DESCRIPTION CPT/HCPCS Code NDC OP/Default Gross Charge Professional fee charge IP/ER Gross Charge ERx Charge Quantity Minimum Negotiated Charge Maximum Negotiated Charge Discounted Self-pay Charge Medicare BCBS Aetna United Health Care Midlands Choice 00120 ANES EAR SURGERY 120 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00124 Anesthesia for Procedures on the Head 124 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Anest Ear surgery 126 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 LENS SURGERY 00142 142 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00160 ANES NOSE/SINUS SURGERY 160 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00170 ANES PROCEDURE ON MOUTH 170 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00300 ANES HEAD NECK TRUNK 300 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00320 ANES NECK ORGAN 1 & OVER 320 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00400 ANES SKIN 400 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00404 ANES SURGERY OF BREAST 404 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00410 ANES CORRECT HEART RHYTHM 410 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Anest Surgery of Shoulder THAY 450 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00532 ANES VASCULAR ACCESS 532 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00630 ANES SPINE CORD SURG 630 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00635 ANES LUMBAR PUNCTURE 635 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Anesthesia for procedures on upper anterior abdominal wall; not otherwise specified THAY 700 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00730 Anes on the Upper Abdomen 730 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00731 ANES UPPER GI VIS 731 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Endoscopic Retrograde Cholangiopancreatography (ERCP) 732 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Anesthesia for lumbar and ventral (incisional) hernias and/or wound dehiscence THAY 752 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00750 HERNIA UMBILICAL ANES CHARGE 750 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00790 ANES UPPER ABD SURGERY 790 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00811 ANES LOWER INTESTINAL SCOPE 811 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Screening Colonoscopy 812 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Anesthesia for combined upper and lower endoscopic procedures 813 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00830 RPR HERNIA LOWER ABDOMEN CHARGE 830 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 ANESTHESIA VENTRAL/ INCIS HERNIA LOWER 832 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00840 ANES LOWER ABD SURGERY 840 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00844 ANES PELVIS SURGERY 844 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00846 ANES HYSTERECTOMY 846 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00851 TUBLIGATION/TRANSECTION CHARGE 851 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00860 ANES SURGERY OF ABDOMEN 860 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00902 ANORECTAL PROC ANEST CHARGE 902 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Bladder Surgery 910 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00912 ANES TRANS RESECTION OF BLDR TUMERS ADDTNL 0:30 CHARGE 912 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00914 ANES REMOVAL OF PROSTATE 914 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00920 ANES GENITALIA SURGERY 920 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00926 ANES REMOVAL OF TESTIS 926 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00940 ANES VAG PROCEDURE 940 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00942 ANES VAG URETHRAL 942 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00944 ANES HYSTERECTOMY VAGINAL 944 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 00952 ANES HYSTEROSCOPE 952 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 ANESTHESIA biopsy 1112 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01220 ANES PROCEDURE ON FEMUR 1220 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01250 ANES UPPER LEG SURGERY 1250 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01320 ANES KNEE MANIPULATION 1320 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01340 ANES KNEE AREA PROCEDURE 1340 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01380 ANES KNEE JOINT PROCEDURE 1380 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01392 ANES KNEE AREA 1392 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01400 ANES KNEE JOINT SURG 1400 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01402 ANES KNEE ARTHRO 1402 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Lower Leg THAY 1470 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01472 ANES FOOT SURGERY 1472 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Lower Leg Surgery 1480 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01484 ANES LOWER LEG REV 1484 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01610 ANESTHESIA SURGERY OF SHOULDER FMC CHARGE 1610 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Anest Manipulation of shoulder 1620 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01630 ANEST SHOULDER JOINT SURGERY CHARGE 1630 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01622 SHOULDER SURGERY ARTHROSCOPY 1622 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01710 ANES ELBOW AREA SURGERY 1710 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01740 ANES UPPER ARM SURGERY 1740 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Carpal Tunnel Release PROFEE 1810 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 "Closed procedure on radius, ulna, wrist, and hand THAY" 1820 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Lower Arm Surgery Anest\nProfessional 1830 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01936 ANES INTERSTIM PERC 1936 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01961 ANES CS DELIVERY 1961 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01965 ANES MISSED AB PROC 1965 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 CRNA FEES- 01967 ANES VAGINAL DELIVERY 1967 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01968 ANES CSDELIVERY ADD 1968 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01968 ANES EPID C-SE 1 1968 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01991 Anesthesia for Therapeutic Nerve Block 1991 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 01992 ANES NERVE BLOCK 1992 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 FINE NEEDLE ASPIRATION BX;W/IMAGING; 1ST LESION CCC 10021 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 55000 FINE NEEDLE ASPIRATION 10021 $315.00 $204.00 $315.00 $223.65 $315.00 $315.00 $223.65 $302.40 $296.10 $299.25 $308.70 "Drain Skin Abscess, Simple/Single Charge" 10060 $249.00 $249.00 $176.79 $249.00 $249.00 $176.79 $239.04 $234.06 $236.55 $244.02 10060 I & D ABSCESS 10060 $315.00 $249.00 $315.00 $223.65 $315.00 $315.00 $223.65 $302.40 $296.10 $299.25 $308.70 "Drain Skin Abscess, Complex/Multiple Charge" 10061 $476.00 $476.00 $337.96 $476.00 $476.00 $337.96 $456.96 $447.44 $452.20 $466.48 10061 DRAIN SKIN ABCESS 10061 "$1,038.00 " $432.00 "$1,038.00 " $736.98 "$1,038.00 " "$1,038.00 " $736.98 $996.48 $975.72 $986.10 "$1,017.24 " I&D Pilonidal Cyst; Simple Charge 10080 $382.00 $382.00 $271.22 $382.00 $382.00 $271.22 $366.72 $359.08 $362.90 $374.36 10080 I & D PIDONIDAL CYST 10080 $633.00 $382.00 $633.00 $449.43 $633.00 $633.00 $449.43 $607.68 $595.02 $601.35 $620.34 10081 Incision & Drainage of Pilonidal cyst; complicated 10081 $574.00 $763.00 $574.00 $407.54 $574.00 $574.00 $407.54 $551.04 $539.56 $545.30 $562.52 "Incision & Removal of Foreign Body, Subcutaneous Tissues; Simple Charge" 10120 $317.00 $317.00 $225.07 $317.00 $317.00 $225.07 $304.32 $297.98 $301.15 $310.66 10120 REM FB W INCISION 10120 $732.00 $317.00 $732.00 $519.72 $732.00 $732.00 $519.72 $702.72 $688.08 $695.40 $717.36 Drainage of Skin Lesion Charge 10140 $350.00 $350.00 $248.50 $350.00 $350.00 $248.50 $336.00 $329.00 $332.50 $343.00 10140 I & D HEMATOMA 10140 "$1,925.00 " $350.00 "$1,925.00 " "$1,366.75 " "$1,925.00 " "$1,925.00 " "$1,366.75 " "$1,848.00 " "$1,809.50 " "$1,828.75 " "$1,886.50 " "Puncture Aspirtn of Abscess, Hematoma, Bulla, or Cyst Charge" 10160 $272.00 $272.00 $193.12 $272.00 $272.00 $193.12 $261.12 $255.68 $258.40 $266.56 10160 PUNCTURE ASPIRATION 10160 $325.00 $272.00 $325.00 $230.75 $325.00 $325.00 $230.75 $312.00 $305.50 $308.75 $318.50 "Debride Skin/Tissue, Fx Charge" 11010 "$1,004.00 " "$1,004.00 " $712.84 "$1,004.00 " "$1,004.00 " $712.84 $963.84 $943.76 $953.80 $983.92 11010 DEBRIDEMENRT W FB 11010 "$1,546.00 " "$1,004.00 " "$1,546.00 " "$1,097.66 " "$1,546.00 " "$1,546.00 " "$1,097.66 " "$1,484.16 " "$1,453.24 " "$1,468.70 " "$1,515.08 " Deb skin bone at fx site 11012 "$1,431.00 " "$1,431.00 " "$1,016.01 " "$1,431.00 " "$1,431.00 " "$1,016.01 " "$1,373.76 " "$1,345.14 " "$1,359.45 " "$1,402.38 " 11012 DEBRID SKIN MUS BONE 11012 "$4,202.00 " "$1,431.00 " "$4,202.00 " "$2,983.42 " "$4,202.00 " "$4,202.00 " "$2,983.42 " "$4,033.92 " "$3,949.88 " "$3,991.90 " "$4,117.96 " Debride Skin/Soft Tissue Charge 11042 $254.00 $254.00 $180.34 $254.00 $254.00 $180.34 $243.84 $238.76 $241.30 $248.92 11042 DEBRIDEMENT SKIN SUB 11042 $432.00 $254.00 $432.00 $306.72 $432.00 $432.00 $306.72 $414.72 $406.08 $410.40 $423.36 Debride skin/tissue/muscle first 20sq cm 11043 $480.00 $480.00 $340.80 $480.00 $480.00 $340.80 $460.80 $451.20 $456.00 $470.40 Debridement Muscle/Fascic 20 Q CM 11043 "$1,266.00 " $480.00 "$1,266.00 " $898.86 "$1,266.00 " "$1,266.00 " $898.86 "$1,215.36 " "$1,190.04 " "$1,202.70 " "$1,240.68 " "11044 DEBRIDE SKN,SUBC TSS & BN CHARGE" 11044 $651.00 $651.00 $462.21 $651.00 $651.00 $462.21 $624.96 $611.94 $618.45 $637.98 Debridement Bone 20 SQ CM 11044 "$1,205.00 " $651.00 "$1,205.00 " $855.55 "$1,205.00 " "$1,205.00 " $855.55 "$1,156.80 " "$1,132.70 " "$1,144.75 " "$1,180.90 " Debridenent Subg Tissue Add-on 11045 $455.00 $86.00 $455.00 $323.05 $455.00 $455.00 $323.05 $436.80 $427.70 $432.25 $445.90 11055 PARING/CUTTING LES SNGL 11055 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 11055 PARING AND CUTTING 11055 $127.00 $118.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 11056 PARING/CUTTING LES 2-4 11056 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 11056 REMOVE CALLOUS 11056 $276.00 $141.00 $276.00 $195.96 $276.00 $276.00 $195.96 $264.96 $259.44 $262.20 $270.48 11057 PARING/CUTTING LES >4 11057 $320.00 $157.00 $320.00 $227.20 $320.00 $320.00 $227.20 $307.20 $300.80 $304.00 $313.60 "11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); Single lesion THAY" 11102 $205.00 $205.00 $145.55 $205.00 $205.00 $145.55 $196.80 $192.70 $194.75 $200.90 "11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); Single lesion" 11102 $740.00 $205.00 $740.00 $525.40 $740.00 $740.00 $525.40 $710.40 $695.60 $703.00 $725.20 11103 Each Separate/additional lesion THAY 11103 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 11103 Each Separate/additional lesion 11103 $276.00 $111.00 $276.00 $195.96 $276.00 $276.00 $195.96 $264.96 $259.44 $262.20 $270.48 "11104 Punch Biopsy of skin; (including simple closure, when performed) single lesion" 11104 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 11104 Punch Biopsy of skin; single lesion 11104 $644.00 $258.00 $644.00 $457.24 $644.00 $644.00 $457.24 $618.24 $605.36 $611.80 $631.12 11105 each separate/additional lesion THAY 11105 $127.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 11105 each seperate/additional lesion 11105 $158.00 $127.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 11106 Incisional biopsy of skin THAY 11106 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 "11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesio" 11106 $782.00 $312.00 $782.00 $555.22 $782.00 $782.00 $555.22 $750.72 $735.08 $742.90 $766.36 11107 Each Separate/additional lesion THAY 11107 $149.00 $149.00 $105.79 $149.00 $149.00 $105.79 $143.04 $140.06 $141.55 $146.02 11107 Each Separate/additional lesion 11107 $252.00 $149.00 $252.00 $178.92 $252.00 $252.00 $178.92 $241.92 $236.88 $239.40 $246.96 11200 REMOVAL OF SKIN TAGS 11200 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 11200 SKIN TAG UP TO 15 11200 $594.00 $184.00 $594.00 $421.74 $594.00 $594.00 $421.74 $570.24 $558.36 $564.30 $582.12 11201 SKIN TAG RMVL EA 10 LES 11201 $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 11300 SHVNG EPDRML LES SNGL TAL 11300 $203.00 $203.00 $144.13 $203.00 $203.00 $144.13 $194.88 $190.82 $192.85 $198.94 11301 SHAVE EPIDERMAL LES SNGL 11301 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 "11302 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion 1.1 to 2.0cm" 11302 $291.00 $291.00 $206.61 $291.00 $291.00 $206.61 $279.36 $273.54 $276.45 $285.18 "Shaving of epidermal or dermal lesion, singe lesion, trunk, arms or legs; lesion diameter over 2.0 c" 11303 $321.00 $321.00 $227.91 $321.00 $321.00 $227.91 $308.16 $301.74 $304.95 $314.58 "11303 SHAVING T,A, OR L OV" 11303 $802.00 $321.00 $802.00 $569.42 $802.00 $802.00 $569.42 $769.92 $753.88 $761.90 $785.96 11305 SHAVE EPDRML LES SNHFG 11305 $214.00 $214.00 $151.94 $214.00 $214.00 $151.94 $205.44 $201.16 $203.30 $209.72 11306 SHAVE LES SCLP NCK HND FT 11306 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 "Shave (Epi)Dermal Lesion, Single, Scalp, Neck, Hands, Feet, Genital; Diam 1.1 to 2.0 cm Charge" 11307 $300.00 $300.00 $213.00 $300.00 $300.00 $213.00 $288.00 $282.00 $285.00 $294.00 "Shave (Epi)Dermal Lesion, Single, Scalp, Neck, Hands, Feet, Genital; Diam 2.0+ cm Charge" 11308 $320.00 $320.00 $227.20 $320.00 $320.00 $227.20 $307.20 $300.80 $304.00 $313.60 "Shave (Epi)Dermal Lesion, Single, Face/Ears/Eyelids/Nose/Lips/Mucous Membrane; Diam 0.5 cm > Charge" 11310 $236.00 $236.00 $167.56 $236.00 $236.00 $167.56 $226.56 $221.84 $224.20 $231.28 11310 SHAVE EXC .5 OR < 11310 $246.00 $236.00 $246.00 $174.66 $246.00 $246.00 $174.66 $236.16 $231.24 $233.70 $241.08 "Shave (Epi)Dermal Lesion, Single, Face/Ears/Eyelids/Nose/Lips/Mucous Memb; Diam 0.6 to 1.0 cm Charge" 11311 $282.00 $282.00 $200.22 $282.00 $282.00 $200.22 $270.72 $265.08 $267.90 $276.36 "Shave (Epi)Dermal Lesion, Single, Face/Ears/Eyelids/Nose/Lips/Mucous Memb; Diam 1.1 to 2.0 cm Charge" 11312 $330.00 $330.00 $234.30 $330.00 $330.00 $234.30 $316.80 $310.20 $313.50 $323.40 "Shave (Epi)Dermal Lesion, Single, Face/Ears/Eyelids/Nose/Lips/Mucous Membrane; Diam 2.0+ cm Charge" 11313 $387.00 $387.00 $274.77 $387.00 $387.00 $274.77 $371.52 $363.78 $367.65 $379.26 "Remove Lesion, Trunk/Arm/Leg <.5 cm Charge" 11400 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 11400 EXC BENIGN LES T/A/L 11400 "$1,882.00 " $258.00 "$1,882.00 " "$1,336.22 " "$1,882.00 " "$1,882.00 " "$1,336.22 " "$1,806.72 " "$1,769.08 " "$1,787.90 " "$1,844.36 " "Remove Lesion, Trunk/Arm/Leg .6 to 1.0 cm Charge" 11401 $314.00 $314.00 $222.94 $314.00 $314.00 $222.94 $301.44 $295.16 $298.30 $307.72 11401 EXC BENIGN LES T/A/L 11401 "$1,217.00 " $314.00 "$1,217.00 " $864.07 "$1,217.00 " "$1,217.00 " $864.07 "$1,168.32 " "$1,143.98 " "$1,156.15 " "$1,192.66 " "Remove Lesion, Trunk/Arm/Leg 1.1 to 2.0 cm Charge" 11402 $348.00 $348.00 $247.08 $348.00 $348.00 $247.08 $334.08 $327.12 $330.60 $341.04 "Remove Lesion, Trunk/Arm/Leg 2.1 to 3.0 cm Charge" 11403 $402.00 $402.00 $285.42 $402.00 $402.00 $285.42 $385.92 $377.88 $381.90 $393.96 11403 EXC BENIGN LESN 11403 "$2,180.00 " $402.00 "$2,180.00 " "$1,547.80 " "$2,180.00 " "$2,180.00 " "$1,547.80 " "$2,092.80 " "$2,049.20 " "$2,071.00 " "$2,136.40 " "Remove Lesion, Trunk/Arm/Leg 3.1 to 4.0 cm Charge" 11404 $454.00 $454.00 $322.34 $454.00 $454.00 $322.34 $435.84 $426.76 $431.30 $444.92 11404 EXC BENIGN LES T.A.L 11404 "$2,121.00 " $454.00 "$2,121.00 " "$1,505.91 " "$2,121.00 " "$2,121.00 " "$1,505.91 " "$2,036.16 " "$1,993.74 " "$2,014.95 " "$2,078.58 " "Remove Lesion, Trunk/Arm/Leg >4.0 cm Charge" 11406 $650.00 $650.00 $461.50 $650.00 $650.00 $461.50 $624.00 $611.00 $617.50 $637.00 11406 EXC BEN LESN >4.0 CM 11406 "$2,827.00 " $650.00 "$2,827.00 " "$2,007.17 " "$2,827.00 " "$2,827.00 " "$2,007.17 " "$2,713.92 " "$2,657.38 " "$2,685.65 " "$2,770.46 " "Remove Lesion, Scalp/Neck/Hand/Foot < .5 cm Charge" 11420 $260.00 $260.00 $184.60 $260.00 $260.00 $184.60 $249.60 $244.40 $247.00 $254.80 "Remove Lesion, Scalp/Neck/Hand/Foot .6 to 1.0 cm Charge" 11421 $329.00 $329.00 $233.59 $329.00 $329.00 $233.59 $315.84 $309.26 $312.55 $322.42 "11421 EXC BEN LESN S,N,H,F" 11421 "$2,507.00 " $329.00 "$2,507.00 " "$1,779.97 " "$2,507.00 " "$2,507.00 " "$1,779.97 " "$2,406.72 " "$2,356.58 " "$2,381.65 " "$2,456.86 " "Remove Lesion, Scalp/Neck/Hand/Foot 1.1 to 2.0 cm Charge" 11422 $370.00 $370.00 $262.70 $370.00 $370.00 $262.70 $355.20 $347.80 $351.50 $362.60 "Remove Lesion, Scalp/Neck/Hand/Foot 2.1 to 3.0 cm Charge" 11423 $421.00 $421.00 $298.91 $421.00 $421.00 $298.91 $404.16 $395.74 $399.95 $412.58 "Remove Lesion, Scalp/Neck/Hand/Foot 3.1 to 4.0 cm Charge" 11424 $487.00 $487.00 $345.77 $487.00 $487.00 $345.77 $467.52 $457.78 $462.65 $477.26 "11424 EXC BEN LESN S,N,H,F" 11424 "$2,477.00 " $487.00 "$2,477.00 " "$1,758.67 " "$2,477.00 " "$2,477.00 " "$1,758.67 " "$2,377.92 " "$2,328.38 " "$2,353.15 " "$2,427.46 " "Remove Lesion, Scalp/Neck/Hand/Foot >4.0 cm Charge" 11426 $694.00 $694.00 $492.74 $694.00 $694.00 $492.74 $666.24 $652.36 $659.30 $680.12 11426 EXC BEN LES>4 CM 11426 "$2,239.00 " $694.00 "$2,239.00 " "$1,589.69 " "$2,239.00 " "$2,239.00 " "$1,589.69 " "$2,149.44 " "$2,104.66 " "$2,127.05 " "$2,194.22 " "Remove Lesion, Face/Lid/Ear/Nose/Lip <.5 cm Charge" 11440 $287.00 $287.00 $203.77 $287.00 $287.00 $203.77 $275.52 $269.78 $272.65 $281.26 11440 LESION-BENIGN FACE 11440 $994.00 $287.00 $994.00 $705.74 $994.00 $994.00 $705.74 $954.24 $934.36 $944.30 $974.12 "Remove Lesion, Face/Lid/Ear/Nose/Lip .6 to 1.0 cm Charge" 11441 $353.00 $353.00 $250.63 $353.00 $353.00 $250.63 $338.88 $331.82 $335.35 $345.94 11441 LES BEN FACE/EARS/ O 11441 $549.00 $353.00 $549.00 $389.79 $549.00 $549.00 $389.79 $527.04 $516.06 $521.55 $538.02 "Remove Lesion, Face/Lid/Ear/Nose/Lip 1.1 to 2.0 cm Charge" 11442 $393.00 $393.00 $279.03 $393.00 $393.00 $279.03 $377.28 $369.42 $373.35 $385.14 "11442 EX BEN LESN F,E,E,N," 11442 "$2,231.00 " $393.00 "$2,231.00 " "$1,584.01 " "$2,231.00 " "$2,231.00 " "$1,584.01 " "$2,141.76 " "$2,097.14 " "$2,119.45 " "$2,186.38 " "Remove Lesion, Face/Lid/Ear/Nose/Lip 2.1 to 3.0 cm Charge" 11443 $468.00 $468.00 $332.28 $468.00 $468.00 $332.28 $449.28 $439.92 $444.60 $458.64 "Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.5 cm or Less Charge" 11600 $404.00 $404.00 $286.84 $404.00 $404.00 $286.84 $387.84 $379.76 $383.80 $395.92 "Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.6 to 1.0 cm Charge" 11601 $476.00 $476.00 $337.96 $476.00 $476.00 $337.96 $456.96 $447.44 $452.20 $466.48 "Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 1.1 to 2.0 cm Charge" 11602 $515.00 $515.00 $365.65 $515.00 $515.00 $365.65 $494.40 $484.10 $489.25 $504.70 "Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 2.1 to 3.0 cm Charge" 11603 $589.00 $589.00 $418.19 $589.00 $589.00 $418.19 $565.44 $553.66 $559.55 $577.22 11603 LES MAL TRUNK ARM LE 11603 $667.00 $589.00 $667.00 $473.57 $667.00 $667.00 $473.57 $640.32 $626.98 $633.65 $653.66 "Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 3.1 to 4.0 cm Charge" 11604 $652.00 $652.00 $462.92 $652.00 $652.00 $462.92 $625.92 $612.88 $619.40 $638.96 11604 LES MAL TRUNK ARM LE 11604 "$2,779.00 " $652.00 "$2,779.00 " "$1,973.09 " "$2,779.00 " "$2,779.00 " "$1,973.09 " "$2,667.84 " "$2,612.26 " "$2,640.05 " "$2,723.42 " Exc mal les trk/arm/leg over 4.0cm 11606 $931.00 $931.00 $661.01 $931.00 $931.00 $661.01 $893.76 $875.14 $884.45 $912.38 "Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 0.5 cm > Charge" 11620 $406.00 $406.00 $288.26 $406.00 $406.00 $288.26 $389.76 $381.64 $385.70 $397.88 "Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 0.6 to 1.0 cm Charge" 11621 $478.00 $478.00 $339.38 $478.00 $478.00 $339.38 $458.88 $449.32 $454.10 $468.44 "Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 1.1 to 2.0 cm Charge" 11622 $532.00 $532.00 $377.72 $532.00 $532.00 $377.72 $510.72 $500.08 $505.40 $521.36 "Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 2.1 to 3.0 cm Charge" 11623 $624.00 $624.00 $443.04 $624.00 $624.00 $443.04 $599.04 $586.56 $592.80 $611.52 "Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 3.1 to 4.0 cm Charge" 11624 $704.00 $704.00 $499.84 $704.00 $704.00 $499.84 $675.84 $661.76 $668.80 $689.92 "11624 EXC MAL LESN S,N,H,F" 11624 "$4,678.00 " $704.00 "$4,678.00 " "$3,321.38 " "$4,678.00 " "$4,678.00 " "$3,321.38 " "$4,490.88 " "$4,397.32 " "$4,444.10 " "$4,584.44 " "Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 4.0+ cm Charge" 11626 $845.00 $845.00 $599.95 $845.00 $845.00 $599.95 $811.20 $794.30 $802.75 $828.10 "Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0.5 cm or Less Charge" 11640 $419.00 $419.00 $297.49 $419.00 $419.00 $297.49 $402.24 $393.86 $398.05 $410.62 "Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0.6 to 1.0 cm Charge" 11641 $495.00 $495.00 $351.45 $495.00 $495.00 $351.45 $475.20 $465.30 $470.25 $485.10 11641 LES MAL FACE ER EY N 11641 "$1,300.00 " $495.00 "$1,300.00 " $923.00 "$1,300.00 " "$1,300.00 " $923.00 "$1,248.00 " "$1,222.00 " "$1,235.00 " "$1,274.00 " "Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 1.1 to 2.0 cm Charge" 11642 $564.00 $564.00 $400.44 $564.00 $564.00 $400.44 $541.44 $530.16 $535.80 $552.72 "Remove Malig Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Diam 2.1 to 3.0 cm Charge" 11643 "$2,741.00 " $663.00 "$2,741.00 " "$1,946.11 " "$2,741.00 " "$2,741.00 " "$1,946.11 " "$2,631.36 " "$2,576.54 " "$2,603.95 " "$2,686.18 " "Remove Malig Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Diam 3.1 to 4.0 cm Charge" 11644 $817.00 $817.00 $580.07 $817.00 $817.00 $580.07 $784.32 $767.98 $776.15 $800.66 11644 LES MAL FAC ER EY NO 11644 "$3,760.00 " $817.00 "$3,760.00 " "$2,669.60 " "$3,760.00 " "$3,760.00 " "$2,669.60 " "$3,609.60 " "$3,534.40 " "$3,572.00 " "$3,684.80 " "Remove Malig Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Diam 4.0+ cm Charge" 11646 "$2,580.00 " "$1,064.00 " "$2,580.00 " "$1,831.80 " "$2,580.00 " "$2,580.00 " "$1,831.80 " "$2,476.80 " "$2,425.20 " "$2,451.00 " "$2,528.40 " 11719 TRIM NAILS 11719 $65.00 $31.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 11720 DEBRIDE NAILS; 1-5 PRO FEE 11720 $144.00 $70.00 $144.00 $102.24 $144.00 $144.00 $102.24 $138.24 $135.36 $136.80 $141.12 Debridenent Nail le or More 11721 $240.00 $96.00 $240.00 $170.40 $240.00 $240.00 $170.40 $230.40 $225.60 $228.00 $235.20 "Avulsion of Nail Plate, Partial or Complete, Simple; Single Charge" 11730 $229.00 $229.00 $162.59 $229.00 $229.00 $162.59 $219.84 $215.26 $217.55 $224.42 11730 AVULSION NAIL PARTIA 11730 $237.00 $229.00 $237.00 $168.27 $237.00 $237.00 $168.27 $227.52 $222.78 $225.15 $232.26 "Avulsion of Nail Plate, Partial or Complete, Simple; each Addtl Nail PlateCharge" 11732 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 11732 AVULSION EA ADD NAIL 11732 $248.00 $69.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 Evac of Subungual Hematoma Charge 11740 $108.00 $108.00 $76.68 $108.00 $108.00 $76.68 $103.68 $101.52 $102.60 $105.84 11740 EVACUATION SUB HEMAT 11740 $269.00 $108.00 $269.00 $190.99 $269.00 $269.00 $190.99 $258.24 $252.86 $255.55 $263.62 "Excise of Nail & matrix, Part. or Complete, for Permanent Removal Charge" 11750 $328.00 $328.00 $232.88 $328.00 $328.00 $232.88 $314.88 $308.32 $311.60 $321.44 Removal Nail Bed 11750 $683.00 $328.00 $683.00 $484.93 $683.00 $683.00 $484.93 $655.68 $642.02 $648.85 $669.34 "Wedge Excise of Skin of Nail Fold (eg, For Ingrown toenail) Charge" 11765 $355.00 $355.00 $252.05 $355.00 $355.00 $252.05 $340.80 $333.70 $337.25 $347.90 11765 EXCISION OF NAIL FOL 11765 $361.00 $355.00 $361.00 $256.31 $361.00 $361.00 $256.31 $346.56 $339.34 $342.95 $353.78 "Injection, intralesional; up to and including seven lesions Med Admin POC" 11900 $114.00 $113.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 11954 SUBQ INJ/FILLING MAT 11954 $321.00 $321.00 $227.91 $321.00 $321.00 $227.91 $308.16 $301.74 $304.95 $314.58 "Removal, Implantable Contraceptive Capsules Charge" 11976 $304.00 $304.00 $215.84 $304.00 $304.00 $215.84 $291.84 $285.76 $288.80 $297.92 "Insertion, non-biodegradable drug delivery implant cc[CHAS]" 11981 $294.00 $294.00 $208.74 $294.00 $294.00 $208.74 $282.24 $276.36 $279.30 $288.12 "11981 Insertion, non-biodegradable drug delivery implant" 11981 $708.00 $294.00 $708.00 $502.68 $708.00 $708.00 $502.68 $679.68 $665.52 $672.60 $693.84 "Removal, Drug Delivery Implant" 11982 "$1,000.00 " $326.00 "$1,000.00 " $710.00 "$1,000.00 " "$1,000.00 " $710.00 $960.00 $940.00 $950.00 $980.00 Removal with reinsertion non bio drug implant 11983 $480.00 $480.00 $340.80 $480.00 $480.00 $340.80 $460.80 $451.20 $456.00 $470.40 "Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.5 cm > Charge" 12001 $185.00 $185.00 $131.35 $185.00 $185.00 $131.35 $177.60 $173.90 $175.75 $181.30 "12001 SIM SPRFCL S,N,A,G,T" 12001 $270.00 $185.00 $270.00 $191.70 $270.00 $270.00 $191.70 $259.20 $253.80 $256.50 $264.60 "Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.6 cm to 7.5 cm Charge" 12002 $226.00 $226.00 $160.46 $226.00 $226.00 $160.46 $216.96 $212.44 $214.70 $221.48 "12002 SIM SPRFCL S,N,A,G,T" 12002 $282.00 $226.00 $282.00 $200.22 $282.00 $282.00 $200.22 $270.72 $265.08 $267.90 $276.36 "Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 7.6 cm to 12.5 cm Charge" 12004 $265.00 $265.00 $188.15 $265.00 $265.00 $188.15 $254.40 $249.10 $251.75 $259.70 "12004 SIM SPRF S,N,A,G,T,E" 12004 $365.00 $265.00 $365.00 $259.15 $365.00 $365.00 $259.15 $350.40 $343.10 $346.75 $357.70 12005 SIM LAC 12.6 TO 20.0 12005 $401.00 $345.00 $401.00 $284.71 $401.00 $401.00 $284.71 $384.96 $376.94 $380.95 $392.98 "Repair Simple Face, Ears, Eyelids, Nose, Lips and/or Mucous Membranes; 2.5 cm > Charge" 12011 $227.00 $227.00 $161.17 $227.00 $227.00 $161.17 $217.92 $213.38 $215.65 $222.46 "12011 SIM SPRFL F,E,E,N,L" 12011 $305.00 $227.00 $305.00 $216.55 $305.00 $305.00 $216.55 $292.80 $286.70 $289.75 $298.90 "Repair Simple Face, Ears, Eyelids, Nose, Lips and/or Mucous Membranes; 2.6 cm to 5.0 cm Charge" 12013 $237.00 $237.00 $168.27 $237.00 $237.00 $168.27 $227.52 $222.78 $225.15 $232.26 "12013 SIM SPRFCL F,E,E,N,L" 12013 $337.00 $237.00 $337.00 $239.27 $337.00 $337.00 $239.27 $323.52 $316.78 $320.15 $330.26 "Repair Simple Face, Ears, Eyelids, Nose, Lips and/or Mucous Membranes; 5.1 cm to 7.5 cm Charge" 12014 $284.00 $284.00 $201.64 $284.00 $284.00 $201.64 $272.64 $266.96 $269.80 $278.32 "12014 SIM SPRFL F,E,E,N,L" 12014 $325.00 $285.00 $325.00 $230.75 $325.00 $325.00 $230.75 $312.00 $305.50 $308.75 $318.50 "12015 SIM SPRF F,E,E,M,L,M" 12015 $859.00 $344.00 $859.00 $609.89 $859.00 $859.00 $609.89 $824.64 $807.46 $816.05 $841.82 12016 SIM SPRFL 12.6-20 CM 12016 $614.00 $433.00 $614.00 $435.94 $614.00 $614.00 $435.94 $589.44 $577.16 $583.30 $601.72 12020 TRT WOUND DEHIS SIMP 12020 $850.00 $596.00 $850.00 $603.50 $850.00 $850.00 $603.50 $816.00 $799.00 $807.50 $833.00 12021 PACKING ABSCESS 12021 "$2,429.00 " $346.00 "$2,429.00 " "$1,724.59 " "$2,429.00 " "$2,429.00 " "$1,724.59 " "$2,331.84 " "$2,283.26 " "$2,307.55 " "$2,380.42 " "Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 2.5 cm or Less" 12031 $509.00 $509.00 $361.39 $509.00 $509.00 $361.39 $488.64 $478.46 $483.55 $498.82 12031 LAC LAYER SCALP AXI 12031 "$1,273.00 " $509.00 "$1,273.00 " $903.83 "$1,273.00 " "$1,273.00 " $903.83 "$1,222.08 " "$1,196.62 " "$1,209.35 " "$1,247.54 " "Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 2.6 cm to 07.5" 12032 $542.00 $542.00 $384.82 $542.00 $542.00 $384.82 $520.32 $509.48 $514.90 $531.16 12032 LAC LAYER SCALP AXIL 12032 "$1,578.00 " $631.00 "$1,578.00 " "$1,120.38 " "$1,578.00 " "$1,578.00 " "$1,120.38 " "$1,514.88 " "$1,483.32 " "$1,499.10 " "$1,546.44 " "Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 7.6 cm to 12.5" 12034 $661.00 $661.00 $469.31 $661.00 $661.00 $469.31 $634.56 $621.34 $627.95 $647.78 12034 LAC LAYER SCALP AXIL 12034 "$1,654.00 " $661.00 "$1,654.00 " "$1,174.34 " "$1,654.00 " "$1,654.00 " "$1,174.34 " "$1,587.84 " "$1,554.76 " "$1,571.30 " "$1,620.92 " "12035 LAYR CLOS SCLP AX TR, EXTREMITIES" 12035 "$1,175.00 " $795.00 "$1,175.00 " $834.25 "$1,175.00 " "$1,175.00 " $834.25 "$1,128.00 " "$1,104.50 " "$1,116.25 " "$1,151.50 " "Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 2.5 cm or Less Charge Tech Chg" 12041 $510.00 $510.00 $362.10 $510.00 $510.00 $362.10 $489.60 $479.40 $484.50 $499.80 12041 LAYER CLOS <=2.5CM 12041 $763.00 $510.00 $763.00 $541.73 $763.00 $763.00 $541.73 $732.48 $717.22 $724.85 $747.74 "Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 2.6 cm to 7.5 cm Charge" 12042 $614.00 $614.00 $435.94 $614.00 $614.00 $435.94 $589.44 $577.16 $583.30 $601.72 "12042 LAYER CLOSR N,H,F,G" 12042 "$1,536.00 " $614.00 "$1,536.00 " "$1,090.56 " "$1,536.00 " "$1,536.00 " "$1,090.56 " "$1,474.56 " "$1,443.84 " "$1,459.20 " "$1,505.28 " 12044 LAYER CLOS 7.6-12.5 12044 "$1,232.00 " $760.00 "$1,232.00 " $874.72 "$1,232.00 " "$1,232.00 " $874.72 "$1,182.72 " "$1,158.08 " "$1,170.40 " "$1,207.36 " 12045 LAYER CLO 12.6-20.0 12045 "$2,091.00 " $836.00 "$2,091.00 " "$1,484.61 " "$2,091.00 " "$2,091.00 " "$1,484.61 " "$2,007.36 " "$1,965.54 " "$1,986.45 " "$2,049.18 " "Layer Closure of Wounds of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.5 cm or Less Charge" 12051 $551.00 $551.00 $391.21 $551.00 $551.00 $391.21 $528.96 $517.94 $523.45 $539.98 12051 LAYER CLOS <2.5CM 12051 "$1,378.00 " $551.00 "$1,378.00 " $978.38 "$1,378.00 " "$1,378.00 " $978.38 "$1,322.88 " "$1,295.32 " "$1,309.10 " "$1,350.44 " "Layer Closure of Wounds of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.6 cm to 05.0 cm Tech Chg" 12052 $625.00 $625.00 $443.75 $625.00 $625.00 $443.75 $600.00 $587.50 $593.75 $612.50 "12052 LAYER CLOS F,E,E,N,L" 12052 "$1,562.00 " $625.00 "$1,562.00 " "$1,109.02 " "$1,562.00 " "$1,562.00 " "$1,109.02 " "$1,499.52 " "$1,468.28 " "$1,483.90 " "$1,530.76 " "Repair interm, wounds of face, ears, eyelids, nose, lips, mucous membranes; 5.1 cm to 7.5 cm Technic" 12053 $730.00 $730.00 $518.30 $730.00 $730.00 $518.30 $700.80 $686.20 $693.50 $715.40 "12053 LAYER CLOS F,E,E,N,L" 12053 $767.00 $730.00 $767.00 $544.57 $767.00 $767.00 $544.57 $736.32 $720.98 $728.65 $751.66 12054 LAY CLS LAC 7.6-12.5 12054 $818.00 $764.00 $818.00 $580.78 $818.00 $818.00 $580.78 $785.28 $768.92 $777.10 $801.64 Repair Complex Trunk 02.6 to 07.5 cm Charge 13101 $832.00 $832.00 $590.72 $832.00 $832.00 $590.72 $798.72 $782.08 $790.40 $815.36 "13121 COMPLEX REPAIR S,A,L" 13121 $987.00 $895.00 $987.00 $700.77 $987.00 $987.00 $700.77 $947.52 $927.78 $937.65 $967.26 13122 COMPL REPR > 7.5 CM 13122 "$1,293.00 " $275.00 "$1,293.00 " $918.03 "$1,293.00 " "$1,293.00 " $918.03 "$1,241.28 " "$1,215.42 " "$1,228.35 " "$1,267.14 " Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet 01.1 to 02.5 cm Charge 13131 $810.00 $810.00 $575.10 $810.00 $810.00 $575.10 $777.60 $761.40 $769.50 $793.80 "13131 CMPX F,C,C,M,N,A,G,H" 13131 "$2,025.00 " $810.00 "$2,025.00 " "$1,437.75 " "$2,025.00 " "$2,025.00 " "$1,437.75 " "$1,944.00 " "$1,903.50 " "$1,923.75 " "$1,984.50 " "13132 CMPX F,C,C,M,N,A,G,H" 13132 "$1,822.00 " $998.00 "$1,822.00 " "$1,293.62 " "$1,822.00 " "$1,822.00 " "$1,293.62 " "$1,749.12 " "$1,712.68 " "$1,730.90 " "$1,785.56 " Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet Each Addl 5cm Tech Charge 13133 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 13133 EA ADD 5 CM OR LESS 13133 "$1,426.00 " $369.00 "$1,426.00 " "$1,012.46 " "$1,426.00 " "$1,426.00 " "$1,012.46 " "$1,368.96 " "$1,340.44 " "$1,354.70 " "$1,397.48 " 13152 CMPLX REP 2.6-7.5CM 13152 "$1,894.00 " "$1,057.00 " "$1,894.00 " "$1,344.74 " "$1,894.00 " "$1,894.00 " "$1,344.74 " "$1,818.24 " "$1,780.36 " "$1,799.30 " "$1,856.12 " "Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less" 14020 "$1,447.00 " "$1,447.00 " "$1,027.37 " "$1,447.00 " "$1,447.00 " "$1,027.37 " "$1,389.12 " "$1,360.18 " "$1,374.65 " "$1,418.06 " 15002 Surgical Prep of Recipient site 15002 "$2,028.00 " $722.00 "$2,028.00 " "$1,439.88 " "$2,028.00 " "$2,028.00 " "$1,439.88 " "$1,946.88 " "$1,906.32 " "$1,926.60 " "$1,987.44 " 15271 Application of Skin Substitute 15271 $900.00 $303.00 $900.00 $639.00 $900.00 $900.00 $639.00 $864.00 $846.00 $855.00 $882.00 Island Pedicle Flap Graft 15740 "$2,103.00 " "$2,103.00 " "$1,493.13 " "$2,103.00 " "$2,103.00 " "$1,493.13 " "$2,018.88 " "$1,976.82 " "$1,997.85 " "$2,060.94 " 15740 FLAP ISLAND PEDICLE 15740 "$5,257.00 " "$2,103.00 " "$5,257.00 " "$3,732.47 " "$5,257.00 " "$5,257.00 " "$3,732.47 " "$5,046.72 " "$4,941.58 " "$4,994.15 " "$5,151.86 " 15780 DERMABRASION; TOTAL FACE 15780 "$1,910.00 " "$1,910.00 " "$1,356.10 " "$1,910.00 " "$1,910.00 " "$1,356.10 " "$1,833.60 " "$1,795.40 " "$1,814.50 " "$1,871.80 " "Chemical peel, facial; epidermal" 15788 $930.00 $930.00 $660.30 $930.00 $930.00 $660.30 $892.80 $874.20 $883.50 $911.40 16000 INITIAL BURN TRTMNT 16000 $176.00 $147.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 "Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5%" 16020 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 16020 DEBRIDEMENT BURN W O 16020 $297.00 $170.00 $297.00 $210.87 $297.00 $297.00 $210.87 $285.12 $279.18 $282.15 $291.06 16025 MED BURN W O ANESTH 16025 $778.00 $311.00 $778.00 $552.38 $778.00 $778.00 $552.38 $746.88 $731.32 $739.10 $762.44 16030 LARGE BURN W O ANEST 16030 $921.00 $393.00 $921.00 $653.91 $921.00 $921.00 $653.91 $884.16 $865.74 $874.95 $902.58 Destruction Benign/Premalig Lesion Charge 17000 $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 17000 CAUTERY BENIGN NEOPL 17000 $276.00 $136.00 $276.00 $195.96 $276.00 $276.00 $195.96 $264.96 $259.44 $262.20 $270.48 "Destruction Benign/Premalig 2-14 Lesions, each Charge" 17003 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 17003 CAUTERY NEOP 2-14LES 17003 $86.00 $11.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Destruction premalignant lesions 15 or more lesions 17004 $315.00 $315.00 $223.65 $315.00 $315.00 $223.65 $302.40 $296.10 $299.25 $308.70 "Destruction (eg, laser/electro/cryo/chemosurgery/curettement), of warts; up to 14 lesions Charge" 17110 $229.00 $229.00 $162.59 $229.00 $229.00 $162.59 $219.84 $215.26 $217.55 $224.42 17110 DEST WARTS MOLLUS 17110 $316.00 $229.00 $316.00 $224.36 $316.00 $316.00 $224.36 $303.36 $297.04 $300.20 $309.68 "Destruction (laser/electro/cryo/chemosurgery/curette), of warts; 15 or more lesions Charge" 17111 $272.00 $272.00 $193.12 $272.00 $272.00 $193.12 $261.12 $255.68 $258.40 $266.56 "Chemical cauterization of granulation tissue (proud flesh, sinus or fistula) Charge" 17250 $169.00 $169.00 $119.99 $169.00 $169.00 $119.99 $162.24 $158.86 $160.55 $165.62 17250 CAUTERIZATION 17250 $422.00 $169.00 $422.00 $299.62 $422.00 $422.00 $299.62 $405.12 $396.68 $400.90 $413.56 "Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm" 17272 $390.00 $390.00 $276.90 $390.00 $390.00 $276.90 $374.40 $366.60 $370.50 $382.20 "Destruction,malignant lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diam 2.1-3cm" 17283 $511.00 $511.00 $362.81 $511.00 $511.00 $362.81 $490.56 $480.34 $485.45 $500.78 "Breast Aspiration, Puncture Charge" 19000 $229.00 $229.00 $162.59 $229.00 $229.00 $162.59 $219.84 $215.26 $217.55 $224.42 19020 MASTOTOMY I&D ABCESS 19020 "$2,432.00 " $973.00 "$2,432.00 " "$1,726.72 " "$2,432.00 " "$2,432.00 " "$1,726.72 " "$2,334.72 " "$2,286.08 " "$2,310.40 " "$2,383.36 " US Guided Biopsy Breast 19083 "$1,814.00 " "$1,323.00 " "$1,814.00 " "$1,287.94 " "$1,814.00 " "$1,814.00 " "$1,287.94 " "$1,741.44 " "$1,705.16 " "$1,723.30 " "$1,777.72 " US Breast Biopsy Loc Plcmt Ea Addl 19084 "$1,250.00 " "$1,250.00 " $887.50 "$1,250.00 " "$1,250.00 " $887.50 "$1,200.00 " "$1,175.00 " "$1,187.50 " "$1,225.00 " "Breast Biopsy; Percutaneous, Needle Core (Not Using Imaging Guidance) Charge" 19100 $310.00 $310.00 $220.10 $310.00 $310.00 $220.10 $297.60 $291.40 $294.50 $303.80 BIOPSY BRST PERC NDL CORE 19100 $346.00 $310.00 $346.00 $245.66 $346.00 $346.00 $245.66 $332.16 $325.24 $328.70 $339.08 Breast Biopsy Open Incision Charge 19101 $692.00 $692.00 $491.32 $692.00 $692.00 $491.32 $664.32 $650.48 $657.40 $678.16 19101 OPEN BREAST BIOPSY 19101 "$3,281.00 " $692.00 "$3,281.00 " "$2,329.51 " "$3,281.00 " "$3,281.00 " "$2,329.51 " "$3,149.76 " "$3,084.14 " "$3,116.95 " "$3,215.38 " Explore of Penetrating Wound; Extremity Charge 20103 "$1,206.00 " "$1,206.00 " $856.26 "$1,206.00 " "$1,206.00 " $856.26 "$1,157.76 " "$1,133.64 " "$1,145.70 " "$1,181.88 " 20103 WOUND EXPLORA EXTREM 20103 "$3,905.00 " "$1,206.00 " "$3,905.00 " "$2,772.55 " "$3,905.00 " "$3,905.00 " "$2,772.55 " "$3,748.80 " "$3,670.70 " "$3,709.75 " "$3,826.90 " "Biopsy, Muscle, Percutaneous Needle Charge" 20206 $493.00 $493.00 $350.03 $493.00 $493.00 $350.03 $473.28 $463.42 $468.35 $483.14 "Inj., Therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel Med Admin POC" 20526 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 20526 INJ THERAPEUTIC CARPL TUNNEL WRIST 20526 $472.00 $160.00 $472.00 $335.12 $472.00 $472.00 $335.12 $453.12 $443.68 $448.40 $462.56 "Inj(s); Single Tendon Sheath, or Ligament, Aponeurosis (eg, Planterar Fascia) Charge" 20550 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 20550 INJECT TENDON 20550 $159.00 $111.00 $159.00 $112.89 $159.00 $159.00 $112.89 $152.64 $149.46 $151.05 $155.82 Inj tendon origin/insert 20551 $171.00 $113.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 "Inj(s); Single or Mult Trigger Point(S), One or Two Muscle(s) Charge" 20552 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 20552 INJ TRIG POINT <2GRP 20552 $348.00 $116.00 $348.00 $247.08 $348.00 $348.00 $247.08 $334.08 $327.12 $330.60 $341.04 "Inj(s); Single or Mult Trigger Point(S), Three or More Muscle(s) Charge" 20553 $134.00 $134.00 $95.14 $134.00 $134.00 $95.14 $128.64 $125.96 $127.30 $131.32 20553 Inj Trigger Point 3 Or Mo 20553 $352.00 $134.00 $352.00 $249.92 $352.00 $352.00 $249.92 $337.92 $330.88 $334.40 $344.96 "Arthrocentesis, Aspirtn and/or Inj; Small Joint or Bursa (eg, Fingers, toes) Charge" 20600 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Brain/Inj Joint/Bursa w/o US 20600 $231.00 $102.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 "Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge" 20605 $106.00 $106.00 $75.26 $106.00 $106.00 $75.26 $101.76 $99.64 $100.70 $103.88 20605 ASP INJ INT JOINT 20605 $235.00 $106.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 20610 DRAIN/INJ JOINT/BURSA W/O US 20610 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 20610 ASP INJ MAJOR JOINT 20610 $246.00 $125.00 $246.00 $174.66 $246.00 $246.00 $174.66 $236.16 $231.24 $233.70 $241.08 Aspirtn and/or Inj of Ganglion Cyst(s) Any Location Charge 20612 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 21310 NASAL FRACTURE CARE 21310 "$1,758.00 " $275.00 "$1,758.00 " "$1,248.18 " "$1,758.00 " "$1,758.00 " "$1,248.18 " "$1,687.68 " "$1,652.52 " "$1,670.10 " "$1,722.84 " "70121552 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater" 21552 "$3,472.00 " $917.00 "$3,472.00 " "$2,465.12 " "$3,472.00 " "$3,472.00 " "$2,465.12 " "$3,333.12 " "$3,263.68 " "$3,298.40 " "$3,402.56 " Excision tumor soft tissue of back or flank subcutaneous less than 3 cm 21930 $996.00 $996.00 $707.16 $996.00 $996.00 $707.16 $956.16 $936.24 $946.20 $976.08 21930 EXC TUMOR BACK FLANK 21930 "$4,283.00 " $996.00 "$4,283.00 " "$3,040.93 " "$4,283.00 " "$4,283.00 " "$3,040.93 " "$4,111.68 " "$4,026.02 " "$4,068.85 " "$4,197.34 " Exc Back Les Sc >3Cm 21931 $965.00 $965.00 $685.15 $965.00 $965.00 $685.15 $926.40 $907.10 $916.75 $945.70 21931 EXCISION LIPOMA FLANK 21931 "$4,233.00 " $965.00 "$4,233.00 " "$3,005.43 " "$4,233.00 " "$4,233.00 " "$3,005.43 " "$4,063.68 " "$3,979.02 " "$4,021.35 " "$4,148.34 " 22902 Excision Benign tumor abdomen sq 22902 $922.00 $922.00 $654.62 $922.00 $922.00 $654.62 $885.12 $866.68 $875.90 $903.56 "Excision, tumor, soft tissue of shoulder, subcutaneous; 3cm or greater" 23071 $862.00 $862.00 $612.02 $862.00 $862.00 $612.02 $827.52 $810.28 $818.90 $844.76 Closed Trtmt of Clavicular Fx; w/o Manipulation 23500 $453.00 $453.00 $321.63 $453.00 $453.00 $321.63 $434.88 $425.82 $430.35 $443.94 23500 FX CLAVICULAR W O MA 23500 "$1,133.00 " $453.00 "$1,133.00 " $804.43 "$1,133.00 " "$1,133.00 " $804.43 "$1,087.68 " "$1,065.02 " "$1,076.35 " "$1,110.34 " 23505 FX CLAVICULAR W MAN 23505 $773.00 $735.00 $773.00 $548.83 $773.00 $773.00 $548.83 $742.08 $726.62 $734.35 $757.54 23540 CL TRT SHOULDER DISL 23540 $572.00 $475.00 $572.00 $406.12 $572.00 $572.00 $406.12 $549.12 $537.68 $543.40 $560.56 23570 CLOS TRMT FX SCAPULA 23570 "$1,199.00 " $480.00 "$1,199.00 " $851.29 "$1,199.00 " "$1,199.00 " $851.29 "$1,151.04 " "$1,127.06 " "$1,139.05 " "$1,175.02 " Closed Trtmt of Proximal Humeral (Surgical or Anatomical Neck) Fx; w/o Manipulation Charge 23600 $680.00 $680.00 $482.80 $680.00 $680.00 $482.80 $652.80 $639.20 $646.00 $666.40 23600 CLS TRTMT PRX HUMRS 23600 "$1,699.00 " $680.00 "$1,699.00 " "$1,206.29 " "$1,699.00 " "$1,699.00 " "$1,206.29 " "$1,631.04 " "$1,597.06 " "$1,614.05 " "$1,665.02 " Closed Trtmt of Greater Humeral Tuberosity Fx; w/o Manipulation Charge 23620 $555.00 $555.00 $394.05 $555.00 $555.00 $394.05 $532.80 $521.70 $527.25 $543.90 23620 FX GRT HUM TUB W OMA 23620 $666.00 $555.00 $666.00 $472.86 $666.00 $666.00 $472.86 $639.36 $626.04 $632.70 $652.68 23625 FX GRT HUMERAL TUBER 23625 "$1,844.00 " $790.00 "$1,844.00 " "$1,309.24 " "$1,844.00 " "$1,844.00 " "$1,309.24 " "$1,770.24 " "$1,733.36 " "$1,751.80 " "$1,807.12 " "Closed Trtmt of Shoulder Dislocation, w/Manipulation; w/o Anesthesia Charge" 23650 $664.00 $664.00 $471.44 $664.00 $664.00 $471.44 $637.44 $624.16 $630.80 $650.72 23650 DISLOC SHOU CL W MAN 23650 "$1,661.00 " $664.00 "$1,661.00 " "$1,179.31 " "$1,661.00 " "$1,661.00 " "$1,179.31 " "$1,594.56 " "$1,561.34 " "$1,577.95 " "$1,627.78 " 23665 FX GRT HUMER TUBER 23665 "$1,862.00 " $886.00 "$1,862.00 " "$1,322.02 " "$1,862.00 " "$1,862.00 " "$1,322.02 " "$1,787.52 " "$1,750.28 " "$1,768.90 " "$1,824.76 " "Excision tumor, soft tissue of upper arm/elbow, 3cm or >" 24071 $835.00 $835.00 $592.85 $835.00 $835.00 $592.85 $801.60 $784.90 $793.25 $818.30 Closed Trtmt of Humeral Shaft Fx; w/o Manipulation Charge 24500 $741.00 $741.00 $526.11 $741.00 $741.00 $526.11 $711.36 $696.54 $703.95 $726.18 24505 FX HUM SHFT CL W MAN 24505 "$2,427.00 " "$1,032.00 " "$2,427.00 " "$1,723.17 " "$2,427.00 " "$2,427.00 " "$1,723.17 " "$2,329.92 " "$2,281.38 " "$2,305.65 " "$2,378.46 " Closed treatment of supracondylar humeral fracture w/wo intercondylar ext. without manipulation 24530 $786.00 $786.00 $558.06 $786.00 $786.00 $558.06 $754.56 $738.84 $746.70 $770.28 24530 SUPRACONDY HUM FRACT 24530 "$1,965.00 " $786.00 "$1,965.00 " "$1,395.15 " "$1,965.00 " "$1,965.00 " "$1,395.15 " "$1,886.40 " "$1,847.10 " "$1,866.75 " "$1,925.70 " "Closed Trtmt of Humeral Epicondylar Fx, Medial or Lateral; w/o Manipulation Charge" 24560 $676.00 $676.00 $479.96 $676.00 $676.00 $479.96 $648.96 $635.44 $642.20 $662.48 24560 FX HUM EPICON MED LA 24560 $837.00 $676.00 $837.00 $594.27 $837.00 $837.00 $594.27 $803.52 $786.78 $795.15 $820.26 24576 FX HUMERAL COND W O 24576 "$1,780.00 " $712.00 "$1,780.00 " "$1,263.80 " "$1,780.00 " "$1,780.00 " "$1,263.80 " "$1,708.80 " "$1,673.20 " "$1,691.00 " "$1,744.40 " 24600 DISLOC ELBOW CL WO A 24600 "$1,925.00 " $770.00 "$1,925.00 " "$1,366.75 " "$1,925.00 " "$1,925.00 " "$1,366.75 " "$1,848.00 " "$1,809.50 " "$1,828.75 " "$1,886.50 " 24605 Clsd Tx Elbow Disl W/Anes 24605 "$1,775.00 " $980.00 "$1,775.00 " "$1,260.25 " "$1,775.00 " "$1,775.00 " "$1,260.25 " "$1,704.00 " "$1,668.50 " "$1,686.25 " "$1,739.50 " "Closed Trtmt of Radial Head Subluxation In Child, Nursemaid Elbow, w/Manipulation Charge" 24640 $323.00 $323.00 $229.33 $323.00 $323.00 $229.33 $310.08 $303.62 $306.85 $316.54 24640 CLO RAD HEAD SUBLUXA 24640 $535.00 $214.00 $535.00 $379.85 $535.00 $535.00 $379.85 $513.60 $502.90 $508.25 $524.30 Closed Trtmt of Radial Head or Neck Fx; w/o Manipulation Charge 24650 $541.00 $541.00 $384.11 $541.00 $541.00 $384.11 $519.36 $508.54 $513.95 $530.18 24650 FX RADIAL H N CL WO 24650 "$1,353.00 " $541.00 "$1,353.00 " $960.63 "$1,353.00 " "$1,353.00 " $960.63 "$1,298.88 " "$1,271.82 " "$1,285.35 " "$1,325.94 " "Closed Trtmt of Ulnar Fx, Proximal End (Olecranon Process); w/o Manipulation Charge" 24670 $601.00 $601.00 $426.71 $601.00 $601.00 $426.71 $576.96 $564.94 $570.95 $588.98 24670 FX PROX ULNAR WO MAN 24670 $684.00 $601.00 $684.00 $485.64 $684.00 $684.00 $485.64 $656.64 $642.96 $649.80 $670.32 25000 Inc Exten Tendn Shth Wrst 25000 "$2,070.00 " $703.00 "$2,070.00 " "$1,469.70 " "$2,070.00 " "$2,070.00 " "$1,469.70 " "$1,987.20 " "$1,945.80 " "$1,966.50 " "$2,028.60 " Excision Tumor SubQ >3 Cm 25071 $876.00 $876.00 $621.96 $876.00 $876.00 $621.96 $840.96 $823.44 $832.20 $858.48 "Excise, Tumor, Soft Tissue of Forearm and/or Wrist Area; Subcutaneous Charge" 25075 "$1,019.00 " "$1,019.00 " $723.49 "$1,019.00 " "$1,019.00 " $723.49 $978.24 $957.86 $968.05 $998.62 Repair forearm tendon/muscle 25260 "$1,309.00 " "$1,309.00 " $929.39 "$1,309.00 " "$1,309.00 " $929.39 "$1,256.64 " "$1,230.46 " "$1,243.55 " "$1,282.82 " 25260 REPR FRARM WRST TEND 25260 "$5,666.00 " "$1,309.00 " "$5,666.00 " "$4,022.86 " "$5,666.00 " "$5,666.00 " "$4,022.86 " "$5,439.36 " "$5,326.04 " "$5,382.70 " "$5,552.68 " Closed Trtmt of Radial Shaft Fx; w/o Manipulation Charge 25500 $573.00 $573.00 $406.83 $573.00 $573.00 $406.83 $550.08 $538.62 $544.35 $561.54 25500 FX RADIAL SHAFT WO M 25500 "$1,433.00 " $573.00 "$1,433.00 " "$1,017.43 " "$1,433.00 " "$1,433.00 " "$1,017.43 " "$1,375.68 " "$1,347.02 " "$1,361.35 " "$1,404.34 " FX CLSD RAD SHFT W MAN 25505 "$2,597.00 " "$1,039.00 " "$2,597.00 " "$1,843.87 " "$2,597.00 " "$2,597.00 " "$1,843.87 " "$2,493.12 " "$2,441.18 " "$2,467.15 " "$2,545.06 " Closed Trtmt of Ulnar Shaft Fx; w/o Manipulation Charge 25530 $542.00 $542.00 $384.82 $542.00 $542.00 $384.82 $520.32 $509.48 $514.90 $531.16 25530 FX ULNAR SHAFT 25530 "$1,354.00 " $542.00 "$1,354.00 " $961.34 "$1,354.00 " "$1,354.00 " $961.34 "$1,299.84 " "$1,272.76 " "$1,286.30 " "$1,326.92 " Closed Trtmt of Radial & Ulnar Shaft Fxs; w/o Manipulation Charge 25560 $585.00 $585.00 $415.35 $585.00 $585.00 $415.35 $561.60 $549.90 $555.75 $573.30 25560 FX RAD ULN SH CL WO 25560 "$1,462.00 " $585.00 "$1,462.00 " "$1,038.02 " "$1,462.00 " "$1,462.00 " "$1,038.02 " "$1,403.52 " "$1,374.28 " "$1,388.90 " "$1,432.76 " Closed Trtmt of Radial & Ulnar Shaft Fxs; w/Manipulation Charge 25565 "$1,069.00 " "$1,069.00 " $758.99 "$1,069.00 " "$1,069.00 " $758.99 "$1,026.24 " "$1,004.86 " "$1,015.55 " "$1,047.62 " 25565 FX RAD ULN SH CL WIT 25565 "$2,672.00 " "$1,069.00 " "$2,672.00 " "$1,897.12 " "$2,672.00 " "$2,672.00 " "$1,897.12 " "$2,565.12 " "$2,511.68 " "$2,538.40 " "$2,618.56 " "Closed treatment of distal radial fracture (eg, Colles or Smith type) w/o manipualtion charge" 25600 $683.00 $683.00 $484.93 $683.00 $683.00 $484.93 $655.68 $642.02 $648.85 $669.34 25600 CLOS TRTMT DSTL RAD 25600 $774.00 $683.00 $774.00 $549.54 $774.00 $774.00 $549.54 $743.04 $727.56 $735.30 $758.52 "Closed treatment of distal radial fracture (eg, Colles or Smith type) w/ manipualtion charge" 25605 "$1,121.00 " "$1,121.00 " $795.91 "$1,121.00 " "$1,121.00 " $795.91 "$1,076.16 " "$1,053.74 " "$1,064.95 " "$1,098.58 " 25605 CLOS TRTMT DSTL RAD 25605 "$1,239.00 " "$1,121.00 " "$1,239.00 " $879.69 "$1,239.00 " "$1,239.00 " $879.69 "$1,189.44 " "$1,164.66 " "$1,177.05 " "$1,214.22 " Closed Trtmt of Carpal Scaphoid (Navicular) Fx; w/o Manipulation Charge 25622 $633.00 $633.00 $449.43 $633.00 $633.00 $449.43 $607.68 $595.02 $601.35 $620.34 Closed treatment of carpal bone fracture without manipulation each bone 25630 $632.00 $632.00 $448.72 $632.00 $632.00 $448.72 $606.72 $594.08 $600.40 $619.36 25630 TREAT WRISTBONE FRAC 25630 "$1,579.00 " $632.00 "$1,579.00 " "$1,121.09 " "$1,579.00 " "$1,579.00 " "$1,121.09 " "$1,515.84 " "$1,484.26 " "$1,500.05 " "$1,547.42 " Closed Trtmt of Ulnar Styloid Fx Charge 25650 $670.00 $670.00 $475.70 $670.00 $670.00 $475.70 $643.20 $629.80 $636.50 $656.60 25650 FX ULNAR STYLOID CLO 25650 $934.00 $670.00 $934.00 $663.14 $934.00 $934.00 $663.14 $896.64 $877.96 $887.30 $915.32 Drainage of Finger Abscess; Simple Charge 26010 $566.00 $566.00 $401.86 $566.00 $566.00 $401.86 $543.36 $532.04 $537.70 $554.68 26010 DRAIN FINGER ABCESS 26010 "$1,025.00 " $566.00 "$1,025.00 " $727.75 "$1,025.00 " "$1,025.00 " $727.75 $984.00 $963.50 $973.75 "$1,004.50 " 26055 INCISE FINGER TENDON SHEATH 26055 "$1,934.00 " $645.00 "$1,934.00 " "$1,373.14 " "$1,934.00 " "$1,934.00 " "$1,373.14 " "$1,856.64 " "$1,817.96 " "$1,837.30 " "$1,895.32 " "26123 Fasciectomy, partial palmar with release of single digit including proximal interphalangeal jo" 26123 "$4,995.00 " "$1,735.00 " "$4,995.00 " "$3,546.45 " "$4,995.00 " "$4,995.00 " "$3,546.45 " "$4,795.20 " "$4,695.30 " "$4,745.25 " "$4,895.10 " "26125 add-on Fasciectomy, partial palmar with release of single digit including proximal interphalan" 26125 "$2,992.00 " $570.00 "$2,992.00 " "$2,124.32 " "$2,992.00 " "$2,992.00 " "$2,124.32 " "$2,872.32 " "$2,812.48 " "$2,842.40 " "$2,932.16 " "Excision of lesion of tendon sheath or joint capsule (eg, cyst, ganglion), hand/finger" 26160 "$1,211.00 " "$1,211.00 " $859.81 "$1,211.00 " "$1,211.00 " $859.81 "$1,162.56 " "$1,138.34 " "$1,150.45 " "$1,186.78 " 26160 EXC LES TENDON SHEAT 26160 "$2,415.00 " "$1,211.00 " "$2,415.00 " "$1,714.65 " "$2,415.00 " "$2,415.00 " "$1,714.65 " "$2,318.40 " "$2,270.10 " "$2,294.25 " "$2,366.70 " "Repair, Extensor Tendon, Hand, Primary or Secondary; w/o Free Graft, each Tendon Charge" 26410 "$1,151.00 " "$1,151.00 " $817.21 "$1,151.00 " "$1,151.00 " $817.21 "$1,104.96 " "$1,081.94 " "$1,093.45 " "$1,127.98 " 26410 EXTENS TEND REP HAND 26410 "$6,346.00 " "$1,151.00 " "$6,346.00 " "$4,505.66 " "$6,346.00 " "$6,346.00 " "$4,505.66 " "$6,092.16 " "$5,965.24 " "$6,028.70 " "$6,219.08 " "Repair, Extensor Tendon, Finger, Primary or Secondary; w/o Free Graft, each Tendon Charge" 26418 "$1,180.00 " "$1,180.00 " $837.80 "$1,180.00 " "$1,180.00 " $837.80 "$1,132.80 " "$1,109.20 " "$1,121.00 " "$1,156.40 " 26418 REPAIR FINGER TENDON 26418 "$2,914.00 " "$1,180.00 " "$2,914.00 " "$2,068.94 " "$2,914.00 " "$2,914.00 " "$2,068.94 " "$2,797.44 " "$2,739.16 " "$2,768.30 " "$2,855.72 " "Closed Trtmt of Metacarpal Fx, Single; w/o Manipulation, each Bone Charge" 26600 $611.00 $611.00 $433.81 $611.00 $611.00 $433.81 $586.56 $574.34 $580.45 $598.78 26600 CLOS TRMT METACARPAL FX W/O MANI 26600 "$1,526.00 " $611.00 "$1,526.00 " "$1,083.46 " "$1,526.00 " "$1,526.00 " "$1,083.46 " "$1,464.96 " "$1,434.44 " "$1,449.70 " "$1,495.48 " 26605 CLOS FX METACA W MAN 26605 $402.00 $671.00 $402.00 $285.42 $402.00 $402.00 $285.42 $385.92 $377.88 $381.90 $393.96 "Closed Trtmt of Metacarpal Fx, Single; w/Manipulation, each Bone Charge" 26605 $671.00 $671.00 $476.41 $671.00 $671.00 $476.41 $644.16 $630.74 $637.45 $657.58 26641 THUMB DISLOCATE TRT 26641 "$1,961.00 " $785.00 "$1,961.00 " "$1,392.31 " "$1,961.00 " "$1,961.00 " "$1,392.31 " "$1,882.56 " "$1,843.34 " "$1,862.95 " "$1,921.78 " 26670 CLTX CARP MTCRPL DIS 26670 "$1,799.00 " $720.00 "$1,799.00 " "$1,277.29 " "$1,799.00 " "$1,799.00 " "$1,277.29 " "$1,727.04 " "$1,691.06 " "$1,709.05 " "$1,763.02 " "Closed Trtmt of Metacarpophalangeal Dislocation, Single, w/Manipulation; w/o Anesthesia Tech Chg" 26700 $685.00 $685.00 $486.35 $685.00 $685.00 $486.35 $657.60 $643.90 $650.75 $671.30 26700 TRMT CETAC C DISLO S 26700 "$1,713.00 " $685.00 "$1,713.00 " "$1,216.23 " "$1,713.00 " "$1,713.00 " "$1,216.23 " "$1,644.48 " "$1,610.22 " "$1,627.35 " "$1,678.74 " "Closed tx of phalangeal shaft fx, proximal or midlle phalanx, finger or thumb: without manipulation," 26720 $410.00 $410.00 $291.10 $410.00 $410.00 $291.10 $393.60 $385.40 $389.50 $401.80 26720 FX PHLAN PROX WO MAN 26720 "$1,412.00 " $410.00 "$1,412.00 " "$1,002.52 " "$1,412.00 " "$1,412.00 " "$1,002.52 " "$1,355.52 " "$1,327.28 " "$1,341.40 " "$1,383.76 " 26725 CL TX PHAL SHFT FX P 26725 "$1,756.00 " $702.00 "$1,756.00 " "$1,246.76 " "$1,756.00 " "$1,756.00 " "$1,246.76 " "$1,685.76 " "$1,650.64 " "$1,668.20 " "$1,720.88 " "Articular fracture, involving metacarpophalangeal or interphalangeal joint - closed treatment of wo" 26740 $477.00 $477.00 $338.67 $477.00 $477.00 $338.67 $457.92 $448.38 $453.15 $467.46 26742 FRAC W DISLOC THER 26742 "$2,913.00 " $771.00 "$2,913.00 " "$2,068.23 " "$2,913.00 " "$2,913.00 " "$2,068.23 " "$2,796.48 " "$2,738.22 " "$2,767.35 " "$2,854.74 " "Closed Trtmt of Distal Phalangeal Fx, Finger or Thumb; w/o Manipulation, each Charge" 26750 $383.00 $383.00 $271.93 $383.00 $383.00 $271.93 $367.68 $360.02 $363.85 $375.34 26750 CLOS DIST PHALANGEAL 26750 $457.00 $383.00 $457.00 $324.47 $457.00 $457.00 $324.47 $438.72 $429.58 $434.15 $447.86 "Closed Trtmt of Distal Phalangeal Fx, Finger or Thumb; w/Manipulation, each Charge" 26755 $655.00 $655.00 $465.05 $655.00 $655.00 $465.05 $628.80 $615.70 $622.25 $641.90 26755 CL DIS PHAL FX W MAN 26755 "$1,123.00 " $655.00 "$1,123.00 " $797.33 "$1,123.00 " "$1,123.00 " $797.33 "$1,078.08 " "$1,055.62 " "$1,066.85 " "$1,100.54 " "OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL FIXATION, WHEN PERF" 26765 "$1,041.00 " "$1,041.00 " $739.11 "$1,041.00 " "$1,041.00 " $739.11 $999.36 $978.54 $988.95 "$1,020.18 " "Closed Trtmt of Interphalangeal Joint Dislocation, Single, w/Manipulation; w/o Anesthesia Charge" 26770 $582.00 $582.00 $413.22 $582.00 $582.00 $413.22 $558.72 $547.08 $552.90 $570.36 26770 TX INTERPHA JOIN DIS 26770 $594.00 $582.00 $594.00 $421.74 $594.00 $594.00 $421.74 $570.24 $558.36 $564.30 $582.12 26775 TX INTERPHA JOIN ANE 26775 $907.00 $799.00 $907.00 $643.97 $907.00 $907.00 $643.97 $870.72 $852.58 $861.65 $888.86 "Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single," 26951 "$1,333.00 " "$1,333.00 " $946.43 "$1,333.00 " "$1,333.00 " $946.43 "$1,279.68 " "$1,253.02 " "$1,266.35 " "$1,306.34 " 26951 AMPUTATION FINGER 26951 "$5,245.00 " "$1,333.00 " "$5,245.00 " "$3,723.95 " "$5,245.00 " "$5,245.00 " "$3,723.95 " "$5,035.20 " "$4,930.30 " "$4,982.75 " "$5,140.10 " "Injection Procedure For Sacroiliac Joint; Provision Of Anesthetic, Steroid And/Or Other Therapeutic" 27096 $972.00 $338.00 $972.00 $690.12 $972.00 $972.00 $690.12 $933.12 $913.68 $923.40 $952.56 27230 TRT FEMORAL FRACTURE 27230 "$2,474.00 " $992.00 "$2,474.00 " "$1,756.54 " "$2,474.00 " "$2,474.00 " "$1,756.54 " "$2,375.04 " "$2,325.56 " "$2,350.30 " "$2,424.52 " 27250 TRMT DISLOC POST HIP W/ ANEST 27250 $968.00 $377.00 $968.00 $687.28 $968.00 $968.00 $687.28 $929.28 $909.92 $919.60 $948.64 27265 Clsd Tx Arthro Disl W/O 27265 "$2,099.00 " $840.00 "$2,099.00 " "$1,490.29 " "$2,099.00 " "$2,099.00 " "$1,490.29 " "$2,015.04 " "$1,973.06 " "$1,994.05 " "$2,057.02 " 27266 TRMT DISLOC POST HIP 27266 "$3,011.00 " "$1,204.00 " "$3,011.00 " "$2,137.81 " "$3,011.00 " "$3,011.00 " "$2,137.81 " "$2,890.56 " "$2,830.34 " "$2,860.45 " "$2,950.78 " "I&D, Deep Abscess, Bursa, or Hematoma, Thigh or Knee Region Charge" 27301 "$1,396.00 " "$1,396.00 " $991.16 "$1,396.00 " "$1,396.00 " $991.16 "$1,340.16 " "$1,312.24 " "$1,326.20 " "$1,368.08 " 27327 PROF EXC THIGH/KNEE LES S 27327 $975.00 $975.00 $692.25 $975.00 $975.00 $692.25 $936.00 $916.50 $926.25 $955.50 Exc Thigh/Knee Les Sc >3Cm 27337 $860.00 $860.00 $610.60 $860.00 $860.00 $610.60 $825.60 $808.40 $817.00 $842.80 27447 ARTHROPLASTY TOT KNE 27447 "$9,458.00 " "$2,809.00 " "$9,458.00 " "$6,715.18 " "$9,458.00 " "$9,458.00 " "$6,715.18 " "$9,079.68 " "$8,890.52 " "$8,985.10 " "$9,268.84 " 27502 FX CLO FEMORAL SHAFT 27502 "$2,749.00 " "$1,576.00 " "$2,749.00 " "$1,951.79 " "$2,749.00 " "$2,749.00 " "$1,951.79 " "$2,639.04 " "$2,584.06 " "$2,611.55 " "$2,694.02 " 27510 FIX FEMUR W/ MANIPULATION 27510 "$1,842.00 " "$1,417.00 " "$1,842.00 " "$1,307.82 " "$1,842.00 " "$1,842.00 " "$1,307.82 " "$1,768.32 " "$1,731.48 " "$1,749.90 " "$1,805.16 " "Closed Trtmt of Patellar Fx, w/o Manipulation Charge" 27520 $668.00 $668.00 $474.28 $668.00 $668.00 $474.28 $641.28 $627.92 $634.60 $654.64 27520 FX PATELLAR CLO W O 27520 "$1,670.00 " $668.00 "$1,670.00 " "$1,185.70 " "$1,670.00 " "$1,670.00 " "$1,185.70 " "$1,603.20 " "$1,569.80 " "$1,586.50 " "$1,636.60 " "Closed Trtmt of Tibial Fx, Proximal (Plateau); w/o Manipulation Charge" 27530 $626.00 $626.00 $444.46 $626.00 $626.00 $444.46 $600.96 $588.44 $594.70 $613.48 27530 CLOS TX TIB FX PROXI 27530 "$1,131.00 " $626.00 "$1,131.00 " $803.01 "$1,131.00 " "$1,131.00 " $803.01 "$1,085.76 " "$1,063.14 " "$1,074.45 " "$1,108.38 " 27562 Closed treatment of patellar dislocation; requiring anesthes 27560 "$1,907.00 " $763.00 "$1,907.00 " "$1,353.97 " "$1,907.00 " "$1,907.00 " "$1,353.97 " "$1,830.72 " "$1,792.58 " "$1,811.65 " "$1,868.86 " Closed Trtmt of Tibial Shaft Fx (With or w/o Fibular Fx); w/o Manipulation Charge 27750 $716.00 $716.00 $508.36 $716.00 $716.00 $508.36 $687.36 $673.04 $680.20 $701.68 27750 FX TIBAL SH CL WO 27750 "$1,789.00 " $716.00 "$1,789.00 " "$1,270.19 " "$1,789.00 " "$1,789.00 " "$1,270.19 " "$1,717.44 " "$1,681.66 " "$1,699.55 " "$1,753.22 " 27752 FX TIBIA W MANIPULAT 27752 "$1,576.00 " "$1,109.00 " "$1,576.00 " "$1,118.96 " "$1,576.00 " "$1,576.00 " "$1,118.96 " "$1,512.96 " "$1,481.44 " "$1,497.20 " "$1,544.48 " Closed Trtmt of Medial Malleolus Fx; w/o Manipulation Charge 27760 $692.00 $692.00 $491.32 $692.00 $692.00 $491.32 $664.32 $650.48 $657.40 $678.16 27760 FX MED MALLEOLUS CLO 27760 $814.00 $692.00 $814.00 $577.94 $814.00 $814.00 $577.94 $781.44 $765.16 $773.30 $797.72 27762 FX MED MALLEO W MANI 27762 "$1,288.00 " $991.00 "$1,288.00 " $914.48 "$1,288.00 " "$1,288.00 " $914.48 "$1,236.48 " "$1,210.72 " "$1,223.60 " "$1,262.24 " Closed treat post malleolus fx w/o manip 27767 $587.00 $587.00 $416.77 $587.00 $587.00 $416.77 $563.52 $551.78 $557.65 $575.26 Closed Trtmt of Proximal Fibula or Shaft Fx; w/o Manipulation Charge 27780 $633.00 $633.00 $449.43 $633.00 $633.00 $449.43 $607.68 $595.02 $601.35 $620.34 27780 CLOS TX PRX FIB SHAF 27780 $743.00 $633.00 $743.00 $527.53 $743.00 $743.00 $527.53 $713.28 $698.42 $705.85 $728.14 Closed Trtmt of Distal Fibular Fx (Lateral Malleolus); w/o Manipulation Charge 27786 $653.00 $653.00 $463.63 $653.00 $653.00 $463.63 $626.88 $613.82 $620.35 $639.94 27786 CLOS TX DISTAL FIBUL 27786 "$1,631.00 " $653.00 "$1,631.00 " "$1,158.01 " "$1,631.00 " "$1,631.00 " "$1,158.01 " "$1,565.76 " "$1,533.14 " "$1,549.45 " "$1,598.38 " Treatment of ankle fracture 27788 $878.00 $878.00 $623.38 $878.00 $878.00 $623.38 $842.88 $825.32 $834.10 $860.44 27788 CLOS TX DISTAL FIBUL 27788 "$1,494.00 " $878.00 "$1,494.00 " "$1,060.74 " "$1,494.00 " "$1,494.00 " "$1,060.74 " "$1,434.24 " "$1,404.36 " "$1,419.30 " "$1,464.12 " Closed treatment of bimalleolar ankle fracture; without manipulation 27808 $692.00 $692.00 $491.32 $692.00 $692.00 $491.32 $664.32 $650.48 $657.40 $678.16 27808 TRTMT BIMALLIOLAR AN 27808 "$1,730.00 " $692.00 "$1,730.00 " "$1,228.30 " "$1,730.00 " "$1,730.00 " "$1,228.30 " "$1,660.80 " "$1,626.20 " "$1,643.50 " "$1,695.40 " 27810 FX BIMALLEOLAR ANKLE 27810 "$1,181.00 " $972.00 "$1,181.00 " $838.51 "$1,181.00 " "$1,181.00 " $838.51 "$1,133.76 " "$1,110.14 " "$1,121.95 " "$1,157.38 " Closed Trtmt of Trimalleolar Ankle Fx; w/Manipulation 27818 "$1,011.00 " "$1,011.00 " $717.81 "$1,011.00 " "$1,011.00 " $717.81 $970.56 $950.34 $960.45 $990.78 27818 FX ANKLE TRIMALLEOLA 27818 "$1,970.00 " "$1,011.00 " "$1,970.00 " "$1,398.70 " "$1,970.00 " "$1,970.00 " "$1,398.70 " "$1,891.20 " "$1,851.80 " "$1,871.50 " "$1,930.60 " "Tibia fracture, distal, wt bearing articular surface portion - closed treatment of w or wo anesthes" 27824 $655.00 $655.00 $465.05 $655.00 $655.00 $465.05 $628.80 $615.70 $622.25 $641.90 27824 FX DISTAL FIBULA 27824 "$1,636.00 " $655.00 "$1,636.00 " "$1,161.56 " "$1,636.00 " "$1,636.00 " "$1,161.56 " "$1,570.56 " "$1,537.84 " "$1,554.20 " "$1,603.28 " 27825 closed treatment of tibia 27825 "$1,135.00 " "$1,135.00 " $805.85 "$1,135.00 " "$1,135.00 " $805.85 "$1,089.60 " "$1,066.90 " "$1,078.25 " "$1,112.30 " 27840 Reduction of Ankle Dislocation 27840 $900.00 $782.00 $900.00 $639.00 $900.00 $900.00 $639.00 $864.00 $846.00 $855.00 $882.00 "28010 - Tenotomy, percutaneous, toe; single tendon" 28010 "$1,411.00 " $498.00 "$1,411.00 " "$1,001.81 " "$1,411.00 " "$1,411.00 " "$1,001.81 " "$1,354.56 " "$1,326.34 " "$1,340.45 " "$1,382.78 " 28192 REMOV FB FOOT DEEP 28192 "$2,503.00 " "$1,001.00 " "$2,503.00 " "$1,777.13 " "$2,503.00 " "$2,503.00 " "$1,777.13 " "$2,402.88 " "$2,352.82 " "$2,377.85 " "$2,452.94 " "28200 Repair, tendon, flexor, foot; primary or secondary, without" 28200 "$2,077.00 " $691.00 "$2,077.00 " "$1,474.67 " "$2,077.00 " "$2,077.00 " "$1,474.67 " "$1,993.92 " "$1,952.38 " "$1,973.15 " "$2,035.46 " 28208 Rpr Tend Exten Ft 1&2 Ea 28208 "$3,750.00 " $673.00 "$3,750.00 " "$2,662.50 " "$3,750.00 " "$3,750.00 " "$2,662.50 " "$3,600.00 " "$3,525.00 " "$3,562.50 " "$3,675.00 " 29065-APPLICATION OF LONG ARM CAST-SC PF 28230 "$5,969.00 " $932.00 "$5,969.00 " "$4,237.99 " "$5,969.00 " "$5,969.00 " "$4,237.99 " "$5,730.24 " "$5,610.86 " "$5,670.55 " "$5,849.62 " 28285 Correction Hammertoe 28285 "$2,926.00 " $812.00 "$2,926.00 " "$2,077.46 " "$2,926.00 " "$2,926.00 " "$2,077.46 " "$2,808.96 " "$2,750.44 " "$2,779.70 " "$2,867.48 " 28297 CORRECTION HALLUX VALGUS 28297 "$5,007.00 " "$1,283.00 " "$5,007.00 " "$3,554.97 " "$5,007.00 " "$5,007.00 " "$3,554.97 " "$4,806.72 " "$4,706.58 " "$4,756.65 " "$4,906.86 " "28306 Osteotomy, with or without lengthening, shortening or angula" 28308 "$3,024.00 " $809.00 "$3,024.00 " "$2,147.04 " "$3,024.00 " "$3,024.00 " "$2,147.04 " "$2,903.04 " "$2,842.56 " "$2,872.80 " "$2,963.52 " Closed Trtmt of Calcaneal Fx; w/o Manipulation Charge 28400 $517.00 $517.00 $367.07 $517.00 $517.00 $367.07 $496.32 $485.98 $491.15 $506.66 28400 FX CLACLNEAL CLOS W/O MANIP- PROF 28400 $897.00 $517.00 $897.00 $636.87 $897.00 $897.00 $636.87 $861.12 $843.18 $852.15 $879.06 Closed Trtmt of Talus Fx; w/o Manipulation Charge 28430 $497.00 $497.00 $352.87 $497.00 $497.00 $352.87 $477.12 $467.18 $472.15 $487.06 28435 CLO TX TALUS FX W MA 28435 "$2,739.00 " $753.00 "$2,739.00 " "$1,944.69 " "$2,739.00 " "$2,739.00 " "$1,944.69 " "$2,629.44 " "$2,574.66 " "$2,602.05 " "$2,684.22 " "Trtmt of Tarsal Bone Fx (Except Talus & Calcaneus); w/o Manipulation, each Charge" 28450 $446.00 $446.00 $316.66 $446.00 $446.00 $316.66 $428.16 $419.24 $423.70 $437.08 28450 FX TARSAL BONE EACH 28450 $728.00 $446.00 $728.00 $516.88 $728.00 $728.00 $516.88 $698.88 $684.32 $691.60 $713.44 "Closed Trtmt of Metatarsal Fx; w/o Manipulation, each Charge" 28470 $458.00 $458.00 $325.18 $458.00 $458.00 $325.18 $439.68 $430.52 $435.10 $448.84 28470 FX METATARSAL CL WO 28470 $882.00 $458.00 $882.00 $626.22 $882.00 $882.00 $626.22 $846.72 $829.08 $837.90 $864.36 "Closed Trtmt of Fx Great toe, Phalanx or Phalanges; w/o Manipulation Charge" 28490 $302.00 $302.00 $214.42 $302.00 $302.00 $214.42 $289.92 $283.88 $286.90 $295.96 28490 FX BIG TOE 28490 $413.00 $302.00 $413.00 $293.23 $413.00 $413.00 $293.23 $396.48 $388.22 $392.35 $404.74 "Closed Trtmt of Fx Great toe, Phalanx or Phalanges; w/Manipulation Charge" 28495 $378.00 $378.00 $268.38 $378.00 $378.00 $268.38 $362.88 $355.32 $359.10 $370.44 "Closed Trtmt of Fx, Phalanx or Phalanges, Other Than Great to e; w/Manipulation, each Charge" 28510 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 28510 CLOS TX FX PHLNX PHL 28510 $646.00 $258.00 $646.00 $458.66 $646.00 $646.00 $458.66 $620.16 $607.24 $613.70 $633.08 "Closed Trtmt of Fx, Phalanx or Phalanges, Other Than Great toe; w/o Manipulation, each Charge" 28515 $344.00 $344.00 $244.24 $344.00 $344.00 $244.24 $330.24 $323.36 $326.80 $337.12 28515 REDUCTION TOE FRAC 28515 $374.00 $334.00 $374.00 $265.54 $374.00 $374.00 $265.54 $359.04 $351.56 $355.30 $366.52 Closed Trtmt of Sesamoid Fx Charge 28530 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 28630 CLO TX METATAR DISL 28630 $569.00 $330.00 $569.00 $403.99 $569.00 $569.00 $403.99 $546.24 $534.86 $540.55 $557.62 Closed Trtmt of Interphalangeal Joint Dislocation; w/o Anesthesia Charge 28660 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 28660 CLTX IPHAL JT DISCLO 28660 $431.00 $248.00 $431.00 $306.01 $431.00 $431.00 $306.01 $413.76 $405.14 $409.45 $422.38 28740 ARTHRODESIS MIDTARSOMETATAR SINGLE JT 28740 "$8,105.00 " "$1,316.00 " "$8,105.00 " "$5,754.55 " "$8,105.00 " "$8,105.00 " "$5,754.55 " "$7,780.80 " "$7,618.70 " "$7,699.75 " "$7,942.90 " "Exploration with removal of deep foreign body, forearm or wrist-pro" 29065 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 29065 LONG ARM CAST 29065 $533.00 $198.00 $533.00 $378.43 $533.00 $533.00 $378.43 $511.68 $501.02 $506.35 $522.34 "Applic, Cast; Elbow to Finger (Short Arm) Charge" 29075 $179.00 $179.00 $127.09 $179.00 $179.00 $127.09 $171.84 $168.26 $170.05 $175.42 29075 Short Arm Cast 29075 $447.00 $179.00 $447.00 $317.37 $447.00 $447.00 $317.37 $429.12 $420.18 $424.65 $438.06 Applic of Long Arm Splint (Shoulder to Hand) Charge 29105 $171.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 29105 LONG ARM SPLINT 29105 $239.00 $171.00 $239.00 $169.69 $239.00 $239.00 $169.69 $229.44 $224.66 $227.05 $234.22 Application of Short Arm Splint; Static 29125 $134.00 $134.00 $95.14 $134.00 $134.00 $95.14 $128.64 $125.96 $127.30 $131.32 29125 SHORT ARM SPLINT 29125 $140.00 $134.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 Applic of Finger Splint; Static Charge 29130 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 29130 SPLINT FINGER 29130 $153.00 $86.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 "Strapping; Shoulder (eg, Velpeau) Charge" 29240 $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 29240 STRAPPING SHOULDER 29240 $267.00 $65.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 Strapping; Elbow or Wrist Charge 29260 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 29260 STRAPPING ELBOW WRIST 29260 $239.00 $63.00 $239.00 $169.69 $239.00 $239.00 $169.69 $229.44 $224.66 $227.05 $234.22 29280 STRAPPING HAND FING 29280 $164.00 $65.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 Applic of Long Leg Cast (Thigh to toes); Charge 29345 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 29345 CAST LONG LEG 29345 $437.00 $279.00 $437.00 $310.27 $437.00 $437.00 $310.27 $419.52 $410.78 $415.15 $428.26 Applic of Short Leg Cast (Below Knee to toes); Charge 29405 $168.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 29405 Cast Applic Short Leg 29405 $336.00 $168.00 $336.00 $238.56 $336.00 $336.00 $238.56 $322.56 $315.84 $319.20 $329.28 Applic of Long Leg Splint (Thigh to Ankle or toes) Charge 29505 $178.00 $178.00 $126.38 $178.00 $178.00 $126.38 $170.88 $167.32 $169.10 $174.44 29505 LONG LEG SPLINT APPL 29505 $206.00 $178.00 $206.00 $146.26 $206.00 $206.00 $146.26 $197.76 $193.64 $195.70 $201.88 Applic of Short Leg Splint (Calf to Foot) Charge 29515 $149.00 $149.00 $105.79 $149.00 $149.00 $105.79 $143.04 $140.06 $141.55 $146.02 29515 SHORT LEG SPLINT 29515 $175.00 $149.00 $175.00 $124.25 $175.00 $175.00 $124.25 $168.00 $164.50 $166.25 $171.50 Strapping; Knee Charge 29530 $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 29530 STRAPPING KNEE 29530 $161.00 $65.00 $161.00 $114.31 $161.00 $161.00 $114.31 $154.56 $151.34 $152.95 $157.78 Strapping; Ankle and/or Foot Charge 29540 $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 29540 ANKLE STRAPPING 29540 $150.00 $61.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 UNNA BOOT INCLUDING OC Clinic Charge 29580 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 STRAPPING UNNA BOOT CHARGE 29580 $247.00 $131.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 SHOULDER ARTHROSCOPY/SURGERY 29807 "$4,200.00 " "$2,146.00 " "$4,200.00 " "$2,982.00 " "$4,200.00 " "$4,200.00 " "$2,982.00 " "$4,032.00 " "$3,948.00 " "$3,990.00 " "$4,116.00 " 29826 SHOULDER ARTHROSCOPY/SURGERY-SC PF 29826 "$5,293.00 " $364.00 "$5,293.00 " "$3,758.03 " "$5,293.00 " "$5,293.00 " "$3,758.03 " "$5,081.28 " "$4,975.42 " "$5,028.35 " "$5,187.14 " 29827 Scope Shldr Rt Cuff Repr 29827 "$7,600.00 " "$2,208.00 " "$7,600.00 " "$5,396.00 " "$7,600.00 " "$7,600.00 " "$5,396.00 " "$7,296.00 " "$7,144.00 " "$7,220.00 " "$7,448.00 " 29828 Biceps Tenodesis 29828 "$5,334.00 " "$1,898.00 " "$5,334.00 " "$3,787.14 " "$5,334.00 " "$5,334.00 " "$3,787.14 " "$5,120.64 " "$5,013.96 " "$5,067.30 " "$5,227.32 " 29877 Arthros Debrid/Shave Cart 29877 "$5,902.00 " "$1,289.00 " "$5,902.00 " "$4,190.42 " "$5,902.00 " "$5,902.00 " "$4,190.42 " "$5,665.92 " "$5,547.88 " "$5,606.90 " "$5,783.96 " "30117 Excision or Destruction (eg, laser), Intranasal Lesion; Internal Approach" 30117 "$2,619.00 " "$1,873.00 " "$2,619.00 " "$1,859.49 " "$2,619.00 " "$2,619.00 " "$1,859.49 " "$2,514.24 " "$2,461.86 " "$2,488.05 " "$2,566.62 " Removal FB intranasal 30300 $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 30300 REM FB INTRANASAL 30300 $963.00 $385.00 $963.00 $683.73 $963.00 $963.00 $683.73 $924.48 $905.22 $914.85 $943.74 "30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replaceme" 30520 "$3,476.00 " "$1,319.00 " "$3,476.00 " "$2,467.96 " "$3,476.00 " "$3,476.00 " "$2,467.96 " "$3,336.96 " "$3,267.44 " "$3,302.20 " "$3,406.48 " "30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electro" 30802 "$1,687.00 " $587.00 "$1,687.00 " "$1,197.77 " "$1,687.00 " "$1,687.00 " "$1,197.77 " "$1,619.52 " "$1,585.78 " "$1,602.65 " "$1,653.26 " "Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery and/or Packing) Any Method Charge" 30901 $286.00 $286.00 $203.06 $286.00 $286.00 $203.06 $274.56 $268.84 $271.70 $280.28 30901 PACKING NOSE 30901 $715.00 $286.00 $715.00 $507.65 $715.00 $715.00 $507.65 $686.40 $672.10 $679.25 $700.70 30903 NASAL HEM ANT COMPLX 30903 "$1,125.00 " $450.00 "$1,125.00 " $798.75 "$1,125.00 " "$1,125.00 " $798.75 "$1,080.00 " "$1,057.50 " "$1,068.75 " "$1,102.50 " 30905 HEMRG NASAL POST PAC 30905 "$1,711.00 " $684.00 "$1,711.00 " "$1,214.81 " "$1,711.00 " "$1,711.00 " "$1,214.81 " "$1,642.56 " "$1,608.34 " "$1,625.45 " "$1,676.78 " "Control nasal hemmorhage, posterior, with posterior nasal packs and or cautery, any method; subseque" 30906 $715.00 $715.00 $507.65 $715.00 $715.00 $507.65 $686.40 $672.10 $679.25 $700.70 30906 NASAL HEM POST SEQSQ 30906 "$1,789.00 " $715.00 "$1,789.00 " "$1,270.19 " "$1,789.00 " "$1,789.00 " "$1,270.19 " "$1,717.44 " "$1,681.66 " "$1,699.55 " "$1,753.22 " "MD Pro Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral Charge" 31231 $170.00 $214.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 31500 INTUBAT ENDOTR EM PR 31500 $592.00 $302.00 $592.00 $420.32 $592.00 $592.00 $420.32 $568.32 $556.48 $562.40 $580.16 "31570 Laryngoscopy, Direct, with Injection Into Vocal Cord(s), Therapeutic" 31570 "$2,937.00 " $703.00 "$2,937.00 " "$2,085.27 " "$2,937.00 " "$2,937.00 " "$2,085.27 " "$2,819.52 " "$2,760.78 " "$2,790.15 " "$2,878.26 " Diagnostic Larynoscopy 31575 $605.00 $242.00 $605.00 $429.55 $605.00 $605.00 $429.55 $580.80 $568.70 $574.75 $592.90 32551 TUBE THORACOSTOMY 32551 "$1,083.00 " $329.00 "$1,083.00 " $768.93 "$1,083.00 " "$1,083.00 " $768.93 "$1,039.68 " "$1,018.02 " "$1,028.85 " "$1,061.34 " 32554 THORACENTESIS W/O IMAGING GUIDANCE 32554 $567.00 $443.00 $567.00 $402.57 $567.00 $567.00 $402.57 $544.32 $532.98 $538.65 $555.66 32555 THORACENTESIS W/ IMAGING GUIDANCE 32555 "$1,136.00 " $628.00 "$1,136.00 " $806.56 "$1,136.00 " "$1,136.00 " $806.56 "$1,090.56 " "$1,067.84 " "$1,079.20 " "$1,113.28 " 32556 Insert Cath Pleura W/O Im 32556 "$3,188.00 " "$1,275.00 " "$3,188.00 " "$2,263.48 " "$3,188.00 " "$3,188.00 " "$2,263.48 " "$3,060.48 " "$2,996.72 " "$3,028.60 " "$3,124.24 " 36410 NON ROUTINE BLOOD DRAM >3 YEARS 36410 $271.00 $271.00 $192.41 $271.00 $271.00 $192.41 $260.16 $254.74 $257.45 $265.58 36415 Venous Draw 36415 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 Blood Alcohol to Sheriff's Dept 36415 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 COLLECTION: Venous Draw 36415 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 VENIPUNCTURE 36415 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 COLLECTION: Capillary 36416 $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 Blood Administration 1 Unit 36430 $800.00 $800.00 $568.00 $800.00 $800.00 $568.00 $768.00 $752.00 $760.00 $784.00 Blood Administration 2 Units 36430 $800.00 $800.00 $568.00 $800.00 $800.00 $568.00 $768.00 $752.00 $760.00 $784.00 Blood Administration 3 + Units 36430 "$1,169.00 " "$1,169.00 " $829.99 "$1,169.00 " "$1,169.00 " $829.99 "$1,122.24 " "$1,098.86 " "$1,110.55 " "$1,145.62 " "Injection of sclerosing solution; multiple veins, same leg" 36471 $398.00 $398.00 $282.58 $398.00 $398.00 $282.58 $382.08 $374.12 $378.10 $390.04 36510 UMBILICAL CATH 36510 $328.00 $175.00 $328.00 $232.88 $328.00 $328.00 $232.88 $314.88 $308.32 $311.60 $321.44 36556 INSERT NON T CV CATH 36556 "$1,880.00 " $440.00 "$1,880.00 " "$1,334.80 " "$1,880.00 " "$1,880.00 " "$1,334.80 " "$1,804.80 " "$1,767.20 " "$1,786.00 " "$1,842.40 " 36558 CENTRAL LINE 36558 "$5,003.00 " "$1,589.00 " "$5,003.00 " "$3,552.13 " "$5,003.00 " "$5,003.00 " "$3,552.13 " "$4,802.88 " "$4,702.82 " "$4,752.85 " "$4,902.94 " 36561 INSERT TUNNELED CV CATH 36561 "$2,275.00 " $708.00 "$2,275.00 " "$1,615.25 " "$2,275.00 " "$2,275.00 " "$1,615.25 " "$2,184.00 " "$2,138.50 " "$2,161.25 " "$2,229.50 " XR Insert PICC Line 5+ Year 36573 "$2,865.00 " "$2,865.00 " "$2,034.15 " "$2,865.00 " "$2,865.00 " "$2,034.15 " "$2,750.40 " "$2,693.10 " "$2,721.75 " "$2,807.70 " 36590 Rmvl Tun Ctr Vad W/Subq 36590 "$1,294.00 " $460.00 "$1,294.00 " $918.74 "$1,294.00 " "$1,294.00 " $918.74 "$1,242.24 " "$1,216.36 " "$1,229.30 " "$1,268.12 " COLLECTION: Port Draw 36591 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 PORT/PICC LINE BLOOD DRAW 36591 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 COLLECTION: PICC 36592 $144.00 $144.00 $102.24 $144.00 $144.00 $102.24 $138.24 $135.36 $136.80 $141.12 XR Fluoro Guidance for CVA Check 36598 $598.00 $598.00 $424.58 $598.00 $598.00 $424.58 $574.08 $562.12 $568.10 $586.04 COLLECTION: Arterial Draw 36600 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 36680 INTRAOSSEOUS NEEDLE 36680 $326.00 $123.00 $326.00 $231.46 $326.00 $326.00 $231.46 $312.96 $306.44 $309.70 $319.48 "Ligation, division, and or excision of varicose vein cluster(s), 1 leg Technical Charge" 37785 $721.00 $721.00 $511.91 $721.00 $721.00 $511.91 $692.16 $677.74 $684.95 $706.58 38220 BONE MARROW ASPIRATE 38220 "$2,856.00 " $345.00 "$2,856.00 " "$2,027.76 " "$2,856.00 " "$2,856.00 " "$2,027.76 " "$2,741.76 " "$2,684.64 " "$2,713.20 " "$2,798.88 " 38221 BONE MARROW BIOPSY 38221 $765.00 $325.00 $765.00 $543.15 $765.00 $765.00 $543.15 $734.40 $719.10 $726.75 $749.70 Diagnostic Bone Marrow Biopsy and Aspirations 38222 "$1,065.00 " $361.00 "$1,065.00 " $756.15 "$1,065.00 " "$1,065.00 " $756.15 "$1,022.40 " "$1,001.10 " "$1,011.75 " "$1,043.70 " 38500 BIOPSY REM LYMPH NOD 38500 "$3,703.00 " $685.00 "$3,703.00 " "$2,629.13 " "$3,703.00 " "$3,703.00 " "$2,629.13 " "$3,554.88 " "$3,480.82 " "$3,517.85 " "$3,628.94 " Lymph Node biopsy(s); by needle Technical Charge 38505 $263.00 $263.00 $186.73 $263.00 $263.00 $186.73 $252.48 $247.22 $249.85 $257.74 40650 REPR LIP FULL THICK 40650 "$1,306.00 " $951.00 "$1,306.00 " $927.26 "$1,306.00 " "$1,306.00 " $927.26 "$1,253.76 " "$1,227.64 " "$1,240.70 " "$1,279.88 " Exc Les-vestibule Mouth; Wo Re 40810 $437.00 $437.00 $310.27 $437.00 $437.00 $310.27 $419.52 $410.78 $415.15 $428.26 "Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair" 40812 $604.00 $604.00 $428.84 $604.00 $604.00 $428.84 $579.84 $567.76 $573.80 $591.92 40812 EX LES MUCOUSA/SUBMUCOUSA VEST MOUTH 40812 "$3,525.00 " $604.00 "$3,525.00 " "$2,502.75 " "$3,525.00 " "$3,525.00 " "$2,502.75 " "$3,384.00 " "$3,313.50 " "$3,348.75 " "$3,454.50 " Incision Of Lingual Frenum (Frenotomy) 41010 $431.00 $431.00 $306.01 $431.00 $431.00 $306.01 $413.76 $405.14 $409.45 $422.38 41010 TONGUE TIE PROCEDURE 41010 "$3,439.00 " $431.00 "$3,439.00 " "$2,441.69 " "$3,439.00 " "$3,439.00 " "$2,441.69 " "$3,301.44 " "$3,232.66 " "$3,267.05 " "$3,370.22 " "Excision lesion of tongue, without closure" 41110 $453.00 $453.00 $321.63 $453.00 $453.00 $321.63 $434.88 $425.82 $430.35 $443.94 41250 Repair tongue laceration 41250 $589.00 $574.00 $589.00 $418.19 $589.00 $589.00 $418.19 $565.44 $553.66 $559.55 $577.22 "Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex" 41252 $667.00 $667.00 $473.57 $667.00 $667.00 $473.57 $640.32 $626.98 $633.65 $653.66 41252 REP LAC TONG>2.6C 41252 $932.00 $667.00 $932.00 $661.72 $932.00 $932.00 $661.72 $894.72 $876.08 $885.40 $913.36 "Drainage of abscess, cyst, hematoma, from dentoalveolar structures Tech Chg" 41800 $606.00 $606.00 $430.26 $606.00 $606.00 $430.26 $581.76 $569.64 $575.70 $593.88 41800 DRAIN GUM LESION 41800 "$1,515.00 " $606.00 "$1,515.00 " "$1,075.65 " "$1,515.00 " "$1,515.00 " "$1,075.65 " "$1,454.40 " "$1,424.10 " "$1,439.25 " "$1,484.70 " Sialolithotomy; Uncomp Intraor 42330 $486.00 $486.00 $345.06 $486.00 $486.00 $345.06 $466.56 $456.84 $461.70 $476.28 42415 Exc Prtd Tum Prsv Fac Nrv 42415 "$4,511.00 " "$2,216.00 " "$4,511.00 " "$3,202.81 " "$4,511.00 " "$4,511.00 " "$3,202.81 " "$4,330.56 " "$4,240.34 " "$4,285.45 " "$4,420.78 " 42820 Tonsillectomy and adenoidectomy; younger than age 12 42820 "$6,063.00 " $608.00 "$6,063.00 " "$4,304.73 " "$6,063.00 " "$6,063.00 " "$4,304.73 " "$5,820.48 " "$5,699.22 " "$5,759.85 " "$5,941.74 " 42821 Tonsillectomy and adenoidectomy; age 12 or over 42821 "$4,451.00 " $631.00 "$4,451.00 " "$3,160.21 " "$4,451.00 " "$4,451.00 " "$3,160.21 " "$4,272.96 " "$4,183.94 " "$4,228.45 " "$4,361.98 " 43200 ESOPHAGOSCOPY DIAGN 43200 "$3,557.00 " $474.00 "$3,557.00 " "$2,525.47 " "$3,557.00 " "$3,557.00 " "$2,525.47 " "$3,414.72 " "$3,343.58 " "$3,379.15 " "$3,485.86 " 43215 ESOPHAGOSCOPY FB REM 43215 "$1,871.00 " $557.00 "$1,871.00 " "$1,328.41 " "$1,871.00 " "$1,871.00 " "$1,328.41 " "$1,796.16 " "$1,758.74 " "$1,777.45 " "$1,833.58 " 43235 UGI DIAGNOSTIC 43235 "$1,871.00 " $557.00 "$1,871.00 " "$1,328.41 " "$1,871.00 " "$1,871.00 " "$1,328.41 " "$1,796.16 " "$1,758.74 " "$1,777.45 " "$1,833.58 " 43239 UGI W BIOPSY 43239 "$1,925.00 " $746.00 "$1,925.00 " "$1,366.75 " "$1,925.00 " "$1,925.00 " "$1,366.75 " "$1,848.00 " "$1,809.50 " "$1,828.75 " "$1,886.50 " 43247 UGI ENDO; W REMOV FB 43247 "$1,897.00 " $749.00 "$1,897.00 " "$1,346.87 " "$1,897.00 " "$1,897.00 " "$1,346.87 " "$1,821.12 " "$1,783.18 " "$1,802.15 " "$1,859.06 " 43249 DILA ESOPH W BALLOON 43249 "$5,476.00 " "$2,191.00 " "$5,476.00 " "$3,887.96 " "$5,476.00 " "$5,476.00 " "$3,887.96 " "$5,256.96 " "$5,147.44 " "$5,202.20 " "$5,366.48 " 43255 EGD W/ CAUT ULCER 43255 "$2,266.00 " "$1,374.00 " "$2,266.00 " "$1,608.86 " "$2,266.00 " "$2,266.00 " "$1,608.86 " "$2,175.36 " "$2,130.04 " "$2,152.70 " "$2,220.68 " 43450 DILATION OF ESOPHAGU 43450 "$3,009.00 " $344.00 "$3,009.00 " "$2,136.39 " "$3,009.00 " "$3,009.00 " "$2,136.39 " "$2,888.64 " "$2,828.46 " "$2,858.55 " "$2,948.82 " 43761 Reposition Gastrostomy Tube 43761 $160.00 $220.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Change of gastrostomy tube percutaneous without imaging or endoscopic guidance 43762 $461.00 $461.00 $327.31 $461.00 $461.00 $327.31 $442.56 $433.34 $437.95 $451.78 43760 CHANGE G TUBE 43762 $570.00 $461.00 $570.00 $404.70 $570.00 $570.00 $404.70 $547.20 $535.80 $541.50 $558.60 44005 LYSIS OF ADHESIONS 44005 "$5,620.00 " "$2,248.00 " "$5,620.00 " "$3,990.20 " "$5,620.00 " "$5,620.00 " "$3,990.20 " "$5,395.20 " "$5,282.80 " "$5,339.00 " "$5,507.60 " 44050 RELEASE OF SMALL BOWEL OBSTRUCTION 44050 "$4,800.00 " "$1,920.00 " "$4,800.00 " "$3,408.00 " "$4,800.00 " "$4,800.00 " "$3,408.00 " "$4,608.00 " "$4,512.00 " "$4,560.00 " "$4,704.00 " 44120 ENTERECTOMY RESECTN 44120 "$6,380.00 " "$2,513.00 " "$6,380.00 " "$4,529.80 " "$6,380.00 " "$6,380.00 " "$4,529.80 " "$6,124.80 " "$5,997.20 " "$6,061.00 " "$6,252.40 " 44139 MOBILIZ SPLENIC FLEX 44139 $622.00 $249.00 $622.00 $441.62 $622.00 $622.00 $441.62 $597.12 $584.68 $590.90 $609.56 44140 COLECTOMY PARTIAL 44140 "$6,900.00 " "$2,760.00 " "$6,900.00 " "$4,899.00 " "$6,900.00 " "$6,900.00 " "$4,899.00 " "$6,624.00 " "$6,486.00 " "$6,555.00 " "$6,762.00 " "44160 Colectomy, partial, with removal of terminal ileum with ileo" 44160 "$6,394.00 " "$2,558.00 " "$6,394.00 " "$4,539.74 " "$6,394.00 " "$6,394.00 " "$4,539.74 " "$6,138.24 " "$6,010.36 " "$6,074.30 " "$6,266.12 " 44204 COLECTOMY 44204 "$6,366.00 " "$3,180.00 " "$6,366.00 " "$4,519.86 " "$6,366.00 " "$6,366.00 " "$4,519.86 " "$6,111.36 " "$5,984.04 " "$6,047.70 " "$6,238.68 " 44205 LAP COLECTOMY 44205 "$6,920.00 " "$2,768.00 " "$6,920.00 " "$4,913.20 " "$6,920.00 " "$6,920.00 " "$4,913.20 " "$6,643.20 " "$6,504.80 " "$6,574.00 " "$6,781.60 " 44380 ILEOSCOPY 44380 "$2,064.00 " $364.00 "$2,064.00 " "$1,465.44 " "$2,064.00 " "$2,064.00 " "$1,465.44 " "$1,981.44 " "$1,940.16 " "$1,960.80 " "$2,022.72 " "43772 Laparoscopy, surgical, gastric restrictive procedure; remova" 44388 "$1,351.00 " $614.00 "$1,351.00 " $959.21 "$1,351.00 " "$1,351.00 " $959.21 "$1,296.96 " "$1,269.94 " "$1,283.45 " "$1,323.98 " 44389 COLONOSC STOMA BIOPS 44389 "$2,213.00 " $810.00 "$2,213.00 " "$1,571.23 " "$2,213.00 " "$2,213.00 " "$1,571.23 " "$2,124.48 " "$2,080.22 " "$2,102.35 " "$2,168.74 " 44394 COLONOSC STOMA RM LS 44394 "$2,120.00 " $862.00 "$2,120.00 " "$1,505.20 " "$2,120.00 " "$2,120.00 " "$1,505.20 " "$2,035.20 " "$1,992.80 " "$2,014.00 " "$2,077.60 " 44604 REP PERFORATED INTES 44604 "$5,447.00 " "$2,179.00 " "$5,447.00 " "$3,867.37 " "$5,447.00 " "$5,447.00 " "$3,867.37 " "$5,229.12 " "$5,120.18 " "$5,174.65 " "$5,338.06 " "44620 Closure of enterostomy, large or small intestine;" 44620 "$4,483.00 " "$1,793.00 " "$4,483.00 " "$3,182.93 " "$4,483.00 " "$4,483.00 " "$3,182.93 " "$4,303.68 " "$4,214.02 " "$4,258.85 " "$4,393.34 " 44799 UNLISTED PROCEDURE INTESTINE ProFee 44799 $- "$2,115.00 " $- $- $- $- $- $- $- $- $- 44955 APPENDCTMY WITH SURG 44955 "$1,326.00 " $174.00 "$1,326.00 " $941.46 "$1,326.00 " "$1,326.00 " $941.46 "$1,272.96 " "$1,246.44 " "$1,259.70 " "$1,299.48 " 44960 APPENDECTOMY FOR RUP 44960 "$4,489.00 " "$1,796.00 " "$4,489.00 " "$3,187.19 " "$4,489.00 " "$4,489.00 " "$3,187.19 " "$4,309.44 " "$4,219.66 " "$4,264.55 " "$4,399.22 " 44970 APPENDECTOMY LAP 44970 "$4,654.00 " "$1,234.00 " "$4,654.00 " "$3,304.34 " "$4,654.00 " "$4,654.00 " "$3,304.34 " "$4,467.84 " "$4,374.76 " "$4,421.30 " "$4,560.92 " Proctosigmoidoscopy w/ or w/o Specimen Collection Charge 45300 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 45300 Proctoscopy 45300 "$1,978.00 " $253.00 "$1,978.00 " "$1,404.38 " "$1,978.00 " "$1,978.00 " "$1,404.38 " "$1,898.88 " "$1,859.32 " "$1,879.10 " "$1,938.44 " Proctosigmoidoscopy rigid with biopsy single or multiple 45305 $318.00 $318.00 $225.78 $318.00 $318.00 $225.78 $305.28 $298.92 $302.10 $311.64 Sigmoidoscopy flexible diagnostic with or without collection of specimen by brushing or washing 45330 $356.00 $356.00 $252.76 $356.00 $356.00 $252.76 $341.76 $334.64 $338.20 $348.88 45330 SIGMOIDOSCOPY 45330 "$1,725.00 " $356.00 "$1,725.00 " "$1,224.75 " "$1,725.00 " "$1,725.00 " "$1,224.75 " "$1,656.00 " "$1,621.50 " "$1,638.75 " "$1,690.50 " "Sigmoidoscopy, Flexible; w/Biopsy, Single or Mult Charge" 45331 $556.00 $556.00 $394.76 $556.00 $556.00 $394.76 $533.76 $522.64 $528.20 $544.88 45331 SIGMOIDOSCOPY W BIOP 45331 "$1,947.00 " $556.00 "$1,947.00 " "$1,382.37 " "$1,947.00 " "$1,947.00 " "$1,382.37 " "$1,869.12 " "$1,830.18 " "$1,849.65 " "$1,908.06 " 45378 COLONOSCOPY DIAG 45378 "$1,813.00 " $672.00 "$1,813.00 " "$1,287.23 " "$1,813.00 " "$1,813.00 " "$1,287.23 " "$1,740.48 " "$1,704.22 " "$1,722.35 " "$1,776.74 " 45380 COLONOSCOPY W BIOPSY 45380 "$1,873.00 " $864.00 "$1,873.00 " "$1,329.83 " "$1,873.00 " "$1,873.00 " "$1,329.83 " "$1,798.08 " "$1,760.62 " "$1,779.35 " "$1,835.54 " 45381 COLONOSCOPY SUBMUCOUS INJ. 45381 "$3,986.00 " $844.00 "$3,986.00 " "$2,830.06 " "$3,986.00 " "$3,986.00 " "$2,830.06 " "$3,826.56 " "$3,746.84 " "$3,786.70 " "$3,906.28 " 45384 COLONOS REM HOT BIOP 45384 "$2,316.00 " $958.00 "$2,316.00 " "$1,644.36 " "$2,316.00 " "$2,316.00 " "$1,644.36 " "$2,223.36 " "$2,177.04 " "$2,200.20 " "$2,269.68 " 45385 COLONOS W REM LESION 45385 "$1,992.00 " $907.00 "$1,992.00 " "$1,414.32 " "$1,992.00 " "$1,992.00 " "$1,414.32 " "$1,912.32 " "$1,872.48 " "$1,892.40 " "$1,952.16 " 45541 REDUCTION RECTAL PROLAPSE 45541 "$13,501.00 " "$1,962.00 " "$13,501.00 " "$9,585.71 " "$13,501.00 " "$13,501.00 " "$9,585.71 " "$12,960.96 " "$12,690.94 " "$12,825.95 " "$13,230.98 " 45915 REMOVAL RECTUM FOREIGN BODY 45915 "$12,045.00 " $707.00 "$12,045.00 " "$8,551.95 " "$12,045.00 " "$12,045.00 " "$8,551.95 " "$11,563.20 " "$11,322.30 " "$11,442.75 " "$11,804.10 " 46040 I&D PERIRECTAL ABSCE 46040 "$2,386.00 " "$1,117.00 " "$2,386.00 " "$1,694.06 " "$2,386.00 " "$2,386.00 " "$1,694.06 " "$2,290.56 " "$2,242.84 " "$2,266.70 " "$2,338.28 " "I&D, Perianal Abscess, Superficial Charge" 46050 $434.00 $434.00 $308.14 $434.00 $434.00 $308.14 $416.64 $407.96 $412.30 $425.32 46050 I&D PERIANAL ABSCESS 46050 "$2,992.00 " $434.00 "$2,992.00 " "$2,124.32 " "$2,992.00 " "$2,992.00 " "$2,124.32 " "$2,872.32 " "$2,812.48 " "$2,842.40 " "$2,932.16 " "Incision of Thrombosed Hemorrhoid, Ext Charge" 46083 $381.00 $381.00 $270.51 $381.00 $381.00 $270.51 $365.76 $358.14 $361.95 $373.38 46083 INCISE EXTRNL HEMORR 46083 $631.00 $381.00 $631.00 $448.01 $631.00 $631.00 $448.01 $605.76 $593.14 $599.45 $618.38 "Papillectomy or Excise of Single Tag, AnusCharge" 46220 $451.00 $451.00 $320.21 $451.00 $451.00 $320.21 $432.96 $423.94 $428.45 $441.98 46220 EXC SINGLE ANAL TAG 46220 "$3,703.00 " $451.00 "$3,703.00 " "$2,629.13 " "$3,703.00 " "$3,703.00 " "$2,629.13 " "$3,554.88 " "$3,480.82 " "$3,517.85 " "$3,628.94 " 46505 Chemodenervation of internal anal sphincter 46505 "$2,431.00 " $606.00 "$2,431.00 " "$1,726.01 " "$2,431.00 " "$2,431.00 " "$1,726.01 " "$2,333.76 " "$2,285.14 " "$2,309.45 " "$2,382.38 " Anoscopy Charge 46600 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 46750 ANAL SPHINCTEROPLAST 46750 "$2,488.00 " "$1,582.00 " "$2,488.00 " "$1,766.48 " "$2,488.00 " "$2,488.00 " "$1,766.48 " "$2,388.48 " "$2,338.72 " "$2,363.60 " "$2,438.24 " "Destruct of Lesion(s), Anus (condyloma/papilloma/molluscum contag/herp. ves.), Simple; Chem. Charge" 46900 $494.00 $494.00 $350.74 $494.00 $494.00 $350.74 $474.24 $464.36 $469.30 $484.12 47562 LAP CHOLECYSTECTOMY 47562 "$3,215.00 " "$1,350.00 " "$3,215.00 " "$2,282.65 " "$3,215.00 " "$3,215.00 " "$2,282.65 " "$3,086.40 " "$3,022.10 " "$3,054.25 " "$3,150.70 " 47563 LAP CHOLE W CHOLANGI 47563 "$3,103.00 " "$1,467.00 " "$3,103.00 " "$2,203.13 " "$3,103.00 " "$3,103.00 " "$2,203.13 " "$2,978.88 " "$2,916.82 " "$2,947.85 " "$3,040.94 " 47600 CHOLECYSTECTOMY 47600 "$4,041.00 " "$2,192.00 " "$4,041.00 " "$2,869.11 " "$4,041.00 " "$4,041.00 " "$2,869.11 " "$3,879.36 " "$3,798.54 " "$3,838.95 " "$3,960.18 " 47605 CHOLECYSTECTOMY W CH 47605 "$4,520.00 " "$2,305.00 " "$4,520.00 " "$3,209.20 " "$4,520.00 " "$4,520.00 " "$3,209.20 " "$4,339.20 " "$4,248.80 " "$4,294.00 " "$4,429.60 " 49000 EXPLORATY LAPAROTOMY 49000 "$3,961.00 " "$1,584.00 " "$3,961.00 " "$2,812.31 " "$3,961.00 " "$3,961.00 " "$2,812.31 " "$3,802.56 " "$3,723.34 " "$3,762.95 " "$3,881.78 " PARACENTESIS W/O IMAGING 49082 "$1,688.00 " $415.00 "$1,688.00 " "$1,198.48 " "$1,688.00 " "$1,688.00 " "$1,198.48 " "$1,620.48 " "$1,586.72 " "$1,603.60 " "$1,654.24 " 49083 PARACENTESIS 49083 "$1,049.00 " $622.00 "$1,049.00 " $744.79 "$1,049.00 " "$1,049.00 " $744.79 "$1,007.04 " $986.06 $996.55 "$1,028.02 " 49084 Paracentesis 49084 "$3,219.00 " $223.00 "$3,219.00 " "$2,285.49 " "$3,219.00 " "$3,219.00 " "$2,285.49 " "$3,090.24 " "$3,025.86 " "$3,058.05 " "$3,154.62 " DIAGNOSTIC LAPAROSCO 49320 "$9,251.00 " $675.00 "$9,251.00 " "$6,568.21 " "$9,251.00 " "$9,251.00 " "$6,568.21 " "$8,880.96 " "$8,695.94 " "$8,788.45 " "$9,065.98 " 49505 REP INGU HERN 5 UP W 49505 "$3,490.00 " "$1,068.00 " "$3,490.00 " "$2,477.90 " "$3,490.00 " "$3,490.00 " "$2,477.90 " "$3,350.40 " "$3,280.60 " "$3,315.50 " "$3,420.20 " 49507 REPAIR ING HER INCAR 49507 "$4,122.00 " "$1,202.00 " "$4,122.00 " "$2,926.62 " "$4,122.00 " "$4,122.00 " "$2,926.62 " "$3,957.12 " "$3,874.68 " "$3,915.90 " "$4,039.56 " "49520 Repair recurrent inguinal hernia, any age; reducible" 49520 "$3,705.00 " "$1,296.00 " "$3,705.00 " "$2,630.55 " "$3,705.00 " "$3,705.00 " "$2,630.55 " "$3,556.80 " "$3,482.70 " "$3,519.75 " "$3,630.90 " 49560 REPAIR INITIAL VENTRAL HERNIA REDUCIBLE Clinic Charge 49560 "$3,398.00 " "$1,514.00 " "$3,398.00 " "$2,412.58 " "$3,398.00 " "$3,398.00 " "$2,412.58 " "$3,262.08 " "$3,194.12 " "$3,228.10 " "$3,330.04 " 49561 INCARCERATED INCISCIONAL HERNIA 49561 "$4,587.00 " "$1,906.00 " "$4,587.00 " "$3,256.77 " "$4,587.00 " "$4,587.00 " "$3,256.77 " "$4,403.52 " "$4,311.78 " "$4,357.65 " "$4,495.26 " 49568 IMPLANTATION OF MESH 49568 "$2,801.00 " $548.00 "$2,801.00 " "$1,988.71 " "$2,801.00 " "$2,801.00 " "$1,988.71 " "$2,688.96 " "$2,632.94 " "$2,660.95 " "$2,744.98 " 49585 REPAIR UMBILICAL HER 49585 "$1,990.00 " $914.00 "$1,990.00 " "$1,412.90 " "$1,990.00 " "$1,990.00 " "$1,412.90 " "$1,910.40 " "$1,870.60 " "$1,890.50 " "$1,950.20 " "49654 - Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed);" 49654 "$4,038.25 " "$1,734.00 " "$4,038.25 " "$2,867.16 " "$4,038.25 " "$4,038.25 " "$2,867.16 " "$3,876.72 " "$3,795.96 " "$3,836.34 " "$3,957.49 " "Bladder irrigation, simple, lavage and/or instillation" 51700 $156.00 $156.00 $110.76 $156.00 $156.00 $110.76 $149.76 $146.64 $148.20 $152.88 51701 INSERT BLADDER CATHE CHARGE 51701 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Insert of Non-Indewelling Bladder Cath 51701 $129.00 $94.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Insert Foley Cath Tech Chg 51702 $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 51702 FOLEY CATH INSERTION 51702 $168.00 $130.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 Change of cystostomy tube; simple 51705 $197.00 $197.00 $139.87 $197.00 $197.00 $139.87 $189.12 $185.18 $187.15 $193.06 Bladder instillation of anticarcinogenic agent (including retention time) 51720 $806.00 $177.00 $806.00 $572.26 $806.00 $806.00 $572.26 $773.76 $757.64 $765.70 $789.88 Uroflowmetry - Charge 51736 $166.00 $166.00 $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 Uroflowmetry - Procedure Charge 51736 $166.00 $166.00 $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 Bladder Scan - Procedure Charge 51798 $168.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 51840 MMK PROCEDURE 51840 "$3,566.00 " "$1,426.00 " "$3,566.00 " "$2,531.86 " "$3,566.00 " "$3,566.00 " "$2,531.86 " "$3,423.36 " "$3,352.04 " "$3,387.70 " "$3,494.68 " 52000 CYSTOSCOPY 52000 "$1,824.00 " $396.00 "$1,824.00 " "$1,295.04 " "$1,824.00 " "$1,824.00 " "$1,295.04 " "$1,751.04 " "$1,714.56 " "$1,732.80 " "$1,787.52 " 52005 Cysto W/Ureteral Cath 52005 "$1,040.00 " $- "$1,040.00 " $738.40 "$1,040.00 " "$1,040.00 " $738.40 $998.40 $977.60 $988.00 "$1,019.20 " 52281 Cysto w/ calibrat/dilation 52281 "$2,313.00 " $628.00 "$2,313.00 " "$1,642.23 " "$2,313.00 " "$2,313.00 " "$1,642.23 " "$2,220.48 " "$2,174.22 " "$2,197.35 " "$2,266.74 " 52310 RMVL CALCULUS 52310 "$3,078.00 " $566.00 "$3,078.00 " "$2,185.38 " "$3,078.00 " "$3,078.00 " "$2,185.38 " "$2,954.88 " "$2,893.32 " "$2,924.10 " "$3,016.44 " 52330 CYSTOSCOPY AND TREATMENT 52330 "$3,732.00 " "$1,138.00 " "$3,732.00 " "$2,649.72 " "$3,732.00 " "$3,732.00 " "$2,649.72 " "$3,582.72 " "$3,508.08 " "$3,545.40 " "$3,657.36 " 52332 CYSTO W INSERT INDWELL STEN 52332 "$2,650.00 " $992.00 "$2,650.00 " "$1,881.50 " "$2,650.00 " "$2,650.00 " "$1,881.50 " "$2,544.00 " "$2,491.00 " "$2,517.50 " "$2,597.00 " CYSTOURETHROSCOPY W/INS OF PERM ADJ TRANSPROSTATIC IMPL SINGLE IMPLANT 52441 "$3,427.00 " "$2,649.00 " "$3,427.00 " "$2,433.17 " "$3,427.00 " "$3,427.00 " "$2,433.17 " "$3,289.92 " "$3,221.38 " "$3,255.65 " "$3,358.46 " CYSTOURETHROSCOPY W/INS OF PERM ADJ TRANSPROSTATIC IMPL; EA ADDL IMPL 52442 "$2,830.00 " "$1,982.00 " "$2,830.00 " "$2,009.30 " "$2,830.00 " "$2,830.00 " "$2,009.30 " "$2,716.80 " "$2,660.20 " "$2,688.50 " "$2,773.40 " "Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum), simple; chemical" 54050 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 "Destruction of lesion(s), penis, cryosurgery" 54056 $295.00 $295.00 $209.45 $295.00 $295.00 $209.45 $283.20 $277.30 $280.25 $289.10 "Circumcision, Using Clamp or Other Device; Newborn Charge" 54150 $325.00 $325.00 $230.75 $325.00 $325.00 $230.75 $312.00 $305.50 $308.75 $318.50 54150 CIRCUMCISION NEWBORN 54150 "$5,517.00 " $325.00 "$5,517.00 " "$3,917.07 " "$5,517.00 " "$5,517.00 " "$3,917.07 " "$5,296.32 " "$5,185.98 " "$5,241.15 " "$5,406.66 " "54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days o" 54161 "$2,750.00 " $422.00 "$2,750.00 " "$1,952.50 " "$2,750.00 " "$2,750.00 " "$1,952.50 " "$2,640.00 " "$2,585.00 " "$2,612.50 " "$2,695.00 " Lysis of penile post circumcision adhesions 54162 $547.00 $547.00 $388.37 $547.00 $547.00 $388.37 $525.12 $514.18 $519.65 $536.06 54162 LYSIS PENILE ADHESNS 54162 "$2,893.00 " $547.00 "$2,893.00 " "$2,054.03 " "$2,893.00 " "$2,893.00 " "$2,054.03 " "$2,777.28 " "$2,719.42 " "$2,748.35 " "$2,835.14 " 54220 Under Introduction Procedures on the Penis 54220 "$1,096.00 " $438.00 "$1,096.00 " $778.16 "$1,096.00 " "$1,096.00 " $778.16 "$1,052.16 " "$1,030.24 " "$1,041.20 " "$1,074.08 " Foreskin Manipulation Including Lysis Of Preputial Adhesions And Stretching 54450 $147.00 $147.00 $104.37 $147.00 $147.00 $104.37 $141.12 $138.18 $139.65 $144.06 "Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication" 55000 $246.00 $246.00 $174.66 $246.00 $246.00 $174.66 $236.16 $231.24 $233.70 $241.08 55100 I&D SCROTAL WALL ABSCESS CHARGE 55100 $461.00 $461.00 $327.31 $461.00 $461.00 $327.31 $442.56 $433.34 $437.95 $451.78 55250 VASECTOMY 55250 "$3,196.00 " $784.00 "$3,196.00 " "$2,269.16 " "$3,196.00 " "$3,196.00 " "$2,269.16 " "$3,068.16 " "$3,004.24 " "$3,036.20 " "$3,132.08 " "55700 Biopsy, prostate; needle or punch, single or multiple, any approach" 55700 $867.00 $280.00 $867.00 $615.57 $867.00 $867.00 $615.57 $832.32 $814.98 $823.65 $849.66 I&D of Vulva or Perineal Abscess Charge 56405 $239.00 $239.00 $169.69 $239.00 $239.00 $169.69 $229.44 $224.66 $227.05 $234.22 56405 I & D PERINEAL ABSCESS 56405 $305.00 $239.00 $305.00 $216.55 $305.00 $305.00 $216.55 $292.80 $286.70 $289.75 $298.90 I&D of Bartholin's Gland Abscess Charge 56420 $284.00 $284.00 $201.64 $284.00 $284.00 $201.64 $272.64 $266.96 $269.80 $278.32 56440 Marsupialization of Bartholin's gland cyst 56440 "$3,123.00 " $380.00 "$3,123.00 " "$2,217.33 " "$3,123.00 " "$3,123.00 " "$2,217.33 " "$2,998.08 " "$2,935.62 " "$2,966.85 " "$3,060.54 " "Destruct, Vulva Lesion Simple Charge" 56501 $301.00 $301.00 $213.71 $301.00 $301.00 $213.71 $288.96 $282.94 $285.95 $294.98 "Destruction Of Vaginal Lesion(S); Simple (Eg, Laser Surgery, Electrosurgery, Chemosurgery)" 57061 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 57100 BIOPSY VAGINA MURCOSA 57100 "$2,412.00 " $192.00 "$2,412.00 " "$1,712.52 " "$2,412.00 " "$2,412.00 " "$1,712.52 " "$2,315.52 " "$2,267.28 " "$2,291.40 " "$2,363.76 " Fitting/Insert Pessary/Other Support Charge 57160 $132.00 $132.00 $93.72 $132.00 $132.00 $93.72 $126.72 $124.08 $125.40 $129.36 57160 INSERT PESSARY/OTHER DEVI 57160 $153.00 $132.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 57240 COLPORRHAPHY ANTERI 57240 "$6,991.00 " "$1,257.00 " "$6,991.00 " "$4,963.61 " "$6,991.00 " "$6,991.00 " "$4,963.61 " "$6,711.36 " "$6,571.54 " "$6,641.45 " "$6,851.18 " 57250 COLPORRAHPHY POSTERI 57250 "$7,702.00 " "$1,260.00 " "$7,702.00 " "$5,468.42 " "$7,702.00 " "$7,702.00 " "$5,468.42 " "$7,393.92 " "$7,239.88 " "$7,316.90 " "$7,547.96 " 57260 COLPORRHAPHY A & P 57260 "$4,399.00 " "$1,610.00 " "$4,399.00 " "$3,123.29 " "$4,399.00 " "$4,399.00 " "$3,123.29 " "$4,223.04 " "$4,135.06 " "$4,179.05 " "$4,311.02 " 57265 COLPO A&P ENTERO REP 57265 "$11,286.00 " "$1,806.00 " "$11,286.00 " "$8,013.06 " "$11,286.00 " "$11,286.00 " "$8,013.06 " "$10,834.56 " "$10,608.84 " "$10,721.70 " "$11,060.28 " 57282 COLPOPEXY 57282 "$5,479.00 " "$1,076.00 " "$5,479.00 " "$3,890.09 " "$5,479.00 " "$5,479.00 " "$3,890.09 " "$5,259.84 " "$5,150.26 " "$5,205.05 " "$5,369.42 " 57284 PARAVAGINAL DEFECT 57284 "$2,356.00 " "$1,727.00 " "$2,356.00 " "$1,672.76 " "$2,356.00 " "$2,356.00 " "$1,672.76 " "$2,261.76 " "$2,214.64 " "$2,238.20 " "$2,308.88 " 57288 SLING PROCEDURE 57288 "$6,596.00 " "$1,527.00 " "$6,596.00 " "$4,683.16 " "$6,596.00 " "$6,596.00 " "$4,683.16 " "$6,332.16 " "$6,200.24 " "$6,266.20 " "$6,464.08 " 57410 PELVIC EXAM 57410 "$3,298.00 " $223.00 "$3,298.00 " "$2,341.58 " "$3,298.00 " "$3,298.00 " "$2,341.58 " "$3,166.08 " "$3,100.12 " "$3,133.10 " "$3,232.04 " EXAM/BIOPSY OF VAG W/SCOPE 57421 $843.00 $337.00 $843.00 $598.53 $843.00 $843.00 $598.53 $809.28 $792.42 $800.85 $826.14 Exam of Cervix W/ Scope 57452 $861.00 $238.00 $861.00 $611.31 $861.00 $861.00 $611.31 $826.56 $809.34 $817.95 $843.78 Colposcopy Cervix/Upper Vag w/Bx Cervix & Endo Charge 57454 $329.00 $329.00 $233.59 $329.00 $329.00 $233.59 $315.84 $309.26 $312.55 $322.42 57454 COLPOSCOPY W BX CERV 57454 $889.00 $329.00 $889.00 $631.19 $889.00 $889.00 $631.19 $853.44 $835.66 $844.55 $871.22 COLPOSCOPY W/ CURETTAGE Clinic Charge 57456 $291.00 $291.00 $206.61 $291.00 $291.00 $206.61 $279.36 $273.54 $276.45 $285.18 "Biopsy, Single or Multiple, or Local Excision of Lesion" 57500 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 57500 BIOPSY OF CERVIX. 57500 $788.00 $279.00 $788.00 $559.48 $788.00 $788.00 $559.48 $756.48 $740.72 $748.60 $772.24 Endocervical curettage Technical Charge 57505 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 "57800 Dilation of cervical canal, instrumental (separate procedure" 57800 $147.00 $136.00 $147.00 $104.37 $147.00 $147.00 $104.37 $141.12 $138.18 $139.65 $144.06 Biopsy Endometrial Charge 58100 $194.00 $194.00 $137.74 $194.00 $194.00 $137.74 $186.24 $182.36 $184.30 $190.12 58100 ENDOMETRIAL ASPIRATI 58100 $264.00 $194.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 "Dilation and Curettage, DX or Therapeutic" 58120 $562.00 $562.00 $399.02 $562.00 $562.00 $399.02 $539.52 $528.28 $533.90 $550.76 58120 D & C DIAGNOSTIC 58120 "$5,992.00 " $562.00 "$5,992.00 " "$4,254.32 " "$5,992.00 " "$5,992.00 " "$4,254.32 " "$5,752.32 " "$5,632.48 " "$5,692.40 " "$5,872.16 " 58150 HYSTERECTOMY ABDOM 58150 "$5,293.00 " "$2,117.00 " "$5,293.00 " "$3,758.03 " "$5,293.00 " "$5,293.00 " "$3,758.03 " "$5,081.28 " "$4,975.42 " "$5,028.35 " "$5,187.14 " 58152 HYSTERECTOMY 58152 "$6,538.00 " "$2,615.00 " "$6,538.00 " "$4,641.98 " "$6,538.00 " "$6,538.00 " "$4,641.98 " "$6,276.48 " "$6,145.72 " "$6,211.10 " "$6,407.24 " 58260 HYSTER VAGINAL 58260 "$3,145.00 " "$1,735.00 " "$3,145.00 " "$2,232.95 " "$3,145.00 " "$3,145.00 " "$2,232.95 " "$3,019.20 " "$2,956.30 " "$2,987.75 " "$3,082.10 " 58262 HYSTER VAG TUBE OVAR 58262 "$6,841.00 " "$1,929.00 " "$6,841.00 " "$4,857.11 " "$6,841.00 " "$6,841.00 " "$4,857.11 " "$6,567.36 " "$6,430.54 " "$6,498.95 " "$6,704.18 " 58267 HYST VAG W URINE REP 58267 "$5,270.00 " "$2,210.00 " "$5,270.00 " "$3,741.70 " "$5,270.00 " "$5,270.00 " "$3,741.70 " "$5,059.20 " "$4,953.80 " "$5,006.50 " "$5,164.60 " 58291 HYSTER VAG UTER>250 58291 "$7,473.00 " "$2,620.00 " "$7,473.00 " "$5,305.83 " "$7,473.00 " "$7,473.00 " "$5,305.83 " "$7,174.08 " "$7,024.62 " "$7,099.35 " "$7,323.54 " "IUD, Insert Charge" 58300 $167.00 $167.00 $118.57 $167.00 $167.00 $118.57 $160.32 $156.98 $158.65 $163.66 58300 Insertion Iud 58300 "$1,859.00 " $167.00 "$1,859.00 " "$1,319.89 " "$1,859.00 " "$1,859.00 " "$1,319.89 " "$1,784.64 " "$1,747.46 " "$1,766.05 " "$1,821.82 " "IUD, Remove Charge" 58301 $199.00 $199.00 $141.29 $199.00 $199.00 $141.29 $191.04 $187.06 $189.05 $195.02 58301 Removal of intrauterine device (IUD) 58301 "$3,062.00 " $199.00 "$3,062.00 " "$2,174.02 " "$3,062.00 " "$3,062.00 " "$2,174.02 " "$2,939.52 " "$2,878.28 " "$2,908.90 " "$3,000.76 " 58550 LAP ASSISTED TOTAL HYSTERECTOMY 58550 "$5,787.00 " "$1,841.00 " "$5,787.00 " "$4,108.77 " "$5,787.00 " "$5,787.00 " "$4,108.77 " "$5,555.52 " "$5,439.78 " "$5,497.65 " "$5,671.26 " 58552 LAP VAG HYS W SAL OO 58552 "$4,950.00 " "$2,059.00 " "$4,950.00 " "$3,514.50 " "$4,950.00 " "$4,950.00 " "$3,514.50 " "$4,752.00 " "$4,653.00 " "$4,702.50 " "$4,851.00 " 58558 HYSTEROSCOPY W/BX W/O D&C 58558 "$2,800.00 " $490.00 "$2,800.00 " "$1,988.00 " "$2,800.00 " "$2,800.00 " "$1,988.00 " "$2,688.00 " "$2,632.00 " "$2,660.00 " "$2,744.00 " "58563 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical" 58563 "$3,557.00 " $522.00 "$3,557.00 " "$2,525.47 " "$3,557.00 " "$3,557.00 " "$2,525.47 " "$3,414.72 " "$3,343.58 " "$3,379.15 " "$3,485.86 " 58571 LAP HYSTERECTORY 58571 "$15,103.00 " "$1,871.00 " "$15,103.00 " "$10,723.13 " "$15,103.00 " "$15,103.00 " "$10,723.13 " "$14,498.88 " "$14,196.82 " "$14,347.85 " "$14,800.94 " 58605 LIG TRANS POSTPART 58605 "$1,037.00 " $691.00 "$1,037.00 " $736.27 "$1,037.00 " "$1,037.00 " $736.27 $995.52 $974.78 $985.15 "$1,016.26 " 58611 LIG TRANS W C-SECTIO 58611 $519.00 $161.00 $519.00 $368.49 $519.00 $519.00 $368.49 $498.24 $487.86 $493.05 $508.62 58660 LAP LYSIS ADHISIONS 58660 "$5,622.00 " "$1,408.00 " "$5,622.00 " "$3,991.62 " "$5,622.00 " "$5,622.00 " "$3,991.62 " "$5,397.12 " "$5,284.68 " "$5,340.90 " "$5,509.56 " 58661 LAP W REM ADNEXAL ST 58661 "$5,485.00 " "$1,358.00 " "$5,485.00 " "$3,894.35 " "$5,485.00 " "$5,485.00 " "$3,894.35 " "$5,265.60 " "$5,155.90 " "$5,210.75 " "$5,375.30 " 58662 CAUTERIZE ENDOMETRI 58662 "$7,034.00 " "$1,483.00 " "$7,034.00 " "$4,994.14 " "$7,034.00 " "$7,034.00 " "$4,994.14 " "$6,752.64 " "$6,611.96 " "$6,682.30 " "$6,893.32 " 58940 OOPHORECTOMY PART TO 58940 "$2,769.00 " "$1,108.00 " "$2,769.00 " "$1,965.99 " "$2,769.00 " "$2,769.00 " "$1,965.99 " "$2,658.24 " "$2,602.86 " "$2,630.55 " "$2,713.62 " 58956 TOTAL ABD HYSTER 58956 "$7,153.00 " "$2,861.00 " "$7,153.00 " "$5,078.63 " "$7,153.00 " "$7,153.00 " "$5,078.63 " "$6,866.88 " "$6,723.82 " "$6,795.35 " "$7,009.94 " Fetal Nonstress Test 59025 $336.00 $336.00 $238.56 $336.00 $336.00 $238.56 $322.56 $315.84 $319.20 $329.28 59151 SALPINGECTOMY 59151 "$4,553.00 " "$1,526.00 " "$4,553.00 " "$3,232.63 " "$4,553.00 " "$4,553.00 " "$3,232.63 " "$4,370.88 " "$4,279.82 " "$4,325.35 " "$4,461.94 " 59160 D&C POSTPARTUM 59160 $748.00 $440.00 $748.00 $531.08 $748.00 $748.00 $531.08 $718.08 $703.12 $710.60 $733.04 59300 EPISIOTOMY VAGINAL 59300 $409.00 $- $- $- $- $- $- $- $- 59400 OB CARE COMPL 59400 59400 "$4,278.00 " $- $- $- $- $- $- $- $- 59409 VAGINAL DELIVRY ONLY 59409 "$1,648.00 " $- $- $- $- $- $- $- $- 59410 VAG DELIV INCL POSTP 59410 "$2,112.00 " $- $- $- $- $- $- $- $- 59414 DELIVERY OF PLACENTA 59414 $185.00 $- $- $- $- $- $- $- $- 59425 ANTEPARTUM CARE ONLY 4-6 VISITS Clinic Charge 59425 $933.00 $933.00 $662.43 $933.00 $933.00 $662.43 $895.68 $877.02 $886.35 $914.34 59425 ANTEPARTUM CARE 4-6 VISITS 59425 "$2,332.00 " $933.00 "$2,332.00 " "$1,655.72 " "$2,332.00 " "$2,332.00 " "$1,655.72 " "$2,238.72 " "$2,192.08 " "$2,215.40 " "$2,285.36 " 59426 ANTEPARTUM CARE 7+VI 59426 "$1,668.00 " "$1,668.00 " "$1,184.28 " "$1,668.00 " "$1,668.00 " "$1,184.28 " "$1,601.28 " "$1,567.92 " "$1,584.60 " "$1,634.64 " 59426 ANTEPARTUM CARE 7+VI 59426 "$4,171.00 " "$1,668.00 " "$4,171.00 " "$2,961.41 " "$4,171.00 " "$4,171.00 " "$2,961.41 " "$4,004.16 " "$3,920.74 " "$3,962.45 " "$4,087.58 " Postpartum Care only - 59430 59430 $396.00 $396.00 $281.16 $396.00 $396.00 $281.16 $380.16 $372.24 $376.20 $388.08 "59510 OB CARE,C SECT,COMPL" 59510 "$11,786.00 " "$4,714.00 " "$11,786.00 " "$8,368.06 " "$11,786.00 " "$11,786.00 " "$8,368.06 " "$11,314.56 " "$11,078.84 " "$11,196.70 " "$11,550.28 " 59514 C SECT DELIVERY ONLY 59514 "$1,848.00 " $- $- $- $- $- $- $- $- 59514 C SECTION ASSIST 59514 "$1,848.00 " $- $- $- $- $- $- $- $- 59515 C SEC W POSTPRT CARE 59515 "$2,552.00 " $- $- $- $- $- $- $- $- "Vaginal Delivery Only, After Previous Cesarean Delivery; Including Postpartum Care" 59614 "$2,290.00 " "$2,290.00 " "$1,625.90 " "$2,290.00 " "$2,290.00 " "$1,625.90 " "$2,198.40 " "$2,152.60 " "$2,175.50 " "$2,244.20 " 59812 TRTMT INCMPLT ABORTI 59812 $853.00 $662.00 $853.00 $605.63 $853.00 $853.00 $605.63 $818.88 $801.82 $810.35 $835.94 59820 TREAT MISSED ABORTIO 59820 "$6,650.00 " $797.00 "$6,650.00 " "$4,721.50 " "$6,650.00 " "$6,650.00 " "$4,721.50 " "$6,384.00 " "$6,251.00 " "$6,317.50 " "$6,517.00 " 62270 LUMBAR PUNCTURE DIAG 62270 $734.00 $309.00 $734.00 $521.14 $734.00 $734.00 $521.14 $704.64 $689.96 $697.30 $719.32 62273 INJ EPID BLOOD PATCH 62273 $670.00 $366.00 $670.00 $475.70 $670.00 $670.00 $475.70 $643.20 $629.80 $636.50 $656.60 XR Myelography Lumbosacral 62304 "$1,154.00 " "$1,154.00 " $819.34 "$1,154.00 " "$1,154.00 " $819.34 "$1,107.84 " "$1,084.76 " "$1,096.30 " "$1,130.92 " "Epidural, cervical or thoracic w/ imaging guidance (fluoroscopy or CT)" 62321 "$1,261.00 " $531.00 "$1,261.00 " $895.31 "$1,261.00 " "$1,261.00 " $895.31 "$1,210.56 " "$1,185.34 " "$1,197.95 " "$1,235.78 " "Epidural lumbar or sacral, w/out imaging guidance" 62322 $812.00 $323.00 $812.00 $576.52 $812.00 $812.00 $576.52 $779.52 $763.28 $771.40 $795.76 "Epidural lumbar or sacral, w/ imaging guidance (fluoroscopy or CT)" 62323 "$1,229.00 " $524.00 "$1,229.00 " $872.59 "$1,229.00 " "$1,229.00 " $872.59 "$1,179.84 " "$1,155.26 " "$1,167.55 " "$1,204.42 " XR Lumbar Puncture 62328 "$1,250.00 " "$1,250.00 " $887.50 "$1,250.00 " "$1,250.00 " $887.50 "$1,200.00 " "$1,175.00 " "$1,187.50 " "$1,225.00 " "Implantation of Neuro Electrode Array, Epidural" 63650 "$6,155.00 " "$3,374.00 " "$6,155.00 " "$4,370.05 " "$6,155.00 " "$6,155.00 " "$4,370.05 " "$5,908.80 " "$5,785.70 " "$5,847.25 " "$6,031.90 " "Percutaneous implantation of neurostimulator electrode array, epidural)" 63685 "$13,750.00 " $746.00 "$13,750.00 " "$9,762.50 " "$13,750.00 " "$13,750.00 " "$9,762.50 " "$13,200.00 " "$12,925.00 " "$13,062.50 " "$13,475.00 " "Inj, Anesthetic Agent; Greater Occipital Nerve Charge" 64405 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 64405 N BLOCK INJ OCCIPITAL 64405 $473.00 $170.00 $473.00 $335.83 $473.00 $473.00 $335.83 $454.08 $444.62 $449.35 $463.54 64421 BLOCK INTERCOSTAL 64421 $322.39 $322.39 $228.90 $322.39 $322.39 $228.90 $309.49 $303.05 $306.27 $315.94 Inj. anesthetic agent; ilioinguinal ilidyprogastric nerves 64425 "$1,011.00 " $291.00 "$1,011.00 " $717.81 "$1,011.00 " "$1,011.00 " $717.81 $970.56 $950.34 $960.45 $990.78 "64447 Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures" 64447 $714.00 $258.00 $714.00 $506.94 $714.00 $714.00 $506.94 $685.44 $671.16 $678.30 $699.72 "Injection, anesthetic agent: other peripheral nerve or branch" 64450 $785.00 $162.00 $785.00 $557.35 $785.00 $785.00 $557.35 $753.60 $737.90 $745.75 $769.30 "64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging" 64454 $781.00 $250.00 $781.00 $554.51 $781.00 $781.00 $554.51 $749.76 $734.14 $741.95 $765.38 Injection Plantar Common Digital Nerve 64455 $166.00 $102.00 $166.00 $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 64483 TRANSFORAMINAL INJ LUM/SAC PRO 64483 "$1,575.00 " $477.00 "$1,575.00 " "$1,118.25 " "$1,575.00 " "$1,575.00 " "$1,118.25 " "$1,512.00 " "$1,480.50 " "$1,496.25 " "$1,543.50 " 64484 TRANSFORAMINAL INJ LUM EA ADD PRO 64484 "$1,228.00 " $207.00 "$1,228.00 " $871.88 "$1,228.00 " "$1,228.00 " $871.88 "$1,178.88 " "$1,154.32 " "$1,166.60 " "$1,203.44 " 64490 MEDIAL BLOCK CRV/THRC L1 64490 "$1,460.00 " $399.00 "$1,460.00 " "$1,036.60 " "$1,460.00 " "$1,460.00 " "$1,036.60 " "$1,401.60 " "$1,372.40 " "$1,387.00 " "$1,430.80 " 64491 MEDIAL BLOCK CRV/THRC L2 64491 "$1,156.00 " $199.00 "$1,156.00 " $820.76 "$1,156.00 " "$1,156.00 " $820.76 "$1,109.76 " "$1,086.64 " "$1,098.20 " "$1,132.88 " 64492 MEDIAL BLOCK CRV/THRC L3 64492 $944.00 $201.00 $944.00 $670.24 $944.00 $944.00 $670.24 $906.24 $887.36 $896.80 $925.12 64493 Medial Block Lum/Sac L1 Bilateral 64493 "$1,230.00 " $363.00 "$1,230.00 " $873.30 "$1,230.00 " "$1,230.00 " $873.30 "$1,180.80 " "$1,156.20 " "$1,168.50 " "$1,205.40 " 64494 Medial Block Lum/Sac L2 Bilateral 64494 "$1,094.00 " $185.00 "$1,094.00 " $776.74 "$1,094.00 " "$1,094.00 " $776.74 "$1,050.24 " "$1,028.36 " "$1,039.30 " "$1,072.12 " 64495 MEDIAL BLOCK LUM/SAC L3 64495 $563.00 $185.00 $563.00 $399.73 $563.00 $563.00 $399.73 $540.48 $529.22 $534.85 $551.74 64520 INJ ANES LMBR/THRC Paravertebral 64520 "$3,569.00 " $423.00 "$3,569.00 " "$2,533.99 " "$3,569.00 " "$3,569.00 " "$2,533.99 " "$3,426.24 " "$3,354.86 " "$3,390.55 " "$3,497.62 " 64615 CHEMODENERV MUSCLE MIGRAINE 64615 $443.00 $296.00 $443.00 $314.53 $443.00 $443.00 $314.53 $425.28 $416.42 $420.85 $434.14 64650 Chemonerv Eccrine Glands 64640 "$1,188.00 " $286.00 "$1,188.00 " $843.48 "$1,188.00 " "$1,188.00 " $843.48 "$1,140.48 " "$1,116.72 " "$1,128.60 " "$1,164.24 " 64721 Neuroplasty Median Nerve 64721 "$2,236.00 " $888.00 "$2,236.00 " "$1,587.56 " "$2,236.00 " "$2,236.00 " "$1,587.56 " "$2,146.56 " "$2,101.84 " "$2,124.20 " "$2,191.28 " 64999 Unlisted Nervous System 64999 $793.00 $- $793.00 $563.03 $793.00 $793.00 $563.03 $761.28 $745.42 $753.35 $777.14 "Foreign Body Remove, Superficial Conjunctival Tech Chg" 65205 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 65205 REM FB EXTERNAL EYE 65205 $341.00 $98.00 $341.00 $242.11 $341.00 $341.00 $242.11 $327.36 $320.54 $323.95 $334.18 "Foreign Body Remove, Embedded Conjunctival Tech Chg" 65210 $119.00 $119.00 $84.49 $119.00 $119.00 $84.49 $114.24 $111.86 $113.05 $116.62 "Removal of foreign body, corneal, w/o slit lamp" 65220 $124.00 $124.00 $88.04 $124.00 $124.00 $88.04 $119.04 $116.56 $117.80 $121.52 65220 REM FB CORNEA 65220 $314.00 $124.00 $314.00 $222.94 $314.00 $314.00 $222.94 $301.44 $295.16 $298.30 $307.72 "Removal of foreign body, corneal, w/slit lamp" 65222 $157.00 $145.00 $157.00 $111.47 $157.00 $157.00 $111.47 $150.72 $147.58 $149.15 $153.86 65235 FB REM ANT CHAMB LEN 65235 "$1,753.00 " "$1,513.00 " "$1,753.00 " "$1,244.63 " "$1,753.00 " "$1,753.00 " "$1,244.63 " "$1,682.88 " "$1,647.82 " "$1,665.35 " "$1,717.94 " 65435 REM CORNEAL EPITHELI 65435 $784.00 $173.00 $784.00 $556.64 $784.00 $784.00 $556.64 $752.64 $736.96 $744.80 $768.32 SP YAG LASER PROCEDU 66821 $500.01 $700.00 $500.01 $355.01 $500.01 $500.01 $355.01 $480.01 $470.01 $475.01 $490.01 "66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechan" 66984 "$1,358.00 " "$2,425.00 " "$1,358.00 " $964.18 "$1,358.00 " "$1,358.00 " $964.18 "$1,303.68 " "$1,276.52 " "$1,290.10 " "$1,330.84 " "Blepharotomy, Drainage of Abscess, Eyelid Charge" 67700 $576.00 $576.00 $408.96 $576.00 $576.00 $408.96 $552.96 $541.44 $547.20 $564.48 "67700 Blepharotomy, drainage of abscess, eyelid" 67700 $886.00 $576.00 $886.00 $629.06 $886.00 $886.00 $629.06 $850.56 $832.84 $841.70 $868.28 "Correction of trichiasis; epilation, by forceps only" 67820 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 EXC LES EYELID W/O CLOS 67840 $585.00 $585.00 $415.35 $585.00 $585.00 $415.35 $561.60 $549.90 $555.75 $573.30 REMOVAL FB EYELID 67938 $530.00 $530.00 $376.30 $530.00 $530.00 $376.30 $508.80 $498.20 $503.50 $519.40 67938 REMOVAL FB EYELID 67938 "$2,149.00 " $530.00 "$2,149.00 " "$1,525.79 " "$2,149.00 " "$2,149.00 " "$1,525.79 " "$2,063.04 " "$2,020.06 " "$2,041.55 " "$2,106.02 " Snip Incs Lacrimal Punctum 68399 $34.00 $34.00 $24.14 $34.00 $34.00 $24.14 $32.64 $31.96 $32.30 $33.32 "Incision and Drainage, Ext. Ear, simple Charge" 69000 $388.00 $388.00 $275.48 $388.00 $388.00 $275.48 $372.48 $364.72 $368.60 $380.24 69000 DRAINAGE EXT EAR 69000 "$3,668.00 " $388.00 "$3,668.00 " "$2,604.28 " "$3,668.00 " "$3,668.00 " "$2,604.28 " "$3,521.28 " "$3,447.92 " "$3,484.60 " "$3,594.64 " Ear Piercing Charge 69090 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 Biopsy External Ear Clinic Charge 69100 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 Biopsy External Ear Profee 69100 $853.00 $204.00 $853.00 $605.63 $853.00 $853.00 $605.63 $818.88 $801.82 $810.35 $835.94 69200 REMOVAL FB EAR 69200 $142.00 $170.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 Removal foreign body from external auditory canal; without general anesthesia Charge 69200 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 69205 Removal foreign body from external auditory canal; with gene 69205 $516.00 $206.00 $516.00 $366.36 $516.00 $516.00 $366.36 $495.36 $485.04 $490.20 $505.68 "Ear Irrigation, lavage only" 69209 $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 "Ear Irrigation, with instrumentation" 69210 $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 69210 EAR IRRIGATION 69210 $113.00 $99.00 $113.00 $80.23 $113.00 $113.00 $80.23 $108.48 $106.22 $107.35 $110.74 69220 PHY DEBRIDEMENT MASTOIDECTOMY CAVITY SIM. 69220 $174.00 $168.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 69424 VENTILATING TUBE REMOVAL GENERAL ANESTH 69424 "$3,274.00 " $265.00 "$3,274.00 " "$2,324.54 " "$3,274.00 " "$3,274.00 " "$2,324.54 " "$3,143.04 " "$3,077.56 " "$3,110.30 " "$3,208.52 " 69436 TYPANOSTOMY REQUIRING INSERT VENT TUB 69436 "$3,554.00 " $330.00 "$3,554.00 " "$2,523.34 " "$3,554.00 " "$3,554.00 " "$2,523.34 " "$3,411.84 " "$3,340.76 " "$3,376.30 " "$3,482.92 " XR Mandible Complete Minimum 4 Views 70110 $404.00 $404.00 $286.84 $404.00 $404.00 $286.84 $387.84 $379.76 $383.80 $395.92 XR Mastoids Complete Bilateral 70120 $299.00 $299.00 $212.29 $299.00 $299.00 $212.29 $287.04 $281.06 $284.05 $293.02 XR Facial Bones < 3 Views 70140 $201.00 $201.00 $142.71 $201.00 $201.00 $142.71 $192.96 $188.94 $190.95 $196.98 XR Facial Bones Minimum 3 Views 70150 $408.00 $408.00 $289.68 $408.00 $408.00 $289.68 $391.68 $383.52 $387.60 $399.84 XR Nasal Bones Minimum 3 Views 70160 $315.00 $315.00 $223.65 $315.00 $315.00 $223.65 $302.40 $296.10 $299.25 $308.70 XR Sinuses Paranasal < 3 Views 70210 $223.00 $223.00 $158.33 $223.00 $223.00 $158.33 $214.08 $209.62 $211.85 $218.54 XR Sinuses Paranasal Complete 70220 $245.00 $245.00 $173.95 $245.00 $245.00 $173.95 $235.20 $230.30 $232.75 $240.10 XR Skull < 4 Views 70250 $298.00 $298.00 $211.58 $298.00 $298.00 $211.58 $286.08 $280.12 $283.10 $292.04 XR Skull Complete 70260 $476.00 $476.00 $337.96 $476.00 $476.00 $337.96 $456.96 $447.44 $452.20 $466.48 XR Temporomandibular Joints 70328 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR TMJ Open and Closed Bilateral 70330 $347.00 $347.00 $246.37 $347.00 $347.00 $246.37 $333.12 $326.18 $329.65 $340.06 MRI TMJ 70336 "$2,096.00 " "$2,096.00 " "$1,488.16 " "$2,096.00 " "$2,096.00 " "$1,488.16 " "$2,012.16 " "$1,970.24 " "$1,991.20 " "$2,054.08 " XR Neck Soft Tissue 70360 $287.00 $287.00 $203.77 $287.00 $287.00 $203.77 $275.52 $269.78 $272.65 $281.26 CT Head or Brain w/o Contrast 70450 "$1,849.00 " "$1,849.00 " "$1,312.79 " "$1,849.00 " "$1,849.00 " "$1,312.79 " "$1,775.04 " "$1,738.06 " "$1,756.55 " "$1,812.02 " CT Head or Brain w/ Contrast 70460 "$2,057.00 " "$2,057.00 " "$1,460.47 " "$2,057.00 " "$2,057.00 " "$1,460.47 " "$1,974.72 " "$1,933.58 " "$1,954.15 " "$2,015.86 " CT Head or Brain w/ + w/o Contrast 70470 "$2,287.00 " "$2,287.00 " "$1,623.77 " "$2,287.00 " "$2,287.00 " "$1,623.77 " "$2,195.52 " "$2,149.78 " "$2,172.65 " "$2,241.26 " CT Orbit Sella etc. w/o Contrast 70480 "$1,927.00 " "$1,927.00 " "$1,368.17 " "$1,927.00 " "$1,927.00 " "$1,368.17 " "$1,849.92 " "$1,811.38 " "$1,830.65 " "$1,888.46 " CT Orbit Sella etc. w/ Contrast 70481 "$2,224.00 " "$2,224.00 " "$1,579.04 " "$2,224.00 " "$2,224.00 " "$1,579.04 " "$2,135.04 " "$2,090.56 " "$2,112.80 " "$2,179.52 " CT Orbit Sella etc. w/ + w/o Contrast 70482 "$2,530.00 " "$2,530.00 " "$1,796.30 " "$2,530.00 " "$2,530.00 " "$1,796.30 " "$2,428.80 " "$2,378.20 " "$2,403.50 " "$2,479.40 " CT Maxillofacial w/o Contrast 70486 "$1,666.00 " "$1,666.00 " "$1,182.86 " "$1,666.00 " "$1,666.00 " "$1,182.86 " "$1,599.36 " "$1,566.04 " "$1,582.70 " "$1,632.68 " CT Maxillofacial w/ Contrast 70487 "$2,025.00 " "$2,025.00 " "$1,437.75 " "$2,025.00 " "$2,025.00 " "$1,437.75 " "$1,944.00 " "$1,903.50 " "$1,923.75 " "$1,984.50 " CT Maxillofacial w/ + w/o Contrast 70488 "$2,341.00 " "$2,341.00 " "$1,662.11 " "$2,341.00 " "$2,341.00 " "$1,662.11 " "$2,247.36 " "$2,200.54 " "$2,223.95 " "$2,294.18 " CT Soft Tissue Neck w/o Contrast 70490 "$1,901.00 " "$1,901.00 " "$1,349.71 " "$1,901.00 " "$1,901.00 " "$1,349.71 " "$1,824.96 " "$1,786.94 " "$1,805.95 " "$1,862.98 " CT Soft Tissue Neck w/ Contrast 70491 "$2,175.00 " "$2,175.00 " "$1,544.25 " "$2,175.00 " "$2,175.00 " "$1,544.25 " "$2,088.00 " "$2,044.50 " "$2,066.25 " "$2,131.50 " CT Soft Tissue Neck/Chest w/ + w/o Cont 70492 "$2,578.00 " "$2,578.00 " "$1,830.38 " "$2,578.00 " "$2,578.00 " "$1,830.38 " "$2,474.88 " "$2,423.32 " "$2,449.10 " "$2,526.44 " CT Angiography Head w/ + w/o Contrast 70496 "$2,594.00 " "$2,594.00 " "$1,841.74 " "$2,594.00 " "$2,594.00 " "$1,841.74 " "$2,490.24 " "$2,438.36 " "$2,464.30 " "$2,542.12 " CT Angiography Neck W/WO Contrast 70498 "$2,565.00 " "$2,565.00 " "$1,821.15 " "$2,565.00 " "$2,565.00 " "$1,821.15 " "$2,462.40 " "$2,411.10 " "$2,436.75 " "$2,513.70 " THAY CT Angiography Neck W/WO Contrast 70498 "$2,565.00 " "$2,565.00 " "$1,821.15 " "$2,565.00 " "$2,565.00 " "$1,821.15 " "$2,462.40 " "$2,411.10 " "$2,436.75 " "$2,513.70 " MRI Face Neck Orbit w/o Contrast 70540 "$3,302.00 " "$3,302.00 " "$2,344.42 " "$3,302.00 " "$3,302.00 " "$2,344.42 " "$3,169.92 " "$3,103.88 " "$3,136.90 " "$3,235.96 " MRI Face Neck Orbit w/ + w/o Contrast 70543 "$2,615.00 " "$2,615.00 " "$1,856.65 " "$2,615.00 " "$2,615.00 " "$1,856.65 " "$2,510.40 " "$2,458.10 " "$2,484.25 " "$2,562.70 " MRA Head w/o Contrast 70544 "$2,710.00 " "$2,710.00 " "$1,924.10 " "$2,710.00 " "$2,710.00 " "$1,924.10 " "$2,601.60 " "$2,547.40 " "$2,574.50 " "$2,655.80 " MRA Head w/ Contrast 70545 "$5,173.00 " "$5,173.00 " "$3,672.83 " "$5,173.00 " "$5,173.00 " "$3,672.83 " "$4,966.08 " "$4,862.62 " "$4,914.35 " "$5,069.54 " MRA Head w/ + w/o Contrast 70546 "$3,913.00 " "$3,913.00 " "$2,778.23 " "$3,913.00 " "$3,913.00 " "$2,778.23 " "$3,756.48 " "$3,678.22 " "$3,717.35 " "$3,834.74 " MRA Neck w/o Contrast 70547 "$2,459.00 " "$2,459.00 " "$1,745.89 " "$2,459.00 " "$2,459.00 " "$1,745.89 " "$2,360.64 " "$2,311.46 " "$2,336.05 " "$2,409.82 " MRA Neck w/ Contrast 70548 "$3,007.00 " "$3,007.00 " "$2,134.97 " "$3,007.00 " "$3,007.00 " "$2,134.97 " "$2,886.72 " "$2,826.58 " "$2,856.65 " "$2,946.86 " MRA Neck w/ + w/o Contrast 70549 "$3,465.00 " "$3,465.00 " "$2,460.15 " "$3,465.00 " "$3,465.00 " "$2,460.15 " "$3,326.40 " "$3,257.10 " "$3,291.75 " "$3,395.70 " MRI Brain w/o Contrast 70551 "$3,036.00 " "$3,036.00 " "$2,155.56 " "$3,036.00 " "$3,036.00 " "$2,155.56 " "$2,914.56 " "$2,853.84 " "$2,884.20 " "$2,975.28 " MRI Brain w/ Contrast 70552 "$3,158.00 " "$3,158.00 " "$2,242.18 " "$3,158.00 " "$3,158.00 " "$2,242.18 " "$3,031.68 " "$2,968.52 " "$3,000.10 " "$3,094.84 " MRI Brain w/ + w/o Contrast 70553 "$3,118.00 " "$3,118.00 " "$2,213.78 " "$3,118.00 " "$3,118.00 " "$2,213.78 " "$2,993.28 " "$2,930.92 " "$2,962.10 " "$3,055.64 " XR Chest 1 View 71045 $238.00 $238.00 $168.98 $238.00 $238.00 $168.98 $228.48 $223.72 $226.10 $233.24 XR Chest 2 Views 71046 $294.00 $294.00 $208.74 $294.00 $294.00 $208.74 $282.24 $276.36 $279.30 $288.12 XR Chest 2 Views w/ Apical Lordotic 71046 $294.00 $294.00 $208.74 $294.00 $294.00 $208.74 $282.24 $276.36 $279.30 $288.12 XR Chest 2 Views w/ Obliques 71046 $294.00 $294.00 $208.74 $294.00 $294.00 $208.74 $282.24 $276.36 $279.30 $288.12 XR Chest Decubitus 71047 $399.00 $399.00 $283.29 $399.00 $399.00 $283.29 $383.04 $375.06 $379.05 $391.02 XR Ribs 2 Views Left 71100 $295.00 $295.00 $209.45 $295.00 $295.00 $209.45 $283.20 $277.30 $280.25 $289.10 XR Ribs 2 Views Right 71100 $295.00 $295.00 $209.45 $295.00 $295.00 $209.45 $283.20 $277.30 $280.25 $289.10 XR Ribs 3 Views Left 71101 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 XR Ribs 3 Views Right 71101 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 XR Ribs 3 Views Bilateral 71110 $427.00 $427.00 $303.17 $427.00 $427.00 $303.17 $409.92 $401.38 $405.65 $418.46 XR Sternum Minimum 2 Views 71120 $259.00 $259.00 $183.89 $259.00 $259.00 $183.89 $248.64 $243.46 $246.05 $253.82 XR Sternoclavicular Joint(s) 71130 $218.00 $218.00 $154.78 $218.00 $218.00 $154.78 $209.28 $204.92 $207.10 $213.64 CT Chest W/O Contrast 71250 "$2,035.00 " "$2,035.00 " "$1,444.85 " "$2,035.00 " "$2,035.00 " "$1,444.85 " "$1,953.60 " "$1,912.90 " "$1,933.25 " "$1,994.30 " CT Low Dose Lung Screening 71250 "$2,035.00 " "$2,035.00 " "$1,444.85 " "$2,035.00 " "$2,035.00 " "$1,444.85 " "$1,953.60 " "$1,912.90 " "$1,933.25 " "$1,994.30 " THAY CT Chest w/o Contrast 71250 "$2,035.00 " "$2,035.00 " "$1,444.85 " "$2,035.00 " "$2,035.00 " "$1,444.85 " "$1,953.60 " "$1,912.90 " "$1,933.25 " "$1,994.30 " CT Chest W/Contrast 71260 "$2,295.00 " "$2,295.00 " "$1,629.45 " "$2,295.00 " "$2,295.00 " "$1,629.45 " "$2,203.20 " "$2,157.30 " "$2,180.25 " "$2,249.10 " THAY CT Chest w/ Contrast 71260 "$2,295.00 " "$2,295.00 " "$1,629.45 " "$2,295.00 " "$2,295.00 " "$1,629.45 " "$2,203.20 " "$2,157.30 " "$2,180.25 " "$2,249.10 " CT Chest W/WO Contrast 71270 "$2,615.00 " "$2,615.00 " "$1,856.65 " "$2,615.00 " "$2,615.00 " "$1,856.65 " "$2,510.40 " "$2,458.10 " "$2,484.25 " "$2,562.70 " THAY CT Chest w/ + w/o Contrast 71270 "$2,615.00 " "$2,615.00 " "$1,856.65 " "$2,615.00 " "$2,615.00 " "$1,856.65 " "$2,510.40 " "$2,458.10 " "$2,484.25 " "$2,562.70 " CT Angiography Chest W/WO Contrast 71275 "$3,023.00 " "$3,023.00 " "$2,146.33 " "$3,023.00 " "$3,023.00 " "$2,146.33 " "$2,902.08 " "$2,841.62 " "$2,871.85 " "$2,962.54 " MRI Chest w/o Contrast 71550 "$3,454.00 " "$3,454.00 " "$2,452.34 " "$3,454.00 " "$3,454.00 " "$2,452.34 " "$3,315.84 " "$3,246.76 " "$3,281.30 " "$3,384.92 " MRI Chest w/ + w/o Contrast 71552 "$3,885.00 " "$3,885.00 " "$2,758.35 " "$3,885.00 " "$3,885.00 " "$2,758.35 " "$3,729.60 " "$3,651.90 " "$3,690.75 " "$3,807.30 " MRA Chest w/ + w/o Contrast 71555 "$3,119.00 " "$3,119.00 " "$2,214.49 " "$3,119.00 " "$3,119.00 " "$2,214.49 " "$2,994.24 " "$2,931.86 " "$2,963.05 " "$3,056.62 " XR Spine Any Level Single View 72020 $224.00 $224.00 $159.04 $224.00 $224.00 $159.04 $215.04 $210.56 $212.80 $219.52 XR Spine Cervical 2 or 3 Views 72040 $296.00 $296.00 $210.16 $296.00 $296.00 $210.16 $284.16 $278.24 $281.20 $290.08 XR Spine Cervical 4 or 5 Views 72050 $460.00 $460.00 $326.60 $460.00 $460.00 $326.60 $441.60 $432.40 $437.00 $450.80 XR Spine Cervical Comp w/ Flex/Ext 72052 $644.00 $644.00 $457.24 $644.00 $644.00 $457.24 $618.24 $605.36 $611.80 $631.12 XR Spine Thoracic 2 Views 72070 $319.00 $319.00 $226.49 $319.00 $319.00 $226.49 $306.24 $299.86 $303.05 $312.62 XR Spine Thoracic 3 Views 72072 $422.00 $422.00 $299.62 $422.00 $422.00 $299.62 $405.12 $396.68 $400.90 $413.56 XR Spine Thoracolumbar 2 Views 72080 $301.00 $301.00 $213.71 $301.00 $301.00 $213.71 $288.96 $282.94 $285.95 $294.98 XR Spine Entire 1 View 72081 $227.00 $227.00 $161.17 $227.00 $227.00 $161.17 $217.92 $213.38 $215.65 $222.46 XR Spine Entire 2-3 Views 72082 $416.00 $416.00 $295.36 $416.00 $416.00 $295.36 $399.36 $391.04 $395.20 $407.68 XR Spine Entire 4-5 Views 72083 $400.00 $400.00 $284.00 $400.00 $400.00 $284.00 $384.00 $376.00 $380.00 $392.00 XR Spine Entire Min 6 Views 72084 "$1,023.00 " "$1,023.00 " $726.33 "$1,023.00 " "$1,023.00 " $726.33 $982.08 $961.62 $971.85 "$1,002.54 " XR Spine Lumbosacral 2 or 3 Views 72100 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 XR Spine Lumbosacral Minimum 4 Views 72110 $450.00 $450.00 $319.50 $450.00 $450.00 $319.50 $432.00 $423.00 $427.50 $441.00 XR Spine Lumbosacral Complete w/ Bending 72114 $663.00 $663.00 $470.73 $663.00 $663.00 $470.73 $636.48 $623.22 $629.85 $649.74 CT Spine Cervical w/o Contrast 72125 "$2,163.00 " "$2,163.00 " "$1,535.73 " "$2,163.00 " "$2,163.00 " "$1,535.73 " "$2,076.48 " "$2,033.22 " "$2,054.85 " "$2,119.74 " CT Spine Cervical w/ Contrast 72126 "$2,378.00 " "$2,378.00 " "$1,688.38 " "$2,378.00 " "$2,378.00 " "$1,688.38 " "$2,282.88 " "$2,235.32 " "$2,259.10 " "$2,330.44 " CT Spine Cervical w/ + w/o Contrast 72127 "$2,534.00 " "$2,534.00 " "$1,799.14 " "$2,534.00 " "$2,534.00 " "$1,799.14 " "$2,432.64 " "$2,381.96 " "$2,407.30 " "$2,483.32 " CT Spine Thoracic w/o Contrast 72128 "$2,012.00 " "$2,012.00 " "$1,428.52 " "$2,012.00 " "$2,012.00 " "$1,428.52 " "$1,931.52 " "$1,891.28 " "$1,911.40 " "$1,971.76 " CT Spine Thoracic w/ Contrast 72129 "$2,435.00 " "$2,435.00 " "$1,728.85 " "$2,435.00 " "$2,435.00 " "$1,728.85 " "$2,337.60 " "$2,288.90 " "$2,313.25 " "$2,386.30 " CT Spine Thoracic w/ + w/o Contrast 72130 "$2,445.00 " "$2,445.00 " "$1,735.95 " "$2,445.00 " "$2,445.00 " "$1,735.95 " "$2,347.20 " "$2,298.30 " "$2,322.75 " "$2,396.10 " CT Spine Lumbar w/o Contrast 72131 "$2,047.00 " "$2,047.00 " "$1,453.37 " "$2,047.00 " "$2,047.00 " "$1,453.37 " "$1,965.12 " "$1,924.18 " "$1,944.65 " "$2,006.06 " CT Spine Lumbar w/ Contrast 72132 "$2,220.00 " "$2,220.00 " "$1,576.20 " "$2,220.00 " "$2,220.00 " "$1,576.20 " "$2,131.20 " "$2,086.80 " "$2,109.00 " "$2,175.60 " MRI Spine Cervical w/o Contrast 72141 "$3,068.00 " "$3,068.00 " "$2,178.28 " "$3,068.00 " "$3,068.00 " "$2,178.28 " "$2,945.28 " "$2,883.92 " "$2,914.60 " "$3,006.64 " MRI Spine Cervical w/ Contrast 72142 "$2,166.00 " "$2,166.00 " "$1,537.86 " "$2,166.00 " "$2,166.00 " "$1,537.86 " "$2,079.36 " "$2,036.04 " "$2,057.70 " "$2,122.68 " MRI Spine Thoracic w/o Contrast 72146 "$3,066.00 " "$3,066.00 " "$2,176.86 " "$3,066.00 " "$3,066.00 " "$2,176.86 " "$2,943.36 " "$2,882.04 " "$2,912.70 " "$3,004.68 " MRI Spine Thoracic w/ Contrast 72147 "$1,902.00 " "$1,902.00 " "$1,350.42 " "$1,902.00 " "$1,902.00 " "$1,350.42 " "$1,825.92 " "$1,787.88 " "$1,806.90 " "$1,863.96 " MRI Spine Lumbar w/o Contrast 72148 "$3,028.00 " "$3,028.00 " "$2,149.88 " "$3,028.00 " "$3,028.00 " "$2,149.88 " "$2,906.88 " "$2,846.32 " "$2,876.60 " "$2,967.44 " MRI Spine Lumbar w/ Contrast 72149 "$3,118.00 " "$3,118.00 " "$2,213.78 " "$3,118.00 " "$3,118.00 " "$2,213.78 " "$2,993.28 " "$2,930.92 " "$2,962.10 " "$3,055.64 " MRI Spine Cervical w/ + w/o Contrast 72156 "$4,028.00 " "$4,028.00 " "$2,859.88 " "$4,028.00 " "$4,028.00 " "$2,859.88 " "$3,866.88 " "$3,786.32 " "$3,826.60 " "$3,947.44 " MRI Spine Thoracic w/ + w/o Contrast 72157 "$3,919.00 " "$3,919.00 " "$2,782.49 " "$3,919.00 " "$3,919.00 " "$2,782.49 " "$3,762.24 " "$3,683.86 " "$3,723.05 " "$3,840.62 " MRI Spine Lumbar w/ + w/o Contrast 72158 "$3,669.00 " "$3,669.00 " "$2,604.99 " "$3,669.00 " "$3,669.00 " "$2,604.99 " "$3,522.24 " "$3,448.86 " "$3,485.55 " "$3,595.62 " MRA Spinal Canal 72159 "$2,922.00 " "$2,922.00 " "$2,074.62 " "$2,922.00 " "$2,922.00 " "$2,074.62 " "$2,805.12 " "$2,746.68 " "$2,775.90 " "$2,863.56 " XR Pelvis 1 View 72170 $265.00 $265.00 $188.15 $265.00 $265.00 $188.15 $254.40 $249.10 $251.75 $259.70 CT Angiography Pelvis w/ + w/o Contrast 72191 "$3,425.00 " "$3,425.00 " "$2,431.75 " "$3,425.00 " "$3,425.00 " "$2,431.75 " "$3,288.00 " "$3,219.50 " "$3,253.75 " "$3,356.50 " CT Pelvis w/o Contrast 72192 "$1,999.00 " "$1,999.00 " "$1,419.29 " "$1,999.00 " "$1,999.00 " "$1,419.29 " "$1,919.04 " "$1,879.06 " "$1,899.05 " "$1,959.02 " CT Pelvis w/ Contrast 72193 "$2,353.00 " "$2,353.00 " "$1,670.63 " "$2,353.00 " "$2,353.00 " "$1,670.63 " "$2,258.88 " "$2,211.82 " "$2,235.35 " "$2,305.94 " CT Pelvis w/ + w/o Contrast 72194 "$2,581.00 " "$2,581.00 " "$1,832.51 " "$2,581.00 " "$2,581.00 " "$1,832.51 " "$2,477.76 " "$2,426.14 " "$2,451.95 " "$2,529.38 " MRI Pelvis w/o Contrast 72195 "$2,706.00 " "$2,706.00 " "$1,921.26 " "$2,706.00 " "$2,706.00 " "$1,921.26 " "$2,597.76 " "$2,543.64 " "$2,570.70 " "$2,651.88 " MRI Pelvis w/ Contrast 72196 "$3,196.00 " "$3,196.00 " "$2,269.16 " "$3,196.00 " "$3,196.00 " "$2,269.16 " "$3,068.16 " "$3,004.24 " "$3,036.20 " "$3,132.08 " MRI Pelvis w/ + w/o Contrast 72197 "$3,362.00 " "$3,362.00 " "$2,387.02 " "$3,362.00 " "$3,362.00 " "$2,387.02 " "$3,227.52 " "$3,160.28 " "$3,193.90 " "$3,294.76 " MRA Pelvis w/ + w/o Contrast 72198 "$2,807.00 " "$2,807.00 " "$1,992.97 " "$2,807.00 " "$2,807.00 " "$1,992.97 " "$2,694.72 " "$2,638.58 " "$2,666.65 " "$2,750.86 " XR Sacroiliac Joints 1 or 2 Views 72200 $321.00 $321.00 $227.91 $321.00 $321.00 $227.91 $308.16 $301.74 $304.95 $314.58 XR Sacroiliac Joints 72202 $316.00 $316.00 $224.36 $316.00 $316.00 $224.36 $303.36 $297.04 $300.20 $309.68 XR Sacrum/Coccyx Minimum 2 Views 72220 $281.00 $281.00 $199.51 $281.00 $281.00 $199.51 $269.76 $264.14 $266.95 $275.38 XR Clavicle Left 73000 $263.00 $263.00 $186.73 $263.00 $263.00 $186.73 $252.48 $247.22 $249.85 $257.74 XR Clavicle Right 73000 $263.00 $263.00 $186.73 $263.00 $263.00 $186.73 $252.48 $247.22 $249.85 $257.74 XR Scapula Left 73010 $340.00 $340.00 $241.40 $340.00 $340.00 $241.40 $326.40 $319.60 $323.00 $333.20 XR Scapula Right 73010 $340.00 $340.00 $241.40 $340.00 $340.00 $241.40 $326.40 $319.60 $323.00 $333.20 XR Shoulder 1 View Left 73020 $212.00 $212.00 $150.52 $212.00 $212.00 $150.52 $203.52 $199.28 $201.40 $207.76 XR Shoulder 1 View Right 73020 $212.00 $212.00 $150.52 $212.00 $212.00 $150.52 $203.52 $199.28 $201.40 $207.76 XR Shoulder 2 Views Left 73030 $311.00 $311.00 $220.81 $311.00 $311.00 $220.81 $298.56 $292.34 $295.45 $304.78 XR Shoulder 2 Views Right 73030 $311.00 $311.00 $220.81 $311.00 $311.00 $220.81 $298.56 $292.34 $295.45 $304.78 XR Arthrogram Shoulder Left 73040 $800.00 $800.00 $568.00 $800.00 $800.00 $568.00 $768.00 $752.00 $760.00 $784.00 XR Arthrogram Shoulder Right 73040 $800.00 $800.00 $568.00 $800.00 $800.00 $568.00 $768.00 $752.00 $760.00 $784.00 XR AC Joints w/ or w/o weights Bilateral 73050 $274.00 $274.00 $194.54 $274.00 $274.00 $194.54 $263.04 $257.56 $260.30 $268.52 XR Humerus Left 73060 $273.00 $273.00 $193.83 $273.00 $273.00 $193.83 $262.08 $256.62 $259.35 $267.54 XR Humerus Right 73060 $273.00 $273.00 $193.83 $273.00 $273.00 $193.83 $262.08 $256.62 $259.35 $267.54 XR Elbow 2 Views Left 73070 $241.00 $241.00 $171.11 $241.00 $241.00 $171.11 $231.36 $226.54 $228.95 $236.18 XR Elbow 2 Views Right 73070 $241.00 $241.00 $171.11 $241.00 $241.00 $171.11 $231.36 $226.54 $228.95 $236.18 XR Elbow Complete Left 73080 $286.00 $286.00 $203.06 $286.00 $286.00 $203.06 $274.56 $268.84 $271.70 $280.28 XR Elbow Complete Right 73080 $286.00 $286.00 $203.06 $286.00 $286.00 $203.06 $274.56 $268.84 $271.70 $280.28 XR Forearm 2 Views Left 73090 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 XR Forearm 2 Views Right 73090 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 XR Upper Ext Infant 1 View Left 73092 $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 XR Upper Ext Infant 1 View Right 73092 $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 XR Wrist 2 Views Left 73100 $219.00 $219.00 $155.49 $219.00 $219.00 $155.49 $210.24 $205.86 $208.05 $214.62 XR Wrist 2 Views Right 73100 $219.00 $219.00 $155.49 $219.00 $219.00 $155.49 $210.24 $205.86 $208.05 $214.62 XR Wrist Complete Left 73110 $265.00 $265.00 $188.15 $265.00 $265.00 $188.15 $254.40 $249.10 $251.75 $259.70 XR Wrist Complete Right 73110 $265.00 $265.00 $188.15 $265.00 $265.00 $188.15 $254.40 $249.10 $251.75 $259.70 XR Hand 2 Views Left 73120 $217.00 $217.00 $154.07 $217.00 $217.00 $154.07 $208.32 $203.98 $206.15 $212.66 XR Hand 2 Views Right 73120 $217.00 $217.00 $154.07 $217.00 $217.00 $154.07 $208.32 $203.98 $206.15 $212.66 XR Hand Complete Left 73130 $283.00 $283.00 $200.93 $283.00 $283.00 $200.93 $271.68 $266.02 $268.85 $277.34 XR Hand Complete Right 73130 $283.00 $283.00 $200.93 $283.00 $283.00 $200.93 $271.68 $266.02 $268.85 $277.34 XR Finger 2nd Digit Left 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger 2nd Digit Right 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger 3rd Digit Left 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger 3rd Digit Right 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger 4th Digit Left 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger 4th Digit Right 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger 5th Digit Left 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger 5th Digit Right 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger Thumb Left 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 XR Finger Thumb Right 73140 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 CT Upper Extremity w/o Contrast Left 73200 "$1,821.00 " "$1,821.00 " "$1,292.91 " "$1,821.00 " "$1,821.00 " "$1,292.91 " "$1,748.16 " "$1,711.74 " "$1,729.95 " "$1,784.58 " CT Upper Extremity w/o Contrast Right 73200 "$1,821.00 " "$1,821.00 " "$1,292.91 " "$1,821.00 " "$1,821.00 " "$1,292.91 " "$1,748.16 " "$1,711.74 " "$1,729.95 " "$1,784.58 " CT Upper Extremity w/ Contrast Left 73201 "$2,168.00 " "$2,168.00 " "$1,539.28 " "$2,168.00 " "$2,168.00 " "$1,539.28 " "$2,081.28 " "$2,037.92 " "$2,059.60 " "$2,124.64 " CT Upper Extremity w/ Contrast Right 73201 "$2,168.00 " "$2,168.00 " "$1,539.28 " "$2,168.00 " "$2,168.00 " "$1,539.28 " "$2,081.28 " "$2,037.92 " "$2,059.60 " "$2,124.64 " CT Upper Extremity w/+w/o Contrast Left 73202 "$2,761.00 " "$2,761.00 " "$1,960.31 " "$2,761.00 " "$2,761.00 " "$1,960.31 " "$2,650.56 " "$2,595.34 " "$2,622.95 " "$2,705.78 " CT Upper Extremity w/+w/o Contrast Right 73202 "$2,761.00 " "$2,761.00 " "$1,960.31 " "$2,761.00 " "$2,761.00 " "$1,960.31 " "$2,650.56 " "$2,595.34 " "$2,622.95 " "$2,705.78 " MRI UE Non Joint w/o Contrast Left 73218 "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,240.64 " "$2,193.96 " "$2,217.30 " "$2,287.32 " MRI UE Non Joint w/o Contrast Right 73218 "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,240.64 " "$2,193.96 " "$2,217.30 " "$2,287.32 " MRI UE Non Joint w/ Contrast Left 73219 "$2,861.00 " "$2,861.00 " "$2,031.31 " "$2,861.00 " "$2,861.00 " "$2,031.31 " "$2,746.56 " "$2,689.34 " "$2,717.95 " "$2,803.78 " MRI UE Non Joint w/ Contrast Right 73219 "$2,861.00 " "$2,861.00 " "$2,031.31 " "$2,861.00 " "$2,861.00 " "$2,031.31 " "$2,746.56 " "$2,689.34 " "$2,717.95 " "$2,803.78 " MRI UE Non Joint w/ + w/o Contrast Left 73220 "$2,959.00 " "$2,959.00 " "$2,100.89 " "$2,959.00 " "$2,959.00 " "$2,100.89 " "$2,840.64 " "$2,781.46 " "$2,811.05 " "$2,899.82 " MRI UE Non Joint w/ + w/o Contrast Right 73220 "$2,959.00 " "$2,959.00 " "$2,100.89 " "$2,959.00 " "$2,959.00 " "$2,100.89 " "$2,840.64 " "$2,781.46 " "$2,811.05 " "$2,899.82 " MRI UE Joint w/o Contrast Left 73221 "$2,297.00 " "$2,297.00 " "$1,630.87 " "$2,297.00 " "$2,297.00 " "$1,630.87 " "$2,205.12 " "$2,159.18 " "$2,182.15 " "$2,251.06 " MRI UE Joint w/o Contrast Right 73221 "$2,297.00 " "$2,297.00 " "$1,630.87 " "$2,297.00 " "$2,297.00 " "$1,630.87 " "$2,205.12 " "$2,159.18 " "$2,182.15 " "$2,251.06 " MRI UE Joint w/ + w/o Contrast Left 73223 "$3,346.00 " "$3,346.00 " "$2,375.66 " "$3,346.00 " "$3,346.00 " "$2,375.66 " "$3,212.16 " "$3,145.24 " "$3,178.70 " "$3,279.08 " MRI UE Joint w/ + w/o Contrast Right 73223 "$3,346.00 " "$3,346.00 " "$2,375.66 " "$3,346.00 " "$3,346.00 " "$2,375.66 " "$3,212.16 " "$3,145.24 " "$3,178.70 " "$3,279.08 " MRA Upper Extremity Left 73225 "$2,435.00 " "$2,435.00 " "$1,728.85 " "$2,435.00 " "$2,435.00 " "$1,728.85 " "$2,337.60 " "$2,288.90 " "$2,313.25 " "$2,386.30 " MRA Upper Extremity Right 73225 "$2,435.00 " "$2,435.00 " "$1,728.85 " "$2,435.00 " "$2,435.00 " "$1,728.85 " "$2,337.60 " "$2,288.90 " "$2,313.25 " "$2,386.30 " XR Hip 1 View Left 73501 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 XR Hip 1 View Right 73501 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 XR Hip 2-3 Views Lt w/ Pelvis 73502 $300.00 $300.00 $213.00 $300.00 $300.00 $213.00 $288.00 $282.00 $285.00 $294.00 XR Hip 2-3 Views Rt w/ Pelvis 73502 $300.00 $300.00 $213.00 $300.00 $300.00 $213.00 $288.00 $282.00 $285.00 $294.00 XR Hip Min 4 Views Lt w/ Pelvis 73503 $267.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 XR Hip Min 4 Views Rt w/ Pelvis 73503 $267.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 XR Hips Bil w/ Pelvis 2 Views 73521 $411.00 $411.00 $291.81 $411.00 $411.00 $291.81 $394.56 $386.34 $390.45 $402.78 XR Hips Bil w/ Pelvis 3-4 Views 73522 $499.00 $499.00 $354.29 $499.00 $499.00 $354.29 $479.04 $469.06 $474.05 $489.02 XR Hips Bil w/ Pelvis Min 5 Views 73523 $582.00 $582.00 $413.22 $582.00 $582.00 $413.22 $558.72 $547.08 $552.90 $570.36 XR Femur 1 View Left 73551 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 XR Femur 1 View Right 73551 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 XR Femur 2 Views Left 73552 $295.00 $295.00 $209.45 $295.00 $295.00 $209.45 $283.20 $277.30 $280.25 $289.10 XR Femur 2 Views Right 73552 $295.00 $295.00 $209.45 $295.00 $295.00 $209.45 $283.20 $277.30 $280.25 $289.10 XR Knee One or Two Views Left 73560 $274.00 $274.00 $194.54 $274.00 $274.00 $194.54 $263.04 $257.56 $260.30 $268.52 XR Knee One or Two Views Right 73560 $274.00 $274.00 $194.54 $274.00 $274.00 $194.54 $263.04 $257.56 $260.30 $268.52 XR Knee 3 Views Left 73562 $325.00 $325.00 $230.75 $325.00 $325.00 $230.75 $312.00 $305.50 $308.75 $318.50 XR Knee 3 Views Right 73562 $325.00 $325.00 $230.75 $325.00 $325.00 $230.75 $312.00 $305.50 $308.75 $318.50 XR Knee Complete Left 73564 $320.00 $320.00 $227.20 $320.00 $320.00 $227.20 $307.20 $300.80 $304.00 $313.60 XR Knee Complete Right 73564 $320.00 $320.00 $227.20 $320.00 $320.00 $227.20 $307.20 $300.80 $304.00 $313.60 XR Knee Standing AP Bilateral 73565 $261.00 $261.00 $185.31 $261.00 $261.00 $185.31 $250.56 $245.34 $247.95 $255.78 XR Tibia/Fibula 2 Views Left 73590 $271.00 $271.00 $192.41 $271.00 $271.00 $192.41 $260.16 $254.74 $257.45 $265.58 XR Tibia/Fibula 2 Views Right 73590 $271.00 $271.00 $192.41 $271.00 $271.00 $192.41 $260.16 $254.74 $257.45 $265.58 XR Lower Extremity Infant Left 73592 $199.00 $199.00 $141.29 $199.00 $199.00 $141.29 $191.04 $187.06 $189.05 $195.02 XR Lower Extremity Infant Right 73592 $199.00 $199.00 $141.29 $199.00 $199.00 $141.29 $191.04 $187.06 $189.05 $195.02 XR Ankle 2 Views Left 73600 $225.00 $225.00 $159.75 $225.00 $225.00 $159.75 $216.00 $211.50 $213.75 $220.50 XR Ankle 2 Views Right 73600 $225.00 $225.00 $159.75 $225.00 $225.00 $159.75 $216.00 $211.50 $213.75 $220.50 XR Ankle Complete Left 73610 $284.00 $284.00 $201.64 $284.00 $284.00 $201.64 $272.64 $266.96 $269.80 $278.32 XR Ankle Complete Right 73610 $284.00 $284.00 $201.64 $284.00 $284.00 $201.64 $272.64 $266.96 $269.80 $278.32 XR Foot 2 Views Left 73620 $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 XR Foot 2 Views Right 73620 $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 XR Foot Complete Left 73630 $296.00 $296.00 $210.16 $296.00 $296.00 $210.16 $284.16 $278.24 $281.20 $290.08 XR Foot Complete Right 73630 $296.00 $296.00 $210.16 $296.00 $296.00 $210.16 $284.16 $278.24 $281.20 $290.08 XR Os Calc Heel Left 73650 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 XR Os Calc Heel Right 73650 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 XR Toes 2nd Digit Left 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes 2nd Digit Right 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes 3rd Digit Left 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes 3rd Digit Right 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes 4th Digit Left 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes 4th Digit Right 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes 5th Digit Left 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes 5th Digit Right 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes Great Left 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 XR Toes Great Right 73660 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 CT Lower Extremity w/o Contrast Left 73700 "$1,963.00 " "$1,963.00 " "$1,393.73 " "$1,963.00 " "$1,963.00 " "$1,393.73 " "$1,884.48 " "$1,845.22 " "$1,864.85 " "$1,923.74 " CT Lower Extremity w/o Contrast Right 73700 "$1,963.00 " "$1,963.00 " "$1,393.73 " "$1,963.00 " "$1,963.00 " "$1,393.73 " "$1,884.48 " "$1,845.22 " "$1,864.85 " "$1,923.74 " CT Lower Extremity w/ Contrast Left 73701 "$2,105.00 " "$2,105.00 " "$1,494.55 " "$2,105.00 " "$2,105.00 " "$1,494.55 " "$2,020.80 " "$1,978.70 " "$1,999.75 " "$2,062.90 " CT Lower Extremity w/ Contrast Right 73701 "$2,105.00 " "$2,105.00 " "$1,494.55 " "$2,105.00 " "$2,105.00 " "$1,494.55 " "$2,020.80 " "$1,978.70 " "$1,999.75 " "$2,062.90 " CT Lower Extremity w/+w/o Contrast Left 73702 "$2,668.00 " "$2,668.00 " "$1,894.28 " "$2,668.00 " "$2,668.00 " "$1,894.28 " "$2,561.28 " "$2,507.92 " "$2,534.60 " "$2,614.64 " CT Lower Extremity w/+w/o Contrast Right 73702 "$2,668.00 " "$2,668.00 " "$1,894.28 " "$2,668.00 " "$2,668.00 " "$1,894.28 " "$2,561.28 " "$2,507.92 " "$2,534.60 " "$2,614.64 " MRI LE Non Joint w/o Contrast Left 73718 "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,240.64 " "$2,193.96 " "$2,217.30 " "$2,287.32 " MRI LE Non Joint w/o Contrast Right 73718 "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,334.00 " "$2,334.00 " "$1,657.14 " "$2,240.64 " "$2,193.96 " "$2,217.30 " "$2,287.32 " MRI LE Non Joint w/ + w/o Contrast Left 73720 "$2,859.00 " "$2,859.00 " "$2,029.89 " "$2,859.00 " "$2,859.00 " "$2,029.89 " "$2,744.64 " "$2,687.46 " "$2,716.05 " "$2,801.82 " MRI LE Non Joint w/ + w/o Contrast Right 73720 "$2,859.00 " "$2,859.00 " "$2,029.89 " "$2,859.00 " "$2,859.00 " "$2,029.89 " "$2,744.64 " "$2,687.46 " "$2,716.05 " "$2,801.82 " MRI LE Joint w/o Contrast Left 73721 "$2,320.00 " "$2,320.00 " "$1,647.20 " "$2,320.00 " "$2,320.00 " "$1,647.20 " "$2,227.20 " "$2,180.80 " "$2,204.00 " "$2,273.60 " MRI LE Joint w/o Contrast Right 73721 "$2,320.00 " "$2,320.00 " "$1,647.20 " "$2,320.00 " "$2,320.00 " "$1,647.20 " "$2,227.20 " "$2,180.80 " "$2,204.00 " "$2,273.60 " MRI LE Joint w/ Contrast Left 73722 "$3,458.00 " "$3,458.00 " "$2,455.18 " "$3,458.00 " "$3,458.00 " "$2,455.18 " "$3,319.68 " "$3,250.52 " "$3,285.10 " "$3,388.84 " MRI LE Joint w/ Contrast Right 73722 "$3,458.00 " "$3,458.00 " "$2,455.18 " "$3,458.00 " "$3,458.00 " "$2,455.18 " "$3,319.68 " "$3,250.52 " "$3,285.10 " "$3,388.84 " MRI LE Joint w/ + w/o Contrast Left 73723 "$3,208.00 " "$3,208.00 " "$2,277.68 " "$3,208.00 " "$3,208.00 " "$2,277.68 " "$3,079.68 " "$3,015.52 " "$3,047.60 " "$3,143.84 " MRI LE Joint w/ + w/o Contrast Right 73723 "$3,208.00 " "$3,208.00 " "$2,277.68 " "$3,208.00 " "$3,208.00 " "$2,277.68 " "$3,079.68 " "$3,015.52 " "$3,047.60 " "$3,143.84 " MRA Lower Extremity Left 73725 "$2,659.00 " "$2,659.00 " "$1,887.89 " "$2,659.00 " "$2,659.00 " "$1,887.89 " "$2,552.64 " "$2,499.46 " "$2,526.05 " "$2,605.82 " MRA Lower Extremity Right 73725 "$2,659.00 " "$2,659.00 " "$1,887.89 " "$2,659.00 " "$2,659.00 " "$1,887.89 " "$2,552.64 " "$2,499.46 " "$2,526.05 " "$2,605.82 " XR Abdomen 1 View 74018 $262.00 $262.00 $186.02 $262.00 $262.00 $186.02 $251.52 $246.28 $248.90 $256.76 XR Abdomen 2 View 74019 $342.00 $342.00 $242.82 $342.00 $342.00 $242.82 $328.32 $321.48 $324.90 $335.16 XR Abdomen Series w/ Chest1 View 74022 $483.00 $483.00 $342.93 $483.00 $483.00 $342.93 $463.68 $454.02 $458.85 $473.34 CT Abdomen w/o Contrast 74150 "$2,064.00 " "$2,064.00 " "$1,465.44 " "$2,064.00 " "$2,064.00 " "$1,465.44 " "$1,981.44 " "$1,940.16 " "$1,960.80 " "$2,022.72 " CT Abdomen w/ Contrast 74160 "$2,402.00 " "$2,402.00 " "$1,705.42 " "$2,402.00 " "$2,402.00 " "$1,705.42 " "$2,305.92 " "$2,257.88 " "$2,281.90 " "$2,353.96 " CT Abdomen w/ + w/o Contrast 74170 "$2,727.00 " "$2,727.00 " "$1,936.17 " "$2,727.00 " "$2,727.00 " "$1,936.17 " "$2,617.92 " "$2,563.38 " "$2,590.65 " "$2,672.46 " CT Angiography Abdomen/Pelvis w/ + w/o C 74174 "$4,964.00 " "$4,964.00 " "$3,524.44 " "$4,964.00 " "$4,964.00 " "$3,524.44 " "$4,765.44 " "$4,666.16 " "$4,715.80 " "$4,864.72 " CT Angiography Abdomen w/ + w/o Contrast 74175 "$3,016.00 " "$3,016.00 " "$2,141.36 " "$3,016.00 " "$3,016.00 " "$2,141.36 " "$2,895.36 " "$2,835.04 " "$2,865.20 " "$2,955.68 " CT Abdomen/Pelvis w/o Contrast 74176 "$3,518.00 " "$3,518.00 " "$2,497.78 " "$3,518.00 " "$3,518.00 " "$2,497.78 " "$3,377.28 " "$3,306.92 " "$3,342.10 " "$3,447.64 " THAY CT Abd/Pelv w/o Cont 74176 "$3,518.00 " "$3,518.00 " "$2,497.78 " "$3,518.00 " "$3,518.00 " "$2,497.78 " "$3,377.28 " "$3,306.92 " "$3,342.10 " "$3,447.64 " CT Abdomen/Pelvis w/ Contrast 74177 "$4,184.00 " "$4,184.00 " "$2,970.64 " "$4,184.00 " "$4,184.00 " "$2,970.64 " "$4,016.64 " "$3,932.96 " "$3,974.80 " "$4,100.32 " THAY CT Abd/Pelv w/ Cont 74177 "$4,184.00 " "$4,184.00 " "$2,970.64 " "$4,184.00 " "$4,184.00 " "$2,970.64 " "$4,016.64 " "$3,932.96 " "$3,974.80 " "$4,100.32 " CT Abdomen/Pelvis w + w/o Contrast 74178 "$4,683.00 " "$4,683.00 " "$3,324.93 " "$4,683.00 " "$4,683.00 " "$3,324.93 " "$4,495.68 " "$4,402.02 " "$4,448.85 " "$4,589.34 " THAY CT Abd/Pelv w/ + w/o Cont 74178 "$4,683.00 " "$4,683.00 " "$3,324.93 " "$4,683.00 " "$4,683.00 " "$3,324.93 " "$4,495.68 " "$4,402.02 " "$4,448.85 " "$4,589.34 " MRI Abdomen w/o Contrast 74181 "$2,830.00 " "$2,830.00 " "$2,009.30 " "$2,830.00 " "$2,830.00 " "$2,009.30 " "$2,716.80 " "$2,660.20 " "$2,688.50 " "$2,773.40 " MRI Abdomen w/ + w/o Contrast 74183 "$3,892.00 " "$3,892.00 " "$2,763.32 " "$3,892.00 " "$3,892.00 " "$2,763.32 " "$3,736.32 " "$3,658.48 " "$3,697.40 " "$3,814.16 " MRA Abdomen w/ + w/o Contrast 74185 "$2,773.00 " "$2,773.00 " "$1,968.83 " "$2,773.00 " "$2,773.00 " "$1,968.83 " "$2,662.08 " "$2,606.62 " "$2,634.35 " "$2,717.54 " XR Fluoro Esophagus 74220 $591.00 $591.00 $419.61 $591.00 $591.00 $419.61 $567.36 $555.54 $561.45 $579.18 XR Esophagus w/ Air Contrast 74221 $547.00 $547.00 $388.37 $547.00 $547.00 $388.37 $525.12 $514.18 $519.65 $536.06 XR Fluoro Modified Esophagram 74230 $523.00 $523.00 $371.33 $523.00 $523.00 $371.33 $502.08 $491.62 $496.85 $512.54 XR Upper GI w/ Small Bowel 74240 $591.00 $591.00 $419.61 $591.00 $591.00 $419.61 $567.36 $555.54 $561.45 $579.18 XR Upper GI w/ Air w/ Small Bowel 74246 $773.00 $773.00 $548.83 $773.00 $773.00 $548.83 $742.08 $726.62 $734.35 $757.54 THAY XR Fluoro GI w/ Small Bowel add on 74248 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 XR Small Bowel Series 74250 $682.00 $682.00 $484.22 $682.00 $682.00 $484.22 $654.72 $641.08 $647.90 $668.36 XR Fluoro Barium Enema Single 74270 $738.00 $738.00 $523.98 $738.00 $738.00 $523.98 $708.48 $693.72 $701.10 $723.24 XR Barium Enema w/ Air Complete 74280 "$1,056.00 " "$1,056.00 " $749.76 "$1,056.00 " "$1,056.00 " $749.76 "$1,013.76 " $992.64 "$1,003.20 " "$1,034.88 " XR Cholecystography (GB) Oral Contrast 74290 $396.00 $396.00 $281.16 $396.00 $396.00 $281.16 $380.16 $372.24 $376.20 $388.08 XR Cholangiogram in OR 74300 $673.00 $673.00 $477.83 $673.00 $673.00 $477.83 $646.08 $632.62 $639.35 $659.54 XR IVP 74410 $822.00 $822.00 $583.62 $822.00 $822.00 $583.62 $789.12 $772.68 $780.90 $805.56 XR IVP w/ Tomos 74415 "$1,333.00 " "$1,333.00 " $946.43 "$1,333.00 " "$1,333.00 " $946.43 "$1,279.68 " "$1,253.02 " "$1,266.35 " "$1,306.34 " XR Cystogram Non Voiding 74430 "$1,029.00 " "$1,029.00 " $730.59 "$1,029.00 " "$1,029.00 " $730.59 $987.84 $967.26 $977.55 "$1,008.42 " XR Cystogram Voiding 74455 $776.00 $776.00 $550.96 $776.00 $776.00 $550.96 $744.96 $729.44 $737.20 $760.48 XR Hysterosalpingography 74740 "$1,026.00 " "$1,026.00 " $728.46 "$1,026.00 " "$1,026.00 " $728.46 $984.96 $964.44 $974.70 "$1,005.48 " MRI Cardiac Morphology w/o Contrast 75557 "$2,338.00 " "$2,338.00 " "$1,659.98 " "$2,338.00 " "$2,338.00 " "$1,659.98 " "$2,244.48 " "$2,197.72 " "$2,221.10 " "$2,291.24 " CT Cardiac Calcium Score 75571 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 CT Angiography Aorta w/ Runoff 75635 "$3,148.00 " "$3,148.00 " "$2,235.08 " "$3,148.00 " "$3,148.00 " "$2,235.08 " "$3,022.08 " "$2,959.12 " "$2,990.60 " "$3,085.04 " XR Venography SVC 75820 "$1,945.00 " "$1,945.00 " "$1,380.95 " "$1,945.00 " "$1,945.00 " "$1,380.95 " "$1,867.20 " "$1,828.30 " "$1,847.75 " "$1,906.10 " XR Fluoroscopy Up to 1 Hour 76000 $561.00 $561.00 $398.31 $561.00 $561.00 $398.31 $538.56 $527.34 $532.95 $549.78 XR Foreign Body Loc Nose/Rectum Child 76010 $332.00 $332.00 $235.72 $332.00 $332.00 $235.72 $318.72 $312.08 $315.40 $325.36 CT 3D Reconstruction 76377 $729.00 $729.00 $517.59 $729.00 $729.00 $517.59 $699.84 $685.26 $692.55 $714.42 THAY CT 3D Reconstruction 76377 $729.00 $729.00 $517.59 $729.00 $729.00 $517.59 $699.84 $685.26 $692.55 $714.42 CT Limited or Localized F/U Study 76380 $982.00 $982.00 $697.22 $982.00 $982.00 $697.22 $942.72 $923.08 $932.90 $962.36 US Thyroid 76536 $526.00 $526.00 $373.46 $526.00 $526.00 $373.46 $504.96 $494.44 $499.70 $515.48 US Chest 76604 $487.00 $487.00 $345.77 $487.00 $487.00 $345.77 $467.52 $457.78 $462.65 $477.26 US Breast Left Complete. 76641 $420.00 $420.00 $298.20 $420.00 $420.00 $298.20 $403.20 $394.80 $399.00 $411.60 US Breast Right Complete. 76641 $420.00 $420.00 $298.20 $420.00 $420.00 $298.20 $403.20 $394.80 $399.00 $411.60 US Breast Left Limited. 76642 $359.00 $359.00 $254.89 $359.00 $359.00 $254.89 $344.64 $337.46 $341.05 $351.82 US Breast Right Limited. 76642 $359.00 $359.00 $254.89 $359.00 $359.00 $254.89 $344.64 $337.46 $341.05 $351.82 US Abdomen Complete 76700 $778.00 $778.00 $552.38 $778.00 $778.00 $552.38 $746.88 $731.32 $739.10 $762.44 US Abdomen Limited 76705 $610.00 $610.00 $433.10 $610.00 $610.00 $433.10 $585.60 $573.40 $579.50 $597.80 US Retroperitoneal Complete 76770 $713.00 $713.00 $506.23 $713.00 $713.00 $506.23 $684.48 $670.22 $677.35 $698.74 US Retroperitoneal Limited 76775 $557.00 $557.00 $395.47 $557.00 $557.00 $395.47 $534.72 $523.58 $529.15 $545.86 US Pregnancy < 14 weeks 76801 $609.00 $609.00 $432.39 $609.00 $609.00 $432.39 $584.64 $572.46 $578.55 $596.82 US Pregnancy Multi Gest < 14 weeks 76802 $339.00 $339.00 $240.69 $339.00 $339.00 $240.69 $325.44 $318.66 $322.05 $332.22 US Pregnancy > 14 weeks 76805 $707.00 $707.00 $501.97 $707.00 $707.00 $501.97 $678.72 $664.58 $671.65 $692.86 US Pregnancy Multi Gest > 14 weeks 76810 $600.00 $600.00 $426.00 $600.00 $600.00 $426.00 $576.00 $564.00 $570.00 $588.00 US Pregnancy Limited 76815 $444.00 $444.00 $315.24 $444.00 $444.00 $315.24 $426.24 $417.36 $421.80 $435.12 US Pregnancy Follow Up 76816 $339.00 $339.00 $240.69 $339.00 $339.00 $240.69 $325.44 $318.66 $322.05 $332.22 US Pregnancy Transvaginal 76817 $539.00 $539.00 $382.69 $539.00 $539.00 $382.69 $517.44 $506.66 $512.05 $528.22 US Fetal Biophysical Profile 76819 $334.00 $334.00 $237.14 $334.00 $334.00 $237.14 $320.64 $313.96 $317.30 $327.32 THAY US Transvaginal 76830 $586.00 $586.00 $416.06 $586.00 $586.00 $416.06 $562.56 $550.84 $556.70 $574.28 US Transvaginal 76830 $586.00 $586.00 $416.06 $586.00 $586.00 $416.06 $562.56 $550.84 $556.70 $574.28 THAY US Pelvic Complete 76856 $710.00 $710.00 $504.10 $710.00 $710.00 $504.10 $681.60 $667.40 $674.50 $695.80 US Pelvic Complete 76856 $710.00 $710.00 $504.10 $710.00 $710.00 $504.10 $681.60 $667.40 $674.50 $695.80 US Pelvic Limited 76857 $386.00 $386.00 $274.06 $386.00 $386.00 $274.06 $370.56 $362.84 $366.70 $378.28 US Scrotum (Contents) 76870 $596.00 $596.00 $423.16 $596.00 $596.00 $423.16 $572.16 $560.24 $566.20 $584.08 US Extremity Non-Vasc Real-time Complete 76881 $526.00 $526.00 $373.46 $526.00 $526.00 $373.46 $504.96 $494.44 $499.70 $515.48 US Extremity Non-Vasc Real-time Limited 76882 $464.00 $464.00 $329.44 $464.00 $464.00 $329.44 $445.44 $436.16 $440.80 $454.72 US Guidance Needle Placement 76942 $691.00 $691.00 $490.61 $691.00 $691.00 $490.61 $663.36 $649.54 $656.45 $677.18 XR Fluoro Guidance for CVA Placement 77001 $879.00 $879.00 $624.09 $879.00 $879.00 $624.09 $843.84 $826.26 $835.05 $861.42 XR Fluoro Guidance Needle Placement 77002 $351.00 $351.00 $249.21 $351.00 $351.00 $249.21 $336.96 $329.94 $333.45 $343.98 XR Fluoro Guidance Needle Loc Spine 77003 $794.00 $794.00 $563.74 $794.00 $794.00 $563.74 $762.24 $746.36 $754.30 $778.12 Digital breast tomosynthesis; unilateral 77061 $687.00 $687.00 $487.77 $687.00 $687.00 $487.77 $659.52 $645.78 $652.65 $673.26 Digital breast tomosynthesis; bilateral 77062 $869.00 $869.00 $616.99 $869.00 $869.00 $616.99 $834.24 $816.86 $825.55 $851.62 "Diagnostic digital breast tomosynthesis, unilateral or bilat" 77063 $287.00 $287.00 $203.77 $287.00 $287.00 $203.77 $275.52 $269.78 $272.65 $281.26 "Screening digital breast tomosynthesis, bilateral (List sepa" 77063 $287.00 $287.00 $203.77 $287.00 $287.00 $203.77 $275.52 $269.78 $272.65 $281.26 MA Mammo Diagnostic 3D Left. 77065 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 MA Mammo Diagnostic 3D Right. 77065 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 MA Mammogram Diagnostic Left. 77065 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 MA Mammogram Diagnostic Right. 77065 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 THAY MA Routine Screen Lt + Diag Rt 77065 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 THAY MA Routine Screen Rt + Diag Lt 77065 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 MA Mammo Diagnostic 3D Bilateral. 77066 $360.00 $360.00 $255.60 $360.00 $360.00 $255.60 $345.60 $338.40 $342.00 $352.80 MA Mammogram Diagnostic Bilateral. 77066 $360.00 $360.00 $255.60 $360.00 $360.00 $255.60 $345.60 $338.40 $342.00 $352.80 MA Mammo Screening 3D Bilateral. 77067 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 MA Mammo Screening 3D Left. 77067 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 MA Mammo Screening 3D Right. 77067 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 MA Mammo Screening Implants. 77067 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 MA Mammogram Routine Screening Bilat. 77067 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 MA Mammogram Routine Screening Left. 77067 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 MA Mammogram Routine Screening Right. 77067 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 XR Bone Age Studies 77072 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 XR Bone Survey Limited 77074 $627.00 $627.00 $445.17 $627.00 $627.00 $445.17 $601.92 $589.38 $595.65 $614.46 XR Bone Survey Complete 77075 $760.00 $760.00 $539.60 $760.00 $760.00 $539.60 $729.60 $714.40 $722.00 $744.80 XR Bone Survey Infant 77076 $534.00 $534.00 $379.14 $534.00 $534.00 $379.14 $512.64 $501.96 $507.30 $523.32 BD Bone Density DEXA Axial Skeleton 77080 $431.00 $431.00 $306.01 $431.00 $431.00 $306.01 $413.76 $405.14 $409.45 $422.38 77080 DEXA SCAN INTERP 77080 $82.00 $- $- $- $- $- $- $- $- BD Bone Density DEXA App Skeleton 77081 $333.00 $333.00 $236.43 $333.00 $333.00 $236.43 $319.68 $313.02 $316.35 $326.34 NM Parathyroid Study 78070 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " NM Liver Imaging Static 78215 "$1,500.00 " "$1,500.00 " "$1,065.00 " "$1,500.00 " "$1,500.00 " "$1,065.00 " "$1,440.00 " "$1,410.00 " "$1,425.00 " "$1,470.00 " NM HIDA Scan w/o CCK 78226 "$1,524.00 " "$1,524.00 " "$1,082.04 " "$1,524.00 " "$1,524.00 " "$1,082.04 " "$1,463.04 " "$1,432.56 " "$1,447.80 " "$1,493.52 " NM Hepatobiliary Duct System Imaging 78227 "$1,740.00 " "$1,740.00 " "$1,235.40 " "$1,740.00 " "$1,740.00 " "$1,235.40 " "$1,670.40 " "$1,635.60 " "$1,653.00 " "$1,705.20 " NM Gastrointestinal Blood Loss Imaging 78278 "$1,461.00 " "$1,461.00 " "$1,037.31 " "$1,461.00 " "$1,461.00 " "$1,037.31 " "$1,402.56 " "$1,373.34 " "$1,387.95 " "$1,431.78 " NM Intestine Imaging 78290 "$1,415.00 " "$1,415.00 " "$1,004.65 " "$1,415.00 " "$1,415.00 " "$1,004.65 " "$1,358.40 " "$1,330.10 " "$1,344.25 " "$1,386.70 " NM Bone Imaging Limited 78300 "$1,213.00 " "$1,213.00 " $861.23 "$1,213.00 " "$1,213.00 " $861.23 "$1,164.48 " "$1,140.22 " "$1,152.35 " "$1,188.74 " NM Bone Joint Imaging Multi 78305 "$1,001.00 " "$1,001.00 " $710.71 "$1,001.00 " "$1,001.00 " $710.71 $960.96 $940.94 $950.95 $980.98 NM Bone Imaging Whole Body 78306 "$1,605.00 " "$1,605.00 " "$1,139.55 " "$1,605.00 " "$1,605.00 " "$1,139.55 " "$1,540.80 " "$1,508.70 " "$1,524.75 " "$1,572.90 " NM Bone Three Phase Study 78315 "$1,845.00 " "$1,845.00 " "$1,309.95 " "$1,845.00 " "$1,845.00 " "$1,309.95 " "$1,771.20 " "$1,734.30 " "$1,752.75 " "$1,808.10 " 78452 NUC MED MYOCARD PERF IMAGE CHARGE 78452 "$3,768.00 " "$3,768.00 " "$2,675.28 " "$3,768.00 " "$3,768.00 " "$2,675.28 " "$3,617.28 " "$3,541.92 " "$3,579.60 " "$3,692.64 " NM Venous Thrombosis Imaging Bilateral 78458 "$1,096.00 " "$1,096.00 " $778.16 "$1,096.00 " "$1,096.00 " $778.16 "$1,052.16 " "$1,030.24 " "$1,041.20 " "$1,074.08 " NM Myocardial Infarct Avid Planar 78466 "$1,460.00 " "$1,460.00 " "$1,036.60 " "$1,460.00 " "$1,460.00 " "$1,036.60 " "$1,401.60 " "$1,372.40 " "$1,387.00 " "$1,430.80 " NM Cardiac Blood Pool Gated Rest/Stress 78472 "$1,918.00 " "$1,918.00 " "$1,361.78 " "$1,918.00 " "$1,918.00 " "$1,361.78 " "$1,841.28 " "$1,802.92 " "$1,822.10 " "$1,879.64 " NM Pulmonary Vent Gas w/ Mult Projection 78579 "$1,759.00 " "$1,759.00 " "$1,248.89 " "$1,759.00 " "$1,759.00 " "$1,248.89 " "$1,688.64 " "$1,653.46 " "$1,671.05 " "$1,723.82 " NM Pulmonary Perfusion Imaging 78580 "$1,363.00 " "$1,363.00 " $967.73 "$1,363.00 " "$1,363.00 " $967.73 "$1,308.48 " "$1,281.22 " "$1,294.85 " "$1,335.74 " NM Pulmonary Ventilation/Perfusion 78582 "$2,035.00 " "$2,035.00 " "$1,444.85 " "$2,035.00 " "$2,035.00 " "$1,444.85 " "$1,953.60 " "$1,912.90 " "$1,933.25 " "$1,994.30 " NM Brain Imaging Ltd Static w/ Vascular 78606 "$2,191.00 " "$2,191.00 " "$1,555.61 " "$2,191.00 " "$2,191.00 " "$1,555.61 " "$2,103.36 " "$2,059.54 " "$2,081.45 " "$2,147.18 " NM Brain Imaging Vascular Flow Only 78610 "$1,340.00 " "$1,340.00 " $951.40 "$1,340.00 " "$1,340.00 " $951.40 "$1,286.40 " "$1,259.60 " "$1,273.00 " "$1,313.20 " NM Kidney Imaging Static 78700 "$1,461.00 " "$1,461.00 " "$1,037.31 " "$1,461.00 " "$1,461.00 " "$1,037.31 " "$1,402.56 " "$1,373.34 " "$1,387.95 " "$1,431.78 " NM Kidney Imaging w/ Flow w/o Pharm 78707 "$1,386.00 " "$1,386.00 " $984.06 "$1,386.00 " "$1,386.00 " $984.06 "$1,330.56 " "$1,302.84 " "$1,316.70 " "$1,358.28 " NM Kidney Imaging w/ Flow w/ Pharm 78708 "$1,509.00 " "$1,509.00 " "$1,071.39 " "$1,509.00 " "$1,509.00 " "$1,071.39 " "$1,448.64 " "$1,418.46 " "$1,433.55 " "$1,478.82 " NM Testicular Imaging 78761 "$1,461.00 " "$1,461.00 " "$1,037.31 " "$1,461.00 " "$1,461.00 " "$1,037.31 " "$1,402.56 " "$1,373.34 " "$1,387.95 " "$1,431.78 " NM Bone Spect 78803 "$2,360.00 " "$2,360.00 " "$1,675.60 " "$2,360.00 " "$2,360.00 " "$1,675.60 " "$2,265.60 " "$2,218.40 " "$2,242.00 " "$2,312.80 " NM Liver Imaging Spect 78803 "$2,360.00 " "$2,360.00 " "$1,675.60 " "$2,360.00 " "$2,360.00 " "$1,675.60 " "$2,265.60 " "$2,218.40 " "$2,242.00 " "$2,312.80 " NM Liver Imaging Spect w/ Vascular Flow 78803 "$2,360.00 " "$2,360.00 " "$1,675.60 " "$2,360.00 " "$2,360.00 " "$1,675.60 " "$2,265.60 " "$2,218.40 " "$2,242.00 " "$2,312.80 " PET Skull - Mid Thigh 78815 "$5,363.00 " "$5,363.00 " "$3,807.73 " "$5,363.00 " "$5,363.00 " "$3,807.73 " "$5,148.48 " "$5,041.22 " "$5,094.85 " "$5,255.74 " PET Whole Body 78816 "$5,479.00 " "$5,479.00 " "$3,890.09 " "$5,479.00 " "$5,479.00 " "$3,890.09 " "$5,259.84 " "$5,150.26 " "$5,205.05 " "$5,369.42 " Basic Metabolic Panel Standard 80048 $133.00 $133.00 $94.43 $133.00 $133.00 $94.43 $127.68 $125.02 $126.35 $130.34 General Health Panel 80050 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 Electrolyte Panel 80051 $108.00 $108.00 $76.68 $108.00 $108.00 $76.68 $103.68 $101.52 $102.60 $105.84 Comprehensive Metabolic Panel Standard 80053 $156.00 $156.00 $110.76 $156.00 $156.00 $110.76 $149.76 $146.64 $148.20 $152.88 OB Panel w/ Reflex NLL 80055 $276.00 $276.00 $195.96 $276.00 $276.00 $195.96 $264.96 $259.44 $262.20 $270.48 Lipid Panel Standard 80061 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 Renal Function Panel Standard 80069 $143.00 $143.00 $101.53 $143.00 $143.00 $101.53 $137.28 $134.42 $135.85 $140.14 Hep Pnl Acute W/Rflx RPS 80074 $289.00 $289.00 $205.19 $289.00 $289.00 $205.19 $277.44 $271.66 $274.55 $283.22 Hepatitis Panel (4) LC 80074 $289.00 $289.00 $205.19 $289.00 $289.00 $205.19 $277.44 $271.66 $274.55 $283.22 Hepatitis Panel Acute w/ Reflex NLL 80074 $289.00 $289.00 $205.19 $289.00 $289.00 $205.19 $277.44 $271.66 $274.55 $283.22 Hepatic Function Panel Standard 80076 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "Obstetric Panel, Including HIV LC" 80081 $256.00 $256.00 $181.76 $256.00 $256.00 $181.76 $245.76 $240.64 $243.20 $250.88 Carbamazepine Level 80156 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 Clozapine LC 80159 $225.00 $225.00 $159.75 $225.00 $225.00 $159.75 $216.00 $211.50 $213.75 $220.50 Digoxin Level 2 80162 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 Valproic Acid Level 80164 $146.00 $146.00 $103.66 $146.00 $146.00 $103.66 $140.16 $137.24 $138.70 $143.08 Ethosuximide (Zarontin) NLL 80168 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 "Ethosuximide (Zarontin), Serum LC" 80168 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Ethosuximide RPS 80168 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 "Gentamicin Trough, Serum LC" 80170 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 "Gabapentin (Neurontin), Serum LC" 80171 $337.00 $337.00 $239.27 $337.00 $337.00 $239.27 $323.52 $316.78 $320.15 $330.26 Lamictal RPS 80175 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 "Lamotrigine (Lamictal), Serum LC" 80175 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 Lamotrigine NLL 80175 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 Keppra RPS 80177 $216.00 $216.00 $153.36 $216.00 $216.00 $153.36 $207.36 $203.04 $205.20 $211.68 "Levetiracetam (Keppra), S LC" 80177 $216.00 $216.00 $153.36 $216.00 $216.00 $153.36 $207.36 $203.04 $205.20 $211.68 "Lithium (Eskalith), Serum LC" 80178 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Lithium NLL 80178 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Lithium RPS 80178 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 "Oxcarbazepine (Trileptal), LC" 80183 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 Oxcarbazepine RPS 80183 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 Phenobarbital NLL 80184 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Phenobarbital RPS 80184 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 "Phenobarbital, Serum LC" 80184 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 "Phenobarbital, Serum LC" 80184 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Phenytoin Lvl 80185 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Posaconazole level RPS 80187 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 "Primidone, Serum LC" 80188 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Fk506 Level RPS 80197 $195.00 $195.00 $138.45 $195.00 $195.00 $138.45 $187.20 $183.30 $185.25 $191.10 Tacrolimus (FK 506) NLL 80197 $195.00 $195.00 $138.45 $195.00 $195.00 $138.45 $187.20 $183.30 $185.25 $191.10 Tacrolimus by Immunoassay LC 80197 $195.00 $195.00 $138.45 $195.00 $195.00 $138.45 $187.20 $183.30 $185.25 $191.10 Theophylline NLL 80198 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 "Theophylline, Serum LC" 80198 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 "Tobramycin Random, Serum LC" 80200 $162.00 $162.00 $115.02 $162.00 $162.00 $115.02 $155.52 $152.28 $153.90 $158.76 "Tobramycin, Random NLL" 80200 $162.00 $162.00 $115.02 $162.00 $162.00 $115.02 $155.52 $152.28 $153.90 $158.76 Topiramate (Topamax) NLL 80201 $224.00 $224.00 $159.04 $224.00 $224.00 $159.04 $215.04 $210.56 $212.80 $219.52 "Topiramate (Topamax), Serum LC" 80201 $224.00 $224.00 $159.04 $224.00 $224.00 $159.04 $215.04 $210.56 $212.80 $219.52 Topiramate RPS 80201 $224.00 $224.00 $159.04 $224.00 $224.00 $159.04 $215.04 $210.56 $212.80 $219.52 Vancomycin Lvl Peak 80202 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 Vancomycin Lvl Trough 80202 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 Zonisamide RPS 80203 $155.00 $155.00 $110.05 $155.00 $155.00 $110.05 $148.80 $145.70 $147.25 $151.90 "Zonisamide(Zonegran), Serum LC" 80203 $155.00 $155.00 $110.05 $155.00 $155.00 $110.05 $148.80 $145.70 $147.25 $151.90 80299 (4105506) PANEL COMPONENT 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Adalimum AB - Adalimumab AB 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Adalimumab and Anti-Adalimumab Ab 1 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Adalimumab+Ab (Serial Monitor) NLL 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Flecainide (Tambocor) LC 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Gabapentin NLL 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 "Levetiracetam (Keppra), Serum NLL" 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Oxcarbazepine Metabolite NLL 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 "Salicylate, Serum LC" 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Zonisamide NLL 80299 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 Urine Drug Screen Standard QST 80305 $183.00 $183.00 $129.93 $183.00 $183.00 $129.93 $175.68 $172.02 $173.85 $179.34 Meconium Drug Screen RPS 80307 $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 Meconium Panel 10 LC 80307 $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 Salicylate RPS 80307 $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 Ethanol Level 80320 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 "Nicotine & Metabolites, Serum RPS" 80323 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 "Nicotine w/ Metabolites, Ur NLL" 80323 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 Acetaminophen Level 80329 $206.00 $206.00 $146.26 $206.00 $206.00 $146.26 $197.76 $193.64 $195.70 $201.88 "Felbamate (Felbatol(R)), Serum LC" 80339 $342.00 $342.00 $242.82 $342.00 $342.00 $242.82 $328.32 $321.48 $324.90 $335.16 Lacosamide LC 80339 $342.00 $342.00 $242.82 $342.00 $342.00 $242.82 $328.32 $321.48 $324.90 $335.16 Lacosamide RPS 80339 $342.00 $342.00 $242.82 $342.00 $342.00 $242.82 $328.32 $321.48 $324.90 $335.16 Paliperidone RPS 80342 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 "Paliperidone, Serum LC" 80342 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 Urine Diuretic Screen LC 80377 $197.00 $197.00 $139.87 $197.00 $197.00 $139.87 $189.12 $185.18 $187.15 $193.06 UA Complete 1 81000 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 UA pH 81002 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 UA Specific Gravity 1 81002 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 Urinalysis Standard 81002 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 Urine Dipstick POC 81002 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 81003 Urinalysis w/o micro 81003 $36.00 $36.00 $25.56 $36.00 $36.00 $25.56 $34.56 $33.84 $34.20 $35.28 UA Micro Standard 81015 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 81025 Urine Pregnancy Test 81025 $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 Urine Pregnancy Test 81025 $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 Urine Pregnancy Test POC 81025 $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 "BCR/ABL p210, Quant Monitor NLL" 81206 $989.00 $989.00 $702.19 $989.00 $989.00 $702.19 $949.44 $929.66 $939.55 $969.22 BCR-ABL (M-TH only) LC 81206 $989.00 $989.00 $702.19 $989.00 $989.00 $702.19 $949.44 $929.66 $939.55 $969.22 Bcr-abl Quantitative p210 Assay RPS 81206 $989.00 $989.00 $702.19 $989.00 $989.00 $702.19 $949.44 $929.66 $939.55 $969.22 81240 (4101113) PANEL COMPONENT 81240 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 81240 (4101126) PANEL COMPONENT 81240 $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 Factor V Leiden Mutation LC 81241 $343.00 $343.00 $243.53 $343.00 $343.00 $243.53 $329.28 $322.42 $325.85 $336.14 "Factor V Leiden R506Q Mut, Blood NLL" 81241 $343.00 $343.00 $243.53 $343.00 $343.00 $243.53 $329.28 $322.42 $325.85 $336.14 Leiden Factor V RPS 81241 $343.00 $343.00 $243.53 $343.00 $343.00 $243.53 $329.28 $322.42 $325.85 $336.14 Hemochromatosis HFE Gene Analysis NLL 81256 $351.00 $351.00 $249.21 $351.00 $351.00 $249.21 $336.96 $329.94 $333.45 $343.98 "Hered.Hemochromatosis, DNA LC" 81256 $351.00 $351.00 $249.21 $351.00 $351.00 $249.21 $336.96 $329.94 $333.45 $343.98 "JAK2 Mutation Analysis, Qual LC" 81270 $566.00 $566.00 $401.86 $566.00 $566.00 $401.86 $543.36 $532.04 $537.70 $554.68 JAK2 V617F Mutation RPS 81270 $566.00 $566.00 $401.86 $566.00 $566.00 $401.86 $543.36 $532.04 $537.70 $554.68 MTHFR LC 81291 $463.00 $463.00 $328.73 $463.00 $463.00 $328.73 $444.48 $435.22 $439.85 $453.74 Mthfr Mutation RPS 81291 $463.00 $463.00 $328.73 $463.00 $463.00 $328.73 $444.48 $435.22 $439.85 $453.74 Unlisted molecular pathology procedure 81479 $620.00 $620.00 $440.20 $620.00 $620.00 $440.20 $595.20 $582.80 $589.00 $607.60 "QUAD Screen, Maternal NLL" 81511 $598.00 $598.00 $424.58 $598.00 $598.00 $424.58 $574.08 $562.12 $568.10 $586.04 Beta-Hydroxybutyrate NLL 82010 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 "Acylcarnitine Profile, Plasma LC" 82017 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 ACTH Adrenocorticotropic Hormone Level RPS 82024 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 "ACTH, Plasma LC" 82024 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 "Adrenocorticotropic Hormone (ACTH), Plasma NLL" 82024 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 Albumin Level 82040 $44.00 $44.00 $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 Microalb/Creat Ratio 82043 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Breath/alcohol test 82075 $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 Aldolase LC 82085 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Aldolase RPS 82085 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 "Aldolase, Serum NLL" 82085 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 "Aldosterone LCMS, Serum LC" 82088 $143.00 $143.00 $101.53 $143.00 $143.00 $101.53 $137.28 $134.42 $135.85 $140.14 Aldosterone RPS 82088 $143.00 $143.00 $101.53 $143.00 $143.00 $101.53 $137.28 $134.42 $135.85 $140.14 A Fetoprotein/Ca RPS 82105 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 AFP Tetra LC 82105 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "Afp, Maternal Screen RPS" 82105 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "AFP, Serum, Open Spina Bifida LC" 82105 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "AFP, Serum, Tumor Marker LC" 82105 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "AFP, Single Marker, Maternal NLL" 82105 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "Alpha-Fetoprotein (AFP) Tumor Marker, Serum NLL" 82105 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 Ammonia (NH3) NLL 82140 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Ammonia Venous RPS 82140 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 "Ammonia, Plasma LC" 82140 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Amylase Level 82150 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 Angiotensin-Converting Enzyme LC 82164 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 82172 (4101213) PANEL COMPONENT 82172 $144.00 $144.00 $102.24 $144.00 $144.00 $102.24 $138.24 $135.36 $136.80 $141.12 Beta 2 Microglob/Bld RPS 82232 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 "Beta-2 Microglobulin, Serum LC" 82232 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 "Beta-2-Microglobulin, Serum NLL" 82232 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 Bile Acids LC 82239 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 Bile Acids Total RPS 82239 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 "Bile Acids, Total NLL" 82239 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 82247 (4101213) PANEL COMPONENT 82247 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 Bilirubin Neonatal 82247 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 Bilirubin Total 82247 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 Neonatal Bili 82247 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 Neonatal Bilirubin 1 82247 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 Bilirubin Conjugated 82248 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 "Biotinidase, each specimen" 82261 $84.00 $84.00 $59.64 $84.00 $84.00 $59.64 $80.64 $78.96 $79.80 $82.32 Hemoccult Diagnostic POC 82270 $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 Hemoccult POC THAY 82270 $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 Stool for Occult Blood POC - THAY 82270 $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 Hemoccult Gastric POC 82271 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 "Occult Blood, Stool, 1 Specimen Only NLL" 82272 $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 Fecal HgB Diagnosis RPS 82274 $45.00 $45.00 $31.95 $45.00 $45.00 $31.95 $43.20 $42.30 $42.75 $44.10 GI Fecal Hemoglobin Bld/Stool RPS 82274 $45.00 $45.00 $31.95 $45.00 $45.00 $31.95 $43.20 $42.30 $42.75 $44.10 "Occult Blood, Fecal, IA LC" 82274 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 Vitamin D 25 Hydroxy Level 82306 $191.00 $191.00 $135.61 $191.00 $191.00 $135.61 $183.36 $179.54 $181.45 $187.18 PTH Calcium Level Total PSPC 82310 $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 Calcium Ionized NLL 82330 $108.00 $108.00 $76.68 $108.00 $108.00 $76.68 $103.68 $101.52 $102.60 $105.84 "Calcium, Ionized, Serum LC" 82330 $108.00 $108.00 $76.68 $108.00 $108.00 $76.68 $103.68 $101.52 $102.60 $105.84 Ionized Calcium Level 82330 $108.00 $108.00 $76.68 $108.00 $108.00 $76.68 $103.68 $101.52 $102.60 $105.84 82340 (4100831) PANEL COMPONENT 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Calcium Urine Random NLL 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Calcium Urine Timed NLL 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 "Calcium, 24Hr Urine LC" 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 "Calcium, Random Urine LC" 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Calcium/Random Urine RPS 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Calcium/Timed Urine RPS 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 LC 82340 82340 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 "Calculi, Urinary LC" 82360 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 Stone Analysis NLL 82365 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Stone Analysis RPS 82365 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Carbon Dioxide Level 82374 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 Carbon Monoxide Quant. Blood NLL 82375 $132.00 $132.00 $93.72 $132.00 $132.00 $93.72 $126.72 $124.08 $125.40 $129.36 "Carbon Monoxide, Blood LC" 82375 $132.00 $132.00 $93.72 $132.00 $132.00 $93.72 $126.72 $124.08 $125.40 $129.36 Carboxyhemoglobin RPS 82375 $132.00 $132.00 $93.72 $132.00 $132.00 $93.72 $126.72 $124.08 $125.40 $129.36 CEA LC 82378 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 CEA NLL 82378 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 Cea RPS 82378 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 Catecholamine Fractionation Urinary NLL 82384 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 "Catecholamines, Plasma LC" 82384 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 "Catecholamines,Uprig RPS" 82384 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 "Catecholamines,Ur.,Free,24 Hr LC" 82384 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 Ceruloplasmin NLL 82390 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 Ceruloplasmin LC 82390 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 Ceruloplasmin RPS 82390 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 Adalimum AB & Adalimumab AB 82397 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 Adalimumab and Anti-Adalimumab Ab 82397 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 Adalimumab+Ab (Serial Monitor) LC 82397 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 Anti-Adalimumab Antibody NLL 82397 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 Parathyroid Hormone Related Peptide NLL 82397 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 PTHrP (PTH-Related Peptide) LC 82397 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 Chloride Level 82435 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 Chloride Urine Random NLL 82436 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 82465 (4101213) PANEL COMPONENT 82465 $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 Cholesterol Total 82465 $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 "Citrate Excretion, Urine NLL" 82507 $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 "Citric Acid (Citrate), Urine LC" 82507 $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 Citric Acid Urine RPS 82507 $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 Copper Blood RPS 82525 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 Copper Serum LC 82525 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 "Cortisol, Urinary Free LC" 82530 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 Cortisol 1 Hour 82533 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Cortisol 30 Min 82533 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Cortisol Baseline 82533 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Cortisol Level 82533 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Cortisol Level AM 82533 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Cortisol Level PM 82533 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Salivary Cortisol LC 82533 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 Lacosamide (VIMPAT) (MT777) NLL 82542 $291.00 $291.00 $206.61 $291.00 $291.00 $206.61 $279.36 $273.54 $276.45 $285.18 Promethus Thiopurine Metabolite 82542 $291.00 $291.00 $206.61 $291.00 $291.00 $206.61 $279.36 $273.54 $276.45 $285.18 Cardiac Panel Standard 82550 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 Creatine Kinase 82550 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 CKMB 82553 $161.00 $161.00 $114.31 $161.00 $161.00 $114.31 $154.56 $151.34 $152.95 $157.78 Creatine Kinase-MB 82553 $161.00 $161.00 $114.31 $161.00 $161.00 $114.31 $154.56 $151.34 $152.95 $157.78 Creatinine 82565 $57.00 $57.00 $40.47 $57.00 $57.00 $40.47 $54.72 $53.58 $54.15 $55.86 "Creatinine, Body Fluid LC" 82565 $57.00 $57.00 $40.47 $57.00 $57.00 $40.47 $54.72 $53.58 $54.15 $55.86 (4109851 PANEL COMPONENT) 82570 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 82570 (4100831) PANEL COMPONENT 82570 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Creatinine Level 24 Hour Urine 82570 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Creatinine Level Urine 82570 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 LC 82570 82570 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Protein/Creatinine Ratio Urine 82570 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 "Protein/Creatinine, Urine" 82570 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Creat Cl 5 82575 $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 Creatinine Clearance Standard 82575 $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 82585 (4108257) PANEL COMPONENT 82585 $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 82595 (4108257) PANEL COMPONENT 82595 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 Vitamin B12 Level 82607 $127.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 Dehydroepiandrosterone (DHEA) LC 82626 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 "Dehydroepiandrosterone (DHEA), Serum NLL" 82626 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 Dehydroepiandrosterone (DHEA) Sulfate LC 82627 $168.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 Dehydroepiandrosterone Sulfate (DHEA-S) NLL 82627 $168.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 "Calcitriol(1,25 di-OH Vit D) LC" 82652 $235.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 Vit D 1 25 Dihydroxy RPS 82652 $235.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 "Vitamin D, 1,25-Dihydroxy, Serum NLL" 82652 $235.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 "Pancreatic Elastase, Fecal LC" 82656 $238.00 $238.00 $168.98 $238.00 $238.00 $168.98 $228.48 $223.72 $226.10 $233.24 "Pancreatic Elastase, Stool NLL" 82656 $238.00 $238.00 $168.98 $238.00 $238.00 $168.98 $228.48 $223.72 $226.10 $233.24 "82657 Enzyme activity in blood cells, cultured cells, or tissue, n" 82657 $358.00 $358.00 $254.18 $358.00 $358.00 $254.18 $343.68 $336.52 $340.10 $350.84 IEF Confirms NLL 82664 $300.00 $300.00 $213.00 $300.00 $300.00 $213.00 $288.00 $282.00 $285.00 $294.00 "Erythropoietin (EPO), Serum LC" 82668 $172.00 $172.00 $122.12 $172.00 $172.00 $122.12 $165.12 $161.68 $163.40 $168.56 "Erythropoietin (EPO), Serum NLL" 82668 $172.00 $172.00 $122.12 $172.00 $172.00 $122.12 $165.12 $161.68 $163.40 $168.56 Erythropoietin RPS 82668 $172.00 $172.00 $122.12 $172.00 $172.00 $122.12 $165.12 $161.68 $163.40 $168.56 Estradiol LC 82670 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 Estradiol RPS 82670 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 "Estradiol, Enhanced NLL" 82670 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 "Estradiol, Sensitive, LC" 82670 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 "Estradiol, Serum NLL" 82670 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 "Estrogens, Fractions RPS" 82671 $152.00 $152.00 $107.92 $152.00 $152.00 $107.92 $145.92 $142.88 $144.40 $148.96 "Estrogen, Total and Fractionated PSPC" 82672 $219.00 $219.00 $155.49 $219.00 $219.00 $155.49 $210.24 $205.86 $208.05 $214.62 "Estrogens, Total LC" 82672 $219.00 $219.00 $155.49 $219.00 $219.00 $155.49 $210.24 $205.86 $208.05 $214.62 82677 (4103600) PANEL COMPONENT 82677 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 82677 (4103840) PANEL COMPONENT 82677 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "Fecal Fat, Qualitative LC" 82705 $64.00 $64.00 $45.44 $64.00 $64.00 $45.44 $61.44 $60.16 $60.80 $62.72 82726 Very long chain fatty acids 82726 $483.00 $483.00 $342.93 $483.00 $483.00 $342.93 $463.68 $454.02 $458.85 $473.34 Ferritin 82728 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 Fetal Fibronectin LC 82731 $461.00 $461.00 $327.31 $461.00 $461.00 $327.31 $442.56 $433.34 $437.95 $451.78 Fibronectin Fetal RPS 82731 $461.00 $461.00 $327.31 $461.00 $461.00 $327.31 $442.56 $433.34 $437.95 $451.78 Folate Level 82746 $124.00 $124.00 $88.04 $124.00 $124.00 $88.04 $119.04 $116.56 $117.80 $121.52 82760 Galactose 82760 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 Galactose-1-phosphate uridyl transferase; screen 82776 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 82784 (4103585) PANEL COMPONENT 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 82784 (4109355) PANEL COMPONENT 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 Celiac Disease Scrn RPS 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 IgA NLL 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 Iga Quant Only/Serum RPS 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 IgG NLL 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 Igg Quant Only/Serum RPS 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 IgM NLL 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 Igm Quant Only/Serum RPS 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 "Immunoglobulin A, Quant. Serum LC" 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 "Immunoglobulin G, Qn, Serum LC" 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 "Immunoglobulin M, Qn, Serum LC" 82784 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 Ige RPS 82785 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 "Immunoglobulin E (IgE), Serum NLL" 82785 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 "Immunoglobulin E, Total LC" 82785 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 82787 (4103585) PANEL COMPONENT 82787 $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 pH Arterial 82800 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Arterial Blood Gas Standard 82803 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 "Glucose, Body Fluid LC" 82945 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 "Glucose, Cerebrospinal Fluid LC" 82945 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 "Glucose, Fluid NLL" 82945 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 82947 (4101213) PANEL COMPONENT 82947 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 Glucose Level 82947 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 82270 Secult 82948 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 82948 Glucose Blood 82948 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 .Glucose Baseline 82950 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 Gestational Diabetic Screen 82950 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 .GTT-1 Hr 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 .GTT-1 Hr 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 .GTT-1Hr OB 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 .GTT-3 Hr OB 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 Gluc 1 Hr OB 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 GTT 1 Hr 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 GTT 2 Hr 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 GTT 3 Hr 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 GTT 4 Hr 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 GTT 5 Hr 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 GTT OB 3 Hour 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 LTT 82951 $174.00 $174.00 $123.54 $174.00 $174.00 $123.54 $167.04 $163.56 $165.30 $170.52 .GTT-2 Hr 82952 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 .GTT-3 Hr 82952 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 .GTT-4 Hr 82952 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 .GTT-5 Hr 82952 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 Gluc 3 Hr OB 82952 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 "Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure)" 82952 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 "Lactose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure)" 82952 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 82955 (4103490) PANEL COMPONENT 82955 $127.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 Glucose 6 Phosphate Dehydrogenase NLL 82955 $127.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 82977 (4101213) PANEL COMPONENT 82977 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 Gamma Glutamyl Transferase 82977 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 FSH - Follicle Stimulating Hormone NLL 83001 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Fsh RPS 83001 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "FSH, Serum LC" 83001 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "Cortisol, Saliva NLL" 83002 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 LH - Luteinizing Hormone NLL 83002 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Lh RPS 83002 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "Luteinizing Hormone(LH), S LC" 83002 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "Growth Hormone, Serum NLL" 83003 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "Growth Hormone, Serum LC" 83003 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "Growth Hormone, Serum RPS" 83003 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 83010 (4101213) PANEL COMPONENT 83010 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Haptoglobin LC 83010 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Haptoglobin NLL 83010 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Haptoglobin RPS 83010 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 H. Pylori drug administration 83014 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Helicobacter pylori; drug administration 83014 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 83020 (4100015) PANEL COMPONENT 83020 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 Hemoglobin fractionation and quantitation; electrophoresis 83020 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 83021 (4100015) PANEL COMPONENT 83021 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Hemoglobin A1c 83036 $74.00 $74.00 $52.54 $74.00 $74.00 $52.54 $71.04 $69.56 $70.30 $72.52 Hemoglobin A1C 2 83036 $74.00 $74.00 $52.54 $74.00 $74.00 $52.54 $71.04 $69.56 $70.30 $72.52 "Hemoglobin, Unstable NLL" 83068 $137.00 $137.00 $97.27 $137.00 $137.00 $97.27 $131.52 $128.78 $130.15 $134.26 83090 (4101113) PANEL COMPONENT 83090 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 "Homocyst(e)ine, Plasma LC" 83090 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 "Homocysteine, Total, Plasma NLL" 83090 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 Homocysteine/Blood RPS 83090 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 "Free Lambda Lt Chains,S LC" 83383 $169.00 $169.00 $119.99 $169.00 $169.00 $119.99 $162.24 $158.86 $160.55 $165.62 "5-HIAA,Quant.,24 Hr Urine LC" 83497 $140.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 "5-Hydroxyindoleacetic Acid (5-HIAA), Urine NLL" 83497 $140.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 "17-Hydroxyprogesterone, Serum NLL" 83498 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 17-OH Progesterone LC 83498 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 "Hydroxyprogesterone, 17-d" 83498 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 83516 (4102710) PANEL COMPONENT 1 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 83516 (4102710) PANEL COMPONENT 2 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 83516 (4105810) PANEL COMPONENT 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 83516 Immunoassay for analyte other than infectious agent antibody 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 "Antigliadin Abs, IgA LC" 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 "Antigliadin Abs, IgG LC" 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 Endo(IgA)+Glia(IgA/G)+Ret I... LC 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 GLIADIN IGA 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 GLIADIN IGG 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 Immunoassay for analyte other than infectious agent antibody 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 Serine Protease 3 Ab RPS 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 SMOOTH MUSCLE AB IGG RPS 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 TISSUE TRANSGLUTAMINASE AB IGA 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 "Tissue Transglutaminase AB, IgA NLL" 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 Ttg Iga RPS 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 t-Transglutaminase (tTG) IgA LC 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 t-Transglutaminase (tTG) IgG LC 83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 83519 Immunoassay for analyte other than infectious agent antibody 83519 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 21-Hydroxylase Antibodies NLL 83519 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 21-Hydroxylase Antibodies LC 83519 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 83519 (410875) PANEL COMPONENT 83519 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 "Acetylcholine Receptor (AChR) Binding Ab, Serum NLL" 83519 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 ACh Receptor(Muscle)Modulating LC 83519 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 AChR Binding Abs LC 83519 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 LC 83519 83519 $258.00 $258.00 $183.18 $258.00 $258.00 $183.18 $247.68 $242.52 $245.10 $252.84 "Paraneoplastic, Mayo RPS" 83520 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 83520 (4105810) PANEL COMPONENT 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 83520 (410875) PANEL COMPONENT 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 83520 Immunoassay for analyte other than infectious agent antibody 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 Antiproteinase 3 (PR-3) Abs LC 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 Kappa Lambda Qnt RPS 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 LC 83520 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 MG Eval Adult RPS 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 Pancreatic Elastase RPS 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 Sensori Motor Neuropathy Comp. LC 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 Tsh Receptor Ab RPS 83520 $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 Insulin LC 83525 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Insulin RPS 83525 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 "Insulin, Fasting NLL" 83525 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 IRON 83540 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 Iron Level 83540 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 Lactic Acid 83605 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 Lactate Dehydrogenase 83615 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 "Lactic Dehyrogenase (LD), Fluid NLL" 83615 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 "LD, Body Fluid LC" 83615 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 Ld/Fluid RPS 83615 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 Wbc/Stool RPS 83630 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 LEAD LEVEL 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Lead Level NLL 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Lead RPS 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Lead, Blood (Adult) LC" 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Lead, Blood (Pediatric) LC" 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Lead, Blood Adult NLL" 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Lead, Capillary Pediatric LC" 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Lead, Capillary Pediatric NLL" 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Lead, Venous Pediatric NLL" 83655 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Lipase Level 83690 $97.00 $97.00 $68.87 $97.00 $97.00 $68.87 $93.12 $91.18 $92.15 $95.06 Cholesterol High Density Lipid 83718 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 Direct LDL 83721 $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 Magnesium Level 83735 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 "Mass spectrometry and tandem mass spectrometry (MS, MS/MS)" 83789 $271.00 $271.00 $192.41 $271.00 $271.00 $192.41 $260.16 $254.74 $257.45 $265.58 "Metanephrines, Frac, Qn, 24-H, Ur LC" 83835 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 "Metanephrines, Frac., Pl. Free LC" 83835 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 "Metanephrines, Fract.,Free, Plasma NLL" 83835 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 "Metanephrines, Fractionated, 24 hr, Urine NLL" 83835 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 "Metanephrines,Plasma RPS" 83835 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 Myoglobin NLL 83874 $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 "Myoglobin, Serum LC" 83874 $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 Myeloperoxidase Ab (MPO) IgG NLL 83876 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 Natriuretic Peptide (BNP) 83880 $249.00 $249.00 $176.79 $249.00 $249.00 $176.79 $239.04 $234.06 $236.55 $244.02 NT Pro-BNP 83880 $249.00 $249.00 $176.79 $249.00 $249.00 $176.79 $239.04 $234.06 $236.55 $244.02 proBNP LC 83880 $249.00 $249.00 $176.79 $249.00 $249.00 $176.79 $239.04 $234.06 $236.55 $244.02 Free K+L Lt Chains Ur Qn LC 83883 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 83883 (4100006) PANEL COMPONENT 83883 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 83883 (4101213) PANEL COMPONENT 83883 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 83883 (4109356) PANEL COMPONENT 83883 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 "Free Kappa Lt Chains,S LC" 83883 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 "Kappa, Serum NLL" 83883 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 "Lambda, Serum NLL" 83883 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 LC 83883 83883 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 LC 83916 83916 $418.00 $418.00 $296.78 $418.00 $418.00 $296.78 $401.28 $392.92 $397.10 $409.64 Methylmalonic Acid NLL 83921 $222.00 $222.00 $157.62 $222.00 $222.00 $157.62 $213.12 $208.68 $210.90 $217.56 Osmolality LC 83930 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Osmolality RPS 83930 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Osmolality Serum NLL 83930 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Osmolality Urine NLL 83935 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 "Osmolality, Urine LC" 83935 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Osmolality/Tmd Urine RPS 83935 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Urine Osmolality Random RPS 83935 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Oxalate Urine RPS 83945 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 "Oxalate, Quant, 24-Hour Urine LC" 83945 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 "Oxalate, Urine NLL" 83945 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 Parathyroid Hormone (PTH) Intact NLL 83970 $229.00 $229.00 $162.59 $229.00 $229.00 $162.59 $219.84 $215.26 $217.55 $224.42 Pth Intact RPS 83970 $229.00 $229.00 $162.59 $229.00 $229.00 $162.59 $219.84 $215.26 $217.55 $224.42 "PTH, Intact LC" 83970 $229.00 $229.00 $162.59 $229.00 $229.00 $162.59 $219.84 $215.26 $217.55 $224.42 pH Fluid NLL 83986 $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 "pH, Body Fluid LC" 83986 $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 Calprotectin Fecal LC 83993 $418.00 $418.00 $296.78 $418.00 $418.00 $296.78 $401.28 $392.92 $397.10 $409.64 "Calprotectin, Fecal NLL" 83993 $418.00 $418.00 $296.78 $418.00 $418.00 $296.78 $401.28 $392.92 $397.10 $409.64 "Calprotectin, Stool RPS" 83993 $418.00 $418.00 $296.78 $418.00 $418.00 $296.78 $401.28 $392.92 $397.10 $409.64 "Phenylalanine (PKU), blood" 84030 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 Alk Phos Isoenzyme LC 84075 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 Alkaline Phosphatase 84075 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 84080 Alk Phos Isoenzyme 84080 $185.00 $185.00 $131.35 $185.00 $185.00 $131.35 $177.60 $173.90 $175.75 $181.30 Phosphorus Level 84100 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 Phosphorus Urine Timed NLL 84105 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "Phosphorus, 24 hr Urine LC" 84105 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 Phosphorus/Tmd Urine RPS 84105 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 Potassium Level 84132 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 Potassium Urine Random NLL 84133 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 "Potassium, Urine LC" 84133 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 Prealbumin LC 84134 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 Prealbumin NLL 84134 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 Prealbumin RPS 84134 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 Progesterone NLL 84144 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 Progesterone LC 84144 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 Progesterone RPS 84144 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 Procalcitonin 84145 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 Procalcitonin NLL 84145 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 Procalcitonin LC 84145 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 Prolactin LC 84146 $149.00 $149.00 $105.79 $149.00 $149.00 $105.79 $143.04 $140.06 $141.55 $146.02 Prolactin NLL 84146 $149.00 $149.00 $105.79 $149.00 $149.00 $105.79 $143.04 $140.06 $141.55 $146.02 Prolactin RPS 84146 $149.00 $149.00 $105.79 $149.00 $149.00 $105.79 $143.04 $140.06 $141.55 $146.02 PSA Diagnostic 84153 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 "84155 Protein, total, except by refractometry; serum, plasma or wh" 84155 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 LC 84155 84155 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 PROTEIN TOTAL 84155 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 Protein Total 84155 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 (4101500 PANEL COMPONENT) 84156 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 84156 (4102525) PANEL COMPONENT 84156 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 84156 (4105065) PANEL COMPONENT 84156 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 "84156 Protein, total, except by refractometry; urine" 84156 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 Protein 24 Hour Urine 84156 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 Protein Level Urine 84156 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 "Protein, Body Fluid LC" 84157 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 "Protein, Total, CSF LC" 84157 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 "Protein, Total, Fluid NLL" 84157 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 Protein/Fluid RPS 84157 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 84165 (4105614) PANEL COMPONENT 84165 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 LC 84165 84165 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 "Protein Elec + Interp, Serum LC" 84165 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 Protein/Serum &Elect RPS 84165 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 Protein Electro Urine Random w/o T.Protein NLL 84166 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Protein Electro Urine Timed w/o T.Protein NLL 84166 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Protein Electro Urine Timed w/ T.Protein NLL 84166 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 "Protein Electro, 24-Hour Urine LC" 84166 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 "Protein Electro, Random Urine LC" 84166 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Protein/Urine &Elect RPS 84166 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 CRMP-5 IgG Western Blot LC 84182 $255.00 $255.00 $181.05 $255.00 $255.00 $181.05 $244.80 $239.70 $242.25 $249.90 "Proinsulin ICMA, Endo Sci LC" 84206 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 "Proinsulin, Plasma NLL" 84206 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 Soluble Transferrin Receptor LC 84238 $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 Renin Activity RPS 84244 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 "Renin Activity, Plasma LC" 84244 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 "Renin Activity, Plasma NLL" 84244 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 "Serotonin, Serum RPS" 84260 $254.00 $254.00 $180.34 $254.00 $254.00 $180.34 $243.84 $238.76 $241.30 $248.92 84270 Sex hormone binding globulin (SHBG) 84270 $137.00 $137.00 $97.27 $137.00 $137.00 $97.27 $131.52 $128.78 $130.15 $134.26 Sex Horm Bind Glob RPS 84270 $137.00 $137.00 $97.27 $137.00 $137.00 $97.27 $131.52 $128.78 $130.15 $134.26 Sex Hormone Binding Globulin LC 84270 $137.00 $137.00 $97.27 $137.00 $137.00 $97.27 $131.52 $128.78 $130.15 $134.26 Sodium Level 84295 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 Sodium Urine Random NLL 84300 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 "Sodium, Urine LC" 84300 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 Sodium/Timed Urine RPS 84300 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 IGF-1 Insulin-Like Growth Factor-1 NLL 84305 $234.00 $234.00 $166.14 $234.00 $234.00 $166.14 $224.64 $219.96 $222.30 $229.32 IGF-1 LC 84305 $234.00 $234.00 $166.14 $234.00 $234.00 $166.14 $224.64 $219.96 $222.30 $229.32 "Insulin like growth factor 1, serum RPS" 84305 $234.00 $234.00 $166.14 $234.00 $234.00 $166.14 $224.64 $219.96 $222.30 $229.32 84402 (4105752) PANEL COMPONENT 84402 $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 LC 84402 84402 $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 LC 84403 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 Testosterone Free MS/Dialysis LC 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 Testosterone Panel RPS 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 Testosterone RPS 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 Testosterone RPS 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 TESTOSTERONE TOTAL 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 Testosterone Total NLL 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 "Testosterone, Serum LC" 84403 $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 "Thiamin (Vitamin B1), WB NLL" 84425 $166.00 $166.00 $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 Vitamin B1 (Thiamine) Whl Blood LC 84425 $166.00 $166.00 $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 Vitamin B1 RPS 84425 $266.00 $266.00 $188.86 $266.00 $266.00 $188.86 $255.36 $250.04 $252.70 $260.68 (4103435 PANEL COMPONENT) 84432 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 LC 84432 84432 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 Thyroglobulin Panel RPS 84432 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 Thyroglobulin RPS 84432 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 84436 (4102820) PANEL COMPONENT 84436 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 T4 Thyroxine 84436 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 Thyroxine (T4) LC 84436 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 Thyroxine; requiring elution 84437 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 Free T4 84439 $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 Thyroid Stimulating Hormone 84443 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 Thyroid Stim Immunoglobulin LC 84445 $347.00 $347.00 $246.37 $347.00 $347.00 $246.37 $333.12 $326.18 $329.65 $340.06 Thyroid Stimulating Globulin RPS 84445 $347.00 $347.00 $246.37 $347.00 $347.00 $246.37 $333.12 $326.18 $329.65 $340.06 Thyroid Stimulating Immunoglobulin (TSI) (LATS) NLL 84445 $347.00 $347.00 $246.37 $347.00 $347.00 $246.37 $333.12 $326.18 $329.65 $340.06 84450 (4101213) PANEL COMPONENT 84450 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Aspartate Aminotransferase 84450 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 84460 (4101213) PANEL COMPONENT 84460 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 Alanine Aminotransferase 84460 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 ALT (SGPT) NLL 84460 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 ALT (SGPT) LC 84460 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 Iron Profile Standard 84466 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 Transferrinn PSPC 84466 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 Troponin I SLHS 84466 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 84478 (4101213) PANEL COMPONENT 84478 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 Triglycerides 84478 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 84479 (4102820) PANEL COMPONENT 84479 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 T3 Uptake LC 84479 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 T3 Uptake LC 84479 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 T3 Total (Triiodothyronine) NLL 84480 $119.00 $119.00 $84.49 $119.00 $119.00 $84.49 $114.24 $111.86 $113.05 $116.62 T3 Total RPS 84480 $119.00 $119.00 $84.49 $119.00 $119.00 $84.49 $114.24 $111.86 $113.05 $116.62 Triiodothyronine (T3) LC 84480 $119.00 $119.00 $84.49 $119.00 $119.00 $84.49 $114.24 $111.86 $113.05 $116.62 T3 Free (Triiodothyronine) NLL 84481 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 T3 Free RPS 84481 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 "Triiodothyronine,Free,Serum LC" 84481 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 Reverse T3 LC 84482 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 Reverse T3 RPS 84482 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 "T3 Reverse, LCMSMS NLL" 84482 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 Troponin T RPS 84484 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 TROPONIN 84484 $201.00 $201.00 $142.71 $201.00 $201.00 $142.71 $192.96 $188.94 $190.95 $196.98 Troponin I 84484 $201.00 $201.00 $142.71 $201.00 $201.00 $142.71 $192.96 $188.94 $190.95 $196.98 Blood Urea Nitrogen 84520 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 Urea Nitrogen Clearance LC 84545 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 Uric Acid 84550 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 "Uric Acid, Body Fluid LC" 84560 $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 Vanillylmandelic Acid (VMA) 24 Hour Urine ( NLL 84585 $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 Vitamin A NLL 84590 $162.00 $162.00 $115.02 $162.00 $162.00 $115.02 $155.52 $152.28 $153.90 $158.76 "Vitamin A, Serum LC" 84590 $162.00 $162.00 $115.02 $162.00 $162.00 $115.02 $155.52 $152.28 $153.90 $158.76 "Zinc, Serum NLL" 84630 $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 C-Peptide RPS 84681 $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 "C-Peptide, Serum LC" 84681 $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 "C-Peptide, Serum NLL" 84681 $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 84702 (4103600) PANEL COMPONENT 84702 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 84702 (4103840) PANEL COMPONENT 84702 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 "Beta Hcg, Tumor Mark RPS" 84702 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 Beta-HCG (Tumor Marker) NLL 84702 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 hCG Quantitative 84702 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 "hCG,Beta Subunit, Qnt, Serum LC" 84702 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 Serum Pregnancy Test 84703 $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 Hematocrit POC 85013 $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 Hematocrit 85014 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 Hemoglobin and Hematocrit 85014 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 HEMOGLOBIN 85018 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 Hemoglobin 85018 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 Hemoglobin POC 85018 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 CBC w/Diff Standard 85025 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Ob Panel RPS 85025 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Hemogram Standard 85027 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 G6PDH Activity LC 85041 $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 Retic Count NLL 85045 $47.00 $47.00 $33.37 $47.00 $47.00 $33.37 $45.12 $44.18 $44.65 $46.06 Reticulocyte Count LC 85045 $47.00 $47.00 $33.37 $47.00 $47.00 $33.37 $45.12 $44.18 $44.65 $46.06 Reticulocyte Count RPS 85046 $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 WBC with ANC 85048 $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 Platelet Count 85049 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 Coag Factor II Assay NLL 85210 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Coag Factor V Assay NLL 85220 $288.00 $288.00 $204.48 $288.00 $288.00 $204.48 $276.48 $270.72 $273.60 $282.24 Coag Factor VII Assay NLL 85230 $189.00 $189.00 $134.19 $189.00 $189.00 $134.19 $181.44 $177.66 $179.55 $185.22 85300 (4101126) PANEL COMPONENT 85300 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 Anti-Thrombin III RPS 85300 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 Thrombotic Risk Assessment LC 85300 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 85303 (4101113) PANEL COMPONENT 85303 $187.00 $187.00 $132.77 $187.00 $187.00 $132.77 $179.52 $175.78 $177.65 $183.26 85303 (4101126) PANEL COMPONENT 85303 $187.00 $187.00 $132.77 $187.00 $187.00 $132.77 $179.52 $175.78 $177.65 $183.26 Protein C Activity RPS 85303 $187.00 $187.00 $132.77 $187.00 $187.00 $132.77 $179.52 $175.78 $177.65 $183.26 Protein C-Functional LC 85303 $187.00 $187.00 $132.77 $187.00 $187.00 $132.77 $179.52 $175.78 $177.65 $183.26 Protein S-Functional LC 85303 $187.00 $187.00 $132.77 $187.00 $187.00 $132.77 $179.52 $175.78 $177.65 $183.26 85306 (4101113) PANEL COMPONENT 85306 $252.00 $252.00 $178.92 $252.00 $252.00 $178.92 $241.92 $236.88 $239.40 $246.96 85306 (4101126) PANEL COMPONENT 85306 $252.00 $252.00 $178.92 $252.00 $252.00 $178.92 $241.92 $236.88 $239.40 $246.96 Protein S Functional RPS 85306 $252.00 $252.00 $178.92 $252.00 $252.00 $178.92 $241.92 $236.88 $239.40 $246.96 85307 (4101113) PANEL COMPONENT 85307 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 85307 (4101126) PANEL COMPONENT 85307 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 85366 (4101126) PANEL COMPONENT 85366 $221.00 $221.00 $156.91 $221.00 $221.00 $156.91 $212.16 $207.74 $209.95 $216.58 85379 (4101126) PANEL COMPONENT 85379 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 D-Dimer 85379 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 85384 (4101126) PANEL COMPONENT 85384 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Fibrinogen Activity LC 85384 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Fibrinogen NLL 85384 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Fibrinogen RPS 85384 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 85390 (4101126) PANEL COMPONENT 85390 $277.00 $277.00 $196.67 $277.00 $277.00 $196.67 $265.92 $260.38 $263.15 $271.46 85420 (4101113) PANEL COMPONENT 85420 $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 Fetal Screen (Fetal Maternal Bleed) NLL 85461 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Fetomaternal Hemorrhage Screen LC 85461 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Reference Fetal Screen 85461 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 85520 Heparin assay 85520 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Heparin Anti-Xa LC 85520 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Leukocyte Alkaline Phos Score LC 85540 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 .Hexagonal Phase Phospholipid LC 85598 $159.00 $159.00 $112.89 $159.00 $159.00 $112.89 $152.64 $149.46 $151.05 $155.82 85610 (4101126) PANEL COMPONENT 85610 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 Lupus Panel RPS 85610 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 Prothrombin Time 85610 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 Protime/PTT 85610 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 .dRVVT Mix LC 85613 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 85613 (4101113) PANEL COMPONENT 85613 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 85613 (4101126) PANEL COMPONENT 85613 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 85613 (4103378) PANEL COMPONENT 85613 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 85613 Russell viper venom time (includes venom); diluted 85613 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 LC 85613 85613 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 Sed Rate (ESR) 85651 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 Hgb Solubility LC 85660 $30.00 $30.00 $21.30 $30.00 $30.00 $21.30 $28.80 $28.20 $28.50 $29.40 85670 (4101126) PANEL COMPONENT 85670 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 85670 Thrombin time; plasma 85670 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 PTT+PT+APCR+AT3 Funct+D Dimer LC 85670 $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 85730 (4101126) PANEL COMPONENT 85730 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 85730 (4103378) PANEL COMPONENT 85730 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 "85730 Thromboplastin time, partial (PTT); plasma or whole blood" 85730 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 LC 85730 85730 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 Partial Thromboplastin Time 85730 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 PTT 85730 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 .PTT-LA Mix LC 85732 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 85732 (4101113) PANEL COMPONENT 85732 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 Lupus Anticoagulant Reflex LC 85732 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 F001-IgE Egg White LC 86003 $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 F024-IgE Shrimp LC 86003 $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 F083-IgE Chicken LC 86003 $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 ANCA Screen w/Reflex w/Titer NLL 86021 $316.00 $316.00 $224.36 $316.00 $316.00 $224.36 $303.36 $297.04 $300.20 $309.68 Plt Associated Anti-Ia/IIa LC 86022 $694.00 $694.00 $492.74 $694.00 $694.00 $492.74 $666.24 $652.36 $659.30 $680.12 Plt Associated Anti-Ib/IX LC 86022 $694.00 $694.00 $492.74 $694.00 $694.00 $492.74 $666.24 $652.36 $659.30 $680.12 Plt Associated Anti-IIb/IIIa LC 86022 $694.00 $694.00 $492.74 $694.00 $694.00 $492.74 $666.24 $652.36 $659.30 $680.12 86038 (4100915) PANEL COMPONENT 86038 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 ANA Screen NLL 86038 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 Ana Screen Rflx To Anasrx RPS 86038 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 "Antinuclear AB, HEp-2 Substrate NLL" 86038 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 Antinuclear Antibodies Direct LC 86038 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 "Antinuclear Antibodies, IFA LC" 86038 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 Antistreptolysin O Ab LC 86060 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 "Antistreptolysin-O (ASO), Quant, NLL" 86060 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 C-Reactive Protein 86140 $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 86146 (4101113) PANEL COMPONENT 86146 $147.00 $147.00 $104.37 $147.00 $147.00 $104.37 $141.12 $138.18 $139.65 $144.06 BETA 2GP 1 ANTIBODY IGG 86146 $147.00 $147.00 $104.37 $147.00 $147.00 $104.37 $141.12 $138.18 $139.65 $144.06 BETA 2GP 1 ANTIBODY IGM 86146 $147.00 $147.00 $104.37 $147.00 $147.00 $104.37 $141.12 $138.18 $139.65 $144.06 LC 86146 86146 $147.00 $147.00 $104.37 $147.00 $147.00 $104.37 $141.12 $138.18 $139.65 $144.06 86147 (4101113) PANEL COMPONENT 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 86147 (4101155) PANEL COMPONENT 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 86147 Cardiolipin Abs RPS Add-On 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 "Anticardiolipin Ab, IgA, Qn LC" 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 "Anticardiolipin Ab, IgG/M, Qn LC" 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 Cardiolipin Abs RPS 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 "Cardiolipin Ab, Iga RPS" 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 Phospholipid Ab IgA NLL 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 PHOSPHOLIPID AB IGG 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 PHOSPHOLIPID AB IGM 86147 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 Complement C3 RPS 86160 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 "Complement C3, Serum LC" 86160 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Complement C4 RPS 86160 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "Complement C4, Serum LC" 86160 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "Complement, Total (CH50) LC" 86162 $166.00 $166.00 $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 ANA+CCP(IgG/A) Antibodies LC 86200 $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 CCP Antibodies IgG/IgA LC 86200 $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 "Ccp Antibody, Igg RPS" 86200 $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 Cyclic Citrullinated Peptide Ab NLL 86200 $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 Anti-dsDNA Antibodies LC 86225 $104.00 $104.00 $73.84 $104.00 $104.00 $73.84 $99.84 $97.76 $98.80 $101.92 Myeloperoxidase Ab RPS 86225 $104.00 $104.00 $73.84 $104.00 $104.00 $73.84 $99.84 $97.76 $98.80 $101.92 86235 (4101166) PANEL COMPONENT 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Ana Autoab Ssa RPS 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Ana Autoab Ssb RPS 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "Autoantibodies to SSA (Ro) Antigen, Serum NLL" 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Autoantibodies to SS-B/La (Sjogren's Syndrome AB)(SSB Autoantibodies) NLL 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "Sjogren's Ab, Anti-SS-A/-SS-B LC" 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Sjogren's Anti-SS-A LC 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 Sjogren's Anti-SS-B LC 86235 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "86256 Fluorescent noninfectious agent antibody; titer, each antibo" 86255 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 86255 (4102710) PANEL COMPONENT 86255 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 Ana Ifa Screen RPS 86255 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 dsDNA (nDNA) Scrn by Crithidia LC 86255 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 Endomysial Antibody IgA LC 86255 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 Neutrophil Cytoplasm RPS 86255 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 RETICULIN ANTIBODY 86255 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 Reticulin IgA Abs LC 86255 $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 86256 (4102710) PANEL COMPONENT 86256 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 86256 (4105565) PANEL COMPONENT 86256 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Antineutrophil Cytoplasmic Ab LC 86256 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 ENDOMYSIAL AB IGA SERUM 86256 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Endomysial Ab Titer RPS 86256 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 LC 86256 86256 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Ca 15-3 RPS 86300 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 CA 27.29 LC 86300 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 CA 27.29 NLL 86300 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 Ca27.29 RPS 86300 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 Cancer Antigen (CA) 15-3 LC 86300 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 CA 19-9 RPS 86301 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 Carbohydrate Ag 19-9 (Serial) LC 86301 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 Ca 125 RPS 86304 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 CA125 NLL 86304 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Cancer Antigen (CA) 125 LC 86304 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Rapid Mono Screen Standard 86308 $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 "Chromogranin A, Serum RPS" 86316 $235.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 Nuclear Matrix Protein (NMP) 22 LC 86316 $235.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 86317 (4103296) PANEL COMPONENT 86317 $127.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 Pneumococcal Ab RPS 86317 $127.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 Immunofixation Serum (Qualitative) NLL 86334 $161.00 $161.00 $114.31 $161.00 $161.00 $114.31 $154.56 $151.34 $152.95 $157.78 "Immunofixation, Serum LC" 86334 $161.00 $161.00 $114.31 $161.00 $161.00 $114.31 $154.56 $151.34 $152.95 $157.78 "Immunotyping with interp, serum PSPC/RPS" 86334 $161.00 $161.00 $114.31 $161.00 $161.00 $114.31 $154.56 $151.34 $152.95 $157.78 Immunofixation (IFE) Urine LC 86335 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Immunofixation Urine (Qualitative) NLL 86335 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Immunofixation/Urine RPS 86335 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 86336 (4103600) PANEL COMPONENT 86336 $154.00 $154.00 $109.34 $154.00 $154.00 $109.34 $147.84 $144.76 $146.30 $150.92 86336 (4103840) PANEL COMPONENT 86336 $154.00 $154.00 $109.34 $154.00 $154.00 $109.34 $147.84 $144.76 $146.30 $150.92 GAD65 AB Assay (Glutamic Acid Decarboxylase Antibody) NLL 86341 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 Glutamic Acid Decarboxylate PSPC 86341 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 LC 86376 86376 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Thyroid Ab Panel RPS 86376 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Thyroid Peroxidase (TPO) Ab LC 86376 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Thyroid Peroxidase (TPO) Antibody NLL 86376 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Thyroid Peroxidase A RPS 86376 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 THYROPEROXIDASE ANTIBODIES 86376 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Rheumatoid Factor 86431 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 Rheumatoid Factor. 86431 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 "M Tuberculosis, QuantiFERON (TB) NLL" 86480 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 QuantiFERON TB Gold (In Tube) LC 86480 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 Tb Interferon Ag RPS 86480 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 T-SPOT TB (Oxford Lab) NLL 86481 $219.00 $219.00 $155.49 $219.00 $219.00 $155.49 $210.24 $205.86 $208.05 $214.62 TB Skin Test POC 86580 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 RPR LC 86592 $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 Rpr RPS 86592 $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 RPR w/ Reflex Titer NLL 86592 $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 LC 86317 86609 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 LC 86618 86618 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Lyme Ab Total w Reflex LC 86618 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Lyme Antibody RPS 86618 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 LYME DISEASE SEROLOGY 86618 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Lyme Disease Serology NLL 86618 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 "Lyme, Western Blot, Serum LC" 86618 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 86638 (4104655) PANEL COMPONENT 86638 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 LC 86638 86638 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 86644 (4105200) PANEL COMPONENT 86644 $140.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 CMV Abs IgG/IgM LC 86644 $140.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 "Cytomegalovirus (CMV) Ab, IgG LC" 86644 $140.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 LC 86644 86644 $140.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 86645 (4105205) PANEL COMPONENT 86645 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "Cytomegalovirus (CMV) Ab, IgM LC" 86645 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 LC 86645 86645 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Ebv Antibody RPS 86663 $104.00 $104.00 $73.84 $104.00 $104.00 $73.84 $99.84 $97.76 $98.80 $101.92 "EBV Early Antigen Ab, IgG LC" 86663 $104.00 $104.00 $73.84 $104.00 $104.00 $73.84 $99.84 $97.76 $98.80 $101.92 "EBV Early Antigen Ab, IgG LC" 86663 $104.00 $104.00 $73.84 $104.00 $104.00 $73.84 $99.84 $97.76 $98.80 $101.92 86664 (4102110) PANEL COMPONENT 86664 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 "86664 Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)" 86664 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 "EBV Nuclear Antigen Ab, IgG LC" 86664 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 "EBV Nuclear Antigen Ab, IgG LC" 86664 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 86665 (4102110) PANEL COMPONENT 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 "86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)" 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 "EBV Ab VCA IgM, LC" 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 "EBV Ab VCA, IgG LC" 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 "EBV Ab VCA, IgM LC" 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 "EBV Ab VCA, IgM LC" 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 EBV Acute Infection Antibodies LC 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 "Epstein-Barr Virus VCA, IgG NLL" 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 "Epstein-Barr Virus VCA, IgM NLL" 86665 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 86666 (4109812) PANEL COMPONENT 86666 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 "Ehrlichia Igg, Igm RPS" 86666 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 LC 86666 86666 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 86671 (4105564) PANEL COMPONENT 86671 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Saccharomyces Cerevisiae Ab, IgA NLL" 86671 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Saccharomyces cerevisiae Panel LC 86671 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 H PYLORI AB IGA 86677 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 H PYLORI AB IGG 86677 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 H PYLORI AB IGM 86677 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 H Pylori AB IgM LC 86677 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 "H. pylori IgG, Abs LC" 86677 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 "Helicobacter Pylori AB, IgG NLL" 86677 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 "Helicobacter pylori, IgA LC" 86677 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 HIV Confirmation RPS 86689 $97.00 $97.00 $68.87 $97.00 $97.00 $68.87 $93.12 $91.18 $92.15 $95.06 86694 (4101175) PANEL COMPONENT 86694 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 LC 86694 86694 $120.00 $120.00 $85.20 $120.00 $120.00 $85.20 $115.20 $112.80 $114.00 $117.60 86695 (4101175) PANEL COMPONENT 86695 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 Hsv 1 And 2 Panel RPS 86695 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 LC 86695 86695 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 86696 (4101175) PANEL COMPONENT 86696 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 "86696 Antibody; herpes simplex, type 2" 86696 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 LC 86696 86696 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 86702 Antibody; HIV-2 86702 $149.00 $149.00 $105.79 $149.00 $149.00 $105.79 $143.04 $140.06 $141.55 $146.02 "Hep B Core Ab, Tot LC" 86704 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 "Hepatitis B Core Ab, Total NLL" 86704 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 Hepatitis B/C Ab RPS 86704 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 Hep B Surface Ab Qual LC 86706 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Hepatitis B Surface AB (HBS AB) NLL 86706 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "Hepatitis B Surface Ab, Immune Status NLL" 86706 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Hepatitis B/S Ab RPS 86706 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Hep Be Ab LC 86707 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 LC 86735 86735 $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 Mumps Ab IgM NLL 86735 $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 "Mumps Antibodies, IgG LC" 86735 $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 "Mumps Antibodies, IgM LC" 86735 $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 Mumps Antibody Igg RPS 86735 $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 Mumps IgG Screen NLL 86735 $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 LC 86753 86753 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 PROTOZOA AB 86753 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 LC 86757 86757 $165.00 $165.00 $117.15 $165.00 $165.00 $117.15 $158.40 $155.10 $156.75 $161.70 ROCKY MOUNTAIN (PANEL COMPONENT) 86757 $165.00 $165.00 $117.15 $165.00 $165.00 $117.15 $158.40 $155.10 $156.75 $161.70 86762 Antibody; rubella 86762 $84.00 $84.00 $59.64 $84.00 $84.00 $59.64 $80.64 $78.96 $79.80 $82.32 LC 86762 86762 $84.00 $84.00 $59.64 $84.00 $84.00 $59.64 $80.64 $78.96 $79.80 $82.32 "Rubella Ab, IgG NLL" 86762 $84.00 $84.00 $59.64 $84.00 $84.00 $59.64 $80.64 $78.96 $79.80 $82.32 "Rubella Antibodies, IgG LC" 86762 $84.00 $84.00 $59.64 $84.00 $84.00 $59.64 $80.64 $78.96 $79.80 $82.32 Rubella Igg Eia RPS 86762 $84.00 $84.00 $59.64 $84.00 $84.00 $59.64 $80.64 $78.96 $79.80 $82.32 LC 86765 86765 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 Measles(Rubeola) Igg RPS 86765 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 "Rubeola (Measles) AB, IgG NLL" 86765 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 "Rubeola Antibodies, IgG LC" 86765 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 "SARS-CoV-2 (COVID-19) Antibody, IgG RPS" 86769 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 Tetanus Antitoxoid IgG Ab LC 86774 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 86780 Antibody; Treponema pallidum 86780 $79.00 $79.00 $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 Syphilis IgG RPS 86780 $79.00 $79.00 $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 Varicella Ab Screen RPS 86787 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 "Varicella-Zoster V Ab, IgG LC" 86787 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 "Varicella-Zoster Virus, IgG NLL" 86787 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 86788 (4102610) PANEL COMPONENT 86788 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 LC 86789 86788 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "West Nile Igg Igm,Se RPS" 86788 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 86789 (4102610) PANEL COMPONENT 86789 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 86789 Antibody; West Nile virus 86789 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 LC 86788 86789 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 LC 86790 86790 $245.00 $245.00 $173.95 $245.00 $245.00 $173.95 $235.20 $230.30 $232.75 $240.10 86800 (4103650) PANEL COMPONENT 86800 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 86800 Thyroglobulin antibody 86800 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 Anti-Thyroglobulin RPS 86800 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 LC 86800 86800 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 Thyroglobulin (Tg) Antibody NLL 86800 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 THYROGLOBULIN AB 86800 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 Thyroglobulin Antibody LC 86800 $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 HCV Antibody LC 86803 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 Hepatitis C (HCV) Ab NLL 86803 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 Hepatitis C Antibody RPS 86803 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 Antibody Screen Gel 86850 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 REF Antibody Screen LISA 86850 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Reference Elution 86860 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 Bill ABID 86870 $169.00 $169.00 $119.99 $169.00 $169.00 $119.99 $162.24 $158.86 $160.55 $165.62 REF Antibody Screen 86870 $169.00 $169.00 $119.99 $169.00 $169.00 $119.99 $162.24 $158.86 $160.55 $165.62 REF Antibody Screen Modified 86870 $169.00 $169.00 $119.99 $169.00 $169.00 $119.99 $162.24 $158.86 $160.55 $165.62 Direct Coombs 86880 $77.00 $77.00 $54.67 $77.00 $77.00 $54.67 $73.92 $72.38 $73.15 $75.46 Ref DAT 86880 $77.00 $77.00 $54.67 $77.00 $77.00 $54.67 $73.92 $72.38 $73.15 $75.46 ABORh 86900 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 Newborn ABORh 86900 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 Reference ABO/Rh 86900 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 REF Weak D with ABO/Rh RPS 86901 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 Reference Weak D 86901 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 Rh Typing 86901 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 Bill Antigen Type RBCs 86902 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 Bill Only Antigen Testing 86905 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 REF Antigen Type 86905 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 Compatible - Computer XM Interp 86922 $189.00 $189.00 $134.19 $189.00 $189.00 $134.19 $181.44 $177.66 $179.55 $185.22 Compatible - X-Match AHG Interp 86922 $189.00 $189.00 $134.19 $189.00 $189.00 $134.19 $181.44 $177.66 $179.55 $185.22 REF Crossmatch 86922 $189.00 $189.00 $134.19 $189.00 $189.00 $134.19 $181.44 $177.66 $179.55 $185.22 REF Antibody Screen Warm 86978 $199.00 $199.00 $141.29 $199.00 $199.00 $141.29 $191.04 $187.06 $189.05 $195.02 LC 87015 87015 $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 Blood Culture - Aerobic Only RPS 87040 $183.00 $183.00 $129.93 $183.00 $183.00 $129.93 $175.68 $172.02 $173.85 $179.34 Blood Culture RPS 87040 $183.00 $183.00 $129.93 $183.00 $183.00 $129.93 $175.68 $172.02 $173.85 $179.34 "Blood Culture, Routine LC" 87040 $183.00 $183.00 $129.93 $183.00 $183.00 $129.93 $175.68 $172.02 $173.85 $179.34 "Culture, Blood NLL" 87040 $183.00 $183.00 $129.93 $183.00 $183.00 $129.93 $175.68 $172.02 $173.85 $179.34 87045 (4100800) PANEL COMPONENT 87045 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 87045 (4101030) PANEL COMPONENT 87045 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 LC 87045 87045 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 Stool Cult By Eia RPS 87045 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 87046 (4100800) PANEL COMPONENT 87046 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 87046 (4101030) PANEL COMPONENT 87046 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 "87046 Culture, bacterial; stool, aerobic, additional pathogens, is" 87046 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 "Culture, Yersinia NLL" 87046 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 LC 87046 87046 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 87070 (4104610) PANEL COMPONENT 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 87070 (4105640) PANEL COMPONENT 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 87070 (4105655) PANEL COMPONENT 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Aerobe/Anaerobe Cult RPS 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Aerobic Bacterial Culture LC 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Aerobic Culture RPS 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 "Culture, Ear NLL" 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 "Culture, Environmental NLL" 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 "Culture, Superficial Wound NLL" 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 "Culture, Throat NLL" 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Environmental Culture LC 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 "Genital Culture, Routine LC" 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Gram Stain w/Sputum Cult Rflx LC 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Gram Stain/Body Fluid Culture LC 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 LC 87070 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Sputum Culture RPS 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Synovial Fluid Cultu RPS 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Tissue Culture RPS 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Upper Respiratory Culture LC 87070 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 87075 (4105640) PANEL COMPONENT 87075 $113.00 $113.00 $80.23 $113.00 $113.00 $80.23 $108.48 $106.22 $107.35 $110.74 87075 (4105655) PANEL COMPONENT 87075 $113.00 $113.00 $80.23 $113.00 $113.00 $80.23 $108.48 $106.22 $107.35 $110.74 "87075 Culture, bacterial; any source, except blood, anaerobic with" 87075 $113.00 $113.00 $80.23 $113.00 $113.00 $80.23 $108.48 $106.22 $107.35 $110.74 LC 87075 87075 $113.00 $113.00 $80.23 $113.00 $113.00 $80.23 $108.48 $106.22 $107.35 $110.74 Bill Only - CULTURE ID 87077 $79.00 $79.00 $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 87081 (4105445) PANEL COMPONENT 87081 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Beta Strep Gp A Culture LC 87081 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Grp B Strep Culture RPS 87081 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 LC 87081 87081 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 MRSA Screening Culture LC 87081 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 "Culture, Urine NLL" 87086 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Urine Culture RPS 87086 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 "Urine Culture, Routine LC" 87086 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Bill only - Culture Presumptive ID 87088 $76.00 $76.00 $53.96 $76.00 $76.00 $53.96 $72.96 $71.44 $72.20 $74.48 Fungus Cult Dermatop RPS 87101 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 Fungal Culture RPS 87102 $124.00 $124.00 $88.04 $124.00 $124.00 $88.04 $119.04 $116.56 $117.80 $121.52 Fungus Culture With Stain LC 87102 $124.00 $124.00 $88.04 $124.00 $124.00 $88.04 $119.04 $116.56 $117.80 $121.52 Fungal Blood Culture RPS 87103 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 Bill Only - FUNGAL ID 87106 $108.00 $108.00 $76.68 $108.00 $108.00 $76.68 $103.68 $101.52 $102.60 $105.84 Bill Only - ID FUNGAL MOLD 87107 $57.00 $57.00 $40.47 $57.00 $57.00 $40.47 $54.72 $53.58 $54.15 $55.86 Afb Cult & Smear RPS 87116 $154.00 $154.00 $109.34 $154.00 $154.00 $109.34 $147.84 $144.76 $146.30 $150.92 LC 87116 87116 $154.00 $154.00 $109.34 $154.00 $154.00 $109.34 $147.84 $144.76 $146.30 $150.92 Bill Only - Immunologic ID 87147 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 Culture Serol 87147 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 87150 Blood Path Panel RPS 87150 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 Blood Path Panel RPS 87150 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 Bill Only - Anaerobe ID 87153 $486.00 $486.00 $345.06 $486.00 $486.00 $345.06 $466.56 $456.84 $461.70 $476.28 "87176 Homogenization, tissue, for culture" 87176 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 87177 (4105385) PANEL COMPONENT 87177 $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 LC 87177 87177 $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 Ova & Parasite (Foreign Travel Only) RPS 87177 $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 Bill Only - CULTURE SENSITIVITY 3 87184 $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 Bill Only - CULTURE SENSITIVITY 87186 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Bill Only - CULTURE SUSCEPTIBILITY 87186 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 Bill Only - ET Susceptibility 87188 $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 Bill Only - KB Susceptibility 87188 $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 87205 (4104610) PANEL COMPONENT 87205 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 87205 (4105640) PANEL COMPONENT 87205 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 87205 (4105655) PANEL COMPONENT 87205 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 "87205 Smear, primary source with interpretation; Gram or Giemsa st" 87205 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 Gram Stain Evaluation With Sputum Culture Reflex LC 87205 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 Gram Stain LC 87205 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 LC 87205 87205 $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 "87206 Smear, primary source with interpretation; fluorescent and/o" 87206 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 Acid Fast Smear LC 87206 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 LC 87206 87206 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 87207 (4102575) PANEL COMPONENT 87207 $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 87209 (4105385) PANEL COMPONENT 87209 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 LC 87209 87209 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 "87209 Smear, primary source with interpretation; complex special s" 87209 $51.00 $- $- $- $- $- $- $- $- Wet Prep 3 87210 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 Galactomannan Bal RPS 87305 $271.00 $271.00 $192.41 $271.00 $271.00 $192.41 $260.16 $254.74 $257.45 $265.58 Crypto Ag By Eia RPS 87328 $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 Cryptosporidium Detection LC 87328 $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 Giardia Ag By Eia RPS 87329 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 Giardia Ag EIA Stool NLL 87329 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "Giardia Lamblia Direct Detection EIA, LC" 87329 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "H. pylori Stool Ag, EIA LC" 87338 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 H. Pylori Stool Anti RPS 87338 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 "Helicobacter pylori Antigen, Feces NLL" 87338 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 "87340 Infectious agent antigen detection by immunoassay technique," 87340 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 HBsAg Screen LC 87340 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 Hepatitis B Surface Ag Qual. (HBS) w/ reflex Confirmation NLL 87340 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 Hepatitis B/S Ag RPS 87340 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 "Hepatitis Be Ag, LC" 87350 $112.00 $112.00 $79.52 $112.00 $112.00 $79.52 $107.52 $105.28 $106.40 $109.76 "Histoplasma Ag Eia, RPS" 87385 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 Histoplasma Ag Serum RPS 87385 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 "Histoplasma Ag, U NLL" 87385 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 "Histoplasma Antigen, Urine LC" 87385 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 "87389 Infectious agent antigen detection by immunoassay technique," 87389 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 HIV 1/2 Evaluation w/ reflex to Confirmation NLL 87389 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 HIV 4th Gen Screen w Reflex LC 87389 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 Hiv Ag/Ab Panel RPS 87389 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 "87390 Infectious agent antigen detection by immunoassay technique," 87390 $44.00 $44.00 $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 Influenza A&B 2 87400 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 INFLUENZA B 87400 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 Respiratory Syncytial Virus 2 87420 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 "Rotavirus Ag, EIA LC" 87425 $152.00 $152.00 $107.92 $152.00 $152.00 $107.92 $145.92 $142.88 $144.40 $148.96 Rotavirus by EIA NLL 87425 $152.00 $152.00 $107.92 $152.00 $152.00 $107.92 $145.92 $142.88 $144.40 $148.96 87427 (4100800) PANEL COMPONENT 87427 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 E coli Shiga Toxin EIA LC 87427 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 E. Coli Shiga Toxin w/ Reflex Culture NLL 87427 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 LC 87427 87427 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 L. pneumophila Serogp 1 Ur Ag LC 87449 $168.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 Candida DNA Probe RPS 87480 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 87486 Infectious agent detection by nucleic acid (DNA or RNA); Chl 87486 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 Chlam/Gc Amp Probe RPS 87491 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 "Chlamydia trachomatis, NAA LC" 87491 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 "Chlamydia Trachomatis, Swab/Urine NLL" 87491 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 C Diff 87493 $165.00 $165.00 $117.15 $165.00 $165.00 $117.15 $158.40 $155.10 $156.75 $161.70 C Diff Toxin EIA Screen Standard 87493 $165.00 $165.00 $117.15 $165.00 $165.00 $117.15 $158.40 $155.10 $156.75 $161.70 Flu A & B 87502 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 GI Pathogen Panel w/ Reflex NLL 87507 "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,000.64 " "$1,958.96 " "$1,979.80 " "$2,042.32 " "GI Profile, Stool, PCR LC" 87507 "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,000.64 " "$1,958.96 " "$1,979.80 " "$2,042.32 " Gardnerella DNA Probe RPS 87510 $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 HBV Real-Time PCR Qn LC 87517 $403.00 $403.00 $286.13 $403.00 $403.00 $286.13 $386.88 $378.82 $382.85 $394.94 Hcv Rna Detect/Quant RPS 87522 $489.00 $489.00 $347.19 $489.00 $489.00 $347.19 $469.44 $459.66 $464.55 $479.22 "HCV RT-PCR, Quant (Non-Graph) LC" 87522 $489.00 $489.00 $347.19 $489.00 $489.00 $347.19 $469.44 $459.66 $464.55 $479.22 Hepatitis C Virus (HCV) Detect/Quant by RT-PCR NLL 87522 $489.00 $489.00 $347.19 $489.00 $489.00 $347.19 $469.44 $459.66 $464.55 $479.22 "Hepatitis C, RNA, Quant PCR NLL" 87522 $489.00 $489.00 $347.19 $489.00 $489.00 $347.19 $469.44 $459.66 $464.55 $479.22 87529 (4102360) PANEL COMPONENT 87529 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 HERPES SIMPLEX VIRUS 1 BY NAAT 87529 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 HERPES SIMPLEX VIRUS 2 BY NAAT 87529 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 HSV 1/2 NAA LC 87529 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 Hsv Direct Swab RPS 87529 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 HSV NAA LC 87529 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 LC 87529 87529 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 HIV RNA Quant Ultra RPS 87536 $519.00 $519.00 $368.49 $519.00 $519.00 $368.49 $498.24 $487.86 $493.05 $508.62 87581 (4104657) PANEL COMPONENT 87581 $171.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 87581 Infectious agent detection by nucleic acid (DNA or RNA); Myc 87581 $171.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 Mycoplasma pneumoniae by PCR NLL 87581 $171.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 87591 Infectious agent detection by nucleic acid (DNA or RNA); Nei 87591 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 "N. Gonorrhoeae, Swab/Urine NLL" 87591 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 Neisseria gonorrhoeae NAA LC 87591 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 87633 (4104657) PANEL COMPONENT 87633 "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,000.64 " "$1,958.96 " "$1,979.80 " "$2,042.32 " RVP PCR LC 87633 "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,084.00 " "$2,084.00 " "$1,479.64 " "$2,000.64 " "$1,958.96 " "$1,979.80 " "$2,042.32 " SARS-CoV-2 (COVID-) RNA (ID NOW) 87635 $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 Strep A Molecular 87651 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 Trichomonas DNA Probe RPS 87660 $89.00 $89.00 $63.19 $89.00 $89.00 $63.19 $85.44 $83.66 $84.55 $87.22 87798 (4102360) PANEL COMPONENT 87798 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 87798 (4104657) PANEL COMPONENT 87798 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 "87798 Infectious agent detection by nucleic acid (DNA or RNA), not" 87798 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 Bordetella Pertussis-Parapertussis NLL 87798 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 Bordetella Pertussis-Parapertussis NLL ADD-ON 87798 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 LC 87798 87798 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 "BK Virus DNA Detection and Quantitation, Blood RPS" 87799 $669.00 $669.00 $474.99 $669.00 $669.00 $474.99 $642.24 $628.86 $635.55 $655.62 Respiratory Syncytial Virus 87801 $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 87880 Rapid Strep 87880 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 Rapid Strep POC 87880 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 Strep A EIA Screen Standard 87880 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 87880 ICON STREP SCREEN 87880 $75.00 $- $- $- $- $- $- $- $- Bill Only - CYTOSELECTIVE CELL INHANCEMENT 88112 $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 Bill Only - Pap Hospital 88142 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Bill Only - CYTOLOGY CONC TECH/ SMEAR STUDY 88160 $302.00 $302.00 $214.42 $302.00 $302.00 $214.42 $289.92 $283.88 $286.90 $295.96 Bill Only - SUGICAL PATH FINE NEEDLE INTERP ONLY 88173 $653.00 $653.00 $463.63 $653.00 $653.00 $463.63 $626.88 $613.82 $620.35 $639.94 Bill Only - SURGICAL PATH FINE NEEDLE INTERP ONLY #2 88173 $653.00 $653.00 $463.63 $653.00 $653.00 $463.63 $626.88 $613.82 $620.35 $639.94 "Surgery Path, Gross only" 88300 $89.00 $89.00 $63.19 $89.00 $89.00 $63.19 $85.44 $83.66 $84.55 $87.22 Bill Only - SURGICAL PATH LEVEL II GROSS AND MICRO 88302 $71.00 $71.00 $50.41 $71.00 $71.00 $50.41 $68.16 $66.74 $67.45 $69.58 Bill Only - SURGICAL PATH LEVEL III GROSS AND MICRO 88304 $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 Bill Only - SURGICAL PATH LEVEL IV GROSS AND MICRO 88305 $175.00 $175.00 $124.25 $175.00 $175.00 $124.25 $168.00 $164.50 $166.25 $171.50 Bill Only - SURGICAL PATH LEVEL V GROSS AND MICRO 88307 "$1,138.00 " "$1,138.00 " $807.98 "$1,138.00 " "$1,138.00 " $807.98 "$1,092.48 " "$1,069.72 " "$1,081.10 " "$1,115.24 " Bill Only - SURGICAL PATH LEVEL VI GROSS AND MICRO 88309 "$1,733.00 " "$1,733.00 " "$1,230.43 " "$1,733.00 " "$1,733.00 " "$1,230.43 " "$1,663.68 " "$1,629.02 " "$1,646.35 " "$1,698.34 " Bill Only - DECALCIFICATION 88311 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 Bill Only - SURGICAL PATH SPECIAL STAINS FOR MICRO ORGANISMS 88312 $424.00 $424.00 $301.04 $424.00 $424.00 $301.04 $407.04 $398.56 $402.80 $415.52 "Surgery Path, Special Stain-other" 88313 $304.00 $304.00 $215.84 $304.00 $304.00 $215.84 $291.84 $285.76 $288.80 $297.92 Peroxidase Leukocyte RPS 88319 $289.00 $289.00 $205.19 $289.00 $289.00 $205.19 $277.44 $271.66 $274.55 $283.22 Bill Only - IMMUNOPEROXIDASE STAIN ADDITIONAL STAIN MEDICARE 88341 $394.00 $394.00 $279.74 $394.00 $394.00 $279.74 $378.24 $370.36 $374.30 $386.12 Bill Only - IMMUNOPEROXIDASE STAIN (NON MEDICARE) 88342 $452.00 $452.00 $320.92 $452.00 $452.00 $320.92 $433.92 $424.88 $429.40 $442.96 Bill Only - IMMUNOPEROXIDASE STAIN MEDICARE 88342 $452.00 $452.00 $320.92 $452.00 $452.00 $320.92 $433.92 $424.88 $429.40 $442.96 Bill Only - IMMUNO CYTO CHEMISTRY HER2 88361 $375.00 $375.00 $266.25 $375.00 $375.00 $266.25 $360.00 $352.50 $356.25 $367.50 Bill Only - IMMUNO CYTO CHEMISTRY KI 67 88361 $375.00 $375.00 $266.25 $375.00 $375.00 $266.25 $360.00 $352.50 $356.25 $367.50 Bill Only - RECEPTOR ASSAY ESTROGEN 88361 $375.00 $375.00 $266.25 $375.00 $375.00 $266.25 $360.00 $352.50 $356.25 $367.50 Bill Only - RECEPTOR ASSAY PROGESTERONE 88361 $375.00 $375.00 $266.25 $375.00 $375.00 $266.25 $360.00 $352.50 $356.25 $367.50 Bill Only - CULTURE CELL COUNT 89050 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 Bill Only - SPECIAL STAIN OTHER 89050 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 Fluid Cell Count NLL 89050 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 "Cell Count, CSF LC" 89051 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 "Cell Ct, Serous Fluid LC" 89051 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 Fluid Cell Cnt & Dif RPS 89051 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 Fluid Cell Count w/Cell ID NLL 89051 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 Leukocytes Stool NLL 89055 $74.00 $74.00 $52.54 $74.00 $74.00 $52.54 $71.04 $69.56 $70.30 $72.52 "White Blood Cells (WBC), Stool LC" 89055 $74.00 $74.00 $52.54 $74.00 $74.00 $52.54 $71.04 $69.56 $70.30 $72.52 Crystal Id/Fluid RPS 89060 $71.00 $71.00 $50.41 $71.00 $71.00 $50.41 $68.16 $66.74 $67.45 $69.58 "Crystal, Synovial/Fluid LC" 89060 $71.00 $71.00 $50.41 $71.00 $71.00 $50.41 $68.16 $66.74 $67.45 $69.58 Synovial Fluid Crystals NLL 89060 $71.00 $71.00 $50.41 $71.00 $71.00 $50.41 $68.16 $66.74 $67.45 $69.58 Semen Morphology incl. Cell Count NLL 89320 $171.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 Semen Post Vasectomy 89321 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Resp Syncytial Virus Immun Glo 90378 "$2,124.50 " "$2,124.50 " "$1,508.40 " "$2,124.50 " "$2,124.50 " "$1,508.40 " "$2,039.52 " "$1,997.03 " "$2,018.28 " "$2,082.01 " PALIVIZUMAB (SYNAGIS) 100MG/1ML VIAL 90378 "$4,011.50 " "$4,011.50 " "$2,848.17 " "$4,011.50 " "$4,011.50 " "$2,848.17 " "$3,851.04 " "$3,770.81 " "$3,810.93 " "$3,931.27 " "90385 Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use" 90384 $227.00 $227.00 $161.17 $227.00 $227.00 $161.17 $217.92 $213.38 $215.65 $222.46 390471 ED IMMUNIZATION ADMIN CHARGE 90471 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 90471 H1N1 FLU VACCINE ADMIN 90471 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 90471 Immunization administration; 1 vaccine 90471 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Admin Immunization Technical Charge 90471 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 IMMUNIZATION ADMIN CHARGE 90471 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Immunization Admin Single Or Combination POC 90471 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Each additional vaccine 90472 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 "90473 Immunization administration, oral" 90473 $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 90474 Immunization Administration by intranasal or oral route; each additional vaccine Charge 90474 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 Admin Charge 90474 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 VFC 90734 Meningococcal Vaccine 90620 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Bexsero - Meningococcal Group B Vaccine 0.5 mg 90620 $391.00 $391.00 $277.61 $391.00 $391.00 $277.61 $375.36 $367.54 $371.45 $383.18 J3490 Meingococcal 90620 $391.00 $391.00 $277.61 $391.00 $391.00 $277.61 $375.36 $367.54 $371.45 $383.18 Influenza ID (Fluzone QIV) PF 0.1ML 90630 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 "90632 Hepatitis A vaccine, adult dosage, for intramuscular use" 90632 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 Havrix Hepatitis A Adult Vaccine 90632 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 Havrix - Hepatitis A Ped/Adol Vac 2 Dose 90633 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "90633 VFC - Hep A vaccine, pediatric/adolescent dosage-2 dose schedule, IM" 90633 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "VFC 90647 Hemophilus Influenza B Vaccine (Hib), PRP-OMP conj. 3-dose IM use POC" 90647 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "Hemophilus Influenza B Vaccine (Hib), PRP-OMP conj. 3-dose IM use POC" 90647 $208.00 $208.00 $147.68 $208.00 $208.00 $147.68 $199.68 $195.52 $197.60 $203.84 90648 VFC Comvax Prog Hib and Hep 90648 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "90648 VFC-Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), IM" 90648 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose), IM POC" 90648 $154.00 $154.00 $109.34 $154.00 $154.00 $109.34 $147.84 $144.76 $146.30 $150.92 "90649 VFC-Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule," 90649 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 VFC 90651 HPV 90651 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 HPV (human papillomavirus vaccine) 90651 $294.00 $294.00 $208.74 $294.00 $294.00 $208.74 $282.24 $276.36 $279.30 $288.12 90655 VFC Influenza 6-35 months 90655 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 90656 VFC Influenza 90656 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 VFC Flu Vaccine Split 6-35 Months IM POC 90657 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Flu Vaccine Live Intranasal POC 90660 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "Influenza Vaccine, QIV" 90662 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 "90670 VFC- Pneumococcal conjugate vaccine, 13 valent, IM" 90670 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 pneumococcal 13-valent vaccine 90670 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 "Pneumococcal conjugate vaccine, 13 valent, for IM use" 90670 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 "Pneumococcal conjugate vaccine, 13 valent, for intramuscular use" 90670 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 Prevnar 13 (PCV13) pneumococcal conj vac 90670 $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 Rabies Vaccine (Rabavert) IM 90675 "$1,135.00 " "$1,135.00 " $805.85 "$1,135.00 " "$1,135.00 " $805.85 "$1,089.60 " "$1,066.90 " "$1,078.25 " "$1,112.30 " Medication Charge 90680 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 Medication Charge 90680 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Quadrivalent Preservative Free Influenza Vaccine 6-35mos 90685 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 Flublok Influenza QV 90686 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "Influenza virus vaccine, quadrivalent, split virus, preservative free, >3 yrs, for IM use" 90686 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 Quadrivalent Preservative Free Influenza Vaccine +6mo 90686 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "Typhoid vaccine, Vi capsular polysaccharide (ViCPs) IM use" 90691 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 Kinrix-Diphth/tet/acc pertussis/polio(DTaP) 90696 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "90696 VFC - DtaP/IPV Kindrix- Diphtheria, tetanus toxoids, acellular pertussis vaccine and polioviru" 90696 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovir" 90698 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 Infanrix (DTaP) under 7 yrs 90700 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "90700 VFC - Dtap- Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), younger than" 90700 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "90700 VFC - Dtap- Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), younger than" 90700 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "90707 VFC- Measles, mumps and rubella virus vaccine (MMR), live, SQ" 90707 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 MMR Measles/Mumps/Rubella Vacc POC 90707 $273.00 $273.00 $193.83 $273.00 $273.00 $193.83 $262.08 $256.62 $259.35 $267.54 Proquad (MMRV) live 90710 $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 "90710 VFC- Measles, mumps, rubella, and varicella vaccine (MMRV), live, SQ" 90710 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "90713 VFC- Poliovirus vaccine, inactivated (IPV), SQ or IM" 90713 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 IPV Inactivated Poliovirus Vaccine POC 90713 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 90714 Tenivac Tetanus-diphtheria (Td) PF 7yrs up [CHAS] 90714 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 90715 VFC Tdap Vaccine 7+years 90715 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 "90715 Tetanus, diphtheria toxoids & acellular pertussis vaccine (TdaP), 7 years or older, IM [CHAS]" 90715 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 BOOSTRIX (Tdap) 0.5ML SYR >10YRS 90715 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "90716 VFC- Varicella virus vaccine, live, SQ" 90716 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Varivax - Varicella Virus Vacc POC 90716 $354.00 $354.00 $251.34 $354.00 $354.00 $251.34 $339.84 $332.76 $336.30 $346.92 "90723 VFC- Pediarix DTAP Hep B- Diphtheria, tetanus toxids, acellular pertussis vaccine, Hep B, an." 90723 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Diphth/HepB/Pertussis/Polio/Tetanus POC 90723 $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 90732 Pneumovax Pneumococcal 23-Valent Adult [CHAS] 90732 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 "90734 VFC-Meningococcal conjugate vaccine, serogroups A, C, Y, and W-135 (tetravalent), IM" 90734 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 90734 Menactra-meningococcal conj vacc ACYW 13[CHAS] 90734 $282.00 $282.00 $200.22 $282.00 $282.00 $200.22 $270.72 $265.08 $267.90 $276.36 90736 Zostavax - Zoster (shingles) vacc-live [CHAS] 90736 $400.00 $400.00 $284.00 $400.00 $400.00 $284.00 $384.00 $376.00 $380.00 $392.00 "90740 Hepatitis B vaccine, adult dosage, for intramuscular use" 90740 "$1,287.00 " "$1,287.00 " $913.77 "$1,287.00 " "$1,287.00 " $913.77 "$1,235.52 " "$1,209.78 " "$1,222.65 " "$1,261.26 " "90744 VFC- Hep B vaccine, pediatric/adolescent dosage-3 dose schedule, IM" 90744 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Engerix (Recombinant Hep B) 90744 90744 $272.00 $272.00 $193.12 $272.00 $272.00 $193.12 $261.12 $255.68 $258.40 $266.56 Engerix B (HepB) Vacc Peds 3 dose 90744 $272.00 $272.00 $193.12 $272.00 $272.00 $193.12 $261.12 $255.68 $258.40 $266.56 90746 Engerix B (HepB) Vacc Adult 3 dose [CHAS] 90746 $185.00 $185.00 $131.35 $185.00 $185.00 $131.35 $177.60 $173.90 $175.75 $181.30 Shingrix Zoster vccine (HZV) recomb/adjuv 90750 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 90785 PHYOCHOTHERAPY COMPLEX INTERACTIVE 90785 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 90791 $747.00 $- $747.00 $530.37 $747.00 $747.00 $530.37 $717.12 $702.18 $709.65 $732.06 90791 PSYCH EVAL 90791 $299.00 $- $- $- $- $- $- $- $- 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 90792 $832.00 $- $832.00 $590.72 $832.00 $832.00 $590.72 $798.72 $782.08 $790.40 $815.36 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES 90832 $192.00 $- $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 16 - 37 mins. Individual Psychotherapy 90832 $192.00 $- $- $- $- $- $- $- $- "Psychotherapy, 30 minutes" 90833 $192.00 $192.00 $136.32 $192.00 $192.00 $136.32 $184.32 $180.48 $182.40 $188.16 90834 PSYCHOTHERAPY W/PATIENT 45 MIN 90834 $260.00 $- $260.00 $184.60 $260.00 $260.00 $184.60 $249.60 $244.40 $247.00 $254.80 38 - 52 mins. Individual Psychotherapy 90834 $260.00 $- $- $- $- $- $- $- $- 90836 PSYCHOTHERAPY W/PATIENT 45MIN W/ E/M 90836 $260.00 $260.00 $184.60 $260.00 $260.00 $184.60 $249.60 $244.40 $247.00 $254.80 90837 PSYCHOTHERAPY W/PATIENT 60 MIN 90837 $299.00 $- $299.00 $212.29 $299.00 $299.00 $212.29 $287.04 $281.06 $284.05 $293.02 53 - 67 mins. Individual Psychotherapy 90837 $299.00 $- $- $- $- $- $- $- $- 90838PSYCH 60MINW/PATIENT/FAM EA ADDTL 90838 $299.00 $299.00 $212.29 $299.00 $299.00 $212.29 $287.04 $281.06 $284.05 $293.02 90839 Psychotherapy for crisis; first 60 minutes 90839 $500.00 $500.00 $355.00 $500.00 $500.00 $355.00 $480.00 $470.00 $475.00 $490.00 90840 PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES 90840 $250.00 $- $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 90845 PSYCHOANALYSIS 90845 $518.00 $- $518.00 $367.78 $518.00 $518.00 $367.78 $497.28 $486.92 $492.10 $507.64 Family psychotherapy w/o patient present 90846 $307.00 $- $- $- $- $- $- $- $- 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS 90847 $307.00 $- $307.00 $217.97 $307.00 $307.00 $217.97 $294.72 $288.58 $291.65 $300.86 Family psychotherapy w/ patient present (conjoint) 90847 $307.00 $- $- $- $- $- $- $- $- 90849 MULTIPLE FAMILY GROUP PSYCHOTHERAPY 90849 $243.00 $- $243.00 $172.53 $243.00 $243.00 $172.53 $233.28 $228.42 $230.85 $238.14 90853 GROUP PSYCHOTHERAPY 90853 $243.00 $243.00 $172.53 $243.00 $243.00 $172.53 $233.28 $228.42 $230.85 $238.14 Group psychotherapy 90853 $243.00 $- $- $- $- $- $- $- $- 90882 ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYCH PT 90882 $417.00 $- $417.00 $296.07 $417.00 $417.00 $296.07 $400.32 $391.98 $396.15 $408.66 90887 INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY 90887 $210.00 $- $210.00 $149.10 $210.00 $210.00 $149.10 $201.60 $197.40 $199.50 $205.80 90889 PREP REPORT PT PSYCH STATUS AGENCY/PAYER 90889 $353.00 $- $353.00 $250.63 $353.00 $353.00 $250.63 $338.88 $331.82 $335.35 $345.94 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 90899 $128.00 $- $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 92504-BINOCULAR MICRSCOPY SEP DX PROC-SC PF 92504 $225.00 $61.00 $225.00 $159.75 $225.00 $225.00 $159.75 $216.00 $211.50 $213.75 $220.50 TREATMENT OF SPEECH LANGUAGE ETC˙THAY 92507 $257.00 $257.00 $182.47 $257.00 $257.00 $182.47 $246.72 $241.58 $244.15 $251.86 Tx of Speech/Lang/Voice/Comm/Auditory - Tx of Speech/Lang/Voice/Comm/Auditory Chg 92507 $257.00 $257.00 $182.47 $257.00 $257.00 $182.47 $246.72 $241.58 $244.15 $251.86 Speech Fluency Eval - Speech Fluency Eval Charge 92521 $243.00 $243.00 $172.53 $243.00 $243.00 $172.53 $233.28 $228.42 $230.85 $238.14 Speech Sound Prod Eval Charge Medicaid 92522 $196.00 $196.00 $139.16 $196.00 $196.00 $139.16 $188.16 $184.24 $186.20 $192.08 Speech Sound Production Eval - Speech Sound Production Eval Charge 92522 $196.00 $196.00 $139.16 $196.00 $196.00 $139.16 $188.16 $184.24 $186.20 $192.08 92523 Evaluation of language comprehension and expression 92523 $418.00 $418.00 $296.78 $418.00 $418.00 $296.78 $401.28 $392.92 $397.10 $409.64 Speech Sound Prod w/ Languarge Charge - Speech Sound Prod w/ Language Charge 92523 $418.00 $418.00 $296.78 $418.00 $418.00 $296.78 $401.28 $392.92 $397.10 $409.64 Behav/Qual Analysis of Voice and Resonance - Behav/Qual Analysis of Voice and Resonance Charge 92524 $273.00 $273.00 $193.83 $273.00 $273.00 $193.83 $262.08 $256.62 $259.35 $267.54 TREAT SWALLOWING ORAL DYSFNC FOR FEEDING˙THAY 92526 $246.00 $246.00 $174.66 $246.00 $246.00 $174.66 $236.16 $231.24 $233.70 $241.08 Treatment of Swallowing Dysfunction - Treatment of Swallowing Dysfunction 92526 $246.00 $246.00 $174.66 $246.00 $246.00 $174.66 $236.16 $231.24 $233.70 $241.08 Pure Tone Audiometry; Air & Bo 92553 $79.00 $79.00 $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 92555 SPEECH THRESHOLDS 92555 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 92556 SPEECH THRESH & DISC 92556 $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 AUDIO THRESHOLD/SPEECH 92557 $188.00 $188.00 $133.48 $188.00 $188.00 $133.48 $180.48 $176.72 $178.60 $184.24 92567 TYMPANOMETRY Clinic Charge 92567 $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 Acoustic Reflex Testing; Threshold Charge 92568 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 Eval for Use/Fitting of Voice Prosthetic Dvc Chg 92597 $156.00 $156.00 $110.76 $156.00 $156.00 $110.76 $149.76 $146.64 $148.20 $152.88 Yes - Eval for Use/Fitting of Voice Prosthetic Dvc Chg 92597 $156.00 $156.00 $110.76 $156.00 $156.00 $110.76 $149.76 $146.64 $148.20 $152.88 Yes - Speech Generating Device Evaluation 1st hr Charge 92607 $278.00 $278.00 $197.38 $278.00 $278.00 $197.38 $266.88 $261.32 $264.10 $272.44 Speech Generating Device Eval Additional 30 Min 92608 $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 7392609 THERAP SVCS USE OF SP GEN DEV 92609 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 Screening Charge (Pediatric) 92609 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 Screening Charge (Pediatric) - Screening Charge (Pediatric) 92609 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 SLP Speech-Gen Dev Prog and Mod 92609 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 Yes - SLP Speech-Gen Dev Prog and Mod 92609 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg 92610 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 EVAL OF ORAL AND PHARYNGEAL SWALLOWING˙THAY 92610 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 Fluoroscopic Evaluation of Swallow Function Charge - Fluoroscopic Evaluation of Swallow Function Charge 92611 $191.00 $191.00 $135.61 $191.00 $191.00 $135.61 $183.36 $179.54 $181.45 $187.18 92950 CPR ED CHARGE 92950 $761.00 $659.00 $761.00 $540.31 $761.00 $761.00 $540.31 $730.56 $715.34 $722.95 $745.78 92960 CARDIOVERSION 92960 "$1,418.00 " $335.00 "$1,418.00 " "$1,006.78 " "$1,418.00 " "$1,418.00 " "$1,006.78 " "$1,361.28 " "$1,332.92 " "$1,347.10 " "$1,389.64 " EKG w/ Interpretation 93000 $246.00 $35.00 $246.00 $174.66 $246.00 $246.00 $174.66 $236.16 $231.24 $233.70 $241.08 93000 EKG w/ Interp. 93000 $281.00 $35.00 $281.00 $199.51 $281.00 $281.00 $199.51 $269.76 $264.14 $266.95 $275.38 EKG 93005 $267.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 EKG Task 93005 $267.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 EKG Task 93005 $267.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 EKG without Interp 93005 $267.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 93010 EKG INTERP 93010 $18.00 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 EKG Interp Only 93010 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 EKG Interpretation Only 93010 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 Treadmill 93015 $848.00 $848.00 $602.08 $848.00 $848.00 $602.08 $814.08 $797.12 $805.60 $831.04 93016 STRESS TEST DR SUPER 93016 $48.00 $- $- $- $- $- $- $- $- 93017 CARD REHAB STRESS TEST TREADMIL 93017 "$1,026.00 " "$1,026.00 " $728.46 "$1,026.00 " "$1,026.00 " $728.46 $984.96 $964.44 $974.70 "$1,005.48 " 93018 TREADMILL INTERP & 93018 $32.00 $- $- $- $- $- $- $- $- "Rhythm ECG, 1-3 leads; with interpretation and report" 93040 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 93225 CARD REHAB HOLTER MONITOR 24 HO 93225 $445.00 $445.00 $315.95 $445.00 $445.00 $315.95 $427.20 $418.30 $422.75 $436.10 93226 CARD REHAB HOLT MONITOR RECORD 93226 $650.00 $650.00 $461.50 $650.00 $650.00 $461.50 $624.00 $611.00 $617.50 $637.00 S-ICD Programming Device Eval 93260 $361.00 $361.00 $256.31 $361.00 $361.00 $256.31 $346.56 $339.34 $342.95 $353.78 S-ICD Interrogation Device Eval 93261 $330.00 $330.00 $234.30 $330.00 $330.00 $234.30 $316.80 $310.20 $313.50 $323.40 93268 CARD REHAB KING OF HEART 93268 $730.00 $730.00 $518.30 $730.00 $730.00 $518.30 $700.80 $686.20 $693.50 $715.40 93270 CARD REHAB PATIENT EVENT MONITOR 93270 $288.00 $288.00 $204.48 $288.00 $288.00 $204.48 $276.48 $270.72 $273.60 $282.24 93279 PACEMAKER EVAL SINGLE 93279 $291.00 $291.00 $206.61 $291.00 $291.00 $206.61 $279.36 $273.54 $276.45 $285.18 93280 PACEMAKER EVAL DUAL 93280 $341.00 $341.00 $242.11 $341.00 $341.00 $242.11 $327.36 $320.54 $323.95 $334.18 PACEMAKER EVAL MULTI 93281 $368.00 $368.00 $261.28 $368.00 $368.00 $261.28 $353.28 $345.92 $349.60 $360.64 93282 ICD EVAL SINGLE 93282 $355.00 $355.00 $252.05 $355.00 $355.00 $252.05 $340.80 $333.70 $337.25 $347.90 93283 ICD EVAL DUAL 93283 $448.00 $448.00 $318.08 $448.00 $448.00 $318.08 $430.08 $421.12 $425.60 $439.04 ICD EVAL MULT 93284 $485.00 $485.00 $344.35 $485.00 $485.00 $344.35 $465.60 $455.90 $460.75 $475.30 PACEMAKER INTERROGATION 93288 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 ICD INTERROGATION 93289 $317.00 $317.00 $225.07 $317.00 $317.00 $225.07 $304.32 $297.98 $301.15 $310.66 93306 ECHO 2D COMPLETE CHARGE 93306 "$1,898.00 " "$1,898.00 " "$1,347.58 " "$1,898.00 " "$1,898.00 " "$1,347.58 " "$1,822.08 " "$1,784.12 " "$1,803.10 " "$1,860.04 " US ECHO Complete 93306 "$1,898.00 " "$1,898.00 " "$1,347.58 " "$1,898.00 " "$1,898.00 " "$1,347.58 " "$1,822.08 " "$1,784.12 " "$1,803.10 " "$1,860.04 " 93307 ECHOCARDIOGRAM 93307 "$1,667.00 " "$1,667.00 " "$1,183.57 " "$1,667.00 " "$1,667.00 " "$1,183.57 " "$1,600.32 " "$1,566.98 " "$1,583.65 " "$1,633.66 " 93308 BUBBLE STUDY (ECHO LMTD) CHARGE 93308 $805.00 $805.00 $571.55 $805.00 $805.00 $571.55 $772.80 $756.70 $764.75 $788.90 US Echo 2D Limited 93308 $805.00 $805.00 $571.55 $805.00 $805.00 $571.55 $772.80 $756.70 $764.75 $788.90 US Echo Color Flow Doppler 93325 $446.00 $446.00 $316.66 $446.00 $446.00 $316.66 $428.16 $419.24 $423.70 $437.08 93350 STRESS ECHO CHARGE 93350 "$1,414.00 " "$1,414.00 " "$1,003.94 " "$1,414.00 " "$1,414.00 " "$1,003.94 " "$1,357.44 " "$1,329.16 " "$1,343.30 " "$1,385.72 " "Stress Echocardiogram, Exercise, Treadmill or Pharmacologically Induced" 93350 "$1,414.00 " "$1,414.00 " "$1,003.94 " "$1,414.00 " "$1,414.00 " "$1,003.94 " "$1,357.44 " "$1,329.16 " "$1,343.30 " "$1,385.72 " 93784 CARD REHAB BP MONITOR 93784 $237.00 $237.00 $168.27 $237.00 $237.00 $168.27 $227.52 $222.78 $225.15 $232.26 "93797 CARDIAC REHAB PHASE 3, DAILY" 93797 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 "93797 CARDIAC REHAB PHASE 3, DAILY" 93797 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 93798 CARDIAC REHAB PHASE II CHARGE 93798 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 US Carotid Duplex Bilateral 93880 "$1,299.00 " "$1,299.00 " $922.29 "$1,299.00 " "$1,299.00 " $922.29 "$1,247.04 " "$1,221.06 " "$1,234.05 " "$1,273.02 " US Carotid Duplex Left 93882 $697.00 $697.00 $494.87 $697.00 $697.00 $494.87 $669.12 $655.18 $662.15 $683.06 US Carotid Duplex Right 93882 $697.00 $697.00 $494.87 $697.00 $697.00 $494.87 $669.12 $655.18 $662.15 $683.06 US Transcranial Doppler Complete 93886 "$1,297.00 " "$1,297.00 " $920.87 "$1,297.00 " "$1,297.00 " $920.87 "$1,245.12 " "$1,219.18 " "$1,232.15 " "$1,271.06 " US Ankle Brachial Index 93922 $474.00 $474.00 $336.54 $474.00 $474.00 $336.54 $455.04 $445.56 $450.30 $464.52 US LE Arterial Doppler Multi Lvl Bilat 93923 $817.00 $817.00 $580.07 $817.00 $817.00 $580.07 $784.32 $767.98 $776.15 $800.66 US LE Doppler w/ Stress Test 93924 $829.00 $829.00 $588.59 $829.00 $829.00 $588.59 $795.84 $779.26 $787.55 $812.42 US LE Arterial Duplex Bilateral 93925 "$1,060.00 " "$1,060.00 " $752.60 "$1,060.00 " "$1,060.00 " $752.60 "$1,017.60 " $996.40 "$1,007.00 " "$1,038.80 " US LE Arterial Duplex Left 93926 $851.00 $851.00 $604.21 $851.00 $851.00 $604.21 $816.96 $799.94 $808.45 $833.98 US LE Arterial Duplex Right 93926 $851.00 $851.00 $604.21 $851.00 $851.00 $604.21 $816.96 $799.94 $808.45 $833.98 US UE Arterial Duplex Bilateral 93930 "$1,044.00 " "$1,044.00 " $741.24 "$1,044.00 " "$1,044.00 " $741.24 "$1,002.24 " $981.36 $991.80 "$1,023.12 " US UE Arterial Duplex Left 93931 $678.00 $678.00 $481.38 $678.00 $678.00 $481.38 $650.88 $637.32 $644.10 $664.44 US UE Arterial Duplex Right 93931 $678.00 $678.00 $481.38 $678.00 $678.00 $481.38 $650.88 $637.32 $644.10 $664.44 US LE Venous Duplex Bilateral 93970 "$1,245.00 " "$1,245.00 " $883.95 "$1,245.00 " "$1,245.00 " $883.95 "$1,195.20 " "$1,170.30 " "$1,182.75 " "$1,220.10 " US UE Venous Duplex Bilateral 93970 "$1,245.00 " "$1,245.00 " $883.95 "$1,245.00 " "$1,245.00 " $883.95 "$1,195.20 " "$1,170.30 " "$1,182.75 " "$1,220.10 " US LE Venous Duplex Left 93971 $971.00 $971.00 $689.41 $971.00 $971.00 $689.41 $932.16 $912.74 $922.45 $951.58 US LE Venous Duplex Right 93971 $971.00 $971.00 $689.41 $971.00 $971.00 $689.41 $932.16 $912.74 $922.45 $951.58 US UE Venous Duplex Left 93971 $971.00 $971.00 $689.41 $971.00 $971.00 $689.41 $932.16 $912.74 $922.45 $951.58 US UE Venous Duplex Right 93971 $971.00 $971.00 $689.41 $971.00 $971.00 $689.41 $932.16 $912.74 $922.45 $951.58 US Kidney Venous Duplex Arterial Comp 93975 "$1,012.00 " "$1,012.00 " $718.52 "$1,012.00 " "$1,012.00 " $718.52 $971.52 $951.28 $961.40 $991.76 US Aorta IVC Iliac Duplex Complete 93978 $844.00 $844.00 $599.24 $844.00 $844.00 $599.24 $810.24 $793.36 $801.80 $827.12 US Aorta IVC Iliac Duplex Limited 93979 $769.00 $769.00 $545.99 $769.00 $769.00 $545.99 $738.24 $722.86 $730.55 $753.62 US Duplex Hemodialysis Access Flow 93990 $964.00 $964.00 $684.44 $964.00 $964.00 $684.44 $925.44 $906.16 $915.80 $944.72 Ventilation assist 94002 "$1,118.00 " $- $- $- $- $- $- $- $- 94010 CARD REHAB SPIROMETRY 94010 $286.00 $286.00 $203.06 $286.00 $286.00 $203.06 $274.56 $268.84 $271.70 $280.28 Spirometry PFT 94010 $286.00 $286.00 $203.06 $286.00 $286.00 $203.06 $274.56 $268.84 $271.70 $280.28 94010 SPIROMETRY INTERP 94010 $73.00 $- $- $- $- $- $- $- $- 94014 CARD REHAB PT RECRD SPIROMETRY AND READ 94014 $292.00 $292.00 $207.32 $292.00 $292.00 $207.32 $280.32 $274.48 $277.40 $286.16 94015 CARD REHAB PT RECORDED SPIROMETRY 94015 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 CARD REHAB REVIEW PT SPIROMETRY 94016 $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 "Spirometry, Pre & Post" 94060 $621.00 $621.00 $440.91 $621.00 $621.00 $440.91 $596.16 $583.74 $589.95 $608.58 94060 BRONCHOSPASM INTERP 94060 $123.00 $- $- $- $- $- $- $- $- 94070 CARD REHAB BRONCHOSPASM EVAL-MULTI SPIRO 94070 "$1,255.00 " "$1,255.00 " $891.05 "$1,255.00 " "$1,255.00 " $891.05 "$1,204.80 " "$1,179.70 " "$1,192.25 " "$1,229.90 " 94150 CARD REHAB VITAL CAPACITY TEST 94150 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 "Vital Capacity, total Charge" 94150 $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 94200 CARD REHAB LUNG FUNC TEST (MBC/MVV) 94200 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 94250 CARD REHAB EXPIRED GAS COLLECTION 94250 $324.00 $324.00 $230.04 $324.00 $324.00 $230.04 $311.04 $304.56 $307.80 $317.52 94250 CO ANALYSIS BREATH 94250 $324.00 $324.00 $230.04 $324.00 $324.00 $230.04 $311.04 $304.56 $307.80 $317.52 94375 CARD REHAB RESPIRATORY FLOW VOLUME LOOP 94375 $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 94400 CARD REHAB CO2 BREATHING RESPONSE CURVE 94400 $296.00 $296.00 $210.16 $296.00 $296.00 $210.16 $284.16 $278.24 $281.20 $290.08 94450 CARD REHAB HYPOXIA RESPONSE CURVE 94450 $376.00 $376.00 $266.96 $376.00 $376.00 $266.96 $360.96 $353.44 $357.20 $368.48 94452 CARD REHAB HAST W/ REPORT 94452 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 94453 CARD REHAB HAST W/ OXYGEN TITRATE 94453 $275.00 $275.00 $195.25 $275.00 $275.00 $195.25 $264.00 $258.50 $261.25 $269.50 94621 CARD REHAB PULMONARY STRESS TEST/COMPLEX 94621 "$1,411.00 " "$1,411.00 " "$1,001.81 " "$1,411.00 " "$1,411.00 " "$1,001.81 " "$1,354.56 " "$1,326.34 " "$1,340.45 " "$1,382.78 " 94640 AEROSOL INHALATION 94640 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 94640 Nebulizer Charge. 94640 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 94640 TJN 94640 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 NEBULIZER PER DAY CHARGE 94640 $170.00 $170.00 $120.70 $170.00 $170.00 $120.70 $163.20 $159.80 $161.50 $166.60 94664 CARD REHAB EVALUATE PT USE OF INHALER 94664 $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 94680 CARD REHAB O2 UPTAKE REST AND EXERCISE 94680 $284.00 $284.00 $201.64 $284.00 $284.00 $201.64 $272.64 $266.96 $269.80 $278.32 94681 CARD REHAB CO2 & 02 REST AND EXERCISE 94681 $465.00 $465.00 $330.15 $465.00 $465.00 $330.15 $446.40 $437.10 $441.75 $455.70 94690 CARD REHAB INDIRECT CAL O2 REST 94690 $377.00 $377.00 $267.67 $377.00 $377.00 $267.67 $361.92 $354.38 $358.15 $369.46 94726 CARD REHAB PLETHYSMOGRAPHY INC AIRWAY RESIS. 94726 $446.00 $446.00 $316.66 $446.00 $446.00 $316.66 $428.16 $419.24 $423.70 $437.08 "94727 CARD REHAB GAS DIL.OR WASHOUT LV,INC CLOS VOL ETC" 94727 $398.00 $398.00 $282.58 $398.00 $398.00 $282.58 $382.08 $374.12 $378.10 $390.04 94728 CARD REHAB AIRWAY RESISTANCE BY IOS 94728 $243.00 $243.00 $172.53 $243.00 $243.00 $172.53 $233.28 $228.42 $230.85 $238.14 "94729 CARD REHAB DIFFUSION CAPACITY (CO,MEMBRANE)" 94729 $425.00 $425.00 $301.75 $425.00 $425.00 $301.75 $408.00 $399.50 $403.75 $416.50 94750 CARD REHAB PULMONARY COMPLIANCE STUDY 94750 $202.00 $202.00 $143.42 $202.00 $202.00 $143.42 $193.92 $189.88 $191.90 $197.96 94762 CARD REHAB OVERNIGHT PULSE OX 94762 $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 95012 CARD REHAB EXHALED NITRIC OXIDE 95012 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 "95070 CARD REHAB INHALATION CHAL NOT INCLUD SPIRO,METHA/A" 95070 $463.00 $463.00 $328.73 $463.00 $463.00 $328.73 $444.48 $435.22 $439.85 $453.74 "95071 CARD REHAB INHAL CHAL NOT INCL SPIRO,SPEC ANTIGEN" 95071 $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 Allergy Injection Single POC 95115 $34.00 $34.00 $24.14 $34.00 $34.00 $24.14 $32.64 $31.96 $32.30 $33.32 Professional services for allergen immunotherapy; 2 or more injections 95117 $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 4456250 - HOME SLEEP STUDY 95806 $456.00 $456.00 $323.76 $456.00 $456.00 $323.76 $437.76 $428.64 $433.20 $446.88 "Sleep study, unattended" 95806 $456.00 $456.00 $323.76 $456.00 $456.00 $323.76 $437.76 $428.64 $433.20 $446.88 95810 Polysomnography Sleep Study 95810 "$3,425.00 " "$3,425.00 " "$2,431.75 " "$3,425.00 " "$3,425.00 " "$2,431.75 " "$3,288.00 " "$3,219.50 " "$3,253.75 " "$3,356.50 " "Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep," 95810 "$3,425.00 " "$3,425.00 " "$2,431.75 " "$3,425.00 " "$3,425.00 " "$2,431.75 " "$3,288.00 " "$3,219.50 " "$3,253.75 " "$3,356.50 " 95811 CPAP/BiPAP Titration Sleep Study 95811 "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,638.40 " "$3,562.60 " "$3,600.50 " "$3,714.20 " 95811 Polysomnography Sleep Study w/CPAP 95811 "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,638.40 " "$3,562.60 " "$3,600.50 " "$3,714.20 " 95811 Split Night Polysomnography Sleep Study 95811 "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,638.40 " "$3,562.60 " "$3,600.50 " "$3,714.20 " "Polysomnography; age 6 years or older, sleep staging with 4 or more with initiation of continuous" 95811 "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,790.00 " "$3,790.00 " "$2,690.90 " "$3,638.40 " "$3,562.60 " "$3,600.50 " "$3,714.20 " ROM Each Extremity/Trunk Charges 95851 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 "ROM measures & report; each extremity, trunk, not hands" 95851 $129.00 $129.00 $91.59 $129.00 $129.00 $91.59 $123.84 $121.26 $122.55 $126.42 95992 OT Canalith Repositioning Charge 95992 $97.00 $97.00 $68.87 $97.00 $97.00 $68.87 $93.12 $91.18 $92.15 $95.06 PT Canalith Repositioning Charge 95992 $97.00 $97.00 $68.87 $97.00 $97.00 $68.87 $93.12 $91.18 $92.15 $95.06 Standardized Aphasia Assessment Charge 96105 $223.00 $223.00 $158.33 $223.00 $223.00 $158.33 $214.08 $209.62 $211.85 $218.54 Yes - Standardized Aphasia Assessment Charge 96105 $223.00 $223.00 $158.33 $223.00 $223.00 $158.33 $214.08 $209.62 $211.85 $218.54 Standardized Cognitive Eval Charge 96125 $235.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 Yes - Standardized Cognitive Eval Charge 96125 $235.00 $235.00 $166.85 $235.00 $235.00 $166.85 $225.60 $220.90 $223.25 $230.30 96360 HYDRATION (1ST HR) CHARGE 96360 $309.00 $309.00 $219.39 $309.00 $309.00 $219.39 $296.64 $290.46 $293.55 $302.82 96361 HYDRATION ADDITIONAL HOUR CHARGE 96361 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 IV INFUSION 0-1 HOUR 96365 $329.00 $329.00 $233.59 $329.00 $329.00 $233.59 $315.84 $309.26 $312.55 $322.42 96366 INF THERAPY SUBS/HR CHARGE 96366 $102.00 $102.00 $72.42 $102.00 $102.00 $72.42 $97.92 $95.88 $96.90 $99.96 96367 SEQ INFUSION UP TO 1HR 96367 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Concurrent Infusion 96368 $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 "96372 Therapeutic; prophylactic, or diagnostic injection, subcutaneous or intramuscular" 96372 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 96372 INJECTION EA IM/SQ/ANTIBI 96372 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 "Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular" 96372 $110.00 $110.00 $78.10 $110.00 $110.00 $78.10 $105.60 $103.40 $104.50 $107.80 96374 IVP SINGLE OR INT CHARGE 96374 $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 "96374 Therapeutic, prophylactic, or diagnostic injection; IV push," 96374 $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 "96374 Therapeutic, prophylactic, or diagnostic injection; IV push." 96374 $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 IV PUSH Initial/ SIN Tech Chg 96374 $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 96375 IV INJ EA ADD NEW DRUG 96375 $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 96376 IVP EA ADDITIONAL SAME DRUG CHARGE 96376 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 "ADDITIONAL IV PUSH, SAME DRUG" 96376 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 "96401 CHEMO ADMIN, SUBCUT OR IM, NON-HORMONAL CHARGE" 96401 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 "96409 CHEMO ADMIN, IV PUSH, INITIAL CHARGE" 96409 $391.00 $391.00 $277.61 $391.00 $391.00 $277.61 $375.36 $367.54 $371.45 $383.18 "96411 CHEMO ADMIN, IV PUSH, EA ADDL CHARGE" 96411 $254.00 $254.00 $180.34 $254.00 $254.00 $180.34 $243.84 $238.76 $241.30 $248.92 "96413 CHEMO ADMIN, IV INFUSION, UP TO 1 HOUR CHARGE" 96413 $599.00 $599.00 $425.29 $599.00 $599.00 $425.29 $575.04 $563.06 $569.05 $587.02 "96415 CHEMO ADMIN, IV INFUSION, EA ADDL HOUR CHARGE" 96415 $179.00 $179.00 $127.09 $179.00 $179.00 $127.09 $171.84 $168.26 $170.05 $175.42 Chemo Pump 96416 $554.00 $554.00 $393.34 $554.00 $554.00 $393.34 $531.84 $520.76 $526.30 $542.92 "96417 CHEMO ADMIN, IV INFUSION, EA ADDL SEQUENTIAL INFUSION CHARGE" 96417 $271.00 $271.00 $192.41 $271.00 $271.00 $192.41 $260.16 $254.74 $257.45 $265.58 MECHANICAL TRACTION - Mechanical Traction Charge 97012 $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 UNATTENDED ELECTRICAL THERAPY - Unattended Electrical Therapy Charge 97014 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 UNATTENDED ELECTRICAL THERAPY - Unattended Electrical Therapy Charge 97014 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 Vasopneumatic Device Charge - Vasopneumatic Device Charge 97016 $71.00 $71.00 $50.41 $71.00 $71.00 $50.41 $68.16 $66.74 $67.45 $69.58 Yes - Vasopneumatic Device Charge 97016 $71.00 $71.00 $50.41 $71.00 $71.00 $50.41 $68.16 $66.74 $67.45 $69.58 Paraffin Bath - Paraffin Bath Charge 97018 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 Paraffin Bath Charge - Paraffin Bath Charge 97018 $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 PT Whirlpool Full Body - Whirlpool Full Body Charge 97022 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Whirlpool - Whirlpool Extremity Charge 97022 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Attended E-Stim Charges 97032 $64.00 $64.00 $45.44 $64.00 $64.00 $45.44 $61.44 $60.16 $60.80 $62.72 Attended E-Stim Charges 97032 $64.00 $64.00 $45.44 $64.00 $64.00 $45.44 $61.44 $60.16 $60.80 $62.72 Iontophoresis Charges 97033 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 Iontophoresis Charges 97033 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 OT Contrast Bath Charges 97035 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 Ultrasound Charges 97035 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 Ultrasound Charges 97035 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 Therapeutic Exercise Charges 97110 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Therapeutic Exercise Charges 97110 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 THERAPEUTIC PROCEDURE EXERCISES 15 MIN THAY 97110 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Therapeutic Procedure Exercises 15 min THAY 97110 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Therapeutic Exercise Charges 97110 $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 Neuromuscular Reeducation Charges 97112 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Neuromuscular Reeducation Charges 97112 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 Aquatic Charge 97113 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Aquatic Therapy Charges 97113 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 Gait Training Charges 97116 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 Gait Training Charges 97116 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 Gait Training includes stair climbing THAY 97116 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 "OT Cog Ther Intervent,First 15 Min Units" 97129 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 OT Cognitive Function Charge 97129 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "SLP Cog Ther Intervent,First 15Min Units" 97129 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 SLP Cognitive Function Charge 97129 $114.00 $114.00 $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 "OT Cog Ther Intervent, Addl 15 Min Units" 97130 $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 "SLP Cog Ther Intervent, Addl 15Min Units" 97130 $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 SNF Charge Min THAY 97139 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Manual Therapy Charge Units 97140 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 Manual Therapy Charge Units 97140 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 "97161 PT eval, low complexity 20 min." 97161 $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 PT Low Complex Units 97161 $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 "97162 PT eval, mod complexity 30 min." 97162 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 PT Moderate Complex Units 97162 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 "97163 PT eval, high complexity 45 min." 97163 $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 PT High Complex Units 97163 $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 PT ReEval Units 97164 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 PT RE-EVALUATION 97164 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 "97165 OT eval, low complexity 30 min." 97165 $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 OT Low Complex Units 97165 $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 "97166 OT eval, mod complexity 45 min." 97166 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 OT Moderate Complex Units 97166 $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 "97167 OT eval, high complexity 60 min." 97167 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 OT High Complex Units 97167 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 OT ReEval Units 97168 $132.00 $132.00 $132.00 $93.72 $132.00 $132.00 $93.72 $126.72 $124.08 $125.40 $129.36 OT Re-Evaluation CHARGE 97168 $132.00 $132.00 $93.72 $132.00 $132.00 $93.72 $126.72 $124.08 $125.40 $129.36 ST Therapeutic Activities Charges 97530 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 Therapeutic Activities 15 min THAY 97530 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 THERAPEUTIC ACTIVITIES 15 MIN˙THAY 97530 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 Therapeutic Activities Charge 97530 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 Therapeutic Activities Charges 97530 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 Sensory Stimulation Charge 97533 $226.00 $226.00 $160.46 $226.00 $226.00 $160.46 $216.96 $212.44 $214.70 $221.48 ADL Training Charges 97535 $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 "PT Self Care, Home Management Charges" 97535 $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 SELF CARE HOME MANAGEMENT 15 MIN˙THAY 97535 $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 Community/Work Reintegration Charges 97537 $70.00 $70.00 $49.70 $70.00 $70.00 $49.70 $67.20 $65.80 $66.50 $68.60 Yes - Work Reconditioning Initial Charge 97537 $70.00 $70.00 $49.70 $70.00 $70.00 $49.70 $67.20 $65.80 $66.50 $68.60 Wheelchair Charge 97542 $70.00 $70.00 $49.70 $70.00 $70.00 $49.70 $67.20 $65.80 $66.50 $68.60 WHEELCHAIR MANAGEMENT 15 MIN THAY 97542 $70.00 $70.00 $49.70 $70.00 $70.00 $49.70 $67.20 $65.80 $66.50 $68.60 Wheelchair Management Charges 97542 $70.00 $70.00 $49.70 $70.00 $70.00 $49.70 $67.20 $65.80 $66.50 $68.60 "Debridement, total wound(s) surface area; first 20 sq cm or less" 97597 $186.00 $186.00 $132.06 $186.00 $186.00 $132.06 $178.56 $174.84 $176.70 $182.28 97597 WOUND DEBRIDEMENT 97597 $464.00 $186.00 $464.00 $329.44 $464.00 $464.00 $329.44 $445.44 $436.16 $440.80 $454.72 Debridement Minutes Less Than 20 97597 $464.00 $464.00 $329.44 $464.00 $464.00 $329.44 $445.44 $436.16 $440.80 $454.72 Selective Debridement Charge 97597 $464.00 $464.00 $329.44 $464.00 $464.00 $329.44 $445.44 $436.16 $440.80 $454.72 Selective Debridement Charge - Selective Debridement Charge 97597 $464.00 $464.00 $329.44 $464.00 $464.00 $329.44 $445.44 $436.16 $440.80 $454.72 97598 Debride Add 20 Sq Cm 97598 $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 PT Wound Care Non Selective Charge - PT Wound Care Non Selective Charge 97602 $205.00 $205.00 $145.55 $205.00 $205.00 $145.55 $196.80 $192.70 $194.75 $200.90 Negative Pressure Wound Therapy < 50cm 97605 $231.00 $231.00 $164.01 $231.00 $231.00 $164.01 $221.76 $217.14 $219.45 $226.38 "Negative pressure wound therapy (e.g., vacuum-assisted drainage collection)>50 sq cm" 97606 $263.00 $263.00 $186.73 $263.00 $263.00 $186.73 $252.48 $247.22 $249.85 $257.74 7091000 PT EMPLOYEE EVALS CHARGE 97750 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 7291000 OT EMPLOYEMENT EVAL CHARGE 97750 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 Functional Capacity Eval Charge - Functional Capacity Eval Charge 97750 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 ORTHOTIC MANAGEMENT AND TRAINING 15 MIN˙THAY 97760 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 Orthotic Mgmt and Training Charges 97760 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 Orthotic Mgmt and Training Charges 97760 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 "OT Jobst Measurement, Charge" 97760 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 PT Unlisted Therapeutic Procedures Charges 97760 $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 Prosthetic Charge 97761 $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 Prosthetic Training Charges 97761 $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 Checkout for Prosth/Orth Use Charges 97763 $106.00 $106.00 $75.26 $106.00 $106.00 $75.26 $101.76 $99.64 $100.70 $103.88 Checkout for Prosth/Orth Use Charges 97763 $106.00 $106.00 $75.26 $106.00 $106.00 $75.26 $101.76 $99.64 $100.70 $103.88 OT Orthotic Mgmt/Train Establish Charge 97763 $106.00 $106.00 $75.26 $106.00 $106.00 $75.26 $101.76 $99.64 $100.70 $103.88 PT Orthotic Mgmt/Train Establish Charge 97763 $106.00 $106.00 $75.26 $106.00 $106.00 $75.26 $101.76 $99.64 $100.70 $103.88 Manual Traction Charge 97799 $97.00 $97.00 $68.87 $97.00 $97.00 $68.87 $93.12 $91.18 $92.15 $95.06 97802 MNT INDIV INITIAL ASSESSMENT AND INTERVENTION (EA 15 MIN) CHARGE 97802 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 97803 Medical Nutrition Therapy; Re-Assessment/Intervention 15 Min 97803 $171.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 97803 MNT INITIAL RE-ASSMNT EA 15 CHARGE. 97803 $171.00 $171.00 $121.41 $171.00 $171.00 $121.41 $164.16 $160.74 $162.45 $167.58 Osteopathic Manipulative Trtmt (OMT); Three to Four Body Regions Involved Charge 98926 $240.00 $240.00 $170.40 $240.00 $240.00 $170.40 $230.40 $225.60 $228.00 $235.20 DRUG SCREEN QUEST-CL 99000 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 Handling and/or Conveyance of Specimen For Transfer From The Physician's Office to A Lab Charge 99000 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 After Hours Visit - 99050 99050 $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 Supplies and materials 99070 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 99100 ANETH EXTM AGE <1 & >70 CHARGE 99100 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 99140 EMERGENCY CONDITIONS CHARGE 99140 $100.00 $100.00 $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 "Phlebotomy, therapeutic" 99195 $205.00 $205.00 $145.55 $205.00 $205.00 $145.55 $196.80 $192.70 $194.75 $200.90 Therapeutic Phlebotomy 8 99195 $205.00 $205.00 $145.55 $205.00 $205.00 $145.55 $196.80 $192.70 $194.75 $200.90 99195 PLEBOTOMY 99195 $205.00 $- $- $- $- $- $- $- $- Office/OP New Visit Level 1 99201 99201 $98.00 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 Room/Bed: SPecialist RM OV 1-New Patient 99201 $245.00 $245.00 $173.95 $245.00 $245.00 $173.95 $235.20 $230.30 $232.75 $240.10 Office/OP New Visit Level 2 99202 99202 $164.00 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 ROOM/BED: SPECIALIST RM OV II - New Patient 99202 $411.00 $411.00 $291.81 $411.00 $411.00 $291.81 $394.56 $386.34 $390.45 $402.78 Office/OP New Visit Level 3 99203 99203 $233.00 $233.00 $233.00 $165.43 $233.00 $233.00 $165.43 $223.68 $219.02 $221.35 $228.34 ROOM/BED: SPECIALIST RM OV III - New Patient 99203 $581.00 $581.00 $412.51 $581.00 $581.00 $412.51 $557.76 $546.14 $551.95 $569.38 Office/OP New Visit Level 4 99204 99204 $355.00 $355.00 $355.00 $252.05 $355.00 $355.00 $252.05 $340.80 $333.70 $337.25 $347.90 Room/Bed: Specialist RM OV 4 - New 99204 $888.00 $888.00 $630.48 $888.00 $888.00 $630.48 $852.48 $834.72 $843.60 $870.24 Office/OP New Visit Level 5 99205 99205 $447.00 $447.00 $447.00 $317.37 $447.00 $447.00 $317.37 $429.12 $420.18 $424.65 $438.06 Room/Bed: Specialist RM OV 5 - New 99205 "$1,117.00 " "$1,117.00 " $793.07 "$1,117.00 " "$1,117.00 " $793.07 "$1,072.32 " "$1,049.98 " "$1,061.15 " "$1,094.66 " 99211 ESTAB PAT LEVEL 1 99211 $49.00 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 Nurse Visit - 99211 99211 $49.00 $49.00 $34.79 $49.00 $49.00 $34.79 $47.04 $46.06 $46.55 $48.02 ROOM/BED: SPECIALIST RM OV I - Established 99211 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 ROOM/BED: Treatment Room 0-1 99211 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 ROOM/BED: Treatment Room 1-2 99211 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 99212 ESTAB PAT LEVEL 2 99212 $97.00 $97.00 $97.00 $68.87 $97.00 $97.00 $68.87 $93.12 $91.18 $92.15 $95.06 ROOM/BED: SPECIALIST RM OV II - Established 99212 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 ROOM/BED: Treatment Room 2-3 99212 $242.00 $242.00 $171.82 $242.00 $242.00 $171.82 $232.32 $227.48 $229.90 $237.16 99213 ESTAB PAT LEVEL 3 99213 $161.00 $161.00 $161.00 $114.31 $161.00 $161.00 $114.31 $154.56 $151.34 $152.95 $157.78 ROOM/BED: SPECIALIST RM OV III - Established 99213 $401.00 $401.00 $284.71 $401.00 $401.00 $284.71 $384.96 $376.94 $380.95 $392.98 ROOM/BED: Treatment Room 3+ 99213 $401.00 $401.00 $284.71 $401.00 $401.00 $284.71 $384.96 $376.94 $380.95 $392.98 99214 ESTAB PAT LEVEL 4 99214 $236.00 $236.00 $236.00 $167.56 $236.00 $236.00 $167.56 $226.56 $221.84 $224.20 $231.28 Room/Bed: Specialist RM OV 4 - Established 99214 $590.00 $590.00 $418.90 $590.00 $590.00 $418.90 $566.40 $554.60 $560.50 $578.20 99215 ESTAB PAT LEVEL 5 CHARGE 99215 $316.00 $316.00 $316.00 $224.36 $316.00 $316.00 $224.36 $303.36 $297.04 $300.20 $309.68 Room/Bed: Specialist RM OV 5 - Established 99215 $790.00 $790.00 $560.90 $790.00 $790.00 $560.90 $758.40 $742.60 $750.50 $774.20 99217 OBSERVATION CARE DIS 99217 $160.00 $- $- $- $- $- $- $- $- 99218 DETAIL HIST LOW OBSE 99218 $218.00 $- $- $- $- $- $- $- $- 99219 COMP HIS MED OBSERV 99219 $297.00 $- $- $- $- $- $- $- $- 99220 COMP HIST HI OBSERV 99220 $407.00 $- $- $- $- $- $- $- $- 99221 COMP H&P LOW INITIAL 99221 $220.00 $- $- $- $- $- $- $- $- 99222 COMP H&P MOD INITIAL 99222 $299.00 $- $- $- $- $- $- $- $- 99223 COMP H&P HI INITIAL 99223 $443.00 $- $- $- $- $- $- $- $- 99224 OBS VISIT LOW 99224 $87.00 $- $- $- $- $- $- $- $- 99225 OBS VISIT EXPANDED 99225 $160.00 $- $- $- $- $- $- $- $- 99226 OBS VISIT MODERATE 99226 $230.00 $- $- $- $- $- $- $- $- 99231 HOSP VISIT LOW 99231 $86.00 $- $- $- $- $- $- $- $- 99232 HOSP VISIT EXPANDED 99232 $160.00 $- $- $- $- $- $- $- $- 99233 HOSP VISIT DETAILED 99233 $228.00 $- $- $- $- $- $- $- $- 99234 LOW A/D 1 DAY 99234 $291.00 $- $- $- $- $- $- $- $- 99235 MOD A/D 1 DAY 99235 $371.00 $- $- $- $- $- $- $- $- 99236 HI A/D 1 DAY 99236 $478.00 $- $- $- $- $- $- $- $- 99238 DISCHARGE DAY MGMT 99238 $160.00 $- $- $- $- $- $- $- $- 99239 DISCH DAY MGMT >30 99239 $235.00 $- $- $- $- $- $- $- $- 99241 OFFICE CONSULTATION 99241 $197.00 $- $- $- $- $- $- $- $- 99242 Office Consultation for a New or Established Patient 99242 $195.00 $- $- $- $- $- $- $- $- 99251 INPATIENT CONSULTATION level 1 99251 $108.00 $- $- $- $- $- $- $- $- 99252 INPATIENT CONSULTATION level 2 99252 $165.00 $- $- $- $- $- $- $- $- 99281 EMERGENCY ROOM CAT 1 99281 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 99281 ER OP PROBLEM FOCUSE 99281 $46.00 $- $- $- $- $- $- $- $- 99282 EMERGENCY ROOM CAT 2 99282 $284.00 $284.00 $201.64 $284.00 $284.00 $201.64 $272.64 $266.96 $269.80 $278.32 99282 ER OP EXP PROBLEM LO 99282 $91.00 $- $- $- $- $- $- $- $- 99283 EMERGENCY ROOM CAT 3 99283 $449.00 $449.00 $318.79 $449.00 $449.00 $318.79 $431.04 $422.06 $426.55 $440.02 99283 ER OP EXP PROBLEM MO 99283 $135.00 $- $- $- $- $- $- $- $- 99284 EMERGENCY ROOM CAT 4 99284 $673.00 $673.00 $477.83 $673.00 $673.00 $477.83 $646.08 $632.62 $639.35 $659.54 99284 ER OP DETAILED PROB 99284 $257.00 $- $- $- $- $- $- $- $- 99285 EMERGENCY ROOM CAT 5 99285 $997.00 $997.00 $707.87 $997.00 $997.00 $707.87 $957.12 $937.18 $947.15 $977.06 99285 ER OP COMP PROBLEM H 99285 $378.00 $- $- $- $- $- $- $- $- 99291 E.R.CRITICAL CARE 99291 "$1,521.00 " "$1,521.00 " "$1,079.91 " "$1,521.00 " "$1,521.00 " "$1,079.91 " "$1,460.16 " "$1,429.74 " "$1,444.95 " "$1,490.58 " 99291 CRITICAL CARE FIRST 99291 $601.00 $- $- $- $- $- $- $- $- 99292-CRITICAL CARE ADDL 30 MIN-ER TECH 99292 $966.00 $966.00 $685.86 $966.00 $966.00 $685.86 $927.36 $908.04 $917.70 $946.68 99292 CRITCL CARE EACH AD 99292 $267.00 $- $- $- $- $- $- $- $- Initial Nursing Fac Care- Low- 99304 99304 $197.00 $197.00 $139.87 $197.00 $197.00 $139.87 $189.12 $185.18 $187.15 $193.06 99304 D COMP NUR L N 99304 $197.00 $- $- $- $- $- $- $- $- Initial Nursing Fac Care- Mod- 99305 99305 $285.00 $285.00 $202.35 $285.00 $285.00 $202.35 $273.60 $267.90 $270.75 $279.30 99305 D COMP NUR M N 99305 $285.00 $- $- $- $- $- $- $- $- Initial Nursing Fac Care- High- 99306 99306 $366.00 $366.00 $259.86 $366.00 $366.00 $259.86 $351.36 $344.04 $347.70 $358.68 99306 D COMP NUR H N 99306 $366.00 $- $- $- $- $- $- $- $- "Subsequent nursing facility care (History, Examination and MDM)." 99307 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 99307 NUR FOC PROB F 99307 $96.00 $- $- $- $- $- $- $- $- 99308 NURS FOC PRO L 99308 $150.00 $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 "Subsequent nursing facility care (History, Examination and MDM of low complexity" 99308 $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 99309 DET MOD COMP E 99309 $200.00 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 Subsequent Nursing Fac Care- Mod- 99309 99309 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 99309 NURS DE PROB M 99309 $200.00 $- $- $- $- $- $- $- $- "Subsequent nursing facility care, per day, for the eval and mgmt of a patient, High complexity" 99310 $296.00 $296.00 $210.16 $296.00 $296.00 $210.16 $284.16 $278.24 $281.20 $290.08 99310 NUR COM PROB H 99310 $296.00 $- $- $- $- $- $- $- $- 99315 SWING BED DISCH 99315 $160.00 $160.00 $113.60 $160.00 $160.00 $113.60 $153.60 $150.40 $152.00 $156.80 Annual Nursing Facility Assessment 99318 $210.00 $210.00 $149.10 $210.00 $210.00 $149.10 $201.60 $197.40 $199.50 $205.80 ASST LIVING EST PAT- LEVEL 2- LOW 99335 $208.00 $208.00 $147.68 $208.00 $208.00 $147.68 $199.68 $195.52 $197.60 $203.84 Home Visit Level 1 New - 99341 99341 $121.00 $121.00 $85.91 $121.00 $121.00 $85.91 $116.16 $113.74 $114.95 $118.58 Home Visit Level 2 New - 99342 99342 $175.00 $175.00 $124.25 $175.00 $175.00 $124.25 $168.00 $164.50 $166.25 $171.50 Home Visit Level 3 New - 99343 99343 $285.00 $285.00 $202.35 $285.00 $285.00 $202.35 $273.60 $267.90 $270.75 $279.30 99347 FOCUS PROB LO HOME V 99347 $121.00 $- $- $- $- $- $- $- $- Home visit estab.˙ pt 99348 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 Home Visit Level 3 Established - 99349 99349 $283.00 $283.00 $200.93 $283.00 $283.00 $200.93 $271.68 $266.02 $268.85 $277.34 Prolonged Physician Service Outpatient with Direct Patient Contact First Hour - 99354 99354 $285.00 $285.00 $202.35 $285.00 $285.00 $202.35 $273.60 $267.90 $270.75 $279.30 Preventive Medicine < 1 year New Pat - 99381 99381 $241.00 $241.00 $171.11 $241.00 $241.00 $171.11 $231.36 $226.54 $228.95 $236.18 Preventive Medicine 1-4 years New Pat - 99382 99382 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 Preventive Medicine 5-11 years New Pat - 99383 99383 $263.00 $263.00 $186.73 $263.00 $263.00 $186.73 $252.48 $247.22 $249.85 $257.74 Preventive Medicine 12-17 years New Pat - 99384 99384 $297.00 $297.00 $210.87 $297.00 $297.00 $210.87 $285.12 $279.18 $282.15 $291.06 Preventive Medicine 18-39 years New Pat - 99385 99385 $288.00 $288.00 $204.48 $288.00 $288.00 $204.48 $276.48 $270.72 $273.60 $282.24 Preventive Medicine 40-64 years New Pat - 99386 99386 $334.00 $334.00 $237.14 $334.00 $334.00 $237.14 $320.64 $313.96 $317.30 $327.32 Preventive Medicine 65+ years New Pat - 99387 99387 $362.00 $362.00 $257.02 $362.00 $362.00 $257.02 $347.52 $340.28 $343.90 $354.76 Preventive Medicine < 1 year Established Pat- 99391 99391 $218.00 $218.00 $154.78 $218.00 $218.00 $154.78 $209.28 $204.92 $207.10 $213.64 Preventive Medicine 1-4 years Established 99392 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 Preventive Medicine 5-11 years Established Pat - 99393 99393 $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 Preventive Medicine 12-17 years Established Pat - 99394 99394 $254.00 $254.00 $180.34 $254.00 $254.00 $180.34 $243.84 $238.76 $241.30 $248.92 Preventive Medicine 18-39 years Established Pat - 99395 99395 $260.00 $260.00 $184.60 $260.00 $260.00 $184.60 $249.60 $244.40 $247.00 $254.80 Preventive Medicine 40-64 years Established Pat- 99396 99396 $277.00 $277.00 $196.67 $277.00 $277.00 $196.67 $265.92 $260.38 $263.15 $271.46 Preventive Medicine 65+ years Established Pat - 99397 99397 $297.00 $297.00 $210.87 $297.00 $297.00 $210.87 $285.12 $279.18 $282.15 $291.06 99406 Smoking Cessation Counseling Intermediate THAY 99406 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 Smoking and tobacco use cessation counseling 3-7 min 99406 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 99407 Smoking Cessation Counseling Intensive THAY 99407 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 99407 Tobacco cessation counseling intensive > 10 minutes 99407 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 99441 - Telephone Evaluation & Management; 5-10 minutes 99441 $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 99442 - Telephone Evaluation & Management; 11-20 minutes 99442 $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 99443 - Telephone Evaluation & Management; 21-30 minutes 99443 $88.00 $88.00 $88.00 $62.48 $88.00 $88.00 $62.48 $84.48 $82.72 $83.60 $86.24 99460 NEWBORN CARE NORMAL 99460 $212.00 $- $- $- $- $- $- $- $- 99462 NEWBORN VISIT 99462 $92.00 $- $- $- $- $- $- $- $- 99463 NEWBORN CARE ADM/DISC SAME DAY 99463 $244.00 $- $- $- $- $- $- $- $- 99464 ATTEND AT DELIVERY 99464 $165.00 $- $- $- $- $- $- $- $- 99465 NEWBORN RESUSCITATION 99465 $322.00 $- $- $- $- $- $- $- $- 99468 INT IP NEONAT CC<28D 99468 "$2,030.00 " $- $- $- $- $- $- $- $- Chronic Care management 1st visit 99487 $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 Chronic Care Management addl 30 min 99489 $74.00 $74.00 $52.54 $74.00 $74.00 $52.54 $71.04 $69.56 $70.30 $72.52 Advance Care Planning 99497 $186.00 $186.00 $132.06 $186.00 $186.00 $132.06 $178.56 $174.84 $176.70 $182.28 99497 Advance Care Planning 99497 $186.00 $- $- $- $- $- $- $- $- Advance Care Planning Additional 30 minutes 99498 $164.00 $164.00 $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 99498 Advance Care Planning Additional 30 minutes 99498 $164.00 $- $- $- $- $- $- $- $- Gi Path Panel Pcr RPS 0097U $541.00 $541.00 $384.11 $541.00 $541.00 $384.11 $519.36 $508.54 $513.95 $530.18 Resp Path Panel Pcr RPS 0099U $542.00 $542.00 $384.82 $542.00 $542.00 $384.82 $520.32 $509.48 $514.90 $531.16 0296T CARD REHAB ZIO PATCH HOOKUP 0296T $408.00 $408.00 $289.68 $408.00 $408.00 $289.68 $391.68 $383.52 $387.60 $399.84 0447T Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision 0447T $349.00 $349.00 $247.79 $349.00 $349.00 $247.79 $335.04 $328.06 $331.55 $342.02 Neutrophil Cytoplasm RPS 1-83516|2-83516 $145.00 $145.00 $102.95 $145.00 $145.00 $102.95 $139.20 $136.30 $137.75 $142.10 PSA Total+% Free LC 1-84153|2-84154 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 KNEE BRACE PAT SM 1-L1820|2-L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 TUBERCULIN TEST(APLISOL) 5TU/0.1ML [THAY] 86580 42023-0104-01 $41.32 $41.32 0.1 mL $29.34 $41.32 $41.32 $29.34 $39.67 $38.84 $39.25 $40.49 RABIES IMMUNE GLOBULIN (HYPERRAB) 300 UNITS/ML [THAY] 90375 13533-0318-01 "$1,724.28 " "$1,724.28 " 1 mL "$1,224.24 " "$1,724.28 " "$1,724.28 " "$1,224.24 " "$1,655.31 " "$1,620.82 " "$1,638.07 " "$1,689.79 " PALIVIZUMAB (SYNAGIS) 50MG/0.5ML VIAL [THAY] 90378 60574-4114-01 "$2,894.11 " "$2,894.11 " 0.5 mL "$2,054.82 " "$2,894.11 " "$2,894.11 " "$2,054.82 " "$2,778.34 " "$2,720.46 " "$2,749.40 " "$2,836.23 " PALIVIZUMAB (SYNAGIS) 100MG/1ML VIAL [THAY] 90378 60574-4113-01 "$4,768.76 " "$4,768.76 " 1 mL "$3,385.82 " "$4,768.76 " "$4,768.76 " "$3,385.82 " "$4,578.01 " "$4,482.64 " "$4,530.33 " "$4,673.39 " HEPATITIS A (HAVRIX) PED 0.5ML SYR <18YR [THAY] 90633 58160-0825-52 $98.64 $98.64 0.5 mL $70.03 $98.64 $98.64 $70.03 $94.69 $92.72 $93.70 $96.66 INFLUENZA HIGH DOSE (Fluzone HD) 0.65 ML PF SYR [THAY] 90662 49281-0120-65 $51.00 $51.00 0.7 mL $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 PNUEMOCOCCAL (PREVNAR 13) 0.5ML SYR [THAY] 90670 00005-1971-02 $471.83 $471.83 0.5 mL $335.00 $471.83 $471.83 $335.00 $452.96 $443.52 $448.24 $462.40 RABIES VACCINE (RABAVERT) VIAL [THAY] 90675 58160-0964-12 $828.80 $828.80 1 EA $588.45 $828.80 $828.80 $588.45 $795.65 $779.07 $787.36 $812.22 INFLUENZA (FLUZONE QIV)PF 0.5ML SYR [THAY] 90686 49281-0420-50 $63.55 $63.55 0.5 mL $45.12 $63.55 $63.55 $45.12 $61.00 $59.73 $60.37 $62.27 INFLUENZA (FLUZONE QIV)PF 0.5ML VIAL [THAY] 90686 49281-0419-10 $63.65 $63.65 0.5 mL $45.19 $63.65 $63.65 $45.19 $61.11 $59.83 $60.47 $62.38 EGG-FREE INFLUENZA (Flublok QIV) 0.5ML PF SYR [THAY] 90686 49281-0719-10 $137.91 $137.91 0.5 mL $97.91 $137.91 $137.91 $97.91 $132.39 $129.63 $131.01 $135.15 MEASLES-MUMPS-RUBELLA (MMR II)0.5ML VIAL [THAY] 90707 00006-4681-00 $207.93 $207.93 1 mL $147.63 $207.93 $207.93 $147.63 $199.61 $195.45 $197.53 $203.77 TETANUS/DIPHTHERIA Td (TENIVAC)SYR [THAY] 90714 49281-0215-15 $100.59 $100.59 0.5 mL $71.42 $100.59 $100.59 $71.42 $96.57 $94.56 $95.56 $98.58 BOOSTRIX (Tdap) 0.5ML SYR >10YRS [THAY] 90715 58160-0842-52 $117.96 $117.96 0.5 mL $83.75 $117.96 $117.96 $83.75 $113.24 $110.88 $112.06 $115.60 PNEUMOVAX 23 (25MCG/0.5ML) VIAL [THAY] 90732 00006-4837-03 $272.47 $272.47 0.5 mL $193.45 $272.47 $272.47 $193.45 $261.57 $256.12 $258.84 $267.02 PNEUMOVAX 23 (25MCG/0.5ML) VIAL [THAY] 90732 00006-4943-00 $272.47 $272.47 0.5 mL $193.45 $272.47 $272.47 $193.45 $261.57 $256.12 $258.84 $267.02 hepatitis B adult vaccine 20 mcg/mL Sus (THAY) 90740 58160-0821-52 $161.18 $161.18 1 mL $114.44 $161.18 $161.18 $114.44 $154.73 $151.51 $153.12 $157.96 HEPATITIS B (ENGERIX-B) PED 0.5ML SYR [THAY] 90744 58160-0820-52 $133.26 $133.26 1 mL $94.61 $133.26 $133.26 $94.61 $127.93 $125.26 $126.59 $130.59 RECOMBIVAX HB ADULT 10MCG/1ML SYR [THAY] 90746 00006-4094-09 $165.12 $165.12 1 mL $117.24 $165.12 $165.12 $117.24 $158.52 $155.21 $156.86 $161.82 "zoster vaccine, inactivated adjuvanted REC" 90750 58160-0819-12 $366.08 $366.08 1 EA $259.92 $366.08 $366.08 $259.92 $351.44 $344.12 $347.78 $358.76 Ambulance Mileage Five A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 Ambulance Mileage Four A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 Ambulance Mileage One A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 Ambulance Mileage Six A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 Ambulance Mileage Three A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 Ambulance Mileage Two A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 MILEAGE-AMBULANCE A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 MILEAGE-AMBULANCE/### A0425 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 ALS ALL INCLUSIVES-AMBULANCE A0427 "$1,160.00 " "$1,160.00 " $823.60 "$1,160.00 " "$1,160.00 " $823.60 "$1,113.60 " "$1,090.40 " "$1,102.00 " "$1,136.80 " ALS ALL INCLUSIVES-AMBULANCE/### A0427 "$1,160.00 " "$1,160.00 " $823.60 "$1,160.00 " "$1,160.00 " $823.60 "$1,113.60 " "$1,090.40 " "$1,102.00 " "$1,136.80 " Ambulance Option 4 - Ambulance Charge Options A0427 "$1,160.00 " "$1,160.00 " $823.60 "$1,160.00 " "$1,160.00 " $823.60 "$1,113.60 " "$1,090.40 " "$1,102.00 " "$1,136.80 " Ambulance Option 1 - Ambulance Charge Options A0428 $590.00 $590.00 $418.90 $590.00 $590.00 $418.90 $566.40 $554.60 $560.50 $578.20 BLS NON EMERG-AMBULANCE A0428 $590.00 $590.00 $418.90 $590.00 $590.00 $418.90 $566.40 $554.60 $560.50 $578.20 BLS NON EMERG-AMBULANCE/### A0428 $590.00 $590.00 $418.90 $590.00 $590.00 $418.90 $566.40 $554.60 $560.50 $578.20 Ambulance Option 2 - Ambulance Charge Options A0429 $775.00 $775.00 $550.25 $775.00 $775.00 $550.25 $744.00 $728.50 $736.25 $759.50 BLS ALL INCLUSIVES-AMBULANCE A0429 $775.00 $775.00 $550.25 $775.00 $775.00 $550.25 $744.00 $728.50 $736.25 $759.50 BLS ALL INCLUSIVES-AMBULANCE/## A0429 $775.00 $775.00 $550.25 $775.00 $775.00 $550.25 $744.00 $728.50 $736.25 $759.50 ALS NON EMERG-AMBULANCE A0433 "$1,586.00 " "$1,586.00 " "$1,126.06 " "$1,586.00 " "$1,586.00 " "$1,126.06 " "$1,522.56 " "$1,490.84 " "$1,506.70 " "$1,554.28 " ALS NON EMERG-AMBULANCE/### A0433 "$1,586.00 " "$1,586.00 " "$1,126.06 " "$1,586.00 " "$1,586.00 " "$1,126.06 " "$1,522.56 " "$1,490.84 " "$1,506.70 " "$1,554.28 " Ambulance Option 3 - Ambulance Charge Options A0433 "$1,586.00 " "$1,586.00 " "$1,126.06 " "$1,586.00 " "$1,586.00 " "$1,126.06 " "$1,522.56 " "$1,490.84 " "$1,506.70 " "$1,554.28 " SODIUM CHLORIDE (NS) 0.9% 10ML VIAL [THAY] A4216 63323-0186-10 $21.85 $21.85 10 mL $15.51 $21.85 $21.85 $15.51 $20.98 $20.54 $20.76 $21.41 SODIUM CHLORIDE (NS) 0.9% 10ML VIAL [THAY] A4216 00409-4888-10 $22.22 $22.22 10 mL $15.78 $22.22 $22.22 $15.78 $21.34 $20.89 $21.11 $21.78 SODIUM CHL BACTERIOSTATIC 0.9% 30ML [THAY] A4216 00409-1966-07 $22.71 $22.71 30 mL $16.13 $22.71 $22.71 $16.13 $21.81 $21.35 $21.58 $22.26 DEXTROSE 50% ABBOJECT (25GM/50ML) [THAY] A4216 00409-7517-16 $39.23 $39.23 50 mL $27.85 $39.23 $39.23 $27.85 $37.66 $36.87 $37.26 $38.44 DEXTROSE 50% ABBOJECT (25GM/50ML) [THAY] A4216 00409-4902-34 $39.66 $39.66 50 mL $28.16 $39.66 $39.66 $28.16 $38.07 $37.28 $37.67 $38.86 sterile water - Sol A4217 00409-4887-10 $22.13 $22.13 10 mL $15.71 $22.13 $22.13 $15.71 $21.24 $20.80 $21.02 $21.68 A4217 Morgan Lens Tray A4217 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 SODIUM CHLORIDE(0.9%)NEBULIZER 3ML [THAY] A4218 00487-9301-03 $4.25 $4.25 3 mL $3.02 $4.25 $4.25 $3.02 $4.08 $4.00 $4.04 $4.17 SODIUM CHLORIDE(0.9%)NEBULIZER 3ML [THAY] A4218 00487-9301-33 $4.32 $4.32 3 mL $3.07 $4.32 $4.32 $3.07 $4.15 $4.06 $4.10 $4.23 SODIUM CHLORIDE(0.9%)NEBULIZER 3ML [THAY] A4218 00378-6985-01 $4.87 $4.87 3 mL $3.46 $4.87 $4.87 $3.46 $4.67 $4.58 $4.63 $4.77 Insertion tray without drainage bag and without catheter (accessories only) A4310 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 "Insertion Tray With Drainage Bag With Indwelling Catheter, Foley Type, Two-Way Latex With Coating" A4314 $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 FOLEY CATHETER TWO W A4344 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 A4346 Foley Catheter Three A4346 $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 "Intermittent urinary catheter; straight tip," A4351 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 Intrmt Urin Cath W/insert Supp A4353 $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 Insertion tray with drainage bag but without catheter A4354 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 "Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube" A4357 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 Urinary Leg Bag Vinyl W/wo Tub A4358 $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 Ace Wrap A4465 $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 A4550 DermaBond Charge A4550 $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 A4565 Arm Sling Infant A4565 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 A4565 Arm Sling Peds A4565 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 A4565 Arm Sling Universal A4565 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 ARM SLING INFANT A4565 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 ARM SLING PEDS A4565 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 ARM SLING UNIVERSAL A4565 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 Slings Charge A4565 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 A4570 Colles Splint LT/LG A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 A4570 Colles Splint LT/MED A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 A4570 Colles Splint LT/SM A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 A4570 Colles Splint RT/LG A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 A4570 Colles Splint RT/MED A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 A4570 Colles Splint RT/SM A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 A4570 Strassburg Sock A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 COLLES SPLINT LT LG A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 COLLES SPLINT LT MED A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 COLLES SPLINT LT SM A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 COLLES SPLINT RT LG A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 COLLES SPLINT RT MED A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 COLLES SPLINT RT SM A4570 $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 CAST LONG ARM A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 CAST LONG LEG A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 CAST OCL SPLINT ARM A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 CAST OCL SPLINT ARM A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 CAST OCL SPLINT LEG A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 CAST OCL SPLINT LEG A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 CAST SHORT ARM A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 CAST SHORT LEG A4590 $96.00 $96.00 $68.16 $96.00 $96.00 $68.16 $92.16 $90.24 $91.20 $94.08 READI-CAT2 450ML [THAY] A4641 32909-0725-03 $23.26 $23.26 450 mL $16.52 $23.26 $23.26 $16.52 $22.33 $21.87 $22.10 $22.80 MD-GASTROVIEW 66-10% 30ML [THAY] A4641 00019-4816-04 $102.50 $102.50 30 mL $72.78 $102.50 $102.50 $72.78 $98.40 $96.35 $97.38 $100.45 CYSTO CONRAY II 17.2% 250ML BOTTLE [THAY] A4641 00019-0862-07 $133.50 $133.50 250 mL $94.79 $133.50 $133.50 $94.79 $128.16 $125.49 $126.83 $130.83 TEGADERM 4X4 A6257 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 thiamine 100 mg Tab A9152 51645-0905-99 $3.60 $3.60 1 - $2.56 $3.60 $3.60 $2.56 $3.46 $3.39 $3.42 $3.53 ASCORBIC ACID(VITAMIN C)500MG TAB [THAY] A9152 00904-0523-61 $3.63 $3.63 1 tab(s) $2.58 $3.63 $3.63 $2.58 $3.49 $3.42 $3.45 $3.56 CALCIUM CARBONATE (TUMS) 500MG CHEW [THAY] A9152 66553-0004-01 $3.65 $3.65 1 tab(s) $2.59 $3.65 $3.65 $2.59 $3.50 $3.43 $3.47 $3.58 THIAMINE 100MG TAB [THAY] A9152 77333-0934-10 $3.89 $3.89 1 - $2.76 $3.89 $3.89 $2.76 $3.73 $3.65 $3.69 $3.81 FERROUS SULFATE (IRON) 325MG TAB [THAY] A9152 00245-0108-11 $4.37 $4.37 1 tab(s) $3.10 $4.37 $4.37 $3.10 $4.20 $4.11 $4.15 $4.28 Phytonadione 100 mcg Tab A9152 54629-0841-21 $4.40 $4.40 1 tab(s) $3.12 $4.40 $4.40 $3.12 $4.22 $4.14 $4.18 $4.31 FERROUS SULFATE (IRON) 325MG TAB [THAY] A9152 00245-0108-01 $5.14 $5.14 1 tab(s) $3.65 $5.14 $5.14 $3.65 $4.93 $4.83 $4.88 $5.04 SENNOSIDES/DOCUSATE SOD(SENNA PLUS) [THAY] A9153 00904-6724-61 $3.57 $3.57 1 tab(s) $2.54 $3.57 $3.57 $2.54 $3.43 $3.36 $3.39 $3.50 cholecalciferol 1000 intl units (Vit D-3) [THAY] A9153 10006-0700-33 $3.59 $3.59 1 tab(s) $2.55 $3.59 $3.59 $2.55 $3.45 $3.38 $3.41 $3.52 cholecalciferol 1000 intl units (Vit D-3) [THAY] A9153 20555-0033-00 $3.59 $3.59 1 tab(s) $2.55 $3.59 $3.59 $2.55 $3.45 $3.38 $3.41 $3.52 SENNOSIDES/DOCUSATE SOD(SENNA PLUS) [THAY] A9153 00536-1247-01 $3.59 $3.59 1 tab(s) $2.55 $3.59 $3.59 $2.55 $3.45 $3.38 $3.42 $3.52 cholecalciferol 1000 intl units (Vit D-3) [THAY] A9153 00904-5824-61 $3.61 $3.61 1 tab(s) $2.57 $3.61 $3.61 $2.57 $3.47 $3.40 $3.43 $3.54 SENNOSIDES/DOCUSATE SOD(SENNA PLUS) [THAY] A9153 51645-0850-99 $3.68 $3.68 1 tab(s) $2.61 $3.68 $3.68 $2.61 $3.53 $3.46 $3.49 $3.60 multivitamin with minerals Therapeutic Multiple Vitamins with Minerals Tab A9153 00904-5492-61 $3.71 $3.71 1 tab(s) $2.64 $3.71 $3.71 $2.64 $3.56 $3.49 $3.53 $3.64 SENNOSIDES/DOCUSATE SOD(SENNA PLUS) [THAY] A9153 63739-0432-10 $3.86 $3.86 1 tab(s) $2.74 $3.86 $3.86 $2.74 $3.71 $3.63 $3.67 $3.79 Abdominal Binder Universal A9270 $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 CARDIOLITE 25-30 mCi CHARGE ONLY [THAY] A9500 11194-0001-20 $109.99 $109.99 1 EA $78.09 $109.99 $109.99 $78.09 $105.59 $103.39 $104.49 $107.79 CARDIOLITE 8-10 mCi CHARGE ONLY [THAY] A9500 11194-0001-20 $109.99 $109.99 1 EA $78.09 $109.99 $109.99 $78.09 $105.59 $103.39 $104.49 $107.79 TC99m SESTAMIBI SYRINGE CHARGE ONLY [THAY] A9500 65857-0500-20 $109.99 $109.99 1 EA $78.09 $109.99 $109.99 $78.09 $105.59 $103.39 $104.49 $107.79 TC99m MEDRONATE UP TO 30MC (MDP) CHARGE ONLY [THAY] A9503 45567-0040-02 $34.97 $34.97 1 EA $24.83 $34.97 $34.97 $24.83 $33.57 $32.87 $33.22 $34.27 TC99m SODIUM PERTECHNETATE CHARGE ONLY [THAY] A9512 99999-9999-99 $34.97 $34.97 1 EA $24.83 $34.97 $34.97 $24.83 $33.57 $32.87 $33.22 $34.27 TC99m MEBROFENIN (CHOLETEC) VIAL [THAY] A9537 00270-0083-20 $219.50 $219.50 1 EA $155.85 $219.50 $219.50 $155.85 $210.72 $206.33 $208.53 $215.11 TC99m ALBUMIN AGGR UP TO 10mCi (MAA) CHARGE ONLY [THAY] A9540 65174-0270-05 $34.97 $34.97 1 EA $24.83 $34.97 $34.97 $24.83 $33.57 $32.87 $33.22 $34.27 THAY Fludeoxyglucose F-18 - Sol A9552 $857.00 $857.00 $608.47 $857.00 $857.00 $608.47 $822.72 $805.58 $814.15 $839.86 FLUDEOXYGLUCOSE F-18 (FDG F-18) SOL [THAY] A9552 40028-0511-30 "$39,020.00 " "$39,020.00 " 30 mL "$27,704.20 " "$39,020.00 " "$39,020.00 " "$27,704.20 " "$37,459.20 " "$36,678.80 " "$37,069.00 " "$38,239.60 " XE133 (XENON) PER 10 MCI [THAY] A9558 11994-0127-11 $132.02 $132.02 1 EA $93.73 $132.02 $132.02 $93.73 $126.74 $124.10 $125.42 $129.38 OXIDRONATE-HDP 0-30 mCI CHARGE ONLY [THAY] A9561 00019-9091-40 $72.99 $72.99 1 EA $51.83 $72.99 $72.99 $51.83 $70.07 $68.61 $69.34 $71.53 GADOTERIDOL (PROHANCE) 20ML VIAL [THAY] A9576 00270-1111-03 $272.26 $272.26 20 mL $193.30 $272.26 $272.26 $193.30 $261.37 $255.92 $258.64 $266.81 MAGNEVIST 46.9% 20ML VIAL [THAY] A9579 50419-0188-02 $219.20 $219.20 20 mL $155.63 $219.20 $219.20 $155.63 $210.43 $206.05 $208.24 $214.82 MAGNEVIST 46.9% 20ML VIAL [THAY] A9579 50419-0188-84 $219.20 $219.20 20 mL $155.63 $219.20 $219.20 $155.63 $210.43 $206.05 $208.24 $214.82 MAGNEVIST 46.9% 20ML VIAL [THAY] A9579 50419-0188-38 $236.00 $236.00 20 mL $167.56 $236.00 $236.00 $167.56 $226.56 $221.84 $224.20 $231.28 BUPIVACAINE LIPOSOME (EXPAREL) 1.3% PFVL [THAY] C9290 65250-0133-04 $440.24 $440.24 10 mL $312.57 $440.24 $440.24 $312.57 $422.63 $413.83 $418.23 $431.44 Elbow Protectors E0191 $205.00 $205.00 $145.55 $205.00 $205.00 $145.55 $196.80 $192.70 $194.75 $200.90 "BILI LIGHT/PHOTOTHERAPY, PER DAY CHARGE" E0202 $125.00 $125.00 $88.75 $125.00 $125.00 $88.75 $120.00 $117.50 $118.75 $122.50 G0008 Admin Influenza Virus Vaccine POC G0008 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 G0008 ADMINISTRATION FLU VACCINE CHARGE G0008 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 MEDICARE ONLY FLU VACCINE ADMIN CHARGE G0008 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 G0009 ADMINISTRATION PNEUMONIA VACCINE CHARGE G0009 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 MEDICARE ONLY PNEUMONIA VACCINE ADMIN CHARGE G0009 $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 G0071 Virtual face-to-face communication G0071 $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 Cervical or vaginal cancer screening; pelvic and clinical breast examination G0101 $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 PSA Screen G0103 $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 SCREENING SIGMOIDOSCOPY G0104 $356.00 "$3,097.00 " $356.00 $252.76 $356.00 $356.00 $252.76 $341.76 $334.64 $338.20 $348.88 COLONOSC SCRN HIRISK G0105 $671.00 "$1,831.00 " $671.00 $476.41 $671.00 $671.00 $476.41 $644.16 $630.74 $637.45 $657.58 G0108 DIABETES EDUCATION INDIV 30 M CHARGE. G0108 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 G0109 DIABETES GROUP OUTPATIENT SELF MGMT TRAINING (EA 30 MIN) CHARGE G0109 $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 COLONOSC SCRN MEDIC G0121 "$1,785.00 " $672.00 "$1,785.00 " "$1,267.35 " "$1,785.00 " "$1,785.00 " "$1,267.35 " "$1,713.60 " "$1,677.90 " "$1,695.75 " "$1,749.30 " Electrical Stimulation (Unattended) Minutes G0283 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 E-Stim for Wound Other Charge G0283 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 ROOM/BED: Observation G0378 Interval Interval #VALUE! #VALUE! Interval #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! "IPPE/PX/65+YEARS,E 99397" G0402 $198.00 $198.00 $140.58 $198.00 $198.00 $140.58 $190.08 $186.12 $188.10 $194.04 "IPPE/PX/65+YEARS,N 99387" G0402 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 Preventive Medicine 40-64 years Established G0402 $253.00 $253.00 $179.63 $253.00 $253.00 $179.63 $242.88 $237.82 $240.35 $247.94 G0404 IPPE/EKG Tracing G0404 $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 EKG Interpretation and Report G0405 $35.00 $35.00 $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 Bill Only - Prostate Needle Biopsy G0416 "$1,624.00 " "$1,624.00 " "$1,153.04 " "$1,624.00 " "$1,624.00 " "$1,153.04 " "$1,559.04 " "$1,526.56 " "$1,542.80 " "$1,591.52 " CARD REHAB PHASE 2 PULMONARY REHAB G0424 $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 "Annual Wellness Visit, Initial (AWV)" G0438 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 "Annual Wellness Visit, Subsequent (AWV)" G0439 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 "G0447 Face-to-face behavioral counseling for obesity, 15 minutes" G0447 $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 Hospital outpatient clinic visit G0463 $296.00 $- $- $- $- $- $- $- $- Chronic Care Management 20 min G0511 $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 Chronic Care Management CCM 99490 G0511 $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 Virtual Check in- RHC G2010 G2010 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 VIRTUAL BRIEF PHONE CALL G2012 $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 G2025 Telehealth Visit- RHC G2025 $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 WARFARIN SODIUM (COUMADIN) 1MG TAB [THAY] G8967 00832-1211-01 $4.73 $4.73 1 tab(s) $3.36 $4.73 $4.73 $3.36 $4.54 $4.45 $4.49 $4.64 WARFARIN SODIUM (COUMADIN) 5MG TAB [THAY] G8967 62584-0994-01 $4.79 $4.79 1 tab(s) $3.40 $4.79 $4.79 $3.40 $4.59 $4.50 $4.55 $4.69 WARFARIN SODIUM (COUMADIN)2.5MG TAB [THAY] G8967 00832-1213-01 $4.82 $4.82 1 tab(s) $3.42 $4.82 $4.82 $3.42 $4.63 $4.53 $4.58 $4.72 WARFARIN SODIUM (COUMADIN) 3MG TAB [THAY] G8967 00832-1214-01 $4.82 $4.82 1 tab(s) $3.42 $4.82 $4.82 $3.42 $4.63 $4.53 $4.58 $4.72 WARFARIN SODIUM (COUMADIN) 1MG TAB [THAY] G8967 00056-0169-75 $8.45 $8.45 1 tab(s) $6.00 $8.45 $8.45 $6.00 $8.11 $7.94 $8.03 $8.28 WARFARIN SODIUM (COUMADIN)2.5MG TAB [THAY] G8967 00056-0176-75 $8.83 $8.83 1 tab(s) $6.27 $8.83 $8.83 $6.27 $8.47 $8.30 $8.39 $8.65 WARFARIN SODIUM (COUMADIN) 3MG TAB [THAY] G8967 00056-0188-75 $8.85 $8.85 1 tab(s) $6.28 $8.85 $8.85 $6.28 $8.49 $8.32 $8.41 $8.67 WARFARIN SODIUM (COUMADIN) 5MG TAB [THAY] G8967 00056-0172-75 $9.05 $9.05 1 tab(s) $6.43 $9.05 $9.05 $6.43 $8.69 $8.51 $8.60 $8.87 ACETAMINOPHEN(OFIRMEV) 1000MG/100ML VIAL [THAY] J0131 43825-0102-01 $124.30 $124.30 100 mL $88.25 $124.30 $124.30 $88.25 $119.33 $116.84 $118.09 $121.81 ACETYLCYSTEINE(ACETADOTE)6000MG/30ML IV VIAL [THAY] J0132 63323-0963-30 $471.20 $471.20 30 mL $334.55 $471.20 $471.20 $334.55 $452.35 $442.93 $447.64 $461.78 ADENOSINE (ADENOCARD) 6MG/2ML SYRINGE [THAY] J0153 17478-0542-02 $34.88 $34.88 2 mL $24.76 $34.88 $34.88 $24.76 $33.48 $32.78 $33.13 $34.18 ADENOSINE (ADENOCARD) 6MG/2ML SYRINGE [THAY] J0153 25021-0301-72 $58.40 $58.40 2 mL $41.46 $58.40 $58.40 $41.46 $56.06 $54.90 $55.48 $57.23 ADENOSINE (ADENOCARD) 6MG/2ML SYRINGE [THAY] J0153 00469-8234-12 $106.48 $106.48 2 mL $75.60 $106.48 $106.48 $75.60 $102.22 $100.09 $101.16 $104.35 Adrenalin epinephrine inject J0171 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 IV J0171 Adrenalin epinephrine inject J0171 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 EPINEPHRINE HCL 1MG/ML AMP [THAY] J0171 00409-7241-01 $25.04 $25.04 1 mL $17.78 $25.04 $25.04 $17.78 $24.04 $23.54 $23.79 $24.54 EPINEPHRINE HCL 0.1MG/ML 10 ML ABBOJECT [THAY] J0171 00409-4921-34 $30.94 $30.94 10 mL $21.97 $30.94 $30.94 $21.97 $29.71 $29.09 $29.40 $30.33 EPINEPHRINE HCL 0.1MG/ML 10 ML ABBOJECT [THAY] J0171 76329-3316-01 $41.00 $41.00 10 mL $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 EPINEPHRINE HCL 1MG/ML AMP [THAY] J0171 54288-0103-10 $55.00 $55.00 1 mL $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 EPINEPHrine 1 mg/mL Sol J0171 42023-0159-25 $55.90 $55.90 1 mL $39.69 $55.90 $55.90 $39.69 $53.67 $52.55 $53.11 $54.79 AMINOPHYLLINE 500MG/20ML VIAL [THAY] J0280 00409-5922-01 $36.81 $36.81 20 mL $26.13 $36.81 $36.81 $26.13 $35.34 $34.60 $34.97 $36.07 AMINOPHYLLINE 250MG/10ML VIAL [THAY] J0280 00409-5921-01 $47.29 $47.29 10 mL $33.57 $47.29 $47.29 $33.57 $45.40 $44.45 $44.92 $46.34 AMIODARONE(CORDARONE)150MG/3ML VIAL [THAY] J0282 63323-0616-03 $23.38 $23.38 3 mL $16.60 $23.38 $23.38 $16.60 $22.44 $21.98 $22.21 $22.91 AMIODARONE HCL(NEXTERONE)150MG/100ML BAG [THAY] J0282 43066-0150-10 $118.26 $118.26 100 mL $83.96 $118.26 $118.26 $83.96 $113.53 $111.16 $112.34 $115.89 AMIODARONE HCL(NEXTERONE)360MG/200ML BAG [THAY] J0282 43066-0360-20 $130.74 $130.74 200 mL $92.82 $130.74 $130.74 $92.82 $125.51 $122.89 $124.20 $128.12 AMPICILLIN 1000MG VIAL [THAY] J0290 63323-0389-10 $34.16 $34.16 1 EA $24.25 $34.16 $34.16 $24.25 $32.79 $32.11 $32.45 $33.48 AMPICILLIN 1000MG VIAL [THAY] J0290 63323-0704-08 $34.16 $34.16 1 EA $24.25 $34.16 $34.16 $24.25 $32.79 $32.11 $32.45 $33.48 AMPICILLIN 1000MG VIAL [THAY] J0290 67850-0021-10 $35.80 $35.80 1 EA $25.42 $35.80 $35.80 $25.42 $34.37 $33.65 $34.01 $35.08 AMPICILLIN 1000MG VIAL [THAY] J0290 55150-0113-10 $36.41 $36.41 1 EA $25.85 $36.41 $36.41 $25.85 $34.95 $34.23 $34.59 $35.68 AMPICILLIN/SULBACTAM(UNASYN)1.5GM VIAL [THAY] J0295 00641-6116-10 $28.40 $28.40 1 EA $20.16 $28.40 $28.40 $20.16 $27.26 $26.70 $26.98 $27.83 AMPICILLIN/SULBACTAM(UNASYN)1.5GM VIAL [THAY] J0295 63323-0368-20 $29.34 $29.34 1 EA $20.83 $29.34 $29.34 $20.83 $28.16 $27.58 $27.87 $28.75 AMPICILLIN/SULBACTAM(UNASYN)1.5GM VIAL [THAY] J0295 71288-0005-20 $32.31 $32.31 1 EA $22.94 $32.31 $32.31 $22.94 $31.02 $30.37 $30.70 $31.67 AMPICILLIN/SULBACTAM(UNASYN)1.5GM VIAL [THAY] J0295 00049-0013-83 $38.24 $38.24 1 EA $27.15 $38.24 $38.24 $27.15 $36.71 $35.94 $36.32 $37.47 Succinylcholine(Quelicin)200MG/10ML [THAY] J0330 00409-6629-02 $66.03 $66.03 10 mL $46.88 $66.03 $66.03 $46.88 $63.39 $62.07 $62.73 $64.71 Succinylcholine(Quelicin)200MG/10ML [THAY] J0330 69918-0700-25 $66.03 $66.03 10 mL $46.88 $66.03 $66.03 $46.88 $63.39 $62.07 $62.73 $64.71 Succinylcholine(Quelicin)200MG/10ML [THAY] J0330 00781-3411-95 $67.95 $67.95 10 mL $48.24 $67.95 $67.95 $48.24 $65.23 $63.87 $64.55 $66.59 HYDRALAZINE (APRESOLINE) 20MG/1ML VIAL [THAY] J0360 63323-0614-01 $51.39 $51.39 1 mL $36.49 $51.39 $51.39 $36.49 $49.34 $48.31 $48.82 $50.36 HYDRALAZINE (APRESOLINE) 20MG/1ML VIAL [THAY] J0360 17478-0934-01 $126.14 $126.14 1 mL $89.56 $126.14 $126.14 $89.56 $121.10 $118.57 $119.83 $123.62 ARIPiprazole (ABILIFY MAINTENA) 400 mg REC SYR [THAY] J0401 59148-0072-80 "$4,114.52 " "$4,114.52 " 1 mL "$2,921.31 " "$4,114.52 " "$4,114.52 " "$2,921.31 " "$3,949.94 " "$3,867.65 " "$3,908.79 " "$4,032.23 " AZITHROMYCIN(ZITHROMAX)500MG VIAL [THAY] J0456 25021-0112-10 $34.40 $34.40 1 EA $24.42 $34.40 $34.40 $24.42 $33.02 $32.34 $32.68 $33.71 AZITHROMYCIN(ZITHROMAX)500MG VIAL [THAY] J0456 63323-0398-14 $37.84 $37.84 1 EA $26.87 $37.84 $37.84 $26.87 $36.33 $35.57 $35.95 $37.08 AZITHROMYCIN(ZITHROMAX)500MG VIAL [THAY] J0456 55150-0174-10 $42.00 $42.00 1 EA $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 ATROPINE SULFATE 0.1MG/ML(10ML) ABBOJECT [THAY] J0461 00409-1630-10 $33.25 $33.25 10 mL $23.60 $33.25 $33.25 $23.60 $31.92 $31.25 $31.58 $32.58 ATROPINE SULFATE 0.4MG/ML 1ML VIAL [THAY] J0461 00517-0401-25 $37.50 $37.50 1 mL $26.63 $37.50 $37.50 $26.63 $36.00 $35.25 $35.63 $36.75 ATROPINE SULFATE 0.1MG/ML(10ML) ABBOJECT [THAY] J0461 76329-3339-01 $41.60 $41.60 10 mL $29.54 $41.60 $41.60 $29.54 $39.94 $39.10 $39.52 $40.77 ATROPINE SULFATE 0.1MG/ML(10ML) ABBOJECT [THAY] J0461 00409-4911-34 $42.20 $42.20 10 mL $29.96 $42.20 $42.20 $29.96 $40.51 $39.67 $40.09 $41.36 ATROPINE SULFATE 0.4MG/ML 20ML VIAL [THAY] J0461 00641-6006-10 $104.24 $104.24 20 mL $74.01 $104.24 $104.24 $74.01 $100.07 $97.99 $99.03 $102.16 benralizumab 30 mg/mL Sol J0517 00310-1730-30 "$7,069.87 " "$7,069.87 " 1 EA "$5,019.61 " "$7,069.87 " "$7,069.87 " "$5,019.61 " "$6,787.07 " "$6,645.68 " "$6,716.37 " "$6,928.47 " "BICILLIN CR TO 600,000" J0558 $133.00 $133.00 $94.43 $133.00 $133.00 $94.43 $127.68 $125.02 $126.35 $130.34 BICILLIN C-R 1.2MU/2ML SYR [THAY] J0558 60793-0600-10 $321.06 $321.06 2 mL $227.95 $321.06 $321.06 $227.95 $308.22 $301.80 $305.01 $314.64 BICILLIN C-R 1.2MU/2ML SYR [THAY] J0558 60793-0601-10 $321.06 $321.06 2 mL $227.95 $321.06 $321.06 $227.95 $308.22 $301.80 $305.01 $314.64 ONABOTULINUMTOXINA (BOTOX) 100 UNIT REC VIAL [THAY] J0585 00023-1145-01 "$1,462.40 " "$1,462.40 " 1 EA "$1,038.30 " "$1,462.40 " "$1,462.40 " "$1,038.30 " "$1,403.90 " "$1,374.66 " "$1,389.28 " "$1,433.15 " Butorphanol tartrate 1 mg J0595 $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 IV J0595 STADOL 1MG J0595 $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 BUTORPHANOL TART(STADOL)1MG/ML VIAL [THAY] J0595 00409-1623-01 $29.58 $29.58 1 mL $21.00 $29.58 $29.58 $21.00 $28.39 $27.80 $28.10 $28.98 CALCIUM GLUCONATE 10% (1000MG/10ML) [THAY] J0610 63323-0311-10 $32.96 $32.96 10 mL $23.40 $32.96 $32.96 $23.40 $31.64 $30.98 $31.31 $32.30 calcium chloride 100 mg/mL Sol J0610 00409-4928-34 $40.47 $40.47 10 mL $28.74 $40.47 $40.47 $28.74 $38.85 $38.04 $38.45 $39.66 CALCIUM GLUCONATE 10% (1000MG/10ML) [THAY] J0610 63323-0360-19 $41.96 $41.96 10 mL $29.79 $41.96 $41.96 $29.79 $40.28 $39.44 $39.86 $41.12 -SALMON (MIACALCIN) 400IU/2ML INJ [THAY] J0630 67457-0675-02 "$4,561.15 " "$4,561.15 " 2 mL "$3,238.42 " "$4,561.15 " "$4,561.15 " "$3,238.42 " "$4,378.71 " "$4,287.48 " "$4,333.09 " "$4,469.93 " leucovorin 200 mg REC J0640 25021-0815-30 $146.00 $146.00 1 EA $103.66 $146.00 $146.00 $103.66 $140.16 $137.24 $138.70 $143.08 leucovorin 350 mg REC J0640 25021-0816-30 $218.00 $218.00 1 EA $154.78 $218.00 $218.00 $154.78 $209.28 $204.92 $207.10 $213.64 MEPIVACAINE(CARBOCAINE-MPF)1.5% 30ML [THAY] J0670 00409-1041-30 $33.34 $33.34 30 mL $23.67 $33.34 $33.34 $23.67 $32.01 $31.34 $31.67 $32.67 Cefazolin sodium injection J0690 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 IV J0690 CEFAZOLIN SODIUM 1GM J0690 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 ceFAZolin SODIUM (Ancef)1000MG VIAL [THAY] J0690 00409-0805-01 $22.64 $22.64 1 EA $16.07 $22.64 $22.64 $16.07 $21.73 $21.28 $21.51 $22.19 ceFAZolin SODIUM (Ancef)1000MG VIAL [THAY] J0690 00143-9924-90 $23.28 $23.28 1 EA $16.53 $23.28 $23.28 $16.53 $22.35 $21.89 $22.12 $22.82 ceFAZolin SODIUM (Ancef)1000MG VIAL [THAY] J0690 60505-6142-05 $25.22 $25.22 1 EA $17.91 $25.22 $25.22 $17.91 $24.22 $23.71 $23.96 $24.72 CEFEPIME HCL (MAXIPIME) 2000MG VIAL [THAY] J0692 44567-0241-10 $43.67 $43.67 1 EA $31.00 $43.67 $43.67 $31.00 $41.92 $41.05 $41.48 $42.79 CEFEPIME HCL (MAXIPIME) 2000MG VIAL [THAY] J0692 63323-0340-20 $43.76 $43.76 1 EA $31.07 $43.76 $43.76 $31.07 $42.01 $41.13 $41.57 $42.88 CEFEPIME HCL (MAXIPIME) 2000MG VIAL [THAY] J0692 25021-0122-67 $44.00 $44.00 1 EA $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 CEFTRIAXONE (ROCEPHIN) 500MG VIAL [THAY] J0696 00409-7338-01 $22.28 $22.28 1 EA $15.82 $22.28 $22.28 $15.82 $21.39 $20.94 $21.17 $21.83 CEFTRIAXONE (ROCEPHIN) 1000MG VIAL [THAY] J0696 00409-7332-01 $23.82 $23.82 1 EA $16.91 $23.82 $23.82 $16.91 $22.87 $22.39 $22.63 $23.34 CEFTRIAXONE (ROCEPHIN) 1000MG VIAL [THAY] J0696 25021-0106-10 $25.76 $25.76 1 EA $18.29 $25.76 $25.76 $18.29 $24.73 $24.21 $24.47 $25.24 CEFTRIAXONE (ROCEPHIN) 1000MG VIAL [THAY] J0696 25021-0106-67 $25.76 $25.76 1 EA $18.29 $25.76 $25.76 $18.29 $24.73 $24.21 $24.47 $25.24 CEFTRIAXONE (ROCEPHIN) 1000MG VIAL J0696 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 CEFTRIAXONE (ROCEPHIN) 500MG VIAL J0696 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 IV J0696 Rocephin Injection per 250 MG Charge J0696 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 J0696 Ceftriaxone 250 MG Vial [CHAS] J0696 $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 CEFTRIAXONE (ROCEPHIN) 1000MG VIAL [THAY] J0696 00143-9857-25 $55.00 $55.00 1 EA $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 CEFTRIAXONE (ROCEPHIN) 500MG VIAL [THAY] J0696 00781-3207-95 $73.77 $73.77 1 EA $52.38 $73.77 $73.77 $52.38 $70.82 $69.34 $70.08 $72.29 CEFTRIAXONE (ROCEPHIN) 1000MG VIAL [THAY] J0696 60505-0752-04 $111.90 $111.90 1 EA $79.45 $111.90 $111.90 $79.45 $107.42 $105.19 $106.31 $109.66 CEFTRIAXONE (ROCEPHIN) 1000MG VIAL [THAY] J0696 00781-3208-95 $112.00 $112.00 1 EA $79.52 $112.00 $112.00 $79.52 $107.52 $105.28 $106.40 $109.76 BETAMETHASONE (CELESTONE) 30MG/5ML VIAL [THAY] J0702 00085-4320-01 $109.76 $109.76 5 mL $77.93 $109.76 $109.76 $77.93 $105.37 $103.17 $104.27 $107.56 BETAMETHASONE (CELESTONE) 30MG/5ML VIAL [THAY] J0702 51754-5060-01 $116.00 $116.00 5 mL $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 BETAMETHASONE (CELESTONE) 30MG/5ML VIAL [THAY] J0702 00517-0720-01 $143.60 $143.60 5 mL $101.96 $143.60 $143.60 $101.96 $137.86 $134.98 $136.42 $140.73 BETAMETHASONE (CELESTONE) 30MG/5ML VIAL [THAY] J0702 $143.60 $143.60 $101.96 $143.60 $143.60 $101.96 $137.86 $134.98 $136.42 $140.73 CEFTAROLINE FOSAMIL (TEFLARO) 600MG VIAL [THAY] J0712 00456-0600-10 $481.09 $481.09 1 EA $341.57 $481.09 $481.09 $341.57 $461.85 $452.22 $457.04 $471.47 CEFTAZIDIME (FORTAZ) 1000MG VIAL [THAY] J0713 00409-5082-16 $30.08 $30.08 1 EA $21.36 $30.08 $30.08 $21.36 $28.88 $28.28 $28.58 $29.48 CEFTAZIDIME (FORTAZ) 1000MG VIAL [THAY] J0713 44567-0235-25 $31.25 $31.25 1 EA $22.19 $31.25 $31.25 $22.19 $30.00 $29.38 $29.69 $30.63 CEFTAZIDIME (FORTAZ) 1000MG VIAL [THAY] J0713 25021-0127-20 $32.48 $32.48 1 EA $23.06 $32.48 $32.48 $23.06 $31.18 $30.53 $30.86 $31.83 CERTOLIZUMAB (CIMZIA) 400 MG/KIT [THAY] J0717 50474-0700-62 "$6,251.50 " "$6,251.50 " 1 EA "$4,438.57 " "$6,251.50 " "$6,251.50 " "$4,438.57 " "$6,001.44 " "$5,876.41 " "$5,938.93 " "$6,126.47 " cloNIDine 100 mcg/mL Sol J0735 39822-2000-01 $26.00 $26.00 1 mL $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 cloNIDine 100 mcg/mL Sol J0735 00143-9724-01 $30.08 $30.08 1 mL $21.36 $30.08 $30.08 $21.36 $28.88 $28.28 $28.58 $29.48 CIPROFLOXACIN(CIPRO) 400MG/200ML IV [THAY] J0744 00409-4777-02 $42.08 $42.08 200 mL $29.88 $42.08 $42.08 $29.88 $40.40 $39.56 $39.98 $41.24 CIPROFLOXACIN(CIPRO) 400MG/200ML IV [THAY] J0744 36000-0009-24 $45.40 $45.40 200 mL $32.23 $45.40 $45.40 $32.23 $43.58 $42.68 $43.13 $44.49 IV J0780 COMPAZINE 10 MG J0780 $44.00 $44.00 $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 Prochlorperazine injection J0780 $44.00 $44.00 $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 PROCHLORPERAZINE(COMPAZINE)10MG/2ML VIAL [THAY] J0780 23155-0294-41 $64.40 $64.40 2 mL $45.72 $64.40 $64.40 $45.72 $61.82 $60.54 $61.18 $63.11 PROCHLORPERAZINE(COMPAZINE)10MG/2ML VIAL [THAY] J0780 23155-0294-42 $64.40 $64.40 2 mL $45.72 $64.40 $64.40 $45.72 $61.82 $60.54 $61.18 $63.11 PROCHLORPERAZINE(COMPAZINE)10MG/2ML VIAL [THAY] J0780 23155-0294-31 $71.14 $71.14 2 mL $50.51 $71.14 $71.14 $50.51 $68.29 $66.87 $67.58 $69.72 COSYNTROPIN (COSTROSYN) 0.25MG VIAL [THAY] J0834 00781-3440-95 $212.48 $212.48 1 EA $150.86 $212.48 $212.48 $150.86 $203.98 $199.73 $201.86 $208.23 DAPTOmycin (CUBICIN) 500MG VIAL [THAY] J0878 43598-0413-11 $620.00 $620.00 1 EA $440.20 $620.00 $620.00 $440.20 $595.20 $582.80 $589.00 $607.60 DAPTOmycin (CUBICIN) 500MG VIAL [THAY] J0878 00703-0125-01 "$1,089.08 " "$1,089.08 " 1 EA $773.25 "$1,089.08 " "$1,089.08 " $773.25 "$1,045.52 " "$1,023.74 " "$1,034.63 " "$1,067.30 " DAPTOmycin (CUBICIN) 500MG VIAL [THAY] J0878 67919-0011-01 "$1,089.18 " "$1,089.18 " 1 EA $773.32 "$1,089.18 " "$1,089.18 " $773.32 "$1,045.61 " "$1,023.83 " "$1,034.72 " "$1,067.40 " DAPTOmycin (CUBICIN) 500MG VIAL [THAY] J0878 67919-0012-01 "$1,089.18 " "$1,089.18 " 1 EA $773.32 "$1,089.18 " "$1,089.18 " $773.32 "$1,045.61 " "$1,023.83 " "$1,034.72 " "$1,067.40 " DAPTOmycin (CUBICIN) 500MG VIAL [THAY] J0878 67919-0012-02 "$1,089.18 " "$1,089.18 " 1 EA $773.32 "$1,089.18 " "$1,089.18 " $773.32 "$1,045.61 " "$1,023.83 " "$1,034.72 " "$1,067.40 " "EPOETIN ALFA(PROCRIT)10,000 UNIT/ML [THAY]" J0885 59676-0310-01 $661.40 $661.40 1 mL $469.59 $661.40 $661.40 $469.59 $634.94 $621.72 $628.33 $648.17 "EPOETIN ALFA(PROCRIT)40,000 UNIT/ML [THAY]" J0885 59676-0340-01 "$2,200.76 " "$2,200.76 " 1 mL "$1,562.54 " "$2,200.76 " "$2,200.76 " "$1,562.54 " "$2,112.73 " "$2,068.71 " "$2,090.72 " "$2,156.74 " DEFEROXAMINE (DESFERAL) 500MG VIAL [THAY] J0895 00409-2336-10 $43.53 $43.53 1 EA $30.90 $43.53 $43.53 $30.90 $41.78 $40.91 $41.35 $42.65 Prolia 60 mg J0897 "$2,015.00 " "$2,015.00 " "$1,430.65 " "$2,015.00 " "$2,015.00 " "$1,430.65 " "$1,934.40 " "$1,894.10 " "$1,914.25 " "$1,974.70 " DENOSUMAB (PROLIA) 60MG/ML SYR [THAY] J0897 55513-0710-01 "$2,506.88 " "$2,506.88 " 1 mL "$1,779.88 " "$2,506.88 " "$2,506.88 " "$1,779.88 " "$2,406.60 " "$2,356.47 " "$2,381.54 " "$2,456.74 " DENOSUMAB (XGEVA) 120MG/1.7ML VIAL [THAY] J0897 55513-0730-01 "$4,130.73 " "$4,130.73 " 1.7 mL "$2,932.82 " "$4,130.73 " "$4,130.73 " "$2,932.82 " "$3,965.51 " "$3,882.89 " "$3,924.20 " "$4,048.12 " Depo-Estradiol Injection 5 mg Charge J1000 $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 DEPO-ESTRADIOL 25MG/5ML IM VIAL [THAY] J1000 00009-0271-01 $272.70 $272.70 5 mL $193.62 $272.70 $272.70 $193.62 $261.79 $256.34 $259.07 $267.25 METHYLPREDNISOLONE (DEPO-MEDROL) 40MG/ML VIAL [THAY] J1030 00009-3073-01 $45.36 $45.36 1 mL $32.21 $45.36 $45.36 $32.21 $43.55 $42.64 $43.09 $44.45 Methylprednisolone Injection 80 mg Charge J1040 $37.00 $37.00 $26.27 $37.00 $37.00 $26.27 $35.52 $34.78 $35.15 $36.26 methylPREDNISolone 80 mg/mL Sus J1040 00703-0051-04 $54.32 $54.32 1 mL $38.57 $54.32 $54.32 $38.57 $52.15 $51.06 $51.60 $53.23 METHYLPREDNISOLONE(DEPOMEDROL)80MG/ML VIAL [THAY] J1040 00009-3475-03 $64.02 $64.02 1 mL $45.45 $64.02 $64.02 $45.45 $61.46 $60.18 $60.82 $62.74 J1050 Depo Provera 150 mg (for contraception) J1050 $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 MEDROXYPROGESTERONE(DEPO-PROVERA)150MG/ML SYR [THAY] J1050 00548-5701-00 $152.00 $152.00 1 mL $107.92 $152.00 $152.00 $107.92 $145.92 $142.88 $144.40 $148.96 MEDROXYPROGESTERONE(DEPO-PROVERA)150MG/ML SYR [THAY] J1050 59762-4538-02 $250.40 $250.40 1 mL $177.78 $250.40 $250.40 $177.78 $240.38 $235.38 $237.88 $245.39 MEDROXYPROGESTERONE(DEPO-PROVERA)150MG/ML SYR [THAY] J1050 00009-7376-11 $499.48 $499.48 1 mL $354.63 $499.48 $499.48 $354.63 $479.50 $469.51 $474.51 $489.49 J1080 Testosterone cypionat 200 MG [CHAS] J1071 $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 DEPO-TESTOSTERONE 200MG/ML VIAL [THAY] J1071 00409-6562-01 $64.38 $64.38 1 mL $45.71 $64.38 $64.38 $45.71 $61.80 $60.52 $61.16 $63.09 DEPO-TESTOSTERONE 200MG/ML VIAL [THAY] J1071 00009-0417-01 $68.00 $68.00 1 mL $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 DEXAMETHASONE (DECADRON) 4MG/ML 30ML VIAL [THAY] J1100 63323-0165-30 $22.28 $22.28 1 mL $15.82 $22.28 $22.28 $15.82 $21.38 $20.94 $21.16 $21.83 Dexamethasone(Decadron)4MG/ML VIAL [THAY] J1100 63323-0165-16 $25.28 $25.28 1 mL $17.95 $25.28 $25.28 $17.95 $24.27 $23.76 $24.02 $24.77 Dexamethasone(Decadron)4MG/ML VIAL [THAY] J1100 63323-0165-01 $25.76 $25.76 1 mL $18.29 $25.76 $25.76 $18.29 $24.73 $24.21 $24.47 $25.24 "IV J1100 Injection, dexamethosone sodium phosphate, 1 mg" J1100 $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 J1100 Dexamethasone 10 mg SDV ccc[CHAS] old J1100 $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 J1100 Dexamthasone 4 mg SDV - 1MG [CHAS] J1100 $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 dexamethasone 10 mg/mL preservative-free Sol J1100 63323-0506-01 $33.73 $33.73 1 mL $23.95 $33.73 $33.73 $23.95 $32.38 $31.70 $32.04 $33.05 dexamethasone 4 mg/mL Sol J1100 63323-0165-05 $33.82 $33.82 5 mL $24.02 $33.82 $33.82 $24.02 $32.47 $31.79 $32.13 $33.15 dexamethasone 4 mg/mL Sol J1100 63323-0165-26 $46.40 $46.40 5 mL $32.94 $46.40 $46.40 $32.94 $44.54 $43.62 $44.08 $45.47 "Injection, Dihydroergotamine Mesylate, Per 1 mg Med Admin POC" J1110 $237.00 $237.00 $168.27 $237.00 $237.00 $168.27 $227.52 $222.78 $225.15 $232.26 DIGOXIN (LANOXIN) 0.5MG/2ML AMP [THAY] J1160 00641-1410-35 $33.20 $33.20 2 mL $23.57 $33.20 $33.20 $23.57 $31.87 $31.21 $31.54 $32.54 DIGOXIN (LANOXIN) 0.5MG/2ML AMP [THAY] J1160 24987-0260-10 $34.40 $34.40 2 mL $24.42 $34.40 $34.40 $24.42 $33.02 $32.33 $32.68 $33.71 DIGOXIN (LANOXIN) 0.5MG/2ML AMP [THAY] J1160 00781-3059-95 $34.95 $34.95 2 mL $24.81 $34.95 $34.95 $24.81 $33.55 $32.85 $33.20 $34.25 PHENYTOIN (DILANTIN) 100MG/2ML VIAL [THAY] J1165 00641-0493-25 $23.03 $23.03 2 mL $16.35 $23.03 $23.03 $16.35 $22.11 $21.65 $21.88 $22.57 phenytoin 50 mg/mL Sol J1165 00641-2555-45 $24.35 $24.35 5 mL $17.29 $24.35 $24.35 $17.29 $23.38 $22.89 $23.13 $23.86 dexrazoxane 250 mg REC J1190 67457-0207-25 $678.22 $678.22 1 mL $481.54 $678.22 $678.22 $481.54 $651.09 $637.53 $644.31 $664.66 dexrazoxane 500 mg REC J1190 47781-0578-07 $977.60 $977.60 1 mL $694.10 $977.60 $977.60 $694.10 $938.50 $918.94 $928.72 $958.05 "IV J1200 Injection, diphenhydramine HCl, up to 50 mg" J1200 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 J1200 Diphenhydramine 50mg SDV [CHAS] J1200 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 diphenhydrAMINE(Benadryl)50MG/ML VIAL [THAY] J1200 00641-0376-25 $22.56 $22.56 1 mL $16.02 $22.56 $22.56 $16.02 $21.66 $21.20 $21.43 $22.11 diphenhydrAMINE(Benadryl)50MG/ML VIAL [THAY] J1200 63323-0664-01 $26.60 $26.60 1 mL $18.89 $26.60 $26.60 $18.89 $25.54 $25.00 $25.27 $26.07 DIMETHYL SULFOXIDE (RIMSO) 50% SOLN [THAY] J1212 67457-0177-50 "$1,117.47 " "$1,117.47 " 50 mL $793.40 "$1,117.47 " "$1,117.47 " $793.40 "$1,072.77 " "$1,050.42 " "$1,061.59 " "$1,095.12 " DOBUTAMINE PREMIX 250MG/250ML IV BAG [THAY] J1250 00338-1073-02 $81.20 $81.20 250 mL $57.65 $81.20 $81.20 $57.65 $77.95 $76.32 $77.14 $79.57 DOPAMINE 400MG/250ML IV BAG [THAY] J1265 00338-1007-02 $64.23 $64.23 250 mL $45.60 $64.23 $64.23 $45.60 $61.66 $60.38 $61.02 $62.95 ERTAPENEM (INVANZ) 1000MG VIAL [THAY] J1335 55150-0282-20 $320.00 $320.00 1 EA $227.20 $320.00 $320.00 $227.20 $307.20 $300.80 $304.00 $313.60 ERTAPENEM (INVANZ) 1000MG VIAL [THAY] J1335 00006-3843-71 $328.78 $328.78 1 EA $233.44 $328.78 $328.78 $233.44 $315.63 $309.06 $312.34 $322.21 ferric carboxymaltose (as elemental iron) 50 mg/mL Sol J1439 00517-0650-01 "$2,302.78 " "$2,302.78 " 15 mL "$1,634.97 " "$2,302.78 " "$2,302.78 " "$1,634.97 " "$2,210.67 " "$2,164.61 " "$2,187.64 " "$2,256.72 " filgrastim 300 mcg/0.5 mL Sol J1442 55513-0924-91 $820.88 $820.88 0.5 mL $582.82 $820.88 $820.88 $582.82 $788.04 $771.63 $779.84 $804.46 filgrastim 480 mcg/0.8 mL Sol J1442 55513-0209-10 "$1,295.42 " "$1,295.42 " 0.8 mL $919.75 "$1,295.42 " "$1,295.42 " $919.75 "$1,243.61 " "$1,217.70 " "$1,230.65 " "$1,269.52 " FLUCONAZOLE(DIFLUCAN)200MG/100ML IV [THAY] J1450 36000-0002-06 $50.60 $50.60 100 mL $35.93 $50.60 $50.60 $35.93 $48.58 $47.56 $48.07 $49.59 fluconazole 200 mg/100 mL-0.9% Sol J1450 25021-0113-82 $56.60 $56.60 100 mL $40.19 $56.60 $56.60 $40.19 $54.34 $53.20 $53.77 $55.47 FLUCONAZOLE(DIFLUCAN)200MG/100ML IV [THAY] J1450 00409-4688-23 $63.21 $63.21 100 mL $44.88 $63.21 $63.21 $44.88 $60.68 $59.42 $60.05 $61.94 FLUCONAZOLE(DIFLUCAN)200MG/100ML IV [THAY] J1450 00338-6046-48 $79.79 $79.79 100 mL $56.65 $79.79 $79.79 $56.65 $76.59 $75.00 $75.80 $78.19 fosaprepitant 150 mg REC J1453 00006-3061-00 $823.12 $823.12 1 mL $584.42 $823.12 $823.12 $584.42 $790.20 $773.73 $781.96 $806.66 HEPATITIS B IMMUN GL J1561 $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 IMMUNE GLOBULIN (GAMMAGARD 10%) IV 20GM [THAY] J1569 00944-2700-06 "$5,690.70 " "$5,690.70 " 200 mL "$4,040.39 " "$5,690.70 " "$5,690.70 " "$4,040.39 " "$5,463.07 " "$5,349.25 " "$5,406.16 " "$5,576.88 " IMMUNE GLOBULIN (GAMMAGARD 10%) IV 30GM [THAY] J1569 00944-2700-07 "$8,518.54 " "$8,518.54 " 300 mL "$6,048.17 " "$8,518.54 " "$8,518.54 " "$6,048.17 " "$8,177.80 " "$8,007.43 " "$8,092.62 " "$8,348.17 " HEPATITIS B IMMUNE GLOBULIN [THAY] J1571 59730-4202-01 $387.38 $387.38 1 mL $275.04 $387.38 $387.38 $275.04 $371.88 $364.14 $368.01 $379.63 GENTAMICIN (GARAMYCIN)80MG/2ML VIAL [THAY] J1580 63323-0010-94 $26.19 $26.19 2 mL $18.60 $26.19 $26.19 $18.60 $25.14 $24.62 $24.88 $25.67 "Injection, glucagon hydrochloride, per 1 mg" J1610 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 "IV J1610 Injection, glucagon hydrochloride, per 1 mg" J1610 $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 GLUCAGON (rDNA) EMERGENCY 1MG KIT [THAY] J1610 00002-8031-01 $693.92 $693.92 1 EA $492.68 $693.92 $693.92 $492.68 $666.16 $652.28 $659.22 $680.04 "INJECTION, HALOPERIDOL, UP TO 5 MG" J1630 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 "IV J1630 Injection, haloperidol, up to 5 mg" J1630 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 HALOPERIDOL (HALDOL) 5MG/ML VIAL [THAY] J1630 63323-0474-01 $34.38 $34.38 1 mL $24.41 $34.38 $34.38 $24.41 $33.00 $32.31 $32.66 $33.69 HEPARIN SODIUM LOCK FLUSH 300UN/3ML [THAY] J1642 08290-3064-23 $21.12 $21.12 3 mL $15.00 $21.12 $21.12 $15.00 $20.28 $19.85 $20.06 $20.70 HEPARIN SODIUM LOCK FLUSH 300UN/3ML [THAY] J1642 08290-3065-17 $21.27 $21.27 3 mL $15.10 $21.27 $21.27 $15.10 $20.42 $19.99 $20.21 $20.84 HEPARIN SODIUM LOCK FLUSH 300UN/3ML [THAY] J1642 64253-0333-33 $26.78 $26.78 3 mL $19.01 $26.78 $26.78 $19.01 $25.71 $25.17 $25.44 $26.24 HEPARIN SODIUM 5000UNIT/ML VIAL [THAY] J1644 00409-2723-01 $24.15 $24.15 1 mL $17.15 $24.15 $24.15 $17.15 $23.19 $22.70 $22.94 $23.67 HEPARIN SODIUM 5000UNIT/ML VIAL [THAY] J1644 25021-0402-66 $26.24 $26.24 1 mL $18.63 $26.24 $26.24 $18.63 $25.19 $24.67 $24.93 $25.72 HEPARIN SODIUM 5000UNIT/ML VIAL [THAY] J1644 67457-0949-01 $26.24 $26.24 1 mL $18.63 $26.24 $26.24 $18.63 $25.19 $24.67 $24.93 $25.72 "HEPARIN SODIUM 10,000UN/10ML VIAL [THAY]" J1644 63323-0540-11 $38.17 $38.17 10 mL $27.10 $38.17 $38.17 $27.10 $36.65 $35.88 $36.27 $37.41 heparin 10000 units/mL Sol J1644 67457-0603-99 $38.24 $38.24 4 mL $27.15 $38.24 $38.24 $27.15 $36.71 $35.95 $36.33 $37.48 HEPARIN SODIUM 2000UN/2ML VIAL [THAY] J1644 63323-0276-02 $52.97 $52.97 2 mL $37.61 $52.97 $52.97 $37.61 $50.86 $49.80 $50.33 $51.91 HEPARIN 25000UNITS/250ML IV PREMIX [THAY] J1644 00264-9587-20 $68.75 $68.75 250 mL $48.81 $68.75 $68.75 $48.81 $66.00 $64.62 $65.31 $67.37 ENOXAPARIN (LOVENOX) 30MG/0.3ML SYR [THAY] J1650 00075-0624-30 $79.54 $79.54 0.3 mL $56.47 $79.54 $79.54 $56.47 $76.36 $74.77 $75.56 $77.95 enoxaparin 40 mg/0.4 mL Sol J1650 00955-1004-10 $91.36 $91.36 0.4 mL $64.87 $91.36 $91.36 $64.87 $87.71 $85.88 $86.80 $89.54 ENOXAPARIN (LOVENOX) 40MG/0.4ML SYR [THAY] J1650 00075-0620-40 $99.38 $99.38 0.4 mL $70.56 $99.38 $99.38 $70.56 $95.41 $93.42 $94.41 $97.39 ENOXAPARIN (LOVENOX) 40MG/0.4ML SYR [THAY] J1650 00075-8014-10 $99.38 $99.38 0.4 mL $70.56 $99.38 $99.38 $70.56 $95.41 $93.42 $94.41 $97.39 ENOXAPARIN (LOVENOX)60MG/0.6ML SYR [THAY] J1650 00075-0621-60 $139.22 $139.22 0.6 mL $98.84 $139.22 $139.22 $98.84 $133.65 $130.86 $132.26 $136.43 ENOXAPARIN (LOVENOX)60MG/0.6ML SYR [THAY] J1650 00075-8016-10 $139.22 $139.22 0.6 mL $98.84 $139.22 $139.22 $98.84 $133.65 $130.86 $132.26 $136.43 ENOXAPARIN (LOVENOX) 100MG/1ML SYR [THAY] J1650 00075-0623-00 $218.69 $218.69 1 mL $155.27 $218.69 $218.69 $155.27 $209.94 $205.57 $207.75 $214.31 ENOXAPARIN(LOVENOX)150MG/1ML SYR [THAY] J1650 00075-2915-01 $318.14 $318.14 1 mL $225.88 $318.14 $318.14 $225.88 $305.41 $299.05 $302.23 $311.77 HYDROCORTISONE(SOLU-CORTEF)250MG VIAL [THAY] J1720 00009-0013-05 $63.12 $63.12 1 EA $44.82 $63.12 $63.12 $44.82 $60.60 $59.33 $59.96 $61.86 insulin regular human recombinant 1 unit/mL-NaCl 0.9% Sol J1815 00338-0126-12 $120.80 $120.80 100 mL $85.77 $120.80 $120.80 $85.77 $115.97 $113.55 $114.76 $118.38 INSULIN REGULAR(HUMULIN R)300UN/3ML [THAY] J1815 00002-8215-17 $127.06 $127.06 3 mL $90.21 $127.06 $127.06 $90.21 $121.98 $119.44 $120.71 $124.52 NPH HUMAN INSULIN(HUMULIN N)300UN/3ML [THAY] J1815 00002-8315-17 $127.06 $127.06 3 mL $90.21 $127.06 $127.06 $90.21 $121.98 $119.44 $120.71 $124.52 INSULIN 70/30(HUMULIN 70/30)300UN/3ML [THAY] J1815 00002-8715-17 $127.06 $127.06 3 mL $90.21 $127.06 $127.06 $90.21 $121.98 $119.44 $120.71 $124.52 INSULIN LISPRO(HUMALOG)300UNIT/3ML [THAY] J1815 00002-7510-17 $217.78 $217.78 3 mL $154.62 $217.78 $217.78 $154.62 $209.07 $204.71 $206.89 $213.42 INSULIN GLARGINE(LANTUS)100UNIT/ML [THAY] J1815 00088-2220-33 $530.41 $530.41 10 mL $376.59 $530.41 $530.41 $376.59 $509.19 $498.58 $503.88 $519.80 "Injection, ketorolac tromethamine charge." J1885 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 "IV J1885 Injection, ketorolac tromethamine, per 15 mg" J1885 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 J1885 Ketorolac 30 mg SDV [CHAS] J1885 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 Ketorolac (Toradol) 30MG/ML VIAL [THAY] J1885 63323-0162-16 $22.09 $22.09 1 mL $15.68 $22.09 $22.09 $15.68 $21.20 $20.76 $20.98 $21.65 KETOROLAC (TORADOL) 60MG/2ML VIAL [THAY] J1885 63323-0162-26 $22.47 $22.47 2 mL $15.96 $22.47 $22.47 $15.96 $21.57 $21.12 $21.35 $22.02 Ketorolac (Toradol) 30MG/ML VIAL [THAY] J1885 72611-0722-25 $22.69 $22.69 1 mL $16.11 $22.69 $22.69 $16.11 $21.78 $21.33 $21.55 $22.23 KETOROLAC (TORADOL) 60MG/2ML VIAL [THAY] J1885 47781-0585-68 $22.98 $22.98 2 mL $16.31 $22.98 $22.98 $16.31 $22.06 $21.60 $21.83 $22.52 KETOROLAC (TORADOL) 60MG/2ML VIAL [THAY] J1885 00409-3796-01 $26.96 $26.96 2 mL $19.14 $26.96 $26.96 $19.14 $25.88 $25.34 $25.61 $26.42 Ketorolac (Toradol) 30MG/ML VIAL [THAY] J1885 63323-0162-01 $32.00 $32.00 1 mL $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 Ketorolac (Toradol) 30MG/ML VIAL [THAY] J1885 00409-3795-01 $33.80 $33.80 1 mL $24.00 $33.80 $33.80 $24.00 $32.45 $31.77 $32.11 $33.12 KETOROLAC (TORADOL) 60MG/2ML VIAL [THAY]KETOROLAC (TORADOL) 60MG/2ML VIAL [THAY] J1885 63323-0162-02 $35.00 $35.00 2 mL $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 00409-3795-01 - KETOROLAC (TORADOL) 30MG/ML VIAL [THAY] J1885 $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 lanreotide 120 mg/0.5 mL Sol J1930 15054-1120-04 "$11,492.48 " "$11,492.48 " 0.5 mL "$8,159.66 " "$11,492.48 " "$11,492.48 " "$8,159.66 " "$11,032.78 " "$10,802.93 " "$10,917.86 " "$11,262.63 " FUROSEMIDE (LASIX) 40MG/4ML VIAL [THAY] J1940 00409-6102-04 $27.36 $27.36 4 mL $19.42 $27.36 $27.36 $19.42 $26.26 $25.71 $25.99 $26.81 FUROSEMIDE (LASIX) 20MG/2ML VIAL [THAY] J1940 00409-6102-02 $30.49 $30.49 2 mL $21.64 $30.49 $30.49 $21.64 $29.27 $28.66 $28.96 $29.88 FUROSEMIDE (LASIX) 100MG/10ML VIAL [THAY] J1940 00409-6102-10 $34.63 $34.63 10 mL $24.59 $34.63 $34.63 $24.59 $33.25 $32.56 $32.90 $33.94 furosemide 10 mg/mL Sol J1940 63323-0280-02 $34.83 $34.83 2 mL $24.73 $34.83 $34.83 $24.73 $33.44 $32.74 $33.09 $34.14 FUROSEMIDE (LASIX) 40MG/4ML VIAL [THAY] J1940 63323-0280-04 $49.83 $49.83 4 mL $35.38 $49.83 $49.83 $35.38 $47.84 $46.84 $47.34 $48.84 FUROSEMIDE (LASIX) 40MG/4ML VIAL [THAY] J1940 63323-0280-26 $49.83 $49.83 4 mL $35.38 $49.83 $49.83 $35.38 $47.84 $46.84 $47.34 $48.84 FUROSEMIDE (LASIX) 100MG/10ML VIAL [THAY]FUROSEMIDE (LASIX) 100MG/10ML VIAL [THAY] J1940 63323-0280-10 $76.06 $76.06 10 mL $54.01 $76.06 $76.06 $54.01 $73.02 $71.50 $72.26 $74.54 FUROSEMIDE (LASIX) 100MG/10ML VIAL [THAY]FUROSEMIDE (LASIX) 100MG/10ML VIAL [THAY] J1940 63323-0280-36 $76.06 $76.06 10 mL $54.01 $76.06 $76.06 $54.01 $73.02 $71.50 $72.26 $74.54 LEUPROLIDE ACETATE (ELIGARD) 45MG KIT [THAY] J1950 00024-0605-45 "$4,458.80 " "$4,458.80 " 1 EA "$3,165.75 " "$4,458.80 " "$4,458.80 " "$3,165.75 " "$4,280.45 " "$4,191.27 " "$4,235.86 " "$4,369.62 " LEUPROLIDE ACETATE (ELIGARD) 45MG KIT [THAY] J1950 62935-0453-45 "$4,573.02 " "$4,573.02 " 1 EA "$3,246.85 " "$4,573.02 " "$4,573.02 " "$3,246.85 " "$4,390.10 " "$4,298.64 " "$4,344.37 " "$4,481.56 " levETIRAcetam 100 mg/mL Sol J1953 63323-0400-05 $38.94 $38.94 5 mL $27.64 $38.94 $38.94 $27.64 $37.38 $36.60 $36.99 $38.16 levoFLOXacin (LEVAQUIN)500MG/100ML [THAY] J1956 36000-0047-24 $51.14 $51.14 100 mL $36.31 $51.14 $51.14 $36.31 $49.10 $48.07 $48.58 $50.12 LEVOFLOXACIN (LEVAQUIN)250MG/50ML [THAY] J1956 25021-0132-66 $51.80 $51.80 50 mL $36.78 $51.80 $51.80 $36.78 $49.73 $48.69 $49.21 $50.76 LEVOFLOXACIN (LEVAQUIN)250MG/50ML [THAY] J1956 25021-0132-81 $51.80 $51.80 50 mL $36.78 $51.80 $51.80 $36.78 $49.73 $48.69 $49.21 $50.76 levoFLOXacin (LEVAQUIN)500MG/100ML [THAY] J1956 25021-0132-67 $61.40 $61.40 100 mL $43.59 $61.40 $61.40 $43.59 $58.94 $57.72 $58.33 $60.17 levoFLOXacin (LEVAQUIN)500MG/100ML [THAY] J1956 25021-0132-82 $61.40 $61.40 100 mL $43.59 $61.40 $61.40 $43.59 $58.94 $57.72 $58.33 $60.17 levoFLOXacin (LEVAQUIN)500MG/100ML [THAY] J1956 44567-0436-24 $65.12 $65.12 100 mL $46.24 $65.12 $65.12 $46.24 $62.52 $61.21 $61.86 $63.82 levoFLOXacin (LEVAQUIN)500MG/100ML [THAY] J1956 00781-3342-09 $68.07 $68.07 100 mL $48.33 $68.07 $68.07 $48.33 $65.35 $63.99 $64.67 $66.71 LIDOCAINE(CARDIAC)100MG/5ML ABBOJEC [THAY] J2001 00409-1323-05 $27.90 $27.90 5 mL $19.81 $27.90 $27.90 $19.81 $26.78 $26.22 $26.50 $27.34 LIDOCAINE(CARDIAC)100MG/5ML ABBOJEC [THAY] J2001 76329-3390-01 $34.06 $34.06 5 mL $24.18 $34.06 $34.06 $24.18 $32.70 $32.01 $32.36 $33.38 LIDOCAINE 0.4%(2000MG/500ML)PREMIX IV [THAY] J2001 00338-0409-03 $48.99 $48.99 500 mL $34.78 $48.99 $48.99 $34.78 $47.03 $46.05 $46.54 $48.01 LIDOCAINE 0.4%(2000MG/500ML)PREMIX IV [THAY] J2001 00264-9594-10 $49.83 $49.83 500 mL $35.38 $49.83 $49.83 $35.38 $47.84 $46.84 $47.34 $48.83 LINEZOLID (ZYVOX)600MG/300ML IV BAG [THAY] J2020 00009-7807-02 $148.69 $148.69 300 mL $105.57 $148.69 $148.69 $105.57 $142.74 $139.77 $141.25 $145.71 LINEZOLID (ZYVOX)600MG/300ML IV BAG [THAY] J2020 00009-5140-01 $209.54 $209.54 300 mL $148.77 $209.54 $209.54 $148.77 $201.16 $196.97 $199.06 $205.35 IV J2060 Ativan 2mg J2060 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 J2060 Lorazepam 2 mg/1 mL [CHAS] J2060 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 LORAZEPAM (ATIVAN) 2MG/ML VIAL [THAY] J2060 00641-6207-25 $21.24 $21.24 1 mL $15.08 $21.24 $21.24 $15.08 $20.39 $19.96 $20.18 $20.81 LORAZEPAM (ATIVAN) 2MG/ML VIAL [THAY] J2060 00641-6044-25 $22.34 $22.34 1 mL $15.86 $22.34 $22.34 $15.86 $21.45 $21.00 $21.22 $21.89 DEMEROL 100 MG INJ J2175 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 DEMEROL 50 MG INJ J2175 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 "IV J2175 Injection, meperidine hydrochloride, per 100 mg" J2175 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 Meperidine (Demerol) 50MG/ML CARP [THAY] J2175 00641-6053-25 $25.25 $25.25 1 mL $17.93 $25.25 $25.25 $17.93 $24.24 $23.74 $23.99 $24.75 meperidine 25 mg/mL Sol J2175 00641-6052-25 $25.54 $25.54 1 mL $18.13 $25.54 $25.54 $18.13 $24.52 $24.01 $24.26 $25.03 MEPERIDINE (DEMEROL) 25MG/ML CARP [THAY] J2175 00409-1176-30 $34.28 $34.28 1 mL $24.34 $34.28 $34.28 $24.34 $32.91 $32.22 $32.57 $33.59 Meperidine (Demerol) 50MG/ML CARP [THAY] J2175 00409-1178-30 $34.76 $34.76 1 mL $24.68 $34.76 $34.76 $24.68 $33.37 $32.67 $33.02 $34.06 MEPERIDINE (DEMEROL)PCA 300MG/30ML [THAY] J2175 00409-6030-04 $51.68 $51.68 30 mL $36.69 $51.68 $51.68 $36.69 $49.61 $48.58 $49.10 $50.65 MEROPENEM (MERREM) 500MG VIAL [THAY] J2185 63323-0507-20 $44.00 $44.00 1 EA $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 MEROPENEM (MERREM) 500MG VIAL [THAY] J2185 00310-0325-20 $100.54 $100.54 1 EA $71.38 $100.54 $100.54 $71.38 $96.52 $94.51 $95.51 $98.53 METHYLERGONOVINE(METHERGINE)0.2MG/ML AMP [THAY] J2210 17478-0501-01 $37.15 $37.15 1 mL $26.38 $37.15 $37.15 $26.38 $35.67 $34.92 $35.30 $36.41 METHYLERGONOVINE(METHERGINE)0.2MG/ML AMP [THAY]METHYLERGONOVINE(METHERGINE)0.2MG/ML AMP [THAY] J2210 51991-0144-17 $67.42 $67.42 1 mL $47.87 $67.42 $67.42 $47.87 $64.73 $63.38 $64.05 $66.08 micafungin 100 mg REC J2248 00469-3211-10 $468.80 $468.80 1 EA $332.85 $468.80 $468.80 $332.85 $450.05 $440.67 $445.36 $459.42 Midazolam (Versed) VIAL 2MG/2ML [THAY] J2250 00409-2305-17 $22.21 $22.21 2 mL $15.77 $22.21 $22.21 $15.77 $21.32 $20.87 $21.10 $21.76 MIDAZOLAM (VERSED) 10MG/10ML VIAL [THAY] J2250 00641-6056-10 $25.28 $25.28 10 mL $17.95 $25.28 $25.28 $17.95 $24.27 $23.76 $24.02 $24.77 "IV J2270 Injection, morphine sulfate, up to 10 mg" J2270 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 MORPHINE SULFATE 10 J2270 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 MORPHINE SULFATE 2MG/ML CARP J2270 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 MORPHINE SULFATE 2MG/ML CARP [THAY] J2270 00409-1890-01 $24.51 $24.51 1 mL $17.40 $24.51 $24.51 $17.40 $23.53 $23.04 $23.29 $24.02 Morphine Sulfate 10MG/ML CARP [THAY] J2270 00409-1893-01 $24.51 $24.51 1 mL $17.40 $24.51 $24.51 $17.40 $23.53 $23.04 $23.29 $24.02 Morphine Sulfate 10MG/ML [THAY] J2270 00641-6127-25 $25.20 $25.20 1 mL $17.89 $25.20 $25.20 $17.89 $24.19 $23.69 $23.94 $24.70 morphine 4 mg/mL preservative-free Sol J2270 76045-0005-10 $25.26 $25.26 1 mL $17.93 $25.26 $25.26 $17.93 $24.25 $23.74 $23.99 $24.75 MORPHINE SULFATE 4MG/ML [THAY] J2270 63323-0454-01 $26.89 $26.89 1 mL $19.09 $26.89 $26.89 $19.09 $25.81 $25.27 $25.54 $26.35 MORPHINE PCA 1MG/ML SYR [THAY] J2270 76329-1911-01 $48.80 $48.80 30 mL $34.65 $48.80 $48.80 $34.65 $46.85 $45.87 $46.36 $47.82 Morphine SULF(Duramorph)5MG/10ML PF [THAY] J2274 00409-3814-12 $34.69 $34.69 10 mL $24.63 $34.69 $34.69 $24.63 $33.30 $32.61 $32.95 $33.99 Morphine SULF(Duramorph)5MG/10ML PF [THAY] J2274 00641-6020-10 $83.24 $83.24 10 mL $59.10 $83.24 $83.24 $59.10 $79.91 $78.25 $79.08 $81.58 IV J2300 Nubain 10 mg. J2300 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 J2300 Nalbuphine 10 mg/mL - 1 mL amp [CHAS] J2300 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 Nalbuphine HCL(Nubain)10MG/ML AMP [THAY] J2300 00409-1463-01 $28.69 $28.69 1 mL $20.37 $28.69 $28.69 $20.37 $27.54 $26.97 $27.26 $28.12 NALOXONE HCL (NARCAN) 0.4MG/ML CARPUJECT [THAY] J2310 00641-6132-25 $44.00 $44.00 1 mL $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 NALOXONE HCL (NARCAN) 0.4MG/ML CARPUJECT [THAY] J2310 00409-1782-69 $57.06 $57.06 1 mL $40.51 $57.06 $57.06 $40.51 $54.77 $53.63 $54.20 $55.91 NALOXONE HCL (NARCAN) 0.4MG/ML CARPUJECT [THAY] J2310 00409-1215-01 $57.99 $57.99 1 mL $41.17 $57.99 $57.99 $41.17 $55.67 $54.51 $55.09 $56.83 NALOXONE HCL (NARCAN) 0.4MG/ML CARPUJECT [THAY] J2310 67457-0292-02 $67.45 $67.45 1 mL $47.89 $67.45 $67.45 $47.89 $64.75 $63.40 $64.07 $66.10 ocrelizumab 300 mg/10 mL Sol J2350 50242-0150-01 "$23,420.00 " "$23,420.00 " 10 mL "$16,628.20 " "$23,420.00 " "$23,420.00 " "$16,628.20 " "$22,483.20 " "$22,014.80 " "$22,249.00 " "$22,951.60 " OCTREOTICE (SANDOSTATIN) 100mcg/ml SOLN (THAY) J2354 25021-0452-01 $35.60 $35.60 1 mL $25.28 $35.60 $35.60 $25.28 $34.18 $33.46 $33.82 $34.89 OCTREOTICE (SANDOSTATIN) 100mcg/ml SOLN (THAY) J2354 63323-0376-01 $43.86 $43.86 1 mL $31.14 $43.86 $43.86 $31.14 $42.10 $41.22 $41.66 $42.98 OMALIZUMAB (XOLAIR) 150MG VIAL [THAY] J2357 50242-0040-62 "$2,276.97 " "$2,276.97 " 1 EA "$1,616.65 " "$2,276.97 " "$2,276.97 " "$1,616.65 " "$2,185.89 " "$2,140.35 " "$2,163.12 " "$2,231.43 " PHENYLEPHRINE HCL 10MG/ML VIAL [THAY] J2370 00641-6142-25 $34.40 $34.40 1 mL $24.42 $34.40 $34.40 $24.42 $33.02 $32.34 $32.68 $33.71 IV J2405 ZOFRAN 4 MG IV J2405 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 ZOFRAN 4 MG J2405 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 Ondansetron HCL(Zofran)4MG/2ML VIAL [THAY] J2405 23155-0378-42 $21.11 $21.11 2 mL $14.99 $21.11 $21.11 $14.99 $20.27 $19.84 $20.05 $20.69 Ondansetron HCL(Zofran)4MG/2ML VIAL [THAY] J2405 23155-0548-42 $21.11 $21.11 2 mL $14.99 $21.11 $21.11 $14.99 $20.27 $19.84 $20.05 $20.69 Ondansetron HCL(Zofran)4MG/2ML VIAL [THAY] J2405 00641-6078-25 $22.28 $22.28 2 mL $15.82 $22.28 $22.28 $15.82 $21.39 $20.94 $21.17 $21.83 Ondansetron HCL(Zofran)4MG/2ML VIAL [THAY] J2405 36000-0012-25 $22.60 $22.60 2 mL $16.05 $22.60 $22.60 $16.05 $21.70 $21.24 $21.47 $22.15 Ondansetron HCL(Zofran)4MG/2ML VIAL [THAY] J2405 00409-4755-03 $22.76 $22.76 2 mL $16.16 $22.76 $22.76 $16.16 $21.85 $21.39 $21.62 $22.30 oritavancin 400 mg REC J2407 70842-0140-03 "$2,051.17 " "$2,051.17 " 1 mL "$1,456.33 " "$2,051.17 " "$2,051.17 " "$1,456.33 " "$1,969.12 " "$1,928.10 " "$1,948.61 " "$2,010.14 " paliperidone 234 mg/1.5 mL ER J2426 50458-0564-01 "$3,229.17 " "$3,229.17 " 1 mL "$2,292.71 " "$3,229.17 " "$3,229.17 " "$2,292.71 " "$3,100.00 " "$3,035.42 " "$3,067.71 " "$3,164.59 " paliperidone 819 mg/2.625 mL ER J2426 50458-0609-01 "$11,573.00 " "$11,573.00 " 2.625 mL "$8,216.83 " "$11,573.00 " "$11,573.00 " "$8,216.83 " "$11,110.08 " "$10,878.62 " "$10,994.35 " "$11,341.54 " PALONOSETRON (ALOXI) 0.25 mg/5 mL SOL [THAY] J2469 55111-0694-07 $260.00 $260.00 5 mL $184.60 $260.00 $260.00 $184.60 $249.60 $244.40 $247.00 $254.80 palonosetron 0.25 mg/5 mL Sol J2469 60505-6193-01 $356.00 $356.00 5 mL $252.76 $356.00 $356.00 $252.76 $341.76 $334.64 $338.20 $348.88 palonosetron 0.25 mg/5 mL Sol J2469 25021-0783-05 $752.00 $752.00 5 mL $533.92 $752.00 $752.00 $533.92 $721.92 $706.88 $714.40 $736.96 PALONOSETRON (ALOXI) 0.25 mg/5 mL SOL [THAY] J2469 16729-0365-66 $998.36 $998.36 5 mL $708.84 $998.36 $998.36 $708.84 $958.43 $938.46 $948.44 $978.39 PEGFILGRASTIM (NEULASTA) 6MG/0.6ML [THAY] J2505 55513-0190-01 "$8,992.72 " "$8,992.72 " 0.6 mL "$6,384.83 " "$8,992.72 " "$8,992.72 " "$6,384.83 " "$8,633.02 " "$8,453.16 " "$8,543.09 " "$8,812.87 " PEGFILGRASTIM 6MG/0.6 ML (NEULASTA) ONPRO KIT [THAY] J2505 55513-0192-01 "$8,992.72 " "$8,992.72 " 0.6 mL "$6,384.83 " "$8,992.72 " "$8,992.72 " "$6,384.83 " "$8,633.02 " "$8,453.16 " "$8,543.09 " "$8,812.87 " PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 61990-0120-02 $34.25 $34.25 1 EA $24.32 $34.25 $34.25 $24.32 $32.88 $32.20 $32.54 $33.57 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 60505-6157-04 $43.47 $43.47 1 EA $30.87 $43.47 $43.47 $30.87 $41.73 $40.86 $41.30 $42.60 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 00409-3385-13 $44.72 $44.72 1 EA $31.75 $44.72 $44.72 $31.75 $42.93 $42.04 $42.49 $43.83 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 63323-0300-30 $53.29 $53.29 1 EA $37.83 $53.29 $53.29 $37.83 $51.16 $50.09 $50.62 $52.22 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 63323-0300-36 $53.29 $53.29 1 EA $37.83 $53.29 $53.29 $37.83 $51.16 $50.09 $50.62 $52.22 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 63323-0983-21 $53.29 $53.29 1 EA $37.83 $53.29 $53.29 $37.83 $51.16 $50.09 $50.62 $52.22 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 00781-3350-95 $56.93 $56.93 1 EA $40.42 $56.93 $56.93 $40.42 $54.65 $53.51 $54.08 $55.79 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 55150-0120-30 $63.51 $63.51 1 EA $45.09 $63.51 $63.51 $45.09 $60.97 $59.70 $60.33 $62.24 PIPERACILLIN/TAZOBACT(ZOSYN)3.375GM [THAY] J2543 64679-0056-01 $63.51 $63.51 1 EA $45.09 $63.51 $63.51 $45.09 $60.97 $59.70 $60.33 $62.24 piperacillin-tazobactam 4 g-0.5 g REC J2543 55150-0121-50 $75.10 $75.10 1 EA $53.32 $75.10 $75.10 $53.32 $72.10 $70.59 $71.35 $73.60 J2550 Promethazine 25 mg/mL SDV [CHAS] J2550 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 PROMETHAZINE(PHENERGAN)25MG/ML AMP [THAY] J2550 00641-0928-21 $23.60 $23.60 1 mL $16.76 $23.60 $23.60 $16.76 $22.66 $22.18 $22.42 $23.13 PROMETHAZINE(PHENERGAN)25MG/ML AMP [THAY] J2550 00641-1495-35 $24.44 $24.44 1 mL $17.35 $24.44 $24.44 $17.35 $23.46 $22.97 $23.21 $23.95 PROMETHAZINE(PHENERGAN)25MG/ML AMP [THAY] J2550 39822-5500-03 $24.80 $24.80 1 mL $17.61 $24.80 $24.80 $17.61 $23.81 $23.31 $23.56 $24.30 PROMETHAZINE(PHENERGAN)25MG/ML AMP [THAY] J2550 00641-6084-25 $28.09 $28.09 1 mL $19.95 $28.09 $28.09 $19.95 $26.97 $26.41 $26.69 $27.53 Oxytocin (Pitocin) 10UNITS/ML VIAL [THAY] J2590 63323-0012-01 $23.58 $23.58 1 mL $16.74 $23.58 $23.58 $16.74 $22.63 $22.16 $22.40 $23.10 Oxytocin (Pitocin) 10UNITS/ML VIAL [THAY] J2590 42023-0116-25 $28.64 $28.64 1 mL $20.33 $28.64 $28.64 $20.33 $27.49 $26.92 $27.21 $28.07 Inj progesterone per 50 MG J2675 $64.00 $64.00 $45.44 $64.00 $64.00 $45.44 $61.44 $60.16 $60.80 $62.72 PROCAINAMIDE (PRONESTYL) 1000MG/10ML VIA [THAY] J2690 00409-1902-01 $227.31 $227.31 10 mL $161.39 $227.31 $227.31 $161.39 $218.22 $213.67 $215.95 $222.77 OXACILLIN (BACTOCILL) 2000MG VIAL [THAY] J2700 25021-0162-24 $76.25 $76.25 1 EA $54.14 $76.25 $76.25 $54.14 $73.20 $71.68 $72.44 $74.73 Propofol (Diprivan) 1% 20ML VIAL [THAY] J2704 63323-0269-94 $25.76 $25.76 20 mL $18.29 $25.76 $25.76 $18.29 $24.73 $24.21 $24.47 $25.24 NEOSTIGMINE (BLOXIVERZ) 10MG/10ML [THAY] J2710 76014-0003-10 $64.06 $64.06 10 mL $45.49 $64.06 $64.06 $45.49 $61.50 $60.22 $60.86 $62.78 PROTAMINE SULFATE 250MG(10MG/ML)25ML VL [THAY] J2720 63323-0229-30 $108.46 $108.46 25 mL $77.01 $108.46 $108.46 $77.01 $104.12 $101.95 $103.04 $106.29 Metoclopramide (Reglan) 10MG/2ML IV [THAY] J2765 00409-3414-01 $22.78 $22.78 2 mL $16.17 $22.78 $22.78 $16.17 $21.86 $21.41 $21.64 $22.32 Metoclopramide (Reglan) 10MG/2ML IV [THAY] J2765 00703-4502-84 $26.55 $26.55 2 mL $18.85 $26.55 $26.55 $18.85 $25.48 $24.95 $25.22 $26.01 rasburicase 7.5 mg REC J2783 00024-5151-75 "$6,263.31 " "$6,263.31 " 1 mL "$4,446.95 " "$6,263.31 " "$6,263.31 " "$4,446.95 " "$6,012.78 " "$5,887.51 " "$5,950.15 " "$6,138.05 " REGADENOSON(LEXISCAN)0.4MG/5ML SYR [THAY] J2785 00469-6501-89 $603.10 $603.10 5 mL $428.20 $603.10 $603.10 $428.20 $578.98 $566.91 $572.95 $591.04 RHIG J2790 $341.00 $341.00 $242.11 $341.00 $341.00 $242.11 $327.36 $320.54 $323.95 $334.18 ROPIVACAINE(NAROPIN)150MG/30ML PF [THAY] J2795 63323-0286-30 $72.10 $72.10 30 mL $51.19 $72.10 $72.10 $51.19 $69.22 $67.77 $68.49 $70.66 ROPIVACAINE 0.2% SOL [THAY] J2795 63323-0285-61 $112.71 $112.71 100 mL $80.03 $112.71 $112.71 $80.03 $108.20 $105.95 $107.08 $110.46 ROPIVACAINE (NAROPIN) 0.2% 100ML PF VIAL [THAY] J2795 63323-0285-65 $117.58 $117.58 100 mL $83.48 $117.58 $117.58 $83.48 $112.88 $110.53 $111.70 $115.23 ROPIVACAINE (NAROPIN) 0.2% 100ML PF VIAL [THAY] - - Inpatient - Thayer County Health Services - Inactive - 63323-0285-61 J2795 55150-0196-99 $164.00 $164.00 100 mL $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 ROMIPLOSTIM (NPLATE) 250MCG VIAL [THAY] J2796 55513-0221-01 "$2,816.80 " "$2,816.80 " 1 EA "$1,999.93 " "$2,816.80 " "$2,816.80 " "$1,999.93 " "$2,704.13 " "$2,647.79 " "$2,675.96 " "$2,760.46 " KINEVAC 5MCG VIAL [THAY] J2805 00270-0556-15 $262.81 $262.81 1 EA $186.59 $262.81 $262.81 $186.59 $252.30 $247.04 $249.67 $257.55 "IV J2930 Injection, methylprednisolone sodium succinate, up to 125 mg" J2930 $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 Methylprednisolone injection up to 125mg J2930 $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 METHYLPREDNISOLONE(SOLU-MEDROL) 125MG VIAL [THAY] J2930 00009-0047-22 $43.25 $43.25 1 EA $30.71 $43.25 $43.25 $30.71 $41.52 $40.66 $41.09 $42.39 METHYLPREDNISOLONE(SOLU-MEDROL)500MG VIAL [THAY] J2930 00009-0758-01 $75.48 $75.48 1 EA $53.59 $75.48 $75.48 $53.59 $72.46 $70.95 $71.71 $73.97 methylPREDNISolone (SOLU-MEDROL) 1 gram REC VIAL [THAY] J2930 00009-0698-01 $120.54 $120.54 1 EA $85.58 $120.54 $120.54 $85.58 $115.72 $113.31 $114.51 $118.13 ALTEPLASE(CATHFLO ACTIVASE)2MG VIAL [THAY] J2997 50242-0041-64 $387.34 $387.34 1 EA $275.01 $387.34 $387.34 $275.01 $371.85 $364.10 $367.97 $379.59 ALTEPLASE (ACTIVASE) 100MG VIAL [THAY] J2997 50242-0085-27 "$12,692.52 " "$12,692.52 " 1 EA "$9,011.69 " "$12,692.52 " "$12,692.52 " "$9,011.69 " "$12,184.82 " "$11,930.97 " "$12,057.89 " "$12,438.67 " fentaNYL (Sublimaze) 100MCG/2ML VIAL [THAY] J3010 00409-9094-22 $22.67 $22.67 2 mL $16.09 $22.67 $22.67 $16.09 $21.76 $21.31 $21.54 $22.22 fentaNYL (Sublimaze) 100MCG/2ML VIAL [THAY] J3010 00409-9093-32 $23.50 $23.50 2 mL $16.69 $23.50 $23.50 $16.69 $22.56 $22.09 $22.33 $23.03 fentaNYL (Sublimaze) 100MCG/2ML VIAL [THAY] J3010 00641-6027-25 $24.76 $24.76 2 mL $17.58 $24.76 $24.76 $17.58 $23.77 $23.28 $23.53 $24.27 "Imitrex, sumatriptan succinate, per 6 mg" J3030 $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 SUMATRIPTAN SUCC(IMITREX) 6MG/0.5ML [THAY] J3030 63323-0273-01 $142.50 $142.50 0.5 mL $101.18 $142.50 $142.50 $101.18 $136.80 $133.95 $135.38 $139.65 SUMATRIPTAN SUCC(IMITREX) 6MG/0.5ML [THAY] J3030 55150-0173-01 $190.00 $190.00 0.5 mL $134.90 $190.00 $190.00 $134.90 $182.40 $178.60 $180.50 $186.20 TENECTEPLASE (TNKASE) 50MG IV KIT [THAY] J3101 50242-0120-01 "$8,714.34 " "$8,714.34 " 1 EA "$6,187.18 " "$8,714.34 " "$8,714.34 " "$6,187.18 " "$8,365.76 " "$8,191.48 " "$8,278.62 " "$8,540.05 " TERBUTALINE SULF(BRETHINE)1MG/ML VL [THAY] J3105 00143-9746-10 $29.60 $29.60 1 mL $21.02 $29.60 $29.60 $21.02 $28.42 $27.82 $28.12 $29.01 TERBUTALINE SULF(BRETHINE)1MG/ML VL [THAY] J3105 55390-0101-10 $29.60 $29.60 1 mL $21.02 $29.60 $29.60 $21.02 $28.42 $27.82 $28.12 $29.01 TERBUTALINE SULF(BRETHINE)1MG/ML VL [THAY] J3105 63323-0665-01 $63.18 $63.18 1 mL $44.86 $63.18 $63.18 $44.86 $60.65 $59.39 $60.02 $61.92 romosozumab 105 mg/1.17 mL Sol J3111 55513-0880-02 "$3,305.00 " "$3,305.00 " 2.34 mL "$2,346.55 " "$3,305.00 " "$3,305.00 " "$2,346.55 " "$3,172.80 " "$3,106.70 " "$3,139.75 " "$3,238.90 " KENALOG 40MG IM/IV J3301 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 TRIAMCINOLONE(KENALOG)40MG/1ML VIAL [THAY] J3301 00703-0241-01 $39.42 $39.42 1 mL $27.99 $39.42 $39.42 $27.99 $37.84 $37.05 $37.45 $38.63 TRIAMCINOLONE(KENALOG)40MG/1ML VIAL [THAY] J3301 70121-1049-02 $40.40 $40.40 1 mL $28.68 $40.40 $40.40 $28.68 $38.78 $37.98 $38.38 $39.59 TRIAMCINOLONE(KENALOG)40MG/1ML VIAL [THAY] J3301 00003-0293-05 $42.46 $42.46 1 mL $30.15 $42.46 $42.46 $30.15 $40.76 $39.91 $40.34 $41.61 "IV J3360 Injection, diazepam, up to 5 mg" J3360 $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 J3360 Diazepam 10 mg/2 mL [CHAS] J3360 $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 DIAZEPAM(VALIUM) 10MG/2ML CARPUJECT [THAY] J3360 00409-1273-32 $82.89 $82.89 2 mL $58.85 $82.89 $82.89 $58.85 $79.58 $77.92 $78.75 $81.24 VANCOMYCIN VIAL 500MG [THAY] J3370 63323-0221-16 $24.82 $24.82 1 EA $17.62 $24.82 $24.82 $17.62 $23.83 $23.33 $23.58 $24.32 VANCOMYCIN HCL (VANCO) 1000MG VIAL [THAY] J3370 63323-0284-45 $28.04 $28.04 1 EA $19.91 $28.04 $28.04 $19.91 $26.92 $26.36 $26.64 $27.48 VANCOMYCIN HCL (VANCO) 1000MG VIAL [THAY] J3370 47781-0597-91 $34.98 $34.98 1 EA $24.83 $34.98 $34.98 $24.83 $33.58 $32.88 $33.23 $34.28 VANCOMYCIN VIAL 500MG [THAY] J3370 63323-0221-10 $36.80 $36.80 1 EA $26.13 $36.80 $36.80 $26.13 $35.33 $34.59 $34.96 $36.06 VANCOMYCIN VIAL 500MG [THAY] J3370 63323-0221-38 $36.80 $36.80 1 EA $26.13 $36.80 $36.80 $26.13 $35.33 $34.59 $34.96 $36.06 VANCOMYCIN HCL (VANCO) 1000MG VIAL [THAY] J3370 70860-0105-20 $38.00 $38.00 1 EA $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 VANCOMYCIN HCL (VANCO) 1000MG VIAL [THAY] J3370 63323-0284-20 $58.16 $58.16 1 EA $41.29 $58.16 $58.16 $41.29 $55.83 $54.67 $55.25 $57.00 VANCOMYCIN HCL (VANCO) 1000MG VIAL [THAY] J3370 00409-6533-01 $58.50 $58.50 1 EA $41.53 $58.50 $58.50 $41.53 $56.16 $54.99 $55.57 $57.33 HYDROXYZINE 25MG J3410 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 IV J3410 HYDROXYZINE 25MG J3410 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 hydrOXYzine hydrochloride 25 mg/mL Sol J3410 00517-4201-25 $68.40 $68.40 1 mL $48.56 $68.40 $68.40 $48.56 $65.66 $64.30 $64.98 $67.03 Thiamine hcl 100 mg J3411 $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 THIAMINE HCL (VIT B1)200MG/2ML VIAL [THAY] J3411 63323-0013-02 $44.88 $44.88 2 mL $31.86 $44.88 $44.88 $31.86 $43.08 $42.18 $42.63 $43.98 THIAMINE HCL (VIT B1)200MG/2ML VIAL [THAY]THIAMINE HCL (VIT B1)200MG/2ML VIAL [THAY] J3411 63323-0013-26 $44.88 $44.88 2 mL $31.86 $44.88 $44.88 $31.86 $43.08 $42.18 $42.63 $43.98 J3420 Vitamin B-12 (Cyanocobalamin)1000 mcg [CHAS] J3420 $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 CYANOCOBALAMIN (VIT B12) 1000MCG/ML VIAL [THAY] J3420 63323-0044-01 $36.58 $36.58 1 mL $25.97 $36.58 $36.58 $25.97 $35.12 $34.39 $34.75 $35.85 CYANOCOBALAMIN (VIT B12) 1000MCG/ML VIAL [THAY] J3420 70069-0005-10 $36.99 $36.99 1 mL $26.26 $36.99 $36.99 $26.26 $35.51 $34.77 $35.14 $36.25 cyanocobalamin 1000 mcg/mL Sol J3420 70069-0005-01 $37.00 $37.00 1 mL $26.27 $37.00 $37.00 $26.27 $35.52 $34.78 $35.15 $36.26 CYANOKIT 5GM [THAY] J3420 11704-0370-01 "$1,578.70 " "$1,578.70 " 1 kit(s) "$1,120.88 " "$1,578.70 " "$1,578.70 " "$1,120.88 " "$1,515.55 " "$1,483.98 " "$1,499.77 " "$1,547.13 " PHYTONADIONE(VITAMIN K1)1MG/0.5ML PEDS [THAY] J3430 00409-9157-01 $32.75 $32.75 0.5 mL $23.25 $32.75 $32.75 $23.25 $31.44 $30.79 $31.11 $32.10 Vitamin k phytonadione inj J3430 $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 PHYTONADIONE(VITAMIN K1)1MG/0.5ML PEDS [THAY] J3430 76329-1240-01 $74.00 $74.00 0.5 mL $52.54 $74.00 $74.00 $52.54 $71.04 $69.56 $70.30 $72.52 PHYTONADION(VITAMIN K)10MG/ML ADULT [THAY] J3430 43598-0405-16 $122.64 $122.64 1 mL $87.07 $122.64 $122.64 $87.07 $117.73 $115.28 $116.51 $120.19 PHYTONADION(VITAMIN K)10MG/ML ADULT [THAY] J3430 00409-9158-01 $135.78 $135.78 1 mL $96.40 $135.78 $135.78 $96.40 $130.35 $127.63 $128.99 $133.06 HYALURONIDASE OVINE (VITRASE) 1.2ML VIAL [THAY] J3471 24208-0002-01 $195.80 $195.80 1.2 mL $139.02 $195.80 $195.80 $139.02 $187.97 $184.06 $186.01 $191.89 HYALURONIDASE OVINE (VITRASE) 1.2ML VIAL [THAY] J3471 24208-0002-02 $256.32 $256.32 1.2 mL $181.99 $256.32 $256.32 $181.99 $246.07 $240.94 $243.50 $251.19 HYALURONIDASE (HYLENEX) 150UNITS/ML 1ML VIAL [THAY] J3473 18657-0117-04 $153.92 $153.92 1 mL $109.28 $153.92 $153.92 $109.28 $147.76 $144.68 $146.22 $150.84 MAGNESIUM SULFATE 40GM/1000ML IV PREMIX [THAY] J3475 63323-0106-10 $20.26 $20.26 1 mL $14.39 $20.26 $20.26 $14.39 $19.45 $19.05 $19.25 $19.86 MAGNESIUM SULFATE 50% 1GM/2ML VIAL [THAY] J3475 63323-0064-02 $23.79 $23.79 2 mL $16.89 $23.79 $23.79 $16.89 $22.84 $22.36 $22.60 $23.32 MAGNESIUM SULFATE 50% 1GM/2ML VIAL [THAY] J3475 63323-0064-03 $23.79 $23.79 2 mL $16.89 $23.79 $23.79 $16.89 $22.84 $22.36 $22.60 $23.32 MAGNESIUM SULFATE 50% 1GM/2ML VIAL [THAY] J3475 63323-0064-26 $23.79 $23.79 2 mL $16.89 $23.79 $23.79 $16.89 $22.84 $22.36 $22.60 $23.32 magnesium sulfate 2 g/50 mL-sterile water Sol J3475 63323-0106-05 $73.50 $73.50 50 mL $52.18 $73.50 $73.50 $52.18 $70.56 $69.09 $69.82 $72.03 POTASSIUM CHLORIDE 20MEQ/10ML VIAL [THAY] J3480 00409-6651-06 $22.96 $22.96 10 mL $16.30 $22.96 $22.96 $16.30 $22.04 $21.58 $21.81 $22.50 POTASSIUM CHLORIDE 40mEq/20mL (THAY) J3480 63323-0965-20 $23.77 $23.77 20 mL $16.88 $23.77 $23.77 $16.88 $22.82 $22.34 $22.58 $23.29 potassium chloride 20 mEq/100 mL Sol J3480 00338-0705-48 $28.40 $28.40 100 mL $20.17 $28.40 $28.40 $20.17 $27.27 $26.70 $26.98 $27.84 potassium chloride 20 mEq/100 mL Sol J3480 00409-7075-26 $32.10 $32.10 100 mL $22.79 $32.10 $32.10 $22.79 $30.82 $30.17 $30.50 $31.46 KCL 20MEQ IN 0.45% NS 1000ML IV BAG [THAY] J3480 00338-0704-34 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 KCL 20MEQ IN 0.45% NS 1000ML IV BAG [THAY] J3480 00409-9257-39 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 ZOLEDRONIC ACID (ZOMETA) 4 MG/100 ML SOL [THAY] J3489 00409-4229-01 $164.00 $164.00 100 mL $116.44 $164.00 $164.00 $116.44 $157.44 $154.16 $155.80 $160.72 ZOLEDRONIC ACID (RECLAST) 5MG/100ML SOLN [THAY] J3489 55111-0688-52 $740.00 $740.00 100 mL $525.40 $740.00 $740.00 $525.40 $710.40 $695.60 $703.00 $725.20 ZOLENDRONIC ACID (ZOMETA) 4MG/5ML [THAY] J3489 23155-0170-31 "$1,940.00 " "$1,940.00 " 5 mL "$1,377.40 " "$1,940.00 " "$1,940.00 " "$1,377.40 " "$1,862.40 " "$1,823.60 " "$1,843.00 " "$1,901.20 " ZOLEDRONIC ACID (RECLAST) 5MG/100ML SOLN [THAY] J3489 23155-0186-31 "$2,008.16 " "$2,008.16 " 100 mL "$1,425.79 " "$2,008.16 " "$2,008.16 " "$1,425.79 " "$1,927.83 " "$1,887.67 " "$1,907.75 " "$1,968.00 " BAMLANIVIMAB 35 mg/mL Soln J3490 00002-7910-01 $- $- 1 mL $- $- $- $- $- $- $- $- SODIUM CHLORIDE (NS)0.9% FLUSH 10ML [THAY] J3490 08881-5701-21 $- $- 10 mL $- $- $- $- $- $- $- $- CASIRIVIMAB 120 mg/mL Soln J3490 61755-0024-01 $- $- 1 mL $- $- $- $- $- $- $- $- Imdevimab 120 mg/mL Soln J3490 61755-0025-01 $- $- 1 mL $- $- $- $- $- $- $- $- DOCUSATE SODIUM(COLACE)100MG/10ML ORAL SOLN [THAY] J3490 50383-0771-10 $3.50 $3.50 10 mL $2.49 $3.50 $3.50 $2.49 $3.36 $3.29 $3.33 $3.43 SODIUM BICARBONATE 650MG TAB [THAY] J3490 64980-0182-10 $3.53 $3.53 1 tab(s) $2.50 $3.53 $3.53 $2.50 $3.39 $3.32 $3.35 $3.46 SODIUM BICARBONATE 650MG TAB [THAY] J3490 64980-0294-10 $3.53 $3.53 1 tab(s) $2.50 $3.53 $3.53 $2.50 $3.39 $3.32 $3.35 $3.46 ASPIRIN EC 325MG TAB [THAY] J3490 57896-0921-01 $3.53 $3.53 1 tab(s) $2.51 $3.53 $3.53 $2.51 $3.39 $3.32 $3.36 $3.46 SODIUM BICARBONATE 650MG TAB [THAY] J3490 00536-1047-10 $3.56 $3.56 1 tab(s) $2.53 $3.56 $3.56 $2.53 $3.42 $3.35 $3.39 $3.49 DOCUSATE SODIUM (DOK) 100MG CAP [THAY] J3490 63739-0478-10 $3.59 $3.59 1 cap(s) $2.55 $3.59 $3.59 $2.55 $3.44 $3.37 $3.41 $3.52 PSEUDOEPHEDRINE(SUDOGEST)30MG TAB [THAY] J3490 00904-5053-24 $3.61 $3.61 1 tab(s) $2.56 $3.61 $3.61 $2.56 $3.46 $3.39 $3.43 $3.53 ASPIRIN EC 325MG TAB [THAY] J3490 63739-0523-01 $3.61 $3.61 1 tab(s) $2.56 $3.61 $3.61 $2.56 $3.47 $3.39 $3.43 $3.54 ASPIRIN CHEWABLE 81MG TAB [THAY] J3490 00536-1008-36 $3.63 $3.63 1 tab(s) $2.57 $3.63 $3.63 $2.57 $3.48 $3.41 $3.44 $3.55 ASPIRIN CHEWABLE 81MG TAB [THAY] J3490 12843-0132-31 $3.63 $3.63 1 tab(s) $2.58 $3.63 $3.63 $2.58 $3.49 $3.41 $3.45 $3.56 ASPIRIN CHEWABLE 81MG TAB [THAY] J3490 66553-0002-01 $3.65 $3.65 1 tab(s) $2.59 $3.65 $3.65 $2.59 $3.50 $3.43 $3.46 $3.57 IBUPROFEN (MOTRIN) 200MG TAB [THAY] J3490 00904-7914-61 $3.66 $3.66 1 tab(s) $2.60 $3.66 $3.66 $2.60 $3.51 $3.44 $3.48 $3.59 SIMETHICONE (MYLICON) 80MG CHEW TAB [THAY] J3490 63739-0225-10 $3.68 $3.68 1 tab(s) $2.61 $3.68 $3.68 $2.61 $3.53 $3.46 $3.50 $3.61 ASPIRIN CHEWABLE 81MG TAB [THAY] J3490 63739-0434-01 $3.69 $3.69 1 tab(s) $2.62 $3.69 $3.69 $2.62 $3.54 $3.47 $3.51 $3.62 GLYCERIN (ADULT) 3GM SUPPOSITORY [THAY] J3490 00713-0101-26 $3.73 $3.73 1 supp $2.65 $3.73 $3.73 $2.65 $3.58 $3.51 $3.54 $3.66 DOCUSATE SODIUM (DOK) 100MG CAP [THAY] J3490 60687-0129-01 $3.78 $3.78 1 cap(s) $2.68 $3.78 $3.78 $2.68 $3.63 $3.55 $3.59 $3.71 THROAT (CHLORASEPTIC) LOZENGE[THAY] J3490 63736-0204-18 $3.79 $3.79 1 lozenge(s) $2.69 $3.79 $3.79 $2.69 $3.64 $3.56 $3.60 $3.71 sodium chloride 1 g Tab J3490 69367-0220-01 $3.84 $3.84 1 tab(s) $2.72 $3.84 $3.84 $2.72 $3.68 $3.61 $3.64 $3.76 DOCUSATE SODIUM (DOK) 100MG CAP [THAY] J3490 00904-2244-61 $3.85 $3.85 1 cap(s) $2.73 $3.85 $3.85 $2.73 $3.69 $3.62 $3.65 $3.77 DOCUSATE SODIUM (DOK) 100MG CAP [THAY] J3490 00904-6455-61 $3.85 $3.85 1 cap(s) $2.73 $3.85 $3.85 $2.73 $3.69 $3.62 $3.65 $3.77 CITRIC ACID/SODIUM CITRATE(BICITRA) [THAY] J3490 00121-0595-16 $3.86 $3.86 5 mL $2.74 $3.86 $3.86 $2.74 $3.70 $3.62 $3.66 $3.78 MINERAL OIL 30ML EACH [THAY] J3490 37205-0831-43 $3.86 $3.86 30 mL $2.74 $3.86 $3.86 $2.74 $3.70 $3.63 $3.66 $3.78 BISACODYL (DULCOLAX) 10MG SUPP [THAY] J3490 00713-0109-01 $3.90 $3.90 1 supp $2.77 $3.90 $3.90 $2.77 $3.74 $3.66 $3.70 $3.82 BISACODYL (DULCOLAX) 10MG SUPP [THAY] J3490 00713-0109-12 $4.04 $4.04 1 supp $2.87 $4.04 $4.04 $2.87 $3.88 $3.80 $3.84 $3.96 LORATADINE (CLARITIN) 10MG TAB [THAY] J3490 00904-6852-61 $4.07 $4.07 1 tab(s) $2.89 $4.07 $4.07 $2.89 $3.91 $3.83 $3.87 $3.99 BISACODYL (DULCOLAX) 10MG SUPP [THAY] J3490 00536-1355-12 $4.20 $4.20 1 supp $2.98 $4.20 $4.20 $2.98 $4.03 $3.94 $3.99 $4.11 hydrocortisone topical 1% Cre J3490 00904-7623-31 $4.21 $4.21 1 - $2.99 $4.21 $4.21 $2.99 $4.04 $3.96 $4.00 $4.13 HYDROCORTISONE (HYCORT) 1% CREAM [THAY] J3490 00168-0154-08 $4.21 $4.21 1.5 app $2.99 $4.21 $4.21 $2.99 $4.05 $3.96 $4.00 $4.13 FLUORESCEIN (FUL-GLO)0.6MG OPTH STRIP [THAY] J3490 17478-0403-03 $4.30 $4.30 1 EA $3.05 $4.30 $4.30 $3.05 $4.13 $4.04 $4.09 $4.21 BISACODYL (DULCOLAX) 10MG SUPP [THAY] J3490 00574-7050-12 $4.35 $4.35 1 supp $3.09 $4.35 $4.35 $3.09 $4.17 $4.09 $4.13 $4.26 DILTIAZEM CD(CARDIZEM CD)120MG 24HR [THAY] J3490 60687-0195-01 $4.37 $4.37 1 cap(s) $3.10 $4.37 $4.37 $3.10 $4.19 $4.10 $4.15 $4.28 DILTIAZEM CD(CARDIZEM CD)120MG 24HR [THAY] J3490 68084-0052-01 $4.37 $4.37 1 cap(s) $3.10 $4.37 $4.37 $3.10 $4.19 $4.10 $4.15 $4.28 FLUORESCEIN (FUL-GLO)1MG OPTH STRIP [THAY] J3490 17478-0404-01 $4.38 $4.38 1 EA $3.11 $4.38 $4.38 $3.11 $4.20 $4.11 $4.16 $4.29 citric acid-sodium citrate 334 mg-500 mg/5 mL Sol J3490 58657-0310-16 $4.41 $4.41 5 mL $3.13 $4.41 $4.41 $3.13 $4.23 $4.14 $4.19 $4.32 CITRIC ACID/SODIUM CITRATE(BICITRA) [THAY] J3490 60258-0001-16 $4.41 $4.41 5 mL $3.13 $4.41 $4.41 $3.13 $4.23 $4.14 $4.19 $4.32 FLUORESCEIN (FUL-GLO)1MG OPTH STRIP [THAY] J3490 17238-0900-11 $4.45 $4.45 1 EA $3.16 $4.45 $4.45 $3.16 $4.27 $4.18 $4.23 $4.36 BACITRACIN-NEOMYCIN-POLYMYXIN(TABO) PACKET [THAY] J3490 00168-0012-09 $4.47 $4.47 1 app $3.17 $4.47 $4.47 $3.17 $4.29 $4.20 $4.24 $4.38 GUAIFENESIN SR (MUCINEX) 600MG TAB [THAY] J3490 63824-0008-34 $4.54 $4.54 1 tab(s) $3.23 $4.54 $4.54 $3.23 $4.36 $4.27 $4.32 $4.45 BACITRACIN-NEOMYCIN-POLYMYXIN(TABO) PACKET [THAY] J3490 45802-0143-70 $4.56 $4.56 1 app $3.23 $4.56 $4.56 $3.23 $4.37 $4.28 $4.33 $4.46 ACETAMINOPHEN (TYLENOL) 120MG SUPP [THAY] J3490 45802-0732-30 $4.67 $4.67 1 supp $3.31 $4.67 $4.67 $3.31 $4.48 $4.39 $4.43 $4.57 ACETAMINOPHEN (TYLENOL) 120MG SUPP [THAY] J3490 00713-0118-12 $4.72 $4.72 1supp $3.35 $4.72 $4.72 $3.35 $4.53 $4.43 $4.48 $4.62 GUAIFENESIN (ROBITUSSIN) 200MG/10ML [THAY] J3490 00121-1744-10 $4.77 $4.77 10 mL $3.39 $4.77 $4.77 $3.39 $4.58 $4.49 $4.54 $4.68 ACETAMINOPHEN (TYLENOL) 325MG SUPP [THAY] J3490 00713-0164-12 $4.81 $4.81 1 supp $3.42 $4.81 $4.81 $3.42 $4.62 $4.53 $4.57 $4.72 DOCUSATE SODIUM(COLACE)100MG/10ML ORAL SOLN [THAY] J3490 00121-0544-10 $4.90 $4.90 10 mL $3.48 $4.90 $4.90 $3.48 $4.70 $4.61 $4.66 $4.80 GLYCERIN (ADULT) 3GM SUPPOSITORY [THAY] J3490 00713-0101-09 $5.06 $5.06 1 supp $3.59 $5.06 $5.06 $3.59 $4.86 $4.76 $4.81 $4.96 LORATADINE (CLARITIN) 10MG TAB [THAY] J3490 00904-5793-61 $5.10 $5.10 1 tab(s) $3.62 $5.10 $5.10 $3.62 $4.90 $4.79 $4.84 $5.00 ACETAMINOPHEN (TYLENOL) 325MG SUPP [THAY] J3490 51672-2116-02 $5.10 $5.10 1 supp $3.62 $5.10 $5.10 $3.62 $4.90 $4.80 $4.85 $5.00 LORATADINE (CLARITIN) 10MG TAB [THAY] J3490 00904-6074-61 $5.21 $5.21 1 tab(s) $3.70 $5.21 $5.21 $3.70 $5.00 $4.90 $4.95 $5.11 IBUPROFEN(MOTRIN)100MG/5ML PO SUSP [THAY] J3490 68094-0494-61 $5.24 $5.24 5 mL $3.72 $5.24 $5.24 $3.72 $5.03 $4.93 $4.98 $5.14 IBUPROFEN(MOTRIN)100MG/5ML PO SUSP [THAY] J3490 68094-0494-62 $5.24 $5.24 5 mL $3.72 $5.24 $5.24 $3.72 $5.03 $4.93 $4.98 $5.14 LOPERAMIDE HCL (IMODIUM) 2MG CAP [THAY] J3490 51079-0690-20 $5.25 $5.25 1 cap(s) $3.73 $5.25 $5.25 $3.73 $5.04 $4.93 $4.99 $5.14 oxymetazoline nasal 0.05% Spr J3490 00904-6761-30 $5.42 $5.42 15 spray(s) $3.85 $5.42 $5.42 $3.85 $5.20 $5.09 $5.15 $5.31 SILVER NITRATE APPLICATORS [THAY] J3490 12870-0001-01 $5.45 $5.45 1 EA $3.87 $5.45 $5.45 $3.87 $5.23 $5.12 $5.18 $5.34 MINERAL OIL 30ML EACH [THAY] J3490 48433-0202-30 $5.45 $5.45 30 mL $3.87 $5.45 $5.45 $3.87 $5.23 $5.13 $5.18 $5.34 GUAIFENESIN SR (MUCINEX) 600MG TAB [THAY] J3490 68084-0572-01 $5.50 $5.50 1 tab(s) $3.91 $5.50 $5.50 $3.91 $5.28 $5.17 $5.23 $5.39 NYSTATIN 500000UNITS/5ML SUSP [THAY] J3490 66689-0037-99 $5.52 $5.52 5 mL $3.92 $5.52 $5.52 $3.92 $5.30 $5.19 $5.24 $5.41 lidocaine topical 2% Sol J3490 50383-0775-17 $5.66 $5.66 15 mL $4.02 $5.66 $5.66 $4.02 $5.43 $5.32 $5.38 $5.55 MAGNESIUM CITRATE (CITROMA) 300ML [THAY] J3490 37205-0110-38 $5.83 $5.83 296 mL $4.14 $5.83 $5.83 $4.14 $5.59 $5.48 $5.54 $5.71 DILTIAZEM(CARDIZEM ER)180MG/24HR [THAY] J3490 51079-0948-08 $5.91 $5.91 1 cap(s) $4.19 $5.91 $5.91 $4.19 $5.67 $5.55 $5.61 $5.79 MAGNESIUM CITRATE (CITROMA) 300ML [THAY] J3490 00869-0693-38 $5.96 $5.96 296 mL $4.23 $5.96 $5.96 $4.23 $5.72 $5.60 $5.66 $5.84 MAGNESIUM CITRATE (CITROMA) 300ML [THAY] J3490 00869-0667-38 $6.04 $6.04 296 mL $4.29 $6.04 $6.04 $4.29 $5.80 $5.68 $5.74 $5.92 ACETAMINOPHEN(TYLENOL)160MG/5ML ORAL SUSP [THAY] J3490 00121-0657-05 $6.05 $6.05 5 mL $4.30 $6.05 $6.05 $4.30 $5.81 $5.69 $5.75 $5.93 oxymetazoline nasal 0.05% Spr J3490 00904-5711-35 $6.07 $6.07 15 spray(s) $4.31 $6.07 $6.07 $4.31 $5.83 $5.70 $5.76 $5.95 DILTIAZEM(CARDIZEM ER)180MG/24HR [THAY] J3490 60505-0015-06 $6.18 $6.18 1 cap(s) $4.39 $6.18 $6.18 $4.39 $5.93 $5.81 $5.87 $6.06 DILTIAZEM CD(CARDIZEM CD)120MG 24HR [THAY] J3490 63739-0283-10 $6.49 $6.49 1 cap(s) $4.61 $6.49 $6.49 $4.61 $6.23 $6.10 $6.17 $6.36 NYSTATIN 500000UNITS/5ML SUSP [THAY] J3490 66689-0037-50 $6.58 $6.58 5 mL $4.67 $6.58 $6.58 $4.67 $6.31 $6.18 $6.25 $6.45 CETACAINE TOPICAL ANESTHETIC SPRAY [THAY] J3490 10223-0201-01 $6.82 $6.82 1 spray(s) $4.84 $6.82 $6.82 $4.84 $6.55 $6.41 $6.48 $6.68 lidocaine topical 4% Fil J3490 41167-0058-40 $6.83 $6.83 1 EA $4.85 $6.83 $6.83 $4.85 $6.55 $6.42 $6.49 $6.69 NYSTATIN 500000UNITS/5ML SUSP [THAY]NYSTATIN 500000UNITS/5ML SUSP [THAY] J3490 00121-4810-40 $6.87 $6.87 5 mL $4.88 $6.87 $6.87 $4.88 $6.59 $6.46 $6.52 $6.73 NYSTATIN 500000UNITS/5ML SUSP [THAY]NYSTATIN 500000UNITS/5ML SUSP [THAY] J3490 68094-0599-62 $6.89 $6.89 5 mL $4.89 $6.89 $6.89 $4.89 $6.62 $6.48 $6.55 $6.75 CARBAMIDE PEROXIDE(EAR DROPS)6.5% [THAY] J3490 00904-6627-35 $6.98 $6.98 15 drop(s) $4.96 $6.98 $6.98 $4.96 $6.70 $6.56 $6.63 $6.84 POLYETHYLENE GLYCOL (MIRALAX) 17GM [THAY] J3490 00904-6931-26 $7.24 $7.24 1 EA $5.14 $7.24 $7.24 $5.14 $6.95 $6.80 $6.88 $7.09 NITROGLYCERIN 0.4MG/HR 24HR PATCH [THAY] J3490 49730-0112-30 $7.25 $7.25 1 patch(es) $5.15 $7.25 $7.25 $5.15 $6.96 $6.82 $6.89 $7.11 GUAIFENESIN DM(ROBITUSSIN DM)10ML [THAY] J3490 00121-0638-10 $7.40 $7.40 10 mL $5.25 $7.40 $7.40 $5.25 $7.10 $6.96 $7.03 $7.25 CARBAMIDE PEROXIDE(EAR DROPS)6.5% [THAY] J3490 57896-0339-05 $7.46 $7.46 15 drop(s) $5.30 $7.46 $7.46 $5.30 $7.16 $7.01 $7.09 $7.31 FLURBIPROFEN(OCUFEN)0.03% OPTH SOLN [THAY] J3490 24208-0314-25 $7.49 $7.49 0.5 drop(s) $5.32 $7.49 $7.49 $5.32 $7.19 $7.04 $7.12 $7.34 FLEET OIL ENEMA 133ML [THAY] J3490 00132-0301-40 $7.66 $7.66 133 mL $5.44 $7.66 $7.66 $5.44 $7.35 $7.20 $7.28 $7.51 RACEPINEPHRINE(S2) 2.25% 0.5ML NEB [THAY] J3490 00487-5901-99 $7.75 $7.75 1 mL $5.50 $7.75 $7.75 $5.50 $7.44 $7.29 $7.36 $7.60 NICOTINE (NICODERM) 7MG/24HR PTCH [THAY] J3490 00067-5124-14 $7.77 $7.77 1 patch(es) $5.51 $7.77 $7.77 $5.51 $7.46 $7.30 $7.38 $7.61 NICOTINE (NICODERM) 14MG/24HR PTCH [THAY] J3490 00067-5125-14 $7.77 $7.77 1 patch(es) $5.51 $7.77 $7.77 $5.51 $7.46 $7.30 $7.38 $7.61 NICOTINE (NICODERM) 21MG/24HR PTCH [THAY] J3490 00067-5126-14 $7.77 $7.77 1 patch(es) $5.51 $7.77 $7.77 $5.51 $7.46 $7.30 $7.38 $7.61 NICOTINE (NICODERM) 14MG/24HR PTCH [THAY] J3490 00536-1107-88 $7.78 $7.78 1 patch(es) $5.53 $7.78 $7.78 $5.53 $7.47 $7.32 $7.40 $7.63 NICOTINE (NICODERM) 21MG/24HR PTCH [THAY] J3490 00536-1108-88 $7.78 $7.78 1 patch(es) $5.53 $7.78 $7.78 $5.53 $7.47 $7.32 $7.40 $7.63 NICOTINE (NICODERM) 7MG/24HR PTCH [THAY] J3490 00536-5894-88 $7.78 $7.78 1 patch(es) $5.53 $7.78 $7.78 $5.53 $7.47 $7.32 $7.40 $7.63 NICOTINE (NICODERM) 21MG/24HR PTCH [THAY] J3490 00536-5896-88 $7.78 $7.78 1 patch(es) $5.53 $7.78 $7.78 $5.53 $7.47 $7.32 $7.40 $7.63 SALINE (DEEP SEA) NASAL SPRAY 0.65% [THAY] J3490 00904-3865-75 $7.80 $7.80 45 spray(s) $5.53 $7.80 $7.80 $5.53 $7.48 $7.33 $7.41 $7.64 MIDAZOLAM HCL (VERSED) 2MG/ML SYRP [THAY] J3490 00054-3566-99 $7.81 $7.81 1 mL $5.55 $7.81 $7.81 $5.55 $7.50 $7.34 $7.42 $7.65 NITROGLYCERIN 0.4MG/HR 24HR PATCH [THAY] J3490 68382-0310-30 $7.85 $7.85 1 patch(es) $5.57 $7.85 $7.85 $5.57 $7.53 $7.37 $7.45 $7.69 MILK OF MAGNESIA 30ML EACH [THAY] J3490 00121-0431-30 $8.18 $8.18 30 mL $5.81 $8.18 $8.18 $5.81 $7.86 $7.69 $7.77 $8.02 POLYETHYLENE GLYCOL (MIRALAX) 17GM [THAY] J3490 45802-0868-66 $8.43 $8.43 1 EA $5.98 $8.43 $8.43 $5.98 $8.09 $7.92 $8.01 $8.26 CARBAMIDE PEROXIDE(EAR DROPS)6.5% [THAY] J3490 00904-3220-35 $8.46 $8.46 15 drop(s) $6.01 $8.46 $8.46 $6.01 $8.12 $7.95 $8.04 $8.29 NICOTINE (NICODERM) 7MG/24HR PTCH [THAY] J3490 00067-5124-07 $8.54 $8.54 1 patch(es) $6.06 $8.54 $8.54 $6.06 $8.20 $8.02 $8.11 $8.37 NICOTINE (NICODERM) 14MG/24HR PTCH [THAY] J3490 00067-5125-07 $8.54 $8.54 1 patch(es) $6.06 $8.54 $8.54 $6.06 $8.20 $8.02 $8.11 $8.37 NICOTINE (NICODERM) 21MG/24HR PTCH [THAY] J3490 00067-5126-07 $8.54 $8.54 1 patch(es) $6.06 $8.54 $8.54 $6.06 $8.20 $8.02 $8.11 $8.37 IODINE STRONG(LUGOLS)5% SOLN [THAY] J3490 48433-0230-15 $8.67 $8.67 15 mL $6.16 $8.67 $8.67 $6.16 $8.33 $8.15 $8.24 $8.50 ARTIFICIAL TEARS 1.4% OPTH SOLN 15ML [THAY] J3490 00536-1970-72 $8.83 $8.83 15 drop(s) $6.27 $8.83 $8.83 $6.27 $8.47 $8.30 $8.39 $8.65 POLYETHYLENE GLYCOL (MIRALAX) 17GM [THAY] J3490 68084-0430-98 $9.07 $9.07 1 EA $6.44 $9.07 $9.07 $6.44 $8.70 $8.52 $8.61 $8.88 GUAIFENESIN DM(ROBITUSSIN DM)10ML [THAY] J3490 00121-1276-00 $9.26 $9.26 10 mL $6.58 $9.26 $9.26 $6.58 $8.89 $8.71 $8.80 $9.08 PHENASEPTIC(CHLORASEPTIC)THROAT SPR [THAY] J3490 00536-2425-58 $9.46 $9.46 180 spray(s) $6.72 $9.46 $9.46 $6.72 $9.08 $8.89 $8.99 $9.27 NITROGLYCERIN(NITRO-BID)2% OINT 1GM [THAY] J3490 00281-0326-08 $9.51 $9.51 1 in $6.75 $9.51 $9.51 $6.75 $9.13 $8.94 $9.03 $9.32 POLYETHYLENE GLYCOL (MIRALAX) 17GM [THAY] J3490 00574-0412-07 $9.51 $9.51 1 EA $6.76 $9.51 $9.51 $6.76 $9.13 $8.94 $9.04 $9.32 sodium chloride nasal 0.65% Gel J3490 00225-0525-47 $9.66 $9.66 14.1 EA $6.86 $9.66 $9.66 $6.86 $9.27 $9.08 $9.18 $9.47 ZINC OXIDE 20% OINT 30GM TUBE [THAY] J3490 00168-0062-31 $10.34 $10.34 30 app $7.34 $10.34 $10.34 $7.34 $9.92 $9.72 $9.82 $10.13 ALUM 400/MAG 400/ SIMETH 40 DS 30ML UD [THAY] J3490 00121-1762-30 $10.39 $10.39 30 mL $7.37 $10.39 $10.39 $7.37 $9.97 $9.76 $9.87 $10.18 POVIDONE/IODINE (BETADINE) 10% OINT [THAY] J3490 00904-1102-31 $10.60 $10.60 30 app $7.53 $10.60 $10.60 $7.53 $10.18 $9.97 $10.07 $10.39 TRIPLE ANTIBIOTIC OINTMENT 30GM [THAY] J3490 00713-0268-31 $10.96 $10.96 30 app $7.78 $10.96 $10.96 $7.78 $10.52 $10.30 $10.41 $10.74 ARTIFICIAL TEARS 1.4% OPTH SOLN 15ML [THAY] J3490 00904-6492-35 $11.08 $11.08 15 drop(s) $7.87 $11.08 $11.08 $7.87 $10.64 $10.42 $10.53 $10.86 CETACAINE TOPICAL ANESTHETIC SPRAY [THAY] J3490 10223-0201-03 $11.24 $11.24 1 spray(s) $7.98 $11.24 $11.24 $7.98 $10.79 $10.57 $10.68 $11.02 CYCLOPENTOLATE(AK-PENTOLATE)1% OPTH [THAY] J3490 17478-0100-02 $11.39 $11.39 0.5 drop(s) $8.08 $11.39 $11.39 $8.08 $10.93 $10.70 $10.82 $11.16 NASAL DECONGESTANT 1% 30ML BOTTLE [THAY] J3490 37205-0483-10 $11.48 $11.48 30 mL $8.15 $11.48 $11.48 $8.15 $11.02 $10.79 $10.91 $11.25 TROLAMINE(SPORTSCREME)10% 85GM CRM [THAY] J3490 41167-0730-03 $12.14 $12.14 85 app $8.62 $12.14 $12.14 $8.62 $11.65 $11.41 $11.53 $11.90 ARTIFICIAL TEARS 1.4% OPTH SOLN 15ML [THAY] J3490 00536-1084-94 $12.26 $12.26 15 drop(s) $8.70 $12.26 $12.26 $8.70 $11.77 $11.52 $11.65 $12.01 CYCLOPENTOLATE(AK-PENTOLATE)1% OPTH [THAY] J3490 61314-0396-01 $12.40 $12.40 0.5 drop(s) $8.80 $12.40 $12.40 $8.80 $11.90 $11.66 $11.78 $12.15 CARBAMIDE PEROXIDE(EAR DROPS)6.5% [THAY] J3490 42037-0104-78 $12.68 $12.68 15 drop(s) $9.00 $12.68 $12.68 $9.00 $12.17 $11.92 $12.05 $12.43 BENZOCAINE AEROSOL(AMERICAINE)20% [THAY] J3490 63736-0378-82 $12.84 $12.84 57 spray(s) $9.12 $12.84 $12.84 $9.12 $12.33 $12.07 $12.20 $12.58 DIABETIC TUSSIN DM [THAY] J3490 61787-0062-04 $12.86 $12.86 118 mL $9.13 $12.86 $12.86 $9.13 $12.35 $12.09 $12.22 $12.60 Sevoflurane(Ultane)250ML INHAL SOLN [THAY] J3490 00074-4456-04 $13.02 $13.02 5 mL $9.25 $13.02 $13.02 $9.25 $12.50 $12.24 $12.37 $12.76 CAMPHOR-MENTHOL (MENTHOLATUM) OINT [THAY] J3490 10742-0001-02 $13.11 $13.11 85 app $9.31 $13.11 $13.11 $9.31 $12.59 $12.33 $12.46 $12.85 PHENYLEPHRINE (AK-DILATE) 10% OPTH [THAY] J3490 42702-0103-05 $13.60 $13.60 0.5 drop(s) $9.66 $13.60 $13.60 $9.66 $13.06 $12.78 $12.92 $13.33 PHENYLEPHRINE (AK-DILATE) 10% OPTH [THAY] J3490 17478-0206-05 $14.00 $14.00 0.5 drop(s) $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 menthol-zinc oxide topical 0.44%-20.6% Oin J3490 00799-0001-04 $14.00 $14.00 113 app $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 MONTELUKAST (SINGULAIR) 10MG TAB [THAY] J3490 68084-0875-01 $14.51 $14.51 1 tab(s) $10.30 $14.51 $14.51 $10.30 $13.93 $13.64 $13.79 $14.22 ARTIFICIAL TEARS 1.4% OPTH SOLN 15ML [THAY] J3490 17478-0060-12 $14.62 $14.62 15 drop(s) $10.38 $14.62 $14.62 $10.38 $14.04 $13.74 $13.89 $14.33 phenol topical 89% Swa J3490 00884-6297-30 $14.92 $14.92 1 EA $10.59 $14.92 $14.92 $10.59 $14.32 $14.02 $14.17 $14.62 MIDAZOLAM 5 MG/2.5 ML SYR [THAY] J3490 68094-0762-62 $16.16 $16.16 2.5 mL $11.47 $16.16 $16.16 $11.47 $15.51 $15.19 $15.35 $15.83 tetracaine ophthalmic 0.5% Sol [THAY] J3490 00065-0741-14 $16.27 $16.27 2 mL $11.55 $16.27 $16.27 $11.55 $15.62 $15.30 $15.46 $15.95 DIBUCAINE (NUPERCAINAL) 1% OINT [THAY] J3490 45802-0050-03 $16.36 $16.36 30 app $11.61 $16.36 $16.36 $11.61 $15.70 $15.38 $15.54 $16.03 ORALYTE (PEDIALYTE) 1000ML BOTTLE [THAY] J3490 00536-0935-86 $16.66 $16.66 1000 mL $11.83 $16.66 $16.66 $11.83 $15.99 $15.66 $15.83 $16.33 TRIPLE ANTIBIOTIC OINTMENT 30GM [THAY] J3490 45802-0143-03 $16.68 $16.68 30 app $11.84 $16.68 $16.68 $11.84 $16.01 $15.68 $15.84 $16.34 DESFLURANE(Suprane)240ML INHAL SOLN [THAY] J3490 10019-0641-34 $16.82 $16.82 8 mL $11.94 $16.82 $16.82 $11.94 $16.14 $15.81 $15.98 $16.48 TIMOLOL (TIMOPTIC) 0.5% OPTH SOLN [THAY] J3490 60758-0801-05 $17.12 $17.12 5 drop(s) $12.16 $17.12 $17.12 $12.16 $16.44 $16.09 $16.26 $16.78 ZINC OXIDE 20% OINT 30GM TUBE [THAY] J3490 75834-0170-01 $17.36 $17.36 30 app $12.33 $17.36 $17.36 $12.33 $16.67 $16.32 $16.49 $17.01 LANOLIN (TENDER CARE) OINT [THAY] J3490 02045-1871-22 $17.48 $17.48 60 tubes $12.41 $17.48 $17.48 $12.41 $16.78 $16.43 $16.61 $17.13 LIDOCAINE 2% JELLY 5ML TUBE [THAY] J3490 76329-3012-05 $17.80 $17.80 5 app $12.64 $17.80 $17.80 $12.64 $17.09 $16.73 $16.91 $17.44 GENTEAL GEL 10ML OPTH [THAY] J3490 00078-0429-47 $18.20 $18.20 10 drop(s) $12.92 $18.20 $18.20 $12.92 $17.47 $17.10 $17.29 $17.83 LIDOCAINE 2% JELLY 5ML TUBE [THAY] J3490 17478-0840-05 $19.60 $19.60 5 app $13.92 $19.60 $19.60 $13.92 $18.82 $18.43 $18.62 $19.21 GENTIAN VIOLET 1% 60ML BOTTLE [THAY] J3490 00395-1003-92 $20.22 $20.22 59 app $14.36 $20.22 $20.22 $14.36 $19.41 $19.01 $19.21 $19.82 LIDOCAINE 2% JELLY 5ML TUBE [THAY] J3490 17478-0711-10 $20.80 $20.80 5 app $14.77 $20.80 $20.80 $14.77 $19.97 $19.55 $19.76 $20.38 epinephrine-lidocaine 1:100000-2% Sol J3490 50227-1030-05 $20.84 $20.84 1.7 mL $14.79 $20.84 $20.84 $14.79 $20.00 $19.59 $19.80 $20.42 FLURBIPROFEN(OCUFEN)0.03% OPTH SOLN [THAY] J3490 69292-0722-25 $21.28 $21.28 0.5 drop(s) $15.11 $21.28 $21.28 $15.11 $20.43 $20.00 $20.22 $20.85 ALOE VESTA OINT 43.6% 226GM TUBE [THAY] J3490 43553-3249-08 $21.46 $21.46 226 app $15.24 $21.46 $21.46 $15.24 $20.60 $20.17 $20.39 $21.03 polyethylene glycol 3350 238 gm Powder J3490 3.45803E+11 $21.64 $21.64 1 oz $15.36 $21.64 $21.64 $15.36 $20.77 $20.34 $20.56 $21.21 BACITRACIN ZINC OINT 500U/GM TUBE [THAY] J3490 00472-1105-56 $22.17 $22.17 30 - $15.74 $22.17 $22.17 $15.74 $21.28 $20.84 $21.06 $21.73 METOPROLOL TART(LOPRESSOR)5MG/5ML CARPUJECT [THAY] J3490 47781-0587-17 $22.35 $22.35 5 mL $15.87 $22.35 $22.35 $15.87 $21.46 $21.01 $21.23 $21.90 METOPROLOL TART(LOPRESSOR)5MG/5ML VIAL [THAY] J3490 72611-0740-10 $22.35 $22.35 5 mL $15.87 $22.35 $22.35 $15.87 $21.46 $21.01 $21.23 $21.90 BUPIVACAINE(MARCAINE) 0.5% PF 10ML [THAY] J3490 55150-0170-30 $22.36 $22.36 10 mL $15.88 $22.36 $22.36 $15.88 $21.47 $21.02 $21.24 $21.91 BACTERIOSTATIC WATER 30ML VIAL [THAY] J3490 00409-3977-03 $22.88 $22.88 30 mL $16.25 $22.88 $22.88 $16.25 $21.97 $21.51 $21.74 $22.43 LIDOCAINE(XYLOCAINE)EPI 1% 20ML [THAY] J3490 63323-0482-26 $23.12 $23.12 20 mL $16.42 $23.12 $23.12 $16.42 $22.20 $21.73 $21.96 $22.66 LORATADINE (CLARITIN) 5MG/5ML SYRUP [THAY] J3490 51672-2073-08 $23.28 $23.28 120 mL $16.53 $23.28 $23.28 $16.53 $22.35 $21.88 $22.12 $22.82 Lidocaine (Xylocaine)2% PF 5ML VIAL [THAY] J3490 63323-0495-26 $23.60 $23.60 5 mL $16.76 $23.60 $23.60 $16.76 $22.66 $22.18 $22.42 $23.13 BUPIVACAINE(MARCAINE)0.25% PF 10ML [THAY] J3490 00409-1159-01 $23.94 $23.94 10 mL $17.00 $23.94 $23.94 $17.00 $22.98 $22.50 $22.74 $23.46 TROPICAMIDE (TROPICACYL) 0.5% OPTH [THAY] J3490 17478-0101-12 $24.00 $24.00 15 mL $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 VERAPAMIL HCL (CALAN) 2.5MG/ML VIAL [THAY] J3490 00409-1144-01 $24.11 $24.11 2 mL $17.12 $24.11 $24.11 $17.12 $23.15 $22.67 $22.91 $23.63 LIDOCAINE/EPI(XYLOCAINE/EPI)2% 20ML VIAL [THAY] J3490 00409-3182-03 $24.27 $24.27 20 mL $17.23 $24.27 $24.27 $17.23 $23.30 $22.82 $23.06 $23.79 ERYTHROMYCIN 0.5% OPTH 1 GM OINT [THAY] J3490 17478-0070-31 $24.43 $24.43 1 app $17.35 $24.43 $24.43 $17.35 $23.46 $22.97 $23.21 $23.95 BUPIVACAINE(MARCAINE) 0.5% PF 10ML [THAY] J3490 00409-1162-01 $24.51 $24.51 10 mL $17.40 $24.51 $24.51 $17.40 $23.53 $23.04 $23.29 $24.02 ERYTHROMYCIN 0.5% OPTH 1 GM OINT [THAY] J3490 17478-0824-01 $24.73 $24.73 1 app $17.56 $24.73 $24.73 $17.56 $23.74 $23.24 $23.49 $24.23 BUPIVACAINE(MARCAINE)0.75% 10ML VL [THAY] J3490 00409-1165-01 $24.80 $24.80 10 mL $17.61 $24.80 $24.80 $17.61 $23.81 $23.31 $23.56 $24.30 DILTIAZEM (CARDIZEM) 25MG/5ML VIAL [THAY] J3490 17478-0817-05 $24.90 $24.90 5 mL $17.68 $24.90 $24.90 $17.68 $23.90 $23.41 $23.66 $24.40 LIDOCAINE (XYLOCAINE) 2% 20ML VIAL [THAY] J3490 00409-4277-01 $25.02 $25.02 20 mL $17.77 $25.02 $25.02 $17.77 $24.02 $23.52 $23.77 $24.52 MICONAZOLE (MONISTAT) 2% VAGINAL CR [THAY] J3490 00472-0730-63 $25.46 $25.46 45 app $18.08 $25.46 $25.46 $18.08 $24.44 $23.93 $24.19 $24.95 BUPIVACAINE(MARCAINE)0.75% SPINAL [THAY] J3490 00409-3613-01 $25.67 $25.67 2 mL $18.23 $25.67 $25.67 $18.23 $24.65 $24.13 $24.39 $25.16 LIDOCAINE JELLY 2% 20ML UROJET [THAY] J3490 76329-3015-05 $26.20 $26.20 20 mL $18.60 $26.20 $26.20 $18.60 $25.15 $24.63 $24.89 $25.68 BUPIVACAINE(MARCAINE)0.25% PF 10ML [THAY] J3490 55150-0167-10 $26.24 $26.24 10 mL $18.63 $26.24 $26.24 $18.63 $25.19 $24.67 $24.93 $25.72 CARBOPROST (HEMABATE) 250MCG/ML AMP [THAY] J3490 00009-0856-05 $26.29 $26.29 1 mL $18.66 $26.29 $26.29 $18.66 $25.24 $24.71 $24.97 $25.76 METOPROLOL TART(LOPRESSOR)5MG/5ML CARPUJECT [THAY] J3490 00143-9660-10 $26.47 $26.47 5 mL $18.79 $26.47 $26.47 $18.79 $25.41 $24.88 $25.14 $25.94 METOPROLOL TART(LOPRESSOR)5MG/5ML CARPUJECT [THAY] J3490 00143-9873-25 $26.47 $26.47 5 mL $18.79 $26.47 $26.47 $18.79 $25.41 $24.88 $25.15 $25.94 Lidocaine (Xylocaine)2% PF 5ML VIAL [THAY] J3490 63323-0495-07 $26.84 $26.84 5 mL $19.06 $26.84 $26.84 $19.06 $25.77 $25.23 $25.50 $26.30 MUPIROCIN (BACTROBAN )2% 22GM OINT [THAY] J3490 45802-0112-22 $26.90 $26.90 22 app $19.10 $26.90 $26.90 $19.10 $25.82 $25.29 $25.55 $26.36 LIDOCAINE(XYLOCAINE)1% PF 30ML VIAL [THAY] J3490 00409-4279-02 $27.04 $27.04 30 mL $19.20 $27.04 $27.04 $19.20 $25.96 $25.42 $25.69 $26.50 BUPIVACAINE(MARCAINE)0.75% 10ML VL [THAY] J3490 55150-0171-10 $27.16 $27.16 10 mL $19.28 $27.16 $27.16 $19.28 $26.07 $25.53 $25.80 $26.62 LIDOCAINE/EPI(XYLOCAINE/EPI)2% 20ML VIAL [THAY] J3490 00409-3182-01 $27.18 $27.18 20 mL $19.29 $27.18 $27.18 $19.29 $26.09 $25.55 $25.82 $26.63 Lidocaine (Xylocaine)2% PF 5ML VIAL [THAY] J3490 55150-0165-05 $27.20 $27.20 5 mL $19.31 $27.20 $27.20 $19.31 $26.11 $25.57 $25.84 $26.66 BUPIVACAINE(MARCAINE) 0.5% PF 10ML [THAY] J3490 55150-0169-10 $27.20 $27.20 10 mL $19.31 $27.20 $27.20 $19.31 $26.11 $25.57 $25.84 $26.66 LIDOCAINE (XYLOCAINE) 2% 10ML VIAL [THAY] J3490 63323-0486-17 $27.20 $27.20 10 mL $19.31 $27.20 $27.20 $19.31 $26.11 $25.57 $25.84 $26.66 DILTIAZEM (CARDIZEM) 50MG/10ML VIAL [THAY] J3490 17478-0817-10 $27.29 $27.29 10 mL $19.37 $27.29 $27.29 $19.37 $26.19 $25.65 $25.92 $26.74 DILTIAZEM (CARDIZEM) 50MG/10ML VIAL [THAY] J3490 17478-0937-10 $27.29 $27.29 10 mL $19.37 $27.29 $27.29 $19.37 $26.19 $25.65 $25.92 $26.74 BUMETANIDE (BUMEX) 2.5MG/10ML SOL [THAY] J3490 00641-6007-10 $27.35 $27.35 10 mL $19.42 $27.35 $27.35 $19.42 $26.26 $25.71 $25.99 $26.81 ePHEDrine SULFATE 50MG/ML AMP [THAY] J3490 17478-0823-01 $27.36 $27.36 1 mL $19.43 $27.36 $27.36 $19.43 $26.27 $25.72 $25.99 $26.81 BUMETANIDE (BUMEX) 2.5MG/10ML SOL [THAY] J3490 00409-1412-10 $27.56 $27.56 10 mL $19.57 $27.56 $27.56 $19.57 $26.46 $25.91 $26.18 $27.01 DILTIAZEM (CARDIZEM) 25MG/5ML VIAL [THAY] J3490 00641-6013-10 $27.61 $27.61 5 mL $19.60 $27.61 $27.61 $19.60 $26.50 $25.95 $26.23 $27.06 Labetalol (Trandate)100MG/20ML VIAL [THAY] J3490 00409-2267-20 $28.48 $28.48 20 mL $20.22 $28.48 $28.48 $20.22 $27.34 $26.77 $27.06 $27.91 Alfentanil (Alfenta) 1000MCG/2ML AMP [THAY] J3490 00409-2266-02 $28.69 $28.69 2 mL $20.37 $28.69 $28.69 $20.37 $27.54 $26.97 $27.25 $28.11 ERYTHROMYCIN 0.5% OPTH 1 GM OINT [THAY] J3490 24208-0910-19 $28.83 $28.83 1 app $20.47 $28.83 $28.83 $20.47 $27.68 $27.10 $27.39 $28.25 BUPIVACAINE/EPI 0.25% PF 10ML [THAY] J3490 00409-1746-10 $28.83 $28.83 10 mL $20.47 $28.83 $28.83 $20.47 $27.68 $27.10 $27.39 $28.26 LIDOCAINE(XYLOCAINE)EPI 1% 20ML [THAY] J3490 63323-0482-27 $29.00 $29.00 20 mL $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 LIDOCAINE/EPI(XYLOCAINE/EPI)2% 20ML VIAL [THAY] J3490 63323-0483-27 $29.12 $29.12 20 mL $20.68 $29.12 $29.12 $20.68 $27.96 $27.37 $27.66 $28.54 Lidocaine (Xylocaine MPF)0.5% 250MG/50ML [THAY] J3490 00409-4278-01 $29.29 $29.29 50 mL $20.79 $29.29 $29.29 $20.79 $28.12 $27.53 $27.82 $28.70 BUPIVACAINE(MARCAINE)0.75% 10ML VL [THAY] J3490 00409-1582-10 $29.32 $29.32 10 mL $20.82 $29.32 $29.32 $20.82 $28.15 $27.56 $27.86 $28.74 BUPIVACAINE(MARCAINE)/EPI 0.5% PFVL [THAY] J3490 00409-1749-10 $29.38 $29.38 10 mL $20.86 $29.38 $29.38 $20.86 $28.20 $27.61 $27.91 $28.79 BUPIVACAINE/EPI 0.25% PF 10ML [THAY] J3490 00409-9042-01 $29.58 $29.58 10 mL $21.00 $29.58 $29.58 $21.00 $28.39 $27.80 $28.10 $28.98 SUFentanil CITRATE(Sufenta)50MCG/ML AMP [THAY] J3490 17478-0050-01 $30.76 $30.76 1 mL $21.84 $30.76 $30.76 $21.84 $29.53 $28.92 $29.23 $30.15 OSELTAMIVIR 75 MG CAPSULE [THAY] J3490 63739-0050-07 $30.82 $30.82 1 cap(s) $21.88 $30.82 $30.82 $21.88 $29.59 $28.97 $29.28 $30.20 BUPIVACAINE(MARCAINE)0.75% SPINAL [THAY] J3490 00409-1761-02 $30.92 $30.92 2 mL $21.95 $30.92 $30.92 $21.95 $29.68 $29.06 $29.37 $30.30 BUPIVACAINE(MARCAINE) 0.5% PF 10ML [THAY] J3490 63323-0466-17 $30.94 $30.94 10 mL $21.97 $30.94 $30.94 $21.97 $29.71 $29.09 $29.40 $30.33 BUPIVACAINE(MARCAINE)/EPI 0.5% 30ML PFVL [THAY] J3490 00409-1749-29 $31.26 $31.26 30 mL $22.20 $31.26 $31.26 $22.20 $30.01 $29.39 $29.70 $30.64 EUCERIN CREAM [THAY] J3490 72140-0000-21 $31.48 $31.48 454 app $22.35 $31.48 $31.48 $22.35 $30.22 $29.59 $29.90 $30.85 HYDROCORTISONE (ANUMED-HC)25MG SUPP [THAY] J3490 59741-0301-12 $31.60 $31.60 1 supp $22.44 $31.60 $31.60 $22.44 $30.34 $29.70 $30.02 $30.97 "epinephrine-lidocaine 1:200,000-1.5% preservative-free Sol" J3490 00409-1209-01 $31.66 $31.66 5 mL $22.48 $31.66 $31.66 $22.48 $30.40 $29.76 $30.08 $31.03 TOBRAMYCIN (TOBREX) 0.3% OPTH SOLN [THAY] J3490 70069-0131-01 $31.72 $31.72 5 mL $22.52 $31.72 $31.72 $22.52 $30.45 $29.82 $30.13 $31.09 OSELTAMIVIR 30 MG CAPSULE [THAY] J3490 68180-0675-11 $31.86 $31.86 1 cap(s) $22.62 $31.86 $31.86 $22.62 $30.59 $29.95 $30.27 $31.22 OSELTAMIVIR 30 MG CAPSULE [THAY] J3490 70710-1008-02 $31.86 $31.86 1 cap(s) $22.62 $31.86 $31.86 $22.62 $30.59 $29.95 $30.27 $31.22 TRIAMCINOLONE(ARISTOCORT)0.1% CRM 80GM [THAY] J3490 00168-0004-80 $31.88 $31.88 80 app $22.63 $31.88 $31.88 $22.63 $30.60 $29.97 $30.29 $31.24 Vecuronium (Norcuron) 10MG VIAL [THAY] J3490 67457-0438-10 $32.00 $32.00 1 EA $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 Rocuronium (Zemuron) 50MG/5ML VIAL [THAY] J3490 67457-0573-05 $32.13 $32.13 5 mL $22.81 $32.13 $32.13 $22.81 $30.84 $30.20 $30.52 $31.48 TOBRAMYCIN (TOBREX) 0.3% OPTH SOLN [THAY] J3490 24208-0290-05 $32.20 $32.20 5 mL $22.86 $32.20 $32.20 $22.86 $30.91 $30.27 $30.59 $31.56 METOPROLOL TART(LOPRESSOR)5MG/5ML CARPUJECT [THAY] J3490 00409-1778-35 $32.60 $32.60 5 mL $23.15 $32.60 $32.60 $23.15 $31.29 $30.64 $30.97 $31.95 Ketamine (Ketalar) 500MG/10ML VIAL [THAY] J3490 00143-9508-10 $32.72 $32.72 10 mL $23.23 $32.72 $32.72 $23.23 $31.41 $30.76 $31.08 $32.07 BUPIVACAINE/EPI 0.25% PF 10ML [THAY] J3490 63323-0468-17 $32.74 $32.74 10 mL $23.25 $32.74 $32.74 $23.25 $31.43 $30.78 $31.11 $32.09 HYDROCORTISONE (ANUMED-HC)25MG SUPP [THAY] J3490 00574-7090-12 $32.85 $32.85 1 supp $23.32 $32.85 $32.85 $23.32 $31.54 $30.88 $31.21 $32.19 BUPIVACAINE(MARCAINE)/EPI 0.5% PFVL [THAY] J3490 63323-0462-17 $33.06 $33.06 10 mL $23.47 $33.06 $33.06 $23.47 $31.73 $31.07 $31.40 $32.39 TRIAMCINOLONE(ARISTOCORT)0.1% CRM 80GM [THAY] J3490 67877-0251-80 $33.10 $33.10 80 app $23.50 $33.10 $33.10 $23.50 $31.78 $31.11 $31.45 $32.44 ETOMIDATE(AMIDATE)40MG/20ML ABOJECT [THAY] J3490 00409-6695-02 $33.10 $33.10 20 mL $23.50 $33.10 $33.10 $23.50 $31.78 $31.12 $31.45 $32.44 TOBRAMYCIN (TOBREX) 0.3% OPTH SOLN [THAY] J3490 17478-0290-10 $33.12 $33.12 5 mL $23.52 $33.12 $33.12 $23.52 $31.80 $31.13 $31.46 $32.46 SILVER SULFADIAZINE(SSD)1% 50GM CRM [THAY] J3490 67877-0124-05 $34.24 $34.24 50 app $24.31 $34.24 $34.24 $24.31 $32.87 $32.19 $32.53 $33.56 SILVER SULFADIAZINE(SSD)1% 50GM CRM [THAY] J3490 67877-0124-50 $34.24 $34.24 50 app $24.31 $34.24 $34.24 $24.31 $32.87 $32.19 $32.53 $33.56 OSELTAMIVIR 75 MG CAPSULE [THAY] J3490 68180-0677-11 $34.41 $34.41 1 cap(s) $24.43 $34.41 $34.41 $24.43 $33.04 $32.35 $32.69 $33.73 LEPTOSPERMUM HONEY 100 % Paste J3490 09958-0033-61 $34.64 $34.64 1 app $24.59 $34.64 $34.64 $24.59 $33.25 $32.56 $32.91 $33.95 SILVER SULFADIAZINE(SSD)1% 50GM CRM [THAY] J3490 43598-0210-55 $35.00 $35.00 50 app $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 IV J3490 HYDROXPROGESTERONE J3490 $35.00 $35.00 $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 "J3490 (MEDICAID) DEPO PROVERA PROGESTERONE 1MG INJ, 150 TOTAL MG" J3490 $35.00 $35.00 $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 MEDIHONEY WOUND DRESSING [THAY] J3490 $35.00 $35.00 $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 Vecuronium (Norcuron) 10MG VIAL [THAY] J3490 00703-2914-03 $35.12 $35.12 1 EA $24.94 $35.12 $35.12 $24.94 $33.72 $33.01 $33.36 $34.42 Rocuronium (Zemuron) 50MG/5ML VIAL [THAY] J3490 63323-0426-05 $36.26 $36.26 5 mL $25.74 $36.26 $36.26 $25.74 $34.81 $34.08 $34.45 $35.53 THP Tobramycin 0.3% Opthalmic SOLN #1 [THAY] J3490 99999-9999-78 $36.38 $36.38 1 EA $25.83 $36.38 $36.38 $25.83 $34.92 $34.20 $34.56 $35.65 Glycopyrrolate (Robinul) 0.2MG/1ML [THAY] J3490 00143-9682-25 $36.80 $36.80 1 mL $26.13 $36.80 $36.80 $26.13 $35.33 $34.59 $34.96 $36.06 OSELTAMIVIR (TAMIFLU) 45MG CAP [THAY] J3490 00004-0801-85 $36.94 $36.94 1 cap(s) $26.23 $36.94 $36.94 $26.23 $35.46 $34.73 $35.09 $36.20 ETOMIDATE(AMIDATE)40MG/20ML ABOJECT [THAY] J3490 68382-0545-08 $37.04 $37.04 20 mL $26.30 $37.04 $37.04 $26.30 $35.56 $34.82 $35.19 $36.30 FENTANYL (DURAGESIC) 25MCG/HR PATCH [THAY] J3490 49884-0761-78 $37.30 $37.30 1 patch(es) $26.49 $37.30 $37.30 $26.49 $35.81 $35.07 $35.44 $36.56 Ketamine (Ketalar) 500MG/10ML VIAL [THAY] J3490 67457-0001-10 $37.55 $37.55 10 mL $26.66 $37.55 $37.55 $26.66 $36.05 $35.30 $35.67 $36.80 CIPROFLOXACIN(CIPRO)0.3% OPTH SOLN 5ML [THAY] J3490 69315-0308-05 $37.60 $37.60 5 drop(s) $26.70 $37.60 $37.60 $26.70 $36.10 $35.34 $35.72 $36.85 TIMOLOL (TIMOPTIC) 0.5% OPTH SOLN [THAY] J3490 61314-0227-05 $38.00 $38.00 5 drop(s) $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 Labetalol (Trandate)100MG/20ML VIAL [THAY] J3490 72266-0102-01 $39.20 $39.20 20 mL $27.83 $39.20 $39.20 $27.83 $37.63 $36.85 $37.24 $38.42 METRONIDAZOLE(FLAGYL)500MG/100ML IV [THAY] J3490 00338-9541-24 $39.32 $39.32 100 mL $27.92 $39.32 $39.32 $27.92 $37.75 $36.96 $37.35 $38.53 METRONIDAZOLE(FLAGYL)500MG/100ML IV [THAY] J3490 00409-7811-24 $39.34 $39.34 100 mL $27.93 $39.34 $39.34 $27.93 $37.77 $36.98 $37.38 $38.56 PROMETHAZINE (PROMETHEGAN)25MG SUPP [THAY] J3490 00713-0526-12 $39.41 $39.41 1 supp $27.98 $39.41 $39.41 $27.98 $37.83 $37.05 $37.44 $38.62 PROMETHAZINE(PROMETHEGAN)12.5MG SUP [THAY] J3490 00713-0536-12 $39.41 $39.41 1 supp $27.98 $39.41 $39.41 $27.98 $37.83 $37.05 $37.44 $38.62 PROMETHAZINE (PROMETHEGAN)25MG SUPP [THAY] J3490 51672-5297-01 $39.41 $39.41 1 supp $27.98 $39.41 $39.41 $27.98 $37.83 $37.05 $37.44 $38.62 OSELTAMIVIR (TAMIFLU) 75MG CAP [THAY] J3490 00004-0800-85 $39.95 $39.95 1 cap(s) $28.37 $39.95 $39.95 $28.37 $38.35 $37.55 $37.95 $39.15 METRONIDAZOLE(FLAGYL)500MG/100ML IV [THAY] J3490 00264-5535-32 $40.05 $40.05 100 mL $28.44 $40.05 $40.05 $28.44 $38.45 $37.65 $38.05 $39.25 Alfentanil (Alfenta) 1000MCG/2ML AMP [THAY] J3490 17478-0067-02 $41.04 $41.04 2 mL $29.14 $41.04 $41.04 $29.14 $39.40 $38.58 $38.99 $40.22 Vecuronium (Norcuron) 10MG VIAL [THAY] J3490 41616-0931-44 $41.26 $41.26 1 EA $29.29 $41.26 $41.26 $29.29 $39.61 $38.78 $39.20 $40.43 BUPIVACAINE(MARCAINE)/EPI 0.5% 30ML PFVL [THAY] J3490 63323-0462-37 $41.70 $41.70 30 mL $29.60 $41.70 $41.70 $29.60 $40.03 $39.19 $39.61 $40.86 ETOMIDATE(AMIDATE)40MG/20ML VIAL [THAY] J3490 55150-0222-20 $42.20 $42.20 20 mL $29.96 $42.20 $42.20 $29.96 $40.51 $39.67 $40.09 $41.36 scopolamine 1 mg/72 hr ER J3490 45802-0580-84 $42.52 $42.52 1 EA $30.19 $42.52 $42.52 $30.19 $40.82 $39.97 $40.39 $41.67 LATANOPROST(XALATAN)0.005% OPTH SOL [THAY] J3490 17478-0625-12 $42.88 $42.88 2.5 drop(s) $30.44 $42.88 $42.88 $30.44 $41.16 $40.31 $40.74 $42.02 DAPAGLIFLOZIN (FARXIGA) 5 MG TAB [THAY] J3490 00310-6205-30 $42.89 $42.89 1 tab(s) $30.45 $42.89 $42.89 $30.45 $41.18 $40.32 $40.75 $42.03 SODIUM BICARB 8.4% 50MEQ/50ML ABBO [THAY] J3490 00409-6625-02 $43.26 $43.26 50 mL $30.71 $43.26 $43.26 $30.71 $41.53 $40.66 $41.09 $42.39 MULTIVITAMIN (INFUVITE) VIAL [THAY] J3490 54643-5649-01 $44.28 $44.28 10 mL $31.44 $44.28 $44.28 $31.44 $42.50 $41.62 $42.06 $43.39 LIDOCAINE(XYLOCAINE)1% PF 30ML VIAL [THAY] J3490 63323-0492-37 $44.60 $44.60 30 mL $31.67 $44.60 $44.60 $31.67 $42.82 $41.92 $42.37 $43.71 FENTANYL (DURAGESIC) 12MCG/HR PATCH [THAY] J3490 00378-9119-98 $44.60 $44.60 1 patch(es) $31.67 $44.60 $44.60 $31.67 $42.82 $41.93 $42.37 $43.71 SODIUM BICARB 8.4% 50MEQ/50ML ABBO [THAY] J3490 00409-6637-34 $45.34 $45.34 50 mL $32.19 $45.34 $45.34 $32.19 $43.53 $42.62 $43.08 $44.44 SODIUM BICARB 4.2% (5MEQ/10ML) ABBO [THAY] J3490 00409-5534-34 $45.94 $45.94 10 mL $32.62 $45.94 $45.94 $32.62 $44.11 $43.19 $43.65 $45.03 FENTANYL (DURAGESIC) 25MCG/HR PATCH [THAY] J3490 47781-0424-47 $46.53 $46.53 1 patch(es) $33.04 $46.53 $46.53 $33.04 $44.67 $43.74 $44.21 $45.60 FENTANYL (DURAGESIC) 25MCG/HR PATCH [THAY] J3490 60505-7006-02 $46.53 $46.53 1 patch(es) $33.04 $46.53 $46.53 $33.04 $44.67 $43.74 $44.21 $45.60 clindamycin 600 mg-5%/50 mL Sol[THAY] J3490 00009-3375-01 $46.60 $46.60 50 mL $33.09 $46.60 $46.60 $33.09 $44.74 $43.80 $44.27 $45.67 "BACITRACIN 50,000 UNIT VIAL [THAY]" J3490 00009-0241-01 $46.62 $46.62 1 EA $33.10 $46.62 $46.62 $33.10 $44.75 $43.82 $44.29 $45.68 "BACITRACIN 50,000 UNIT VIAL [THAY]" J3490 00009-0233-01 $46.62 $46.62 1 EA $33.10 $46.62 $46.62 $33.10 $44.76 $43.82 $44.29 $45.69 Labetalol (Trandate)100MG/20ML VIAL [THAY] J3490 47781-0586-29 $47.50 $47.50 20 mL $33.73 $47.50 $47.50 $33.73 $45.60 $44.65 $45.13 $46.55 NYSTATIN(NYSTOP)100000UN/GM POWDER [THAY] J3490 68308-0152-15 $47.90 $47.90 15 app $34.01 $47.90 $47.90 $34.01 $45.98 $45.03 $45.50 $46.94 HYDROCORTISONE (ANUMED-HC)25MG SUPP [THAY] J3490 00713-0503-12 $49.29 $49.29 1 supp $35.00 $49.29 $49.29 $35.00 $47.32 $46.34 $46.83 $48.31 Lidocaine (Xylocaine MPF)0.5% 250MG/50ML [THAY] J3490 63323-0491-57 $50.22 $50.22 50 mL $35.65 $50.22 $50.22 $35.65 $48.21 $47.20 $47.71 $49.21 ACTIVATED CHARCOAL (ACTIDOSE) 50GM [THAY] J3490 00574-0120-76 $50.80 $50.80 240 mL $36.07 $50.80 $50.80 $36.07 $48.77 $47.75 $48.26 $49.78 trace elements with selenium 10 mcg-1 mg-0.5 mg-60 mcg-5 mg/mL Sol J3490 00517-8201-25 $51.25 $51.25 1 mL $36.39 $51.25 $51.25 $36.39 $49.20 $48.18 $48.69 $50.23 SODIUM BICARB 8.4% 50MEQ/50ML ABBO [THAY] J3490 76329-3352-01 $52.40 $52.40 50 mL $37.20 $52.40 $52.40 $37.20 $50.30 $49.26 $49.78 $51.35 Flumazenil (Romazicon) 1MG/10ML VIAL [THAY] J3490 00143-9783-10 $52.50 $52.50 10 mL $37.28 $52.50 $52.50 $37.28 $50.40 $49.35 $49.88 $51.45 Flumazenil (Romazicon) 1MG/10ML VIAL [THAY] J3490 00143-9784-10 $52.50 $52.50 10 mL $37.28 $52.50 $52.50 $37.28 $50.40 $49.35 $49.88 $51.45 Glycopyrrolate (Robinul) 0.2MG/1ML [THAY] J3490 00517-4601-25 $52.50 $52.50 1 mL $37.28 $52.50 $52.50 $37.28 $50.40 $49.35 $49.88 $51.45 APRACLONIDINE (IOPIDINE )1% OPTH 0.2ML AMP [THAY] J3490 00065-0660-10 $53.91 $53.91 1 drop(s) $38.28 $53.91 $53.91 $38.28 $51.75 $50.68 $51.21 $52.83 MUPIROCIN (BACTROBAN )2% 22GM OINT [THAY] J3490 51672-1312-00 $54.00 $54.00 22 app $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 TROPICAMIDE (TROPICACYL) 0.5% OPTH [THAY] J3490 24208-0590-64 $54.00 $54.00 15 mL $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 BELLADONNA 16.2MG & OPIUM 60MG SUPP [THAY] J3490 00574-7040-12 $54.18 $54.18 1 supp $38.47 $54.18 $54.18 $38.47 $52.01 $50.93 $51.47 $53.10 CLINDAMYCIN (CLEOCIN) 300 MG/50ML PREMIX [THAY] J3490 00781-3288-09 $54.68 $54.68 50 mL $38.82 $54.68 $54.68 $38.82 $52.49 $51.40 $51.94 $53.58 TOBRAMYCIN (TOBREX) 0.3% OPTH SOLN [THAY] J3490 62332-0518-05 $54.97 $54.97 5 mL $39.03 $54.97 $54.97 $39.03 $52.77 $51.67 $52.22 $53.87 scopolamine 1.5 mg ER J3490 10019-0553-03 $55.11 $55.11 1 EA $39.13 $55.11 $55.11 $39.13 $52.91 $51.80 $52.35 $54.01 MOXIFLOXACIN(VIGAMOX)0.5% OPTH SOLN [THAY] J3490 00065-4013-03 $56.24 $56.24 0.5 drop(s) $39.93 $56.24 $56.24 $39.93 $53.99 $52.86 $53.42 $55.11 NYSTATIN 100000UNIT/GM CREAM 30GM [THAY] J3490 00603-7818-78 $56.50 $56.50 30 app $40.12 $56.50 $56.50 $40.12 $54.24 $53.11 $53.68 $55.37 NYSTATIN 100000UNIT/GM CREAM 30GM [THAY] J3490 45802-0059-11 $56.50 $56.50 30 app $40.12 $56.50 $56.50 $40.12 $54.24 $53.11 $53.68 $55.37 NYSTATIN 100000UNIT/GM CREAM 30GM [THAY] J3490 51672-1289-02 $56.66 $56.66 30 app $40.23 $56.66 $56.66 $40.23 $54.39 $53.26 $53.83 $55.53 FENTANYL (DURAGESIC) 50MCG/HR PATCH [THAY] J3490 00378-9122-98 $56.72 $56.72 1 patch(es) $40.27 $56.72 $56.72 $40.27 $54.45 $53.32 $53.88 $55.59 FENTANYL (DURAGESIC) 50MCG/HR PATCH [THAY] J3490 00406-9050-76 $56.72 $56.72 1 patch(es) $40.27 $56.72 $56.72 $40.27 $54.45 $53.32 $53.88 $55.59 GENTAMICIN (GENTAK) 0.3% OPTH OINT [THAY] J3490 17478-0284-35 $57.16 $57.16 3.5 app $40.58 $57.16 $57.16 $40.58 $54.87 $53.73 $54.30 $56.02 MULTIVITAMIN PED (INFUVITE PED) VIAL [THAY] J3490 54643-5646-01 $57.95 $57.95 5 mL $41.14 $57.95 $57.95 $41.14 $55.63 $54.47 $55.05 $56.79 NYSTATIN(NYSTOP)100000UN/GM POWDER [THAY] J3490 42543-0052-61 $58.92 $58.92 15 app $41.83 $58.92 $58.92 $41.83 $56.56 $55.38 $55.97 $57.74 MOXIFLOXACIN(VIGAMOX)0.5% OPTH SOLN [THAY] J3490 60505-0582-04 $59.78 $59.78 0.5 drop(s) $42.45 $59.78 $59.78 $42.45 $57.39 $56.20 $56.79 $58.59 MOXIFLOXACIN(VIGAMOX)0.5% OPTH SOLN [THAY] J3490 65862-0840-03 $59.78 $59.78 0.5 drop(s) $42.45 $59.78 $59.78 $42.45 $57.39 $56.20 $56.79 $58.59 NYSTATIN(NYSTOP)100000UN/GM POWDER [THAY] J3490 00832-0465-15 $60.19 $60.19 15 app $42.73 $60.19 $60.19 $42.73 $57.78 $56.58 $57.18 $58.99 clindamycin 600 mg-5%/50 mL Sol[THAY] J3490 00338-3612-24 $60.63 $60.63 50 mL $43.05 $60.63 $60.63 $43.05 $58.21 $56.99 $57.60 $59.42 FENTANYL (DURAGESIC) 50MCG/HR PATCH [THAY] J3490 47781-0426-47 $62.32 $62.32 1 patch(es) $44.25 $62.32 $62.32 $44.25 $59.83 $58.58 $59.21 $61.08 FENTANYL (DURAGESIC) 50MCG/HR PATCH [THAY] J3490 60505-7007-02 $62.32 $62.32 1 patch(es) $44.25 $62.32 $62.32 $44.25 $59.83 $58.58 $59.21 $61.08 FENTANYL (DURAGESIC) 50MCG/HR PATCH [THAY] J3490 60505-7082-02 $62.32 $62.32 1 patch(es) $44.25 $62.32 $62.32 $44.25 $59.83 $58.58 $59.21 $61.08 CLINDAMYCIN (CLEOCIN) 300 MG/50ML PREMIX [THAY] J3490 00009-3381-01 $62.34 $62.34 50 mL $44.26 $62.34 $62.34 $44.26 $59.85 $58.60 $59.22 $61.09 TOBRAYMCIN/DEXAMETH (TOBRADEX) OINT [THAY] J3490 00065-0648-35 $62.68 $62.68 0.5 app $44.50 $62.68 $62.68 $44.50 $60.17 $58.92 $59.55 $61.43 clindamycin 900 mg-5%/50 mL Sol[THAY] J3490 00338-3814-24 $66.32 $66.32 50 mL $47.09 $66.32 $66.32 $47.09 $63.67 $62.34 $63.00 $64.99 CLOTRIMAZOLE/BETAMETHASONE(LOTRISONE)45GM [THAY] J3490 00168-0258-46 $69.34 $69.34 45 app $49.23 $69.34 $69.34 $49.23 $66.57 $65.18 $65.87 $67.95 PROPARACAINE HCL(ALCAINE)0.5% OPTH [THAY] J3490 17478-0263-12 $69.81 $69.81 15 drop(s) $49.56 $69.81 $69.81 $49.56 $67.01 $65.62 $66.31 $68.41 TRANEXAMIC ACID 1000MG/10ML SDV [THAY] J3490 00517-0960-10 $69.96 $69.96 10 mL $49.67 $69.96 $69.96 $49.67 $67.16 $65.76 $66.46 $68.56 TRANEXAMIC ACID 1000MG/10ML SDV [THAY] J3490 60505-6169-01 $70.40 $70.40 10 mL $49.98 $70.40 $70.40 $49.98 $67.58 $66.18 $66.88 $68.99 EYE WASH(EYE STREAM)120ML OPTH SOLN [THAY] J3490 00065-0530-04 $70.70 $70.70 120 mL $50.20 $70.70 $70.70 $50.20 $67.87 $66.46 $67.17 $69.29 atropine ophthalmic 1% Sol J3490 17478-0215-02 $70.90 $70.90 2 mL $50.34 $70.90 $70.90 $50.34 $68.06 $66.65 $67.36 $69.48 clindamycin 900 mg-5%/50 mL Sol J3490 00781-3290-09 $71.25 $71.25 50 mL $50.59 $71.25 $71.25 $50.59 $68.40 $66.97 $67.69 $69.82 INTRALIPID 20% 250ML [THAY] J3490 00264-4460-30 $74.54 $74.54 250 mL $52.92 $74.54 $74.54 $52.92 $71.55 $70.06 $70.81 $73.04 CIPROFLOXACIN(CIPRO)0.3% OPTH SOLN 5ML [THAY] J3490 61314-0656-05 $74.97 $74.97 5 drop(s) $53.23 $74.97 $74.97 $53.23 $71.97 $70.47 $71.22 $73.47 SORBITOL 3% IRRIGATION 3000ML BAG [THAY] J3490 00338-0295-47 $75.68 $75.68 3000 mL $53.73 $75.68 $75.68 $53.73 $72.65 $71.14 $71.90 $74.17 clindamycin 600 mg-5%/50 mL Sol[THAY] J3490 00009-3375-02 $76.86 $76.86 50 mL $54.57 $76.86 $76.86 $54.57 $73.79 $72.25 $73.02 $75.32 NITROGLYCERIN 25MG/250ML IV BOTTLE [THAY] J3490 00338-1047-02 $77.16 $77.16 250 mL $54.78 $77.16 $77.16 $54.78 $74.07 $72.53 $73.30 $75.61 DOXYCYCLINE 100MG VIAL [THAY] J3490 63323-0130-11 $77.98 $77.98 1 EA $55.37 $77.98 $77.98 $55.37 $74.86 $73.30 $74.08 $76.42 LIDOCAINE/PRILOCAINE(EMLA)2.5% CRM [THAY] J3490 00168-0357-56 $78.37 $78.37 1 EA $55.64 $78.37 $78.37 $55.64 $75.24 $73.67 $74.45 $76.80 Rocuronium (Zemuron) 50MG/5ML VIAL [THAY] J3490 67457-0573-00 $79.17 $79.17 5 mL $56.21 $79.17 $79.17 $56.21 $76.00 $74.42 $75.21 $77.59 clindamycin 900 mg-5%/50 mL Sol[THAY] J3490 00009-9890-02 $86.15 $86.15 50 mL $61.16 $86.15 $86.15 $61.16 $82.70 $80.98 $81.84 $84.42 PREDNISOLONE ACET(ECONOPRED)1% OPTH [THAY] J3490 61314-0637-05 $86.98 $86.98 5 mL $61.76 $86.98 $86.98 $61.76 $83.50 $81.76 $82.63 $85.24 ETOMIDATE(AMIDATE)40MG/20ML ABOJECT [THAY] J3490 00409-8060-29 $88.21 $88.21 20 mL $62.63 $88.21 $88.21 $62.63 $84.68 $82.92 $83.80 $86.44 VERAPAMIL HCL (CALAN) 2.5MG/ML VIAL [THAY] J3490 00409-1144-05 $89.46 $89.46 2 mL $63.51 $89.46 $89.46 $63.51 $85.88 $84.09 $84.98 $87.67 LIDOCAINE(XYLOCAINE)1% PF 2ML VIAL [THAY]LIDOCAINE(XYLOCAINE)1% PF 2ML VIAL [THAY] J3490 63323-0492-27 $93.90 $93.90 30 mL $66.67 $93.90 $93.90 $66.67 $90.14 $88.26 $89.20 $92.02 TOBRAMYCIN/DEXAM(TOBRADEX)OPTH SUSP [THAY] J3490 24208-0295-25 $95.02 $95.02 2.5 drop(s) $67.46 $95.02 $95.02 $67.46 $91.22 $89.32 $90.27 $93.12 VERAPAMIL HCL (CALAN) 2.5MG/ML VIAL [THAY] J3490 51754-0204-04 $97.16 $97.16 2 mL $68.98 $97.16 $97.16 $68.98 $93.27 $91.33 $92.30 $95.22 SILVER SULFADIAZIN(SSD)1% 400GM CRM [THAY] J3490 43598-0210-40 $99.39 $99.39 400 app $70.57 $99.39 $99.39 $70.57 $95.41 $93.42 $94.42 $97.40 SILVER SULFADIAZIN(SSD)1% 400GM CRM [THAY]SILVER SULFADIAZIN(SSD)1% 400GM CRM [THAY] J3490 67877-0124-40 $101.43 $101.43 400 app $72.01 $101.43 $101.43 $72.01 $97.37 $95.34 $96.36 $99.40 ESOMEPRAZOLE (NEXIUM) 40MG VIAL [THAY] J3490 16729-0252-69 $103.76 $103.76 1 EA $73.67 $103.76 $103.76 $73.67 $99.61 $97.53 $98.57 $101.68 ESOMEPRAZOLE (NEXIUM) 40MG VIAL [THAY] J3490 67457-0392-99 $103.76 $103.76 1 EA $73.67 $103.76 $103.76 $73.67 $99.61 $97.53 $98.57 $101.68 dorzolamide-timolol ophthalmic 2.23%-0.68% Sol J3490 24208-0486-10 $105.24 $105.24 10 drop(s) $74.72 $105.24 $105.24 $74.72 $101.03 $98.92 $99.97 $103.13 FOLIC ACID 50MG/10ML VIAL [THAY] J3490 39822-1100-01 $107.50 $107.50 10 mL $76.33 $107.50 $107.50 $76.33 $103.20 $101.05 $102.13 $105.35 FOLIC ACID 50MG/10ML VIAL [THAY] J3490 $107.50 $107.50 $76.33 $107.50 $107.50 $76.33 $103.20 $101.05 $102.13 $105.35 acetic acid topical 5% Sol J3490 51552-0055-06 $109.27 $109.27 473 mL $77.58 $109.27 $109.27 $77.58 $104.90 $102.71 $103.81 $107.08 CLOTRIMAZOLE/BETAMETHASONE(LOTRISONE)45GM [THAY] J3490 66993-0898-45 $114.44 $114.44 45 app $81.26 $114.44 $114.44 $81.26 $109.87 $107.58 $108.72 $112.16 FLUTICASONE PROP(FLONASE)NASAL SPRY [THAY] J3490 00054-3270-99 $116.91 $116.91 16 spray(s) $83.00 $116.91 $116.91 $83.00 $112.23 $109.89 $111.06 $114.57 INTRALIPID 20% 250ML [THAY] J3490 00338-0519-02 $118.15 $118.15 250 mL $83.89 $118.15 $118.15 $83.89 $113.42 $111.06 $112.24 $115.79 MAFENIDE ACET(SULFAMYLON)8.5% 57GM [THAY] J3490 51079-0623-81 $119.27 $119.27 60 app $84.68 $119.27 $119.27 $84.68 $114.50 $112.11 $113.31 $116.88 trypan blue ophthalmic 0.06% Sol (Vision Blue) [THAY] J3490 68803-0612-10 $124.00 $124.00 1 mL $88.04 $124.00 $124.00 $88.04 $119.04 $116.56 $117.80 $121.52 ePHEDrine SULFATE 50MG/ML AMP [THAY] J3490 17478-0515-00 $125.55 $125.55 1 mL $89.14 $125.55 $125.55 $89.14 $120.53 $118.02 $119.27 $123.04 ESOMEPRAZOLE (NEXIUM) 40MG VIAL [THAY] J3490 00186-6040-01 $127.16 $127.16 1 EA $90.28 $127.16 $127.16 $90.28 $122.07 $119.53 $120.80 $124.61 parenteral nutrition solution w/electrolytes Amino Acids 2.75% with 5% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol J3490 00338-1142-03 $127.42 $127.42 1000 mL $90.47 $127.42 $127.42 $90.47 $122.32 $119.77 $121.05 $124.87 FOLIC ACID 50MG/10ML VIAL [THAY] J3490 63323-0184-10 $128.28 $128.28 10 mL $91.08 $128.28 $128.28 $91.08 $123.15 $120.58 $121.87 $125.71 parenteral nutrition solution w/electrolytes Amino Acids 5% with 15% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol J3490 00338-1147-03 $129.16 $129.16 1000 mL $91.70 $129.16 $129.16 $91.70 $123.99 $121.41 $122.70 $126.58 PROCTOZONE-HC (ANUSOL-HC) 2.5% 30G CREAM [THAY] J3490 69315-0312-28 $131.58 $131.58 28.35 app $93.42 $131.58 $131.58 $93.42 $126.31 $123.68 $125.00 $128.94 FLUTICASONE PROP(FLONASE)NASAL SPRY [THAY] J3490 60505-0829-01 $131.89 $131.89 16 spray(s) $93.64 $131.89 $131.89 $93.64 $126.61 $123.98 $125.30 $129.25 INTRALIPID 20% 250ML [THAY] J3490 00338-0519-09 $133.78 $133.78 250 mL $94.98 $133.78 $133.78 $94.98 $128.42 $125.75 $127.09 $131.10 PROCTOZONE-HC (ANUSOL-HC) 2.5% 30G CREAM [THAY] J3490 10631-0407-01 $134.99 $134.99 28.35 app $95.85 $134.99 $134.99 $95.85 $129.60 $126.90 $128.25 $132.29 PENICLILLIN G SODIUM 5000000UN VIAL [THAY] J3490 00781-6153-95 $135.20 $135.20 1 EA $95.99 $135.20 $135.20 $95.99 $129.79 $127.08 $128.44 $132.49 ESOMEPRAZOLE (NEXIUM) 40MG VIAL [THAY] J3490 55150-0185-05 $140.00 $140.00 1 EA $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 LATANOPROST(XALATAN)0.005% OPTH SOL [THAY] J3490 61314-0547-01 $146.50 $146.50 2.5 drop(s) $104.02 $146.50 $146.50 $104.02 $140.64 $137.71 $139.18 $143.57 PILOCARPINE(PILOPINE HS)4% OPTH GEL [THAY] J3490 00065-0215-35 $147.46 $147.46 4 app $104.70 $147.46 $147.46 $104.70 $141.56 $138.61 $140.09 $144.51 THP Promethazine 25mg SUPP #4 [THAY] J3490 99999-9999-72 $148.64 $148.64 1 EA $105.53 $148.64 $148.64 $105.53 $142.69 $139.72 $141.21 $145.67 PILOCARPINE(ISOPTO CARPINE) 2% OPTH SOLN [THAY] J3490 61314-0204-15 $155.22 $155.22 15 mL $110.20 $155.22 $155.22 $110.20 $149.01 $145.90 $147.45 $152.11 PHENYLEPHRINE(AK-DIALATE)2.5% OPTH [THAY] J3490 42702-0102-15 $166.00 $166.00 15 mL $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 PHENYLEPHRINE(AK-DIALATE)2.5% OPTH [THAY] J3490 17478-0201-15 $172.75 $172.75 15 mL $122.65 $172.75 $172.75 $122.65 $165.84 $162.39 $164.11 $169.30 fluticasone nasal 1 EA Spray J3490 99999-9999-65 $179.25 $179.25 1 EA $127.27 $179.25 $179.25 $127.27 $172.08 $168.49 $170.29 $175.66 CALCITONIN SALMON(MIACALCIN)200UN NASAL [THAY] J3490 49884-0161-11 $181.81 $181.81 3.7 spray(s) $129.09 $181.81 $181.81 $129.09 $174.54 $170.90 $172.72 $178.17 ACETYLCHOLINE (MIOCHOL-E) 1% [THAY] J3490 24208-0539-20 $182.02 $182.02 1 EA $129.23 $182.02 $182.02 $129.23 $174.74 $171.10 $172.92 $178.38 THP Neo/Poly/HC Otic SUSP #1 [THAY] J3490 99999-9999-69 $207.14 $207.14 1 EA $147.07 $207.14 $207.14 $147.07 $198.85 $194.71 $196.78 $202.99 OFLOXACIN (OCUFLOX) 0.3% OPTH SOLN [THAY] J3490 64980-0515-01 $207.49 $207.49 10 drop(s) $147.32 $207.49 $207.49 $147.32 $199.19 $195.04 $197.12 $203.34 CLINIMIX E 2000ML IV BAG [THAY] J3490 00338-1119-04 $213.28 $213.28 2000 mL $151.43 $213.28 $213.28 $151.43 $204.75 $200.48 $202.62 $209.01 parenteral nutrition solution w/electrolytes Amino Acids 5% with 15% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol J3490 00338-1123-04 $214.60 $214.60 2000 mL $152.37 $214.60 $214.60 $152.37 $206.02 $201.72 $203.87 $210.31 METRONIDAZOLE(METROGEL)0.75% VAG [THAY] J3490 00781-7077-87 $233.25 $233.25 70 app $165.60 $233.25 $233.25 $165.60 $223.92 $219.25 $221.58 $228.58 ofloxacin otic 0.3% Sol J3490 60505-0363-01 $235.42 $235.42 5 mL $167.15 $235.42 $235.42 $167.15 $226.00 $221.29 $223.65 $230.71 MAFENIDE TOPICAL (SULFAMYLON) 5% REC POWDER [THAY] J3490 49884-0902-78 $245.18 $245.18 1 packet(s) $174.08 $245.18 $245.18 $174.08 $235.37 $230.47 $232.92 $240.28 SUGAMMADEX (BRIDION)100MG/ML 2 ML VIAL [THAY] J3490 00006-5423-12 $259.38 $259.38 2 mL $184.16 $259.38 $259.38 $184.16 $249.00 $243.81 $246.41 $254.19 NEOMY-POLY-HC(CORTISPORIN)OTIC SUSP [THAY] J3490 24208-0635-62 $259.98 $259.98 10 drop(s) $184.58 $259.98 $259.98 $184.58 $249.58 $244.38 $246.98 $254.78 BRIMONIDINE (ALPHAGAN P) 0.15% OPTH [THAY] J3490 61314-0144-05 $266.82 $266.82 5 drop(s) $189.44 $266.82 $266.82 $189.44 $256.14 $250.81 $253.47 $261.48 BRIMONIDINE (ALPHAGAN P) 0.15% OPTH [THAY] J3490 00023-9177-05 $310.98 $310.98 5 drop(s) $220.79 $310.98 $310.98 $220.79 $298.54 $292.32 $295.43 $304.76 TRAVOPROST (TRAVATAN Z) 0.004% OPTH [THAY] J3490 00781-6185-56 $314.28 $314.28 2.5 drop(s) $223.14 $314.28 $314.28 $223.14 $301.70 $295.42 $298.56 $307.99 TRAVOPROST (TRAVATAN Z) 0.004% OPTH [THAY] J3490 00065-0260-25 $334.96 $334.96 2.5 drop(s) $237.82 $334.96 $334.96 $237.82 $321.56 $314.86 $318.21 $328.26 COCAINE 4% SOLN 4ML [THAY] J3490 00527-1728-74 $338.68 $338.68 4 mL $240.46 $338.68 $338.68 $240.46 $325.13 $318.36 $321.75 $331.91 EPINEPHRINE HCL (ADRENALIN) 0.1% TOP [THAY] J3490 42023-0103-01 $379.85 $379.85 30 app $269.70 $379.85 $379.85 $269.70 $364.66 $357.06 $360.86 $372.26 TOBRAMYCIN (TOBREX) 0.3% OPTH OINT [THAY] J3490 00065-0644-35 $389.85 $389.85 3.5 app $276.79 $389.85 $389.85 $276.79 $374.25 $366.45 $370.35 $382.05 collagenase topical 250 units/g Oin J3490 50484-0010-30 $430.60 $430.60 30 app $305.73 $430.60 $430.60 $305.73 $413.38 $404.76 $409.07 $421.99 VASOPRESSIN(PITRESSIN)20UN/ML VIAL [THAY] J3490 42023-0164-25 $451.50 $451.50 1 mL $320.56 $451.50 $451.50 $320.56 $433.44 $424.41 $428.92 $442.47 NITROGLYCERIN 0.4MG/SPRAY 4.9GM EA [THAY] J3490 45802-0210-01 $452.44 $452.44 4.9 spray(s) $321.23 $452.44 $452.44 $321.23 $434.34 $425.29 $429.82 $443.39 NITROGLYCERIN 0.4MG/SPRAY 4.9GM EA [THAY] J3490 70003-0300-65 $452.44 $452.44 4.9 spray(s) $321.23 $452.44 $452.44 $321.23 $434.34 $425.29 $429.82 $443.39 DIAZEPAM(DIASTAT PEDIATRIC)2.5MG RECTAL [THAY] J3490 68682-0650-20 $464.35 $464.35 1 EA $329.69 $464.35 $464.35 $329.69 $445.78 $436.49 $441.13 $455.06 DIAZEPAM(DIASTAT PEDIATRIC)2.5MG RECTAL [THAY] J3490 66490-0650-20 $525.79 $525.79 1 EA $373.31 $525.79 $525.79 $373.31 $504.76 $494.24 $499.50 $515.27 NITROGLYCERIN 0.4MG/SPRAY 4.9GM EA [THAY] J3490 70007-0300-65 $663.74 $663.74 4.9 spray(s) $471.26 $663.74 $663.74 $471.26 $637.19 $623.92 $630.55 $650.47 CARBOPROST (HEMABATE) 250MCG/ML AMP [THAY] J3490 00009-0856-08 $870.64 $870.64 1 mL $618.15 $870.64 $870.64 $618.15 $835.81 $818.40 $827.11 $853.23 DANTROLENE SODIUM (RYANODEX) 250MG VIAL [THAY] J3490 42367-0540-32 "$4,575.43 " "$4,575.43 " 1 - "$3,248.56 " "$4,575.43 " "$4,575.43 " "$3,248.56 " "$4,392.41 " "$4,300.91 " "$4,346.66 " "$4,483.92 " ALBUTEROL(VENTOLIN HFA)90MCG INHAL [THAY] J3535 00173-0682-21 $50.75 $50.75 8 puff(s) $36.03 $50.75 $50.75 $36.03 $48.72 $47.70 $48.21 $49.73 ALBUTEROL(VENTOLIN HFA)90MCG INHAL [THAY] J3535 00173-0682-24 $56.94 $56.94 8 puff(s) $40.43 $56.94 $56.94 $40.43 $54.66 $53.52 $54.09 $55.80 THP Albuterol 60 Doses/8gm MDI #1 [THAY] J3535 99999-9999-52 $60.82 $60.82 1 EA $43.18 $60.82 $60.82 $43.18 $58.39 $57.17 $57.78 $59.60 ALBUTEROL(VENTOLIN HFA)90MCG INHAL [THAY] J3535 00093-3174-31 $108.50 $108.50 8 puff(s) $77.03 $108.50 $108.50 $77.03 $104.16 $101.99 $103.07 $106.33 ALBUTEROL(VENTOLIN HFA)90MCG INHAL [THAY] J3535 59310-0579-22 $114.00 $114.00 8 puff(s) $80.94 $114.00 $114.00 $80.94 $109.44 $107.16 $108.30 $111.72 fluticasone-vilanterol 100 mcg-25 mcg/inh Pow J3535 00173-0859-14 $125.79 $125.79 14 puff(s) $89.31 $125.79 $125.79 $89.31 $120.75 $118.24 $119.50 $123.27 fluticasone-vilanterol 200 mcg-25 mcg/inh Pow J3535 00173-0882-14 $125.79 $125.79 14 puff(s) $89.31 $125.79 $125.79 $89.31 $120.75 $118.24 $119.50 $123.27 UMECLIDINIUM (INCRUSE) 62.5 MCG/INH [THAY] J3535 00173-0873-06 $131.33 $131.33 7 inh $93.25 $131.33 $131.33 $93.25 $126.08 $123.45 $124.77 $128.71 ALBUTEROL(VENTOLIN HFA)90MCG INHAL [THAY] J3535 00254-1007-52 $136.57 $136.57 8 puff(s) $96.97 $136.57 $136.57 $96.97 $131.11 $128.38 $129.74 $133.84 SODIUM CHLORIDE 0.9% 1000ML IV BAG [THAY] J7030 00264-7800-00 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 SODIUM CHLORIDE 0.9% 1000ML IV BAG [THAY] J7030 00338-0049-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 SODIUM CHLORIDE 0.9% 1000ML IV BAG [THAY] J7030 00409-7983-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 SODIUM CHLORIDE 0.9% 50ML IV BAG [THAY] J7040 00338-0049-11 $40.00 $40.00 50 mL $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 SODIUM CHLORIDE 0.9% 100ML IV BAG [THAY] J7040 00338-0049-18 $40.00 $40.00 100 mL $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 SODIUM CHLORIDE 0.9% 100ML IV BAG [THAY] J7040 00338-0049-38 $40.00 $40.00 100 mL $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 SODIUM CHLORIDE 0.9% 50ML IV BAG [THAY] J7040 00338-0049-41 $40.00 $40.00 50 mL $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 SODIUM CHLORIDE 0.9% 100ML MINI-BAG [THAY] J7040 00338-0553-18 $40.00 $40.00 100 mL $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 SODIUM CHLORIDE 0.9% 100ML IV BAG [THAY] J7040 00409-7984-23 $40.00 $40.00 100 mL $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 SODIUM CHLORIDE 0.9% 500ML IV BAG [THAY] J7040 00264-7800-10 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 SODIUM CHLORIDE 0.9% 500ML IV BAG [THAY] J7040 00338-0049-03 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 SODIUM CHLORIDE 0.9% 500ML IV BAG [THAY] J7040 00409-7983-03 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 DEXTROSE 5% / 0.9% NS 1000ML IV BAG [THAY] J7042 00409-7941-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 SODIUM CHLORIDE 0.9% 250ML IV BAG [THAY] J7050 00264-7800-20 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 SODIUM CHLORIDE 0.9% 250ML IV BAG [THAY] J7050 00338-0049-02 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 SODIUM CHLORIDE 0.9% 250ML IV BAG [THAY] J7050 00409-7983-02 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 SODIUM CHLORIDE 0.9% 250ML IV BAG [THAY] J7050 00409-7983-53 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 SODIUM CHLORIDE 0.9% 250ML IV BAG [THAY] J7050 63323-0623-74 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 SODIUM CHLORIDE 0.9% 250ML IV BAG [THAY] J7050 63323-0623-75 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 DEXTROSE 5% 100ML IV BAG [THAY] J7060 00264-1510-32 $40.00 $40.00 100 mL $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 DEXTROSE 5% 250ML IV BAG [THAY] J7060 00409-7922-02 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 DEXTROSE 5% 250ML IV BAG [THAY] J7060 00409-7922-53 $50.00 $50.00 250 mL $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 DEXTROSE 5% 500ML IV BAG [THAY] J7060 00338-0017-03 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 DEXTROSE 5% 500ML IV BAG [THAY] J7060 00409-7922-03 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 parenteral nutrition solution Dextrose 10% in Water Sol J7060 63323-0824-75 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 DEXTROSE 5% 100ML IV BAG [THAY] J7060 00338-0017-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 LACTATED RINGERS 500ML IV BAG [THAY] J7120 00409-7953-03 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 LACTATED RINGERS 1000ML IV BAG [THAY] J7120 00264-7750-00 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 LACTATED RINGERS 1000ML IV BAG [THAY] J7120 00338-0117-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 DEXTROSE 5% / LACTATED RINGERS 1000ML IV [THAY] J7120 00338-0125-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 DEXTROSE 5% / LACTATED RINGERS 1000ML IV [THAY] J7120 00409-7929-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 LACTATED RINGERS 1000ML IV BAG [THAY] J7120 00409-7953-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 SODIUM CHLORIDE 0.3% 500ML IV BAG [THAY] J7131 00338-0054-03 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 SODIUM CHLORIDE 0.3% 500ML IV BAG [THAY] J7131 63323-0530-75 $75.00 $75.00 500 mL $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 "J7298 Levonorgestrel-Releasing Intrauterine Contraceptive System, 52 Mg, 5 Year" J7298 "$1,266.00 " "$1,266.00 " $898.86 "$1,266.00 " "$1,266.00 " $898.86 "$1,215.36 " "$1,190.04 " "$1,202.70 " "$1,240.68 " IUD MIRENA 52MG [THAY] J7298 50419-0421-01 "$1,487.39 " "$1,487.39 " 1 EA "$1,056.05 " "$1,487.39 " "$1,487.39 " "$1,056.05 " "$1,427.90 " "$1,398.15 " "$1,413.02 " "$1,457.65 " Intrauterine Copper Contraceptive Charge J7300 $783.00 $783.00 $555.93 $783.00 $783.00 $555.93 $751.68 $736.02 $743.85 $767.34 IUD CONTRAC PARAGARD J7300 $783.00 $- $- $- $- $- $- $- $- Etonogestrel Implant (Implanon) J7307 "$1,164.00 " "$1,164.00 " $826.44 "$1,164.00 " "$1,164.00 " $826.44 "$1,117.44 " "$1,094.16 " "$1,105.80 " "$1,140.72 " ETONOGESTREL (NEXPLANON) IMPLANT [THAY] J7307 00052-0274-01 "$1,703.30 " "$1,703.30 " 1 EA "$1,209.34 " "$1,703.30 " "$1,703.30 " "$1,209.34 " "$1,635.17 " "$1,601.10 " "$1,618.14 " "$1,669.23 " ETONOGESTREL (NEXPLANON) IMPLANT [THAY] J7307 00052-4330-01 "$1,927.03 " "$1,927.03 " 1 EA "$1,368.19 " "$1,927.03 " "$1,927.03 " "$1,368.19 " "$1,849.94 " "$1,811.40 " "$1,830.67 " "$1,888.49 " SODIUM HYALURONATE (DUROLANE) 60MG/3ML SYR [THAY] J7318 89130-2020-01 "$2,009.00 " "$2,009.00 " 3 mL "$1,426.39 " "$2,009.00 " "$2,009.00 " "$1,426.39 " "$1,928.64 " "$1,888.46 " "$1,908.55 " "$1,968.82 " SODIUM HYALURONATE (GEL-ONE) 30MG/3ML INJ [THAY] J7321 87541-0300-91 "$2,264.00 " "$2,264.00 " 3 mL "$1,607.44 " "$2,264.00 " "$2,264.00 " "$1,607.44 " "$2,173.44 " "$2,128.16 " "$2,150.80 " "$2,218.72 " Euflexxa Inj per Dose J7323 $578.00 $578.00 $410.38 $578.00 $578.00 $410.38 $554.88 $543.32 $549.10 $566.44 SOD HYALURONATE (EUFLEXXA) 20MG/2ML [THAY] J7323 55566-4100-01 $835.83 $835.83 2 mL $593.44 $835.83 $835.83 $593.44 $802.39 $785.68 $794.04 $819.11 hyaluronan 30 mg/2 mL Sol J7324 59676-0360-01 "$1,167.20 " "$1,167.20 " 2 mL $828.71 "$1,167.20 " "$1,167.20 " $828.71 "$1,120.51 " "$1,097.17 " "$1,108.84 " "$1,143.86 " hylan G-F 20 48 mg/6 mL Sol J7325 58468-0090-03 "$2,649.66 " "$2,649.66 " 6 mL "$1,881.26 " "$2,649.66 " "$2,649.66 " "$1,881.26 " "$2,543.68 " "$2,490.68 " "$2,517.18 " "$2,596.67 " HYALURONAN (MONOVISC) INJ SYR [THAY] J7327 59676-0820-01 "$2,900.00 " "$2,900.00 " 4 mL "$2,059.00 " "$2,900.00 " "$2,900.00 " "$2,059.00 " "$2,784.00 " "$2,726.00 " "$2,755.00 " "$2,842.00 " METHYLPREDNISOLONE 4MG DOSE PACK [THAY] J7509 59762-4440-02 $63.54 $63.54 21 tab(s) $45.11 $63.54 $63.54 $45.11 $61.00 $59.73 $60.36 $62.27 METHYLPREDNISOLONE 4MG DOSE PACK [THAY] J7509 59746-0001-03 $72.78 $72.78 21 tab(s) $51.67 $72.78 $72.78 $51.67 $69.87 $68.41 $69.14 $71.32 PREDNISOLONE (PEDIAPRED) 5MG/5ML [THAY] J7510 50383-0040-04 $196.41 $196.41 118 mL $139.45 $196.41 $196.41 $139.45 $188.55 $184.63 $186.59 $192.48 PREDNISOLONE (PEDIAPRED) 5MG/5ML [THAY] J7510 13925-0166-04 $196.53 $196.53 118 mL $139.54 $196.53 $196.53 $139.54 $188.67 $184.74 $186.70 $192.60 PREDNISONE (DELTASONE) 5MG TAB [THAY] J7512 63739-0518-10 $3.91 $3.91 1 tab(s) $2.78 $3.91 $3.91 $2.78 $3.76 $3.68 $3.72 $3.84 PREDNISONE (DELTASONE) 10MG TAB [THAY] J7512 60687-0134-01 $3.92 $3.92 1 tab(s) $2.79 $3.92 $3.92 $2.79 $3.77 $3.69 $3.73 $3.85 PREDNISONE (DELTASONE) 10MG TAB [THAY] J7512 63739-0519-10 $3.96 $3.96 1 tab(s) $2.81 $3.96 $3.96 $2.81 $3.80 $3.72 $3.76 $3.88 PREDNISONE (DELTASONE) 5MG TAB [THAY] J7512 00054-8724-25 $4.00 $4.00 1 tab(s) $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 PREDNISONE (DELTASONE) 10MG TAB [THAY] J7512 00054-0017-20 $4.03 $4.03 1 tab(s) $2.86 $4.03 $4.03 $2.86 $3.87 $3.79 $3.83 $3.95 PREDNISONE (DELTASONE) 1MG TAB [THAY] J7512 00054-8739-25 $4.06 $4.06 1 tab(s) $2.88 $4.06 $4.06 $2.88 $3.89 $3.81 $3.85 $3.98 ARFORMOTEROL (BROVANA) 15MCG/2ML NEB [THAY] J7605 63402-0911-30 $45.18 $45.18 2 mL $32.08 $45.18 $45.18 $32.08 $43.38 $42.47 $42.92 $44.28 ACETYLCYSTEINE(MUCOMYST)10% 4ML INH VIAL [THAY] J7608 00517-7504-25 $23.92 $23.92 4 mL $16.99 $23.92 $23.92 $16.99 $22.97 $22.49 $22.73 $23.45 acetylcysteine 10% Sol J7608 63323-0695-04 $28.55 $28.55 4 mL $20.27 $28.55 $28.55 $20.27 $27.41 $26.84 $27.12 $27.98 ACETYLCYSTEINE(MUCOMYST)20% 30ML INH VIAL [THAY] J7608 00409-3308-03 $28.55 $28.55 30 mL $20.27 $28.55 $28.55 $20.27 $27.41 $26.84 $27.13 $27.98 acetylcysteine 20% Sol J7608 63323-0694-04 $34.70 $34.70 4 mL $24.63 $34.70 $34.70 $24.63 $33.31 $32.61 $32.96 $34.00 ACETYLCYSTEINE(MUCOMYST)20% 30ML INH VIAL [THAY] J7608 63323-0690-30 $54.01 $54.01 30 mL $38.35 $54.01 $54.01 $38.35 $51.85 $50.77 $51.31 $52.93 ALBUTEROL(VENTOLIN)2.5MG/3ML INHAL [THAY] J7613 60687-0395-83 $4.49 $4.49 3 mL $3.19 $4.49 $4.49 $3.19 $4.31 $4.22 $4.27 $4.40 ALBUTEROL(VENTOLIN)2.5MG/3ML INHAL [THAY] J7613 00487-9501-01 $5.60 $5.60 3 mL $3.98 $5.60 $5.60 $3.98 $5.38 $5.26 $5.32 $5.49 ALBUTEROL(ACCUNEB)1.25MG/3ML INHAL [THAY] J7613 00487-9904-01 $7.32 $7.32 3 mL $5.20 $7.32 $7.32 $5.20 $7.03 $6.88 $6.95 $7.17 THP Albuterol 2.5mg/3mL (0.083%) NEB #6 [THAY] J7613 99999-9999-51 $10.20 $10.20 1 EA $7.24 $10.20 $10.20 $7.24 $9.79 $9.59 $9.69 $10.00 LEVALBUTEROL(XOPENEX)1.25MG/3ML NEB [THAY] J7614 66993-0023-27 $17.40 $17.40 3 mL $12.35 $17.40 $17.40 $12.35 $16.70 $16.36 $16.53 $17.05 LEVALBUTEROL(XOPENEX)1.25MG/3ML NEB [THAY] J7614 00093-4148-64 $17.41 $17.41 3 mL $12.36 $17.41 $17.41 $12.36 $16.71 $16.37 $16.54 $17.06 IPRATROPIUM/ALBUTEROL(DUONEB)INHAL [THAY] J7620 00487-0201-03 $8.38 $8.38 3 mL $5.95 $8.38 $8.38 $5.95 $8.05 $7.88 $7.96 $8.21 IPRATROPIUM/ALBUTEROL(DUONEB)INHAL [THAY] J7620 00487-0201-01 $8.42 $8.42 3 mL $5.98 $8.42 $8.42 $5.98 $8.08 $7.91 $8.00 $8.25 BUDESONIDE(PULMICORT)0.5MG/2ML NEB [THAY] J7626 00093-6816-73 $26.16 $26.16 2 mL $18.57 $26.16 $26.16 $18.57 $25.11 $24.59 $24.85 $25.63 BUDESONIDE(PULMICORT)0.5MG/2ML NEB [THAY] J7626 00487-9701-01 $26.33 $26.33 2 mL $18.70 $26.33 $26.33 $18.70 $25.28 $24.75 $25.01 $25.80 BUDESONIDE(PULMICORT)0.5MG/2ML NEB [THAY] J7626 00186-1989-04 $28.62 $28.62 2 mL $20.32 $28.62 $28.62 $20.32 $27.47 $26.90 $27.19 $28.04 IPRATROPIUM BROMIDE 0.02% INHAL SOL [THAY] J7644 00487-9801-01 $6.64 $6.64 2.5 mL $4.71 $6.64 $6.64 $4.71 $6.37 $6.24 $6.31 $6.51 ACETAMINOPHEN (TYLENOL) 325MG TAB [THAY] J8499 00536-3222-01 $3.58 $3.58 1 tab(s) $2.54 $3.58 $3.58 $2.54 $3.44 $3.37 $3.40 $3.51 ALPRAZolam 0.25 mg TabALPRAZOLAM (XANAX) 0.25MG TAB [THAY] J8499 65862-0676-01 $3.61 $3.61 1 tab(s) $2.56 $3.61 $3.61 $2.56 $3.46 $3.39 $3.43 $3.53 ACETAMINOPHEN (TYLENOL) 325MG TAB [THAY] J8499 63739-0440-01 $3.63 $3.63 1 tab(s) $2.57 $3.63 $3.63 $2.57 $3.48 $3.41 $3.44 $3.55 LISINOPRIL (ZESTRIL) 10MG TAB [THAY] J8499 00904-6798-61 $3.63 $3.63 1 tab(s) $2.58 $3.63 $3.63 $2.58 $3.48 $3.41 $3.45 $3.56 ACETAMINOPHEN (TYLENOL) 325MG TAB [THAY] J8499 00904-1982-61 $3.63 $3.63 1 tab(s) $2.58 $3.63 $3.63 $2.58 $3.49 $3.41 $3.45 $3.56 IBUPROFEN (MOTRIN) 400MG TAB [THAY] J8499 63739-0672-10 $3.65 $3.65 1 tab(s) $2.59 $3.65 $3.65 $2.59 $3.50 $3.43 $3.47 $3.58 METFORMIN HCL(GLUCOPHAGE)500MG TAB [THAY] J8499 00904-6689-61 $3.65 $3.65 1 tab(s) $2.59 $3.65 $3.65 $2.59 $3.51 $3.43 $3.47 $3.58 METFORMIN HCL(GLUCOPHAGE)500MG TAB [THAY] J8499 63739-0640-10 $3.66 $3.66 1 tab(s) $2.60 $3.66 $3.66 $2.60 $3.52 $3.44 $3.48 $3.59 HYDROCHLOROTHIAZIDE 25MG TAB [THAY] J8499 16729-0183-01 $3.67 $3.67 1 tab(s) $2.61 $3.67 $3.67 $2.61 $3.52 $3.45 $3.49 $3.60 TRAMADOL HCL (ULTRAM) 50MG TAB [THAY] J8499 63739-0671-10 $3.67 $3.67 1 tab(s) $2.61 $3.67 $3.67 $2.61 $3.53 $3.45 $3.49 $3.60 LORAZEPAM (ATIVAN) 0.5MG TAB [THAY] J8499 00904-6007-61 $3.68 $3.68 1 tab(s) $2.61 $3.68 $3.68 $2.61 $3.53 $3.46 $3.49 $3.60 LORazepam 0.5 mg Tab (THAY) J8499 63739-0499-10 $3.68 $3.68 1 tab(s) $2.61 $3.68 $3.68 $2.61 $3.53 $3.46 $3.50 $3.61 CYCLOBENZAPRINE (FLEXERIL) 10MG TAB [THAY] J8499 63739-0531-10 $3.69 $3.69 1 tab(s) $2.62 $3.69 $3.69 $2.62 $3.54 $3.47 $3.51 $3.62 FAMOTIDINE (PEPCID) 20MG TAB [THAY] J8499 63739-0645-10 $3.71 $3.71 1 tab(s) $2.63 $3.71 $3.71 $2.63 $3.56 $3.48 $3.52 $3.63 zolpidem 5 mg Tab (THAY) J8499 00904-6082-61 $3.71 $3.71 1 tab(s) $2.63 $3.71 $3.71 $2.63 $3.56 $3.49 $3.52 $3.63 METOPROLOL TARTR(LOPRESSOR)25MG TAB [THAY] J8499 62584-0265-01 $3.72 $3.72 1 tab(s) $2.64 $3.72 $3.72 $2.64 $3.57 $3.49 $3.53 $3.64 GABAPENTIN (NEURONTIN) 100MG CAP [THAY] J8499 63739-0591-10 $3.72 $3.72 1 cap(s) $2.64 $3.72 $3.72 $2.64 $3.57 $3.49 $3.53 $3.64 furosemide 20 mg Tab J8499 00904-5796-61 $3.73 $3.73 1 tab(s) $2.65 $3.73 $3.73 $2.65 $3.58 $3.51 $3.55 $3.66 HydrALAZINE HCL(APRESOLINE)10MG TAB [THAY] J8499 00904-6440-61 $3.75 $3.75 1 tab(s) $2.66 $3.75 $3.75 $2.66 $3.60 $3.52 $3.56 $3.67 BENZTROPINE (COGENTIN) 0.5MG TAB [THAY] J8499 68084-0381-01 $3.75 $3.75 1 tab(s) $2.66 $3.75 $3.75 $2.66 $3.60 $3.53 $3.56 $3.68 HYDROCHLOROTHIAZIDE 25MG TAB [THAY] J8499 63739-0128-10 $3.75 $3.75 1 tab(s) $2.67 $3.75 $3.75 $2.67 $3.60 $3.53 $3.57 $3.68 FUROSEMIDE (LASIX) 40MG TAB [THAY] J8499 00904-5797-61 $3.77 $3.77 1 tab(s) $2.67 $3.77 $3.77 $2.67 $3.62 $3.54 $3.58 $3.69 METOCLOPRAMIDE HCL(REGLAN)5MG TAB [THAY] J8499 63739-0103-10 $3.77 $3.77 1 tab(s) $2.68 $3.77 $3.77 $2.68 $3.62 $3.55 $3.58 $3.70 METOPROLOL TARTR(LOPRESSOR)50MG TAB [THAY] J8499 62584-0266-01 $3.78 $3.78 1 tab(s) $2.68 $3.78 $3.78 $2.68 $3.62 $3.55 $3.59 $3.70 GABAPENTIN (NEURONTIN) 100MG CAP [THAY] J8499 00904-6665-61 $3.78 $3.78 1 cap(s) $2.68 $3.78 $3.78 $2.68 $3.63 $3.55 $3.59 $3.71 FUROSEMIDE (LASIX) 20MG TAB [THAY] J8499 51079-0072-20 $3.79 $3.79 1 tab(s) $2.69 $3.79 $3.79 $2.69 $3.64 $3.57 $3.60 $3.72 HYDROCHLOROTHIAZIDE 25MG TAB [THAY] J8499 68084-0086-01 $3.80 $3.80 1 tab(s) $2.70 $3.80 $3.80 $2.70 $3.64 $3.57 $3.61 $3.72 TRAZODONE HCL (DESYREL) 50MG TAB [THAY] J8499 00904-6868-61 $3.80 $3.80 1 tab(s) $2.70 $3.80 $3.80 $2.70 $3.64 $3.57 $3.61 $3.72 FAMOTIDINE (PEPCID) 20MG TAB [THAY] J8499 00904-5780-51 $3.80 $3.80 1 tab(s) $2.70 $3.80 $3.80 $2.70 $3.65 $3.57 $3.61 $3.72 LISINOPRIL (ZESTRIL) 10MG TAB [THAY] J8499 60687-0325-01 $3.80 $3.80 1 tab(s) $2.70 $3.80 $3.80 $2.70 $3.65 $3.57 $3.61 $3.72 DONEPEZIL (ARICEPT) 10MG TAB [THAY] J8499 00904-6478-61 $3.83 $3.83 1 tab(s) $2.72 $3.83 $3.83 $2.72 $3.67 $3.60 $3.64 $3.75 HYDRALAZINE HCL(APRESOLINE)50MG TAB [THAY] J8499 00904-6442-61 $3.83 $3.83 1 tab(s) $2.72 $3.83 $3.83 $2.72 $3.67 $3.60 $3.64 $3.75 FUROSEMIDE (LASIX) 40MG TAB [THAY] J8499 51079-0073-20 $3.84 $3.84 1 tab(s) $2.72 $3.84 $3.84 $2.72 $3.68 $3.61 $3.64 $3.76 dilTIAZem HCL (CARDIZEM) 30MG TAB [THAY] J8499 63739-0079-10 $3.86 $3.86 1 tab(s) $2.74 $3.86 $3.86 $2.74 $3.70 $3.62 $3.66 $3.78 FOLIC ACID 1MG TAB [THAY] J8499 62584-0897-01 $3.88 $3.88 1 tab(s) $2.75 $3.88 $3.88 $2.75 $3.72 $3.65 $3.69 $3.80 GABAPENTIN (NEURONTIN) 300MG CAP [THAY] J8499 00904-6666-61 $3.89 $3.89 1 cap(s) $2.76 $3.89 $3.89 $2.76 $3.74 $3.66 $3.70 $3.81 GABAPENTIN (NEURONTIN) 300MG CAP [THAY] J8499 63739-0236-10 $3.91 $3.91 1 cap(s) $2.77 $3.91 $3.91 $2.77 $3.75 $3.67 $3.71 $3.83 FUROSEMIDE (LASIX) 20MG TAB [THAY] J8499 51079-0072-19 $3.92 $3.92 1 tab(s) $2.78 $3.92 $3.92 $2.78 $3.76 $3.68 $3.72 $3.84 FUROSEMIDE (LASIX) 40MG TAB [THAY] J8499 51079-0073-19 $3.93 $3.93 1 tab(s) $2.79 $3.93 $3.93 $2.79 $3.77 $3.69 $3.73 $3.85 IBUPROFEN (MOTRIN) 400MG TAB [THAY] J8499 00904-5853-61 $3.93 $3.93 1 tab(s) $2.79 $3.93 $3.93 $2.79 $3.77 $3.70 $3.73 $3.85 SulfaSALAzine 500 mg (Azulfidine) Tab [THAY] J8499 59762-5000-02 $3.94 $3.94 1 EA $2.80 $3.94 $3.94 $2.80 $3.78 $3.70 $3.74 $3.86 cloNIDine 0.1 mg Tab (CATAPRESS) 0.1MG TAB [THAY] J8499 00904-5656-61 $3.97 $3.97 1 tab(s) $2.82 $3.97 $3.97 $2.82 $3.81 $3.73 $3.77 $3.89 cloNIDine 0.1 mg Tab (CATAPRESS) 0.1MG TAB [THAY] J8499 51079-0299-20 $3.97 $3.97 1 tab(s) $2.82 $3.97 $3.97 $2.82 $3.81 $3.73 $3.77 $3.89 DIVALPROEX SODIUM (DEPAKOTE DR) 250MG TAB [THAY] J8499 00904-6860-61 $3.98 $3.98 1 - $2.82 $3.98 $3.98 $2.82 $3.82 $3.74 $3.78 $3.90 METOPROLOL TARTR(LOPRESSOR)25MG TAB [THAY] J8499 51079-0255-20 $3.99 $3.99 1 tab(s) $2.83 $3.99 $3.99 $2.83 $3.83 $3.75 $3.79 $3.91 CIPROFLOXACIN HCL (CIPRO) 250MG TAB [THAY] J8499 63739-0700-10 $3.99 $3.99 1 tab(s) $2.83 $3.99 $3.99 $2.83 $3.83 $3.75 $3.79 $3.91 AMLODIPINE BESYLATE(NORVASC)5MG TAB [THAY] J8499 59762-1530-05 $3.99 $3.99 1 tab(s) $2.83 $3.99 $3.99 $2.83 $3.83 $3.75 $3.79 $3.91 NAPROXEN (NAPROSYN) 500MG TAB [THAY] J8499 63739-0403-10 $4.01 $4.01 1 tab(s) $2.85 $4.01 $4.01 $2.85 $3.85 $3.77 $3.81 $3.93 cloNIDine 0.1 mg Tab (CATAPRESS) 0.1MG TAB [THAY] J8499 00228-2127-10 $4.02 $4.02 1 tab(s) $2.85 $4.02 $4.02 $2.85 $3.86 $3.78 $3.82 $3.94 IBUPROFEN (MOTRIN) 400MG TAB [THAY] J8499 68084-0658-01 $4.02 $4.02 1 tab(s) $2.85 $4.02 $4.02 $2.85 $3.86 $3.78 $3.82 $3.94 ANTACID LIQUID (MAALOX) 18ML/FOR GI COCKTAIL ONLY [THAY] J8499 37205-0535-40 $4.04 $4.04 30 mL $2.87 $4.04 $4.04 $2.87 $3.88 $3.80 $3.84 $3.96 VENLAFAXINE (EFFEXOR) XR 37.5MG CAP [THAY] J8499 59762-0180-02 $4.05 $4.05 1 cap(s) $2.88 $4.05 $4.05 $2.88 $3.89 $3.81 $3.85 $3.97 METOPROLOL TARTR(LOPRESSOR)25MG TAB [THAY] J8499 00904-6340-61 $4.06 $4.06 1 tab(s) $2.88 $4.06 $4.06 $2.88 $3.90 $3.82 $3.86 $3.98 SULFAMETHOXAZOLE/TMP(BACTRIM DS) [THAY] J8499 68084-0230-01 $4.09 $4.09 1 tab(s) $2.90 $4.09 $4.09 $2.90 $3.92 $3.84 $3.88 $4.01 HYDROXYZINE HCL (ATARAX) 25MG TAB [THAY] J8499 00904-6617-61 $4.11 $4.11 1 tab(s) $2.92 $4.11 $4.11 $2.92 $3.94 $3.86 $3.90 $4.03 melatonin 5 mg Tab J8499 77333-0520-10 $4.12 $4.12 1 tab(s) $2.93 $4.12 $4.12 $2.93 $3.96 $3.88 $3.92 $4.04 MEDROXYPROGESTERO(PROVERA)2.5MG TAB [THAY] J8499 00555-0872-02 $4.13 $4.13 1 tab(s) $2.93 $4.13 $4.13 $2.93 $3.96 $3.88 $3.92 $4.04 MEDROXYPROGESTERO(PROVERA)2.5MG TAB [THAY] J8499 59762-3740-01 $4.13 $4.13 1 tab(s) $2.93 $4.13 $4.13 $2.93 $3.96 $3.88 $3.92 $4.04 PROPRANOLOL HCL (INDERAL) 10MG TAB [THAY] J8499 00904-0411-61 $4.14 $4.14 1 tab(s) $2.94 $4.14 $4.14 $2.94 $3.97 $3.89 $3.93 $4.05 DIAZEPAM (VALIUM) 5MG TAB [THAY] J8499 00904-5880-61 $4.14 $4.14 1 tab(s) $2.94 $4.14 $4.14 $2.94 $3.97 $3.89 $3.93 $4.06 DIAZEPAM (VALIUM) 5MG TAB [THAY] J8499 51079-0285-20 $4.14 $4.14 1 tab(s) $2.94 $4.14 $4.14 $2.94 $3.98 $3.89 $3.94 $4.06 HYDROXYZINE HCL (ATARAX) 25MG TAB [THAY] J8499 63739-0486-10 $4.15 $4.15 1 tab(s) $2.95 $4.15 $4.15 $2.95 $3.98 $3.90 $3.94 $4.07 QUETIAPINE FUMARATE(SEROQUEL)25MG TAB [THAY] J8499 00904-6638-61 $4.20 $4.20 1 tab(s) $2.98 $4.20 $4.20 $2.98 $4.03 $3.94 $3.99 $4.11 PROPRANOLOL HCL (INDERAL) 10MG TAB [THAY] J8499 00904-6550-61 $4.20 $4.20 1 tab(s) $2.98 $4.20 $4.20 $2.98 $4.04 $3.95 $3.99 $4.12 FOLIC ACID 1MG TAB [THAY] J8499 51079-0105-20 $4.22 $4.22 1 tab(s) $3.00 $4.22 $4.22 $3.00 $4.05 $3.97 $4.01 $4.14 ATORVASTATIN (LIPITOR) 10MG TAB [THAY] J8499 51079-0208-20 $4.24 $4.24 1 tab(s) $3.01 $4.24 $4.24 $3.01 $4.07 $3.98 $4.02 $4.15 SULFAMETHOXAZOLE/TMP(BACTRIM DS) [THAY]SULFAMETHOXAZOLE/TMP(BACTRIM DS) [THAY] J8499 00904-2725-61 $4.25 $4.25 1 tab(s) $3.01 $4.25 $4.25 $3.01 $4.08 $3.99 $4.03 $4.16 GLIPIZIDE (GLUCOTROL) 5MG TAB [THAY] J8499 51079-0810-20 $4.25 $4.25 1 tab(s) $3.02 $4.25 $4.25 $3.02 $4.08 $3.99 $4.04 $4.16 ALLOPURINOL (ZYLOPRIM) 100MG TAB [THAY] J8499 51079-0205-20 $4.25 $4.25 1 tab(s) $3.02 $4.25 $4.25 $3.02 $4.08 $4.00 $4.04 $4.17 SUCRALFATE (CARAFATE) 1GM TAB [THAY] J8499 51079-0753-20 $4.26 $4.26 1 tab(s) $3.02 $4.26 $4.26 $3.02 $4.09 $4.00 $4.05 $4.17 FAMOTIDINE (PEPCID) 20MG TAB [THAY] J8499 51079-0966-19 $4.27 $4.27 1 tab(s) $3.03 $4.27 $4.27 $3.03 $4.10 $4.02 $4.06 $4.19 OXYCODONE (ROXICODONE) 5MG TAB [THAY] J8499 00904-6966-61 $4.29 $4.29 1 tab(s) $3.04 $4.29 $4.29 $3.04 $4.12 $4.03 $4.07 $4.20 ALLOPURINOL (ZYLOPRIM) 100MG TAB [THAY] J8499 00904-6571-61 $4.29 $4.29 1 tab(s) $3.05 $4.29 $4.29 $3.05 $4.12 $4.04 $4.08 $4.21 GLIPIZIDE (GLUCOTROL) 5MG TAB [THAY] J8499 00904-6637-61 $4.30 $4.30 1 tab(s) $3.05 $4.30 $4.30 $3.05 $4.13 $4.04 $4.09 $4.22 INDOMETHACIN (INDOCIN) 25MG CAP [THAY] J8499 51079-0190-20 $4.30 $4.30 1 cap(s) $3.06 $4.30 $4.30 $3.06 $4.13 $4.05 $4.09 $4.22 SERTRALINE HCL (ZOLOFT) 50MG TAB [THAY] J8499 68084-0181-01 $4.30 $4.30 1 tab(s) $3.06 $4.30 $4.30 $3.06 $4.13 $4.05 $4.09 $4.22 PROPRANOLOL HCL (INDERAL) 10MG TAB [THAY] J8499 00603-5482-21 $4.32 $4.32 1 tab(s) $3.06 $4.32 $4.32 $3.06 $4.14 $4.06 $4.10 $4.23 METOCLOPRAMIDE HCL(REGLAN)5MG TAB [THAY] J8499 63739-0481-10 $4.33 $4.33 1 tab(s) $3.07 $4.33 $4.33 $3.07 $4.16 $4.07 $4.11 $4.24 HYDROCODONE/APAP (NORCO)5/325MG TAB [THAY]HYDROCODONE/APAP (NORCO)5/325MG TAB [THAY] J8499 00904-6567-61 $4.35 $4.35 1 tab(s) $3.09 $4.35 $4.35 $3.09 $4.18 $4.09 $4.13 $4.26 SPIRONOLACTONE (ALDACTONE) 25MG TAB [THAY] J8499 51079-0103-20 $4.36 $4.36 1 tab(s) $3.09 $4.36 $4.36 $3.09 $4.18 $4.09 $4.14 $4.27 INDOMETHACIN (INDOCIN) 25MG CAP [THAY] J8499 50268-0430-15 $4.36 $4.36 1 cap(s) $3.10 $4.36 $4.36 $3.10 $4.19 $4.10 $4.14 $4.27 AMOXICILLIN (AMOXIL) 500MG CAPS [THAY] J8499 00781-2613-01 $4.37 $4.37 1 cap(s) $3.10 $4.37 $4.37 $3.10 $4.19 $4.11 $4.15 $4.28 TRAZODONE HCL (DESYREL) 50MG TAB [THAY] J8499 00904-3990-61 $4.37 $4.37 1 tab(s) $3.10 $4.37 $4.37 $3.10 $4.20 $4.11 $4.15 $4.28 TRAZODONE HCL (DESYREL) 50MG TAB [THAY] J8499 00904-6554-61 $4.37 $4.37 1 tab(s) $3.10 $4.37 $4.37 $3.10 $4.20 $4.11 $4.15 $4.28 dilTIAZem HCL (CARDIZEM) 30MG TAB [THAY] J8499 51079-0745-20 $4.40 $4.40 1 tab(s) $3.12 $4.40 $4.40 $3.12 $4.22 $4.13 $4.18 $4.31 FUROSEMIDE (LASIX) 80MG TAB [THAY] J8499 51079-0527-20 $4.40 $4.40 1 tab(s) $3.12 $4.40 $4.40 $3.12 $4.22 $4.14 $4.18 $4.31 melatonin 5 mg Tab J8499 50268-0533-15 $4.44 $4.44 1 tab(s) $3.15 $4.44 $4.44 $3.15 $4.26 $4.17 $4.21 $4.35 SERTRALINE HCL (ZOLOFT) 50MG TAB [THAY] J8499 60687-0242-01 $4.48 $4.48 1 tab(s) $3.18 $4.48 $4.48 $3.18 $4.30 $4.21 $4.26 $4.39 ATORVASTATIN (LIPITOR) 10MG TAB [THAY] J8499 00904-6290-61 $4.50 $4.50 1 tab(s) $3.19 $4.50 $4.50 $3.19 $4.32 $4.23 $4.27 $4.41 LEVOTHYROXINE (SYNTROID) 88MCG TAB [THAY] J8499 00378-1807-01 $4.50 $4.50 1 tab(s) $3.20 $4.50 $4.50 $3.20 $4.32 $4.23 $4.28 $4.41 BACLOFEN (LIORESAL) 10MG TAB [THAY] J8499 00904-6475-61 $4.50 $4.50 1 tab(s) $3.20 $4.50 $4.50 $3.20 $4.32 $4.23 $4.28 $4.41 LISINOPRIL (ZESTRIL) 10MG TAB [THAY] J8499 00904-5808-61 $4.52 $4.52 1 tab(s) $3.21 $4.52 $4.52 $3.21 $4.34 $4.25 $4.29 $4.43 LISINOPRIL (ZESTRIL) 10MG TAB [THAY] J8499 00904-6485-61 $4.52 $4.52 1 tab(s) $3.21 $4.52 $4.52 $3.21 $4.34 $4.25 $4.29 $4.43 AMITRIPTYLINE HCL (ELAVIL) 25MG TAB [THAY] J8499 60687-0433-01 $4.53 $4.53 1 tab(s) $3.22 $4.53 $4.53 $3.22 $4.35 $4.26 $4.31 $4.44 GABAPENTIN (NEURONTIN) 100MG CAP [THAY] J8499 71093-0120-04 $4.56 $4.56 1 cap(s) $3.24 $4.56 $4.56 $3.24 $4.38 $4.29 $4.33 $4.47 BENZTROPINE (COGENTIN) 0.5MG TAB [THAY] J8499 00904-6788-61 $4.56 $4.56 1 tab(s) $3.24 $4.56 $4.56 $3.24 $4.38 $4.29 $4.33 $4.47 HydrALAZINE HCL(APRESOLINE)10MG TAB [THAY] J8499 68084-0447-01 $4.57 $4.57 1 tab(s) $3.24 $4.57 $4.57 $3.24 $4.38 $4.29 $4.34 $4.47 OXYCODONE (ROXICODONE) 5MG TAB [THAY] J8499 68084-0354-01 $4.58 $4.58 1 tab(s) $3.25 $4.58 $4.58 $3.25 $4.40 $4.31 $4.35 $4.49 LEVOTHYROXINE (SYNTHROID) 50MCG TAB [THAY] J8499 51079-0440-20 $4.59 $4.59 1 tab(s) $3.26 $4.59 $4.59 $3.26 $4.40 $4.31 $4.36 $4.49 ACETAMINOPHEN (TYLENOL) 325MG TAB [THAY] J8499 50580-0600-02 $4.60 $4.60 1 tab(s) $3.26 $4.60 $4.60 $3.26 $4.41 $4.32 $4.37 $4.50 OXYCODONE (ROXICODONE) 5MG TAB [THAY] J8499 00904-6444-61 $4.61 $4.61 1 tab(s) $3.27 $4.61 $4.61 $3.27 $4.42 $4.33 $4.38 $4.52 METRONIDAZOLE (FLAGYL) 250MG TAB [THAY] J8499 51079-0216-20 $4.61 $4.61 1 tab(s) $3.27 $4.61 $4.61 $3.27 $4.42 $4.33 $4.38 $4.52 BACLOFEN (LIORESAL) 10MG TAB [THAY] J8499 63739-0479-10 $4.61 $4.61 1 tab(s) $3.27 $4.61 $4.61 $3.27 $4.43 $4.33 $4.38 $4.52 SulfaSALAzine 500 mg (Azulfidine) Tab [THAY] J8499 50268-0730-15 $4.62 $4.62 1 EA $3.28 $4.62 $4.62 $3.28 $4.43 $4.34 $4.38 $4.52 LEVOTHYROXINE (SYNTHROID) 50MCG TAB [THAY] J8499 00904-6950-61 $4.63 $4.63 1 tab(s) $3.28 $4.63 $4.63 $3.28 $4.44 $4.35 $4.39 $4.53 HYDRALAZINE HCL(APRESOLINE)50MG TAB [THAY] J8499 23155-0003-01 $4.63 $4.63 1 tab(s) $3.28 $4.63 $4.63 $3.28 $4.44 $4.35 $4.39 $4.53 QUEtiapine FUMAR(SEROQUEL)100MG TAB [THAY] J8499 00904-6640-61 $4.63 $4.63 1 tab(s) $3.29 $4.63 $4.63 $3.29 $4.44 $4.35 $4.40 $4.54 LEVOTHYROXINE (SYNTHROID) 50MCG TAB [THAY] J8499 60687-0464-01 $4.63 $4.63 1 tab(s) $3.29 $4.63 $4.63 $3.29 $4.44 $4.35 $4.40 $4.54 METOPROLOL TARTR(LOPRESSOR)50MG TAB [THAY] J8499 51079-0801-20 $4.64 $4.64 1 tab(s) $3.30 $4.64 $4.64 $3.30 $4.46 $4.36 $4.41 $4.55 GABAPENTIN (NEURONTIN) 100MG CAP [THAY] J8499 68084-0783-01 $4.67 $4.67 1 cap(s) $3.31 $4.67 $4.67 $3.31 $4.48 $4.39 $4.43 $4.57 HYDROCODONE/APAP (NORCO)5/325MG TAB [THAY] J8499 00904-6419-61 $4.67 $4.67 1 tab(s) $3.32 $4.67 $4.67 $3.32 $4.49 $4.39 $4.44 $4.58 BENZTROPINE (COGENTIN) 0.5MG TAB [THAY] J8499 60687-0356-01 $4.68 $4.68 1 tab(s) $3.32 $4.68 $4.68 $3.32 $4.49 $4.40 $4.44 $4.58 AMIODARONE (PACERONE) 200MG TAB [THAY] J8499 00904-6556-61 $4.68 $4.68 1 tab(s) $3.32 $4.68 $4.68 $3.32 $4.50 $4.40 $4.45 $4.59 CARBIDOPA/LEVODOPA(SINEMET)25/100MG TAB [THAY] J8499 00904-6237-61 $4.69 $4.69 1 tab(s) $3.33 $4.69 $4.69 $3.33 $4.51 $4.41 $4.46 $4.60 DICYCLOMINE HCL (BENTYL) 10MG CAP [THAY] J8499 51079-0118-20 $4.69 $4.69 1 cap(s) $3.33 $4.69 $4.69 $3.33 $4.51 $4.41 $4.46 $4.60 LEVOTHYROXINE (SYNTROID) 88MCG TAB [THAY] J8499 42292-0038-20 $4.71 $4.71 1 tab(s) $3.35 $4.71 $4.71 $3.35 $4.52 $4.43 $4.48 $4.62 venlafaxine 37.5 mg ER J8499 00904-6468-61 $4.73 $4.73 1 cap(s) $3.36 $4.73 $4.73 $3.36 $4.54 $4.45 $4.50 $4.64 METOPROLOL TARTR(LOPRESSOR)50MG TAB [THAY] J8499 00904-6341-61 $4.77 $4.77 1 tab(s) $3.39 $4.77 $4.77 $3.39 $4.58 $4.48 $4.53 $4.67 ALPRAZOLAM (XANAX) 0.25MG TAB [THAY] J8499 00904-5858-61 $4.77 $4.77 1 tab(s) $3.39 $4.77 $4.77 $3.39 $4.58 $4.48 $4.53 $4.67 ALPRAZOLAM (XANAX) 0.25MG TAB [THAY] J8499 51079-0788-20 $4.77 $4.77 1 tab(s) $3.39 $4.77 $4.77 $3.39 $4.58 $4.48 $4.53 $4.68 AMITRIPTYLINE HCL (ELAVIL) 25MG TAB [THAY] J8499 00904-0201-61 $4.77 $4.77 1 tab(s) $3.39 $4.77 $4.77 $3.39 $4.58 $4.49 $4.53 $4.68 AMITRIPTYLINE HCL (ELAVIL) 25MG TAB [THAY] J8499 51079-0107-20 $4.77 $4.77 1 tab(s) $3.39 $4.77 $4.77 $3.39 $4.58 $4.49 $4.53 $4.68 GUAIFENESIN/CODEINE 100-10MG/5ML EA [THAY] J8499 00121-1775-05 $4.80 $4.80 5 mL $3.41 $4.80 $4.80 $3.41 $4.61 $4.51 $4.56 $4.70 DICYCLOMINE HCL (BENTYL) 10MG CAP [THAY] J8499 60687-0369-01 $4.82 $4.82 1 cap(s) $3.42 $4.82 $4.82 $3.42 $4.63 $4.53 $4.58 $4.72 LEVOTHYROXINE (SYNTHROID) 100MCG TAB [THAY] J8499 51079-0442-20 $4.83 $4.83 1 tab(s) $3.43 $4.83 $4.83 $3.43 $4.63 $4.54 $4.58 $4.73 ACETAMINOPHEN (TYLENOL) 650MG SUPP [THAY] J8499 45802-0730-30 $4.83 $4.83 1 supp $3.43 $4.83 $4.83 $3.43 $4.64 $4.54 $4.59 $4.74 HYDROCORTISONE (CORTEF) 10MG TAB [THAY] J8499 68084-0469-01 $4.84 $4.84 1 tab(s) $3.44 $4.84 $4.84 $3.44 $4.65 $4.55 $4.60 $4.74 CEPHALEXIN (KEFLEX) 250MG CAP [THAY] J8499 50268-0151-15 $4.86 $4.86 1 cap(s) $3.45 $4.86 $4.86 $3.45 $4.66 $4.56 $4.61 $4.76 potassium chloride 20 mEq ER J8499 00245-5319-01 $4.86 $4.86 1 tab(s) $3.45 $4.86 $4.86 $3.45 $4.67 $4.57 $4.62 $4.76 POTASSIUM CL (KLOR-CON)20MEQ TAB CR [THAY] J8499 66758-0190-13 $4.86 $4.86 1 tab(s) $3.45 $4.86 $4.86 $3.45 $4.67 $4.57 $4.62 $4.76 PHENYTOIN SOD ER(DILANTIN)100MG CAP [THAY] J8499 51079-0905-20 $4.86 $4.86 1 cap(s) $3.45 $4.86 $4.86 $3.45 $4.67 $4.57 $4.62 $4.76 CLINDAMYCIN (CLEOCIN) 150MG CAP [THAY] J8499 63739-0059-10 $4.87 $4.87 1 cap(s) $3.46 $4.87 $4.87 $3.46 $4.67 $4.58 $4.62 $4.77 ATORVASTATIN (LIPITOR) 10MG TAB [THAY] J8499 00904-6292-61 $4.88 $4.88 1 tab(s) $3.47 $4.88 $4.88 $3.47 $4.69 $4.59 $4.64 $4.78 CEPHALEXIN (KEFLEX) 250MG CAP [THAY] J8499 00093-3145-01 $4.89 $4.89 1 cap(s) $3.47 $4.89 $4.89 $3.47 $4.69 $4.59 $4.64 $4.79 ALPRAZOLAM (XANAX) 0.25MG TAB [THAY] J8499 67253-0900-10 $4.89 $4.89 1 tab(s) $3.47 $4.89 $4.89 $3.47 $4.69 $4.60 $4.65 $4.79 LORAZEPAM (ATIVAN) 0.5MG TAB [THAY] J8499 51079-0417-19 $4.89 $4.89 1 tab(s) $3.47 $4.89 $4.89 $3.47 $4.69 $4.60 $4.65 $4.79 LORAZEPAM (ATIVAN) 0.5MG TAB [THAY] J8499 51079-0417-20 $4.89 $4.89 1 tab(s) $3.47 $4.89 $4.89 $3.47 $4.69 $4.60 $4.65 $4.79 MECLIZINE HCL (ANTIVERT) 12.5MG TAB [THAY] J8499 50268-0522-15 $4.90 $4.90 1 tab(s) $3.48 $4.90 $4.90 $3.48 $4.70 $4.61 $4.65 $4.80 METFORMIN HCL(GLUCOPHAGE)500MG TAB [THAY] J8499 60687-0155-01 $4.90 $4.90 1 tab(s) $3.48 $4.90 $4.90 $3.48 $4.71 $4.61 $4.66 $4.80 METFORMIN HCL(GLUCOPHAGE)500MG TAB [THAY] J8499 62584-0259-01 $4.90 $4.90 1 tab(s) $3.48 $4.90 $4.90 $3.48 $4.71 $4.61 $4.66 $4.80 LEVOTHYROXINE (SYNTHROID) 100MCG TAB [THAY] J8499 00904-6953-61 $4.91 $4.91 1 tab(s) $3.48 $4.91 $4.91 $3.48 $4.71 $4.61 $4.66 $4.81 GUAIFENESIN/CODEINE 100-10MG/5ML EA [THAY] J8499 50383-0087-07 $4.91 $4.91 5 mL $3.49 $4.91 $4.91 $3.49 $4.71 $4.62 $4.66 $4.81 ACETAMINOPHEN (TYLENOL) 650MG SUPP [THAY] J8499 00713-0165-12 $4.91 $4.91 1 supp $3.49 $4.91 $4.91 $3.49 $4.72 $4.62 $4.67 $4.82 LEVOTHYROXINE (SYNTHROID) 112MCG TAB [THAY] J8499 42292-0039-20 $4.91 $4.91 1 tab(s) $3.49 $4.91 $4.91 $3.49 $4.72 $4.62 $4.67 $4.82 MECLIZINE HCL (ANTIVERT) 12.5MG TAB [THAY] J8499 51079-0423-20 $4.93 $4.93 1 tab(s) $3.50 $4.93 $4.93 $3.50 $4.73 $4.63 $4.68 $4.83 OXYBUTYNIN CL (DITROPAN) 5MG TAB [THAY] J8499 00904-2821-61 $4.94 $4.94 1 tab(s) $3.51 $4.94 $4.94 $3.51 $4.74 $4.64 $4.69 $4.84 METFORMIN HCL(GLUCOPHAGE)500MG TAB [THAY] J8499 00904-6326-61 $4.95 $4.95 1 tab(s) $3.51 $4.95 $4.95 $3.51 $4.75 $4.65 $4.70 $4.85 CLINDAMYCIN (CLEOCIN) CAPSULE [THAY] J8499 00904-5959-61 $4.96 $4.96 1 cap(s) $3.52 $4.96 $4.96 $3.52 $4.76 $4.66 $4.71 $4.86 BACLOFEN (LIORESAL) 10MG TAB [THAY] J8499 63739-0007-10 $4.96 $4.96 1 tab(s) $3.52 $4.96 $4.96 $3.52 $4.76 $4.66 $4.71 $4.86 VALPROIC ACID (DEPAKENE) 250MG/5ML CUP [THAY] J8499 68094-0193-62 $4.99 $4.99 5 mL $3.54 $4.99 $4.99 $3.54 $4.79 $4.69 $4.74 $4.89 ISOSORBIDE DINITRATE(ISORDIL)10MG TAB [THAY] J8499 00904-6619-61 $5.02 $5.02 1 tab(s) $3.57 $5.02 $5.02 $3.57 $4.82 $4.72 $4.77 $4.92 calcitriol 0.25 mcg Cap J8499 60687-0345-01 $5.03 $5.03 1 EA $3.57 $5.03 $5.03 $3.57 $4.83 $4.73 $4.78 $4.93 busPIRone 5 mg Tab J8499 68382-0180-01 $5.04 $5.04 1 tab(s) $3.58 $5.04 $5.04 $3.58 $4.84 $4.74 $4.79 $4.94 busPIRone 5 mg Tab J8499 51079-0985-20 $5.04 $5.04 1 tab(s) $3.58 $5.04 $5.04 $3.58 $4.84 $4.74 $4.79 $4.94 DONEPEZIL (ARICEPT) 10MG TAB [THAY] J8499 60687-0303-01 $5.05 $5.05 1 tab(s) $3.59 $5.05 $5.05 $3.59 $4.85 $4.75 $4.80 $4.95 BETHANECHOL (URECHOLINE)25MG TAB [THAY] J8499 00904-6178-61 $5.05 $5.05 1 tab(s) $3.59 $5.05 $5.05 $3.59 $4.85 $4.75 $4.80 $4.95 HYDROCODONE/APAP (NORCO)5/325MG TAB [THAY] J8499 00406-0123-62 $5.09 $5.09 1 tab(s) $3.61 $5.09 $5.09 $3.61 $4.89 $4.79 $4.84 $4.99 TRAMADOL HCL (ULTRAM) 50MG TAB [THAY] J8499 51079-0991-20 $5.09 $5.09 1 tab(s) $3.62 $5.09 $5.09 $3.62 $4.89 $4.79 $4.84 $4.99 CARBIDOPA/LEVODOPA(SINEMET)25/100MG TAB [THAY] J8499 51079-0884-20 $5.10 $5.10 1 tab(s) $3.62 $5.10 $5.10 $3.62 $4.89 $4.79 $4.84 $4.99 HALOPERIDOL (HALDOL) 1MG TAB [THAY] J8499 00904-5923-61 $5.10 $5.10 1 tab(s) $3.62 $5.10 $5.10 $3.62 $4.89 $4.79 $4.84 $4.99 TRAMADOL HCL (ULTRAM) 50MG TAB [THAY] J8499 55154-2541-04 $5.10 $5.10 1 tab(s) $3.62 $5.10 $5.10 $3.62 $4.90 $4.79 $4.85 $5.00 ATENOLOL (TENORMIN) 25MG TAB [THAY] J8499 51079-0759-20 $5.10 $5.10 1 tab(s) $3.62 $5.10 $5.10 $3.62 $4.90 $4.79 $4.85 $5.00 valproic acid 250 mg/5 mL Syr J8499 00121-4675-05 $5.13 $5.13 5 mL $3.64 $5.13 $5.13 $3.64 $4.92 $4.82 $4.87 $5.02 LEVOTHYROXINE (SYNTHROID) 112MCG TAB [THAY] J8499 60687-0508-01 $5.13 $5.13 1 tab(s) $3.65 $5.13 $5.13 $3.65 $4.93 $4.83 $4.88 $5.03 CARBIDOPA/LEVODOPA(SINEMET)25/100MG TAB [THAY] J8499 68084-0093-01 $5.14 $5.14 1 tab(s) $3.65 $5.14 $5.14 $3.65 $4.93 $4.83 $4.88 $5.04 TORSEMIDE (DEMADEX) 20MG TAB [THAY]TORSEMIDE (DEMADEX) 20MG TAB [THAY]TORSEMIDE (DEMADEX) 20MG TAB [THAY]TORSEMIDE (DEMADEX) 20MG TAB [THAY]TORSEMIDE (DEMADEX) 20MG TAB [THAY] J8499 50268-0756-15 $5.16 $5.16 1 - $3.66 $5.16 $5.16 $3.66 $4.95 $4.85 $4.90 $5.05 CARBIDOPA/LEVODOPA CR 25/100 TAB [THAY] J8499 68084-0281-01 $5.17 $5.17 1 tab(s) $3.67 $5.17 $5.17 $3.67 $4.96 $4.86 $4.91 $5.07 MECLIZINE HCL (ANTIVERT) 12.5MG TAB [THAY] J8499 00904-6516-61 $5.19 $5.19 1 tab(s) $3.68 $5.19 $5.19 $3.68 $4.98 $4.87 $4.93 $5.08 ATORVASTATIN (LIPITOR) 40MG TAB [THAY] J8499 68084-0099-01 $5.21 $5.21 1 tab(s) $3.70 $5.21 $5.21 $3.70 $5.01 $4.90 $4.95 $5.11 TRAMADOL HCL (ULTRAM) 50MG TAB [THAY] J8499 00904-6365-61 $5.24 $5.24 1 tab(s) $3.72 $5.24 $5.24 $3.72 $5.03 $4.93 $4.98 $5.14 DIPHENOXYLATE/ATROPINE (LOMOTIL)TAB [THAY] J8499 00378-0415-01 $5.25 $5.25 1 tab(s) $3.73 $5.25 $5.25 $3.73 $5.04 $4.94 $4.99 $5.15 hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab J8499 68084-0750-25 $5.28 $5.28 1 tab(s) $3.75 $5.28 $5.28 $3.75 $5.07 $4.96 $5.02 $5.17 METOCLOPRAMIDE HCL(REGLAN)5MG TAB [THAY] J8499 51079-0886-20 $5.31 $5.31 1 tab(s) $3.77 $5.31 $5.31 $3.77 $5.09 $4.99 $5.04 $5.20 HALOPERIDOL (HALDOL) TAB 5MG [THAY] J8499 00904-6782-61 $5.32 $5.32 1 tab(s) $3.77 $5.32 $5.32 $3.77 $5.10 $5.00 $5.05 $5.21 HYDROXYZINE HCL (ATARAX) 25MG TAB [THAY] J8499 51079-0806-20 $5.33 $5.33 1 tab(s) $3.78 $5.33 $5.33 $3.78 $5.12 $5.01 $5.06 $5.22 METRONIDAZOLE (FLAGYL) 500 mg Tab [THAY] J8499 60687-0424-01 $5.34 $5.34 1 EA $3.79 $5.34 $5.34 $3.79 $5.13 $5.02 $5.07 $5.23 METRONIDAZOLE (FLAGYL) 500 mg Tab [THAY] J8499 60687-0550-01 $5.34 $5.34 1 EA $3.79 $5.34 $5.34 $3.79 $5.13 $5.02 $5.07 $5.23 POTASSIUM CL (KLOR-CON)20MEQ TAB CR [THAY] J8499 63739-0447-10 $5.36 $5.36 1 tab(s) $3.81 $5.36 $5.36 $3.81 $5.15 $5.04 $5.09 $5.25 METRONIDAZOLE (FLAGYL) 500 mg Tab [THAY] J8499 00904-6568-61 $5.36 $5.36 1 EA $3.81 $5.36 $5.36 $3.81 $5.15 $5.04 $5.09 $5.25 CARBIDOPA/LEVODOPA CR 25/100 TAB [THAY] J8499 51079-0978-20 $5.36 $5.36 1 tab(s) $3.81 $5.36 $5.36 $3.81 $5.15 $5.04 $5.09 $5.25 PROPAFENONE HCL(RYTHMOL)150MG TAB [THAY] J8499 68084-0361-01 $5.38 $5.38 1 tab(s) $3.82 $5.38 $5.38 $3.82 $5.16 $5.05 $5.11 $5.27 lactulose 10 g/15 mL Syr J8499 00121-1154-40 $5.39 $5.39 30 mL $3.83 $5.39 $5.39 $3.83 $5.17 $5.07 $5.12 $5.28 LACTULOSE(CHRONULAC)20GM/30ML EACH [THAY] J8499 00121-4577-30 $5.40 $5.40 30 mL $3.83 $5.40 $5.40 $3.83 $5.18 $5.08 $5.13 $5.29 CYCLOBENZAPRINE (FLEXERIL) 10MG TAB [THAY] J8499 51079-0644-20 $5.44 $5.44 1 tab(s) $3.86 $5.44 $5.44 $3.86 $5.22 $5.11 $5.17 $5.33 dilTIAZem HCL (CARDIZEM) 30MG TAB [THAY] J8499 00093-0318-01 $5.50 $5.50 1 tab(s) $3.90 $5.50 $5.50 $3.90 $5.28 $5.17 $5.22 $5.39 doxazosin 1 mg Tab J8499 00904-5522-61 $5.53 $5.53 1 tab(s) $3.93 $5.53 $5.53 $3.93 $5.31 $5.20 $5.26 $5.42 POTASSIUM CL (MICRO K) 10MEQ CR CAP [THAY] J8499 00904-6930-61 $5.54 $5.54 1 cap(s) $3.94 $5.54 $5.54 $3.94 $5.32 $5.21 $5.27 $5.43 HALOPERIDOL (HALDOL) TAB 5MG [THAY] J8499 68382-0079-01 $5.55 $5.55 1 tab(s) $3.94 $5.55 $5.55 $3.94 $5.33 $5.21 $5.27 $5.44 MIDODRINE HCL(PROAMANTINE)2.5MG TAB [THAY] J8499 50268-0561-15 $5.56 $5.56 1 tab(s) $3.95 $5.56 $5.56 $3.95 $5.34 $5.22 $5.28 $5.45 VERAPAMIL HCL (CALAN SR) 120MG TAB [THAY] J8499 68462-0292-01 $5.65 $5.65 1 tab(s) $4.01 $5.65 $5.65 $4.01 $5.42 $5.31 $5.36 $5.53 ISOSORBIDE DINITRATE(ISORDIL)10MG TAB [THAY] J8499 00781-1556-13 $5.67 $5.67 1 tab(s) $4.02 $5.67 $5.67 $4.02 $5.44 $5.33 $5.38 $5.55 OMEPRAZOLE DR (PRILOSEC) 20MG CAP [THAY] J8499 68084-0128-01 $5.73 $5.73 1 cap(s) $4.07 $5.73 $5.73 $4.07 $5.50 $5.38 $5.44 $5.61 METOPROLOL SUCC (TOPROL XL)25MG TAB [THAY] J8499 68084-0659-01 $5.73 $5.73 1 tab(s) $4.07 $5.73 $5.73 $4.07 $5.50 $5.39 $5.44 $5.62 carBAMazepine (TEGRETOL) 200MG TAB [THAY] J8499 00904-6172-61 $5.74 $5.74 1 tab(s) $4.07 $5.74 $5.74 $4.07 $5.51 $5.39 $5.45 $5.62 CLINDAMYCIN (CLEOCIN) CAPSULE [THAY] J8499 42292-0018-20 $5.80 $5.80 1 cap(s) $4.12 $5.80 $5.80 $4.12 $5.57 $5.45 $5.51 $5.68 METOPROLOL SUCC (TOPROL XL)25MG TAB [THAY] J8499 51079-0169-20 $5.84 $5.84 1 tab(s) $4.15 $5.84 $5.84 $4.15 $5.61 $5.49 $5.55 $5.72 CYCLOBENZAPRINE (FLEXERIL) 10MG TAB [THAY] J8499 00904-7809-61 $5.92 $5.92 1 tab(s) $4.20 $5.92 $5.92 $4.20 $5.68 $5.56 $5.62 $5.80 HYDROCODONE/APAP(NORCO)10/325MG TAB [THAY] J8499 00406-0125-62 $5.92 $5.92 1 tab(s) $4.20 $5.92 $5.92 $4.20 $5.68 $5.56 $5.62 $5.80 CEPHALEXIN (KEFLEX) 500MG CAP [THAY] J8499 50268-0152-11 $5.94 $5.94 1 cap(s) $4.22 $5.94 $5.94 $4.22 $5.71 $5.59 $5.65 $5.83 CEPHALEXIN (KEFLEX) 500MG CAP [THAY] J8499 50268-0152-15 $5.94 $5.94 1 cap(s) $4.22 $5.94 $5.94 $4.22 $5.71 $5.59 $5.65 $5.83 METOPROLOL SUCC (TOPROL XL)25MG TAB [THAY] J8499 00904-6322-61 $5.98 $5.98 1 tab(s) $4.24 $5.98 $5.98 $4.24 $5.74 $5.62 $5.68 $5.86 ISOSORBIDE DINITRATE(ISORDIL)10MG TAB [THAY] J8499 68084-0082-01 $6.00 $6.00 1 tab(s) $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 NIFEDIPINE (PROCARDIA) 10MG CAP [THAY] J8499 60687-0425-01 $6.01 $6.01 1 cap(s) $4.26 $6.01 $6.01 $4.26 $5.77 $5.65 $5.71 $5.89 NIFEDIPINE (PROCARDIA) 10MG CAP [THAY] J8499 68084-0022-01 $6.01 $6.01 1 cap(s) $4.26 $6.01 $6.01 $4.26 $5.77 $5.65 $5.71 $5.89 NAPROXEN (NAPROSYN) 500MG TAB [THAY] J8499 53746-0190-01 $6.02 $6.02 1 tab(s) $4.27 $6.02 $6.02 $4.27 $5.77 $5.65 $5.71 $5.90 CARBIDOPA/LEVODOPA(SINEMET)25/100MG TAB [THAY] J8499 63739-0047-10 $6.03 $6.03 1 tab(s) $4.28 $6.03 $6.03 $4.28 $5.79 $5.67 $5.73 $5.91 calcitriol 0.25 mcg Cap J8499 23155-0662-03 $6.06 $6.06 1 EA $4.30 $6.06 $6.06 $4.30 $5.82 $5.70 $5.76 $5.94 DOXYCYCLINE HYCLATE (VIBRATABS)100MG TAB [THAY] J8499 62584-0693-01 $6.06 $6.06 1 tab(s) $4.30 $6.06 $6.06 $4.30 $5.82 $5.70 $5.76 $5.94 NAPROXEN (NAPROSYN) 500MG TAB [THAY] J8499 60687-0268-01 $6.18 $6.18 1 tab(s) $4.39 $6.18 $6.18 $4.39 $5.93 $5.81 $5.87 $6.06 NAPROXEN (NAPROSYN) 500MG TAB [THAY] J8499 60687-0491-01 $6.18 $6.18 1 tab(s) $4.39 $6.18 $6.18 $4.39 $5.93 $5.81 $5.87 $6.06 NAPROXEN (NAPROSYN) 500MG TAB [THAY] J8499 68084-0127-01 $6.18 $6.18 1 tab(s) $4.39 $6.18 $6.18 $4.39 $5.93 $5.81 $5.87 $6.06 BISOPROLOL FUMARATE(ZEBETA)5MG TAB [THAY] J8499 68084-0487-21 $6.20 $6.20 1 tab(s) $4.40 $6.20 $6.20 $4.40 $5.96 $5.83 $5.89 $6.08 GLIPIZIDE XL(GLUCOTROL XL)2.5MG TAB [THAY] J8499 68084-0295-21 $6.22 $6.22 1 tab(s) $4.42 $6.22 $6.22 $4.42 $5.97 $5.85 $5.91 $6.10 GABAPENTIN (NEURONTIN) 300MG CAP [THAY] J8499 68084-0762-01 $6.25 $6.25 1 cap(s) $4.44 $6.25 $6.25 $4.44 $6.00 $5.88 $5.94 $6.13 BISOPROLOL FUMARATE(ZEBETA)5MG TAB [THAY] J8499 29300-0126-13 $6.31 $6.31 1 tab(s) $4.48 $6.31 $6.31 $4.48 $6.05 $5.93 $5.99 $6.18 CLOTRIMAZOLE (MYCELEX) 10MG TROCHE [THAY] J8499 00574-0107-77 $6.36 $6.36 1 lozenge(s) $4.51 $6.36 $6.36 $4.51 $6.10 $5.98 $6.04 $6.23 MIDODRINE HCL(PROAMANTINE)2.5MG TAB [THAY] J8499 68084-0240-01 $6.36 $6.36 1 tab(s) $4.52 $6.36 $6.36 $4.52 $6.11 $5.98 $6.04 $6.24 METOPROLOL SUCC (TOPROL XL)25MG TAB [THAY] J8499 00186-1088-39 $6.37 $6.37 1 tab(s) $4.52 $6.37 $6.37 $4.52 $6.11 $5.99 $6.05 $6.24 VERAPAMIL HCL (CALAN SR) 180MG TAB [THAY] J8499 68462-0293-01 $6.38 $6.38 1 tab(s) $4.53 $6.38 $6.38 $4.53 $6.12 $6.00 $6.06 $6.25 LEVOTHYROXINE (SYNTHROID) 100MCG TAB [THAY] J8499 00074-6624-11 $6.47 $6.47 1 tab(s) $4.59 $6.47 $6.47 $4.59 $6.21 $6.08 $6.15 $6.34 LEVOTHYROXINE (SYNTHROID) 112MCG TAB [THAY] J8499 00074-9296-90 $6.47 $6.47 1 tab(s) $4.59 $6.47 $6.47 $4.59 $6.21 $6.08 $6.15 $6.34 LEVOTHYROXINE (SYNTROID) 88MCG TAB [THAY] J8499 00074-6594-90 $6.47 $6.47 1 tab(s) $4.59 $6.47 $6.47 $4.59 $6.21 $6.08 $6.15 $6.34 HALOPERIDOL (HALDOL) TAB 5MG [THAY] J8499 51079-0736-20 $6.48 $6.48 1 tab(s) $4.60 $6.48 $6.48 $4.60 $6.23 $6.10 $6.16 $6.36 FLUDROCORTISONE (FLORINEF)0.1MG TAB [THAY] J8499 50268-0330-15 $6.70 $6.70 1 tab(s) $4.75 $6.70 $6.70 $4.75 $6.43 $6.29 $6.36 $6.56 carBAMazepine (TEGRETOL) 200MG TAB [THAY] J8499 51079-0385-20 $6.70 $6.70 1 tab(s) $4.76 $6.70 $6.70 $4.76 $6.43 $6.30 $6.36 $6.56 TERAZOSIN HCL (HYTRIN) 2MG CAP [THAY] J8499 50268-0765-15 $6.71 $6.71 1 cap(s) $4.76 $6.71 $6.71 $4.76 $6.44 $6.31 $6.38 $6.58 TERAZOSIN HCL (HYTRIN) 2MG CAP [THAY] J8499 51079-0937-20 $6.71 $6.71 1 cap(s) $4.76 $6.71 $6.71 $4.76 $6.44 $6.31 $6.38 $6.58 PROPAFENONE HCL(RYTHMOL)150MG TAB [THAY] J8499 00591-0582-01 $6.77 $6.77 1 tab(s) $4.81 $6.77 $6.77 $4.81 $6.50 $6.37 $6.43 $6.64 AMLODIPINE BESYLATE(NORVASC)5MG TAB [THAY] J8499 00904-6370-61 $6.79 $6.79 1 tab(s) $4.82 $6.79 $6.79 $4.82 $6.51 $6.38 $6.45 $6.65 carBAMazepine (TEGRETOL) 200MG TAB [THAY] J8499 68084-0444-01 $6.79 $6.79 1 tab(s) $4.82 $6.79 $6.79 $4.82 $6.52 $6.38 $6.45 $6.65 ISOSORBIDE MONONITRATE(IMDUR)30MG TAB [THAY] J8499 00904-6449-61 $6.82 $6.82 1 tab(s) $4.84 $6.82 $6.82 $4.84 $6.55 $6.41 $6.48 $6.68 HYDROXYCHLOROQUINE(PLAQUENIL)200MG TAB [THAY] J8499 00904-7046-61 $6.83 $6.83 1 tab(s) $4.85 $6.83 $6.83 $4.85 $6.56 $6.42 $6.49 $6.70 ISOSORBIDE MONONITRATE(IMDUR)30MG TAB [THAY] J8499 68084-0591-01 $6.85 $6.85 1 tab(s) $4.87 $6.85 $6.85 $4.87 $6.58 $6.44 $6.51 $6.72 LOSARTAN (COZAAR) 25MG TAB [THAY] J8499 68084-0346-01 $6.86 $6.86 1 tab(s) $4.87 $6.86 $6.86 $4.87 $6.58 $6.44 $6.51 $6.72 PROPAFENONE HCL(RYTHMOL)150MG TAB [THAY] J8499 51079-0996-20 $6.87 $6.87 1 tab(s) $4.88 $6.87 $6.87 $4.88 $6.59 $6.46 $6.52 $6.73 DIGOXIN (LANOXIN) 0.125MG TAB [THAY] J8499 00904-5921-61 $6.87 $6.87 1 tab(s) $4.88 $6.87 $6.87 $4.88 $6.59 $6.46 $6.53 $6.73 MIDODRINE HCL(PROAMANTINE)2.5MG TAB [THAY] J8499 00245-0211-11 $6.88 $6.88 1 tab(s) $4.89 $6.88 $6.88 $4.89 $6.61 $6.47 $6.54 $6.75 AMLODIPINE BESYLATE(NORVASC)5MG TAB [THAY] J8499 51079-0451-20 $6.96 $6.96 1 tab(s) $4.94 $6.96 $6.96 $4.94 $6.68 $6.54 $6.61 $6.82 FAMOTIDINE (PEPCID) 20MG TAB [THAY] J8499 51079-0966-20 $6.98 $6.98 1 tab(s) $4.95 $6.98 $6.98 $4.95 $6.70 $6.56 $6.63 $6.84 DIVALPROEX SODIUM (DEPAKOTE DR) 250MG TAB [THAY] J8499 68084-0776-01 $7.02 $7.02 1 - $4.99 $7.02 $7.02 $4.99 $6.74 $6.60 $6.67 $6.88 HALOPERIDOL (HALDOL) TAB 5MG [THAY] J8499 00904-5925-61 $7.04 $7.04 1 tab(s) $5.00 $7.04 $7.04 $5.00 $6.76 $6.62 $6.69 $6.90 RISPERIDONE (RISPERDAL) 0.25MG TAB [THAY] J8499 50458-0590-10 $7.54 $7.54 1 tab(s) $5.35 $7.54 $7.54 $5.35 $7.23 $7.08 $7.16 $7.39 amantadine 100 mg Cap J8499 00591-4930-01 $7.54 $7.54 1 EA $5.35 $7.54 $7.54 $5.35 $7.24 $7.09 $7.16 $7.39 metOLazone 2.5 mg Tab J8499 00185-5050-01 $7.65 $7.65 1 tab(s) $5.43 $7.65 $7.65 $5.43 $7.34 $7.19 $7.26 $7.49 TOPIRAMATE (TOPAMAX) 25MG TAB [THAY] J8499 68084-0342-01 $7.70 $7.70 1 tab(s) $5.47 $7.70 $7.70 $5.47 $7.39 $7.24 $7.32 $7.55 CARVEDILOL (COREG) 3.125MG TAB [THAY] J8499 00904-6300-61 $7.70 $7.70 1 tab(s) $5.47 $7.70 $7.70 $5.47 $7.39 $7.24 $7.32 $7.55 CARVEDILOL (COREG) 12.5MG TAB [THAY] J8499 00904-6302-61 $7.70 $7.70 1 tab(s) $5.47 $7.70 $7.70 $5.47 $7.39 $7.24 $7.32 $7.55 CARVEDILOL (COREG) 3.125MG TAB [THAY] J8499 51079-0771-20 $7.77 $7.77 1 tab(s) $5.52 $7.77 $7.77 $5.52 $7.46 $7.30 $7.38 $7.61 CARVEDILOL (COREG) 12.5MG TAB [THAY] J8499 51079-0931-20 $7.77 $7.77 1 tab(s) $5.52 $7.77 $7.77 $5.52 $7.46 $7.30 $7.38 $7.61 THP DiphenhydrAMINE 25mg CAP #9 [THAY] J8499 99999-9999-63 $7.77 $7.77 1 EA $5.52 $7.77 $7.77 $5.52 $7.46 $7.30 $7.38 $7.61 KETOROLAC (TORADOL) 10MG TAB [THAY] J8499 00093-0314-01 $7.81 $7.81 1 tab(s) $5.55 $7.81 $7.81 $5.55 $7.50 $7.35 $7.42 $7.66 METOCLOPRAMIDE(REGLAN)10MG/10ML PO [THAY] J8499 00121-1576-10 $7.95 $7.95 10 mL $5.65 $7.95 $7.95 $5.65 $7.63 $7.47 $7.55 $7.79 BISOPROLOL FUMARATE(ZEBETA)5MG TAB [THAY] J8499 52817-0270-10 $8.01 $8.01 1 tab(s) $5.68 $8.01 $8.01 $5.68 $7.69 $7.53 $7.61 $7.85 BISOPROLOL FUMARATE(ZEBETA)5MG TAB [THAY] J8499 52817-0270-30 $8.01 $8.01 1 tab(s) $5.68 $8.01 $8.01 $5.68 $7.69 $7.53 $7.61 $7.85 VERAPAMIL HCL (CALAN SR) 120MG TAB [THAY] J8499 51079-0894-20 $8.13 $8.13 1 tab(s) $5.77 $8.13 $8.13 $5.77 $7.81 $7.65 $7.73 $7.97 RISPERIDONE (RISPERDAL) 1MG TAB [THAY] J8499 50458-0592-10 $8.21 $8.21 1 tab(s) $5.83 $8.21 $8.21 $5.83 $7.88 $7.72 $7.80 $8.04 THP LORazepam 0.5mg TAB #5 [THAY] J8499 99999-9999-67 $8.37 $8.37 1 EA $5.94 $8.37 $8.37 $5.94 $8.03 $7.87 $7.95 $8.20 DIVALPROEX(DEPAKOTE ER)500MG/24H TB [THAY] J8499 00904-6364-61 $8.44 $8.44 1 tab(s) $5.99 $8.44 $8.44 $5.99 $8.11 $7.94 $8.02 $8.27 VERAPAMIL HCL (CALAN SR) 180MG TAB [THAY] J8499 51079-0899-20 $8.48 $8.48 1 tab(s) $6.02 $8.48 $8.48 $6.02 $8.15 $7.98 $8.06 $8.32 TOPIRAMATE (TOPAMAX) 25MG TAB [THAY] J8499 51079-0726-20 $8.61 $8.61 1 tab(s) $6.11 $8.61 $8.61 $6.11 $8.27 $8.09 $8.18 $8.44 LEVETIRACETAM (KEPPRA) 250MG TAB [THAY] J8499 00904-6051-61 $8.68 $8.68 1 tab(s) $6.16 $8.68 $8.68 $6.16 $8.33 $8.16 $8.24 $8.50 SOTALOL HCL (BETAPACE) 80MG TAB [THAY] J8499 00245-0012-01 $8.72 $8.72 1 tab(s) $6.19 $8.72 $8.72 $6.19 $8.37 $8.19 $8.28 $8.54 LEVETIRACETAM (KEPPRA) 250MG TAB [THAY] J8499 50268-0467-15 $8.77 $8.77 1 tab(s) $6.23 $8.77 $8.77 $6.23 $8.42 $8.24 $8.33 $8.59 FLUoxetine 20 mg Cap J8499 65862-0193-01 $8.84 $8.84 1 cap(s) $6.27 $8.84 $8.84 $6.27 $8.48 $8.31 $8.39 $8.66 BETHANECHOL (URECHOLINE)25MG TAB [THAY] J8499 00832-0512-01 $8.84 $8.84 1 tab(s) $6.28 $8.84 $8.84 $6.28 $8.49 $8.31 $8.40 $8.66 MIRTAZAPINE (REMERON) 15MG TAB [THAY] J8499 51079-0086-20 $8.93 $8.93 1 tab(s) $6.34 $8.93 $8.93 $6.34 $8.57 $8.39 $8.48 $8.75 PAROXETINE (PAXIL) TAB 20MG [THAY] J8499 68084-0045-01 $9.08 $9.08 1 tab(s) $6.45 $9.08 $9.08 $6.45 $8.71 $8.53 $8.62 $8.90 DIGOXIN (LANOXIN) 0.125MG TAB [THAY] J8499 24987-0242-56 $9.26 $9.26 1 tab(s) $6.57 $9.26 $9.26 $6.57 $8.89 $8.70 $8.80 $9.07 THP Acetaminophen-OXYcodone 5-325mg TAB #5 [THAY] J8499 99999-9999-71 $9.75 $9.75 1 EA $6.92 $9.75 $9.75 $6.92 $9.36 $9.17 $9.26 $9.56 BETHANECHOL (URECHOLINE)25MG TAB [THAY] J8499 50268-0114-15 $9.79 $9.79 1 tab(s) $6.95 $9.79 $9.79 $6.95 $9.40 $9.20 $9.30 $9.59 METOLAZONE (ZAROXOLYN) 2.5MG TAB [THAY] J8499 51079-0023-20 $10.07 $10.07 1 tab(s) $7.15 $10.07 $10.07 $7.15 $9.67 $9.47 $9.57 $9.87 HYDROCODONE/APAP ORAL SOLN UD [THAY] J8499 68094-0714-62 $10.09 $10.09 15 mL $7.17 $10.09 $10.09 $7.17 $9.69 $9.49 $9.59 $9.89 CLOTRIMAZOLE (MYCELEX) 10MG TROCHE [THAY] J8499 00054-8146-22 $10.37 $10.37 1 lozenge(s) $7.36 $10.37 $10.37 $7.36 $9.96 $9.75 $9.85 $10.16 AMLODIPINE BESYLATE(NORVASC)5MG TAB [THAY] J8499 50268-0084-15 $10.46 $10.46 1 tab(s) $7.42 $10.46 $10.46 $7.42 $10.04 $9.83 $9.93 $10.25 NITROFURANTOIN (MACROBID) 100MG CAP [THAY] J8499 68084-0446-01 $10.56 $10.56 1 cap(s) $7.50 $10.56 $10.56 $7.50 $10.14 $9.93 $10.03 $10.35 RISPERIDONE (RISPERDAL) 0.25MG TAB [THAY] J8499 00904-6357-61 $10.66 $10.66 1 tab(s) $7.57 $10.66 $10.66 $7.57 $10.24 $10.02 $10.13 $10.45 DIVALPROEX(DEPAKOTE ER)500MG/24H TB [THAY] J8499 00904-6364-45 $10.90 $10.90 1 tab(s) $7.74 $10.90 $10.90 $7.74 $10.46 $10.24 $10.35 $10.68 VENLAFAXINE (EFFEXOR) XR 37.5MG CAP [THAY] J8499 68084-0698-01 $10.98 $10.98 1 cap(s) $7.80 $10.98 $10.98 $7.80 $10.54 $10.32 $10.43 $10.76 VENLAFAXINE (EFFEXOR) XR 37.5MG CAP [THAY] J8499 00904-6246-61 $10.99 $10.99 1 cap(s) $7.81 $10.99 $10.99 $7.81 $10.56 $10.34 $10.45 $10.77 DOXAZOSIN MESYLATE(CARDURA) 1MG TAB [THAY] J8499 51079-0957-20 $11.03 $11.03 1 tab(s) $7.83 $11.03 $11.03 $7.83 $10.59 $10.37 $10.48 $10.81 QUETIAPINE FUMARATE(SEROQUEL)25MG TAB [THAY] J8499 68084-0530-01 $11.05 $11.05 1 tab(s) $7.85 $11.05 $11.05 $7.85 $10.61 $10.39 $10.50 $10.83 AMOXIL/K CLAV(AUGMENTIN)500/125MG TAB [THAY] J8499 66685-1002-00 $11.07 $11.07 1 tab(s) $7.86 $11.07 $11.07 $7.86 $10.63 $10.40 $10.52 $10.85 RISPERIDONE (RISPERDAL) 0.25MG TAB [THAY] J8499 68084-0270-01 $11.29 $11.29 1 tab(s) $8.01 $11.29 $11.29 $8.01 $10.83 $10.61 $10.72 $11.06 VALACYCLOVIR (VALTREX) 500MG TAB [THAY] J8499 00904-6565-07 $11.44 $11.44 1 tab(s) $8.12 $11.44 $11.44 $8.12 $10.98 $10.75 $10.87 $11.21 THP Sulfamethoxazole/TMP 800mg/160mg TAB #6 [THAY] J8499 99999-9999-75 $11.48 $11.48 1 EA $8.15 $11.48 $11.48 $8.15 $11.02 $10.79 $10.90 $11.25 QUETIAPINE FUMARATE(SEROQUEL)25MG TAB [THAY] J8499 00904-6277-61 $11.49 $11.49 1 tab(s) $8.16 $11.49 $11.49 $8.16 $11.03 $10.80 $10.92 $11.26 POTASSIUM CL (MICRO K) 10MEQ CR CAP [THAY] J8499 50268-0671-13 $11.50 $11.50 1 cap(s) $8.16 $11.50 $11.50 $8.16 $11.04 $10.81 $10.92 $11.27 SULFATRIM SUSP(BACTRIM)800MG/160MG 20ML [THAY] J8499 00121-4793-20 $11.50 $11.50 20 mL $8.17 $11.50 $11.50 $8.17 $11.04 $10.81 $10.93 $11.27 CEFUROXIME AXETIL (CEFTIN)250MG TAB [THAY] J8499 60687-0272-94 $11.75 $11.75 1 tab(s) $8.34 $11.75 $11.75 $8.34 $11.28 $11.05 $11.16 $11.52 omeprazole 20 mg DR J8499 68382-0412-01 $11.80 $11.80 1 cap(s) $8.38 $11.80 $11.80 $8.38 $11.33 $11.09 $11.21 $11.57 TAMSULOSIN HCL (FLOMAX) 0.4MG CAP [THAY] J8499 00904-6401-61 $11.92 $11.92 1 cap(s) $8.46 $11.92 $11.92 $8.46 $11.44 $11.20 $11.32 $11.68 TAMSULOSIN HCL (FLOMAX) 0.4MG CAP [THAY] J8499 51079-0294-20 $11.93 $11.93 1 cap(s) $8.47 $11.93 $11.93 $8.47 $11.45 $11.21 $11.33 $11.69 TAMSULOSIN HCL (FLOMAX) 0.4MG CAP [THAY] J8499 68382-0132-10 $11.93 $11.93 1 cap(s) $8.47 $11.93 $11.93 $8.47 $11.45 $11.21 $11.33 $11.69 ACETAZOLAMIDE ER (DIAMOX SEQUELS)500MG CAP [THAY] J8499 50742-0233-01 $12.09 $12.09 1 cap(s) $8.58 $12.09 $12.09 $8.58 $11.60 $11.36 $11.48 $11.85 CLOPIDOGREL (PLAVIX) 75MG TAB [THAY] J8499 00904-6294-61 $12.22 $12.22 1 tab(s) $8.68 $12.22 $12.22 $8.68 $11.73 $11.49 $11.61 $11.98 CELECOXIB (CELEBREX) 100MG CAP [THAY] J8499 00904-6502-61 $12.23 $12.23 1 cap(s) $8.69 $12.23 $12.23 $8.69 $11.74 $11.50 $11.62 $11.99 ESCITALORPAM10 mg (LEXAPRO) TAB [THAY] J8499 00904-6426-61 $12.26 $12.26 1 EA $8.71 $12.26 $12.26 $8.71 $11.77 $11.53 $11.65 $12.02 HYDROXYCHLOROQUINE(PLAQUENIL)200MG TAB [THAY] J8499 68084-0269-01 $12.28 $12.28 1 tab(s) $8.72 $12.28 $12.28 $8.72 $11.79 $11.54 $11.67 $12.03 CEFUROXIME AXETIL (CEFTIN)250MG TAB [THAY] J8499 68180-0302-20 $12.30 $12.30 1 tab(s) $8.73 $12.30 $12.30 $8.73 $11.81 $11.56 $11.68 $12.05 THP PredniSONE 10mg TAB #10 [THAY] J8499 99999-9999-73 $12.34 $12.34 1 EA $8.76 $12.34 $12.34 $8.76 $11.85 $11.60 $11.72 $12.09 DOXYCYCLINE HYCLATE (VIBRATABS)100MG TAB [THAY] J8499 00904-0430-04 $12.59 $12.59 1 tab(s) $8.94 $12.59 $12.59 $8.94 $12.09 $11.84 $11.96 $12.34 RISPERIDONE (RISPERDAL) 1MG TAB [THAY] J8499 00904-6359-61 $12.63 $12.63 1 tab(s) $8.97 $12.63 $12.63 $8.97 $12.12 $11.87 $12.00 $12.38 ZOLPIDEM TARTRATE (AMBIEN) 5MG TAB [THAY] J8499 51079-0724-20 $12.74 $12.74 1 tab(s) $9.04 $12.74 $12.74 $9.04 $12.23 $11.97 $12.10 $12.48 MELOXICAM (MOBIC) 15MG TAB [THAY] J8499 50268-0526-15 $12.83 $12.83 1 tab(s) $9.11 $12.83 $12.83 $9.11 $12.31 $12.06 $12.19 $12.57 ESCITALORPAM10 mg (LEXAPRO) TAB [THAY] J8499 65862-0374-01 $12.93 $12.93 1 EA $9.18 $12.93 $12.93 $9.18 $12.41 $12.15 $12.28 $12.67 HYDROCODONE/APAP ORAL SOLN UD [THAY] J8499 66689-0023-50 $13.22 $13.22 15 mL $9.39 $13.22 $13.22 $9.39 $12.70 $12.43 $12.56 $12.96 ACETAZOLAMIDE(DIAMOX SEQUELS)500MG CAP [THAY] J8499 68084-0401-21 $13.29 $13.29 1 cap(s) $9.44 $13.29 $13.29 $9.44 $12.76 $12.49 $12.62 $13.02 SULFATRIM SUSP(BACTRIM)800MG/160MG 20ML [THAY] J8499 50383-0824-21 $13.38 $13.38 20 mL $9.50 $13.38 $13.38 $9.50 $12.84 $12.57 $12.71 $13.11 OXYCODONE ER (OXYCONTIN) 10MG TAB [THAY] J8499 59011-0410-20 $13.42 $13.42 1 tab(s) $9.53 $13.42 $13.42 $9.53 $12.88 $12.61 $12.75 $13.15 AMOXIL/K CLAV(AUGMENTIN)875/125MG TAB [THAY] J8499 00093-2275-34 $13.60 $13.60 1 tab(s) $9.66 $13.60 $13.60 $9.66 $13.06 $12.79 $12.92 $13.33 AMOXIL/K CLAV(AUGMENTIN)875/125MG TAB [THAY] J8499 66685-1001-00 $13.60 $13.60 1 tab(s) $9.66 $13.60 $13.60 $9.66 $13.06 $12.79 $12.92 $13.33 NITROFURANTOIN (MACROBID) 100MG CAP [THAY] J8499 51079-0348-20 $13.70 $13.70 1 cap(s) $9.73 $13.70 $13.70 $9.73 $13.15 $12.88 $13.02 $13.43 CEFDINIR (OMNICEF)300MG CAP [THAY] J8499 65862-0177-60 $13.72 $13.72 1 cap(s) $9.74 $13.72 $13.72 $9.74 $13.17 $12.89 $13.03 $13.44 CEFDINIR (OMNICEF)300MG CAP [THAY] J8499 00781-2176-60 $13.73 $13.73 1 cap(s) $9.75 $13.73 $13.73 $9.75 $13.18 $12.90 $13.04 $13.45 POTASSIUM CL (MICRO K) 10MEQ CR CAP [THAY] J8499 00904-6068-61 $14.08 $14.08 1 cap(s) $9.99 $14.08 $14.08 $9.99 $13.51 $13.23 $13.37 $13.79 POTASSIUM CL (10%) 20MEQ/15ML ORAL EACH [THAY] J8499 00121-1465-15 $14.34 $14.34 15 mL $10.18 $14.34 $14.34 $10.18 $13.76 $13.47 $13.62 $14.05 CIPROFLOXACIN HCL (CIPRO) 250MG TAB [THAY] J8499 60687-0528-01 $14.42 $14.42 1 tab(s) $10.24 $14.42 $14.42 $10.24 $13.84 $13.55 $13.70 $14.13 CIPROFLOXACIN HCL (CIPRO) 250MG TAB [THAY] J8499 68084-0069-01 $14.42 $14.42 1 tab(s) $10.24 $14.42 $14.42 $10.24 $13.84 $13.55 $13.70 $14.13 DOXYCYCLINE HYCLATE (VIBRATABS)100MG TAB [THAY] J8499 62584-0693-21 $14.68 $14.68 1 tab(s) $10.42 $14.68 $14.68 $10.42 $14.09 $13.79 $13.94 $14.38 THP Amoxicillin 500mg CAP #9 [THAY] J8499 99999-9999-56 $14.81 $14.81 1 EA $10.52 $14.81 $14.81 $10.52 $14.22 $13.92 $14.07 $14.52 ITRACONAZOLE 100 MG CAPSULE [THAY] J8499 50268-0450-12 $14.81 $14.81 1 cap(s) $10.52 $14.81 $14.81 $10.52 $14.22 $13.93 $14.07 $14.52 THP acetaminophen-HYDROcodone 5-325mg tab #5 [THAY] J8499 99999-9999-01 $14.95 $14.95 1 EA $10.62 $14.95 $14.95 $10.62 $14.35 $14.06 $14.21 $14.65 DULOXETINE (CYMBALTA) 30MG CAP [THAY] J8499 00904-6453-61 $15.35 $15.35 1 cap(s) $10.90 $15.35 $15.35 $10.90 $14.74 $14.43 $14.58 $15.04 DUTASTERIDE (AVODART) 0.5MG CAP [THAY] J8499 50268-0282-13 $15.60 $15.60 1 cap(s) $11.07 $15.60 $15.60 $11.07 $14.97 $14.66 $14.82 $15.28 DUTASTERIDE (AVODART) 0.5MG CAP [THAY] J8499 60505-3877-03 $15.60 $15.60 1 cap(s) $11.08 $15.60 $15.60 $11.08 $14.98 $14.67 $14.82 $15.29 AMOXICILLIN 250MG/5ML SUSP 100ML [THAY] J8499 00143-9889-01 $15.68 $15.68 100 mL $11.13 $15.68 $15.68 $11.13 $15.05 $14.74 $14.90 $15.37 amoxicillin 250 mg/5 mL REC J8499 00781-6041-46 $15.68 $15.68 100 mL $11.13 $15.68 $15.68 $11.13 $15.05 $14.74 $14.90 $15.37 AMOXICILLIN 250MG/5ML SUSP 100ML [THAY] J8499 67253-0148-46 $15.68 $15.68 100 mL $11.13 $15.68 $15.68 $11.13 $15.05 $14.74 $14.90 $15.37 THP Tramadol 50 mg TAB #5 [THAY] J8499 99999-9999-79 $15.72 $15.72 1 EA $11.16 $15.72 $15.72 $11.16 $15.09 $14.77 $14.93 $15.40 TOPIRAMATE (TOPAMAX) 100MG TAB [THAY] J8499 68084-0344-01 $15.90 $15.90 1 tab(s) $11.29 $15.90 $15.90 $11.29 $15.26 $14.95 $15.11 $15.58 TAPENTADOL (NUCYNTA) 50MG TAB [THAY] J8499 50458-0820-04 $16.14 $16.14 1 tab(s) $11.46 $16.14 $16.14 $11.46 $15.50 $15.17 $15.33 $15.82 DONEPEZIL (ARICEPT) 10MG TAB [THAY] J8499 00904-6409-61 $16.24 $16.24 1 tab(s) $11.53 $16.24 $16.24 $11.53 $15.59 $15.27 $15.43 $15.91 QUEtiapine FUMAR(SEROQUEL)100MG TAB [THAY] J8499 50268-0632-15 $16.42 $16.42 1 tab(s) $11.66 $16.42 $16.42 $11.66 $15.76 $15.43 $15.60 $16.09 QUEtiapine FUMAR(SEROQUEL)100MG TAB [THAY] J8499 60687-0349-01 $16.45 $16.45 1 tab(s) $11.68 $16.45 $16.45 $11.68 $15.80 $15.47 $15.63 $16.12 QUEtiapine FUMAR(SEROQUEL)100MG TAB [THAY] J8499 68084-0532-01 $16.45 $16.45 1 tab(s) $11.68 $16.45 $16.45 $11.68 $15.80 $15.47 $15.63 $16.12 TOPIRAMATE (TOPAMAX) 100MG TAB [THAY] J8499 51079-0728-20 $17.43 $17.43 1 tab(s) $12.37 $17.43 $17.43 $12.37 $16.73 $16.38 $16.56 $17.08 VALACYCLOVIR (VALTREX) 500MG TAB [THAY] J8499 51079-0093-03 $17.95 $17.95 1 tab(s) $12.74 $17.95 $17.95 $12.74 $17.23 $16.87 $17.05 $17.59 TAPENTADOL (NUCYNTA) 50MG TAB [THAY] J8499 50458-0820-02 $18.77 $18.77 1 tab(s) $13.32 $18.77 $18.77 $13.32 $18.02 $17.64 $17.83 $18.39 TAPENTADOL (NUCYNTA) 50MG TAB [THAY] J8499 69865-0210-02 $18.77 $18.77 1 tab(s) $13.32 $18.77 $18.77 $13.32 $18.02 $17.64 $17.83 $18.39 THP Ondansetron 4mg TAB #8 [THAY] J8499 99999-9999-80 $18.89 $18.89 1 EA $13.41 $18.89 $18.89 $13.41 $18.14 $17.76 $17.95 $18.51 DULOXETINE (CYMBALTA) 30MG CAP [THAY] J8499 68084-0683-01 $18.90 $18.90 1 cap(s) $13.42 $18.90 $18.90 $13.42 $18.14 $17.77 $17.96 $18.52 THP Cyclobenzaprine 10mg TAB #5 [THAY] J8499 99999-9999-62 $19.10 $19.10 1 EA $13.56 $19.10 $19.10 $13.56 $18.33 $17.95 $18.14 $18.71 THP Amoxicillin 250mg/5ml SUSP #1 [THAY] J8499 99999-9999-53 $19.18 $19.18 1 EA $13.62 $19.18 $19.18 $13.62 $18.41 $18.03 $18.22 $18.80 DUTASTERIDE (AVODART) 0.5MG CAP [THAY] J8499 00173-0712-15 $19.35 $19.35 1 cap(s) $13.74 $19.35 $19.35 $13.74 $18.58 $18.19 $18.38 $18.96 AMIODARONE (PACERONE) 200MG TAB [THAY] J8499 00245-0147-01 $19.39 $19.39 1 tab(s) $13.77 $19.39 $19.39 $13.77 $18.61 $18.23 $18.42 $19.00 SULFATRIM SUSP(BACTRIM)800MG/160MG 20ML [THAY] J8499 00121-0853-40 $20.20 $20.20 20 mL $14.34 $20.20 $20.20 $14.34 $19.39 $18.99 $19.19 $19.80 COLCHICINE (COLCRYS) 0.6MG TAB [THAY] J8499 64764-0119-07 $20.26 $20.26 1 tab(s) $14.38 $20.26 $20.26 $14.38 $19.45 $19.04 $19.24 $19.85 FLUCONAZOLE (DIFLUCAN) 100MG TAB [THAY] J8499 59762-5016-01 $21.01 $21.01 1 tab(s) $14.92 $21.01 $21.01 $14.92 $20.17 $19.75 $19.96 $20.59 apixaban 2.5 mg Tab J8499 00003-0893-31 $21.27 $21.27 1 tab(s) $15.10 $21.27 $21.27 $15.10 $20.42 $19.99 $20.20 $20.84 SULFATRIM SUSP(BACTRIM)800MG/160MG 20ML [THAY] J8499 65862-0496-47 $21.72 $21.72 20 mL $15.42 $21.72 $21.72 $15.42 $20.85 $20.41 $20.63 $21.28 OXYCODONE ER(OXYCONTIN) 20MG TAB [THAY] J8499 59011-0420-20 $21.98 $21.98 1 tab(s) $15.60 $21.98 $21.98 $15.60 $21.10 $20.66 $20.88 $21.54 CELECOXIB (CELEBREX) 100MG CAP [THAY] J8499 00025-1520-34 $22.02 $22.02 1 cap(s) $15.64 $22.02 $22.02 $15.64 $21.14 $20.70 $20.92 $21.58 FLUCONAZOLE (DIFLUCAN) 100MG TAB [THAY] J8499 50268-0337-15 $22.56 $22.56 1 tab(s) $16.02 $22.56 $22.56 $16.02 $21.66 $21.21 $21.43 $22.11 ESOMEPRAZOLE (NEXIUM) 40MG PACKET [THAY] J8499 69097-0529-34 $23.01 $23.01 1 EA $16.34 $23.01 $23.01 $16.34 $22.09 $21.63 $21.86 $22.55 AMOXICILLIN (AMOXIL) 400MG/5ML 100ML BOT [THAY] J8499 00093-4161-73 $23.12 $23.12 100 mL $16.42 $23.12 $23.12 $16.42 $22.20 $21.73 $21.96 $22.66 AMOXICILLIN (AMOXIL) 400MG/5ML 100ML BOT [THAY] J8499 00143-9887-01 $23.12 $23.12 100 mL $16.42 $23.12 $23.12 $16.42 $22.20 $21.73 $21.96 $22.66 SUCRALFATE(CARAFATE)1GM/10ML SUSP [THAY] J8499 00121-0747-10 $23.62 $23.62 10 mL $16.77 $23.62 $23.62 $16.77 $22.68 $22.20 $22.44 $23.15 ESOMEPRAZOLE (NEXIUM) 40MG PACKET [THAY] J8499 00186-4040-01 $25.18 $25.18 1 EA $17.88 $25.18 $25.18 $17.88 $24.17 $23.67 $23.92 $24.68 COLCHICINE (COLCRYS) 0.6MG TAB [THAY] J8499 42292-0054-03 $25.80 $25.80 1 tab(s) $18.32 $25.80 $25.80 $18.32 $24.77 $24.25 $24.51 $25.28 COLCHICINE (COLCRYS) 0.6MG TAB [THAY] J8499 60687-0389-21 $25.80 $25.80 1 tab(s) $18.32 $25.80 $25.80 $18.32 $24.77 $24.25 $24.51 $25.28 SUCRALFATE(CARAFATE)1GM/10ML SUSP [THAY]SUCRALFATE(CARAFATE)1GM/10ML SUSP [THAY] J8499 68094-0171-59 $26.02 $26.02 10 mL $18.47 $26.02 $26.02 $18.47 $24.98 $24.46 $24.72 $25.50 LEVOFLOXACIN (LEVAQUIN) 250MG TAB [THAY] J8499 00904-6351-61 $32.95 $32.95 1 tab(s) $23.40 $32.95 $32.95 $23.40 $31.63 $30.97 $31.30 $32.29 THP Clindamycin 150mg CAP #12 [THAY] J8499 99999-9999-61 $34.60 $34.60 1 EA $24.57 $34.60 $34.60 $24.57 $33.22 $32.52 $32.87 $33.91 LEVOFLOXACIN (LEVAQUIN) 250MG TAB [THAY] J8499 68084-0481-01 $36.49 $36.49 1 tab(s) $25.91 $36.49 $36.49 $25.91 $35.03 $34.30 $34.66 $35.76 POTASSIUM CL (10%) 20MEQ/15ML ORAL EACH [THAY] J8499 60687-0341-71 $36.91 $36.91 15 mL $26.20 $36.91 $36.91 $26.20 $35.43 $34.69 $35.06 $36.17 RIVAROXABAN (XARELTO) 15MG TAB [THAY] J8499 50458-0578-10 $39.34 $39.34 1 tab(s) $27.93 $39.34 $39.34 $27.93 $37.77 $36.98 $37.37 $38.55 RIVAROXABAN (XARELTO) 10MG TAB [THAY] J8499 50458-0580-10 $39.34 $39.34 1 tab(s) $27.93 $39.34 $39.34 $27.93 $37.77 $36.98 $37.37 $38.55 POTASSIUM CL (10%) 20MEQ/15ML ORAL EACH [THAY] J8499 66689-0047-50 $40.71 $40.71 15 mL $28.90 $40.71 $40.71 $28.90 $39.08 $38.26 $38.67 $39.89 ALENDRONATE SODIUM(FOSAMAX)70MG TAB [THAY] J8499 00093-5171-44 $44.48 $44.48 1 tab(s) $31.58 $44.48 $44.48 $31.58 $42.70 $41.81 $42.25 $43.59 ALENDRONATE SODIUM(FOSAMAX)70MG TAB [THAY] J8499 69097-0224-16 $44.48 $44.48 1 tab(s) $31.58 $44.48 $44.48 $31.58 $42.70 $41.81 $42.25 $43.59 FLUCONAZOLE (DIFLUCAN) 100MG TAB [THAY] J8499 68084-0728-01 $51.50 $51.50 1 tab(s) $36.57 $51.50 $51.50 $36.57 $49.44 $48.41 $48.93 $50.47 SUMATRIPTAN SUCC(IMITREX)100MG TAB [THAY] J8499 55111-0293-09 $53.78 $53.78 1 tab(s) $38.18 $53.78 $53.78 $38.18 $51.63 $50.55 $51.09 $52.70 MORPHINE(ROXANOL) 20MG/ML ORAL SOLN 30ML [THAY] J8499 00054-0404-44 $53.90 $53.90 30 mL $38.27 $53.90 $53.90 $38.27 $51.74 $50.67 $51.21 $52.82 morphine 20 mg/mL Con J8499 00054-0517-44 $53.90 $53.90 30 mL $38.27 $53.90 $53.90 $38.27 $51.74 $50.67 $51.21 $52.82 MORPHINE(ROXANOL) 20MG/ML ORAL SOLN 30ML [THAY] J8499 00527-1425-36 $53.90 $53.90 30 mL $38.27 $53.90 $53.90 $38.27 $51.74 $50.67 $51.21 $52.82 NITROGLYCERIN (NITROSTAT) 0.4MG SL [THAY] J8499 59762-3304-03 $54.85 $54.85 25 tab(s) $38.94 $54.85 $54.85 $38.94 $52.65 $51.55 $52.10 $53.75 THP Prednisolone 5 mg/5 mL SUSP #1 [THAY] J8499 99999-9999-74 $56.05 $56.05 1 EA $39.79 $56.05 $56.05 $39.79 $53.80 $52.68 $53.24 $54.92 METHYLERGONOVINE(METHERGINE)0.2MG TAB [THAY] J8499 43386-0140-07 $59.39 $59.39 1 tab(s) $42.16 $59.39 $59.39 $42.16 $57.01 $55.82 $56.42 $58.20 norepinephrine 1 mg/mL Sol J8499 67457-0852-04 $63.65 $63.65 4 mL $45.19 $63.65 $63.65 $45.19 $61.10 $59.83 $60.47 $62.38 paliperidone 3 mg ER J8499 10147-0952-03 $64.56 $64.56 1 tab(s) $45.83 $64.56 $64.56 $45.83 $61.97 $60.68 $61.33 $63.26 vancomycin 125 mg Cap J8499 68180-0166-13 $66.11 $66.11 1 cap(s) $46.94 $66.11 $66.11 $46.94 $63.47 $62.14 $62.81 $64.79 vancomycin 125 mg Cap J8499 62559-0390-20 $66.11 $66.11 1 cap(s) $46.94 $66.11 $66.11 $46.94 $63.47 $62.15 $62.81 $64.79 azithromycin 1 EA Tab J8499 99999-9999-58 $66.13 $66.13 1 EA $46.95 $66.13 $66.13 $46.95 $63.48 $62.16 $62.82 $64.80 THP Amoxicillin/Clavulanate 875mg/125mg TAB #6[THAY] J8499 99999-9999-54 $67.62 $67.62 1 EA $48.01 $67.62 $67.62 $48.01 $64.91 $63.56 $64.24 $66.27 THP Nitrofurantoin 100mg CAP #6 [THAY] J8499 99999-9999-70 $68.22 $68.22 1 EA $48.43 $68.22 $68.22 $48.43 $65.49 $64.12 $64.80 $66.85 THP Cefdinir 300mg CAP #6 [THAY] J8499 99999-9999-60 $68.37 $68.37 1 EA $48.54 $68.37 $68.37 $48.54 $65.63 $64.26 $64.95 $67.00 THP Doxycycline 100mg TAB #6 [THAY] J8499 99999-9999-64 $71.15 $71.15 1 EA $50.52 $71.15 $71.15 $50.52 $68.31 $66.88 $67.59 $69.73 ciprofloxacin 1 EA Tab J8499 99999-9999-59 $72.51 $72.51 1 EA $51.48 $72.51 $72.51 $51.48 $69.61 $68.16 $68.88 $71.06 AMOXICILLIN/CLAV(AUGMENTIN)400MG/5ML 50ML BOT [THAY] J8499 65862-0534-50 $73.80 $73.80 50 mL $52.40 $73.80 $73.80 $52.40 $70.85 $69.37 $70.11 $72.32 AMOXICILLIN/CLAV(AUGMENTIN)400MG/5ML 50ML BOT [THAY] J8499 66685-1012-00 $73.80 $73.80 50 mL $52.40 $73.80 $73.80 $52.40 $70.85 $69.37 $70.11 $72.32 THP Azithromycin 300mg/5ml SUSP #1 [THAY] J8499 99999-9999-57 $76.76 $76.76 1 EA $54.50 $76.76 $76.76 $54.50 $73.69 $72.15 $72.92 $75.22 NITROGLYCERIN (NITROSTAT) 0.4MG SL [THAY] J8499 00071-0418-13 $78.29 $78.29 25 tab(s) $55.58 $78.29 $78.29 $55.58 $75.15 $73.59 $74.37 $76.72 AMOXICILLIN/CLAV(AUGMENTIN)400MG/5ML 50ML BOT [THAY] J8499 00143-9982-50 $79.00 $79.00 50 mL $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 CEFPROZIL (CEFZIL) 250MG/5ML 50ML BOTTLE [THAY] J8499 00781-6203-91 $81.68 $81.68 50 mL $57.99 $81.68 $81.68 $57.99 $78.41 $76.78 $77.60 $80.05 CEFPROZIL (CEFZIL) 250MG/5ML 50ML BOTTLE [THAY] J8499 68180-0402-01 $81.68 $81.68 50 mL $57.99 $81.68 $81.68 $57.99 $78.41 $76.78 $77.60 $80.05 THP Amoxicillin/Clavulanate 400-57mg/5mL SUSP #1 [THAY] J8499 99999-9999-55 $82.50 $82.50 1 EA $58.58 $82.50 $82.50 $58.58 $79.20 $77.55 $78.38 $80.85 HYOSCYAMINE (LEVSIN) 0.125 MG/ML ORAL DROPS [THAY] J8499 39328-0047-15 $83.08 $83.08 15 mL $58.99 $83.08 $83.08 $58.99 $79.76 $78.10 $78.93 $81.42 PATIROMER (VELTASSA) 8.4 GM POWDER [THAY] J8499 53436-0084-04 $91.49 $91.49 1 EA $64.96 $91.49 $91.49 $64.96 $87.83 $86.00 $86.92 $89.66 LORAZEPAM (ATIVAN) 2MG/ML ORAL CONC [THAY] J8499 00054-3532-44 $99.56 $99.56 30 mL $70.69 $99.56 $99.56 $70.69 $95.58 $93.59 $94.58 $97.57 THP Fluconazole 100mg TAB #6 [THAY] J8499 99999-9999-66 $112.09 $112.09 1 EA $79.58 $112.09 $112.09 $79.58 $107.60 $105.36 $106.48 $109.85 posaconazole 100 mg DR J8499 00527-2133-35 $151.52 $151.52 1 tab(s) $107.58 $151.52 $151.52 $107.58 $145.46 $142.43 $143.94 $148.49 THP Oseltamivir 75mg CAP #6 [THAY] J8499 99999-9999-77 $170.92 $170.92 1 EA $121.35 $170.92 $170.92 $121.35 $164.08 $160.66 $162.37 $167.50 oseltamivir 1 EA Cap J8499 99999-9999-76 $177.16 $177.16 1 EA $125.78 $177.16 $177.16 $125.78 $170.07 $166.53 $168.30 $173.62 THP Levofloxacin 250mg TAB #6 [THAY] J8499 99999-9999-68 $204.92 $204.92 1 EA $145.49 $204.92 $204.92 $145.49 $196.72 $192.62 $194.67 $200.82 CEFDINIR (OMNICEF) 250MG/5ML 100ML BOTTLE [THAY] J8499 00781-6078-46 $318.58 $318.58 100 mL $226.19 $318.58 $318.58 $226.19 $305.84 $299.47 $302.65 $312.21 CEFDINIR (OMNICEF) 250MG/5ML 100ML BOTTLE [THAY] J8499 68180-0723-10 $318.58 $318.58 100 mL $226.19 $318.58 $318.58 $226.19 $305.84 $299.47 $302.65 $312.21 APREPITANT (EMEND) 40MG CAP [THAY] J8501 00006-0464-10 $286.77 $286.77 1 cap(s) $203.60 $286.77 $286.77 $203.60 $275.30 $269.56 $272.43 $281.03 DEXAMETHASONE (DECADRON) 4MG TAB [THAY] J8540 00054-8175-25 $5.91 $5.91 1 tab(s) $4.20 $5.91 $5.91 $4.20 $5.67 $5.55 $5.61 $5.79 DOXOrubicin (ADRIAMYCIN) 50 MG/25 ML SOL [THAY] J9000 00069-3032-20 $108.10 $108.10 25 mL $76.75 $108.10 $108.10 $76.75 $103.78 $101.61 $102.70 $105.94 DOXOrubicin (ADRIAMYCIN) 200MG/100 ML SOL [THAY] J9000 00069-3034-20 $204.56 $204.56 100 mL $145.24 $204.56 $204.56 $145.24 $196.38 $192.29 $194.33 $200.47 azaCITIDine 100 mg REC J9025 16729-0306-10 $554.00 $554.00 1 mL $393.34 $554.00 $554.00 $393.34 $531.84 $520.76 $526.30 $542.92 azaCITIDine (VIDAZA) 100 mg REC VIAL [THAY] J9025 69097-0805-40 $554.00 $554.00 1 mL $393.34 $554.00 $554.00 $393.34 $531.84 $520.76 $526.30 $542.92 azaCITIDine (VIDAZA) 100 mg REC VIAL [THAY] J9025 59572-0102-01 "$1,169.76 " "$1,169.76 " 1 mL $830.53 "$1,169.76 " "$1,169.76 " $830.53 "$1,122.97 " "$1,099.57 " "$1,111.27 " "$1,146.36 " BENDAMUSTINE (BENDEKA) 100MG/4ML [THAY] J9034 42367-0521-25 "$4,725.49 " "$4,725.49 " 4 mL "$3,355.09 " "$4,725.49 " "$4,725.49 " "$3,355.09 " "$4,536.47 " "$4,441.96 " "$4,489.21 " "$4,630.98 " BLEOMYCIN 30 UNITS REC VIAL [THAY] J9040 71288-0107-20 $210.06 $210.06 1 mL $149.14 $210.06 $210.06 $149.14 $201.66 $197.46 $199.56 $205.86 BORTEZOMIB (VELCADE) 3.5MG VIAL [THAY] J9041 63020-0049-01 "$3,127.76 " "$3,127.76 " 1 EA "$2,220.71 " "$3,127.76 " "$3,127.76 " "$2,220.71 " "$3,002.65 " "$2,940.09 " "$2,971.37 " "$3,065.20 " CABAZITAXEL (JEVTANA) 60 mg/1.5 mL Sol [THAY] J9043 00024-5824-11 "$19,805.47 " "$19,805.47 " 1.5 - "$14,061.88 " "$19,805.47 " "$19,805.47 " "$14,061.88 " "$19,013.25 " "$18,617.14 " "$18,815.19 " "$19,409.36 " CARBOplatin 10 mg/mL Sol J9045 00703-4246-01 $53.36 $53.36 1 mL $37.89 $53.36 $53.36 $37.89 $51.23 $50.16 $50.69 $52.29 CARBOplatin 10 mg/mL Sol J9045 00703-4239-01 $208.60 $208.60 60 mL $148.11 $208.60 $208.60 $148.11 $200.26 $196.08 $198.17 $204.43 CISplatin 50MG/50ML SOLN [THAY] J9060 16729-0288-11 $95.00 $95.00 50 mL $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 CYCLOPHOSPHAMIDE 500 MG VIAL [THAY] J9070 70121-1238-01 $841.12 $841.12 1 mL $597.20 $841.12 $841.12 $597.20 $807.48 $790.65 $799.06 $824.30 cyclophosphamide 1 g REC J9070 10019-0956-01 "$1,815.32 " "$1,815.32 " 1 mL "$1,288.88 " "$1,815.32 " "$1,815.32 " "$1,288.88 " "$1,742.71 " "$1,706.40 " "$1,724.55 " "$1,779.01 " cyclophosphamide 2 g REC J9070 10019-0957-01 "$2,862.80 " "$2,862.80 " 1 mL "$2,032.59 " "$2,862.80 " "$2,862.80 " "$2,032.59 " "$2,748.29 " "$2,691.03 " "$2,719.66 " "$2,805.54 " DOCEtaxel 20 mg/mL Sol J9171 16729-0267-63 $780.30 $780.30 1 mL $554.01 $780.30 $780.30 $554.01 $749.09 $733.48 $741.29 $764.69 DOCEtaxel 20 mg/mL Sol J9171 16729-0267-65 "$4,431.80 " "$4,431.80 " 8 mL "$3,146.58 " "$4,431.80 " "$4,431.80 " "$3,146.58 " "$4,254.53 " "$4,165.89 " "$4,210.21 " "$4,343.16 " ETOPOSIDE (TOPOSAR) 500MG/25ML VIAL [THAY] J9181 16729-0114-08 $163.70 $163.70 25 mL $116.23 $163.70 $163.70 $116.23 $157.15 $153.88 $155.52 $160.43 fluorouracil 50 mg/mL Sol J9190 63323-0117-51 $80.84 $80.84 50 mL $57.40 $80.84 $80.84 $57.40 $77.61 $75.99 $76.80 $79.22 fluorouracil 50 mg/mL Sol J9190 16729-0276-68 $81.88 $81.88 10 mL $58.13 $81.88 $81.88 $58.13 $78.60 $76.97 $77.79 $80.24 fluorouracil 50 mg/mL Sol J9190 16729-0276-67 $107.38 $107.38 20 mL $76.24 $107.38 $107.38 $76.24 $103.08 $100.94 $102.01 $105.23 fluorouracil 50 mg/mL Sol J9190 63323-0117-61 $111.68 $111.68 100 mL $79.29 $111.68 $111.68 $79.29 $107.21 $104.98 $106.10 $109.45 GEMCITABINE 1GRAM/10ML VIAL [THAY] J9201 16729-0419-03 $208.40 $208.40 10 mL $147.96 $208.40 $208.40 $147.96 $200.06 $195.90 $197.98 $204.23 GEMCITABINE 2 GRAM/20 ML VIAL [THAY] J9201 16729-0426-05 $331.60 $331.60 20 mL $235.44 $331.60 $331.60 $235.44 $318.34 $311.70 $315.02 $324.97 GOSERELIN (ZOLADEX) 3.6 MG IMPLANT [THAY] J9202 70720-0950-36 "$1,544.60 " "$1,544.60 " 1 EA "$1,096.67 " "$1,544.60 " "$1,544.60 " "$1,096.67 " "$1,482.82 " "$1,451.92 " "$1,467.37 " "$1,513.71 " GOSERELIN (ZOLADEX) 10.8 MG IMPLANT [THAY] J9202 70720-0951-30 "$3,480.35 " "$3,480.35 " 1 EA "$2,471.05 " "$3,480.35 " "$3,480.35 " "$2,471.05 " "$3,341.14 " "$3,271.53 " "$3,306.33 " "$3,410.74 " leuprolide 7.5 mg/month PWD J9217 62935-0753-75 "$1,104.06 " "$1,104.06 " 1 EA $783.88 "$1,104.06 " "$1,104.06 " $783.88 "$1,059.90 " "$1,037.82 " "$1,048.86 " "$1,081.98 " leuprolide 22.5 mg/3 months PWD J9217 62935-0223-05 "$2,621.73 " "$2,621.73 " 1 EA "$1,861.43 " "$2,621.73 " "$2,621.73 " "$1,861.43 " "$2,516.86 " "$2,464.42 " "$2,490.64 " "$2,569.29 " IPILIMUMAB (YERVOY) 50MG/10ML VIAL [THAY] J9228 00003-2327-11 "$13,552.54 " "$13,552.54 " 10 mL "$9,622.30 " "$13,552.54 " "$13,552.54 " "$9,622.30 " "$13,010.44 " "$12,739.39 " "$12,874.91 " "$13,281.49 " IPILIMUMAB (YERVOY) 200MG/40ML VIAL [THAY] J9228 00003-2328-22 "$54,060.01 " "$54,060.01 " 40 mL "$38,382.61 " "$54,060.01 " "$54,060.01 " "$38,382.61 " "$51,897.61 " "$50,816.41 " "$51,357.01 " "$52,978.81 " methotrexate 25 mg/mL preservative-free Sol J9250 16729-0277-30 $59.80 $59.80 2 mL $42.46 $59.80 $59.80 $42.46 $57.41 $56.21 $56.81 $58.60 Methotrexate sodium injection J9260 $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 OXALIPLATIN (ELOXATIN) 5 mg/mL 20 ML VIAL [THAY] J9263 60505-6132-07 $290.00 $290.00 20 mL $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 PACLITAXEL (TAXOL) 150MG/25ML VIAL [THAY] J9267 00703-4767-01 $208.40 $208.40 25 mL $147.96 $208.40 $208.40 $147.96 $200.06 $195.90 $197.98 $204.23 PACLitaxel 6 mg/mL Sol J9267 00703-3218-81 $290.00 $290.00 50 mL $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 PEMBROLIZUMAB (KEYTRUDA) 25 MG/ML SOL [THAY] J9271 00006-3026-02 "$6,917.89 " "$6,917.89 " 4 mL "$4,911.70 " "$6,917.89 " "$6,917.89 " "$4,911.70 " "$6,641.17 " "$6,502.81 " "$6,571.99 " "$6,779.53 " mitoMYcin 40 mg REC J9280 16729-0116-38 "$2,679.04 " "$2,679.04 " 1 EA "$1,902.12 " "$2,679.04 " "$2,679.04 " "$1,902.12 " "$2,571.88 " "$2,518.30 " "$2,545.09 " "$2,625.46 " NIVOLUMAB (OPDIVO) 100MG/10ML VIAL [THAY] J9299 00003-3774-12 "$4,985.33 " "$4,985.33 " 10 mL "$3,539.58 " "$4,985.33 " "$4,985.33 " "$3,539.58 " "$4,785.92 " "$4,686.21 " "$4,736.06 " "$4,885.62 " obinutuzumab 25 mg/mL Sol J9301 50242-0070-01 "$11,841.80 " "$11,841.80 " 40 mL "$8,407.68 " "$11,841.80 " "$11,841.80 " "$8,407.68 " "$11,368.13 " "$11,131.29 " "$11,249.71 " "$11,604.96 " PEMEtrexed 100 mg REC J9305 00002-7640-01 "$1,799.20 " "$1,799.20 " 1 mL "$1,277.43 " "$1,799.20 " "$1,799.20 " "$1,277.43 " "$1,727.23 " "$1,691.25 " "$1,709.24 " "$1,763.22 " PEMEtrexed 500 mg REC J9305 00002-7623-01 "$6,609.47 " "$6,609.47 " 1 mL "$4,692.72 " "$6,609.47 " "$6,609.47 " "$4,692.72 " "$6,345.09 " "$6,212.90 " "$6,279.00 " "$6,477.28 " PERTUZUMAB (PERJETA) 420MG/14ML SOL [THAY] J9306 50242-0145-01 "$9,298.16 " "$9,298.16 " 14 mL "$6,601.69 " "$9,298.16 " "$9,298.16 " "$6,601.69 " "$8,926.23 " "$8,740.27 " "$8,833.25 " "$9,112.20 " "hyaluronidase-rituximab 23,400 units-1400 mg/11.7 mL Sol" J9311 50242-0108-01 "$9,490.27 " "$9,490.27 " 11.7 mL "$6,738.09 " "$9,490.27 " "$9,490.27 " "$6,738.09 " "$9,110.66 " "$8,920.85 " "$9,015.76 " "$9,300.46 " riTUXimab (RITUXAN) 100 mg/ 10 mL VIAL [THAY] J9312 50242-0051-21 "$1,966.62 " "$1,966.62 " 10 mL "$1,396.30 " "$1,966.62 " "$1,966.62 " "$1,396.30 " "$1,887.96 " "$1,848.62 " "$1,868.29 " "$1,927.29 " riTUXimab (RITUXAN) 500 MG/50ML VIAL [THAY] J9312 50242-0053-06 "$8,505.68 " "$8,505.68 " 50 mL "$6,039.03 " "$8,505.68 " "$8,505.68 " "$6,039.03 " "$8,165.45 " "$7,995.34 " "$8,080.40 " "$8,335.57 " TRASTUZUMAB (HERCEPTIN) 150 MG VIAL [THAY] J9355 50242-0132-01 "$3,042.16 " "$3,042.16 " 1 mL "$2,159.93 " "$3,042.16 " "$3,042.16 " "$2,159.93 " "$2,920.47 " "$2,859.63 " "$2,890.05 " "$2,981.31 " vinCRIStine 1 mg/mL Sol [THAY] J9370 61703-0309-06 $63.80 $63.80 1 mL $45.30 $63.80 $63.80 $45.30 $61.25 $59.97 $60.61 $62.52 vinCRIStine 2 mg/ 2mL Sol [THAY] J9370 61703-0309-16 $75.64 $75.64 2 mL $53.70 $75.64 $75.64 $53.70 $72.61 $71.10 $71.86 $74.13 fulvestrant 50 mg/mL Sol J9395 25021-0462-74 "$3,540.29 " "$3,540.29 " 10 mL "$2,513.61 " "$3,540.29 " "$3,540.29 " "$2,513.61 " "$3,398.68 " "$3,327.87 " "$3,363.28 " "$3,469.48 " sacituzumab govitecan 180 mg REC J9999 55135-0132-01 "$3,671.60 " "$3,671.60 " 1 EA "$2,606.84 " "$3,671.60 " "$3,671.60 " "$2,606.84 " "$3,524.74 " "$3,451.30 " "$3,488.02 " "$3,598.17 " CERVICAL COLLAR 3 L0120 $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 CERVICAL COLLAR 4 L0120 $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 L0120 Cervical Collar L0120 $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 L0120 Cervical Collar 3 L0120 $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 L0120 Cervical Collar 4 L0120 $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 COLLAR STIFNECK ADUL L0140 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 COLLAR STIFNECK PEDS L0140 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 "COLLAR,STIFNECK INFA" L0140 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 L0140 Collar Stifneck Adult L0140 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 L0140 Collar Stifneck Infant L0140 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 L0140 Collar Stifneck Peds L0140 $248.00 $248.00 $176.08 $248.00 $248.00 $176.08 $238.08 $233.12 $235.60 $243.04 L0150 Stifneck Collar L0150 $34.00 $34.00 $24.14 $34.00 $34.00 $24.14 $32.64 $31.96 $32.30 $33.32 L0220 Rib Belt L0220 $396.00 $396.00 $281.16 $396.00 $396.00 $281.16 $380.16 $372.24 $376.20 $388.08 L0220 Rib Belt FEMALE Universal L0220 $396.00 $396.00 $281.16 $396.00 $396.00 $281.16 $380.16 $372.24 $376.20 $388.08 L0220 Rib Belt MALE Universal L0220 $396.00 $396.00 $281.16 $396.00 $396.00 $281.16 $380.16 $372.24 $376.20 $388.08 RIB BELT FEMALE UNIV L0220 $396.00 $396.00 $281.16 $396.00 $396.00 $281.16 $380.16 $372.24 $376.20 $388.08 RIB BELT MALE UNIV L0220 $396.00 $396.00 $281.16 $396.00 $396.00 $281.16 $380.16 $372.24 $376.20 $388.08 KNEE BRACE HINGED 2X L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 KNEE BRACE HINGED 3X L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 KNEE BRACE HINGED LG L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 KNEE BRACE HINGED MD L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 KNEE BRACE HINGED SM L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 KNEE BRACE HINGED XL L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 L1812 Knee Brace Hinged LG L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 L1812 Knee Brace Hinged MED L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 L1812 Knee Brace Hinged SM L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 L1812 Knee Brace Hinged XL L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 L1812 Knee Brace Hinged XXL L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 L1812 Knee Brace Hinged XXXL L1812 $290.00 $290.00 $205.90 $290.00 $290.00 $205.90 $278.40 $272.60 $275.50 $284.20 KNEE IMMOB/16 UNIV L1830 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 KNEE IMMOB/18 UNIV L1830 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 KNEE IMMOB/20 UNIV L1830 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 L1830 Canvas Knee Immobili L1830 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 L1830 Knee Immobilizer 16 Univ L1830 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 L1830 Knee Immobilizer 18 Univ L1830 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 L1830 Knee Immobilizer 20 Univ L1830 $264.00 $264.00 $187.44 $264.00 $264.00 $187.44 $253.44 $248.16 $250.80 $258.72 L1832 Hinged Knee Support L1832 $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 L1832 Patellar Knee Brace L1832 $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 L1832 Multi Peril Knee SPL L1832 $106.00 $106.00 $75.26 $106.00 $106.00 $75.26 $101.76 $99.64 $100.70 $103.88 ANKLE BRACE DJ LRG L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 ANKLE BRACE DJ MED L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 ANKLE BRACE DJ SM L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 ANKLE BRACE DJ XL L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 ANKLE BRACE DJ XSM L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 ANKLE BRACE DJ XXL L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 L1902 Ankle Brace DJ LG L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 L1902 Ankle Brace DJ SM L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 L1902 Ankle Brace DJ XL L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 L1902 Ankle Brace DJ XSM L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 L1902 Ankle Brace DJ XXL L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 L1902 Ankle Brace MED L1902 $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 Airform Ing Ank Charge L1906 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 Walker Boot L1930 $181.00 $181.00 $128.51 $181.00 $181.00 $128.51 $173.76 $170.14 $171.95 $177.38 L2116 Short Leg Equalizer L2116 $166.00 $166.00 $117.86 $166.00 $166.00 $117.86 $159.36 $156.04 $157.70 $162.68 KNEE BRACE PAT 2XL L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 KNEE BRACE PAT LG L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 KNEE BRACE PAT MD L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 KNEE BRACE PAT XL L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 L2795 Knee Brace Pat LG L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 L2795 Knee Brace Pat MED L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 L2795 Knee Brace Pat SM L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 L2795 Knee Brace Pat XL L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 L2795 Knee Brace Pat XXL L2795 $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 HEEL CUSHION LG/XL L3170 $157.00 $157.00 $111.47 $157.00 $157.00 $111.47 $150.72 $147.58 $149.15 $153.86 HEEL CUSHION SM/MED L3170 $157.00 $157.00 $111.47 $157.00 $157.00 $111.47 $150.72 $147.58 $149.15 $153.86 L3170 Heel Cushion LG/XL L3170 $157.00 $157.00 $111.47 $157.00 $157.00 $111.47 $150.72 $147.58 $149.15 $153.86 L3170 Heel Cushion SM/MED L3170 $157.00 $157.00 $111.47 $157.00 $157.00 $111.47 $150.72 $147.58 $149.15 $153.86 Bucks Boot Charge L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3260 Post-Op Shoe Female LG L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3260 Post-Op Shoe Female MED L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3260 Post-Op Shoe Female SM L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3260 Post-Op Shoe Male LG L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3260 Post-Op Shoe Male MED L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3260 Post-Op Shoe Male SM L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3260 Post-Op Shoe Male XL L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 POST OP SHOE FEM LG L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 POST OP SHOE FEM MED L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 POST OP SHOE FEM SM L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 POST OP SHOE MALE LG L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 POST OP SHOE MALE MD L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 POST OP SHOE MALE SM L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 POST OP SHOE MALE XL L3260 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 L3480 Heel Pads Cups L3480 $57.00 $57.00 $40.47 $57.00 $57.00 $40.47 $54.72 $53.58 $54.15 $55.86 L3485 Tulis Heel Cushion LG L3485 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 L3485 Tulis Heel Cushion REG L3485 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 TULIS HEEL CUP LG L3485 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 TULIS HEEL CUP REG L3485 $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 CLAVICLE SPLINT LRG L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 CLAVICLE SPLINT MED L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 CLAVICLE SPLINT PEDS L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 CLAVICLE SPLINT SM L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 CLAVICLE SPLINT XL L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Clavicle Splint LG L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Clavicle Splint MED L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Clavicle Splint PEDS L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Clavicle Splint SM L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Clavicle Splint XL L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Shoulder Immobilizer LG L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Shoulder Immobilizer MED L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Shoulder Immobilizer SM L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3650 Shoulder Immobilizer XL L3650 $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 L3660 Figure of 8 Splint L3660 $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 L3670 Arm Immobilizer L3670 $428.00 $428.00 $303.88 $428.00 $428.00 $303.88 $410.88 $402.32 $406.60 $419.44 L3670 Immobilizer Shoulder L3670 $428.00 $428.00 $303.88 $428.00 $428.00 $303.88 $410.88 $402.32 $406.60 $419.44 L3762 Tennis Elbow Strap L3762 $185.00 $185.00 $131.35 $185.00 $185.00 $131.35 $177.60 $173.90 $175.75 $181.30 TENNIS ELBOW STRAP L3762 $185.00 $185.00 $131.35 $185.00 $185.00 $131.35 $177.60 $173.90 $175.75 $181.30 L3808 Finger Splint L3808 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Cock up Splint L3908 $44.00 $44.00 $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 COCKUP SPLINT L LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT L MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT L XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT L XSM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT L/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT R LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT R MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT R SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT R XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 COCKUP SPLINT R XSM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint LT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint LT/MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint LT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint LT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint LT/XSM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint RT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint RT/MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint RT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint RT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Cock-up splint RT/XSM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint LT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint LT/MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint LT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint LT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint RT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint RT/MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint RT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Splint RT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint LT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint LT/MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint LT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint LT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint LT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint RT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint RT/MED L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint RT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3908 Wrist Thumb Splint RT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT LT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT LT/MD L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT LT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT LT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT RT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT RT/MD L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT RT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST SPLINT RT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT LT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT LT/MD L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT LT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT LT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT RT/LG L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT RT/MD L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT RT/SM L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 WRIST THUMB SPLINT RT/XL L3908 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 L3918 Galvanized Metal Brace LG L3918 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 L3918 Galvanized Metal Brace MED L3918 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 L3918 Galvanized Metal Brace SM L3918 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 L3918 Galvanized Metal Brace XL L3918 $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 L3931 Wrist Brace L3931 $36.00 $36.00 $25.56 $36.00 $36.00 $25.56 $34.56 $33.84 $34.20 $35.28 L3999 Stax Finger Splint 1 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 L3999 Stax Finger Splint 2 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 L3999 Stax Finger Splint 3 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 L3999 Stax Finger Splint 4 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 L3999 Stax Finger Splint 5 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 L3999 Stax Finger Splint 5.5 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 L3999 Stax Finger Splint 6 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 L3999 Stax Finger Splint 7 L3999 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 GEL ANKLE BRACE L4350 $259.00 $259.00 $183.89 $259.00 $259.00 $183.89 $248.64 $243.46 $246.05 $253.82 L4350 Gel Ankle Brace L4350 $259.00 $259.00 $183.89 $259.00 $259.00 $183.89 $248.64 $243.46 $246.05 $253.82 L4350 Gel Cast Splint L4350 $259.00 $259.00 $183.89 $259.00 $259.00 $183.89 $248.64 $243.46 $246.05 $253.82 L4387 Walking Boot SH LG L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 L4387 Walking Boot SH MED L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 L4387 Walking Boot SH SM L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 L4387 Walking Boot SH XL L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 L4387 Walking Boot TA LG L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 L4387 Walking Boot TA MED L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 L4387 Walking Boot TA SM L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 L4387 Walking Boot TA XL L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT SH LG L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT SH MED L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT SH SM L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT SH XL L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT TA LG L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT TA MED L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT TA SM L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 WALKING BOOT TA XL L4387 $490.00 $490.00 $347.90 $490.00 $490.00 $347.90 $470.40 $460.60 $465.50 $480.20 Aph RBC ACDA AS3 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 Aph RBC ACDA AS3 LR 1 P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 Aph RBC ACDA AS3 LR 2 P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 Aph RBC CP2D AS3 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 Aph RBC CP2D AS3 LR 1 P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 Aph RBC CP2D AS3 LR 2 P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CP2D AS3 450 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CP2D AS3 500 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CPD 500 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CPD AS1 450 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CPD AS1 500 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CPD AS5 450 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CPD AS5 500 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 RBC CPDA1 500 LR P9016 $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 Aph Plt ACDA LR P9035 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " Aph Plt ACDA LR <3 X log 11 P9035 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " Aph Plt ACDA LR 1 P9035 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " Aph Plt ACDA LR 2 P9035 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " Aph Plt ACDA LR 3 P9035 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " Aph Plt ACDA LR Var Con 1 P9035 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " Aph Plt ACDA PASC LR Cnt 2 P9035 "$1,176.00 " "$1,176.00 " $834.96 "$1,176.00 " "$1,176.00 " $834.96 "$1,128.96 " "$1,105.44 " "$1,117.20 " "$1,152.48 " Aph Plt ACDA LR Irr P9037 "$1,302.00 " "$1,302.00 " $924.42 "$1,302.00 " "$1,302.00 " $924.42 "$1,249.92 " "$1,223.88 " "$1,236.90 " "$1,275.96 " Aph Plt ACDA LR Irr <3 X log 11 1 P9037 "$1,302.00 " "$1,302.00 " $924.42 "$1,302.00 " "$1,302.00 " $924.42 "$1,249.92 " "$1,223.88 " "$1,236.90 " "$1,275.96 " Aph Plt ACDA LR Irr <3 X log 11 2 P9037 "$1,302.00 " "$1,302.00 " $924.42 "$1,302.00 " "$1,302.00 " $924.42 "$1,249.92 " "$1,223.88 " "$1,236.90 " "$1,275.96 " Aph Plt ACDA LR Irr 1 P9037 "$1,302.00 " "$1,302.00 " $924.42 "$1,302.00 " "$1,302.00 " $924.42 "$1,249.92 " "$1,223.88 " "$1,236.90 " "$1,275.96 " Aph Plt ACDA LR Irr 2 P9037 "$1,302.00 " "$1,302.00 " $924.42 "$1,302.00 " "$1,302.00 " $924.42 "$1,249.92 " "$1,223.88 " "$1,236.90 " "$1,275.96 " Aph Plt ACDA LR Irr 3 P9037 "$1,302.00 " "$1,302.00 " $924.42 "$1,302.00 " "$1,302.00 " $924.42 "$1,249.92 " "$1,223.88 " "$1,236.90 " "$1,275.96 " Aph Plt ACDA LR Irr Var Con P9037 "$1,302.00 " "$1,302.00 " $924.42 "$1,302.00 " "$1,302.00 " $924.42 "$1,249.92 " "$1,223.88 " "$1,236.90 " "$1,275.96 " Aph RBC ACDA AS3 LR Irr P9040 $616.00 $616.00 $437.36 $616.00 $616.00 $437.36 $591.36 $579.04 $585.20 $603.68 Aph RBC ACDA AS3 LR Irr 1 P9040 $616.00 $616.00 $437.36 $616.00 $616.00 $437.36 $591.36 $579.04 $585.20 $603.68 Aph RBC CP2D AS3 LR Irr P9040 $616.00 $616.00 $437.36 $616.00 $616.00 $437.36 $591.36 $579.04 $585.20 $603.68 Aph RBC CP2D AS3 LR Irr 1 P9040 $616.00 $616.00 $437.36 $616.00 $616.00 $437.36 $591.36 $579.04 $585.20 $603.68 Aph RBC CP2D AS3 LR Irr 2 P9040 $616.00 $616.00 $437.36 $616.00 $616.00 $437.36 $591.36 $579.04 $585.20 $603.68 RBC CPD AS1 450 LR Irr P9040 $616.00 $616.00 $437.36 $616.00 $616.00 $437.36 $591.36 $579.04 $585.20 $603.68 RBC CPD AS1 500 LR Irr P9040 $616.00 $616.00 $437.36 $616.00 $616.00 $437.36 $591.36 $579.04 $585.20 $603.68 IV INFUS EA ADD HOUR Q0081 $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 IV Infusion 1st Hour Q0081 $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 CHEMO IV - 3 HRS Q0084 $515.00 $515.00 $365.65 $515.00 $515.00 $365.65 $494.40 $484.10 $489.25 $504.70 CHEMO IV 0-2 HOURS Q0084 $515.00 $515.00 $365.65 $515.00 $515.00 $365.65 $494.40 $484.10 $489.25 $504.70 CHEMO 2 TECHN 0-2HRS Q0085 $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 CHEMO 2 TECHN 3 HRS Q0085 $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 CHEMO 2 TECHN 4 HRS Q0085 $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 CHEMO 2 TECHN 5 HRS Q0085 $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 CHEMO 2 TECHN 6 HRS Q0085 $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 Obtaining Pap Smear Collection Q0091 $84.00 $84.00 $59.64 $84.00 $84.00 $59.64 $80.64 $78.96 $79.80 $82.32 AZITHROMYCIN (ZITHROMAX) 250MG TAB [THAY] Q0144 00781-5776-26 $4.46 $4.46 1 tab(s) $3.17 $4.46 $4.46 $3.17 $4.28 $4.19 $4.24 $4.37 AZITHROMYCIN (ZITHROMAX) 250MG TAB [THAY] Q0144 00904-6405-06 $9.35 $9.35 1 tab(s) $6.64 $9.35 $9.35 $6.64 $8.98 $8.79 $8.88 $9.16 AZITHROMYCIN (ZITHROMAX) 250MG TAB [THAY] Q0144 59762-3060-03 $11.66 $11.66 1 tab(s) $8.28 $11.66 $11.66 $8.28 $11.19 $10.96 $11.08 $11.43 AZITHROMYCIN(ZITHROMAX)100MG/5ML 15ML [THAY] Q0144 00093-2027-23 $73.26 $73.26 15 mL $52.01 $73.26 $73.26 $52.01 $70.33 $68.86 $69.60 $71.79 AZITHROMYCIN(ZITHROMAX)100MG/5ML 15ML [THAY] Q0144 42806-0147-31 $73.26 $73.26 15 mL $52.01 $73.26 $73.26 $52.01 $70.33 $68.86 $69.60 $71.79 AZITHROMYCIN (ZITHROMAX) 200MG/5ML 30ML [THAY] Q0144 00093-2026-31 $73.26 $73.26 30 mL $52.01 $73.26 $73.26 $52.01 $70.33 $68.86 $69.60 $71.79 DIPHENHYDRAMINE (BENADRYL) 25MG CAP [THAY] Q0163 00904-5306-61 $3.59 $3.59 1 cap(s) $2.55 $3.59 $3.59 $2.55 $3.44 $3.37 $3.41 $3.51 DIPHENHYDRAMINE(BENADRYL)25MG/10ML PO [THAY] Q0163 00121-0489-10 $7.16 $7.16 10 mL $5.08 $7.16 $7.16 $5.08 $6.87 $6.73 $6.80 $7.02 DIPHENHYDRAMINE(BENADRYL)25MG/10ML PO [THAY] Q0163 00121-0978-00 $10.34 $10.34 10 mL $7.34 $10.34 $10.34 $7.34 $9.93 $9.72 $9.82 $10.13 PROCHLORPERAZINE(COMPAZINE)10MG TAB [THAY] Q0164 00378-5110-01 $5.29 $5.29 1 tab(s) $3.76 $5.29 $5.29 $3.76 $5.08 $4.97 $5.03 $5.18 PROCHLORPERAZINE(COMPAZINE)10MG TAB [THAY] Q0164 51079-0542-20 $5.44 $5.44 1 tab(s) $3.86 $5.44 $5.44 $3.86 $5.23 $5.12 $5.17 $5.33 PROCHLORPERAZINE(COMPAZINE)10MG TAB [THAY] Q0164 50268-0685-15 $5.60 $5.60 1 tab(s) $3.97 $5.60 $5.60 $3.97 $5.37 $5.26 $5.32 $5.49 PROMETHAZINE(PHENERGAN)25MG TAB [THAY] Q0169 51079-0895-20 $4.55 $4.55 1 tab(s) $3.23 $4.55 $4.55 $3.23 $4.37 $4.28 $4.32 $4.46 PROMETHAZINE(PHENERGAN)25MG TAB [THAY] Q0169 68084-0155-01 $4.58 $4.58 1 tab(s) $3.25 $4.58 $4.58 $3.25 $4.40 $4.31 $4.35 $4.49 PROMETHAZINE(PHENERGAN)25MG TAB [THAY] Q0169 00904-6461-61 $5.40 $5.40 1 tab(s) $3.84 $5.40 $5.40 $3.84 $5.19 $5.08 $5.13 $5.30 fosphenytoin 500 mgPE/10 mL Sol Q2009 00069-6001-21 $258.84 $258.84 10 mL $183.78 $258.84 $258.84 $183.78 $248.49 $243.31 $245.90 $253.67 Q3014 Originating Site - Telehealth Q3014 $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 TELEHEALTH SITE FEE Q3014 $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 Telehealth Facility Fee Q3014 $53.00 $- $- $- $- $- $- $- $- FINGER COT 1.5 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FINGER COT 2.25 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FINGER COT 3.25 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FINGER COT 3.75 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FINGER SPLINT 1.5 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FINGER SPLINT 3 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FINGER SPLINT 4 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FINGER SPLINT 6 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 GALV MET BRACE LG Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 GALV MET BRACE MD Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 GALV MET BRACE SM Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 GALV MET BRACE XL Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Cot 1.5 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Cot 2.25 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Cot 3.25 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Cot 3.75 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Splint 1.5 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Splint 3 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Splint 4 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 Q4049 Finger Splint 6 Q4049 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 IOPAMIDOL (ISOVUE-M 200) 20ML SOLN [THAY] Q9966 00270-1411-25 $30.62 $30.62 1 mL $21.74 $30.62 $30.62 $21.74 $29.40 $28.79 $29.09 $30.01 IOPAMIDOL (ISOVUE-M 200) 10ML SOLN [THAY] Q9966 00270-1411-11 $35.51 $35.51 1 mL $25.21 $35.51 $35.51 $25.21 $34.09 $33.38 $33.73 $34.80 OMNIPAQUE 240MG/ML 20ML [THAY] Q9966 00407-1412-20 $255.25 $255.25 20 mL $181.22 $255.25 $255.25 $181.22 $245.04 $239.93 $242.48 $250.14 IOPAMIDOL (ISOVUE) 300 100ML BOTTLE [THAY] Q9967 00270-1315-35 $- $- 100 mL $- $- $- $- $- $- $- $- IOPAMIDOL (ISOVUE) 370 100ML BOTTLE [THAY] Q9967 00270-1316-35 $- $- 100 mL $- $- $- $- $- $- $- $- OPTIRAY 320MG/ML 100ML BOT [THAY] Q9967 00019-1323-11 $228.80 $228.80 100 mL $162.45 $228.80 $228.80 $162.45 $219.65 $215.07 $217.36 $224.22 OPTIRAY 320 100ML PI SYRINGE [THAY] Q9967 00019-1323-83 $255.20 $255.20 100 mL $181.19 $255.20 $255.20 $181.19 $244.99 $239.89 $242.44 $250.10 OPTIRAY 320 125ML PI SRYINGE [THAY] Q9967 00019-1323-81 $306.80 $306.80 125 mL $217.83 $306.80 $306.80 $217.83 $294.53 $288.39 $291.46 $300.66 METHYLENE BLUE 1% 10MG/ML VIAL [THAY] Q9968 00517-0301-10 $35.00 $35.00 1 mL $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 METHYLENE BLUE 1% 10MG/ML VIAL [THAY] Q9968 17478-0504-10 $61.25 $61.25 1 mL $43.49 $61.25 $61.25 $43.49 $58.80 $57.58 $58.19 $60.03 METHYLENE BLUE 0.5% 50MG/10 ML AMP [THAY] Q9968 00517-0374-05 $515.86 $515.86 10 mL $366.26 $515.86 $515.86 $366.26 $495.23 $484.91 $490.07 $505.55 FAMOTIDINE (PEPCID) 20MG/2ML VIAL [THAY] S0028 63323-0739-16 $21.75 $21.75 2 mL $15.44 $21.75 $21.75 $15.44 $20.88 $20.45 $20.66 $21.32 FAMOTIDINE (PEPCID) 20MG/2ML VIAL [THAY] S0028 00641-6022-25 $21.89 $21.89 2 mL $15.54 $21.89 $21.89 $15.54 $21.02 $20.58 $20.80 $21.45 FAMOTIDINE (PEPCID) 20MG/2ML VIAL [THAY] S0028 63323-0739-12 $22.20 $22.20 2 mL $15.76 $22.20 $22.20 $15.76 $21.31 $20.87 $21.09 $21.76 FAMOTIDINE (PEPCID) 20 MG/50ML PREMIX [THAY] S0028 00338-5197-41 $43.04 $43.04 50 mL $30.56 $43.04 $43.04 $30.56 $41.32 $40.46 $40.89 $42.18 AZTREONAM (AZACTAM) 1000MG VIAL [THAY] S0073 00003-2560-16 $89.60 $89.60 1 EA $63.62 $89.60 $89.60 $63.62 $86.02 $84.22 $85.12 $87.81 BUPROPION(WELLBUTRIN)SR 150MG/12HR TAB [THAY] S0106 00904-6585-61 $4.91 $4.91 1 tab(s) $3.48 $4.91 $4.91 $3.48 $4.71 $4.61 $4.66 $4.81 BUPROPION(WELLBUTRIN)SR 150MG/12HR TAB [THAY] S0106 51079-0392-20 $7.12 $7.12 1 tab(s) $5.06 $7.12 $7.12 $5.06 $6.84 $6.69 $6.76 $6.98 ONDANSETRON HCL (ZOFRAN) 4MG TAB [THAY] S0119 51079-0524-20 $4.76 $4.76 1 tab(s) $3.38 $4.76 $4.76 $3.38 $4.57 $4.47 $4.52 $4.66 ONDANSETRON HCL (ZOFRAN) 4MG TAB [THAY] S0119 00904-6551-61 $4.99 $4.99 1 tab(s) $3.54 $4.99 $4.99 $3.54 $4.79 $4.69 $4.74 $4.89 MEGESTROL ACETATE(MEGACE)400MG/10ML ORAL SUSP [THAY] S0179 00121-4776-10 $12.55 $12.55 10 mL $8.91 $12.55 $12.55 $8.91 $12.05 $11.80 $11.92 $12.30 MISOPROSTOL (CYTOTEC) 100MCG TAB [THAY] S0191 68084-0040-01 $6.77 $6.77 1 tab(s) $4.81 $6.77 $6.77 $4.81 $6.50 $6.36 $6.43 $6.63 IUD CONTRACEP MIRENA S4989 $826.00 $- $- $- $- $- $- $- $- S8451 Wrist Splint Futuro S8451 $36.00 $36.00 $25.56 $36.00 $36.00 $25.56 $34.56 $33.84 $34.20 $35.28 ROOM/BED: DIETARY MEDICAID 30M S9470 $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 Bill Only - Coronavirus-CDC U0001 $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 Bill Only - Coronavirus-nonCDC U0002 $250.00 $250.00 $177.50 $250.00 $250.00 $177.50 $240.00 $235.00 $237.50 $245.00 Bill Only SARS COV2 U0003 $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 remdesivir 100 mg REC XW033E5 61958-2901-01 "$1,268.00 " "$1,268.00 " 1 mL $900.28 "$1,268.00 " "$1,268.00 " $900.28 "$1,217.28 " "$1,191.92 " "$1,204.60 " "$1,242.64 " Sterile Water Diluent 0.7 mL [THAY] 00006-4309-00 $- $- 1 mL $- $- $- $- $- $- $- $- potassium chloride 10 mEq Soln 99999-0000-98 $- $- 1 - $- $- $- $- $- $- $- $- Sodium Chloride 0.9% 1 mL Soln 99999-0000-99 $- $- 1 mL $- $- $- $- $- $- $- $- Do Not Use - Magnesium Sulfate Premix Additive [THAY] 9999-999-12 $- $- 1 - $- $- $- $- $- $- $- $- Non-Formulary Patient's Own Medication [THAY] 99999-9999-02 $- $- 1 EA $- $- $- $- $- $- $- $- Do Not Use - Amiodarone Premix Additive [THAY] 99999-9999-03 $- $- 1 - $- $- $- $- $- $- $- $- Do Not Use - Acetylcysteine Premix Additive [THAY] 99999-9999-04 $- $- 1 - $- $- $- $- $- $- $- $- Do Not Use - DOPamine Premix Additive [THAY] 99999-9999-05 $- $- 1 - $- $- $- $- $- $- $- $- Do Not Use - DOBUTamine Premix Additive [THAY] 99999-9999-06 $- $- 1 - $- $- $- $- $- $- $- $- Do Not Use - Nitroglycerin Premix Additive [THAY] 99999-9999-10 $- $- 1 - $- $- $- $- $- $- $- $- Do Not Use - Dextrose 5% Premix Diluent [THAY] 99999-9999-11 $- $- 1 mL $- $- $- $- $- $- $- $- Do Not Use - Sterile Water Premix Diluent [THAY] 99999-9999-12 $- $- 1 mL $- $- $- $- $- $- $- $- Do Not Use - Normal Saline 0.45% Premix Diluent [THAY] 99999-9999-13 $- $- 1 mL $- $- $- $- $- $- $- $- Estradiol Patch Removal [THAY] 99999-9999-14 $- $- 1 EA $- $- $- $- $- $- $- $- Fentanyl Patch Removal [THAY] 99999-9999-15 $- $- 1 EA $- $- $- $- $- $- $- $- Nicotine Patch Removal [THAY] 99999-9999-16 $- $- 1 EA $- $- $- $- $- $- $- $- Nitroglycerin Patch Removal [THAY] 99999-9999-17 $- $- 1 EA $- $- $- $- $- $- $- $- Nursing Note 1 EA No Default 99999-9999-91 $- $- 1 EA $- $- $- $- $- $- $- $- STAX 1 $2.00 $2.00 $1.42 $2.00 $2.00 $1.42 $1.92 $1.88 $1.90 $1.96 ABD PAD $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 ACE BAND 2 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 ACE BAND 3 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 ADAPTIC 3X8 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 ALGER BRUSH $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 BET SWABS PKG/3 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 BLADE SURGICAL 10 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 BLADE SURGICAL 11 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 BLADE SURGICAL 15 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 BULB SYRINGE $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 CASTILE SOAP $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 CATH PLUG $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 CAUTERY TIP CLEANER PAD $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 COBAN 2 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 EYE PAD $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 FIBEROPTIC BLADE DISP $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 GRADUATE $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 HAND EXERCISER BLUE $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 HAND EXERCISER YELLO $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 HEMOCCULT CARD $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 HONAN BALLOON $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 ISLAND DRESSING 4X10 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 ISLAND DRESSING 4X5 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 KERLIX $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 KLING 2 ST $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 KLING 3 ST $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 KLING 4 ST $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 KLING 6 ST $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 LEMON SWABS EACH $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 MARKING PEN ST $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 MASK AEROSOL ADULT $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 MASK AEROSOL PEDS $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 MINILOC ANCHOR OR $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 NASAL CANNULA $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 NEBULIZER TUBING $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 PEG TUBE TRAY LAPAROSCOPIC $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 RED ROBINSON CATH 10 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 RED ROBINSON CATH 12 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 RED ROBINSON CATH 14 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 RED ROBINSON CATH 16 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 RED ROBINSON CATH 18 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 RED ROBINSON CATH 8F $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 RING CUTTER $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SHOE PRESSURE RELIEF/DIABETIC/PT $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SHOULDER TIGERTAPE/HURLBUT $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SHOULDER/ARTHREX INSTRUMENTS $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SP CRUISE CONTROL TU $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SP PHACO HANDPIECE E $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SP PHACO NEEDLE SLEE $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SP PUPIL DILATORS $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SPECIPAN $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SPONGE 2x2 EA $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SPONGE 4X4 EA $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SPONGE 4X4 PKG/10 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SPONGE DRAIN $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SPONGE RATEX PKG 10 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SPONGE TOPPER COVER $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 STERIS V-PRO STRIP $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 STERISTRIP 1/4 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 STERISTRIP 1/8 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SUCTION CATH 14FR $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 SUCTION CATH 6FR $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 TEGADERM IV $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 TELFA 2x3 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 TELFA 3X4 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 TELFA 3X8 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 TUBING O2 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 URINE STRAINER $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 WALKER WHEELS $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 WEE BAG $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 WEEKLEY RED ROB 12FR $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 XEROFORM 2X2 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 XEROFORM 5X9 $4.00 $4.00 $2.84 $4.00 $4.00 $2.84 $3.84 $3.76 $3.80 $3.92 ACE BAND 4 $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 COBAN 3 $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 GREEN FOAM BLOCK/OT $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 HAND EXERCISER GREEN $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 HAND EXERCISER PINK $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 IV BUTTERFLY 23G $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 MASK NON-REBR $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 MAYO COVER $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 MEDIPORE DRESSING $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 STERIDRAPE 1000/102 $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 STERISTRIP 1/2 $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 SUTURE REMOVAL KIT $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 VASELINE GAUZE 1X8 $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 LIGHT HANDLE COVER/GREEN $5.00 $5.00 $3.55 $5.00 $5.00 $3.55 $4.80 $4.70 $4.75 $4.90 ACE BAND 6 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 ASEPTO SYRINGE $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 BACK TABLE COVER $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 CLEAN TRAY BASIN $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 DRAPE SHEET $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 ENDOTRACH TUBE 2.5 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 ENDOTRACH TUBE 3.5 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 ENEMA $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 FEEDING TUBE 10FR $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 FEEDING TUBE 12FR $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 FEEDING TUBE 8FR $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 HYFRECATOR TIP $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 ICE BAG $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 MASK AEROSOL WESTMED $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 NASAL CANNULA PEDS $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 NEEDLE BOOK $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 PENROSE DRAIN $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 SECONDARY TUBING $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 SHAVE PREP TRAY $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 SHOE STRINGS WH 36 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 SPONGE LAP PKG 5 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAPLE REMOVER $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAX 2 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAX 3 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAX 4 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAX 5 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAX 5.5 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAX 6 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 STAX 7 $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 VENTED SPIKE ADAPTER $6.00 $6.00 $4.26 $6.00 $6.00 $4.26 $5.76 $5.64 $5.70 $5.88 OXYCODONE/APAP (PERCOCET) 5/325MG TAB [THAY] 00406-0512-62 $6.24 $6.24 1 tab(s) $4.43 $6.24 $6.24 $4.43 $5.99 $5.86 $5.93 $6.11 OXYCODONE/APAP (PERCOCET) 5/325MG TAB [THAY] 00904-6437-61 $6.24 $6.24 1 tab(s) $4.43 $6.24 $6.24 $4.43 $5.99 $5.86 $5.93 $6.11 OXYCODONE/APAP (PERCOCET) 5/325MG TAB [THAY] 68084-0355-01 $6.27 $6.27 1 tab(s) $4.45 $6.27 $6.27 $4.45 $6.02 $5.89 $5.96 $6.14 BITE BLOCK OR $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 DUODERM 4X4 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 ENEMA BUCKET $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 FOOTPRINTER $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 HUMIDIFIER PREF $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 LITE HANDLE COVER $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 SHOE STRINGS BL 36 $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 SILK 0 TIE $7.00 $7.00 $4.97 $7.00 $7.00 $4.97 $6.72 $6.58 $6.65 $6.86 BENDABLE CONTOUR SPONGE $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOTRACH TUBE 4.0 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOTRACH TUBE 5.5 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOTRACH TUBE 6.0 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOTRACH TUBE 7.0 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOTRACH TUBE 7.5 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOTRACH TUBE 8.0 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOTRACH TUBE 8.5 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 IRRIG SOD CHL 500ML $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 IRRIGATION TRAY $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 IV INJECTION CAP $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 MARKING PEN PERMANENT $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 PACKING STRIP 1/2 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 PACKING STRIP 1/4 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 PLASTER ROLL/SPEC CLINIC $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 SILK 2-0 SH $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 SILK 3-0 SH $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 TOWELS ST PKG 4 $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 TRAY ST CATH $8.00 $8.00 $5.68 $8.00 $8.00 $5.68 $7.68 $7.52 $7.60 $7.84 ENDOFOG $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 ENDOTRACH TUBE 3.0 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 ENDOTRACH TUBE 4.5 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 ENDOTRACH TUBE 5.0 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 ENDOTRACH TUBE 6.5 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 FEEDING TUBE 3FR $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 FOLEY CATH TRAY $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 IV CATH 16G $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 IV CATH 18G BD $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 IV CATH 18G PP $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 IV CATH 20G BD $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 IV CATH 22G BD $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 IV CATH 24G BD $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 MASTISOL/BENZOIN $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 MEDIPORE SURGERY $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 PACKING STRIP 1 PL $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 QUICK CATH FEMALE $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 SCALPEL DISP W/HANDLE 10 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 SCALPEL DISP W/HANDLE 11 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 SCALPEL DISP W/HANDLE 15 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 SILK 4-0 RB-1 $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 SITZ BATH $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 STOPCOCK 3 WAY $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 VICRYL 2-0 SH $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 VICRYL 3-0 SH $9.00 $9.00 $6.39 $9.00 $9.00 $6.39 $8.64 $8.46 $8.55 $8.82 BILIMASK $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 HEEL LIFT LS5 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 HEEL LIFT LS7 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 HEEL LIFT ML5 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 HEEL LIFT ML7 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 HEEL LIFT ML9 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 HEEL LIFT MS5 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 HEEL LIFT MS7 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 SILK 2-0 FSL $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 TRAY PREP $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 UMBILICAL TAPE $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 VICRYL 0 CT-1 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 VICRYL 2-0 CT-1 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 VICRYL 2-0 CT-2 J333 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 VICRYL 3-0 CT-1 $10.00 $10.00 $7.10 $10.00 $10.00 $7.10 $9.60 $9.40 $9.50 $9.80 COBAN 4 ST $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 ETHIBOND 0 CT-1 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 HEEL LIFT LL5 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 HEEL LIFT ML12 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 HEEL LIFT MS9 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 IV CATH 20G PP $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 IV CATH 22G PP $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 IV J-LOOP $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 KANGAROO SPIKE SYSTEM $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 LEG LIFTER/RIDGED $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 PACKING STRIP 1 IOD $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 SILK 4-0 FS-2 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 SPLIT DRAPE OR $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 VICRYL 0 CT-2 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 VICRYL 1 CT-1 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 VICRYL 2-0 CTX $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 VICRYL O UR-6 $10.01 $10.01 $7.11 $10.01 $10.01 $7.11 $9.61 $9.41 $9.51 $9.81 ACE BAND 6 DOUBLE $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 CATH TUBE HOLDER $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 DERMAL BIOPSY PUNCH $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 ETHILON 3-0 FS-1 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 FILTER TUBING 1.2 MICRON $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 LEGGINGS/OR $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 ONDANSETRON INJECTION PER 1MG $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 SHOE HORN SHORT $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 SPONGE PEANUT PK 5 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 TED HOSE KNEE SM $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 VICRYL 1 CT-1 CP $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 VICRYL 3-0 TIE $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 VICRYL PLUS 2-0 CT-1 $11.00 $11.00 $7.81 $11.00 $11.00 $7.81 $10.56 $10.34 $10.45 $10.78 TUCKS PADS [THAY] 04200-2302-68 $11.80 $11.80 1 EA $8.38 $11.80 $11.80 $8.38 $11.33 $11.09 $11.21 $11.56 BD INFUSER TUBING $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 CHROMIC 2-0 SH $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 CLIPPER BLADE 3M $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 ELECTRODE TENS 2X3.5 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 FOLEY CATH 28FR 30CC $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 IV CATH 24PP $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 LEG BAG $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 PACKING STRIP 2 PL $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 PI TUBING $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 SILK 2-0 TIE $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 SILK 3-0 TIE $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 SPIROMETER INCENT $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 TED HOSE KNEE LG $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 TED HOSE KNEE MED $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 TED HOSE KNEE XL $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 THERAPUTTY GREEN $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 THERAPUTTY RED $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 THERAPUTTY YELLOW $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 VICRYL 3-0 FS-2 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 VICRYL 4-0 FS-2 $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 VICRYL 4-0 KEITH NEEDLE $12.00 $12.00 $8.52 $12.00 $12.00 $8.52 $11.52 $11.28 $11.40 $11.76 CHROMIC 3-0 REEL $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 FOLEY BAG $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 IV CATH 14G $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 PROLENE 0 CT-1 $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 PROLENE 3-0 FSL $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 SILK 3-0 FS-1 $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 VICRYL 2 TP1 $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 VICRYL 2-0 FS-1 $13.00 $13.00 $9.23 $13.00 $13.00 $9.23 $12.48 $12.22 $12.35 $12.74 ALLEVYN 3X3 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 MESALT $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 NEWGEL/OT $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 PROLENE 2-0 CT-1 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 PROLENE 2-0 CT-2 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 PROLENE 3-0 FS-1 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 SHOE HORN LONG $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 STERIDRAPE 1015 $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 STOCKINETTE DISP $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 SUCTION TIP POOLE $14.00 $14.00 $9.94 $14.00 $14.00 $9.94 $13.44 $13.16 $13.30 $13.72 COMPRESSION GLOVE LG LT $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 COMPRESSION GLOVE LG RT $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 COMPRESSION GLOVE SM LT $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 COMPRESSION GLOVE SM RT $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 FOLEY CATH 24FR 5CC $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 INTUBATION STYLET LG $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 INTUBATION STYLET SM $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 PDS 3-0 SH $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 PDS11 0 CT-1 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 REACHER $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 SPONGE TONSIL $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 VICRYL 3-0 V-34 $15.00 $15.00 $10.65 $15.00 $15.00 $10.65 $14.40 $14.10 $14.25 $14.70 ANES MASK #4 $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 BIPAP FILTER $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 CHROMIC 3-0 SH $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 ELECTRODE TENS 2X2 $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 10FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 12FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 14FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 16FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 18FR 30CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 18FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 20FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 22FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 FOLEY CATH 8FR 5CC $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 IRRIG WATER 1000ML $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 IRRIG WATER 500ML $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 PDS11 4-0 FS-2 $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 PROLENE 4-0 FS-2 $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 PROLENE 5-0 FS-2 $16.00 $16.00 $11.36 $16.00 $16.00 $11.36 $15.36 $15.04 $15.20 $15.68 ARTIFLEX $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 CHROMIC 4-0 SH $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 ET TUBE HOLDER ADULT $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 HUBER NEEDLE 20G 1 $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 LIGACLIP $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 PILL ORGANIZER/OT $17.00 $17.00 $12.07 $17.00 $17.00 $12.07 $16.32 $15.98 $16.15 $16.66 BIPOLAR FORCEP CORD $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 ELASTOPLAST $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 FILTER TUBING $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 FOLEY CATH 24FR 30CC $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 FOLEY CATH 26FR 30CC $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 FOLEY CATH 30FR 30CC $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 HEEL LIFT LARGE $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 HEEL LIFT LG/SPEC $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 HEEL LIFT LS12 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 HEEL LIFT MS12 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 HUBER NEEDLE 20G .75 $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 NG TUBE 14FR $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 NG TUBE 16FR $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 NG TUBE 18FR $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 ORTHO SUCTION TUBE $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 RUBBER MASSAGE BRUSH-OT $18.00 $18.00 $12.78 $18.00 $18.00 $12.78 $17.28 $16.92 $17.10 $17.64 COBAN 6 ST $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 EDEMA GLOVE L MD $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 EDEMA GLOVE R MD $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 HEEL LIFT SM/SPEC $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 HEEL LIFT SMALL $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 PROLENE 3-0 SH $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 STREP A TEST $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 VICRYL 2-0 XLH J581G $19.00 $19.00 $13.49 $19.00 $19.00 $13.49 $18.24 $17.86 $18.05 $18.62 CAUTERY EXTENSION/OR $19.32 $19.32 $13.72 $19.32 $19.32 $13.72 $18.55 $18.16 $18.35 $18.93 Do Not Use - Eptifibatide Premix Additive [THAY] 99999-9999-07 $20.00 $20.00 1 - $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 Do Not Use - Lidocaine Premix Additive [THAY] 99999-9999-09 $20.00 $20.00 1 - $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 CHROMIC 0 LIGAPAK $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 DURAPREP $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 ET TUBE HOLDER PEDS $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 HEEL LIFT LL12 $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 IRRIG SOD CHL 1000ML $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 OXYMASK/OR $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 STAPLER SKIN SM $20.00 $20.00 $14.20 $20.00 $20.00 $14.20 $19.20 $18.80 $19.00 $19.60 COMPRILAN 6CM $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 ELASTOMULL 2 $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 HAND HELPER ROLYAN $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 HEEL LIFT MD/SPEC $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 HEEL LIFT MEDIUM $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 TED HOSE THIGH SM $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 OXYGEN HR CHARGE $21.00 $21.00 $14.91 $21.00 $21.00 $14.91 $20.16 $19.74 $19.95 $20.58 ALLEVYN 5X5 $22.00 $22.00 $15.62 $22.00 $22.00 $15.62 $21.12 $20.68 $20.90 $21.56 ETHILON 4-0 PS-2 $22.00 $22.00 $15.62 $22.00 $22.00 $15.62 $21.12 $20.68 $20.90 $21.56 FOLEY CATH 20FR 30CC $22.00 $22.00 $15.62 $22.00 $22.00 $15.62 $21.12 $20.68 $20.90 $21.56 FOLEY CATH 22FR 30CC $22.00 $22.00 $15.62 $22.00 $22.00 $15.62 $21.12 $20.68 $20.90 $21.56 TED HOSE THIGH LG $22.00 $22.00 $15.62 $22.00 $22.00 $15.62 $21.12 $20.68 $20.90 $21.56 TED HOSE THIGH MED $22.00 $22.00 $15.62 $22.00 $22.00 $15.62 $21.12 $20.68 $20.90 $21.56 TED HOSE THIGH XL $22.00 $22.00 $15.62 $22.00 $22.00 $15.62 $21.12 $20.68 $20.90 $21.56 NIPPLE SHIELD $22.51 $22.51 $15.98 $22.51 $22.51 $15.98 $21.61 $21.16 $21.38 $22.06 SCAR MASSAGE TOOL $22.51 $22.51 $15.98 $22.51 $22.51 $15.98 $21.61 $21.16 $21.38 $22.06 VICRYL 4-0 P-3 $22.51 $22.51 $15.98 $22.51 $22.51 $15.98 $21.61 $21.16 $21.38 $22.06 CPM MACHINE CHARGE $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 ELECTRODE IONTO MD $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 EXTREMITY DRAPE $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 FOREHEAD TEMPERATURE INDICATOR SURGERY $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 OPTICHAMBER $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 TOURNI-COT $23.00 $23.00 $16.33 $23.00 $23.00 $16.33 $22.08 $21.62 $21.85 $22.54 COMPRILAN 8CM $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 IV START KIT $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 THORACENTESIS TUBING $24.00 $24.00 $17.04 $24.00 $24.00 $17.04 $23.04 $22.56 $22.80 $23.52 DONNATAL 6ML/FOR GI COCKTAIL ONLY [THAY] 59212-0432-04 $24.50 $24.50 6 mL $17.40 $24.50 $24.50 $17.40 $23.52 $23.03 $23.28 $24.01 CAUTERY INSULATED TI $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 DRAIN JP RND 10FR $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 GASTRIC LAVAGE KIT $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 LEUKOTAPE $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 LMA SIZE 3 $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 LMA SIZE 4 $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 LMA SIZE 5 $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 PRIMARY TUBING $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 THERABOND $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 OXYGEN PER HR CHARGE $25.00 $25.00 $17.75 $25.00 $25.00 $17.75 $24.00 $23.50 $23.75 $24.50 CAUTERY PAD ADULT $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 EQUIPMENT COVER $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 LUMBAR PUNC TRAY INF $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 PRIMARY TUBING PEDS $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 PROLENE 5-0 P-3 $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 STAPLER SKIN LRG $26.00 $26.00 $18.46 $26.00 $26.00 $18.46 $24.96 $24.44 $24.70 $25.48 BASIN DISP $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 BIOPSY FORCEPS UPPER $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 CAUTERY BLADE TIP $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 CHEWY TUBE-OT $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 CHLORAPREP/OR $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 ENDOMETRIAL SAMPLER $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 UNNA BOOT $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 WEEKLY/MYRINGOTOMY BLADE $27.00 $27.00 $19.17 $27.00 $27.00 $19.17 $25.92 $25.38 $25.65 $26.46 ARTHROSCOPY TUBING $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 HYDROFERA BLUE $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 PACK CYSTO $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 SOCK AID SOFT $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 SUTURE TRAY DISP $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 URINE METER TRAY $28.00 $28.00 $19.88 $28.00 $28.00 $19.88 $26.88 $26.32 $26.60 $27.44 BAIRHUGGER BLANKET U $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 COMPRILAN 10CM $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 ELECTRODE IONTO LG $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 ELECTRODE IONTO SM $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 FOOT FUNNEL/OT $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 NEOTEE TUBING $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 PACK GYN $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 PROLENE 4-0 P-3 $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 SCOPE WARMER/OR $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 SOCK AID RIGID $29.00 $29.00 $20.59 $29.00 $29.00 $20.59 $27.84 $27.26 $27.55 $28.42 BARIATRIC WALKER $30.00 $30.00 $21.30 $30.00 $30.00 $21.30 $28.80 $28.20 $28.50 $29.40 BIOPSY FORCEP COLON $30.00 $30.00 $21.30 $30.00 $30.00 $21.30 $28.80 $28.20 $28.50 $29.40 CAUTERY NEEDLE TIP $30.00 $30.00 $21.30 $30.00 $30.00 $21.30 $28.80 $28.20 $28.50 $29.40 CLEAN GUARD BUTTONS $30.00 $30.00 $21.30 $30.00 $30.00 $21.30 $28.80 $28.20 $28.50 $29.40 MONOCRYL 4-0 PS-2 $30.00 $30.00 $21.30 $30.00 $30.00 $21.30 $28.80 $28.20 $28.50 $29.40 BINDER ABD UNIV $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 CHROMIC 5-0 P-3 $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 CIRCULAIRE II SYSTEM $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 LUMBAR PUNC TRAY ADU $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 PACK BASIC $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 SUPPORTER MANS $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 UTERINE EXPLORA EMB $31.00 $31.00 $22.01 $31.00 $31.00 $22.01 $29.76 $29.14 $29.45 $30.38 CYSTO IRRIG SET $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 PROLENE 6-0 P-3 $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 THAY MA CAD Diagnostic $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 WEEKLY/COTTONOIDS $32.00 $32.00 $22.72 $32.00 $32.00 $22.72 $30.72 $30.08 $30.40 $31.36 CHROMIC 2-0 CT-1 $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 METATARSAL BARS MD $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 METATARSAL BARS SM $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 OVERDOOR PULLEY $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 PCA TUBING $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 TUBE T $33.00 $33.00 $23.43 $33.00 $33.00 $23.43 $31.68 $31.02 $31.35 $32.34 VENT SET ANES THAY $33.17 $33.17 $23.55 $33.17 $33.17 $23.55 $31.84 $31.18 $31.51 $32.51 PROMOGRAN DRESSING $34.00 $34.00 $24.14 $34.00 $34.00 $24.14 $32.64 $31.96 $32.30 $33.32 STERILE INSTRUMENTS CHARGE $34.00 $34.00 $24.14 $34.00 $34.00 $24.14 $32.64 $31.96 $32.30 $33.32 GAIT BELT 54IN $35.00 $35.00 $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 KINESIO TAPE/PT $35.00 $35.00 $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 LUKI ASPIRATING TUBE/OR $35.00 $35.00 $24.85 $35.00 $35.00 $24.85 $33.60 $32.90 $33.25 $34.30 ELLIK $36.00 $36.00 $25.56 $36.00 $36.00 $25.56 $34.56 $33.84 $34.20 $35.28 PLAIN 5-0 PC-1 $36.00 $36.00 $25.56 $36.00 $36.00 $25.56 $34.56 $33.84 $34.20 $35.28 AMNIOCENTESIS TRAY $37.00 $37.00 $26.27 $37.00 $37.00 $26.27 $35.52 $34.78 $35.15 $36.26 COMPRILAN 12CM $37.00 $37.00 $26.27 $37.00 $37.00 $26.27 $35.52 $34.78 $35.15 $36.26 CRUTCHES MED $37.00 $37.00 $26.27 $37.00 $37.00 $26.27 $35.52 $34.78 $35.15 $36.26 FOLEY CATH COUDE 16F $37.00 $37.00 $26.27 $37.00 $37.00 $26.27 $35.52 $34.78 $35.15 $36.26 TEMP PUMP PAD $37.00 $37.00 $26.27 $37.00 $37.00 $26.27 $35.52 $34.78 $35.15 $36.26 AMBU BAG ADULT $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 FOLEY CATH 22FR 3WAY $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 FOLEY CATH 24FR 3WAY $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 HEMOVAC DRAIN $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 ISOBAND $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 PEAK FLOW METER $38.00 $38.00 $26.98 $38.00 $38.00 $26.98 $36.48 $35.72 $36.10 $37.24 CRUTCHES LRG $39.00 $39.00 $27.69 $39.00 $39.00 $27.69 $37.44 $36.66 $37.05 $38.22 BLOOD TUBING $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 CAUTERY DISP $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 CHEST TUBE 16FR X 10 $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 LMA TUBE $40.00 $40.00 $28.40 $40.00 $40.00 $28.40 $38.40 $37.60 $38.00 $39.20 ACTICOAT 4X4 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 ESMARK 4 $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 POLYP TRAP $41.00 $41.00 $29.11 $41.00 $41.00 $29.11 $39.36 $38.54 $38.95 $40.18 OVERDOOR TRACTION/PT $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 SILK 3-0 SH W TRAY $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 TRIGGER FINGER SOLUTION/MED $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 TRIGGER FINGER SOLUTION/SM $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 TRIGGER FINGER SOLUTIONS/LG $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 TRIGGER FINGER SOLUTIONS/XL $42.00 $42.00 $29.82 $42.00 $42.00 $29.82 $40.32 $39.48 $39.90 $41.16 EPIDURAL PUMP TUBING $42.51 $42.51 $30.18 $42.51 $42.51 $30.18 $40.81 $39.96 $40.38 $41.66 INTRAOSSEOUS NEEDLE $42.51 $42.51 $30.18 $42.51 $42.51 $30.18 $40.81 $39.96 $40.38 $41.66 IOBAN DRAPE $42.51 $42.51 $30.18 $42.51 $42.51 $30.18 $40.81 $39.96 $40.38 $41.66 LAP CHOLE DRAPE $42.51 $42.51 $30.18 $42.51 $42.51 $30.18 $40.81 $39.96 $40.38 $41.66 MAXON 1 TT20 $42.51 $42.51 $30.18 $42.51 $42.51 $30.18 $40.81 $39.96 $40.38 $41.66 U-DRAPE $42.51 $42.51 $30.18 $42.51 $42.51 $30.18 $40.81 $39.96 $40.38 $41.66 AMBU BAG PEDS $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 CHEWY TUBE/SUPER OT $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 ELBOW HEEL PROTECTOR $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 FOLEY CATH KIT 16FR $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 PACK LAP $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 TOURNIQUET OR $43.00 $43.00 $30.53 $43.00 $43.00 $30.53 $41.28 $40.42 $40.85 $42.14 AQUACEL 4X4 $44.00 $44.00 $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 WALKER GLIDES $44.00 $44.00 $31.24 $44.00 $44.00 $31.24 $42.24 $41.36 $41.80 $43.12 CEMENT CURETTE SM $45.00 $45.00 $31.95 $45.00 $45.00 $31.95 $43.20 $42.30 $42.75 $44.10 HYSTEROSCOPY DRAPE $45.00 $45.00 $31.95 $45.00 $45.00 $31.95 $43.20 $42.30 $42.75 $44.10 IT STAYS $45.00 $45.00 $31.95 $45.00 $45.00 $31.95 $43.20 $42.30 $42.75 $44.10 WEEKLY/EAR TUBE COLLAR BUTTON VENT TUBE $45.00 $45.00 $31.95 $45.00 $45.00 $31.95 $43.20 $42.30 $42.75 $44.10 BIPAP CURCUIT $46.00 $46.00 $32.66 $46.00 $46.00 $32.66 $44.16 $43.24 $43.70 $45.08 ESMARK 6 $46.00 $46.00 $32.66 $46.00 $46.00 $32.66 $44.16 $43.24 $43.70 $45.08 PACK LAPAROSCOPY $47.00 $47.00 $33.37 $47.00 $47.00 $33.37 $45.12 $44.18 $44.65 $46.06 SERV 10:00PM-8:00AM $47.00 $47.00 $33.37 $47.00 $47.00 $33.37 $45.12 $44.18 $44.65 $46.06 SODIUM CHLORIDE 0.9% 100ML VIAL [THAY] 63323-0186-00 $47.22 $47.22 100 mL $33.52 $47.22 $47.22 $33.52 $45.33 $44.38 $44.86 $46.27 BIOFREEZE $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 EDEMA GLOVE L LG $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 EDEMA GLOVE L SM $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 EDEMA GLOVE R LG $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 EDEMA GLOVE R SM $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 SUCTION CHARGE $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 TENNIS ELBOW BAND/PT $48.00 $48.00 $34.08 $48.00 $48.00 $34.08 $46.08 $45.12 $45.60 $47.04 CAUTERY PENCIL $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 DELTA CAST/OT $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 SHOE ACCOM CHILD $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 STERIS V-PRO BIOLOGICAL $50.00 $50.00 $35.50 $50.00 $50.00 $35.50 $48.00 $47.00 $47.50 $49.00 90662 Influenza Vaccine -Split Virus Hi dose [CHAS] $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 FINGER SLEEVE XL/OT $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 FINGER SLEEVE XXL/OT $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 FOLEY CATH 20FR 3WAY $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 FOLEY CATH 26FR 3WAY $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 NITRO TUBING $51.00 $51.00 $36.21 $51.00 $51.00 $36.21 $48.96 $47.94 $48.45 $49.98 THRESHOLD PEP DEVICE $52.00 $52.00 $36.92 $52.00 $52.00 $36.92 $49.92 $48.88 $49.40 $50.96 ELECTRODE VITALSTIM $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 MAXON 1 HGU-46 $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 METATARSAL BARS LG $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 SABER EVAC BULB/OR $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 SUCTION COAGULATOR $53.00 $53.00 $37.63 $53.00 $53.00 $37.63 $50.88 $49.82 $50.35 $51.94 MOTHER TO BE BRACE XL $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 PROFORE BANDAGE $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 VICRYL 10-0 CS140-6 $54.00 $54.00 $38.34 $54.00 $54.00 $38.34 $51.84 $50.76 $51.30 $52.92 STIMUPLEX NEEDLE/KNEE BLOCKS $55.00 $55.00 $39.05 $55.00 $55.00 $39.05 $52.80 $51.70 $52.25 $53.90 MOTHER TO BE BRACE LG $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 MOTHER TO BE BRACE MED $56.00 $56.00 $39.76 $56.00 $56.00 $39.76 $53.76 $52.64 $53.20 $54.88 PORTAWARMER MATTRESS $57.00 $57.00 $40.47 $57.00 $57.00 $40.47 $54.72 $53.58 $54.15 $55.86 NASAL BET. ANTISEPTIC $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 PICC DRESSING TRAY $58.00 $58.00 $41.18 $58.00 $58.00 $41.18 $55.68 $54.52 $55.10 $56.84 CRUTCHES YOUTH $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 PORTA-A-WARMER MATTR $59.00 $59.00 $41.89 $59.00 $59.00 $41.89 $56.64 $55.46 $56.05 $57.82 BAIR PAW GOWN $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 ELECTRODE VITALSTIM SM $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 "PACK,LITHOTOMY" $60.00 $60.00 $42.60 $60.00 $60.00 $42.60 $57.60 $56.40 $57.00 $58.80 LACTATED RINGERS 3000ML IRRIGATION [THAY] 00990-7828-08 $60.08 $60.08 3000 mL $42.66 $60.08 $60.08 $42.66 $57.68 $56.48 $57.08 $58.88 PROSTATE BIOPSY GUIDE/XRAY $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 THUMB SUPPORT L MD $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 THUMB SUPPORT L SM $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 THUMB SUPPORT L XL $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 THUMB SUPPORT R SM $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 THUMB SUPPORT R XL $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 WOUND VEIL $61.00 $61.00 $43.31 $61.00 $61.00 $43.31 $58.56 $57.34 $57.95 $59.78 LACTATED RINGERS 3000ML IRRIGATION [THAY] 00338-0137-27 $61.64 $61.64 3000 mL $43.76 $61.64 $61.64 $43.76 $59.17 $57.94 $58.56 $60.41 CBI TUBING $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 EPIDURAL TRAY SD $62.00 $62.00 $44.02 $62.00 $62.00 $44.02 $59.52 $58.28 $58.90 $60.76 GAIT BELT 70IN $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 SCD MACHINE $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 SCD PUMP RENTAL $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 SCD'S $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 SHOE ACCOM SZ6 $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 STRYKER CEMENT NOZZLE $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 THUMB SUPPORT R MD $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 TRAY PUDENDAL BLOCK $63.00 $63.00 $44.73 $63.00 $63.00 $44.73 $60.48 $59.22 $59.85 $61.74 POWERWEB JR YELLOW $64.00 $64.00 $45.44 $64.00 $64.00 $45.44 $61.44 $60.16 $60.80 $62.72 URO CATCHER BAG $64.00 $64.00 $45.44 $64.00 $64.00 $45.44 $61.44 $60.16 $60.80 $62.72 COBAN COMPRESSION SYSTEM $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 THUMB SUPPORT L LG $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 THUMB SUPPORT L XSM $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 THUMB SUPPORT R LG $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 THUMB SUPPORT R XSM $65.00 $65.00 $46.15 $65.00 $65.00 $46.15 $62.40 $61.10 $61.75 $63.70 370 - Regional Anesthesia/MAC Supplies $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 POWERWEB JR RED $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 SHOE ACCOM SZ5 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 SHOE ACCOM SZ7 $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 SHOULDER IMMOB LRG $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 SHOULDER IMMOB MED $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 SHOULDER IMMOB SM $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 SHOULDER IMMOB XL $66.00 $66.00 $46.86 $66.00 $66.00 $46.86 $63.36 $62.04 $62.70 $64.68 BIOPSY FORCEP HOT $67.00 $67.00 $47.57 $67.00 $67.00 $47.57 $64.32 $62.98 $63.65 $65.66 CHEST TUBE 24FR X 16 $67.00 $67.00 $47.57 $67.00 $67.00 $47.57 $64.32 $62.98 $63.65 $65.66 ENTERIC FEEDING PUMP CHARGE $67.00 $67.00 $47.57 $67.00 $67.00 $47.57 $64.32 $62.98 $63.65 $65.66 PORT ACCESS KIT $67.00 $67.00 $47.57 $67.00 $67.00 $47.57 $64.32 $62.98 $63.65 $65.66 SHOE ACCOM SZ 4 $67.00 $67.00 $47.57 $67.00 $67.00 $47.57 $64.32 $62.98 $63.65 $65.66 SPINAL EPIDURAL SET $67.00 $67.00 $47.57 $67.00 $67.00 $47.57 $64.32 $62.98 $63.65 $65.66 SODIUM CHLORIDE 0.9% 3000ML IRRIGAT [THAY] 00338-0047-47 $68.00 $68.00 3000 mL $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 SHOE ACCOM SZ1 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 SHOE ACCOM SZ2 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 SHOE ACCOM SZ3 $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 TIGERTAIL URETERAL CATH $68.00 $68.00 $48.28 $68.00 $68.00 $48.28 $65.28 $63.92 $64.60 $66.64 CHO PAT SM $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 CHO PAT XLG $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 CHO-PAT XSM $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 DRAIN JP RND 19FR $69.00 $69.00 $48.99 $69.00 $69.00 $48.99 $66.24 $64.86 $65.55 $67.62 CIRCUMCISION TRAY CHARGE $70.00 $70.00 $49.70 $70.00 $70.00 $49.70 $67.20 $65.80 $66.50 $68.60 RICHARDS T-VENT TUBE $70.00 $70.00 $49.70 $70.00 $70.00 $49.70 $67.20 $65.80 $66.50 $68.60 CHEMO INFUS ADDL HR $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 DRESSING AID $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 SP DISP BLADE $72.00 $72.00 $51.12 $72.00 $72.00 $51.12 $69.12 $67.68 $68.40 $70.56 BACK BRACE W INSERT/LG $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 BACK BRACE W INSERT/MED $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 BACK BRACE W INSERT/XL $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 CHEST TUBE 20FR X 16 $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 CHEST TUBE 28FR X 16 $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 CHEST TUBE 32FR X 16 $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 EVAC BOTTLE $73.00 $73.00 $51.83 $73.00 $73.00 $51.83 $70.08 $68.62 $69.35 $71.54 BACK BRACE W INSERT 3XL $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 BACK BRACE W INSERT SMALL $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 GELFOAM $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 NASAL TAMPON PACKIN $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 RING SPLINT/OT $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 SCD SLEEVE REG $75.00 $75.00 $53.25 $75.00 $75.00 $53.25 $72.00 $70.50 $71.25 $73.50 BACK BRACE W INSERT/2XL $76.00 $76.00 $53.96 $76.00 $76.00 $53.96 $72.96 $71.44 $72.20 $74.48 HYPAFIX 2 PT $76.00 $76.00 $53.96 $76.00 $76.00 $53.96 $72.96 $71.44 $72.20 $74.48 TRACTION GLOVE L L-X $76.00 $76.00 $53.96 $76.00 $76.00 $53.96 $72.96 $71.44 $72.20 $74.48 TRACTION GLOVE L S-M $76.00 $76.00 $53.96 $76.00 $76.00 $53.96 $72.96 $71.44 $72.20 $74.48 BACK BRACE W INSERT 4XL $77.00 $77.00 $54.67 $77.00 $77.00 $54.67 $73.92 $72.38 $73.15 $75.46 CAUTERY MACHINE PER $77.00 $77.00 $54.67 $77.00 $77.00 $54.67 $73.92 $72.38 $73.15 $75.46 O2 SENSOR FOREHEAD $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 TRACTION GLOVE R L-X $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 TRACTION GLOVE R S-M $78.00 $78.00 $55.38 $78.00 $78.00 $55.38 $74.88 $73.32 $74.10 $76.44 CHEST TUBE 10FR X 9 $79.00 $79.00 $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 CHEST TUBE 12FR X 9 $79.00 $79.00 $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 WEEKLY/DOYLE OPEN-LUMEN SPLINT $79.00 $79.00 $56.09 $79.00 $79.00 $56.09 $75.84 $74.26 $75.05 $77.42 CPM PAD/OPTIFLEX $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 STRASSBURG SOCK LG $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 STRASSBURG SOCK PED $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 STRASSBURG SOCK REG $80.00 $80.00 $56.80 $80.00 $80.00 $56.80 $76.80 $75.20 $76.00 $78.40 NEONATAL SENSOR $80.01 $80.01 $56.81 $80.01 $80.01 $56.81 $76.81 $75.21 $76.01 $78.41 PACK ORTHO UPPER EXT $80.01 $80.01 $56.81 $80.01 $80.01 $56.81 $76.81 $75.21 $76.01 $78.41 QUILL 2 PDO $80.01 $80.01 $56.81 $80.01 $80.01 $56.81 $76.81 $75.21 $76.01 $78.41 OB Vacuum Kit $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 STRYKER LAP SMOKE FILTER $81.00 $81.00 $57.51 $81.00 $81.00 $57.51 $77.76 $76.14 $76.95 $79.38 CARDIAC MONITOR USE CHARGE $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 CHO PAT LG $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 CHO PAT MD $82.00 $82.00 $58.22 $82.00 $82.00 $58.22 $78.72 $77.08 $77.90 $80.36 DERMABOND $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 "PACK,ORTHO LOWER EXT" $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 SHOULDER HEAD RESTRAINT $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 OB VACUUM KIT $83.00 $83.00 $58.93 $83.00 $83.00 $58.93 $79.68 $78.02 $78.85 $81.34 CROUP TENT PLASTIC $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 HISTOACRYL $85.00 $85.00 $60.35 $85.00 $85.00 $60.35 $81.60 $79.90 $80.75 $83.30 MORGAN LENS $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 SPOT MARKER NEEDLE $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 SUREPRESS 4 $86.00 $86.00 $61.06 $86.00 $86.00 $61.06 $82.56 $80.84 $81.70 $84.28 92569 REFLEX DECAY $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 ENDO TROCAR 12MM $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 ENDO TROCAR 12MM BLU $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 ENDO TROCAR 5MM $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 ENDO TROCAR 5MM BLAD $87.00 $87.00 $61.77 $87.00 $87.00 $61.77 $83.52 $81.78 $82.65 $85.26 PCA CO2 TUBING $89.00 $89.00 $63.19 $89.00 $89.00 $63.19 $85.44 $83.66 $84.55 $87.22 GROIN BRACE/PT $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 MAXON O GS-26 $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 OT Cognitive Function Medicare Charge $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 SILK 4-0 SH $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 SLP Cognitive Function Medicare Charge $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 STRYKER NEPTUNE FILTER $90.00 $90.00 $63.90 $90.00 $90.00 $63.90 $86.40 $84.60 $85.50 $88.20 TRU-CUT BIOPSY NEEDL $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 WALKER SLEDS $91.00 $91.00 $64.61 $91.00 $91.00 $64.61 $87.36 $85.54 $86.45 $89.18 CHO PAT DUAL XL $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 CHO-PAT DUAL SM $92.00 $92.00 $65.32 $92.00 $92.00 $65.32 $88.32 $86.48 $87.40 $90.16 BIPAP MASK/MED $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 Newborn Hearing Screen $93.00 $93.00 $66.03 $93.00 $93.00 $66.03 $89.28 $87.42 $88.35 $91.14 ARISTA APPLICATOR $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 SP IOL $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 STRYKER HOOD W FACE SHIELD $94.00 $94.00 $66.74 $94.00 $94.00 $66.74 $90.24 $88.36 $89.30 $92.12 BIPAP MASK/ SM $95.00 $95.00 $67.45 $95.00 $95.00 $67.45 $91.20 $89.30 $90.25 $93.10 BARD PROSTATE BIOPSY NEEDLE $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 IUP Cath $98.00 $98.00 $69.58 $98.00 $98.00 $69.58 $94.08 $92.12 $93.10 $96.04 BIPAP MASK/LG $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 EAR TUBE SHEEHY $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 SUTURE/ARTHREX AR-7281 $99.00 $99.00 $70.29 $99.00 $99.00 $70.29 $95.04 $93.06 $94.05 $97.02 LVP solution with potassium Dextrose 5% with 0.45% NaCl and KCl 20 mEq/L Sol 00264-7635-00 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 KCL 20MEQ IN 0.9% NS 1000ML IV BAG [THAY] 00264-7865-00 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 SODIUM CHLORIDE 0.45% 1000ML IV BAG [THAY] 00338-0043-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 DEXTROSE 5%/0.2% NS 1000ML IV BAG [THAY] 00338-0077-03 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 DEXTROSE 5%/0.2% NS 1000ML IV BAG [THAY] 00338-0077-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 DEXTROSE 5%/0.45% NS 1000ML IV BAG [THAY] 00338-0085-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 KCL 20MEQ IN D5/0.45% NS 1000ML BAG [THAY] 00338-0671-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 KCL 20MEQ IN 0.9% NS 1000ML IV BAG [THAY] 00338-0691-04 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 KCL 20MEQ IN 0.9% NS 1000ML IV BAG [THAY] 00409-7115-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 KCL 20MEQ IN D5/0.45% NS 1000ML BAG [THAY] 00409-7902-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 DEXTROSE 5%/0.45% NS 1000ML IV BAG [THAY] 00409-7926-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 SODIUM CHLORIDE 0.45% 1000ML IV BAG [THAY] 00409-7985-09 $100.00 $100.00 1000 mL $71.00 $100.00 $100.00 $71.00 $96.00 $94.00 $95.00 $98.00 CARBACHOL(MIOSTAT)0.01% INTRAOCULAR [THAY] 00065-0023-15 $100.83 $100.83 1.5 mL $71.59 $100.83 $100.83 $71.59 $96.80 $94.78 $95.79 $98.82 CHEST TUBE 36FR $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 PACK C-SECTION $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 SI BELT/LG $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 SI BELT/MED $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 IUP CATH $101.00 $101.00 $71.71 $101.00 $101.00 $71.71 $96.96 $94.94 $95.95 $98.98 SI BELT/SM $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 SI BELT/XL $103.00 $103.00 $73.13 $103.00 $103.00 $73.13 $98.88 $96.82 $97.85 $100.94 CPM PAD/DANNINGER $104.00 $104.00 $73.84 $104.00 $104.00 $73.84 $99.84 $97.76 $98.80 $101.92 STRYKER SAW BLADE/2108-152 $104.00 $104.00 $73.84 $104.00 $104.00 $73.84 $99.84 $97.76 $98.80 $101.92 CHO PAT DUAL LG $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 Physical Therapy Re Evaluation THAY $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 PT RE-EVALUATION - Reevaluation Charge $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 STRYKER CAUTERY $105.00 $105.00 $74.55 $105.00 $105.00 $74.55 $100.80 $98.70 $99.75 $102.90 BARD TRUGUIDE NEEDLE $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 PT Evalutation - Low Complex - BCE $107.00 $107.00 $75.97 $107.00 $107.00 $75.97 $102.72 $100.58 $101.65 $104.86 ENDO TROCAR 12MM LONG $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 SURGILON 0 KV-25 $109.00 $109.00 $77.39 $109.00 $109.00 $77.39 $104.64 $102.46 $103.55 $106.82 QUILL 0 PDO $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 TAUT INTRODUCER $111.00 $111.00 $78.81 $111.00 $111.00 $78.81 $106.56 $104.34 $105.45 $108.78 STRYKER NEPTUNE FILTER/ORTHO $112.00 $112.00 $79.52 $112.00 $112.00 $79.52 $107.52 $105.28 $106.40 $109.76 STRYKER SAW BLADE/277-96-275 $113.00 $113.00 $80.23 $113.00 $113.00 $80.23 $108.48 $106.22 $107.35 $110.74 BACK BRACE INSERTS $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 MATERNITY BELT LRG/PT $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 WEEKLY/EAR TUBE T-TUBE $115.00 $115.00 $81.65 $115.00 $115.00 $81.65 $110.40 $108.10 $109.25 $112.70 CHO PAT DUAL MD $116.00 $116.00 $82.36 $116.00 $116.00 $82.36 $111.36 $109.04 $110.20 $113.68 METAGRIP R-1 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 METAGRIP R-2 $117.00 $117.00 $83.07 $117.00 $117.00 $83.07 $112.32 $109.98 $111.15 $114.66 WALL SUCTION $118.00 $118.00 $83.78 $118.00 $118.00 $83.78 $113.28 $110.92 $112.10 $115.64 STRYKER SAW BLADE/2296-3-125 $122.00 $122.00 $86.62 $122.00 $122.00 $86.62 $117.12 $114.68 $115.90 $119.56 COMPRESSION GLOVE 2X $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 COMPRESSION GLOVE MD LT $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 COMPRESSION GLOVE MD RT $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 COMPRESSION GLOVE XL $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 RAPID RHINO 4.5 INFLATABLE $126.00 $126.00 $89.46 $126.00 $126.00 $89.46 $120.96 $118.44 $119.70 $123.48 I FLOW TUNNELER $127.00 $127.00 $90.17 $127.00 $127.00 $90.17 $121.92 $119.38 $120.65 $124.46 STRATAFIX SUTURE - OR $128.00 $128.00 $90.88 $128.00 $128.00 $90.88 $122.88 $120.32 $121.60 $125.44 15341 APLIGRAF ADD25 SQ CM $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 CDL Physicial $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 DRAIN JVAC RESERVOIR $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 SCD SLEEVE LG $130.00 $130.00 $92.30 $130.00 $130.00 $92.30 $124.80 $122.20 $123.50 $127.40 OT REEVALUATION - Reevaluation Charge $131.00 $131.00 $93.01 $131.00 $131.00 $93.01 $125.76 $123.14 $124.45 $128.38 STRYKER ARTHRO BURR $132.00 $132.00 $93.72 $132.00 $132.00 $93.72 $126.72 $124.08 $125.40 $129.36 BACK BRACE ADJ LG $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 BACK BRACE ADJ MD $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 BACK BRACE ADJ SM $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 BACK BRACE ADJ XLG $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 BACK BRACE ADJ XXLG $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 BACK BRACE ADJ XXXLG $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 "Culture, Fungus with Direct Exam/KOH NLL" $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 KNEE BRACE/BREG $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 SHOULDER CANNULA TWIST/HURL $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 SPOT MARKER INK $135.00 $135.00 $95.85 $135.00 $135.00 $95.85 $129.60 $126.90 $128.25 $132.30 BONE MARROW TRAY $136.00 $136.00 $96.56 $136.00 $136.00 $96.56 $130.56 $127.84 $129.20 $133.28 THE BREATHER $137.00 $137.00 $97.27 $137.00 $137.00 $97.27 $131.52 $128.78 $130.15 $134.26 RBC CPD AS1 500 $138.00 $138.00 $97.98 $138.00 $138.00 $97.98 $132.48 $129.72 $131.10 $135.24 FOOT PILLOW BOOT $139.00 $139.00 $98.69 $139.00 $139.00 $98.69 $133.44 $130.66 $132.05 $136.22 AIR LIFT CUSHION/OT $140.00 $140.00 $99.40 $140.00 $140.00 $99.40 $134.40 $131.60 $133.00 $137.20 ADENOID CURETTE 2 $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 BARD NICORE GUIDEWIRE $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 CHEST TUBE DRAIN HEI $141.00 $141.00 $100.11 $141.00 $141.00 $100.11 $135.36 $132.54 $133.95 $138.18 COMBITUBE/KING AIRWAY SZ 2 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 COMBITUBE/KING AIRWAY SZ 2.5 $142.00 $142.00 $100.82 $142.00 $142.00 $100.82 $136.32 $133.48 $134.90 $139.16 EAR TUBE GOODE-T $143.00 $143.00 $101.53 $143.00 $143.00 $101.53 $137.28 $134.42 $135.85 $140.14 TOURNIQUET/COMBAT $146.00 $146.00 $103.66 $146.00 $146.00 $103.66 $140.16 $137.24 $138.70 $143.08 ARM SLEEVE MD $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 BARIATRIC EXCEL FOAM BED $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 SP VISCOELASTIC $150.00 $150.00 $106.50 $150.00 $150.00 $106.50 $144.00 $141.00 $142.50 $147.00 COMBITUBE/KING AIRWAY SZ 3 $150.01 $150.01 $106.51 $150.01 $150.01 $106.51 $144.01 $141.01 $142.51 $147.01 COMBITUBE/KING AIRWAY SZ 4 $150.01 $150.01 $106.51 $150.01 $150.01 $106.51 $144.01 $141.01 $142.51 $147.01 COMBITUBE/KING AIRWAY SZ 5 $150.01 $150.01 $106.51 $150.01 $150.01 $106.51 $144.01 $141.01 $142.51 $147.01 DEFIB PADS ZOLL $150.01 $150.01 $106.51 $150.01 $150.01 $106.51 $144.01 $141.01 $142.51 $147.01 SURGICEL $150.01 $150.01 $106.51 $150.01 $150.01 $106.51 $144.01 $141.01 $142.51 $147.01 BARD MAX-CORE BIOPSY $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 10M $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 10W $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 11M $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 12M $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 5W $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 6W $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 7M $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 7W $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 8M $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 8W $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 9M $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC 9W $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 ORTHOTIC SPORT $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 SHOULDER GEMINI/HURLBUT $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 SHOULDER GUIDEWIRE/ARTHREX $151.00 $151.00 $107.21 $151.00 $151.00 $107.21 $144.96 $141.94 $143.45 $147.98 DRAIN JP FLAT 10FR $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 DRAIN JP FLAT 7FR $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 SURGITIE EZ10G $153.00 $153.00 $108.63 $153.00 $153.00 $108.63 $146.88 $143.82 $145.35 $149.94 ARM AIR SPLINT/OT $154.00 $154.00 $109.34 $154.00 $154.00 $109.34 $147.84 $144.76 $146.30 $150.92 DEFIB PADS ZOLL PED $154.00 $154.00 $109.34 $154.00 $154.00 $109.34 $147.84 $144.76 $146.30 $150.92 ENDO TROCAR 11MM $156.00 $156.00 $110.76 $156.00 $156.00 $110.76 $149.76 $146.64 $148.20 $152.88 SHOULDER SLINGSHOT BRACE/LG $157.00 $157.00 $111.47 $157.00 $157.00 $111.47 $150.72 $147.58 $149.15 $153.86 SHOULDER SLINGSHOT BRACE/M $157.00 $157.00 $111.47 $157.00 $157.00 $111.47 $150.72 $147.58 $149.15 $153.86 ENDOLOOP PDS 2-0 $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 STRYKER PULSAVAK $158.00 $158.00 $112.18 $158.00 $158.00 $112.18 $151.68 $148.52 $150.10 $154.84 PACK TOTAL KNEE HURL $162.00 $162.00 $115.02 $162.00 $162.00 $115.02 $155.52 $152.28 $153.90 $158.76 SUBCLAVIAN TRAY KIT $162.00 $162.00 $115.02 $162.00 $162.00 $115.02 $155.52 $152.28 $153.90 $158.76 TAUT CYSTIC DUCT CATH INTRODUCER $163.00 $163.00 $115.73 $163.00 $163.00 $115.73 $156.48 $153.22 $154.85 $159.74 BACK BRACE SPEC ORDER $165.00 $165.00 $117.15 $165.00 $165.00 $117.15 $158.40 $155.10 $156.75 $161.70 STRYKER SUCT IRRIGAT $165.00 $165.00 $117.15 $165.00 $165.00 $117.15 $158.40 $155.10 $156.75 $161.70 SHOULDER ARM SLEEVE KIT $168.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 SP BSS $168.00 $168.00 $119.28 $168.00 $168.00 $119.28 $161.28 $157.92 $159.60 $164.64 Physical Therapy Evaluation THAY $169.00 $169.00 $119.99 $169.00 $169.00 $119.99 $162.24 $158.86 $160.55 $165.62 PT Evaluation Charge - Evaluation Charge $169.00 $169.00 $119.99 $169.00 $169.00 $119.99 $162.24 $158.86 $160.55 $165.62 STRYKER ARTHRO AGGR/375-544-000 $173.00 $173.00 $122.83 $173.00 $173.00 $122.83 $166.08 $162.62 $164.35 $169.54 ENDO POUCH $175.00 $175.00 $124.25 $175.00 $175.00 $124.25 $168.00 $164.50 $166.25 $171.50 BARIATRIC EXCEL FOAM W/ TRAPEZE $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 Strep Pneumoniae IgG Ab-14 NLL $176.00 $176.00 $124.96 $176.00 $176.00 $124.96 $168.96 $165.44 $167.20 $172.48 CHEMO IM SUBQ TECH $178.00 $178.00 $126.38 $178.00 $178.00 $126.38 $170.88 $167.32 $169.10 $174.44 CHEMO INFUSION TECHN $178.00 $178.00 $126.38 $178.00 $178.00 $126.38 $170.88 $167.32 $169.10 $174.44 CHEMO IV PUSH TECHN $178.00 $178.00 $126.38 $178.00 $178.00 $126.38 $170.88 $167.32 $169.10 $174.44 OCCUPATIONAL THERAPY EVALUATION˙THAY˙ $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 OT EVALUATION MODERATE COMPLEXITY - Evaluation Charge $180.00 $180.00 $127.80 $180.00 $180.00 $127.80 $172.80 $169.20 $171.00 $176.40 ULTRA TAG KIT & TC04 CHARGE ONLY [THAY] 00019-N068-B0 $180.33 $180.33 1 EA $128.03 $180.33 $180.33 $128.03 $173.11 $169.51 $171.31 $176.72 WRIST BRACE SPLINT/PT $182.00 $182.00 $129.22 $182.00 $182.00 $129.22 $174.72 $171.08 $172.90 $178.36 ADENOID CURETTE 4 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 STRYKER SAW BLADE/6118-127-90 $184.00 $184.00 $130.64 $184.00 $184.00 $130.64 $176.64 $172.96 $174.80 $180.32 GLIDESCOPE $188.00 $188.00 $133.48 $188.00 $188.00 $133.48 $180.48 $176.72 $178.60 $184.24 MULTIFIRE STAPLES XR60B $190.00 $190.00 $134.90 $190.00 $190.00 $134.90 $182.40 $178.60 $180.50 $186.20 15431 OASIS ADD 100 SQ CM $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 PACK ARTHROSCOPY $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 SHOULDER CANNULA/HURL $193.00 $193.00 $137.03 $193.00 $193.00 $137.03 $185.28 $181.42 $183.35 $189.14 STRYKER SAW BLADE/6125-119-90 $194.00 $194.00 $137.74 $194.00 $194.00 $137.74 $186.24 $182.36 $184.30 $190.12 BOTOX NEEDLE $196.00 $196.00 $139.16 $196.00 $196.00 $139.16 $188.16 $184.24 $186.20 $192.08 POLYPECTOMY SNARE $199.00 $199.00 $141.29 $199.00 $199.00 $141.29 $191.04 $187.06 $189.05 $195.02 STRYKER BARREL BURR $200.00 $200.00 $142.00 $200.00 $200.00 $142.00 $192.00 $188.00 $190.00 $196.00 I FLOW CATHETER/SOAKER $201.00 $201.00 $142.71 $201.00 $201.00 $142.71 $192.96 $188.94 $190.95 $196.98 ARM SLEEVE LG $203.00 $203.00 $144.13 $203.00 $203.00 $144.13 $194.88 $190.82 $192.85 $198.94 GLIDESCOPE $203.00 $203.00 $144.13 $203.00 $203.00 $144.13 $194.88 $190.82 $192.85 $198.94 MULTIFIRE STAPLES GIA REFILL TCR55 $204.00 $204.00 $144.84 $204.00 $204.00 $144.84 $195.84 $191.76 $193.80 $199.92 OB INSTRUMENT TRAY CHARGE $206.00 $206.00 $146.26 $206.00 $206.00 $146.26 $197.76 $193.64 $195.70 $201.88 THORACENTESIS TRAY $206.00 $206.00 $146.26 $206.00 $206.00 $146.26 $197.76 $193.64 $195.70 $201.88 370 - General Anesthesia Supplies $210.00 $210.00 $149.10 $210.00 $210.00 $149.10 $201.60 $197.40 $199.50 $205.80 STRYKER ARTHR TUBING $210.00 $210.00 $149.10 $210.00 $210.00 $149.10 $201.60 $197.40 $199.50 $205.80 ABDUCTOR CUSHION $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 ARM SLEEVE SM $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 ENDO SURGITIE/AUTOSUTURE $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 GRASPING FORCEP $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 HEEL PROTECTOR PRESSURE RELIEVING $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 METAGRIP L-1 $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 METAGRIP L-2 $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 METAGRIP L-3 $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 METAGRIP R-3 $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 NAKAO SPIDER NET $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 STRYKER SAW BLADE ANGLED/0380-544-100 $210.01 $210.01 $149.11 $210.01 $210.01 $149.11 $201.61 $197.41 $199.51 $205.81 BARD MONOPTY INSTRUM $212.00 $212.00 $150.52 $212.00 $212.00 $150.52 $203.52 $199.28 $201.40 $207.76 FETAL MONITOR CHARGE $213.00 $213.00 $151.23 $213.00 $213.00 $151.23 $204.48 $200.22 $202.35 $208.74 PELVIC SLING LG $215.00 $215.00 $152.65 $215.00 $215.00 $152.65 $206.40 $202.10 $204.25 $210.70 PELVIC SLING REG $215.00 $215.00 $152.65 $215.00 $215.00 $152.65 $206.40 $202.10 $204.25 $210.70 CEMENT MIXING BOWL/STRYKER $216.00 $216.00 $153.36 $216.00 $216.00 $153.36 $207.36 $203.04 $205.20 $211.68 PACK SHOULDER ARTHROSCOPY $219.00 $219.00 $155.49 $219.00 $219.00 $155.49 $210.24 $205.86 $208.05 $214.62 NIGHT SPLINT BOOT LG $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 NIGHT SPLINT BOOT ME $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 SHOULDER FIBERTAPE/HURL $220.00 $220.00 $156.20 $220.00 $220.00 $156.20 $211.20 $206.80 $209.00 $215.60 NIGHT SPLINT BOOT SM $223.00 $223.00 $158.33 $223.00 $223.00 $158.33 $214.08 $209.62 $211.85 $218.54 NIGHT SPLINT BOOT XL $223.00 $223.00 $158.33 $223.00 $223.00 $158.33 $214.08 $209.62 $211.85 $218.54 Umbilical Cath Tray $225.00 $225.00 $159.75 $225.00 $225.00 $159.75 $216.00 $211.50 $213.75 $220.50 UMBILICAL CATH TRAY $225.00 $225.00 $159.75 $225.00 $225.00 $159.75 $216.00 $211.50 $213.75 $220.50 STERIS V-PRO STERILANT $227.00 $227.00 $161.17 $227.00 $227.00 $161.17 $217.92 $213.38 $215.65 $222.46 RESTING HAND SPLINT/PT $229.00 $229.00 $162.59 $229.00 $229.00 $162.59 $219.84 $215.26 $217.55 $224.42 ENDO SCISSORS $230.00 $230.00 $163.30 $230.00 $230.00 $163.30 $220.80 $216.20 $218.50 $225.40 INSUFFLATOR TUBING $232.00 $232.00 $164.72 $232.00 $232.00 $164.72 $222.72 $218.08 $220.40 $227.36 ALEXIS O C-SECTION RETRACTOR $238.00 $238.00 $168.98 $238.00 $238.00 $168.98 $228.48 $223.72 $226.10 $233.24 RAPID RHINO 9.0 POSTERIOR $239.00 $239.00 $169.69 $239.00 $239.00 $169.69 $229.44 $224.66 $227.05 $234.22 ENDO GRASPER $240.00 $240.00 $170.40 $240.00 $240.00 $170.40 $230.40 $225.60 $228.00 $235.20 CPAP COMBO KIT/LG $241.00 $241.00 $171.11 $241.00 $241.00 $171.11 $231.36 $226.54 $228.95 $236.18 CPAP COMBO KIT/MED $241.00 $241.00 $171.11 $241.00 $241.00 $171.11 $231.36 $226.54 $228.95 $236.18 BARIATRIC EXCEL AIR BED $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 SHOULDER TIGERLINK/HURLBUT $244.00 $244.00 $173.24 $244.00 $244.00 $173.24 $234.24 $229.36 $231.80 $239.12 SHOULDER SWITCHING STICK/HURLBUT $247.00 $247.00 $175.37 $247.00 $247.00 $175.37 $237.12 $232.18 $234.65 $242.06 CHEST TUBE KIT $251.00 $251.00 $178.21 $251.00 $251.00 $178.21 $240.96 $235.94 $238.45 $245.98 NEEDLE DECOMPRESSION $251.00 $251.00 $178.21 $251.00 $251.00 $178.21 $240.96 $235.94 $238.45 $245.98 SURGICEL 2X3 $251.00 $251.00 $178.21 $251.00 $251.00 $178.21 $240.96 $235.94 $238.45 $245.98 STRYKER CEMENT TOWER $255.00 $255.00 $181.05 $255.00 $255.00 $181.05 $244.80 $239.70 $242.25 $249.90 INTERSTIM 37092 $260.00 $260.00 $184.60 $260.00 $260.00 $184.60 $249.60 $244.40 $247.00 $254.80 CERVICAL COLLAR MIAMI J $260.01 $260.01 $184.61 $260.01 $260.01 $184.61 $249.61 $244.41 $247.01 $254.81 CYSTO CAUTERY/BUGBEE $260.01 $260.01 $184.61 $260.01 $260.01 $184.61 $249.61 $244.41 $247.01 $254.81 DERMABOND PRINEO/OR $260.01 $260.01 $184.61 $260.01 $260.01 $184.61 $249.61 $244.41 $247.01 $254.81 PEG TUBE REPLACEMENT $260.01 $260.01 $184.61 $260.01 $260.01 $184.61 $249.61 $244.41 $247.01 $254.81 PET INFLATION DEVICE $260.01 $260.01 $184.61 $260.01 $260.01 $184.61 $249.61 $244.41 $247.01 $254.81 TAUT CYSTIC DUCT CATH $260.01 $260.01 $184.61 $260.01 $260.01 $184.61 $249.61 $244.41 $247.01 $254.81 ENDO DISSECTOR $261.00 $261.00 $185.31 $261.00 $261.00 $185.31 $250.56 $245.34 $247.95 $255.78 HEWSON SUTURE RETRIEVER $261.00 $261.00 $185.31 $261.00 $261.00 $185.31 $250.56 $245.34 $247.95 $255.78 PELVIC SLING SM $261.00 $261.00 $185.31 $261.00 $261.00 $185.31 $250.56 $245.34 $247.95 $255.78 BARD BREAST BIOPSY C $267.00 $267.00 $189.57 $267.00 $267.00 $189.57 $256.32 $250.98 $253.65 $261.66 TC99M MERTIATIDE (MAG 3) VIAL [THAY] 00019-N096-B0 $270.00 $270.00 1 EA $191.70 $270.00 $270.00 $191.70 $259.20 $253.80 $256.50 $264.60 BARIATRIC EXCEL AIR W/ TRAPEZE $270.00 $270.00 $191.70 $270.00 $270.00 $191.70 $259.20 $253.80 $256.50 $264.60 JOBST STOC & ACCES $274.00 $274.00 $194.54 $274.00 $274.00 $194.54 $263.04 $257.56 $260.30 $268.52 POISON CONTROL CENTR $279.00 $279.00 $198.09 $279.00 $279.00 $198.09 $267.84 $262.26 $265.05 $273.42 SHOULDER LABRALTAPE/HURL $280.00 $280.00 $198.80 $280.00 $280.00 $198.80 $268.80 $263.20 $266.00 $274.40 SERACULT $285.00 $285.00 $202.35 $285.00 $285.00 $202.35 $273.60 $267.90 $270.75 $279.30 KNEE BRACE SPEC ORDER $286.00 $286.00 $203.06 $286.00 $286.00 $203.06 $274.56 $268.84 $271.70 $280.28 STRYKER BALL ELECTRO $294.00 $294.00 $208.74 $294.00 $294.00 $208.74 $282.24 $276.36 $279.30 $288.12 STRYKER LOOP ELECTRO $294.00 $294.00 $208.74 $294.00 $294.00 $208.74 $282.24 $276.36 $279.30 $288.12 SPLINT BASIC $300.00 $300.00 $213.00 $300.00 $300.00 $213.00 $288.00 $282.00 $285.00 $294.00 CEMENT MIXING KIT H $300.01 $300.01 $213.01 $300.01 $300.01 $213.01 $288.01 $282.01 $285.01 $294.01 ENDO BABCOCK $300.01 $300.01 $213.01 $300.01 $300.01 $213.01 $288.01 $282.01 $285.01 $294.01 ENDO CLIP 10MM $300.01 $300.01 $213.01 $300.01 $300.01 $213.01 $288.01 $282.01 $285.01 $294.01 NEEDLE PERICARDIOCENTESIS $300.01 $300.01 $213.01 $300.01 $300.01 $213.01 $288.01 $282.01 $285.01 $294.01 WEEKLY/NASAL DRESSING (MEROGEL) $300.01 $300.01 $213.01 $300.01 $300.01 $213.01 $288.01 $282.01 $285.01 $294.01 MULTIFIRE GIA 60 TLC55 $304.00 $304.00 $215.84 $304.00 $304.00 $215.84 $291.84 $285.76 $288.80 $297.92 MULTIFIRE STAPLER TX60B $304.00 $304.00 $215.84 $304.00 $304.00 $215.84 $291.84 $285.76 $288.80 $297.92 ENDOSCOPIC OVERTUBE $308.00 $308.00 $218.68 $308.00 $308.00 $218.68 $295.68 $289.52 $292.60 $301.84 PROLENE MESH $311.00 $311.00 $220.81 $311.00 $311.00 $220.81 $298.56 $292.34 $295.45 $304.78 CATH SUPRAPUBIC $312.00 $312.00 $221.52 $312.00 $312.00 $221.52 $299.52 $293.28 $296.40 $305.76 ROOM/BED: TLC $315.00 $315.00 $223.65 $315.00 $315.00 $223.65 $302.40 $296.10 $299.25 $308.70 ROOM/BED: TLC $315.00 $315.00 $223.65 $315.00 $315.00 $223.65 $302.40 $296.10 $299.25 $308.70 ENDO TROCAR 8MM $319.00 $319.00 $226.49 $319.00 $319.00 $226.49 $306.24 $299.86 $303.05 $312.62 THERACOOL SYSTEM TK $320.00 $320.00 $227.20 $320.00 $320.00 $227.20 $307.20 $300.80 $304.00 $313.60 INTRAOSSEOUS EZ IO GUN AND NEEDLE $327.00 $327.00 $232.17 $327.00 $327.00 $232.17 $313.92 $307.38 $310.65 $320.46 IO GUN/NEEDLE $327.00 $327.00 $232.17 $327.00 $327.00 $232.17 $313.92 $307.38 $310.65 $320.46 OM8007 SMARTSTITCH CONNECTOR $330.00 $330.00 $234.30 $330.00 $330.00 $234.30 $316.80 $310.20 $313.50 $323.40 PET BALLOON DIALATOR $330.00 $330.00 $234.30 $330.00 $330.00 $234.30 $316.80 $310.20 $313.50 $323.40 PRAFO BOOT $332.00 $332.00 $235.72 $332.00 $332.00 $235.72 $318.72 $312.08 $315.40 $325.36 OM8010 SMARTSTITCH CONNECTOR $340.00 $340.00 $241.40 $340.00 $340.00 $241.40 $326.40 $319.60 $323.00 $333.20 I FLOW PAINBUSTER/100ML $348.00 $348.00 $247.08 $348.00 $348.00 $247.08 $334.08 $327.12 $330.60 $341.04 OM8077 SMARTSTITCH SUTURE BL COBRAID $363.00 $363.00 $257.73 $363.00 $363.00 $257.73 $348.48 $341.22 $344.85 $355.74 OM8175 SMARTSTITCH CART $363.00 $363.00 $257.73 $363.00 $363.00 $257.73 $348.48 $341.22 $344.85 $355.74 OM8176 SMARTSTITCH CART $363.00 $363.00 $257.73 $363.00 $363.00 $257.73 $348.48 $341.22 $344.85 $355.74 OXYGEN PER DAY CHARGE $369.00 $369.00 $261.99 $369.00 $369.00 $261.99 $354.24 $346.86 $350.55 $361.62 INTERSTIM NEEDLE 040829 $371.00 $371.00 $263.41 $371.00 $371.00 $263.41 $356.16 $348.74 $352.45 $363.58 CARTER CLOSESURE SYSTEM $378.00 $378.00 $268.38 $378.00 $378.00 $268.38 $362.88 $355.32 $359.10 $370.44 Telemetry $382.00 $382.00 $271.22 $382.00 $382.00 $271.22 $366.72 $359.08 $362.90 $374.36 Telemetry $382.00 $382.00 $271.22 $382.00 $382.00 $271.22 $366.72 $359.08 $362.90 $374.36 Telemetry $382.00 $382.00 $271.22 $382.00 $382.00 $271.22 $366.72 $359.08 $362.90 $374.36 GREEN DYE/ DR. YE $385.00 $385.00 $273.35 $385.00 $385.00 $273.35 $369.60 $361.90 $365.75 $377.30 BARD MESH PLUG MD $412.00 $412.00 $292.52 $412.00 $412.00 $292.52 $395.52 $387.28 $391.40 $403.76 BARD MESH PLUG LG $420.00 $420.00 $298.20 $420.00 $420.00 $298.20 $403.20 $394.80 $399.00 $411.60 SP ANT VITR PACK $420.00 $420.00 $298.20 $420.00 $420.00 $298.20 $403.20 $394.80 $399.00 $411.60 PEG TUBE TRAY $420.01 $420.01 $298.21 $420.01 $420.01 $298.21 $403.21 $394.81 $399.01 $411.61 PERTRACH KIT ADULT $420.01 $420.01 $298.21 $420.01 $420.01 $298.21 $403.21 $394.81 $399.01 $411.61 PROLENE MESH PMH $420.01 $420.01 $298.21 $420.01 $420.01 $298.21 $403.21 $394.81 $399.01 $411.61 SP IRIS RETRACTOR $420.01 $420.01 $298.21 $420.01 $420.01 $298.21 $403.21 $394.81 $399.01 $411.61 STRYKER ARTHRO HOOK $420.01 $420.01 $298.21 $420.01 $420.01 $298.21 $403.21 $394.81 $399.01 $411.61 STRYKER ARTHRO WAND $420.01 $420.01 $298.21 $420.01 $420.01 $298.21 $403.21 $394.81 $399.01 $411.61 REDDICK SAYE SCREW $423.00 $423.00 $300.33 $423.00 $423.00 $300.33 $406.08 $397.62 $401.85 $414.54 INTERSTIM 355018 $433.00 $433.00 $307.43 $433.00 $433.00 $307.43 $415.68 $407.02 $411.35 $424.34 BARD MESH PLUG XL $437.00 $437.00 $310.27 $437.00 $437.00 $310.27 $419.52 $410.78 $415.15 $428.26 ENDO CLIP 5MM $440.00 $440.00 $312.40 $440.00 $440.00 $312.40 $422.40 $413.60 $418.00 $431.20 BD Bone Density DEXA Axial Skeleton $440.84 $440.84 $313.00 $440.84 $440.84 $313.00 $423.21 $414.39 $418.80 $432.02 PERTRACH KIT 3.0 $450.00 $450.00 $319.50 $450.00 $450.00 $319.50 $432.00 $423.00 $427.50 $441.00 PERTRACH KIT 3.5 $450.00 $450.00 $319.50 $450.00 $450.00 $319.50 $432.00 $423.00 $427.50 $441.00 PERTRACH KIT 4.0 $450.00 $450.00 $319.50 $450.00 $450.00 $319.50 $432.00 $423.00 $427.50 $441.00 SMARTPORT $450.00 $450.00 $319.50 $450.00 $450.00 $319.50 $432.00 $423.00 $427.50 $441.00 CARDIAC MONITOR DAY CHARGE $451.00 $451.00 $320.21 $451.00 $451.00 $320.21 $432.96 $423.94 $428.45 $441.98 BARD INLAY STENT 6FR 22CM $461.00 $461.00 $327.31 $461.00 $461.00 $327.31 $442.56 $433.34 $437.95 $451.78 COLONOSCOPE $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 GASTROSCOPE $470.00 $470.00 $333.70 $470.00 $470.00 $333.70 $451.20 $441.80 $446.50 $460.60 INTERSTIM KIT 1/OR $471.00 $471.00 $334.41 $471.00 $471.00 $334.41 $452.16 $442.74 $447.45 $461.58 GORE BIO-A-MESH PLUG/OR $487.00 $487.00 $345.77 $487.00 $487.00 $345.77 $467.52 $457.78 $462.65 $477.26 SHOULDER SCORPION NEEDLE $500.00 $500.00 $355.00 $500.00 $500.00 $355.00 $480.00 $470.00 $475.00 $490.00 BAKRI BALLOON $500.01 $500.01 $355.01 $500.01 $500.01 $355.01 $480.01 $470.01 $475.01 $490.01 CARPAL TUNNEL KNIFE/BOHLEN $500.01 $500.01 $355.01 $500.01 $500.01 $355.01 $480.01 $470.01 $475.01 $490.01 PNEUMOTHORAX KIT $500.01 $500.01 $355.01 $500.01 $500.01 $355.01 $480.01 $470.01 $475.01 $490.01 SP CAP TENSION RING $500.01 $500.01 $355.01 $500.01 $500.01 $355.01 $480.01 $470.01 $475.01 $490.01 UTERINE ELEVATOR/ADAM $500.01 $500.01 $355.01 $500.01 $500.01 $355.01 $480.01 $470.01 $475.01 $490.01 OM8075 SMARTSTITCH CART $526.00 $526.00 $373.46 $526.00 $526.00 $373.46 $504.96 $494.44 $499.70 $515.48 OM8076 SMARTSTITCH SUTURE CART $526.00 $526.00 $373.46 $526.00 $526.00 $373.46 $504.96 $494.44 $499.70 $515.48 COBLATOR TURBINATOR WAND $540.00 $540.00 $383.40 $540.00 $540.00 $383.40 $518.40 $507.60 $513.00 $529.20 NM Myocardial Infarct w/ Eject Fraction $553.00 $553.00 $392.63 $553.00 $553.00 $392.63 $530.88 $519.82 $525.35 $541.94 SHOULDER DRILL/HURL $558.00 $558.00 $396.18 $558.00 $558.00 $396.18 $535.68 $524.52 $530.10 $546.84 15340 APLIGRAF 1-25 SQ CM $574.00 $574.00 $407.54 $574.00 $574.00 $407.54 $551.04 $539.56 $545.30 $562.52 XR Cholangiogram T-Tube $580.00 $580.00 $411.80 $580.00 $580.00 $411.80 $556.80 $545.20 $551.00 $568.40 COBLATOR EVAC 70 EXTRA HP WAND $604.00 $604.00 $428.84 $604.00 $604.00 $428.84 $579.84 $567.76 $573.80 $591.92 INTERSTIM TEST SCREENER $618.00 $618.00 $438.78 $618.00 $618.00 $438.78 $593.28 $580.92 $587.10 $605.64 "Excision of nail and nail matrix, partiatl/complete, for permanaent removal;with amputation of tuft" $646.00 $646.00 $458.66 $646.00 $646.00 $458.66 $620.16 $607.24 $613.70 $633.08 ENDO GIA REFILL 30MM-3.5 $691.00 $691.00 $490.61 $691.00 $691.00 $490.61 $663.36 $649.54 $656.45 $677.18 ARISTA 5G $700.00 $700.00 $497.00 $700.00 $700.00 $497.00 $672.00 $658.00 $665.00 $686.00 ENDO GIA REFILL 30MM-2.0 $718.00 $718.00 $509.78 $718.00 $718.00 $509.78 $689.28 $674.92 $682.10 $703.64 NM Thyroid Imaging Only $740.00 $740.00 $525.40 $740.00 $740.00 $525.40 $710.40 $695.60 $703.00 $725.20 OM1502 MAGNUM IMPLANT $742.00 $742.00 $526.82 $742.00 $742.00 $526.82 $712.32 $697.48 $704.90 $727.16 OM9026 AUTOCUFF IMPLANT SET $742.00 $742.00 $526.82 $742.00 $742.00 $526.82 $712.32 $697.48 $704.90 $727.16 OM9027 AUTOCUFF IMPLANT SET $742.00 $742.00 $526.82 $742.00 $742.00 $526.82 $712.32 $697.48 $704.90 $727.16 SHOULDER ANCHOR 1/HURL $742.00 $742.00 $526.82 $742.00 $742.00 $526.82 $712.32 $697.48 $704.90 $727.16 ENDO GIA/COVIDIEN $755.00 $755.00 $536.05 $755.00 $755.00 $536.05 $724.80 $709.70 $717.25 $739.90 VENTRALEX HERNIA PATCH SM $760.00 $760.00 $539.60 $760.00 $760.00 $539.60 $729.60 $714.40 $722.00 $744.80 SHOULDER ANCHOR AR2324BCM $779.00 $779.00 $553.09 $779.00 $779.00 $553.09 $747.84 $732.26 $740.05 $763.42 SHOULDER COMPRESSION SCREW/ARTHREX $782.00 $782.00 $555.22 $782.00 $782.00 $555.22 $750.72 $735.08 $742.90 $766.36 ENDO PPH03 STAPLER $795.00 $795.00 $564.45 $795.00 $795.00 $564.45 $763.20 $747.30 $755.25 $779.10 BARD IMPLANTED/INFUSION PORT $807.00 $807.00 $572.97 $807.00 $807.00 $572.97 $774.72 $758.58 $766.65 $790.86 CEMENT KNEE/ BOHL $832.00 $832.00 $590.72 $832.00 $832.00 $590.72 $798.72 $782.08 $790.40 $815.36 BARD SORBAFIX $880.00 $880.00 $624.80 $880.00 $880.00 $624.80 $844.80 $827.20 $836.00 $862.40 ABSORBATACK/SHORT/OR $896.76 $896.76 $636.70 $896.76 $896.76 $636.70 $860.89 $842.95 $851.92 $878.82 ROOM/BED: Nursery $905.00 $905.00 $642.55 $905.00 $905.00 $642.55 $868.80 $850.70 $859.75 $886.90 ROOM/BED: Nursery $905.00 $905.00 $642.55 $905.00 $905.00 $642.55 $868.80 $850.70 $859.75 $886.90 BARD PHASIX PLUG LRG $910.00 $910.00 $646.10 $910.00 $910.00 $646.10 $873.60 $855.40 $864.50 $891.80 VENTRALEX HERNIA PATCH MD $910.00 $910.00 $646.10 $910.00 $910.00 $646.10 $873.60 $855.40 $864.50 $891.80 ENDO GIA REFILL 45MM-2.0 $930.00 $930.00 $660.30 $930.00 $930.00 $660.30 $892.80 $874.20 $883.50 $911.40 STRYKER SAW BLADE/6725-127-090 $938.00 $938.00 $665.98 $938.00 $938.00 $665.98 $900.48 $881.72 $891.10 $919.24 ENDO GIA REFILL 45MM-3.5 $948.00 $948.00 $673.08 $948.00 $948.00 $673.08 $910.08 $891.12 $900.60 $929.04 TOTAL KNEE SCREW AND SUPPLIES $976.00 $976.00 $692.96 $976.00 $976.00 $692.96 $936.96 $917.44 $927.20 $956.48 PROLENE MESH PHSL $977.00 $977.00 $693.67 $977.00 $977.00 $693.67 $937.92 $918.38 $928.15 $957.46 15430 OASIS 0-100 SQ CM $983.00 $983.00 $697.93 $983.00 $983.00 $697.93 $943.68 $924.02 $933.85 $963.34 BARD PHASIX PLUG XLRG $990.00 $990.00 $702.90 $990.00 $990.00 $702.90 $950.40 $930.60 $940.50 $970.20 PREVENA INCISION KIT $990.00 $990.00 $702.90 $990.00 $990.00 $702.90 $950.40 $930.60 $940.50 $970.20 LIGASURE/LAP/OR "$1,052.00 " "$1,052.00 " $746.92 "$1,052.00 " "$1,052.00 " $746.92 "$1,009.92 " $988.88 $999.40 "$1,030.96 " NM Pulmonary Vent Gas w/ Rebreath Single "$1,063.00 " "$1,063.00 " $754.73 "$1,063.00 " "$1,063.00 " $754.73 "$1,020.48 " $999.22 "$1,009.85 " "$1,041.74 " TISSUE LINK TK "$1,078.00 " "$1,078.00 " $765.38 "$1,078.00 " "$1,078.00 " $765.38 "$1,034.88 " "$1,013.32 " "$1,024.10 " "$1,056.44 " CEMENT VERSABOND H "$1,099.00 " "$1,099.00 " $780.29 "$1,099.00 " "$1,099.00 " $780.29 "$1,055.04 " "$1,033.06 " "$1,044.05 " "$1,077.02 " NM Pulmonary Ventilation Aerosol Multi "$1,117.00 " "$1,117.00 " $793.07 "$1,117.00 " "$1,117.00 " $793.07 "$1,072.32 " "$1,049.98 " "$1,061.15 " "$1,094.66 " PROLENE MESH PHSM "$1,147.00 " "$1,147.00 " $814.37 "$1,147.00 " "$1,147.00 " $814.37 "$1,101.12 " "$1,078.18 " "$1,089.65 " "$1,124.06 " VENTRALEX HERNIA PATCH LG "$1,152.00 " "$1,152.00 " $817.92 "$1,152.00 " "$1,152.00 " $817.92 "$1,105.92 " "$1,082.88 " "$1,094.40 " "$1,128.96 " ROOM/BED: SWB "$1,168.00 " "$1,168.00 " $829.28 "$1,168.00 " "$1,168.00 " $829.28 "$1,121.28 " "$1,097.92 " "$1,109.60 " "$1,144.64 " ROOM/BED: Swingbed "$1,168.00 " "$1,168.00 " $829.28 "$1,168.00 " "$1,168.00 " $829.28 "$1,121.28 " "$1,097.92 " "$1,109.60 " "$1,144.64 " I FLOW PAINBUSTER/600ML "$1,244.00 " "$1,244.00 " $883.24 "$1,244.00 " "$1,244.00 " $883.24 "$1,194.24 " "$1,169.36 " "$1,181.80 " "$1,219.12 " "62328 Spinal Puncture, Lumbar, Dx w/ Fluoro or CT" "$1,250.00 " "$1,250.00 " $887.50 "$1,250.00 " "$1,250.00 " $887.50 "$1,200.00 " "$1,175.00 " "$1,187.50 " "$1,225.00 " SURGIMESH 1415 "$1,260.00 " "$1,260.00 " $894.60 "$1,260.00 " "$1,260.00 " $894.60 "$1,209.60 " "$1,184.40 " "$1,197.00 " "$1,234.80 " ROOM/BED: IP "$1,367.00 " "$1,367.00 " $970.57 "$1,367.00 " "$1,367.00 " $970.57 "$1,312.32 " "$1,284.98 " "$1,298.65 " "$1,339.66 " ROOM/BED: Semi Private "$1,367.00 " "$1,367.00 " $970.57 "$1,367.00 " "$1,367.00 " $970.57 "$1,312.32 " "$1,284.98 " "$1,298.65 " "$1,339.66 " SP CATARACT PACK "$1,418.00 " "$1,418.00 " "$1,006.78 " "$1,418.00 " "$1,418.00 " "$1,006.78 " "$1,361.28 " "$1,332.92 " "$1,347.10 " "$1,389.64 " LIGASURE/OR "$1,428.00 " "$1,428.00 " "$1,013.88 " "$1,428.00 " "$1,428.00 " "$1,013.88 " "$1,370.88 " "$1,342.32 " "$1,356.60 " "$1,399.44 " NM Myocardial Perfusion "$1,712.00 " "$1,712.00 " "$1,215.52 " "$1,712.00 " "$1,712.00 " "$1,215.52 " "$1,643.52 " "$1,609.28 " "$1,626.40 " "$1,677.76 " NM Myocardial Spect Single Rest/Stress "$1,714.00 " "$1,714.00 " "$1,216.94 " "$1,714.00 " "$1,714.00 " "$1,216.94 " "$1,645.44 " "$1,611.16 " "$1,628.30 " "$1,679.72 " STIMULAN ANTIBIOTIC KIT "$1,771.00 " "$1,771.00 " "$1,257.41 " "$1,771.00 " "$1,771.00 " "$1,257.41 " "$1,700.16 " "$1,664.74 " "$1,682.45 " "$1,735.58 " INTERSTIM 3037 "$1,839.00 " "$1,839.00 " "$1,305.69 " "$1,839.00 " "$1,839.00 " "$1,305.69 " "$1,765.44 " "$1,728.66 " "$1,747.05 " "$1,802.22 " COOK FISTULA PLUG "$1,850.00 " "$1,850.00 " "$1,313.50 " "$1,850.00 " "$1,850.00 " "$1,313.50 " "$1,776.00 " "$1,739.00 " "$1,757.50 " "$1,813.00 " ABSORBATACK/LONG/OR "$1,908.00 " "$1,908.00 " "$1,354.68 " "$1,908.00 " "$1,908.00 " "$1,354.68 " "$1,831.68 " "$1,793.52 " "$1,812.60 " "$1,869.84 " LIGASURE/ADAM "$1,929.00 " "$1,929.00 " "$1,369.59 " "$1,929.00 " "$1,929.00 " "$1,369.59 " "$1,851.84 " "$1,813.26 " "$1,832.55 " "$1,890.42 " UROLIFT IMPLANT "$1,950.00 " "$1,950.00 " "$1,384.50 " "$1,950.00 " "$1,950.00 " "$1,384.50 " "$1,872.00 " "$1,833.00 " "$1,852.50 " "$1,911.00 " BIOVANCE 2X3 "$2,000.01 " "$2,000.01 " "$1,420.01 " "$2,000.01 " "$2,000.01 " "$1,420.01 " "$1,920.01 " "$1,880.01 " "$1,900.01 " "$1,960.01 " ROOM/BED: OB "$2,081.00 " "$2,081.00 " "$1,477.51 " "$2,081.00 " "$2,081.00 " "$1,477.51 " "$1,997.76 " "$1,956.14 " "$1,976.95 " "$2,039.38 " ROOM/BED: OB "$2,081.00 " "$2,081.00 " "$1,477.51 " "$2,081.00 " "$2,081.00 " "$1,477.51 " "$1,997.76 " "$1,956.14 " "$1,976.95 " "$2,039.38 " MRI Bone Marrow Blood "$2,101.00 " "$2,101.00 " "$1,491.71 " "$2,101.00 " "$2,101.00 " "$1,491.71 " "$2,016.96 " "$1,974.94 " "$1,995.95 " "$2,058.98 " BARD PHASIX 8CM "$2,142.00 " "$2,142.00 " "$1,520.82 " "$2,142.00 " "$2,142.00 " "$1,520.82 " "$2,056.32 " "$2,013.48 " "$2,034.90 " "$2,099.16 " ADVANTAGE FIT "$2,523.00 " "$2,523.00 " "$1,791.33 " "$2,523.00 " "$2,523.00 " "$1,791.33 " "$2,422.08 " "$2,371.62 " "$2,396.85 " "$2,472.54 " MRI Cardiac Function Limited "$2,708.00 " "$2,708.00 " "$1,922.68 " "$2,708.00 " "$2,708.00 " "$1,922.68 " "$2,599.68 " "$2,545.52 " "$2,572.60 " "$2,653.84 " SURGIMESH 10CM CIRCLE "$2,822.00 " "$2,822.00 " "$2,003.62 " "$2,822.00 " "$2,822.00 " "$2,003.62 " "$2,709.12 " "$2,652.68 " "$2,680.90 " "$2,765.56 " SHOULDER SPEEDBRID/HURLBUT "$2,868.00 " "$2,868.00 " "$2,036.28 " "$2,868.00 " "$2,868.00 " "$2,036.28 " "$2,753.28 " "$2,695.92 " "$2,724.60 " "$2,810.64 " MRI Cardiac Function Complete "$3,032.00 " "$3,032.00 " "$2,152.72 " "$3,032.00 " "$3,032.00 " "$2,152.72 " "$2,910.72 " "$2,850.08 " "$2,880.40 " "$2,971.36 " BARD PHASIX 11 CM "$3,200.01 " "$3,200.01 " "$2,272.01 " "$3,200.01 " "$3,200.01 " "$2,272.01 " "$3,072.01 " "$3,008.01 " "$3,040.01 " "$3,136.01 " MRI Cardiac Velocity Flow Mapping "$3,604.00 " "$3,604.00 " "$2,558.84 " "$3,604.00 " "$3,604.00 " "$2,558.84 " "$3,459.84 " "$3,387.76 " "$3,423.80 " "$3,531.92 " INTERSTIM 3889-28 "$5,276.00 " "$5,276.00 " "$3,745.96 " "$5,276.00 " "$5,276.00 " "$3,745.96 " "$5,064.96 " "$4,959.44 " "$5,012.20 " "$5,170.48 " TEST CHARGE ITEM "$6,750.00 " "$6,750.00 " "$4,792.50 " "$6,750.00 " "$6,750.00 " "$4,792.50 " "$6,480.00 " "$6,345.00 " "$6,412.50 " "$6,615.00 " INTERSTIM 3058 "$17,343.00 " "$17,343.00 " "$12,313.53 " "$17,343.00 " "$17,343.00 " "$12,313.53 " "$16,649.28 " "$16,302.42 " "$16,475.85 " "$16,996.14 " TOTAL KNEE IMPLANTS/HURLBUT "$24,818.00 " "$24,818.00 " "$17,620.78 " "$24,818.00 " "$24,818.00 " "$17,620.78 " "$23,825.28 " "$23,328.92 " "$23,577.10 " "$24,321.64 " THAY PACU interval interval #VALUE! #VALUE! interval #VALUE! #VALUE! #VALUE! #VALUE! THAY Special Procedures PostOp interval interval #VALUE! #VALUE! interval #VALUE! #VALUE! #VALUE! #VALUE! THAY PostOp interval interval #VALUE! #VALUE! interval #VALUE! #VALUE! #VALUE! #VALUE! 99149 MODERATE SEDATION PHYSICIAN $149.00 $- $149.00 $149.00 11752 AMPU TUFT DIS PHALAN $622.00 $- $622.00 $622.00 APPENDECTOMY Emer Charge "$1,343.00 " $- "$1,343.00 " "$1,343.00 "