330.00 $214.50 330184 73650 50 5521 471 320 HEEL 2 VIEWS PST REDUC BIL-RAD O $495.00 $321.75 330184 73650 50 5521 471 320 X-RAY EXAM OF HEEL 2 VIEWS BIL-RAD O $495.00 $321.75 330184 73660 RT 5521 471 320 RAD EXT TOES RT MIN 2 VIE O $267.75 $174.04 330184 73660 LT 5521 471 320 RAD EXT TOES LT MIN 2 VIE O $267.75 $174.04 330184 73660 76 5521 471 320 RAD EXT TOES MIN 2 VW POS O $267.75 $174.04 330184 73660 50 5521 471 320 TOE(S) 2 VIEWS PST REDUC BIL-RAD O $401.62 $261.06 330184 73660 50 5521 471 320 X-RAY EXAM TOE(S) 2 VIEWS BIL-RAD O $401.62 $261.06 330184 73700 RT 5522 299 350 CT Knee w/o contrast rig O "$1,307.25 " $849.71 330184 73700 LT 5522 299 350 CT Knee w/o contrast lef O "$1,307.25 " $849.71 330184 73700 RT 5522 299 350 CT Ankle right O "$1,307.25 " $849.71 330184 73700 LT 5522 299 350 CT Ankle left O "$1,307.25 " $849.71 330184 73700 LT 5522 299 350 Angio Lower Extrem Lft wo O "$1,307.25 " $849.71 330184 73700 RT 5522 299 350 Angio Lower Extrem RT wo O "$1,307.25 " $849.71 330184 73700 50 5522 299 350 Angio Lower Extrem Bil wo O "$1,960.88 " "$1,274.57 " 330184 73701 RT 5571 300 350 CT RT LOWER EXTREMITY W/DYE O $842.10 $547.37 330184 73701 LT 5571 300 350 CT LT LOWER EXTREMITY W/DYE O $842.10 $547.37 330184 73706 50 5571 302 350 Angio Lower Extremities W O "$1,674.00 " "$1,088.10 " 330184 73706 LT 5571 302 350 CT ANGIO LWR EXT LT O "$1,674.00 " "$1,088.10 " 330184 73706 RT 5571 302 350 CT ANGIO RT LWR EXT WO & W DYE-RAD O "$1,674.00 " "$1,088.10 " 330184 73718 LT 5523 293 610 MRI - LWR EXTREM WO CONTR-LT-73718 O "$2,995.00 " "$1,946.75 " 330184 73718 RT 5523 293 610 MRI - LWR EXTREM WO CONTR-RT-73718 O "$2,995.00 " "$1,946.75 " 330184 73718 RT 5523 293 610 MRI FEMUR/THIGH RT W/O CO O "$2,995.00 " "$1,946.75 " 330184 73718 LT 5523 293 610 MRI FEMUR/THIGH LT W/O CO O "$2,995.00 " "$1,946.75 " 330184 73718 LT 5523 293 610 MRI TIBIA / CALF LT W/O C O "$2,995.00 " "$1,946.75 " 330184 73718 RT 5523 293 610 MRI TIBIA / CALF RT W/O C O "$2,995.00 " "$1,946.75 " 330184 73718 50 5523 293 610 MRI LOWER EXTRM WO DYE BIL-RAD O "$4,492.50 " "$2,920.12 " 330184 73719 LT 5572 295 610 MRI - LWR EXTREM W CONTR-LT-73719 O $802.00 $521.30 330184 73719 RT 5572 295 610 MRI - LWR EXTREM W CONTR-RT-73719 O $802.00 $521.30 330184 73720 LT 5572 295 610 MRI - LWR EXTREM W+WO CONTR-LT-73720 O "$3,213.79 " "$2,088.96 " 330184 73720 RT 5572 295 610 MRI - LWR EXTREM W+WO CONTR-RT-73720 O "$3,213.79 " "$2,088.96 " 330184 73720 TC 5572 295 610 MRI LWR EXTREM W&W/O CON O "$3,213.79 " "$2,088.96 " 330184 73720 RT 5572 295 610 MRI TIBIA/CALF RT W & W/O O "$3,213.79 " "$2,088.96 " 330184 73720 LT 5572 295 610 MRI TIBIA / CALF LT W & W O "$3,213.79 " "$2,088.96 " 330184 73720 LT 5572 295 610 MRI FEMUR / THIGH LT W&W/ O "$3,213.79 " "$2,088.96 " 330184 73720 RT 5572 295 610 MRI HUMERUS/BICEPS RT W/O O "$3,213.79 " "$2,088.96 " 330184 73720 LT 5572 295 610 MRI HUMERUS/BICEPS LT W/O O "$3,213.79 " "$2,088.96 " 330184 73720 50 5572 295 610 MRI LWR EXTRM WO & W DYE BIL-RAD O "$4,820.68 " "$3,133.44 " 330184 73721 LT 5523 293 610 MRI KNEE JOINT LT W/O CON-73721-LT O "$2,995.00 " "$1,946.75 " 330184 73721 50 5523 293 610 Hip Bilateral Without O "$4,492.50 " "$2,920.12 " 330184 73721 RT 5523 293 610 MRI ANKLE RT W/O CONTRAST O "$2,995.00 " "$1,946.75 " 330184 73721 LT 5523 293 610 MRI ANKLE LEFT W/O CONTRA O "$2,995.00 " "$1,946.75 " 330184 73721 50 5523 293 610 MRI Lower extrem non join O "$4,492.50 " "$2,920.12 " 330184 73721 LT 5523 293 610 MRI FOOT JOINT LT W/O CON O "$2,995.00 " "$1,946.75 " 330184 73721 RT 5523 293 610 MRI FOOT JOINT RT W/O CON O "$2,995.00 " "$1,946.75 " 330184 73721 RT 5523 293 610 MRI KNEE JOINT RT W/O CON O "$2,995.00 " "$1,946.75 " 330184 73721 RT 5523 293 610 MRI HIP RT W/O CONTRAST O "$2,995.00 " "$1,946.75 " 330184 73721 LT 5523 293 610 MRI HIP LT W/O CONTRAST O "$2,995.00 " "$1,946.75 " 330184 73723 50 5572 295 610 Hip Bilateral With + With O "$2,032.50 " "$1,321.12 " 330184 73723 RT 5572 295 610 MRI FOOT JOINT RT W & W/O O "$1,355.00 " $880.75 330184 73723 LT 5572 295 610 MRI FOOT JOINT LT W & W/O O "$1,355.00 " $880.75 330184 73723 RT 5572 295 610 MRI ANKLE JOINT RT W & W/ O "$1,355.00 " $880.75 330184 73723 50 5572 295 610 MRA LOWER EXTREM W/WO CON O "$2,032.50 " "$1,321.12 " 330184 73723 RT 5572 295 610 MRI KNEE WITH AND W/O CON O "$1,355.00 " $880.75 330184 73723 LT 5572 295 610 MRI KNEE JOINT LT W & W/O O "$1,355.00 " $880.75 330184 73723 RT 5572 295 610 MRI HIP RT W&W/O CONTRAST O "$1,355.00 " $880.75 330184 73723 LT 5572 295 610 MRI HIP LT W & W/O CONTRA O "$1,355.00 " $880.75 330184 73725 LT 282 616 MRA LEXTREM W CONT-LT-C8912 O "$3,021.90 " "$1,964.24 " 330184 73725 RT 282 616 MRA LEXTREM W CONT-RT-C8912 O "$3,021.90 " "$1,964.24 " 330184 73725 LT 282 616 MRA LEXTREM WO CONTR-LT-C8913 O "$1,355.00 " $880.75 330184 73725 RT 282 616 MRA LEXTREM WO CONTR-RT-C8913 O "$1,355.00 " $880.75 330184 73725 LT 282 616 MRA LEXTREM WO/W CONTR-LT-C8914 O "$1,355.00 " $880.75 330184 73725 RT 282 616 MRA LEXTREM WO/W CONTR-RT-C8914 O "$1,355.00 " $880.75 330184 73725 50 282 616 Angio Lower Ext. Bilatera O "$2,032.50 " "$1,321.12 " 330184 73725 RT 282 616 Ang Lwr Ext RT W/W/OUT CO O "$1,355.00 " $880.75 330184 73725 LT 282 616 Ang Lwr Ext LT W/W/OUT CO O "$1,355.00 " $880.75 330184 73725 TC 282 616 Angio Peripheral Runoff w O "$1,551.90 " "$1,008.74 " 330184 73725 TC 282 616 MRA PERIPHERAL RUN-OFF W& O "$1,551.90 " "$1,008.74 " 330184 73725 50 282 616 MRA W/CONT LWR EXT BILAT O "$2,032.50 " "$1,321.12 " 330184 73725 LT 282 616 MRA W/CONT LWR EXT LEFT O "$3,021.90 " "$1,964.24 " 330184 73725 RT 282 616 MRA W/CONT LWR EXT RIGHT O "$3,021.90 " "$1,964.24 " 330184 73725 LT 282 616 MRA W/O CON LWR EXT LEFT O "$1,355.00 " $880.75 330184 73725 50 282 616 MRA W/O CONT LWR EXT BILAT O "$2,032.50 " "$1,321.12 " 330184 73725 RT 282 616 MRA W/O CONT LWR EXT RIGHT O "$1,355.00 " $880.75 330184 73725 50 282 616 MRA W/O FOL W/CONT LWR EXT BILAT O "$2,032.50 " "$1,321.12 " 330184 73725 LT 282 616 MRA W/O FOL W/CONT LWR EXT LEFT O "$1,355.00 " $880.75 330184 73725 RT 282 616 MRA W/O FOL W/CONT LWR EXT RIGHT O "$1,355.55 " $881.11 330184 74018 5521 471 320 X-RAY EXAM ABDOMEN 1 VIEW-74018 O $151.00 $98.15 330184 74019 5522 471 320 X-RAY EXAM ABDOMEN 2 VIEWS-74019 O $285.00 $185.25 330184 74021 5522 471 320 X-RAY EXAM ABDOMEN 3+ VIEWS-74021 O $299.25 $194.51 330184 74150 TC 5522 299 350 CT RENAL PROTOCOL O "$2,097.00 " "$1,363.05 " 330184 74150 TC 5522 299 352 CT ABDOMEN WITHOUT CONTRA O "$2,097.00 " "$1,363.05 " 330184 74160 TC 5571 300 352 CT ABDOMEN WITH CONTRAST O "$3,000.38 " "$1,950.24 " 330184 74160 TC 5571 300 352 ABD W IV Oral Contrast O "$3,000.38 " "$1,950.24 " 330184 74160 TC 5571 300 352 ABD W Oral Contrast O "$3,000.38 " "$1,950.24 " 330184 74160 TC 5571 300 352 CT ABD IV GSTRG CONT + O "$3,000.38 " "$1,950.24 " 330184 74160 TC 5571 300 352 CT ABD GSTRG CONT ONLY + O "$3,000.38 " "$1,950.24 " 330184 74170 TC 5571 300 352 CT ABDOMEN WITH AND WITHO O "$3,664.00 " "$2,381.60 " 330184 74174 5572 302 352 CT ANG ABD&PELV W/DYE-74174 O "$1,150.00 " $747.50 330184 74174 5572 302 352 CT ANG ABD&PELV W/O&W/DYE-74174 O "$1,150.00 " $747.50 330184 74175 TC 5571 302 352 CT ANGIO ABDOMEN O "$2,648.89 " "$1,721.78 " 330184 74176 TC 5523 300 352 CT ABD/PELVIS NON CONTRAS O "$3,567.38 " "$2,318.79 " 330184 74177 TC 5572 300 352 CT ADD/PELVIS WITH CONTRA O "$3,773.50 " "$2,452.78 " 330184 74177 TC 5572 300 350 AB&PEL W ORAL CNT ONLY RC O "$3,773.50 " "$2,452.78 " 330184 74177 TC 5572 300 350 ABD/PLV W IV&ORL CNT RECN O "$3,773.50 " "$2,452.78 " 330184 74177 TC 5572 300 350 CT ABD PLV IV GSTRG CNT+ O "$3,773.50 " "$2,452.78 " 330184 74177 TC 5572 300 350 CT ABD PLV GSTRG ONLY + O "$3,773.50 " "$2,452.78 " 330184 74178 TC 5572 300 352 CT CHEST/ABD/PELVIS NON C O "$3,959.29 " "$2,573.54 " 330184 74178 TC 5572 300 350 ABD/PLV WWO IV&ORL CNT RC O "$3,959.29 " "$2,573.54 " 330184 74181 TC 5523 293 610 MRI ABDOMEN W/O CONTRAST O "$2,944.86 " "$1,914.16 " 330184 74181 TC 5523 293 610 MRI MRCP W/O CONTRAST O "$2,944.86 " "$1,914.16 " 330184 74182 TC 5572 295 610 MRI ABDOMEN WITH CONTRAST O "$1,355.55 " $881.11 330184 74183 TC 5572 295 610 MRI RENAL WITH AND WITHOU O "$3,723.56 " "$2,420.32 " 330184 74183 TC 5572 295 610 MRI ABDOMEN W&W/O CONTR O "$3,723.56 " "$2,420.32 " 330184 74183 TC 5572 295 610 MRI ABD W/W/O CONTRAST(2) O "$3,723.56 " "$2,420.32 " 330184 74185 TC 282 618 Angio Renal With + Withou O $842.10 $547.37 330184 74185 TC 282 618 MRCP With + Without Contr O $842.10 $547.37 330184 74185 TC 282 610 MRA ABDOMEN W&W/O CONTRAS O $842.10 $547.37 330184 74185 TC 282 610 MRA ABDOMINAL AORTA W&W/O O $842.10 $547.37 330184 74185 282 618 MRA W/CONT ABD O $842.10 $547.37 330184 74185 282 618 MRA W/O CONT ABD O $842.10 $547.37 330184 74185 282 618 MRA W/O FOL W/CONT ABD O $842.10 $547.37 330184 74190 TC 5524 389 320 CT PERITONEOGRAM/PARACENT O "$1,361.00 " $884.65 330184 74220 TC 5571 471 320 Esophagram Barium O $542.00 $352.30 330184 74220 TC 5571 471 320 Esophagram Gastrografin O $542.00 $352.30 330184 74230 TC 5571 389 320 RAD ESOPH CINE FOR SWALLO O $610.31 $396.70 330184 74240 5571 389 320 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB-74240 O $605.00 $393.25 330184 74240 TC 5571 389 320 RAD UPPER GI W/OR W/O KUB O "$1,177.00 " $765.05 330184 74240 TC 5571 389 320 Gastrograf UprGISerieswo O "$1,177.00 " $765.05 330184 74240 TC 5571 389 320 UPPER GI DOUBLE CONT W/O O "$1,177.00 " $765.05 330184 74246 5571 389 320 X-RAY XM UPR GI TRC 2CNTRST-74246 O $552.00 $358.80 330184 74248 389 320 X-RAY SM INT F-THRU STD-74248 O $100.00 $65.00 330184 74250 TC 5571 389 320 RAD SMALL BOWEL SERIES O $358.05 $232.73 330184 74270 TC 5571 389 320 RAD BARIUM ENEMA W/-W/O K O $846.30 $550.10 330184 74270 TC 5571 389 320 Gastrograf Enema w/o O $846.30 $550.10 330184 74280 TC 5571 389 320 RAD BARIUM ENEMA AIR CONT O $358.05 $232.73 330184 74283 TC 5571 320 RAD THERAP ENEMA FOR INTU O $358.16 $232.80 330184 74283 TC 5571 320 GASTRO ENEMA THERAP INTUS O $358.16 $232.80 330184 74328 TC 474 320 RAD ERCP BILIARY DUCTAL S O $504.00 $327.60 330184 74329 TC 320 RAD ERCP PANCREATIC DUCTA O $658.00 $427.70 330184 74330 TC 320 RAD ERCP PANC/BILE DUCT S O $697.00 $453.05 330184 74340 TC 474 320 RAD POSITIONING GI TUBE L O $573.30 $372.65 330184 74355 TC 474 320 RAD SPEC PERC PLMNT ENT/C O $578.00 $375.70 330184 74363 TC 474 320 IR DLT BLRY DCT STRICTURE O "$1,263.00 " $820.95 330184 74400 TC 5571 320 XR IVP-Intravenous Pyelog O $684.00 $444.60 330184 74420 TC 5572 389 320 RAD UROGRAM RETRO W/WO KU O "$1,361.00 " $884.65 330184 74425 TC 5572 389 320 RAD UROGRAM ANTEGRADE O "$1,361.00 " $884.65 330184 74425 TC 5572 389 320 RAD NEPHROSTOGRAM O "$1,361.00 " $884.65 330184 74425 TC 5572 389 320 RAD SPEC NEPH SUP & INTER O "$1,361.00 " $884.65 330184 74425 LT 5572 389 320 CONTRST X-RAY URINARY TRACT LT-RAD O "$1,361.00 " $884.65 330184 74425 RT 5572 389 320 CONTRST X-RAY URINARY TRACT RT-RAD O "$1,361.00 " $884.65 330184 74430 TC 5572 389 320 RAD CYSTOGRAM MIN 3 VIEWS O $718.20 $466.83 330184 74450 TC 5523 389 320 RAD URETHROCYSTOGRAM RETR O $684.00 $444.60 330184 74455 TC 5523 389 320 RAD URETHROCYSTOGRAM VOID O "$1,487.00 " $966.55 330184 74470 TC 5524 320 RAD SPEC RENAL CYST PUNCT O $684.00 $444.60 330184 74470 LT 5524 320 X-RAY EXAM KIDNEY LESION LT-RAD O $684.00 $444.60 330184 74470 RT 5524 320 X-RAY EXAM KIDNEY LESION RT-RAD O $684.00 $444.60 330184 74485 TC 5373 474 320 RAD SPEC DILITATION NEPH O "$4,976.00 " "$3,234.40 " 330184 74485 LT 5373 474 320 X-RAY GUIDE GU DILATION LT-RAD O "$4,976.00 " "$3,234.40 " 330184 74485 RT 5373 474 320 X-RAY GUIDE GU DILATION RT-RAD O "$4,976.00 " "$3,234.40 " 330184 74712 5523 610 MRI FETAL SNGL/1ST GESTATION O $341.00 $221.65 330184 74713 610 MRI FETAL EA ADDL GESTATION O "$1,574.00 " "$1,023.10 " 330184 74740 TC 5523 389 320 RAD HYSTEROSALPINGOGRAPHY O $718.20 $466.83 330184 74740 5523 389 320 X-RAY FEMALE GENITAL TRACT LT-RAD O $718.20 $466.83 330184 74740 5523 389 320 X-RAY FEMALE GENITAL TRACT RT-RAD O $718.20 $466.83 330184 75600 TC 5183 320 RAD DSA CAROTID O "$7,143.00 " "$4,642.95 " 330184 75605 TC 5184 280 320 IR ANG AORTA THORACIC O "$11,874.00 " "$7,718.10 " 330184 75605 TC 5184 280 320 RAD ANG ARCH ARTERIOGRAM O "$11,874.00 " "$7,718.10 " 330184 75605 TC 5184 280 320 RAD DSA THORACIC AORTA O "$11,874.00 " "$7,718.10 " 330184 75625 TC 5183 279 320 RAD ANG AORTA ABDOMEN TRA O "$7,143.00 " "$4,642.95 " 330184 75625 TC 5183 279 320 RAD DSA RENAL ARTERIES O "$7,143.00 " "$4,642.95 " 330184 75625 TC 5183 279 320 RAD ANGAORTA ABD CATH O "$7,143.00 " "$4,642.95 " 330184 75630 TC 5183 279 320 RAD ANG AORTA-BILAT ILIOF O "$5,165.00 " "$3,357.25 " 330184 75630 TC 5183 279 320 RAD ANG UNILAT ILIOFEMORA O "$5,165.00 " "$3,357.25 " 330184 75635 TC 5571 302 352 CT ANGIO AORTO-ILLIO PANE O "$2,054.00 " "$1,335.10 " 330184 75710 LT 5183 279 323 EXTREM ANGIO - UNIL-LEFT-75710 O "$7,110.08 " "$4,621.55 " 330184 75710 RT 5183 279 323 EXTREM ANGIO - UNIL-RIGHT-75710 O "$7,110.08 " "$4,621.55 " 330184 75710 TC 5183 279 323 RAD ANG FEMORAL UNILATERA O "$7,110.08 " "$4,621.55 " 330184 75710 TC 5183 279 323 RAD ANG EXTREMITY UNI O "$7,110.08 " "$4,621.55 " 330184 75710 RT 5183 279 323 RAD ANG UP EXTREM RT O "$7,110.08 " "$4,621.55 " 330184 75710 52 5183 279 323 RAD ANG OR EXTREMITY O "$7,110.08 " "$4,621.55 " 330184 75710 LT 5183 279 323 ANG UPR EXT LT O "$7,110.08 " "$4,621.55 " 330184 75710 RT 5183 279 323 Angio Upper Extremity-Rig O "$7,110.08 " "$4,621.55 " 330184 75710 LT 5183 279 323 Angio Upper Extremity-Lef O "$7,110.08 " "$4,621.55 " 330184 75716 TC 5183 279 320 RAD ANG UPPER EXTREM BIL O "$7,143.00 " "$4,642.95 " 330184 75716 TC 5183 279 320 RAD ANG EXTREMITY BILAT O "$7,143.00 " "$4,642.95 " 330184 75726 TC 5184 280 320 RAD ANG VISCERAL SELECTIV O "$8,855.00 " "$5,755.75 " 330184 75726 TC 5184 280 320 RAD ANG VISCERAL SUPRASEL O "$8,855.00 " "$5,755.75 " 330184 75731 TC 5182 320 RAD ANG ADRENAL UNILATERA O "$2,070.00 " "$1,345.50 " 330184 75731 LT 5182 320 ARTERY X-RAYS ADRENAL GLAND LT-RAD O "$2,070.00 " "$1,345.50 " 330184 75731 RT 5182 320 ARTERY X-RAYS ADRENAL GLAND RT-RAD O "$2,070.00 " "$1,345.50 " 330184 75733 TC 5183 320 RAD ANG ADRENAL BILATERAL O "$7,143.00 " "$4,642.95 " 330184 75736 TC 5184 280 320 RAD ANG PELVIC SELECTIVE O "$8,855.00 " "$5,755.75 " 330184 75736 TC 5184 280 320 RAD ANG PELVIC SUPRASELEC O "$8,855.00 " "$5,755.75 " 330184 75736 LT 5184 280 320 ARTERY X-RAYS PELVIS LT-RAD O "$8,855.00 " "$5,755.75 " 330184 75736 RT 5184 280 320 ARTERY X-RAYS PELVIS RT-RAD O "$8,855.00 " "$5,755.75 " 330184 75741 TC 5183 279 320 RAD ANG PULMONARY UNI SEL O "$7,143.00 " "$4,642.95 " 330184 75741 LT 5183 279 320 ARTERY X-RAYS LT LUNG-RAD O "$7,143.00 " "$4,642.95 " 330184 75741 RT 5183 279 320 ARTERY X-RAYS RT LUNG-RAD O "$7,143.00 " "$4,642.95 " 330184 75743 TC 5183 279 320 RAD ANG PULMONARY BIL SEL O "$7,143.00 " "$4,642.95 " 330184 75746 TC 5182 279 320 RAD ANG PULMONARY NONSELE O "$2,070.00 " "$1,345.50 " 330184 75774 TC 280 320 RAD ANG VISCERAL ADDITION O "$2,583.00 " "$1,678.95 " 330184 75809 TC 5522 320 RAD SHUNTOGRAM O $358.05 $232.73 330184 75810 TC 5182 320 RAD ANG SPLENOPORTOGRAM O "$2,070.00 " "$1,345.50 " 330184 75820 TC 5181 277 320 RAD VENO EXTREMITY UNILAT O "$1,802.00 " "$1,171.30 " 330184 75820 LT 5181 277 320 VEIN X-RAY ARM/LEG LT-RAD O "$1,802.00 " "$1,171.30 " 330184 75820 RT 5181 277 320 VEIN X-RAY ARM/LEG RT-RAD O "$1,802.00 " "$1,171.30 " 330184 75822 TC 5182 277 320 RAD VENO EXTREMITY BILATE O "$2,070.00 " "$1,345.50 " 330184 75825 TC 5183 279 320 RAD ANG VENO CAVAL INFERI O "$7,143.00 " "$4,642.95 " 330184 75827 TC 5181 277 320 RAD VENO CAVAL SUPERIOR O "$1,457.00 " $947.05 330184 75831 TC 5183 279 320 RAD VENO RENAL UNILATERAL O "$7,143.00 " "$4,642.95 " 330184 75831 LT 5183 279 320 VEIN X-RAY KIDNEY LT-RAD O "$7,143.00 " "$4,642.95 " 330184 75831 RT 5183 279 320 VEIN X-RAY KIDNEY RT-RAD O "$7,143.00 " "$4,642.95 " 330184 75833 TC 5183 279 320 RAD VENO RENAL BILATERAL O "$7,143.00 " "$4,642.95 " 330184 75860 TC 5183 279 320 VENOGRAPHY VENOUS SINUS P O "$7,143.00 " "$4,642.95 " 330184 75885 TC 5183 320 RAD SPEC TRANSHEP PORTO P O "$7,143.00 " "$4,642.95 " 330184 75885 TC 5183 320 RAD SPEC TRANSHEP PORTO N O "$7,143.00 " "$4,642.95 " 330184 75893 TC 5184 280 320 RAD VENO SAMPLING THRU CA O "$11,874.00 " "$7,718.10 " 330184 75893 TC 5184 280 320 RAD ANG VENOUS SAMPLING C O "$11,874.00 " "$7,718.10 " 330184 75894 TC 474 320 RAD SPEC ARTERIAL EMBOLIZ O "$5,204.85 " "$3,383.15 " 330184 75894 TC 474 320 RAD SPEC VASCULAR OCCLUSI O "$5,204.85 " "$3,383.15 " 330184 75898 TC 5182 277 320 RAD SPEC ANGIO INF/EMB F/ O "$2,070.00 " "$1,345.50 " 330184 75902 TC 474 320 IR RMV MCH OBST MTRL CV O $503.00 $326.95 330184 75970 TC 474 320 RAD SPEC TRANSCATH BIOPSY O "$2,375.00 " "$1,543.75 " 330184 75984 TC 474 320 IR NEPHROSTOMY TUBE CHANG O $487.20 $316.68 330184 75984 TC 474 320 RAD SPEC NEPHROSTOMY TUBE O $487.20 $316.68 330184 75984 TC 474 320 RAD SPEC ABSCESS CATHETER O $487.20 $316.68 330184 75984 TC 474 320 CT PERC CHANGE TUBE\CATH O $487.20 $316.68 330184 75989 TC 474 320 RAD SPEC ABSCESS DRAINAGE O $499.00 $324.35 330184 75989 TC 474 320 CT PERCUTANEOUS DRAINAGE O $499.00 $324.35 330184 75989 TC 474 320 US GUIDANCE PERCY ABSCESS O $499.00 $324.35 330184 76000 TC 5523 389 320 RAD FLUOROSCOPY TO 1 HOUR O $810.86 $527.06 330184 76010 TC 5521 471 320 RAD FOREIGN BODY SERIES C O $190.05 $123.53 330184 76080 TC 5524 389 320 RAD SINUS TRACT STUDY O "$1,196.00 " $777.40 330184 76080 TC 5524 389 320 RAD SPEC ABSCESSOGRAM O "$1,196.00 " $777.40 330184 76098 TC 5524 389 320 RAD MAM STEREO SPECIMENME O "$1,385.74 " $900.73 330184 76098 TC 5524 389 320 Specimen-Right O "$1,385.74 " $900.73 330184 76098 TC 5524 389 320 Specimen-Left O "$1,385.74 " $900.73 330184 76100 TC 5522 320 RAD SPEC LAMINECTOMY OR O $341.00 $221.65 330184 76376 TC 2002 350 CT CORONAL SAG MULT OBL O "$1,104.60 " $717.99 330184 76376 TC 2002 350 CT CORONAL SAG MULTIPL OB O "$1,104.60 " $717.99 330184 76377 TC 2002 350 MRA 3-D RECONSTRUCTION O "$1,181.25 " $767.81 330184 76496 TC 5521 320 Unlisted Proc Intervent O $181.00 $117.65 330184 76497 TC 5521 350 Unlisted Proc CT O $190.05 $123.53 330184 76498 TC 5521 610 Unlisted Proc MRI O $190.05 $123.53 330184 76499 TC 5521 471 320 RAD UNLISTED PROCEDURE O $181.00 $117.65 330184 76499 TC 5521 471 320 Unlisted Proc X-Ray O $181.00 $117.65 330184 76506 TC 5522 288 402 US ECHOENCEPHALOGRAPHY NE O $358.05 $232.73 330184 76536 TC 5522 288 402 US THYROID O $799.84 $519.89 330184 76536 TC 5522 288 402 US SOFT TISSUE HEAD/NECK O $799.84 $519.89 330184 76604 TC 5522 288 402 US CHEST O $726.00 $471.90 330184 76641 LT 5522 288 402 US LT BREAST UNIL COMPLETE O $694.05 $451.13 330184 76641 RT 5522 288 402 US RT BREAST UNIL COMPLETE O $694.05 $451.13 330184 76641 50 5522 288 402 US BREAST BIL COMPLETE O "$1,041.08 " $676.70 330184 76642 LT 5521 288 402 US LT BREAST UNIL LIMITED O $181.00 $117.65 330184 76642 RT 5521 288 402 US RT BREAST UNIL LIMITED O $181.00 $117.65 330184 76700 TC 5522 289 402 US ABDOMEN O "$1,181.00 " $767.65 330184 76705 TC 5522 288 402 US ABDOMEN LMT O $943.00 $612.95 330184 76770 TC 5522 289 402 US RETROPERITONEAL COMPLE O $772.27 $501.98 330184 76775 TC 5522 288 402 US ABDOMINAL AORTA O $946.37 $615.14 330184 76775 TC 5522 288 402 US RENAL O $946.37 $615.14 330184 76775 TC 5522 288 402 US RETROPERITONEAL LMT O $946.37 $615.14 330184 76800 TC 5522 288 402 US INFANT SPINAL CANAL O $190.05 $123.53 330184 76801 TC 5522 470 402 US OB 1ST TRI<14WKS O $358.00 $232.70 330184 76801 TC 5522 470 402 COMPLETE SCAN < 14.0 WEEK O $358.00 $232.70 330184 76801 5522 470 402 OB US < 14 WKS SNGL FETUS O $358.00 $232.70 330184 76802 TC 470 402 US OB 1ST TRI ADD'L O $366.00 $237.90 330184 76802 TC 470 402 US Obstetric Limited O $366.00 $237.90 330184 76802 TC 470 402 EACH ADDITIONAL FETUS<14 O $366.00 $237.90 330184 76802 470 402 OB US < 14 WKS ADDL FETUS O $366.00 $237.90 330184 76805 TC 5522 470 402 US OB MULTIGESTATIONAL>14 O $358.00 $232.70 330184 76805 TC 5522 470 402 US OB 2ND TRI>14 WKS O $358.00 $232.70 330184 76805 TC 5522 470 402 COMPLETE SCAN>OR=14.0 WEE O $358.00 $232.70 330184 76805 5522 470 402 OB US >/= 14 WKS SNGL FETUS O $358.00 $232.70 330184 76810 TC 470 402 EACH ADD'L FETUS>OR=14.0 O $313.00 $203.45 330184 76810 470 402 OB US >/= 14 WKS ADDL FETUS O $313.00 $203.45 330184 76811 TC 5523 402 US OB COMPLETE ANATOMY O $358.00 $232.70 330184 76811 TC 5523 402 COMP SCAN & DETAIL FETAL O $358.00 $232.70 330184 76811 5523 402 OB US DETAILED SNGL FETUS O $358.00 $232.70 330184 76812 TC 402 EACH ADDITIONAL FETUS(DET O $338.00 $219.70 330184 76812 402 OB US DETAILED ADDL FETUS O $338.00 $219.70 330184 76813 TC 5522 470 402 NUCHAL TRANSLUCENCY O $358.05 $232.73 330184 76814 TC 470 402 NUCHAL TRANSLUCENCY ADD'L O $247.00 $160.55 330184 76815 TC 5522 470 402 US OB LIMITED O $358.00 $232.70 330184 76815 TC 5522 470 402 LIMITED ULTRASOUND O $358.00 $232.70 330184 76815 59 5522 470 402 LIMITED ULTRASOUND(MULTI) O $358.00 $232.70 330184 76815 5522 470 402 OB US LIMITED FETUS(S) O $358.00 $232.70 330184 76816 TC 5522 470 402 US OB FOLLOW UP AGE AFI O $358.00 $232.70 330184 76816 TC 5522 470 402 FOLLOW UP/REPEAT ULTRASOU O $358.00 $232.70 330184 76816 59 5522 470 402 FOLLOW UP/REPEAT ULTRASOU O $358.00 $232.70 330184 76816 5522 470 402 OB US FOLLOW-UP PER FETUS O $358.00 $232.70 330184 76817 TC 5522 470 402 US TRANSVAGINAL-OB O $358.00 $232.70 330184 76817 TC 5522 470 402 TRANSVAGINAL OB (CERVICAL O $358.00 $232.70 330184 76817 TC 5522 470 402 TRANSVAGINAL OB(CERVICAL O $358.00 $232.70 330184 76817 5522 470 402 TRANSVAGINAL US OBSTETRIC O $358.00 $232.70 330184 76818 TC 5522 402 BIOPHYSICAL PROFILE(W/NST O $358.05 $232.73 330184 76818 59 5522 402 BIOPHYSICAL PROFILE(W/NST O $358.05 $232.73 330184 76819 TC 5522 470 402 US BIOPHYSICAL PROFILE O $358.05 $232.73 330184 76819 TC 5522 470 402 BIOPHYSICAL PROFILE(W/OUT O $358.05 $232.73 330184 76819 59 5522 470 402 BIOPHYSICAL PROFILE (W/OU O $358.05 $232.73 330184 76820 TC 5522 470 402 US DPLR VELOCIMETRY FETAL O $341.00 $221.65 330184 76820 TC 5522 470 402 UMBILICAL ARTERY ECHO O $341.00 $221.65 330184 76825 TC 5524 402 DOPPLER FETAL ECHOCARDIOG O "$1,361.00 " $884.65 330184 76825 59 5524 402 2D FETAL ECHOCARD MULTI O "$1,361.00 " $884.65 330184 76826 TC 5523 402 F/U 2D FETAL ECHOCARD SGL O $684.00 $444.60 330184 76826 59 5523 402 F/U 2D FETAL ECHOCARD MUL O $684.00 $444.60 330184 76827 TC 5522 402 DOPPLER UMBILICAL OR MCA O $509.00 $330.85 330184 76827 59 5522 402 DOPPLERUMBILICAL OR MCA O $509.00 $330.85 330184 76827 TC 5522 402 DOPPLER SGL O $509.00 $330.85 330184 76828 TC 5522 402 F/U DOPPLER SGL O $358.05 $232.73 330184 76828 59 5522 402 DOPPLER FETAL ECHOCARD F/ O $358.05 $232.73 330184 76828 TC 5522 402 DOPPLER UMBILICAL OR MCA O $358.05 $232.73 330184 76828 59 5522 402 DOPPLERUMBIL CORD OR MCA O $358.05 $232.73 330184 76830 TC 5522 288 402 US TRANSVAGINAL-GYN O $912.71 $593.26 330184 76831 TC 5523 289 402 US HYSTROSONOGRAM O $718.20 $466.83 330184 76856 TC 5522 289 402 US PELVIC NON-OB O $972.04 $631.82 330184 76857 TC 5522 288 402 US PELVIC NON-OB LIMITED O $646.00 $419.90 330184 76870 TC 5522 288 402 US SCROTUM O "$1,178.59 " $766.08 330184 76872 TC 5522 402 US TRANSRECTAL PROSTATE O $358.05 $232.73 330184 76881 LT 5522 288 402 US COMPL JOINT R-T W/IMG-LEFT-76881 O $339.00 $220.35 330184 76881 RT 5522 288 402 US COMPL JOINT R-T W/IMG-RIGHT-76881 O $339.00 $220.35 330184 76882 RT 5522 288 402 Extremity Non Vascular-Ri O $462.00 $300.30 330184 76882 LT 5522 288 402 Extremity Non Vascular-Le O $462.00 $300.30 330184 76882 TC 5522 288 402 US MUSCULOSKELETAL O $462.00 $300.30 330184 76882 LT 5522 288 402 US XTR NON-VASC LMTD LT-RAD O $462.00 $300.30 330184 76882 RT 5522 288 402 US XTR NON-VASC LMTD RT-RAD O $462.00 $300.30 330184 76886 TC 5521 402 US INFANT HIPS O $190.05 $123.53 330184 76936 TC 5722 402 US GUIDED COMPRESSION REP O $703.00 $456.95 330184 76937 TC 472 402 GUID US VSCLR ACCESS SITE O $343.00 $222.95 330184 76942 TC 472 402 US GUIDANCE NEEDLE PLACE O "$1,156.05 " $751.43 330184 76942 TC 472 402 MG US GUIDANCE FOR NEEDLE PLACEMENT O "$1,156.05 " $751.43 330184 76942 TC 472 402 US GUIDED NEEDLE PLCMNT-76942 O "$1,156.05 " $751.43 330184 76942 TC 472 402 US GUIDED NEEDL PLCMNT-76942 O "$1,156.05 " $751.43 330184 76942 TC 472 402 US GUID NEEDLE PLCMNT-76942 O "$1,156.05 " $751.43 330184 76942 TC 472 402 US GUIDED NEEDLE PLCMN-76942 O "$1,156.05 " $751.43 330184 76946 TC 402 U/S GUIDE AMNIO SGL O $460.00 $299.00 330184 76946 59 402 U/S GUIDE AMNIO MULTI O $460.00 $299.00 330184 76999 TC 5521 402 Unlisted Proc Ultrasound O $190.05 $123.53 330184 77001 TC 474 320 FLUORO GUIDANCE O $948.00 $616.20 330184 77002 474 320 FLURO GUID FOR NEEDLE PLACEMENT O "$1,030.00 " $669.50 330184 77002 59 474 320 FLURO GUID NEEDLE PLACEMENT(59MDF) O "$1,030.00 " $669.50 330184 77002 TC 474 320 NEEDLE LOCALIZATION BY XRAY-77002 O "$1,030.00 " $669.50 330184 77003 59 474 320 FLUOROGUIDE FOR SPINE INJ (59 MDF) O $992.00 $644.80 330184 77003 474 320 FLUOROGUIDE FOR SPINE INJECT O $992.00 $644.80 330184 77011 473 350 CT GUID FOR STEREOTACTIC LOCALIZATION-77011 O $153.30 $99.65 330184 77012 TC 473 350 CT GUIDANCE FOR NEED REPL O "$1,867.95 " "$1,214.17 " 330184 77012 TC 473 350 US THORACENTESIS ASP RT O "$1,867.95 " "$1,214.17 " 330184 77012 TC 473 350 CT SCAN FOR NEDLE BX-77012 O "$1,867.95 " "$1,214.17 " 330184 77012 TC 473 350 CT SCN FOR NEEDLE BX-77012 O "$1,867.95 " "$1,214.17 " 330184 77012 TC 473 350 CT SCAN FOR NEEDL BX-77012 O "$1,867.95 " "$1,214.17 " 330184 77012 TC 473 350 CT SCAN FOR NEEDLE BX-77012 O "$1,867.95 " "$1,214.17 " 330184 77013 TC 473 352 CT TISSUE ABLATION MONITO O "$1,143.00 " $742.95 330184 77021 TC 610 MR GUIDANCE FOR NEEDL PLACE-77021 O $213.00 $138.45 330184 77021 TC 610 MR GUIDANCE FOR NEEDLE PLACE-77021 O $213.00 $138.45 330184 77021 TC 610 MR GUIDANCE FOR NEDLE PLACE-77021 O $213.00 $138.45 330184 77021 TC 610 MR GUIDANC FOR NEEDLE PLACE-77021 O $213.00 $138.45 330184 77021 TC 610 MR GUIDNCE FOR NEEDLE PLACE-77021 O $213.00 $138.45 330184 77046 LT 5523 614 MRI BREAST WO CNT-LEFT-77046 O $693.00 $450.45 330184 77046 RT 5523 614 MRI BREAST WO CNT-RIGHT-77046 O $693.00 $450.45 330184 77047 5523 614 MRI BREAST WO CNT BIL-77047 O $693.00 $450.45 330184 77048 LT 614 MRI BREAST W&WO CNT-LEFT-77048 O "$1,158.00 " $752.70 330184 77048 RT 614 MRI BREAST W&WO CNT-RIGHT-77048 O "$1,158.00 " $752.70 330184 77049 614 MRI BREAST W&WO CNT BIL-77049 O "$1,158.00 " $752.70 330184 77053 TC 5523 389 320 GALACTOGRAM SINGLE DUCT O $684.00 $444.60 330184 77053 LT 5523 389 320 X-RAY SNG MAMMARY DUCT LT-RAD O $684.00 $444.60 330184 77053 RT 5523 389 320 X-RAY SNG MAMMARY DUCT RT-RAD O $684.00 $444.60 330184 77054 TC 5523 389 320 GALECTOGRAM MULTIDUCTS O $684.00 $444.60 330184 77054 LT 5523 389 320 X-RAY MLTP MAMMARY DUCTS LT-RAD O $684.00 $444.60 330184 77054 RT 5523 389 320 X-RAY MLTP MAMMARY DUCTS RT-RAD O $684.00 $444.60 330184 77065 LT 286 401 DX MAMMO INCL CAD UNIL-LT O $424.46 $275.90 330184 77065 RT 286 401 DX MAMMO INCL CAD UNIL-RT O $424.46 $275.90 330184 77065 LT 286 401 Mammography Diagnostic-Le O $424.46 $275.90 330184 77065 RT 286 401 Mammography Diagnostic-Ri O $424.46 $275.90 330184 77065 RT 286 401 MAM CAD PST STRO BRS BX R O $424.46 $275.90 330184 77065 LT 286 401 MAM CAD PST STRO BRS BX L O $424.46 $275.90 330184 77065 LT 286 401 MG DIAG SD LEFT + CAD O $424.46 $275.90 330184 77065 RT 286 401 MG DIAG SD RIGHT + CAD O $424.46 $275.90 330184 77066 286 401 DX MAMMO INCL CAD BIL O $531.04 $345.17 330184 77066 TC 286 401 Mammography Diagnostic-Bi O $531.04 $345.17 330184 77066 TC 286 401 MAM CAD PST STRO BRS BX B O $531.04 $345.17 330184 77066 TC 286 401 MG DIAG SD BILT + CAD O $531.04 $345.17 330184 77067 286 403 SCR MAMMO INCL CAD BIL O $566.86 $368.46 330184 77067 52 286 403 SCR MAMMO UNIL INCL CAD-LT-52-77067 O $566.86 $368.46 330184 77067 52 286 403 SCR MAMMO UNIL INCL CAD-RT-52-77067 O $566.86 $368.46 330184 77067 TC 286 403 Mammography Screening-Bil O $566.86 $368.46 330184 77067 52 286 403 Mammography Screening Bil O $566.86 $368.46 330184 77072 TC 5522 471 320 XR Bone Age 0038 O $358.05 $232.73 330184 77073 TC 5522 471 320 RAD BONE LENGTH STUDY O $375.64 $244.16 330184 77073 TC 5522 471 320 BONE LNG STDY SCANOGRAM O $375.64 $244.16 330184 77074 TC 5522 471 320 RAD BONE SURVEY O $239.00 $155.35 330184 77075 TC 5522 389 320 RAD BONE SURVEY W EXT O $341.00 $221.65 330184 77076 TC 5522 471 320 RAD BONE SURVEY INFANT O $341.00 $221.65 330184 77078 TC 5521 352 CT BONE DENSITY O "$1,329.30 " $864.04 330184 77763 TC 5624 342 RAD SPEC RADIUM INSERTION O "$2,235.00 " "$1,452.75 " 330184 78012 TC 5591 331 340 THYROID UPTAKE ONLY O "$1,008.00 " $655.20 330184 78013 TC 5591 331 340 THYROID SCAN NO UPTAKE O "$1,008.00 " $655.20 330184 78014 TC 5591 331 340 Thyroid Scan W/UPTAKE O "$1,058.40 " $687.96 330184 78018 TC 5592 331 340 NM THYROID METASTASES IMA O "$1,298.00 " $843.70 330184 78018 TC 5592 331 340 NM THYROID METASTASES UPT O "$1,298.00 " $843.70 330184 78018 TC 5592 331 340 NM THYROID MET IMAGINGBO O "$1,298.00 " $843.70 330184 78070 TC 5591 332 340 NM PARATHYROID IMAGING O "$1,058.40 " $687.96 330184 78102 TC 5591 340 NM BONE MARROW LIMITED O "$1,008.00 " $655.20 330184 78103 TC 5591 340 NM BONE MARROW MULTIPLE O "$1,008.00 " $655.20 330184 78195 TC 5592 332 341 NM LYMPHOSCINTIGRAPHY O "$1,362.90 " $885.89 330184 78215 TC 5591 332 340 NM LIVER/SPLEEN SCAN O "$1,008.00 " $655.20 330184 78215 TC 5591 332 340 NM LIVER/SPLEEN SCAN SPEC O "$1,008.00 " $655.20 330184 78226 TC 5591 331 340 NM LIVER CHOLESCINTIGRAM O "$1,008.00 " $655.20 330184 78227 5592 331 340 LIVER CHOLESCINTOGRAM W/MORPHINE O "$1,362.90 " $885.89 330184 78227 5592 331 340 LIVER CHOLESCINTOGRAM W/SINCALIDE O "$1,362.90 " $885.89 330184 78227 TC 5592 331 340 NM HPTBLRY GLBLDR W PHARM O "$1,362.90 " $885.89 330184 78230 TC 5591 340 NM SALIVARY GLAND IMG SPE O "$1,008.00 " $655.20 330184 78264 TC 5591 331 340 NM GASTRIC EMPTYING STUDY O "$1,058.40 " $687.96 330184 78278 TC 5591 332 340 NM GI BLEEDING SCAN O $946.00 $614.90 330184 78290 TC 5591 331 340 NM MECKEL'S DIVERTICULUM O "$1,008.00 " $655.20 330184 78291 TC 5591 340 NM PERITONEAL-VENOUS SHUN O "$1,008.00 " $655.20 330184 78300 5591 331 341 BONE &/JOINT IMAGING LIMITED AREA-78300 O "$1,060.00 " $689.00 330184 78300 TC 5591 331 340 NM BONE SCAN LIMITED O "$1,008.00 " $655.20 330184 78305 5591 341 BONE &/JOINT IMAGING MULTIPLE AREAS-78305 O "$1,060.00 " $689.00 330184 78306 5591 331 341 BONE &/JOINT IMAGING WHOLE BODY-78306 O "$1,060.00 " $689.00 330184 78306 TC 5591 331 340 NM BONE SCAN WHOLE BODY O "$1,058.40 " $687.96 330184 78315 5591 331 341 BONE &/JOINT IMAGING 3 PHASE STUDY-78315 O "$1,060.00 " $689.00 330184 78315 TC 5591 331 340 NM BONE SCAN (TRIPLE PHAS O "$1,058.40 " $687.96 330184 78451 TC 5593 332 340 NM MYO PERF SINGLE STUDY O "$2,953.00 " "$1,919.45 " 330184 78452 TC 5593 332 341 NM MYO PERF MULTI STUDIES O "$3,618.30 " "$2,351.89 " 330184 78452 TC 5593 332 340 NM MYO VIABILITY REST/RED O "$3,618.30 " "$2,351.89 " 330184 78452 TC 5593 332 341 SPC MYCRDL PRFSN PHR MULT O "$3,618.30 " "$2,351.89 " 330184 78472 TC 5591 331 340 NM MUGA O "$1,058.40 " $687.96 330184 78580 TC 5591 340 NM LUNG SCAN PERFUSION O "$1,058.40 " $687.96 330184 78630 TC 5592 332 340 NM CISTERNOGRAPHY O "$1,362.90 " $885.89 330184 78630 5592 332 340 NM INJECTION CISTERNOGRAP O "$1,362.90 " $885.89 330184 78707 TC 5592 331 340 NM RENOGRAM ERPF O "$1,362.90 " $885.89 330184 78708 TC 5592 340 NM RENOGRAM PHARMACOLOGIC O "$1,362.90 " $885.89 330184 78761 TC 5591 340 NM TESTICULAR IMAGE W/FLO O "$1,008.00 " $655.20 330184 78800 5591 341 RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED ARE-78800 O "$1,060.00 " $689.00 330184 78801 5591 341 RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS-78801 O "$1,060.00 " $689.00 330184 78802 5593 332 341 RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY-78802 O "$3,690.00 " "$2,398.50 " 330184 78803 5593 332 341 TUMOR LOCALIZ; SPECT (3D)-78803 O "$1,368.00 " $889.20 330184 78803 TC 5593 332 340 NM TUMOR LOCALIZATION SPE O "$1,362.90 " $885.89 330184 78804 TC 5593 332 340 NM TUMOR LOCALIZATION WHO O "$3,446.00 " "$2,239.90 " 330184 78830 5593 332 341 RP LOCLZJ TUM SPECT W/CT 1-78830 O "$3,853.00 " "$2,504.45 " 330184 78831 5593 332 341 RP LOCLZJ TUM SPECT 2 AREAS-78831 O "$3,853.00 " "$2,504.45 " 330184 78832 5594 332 341 RP LOCLZJ TUM SPECT W/CT 2-78832 O "$4,370.00 " "$2,840.50 " 330184 78999 TC 5591 340 Unlisted Proc Nuclear Med O "$1,008.00 " $655.20 330184 79005 TC 5661 340 342 NM HYPERTHYROID THERAPY I O $688.80 $447.72 330184 79005 TC 5661 340 342 NM HYPERTHYROID THER SUBS O $688.80 $447.72 330184 79005 TC 5661 340 342 NM THYROID GLAND ABLATION O $688.80 $447.72 330184 79005 TC 5661 340 342 NM THYROID METASTASES TRE O $688.80 $447.72 330184 80048 403 300 SMA-7 P O $144.65 $94.02 330184 80051 403 300 ELECTROLYTES O $108.00 $70.20 330184 80051 403 300 ELECTROLYTES WHOLE BLOOD O $108.00 $70.20 330184 80053 403 300 COMPREHENSIVE METABOLIC P O $196.32 $127.61 330184 80061 403 300 LIPID PROFILE O $147.50 $95.87 330184 80061 403 300 CARDIO-VASCULAR EVALUATIO O $147.50 $95.87 330184 80069 403 300 RENAL FUNCTION PANEL O $87.00 $56.55 330184 80074 403 301 ACUTE HEPATITIS PANEL-80074 O $163.00 $105.95 330184 80076 403 300 HEPATIC PANEL O $82.00 $53.30 330184 80150 405 300 AMIKACIN PEAK O $94.50 $61.43 330184 80155 405 301 DRUG ASSAY CAFFEINE O $49.00 $31.85 330184 80156 405 300 TEGRETOL/CARBAMAZEPINE LE O $40.00 $26.00 330184 80158 405 300 CYCLOSPORINESPECIFICBLO O $65.10 $42.32 330184 80158 405 301 CYCLOSPORINE LC/M5/MS O $65.10 $42.32 330184 80162 405 300 DIGOXIN LEVEL O $140.44 $91.28 330184 80164 405 300 VALPROIC ACID O $121.53 $78.99 330184 80165 405 301 DIPROPLACETIC ACID FREE-80165 O $48.30 $31.40 330184 80170 405 300 GENTAMICIN LEVEL TROUGH O $59.00 $38.35 330184 80170 405 300 GENTAMICIN LEVEL PEAK O $59.00 $38.35 330184 80170 405 301 GENTAMICIN - RANDOM O $59.00 $38.35 330184 80176 405 300 TOCAINIDE LEVEL O $52.50 $34.12 330184 80176 405 300 LIDOCAINE O $52.50 $34.12 330184 80178 405 300 LITHIUM O $72.00 $46.80 330184 80184 405 300 XPHENOBARBITAL O $125.00 $81.25 330184 80184 405 300 PHENOBARBITOL O $125.00 $81.25 330184 80185 405 300 PHENYTOIN TOTAL O $126.53 $82.24 330184 80186 405 300 DILANTIN FREE O $42.26 $27.47 330184 80186 405 301 Phenytoin; free O $42.26 $27.47 330184 80188 405 300 XPRIMIDONE O $59.85 $38.90 330184 80192 300 PROCAINAMIDE&N-ACETYLPROC O $57.00 $37.05 330184 80194 301 QUINIDINE O $50.00 $32.50 330184 80195 405 301 SIROLIMUS LC/MS/MS O $47.00 $30.55 330184 80195 405 301 ASSAY OF SIROLIMUS O $47.00 $30.55 330184 80197 405 300 PROGRAF-TACROLIMUS(FK506) O $47.00 $30.55 330184 80198 405 300 AMINOPHYLLINE THEOPHYLLIN O $88.20 $57.33 330184 80200 405 301 TOBRAMYCIN PEAK O $55.00 $35.75 330184 80200 405 301 TOBRAMYCIN TROUGH O $55.00 $35.75 330184 80200 405 301 TOBRAMYCIN O $55.00 $35.75 330184 80201 405 300 TOPIRAMATE O $84.00 $54.60 330184 80202 405 300 VANCOMYCIN TROUGH O $133.00 $86.45 330184 80202 405 300 VANCOMYCIN PEAK O $133.00 $86.45 330184 80202 405 300 VANCOMYCIN- RANDOM O $133.00 $86.45 330184 80203 405 301 DRUG SCREEN QUANT ZONISAMIDE O $47.25 $30.71 330184 80299 405 301 FLECAINIDE SERUM O $49.00 $31.85 330184 80299 405 301 METHOTREXATE LEVEL O $49.00 $31.85 330184 80299 405 301 PROZAC & NORFLUOXETINE O $49.00 $31.85 330184 80299 405 301 MEXILETINE O $49.00 $31.85 330184 80299 405 301 AMIODARONE O $49.00 $31.85 330184 80299 405 301 SERTRALINESERUM O $49.00 $31.85 330184 80299 405 301 GABAPENTIN (NEUROTIN) O $49.00 $31.85 330184 80299 405 301 ANTIBIOTIC LEVEL SERUM O $49.00 $31.85 330184 80299 405 301 ALDOMET O $49.00 $31.85 330184 80299 405 301 VERAPAMEL LEVEL O $49.00 $31.85 330184 80299 405 301 NORPACE O $49.00 $31.85 330184 80299 405 301 COGENTIN LEVEL O $49.00 $31.85 330184 80299 405 301 LAMOTRIGINE O $49.00 $31.85 330184 80299 405 301 DARVON (PROPOXYPHENE ) O $49.00 $31.85 330184 80299 405 301 DIGITOXIN LEVEL O $49.00 $31.85 330184 80299 405 301 LEVETIRACETAM O $49.00 $31.85 330184 80299 405 301 HALOPERIDOL O $49.00 $31.85 330184 80299 405 301 RISPERIDONE O $49.00 $31.85 330184 80299 405 301 IBUPROFEN O $49.00 $31.85 330184 80299 405 301 INDERAL O $49.00 $31.85 330184 80299 405 301 KEFLIN DRUG LEVEL O $49.00 $31.85 330184 80299 405 301 QUANTITATION OF DRUG O $49.00 $31.85 330184 80307 401 301 DRUG TEST PRSMV CHEM ANLYZR O $271.45 $176.45 330184 80320 400 301 ASSAY OF ETHANOL- O $312.00 $202.80 330184 80323 400 301 ASSAY OF NICOTINE- O $294.00 $191.10 330184 80324 400 301 ASSAY OF AMPHETAMINES- O $312.00 $202.80 330184 80327 301 ASSAY OF DIHYDROTESTOSTERONE- O $294.00 $191.10 330184 80329 301 ASSAY OF ACETAMINOPHEN- O $312.00 $202.80 330184 80329 301 ASSAY SALICYLATE- O $312.00 $202.80 330184 80332 400 301 ANTIDEPRESSANTS CLASS 1 OR 2-80332/G0480 O $294.00 $191.10 330184 80335 400 301 ASSAY AMITRIPTYLINE- O $312.00 $202.80 330184 80335 400 301 ASSAY DESIPRAMINE- O $312.00 $202.80 330184 80335 400 301 ASSAY DOXEPIN- O $312.00 $202.80 330184 80335 400 301 ASSAY IMIPRAMINE- O $312.00 $202.80 330184 80335 400 301 ASSAY OF NORTIPTYLINE- O $312.00 $202.80 330184 80339 400 301 ASSAY OF METHSUXIMIDE- O $294.00 $191.10 330184 80339 400 301 CLOBAZAM (URBANYL)- O $294.00 $191.10 330184 80342 400 301 ASSAY OF PHENOTHIAZINE- O $294.00 $191.10 330184 80345 301 ASSAY OF BARBITURATES- O $312.00 $202.80 330184 80346 400 301 ASSAY BENZODIAZEPINES- O $312.00 $202.80 330184 80346 400 301 ASSAY OF FLURAZEPAM- O $312.00 $202.80 330184 80348 402 301 DRUG SCREENING BUPRENORPHINE-80348 O $286.00 $185.90 330184 80358 402 301 ASSAY OF METHADONE- O $294.00 $191.10 330184 80361 401 301 ASSAY OF OPIATES- O $312.00 $202.80 330184 80369 301 ASSAY OF MEPROBAMATE- O $294.00 $191.10 330184 80375 400 301 DRUG TEST DEF 1-7 CLASSES O $294.00 $191.10 330184 80500 5671 310 CHROMOSOME ANAL 3 O $120.00 $78.00 330184 81000 300 BILIRUBIN-CHEM QUAL-URINE O $11.00 $7.15 330184 81001 410 300 URINALYSIS-AUTO WITH MIC O $79.30 $51.54 330184 81002 410 307 Urinalysis Nonauto W/o Sc O $9.45 $6.14 330184 81002 410 307 X URINE PH U O $9.45 $6.14 330184 81002 410 307 UA NONAUTO/NONMIRCO O $9.45 $6.14 330184 81003 410 300 SPECIFIC GRAVITY - URINE O $47.78 $31.05 330184 81003 410 300 URINALYSIS-AUTO W/O MICRO O $47.78 $31.05 330184 81003 410 300 URINALYSIS AUTO W/O SCOPE O $47.78 $31.05 330184 81015 410 307 EOSINOPHIL COUNT - URINE O $43.00 $27.95 330184 81015 410 307 URINALYSIS MICRO ONLY O $43.00 $27.95 330184 81025 410 307 PREGNANCY TEST URINE VIS O $120.00 $78.00 330184 81025 410 307 PREGNANCY TEST CLINIC O $120.00 $78.00 330184 81025 410 307 URINE PREGNANCY TESTING O $120.00 $78.00 330184 81050 410 307 XX VOLUME 24HR URINE O $37.28 $24.23 330184 81162 310 BRCA1&2 SEQ & FULL DUP/DEL-81162 O "$5,633.00 " "$3,661.45 " 330184 81163 310 BRCA1&2 GENE FULL SEQ ALYS-81163 O "$1,170.00 " $760.50 330184 81164 310 BRCA1&2 GEN FUL DUP/DEL ALYS-81164 O "$1,460.00 " $949.00 330184 81219 310 CALR GENE COM VARIANTS-81219 O $437.85 $284.60 330184 81220 387 310 CYSTIC FIBROSIS TEST O "$2,787.75 " "$1,812.04 " 330184 81224 300 CFTR GENE INTRON POLY T O $159.00 $103.35 330184 81229 300 CYTOGEN M ARRAY COPY NO&SNP O "$5,305.00 " "$3,448.25 " 330184 81240 385 310 FACTOR V LEIDEN MUT O $783.30 $509.15 330184 81241 385 310 FACTOR II PROTH MUT O $220.50 $143.33 330184 81243 385 300 FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES-81243 O $143.00 $92.95 330184 81251 300 GBA GENE O $761.00 $494.65 330184 81256 385 300 HFE GENE O $235.20 $152.88 330184 81256 385 300 HFE GENE ANALYSIS O $235.20 $152.88 330184 81257 310 ALPHA-GLBLN CMN MTN ANLYS O $897.00 $583.05 330184 81270 385 310 JAK-2 MUTATION DETECTION O "$1,055.00 " $685.75 330184 81291 385 310 MTHFR DNA MUTATION NY O $150.00 $97.50 330184 81329 300 SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS-81329 O $343.00 $222.95 330184 81330 300 SMPD1 GENE COMMON VARIANTS O $398.00 $258.70 330184 81332 300 SERPINA1 GENE O $150.00 $97.50 330184 81335 300 TPMT GENOTYPE-81335 O $437.00 $284.05 330184 81372 386 300 HLA I TYPING COMPLETE LR-81372 O $758.00 $492.70 330184 81376 300 HLA II TYPING 1 LOCUS LR O $419.00 $272.35 330184 81382 300 HLA CLASS II TYPING HIGH RESOLUTIN O $424.00 $275.60 330184 81401 310 MOLECULAR PATHOLOGY LEVEL 1 O $540.75 $351.49 330184 81479 385 310 ACCUTYPE IL28B O $251.00 $163.15 330184 81596 310 LIVER FIBROSIS-81596 O $189.00 $122.85 330184 82009 402 300 ACETINEQUALITATIVE O $47.00 $30.55 330184 82010 400 301 ACETONE ASSAY O $51.45 $33.44 330184 82013 300 ACETYCHOLINESTERASE O $38.00 $24.70 330184 82017 400 301 ACYLCARNITINES QUANT O $101.85 $66.20 330184 82024 399 300 ACTH O $238.88 $155.27 330184 82030 300 CYCLIC-AMP-URINE O $88.00 $57.20 330184 82040 402 300 ALBUMIN SERUM O $50.00 $32.50 330184 82042 402 300 ALBUMIN BODY FLUIDS O $43.84 $28.49 330184 82043 410 300 URINE MICROALBUMIN QT O $109.72 $71.32 330184 82085 400 301 ALDOLASE O $34.96 $22.73 330184 82085 400 301 ALDOLASE-SERUM O $34.96 $22.73 330184 82085 400 301 ALDOLASE-CSF O $34.96 $22.73 330184 82085 400 301 ALDOLASE-URINE O $34.96 $22.73 330184 82088 399 301 ALDOSTERONE SERUM O $351.23 $228.30 330184 82088 399 301 ALDOSTERONE URINE O $351.23 $228.30 330184 82088 399 301 ALDOSTERONE O $351.23 $228.30 330184 82103 400 300 ALPHA 1 ANTITRYPSIN O $196.35 $127.63 330184 82104 400 301 ALPHA-1-ANTITRYPSIN PHENO O $52.50 $34.12 330184 82105 400 301 AFP & HCG MATERNAL O $163.96 $106.57 330184 82105 400 301 X AFP O $163.96 $106.57 330184 82105 400 301 XALPHA FETOPROTEIN O $163.96 $106.57 330184 82105 400 301 XAFP O $163.96 $106.57 330184 82105 400 301 ALPHA FETO PROTEIN TUMOR O $163.96 $106.57 330184 82106 301 ALPHA FETOPROTEIN AMNIOT O $58.00 $37.70 330184 82108 300 ALUMINUM SERUM O $158.55 $103.06 330184 82128 300 AMINO ACID MULT QUALSER O $38.80 $25.22 330184 82128 300 AMINO ACID MULT QUAL U O $38.80 $25.22 330184 82131 301 X CARNITINE-TOTAL O $60.90 $39.59 330184 82131 301 X CARNITINE-FREE O $60.90 $39.59 330184 82131 301 XHOMOCYSTEINE O $60.90 $39.59 330184 82131 301 CYSTINE 24 HR URINE O $60.90 $39.59 330184 82135 400 301 XAMINOLEVULINIC O $58.80 $38.22 330184 82135 400 301 DELTA AMINOLEVULINIC ACID O $58.80 $38.22 330184 82135 400 301 AMINOLEVULINIC ACID O $58.80 $38.22 330184 82139 400 300 AMINO ACID QT 6 OR MORE O $51.45 $33.44 330184 82139 400 300 AMINO ACID QT URINE 6 O O $51.45 $33.44 330184 82140 400 301 AMMONIA O $131.78 $85.65 330184 82140 400 301 X AMMONIA U O $131.78 $85.65 330184 82140 400 301 XX AMONIA URINE O $131.78 $85.65 330184 82150 402 301 AMYLASE O $98.89 $64.28 330184 82150 402 301 AMYLASE URINE RANDOM O $98.89 $64.28 330184 82150 402 301 AMYLASE 24 HR URINE O $98.89 $64.28 330184 82150 402 301 AMYLASE-2HR URINE O $98.89 $64.28 330184 82150 402 301 AMYLASE BODY FLUID O $98.89 $64.28 330184 82150 402 301 AMYLASE ISOENZYMES O $98.89 $64.28 330184 82157 398 300 ANDROSTENEDIONE O $105.00 $68.25 330184 82160 300 ANDROSTERONE O $90.30 $58.70 330184 82164 400 301 ANGIOTENSIN CNVRT ENZYME O $207.11 $134.62 330184 82172 400 301 APOLIPOPROTEIN EACH-82172 O $171.00 $111.15 330184 82175 404 301 XARSENIC O $68.25 $44.36 330184 82180 400 301 "ASCORBIC ACID (VITAMIN C), BLOOD-82180" O $119.00 $77.35 330184 82232 398 300 BETA-2 MICROGLOBULIN O $183.78 $119.46 330184 82232 398 300 BETA-2 MICROGLOBULIN CSF O $183.78 $119.46 330184 82232 398 300 BETA-MICROGLOBULIN URINE O $183.78 $119.46 330184 82239 301 BILE ACIDS; TOTAL O $48.00 $31.20 330184 82247 402 300 TOTAL BILIRUBIN O $66.94 $43.51 330184 82247 402 300 TOTAL BILIRUBIN NEONATAL O $66.94 $43.51 330184 82248 402 300 DIRECT BILIRUBIN O $51.00 $33.15 330184 82248 402 300 DIRECT BILIRUBIN NEONATAL O $51.00 $33.15 330184 82252 300 BILIRUBIN-CHEM QUAL-FECES O $16.00 $10.40 330184 82261 301 BIOTINIDASE EA SPECIMEN-82261 O $49.00 $31.85 330184 82270 402 301 BLOOD OCCULT-FECES O $62.04 $40.32 330184 82270 402 301 Occult Blood Feces O $62.04 $40.32 330184 82270 402 301 OCCULT BLOODFECES 1-3 DE O $62.04 $40.32 330184 82300 301 XCADMIUM O $52.50 $34.12 330184 82300 301 CADMIUM O $52.50 $34.12 330184 82306 401 300 VITAMIN D 25 HYDROXY O $209.61 $136.25 330184 82308 398 300 CALCITONIN O $266.00 $172.90 330184 82310 402 301 CALCIUM TOTAL O $53.00 $34.45 330184 82310 402 301 CALCIUMRNDM URN W/CREATI O $53.00 $34.45 330184 82330 400 300 IONIZED CALCIUM WHOLE BLO O $124.16 $80.71 330184 82340 402 301 CALCIUM URINE 24 HOURS O $21.71 $14.11 330184 82340 402 301 X CALCIUM U O $21.71 $14.11 330184 82340 402 301 XX CALCIUM URINE O $21.71 $14.11 330184 82365 400 301 CALCULI O $165.64 $107.66 330184 82365 400 301 STONE ANALYSIS O $165.64 $107.66 330184 82373 301 CARNITINETOTAL+FREE O $62.00 $40.30 330184 82374 402 300 CARBON DIOXIDE O $17.00 $11.05 330184 82375 400 300 CARBON MONOXIDE QUAN O $173.00 $112.45 330184 82378 400 300 CARCINO-EMBRIONIC ANTIGEN O $163.01 $105.96 330184 82379 400 301 CARNITINE QUANT O $51.45 $33.44 330184 82380 400 301 CAROTENE O $33.60 $21.84 330184 82384 398 301 CATECHOLAMINE FRACTIONATE O $62.00 $40.30 330184 82384 398 301 CATECHOLAMINES UA O $62.00 $40.30 330184 82384 398 301 CK ISOENZYMES O $62.00 $40.30 330184 82384 398 301 CATECHOLAMINE FRAC WO CR O $62.00 $40.30 330184 82390 400 300 CERULOPLASMIN O $155.40 $101.01 330184 82397 400 301 CHEMILUMINESCENT ASSAY O $139.91 $90.94 330184 82415 300 CHLORAMPHENICOL O $40.00 $26.00 330184 82435 402 300 CHLORIDE O $16.00 $10.40 330184 82436 402 301 CHLORIDE URINE SPOT O $50.00 $32.50 330184 82436 402 301 X CHLORIDE U O $50.00 $32.50 330184 82436 402 301 X CHLORIDE 24 HR URINE O $50.00 $32.50 330184 82436 402 301 X CHLORIDE RANDOM URINE O $50.00 $32.50 330184 82436 402 301 CHLORIDE 24 HR URINE O $50.00 $32.50 330184 82436 402 301 CHLORIDE RANDOM URINE O $50.00 $32.50 330184 82438 402 301 CHLORIDE CSF O $8.40 $5.46 330184 82438 402 301 CHLORIDE OTHER SOURCE O $8.40 $5.46 330184 82465 402 300 CHOLESTEROL O $88.00 $57.20 330184 82480 300 CHOLINESTERASE O $28.35 $18.43 330184 82495 404 300 CHROMIUM O $73.50 $47.77 330184 82495 404 300 CHROMIUM URINE O $73.50 $47.77 330184 82507 400 301 X CITRATE U O $100.00 $65.00 330184 82507 400 301 XX CITRATE URINE O $100.00 $65.00 330184 82507 400 301 CITRATE 24HR URINE O $100.00 $65.00 330184 82523 400 301 COLLAGEN CROSSLINKED NTEL O $138.08 $89.75 330184 82523 400 301 N-TELOPEPTIDE(NTX) O $138.08 $89.75 330184 82523 400 301 COLLAGEN CROSS LINKS O $138.08 $89.75 330184 82525 404 300 COPPER O $87.15 $56.65 330184 82528 301 CORTICOSTERONE-82528 O $77.00 $50.05 330184 82530 400 301 CORTISOL FREE SERUM OR PL O $174.82 $113.64 330184 82530 400 301 CORTISOL FREE 24HR URINE O $174.82 $113.64 330184 82530 400 301 CORTISOL FREE O $174.82 $113.64 330184 82533 398 301 TOTAL CORTISOL O $149.10 $96.92 330184 82533 398 301 CORTISOL TOTAL O $149.10 $96.92 330184 82542 400 301 COLUMN CHROMOTOGRAPHY QUANT O $112.35 $73.03 330184 82550 402 301 CPK TOTAL O $71.68 $46.59 330184 82550 402 301 CPK O $71.68 $46.59 330184 82550 402 301 CREATINE KINASE TOTAL O $71.68 $46.59 330184 82550 402 301 CREATINE KINASE TOT O $71.68 $46.59 330184 82553 400 301 CK MB O $21.00 $13.65 330184 82565 402 300 CREATININE BLOOD O $97.44 $63.34 330184 82570 402 301 CREATININE SPOT URINE O $113.91 $74.04 330184 82570 402 301 CREATININE 24 HRS URINE O $113.91 $74.04 330184 82570 402 301 XCREATININE O $113.91 $74.04 330184 82570 402 301 X CREAT 24HR U O $113.91 $74.04 330184 82570 402 301 XX CREATININE URINE O $113.91 $74.04 330184 82570 402 301 CREATINE OTHER SOURCE O $113.91 $74.04 330184 82575 400 300 CREATININE CLEARANCE O $119.70 $77.81 330184 82585 301 CRYOFIBRINOGEN-82585 O $18.00 $11.70 330184 82595 402 300 CRYOGLOBULIN O $62.08 $40.35 330184 82600 300 CYANIDE LEVEL O $70.35 $45.73 330184 82607 398 300 VITAMIN B12 O $137.97 $89.68 330184 82608 301 Vit B12 unsat bind O $49.00 $31.85 330184 82610 400 301 CYSTATIN C O $40.95 $26.62 330184 82626 400 300 DEHYDROEPIANDROSTERONE O $295.05 $191.78 330184 82627 398 300 DEHYDROEPIANDROSTERONE SU O $184.80 $120.12 330184 82633 301 DEOXYCORTICOSTERONE O $106.00 $68.90 330184 82634 301 DEOXYCORTISOL 11 O $100.00 $65.00 330184 82652 401 300 125 DIHYDROXY VITAMIN-D O $262.76 $170.80 330184 82656 301 PANCREATIC ELASTASE FECAL O $31.50 $20.48 330184 82657 400 301 ENZYME CELL ACTIVITY O $65.10 $42.32 330184 82668 400 300 ERYTHROPOIETIN LEVEL O $140.70 $91.46 330184 82670 398 300 ESTRADIOL LEVEL O $277.20 $180.18 330184 82671 398 301 ESTROGENS; FRACTIONATED-82671 O $111.00 $72.15 330184 82672 300 ESTROGEN TOTAL-24HR URINE O $78.12 $50.78 330184 82672 300 ESTROGEN TOTAL O $78.12 $50.78 330184 82677 398 301 X ESTERIOL O $87.15 $56.65 330184 82677 398 301 XFREE ESTRIOL O $87.15 $56.65 330184 82677 398 301 XESTRIOL O $87.15 $56.65 330184 82677 398 301 ESTRIOL O $87.15 $56.65 330184 82679 301 ESTRONE O $90.30 $58.70 330184 82705 402 300 FECAL FAT QUAL O $76.65 $49.82 330184 82710 400 300 LIPIDS TOTAL QUANTITATIVE O $58.00 $37.70 330184 82725 400 301 ASSAY BLOOD FATTY ACIDS O $46.00 $29.90 330184 82726 301 VERY LONG CHAIN FATTY ACIDS O $62.00 $40.30 330184 82728 400 300 FERRITIN O $117.60 $76.44 330184 82735 301 X MAGNESIUM U O $67.20 $43.68 330184 82746 400 300 FOLATE O $122.30 $79.49 330184 82747 409 300 FOLATE RBC O $107.89 $70.13 330184 82775 300 GALACTOSE-1-PHOS URIDYL T O $72.00 $46.80 330184 82777 301 GALECTIN 3-82777 O $75.00 $48.75 330184 82784 400 301 IMMUNOGLOBULIN A O $81.99 $53.29 330184 82784 400 301 IGG O $81.99 $53.29 330184 82784 400 301 IMMUNOGLOBULIN M O $81.99 $53.29 330184 82784 400 301 XQUANTIFICATION IGG O $81.99 $53.29 330184 82784 400 301 XQUANTIFICATION IGA O $81.99 $53.29 330184 82784 400 301 XQUANTIFICATION IGM O $81.99 $53.29 330184 82784 400 301 IMMUNOGLOBULINS-A.G.M O $81.99 $53.29 330184 82784 400 301 IMMUNOGLOBULIN D O $81.99 $53.29 330184 82785 400 301 GAMMAGLOBLN (IMMUNOGLBLN) IGE O $136.24 $88.55 330184 82785 400 301 IMMUNOGLOBULIN E O $136.24 $88.55 330184 82785 400 301 IGE O $136.24 $88.55 330184 82787 400 301 IMMUNOGLOBULIN PANEL O $65.62 $42.66 330184 82787 400 301 IMUNO SUBCLASSES O $65.62 $42.66 330184 82803 400 300 BLD GAS/ELECTRO/I CALCIUM O $325.68 $211.69 330184 82803 400 300 BLOOD GAS WHOLE BLOOD O $325.68 $211.69 330184 82803 400 300 BLD GAS/ELECTROLYTES WHOL O $325.68 $211.69 330184 82803 400 300 BLOOD GAS COLD BLOOD O $325.68 $211.69 330184 82803 400 300 CORD BLOOD GAS-VENOUS O $325.68 $211.69 330184 82938 300 GASTRIN AFTER SECRETIN ST O $61.00 $39.65 330184 82941 398 300 GASTRIN O $206.00 $133.90 330184 82943 398 300 GLUCAGON O $89.25 $58.01 330184 82945 402 301 GLUCOSE CSF O $50.00 $32.50 330184 82945 402 301 GLUCOSE BODY FLUID O $50.00 $32.50 330184 82947 402 301 GLUCOSE O $38.00 $24.70 330184 82947 402 301 GLUCOSE STAT O $38.00 $24.70 330184 82947 402 301 GLUCOSE 24 HR URINE O $38.00 $24.70 330184 82947 402 301 GLUCOSE FASTING O $38.00 $24.70 330184 82947 402 301 Assay Glucose Blood Qua O $38.00 $24.70 330184 82947 402 301 GLUCOSE RANDOM URINE O $38.00 $24.70 330184 82948 402 300 REAGENT STRIP/BLOOD GLUCOSE O $11.55 $7.51 330184 82950 402 301 GLUCOSE 2 HR POST PRANDIA O $17.09 $11.11 330184 82950 402 301 GLUCOSE CHALLENGE TEST O $17.09 $11.11 330184 82950 402 301 GLUCOSE 1 HOUR POST PRAND O $17.09 $11.11 330184 82950 402 301 POST GLUCOSE DOSE O $17.09 $11.11 330184 82951 400 300 GLUC TOL TEST- 3 SPECIMEN O $130.00 $84.50 330184 82952 402 300 GLUCOSE TOLERANCE TEST 4 O $10.50 $6.83 330184 82952 402 300 GTT 6 HR EA > 3 SPEC O $10.50 $6.83 330184 82955 400 300 GLUCOSE 6 PHOSPHASTE DEHY O $34.65 $22.52 330184 82962 402 301 GLUCOSE-BLOOD BY MTR DEV O $25.37 $16.49 330184 82977 402 300 GAMMA GLUTAMYLE TRANSPEPT O $83.47 $54.26 330184 82985 400 301 FRUCTOSUMINE LEVEL O $102.90 $66.89 330184 83001 398 301 FSH O $178.24 $115.85 330184 83001 398 301 FOLLICLE STIMULATING HORM O $178.24 $115.85 330184 83002 398 301 LUTEINIZING HORMONE (24' O $182.96 $118.93 330184 83002 398 301 LH O $182.96 $118.93 330184 83003 398 300 GROWTH HORMONE O $165.00 $107.25 330184 83010 400 300 HAPTOGLOBIN SERUM O $116.29 $75.59 330184 83013 301 H PYLORI UREA BREATH TEST O $242.55 $157.66 330184 83015 300 HEAVY METAL SCREEN SERUM O $68.25 $44.36 330184 83018 404 301 XHEAVY METAL O $78.75 $51.19 330184 83018 404 301 XHEAVY METAL2 O $78.75 $51.19 330184 83018 404 301 THALLIUM O $78.75 $51.19 330184 83020 400 300 HEMOGLOBIN ELECTROPHORESI O $147.00 $95.55 330184 83030 300 HEMOGLOBIN F CHEMICAL O $12.60 $8.19 330184 83036 400 300 GLYCOHEMOGLOBIN O $123.00 $79.95 330184 83060 301 BLOOD SULFHEMOGLOBIN ASSAY O $12.00 $7.80 330184 83070 300 HEMOSIDERIN (URINE) QL O $16.00 $10.40 330184 83088 401 301 HISTAMINE O $175.00 $113.75 330184 83090 398 301 HOMOCYSTEINE QT O $134.40 $87.36 330184 83090 398 301 HOMOCYSTEINE RANDOM URINE O $134.40 $87.36 330184 83150 398 301 HONOVANILLIC ACID (HVA) O $35.00 $22.75 330184 83491 398 300 17 - HYDROXYCORTICOSTERON O $60.00 $39.00 330184 83497 398 300 5 - HIAA O $157.50 $102.38 330184 83498 398 300 17-HYDROXY PROGESTERONE O $302.40 $196.56 330184 83500 300 HYDROXYPROLINE FREE O $78.00 $50.70 330184 83505 300 HYDROXYPROLINE TOTAL O $83.00 $53.95 330184 83516 394 301 PL-7 AUTOANTIBODIES O $112.61 $73.20 330184 83516 394 301 PL-12 AUTOANTIBODIES O $112.61 $73.20 330184 83516 394 301 MI-2 AUTOANTIBODIES O $112.61 $73.20 330184 83516 394 301 KU AUTOANTIBODIES O $112.61 $73.20 330184 83516 394 301 EJ AUTOANTIBODIES O $112.61 $73.20 330184 83516 394 301 OJ AUTOANTIBODIES O $112.61 $73.20 330184 83516 394 301 SRP AUTOANTIBODIES O $112.61 $73.20 330184 83516 394 301 IMMUNOASSAY; ANALYTE O $112.61 $73.20 330184 83516 394 301 TTG IgA Antibody O $112.61 $73.20 330184 83516 394 301 TTG IgG Antibody O $112.61 $73.20 330184 83519 394 301 NEURON SPECIFIC ENOLASE O $48.00 $31.20 330184 83519 394 301 TRYPSIN (TRYPINOGEN) O $48.00 $31.20 330184 83519 394 301 ATRIAL NATRIURETIC FACTOR O $48.00 $31.20 330184 83519 394 301 GAD-G5 AB O $48.00 $31.20 330184 83519 394 301 PARATHYROID HORMONE RELAT O $48.00 $31.20 330184 83519 394 301 IMMUNOASSAY BY READIO O $48.00 $31.20 330184 83519 394 301 IGF BINDING PROTEIN-3 O $48.00 $31.20 330184 83520 394 301 X INHIBIN O $127.31 $82.75 330184 83520 394 301 X-IGA O $127.31 $82.75 330184 83520 394 301 X IGG O $127.31 $82.75 330184 83520 394 301 INTERFERON-BETA AUTO AB O $127.31 $82.75 330184 83520 394 301 GLIADIN AB IGG O $127.31 $82.75 330184 83520 394 301 GLIADIN AB IGA O $127.31 $82.75 330184 83520 394 301 GLOMERULARBASEMENT MEMBR O $127.31 $82.75 330184 83520 394 301 CHEM NOT SPECIFIED O $127.31 $82.75 330184 83520 394 301 MAG AB IGMEIA O $127.31 $82.75 330184 83525 398 301 INSULIN. TOTAL O $149.10 $96.92 330184 83525 398 301 INSULIN TOTAL O $149.10 $96.92 330184 83540 402 301 IRON O $60.38 $39.24 330184 83540 402 301 X IRON O $60.38 $39.24 330184 83540 402 301 XIRON O $60.38 $39.24 330184 83550 400 301 X TIBC O $84.45 $54.90 330184 83550 400 301 XTIBC O $84.45 $54.90 330184 83550 400 301 IRON BINDING CAPACITY O $84.45 $54.90 330184 83582 300 17-KETOGENIC STEROID FRA O $49.00 $31.85 330184 83586 300 17-KETOSTEROID O $32.00 $20.80 330184 83605 400 300 LACTIC ACID WHOLE BLOOD O $119.96 $77.98 330184 83615 402 301 LACTIC DEHYDROGENASE O $74.81 $48.63 330184 83615 402 301 LDH-FLUID O $74.81 $48.63 330184 83615 402 301 LDH BODY FLUID O $74.81 $48.63 330184 83615 402 301 LACATE DEHYDROGENASE O $74.81 $48.63 330184 83625 400 301 LACTATE DEHYDROGENASE ISO O $30.00 $19.50 330184 83625 400 301 LDHISOENZ SEP & QUAN O $30.00 $19.50 330184 83631 301 LACTOFERRIN FECAL (QUANT)-83631 O $70.35 $45.73 330184 83655 404 301 LEAD COUNSELING(SS) O $44.00 $28.60 330184 83655 404 301 LEAD POST SCREENING COUNS O $44.00 $28.60 330184 83655 404 301 XLEAD O $44.00 $28.60 330184 83655 404 301 LEAD O $44.00 $28.60 330184 83655 404 301 LEAD URINE (24 HOUR) O $44.00 $28.60 330184 83662 300 LS RATIO- QUANT O $65.00 $42.25 330184 83670 300 LAP O $25.00 $16.25 330184 83670 300 LAP-URINE O $25.00 $16.25 330184 83690 402 301 LIPASE O $92.14 $59.89 330184 83695 301 ASSAY LIPOPROTEIN(A O $46.20 $30.03 330184 83698 301 ASSAY LIPOPROTEIN PLA2 O $116.00 $75.40 330184 83700 300 LIPOPROTEIN PHENOTYPING O $40.95 $26.62 330184 83718 400 301 HDL-P O $28.00 $18.20 330184 83718 400 301 DIRECT LDL O $28.00 $18.20 330184 83719 300 VERY LOW DENSITY LIPOPROT O $40.00 $26.00 330184 83721 400 301 LDL O $33.00 $21.45 330184 83735 402 301 MAGNESIUM - RBC O $72.19 $46.92 330184 83735 402 301 MAGNESIUM SERUM O $72.19 $46.92 330184 83735 402 301 MAGNESIUM O $72.19 $46.92 330184 83735 402 301 XMAGNESIUM O $72.19 $46.92 330184 83735 402 301 XX MAGNESIUM URINE O $72.19 $46.92 330184 83789 400 301 BILE ACIDS FRACTIONATED O $65.10 $42.32 330184 83789 400 301 MASS&TANDEM SPECT QUANT O $65.10 $42.32 330184 83825 404 301 XMERCURY O $59.00 $38.35 330184 83825 404 301 MERCURY URINE - QT O $59.00 $38.35 330184 83825 404 301 MERCURY SERUM - QT O $59.00 $38.35 330184 83835 398 301 METANEPHRINES O $112.35 $73.03 330184 83873 400 301 MYELIN BASIC PROTEIN CSF O $61.95 $40.27 330184 83874 400 301 MYOGLOBIN-SERUM O $42.89 $27.88 330184 83874 400 301 MYOGLOBIN URINE QUANTITAT O $42.89 $27.88 330184 83874 400 301 MYOGLOBIN O $42.89 $27.88 330184 83880 401 300 BNP ASSAY O $314.32 $204.31 330184 83883 394 301 KAPPA CHAINS 24HR URINE O $175.00 $113.75 330184 83883 394 301 LAMBDA CHAINS 24HR URINE O $175.00 $113.75 330184 83883 394 301 ALPHA-2 MACROGLOBULIN NE O $175.00 $113.75 330184 83883 394 301 FREE KAPPA LAMBDA O $175.00 $113.75 330184 83883 394 301 NEPHELOMETRY O $175.00 $113.75 330184 83885 301 ASSAY OF NICKEL O $70.00 $45.50 330184 83915 400 300 5'-NUCLEOTIDASE O $39.90 $25.93 330184 83916 400 300 OLIGOCLONAL CSF O $72.45 $47.09 330184 83918 404 301 ORGANIC ACIDS TOTAL QN O $58.80 $38.22 330184 83919 301 ORGANIC ACIDS QUAL EACH O $56.00 $36.40 330184 83921 400 301 XMETHLMELONIC ACID O $119.17 $77.46 330184 83921 400 301 ORG ACID SINGLE QUAN O $119.17 $77.46 330184 83930 402 300 OSMOLALITY SERUM O $67.00 $43.55 330184 83935 402 301 OSMOLALITY-URINE-SPOT O $66.15 $43.00 330184 83935 402 301 X OSMOLALITY U O $66.15 $43.00 330184 83935 402 301 OSMOLALITY-24HR-URINE O $66.15 $43.00 330184 83937 398 301 OSTEOCALCIN-83937 O $102.00 $66.30 330184 83945 301 X OXALATE U O $40.00 $26.00 330184 83945 301 XX OXALATE URINE O $40.00 $26.00 330184 83945 301 OXALATE (24' URINE) O $40.00 $26.00 330184 83945 301 OXALIC ACIDRND URN W/CRE O $40.00 $26.00 330184 83970 399 301 PTH INTACT ROUTINE O $343.88 $223.52 330184 83970 399 301 PTH INTACT INTRAOPERATIVE O $343.88 $223.52 330184 83986 402 301 XX PH URINE O $41.00 $26.65 330184 83986 402 301 PH FLUID O $41.00 $26.65 330184 83986 402 301 PH BODY FLU NO BLOOD O $41.00 $26.65 330184 83993 400 301 FECAL CALPROTECTIN-83993 O $70.35 $45.73 330184 84075 402 301 ALKALINE PHOSPHATASE O $65.00 $42.25 330184 84075 402 301 ALK PHOSPHATASE BONE O $65.00 $42.25 330184 84080 400 300 ALK PHOS ISOENZYMES O $121.80 $79.17 330184 84100 402 300 PHOSPHORUS CLEARANCE O $65.36 $42.49 330184 84100 402 300 PHOSPHORUS INORGANIC O $65.36 $42.49 330184 84105 402 301 PHOSPHORUS 24 HR URINE O $19.00 $12.35 330184 84105 402 301 XX PHOSPHATE URINE O $19.00 $12.35 330184 84106 300 PORPHOBILINOGEN URINE Q O $27.30 $17.75 330184 84110 400 300 PORPHOBILINOGEN (24')- QT O $29.00 $18.85 330184 84120 400 301 PORPHYRIN 24HR URINE O $43.00 $27.95 330184 84120 400 301 PORPHRIN QT & FRACT O $43.00 $27.95 330184 84132 402 300 POTASSIUM O $71.00 $46.15 330184 84133 402 301 POTASSIUM 24 HOUR URINE O $44.00 $28.60 330184 84133 402 301 X POTASSIUM U O $44.00 $28.60 330184 84133 402 301 XPOTASSIUM SPOT URINE O $44.00 $28.60 330184 84133 402 301 XPOTASSIUM URINE 24HR O $44.00 $28.60 330184 84133 402 301 XX POTASSIUM URINE O $44.00 $28.60 330184 84133 402 301 POTASSIUM-URINE-SPOT O $44.00 $28.60 330184 84134 400 300 PRE ALBUMIN O $66.15 $43.00 330184 84135 300 PREGNANEDIOL O $66.00 $42.90 330184 84138 300 PREGNANETRIOL O $65.00 $42.25 330184 84140 301 ASSAY OF PREGNENOLONE O $71.00 $46.15 330184 84143 398 301 17HYDROXYPREGNENOLONE O $78.00 $50.70 330184 84144 398 300 PROGESTERONE BLOOD O $75.13 $48.83 330184 84144 398 300 PROGESTERONE (24' URINE) O $75.13 $48.83 330184 84145 398 301 PROCALCITONIN (PCT) O $96.60 $62.79 330184 84146 398 300 PROLACTIN O $189.79 $123.36 330184 84150 300 PROSTOGLANDIN-F O $86.00 $55.90 330184 84150 300 PROSTOGLANDIN-E O $86.00 $55.90 330184 84153 400 301 PSA HIGH SENSITIVITY O $182.00 $118.30 330184 84153 400 301 XPSA TOTAL O $182.00 $118.30 330184 84153 400 301 PROSTATE SPECIFIC ANTIGEN O $182.00 $118.30 330184 84154 400 301 XPSA FREE O $92.40 $60.06 330184 84154 400 301 PSA FREE O $92.40 $60.06 330184 84155 402 300 PROTEIN TOTAL O $48.72 $31.67 330184 84155 402 300 TOTOAL PROTEIN 24 HOURS U O $48.72 $31.67 330184 84155 402 300 TOTAL PROTEIN CSF O $48.72 $31.67 330184 84156 402 301 TOT PROTEIN & CREATININE O $47.05 $30.58 330184 84156 402 301 PROTEIN URINE O $47.05 $30.58 330184 84157 402 301 TOTAL PROTEIN BODY FLUID O $60.00 $39.00 330184 84165 400 301 PROTEIN ELECTROPHORESIS S O $120.00 $78.00 330184 84165 400 301 ELECTROPHORESIS PROTEIN- O $120.00 $78.00 330184 84165 400 301 PROTEIN ELECTROPHORESIS O $120.00 $78.00 330184 84165 400 301 PROTEIN ELECTRO SERUM O $120.00 $78.00 330184 84166 400 301 PROTEIN E-PHORESIS/URINE/CSF-84166 O $61.00 $39.65 330184 84181 301 WESTERN BLOT TEST O $46.00 $29.90 330184 84202 400 301 PROTOPORPHYRIN ZINC O $34.00 $22.10 330184 84202 400 301 PROTOPORPHY RBC QUANT O $34.00 $22.10 330184 84206 398 300 PROINSULIN O $111.30 $72.35 330184 84207 400 300 VITAMIN B-6 O $341.25 $221.81 330184 84210 400 301 PYRUVATE O $143.85 $93.50 330184 84233 300 ESTROGEN RECEPTOR ASSAY O $216.00 $140.40 330184 84238 401 300 ACETYLCHOLINE RECEPTOR AN O $345.45 $224.54 330184 84244 398 301 RENIN O $141.23 $91.80 330184 84244 398 301 RENIN LEVEL O $141.23 $91.80 330184 84255 400 300 SELENIUM BLOOD O $91.93 $59.75 330184 84255 400 300 SELENIUM-URINE O $91.93 $59.75 330184 84260 398 301 SEROTONIN O $61.64 $40.06 330184 84270 400 300 SEX HORMONE BINDING GILBU O $173.78 $112.95 330184 84275 301 LIPID ASSOCIATED SIALIC A O $46.00 $29.90 330184 84295 402 300 SODIUM O $66.94 $43.51 330184 84295 402 300 SODIUM SERUM STAT O $66.94 $43.51 330184 84300 402 301 X SODIUM U O $50.00 $32.50 330184 84300 402 301 XSODIUM SPOT URINE O $50.00 $32.50 330184 84300 402 301 XSODIUM 24HR URINE O $50.00 $32.50 330184 84300 402 301 XX SODIUM URINE O $50.00 $32.50 330184 84300 402 301 SODIUM 24 HR URINE O $50.00 $32.50 330184 84300 402 301 SODIUM-URINE-SPOT O $50.00 $32.50 330184 84302 402 301 SODIUM OTHER SOURCE O $17.85 $11.60 330184 84305 398 300 SOMATOMEDIN-C/IGF-I O $73.00 $47.45 330184 84307 301 SOMATOSTATIN O $63.00 $40.95 330184 84311 402 301 SPECTROPHOTOMETRY O $44.10 $28.67 330184 84315 402 300 SPECIFIC GRAVITY - BODY F O $9.00 $5.85 330184 84376 402 301 STOOL FOR REDUCE SUBS O $19.00 $12.35 330184 84392 301 X SULFATE U O $16.80 $10.92 330184 84392 301 XX SULFATE URINE O $16.80 $10.92 330184 84402 301 X TEST-FREE O $87.00 $56.55 330184 84403 398 301 X TEST-TOTAL O $222.08 $144.35 330184 84403 398 301 TESTOSTERONE TOTAL BLOOD O $222.08 $144.35 330184 84403 398 301 TESTOSTERONE TOTAL-URINE O $222.08 $144.35 330184 84425 400 300 VITAMIN B-1 O $232.58 $151.17 330184 84430 300 THIOCYANATE BLOOD O $40.00 $26.00 330184 84430 300 THIOCYANATE-URINE O $40.00 $26.00 330184 84432 398 300 THYROGLOBULIN O $155.66 $101.18 330184 84436 398 301 XT4 O $76.65 $49.82 330184 84437 300 T4 NEONATAL O $22.00 $14.30 330184 84439 398 301 T4 FREE O $120.50 $78.32 330184 84439 398 301 T-4 FREE DIALYSIS O $120.50 $78.32 330184 84439 398 301 THYROXINE FREE O $120.50 $78.32 330184 84442 398 300 THROXINE BINDING GLOBULIN O $176.40 $114.66 330184 84443 398 301 XTSH O $185.21 $120.39 330184 84443 398 301 THYROID STIMULATING HORMO O $185.21 $120.39 330184 84445 399 301 THRYOID STIMULATING IMMUN O $613.20 $398.58 330184 84450 402 300 AST O $53.00 $34.45 330184 84460 402 300 ALANINE AMINOTRANSFERASE O $53.00 $34.45 330184 84466 400 300 TRANSFERRIN O $135.45 $88.04 330184 84478 402 301 TRIGLYCERIDES O $70.00 $45.50 330184 84479 398 301 XT3 UPTAKE O $71.14 $46.24 330184 84479 398 301 T3 UPTAKE O $71.14 $46.24 330184 84480 398 301 T-3 RIA O $120.75 $78.49 330184 84480 398 301 T-3 TOTAL O $120.75 $78.49 330184 84481 398 300 T3-FREE O $200.55 $130.36 330184 84482 398 301 T3; REVERSE-84482 O $26.00 $16.90 330184 84484 400 300 TROPONIN I QT O $102.00 $66.30 330184 84520 402 300 UREA NITROGEN O $50.00 $32.50 330184 84540 402 300 UREA NITROGEN 24HR URINE O $30.45 $19.79 330184 84540 402 300 UREA NITROGEN SPOT URINE O $30.45 $19.79 330184 84550 402 301 URIC ACID O $61.69 $40.10 330184 84560 402 301 URIC ACID 24 HR URINE O $17.09 $11.11 330184 84560 402 301 URIC ACIDRANDOM URINE O $17.09 $11.11 330184 84560 402 301 X URIC ACID U O $17.09 $11.11 330184 84560 402 301 XX URIC ACID URINE O $17.09 $11.11 330184 84577 300 UROBILINOGEN-CHEMICAL-FEC O $43.00 $27.95 330184 84585 398 301 VMA O $55.81 $36.27 330184 84585 398 301 VMA URINE O $55.81 $36.27 330184 84585 398 301 VMA24 HR URINE W CREATIN O $55.81 $36.27 330184 84586 399 300 VASO INTESTINAL PEPTIDE O $127.05 $82.58 330184 84588 399 301 ANTIDIURETIC HORMONE (ADH O $211.05 $137.18 330184 84590 400 301 VITAMIN A O $153.30 $99.65 330184 84591 400 301 VITAMIN NOS-84591 O $42.00 $27.30 330184 84597 400 301 VITAMIN K O $49.35 $32.08 330184 84600 400 301 ALCOHOLMETHYL BLOOD O $53.87 $35.01 330184 84600 400 301 ISOPROPYL ALCOHOL-BLOOD O $53.87 $35.01 330184 84620 300 XYLOSE TOLERANCE TEST O $38.00 $24.70 330184 84620 300 XYLOSE ABSORPTION PLASMA O $38.00 $24.70 330184 84620 300 XYLOSE ABSORPTION URINE O $38.00 $24.70 330184 84630 404 300 ZINC O $74.03 $48.12 330184 84630 404 300 ZINC-URINE O $74.03 $48.12 330184 84681 400 300 C-PEPTIDE O $147.00 $95.55 330184 84702 398 301 BETA-HC6 TUMOR MARKER O $168.00 $109.20 330184 84702 398 301 X HCG O $168.00 $109.20 330184 84702 398 301 XCHORIONIC GONADOTROPIN O $168.00 $109.20 330184 84702 398 301 XHCG- QUANTITATIVE O $168.00 $109.20 330184 84702 398 301 HCG QUANTITATIVE O $168.00 $109.20 330184 84702 398 301 MYELOPEROXIDASE ANTIBODY O $168.00 $109.20 330184 84702 398 301 HCG-BETA SUBUNIT QUANT O $168.00 $109.20 330184 84703 402 300 HCG QUALITATIVE O $87.00 $56.55 330184 84999 400 301 ANTI-MAG(MYELINE ASSOC GP O $233.00 $151.45 330184 84999 400 301 QUININESERUM O $233.00 $151.45 330184 85002 300 BLEEDING TIME O $15.00 $9.75 330184 85007 408 300 MANUAL DIFF &/OR RBC MORP O $12.60 $8.19 330184 85007 408 300 BLOOD SMEAR O $12.60 $8.19 330184 85007 408 300 XMANUAL DIFF O $12.60 $8.19 330184 85009 300 BUFFY COAT PREP-STAIN O $13.00 $8.45 330184 85014 408 300 HEMOGLOBIN AND HEMATOCRIT O $15.75 $10.24 330184 85018 408 300 HEMOGLOBIN O $26.51 $17.23 330184 85025 408 300 CBC W/AUTO COMPL DIFF O $28.00 $18.20 330184 85025 408 300 CBC W/AUTO COMPL DIFF (NR) O $28.00 $18.20 330184 85027 408 300 CBC ONLY O $21.00 $13.65 330184 85027 408 300 CBC ONLY (NR) O $21.00 $13.65 330184 85032 408 300 PLATELET COUNT-MANUAL O $15.75 $10.24 330184 85032 408 300 RETICULOCYTE COUNTAUTOMA O $15.75 $10.24 330184 85048 408 300 EOSINOPHIL COUNT-BLOOD O $9.00 $5.85 330184 85049 408 305 AUTOMATED PLATELETS-85049 O $15.75 $10.24 330184 85060 305 X BLOOD SMEAR INTERPRETAT O $119.00 $77.35 330184 85097 5674 310 BONE MARROW IRON ST O "$1,374.00 " $893.10 330184 85210 406 305 FACTOR II ASSAY O $45.00 $29.25 330184 85210 406 305 FACTOR II O $45.00 $29.25 330184 85220 407 300 FACTOR V ASSAY O $177.00 $115.05 330184 85230 407 300 FACTOR VII ASSAY O $177.00 $115.05 330184 85240 407 305 FACTOR VIII ASSAY O $31.48 $20.46 330184 85240 407 305 FACTOR VIII ONE STAGE O $31.48 $20.46 330184 85245 407 305 VNF RISTOCETIN CO FACTOR O $31.48 $20.46 330184 85245 407 305 RISTOCETIN COFACTOR O $31.48 $20.46 330184 85245 407 305 FACT VIII RISTOCETINE O $31.48 $20.46 330184 85246 407 305 VON WILLEBRAND FACTOR AG O $31.48 $20.46 330184 85246 407 305 FAC VIII AG VON WILLEBRAN O $31.48 $20.46 330184 85246 407 305 FACTOR VIII ANTIGEN O $31.48 $20.46 330184 85247 305 FACTOR VIII O $31.50 $20.48 330184 85247 305 VON WLLBRND FCT ANT MLT O $31.50 $20.48 330184 85250 407 305 FACTOR IX ASSAY O $66.76 $43.39 330184 85250 407 305 FACTOR IX O $66.76 $43.39 330184 85260 407 300 FACTOR X ASSAY O $161.70 $105.11 330184 85270 407 300 FACTOR XI ASSAY O $64.05 $41.63 330184 85280 407 305 FACTOR XII ASSAY O $148.05 $96.23 330184 85290 305 FACTOR XIIIACTIVITY O $25.00 $16.25 330184 85290 305 FACTOR XIII O $25.00 $16.25 330184 85300 406 300 ANTI-THROMBIN III ACTIVI O $380.10 $247.07 330184 85301 406 305 ANTITHROMBIN III ANTIGEN-85301 O $37.00 $24.05 330184 85302 406 300 PROTEIN C ANTIGEN O $143.00 $92.95 330184 85303 406 305 CLOTTING INHIBITOR PROTEIN C ACTIVITY-85303 O $47.00 $30.55 330184 85305 406 305 PROTEIN S TOTAL ANTIGENIC O $278.00 $180.70 330184 85306 406 305 PROTEIN S ACTIVITY O $89.25 $58.01 330184 85307 400 305 ACTIVATED PROTEIN C RESISTANCE-85307 O $49.00 $31.85 330184 85335 406 305 FACTOR INHIBITOR TEST O $38.00 $24.70 330184 85362 300 FDP-BLOODSEMIQUAN O $24.81 $16.13 330184 85362 300 FDP-URINESEMIQUAN O $24.81 $16.13 330184 85379 406 305 D-DIMER HS O $29.40 $19.11 330184 85384 406 300 FIBRINOGEN ACTIVITY O $179.55 $116.71 330184 85397 407 305 CLOTTING FUNCT ACTIVITY O $30.00 $19.50 330184 85415 305 Fibrino Fact plasm act O $29.00 $18.85 330184 85420 406 305 FUNCTIONAL PLASMINOGEN-85420 O $21.00 $13.65 330184 85460 409 305 FETAL HGB OR RBC O $27.00 $17.55 330184 85460 409 305 FETAL SCREEN TEST O $27.00 $17.55 330184 85540 409 305 ALK PHOS LEUKOCYTE O $30.00 $19.50 330184 85540 409 305 LEUKOCYTE ALKALINE PHOSPH O $30.00 $19.50 330184 85549 400 305 LYSOZYME LEVEL O $67.52 $43.88 330184 85549 400 305 LYSOZYMEURINE O $67.52 $43.88 330184 85557 305 OSMO FRAG RBC INCUBAT O $30.00 $19.50 330184 85610 406 305 PRO-TIME P O $14.15 $9.20 330184 85610 406 305 PROTHROMBIN TIME-STAT O $14.15 $9.20 330184 85610 406 305 PROTHROMBIN TIME O $14.15 $9.20 330184 85610 406 305 PROTHROMBIN TIME O $14.15 $9.20 330184 85611 406 305 SUBSTITUTION PLASMA FRACTION PT O $14.00 $9.10 330184 85613 406 300 LUPUS ANTICOAGULANT O $266.70 $173.35 330184 85652 300 SEDIMENTATION RATE AUTOMA O $9.45 $6.14 330184 85652 300 SED RATE PNON-AUTO O $9.45 $6.14 330184 85660 408 300 SICKLE CELL SCREENING O $30.45 $19.79 330184 85670 406 300 THROMBIN TIME O $59.00 $38.35 330184 85730 406 305 PARTIAL THROMBOPLASTIN O $22.00 $14.30 330184 85730 406 305 THROMB TIME PLASMA/WB O $22.00 $14.30 330184 85730 406 305 PTT ACTIVATED O $22.00 $14.30 330184 85732 406 305 CIRCULATING ANTICOAGULANT O $113.00 $73.45 330184 85810 409 300 VISCOSITY O $40.00 $26.00 330184 85999 305 UNLISTED HEMAT & COAG PROCEDURE O $248.00 $161.20 330184 86000 394 300 FEBRILE AGGLUTININS O $24.00 $15.60 330184 86001 302 ALLERGEN SPEC IGG O $17.00 $11.05 330184 86003 394 302 ALLERGEN SPECIFIC IGE O $75.86 $49.31 330184 86003 394 302 ALLERGY TESTING (IGE) O $75.86 $49.31 330184 86003 394 302 ALLERGEN SPEC IGE O $75.86 $49.31 330184 86021 302 XP-ANCA O $55.00 $35.75 330184 86021 302 XC-ANCA O $55.00 $35.75 330184 86021 302 NEUTROPHIL CYTOPLASMIC AB O $55.00 $35.75 330184 86021 302 PROTEINASE-3 ANTIBODY O $55.00 $35.75 330184 86021 302 ANTIBODY IDENTIFI LEUKO O $55.00 $35.75 330184 86022 394 302 XDIRECT PLT O $66.15 $43.00 330184 86022 394 302 PLATELT AB IGG INDIRECT O $66.15 $43.00 330184 86022 394 302 PLATELET GLYCOPROTEIN AB O $66.15 $43.00 330184 86022 394 302 HEPARIN INDUCED PLT ANTIB O $66.15 $43.00 330184 86022 394 302 PLATELET ANTIBODIES O $66.15 $43.00 330184 86023 394 302 XINDIRECT PLT O $43.00 $27.95 330184 86023 394 302 PLATELET ASSOC IMMUNO O $43.00 $27.95 330184 86038 394 302 ANA O $138.07 $89.75 330184 86038 394 302 CENTROMERE AB W/REFLEX TO O $138.07 $89.75 330184 86038 394 302 CENTROMERE AB W/TITER O $138.07 $89.75 330184 86038 394 302 ANTINUCLEAR ANTIBODIE O $138.07 $89.75 330184 86060 394 300 ASO/ ASLO O $150.15 $97.60 330184 86078 5672 310 TRANSFUSION REACTION INVE O $329.70 $214.31 330184 86140 394 302 C-REACTIVE PROTEIN O $87.15 $56.65 330184 86140 394 302 C-REACTIVE PROTEIN HIGH S O $87.15 $56.65 330184 86140 394 302 C-REACTIVE PROTEIN QUANTI O $87.15 $56.65 330184 86141 302 CRP HIGH SENSITIVITY O $204.00 $132.60 330184 86146 400 302 BETA-2-GPI I IGA O $251.00 $163.15 330184 86146 400 302 BETA-2-GPI I IGG O $251.00 $163.15 330184 86146 400 302 BETA-2-GPI I IGM O $251.00 $163.15 330184 86146 400 302 BETA 2 GLYCOPROTEIN O $251.00 $163.15 330184 86146 400 302 CARDIOLIPIN AB IGG O $251.00 $163.15 330184 86146 400 302 CARDIOLIPIN AB IGA O $251.00 $163.15 330184 86146 400 302 CARDIOLIPIN AB IGM O $251.00 $163.15 330184 86147 395 302 XCARDIOLIPIN IGG O $104.84 $68.14 330184 86147 395 302 XCARDIOLIPIN IGM O $104.84 $68.14 330184 86147 395 302 CARDIOLIPIN ANTIBODY O $104.84 $68.14 330184 86147 395 302 B2-GLYCOPROTEIN I IGA O $104.84 $68.14 330184 86147 395 302 B2-GLYCOPROTEIN I IGM O $104.84 $68.14 330184 86147 395 302 B2-GLYCOPROTEIN I IGG O $104.84 $68.14 330184 86148 400 302 ANTI-PHOSPHATIDYL ANT O $58.00 $37.70 330184 86148 400 302 PHOSPHATIDYLSERINE ANTB O $58.00 $37.70 330184 86148 400 302 PHSPHTDYLSRN ANTBD IGG O $58.00 $37.70 330184 86148 400 302 PHSPHTDYLSRN ANTBD IGM O $58.00 $37.70 330184 86148 400 302 PHSPHTDYLSRN ANTBD IGA O $58.00 $37.70 330184 86157 394 300 COLD AGGLUTININSSERUM O $36.75 $23.89 330184 86160 394 300 C3-COMPLEMENT O $124.91 $81.19 330184 86160 394 300 C4 COMPLEMENT O $124.91 $81.19 330184 86160 394 300 C1-ESTERASE O $124.91 $81.19 330184 86160 394 300 C2-COMPLEMENT. EACH O $124.91 $81.19 330184 86161 394 302 COMPLEMENT/FUNCTION ACTIVITY O $43.05 $27.98 330184 86162 394 302 COMPLEMENTTOTAL(CH50) O $70.00 $45.50 330184 86200 394 300 CYCLIC CITRULLINE PEP IGG O $192.96 $125.42 330184 86215 394 302 DEOXYRIBONUCLEASE AB O $47.25 $30.71 330184 86225 394 300 ANTI-DNA.DBL-STR/NTV O $127.21 $82.68 330184 86235 394 302 XSS-A O $230.48 $149.81 330184 86235 394 302 XSS-B O $230.48 $149.81 330184 86235 394 302 X SM O $230.48 $149.81 330184 86235 394 302 X RNP O $230.48 $149.81 330184 86235 394 302 JO-1 AUTOANTIBODIES O $230.48 $149.81 330184 86235 394 302 CYCLIC CITRULLINATED PEPT O $230.48 $149.81 330184 86235 394 302 PM-SCL AB O $230.48 $149.81 330184 86235 394 302 ENA AB(SM/RNP) O $230.48 $149.81 330184 86235 394 302 SCL-70 AB O $230.48 $149.81 330184 86235 394 302 EXTRACT NUCLEAR ANTIG O $230.48 $149.81 330184 86235 394 302 JO-1 ANTIBODY O $230.48 $149.81 330184 86255 394 302 ANTI PARIETAL CELL ABQUA O $146.19 $95.02 330184 86255 394 302 ANTI-MITOCHONDRIAL ANTIBO O $146.19 $95.02 330184 86255 394 302 XROCKY MOUNT IGG O $146.19 $95.02 330184 86255 394 302 XROCKY MOUNT IGM O $146.19 $95.02 330184 86255 394 302 ANTI SMOOTH MUSCLE ANTIBO O $146.19 $95.02 330184 86255 394 302 ENDOMYSIAL ANTIBODY IGA O $146.19 $95.02 330184 86255 394 302 FLUORESCENT ANTIBODY O $146.19 $95.02 330184 86256 394 302 ANTI-HU O $180.07 $117.05 330184 86256 394 302 ANTI-ENDOMYSIAL AB IGA O $180.07 $117.05 330184 86300 396 302 IMMUNOASSAY CA 15-3 O $71.00 $46.15 330184 86305 300 HUMAN EPIDIDYMIS PROTEIN 4 (HE4)-86305 O $52.00 $33.80 330184 86308 394 302 MONONUCLEOSIS O $18.64 $12.11 330184 86308 394 302 XHETEROPHILE AB SCREEN O $18.64 $12.11 330184 86308 394 302 HETEROPHILE ANTIBODIES O $18.64 $12.11 330184 86310 302 XDIFFERENTIAL ABSORPTION/ O $24.00 $15.60 330184 86316 400 302 CA 27.29 SERUM O $191.62 $124.56 330184 86316 400 302 CA-125 ANTIGEN O $191.62 $124.56 330184 86316 400 302 CHROMOGRANIN A O $191.62 $124.56 330184 86316 400 302 CARBOHYDRATE ANTIGEN 19-9 O $191.62 $124.56 330184 86316 400 302 SQUAMOUS CELL CARCINOMA O $191.62 $124.56 330184 86316 400 302 IMMUNO TUMOR ANTIGEN O $191.62 $124.56 330184 86316 400 302 TUMOR AG ASSAY QUANT O $191.62 $124.56 330184 86317 394 302 IMMUNOASSAY INFECTIOUS AGENT O $53.55 $34.81 330184 86320 300 RIBOSOMAL P PROTEIN ANTIB O $80.85 $52.55 330184 86325 300 IMMUNOELECTROPHORESIS UR O $77.00 $50.05 330184 86328 302 IA NFCT AB SARSCOV2 COVID19-86328 O $45.00 $29.25 330184 86331 394 302 IMMUNODIFFUSION OUCHTERLONY O $41.00 $26.65 330184 86332 395 302 RAJI CELL SERUM O $88.20 $57.33 330184 86332 395 302 C1-Q O $88.20 $57.33 330184 86332 395 302 C1Q BINDING ASSAY O $88.20 $57.33 330184 86334 394 302 XIMMUNOFIXATION INTERPRET O $254.00 $165.10 330184 86334 394 302 IMMUNOFIXATION CSF O $254.00 $165.10 330184 86334 394 302 IMMUNOFIXATION URINE O $254.00 $165.10 330184 86336 400 302 INHIBIN A O $53.00 $34.45 330184 86337 398 302 INSULIN ANTIBODIES O $77.00 $50.05 330184 86340 398 300 INTRINSIC FACTOR ANTIBODY O $163.00 $105.95 330184 86341 394 302 ISLET CELL ANTIBODY O $123.90 $80.54 330184 86343 302 LEUKOCYTE HISTAMINE RELEASE O $22.00 $14.30 330184 86355 395 302 XFLOW CYTOMETRY O $129.00 $83.85 330184 86357 395 302 XWBC O $129.00 $83.85 330184 86359 395 302 XT CELL O $224.00 $145.60 330184 86360 395 302 XABSOLUTE CD4/CD8 O $169.19 $109.97 330184 86360 395 302 T cell CD4 & CD8 O $169.19 $109.97 330184 86361 395 302 LYMPH SUBSET PANEL 5 O $96.60 $62.79 330184 86376 398 302 XTHYROID PEROXIDASE ANTIB O $206.85 $134.45 330184 86376 398 302 THYROID AUTOANTIBODIES O $206.85 $134.45 330184 86376 398 302 MICROSOMAL ANTIBODIES O $206.85 $134.45 330184 86382 394 302 VIRAL NEUTRALIZATION-86382 O $60.90 $39.59 330184 86403 302 PARTICLE AGGLUT; SCN O $73.50 $47.77 330184 86408 302 NEUTLZ ANTIBODY SARS-COV-2 SCREEN-86408 O $370.00 $240.50 330184 86409 302 NEUTLZ ANTIBODY SARS-COV-2 TITER-86409 O $407.00 $264.55 330184 86413 302 SARS-COV-2 ANTB QUANTITATIVE-86413 O $369.00 $239.85 330184 86430 300 RA LATEX- QUALITATIVE O $87.67 $56.99 330184 86480 395 302 QUANTITERON TB GOLD O $411.08 $267.20 330184 86580 5731 394 302 OCCUPATION HEALTH PPD-86580 O $39.90 $25.93 330184 86580 5731 394 302 INTRADERMAL TB TEST (PPD) O $39.90 $25.93 330184 86580 5731 394 302 INTRADERMAL TB TEST(PPD) O $39.90 $25.93 330184 86580 5731 394 302 PPD O $39.90 $25.93 330184 86580 5731 394 302 TB INTRADERMAL TEST O $39.90 $25.93 330184 86592 394 300 VDRL/RPR O $97.13 $63.13 330184 86592 394 300 VDRL-CSF O $97.13 $63.13 330184 86603 394 302 ADENOVIRUS ANTIBODY O $21.00 $13.65 330184 86603 394 302 ADENOVIRUS O $21.00 $13.65 330184 86606 394 302 ASPERGILLUS AB O $20.95 $13.62 330184 86606 394 302 ASPERGILLUS ANTIBODY O $20.95 $13.62 330184 86609 302 XIGG EHRICHIA CHAFFEENSIS O $20.00 $13.00 330184 86609 302 XIGM EHRLICHIA CHAFFEENSI O $20.00 $13.00 330184 86609 302 BACTERIUM ANTIBODY O $20.00 $13.00 330184 86611 394 302 BARTONELLA O $20.00 $13.00 330184 86612 394 302 BLASTOMYCES O $21.00 $13.65 330184 86612 394 302 BLASTOMYCES ANTIBDY IMMUNODIFFUSION O $21.00 $13.65 330184 86615 300 BORDETELLA PERTUSSIS-FTA O $110.25 $71.66 330184 86617 394 302 LYME TITER IGG O $317.02 $206.06 330184 86617 394 302 LYME DISEASE WESTERN BLOT O $317.02 $206.06 330184 86617 394 302 LYME IGG/IGM WB-CSF O $317.02 $206.06 330184 86618 394 302 LYME DISEASE SEROLOGY O $289.98 $188.49 330184 86618 394 302 LYME DISEASE AB O $289.98 $188.49 330184 86622 394 302 BRUCELLA O $36.75 $23.89 330184 86628 302 CANDIDA ANTIBODY O $20.00 $13.00 330184 86631 394 302 XCHLAMYDIA P IGG O $20.95 $13.62 330184 86631 394 302 XCHLAMYDIA P IGA O $20.95 $13.62 330184 86631 394 302 XCHLAMYDIA T IGG O $20.95 $13.62 330184 86631 394 302 XCHLAMYDIA T IGA O $20.95 $13.62 330184 86631 394 302 XCHLAMYDIA PS IGG O $20.95 $13.62 330184 86631 394 302 XCHLAMYDIA PS IGA O $20.95 $13.62 330184 86631 394 302 X C.TRACHOMATIS IGA O $20.95 $13.62 330184 86631 394 302 X C.TRACHOMATIS IGG O $20.95 $13.62 330184 86631 394 302 X C.PNEUMONIAE IGG O $20.95 $13.62 330184 86631 394 302 X C.PNEUMONIAE IGA O $20.95 $13.62 330184 86631 394 302 X C.PSITTACI IGG O $20.95 $13.62 330184 86631 394 302 X C.PSITTACI IGA O $20.95 $13.62 330184 86631 394 302 CHLAMYDIA PRE AB O $20.95 $13.62 330184 86632 394 302 XCHLAMYDIA P IGM O $21.00 $13.65 330184 86632 394 302 XCHLAMYDIA T IGM O $21.00 $13.65 330184 86632 394 302 XCHLAMYDIA PS IGM O $21.00 $13.65 330184 86632 394 302 X C.TRACHOMATIS IGM O $21.00 $13.65 330184 86632 394 302 X C.PSITTACI IGM O $21.00 $13.65 330184 86632 394 302 X C.PNEUMONIAE IGM O $21.00 $13.65 330184 86635 394 302 COCCIDIODES O $21.00 $13.65 330184 86635 394 302 COCCIDIOIDES O $21.00 $13.65 330184 86638 394 302 Q FEVER ANTIBODY O $21.00 $13.65 330184 86641 394 300 CRYPTOCOCCAL ANTIBODY O $21.00 $13.65 330184 86644 394 302 X CMV AB O $52.00 $33.80 330184 86644 394 302 CMV-ANTIBODIES IGG CSF O $52.00 $33.80 330184 86644 394 302 CMV ANTIBODY IGG O $52.00 $33.80 330184 86645 394 300 CMV IGM O $39.90 $25.93 330184 86648 302 DIPHTHERIA ANTITOXOID O $20.00 $13.00 330184 86652 302 ARBOVIRUS O $21.00 $13.65 330184 86653 302 ST.LOUIS ENCEPHALITIS-SER O $21.00 $13.65 330184 86653 302 encephalitis St Louis O $21.00 $13.65 330184 86658 394 302 XB1 O $20.95 $13.62 330184 86658 394 302 XB2 O $20.95 $13.62 330184 86658 394 302 XB3 O $20.95 $13.62 330184 86658 394 302 XB4 O $20.95 $13.62 330184 86658 394 302 XB5 O $20.95 $13.62 330184 86658 394 302 XB6 O $20.95 $13.62 330184 86658 394 302 COXSACKIE VIRUS TYPE A PA O $20.95 $13.62 330184 86658 394 302 ENTEROVIRUS O $20.95 $13.62 330184 86665 394 302 XEBV ANTIBODY IGG O $66.00 $42.90 330184 86665 394 302 XEBV ANTIBODY IGM O $66.00 $42.90 330184 86665 394 302 EB virus EA O $66.00 $42.90 330184 86666 394 302 EHRLICHIA ANTIBODY HGE O $172.00 $111.80 330184 86666 394 302 EHRLICHIA ANTIBODY HME O $172.00 $111.80 330184 86671 394 302 X CEREVISIAE IGG/IGM O $17.85 $11.60 330184 86671 394 302 X P/ANCA O $17.85 $11.60 330184 86671 394 302 FUNGUS NOT SPECIFIED O $17.85 $11.60 330184 86671 394 302 S. CEREVISIAE (ASCA) (IGA) O $17.85 $11.60 330184 86671 394 302 S. CEREVISIAE (ASCA) (IGG) O $17.85 $11.60 330184 86677 394 302 H. PYLORI RAPID UREA SCRE O $20.00 $13.00 330184 86677 394 302 H PYLORI IGG O $20.00 $13.00 330184 86677 394 302 H PYLORI IGA O $20.00 $13.00 330184 86677 394 302 HELICOBACTER PYLORI O $20.00 $13.00 330184 86682 394 302 HELMINTH O $21.00 $13.65 330184 86684 302 Haemophilus influenza O $54.00 $35.10 330184 86694 394 302 XHERPES II IGG O $78.22 $50.85 330184 86694 394 302 XHERPES II IGM O $78.22 $50.85 330184 86694 394 302 X HERPES SIMPLEX N/S AB O $78.22 $50.85 330184 86695 394 302 XHERPES I IGG O $47.49 $30.87 330184 86695 394 302 XHERPES I IGM O $47.49 $30.87 330184 86695 394 302 XHSV 1 IGG O $47.49 $30.87 330184 86695 394 302 XHSV 1 IGM O $47.49 $30.87 330184 86695 394 302 HERPES SIMPLEX I IGG TIT O $47.49 $30.87 330184 86695 394 302 HERPES SIMPLEX TYPE 1 O $47.49 $30.87 330184 86696 394 302 XHSV 2 IGG O $66.00 $42.90 330184 86696 394 302 XHSV 2 IGM O $66.00 $42.90 330184 86696 394 302 HERPES SIMPLEX II IGG TI O $66.00 $42.90 330184 86698 394 302 HISTOPLASMA AB O $40.43 $26.28 330184 86698 394 302 HISTOPLASMA IGGIGM IGA O $40.43 $26.28 330184 86698 394 302 HISTOPLASMA AG DETECTOR O $40.43 $26.28 330184 86701 394 302 SPECIAL VIROLOGY TESTING O $31.50 $20.48 330184 86701 394 302 RAPID TEST O $31.50 $20.48 330184 86701 394 302 HIV 1 AB(WESTERN BLOT) O $31.50 $20.48 330184 86701 394 302 HIV-1 AB (EIA) O $31.50 $20.48 330184 86701 394 302 HIV ANTIBODY CONFIRMATION O $31.50 $20.48 330184 86703 394 302 HIV 1/2 AB(EIA) O $49.35 $32.08 330184 86703 394 302 HIV ORAQUICK O $49.35 $32.08 330184 86703 394 302 HIV-1/HIV-2 1 RESULT ANTBDY O $49.35 $32.08 330184 86703 394 302 HIV 1/2 EIA SCREEN O $49.35 $32.08 330184 86704 394 302 XHEP B CORE AB TOTAL O $99.75 $64.84 330184 86704 394 302 HEPATITIS B CORE AB O $99.75 $64.84 330184 86706 394 302 XHEP B SUR AB O $103.43 $67.23 330184 86706 394 302 HEPATITIS B SURFACE ANTIB O $103.43 $67.23 330184 86706 394 302 HEP B SURFACE AB QUANT O $103.43 $67.23 330184 86707 394 302 HEPATITIS BE ANTIBODY/BE O $163.80 $106.47 330184 86707 394 302 HEPATITIS BE ANTIBODY O $163.80 $106.47 330184 86708 394 302 XHEP A AB TOTAL O $139.65 $90.77 330184 86708 394 302 HEPATITIS A ANTIBODY O $139.65 $90.77 330184 86709 394 300 HEPATITIS A ANTIBODY IGM O $85.84 $55.79 330184 86710 394 302 XINFLUENZA IGG O $48.30 $31.40 330184 86710 394 302 XINFLUENZA IGM O $48.30 $31.40 330184 86710 394 302 INFLNZA TYP A ANTBSERUM O $48.30 $31.40 330184 86710 394 302 INFLNZA TYP B ANTBSERUM O $48.30 $31.40 330184 86713 394 300 LEGIONELLA AB O $91.00 $59.15 330184 86717 302 LEISHMANIA ANTIBODY O $20.00 $13.00 330184 86720 394 302 LEPTOSPIRA O $20.00 $13.00 330184 86735 394 300 XMUMPS O $104.21 $67.74 330184 86735 394 300 MUMPS VIRUS ANTIBODY IGG O $104.21 $67.74 330184 86735 394 300 MUMPS ANTIBODY IGM O $104.21 $67.74 330184 86738 394 300 MYCOPLASMA PNEUMONIAE IGM O $93.45 $60.74 330184 86747 394 302 XPARVOVIRUS IGG O $54.13 $35.18 330184 86747 394 302 XPARVOVIRUS IGM O $54.13 $35.18 330184 86747 394 302 PARVO VIRUS B19 ABIGM IGG O $54.13 $35.18 330184 86753 394 302 AMOEBIC SEROLOGY O $21.00 $13.65 330184 86753 394 302 XPROTOZOA A O $21.00 $13.65 330184 86753 394 302 XPROTOZOA 2 O $21.00 $13.65 330184 86753 394 302 AMOEBA AB O $21.00 $13.65 330184 86753 394 302 PROTOZOA NOT SPECIFI O $21.00 $13.65 330184 86753 394 302 BABESIA MICROTI (IGGIGM) O $21.00 $13.65 330184 86757 394 302 RICKETTSIA ANTIBODY O $69.30 $45.05 330184 86762 394 302 XRUBELLA O $150.68 $97.94 330184 86762 394 302 X RUBELLA AB O $150.68 $97.94 330184 86762 394 302 RUBELLA AB O $150.68 $97.94 330184 86762 394 302 RUBELLA ANTIBODY IGG IMMU O $150.68 $97.94 330184 86765 394 302 XRUBEOLA O $164.32 $106.81 330184 86765 394 302 RUBEOLA MEASLES IGG O $164.32 $106.81 330184 86765 394 302 RUBEOLA ANTIBODIES IGM O $164.32 $106.81 330184 86769 394 302 SARS-COV-2 COVID-19 ANTIBODY-86769 O $128.00 $83.20 330184 86774 302 TETANUS ANTITOXOID O $51.00 $33.15 330184 86777 394 302 X TOXOP-IGG O $52.00 $33.80 330184 86777 394 302 X TOXOPLASMA AB O $52.00 $33.80 330184 86777 394 302 TOXOPLASMA IGG CSF O $52.00 $33.80 330184 86777 394 302 TOXOPLASMA O $52.00 $33.80 330184 86778 394 302 X TOXOP-IGM O $46.02 $29.91 330184 86778 394 302 TOXOPLASMA ANTIBODY IGM O $46.02 $29.91 330184 86778 394 302 TOXOPLASMA IGM O $46.02 $29.91 330184 86780 394 302 SERUM FTA O $142.28 $92.48 330184 86780 394 302 FTA-CSF O $142.28 $92.48 330184 86787 394 302 VARICELLA SEROLOGY O $151.73 $98.62 330184 86787 394 302 VARICELLA ZOSTER ANTI IGG O $151.73 $98.62 330184 86788 302 WEST NILE IGM O $21.00 $13.65 330184 86788 302 WNV AB IGM O $21.00 $13.65 330184 86789 394 302 WEST NILE VIRUS O $51.45 $33.44 330184 86789 394 302 WNV IGG CSF O $51.45 $33.44 330184 86790 394 302 XTYPHUS FEVER IGG O $21.00 $13.65 330184 86790 394 302 XTYPHUS FEVER IGM O $21.00 $13.65 330184 86790 394 302 HTLV III ANTIBODY O $21.00 $13.65 330184 86790 394 302 VIRUS NOT SPECIFIED O $21.00 $13.65 330184 86790 394 302 DENGUE FVR ANTBDS IGG IGM O $21.00 $13.65 330184 86800 398 302 XTHYROGLOBULIN ANTIBODY O $280.77 $182.50 330184 86800 398 302 THYROGLOBIN AB O $280.77 $182.50 330184 86803 394 302 HEPATITUS C ANTIBODY O $212.49 $138.12 330184 86803 394 302 XHEP C AB O $212.49 $138.12 330184 86804 302 HEP C AB CONFIRM TEST O $53.00 $34.45 330184 86812 486 300 HLA-B27 O $257.25 $167.21 330184 86813 393 300 HLA-A3B7B14 O $199.00 $129.35 330184 86849 302 Unlisted immunology procedure O $62.00 $40.30 330184 86850 5671 393 300 ANTIBODY SCREEN EA TECH O $198.91 $129.29 330184 86850 5671 393 300 BLOOD CROSSMATCH FIRST UN O $198.91 $129.29 330184 86850 5671 393 300 XANTIBODY SCREEN O $198.91 $129.29 330184 86850 5671 393 300 X ANTIBODY SCREEN O $198.91 $129.29 330184 86860 5672 393 300 ANTOBODY ELUTION O $329.70 $214.31 330184 86870 5673 393 300 ANTIBODY PANEL-EACH PANEL O $658.00 $427.70 330184 86870 5673 393 300 AB ID PREWARM O $658.00 $427.70 330184 86880 5732 393 300 CORD BLOOD-DIRECT COOMBS O $104.00 $67.60 330184 86880 5732 393 300 DIRECT ANTIGLOBULIN TEST O $104.00 $67.60 330184 86886 5672 393 300 AHG TITER O $329.70 $214.31 330184 86890 5672 300 AUTOLOGUS DONATIONS O $557.00 $362.05 330184 86900 5734 393 305 XBLOOD TYPING ABO O $156.97 $102.03 330184 86900 5734 393 305 X BLOOD TYPINGABO O $156.97 $102.03 330184 86900 5734 393 305 XXABO O $156.97 $102.03 330184 86900 5734 393 305 XABO O $156.97 $102.03 330184 86900 5734 393 305 BLOOD TYPING ABO AND RH O $156.97 $102.03 330184 86901 5732 486 305 XRH O $111.83 $72.69 330184 86901 5732 486 305 X RH O $111.83 $72.69 330184 86901 5732 486 305 XXRH O $111.83 $72.69 330184 86902 5673 393 300 XCROSSMATCH X1 O $557.00 $362.05 330184 86906 5732 486 300 RH PHENOTYPE TESTS O $90.30 $58.70 330184 86920 5672 393 300 CROSSMATCH IMMED SPIN O $348.00 $226.20 330184 86922 5672 393 300 BLOOD CROSSMATCH EA. ADD. O $348.00 $226.20 330184 86923 5672 302 ELECTRONIC CROSSMATCH O $329.70 $214.31 330184 87015 396 306 SPECIMEN INFECT AGNT CONCNTJ O $24.15 $15.70 330184 87040 396 300 CULT BACTERIA BLOOD O $102.00 $66.30 330184 87045 396 300 CULT BACTERIA STOOL O $139.00 $90.35 330184 87070 396 300 CULTURE WOUND-87070 O $31.50 $20.48 330184 87070 396 300 CULT BACTERIA THROAT COMP O $31.50 $20.48 330184 87070 396 300 CULT MALE GENITAL COMPLET O $31.50 $20.48 330184 87070 396 300 CULT FEMALE GENITAL COMPL O $31.50 $20.48 330184 87070 396 300 CULTU BACTERIAL BONE MARR O $31.50 $20.48 330184 87070 396 300 CULT BACTERIAL LOWER RESP O $31.50 $20.48 330184 87070 396 300 CULTURE BACTERIA FLUID O $31.50 $20.48 330184 87070 396 300 CULT BACTERIA CATHETER O $31.50 $20.48 330184 87070 396 300 CULTURE AUTOPSY O $31.50 $20.48 330184 87070 396 306 CULTURE OTHR SPECIMN AEROBIC O $31.50 $20.48 330184 87071 396 300 CULT FEMALE TRICH/MONILIA O $33.60 $21.84 330184 87071 396 300 CULT BACTERIA NOSE O $33.60 $21.84 330184 87075 396 306 CULTUREANAEROBIC O $126.00 $81.90 330184 87075 396 300 CULT LEGIONELLA O $126.00 $81.90 330184 87077 396 306 CULTURE NEISSERIA GONORRH O $29.40 $19.11 330184 87077 396 300 GROUP B STREP CULTURE O $29.40 $19.11 330184 87081 396 300 CULT P PATHOG - SCREEN-87081 O $24.15 $15.70 330184 87081 396 300 STREP GROUP B ANTIGEN VA O $24.00 $15.60 330184 87081 396 300 CULT BACTERIA THROAT-STRE O $24.00 $15.60 330184 87081 396 300 CLOTESTRUT O $24.00 $15.60 330184 87088 396 300 CULT BACTERIA URINE CULTU O $78.49 $51.02 330184 87101 396 306 Skin Fungi Culture O $27.30 $17.75 330184 87101 396 306 Skin Fungi Culter - 8710 O $27.30 $17.75 330184 87102 396 300 FUNGUS CULTURE NOT BLOOD-87102 O $21.00 $13.65 330184 87106 396 300 CULURE- FUNGUS ID O $65.10 $42.32 330184 87109 396 306 CULTURE MYCOPLASMA O $52.50 $34.12 330184 87110 396 306 CHLAMYDIA CULTURE O $31.50 $20.48 330184 87116 396 300 CULTURE AFB - ISOL & ID-87116 O $27.00 $17.55 330184 87140 396 306 CULTURE TYPE IMMUNLUORESC O $19.95 $12.97 330184 87168 396 300 TICK IDENTIFICATION O $15.75 $10.24 330184 87169 396 306 SCABIES EXAMINATION O $15.00 $9.75 330184 87172 396 306 PINWORM EXAM O $15.00 $9.75 330184 87176 396 300 TISSUE HOMOGENIZATION CULTR-87176 O $15.00 $9.75 330184 87177 396 306 OVA & PARASITES O $160.00 $104.00 330184 87186 396 306 ANTIBIOTIC SENSITIVITY O $20.00 $13.00 330184 87205 396 300 GRAM STAIN ONLY O $80.00 $52.00 330184 87205 396 300 FUNGUS INDIA INK SMEAR O $80.00 $52.00 330184 87205 396 300 STOOL WBC O $80.00 $52.00 330184 87206 396 306 AFB DIRECT SMEAR O $36.75 $23.89 330184 87207 396 300 MALARIA SMEAR O $125.00 $81.25 330184 87207 396 306 BLOOD TRANSFUSION RXN O $125.00 $81.25 330184 87207 396 300 CRYPTOSPORIDIUM STUDY (MA O $125.00 $81.25 330184 87209 396 306 OVA AND PARA SP STAIN O $62.00 $40.30 330184 87210 396 300 SMEAR WET MOUNT SALINE/INK O $15.00 $9.75 330184 87230 300 CLOSTRIDIUM DIFFICLE TOXI O $87.15 $56.65 330184 87252 397 306 XTISSUE CULT O $94.00 $61.10 330184 87252 397 306 HERPES CULTURE O $94.00 $61.10 330184 87252 397 306 RSV-CULTURE O $94.00 $61.10 330184 87252 397 306 CMV CULTURE O $94.00 $61.10 330184 87252 397 300 VIRAL CULTURE O $94.00 $61.10 330184 87252 397 306 virus iso inoculation O $94.00 $61.10 330184 87265 306 BORDETELLA PERTUSIS AGDFA O $30.00 $19.50 330184 87270 300 CHLAMYDIA O $31.50 $20.48 330184 87299 306 TRICHOMONAS WET PREP O $90.30 $58.70 330184 87305 396 306 ASPERGILLUS O $30.00 $19.50 330184 87305 396 306 Fungi cult other source O $30.00 $19.50 330184 87305 396 306 Aspergillus O $30.00 $19.50 330184 87305 396 306 ASPERGILLUS AG O $30.00 $19.50 330184 87329 396 306 GIARDIA AG ETA STOOL O $31.48 $20.46 330184 87329 396 306 GIARDIA O $31.48 $20.46 330184 87332 306 CMV ANTIGENURINE O $30.00 $19.50 330184 87337 302 ENTAMOEBA HISTOLYTICA GROUP O $31.50 $20.48 330184 87338 396 306 H. PYLORI ANTIGEN STOOL O $151.20 $98.28 330184 87338 396 306 HELIBACTER PYLORI/STOOL O $151.20 $98.28 330184 87340 396 306 XHEP B SURG AG O $92.10 $59.87 330184 87340 396 300 HEPATITIS B SURFACE ANTIG O $92.10 $59.87 330184 87341 306 HEPATITIS B SURF AB NEUT O $35.00 $22.75 330184 87350 396 306 HEPATITIS BE AG O $41.51 $26.98 330184 87350 396 306 HBeAG O $41.51 $26.98 330184 87380 300 HEPATITIS DELTA O $56.00 $36.40 330184 87385 396 306 HISTOPLASMA CAPSULA O $30.00 $19.50 330184 87385 396 302 HISTOPLASMA ANTIGEN URINE O $30.00 $19.50 330184 87389 396 306 HIV-1 AG W/HIV-1 & HIV-2 AB-87389 O $87.15 $56.65 330184 87390 306 XHIV-1 O $61.00 $39.65 330184 87400 306 XX FLU A O $30.00 $19.50 330184 87400 306 XX FLU B O $30.00 $19.50 330184 87420 396 300 RSV DIRECT ANTIGEN EIA O $119.00 $77.35 330184 87425 396 306 ROTAVIRUS O $30.00 $19.50 330184 87426 306 IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS-87426 O $30.00 $19.50 330184 87428 302 IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B-87428 O $119.00 $77.35 330184 87449 396 300 LEGIONELLA URINARY ANTIGE O $102.78 $66.81 330184 87449 396 300 BACTERIAL ANTIGENS EACH O $102.78 $66.81 330184 87471 306 BARTONELLA O $126.00 $81.90 330184 87476 397 306 BORRELIA BURGDORFERI O $120.00 $78.00 330184 87480 396 306 CANDIDA NA DIRECT PROBE-87480 O $69.00 $44.85 330184 87481 306 CANDIDA NA AMPLIFIED PROBE-87481 O $126.00 $81.90 330184 87486 397 306 CHLAMYDIA P AMPLIF NA PROBE-87486 O $120.00 $78.00 330184 87490 300 GEN PROBE CHLAMYDIA TRACH O $69.00 $44.85 330184 87490 306 XCHLAMYDIA DNA PROBE O $69.00 $44.85 330184 87491 397 306 CHLAMYDIA URINE O $126.00 $81.90 330184 87491 397 306 XMOLECULAR DIAG O $126.00 $81.90 330184 87491 397 306 X MOLECULAR DIAGNOSTICS O $126.00 $81.90 330184 87491 397 306 C. TRACHOMATIS AMP DNA O $126.00 $81.90 330184 87491 397 306 MOLECULAR DIAGNOSTICS O $126.00 $81.90 330184 87491 397 306 HEPATITIS C GENOTYPE O $126.00 $81.90 330184 87491 397 306 CHLAMYDIA TRACHOMATIS PCR O $126.00 $81.90 330184 87491 397 306 CHLAMYDIA TRACH AMPL O $126.00 $81.90 330184 87496 397 300 CMV DNA BY PCR O $126.00 $81.90 330184 87496 397 306 URINE FOR CMV O $126.00 $81.90 330184 87497 397 306 CYTOMEGALOVIRUS O $147.00 $95.55 330184 87497 397 306 Virus iso centrifuge O $147.00 $95.55 330184 87497 397 306 cytomegalovirus O $147.00 $95.55 330184 87498 306 ENTEROVIRUS REVE TRANSCRIPTASE O $126.00 $81.90 330184 87502 306 INFLUENZA A + B MOLECULAR TEST O $306.60 $199.29 330184 87510 396 306 GARDNERELLA DIR NA PROBE-87510 O $69.00 $44.85 330184 87512 306 GARDNERELLA NA QUAN-87512 O $150.15 $97.60 330184 87516 306 HEPATITIS B DNA AMP PROBE O $120.00 $78.00 330184 87517 397 300 HEPATITIS B VIRUS DNAQUA O $154.00 $100.10 330184 87517 397 306 HEPATITIS B VIRAL DNA QUA O $154.00 $100.10 330184 87517 397 306 HEP B VIRUS QUANT O $154.00 $100.10 330184 87521 397 306 HEPATITIS C RNA BY PCR O $120.00 $78.00 330184 87522 397 306 HEPATITIS C VIRUS (RIBA) O $154.00 $100.10 330184 87522 397 306 HCV RNA QN PCR O $154.00 $100.10 330184 87522 397 306 HEP C RNA PCR ULTRA O $154.00 $100.10 330184 87522 397 306 HEPATITIS C QUANT O $154.00 $100.10 330184 87529 397 306 HERPES PCR CSF O $126.37 $82.14 330184 87529 397 300 HERPES BY PCR O $126.37 $82.14 330184 87529 397 306 HERPES CSF BY PCR O $126.37 $82.14 330184 87532 306 HERPES 6 AMPLIF NA PROBE-87532 O $120.00 $78.00 330184 87535 397 300 "HIV-1 RNA, QUALITATIVE TMA-87535" O $88.00 $57.20 330184 87536 397 306 HIV-1 RNA QUANT PCR O $306.42 $199.17 330184 87536 397 306 HIV-1 ULTRASENSITIVE QUAN O $306.42 $199.17 330184 87536 397 306 VIROL- QUANTIFICATION CHR O $306.42 $199.17 330184 87536 397 306 HIV-1 ULTRS RNAQNRT-PCR O $306.42 $199.17 330184 87555 306 AFB CULTURE SMEAR & NUCLEIC ACID TEST-87555 O $72.45 $47.09 330184 87556 397 306 MYCOBACTERIA T AMPLIF NA PROBE-87556 O $120.00 $78.00 330184 87581 397 306 M.PNEUMON DNA AMP PROBE O $120.00 $78.00 330184 87590 300 GEN PROBE NEISSER GONORRH O $69.00 $44.85 330184 87590 306 XGC/DNA PROBE O $69.00 $44.85 330184 87591 397 306 XGEL ELECTROPHORESIS O $126.37 $82.14 330184 87591 397 306 XSEPARATION O $126.37 $82.14 330184 87591 397 306 X SEPARATION BY GEL ELECT O $126.37 $82.14 330184 87591 397 306 N. GONORRHEA GEL O $126.37 $82.14 330184 87591 397 306 SEPARATION BY GEL ELECTRO O $126.37 $82.14 330184 87591 397 306 MOLECULAR DIAG ELECTR O $126.37 $82.14 330184 87591 397 306 NEISS GONOR AMP PROB O $126.37 $82.14 330184 87624 397 306 HPV HIGH-RISK TYPES O $126.00 $81.90 330184 87625 397 306 HPV TYPES 16 & 18 ONLY O $120.00 $78.00 330184 87633 388 306 RESP VIRUS 12-25 TARGETS-87633 O "$1,500.45 " $975.29 330184 87635 397 306 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ-87635 O $150.00 $97.50 330184 87636 306 IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ-87636 O $90.00 $58.50 330184 87637 306 IADNA SARSCOV2& INF A&B & RSV MULT AMP PROBE TQ-87637 O "$1,417.00 " $921.05 330184 87660 396 306 TRICHOMONAS VAGIN DIR PROBE-87660 O $69.00 $44.85 330184 87661 397 306 TRICHOMONAS VAGINALIS AMPLIF-87661 O $126.00 $81.90 330184 87798 397 306 JC VIRUS(PCR) O $126.00 $81.90 330184 87798 397 306 H1N1 (CONFIRMATORY) - BRL O $126.00 $81.90 330184 87798 397 306 H1N1 (CONFIRMATORY) - FOC O $126.00 $81.90 330184 87798 397 300 LYME BY PCR O $126.00 $81.90 330184 87798 397 306 INFECT AGENT DETEC O $126.00 $81.90 330184 87798 397 306 Virus iso w ident O $126.00 $81.90 330184 87798 397 306 Infect agent detect O $126.00 $81.90 330184 87798 397 306 Trichomonas vaginalis RNA Qualitative O $126.00 $81.90 330184 87799 397 306 INFECT AGENT DETEC QN O $154.35 $100.33 330184 87801 397 306 DNA/RNA; MULTI ORG - AMP PR-87801 O $241.00 $156.65 330184 87804 306 INFLU INF AGT W DIR OBS-87804 O $31.50 $20.48 330184 87811 306 IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS-87811 O $140.00 $91.00 330184 87880 300 STREP GROUP A DIRECT ANTI O $122.06 $79.34 330184 87880 300 STREP A ASSAY W/OPTIC O $122.06 $79.34 330184 87899 396 300 INFLUENZA A&B DIRECT ANTI O $102.90 $66.89 330184 87899 396 306 CRYPTOCCOCCAL AG-CSF O $102.90 $66.89 330184 87900 388 306 PHENOTYPE INFECT AGENT DRUG O $469.35 $305.08 330184 87901 388 306 HIV GENOTYPE O $927.15 $602.65 330184 87902 388 306 HCV RNA GENOTYPE LIPA O "$2,542.00 " "$1,652.30 " 330184 87902 388 306 HEPATITIS C VIRUS O "$2,542.00 " "$1,652.30 " 330184 87906 306 HIV-1 Integrase Genotype O $463.05 $300.98 330184 88020 310 AUTOPSY W/OUT BRAIN O $0.00 $0.00 330184 88027 310 AUTOPSY WITH BRIAN O $0.00 $0.00 330184 88104 5732 390 311 CYTOLOGY BODY FLUIDS O $90.17 $58.61 330184 88104 5732 390 311 INTERP OF FLUIDS CHRG ONL O $90.17 $58.61 330184 88108 5732 390 311 CYTOLOGY BRONCIAL WASHING O $90.17 $58.61 330184 88108 5732 390 311 CYTOLOGY BRONCHIAL O $90.17 $58.61 330184 88108 5732 390 311 CONCENTRAT TECH SMEAR-CHR O $90.17 $58.61 330184 88112 5671 391 311 Cytopath cell enhance tech O $384.00 $249.60 330184 88141 311 LAB SMEAR CERVOR O $81.00 $52.65 330184 88142 392 311 CTYOTHINPREP PAP REFLEX O $72.95 $47.42 330184 88142 392 311 CYTOLOGYTHINPREP PAP O $72.95 $47.42 330184 88142 392 311 THIN PREP CYTO MAN SCR-CH O $72.95 $47.42 330184 88142 392 311 CYTOLOGY THINPREP PAP O $72.95 $47.42 330184 88142 392 311 CYTLGY THNPRP PAP W RFLX O $72.95 $47.42 330184 88160 5731 390 311 CYTOPATH SCR & INTERP CHR O $38.00 $24.70 330184 88161 5731 311 CYTOPATH PREP SCREEN CHR O $86.00 $55.90 330184 88162 5671 311 EXTENDED STUDY OVER 5 CHR O $120.00 $78.00 330184 88172 5672 391 311 X FNA EVALUATION O $348.00 $226.20 330184 88172 5672 391 311 CYTO EVAL FNA IMMEDIATE S O $348.00 $226.20 330184 88172 5672 391 311 EVAL FNA IMMED ADEQ-CHRG O $348.00 $226.20 330184 88173 5671 391 311 FINE NEEDLE ASPIRATE O $126.14 $81.99 330184 88173 5671 391 311 X INTERPRETATION & REPORT O $126.14 $81.99 330184 88173 5671 391 311 FINE NEEDLE ASPIRATE CHRG O $126.14 $81.99 330184 88175 310 CYTOPATH C/V AUTO FLUID REDO-88175 O $67.00 $43.55 330184 88177 310 CYTP FNA EVAL EA ADDL-88177 O $65.00 $42.25 330184 88182 5671 311 X CD3 O $126.14 $81.99 330184 88182 5671 311 X CD5 O $126.14 $81.99 330184 88182 5671 310 X CD7 O $126.14 $81.99 330184 88182 5671 310 X CD10 O $126.14 $81.99 330184 88182 5671 310 X CD13 O $126.14 $81.99 330184 88182 5671 310 X CD14 O $126.14 $81.99 330184 88182 5671 310 X CD19 O $126.14 $81.99 330184 88182 5671 310 X CD20 O $126.14 $81.99 330184 88182 5671 310 X CD33 O $126.14 $81.99 330184 88182 5671 310 X CD34 O $126.14 $81.99 330184 88182 5671 310 X CD38 O $126.14 $81.99 330184 88182 5671 310 X CD61 O $126.14 $81.99 330184 88182 5671 310 X CD71 O $126.14 $81.99 330184 88184 5673 391 310 X FLOW CYTOMETRY O $557.00 $362.05 330184 88184 5673 391 311 FLOW CYTOMETRY(TECH COMP) O $557.00 $362.05 330184 88185 308 310 X ADDITIONAL MARKERS O $332.00 $215.80 330184 88185 308 311 FLOW CYTOMETRY(EA MRKR) O $332.00 $215.80 330184 88189 310 X 16 OR MORE MARKERS O $534.00 $347.10 330184 88230 308 310 TISSUE CULTURE LYMPHOCYTE O $70.00 $45.50 330184 88237 308 310 CHROMOSOME ANAL 2 O $88.00 $57.20 330184 88262 386 310 CHROMOSOME ANAL O $448.82 $291.73 330184 88262 386 310 CHROM ANALY; 15-20 CELLS-88262 O $448.82 $291.73 330184 88271 385 311 MOLECULAR CYTOGENETICS O $62.00 $40.30 330184 88275 385 311 INTERFPHASE INSITU HYBRIDIZATN O $138.00 $89.70 330184 88300 5731 390 310 GROSS EXAM ONLY O $102.38 $66.54 330184 88300 5731 390 310 GROSS EXAM ONLY-CHRG ONLY O $102.38 $66.54 330184 88302 5731 390 310 SURG PATH LEVEL 2 O $315.26 $204.92 330184 88302 5731 390 310 GROSS/MICRO EXAM ID-CHRG O $315.26 $204.92 330184 88304 5671 391 310 SURG PATH LEVEL 3 O $328.65 $213.62 330184 88304 5671 391 310 GROSS/MICRO LEVEL 3-CHRG O $328.65 $213.62 330184 88305 5671 391 310 SURG PATH LEVEL 4 O $334.04 $217.13 330184 88305 5671 391 310 GROSS/MICRO LEVEL 4-CHRG O $334.04 $217.13 330184 88305 5671 391 310 TISSUE EXAM BY PATHLGST LVL 4-88305 O $334.04 $217.13 330184 88305 5671 391 310 TISUE EXAM BY PATHLGST LVL 4-88305 O $334.04 $217.13 330184 88305 5671 391 310 TISSUE EXM BY PATHLGST LVL 4-88305 O $334.04 $217.13 330184 88307 5673 308 310 SURG PATH LEVEL 5 O $546.00 $354.90 330184 88307 5673 308 310 GROSS/MICRO LEVEL 5-CHRG O $546.00 $354.90 330184 88309 5674 308 310 SURG PATH LEVEL 8 O "$1,765.84 " "$1,147.79 " 330184 88309 5674 308 310 GROSS/MICRO LEVEL 6-CHRG O "$1,765.84 " "$1,147.79 " 330184 88311 390 310 DECAL PROCEDURE-CHRG ONLY O $106.31 $69.10 330184 88312 5671 391 310 SP STAINS GROUP 1-CHRG ON O $234.68 $152.54 330184 88313 5732 390 310 SP STAINS GROUP 2-CHRG ON O $173.51 $112.78 330184 88321 5732 310 CONSULT AND RPT REF O $86.00 $55.90 330184 88321 5732 310 CONSULT AND REPORT REFERR O $86.00 $55.90 330184 88323 5671 310 CONSULT REPORT/SLIDE/TC O $314.00 $204.10 330184 88329 5732 310 CONSULT DURING SURG-CHRG O $86.00 $55.90 330184 88331 5672 391 310 CONSULT 1ST TISSUE BLK-CH O $314.00 $204.10 330184 88332 391 310 CONSULT EA ADDL BLK-CHRG O $163.00 $105.95 330184 88333 5674 391 310 CONSULT CYTOLOGICAL-CHRG O "$1,374.00 " $893.10 330184 88334 310 CYTOL EXAM ADDL SITE-CHRG O $47.00 $30.55 330184 88342 5672 391 310 IMMUNOHISTOCHEMISTRY AB O $498.78 $324.21 330184 88360 5672 308 310 Tumor immunohistochem/manual O $636.56 $413.77 330184 88367 5673 308 310 AUTOMATED HER2 FISH O $557.00 $362.05 330184 88367 5673 308 310 Automated HER2 Fish TC Only O $557.00 $362.05 330184 88368 5673 308 310 Fish Probes Manual TC O $557.00 $362.05 330184 88399 5671 310 TISSUE EXAM O $126.00 $81.90 330184 89050 309 CELL COUNT-CSF O $15.00 $9.75 330184 89050 309 CELL COUNT-BODY FLUID O $15.00 $9.75 330184 89051 390 300 CELL COUNT - CSF O $129.68 $84.29 330184 89051 390 300 CELL COUNT-BODY FLUID O $129.68 $84.29 330184 89051 390 309 BODY FLUID PROFILE O $129.68 $84.29 330184 89060 390 300 CRYSTALS BODY FLUID O $25.76 $16.74 330184 89060 390 310 CRYSTAL IDENT BY PATH-CHR O $25.76 $16.74 330184 89160 300 MEAT FIBERS-FECES O $13.00 $8.45 330184 89190 309 EOSINOPHILS-NASAL SMEAR O $16.00 $10.40 330184 89240 5671 310 STARCH-FECES O $126.00 $81.90 330184 90371 1630 444 636 H-BIG 5ML O $0.00 $0.00 330184 90371 1630 444 636 H-BIG 1ML INJECTION O $0.00 $0.00 330184 90375 9133 460 636 RABIES IMMUNE GLOBULIN 1ML(HYPERRAB) 300U/ML-90375 O $0.00 $0.00 330184 90375 9133 460 636 RABIES IMMUNE GLOBULIN 5ML(HYPERRAB) 300U/ML-90375 O $0.00 $0.00 330184 90375 9133 460 636 IMOGAM RABIES 300IU/2ML O $0.00 $0.00 330184 90375 9133 460 636 RABIES IMMUNE GLOBULIN O $432.00 $280.80 330184 90377 636 RABIES IG HT&SOL HUMAN IM/SC-90377 O $1.00 $0.65 330184 90378 9003 444 636 RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG-90378 O $0.00 $0.00 330184 90384 636 RHO(D)IMMN GLOBULIN FULL O $168.00 $109.20 330184 90385 636 RHO(D)IMMN GLOBULIN MINI O $52.00 $33.80 330184 90389 636 TETANUS IMMUNE GLOBULIN O $87.00 $56.55 330184 90460 771 IM ADM 1ST/ONLY COMP<19 O $139.00 $90.35 330184 90461 771 IM ADM EACH ADDL COMP<19 O $72.00 $46.80 330184 90471 5692 459 771 IMMUNIZATION ADMIN 1ST VA-90471 O $105.00 $68.25 330184 90471 5692 459 771 IMMUNIZATION ADMIN 1ST VA O $105.00 $68.25 330184 90471 5692 459 771 ADMIN HEP B VACCINE O $105.00 $68.25 330184 90471 5692 459 771 ADMIN PNEUMO VACCINE O $105.00 $68.25 330184 90471 5692 459 771 ADMIN INFLUENZA VACCINE O $105.00 $68.25 330184 90471 5692 459 771 ADMIN HEPATITIS B VACCINE O $105.00 $68.25 330184 90471 5692 459 771 ADMINISTRATION OF INFLUEN O $105.00 $68.25 330184 90471 5692 459 771 PEDS ADMIN INFLUENZA VAC O $105.00 $68.25 330184 90471 5692 459 771 IMMUNIZATION ADMIN-1 VACC O $105.00 $68.25 330184 90471 5692 459 771 IMMUNIZATION ADMIN 1ST Vaccine O $105.00 $68.25 330184 90471 5692 459 771 ADMIN INFLUENZA VACCINE O $105.00 $68.25 330184 90471 5692 459 771 ADMIN PNEUMO VACCINE O $105.00 $68.25 330184 90471 5692 459 771 ADM OF INFLZ VIRUS VACC O $105.00 $68.25 330184 90472 459 771 IMMUNIZATION ADMIN EA ADD-90472 O $53.00 $34.45 330184 90472 459 771 IMMUNIZATION ADMIN EA ADDL VACCINE O $53.00 $34.45 330184 90472 459 771 IMMZ ADM EA VACCINE O $53.00 $34.45 330184 90473 5692 771 IMMUNE ADMIN ORAL/NASAL O $161.00 $104.65 330184 90474 771 IMMUNE ADMIN ORAL/NASAL ADDL O $48.00 $31.20 330184 90620 636 BEXSERO 0.5ML SUSP SYRNG (NON VFC) O $296.00 $192.40 330184 90620 SL 636 BEXSERO 0.5ML SUSP SYRNG (VFC) O $0.01 $0.01 330184 90621 636 TREMENBA-MENINGOCOCCAL VAC (VFC)-90621 O $0.00 $0.00 330184 90621 SL 636 TREMENBA-MENINGOCOCCAL VAC(VFC)-90621 O $0.01 $0.01 330184 90621 636 TREMENBA-MENINGOC VAC(NON-VFC)-90621 O $227.00 $147.55 330184 90625 636 CHOLERA VACCINE LIVE ORAL-1 ADULT DOSAGE O $0.01 $0.01 330184 90632 636 HEPATITIS A ADULT VACCINE 1440 UNITS/ML PRESERVATIVE FREE SUSP-90632 O $0.00 $0.00 330184 90632 636 HEPATITIS A VAQTA 50U/ML VIAL-90632 O $171.00 $111.15 330184 90632 636 HAVRIX HEP A INACT1 ML O $0.00 $0.00 330184 90632 636 Hep A vaccIm 19+ O $84.00 $54.60 330184 90633 SL 636 HEP A (720 ELU)19YRS-SL O $0.01 $0.01 330184 90633 636 HEP A VACC PED/ADOL 2 DOSE(NON VFC) O $54.00 $35.10 330184 90634 SL 636 HEP A VACC PED/ADOL 3 DOSE-VFC O $0.01 $0.01 330184 90634 636 HEP A VACC PED/ADOL 3 DOSE O $54.00 $35.10 330184 90636 636 HEPATITIS A HEPATITIS B VACCINE 720 UNITS-20 MCG/ML PRESERVATIVE FREE SUSP-90636 O $0.00 $0.00 330184 90636 636 HEPATITIS A-HEPATITIS B VACCINE 720 UNITS-20 MCG/ML PF SUSP-90636 O $0.00 $0.00 330184 90636 636 Hepatis A & Hepatitis B O $0.00 $0.00 330184 90636 SL 636 HEP A/HEP B VACC ADULT IM-SL(VFC) O $0.01 $0.01 330184 90636 636 HEP A/HEP B VACC ADULT IM O $165.00 $107.25 330184 90644 636 HIB-MENCY VACCINE 4 DOSE IM O $33.00 $21.45 330184 90647 SL 636 Hib Vacc Prp-ompIm-SL O $0.01 $0.01 330184 90647 636 HIB PRP-OMP VACC 3 DOSE IM(NON VFC) O $37.00 $24.05 330184 90648 414 636 ActHIB (HAEMOPH B POLYSAC CONJ-TET TOX)-90648 O $0.00 $0.00 330184 90648 SL 414 636 HIB-PEDS-SL O $0.01 $0.01 330184 90648 414 636 HIB PRP-T VACCINE 4 DOSE IM(NON VFC) O $30.00 $19.50 330184 90649 636 4VHPV VACCINE 3 DOSE IM-90649 O $0.00 $0.00 330184 90649 636 HUMAN PAPILLOMAVIRUS VACCINE QUADRIVALENT (HPV) SUSP-90649 O $0.00 $0.00 330184 90649 636 HUMAN PAPILLOMAVIRUS (HPV O $348.00 $226.20 330184 90651 SL 636 GARDASIL INJ<19 YRS-90651-SL O $0.01 $0.01 330184 90651 636 Gardasil INJ-90651 O $348.00 $226.20 330184 90654 SL 636 FLU VACC IIV3 NO PRESERV ID-VF O $0.01 $0.01 330184 90654 636 INFLUENZA VACCINE O $20.00 $13.00 330184 90654 636 FLU VACCINE NO PRESERV ID O $20.00 $13.00 330184 90655 636 IIV3 VACC NO PRSV .25ML DOS IM O $1.00 $0.65 330184 90656 SL 636 IIV3 VAC NO PRSV .5 ML DOS-IM- O $0.01 $0.01 330184 90656 636 IIV3 VACC NO PRSV .5 ML DOS IM(CLNC) O $24.00 $15.60 330184 90656 636 IIV3 VACC NO PRSV .5 ML DOS IM(ONC) O $24.00 $15.60 330184 90657 SL 636 IIV3 VACC .25ML DOS IM-VFC-906 O $0.01 $0.01 330184 90657 636 IIV3 VACC .25ML DOS IM(CLNC) O $85.00 $55.25 330184 90658 636 IIV3 VACC .5 ML DOS IM(CLNC) O $22.00 $14.30 330184 90658 636 INFLUENZA QUAD 2019-20 SEASON-Q2036 O $0.00 $0.00 330184 90660 636 Flu Vaccine Nasal O $46.00 $29.90 330184 90661 636 CCIIV3 VAC IM CULT PRSV FREE .5ML DOS O $43.00 $27.95 330184 90662 414 636 FLUZONE HIGHDOSE 20182019 FORMULA90662 O $0.00 $0.00 330184 90662 414 636 INFLUENZA VACCINE HIGH DOSE 2019-20-90662 O $0.00 $0.00 330184 90662 414 636 FLUZONE HD 2020-21 SEASON 0.7ML-90662 O $0.00 $0.00 330184 90662 414 636 FLUZONE HD 2020-21 SEASN 0.7ML-90662 O $153.00 $99.45 330184 90662 SL 414 636 FLUZONE HD 2020-21 SEASN 0.7ML-90662 (VFC) O $0.01 $0.01 330184 90662 414 636 FLUZONE VACCINE AGE 65+ O $84.41 $54.87 330184 90662 414 636 FLU VACC PRSV FREE INC ANTIG (ONC) O $84.41 $54.87 330184 90662 414 636 INFL HGH DS 0.5ML VL(AGE>65)-NON-VFC O $92.95 $60.42 330184 90662 SL 414 636 INFLUENZA HGH DS 0.5ML VIAL(AGE>65)-VFC O $0.01 $0.01 330184 90670 415 636 PNEUMOCOCCAL13VAL CONJ-DIP (Prevnar 13) O $0.00 $0.00 330184 90670 SL 415 636 PREVNAR<5 O $0.01 $0.01 330184 90670 415 636 PNEUMOCOCCAL VACC 13 VAL IM(ONC) O $336.00 $218.40 330184 90670 415 636 PREVNAR 13 O $336.00 $218.40 330184 90672 636 FLU VACC 4 VALENT NASAL (ONC)-90672 O $64.81 $42.13 330184 90672 636 INFLU  VAC 0.2ML NASAL-NON-VFC-90672 O $67.66 $43.98 330184 90672 SL 636 INFLUENZA  VAC 0.2ML NASAL-VFC-90672 O $0.01 $0.01 330184 90673 636 INFLUENZA VACCINE-FLUBLOK-0.5ML PFS O $0.00 $0.00 330184 90673 636 INFLU 0.5ML SYR (NON-EGG)-NON-VFC O $75.00 $48.75 330184 90673 SL 636 INFLUENZA 0.5ML SYR (NON-EGG)-VFC O $0.01 $0.01 330184 90674 636 CCIIV4 VAC NO PRSV 0.5 ML IM-90674 O $63.00 $40.95 330184 90674 SL 636 CCIIV4 VAC NO PRSV 0.5 ML IM(VFC)-90674 O $0.01 $0.01 330184 90675 9139 415 636 RABAVERT 2.5 UNITS-90675 O $0.00 $0.00 330184 90675 9139 415 636 IMOVAX RABIES VACCIN O $0.00 $0.00 330184 90675 9139 415 636 RABIES VACCINE O $406.00 $263.90 330184 90675 9139 415 636 RABIES VACCINE IM O $406.00 $263.90 330184 90680 SL 636 ROTATEQ (ROTAVIRUS)-SL O $0.01 $0.01 330184 90680 636 RV5 VACC 3 DOSE LIVE ORAL(NON VFC) O $198.00 $128.70 330184 90682 636 RIV4 VACC RECOMBINANT DNA IM-90682 O $38.00 $24.70 330184 90682 636 RIV4 VACC RECOMBINANT DNA IM-90682 O $0.00 $0.00 330184 90682 636 FLUBLOK QUADRIVALENT 20182019 FORMULA90682 O $0.00 $0.00 330184 90682 636 INFLUENZA RECOMBINANT EGG/PRESERVATICE FREE VACCINE 2019-20-90682 O $0.00 $0.00 330184 90682 636 FLUBLOK 2020-21 SEASON 0.5ML-90682 O $0.00 $0.00 330184 90682 636 FLUBLOK 2020-21 SEASN 0.5ML-90682 O $149.43 $97.13 330184 90682 SL 636 FLUBLOK 2020-21 SEASN 0.5ML-90682 (VFC) O $0.01 $0.01 330184 90685 636 INFLU 0.25ML(IIV4)SPLT VRS IM (NON VFC)90685 O $57.00 $37.05 330184 90685 SL 636 INFLU 0.25ML(IIV4)SPLT VRS IM (VFC)-SL-90685 O $0.01 $0.01 330184 90686 414 636 INFLUENZA VACCINE-FLULAVAL-0.5ML PFS-90686 O $0.00 $0.00 330184 90686 414 636 FLULAVAL 201819 PREMIX FLU VACC90686 O $0.00 $0.00 330184 90686 414 636 INFLU-FLULAVAL QUADRIV GE 6MOS (2019-20)90686 O $0.00 $0.00 330184 90686 414 636 FLULAVAL 2020-21 SEASON 0.5ML-90686 O $0.00 $0.00 330184 90686 414 636 FLULAVAL 2020-21 SEASN 0.5ML-90686 O $51.42 $33.42 330184 90686 SL 414 636 FLULAVAL 2020-21 SEASN 0.5ML-90686 (VFC) O $0.01 $0.01 330184 90686 414 636 FLU VAC 0.5ML NO PRSV 4 VAL (ONC)90686 O $38.00 $24.70 330184 90686 414 636 INFLU 0.5ML(IIV4)SPLT VRS IM (NON VFC)90686 O $38.00 $24.70 330184 90686 SL 414 636 INFLU 0.5ML(IIV4)SPLT VRS IM (VFC)-SL-90686 O $0.01 $0.01 330184 90687 636 FLU VAC 0.25ML 4 VAL (CLNC)-90687 O $38.00 $24.70 330184 90687 SL 636 IIV4 VACC SPLT 0.25 ML IM(VFC)-90687-SL O $0.01 $0.01 330184 90688 636 FLU VAC 0.5ML 4 VAL (CLNC)-90688 O $38.00 $24.70 330184 90688 SL 636 IIV4 VACC SPLT 0.5 ML IM(VFC)-90688-SL O $0.01 $0.01 330184 90691 636 TYPHOID VI YPHIM 25MCG/0.5ML SYR-90691 O $293.00 $190.45 330184 90691 636 TYPHOID VACCINE IM O $186.00 $120.90 330184 90696 636 KINRIX 0.5ML SNGL DOSE SYRNG(NON VFC) O $119.00 $77.35 330184 90696 SL 636 KINRIX 0.5ML SNGL DOSE SYRNG(VFC) O $0.01 $0.01 330184 90698 SL 636 PENTACEL VACCINE-SL O $0.01 $0.01 330184 90698 636 DTAP-IPV/HIB VACCINE IM(NON VFC) O $171.00 $111.15 330184 90700 414 636 Infanrix PFS Vaccine < 7YRS O $0.00 $0.00 330184 90700 414 636 Neonatal DTaP (infanrix) < 7YRS O $0.00 $0.00 330184 90700 SL 414 636 DTAP-PEDS <7 YRS IM O $0.01 $0.01 330184 90700 414 636 DTAP VACCINE < 7 YRS IM(NON VFC) O $51.00 $33.15 330184 90702 414 636 DT(PEDIATRIC)<7YRS IM O $19.00 $12.35 330184 90702 414 636 DT<7 YEARS O $19.00 $12.35 330184 90707 414 636 M-M-R II INJECTION O $0.00 $0.00 330184 90707 SL 414 636 MMR<19-SL O $0.01 $0.01 330184 90707 414 636 MMR  -90707                            O $126.00 $81.90 330184 90710 636 MMRV VACCINE LIVE SQ-90710 O $611.00 $397.15 330184 90710 SL 636 PROQUAD(MMRV) VACC-PE-SL O $0.01 $0.01 330184 90710 636 MMRV VACCINE SC(NON VFC) O $342.00 $222.30 330184 90713 636 POLIOVIRUS VACC IPOL 5ML VIAL-90713 O $931.00 $605.15 330184 90713 SL 636 POLIO-SL O $0.01 $0.01 330184 90713 636 POLIOVIRUS IPV SC/IM O $39.00 $25.35 330184 90713 636 POLIOVRS VACC INCTVTD SUSP O $0.00 $0.00 330184 90714 414 636 TETANUS & DIPHTHERIA INJC O $0.00 $0.00 330184 90714 SL 414 636 TD-7<19 SL O $0.01 $0.01 330184 90714 414 636 Td Vacc 7 + -90714                         O $59.00 $38.35 330184 90714 414 636 TD FOR 7 YEARS OR OLDER O $59.00 $38.35 330184 90715 414 636 TDAP ADACEL 0.5ML SYRINGE-90715 O $106.00 $68.90 330184 90715 414 636 Adacel Vial Vacc >7 YRS O $0.00 $0.00 330184 90715 SL 414 636 TDAP VACCINE-7-19-SL O $0.01 $0.01 330184 90715 414 636 TDAP VACCINE  7+ -90715               O $93.00 $60.45 330184 90715 414 636 TDAP (ER) O $93.00 $60.45 330184 90715 414 636 BOOSTRIX VACCINE(Tdap)V O $0.00 $0.00 330184 90716 636 VAR VACCINE LIVE SUBQ-90716 O $0.00 $0.00 330184 90716 636 VARICELLA VIRUS VACCINE - PWD FOR INJECTION-90716 O $0.00 $0.00 330184 90716 636 varicella Vaccine O $0.00 $0.00 330184 90716 SL 636 VARICELLA <19-SL O $0.01 $0.01 330184 90716 636 VARICELLA  -90716                      O $278.00 $180.70 330184 90717 636 YELLOW FEVER YF-VAX PWD VIAL-90717 O "$1,565.00 " "$1,017.25 " 330184 90717 636 YELLOW FEVER VACCINE SC O $97.00 $63.05 330184 90723 SL 636 PEDIARIX-SL O $0.01 $0.01 330184 90723 636 DTAP-HEP B-IPV VACCINE IM(NON VFC) O $165.00 $107.25 330184 90723 636 DTAP-HEP B-IPV VACCINE IM O $0.00 $0.00 330184 90732 414 636 PNEUMOCOCCAL VAC POLYVALE 2 YRS O $0.00 $0.00 330184 90732 SL 414 636 PNEUMOCOCCAL VACC 5-19 SL O $0.01 $0.01 330184 90732 414 636 PNEUMOCOCCAL VAC -90732                  O $146.00 $94.90 330184 90732 414 636 PNEUMOCOCCAL VACC 23 VAL IM O $146.00 $94.90 330184 90732 414 636 PNEUMOCOCCAL VAC 19+ O $146.00 $94.90 330184 90733 636 meningococcal polysaccharide vaccine multiple dose PWDI-90733 O $0.00 $0.00 330184 90734 415 636 meningococcal conjugate vaccine - SOLN-90734 O $0.00 $0.00 330184 90734 415 636 Menveo (MENINGOC VACC ACY W-135 DIP)-90734 O $0.00 $0.00 330184 90734 415 636 MENINGOCOCCAL VACC MENACTRA 0.5ML VIAL-90734 O $330.00 $214.50 330184 90734 415 636 MENACWY VACCINE IM O $0.00 $0.00 330184 90734 SL 415 636 MENACWY VACCINE IM<19-SL O $0.01 $0.01 330184 90734 415 636 MENACWY VACCINE IM -90734 O $228.00 $148.20 330184 90736 636 Zoster Vacc Sc O $351.00 $228.15 330184 90743 SL 636 HEPB VAC 2 DOSE ADOL IM(VFC)-9 O $0.01 $0.01 330184 90743 636 HEPATITIS B PEDIATRIC VACCINE 10 MCG/0.5 ML SUSP-90743 O $0.00 $0.00 330184 90743 636 RECOMBIVAX-PF 0.5ML O $0.00 $0.00 330184 90743 636 Hep B vacc Adol 2 dose O $36.00 $23.40 330184 90743 636 HEPB VACC 2 DOSE ADOLESC IM-90743 O $0.00 $0.00 330184 90744 414 636 HEPB VAC 3 DOSE PED/ADOL IM(no O $37.00 $24.05 330184 90744 SL 414 636 HEP B 3 DOSE 0-19 YRS-SL O $0.01 $0.01 330184 90744 414 636 HEP B VACC PED/ADOL 3 DOSE IM O $36.00 $23.40 330184 90744 414 636 HEPB VACC 3 DOSE ADOLESC IM-90744 O $0.00 $0.00 330184 90746 414 636 RECOMBIVAX-HB 1ML O $0.00 $0.00 330184 90746 414 636 Hep B vaccine Adult Im O $76.00 $49.40 330184 90746 414 636 HEPATITIS B IMMUNE GLOBUL O $76.00 $49.40 330184 90747 636 Neonatal Hepatitis B Vacc 3 dose ped/adol O $0.00 $0.00 330184 90747 636 Hep B DIALYSIS (4 DOSE) O $76.00 $49.40 330184 90748 SL 636 COMVAX-SL O $0.01 $0.01 330184 90748 636 COMVAX -90748                           O $15.00 $9.75 330184 90785 GQ 780 PHONE-INTERACTIVE COMPLEXITY-90785 O $51.00 $33.15 330184 90785 GT 780 VIDEO-INTERACTIVE COMPLEXITY-90785 O $51.00 $33.15 330184 90785 900 INTERACTIVE COMPLEXITY O $51.00 $33.15 330184 90791 GQ 5823 780 PHONE-DIAG PSYC INTRVW WO E/M-90791 O $538.13 $349.78 330184 90791 GT 5823 780 VIDEO-DIAG PSYC INTRVW WO E/M-90791 O $538.13 $349.78 330184 90791 5823 900 DIAG PSYCH INTRVW WO E/M O $538.12 $349.78 330184 90791 5823 900 DIAG PSYC INTRVW WO E/M O $538.12 $349.78 330184 90792 GQ 5823 780 PHONE-DIAG PSYCH INTRVW W E/M-90792 O $400.05 $260.03 330184 90792 GT 5823 780 VIDEO-DIAG PSYCH INTRVW W E/M-90792 O $400.05 $260.03 330184 90792 5823 900 DIAG PSYCH INTRVW W E/M O $400.05 $260.03 330184 90832 GQ 5823 315 780 PHONE-PSYCHTHPY 30 MINS W PTNT-90832 O $329.47 $214.16 330184 90832 GT 5823 315 780 VIDEO-PSYCHTHPY 30 MINS W PTNT-90832 O $329.47 $214.16 330184 90832 5823 315 914 PSYCHTHPY 30 MINS W PTNT O $329.47 $214.15 330184 90833 GQ 315 780 PHONE-PSYCHTHPY 30 MINS W PTNT E&M-90833 O $135.45 $88.04 330184 90833 GT 315 780 VIDEO-PSYCHTHPY 30 MINS W PTNT E&M-90833 O $135.45 $88.04 330184 90833 315 914 PSYCHTHPY 30 MINS W PTNT E&M O $135.45 $88.04 330184 90834 GQ 5823 316 780 PHONE-PSYCHTHPY 45 MINS W PTNT-90834 O $400.05 $260.03 330184 90834 GT 5823 316 780 VIDEO-PSYCHTHPY 45 MINS W PTNT-90834 O $400.05 $260.03 330184 90834 5823 316 914 PSYCHTHPY 45 MINS W PTNT O $400.05 $260.03 330184 90836 GQ 316 780 PHONE-PSYCHTHPY 45 MINS W PTNT W E&M-90836 O $180.60 $117.39 330184 90836 GT 316 780 VIDEO-PSYCHTHPY 45 MINS W PTNT W E&M-90836 O $180.60 $117.39 330184 90836 316 914 PSYCHTHPY 45 MINS W PTNT W E&M O $180.60 $117.39 330184 90837 5823 914 PSYTX W PT 60 MINUTES-90837 O $381.00 $247.65 330184 90837 GQ 5823 780 PHONE-PSYTX W PT 60 MINUTES-90837 O $381.28 $247.83 330184 90837 GT 5823 780 VIDEO-PSYTX W PT 60 MINUTES-90837 O $381.28 $247.83 330184 90838 316 900 PSYTX W PT W E/M 60 MIN-90838 O $180.60 $117.39 330184 90838 GQ 316 780 PHONE-PSYTX W PT W E/M 60 MIN-90838 O $180.60 $117.39 330184 90838 GT 316 780 VIDEO-PSYTX W PT W E/M 60 MIN-90838 O $180.60 $117.39 330184 90839 5823 900 PSYCHOTHPY FOR CRISIS; 1ST 60 MINS-90839 O $381.00 $247.65 330184 90839 GQ 5823 780 PHONE-PSYCHOTHPY FOR CRISIS; 1ST 60 MINS-90839 O $381.00 $247.65 330184 90839 GT 5823 780 VIDEO-PSYCHOTHPY FOR CRISIS; 1ST 60 MINS-90839 O $381.00 $247.65 330184 90840 900 PSYCHOTHPY FOR CRISIS; EA 30 MINUTES-90840 O $140.00 $91.00 330184 90840 GQ 780 PHONE-PSYCHOTHPY FOR CRISIS; EA 30 MINUTES-90840 O $140.00 $91.00 330184 90840 GT 780 VIDEO-PSYCHOTHPY FOR CRISIS; EA 30 MINUTES-90840 O $140.00 $91.00 330184 90845 GQ 5823 780 PHONE-PSYCHOANALYSIS-90845 O $398.00 $258.70 330184 90845 GT 5823 780 VIDEO-PSYCHOANALYSIS-90845 O $398.00 $258.70 330184 90846 GQ 5823 317 780 PHONE-FAMILY PSYTX W/O PT 50 MIN-90846 O $392.18 $254.92 330184 90846 GT 5823 317 780 VIDEO-FAMILY PSYTX W/O PT 50 MIN-90846 O $392.18 $254.92 330184 90846 5823 317 916 FAMILY PSYCHTHPY WO PTNT PRESENT 50 MINS O $392.18 $254.91 330184 90847 GQ 5823 317 780 PHONE-FMLY PSYCHTHPY W PTNT 50 MINS-90847 O $398.00 $258.70 330184 90847 GT 5823 317 780 VIDEO-FMLY PSYCHTHPY W PTNT 50 MINS-90847 O $398.00 $258.70 330184 90847 5823 317 916 FAMILY PSYCHTHPY W PTNT PRESENT 50 MINS O $400.05 $260.03 330184 90853 GQ 5822 780 PHONE-GROUP THERAPY-90853 O $213.00 $138.45 330184 90853 GT 5822 780 VIDEO-GROUP THERAPY-90853 O $213.00 $138.45 330184 90853 5822 915 MH-GROUP THERAPY O $213.00 $138.45 330184 90853 5822 915 GROUP THERAPY 90853 O $213.00 $138.45 330184 90863 900 MH-MEDICATION MANAGEMENT O $264.00 $171.60 330184 90863 900 MEDICINE MGMT(PHARM) O $264.00 $171.60 330184 90875 GQ 780 PHONE-PSYCHOPHYSIOLOGICAL THPY-90875 O $589.00 $382.85 330184 90875 GT 780 VIDEO-PSYCHOPHYSIOLOGICAL THPY-90875 O $589.00 $382.85 330184 90999 821 HEMO DIALYSIS O "$1,622.25 " "$1,054.46 " 330184 91010 5723 750 ESOPHAGUS MOTILITY STUDY O "$1,047.00 " $680.55 330184 91110 5301 750 WIRELESS CAPSULE ENDOSCOP O "$4,466.70 " "$2,903.36 " 330184 91300 636 PFIZER COVID 19 VACCINE 30 MCG/0.3ML-91300 O $0.00 $0.00 330184 91301 636 MODERNA COVID 19 VACCINE 100MCG/0.5ML-91301 O $0.00 $0.00 330184 92002 5012 510 OPTHAL SERV INTERMED NEW-92002 O $323.00 $209.95 330184 92004 5012 491 510 OPTHAL SERV COMPREH NEW-92004 O $339.15 $220.45 330184 92012 5012 510 OPTHAL SERV INTERMED ESTB-92012 O $339.15 $220.45 330184 92014 5012 510 OPTHAL SERV COMPREH ESTB-92014 O $339.15 $220.45 330184 92015 510 Determine Refractive Stat O $322.35 $209.53 330184 92020 5734 510 GONIOSCOPY O $318.15 $206.80 330184 92133 5733 510 CMPTR OPHTH IMG OPTC NERV O $165.00 $107.25 330184 92201 5733 510 OPSCPY EXTND RTA DRAW UNI/BI-92201 O $168.00 $109.20 330184 92202 5733 510 OPSCPY EXTND ON/MAC DRAW-92202 O $168.00 $109.20 330184 92507 GN 272 440 ST-SPEECH/LANG/COMM TX O $449.40 $292.11 330184 92507 GN 272 440 ST-SPEECH THERAPY O $449.40 $292.11 330184 92508 GN 440 ST-SPEECH THERAPY GROUP O $66.00 $42.90 330184 92511 5151 249 450 NASOPHARYNGOSCOPY W ENDOS O $442.00 $287.30 330184 92521 GN 272 444 EVALUATION OF SPEECH FLUENCY O $337.05 $219.08 330184 92522 GN 272 444 EVALUATE SPEECH PRODUCTION O $352.80 $229.32 330184 92523 GN 272 444 SPEECH SOUND LANG COMPREHEN O $666.75 $433.39 330184 92524 GN 272 440 BEHAVRAL QUALIT ANALYS VOICE O $390.60 $253.89 330184 92526 GN 269 440 ST-SWALLOW DYSFUNCTION TX O $384.30 $249.80 330184 92550 5721 470 TYMPANOMETRY & REFLX THRE O $327.00 $212.55 330184 92551 471 Pure Tone Hearing Test A O $152.00 $98.80 330184 92552 5734 471 AUDIOGRAM O $173.25 $112.61 330184 92552 5734 471 PURE TONE AUDIOMETRY AIR O $173.25 $112.61 330184 92555 5732 470 ST SPEECH AUDIOMETRY THRE O $86.00 $55.90 330184 92557 5721 471 ST-COMPR AUDIO EVAL O $383.00 $248.95 330184 92558 471 AUD EOA SCREENING AUTO AN O $166.00 $107.90 330184 92567 5732 471 TYPANOGRAM O $126.00 $81.90 330184 92567 5732 471 ST-TYPAN/IMPEDENCE TEST O $126.00 $81.90 330184 92568 5732 470 ST-ACOUSTIC REFLEX TESTIN O $86.00 $55.90 330184 92579 5721 470 ST VISUAL REINFORCEMENT A O $327.00 $212.55 330184 92582 5721 470 ST CONDITIONING PLAY AUDI O $373.00 $242.45 330184 92585 5722 257 470 ST-AUDIO EVOKED POTENTIAL O $630.00 $409.50 330184 92587 5722 471 NEWBORN HEARING SCREEN IN O $607.00 $394.55 330184 92587 5722 471 NEWBORN HEARING SCREEN RE O $607.00 $394.55 330184 92587 5722 471 ST-NEWBORN HEARING SCREEN O $607.00 $394.55 330184 92590 470 ST-HEAR AID EVALUATION O $300.00 $195.00 330184 92592 471 HEARING AID CHECK MONAURAL O $64.00 $41.60 330184 92597 GN 440 ST-EVAL FOR VOICE PROSTH O $220.50 $143.33 330184 92606 GN 440 ST-MODIFICATION/TRAINING O $312.90 $203.39 330184 92609 GN 269 440 ST-AUGMENTATIVE DEV TRAIN O $320.00 $208.00 330184 92610 GN 272 444 ST-DSYPHAGIA CONSULTATION O $537.08 $349.10 330184 92611 GN 389 444 ST-VIDEO FLUOROSCOPIC EXA O $615.30 $399.95 330184 92626 5721 470 EVAL AUD FUNCJ 1ST HOUR-92626 O $419.00 $272.35 330184 92626 GN 5721 440 ST-EVAL AUD FUNCJ 1ST HOUR-92626 O $419.00 $272.35 330184 92627 470 EVAL AUD FUNCJ EA ADDL 15 M-92627 O $52.00 $33.80 330184 92627 GN 440 ST-EVAL AUD FUNCJ EA ADDL 15 M-92627 O $52.00 $33.80 330184 92652 470 AEP THRSHLD EST MLT FREQ I&R-92652 O $1.00 $0.65 330184 92653 470 AEP NEURODIAGNOSTIC I&R-92653 O $1.00 $0.65 330184 92950 5722 92 480 CARDIOPULMONARY RESUSITAT O "$1,646.40 " "$1,070.16 " 330184 92950 5722 92 480 CPR O "$1,646.40 " "$1,070.16 " 330184 92953 5781 93 450 TEMP TRANSCUTANEOUS PACIN O "$1,456.00 " $946.40 330184 92960 5781 93 480 CARDIOVERSION O "$2,262.49 " "$1,470.62 " 330184 92960 5781 93 480 CARDIOVERSION (RR) O "$2,262.49 " "$1,470.62 " 330184 92977 5694 450 THOMBOLYSISCORONARYIV I O $846.00 $549.90 330184 93005 5733 413 730 EKG 12 LEAD O $336.14 $218.49 330184 93005 5733 413 730 ECG 12 Lead O $336.14 $218.49 330184 93005 5733 413 730 ECG OTHER O $336.14 $218.49 330184 93005 5733 413 730 EKG INTERPRETATION AND RE O $336.14 $218.49 330184 93005 5733 413 730 EKG INTERPRETATION O $336.14 $218.49 330184 93005 5733 413 730 EKG TRACING ONLY (ONC) O $336.14 $218.49 330184 93017 5722 80 482 NM CARDIOVASCULAR STRESS O $738.15 $479.80 330184 93017 5722 80 482 NM CARDIO STRESS SUP O $738.15 $479.80 330184 93017 5722 80 482 STRESS TEST W OR W/O PHAR O $738.15 $479.80 330184 93017 5722 80 482 Stress echocardiogram(dob O $738.15 $479.80 330184 93041 5733 413 730 ECG RHYTHM STRIP O $165.00 $107.25 330184 93225 5734 731 ECG MONITOR/REPORT24 HOU O $510.10 $331.56 330184 93225 5734 731 HOLTER MONITOR 24 HR O $510.10 $331.56 330184 93225 5734 731 Ecg Monitor/record 24 Hr O $510.10 $331.56 330184 93241 730 EXT ECG>48HR<7D REC SCAN A/R-93241 O $1.00 $0.65 330184 93242 730 EXT ECG>48HR<7D RECORDING-93242 O $1.00 $0.65 330184 93243 730 EXT ECG>48HR<7D SCAN A/R-93243 O $1.00 $0.65 330184 93244 730 EXT ECG>48HR<7D REV&INTERPJ-93244 O $1.00 $0.65 330184 93245 730 EXT ECG>7D<15D REC SCAN A/R-93245 O $1.00 $0.65 330184 93246 730 EXT ECG>7D<15D RECORDING-93246 O $1.00 $0.65 330184 93247 730 EXT ECG>7D<15D SCAN A/R-93247 O $1.00 $0.65 330184 93248 730 EXT ECG>7D<15D REV&INTERPJ-93248 O $1.00 $0.65 330184 93279 5741 480 Pm device progr eval sngl O $106.00 $68.90 330184 93280 5741 480 Pm device progr eval dual O $106.00 $68.90 330184 93281 5741 480 Pm device progr eval multi O $106.00 $68.90 330184 93282 5741 480 Icd device progr eval 1 sngl O $106.00 $68.90 330184 93283 5741 480 Icd device progr eval dual O $106.00 $68.90 330184 93284 5741 480 Icd device progr eval mult O $106.00 $68.90 330184 93285 5741 480 ILR DEVICE EVAL PROGR-93285 O $115.00 $74.75 330184 93288 5741 480 Pm device eval in person O $106.00 $68.90 330184 93289 5741 480 Icd device interrogate O $106.00 $68.90 330184 93291 5731 480 ILR DEVICE INTERROGATE-93291 O $53.00 $34.45 330184 93306 5524 81 480 TTE W/DOPPLER COMPLETE-93306 O "$2,354.62 " "$1,530.51 " 330184 93306 5524 81 480 Tte W/doppler Complete O "$2,354.62 " "$1,530.51 " 330184 93307 5523 480 ECHOCARDIOGRAM WITH DOPPL O "$1,429.05 " $928.88 330184 93307 5523 480 ECHOCARDIOGRAM COMPLETE O "$1,429.05 " $928.88 330184 93307 5523 480 Tte W/o Doppler Complete O "$1,429.05 " $928.88 330184 93308 5523 81 480 ECHOCARDIOGRAM F/U LIMITE O $718.20 $466.83 330184 93312 5524 81 480 TRANSESOPHAGEAL ECHOCARDI O "$2,234.40 " "$1,452.36 " 330184 93320 59 81 480 DOPPLER ECHO; COMPLETE-93320-59 O "$1,272.00 " $826.80 330184 93320 81 480 ECHOCARDIOGRAM DOPPLER O "$1,272.00 " $826.80 330184 93325 59 288 480 DOPPLER COLOR FLW VEL-93325-59 O $940.28 $611.18 330184 93325 288 480 ECHOCAR DOPP COLOR FLOW V O $940.28 $611.18 330184 93325 288 480 COLOR FLOW MAPPING SGL O $940.28 $611.18 330184 93325 59 288 480 COLOR FLOW MAPPING MULTI O $940.28 $611.18 330184 93350 5524 81 480 STRESS ECHOCARDIOGRAPHY O "$1,196.00 " $777.40 330184 93660 5723 480 Tilt Table Eval W W/O O "$1,320.90 " $858.59 330184 93660 5723 480 TILT TABLE STUDY O "$1,320.90 " $858.59 330184 93660 5723 480 Tilt Table Evaluation O "$1,320.90 " $858.59 330184 93797 5771 943 PHY SPRVSD NON MNTRD RHB O $334.00 $217.10 330184 93798 5771 943 PHY SPRVSD MONITORED CARD O $334.00 $217.10 330184 93880 5523 288 920 US DOPPLER CAROTID O "$1,365.53 " $887.59 330184 93923 5721 80 921 Ue/Le Aretrial Stdu Cmpl O $385.00 $250.25 330184 93924 5721 921 Le Art Stdy Rest&Exer Cmp O $385.00 $250.25 330184 93925 5523 289 920 US DOP LWR/EXT ART BILAT O "$1,766.10 " "$1,147.96 " 330184 93926 LT 5522 288 920 US DOPPLER ART LT LEG O "$1,056.82 " $686.94 330184 93926 RT 5522 288 920 US DOP LWR/EXT ART RT O "$1,056.82 " $686.94 330184 93931 LT 5522 288 920 US Doppler Arterial Uppe O $989.00 $642.85 330184 93931 RT 5522 288 920 US DOPPLER ART.RT ARM O $989.00 $642.85 330184 93970 5523 289 921 US DOPPLER VEIN UPPER BIL O "$1,308.83 " $850.74 330184 93970 5523 289 921 US DOPPLER EXT. VEINS BIL O "$2,401.35 " "$1,560.88 " 330184 93971 LT 5522 288 921 US DOPPLER VEIN UPPER LEF O "$1,308.83 " $850.74 330184 93971 RT 5522 288 921 US DOPPLER VEIN UPPER RIG O "$1,308.83 " $850.74 330184 93971 LT 5522 288 921 US DOPPLER VEIN LOWER LEF O "$1,308.83 " $850.74 330184 93971 RT 5522 288 921 US DOPPLER VEIN LOWER RIG O "$1,308.83 " $850.74 330184 93975 5523 289 920 DPLR ART/VEN AB/PLV COMP O "$1,951.95 " "$1,268.77 " 330184 93976 5522 289 920 DPLR ART/VEN AB/PLV LMTD O $358.00 $232.70 330184 93976 5522 289 920 US DOPPLER PELVIC O $358.00 $232.70 330184 93976 5522 289 920 US DPLX ART/VEN FLW SCRTL O $358.00 $232.70 330184 93980 5522 920 US PENILE DOPPLER O $341.00 $221.65 330184 93990 5522 921 US DOPPLER DIALYSIS ACCES O $899.85 $584.90 330184 94002 5801 67 460 VENT ASSIST & MGNT O "$1,347.15 " $875.65 330184 94002 5801 67 410 NEONATAL.VENT MNGT 1ST DA O "$1,347.15 " $875.65 330184 94002 5801 67 460 WEANING PARAMETER(VTVEF O "$1,347.15 " $875.65 330184 94002 5801 67 410 VENTILATION ASSIST AND MA O "$1,347.15 " $875.65 330184 94003 5801 67 410 NEONATAL VENT SUBSQ DAY O "$1,347.15 " $875.65 330184 94010 5721 60 460 SPITOMETRY W/GRAPHIC REC O $640.89 $416.58 330184 94010 5721 60 460 SPIROMETRY W/GRAPHIC RECO O $640.89 $416.58 330184 94010 5721 60 460 P-SPIROMETRY S O $640.89 $416.58 330184 94010 5721 60 460 SPIROMETRY BREATHING CPCTY TEST O $640.89 $416.58 330184 94060 5722 60 460 BRONCHSPASM EVAL BFR & AF O "$1,208.42 " $785.47 330184 94060 5722 60 460 EVALUATION WHEEZING O "$1,208.42 " $785.47 330184 94150 5721 412 460 VITAL CAPACITY TOTAL O $327.00 $212.55 330184 94150 5721 412 460 Vital capacity total O $327.00 $212.55 330184 94200 5733 412 460 PEAK FLOW RATE O $257.00 $167.05 330184 94375 5722 460 RESPIRATORY FLOW VOLUME O $607.00 $394.55 330184 94375 5722 460 RESP VOLUME FLOW LOOP O $607.00 $394.55 330184 94640 5791 65 410 AEROSOL (DAILY) O $460.00 $299.00 330184 94640 5791 65 410 METERED DOSE INHALER(MDI) O $460.00 $299.00 330184 94640 5791 65 410 AEROSOL INHALATION SUBSQ O $460.00 $299.00 330184 94640 5791 65 410 Airway Inhalation Treatme O $460.00 $299.00 330184 94640 5791 65 410 AEROSOL NEB TREATMENTINI O $460.00 $299.00 330184 94640 5791 65 410 INHALATION TX-ACUTE AIRWA O $460.00 $299.00 330184 94640 5791 65 410 AEROSOL NEB TREATMENT-INI O $460.00 $299.00 330184 94640 76 5791 65 410 AEROSOL NEB TREATMENTSUB O $460.00 $299.00 330184 94640 5791 65 410 AIRWAY INHALATION TREATMENT O $460.00 $299.00 330184 94644 5734 410 CNT INH W/ARSL MED 1ST HR O $318.15 $206.80 330184 94645 410 CNT INH W/ARSL MED EA HR O $19.00 $12.35 330184 94660 5791 67 410 CPAP INITIATION & MGMT O "$1,150.00 " $747.50 330184 94660 5791 67 410 BIPAP INITIATION & MGMT O "$1,150.00 " $747.50 330184 94660 5791 67 410 BIPAP INITIATION & MANAG O "$1,150.00 " $747.50 330184 94664 GQ 5791 65 780 PHONE-INIT INHALATION THPY-94664 O $474.00 $308.10 330184 94664 GT 5791 65 780 VIDEO-INIT INHALATION THPY-94664 O $474.00 $308.10 330184 94664 5791 65 410 AEROSOL INHALATION INITIA O $474.00 $308.10 330184 94664 5791 65 410 MED NEB O $474.00 $308.10 330184 94664 5791 65 410 METERED DOSE INHALER(MDI) O $474.00 $308.10 330184 94664 5791 65 410 INITIAL INHALATION THERAP O $474.00 $308.10 330184 94726 5722 412 460 FUNCTIONAL RESIDUAL CAPA O $993.00 $645.45 330184 94726 5722 412 460 FUNCTIONAL RESIDUAL CAPAC O $993.00 $645.45 330184 94727 5721 412 460 MULTI-BREATH NITROGEN WA O $404.25 $262.76 330184 94729 412 460 CARBON MONO DIFFUSING CA O $710.00 $461.50 330184 94729 412 460 CO DIFFUSING CAPACITY O $710.00 $461.50 330184 94760 2004 460 PULSE OXIMETRY READING(ON O $153.37 $99.69 330184 94760 2004 460 OXYGEN SATURATION O $153.37 $99.69 330184 94760 2004 460 OXIMETER(SPOT CHECK) O $153.37 $99.69 330184 94760 2004 460 PULSE OXIMETRY O $153.37 $99.69 330184 94760 2004 460 MEASURE BLOOD OXYGEN LEVEL O $153.37 $99.69 330184 94761 2004 460 PULSE OXIMETRY MULTI O $205.28 $133.43 330184 94761 2004 460 MEASURE BLOOD OXYGEN LEVEL-MULTIP O $205.28 $133.43 330184 94762 5721 412 460 PULSE OXIMETRY CONTINUOUS O $404.25 $262.76 330184 94799 5721 460 OXYGEN O $373.00 $242.45 330184 94799 5721 460 UNLISTED PULMONARY SERVIC O $373.00 $242.45 330184 95115 5691 510 Immunotherapy One Inject O $105.00 $68.25 330184 95250 5012 920 CONT GLUC MNTR PHYS/QHP EQP-95250 O $359.10 $233.42 330184 95251 920 CONT GLUC MNTR ANALYSIS I&R-95251 O $260.00 $169.00 330184 95805 5723 222 740 MULTIPLE SLEEP LATENCY ST O "$2,746.80 " "$1,785.42 " 330184 95806 5721 740 SLEEP STUDY UNATT&RESP EFFT-95806 O $323.40 $210.21 330184 95807 52 5723 222 740 SLEEP STUDY ATTD-REDUCED-95807-52 O "$1,335.00 " $867.75 330184 95807 5723 222 740 SLEEP STUDY ATTENDED-95807 O "$1,335.00 " $867.75 330184 95810 5724 222 740 POLYSOMNOGRAM 4 OR > ATTD O "$2,746.00 " "$1,784.90 " 330184 95810 5724 222 740 POLYSOMNOGRAM 4 OR>ATTD O "$2,746.00 " "$1,784.90 " 330184 95811 5724 222 740 POLYSOMNOGRAM W/CPAP O "$2,746.80 " "$1,785.42 " 330184 95816 5722 211 740 EEG AWAKE & DROWSY O "$1,199.10 " $779.41 330184 95819 5722 211 740 EEG AWAKE & ASLEEP O $897.49 $583.37 330184 95824 5723 211 740 EEG CEREBRAL DEATH EVAL O $378.00 $245.70 330184 95851 430 RNG MTN MEASUREMENTS EA EXT LT O $54.00 $35.10 330184 95851 430 RNG MTN MEASUREMENTS EA EXT RT O $54.00 $35.10 330184 95860 5734 213 922 MUSCLE TEST ONE LIMB O $303.00 $196.95 330184 95861 5734 213 922 MUSCLE TEST 2 LIMBS O $303.00 $196.95 330184 95863 5721 922 MUSCLE TEST 3 LIMBS O $385.00 $250.25 330184 95864 5721 922 MUSCLE TEST 4 LIMBS O $385.00 $250.25 330184 95867 5721 213 922 MUSCLE TEST CRAN NERV UNILAT O $385.00 $250.25 330184 95868 5721 213 922 MUSCLE TEST CRAN NERVE BILAT O $385.00 $250.25 330184 95869 5721 922 MUSCLE TEST THOR PARASPINAL O $385.00 $250.25 330184 95870 5733 213 922 MUSCLE TEST NONPARASPINAL O $165.00 $107.25 330184 95872 5721 922 MUSCLE TEST ONE FIBER O $385.00 $250.25 330184 95874 922 GUIDE NERV DESTR NEEDLE EMG O $68.00 $44.20 330184 95885 50 922 EMG BIL W/NERV TST LIMIT; <5 MUSC;EA EXT O $52.00 $33.80 330184 95885 LT 922 EMG LT W/NERV TST LIMIT; <5 MUSC; EA EXT O $52.00 $33.80 330184 95885 RT 922 EMG RT W/NERV TST LIMIT; <5 MUSC; EA EXT O $52.00 $33.80 330184 95886 50 922 EMG BIL W/NERV TEST COMP; >5 MUSC;EA EXT O $59.00 $38.35 330184 95886 LT 922 EMG LT W/NERV TEST COMP; >5 MUSC; EA EXT O $59.00 $38.35 330184 95886 RT 922 EMG RT W/NERV TEST COMP; >5 MUSC; EA EXT O $59.00 $38.35 330184 95887 50 922 EMG BIL W/NERV TEST NONEXTRMITY-PER SITE O $63.00 $40.95 330184 95887 LT 922 EMG LT W/NERV TEST NONEXTREMITY-PER SITE O $63.00 $40.95 330184 95887 RT 922 EMG RT W/NERV TEST NONEXTREMITY-PER SITE O $63.00 $40.95 330184 95907 5721 922 1-2 Nerve conduction studies O $385.00 $250.25 330184 95908 5722 922 3-4 Nerve conduction studies O $703.00 $456.95 330184 95909 5722 922 5-6 Nerve conduction studies O $703.00 $456.95 330184 95910 5722 922 7-8 Nerve conduction studies O $703.00 $456.95 330184 95911 5723 922 9-10 Nerve conduction studies O "$1,258.00 " $817.70 330184 95912 5723 922 11-12 Nerve conduction studies O "$1,258.00 " $817.70 330184 95913 5723 922 13 or more Nerve conduction studies O "$1,258.00 " $817.70 330184 95940 2003 920 SPINAL MONITORING CHARGE O $118.65 $77.12 330184 96110 440 DEVELOPMENTAL SCREEN W/SCORE-96110 O $193.00 $125.45 330184 96110 GQ 780 PHONE-DEVELOPM SCREEN W/SCORE-96110 O $193.00 $125.45 330184 96110 GT 780 VIDEO-DEVELOPM SCREEN W/SCORE-96110 O $193.00 $125.45 330184 96110 440 DEVELOPMENTAL SCREEN W/SCORE O $193.00 $125.45 330184 96112 GQ 5721 780 PHONE-DEVEL TST PHYS/QHP 1ST HR-96112 O $418.00 $271.70 330184 96112 GT 5721 780 VIDEO-DEVEL TST PHYS/QHP 1ST HR-96112 O $418.00 $271.70 330184 96113 GQ 780 PHONE-DEVEL TST PHYS/QHP EA ADL-96113 O $306.00 $198.90 330184 96113 GT 780 VIDEO-DEVEL TST PHYS/QHP EA ADL-96113 O $306.00 $198.90 330184 96116 GQ 5722 780 PHONE-NUBHVL XM PHYS/QHP 1ST HR-96116 O $765.00 $497.25 330184 96116 GT 5722 780 VIDEO-NUBHVL XM PHYS/QHP 1ST HR-96116 O $765.00 $497.25 330184 96121 GQ 780 PHONE-NUBHVL XM PHY/QHP EA ADDL HR-96121 O $497.00 $323.05 330184 96121 GT 780 VIDEO-NUBHVL XM PHY/QHP EA ADDL HR-96121 O $497.00 $323.05 330184 96127 5732 918 BRIEF EMOTIONAL/BEHAV ASSMT-96127 O $39.90 $25.93 330184 96127 GQ 5732 780 PHONE-BRIEF EMOTNL-BEHAV ASSMT-96127 O $39.90 $25.93 330184 96127 GT 5732 780 VIDEO-BRIEF EMOTNL-BEHAV ASSMT-96127 O $39.90 $25.93 330184 96130 5721 918 PSYCL TST EVAL PHYS/QHP 1ST HR-96130 O $408.00 $265.20 330184 96130 GQ 5721 780 PHONE-PSYCL TST EVAL PHYS/QHP 1ST HR-96130 O $408.00 $265.20 330184 96130 GT 5721 780 VIDEO-PSYCL TST EVAL PHYS/QHP 1ST HR-96130 O $408.00 $265.20 330184 96131 918 PSYCL TST EVAL PHYS/QHP ADDTL HRS-96131 O $233.00 $151.45 330184 96131 GQ 780 PHONE-PSYCL TST EVAL PHYS/QHP ADDTL HRS-96131 O $233.00 $151.45 330184 96131 GT 780 VIDEO-PSYCL TST EVAL PHYS/QHP ADDTL HRS-96131 O $233.00 $151.45 330184 96132 GQ 5721 780 PHONE-NRPSYC TST EVAL PHYS/QHP 1ST-96132 O $418.00 $271.70 330184 96132 GT 5721 780 VIDEO-NRPSYC TST EVAL PHYS/QHP 1ST-96132 O $418.00 $271.70 330184 96133 GQ 780 PHONE-NRPSYC TST EVAL PHYS/QHP EA-96133 O $605.00 $393.25 330184 96133 GT 780 VIDEO-NRPSYC TST EVAL PHYS/QHP EA-96133 O $605.00 $393.25 330184 96136 5731 918 PSYCL/NRPSYC TST PHY/QHP 1ST 30 MINS-96136 O $52.00 $33.80 330184 96136 GQ 5731 780 PHONE-PSYCL/NRPSYC TST PHY/QHP 1ST 30 MINS-96136 O $52.00 $33.80 330184 96136 GT 5731 780 VIDEO-PSYCL/NRPSYC TST PHY/QHP 1ST 30 MINS-96136 O $52.00 $33.80 330184 96137 918 PSYCL/NRPSYC TST PHY/QHP ADDTL 30MINS-96137 O $55.00 $35.75 330184 96137 GQ 780 PHONE-PSYCL/NRPSYC TST PHY/QHP ADDTL 30MINS-96137 O $55.00 $35.75 330184 96137 GT 780 VIDEO-PSYCL/NRPSYC TST PHY/QHP ADDTL 30MINS-96137 O $55.00 $35.75 330184 96138 5731 918 PSYCL/NRPSYC TECH 1ST 30MINS-96138 O $52.00 $33.80 330184 96138 GQ 5731 780 PHONE-PSYCL/NRPSYC TECH 1ST 30MINS-96138 O $52.00 $33.80 330184 96138 GT 5731 780 VIDEO-PSYCL/NRPSYC TECH 1ST 30MINS-96138 O $52.00 $33.80 330184 96139 918 PSYCL/NRPSYC TST TECH ADDTL 30MINS-96139 O $118.00 $76.70 330184 96139 GQ 780 PHONE-PSYCL/NRPSYC TST TECH ADDTL 30MINS-96139 O $118.00 $76.70 330184 96139 GT 780 VIDEO-PSYCL/NRPSYC TST TECH ADDTL 30MINS-96139 O $118.00 $76.70 330184 96146 5731 918 PSYCL/NRPSYC TST AUTO RESULT-96146 O $52.00 $33.80 330184 96150 GQ 780 PHONE-INITL HLTH & BHVR ASSMNT W PATIENT–96150 O $184.00 $119.60 330184 96150 GT 780 VIDEO-INITL HLTH & BHVR ASSMNT W PATIENT–96150 O $184.00 $119.60 330184 96151 GQ 780 PHONE-HLTH & BHVR REASSMNT-96151 O $223.65 $145.37 330184 96151 GT 780 VIDEO-HLTH & BHVR REASSMNT-96151 O $223.65 $145.37 330184 96152 GQ 780 PHONE-HLTH & BHVR INTRVNT–F2F INDVDL-96152 O $184.00 $119.60 330184 96152 GT 780 VIDEO-HLTH & BHVR INTRVNT–F2F INDVDL-96152 O $184.00 $119.60 330184 96153 GQ 780 PHONE-HLTH & BHVR INTRVNT; GROUP-96153 O $76.00 $49.40 330184 96153 GT 780 VIDEO-HLTH & BHVR INTRVNT; GROUP-96153 O $76.00 $49.40 330184 96154 GQ 780 PHONE-HLTH & BHVR INTRVNT; FMLY W PAT-96154 O $223.65 $145.37 330184 96154 GT 780 VIDEO-HLTH & BHVR INTRVNT; FMLY W PAT-96154 O $223.65 $145.37 330184 96156 5822 914 HLTH BHV ASSMT/REASSESSMENT-96156 O $238.00 $154.70 330184 96156 GQ 5822 780 PHONE-HLTH BHV ASSMT/REASSESSMENT-96156 O $238.00 $154.70 330184 96156 GT 5822 780 VIDEO-HLTH BHV ASSMT/REASSESSMENT-96156 O $238.00 $154.70 330184 96158 5822 914 HLTH BHV IVNTJ INDIV 1ST 30-96158 O $238.00 $154.70 330184 96158 GQ 5822 780 PHONE-HLTH BHV IVNTJ INDIV 1ST 30-96158 O $238.00 $154.70 330184 96158 GT 5822 780 VIDEO-HLTH BHV IVNTJ INDIV 1ST 30-96158 O $238.00 $154.70 330184 96159 914 HLTH BHV IVNTJ INDIV EA ADDL-96159 O $60.00 $39.00 330184 96159 GQ 780 PHONE-HLTH BHV IVNTJ INDIV EA ADDL-96159 O $60.00 $39.00 330184 96159 GT 780 VIDEO-HLTH BHV IVNTJ INDIV EA ADDL-96159 O $60.00 $39.00 330184 96160 5821 510 PT-FOCUSED HLTH RISK ASSMT O $79.80 $51.87 330184 96160 GQ 5821 780 PHONE-PT-FOCUSED HLTH RISK ASSMT-96160 O $79.80 $51.87 330184 96160 GT 5821 780 VIDEO-PT-FOCUSED HLTH RISK ASSMT-96160 O $79.80 $51.87 330184 96161 5821 510 CAREGIVER HEALTH RISK ASSMT O $79.80 $51.87 330184 96161 GQ 5821 780 PHONE-CAREGIVER HEALTH RISK ASSMT-96161 O $79.80 $51.87 330184 96161 GT 5821 780 VIDEO-CAREGIVER HEALTH RISK ASSMT-96161 O $79.80 $51.87 330184 96164 5821 915 HLTH BHV IVNTJ GRP 1ST 30-96164 O $83.00 $53.95 330184 96164 GQ 5821 780 PHONE-HLTH BHV IVNTJ GRP 1ST 30-96164 O $83.00 $53.95 330184 96164 GT 5821 780 VIDEO-HLTH BHV IVNTJ GRP 1ST 30-96164 O $83.00 $53.95 330184 96165 915 HLTH BHV IVNTJ GRP EA ADDL-96165 O $10.00 $6.50 330184 96165 GQ 780 PHONE-HLTH BHV IVNTJ GRP EA ADDL-96165 O $10.00 $6.50 330184 96165 GT 780 VIDEO-HLTH BHV IVNTJ GRP EA ADDL-96165 O $10.00 $6.50 330184 96167 5821 916 HLTH BHV IVNTJ FAM 1ST 30-96167 O $83.00 $53.95 330184 96167 GQ 5821 780 PHONE-HLTH BHV IVNTJ FAM 1ST 30-96167 O $83.00 $53.95 330184 96167 GT 5821 780 VIDEO-HLTH BHV IVNTJ FAM 1ST 30-96167 O $83.00 $53.95 330184 96168 916 HLTH BHV IVNTJ FAM EA ADDL-96168 O $65.00 $42.25 330184 96170 GQ 780 PHONE-HLTH BHV IVNTJ FAM WO PT 1ST-96170 O $528.00 $343.20 330184 96170 GT 780 VIDEO-HLTH BHV IVNTJ FAM WO PT 1ST-96170 O $528.00 $343.20 330184 96171 GQ 780 PHONE-HLTH BHV IVNTJ FAM W/O PT EA-96171 O $264.00 $171.60 330184 96171 GT 780 VIDEO-HLTH BHV IVNTJ FAM W/O PT EA-96171 O $264.00 $171.60 330184 96360 59 5693 111 260 HYDRATION IV INFUSION INIT 31- O $623.70 $405.41 330184 96360 5693 111 260 HYDRATION IV INFUSION INI O $623.70 $405.41 330184 96360 5693 111 260 HYDRATION IV INFUSIONINI O $623.70 $405.41 330184 96361 59 5691 110 260 HYDRATE IV INFUSION ADD-ON-963 O $357.26 $232.22 330184 96361 5691 110 260 HYDRATE IV INFUSION AD- O $357.26 $232.22 330184 96361 5691 110 260 HYDRATE IV INFUSION ADD- O $357.26 $232.22 330184 96365 59 5693 111 260 THER/PROPH/DIAG IV INF INIT =< O $892.69 $580.25 330184 96365 5693 111 260 INFUSTION THERAPY PER HOU O $892.69 $580.25 330184 96365 5693 111 260 Ther/proph/diag Iv Inf I O $892.69 $580.25 330184 96365 5693 111 260 INFUSION TX-NON CHEMO-MCA O $892.69 $580.25 330184 96365 5693 111 260 INF THERAPY P/HR OTHER TH O $892.69 $580.25 330184 96365 5693 111 260 THER/PROPH/DIAG IV INFIN O $892.69 $580.25 330184 96366 59 5691 110 260 THER/PROPH/DIAG IV INF ADDON-9 O $568.84 $369.74 330184 96366 5691 110 260 INFUSION TX-NON-CHEMO 1-8 O $568.84 $369.74 330184 96366 5691 110 260 THER/PROPH/DG IV INFADD- O $568.84 $369.74 330184 96367 59 5692 111 260 TX/PROPH/DG ADDL SEQ IV INF-96 O $260.93 $169.60 330184 96367 5692 111 260 INFUSION TX-NON-CHEMO<1 H O $260.93 $169.60 330184 96367 5692 111 260 TX/PROPH/DG ADDL SEQ IV I O $260.93 $169.60 330184 96368 111 260 THER/DIAG CONCURRENT INF O $144.90 $94.18 330184 96372 59 5692 109 260 THER/PROPH/DIAG INJ SC/IM-9637 O $176.10 $114.47 330184 96372 5692 109 260 IM INJECTION O $176.10 $114.47 330184 96372 5692 109 260 SQ INJECTION O $176.10 $114.47 330184 96372 5692 109 260 Ther/proph/diag Inj Sc/i O $176.10 $114.47 330184 96372 5692 109 260 THERAPEUTIC INJECTION O $176.10 $114.47 330184 96372 5692 109 260 IM INJECTION ANTIBIOTIC O $176.10 $114.47 330184 96372 5692 109 260 90782 INTRAMUSCULAR THERA O $176.10 $114.47 330184 96372 5692 109 260 INJECTIONS-SUBCUTANEOUS O O $176.10 $114.47 330184 96372 59 5692 109 260 THER PRPH DIAG INJ SC IM (L&D-MDF 59) O $176.10 $114.47 330184 96372 59 5692 109 260 THER PRPH DIAG INJ SC IM (ONC-MDF 59) O $176.10 $114.47 330184 96372 59 5692 109 260 THER PRPH DIAG INJ SC IM (CLN-MDF 59) O $176.10 $114.47 330184 96372 59 5692 109 260 THER PRPH DIAG INJ SC IM (ER-MDF 59) O $176.10 $114.47 330184 96373 5693 260 THERA PROPHY DIAG INJ O $551.00 $358.15 330184 96373 5693 260 THER/PROPH/DIAG INJ ADD-O O $551.00 $358.15 330184 96373 5693 260 THER/PROPH/DIAG INJ IA O $551.00 $358.15 330184 96374 59 5693 109 260 THER/PROPH/DIAG INJ IV PUSH-96 O $362.25 $235.46 330184 96374 5693 109 260 IV INFUSION FOR THERAPY O $362.25 $235.46 330184 96374 5693 109 260 MEDICATION ADMIN IV O $362.25 $235.46 330184 96374 5693 109 260 Ther/proph/diag Inj Iv P O $362.25 $235.46 330184 96374 5693 109 260 90784 INTRAVENOUS THERAPE O $362.25 $235.46 330184 96374 5693 109 260 THER/PROPH/DIAG INJ IA O $362.25 $235.46 330184 96374 5693 109 260 THER/PROPH/DIAG INJIV PU O $362.25 $235.46 330184 96374 59 5693 109 260 THER/PRPH/DIAG INJ IV PUSH(L&D-MDF 59) O $362.25 $235.46 330184 96374 59 5693 109 260 THER/PRPH/DIAG INJ IV PUSH(ONC-MDF 59) O $362.25 $235.46 330184 96374 59 5693 109 260 THER/PRPH/DIAG INJ IV PUSH(CLN-MDF 59) O $362.25 $235.46 330184 96374 59 5693 109 260 THER/PRPH/DIAG INJ IV PUSH(ER-MDF 59) O $362.25 $235.46 330184 96375 59 5691 109 260 TX/PRO/DX INJ NEW DRUG ADDON-9 O $179.81 $116.88 330184 96375 5691 109 260 THER/PROPH/DIAG INJ ADD-O O $179.81 $116.88 330184 96375 5691 109 260 Tx/pro/dx Inj New Drug An O $179.81 $116.88 330184 96376 59 109 260 TX/PRO/DX INJ SAME DRUG ADDON- O $175.88 $114.32 330184 96376 109 260 THER/PROPH/DIAG ADD-ON (S O $175.88 $114.32 330184 96376 109 260 THER PROPH DIAG SEQ INTR O $175.88 $114.32 330184 96377 59 5691 260 APPLICATON ON-BODY INJECTOR-96 O $111.00 $72.15 330184 96379 5691 260 THER/PROP/DIAG INJ/INF PR O $105.00 $68.25 330184 96401 5692 109 331 CHEMO ADMIN IM/SQ O $289.80 $188.37 330184 96402 5692 109 331 CHEMO HORMON ANTINEOPL SQ O $339.41 $220.62 330184 96409 5693 109 331 CHEMO ADMIN PUSH AND INFU O $854.44 $555.38 330184 96409 5693 109 331 CHEMO IV PUSH SNGL/ INI O $854.44 $555.38 330184 96411 5692 331 CHEMO IV PUSH ADDL DRUG O $402.41 $261.57 330184 96413 5694 111 335 CHEMO IV INFUSION 1 HR O "$1,568.00 " "$1,019.20 " 330184 96415 5692 110 335 CHEMOIV INFUSIONEACH AD O $450.19 $292.62 330184 96416 5694 335 CHEMO ADMIN INFUSION O "$1,096.86 " $712.96 330184 96416 5694 335 CHEMO ADMIN IV INF TECH O "$1,096.86 " $712.96 330184 96417 5692 111 335 CHEMO IV INFUS EACH ADDL O $446.51 $290.23 330184 96420 5694 335 CHEMO ADMIN PUSH TECHNIQU O $770.00 $500.50 330184 96420 5694 335 CHEMO ADM INTRA-ARTERIAL O $770.00 $500.50 330184 96446 5694 111 331 CHEMO ADM PERITONEAL CVTY O $846.00 $549.90 330184 96450 5694 110 331 CHEMO ADMIN INTRATHECAL O $846.00 $549.90 330184 96521 5693 335 REFILL AND MAINT PORT PUM O $544.00 $353.60 330184 96522 5693 335 REFILL MAINT IMPLANT PUMP O $544.00 $353.60 330184 96523 5733 109 335 IRRIG DRUG DELIVERY DEVIC O $173.25 $112.61 330184 96542 5693 331 CHEMOTHERAPY INJECTION O $544.00 $353.60 330184 97010 GP 420 PT-HOT/COLD PACKS O $71.40 $46.41 330184 97010 GO 430 OT-HOT/COLD PACKS O $71.40 $46.41 330184 97012 GP 493 420 PT-TRACTION MECHANICAL O $47.00 $30.55 330184 97014 420 PT-E STIM(UNATTENDED) O $135.00 $87.75 330184 97014 420 PT E STIM UNATTENDED MED O $135.00 $87.75 330184 97014 430 OT E STIM (UNATTENDED) O $135.00 $87.75 330184 97018 420 Paraffin Bath Therapy O $34.00 $22.10 330184 97018 GP 420 PT-PARAFFIN BATH O $34.00 $22.10 330184 97018 GO 430 OT-PARAFFIN BATH O $34.00 $22.10 330184 97022 GP 493 420 PT-WHIRLPOOL O $74.50 $48.42 330184 97022 GO 493 430 OT WHIRLPOOL O $74.50 $48.42 330184 97032 GP 493 420 PT ELEC STIM ATTENDED EA O $56.00 $36.40 330184 97033 GP 420 IONTOPHORESIS EA 15 MIN O $64.00 $41.60 330184 97034 GP 420 PT CNTRST BATHS EACH 15M O $53.00 $34.45 330184 97034 GO 430 OT CNTRST BATHS EACH 15M O $53.00 $34.45 330184 97035 GP 493 420 PT-ULTRASOUND EA 15 MIN. O $83.21 $54.09 330184 97035 GP 493 420 PT-UNLTRSOUND EA 15 MIN O $83.21 $54.09 330184 97035 GO 493 430 OT ULTRASOUND EA 15MN O $83.21 $54.09 330184 97039 GP 420 FLUIDOTHERAPY (PT) O $89.25 $58.01 330184 97039 GO 430 FLUIDOTHERAPY (OT) O $89.25 $58.01 330184 97110 GP 269 420 PT-THERAPEUTIC EXERCISES O $199.24 $129.50 330184 97110 GO 269 430 OT-THERAPEUTIC EXERCISES O $199.24 $129.50 330184 97112 GP 269 420 PT-NEUROMUSC RE-ED EA 15 O $153.56 $99.82 330184 97112 GO 269 430 OT-NEUROMUSCULAR RE-ED EA O $153.56 $99.82 330184 97116 GP 493 420 PT-GAIT TRAINING EA 15 MI O $170.62 $110.91 330184 97124 GP 493 420 MASSAGE THPY PER 15 MINS O $76.00 $49.40 330184 97129 GN 269 440 THER IVNTJ COG FUNC CNTCT 1ST 15 MINS-97129 O $70.00 $45.50 330184 97129 GO 269 430 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINS-97129 O $70.00 $45.50 330184 97129 GP 269 420 THER IVNTJ COG FUNCJ CNTC 1ST 15 MINS-97129 O $70.00 $45.50 330184 97130 GP 269 420 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINS-97130 O $66.00 $42.90 330184 97130 GN 269 440 THER IVNT COG FUNC CNTCT EA ADDL 15 MINS-97130 O $66.00 $42.90 330184 97130 GO 269 430 THER IVNTJ COG FUNC CNTCT EA ADDL 15 MINS-97130 O $66.00 $42.90 330184 97140 GP 269 420 PT-MANUAL THERAPY EA 15 M O $165.00 $107.25 330184 97140 GO 269 430 OT-MANUAL THERAPY EA 15 M O $165.00 $107.25 330184 97150 GP 269 420 PT THERAPEUTIC PROC GRP O $52.50 $34.12 330184 97150 GO 269 430 OT THERAPEUTIC PROC GRP O $52.50 $34.12 330184 97161 GP 271 424 PT EVAL LOW COMPLEX 20 MIN O $386.14 $250.99 330184 97162 GP 271 424 PT EVAL MOD COMPLEX 30 MIN O $391.65 $254.57 330184 97163 GP 271 424 PT EVAL HIGH COMPLEX 45 MIN O $403.46 $262.25 330184 97164 GP 271 424 PT RE-EVAL EST PLAN CARE O $273.00 $177.45 330184 97165 GO 270 434 OT EVAL LOW COMPLEX 30 MIN O $385.00 $250.25 330184 97166 GO 270 434 OT EVAL MOD COMPLEX 45 MIN O $414.00 $269.10 330184 97167 GO 270 434 OT EVAL HIGH COMPLEX 60 MIN O "$1,041.00 " $676.65 330184 97168 GO 270 434 OT RE-EVAL EST PLAN CARE O $350.00 $227.50 330184 97530 GP 269 420 PT-THERAPEUTIC ACTIVITIES O $172.99 $112.44 330184 97530 GO 269 430 OT-THERAPEUTIC ACTIVITIES O $172.99 $112.44 330184 97533 GO 430 OT-SENS INTEG EA 15 MINS O $84.00 $54.60 330184 97535 GP 493 420 PT-ADL TRAINING EA 5 MIN. O $139.65 $90.77 330184 97535 GO 493 430 OT-ADL TRAINING EA 15 MIN O $139.65 $90.77 330184 97542 GO 269 430 OT-WHEELCHAIR TRAINING EA O $89.00 $57.85 330184 97542 GP 269 420 PT WHEEL MGMT TRN O $89.00 $57.85 330184 97597 5051 17 510 Rmvl Devital Tis 20 Cm/< O $486.00 $315.90 330184 97598 18 510 Rmvl DevitalTisAddl20Cm O $14.70 $9.56 330184 97602 5051 510 NSW DEBRIDEM WO ANS / SESSION O $425.00 $276.25 330184 97605 5051 510 NEGTV PRESS WOUND TX<50CM O $425.00 $276.25 330184 97606 5052 510 NEGTV PRESS WOUND TX>50CM O $755.00 $490.75 330184 97750 GP 420 PT-PHYS PERFORM TEST W/RP O $96.00 $62.40 330184 97760 GP 269 420 PT-ORTHOTIC TRAINING EA 1 O $117.60 $76.44 330184 97760 GO 269 430 OT-ORTHOTIC TRAINING EA 1 O $117.60 $76.44 330184 97761 GP 269 420 PT-PROSTHETIC TRAINING EA O $97.00 $63.05 330184 97761 GO 269 430 OT-PROSTHETIC TRAINING EA O $97.00 $63.05 330184 97763 GP 269 420 PT-ORTHC/PROSTC MGMT SBSQ ENC-97763 O $150.15 $97.60 330184 97763 GO 269 430 OT-ORTHC/PROSTC MGMT SBSQ ENC-97763 O $150.15 $97.60 330184 97802 GQ 118 780 PHONE-MEDICAL NUTRITIONAL THERAPY-97802 O $149.10 $96.92 330184 97802 GT 118 780 VIDEO-MEDICAL NUTRITIONAL THERAPY-97802 O $149.10 $96.92 330184 97802 118 942 MEDICAL NUTRITIONAL THERA-97802 O $149.10 $96.92 330184 97803 GQ 118 780 PHONE-MEDICAL NUTRIT THPY REASS-97803 O $36.75 $23.89 330184 97803 GT 118 780 VIDEO-MEDICAL NUTRIT THPY REASS-97803 O $36.75 $23.89 330184 97803 118 942 MEDICAL NUTRITIONAL THERA-97803 O $36.75 $23.89 330184 97804 GQ 780 PHONE-GRP NUTRITION THERAPY ;EA-97804 O $19.00 $12.35 330184 97804 GT 780 VIDEO-GRP NUTRITION THERAPY ;EA-97804 O $19.00 $12.35 330184 97804 942 Med nutr thrpy; grp each-97804 O $19.00 $12.35 330184 97804 942 Group= 30 min-97804 O $19.00 $12.35 330184 98966 780 NON PHYS TELEPH ASSESSMENT 5-10 MIN-98966 O $99.00 $64.35 330184 98967 780 NON PHYS TELEPH ASSESSMENT 11-20 MIN-98967 O $220.00 $143.00 330184 98968 780 NON PHYS TELEPH ASSESSMENT 21-30 MIN-98968 O $278.00 $180.70 330184 99000 300 SPECIMEN HANDLING OFFICE-LAB-99000 O $10.00 $6.50 330184 99173 510 VISION TEST O $112.00 $72.80 330184 99195 5734 940 PHLEBOTOMY THERAPEUTIC-99195 O $336.53 $218.74 330184 99195 5734 940 PHLEBOTOMY THERAPEUTIC O $336.53 $218.74 330184 99195 5734 940 THERAPEUTIC PHLEBOTOMY O $336.53 $218.74 330184 99201 510 PRE-EMPLOYMENT PHYSICAL ASSESSMENT-99201 O $367.50 $238.88 330184 99201 510 SUTURE REMOVAL CLN-99201 O $32.00 $20.80 330184 99201 450 SUTURE REMOVAL ED-99201 O $97.00 $63.05 330184 99201 450 ER-TRIAGE-99201 O $0.01 $0.01 330184 99201 510 WOUND CHECK CLN-99201 O $32.00 $20.80 330184 99201 450 WOUND CHECK ER-99201 O $32.00 $20.80 330184 99201 GQ 780 PHONE-CLINIC LEVEL 1 NEW-99201 O $97.00 $63.05 330184 99201 GT 780 VIDEO-CLINIC LEVEL 1 NEW-99201 O $97.00 $63.05 330184 99201 510 ANTEPARTUM LAB NEW LEVEL 1-99201 O $211.00 $137.15 330184 99201 510 BARIATRIC SURG NEW LEVEL 1-99201 O $211.00 $137.15 330184 99201 510 BREAST CTR NEW LEVEL 1-99201 O $211.00 $137.15 330184 99201 510 INFECTIOUS DIS NEW LEVEL 1-99201 O $211.00 $137.15 330184 99201 25 510 ANTEP LAB NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 99201 25 510 BARTR SURG NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 99201 25 510 BRST CTR NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 99201 25 510 INFCT DIS NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 99201 510 SURGICAL CLINIC LEVEL 1 N O $97.00 $63.05 330184 99201 510 ORTHOPEDIC CLINIC LEVEL 1 O $97.00 $63.05 330184 99201 510 EYE CLINIC LEVEL 1 NEW O $32.00 $20.80 330184 99201 510 MEDICAT CLINIC LEVEL 1 NE O $97.00 $63.05 330184 99201 510 PEDIATRICS VIS LEVEL1 NEW O $32.00 $20.80 330184 99201 510 CARDIOLOGY CLINIC LEVEL 1 O $32.00 $20.80 330184 99201 510 HEMATOLOGY NEW O $32.00 $20.80 330184 99201 510 PRETEST COUSEL W/O BLOODW O $32.00 $20.80 330184 99201 510 G.I. CLINIC LEVEL 1 NEW O $32.00 $20.80 330184 99201 510 PODIATRY CLINIC LEVEL 1 N O $32.00 $20.80 330184 99201 510 PEDIATRIC CARDIOLOGY LEVE O $32.00 $20.80 330184 99201 510 PEDIATRIC HEMATOLOGY/ONC O $32.00 $20.80 330184 99201 510 RHEUMATOLOGY CLINIC LEVEL O $32.00 $20.80 330184 99201 510 Pediatric Surgery New Le O $32.00 $20.80 330184 99201 510 BREAST CLINIC LEVEL 1 NEW O $32.00 $20.80 330184 99201 513 Peds DvL Psch New Level 1 O $32.00 $20.80 330184 99201 510 PEDIATRIC VISIT LEV 1 NEW O $97.00 $63.05 330184 99201 510 ENDOCRINOLOGY CLINIC LEVE O $32.00 $20.80 330184 99201 510 NEUROLOGY CLINIC LEVEL 1 O $32.00 $20.80 330184 99201 510 UROLOGY CLINIC LEVEL 1 NE O $32.00 $20.80 330184 99201 510 PEDIATRICS VISIT LEVEL 1 O $32.00 $20.80 330184 99201 510 OB clinic level 1 New O $97.00 $63.05 330184 99201 510 GYN New Visit Level 1 O $97.00 $63.05 330184 99201 510 PULMONARY NEW VST LEVEL 1 O $32.00 $20.80 330184 99201 510 NEPHROLOGY NEW VT LEVEL 1 O $32.00 $20.80 330184 99201 510 SPINE CLNC LEVEL 1 NEW O $32.00 $20.80 330184 99201 580 GERIATRIC DAY CARE O $32.00 $20.80 330184 99201 580 Adult Day Care Trnspt Rnd O $32.00 $20.80 330184 99201 580 Adult Day Care Trnspt One O $32.00 $20.80 330184 99201 510 INFUSION SUITE NEW LEVEL 1 O $32.00 $20.80 330184 99201 25 510 INF SUITE NEW LEVEL 1W/ 25 MDF O $32.00 $20.80 330184 99201 510 DERM LEVEL 1 NEW O $32.00 $20.80 330184 99201 510 COLORECTAL CLNC LVL 1 NEW O $97.00 $63.05 330184 99201 510 ONCOLOGY NEW LEVEL 1 O $32.00 $20.80 330184 99201 25 510 CLINIC NEW LEVEL 1 W 25 MDF O $97.00 $63.05 330184 99202 GQ 780 PHONE-CLINIC LEVEL 2 NEW-99202 O $121.24 $78.81 330184 99202 GT 780 VIDEO-CLINIC LEVEL 2 NEW-99202 O $121.24 $78.81 330184 99202 510 ANTEPARTUM LAB NEW LEVEL 2-99202 O $318.00 $206.70 330184 99202 510 BARIATRIC SURG NEW LEVEL 2-99202 O $318.00 $206.70 330184 99202 510 BREAST CTR NEW LEVEL 2-99202 O $318.00 $206.70 330184 99202 510 INFECTIOUS DIS NEW LEVEL 2-99202 O $318.00 $206.70 330184 99202 25 510 ANTEP LAB NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 99202 25 510 BARTR SURG NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 99202 25 510 BRST CTR NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 99202 25 510 INFCT DIS NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 99202 510 PEDIATRIC SURGERY LEVEL 2 O $121.24 $78.81 330184 99202 510 PEDIATRIC CARDIOLOGY LEVE O $121.24 $78.81 330184 99202 510 PEDIATRIC HEMATOLOGY/ONCO O $121.24 $78.81 330184 99202 513 Peds Dvl Psch New Level 2 O $121.24 $78.81 330184 99202 510 MEDICAT CLINIC LEVEL 2 NE O $121.24 $78.81 330184 99202 510 ORTHOPEDIC CLINIC LEVEL 2 O $121.24 $78.81 330184 99202 510 PODIATRY CLINIC LEVEL 2 N O $121.24 $78.81 330184 99202 510 EYE CLINIC LEVEL 2 NEW O $121.24 $78.81 330184 99202 510 CARDIOLOGY CLINIC LEVEL 2 O $121.24 $78.81 330184 99202 510 NEUROLOGY CLINIC LEVEL 2 O $121.24 $78.81 330184 99202 510 SURGICAL CLINIC LEVEL 2 N O $121.24 $78.81 330184 99202 510 UROLOGY CLINIC LEVEL 2 NE O $121.24 $78.81 330184 99202 510 Rheumatolgoy Clinic Level O $121.24 $78.81 330184 99202 510 Dermatology Clinic Lvl2n O $121.24 $78.81 330184 99202 510 G.I. CLINIC LEVEL 2 NEW O $121.24 $78.81 330184 99202 510 BREAST CLINIC LEV 2 NEW O $121.24 $78.81 330184 99202 510 ENDOCRINOLOGY CLINIC LEVE O $121.24 $78.81 330184 99202 510 SPINE CLINIC LEVEL 2 NEW O $121.24 $78.81 330184 99202 510 PEDIATRICS VISIT LEVEL 2 O $121.24 $78.81 330184 99202 510 MEDICAL CLINIC LEVEL 2 NE O $121.24 $78.81 330184 99202 510 OB clinic level 2 New O $121.24 $78.81 330184 99202 510 MEDICAL CLNC LEVEL 2 NEW O $121.24 $78.81 330184 99202 510 GYN New Visit Level 2 O $121.24 $78.81 330184 99202 510 PULMONARY NEW VST LEVEL 2 O $121.24 $78.81 330184 99202 510 NEPHROLOGY NEW VT LEVEL 2 O $121.24 $78.81 330184 99202 510 INFUSION SUITE NEW LEVEL 2 O $121.24 $78.81 330184 99202 25 510 INF SUITE NEW LEVEL 2W/ 25 MDF O $121.24 $78.81 330184 99202 510 COLORECTAL CLNC LVL 2 NEW O $121.24 $78.81 330184 99202 510 ONCOLOGY NEW LEVEL 2 O $121.24 $78.81 330184 99202 25 510 CLINIC NEW LEVEL 2 W 25 MDF O $121.24 $78.81 330184 99202 510 CLIN NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 99202 25 510 CLN NEW VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 99202 25 510 CLN NEW(PBB) VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 99202 510 CLN NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 99202 GT 780 VID-CLN NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 99202 GT 780 VID-CLN NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 99202 25 510 ANTEP NEW(PBB) VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 99202 510 ANTEP NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 99202 25 510 ONC NEW VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 99202 510 ONC NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 99202 GT 780 VID-ANTEP NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 99202 GT 780 VID-ONC NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 99203 GQ 780 PHONE-CLINIC LEVEL 3 NEW-99203 O $151.56 $98.51 330184 99203 GT 780 VIDEO-CLINIC LEVEL 3 NEW-99203 O $151.56 $98.51 330184 99203 510 ANTEPARTUM LAB NEW LEVEL 3-99203 O $337.00 $219.05 330184 99203 510 BARIATRIC SURG NEW LEVEL 3-99203 O $337.00 $219.05 330184 99203 510 BREAST CTR NEW LEVEL 3-99203 O $337.00 $219.05 330184 99203 510 INFECTIOUS DIS NEW LEVEL 3-99203 O $337.00 $219.05 330184 99203 25 510 ANTEP LAB NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 99203 25 510 BARTR SURG NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 99203 25 510 BRST CTR NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 99203 25 510 INFCT DIS NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 99203 510 PEDIATRIC SURGERY LEVEL 3 O $151.56 $98.51 330184 99203 510 PEDIATRIC CARDIOLOGY LEVE O $151.56 $98.51 330184 99203 510 PEDIATRIC HEMATOLOGY/ONCO O $151.56 $98.51 330184 99203 513 Peds Dvl Psch New Level 3 O $151.56 $98.51 330184 99203 510 MEDICAL CLINIC LEVEL 3 NE O $151.56 $98.51 330184 99203 510 ORTHOPEDIC CLINIC LEVEL 3 O $151.56 $98.51 330184 99203 510 PODIATRY CLINIC LEVEL 3 N O $151.56 $98.51 330184 99203 510 EYE CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 99203 510 CARDIOLOGY CLINIC LEVEL 3 O $151.56 $98.51 330184 99203 510 NEUROLOGY CLINIC LEVEL 3 O $151.56 $98.51 330184 99203 510 SURGICAL CLINIC LEVEL 3 N O $151.56 $98.51 330184 99203 510 UROLOGY CLINIC LEVEL 3 NE O $151.56 $98.51 330184 99203 510 RHEUMATOLOGY CLINIC LEVEL O $151.56 $98.51 330184 99203 510 ENT Clinic Level 3 New O $151.56 $98.51 330184 99203 510 G.I. CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 99203 510 BREAST CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 99203 510 ENDOCRINOLOGY CLINIC LEVE O $151.56 $98.51 330184 99203 510 SPINE CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 99203 510 PEDIATRICS VISIT LEVEL 3 O $151.56 $98.51 330184 99203 510 PEDIATRICS CLINIC LEVEL O $151.56 $98.51 330184 99203 510 OB clinic level 3 New O $151.56 $98.51 330184 99203 510 GYN New Visit Level 3 O $151.56 $98.51 330184 99203 510 PULMONARY NEW VST LEVEL 3 O $151.56 $98.51 330184 99203 510 NEPHROLOGY NEW VT LEVEL 3 O $151.56 $98.51 330184 99203 510 INFUSION SUITE NEW LEVEL 3 O $151.56 $98.51 330184 99203 25 510 INF SUITE NEW LEVEL 3W/ 25 MDF O $151.56 $98.51 330184 99203 510 DERM LEVEL 3 NEW O $151.56 $98.51 330184 99203 510 COLORECTAL CLNC LVL 3 NEW O $151.56 $98.51 330184 99203 510 ONCOLOGY NEW LEVEL 3 O $151.56 $98.51 330184 99203 25 510 CLINIC NEW LEVEL 3 W 25 MDF O $151.56 $98.51 330184 99203 510 CLIN NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 99203 25 510 CLN NEW VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 99203 25 510 CLN NEW(PBB) VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 99203 510 CLN NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 99203 GT 780 VID-CLN NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 99203 GT 780 VID-CLN NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 99203 25 510 ANTEP NEW(PBB) VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 99203 510 ANTEP NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 99203 25 510 ONC NEW VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 99203 510 ONC NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 99203 GT 780 VID-ANTEP NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 99203 GT 780 VID-ONC NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 99204 GQ 780 PHONE-CLINIC LEVEL 4 NEW-99204 O $189.44 $123.14 330184 99204 GT 780 VIDEO-CLINIC LEVEL 4 NEW-99204 O $189.44 $123.14 330184 99204 510 ANTEPARTUM LAB NEW LEVEL 4-99204 O $385.00 $250.25 330184 99204 510 BARIATRIC SURG NEW LEVEL 4-99204 O $385.00 $250.25 330184 99204 510 BREAST CTR NEW LEVEL 4-99204 O $385.00 $250.25 330184 99204 510 INFECTIOUS DIS NEW LEVEL 4-99204 O $385.00 $250.25 330184 99204 25 510 ANTEP LAB NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 99204 25 510 BARTR SURG NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 99204 25 510 BRST CTR NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 99204 25 510 INFCT DIS NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 99204 510 Pediatric Surgery New Le O $189.44 $123.14 330184 99204 510 PEDIATRIC CARDIOLOGY LEVE O $189.44 $123.14 330184 99204 510 PEDIATRIC HEMATOLOGY/ONCO O $189.44 $123.14 330184 99204 513 Peds Dvl Psch New Level 4 O $189.44 $123.14 330184 99204 510 MEDICAL CLINIC LEVEL 4 NE O $189.44 $123.14 330184 99204 510 ORTHOPEDIC CLINIC LEVEL 4 O $189.44 $123.14 330184 99204 510 PODIATRY CLINIC LEVEL 4 N O $189.44 $123.14 330184 99204 510 EYE CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 99204 510 CARDIOLOGY CLINIC LEVEL 4 O $189.44 $123.14 330184 99204 510 NEUROLOGY CLINIC LEVEL 4 O $189.44 $123.14 330184 99204 510 SURGICAL CLINIC LEVEL 4 N O $189.44 $123.14 330184 99204 510 UROLOGY CLINIC LEVEL 4 NE O $189.44 $123.14 330184 99204 510 RHEUMATOLOGY CLINIC LEVEL O $189.44 $123.14 330184 99204 510 G.I. CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 99204 510 BREAST CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 99204 510 ENDOCRINOLOGY CLINIC LEVE O $189.44 $123.14 330184 99204 510 SPINE CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 99204 510 PEDIATRICS VISIT LEVEL 4 O $189.44 $123.14 330184 99204 510 SOCIAL WORK PRENATAL VISI O $189.44 $123.14 330184 99204 510 Gyn New Visit O $189.44 $123.14 330184 99204 510 OB clinic level 4 New O $189.44 $123.14 330184 99204 510 SOCIAL WORK VISIT PRENATA O $189.44 $123.14 330184 99204 510 GYN New Visit Level 4 O $189.44 $123.14 330184 99204 510 PULMONARY NEW VST LEVEL 4 O $189.44 $123.14 330184 99204 510 NEPHROLOGY NEW VT LEVEL 4 O $189.44 $123.14 330184 99204 510 MEDICAL CLNC LEVEL 4 NEW O $189.44 $123.14 330184 99204 510 INFUSION SUITE NEW LEVEL 4 O $189.44 $123.14 330184 99204 25 510 INF SUITE NEW LEVEL 4W/ 25 MDF O $189.44 $123.14 330184 99204 510 DERM LEVEL 4 NEW O $189.44 $123.14 330184 99204 510 COLORECTAL CLNC LVL 4 NEW O $189.44 $123.14 330184 99204 510 ONCOLOGY NEW LEVEL 4 O $189.44 $123.14 330184 99204 25 510 CLINIC NEW LEVEL 4 W 25 MDF O $189.44 $123.14 330184 99204 510 CLIN NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 99204 25 510 CLN NEW VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 99204 25 510 CLN NEW(PBB) VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 99204 510 CLN NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 99204 GT 780 VID-CLN NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 99204 GT 780 VID-CLN NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 99204 25 510 ANTEP NEW(PBB) VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 99204 510 ANTEP NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 99204 25 510 ONC NEW VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 99204 510 ONC NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 99204 GT 780 VID-ANTEP NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 99204 GT 780 VID-ONC NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 99205 GQ 780 PHONE-CLINIC LEVEL 5 NEW-99205 O $236.81 $153.93 330184 99205 GT 780 VIDEO-CLINIC LEVEL 5 NEW-99205 O $236.81 $153.93 330184 99205 510 ANTEPARTUM LAB NEW LEVEL 5-99205 O $493.00 $320.45 330184 99205 510 BARIATRIC SURG NEW LEVEL 5-99205 O $493.00 $320.45 330184 99205 510 BREAST CTR NEW LEVEL 5-99205 O $493.00 $320.45 330184 99205 510 INFECTIOUS DIS NEW LEVEL 5-99205 O $493.00 $320.45 330184 99205 25 510 ANTEP LAB NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 99205 25 510 BARTR SURG NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 99205 25 510 BRST CTR NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 99205 25 510 INFCT DIS NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 99205 510 Initial New Pren Vi 1St T O $236.81 $153.92 330184 99205 510 Pediatric Surgery New Lev O $236.81 $153.92 330184 99205 510 PEDIATRIC HEMATOLOGY/ONCO O $236.81 $153.92 330184 99205 510 PEDIATRIC CARDIOLOGY LEVE O $236.81 $153.92 330184 99205 513 Peds Dvl Psch New Level 5 O $236.81 $153.92 330184 99205 510 MEDICAT CLINIC LEVEL 5 NE O $236.81 $153.92 330184 99205 510 ORTHOPEDIC CLINIC LEVEL 5 O $236.81 $153.92 330184 99205 510 PODIATRY CLINIC LEVEL 5 N O $236.81 $153.92 330184 99205 510 EYE CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 99205 510 CARDIOLOGY CLINIC LEVEL 5 O $236.81 $153.92 330184 99205 510 NEUROLOGY CLINIC LEVEL 5 O $236.81 $153.92 330184 99205 510 SURGICAL CLINIC LEVEL 5 N O $236.81 $153.92 330184 99205 510 UROLOGY CLINIC LEVEL 5 NE O $236.81 $153.92 330184 99205 510 Rheumatolgoy Clinic Level O $236.81 $153.92 330184 99205 510 G.I. CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 99205 510 BREAST CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 99205 510 Endocrinte New Level 5 O $236.81 $153.92 330184 99205 510 SPINE CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 99205 510 PEDIATRICS VISIT LEV 5 NE O $236.81 $153.92 330184 99205 510 OB clinic level 5 New O $236.81 $153.92 330184 99205 510 Initial New Pren 2Nd Tri O $236.81 $153.92 330184 99205 510 Init New Prenat 3Rd Tri O $236.81 $153.92 330184 99205 510 GYN New Visit Level 5 O $236.81 $153.92 330184 99205 510 PULMONARY NEW VST LEVEL 5 O $236.81 $153.92 330184 99205 510 NEPHROLOGY NEW VT LEVEL 5 O $236.81 $153.92 330184 99205 510 MEDICAL CLNC LEVEL 5 NEW O $236.81 $153.92 330184 99205 510 INFUSION SUITE NEW LEVEL 5 O $236.81 $153.92 330184 99205 25 510 INF SUITE NEW LEVEL 5W/ 25 MDF O $236.81 $153.92 330184 99205 510 DERM LEVEL 5 NEW O $236.81 $153.92 330184 99205 510 COLORECTAL CLNC LVL 5 NEW O $236.81 $153.92 330184 99205 510 ONCOLOGY NEW LEVEL 5 O $236.81 $153.92 330184 99205 25 510 CLINIC NEW LEVEL 5 W 25 MDF O $236.81 $153.92 330184 99205 510 CLIN NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 99205 25 510 CLN NEW VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 99205 25 510 CLN NEW(PBB) VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 99205 510 CLN NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 99205 GT 780 VID-CLN NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 99205 GT 780 VID-CLN NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 99205 25 510 ANTEP NEW(PBB) VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 99205 510 ANTEP NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 99205 25 510 ONC NEW VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 99205 510 ONC NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 99205 GT 780 VID-ANTEP NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 99205 GT 780 VID-ONC NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 99211 491 510 ANNUAL ASSESSMENT-99211 O $283.50 $184.28 330184 99211 GQ 491 780 PHONE-CLINIC LEVEL 1 ESTBL-99211 O $74.61 $48.50 330184 99211 GT 491 780 VIDEO-CLINIC LEVEL 1 ESTBL-99211 O $74.61 $48.50 330184 99211 491 510 ANTEPARTUM LAB ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 99211 491 510 BARIATRIC SURG ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 99211 491 510 BREAST CTR ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 99211 491 510 INFECTIOUS DIS ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 99211 25 491 510 ANTEP LAB ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 99211 25 491 510 BARTR SURG ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 99211 25 491 510 BRST CTR ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 99211 25 491 510 INFCT DIS ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 99211 491 510 SURGICAL CLINIC LEVEL 1 E O $170.00 $110.50 330184 99211 491 510 ORTHOPEDIC LEVEL 1 ESTABL O $74.61 $48.50 330184 99211 491 510 EYE CLINIC LEVEL 1 ESTABL O $170.00 $110.50 330184 99211 491 510 MEDICAL CLINIC LEVEL 1 ES O $74.61 $48.50 330184 99211 491 510 PEDIATRICS VISIT LEVEL 1 O $74.61 $48.50 330184 99211 491 510 ENDOCRINOLOGY CLINIC LEVE O $170.00 $110.50 330184 99211 491 510 CARDIOLOGY CLINIC LEVEL 1 O $170.00 $110.50 330184 99211 491 510 HEMATOLOGY REVISIT O $170.00 $110.50 330184 99211 491 510 PERIPHERI VASC REVISIT O $170.00 $110.50 330184 99211 491 510 TB CHEST REVISIT O $170.00 $110.50 330184 99211 491 510 UROLOGY CLINIC LEVEL 1 ES O $170.00 $110.50 330184 99211 491 510 G.I. CLINIC LEVEL 1 ESTAB O $74.61 $48.50 330184 99211 491 510 PODIATRY CLINIC LEVEL 1 E O $74.61 $48.50 330184 99211 491 510 PEDIATRIC CARDIOLOGY LEVE O $170.00 $110.50 330184 99211 491 510 PEDS HEMATOLOGY/ONCOLOGY O $170.00 $110.50 330184 99211 491 510 Adolescent Clinic Lvl1Es O $170.00 $110.50 330184 99211 491 510 RHEUMATOLOGY CLINIC LEVEL O $170.00 $110.50 330184 99211 491 510 PEDIATRIC SURGERY LEVEL 1 O $74.61 $48.50 330184 99211 491 510 BREAST CLINIC LEVEL 1 EST O $170.00 $110.50 330184 99211 491 513 Peds Dvl Psch EST Level 1 O $74.61 $48.50 330184 99211 491 510 NUTRITIONAL CONSULTATION O $170.00 $110.50 330184 99211 491 510 ROUTINE FOLLOW UP VISIT O $170.00 $110.50 330184 99211 491 510 SURGICAL CLINIC LEVEL 1 E O $74.61 $48.50 330184 99211 491 510 NEUROLOGY CLINIC LEVEL 1 O $74.61 $48.50 330184 99211 491 510 CLINIC CONSULT LEVEL 1 O $170.00 $110.50 330184 99211 491 510 NUTRITIONAL COUNS PRENATA O $170.00 $110.50 330184 99211 491 510 OB clinic level 1 Estb O $74.61 $48.50 330184 99211 491 510 NUTRITION CONS PRENATAL O $170.00 $110.50 330184 99211 491 510 POST TEST COUSELING LIMIT O $170.00 $110.50 330184 99211 491 510 GYN Established Visit Lev O $74.61 $48.50 330184 99211 491 510 PULMONARY EST VST LEVEL 1 O $170.00 $110.50 330184 99211 491 510 NEPHROLOGY EST VT LEVEL 1 O $170.00 $110.50 330184 99211 491 510 SPINE CLNC LEVEL 1 ESTAB O $170.00 $110.50 330184 99211 491 510 INSULIN PUMP TRNG 30 MINS O $74.61 $48.50 330184 99211 491 510 INSULIN PUMP TRAINING F/U O $170.00 $110.50 330184 99211 491 510 NUTRTN CARB CNCL PMP 30M O $170.00 $110.50 330184 99211 491 510 INFUSION SUITE ESTB LEVEL 1 O $74.61 $48.50 330184 99211 25 491 510 INF SUITE ESTB LEVEL 1W/ 25 MDF O $74.61 $48.50 330184 99211 491 510 DERM LEVEL 1 ESTB O $170.00 $110.50 330184 99211 491 510 COLORECTAL CLNC LVL 1 EST O $74.61 $48.50 330184 99211 491 510 ONCOLOGY ESTB LEVEL 1 O $74.61 $48.50 330184 99211 25 491 510 CLINIC ESTB LEVEL 1 W 25 MDF O $74.61 $48.50 330184 99211 25 491 510 CLIN EST VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 99211 491 510 CLIN EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 99211 25 491 510 CLN EST(PBB) VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 99211 491 510 CLN EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 99211 GT 491 780 VID-CLN EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 99211 GT 491 780 VID-CLN EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 99211 25 491 510 ANTEP EST(PBB) VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 99211 491 510 ANTEP EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 99211 25 491 510 ONC EST VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 99211 491 510 ONC EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 99211 GT 491 780 VID-ANTEP EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 99211 GT 491 780 VID-ONC EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 99212 GQ 491 780 PHONE-CLINIC LEVEL 2 ESTBL-99212 O $93.26 $60.62 330184 99212 GT 491 780 VIDEO-CLINIC LEVEL 2 ESTBL-99212 O $93.26 $60.62 330184 99212 491 510 ANTEPARTUM LAB ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 99212 491 510 BARIATRIC SURG ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 99212 491 510 BREAST CTR ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 99212 491 510 INFECTIOUS DIS ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 99212 25 491 510 ANTEP LAB ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 99212 25 491 510 BARTR SURG ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 99212 25 491 510 BRST CTR ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 99212 25 491 510 INFCT DIS ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 99212 491 510 PEDIATRIC SURGERY LEVEL 2 O $93.26 $60.62 330184 99212 491 510 PEDIATRIC CARDIOLOGY LEVE O $93.26 $60.62 330184 99212 491 510 PEDIATRIC HEMATOLOGY/ONCO O $93.26 $60.62 330184 99212 491 513 Peds Dvl Psch EST Level 2 O $93.26 $60.62 330184 99212 491 510 MEDICAL CLINIC LEVEL 2 ES O $93.26 $60.62 330184 99212 491 510 ORTHOPEDIC CLINIC LEVEL 2 O $93.26 $60.62 330184 99212 491 510 PODIATRY CLINIC LEVEL 2 E O $93.26 $60.62 330184 99212 491 510 EYE CLINIC LEVEL 2 ESTABL O $93.26 $60.62 330184 99212 491 510 CARDIOLOGY CLINIC LEVEL 2 O $93.26 $60.62 330184 99212 491 510 NEUROLOGY CLINIC LEVEL 2 O $93.26 $60.62 330184 99212 491 510 SURGICAL CLINIC LEVEL 2 E O $93.26 $60.62 330184 99212 491 510 UROLOGY CLINIC LEVEL 2 ES O $93.26 $60.62 330184 99212 491 510 RHEUMATOLOGY CLINI LEVEL O $93.26 $60.62 330184 99212 491 510 Dermatology Clinic Lvl 2 O $93.26 $60.62 330184 99212 491 510 G.I. CLINIC LEVEL 2 ESTAB O $93.26 $60.62 330184 99212 491 510 BREAST CLINIC LEVEL 2 EST O $93.26 $60.62 330184 99212 491 510 ENDOCRINOLOGY CLINIC LEVE O $93.26 $60.62 330184 99212 491 510 SPINE CLINIC LEVEL 2 EST O $93.26 $60.62 330184 99212 491 510 PEDIATRICS VISIT LEVEL 2 O $93.26 $60.62 330184 99212 491 510 PEDIATRICS CLINIC LEVEL 2 O $93.26 $60.62 330184 99212 491 510 HEMATOLOGY LEVEL 2 EST O $93.26 $60.62 330184 99212 491 510 OB clinic level 2 Estb O $93.26 $60.62 330184 99212 491 510 GYN Established Visit Lev O $93.26 $60.62 330184 99212 491 510 PULMONARY EST VST LEVEL 2 O $93.26 $60.62 330184 99212 491 510 NEPHROLOGY EST VT LEVEL 2 O $93.26 $60.62 330184 99212 491 510 INFUSION SUITE ESTB LEVEL 2 O $93.26 $60.62 330184 99212 25 491 510 INF SUITE ESTB LEVEL 2W/ 25 MDF O $93.26 $60.62 330184 99212 491 510 COLORECTAL CLNC LVL 2 EST O $93.26 $60.62 330184 99212 491 510 ONCOLOGY ESTB LEVEL 2 O $93.26 $60.62 330184 99212 25 491 510 CLINIC ESTB LEVEL 2 W 25 MDF O $93.26 $60.62 330184 99212 25 491 510 CLIN EST VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 99212 491 510 CLIN EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 99212 25 491 510 CLN EST(PBB) VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 99212 491 510 CLN EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 99212 GT 491 780 VID-CLN EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 99212 GT 491 780 VID-CLN EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 99212 25 491 510 ANTEP EST(PBB) VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 99212 491 510 ANTEP EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 99212 25 491 510 ONC EST VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 99212 491 510 ONC EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 99212 GT 491 780 VID-ANTEP EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 99212 GT 491 780 VID-ONC EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 99213 GQ 491 780 PHONE-CLINIC LEVEL 1 ESTBL-99213 O $116.58 $75.78 330184 99213 GT 491 780 VIDEO-CLINIC LEVEL 1 ESTBL-99213 O $116.58 $75.78 330184 99213 491 510 ANTEPARTUM LAB ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 99213 491 510 BARIATRIC SURG ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 99213 491 510 BREAST CTR ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 99213 491 510 INFECTIOUS DIS ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 99213 25 491 510 ANTEP LAB ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 99213 25 491 510 BARTR SURG ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 99213 25 491 510 BRST CTR ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 99213 25 491 510 INFCT DIS ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 99213 491 510 PEDIATRIC SURGERY LEVEL 3 O $116.58 $75.78 330184 99213 491 510 PEDIATRIC CARDIOLOGY LEVE O $116.58 $75.78 330184 99213 491 510 PEDIATRIC HEMATOLOGY/ONCO O $116.58 $75.78 330184 99213 491 513 PED DEVEL PSYCH EST LVL 3 O $116.58 $75.78 330184 99213 491 510 MEDICAL CLINIC LEVEL 3 ES O $116.58 $75.78 330184 99213 491 510 ORTHOPEDIC CLINIC LEVEL 3 O $116.58 $75.78 330184 99213 491 510 PODIATRY CLINIC LEVEL 3 E O $116.58 $75.78 330184 99213 491 510 EYE CLINIC LEVEL 3 ESTABL O $116.58 $75.78 330184 99213 491 510 CARDIOLOGY CLINIC LEVEL 3 O $116.58 $75.78 330184 99213 491 510 NEUROLOGY CLINIC LEVEL 3 O $116.58 $75.78 330184 99213 491 510 SURGICAL CLINIC LEVEL 3 E O $116.58 $75.78 330184 99213 491 510 UROLOGY CLINIC LEVEL 3 ES O $116.58 $75.78 330184 99213 491 510 RHEUMATOLOGY CLINIC LEVEL O $116.58 $75.78 330184 99213 491 510 G.I. CLINIC LEVEL 3 ESTAB O $116.58 $75.78 330184 99213 491 510 BREAST CLINIC LEVEL 3 EST O $116.58 $75.78 330184 99213 491 510 ENDOCRINOLOGY CLINIC LEVE O $116.58 $75.78 330184 99213 491 510 SPINE CLINIC LEVEL 3 EST O $116.58 $75.78 330184 99213 491 510 OB clinic level 3 Estb O $116.58 $75.78 330184 99213 491 510 PEDIATRICS VISIT LEVEL 3 O $116.58 $75.78 330184 99213 491 510 ONCOLOGY CLINIC LEVEL 3 E O $116.58 $75.78 330184 99213 491 510 MEDICAL CLINIC LEVEL 3 S O $116.58 $75.78 330184 99213 491 510 PEDIATRICS CLINIC LEVEL 3 O $116.58 $75.78 330184 99213 491 510 GYN Established Visit Lev O $116.58 $75.78 330184 99213 491 510 PULMONARY EST VST LEVEL 3 O $116.58 $75.78 330184 99213 491 510 NEPHROLOGY EST VT LEVEL 3 O $116.58 $75.78 330184 99213 491 510 INFUSION SUITE ESTB LEVEL 3 O $116.58 $75.78 330184 99213 25 491 510 INF SUITE ESTB LEVEL 3W/ 25 MDF O $116.58 $75.78 330184 99213 491 510 DERM LEVEL 3 ESTB O $116.58 $75.78 330184 99213 491 510 COLORECTAL CLNC LVL 3 EST O $116.58 $75.78 330184 99213 491 510 ONCOLOGY ESTB LEVEL 3 O $116.58 $75.78 330184 99213 25 491 510 CLINIC ESTB LEVEL 3 W 25 MDF O $116.58 $75.78 330184 99213 25 491 510 CLIN EST VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 99213 491 510 CLIN EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 99213 25 491 510 CLN EST(PBB) VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 99213 491 510 CLN EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 99213 GT 491 780 VID-CLN EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 99213 GT 491 780 VID-CLN EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 99213 25 491 510 ANTEP EST(PBB) VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 99213 491 510 ANTEP EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 99213 25 491 510 ONC EST VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 99213 491 510 ONC EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 99213 GT 491 780 VID-ANTEP EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 99213 GT 491 780 VID-ONC EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 99214 GQ 491 780 PHONE-CLINIC LEVEL 4 ESTBL-99214 O $145.73 $94.72 330184 99214 GT 491 780 VIDEO-CLINIC LEVEL 4 ESTBL-99214 O $145.73 $94.72 330184 99214 491 510 ANTEPARTUM LAB ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 99214 491 510 BARIATRIC SURG ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 99214 491 510 BREAST CTR ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 99214 491 510 INFECTIOUS DIS ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 99214 25 491 510 ANTEP LAB ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 99214 25 491 510 BARTR SURG ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 99214 25 491 510 BRST CTR ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 99214 25 491 510 INFCT DIS ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 99214 491 510 PEDIATRIC SURGERY LEVEL 4 O $145.73 $94.72 330184 99214 491 510 PEDIATRIC CARDIOLOGY LEVE O $145.73 $94.72 330184 99214 491 510 PEDIATRIC HEMATOLOGY/ONCO O $145.73 $94.72 330184 99214 491 513 Peds Dvl Psch EST Level 4 O $145.73 $94.72 330184 99214 491 510 MEDICAL CLINIC LEVEL 4 ES O $145.73 $94.72 330184 99214 491 510 ORTHOPEDIC CLINIC LEVEL 4 O $145.73 $94.72 330184 99214 491 510 PODIATRY CLINIC LEVEL 4 E O $145.73 $94.72 330184 99214 491 510 EYE CLINIC LEVEL 4 ESTABL O $145.73 $94.72 330184 99214 491 510 CARDIOLOGY CLINIC LEVEL 4 O $145.73 $94.72 330184 99214 491 510 NEUROLOGY CLINIC LEVEL 4 O $145.73 $94.72 330184 99214 491 510 SURGICAL CLINIC LEVEL 4 E O $145.73 $94.72 330184 99214 491 510 UROLOGY CLINIC LEVEL 4 ES O $145.73 $94.72 330184 99214 491 510 RHEUMATOLOGY CLINIC LEVEL O $145.73 $94.72 330184 99214 491 510 G.I. CLINIC LEVEL 4 NEW E O $145.73 $94.72 330184 99214 491 510 BREAST CLINIC LEVEL 4 EST O $145.73 $94.72 330184 99214 491 510 ENDOCRINOLOGY CLINIC LEVE O $145.73 $94.72 330184 99214 491 510 SPINE CLINIC LEVEL 4 EST O $145.73 $94.72 330184 99214 491 510 PEDIATRICS VISIT LEVEL 4 O $145.73 $94.72 330184 99214 491 510 PEDIATRICS CLINIC LEVEL O $145.73 $94.72 330184 99214 491 510 OB clinic level 4 Estb O $145.73 $94.72 330184 99214 491 510 GYN Established Visit Lev O $145.73 $94.72 330184 99214 491 510 PULMONARY EST VST LEVEL 4 O $145.73 $94.72 330184 99214 491 510 NEPHROLOGY EST VT LEVEL 4 O $145.73 $94.72 330184 99214 491 510 INFUSION SUITE ESTB LEVEL 4 O $145.73 $94.72 330184 99214 25 491 510 INF SUITE ESTB LEVEL 4W/ 25 MDF O $145.73 $94.72 330184 99214 491 510 DERM LEVEL 4 ESTB O $145.73 $94.72 330184 99214 491 510 COLORECTAL CLNC LVL 4 EST O $145.73 $94.72 330184 99214 491 510 ONCOLOGY ESTB LEVEL 4 O $145.73 $94.72 330184 99214 25 491 510 CLINIC ESTB LEVEL 4 W 25 MDF O $145.73 $94.72 330184 99214 25 491 510 CLIN EST VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 99214 491 510 CLIN EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 99214 25 491 510 CLN EST(PBB) VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 99214 491 510 CLN EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 99214 GT 491 780 VID-CLN EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 99214 GT 491 780 VID-CLN EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 99214 25 491 510 ANTEP EST(PBB) VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 99214 491 510 ANTEP EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 99214 25 491 510 ONC EST VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 99214 491 510 ONC EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 99214 GT 491 780 VID-ANTEP EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 99214 GT 491 780 VID-ONC EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 99215 GQ 491 780 PHONE-CLINIC LEVEL 5 ESTBL-99215 O $182.16 $118.40 330184 99215 GT 491 780 VIDEO-CLINIC LEVEL 5 ESTBL-99215 O $182.16 $118.40 330184 99215 491 510 ANTEPARTUM LAB ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 99215 491 510 BARIATRIC SURG ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 99215 491 510 BREAST CTR ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 99215 491 510 INFECTIOUS DIS ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 99215 25 491 510 ANTEP LAB ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 99215 25 491 510 BARTR SURG ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 99215 25 491 510 BRST CTR ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 99215 25 491 510 INFCT DIS ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 99215 491 510 PEDIATRIC SURGERY LEVEL 5 O $182.16 $118.40 330184 99215 491 510 PEDIATRIC HEMATOLOGY/ONC O $182.16 $118.40 330184 99215 491 510 PEDIATRIC CARDIOLOGY LEVE O $182.16 $118.40 330184 99215 491 513 Peds Dvl Psch EST Level 5 O $182.16 $118.40 330184 99215 491 510 MEDICAL CLINIC LEVEL 5 ES O $182.16 $118.40 330184 99215 491 510 ORTHOPEDIC CLINIC LEVEL 5 O $182.16 $118.40 330184 99215 491 510 PODIATRY CLINIC LEVEL 5 E O $182.16 $118.40 330184 99215 491 510 EYE CLINIC LEVEL 5 ESTABL O $182.16 $118.40 330184 99215 491 510 CARDIOLOGY CLINIC LEVEL 5 O $182.16 $118.40 330184 99215 491 510 NEUROLOGY CLINIC LEVEL 5 O $182.16 $118.40 330184 99215 491 510 SURGICAL CLINIC LEVEL 5 E O $182.16 $118.40 330184 99215 491 510 UROLOGY CLINIC LEVEL 5 ES O $182.16 $118.40 330184 99215 491 510 RHEUMATOLOGY CLINIC LEVEL O $182.16 $118.40 330184 99215 491 510 G.I. CLINIC LEVEL 5 ESTAB O $182.16 $118.40 330184 99215 491 510 BREAST CLINIC LEVEL 5 EST O $182.16 $118.40 330184 99215 491 510 ENDOCRINOLOGY CLINIC LEVE O $182.16 $118.40 330184 99215 491 510 SPINE CLINIC LEVEL 5 EST O $182.16 $118.40 330184 99215 491 510 PEDIATRICS VISIT LEVEL 5 O $182.16 $118.40 330184 99215 491 510 OB clinic level 5 Estb O $182.16 $118.40 330184 99215 491 510 GYN Established Visit Lev O $182.16 $118.40 330184 99215 491 510 Initial Estab Prena 1St T O $182.16 $118.40 330184 99215 491 510 Initial Estab Prena 2Nd T O $182.16 $118.40 330184 99215 491 510 PULMONARY EST VST LEVEL 5 O $182.16 $118.40 330184 99215 491 510 NEPHROLOGY EST VT LEVEL 5 O $182.16 $118.40 330184 99215 491 510 INFUSION SUITE ESTB LEVEL 5 O $182.16 $118.40 330184 99215 25 491 510 INF SUITE ESTB LEVEL 5W/ 25 MDF O $182.16 $118.40 330184 99215 491 510 DERM LEVEL 5 ESTB O $182.16 $118.40 330184 99215 491 510 COLORECTAL CLNC LVL 5 EST O $182.16 $118.40 330184 99215 491 510 ONCOLOGY ESTB LEVEL 5 O $182.16 $118.40 330184 99215 25 491 510 CLINIC ESTB LEVEL 5 W 25 MDF O $182.16 $118.40 330184 99215 25 491 510 CLIN EST VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 99215 491 510 CLIN EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 99215 25 491 510 CLN EST(PBB) VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 99215 491 510 CLN EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 99215 GT 491 780 VID-CLN EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 99215 GT 491 780 VID-CLN EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 99215 25 491 510 ANTEP EST(PBB) VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 99215 491 510 ANTEP EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 99215 25 491 510 ONC EST VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 99215 491 510 ONC EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 99215 GT 491 780 VID-ANTEP EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 99215 GT 491 780 VID-ONC EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 99241 510 Office Consultation Level O $412.00 $267.80 330184 99242 510 Office Consultation Level O $412.00 $267.80 330184 99243 510 Office Consultation Level O $412.00 $267.80 330184 99244 510 Office Consultation Level O $412.00 $267.80 330184 99245 510 Office Consultation Level O $412.00 $267.80 330184 99281 5021 491 450 ER - MINOR O $354.14 $230.19 330184 99281 25 5021 491 450 ER MINOR W MOD O $354.14 $230.19 330184 99282 5022 491 450 ER VISIT - SIMPLE O $452.55 $294.16 330184 99282 25 5022 491 450 ER SIMPLE W MOD O $452.55 $294.16 330184 99282 5022 491 450 EMERGENCY ROOM FEE O $452.55 $294.16 330184 99283 5023 491 450 ER VISIT - INTERMEDIATE O $867.30 $563.75 330184 99283 25 5023 491 450 ER INTERMEDIATE W MOD O $867.30 $563.75 330184 99284 5024 491 450 ER VISIT - COMPLEX O "$1,354.50 " $880.43 330184 99284 25 5024 491 450 ER VISIT COMPLEX WITH MOD O "$1,354.50 " $880.43 330184 99285 5025 491 450 ER VISIT - MAJOR O "$1,942.50 " "$1,262.62 " 330184 99285 25 5025 491 450 ER MAJOR W MOD O "$1,942.50 " "$1,262.62 " 330184 99285 25 5025 491 450 ER VISIT MAJOR WITH MODIF O "$1,942.50 " "$1,262.62 " 330184 99291 5041 491 450 CRITICAL CARE UP TO 75 MI O "$2,183.16 " "$1,419.05 " 330184 99291 25 5041 491 450 ER VISIT CRITICAL CARE W/ O "$2,183.16 " "$1,419.05 " 330184 99291 5041 491 450 ER CRITICAL CARE-30 TO 74 O "$2,183.16 " "$1,419.05 " 330184 99292 491 450 99292 CRITICAL CARE ADDIT O "$1,156.00 " $751.40 330184 99354 510 Prolonged Service Office O $264.00 $171.60 330184 99355 510 Prolonged Service Office O $126.00 $81.90 330184 99381 25 510 INIT PM E/M NEW PAT INFANT-99381-25 O $277.20 $180.18 330184 99381 510 WELL BABY (0-1) O $277.20 $180.18 330184 99382 25 510 INIT PM E/M NEW PAT 1-4 YRS-99382-25 O $311.85 $202.70 330184 99382 510 WELL CHILD (1-4) O $311.85 $202.70 330184 99383 25 510 PREV VISIT NEW AGE 5-11-99383-25 O $347.55 $225.91 330184 99383 510 WELL CHILD (5-11) O $347.55 $225.91 330184 99383 510 WELL CHILD (5-11) NEW O $347.55 $225.91 330184 99384 25 510 PREV VISIT NEW AGE 12-17-99384-25 O $382.20 $248.43 330184 99384 510 WELL ADOLESCENT (12-17) O $382.20 $248.43 330184 99385 25 510 PREV VISIT NEW AGE 18-39-99385-25 O $416.85 $270.95 330184 99385 510 WELL ADOLESCENT (18+) O $416.85 $270.95 330184 99385 510 Prev Visit New Age 18-3 O $416.85 $270.95 330184 99386 510 Prev Visit New Age 40-6 O $452.55 $294.16 330184 99387 770 Init Pm E/m New Pat 65+ O $485.10 $315.31 330184 99391 25 770 PER PM REEVAL EST PAT INFANT-99391-25 O $207.90 $135.14 330184 99391 770 WELL BABY ESTABLISHED (0- O $207.90 $135.14 330184 99391 770 WELL BABY (0-1) EST O $207.90 $135.14 330184 99392 25 770 PREV VISIT EST AGE 1-4-99392-25 O $243.60 $158.34 330184 99392 770 WELL CHILD ESTABLISHED (1 O $243.60 $158.34 330184 99392 770 WELL CHILD (1-4) EST O $243.60 $158.34 330184 99393 25 770 PREV VISIT EST AGE 5-11-99393-25 O $277.20 $180.18 330184 99393 770 WELL CHILD ESTABLISHED(5- O $277.20 $180.18 330184 99394 25 770 PREV VISIT EST AGE 12-17-99394-25 O $311.85 $202.70 330184 99394 770 WELL ADOLESCENT ESTABLISH O $311.85 $202.70 330184 99394 770 WELL CHILD (12-17) EST O $311.85 $202.70 330184 99395 25 491 770 PREV VISIT EST AGE 18-39-99395-25 O $347.55 $225.91 330184 99395 491 770 WELL ADOLDESCENT ESTABLIS O $347.55 $225.91 330184 99395 491 770 Prev Visit Est Age 18-3 O $347.55 $225.91 330184 99396 491 770 Prev Visit Est Age 40-6 O $382.20 $248.43 330184 99397 491 770 Per Pm Reeval Est Pat 65+ O $416.85 $270.95 330184 99401 510 SPECIAL VIROLOGY PRETEST O $243.60 $158.34 330184 99401 510 Prvntv counsl individ 15-99401 O $243.60 $158.34 330184 99401 510 SPECIAL VIROLOGY POST TES O $243.60 $158.34 330184 99402 510 Prvntv counsl individ 30-99402 O $264.00 $171.60 330184 99403 510 Prvntv counsl individ 45 O $297.00 $193.05 330184 99404 510 Prvntv counsl individ 60 O $331.00 $215.15 330184 99406 5821 324 942 SMOKING CESSATION 3-10MIN(99406) O $79.80 $51.87 330184 99407 5821 324 942 SMOKING CESSATION >10 MIN(99407)-NR O $79.80 $51.87 330184 99408 GQ 780 PHONE-ASMT/CNSL ALCHL/DRG 15-30MINS-99408 O $43.05 $27.98 330184 99408 GT 780 VIDEO-ASMT/CNSL ALCHL/DRG 15-30MINS-99408 O $43.05 $27.98 330184 99408 510 ASSM CNSL ALCH/DRUG 15-30 O $43.05 $27.98 330184 99409 GQ 780 PHONE-ASMT/CNSLN ALCHL/DRUG >30MINS-99409 O $79.00 $51.35 330184 99409 GT 780 VIDEO-ASMT/CNSLN ALCHL/DRUG >30MINS-99409 O $79.00 $51.35 330184 99409 510 ASSM/CNSL ALCH/DRUG >30 O $79.00 $51.35 330184 99415 510 PROLONG CLINCL STAFF SVC-1ST HOUR O $23.00 $14.95 330184 99416 510 PROLONG CLINCL STAFF SVC EA 30 MINS O $3.00 $1.95 330184 99417 510 PROLNG OFF/OP E/M EA 15 MIN-99417 O $1.00 $0.65 330184 99439 510 CHRNC CARE MGMT SVC EA ADDL-99439 O $1.00 $0.65 330184 99441 GQ 780 PHONE E/M PHYS/QHP 5-10 MIN-99441 O $99.00 $64.35 330184 99441 450 PHONE E/M PHYS/QHP 5-10 MINS-99441 O $99.00 $64.35 330184 99441 GQ 780 PHONE E/M PHYS/QHP 5-10 MIN-PBB-99441 O $59.00 $38.35 330184 99442 GQ 780 PHONE E/M PHYS/QHP 11-20 MIN-99442 O $220.00 $143.00 330184 99442 450 PHONE E/M PHYS/QHP 11-20 MINS-99442 O $220.00 $143.00 330184 99442 GQ 780 PHONE E/M PHYS/QHP 11-20 MIN-PBB-99442 O $132.00 $85.80 330184 99443 GQ 780 PHONE E/M PHYS/QHP 21-30 MIN-99443 O $278.00 $180.70 330184 99443 450 PHONE E/M PHYS/QHP 21-30 MINS-99443 O $278.00 $180.70 330184 99443 GQ 780 PHONE E/M PHYS/QHP 21-30 MIN-PBB-99443 O $167.00 $108.55 330184 99483 GQ 5822 780 PHONE-ASSMT & CARE PLN PT COG IMP-99483 O $238.00 $154.70 330184 99483 GT 5822 780 VIDEO-ASSMT & CARE PLN PT COG IMP-99483 O $238.00 $154.70 330184 99497 5822 510 ADVNCD CARE PLAN 30 MIN-99497 O $213.00 $138.45 330184 99497 GQ 5822 780 PHONE-ADVNCD CARE PLAN 30 MIN-99497 O $213.00 $138.45 330184 99497 GT 5822 780 VIDEO-ADVNCD CARE PLAN 30 MIN-99497 O $213.00 $138.45 330184 99498 510 ADVNCD CARE PLAN ADDL 30 MIN-99498 O $85.00 $55.25 330184 99498 GQ 780 PHONE-ADVNCD CARE PLAN ADDL 30 MIN-99498 O $85.00 $55.25 330184 99498 GT 780 VIDEO-ADVNCD CARE PLAN ADDL 30 MIN-99498 O $85.00 $55.25 330184 0001A 771 ADM SARS COV 2 VACC INIT 30 MCG DOSE-0001A O $42.00 $27.30 330184 0001A 771 ADM SARS COV 2 VAC INIT 30 MCG DOSE-0001A O $42.00 $27.30 330184 0002A 771 ADM SARS COV 2 VACC 2ND 30 MCG DOSE-0002A O $69.00 $44.85 330184 0002A 771 ADM SARS COV 2 VAC 2ND 30 MCG DOSE-0002A O $69.00 $44.85 330184 0011A 771 ADM SARS COV 2 VACC INIT 100 MCG DOSE-0011A O $42.00 $27.30 330184 0011A 771 ADM SARS COV 2 VAC INIT 100 MCG DOSE-0011A O $42.00 $27.30 330184 0012A 771 ADM SARS COV 2 VACC 2ND 100 MCG DOSE-0012A O $69.00 $44.85 330184 0012A 771 ADM SARS COV 2 VAC 2ND 100 MCG DOSE-0012A O $69.00 $44.85 330184 0223U 300 NFCT DS 22 TRGT SARS-COV-2-0223U O "$1,043.00 " $677.95 330184 0224U 300 ANTIBODY SARS-COV-2 TITER(S)-0224U O "$1,148.00 " $746.20 330184 0225U 300 NFCT DS DNA&RNA 21 TARGETS SARS-COV-2 AMP PROBE-0225U O $165.00 $107.25 330184 0226U 300 SUROGAT VIR NEUTRLZJ TST SARSCOV2 ELISA PLSM SRM-0226U O $350.00 $227.50 330184 0241U 306 NFCT DS RNA 4 TARGETS UPPR RESP SPEC-0241U O "$1,521.00 " $988.65 330184 4124F 510 CNSLNG APP USE OF ANTBTCS O $17.00 $11.05 330184 A4264 278 BIRTH CONTROL SYSTEM (ESS O "$7,024.00 " "$4,565.60 " 330184 A4358 272 URINARY DRAINAGE BAG O $52.00 $33.80 330184 A4367 272 Ostomy Belt- Size Lg O $5.00 $3.25 330184 A4371 272 Ostomy Powder O $8.00 $5.20 330184 A4385 272 Ostomy Flat Barrier2 O $6.00 $3.90 330184 A4385 272 Ostomy Flat Barrier4 O $6.00 $3.90 330184 A4411 272 OctomyConvexRing2 O $8.00 $5.20 330184 A4412 272 Ostomy High OutputP O $6.00 $3.90 330184 A4428 272 Urostomy Pouch- One O $7.00 $4.55 330184 A4430 272 Fecal Collector O $10.00 $6.50 330184 A4432 272 UROSTOMYPOUCH2.7 O $3.00 $1.95 330184 A4561 278 PESSARY RUBBER ANY TYPE O $124.00 $80.60 330184 A4562 278 PESSARY NON RUBBER ANY TYPE O $124.00 $80.60 330184 A4570 270 DENVER NASAL SPLINT LARGE O $197.00 $128.05 330184 A4648 2006 278 SENTINAL NODE MARKER O $291.00 $189.15 330184 A4648 2006 278 RAD MAM STEREO CLIP DEVIE O $230.00 $149.50 330184 A4648 2006 278 US CLIP DEVICE O $231.00 $150.15 330184 A6154 272 Ostomy Fistula Pouch O $17.00 $11.05 330184 A6550 272 NPWT Black Foam Dr O $55.00 $35.75 330184 A6550 272 NPWTBlack FoamMed O $70.00 $45.50 330184 A6550 272 NPWTAbdominalBlac O $608.00 $395.20 330184 A6550 272 NPWT Y- Connector O $8.00 $5.20 330184 A9500 2000 343 NM TC99M SESTABMIBI O $177.00 $115.05 330184 A9502 2000 343 NM TC99M MYOVIEW O $343.00 $222.95 330184 A9503 2000 343 NM TC99 MEDRONATE O $130.00 $84.50 330184 A9504 343 NM TC99M LABELED RBC PERT O $232.00 $150.80 330184 A9505 2000 343 NM THALLIUM 201/MCI O $71.00 $46.15 330184 A9512 2000 343 NM TC99M PERTECHNETATE O $130.00 $84.50 330184 A9516 2000 343 Iodine 123 per uci capsul O $1.00 $0.65 330184 A9517 1064 244 344 NM I-131 CAPSULE MIN 5 MI O $382.00 $248.30 330184 A9517 1064 244 344 NM I-131 CAPSULE EA ADDTL O $34.00 $22.10 330184 A9521 2000 343 TC99 CERETEC UP TO 25 MILICURIES O "$2,760.00 " "$1,794.00 " 330184 A9521 2000 343 NM TC99M HMPAO/CERETEC O "$1,374.00 " $893.10 330184 A9536 343 NM TC99M DEPREOTIDEPER L O "$1,161.00 " $754.65 330184 A9537 2000 343 NM TC99M MEBRO/CHOLETEC L O $153.00 $99.45 330184 A9538 2000 343 PYROPHOSPHATE [PYP]UP TO 25 MILICURIES O $60.00 $39.00 330184 A9539 2000 343 NM TC99M D.T.P.A. PER VIL O $78.00 $50.70 330184 A9540 2000 343 NM TC99M M.A.A. O $106.00 $68.90 330184 A9541 2000 343 NM TC 99M SULFUR COLLOIDE O $238.00 $154.70 330184 A9547 2000 343 NM IN111 LABELED WBC O "$3,359.00 " "$2,183.35 " 330184 A9548 2000 343 NM IN111 D.T.P.A. PER 1.I O "$3,736.00 " "$2,428.40 " 330184 A9556 343 NM GA67 CITRATE PER MCI O $39.00 $25.35 330184 A9560 2000 343 NM TC99M D.T.P.A. PER VIL O $121.00 $78.65 330184 A9562 2000 343 NM TC 99M MAG 3 PER VIAL O $421.00 $273.65 330184 A9566 343 NM TC99M FANOLESCOMAB O "$1,609.00 " "$1,045.85 " 330184 A9572 2000 343 NM IN III SATUMOMAB PENDE O "$4,000.00 " "$2,600.00 " 330184 A9572 2000 343 In-111 Pentetreotide 6 m O "$4,000.00 " "$2,600.00 " 330184 A9579 2001 636 Gadolinium (Omniscan) O $0.00 $0.00 330184 A9585 636 GADAVIST 1MMOL/ML 10 ML VIAL-A9585 O $0.00 $0.00 330184 A9585 636 GADAVIST 1MMOL/ML 15 ML VIAL-A9585 O $0.00 $0.00 330184 A9585 636 GADAVIST 1MMOL/ML 7.5 ML VIAL-A9585 O $0.00 $0.00 330184 C1713 2006 278 2.0MM MINI PLATE ST 3 HOL O $86.00 $55.90 330184 C1713 2006 278 SMALL FRAGMENT T PLATE O $331.00 $215.15 330184 C1713 2006 278 SMALL FRAGEMENT TUBULAR P O $115.00 $74.75 330184 C1713 2006 278 KIRSCHNER WIRE O $16.66 $10.83 330184 C1713 2006 278 KIRSCHNER WIRE 0.4MM O $34.00 $22.10 330184 C1713 2006 278 Cortical Screw Alta/Dhs O $111.00 $72.15 330184 C1713 2006 278 KIRSCHNER WIRE 1/16 X 9 O $35.00 $22.75 330184 C1713 2006 278 STEINMAN PIN 3/32 X 9 O $58.00 $37.70 330184 C1713 2006 278 STEINMAN PIN 3.6MM X 9 T O $78.00 $50.70 330184 C1713 2006 278 STEINMAN PIN O $78.00 $50.70 330184 C1713 2006 278 LAG SCREW O $586.00 $380.90 330184 C1713 2006 278 ARTHREX BIOANCHOR SCREW O $960.00 $624.00 330184 C1713 2006 278 ARTHREX BIOTENODESIS DIS O $500.00 $325.00 330184 C1713 2006 278 ARTHREX BIOTENODESIS SCR O $762.00 $495.30 330184 C1713 2006 278 ARTHREX FIBERWIRE SUTURE O $56.00 $36.40 330184 C1713 2006 278 ARTHREX MICROSUTURE LASS O $875.00 $568.75 330184 C1713 2006 278 ARTHREX MINI ANCHOR BIOS O $575.00 $373.75 330184 C1713 2006 278 ARTHREX OATS SMALL JOINT O "$1,400.00 " $910.00 330184 C1713 2006 278 ARTHREX TIGHTROPE REPAIR O "$2,430.00 " "$1,579.50 " 330184 C1713 2006 278 BONE CEMENT O $240.00 $156.00 330184 C1713 2006 278 SCREWS-OTHER O $235.00 $152.75 330184 C1713 2006 278 ORTHOSOTE PINS O $315.00 $204.75 330184 C1713 2006 278 MENISCAL REPAIR-FASTFIX O $950.00 $617.50 330184 C1713 2006 278 SIDE PLATE ALTA/DHS O "$1,183.00 " $768.95 330184 C1713 2006 278 MINI FRAGMENT DCP PLATE O $399.00 $259.35 330184 C1713 2006 278 MINI FRAGMENT PLATE O $133.00 $86.45 330184 C1713 2006 278 SMALL FRAGMENT DCP PLATE O $286.00 $185.90 330184 C1713 2006 278 SMALL FRAGMENT CLOVERLEAF O $826.00 $536.90 330184 C1713 2006 278 LARGE FRAGMENT DCP PLATE O $452.00 $293.80 330184 C1713 2006 278 LARGE FRAGMENT T PLATE O $587.00 $381.55 330184 C1713 2006 278 ACL SCREWS O $347.00 $225.55 330184 C1713 2006 278 ANCHRS/SCRW B2B TAKMANUA O $0.00 $0.00 330184 C1713 2006 278 RECONSTRUCTION PLATES O "$1,681.00 " "$1,092.65 " 330184 C1713 2006 278 SURE TAC IMPLANTS O $604.00 $392.60 330184 C1713 2006 278 PLATESOTHER MANUAL O $0.00 $0.00 330184 C1713 2006 278 CANNULATED SCREW 73 O $560.00 $364.00 330184 C1713 2006 278 BIOPLATE SCREWS O $98.00 $63.70 330184 C1713 2006 278 BIOPLATE PLATES O $593.00 $385.45 330184 C1713 2006 278 RODSOTHER MANUAL O $0.00 $0.00 330184 C1713 2006 278 SCREWSOTHER MANUAL O $0.00 $0.00 330184 C1713 2006 278 NAILS/PINSOTHER MANUAL O $0.00 $0.00 330184 C1713 2006 278 ARTHROCARESPD SCR LCK FI O $990.00 $643.50 330184 C1713 2006 278 MINI MAG KNOTLESS IMPLANT O "$1,073.00 " $697.45 330184 C1713 2006 278 MAYFIELD PINS O $0.00 $0.00 330184 C1713 2006 278 IMPLANTTOE O $0.00 $0.00 330184 C1713 2006 278 STAPLEFOOT O $0.00 $0.00 330184 C1713 2006 278 CABLE W/CRIMP O $0.00 $0.00 330184 C1713 2006 278 HELICAL BLADE O $0.00 $0.00 330184 C1713 2006 278 ARTHREX SUTURE TAK O $930.00 $604.50 330184 C1713 2006 278 Arthrex Trim It O $544.00 $353.60 330184 C1713 2006 278 ARTHREX ACHIL SPEED BRIDG O "$3,845.00 " "$2,499.25 " 330184 C1713 2006 278 ARTHREX MINI TIGHTROPE O "$1,420.00 " $923.00 330184 C1713 2006 278 ARTHREX MINI TGHTRP PLATE O $400.00 $260.00 330184 C1713 2006 278 ARTHREX PARS ACH SUT PAK O "$1,500.00 " $975.00 330184 C1713 2006 278 ARTHREX LATERAL ANKLE O "$3,575.00 " "$2,323.75 " 330184 C1713 2006 278 ARTHREX SCREW LOCKING O $281.00 $182.65 330184 C1713 2006 278 ARTHREX SCREW NON LOCKING O $80.00 $52.00 330184 C1713 2006 278 ARTHREX SCREW CANNULATED O $382.00 $248.30 330184 C1713 2006 278 ARHTREX PLATE LCKNG TUBUL O $520.00 $338.00 330184 C1713 2006 278 ARHTREX PLATE LCK DST FIB O "$1,820.00 " "$1,183.00 " 330184 C1713 2006 278 ARTHREX PLATE LCK STRAIGH O "$1,392.00 " $904.80 330184 C1713 2006 278 ARTHREX PLT LCK MED HOOK O "$2,192.00 " "$1,424.80 " 330184 C1713 2006 278 EXTERNAL FIXATOR LRG BONE O $0.00 $0.00 330184 C1713 2006 278 EXTERNAL FIXATOR SML BONE O $0.00 $0.00 330184 C1713 2006 278 IMPLANTACL KNEE O $0.00 $0.00 330184 C1713 2006 278 IMPLANTANKLE O $0.00 $0.00 330184 C1713 2006 278 IMPLANTARM/FRARM/BICEPS O $0.00 $0.00 330184 C1713 2006 278 IMPLANTSHOULDER O $0.00 $0.00 330184 C1713 2006 278 ACUMED/ACULOX-PLATE XL DISTAL RADIUS O "$2,049.00 " "$1,331.85 " 330184 C1713 2006 278 ACUMED/ACULOX-PLATE-DISTAL RADIUS O "$1,787.00 " "$1,161.55 " 330184 C1713 2006 278 ACUMED/ACULOX-SCREWS CORTICAL O $146.00 $94.90 330184 C1713 2006 278 ACUMED/ACULOX-SCREWS LOCKING O $239.00 $155.35 330184 C1713 2006 278 ACUMED/ACULOX-SCREWS THREADED SMOOTH O $197.00 $128.05 330184 C1713 2006 278 ARTHREX-ACL TIGHTROPE O $774.00 $503.10 330184 C1713 2006 278 ARTHREX-ANK IMPL-INTERNAL BRACE LIGAMENT O "$2,155.00 " "$1,400.75 " 330184 C1713 2006 278 ARTHREX-ANKLE IMPLANT-ARTHROBROSTROM O "$3,205.00 " "$2,083.25 " 330184 C1713 2006 278 ARTHREX-DELTOID LIGAMENT RECONST O "$4,321.00 " "$2,808.65 " 330184 C1713 2006 278 ARTHREX-KNOTLESS TIGHTROPE O "$1,945.00 " "$1,264.25 " 330184 C1713 2006 278 ARTHREX-PLATE-LOCKING DISTAL FIBULA O "$1,728.00 " "$1,123.20 " 330184 C1713 2006 278 ARTHREX-PLATE-LOCKING LATERAL HOOK O "$1,779.00 " "$1,156.35 " 330184 C1713 2006 278 ARTHREX-PLATE-LOCKING TUBULAR O $572.00 $371.80 330184 C1713 2006 278 ARTHREX-SCREW-LOW PROF CANC/CORTICAL O $88.00 $57.20 330184 C1713 2006 278 ARTHREX-SCREW-2.7 MM LOW PROF O $265.00 $172.25 330184 C1713 2006 278 ARTHREX-SUTURE ANCHOR-MINI PUSH LOCK O $718.00 $466.70 330184 C1713 2006 278 ARTHREX-SUTURE ANCHOR-PUSH LOCK O $884.00 $574.60 330184 C1713 2006 278 ARTHREX-BIOSUTURE TAK-MINI O $718.00 $466.70 330184 C1713 2006 278 ARTHREX-BIOSUTURE TAK-SMALL JOINT O $718.00 $466.70 330184 C1713 2006 278 ARTHREX-IMPLANT DISTAL BICEP O "$1,879.00 " "$1,221.35 " 330184 C1714 2006 278 CATHETERATHERECTOMY O "$8,387.00 " "$5,451.55 " 330184 C1714 2006 278 CTHTRATHERECTOMY(MANUAL) O $0.00 $0.00 330184 C1721 2006 275 CARDIO-DEFIBDUAL CHAMBER O $0.00 $0.00 330184 C1722 2006 275 CARDIO-DEFIBSGL CHAMBER O $0.00 $0.00 330184 C1724 2006 278 CSI-STEALTH O "$7,503.00 " "$4,876.95 " 330184 C1725 2006 278 ANGIOPLASTY CATHETER O "$1,224.00 " $795.60 330184 C1725 2006 278 RAD CATH BALLOON CATH O $506.00 $328.90 330184 C1725 2006 278 RAD CHG ULTRA THIN BALLOH O $539.00 $350.35 330184 C1725 2006 278 RAD CHG CUTTING BALLOON O "$1,991.00 " "$1,294.15 " 330184 C1725 2006 278 RAD TALON CATH O "$1,052.00 " $683.80 330184 C1725 2006 278 RAD CHG ANGIOPLASTY CATHR O "$1,135.00 " $737.75 330184 C1726 2006 278 AMPLATZ RENAL DILATION SE O $676.00 $439.40 330184 C1726 2006 278 CATHETERBALLOON DIL NON- O $22.00 $14.30 330184 C1726 2006 278 SINUS BALLOON CATHETER O "$2,046.00 " "$1,329.90 " 330184 C1726 2006 278 ERCP Balloon/Sphincteroto O "$1,184.00 " $769.60 330184 C1726 2006 278 SINUS ILLUM SYSTM & ACCSS O "$1,449.00 " $941.85 330184 C1726 2006 278 IR-BLUE MAX BALLOON CATH O $685.00 $445.25 330184 C1726 2006 278 BALLOON SINUPLASTY KIT O $0.00 $0.00 330184 C1727 2006 278 CATHBALLOON DILTMANUAL O $0.00 $0.00 330184 C1727 2006 278 CATHETERBALLOON TIS DIS O $22.00 $14.30 330184 C1727 2006 278 HERNIA DISTENTION BALLOON O $571.00 $371.15 330184 C1727 2006 278 NOVASURE O "$2,549.00 " "$1,656.85 " 330184 C1729 2006 278 CAREFUSION-DRAINAGE CATH O $424.00 $275.60 330184 C1729 2006 278 PERCUT NEPHROSTOMY SET 8. O $936.00 $608.40 330184 C1729 2006 278 PERCUT NEPHROSTOMY SET O $938.00 $609.70 330184 C1729 2006 278 KAYE NEPHROSTOMY TAMPONAD O $994.00 $646.10 330184 C1729 2006 278 MALECOT CATH O $113.00 $73.45 330184 C1729 2006 278 RAD CHG NEPHROURETERAL DT O $309.00 $200.85 330184 C1750 2006 278 TENCKHOFF PERITONEAL DIAL O $425.00 $276.25 330184 C1750 2006 278 CATHETERHEMODIALYSIS LON O $0.00 $0.00 330184 C1750 2006 278 CTH HEMODIALYSIS LNG TERM O $600.00 $390.00 330184 C1751 2006 278 HICKMAN RIGHT ATRIEL CATH O $448.00 $291.20 330184 C1751 2006 278 CATHETERINFUSION NON-DA O $530.00 $344.50 330184 C1751 2006 278 PICC LINE CATH O $148.00 $96.20 330184 C1751 2006 278 CTH INFINSRT PERIPHERAL O $250.00 $162.50 330184 C1752 2006 278 CATHETERHEMODIALYSIS SHO O $191.00 $124.15 330184 C1752 2006 278 CTH HEMODIALYSIS SHR TERM O $200.00 $130.00 330184 C1755 278 URO Drain System O $141.00 $91.65 330184 C1755 278 CTHTR INTRATHCL ACCSY KIT O $0.00 $0.00 330184 C1757 2006 278 CATHETERTHROMBECTOMY/EMB O $189.00 $122.85 330184 C1758 2006 278 URETERAL CATH CONE TIP O $78.00 $50.70 330184 C1758 2006 278 STENTSOFT FLEX URETERALP O $617.00 $401.05 330184 C1760 2006 278 CLOSURE DEVICE O $85.00 $55.25 330184 C1760 2006 278 VASCULAR CLOSURE DEVICE O $524.00 $340.60 330184 C1760 2006 278 RAD CHG ANGIOSEAL O $458.00 $297.70 330184 C1762 455 278 DBX MIX 10CC O "$4,291.00 " "$2,789.15 " 330184 C1762 455 278 DBX MIX 20CC O "$8,429.00 " "$5,478.85 " 330184 C1762 455 278 GRAFT JACKET O "$6,835.00 " "$4,442.75 " 330184 C1762 455 278 ORTHOBLEND 5CC O "$2,391.00 " "$1,554.15 " 330184 C1762 455 278 ANTERIOR TIBIALIS TENDON O "$6,130.00 " "$3,984.50 " 330184 C1762 455 278 DBX PUTTY O "$3,085.00 " "$2,005.25 " 330184 C1762 455 278 CANCELLOS CHIPS O "$1,201.00 " $780.65 330184 C1762 455 278 GRAFTON GEL 1CC O $483.00 $313.95 330184 C1762 455 278 GRAFTON GEL-5CC O "$1,963.00 " "$1,275.95 " 330184 C1762 455 278 GRAFTON GEL-10 CC O "$3,027.00 " "$1,967.55 " 330184 C1762 455 278 ACF SPACER 6-89MM O "$2,320.00 " "$1,508.00 " 330184 C1762 455 278 ACF SPACER 9MM O "$2,440.00 " "$1,586.00 " 330184 C1762 455 278 PATELLO WEDGE O "$2,189.00 " "$1,422.85 " 330184 C1762 455 278 ILIAC CREST WEDGE O "$1,979.00 " "$1,286.35 " 330184 C1762 455 278 FEMORAL SHAFT O "$3,426.00 " "$2,226.90 " 330184 C1762 455 278 HUMAN TISSUE MANUAL O $0.00 $0.00 330184 C1763 455 278 CONNECTIVE TISSUENON HUM O $0.00 $0.00 330184 C1763 455 278 VITOSS MACRO MORSELS O "$3,782.00 " "$2,458.30 " 330184 C1763 455 278 VITOSS FOAM CUP O "$7,107.00 " "$4,619.55 " 330184 C1763 455 278 VITOSS FOAM STRIP O "$3,701.00 " "$2,405.65 " 330184 C1763 455 278 INFUSE PORT LGE-BMP O "$13,383.00 " "$8,698.95 " 330184 C1763 455 278 TRU WEDGE O "$1,207.00 " $784.55 330184 C1763 455 278 DURAFORM SPONGE NEURO O "$2,535.00 " "$1,647.75 " 330184 C1763 455 278 NON-HUMAN TISSUE O $0.00 $0.00 330184 C1763 455 278 MASTERGRAFT 5 O "$2,718.00 " "$1,766.70 " 330184 C1764 2006 278 EVENT RECORDER CARDIAC-C1764 O $0.00 $0.00 330184 C1764 2006 278 EVENT RECORDER CARDIAC-C1764 O "$11,039.00 " "$7,175.35 " 330184 C1765 278 SEPRAFILM ADHESION BARRIE O $449.00 $291.85 330184 C1765 278 INTERCEED ADHESION BARRIE O $521.00 $338.65 330184 C1766 2006 272 PINNACLE INTODUCER SHEATH O $402.00 $261.30 330184 C1766 2006 272 PINNACLE INTODUCER SHEATH O $175.00 $113.75 330184 C1767 2006 278 GENERATOR NEURO NON-RECH-C1767 O $0.00 $0.00 330184 C1767 2006 278 GENERATORNEUROSTIMULATOR O $0.00 $0.00 330184 C1768 2006 278 GRAFT AXILLO-BIFEMORAL O "$6,003.00 " "$3,901.95 " 330184 C1768 2006 278 GRAFT STRAIGHT LINED O "$2,115.00 " "$1,374.75 " 330184 C1768 2006 278 PATCH CAROTIN-GORE O $637.00 $414.05 330184 C1768 2006 278 GRAFT IMPRA VECTRA VEOTR O "$2,752.00 " "$1,788.80 " 330184 C1768 2006 278 GRAFT IMPRA DISTAFLO O "$5,607.00 " "$3,644.55 " 330184 C1768 2006 278 GRAFT BIFURCATED O "$2,445.00 " "$1,589.25 " 330184 C1768 2006 278 GRAFT VASCULAR O $0.00 $0.00 330184 C1768 2006 278 VASCULAR GRAFT O $0.00 $0.00 330184 C1769 2006 278 CAREFUSION-GUIDEWIRE O $424.00 $275.60 330184 C1769 2006 278 GLIDEWIRE 35X150CM ANGLE O $192.00 $124.80 330184 C1769 2006 278 GUIDEWIRE O $196.00 $127.40 330184 C1769 2006 278 SINUS GUIDEWIRE O $887.00 $576.55 330184 C1769 2006 278 ERCP WIRES O "$1,745.00 " "$1,134.25 " 330184 C1769 2006 278 GLIDE CATH O $129.00 $83.85 330184 C1769 2006 278 GUIDE WIRE O $0.00 $0.00 330184 C1769 2006 278 RAD CHG BENTSON- GUIDEWIE O $249.00 $161.85 330184 C1769 2006 278 RAD CHG PTA GUIDEWIRE-W/G O $240.00 $156.00 330184 C1769 2006 278 RAD CHG GUIDEWIRE O $111.00 $72.15 330184 C1769 2006 278 CSI-GUIDE WIRES O $332.00 $215.80 330184 C1771 2006 278 REPR DEVICE URINARY INCON O $0.00 $0.00 330184 C1772 278 MEDICATION PUMP & PTM O $0.00 $0.00 330184 C1773 2006 272 ENSNARE 18/30M 120CM O $361.00 $234.65 330184 C1773 2006 272 RETRIEVAL SYSTEM REGULAR O $308.00 $200.20 330184 C1773 2006 272 RETRIEVAL SYSTEM MINI O $620.00 $403.00 330184 C1776 2006 278 JOINT DEVICE O $0.00 $0.00 330184 C1776 2006 278 SPINAL IMPLANTS & CAGES O $0.00 $0.00 330184 C1778 2006 278 LEAD NEUROSTIMULATOR-C1778 O $0.00 $0.00 330184 C1780 2006 276 INTRA OCULAR LENS O $0.00 $0.00 330184 C1781 2006 278 MESH 3X6 (BARD) O $368.00 $239.20 330184 C1781 2006 278 MESH COMPOSIX(LAPROSCOPIC O "$3,317.00 " "$2,156.05 " 330184 C1781 2006 278 SURGISIS HERNIA GRAFT O "$3,152.00 " "$2,048.80 " 330184 C1781 2006 278 TET 1208 DR O $363.00 $235.95 330184 C1781 2006 278 TET 1208 DL O $363.00 $235.95 330184 C1781 2006 278 PC012 O "$1,159.00 " $753.35 330184 C1781 2006 278 MESH O $0.00 $0.00 330184 C1781 2006 278 MESH TITANIUM O $0.00 $0.00 330184 C1781 2006 278 MESH (ETHICON BROLENE) O $765.00 $497.25 330184 C1781 2006 278 MESH COMPOSIX MESH LAPARO O "$3,317.00 " "$2,156.05 " 330184 C1781 2006 278 MESH COMPOSIX KUGER PATCH O "$4,096.00 " "$2,662.40 " 330184 C1781 2006 278 MESHCOMPOSIX KUGER PATCH O "$2,364.00 " "$1,536.60 " 330184 C1781 2006 278 MESH COMPOSIX(VENTRAL) 10 O "$4,982.00 " "$3,238.30 " 330184 C1781 2006 278 MESH COMPOSIX (VENTRAL) 4 O "$1,341.00 " $871.65 330184 C1781 2006 278 MESH COMPOSIX KUGEL PATCH O "$1,593.00 " "$1,035.45 " 330184 C1781 2006 278 MESHVENTRALEX 4MM O "$1,451.00 " $943.15 330184 C1781 2006 278 MESH 3D MLXL O $602.00 $391.30 330184 C1781 2006 278 MESH PLUGS-SML O $742.00 $482.30 330184 C1781 2006 278 MESH SURGISIS 13-20 O "$3,751.00 " "$2,438.15 " 330184 C1781 2006 278 MESH SURGISIS 8X15 O $536.00 $348.40 330184 C1781 2006 278 MESH SURGIPRO O $145.00 $94.25 330184 C1781 2006 278 ANAL FISTULA PLUG O $0.00 $0.00 330184 C1782 2006 272 MORCELLATOR O "$1,238.00 " $804.70 330184 C1787 2006 278 PT PROGR NEUROSTIM-C1787 O $0.00 $0.00 330184 C1787 2006 278 INTELLIS PATIENT PROGRAMMER: 97745(C1787) O $0.00 $0.00 330184 C1788 2006 278 VENOUS ACCESS PORT O "$4,950.00 " "$3,217.50 " 330184 C1788 2006 278 CRANIAL ACCESS PORT O $0.00 $0.00 330184 C1788 2006 278 RAD SPEC IMPLANTABLE PORT O "$2,161.00 " "$1,404.65 " 330184 C1788 2006 278 RAD CHG PORT INDWELLING O "$1,188.00 " $772.20 330184 C1789 2006 278 TISSUE EXPANDER O "$3,403.00 " "$2,211.95 " 330184 C1789 2006 278 PROSTHESISBREAST O $0.00 $0.00 330184 C1789 2006 278 PROSTHESISBREAST O "$1,900.00 " "$1,235.00 " 330184 C1813 2006 278 PROSTHESISPENILE INFLATA O $0.00 $0.00 330184 C1815 2006 278 PROSTHESISURINARY SPHINC O $0.00 $0.00 330184 C1820 2006 278 INTELLIS RECHARGEABLE BATTERY:97715(C1820) O $0.00 $0.00 330184 C1874 2006 278 STENTVASCULAR COVERED O $0.00 $0.00 330184 C1876 2006 278 ANGIOPLASTY STENT O "$3,879.00 " "$2,521.35 " 330184 C1876 2006 278 URETHRAL STENT O $0.00 $0.00 330184 C1876 2006 278 ERCP STENTS O "$1,745.00 " "$1,134.25 " 330184 C1876 2006 278 GUIDING STENT O $35.00 $22.75 330184 C1876 2006 278 RAD CHG WALL STENT ENDOPS O "$3,249.00 " "$2,111.85 " 330184 C1876 2006 278 RAD CHG BILIARY STENT O "$3,473.00 " "$2,257.45 " 330184 C1876 2006 278 RAD CHG ANGIOPLASTY STENT O "$3,599.00 " "$2,339.35 " 330184 C1880 2006 278 VENA CAVA FILTER O "$2,810.00 " "$1,826.50 " 330184 C1880 2006 278 RAD CHG VENA CAVA FILTER O "$2,608.00 " "$1,695.20 " 330184 C1887 2006 278 CATHETER GUIDING O $30.00 $19.50 330184 C1887 2006 278 SINUS GUIDE CATHETER O $887.00 $576.55 330184 C1887 2006 278 SINUS IRRIGATION CATHETER O $0.00 $0.00 330184 C1887 2006 278 RAD CHG FAST TRACKER CATR O "$1,296.00 " $842.40 330184 C1887 2006 278 RAD CHG VASCULAR ACCESS H O "$1,296.00 " $842.40 330184 C1887 2006 278 RAD CHG CATHETERGUIDING O $284.00 $184.60 330184 C1892 2006 272 PEEL AWAY INTRODUCER SET O $381.00 $247.65 330184 C1892 2006 272 INTRODUCER GUIDE IC PEEL O $0.00 $0.00 330184 C1893 2006 272 INTRODCER GUIDE IC EP NON O $77.00 $50.05 330184 C1894 2006 278 CAREFUSION-INTRO/SHEATH NON LSR O $424.00 $275.60 330184 C1894 2006 278 INTRO/SHEATH NON-LASER-C1894 O $0.00 $0.00 330184 C1894 2006 278 RAD CHG RENAL GUIDING SHH O $162.00 $105.30 330184 C1898 2006 275 Lead Pacer Single O $0.00 $0.00 330184 C1899 275 LEAD PACER/DEF COMBO O $0.00 $0.00 330184 C2615 278 SEALANT PULMONARY LIQUID O "$1,819.00 " "$1,182.35 " 330184 C2617 2006 278 URETERAL PIGTAIL STENT O $873.00 $567.45 330184 C2617 2006 278 URETERAL PIGTAIL 6 X3 O $873.00 $567.45 330184 C2617 2006 278 STENT NON-COR TEMP W/O DE O $329.00 $213.85 330184 C2617 2006 278 RENAL BILARY STENT O "$3,728.00 " "$2,423.20 " 330184 C2617 2006 278 RAD CHG STENT NON COR TEL O $305.00 $198.25 330184 C2618 2006 272 CT CRYOABLATION NEEDLE PE O "$1,301.00 " $845.65 330184 C2619 275 PACERDUAL CHAMBER NRR O $0.00 $0.00 330184 C2620 275 PACERSGL CHAMBER NRR O $0.00 $0.00 330184 C2622 278 PROSTHESISPENILE NON INF O $0.00 $0.00 330184 C2625 2006 278 STENT NON-COR TEMP W/DEL O $0.00 $0.00 330184 C2627 2006 278 CATHETERSUPRA-PUBIC INTR O $459.00 $298.35 330184 C2627 2006 278 CATH SUPRAPUBIC/CYSTOSCOPIC O $42.00 $27.30 330184 C2627 2006 278 CATHETERSETBONANNO SUPR O $42.00 $27.30 330184 C2628 2006 278 CATHETEROCCLUSIONMANUAL O $0.00 $0.00 330184 C2628 2006 278 RAD CHG CATHETER OCCLUSIN O $0.00 $0.00 330184 C2629 272 INTRODUCERNOT GUIDINGEP O $0.00 $0.00 330184 C2631 2006 278 REPAIR DEV URO INCONT W/O O "$1,776.00 " "$1,154.40 " 330184 C2631 2006 278 TVT TAPE O "$2,434.00 " "$1,582.10 " 330184 C8906 5572 614 MRI BREAST BILAT W CONTR-C8906 O "$1,371.00 " $891.15 330184 C8929 5573 480 TTE W OR WO FOL WCON DOPLR-C89 O "$2,050.00 " "$1,332.50 " 330184 C8957 5694 260 "PROLONGED IV INF, REQ PUMP" O $846.00 $549.90 330184 C9113 496 636 PANTOPRAZOLE SODIUM INJ PER VIAL O $0.00 $0.00 330184 C9113 496 636 PANTOPRAZOLE 40MG VIAL O $0.00 $0.00 330184 C9132 9132 463 636 KCENTRA PER I.U. O $4.44 $2.89 330184 C9254 435 636 VIMPAT (LACOSAMIDE) 10MG/ML SDV O $0.00 $0.00 330184 C9290 435 636 BUPIVACAINE LIPSM(EXPAREL)10MLC9290 O $0.00 $0.00 330184 C9290 435 636 BUPIVACAINE LIPSM(EXPAREL)20MLC9290 O $0.00 $0.00 330184 C9352 278 NERVE GUIDE (PER CM) O $0.00 $0.00 330184 C9352 278 NEUROGEN NERVE GUIDE (PER O $0.00 $0.00 330184 C9353 278 NERVE WRAP (PER CM) O $0.00 $0.00 330184 C9399 636 ZALTRAP 100MG INJECTION A O $0.00 $0.00 330184 C9399 636 ZALTRAP 100 MG INJ O $0.00 $0.00 330184 C9488 9488 636 INJ CONIVAPTAN HCL 1MG-C9488 O $0.00 $0.00 330184 C9803 5731 300 HSP OP CLINIC VISIT SPEC COLLECT FOR 2[SARS-COV-2]COVID-19 ANY SPCM SRC-C9803 O $57.45 $37.34 330184 E0748 290 SPINAL FUSION STIMULATOR O "$15,510.00 " "$10,081.50 " 330184 G0101 5822 770 PAP SMEAR SCREENING O $223.65 $145.37 330184 G0108 GQ 428 780 PHONE-DIABETIC EDCTN IND 30 MIN-G0108 O $180.60 $117.39 330184 G0108 GT 428 780 VIDEO-DIABETIC EDCTN IND 30 MIN-G0108 O $180.60 $117.39 330184 G0108 428 942 DIABETIC SELF MNGT TRNG I O $180.60 $117.39 330184 G0108 428 942 Diabetic self mngt trng g O $180.60 $117.39 330184 G0108 428 942 Diabtc. Self Mgmt IND G01 O $180.60 $117.39 330184 G0108 428 942 DIABETIC EDCTN IND 30 MIN O $180.60 $117.39 330184 G0109 GQ 780 PHONE-DIABETIC EDCTN GRP 30 MIN-G0109 O $121.80 $79.17 330184 G0109 GT 780 VIDEO-DIABETIC EDCTN GRP 30 MIN-G0109 O $121.80 $79.17 330184 G0109 942 Diabtc Self Mgmt Grp. G01 O $121.80 $79.17 330184 G0109 942 DIABETIC EDCTN GRP 30 MIN O $121.80 $79.17 330184 G0127 5733 361 TRIM DYSTR NAILS ANY# O $135.00 $87.75 330184 G0245 5012 510 Initial Foot Exam Pt Lops O $339.15 $220.45 330184 G0246 5012 510 Followup Eval Of Foot Pt O $279.00 $181.35 330184 G0247 5051 510 Routine Footcare Pt W lop O $425.00 $276.25 330184 G0270 942 Mnt Subs Tx For Change Dx O $35.00 $22.75 330184 G0270 942 REASSES/INDIV/2ND REF FOR-G0270 O $35.00 $22.75 330184 G0271 942 Group Mnt 2 or More 30 Mi O $19.00 $12.35 330184 G0271 942 re-assess/grp/2nd ref for-G0271 O $19.00 $12.35 330184 G0296 5822 770 VISIT TO DETERM LDCT ELIG-G0296 O $213.00 $138.45 330184 G0297 5521 299 350 LDCT FOR LUNG CA SCREEN-G0297 O $181.00 $117.65 330184 G0378 450 762 OBS SERVICES (PER HOUR) O $451.00 $293.15 330184 G0379 5025 491 762 DRCT REFERAL OBS SERVICE O "$1,479.00 " $961.35 330184 G0390 5045 682 TRAUMA RESPONSE CRITICAL O "$2,770.95 " "$1,801.12 " 330184 G0420 GQ 780 PHONE-ED SVC CKD IND PER SESS-G0420 O $366.00 $237.90 330184 G0420 GT 780 VIDEO-ED SVC CKD IND PER SESS-G0420 O $366.00 $237.90 330184 G0424 5733 948 PULMONARY REHAB W EXER O $165.00 $107.25 330184 G0436 GQ 780 PHONE-SMOKING CESSATION 3-10MIN-G0436 O $40.00 $26.00 330184 G0436 GT 780 VIDEO-SMOKING CESSATION 3-10MIN-G0436 O $40.00 $26.00 330184 G0437 GQ 780 PHONE-SMOKING CESSATION >10MIN-GO437 O $83.00 $53.95 330184 G0437 GT 780 VIDEO-SMOKING CESSATION >10MIN-GO437 O $83.00 $53.95 330184 G0444 5821 770 ANNUAL DEPRESSION SCRNG 15 MINS-G0444 O $79.80 $51.87 330184 G0447 5822 770 BEHAV COUNSEL OBESITY 15MINS-G0447 O $216.00 $140.40 330184 G0447 GQ 5822 780 PHONE-BEHAV COUNS OBES 15MINS-G0447 O $216.00 $140.40 330184 G0447 GT 5822 780 VIDEO-BEHAV COUNS OBES 15MINS-G0447 O $216.00 $140.40 330184 G0463 5012 491 510 Postop Follow-up Visit O $412.00 $267.80 330184 G0463 5012 491 510 Post Partum Interim O $412.00 $267.80 330184 G0506 GQ 780 PHONE-COMP ASSES CARE PLAN CCM SVC-G0506 O $168.00 $109.20 330184 G0506 GT 780 VIDEO-COMP ASSES CARE PLAN CCM SVC-G0506 O $168.00 $109.20 330184 G1004 490 340 CDSM-NAT DEC SUP COMP-NUC MED-G1004 O $0.01 $0.01 330184 G1004 490 350 CDSM-NAT DEC SUP COMP-CT-G1004 O $0.01 $0.01 330184 G1004 490 320 CDSM-NAT DEC SUP COMP-DIAG-G1004 O $0.01 $0.01 330184 G1004 490 610 CDSM-NAT DEC SUP COMP-MRI-G1004 O $0.01 $0.01 330184 G2012 GQ 780 PHONE-BRIEF CHECK IN BY MD/QHP-G2012 O $56.00 $36.40 330184 G2012 GT 780 VIDEO-BRIEF CHECK IN BY MD/QHP-G2012 O $56.00 $36.40 330184 G2023 300 SPECIMEN COLLECT COVID-19-ANY SOURCE-G2023 O $60.00 $39.00 330184 G2024 300 SPEC COLL SNF/LAB COVID-19-G2024 O $60.00 $39.00 330184 G8431 510 POS CLIN DEPRES SCRN F/U DOC-G8431 O $412.00 $267.80 330184 G8510 510 SCR DEP NEG-NO PLAN REQD-G8510 O $273.00 $177.45 330184 H1000 919 PN AT RISK ASSESSM-H1000 O $117.00 $76.05 330184 H1005 919 PN COMPL SERV PKG-H1005 O $40.00 $26.00 330184 H2010 919 COMPR MED SERVC/15 MIN-H2010 O $158.00 $102.70 330184 H2011 919 CRISIS INTERV/15 MIN-H2011 O $161.70 $105.11 330184 J0129 JW 9230 636 ABATACEPT INJECTION 10MG-J0129-JW O $0.00 $0.00 330184 J0129 9230 636 Orencia Injection 250 mg O $0.00 $0.00 330184 J0131 435 636 ACETAMINOPHEN 1000/100ML O $0.00 $0.00 330184 J0131 435 636 Acetaminophen IV O $0.00 $0.00 330184 J0132 435 636 ACETADOTE 6G/30 ML33 ML O $0.00 $0.00 330184 J0133 496 636 NICU acyclovir 500 mg PWDI-J0133 O $0.00 $0.00 330184 J0133 496 636 acyclovir 50 mg/mL Solution-J0133 O $0.00 $0.00 330184 J0133 496 636 ACYCLOVIR 50MG/ML 10 ML VIAL-J0133 O $0.00 $0.00 330184 J0133 496 636 ACYCLOVIR INJECTION 500MG O $0.00 $0.00 330184 J0135 JW 1083 443 636 INJ ADALIMUMAB 20 MG-J0135-JW O $0.00 $0.00 330184 J0135 1083 443 636 Adalimumab 40mg 0.8 mL O $0.00 $0.00 330184 J0153 435 636 adenosine 3 mg/mL SOLN 20 mL-J0153 O $0.00 $0.00 330184 J0153 435 636 adenosine 3 mg/mL SOLN-J0153 O $0.00 $0.00 330184 J0153 435 636 ADENOSINE INJ 1MG-NON PHOSPHATE O $0.00 $0.00 330184 J0171 496 636 EPINEPH PRESRV FREE 1MG/ML AMPULE-J0171 O $0.00 $0.00 330184 J0171 496 636 EPINEPHRINE INJ 1MG/ML-J0171 O $0.00 $0.00 330184 J0171 496 636 EPINEPHRINE 1-1000 INJCTN O $0.00 $0.00 330184 J0171 496 636 EPINEPHRINE HCL O $0.00 $0.00 330184 J0171 496 636 EPINEPHRINE INJ 1- 1000 30 O $0.00 $0.00 330184 J0171 496 636 EPINEPHRINE 1-1000 INJ O $0.00 $0.00 330184 J0171 496 636 PROLIA 60 MG INJ O $0.00 $0.00 330184 J0171 496 636 INJ ADRNLN EPINEPHRINE 0.1 MG O $7.00 $4.55 330184 J0171 496 636 INJ ADRENALIN EPINEPHRINE 0.1 MG O $0.00 $0.00 330184 J0202 1809 636 LEMTRADA SF (ALEMTUZUMAB) 10MG/ML 1.2 ML-J0202 O $0.00 $0.00 330184 J0202 1809 636 INJECTION ALEMTUZUMAB 1MG- O $0.00 $0.00 330184 J0210 437 636 METHYLDOPATE 250MG INJ O $0.00 $0.00 330184 J0270 435 636 PROSTIN VR PED 500MCG/ML O $0.00 $0.00 330184 J0278 496 636 amikacin 250 mg/mL (2 mL) SOLN-J0278 O $0.00 $0.00 330184 J0278 496 636 amikacin 250 mg/mL (4 mL) SOLN-J0278 O $0.00 $0.00 330184 J0278 496 636 AMIKACIN SULFATE 500MG IN O $0.00 $0.00 330184 J0280 496 636 AMINOPHYLLINE 500MG/20ML O $0.00 $0.00 330184 J0280 496 636 AMINOPHYLLINE 500MG O $0.00 $0.00 330184 J0280 496 636 AMINOPHYLLINE 500MG O $1.08 $0.70 330184 J0280 496 636 INJ AMINOPHYLLIN UP TO 250 MG O $0.00 $0.00 330184 J0282 496 636 AMIODARONE HCL 50MG INJ O $0.00 $0.00 330184 J0282 496 636 AMIODARONE 900MG/18ML O $0.00 $0.00 330184 J0282 496 636 AMIODARONE 150MG/100ML O $0.00 $0.00 330184 J0282 496 636 AMIODARONE 360MG/100ML O $0.00 $0.00 330184 J0285 435 636 INJ AMPHOTERICIN B 50 MG O $0.00 $0.00 330184 J0285 435 636 Amphotericin B 50mg vial O $0.00 $0.00 330184 J0287 JW 9024 436 636 INJ AMPHOTERICIN B LIPID CMPLX 10 MG-J0287-JW O $0.00 $0.00 330184 J0287 9024 436 636 AMPHOTERICIN B LIPID 50 M O $0.00 $0.00 330184 J0290 496 636 NICU ampicillin 250 mg /mL O $0.00 $0.00 330184 J0290 496 636 NICU ampicillin 100 mg/mL O $0.00 $0.00 330184 J0290 496 636 AMPICILLIN SODIUM .5GM IN O $0.00 $0.00 330184 J0290 496 636 AMPICILLIN INJECTION 1GM O $0.00 $0.00 330184 J0290 496 636 AMPICILLIN SODIUM INJ 2GM O $0.00 $0.00 330184 J0290 496 636 NEONATE Ampicillin100m O $0.00 $0.00 330184 J0295 496 636 AMPICILLIN SULBACTAM 3GM O $0.00 $0.00 330184 J0295 496 636 AMPICILLIN/SULBACTAM 1.5G O $0.00 $0.00 330184 J0330 496 636 SUCCINYLCHOLINE CHL UP TO 20 MG-J0330 O $5.07 $3.30 330184 J0330 496 636 QUELICIN 200MG/10ML O $0.00 $0.00 330184 J0360 496 636 HYDRALAZINE 20MG/ML INJCT O $0.00 $0.00 330184 J0401 1468 636 ARIPIPRAZOLE MAINTENA SYRINGE 400MG-J0401 O $0.00 $0.00 330184 J0401 1468 636 ARIPIPRAZOLE MAINTENA 400MG ER VIAL INJ-J0401 O $0.00 $0.00 330184 J0456 496 636 ZITHROMAX I 500 MG O $0.00 $0.00 330184 J0456 496 636 AZITHROMYCIN 500 MG O $0.00 $0.00 330184 J0461 496 636 ATROPINE 0.5MG/5ML O $0.00 $0.00 330184 J0461 496 636 ATROPINE SULFATE 1MG INJ O $0.00 $0.00 330184 J0461 496 636 atropine 0.4mg vial 0.4mg O $0.00 $0.00 330184 J0470 636 Bal in Oil 100mg/1ml O $0.00 $0.00 330184 J0490 JW 1353 636 BELIMUMAB INJECTION 10 MG-J0490-JW O $0.00 $0.00 330184 J0490 1353 636 belimumab 120 mg PWDI-J0490 O $0.00 $0.00 330184 J0490 1353 636 belimumab 400 mg PWDI-J0490 O $0.00 $0.00 330184 J0490 1353 636 INJ BELIMUMAB 10 MG O $0.00 $0.00 330184 J0515 435 636 COGENTIN 2MG/2ML O $0.00 $0.00 330184 J0517 9466 636 BENRALIZUMAB (FASENRA) 30MG/ML SYRINGE-J0517 O $0.00 $0.00 330184 J0558 9088 636 PENG BENZATHINE/PRCN INJ 100K O $180.00 $117.00 330184 J0561 JW 1829 436 636 PENICLLN G BENZATHINE INJ 100K U-J0561-JW O $0.00 $0.00 330184 J0561 1829 436 636 BICILLIN LA 600MU/ML O $0.00 $0.00 330184 J0561 1829 436 636 BICILLIN LA 1.2 M.U. O $0.00 $0.00 330184 J0561 1829 436 636 BICILLIN LA 2.4MMU O $0.00 $0.00 330184 J0561 1829 436 636 PENICLLN G BENZATHINE INJ 100K UNITS O $18.00 $11.70 330184 J0572 435 636 buprenorphine-naloxone 2 mg-0.5 mg FILM-J0572 O $0.00 $0.00 330184 J0573 435 636 BUPRENORPHINENALOXONE 4 MG1 MG FILM O $0.00 $0.00 330184 J0574 435 636 buprenorphine-naloxone 8 mg-2 mg FILM-J0574 O $0.00 $0.00 330184 J0575 636 BUPRENORPHINENALOXONE 12 MG3 MG FILM O $0.00 $0.00 330184 J0585 JW 902 439 636 INJ ONABOTULINUMTOXINA 1 UNIT-J0585-JW O $0.00 $0.00 330184 J0585 902 439 636 onabotulinumtoxinA 100 units PWDI-J0585 O $0.00 $0.00 330184 J0585 902 439 636 onabotulinumtoxinA 200 units PWDI-J0585 O $0.00 $0.00 330184 J0585 902 439 636 BOTOX O $0.00 $0.00 330184 J0585 902 439 636 ONABOTULINUMTOXINA 200 UN O $0.00 $0.00 330184 J0592 636 INJ BUPRENORPHINE HCL 0.1 MG O $0.00 $0.00 330184 J0592 636 BUPRENORPHINE 0.3 MG/ML SOLN-J0592 O $0.00 $0.00 330184 J0600 1274 463 636 Calcium Disodium Versen O $0.00 $0.00 330184 J0604 636 Sensipar Tablets 30 mg O $0.00 $0.00 330184 J0610 496 636 CALCIUM GLUCON. 10% O $0.00 $0.00 330184 J0630 1433 460 636 CALCIMAR 400U/2ML O $0.00 $0.00 330184 J0636 496 636 CALCIJEX 1 MCG/ML INJ O $0.00 $0.00 330184 J0637 JW 436 636 INJ CASPOFUNGIN ACETATE 5 MG-J0637-JW O $0.00 $0.00 330184 J0637 436 636 CANCIDAS 50 O $0.00 $0.00 330184 J0637 436 636 CANCIDAS 70 O $0.00 $0.00 330184 J0640 430 636 LEUCOVORIN CALCIUM 50MG I O $0.00 $0.00 330184 J0640 430 636 Leucovorin 100mg vial O $0.00 $0.00 330184 J0640 430 636 leocovorin 350mg vial O $0.00 $0.00 330184 J0640 430 636 Leucovorin 500mg vial O $0.00 $0.00 330184 J0640 430 636 CALCIUM FOLINATE 10MG/ML O $0.00 $0.00 330184 J0640 430 636 INJ LEUCOVORIN CALCIUM PER 50 MG O $0.00 $0.00 330184 J0641 1236 432 636 LEVOLEUCOVORIN 50 MG O $0.00 $0.00 330184 J0641 1236 432 636 LEVOLEUCOVORIN 50 MG VIAL O $0.00 $0.00 330184 J0641 1236 432 636 LEVOleucovorin 50 mg PW O $0.00 $0.00 330184 J0641 1236 432 636 CALCIUM FOLINATE 10MGML O $0.00 $0.00 330184 J0670 496 636 Mepivacaine 1% P F vial O $0.00 $0.00 330184 J0670 496 636 MEPIVACAINE INJ 1.5% 30ML O $0.00 $0.00 330184 J0670 496 636 Mepivacaine 2% P F 20 ml O $0.00 $0.00 330184 J0670 496 636 MEPIVACAINE INJ 1.5% O $0.00 $0.00 330184 J0670 496 636 Mepivacaine 1% P F vial O $8.16 $5.30 330184 J0670 496 636 MEPIVACAINE INJ 1.5% O $11.52 $7.49 330184 J0690 496 636 ceFAZolin 500 mg PWDI-J0690 O $0.00 $0.00 330184 J0690 496 636 ceFAZolin 1 g PWDI Rx-J0690 O $0.00 $0.00 330184 J0690 496 636 CEFAZOLIN SODIUM 1GM INJ O $0.00 $0.00 330184 J0690 496 636 Cefazolin 1 Gram 50mL Pr O $0.00 $0.00 330184 J0690 496 636 CEFAZOLIN 2G/50ML PREMIX O $0.00 $0.00 330184 J0692 496 636 MAXIPIME 161 INJECTION O $0.00 $0.00 330184 J0692 496 636 MAXIPME 2G INJ 1EA/2G 20M O $0.00 $0.00 330184 J0692 496 636 CEFIPIME PREMIXED1000M O $0.00 $0.00 330184 J0692 496 636 CEFIPIME PREMIXED2000M O $0.00 $0.00 330184 J0692 496 636 cefepime 1000 mg 50 mL O $0.00 $0.00 330184 J0692 496 636 cefEPIme 2000 mg/100 mL-J0692 O $0.00 $0.00 330184 J0692 496 636 cefepime 2000 mg 100 mL O $0.00 $0.00 330184 J0694 435 636 CEFOXITIN 2G/DEXTROSE 50ML PREMIX 24 COUNT CASE-J0694 O $0.00 $0.00 330184 J0694 435 636 CEFOXITIN 1G/DEXTROSE 50ML PREMIX 24 COUNT CASE-J0694 O $0.00 $0.00 330184 J0694 435 636 MEFOXIN 1GM O $0.00 $0.00 330184 J0694 435 636 MEFOXIN 2GM O $0.00 $0.00 330184 J0695 9452 636 INJ CEFTOLOZANE 50MG TAZOBACTAM 25MG-J0695 O $0.00 $0.00 330184 J0695 9452 636 INJ CEFTOLOZANE 50-TAZOBACTAM 25-J0695 O $0.00 $0.00 330184 J0696 496 636 NICU cef-TRIAX-one 250 mg/1 mL I.M.-J0696 O $0.00 $0.00 330184 J0696 496 636 NICU ceftriaxone 250 mg Syringe-J0696 O $0.00 $0.00 330184 J0696 496 636 ROCEPHIN 1GM O $0.00 $0.00 330184 J0696 496 636 ROCEPHIN 2GM O $0.00 $0.00 330184 J0696 496 636 ROCEPHIN 500 MG O $0.00 $0.00 330184 J0696 496 636 ROCEPHIN 250MG O $0.00 $0.00 330184 J0696 496 636 CEFTRIAZONE 1G/50ML INJ O $0.00 $0.00 330184 J0696 496 636 Ceftriaxone Frozen Inj 2 O $0.00 $0.00 330184 J0696 496 636 Neonatal Ceftriaxone40m O $0.00 $0.00 330184 J0696 496 636 cefTRIAXone 2 g PWDI O $0.00 $0.00 330184 J0696 496 636 CEFTRIAXONE SODIUM INJ 250MG O $2.00 $1.30 330184 J0697 496 636 KEFUROX 750MG O $0.00 $0.00 330184 J0697 496 636 KEFUROX 1.5GM INJECTION O $0.00 $0.00 330184 J0698 496 636 CEFOTAXIME SODIUM INJ 1GM O $0.00 $0.00 330184 J0698 496 636 CEFOTAXIME SODIUM INJ O $0.00 $0.00 330184 J0698 496 636 NEONATALCefotaxime1Gr O $0.00 $0.00 330184 J0702 435 636 BETAMETHASONE SOD PHOSPH O $0.00 $0.00 330184 J0702 435 636 Betamethasone Acet&sod Ph O $3.00 $1.95 330184 J0706 496 636 CAFCIT INJ 20MG/ML 3ML O $0.00 $0.00 330184 J0706 496 636 Neonatal CaffeineCitrate6 O $0.00 $0.00 330184 J0712 JW 1824 432 636 CEFTAROLINE FOSAMIL INJ 10 MG-J0712-JW O $0.00 $0.00 330184 J0712 1824 432 636 Teflaro 400mg O $0.00 $0.00 330184 J0712 1824 432 636 TEFLARO 600 MG VIALS O $0.00 $0.00 330184 J0713 496 636 cefTAZidime 1 g/50 mL-D5% SOLN-J0713 O $0.00 $0.00 330184 J0713 496 636 cefTAZidime 2 g/50 mL-D5% SOLN-J0713 O $0.00 $0.00 330184 J0713 496 636 cefTAZidime 500 mg PWDI-J0713 O $0.00 $0.00 330184 J0713 496 636 TAZIDIME 2GM O $0.00 $0.00 330184 J0713 496 636 TAZIDIME 1GM O $0.00 $0.00 330184 J0713 496 636 Ceftazidime 1 Gram 50mL O $0.00 $0.00 330184 J0713 496 636 Ceftazidime 2 Grams 50mL O $0.00 $0.00 330184 J0713 496 636 NeonatalCeftazidime100 O $0.00 $0.00 330184 J0713 496 636 INJ CEFTAZIDIME PER 500 MG O $0.00 $0.00 330184 J0714 1825 636 CEFTAZIDIME 2.0G/AVIBACTAM 0.5G O $0.00 $0.00 330184 J0714 JW 1825 636 CEFTAZIDIME AND AVIBACTAM-J0714-JW O $0.00 $0.00 330184 J0714 1825 636 AVYCAZ (CETAZIDIME/AVIBACTAM) 2GM/0.5GM O $0.00 $0.00 330184 J0735 435 636 clonidine 100 mcg/mL SOLN O $0.00 $0.00 330184 J0743 435 636 IMIPENEM CILASTATIN 500MG O $0.00 $0.00 330184 J0743 435 636 PRIMAXIN 250 MG INJ 25 EA O $0.00 $0.00 330184 J0744 496 636 CIPROFLOXACIN 400MG/100ML O $0.00 $0.00 330184 J0744 496 636 CIPROFLOXACIN 200MG/100ML O $0.00 $0.00 330184 J0744 496 636 CIPROFLOXACIN 200MG VIAL O $0.00 $0.00 330184 J0770 435 636 COLISTIMETHATE UP TO150 MG INJECT O $0.00 $0.00 330184 J0780 496 636 PROCHLORPERAZINE EDI. INJ O $0.00 $0.00 330184 J0834 435 636 CORTROSYN 250MCG O $0.00 $0.00 330184 J0875 1823 462 636 DALVANCE 500MG-J0875 O $0.00 $0.00 330184 J0878 JW 9124 433 636 INJ DAPTOMYCIN 1 MG-J0878-JW O $0.00 $0.00 330184 J0878 9124 433 636 Daptomycin 500mg vial O $0.00 $0.00 330184 J0881 1685 438 636 ARANESP 300MCG/0.6ML1 ML O $0.00 $0.00 330184 J0881 1685 438 636 ARANESP 100 MCG/ML2 ML O $0.00 $0.00 330184 J0881 1685 438 636 ARANESP 200MCG/0.4MLINJE O $0.00 $0.00 330184 J0881 1685 438 636 DARBEPOETIN ALPHA ARANES O $0.00 $0.00 330184 J0881 1685 438 636 darbepoetin 60mcg Inj O $0.00 $0.00 330184 J0881 1685 438 636 ARANESP 500 MCG/1 ML O $0.00 $0.00 330184 J0881 1685 438 636 Aranesp Injection 25 mcg O $0.00 $0.00 330184 J0881 1685 438 636 Darbepoetin 150mcg Syr O $0.00 $0.00 330184 J0882 1482 636 ARANESP 300MCG/0.6ML1 O $0.00 $0.00 330184 J0882 1482 636 ARANESP 100 MCG/ML2 ML O $0.00 $0.00 330184 J0882 1482 636 ARANESP 200MCG/0.4MLIN O $0.00 $0.00 330184 J0882 1482 636 DARBEPOETIN ALPHA ARAN O $0.00 $0.00 330184 J0882 1482 636 DARBEPOETIN ALPHA 60 MC O $0.00 $0.00 330184 J0882 1482 636 ARANESP 500 MCG/1 MLESR O $0.00 $0.00 330184 J0882 1482 636 Aranesp Injection 25 mcg O $0.00 $0.00 330184 J0882 1482 636 DARBEPOETIN 150MCG SYR O $0.00 $0.00 330184 J0882 1482 636 ARANESP 100 MCG/ML2 M O $0.00 $0.00 330184 J0882 1482 636 ARANESP 200MCG/0.4MLI O $0.00 $0.00 330184 J0882 1482 636 DARBEPOETIN ALPHA ARA O $0.00 $0.00 330184 J0882 1482 636 DARBEPOETIN ALPHA 60 M O $0.00 $0.00 330184 J0882 1482 636 ARANESP 500 MCG/1 ML O $0.00 $0.00 330184 J0882 1482 636 Darbepoetin 150mcg Syr O $0.00 $0.00 330184 J0883 1859 636 ARGATROBAN NONESRD USE 1MG-J0883 O $0.00 $0.00 330184 J0883 1859 636 ARGATROBAN 1 MG/ML SOLN O $0.00 $0.00 330184 J0884 9065 636 ARGATROBAN ESRD DIALYSIS 1MG-J0884 O $0.00 $0.00 330184 J0885 JW 1686 438 636 EPOETIN ALFA NON-ESRD 1000 UNITS-J0885-JW O $0.00 $0.00 330184 J0885 1686 438 636 "epoetin alfa 10,000 units/mL SOLN (Epogen)-J0885" O $0.00 $0.00 330184 J0885 1686 438 636 "epoetin alfa 2,000 units SOLN (Epogen)-J0885" O $0.00 $0.00 330184 J0885 1686 438 636 "epoetin alfa 20,000 units/mL SOLN (Epogen)-J0885" O $0.00 $0.00 330184 J0885 1686 438 636 "epoetin alfa 3,000 units/mL SOLN (Epogen)-J0885" O $0.00 $0.00 330184 J0885 1686 438 636 epoetin alfa 4000 units/mL SOLN (Epogen)-J0885 O $0.00 $0.00 330184 J0885 1686 438 636 PROCRIT 2M UNITS O $0.00 $0.00 330184 J0885 1686 438 636 PROCRIT 3M UNITS O $0.00 $0.00 330184 J0885 1686 438 636 PROCRIT 4M UNITS O $0.00 $0.00 330184 J0885 1686 438 636 PROCRIT 10M UNITS O $0.00 $0.00 330184 J0885 1686 438 636 PROCRIT 20M UNITS O $0.00 $0.00 330184 J0885 1686 438 636 PROCRIT 40M UNITS O $0.00 $0.00 330184 J0894 JW 9231 434 636 DECITABINE INJ 1 MG-J0894-JW O $0.00 $0.00 330184 J0894 9231 434 636 decitabine 50mg vial O $0.00 $0.00 330184 J0895 435 636 DESFERAL 500MG O $0.00 $0.00 330184 J0895 435 636 INJ DEFEROXAMINE MESYLATE 500 MG O $0.00 $0.00 330184 J0897 JW 9272 443 636 DENOSUMAB INJ 1 MG-J0897-JW O $0.00 $0.00 330184 J0897 9272 443 636 XGEVA 120 MG INJ O $0.00 $0.00 330184 J0897 9272 443 636 XGEVA 120MG INJ O $0.00 $0.00 330184 J0897 9272 443 636 PROLIA 60 MG INJ O $0.00 $0.00 330184 J0897 9272 443 636 denosumab 120 mg SOLN O $0.00 $0.00 330184 J0897 9272 443 636 denosumab 60 mg SOLN O $0.00 $0.00 330184 J1030 496 636 DEPO_MEDROL 40 MG INJ-J1030 O $19.45 $12.64 330184 J1030 496 636 DEPOMEDROL 40MG O $0.00 $0.00 330184 J1030 496 636 Methylprednisolone 40 Mg O $26.00 $16.90 330184 J1040 496 636 DEPO-MEDROL 80MG/ML1 ML O $0.00 $0.00 330184 J1040 496 636 Methylprednisolone 80 Mg O $19.00 $12.35 330184 J1050 636 Medroxyprogesterone150 O $0.00 $0.00 330184 J1050 636 MEDROXYPROGESTERNE ACETATE 1MG O $0.75 $0.49 330184 J1071 496 636 INJ TESTOSTERONE CYPIONATE O $0.00 $0.00 330184 J1071 496 636 INJ TESTOSTERONE CYPIONATE-J1071 O $0.27 $0.18 330184 J1094 636 Inj Dexamethasone Acetate O $0.00 $0.00 330184 J1094 636 Inj Dexamethasone Acetate O $1.00 $0.65 330184 J1100 496 636 dexamethasone 10 mg/mL Solution-J1100 O $0.00 $0.00 330184 J1100 496 636 dexamethasone 10 mg/mL SOLN 10 mL-J1100 O $0.00 $0.00 330184 J1100 496 636 DEXAMETHASONE SODIUM PHOS O $0.00 $0.00 330184 J1100 496 636 Dexamethasone Sodium Phos O $2.00 $1.30 330184 J1100 496 636 DECADRON/ DEXAMETHASONE 1 MG O $0.36 $0.23 330184 J1110 435 636 DIHYDROERGOTAMINE 1MG INJ O $0.00 $0.00 330184 J1120 435 636 DIAMOX 500MG O $0.00 $0.00 330184 J1160 496 636 DIGOXIN INJECTION O $0.00 $0.00 330184 J1160 496 636 LANOXIN PED 0.1MG/ML1 ML O $0.00 $0.00 330184 J1162 JW 1687 463 636 DIGOXIN IMMUNE FAB (OVINE)PER VIAL-J1162-JW O $0.00 $0.00 330184 J1162 1687 463 636 DIGOXIN IMMUNE FAB(OVINE) O $0.00 $0.00 330184 J1165 496 636 DILANTIN 250MG/5ML O $0.00 $0.00 330184 J1165 496 636 DILANTIN 100MG/2ML O $0.00 $0.00 330184 J1170 496 636 HYDROmorphone 10 mg/mL SOLN-J1170 O $0.00 $0.00 330184 J1170 496 636 HYDROMORPHONE 0.5MG/0.5ML SYR-J1170 O $0.00 $0.00 330184 J1170 496 636 DILAUDID 2MG/ML O $0.00 $0.00 330184 J1170 496 636 Hydromorphone 4mg mL i O $0.00 $0.00 330184 J1170 496 636 HYDROMORPHON 10MG/100ML O $0.00 $0.00 330184 J1170 496 636 HYDROMORPHONE 1 MG INJ O $0.00 $0.00 330184 J1200 496 636 DIPHENHYDRAMINE 50MG INJ O $0.00 $0.00 330184 J1200 496 636 DIPHENHYDRMN HCL INJ UP TO 50MG O $2.00 $1.30 330184 J1200 496 636 DIPHENHYDRAMINE 50M O $0.54 $0.35 330184 J1205 436 636 CHLOROTHIAZIDE SODM INJ 500MG O $238.00 $154.70 330184 J1230 636 METHADONE 10MG/ML INJEC O $0.00 $0.00 330184 J1245 496 636 DIPYRIDAMOLE 5mg/mL 10 mj O $0.00 $0.00 330184 J1250 496 636 DOBUTREX 250MG/20ML O $0.00 $0.00 330184 J1250 496 636 Dobutamine 500mg 250mL O $0.00 $0.00 330184 J1250 496 636 Inj Dobutamine Hcl/250 Mg O $30.00 $19.50 330184 J1265 496 636 Dopamine 400mg 250 mL O $0.00 $0.00 330184 J1265 496 636 DOPAMINE HCL 400MG/10ML I O $0.00 $0.00 330184 J1265 496 636 DOPAMINE 800MG/D5W 250ML O $0.00 $0.00 330184 J1265 496 636 DOPAMINE 800MG/D5W 500ML O $0.00 $0.00 330184 J1265 496 636 INJ DOPAMINE HCL 40 MG O $0.00 $0.00 330184 J1267 9317 436 636 Doripenem 500mg vial O $0.00 $0.00 330184 J1300 9236 465 636 Eculizumab 300mg 30mL v O $0.00 $0.00 330184 J1324 435 636 Enfuvirtide 90mg vial O $0.00 $0.00 330184 J1327 JW 1607 434 636 EPTIFIBATIDE INJ 5 MG-J1327-JW O $0.00 $0.00 330184 J1327 1607 434 636 EPTIFIBADTIDE INJ 5 MG O $0.00 $0.00 330184 J1327 1607 434 636 INTEGRILIN 75MG/100ML INJ O $0.00 $0.00 330184 J1335 435 636 INVANZ 1GINJECTION O $0.00 $0.00 330184 J1364 JW 435 636 ERYTHROCIN INJ PER 500 MG-J1364-JW O $0.00 $0.00 330184 J1364 435 636 ERYTHROCIN LACTOBION 500 MG INJ O $0.00 $0.00 330184 J1410 JW 9038 437 636 INJ ESTROGEN CONJUGATE 25 MG-J1410-JW O $0.00 $0.00 330184 J1410 9038 437 636 PREMARIN 25MG/5ML O $0.00 $0.00 330184 J1442 JW 1469 636 INJ FILGRASTIM EXCL BIOSIMIL 1MCG-J1442-JW O $0.00 $0.00 330184 J1442 1469 636 filgrastim 300 mcg/mL Solution-J1442 O $0.00 $0.00 330184 J1442 1469 636 filgrastim 480 mcg/1.6 mL SOLN-J1442 O $0.00 $0.00 330184 J1442 1469 636 NEUPOGEN (FILGR)300 MCG/0.5ML-J1442 O $0.00 $0.00 330184 J1442 1469 636 INJ FILGRASTIM G-CSF 1MCG O $0.00 $0.00 330184 J1450 496 636 FLUCONAZOLE 400MG/NORMAL SALINE 200ML-J1450 O $0.00 $0.00 330184 J1450 496 636 FLUCONAZOLE INJ 200MG/100 O $0.00 $0.00 330184 J1450 496 636 FLUCONAZOLE INJ 400MG/200 O $0.00 $0.00 330184 J1450 496 636 fluconazole 100mg 50mLIV O $0.00 $0.00 330184 J1451 JW 1689 438 636 FOMEPIZOLE 15 MG-J1451-JW O $0.00 $0.00 330184 J1451 1689 438 636 ANTIZOL 1G/ML1.5 ML O $0.00 $0.00 330184 J1459 1214 461 636 INJ IVIG PRIVIGEN 500 MG-J1459 O $0.00 $0.00 330184 J1460 1850 636 GAMASTAN S/D2 ML O $0.00 $0.00 330184 J1460 1850 636 Gamastatin 6 mL Vial O $0.00 $0.00 330184 J1561 JW 948 636 GAMUNEX-C/GAMMAKED 500MG-J1561-JW O $0.00 $0.00 330184 J1561 948 636 Immune Globulin (Human) 10% 1 gm/10ml O $0.00 $0.00 330184 J1561 948 636 Immune Globulin (Human) 10% 2.5gm/25ml O $0.00 $0.00 330184 J1561 948 636 IMMUNE GLOBULIN 10% 40G-J1561 O $0.00 $0.00 330184 J1561 948 636 Gamunex IVIG Injection 10 O $0.00 $0.00 330184 J1566 2731 461 636 GAMMAR IV 5GM INJECTION O $0.00 $0.00 330184 J1566 2731 461 636 IMMUNOGLOBULIN HUMAN 10GM O $0.00 $0.00 330184 J1566 2731 461 636 CARIMUNE 6000 MG VIAL O $0.00 $0.00 330184 J1568 JW 943 636 OCTAGAM INJECTION 500 MG-J1568-JW O $0.00 $0.00 330184 J1568 943 636 imm glob IV 5% SOLN 100 Ml-J1568 O $0.00 $0.00 330184 J1568 943 636 imm glob IV 5% SOLN 200 Ml-J1568 O $0.00 $0.00 330184 J1568 943 636 OCTAGAM 10% IVIG 10G/100ML-J1568 O $0.00 $0.00 330184 J1568 943 636 OCTAGAM 10% IVIG 20G/200ML-J1568 O $0.00 $0.00 330184 J1568 943 636 OCTAGAM 10% IVIG 30G/300ML-J1568 O $0.00 $0.00 330184 J1568 943 636 OCTAGAM 10% IVIG 5G/50ML-J1568 O $0.00 $0.00 330184 J1568 943 636 IMMUNOGLOBULIN HUMAN INJ O $0.00 $0.00 330184 J1569 944 461 636 "GAMMAGARD LIQUID 10 %, 20000 MG/ 200ML-J1569" O $0.00 $0.00 330184 J1569 944 461 636 GAMMAGARD LIQUID 10% 10000 MG/ 200ML-J1569 O $0.00 $0.00 330184 J1569 944 461 636 GAMMAGARD LIQUID 10% 5000 MG/ 50 ML-J1569 O $0.00 $0.00 330184 J1570 436 636 CYTOVENE 500MG INJECTION O $0.00 $0.00 330184 J1580 496 636 gentamicin 80 mg/100 mL Premix Solution-J1580 O $0.00 $0.00 330184 J1580 496 636 gentamicin 80 mg/50 mL-0.9% SOLN-J1580 O $0.00 $0.00 330184 J1580 496 636 GENTAMICIN 60MG/50ML INJ O $0.00 $0.00 330184 J1580 496 636 GENTAMICIN 80MG/50ML INJ O $0.00 $0.00 330184 J1580 496 636 GENTAMICIN 20MG/2ML INJ O $0.00 $0.00 330184 J1580 496 636 GENTAMICIN 80MG/2ML INJ O $0.00 $0.00 330184 J1602 1475 636 SIMPONI ARIA (GOLIMUMAB) SF 12.5 MG/ML-J1602 O $0.00 $0.00 330184 J1610 JW 9042 437 636 INJ GLUCAGON HCL PER 1 MG-J1610-JW O $0.00 $0.00 330184 J1610 9042 437 636 GLUCAGON 1 MG O $0.00 $0.00 330184 J1626 496 636 KYTRIL 0.1MG/ML1 ML O $0.00 $0.00 330184 J1630 496 636 haloperidol 5 mg/mL SOLN-J1630 O $0.00 $0.00 330184 J1630 496 636 haloperidol 50 mg/10 mL SOLN-J1630 O $0.00 $0.00 330184 J1630 496 636 HALOPERIDOL LACTATE INJ O $0.00 $0.00 330184 J1631 435 636 HALDOL DECANOA. 50MG O $0.00 $0.00 330184 J1631 435 636 Haloperidol Dec 100mg/mLL O $0.00 $0.00 330184 J1642 496 636 Heparin 100 units/mL Flush Solution Inj O $0.00 $0.00 330184 J1642 496 636 NICU heparin 100 units/mL PF SOLN-J1642 O $0.00 $0.00 330184 J1642 496 636 HEPARIN 100 UNITS/ML FLUSH SOLUTION INJ-J1642 O $0.00 $0.00 330184 J1642 496 636 HEPARIN NEONATAL 100UNITS O $0.00 $0.00 330184 J1642 496 636 Heparin 100 units/mL FluL O $0.00 $0.00 330184 J1642 496 636 Neonatal Heparin InfusB O $0.00 $0.00 330184 J1642 496 636 INJ HEPARIN SODIUM PER 10 UNITS O $0.00 $0.00 330184 J1644 496 636 HEPARIN 1000 UNITS/ 500 ML NS O $7.00 $4.55 330184 J1644 496 636 HEPARIN 1000 UNITS/ML(1 ML VIALS) O $3.00 $1.95 330184 J1644 496 636 heparin 10000 units/mL SOLN-J1644 O $0.00 $0.00 330184 J1644 496 636 heparin 1000 units/mL Solution Inj-J1644 O $0.00 $0.00 330184 J1644 496 636 heparin 1000 units/mL SOLN - (NOMOGRAM)-J1644 O $0.00 $0.00 330184 J1644 496 636 heparin 1000 units/mL SOLN-J1644 O $0.00 $0.00 330184 J1644 496 636 HEPARIN 5000 UNIT INJ O $0.00 $0.00 330184 J1644 496 636 HEPARIN 1000 UNIT INJ O $0.00 $0.00 330184 J1644 496 636 HEPARIN 25000U/D5W 50U O $0.00 $0.00 330184 J1644 496 636 HEPARIN 25000U/D5W 100U O $0.00 $0.00 330184 J1644 496 636 HEPARIN 25000 U/0.5% NAC O $0.00 $0.00 330184 J1644 496 636 HEPARIN 5000UNITS/mL 10mL O $0.00 $0.00 330184 J1644 496 636 HEPARIN 1000 UNITS/ML10ML O $0.00 $0.00 330184 J1650 496 636 ENOXAPARIN INJ 30MG/.3ML O $0.00 $0.00 330184 J1650 496 636 LOVENOX 40 MG/0.4 ML INJ O $0.00 $0.00 330184 J1650 496 636 LOVENOX 60 MG 10.G ML INJ O $0.00 $0.00 330184 J1650 496 636 Lovenox 80mg 0.8 mL Syri O $0.00 $0.00 330184 J1650 496 636 LOVENOX 100MG INJ O $0.00 $0.00 330184 J1650 496 636 LOVENOX 120MG INJ O $0.00 $0.00 330184 J1652 435 636 ARIXTRA 2.5MG ING O $0.00 $0.00 330184 J1652 435 636 ARIXTRA 7.5MG INJ O $0.00 $0.00 330184 J1652 435 636 ARIXTRA 10MG INJ O $0.00 $0.00 330184 J1652 435 636 ARIXTRA 5MG SYRINGE O $0.00 $0.00 330184 J1670 JW 1670 438 636 HMN TETANUS IG INJ TO 250 UNITS-J1670-JW O $0.00 $0.00 330184 J1670 1670 438 636 Hypertet 250mg injection O $0.00 $0.00 330184 J1720 496 636 hydrocortisone 250 mg preservative-free PWDI-J1720 O $0.00 $0.00 330184 J1720 496 636 hydrocortisone 100 mg preservative-free PWDI-J1720 O $0.00 $0.00 330184 J1720 496 636 SOLU CORTEF 100MG O $0.00 $0.00 330184 J1720 496 636 SOLU CORTEF 500 MG O $0.00 $0.00 330184 J1740 9229 636 BONIVA 3MG/3ML INJECTION O $0.00 $0.00 330184 J1741 435 636 Neoprofen Vial 20 mg O $0.00 $0.00 330184 J1741 435 636 IBUPROFEN LYSINE 10 MG/ML SOLN O $0.00 $0.00 330184 J1745 JW 7043 461 636 INFLIXIMAB NOT BIOSIMIL 10MG-J1745-JW O $0.00 $0.00 330184 J1745 7043 461 636 Infliximab 100mg vial O $0.00 $0.00 330184 J1756 436 636 VENOFER INJ 100MG/5ML O $0.00 $0.00 330184 J1790 496 636 DROPERIDOL UP TO 5 MG-J1790 O $9.46 $6.15 330184 J1790 496 636 DROPERIDOL 2.5MG/ML INJCT O $0.00 $0.00 330184 J1800 496 636 PROPRANOLOL 1MG/ML INJCTN O $0.00 $0.00 330184 J1815 496 636 HUMULIN NPH INSULIN REPOS O $0.00 $0.00 330184 J1815 496 636 LANTUS INSULIN 100 UNITS/ O $0.00 $0.00 330184 J1815 496 636 NOVOLOG MIX FLEXPEN 3 ML O $0.00 $0.00 330184 J1815 496 636 LEVEMIR FLEXPEN 3 ML O $0.00 $0.00 330184 J1815 496 636 Humulin R 3ml 100 units/m O $0.00 $0.00 330184 J1815 496 636 Humulin N 3 ml 100 units/ O $0.00 $0.00 330184 J1815 496 636 Humalog 50 50 insulin O $0.00 $0.00 330184 J1815 496 636 INSULIN HUMALOG O $0.00 $0.00 330184 J1815 496 636 "INJECTION, INSULIN, PER 5 UNITS" O $2.00 $1.30 330184 J1815 496 636 HUMULIN U-500 20ML O $0.00 $0.00 330184 J1840 636 KANAMYCIN SULFATE INJ 1GM O $0.00 $0.00 330184 J1885 496 636 TORADOL 30MG/ML INJECTION O $0.00 $0.00 330184 J1885 496 636 TORADOL 60MG/2ML INJCTN O $0.00 $0.00 330184 J1885 496 636 TORADOL 15MG/ML INJECTION O $0.00 $0.00 330184 J1885 496 636 KETOROLAC TROMETHAMNE INJ 15MG O $4.00 $2.60 330184 J1940 496 636 FUROSEMIDE 40MG/4ML INJCT O $0.00 $0.00 330184 J1940 496 636 FUROSEMIDE INJ 100MG/10ML O $0.00 $0.00 330184 J1940 496 636 Furosemide Injection 20 m O $0.00 $0.00 330184 J1940 496 636 FUROSEMIDE 40MG/4ML O $0.64 $0.42 330184 J1950 800 441 636 LUPRON DEPOT INJ PER 3.75 MG-J1950 O $935.00 $607.75 330184 J1950 800 441 636 Lupron 3.75mg DEPOT KIT O $0.00 $0.00 330184 J1950 800 441 636 Leuprolide 11.25mg DEPO O $0.00 $0.00 330184 J1950 800 441 636 INJ LEUPROLIDE ACETATE PER 3.75 MG O $0.00 $0.00 330184 J1953 435 636 LEVETIRACETAM 1500MG/100ML NRML SAL-J1953 O $0.00 $0.00 330184 J1953 435 636 KEPPRA 500MG/5ML INJ SML/ O $0.00 $0.00 330184 J1953 435 636 NeonatalLevetiraceta500 O $0.00 $0.00 330184 J1953 435 636 LEVETIRACETAM 500MG/100ML O $0.00 $0.00 330184 J1953 435 636 LEVETIRACETAM 1000MG/100M O $0.00 $0.00 330184 J1955 435 636 INJ LEVOCARNITINE PER 1GM-J1955 O $0.00 $0.00 330184 J1956 496 636 LEVOFLOXACIN 250MG/50ML O $0.00 $0.00 330184 J1956 496 636 LEVOFLOXACIN 500MG/100ML O $0.00 $0.00 330184 J1956 496 636 LEVOFLOXACIN 750MG/100ML O $0.00 $0.00 330184 J2001 496 636 LIDOCAINE 1% 20ML VIALS O $4.00 $2.60 330184 J2001 496 636 EPINEPHRINE-LIDOCAINE 1:100000-2% SOLN 20ML-J2001 O $0.00 $0.00 330184 J2001 496 636 Lidocaine 2% 100mg 5 mL O $0.00 $0.00 330184 J2001 496 636 XYLOCAINE 2% 5ML O $0.00 $0.00 330184 J2001 496 636 LIDO. 0.4%/DEXT. 5% O $0.00 $0.00 330184 J2001 496 636 LIDO. 0.8%/DEXT. 5% O $0.00 $0.00 330184 J2001 496 636 LIDOCAINE 1% 20ML INJCTN O $0.00 $0.00 330184 J2001 496 636 LIDOCAINE 2% INJECTION O $0.00 $0.00 330184 J2001 496 636 LIDOCAINE MPF 1% 30ML INJ O $0.00 $0.00 330184 J2001 496 636 LIDOCAINE MPF .05% 50ML O $0.00 $0.00 330184 J2001 496 636 lidocaine 2% MPF 10mL vi O $0.00 $0.00 330184 J2001 496 636 Lidocaine 1% 5mL Pediatri O $0.00 $0.00 330184 J2001 496 636 Lidocaine 1% MPF 5 mL vi O $0.00 $0.00 330184 J2001 496 636 LIDOCAINE 1% 20ML INJ O $0.84 $0.55 330184 J2001 496 636 INJ LIDOCAINE HCL (INTRVNS INFSN) 10 MG O $0.00 $0.00 330184 J2020 435 636 ZYVOX IV 600MG/300ML300M O $0.00 $0.00 330184 J2060 496 636 ATIVAN 2MG/ML O $0.00 $0.00 330184 J2060 496 636 LORAZEPAM 40MG/10ML O $0.00 $0.00 330184 J2150 496 636 MANNITOL 25%/12.5GM O $0.00 $0.00 330184 J2175 496 636 MEPERIDINE HYDROCHLORIDE O $0.00 $0.00 330184 J2182 9473 636 MEPOLIZUMAB (NUCALA) 100MG/ML SYRINGE-J2182 O $0.00 $0.00 330184 J2185 435 636 MEROPENEM 1 GM DUPLEX CONT-J2185 O $0.00 $0.00 330184 J2185 435 636 MERRUM 1G INJECTION O $0.00 $0.00 330184 J2185 435 636 MERREM 500MGINJECTION O $0.00 $0.00 330184 J2210 496 636 METHERGINE 0.2MG/ML O $0.00 $0.00 330184 J2212 435 636 Relistor Injection 12 mg/ O $0.00 $0.00 330184 J2250 496 636 midazolam-NaCl 0.9% 100 mG/100 mL SOLN O $0.00 $0.00 330184 J2250 496 636 midazolam 5 mg/mL Solution-J2250 O $0.00 $0.00 330184 J2250 496 636 MIDAZOLAM HYDRCHL PER 1 MG-J2250 O $0.10 $0.07 330184 J2250 496 636 MIDAZOLAM 5MG/5ML O $0.00 $0.00 330184 J2250 496 636 VERSED INJECTION O $0.00 $0.00 330184 J2250 496 636 VERSED 5MG/ML1 ML O $0.00 $0.00 330184 J2250 496 636 INJ MIDAZOLAM HYDROCHLORIDE PER 1 MG O $1.70 $1.10 330184 J2250 496 636 MIDAZOLAM 50MG/10ML INJ O $0.00 $0.00 330184 J2250 496 636 MIDAZOLAM 50MG/100ML IV O $0.00 $0.00 330184 J2250 496 636 MIDAZOLAM 100MG/100ML IVB O $0.00 $0.00 330184 J2250 496 636 INJ MIDAZOLAM HYDROCHLORIDE PER 1 MG O $0.00 $0.00 330184 J2260 496 636 MILRINONE LACTATE 20MG/20 O $0.00 $0.00 330184 J2260 496 636 Milrinone 20mg 100mLD5 O $0.00 $0.00 330184 J2270 496 636 morphine 50 mg/mL Solution-J2270 O $0.00 $0.00 330184 J2270 496 636 NICU morphine 0.2 mg/mL preservative-free SOLN-J2270 O $0.00 $0.00 330184 J2270 496 636 morphine 2 mg/mL Solution-J2270 O $0.00 $0.00 330184 J2270 496 636 MORPHINE 4 MG/ML PF VIAL-J2270 O $0.00 $0.00 330184 J2270 496 636 MORPHINE 2MG/1ML O $0.00 $0.00 330184 J2270 496 636 MORPHINE 8MG/ML O $0.00 $0.00 330184 J2270 496 636 MORPHINE 10MG/ML O $0.00 $0.00 330184 J2270 496 636 MORPHINE 4 MG IV CARPHJEC O $0.00 $0.00 330184 J2274 435 636 IN MORPHINE PRESERV FREE 10MG O $0.00 $0.00 330184 J2280 435 636 AVELOX IV 400MG/250ML250 O $0.00 $0.00 330184 J2300 496 636 Nalbuphine 20mg mL inj O $0.00 $0.00 330184 J2300 496 636 Nalbuphine 10mg mL inj O $0.00 $0.00 330184 J2310 435 636 NALOXONE INJ .4MG/1ML O $0.00 $0.00 330184 J2310 435 636 NALOXONE 4MG 10ML MDV INJ O $0.00 $0.00 330184 J2350 9494 465 636 OCRELIZUMAB(OCREVUS)30MG/ML 10 ML VIAL-J2350 O $0.00 $0.00 330184 J2350 9494 465 636 "INJ, OCRELIZUMAB 1 MG-J2350" O $0.00 $0.00 330184 J2353 JW 1207 462 636 OCTREOTIDE DEPOT 1 MG IM INJ-J2353-JW O $0.00 $0.00 330184 J2353 1207 462 636 SANDOSTATIN LAR 20MG INJ O $0.00 $0.00 330184 J2354 496 636 SANDOSTATIN 1MG INJ O $0.00 $0.00 330184 J2354 496 636 SANDOSTATE INJECTION O $0.00 $0.00 330184 J2354 496 636 OCTREOTIDE ACETATE 1MG O $0.00 $0.00 330184 J2354 496 636 OCTREOTIDE NOT DEPOT 25 MCG INJ-J2354 O $0.00 $0.00 330184 J2357 9300 460 636 OMALIZUMAB (XOLAIR) 150MG SYRINGE-J2357 O $0.00 $0.00 330184 J2357 9300 460 636 OMALIZUMAB (XOLAIR) 75MG SYRINGE-J2357 O $0.00 $0.00 330184 J2370 496 636 PHENYLEPHRINE INJECTION O $0.00 $0.00 330184 J2400 435 636 INJ CHLOROPROCAINE HYDROCHLRD PER 30 ML O $0.00 $0.00 330184 J2405 496 636 ZOFRAN 1MG O $0.00 $0.00 330184 J2405 496 636 ONDANSETRON HCL 2MG/ML O $0.00 $0.00 330184 J2405 496 636 INJ ONDANSETRON HYDROCHLORIDE PER 1 MG O $1.71 $1.11 330184 J2405 496 636 ZOFRAN/ ONDANSETRON PER 1 MG-J2405 O $0.23 $0.15 330184 J2405 496 636 ONDANSETRON HCL 1M O $1.25 $0.81 330184 J2405 496 636 ondansetron 2 mg mL SOL O $0.00 $0.00 330184 J2426 9255 444 636 PALIPERIDONE PALMITATE 117MG/0.75ML-J2426 O $0.00 $0.00 330184 J2426 9255 444 636 PALIPERIDONE PALMITATE 156MG/1ML-J2426 O $0.00 $0.00 330184 J2426 9255 444 636 PALIPERIDONE PALMITATE 234MG/1.5ML-J2426 O $0.00 $0.00 330184 J2426 9255 444 636 PALIPERIDONE PALPITATE 78MG/0.5ML-J2426 O $0.00 $0.00 330184 J2426 9255 444 636 paliperidone 156 mg/mL ERSUS-J2426 O $0.00 $0.00 330184 J2426 9255 444 636 paliperidone 234 mg/1.5 mL ERSUS-J2426 O $0.00 $0.00 330184 J2426 9255 444 636 PALIPERIDONE PALMITATE INJ PER MG O $0.00 $0.00 330184 J2430 435 636 Pamidronate 30mg vial O $0.00 $0.00 330184 J2430 435 636 PAMIDRONATE DISODIUM 30 M O $0.00 $0.00 330184 J2440 496 636 PAPAVERINE HCL 30MG/ML1 O $0.00 $0.00 330184 J2469 JW 432 636 PALONOSETRON HCL 25 MCG-J2469-JW O $0.00 $0.00 330184 J2469 432 636 ALOXI 0.25MG/5ML INJ O $0.00 $0.00 330184 J2501 496 636 ZEMPLAR 5MCG/ML2 ML O $0.00 $0.00 330184 J2501 496 636 INJ PARICALCITOL 1 MCG O $0.00 $0.00 330184 J2505 JW 9119 462 636 PEGFILGRASTIM 6 MG INJ-J2505-JW O $0.00 $0.00 330184 J2505 9119 462 636 NEULASTA 6MG/0.6ML O $0.00 $0.00 330184 J2510 435 636 Procaine Penicillin 600 O $0.00 $0.00 330184 J2510 435 636 Procaine Penicillin 1.2 O $0.00 $0.00 330184 J2540 496 636 PENICILLIN G POTASSIUM 5M O $0.00 $0.00 330184 J2543 435 636 ZOSYN 2.25 G O $0.00 $0.00 330184 J2543 435 636 ZOSYN 3.375G INJECTION 10 O $0.00 $0.00 330184 J2543 435 636 ZOSYN 4.5GINJECTION O $0.00 $0.00 330184 J2543 435 636 Piperacillin-Tazobactam O $0.00 $0.00 330184 J2543 435 636 PIPERACILLIN-Tazobactam O $0.00 $0.00 330184 J2545 636 Pentamine 300mg Powde O $0.00 $0.00 330184 J2550 496 636 promethazine 50 mg/mL SOLN-J2550 O $0.00 $0.00 330184 J2550 496 636 promethazine 25 mg/mL SOLN-J2550 O $0.00 $0.00 330184 J2550 496 636 PROMETHAZINE HCL O $0.00 $0.00 330184 J2560 435 636 PHENOBARBITAL 130MG O $0.00 $0.00 330184 J2560 435 636 PHENOBARBITAL 65MG INJ O $0.00 $0.00 330184 J2590 496 636 oxytocin 10 units/mL Solution-J2590 O $0.00 $0.00 330184 J2590 496 636 OXYTOCIN 30 UNITS IN 500ML NS-J2590 O $0.00 $0.00 330184 J2590 496 636 PITOCIN 10U/ML O $0.00 $0.00 330184 J2590 496 636 OXYTOCIN INJECTION 20UNIT O $0.00 $0.00 330184 J2590 496 636 OXYTOCIN 20 UNITS IN 1 ML O $0.00 $0.00 330184 J2590 496 636 Oxytocin10units1000mLL O $0.00 $0.00 330184 J2597 JW 1440 437 636 INJ DESMOPRESSIN ACETATE PER 1 MCG-J2597-JW O $0.00 $0.00 330184 J2597 1440 437 636 DDAVP 4MCG/ML O $0.00 $0.00 330184 J2650 636 PREDNISOLN ACETATE INJ(<= 1ML) O $1.00 $0.65 330184 J2680 435 636 FLUPHENAZINE DECACOATE IN O $0.00 $0.00 330184 J2690 435 636 PROCAINAMIDE1GM/10ML O $0.00 $0.00 330184 J2690 435 636 Procainamide 500mg mL V O $0.00 $0.00 330184 J2700 435 636 OXACILLIN SODIUM INJ 1GM O $0.00 $0.00 330184 J2700 435 636 OXACILLIN SODIUM 2GM INJ O $0.00 $0.00 330184 J2704 496 636 "INJ, PROPOFOL, 10 MG" O $0.00 $0.00 330184 J2704 496 636 DIPRIVAN 200MG/20ML INJCT O $0.00 $0.00 330184 J2704 496 636 DIPRIVAN 10 MG/ML INJ 50M O $0.00 $0.00 330184 J2704 496 636 DIPRIVAN 10MG/ML100ML O $0.00 $0.00 330184 J2710 496 636 neostigmine 0.5 mg/mL SOLN-J2710 O $0.00 $0.00 330184 J2710 496 636 neostigmine 1 mg/mL SOLN-J2710 O $0.00 $0.00 330184 J2710 496 636 NEOSTIGMINE METHYSULFATE O $0.00 $0.00 330184 J2720 496 636 PROTAMINE SULFATE INJCTN O $0.00 $0.00 330184 J2730 436 636 Protopam 1 gram vial O $0.00 $0.00 330184 J2760 1458 435 636 REGITINE 5MG O $0.00 $0.00 330184 J2765 496 636 METOCLOPRAMIDE 10MG INJ O $0.00 $0.00 330184 J2770 2770 433 636 SYNERCID 500MG/VIAL.INJ O $0.00 $0.00 330184 J2780 496 636 ZANTAC 50MG/2ML O $0.00 $0.00 330184 J2783 738 461 636 RASBURICASE 1MG-J2783 O $0.00 $0.00 330184 J2783 738 461 636 RASBURICASE 7.5MG-J2783 O $0.00 $0.00 330184 J2785 490 636 REGADENOSCON(LEXISCAN) O $0.00 $0.00 330184 J2788 435 636 Rho D immune Globulin 50 O $32.00 $20.80 330184 J2788 435 636 HYPERRHO 50MCG (250IU) LAB O $0.00 $0.00 330184 J2790 436 636 RH IMMUNE GLOBULIN O $85.00 $55.25 330184 J2790 436 636 Rho D immune Globulin Inj O $85.00 $55.25 330184 J2790 436 636 HYPERRHO 300MCG (1500IU) LAB O $0.00 $0.00 330184 J2792 JW 1609 636 IV HUMAN RHO D IG INJ 100 IU-J2792-JW O $0.00 $0.00 330184 J2792 1609 636 WINRHO SDF 5000YINJECTIO O $0.00 $0.00 330184 J2792 1609 636 Rho(D) Immune globulin O $0.00 $0.00 330184 J2794 JW 9125 439 636 INJ RISPERIDONE LG ACTNG 0.5 MG-J2794-JW O $0.00 $0.00 330184 J2794 9125 439 636 Risperidone CONSTA 25 O $0.00 $0.00 330184 J2794 9125 439 636 Risperidone CONSTA 37.5 O $0.00 $0.00 330184 J2794 9125 439 636 Risperidone CONSTA 50m O $0.00 $0.00 330184 J2795 496 636 ropivacaine 1% SOLN 20 mL O $0.00 $0.00 330184 J2795 496 636 ROPIVACAINE HCL INJECTION PER MG O $0.00 $0.00 330184 J2796 9245 636 NPLATE 250 MCG INJECTION O $0.00 $0.00 330184 J2800 636 METHOCARBAMOL INJ UP TO10 O $0.00 $0.00 330184 J2800 636 INJ METHOCARBAMOL UP TO 10 ML O $0.00 $0.00 330184 J2805 431 636 SINCALIDE 5MCG POWDER O $0.00 $0.00 330184 J2916 636 FERRLECIT AMPU 62.5MG/5ML O $0.00 $0.00 330184 J2920 496 636 SOLU MEDROL 40MG O $0.00 $0.00 330184 J2920 496 636 METHYLPREDNISOLONE INJ UP TO 40MG O $16.74 $10.88 330184 J2930 496 636 SOLU MEDROL 125 MG O $0.00 $0.00 330184 J2930 496 636 SOLU MEDROL 500 MG O $0.00 $0.00 330184 J2930 496 636 SOLU MEDROL 1GM O $0.00 $0.00 330184 J2997 JW 7048 436 636 TPA INJ 1 MG-J2997-JW O $0.00 $0.00 330184 J2997 7048 436 636 ACTIVASE 50MG O $0.00 $0.00 330184 J2997 7048 436 636 ACTIVASE 100MG/100ML INJ O $0.00 $0.00 330184 J2997 7048 436 636 ALTEPLASE CATHETER 1 MG O $0.00 $0.00 330184 J3010 496 636 NICU fentaNYL 1 mcg/mL SOLN-J3010 O $0.00 $0.00 330184 J3010 496 636 fentaNYL 100 mCg/2 mL Solution Inj-J3010 O $0.00 $0.00 330184 J3010 496 636 FENTANYL 250MCG/5ML O $0.00 $0.00 330184 J3010 496 636 FENTANYL CITRATE UP TO 2M O $0.00 $0.00 330184 J3010 496 636 FENTANYL CITRATE 0.05 O $0.00 $0.00 330184 J3010 496 636 FENTANYL 0.05MG/ML 5ML AMP O $0.00 $0.00 330184 J3010 496 636 FENTANYL CITRATE INJ 0.1 MG-J3010 O $3.13 $2.03 330184 J3010 496 636 FENTANYL 250MCG/5ML O $0.50 $0.33 330184 J3030 435 636 SUMATRIPTAN INJ 6MG/.5ML O $0.00 $0.00 330184 J3101 JW 9002 636 TENECTEPLASE INJ 1 MG-J3101-JW O $0.00 $0.00 330184 J3101 9002 636 TNKASE 50MGKIT O $0.00 $0.00 330184 J3105 496 636 BRETHINE 1MG/ML INJECTION O $0.00 $0.00 330184 J3121 636 INJ TESTOSTERO ENANTHATE 1MG O $0.42 $0.27 330184 J3121 636 INJ TESTOSTERO ENANTHATE 1MG O $0.00 $0.00 330184 J3230 435 636 chlorproMAZINE 25 mg/1 mL SOLN-J3230 O $0.00 $0.00 330184 J3230 435 636 chlorproMAZINE 50 mg/2 mL SOLN-J3230 O $0.00 $0.00 330184 J3230 435 636 CHLORPROMAZINE INJ 5MG/2M O $0.00 $0.00 330184 J3243 JW 9228 436 636 TIGECYCLINE INJ 1 MG-J3243-JW O $0.00 $0.00 330184 J3243 9228 436 636 Tigecycline 50mg vial O $0.00 $0.00 330184 J3250 435 636 TRIMETHOBENZAMIDE INJCTN O $0.00 $0.00 330184 J3260 496 636 NEBCIN 80MG/2ML O $0.00 $0.00 330184 J3260 496 636 NEBCIN 1.2GM POWDER O $0.00 $0.00 330184 J3262 JW 9264 444 636 TOCILIZUMAB INJ 1 MG-J3262-JW O $0.00 $0.00 330184 J3262 9264 444 636 TOCLIZUMAB (ACTEMRA) 20MG/ML 4 ML VIAL-J3262 O $0.00 $0.00 330184 J3262 9264 444 636 TOCILIZUMAB 200MG/10ML O $0.00 $0.00 330184 J3262 9264 444 636 Tocilizumab 200mg 10 mL O $0.00 $0.00 330184 J3265 636 TORSEMIDE 10MG 1ML INJ O $0.00 $0.00 330184 J3301 496 636 TRIAMCINOLONE INJ50MG/5ML O $0.00 $0.00 330184 J3301 496 636 KENALOG-40 40 MG O $0.00 $0.00 330184 J3301 496 636 Triamcinolone Acet Inj No O $3.00 $1.95 330184 J3358 9487 463 636 STELARA (USTEKINUMAB) 130 MG SDPF VIAL-J3358 O $0.00 $0.00 330184 J3360 496 636 DIAZEPAM 10MG/2ML O $0.00 $0.00 330184 J3370 496 636 vancomycin 750 mg/150 mL-D5% SOLN-J3370 O $0.00 $0.00 330184 J3370 496 636 vancomycin 500 mg/100 mL SOLN Rx-J3370 O $0.00 $0.00 330184 J3370 496 636 VANCOMYCIN 1.25GM VIAL-J3370 O $0.00 $0.00 330184 J3370 496 636 VANCOMYCIN 1.5GM VIAL-J3370 O $0.00 $0.00 330184 J3370 496 636 VANCOMYCIN 250MG VIAL-J3370 O $0.00 $0.00 330184 J3370 496 636 VANCOMYCIN 500MG INJECT O $0.00 $0.00 330184 J3370 496 636 VANCOMYCIN HCL 1GINJECTI O $0.00 $0.00 330184 J3370 496 636 VANCOMYCIN HCL O $0.00 $0.00 330184 J3370 496 636 Vancomycin 1 Gram Prem O $0.00 $0.00 330184 J3370 496 636 VANCOMYCIN 500MG ORAL O $0.00 $0.00 330184 J3370 496 636 NEONATAL Vancomycin50 O $0.00 $0.00 330184 J3370 496 636 INJ VANCOMYCIN HCL 500 MG O $0.00 $0.00 330184 J3380 1489 462 636 "INJECTION, VEDOLIZUMAB 1MG-J3380" O $0.00 $0.00 330184 J3410 496 636 HYDROXYZINE INJECTION O $0.00 $0.00 330184 J3411 496 636 THIAMINE 100MG 1ML INJ O $0.00 $0.00 330184 J3415 496 636 PYRIDOXINE 100MG/ML INJCT O $0.00 $0.00 330184 J3420 496 636 CYANOCOBALAMIN 1000MCG IN O $0.00 $0.00 330184 J3420 496 636 VITAMIN B12 INJ UP TO 1000MCG O $7.00 $4.55 330184 J3430 435 636 PHYTONADIONE 1MG INJ O $0.00 $0.00 330184 J3430 435 636 PHYTONADIONE 10MG INJ O $0.00 $0.00 330184 J3465 435 636 VORICONAZOLE 200MG/20ML I O $0.00 $0.00 330184 J3471 636 HYALURONIDASE O $0.00 $0.00 330184 J3471 636 HYALURONIDASE 200 UNITS/ML SOLN-J3471 O $0.00 $0.00 330184 J3471 636 VITRASE 200 UNITS ML-J3471 (PER UNIT) O $0.00 $0.00 330184 J3473 436 636 HYALURONIDASE HUMAN RECOMB O $0.00 $0.00 330184 J3475 496 636 MAGNESIUM SULFATE 8.12MEQ O $0.00 $0.00 330184 J3475 496 636 Magnesium 4 Grams 100m O $0.00 $0.00 330184 J3475 496 636 MAGNESIUM SULFATE 4% INJ O $0.00 $0.00 330184 J3475 496 636 MAGNESIUM SO4 2G/100ML O $0.00 $0.00 330184 J3475 496 636 Magnesium 1 Grams 100 O $0.00 $0.00 330184 J3475 496 636 MGNSM SLFT 40MG/ML 1000ML O $0.00 $0.00 330184 J3475 496 636 MAGNESIUM SO4 2GR 50 ML SW O $0.00 $0.00 330184 J3480 496 636 POTASSIUM CHLORIDE O $0.00 $0.00 330184 J3480 496 636 POTASSIUM C 20 MEQ/100ML O $0.00 $0.00 330184 J3480 496 636 POTASSIUM C 20MEQ-0.9%10 O $0.00 $0.00 330184 J3480 496 636 DEXTROSE-LA 20MEQ/L-5%10 O $0.00 $0.00 330184 J3480 496 636 DEXTROSE-KC 5%-20MEQ/L10 O $0.00 $0.00 330184 J3480 496 636 DEXTROSE-KC 5%-40MEQ/L10 O $0.00 $0.00 330184 J3480 496 636 DEXTROSE-N 5-0.45%-20MEQ/ O $0.00 $0.00 330184 J3480 496 636 DEXTROSE-N 5-0.45%-40MEQ/ O $0.00 $0.00 330184 J3480 496 636 POTASSIUM C 10MEQ/100ML1 O $0.00 $0.00 330184 J3480 496 636 DEXTROSE-N 5-0.9%-20MEQ/L O $0.00 $0.00 330184 J3480 496 636 POTASSIUM CHLORIDE 20 MEQ O $0.00 $0.00 330184 J3485 435 636 ZIDOVUDINE 200MG INJ O $0.00 $0.00 330184 J3485 435 636 Neonatal Zidovudine 20m O $0.00 $0.00 330184 J3486 435 636 Geodon injection 20mg via O $0.00 $0.00 330184 J3489 435 636 zoledronic acid 4 mg/5 mL SOLN-J3489 O $0.00 $0.00 330184 J3489 435 636 zoledronic acid 5 mg/100 mL Premix Solution-J3489 O $0.00 $0.00 330184 J3489 435 636 INJ ZOLDEDRONIC ACID 1MG O $0.00 $0.00 330184 J3490 435 636 0.25% BUPIVACAINE EPINEPHRINE 1:200K O $0.00 $0.00 330184 J3490 435 636 DEXMEDETOMIDINE 4MCG/ML 1X100ML-J3490 O $0.00 $0.00 330184 J3490 435 636 SUGAMMADEX 100MG/ML 1X2ML-J3490 O $272.00 $176.80 330184 J3490 435 636 SUGAMMADEX 100MG/ML 1X5ML-J3490 O $0.00 $0.00 330184 J3490 435 636 SUGAMMADEX 1X5ML-J3490 O $498.00 $323.70 330184 J3490 435 636 diltiazem 5 mg/mL SOLN (10mL)-J3490 O $0.00 $0.00 330184 J3490 435 636 diltiazem 5 mg/mL SOLN (50 mL)-J3490 O $0.00 $0.00 330184 J3490 435 636 "sodium chloride 0.45% 1,000 mL SOLN-J3490" O $0.00 $0.00 330184 J3490 435 636 Sodium Chloride 0.45% 500 mL SOLN O $0.00 $0.00 330184 J3490 435 636 hetastarch 30 gm/500 mL 0.9% NaCl Premix Solution-J3490 O $0.00 $0.00 330184 J3490 435 636 hetastarch 60 mg/mL-LR SOLN-J3490 O $0.00 $0.00 330184 J3490 435 636 LABETALOL VIALS 20MG/4MLJ3490 O $0.00 $0.00 330184 J3490 435 636 BUPIVACAINE 0.5% SOLN (30 ML)-J3490 O $0.00 $0.00 330184 J3490 435 636 CLINDAMYCIN 900 MG/6 ML SOLN.-J3490 O $0.00 $0.00 330184 J3490 435 636 DANTROLENE 20 MG PWDI-J3490 O $0.00 $0.00 330184 J3490 435 636 FAMOTIDINE 10 MG/ML SOLN-J3490 O $0.00 $0.00 330184 J3490 435 636 NAFCILIN 1 G PWDI-J3490 O $0.00 $0.00 330184 J3490 435 636 NAFCILLIN 1 G PWDI-J3490 O $0.00 $0.00 330184 J3490 435 636 SOD THIOSULFATE 250MG/ML-J3490 O $0.00 $0.00 330184 J3490 435 636 TETRACAINE 1% SOLN-J3490 O $0.00 $0.00 330184 J3490 435 636 REMDESIVIR 100MG VIAL-J3490 O $0.00 $0.00 330184 J3490 435 636 LABETALOL 5MG/ML (4ML SYRNG)-J3490 O $0.00 $0.00 330184 J3490 435 636 AMICAR 5GM/20ML O $0.00 $0.00 330184 J3490 435 636 KETALAR 500MG/10ML O $0.00 $0.00 330184 J3490 435 636 Sodium Acetate 2 meqmL O $0.00 $0.00 330184 J3490 435 636 Ethacrynic Acid 50mg vial O $0.00 $0.00 330184 J3490 435 636 LABETALOL INJ 100MG/20ML O $0.00 $0.00 330184 J3490 435 636 Calcium Chloride 1000mg O $0.00 $0.00 330184 J3490 435 636 DOXY-100 100MG O $0.00 $0.00 330184 J3490 435 636 AZTREONAM INJECTION 1GM O $0.00 $0.00 330184 J3490 435 636 HESPAN 500ML O $0.00 $0.00 330184 J3490 435 636 MARCAINE SPIN. 0.75% O $0.00 $0.00 330184 J3490 435 636 BREVIBLOC 100MG O $0.00 $0.00 330184 J3490 435 636 CLINDAMYCIN 300MG/2ML INJ O $0.00 $0.00 330184 J3490 435 636 CLINDAMYCIN 600MG/4ML INJ O $0.00 $0.00 330184 J3490 435 636 RIFAMPIN INJECTION 600MG O $0.00 $0.00 330184 J3490 435 636 PEPCID 20MG/2ML INJ. O $0.00 $0.00 330184 J3490 435 636 SENSORCAINE 0.25% INJECT O $0.00 $0.00 330184 J3490 435 636 BUPIVACAINE HCL O $0.00 $0.00 330184 J3490 435 636 SENSORCAINE-MPF EPINEPHR O $0.00 $0.00 330184 J3490 435 636 BUPIVACAINE/EPINEPHRINE O $0.00 $0.00 330184 J3490 435 636 METRONIDAZOLE 500MG/100ML O $0.00 $0.00 330184 J3490 435 636 NITROGLYCERIN 50MG/10ML O $0.00 $0.00 330184 J3490 435 636 VASOTEC I.V. 2.5MG/2ML O $0.00 $0.00 330184 J3490 435 636 VECURONIUM BROMIDE 10MG I O $0.00 $0.00 330184 J3490 435 636 VASOTEC IV 1.25MG/ML INJ O $0.00 $0.00 330184 J3490 435 636 MAZICON 1MG/10ML INJCTN O $0.00 $0.00 330184 J3490 435 636 CALCIUM CHLORIDE 10% INJ O $0.00 $0.00 330184 J3490 435 636 CARDIZEM INJECTION 25MG O $0.00 $0.00 330184 J3490 435 636 NITROGLYCERIN 100MG/D5W O $0.00 $0.00 330184 J3490 435 636 LIDOCAINE 2% INJECTION O $0.00 $0.00 330184 J3490 435 636 GLYCOPYRROLATE .2MG O $0.00 $0.00 330184 J3490 435 636 FOLIC ACID INJ 50MG/10ML O $0.00 $0.00 330184 J3490 435 636 VASOPRESSIN INJ 20U/ML SD O $0.00 $0.00 330184 J3490 435 636 SODIUM THIOSULFATE 1GM/10 O $0.00 $0.00 330184 J3490 435 636 PENICILLIN G SODIUM INJ O $0.00 $0.00 330184 J3490 435 636 SULFAMETHOXAZOLE TRIMETHO O $0.00 $0.00 330184 J3490 435 636 METOPROLOL TARTRATE 5MG O $0.00 $0.00 330184 J3490 435 636 AZTREONAM 2G INJECTION O $0.00 $0.00 330184 J3490 435 636 NIMBEX 2MG 1ML O $0.00 $0.00 330184 J3490 435 636 ROCURONIUM BROMIDE 10MG O $0.00 $0.00 330184 J3490 435 636 ZEMURON 10MG/ML1 ML O $0.00 $0.00 330184 J3490 435 636 AMIDATE 2MG/ML10 ML O $0.00 $0.00 330184 J3490 435 636 NEXIUM I.V. 40MG INJECTI O $0.00 $0.00 330184 J3490 435 636 NITROGLYCERIN 50MG/D5W 25 O $0.00 $0.00 330184 J3490 435 636 NAFCILLIN SODIUM 1GINJ O $0.00 $0.00 330184 J3490 435 636 NAFCILLIN SODIUM 2GINJEC O $0.00 $0.00 330184 J3490 435 636 Glycopyrrolate 0.2mg mL5 O $0.00 $0.00 330184 J3490 435 636 Bupivicaine Inj 0.5%/10 m O $0.00 $0.00 330184 J3490 435 636 Bupivacaine0.75%MPF 10 O $0.00 $0.00 330184 J3490 435 636 Aztreonam 2 Grams 50mL O $0.00 $0.00 330184 J3490 435 636 300MG CLEOCIN INJ BAG O $0.00 $0.00 330184 J3490 435 636 600MG CLEOCIN INJ BAG O $0.00 $0.00 330184 J3490 435 636 900MG CLEOCIN INJ BAG O $0.00 $0.00 330184 J3490 435 636 LABETALOL 200 MG O $0.00 $0.00 330184 J3490 435 636 Bumetanide Injection 2.5 O $0.00 $0.00 330184 J3490 435 636 Brevital Injection 500 mg O $0.00 $0.00 330184 J3490 435 636 Famotidine Inj 20MG/50ML O $0.00 $0.00 330184 J3490 435 636 SDM CHL 0.45 % SOL 1000 ML O $0.00 $0.00 330184 J3490 435 636 Aztreonam 1 Gram 50mL P O $0.00 $0.00 330184 J3490 435 636 Bupivacaine 0.5% 30mL vi O $0.00 $0.00 330184 J3490 435 636 PhysostigimeSalicylatee2 O $0.00 $0.00 330184 J3490 435 636 Olanzapie 10mg Injection O $0.00 $0.00 330184 J3490 435 636 Bupivacaine-EPI 0.25% M O $0.00 $0.00 330184 J3490 435 636 Bupivacaine-Epi 0.5% MP O $0.00 $0.00 330184 J3490 435 636 Sodium Chloride 0.45% O $16.00 $10.40 330184 J3490 435 636 Levothyroxine 100 mcg/Vi-J3490 O $0.00 $0.00 330184 J3490 435 636 GLYCOPYRROLATE COMP CON O $0.00 $0.00 330184 J3490 435 636 LVP SOLUTION SODIUM CHLORIDE 0.45% SOLN O $0.00 $0.00 330184 J3490 435 636 QUINIDINE 80 MG/ML SOLN O $0.00 $0.00 330184 J3535 636 albuterol CFC free 90 mcg/inh AERO... O $0.00 $0.00 330184 J3535 636 ALBUTERL CFC FREE 90 MCG/INH METER DOSE INHALER-J3535 O $0.00 $0.00 330184 J3535 636 ALBUTERO CFC FREE 90 MCG/INH AERO...-J3535 O $0.00 $0.00 330184 J3535 636 ALBUTEROL CFC FRE 90 MCG/INH METER DOSE INHALER-J3535 O $0.00 $0.00 330184 J3535 636 ALBUTEROL CFC FREE 90 MCG/INH METER DOSE INHALER-J3535 O $0.00 $0.00 330184 J3535 636 TIOTROPIUM (SPIRIVA) RESPIMAT 4GM-J3535 O $0.00 $0.00 330184 J3535 636 Momentasone 220mcgMD O $0.00 $0.00 330184 J3535 636 SYMBICORT 160MG INHALER O $0.00 $0.00 330184 J3535 636 SYMBICORT INHALER 80/4.5M O $0.00 $0.00 330184 J3535 636 COMBIVENT O $0.00 $0.00 330184 J3590 636 PRAXBIND(IDARUCIZUMAB)2.5G50ML O $0.00 $0.00 330184 J7030 496 636 0.9% SODIUM CHLORIDE 500ML BAG O $4.00 $2.60 330184 J7030 496 636 SDM CHL 0.9% SOL 1000MLRX O $0.00 $0.00 330184 J7030 496 636 Sodium Chloride 0.9%/100 O $14.00 $9.10 330184 J7040 496 258 SDM CHL 0.9% SOL 500ML(RX O $0.00 $0.00 330184 J7040 496 636 Sodium Chloride 0.9% no O $0.00 $0.00 330184 J7040 496 258 STERILE SALINE 3000 CC BA O $15.00 $9.75 330184 J7040 496 258 Sodium Chloride 0.9%/500 O $15.00 $9.75 330184 J7040 496 258 Sodium Chloride 3% /500mL O $15.00 $9.75 330184 J7042 496 258 D5W/NS 1000 ML O $0.00 $0.00 330184 J7042 496 258 Dextrose 5% with 0.9% O $0.00 $0.00 330184 J7042 496 258 Dextrose 5% /Nacl 0.9% 10 O $12.00 $7.80 330184 J7042 496 258 Dextrose 5% Nacl 0.33% 5 O $12.00 $7.80 330184 J7050 496 636 SDM CHL 0.9% SOL 50ML(RX) O $0.00 $0.00 330184 J7050 496 636 SDM CHL 0.9% SOL 100ML(RX O $0.00 $0.00 330184 J7050 496 636 SDM CHL 0.9% SOL 250ML(RX O $0.00 $0.00 330184 J7050 496 636 Sodium Chloride 0.9% 50M O $14.00 $9.10 330184 J7050 496 636 Sodium Chloride 0.9%/ 250 O $16.00 $10.40 330184 J7050 496 636 Sodium Chloride 0.9% Inj O $12.00 $7.80 330184 J7050 496 636 NaCl 0.9% 250 mL nonDEHP O $0.00 $0.00 330184 J7060 496 636 dextrose 5% in water Solution non-DEHP-J7060 O $0.00 $0.00 330184 J7060 496 636 Dextrose 5% in Water 100 mL SOLN non-DEHP-J7060 O $0.00 $0.00 330184 J7060 496 636 NICU acetaminophen 80 mg/0.8 mL LIQ O $0.00 $0.00 330184 J7060 496 258 DEXTROSE AMPULE 10%/5ML O $0.00 $0.00 330184 J7060 496 258 DEXTROSE 5%50 ML O $0.00 $0.00 330184 J7060 496 258 DEXTROSE 5% 500ML O $0.00 $0.00 330184 J7060 496 258 D5W 100 ML O $0.00 $0.00 330184 J7060 496 258 D5W 1000 ML O $0.00 $0.00 330184 J7060 496 258 Dextrose 5% Water 250 m O $0.00 $0.00 330184 J7060 496 258 Dextrose 5% 500mL Bag O $0.00 $0.00 330184 J7060 496 258 Dextrose 5% 250mL non-D O $0.00 $0.00 330184 J7060 496 258 Dextrose 5%/250mL O $16.00 $10.40 330184 J7060 496 258 Dextrose 5%/500mL O $16.00 $10.40 330184 J7060 496 258 Dextrose 5% /1000mL O $16.00 $10.40 330184 J7060 496 258 Dextrose 5%/100mL O $16.00 $10.40 330184 J7060 496 258 Dextrose 10% /500mL O $16.00 $10.40 330184 J7060 496 258 Dextrose 5% 250Ml Inj O $16.00 $10.40 330184 J7060 496 258 DEXTROSE AMPULE 10%/ O $1.78 $1.16 330184 J7070 636 INFUSION D-5-W 1000 CC O $0.00 $0.00 330184 J7100 496 636 DEXTRAN 40/NACL 0.9% O $30.00 $19.50 330184 J7120 496 258 LCTD RNGRS 1000ML INF BAG O $0.00 $0.00 330184 J7120 496 258 Lactated Ringers 500mL Bg O $0.00 $0.00 330184 J7120 496 258 Dextrose 5% Lac. Ring.10 O $19.00 $12.35 330184 J7120 496 258 Lactated Ringers 500mL O $19.00 $12.35 330184 J7120 496 258 Lactated Ringers 1000mL O $19.00 $12.35 330184 J7121 496 258 RINGERS LACTATE INFUSION UP TO 1000 CC O $0.00 $0.00 330184 J7131 636 NACL3%(HYPERTONIC)500 O $0.00 $0.00 330184 J7189 1705 636 FACTOR VIIA PER UNIT O $3.00 $1.95 330184 J7192 927 463 636 FACTOR VIII O $2.00 $1.30 330184 J7195 932 463 636 FACTOR IX RECOMB NOS PER IUJ7195 O $4.53 $2.94 330184 J7297 439 636 LEVONORGESTREL IU 52MG 3 YR- O $0.01 $0.01 330184 J7298 439 636 LEVONORGESTREL IU 52MG 5 YR- O $933.00 $606.45 330184 J7300 436 636 Intraut Copper Contracept O $675.00 $438.75 330184 J7307 439 636 ETONOGESTREL IMPLANT SYSTEM O "$1,978.26 " "$1,285.87 " 330184 J7321 636 Hyalgan 20mg injection O $0.00 $0.00 330184 J7321 636 Hyalgan/supartz Inj Per D O $90.00 $58.50 330184 J7323 875 636 Euflexxa Inj Per Dose O $292.00 $189.80 330184 J7324 877 636 Orthovisc Inj Per Dose O $201.00 $130.65 330184 J7325 874 438 636 Hylan G-F 20 8mg mL inj O $0.00 $0.00 330184 J7325 874 438 636 Synvisc Or Synvisc-one (p O $24.00 $15.60 330184 J7325 874 438 636 SYNVISC INJ O $24.00 $15.60 330184 J7500 496 636 AZATHIOPRINE ORAL 50 MG O $0.00 $0.00 330184 J7502 496 636 Cortisporin Topical Oint O $0.00 $0.00 330184 J7502 496 636 CYCLOSPORINE 100MG CAPSLE O $0.00 $0.00 330184 J7502 496 636 Neoral 100mg capsule O $0.00 $0.00 330184 J7507 496 636 Tacrolimus 0.5mg capsule O $0.00 $0.00 330184 J7507 496 636 Tacrolimus 1 mg capsule O $0.00 $0.00 330184 J7509 636 MEDROL 4 MG O $0.00 $0.00 330184 J7509 636 MEDROL 16 MG O $0.00 $0.00 330184 J7510 496 636 PEDIAPRED 5MG/5ML LIQUID O $0.00 $0.00 330184 J7510 496 636 PREDINISOLONE LQD 15MG/5M O $0.00 $0.00 330184 J7512 496 636 PREDNISONE IR OR DR ORAL 1MG- O $0.00 $0.00 330184 J7512 496 636 predniSONE 10 mg Tablet-J7512 O $0.00 $0.00 330184 J7512 496 636 predniSONE 2.5 mg TAB-J7512 O $0.00 $0.00 330184 J7512 496 636 predniSONE 20 mg Tablet-J7512 O $0.00 $0.00 330184 J7512 496 636 predniSONE 5 mg Tablet-J7512 O $0.00 $0.00 330184 J7512 496 636 predniSONE 1 mg Tablet-J7512 O $0.00 $0.00 330184 J7512 496 636 PREDNISONE IR/DR ORAL 1MG (CLN) O $0.01 $0.01 330184 J7515 496 636 Neoral Capsule 25 mg O $0.00 $0.00 330184 J7515 496 636 Cyclosporin 25mg capsule O $0.00 $0.00 330184 J7517 496 636 Mycophenolate 250mg cp O $0.00 $0.00 330184 J7517 496 636 MYCOPHENOLATE MOFETIL ORAL 250 MG O $0.00 $0.00 330184 J7520 430 636 Sirolumus 1 mg tablet O $0.00 $0.00 330184 J7525 9006 437 636 TACROLIMUS INJ O $0.00 $0.00 330184 J7599 636 CellCept Injection 500 mg O $0.00 $0.00 330184 J7608 496 636 acetylcysteine 20% Oral SOLN O $0.00 $0.00 330184 J7608 496 636 acetylcysteine 10% Soln for nebulizer O $0.00 $0.00 330184 J7608 496 636 acetylcysteine 10% SOLN 30 mL O $0.00 $0.00 330184 J7608 496 636 acetylcysteine 20% Soln for Nebulizer O $0.00 $0.00 330184 J7608 496 636 ACETYLCYSTEINE 20% SOLN 30 ML-J7608 O $0.00 $0.00 330184 J7613 636 ALBUTEROL SLTN .083%/3ML O $0.00 $0.00 330184 J7613 636 ALBUTEROL 0.63/3ML NEBULE O $0.00 $0.00 330184 J7613 636 ALBUTEROL 1.25/3ML NEB O $0.00 $0.00 330184 J7614 496 636 Xopenex 0.63mg nebs O $0.00 $0.00 330184 J7614 496 636 Xopenex nebs 1.25mg nebs O $0.00 $0.00 330184 J7620 636 IPRATROPIUM/ALBUTERAL NEB O $0.00 $0.00 330184 J7626 636 BUDESONIDE 0.25 MG/2 ML (NEB) SUSPENSION-J7626 O $0.00 $0.00 330184 J7626 636 Budesonide 0.25mg Inhal O $0.00 $0.00 330184 J7626 636 PULMICORT RESPULES 0.5MG/ O $0.00 $0.00 330184 J7639 636 DORNASE ALFA NON-COMP UNIT O $0.00 $0.00 330184 J7644 636 IPRATROPIUM INH SLTN .02% O $0.00 $0.00 330184 J7682 636 TOBRAMYCIN INHALATION SOLN 56s O $0.00 $0.00 330184 J7799 435 636 DEXTROSE 50% SOLN (50 ML VIAL)-J7799 O $0.00 $0.00 330184 J7799 435 636 MANNITOL 20% SOLN (500 ML PREMIX)-J7799 O $0.00 $0.00 330184 J7799 435 636 Mannitol 20% Premixe500 O $0.00 $0.00 330184 J7799 435 636 DEXTROSE 25%(2.5GM) O $0.00 $0.00 330184 J7799 435 636 DEXTROSE 50% 25MG INJ O $0.00 $0.00 330184 J7799 435 636 D5W/0.5 NS 1000 ML O $0.00 $0.00 330184 J7799 435 636 D5W/0.33 NS 1000 ML O $0.00 $0.00 330184 J7799 435 636 Dextrose 5% 0.45% NS 500 O $0.00 $0.00 330184 J7799 435 636 DEXTROSE 10% BAG 250ML O $0.00 $0.00 330184 J7799 435 636 Dextrose 10% /1000mL O $16.00 $10.40 330184 J7799 435 636 Dextrose 5% Nacl 0.45% 5 O $12.00 $7.80 330184 J7799 435 636 Dextrose 5% /Nacl 0.45% 1 O $12.00 $7.80 330184 J7799 435 636 Dextrose 5% /Nacl 0.33% 1 O $12.00 $7.80 330184 J7799 435 636 DEXTROSE 10% 500ML O $0.00 $0.00 330184 J8499 636 HYDROXYZINE HCL 25MG TBLT O $0.00 $0.00 330184 J8499 636 HYDROXYZINE 10MG TABLET O $0.00 $0.00 330184 J8499 636 CORTEF 10MG TABLET O $0.00 $0.00 330184 J8499 636 HYDROCORTISONE 20MG TBLT O $0.00 $0.00 330184 J8499 636 Acyclovir Tablet 400 mg O $0.00 $0.00 330184 J8499 636 HYDROCORTISONE 5 MG TAB O $0.00 $0.00 330184 J8501 JW 431 636 APREPITANT ORAL 5 MG-J8501-JW O $0.00 $0.00 330184 J8501 431 636 aprepitant 80 mg capsule-J8501 O $0.00 $0.00 330184 J8501 431 636 aprepitant 125 mg CAP-J8501 O $0.00 $0.00 330184 J8501 431 636 EMEND 125MGCAPSULE O $0.00 $0.00 330184 J8530 430 636 CYCLOPHOSPHAMIDE 25MG CAPSULES-J8530 O $0.00 $0.00 330184 J8530 430 636 CYCLOPHOSPHAMIDE 50MG CAPSULES-J8530 O $0.00 $0.00 330184 J8530 430 636 Cytoxan 25mg tablet O $0.00 $0.00 330184 J8540 495 636 dexamethasone 2 mg TAB-J8540 O $0.00 $0.00 330184 J8540 495 636 DEXAMATHASONE 1MG/ML SOL-J8540 O $0.00 $0.00 330184 J8540 495 636 DEXAMETHASONE 0.75MG O $0.00 $0.00 330184 J8540 495 636 DEXAMETHASONE 4MG UD O $0.00 $0.00 330184 J8540 495 636 DEXAMETHASONE 0.5MG O $0.00 $0.00 330184 J8540 495 636 DEXAMETHASONE .5MG/5ML LD O $0.00 $0.00 330184 J8560 802 431 636 Etoposide 50mg capsule O $0.00 $0.00 330184 J8597 636 METOCLOPRAMIDE 10MG/10ML 50X 10ML CUPS-J8597 O $0.00 $0.00 330184 J8597 636 ANTIEMETIC DRUG ORAL NOS O $0.00 $0.00 330184 J8597 636 ANTIEMETIC DRUG ORAL NOS-J8597 O $0.00 $0.00 330184 J8597 636 metoclopramide 5 mg TAB-J8597 O $0.00 $0.00 330184 J8597 636 metoclopramide 10 mg Tablet-J8597 O $0.00 $0.00 330184 J8597 636 METOCLOPRAMIDE 5 MG/5 ML SYR-J8597 O $0.00 $0.00 330184 J8597 636 MECLIZINE HCL 25 MG O $0.00 $0.00 330184 J8597 636 METOCLOPRAMIDE 5MG/5ML O $0.00 $0.00 330184 J8597 636 MECLIZINE HCL 12.5MG TBLT O $0.00 $0.00 330184 J8597 636 METOCLOPRAMIDE 10M O $0.30 $0.20 330184 J8600 430 636 MELPHALAN 2MG TAB O $0.00 $0.00 330184 J8600 430 636 Melphan 2 mg tab O $0.00 $0.00 330184 J8610 495 636 Methotrexate 2.5mg tabl O $0.00 $0.00 330184 J9000 430 636 Doxorubicin 10mg vial O $0.00 $0.00 330184 J9000 430 636 DOXORUBICIN INJ 20MG O $0.00 $0.00 330184 J9000 430 636 Doxorubicin 50mg vial O $0.00 $0.00 330184 J9017 9012 434 636 ARSNC TRXD 10MG/10ML AMPU O $0.00 $0.00 330184 J9022 9483 636 ATEZOLIZUMAB 60MG/ML 1X14ML -J9022 O $0.00 $0.00 330184 J9025 1709 432 636 Azacitidine 100mg vial O $0.00 $0.00 330184 J9030 9322 636 BCG vaccine O $0.00 $0.00 330184 J9033 JW 9243 462 636 "INJ., TREANDA 1 MG-J9033-JW" O $0.00 $0.00 330184 J9033 9243 462 636 Bendamustine 100mg vial O $0.00 $0.00 330184 J9034 1861 636 INJ BENDAMUSTINE HCL (BENDEKA)1 MG-J9034 O $0.00 $0.00 330184 J9035 JW 9214 462 636 INJ BEVACIZUMAB 10 MG-J9035-JW O $0.00 $0.00 330184 J9035 9214 462 636 Bevacizumab 100mg vial O $0.00 $0.00 330184 J9035 9214 462 636 Bevacizumab 400mg vial O $0.00 $0.00 330184 J9040 431 636 Bleomycin 15 units vial O $0.00 $0.00 330184 J9041 JW 9207 441 636 INJ BORTEZOMIB 0.1 MG-J9041-JW O $0.00 $0.00 330184 J9041 9207 441 636 VELCADE 3.5MGINJECTION O $0.00 $0.00 330184 J9042 9287 464 636 BRENTUXIMAB VEDOTIN 50MG SD PRES FREE-J9042 O $0.00 $0.00 330184 J9043 9276 463 636 Jevtana 40MG/ML 1.5ML O $0.00 $0.00 330184 J9045 430 636 Carboplatin 450mg vial O $0.00 $0.00 330184 J9045 430 636 Carboplatin 150mg vial O $0.00 $0.00 330184 J9045 430 636 Carboplatin 50mg vial O $0.00 $0.00 330184 J9045 430 636 CARBOPLATIN 600MG/60ML O $0.00 $0.00 330184 J9045 430 636 CARBOPLTN 600MG/60ML(COST O $0.00 $0.00 330184 J9047 9295 460 636 INJ CARFILZOMIB 1 MG O $0.00 $0.00 330184 J9050 812 463 636 BICNU 100MG O $0.00 $0.00 330184 J9055 9215 461 636 Cetuximab 100mg vial O $0.00 $0.00 330184 J9060 430 636 CISPLATIN INJ 10MG O $0.00 $0.00 330184 J9060 430 636 CISPLATIN INJ 50MG O $0.00 $0.00 330184 J9060 430 636 Cisplatin 1 mg ml 50 mlv O $0.00 $0.00 330184 J9060 430 636 CISPLATIN 100 MG/100 ML O $0.00 $0.00 330184 J9070 JW 1408 432 636 CYCLOPHOSPHAMIDE 100 MG-J9070-JW O $0.00 $0.00 330184 J9070 1408 432 636 Cytoxan 1 Gram vial O $0.00 $0.00 330184 J9070 1408 432 636 CYCLOPHOSPHAMIDE INJ 200 O $0.00 $0.00 330184 J9070 1408 432 636 Cytoxan 500mg vial O $0.00 $0.00 330184 J9070 1408 432 636 CYCLOPHOSPHAMIDE INJ 100M O $0.00 $0.00 330184 J9070 1408 432 636 Cyclophosphamide 100 Mg I O $1.00 $0.65 330184 J9070 1408 432 636 Cyclophosphamide 200 Mg I O $1.00 $0.65 330184 J9070 1408 432 636 Cyclophosphamide 500 Mg I O $1.00 $0.65 330184 J9100 495 636 Cytarabine 1 Gram Vial O $0.00 $0.00 330184 J9100 495 636 Cytarabine 100mg vial O $0.00 $0.00 330184 J9100 495 636 Cytarabine Injection 2 gm O $0.00 $0.00 330184 J9100 495 636 Cytarabine 2 Grams vial O $0.00 $0.00 330184 J9130 430 636 DTIC 100mg vial O $0.00 $0.00 330184 J9130 430 636 DTIC 200mg vial O $0.00 $0.00 330184 J9145 9476 636 DARATUMUMAB 20MG/ML(1X20ML)-J9145 O $0.00 $0.00 330184 J9145 9476 636 DARATUMUMAB 20MG/ML(1X5ML)-J9145 O $0.00 $0.00 330184 J9145 9476 636 "INJECTION, DARATUMUMAB 10 MG-J9145" O $0.00 $0.00 330184 J9171 JW 823 432 636 DOCETAXEL INJECTION 1 MG-J9171-JW O $0.00 $0.00 330184 J9171 823 432 636 TAXOTERE 40MG/ML INJ O $0.00 $0.00 330184 J9171 823 432 636 TAXOTERE 40MG/ML INJ.5ML O $0.00 $0.00 330184 J9171 823 432 636 Docetaxel 80mg vial O $0.00 $0.00 330184 J9171 823 432 636 Docetaxel 20mg vial O $0.00 $0.00 330184 J9178 430 636 Epirubicin 50mg vial O $0.00 $0.00 330184 J9179 1426 461 636 ERIBULIN 1MG/2ML(CHEMO) O $0.00 $0.00 330184 J9179 1426 461 636 eribulin 1 mg 2 mL SOLN O $0.00 $0.00 330184 J9181 430 636 Etoposide 100mg 5mL vial O $0.00 $0.00 330184 J9181 430 636 ETOPOSIDE 10MG INJ O $0.00 $0.00 330184 J9185 431 636 Fludarabine 50mg vial O $0.00 $0.00 330184 J9190 495 636 Fluorouracil 500mg vial O $0.00 $0.00 330184 J9201 435 636 Gemzaar 1 Gram vial O $0.00 $0.00 330184 J9201 435 636 Gemzaar 200mg vial O $0.00 $0.00 330184 J9202 810 444 636 GOSERELIN ACETATE IMPL (3.6 MG) O $0.00 $0.00 330184 J9206 636 Irinotecan 40mg vial O $0.00 $0.00 330184 J9206 636 Irinotecan 100mg vial O $0.00 $0.00 330184 J9207 9240 636 Ixabepilone 15mg vial O $0.00 $0.00 330184 J9207 9240 636 Ixabepilone 45mg vial O $0.00 $0.00 330184 J9208 431 636 Ifex 1 Gram vial O $0.00 $0.00 330184 J9208 431 636 IFEX 3 Gram vial O $0.00 $0.00 330184 J9209 430 636 MESNEX 400MG/4ML O $0.00 $0.00 330184 J9209 430 636 MESNA 1GM INJECTION O $0.00 $0.00 330184 J9214 836 441 636 Intron 10000 units vial O $0.00 $0.00 330184 J9214 836 441 636 Interferon Alfa 50000 un O $0.00 $0.00 330184 J9217 9217 434 636 LUPRON DEPOT 45MG O $0.00 $0.00 330184 J9217 JW 9217 434 636 LEUPROLIDE ACETATE 7.5 MG-J9217-JW O $0.00 $0.00 330184 J9217 9217 434 636 ELIGARD(LEUPROLIDE SQ)22.5MG-J9217 O $0.00 $0.00 330184 J9217 9217 434 636 ELIGARD(LEUPROLIDE SQ)30 MG-J9217 O $0.00 $0.00 330184 J9217 9217 434 636 ELIGARD(LEUPROLIDE SQ)45 MG-J9217 O $0.00 $0.00 330184 J9217 9217 434 636 ELIGARD(LEUPROLIDE SQ)7.5MG-J9217 O $0.00 $0.00 330184 J9217 9217 434 636 leuprolide 30 mg depot (4 month) Kit-J9217 O $0.00 $0.00 330184 J9217 9217 434 636 leuprolide 30 mg/4 months (Eligard)-J9217 O $0.00 $0.00 330184 J9217 9217 434 636 Leuprolide 7.5mg DEPO KI O $0.00 $0.00 330184 J9217 9217 434 636 Leuprolide 22.5mg DEPOT O $0.00 $0.00 330184 J9228 9284 465 636 IPILIMUMAB INJ 1MG-J9228 O $0.00 $0.00 330184 J9245 840 636 MELPHALAN HCL INJ 50 MG O $0.00 $0.00 330184 J9245 JW 840 636 MELPHALAN HCL INJ 50 MG-J9245-JW O $0.00 $0.00 330184 J9250 636 Methotrexate 50mg 2mLP O $0.00 $0.00 330184 J9250 636 METHOTREXATE 200MG O $0.00 $0.00 330184 J9250 636 Methotrexate 1 Gram PFV O $0.00 $0.00 330184 J9260 495 636 METHOTREXATE SODIUM 50 MG O $0.00 $0.00 330184 J9263 JW 435 636 OXALIPLATIN INJ 0.5 MG-J9263-JW O $0.00 $0.00 330184 J9263 435 636 Oxaliplatin 50mg vial O $0.00 $0.00 330184 J9263 435 636 Oxaliplatin 100mg vial O $0.00 $0.00 330184 J9264 JW 1712 460 636 PACLITAXEL PROTEIN BOUND 1 MG-J9264-JW O $0.00 $0.00 330184 J9264 1712 460 636 Paclitaxel-Protein-Bound O $0.00 $0.00 330184 J9267 430 636 PAClitaxel 6 mg/mL SOLN 5mL Vial-J9267 O $0.00 $0.00 330184 J9267 430 636 PAClitaxel 6 mG/mL Solution 16.7mL Vial-J9267 O $0.00 $0.00 330184 J9267 430 636 PACLITAXEL INJECTION 1MG O $0.00 $0.00 330184 J9271 1490 636 INJ PEMBROLIZUMAB 1 MG-J9271 O $0.00 $0.00 330184 J9280 JW 1232 441 636 MITOMYCIN INJ 5MG-J9280-JW O $0.00 $0.00 330184 J9280 1232 441 636 Mitomycin 20mg vial O $0.00 $0.00 330184 J9280 1232 441 636 Mitomycin 5 mg vial O $0.00 $0.00 330184 J9280 1232 441 636 Mitomycin 2mg 5mL Eyed O $0.00 $0.00 330184 J9280 1232 441 636 INJ MITOMYCIN 5 MG O $0.00 $0.00 330184 J9293 864 432 636 Mitoxantrone 20mg mL Vi O $0.00 $0.00 330184 J9293 864 432 636 Mitoxandrone 25mg vial O $0.00 $0.00 330184 J9299 JW 9453 463 636 INJ NIVOLUMAB 1MG-J9299-JW O $0.00 $0.00 330184 J9299 9453 463 636 NIVOLUMAB (OPDIVO) 10 MG/ML 4ML VIAL-J9299 O $0.00 $0.00 330184 J9299 9453 463 636 NIVOLUMAB INJ 1MG- O $0.00 $0.00 330184 J9301 1476 636 OBINUTUZUMAB INJ 10 MG O $0.00 $0.00 330184 J9301 JW 1476 636 OBINUTUZUMAB INJ 10MG-J9301-JW O $0.00 $0.00 330184 J9303 9235 636 Panitumumab 100mg 5 m O $0.00 $0.00 330184 J9305 JW 9213 463 636 INJ PEMTREXED 10 MG-J9305-JW O $0.00 $0.00 330184 J9305 9213 463 636 Pemetrexed 500mg vial O $0.00 $0.00 330184 J9305 9213 463 636 Pemetrexed 100mg vial O $0.00 $0.00 330184 J9306 JW 1471 462 636 INJ PERTUZUMAB 1 MG-J9306-JW O $0.00 $0.00 330184 J9306 1471 462 636 PERTUZUMAB INJECTION PER 1 MG O $0.00 $0.00 330184 J9308 JW 1488 636 INJ RAMUCIRUMAB 5MG-J9308-JW O $0.00 $0.00 330184 J9308 1488 636 INJECTION RAMUCIRUMAB 5 MG- O $0.00 $0.00 330184 J9312 9186 463 636 Rituxan 100mg vial(per 10mg) O $0.00 $0.00 330184 J9312 9186 463 636 Rituxn 500mg vial(per 10mg) O $0.00 $0.00 330184 J9315 9265 636 romiDEPsin 10 mg PWDI O $0.00 $0.00 330184 J9320 850 636 Streptozocin 1 Gram IV O $0.00 $0.00 330184 J9330 1168 636 TORISEL 25MG VIAL (TIMSIR O $0.00 $0.00 330184 J9351 430 636 Topotecan 4 mg vial O $0.00 $0.00 330184 J9355 1613 462 636 TRASTUZUMAB INJ 10 MG-J9355 O $0.00 $0.00 330184 J9360 430 636 Vinblastine 10mg vial O $0.00 $0.00 330184 J9370 495 636 Vincristine 1mg mLVial1m O $0.00 $0.00 330184 J9370 495 636 Vincristine2mg2mLVial2m O $0.00 $0.00 330184 J9390 430 636 Vinorelbine 50mg vial O $0.00 $0.00 330184 J9395 JW 9120 443 636 FULVESTRANT 25 MG INJ-J9395-JW O $0.00 $0.00 330184 J9395 9120 443 636 FASLODEX 125MG/2.5ML1ML O $0.00 $0.00 330184 J9400 9296 636 INJ ZIVAFLIBERCEPT 1 MG O $0.00 $0.00 330184 L3702 274 EO W/O JOINT CUSTOM O $475.00 $308.75 330184 L3762 274 EO RIGID W/O JOINTS PRE OTS O $90.00 $58.50 330184 L3808 274 WHFOLONG OPPONENSCUSTOM O $665.00 $432.25 330184 L3808 274 WHFO W/O JOINT CUSTOM O $665.00 $432.25 330184 L3906 274 WHO ULNAR GUTTER CUSTOM F O $700.00 $455.00 330184 L3908 274 OT WRIST COCK-UP NON-MOLD O $135.00 $87.75 330184 L3913 274 HFO W/O JOINT CUSTOM O $450.00 $292.50 330184 L3925 274 OT FO PIP/DIP WITH JOINT/ O $85.00 $55.25 330184 L3925 274 FO PREFABRICATED O $85.00 $55.25 330184 L3927 274 OT FO PIP/DIP W/O JOINT/S O $55.00 $35.75 330184 L3933 274 OT FO W/O JOINT CUSTOM O $350.00 $227.50 330184 L8689 274 INTELLIS PATIENT RECHARGER:97755(L8689) O $0.00 $0.00 330184 M0239 771 BAMLANIVIMAB-XXXX IV INFUS & MONIT-M0239 O $775.00 $503.75 330184 M0239 771 BAMLANIVIMAB-XXXX IV INF & MONIT-M0239 O $775.00 $503.75 330184 P9012 9511 113 390 CRYOPRECIPITATE O $180.00 $117.00 330184 P9017 9508 390 FRESH FROZEN PLASMA O $132.00 $85.80 330184 P9021 9517 390 RBC 1 UNIT (PRBC) O $435.75 $283.24 330184 P9034 9507 390 SINGLE DONOR PLATELET O "$1,237.95 " $804.67 330184 P9045 963 113 636 Albumin 5% SOLN 250mL O $0.00 $0.00 330184 P9045 963 113 636 5% ALBUMIN O $120.00 $78.00 330184 P9047 965 113 636 Albumin 25% SOLN 50mL O $0.00 $0.00 330184 P9047 965 113 636 25% ALBUMIN O $140.00 $91.00 330184 P9604 300 HOME VISIT TRAVEL O $36.00 $23.40 330184 Q0091 5731 923 PAP SMEAR COLLECTION-Q0091 O $39.90 $25.93 330184 Q0144 490 636 azithromycin 100 mg/5 mL PWDR O $0.00 $0.00 330184 Q0144 490 636 azithromycin 200 mg/5 mL Powder for Reconstitution O $0.00 $0.00 330184 Q0144 490 636 AZITHROMYCIN 200 MG/5 ML POWDER FOR RECONSTITUTION-Q0144 O $0.00 $0.00 330184 Q0144 490 636 ZITHROMAX 200 MG/5ML SUSP O $0.00 $0.00 330184 Q0144 490 636 "AZITHROMYCIN DIHYDRATE, ORAL" O $72.00 $46.80 330184 Q0161 636 chlorproMAZINE 10 mg TAB-Q0161 O $0.00 $0.00 330184 Q0161 636 chlorproMAZINE 25 mg TAB-Q0161 O $0.00 $0.00 330184 Q0161 636 chlorproMAZINE 50 mg TAB-Q0161 O $0.00 $0.00 330184 Q0161 636 CHLORPROMAZINE 100MG O $0.00 $0.00 330184 Q0161 636 CHLORPROMAZINE HCL 5MG ORAL O $0.00 $0.00 330184 Q0162 496 636 ZOFRAN-ONDANSETRON ORAL 1MG-Q0162 O $0.23 $0.15 330184 Q0162 496 636 ONDANSETRON 8MG ORAL O $0.00 $0.00 330184 Q0162 496 636 Ondansetron 8 mg tablet O $0.00 $0.00 330184 Q0162 496 636 ONDANSETRON ODT 4MG TABS O $0.00 $0.00 330184 Q0162 496 636 ondansetron 4 mg Oral Tab O $0.00 $0.00 330184 Q0163 496 636 DIPHENHYDRAMINE HCL 25MG O $0.00 $0.00 330184 Q0163 496 636 DIPHENHYDRAMINE 25MG/10ML O $0.00 $0.00 330184 Q0163 496 636 Diphenhydramine 50mg c O $0.00 $0.00 330184 Q0164 636 COMPAZINE 5 MG O $0.00 $0.00 330184 Q0166 636 GRANISETRON HCL 1MG TBLT O $0.00 $0.00 330184 Q0167 636 DRONABINOL 2.5 MG ORAL O $0.00 $0.00 330184 Q0169 496 636 PROMETHAZINE HCL LIQID O $0.00 $0.00 330184 Q0169 496 636 PROMETHAZINE HCL 12.5MG ORAL O $0.00 $0.00 330184 Q0173 496 636 Trimethobenzamide300m O $0.00 $0.00 330184 Q0175 496 636 PERPHENAZINE TABLET 2MG O $0.00 $0.00 330184 Q0175 496 636 Perphenazine 8mg tablet O $0.00 $0.00 330184 Q0177 636 hydrOXYzine pamoate 50 mg CAP-Q0177 O $0.00 $0.00 330184 Q0177 636 hydrOXYzine pamoate 25 mg CAP-Q0177 O $0.00 $0.00 330184 Q0177 636 HYDROXYZINE 25MG U/D O $0.00 $0.00 330184 Q0239 636 BAMLANIVIMAB 700MG/20ML VIAL O $0.00 $0.00 330184 Q2009 9321 435 636 FOSPHENYTOIN 50 MG O $0.00 $0.00 330184 Q2009 9321 435 636 Neonatal Fosphenytoin O $0.00 $0.00 330184 Q2009 9321 435 636 INJ FOSPHENYTOIN 50 MG PHENYTOIN EQVLNT O $0.00 $0.00 330184 Q2036 636 INFLUENZA VIRUS-Q2036 O $0.00 $0.00 330184 Q2036 636 Fluarix Injection 2010-11 O $0.00 $0.00 330184 Q2038 414 636 FLUZONE VAC 3 YRS & > IM-Q2038 O $39.67 $25.79 330184 Q2050 7046 461 636 DOXORUBICIN INJ 10MG O $0.00 $0.00 330184 Q3014 497 780 TELEHEALTH ORG SITE FAC FEE-Q3014 O $136.00 $88.40 330184 Q4081 JW 436 636 EPO ALFA 100 UNITS ESRD-Q4081-JW O $0.00 $0.00 330184 Q4081 436 634 "EPOETIN ALFA, 100 UNITS ESRD" O $0.00 $0.00 330184 Q4100 455 278 WOUND DRESSING O $0.00 $0.00 330184 Q4100 455 278 SKIN SUBSTITUTE(LIFECELL) O $0.00 $0.00 330184 Q4101 278 APLIGRAFT (PER SQ CM) O $83.00 $53.95 330184 Q4104 455 278 BILAYER MATRIX WND DRESSI O $0.00 $0.00 330184 Q4106 278 DERMAGRAFT (PER SQ CM) O $46.00 $29.90 330184 Q4158 278 KERECIS 3X3.5 CM (PER SQ CM)-Q4158 O $131.00 $85.15 330184 Q4158 278 KERECIS 3X7 CM (PER SQ CM)-Q4158 O $129.00 $83.85 330184 Q4158 278 KERECIS 7X10 CM (PER SQ CM)-Q4158 O $119.00 $77.35 330184 Q4158 278 KERECIS 7X7 CM (PER SQ CM)-Q4158 O $110.00 $71.50 330184 Q5104 9036 636 RENFLEXIS (INFLIXIMAB-ABDA)100MG VIAL-Q5104 O $0.00 $0.00 330184 Q9951 636 LOW OSMOLAR CONTRAST 400> O $0.00 $0.00 330184 Q9961 636 HOCM 250-299 MG/ML IODINE 1ML O $0.00 $0.00 330184 Q9961 636 iothalamate 60% SOLN (Conray 150 mL)-Q9961 O $0.00 $0.00 330184 Q9961 636 Iothalamate 60% SOLN (Conray 100 mL)-Q9961 O $0.00 $0.00 330184 Q9961 636 IOTHALAMATE 60%30ML BTL PER ML-Q9961 O $0.00 $0.00 330184 Q9961 636 Iothalamate 60%SOLN 50 O $0.00 $0.00 330184 Q9963 2001 636 HOCM 350-399 MG/ML IODINE 1ML O $0.00 $0.00 330184 Q9963 2001 636 Gastrografin 37%120 mL O $0.00 $0.00 330184 Q9965 2001 636 LOW OSMOLAR CONTRAST TO 1 O $1.00 $0.65 330184 Q9965 2001 636 LOW OSMOLAR CONTRAST TO 1 O $4.00 $2.60 330184 Q9966 2001 636 Iodixanol 270 mg/mL SOLN (Visipaque) 150 Ml-Q9966 O $0.00 $0.00 330184 Q9966 2001 636 Iodixanol 270 mg/mL SOLN 100 Ml-Q9966 O $0.00 $0.00 330184 Q9966 2001 636 Visipaque 270 mg/mL 100mL O $0.00 $0.00 330184 Q9966 2001 636 Iodixanol 270 mg/ml SOL O $0.00 $0.00 330184 Q9966 2001 636 LOW OSMOLAR CONTRAST 200 O $3.00 $1.95 330184 Q9966 2001 636 LOW OSMOLAR CONTRAST 250 O $1.00 $0.65 330184 Q9966 2001 636 CT CNTRST LOCM 300MG/100 O $1.00 $0.65 330184 Q9967 2001 636 IOHEXOL 300MG/ML 100 ML O $280.00 $182.00 330184 Q9967 2001 636 IOHEXOL 300MG/ML 50 ML O $106.00 $68.90 330184 Q9967 2001 636 iohexol 300 mg/mL SOLN 10 mL O $0.00 $0.00 330184 Q9967 2001 636 iohexol 300 mg/mL SOLN 50 mL O $0.00 $0.00 330184 Q9967 2001 636 Omnipaque Injection 300 m O $0.00 $0.00 330184 Q9967 2001 636 LOW OSMOLAR CONTRAST 300 O $1.00 $0.65 330184 Q9967 2001 636 LOW OSMOLAR CONTRAST 350 O $0.00 $0.00 330184 Q9967 2001 636 Visipaque 320 mg/mL 100mL O $0.00 $0.00 330184 Q9968 1446 490 636 VISUALIZATION ADJUNCT 1 MG O $0.00 $0.00 330184 Q9968 JW 1446 490 636 VISUALIZATION ADJUNCT 1 MG-Q9968-JW O $0.00 $0.00 330184 Q9968 1446 490 636 METHYLENE BLUE INJ 1MG O $0.00 $0.00 330184 Q9968 1446 490 636 LYMPHAZURIN 10MG/ML5 ML O $0.00 $0.00 330184 S0109 435 636 METHADONE 40 MG DISK O $0.00 $0.00 330184 S0171 636 Bumetanide Injection 1mg/ O $0.00 $0.00 330184 S9484 900 CRISIS INTERVENTION/HR-S9484 O $926.00 $601.90 330184 S9485 900 CRISIS INTERVENTION/DIEM-S9485 O "$2,223.00 " "$1,444.95 " 330184 T1013 2005 940 MED LANG INTERP SERV(CLN) O $8.40 $5.46 330184 T1013 2005 940 MED LANG INTRP SERV (ER) O $8.40 $5.46 330184 U0001 306 NOVEL CORONAVIRUS-SARS-CoV-2(U0001) O $90.00 $58.50 330184 U0002 306 NON-CDC LAB TESTS SARS-COVID-19(U0002) O $128.00 $83.20 330184 U0003 306 SARS-COV-2 COVID-19 AMP PRB HGH THRGHPT TECH-U0003 O $150.00 $97.50 330184 U0004 306 COVID-19 LAB TEST NON-CDC HIGH THRGHPT TECH-U0004 O $250.00 $162.50 330184 250 DOLUTEGRAVIR 50MG (TIVICAY) O $0.00 $0.00 330184 250 LMX-LIDOCAINE 4% ANESTHETIC CREAM O $0.00 $0.00 330184 250 IMIPRAMINE 50MG UD 100 TABS O $0.00 $0.00 330184 250 ZINC OXIDE (BOUDREAUX'S BUTT PASTE) 16% 1OZ O $0.00 $0.00 330184 250 ATAZANAVIR 300MG/COBICISTAT 150MG TABL X 30 O $0.00 $0.00 330184 250 HEPARIN 1000U/0.9% NS 500ML 18 EACH O $0.00 $0.00 330184 250 XYLOCAINE MPF (LIDOCAINE) 1% 10MG/ML 25X2ML O $0.00 $0.00 330184 250 APIXABAN 2.5MG ORAL TABS O $0.00 $0.00 330184 250 CREON-LIPASE6K PROTEASE19K AMYLASE30K O $0.00 $0.00 330184 250 ONFI (CLOBAZAM) 10MG 1X101 O $0.00 $0.00 330184 250 TRONOLANE (PRAMOX1% ZINC OX 5%)30G CREAM O $0.00 $0.00 330184 250 LQD POLIBAR + (BARIUM SUSP 105%) 1900ML O $42.00 $27.30 330184 250 VIMPAT (LACOSAMIDE) 100MG 1X60 O $0.00 $0.00 330184 250 GLATIRAMER ACETATE 20 MG INJ O $0.00 $0.00 330184 250 ENTREST0(VALSARTAN) 24MG/26MG O $0.00 $0.00 330184 250 ENTRESTO(VALSARTAN) 49/51MG O $0.00 $0.00 330184 250 ENTRESTO(VALSARTAN) 97MG/103MG O $0.00 $0.00 330184 250 GENVOYA O $0.00 $0.00 330184 250 RILPIVIRINE 25MG TABL O $0.00 $0.00 330184 250 PALIPERIDONE ER TABS (INVEGA) 6MG O $0.00 $0.00 330184 250 THEOPHYLLINE ANHYDROUS O $0.00 $0.00 330184 250 TRAMADOL ER 100MG TABS O $0.00 $0.00 330184 250 DRUGS-GENERAL CLASSIFICATION (250REV) O $0.00 $0.00 330184 250 NON FORMULARY CHARGE CAPTURE O $0.00 $0.00 330184 250 AMINO ACID 4.25%/D10W (clinimix 4.25/10) O $0.00 $0.00 330184 250 AMINO ACID 5%/D15W O $0.00 $0.00 330184 250 AMINO ACID 5%/D15W/LYTES/CA O $0.00 $0.00 330184 250 DILTIAZEM HCL 90MG O $0.00 $0.00 330184 250 INDOMETHACIN SUPPOSTIORY 50MG O $0.00 $0.00 330184 250 ASCORBIC ACID (VITAMIN C) 500MG/ML INJ O $0.00 $0.00 330184 250 HYDROCORTISONE 5MG TABS-J8499 O $0.00 $0.00 330184 250 LMX (LIDOCAINE 4% ANESTHETIC CREAM) O $0.00 $0.00 330184 250 IMATINIB 400MG TABLET 1X30 O $0.00 $0.00 330184 250 DILTIAZEM 90MG/12 HRS ERC O $0.00 $0.00 330184 636 636 REV CODE DRUG MSSG HCPC O $0.00 $0.00 330184 250 FLUTICASONE/VILANTEROL 100-25 MCG O $0.00 $0.00 330184 250 FLUTICASONE/VILANTEROL 200-25 MCG O $0.00 $0.00 330184 250 MIVACURIUM CHLORIDE 2MG/ML 1X10ML O $85.00 $55.25 330184 250 MIVACURIUM CHLORIDE 2MG/ML 1X5ML O $65.00 $42.25 330184 250 UMECLIDINIUM/VILANTEROL 62.5-25 MCG O $0.00 $0.00 330184 250 PALIPERIDONE 3MG O $0.00 $0.00 330184 250 PALIPERIDONE 6MG O $0.00 $0.00 330184 250 ACETAMINOPHEN SUPPOS 120MG O $0.49 $0.32 330184 250 ACETAMINOPHEN SUPPOS 325MG O $1.26 $0.82 330184 250 ACETAMINOPHEN SUPPOS 480ML O $9.39 $6.10 330184 250 ALBUTEROL NEBULIZATION(GENER) O $0.46 $0.30 330184 250 BENADRYL SUSPENSION(DIPHENHYDRAMINE) O $0.30 $0.20 330184 250 IBUPROFEN 400MG TABL O $0.15 $0.10 330184 250 IBUPROFEN SUSPENSION(GENER) O $0.39 $0.25 330184 250 IPRATROPIUM NEBULIZATION(GENER) O $0.53 $0.34 330184 250 NORMAL SALINE NEBULIZ(GENER) O $0.36 $0.23 330184 250 ACETAMINOPHEN RECTAL SUPPOSITORY (INFANT) O $0.00 $0.00 330184 250 BACTRIM DESENSITIZATION 1:10 DILUTION 30ML O $0.00 $0.00 330184 250 BACTRIM DESENSITIZATION 1:100 DILUTION 30ML O $0.00 $0.00 330184 250 BACTRIM DESENSITIZATION 1:1000 DILUTION 30ML O $0.00 $0.00 330184 250 alendronate 35 mg TAB O $0.00 $0.00 330184 250 amoxicillin 125 mg/5 mL PWDR 100 mL O $0.00 $0.00 330184 250 amoxicillin 125 mg/5 mL PWDR 80 mL O $0.00 $0.00 330184 250 ampicillin 250 mg CAP O $0.00 $0.00 330184 250 ampicillin 500 mg CAP O $0.00 $0.00 330184 250 apixaban 2.5 mg TAB O $0.00 $0.00 330184 250 atorvastatin 20 mg TAB O $0.00 $0.00 330184 250 atorvastatin 40 mg TAB O $0.00 $0.00 330184 250 citalopram 10 mg TAB O $0.00 $0.00 330184 250 clarithromycin 125 mg/5 mL PWDR O $0.00 $0.00 330184 250 clarithromycin 250 mg/5 mL (100 mL) PWDR O $0.00 $0.00 330184 250 clarithromycin 250 mg/5 mL (50 mL) PWDR O $0.00 $0.00 330184 250 codeine-guaiFENesin 20 mg-200 mg/10 mL SYR O $0.00 $0.00 330184 250 cyanocobalamin 500 mcg TAB O $0.00 $0.00 330184 250 dextromethorphan-guaiFENesin 20 mg-200 mg/10 mL LIQ O $0.00 $0.00 330184 250 diphenhydrAMINE topical 2% CREA O $0.00 $0.00 330184 250 diphenhydrAMINE-zinc acetate topical 2%-0.1% CREA O $0.00 $0.00 330184 250 dolutegravir 50 mg TAB O $0.00 $0.00 330184 250 doxepin 50 mg CAP O $0.00 $0.00 330184 250 erythromycin 250 mg DRC O $0.00 $0.00 330184 250 escitalopram 10 mg TAB O $0.00 $0.00 330184 250 escitalopram 5 mg HALF-Tablet O $0.00 $0.00 330184 250 escitalopram 5 mg TAB O $0.00 $0.00 330184 250 felodipine 10 mg ERT O $0.00 $0.00 330184 250 fluticasone-vilanterol 100 mcg-25 mcg/inh PWD O $0.00 $0.00 330184 250 fluticasone-vilanterol 200 mcg-25 mcg/inh PWD O $0.00 $0.00 330184 250 glipiZIDE 10 mg TAB O $0.00 $0.00 330184 250 glyBURIDE 1.25 mg TAB O $0.00 $0.00 330184 250 lisinopril 2.5 mg TAB O $0.00 $0.00 330184 250 lisinopril 5 mg Tablet O $0.00 $0.00 330184 250 metroNIDAZOLE 500 mg TAB O $0.00 $0.00 330184 250 midazolam-NaCl 0.9% 50 mG/50 mL SOLN O $0.00 $0.00 330184 250 mirtazapine 15 mg Tablet O $0.00 $0.00 330184 250 mirtazapine 7.5 mg HALF-Tablet O $0.00 $0.00 330184 250 nebivolol 10 mg TAB O $0.00 $0.00 330184 250 nystatin-triamc tpcl (15G)100K units/g-0.1% CREA O $0.00 $0.00 330184 250 oxytocin 30 units/500 mL-LR SOLN O $0.00 $0.00 330184 250 pantoprazole 20 mg DELAYED RELEASE Tablet O $0.00 $0.00 330184 250 penicillamine 250 mg TAB O $0.00 $0.00 330184 250 penicillin V potassium 250 mg/5 mL (100 mL) PWDR O $0.00 $0.00 330184 250 penicillin V potassium 250 mg/5 mL (200 mL) PWDR Rx O $0.00 $0.00 330184 250 povidone iodine ophthalmic 5% SOLN O $0.00 $0.00 330184 250 pravastatin 10 mg TAB O $0.00 $0.00 330184 250 rivaroxaban 10 mg TAB O $0.00 $0.00 330184 250 rivaroxaban 15 mg TAB O $0.00 $0.00 330184 250 rivaroxaban 20 mg TAB O $0.00 $0.00 330184 250 saliva substitutes - GEL O $0.00 $0.00 330184 250 selenium sulfide topical 2.25% SHAMpoo O $0.00 $0.00 330184 250 simvastatin 40 mg TAB O $0.00 $0.00 330184 250 sitaGLIPtin 100 mg TAB O $0.00 $0.00 330184 250 sitaGLIPtin 25 mg TAB O $0.00 $0.00 330184 250 sitaGLIPtin 50 mg TAB O $0.00 $0.00 330184 250 testosterone 25 mg/2.5 g (1%) GEL O $0.00 $0.00 330184 250 testosterone 50 mg/5 g (1%) GEL O $0.00 $0.00 330184 250 timolol ophthalmic 0.5% (10 mL) SOLN O $0.00 $0.00 330184 250 venlafaxine 75 mg XR O $0.00 $0.00 330184 250 verapamil 40 mg HALF-Tablet O $0.00 $0.00 330184 250 verapamil 40 mg TAB O $0.00 $0.00 330184 250 verapamil 80 mg TAB O $0.00 $0.00 330184 250 AtoMOXetine 40 mg CAP NF O $0.00 $0.00 330184 250 ALPRAZolam 1 mg ERT O $0.00 $0.00 330184 250 ARIPiprazole 30 mg TAB O $0.00 $0.00 330184 250 Doxycycline MONOhydrate 100 mg CAPSULE O $0.00 $0.00 330184 250 FIDAXOMICIN 200MG TABS O $0.00 $0.00 330184 250 Hemorrhoidal H topical 0.25% OINT 30 Gram O $0.00 $0.00 330184 250 Hemorrhoidal H topical 0.25% OINT 60 Gram O $0.00 $0.00 330184 250 HYDROmorphone 10 mG/0.9% NaCl 100 mL O $0.00 $0.00 330184 250 Morphine Sulfate PCA 50 mL O $0.00 $0.00 330184 250 NICU Morph Oral Soln 0.4mg/ml O $0.00 $0.00 330184 250 OxyCODONE IMMED Release15 mg TAB O $0.00 $0.00 330184 250 Prenatal with Folic Acid 1 mg Tablet O $0.00 $0.00 330184 250 Prenatal Multivitamins with Folic Acid 0.8 mg TAB O $0.00 $0.00 330184 250 PHENobarbital 16.2 mg TAB O $0.00 $0.00 330184 250 PHENobarbital 32.4 mg TAB O $0.00 $0.00 330184 250 PHENobarbital 97.2 mg TAB O $0.00 $0.00 330184 250 QUEtiapine 300 mg ERT O $0.00 $0.00 330184 250 QUEtiapine 50 mg TAB O $0.00 $0.00 330184 206 PCU O "$6,818.70 " "$4,432.16 " 330184 250 colchicine 0.6 mg Tablet O $0.00 $0.00 330184 250 acetaminophen 80 mg/0.8 mL SUSP O $0.00 $0.00 330184 250 albutrl CFC free 90 mcg/inh Meter Dose Inhaler O $0.00 $0.00 330184 250 alendronate 70 mg Tablet O $0.00 $0.00 330184 250 apixaban 5 mg TAB O $0.00 $0.00 330184 250 atenolol 12.5 mg HALF-Tablet O $0.00 $0.00 330184 250 atenolol 25 mg TAB O $0.00 $0.00 330184 250 bacitracin topical zinc 500 units/g OINT O $0.00 $0.00 330184 250 bacitracin tpcl zinc 500 units/g U/D OINT O $0.00 $0.00 330184 250 baclofen 10 mg TAB O $0.00 $0.00 330184 250 baclofen 5 mg HALF-Tablet O $0.00 $0.00 330184 250 bromocriptine 1.25 mg HALF-Tablet O $0.00 $0.00 330184 250 bromocriptine 2.5 mg TAB O $0.00 $0.00 330184 250 bumetanide 0.5 mg HALF-Tablet O $0.00 $0.00 330184 250 bumetanide 0.5 mg TAB O $0.00 $0.00 330184 250 busPIRone 2.5 mg HALF-Tablet O $0.00 $0.00 330184 250 busPIRone 5 mg TAB O $0.00 $0.00 330184 250 chlorthalidone 12.5 mg HALF-Tablet O $0.00 $0.00 330184 250 chlorthalidone 25 mg TAB O $0.00 $0.00 330184 250 citalopram 20 mg Tablet O $0.00 $0.00 330184 250 citric acid-sodium citrate 15 mL SOLN O $0.00 $0.00 330184 250 citric acid-sodium citrate 30 mL SOLN O $0.00 $0.00 330184 250 codeine-guaiFENesin 10 mg-100 mg/5 mL SYR O $0.00 $0.00 330184 250 colchicine 0.3 mg HALF-Tablet O $0.00 $0.00 330184 250 colchicine 0.6 mg CAP O $0.00 $0.00 330184 250 cyanocobalamin 1000 mcg TAB O $0.00 $0.00 330184 250 dexmedetomidine 4 mcg/mL Loading Dose-J3490 O $0.00 $0.00 330184 250 dexmedetomidine 4 mcg/mL Titration Drip-J3490 O $0.00 $0.00 330184 250 dextromethorphan-guaifenesin 10 mg-100 mg/5 mL LIQ O $0.00 $0.00 330184 250 dipyridamole 25 mg HALF-Tablet O $0.00 $0.00 330184 250 dipyridamole 25 mg TAB O $0.00 $0.00 330184 250 doxazosin 1 mg HALF-Tablet O $0.00 $0.00 330184 250 doxazosin 1 mg TAB O $0.00 $0.00 330184 250 doxepin 25 mg CAP O $0.00 $0.00 330184 250 emollients-topical-CREAM O $0.00 $0.00 330184 250 emollients-topical-CREAM. O $0.00 $0.00 330184 250 "emollients, topical - CREA" O $0.00 $0.00 330184 250 emtricitabine-tenofovir 200 mg-300 mg TAB for PEP O $0.00 $0.00 330184 250 emtricitabine-tenofovir 200-300 mg TAB O $0.00 $0.00 330184 250 felodipine 5 mg ERT O $0.00 $0.00 330184 250 fluvoxaMINE 25 mg HALF-Tablet O $0.00 $0.00 330184 250 fluvoxaMINE 50 mg TAB O $0.00 $0.00 330184 250 furosemide 40 mg/5 mL Oral SOLN O $0.00 $0.00 330184 250 glipiZIDE 2.5 mg HALF-Tablet O $0.00 $0.00 330184 250 glipiZIDE 5 mg TAB O $0.00 $0.00 330184 250 glyBURIDE 1.25 mg HALF-Tablet O $0.00 $0.00 330184 250 glyBURIDE 2.5 mg TAB O $0.00 $0.00 330184 250 hydrochlrthzd-trmtrn cap 25-37.5 mg O $0.00 $0.00 330184 250 hydrochlrthzd-trmtrn tab 25-37.5 mg O $0.00 $0.00 330184 250 hydrocortisone 100 mg PWDI O $0.00 $0.00 330184 250 isoniazid 150 mg HALF-Tablet O $0.00 $0.00 330184 250 isoniazid 300 mg Tablet O $0.00 $0.00 330184 250 lidocaine topical 2% SOLN O $0.00 $0.00 330184 250 lidocaine viscous 2% topical Solution (20ml) O $0.00 $0.00 330184 250 magnesium oxide 200 mg HALF-Tablet O $0.00 $0.00 330184 250 magnesium oxide 400 mg Tablet O $0.00 $0.00 330184 250 metolazone 2.5 mg HALF-Tablet O $0.00 $0.00 330184 250 metolazone 2.5 mg Tablet O $0.00 $0.00 330184 250 metoprolol succinate 25 mg Tablet ER O $0.00 $0.00 330184 250 metoprolol tartrate 12.5 mg HALF-Tablet O $0.00 $0.00 330184 250 metoprolol tartrate 25 mg TAB O $0.00 $0.00 330184 250 metoprolol 12.5 mg ERT HALF-Tablet O $0.00 $0.00 330184 250 metroNIDAZOLE 250 mg Tablet O $0.00 $0.00 330184 250 morphine 10 mg/5 mL Solution O $0.00 $0.00 330184 250 multivitamin Multiple Vitamins CAP O $0.00 $0.00 330184 250 multivitamin Pediatric Multiple Vitamins LIQ O $0.00 $0.00 330184 250 nabumetone 250 mg HALF-Tablet O $0.00 $0.00 330184 250 nabumetone 500 mg Tablet O $0.00 $0.00 330184 250 nebivolol 5 mg TAB O $0.00 $0.00 330184 250 nystatin-triamc tpcl (30G)100K units/g-0.1% CREA O $0.00 $0.00 330184 250 pantoprazole 40 mg DELAYED RELEASE Tablet O $0.00 $0.00 330184 250 pantoprazole 40 mg ECGR O $0.00 $0.00 330184 250 penicillin V potassium 250 mg TAB O $0.00 $0.00 330184 250 pramipexole 0.125 mg TAB O $0.00 $0.00 330184 250 pramipexole 0.25 mg HALF-Tablet O $0.00 $0.00 330184 250 pravastatin 20 mg TAB O $0.00 $0.00 330184 250 prednisoLONE 1mL ophthlmc acetate 1% SUSP O $0.00 $0.00 330184 250 prednisoLONE 5mL ophthlmc acetate 1% SUSP O $0.00 $0.00 330184 250 primidone 125 mg HALF-Tablet O $0.00 $0.00 330184 250 primidone 250 mg TAB O $0.00 $0.00 330184 250 raltegravir 400 mg TAB O $0.00 $0.00 330184 250 raltegravir 400 mg TAB for PEP O $0.00 $0.00 330184 250 saliva substitutes - SPR O $0.00 $0.00 330184 250 selenium sulfide topical 1% SHAM O $0.00 $0.00 330184 250 sertraline 25 mg HALF-Tablet O $0.00 $0.00 330184 250 sertraline 25 mg Tablet O $0.00 $0.00 330184 250 simvastatin 20 mg Tablet O $0.00 $0.00 330184 250 sodium polystyrene sulfonate 30 Grams/120ml ENE O $0.00 $0.00 330184 250 sodium polystyrene(susp)sulfonate 30 Grams/120 mL Enema O $0.00 $0.00 330184 250 sotalol 120 mg TAB O $0.00 $0.00 330184 250 sotalol 40 mg HALF-Tablet O $0.00 $0.00 330184 250 sotalol 60 mg HALF-Tablet O $0.00 $0.00 330184 250 sotalol 80 mg TAB O $0.00 $0.00 330184 250 spironolactone 12.5 mg TAB HALF-Tablet O $0.00 $0.00 330184 250 spironolactone 25 mg Tablet O $0.00 $0.00 330184 250 timolol ophthalmic 0.25% Solution O $0.00 $0.00 330184 250 traZODone 25 mg HALF-Tablet O $0.00 $0.00 330184 250 traZODone 50 mg Tablet O $0.00 $0.00 330184 250 trihexyphenidyl 1 mg HALF-Tablet O $0.00 $0.00 330184 250 trihexyphenidyl 2 mg TAB O $0.00 $0.00 330184 250 venlafaxine 37.5 mg XR O $0.00 $0.00 330184 250 verapamil 120 mg TAB O $0.00 $0.00 330184 250 verapamil 60 mg HALF-Tablet O $0.00 $0.00 330184 250 warfarin 0.5 mg HALF-Tablet O $0.00 $0.00 330184 250 warfarin 1 mg TAB O $0.00 $0.00 330184 250 AtoMOXetine 80 mg CAP NF O $0.00 $0.00 330184 250 ALPRAZolam 0.5 mg TAB O $0.00 $0.00 330184 250 ARIPiprazole 15 mg TAB O $0.00 $0.00 330184 250 Doxycycline HYCLATE 100 mg CAPSULE O $0.00 $0.00 330184 250 Doxycycline HYCLATE 100 mg TABLET O $0.00 $0.00 330184 250 Hemorrhoidal H topical 0.25%-3% OINT O $0.00 $0.00 330184 250 Multiple Vitamins with Zinc LIQ O $0.00 $0.00 330184 250 MultiVitamins Essentials TAB O $0.00 $0.00 330184 250 OxyCODONE IMMEDIATE Release 5 mg Tablet O $0.00 $0.00 330184 250 PHENobarbital 100 mg TAB O $0.00 $0.00 330184 250 PHENobarbital 15 mg TAB O $0.00 $0.00 330184 250 PHENobarbital 30 mg TAB O $0.00 $0.00 330184 250 QUEtiapine 12.5 mg HALF-tablet O $0.00 $0.00 330184 250 QUEtiapine 150 mg ERT O $0.00 $0.00 330184 250 QUEtiapine 25 mg Tablet O $0.00 $0.00 330184 250 REFRESH CELLUVISC LUBRCNT EYE DROPS 1% O $0.00 $0.00 330184 270 PULMONARY ARTERY CATHETER O "$2,413.00 " "$1,568.45 " 330184 250 DARANUVIR 800MG/COBICIST 150MG TABS O $0.00 $0.00 330184 250 LEVOCARNITINE 250 MG O $0.00 $0.00 330184 250 VALGANCYCLOVIR 450MG O $0.00 $0.00 330184 250 CEFTAZIDIME 500 MG PWDI- O $0.00 $0.00 330184 250 CHLORHEXIDINE 4% 118ML BOTTLE O $0.00 $0.00 330184 250 CLOZAPIN 25 MG TAB- O $0.00 $0.00 330184 250 CLOZAPINE 25 MG TAB O $0.00 $0.00 330184 250 CLOZPINE 25 MG TAB- O $0.00 $0.00 330184 250 CLZAPINE 25 MG TAB- O $0.00 $0.00 330184 250 HETASTARCH 30 GM/500 ML 0.9% NACL PREMIX SOLUTION- O $0.00 $0.00 330184 250 HYDOXOCOBALAMIN 5GM (CYANOKIT) O $0.00 $0.00 330184 250 HYDROCORTISONE 500 MG PWDI- O $0.00 $0.00 330184 250 HYDROMORPHONE 0.2 MG/ML IN 50 ML NS O $0.00 $0.00 330184 250 METOCLOPRAMIDE 5 MG/ML SOLN- O $0.00 $0.00 330184 250 MIDAZOLAM 1 MG/ML IN 150ML NS O $0.00 $0.00 330184 250 MORPHINE 1MG/ML IN 100ML NS O $0.00 $0.00 330184 250 MULTIVITAMIN MULTIPLE VITAMINS CAP- O $0.00 $0.00 330184 250 NAFCILLIN 2 G POWDER FOR INJECTION- O $0.00 $0.00 330184 250 NOREPINEPHRINE 16MG IN 250ML D5W O $0.00 $0.00 330184 250 NOREPINEPHRINE 16MG IN 250ML NS O $0.00 $0.00 330184 250 PHYSOSTIGMINE 1 MG/ML SOLUTION- O $0.00 $0.00 330184 250 TETANUS TOXOID 5 UNITS/0.5 ML SUSPENSION- O $0.00 $0.00 330184 250 2MCG/ML FENTANYL AND 0.125% BUPIVACAINE IN 100ML NS O $0.00 $0.00 330184 636 NON-FORMULARY CHARGE O $0.00 $0.00 330184 250 MELATONIN 1MG TAB O $0.00 $0.00 330184 250 MELATONIN 3MG UNIT DOSE TABS O $0.00 $0.00 330184 250 MELATONIN 5MG UNIT DOSE TAB O $0.00 $0.00 330184 250 GABAPENTIN 250MG/5ML UNIT DOSE CUPS 40X5ML O $0.00 $0.00 330184 250 SODIUM POLYSTYRENE POWD 12X15G O $0.00 $0.00 330184 250 FLUOROMETHOLONE OPHTH OINT 0.1% O $0.00 $0.00 330184 250 SODIUM POLYSTYRENE 15 GRAM POWDER O $0.00 $0.00 330184 250 HURRICAINE ONE-SPRAY O $31.27 $20.33 330184 250 LIDOCAINE 2% TOP JELLY PF PRE-FILLED SYRINGE 6ML O $0.00 $0.00 330184 250 VELTASSA (PATIROMER) 8.4 GM O $0.00 $0.00 330184 250 LANOSOOTHE CREAM 7G TUBE O $0.00 $0.00 330184 250 LANSINOH CREAM 40G TUBE O $0.00 $0.00 330184 250 CIPRODEX OTIC SUSPENSION O $0.00 $0.00 330184 250 "DEXTROSE GEL, 40%, LEMON,37.5GM " O $0.00 $0.00 330184 250 EMTRICITABINE/TENOFOVIR ALAFENAMIDE 200MG-25MG TABS O $0.00 $0.00 330184 250 RCK (ROPIV 2.46 MG/ML-CLON 0.8 MCG/ML-KETOR 0.3 MG/ML) O $0.00 $0.00 330184 250 LOKELMA 10 GRAM ORAL PACKET O $0.00 $0.00 330184 250 CEFAZOLIN 15MG + HEPARIN 7500U + NORMAL SALINE O $0.00 $0.00 330184 250 CEFAZOLIN 5MG+HEPARIN 2500 UNTS + NORMAL SALINE O $0.00 $0.00 330184 250 CEFTAZIDIME 0.5MG + HEPARIN 100 + NORMAL SALINE O $0.00 $0.00 330184 250 GENTAMYCIN 1MG + HEPARIN 2500U + NORMAL SALINE O $0.00 $0.00 330184 250 VANCOMYCIN 2.5MG + HEPARIN 2500U + NORMAL SALINE O $0.00 $0.00 330184 250 POTASSIUM ACETATE 2 MEQ/ML SOLUTION O $0.00 $0.00 330184 250 SEVELAMER CARBONATE 800MG O $0.00 $0.00 330184 250 SODIUM CHLORIDE 0.9% (250 ML) IRRIG SOLN O $0.00 $0.00 330184 250 SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM O $0.00 $0.00 330184 250 POVIDONE/POLYVINYL ALCOHOL 0.6%-1.4% O $0.00 $0.00 330184 250 LIDOCAINE 4% CREAM 15 GRAM TUBE O $0.00 $0.00 330184 250 EZ-DISK 700 MG TABLET (BARIUM SULFATE) O $0.00 $0.00 330184 250 NYSTATIN PWDR 30 GM VIAL O $0.00 $0.00 330184 250 SEVELAMER CARBONATE POWDER PACKET O $0.00 $0.00 330184 250 VARIBAR NECTAR 40% W/V (BARIUM SULFATE ) 240 ML O $0.00 $0.00 330184 250 "VARIBAR PUDDING 30% (BARIUM SULFATE), 230 ML" O $0.00 $0.00 330184 250 VARIBAR THIN HONEY 40% W/V (BARIUM SULFATE) 250 ML O $0.00 $0.00 330184 250 VARIBAR THIN LIQUID 81% W/W (BARIUM SULFATE) O $0.00 $0.00 330184 250 VIT B COMPLEX/C/FOLIC ACID O $0.00 $0.00 330184 250 DANTROLENE (RYANODEX) 250MG O $0.00 $0.00 330184 250 DOXYCYLINE MONOHYDRATE SUSP 25MG/5ML O $0.00 $0.00 330184 250 NORTREL (NORETHINDRONE/ETHINYL ESTRADIOL 1/35 TABLET) O $0.00 $0.00 330184 250 CISATRACURIUM 10 MG/ML 20 ML VIAL (NIMBEX) O $0.00 $0.00 330184 250 DELFLEX 1.5% 5000 MLL PD BAG O $0.00 $0.00 330184 250 DELFLEX 2.5% 5000ML PD BAG O $0.00 $0.00 330184 250 ASTRINGYN 8 GM O $0.00 $0.00 330184 250 LORAZEPAM INTENSOL CONCENTRATED SOLN O $0.00 $0.00 330184 250 DANTROLENE SODIUM 250MG O "$5,499.00 " "$3,574.35 " 330184 270 BAKRI POSTPARTUM BALLOON O $204.00 $132.60 330184 270 KIWI SUCTION O $190.00 $123.50 330184 250 INSULIN REG HUM IN 0.9%NACL 100ml Bag O $0.00 $0.00 330184 250 NICARDIPINE/SAL PREMIX 200 ML BAG O $0.00 $0.00 330184 250 FLUCONAZOLE ORAL SUSPENSION 40MG/ML O $0.00 $0.00 330184 250 LEVOTHYROXINE 100MCG SDV O $0.00 $0.00 330184 272 CATHETERCCOUNCIL FOLEY 1 O $91.00 $59.15 330184 272 CatheterCouncilFoley20 O $91.00 $59.15 330184 272 CatheterCouncilFoley22 O $91.00 $59.15 330184 272 TUBE RECTAL 20F O $18.00 $11.70 330184 272 TUBE RECTAL 24F O $18.00 $11.70 330184 272 Filiform Straight 5 ea O $198.00 $128.70 330184 272 Filiform Straight ea O $198.00 $128.70 330184 272 Filiform Uretheral Foll1 O $327.00 $212.55 330184 272 Filiform Uretheral Foll2 O $327.00 $212.55 330184 272 Filiform Spiral 4 O $198.00 $128.70 330184 272 Filiform Spiral 5 O $198.00 $128.70 330184 272 Filiform Spiral 6 O $198.00 $128.70 330184 272 SHILEY TRACH (UNCUFFED) 0 O $204.00 $132.60 330184 272 SHILEY TRACH (UNCUFFED) 2 O $204.00 $132.60 330184 272 SHILEY TRACH (UNCUFFED) 3 O $204.00 $132.60 330184 272 SHILEY TRACH (UNCUFFED) 4 O $204.00 $132.60 330184 272 SHILEY TRACH (UNCUFFED) 6 O $204.00 $132.60 330184 272 SHILEY TRACH (UNCUFFED) 8 O $204.00 $132.60 330184 271 UROSTOMY BAGS 1.50 O $198.00 $128.70 330184 271 OSTOMYIRRIGATION POUCH 4 O $37.00 $24.05 330184 271 AMBU BAG DISPOSABLE O $182.00 $118.30 330184 272 CATHETER TROCAR (CHEST) O $143.00 $92.95 330184 270 ISOLATION CART O $0.00 $0.00 330184 271 RECTAL PROBE HYPER-HYPOT O $118.00 $76.70 330184 271 LIMB RESTRAINT-DISP O $57.00 $37.05 330184 272 DRESSING TELFA 4X6 O $191.00 $124.15 330184 272 Dressing Telfa 4x6 O $191.00 $124.15 330184 272 CURAFIL GEL WOUND O $32.00 $20.80 330184 271 Sof-Care Mattress O $141.00 $91.65 330184 271 SOF-CARE CHAIR PAD O $71.00 $46.15 330184 272 TEGADERM O $110.00 $71.50 330184 271 WOUND MEASURING DEVICE O $34.00 $22.10 330184 272 SKIN PREPS O $25.00 $16.25 330184 271 SIDE RAIL CUSHIONS O $130.00 $84.50 330184 271 HIP SPLINT COMPLETE O $622.00 $404.30 330184 271 HIP SPLINT REPLACEMENT P O $37.00 $24.05 330184 271 HIP SPLINT REPLACEMENT ST O $108.00 $70.20 330184 271 FEMALE INCONTINENCE POUCH O $71.00 $46.15 330184 271 BOOT PERIOPERATIVE O $175.00 $113.75 330184 270 IV PUMP O $0.00 $0.00 330184 271 TAPE MEASURE 60 O $1.00 $0.65 330184 271 PADS HYPOTHERMIA DISPOSA O $60.00 $39.00 330184 271 ANTI-REFLEX VALVE O $4.00 $2.60 330184 271 VENODYNE STOCKING/SLEEVES O $212.00 $137.80 330184 271 SURE SAFE RAISED TOILET S O $196.00 $127.40 330184 272 BAZA CREAM ANTIFUNGAL BAR O $42.00 $27.30 330184 272 BAZA PRO CREAM OCCLUSIVE O $35.00 $22.75 330184 271 PERI-WASH II MEDICATED AN O $20.00 $13.00 330184 272 Nosting Film Barrier1.0m O $59.00 $38.35 330184 272 NOSTING FILM BARRIER 3.0 O $123.00 $79.95 330184 272 GASTROSTOMY TUBE O $744.00 $483.60 330184 272 TEGADERM DRESSING HP O $20.00 $13.00 330184 272 TegasorbDressin5 ?x6 ? O $71.00 $46.15 330184 272 Tegasorb Dressing 4x4 ? O $32.00 $20.80 330184 272 TEGASORB DRESSING 2 3/4 X O $20.00 $13.00 330184 272 Curafil Gauze 8 x 4 O $20.00 $13.00 330184 272 CURAFIL GAUZE 4 X 4 O $12.00 $7.80 330184 272 TELFA ISLAND DRESSING 4X O $12.00 $7.80 330184 272 TELFA ISLAND DRESSING 4X O $20.00 $13.00 330184 270 COMPRESSION DEVICE SLEEVE O $300.00 $195.00 330184 272 TELFA XTRA DRESSING 4X6 O $12.00 $7.80 330184 272 TELFA XTRA DRESSING 6X7 O $20.00 $13.00 330184 272 Tube Blakemore O $393.00 $255.45 330184 272 TRAYS EXCHANGE O $18.00 $11.70 330184 272 CATHETER MULTI-LUMEN O $274.00 $178.10 330184 272 DOUBLE-LUMEN CATHETER O $245.00 $159.25 330184 272 FEEDING TUBE FLEX-FLO 12 O $151.00 $98.15 330184 272 EYE TRAY DISPOSABLE O $96.00 $62.40 330184 271 BILE BAGS DAVOL 1585 O $58.00 $37.70 330184 272 TRACH TUBES LOW PRES CUF O $302.00 $196.30 330184 271 BINDERS ABDOMINAL COMBO S O $139.00 $90.35 330184 271 BINDERS ABDOMINAL COMBO L O $139.00 $90.35 330184 272 SALEM SUMP TUBES 16F O $30.00 $19.50 330184 272 SALEM SUMP TUBES 18F O $30.00 $19.50 330184 272 INNER CANNULA SIZE 4 O $257.00 $167.05 330184 272 INNER CANNULA SIZE 6 O $257.00 $167.05 330184 272 INNER CANNULA SIZE 8 O $257.00 $167.05 330184 271 SYRINGES TOOMEY 70CC O $22.00 $14.30 330184 271 URINE METERS DAVOL #3590 O $108.00 $70.20 330184 271 SITZ BATH VOLLRATH O $34.00 $22.10 330184 271 TRACH CARE KITS SUPERIOR O $22.00 $14.30 330184 272 SUCTION CATH 1OF 2 GLOVE O $86.00 $55.90 330184 272 CATHETER TRAY DISP W/BAG O $37.00 $24.05 330184 272 CATHETER TRAY BARD 89740 O $106.00 $68.90 330184 272 DRAINAGE BAG URINARY BA O $60.00 $39.00 330184 270 CRYOTHERM KNEE WRAP O $151.00 $98.15 330184 272 BONE MARROW TRAY O $300.00 $195.00 330184 272 Tube Canter Adult O $259.00 $168.35 330184 272 UROSTOMY DRAIN TUBE O $48.00 $31.20 330184 272 CATHETER COUNCIL FOLEY 1 O $91.00 $59.15 330184 272 OSTOMY SYSTEM BAG 4 (TWO O $22.00 $14.30 330184 272 OSTOMY LOOP BRIDGE O $22.00 $14.30 330184 271 Bowl Plastic O $2.00 $1.30 330184 272 SPINAL TRAYINFANT O $113.00 $73.45 330184 271 TUBE RECTAL 18F O $18.00 $11.70 330184 272 TUBE MILLER ABBOTT (ADUL O $331.00 $215.15 330184 272 Filiform Straight 3 O $198.00 $128.70 330184 271 AIRWAYORAL O $4.00 $2.60 330184 272 UROSTOMY SYSTEM (TWO PIEC O $25.00 $16.25 330184 272 OSTOMYPROF. STERILE DRAI O $60.00 $39.00 330184 272 Filiform Uretheral Foll08 O $327.00 $212.55 330184 272 Filiform Spiral 3 O $198.00 $128.70 330184 272 STYLET ENDOTRACHEAL O $34.00 $22.10 330184 272 OSTOMYSKIN BARRIOR 2.75 O $34.00 $22.10 330184 271 OSTOMY BELT TWO PIECE SY O $42.00 $27.30 330184 272 SKIN PREP BX O $69.00 $44.85 330184 272 OSTOMYSKIN BARRIOR 4W/F O $54.00 $35.10 330184 272 OSTOMY STARTER KIT (W/TOT O $417.00 $271.05 330184 271 OSTOMY SYSTEM BAG 2.75 O $18.00 $11.70 330184 271 UROSTOMY BAGS 1.75 O $198.00 $128.70 330184 271 OSTOMYIRRIGATION POUCH 2 O $37.00 $24.05 330184 271 STOMYPREMIUM PASTE O $71.00 $46.15 330184 271 OSTOMY BAG CLAMP O $4.00 $2.60 330184 271 OSTOMYIRRIGATION KIT (CO O $187.00 $121.55 330184 270 CRASH CART O $178.00 $115.70 330184 270 Alternating Air Mattress O $141.00 $91.65 330184 272 AMBU BAG MASK DISPOSABLE O $34.00 $22.10 330184 271 AQUATHERMIA PAD O $25.00 $16.25 330184 271 CENTRAL SUPPLY MISC. O $0.00 $0.00 330184 272 CATHETER FOLEY 14F 5CC O $63.00 $40.95 330184 272 CATHETER FOLEY 22F 5CC O $63.00 $40.95 330184 272 CATHETER FOLEY COUDE-14F O $110.00 $71.50 330184 272 CATHETER SUBCLAVIAN 16G O $91.00 $59.15 330184 271 SUCTION INSTRUMENT YANKA O $4.00 $2.60 330184 272 CATHETER FOLEY 3-WAY 18F O $127.00 $82.55 330184 272 CATHETER FOLEY 3-WAY 20F O $127.00 $82.55 330184 272 CATHETER FOLEY 3-WAY 22F O $127.00 $82.55 330184 272 CATHETER FOLEY 3-WAY 24F O $127.00 $82.55 330184 272 TUBING CYSTO IRRIGATING O $30.00 $19.50 330184 272 ARGYLE SUCTION CATH O $3.00 $1.95 330184 272 ANGIOCATH O $4.00 $2.60 330184 272 IV EXTENSION O $25.00 $16.25 330184 271 SUCTION CANISTER LINER 1 O $25.00 $16.25 330184 271 DISPOSABLE ELECTRODES O $3.00 $1.95 330184 272 NIPPLE SHIELD O $30.00 $19.50 330184 272 BLADDER IRRIGATION SET PI O $22.00 $14.30 330184 272 BLOOD WARMING COILS #4663 O $245.00 $159.25 330184 271 BLADDER IRRIGATION SET BU O $22.00 $14.30 330184 270 SLIPPERS PILLOW PAWS SMA O $2.00 $1.30 330184 270 SLIPPERS PILLOW PAWS MED O $2.00 $1.30 330184 270 SLIPPERS PILLOW PAWS LAR O $2.00 $1.30 330184 272 STOPCOCK 4 WAY MORSE O $20.00 $13.00 330184 272 BLOOD COLLECTION SET O $2.00 $1.30 330184 271 BAGS LEG MEDIUM INMED #45 O $22.00 $14.30 330184 271 BAGS LEG LARGE INMED #452 O $22.00 $14.30 330184 271 AIRWAY NASOPHERANGEAL 6MM O $42.00 $27.30 330184 270 AIRWAY NASOPHERANGEAL 7MM O $42.00 $27.30 330184 271 AIRWAY NASOPHERANGEAL 8MM O $42.00 $27.30 330184 271 STAPLER SKIN STAPLE REMO O $60.00 $39.00 330184 272 SUTURE REMOVAL TRAY DISP O $18.00 $11.70 330184 272 SPINAL TRAYS ADULT DISP O $178.00 $115.70 330184 271 ELECTRODES CLOTH BARD 3/ O $20.00 $13.00 330184 271 ELECTRODES NDM DIAPHORET O $34.00 $22.10 330184 272 FEEDING SET GRAVITY 2L80 O $96.00 $62.40 330184 272 ENDOTRACH TUBE-PORTEX 5.0 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 5.5 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 6.0 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 6.5 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 7.0 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 7.5 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 8.0 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 8.5 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 9.0 O $48.00 $31.20 330184 272 ENDOTRACH TUBE-PORTEX 9.5 O $48.00 $31.20 330184 272 NASAL TUBE IVORY TRACH #5 O $42.00 $27.30 330184 272 NASAL TUBE IVORY TRACH #6 O $42.00 $27.30 330184 272 NASAL TUBE IVORY TRACH #7 O $42.00 $27.30 330184 272 NASAL TUBE IVORY TRACH #8 O $42.00 $27.30 330184 272 NASAL TUBE IVORY TRACH #9 O $42.00 $27.30 330184 272 QUANTUM TOPFILL O $35.00 $22.75 330184 272 QUANTUM SPIKESET WITH FLU O $35.00 $22.75 330184 271 PERI SKIN CARE (KIT) O $59.00 $38.35 330184 271 FOOT COVER (REGULAR) O $450.00 $292.50 330184 271 FOOT COVER (LARGE) O $450.00 $292.50 330184 271 FINGER CONTROL (MITTENS) O $91.00 $59.15 330184 272 CALCIUM ALGINATE DRESSING O $23.00 $14.95 330184 272 CALCIUM ZINC ALGINATE DRE O $20.00 $13.00 330184 271 PRESSURE REDUCING MATTRES O $260.00 $169.00 330184 272 SUBCLAVIAN CATHETER 11.5 O $160.00 $104.00 330184 272 DUAL LUMON CATHETER 11.5 O $160.00 $104.00 330184 270 KNEE IMOBILIZER O $51.00 $33.15 330184 270 ANKLE SUPPORT O $68.00 $44.20 330184 270 HUGER NEEDLE O $429.00 $278.85 330184 270 WINGED INFUSION SET O $429.00 $278.85 330184 270 ORTHO GLASS SPLITING ROLL O $612.00 $397.80 330184 270 HUMERAL FRACTURE BRACE O $330.00 $214.50 330184 270 BUCKS BOOT O $33.00 $21.45 330184 270 SHOULDER SLINGS O $6.00 $3.90 330184 270 ECONOMY HEAD RESTS O $12.00 $7.80 330184 270 HOLLISTER PREMIUM POWDER O $19.00 $12.35 330184 270 TURKEL THOROCENTESIS SYST O $105.00 $68.25 330184 270 VASCU PICC INSERTION TRAY O $284.00 $184.60 330184 270 BONE MARROW BX/ASP TRAY O $31.00 $20.15 330184 250 NAPHAZOLINE SLTN .023%/15 O $0.00 $0.00 330184 250 FLORINEF 0.1MG O $0.00 $0.00 330184 250 HALDOL 10 MG O $0.00 $0.00 330184 250 ALLBEE WITH C O $0.00 $0.00 330184 250 AMICAR 500 MG O $0.00 $0.00 330184 250 HEXAVITAMIN O $0.00 $0.00 330184 250 ANAPROX 275 MG O $0.00 $0.00 330184 250 HYDREA 500 MG O $0.00 $0.00 330184 250 INDERAL LA 80MG U/D O $0.00 $0.00 330184 250 INDOCIN SR 75 MG O $0.00 $0.00 330184 250 LEUKERAN 2 MG O $0.00 $0.00 330184 250 LIORESAL 10 MG O $0.00 $0.00 330184 250 ASPIRIN 325MG TAB O $0.00 $0.00 330184 250 AZULFIDINE 500 MG O $0.00 $0.00 330184 250 BACID 500 U O $0.00 $0.00 330184 250 BENEMID 500 MG O $0.00 $0.00 330184 250 BRETHINE 2.5 MG O $0.00 $0.00 330184 250 BRETHINE 5 MG O $0.00 $0.00 330184 250 BUMEX 1 MG O $0.00 $0.00 330184 250 BUMEX 0.5 MG O $0.00 $0.00 330184 250 MEPERIDINE 50 MG O $0.00 $0.00 330184 250 MEPHYTON 5 MG O $0.00 $0.00 330184 250 MESTINON 60 MG O $0.00 $0.00 330184 250 DICYCLOMINE TABLET 20MG O $0.00 $0.00 330184 250 CAPOTEN 12.5 MG O $0.00 $0.00 330184 250 CAPOTEN 25 MG O $0.00 $0.00 330184 250 SUCRALFATE TABLET 1GM O $0.00 $0.00 330184 250 CODEINE 15 MG O $0.00 $0.00 330184 250 MESTINON 180 MG SR O $0.00 $0.00 330184 250 METHADONE 5 MG O $0.00 $0.00 330184 250 METHERGINE 0.2 MG O $0.00 $0.00 330184 250 NYSTATIN TRIAMCINOLONE 15 O $0.00 $0.00 330184 250 Hydrocortisone 40mg tabl O $0.00 $0.00 330184 250 COUMADIN 2 MGTABLET O $0.00 $0.00 330184 250 COUMADIN 2.5 MG O $0.00 $0.00 330184 250 COUMADIN 5 MG O $0.00 $0.00 330184 250 CYTOMEL 5 MCG O $0.00 $0.00 330184 250 MEXITIL 150 MG O $0.00 $0.00 330184 250 MEXITIL 200 MG O $0.00 $0.00 330184 250 MIDAMOR 5 MG O $0.00 $0.00 330184 250 DAPSONE 25 MG O $0.00 $0.00 330184 250 DECLOMYCIN 150 MG O $0.00 $0.00 330184 250 MYAMBUTOL 100 MG O $0.00 $0.00 330184 250 MYAMBUTOL 400 MG O $0.00 $0.00 330184 250 MYSOLINE 250 MG O $0.00 $0.00 330184 250 MYSOLINE 50 MG O $0.00 $0.00 330184 250 NITROSTAT 0.4 MG O $0.00 $0.00 330184 250 NIZORAL 200 MG O $0.00 $0.00 330184 250 PERCOCET O $0.00 $0.00 330184 250 DEPAKOTE 250 MG O $0.00 $0.00 330184 250 VANTIN FC 200MGTABLET O $0.00 $0.00 330184 250 DIAMOX 500 MG O $0.00 $0.00 330184 250 DILANTIN 100 MG O $0.00 $0.00 330184 250 AMMONIUM CHLORIDE O $0.00 $0.00 330184 250 FOLVITE 50MG/10ML O $0.00 $0.00 330184 250 HEPARIN FLUSH 25U O $0.00 $0.00 330184 250 HEAPRIN 10000U/ML O $0.00 $0.00 330184 250 HUMULIN-N INSULIN O $0.00 $0.00 330184 250 HYTONE 2.5% 30 GM O $0.00 $0.00 330184 250 NPH INSULIN O $0.00 $0.00 330184 250 REGULAR INSULIN O $0.00 $0.00 330184 250 ISOPROTERENOL INJ 1MG/5ML O $0.00 $0.00 330184 250 DONNATAL O $0.00 $0.00 330184 250 DYRENIUM 50 MG O $0.00 $0.00 330184 250 Ethacrynic Acid 25mg tab O $0.00 $0.00 330184 250 ERYTHROMYCIN 250MG TBT EC O $0.00 $0.00 330184 250 ESKALITH SR 450 MG O $0.00 $0.00 330184 250 FERROUS GLUC. 300 MG O $0.00 $0.00 330184 250 FLUOR-I-STRIP O $0.00 $0.00 330184 250 Fluoromethalone 0.1% Ey O $0.00 $0.00 330184 250 INFLAMASE FORTE 5 ML O $0.00 $0.00 330184 250 CARBACHOL 3% 15 ML O $0.00 $0.00 330184 250 Homatropine 2% Eye Drp O $0.00 $0.00 330184 250 Homatropine 5% Eye Drp O $0.00 $0.00 330184 250 LOPROX 1% 15 GM O $0.00 $0.00 330184 250 LOTRISONE 15 GM O $0.00 $0.00 330184 250 Trace Elements 2 ml inj O $0.00 $0.00 330184 250 dexa/neo/polyB ophth 3.5 g OINT O $0.00 $0.00 330184 250 dexa/neo/polyB ophth 3.5 g SUSP O $0.00 $0.00 330184 250 MERUVAX II VACCINE O $0.00 $0.00 330184 250 MIOSTAT 0.01%/1.5ML O $0.00 $0.00 330184 250 NAPHCON-A 15ML SOLN O $0.00 $0.00 330184 250 NIZORAL 2% 15 GM O $0.00 $0.00 330184 250 Phenyephrine 10% Eye Dr O $0.00 $0.00 330184 250 PILOCAR 1%/15ML SOLN O $0.00 $0.00 330184 250 PILOCAR 2%/15ML SOLN O $0.00 $0.00 330184 250 Pilocarpine 3% Eye Drops O $0.00 $0.00 330184 250 Pilocarpine 4% Eye Drops O $0.00 $0.00 330184 250 PILOCAR 1%/ML DROPTS O $0.00 $0.00 330184 250 PONTOCAINE 1%/2ML O $0.00 $0.00 330184 250 PRAMOSONE 1% 30GM O $0.00 $0.00 330184 250 PrednisoloneAcetate0.12 O $0.00 $0.00 330184 250 PREMARIN 42.5GM/APPL O $0.00 $0.00 330184 250 PREPARATION H 30GM O $0.00 $0.00 330184 250 PROLIXIN 25MG/10ML O $0.00 $0.00 330184 250 REGLAN 50MG/10ML O $0.00 $0.00 330184 250 Pyridostigmine 5mg mLinj O $0.00 $0.00 330184 250 SODIUM BICARBONATE INJ O $0.00 $0.00 330184 250 SOD.CHL. 0.9%/50ML O $0.00 $0.00 330184 250 SOD.PHOSPHATE 45MMO O $0.00 $0.00 330184 250 STERILE WATER 10ML O $0.00 $0.00 330184 250 STERILE WATER 50ML O $0.00 $0.00 330184 250 TENSILON 10MG/ML O $0.00 $0.00 330184 250 TETRACAINE 0.5%/ML O $0.00 $0.00 330184 250 TOBREX 0.3%/3.5GM O $0.00 $0.00 330184 250 TRACRIUM 100MG/10ML O $0.00 $0.00 330184 250 VISINE 0.05%/15ML O $0.00 $0.00 330184 250 VITAMIN E 30GM O $0.00 $0.00 330184 250 Hydrocortisone Valerate O $0.00 $0.00 330184 250 LIDOCAINE JELLY 2%/30ML O $0.00 $0.00 330184 250 Lidocaine 2.5% Ointment3 O $0.00 $0.00 330184 250 Zinc Sulfate 1 mg mL Vial O $0.00 $0.00 330184 250 ACYCLOVIR OINTMENT 5% 15 O $0.00 $0.00 330184 250 ANUSOL 30 GM O $0.00 $0.00 330184 250 TRIAMCINOLONE OINT .5% O $0.00 $0.00 330184 250 ARM-A-VIAL NACL 3ML O $0.00 $0.00 330184 250 ATROPISOL 1%/1ML O $0.00 $0.00 330184 250 Betaxolol 0.5% Eye Drops O $0.00 $0.00 330184 250 PLAQUENIL 200 MG O $0.00 $0.00 330184 250 PREMARIN 0.625 MG O $0.00 $0.00 330184 250 PREMARIN 0.3 MG O $0.00 $0.00 330184 250 CYCLOGYL 1%/2ML O $0.00 $0.00 330184 250 CYCLOMYDRIL 2ML O $0.00 $0.00 330184 250 PROVERA 10 MG O $0.00 $0.00 330184 250 PURINETHOL 50 MG O $0.00 $0.00 330184 250 Dantrolene 20mg vial O $0.00 $0.00 330184 250 DEXTROSE 50%/50ML O $0.00 $0.00 330184 250 DIPROSONE 0.05%/15GM O $0.00 $0.00 330184 250 EPHEDRINE 50MG/ML INJ O $0.00 $0.00 330184 250 THYROID 15MG O $0.00 $0.00 330184 250 THYROID 60MG O $0.00 $0.00 330184 250 ROCALTROL 0.25 MCG O $0.00 $0.00 330184 250 TRENTAL 400MG O $0.00 $0.00 330184 250 SENOKOT 187 MG O $0.00 $0.00 330184 250 Bethanechol 5 mg tablet O $0.00 $0.00 330184 250 SLO-PHYLLIN 100 MG O $0.00 $0.00 330184 250 ZANTAC 150MG O $0.00 $0.00 330184 250 SODIUM BICARBONATE 648MG O $0.00 $0.00 330184 250 SYNTHROID 50 MCG O $0.00 $0.00 330184 250 LEVOTHYROXINE TBLT 75MCCG O $0.00 $0.00 330184 250 SYNTHROID 150 MCG O $0.00 $0.00 330184 250 TAPAZOLE 5 MG O $0.00 $0.00 330184 250 SECTRAL 200 MG O $0.00 $0.00 330184 250 ACETAMINOPHEN 120MG O $0.00 $0.00 330184 250 ACETAMINOPHEN 650MG O $0.00 $0.00 330184 250 ADRENALIN 30ML SOLN O $0.00 $0.00 330184 250 ASPIRIN 600MG O $0.00 $0.00 330184 250 BACITRACIN 0.9GM OINTMENT O $0.00 $0.00 330184 250 Eye Wash 120ml O $0.00 $0.00 330184 250 CETACAINE AER SPRAY O $0.00 $0.00 330184 250 CETAPHIL LOTION O $0.00 $0.00 330184 250 CITRATE OF MAGNESIA O $0.00 $0.00 330184 250 CORTENEMA 100MG/60ML O $0.00 $0.00 330184 250 DDAVP 0.01%/2.5ML O $0.00 $0.00 330184 250 DOME-PASTE BANDAGE O $0.00 $0.00 330184 250 DOMEBORO POWDER PKT O $0.00 $0.00 330184 250 DONNATAL ELIXER O $0.00 $0.00 330184 250 WATER FOR IRRIGATION O $0.00 $0.00 330184 250 EPSOM SALT GRANULE O $0.00 $0.00 330184 250 FEOSOL 220MG/5ML O $0.00 $0.00 330184 250 FLEET ENEMA 135ML O $0.00 $0.00 330184 250 FLEET ENEMA PED SOLN O $0.00 $0.00 330184 250 FLEET OIL ENEMA O $0.00 $0.00 330184 250 Sterile Water forInj1000m O $0.00 $0.00 330184 250 DEXTRAN 70 & 75 INJ 100ML O $0.00 $0.00 330184 250 Hydrocortisone 2.5% Topic O $0.00 $0.00 330184 250 Triamcinolone 0.1% Oral P O $0.00 $0.00 330184 250 MORPHINE 10MG/5ML O $0.00 $0.00 330184 250 MYLICON 30ML DROPS O $0.00 $0.00 330184 250 NASALIDE 0.025% SPY O $0.00 $0.00 330184 250 NEO-SYNEP.0.125% DRP O $0.00 $0.00 330184 250 NEO-SYNEP. 0.25% DRP O $0.00 $0.00 330184 250 Neo-Synephrine 0.5% Na O $0.00 $0.00 330184 250 NEO-SYNEP 0.5% SPRAY O $0.00 $0.00 330184 250 DEOD OPIUM TINC ORAL O $0.00 $0.00 330184 250 Hexachlorophene 3% To O $0.00 $0.00 330184 250 POLY-VI-SOL DROPS O $0.00 $0.00 330184 250 POLYSPORIN POWDER O $0.00 $0.00 330184 250 PREPARATION H O $0.00 $0.00 330184 250 ROBITUSSIN 100MG/5ML O $0.00 $0.00 330184 250 Selenium 2.25% Shampoo O $0.00 $0.00 330184 250 SODIUM BICARBONATE 120GM O $0.00 $0.00 330184 250 TRANSDERM-SCOP 1.5MG O $0.00 $0.00 330184 250 TYLENOL CHILDREN DRP O $0.00 $0.00 330184 250 SURGICEL 2X3 STRIP O $0.00 $0.00 330184 250 NITRO-DUR II 5MG O $0.00 $0.00 330184 250 NITRO-DUR II 7.5MG O $0.00 $0.00 330184 250 Nitroglycerin 0.6mg hour O $0.00 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330184 250 METHYLDOPA 500MG TABLET O $0.00 $0.00 330184 250 FERROUS SULFATE SOLUTION O $0.00 $0.00 330184 250 THIORIDAZINE 25MG TABLET O $0.00 $0.00 330184 250 NIFEDIPINE 10MG CAPSULE O $0.00 $0.00 330184 250 DICLOXACILLIN 250MG CAPSL O $0.00 $0.00 330184 250 BISACODYL 5MG TABLET O $0.00 $0.00 330184 250 Sodium Chloride 23.4% v O $0.00 $0.00 330184 250 POTASSIUM CHLORIDE INJ O $0.00 $0.00 330184 250 BACITRACIN OINTMENT O $0.00 $0.00 330184 250 BETAGAN OPHTH .5% SOLTN O $0.00 $0.00 330184 250 ISOSORBIDE DINITRATE TBLT O $0.00 $0.00 330184 250 TRAZODONE 50MG TABLET O $0.00 $0.00 330184 250 NIFEDIPINE XL TABLET 30MG O $0.00 $0.00 330184 250 MILK OF MAGNESIA 30ML O $0.00 $0.00 330184 250 HYDROMORPHONE 2MG TABLET O $0.00 $0.00 330184 250 HYDROMORPHONE 4MG TABLET O $0.00 $0.00 330184 250 PAREGORIC TINC O $0.00 $0.00 330184 250 Desipramine 25mg tablet O $0.00 $0.00 330184 250 BETAGAN .25% SOLUTION O $0.00 $0.00 330184 250 Niacin 50mg tablet O $0.00 $0.00 330184 250 MAGNESIUM SULFATE INJ O 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$0.00 $0.00 330184 250 PREDNISOLONE 1%/5ML O $0.00 $0.00 330184 250 NITROPRESS 50MG INJECTION O $0.00 $0.00 330184 250 CYTOTEC 100MCG TABLET O $0.00 $0.00 330184 250 SANI-SUPP SUPPOSITORY O $0.00 $0.00 330184 250 DURAGESIC TRANSDERMAL STP O $0.00 $0.00 330184 250 AMMONIA INHALANT O $0.00 $0.00 330184 250 FURADANTIN 25MG/5ML O $0.00 $0.00 330184 250 DOXEPIN .10MG CAPSULE O $0.00 $0.00 330184 250 PHOSLO 667MG TABLET O $0.00 $0.00 330184 250 CARBIDOPA LEVODOPA CR TBT O $0.00 $0.00 330184 250 NASAL DROPS SOLUTION O $0.00 $0.00 330184 250 ERTHROMYCIN OINTMENT .5% O $0.00 $0.00 330184 250 KLONOPIN 1MG TABLET O $0.00 $0.00 330184 250 MONISTAT 7 DAY VAG SUPPTY O $0.00 $0.00 330184 250 AMANTADINE CAPSULE O $0.00 $0.00 330184 250 ACETAMINOPHEN TABLET O $0.00 $0.00 330184 250 PARLODEL 2.5MG TABLET O $0.00 $0.00 330184 250 CHLORTHALIDONE 25MG TBLT O $0.00 $0.00 330184 250 TRI-VI-FLOR DR 0.25MG/ML O $0.00 $0.00 330184 250 PHENOBARBITAL 20MG/5ML LD O $0.00 $0.00 330184 250 METOCLOPRAMIDE TABLET O $0.00 $0.00 330184 250 ALCOHOL INJ DEHYDRATED O $0.00 $0.00 330184 250 Ethanol 98% solution for O $0.00 $0.00 330184 250 CARISOPRODOL 350MG TABLET O $0.00 $0.00 330184 250 VERAPAMIL 80MG TABLET O $0.00 $0.00 330184 250 SURVANTA INTRATRACHEAL IN O $0.00 $0.00 330184 250 Isoniazide 100mg tablet O $0.00 $0.00 330184 250 TOBRADEX OINTMENT TUBE O $0.00 $0.00 330184 250 GLYCERIN SUPP PEDS O $0.00 $0.00 330184 250 Sterile Water Irrig 3000 O $0.00 $0.00 330184 250 Sodium Hyaluronate HEA O $0.00 $0.00 330184 250 VERAPAMIL HCL 120MG TBLT O $0.00 $0.00 330184 250 GENTAMICIN OINT .1%/15MG O $0.00 $0.00 330184 250 NEUTRA PHOS K POWDER O $0.00 $0.00 330184 250 MAXZIDE 25 TABLET O $0.00 $0.00 330184 250 FLUPHENAZINE 2.5MG TABLET O $0.00 $0.00 330184 250 SODIUM CHLORIDE INJECTION O $0.00 $0.00 330184 250 Quinidine 200mg tablet O $0.00 $0.00 330184 250 SSD 1% CREAM 50GM TUBE O $0.00 $0.00 330184 250 ALBUTEROL 2MG/5ML 5ML U/D O $0.00 $0.00 330184 250 THIOTHIXENE 5MG CAPSULE O $0.00 $0.00 330184 250 DISOPYRAMIDE PHOS 100MG C O $0.00 $0.00 330184 250 SSD 1% CREAM400GM/TUBE O $0.00 $0.00 330184 250 BETAMETHASONE VALERATE O $0.00 $0.00 330184 250 DIPROLENE AF .05% CREAM O $0.00 $0.00 330184 250 TEMAZEPAM 15MG CAPSULE O $0.00 $0.00 330184 250 VIDEX 25MG TBLT CHEWABLE O $0.00 $0.00 330184 250 VIDEX 100MG TBLT CHEWABLE O $0.00 $0.00 330184 250 LIQUI-CHAR AQUEOUS BASE O $0.00 $0.00 330184 250 LIQUI-CHAR SORBITOL 25GM O $0.00 $0.00 330184 250 THERAPEUTIC MULTIVITAMIN O $0.00 $0.00 330184 250 LIDOCAINE TPC 4% SLTN 50M O $0.00 $0.00 330184 250 Disopyramide 150mg caps O $0.00 $0.00 330184 250 Quinaglute 324mg ER tab O $0.00 $0.00 330184 250 QUINIDINE GLUCONATE 324MT O $0.00 $0.00 330184 250 CALCIUM GLUCONATE 10% INJ O $0.00 $0.00 330184 250 CYCLOBENZAPRINE 10MG TAB O $0.00 $0.00 330184 250 VITAMIN A&D ECP OINTMENT O $0.00 $0.00 330184 250 LANOLIN HYDROUS ECP OINT O $0.00 $0.00 330184 250 ZINC OXIDE OINTMENT ECP20 O $0.00 $0.00 330184 250 CALCIFEROL 50MU TABLET O $0.00 $0.00 330184 250 KLOPOPIN .5MG TABLET O $0.00 $0.00 330184 250 WHITE PETROLATUM OINTMENT O $0.00 $0.00 330184 250 BISACODYL 10MG SPPSTY 50E O $0.00 $0.00 330184 250 FLUOCINODIDE .05% CRM 15G O $0.00 $0.00 330184 250 HYDROCORTISONE CRM .5% O $0.00 $0.00 330184 250 PHENERGAN VC W/CODEINE O $0.00 $0.00 330184 250 Fluocinolone 0.025% crea O $0.00 $0.00 330184 250 FLUOCINONIDE .05% SLTN O $0.00 $0.00 330184 250 Thioridazine 50 mg tablet O $0.00 $0.00 330184 250 SODIUM CHLORIDE 1G TBLT O $0.00 $0.00 330184 250 INHALATION 2.25% SOLUTION O $0.00 $0.00 330184 250 LINDO CAINE 5% DEXTRS INJ O $0.00 $0.00 330184 250 CHLORAL HYDRATE 500MG/ML O $0.00 $0.00 330184 250 CARDIZEM INJECTION 50MG O $0.00 $0.00 330184 250 CARDIZEM CD 180MG CAPSULE O $0.00 $0.00 330184 250 RELAFEN 500MG TABLET O $0.00 $0.00 330184 250 CARDIZEM CD 240MG CAPSULE O $0.00 $0.00 330184 250 CARDIZEM CD 300MG CAPSULE O $0.00 $0.00 330184 250 FLUPHENAZINE 1MG TABLET O $0.00 $0.00 330184 250 Synthroid 0.112 mg tablet O $0.00 $0.00 330184 250 CALADRYL TOPICAL LOTION O $0.00 $0.00 330184 250 PROZAC 20MG CAPSULE O $0.00 $0.00 330184 250 QUININE SULFATE 325MG CAP O $0.00 $0.00 330184 250 PHENOBARBITAL 100MG TBLT O $0.00 $0.00 330184 250 ALUMINUM/MAG HYDR/SIMETH O $0.00 $0.00 330184 250 TRI BUFFERED BUFFERIN TBT O $0.00 $0.00 330184 250 HUMULIN 50/50 INSULIN O $0.00 $0.00 330184 250 CARRINGTON ANTIFUNGAL CRM O $0.00 $0.00 330184 250 MINOCYCLINE 50MG CAPSULE O $0.00 $0.00 330184 250 Trifluoperazine 1 mg tab O $0.00 $0.00 330184 250 MONISTAT DERM CREAM .2% O $0.00 $0.00 330184 250 DESITIN OINTMENT 30GM TBE O $0.00 $0.00 330184 250 GENTAMICIN SULFATE CREAM O $0.00 $0.00 330184 250 WESTCORT OINTMENT .2% O $0.00 $0.00 330184 250 CAFFEINE SODIUM BENZOATE O $0.00 $0.00 330184 250 SURGICEL 4X8 STRIP O $0.00 $0.00 330184 250 PURALUBE OPHTH OINTMENT O $0.00 $0.00 330184 250 PENICILLIN V POTASSIUM O $0.00 $0.00 330184 250 ROXICODONE 5MG TABLET O $0.00 $0.00 330184 250 KAY CIEL 20MEQ POWDER O $0.00 $0.00 330184 250 ACETAZOLAMIDE 250MG TABLT O $0.00 $0.00 330184 250 FLUCOINONIDE .05% OINTMNT O $0.00 $0.00 330184 250 ASPININ 81MG TABLET O $0.00 $0.00 330184 250 CARDIZEM CD 120MG CAPSULE O $0.00 $0.00 330184 250 MEPROBAMATE 200MG TABLET O $0.00 $0.00 330184 250 LIDEX GEL .05% O $0.00 $0.00 330184 250 MESALAMINE TBLT 400MG SR O $0.00 $0.00 330184 250 ZITHROMAX 250MG CAPSULE O $0.00 $0.00 330184 250 NYSTATIN TRIMCINOLONE ACT O $0.00 $0.00 330184 250 HYDROCORTISONE CREAM 1% O $0.00 $0.00 330184 250 HYDROCORTISONE LOTION 1% O $0.00 $0.00 330184 250 CEPACOL LOZENGE O $0.00 $0.00 330184 250 SYNTHROID 8MCG TABLET O $0.00 $0.00 330184 250 HYDROCORTISONE LOTION .5% O $0.00 $0.00 330184 250 Nitroglycerine 0.1mg hr p O $0.00 $0.00 330184 250 Nitroglycerine 0.4mg hr p O $0.00 $0.00 330184 250 NORTRIPTYLINE 10MG CAPSUL O $0.00 $0.00 330184 250 PRTROLATUM WHITE 5GM ONT O $0.00 $0.00 330184 250 MIVACRON 100MG/50ML INJCT O $0.00 $0.00 330184 250 VERAPAMIL 240MG TABLET O $0.00 $0.00 330184 250 HEXAVITAMIN LIQUID 5ML O $0.00 $0.00 330184 250 ALLOPURINOL 100MG TABLET O $0.00 $0.00 330184 250 Thiothixene 1 mg capsule O $0.00 $0.00 330184 250 STERILE MINERAL OIL LIGHT O $0.00 $0.00 330184 250 K-DUR Tablets 10 mEq O $0.00 $0.00 330184 250 LOTENSIN 5MG TABLET O $0.00 $0.00 330184 250 Benazepril 10mg tablet O $0.00 $0.00 330184 250 LOTENSIN 20MG TABLET O $0.00 $0.00 330184 250 AMLODIPINE BESYLATE 2.5MG O $0.00 $0.00 330184 250 AMLODIPINE BESYLATE 5MG O $0.00 $0.00 330184 250 AMLODIPINE BESYLATE 10MG O $0.00 $0.00 330184 250 MUPIROCIN 2% 15GM O $0.00 $0.00 330184 250 PROVERA 2.5MG TABLET O $0.00 $0.00 330184 250 METHYLPHENIDATE 5MG TBLT O $0.00 $0.00 330184 250 TRIAMCINOLINE 1% 15GM O $0.00 $0.00 330184 250 BETAMETHASONE 0.1% ONTMT O $0.00 $0.00 330184 250 ASCORBIC ACID 500MG/2ML O $0.00 $0.00 330184 250 IODINE POTASSIUM IODIDE O $0.00 $0.00 330184 250 VALPROATE SODIUM 250MG5ML O $0.00 $0.00 330184 250 DILTIAZEM HCL 30MG O $0.00 $0.00 330184 250 SOTALOL HCL 80MG O $0.00 $0.00 330184 250 VERAPAMIL HCL 120MG O $0.00 $0.00 330184 250 SULFAMETHOXAZOLE TRIMETH O $0.00 $0.00 330184 250 LIDOCAINE .5% EPI 1-20000 O $0.00 $0.00 330184 250 MORPHINE SULFATE 50MG/50 O $0.00 $0.00 330184 250 CODEINE SULFATE 30MG TBLT O $0.00 $0.00 330184 250 Phenobarbital 30mg tablet O $0.00 $0.00 330184 250 ISOFLURANE O $0.00 $0.00 330184 250 KETOROLAC TROMETHAMINE 15 O $0.00 $0.00 330184 250 DILTIAZEM HCL 60MG O $0.00 $0.00 330184 250 Triamcinolone 0.025% cre O $0.00 $0.00 330184 250 FLUOCINOLONE ACETONIDE O $0.00 $0.00 330184 250 MINOXIDIL 2.5MG TABLET O $0.00 $0.00 330184 250 SUPRANE INHALATION SLTN O $0.00 $0.00 330184 250 LIDOCAINE 5% OINTMENT O $0.00 $0.00 330184 250 Neosporin Eye Drops 10m O $0.00 $0.00 330184 250 CARBAMAZEPINE SSP 100MG5M O $0.00 $0.00 330184 250 SODIUM PHOS. BIPHOS 90ML O $0.00 $0.00 330184 250 AMOXICILLIN CAPSULE 250MG O $0.00 $0.00 330184 250 MULT VITAMINS CAP NEPHRO O $0.00 $0.00 330184 250 PRAVASTATIN TABLET 20MG O $0.00 $0.00 330184 250 HALOPERIDOL TABLET 1MG O $0.00 $0.00 330184 250 AMOXICILLIN 125MG 5ML O $0.00 $0.00 330184 250 AMOXICILLIN 250MG 5ML O $0.00 $0.00 330184 250 ATENOLOL 25MG O $0.00 $0.00 330184 250 ACYCLOVIR TABLET 800MG O $0.00 $0.00 330184 250 Tropicamide 0.5% Eye Dr O $0.00 $0.00 330184 250 INSULIN 1000U/10ML NOVOLI O $0.00 $0.00 330184 250 INSULIN 1000U 10ML INJCTN O $0.00 $0.00 330184 250 INSULIN INJ 1000U/10ML NO O $0.00 $0.00 330184 250 LEVOTHYROXINE INJ 500MCG O $0.00 $0.00 330184 250 COCAINE SLTN 4%/4ML O $0.00 $0.00 330184 250 INDAPAMIDE TBLT 1.25MG O $0.00 $0.00 330184 250 SODIUM CHLORIDE IRRIG O $0.00 $0.00 330184 250 Nifedipine 90mg XL tablet O $0.00 $0.00 330184 250 CLINDAMYCIN CAPSULE 150MG O $0.00 $0.00 330184 250 METHOCARBAMOL TBLET 750MG O $0.00 $0.00 330184 250 METHOCARBAMOL TBLT 500MG O $0.00 $0.00 330184 250 SUCRALFATE SUSP 1GM/10ML O $0.00 $0.00 330184 250 CARBIDOPA/LEVODOPA CR25 O $0.00 $0.00 330184 250 NIACIN TABLET 500MG O $0.00 $0.00 330184 250 METOPROLOL TABLET 50MG O $0.00 $0.00 330184 250 GEMFIBROZIL TABLET 600MG O $0.00 $0.00 330184 250 LOPERAMIDE CAPSULE 2MG O $0.00 $0.00 330184 250 NICOTINE PATCH 14MG O $0.00 $0.00 330184 250 NICOTINE 21MG PATCH O $0.00 $0.00 330184 250 SERTRALINE 50MG TABLET O $0.00 $0.00 330184 250 PAROXETINE HYDROCHLORIDE O $0.00 $0.00 330184 250 PENICILLIN G POTASSIUM 1M O $0.00 $0.00 330184 250 Amantadine 50mg 5 ml Sy O $0.00 $0.00 330184 250 FENTANYL TRANSDERMAL SYS O $0.00 $0.00 330184 250 NAPROXEN 250MG TABLET O $0.00 $0.00 330184 250 BetamethasoneDipro.05% O $0.00 $0.00 330184 250 Lindane 1% Lotion O $0.00 $0.00 330184 250 HALOPERIDOL TABLET 2MG O $0.00 $0.00 330184 250 CLOTRIMAZOLE CREAM 1%/15G O $0.00 $0.00 330184 250 CALCIUM CARBONATE TBT 500 O $0.00 $0.00 330184 250 PERSANTINE 25MG O $0.00 $0.00 330184 250 NAPROXEN TABLET 375MG O $0.00 $0.00 330184 250 ACETAMINOPHEN TABLET 500M O $0.00 $0.00 330184 250 LACTULOSE LQD 10GM/15ML O $0.00 $0.00 330184 250 ZOLPIDEM TABLET 5MG O $0.00 $0.00 330184 250 Zolpidem 10mg tablet O $0.00 $0.00 330184 250 INDIGO CARMINE INJ 40MG/5 O $0.00 $0.00 330184 250 ALUM MAG HYDROXIDE SIMETH O $0.00 $0.00 330184 250 Lindane 1% Shampoo O $0.00 $0.00 330184 250 PROPYLTHIOURACIL 50MG TBT O $0.00 $0.00 330184 250 ECONAZOLE NITRATE 1% 15GM O $0.00 $0.00 330184 250 NICOTINE PATCH 7MG/24HR O $0.00 $0.00 330184 250 AMOXICILLIN 500MG CAPSULE O $0.00 $0.00 330184 250 LIDOCAINE 2% 10ML JELLY O $0.00 $0.00 330184 250 LIDOCAINE JELLY 2%/5ML O $0.00 $0.00 330184 250 ALPRAZOLAM .25MG TABLET O $0.00 $0.00 330184 250 MEGESTROL ACETATE 40MG TB O $0.00 $0.00 330184 250 ACETAMINOPHEN 80MG TBT CH O $0.00 $0.00 330184 250 VALPROIC ACID 250MG CPSL O $0.00 $0.00 330184 250 MEDROXYPROGESTERONE TBLT O $0.00 $0.00 330184 250 MINOXIDIL TABLET 10MG O $0.00 $0.00 330184 250 TETRACYCLINE CPSL 250MG O $0.00 $0.00 330184 250 ALBUTEROL SULFATE 90MCG O $0.00 $0.00 330184 250 CARBIDOPA/LEVODOPA 10-100 O $0.00 $0.00 330184 250 CARBIDOPA/LEVEDOPA 25-100 O $0.00 $0.00 330184 250 CARBIDOPA/LEVODOPA 25-250 O $0.00 $0.00 330184 250 BETAXOLOL OPHTH .25%/2.5M O $0.00 $0.00 330184 250 NEOMYCIN POLYMYXIN SLTN O $0.00 $0.00 330184 250 NEOMYCIN POLYMYXIN SUSP O $0.00 $0.00 330184 250 Bacitracin Neomycin Poly O $0.00 $0.00 330184 250 CIMETIDINE 300MG TABLET O $0.00 $0.00 330184 250 DIGOXIN TABLET .125MG O $0.00 $0.00 330184 250 DIGOXIN TABLET .25MG O $0.00 $0.00 330184 250 CLARITHROMYCIN 500MG TBLT O $0.00 $0.00 330184 250 Desipramine 10mg tablet O $0.00 $0.00 330184 250 TAMOXIFEN TABLET 10MG O $0.00 $0.00 330184 250 DOXAZOSIN TABLET 4MG O $0.00 $0.00 330184 250 NEOMYCIN POLYMYXIN BACITR O $0.00 $0.00 330184 250 IBUPROFEN TABLET 200MG O $0.00 $0.00 330184 250 CLARITHROMYCIN 250MG TBLT O $0.00 $0.00 330184 250 PRAMOXINE W/HYDROCORTISON O $0.00 $0.00 330184 250 MULTIPLE VITAMIN TABLET O $0.00 $0.00 330184 250 ALLOPURINOL 300MG TABLET O $0.00 $0.00 330184 250 AMPICILLIN SODIUM 500MG O $0.00 $0.00 330184 250 PYRAZINAMIDE 500MG TABLET O $0.00 $0.00 330184 250 DIAZEPAM 10MG INJECTION O $0.00 $0.00 330184 250 TRIFLUOPERAZINE TBLT 5MG O $0.00 $0.00 330184 250 HALOPERIDOL LIQUID 2MG/ML O $0.00 $0.00 330184 250 MORPHINE SULFATE 30MG TBT O $0.00 $0.00 330184 250 HYDROCODONE APAP 300/5 TAB O $0.00 $0.00 330184 250 AMPICILLIN SODIUM 250MG O $0.00 $0.00 330184 250 RIFAMPIN CAPSULE 300MG O $0.00 $0.00 330184 250 CHLORDIAZEPOXIDE CLIDINIU O $0.00 $0.00 330184 250 MORPHINE TABLET 100MG O $0.00 $0.00 330184 250 GLIPIZIDE 5MG TABLET O $0.00 $0.00 330184 250 OFLOXACIN OPHTH SLNT .3% O $0.00 $0.00 330184 250 PANCURONIUM INJ 10MG/10ML O $0.00 $0.00 330184 250 HALOPERIDOL 5MG TABLET O $0.00 $0.00 330184 250 DICLOFENAC OPHTH SLNT .1% O $0.00 $0.00 330184 250 ZINC SULFATE CPSL 220MG O $0.00 $0.00 330184 250 PERSANTINE 50MG O $0.00 $0.00 330184 250 PRAZOSIN CAPSULE 1MG O $0.00 $0.00 330184 250 TRIAMCINOLONE CREAM .5% O $0.00 $0.00 330184 250 CODEINE PHOSPHATE GUAIFEN O $0.00 $0.00 330184 250 AMYLASE LIPASE PROTEASAE O $0.00 $0.00 330184 250 PRAZOSIN HCL 5MG CAPSULE O $0.00 $0.00 330184 250 SKIN EMOLLIENT 60GM CRM O $0.00 $0.00 330184 250 DICYCLOMINE 10MG CAPSULE O $0.00 $0.00 330184 250 HEPARIN FLUSH 25U INJECT O $0.00 $0.00 330184 250 NITROFURANTOIN 50MG CAPSL O $0.00 $0.00 330184 250 NITROCLYCERIN 2% 30GM OIN O $0.00 $0.00 330184 250 MORPHINE SULFATE 60MG TBL O $0.00 $0.00 330184 250 DOXAZOSIN MESYLATE 1MG O $0.00 $0.00 330184 250 PROCHLORPERAZINE 25MG SUP O $0.00 $0.00 330184 250 PROPRANOLOL 60MG CAPSULE O $0.00 $0.00 330184 250 LAMOTRIGINE 100MG TABLET O $0.00 $0.00 330184 250 ALBUTEROL SULFATE .5% SLT O $0.00 $0.00 330184 250 CITRIC ACID SODIUM CITRAT O $0.00 $0.00 330184 250 CYANOCOBALANIN 50MCG TBLT O $0.00 $0.00 330184 250 CALAMINE ZINC OXIDE CAL O $0.00 $0.00 330184 250 LORAZEPAM 1MG TABLET O $0.00 $0.00 330184 250 Sulfadiazine 500mg tablet O $0.00 $0.00 330184 250 ASPIRIN 300MG O $0.00 $0.00 330184 250 HYDROCORTISONE ACETATE 25 O $0.00 $0.00 330184 250 HEMORRHOIDAL PREPARATION O $0.00 $0.00 330184 250 NORTRIPTYLINE 25MG CPSL O $0.00 $0.00 330184 250 ASPIRIN 81MG TABLET O $0.00 $0.00 330184 250 ERYTHROMYCIN SULFISOXAZOL O $0.00 $0.00 330184 250 DOCUSUTE SODIUM 100MG CAP O $0.00 $0.00 330184 250 CARBAMIDE PEROXIDE SLTN O $0.00 $0.00 330184 250 GLYBURIDE 5MG TABLET O $0.00 $0.00 330184 250 SODIUM CHLORIDE .65% 45ML O $0.00 $0.00 330184 250 PROPOXYPHENE NAPSYLATE O $0.00 $0.00 330184 250 CLONIDINE HCL .1MG TBLT O $0.00 $0.00 330184 250 DIBUCAINE 1%30 GM O $0.00 $0.00 330184 250 FOLIC ACID 1MG TABLET O $0.00 $0.00 330184 250 HYDROCORTISONE 2.5% CREAM O $0.00 $0.00 330184 250 LEVOTHYROXINE SODIUM TBLT O $0.00 $0.00 330184 250 PHENAZOPYRIDINE HCL 100MG O $0.00 $0.00 330184 250 DIPHENHYDRAMINE 2% 30GM O $0.00 $0.00 330184 250 GLYBURIDE 25MG TABLET O $0.00 $0.00 330184 250 PHENYTOIN 100MG 4ML SUSP O $0.00 $0.00 330184 250 TRIAMCINOLONE .1% 15GM O $0.00 $0.00 330184 250 ACETAMINOPHEN BUTALBITAL O $0.00 $0.00 330184 250 AFTIFICIAL TEARS 15ML SLN O $0.00 $0.00 330184 250 IBUPROFEN 600MG TABLET O $0.00 $0.00 330184 250 LEVOTHYROXINE SODIUM 200M O $0.00 $0.00 330184 250 NOREPINEPHRINE BITARTRATE O $0.00 $0.00 330184 250 TOBRAMYCIN .3% 5ML SLTN O $0.00 $0.00 330184 250 METFORMIN HYDROCHLORIDE O $0.00 $0.00 330184 250 IMDURER O $0.00 $0.00 330184 250 LIDOCAINE VISCOUS 2% LQD O $0.00 $0.00 330184 250 LEUCOVORIN CALCIUM 5MG O $0.00 $0.00 330184 250 BISMUTH SUBSALICYLATE O $0.00 $0.00 330184 250 CLOTRIMAZOLE SUPPOSITORY O $0.00 $0.00 330184 250 MEPERIDINE 100MG INJ O $0.00 $0.00 330184 250 Tolfanate 1% cream 15 g O $0.00 $0.00 330184 250 LAVAGE 4000ML POWDER O $0.00 $0.00 330184 250 ACETAMINOPHEN CODEINE TBT O $0.00 $0.00 330184 250 CHLORDIAZEPOXIDE 5MG CPSL O $0.00 $0.00 330184 250 PHENYLEPHRINE 2.5% OPHTHL O $0.00 $0.00 330184 250 NEURSURGERY KIT O $0.00 $0.00 330184 250 Penicillamine 250mg tab O $0.00 $0.00 330184 250 METHAZOLAMIDE 50MG TABLET O $0.00 $0.00 330184 250 CIMETIDINE HYDROCHLORIDE O $0.00 $0.00 330184 250 PROPRANOLOL 10MG TABLET O $0.00 $0.00 330184 250 PROPRANOLOL HCL 20MG TBLT O $0.00 $0.00 330184 250 GUAIFENESIN 600MG TABLET O $0.00 $0.00 330184 250 NRS-NASAL RELIEF 0.05%15 O $0.00 $0.00 330184 250 SIMETHICONE 80MG TABLET O $0.00 $0.00 330184 250 Capsaicin 0.025 % Topical O $0.00 $0.00 330184 250 LEVODOPA CARBIDOPA O $0.00 $0.00 330184 250 HALOPERIDOL .5MG TABLET O $0.00 $0.00 330184 250 TERAZOSIN HYDROCHLORIDE O $0.00 $0.00 330184 250 MICONAZOLE NITRATE 2% CRM O $0.00 $0.00 330184 250 MULTIPLE VITAMINS INJ O $0.00 $0.00 330184 250 CIMETIDINE 300MG 5ML ELIX O $0.00 $0.00 330184 250 LIDOCAINE 1%/EPI INJECTN O $0.00 $0.00 330184 250 EDROPHONIUM CHLORIDE INJ O $0.00 $0.00 330184 250 ARTIFICIAL TEARS SLTN O $0.00 $0.00 330184 250 IBUPROFEN 400MG TABLET O $0.00 $0.00 330184 250 ATENOLOL 50MG TABLET O $0.00 $0.00 330184 250 CLOTRIMAZOLE 1% CREAM O $0.00 $0.00 330184 250 PROMETHAZINE CODEINE PHOS O $0.00 $0.00 330184 250 CYPROHEPTADINE 4MG TABLET O $0.00 $0.00 330184 250 pentamidine 300mg vial O $0.00 $0.00 330184 250 WITCH HAZEL O $0.00 $0.00 330184 250 SODIUM CHLORIDE 30ML INJ O $0.00 $0.00 330184 250 NIFEDIPINE 60MG TBLT 24HR O $0.00 $0.00 330184 250 DINOPROSTONE 10MG O $0.00 $0.00 330184 250 NYSTATIN 100MU 1ML O $0.00 $0.00 330184 250 NIFEDIPINE 30MG TABLET O $0.00 $0.00 330184 250 Albendazole 200mg tablet O $0.00 $0.00 330184 250 IBUPROFEN 100MG 5ML SUSP O $0.00 $0.00 330184 250 NYSTATIN 100MU 1GM POWDER O $0.00 $0.00 330184 250 INDOMETHACIN SODIUM TRIHY O $0.00 $0.00 330184 250 LAMIVUDINE 150MG TABLET O $0.00 $0.00 330184 250 TORSEMIDE 5MG TABLET O $0.00 $0.00 330184 250 TORSEMIDE 20MG TABLET O $0.00 $0.00 330184 250 TORSEMIDE 10MG TABLET O $0.00 $0.00 330184 250 OXYCONTIN 10MG HCL O $0.00 $0.00 330184 250 OXYCODONE HCL 20MG TABLET O $0.00 $0.00 330184 250 LIDOCAINE PRILOCAINE KIT O $0.00 $0.00 330184 250 CEPHALEXIN 250 MG 1 CAPSL O $0.00 $0.00 330184 250 CLARITIN 10MG TABLET OR O $0.00 $0.00 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250 COZAAR 50MGTABLET O $0.00 $0.00 330184 250 METOPROLOL TARTRAT 25MGT O $0.00 $0.00 330184 250 COREG 25MGTABLET O $0.00 $0.00 330184 250 COMBIVIRTABLET O $0.00 $0.00 330184 250 VIREAD 300MGTABLET O $0.00 $0.00 330184 250 SUSTIVA 200MGCAPSULE O $0.00 $0.00 330184 250 ZIAGEN 300MGTABLET O $0.00 $0.00 330184 250 KALETRA LF 133.3-33.3MGC O $0.00 $0.00 330184 250 SPIRIVA CA 18MCG1 POWD O $0.00 $0.00 330184 250 DEPAKOTE DR 500MGTABLET O $0.00 $0.00 330184 250 LIDODERM PATCH 5% PATCH O $0.00 $0.00 330184 250 RISPERDAL 0.25MGTABLET O $0.00 $0.00 330184 250 Imatinab 400mg tablet O $0.00 $0.00 330184 250 AGGRENOXCAPSULE CR 12HR O $0.00 $0.00 330184 250 AVELOX 400MGTABLET O $0.00 $0.00 330184 250 TRUVADATABLET O $0.00 $0.00 330184 250 NOVOLOG 100U/ML10 ML O $0.00 $0.00 330184 250 ALBUTEROL SULF 5MG/MLSOL O $0.00 $0.00 330184 250 NEXIUM DR 40MG CAPSULE DR O $0.00 $0.00 330184 250 NEXIUM DR 20MGCAPSULE DR O $0.00 $0.00 330184 250 SURGIFOAM 100C (1975) O $0.00 $0.00 330184 250 QUEtiapine100 mg 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1MG TABLET O $0.00 $0.00 330184 250 ROPINIROL 2 MG TABLET O $0.00 $0.00 330184 250 ALENDRONATE 70 MG TABLET O $0.00 $0.00 330184 250 LEXIVA TABLET 700 MG #60 O $0.00 $0.00 330184 250 NYSTOP POWD 100MU/GPOWDE O $0.00 $0.00 330184 250 CALADRYL LOTION O $0.00 $0.00 330184 250 ARANESP 60 MCG/0.3 ML O $0.00 $0.00 330184 250 SURGIFOAM 100 (1974) O $0.00 $0.00 330184 250 Pioglitazone 15 mg O $0.00 $0.00 330184 250 Indinavir Tablet 400 mg O $0.00 $0.00 330184 250 Rosuvastatin Tablet 5 mg O $0.00 $0.00 330184 250 Finasteride Tablet 5 mg O $0.00 $0.00 330184 250 Nicardipine Injection 25 O $0.00 $0.00 330184 250 Reyataz Capsule 200 mg O $0.00 $0.00 330184 250 Effient Tablet 5 mg O $0.00 $0.00 330184 250 Effient Tablet 10 mg O $0.00 $0.00 330184 250 Malarone Tablet 250/100 O $0.00 $0.00 330184 250 Calmoseptine Ointment 3.5 O $0.00 $0.00 330184 250 Silvasorb Gel 44 ml O $0.00 $0.00 330184 250 Allopurinol Injection 500 O $0.00 $0.00 330184 250 Sensipar tablets 60 mg O $0.00 $0.00 330184 250 ActHIB Injection 10 mcg/0 O $0.00 $0.00 330184 250 Fentanyl Patch 12 mcg/hr O $0.00 $0.00 330184 250 Argatroban Injection 250m O $0.00 $0.00 330184 250 Miconazole Cream 1%/15 G O $0.00 $0.00 330184 250 Roxicet Solution 5 mg/325 O $0.00 $0.00 330184 250 Nucynta Tablet 50mg O $0.00 $0.00 330184 250 Nucynta Tablet 75mg O $0.00 $0.00 330184 250 Hydrocodone/Homatropine C O $0.00 $0.00 330184 250 Oxycodone Solution 5mg/5m O $0.00 $0.00 330184 250 Acticoat Dressing 4x4 O $0.00 $0.00 330184 250 Depakote Sprinkle 125 mg O $0.00 $0.00 330184 250 Proparacaine OPHTH Drop 0 O $0.00 $0.00 330184 250 Namenda Tablet 10 mg O $0.00 $0.00 330184 250 Bystolic Tablet 2.5 mg O $0.00 $0.00 330184 250 Abilify Tablet 2 mg O $0.00 $0.00 330184 250 Bactroban Cream 2%/15 gm O $0.00 $0.00 330184 250 Ancobon Capsule 250 mg O $0.00 $0.00 330184 250 Comtan Tablet 200mg O $0.00 $0.00 330184 250 Daraprim Tablet 25 mg O $0.00 $0.00 330184 250 Desmopressin Tablet 0.2 m O $0.00 $0.00 330184 250 Gabitril Tablet 4 mg O $0.00 $0.00 330184 250 Florastor Capsule 250 mg O $0.00 $0.00 330184 250 Femara Tablet 2.5 mg O $0.00 $0.00 330184 250 Invega Tablet 6 mg O $0.00 $0.00 330184 250 Femoral Block (Bupivacain O $0.00 $0.00 330184 250 Opana ER Tablet 15 mg O $0.00 $0.00 330184 250 Lorazepam Tablet 2 mg O $0.00 $0.00 330184 250 Metronidazole Gel 0.75% O $0.00 $0.00 330184 250 Nicotine Gum 2mg O $0.00 $0.00 330184 250 Sulfamylon Sol PWD 5% O $0.00 $0.00 330184 250 Iodosorb Gel 1.4 oz O $0.00 $0.00 330184 250 Invirase Tablet 500 mg O $0.00 $0.00 330184 250 Prezista Tablet 600 mg O $0.00 $0.00 330184 250 Multaq Tablet 400 mg O $0.00 $0.00 330184 250 Pramipexole Tablet 0.125 O $0.00 $0.00 330184 250 Oxcarbazepine Tablet 150 O $0.00 $0.00 330184 250 Pradaxa Tablet 75 mg O $0.00 $0.00 330184 250 Pradaxa Tablet 150 mg O $0.00 $0.00 330184 250 Nexium IV 40 mg O $0.00 $0.00 330184 250 Potassium Chloride 30 mL O $0.00 $0.00 330184 250 Iohexol Injection 100ml O $0.00 $0.00 330184 250 Sinografin 52.70% O $0.00 $0.00 330184 250 Gastrografin 66%-10%12 O $0.00 $0.00 330184 250 Barium Sulfate 98% PW O $0.00 $0.00 330184 250 E-Z HD 98% O $0.00 $0.00 330184 250 E-Z GAS II Granule packet O $0.00 $0.00 330184 250 Barium Sulfate 13% Pow O $0.00 $0.00 330184 250 Entero Vu O $0.00 $0.00 330184 250 Barium Sulfate 2.1% SUS O $0.00 $0.00 330184 250 Naproxen Oral Suspension O $0.00 $0.00 330184 250 Barium Sulfate 96% PW O $0.00 $0.00 330184 250 EZ paque O $0.00 $0.00 330184 250 Barium Sulfate 96% PWA O $0.00 $0.00 330184 250 Conray 282 mg/mL 50mL O $0.00 $0.00 330184 250 Conray 282 mg/mL 150mL O $0.00 $0.00 330184 250 Omniscan 287 mg/mL 20 mL O $0.00 $0.00 330184 250 Iothalamate 60% SOL100 O $0.00 $0.00 330184 250 iohexol 300 mg/mL SOL O $0.00 $0.00 330184 250 Readi-Cat 2 5.25 gm 250 O $0.00 $0.00 330184 250 E-Z-Gas II 4 grams O $0.00 $0.00 330184 250 Polibar 454g O $0.00 $0.00 330184 250 Clinimix-E 2000mL 4.25/10 O $0.00 $0.00 330184 250 Clinimix-E 2000mL 5/20 O $0.00 $0.00 330184 250 Amino Acids 2.75%/D5% SOLN O $0.00 $0.00 330184 250 Gebauers Ethychloride Spr O $0.00 $0.00 330184 250 Eletriptan 20mg TAB (REL) O $0.00 $0.00 330184 250 diazoxide 50 mg/mL SUSP O $0.00 $0.00 330184 250 LITHIUM CARBONATE 300MG R O $0.00 $0.00 330184 250 LITHIUM CARBONATE 150MG R O $0.00 $0.00 330184 250 betameth dipro aug 0.05% OINT O $0.00 $0.00 330184 250 Betamethasone Diproprionr O $0.00 $0.00 330184 250 MIDRIN CAPSULE O $0.00 $0.00 330184 250 AMOXICILLIN 200mg/5mL 50R O $0.00 $0.00 330184 250 AMOXICILLIN 400mg/5mL 50R O $0.00 $0.00 330184 250 AMOXICILLIN-CLAVULANATE R O $0.00 $0.00 330184 250 BUPIVICAINE 0.25% 5ML VIA O $0.00 $0.00 330184 250 BUPIVICAINE 0.5% 5ML VIAL O $0.00 $0.00 330184 250 GENTAMICIN OPHTH OINT 3.5 O $0.00 $0.00 330184 250 GENTAMICIN OPHTH SOL 0.3% O $0.00 $0.00 330184 250 Bupivacaine-Fentanyl 0. O $0.00 $0.00 330184 250 Bupivacaine-Fentanyl 0.1 O $0.00 $0.00 330184 250 INTRAOPERATIVE FORMULA O $0.00 $0.00 330184 250 Ropivacaine-Clonidine-E O $0.00 $0.00 330184 250 D5W/LR 1000ML INF BAG O $0.00 $0.00 330184 250 CODE C CART CHARGE O $0.00 $0.00 330184 250 Lisinopril 20mg tablet O $0.00 $0.00 330184 250 Bupivacaine 0.75% 30mL v O $0.00 $0.00 330184 250 SodiumHypochlorite0.25 O $0.00 $0.00 330184 250 CLEAR O $0.00 $0.00 330184 250 Calcium 500mg Vitamin D O $0.00 $0.00 330184 250 Divalproex Sodium 250mg O $0.00 $0.00 330184 250 Divalproex Sodium 125mg O $0.00 $0.00 330184 250 Flurbiprofen 0.03% Eye Dr O $0.00 $0.00 330184 250 Furosemide 40mg 5mL Or O $0.00 $0.00 330184 250 Gatifloxacin 0.5% Eye Dro O $0.00 $0.00 330184 250 Hepatitis A Pediatric Vac O $0.00 $0.00 330184 250 Griseofulvin 250mg tablet O $0.00 $0.00 330184 250 Lamivudine 10mg mL Syru O $0.00 $0.00 330184 250 Iodixanol 320mg mL SOLN O $0.00 $0.00 330184 250 Tryphan Blue SOLN O $0.00 $0.00 330184 250 Tobramycin 60mg Inhala O $0.00 $0.00 330184 250 Theophylline 80mg 5mLSy O $0.00 $0.00 330184 250 Trihexyphenidyl 5 mg tab O $0.00 $0.00 330184 250 Telmisartan 40mg tablet O $0.00 $0.00 330184 250 Pramipexole 0.5mg tablet O $0.00 $0.00 330184 250 Primaquine 23.5mg tablet O $0.00 $0.00 330184 250 Lidocaine 4% LTA Kit O $0.00 $0.00 330184 250 Lithium Citrate 300mg 5m O $0.00 $0.00 330184 636 Duovisc Eye Injection O $0.00 $0.00 330184 250 NeoSporin GU Irrigant O $0.00 $0.00 330184 250 Augmentin 125mg 5mL Or O $0.00 $0.00 330184 250 Thrombin 20000 IUTopica O $0.00 $0.00 330184 250 Peg-Interferon 180 mcginj O $0.00 $0.00 330184 250 MultiVits with Minerals A O $0.00 $0.00 330184 250 Calcium Carbonate 600mg O $0.00 $0.00 330184 250 Misoprostol O $0.00 $0.00 330184 250 Talc Powder Sterile 30mL O $0.00 $0.00 330184 250 NACL Irrigation 250mL O $0.00 $0.00 330184 250 Nisoldpine 8.5mg ER tabl O $0.00 $0.00 330184 250 Permethrin 1% Lotion O $0.00 $0.00 330184 250 Benzoin Tincture O $0.00 $0.00 330184 250 Hydrocortisone 1% Topica O $0.00 $0.00 330184 250 Benzocaine 20% Topical S O $0.00 $0.00 330184 250 Thioridazine 10mg tablet O $0.00 $0.00 330184 250 Fosinoprl 10mg Tablet O $0.00 $0.00 330184 250 Infuvite Pediatric Inject O $0.00 $0.00 330184 250 Neonatal CaffeineCitrate2 O $0.00 $0.00 330184 250 Neonatal Zidovudine 10m O $0.00 $0.00 330184 250 Neonatal Ranitidine15mg O $0.00 $0.00 330184 250 Neonatal Ferrous Sulfate O $0.00 $0.00 330184 250 Epinephrine-Lidocaine 1% O $0.00 $0.00 330184 250 Epinephrine-Lidocaine 2% O $0.00 $0.00 330184 250 Bupivacaine-Epi 0.5% MP O $0.00 $0.00 330184 250 ATOMOXETINE 60MG CAP O $0.00 $0.00 330184 250 Atomoxetine 80mg Cap O $0.00 $0.00 330184 250 MAGIC MOUTHWASH O $0.00 $0.00 330184 250 Morphine Sulfate 100mg O $0.00 $0.00 330184 250 Sildenafil 20 mg Tablet O $0.00 $0.00 330184 250 med chain triglyc OIL O $0.00 $0.00 330184 300 AUTOMATED HEMOGRAM INDICI O $26.00 $16.90 330184 301 CK MB% O $0.00 $0.00 330184 300 CYTOLOGY GYN O $0.00 $0.00 330184 300 AUTOPSY O $0.00 $0.00 330184 270 CENTRAL VENOUS CATHETER O $412.65 $268.22 330184 270 NEONATAL BLOOD PRESSURE C O $35.00 $22.75 330184 270 IV CATHETER O $25.00 $16.25 330184 270 NEONATAL IV SETS O $35.00 $22.75 330184 270 IV EXTENSION SET WITH FIL O $51.00 $33.15 330184 270 OXYGEN SATURATION LEAD O $205.00 $133.25 330184 270 STERILE CIRCUMCISION BELL O $36.00 $23.40 330184 270 DOUBLE BREAST COLLECTION O $154.00 $100.10 330184 360 OR INITIAL 30 MINS (L&D) O "$4,468.80 " "$2,904.72 " 330184 272 CATHLON CATH 16 O $23.00 $14.95 330184 272 DAVOL EAR SYRINGE O $18.00 $11.70 330184 720 DELIVERY ROOM O "$2,076.90 " "$1,349.99 " 330184 720 DELIVERY ROOM RETURN O $0.00 $0.00 330184 270 FETAL BLD SAMPLE KIT O $304.50 $197.93 330184 272 NEWBORN STYLET DISP O $52.00 $33.80 330184 360 OR SUBSEQUENT 30 MIN O "$1,575.00 " "$1,023.75 " 330184 272 SHIRODKAR SUT INSERT O "$2,330.00 " "$1,514.50 " 330184 270 SPIRAL ELECTRODE O $110.25 $71.66 330184 270 SUTURE GUN 25W O $64.00 $41.60 330184 272 INTRAUTER PRESSURE KIT O $252.00 $163.80 330184 271 FETAL MONITOR STRAPS O $5.00 $3.25 330184 270 EXTENSION SET O $45.00 $29.25 330184 270 DISP BREASTMILK COLLECTIO O $127.00 $82.55 330184 270 BREAST SHIELD O $80.85 $52.55 330184 270 IMED PRIMARY ADM SET O $38.00 $24.70 330184 270 REM POLYHESIVE ELECTRODE O $32.00 $20.80 330184 270 PENCIL HANDSWITCHING O $36.00 $23.40 330184 270 MITYVAC EXTRACTION CUP O $232.00 $150.80 330184 270 SQS DISPOSABLE SUTURE GUN O $507.00 $329.55 330184 272 INFANT O2 MASK O $31.00 $20.15 330184 762 OBSERVATION PER HOUR O $0.00 $0.00 330184 270 BREAST PUMP O $105.00 $68.25 330184 270 LABOR & DELIVERY MISC O $0.00 $0.00 330184 369 OR MAJOR 1/2 HR O "$4,468.80 " "$2,904.72 " 330184 369 OR MAJOR 3/4 HR O "$5,256.30 " "$3,416.60 " 330184 369 OR MAJOR 1 HR O "$5,650.05 " "$3,672.53 " 330184 369 OR MAJOR 1 1/4 HR O "$5,256.30 " "$3,416.60 " 330184 369 OR MAJOR 1 1/2 HR O "$7,225.05 " "$4,696.28 " 330184 369 OR MAJOR 1 3/4 HR O "$8,012.55 " "$5,208.16 " 330184 369 OR MAJOR 2 HR O "$8,800.05 " "$5,720.03 " 330184 369 OR MAJOR 2 1/4 HR O "$9,202.20 " "$5,981.43 " 330184 369 OR MAJOR 2 1/2 HR O "$10,375.05 " "$6,743.78 " 330184 369 OR MAJOR 2 3/4 HR O "$11,162.55 " "$7,255.66 " 330184 369 OR MAJOR 3 HR O "$11,950.05 " "$7,767.53 " 330184 369 OR MAJOR 3 1/4 HR O "$12,737.55 " "$8,279.41 " 330184 369 OR MAJOR 3 1/2 HR O "$13,525.05 " "$8,791.28 " 330184 369 OR MAJOR 3 3/4 HR O "$14,312.55 " "$9,303.16 " 330184 369 OR MAJOR 4 HR O "$15,100.05 " "$9,815.03 " 330184 369 OR MAJOR 4 1/4 HR O "$15,887.55 " "$10,326.91 " 330184 369 OR MAJOR 4 1/2 HR O "$16,675.05 " "$10,838.78 " 330184 369 OR MAJOR 4 3/4 HR O "$17,462.55 " "$11,350.66 " 330184 369 OR MAJOR 5 HR O "$18,250.05 " "$11,862.53 " 330184 369 OR MAJOR 5 1/4 HR O "$19,037.55 " "$12,374.41 " 330184 369 OR MAJOR 5 1/2 HR O "$19,825.05 " "$12,886.28 " 330184 369 OR MAJOR 5 3/4 HR O "$20,612.55 " "$13,398.16 " 330184 369 OR MAJOR 6 HR O "$21,400.05 " "$13,910.03 " 330184 369 OR MAJOR EACH ADD 15 MIN O $787.50 $511.88 330184 272 WINTER BARS O $812.00 $527.80 330184 270 HALL BURRS 1.6X4.5 O $131.00 $85.15 330184 272 TEFLON TUBES O $60.00 $39.00 330184 270 ARMSTRONG BEVELLED TEFLON O $111.00 $72.15 330184 272 DENVER NASAL SPLINT SMALL O $324.00 $210.60 330184 272 CYLINDRICAL DENTAL SPONGE O $18.00 $11.70 330184 272 MYRINGOTOMY KNIFE O $103.00 $66.95 330184 270 ABORTION TUBING COLLECTIO O $355.00 $230.75 330184 272 ASPIRATING CURETTE CURVED O $48.00 $31.20 330184 272 CERVICAL BIOPSY BLADE O $58.00 $37.70 330184 272 HUMI UTERINE MANIPULATOR O $245.00 $159.25 330184 270 EXTENSION SET-HYSTEROSCOP O $59.00 $38.35 330184 272 DERMATOME BLADES O $91.00 $59.15 330184 272 PUDENZ VENTRICULAR CATH O $448.00 $291.20 330184 272 RAIMONDI PERITONEAL CATH O "$1,128.00 " $733.20 330184 272 OMMAYA CSF RESERVOIR O $542.00 $352.30 330184 272 SPIRAL NEURO BLADE O $385.00 $250.25 330184 272 SCOTT'S NEEDLE O $525.00 $341.25 330184 270 HALO TRACTION SIZE A BREM O "$1,232.00 " $800.80 330184 272 CRAINOPLASTY KIT O "$1,232.00 " $800.80 330184 272 ANEUROPLASTY KIT O $729.00 $473.85 330184 272 PUDENZ VENT CATH 5CM RT A O $500.00 $325.00 330184 270 CATHETERVENTRICULAR W/FL O $500.00 $325.00 330184 272 MISHLER DUAL CHAMBER FLUS O "$1,122.00 " $729.30 330184 270 CRAINIOTOMY DRAINAGE KIT O $259.00 $168.35 330184 272 CYTOLOGY BRUSH O $141.00 $91.65 330184 272 BRONCHIAL BRUSH O $89.00 $57.85 330184 272 SIGMOIDOSCOPE SPECULUM DI O $4.00 $2.60 330184 270 CatheterFogarty(A/EIr O $355.00 $230.75 330184 270 FOGARTY BILIARY PROBE CAT O $331.00 $215.15 330184 278 SUNDT CAROTID SHUNT O $651.00 $423.15 330184 278 PRUITT INAHARA CAROTID GR O $598.00 $388.70 330184 270 INSITU VALVE CUTTER O $574.00 $373.10 330184 270 VENA CAVA CLIP O $671.00 $436.15 330184 272 FOGERTY SOFT JAW INSERT S O $86.00 $55.90 330184 272 DISPOSABLE VEIN STRIPPERS O $118.00 $76.70 330184 272 MAXI LOOPS BLUE O $34.00 $22.10 330184 270 BULLDOG DISP ANG O $106.00 $68.90 330184 270 Eye shield Universal O $4.00 $2.60 330184 270 CORNEAL SHIELD DISP O $44.00 $28.60 330184 270 OPTHALMIC KNIFE (ALCON) O $70.00 $45.50 330184 270 MICROSPONGES O $20.00 $13.00 330184 270 URETERAL CATH CONN MALE L O $131.00 $85.15 330184 272 RETENTION DISC O $60.00 $39.00 330184 270 URETERAL DILATION CATH 8F O $685.00 $445.25 330184 270 URETERAL DILATION SET O $544.00 $353.60 330184 270 STONE DISINTEGRATOR ELECT O $993.00 $645.45 330184 272 URETERAL STONE DISLODGER O "$1,181.00 " $767.65 330184 272 PERC FLAT WIRE SEGURA TYP O $994.00 $646.10 330184 272 ForcepPercutaneous Gr O $574.00 $373.10 330184 270 SIDE ARM FITTING FOR DYE O $131.00 $85.15 330184 270 USE OF LIGASURE MACHINE O $296.00 $192.40 330184 270 CATHETER FOLEY 5CC/30CCD O $96.00 $62.40 330184 272 STABILIZING LOOPS 24 FR O $248.00 $161.20 330184 272 PUNCTATE ELECTRODE GREY O $350.00 $227.50 330184 270 Drape3M #1071 Urological O $63.00 $40.95 330184 270 VESSEL TIPS O $103.00 $66.95 330184 270 FEMORAL SPONGEWICK O $113.00 $73.45 330184 272 INTRAMEDULLARY BRUSH O $86.00 $55.90 330184 278 RUSH PINS/RODS O $367.00 $238.55 330184 278 SUPRA CONDYLAR ZICKEL NAI O "$3,363.00 " "$2,185.95 " 330184 272 BEAVER MENISCUS BLADE 95F O $86.00 $55.90 330184 270 BLADES ARTHROSCOPIC O $231.00 $150.15 330184 270 MASK ENT NAVIGATOR O $662.00 $430.30 330184 270 VERSASCOPE LOOPE ELECTROD O $859.00 $558.35 330184 270 ENDOSTITCH SURGIDAC O $121.00 $78.65 330184 270 STAPLER DST EEA O $922.00 $599.30 330184 270 STAPLER EEA ORVIL O $189.00 $122.85 330184 270 DRILL / DRILL BITS O $0.00 $0.00 330184 270 BLADE SAW O $0.00 $0.00 330184 270 Bovie Pad O $34.00 $22.10 330184 272 RESECTOSCOPE CORD O $18.00 $11.70 330184 272 HOT TEMP CAUTERY O $58.00 $37.70 330184 272 RECTAL PROBE DISPOSABLE O $113.00 $73.45 330184 270 HEMOVAC O $68.00 $44.20 330184 270 HYSTERECTOMY DRAIN O $293.00 $190.45 330184 270 ABRAMSON ALL PURPOSE DRAI O $238.00 $154.70 330184 270 NERVE LOCATOR O $260.00 $169.00 330184 270 MIC GASTROSTOMY KIT O $399.00 $259.35 330184 272 JEJUNAL FEEDING TUBE SAC O $448.00 $291.20 330184 272 BAKER JEJUNOSTOMY KIT O "$1,163.00 " $755.95 330184 272 LEVEEN ASCITES VALVE O "$2,056.00 " "$1,336.40 " 330184 270 T TUBE 14 FR O $86.00 $55.90 330184 270 CHEST TROCAR CATH 32 FR O $166.00 $107.90 330184 270 THORACIC CATH 12 FR O $77.00 $50.05 330184 270 RECTAL TUBE O $48.00 $31.20 330184 270 RED RUBBER CATH ASSORT SI O $25.00 $16.25 330184 270 DRAPE MICROSCOPE O $201.00 $130.65 330184 270 CASSETTE COVERS O $20.00 $13.00 330184 270 X-RAY DRAPE O $69.00 $44.85 330184 270 CRANIAL INCISE DRAPE O $367.00 $238.55 330184 270 3M 1020 DRAPE O $37.00 $24.05 330184 270 3M 1030 DRAPE O $71.00 $46.15 330184 270 3M 1040 DRAPE O $54.00 $35.10 330184 270 3M 1003 DRAPE LEG BAG O $63.00 $40.95 330184 270 3M 1017 DRAPE ORTHOPEDIC O $130.00 $84.50 330184 270 3M 1018 DRAPE O $37.00 $24.05 330184 270 3M 1050 DRAPE O $63.00 $40.95 330184 270 3M 1051 DRAPE O $130.00 $84.50 330184 270 STAPLE 55P-3.5 CARTRIDGE O $725.00 $471.25 330184 270 STAPLERMULTIFIRE GIA O $859.00 $558.35 330184 272 STAPLERCEEA O "$1,234.00 " $802.10 330184 272 STAPLE DISP PLDS 15 W O $673.00 $437.45 330184 272 STAPLERSURGICLIP O $651.00 $423.15 330184 270 TRU CUT DISP BIOPSY NEEDL O $175.00 $113.75 330184 270 TUBINGSUCTION 1/4 X 12 O $3.00 $1.95 330184 270 FORCEPSSNARESBRUSH O $364.00 $236.60 330184 270 TUBE FOR SNARE WIRE O $436.00 $283.40 330184 270 USE OF ENDOSCOPE O $293.00 $190.45 330184 270 VIDEO SYSTEM O $293.00 $190.45 330184 270 USE OF GASTROSCOPE FORCEP O $293.00 $190.45 330184 270 BETADINE SOLUTION4 OZ. O $2.00 $1.30 330184 270 PACKSHOE COVERS O $1.00 $0.65 330184 270 PACKLAPAROTOMY ULTRAPACK O $130.00 $84.50 330184 270 PEANUT SPONGES O $3.00 $1.95 330184 270 SPONGELAP STERILE 18X18 O $1.00 $0.65 330184 270 STAPLERSKIN ROYAL 25W O $74.00 $48.10 330184 270 ANTI-FOG SOLUTIONSTERILE O $63.00 $40.95 330184 272 ENDO DISSECT INSTRUMENT O $627.00 $407.55 330184 272 ENDO GIA STAPLER O "$2,328.00 " "$1,513.20 " 330184 270 ENDO GIA LOADING UNITS O $883.00 $573.95 330184 272 ENDOGRASP DISP.INSTRUMENT O $683.00 $443.95 330184 270 ENDOSHEARSLONG 5MM INST O $557.00 $362.05 330184 270 SURGI-NEEDLEDISPOSABLE 1 O $156.00 $101.40 330184 270 SYRINGES10CC 21 GUAGE X O $1.00 $0.65 330184 272 ENDOCLINCH O $553.00 $359.45 330184 272 ENDO KITTNER DISSECT O $96.00 $62.40 330184 270 CHOLANGIOGRAPHY CATHETER O $284.00 $184.60 330184 272 ENDOCATCH DISP. SPECIMEN O $530.00 $344.50 330184 270 PACKCYSTO O $60.00 $39.00 330184 270 SOLUTIONGLYCENE 3L (2B73 O $60.00 $39.00 330184 270 PACKLAP SHEETADOLESCENT O $43.00 $27.95 330184 270 PACKMINOR O $129.00 $83.85 330184 270 PACKARTHROSCOPY ULTRAPAC O $219.00 $142.35 330184 270 PACK EXTREMITY DRAPE O $220.00 $143.00 330184 270 PACK FAN FOLDED SHEETS 5 O $14.00 $9.10 330184 270 USE OF TOURNIQUET O $293.00 $190.45 330184 250 SOLUTION 9% SOD CHL 3000C O $34.00 $22.10 330184 270 STANDARD NOZZLE WITH OBTU O $144.00 $93.60 330184 270 UNIVERSAL BONE PLUG ASSEM O $506.00 $328.90 330184 270 CATHETER SECURE DEVICE O $14.00 $9.10 330184 270 SYRINGES 20CC W/OUT NEED O $1.00 $0.65 330184 270 USE OF MICROSCOPE O $293.00 $190.45 330184 270 PACKLAP SHEET TRANSVERS O $42.00 $27.30 330184 272 STAPLER MULTIFIRE TA O $828.00 $538.20 330184 270 STAPLERGIA LOADING UNIT O $463.00 $300.95 330184 270 STAPLER TA LOADING UNIT O $404.00 $262.60 330184 270 URINE METER CATH TRAY O $108.00 $70.20 330184 270 CATHETER SUCTION RED RUB O $15.00 $9.75 330184 270 DRESSING VASELINE STERIL O $3.00 $1.95 330184 270 SUSPENSORIES LARGE O $37.00 $24.05 330184 270 CELL SAVER O $0.00 $0.00 330184 270 CEMENT MIXING SYSTEM O $0.00 $0.00 330184 270 STERIDRAPES 90X45 O $35.00 $22.75 330184 270 ESMARK BANDAGE 6X9 O $37.00 $24.05 330184 270 USE OF FLUROSCOPE O $274.00 $178.10 330184 270 STOCKINETTE IMPERVIOUS O $37.00 $24.05 330184 270 CATHETERFOLEY 165V 16FR O $25.00 $16.25 330184 270 TUBINGCYSTO IRRIGATING O $25.00 $16.25 330184 270 CAMERA DRAPE O $43.00 $27.95 330184 270 CONTIGEN COLLAGEN IMPLANT O "$1,977.00 " "$1,285.05 " 330184 270 USE OF ULTRASOUND MACHINE O $293.00 $190.45 330184 272 SINGLE ACTION PUMPING SYS O $271.00 $176.15 330184 270 HEMOVACS 400ML MED TUBING O $111.00 $72.15 330184 270 MAGUIRE PELVIC POSITIONER O $110.00 $71.50 330184 270 BLADES SAW O $458.00 $297.70 330184 270 PACK HIP O $576.00 $374.40 330184 270 IRRIGATOR ARTHROSCOPY O $164.00 $106.60 330184 270 UNIVERSAL BOND PLUG KIT O $556.00 $361.40 330184 270 TOP NOTCH BIOPSY NEEDLE O $127.00 $82.55 330184 270 STONE EXTRACTOR RUTNER B O $486.00 $315.90 330184 270 OVERHEAD TABLE COVER W/EX O $58.00 $37.70 330184 270 PHILADELPHIA COLLAR O $131.00 $85.15 330184 272 ADULT SKULL PERFORATOR S O $646.00 $419.90 330184 270 STRAIGHT FLUTE NEURO BLAD O $381.00 $247.65 330184 270 WIRE PASS DRILL O $381.00 $247.65 330184 270 STAPLER SKIN O $71.00 $46.15 330184 270 ANTI-FOG SCOPE SCRUBBER O $105.00 $68.25 330184 270 ENDO BABCOCK O $562.00 $365.30 330184 272 ENDO SHEARS O $557.00 $362.05 330184 270 ENDOFLO IRRIGATION SYSTEM O $420.00 $273.00 330184 270 ENDOSCIPIC IRRIGATION TUB O $198.00 $128.70 330184 270 SURGIPORT TROCARS 10MM O $459.00 $298.35 330184 270 VERSAPORT TROCARS 5MM O $369.00 $239.85 330184 272 CATHETERABLATIONNON-CAR O $0.00 $0.00 330184 270 CELL SAVER EQUIPMENT O $497.00 $323.05 330184 270 BURS O $106.00 $68.90 330184 270 ACL KITS O $429.00 $278.85 330184 270 SURE TAC PAC O $293.00 $190.45 330184 270 ARTHROSCOPIC CANNULA O $57.00 $37.05 330184 270 BIOPREP KIT O $360.00 $234.00 330184 270 TIBIAL SCRUB BRUSH O $48.00 $31.20 330184 270 MIXEVACS O $191.00 $124.15 330184 270 ARTHROWAND O $680.00 $442.00 330184 270 ABDUCTION PILLOW O $166.00 $107.90 330184 270 DALL MILES SLEEVES O $462.00 $300.30 330184 270 DALL MILES CABLES O $858.00 $557.70 330184 270 DALL MILES GRIPS O "$1,682.00 " "$1,093.30 " 330184 270 INJECTION NEEDLE O $131.00 $85.15 330184 270 SPINE CABLE DOUBLE LEAD O $0.00 $0.00 330184 270 LOCKING CAP O $0.00 $0.00 330184 270 CLIP OFFSET O $300.00 $195.00 330184 270 THORACIC HOOK O $0.00 $0.00 330184 270 USE OF SHAVER SYSTEM O $293.00 $190.45 330184 270 STAPLES EAR PROSTHESIS O $217.00 $141.05 330184 270 SUPRA FOIL IMPLANT O $51.00 $33.15 330184 270 SUCTION BOVIE COAGULATOR O $115.00 $74.75 330184 270 ERBE PROBE O $579.00 $376.35 330184 270 USE OF HEATER PROBE MACHI O $293.00 $190.45 330184 270 VNUS CATHETER O "$2,101.00 " "$1,365.65 " 330184 270 VNUS PACK O $274.00 $178.10 330184 270 MEROCEL DRESSING PACK O $160.00 $104.00 330184 270 SALEM SUMP TUBE O $30.00 $19.50 330184 270 SUCTION CATH GLOVE KIT O $86.00 $55.90 330184 270 BAND LIGATOR O $544.00 $353.60 330184 270 HEATER PROBE O "$1,341.00 " $871.65 330184 270 USE OF DILATORS O $293.00 $190.45 330184 270 USE OF ERBE MACHINE O $293.00 $190.45 330184 270 SCLEROTHERAPY NEEDLE O $126.00 $81.90 330184 270 CLO TEST O $25.00 $16.25 330184 270 SPOT ENDOSCOPIC MARKER O $57.00 $37.05 330184 270 MIC REPLACEMENT TUBE O $102.00 $66.30 330184 270 ENT COBLATOR O $629.00 $408.85 330184 270 BLOOD PLASMA COLLECTION S O $0.00 $0.00 330184 272 IV TUBING O $35.00 $22.75 330184 270 MIDAS REX TOOL O $330.00 $214.50 330184 270 VERSAPOINT O $777.00 $505.05 330184 270 FALLOPE RING BAND KITS O $512.00 $332.80 330184 278 FALLOPE RING BAND KITS CHRG O $512.00 $332.80 330184 270 SINUS SHAVER BLADE O $477.00 $310.05 330184 270 SINUS GUIDE CATH HANDLE O $156.00 $101.40 330184 270 SINUS BALLOON INFLTN DEV O $211.00 $137.15 330184 270 TRACH TUBE O $811.00 $527.15 330184 270 TISSEEL FIBRIN SEALER KIT O "$1,853.00 " "$1,204.45 " 330184 270 ICP MONITORING KIT O $991.00 $644.15 330184 270 PACK CUSTOM EYE O "$1,500.00 " $975.00 330184 272 BIPOLAR CORD O $42.00 $27.30 330184 272 IHAMED CALIBRATION O $363.00 $235.95 330184 270 COLOSTOMY KIT O $417.00 $271.05 330184 270 BAG BILE DRAINAGE LEG O $58.00 $37.70 330184 270 FULLER SHIELD O $58.00 $37.70 330184 270 VERASCOPE SHEATH O $274.00 $178.10 330184 270 PACKINGPLAIN/LODOFORM O $57.00 $37.05 330184 270 USE OF AUTOSONIX MACHINE O $293.00 $190.45 330184 270 USE OF LIGASURE MACHINE O $293.00 $190.45 330184 270 INLET CLOSURE DEVICE O $319.00 $207.35 330184 270 LONG LEG CAST O "$1,140.00 " $741.00 330184 270 ENDO BUTTONS O $612.00 $397.80 330184 272 DISTAL RADIUS EXT FIXATIO O "$4,730.00 " "$3,074.50 " 330184 278 ANTIBIOTIC CEMENT O "$1,019.00 " $662.35 330184 272 LARGE BONE FIXATION O "$7,241.00 " "$4,706.65 " 330184 272 SMALL BONE FIXATION O "$4,827.00 " "$3,137.55 " 330184 270 COLD THERAPY BLANKET O $68.00 $44.20 330184 272 TRANSFUSION KIT O $357.00 $232.05 330184 270 IMP KNEE POSITIONERS O $143.00 $92.95 330184 270 MICRO FIBER STRIPPERS O $536.00 $348.40 330184 272 UROLOGY TRAY O $435.00 $282.75 330184 272 FOLEY COUDE TIP O $102.00 $66.30 330184 278 TESTICULAR PROSTHESIS O "$3,018.00 " "$1,961.70 " 330184 272 PLEURX CATH KIT O "$1,559.00 " "$1,013.35 " 330184 272 ULTRA SHEARS O $765.00 $497.25 330184 278 URETEX IMPLANT SLING O "$1,984.00 " "$1,289.60 " 330184 272 MAMMOSITE BALLOON AFTERLO O "$7,376.00 " "$4,794.40 " 330184 272 ANGIO CATH O $54.00 $35.10 330184 272 CVP CATH O $226.00 $146.90 330184 272 SEAM GUARD O $470.00 $305.50 330184 270 INFUSE PORT MED-BMP O "$11,800.00 " "$7,670.00 " 330184 270 INFUSE PORT SMALL-BMP O "$9,387.00 " "$6,101.55 " 330184 270 VITAGEL SURG HEMOSTAT O "$1,379.00 " $896.35 330184 278 INTEGRA NEURO SHUNT O "$6,168.00 " "$4,009.20 " 330184 272 INTEGRA RESERVOIR O $804.00 $522.60 330184 272 TISSUE LINK O "$1,207.00 " $784.55 330184 270 ACIST KIT O $167.00 $108.55 330184 270 ENDO STITCH SUTURE DEVICE O $256.00 $166.40 330184 272 ARTHRCRSMRTSTCH M CONN O $372.00 $241.80 330184 270 CELL SAVER MACHINE O $293.00 $190.45 330184 270 NEPTUNE SUCTION SYSTEM O $324.00 $210.60 330184 270 LIPO SUCTION MACHINE O $293.00 $190.45 330184 272 CATHETER DUPLOCATH APPLIC O $0.00 $0.00 330184 270 DRAPE IOBAN O $33.00 $21.45 330184 270 LUMBAR DRAINAGE KIT O $0.00 $0.00 330184 270 PACKUNIVERSAL O $169.00 $109.85 330184 270 DRAPE 3M# 1015 U-DRAPE O $71.00 $46.15 330184 270 LIGASURE ADVANCE O "$2,022.00 " "$1,314.30 " 330184 270 TUBING INSUFFLATION O $51.00 $33.15 330184 270 T-4 O $54.00 $35.10 330184 272 CATH HEMATURIA O $0.00 $0.00 330184 270 LASER FIBER 1000 O "$2,669.00 " "$1,734.85 " 330184 270 LASER FIBER 200 O "$3,219.00 " "$2,092.35 " 330184 270 LASER FIBER 365 O "$1,073.00 " $697.45 330184 270 LASER FIBER 550 O "$1,288.00 " $837.20 330184 270 EYE SHIELD CLEAR O $24.00 $15.60 330184 270 TUBEMIC GASTROSTOMY O $76.00 $49.40 330184 270 LEADS O "$3,512.00 " "$2,282.80 " 330184 278 CARDIAC DEFIBRILLATOR PAR O "$19,964.00 " "$12,976.60 " 330184 278 CARDIAC DEFIBRILLATOR PAR O "$17,970.00 " "$11,680.50 " 330184 270 FOLEY CATH TRAY O $139.00 $90.35 330184 270 X-RAY DRAPLE O $86.00 $55.90 330184 250 250 CC NUSALINE O $106.00 $68.90 330184 270 PROTACK HERNIA STAPLER O $783.00 $508.95 330184 270 ENDO PADDLE RETRACT O $413.00 $268.45 330184 270 USE OF BRONCHOSCOPEFORUP O $293.00 $190.45 330184 270 THORACOPORT O $216.00 $140.40 330184 270 ENDO LUNG O $272.00 $176.80 330184 270 ENDOCLIP SML O $397.00 $258.05 330184 270 PURSE STRING INST FOR CEE O $272.00 $176.80 330184 270 STAPLERROTICULATOR O "$1,089.00 " $707.85 330184 270 STAPLERVERSAFIRE GIA O $264.00 $171.60 330184 270 ENDO GIA ROTICULATOR O $725.00 $471.25 330184 270 ENDO MINI SHEARS O $321.00 $208.65 330184 270 ENDO SCIZ O $239.00 $155.35 330184 270 ENDO MINI RETRACT O $297.00 $193.05 330184 278 LAP-BAND O "$9,900.00 " "$6,435.00 " 330184 270 ABDOMINAL BINDER O $86.00 $55.90 330184 278 LIPOSUCTION EQUIPMENT O $217.00 $141.05 330184 278 SPECIMEN TRAP SPUTUM O $22.00 $14.30 330184 270 CHEST DRAINAGE UNIT PLEAU O $115.00 $74.75 330184 270 CAST HAND FOREARM O $680.00 $442.00 330184 270 USE OF BOVIE MACHINE O $293.00 $190.45 330184 270 SPLINT WRIST O $86.00 $55.90 330184 270 JP DRAIN RESERVOIR O $291.00 $189.15 330184 272 LIGASURE LAPAROSCOPIC O "$1,183.00 " $768.95 330184 272 LIGASURE OPEN O "$1,733.00 " "$1,126.45 " 330184 272 NASAL SPLINT (NEIMAN XOME O $74.00 $48.10 330184 270 CEMENT REMOVAL INSTRMT O $0.00 $0.00 330184 270 BALLOON KYPHOPLASTY SUPPL O $0.00 $0.00 330184 270 IMBIBE SYRINGE O $639.00 $415.35 330184 270 IMBIBE NEEDLE O $256.00 $166.40 330184 270 USE OF HEADLIGHT O $293.00 $190.45 330184 270 Endo Stitch Surgidac O $121.00 $78.65 330184 270 ENDO STITCH SUTURE O $46.00 $29.90 330184 270 USE OF ABORTION CART O $293.00 $190.45 330184 270 PACK LAP CHOLE O $768.00 $499.20 330184 270 BRA JOBST O $117.00 $76.05 330184 270 USE OF NAVG SYST & BATT O $410.00 $266.50 330184 270 BLADE CARPAL TUNNEL RELE O $511.00 $332.15 330184 270 PACK TOTAL JOINT O "$1,687.00 " "$1,096.55 " 330184 270 ARTHRWNDTOPAZ MICRODEBRD O $820.00 $533.00 330184 272 BONE MARROW ASPIRATION KI O $0.00 $0.00 330184 270 Stapler Duet reload O "$1,153.00 " $749.45 330184 270 Stapler Abstack O "$1,135.00 " $737.75 330184 270 Irrigator Versajet O $958.00 $622.70 330184 270 Davinci robot accessories O $650.00 $422.50 330184 270 Dressing pack (Nasopore) O $508.00 $330.20 330184 270 Use of Ablation machine ( O $296.00 $192.40 330184 270 Use of ENT coblator machi O $296.00 $192.40 330184 270 Use of Laser O $296.00 $192.40 330184 270 Use of Lithotripsy machin O $296.00 $192.40 330184 270 Use of ACIST machine O $296.00 $192.40 330184 250 IV SOLT 50-1000 MLS O $20.00 $13.00 330184 270 OPERATING ROOM SUPPLY MIS O $0.00 $0.00 330184 920 UROLOGY DYNAMIC STUDY O $520.00 $338.00 330184 920 UROLOGY EMG CYSTOMETROGRA O $441.00 $286.65 330184 270 RAD CHG PICC LINE SET O $250.00 $162.50 330184 270 RAD CHG SGL ACTN PUMPINGS O $252.00 $163.80 330184 270 RAD CHG USE OF BOVIE MCHN O $273.00 $177.45 330184 270 RAD CHG STAPLE 55P 3.5 CT O $673.00 $437.45 330184 270 RAD CHG SURGIFOAM SPONGE O $142.00 $92.30 330184 270 RAD CHG BIOPSY NEEDLE O $42.00 $27.30 330184 270 RAD CHG BASIC BIOPSY TRAY O $37.00 $24.05 330184 270 RAD CHG BASIC ANGIO TRAY O $89.00 $57.85 330184 270 RAD CHG ANGIO PREP KIT O $82.00 $53.30 330184 270 RAD CHG NEPHROSTOMY TUBE O $24.00 $15.60 330184 270 RAD CHG CONNECT TUBE W/BG O $18.00 $11.70 330184 270 RAD CHG SUTURE O $24.00 $15.60 330184 270 RAD CHG DERMABOND O $60.00 $39.00 330184 270 RAD CHG CHEST DRAIN UNITL O $98.00 $63.70 330184 270 CT OSTEOCUT NEEDLE O $22.00 $14.30 330184 270 INCENTIVE SPIROMETER O $96.00 $62.40 330184 272 02 MASK EQUIP CHG O $68.00 $44.20 330184 271 VENTI MASK O $45.00 $29.25 330184 272 VENTILATOR CIRCUIT DISPOS O $45.00 $29.25 330184 271 DISP CROUPETT CANOPY O $133.00 $86.45 330184 270 CLSD TRACH SUCTION CATH O $42.00 $27.30 330184 250 METAPROTERENO .3/2.5 ML O $71.00 $46.15 330184 370 ANESTHESIA INITIAL HALF O $991.50 $644.48 330184 370 ANEST 1 HR O "$1,982.25 " "$1,288.46 " 330184 370 ANEST 1 1/4 HR O "$2,478.00 " "$1,610.70 " 330184 370 ANEST 1 1/2 HR O "$2,973.00 " "$1,932.45 " 330184 370 ANEST 1 3/4 HR O "$3,468.75 " "$2,254.69 " 330184 370 ANEST 2 HR O "$3,963.75 " "$2,576.44 " 330184 370 ANEST 2 1/4 HR O "$4,460.25 " "$2,899.16 " 330184 370 ANEST 2 1/2 HR O "$4,955.25 " "$3,220.91 " 330184 370 ANEST 2 3/4 HR O "$5,451.00 " "$3,543.15 " 330184 370 ANEST 3 HR O "$5,946.00 " "$3,864.90 " 330184 370 ANEST 3 1/4 HR O "$6,441.75 " "$4,187.14 " 330184 370 ANEST 3 1/2 HR O "$6,937.50 " "$4,509.38 " 330184 370 ANEST 3 3/4 HR O "$7,432.50 " "$4,831.12 " 330184 370 ANEST 4 HR O "$7,928.25 " "$5,153.36 " 330184 370 ANEST 4 1/4 HR O "$8,424.00 " "$5,475.60 " 330184 370 ANEST 4 1/2 HR O "$8,919.00 " "$5,797.35 " 330184 370 ANEST 4 3/4 HR O "$9,414.75 " "$6,119.59 " 330184 370 ANEST 5 HR O "$9,909.75 " "$6,441.34 " 330184 370 ANEST 5 1/4 HR O "$10,406.25 " "$6,764.06 " 330184 370 ANEST 5 1/2 HR O "$10,901.25 " "$7,085.81 " 330184 370 ANEST 5 3/4 HR O "$11,396.25 " "$7,407.56 " 330184 370 ANEST 6 HR O "$11,892.00 " "$7,729.80 " 330184 370 ANEST EACH ADD 15 MIN O $495.75 $322.24 330184 270 NEUROLEPT IV O $141.00 $91.65 330184 270 EPIDURAL MINI PACKS O $139.00 $90.35 330184 270 BREATHING CIRCUITS O $5.00 $3.25 330184 270 SPINAL NEEDLES O $4.00 $2.60 330184 270 LTA KIT O $10.00 $6.50 330184 270 4 WAY STOPCOCK O $1.00 $0.65 330184 270 GENERAL SUPPLIES FOR ANES O $424.00 $275.60 330184 270 SPINAL ANESTHESIA SUPPLIE O $320.00 $208.00 330184 270 EPIDURAL ANESTHESIA O $382.00 $248.30 330184 270 DOUBLE LUMEN TUBE O "$1,273.00 " $827.45 330184 270 LASER FLEX CUFFED TUBE O "$4,600.00 " "$2,990.00 " 330184 270 LASER FLEX UNCUFFED O "$4,486.00 " "$2,915.90 " 330184 270 INJECTOFLEX TUBE O "$1,613.00 " "$1,048.45 " 330184 270 REINFORCED SILICONE TUBE O $579.00 $376.35 330184 270 ARTERIAL LINE CATHETER O "$2,168.00 " "$1,409.20 " 330184 270 CENTRAL LINE CATHETER O $269.00 $174.85 330184 270 AMBU BAG O $264.00 $171.60 330184 270 UPPER DISPOSABLE WARMING O $234.00 $152.10 330184 270 LOWER DISP WARMING BLANKE O $234.00 $152.10 330184 270 DRYDEN CO2 ABSORBERS O "$3,085.00 " "$2,005.25 " 330184 270 ISO GARD MOUNTING SYSTEM O "$6,254.00 " "$4,065.10 " 330184 270 FLUID WARMING SET LEVEL I O $393.00 $255.45 330184 270 T CONNECTOR EXT LEVEL I O $40.00 $26.00 330184 270 TEMPERATURE PROBE O $73.00 $47.45 330184 270 FIELD BLOCK REGIONAL BLOC O $213.00 $138.45 330184 270 HYPOTHERMIA BLANKET LARGE O $173.00 $112.45 330184 270 HYPOTHERMIA BLANKET SMALL O $144.00 $93.60 330184 270 LEVEL ONE RAPID INFUSION O $670.00 $435.50 330184 270 COMBINED SPINAL & EPIDORA O $781.00 $507.65 330184 270 DISP EPIDURAL ANEST TRAY O $78.00 $50.70 330184 710 RECOVERY ROOM INITIAL 30 O $984.90 $640.19 330184 710 INSPIROMETER ADAPTOR O $1.00 $0.65 330184 272 A LINE INSERTION TRAY O $0.00 $0.00 330184 710 RECOVERYADDLI. 30 MIN O $177.45 $115.34 330184 710 RECOVERY INITIAL 30 MIN O $984.90 $640.19 330184 710 MATERNITY RECOVER INITIAL O $661.00 $429.65 330184 710 MATERNITY RECOVERYADDL 30 O $331.00 $215.15 330184 270 ICE PACK ORTH O $312.00 $202.80 330184 250 Sodium Chloride 0.45%/10 O $16.00 $10.40 330184 258 Osmitrol 20%/500Ml Inj O $30.00 $19.50 330184 250 HETASTARCH O $0.00 $0.00 330184 270 CANES/CRUTCHES O $54.00 $35.10 330184 270 SPLINTS (WRISTFINGERARM O $49.00 $31.85 330184 270 LEG KNEE BRACE O $49.00 $31.85 330184 250 Medrxyprogester Acetate I O $12.00 $7.80 330184 450 MINOR SURGERY O $66.00 $42.90 330184 450 BELTS ZIMMER PELVIC O $208.00 $135.20 330184 270 CANES O $49.00 $31.85 330184 270 CAST SPICA BODY O $200.00 $130.00 330184 270 CAST ARM CIRCULAR O $81.00 $52.65 330184 270 CAST LEG TO KNEE O $118.00 $76.70 330184 270 CAST LEG TO THIGH O $200.00 $130.00 330184 270 CLIPS SKELETAL FIN O $16.00 $10.40 330184 270 HEEL ZIMMER WALKING O $16.00 $10.40 330184 270 PINS STEINMAN O $33.00 $21.45 330184 270 SHOULDERS IMMOBLIZER O $56.00 $36.40 330184 270 METAL SLING O $200.00 $130.00 330184 270 SPLINT ALUMIFOAM FIN O $4.00 $2.60 330184 270 SPLINT THOM & TRAC O $316.00 $205.40 330184 270 SPLINT ARM O $49.00 $31.85 330184 270 SPLINT MCLEOD CLAV O $118.00 $76.70 330184 270 SPLINT HAND COCK UP O $52.00 $33.80 330184 270 SPLINT ANTERIOR ELBO O $118.00 $76.70 330184 270 SPLINT POST ELBOW O $110.00 $71.50 330184 270 SPLINT FENCE O $52.00 $33.80 330184 270 SPLINT LEG O $81.00 $52.65 330184 270 SPLINT RIB O $59.00 $38.35 330184 270 SPLIINT POST TIB KNEE O $200.00 $130.00 330184 270 SPLINT POST TIB HIP O $245.00 $159.25 330184 270 STRAPS MOLESKIN O $56.00 $36.40 330184 270 FOX POST NASAL BAL O $56.00 $36.40 330184 270 ESOPHAGEAL OPTURATOR O $497.00 $323.05 330184 270 02 MASK ADULT O $16.00 $10.40 330184 270 02 MASK CHILD O $4.00 $2.60 330184 270 02 CANNULA O $3.00 $1.95 330184 270 02 TUBING O $3.00 $1.95 330184 270 ENDO TRACH TUBES O $52.00 $33.80 330184 270 ORAL AIR WAY O $19.00 $12.35 330184 270 NASAL AIR WAY O $45.00 $29.25 330184 270 MEDICAL SUPPLIES O $321.00 $208.65 330184 270 DERMABOND WOUND CLOSURE O $125.00 $81.25 330184 450 CLSD DISTAL CNDYL FX W/O O "$1,274.00 " $828.10 330184 270 O2 MASK O $16.00 $10.40 330184 450 LEVEL II PROCEDURE - INTE O $0.00 $0.00 330184 450 LEVEL I PROCEDURE - MINOR O $0.00 $0.00 330184 450 LEVEL III PROCEDURE - COM O $0.00 $0.00 330184 450 CLS FX POST HIP ARTHROPHA O $537.00 $349.05 330184 450 REP LAS TONGUE FL MOUTH 2 O "$1,263.00 " $820.95 330184 270 PRIMARY TUBING 60 DROP O $3.00 $1.95 330184 270 PRIMARY TUBING 10 DROP O $3.00 $1.95 330184 270 RAPID INFUSER O $0.00 $0.00 330184 270 INFUSER PRESSURE DISP O $0.00 $0.00 330184 270 STERILE DRAPES O $0.00 $0.00 330184 270 HUBER NEEDLE INFUSION SET O $0.00 $0.00 330184 270 CATH KIT 16FR WBAG O $10.00 $6.50 330184 270 CATH KIT 18FR WBAG O $10.00 $6.50 330184 270 CATH TRAY 16FR WURIM O $15.00 $9.75 330184 270 CATH TRAY 18FR WURIM O $15.00 $9.75 330184 270 CATH SUPRA PUBIC DRN O $0.00 $0.00 330184 270 SUPRA PUBIC CATHETERS O $0.00 $0.00 330184 270 PEDS CATHETERS O $0.00 $0.00 330184 270 TUBING BLOOD O $6.00 $3.90 330184 270 IV BLOOD SET PUMP O $6.00 $3.90 330184 270 HN PUMP O $0.00 $0.00 330184 270 HN TUBING O $0.00 $0.00 330184 270 IRRIGATION SET PISTON O $2.00 $1.30 330184 270 NORMAL SALINE O $0.00 $0.00 330184 270 PRIMARY TUBING O $0.00 $0.00 330184 270 MORGAN LENS O $0.00 $0.00 330184 270 IRRIGATE TUBING BLADDER O $6.00 $3.90 330184 270 SECONDARY TUBING IV MED O $2.00 $1.30 330184 270 PED IV MED PUMP O $0.00 $0.00 330184 270 TUBING BURETTE O $0.00 $0.00 330184 270 ARMBOARD PED O $1.00 $0.65 330184 270 THORADRAIN 3 O $35.00 $22.75 330184 270 TROCAR CATHETER 20FR O $0.00 $0.00 330184 270 TROCAR CATHETER 24FR O $0.00 $0.00 330184 270 TROCAR CATHETER 12FR O $0.00 $0.00 330184 270 THORACENTESIS 8FR O $0.00 $0.00 330184 270 ELECTRODES O $8.00 $5.20 330184 270 PEDS ET SIZES O $0.00 $0.00 330184 270 MCGILLS O $0.00 $0.00 330184 270 CO2 DETECTOR O $0.00 $0.00 330184 270 ET TUBE HOLDER O $9.00 $5.85 330184 270 PEDI BLUE WTOD INFANT MAS O $0.00 $0.00 330184 270 PEDI STYLET O $0.00 $0.00 330184 270 CENTRL LINE PREP PACK O $31.00 $20.15 330184 270 CVP TRIPLE LUMEN KIT O $34.00 $22.10 330184 270 DRESSING CL LINE KIT O $6.00 $3.90 330184 270 CENTRAL LINE PREP KIT O $31.00 $20.15 330184 270 TUBING SUCTI 3/16 X 6FT O $0.00 $0.00 330184 270 DISPOSABLE CANNISTERS LIN O $0.00 $0.00 330184 270 CATH TRAY STR URETHRA O $0.00 $0.00 330184 270 PED URINARY CATH 8FR O $0.00 $0.00 330184 270 PACKING STRIP 2X5YD O $4.00 $2.60 330184 270 STERISTRIPS 1/4X3IN O $2.00 $1.30 330184 270 I D TRAY O $0.00 $0.00 330184 270 STAPLER SKIN ROY 35W O $10.00 $6.50 330184 270 ELECTRODES MONITOR O $0.00 $0.00 330184 270 CASTING TAPE 3IN DELTA O $0.00 $0.00 330184 270 CASTING TAPE 2IN DELTA O $0.00 $0.00 330184 270 CASTING TAPE 4IN DELTA O $0.00 $0.00 330184 270 BANDAGE PLASTER 2IN O $20.00 $13.00 330184 270 BANDAGE PLASTER 4IN O $34.00 $22.10 330184 270 BANDAGE PLASTER 6IN O $57.00 $37.05 330184 270 WEBRILL 2IN X 4YD O $0.00 $0.00 330184 270 MIC G TUBE 20FR O $0.00 $0.00 330184 270 MIC G TUBE 24FR O $0.00 $0.00 330184 270 FEEDING TUBE 8FR O $94.00 $61.10 330184 270 PEG TUBES O $0.00 $0.00 330184 270 ADULT DEFIB PADS O $0.00 $0.00 330184 270 OXYSENSOR OXIMAX O $12.00 $7.80 330184 270 OXYSENSOR PEDS O $6.00 $3.90 330184 270 SIMPLE MASK ADULT O $25.00 $16.25 330184 270 AEROSOL MASK O $0.00 $0.00 330184 270 ADULT MEDIUM FLOW MASK O $0.00 $0.00 330184 270 NASAL CANNULA PEDS O $0.00 $0.00 330184 270 NEBULIZERS POWER MIST O $0.00 $0.00 330184 270 TRACH MASK ADULT O $0.00 $0.00 330184 270 CRIC SET O $0.00 $0.00 330184 270 TRACH CANNULAS O $0.00 $0.00 330184 270 BI PAP O $0.00 $0.00 330184 270 GOGGLES O $4.00 $2.60 330184 270 SUTURE SET DISP O $9.00 $5.85 330184 270 PLASTIC TRAY O $0.00 $0.00 330184 270 SUT MONOSOFT 5.0 P-11 O $0.00 $0.00 330184 270 SUT MONOSOFT 6.0 P-13 O $0.00 $0.00 330184 270 SUT MONOSOFT 7.0 P-16 O $0.00 $0.00 330184 270 SUT MONOSOFT 5.0(SN5695G) O $0.00 $0.00 330184 270 SUT MONOSOFT 5.0(SN-1666) O $0.00 $0.00 330184 270 SUT MONOSOFT 6.0(SN-3697) O $0.00 $0.00 330184 270 SUT MONOSOFT 4.0(SN-5699G O $0.00 $0.00 330184 270 SUT MONOSOFT 4.0(SN-5667G O $0.00 $0.00 330184 270 SUT MONOSOFT 3.0(SN-1669) O $0.00 $0.00 330184 270 SUT POLYSORB 4.0PC-12 O $0.00 $0.00 330184 270 SUT POLYSORB 5.0P-12 O $0.00 $0.00 330184 270 SUT VICRYL RAPIDE 5.0 O $0.00 $0.00 330184 270 SUTSURGIPRO 2.0 GS18 O $0.00 $0.00 330184 270 SPLASHGUARD O $31.00 $20.15 330184 270 ARM SLING MEDIUM O $0.00 $0.00 330184 270 ARM SLING LARGE O $0.00 $0.00 330184 270 ARM SLING X-SMALL O $0.00 $0.00 330184 270 SPLINTFIBERGLASS 2X15 O $0.00 $0.00 330184 270 SPLINTFIBERGLASS 4X15' O $0.00 $0.00 330184 270 SPLINTFIBERGLASS 3X15' O $0.00 $0.00 330184 270 SPLINTFIBERGLASS 5X15' O $0.00 $0.00 330184 270 SPLINTFIBERGLASS 6X15' O $0.00 $0.00 330184 270 LIMB HLDREPIFLEX LGR O $0.00 $0.00 330184 270 WRIST SPLINT LARG LEFT(CO O $0.00 $0.00 330184 270 WRIST SPLINT LARGE RIGHT( O $0.00 $0.00 330184 270 WRIST SPLINT MEDIUM LEFT O $0.00 $0.00 330184 270 LARGE OPEN TOE CAST BOOT O $0.00 $0.00 330184 270 UNIVERSAL ANKLE BRACE O $0.00 $0.00 330184 270 HARD NECK COLLAR O $0.00 $0.00 330184 270 SOFT COLLAR SMALL O $0.00 $0.00 330184 270 SOFT MEDIUM COLLAR O $0.00 $0.00 330184 270 SOFT LARGE COLLAR O $0.00 $0.00 330184 270 SOFT XTRA SMALL COLLAR O $0.00 $0.00 330184 270 PHILI COLLAR MEDIUM O $0.00 $0.00 330184 270 CATHEXT.MALE LARGE O $2.00 $1.30 330184 270 URINE STRAINER O $2.00 $1.30 330184 270 NEB W/TEE TUBE MOUTH O $9.00 $5.85 330184 270 NEB STERILE WATER O $3.00 $1.95 330184 270 POWER MIST NEB O $0.00 $0.00 330184 270 MASK PEDS O $0.00 $0.00 330184 270 MASK ADULTS O $0.00 $0.00 330184 270 TRACH TUBE FLEX CUFF 6.0M O $0.00 $0.00 330184 270 TRACH TUBE FLEX CUFF 7.0M O $0.00 $0.00 330184 270 TRACH TUBE FLEX CUFF 8.0M O $0.00 $0.00 330184 270 TRACH TUBE FLEX CUFF 9.0M O $0.00 $0.00 330184 270 CRUTCH ADULT ASSEMBLED O $23.00 $14.95 330184 270 CRUTCH MEDIUM ASSEMBLED O $23.00 $14.95 330184 270 CRUTCH YOUTH ASSEMBLED O $23.00 $14.95 330184 270 CANE WOOD O $9.00 $5.85 330184 270 AMBU ADULT O $12.00 $7.80 330184 270 AMBU MASK O $12.00 $7.80 330184 270 BAIR HUGGER MACHINE O $0.00 $0.00 330184 270 FLUID WARM LEVEL 1 O $0.00 $0.00 330184 270 TRANSCUT PACE MACH O $0.00 $0.00 330184 270 TRACING PADS O $0.00 $0.00 330184 270 TRANSVENOUS PACING CART O $0.00 $0.00 330184 270 PACING WIRES O $0.00 $0.00 330184 270 PRESSURE PUMP O $0.00 $0.00 330184 270 FINGER SPLINT SMALL O $0.00 $0.00 330184 270 FINGER SPLINT MEDIUM O $0.00 $0.00 330184 270 FINGER SPLINT LARGE O $0.00 $0.00 330184 270 RHINO ROCKETS O $0.00 $0.00 330184 270 IO NEEDLES O $0.00 $0.00 330184 270 BROSELOW CART O $0.00 $0.00 330184 270 DPL KIT O $0.00 $0.00 330184 270 NORMAL SALINE 1000 ML O $0.00 $0.00 330184 270 BURR HOLE DRILL O $0.00 $0.00 330184 270 HALOS O $0.00 $0.00 330184 270 RAPE KIT O $0.00 $0.00 330184 270 URINE (HCG) PREGNANCY O $2.00 $1.30 330184 270 PEDIATRIC SPECI-CATH KIT O $2.00 $1.30 330184 270 GUEST TRAY REGULAR O $44.00 $28.60 330184 270 GUEST TRAY BREAKFAST O $24.00 $15.60 330184 270 PT CRUTCHES O $28.00 $18.20 330184 270 PT CANEWOODEN O $11.00 $7.15 330184 801 FEMORAL DIALYSIS-IN PATIE O $832.00 $540.80 330184 820 FEMORAL DIAYSIS-OUT PATIE O "$2,036.00 " "$1,323.40 " 330184 800 HEMODETOX CARTRIDGE O "$2,835.00 " "$1,842.75 " 330184 800 CAPD TRAINING O "$1,428.00 " $928.20 330184 800 CCPD TRAINING O "$1,428.00 " $928.20 330184 800 HEMO HOME TRAINING O $509.00 $330.85 330184 800 IPD HOME TRAINING O $509.00 $330.85 330184 800 HOME DIALYSIS SUPPLIES O $0.00 $0.00 330184 800 TEMP SUBCLAV CATHETER KIT O $403.00 $261.95 330184 800 PERM SUBCLAV CATHETER KIT O $663.00 $430.95 330184 800 PRM SUBCLAV CATH SPLT KIT O $253.00 $164.45 330184 800 PRM SUBCLAV CATH CPL TRAY O "$1,332.00 " $865.80 330184 300 XCEHM SCREEN PROFILE 19 O $48.00 $31.20 330184 300 X%SAT O $0.00 $0.00 330184 300 XFREE THROXINE INDEX O $0.00 $0.00 330184 310 X HLA-DR O $113.00 $73.45 330184 300 PLATELET ANTIBODY PROFILE O $0.00 $0.00 330184 300 AUTOCLAVE-PHARMACY O $0.00 $0.00 330184 300 ENVIRONMENTAL SURVEILLANC O $0.00 $0.00 330184 301 BABESIA O $0.00 $0.00 330184 300 BCR/ABL GENE REARRANGEMEN O $0.00 $0.00 330184 320 MYOSITIS AB PANEL O $0.00 $0.00 330184 272 AMNIO TRAY O $52.00 $33.80 330184 272 FETAL MONITOR STRAPS O $4.00 $2.60 330184 270 BD Angio Cath O $6.00 $3.90 330184 270 Central Venous Cath[Pe O $220.00 $143.00 330184 270 Umbilical Vessel Cath O $40.00 $26.00 330184 270 Mini Vol Extension Set O $2.00 $1.30 330184 270 IV Extension Set w/ Filte O $2.00 $1.30 330184 270 IV Extension Set w/ T O $6.00 $3.90 330184 270 Argyle Feeding Tube O $4.00 $2.60 330184 270 Argyle Suction Cath O $2.00 $1.30 330184 270 Repogal Catheter O $16.00 $10.40 330184 270 Portex ET Tube [Portex O $14.00 $9.10 330184 270 Hugguble Electrodes O $2.00 $1.30 330184 270 Neonatal B/Cuff O $8.00 $5.20 330184 270 O2 Saturation Lead O $26.00 $16.90 330184 270 Single Breast Feeding O $40.00 $26.00 330184 270 Double Breast Feeding O $60.00 $39.00 330184 270 Nipple Shield O $4.00 $2.60 330184 270 Hemo-tap blood spike O $6.00 $3.90 330184 270 Hemo-nate filter O $6.00 $3.90 330184 270 Vygon Feeding Tube#6 O $4.00 $2.60 330184 270 Vermed Electrodes O $10.00 $6.50 330184 270 CPR Bags w/ Manometer O $6.00 $3.90 330184 270 Pediatric CO2 Detector O $20.00 $13.00 330184 270 Argyle Trocar Cath O $40.00 $26.00 330184 270 Infant Spinal Needle O $6.00 $3.90 330184 270 Eye Shield [Clear O $4.00 $2.60 330184 270 Intubation Stylets O $16.00 $10.40 330184 270 Pulmonary percussion O $6.00 $3.90 330184 271 BREAST PUMP O $106.00 $68.90 330184 369 AMBULATORY SURG INITIAL 30 MIN O "$4,468.80 " "$2,904.72 " 330184 369 AMBULATORY SURGERY -23 H O $762.00 $495.30 330184 369 AMBULATORY SURG EA ADDL15 MIN O $787.50 $511.88 330184 271 EXTERNAL PACEMAKER O $111.00 $72.15 330184 272 MULTIPLUMEN CATH O $505.00 $328.25 330184 272 TEMP PACEMAKER DVI O $199.00 $129.35 330184 272 SOLUTION DIANEAL 2.50 IL O $238.00 $154.70 330184 272 BREATHING CIRCUITS O $45.00 $29.25 330184 270 BUCK TRACTION SPLINT O $216.00 $140.40 330184 250 OXYMETAZOLINE NASAL DECON O $16.44 $10.69 330184 250 NaCl 0.9% 50mL SOLN O $0.00 $0.00 330184 710 L&D RECOVERY INIT 30 MINS O $694.05 $451.13 330184 710 L&D RECOVERY ADTL 30 MINS O $347.55 $225.91 330184 270 ARTHREX ANK DSRCTR STRAPS O $110.00 $71.50 330184 270 ARTHREX CENTER LINE O $575.00 $373.75 330184 270 ARTHSUT FIBRWR/TGRLOOP O $130.00 $84.50 330184 270 ARTHREX SUT TAK DISP KIT O $500.00 $325.00 330184 270 CPM RENTL PAD & CLNG FEE O $0.00 $0.00 330184 270 COMPRESSION DEVICE SEQUEN O $372.00 $241.80 330184 270 BLADEENDOSCOPIC CUBITAL O "$1,700.00 " "$1,105.00 " 330184 270 SHOULDER STABLZ KIT SPYDR O $850.00 $552.50 330184 270 ARTHREX DRILL BITS O $330.00 $214.50 330184 270 ARTHREX BB TAK WSHR ACCES O $70.00 $45.50 330184 270 BONE MARROW ASPIR NEEDLE O $0.00 $0.00 330184 270 BLADESAW O $0.00 $0.00 330184 270 EMBOLIZATION COILS O $0.00 $0.00 330184 270 CATHETERCM SIZING O $258.00 $167.70 330184 270 CATHETERQUICK CROSS O $334.00 $217.10 330184 270 INFLATION DEVICEVASCULAR O $270.00 $175.50 330184 270 TOURNIQUET CUFFDISP O $84.00 $54.60 330184 270 CATHETERDILTN OVER WIRE O "$1,100.00 " $715.00 330184 270 CEMENT MIXNG SYSM (MANUAL O $368.00 $239.20 330184 270 ARTHROWAND/ABLATOR O $0.00 $0.00 330184 270 BOTOXTHERAPEUTIC O "$1,050.00 " $682.50 330184 270 NEEDLEMULTIFIRE O $0.00 $0.00 330184 270 SUTUREMISC O $0.00 $0.00 330184 270 Outside exam consultation O $0.00 $0.00 330184 270 Homer localization wire O $58.00 $37.70 330184 270 Hawkins localization wire O $58.00 $37.70 330184 270 Evacuation bottles O $4.00 $2.60 330184 270 Probe covers O $5.00 $3.25 330184 270 Suction canister O $5.00 $3.25 330184 270 Celero handpiece O $263.00 $170.95 330184 270 Atec handpiece O $273.00 $177.45 330184 270 Atec marker O $74.00 $48.10 330184 270 Hysterosalpingography t O $55.00 $35.75 330184 270 INTRODUCER BIOPSY DEVICE O $20.00 $13.00 330184 250 SODIUM CHLORIDE 0.9%/100 ML O $3.82 $2.48 330184 510 OP NO CHARGE O $1.00 $0.65 330184 250 ASCLERA VIAL O $18.00 $11.70 330184 270 COOLING VEST O $1.00 $0.65 330184 270 Ostomy ColostomyPo O $5.00 $3.25 330184 270 NPWT Canister O $45.00 $29.25 330184 250 ISOPROTERENOL INJ 1M O $37.50 $24.38 330184 250 KETALAR 500MG/10ML O $8.43 $5.48 330184 250 NALOXONE INJ .4MG/1M O $4.69 $3.05 330184 250 PONTOCAINE 1%/2ML O $5.27 $3.43 330184 250 TRACRIUM 100MG/10ML O $10.00 $6.50 330184 250 LABETALOL INJ 00MG/20 O $1.90 $1.23 330184 250 LIDOCAINE JELLY 2%/30 O $9.26 $6.02 330184 250 DILANTIN 250MG/5ML O $1.97 $1.28 330184 250 DOBUTREX 250MG/20ML O $3.94 $2.56 330184 250 CETACAINE AER SPRAY O $28.99 $18.84 330184 250 LIDO. 0.8%/DEXT. 5% O $17.75 $11.54 330184 250 Neo-Synephrine 0.5% N O $3.49 $2.27 330184 250 BREVIBLOC 100MG O $142.25 $92.46 330184 250 ADENOCARD 6MG/2ML O $38.90 $25.29 330184 250 LIDOCAINE MPF 1.5%/20 O $7.14 $4.64 330184 250 SENSORCAINE 0.25% INJ O $0.30 $0.20 330184 250 BUPIVACAINE HCL O $3.00 $1.95 330184 250 NITROGLYCERIN 50MG/ O $7.00 $4.55 330184 250 VERAPAMIL HCL 5 MG O $1.04 $0.68 330184 250 NEOSTIGMINE METHYSU O $1.79 $1.16 330184 250 NIFEDIPINE 10MG CAPSU O $0.67 $0.44 330184 250 VECURONIUM BROMIDE O $7.75 $5.04 330184 250 VERSED 5MG/5ML INJ O $15.00 $9.75 330184 250 NITROPRESS 50MG INJ O $26.21 $17.04 330184 250 DIGOXIN INJECTION O $1.04 $0.68 330184 250 DOPAMINE HCL 400MG/ O $4.40 $2.86 330184 250 PHENYLEPHRINE INJECT O $0.85 $0.55 330184 250 HYDRALAZINE 20MG/ML O $2.94 $1.91 330184 250 LIDOCAINE TPC 4% SLTN O $9.16 $5.95 330184 250 MAZICON 1MG/10ML INJ O $49.20 $31.98 330184 250 LINDO CAINE 5% DEXTRS O $5.23 $3.40 330184 250 CARDIZEM INJECTION 25 O $1.85 $1.20 330184 250 DIPRIVAN 200MG/20ML O $10.88 $7.07 330184 250 PROPRANOLOL 1MG/ML O $10.00 $6.50 330184 250 EPINEPHRINE 1-1000 INJ O $8.88 $5.77 330184 250 LIDOCAINE 2% INJECT O $1.82 $1.18 330184 250 ISOFLURANE O $19.27 $12.53 330184 250 SUPRANE INHALATION O $387.00 $251.55 330184 250 LIDOCAINE 5% OINTMEN O $12.00 $7.80 330184 250 PANCURONIUM INJ 10M O $2.08 $1.35 330184 250 CITRIC ACID SODIUM CIT O $0.51 $0.33 330184 250 EDROPHONIUM CHLORI O $48.00 $31.20 330184 250 LIDOCAINE MPF .05% 50 O $2.50 $1.62 330184 250 ANESTHESIA KIT O $100.00 $65.00 330184 250 NIMBEX 2MG 1ML O $23.93 $15.55 330184 250 ROCURONIUM BROMIDE O $8.90 $5.79 330184 250 SEVOFLURANE 1ML LIQU O $225.60 $146.64 330184 250 DIPRIVAN 10 MG/ML INJ O $11.05 $7.18 330184 250 DIPRIVAN 10MG/ML100 O $36.00 $23.40 330184 250 ZEMURON 10MG/ML1 M O $5.24 $3.41 330184 250 SENSORCAINE -DE O $2.71 $1.76 330184 250 NITRO BIDOINTPACKS2% O $0.83 $0.54 330184 250 FIDAXOMICIN 200MG TABLETS O $0.00 $0.00 330184 250 AYR NASAL SALINE GEL O $0.00 $0.00 330184 250 LACTULOSE ENEMA 200 G/10L O $0.00 $0.00 330184 250 SAFRIS 5 MG SL TABS O $0.00 $0.00 330184 250 SAFRIS 10MG SL TABS O $0.00 $0.00 330184 250 POLYETHYLENE GLYCOL 3350) O $0.00 $0.00 330184 250 QUETIAPINE 50MG XR TABLET O $0.00 $0.00 330184 250 RIFAXIMIN 550 MG TABLET O $0.00 $0.00 330184 250 MELOXICAM 7.5MG TABLET O $0.00 $0.00 330184 250 MIDAZOLAM 20MG/10ML ORL O $0.00 $0.00 330184 250 HYDRCHLOROTHIAZIDE 12.5MG O $0.00 $0.00 330184 250 MORPHINE SULFATE 250MG/ML O $0.00 $0.00 330184 250 MRPH SLFT 100MG/5ML ORAL O $0.00 $0.00 330184 250 VITAMIN D 1000 IU TABS O $0.00 $0.00 330184 250 OLANZAPINE DS 10 MG TAB O $0.00 $0.00 330184 250 FERROUS SULF 220/5 480 ML O $0.00 $0.00 330184 250 BIO-K CAPSULES O $0.00 $0.00 330184 250 RITONOVIR 100 MG TABLET O $0.00 $0.00 330184 250 OXYCONTIN 40 MG ER TABLET O $0.00 $0.00 330184 250 CREON 12 O $0.00 $0.00 330184 250 ANDROGEL 1% PACKETS O $0.00 $0.00 330184 250 MEXILITINE 250 MG CAPSULS O $0.00 $0.00 330184 250 QUETIAPINE 200 MG TABLET O $0.00 $0.00 330184 250 PANCRELIPASE 27 5 17K DRC O $0.00 $0.00 330184 250 TRACE ELEM PED 2 ML VIAL O $0.00 $0.00 330184 250 THROMBIN SPRAY KIT O $0.00 $0.00 330184 250 Amino Acid 10% O $0.00 $0.00 330184 250 Dextrose 70% 600mL O $0.00 $0.00 330184 250 SAFETUSSIN DM SF O $0.00 $0.00 330184 250 SCOT TUSSIN SF EXPECTORAN O $0.00 $0.00 330184 250 PREGABALIN 150 MG O $0.00 $0.00 330184 250 FELODIPINE 5 MG O $0.00 $0.00 330184 250 TICAGRELOR 90 MG TAB O $0.00 $0.00 330184 250 BENAZAPRIL 20 MG TABLET O $0.00 $0.00 330184 250 QUETIAPINE XR TABL O $0.00 $0.00 330184 250 NISOLDIPINE 20 MG ERT O $0.00 $0.00 330184 250 ZIPRASIDONE 60 MG CAPSULE O $0.00 $0.00 330184 250 BIOTENE MOISTURE MTH SPRY O $0.00 $0.00 330184 250 MESALAMINE 800 MG DR TABL O $0.00 $0.00 330184 250 TRANEXAMIC ACID INJ O $0.00 $0.00 330184 250 LACOSAMIDE 50 MG O $0.00 $0.00 330184 250 CILOSTAZOL O $0.00 $0.00 330184 250 ALPRAZOLAM 0.5 MG TABLET O $0.00 $0.00 330184 250 DARUNAVIR 800 MG TAB O $0.00 $0.00 330184 250 LEVOFLOXACIN 250MG TABLET O $0.00 $0.00 330184 250 LEVOFLOXACIN 500MG TABLET O $0.00 $0.00 330184 250 RIVAROXABAN 15 MG TABS O $0.00 $0.00 330184 250 RIVAROXABAN 20 MG TABS O $0.00 $0.00 330184 250 SOTALOL 120 MG TAB O $0.00 $0.00 330184 250 MANNITOL 20% 250 ML IV O $0.00 $0.00 330184 250 JANUVIA 50 MG TAB O $0.00 $0.00 330184 250 Lacosamide 200 mg Tab O $0.00 $0.00 330184 250 IVERMECTIN 3 MG TABS O $0.00 $0.00 330184 250 NaCl 0.9% 250 mL nonDEHP O $0.00 $0.00 330184 250 penicillin V 1000 U/mL Oral 80mL O $0.00 $0.00 330184 250 penicillin V 10000 U/mL Oral 16 mL O $0.00 $0.00 330184 250 ACETIC ACID 3% 500ML O $0.00 $0.00 330184 250 EMTRI-RILPIV-TENOF TAB O $0.00 $0.00 330184 250 LOPIN-RITON 400/100MG/5ML LIQ O $0.00 $0.00 330184 250 PEDITRACE 10 ML VIAL O $0.00 $0.00 330184 250 PRE-PEN VIAL O $0.00 $0.00 330184 250 TETRACAINE VISCOUS 0.5% 5ML O $0.00 $0.00 330184 250 TRIMETHOPRIM 100MG TABS O $0.00 $0.00 330184 250 RIVAROXABAN TAB O $0.00 $0.00 330184 250 OMG3 PLYNSTRTD FTY ACDS ETHYL ESTRS 1000 MG CAP O $0.00 $0.00 330184 250 PRNTRL NTRTN SLN AMNO ACDS 5% W/25% DXTRS SLN O $0.00 $0.00 330184 250 BCTRCNPLYMYXN B OPHTHLMC 500/10000 UTS/G ONT O $0.00 $0.00 330184 250 MNTHLZINC OXD TPCL 0.44%20.625% ONT 2.5 O $0.00 $0.00 330184 250 HYDRXYPRPYL MTHYLCLLULOSE 2.5% SLN OPHTH O $0.00 $0.00 330184 250 ACETYLCHOLINE OPHTHALMIC 1% SOLN 2ML AMP O $0.00 $0.00 330184 250 PREDNISOLONE OPHTHALMC SDM PHSPHT 1% SLN O $0.00 $0.00 330184 250 ACETAMNPHN/BUTLBTL/CAFF 300/50/40 MG CAP O $0.00 $0.00 330184 250 GRISEOFULVIN ULTRMCRCRYSTLLNE 250 MG TAB O $0.00 $0.00 330184 250 SODIUM CHLORIDE 0.9% 1000ML SOLN NONDEHP O $0.00 $0.00 330184 250 PARENTRL NTRTN SLN DXTRS 70% IN WTR SLN O $0.00 $0.00 330184 250 DEXTROSE 5% WITH 0.33% NACL 500 ML SOLN O $0.00 $0.00 330184 250 ALUMNM CHLORD HEXAHYDRTE TPCL 20% SOLN O $0.00 $0.00 330184 250 LEVOTHYROXINE 37.5 MCG (0.0375 MG) TAB O $0.00 $0.00 330184 250 ALUMINUM HYDROXIDE 320 MG/5 ML SUSP O $0.00 $0.00 330184 250 NICARDIPINE 20 MG/200 MLD4.8% SOLN-J3490 O $0.00 $0.00 330184 250 DEXAMETHASONE OPHTHALMIC 0.1% SOLN O $0.00 $0.00 330184 250 DESOXIMETASONE TOPICAL 0.25% CREA O $0.00 $0.00 330184 250 MOXIFLOXACIN OPHTHALMIC 0.5% SOLN O $0.00 $0.00 330184 250 SCOPOLAMINE OPHTHALMIC 0.25% SOLN O $0.00 $0.00 330184 250 APRACLONIDINE OPHTHALMIC 1% SOLN O $0.00 $0.00 330184 250 POVIDONE IODINE TOPICAL 10% OINT O $0.00 $0.00 330184 250 POVIDONE IODINE TOPICAL 10% SWAB O $0.00 $0.00 330184 250 METHYL SALICYLATE TOPICAL OINT O $0.00 $0.00 330184 250 BRINZOLAMIDE OPHTHALMIC 1% SUSP O $0.00 $0.00 330184 250 CHLORHEXIDINE TOPICAL 0.12% LIQ O $0.00 $0.00 330184 250 LIDOCAINE TOPICAL 2% JEL (5 ML) O $0.00 $0.00 330184 250 METRONIDAZOLE VAGINAL 0.75% GEL O $0.00 $0.00 330184 250 GENTIAN VIOLET TOPICAL 1% SOLN O $0.00 $0.00 330184 250 ISOSORBIDE DINITRATE 40 MG ERT O $0.00 $0.00 330184 250 KETOROLAC OPHTHALMIC 0.5% SOLN O $0.00 $0.00 330184 250 LIDOCAINE TPCAL 2% JEL (30 ML) O $0.00 $0.00 330184 250 CLOTRIMAZOLE VAGINAL 1% CREAM O $0.00 $0.00 330184 250 MEDROXYPROGESTERONE 10 MG TAB O $0.00 $0.00 330184 250 GLYCINE IRRIGATION 1.5% SOLN O $0.00 $0.00 330184 250 GUAIFENESIN 200 MG/10 ML LIQ O $0.00 $0.00 330184 250 DESMOPRESSIN 10 MCG/INH SPR O $0.00 $0.00 330184 250 DESONIDE TOPICAL 0.05% CREA O $0.00 $0.00 330184 250 CHARCOALSORBITOL 25 G SUSP O $0.00 $0.00 330184 250 BENZOCAINE TOPICAL 10% GEL O $0.00 $0.00 330184 250 VORICONAZOLE 200 MG TABLET O $0.00 $0.00 330184 250 CHLORPHENIRAMINE 4 MG TAB O $0.00 $0.00 330184 250 WITCH HAZEL TOPICAL LIQ O $0.00 $0.00 330184 250 DARUNAVIR 100 MG/ML SUSP O $0.00 $0.00 330184 250 INDIVIDUAL PILL SPLITTER O $0.00 $0.00 330184 250 LEVOCARNITINE 330 MG TAB O $0.00 $0.00 330184 250 CLORAZEPATE 3.75 MG TAB O $0.00 $0.00 330184 250 ABACAVIR 20 MG/ML SOLN O $0.00 $0.00 330184 250 ACETAMINOPHEN 80 MG TC O $0.00 $0.00 330184 250 LACTASE 9000 UNITS TAB O $0.00 $0.00 330184 250 PANTOPRAZOLE 40 MG DRT O $0.00 $0.00 330184 250 RANOLAZINE 1000 MG ERT O $0.00 $0.00 330184 250 RISPERIDONE 0.5 MG TAB O $0.00 $0.00 330184 250 LANOLIN TOPICAL CREA O $0.00 $0.00 330184 250 NEONATAL TPN GENERAL O $0.00 $0.00 330184 250 AMANTADINE 100 MG TAB O $0.00 $0.00 330184 250 CIMETIDINE 300 MG TAB O $0.00 $0.00 330184 250 NATEGLINIDE 60 MG TAB O $0.00 $0.00 330184 250 SUMATRIPTAN 50 MG TAB O $0.00 $0.00 330184 250 VENLAFAXINE 75 MG TAB O $0.00 $0.00 330184 250 ZIDOVUDINE 300 MG TAB O $0.00 $0.00 330184 250 BOSUTINIB 100 MG TAB O $0.00 $0.00 330184 250 DANTROLENE 25 MG CAP O $0.00 $0.00 330184 250 EPLERENONE 25 MG TAB O $0.00 $0.00 330184 250 FLECAINIDE 50 MG TAB O $0.00 $0.00 330184 250 LURASIDONE 20 MG TAB O $0.00 $0.00 330184 250 LURASIDONE 40 MG TAB O $0.00 $0.00 330184 250 PRAMIPEXOLE 0.25 MG O $0.00 $0.00 330184 250 PYRIDOXINE 50 MG TAB O $0.00 $0.00 330184 250 QUINAPRIL 10 MG TAB O $0.00 $0.00 330184 250 CHARCOAL 25 G SUSP O $0.00 $0.00 330184 250 ESTRADIOL 1 MG TAB O $0.00 $0.00 330184 250 LOXAPINE 25 MG CAP O $0.00 $0.00 330184 250 LOXAPINE 50 MG CAP O $0.00 $0.00 330184 250 MIDODRINE 5 MG TAB O $0.00 $0.00 330184 250 OXAZEPAM 15 MG CAP O $0.00 $0.00 330184 250 APIXABAN 5 MG TAB O $0.00 $0.00 330184 250 NIACIN 100 MG TAB O $0.00 $0.00 330184 250 GLUCOSE 4 G TC O $0.00 $0.00 330184 250 OPIUM 0.4 MG/ML TINCTURE O $0.00 $0.00 330184 250 OSELTAMIVIR (TAMIFLU) 30MG O $0.00 $0.00 330184 250 OSELTAMIVIR (TAMIFLU) 45MG O $0.00 $0.00 330184 250 OSELTAMIVR (TAMIFLU) 6MG/ML O $0.00 $0.00 330184 250 OSELTAMIVR (TAMIFLU) 75MG O $0.00 $0.00 330184 250 PANTOPRAZOLE 20MG CAPSULE O $0.00 $0.00 330184 250 CLINIMIX 5/20 AMINO ACID 5%DESTROSE20% O $0.00 $0.00 330184 250 VENTOLIN HFA (SALBUTAMOL) 200 MTRD INHAL O $0.00 $0.00 330184 250 HYDROCORDONE-APAP 10/325 O $0.00 $0.00 330184 250 HYDROCORDONE-APAP 5/325 O $0.00 $0.00 330184 250 HYDROCORDONE-APAP 7.5/325 O $0.00 $0.00 330184 250 AMANTADINE HCL ORAL O $0.00 $0.00 330184 171 NEW BORN NURSERY BASSINET O "$2,019.15 " "$1,312.45 " 330184 173 NEONATAL LEVEL III BASSINET O "$1,991.00 " "$1,294.15 " 330184 112 OBSTETRICS PVT O "$5,618.55 " "$3,652.06 " 330184 122 OBSTETRICS SEMI-P O "$3,133.29 " "$2,036.64 " 330184 200 ICU O "$7,927.64 " "$5,152.96 " 330184 110 PRIVATE O "$5,786.55 " "$3,761.26 " 330184 120 SEMI PRIVATE O "$5,681.55 " "$3,693.01 " 330184 G0259 RT 761 IR ARTHRO SCRL JNT RT O "$1,535.00 " $997.75 330184 G0259 LT 761 IR ARTHRO SACR JNT LT O "$1,535.00 " $997.75 330184 G0260 5442 761 INJ FOR SACROILIAC JT ANESTH BILAT O "$1,535.00 " $997.75 330184 G0260 LT 5442 761 INJ FOR SACROILIAC JT ANESTH LEFT O "$1,535.00 " $997.75 330184 G0260 RT 5442 761 INJ FOR SACROILIAC JT ANESTH RIGHT O "$1,535.00 " $997.75 330184 G0259 761 INJECT FOR SACROILIAC JOINT BILAT O "$1,535.00 " $997.75 330184 G0259 LT 761 INJECT FOR SACROILIAC JOINT LEFT O "$1,535.00 " $997.75 330184 G0259 RT 761 INJECT FOR SACROILIAC JOINT RIGHT O "$1,535.00 " $997.75 330184 C8909 5572 618 MRA W/CONT CHEST O $684.00 $444.60 330184 C8910 5523 618 MRA W/O CONT CHEST O $684.00 $444.60 330184 C8911 5572 618 MRA W/O FOL W/CONT CHEST O $684.00 $444.60 330184 C8911 TC 5572 618 Angio Chest without + wit O "$1,056.00 " $686.40 330184 C8911 TC 5572 610 Angio Subclavian With + W O "$1,056.00 " $686.40 330184 C8911 TC 5572 610 MRA AORTIC ARCH ROOT W&W/ O "$1,056.00 " $686.40 330184 C8911 TC 5572 618 MRA SUB CLAVIAN W&W/O CON O "$1,056.00 " $686.40 330184 C8920 TC 5572 618 Angio Iliac/Pelvis With + O $842.10 $547.37 330184 C8920 TC 5572 618 MRA PELVIS/ILIAC W&W/O CO O $842.10 $547.37 330184 C8918 5572 618 MRA W/CONT PELVIS O "$1,156.00 " $751.40 330184 C8919 5523 618 MRA W/O CONT PELVIS O $706.00 $458.90 330184 C8920 5572 618 MRA W/O FOL W/CONT PELVIS O "$1,156.00 " $751.40 330184 C8936 LT 5572 610 ANG UPR EXT LT W/W/OUT CO O "$4,434.00 " "$2,882.10 " 330184 C8936 LT 5572 618 MRA UPPER EXTREM LT W&W/O O "$4,434.00 " "$2,882.10 " 330184 C8934 LT 5572 618 MRA W/DYE UPPER EXTREMITY LEFT O $802.00 $521.30 330184 C8934 RT 5572 618 MRA W/DYE UPPER EXTREMITY RIGHT O $802.00 $521.30 330184 C8935 LT 5523 618 MRA W/O DYE UPPER EXTR LEFT O $684.00 $444.60 330184 C8935 RT 5523 618 MRA W/O DYE UPPER EXTR RIGHT O $684.00 $444.60 330184 C8936 LT 5572 618 MRA W/O&W/DYE UPPER EXTR LEFT O "$1,291.00 " $839.15 330184 C8936 RT 5572 618 MRA W/O&W/DYE UPPER EXTR RIGHT O "$1,291.00 " $839.15 330184 C8912 LT 5572 616 MRA LEXTREM W CONT-LT-C8912 O "$3,021.90 " "$1,964.24 " 330184 C8912 RT 5572 616 MRA LEXTREM W CONT-RT-C8912 O "$3,021.90 " "$1,964.24 " 330184 C8913 LT 5523 616 MRA LEXTREM WO CONTR-LT-C8913 O "$1,355.00 " $880.75 330184 C8913 RT 5523 616 MRA LEXTREM WO CONTR-RT-C8913 O "$1,355.00 " $880.75 330184 C8914 LT 5572 616 MRA LEXTREM WO/W CONTR-LT-C8914 O "$1,355.00 " $880.75 330184 C8914 RT 5572 616 MRA LEXTREM WO/W CONTR-RT-C8914 O "$1,355.00 " $880.75 330184 C8914 50 5572 616 Angio Lower Ext. Bilatera O "$2,032.50 " "$1,321.12 " 330184 C8914 RT 5572 616 Ang Lwr Ext RT W/W/OUT CO O "$1,355.00 " $880.75 330184 C8914 LT 5572 616 Ang Lwr Ext LT W/W/OUT CO O "$1,355.00 " $880.75 330184 C8914 TC 5572 616 Angio Peripheral Runoff w O "$1,551.90 " "$1,008.74 " 330184 C8914 TC 5572 616 MRA PERIPHERAL RUN-OFF W& O "$1,551.90 " "$1,008.74 " 330184 C8912 50 5572 616 MRA W/CONT LWR EXT BILAT O "$2,032.50 " "$1,321.12 " 330184 C8912 LT 5572 616 MRA W/CONT LWR EXT LEFT O "$3,021.90 " "$1,964.24 " 330184 C8912 RT 5572 616 MRA W/CONT LWR EXT RIGHT O "$3,021.90 " "$1,964.24 " 330184 C8913 LT 5523 616 MRA W/O CON LWR EXT LEFT O "$1,355.00 " $880.75 330184 C8913 50 5523 616 MRA W/O CONT LWR EXT BILAT O "$2,032.50 " "$1,321.12 " 330184 C8913 RT 5523 616 MRA W/O CONT LWR EXT RIGHT O "$1,355.00 " $880.75 330184 C8914 50 5572 616 MRA W/O FOL W/CONT LWR EXT BILAT O "$2,032.50 " "$1,321.12 " 330184 C8914 LT 5572 616 MRA W/O FOL W/CONT LWR EXT LEFT O "$1,355.00 " $880.75 330184 C8914 RT 5572 616 MRA W/O FOL W/CONT LWR EXT RIGHT O "$1,355.55 " $881.11 330184 C8902 TC 5572 618 Angio Renal With + Withou O $842.10 $547.37 330184 C8902 TC 5572 618 MRCP With + Without Contr O $842.10 $547.37 330184 C8902 TC 5572 610 MRA ABDOMEN W&W/O CONTRAS O $842.10 $547.37 330184 C8902 TC 5572 610 MRA ABDOMINAL AORTA W&W/O O $842.10 $547.37 330184 C8900 5572 618 MRA W/CONT ABD O $842.10 $547.37 330184 C8901 5523 618 MRA W/O CONT ABD O $842.10 $547.37 330184 C8902 5572 618 MRA W/O FOL W/CONT ABD O $842.10 $547.37 330184 C8905 LT 5572 614 MRI BREAST W&WO CNT-LEFT-77048 O "$1,158.00 " $752.70 330184 C8905 RT 5572 614 MRI BREAST W&WO CNT-RIGHT-77048 O "$1,158.00 " $752.70 330184 C8908 5572 614 MRI BREAST W&WO CNT BIL-77049 O "$1,158.00 " $752.70 330184 G0480 301 ASSAY OF ETHANOL- O $312.00 $202.80 330184 G0480 301 ASSAY OF NICOTINE- O $294.00 $191.10 330184 G0480 301 ASSAY OF AMPHETAMINES- O $312.00 $202.80 330184 G0480 301 ASSAY OF DIHYDROTESTOSTERONE- O $294.00 $191.10 330184 G0480 301 ASSAY OF ACETAMINOPHEN- O $312.00 $202.80 330184 G0480 301 ASSAY SALICYLATE- O $312.00 $202.80 330184 G0480 301 ANTIDEPRESSANTS CLASS 1 OR 2-80332/G0480 O $294.00 $191.10 330184 G0480 301 ASSAY AMITRIPTYLINE- O $312.00 $202.80 330184 G0480 301 ASSAY DESIPRAMINE- O $312.00 $202.80 330184 G0480 301 ASSAY DOXEPIN- O $312.00 $202.80 330184 G0480 301 ASSAY IMIPRAMINE- O $312.00 $202.80 330184 G0480 301 ASSAY OF NORTIPTYLINE- O $312.00 $202.80 330184 G0480 301 ASSAY OF METHSUXIMIDE- O $294.00 $191.10 330184 G0480 301 CLOBAZAM (URBANYL)- O $294.00 $191.10 330184 G0480 301 ASSAY OF PHENOTHIAZINE- O $294.00 $191.10 330184 G0480 301 ASSAY OF BARBITURATES- O $312.00 $202.80 330184 G0480 301 ASSAY BENZODIAZEPINES- O $312.00 $202.80 330184 G0480 301 ASSAY OF FLURAZEPAM- O $312.00 $202.80 330184 G0480 301 DRUG SCREENING BUPRENORPHINE-80348 O $286.00 $185.90 330184 G0480 301 ASSAY OF METHADONE- O $294.00 $191.10 330184 G0480 301 ASSAY OF OPIATES- O $312.00 $202.80 330184 G0480 301 ASSAY OF MEPROBAMATE- O $294.00 $191.10 330184 G0480 301 DRUG TEST DEF 1-7 CLASSES O $294.00 $191.10 330184 G0010 5691 771 ADMIN HEP B VACCINE O $105.00 $68.25 330184 G0009 5691 771 ADMIN PNEUMO VACCINE O $105.00 $68.25 330184 G0008 5691 459 771 ADMIN INFLUENZA VACCINE O $105.00 $68.25 330184 G0010 5691 771 ADMIN HEPATITIS B VACCINE O $105.00 $68.25 330184 G0008 5691 459 771 ADMINISTRATION OF INFLUEN O $105.00 $68.25 330184 G0008 5691 459 771 PEDS ADMIN INFLUENZA VAC O $105.00 $68.25 330184 G0008 5691 459 771 ADMIN INFLUENZA VACCINE O $105.00 $68.25 330184 G0009 5691 771 ADMIN PNEUMO VACCINE O $105.00 $68.25 330184 G0008 5691 459 771 ADM OF INFLZ VIRUS VACC O $105.00 $68.25 330184 Q2037 636 IIV3 VACC .5 ML DOS IM(CLNC) O $22.00 $14.30 330184 Q2036 636 INFLUENZA QUAD 2019-20 SEASON-Q2036 O $0.00 $0.00 330184 636 varicella Vaccine O $0.00 $0.00 330184 Q3014 GQ 497 780 PHONE-INTERACTIVE COMPLEXITY-90785 O $51.00 $33.15 330184 Q3014 GT 497 780 VIDEO-INTERACTIVE COMPLEXITY-90785 O $51.00 $33.15 330184 Q3014 GQ 497 780 PHONE-DIAG PSYC INTRVW WO E/M-90791 O $538.13 $349.78 330184 Q3014 GT 497 780 VIDEO-DIAG PSYC INTRVW WO E/M-90791 O $538.13 $349.78 330184 Q3014 GQ 497 780 PHONE-DIAG PSYCH INTRVW W E/M-90792 O $400.05 $260.03 330184 Q3014 GT 497 780 VIDEO-DIAG PSYCH INTRVW W E/M-90792 O $400.05 $260.03 330184 Q3014 GQ 497 780 PHONE-PSYCHTHPY 30 MINS W PTNT-90832 O $329.47 $214.16 330184 Q3014 GT 497 780 VIDEO-PSYCHTHPY 30 MINS W PTNT-90832 O $329.47 $214.16 330184 Q3014 GQ 497 780 PHONE-PSYCHTHPY 30 MINS W PTNT E&M-90833 O $135.45 $88.04 330184 Q3014 GT 497 780 VIDEO-PSYCHTHPY 30 MINS W PTNT E&M-90833 O $135.45 $88.04 330184 Q3014 GQ 497 780 PHONE-PSYCHTHPY 45 MINS W PTNT-90834 O $400.05 $260.03 330184 Q3014 GT 497 780 VIDEO-PSYCHTHPY 45 MINS W PTNT-90834 O $400.05 $260.03 330184 Q3014 GQ 497 780 PHONE-PSYCHTHPY 45 MINS W PTNT W E&M-90836 O $180.60 $117.39 330184 Q3014 GT 497 780 VIDEO-PSYCHTHPY 45 MINS W PTNT W E&M-90836 O $180.60 $117.39 330184 Q3014 GQ 497 780 PHONE-PSYTX W PT 60 MINUTES-90837 O $381.28 $247.83 330184 Q3014 GT 497 780 VIDEO-PSYTX W PT 60 MINUTES-90837 O $381.28 $247.83 330184 Q3014 GQ 497 780 PHONE-PSYTX W PT W E/M 60 MIN-90838 O $180.60 $117.39 330184 Q3014 GT 497 780 VIDEO-PSYTX W PT W E/M 60 MIN-90838 O $180.60 $117.39 330184 Q3014 GQ 497 780 PHONE-PSYCHOTHPY FOR CRISIS; 1ST 60 MINS-90839 O $381.00 $247.65 330184 Q3014 GT 497 780 VIDEO-PSYCHOTHPY FOR CRISIS; 1ST 60 MINS-90839 O $381.00 $247.65 330184 Q3014 GQ 497 780 PHONE-PSYCHOTHPY FOR CRISIS; EA 30 MINUTES-90840 O $140.00 $91.00 330184 Q3014 GT 497 780 VIDEO-PSYCHOTHPY FOR CRISIS; EA 30 MINUTES-90840 O $140.00 $91.00 330184 Q3014 GQ 497 780 PHONE-PSYCHOANALYSIS-90845 O $398.00 $258.70 330184 Q3014 GT 497 780 VIDEO-PSYCHOANALYSIS-90845 O $398.00 $258.70 330184 Q3014 GQ 497 780 PHONE-FAMILY PSYTX W/O PT 50 MIN-90846 O $392.18 $254.92 330184 Q3014 GT 497 780 VIDEO-FAMILY PSYTX W/O PT 50 MIN-90846 O $392.18 $254.92 330184 Q3014 GQ 497 780 PHONE-FMLY PSYCHTHPY W PTNT 50 MINS-90847 O $398.00 $258.70 330184 Q3014 GT 497 780 VIDEO-FMLY PSYCHTHPY W PTNT 50 MINS-90847 O $398.00 $258.70 330184 Q3014 GQ 497 780 PHONE-GROUP THERAPY-90853 O $213.00 $138.45 330184 Q3014 GT 497 780 VIDEO-GROUP THERAPY-90853 O $213.00 $138.45 330184 Q3014 GQ 497 780 PHONE-PSYCHOPHYSIOLOGICAL THPY-90875 O $589.00 $382.85 330184 Q3014 GT 497 780 VIDEO-PSYCHOPHYSIOLOGICAL THPY-90875 O $589.00 $382.85 330184 Q3014 GQ 497 780 PHONE-INIT INHALATION THPY-94664 O $474.00 $308.10 330184 Q3014 GT 497 780 VIDEO-INIT INHALATION THPY-94664 O $474.00 $308.10 330184 G0451 5822 440 DEVELOPMENTAL SCREEN W/SCORE-96110 O $193.00 $125.45 330184 Q3014 GQ 497 780 PHONE-DEVELOPM SCREEN W/SCORE-96110 O $193.00 $125.45 330184 Q3014 GT 497 780 VIDEO-DEVELOPM SCREEN W/SCORE-96110 O $193.00 $125.45 330184 G0451 5822 440 DEVELOPMENTAL SCREEN W/SCORE O $193.00 $125.45 330184 Q3014 GQ 497 780 PHONE-DEVEL TST PHYS/QHP 1ST HR-96112 O $418.00 $271.70 330184 Q3014 GT 497 780 VIDEO-DEVEL TST PHYS/QHP 1ST HR-96112 O $418.00 $271.70 330184 Q3014 GQ 497 780 PHONE-DEVEL TST PHYS/QHP EA ADL-96113 O $306.00 $198.90 330184 Q3014 GT 497 780 VIDEO-DEVEL TST PHYS/QHP EA ADL-96113 O $306.00 $198.90 330184 Q3014 GQ 497 780 PHONE-NUBHVL XM PHYS/QHP 1ST HR-96116 O $765.00 $497.25 330184 Q3014 GT 497 780 VIDEO-NUBHVL XM PHYS/QHP 1ST HR-96116 O $765.00 $497.25 330184 Q3014 GQ 497 780 PHONE-NUBHVL XM PHY/QHP EA ADDL HR-96121 O $497.00 $323.05 330184 Q3014 GT 497 780 VIDEO-NUBHVL XM PHY/QHP EA ADDL HR-96121 O $497.00 $323.05 330184 Q3014 GQ 497 780 PHONE-BRIEF EMOTNL-BEHAV ASSMT-96127 O $39.90 $25.93 330184 Q3014 GT 497 780 VIDEO-BRIEF EMOTNL-BEHAV ASSMT-96127 O $39.90 $25.93 330184 Q3014 GQ 497 780 PHONE-PSYCL TST EVAL PHYS/QHP 1ST HR-96130 O $408.00 $265.20 330184 Q3014 GT 497 780 VIDEO-PSYCL TST EVAL PHYS/QHP 1ST HR-96130 O $408.00 $265.20 330184 Q3014 GQ 497 780 PHONE-PSYCL TST EVAL PHYS/QHP ADDTL HRS-96131 O $233.00 $151.45 330184 Q3014 GT 497 780 VIDEO-PSYCL TST EVAL PHYS/QHP ADDTL HRS-96131 O $233.00 $151.45 330184 Q3014 GQ 497 780 PHONE-NRPSYC TST EVAL PHYS/QHP 1ST-96132 O $418.00 $271.70 330184 Q3014 GT 497 780 VIDEO-NRPSYC TST EVAL PHYS/QHP 1ST-96132 O $418.00 $271.70 330184 Q3014 GQ 497 780 PHONE-NRPSYC TST EVAL PHYS/QHP EA-96133 O $605.00 $393.25 330184 Q3014 GT 497 780 VIDEO-NRPSYC TST EVAL PHYS/QHP EA-96133 O $605.00 $393.25 330184 Q3014 GQ 497 780 PHONE-PSYCL/NRPSYC TST PHY/QHP 1ST 30 MINS-96136 O $52.00 $33.80 330184 Q3014 GT 497 780 VIDEO-PSYCL/NRPSYC TST PHY/QHP 1ST 30 MINS-96136 O $52.00 $33.80 330184 Q3014 GQ 497 780 PHONE-PSYCL/NRPSYC TST PHY/QHP ADDTL 30MINS-96137 O $55.00 $35.75 330184 Q3014 GT 497 780 VIDEO-PSYCL/NRPSYC TST PHY/QHP ADDTL 30MINS-96137 O $55.00 $35.75 330184 Q3014 GQ 497 780 PHONE-PSYCL/NRPSYC TECH 1ST 30MINS-96138 O $52.00 $33.80 330184 Q3014 GT 497 780 VIDEO-PSYCL/NRPSYC TECH 1ST 30MINS-96138 O $52.00 $33.80 330184 Q3014 GQ 497 780 PHONE-PSYCL/NRPSYC TST TECH ADDTL 30MINS-96139 O $118.00 $76.70 330184 Q3014 GT 497 780 VIDEO-PSYCL/NRPSYC TST TECH ADDTL 30MINS-96139 O $118.00 $76.70 330184 Q3014 GQ 497 780 PHONE-INITL HLTH & BHVR ASSMNT W PATIENT–96150 O $184.00 $119.60 330184 Q3014 GT 497 780 VIDEO-INITL HLTH & BHVR ASSMNT W PATIENT–96150 O $184.00 $119.60 330184 Q3014 GQ 497 780 PHONE-HLTH & BHVR REASSMNT-96151 O $223.65 $145.37 330184 Q3014 GT 497 780 VIDEO-HLTH & BHVR REASSMNT-96151 O $223.65 $145.37 330184 Q3014 GQ 497 780 PHONE-HLTH & BHVR INTRVNT–F2F INDVDL-96152 O $184.00 $119.60 330184 Q3014 GT 497 780 VIDEO-HLTH & BHVR INTRVNT–F2F INDVDL-96152 O $184.00 $119.60 330184 Q3014 GQ 497 780 PHONE-HLTH & BHVR INTRVNT; GROUP-96153 O $76.00 $49.40 330184 Q3014 GT 497 780 VIDEO-HLTH & BHVR INTRVNT; GROUP-96153 O $76.00 $49.40 330184 Q3014 GQ 497 780 PHONE-HLTH & BHVR INTRVNT; FMLY W PAT-96154 O $223.65 $145.37 330184 Q3014 GT 497 780 VIDEO-HLTH & BHVR INTRVNT; FMLY W PAT-96154 O $223.65 $145.37 330184 Q3014 GQ 497 780 PHONE-HLTH BHV ASSMT/REASSESSMENT-96156 O $238.00 $154.70 330184 Q3014 GT 497 780 VIDEO-HLTH BHV ASSMT/REASSESSMENT-96156 O $238.00 $154.70 330184 Q3014 GQ 497 780 PHONE-HLTH BHV IVNTJ INDIV 1ST 30-96158 O $238.00 $154.70 330184 Q3014 GT 497 780 VIDEO-HLTH BHV IVNTJ INDIV 1ST 30-96158 O $238.00 $154.70 330184 Q3014 GQ 497 780 PHONE-HLTH BHV IVNTJ INDIV EA ADDL-96159 O $60.00 $39.00 330184 Q3014 GT 497 780 VIDEO-HLTH BHV IVNTJ INDIV EA ADDL-96159 O $60.00 $39.00 330184 Q3014 GQ 497 780 PHONE-PT-FOCUSED HLTH RISK ASSMT-96160 O $79.80 $51.87 330184 Q3014 GT 497 780 VIDEO-PT-FOCUSED HLTH RISK ASSMT-96160 O $79.80 $51.87 330184 Q3014 GQ 497 780 PHONE-CAREGIVER HEALTH RISK ASSMT-96161 O $79.80 $51.87 330184 Q3014 GT 497 780 VIDEO-CAREGIVER HEALTH RISK ASSMT-96161 O $79.80 $51.87 330184 Q3014 GQ 497 780 PHONE-HLTH BHV IVNTJ GRP 1ST 30-96164 O $83.00 $53.95 330184 Q3014 GT 497 780 VIDEO-HLTH BHV IVNTJ GRP 1ST 30-96164 O $83.00 $53.95 330184 Q3014 GQ 497 780 PHONE-HLTH BHV IVNTJ GRP EA ADDL-96165 O $10.00 $6.50 330184 Q3014 GT 497 780 VIDEO-HLTH BHV IVNTJ GRP EA ADDL-96165 O $10.00 $6.50 330184 Q3014 GQ 497 780 PHONE-HLTH BHV IVNTJ FAM 1ST 30-96167 O $83.00 $53.95 330184 Q3014 GT 497 780 VIDEO-HLTH BHV IVNTJ FAM 1ST 30-96167 O $83.00 $53.95 330184 Q3014 GQ 497 780 PHONE-HLTH BHV IVNTJ FAM WO PT 1ST-96170 O $528.00 $343.20 330184 Q3014 GT 497 780 VIDEO-HLTH BHV IVNTJ FAM WO PT 1ST-96170 O $528.00 $343.20 330184 Q3014 GQ 497 780 PHONE-HLTH BHV IVNTJ FAM W/O PT EA-96171 O $264.00 $171.60 330184 Q3014 GT 497 780 VIDEO-HLTH BHV IVNTJ FAM W/O PT EA-96171 O $264.00 $171.60 330184 G0283 493 420 PT-E STIM(UNATTENDED) O $135.00 $87.75 330184 G0283 493 420 PT E STIM UNATTENDED MED O $135.00 $87.75 330184 G0283 493 430 OT E STIM (UNATTENDED) O $135.00 $87.75 330184 Q3014 GQ 497 780 PHONE-MEDICAL NUTRITIONAL THERAPY-97802 O $149.10 $96.92 330184 Q3014 GT 497 780 VIDEO-MEDICAL NUTRITIONAL THERAPY-97802 O $149.10 $96.92 330184 Q3014 GQ 497 780 PHONE-MEDICAL NUTRIT THPY REASS-97803 O $36.75 $23.89 330184 Q3014 GT 497 780 VIDEO-MEDICAL NUTRIT THPY REASS-97803 O $36.75 $23.89 330184 Q3014 GQ 497 780 PHONE-GRP NUTRITION THERAPY ;EA-97804 O $19.00 $12.35 330184 Q3014 GT 497 780 VIDEO-GRP NUTRITION THERAPY ;EA-97804 O $19.00 $12.35 330184 G0463 5012 491 510 SUTURE REMOVAL CLN-99201 O $32.00 $20.80 330184 G0463 5012 491 450 SUTURE REMOVAL ED-99201 O $97.00 $63.05 330184 G0463 5012 491 510 WOUND CHECK CLN-99201 O $32.00 $20.80 330184 G0463 5012 491 450 WOUND CHECK ER-99201 O $32.00 $20.80 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 1 NEW-99201 O $97.00 $63.05 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 1 NEW-99201 O $97.00 $63.05 330184 G0463 5012 491 510 ANTEPARTUM LAB NEW LEVEL 1-99201 O $211.00 $137.15 330184 G0463 5012 491 510 BARIATRIC SURG NEW LEVEL 1-99201 O $211.00 $137.15 330184 G0463 5012 491 510 BREAST CTR NEW LEVEL 1-99201 O $211.00 $137.15 330184 G0463 5012 491 510 INFECTIOUS DIS NEW LEVEL 1-99201 O $211.00 $137.15 330184 G0463 25 5012 491 510 ANTEP LAB NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 G0463 25 5012 491 510 BARTR SURG NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 G0463 25 5012 491 510 BRST CTR NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 G0463 25 5012 491 510 INFCT DIS NEW LVL 1-99201+25MOD O $211.00 $137.15 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 1 N O $97.00 $63.05 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 1 O $97.00 $63.05 330184 G0463 5012 491 510 EYE CLINIC LEVEL 1 NEW O $32.00 $20.80 330184 G0463 5012 491 510 MEDICAT CLINIC LEVEL 1 NE O $97.00 $63.05 330184 G0463 5012 491 510 PEDIATRICS VIS LEVEL1 NEW O $32.00 $20.80 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 1 O $32.00 $20.80 330184 G0463 5012 491 510 HEMATOLOGY NEW O $32.00 $20.80 330184 G0463 5012 491 510 PRETEST COUSEL W/O BLOODW O $32.00 $20.80 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 1 NEW O $32.00 $20.80 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 1 N O $32.00 $20.80 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $32.00 $20.80 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONC O $32.00 $20.80 330184 G0463 5012 491 510 RHEUMATOLOGY CLINIC LEVEL O $32.00 $20.80 330184 G0463 5012 491 510 Pediatric Surgery New Le O $32.00 $20.80 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 1 NEW O $32.00 $20.80 330184 G0463 5012 491 513 Peds DvL Psch New Level 1 O $32.00 $20.80 330184 G0463 5012 491 510 PEDIATRIC VISIT LEV 1 NEW O $97.00 $63.05 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $32.00 $20.80 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 1 O $32.00 $20.80 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 1 NE O $32.00 $20.80 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 1 O $32.00 $20.80 330184 G0463 5012 491 510 OB clinic level 1 New O $97.00 $63.05 330184 G0463 5012 491 510 GYN New Visit Level 1 O $97.00 $63.05 330184 G0463 5012 491 510 PULMONARY NEW VST LEVEL 1 O $32.00 $20.80 330184 G0463 5012 491 510 NEPHROLOGY NEW VT LEVEL 1 O $32.00 $20.80 330184 G0463 5012 491 510 SPINE CLNC LEVEL 1 NEW O $32.00 $20.80 330184 G0463 5012 491 580 GERIATRIC DAY CARE O $32.00 $20.80 330184 G0463 5012 491 580 Adult Day Care Trnspt Rnd O $32.00 $20.80 330184 G0463 5012 491 580 Adult Day Care Trnspt One O $32.00 $20.80 330184 G0463 5012 491 510 INFUSION SUITE NEW LEVEL 1 O $32.00 $20.80 330184 G0463 25 5012 491 510 INF SUITE NEW LEVEL 1W/ 25 MDF O $32.00 $20.80 330184 G0463 5012 491 510 DERM LEVEL 1 NEW O $32.00 $20.80 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 1 NEW O $97.00 $63.05 330184 G0463 5012 491 510 ONCOLOGY NEW LEVEL 1 O $32.00 $20.80 330184 G0463 25 5012 491 510 CLINIC NEW LEVEL 1 W 25 MDF O $97.00 $63.05 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 2 NEW-99202 O $121.24 $78.81 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 2 NEW-99202 O $121.24 $78.81 330184 G0463 5012 491 510 ANTEPARTUM LAB NEW LEVEL 2-99202 O $318.00 $206.70 330184 G0463 5012 491 510 BARIATRIC SURG NEW LEVEL 2-99202 O $318.00 $206.70 330184 G0463 5012 491 510 BREAST CTR NEW LEVEL 2-99202 O $318.00 $206.70 330184 G0463 5012 491 510 INFECTIOUS DIS NEW LEVEL 2-99202 O $318.00 $206.70 330184 G0463 25 5012 491 510 ANTEP LAB NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 G0463 25 5012 491 510 BARTR SURG NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 G0463 25 5012 491 510 BRST CTR NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 G0463 25 5012 491 510 INFCT DIS NEW LVL 2-99202+25MOD O $318.00 $206.70 330184 G0463 5012 491 510 PEDIATRIC SURGERY LEVEL 2 O $121.24 $78.81 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $121.24 $78.81 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONCO O $121.24 $78.81 330184 G0463 5012 491 513 Peds Dvl Psch New Level 2 O $121.24 $78.81 330184 G0463 5012 491 510 MEDICAT CLINIC LEVEL 2 NE O $121.24 $78.81 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 2 O $121.24 $78.81 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 2 N O $121.24 $78.81 330184 G0463 5012 491 510 EYE CLINIC LEVEL 2 NEW O $121.24 $78.81 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 2 O $121.24 $78.81 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 2 O $121.24 $78.81 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 2 N O $121.24 $78.81 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 2 NE O $121.24 $78.81 330184 G0463 5012 491 510 Rheumatolgoy Clinic Level O $121.24 $78.81 330184 G0463 5012 491 510 Dermatology Clinic Lvl2n O $121.24 $78.81 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 2 NEW O $121.24 $78.81 330184 G0463 5012 491 510 BREAST CLINIC LEV 2 NEW O $121.24 $78.81 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $121.24 $78.81 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 2 NEW O $121.24 $78.81 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 2 O $121.24 $78.81 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 2 NE O $121.24 $78.81 330184 G0463 5012 491 510 OB clinic level 2 New O $121.24 $78.81 330184 G0463 5012 491 510 MEDICAL CLNC LEVEL 2 NEW O $121.24 $78.81 330184 G0463 5012 491 510 GYN New Visit Level 2 O $121.24 $78.81 330184 G0463 5012 491 510 PULMONARY NEW VST LEVEL 2 O $121.24 $78.81 330184 G0463 5012 491 510 NEPHROLOGY NEW VT LEVEL 2 O $121.24 $78.81 330184 G0463 5012 491 510 INFUSION SUITE NEW LEVEL 2 O $121.24 $78.81 330184 G0463 25 5012 491 510 INF SUITE NEW LEVEL 2W/ 25 MDF O $121.24 $78.81 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 2 NEW O $121.24 $78.81 330184 G0463 5012 491 510 ONCOLOGY NEW LEVEL 2 O $121.24 $78.81 330184 G0463 25 5012 491 510 CLINIC NEW LEVEL 2 W 25 MDF O $121.24 $78.81 330184 G0463 5012 491 510 CLIN NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW(PBB) VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 G0463 5012 491 510 CLN NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP NEW(PBB) VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC NEW VST 15-29 MIN(MOD25)-99202 O $1.00 $0.65 330184 G0463 5012 491 510 ONC NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP NEW(PBB) VST 15-29 MIN-99202 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC NEW VST 15-29 MIN-99202 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 3 NEW-99203 O $151.56 $98.51 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 3 NEW-99203 O $151.56 $98.51 330184 G0463 5012 491 510 ANTEPARTUM LAB NEW LEVEL 3-99203 O $337.00 $219.05 330184 G0463 5012 491 510 BARIATRIC SURG NEW LEVEL 3-99203 O $337.00 $219.05 330184 G0463 5012 491 510 BREAST CTR NEW LEVEL 3-99203 O $337.00 $219.05 330184 G0463 5012 491 510 INFECTIOUS DIS NEW LEVEL 3-99203 O $337.00 $219.05 330184 G0463 25 5012 491 510 ANTEP LAB NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 G0463 25 5012 491 510 BARTR SURG NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 G0463 25 5012 491 510 BRST CTR NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 G0463 25 5012 491 510 INFCT DIS NEW LVL 3-99203+25MOD O $337.00 $219.05 330184 G0463 5012 491 510 PEDIATRIC SURGERY LEVEL 3 O $151.56 $98.51 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $151.56 $98.51 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONCO O $151.56 $98.51 330184 G0463 5012 491 513 Peds Dvl Psch New Level 3 O $151.56 $98.51 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 3 NE O $151.56 $98.51 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 3 O $151.56 $98.51 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 3 N O $151.56 $98.51 330184 G0463 5012 491 510 EYE CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 3 O $151.56 $98.51 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 3 O $151.56 $98.51 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 3 N O $151.56 $98.51 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 3 NE O $151.56 $98.51 330184 G0463 5012 491 510 RHEUMATOLOGY CLINIC LEVEL O $151.56 $98.51 330184 G0463 5012 491 510 ENT Clinic Level 3 New O $151.56 $98.51 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $151.56 $98.51 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 3 NEW O $151.56 $98.51 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 3 O $151.56 $98.51 330184 G0463 5012 491 510 PEDIATRICS CLINIC LEVEL O $151.56 $98.51 330184 G0463 5012 491 510 OB clinic level 3 New O $151.56 $98.51 330184 G0463 5012 491 510 GYN New Visit Level 3 O $151.56 $98.51 330184 G0463 5012 491 510 PULMONARY NEW VST LEVEL 3 O $151.56 $98.51 330184 G0463 5012 491 510 NEPHROLOGY NEW VT LEVEL 3 O $151.56 $98.51 330184 G0463 5012 491 510 INFUSION SUITE NEW LEVEL 3 O $151.56 $98.51 330184 G0463 25 5012 491 510 INF SUITE NEW LEVEL 3W/ 25 MDF O $151.56 $98.51 330184 G0463 5012 491 510 DERM LEVEL 3 NEW O $151.56 $98.51 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 3 NEW O $151.56 $98.51 330184 G0463 5012 491 510 ONCOLOGY NEW LEVEL 3 O $151.56 $98.51 330184 G0463 25 5012 491 510 CLINIC NEW LEVEL 3 W 25 MDF O $151.56 $98.51 330184 G0463 5012 491 510 CLIN NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW(PBB) VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 G0463 5012 491 510 CLN NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP NEW(PBB) VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC NEW VST 30-44 MIN(MOD25)-99203 O $1.00 $0.65 330184 G0463 5012 491 510 ONC NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP NEW(PBB) VST 30-44 MIN-99203 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC NEW VST 30-44 MIN-99203 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 4 NEW-99204 O $189.44 $123.14 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 4 NEW-99204 O $189.44 $123.14 330184 G0463 5012 491 510 ANTEPARTUM LAB NEW LEVEL 4-99204 O $385.00 $250.25 330184 G0463 5012 491 510 BARIATRIC SURG NEW LEVEL 4-99204 O $385.00 $250.25 330184 G0463 5012 491 510 BREAST CTR NEW LEVEL 4-99204 O $385.00 $250.25 330184 G0463 5012 491 510 INFECTIOUS DIS NEW LEVEL 4-99204 O $385.00 $250.25 330184 G0463 25 5012 491 510 ANTEP LAB NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 G0463 25 5012 491 510 BARTR SURG NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 G0463 25 5012 491 510 BRST CTR NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 G0463 25 5012 491 510 INFCT DIS NEW LVL 4-99204+25MOD O $385.00 $250.25 330184 G0463 5012 491 510 Pediatric Surgery New Le O $189.44 $123.14 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $189.44 $123.14 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONCO O $189.44 $123.14 330184 G0463 5012 491 513 Peds Dvl Psch New Level 4 O $189.44 $123.14 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 4 NE O $189.44 $123.14 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 4 O $189.44 $123.14 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 4 N O $189.44 $123.14 330184 G0463 5012 491 510 EYE CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 4 O $189.44 $123.14 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 4 O $189.44 $123.14 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 4 N O $189.44 $123.14 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 4 NE O $189.44 $123.14 330184 G0463 5012 491 510 RHEUMATOLOGY CLINIC LEVEL O $189.44 $123.14 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $189.44 $123.14 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 4 NEW O $189.44 $123.14 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 4 O $189.44 $123.14 330184 G0463 5012 491 510 SOCIAL WORK PRENATAL VISI O $189.44 $123.14 330184 G0463 5012 491 510 Gyn New Visit O $189.44 $123.14 330184 G0463 5012 491 510 OB clinic level 4 New O $189.44 $123.14 330184 G0463 5012 491 510 SOCIAL WORK VISIT PRENATA O $189.44 $123.14 330184 G0463 5012 491 510 GYN New Visit Level 4 O $189.44 $123.14 330184 G0463 5012 491 510 PULMONARY NEW VST LEVEL 4 O $189.44 $123.14 330184 G0463 5012 491 510 NEPHROLOGY NEW VT LEVEL 4 O $189.44 $123.14 330184 G0463 5012 491 510 MEDICAL CLNC LEVEL 4 NEW O $189.44 $123.14 330184 G0463 5012 491 510 INFUSION SUITE NEW LEVEL 4 O $189.44 $123.14 330184 G0463 25 5012 491 510 INF SUITE NEW LEVEL 4W/ 25 MDF O $189.44 $123.14 330184 G0463 5012 491 510 DERM LEVEL 4 NEW O $189.44 $123.14 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 4 NEW O $189.44 $123.14 330184 G0463 5012 491 510 ONCOLOGY NEW LEVEL 4 O $189.44 $123.14 330184 G0463 25 5012 491 510 CLINIC NEW LEVEL 4 W 25 MDF O $189.44 $123.14 330184 G0463 5012 491 510 CLIN NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW(PBB) VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 G0463 5012 491 510 CLN NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP NEW(PBB) VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC NEW VST 45-59 MIN(MOD25)-99204 O $1.00 $0.65 330184 G0463 5012 491 510 ONC NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP NEW(PBB) VST 45-59 MIN-99204 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC NEW VST 45-59 MIN-99204 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 5 NEW-99205 O $236.81 $153.93 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 5 NEW-99205 O $236.81 $153.93 330184 G0463 5012 491 510 ANTEPARTUM LAB NEW LEVEL 5-99205 O $493.00 $320.45 330184 G0463 5012 491 510 BARIATRIC SURG NEW LEVEL 5-99205 O $493.00 $320.45 330184 G0463 5012 491 510 BREAST CTR NEW LEVEL 5-99205 O $493.00 $320.45 330184 G0463 5012 491 510 INFECTIOUS DIS NEW LEVEL 5-99205 O $493.00 $320.45 330184 G0463 25 5012 491 510 ANTEP LAB NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 G0463 25 5012 491 510 BARTR SURG NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 G0463 25 5012 491 510 BRST CTR NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 G0463 25 5012 491 510 INFCT DIS NEW LVL 5-99205+25MOD O $493.00 $320.45 330184 G0463 5012 491 510 Initial New Pren Vi 1St T O $236.81 $153.92 330184 G0463 5012 491 510 Pediatric Surgery New Lev O $236.81 $153.92 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONCO O $236.81 $153.92 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $236.81 $153.92 330184 G0463 5012 491 513 Peds Dvl Psch New Level 5 O $236.81 $153.92 330184 G0463 5012 491 510 MEDICAT CLINIC LEVEL 5 NE O $236.81 $153.92 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 5 O $236.81 $153.92 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 5 N O $236.81 $153.92 330184 G0463 5012 491 510 EYE CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 5 O $236.81 $153.92 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 5 O $236.81 $153.92 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 5 N O $236.81 $153.92 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 5 NE O $236.81 $153.92 330184 G0463 5012 491 510 Rheumatolgoy Clinic Level O $236.81 $153.92 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 G0463 5012 491 510 Endocrinte New Level 5 O $236.81 $153.92 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 5 NEW O $236.81 $153.92 330184 G0463 5012 491 510 PEDIATRICS VISIT LEV 5 NE O $236.81 $153.92 330184 G0463 5012 491 510 OB clinic level 5 New O $236.81 $153.92 330184 G0463 5012 491 510 Initial New Pren 2Nd Tri O $236.81 $153.92 330184 G0463 5012 491 510 Init New Prenat 3Rd Tri O $236.81 $153.92 330184 G0463 5012 491 510 GYN New Visit Level 5 O $236.81 $153.92 330184 G0463 5012 491 510 PULMONARY NEW VST LEVEL 5 O $236.81 $153.92 330184 G0463 5012 491 510 NEPHROLOGY NEW VT LEVEL 5 O $236.81 $153.92 330184 G0463 5012 491 510 MEDICAL CLNC LEVEL 5 NEW O $236.81 $153.92 330184 G0463 5012 491 510 INFUSION SUITE NEW LEVEL 5 O $236.81 $153.92 330184 G0463 25 5012 491 510 INF SUITE NEW LEVEL 5W/ 25 MDF O $236.81 $153.92 330184 G0463 5012 491 510 DERM LEVEL 5 NEW O $236.81 $153.92 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 5 NEW O $236.81 $153.92 330184 G0463 5012 491 510 ONCOLOGY NEW LEVEL 5 O $236.81 $153.92 330184 G0463 25 5012 491 510 CLINIC NEW LEVEL 5 W 25 MDF O $236.81 $153.92 330184 G0463 5012 491 510 CLIN NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN NEW(PBB) VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 G0463 5012 491 510 CLN NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP NEW(PBB) VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC NEW VST 60-74 MIN(MOD25)-99205 O $1.00 $0.65 330184 G0463 5012 491 510 ONC NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP NEW(PBB) VST 60-74 MIN-99205 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC NEW VST 60-74 MIN-99205 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 1 ESTBL-99211 O $74.61 $48.50 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 1 ESTBL-99211 O $74.61 $48.50 330184 G0463 5012 491 510 ANTEPARTUM LAB ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 G0463 5012 491 510 BARIATRIC SURG ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 G0463 5012 491 510 BREAST CTR ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 G0463 5012 491 510 INFECTIOUS DIS ESTBL LEVEL 1-99211 O $143.00 $92.95 330184 G0463 25 5012 491 510 ANTEP LAB ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 G0463 25 5012 491 510 BARTR SURG ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 G0463 25 5012 491 510 BRST CTR ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 G0463 25 5012 491 510 INFCT DIS ESTBL LVL 1-99211+25MOD O $143.00 $92.95 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 1 E O $170.00 $110.50 330184 G0463 5012 491 510 ORTHOPEDIC LEVEL 1 ESTABL O $74.61 $48.50 330184 G0463 5012 491 510 EYE CLINIC LEVEL 1 ESTABL O $170.00 $110.50 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 1 ES O $74.61 $48.50 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 1 O $74.61 $48.50 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $170.00 $110.50 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 1 O $170.00 $110.50 330184 G0463 5012 491 510 HEMATOLOGY REVISIT O $170.00 $110.50 330184 G0463 5012 491 510 PERIPHERI VASC REVISIT O $170.00 $110.50 330184 G0463 5012 491 510 TB CHEST REVISIT O $170.00 $110.50 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 1 ES O $170.00 $110.50 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 1 ESTAB O $74.61 $48.50 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 1 E O $74.61 $48.50 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $170.00 $110.50 330184 G0463 5012 491 510 PEDS HEMATOLOGY/ONCOLOGY O $170.00 $110.50 330184 G0463 5012 491 510 Adolescent Clinic Lvl1Es O $170.00 $110.50 330184 G0463 5012 491 510 RHEUMATOLOGY CLINIC LEVEL O $170.00 $110.50 330184 G0463 5012 491 510 PEDIATRIC SURGERY LEVEL 1 O $74.61 $48.50 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 1 EST O $170.00 $110.50 330184 G0463 5012 491 513 Peds Dvl Psch EST Level 1 O $74.61 $48.50 330184 G0463 5012 491 510 NUTRITIONAL CONSULTATION O $170.00 $110.50 330184 G0463 5012 491 510 ROUTINE FOLLOW UP VISIT O $170.00 $110.50 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 1 E O $74.61 $48.50 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 1 O $74.61 $48.50 330184 G0463 5012 491 510 CLINIC CONSULT LEVEL 1 O $170.00 $110.50 330184 G0463 5012 491 510 NUTRITIONAL COUNS PRENATA O $170.00 $110.50 330184 G0463 5012 491 510 OB clinic level 1 Estb O $74.61 $48.50 330184 G0463 5012 491 510 NUTRITION CONS PRENATAL O $170.00 $110.50 330184 G0463 5012 491 510 POST TEST COUSELING LIMIT O $170.00 $110.50 330184 G0463 5012 491 510 GYN Established Visit Lev O $74.61 $48.50 330184 G0463 5012 491 510 PULMONARY EST VST LEVEL 1 O $170.00 $110.50 330184 G0463 5012 491 510 NEPHROLOGY EST VT LEVEL 1 O $170.00 $110.50 330184 G0463 5012 491 510 SPINE CLNC LEVEL 1 ESTAB O $170.00 $110.50 330184 G0463 5012 491 510 INSULIN PUMP TRNG 30 MINS O $74.61 $48.50 330184 G0463 5012 491 510 INSULIN PUMP TRAINING F/U O $170.00 $110.50 330184 G0463 5012 491 510 NUTRTN CARB CNCL PMP 30M O $170.00 $110.50 330184 G0463 5012 491 510 INFUSION SUITE ESTB LEVEL 1 O $74.61 $48.50 330184 G0463 25 5012 491 510 INF SUITE ESTB LEVEL 1W/ 25 MDF O $74.61 $48.50 330184 G0463 5012 491 510 DERM LEVEL 1 ESTB O $170.00 $110.50 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 1 EST O $74.61 $48.50 330184 G0463 5012 491 510 ONCOLOGY ESTB LEVEL 1 O $74.61 $48.50 330184 G0463 25 5012 491 510 CLINIC ESTB LEVEL 1 W 25 MDF O $74.61 $48.50 330184 G0463 25 5012 491 510 CLIN EST VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 G0463 5012 491 510 CLIN EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN EST(PBB) VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 G0463 5012 491 510 CLN EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP EST(PBB) VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC EST VST 1-9 MIN(MOD25)-99211 O $1.00 $0.65 330184 G0463 5012 491 510 ONC EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP EST(PBB) VST 1-9 MIN-99211 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC EST VST 1-9 MIN-99211 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 2 ESTBL-99212 O $93.26 $60.62 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 2 ESTBL-99212 O $93.26 $60.62 330184 G0463 5012 491 510 ANTEPARTUM LAB ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 G0463 5012 491 510 BARIATRIC SURG ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 G0463 5012 491 510 BREAST CTR ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 G0463 5012 491 510 INFECTIOUS DIS ESTBL LEVEL 2-99212 O $156.00 $101.40 330184 G0463 25 5012 491 510 ANTEP LAB ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 G0463 25 5012 491 510 BARTR SURG ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 G0463 25 5012 491 510 BRST CTR ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 G0463 25 5012 491 510 INFCT DIS ESTBL LVL 2-99212+25MOD O $156.00 $101.40 330184 G0463 5012 491 510 PEDIATRIC SURGERY LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $93.26 $60.62 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONCO O $93.26 $60.62 330184 G0463 5012 491 513 Peds Dvl Psch EST Level 2 O $93.26 $60.62 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 2 ES O $93.26 $60.62 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 2 E O $93.26 $60.62 330184 G0463 5012 491 510 EYE CLINIC LEVEL 2 ESTABL O $93.26 $60.62 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 2 E O $93.26 $60.62 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 2 ES O $93.26 $60.62 330184 G0463 5012 491 510 RHEUMATOLOGY CLINI LEVEL O $93.26 $60.62 330184 G0463 5012 491 510 Dermatology Clinic Lvl 2 O $93.26 $60.62 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 2 ESTAB O $93.26 $60.62 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 2 EST O $93.26 $60.62 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $93.26 $60.62 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 2 EST O $93.26 $60.62 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 PEDIATRICS CLINIC LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 HEMATOLOGY LEVEL 2 EST O $93.26 $60.62 330184 G0463 5012 491 510 OB clinic level 2 Estb O $93.26 $60.62 330184 G0463 5012 491 510 GYN Established Visit Lev O $93.26 $60.62 330184 G0463 5012 491 510 PULMONARY EST VST LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 NEPHROLOGY EST VT LEVEL 2 O $93.26 $60.62 330184 G0463 5012 491 510 INFUSION SUITE ESTB LEVEL 2 O $93.26 $60.62 330184 G0463 25 5012 491 510 INF SUITE ESTB LEVEL 2W/ 25 MDF O $93.26 $60.62 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 2 EST O $93.26 $60.62 330184 G0463 5012 491 510 ONCOLOGY ESTB LEVEL 2 O $93.26 $60.62 330184 G0463 25 5012 491 510 CLINIC ESTB LEVEL 2 W 25 MDF O $93.26 $60.62 330184 G0463 25 5012 491 510 CLIN EST VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 G0463 5012 491 510 CLIN EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN EST(PBB) VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 G0463 5012 491 510 CLN EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP EST(PBB) VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC EST VST 10-19 MIN(MOD25)-99212 O $1.00 $0.65 330184 G0463 5012 491 510 ONC EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP EST(PBB) VST 10-19 MIN-99212 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC EST VST 10-19 MIN-99212 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 1 ESTBL-99213 O $116.58 $75.78 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 1 ESTBL-99213 O $116.58 $75.78 330184 G0463 5012 491 510 ANTEPARTUM LAB ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 G0463 5012 491 510 BARIATRIC SURG ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 G0463 5012 491 510 BREAST CTR ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 G0463 5012 491 510 INFECTIOUS DIS ESTBL LEVEL 3-99213 O $164.00 $106.60 330184 G0463 25 5012 491 510 ANTEP LAB ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 G0463 25 5012 491 510 BARTR SURG ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 G0463 25 5012 491 510 BRST CTR ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 G0463 25 5012 491 510 INFCT DIS ESTBL LVL 3-99213+25MOD O $164.00 $106.60 330184 G0463 5012 491 510 PEDIATRIC SURGERY LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $116.58 $75.78 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONCO O $116.58 $75.78 330184 G0463 5012 491 513 PED DEVEL PSYCH EST LVL 3 O $116.58 $75.78 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 3 ES O $116.58 $75.78 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 3 E O $116.58 $75.78 330184 G0463 5012 491 510 EYE CLINIC LEVEL 3 ESTABL O $116.58 $75.78 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 3 E O $116.58 $75.78 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 3 ES O $116.58 $75.78 330184 G0463 5012 491 510 RHEUMATOLOGY CLINIC LEVEL O $116.58 $75.78 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 3 ESTAB O $116.58 $75.78 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 3 EST O $116.58 $75.78 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $116.58 $75.78 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 3 EST O $116.58 $75.78 330184 G0463 5012 491 510 OB clinic level 3 Estb O $116.58 $75.78 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 ONCOLOGY CLINIC LEVEL 3 E O $116.58 $75.78 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 3 S O $116.58 $75.78 330184 G0463 5012 491 510 PEDIATRICS CLINIC LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 GYN Established Visit Lev O $116.58 $75.78 330184 G0463 5012 491 510 PULMONARY EST VST LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 NEPHROLOGY EST VT LEVEL 3 O $116.58 $75.78 330184 G0463 5012 491 510 INFUSION SUITE ESTB LEVEL 3 O $116.58 $75.78 330184 G0463 25 5012 491 510 INF SUITE ESTB LEVEL 3W/ 25 MDF O $116.58 $75.78 330184 G0463 5012 491 510 DERM LEVEL 3 ESTB O $116.58 $75.78 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 3 EST O $116.58 $75.78 330184 G0463 5012 491 510 ONCOLOGY ESTB LEVEL 3 O $116.58 $75.78 330184 G0463 25 5012 491 510 CLINIC ESTB LEVEL 3 W 25 MDF O $116.58 $75.78 330184 G0463 25 5012 491 510 CLIN EST VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 G0463 5012 491 510 CLIN EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN EST(PBB) VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 G0463 5012 491 510 CLN EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP EST(PBB) VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC EST VST 20-29 MIN(MOD25)-99213 O $1.00 $0.65 330184 G0463 5012 491 510 ONC EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP EST(PBB) VST 20-29 MIN-99213 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC EST VST 20-29 MIN-99213 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 4 ESTBL-99214 O $145.73 $94.72 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 4 ESTBL-99214 O $145.73 $94.72 330184 G0463 5012 491 510 ANTEPARTUM LAB ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 G0463 5012 491 510 BARIATRIC SURG ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 G0463 5012 491 510 BREAST CTR ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 G0463 5012 491 510 INFECTIOUS DIS ESTBL LEVEL 4-99214 O $228.00 $148.20 330184 G0463 25 5012 491 510 ANTEP LAB ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 G0463 25 5012 491 510 BARTR SURG ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 G0463 25 5012 491 510 BRST CTR ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 G0463 25 5012 491 510 INFCT DIS ESTBL LVL 4-99214+25MOD O $228.00 $148.20 330184 G0463 5012 491 510 PEDIATRIC SURGERY LEVEL 4 O $145.73 $94.72 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $145.73 $94.72 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONCO O $145.73 $94.72 330184 G0463 5012 491 513 Peds Dvl Psch EST Level 4 O $145.73 $94.72 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 4 ES O $145.73 $94.72 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 4 O $145.73 $94.72 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 4 E O $145.73 $94.72 330184 G0463 5012 491 510 EYE CLINIC LEVEL 4 ESTABL O $145.73 $94.72 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 4 O $145.73 $94.72 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 4 O $145.73 $94.72 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 4 E O $145.73 $94.72 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 4 ES O $145.73 $94.72 330184 G0463 5012 491 510 RHEUMATOLOGY CLINIC LEVEL O $145.73 $94.72 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 4 NEW E O $145.73 $94.72 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 4 EST O $145.73 $94.72 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $145.73 $94.72 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 4 EST O $145.73 $94.72 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 4 O $145.73 $94.72 330184 G0463 5012 491 510 PEDIATRICS CLINIC LEVEL O $145.73 $94.72 330184 G0463 5012 491 510 OB clinic level 4 Estb O $145.73 $94.72 330184 G0463 5012 491 510 GYN Established Visit Lev O $145.73 $94.72 330184 G0463 5012 491 510 PULMONARY EST VST LEVEL 4 O $145.73 $94.72 330184 G0463 5012 491 510 NEPHROLOGY EST VT LEVEL 4 O $145.73 $94.72 330184 G0463 5012 491 510 INFUSION SUITE ESTB LEVEL 4 O $145.73 $94.72 330184 G0463 25 5012 491 510 INF SUITE ESTB LEVEL 4W/ 25 MDF O $145.73 $94.72 330184 G0463 5012 491 510 DERM LEVEL 4 ESTB O $145.73 $94.72 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 4 EST O $145.73 $94.72 330184 G0463 5012 491 510 ONCOLOGY ESTB LEVEL 4 O $145.73 $94.72 330184 G0463 25 5012 491 510 CLINIC ESTB LEVEL 4 W 25 MDF O $145.73 $94.72 330184 G0463 25 5012 491 510 CLIN EST VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 G0463 5012 491 510 CLIN EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN EST(PBB) VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 G0463 5012 491 510 CLN EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP EST(PBB) VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC EST VST 30-39 MIN(MOD25)-99214 O $1.00 $0.65 330184 G0463 5012 491 510 ONC EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP EST(PBB) VST 30-39 MIN-99214 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC EST VST 30-39 MIN-99214 O $1.00 $0.65 330184 Q3014 GQ 497 780 PHONE-CLINIC LEVEL 5 ESTBL-99215 O $182.16 $118.40 330184 Q3014 GT 497 780 VIDEO-CLINIC LEVEL 5 ESTBL-99215 O $182.16 $118.40 330184 G0463 5012 491 510 ANTEPARTUM LAB ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 G0463 5012 491 510 BARIATRIC SURG ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 G0463 5012 491 510 BREAST CTR ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 G0463 5012 491 510 INFECTIOUS DIS ESTBL LEVEL 5-99215 O $322.00 $209.30 330184 G0463 25 5012 491 510 ANTEP LAB ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 G0463 25 5012 491 510 BARTR SURG ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 G0463 25 5012 491 510 BRST CTR ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 G0463 25 5012 491 510 INFCT DIS ESTBL LVL 5-99215+25MOD O $322.00 $209.30 330184 G0463 5012 491 510 PEDIATRIC SURGERY LEVEL 5 O $182.16 $118.40 330184 G0463 5012 491 510 PEDIATRIC HEMATOLOGY/ONC O $182.16 $118.40 330184 G0463 5012 491 510 PEDIATRIC CARDIOLOGY LEVE O $182.16 $118.40 330184 G0463 5012 491 513 Peds Dvl Psch EST Level 5 O $182.16 $118.40 330184 G0463 5012 491 510 MEDICAL CLINIC LEVEL 5 ES O $182.16 $118.40 330184 G0463 5012 491 510 ORTHOPEDIC CLINIC LEVEL 5 O $182.16 $118.40 330184 G0463 5012 491 510 PODIATRY CLINIC LEVEL 5 E O $182.16 $118.40 330184 G0463 5012 491 510 EYE CLINIC LEVEL 5 ESTABL O $182.16 $118.40 330184 G0463 5012 491 510 CARDIOLOGY CLINIC LEVEL 5 O $182.16 $118.40 330184 G0463 5012 491 510 NEUROLOGY CLINIC LEVEL 5 O $182.16 $118.40 330184 G0463 5012 491 510 SURGICAL CLINIC LEVEL 5 E O $182.16 $118.40 330184 G0463 5012 491 510 UROLOGY CLINIC LEVEL 5 ES O $182.16 $118.40 330184 G0463 5012 491 510 RHEUMATOLOGY CLINIC LEVEL O $182.16 $118.40 330184 G0463 5012 491 510 G.I. CLINIC LEVEL 5 ESTAB O $182.16 $118.40 330184 G0463 5012 491 510 BREAST CLINIC LEVEL 5 EST O $182.16 $118.40 330184 G0463 5012 491 510 ENDOCRINOLOGY CLINIC LEVE O $182.16 $118.40 330184 G0463 5012 491 510 SPINE CLINIC LEVEL 5 EST O $182.16 $118.40 330184 G0463 5012 491 510 PEDIATRICS VISIT LEVEL 5 O $182.16 $118.40 330184 G0463 5012 491 510 OB clinic level 5 Estb O $182.16 $118.40 330184 G0463 5012 491 510 GYN Established Visit Lev O $182.16 $118.40 330184 G0463 5012 491 510 Initial Estab Prena 1St T O $182.16 $118.40 330184 G0463 5012 491 510 Initial Estab Prena 2Nd T O $182.16 $118.40 330184 G0463 5012 491 510 PULMONARY EST VST LEVEL 5 O $182.16 $118.40 330184 G0463 5012 491 510 NEPHROLOGY EST VT LEVEL 5 O $182.16 $118.40 330184 G0463 5012 491 510 INFUSION SUITE ESTB LEVEL 5 O $182.16 $118.40 330184 G0463 25 5012 491 510 INF SUITE ESTB LEVEL 5W/ 25 MDF O $182.16 $118.40 330184 G0463 5012 491 510 DERM LEVEL 5 ESTB O $182.16 $118.40 330184 G0463 5012 491 510 COLORECTAL CLNC LVL 5 EST O $182.16 $118.40 330184 G0463 5012 491 510 ONCOLOGY ESTB LEVEL 5 O $182.16 $118.40 330184 G0463 25 5012 491 510 CLINIC ESTB LEVEL 5 W 25 MDF O $182.16 $118.40 330184 G0463 25 5012 491 510 CLIN EST VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 G0463 5012 491 510 CLIN EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 G0463 25 5012 491 510 CLN EST(PBB) VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 G0463 5012 491 510 CLN EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-CLN EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 G0463 25 5012 491 510 ANTEP EST(PBB) VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 G0463 5012 491 510 ANTEP EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 G0463 25 5012 491 510 ONC EST VST 40-54 MIN(MOD25)-99215 O $1.00 $0.65 330184 G0463 5012 491 510 ONC EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ANTEP EST(PBB) VST 40-54 MIN-99215 O $1.00 $0.65 330184 Q3014 GT 497 780 VID-ONC EST VST 40-54 MIN-99215 O $1.00 $0.65 330184 G0463 5012 491 510 Office Consultation Level O $412.00 $267.80 330184 G0438 25 510 INIT PM E/M NEW PAT INFANT-99381-25 O $277.20 $180.18 330184 G0439 510 WELL BABY (0-1) O $277.20 $180.18 330184 G0438 25 510 INIT PM E/M NEW PAT 1-4 YRS-99382-25 O $311.85 $202.70 330184 G0439 510 WELL CHILD (1-4) O $311.85 $202.70 330184 G0438 25 510 PREV VISIT NEW AGE 5-11-99383-25 O $347.55 $225.91 330184 G0439 510 WELL CHILD (5-11) O $347.55 $225.91 330184 G0438 510 WELL CHILD (5-11) NEW O $347.55 $225.91 330184 G0438 25 510 PREV VISIT NEW AGE 12-17-99384-25 O $382.20 $248.43 330184 G0439 510 WELL ADOLESCENT (12-17) O $382.20 $248.43 330184 G0438 25 510 PREV VISIT NEW AGE 18-39-99385-25 O $416.85 $270.95 330184 G0439 510 WELL ADOLESCENT (18+) O $416.85 $270.95 330184 G0438 510 Prev Visit New Age 18-3 O $416.85 $270.95 330184 G0438 510 Prev Visit New Age 40-6 O $452.55 $294.16 330184 G0438 770 Init Pm E/m New Pat 65+ O $485.10 $315.31 330184 G0439 25 770 PER PM REEVAL EST PAT INFANT-99391-25 O $207.90 $135.14 330184 G0439 770 WELL BABY ESTABLISHED (0- O $207.90 $135.14 330184 G0439 770 WELL BABY (0-1) EST O $207.90 $135.14 330184 G0439 25 770 PREV VISIT EST AGE 1-4-99392-25 O $243.60 $158.34 330184 G0439 770 WELL CHILD ESTABLISHED (1 O $243.60 $158.34 330184 G0439 770 WELL CHILD (1-4) EST O $243.60 $158.34 330184 G0439 25 770 PREV VISIT EST AGE 5-11-99393-25 O $277.20 $180.18 330184 G0439 770 WELL CHILD ESTABLISHED(5- O $277.20 $180.18 330184 G0439 25 770 PREV VISIT EST AGE 12-17-99394-25 O $311.85 $202.70 330184 G0439 770 WELL ADOLESCENT ESTABLISH O $311.85 $202.70 330184 G0439 770 WELL CHILD (12-17) EST O $311.85 $202.70 330184 G0439 25 770 PREV VISIT EST AGE 18-39-99395-25 O $347.55 $225.91 330184 G0439 770 WELL ADOLDESCENT ESTABLIS O $347.55 $225.91 330184 G0439 770 Prev Visit Est Age 18-3 O $347.55 $225.91 330184 G0439 770 Prev Visit Est Age 40-6 O $382.20 $248.43 330184 G0439 770 Per Pm Reeval Est Pat 65+ O $416.85 $270.95 330184 Q3014 GQ 497 780 PHONE-ASMT/CNSL ALCHL/DRG 15-30MINS-99408 O $43.05 $27.98 330184 Q3014 GT 497 780 VIDEO-ASMT/CNSL ALCHL/DRG 15-30MINS-99408 O $43.05 $27.98 330184 G0396 5821 315 510 ASSM CNSL ALCH/DRUG 15-30 O $43.05 $27.98 330184 Q3014 GQ 497 780 PHONE-ASMT/CNSLN ALCHL/DRUG >30MINS-99409 O $79.00 $51.35 330184 Q3014 GT 497 780 VIDEO-ASMT/CNSLN ALCHL/DRUG >30MINS-99409 O $79.00 $51.35 330184 G0397 5822 316 510 ASSM/CNSL ALCH/DRUG >30 O $79.00 $51.35 330184 Q3014 GQ 497 780 PHONE E/M PHYS/QHP 5-10 MIN-99441 O $99.00 $64.35 330184 Q3014 GQ 497 780 PHONE E/M PHYS/QHP 5-10 MIN-PBB-99441 O $59.00 $38.35 330184 Q3014 GQ 497 780 PHONE E/M PHYS/QHP 11-20 MIN-99442 O $220.00 $143.00 330184 Q3014 GQ 497 780 PHONE E/M PHYS/QHP 11-20 MIN-PBB-99442 O $132.00 $85.80 330184 Q3014 GQ 497 780 PHONE E/M PHYS/QHP 21-30 MIN-99443 O $278.00 $180.70 330184 Q3014 GQ 497 780 PHONE E/M PHYS/QHP 21-30 MIN-PBB-99443 O $167.00 $108.55 330184 Q3014 GQ 497 780 PHONE-ASSMT & CARE PLN PT COG IMP-99483 O $238.00 $154.70 330184 Q3014 GT 497 780 VIDEO-ASSMT & CARE PLN PT COG IMP-99483 O $238.00 $154.70 330184 Q3014 GQ 497 780 PHONE-ADVNCD CARE PLAN 30 MIN-99497 O $213.00 $138.45 330184 Q3014 GT 497 780 VIDEO-ADVNCD CARE PLAN 30 MIN-99497 O $213.00 $138.45 330184 Q3014 GQ 497 780 PHONE-ADVNCD CARE PLAN ADDL 30 MIN-99498 O $85.00 $55.25 330184 Q3014 GT 497 780 VIDEO-ADVNCD CARE PLAN ADDL 30 MIN-99498 O $85.00 $55.25 330184 Q3014 GQ 497 780 PHONE-DIABETIC EDCTN IND 30 MIN-G0108 O $180.60 $117.39 330184 Q3014 GT 497 780 VIDEO-DIABETIC EDCTN IND 30 MIN-G0108 O $180.60 $117.39 330184 Q3014 GQ 497 780 PHONE-DIABETIC EDCTN GRP 30 MIN-G0109 O $121.80 $79.17 330184 Q3014 GT 497 780 VIDEO-DIABETIC EDCTN GRP 30 MIN-G0109 O $121.80 $79.17 330184 Q3014 GQ 497 780 PHONE-ED SVC CKD IND PER SESS-G0420 O $366.00 $237.90 330184 Q3014 GT 497 780 VIDEO-ED SVC CKD IND PER SESS-G0420 O $366.00 $237.90 330184 Q3014 GQ 497 780 PHONE-SMOKING CESSATION 3-10MIN-G0436 O $40.00 $26.00 330184 Q3014 GT 497 780 VIDEO-SMOKING CESSATION 3-10MIN-G0436 O $40.00 $26.00 330184 Q3014 GQ 497 780 PHONE-SMOKING CESSATION >10MIN-GO437 O $83.00 $53.95 330184 Q3014 GT 497 780 VIDEO-SMOKING CESSATION >10MIN-GO437 O $83.00 $53.95 330184 Q3014 GQ 497 780 PHONE-BEHAV COUNS OBES 15MINS-G0447 O $216.00 $140.40 330184 Q3014 GT 497 780 VIDEO-BEHAV COUNS OBES 15MINS-G0447 O $216.00 $140.40 330184 Q3014 GQ 497 780 PHONE-COMP ASSES CARE PLAN CCM SVC-G0506 O $168.00 $109.20 330184 Q3014 GT 497 780 VIDEO-COMP ASSES CARE PLAN CCM SVC-G0506 O $168.00 $109.20 330184 Q3014 GQ 497 780 PHONE-BRIEF CHECK IN BY MD/QHP-G2012 O $56.00 $36.40 330184 Q3014 GT 497 780 VIDEO-BRIEF CHECK IN BY MD/QHP-G2012 O $56.00 $36.40 330184 G0463 5012 491 510 POS CLIN DEPRES SCRN F/U DOC-G8431 O $412.00 $267.80 330184 J3490 435 636 Bumetanide Injection 1mg/ O $0.00 $0.00 330184 003 ECMO/TRCH W MV 96+H/PDX EX FCE MTH&NCK &MJ OR I "$902,221.48 " "$586,443.96 " 330184 004 TRCH W MV 96+H/ PDX EXC FCE MTH&NCK NO MJ OR I "$1,378,347.41 " "$895,925.82 " 330184 039 EXTRACRANIAL PROCEDURES NO CC I "$18,416.02 " "$11,970.41 " 330184 040 PERIPH & CRANL NERV & OTH NERV SYS PROC W MCC I "$295,459.08 " "$192,048.40 " 330184 041 PERIPH&CRAN NRV&OTH NERV SYS PRC W CC I "$127,095.06 " "$82,611.79 " 330184 042 PERIPH & CRANL NERV & OTH NERV SYS PROC NO CC I "$53,874.49 " "$35,018.42 " 330184 054 NERVOUS SYSTEM NEOPLASMS W MCC I "$40,742.68 " "$26,482.74 " 330184 056 DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC I "$101,058.53 " "$65,688.05 " 330184 057 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC I "$55,245.28 " "$35,909.43 " 330184 059 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC I "$59,449.34 " "$38,642.07 " 330184 060 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA NO CC I "$51,429.34 " "$33,429.07 " 330184 061 ACUTE ISCHEMC STROKE W/THROMBLYTIC AGNT W MCC I "$110,255.70 " "$71,666.21 " 330184 062 ACUTE ISCHEMC STROKE W/THROMBLYTIC AGNT W CC I "$74,769.86 " "$48,600.41 " 330184 064 INTRACRANIAL HEMORHG OR CEREBRL INFARCT W MCC I "$214,132.56 " "$139,186.16 " 330184 065 INTRACRANIAL HEMORHG OR CEREBRAL INFARCT W CC I "$131,817.70 " "$85,681.50 " 330184 066 INTRACRANIAL HEMORHG OR CEREBRAL INFRCT NO CC I "$62,212.44 " "$40,438.09 " 330184 067 NONSPEC CVA & PRECERBRL OCCLS W/O INFRCT WMCC I "$28,834.79 " "$18,742.61 " 330184 068 NONSPEC CVA& PRECERBR OCCLS W/O INFRCT W/OMCC I "$28,849.14 " "$18,751.94 " 330184 069 TRANSIENT ISCHEMIA I "$68,884.71 " "$44,775.06 " 330184 070 NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC I "$218,780.67 " "$142,207.44 " 330184 071 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC I "$39,777.86 " "$25,855.61 " 330184 072 NONSPECIFIC CEREBROVASCULAR DISORDERS NO CC I "$43,429.08 " "$28,228.90 " 330184 073 CRANIAL & PERIPHERAL NERVE DISORDERS W MCC I "$38,853.79 " "$25,254.96 " 330184 074 CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC I "$66,561.53 " "$43,265.00 " 330184 077 HYPERTENSIVE ENCEPHALOPATHY W MCC I "$49,338.75 " "$32,070.19 " 330184 078 HYPERTENSIVE ENCEPHALOPATHY W CC I "$33,091.52 " "$21,509.48 " 330184 080 NONTRAUMATIC STUPOR & COMA W MCC I "$67,798.11 " "$44,068.77 " 330184 082 "TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC" I "$34,219.73 " "$22,242.82 " 330184 086 "TRAUMATIC STUPOR & COMA, COMA <1 HR W CC" I "$52,246.37 " "$33,960.14 " 330184 087 "TRAUMATIC STUPOR & COMA, COMA <1 HR NO CC" I "$32,382.52 " "$21,048.64 " 330184 091 OTHER DISORDERS OF NERVOUS SYSTEM W MCC I "$171,298.71 " "$111,344.16 " 330184 092 OTHER DISORDERS OF NERVOUS SYSTEM W CC I "$45,369.17 " "$29,489.96 " 330184 093 OTHER DISORDERS OF NERVOUS SYSTEM NO CC I "$35,419.60 " "$23,022.74 " 330184 095 BACT & TUBERCULOUS INFECTNS OF NERV SYS W CC I "$66,458.95 " "$43,198.32 " 330184 099 NON-BACT INF NERV SYS EXC VIRAL MENGITS NO CC I "$41,991.01 " "$27,294.16 " 330184 100 SEIZURES W MCC I "$63,479.34 " "$41,261.57 " 330184 101 SEIZURES W/O MCC I "$66,153.58 " "$42,999.82 " 330184 103 HEADACHES W/O MCC I "$35,961.37 " "$23,374.89 " 330184 123 NEUROLOGICAL EYE DISORDERS I "$38,266.96 " "$24,873.52 " 330184 125 OTHER DISORDERS OF THE EYE W/O MCC I "$29,890.59 " "$19,428.88 " 330184 146 "EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC" I "$148,139.59 " "$96,290.73 " 330184 149 DYSEQUILIBRIUM I "$48,616.42 " "$31,600.67 " 330184 152 OTITIS MEDIA & URI W MCC I "$55,086.68 " "$35,806.34 " 330184 153 OTITIS MEDIA & URI W/O MCC I "$22,751.87 " "$14,788.72 " 330184 155 NASAL TRAUMA & DEFORMITY W CC I "$40,750.58 " "$26,487.88 " 330184 156 NASAL TRAUMA & DEFORMITY NO CC I "$29,630.15 " "$19,259.59 " 330184 157 DENTAL & ORAL DISEASES W MCC I "$44,026.99 " "$28,617.54 " 330184 159 DENTAL & ORAL DISEASES NO CC I "$11,048.98 " "$7,181.84 " 330184 163 MAJOR CHEST PROCEDURES W MCC I "$445,438.87 " "$289,535.27 " 330184 164 MAJOR CHEST PROCEDURES W CC I "$68,834.94 " "$44,742.71 " 330184 165 MAJOR CHEST PROCEDURES NO CC I "$98,559.53 " "$64,063.69 " 330184 167 OTHER RESP SYSTEM O.R. PROCEDURES W CC I "$79,670.63 " "$51,785.91 " 330184 175 PULMONARY EMBOLISM W MCC I "$114,368.96 " "$74,339.82 " 330184 176 PULMONARY EMBOLISM W/O MCC I "$38,392.77 " "$24,955.30 " 330184 177 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC I "$351,000.54 " "$228,150.35 " 330184 178 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC I "$95,307.61 " "$61,949.95 " 330184 179 RESPIRATORY INFECTIONS & INFLAMMATIONS NO CC I "$18,451.82 " "$11,993.68 " 330184 180 RESPIRATORY NEOPLASMS W MCC I "$127,714.64 " "$83,014.51 " 330184 181 RESPIRATORY NEOPLASMS W CC I "$37,422.46 " "$24,324.60 " 330184 183 MAJOR CHEST TRAUMA W MCC I "$47,664.42 " "$30,981.87 " 330184 184 MAJOR CHEST TRAUMA W CC I "$71,028.00 " "$46,168.20 " 330184 185 MAJOR CHEST TRAUMA NO CC I "$23,417.17 " "$15,221.16 " 330184 188 PLEURAL EFFUSION NO CC I "$32,522.81 " "$21,139.83 " 330184 189 PULMONARY EDEMA & RESPIRATORY FAILURE I "$164,258.37 " "$106,767.94 " 330184 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC I "$159,602.06 " "$103,741.34 " 330184 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC I "$85,815.54 " "$55,780.10 " 330184 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE NO CC I "$56,824.38 " "$36,935.85 " 330184 193 SIMPLE PNEUMONIA & PLEURISY W MCC I "$206,857.08 " "$134,457.10 " 330184 194 SIMPLE PNEUMONIA & PLEURISY W CC I "$82,895.02 " "$53,881.77 " 330184 195 SIMPLE PNEUMONIA & PLEURISY NO CC I "$46,279.59 " "$30,081.73 " 330184 196 INTERSTITIAL LUNG DISEASE W MCC I "$46,584.00 " "$30,279.60 " 330184 197 INTERSTITIAL LUNG DISEASE W CC I "$41,044.30 " "$26,678.79 " 330184 199 PNEUMOTHORAX W MCC I "$21,972.52 " "$14,282.14 " 330184 200 PNEUMOTHORAX W CC I "$60,288.89 " "$39,187.78 " 330184 201 PNEUMOTHORAX NO CC I "$23,407.00 " "$15,214.55 " 330184 202 BRONCHITIS & ASTHMA W CC/MCC I "$51,799.24 " "$33,669.51 " 330184 203 BRONCHITIS & ASTHMA NO CC I "$29,628.32 " "$19,258.41 " 330184 204 RESPIRATORY SIGNS & SYMPTOMS I "$24,026.62 " "$15,617.31 " 330184 205 OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC I "$128,898.53 " "$83,784.04 " 330184 206 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC I "$22,502.35 " "$14,626.53 " 330184 207 RESPIRATORY SYS DIAG W VENT SUPPORT 96+ HOURS I "$733,473.08 " "$476,757.50 " 330184 208 RESPIRATORY SYS DIAG W VENT SUPPORT <96 HOURS I "$157,564.67 " "$102,417.03 " 330184 239 AMP FOR CIRC SYS DISORD EXC UPR LMB&TOE W MCC I "$174,318.26 " "$113,306.87 " 330184 240 AMPUT FOR CIRC SYS DISRD EXC UPR LMB&TOE W CC I "$263,284.22 " "$171,134.74 " 330184 243 PERMANENT CARDIAC PACEMAKER IMPLANT W CC I "$127,122.32 " "$82,629.51 " 330184 252 OTHER VASCULAR PROCEDURES W MCC I "$161,917.65 " "$105,246.47 " 330184 253 OTHER VASCULAR PROCEDURES W CC I "$99,087.87 " "$64,407.12 " 330184 254 OTHER VASCULAR PROCEDURES NO CC I "$92,141.92 " "$59,892.25 " 330184 256 UPPER IMB&TOE AMPUT FOR CIRC SYS DISORD W CC I "$32,608.66 " "$21,195.63 " 330184 258 CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC I "$110,258.20 " "$71,667.83 " 330184 260 CARDIAC PACEMAKER REV EXC DEV REPLCMNT W MCC I "$71,778.18 " "$46,655.82 " 330184 261 CARDIAC PACEMAKER REV EXC DEV REPLCMNT W CC I "$108,173.38 " "$70,312.70 " 330184 262 CARDIAC PACEMAKER REV EXC DEV REPLCMNT NO CC I "$65,612.87 " "$42,648.37 " 330184 268 ARTC & HRT ASST PRCDS EXCPT PLSTN BALLN W MCC I "$188,265.89 " "$122,372.83 " 330184 269 ARTC & HRT ASST PRCDS EXCPT PLSTN BALN WO MCC I "$97,345.25 " "$63,274.41 " 330184 270 OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC I "$114,243.63 " "$74,258.36 " 330184 271 OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC I "$125,645.62 " "$81,669.65 " 330184 280 ACUTE MYOCARDIAL INFARCT DISCHD ALIVE W MCC I "$250,673.06 " "$162,937.49 " 330184 281 ACUTE MYOCARDIAL INFARCT DISCHD ALIVE W CC I "$90,726.23 " "$58,972.05 " 330184 282 ACUTE MYOCARDIAL INFARCT DISCHD ALIVE NO CC I "$25,361.72 " "$16,485.12 " 330184 283 "ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC" I "$468,950.71 " "$304,817.96 " 330184 284 "ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC" I "$47,795.89 " "$31,067.33 " 330184 288 ACUTE & SUBACUTE ENDOCARDITIS W MCC I "$43,782.47 " "$28,458.61 " 330184 289 ACUTE & SUBACUTE ENDOCARDITIS W CC I "$14,161.08 " "$9,204.70 " 330184 291 HEART FAILURE & SHOCK W MCC I "$249,408.55 " "$162,115.55 " 330184 292 HEART FAILURE & SHOCK W CC I "$80,208.05 " "$52,135.23 " 330184 293 HEART FAILURE & SHOCK NO CC I "$32,880.24 " "$21,372.15 " 330184 296 "CARDIAC ARREST, UNEXPLAINED W MCC" I "$79,814.01 " "$51,879.11 " 330184 299 PERIPHERAL VASCULAR DISORDERS W MCC I "$162,964.57 " "$105,926.97 " 330184 300 PERIPHERAL VASCULAR DISORDERS W CC I "$105,133.92 " "$68,337.05 " 330184 301 PERIPHERAL VASCULAR DISORDERS NO CC I "$23,682.54 " "$15,393.65 " 330184 303 ATHEROSCLEROSIS W/O MCC I "$101,722.15 " "$66,119.40 " 330184 304 HYPERTENSION W MCC I "$63,186.06 " "$41,070.94 " 330184 305 HYPERTENSION W/O MCC I "$33,051.26 " "$21,483.32 " 330184 306 CARDIAC CONGENITAL & VALVE DISORDERS W MCC I "$67,439.26 " "$43,835.52 " 330184 307 CARDIAC CONGENITAL & VALVE DISORDERS W/O MCC I "$20,295.98 " "$13,192.39 " 330184 308 CARDIAC ARRHYTHMIA & CONDUCTN DISORDERS W MCC I "$131,908.55 " "$85,740.56 " 330184 309 CARDIAC ARRHYTHMIA & CONDUCTN DISORDERS W CC I "$72,558.17 " "$47,162.81 " 330184 310 CARDIAC ARRHYTHMIA & CONDUCTN DISORDERS NO CC I "$22,301.55 " "$14,496.01 " 330184 311 ANGINA PECTORIS I "$22,515.22 " "$14,634.89 " 330184 312 SYNCOPE & COLLAPSE I "$91,187.09 " "$59,271.61 " 330184 313 CHEST PAIN I "$44,472.37 " "$28,907.04 " 330184 314 OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC I "$142,783.41 " "$92,809.22 " 330184 315 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC I "$32,774.74 " "$21,303.58 " 330184 316 OTHER CIRCULATORY SYSTEM DIAGNOSES NO CC I "$11,624.97 " "$7,556.23 " 330184 326 "STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC" I "$638,724.27 " "$415,170.78 " 330184 327 "STOMACH, ESOPHAGEAL & DUODENAL PROC W CC" I "$53,755.42 " "$34,941.02 " 330184 328 "STOMACH, ESOPHAGEAL & DUODENAL PROC NO CC" I "$38,021.32 " "$24,713.86 " 330184 329 MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC I "$187,621.51 " "$121,953.98 " 330184 330 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC I "$189,447.66 " "$123,140.98 " 330184 331 MAJOR SMALL & LARGE BOWEL PROCEDURES NO CC I "$66,903.63 " "$43,487.36 " 330184 335 PERITONEAL ADHESIOLYSIS W MCC I "$71,204.71 " "$46,283.06 " 330184 336 PERITONEAL ADHESIOLYSIS W CC I "$66,256.25 " "$43,066.56 " 330184 337 PERITONEAL ADHESIOLYSIS NO CC I "$80,864.02 " "$52,561.61 " 330184 338 APPENDECTOMY W COMPLICATED PRIN DIAG W MCC I "$34,208.02 " "$22,235.21 " 330184 339 APPENDECTOMY W COMPLICATED PRIN DIAG W CC I "$75,216.37 " "$48,890.64 " 330184 340 APPENDECTOMY W COMPLICATED PRIN DIAG NO CC I "$43,522.62 " "$28,289.70 " 330184 342 APPENDECTOMY W/O COMPLICATED PRIN DIAG W CC I "$43,493.16 " "$28,270.55 " 330184 343 APPENDECTOMY W/O COMPLICATED PRIN DIAG NO CC I "$37,488.65 " "$24,367.63 " 330184 346 MINOR SMALL & LARGE BOWEL PROCEDURES NO CC I "$41,907.89 " "$27,240.13 " 330184 348 ANAL & STOMAL PROCEDURES W CC I "$48,557.35 " "$31,562.28 " 330184 351 INGUINAL & FEMORAL HERNIA PROCEDURES W CC I "$33,220.79 " "$21,593.51 " 330184 352 INGUINAL & FEMORAL HERNIA PROCEDURES NO CC I "$25,607.35 " "$16,644.78 " 330184 353 HERNIA PROC EXCEPT INGUINAL & FEMORAL W MCC I "$51,223.90 " "$33,295.54 " 330184 354 HERNIA PROCDS EXCEPT INGUINAL & FEMORAL W CC I "$26,796.60 " "$17,417.79 " 330184 355 HERNIA PROC EXCEPT INGUINAL & FEMORAL NO CC I "$26,412.22 " "$17,167.94 " 330184 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC I "$205,410.46 " "$133,516.80 " 330184 357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC I "$77,878.33 " "$50,620.91 " 330184 358 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES NO CC I "$33,059.19 " "$21,488.48 " 330184 368 MAJOR ESOPHAGEAL DISORDERS W MCC I "$61,714.90 " "$40,114.69 " 330184 369 MAJOR ESOPHAGEAL DISORDERS W CC I "$104,677.55 " "$68,040.41 " 330184 370 MAJOR ESOPHAGEAL DISORDERS NO CC I "$9,809.81 " "$6,376.38 " 330184 371 MAJ GASTROIN DISORDRS & PERITNL INFECTS W MCC I "$105,442.27 " "$68,537.48 " 330184 372 MAJ GASTROIN DISORDRS & PERITNL INFECTS W CC I "$42,739.13 " "$27,780.44 " 330184 373 MAJ GASTROIN DISORDRS & PERITNL INFECTS NO CC I "$21,238.65 " "$13,805.12 " 330184 374 DIGESTIVE MALIGNANCY W MCC I "$91,385.72 " "$59,400.72 " 330184 375 DIGESTIVE MALIGNANCY W CC I "$93,245.31 " "$60,609.45 " 330184 377 G.I. HEMORRHAGE W MCC I "$416,661.07 " "$270,829.69 " 330184 378 G.I. HEMORRHAGE W CC I "$175,587.01 " "$114,131.56 " 330184 379 G.I. HEMORRHAGE NO CC I "$33,342.46 " "$21,672.60 " 330184 380 COMPLICATED PEPTIC ULCER W MCC I "$52,336.16 " "$34,018.50 " 330184 381 COMPLICATED PEPTIC ULCER W CC I "$45,289.43 " "$29,438.13 " 330184 382 COMPLICATED PEPTIC ULCER NO CC I "$55,208.21 " "$35,885.34 " 330184 383 UNCOMPLICATED PEPTIC ULCER W MCC I "$99,782.47 " "$64,858.61 " 330184 384 UNCOMPLICATED PEPTIC ULCER W/O MCC I "$28,265.45 " "$18,372.54 " 330184 385 INFLAMMATORY BOWEL DISEASE W MCC I "$38,293.20 " "$24,890.58 " 330184 386 INFLAMMATORY BOWEL DISEASE W CC I "$28,374.40 " "$18,443.36 " 330184 387 INFLAMMATORY BOWEL DISEASE NO CC I "$31,174.49 " "$20,263.42 " 330184 388 G.I. OBSTRUCTION W MCC I "$136,471.92 " "$88,706.75 " 330184 389 G.I. OBSTRUCTION W CC I "$41,664.78 " "$27,082.11 " 330184 390 G.I. OBSTRUCTION NO CC I "$32,714.48 " "$21,264.41 " 330184 391 ESOPHAGTS GASTRO & MISC DIGST DISORDS W MCC I "$105,707.24 " "$68,709.71 " 330184 392 ESOPHAGTS GASTRO & MISC DIGST DISORDS W/O MCC I "$85,791.21 " "$55,764.29 " 330184 393 OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC I "$300,488.03 " "$195,317.22 " 330184 394 OTHER DIGESTIVE SYSTEM DIAGNOSES W CC I "$87,658.19 " "$56,977.82 " 330184 395 OTHER DIGESTIVE SYSTEM DIAGNOSES NO CC I "$19,710.54 " "$12,811.85 " 330184 409 BIL TRACT PROC EXC CHOLCYST W OR W/O CDE W CC I "$41,060.43 " "$26,689.28 " 330184 410 BIL TRACT PRC EXC CHOLCYST W OR W/O CDE NO CC I "$42,903.49 " "$27,887.27 " 330184 417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC I "$98,696.15 " "$64,152.49 " 330184 418 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC I "$47,431.88 " "$30,830.72 " 330184 419 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. NO CC I "$59,487.01 " "$38,666.56 " 330184 421 HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC I "$88,039.65 " "$57,225.77 " 330184 423 OTHER HEPATOBILIARY OR PANCREAS OR PROC W MCC I "$63,574.08 " "$41,323.15 " 330184 432 CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC I "$248,276.74 " "$161,379.88 " 330184 433 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC I "$74,537.86 " "$48,449.61 " 330184 435 MALIG OF HEPATOBILIARY/PANCREAS SYS W MCC I "$80,314.88 " "$52,204.67 " 330184 436 MALIG OF HEPATOBILIARY/PANCREAS SYS W CC I "$50,325.60 " "$32,711.64 " 330184 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC I "$74,996.22 " "$48,747.54 " 330184 439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC I "$42,958.56 " "$27,923.06 " 330184 440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY NO CC I "$38,033.29 " "$24,721.64 " 330184 441 "DISORD OF LIVER EXC MALIG,CIRR,ALC HEPA W MCC" I "$206,255.26 " "$134,065.92 " 330184 442 "DISORD OF LIVER EXC MALIG,CIRR,ALC HEPA W CC" I "$37,404.24 " "$24,312.75 " 330184 443 "DISORD OF LIVER EXC MALIG,CIRR,ALC HEPA NO CC" I "$38,949.46 " "$25,317.15 " 330184 444 DISORDERS OF THE BILIARY TRACT W MCC I "$77,616.48 " "$50,450.71 " 330184 445 DISORDERS OF THE BILIARY TRACT W CC I "$65,392.76 " "$42,505.30 " 330184 446 DISORDERS OF THE BILIARY TRACT NO CC I "$34,552.73 " "$22,459.27 " 330184 454 COMBINED ANTERIOR/POSTERIOR SPINAL FUSN W CC I "$95,640.28 " "$62,166.18 " 330184 455 COMBINED ANTERIOR/POSTERIOR SPINAL FUSN NO CC I "$81,642.17 " "$53,067.41 " 330184 457 "SPIN FUS EXC CERV W CURV MALG, NFEC W CC" I "$109,584.70 " "$71,230.06 " 330184 459 SPINAL FUSION EXCEPT CERVICAL W MCC I "$185,672.60 " "$120,687.19 " 330184 460 SPINAL FUSION EXCEPT CERVICAL W/O MCC I "$214,073.71 " "$139,147.91 " 330184 462 BILAT/MULTI MJ JNT PRCS OF LWR EXTREM W/O MCC I "$442,022.14 " "$287,314.39 " 330184 463 WND DEBRD&SKN GRFT EXC HAND W MCC I "$331,624.58 " "$215,555.98 " 330184 464 WND DEBRD&SKN GRFT EXC HAND W CC I "$92,635.67 " "$60,213.18 " 330184 465 WND DEBRD&SKN GRFT EXC HAND NO CC I "$48,517.52 " "$31,536.39 " 330184 466 REVISION OF HIP OR KNEE REPLACEMENT W MCC I "$34,897.42 " "$22,683.32 " 330184 467 REVISION OF HIP OR KNEE REPLACEMENT W CC I "$131,103.31 " "$85,217.15 " 330184 468 REVISION OF HIP OR KNEE REPLACEMENT NO CC I "$160,094.01 " "$104,061.11 " 330184 469 MAJOR JOINT REPLCMT/REATTCHMT LWR EXTRM W MCC I "$173,421.86 " "$112,724.21 " 330184 470 MAJ JNT REPLCMNT/REATTCH LWR EXTRMTY W/O MCC I "$361,834.73 " "$235,192.57 " 330184 472 CERVICAL SPINAL FUSION W CC I "$117,140.26 " "$76,141.17 " 330184 473 CERVICAL SPINAL FUSION NO CC I "$149,689.06 " "$97,297.89 " 330184 474 AMPUT FOR MUSC/SKLTL SYS & CON TISS DIS W MCC I "$145,654.15 " "$94,675.20 " 330184 478 BIOP OF MUSC/SKELITAL SYS & CONN TISS W CC I "$58,694.83 " "$38,151.64 " 330184 480 HIP & FEMUR PROCEDURES EXC MAJOR JOINT W MCC I "$307,769.09 " "$200,049.91 " 330184 481 HIP & FEMUR PROCEDURES EXC MAJOR JOINT W CC I "$192,381.07 " "$125,047.69 " 330184 482 HIP & FEMUR PROC EXC MAJOR JOINT NO CC I "$114,542.96 " "$74,452.92 " 330184 483 MAJ JNT&LMB REATTCHMT PRC UPR EXTREM W CC/MCC I "$24,899.94 " "$16,184.96 " 330184 486 KNEE PROCEDURES W PDX OF INFECTION W CC I "$38,394.14 " "$24,956.19 " 330184 487 KNEE PROCEDURES W PDX OF INFECTION NO CC I "$62,134.50 " "$40,387.43 " 330184 488 KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC I "$29,519.73 " "$19,187.82 " 330184 489 KNEE PROCEDURES W/O PDX OF INFECTION NO CC I "$46,717.19 " "$30,366.17 " 330184 493 "LWER EXTRM & HUMR PROC EXC HIP,FOOT,FEMR W CC" I "$81,686.52 " "$53,096.23 " 330184 494 "LWER EXTRM & HUMR PRC EXC HIP,FOOT,FEMR NO CC" I "$105,706.20 " "$68,709.03 " 330184 497 LOC EXC & REM INT FIX DEV EXC HIP&FEMR NO CC I "$65,478.86 " "$42,561.26 " 330184 501 SOFT TISSUE PROCEDURES W CC I "$82,234.24 " "$53,452.26 " 330184 502 SOFT TISSUE PROCEDURES NO CC I "$38,056.79 " "$24,736.91 " 330184 503 FOOT PROCEDURES W MCC I "$90,883.92 " "$59,074.55 " 330184 504 FOOT PROCEDURES W CC I "$80,355.84 " "$52,231.30 " 330184 505 FOOT PROCEDURES NO CC I "$47,585.13 " "$30,930.33 " 330184 515 OTH MUSC/SKELET SYS & CONN TISS OR PROC W MCC I "$164,486.19 " "$106,916.02 " 330184 516 OTH MUSC/SKELET SYS & CONN TISS OR PROC W CC I "$87,794.55 " "$57,066.45 " 330184 519 BCK/NCK PROC EXC SPINAL FUSION W CC MCC I "$41,136.64 " "$26,738.81 " 330184 520 BCK/NCK PROC EXC SPINAL FUSION W/O CC/MCC I "$37,844.95 " "$24,599.22 " 330184 534 FRACTURES OF FEMUR W/O MCC I "$17,206.00 " "$11,183.90 " 330184 535 FRACTURES OF HIP & PELVIS W MCC I "$128,128.59 " "$83,283.58 " 330184 536 FRACTURES OF HIP & PELVIS W/O MCC I "$64,115.01 " "$41,674.76 " 330184 539 OSTEOMYELITIS W MCC I "$64,479.91 " "$41,911.94 " 330184 540 OSTEOMYELITIS W CC I "$51,577.07 " "$33,525.10 " 330184 542 PATH FRACTRS & MUSCLSK & CON TIS MALIG W MCC I "$86,420.85 " "$56,173.55 " 330184 543 PATH FRACTRS & MUSCLSK & CON TIS MALIG W CC I "$91,914.43 " "$59,744.38 " 330184 544 PATH FRACTRS & MUSCLSK & CON TIS MALIG NO CC I "$24,040.30 " "$15,626.20 " 330184 545 CONNECTIVE TISSUE DISORDERS W MCC I "$24,165.48 " "$15,707.56 " 330184 546 CONNECTIVE TISSUE DISORDERS W CC I "$17,967.21 " "$11,678.69 " 330184 547 CONNECTIVE TISSUE DISORDERS NO CC I "$95,901.10 " "$62,335.72 " 330184 551 MEDICAL BACK PROBLEMS W MCC I "$50,081.53 " "$32,553.00 " 330184 552 MEDICAL BACK PROBLEMS W/O MCC I "$112,047.78 " "$72,831.06 " 330184 554 BONE DISEASES & ARTHROPATHIES W/O MCC I "$63,022.59 " "$40,964.68 " 330184 556 SIGNS&SYMPTS MUSC/SKELT SYS&CONN TISS W/O MCC I "$72,150.92 " "$46,898.10 " 330184 558 "TENDONITIS, MYOSITIS & BURSITIS W/O MCC" I "$62,559.37 " "$40,663.59 " 330184 559 "AFTERCARE, MUSC/SKELTAL SYS & CONN TISS W MCC" I "$45,067.14 " "$29,293.64 " 330184 560 "AFTERCARE, MUSC/SKELTAL SYS & CONN TISS W CC" I "$111,949.25 " "$72,767.01 " 330184 561 "AFTERCARE, MUSC/SKELTAL SYS & CONN TISS NO CC" I "$34,174.76 " "$22,213.59 " 330184 562 FX SPRN & DISL EXC FEMR HIP PLVS&THGH W MCC I "$93,018.47 " "$60,462.00 " 330184 563 FX SPRN & DISL EXC FMR HIP PELVS&THGH W/O MCC I "$93,600.78 " "$60,840.51 " 330184 564 OTHER MUSC/SKELETL SYS & CONN TISS DIAG W MCC I "$62,530.59 " "$40,644.88 " 330184 565 OTHER MUSC/SKELETAL SYS & CONN TISS DIAG W CC I "$51,650.54 " "$33,572.85 " 330184 566 OTHER MUSC/SKETETL SYS & CONN TISS DIAG NO CC I "$24,066.57 " "$15,643.27 " 330184 571 SKIN DEBRIDEMENT W CC I "$28,099.05 " "$18,264.38 " 330184 572 SKIN DEBRIDEMENT NO CC I "$28,297.98 " "$18,393.69 " 330184 579 "OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC" I "$83,058.44 " "$53,987.99 " 330184 580 "OTHER SKIN, SUBCUT TISS & BREAST PROC W CC" I "$163,503.71 " "$106,277.41 " 330184 581 "OTHER SKIN, SUBCUT TISS & BREAST PROC NO CC" I "$15,101.81 " "$9,816.17 " 330184 592 SKIN ULCERS W MCC I "$126,773.72 " "$82,402.91 " 330184 593 SKIN ULCERS W CC I "$70,448.80 " "$45,791.72 " 330184 594 SKIN ULCERS NO CC I "$22,114.42 " "$14,374.37 " 330184 598 MALIGNANT BREAST DISORDERS W CC I "$96,402.63 " "$62,661.71 " 330184 600 NON-MALIGNANT BREAST DISORDERS W CC/MCC I "$35,272.07 " "$22,926.85 " 330184 601 NON-MALIGNANT BREAST DISORDERS NO CC I "$18,034.66 " "$11,722.53 " 330184 602 CELLULITIS W MCC I "$43,683.19 " "$28,394.07 " 330184 603 CELLULITIS W/O MCC I "$55,937.78 " "$36,359.55 " 330184 604 "TRAUMA TO SKIN, SUBCUT TISS & BREAST W MCC" I "$48,901.27 " "$31,785.83 " 330184 605 "TRAUMA TO SKIN, SUBCUT TISS & BREAST W/O MCC" I "$45,005.20 " "$29,253.38 " 330184 607 MINOR SKIN DISORDERS W/O MCC I "$141,900.91 " "$92,235.59 " 330184 616 AMPUT LOWR LMB ENDOC NUTRIT & METBL DIS W MCC I "$102,540.87 " "$66,651.56 " 330184 617 AMPUT LOWR LMB ENDOC NUTRIT & METBL DIS W CC I "$68,507.91 " "$44,530.14 " 330184 620 O.R. PROCEDURES FOR OBESITY W CC I "$34,493.27 " "$22,420.63 " 330184 621 O.R. PROCEDURES FOR OBESITY NO CC I "$40,968.50 " "$26,629.53 " 330184 623 SKN GRFTS & WND DEBRD/ENDC NUTRT&MET DIS W CC I "$91,234.58 " "$59,302.47 " 330184 627 "THYROID, PARATHYROID & THYROGLOSSAL PRC NO CC" I "$30,649.71 " "$19,922.31 " 330184 629 "OTHER ENDOCRINE, NUTRIT & METAB OR PROC W CC" I "$190,987.69 " "$124,142.00 " 330184 637 DIABETES W MCC I "$77,118.69 " "$50,127.15 " 330184 638 DIABETES W CC I "$68,961.60 " "$44,825.04 " 330184 639 DIABETES NO CC I "$30,645.92 " "$19,919.85 " 330184 640 NUTRITIONAL & MISC METABOLIC DISORDERS W MCC I "$137,057.37 " "$89,087.29 " 330184 641 NUTRITIONAL & MISC METABOLIC DISORDRS W/O MCC I "$79,534.21 " "$51,697.24 " 330184 642 INBORN ERRORS OF METABOLISM I "$42,655.76 " "$27,726.24 " 330184 643 ENDOCRINE DISORDERS W MCC I "$130,149.09 " "$84,596.91 " 330184 644 ENDOCRINE DISORDERS W CC I "$53,316.49 " "$34,655.72 " 330184 645 ENDOCRINE DISORDERS NO CC I "$27,575.89 " "$17,924.33 " 330184 654 MAJOR BLADDER PROCEDURES W CC I "$117,793.67 " "$76,565.89 " 330184 659 KIDNEY & URETER PROC FOR NON-NEOPLASM W MCC I "$20,428.80 " "$13,278.72 " 330184 660 KIDNEY & URETER PROC FOR NON-NEOPLASM W CC I "$95,432.27 " "$62,030.98 " 330184 661 KIDNEY & URETER PROC FOR NON-NEOPLASM NO CC I "$44,296.76 " "$28,792.90 " 330184 663 MINOR BLADDER PROCEDURES W CC I "$32,934.14 " "$21,407.19 " 330184 664 MINOR BLADDER PROCEDURES NO CC I "$38,375.33 " "$24,943.96 " 330184 669 TRANSURETHRAL PROCEDURES W CC I "$98,248.64 " "$63,861.62 " 330184 670 TRANSURETHRAL PROCEDURES NO CC I "$21,058.49 " "$13,688.02 " 330184 673 OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC I "$129,192.96 " "$83,975.42 " 330184 674 OTHER KIDNEY & URINARY TRACT PROCEDURES W CC I "$119,051.59 " "$77,383.53 " 330184 682 RENAL FAILURE W MCC I "$243,496.02 " "$158,272.41 " 330184 683 RENAL FAILURE W CC I "$135,250.81 " "$87,913.03 " 330184 684 RENAL FAILURE NO CC I "$22,453.56 " "$14,594.81 " 330184 687 KIDNEY & URINARY TRACT NEOPLASMS W CC I "$44,996.30 " "$29,247.60 " 330184 688 KIDNEY & URINARY TRACT NEOPLASMS NO CC I "$8,246.09 " "$5,359.96 " 330184 689 KIDNEY & URINARY TRACT INFECTIONS W MCC I "$160,789.33 " "$104,513.06 " 330184 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC I "$85,495.26 " "$55,571.92 " 330184 693 URINARY STONES W/O ESW LITHOTRIPSY W MCC I "$20,236.75 " "$13,153.89 " 330184 694 URINARY STONES W/O ESW LITHOTRIPSY W/O MCC I "$31,394.62 " "$20,406.50 " 330184 696 KIDNEY & URINARY TRACT SIGNS & SYMPTM W/O MCC I "$54,052.81 " "$35,134.33 " 330184 698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC I "$152,507.52 " "$99,129.89 " 330184 699 OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC I "$99,137.85 " "$64,439.60 " 330184 700 OTHER KIDNEY & URINARY TRACT DIAGNOSES NO CC I "$109,963.75 " "$71,476.44 " 330184 713 TRANSURETHRAL PROSTATECTOMY W CC/MCC I "$96,942.43 " "$63,012.58 " 330184 714 TRANSURETHRAL PROSTATECTOMY NO CC I "$61,258.33 " "$39,817.91 " 330184 715 OTH MALE REPROD SYS OR PRC FOR MALIG W CC/MCC I "$35,011.95 " "$22,757.77 " 330184 718 OTHER MALE REPROD SYS OR PROC EXC MALIG NO CC I "$41,130.32 " "$26,734.71 " 330184 722 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC" I "$84,663.62 " "$55,031.35 " 330184 723 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC" I "$29,133.72 " "$18,936.92 " 330184 726 BENIGN PROSTATIC HYPERTROPHY W/O MCC I "$23,290.72 " "$15,138.97 " 330184 728 INFLAMMATION OF MALE REPRODUCTIVE SYS W/O MCC I "$26,045.03 " "$16,929.27 " 330184 729 OTHER MALE REPRODUCTIVE SYSTEM DIAG W CC/MCC I "$10,734.47 " "$6,977.41 " 330184 742 UTERINE & ADNEXA PROC FOR NON-MALIG W CC/MCC I "$69,188.43 " "$44,972.48 " 330184 743 UTERINE & ADNEXA PROC FOR NON-MALIGNCY NO CC I "$47,989.79 " "$31,193.36 " 330184 749 OTHER FEMALE REPRODUCTV SYS OR PROC W CC/MCC I "$70,622.69 " "$45,904.75 " 330184 755 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC" I "$65,502.03 " "$42,576.32 " 330184 758 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC" I "$22,859.05 " "$14,858.38 " 330184 759 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM NO CC" I "$23,343.25 " "$15,173.11 " 330184 760 MENSTRL & OTH FEML REPROD SYS DISORD W CC/MCC I "$21,214.03 " "$13,789.12 " 330184 761 MENSTRL & OTH FEML REPROD SYS DISORD NO CC I "$11,901.75 " "$7,736.13 " 330184 768 VAGINAL DELV W OR PROC EXCEPT STERIL &/OR D&C I "$21,903.39 " "$14,237.20 " 330184 776 POSTPARTUM & POST ABORTION DIAG W/O OR PROC I "$21,773.61 " "$14,152.84 " 330184 779 ABORTION W/O D&C I "$18,319.53 " "$11,907.69 " 330184 783 CESAREAN SECTION W STERILIZATION W MCC I "$25,002.22 " "$16,251.44 " 330184 784 CESAREAN SECTION W STERILIZATION W CC I "$51,833.19 " "$33,691.57 " 330184 785 CESAREAN SECTION W STERILIZATION W/O CC/MCC I "$45,821.61 " "$29,784.05 " 330184 786 CESAREAN SECTION W/O STERILIZATION W MCC I "$57,894.55 " "$37,631.46 " 330184 787 CESAREAN SECTION W/O STERILIZATION W CC I "$91,071.57 " "$59,196.52 " 330184 788 CESAREAN SECTION W/O STERILIZATION W/O CC/MCC I "$95,312.38 " "$61,953.04 " 330184 789 NEONATES DIED/TRANSFD TO OTHER ACUTE CARE FAC I "$20,364.99 " "$13,237.25 " 330184 790 EXTREME IMATURTY\RESP DISTRES SYNDRM NEONATE I "$80,413.80 " "$52,268.97 " 330184 791 PREMATURITY W MAJOR PROBLEMS I "$108,192.11 " "$70,324.87 " 330184 792 PREMATURITY W/O MAJOR PROBLEMS I "$10,763.61 " "$6,996.34 " 330184 793 FULL TERM NEONATE W MAJOR PROBLEMS I "$20,519.17 " "$13,337.46 " 330184 794 NEONATE W OTHER SIGNIFICANT PROBLEMS I "$32,939.78 " "$21,410.86 " 330184 795 NORMAL NEWBORN I "$33,570.86 " "$21,821.06 " 330184 797 VAGINAL DELIVERY W STERILIZATION/D&C W CC I "$29,516.11 " "$19,185.47 " 330184 798 VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC I "$26,991.81 " "$17,544.68 " 330184 802 OTHR OR PROC OF BLOOD & BLOOD FRM ORGNS W MCC I "$68,039.49 " "$44,225.67 " 330184 803 OTHR OR PROC OF BLOOD & BLOOD FRM ORGNS W CC I "$60,070.83 " "$39,046.04 " 330184 805 VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC I "$31,625.26 " "$20,556.42 " 330184 806 VAGINAL DELIVERY W/O STERILIZATION/D&C W CC I "$39,748.92 " "$25,836.80 " 330184 807 VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC I "$76,648.58 " "$49,821.58 " 330184 808 MAJ HEM/IMN DIAG EXC SCKL CELL CRS&COAG W MCC I "$52,940.16 " "$34,411.10 " 330184 809 MAJ HEM/IMN DIAG EXC SCKL CELL CRS&COAG W CC I "$70,977.75 " "$46,135.54 " 330184 810 MAJ HEM/IMN DIAG EXC SCKL CELL CRS&COAG NO CC I "$97,289.77 " "$63,238.35 " 330184 811 RED BLOOD CELL DISORDERS W MCC I "$164,953.20 " "$107,219.58 " 330184 812 RED BLOOD CELL DISORDERS W/O MCC I "$62,902.09 " "$40,886.36 " 330184 813 COAGULATION DISORDERS I "$93,591.75 " "$60,834.64 " 330184 814 RETICULOENDOTHELIAL & IMMUNITY DISORDRS W MCC I "$94,893.43 " "$61,680.73 " 330184 815 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC I "$35,904.57 " "$23,337.97 " 330184 817 OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC I "$23,656.93 " "$15,377.00 " 330184 831 OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC I "$5,162.76 " "$3,355.79 " 330184 832 OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC I "$15,762.91 " "$10,245.89 " 330184 833 OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC I "$30,611.31 " "$19,897.35 " 330184 840 LYMPHOMA & NON-ACUTE LEUKEMIA W MCC I "$43,975.34 " "$28,583.97 " 330184 841 LYMPHOMA & NON-ACUTE LEUKEMIA W CC I "$48,927.99 " "$31,803.19 " 330184 853 INFECTIOUS & PARASITE DISEASES W OR PRC W MCC I "$435,217.70 " "$282,891.50 " 330184 854 INFECTIOUS & PARASITE DISEASES W OR PROC W CC I "$104,474.59 " "$67,908.48 " 330184 856 POSTOP/POST-TRAUMA INFECTIONS W OR PROC W MCC I "$70,573.74 " "$45,872.93 " 330184 857 POSTOP/POST-TRAUMA INFECTIONS W OR PROC W CC I "$49,226.69 " "$31,997.35 " 330184 858 POSTOP/POST-TRAUMA INFECTIONS W OR PROC NO CC I "$126,260.91 " "$82,069.59 " 330184 862 POSTOP/POST-TRAUMA INFECTIONS W MCC I "$90,008.35 " "$58,505.43 " 330184 863 POSTOP/POST-TRAUMA INFECTIONS W/O MCC I "$68,202.29 " "$44,331.49 " 330184 864 FEVER OF UNKNOWN ORIGIN I "$27,433.38 " "$17,831.70 " 330184 865 VIRAL ILLNESS W MCC I "$23,568.84 " "$15,319.75 " 330184 866 VIRAL ILLNESS W/O MCC I "$43,529.71 " "$28,294.31 " 330184 867 OTHR INFECTIOUS & PARASITE DISEASE DIAG W MCC I "$55,473.40 " "$36,057.71 " 330184 870 SEPTICEMIA W MV 96+ HOURS I "$1,226,344.83 " "$797,124.14 " 330184 871 SEPTICEMIA W/O MV 96+ HOURS W MCC I "$558,621.99 " "$363,104.29 " 330184 872 SEPTICEMIA W/O MV 96+ HOURS W/O MCC I "$97,898.08 " "$63,633.75 " 330184 880 ACUTE ADJUST.REACT & PSYCHOSOCIAL DYSFN I "$37,861.03 " "$24,609.67 " 330184 884 ORGANIC DISTURBANCES & MENTAL RETARDATION I "$129,542.21 " "$84,202.44 " 330184 885 PSYCHOSES I "$94,906.64 " "$61,689.31 " 330184 894 "ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA" I "$35,695.56 " "$23,202.11 " 330184 896 ALCOHOL/DRUG ABUSE OR DEPNDNC W/O REHAB W MCC I "$130,337.27 " "$84,719.23 " 330184 897 ALCOHL/DRG ABUSE OR DEPNDNC W/O REHAB W/O MCC I "$83,148.31 " "$54,046.40 " 330184 904 SKIN GRAFTS FOR INJURIES W CC/MCC I "$53,234.69 " "$34,602.55 " 330184 908 OTHER O.R. PROCEDURES FOR INJURIES W CC I "$37,323.54 " "$24,260.30 " 330184 909 OTHER O.R. PROCEDURES FOR INJURIES NO CC I "$96,781.83 " "$62,908.19 " 330184 913 TRAUMATIC INJURY W MCC I "$58,812.80 " "$38,228.32 " 330184 914 TRAUMATIC INJURY W/O MCC I "$34,500.52 " "$22,425.34 " 330184 915 ALLERGIC REACTIONS W MCC I "$45,672.68 " "$29,687.24 " 330184 916 ALLERGIC REACTIONS W/O MCC I "$25,500.12 " "$16,575.08 " 330184 917 POISONING & TOXIC EFFECTS OF DRUGS W MCC I "$98,995.72 " "$64,347.22 " 330184 918 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC I "$37,887.63 " "$24,626.96 " 330184 919 COMPLICATIONS OF TREATMENT W MCC I "$27,428.22 " "$17,828.34 " 330184 920 COMPLICATIONS OF TREATMENT W CC I "$26,081.89 " "$16,953.23 " 330184 922 OTH INJURY/POISONING & TOXIC EFF DIAG W MCC I "$99,288.65 " "$64,537.62 " 330184 923 OTH INJURY/POISONING & TOXIC EFF DIAG W/O MCC I "$16,495.30 " "$10,721.95 " 330184 939 OR PORC W DIAG OTH CONTACT W HLTH SERVS W MCC I "$86,349.39 " "$56,127.10 " 330184 940 OR PORC W DIAG OTH CONTACT W HLTH SERVS W CC I "$83,238.33 " "$54,104.91 " 330184 947 SIGNS & SYMPTOMS W MCC I "$105,406.26 " "$68,514.07 " 330184 948 SIGNS & SYMPTOMS W/O MCC I "$60,718.66 " "$39,467.13 " 330184 949 AFTERCARE W CC/MCC I "$25,878.22 " "$16,820.84 " 330184 951 OTHER FACTORS INFLUENCING HEALTH STATUS I "$146,302.94 " "$95,096.91 " 330184 956 LIMB REATTACH HIP&FEMUR PROC MULT SIGN TRAUMA I "$188,507.20 " "$122,529.68 " 330184 974 HIV W MAJOR RELATED CONDITION W MCC I "$129,660.60 " "$84,279.39 " 330184 975 HIV W MAJOR RELATED CONDITION W CC I "$55,318.24 " "$35,956.85 " 330184 981 EXT OR PROC UNRELATED TO PRIN DIAG W MCC I "$243,870.64 " "$158,515.91 " 330184 982 EXT OR PROC UNRELATED TO PRIN DIAG W CC I "$48,680.02 " "$31,642.01 " 330184 983 EXT OR PROC UNRELATED TO PRIN DIAG NO CC I "$21,329.82 " "$13,864.38 " 330184 987 NON-EXTN OR PROC UNRELATED TO PRIN DIAG W MCC I "$222,923.52 " "$144,900.29 " 330184 988 NON-EXTN OR PROC UNRELATED TO PRIN DIAG W CC I "$27,964.24 " "$18,176.76 " 330184 989 NON-EXTN OR PROC UNRELATED TO PRIN DIAG NO CC I "$47,626.17 " "$30,957.01 " 330184 999 UNGROUPABLE I "$242,387.86 " "$157,552.11 " 330184 Grand Total SEPTICEMIA W/O MV 96+ HOURS W/O MCC I "$126,580.30 " "$82,277.19 " 330184 880 ACUTE ADJUST.REACT & PSYCHOSOCIAL DYSFN I "$33,333.56 " "$21,666.81 " 330184 881 DEPRESSIVE NEUROSES I "$145,504.85 " "$94,578.15 " 330184 882 NEUROSES EXCEPT DEPRESSIVE I "$64,828.31 " "$42,138.40 " 330184 883 DISORDERS OF PERSONALITY & IMPULSE CONTROL I "$69,945.66 " "$45,464.68 " 330184 884 ORGANIC DISTURBANCES & MENTAL RETARDATION I "$137,207.35 " "$89,184.78 " 330184 885 PSYCHOSES I "$521,567.12 " "$339,018.63 " 330184 886 BEHAVIORAL & DEVELOPMENTAL DISORDERS I "$49,389.46 " "$32,103.15 " 330184 887 OTHER MENTAL DISORDER DIAGNOSES I "$9,221.46 " "$5,993.95 " 330184 894 "ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA" I "$31,398.22 " "$20,408.84 " 330184 896 ALCOHOL/DRUG ABUSE OR DEPNDNC W/O REHAB W MCC I "$96,261.47 " "$62,569.95 " 330184 897 ALCOHL/DRG ABUSE OR DEPNDNC W/O REHAB W/O MCC I "$58,285.45 " "$37,885.54 " 330184 904 SKIN GRAFTS FOR INJURIES W CC/MCC I "$53,234.69 " "$34,602.55 " 330184 908 OTHER O.R. PROCEDURES FOR INJURIES W CC I "$37,323.54 " "$24,260.30 " 330184 909 OTHER O.R. PROCEDURES FOR INJURIES NO CC I "$49,308.93 " "$32,050.81 " 330184 913 TRAUMATIC INJURY W MCC I "$58,812.80 " "$38,228.32 " 330184 914 TRAUMATIC INJURY W/O MCC I "$28,138.21 " "$18,289.84 " 330184 915 ALLERGIC REACTIONS W MCC I "$36,246.54 " "$23,560.25 " 330184 916 ALLERGIC REACTIONS W/O MCC I "$25,688.73 " "$16,697.67 " 330184 917 POISONING & TOXIC EFFECTS OF DRUGS W MCC I "$77,745.50 " "$50,534.58 " 330184 918 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC I "$31,197.77 " "$20,278.55 " 330184 919 COMPLICATIONS OF TREATMENT W MCC I "$24,706.85 " "$16,059.45 " 330184 920 COMPLICATIONS OF TREATMENT W CC I "$24,845.16 " "$16,149.36 " 330184 921 COMPLICATIONS OF TREATMENT NO CC I "$20,177.96 " "$13,115.67 " 330184 922 OTH INJURY/POISONING & TOXIC EFF DIAG W MCC I "$64,715.99 " "$42,065.39 " 330184 923 OTH INJURY/POISONING & TOXIC EFF DIAG W/O MCC I "$40,498.70 " "$26,324.16 " 330184 939 OR PORC W DIAG OTH CONTACT W HLTH SERVS W MCC I "$86,349.39 " "$56,127.10 " 330184 940 OR PORC W DIAG OTH CONTACT W HLTH SERVS W CC I "$83,238.33 " "$54,104.91 " 330184 947 SIGNS & SYMPTOMS W MCC I "$62,808.59 " "$40,825.58 " 330184 948 SIGNS & SYMPTOMS W/O MCC I "$51,216.58 " "$33,290.78 " 330184 949 AFTERCARE W CC/MCC I "$21,371.22 " "$13,891.30 " 330184 951 OTHER FACTORS INFLUENCING HEALTH STATUS I "$80,903.18 " "$52,587.06 " 330184 956 LIMB REATTACH HIP&FEMUR PROC MULT SIGN TRAUMA I "$188,507.20 " "$122,529.68 " 330184 974 HIV W MAJOR RELATED CONDITION W MCC I "$96,862.92 " "$62,960.90 " 330184 975 HIV W MAJOR RELATED CONDITION W CC I "$55,318.24 " "$35,956.85 " 330184 977 HIV W OR W/O OTHER RELATED CONDITION I "$43,455.64 " "$28,246.17 " 330184 981 EXT OR PROC UNRELATED TO PRIN DIAG W MCC I "$231,689.32 " "$150,598.06 " 330184 982 EXT OR PROC UNRELATED TO PRIN DIAG W CC I "$72,713.27 " "$47,263.63 " 330184 983 EXT OR PROC UNRELATED TO PRIN DIAG NO CC I "$21,329.82 " "$13,864.38 " 330184 987 NON-EXTN OR PROC UNRELATED TO PRIN DIAG W MCC I "$176,296.60 " "$114,592.79 " 330184 988 NON-EXTN OR PROC UNRELATED TO PRIN DIAG W CC I "$25,002.57 " "$16,251.67 " 330184 989 NON-EXTN OR PROC UNRELATED TO PRIN DIAG NO CC I "$42,111.46 " "$27,372.45 " 330184 999 UNGROUPABLE I "$242,387.86 " "$157,552.11 "