Orchard Hospital Chargemaster
Item # Description Charge
100210 TRANSFUSION BLOOD OR COMPONENT 700.00$
100215 PICC INSERTION FOR PATIENT >5 3,000.00$
200200 TRANSFUSION BLOOD OR COMPONENT 700.00$
400005 OBSERVATION SERVICES - 1ST HR 280.91$
400010 OBSERVATION SERVICES - 2ND HR 156.06$
400015 OBSERVATION SERVICES - 3RD HR 104.04$
400020 OBSERVATION SERVICES - ADDL HR 52.02$
400030 TRANSFUSION BLOOD OR COMPONENT 714.00$
1200011 SIGMOIDOSCOPE 290.55$
1212002 SURGERY RM SETUP-PK 1,126.59$
1212008 RECOVERY RM 1HR 674.88$
1212009 RECOVERY RM 2HR 640.97$
1212014 MINOR RM SUPPLY S/UP 2,642.82$
1213390 MAJOR RM SUPPLY S/UP 3,111.46$
1213391 ORTHOPEDIC RM SET-UP 1,906.94$
1213430 OPERATING RM 3 HR 6,088.33$
1217012 PROCEDURE ROOM 645.81$
1230035 EXC CA TRUNK 630.77$
1251000 OPERATING RM 1 HR 2,437.90$
1251002 OR 1ST ADDTL 1/2 HR 1,209.26$
1251003 OR 2ND ADDTL 1/2 HR 1,209.26$
1400004 BIER BLOCK 132.50$
1400010 SPINAL 317.93$
1412006 NURSE ANES 1/2 HR 310.59$
1412007 NURSE ANES 1 HR 687.99$
1500001 99281 ER EXAM ROOM I 369.75$
1500002 99283 ER EXAM ROOM III 701.25$
1500003 99284 ER EXAM ROOM IV 1,083.75$
1500004 99285 ER EXAM ROOM V 1,572.10$
1500005 99282 ER EXAM ROOM II 554.65$
1500010 99292 ER CRITICAL CARE ADD'L 30 MIN 600.00$
1500025 CHARGE VOIDED 933.75$
1500031 EAR WAX REMOVAL 65.70$
1500035 ER IV BUNDLE 132.05$
1500417 SNELLEN EYE TEST 7> 17.85$
1502000 IV INFUSION INITIAL UP 1 HR 529.95$
1502001 IV INFUSION EA ADD'L HR. 97.90$
1502002 IV INFUSION HYDRAT EA ADD'L HR 97.90$
1502003 INJECTION EA ADD'L PUSH 141.80$
1502004 INJECTION SUBCUTAN OR IM 141.80$
1502005 INJECTION IV PUSH SINGL OR INI 141.80$
1502006 SUBCUT OR IM INJECT 1 VACCINE 113.40$
1502007 INSERT TEMP BLADDER CATH SIMPL 179.60$
Orchard Hospital Chargemaster
1502008 STRAPPING SHOULDER - RIGHT 218.90$
1502009 STRAPPING SHOULDER LEFT 218.90$
1502010 INJECTION EA ADD SEQUENT PUSH 141.80$
1502011 IV INFUSION HYDRATION 31M-1HR 158.80$
1502012 CONTROL NASAL HEMORRHAGE SIMPL 283.00$
1502013 CPR 582.85$
1502015 STRAPPING HAND OR FINGER 195.45$
1502016 SHORT ARM SPLIT - LEFT 342.60$
1502017 SIMPLE REPAIR 2.6 CM TO 5 CM 310.75$
1502018 SIMPLE REPAIR 2.6CM TO 7.5 CM 310.75$
1502019 SHORT ARM SPLINT - RIGHT 342.60$
1502020 SIMPLE REPAIR 2.5 CM OR LESS 310.75$
1502021 REPAIR COMPLETE 1.1CM TO 2.5CM 729.10$
1502022 CONTROL NASAL HEMORRHAGE INITI 283.00$
1502023 SIMPLE REPAIR 2.5 OR LESS 310.75$
1502025 SHORT LEG SPLINT LT CALF/FOOT 342.60$
1502026 SHORT LEG SPLIT RT CALF/FOOT 342.60$
1502030 DISLOCATED SHOULD REDUCTION RT 542.45$
1502031 DISLOCATED SHOULD REDUCTION LT 542.45$
1502032 FOLEY CATHETER - COMPLICATED 332.80$
1502033 FOREIGN BODY REMOVAL EAR - RT 201.50$
1502034 FOREIGN BODY REMOVAL EAR - LT 243.00$
1502037 DIGIT NERVE BLCK LT HAND 2ND D 1,057.25$
1502038 DIGITAL NERVE BLOCK TOE - T5 1,057.25$
1502039 NAIL REMOVAL - TOE - T5 344.75$
1502040 FINGER SPLINT - LEFT THUMB 195.45$
1502041 STRAPPING KNEE - LT 218.90$
1502042 STRAPPING KNEE - RT 218.90$
1502043 LONG ARM SPLINT - RT 342.60$
1502044 LONG ARM SPLIT - LT 342.60$
1502045 FB REMOVAL NOSE - LEFT 195.45$
1502046 FB REMOVAL OF NOSE - RIGHT 195.10$
1502047 BURN DRESSING/DEBRIDE SMALL 310.10$
1502048 STRAPPING TOES 195.45$
1502049 SOFT TISSUE FB REMOVAL 759.80$
1502050 FINGER SPLINT LT HAND 5TH DIGI 195.45$
1502052 WOUND REPAIR INTERM 2.5 CM < 911.35$
1502055 FINGER SPLIT-LT HAND 3RD DIGIT 195.45$
1502056 FINGER SPLIT-LF HAND 2ND DIGIT 195.35$
1502057 FINGER SPLIT-RT HAND 2ND DIGIT 195.45$
1502058 WOUND REPAIR-FACE 2.6CM-5.0CM 911.35$
1502059 IV INFUSION ADDL SEQ - UP 1 HR 128.70$
1502060 FINGER SPLIT-LT HAND/4TH DIGIT 195.45$
1502061 FINGER SPLINT - RT HAND THUMB 195.45$
Orchard Hospital Chargemaster
1502062 IV INFUSION/RX CONCURRENT INF 97.90$
1502063 THORACENTESIS W/O IMAGING GUID 1,426.20$
1502064 DIGIT NERVE BLCK RT HAND 5TH D 1,057.25$
1502065 FINGER SPLIT - RT HAND 3RD DIG 195.45$
1502066 FINGER SPLIT RT HAND 5TH DIGIT 195.45$
1502067 CONTROL NASAL HEMORRHAGE 316.95$
1502068 WOUND REPAIR - INTERM. 729.10$
1502069 LONG LEG SPLINT - RIGHT 342.60$
1502070 LONG LEG SPLINT - LEFT 342.60$
1502071 CERUMEN REMOVAL UNILATERAL 179.90$
1502078 FOREIGN BODY REMOVAL 268.40$
1502079 WOUND REPAIR EYE NOSE LIPS 1,020.70$
1502080 INCISION&DRAINAGE ABSCESS 509.20$
1502081 INSERTION NON TUNNELED CATHETE 2,848.70$
1502082 BURN DRESSING/DEBRIDEMENT MED 387.60$
1502083 INITIAL TMNT 1ST DEGREE BURNS 259.25$
1502084 INSERTION NONINDWELLING CATHET 288.80$
1502085 INSERTION TEMP CATHETER COMPLI 621.55$
1502086 WOUND REPAIR 7.6 CM TO 12.5 CM 310.75$
1502087 99291 ER CRITICAL CARE FIRST 30-75 MIN 1,554.25$
1502088 CHEST TUBE 1,195.55$
1502089 FB REMOVAL - NOSE RIGHT 195.45$
1502090 SOFT TISSUE FB REMOVAL - RT 2,114.95$
1502091 SOFT TISSUE FB REMOVAL - LT 2,114.95$
1502092 REMOVAL OF FB RT 247.00$
1502093 REMOVAL OF FB LT 247.00$
1502094 FRACTURE AND/OR DISLOCATION RT 552.90$
1502095 FRACTURE AND/OR DISLOCATION LT 552.90$
1502096 FOREIGN BODY REMOVAL - EYE/LT 268.40$
1502097 FOREIGN BODY REMOVAL - EYE/RT 268.40$
1502100 ARTHROCENTESIS 612.00$
1502105 WOUND REPAIR 7.6CM TO 12.5CM 428.40$
1502110 TRANSFUSION BLOOD OR COMPONENT 700.00$
1503000 STRAPPING ACE BANDAGE-F-ARM 195.35$
1509560 STRAPPING - ANKLE AND/OR FOOT 218.90$
1510005 ET INTUBATION 282.75$
1510024 BLADDER IRRIGATION 152.00$
1510067 INCISION & DRAINAGE 181.35$
1512015 MODERATE SEDATION - E.R. 357.00$
1512016 INTERMEDIATE REPAIR 2.5 CM OR LESS 450.00$
1512017 INTERMEDIATE REPAIR 2.6 TO 7.5 CM 450.00$
1512018 INTERMEDIATE REPAIR 7.6 TO 12.5 CM 450.00$
1512019 INTERMEDIATE REPAIR 12.6 TO 20.0 CM 450.00$
1512020 IV BUNDLE - SPECIFIC TO ER 132.05$
Orchard Hospital Chargemaster
2000005 PT MCAL 1ST 30 MIN/RPT 160.44$
2000006 PT ELECTRICAL STIMUL UNATTENDED 58.14$
2000007 PT BALANCED TX SET UP 108.05$
2000009 PT THERAPY INITIAL 30 MINS MCAL 128.24$
2000017 PT TESTS/MEASUR -EA ADD'L 15M 80.17$
2000024 PT THER ACTIVITY 69.57$
2000026 PT GAIT TRAINING 91.80$
2000031 PT SELF CARE ADL 75.03$
2000032 PT PARAFFIN BATH 58.66$
2000037 PT THERAPY EA ADD'L 15 MINS MCAL 64.12$
2000038 PT CONTRAST BATH 65.48$
2000040 PT THER EX 87.72$
2000041 PT HOT OR COLD PACKS 47.75$
2000048 PT WHIRLPOOL 45.90$
2000055 PT MECHANICAL TRACTION 96.90$
2000070 PT RE-EVAL 143.82$
2000083 PT TENS 144.62$
2000088 PT MANUAL THERAPY - EA 15 MINS. 112.20$
2000089 PT ULTRA SOUND 63.24$
2000090 PT WHEEL CHAIR TRAINING 59.16$
2000093 PT WOUND CARE MAJOR 924.12$
2000100 PT DRESSING/DEBRIDEMENT 255.00$
2000105 PT DRESSING/DEBRIDEMENT ADD'L 255.00$
2000115 PT NEUROMUSC. RE-ED 137.79$
2000120 PT MASSAGE 69.57$
2000140 PT CANALITH REPOSITION PRO/PERDAY 89.76$
2000150 PT PHYSICAL PERF TESET&MEASURE 68.34$
2000155 PT ELEC. STIM. (MANUAL) 71.40$
2003000 PT EVALUATION LOW COMPLEXITY 249.66$
2003005 PT EVALUATION MODERATE COMPLEX 249.66$
2003010 PT EVALUATION HIGH COMPLEXITY 249.66$
2003015 PT ORTHOTIC MANAGEMENT 84.66$
2100004 ST SWALLOW EVAL 265.20$
2100006 ST SWALLOW FUNCTION TX 191.20$
2100007 ST SWALLOW DYSFUCNTION TX 264.18$
2100010 ST SPEECH TREATMENT GROUP 182.58$
2100011 ST SPEECH FLUENCY EVAL 341.70$
2100012 ST EVAL OF SPEECH SOUND PRODUCTIO 576.30$
2100013 ST EVAL OF SPEECH W/LANG COMPREH 576.30$
2100014 ST EVAL SPEECH GEN DEVICE 1ST HR 210.12$
2100015 ST EVAL SPCH GEN DEVICE EA SUB30M 81.60$
2100016 ST FLOUROSCOPIC SWALLOW EVAL 437.58$
2100020 ST APHASIA EVAL PER HR INTERP/RPT 214.20$
2100021 ST DEVELOP TESTING W/INTER/RPT 340.68$
Orchard Hospital Chargemaster
2100022 ST COGNITIVE TRAINING 91.80$
2100025 ST SENSORY INTEGRATIVE TECHNIQUES 60.18$
2100026 ST BEHAV/QUALITAT ANALYSIS VOICE 419.22$
2100027 ST EVAL USE/FITTING VOICE PROSTH 398.82$
2100029 ST THERAP SVCS USE SPCH GEN DEVIC 229.50$
2200004 OT SELF CARE ADL 75.03$
2200005 OT ELEC.STIM.(MANUAL) 71.40$
2200011 OT THER EX 69.57$
2200022 OT NEUROMUSCULAR RE-EDUCATION 137.79$
2200024 OT THERAPY EXERCISE 87.72$
2200035 OT RE EVALUATION 124.14$
2200043 OT MASSAGE 69.57$
2200044 OT PHYSICAL PERF TEST&MEASURE 68.34$
2200620 OT TENS 144.53$
2200625 OT HOT OR COLD PACKS 47.75$
2200630 OT ELECTRICAL STIMUL UNATTENDED 58.14$
2203000 OT EVALUATION LOW COMPLEXITY 163.50$
2203005 OT EVALUATION MODERATE COMPLEX 163.50$
2203010 OT EVALUATION HIGH COMPLEXITY 163.50$
2206000 OT PARAFFINE BATH 58.66$
2206005 OT CONTRAST BATH 65.48$
2206010 OT ULTRA SOUND 63.24$
2206015 OT MANUAL THERAPY 112.20$
2206020 OT ADL RETRAINING 75.03$
2206021 OT THERAPEUTIC ACTIVITY 69.57$
2206022 OT COGNITIVE THERAPY 91.80$
2206023 OT COMMUNITY WORK REINTEGRATION 75.03$
2206052 OT ORTHOTIC MANAGEMENT 84.66$
2206060 OT MCAL-EVAL 30 MINS PLUS REPORT 160.44$
2206065 OT MCAL - EVAL ADD'L 15 MINS/RPT 80.17$
2206070 OT MCAL -TREATMENT INITIAL 30 MIN 127.63$
2206075 OT MCAL - EA ADD'L 15 MINS 64.12$
2301000 RN INFUSION THERAPY - 1ST HR 432.43$
2301005 RN IV INFUSION EA ADD'L HR 79.87$
2400005 16-37MINS INDIV. PSYCHOTHERAPY 331.50$
2400010 38-52MIN INDIV. PSYCHOTHERAPY 357.00$
2400015 53-67MIN INDIVD PSYCHOTHERAPY 382.50$
2400020 FAMILY PSYCHOT W/O PT PRESENT 382.50$
2400025 FAMILY PSYCHOTHER W/PT PRESENT 382.50$
2400030 GROUP PSYCHOTHERAPY 300.90$
2400035 TELEHEALTH FACILITY FEE 51.00$
3000003 ALBUMIN 70.94$
3000004 ALCOHOL/ETHYL 189.26$
3000005 ALK. PHOSPHATASE 107.15$
Orchard Hospital Chargemaster
3000006 ALT 126.63$
3000007 AMMONIA 187.83$
3000008 AMYLASE 179.52$
3000010 AST 126.63$
3000011 BASIC METABOLIC 119.70$
3000012 BILIRUBIN DIRECT 125.26$
3000013 BILIRUBIN TOTAL 104.65$
3000015 BNP 283.87$
3000016 BUN 114.09$
3000017 CALCIUM 102.97$
3000019 CHLORIDE 100.22$
3000020 CHOLESTEROL 84.86$
3000021 CK 169.78$
3000023 COMP METABOLIC 185.08$
3000024 CREATININE 114.09$
3000025 CREATININE 24 HR URINE 34.78$
3000026 CREATININE CLEARANCE 69.56$
3000027 CREATINE RANDOM URINE 20.86$
3000028 D-DIMER 181.66$
3000029 DIGOXIN LEVEL 137.75$
3000030 DILANTIN/PHENYTOIN 129.44$
3000033 CBC W/ AUTO DIFF 153.40$
3000035 GLUCOSE BLOOD 97.41$
3000036 FECAL OCCULT BLOOD 29.22$
3000037 FERRITIN 107.15$
3000038 FOLATE 32.03$
3000039 FREE T4 164.22$
3000042 GGT 148.87$
3000043 GLUCOSE BLOOD 83.20$
3000045 GLUCOSE ADDITIONAL 66.81$
3000049 GLUCOSE POST DOSE 121.07$
3000050 GLUCOSE TOL 3 SPEC 307.53$
3000053 HEMOGRAM 104.70$
3000054 HEPATIC FUNC PANEL 96.03$
3000055 HGB A1C 33.41$
3000056 HIV RAPID 102.97$
3000057 INFLUENZA A/B 203.75$
3000058 IRON 55.64$
3000059 LACTATE (LACTIC ACID) 86.29$
3000060 LDL CHOLESTEROL DIR 18.11$
3000061 LIPASE 118.27$
3000062 LIPID PANEL 126.63$
3000063 LYTES 105.77$
3000064 MAGNESIUM 105.77$
Orchard Hospital Chargemaster
3000065 MANUAL DIFF 90.83$
3000067 MICROALBUMIN 24 HR URINE 45.90$
3000068 MICROALBUMIN URINE RANDOM 40.34$
3000069 MONO TEST 121.07$
3000070 PHOSPHORUS 65.38$
3000073 POTASSIUM 112.71$
3000074 POTASSIUM 24 HR URINE 28.65$
3000078 FINGERSTICK GLUCOSE IN-HOUSE 66.81$
3000081 PROTEIN TOTAL 24 HR URINE 68.20$
3000082 PROTHROMBIN TIME 104.70$
3000083 PSA TOTAL 157.23$
3000084 PTT 119.85$
3000085 HCG QUANT BETA 69.56$
3000087 RA TITER 48.71$
3000097 RENAL FUNCTION PANEL 8.36$
3000098 RETIC COUNT-AUTOMATED 79.51$
3000101 RSV 238.22$
3000104 SEDIMENTATION RATE 79.51$
3000108 STOOL WBC 29.02$
3000110 PROTEIN TOTAL 57.07$
3000111 TOTAL VOLUME 24 HR URINE 49.10$
3000114 TSH 193.44$
3000117 UREA NITROGEN URINE 51.71$
3000119 URINALYSIS DIP 42.30$
3000120 URINALYSIS MICROSCOPIC ONLY 84.60$
3000121 MICRO (UA) 96.85$
3000122 URINE DRUGS OF ABUSE 273.87$
3000127 VANCOMYCIN 164.22$
3000128 VENIPUNCTURE 25.04$
3000129 VIT B-12 11.12$
3000130 WET MOUNT KOH PREP 66.81$
3000132 URINE DIPSTICK 15.05$
3000140 KETONES 41.77$
3000157 RA FACTOR 16.68$
3000204 TRIGLYCERIDE 98.79$
3000205 TROPONIN I 208.74$
3000206 TSH 193.44$
3000207 QUALITATIVE BETA HCG 122.40$
3000210 URIC ACID BLOOD 114.09$
3000217 VALPROIC ACID 129.44$
3000233 URINE SODIUM 73.75$
3000234 POTASSIUM RAND URINE 83.49$
3000236 PROTEIN TOTAL RAN UR 72.37$
3000300 STREP A RAPID 105.77$
Orchard Hospital Chargemaster
3001300 DIP STICK URINE 23.20$
3002002 URINE PREGNANCY 140.56$
3003500 BUN - UREA NITROGEN - ISTAT 17.49$
3003502 CHLORIDE - ISTAT 20.40$
3003503 C02 CONTENT - ISTAT 21.73$
3003504 CREATININE - ISTAT 22.75$
3003505 GLUCOSE BLOOD - ISTAT 17.44$
3003506 POTASSIUM SERUM - ISTAT 112.71$
3003507 SODIUM - ISTAT 35.24$
3003508 HEMOGLOBIN - ISTAT 9.54$
3003509 HEMATOCRIT - ISTAT 9.54$
3003511 TROPONIN I - ISTAT 43.66$
3003512 BNP - ISTAT 150.60$
3005000 CLOSTR DIFF/CDA - INHOUSE 161.26$
3005089 SALICYLATES SERUM 189.26$
3005094 SODIUM 100.22$
3005104 GASTROCULT SLIDE 16.68$
3005105 HDL 51.51$
3005180 VITAMIN D 25 HYDROXY 156.06$
3005181 ECO2 21.73$
3005182 ACETAMINOPHEN 189.26$
3005183 DIRECT IBC 77.49$
3005184 TRANSFERRIN 7.50$
3200010 THYROGLOBULIN A&B SEND OUT 6.30$
3200086 PROTEIN CREATINE SEND OUT 5.76$
3200088 RAPID PLASMIN REAGIN RPR SEND OUT 3.26$
3200102 RUBELLA IGG SEND OUT 8.73$
3200105 CARBOXY HEROGLOBIN SEND OUT 87.74$
3200106 PATHOLOGY DURING SUGGERY SEND OUT 97.37$
3200107 SODIUM 24 HR URINE SEND OUT 14.98$
3200109 STAIN MICO ORGANISMS SEND OUT 196.24$
3200112 GROSS MICRO LEVEL V SEND OUT 450.79$
3200113 QUINIDINE SEND OUT 160.50$
3200115 IGF-BP3 SEND OUT 19.00$
3200116 UREA NITRO 24HR URINE SEND OUT 16.05$
3200118 ADH SEND OUT 87.74$
3200131 URINE I.D. SEND OUT 2.13$
3200142 HUMAN T CELL LYMPHO SEND OUT 79.18$
3200145 POTASSIUM 24HR URINE SEND OUT 13.91$
3200160 THYROGLOBULIN PANEL SEND OUT 19.58$
3200178 RUBELLA AB SEND OUT 7.76$
3200180 GROSS MICRO EXAM LEVEL III SEND OUT 147.66$
3200181 CYTOPATHOLOGY FINE NEEDLE SEND OUT 205.98$
3200182 CYTOPATHOLOGY SEND OUT 54.89$
Orchard Hospital Chargemaster
3200183 GROSS MICRO EXAM LEVEL IV SEND OUT 202.12$
3200184 GROSS EXAM LEVEL I SEND OUT 68.69$
3200200 GROSS MICRO EXAM LEVEL IV SEND OUT 202.12$
3200230 PIN WORM EXAM SEND OUT 17.12$
3200235 PROTEIN 24 HR URINE SEND OUT 13.91$
3200241 FOOD ALLERGY SEND OUT 163.71$
3200242 IGE SEND OUT 22.47$
3200244 ALLERGEN PROFILE SEND OUT 84.84$
3200245 CYCLIC CITRULLINATED SEND OUT 42.00$
3200246 PORPHYRINS URO COPRO URINE SEND OUT 70.87$
3200688 KEPPRA LEVEL SEND OUT 42.00$
3201000 REERSE T3 - QUEST SEND OUT 15.75$
3201534 CYCLOSPORINE BLOOD SEND OUT 25.20$
3202009 FORTICAL CALCITONIN NASAL SPR SEND OUT 47.94$
3203501 CALCIUM - ISTAT 22.00$
3205001 AEROBIC CULTURE SEND OUT 9.70$
3205002 AFP TUMOR SEND OUT 12.60$
3205003 ANA SEND OUT 5.25$
3205004 ANAEROBIC CULTURE SEND OUT 11.90$
3205005 BETA-2 MICROGLOBULIN SEND OUT 16.05$
3205006 BLOOD CULTURE SEND OUT 9.70$
3205007 CA 125 SEND OUT 12.60$
3205008 CA 19-9 SEND OUT 14.70$
3205009 CA 27-29 SEND OUT 12.60$
3205011 CEA SEND OUT 13.58$
3205012 CHLAMYDIA GC URINE OR SWAB SEND OUT 21.00$
3205013 COMPLEMENT C3 SEND OUT 10.00$
3205014 COMPLEMENT C4 SEND OUT 10.00$
3205015 CORTISOL SEND OUT 9.45$
3205016 CORTISOL URINE 24 HR SEND OUT 182.97$
3205017 C-REACTIVE PROTEN CARDIAC SEND OUT 6.42$
3205018 C-REACTIVE PROTEIN SEND OUT 5.82$
3205019 CULTURE URINE SEND OUT 11.64$
3205020 ESTRADIOL SEND OUT 24.61$
3205021 ESTROGEN SEND OUT 25.25$
3205022 DHEA SULFATE IMMUNOASSAY SEND OUT 9.45$
3205023 TESTOSTERONE FREE SEND OUT 9.98$
3205024 GENTAMICIN SEND OUT 12.60$
3205025 GRAM STAIN SEND OUT 2.38$
3205026 HELICOBACTER-ANTI PY SEND OUT 114.49$
3205027 HCV RNA PCR QI RFLX SEND OUT 141.75$
3205028 HEP C RNA PCR QUAL SEND OUT 116.63$
3205029 NGI HCV QUANTASURE SEND OUT 92.40$
3205030 HEP. B SURFACE A-B SEND OUT 9.63$
Orchard Hospital Chargemaster
3205031 MYOGLOBIN SERUM SEND OUT 17.85$
3205032 HEP A B C PANEL SEND OUT 41.73$
3205033 HEP C VIRAL AB SEND OUT 7.76$
3205034 HERPES CULTURE SEND OUT 58.85$
3205035 HIV 2 AB SEND OUT 115.56$
3205036 HIV-1 AB SEND OUT 26.75$
3205037 H-PYLORI STOOL SEND OUT 43.97$
3205038 B12 UNSATURATED BINDING CAP SEND OUT 13.65$
3205039 HSV 1&2 HERPES SIMPLE TYP 1 SEND OUT 353.10$
3205040 IGF-1 SEND OUT 18.90$
3205041 CULTURE OTH SOURCE NOT BLOOD SEND OUT 5.25$
3205042 ISLET CELL DYSFU SEND OUT 7.76$
3205043 CALCIUM IONIZED SEND OUT 12.60$
3205044 LYME DISEASE IGG WBA SEND OUT 19.97$
3205045 LEAD SEND OUT 8.40$
3205046 LEAD BLOOD PEDIATRIC SEND OUT 25.68$
3205047 THEOPHYLLINE SEND OUT 13.65$
3205048 LUTEINIZING HORMONE SEND OUT 7.35$
3205049 LYME DISEASE AB SEND OUT 37.45$
3205050 METHYLMALONIC ACID SERUM SEND OUT 35.00$
3205051 CULTURE MRSA SCREEN SEND OUT 7.80$
3205052 MUMPS AB IGG TITER SEND OUT 8.73$
3205053 PROTEIN S FUNCTIONAL SEND OUT 23.10$
3205054 OSMOLALITY URINE SEND OUT 24.65$
3205055 OVA & PARASITE SEND OUT 10.50$
3205056 PHENOBARBITAL SERUM SEND OUT 11.55$
3205057 PRE ALBUMIN SEND OUT 7.35$
3205058 PROGESTERONE SEND OUT 10.50$
3205059 PROLACTIN SEND OUT 9.45$
3205060 PTH-C-TERMINAL SEND OUT 18.49$
3205061 UPPER RESPIRATORY CULTURE SEND OUT 9.08$
3205062 RUBEOLA ANTIBODIES IGG SEND OUT 8.73$
3205063 CULTURE STOOL SEND OUT 8.73$
3205064 ANTIBODY IDENT LEUKOCYTE ATIB SEND OUT 26.25$
3205065 ANTI MULLERIAN HORMONE SEND OUT 102.00$
3205066 T3 TOTAL RIA SEND OUT 8.73$
3205067 T3 FREE SEND OUT 7.35$
3205068 T3 UPTAKE SEND OUT 5.25$
3205069 T4 TOTAL SEND OUT 8.40$
3205070 TACROLIMUS FK506 BLOOD SEND OUT 42.00$
3205071 CARBAMAZEPINE TEGRETOL SEND OUT 10.50$
3205072 HEMOGLOBIN (HAB)SOLU SEND OUT 22.47$
3205073 TESTOSTERONE TOTAL SEND OUT 9.70$
3205074 CULTURE THROAT/NOSE SEND OUT 38.63$
Orchard Hospital Chargemaster
3205075 THYROID PEROXIDASE SEND OUT 10.97$
3205076 UNSTATURATED IRON INDING TIBC SEND OUT 75.97$
3205077 LIPOPROTEIN SEND OUT 116.63$
3205078 VARICELLA ZOSTER A-B SEND OUT 5.82$
3205079 VITAMIN D 1 25 HYDRO SEND OUT 19.40$
3205080 LACOSAMIDE LC/MC/MS SEND OUT 90.68$
3205081 FOLATE RBC PROFILE SEND OUT 6.30$
3205082 SUSCEPTIBILITY SEND OUT 5.33$
3205083 INSULIN FREE SEND OUT 67.50$
3205084 ANGIOTENSIN CONV ENZ SEND OUT 15.75$
3205085 CELL CNT BODY FLUID SEND OUT 92.02$
3205086 URIC ACID 24 HR URINE SEND OUT 22.47$
3205087 CMV I/B IGG & IGM SEND OUT 22.47$
3205088 FACTOR VIII ACTIVITY CLOTTING SEND OUT 98.23$
3205089 FACTOR IX ACTIVITY COAG SEND OUT 42.00$
3205090 ANTI SMOOTH MUSCLEAB SEND OUT 9.85$
3205091 MITOCHONDRIAL M2 AB SEND OUT 19.00$
3205092 HEPATITIS A IGM SEND OUT 7.76$
3205093 ASO-SCREEN SEND OUT 6.30$
3205094 CSF PROTEIN SEND OUT 3.34$
3205095 ANCA X2 SEND OUT 87.74$
3205096 COLD AGGLUTINATION SEND OUT 117.70$
3205097 FEBRILE AGGLUTININX6 SEND OUT 149.80$
3205098 EOSINOPHILL URINE RA SEND OUT 51.36$
3205099 CALCULI URINE SEND OUT 38.52$
3205100 PREGNANCY SERUM 39.59$
3205101 HT LVI / HTLV II SEND OUT 27.00$
3205102 DHEA SEND OUT 41.31$
3205103 ASSAY OF PROGESTERONE SEND OUT 48.15$
3205104 BETA 2-GLYCOPROTEIN I SEND OUT 54.46$
3205105 PROTHROMBIN GENE ANALYSIS SEND OUT 92.40$
3205106 THROMBIN TIME SEND OUT 3.26$
3205107 STONE ANALYSIS SEND OUT 36.75$
3205108 SPECIAL STAINS-MISCELLANEOUS SEND OUT 59.43$
3205109 ZONISAMIDE SEND OUT 39.22$
3205110 IGFBP-3 SEND OUT 33.25$
3205111 LACTIC ACID DEHYDROGENASE SEND OUT 3.26$
3205112 THYROXINE SEND OUT 4.19$
3205113 COPPER SEND OUT 10.50$
3205114 ALDOLASE SEND OUT 3.21$
3205115 OSMOLALITY SERUM SEND OUT 8.40$
3205116 TESTOSTERONE SEND OUT 9.70$
3205117 FSH SERUM SEND OUT 7.49$
3205118 ACTH PLASMA SEND OUT 25.25$
Orchard Hospital Chargemaster
3205119 VITAMIN B6 SEND OUT 24.65$
3205122 CYTOMEGALOVIRUS CMV AB SEND OUT 6.56$
3205124 HSV CULTURE AND TYPING SEND OUT 10.50$
3205125 GENITAL CULTURE ROUTINE SEND OUT 25.20$
3205126 C-PEPTIDE SEND OUT 21.00$
3205127 H PLYLORI IGM IGG IGA AB SEND OUT 14.85$
3205129 CCP IGG/IGA SEND OUT 42.00$
3205130 LOWER RESPIRATORY CULTURE SEND OUT 12.84$
3205131 H PYLORI BREATH TEST SEND OUT 111.36$
3205132 HSV CULTURE WITHOUT TYPING SEND OUT 19.72$
3205133 HCV QUANT REAL TIME PCR SEND OUT 92.40$
3205135 HOMOCYSTEINE PLASMA SEND OUT 34.43$
3205136 FREE K+L LT CHAINS QN S SEND OUT 80.18$
3205137 VITAMIN B1 THIAMINE BLOOD SEND OUT 17.85$
3205138 CYTOMEGALOVIRUS CMV QUAT SEND OUT 8.53$
3205140 TOTAL PROTEIN SEND OUT 13.91$
3205141 PROTEIN ELECTROPHORECTIC SEND OUT 9.08$
3205144 STOOL AEROBIC PATHOGENS ISO SEND OUT 9.40$
3205145 STOOL SHIGA LIKE TOXIN SEND OUT 56.70$
3205146 OVA AND PARASITE COMPLEX SEND OUT 10.50$
3205150 WEST NILE VIRUS IGM SEND OUT 55.95$
3205151 WEST NILE VIRUS SEND OUT 55.95$
3205154 GL CELIAC DISEASE GAM/IMMUN SEND OUT 7.74$
3205155 HSV 1&2 HERPES SIMPLEX SEND OUT 16.00$
3205157 NEISSERIA GONORRHOEAE AMP SEND OUT 42.00$
3205159 EBV ACUT EB NUCLEAR ANTIGEN SEND OUT 32.62$
3205160 EBV ACUTE EB EARLY ANTIGEN SEND OUT 14.05$
3205161 EBV ACUTE EB VIRAL CAPSID SEND OUT 32.62$
3205163 IGA QUANT SERUM SEND OUT 7.81$
3205164 DEAMIDATED GLIADIN IGA SEND OUT 33.33$
3205165 DEAMIDATED GLIADIN IGG SEND OUT 29.11$
3205166 HSV 1&2 HERPES SIMPLEX 2 SEND OUT 20.12$
3205167 TISSUE TRANGULATIMASE IGA SEND OUT 29.11$
3205168 TISSUE TRANGLUTAMINASE IGG SEND OUT 29.11$
3205172 HEPATITIS C ANTIBODY SEND OUT 74.68$
3205173 HEPATITIS A AB IGM SEND OUT 7.76$
3205174 HEPATITIS B CORE AB IGM SEND OUT 226.54$
3205190 ANTI-DSDNA ANTIBODIES SEND OUT 8.40$
3205191 HIV 1 & 2 SEND OUT 57.27$
3205602 CA 15-3 SEND OUT 12.26$
3205603 ZINC SEND OUT 12.60$
3206000 TRANSFERRIN SEND OUT 7.35$
3206001 SCLERODERMA ANTIBODY SEND OUT 9.90$
3206002 PROTEIN ELECTROPHORESIS PANEL SEND OUT 19.95$
Orchard Hospital Chargemaster
3206003 DONOR SYPHILLS IGG ANTIBODY SEND OUT 55.37$
3206004 VITAMIN A (RETINOL) SEND OUT 14.70$
3206005 CALPROTECTIN STOOL SEND OUT 133.64$
3206006 DRVVT CONFIRM SEND OUT 41.31$
3206007 HEXAGONAL PHASE CONFIRM SEND OUT 41.31$
3206008 THROMBIN CLOTTING TIME SEND OUT 3.26$
3206009 DRVVT 1:1 MIX SEND OUT 26.72$
3206010 BK VIRUS DNA TIME PCR URINE SEND OUT 131.25$
3206011 ALPHA-1-ANTITRYPSIN QUANTITIVE SEND OUT 10.50$
3206012 CATECHOLAMINES FRAC 24HR URINE SEND OUT 18.48$
3206013 HEPATITIS C VIRAL RNA SEND OUT 136.50$
3206014 VISCOSITY SEND OUT 14.70$
3206015 CHROMOGRANIN SEND OUT 95.00$
3206016 GAMMA-HYDROXYBUTYRIC ACID(GHB) SEND OUT 106.00$
3206017 METANEPHRINES SEND OUT 131.44$
3206018 LAMOTRIGINE SEND OUT 19.03$
3206019 BETA CAROTENE SEND OUT 12.60$
3207000 RBC ANTIBODY ID - BLOOD SOURCE SEND OUT 105.00$
3207005 COOMBS TST DIRECT BLOOD SOURCE SEND OUT 51.00$
3207038 SELENIUM 2.5% SUSP TOPICAL SEND OUT 104.86$
3207121 ALDOSTERONE SEND OUT 20.47$
3207126 RUBELLA SEND OUT 8.73$
3207127 ACUTE HEPATITIS PANEL SEND OUT 21.29$
3207130 PRENATAL/OB PANEL SEND OUT 32.34$
3207135 HEPATITIS B CORE IGM SEND OUT 7.76$
3207136 HEPATITIS B SURFACE AG SEND OUT 3.85$
3207137 HEPATITIS C AB SEND OUT 6.05$
3207138 RPR SEND OUT 3.26$
3207145 HEPATITIS B SURFACE AB SEND OUT 3.85$
3207153 AGINITIS PLUS VG SEND OUT 47.87$
3207154 PARASITE INDETIFIY SEND OUT 17.00$
3207155 TUBERCULOSIS SUSCEPT SEND OUT 9.06$
3207180 PROTEIN ELECTROPHORESIS SEND OUT 9.10$
3207181 HEREDITARY HEMO DNA ANALYSIS SEND OUT 131.25$
3207182 DIHYDROTESTERONE DHT SEND OUT 68.40$
3207183 CERULOPLASMIN SEND OUT 7.35$
3208000 IMMUNO ER PR HER-2 SEND OUT 77.30$
3208585 TSH SEND OUT 6.30$
3208787 FECAL IMMUNOCHEM SEND OUT 49.00$
3209055 DRUG CONFIRMATION EA PROCEDUR SEND OUT 45.00$
3215001 ANDROSTENEDIONE SEND OUT 23.10$
3215002 CYCLIC AMP URINE SEND OUT 104.07$
3215003 FREE ANDROGEN SEND OUT 104.07$
3215005 ORO-SPUTUM CULTURE SEND OUT 2.13$
Orchard Hospital Chargemaster
3215006 CRYPTOSPORIDIUM ANTIGEN SEND OUT 63.00$
3215007 URINE PROTEIN TOTAL W/O CREAT SEND OUT 3.84$
3215008 ALLERGY EVAL 5 NORTH CENTRAL SEND OUT 7.07$
3215009 TSI-THYROID STIMULATING IMMUN SEND OUT 52.50$
3215010 OVA & PARASITES W/GIARDIA ANTI SEND OUT 10.50$
3215011 LEUK/LYMPHOMA 1ST MARKER SEND OUT 15.50$
3215012 SEX HORMONE BINDING GLOBULIN SEND OUT 17.85$
3215013 HLA-B27 ANTIGEN SEND OUT 18.82$
3215016 VITAMIN C LC/MS/MS SEND OUT 9.45$
3215017 LEUK/LYMPHOMA 2ND ADDTL MARKER SEND OUT 15.50$
3215018 LEUK/LYMPHOMA 16+ MARKERS SEND OUT 15.50$
3215019 MERCURY QUANTITATIVE SEND OUT 17.85$
3215020 COXIELLA BURNETII (Q FEVER) SEND OUT 66.82$
3215021 ACETYLCHOLINE RECEPTOR BINDING SEND OUT 84.19$
3215024 GLUTAMIC ACID DECARB-65 ANTIBY SEND OUT 66.82$
3215025 FUNGAL STAIN SEND OUT 10.50$
3215026 FUNGAL TISSUE/SKIN SEND OUT 25.41$
3215027 RED CELL ANTIBODY SCREEN SEND OUT 103.00$
3215028 MYSOLINE SEND OUT 10.50$
3215029 AMYLASE ISOENZYMES SEND OUT 25.21$
3215030 ARSENIC URINE SEND OUT 15.75$
3215032 SPECTROPHOTOMETRY SEND OUT 15.00$
3215033 COCCIDIOIDES ANTIBODIES SEND OUT 15.51$
3215034 ORO-GLUCOSE BODY FLUID NOT BL SEND OUT 5.39$
3215035 ORO-WET MOUNT FOR INFECTIONS SEND OUT 5.86$
3215036 CYTOPATH/CELL ENHANCER SEND OUT 40.68$
3215037 FECES ANALYTE SEND OUT 26.01$
3215039 HIV-1 QUANTIFICATION INCL REV SEND OUT 92.40$
3215040 GABAPENTIN SEND OUT 20.05$
3215042 TETANUS SEND OUT 25.28$
3215043 DIPHTHERIA SEND OUT 26.25$
3215045 TRICHOMONAS VAGINALIS AMPLIFY SEND OUT 99.78$
3215046 HAPTOGLOBIN SEND OUT 9.45$
3215048 PORPHOBILINOGEN QUANTITATIVE SEND OUT 10.50$
3215049 POPHYRINS TOTAL PLASMA SEND OUT 81.97$
3215051 ANTITHROMBIN III ACTIVITY SEND OUT 13.65$
3215052 PROTEIN C FUNCTIONAL SEND OUT 32.55$
3215054 FOLATE RBC SEND OUT 6.30$
3215055 NOROVIRUS RNA PCT RT SEND OUT 113.62$
3215056 CORTICOSITERIOS BDING GLOB SEND OUT 60.00$
3215057 ORO-GRAM STAIN DX SEND OUT 5.78$
3215058 ALUMINUM SEND OUT 12.60$
3215059 ESTRADIOL FREE LC/MS/MS SEND OUT 16.80$
3215060 INSULIN ATIBODIES SEND OUT 10.50$
Orchard Hospital Chargemaster
3215061 HANDLING FEE SEND OUT 25.00$
3215062 PROTEIN CSF FLUID SEND OUT 9.10$
3215063 FUNGUS NOT ELSEWHERE SPECIFY SEND OUT 47.04$
3215066 CALCIUM 24-HR URINE W/O CREAT SEND OUT 5.59$
3215067 ORO-ANTIBODY RBC PANELS SEND OUT 123.00$
3215068 ORO-ANTIHUMAN GLOBIN(COOMBS) SEND OUT 15.00$
3215069 ORO-STAT HANDLING FEE SEND OUT 113.00$
3215070 FLUOXETINE SEND OUT 28.79$
3215071 PSA TOTAL W/REFLEX TO PAS FREE SEND OUT 8.40$
3215072 DRUG ABUSE 9 ITH CONFIRM SEND OUT 136.50$
3215073 LUPUS ANTICOAG EVAL W/REFLEX SEND OUT 6.30$
3215074 POLIOVIRUS (TYPES 1 3) AB NEUT SEND OUT 52.75$
3215075 BACTERIUM PNEUNOMITIS SEND OUT 11.22$
3215076 ASPERGILLIS SEND OUT 11.22$
3215077 ALLERGEN SPEC IGC QUANTATIVE SEND OUT 11.22$
3215078 RETICULOCYTE COUNT AUTOMATED SEND OUT 4.20$
3215079 ASPERGILLUS ANTGN EIA SEND OUT 99.57$
3215082 IHC INTIAL SINGLE AB STAIN SEND OUT 97.76$
3215085 EGFR SEND OUT 477.28$
3215086 LACTOFERRIN FECAL QUALITATIVE SEND OUT 70.35$
3215087 PANCREATIC ELASTASE-1 SEND OUT 224.00$
3215090 FACTOR X ACTIVITY CLOTTING SEND OUT 48.36$
3215091 FACTOR XII ACTIVITY CLOTTING SEND OUT 28.35$
3215092 VON WILLEBRAND FACTOR ANTIGEN SEND OUT 92.40$
3215093 GLYCOMARK SEND OUT 38.31$
3215095 CALCITONIN SEND OUT 18.90$
3215096 HEMOGLOBINOPATHY SEND OUT 3.94$
3215097 HEMOGLOBINOPATHY EVAL SEND OUT 3.94$
3215098 PROTEIN C ANTIGEN SEND OUT 25.20$
3215099 VITAMIN K SEND OUT 99.75$
3215100 REPTILASE TEST SEND OUT 70.35$
3215101 FIBRINOGEN ANTIGEN SEND OUT 9.45$
3215102 FIBRINOGEN ACTIVITY SEND OUT 9.45$
3215103 CARDIOLIPIN AB IGA IGG IGM SEND OUT 30.44$
3215111 ANA TITER/PATTERN SEND OUT 7.35$
3215112 ALDOSTERONE/PRAR LC/MS/MS SEND OUT 39.37$
3215113 ROTAVIRUS ANTIGEN DETECTION SEND OUT 14.70$
3215114 ST.LOUIS ENCEPHALITIS VIRUS SEND OUT 146.05$
3217182 MTHFR DNA MUTATION SEND OUT 173.25$
3217183 LITHIUM SEND OUT 5.25$
3218000 CLOSTR DIFF/CDA - QUEST SEND OUT 90.68$
3280005 CLOSTR DIFF/CDA - OROVILLE SEND OUT 47.80$
3400089 BB RBC UNIT 1 IGG GEL COMPATIBILI 93.20$
3400090 BB RBC UNIT 1 IS TUBE COMPATIBILI 264.65$
Orchard Hospital Chargemaster
3400091 BB RBC UNIT 2 IGG GEL COMPATIBILI 264.65$
3400092 BB RBC UNIT 2 IS TUBE COMPATIBILI 264.65$
3400093 BB RBC UNIT 3 IGG GEL COMPATIBITI 264.65$
3400094 BB RBC UNIT 3 IS TUBE COMPATIBILI 264.65$
3400095 BB RBC UNIT 4 IGG GEL COMPATIBILI 264.65$
3400096 BB RBC UNIT 4 IS TUBE COMPATIBILI 264.65$
3400099 BB R H FACTOR 85.95$
3400100 BB ABO GROUP 85.95$
3400101 BB ANTIBODY SCREEN 90.05$
3400102 BB CYROPRECIPITATE EA. UNIT 483.64$
3400103 BB DIRECT COOMBS - REF LAB 10.59$
3400104 BB PLATELET PHERESIS 645.00$
3400105 BB PRBC #1 CHARGE 263.00$
3400106 BB PRBC #2 CHARGE 263.00$
3400107 BB PRBC #3 CHARGE 263.00$
3400108 BB PRBC #4 CHARGE 263.00$
3400109 BB RHOGAM 447.75$
4000001 XR FACIAL BONES 418.25$
4000002 XR MANDIBLE RT 469.50$
4000003 XR MASTOIDS RT 413.55$
4000004 XR NASAL BONES RT 301.75$
4000005 XR ORBITS RT 189.25$
4000006 XR SINUSES 362.30$
4000007 XR SKULL COMPLETE 570.85$
4000008 XR SKULL LTD LESS THAN 4V 305.20$
4000009 XR NECK SOFT TISSUE 189.90$
4000010 XR TEMPOROMANDIBULAR RT 313.35$
4000025 XR ENTIRE SPINE SURVEY 251.30$
4001001 XR CHEST 1V 179.40$
4001002 XR CHEST 2V 340.15$
4001003 XR CHEST 3V 438.05$
4001004 XR CHEST SP VIEWS 224.85$
4001006 XR RIB BIL W/CHEST 4 VIEWS RT 375.00$
4001007 XR STERNUM 305.20$
4002001 XR CERVICAL SPINE 1V 224.85$
4002002 XR CERVICAL SPINE COMPLETE 5V 414.70$
4002003 XR CERVICAL SPINE COMPLETE + FLEX/EXT 560.35$
4002004 XR CERVICAL SPINE LTD 2V OR 3V 241.15$
4002005 XR LUMBAR SPINE COMPLETE 560.35$
4002006 XR LUMBAR SPINE FLEX/EXT 2,212.35$
4002007 XR LUMBAR SPINE LTD 2V OR 3V 305.20$
4002008 XR PELVIS 1 or 2V 209.70$
4002009 XR PELVIS COMPLETE 305.20$
4002010 XR HIP UNILAT W/ PELVIS 1V RT 228.35$
Orchard Hospital Chargemaster
4002011 XR SACRUM & COCCYX 285.45$
4002012 XR SCOLIOSIS STUDY 1V 305.20$
4002013 XR SI JOINTS 295.90$
4002014 XR THORACIC SPINE LTD 2V 313.35$
4002015 XR THORACIC SPINE 4V COMPLETE 224.85$
4002016 XR THORACO-LUMBAR JNCT 2V 213.10$
4002065 .XR CERVICAL SPINE 1V 50.00$
4003001 XR AC JOINT BILAT 313.35$
4003002 XR ANKLE COMPLETE RT 263.30$
4003003 XR ANKLE LTD 2V RT 259.80$
4003004 XR CLAVICLE RT 293.55$
4003005 XR ELBOW COMPLETE 3V RT 464.85$
4003006 XR ELBOW LTD 2V RT 464.85$
4003007 XR FEMUR LTD VIEW RT 363.45$
4003008 XR FINGER(S) 2V RT 138.25$
4003009 XR FOOT COMPLETE RT 363.45$
4003011 XR FOREARM RT 293.55$
4003012 XR HAND COMPLETE RT 384.45$
4003013 XR HAND LTD 2V RT 238.80$
4003014 XR CALCANEUS RT 251.65$
4003015 XR HIP BILAT 2V W/ PELVIS 482.30$
4003017 XR HUMERUS RT 362.30$
4003018 XR KNEE COMPLETE RT 411.25$
4003019 XR KNEE COMPLETE RT 411.25$
4003020 XR KNEE LTD 2V RT 265.60$
4003021 XR KNEE STANDING BILAT 296.95$
4003022 XR SCAPULA 285.45$
4003023 XR SHOULDER 1V RT 224.85$
4003024 XR SHOULDER COMPLETE RT 363.45$
4003026 XR TIBIA & FIBULA 2V RT 301.75$
4003027 XR TOES RT 161.95$
4003028 XR WRIST COMPLETE RT 376.30$
4003029 XR WRIST LTD 2V RT 244.65$
4004001 XR ABDOMEN 2V 259.80$
4004002 XR ACUTE ABDOMEN SERIES COMPLETE 414.70$
4004003 XR ABDOMEN (KUB) SINGLE VIEW 187.55$
4004004 XR ACUTE ABD SERIES COMP (INCL CHEST) 455.50$
4004005 XR SINGLE FILM CHILD FOREIGN BODY 224.85$
4005240 XR RIBS UNILAT W/ 1V CHEST RT 313.35$
4007001 XR BONE AGE 322.70$
4007002 XR BONE LENGTH 405.85$
4007003 XR BONE SURVEY INFANT 379.80$
4007004 XR BONE SURVEY METASTATIC 592.90$
4007010 XR HIP BILAT 3-4V 565.00$
Orchard Hospital Chargemaster
4007015 .XR HIP BILAT 3-4V 80.00$
4007020 XR HIP BILAT 5V OR MORE 790.00$
4007025 .XR HIP BILAT 5V OR MORE 100.00$
4035002 .XR ABDOMEN (GB) 53.85$
4040002 XR MANDIBLE LT 469.50$
4040003 XR MASTOIDS LT 413.55$
4040004 XR NASAL BONES LT 301.75$
4040005 XR ORBITS LT 189.25$
4040010 XR TEMPOROMANDIBULAR LT 313.35$
4040080 XR HIP UNILAT 2V LT 265.20$
4040090 XR HIP UNILAT W/PELVIS MIN 4V LT 295.80$
4041003 XR SHOULDER ARTHRO LT 696.65$
4041005 XR RIBS UNILAT W/ 1V CHEST LT 313.35$
4041006 XR RIB BIL W/CHEST 4 VIEWS LT 375.00$
4042010 XR HIP UNILAT W/ PELVIS 1V LT 228.35$
4043002 XR ANKLE COMPLETE LT 263.30$
4043003 XR ANKLE LTD 2V LT 259.80$
4043004 XR CLAVICLE LT 293.55$
4043005 XR ELBOW COMPLETE 3V LT 464.85$
4043006 XR ELBOW LTD 2V LT 464.85$
4043007 XR FEMUR LTD VIEW LT 363.45$
4043008 XR FINGER(S) 2V LT 138.25$
4043009 XR FOOT COMPLETE LT 363.45$
4043011 XR FOREARM LT 293.55$
4043012 XR HAND COMPLETE LT 384.45$
4043013 XR HAND LTD 2V LT 238.80$
4043014 XR CALCANEUS LT 251.65$
4043017 XR HUMERUS LT 362.30$
4043018 XR KNEE COMPLETE LT 411.25$
4043019 XR KNEE COMPLETE LT 411.25$
4043020 XR KNEE LTD 2V LT 265.60$
4043023 XR SHOULDER 1V LT 224.85$
4043024 XR SHOULDER COMPLETE LT 363.45$
4043026 XR TIBIA FIBULA 2V LT 301.75$
4043027 XR TOES LT 161.95$
4043028 XR WRIST COMPLETE LT 376.30$
4043029 XR WRIST LTD 2V LT 244.65$
4050002 XR MANDIBLE BILAT 469.50$
4050003 XR MASTOIDS BILAT 413.55$
4050004 XR NASAL BONES BILAT 301.75$
4050005 XR ORBITS BILAT 189.25$
4050006 .XR AC JOINT BILAT 50.55$
4050007 .XR ANKLE COMPLETE 42.85$
4050008 .XR ANKLE LTD 2V 30.75$
Orchard Hospital Chargemaster
4050009 .US EXT BILAT VENOUS DOP UPP/LOW 113.20$
4050010 XR TEMPOROMANDIBULAR BILAT 313.35$
4050012 .XR BONE AGE 46.15$
4050013 .XR BONE LENGTH 126.40$
4050019 .XR CERVICAL SPINE COMPLETE 5V 67.05$
4050020 .XR CERVICAL SPINE LTD 2V OR 3V 27.50$
4050022 .XR CHEST SP VIEWS 36.25$
4050023 .XR CHEST 1V 28.55$
4050024 .XR CHEST 2V 54.95$
4050025 .XR CHEST 3V 70.35$
4050028 .XR CLAVICLE 34.10$
4050029 .XR COLON B.E. 101.10$
4050030 .XR CYSTOGRAM 34.10$
4050032 .XR DEXA VFA (PERIPH/RADIUS,WRIST,HEEL) 14.30$
4050033 XR B.E. STUDY W/ OR W/O KUB 142.85$
4050036 .XR ELBOW COMPLETE 42.85$
4050037 .XR ELBOW LTD 2V 34.10$
4050038 .XR UPP GI VIDEO SWALLOW STUDY 60.45$
4050039 .XR FACIAL BONES 67.05$
4050040 .XR FEMUR LTD 26.40$
4050041 .XR FINGER(S) 2V 23.10$
4050042 .XR FISTULA TRACT 96.70$
4050043 .XR FLUOROSCOPY UP TO 1HR 35.15$
4050044 .XR FOOT COMPLETE 42.85$
4050045 .XR FOOT LTD 26.40$
4050046 .XR FOREARM 34.10$
4050048 .XR HAND LTD 2V 23.10$
4050049 .XR HAND COMPLETE 42.85$
4050050 .XR CALCANEUS 34.10$
4050051 .XR HIP ARTHRO 36.25$
4050052 .XR HIP UNILAT 34.10$
4050053 .XR HIP BILAT 2V W/ PELVIS 40.65$
4050054 .XR HUMERUS 34.10$
4050056 .XR KNEE COMP 49.45$
4050057 .XR KNEE LTD 2V 30.75$
4050058 .XR KNEE COMPLETE 36.25$
4050059 .XR KNEE ARTHRO 122.00$
4050060 .XR KNEE STANDING BILAT 36.25$
4050061 .XR LAMINOGRAPHY 104.40$
4050063 .US EXT BILAT ARTERIAL DOP UPP/LOW 64.85$
4050064 .US EXT UNILAT ARTERIAL DOP UPP/LOW 53.85$
4050066 .XR LUMBAR SPINE FLEX/EXT 37.35$
4050067 .XR LUMBAR SPINE LTD 2V OR 3V 49.45$
4050068 .XR LUMBAR SPINE COMPLETE 90.10$
Orchard Hospital Chargemaster
4050070 .XR MANDIBLE 75.85$
4050072 .XR NASAL BONES 48.35$
4050073 .XR NECK SOFT TISSUE 30.75$
4050080 .XR PELVIS 1 or 2V 34.10$
4050085 .XR LUMBAR SPINE COMPLETE W/ FLEX/EXT 7V 37.35$
4050087 .XR RIBS UNILAT W/ 1V CHEST 50.55$
4050088 .XR RIBS BILAT W/ CHEST 4V 67.05$
4050089 .XR RIBS BILAT 3V 67.05$
4050090 .XR SACRUM & COCCYX 46.15$
4050094 .XR SHOULDER COMPLETE 49.45$
4050095 .XR SHOULDER ARTHRO 105.50$
4050096 .XR SHOULDER 1V 36.25$
4050097 .XR SI JOINTS 36.25$
4050098 .XR SINGLE FILM CHILD FOREIGN BODY 36.25$
4050100 .XR SKULL COMPLETE 92.30$
4050101 .XR SKULL LTD LESS THAN 4V 49.45$
4050103 .XR SPECIMEN RADIOG 26.40$
4050105 XR UPP GI VIDEO SWALLOW STUDY 57.15$
4050107 .XR THERAPEUTIC ENEMA 81.35$
4050108 .XR THORACIC SPINE 4V COMPLETE 36.25$
4050109 .XR THORACIC SPINE LTD 2V 50.55$
4050110 .XR THORACO-LUMBAR JNCT 2V 36.25$
4050112 .XR TIBIA & FIBULA 2V 34.10$
4050113 .XR TEMPOROMANDIBULAR 50.55$
4050114 .XR TOES 26.40$
4050128 .XR WRIST COMPLETE 41.75$
4050129 .XR WRIST LTD 2V 30.75$
4050202 .XR ENTIRE SPINE SURVEY 102.00$
4051002 .XR ABDOMEN (KUB) SINGLE VIEW 30.75$
4051003 XR SHOULDER ARTHRO RT 696.65$
4051004 .XR ABDOMEN 2V 41.75$
4051005 .XR ACUTE ABDOMEN SERIES COMPLETE 92.30$
4051006 XR RIBS BILAT W/ CHEST 4V 375.00$
4051012 .XR SCOLIOSIS STUDY 1V 49.45$
4052003 .XR ACUTE ABD SERIES COMP (INCL CHEST) 36.25$
4052031 .XR B.E. STUDY W/ OR W/O KUB 215.40$
4053002 XR ANKLE COMPLETE BILAT 263.30$
4053003 XR SHOULDER ARTHRO BILAT 696.65$
4053004 XR CLAVICLE BILAT 293.55$
4053005 XR ELBOW COMPLETE 3V BILAT 464.85$
4053006 XR ELBOW LTD 2V BILAT 464.85$
4053009 XR FOOT COMPLETE BILAT 363.45$
4053011 XR FOREARM BILAT 293.55$
4053012 XR HAND COMPLETE BILAT 384.45$
Orchard Hospital Chargemaster
4053013 XR HAND LTD 2V BILAT 238.80$
4053017 XR HUMERUS BILAT 362.30$
4053018 XR KNEE COMPLETE BILAT 411.25$
4053019 XR KNEE COMPLETE BILAT 411.25$
4053020 XR KNEE LTD 2V BILAT 265.60$
4053023 XR SHOULDER 1V BILAT 224.85$
4053024 XR SHOULDER COMPLETE BILAT 363.45$
4053026 XR TIBIA FIBULA 2V BILAT 301.75$
4053028 XR WRIST COMPLETE BILAT 376.30$
4053029 XR WRIST LTD 2V BILAT 244.65$
4054003 XR ANKLE LTD 2V BILAT 259.80$
4060003 .XR MASTOIDS 50.00$
4080001 XR DEXA BASIC (HIPS,PELVIS,SPINE) 446.20$
4080002 XR DEXA VFA (PERIPH,RADIUS,WRIST,HEEL) 109.25$
4090020 XR FLUORO GUIDE SPINE OR PARASPINE 715.00$
4090025 .XR FLUORO GUIDE SPINE OR PARASPINE 129.55$
4090030 XR FLURO GUIDE CENTRAL VENOUS 739.50$
4090035 .XR FLUORO GUIDE CENTRAL VENOUS 79.55$
4090070 XR FLUOROSCOPY UP TO 1HR 990.40$
4090075 .XR FLURO (SEP PROC)UP 1 HR 36.80$
4090080 XR HIP UNILAT 2V RT 265.20$
4090085 .XR HIP UNILAT 2V 35.70$
4090090 XR HIP UNILAT W/PELVIS MIN 4V RT 295.80$
4090095 .XR HIP UNILAT W/PELVIS MIN 4 51.00$
4090100 XR RIBS BILAT 3V 350.00$
4090101 XR FINGER(S) 2V BILAT 138.50$
4090102 XR FOOT LTD LT 209.10$
4090103 XR FOOT LTD RT 209.10$
4090104 XR HIP ARTHRO 196.85$
4090105 XR KNEE ARTHRO 1,039.70$
4090106 XR LUMBAR SPINE COMPLETE W/ FLEX/EXT 7V 550.00$
4090107 XR SC JOINT BILAT 195.85$
4090108 XR SC JOINT LT 195.85$
4090109 XR SC JOINT RT 195.85$
4090110 XR SCOLIOSIS COMPLETE 775.00$
4090111 XR THORACIC SPINE 3V COMPLETE 800.00$
4090112 XR UPP GI W/ SMALL BOWEL F/T (BARIUM) 751.75$
4090113 XR WRIST ARTHRO 960.85$
4090114 .XR BONE SURVEY INFANT 105.00$
4090115 .XR BONE SURVEY METASTATIC 128.60$
4090116 .XR DEXA BASIC (HIPS,PELVIS,SPINE) 35.00$
4090117 .XR HIP UNILAT W/ PELVIS 1V 36.25$
4090118 .XR SC JOINT 35.00$
4090119 .XR SCOLIOSIS COMPLETE 75.00$
Orchard Hospital Chargemaster
4090120 .XR THORACIC SPINE 3V COMPLETE 75.00$
4090122 .XR SCAPULA 46.15$
4090123 .XR RIBS UNILATERAL 2 VIEW 45.00$
4090124 XR RIBS UNILATERAL 2 VIEW RT 350.00$
4090125 XR RIBS UNILATERAL 2 VIEW LT 350.00$
4253601 .MM DIAGNOSTIC MAMMOGRAM BILAT 62.65$
4253602 .MM MAMMOGRAPHY ROUTINE SCREENING 54.95$
4253603 .MM DIAGNOSTIC MAMMOGRAM UNILAT 38.45$
4290001 MM DIAGNOSTIC MAMMOGRAM UNILAT RT 213.20$
4290002 MM DIAGNOSTIC MAMMOGRAM BILAT 230.80$
4290003 MM MAMMOGRAPHY ROUTINE SCREENING 200.00$
4290004 MM DIAGNOSTIC MAMMOGRAM UNILAT LT 213.20$
4300001 MRI CHEST W/ & W/O CONT 3,414.40$
4300002 MRI CHEST W/O CONT 3,375.80$
4300004 MRI CERVICAL SPINE W/O CONT 3,265.45$
4300006 MRI BRAIN W/O CONT 3,051.10$
4300007 MRI LOWER EXT JOINT W/O RT 2,830.95$
4300008 MRI LOW EXTREM JOINT W & W/O RT 2,878.40$
4300010 MRI KNEE W/O CONT RT 2,830.95$
4300011 MRI LOW EXT W/ & W/O CONT RT 3,879.45$
4300012 MRI LOW EXT W/ CONT RT 3,111.15$
4300013 MRI LUMBAR SPINE W/ & W/O CONT 2,620.30$
4300014 MRI LUMBAR SPINE W/O CONT 3,051.10$
4300016 MRI ORBIT/FACE/NECK W/ & W/O CONT 3,908.10$
4300019 MRI ABDOMEN W/O CONT 3,109.35$
4300020 MRI ABDOMEN W/ CONT 3,345.85$
4300023 MRI BRAIN W/ & W/O CONT 3,980.65$
4300025 MRI PELVIS W/ & W/O CONT 3,119.45$
4300026 MRI PELVIS W/O CONT 3,109.35$
4300028 MRI THORACIC SPINE W/ & W/O CONT 4,086.25$
4300029 MRI THORACIC SPINE W/O CONT 4,009.85$
4300031 MRI UPP EXTRE JOINT W/O CONT RT 3,096.25$
4300033 MRI UPP EXT JOINT W/ & W/O CONT RT 2,878.40$
4300034 MRI UPP EXT W/ & W/O CONT RT 2,043.35$
4300035 MRI UPP EXT NOT JOINT W/O CONT RT 3,109.35$
4301000 MRI ABDOMEN W/ & W/O CONT 1,363.25$
4301002 MRA HEAD W/ & W/O CONT 3,146.70$
4301003 MRA HEAD W/O CONT 3,146.70$
4301004 MRA HEAD W/ CONT 1,216.65$
4301007 MRA NECK (CAROTIDS) W/ & W/O CONT 1,606.35$
4301008 MRA NECK (CAROTIDS) W/ CONT 2,500.00$
4301012 MRI LOW EXT W/O CONT RT 3,051.10$
4301013 PROHANCE 10ML SYRINGE CONT 491.85$
4301021 .MRI PITUITARY W&W/O READING 262.65$
Orchard Hospital Chargemaster
4301022 MRA NECK (CAROTIDS) W/O CONT 1,606.35$
4301023 .MRA NECK (CAROTIDS) W/O CONT 151.35$
4301024 MRI ORBIT/FACE/NCK SFT TIS W/ & W/O CONT 1,880.25$
4301025 .MRI ORBIT/FACE/NCK SFT TIS W/ & W/O CON 195.65$
4301026 MRI CERVICAL SPINE W/ & W/O CONT 1,733.65$
4301027 .MRI CSPINE W & W/O 286.85$
4301028 MRI HIP W/O CONT RT 2,830.95$
4301029 .MRI HIP W/O CONT 150.55$
4301030 MRI LOW EXT JOINT W/ & W/O CONT RT 3,806.65$
4301032 MRI LOW EXT JOINT W/O CONT RT 2,830.95$
4301033 .MRI LOW EXT JOINT W/O CONT 149.45$
4301034 MRI FOOT W/O CONT RT 2,830.95$
4301035 .MRI FOOT CONT W/O 149.45$
4301036 MRI SHOULDER W/O CONT RT 1,910.65$
4301037 .MRI SHOULDER W/O CONT 97.80$
4301038 MRI UPP EXT JOINT W/O CONT RT 1,910.65$
4301039 .MRI UPP EXT JOINT W/O CONT 97.80$
4301040 MRI WRIST W/O CONT RT 1,910.65$
4301041 .MRI WRIST W/O CONT 97.80$
4301042 MRI UPP EXT W/O CONT RT 1,910.65$
4301043 .MRI UPP EXT NOT JOINT W/O CONT 97.80$
4301050 .MRI ABDOMEN W/ & W/O CONT 224.90$
4301823 .MRI LOW EXT W/O CONT 179.50$
4301825 MRI BREAST UNILAT W/ & W/O CONT RT 3,960.65$
4301830 .MRI BREAST UNILAT W/ & WO CONT 348.85$
4301835 .MRA HEAD W/ & W/O CONT 386.60$
4301840 MRI CERVICAL SPINE W/ CONT 3,265.45$
4301845 .MRI CERVICAL SPINE W/ CONT 178.05$
4340007 MRI LOWER EXT JOINT W/O LT 2,830.95$
4340008 .MRI LOW EXT JOINT W/ & W/O CONT 2,878.40$
4340010 MRI KNEE W/O CONT LT 2,830.95$
4340011 MRI LOW EXT W/ & W/O CONT LT 3,879.45$
4340012 MRI LOW EXT W/ CONT LT 3,111.15$
4340031 MRI UPP EXTRE JOINT W/O CONT LT 3,096.25$
4340033 MRI UPP EXT JOINT W/ & W/O CONT LT 2,878.40$
4340034 MRI UPP EXT W/ & W/O CONT LT 2,043.35$
4340035 MRI UPP EXT NOT JOINT W/O CONT LT 3,109.35$
4341012 MRI LOW EXT W/O CONT LT 3,051.10$
4341028 MRI HIP W/O CONT LT 2,830.95$
4341030 MRI LOW EXT JOINT W/ & W/O CONT LT 3,806.65$
4341032 MRI LOW EXT JOINT W/O CONT LT 2,830.95$
4341034 MRI FOOT W/O CONT LT 2,830.95$
4341036 MRI SHOULDER W/O CONT LT 1,910.65$
4341038 MRI UPP EXT JOINT W/O CONT LT 1,910.65$
Orchard Hospital Chargemaster
4341040 MRI WRIST W/O CONT LT 1,910.65$
4341042 MRI UPP EXT W/O CONT LT 1,910.65$
4343037 MRI UPP EXT W/ & W/O CONT LT 2,020.95$
4350312 MRI ORBIT/FACE/NECK W/ CONT 1,062.85$
4353001 .MRI ABDOMEN W/ CONT 192.35$
4353002 .MRI ABDOMEN W/O CONT 249.50$
4353003 .MRI ABD W/O CONT 161.55$
4353004 .MRI BRAIN W/O CONT 163.75$
4353005 .MRI BRAIN (PITUITARY) W/ & W/O CONT 262.65$
4353007 .MRI CERVICAL SPINE W/O CONT 178.05$
4353008 .MRI CERVICAL SPINE W/ & W/O CONT 286.85$
4353010 .MRI CHEST W/O CONT 160.45$
4353011 .MRI CHEST W/ & W/O CONT 251.65$
4353013 .MRI ORBIT/FACE/NECK W/ & W/O 237.40$
4353015 .MRI UPP EXT W/ & W/O CONT 239.60$
4353017 .MRI UPP EXT W/O CONT 149.45$
4353021 .MRI LOWER EXT W/O 150.55$
4353023 .MRI LUMBAR SPINE W/ & W/O CONT 262.65$
4353024 .MRI LUMBAR SPINE W/O CONT 164.85$
4353025 .MRI PELVIS W/ CONT 192.35$
4353026 .MRI PELVIS W/O CONT 162.65$
4353027 .MRI PELVIS W/ & W/O CONT 250.60$
4353028 .MRI KNEE W/O CONT 149.45$
4353029 .MRI LOW EXT W/ CONT 179.15$
4353030 .MRI LOW EXT W/ & W/O CONT 238.50$
4353032 .MRI THORACIC SPINE W/ & W/O CONT 286.85$
4353033 .MRI THORACIC SPINE W/O CONT 178.05$
4353034 .MRI TMJ W/O CONT 153.85$
4353037 MRI UPP EXT W/ & W/O CONT RT 2,020.95$
4353038 .MRI UPP EXT JOINT W/ & W/O CONT 180.25$
4353501 .MRA HEAD W/ CONT 129.70$
4353503 .MRA NECK (CAROTIDS) W/ CONT 190.00$
4353504 .MRA NECK (CAROTIDS) W/ & W/O CONT 195.65$
4353505 .MRA PELVIS W/ & W/O CONT 206.60$
4353506 MRA ABDOMEN W/ & W/O CONT 1,363.25$
4353507 MRA PELVIS W/ & W/O CONT 1,272.70$
4353508 MRI BREAST BILAT W/ & W/O CONT 3,980.65$
4353509 MRI ORBIT/FACE/NECK W/O CONT 1,179.25$
4353510 MRI PELVIS W/ CONT 3,510.85$
4353511 MRI THORACIC SPINE W/ CONT 2,933.35$
4353512 .MRA ABDOMEN W/ & W/O CONT 280.00$
4353513 .MRA HEAD W/O CONT 258.05$
4353514 .MRI BREAST BILAT W/ & WO CONT 348.85$
4353515 .MRI ORBIT/FACE/NECK W/ CONT 138.50$
Orchard Hospital Chargemaster
4353516 .MRI ORBIT/FACE/NECK W/O CONT 149.45$
4353517 .MRI THORACIC SPINE W/ CONT 275.00$
4353518 .MRI UPP EXT W/ & W/O CONT 1,910.65$
4353519 MRI BREAST UNILAT W/ & W/O CONT LT 3,960.65$
4363037 .MRI UPP EXT W/ & W/O CONT 225.00$
4400000 US ABDOMEN COMPLETE 1,045.00$
4400001 US NON OB PELVIC LTD 394.55$
4400002 US ABDOMEN LTD (GB) 513.75$
4400003 US KIDNEYS 513.75$
4400004 US AORTA 609.30$
4400005 US OB AFTER 1ST TRIMESTER 1,045.00$
4400006 .US NON OB TRANSVAGINAL 94.50$
4400007 US NON OB PELVIC COMPLETE 611.60$
4400008 US SCROTUM & CONTENTS 611.60$
4400009 US BREAST UNILAT COMPLETE (W/ AXILLA) RT 611.60$
4400011 US EXT BILAT ARTERIAL DOP UPP/LOW 527.75$
4400012 US LOW EXT/ART/UNILAT KIT RT 440.05$
4400013 US EXT BILAT VENOUS DOP UPP/LOW 719.80$
4400014 US ANY EXT/VEN/UNIL RT 415.45$
4400015 US UPP EXT/ART/UNILAT RT 527.75$
4400018 US CAROTID 930.80$
4400020 US GUID NEEDLE BX/ASP/INJ/LOCALIZATION 504.70$
4400021 US PERCUTANEOUS DRAIN 501.60$
4400022 US CHORIONIC 930.80$
4400023 US UNSPECIFIED EXAM 588.35$
4401013 US SOFT TISSUE CHEST (MEDIASTINUM) 631.40$
4401016 US NON OB TRANSVAGINAL 597.55$
4401073 US EXT UPP/LOW NON VASCULAR STUDY RT 339.00$
4401075 US EXT UPP/LOW NON VASCULAR LTD STUDY 65.30$
4403002 US ANKLE BRACHIAL INDEX RT 677.30$
4405005 US ABD PARACENTESIS W/ IMG GUIDE 1,651.40$
4405010 .US ABD PARACENTESIS W/ IMG GUIDE 471.25$
4405015 US THORACENTESIS W/O IMG GUIDE 1,390.25$
4405020 .US THORACENTESIS W/O IMG GUIDE 380.45$
4405025 US THORACENTESIS W/ IMG GUIDE 1,644.25$
4405030 .US THORACENTESIS W/ IMG GUIDE 485.50$
4405035 US GUIDE FOR VASCULAR ACCESS 469.20$
4405040 .US GUIDE FOR VASCULAR ACCESS 76.50$
4405045 .US NON OB PELVIC COMPLETE 146.90$
4405050 US OB < 14 WEEKS PREG 1ST TRIMESTER 1,058.75$
4405055 .US OB < 14 WEEKS PREG 1ST TRIMESTER 218.30$
4405060 US OB TRANSVAGINAL 1,023.05$
4405065 .US OB TRANSVAGINAL 164.75$
4405075 US GUIDED BREAST BIO W/PLACEMENT 2,868.40$
Orchard Hospital Chargemaster
4405076 .US GUIDED BREAST BIO W/PLACEMENT 699.50$
4405077 US GUIDED BREAST BIO ADD LESION 2,340.55$
4405078 .US GUIDED BREAST BIO ADD LESION 339.95$
4405079 US GUIDED PLACEMENT OF BREAST 1,983.00$
4405080 .US GUIDED PLACEMENT OF BREAST 374.60$
4405081 US GUID PLACE OF BREAST ADD 1,692.05$
4405082 .US GUID PLACE OF BREAST ADD 188.45$
4405085 US FINE NDL ASP 982.25$
4405086 .US FINE NDL ASP 281.90$
4405090 US RENAL DOPPLER 1,224.00$
4405500 US LUMBAR RT OR LT FLANK 513.75$
4405510 US SOFT TISSUE UPP BACK R/L QUADRANT 631.40$
4405600 US DIALYSIS GRAFT DOPPLER 1,000.00$
4405610 .US DIALYSIS GRAFT DOPPLER 125.00$
4410001 US ECHO COMPLETE 2,000.00$
4410002 US ECHOCARD WAVE/DOP 552.20$
4410003 US ECHOCARD COLOR FL 552.20$
4440012 US EXT UNILAT ARTERIAL DOP UPP/LOW RT 440.05$
4440014 US EXT UNILAT VENOUS DOP UPP/LOW RT 415.45$
4440015 US UPP EXT/ART/UNILAT LT 527.75$
4441073 US EXT UPP/LOW NON VASCULAR STUDY LT 339.00$
4443002 US ANKLE BRACHIAL INDEX LT 677.30$
4443701 US BILAT ART UPP OR LOW EXT 1-2 LVL 498.55$
4450001 .US LUMBAR RT OR LT FLANK 64.85$
4450010 .US EXT UNILAT VENOUS DOP UPP/LOW 84.65$
4450011 .US AORTA 61.55$
4450016 .US BREAST UNILAT COMPLETE (W/ AXILLA) 61.55$
4450017 .XR CERVICAL SPINE COMPLETE + FLEX/EXT 90.10$
4450018 .US CAROTID 150.55$
4450026 .US CARDIOGRAPHY 103.30$
4450027 .US CHOLANGIOGRAPHY 45.05$
4450055 .US KIDNEYS 62.65$
4450062 .US EXT UPP/LOW NON VASCULAR STUDY 84.15$
4450065 .CT LOW EXT W/O CONT 229.70$
4450075 .US OB AFTER 1ST TRIMESTER 74.75$
4450077 .XR ORBITS 23.10$
4450078 .US PELVIS & HIPS/CHILD 36.25$
4450079 .XR PELVIS COMPLETE 38.45$
4450081 .US CHORIONIC 61.55$
4450082 .US PERCUTANEOUS DRAIN 62.65$
4450091 .US SCAPULA 46.15$
4450093 .US SCROTUM & CONTENTS 58.25$
4450099 .XR SINUSES 30.75$
4450102 .US SMALL BOWEL 67.05$
Orchard Hospital Chargemaster
4450104 .XR STERNUM 49.45$
4450111 .US SOFT TISSUE THYROID/PARATHYROID 45.05$
4450115 .XR UPP GI W/ SMALL BOWEL F/T (BARIUM) 97.80$
4450117 XR SMALL BOWEL F/T 117.60$
4450118 .XR SMALL BOWEL F/T 108.80$
4450119 .US UPPER EXT/BILAT 97.80$
4450120 .US UPP EXT/ART/UNILAT 64.85$
4450122 .US UROGRAPHY BOLUS 100.00$
4450124 .US RENAL DOPPLER 244.80$
4450125 .US VENOGRAM UNIL 117.60$
4450126 .US VOIDING CYSTOGRAM 36.25$
4450127 .XR WRIST ARTHRO 36.25$
4451001 .US FETAL US MULTI 287.95$
4451002 .US SOFT TISSUE UPP BACK R/L QUADRANT 84.65$
4451003 .US EXTREMITY N/V 70.35$
4451004 .US NON OB PELVIC LTD 70.35$
4451005 .US GUID CYST ASP 152.75$
4451006 .US GUID FOR PARA 95.60$
4451007 .US GUID NEEDLE BX/ASP/INJ/LOCALIZATION 75.00$
4451008 US SOFT TISSUE THYROID/PARATHYROID 611.60$
4452005 .US C-SPINE W/CONT 285.75$
4452011 .US CT GUID CYST ASP 382.45$
4452014 .US ABDOMEN COMPLETE 106.60$
4452028 .CT ORBITS/IAC W/ & W/O CONT 251.65$
4452035 .US HIP CT UNILAT 251.65$
4453002 US ANKLE BRACHIAL INDEX BILAT COMPLETE 677.30$
4453701 .US NONINVASIVE UPPER/LOWER 63.75$
4453702 .US ANKLE BRACHIAL INDEX COMPLETE 74.75$
4453703 US ABDOMEN LTD 513.75$
4453704 US AORTA/ILIAC DOPPLER COMPLETE 1,350.00$
4453705 US AORTA/ILIAC DOPPLER LTD 550.00$
4453706 US BLADDER COMPLETE 611.60$
4453707 US BLADDER LTD 609.30$
4453708 US BREAST BILAT COMPLETE (W/ AXILLA) 611.60$
4453709 US BREAST LTD BILAT 775.00$
4453710 US BREAST LTD UNILAT LT 575.00$
4453711 US BREAST LTD UNILAT RT 575.00$
4453712 US DIALYSIS GRAFT DOPPLER 1,000.00$
4453713 US GROIN DOPPLER BILAT 527.75$
4453714 US GROIN DOPPLER UNILAT LT 440.05$
4453715 US GROIN DOPPLER UNILAT RT 440.05$
4453716 US GROIN NON VASCULAR ONLY 233.60$
4453717 US LIVER DOPPLER 1,224.00$
4453718 US LIVER DOPPLER LTD 550.00$
Orchard Hospital Chargemaster
4453719 US MESENTERIC DOPPLER COMPLETE 1,224.00$
4453720 US MESENTERIC DOPPLER LTD 550.00$
4453721 US RENAL DOPPLER LTD 550.00$
4453722 US RETROPERI COMPLETE (RENAL & BLADDER) 609.30$
4453723 US RETROPERI LTD (AORTA OR RENAL) 1,050.00$
4453724 US SCROTAL W/ DOPPLER COMPLETE 1,224.00$
4453725 US SCROTAL W/ DOPPLER LTD 550.00$
4453726 .US SOFT TISSUE HEAD/NECK 82.45$
4453727 US SOFT TISSUE LUMP OR MASS 233.60$
4453728 US UPP EXT/ART/BILAT COMPLETE 1,000.00$
4453729 .US ABDOMEN LTD 62.65$
4453730 .US ABDOMEN LTD (GB) 64.85$
4453731 .US AORTA/ILIAC DOPPLER COMPLETE 115.00$
4453732 .US AORTA/ILIAC DOPPLER LTD 80.00$
4453733 .US BILAT ART UPP OR LOW EXT 1-2 LVL 63.75$
4453734 .US BLADDER COMPLETE 146.90$
4453735 .US BLADDER LTD 61.55$
4453736 .US BREAST BILAT COMPLETE (W/ AXILLA) 61.55$
4453737 .US BREAST LTD BILAT 125.00$
4453738 .US BREAST LTD UNILAT 100.00$
4453739 .US DIALYSIS GRAFT DOPPLER 125.00$
4453740 .US ECHO COMPLETE 110.00$
4453741 .US EXT UPP/LOW NON VASCULAR LTD STUDY 65.30$
4453742 .US GROIN DOPPLER BILAT 64.85$
4453743 .US GROIN DOPPLER UNILAT 53.85$
4453744 .US GROIN NON VASCULAR ONLY 65.30$
4453745 .US KIDNEYS 64.85$
4453746 .US LIVER DOPPLER 244.80$
4453747 .US LIVER DOPPLER LTD 80.00$
4453748 .US MESENTERIC DOPPLER COMPLETE 244.80$
4453749 .US MESENTERIC DOPPLER LTD 80.00$
4453750 .US RENAL DOPPLER LTD 80.00$
4453751 .US RETROPERI COMPLETE(RENAL & BLADDER) 61.55$
4453752 .US RETROPERI LTD (AORTA OR RENAL) 85.00$
4453753 .US SCROTAL W/ DOPPLER COMPLETE 244.80$
4453754 .US SCROTAL W/ DOPPLER LTD 80.00$
4453755 .US SOFT TISSUE CHEST (MEDIASTINUM) 84.65$
4453756 US SOFT TISSUE HEAD/NECK 611.60$
4453757 .US SOFT TISSUE LUMP OR MASS 65.30$
4453759 .US UPP EXT/ART/BILAT COMPLETE 125.00$
4453760 US BREAST UNILAT COMPLETE (W/ AXILLA) LT 611.60$
4453761 US EXT UNILAT ARTERIAL DOP UPP/LOW LT 440.05$
4453762 US EXT UNILAT VENOUS DOP UPP/LOW LT 415.45$
4500001 CT ABDOMEN W/ & W/O CONT 2,762.15$
Orchard Hospital Chargemaster
4500002 CT ABDOMEN W/O CONT 1,050.45$
4500003 CT ABDOMEN W/ CONT 1,128.65$
4500004 CT CHEST W/ & W/O CONT 2,762.15$
4500005 CT CHEST W/O CONT 2,327.65$
4500006 CT CHEST W/ CONT 2,580.45$
4500009 CT CERVICAL SPINE W/ & W/O CONT 2,605.80$
4500010 CT CERVICAL SPINE W/O CONT 1,973.50$
4500012 CT HEAD W & W/O CONT 3,224.70$
4500013 CT HEAD W/O CONT 1,973.50$
4500014 CT HEAD W/ CONT 2,226.30$
4500015 CT HIP UNILATERAL W/O CONT RT 1,546.20$
4500020 CT LOW EXT W/ & W/O CONT RT 2,605.80$
4500021 CT LOW EXT W/O CONT RT 1,546.20$
4500022 CT LOW EXT W/ CONT RT 2,100.25$
4500023 CT LUMBAR SPINE W/O CONT 1,973.50$
4500024 CT ORBITS/IAC/TEMP BONES W/O CONT RT 1,973.50$
4500025 CT ORBITS/IAC W/ CONT RT 2,141.70$
4500026 CT PELVIS W/ & W/O CONT 2,405.90$
4500027 CT PELVIS W/O CONT 1,973.50$
4500028 CT PELVIS W/ CONT 1,843.90$
4500029 CT SINUSES W/ & W/O CONT 2,211.95$
4500030 CT MAXILLOFACIAL/SINUS W/O CONT 1,973.50$
4500031 CT SOFT TISSUE NECK W/ & W/O CONT 2,769.15$
4500032 CT SOFT TISSUE NECK W/O 510.85$
4500033 CT SOFT TISSUE NECK W/ CONT 2,226.30$
4500034 CT THORACIC SPINE W/O CONT 1,613.45$
4500035 CT UPP EXT W/ & W/O CONT RT 2,762.15$
4500036 CT UPP EXT W/O CONT RT 2,830.90$
4500037 CT UPP EXT W/ CONT RT 2,185.95$
4501000 CTA CHEST W/ CONT 2,637.95$
4501001 CTA ABDOMEN W/ & W/O CONT 1,197.10$
4501003 CTA HEAD W/ & W/O CONT 1,197.10$
4501004 CTA LOW EXT W/ CONT RT 1,194.00$
4501005 CTA NECK/CAROTID W/ & W/O CONT 1,197.10$
4501006 CTA PELVIS W/ & W/O CONT 1,194.00$
4501007 CTA UPP EXT W/ CONT RT 1,124.75$
4501008 CT ISOVUE 300/100 ML CONT MED 744.90$
4501009 CT ISOVUE 370/100 ML CONT MED 826.70$
4501010 CT ABDOMEN/PELVIS W/O CONT 1,977.25$
4501011 .CT ABDOMEN/PELVIS W/O CONT 231.55$
4501012 CT ABDOMEN/PELVIS W/ CONT 2,507.75$
4501013 .CT ABDOMEN/PELVIS W/ CONT 228.50$
4501014 CT ABDOMEN/PELVIS W/ & W/O CONT 1,209.50$
4501015 .CT ABDOMEN/PELVIS W/ & W/O CONT 252.95$
Orchard Hospital Chargemaster
4501016 CTA ABDOMEN AORTA & BIL/RUNOFF 1,316.60$
4501017 .CTA ABDOMEN AORTA & BIL/RUNOFF 299.90$
4501018 CTA ABDOMEN/PELVIS W/ CONT 1,552.25$
4501019 .CTA ABDOMEN/PELVIS W/ CONT 275.40$
4501021 .CTA HEAD W/ & W/O CONT 219.30$
4501022 CT MAXILLOFACIAL W/ CONT 721.15$
4501023 .CT MAXILLOFACIAL W/ CONT 173.40$
4501025 CT LUMBAR SPINE W/ & W/O CONT 4,207.50$
4501030 .CT LUMBAR SPINE W/ & W/O CONT 271.30$
4501035 CT CARDIAC CALCIUM HEART SCORE 1,159.75$
4501040 .CT CARDIAC CALCIUM HEART SCORE 204.00$
4511014 CT GASTROGRAFIN 30 ML - CONT 52.95$
4540015 CT HIP UNILATERAL W/O CONT LT 1,546.20$
4540020 CT LOW EXT W/ & W/O CONT LT 2,605.80$
4540021 CT LOW EXT W/O CONT LT 1,546.20$
4540022 CT LOW EXT W/ CONT LT 2,100.25$
4540024 CT ORBITS/IAC/TEMP BONES W/O CONT LT 1,973.50$
4540025 CT ORBITS/IAC W/ CONT LT 2,141.70$
4540035 CT UPP EXT W/ & W/O CONT LT 2,762.15$
4540036 CT UPP EXT W/O CONT LT 2,830.90$
4540037 CT UPP EXT W/ CONT LT 2,185.95$
4541004 CTA LOW EXT W/ CONT LT 1,194.00$
4541007 CTA UPP EXT W/ CONT LT 1,124.75$
4550024 CT ORBITS/IAC/TEMP BONES W/O CONT BILAT 1,973.50$
4550025 CT ORBITS/IAC W/ CONT BILAT 2,141.70$
4550106 .CT THORACIC SPINE W/O CONT 251.65$
4552001 .CT ABDOMEN W/ & W/O CONT 347.30$
4552002 .CT ABDOMEN W/ CONT 285.75$
4552003 .CT ABDOMEN W/O CONT 251.65$
4552004 .CT CERVICAL SPINE W/ & W/O CONT 36.25$
4552006 .CT CERVICAL SPINE W/O CONT 251.65$
4552007 .CT CHEST W/ & W/O CONT 273.65$
4552008 .CT CHEST W/ CONT 286.85$
4552009 .CT CHEST W/O CONT 181.35$
4552012 .CT LOW EXT W/ CONT 125.30$
4552013 .CT MAXILLOFACIAL/SINUS W/O CONT 397.85$
4552016 .CT ORBITS/IAC W/ CONT 149.45$
4552019 .CT SOFT TISSUE NECK W/O 140.70$
4552020 .CT UPP EXT W/O CONT 97.80$
4552021 .CT UPP EXT W/ CONT 125.30$
4552022 .CT UPP EXT W/ & W/O CONT 133.00$
4552023 .CTA ABDOMEN W/ & W/O CONT 206.60$
4552024 .CTA CHEST W/ CONT 208.80$
4552026 .CTA NECK/CAROTID W/ & W/O CONT 191.25$
Orchard Hospital Chargemaster
4552027 .CTA PELVIS W/ & W/O CONT 197.85$
4552032 .CT HEAD W & W/O CONT 319.80$
4552033 .CT HEAD W/ CONT 252.80$
4552034 .CT HEAD W/O CONT 252.80$
4552036 .CT LUMBAR SPINE W/O CONT 251.65$
4552037 .CT SOFT TISSUE NECK W/ CONT 285.75$
4552038 .CT SOFT TISSUE NECK W/ & W/O CONT 251.65$
4552039 .CT ORBITS/IAC/TEMP BONES W/O CONT 251.65$
4552040 .CT PELVIS W/ & W/O CONT 285.75$
4552041 .CT PELVIS W/ CONT 251.65$
4552042 .CT PELVIS W/O CONT 285.75$
4552043 .CT SINUSES W/ & W/O CONT 153.85$
4552048 .CTA LOW EXT W/ CONT 252.80$
4552050 .CTA UPP EXT W/ CONT 197.85$
4552060 .CT LOW EXT W/ & W/O CONT 285.75$
4553000 CT CERVICAL SPINE W/ CONT 2,100.25$
4553001 ISOVUE 300/75 ML CONT MED 744.90$
4553002 CT ISOVUE 370/75 ML CONT MED 826.70$
4553003 CT LUMBAR SPINE W/ CONT 3,000.00$
4553004 CT ORBITS/IAC W/ & W/O CONT 1,470.50$
4553005 CT THORACIC SPINE W/ & W/O CONT 1,200.00$
4553006 CT THORACIC SPINE W/ CONT 1,800.00$
4553007 CTA ABDOMEN W/ CONT 1,197.10$
4553008 CTA ABDOMEN/PELVIS W/ & W/O CONT 1,552.25$
4553009 CTA HEAD W/ CONT 1,197.10$
4553010 CTA NECK/CAROTID W/ CONT 1,197.10$
4553011 .CT CERVICAL SPINE W/ CONT 285.75$
4553012 .CT LUMBAR SPINE W/ CONT 200.00$
4553013 .CT THORACIC SPINE W/ & W/O CONT 125.00$
4553014 .CT THORACIC SPINE W/ CONT 200.00$
4553015 .CTA ABDOMEN W/ CONT 206.60$
4553016 .CTA ABDOMEN/PELVIS W/ & W/O CONT 275.40$
4553017 .CTA HEAD W/ CONT 219.30$
4553018 .CTA NECK/CAROTID W/ CONT 191.25$
4553019 .CT HIP UNILATERAL W/O CONT 229.70$
5100001 EKG - TRACING ONLY (TECH) 311.71$
5500002 CEREBRAL DEATH EVAL 588.90$
5500004 OXYGEN 22.29$
5501000 CPAP/BIPAP MGMT 341.29$
5501002 OXIMETRY SINGLE 67.01$
5501003 OXIMETERY MULTI 171.16$
5501004 OVERNIGHT PULSE OXIMETRY 593.33$
5502000 VENTILATOR 1ST DAY 2,698.21$
5502001 VENTILATOR SUB DAY 2,450.50$
Orchard Hospital Chargemaster
5502014 CO2 EXPIRED GAS DETERMINATION 57.68$
5502030 MDI INI TX 195.33$
5502031 MDI SUB TX 195.33$
5502032 CONTINUOUS NEB 1ST HOUR 309.47$
5502033 CONTINUOUS NEB SUB HOUR 276.32$
5503000 HAND HELD NEB INT TX 116.89$
5503001 HAND HELD NEB SUB TX 116.89$
5503501 IPPB INITIAL TX 321.71$
5503502 IPPB SUBSEQUENT TX 109.09$
5504500 INCENTIVE SPIROMETER SUB 66.81$
5504501 INCENTIVE SPIROMETER INI 158.15$
5505000 CHEST PERCUSS INITIAL TX 222.67$
5505001 CHEST PERCUSSION SUB 93.53$
5506000 INDUCED SPUTUM COLLECT 47.33$
5506003 TRACHEAL SUCTION 42.08$
5509000 ABG ANALYSIS 300.59$
5509001 ARTERIAL PUNTURE 54.57$
5509015 NITROGEN WASHOUT LUNG VOLUMES 186.46$
5509016 NITROGEN WASHOUT LUNG PRO FEE 34.53$
5520001 CARDIAC STRESS TEST TREADMILL 756.99$
5540000 HOLTER MONITOR W/INTERP 292.23$
5540001 MDI SUBSEQ INHALATION TREATMNT 2ND FREQ 195.33$
5540002 MDI SUBSEQ INHALATION TREATMNT 3RD FREQ 195.33$
5540004 HAND HELD NEB SUB TX 2ND FREQUENCY 116.89$
5540005 HAND HELD NEB SUB TX 3RD FREQUENCY 116.89$
5540006 HAND HELD NEB SUB TX ER ONLY 116.89$
5540007 VBG ANALYSIS 300.59$
5540008 CARBOXYHEMOGLOBIN 89.49$
5600000 EEG 744.45$
5600001 PFT SPIROMETRY 311.71$
5600002 PFT PRE/POST BRONCHO 574.41$
5600003 FLOW VOLUME LOOP 240.72$
5600004 SLOW VITAL CAPACITY 80.73$
5600005 MVV MAXIMAL VENTILAT 80.73$
5600006 THORACIC GAS VOL.TGV 205.73$
5600007 AIRWAY RESISTANCE 398.00$
5600008 DLCO DIFFUSION CAPAC 398.00$
5600009 COMPLIANCE STUDY 267.19$
5600010 MIPS / MEPS 80.73$
5600011 BRONCHIAL PROVOCATIO 928.15$
5600012 PULMONARY STRESS TEST 794.58$
5600013 PLETHYSMOGRAPHY 166.46$
5601000 PULSE OXIMETRY SINGLE 141.93$
5601006 GAS DILUTION 121.28$
Orchard Hospital Chargemaster
5601008 HHN OR MDI EVAL/DEMO 156.26$
5601009 PFT SPIROMETRY READING 38.96$
5601010 PFT PRE/POST BRONCHO READING 61.25$
5601011 DLCO DIFFUSION CAPAC READING 44.52$
5601015 RTR SINGLE 15 MIN 135.25$
5601020 RTR SINGLE OTHER 15 MIN 135.25$
5601025 RTR MULTI 135.25$
5607000 CPR 594.51$
5609003 PH BODY FLUID/XBLOOD 194.82$
5609004 PH ONLY BLOOD 194.82$
5610003 RYTHUM STRIP N/INTER 114.09$
6000002 DEBROX (CARBAMIDE PEROXIDE) 6.5 % EAR DR 5.14$
6000003 Cortisporin-TC (neomycin-colist) Otic 461.70$
6001001 BETAXOLOL (BETOPTIC) 0.5% Opth 283.66$
6001003 AZOPT(BRINZOLAMIDE)1% Opth 261.08$
6001004 CIPROFLOXACIN (CILOXAN) 0.3% Opth 139.27$
6001005 CROMOLYN (CROLOM) 4% Opth 90.74$
6001006 CYCLOPENTOLATE (CYCLOGEL) 2% OPTH 15.41$
6001007 ERYTHROMYCIN (ILOTYCIN) OPTH OINT 52.20$
6001008 GENTAMICIN (GENTAK) OPHTH SOL 10.70$
6001010 KETOROLAC (ACULAR) 0.5% 3ML OPTH DROPS 812.34$
6001012 LACRI-LUBE (MINERAL OIL) 56.8-42.5% 18.83$
6001013 LATANOPROST (XALATAN) 0.005% OPTH DROPS 10.70$
6001014 VIGAMOX (MOXIFLOXACIN HCL) 0.5% 195.46$
6001015 PATANOL (OLOPATADINE HCL) 0.1% 176.34$
6001016 REFRESH LUBRICATING EYE DROPS 29.10$
6001017 SULFACETAMIDE SODIUM 10% 148.32$
6001018 TIMOLOL (TIMOPTIC) 0.5% 472.83$
6001019 TOBRAMYCIN (TOBRADEX) 0.3-0.1% 314.30$
6001020 TOBRAMYCIN (TOBREX) 0.3% 78.46$
6001021 BIO GLO (FLUORESCEIN SODIUM) 1MG Opth 17.12$
6001022 tetracaine HCl 0.5% 4mL 49.90$
6001023 sulfacetamide-prednisolone 10%-0.23% 104.33$
6001024 EYE WASH(Na BORATE/BORIC ACID/NaCl) 4 OZ 10.70$
6001025 neomycin-polymyxin-dexameth (MAXITROL) 110.50$
6001026 LIQUI-TEARS(POLYVINYL ALCOHOL) OPTH 15ML 21.09$
6001028 ATROPINE SULF 1% OPTH DROPS 104.16$
6001029 neomycin-polymyxin(NEOSPORIN) 10.91$
6001030 ATROPINE SULF 1% OPTH OINTMENT 3.5GM 106.38$
6002001 COMBIVENT (IPRATROPIUM-ALBUTEROL) INH 351.40$
6002002 ALBUTEROL SULFATE(VENTOLIN HFA) 90MCG 158.10$
6002003 ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) 7.80$
6002004 IPRATRO-ALBUT (DUONEB) 0.5 MG-3 MG 3ML 7.90$
6002005 AMMONIA AROMATIC (AMMONIA) 15% AMP 10.70$
Orchard Hospital Chargemaster
6002006 AZELASTINE (ASTELIN)137MCG NASAL SPRAY 160.07$
6002007 QVAR (BECLOMETHASONE) 40MCG 173.77$
6002008 BUDESONIDE (PULMICORT) 0.5MG/2ML INH 43.66$
6002010 SUPRANE (DESFLURANE) 240ML 1,069.12$
6002011 ADVAIR DISKUS(FLUTICA/SALMETE)100-50MCG 593.21$
6002012 ADVAIR DISKUS(FLUTICA/SALMETE)250-50MCG 593.21$
6002013 ADVAIR DISKUS(FLUTICA/SALMETE)500-50MCG 966.42$
6002014 HEPARIN (PORCINE) / D5W 25,000UNIT/250ML 52.00$
6002016 IPRATROPIUM BRO (ATROVENT) 0.5MG/2.5ML 95.82$
6002017 XOPENEX (LEVALBUTEROL HCL) 0.31MG / 3 ML 96.86$
6002018 XOPENEX (LEVALBUTEROL HCL) 0.63MG/3 ML 96.86$
6002019 ASMANEX(MOMETASONE FUROATE)220MCG 768.78$
6002020 SOJOURN (SEVOFLURANE) 250ML 1,057.16$
6002022 SPIRIVA (TIOTROPIUM BROMIDE) 18MCG MDI 107.70$
6002023 SODIUM CHLORIDE 0.9% 3ML INH 32.53$
6002024 LEVALBUTEROL HCl (XOPENEX) 1.25MG / 3ML 32.53$
6002025 S2 RACEPINEPHRINE 2.25% 0.5ML 96.86$
6002026 budesonide(PULMICORT)0.25mg / 2ml INH 53.39$
6002027 PULMICORT (BUDESONIDE) 1MG/2ML NEB 125.67$
6002028 ALBUTEROL SULFATE 2.5MG/0.5ML INHALATION 42.80$
6002030 PERFOROMIST (FORMOTEROL) 20MCG/2ML 51.41$
6003001 ACETYLCYSTEINE (ACETADOTE) 200MG/ML 30ML 1,307.37$
6003003 ACYCLOVIR (ZOVIRAX) 500MG TAB 126.86$
6003006 CATHFLO ACTIVASE (ALTEPLASE) 2MG INJ 153.22$
6003007 AMINOCAPROIC ACID(AMICAR)250MG/ML IV 228.55$
6003011 AMPICILLIN SODIUM 500MG INJ 16.42$
6003013 AMPICILLIN-SULBACTAM (Unasyn) 3GM INJ 51.48$
6003014 ANTIVENIN LATRODECTUS(Black Widow) 109.57$
6003015 ATROPINE SULF 1MG/10ML (0.1MG/ML) SYR 75.33$
6003017 ATROPINE SULF 0.4MG/ML INJ 13.91$
6003018 ZITHROMAX (AZITHROMYCIN) 500MG INJ 370.94$
6003020 BACITRACIN 50,000 UNIT INJ 331.70$
6003021 BENZTROPINE (COGENTIN) 2MG/2ML INJ 65.91$
6003022 MARCAINE SPINAL 7.5MG/ML 2ML AMP 11.98$
6003023 SENSORCAINE (BUPIVACAINE ) 0.25% 2.5MG 30.82$
6003024 LANTUS SOLOSTAR (INSULIN GLARGINE) 147.01$
6003025 SENSORCAINE(BUPIVACAINE HCL/PF) 0.5% 5MG 30.82$
6003026 SENSORCAINE(BUPIVACAINE HCL/PF)7.5MG 18.83$
6003027 SENSORCAINE-MPF/EPINEPHRINE VIAL 31.67$
6003029 CALCIUM CHLORIDE 10% 100MG/10ML SYR 51.36$
6003030 CANCIDAS (CASPOFUNGIN ACE) 50MG INJ 888.53$
6003031 CANCIDAS (CASPOFUNGIN ACET) 70MG INJ 888.53$
6003032 CEFAZOLIN (ANCEF) 1GM INJ 16.80$
6003033 CEFEPIME (MAXIPIME) 1GM INJ 113.12$
Orchard Hospital Chargemaster
6003034 CEFEPIME (MAXIPIME) 2GM INJ 224.51$
6003040 CEFTRIAXONE (ROCEPHIN) 1GM INJ 31.50$
6003041 CEFTRIAXONE (ROCEPHIN) 250MG INJ 80.46$
6003044 CHLORPROMAZINE (THORAZINE) 25MG/ML INJ 104.66$
6003045 CIPROFLOXACIN / D5W IVPB: 400MG/200ML 201.16$
6003046 SODIUM CHLORIDE 0.9 % 10ML FLUSH 9.10$
6003048 CLINIMIX E 2.75/D10 2.75% 1000ML IV 1,523.68$
6003049 CLINIMIX E 4.25/D10 4.25% 1000ML IV 275.68$
6003050 CLINIMIX E 5%/D15 5% 1000ML IV 80.88$
6003051 CORTROSY (COSYNTROPIN)0.25MG Inj 155.06$
6003052 CROFAB (ANTIVENIN,CROTALIDAE FAB(OVIN) 3,619.10$
6003053 CYANOCOBALAMIN (VIT B-12) 1000MCG/ML INJ 10.70$
6003054 DANTRIUM (DANTROLENE SOD) 20MG IV 591.85$
6003055 CUBICIN (DAPTOMYCIN) 500MG IV 1,562.20$
6003056 PROLIA (DENOSUMAB) 60MG/ML SUBQ INJ 1,140.23$
6003057 DEXMETHASONE (DECADRON) 4MG/ML INJ 35.10$
6003058 D5W 1/4 NS 500ML IV 211.22$
6003060 D5W 1/2 NS 1000ML IV 211.22$
6003061 D5W NS 500ML IV 211.22$
6003062 D5W 1/4 NS 1000ML IV 201.16$
6003063 D5W NS 1000ML IV 211.22$
6003064 DEXTROSE 10% IN WATER (D10W)1000 ML IV 201.16$
6003065 DEXTROSE 5% IN WATER NITRO BAG 500ML IV 211.43$
6003066 DEXTROSE 5% IN WATER 250ML IV 211.22$
6003067 DEXTROSE 5% IN WATER 500ML IV 211.22$
6003068 DEXTROSE 5% IN WATER 1000ML IV 211.22$
6003070 DEXTROSE 5% IN WATER 50ML IV 211.22$
6003072 DEXTROSE 5% IN WATER 100ML IV 211.22$
6003073 DEXTROSE 50% IN WATER 50 ML IV 211.22$
6003074 DEXTROSE 50% (25GM / 50ML) SYR 211.22$
6003076 DIAZEPAM (VALIUM) 5MG/ML INJ 41.94$
6003077 DILTIAZEM (CARDIZEM) 5MG/ML 25ml 29.44$
6003078 DILTIAZEM (CARDIZEM) 5MG/ML 10ml 10.70$
6003079 DIPHENHYDRAMINE (BENADRYL) 50MG/ML INJ 10.70$
6003080 DOBUTAMINE (DOBUTREX) 250 MG/20 ML INJ 73.62$
6003081 dopamine 40mg/ml 5ml 120.70$
6003082 DOPAMINE 400 MG/5 ML INJ 68.48$
6003083 DOXAPRAM (DOPRAM) 20MG/ML 340.34$
6003084 ENALAPRILAT (VASOTEC) 2.5MG/2ML INJ 150.87$
6003085 LOVENOX (ENOXAPARIN SOD) 100MG/1ML INJ 69.49$
6003086 LOVENOX (ENOXAPARIN SODIUM) 30MG/0.3 ML 69.49$
6003087 LOVENOX (ENOXAPARIN SODIUM) 40MG/0.4 ML 69.49$
6003088 LOVENOX (ENOXAPARIN SODIUM) 60MG/0.6 ML 69.49$
6003089 EPHEDRINE SULFATE 50MG/ML INJ 10.70$
Orchard Hospital Chargemaster
6003090 EPI-PEN (EPINEPHRINE) 0.3MG/0.3 ML 878.00$
6003091 EPINEPHRINE 1MG/1ML AMP FOR INJECTION 58.60$
6003093 L.E.T TOPICAL 143.38$
6003094 ESMOLOL HCL (BREVIBLOC) 100MG/10ML INJ 152.94$
6003095 DELESTROGEN(ESTRADIOL VALERATE)10MG/ML 492.20$
6003096 AMIDATE(ETOMIDATE)20MG/10ML IV 107.00$
6003097 FAMOTIDINE (PF) (PEPCID) 20MG/2ML INJ 82.74$
6003098 FOLIC ACID (1MG=0.2ML) 5MG/ML INJ 32.53$
6003099 CEREBYX (FOSPHENYTOIN) 500MG PE/10ML INJ 190.03$
6003100 FOSPHENYTOIN (CEREBYX) 100MG PE/2 ML 88.17$
6003101 FUROSEMIDE (LASIX) 20MG/2ML INJ 86.73$
6003102 FUROSEMIDE (LASIX) 40MG/4ML INJ 86.73$
6003103 FUROSEMIDE (LASIX) 40MG/5ML ORAL LIQ 18.68$
6003104 GARDASIL(QUADRIVALENT) 20MCG/0.5 ML 905.43$
6003105 GENTAMICIN 80MG/2ML INJ 10.70$
6003106 GLUCAGEN KIT (GLUCAGON) 1MG/ML 229.84$
6003107 GLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ 54.32$
6003109 HALOPERIDOL LACTATE (HALDOL) 5MG/ML INJ 42.84$
6003111 HEPARIN SOD (PORCINE) 5,000UNIT/ML INJ 97.37$
6003112 ENGERIX-B (VACCINE HEP B) 20MCG/ML 141.83$
6003113 HUMALOG KWIK PEN (INSULIN LISPRO) 335.18$
6003114 HUMULIN R (INSULIN REGULAR )100UNIT/ML 96.30$
6003115 HYDROMORPHONE (DILAUDID) 1MG/ML INJ 24.00$
6003116 HYDROMORPHONE (DILAUDID) 2MG/ML INJ 23.40$
6003117 IMIPENEM CLISTATIN (PRIMAXIN) 500MG INJ 53.70$
6003118 INVANZ (ERTAPENEM SODIUM) 1GM INJ 421.19$
6003119 IPOL (POLIOMYELITIS)40-8-32UNIT/0.5 ML 141.25$
6003120 D5-NS WITH 20MEQ KCL 1000ML IV 211.22$
6003121 D5W & 20MEQ KCL 1000ML IV 211.22$
6003122 D5W 1/4 NS WITH 20MEQ KCL 1000ML IV 211.22$
6003123 D5-1/2 NS WITH 20 MEQ KCL 1000ML IV 211.22$
6003124 D5-LR WITH 20MEQ KCL 1000ML IV 211.22$
6003125 D5-NS & 40MEQ KCl 1000ML IV 211.22$
6003126 D5W 0.45% NS W/ 40MEQ POT CHL 1000ML IV 211.22$
6003127 KENALOG (TRIAMCINOLONE) 40MG/ML INJ 54.64$
6003128 KETOROLAC (TORADOL) 60MG/2ML INJ 16.00$
6003129 KETOROLAC (TORADOL) 30MG/ML INJ 25.39$
6003131 LABETALOL (TRANDATE) 100MG / 20ML VIAL 13.18$
6003132 LACTATED RINGERS (RINGERS) 1000ML IV 43.80$
6003135 LIDOCAINE HCL 10MG/ML (1 %) 50ml inj 10.70$
6003136 LIDOCAINE HCL 1% 200MG/20ML VIAL 80.18$
6003137 lidocaine 0.4%/D5W 500ml IV 201.16$
6003138 LIDOCAINE HCL/EPINEPHRINE1%-1:100000 1ML 25.04$
6003139 ZYVOX (LINEZOLID) 600 MG/300ML IV 809.39$
Orchard Hospital Chargemaster
6003140 INTRALIPID (FAT EMULSION) 100ML IV 252.95$
6003141 MAGNESIUM SULFATE 2GM/50ML IVPB 100.76$
6003142 MAGNESIUM SULFATE 50% 1GM/2ML INJ 10.70$
6003143 MAGNESIUM SULFATE/D5W: 1GM/100ML IVPB 82.41$
6003144 MANNITOL 25% 50ML INJ 69.34$
6003145 MARCAINE (BUPIVACAINE HCL) 0.25% VIAL 115.17$
6003147 DEMEROL (MEPERIDINE HCL/PF) 25MG/ML INJ 64.20$
6003148 DEMEROL (MEPERIDINE HCL/PF) 50MG/ML INJ 80.25$
6003150 CARBOCAINE(MEPIVACAINE HCL/PF)15MG/ML 62.49$
6003151 BREVITAL (METHOHEXITAL SOD) 500MG IV 409.17$
6003152 METOCLOPRAMIDE (REGLAN) 10MG/2ML INJ 115.56$
6003153 METOPROLOL TART (TOPROL) 5MG/5ML INJ 37.66$
6003154 MIDAZOLAM (VERSED) 2MG/2ML INJ 33.38$
6003155 MIDAZOLAM (VERSED) 10MG/2ML INJ 47.08$
6003156 M-M-R II 1,000-12,500TCID50/0.5 ML VIAL 358.50$
6003157 MORPHINE 2MG/ML INJ 42.80$
6003158 MORPHINE (Surgery USE ONLY) 5MG/ML 34.24$
6003159 MORPHINE 10MG/ML INJ 38.52$
6003160 MORPHINE 4MG/ML INJ 34.24$
6003164 MULTITRACE-5 0.01-1-.5-.06-5MG/ML VIAL 31.67$
6003165 MULTIVITAMIN (INFUVITE) INJ ADULT 10ML 35.88$
6003166 NABI-HB(HEPATITIS B) 1,560UNIT/5 ML 1,110.12$
6003167 NAFCILLIN (UNIPEN) 1GM INJ 81.18$
6003168 NALBUPHINE (NUBAIN) 10MG/ML INJ 8.68$
6003169 NALOXONE (NARCAN) 0.4MG/ML INJ 58.14$
6003171 NEOSTIGMINE METHYLSULFATE 1MG/ML 87.74$
6003172 NITROPRESS (NITROPRUSSIDE Na) 25MG/ML 948.86$
6003174 olanzapine (ZYPREXA) 10MG INJ 260.78$
6003175 ONDANSETRON HCl (ZOFRAN) 4MG/2ML INJ 5.00$
6003176 PENICILLIN G (PFIZERPEN-G) 5 MILLION UN 48.41$
6003177 PHENOBARBITAL 65MG/ML INJ 32.53$
6003178 PHENTOLAMINE (REGITINE) 5MG 699.39$
6003180 PIPERACILLIN-TAZOBACT (ZOSYN) 2.25GM INJ 84.90$
6003181 PIPERACILLIN-TAZOBAC (ZOSYN) 3.375GM INJ 127.42$
6003183 PNEUMOVAX 23 25MCG/0.5 ML 770.44$
6003184 POTASSIUM CHLORIDE 40MEQ/100 ML 179.54$
6003185 NS WITH KCl 40MEQ/1000ML IV 211.22$
6003186 KCL IN 1/2 NORMAL SALINE 20MEQ/1000ML 34.24$
6003187 PROCAINAMIDE (PROCAN) 1GM/2ML INJ 130.86$
6003188 PROCHLORPERAZINE (COMPAZINE) 5MG/ML INJ 62.23$
6003189 PROMETHAZINE (PHENERGAN) 25MG/ML INJ 23.30$
6003190 ADACEL (T-DAP) 0.5ML VACCINE 141.40$
6003192 PROPOFOL (DIPRIVAN) 200MG/20ML 33.00$
6003193 FLUCONAZOLE/NS (DIFLUCAN) 200MG/100ML IV 291.90$
Orchard Hospital Chargemaster
6003194 PROPOFOL (DIPRIVAN) 500MG/50ML 32.00$
6003195 PROPRANOLOL (INDERAL) 1MG/ML INJ 548.06$
6003196 PROTAMINE 50MG/ML INJ 150.23$
6003197 PROTONIX (PANTOPRAZOLE) 40MG INJ 30.00$
6003198 PROTOPAM CHL (PRALIDOXIME CHL) 1G INJ 578.88$
6003199 IMOGAM RABIES-HT 150UNIT/ML 2,393.63$
6003200 IMOVAX RABIES VACCINE 2.5UNIT 1,435.40$
6003201 RINGERS SOLUTION 1000ML IV 211.22$
6003202 rocuronium (ZEMURON) 100mg/10ml 486.85$
6003204 SODIUM CHL 0.45% (1/2 NS) 1000ML IV 171.20$
6003206 SODIUM CHLORIDE 0.9% 1000ML IV 32.36$
6003209 SODIUM CHLORIDE 0.9% 500ML IV 39.00$
6003210 SODIUM CHLORIDE 0.9% 250ML IV 16.36$
6003215 SODIUM CHLORIDE 0.9% 100ML IV 35.00$
6003216 SODIUM CHLORIDE 0.9% 50ML IV 33.40$
6003217 SOLU-CORTEF 100MG/2ML INJ 72.76$
6003218 SOLU-MEDROL(METHYLPRED) 125MG/2ML INJ 32.44$
6003219 SOLU-MEDROL (METHYLPRED) 1GM/8 ML INJ 82.18$
6003220 SOLU-MEDROL (METHYLPRED) 40MG/ML INJ 20.14$
6003221 SOLU-MEDROL 500MG 71.90$
6003222 QUELICIN(SUCCINYLCHOLINE)1000MG/10ML 20.98$
6003223 TERBUTALINE (BRETHINE) 1MG/ML INJ 267.07$
6003224 TESTOSTERONE CYP( DEPO-TEST) 100MG/ML 329.06$
6003226 THIAMINE (VITAMIN B1) 200MG/2ML 34.24$
6003227 THROMBIN bovine 5,000UNIT 479.17$
6003228 TNKASE (TENECTEPLASE) 50MG INJ 7,537.10$
6003229 TOBRAMYCIN (TOBREX) 80MG/2ML INJ 273.75$
6003230 APLISOL (TUBERCULIN ) 5UNIT/0.1 ML 23.94$
6003231 VANCOMYCIN (VANCOCIN) 1GM INJ 28.00$
6003232 VANCOMYCIN (VANCOCIN) 500MG INJ 31.00$
6003233 POTASSIUM (KCL) 20MEQ/100ML IVPB 179.54$
6003234 VECURONIUM (NORCURON) 10MG INJ 46.22$
6003235 VERAPAMIL 5MG/2ML 42.80$
6003236 VITAMIN K1 (PHYTONADIONE) 10MG/ML INJ 90.02$
6003237 XYLOCAINE (LIDOCAINE HCL) 2% 20ML VIAL 16.00$
6003238 XYLOCAINE (LIDOCAINE HCL) 5MG/ML 80.18$
6003239 XYLOCAINE-EPINEPHRINE 2%-1:100,000 102.65$
6003240 XYLOCAINE(LIDOCAINE HCL)5MG/ML 84.06$
6003241 XYLOCAINE/EPINEPHRINE 1%-1:200,000 VIAL 73.85$
6003242 XYLOCAINE/EPINEPHRINE 1%-1:100,000 VIAL 16.36$
6003243 GEODON (ZIPRASIDONE MESYLATE) 20MG INJ 112.61$
6003244 SODIUM BICARB 8.4%10ml 56.46$
6003245 SODIUM BICARBONATE VIAL 8.4% 50MEQ/50ML 10.70$
6003248 AZTREONAM (AZACTAM) 1GM INJ 220.00$
Orchard Hospital Chargemaster
6003249 BUPIVACAINE (PF) 0.25% 2.MG/ML INJ 115.17$
6003250 DOPAMINE 400MG/D5W 250ML IV PREMIX 211.01$
6003251 LEVOFLOXACIN (LEVAQUIN) IVPB 750MG/150ML 339.23$
6003252 LEVOFLOXACIN (LEVAQUIN) D5W 500MG/100ML 339.23$
6003257 SUMATRIPTAN (IMITREX) 6MG/0.5ML INJ 54.70$
6003258 PHENYLEPHRINE (VAZCULEP) 10MG/ML INJ 201.53$
6003262 DEXTROSE 5%-LACTATED RINGERS 1000ML IV 211.22$
6003263 metronidazole NaCl (FLAGYL) 500mg/100ml 75.33$
6003264 PYRIDOXINE (VITAMIN B6) 100MG/ML INJ 160.07$
6003265 CEFTRIAXONE (ROCEPHIN) 500MG INJ 126.69$
6003267 NORMAL SALINE & 20MEQ/L KCl 1000ML IV 211.22$
6003268 LEVOPHED (NOREPINEPHRINE) 1MG/ML INJ 59.92$
6003269 IRON SUCROSE (VENOFER) 200MG/5ML INJ 505.04$
6003270 HYDRALAZINE (APRESOLINE) 20MG/ML INJ 96.73$
6003271 flumazenil (ROMAZICON) 0.5MG/5ML 834.76$
6003272 DEPO-MEDROL (METHYLPRED) 40MG/ML INJ 219.14$
6003273 AMIODARONE (CORDARONE) 150MG/3ML INJ 117.70$
6003274 BUMETANIDE (BUMEX) 0.25MG/ML INJ 283.34$
6003275 WATER BACTERIOSTATIC 30ML INJ 42.80$
6003278 Menomune Vaccine 50MCG/0.5ML INJ 724.86$
6003279 Neut (sodium bicarbonate) 5ML 54.50$
6003281 SODIUM ACETATE 4MEQ/ML 26.08$
6003282 ACETAZOLAMIDE (DIAMOX) 500MG TAB 287.94$
6003283 labetolol (TRANDATE) 20mg/4ml 35.95$
6003286 bupivacaine (PF) 0.5% 5MG INJ 115.17$
6003287 LORAZEPAM (ATIVAN) 2MG/ML INJ 43.66$
6003289 FENTANYL CITRATE 250MCG/5ML INJ 235.40$
6003290 FENTANYL CITRATE 100MCG/2ML INJ 41.94$
6003292 CYANOKIT (HYDROXOCOBALAMIN) 5GM IV 1,096.74$
6003302 albumin, human 25 % IV 25GM 1,201.82$
6003303 KETALAR (KETAMINE) 500MG/5ML INJ 42.80$
6003304 tetracaine HCl 1% 2mL 141.70$
6003306 Bicillin C-R(penicillin G) 1.2MU/2ML IM 187.90$
6003307 FLUPHENAZINE (PROLIXIN)125MG/5ML INJ 115.18$
6003309 rifampin (Rifadin) 600MG 774.51$
6003310 DICYCLOMINE (BENTYL) 20MG/2ML INJ 160.00$
6003311 PHENYTOIN SOD (DILANTIN) 250MG/5ML VL 11.02$
6003312 PHENYTOIN SODIUM 100MG/2ML INJ 20.47$
6003435 Neupogen (filgrastim) 480MCG 42.80$
6003437 LIDOCAINE 2% 100MG/5ML SYR 42.80$
6003438 AMIODARONE (NEXTERONE)150MG/100ML IV 42.80$
6003439 AMIODARONE (NEXTERONE) 360MG/200ML IV 42.80$
6003440 LIDOCAINE HCl (XYLOCAINE) MPF- 0.5% 50ML 42.80$
6003441 DEXTROSE 25% (2.5GM/10ML) SYR 42.80$
Orchard Hospital Chargemaster
6003444 SODIUM BICARBONATE SYR 50MEQ/50ML 42.80$
6003445 nicardipine (Cardene) 25MG/10ML 42.80$
6003447 ANECTINE 20MG/ML(SUCCINYLCHOLINE CL) INJ 42.80$
6003449 HUMULIN 70/30 PEN (INSULIN NPH-REGULAR) 42.80$
6003450 DigiFab 40MG INJ 5,782.11$
6003451 DIGOXIN (LANOXIN) 500MCG/2ML INJ 41.94$
6003452 PHYSOSTIGMINE SALICYLATE 2MG/2ML INJ 31.35$
6003455 sodium chloride 23.4% 30ML 42.80$
6003456 CEFTRIAXONE/D5W 1GM/50ML PREMIX 77.45$
6003457 CEFAZOLIN 1GM/50ML (ANCEF) D5W PREMIX 41.70$
6003458 HESPAN 6% IN NORMAL SALINE 500ML IV 201.16$
6004001 DDAVP (DESMOPRESSIN)10MCG/SPRAY NASAL 291.90$
6004002 DESMOPRESSIN(DESMOPRESSIN)4MCG/ML Inj 63.34$
6004003 fluticasone (FLONASE) 50MCG/SPRAY NASAL 171.20$
6004004 NEO-SYNEPHRINE (PHENYLEPHRINE HCL) 0.5% 79.34$
6004005 NEO-SYNEPHRINE (PHENYLEPHRINE HCL) 1% 19.03$
6004006 SALINE(SODIUM CHLORIDE) 0.65% SPRAY 10.70$
6005001 AGGRENOX(ASPIRIN/DIPYRIDAMOLE)200-25MG 22.26$
6005003 ACETAM-CODEINE(TYLENOL # 3) 300-30MG TAB 10.27$
6005004 ACETAMINOPHEN (TYLENOL)160MG/5ML *ADULT* 26.65$
6005005 ACETAMINOPHEN (TYLENOL/MAPAP) 500MG TAB 8.56$
6005006 TYLENOL (ACETAMINOPHEN) 325MG TAB 8.56$
6005008 acetylcysteine(MUCOMYST)200MG/ML 30 ML 35.10$
6005009 ACIDOPHILUS-PECTIN 25MU TAB 5.90$
6005011 ALBUTEROL (PROVENTIL) 4MG TAB 33.38$
6005012 ALENDRONATE (FOSAMAX) 70MG TAB 47.94$
6005013 ALLOPURINOL (ZYLOPRIM) 100MG TAB 21.40$
6005014 ALLOPURINOL (ZYLOPRIM) 300MG TAB 6.85$
6005015 ALPRAZOLAM (XANAX) 0.25MG TAB 11.98$
6005016 ALPRAZOLAM (XANAX) 0.5MG TAB 11.98$
6005018 AMANTADINE HCl (SYMMETREL)100MG TAB 21.80$
6005019 AMIODARONE (CORDARONE) 200MG TAB 20.54$
6005020 AMITRIPTYLINE (ELAVIL) 25MG TAB 8.56$
6005022 AMLODIPINE (NORVASC) 5MG TAB 17.12$
6005023 AMOXICILLIN-POTAS CLAV (AUGMENTIN) 500MG 17.12$
6005024 AMOXILCILLIN-POTA CLAV (AUGMENTIN) 875MG 17.12$
6005027 AMOXICILLIN (AMOXIL) 500MG CAP 9.42$
6005028 ACETAM-CODEINE 120-12MG/5 ML ELIX 19.97$
6005029 ARIPIPRAZOLE (ABILIFY)10MG TAB 10.30$
6005031 ASPIRIN (ASA) 325MG TAB 10.70$
6005032 ASPIRIN (ASA) 81MG CHEWABLE TAB 10.70$
6005033 ASPIRIN (ASA)81MG EC DELAYED REL TAB 10.70$
6005035 ATENOLOL (TENORMIN) 50MG TAB 10.70$
6005037 AZITHROMYCIN (ZITHROMAX) 250MG TAB 17.12$
Orchard Hospital Chargemaster
6005038 AZITHROMYCIN (ZITHROMAX)200MG/5ML -RECON 194.07$
6005039 BACLOFEN (LIORESOL)10MG TAB 6.85$
6005040 BENAZEPRIL (LOTENSIN) 10MG TAB 10.70$
6005044 BENZONATATE (TESSALON) 100MG CAP 9.42$
6005045 BENZTROPINE (COGENTIN) 1MG TAB 16.73$
6005046 BETHANECHOL (URECHOLINE) 25MG TAB 10.27$
6005047 BISACODYL (DULCOLAX) 5MG TAB 10.70$
6005049 BUMETANIDE (BUMEX) 1MG TAB 11.98$
6005051 BUPROPION HCl(WELLBUTRIN XL)150MG XL TAB 17.12$
6005052 BUPROPION (WELLBUTRIN) HCl 100MG TAB 17.12$
6005053 BUPROPION HCl(WELLBUTRIN SR)150MG SR TAB 17.12$
6005054 BUSPIRONE (BUSPAR) 5MG TAB 11.98$
6005055 CALCITRIOL (ROCALTROL) 0.25MCG CAP 10.70$
6005056 ANTACID (CALCIUM CARBONATE-TUMS) 500 MG 6.85$
6005057 ATACAND(CANDESARTAN CILEXETIL) 8MG TAB 15.97$
6005058 CARBAMAZEPINE (TEGRETOL) 200MG TAB 16.73$
6005059 carbidopa-levodopa(SINEMET)25/100MG TAB 10.70$
6005060 CARBIDOPA-LEVODOPA(SINEMET)25-250MG TAB 6.85$
6005061 CARISOPRODOL (SOMA) 350MG TAB 11.98$
6005062 CARVEDILOL (COREG) 3.125MG TAB 12.84$
6005065 ACTIDOSE/SORBITOL 50GRAM/240ML 111.28$
6005066 ACTIDOSE-AQUA (CHARCOAL)50GRAM/240 ML 140.38$
6005067 CHLORDIAZEPOXIDE(LIBRIUM) 25MG CAP 10.70$
6005068 CHOLESTYRAMINE-SUCROSE(QUESTRAN)4GRAM 40.23$
6005071 CIPROFLOXACIN (CIPRO) 250MG TAB 10.70$
6005073 CITROMA (MAGNESIUM CITRATE) 296ML Oral 10.70$
6005075 CLINDAMYCIN (CLEOCIN) 150MG CAP 17.12$
6005076 CLONAZEPAM (KLONOPIN) 0.5MG TAB 11.98$
6005077 CLONIDINE (CATAPRESS) 0.1MG TAB 10.70$
6005078 PLAVIX (CLOPIDOGREL) 75MG TAB 17.12$
6005079 CLOTRIMAZOLE (MYCELEX)10MG LOZ/TROCHE 17.12$
6005080 COLCRYS (COLCHICINE) 0.6MG TAB 17.12$
6005081 CYCLOBENZAPRINE (FLEXERIL) 10MG TAB 10.70$
6005082 DANTROLENE (DANTRIUM) 25MG CAP 17.12$
6005084 DIAZEPAM (VALIUM) 5MG TAB 10.70$
6005085 DICLOFENAC SOD (VOLTAREN) 75MG TAB 15.06$
6005086 DIGOXIN (LANOXIN) 0.25MG/5ML LIQ 193.57$
6005087 DIGOXIN (LANOXIN) 125MCG TAB 10.70$
6005090 DILTIAZEM HCl (CARIZEM ER) 120MG CAP 10.70$
6005091 DILTIAZEM (CARDIZEM CD) 180MG CAP 17.12$
6005093 DILTIAZEM (CARDIZEM) 60MG TAB 14.55$
6005094 DILTIAZEM (CARDIZEM CD) 300MG CAP 17.12$
6005098 DIPHENHYDRAMINE (BENADRYL) 25MG/10ML LIQ 29.96$
6005099 DIPHENHYDRAMINE (BENADRYL) 25MG TAB 10.70$
Orchard Hospital Chargemaster
6005101 DIPHENOXY ATROPINE (LOMOTIL)2.5-0.025MG 10.70$
6005102 DOCUSATE SODIUM (COLACE) 100MG/10ML LIQ 10.70$
6005103 DOCUSATE SODIUM (COLACE) 100MG CAP 10.70$
6005104 DOCUSATE SODIUM (COLACE) 250MG CAP 10.70$
6005106 DONEPEZIL (ARICEPT) 5MG TAB 5.90$
6005107 DONNATAL 16.2-0.1037-0.0194 MG/5 ML 115.40$
6005108 DOXYCYCLINE HYCLATE(VIBRA TAB) 100MG CAP 10.70$
6005109 DULOXETINE (CYMBALTA) 30MG CAP 10.70$
6005110 AVODART (DUTASTERIDE) 0.5MG CAP 10.70$
6005111 ENALAPRIL (VASOTEC) 5MG TAB 11.98$
6005112 ERYTHROMYCIN (ERY BASE) 250MG TAB 10.70$
6005113 ZETIA (EZETIMIBE) 10MG TAB 31.47$
6005114 FAMOTIDINE (PEPCID) 20MG TAB 15.06$
6005115 ULORIC (FEBUXOSTAT) 40MG TAB 17.12$
6005117 FLUOXETINE (PROZAC) 20MG CAP 15.97$
6005118 FOLIC ACID (FOLATE) 1MG TAB 10.70$
6005119 FOLIC ACID 400MCG TAB 10.70$
6005120 FUROSEMIDE (LASIX) 20MG TAB 10.70$
6005123 GABAPENTIN (NEURONTIN) 100MG CAP 10.70$
6005125 GEMFIBROZIL (LOPID) 600MG TAB 10.70$
6005126 GLIMEPIRIDE (AMARYL) 2MG TAB 11.98$
6005127 GLIPIZIDE (GLUCOTROL) 5MG TAB 10.70$
6005128 GLYBURIDE (DIABETA) 5MG TAB 10.70$
6005129 CODEINE-GUAIFENESIN 10-100MG/5 ML Oral 10.70$
6005131 GUAIFENESIN (ROBITUSSIN) 100MG/5ML LIQ 10.70$
6005133 HALOPERIDOL (HALDOL) 0.5MG TAB 10.70$
6005134 HALOPERIDOL (HALDOL) 2MG TAB 10.70$
6005135 HALOPERIDOL (HALDOL) 5MG TAB 14.55$
6005136 HYDRALAZINE (APRESOLINE) 25MG TAB 10.70$
6005137 HYDRALAZINE (APRESOLINE) 10MG TAB 10.70$
6005138 HYDROCHLOROTHIAZIDE (HCTZ) 25MG TAB 10.70$
6005139 HYDROCODONE-APAP 10-325MG (NORCO) TAB 11.98$
6005141 HYDROCODONE-APAP (NORCO) 7.5/325 MG TAB 14.55$
6005142 HYDROCORTISONE (CORTEF) 10MG TAB 10.70$
6005143 HYDROMORPHONE (DILAUDID) 2MG TAB 10.70$
6005144 HYDROXYUREA (HYDREA) 500MG CAP 10.70$
6005145 HYDROXYZINE PAMOATE (VISTARIL) 25MG CAP 11.98$
6005146 IBUPROFEN (MOTRIN) 100MG/5ML LIQ *ADULT* 10.70$
6005147 IBUPROFEN (MOTRIN) 200MG TAB 13.38$
6005148 IBUPROFEN (MOTRIN) 400MG TAB 13.38$
6005149 IBUPROFEN (MOTRIN) 600MG TAB 13.38$
6005150 INDOMETHACIN (INDOCIN SR) 75MG CAP 17.25$
6005152 ISONIAZID 300MG TAB 10.70$
6005153 ISOSORBIDE DINITRATE (ISORDIL) 10MG TAB 10.70$
Orchard Hospital Chargemaster
6005155 POTASSIUM CHLORIDE (K-DUR) 20MEQ TAB 10.70$
6005156 KLOR-CON (POTASSIUM CHLORIDE) 8MEQ TAB 10.70$
6005161 SYNTHROID (LEVOTHYROXINE) 25MCG TAB 10.70$
6005162 SYNTHROID (LEVOTHYROXINE) 88MCG TAB 10.27$
6005163 ESCITALOPRAM (LEXAPRO) 10MG TAB 10.70$
6005164 LIDOCAINE HCL VISCOUS 2% 15ML SOL 10.70$
6005165 ZYVOX (LINEZOLID) 600MG TAB 242.95$
6005167 LORAZEPAM (ATIVAN) 0.5MG TAB 11.98$
6005168 LORAZEPAM (ATIVAN) 1MG TAB 11.98$
6005169 LOSARTAN (COZAAR) 50MG TAB 11.98$
6005170 MAG AL PLUS (MYLANTA) 30ML ORAL LIQ 10.70$
6005171 MAGNESIUM OXIDE (MAG OX) 400MG TAB 10.70$
6005173 METFORMIN HCL (GLUCOPHAGE) 500MG TAB 10.27$
6005174 METHADONE 10MG TAB 10.70$
6005176 METOCLOPRAMIDE (REGLAN) 5MG TAB 10.70$
6005178 METOCLOPRAMIDE (REGLAN) 10MG/10ML LIQ 10.70$
6005180 METOLAZONE (ZAROXOLYN) 5MG TAB 10.70$
6005181 METOPROLOL SUCC (TOPROL XL) 25MG TAB 10.70$
6005184 METOPROLOL TARTRATE (LOPRESSOR) 25MG TAB 10.70$
6005185 METRONIDZOLE (FLAGYL) 250MG TAB 10.70$
6005186 METRONIDAZOLE (FLAGYL) 500MG TAB 11.98$
6005188 MIRTAZAPINE (REMERON) 15MG TAB 10.70$
6005190 MORPHINE (MS CONTIN) 30MG TAB 10.70$
6005191 AVELOX (MOXIFLOXACIN HCL) 400MG TAB 57.56$
6005195 NABUMETONE (RELAFEN) 500MG TAB 10.70$
6005196 NAMENDA (MEMANTINE HCL) 10MG TAB 10.70$
6005197 NAPROXEN (NAPROSYN) 250MG TAB 10.70$
6005200 NEXIUM (ESOMEPRAZOLE) 40MG CAP 17.12$
6005202 NIFEDIPINE (PROCARDIA XL) 30MG 17.12$
6005203 NITROFURANTOIN 100MG CAP 17.12$
6005204 NITROSTAT (NITROGLYCERIN) 0.4MG SL TAB 56.58$
6005205 ZYPREXA (OLANZAPINE) 2.5MG TAB 17.12$
6005206 OLANZAPINE (ZYPREXA) 10MG TAB 53.00$
6005207 BENICAR (OLMESARTAN MEDOXOMIL) 20MG TAB 17.12$
6005208 OMEPRAZOLE (PRILOSEC) 20MG CAP 17.12$
6005209 ONDANSETRON (ZOFRAN ODT) 4MG TAB 10.70$
6005211 OXCARBAZEPINE (TRILEPTAL) 300MG TAB 17.12$
6005212 OXYBUTYNIN (DITROPAN) 5MG TAB 10.27$
6005213 OXYCODONE (OXY IR) 5MG TAB 14.55$
6005215 OXYCODONE-APAP (PERCOCET) 5/325MG TAB 17.12$
6005216 OXYCONTIN (OXYCODONE HCL) 10MG TAB 15.06$
6005217 OXYCONTIN (OXYCODONE HCL) 40MG TAB 17.12$
6005218 CALCIUM CARB-VITD3 (OSCAL)500MG-200U TAB 6.85$
6005219 PANTOPRAZOLE (PROTONIX) 40MG TAB 17.12$
Orchard Hospital Chargemaster
6005221 PENICILLIN V POTASSIUM 250MG TAB 17.12$
6005222 PENTOXIFYLLINE (TRENTAL) 400MG TAB 10.27$
6005223 PHENAZOPYRIDINE (PYRIDIUM) 200MG TAB 11.98$
6005224 PHENOBARBITAL 40MG/10ML ORAL LIQ 15.30$
6005226 PHENOBARBITAL 32.4MG TAB 10.70$
6005227 PHENYTOIN (DILANTIN) 100MG/4ML ORAL SUSP 10.70$
6005228 PHENYTOIN (DILANTIN) ER 100MG CAP 6.85$
6005229 PHOSPHA NEUTRAL (PHOSPHORUS) 250MG 6.85$
6005232 PIROXICAM (FELDENE) 20MG CAP 17.12$
6005233 PEG 3350 (MIRALAX) 17G PACKET ORAL 10.70$
6005234 POTASSIUM CHL 40MEQ /30ML ORAL SOLN 35.83$
6005235 POTASSIUM CHLORIDE (K-DUR) 10MEQ TAB 211.01$
6005237 MULTI-VITAMIN (THERA-M PLUS) TAB 10.70$
6005238 PRAMIPEXOLE (MIRAPEX) 0.25MG TAB 10.70$
6005239 PREDNISOLONE (ORAPRED) 15MG/5ML ORAL SOL 10.70$
6005240 PREDNISONE (DELTASONE) 10MG TAB 10.70$
6005243 LYRICA (PREGABALIN) 50MG CAP 17.12$
6005244 LYRICA (PREGABALIN) 75MG CAP 17.12$
6005245 PREMARIN (CONJ ESTROGENS) 0.625MG TAB 10.27$
6005246 PRIMIDONE (MYSOLINE) 50MG TAB 10.27$
6005247 PROCHLORPERAZINE (COMPAZINE) 5MG TAB 12.84$
6005248 PROMETHAZINE-CODEI 6.25-10MG/5 ML 18.41$
6005249 PROMETHAZINE (PHENERGAN) 25MG TAB 10.27$
6005250 PROMETHAZINE 6.25MG/5 ML ORAL LIQ 10.70$
6005251 PROMETHAZINE-DM 6.25-15MG/5 ML 10.70$
6005253 PROPAFENONE (RYTHMOL) 150MG TAB 11.98$
6005254 PROPANOLOL (INDERAL) 20MG TAB 17.12$
6005255 PROPYLTHIOURACIL (PTU) 50MG TAB 17.12$
6005256 PSEUDOEPHEDRINE (SUDAFED) 30MG TAB 10.70$
6005257 METAMUCIL (PSYLLIUM FIBER) PACK 10.70$
6005258 VITAMIN B-6 (PYRIDOXINE HCL) 50MG TAB 10.70$
6005264 ZIDOVUDINE (RETROVIR) 300MG TAB 10.70$
6005265 RIFAMPIN (RIFADIN) 300MG CAP 17.12$
6005266 RISPERIDONE (RISPERIDAL) 1MG TAB 17.12$
6005267 RISPERIDONE (RISPERIDAL) 0.25MG TAB 17.12$
6005269 ROPINIROLE HCL (REQUIP) 0.25MG TAB 17.12$
6005271 SENNA (SENOKOT) 528MG/15ML ORAL SYRUP 10.70$
6005272 SENNA (SENOKOT) 8.6MG TAB 10.70$
6005274 QUETIAPINE (SEROQUEL) 100MG TAB 42.40$
6005275 QUETIAPINE (SEROQUEL) 25MG TAB 10.70$
6005276 SERTRALINE (ZOLOFT) 50MG TAB 17.12$
6005277 SIMETHICONE (MYLICON) 80MG CAP 10.70$
6005278 SIMVASTATIN (ZOCOR) 10MG TAB 10.70$
6005280 MONTELUKAST (SINGULAIR) 10MG TAB 17.12$
Orchard Hospital Chargemaster
6005282 SLOW FE (FERROUS SULFATE) 142 MG TAB 10.70$
6005283 SODIUM CITRA /CITRIC ACID (BICITRA) 15ML 79.28$
6005284 SORBITOL SOLUTION 70% 46.18$
6005285 SPIRONOLACTONE (ALDACTONE) 25MG TAB 15.06$
6005286 Kayexalate(SODIUM POLYSTYRENE)15G/60 ML 17.12$
6005287 SSKI (POTASSIUM IODIDE) 1GRAM/ML 53.55$
6005289 SUCRALFATE (CARAFATE) 1GM TAB 10.27$
6005290 SULFAMETH/TRIMET (BACTRIM/SEPTRA DS) TAB 18.83$
6005291 SULFAME/TRIME (BACTRIM) 800/160MG LIQ 12.84$
6005292 SULFASALAZINE (AZULFADINE) 500MG TAB 10.70$
6005294 TAMSULOSIN (FLOMAX) 0.4MG CAP 23.45$
6005295 MICARDIS (TELMISARTAN) 20MG TAB 17.12$
6005296 TEMAZEPAM (RESTORIL) 15MG CAP 17.12$
6005297 TERAZOSIN (HYTRIN) 5MG CAP 10.70$
6005298 TETRACYCLINE (SUMYCIN) 500MG CAP 10.70$
6005299 THEOPHYLLINE (THEO-24) 200 MG CAP 10.70$
6005303 TOPIRAMATE (TOPAMAX) 100MG TAB 10.27$
6005304 TOPIRAMATE (TOPAMAX) 25MG TAB 10.70$
6005305 TRAMADOL (ULTRAM) 50MG TAB 11.98$
6005306 TRAZODONE (DESYREL) 50MG TAB 10.70$
6005307 TRIAMTERENE-HCTZ( DYAZIDE) 37.5-25MG CAP 10.70$
6005308 URSODIOL (ACTIGALL) 300MG CAP 17.12$
6005309 VALACYCLOVIR (VALTREX) 500MG TAB 17.12$
6005310 VALPROIC ACID 250MG/5 ML ORAL LIQ 10.70$
6005312 DIOVAN (VALSARTAN) 80MG TAB 17.12$
6005315 VERAPAMIL 120MG CAP 17.12$
6005316 TOTAL B/C (VITAMIN B COMP W-C) TAB 10.70$
6005317 VITAMIN B-1 (THIAMINE HCl) 100MG TAB 21.40$
6005318 VITAMIN B-12 (CYANOCOBALAMIN) 500MCG TAB 10.70$
6005319 VITAMIN C (ASCORBIC ACID) 500MG TAB 10.70$
6005322 COUMADIN (WARFARIN SODIUM) 1 MG TAB 6.85$
6005323 COUMADIN (WARFARIN SODIUM) 2.5MG TAB 6.85$
6005328 ZINC SULFATE 220 MG (50MG ELEMENTAL) TAB 10.70$
6005330 ZOLPIDEM (AMBIEN) 5MG TAB 25.70$
6005332 LISINOPRIL (ZESTRIL/PRINIVIL) 20MG TAB 17.12$
6005333 ATORVASTATIN (LIPITOR) 20MG TAB 17.12$
6005335 CEPHALEXIN (KEFLEX) 250MG CAP 16.26$
6005336 ATORVASTATIN (LIPITOR)10MG TAB 17.12$
6005337 CARVEDILOL (COREG)12.5MG TAB 12.84$
6005338 CILOSTAZOL (PLETAL) 100MG TAB 10.70$
6005341 DIVALPROEX (DEPAKOTE) 250MG TAB 11.98$
6005343 GABAPENTIN (NEURONTIN) 300MG CAP 17.12$
6005346 IBUPROFEN (MOTRIN) 800MG TAB 13.38$
6005347 SYNTHROID (LEVOTHYROXINE) 112MCG TAB 10.70$
Orchard Hospital Chargemaster
6005350 LORATADINE (CLARITIN) 10MG TAB 11.98$
6005351 MEDROXYPROGESTERONE (PROVERA) 2.5MG TAB 10.27$
6005352 LANSOPRAZOLE (PREVACID) 30MG CAP 11.13$
6005353 LEVETRIACETAM (KEPPRA) 500MG TAB 10.70$
6005354 MELOXICAM (MOBIC) 15MG TAB 10.70$
6005358 OXYBUTYNIN Cl (DITROPAN XL) 5MG ER TAB 10.70$
6005359 TRIHEXYPHNIDYL (ARTANE) 2MG TAB 10.70$
6005361 VENLAFAXINE (EFFEXOR) XR 37.5MG CAP 17.12$
6005363 AMOXICILLIN (AMOXIL) 250mg/5ml (Recon) 10.70$
6005365 GOLYTELY (PEG 3350) 4000ML ORAL LIQ 42.80$
6005369 FLUCONAZOLE (DIFLUCAN) 150MG TAB 14.55$
6005370 DEXTROMETHOR-GUAIFENE 10-100MG/5ML LIQ 10.70$
6005371 FERROUS SULFATE 300MG/5ML ORAL LIQ 10.70$
6005372 CIPROFLOXACIN (CIPRO) 500MG TAB 17.12$
6005373 LACTULOSE (ENULOSE) 20GM/30ML ORAL SOLN 10.70$
6005382 AMITRIPTYLINE (ELAVIL) 100MG TAB 10.70$
6005384 ISOSORBIDE MONONITRATE (IMDUR) 30MG TAB 17.12$
6005385 LOPERAMIDE (IMODIUM) 2MG TAB 10.70$
6005387 DEXAMETHASONE (DECADRON) 4MG TAB 10.70$
6005389 COUMADIN (WARFARIN SODIUM) 5 MG TAB 10.70$
6005390 PRAVASTATIN (PRAVACHOL) 20MG TAB 17.12$
6005391 NAPROXEN (NAPROSYN) 375MG TAB 10.70$
6005392 MECLIZINE (ANTIVERT) 25MG TAB 10.70$
6005393 LISINOPRIL (ZESTRIL/PRINIVIL) 5MG TAB 10.70$
6005394 METHOTREXATE (TREXALL) 2.5MG TAB 10.70$
6005395 FERROUS SULFATE (FEOSOL) 324MG TAB 10.70$
6005397 DOXAZOSIN (CARDURA) 2MG TAB 10.70$
6005398 MEGESTROL (MEGACE) 400MG/10ML ORAL SUSP 10.70$
6005400 ACCUPRIL (QUINAPRIL) 10MG TAB 10.70$
6005401 SYNTHROID (LEVOTHYROXINE) 100MCG TAB 10.70$
6005402 LEVOFLOXACIN (LEVAQUIN) 500MG TAB 10.70$
6005403 FLUDORCORTISONE (FLORINEF) 0.1MG TAB 14.55$
6005405 FINASTERIDE (PROSCAR) 5MG TAB 10.70$
6005406 ACYCLOVIR (ZOVIRAX) 400MG TAB 10.70$
6005407 MILK OF MAGNESIA (MOM) 30ML LIQ 10.70$
6005408 ALBUTEROL SULF (PROVENTIL) 4MG TAB 10.70$
6005411 SODIUM CHLORIDE 1GM TAB 10.00$
6005412 PAROXETINE HCl (PAXIL) 20 MG TAB 17.12$
6005414 NYSTATIN ORAL SUSP 500,000UNIT/5ML 10.70$
6005415 BUPROPION (WELLBUTRIN) HCL 100MG SR TAB 21.40$
6005419 Senna Plus (sennosides)8.6mg/50mg 21.40$
6005420 DICYCLOMINE (BENTYL) 20MG/10ML INJ 260.34$
6005422 XARELTO (RIVARIXABAN) 10MG TAB 22.87$
6005423 OXYCONTIN (OXYCODONE) 20MG TAB 21.40$
Orchard Hospital Chargemaster
6005425 PROCRIT (EPOETIN ALFA) 20,000 U/ML INJ 2,405.36$
6005427 NICARDIPINE (CARDENE) 30MG CAP 21.40$
6005428 NICARDIPINE (CARDENE) 20MG CAP 21.40$
6005431 CALCIUM ACETATE (PHOSLO) 667MG CAP 21.40$
6005436 SUMATRIPTAN SUCCINATE (IMITEX) 50MG TAB 21.40$
6005437 THEOPHYLLINE(Theo-24) 80MG/15ML ORAL LIQ 69.66$
6005438 TIZANIDINE (ZANAFLEX) 4MG TAB 10.70$
6005441 CHOLECALCIFEROL (VIT-D3) 1000UNIT TAB 21.40$
6005450 HYDROCODONE/ACET (NORCO) 7.5-500MG/15ML 17.09$
6005451 HYDROCODONE-APAP 5MG-325MG (NORCO) TAB 10.70$
6005453 METHYLERGONOVINE (METHERGINE) 0.2MG INJ 156.10$
6005454 NORTRIPTYLINE (PAMELOR) 25MG CAP 10.70$
6005460 sodium phosphate 3 mmo/ml 149.80$
6005999 VERAPAMIL 120MG TAB 21.40$
6006001 ACEPHEN (ACETAMINOPHEN)120MG SUPP 9.63$
6006002 ACEPHEN (ACETAMINOPHEN) 325MG SUPP 8.56$
6006003 ACEPHEN (ACETAMINOPHEN) 650MG SUPP 8.56$
6006004 ASPIRIN (ASA) 300MG SUPP 10.70$
6006005 BISAC-EVAC(BISACODYL/DULCOLAX) 10MG SUPP 6.85$
6006006 GLYCERIN (CHILD) SUPP 10.70$
6006007 GLYCERIN (ADULT) SUPP 6.85$
6006008 PROCTOSOL HC (HYDROCORTISONE) 2.5% CREAM 138.82$
6006009 ANUCORT-HC(HYDROCORTISONE ACE) 25MG SUPP 8.56$
6006010 PHENADOZ (PROMETHAZINE) 12.5MG SUPP 17.12$
6006011 PHENADOZ (PROMETHAZINE) 25MG SUPP 17.12$
6006013 Fleet Enema (sodium phosphates) 10.70$
6006014 PROCHLORPERAZINE (COMPAZINE) 25MG SUPP 25.88$
6006050 Rowasa 4GM 21.40$
6007003 BACITRACIN ZINC OINT 91.59$
6007004 CATAPRES-TTS(CLONIDINE)0.1MG/24 HR PATCH 27.39$
6007006 CLOTRIMAZOLE (LOTRIMIN) 1% TOPICAL CRM 13.70$
6007008 ETHYL CHLORIDE (PAIN EASE) 100% SPRAY 36.81$
6007009 EXELON (RIVASTIGMINE) 4.6MG/24 HOUR 57.14$
6007011 FENTANYL (DURAGESIC) 100MCG/HR PATCH 280.86$
6007012 FENTANYL (DURAGESIC) 75MCG/HR PATCH 225.03$
6007013 FLUOCINONIDE (SYNALAR) 0.05% 71.90$
6007014 FLUOCINONIDE (LIDEX) 0.05% 60.78$
6007015 GELFOAM SPONGE SIZE 100 (GELATIN) 278.15$
6007016 HURRICAINE (BENZOCAINE) 20% SPRAY 60gr 168.26$
6007017 HYDROCERIN (MINERAL OIL/PETROLATUM) 23.37$
6007018 HYDROCORTISONE 1% CREAM 28GM 4.28$
6007019 INDIGO CARMINE 40MG/5ML 110.00$
6007020 KETOCONAZOLE (NIZORAL) 2% CREAM 60GM 234.14$
6007021 lidocaine-prilocaine (EMLA) 5G 73.06$
Orchard Hospital Chargemaster
6007022 LIDOCAINE HCL 4% TOPICAL SOL (50ML) 38.52$
6007023 LIDOCAINE (LIDODERM) 5% PATCH 52.63$
6007024 MUPIROCIN (BACTROBAN) 2% OINTMENT 248.43$
6007026 NICOTINE (NICODERM) 21MG/24 HR 17.12$
6007027 nicotine (nicotine) 7MG/HR TD patch 17.12$
6007028 NITRO-BID 2% OINT UD PACK 6.85$
6007029 NITROGLYCERIN 0.4MG/HR PATCH 28.03$
6007030 NYSTATIN 100,000UNIT/G OINT 30G 14.55$
6007031 NYSTATIN 100,000UNIT/G 30GM CREAM 17.12$
6007035 nystatin-triamcinolone OINTMENT 30G 218.30$
6007036 NYSTOP (NYSTATIN) 100,000UNIT/G POWDER 36.80$
6007037 RISAMINE(MENTHOL/ZINC)0.44-20.625% 10.70$
6007039 SILVER NITRATE APPLICATORS 75-25% 53.76$
6007040 SSD SILVER SULFADIAZINE 1% 400gm JAR 393.15$
6007041 SILVER SULFADIAZINE (SSD) 1% 50GM TUBE 49.45$
6007042 TRANSDERM-SCOP 1.5MG 104.20$
6007043 TRIAMCINOLONE ACETONIDE 0.1% CREAM 30G 383.58$
6007045 triamcinolone acetonide (KENALOG) 0.5% 10.70$
6007048 ZINC OXIDE 20% OINTMENT 10.27$
6007050 ZOVIRAX (ACYCLOVIR) 5% 911.88$
6007051 POVIDONE-IODINE 10% 10.70$
6007052 FENTANYL (DURAGESIC) 50MCG/HR PATCH 138.72$
6007053 FENTANYL (DURAGESIC) 25 MCG/HR PATCH 80.23$
6007054 permethrin (ELIMITE) 5% 60GM CREAM 617.76$
6007055 TRIPLE ANTIBIOTIC OINTMENT 5.35$
6007057 Mentax (butenafine) 1% 263.33$
6007058 lidocaine (XYLOCAINE) 2% TOPICAL JELLY 10.70$
6007059 bacitracin-polymyxin B(POLYSPORIN) 6.40$
6007060 Santyl (collagenase) 250u/GM 265.95$
6007062 lidocaine HCl(UROJET)200mg/10ml Gel 47.46$
6008001 PREMARIN (ESTROGENS) 0.625MG/G 902.22$
6008002 miconazole nitrate (MONISTAT 7) VAGINAL 10.70$
6009001 WATER (WATER FOR IRRIGATION,STERILE) 43.00$
6009003 WATER(WATER FOR IRRIGATION,STERILE)250ML 201.16$
6009004 WATER FOR INJECTION,STERILE 31.67$
6009005 WATER STERILE FOR INJ 10ML 82.41$
6009006 WATER (WATER FOR INJECTION,STERILE) 21.40$
6009007 MINERAL OIL MISCELLANEOUS 473ML 44.51$
6009010 CALCIUM GLUCONATE 100MG/ML IV 40.23$
6009011 SODIUM CHLORIDE 0.9% SOLN 3000ML 211.22$
6009012 SODIUM CHLORIDE 0.9% IRRIGATION 250ML 83.89$
6009014 ISOVUE-300 (IOPAMIDOL) 61% 100ML 48.00$
6009016 ISOVUE-370 (IOPAMIDOL) 76% 150ML 62.49$
6009017 Prohance (gadoteridol) 10ML 42.80$
Orchard Hospital Chargemaster
6009064 Bicillin L-A(penicillin G) 1.2MU IM 445.98$
6009126 SODIUM CHLORIDE 0.9 % 10ML VIAL 31.67$
6009143 BUTRANS (BUPRENORPHINE) 5MCG/HR PATCH 222.90$
6009146 SYNTHROID (LEVOTHYROXINE) 100MCG/5ML INJ 510.83$
6009147 DILTIAZEM HCl 50MG/10ML (CARDIZEM) INJ 14.14$
6009148 TOLTERODINE (DETROL LA) 2MG CAP 42.09$
6009150 PREDNISONE 1MG TAB 10.70$
6009151 3% SODIUM CHLORIDE 4ML INH 10.70$
6009152 SODIUM CHLORIDE 0.9% IRRIGATION 1000ML 26.84$
6009153 MEROPENEM/NS 1GM IVPB 119.50$
6009154 PEDIATRIC ELECTOLYTE (PEDIALYTE) 1000ML 18.70$
6009155 HEPARIN LOCK FLUSH 100 UNITS/ML 5ML SYR 12.70$
6009156 ACETAZOLAMIDE (DIAMOX) 250MG TAB 10.00$
6009157 Ofirmev (acetaminophen) 1000mg/100ml 77.56$
6009158 potassium phosphate dibasic 3mM/ML 13.10$
6009159 CITALOPRAM (CELEXA) 10MG TAB 12.22$
6009161 LEVOFLOXACIN (LEVAQUIN) 250MG TAB 45.28$
6009162 PIOGLITAZONE (ACTOS) 15MG TAB 36.10$
6009163 ZIPRASIDONE HCl (GEODON) 20MG CAP 25.09$
6009165 LACTULOSE 20G/30ML 8OZ BOTTLE 240ML 10.00$
6009166 XIFAXAN (RIFAXIMIN) 550MG TAB 116.48$
6009167 SYMBICORT (BUDESONIDE-FORMOTEROL)160/4.5 998.71$
6009169 ascorbic acid(VITAMIN C) 500mg/ml 50ml 184.80$
6009171 Dakin's Sol (sodium hypochlorite) 473ML 40.00$
6009172 IRBESARTAN (AVAPRO) 150MG TAB 17.74$
6009173 Gastrografin 30ml(diatrizoate meglumine) 143.99$
6009174 MIDODRINE (PROAMATINE) 5MG TAB 10.00$
6009175 METHYLENE BLUE (ANTIDOTE)10mg/ml 45.56$
6009176 PERMETHRIN (NIX) 1% 60ml LIQUID 42.60$
6009178 NITROGLYCERIN 25MG/D5W 250ML IV PREMIX 33.34$
6009179 TAMIFLU (OSELTAMIVIR) 75MG CAP 42.88$
6009180 dextrose 50%/water 500ML(D50W) IV 33.60$
6009181 NASAcort (triAMCINolone acetonide) 55MCG 45.60$
6009183 PAMIDRONATE 30MG/10ML INJ 37.84$
6009184 VOLTAREN (DICLOFENAC SOD) 1% 2GM TOPICAL 98.16$
6009185 CLINIMIX E 5/D20 1000ML IV 81.44$
6009186 VECURONIUM BROMIDE (VECURON) 20MG INJ 36.38$
6009187 BISMUSTH SUBSALICYLATE(PEPTO-BISMOL) LIQ 16.88$
6009188 RabAvert 2.5U 376.20$
6009189 FAMOTIDINE (PEPCID) 40MG/4ML INJ 19.84$
6009190 CELEBREX (CELECOXIB) 100MG CAP 24.16$
6009193 COENZYME Q10 100MG CAP 5.04$
6009195 Pancrelipase 5000UNIT cap 9.44$
6009197 Fluzone High-Dose 131.70$
Orchard Hospital Chargemaster
6009198 Fluzone Quad Pedi 87.40$
6009199 Fluzone Quad (6 months and up) 0.5ml 84.40$
6009200 FLUMIST QUAD 0.2ML 75.28$
6009201 CHOLECALCIFEROL (VIT-D3) 5000IU CAP 5.20$
6009203 DIOVAN (VALSARTAN) 40MG TAB 26.70$
6009205 Florastor (saccharomyces) 250mg pack 5.70$
6009207 METHENAMINE (MANDELAMINE) 500MG TAB 13.80$
6009213 DOBUTAMINE/D5W 250MG/250ML (DOBUTREX) IV 43.00$
6009215 malathion (OVIDE) 283.30$
6009216 MORPHINE SULF IR (MSIR) 15MG TAB 5.80$
6009217 LAMOTRIGINE (LAMICTAL) 25MG TAB 5.90$
6009219 MELATONIN 3MG TAB 5.30$
6009220 LEVETRIACETAM (KEPPRA) 500MG/5ML INJ 37.70$
6009221 MORPHINE 10MG/5ML ORAL SOLN 8.80$
6009223 ITRACONAZOLE (SPORANOX) 100MG CAP 32.00$
6009225 FETZIMA (LEVOMILNACIPRAN) 40MG CAP 63.18$
6009226 AMITIZA (LUBIPROSTONE) 8MCG TAB 50.49$
6009227 BILTRICIDE (PRAZIQUANTEL) 600MG TAB 313.16$
6009228 fondaparinux (ARIXTRA) 2.5mg/0.5ml 75.40$
6009230 CLOTRIMAZOLE-BETAMETHASONE (LOTRISONE) 82.00$
6009231 zoledronic acid (RECLAST) 5mg/100ml 268.20$
6009234 INDAPRAMIDE (LOZOL) 2.5MG TAB 8.10$
6009237 MEROPENEM (MERREM) 500MG INJ 39.30$
6009238 GUANFACINE (TENEX) 1MG TAB 5.60$
6009242 CRESTOR (ROSUVASTATIN) 10MG TAB 48.50$
6009243 HYDROXYZINE HCL (ATARAX) 50MG/ML INJ 28.60$
6009244 sildenafil (REVATIO) 20MG tab 8.37$
6009245 clobetasol(TEMOVATE)0.05% Topical 190.90$
6009250 ELIQUIS (APIXABAN) 5MG TAB 29.60$
6009252 PREDNISONE (DELTASONE) 50MG TAB 7.50$
6009253 butorphanol tartrate (STADOL) 1mg/ml Inj 30.20$
6009258 ACETYLCYSTEINE (MUCOMYST) 200MG/ML 4ML 30.40$
6009261 salsalate 500mg 10.80$
6009266 BETHANECHOL CHL (URECHOLINE) 10MG TAB 8.90$
6009268 CEFUROXIME AXETIL (CEFTIN) 250MG TAB 16.50$
6009269 Hydrogel 100GM 59.10$
6009270 DIVALPROEX (DEPAKOTE) 500MG TAB 10.90$
6009272 pyridostigmine bromide 60mg 11.10$
6009276 DRONABINOL (MARINOLl) 2.5MG CAP 24.10$
6009278 cefoxitin 1g/D5W 50mL Premixed Bag 54.50$
6009279 ceftriaxone/D5W 2Gm/50ML Premix 87.00$
6009280 VANCOMYCIN (VANCOCIN) 125MG CAP 31.30$
6009281 VANCOMYCIN (VANCOCIN) 750MG INJ 32.60$
6009282 CLINDAMYCIN/D5W 300MG/50ML IVPB PREMIX 34.20$
Orchard Hospital Chargemaster
6009283 cefazolin/D5W 2gm/50ML Premix 40.80$
6009284 HEPARIN LOCK FLUSH 10 UNITS/5ML SYR 11.40$
6009285 METFORMIN (GLUCOPHAGE) 850MG TAB 10.10$
6009286 hyoscyamine sulfate TAB 104.50$
6009287 vitamin A 10,000U cap (retinyl) 10.00$
6013004 ADENOSINE(ADENOCARD)3MG/ML IV 134.39$
6013010 AMPICILLIN SODIUM 1GM INJ 41.06$
6013012 AMPICILLIN-SULBACTAM (UNASYN) 1.5GM INJ 87.48$
6013093 EPINEPHRINE 1MG/10ML SYR 33.38$
6014000 CL-CEFAZOLIN (ANCEF) 1GM INJ 13.00$
6014001 CL-CEFTRIAXONE (ROCEPHIN) 1GM INJ 99.50$
6014002 CL-CEFTRIAXONE (Rocephin) 1GM IM/Vialmat 99.50$
6014003 CL-CEFTRIAXONE (ROCEPHIN) 500MG INJ 15.80$
6014004 CL-CYANOCOBALAMIN (VIT B-12) 1000MCG INJ 27.60$
6014005 CL-DIPHENHYDRAMINE (BENADRYL) 50MG/ML VL 13.20$
6014006 CL-DEBROX (CARBAMIDE PEROXIDE) 6.5% 15ML 14.10$
6014007 CL-EPINEPHrine 1MG/1ML INJ 18.10$
6014008 CL-EPIPEN (EPINEPHRINE) 0.3MG/0.3 ML 346.70$
6014009 CL-FOLIC ACID (1MG=0.2ML) 5MG/ML INJ 90.00$
6014010 CL-FUROSEMIDE (LASIX) 40MG/4ML INJ 29.10$
6014011 CL-INFUVITE ADULT INJ 10ML 50.40$
6014012 CL-KENALOG (TRIAMCINOLONE) 40MG/ML 49.00$
6014013 CL-KETOROLAC (TORADOL) 30MG/ML INJ 22.50$
6014014 CL-KETOROLAC (TORADOL) 60MG/2ML INJ 14.10$
6014015 CL-LABETALOL 100MG/20ML INJ 24.68$
6014016 CL-LIDOCAINE (XYLOCAINE) 2% 20ML INJ 32.30$
6014017 CL-LIDOCAINE HCL 10MG/ML (1 %) 179.80$
6014018 CL-LIDOCAINE HCL/EPINEPHRINE1%-1:100000 18.30$
6014019 CL-LIDOCAINE VISCOUS 2% 15ML UDC 12.30$
6014020 CL-MAGNESIUM SULFATE 2GM/50ML 34.60$
6014021 CL-MARCAINE (BUPIVACAINE HCL) 0.25% VIAL 19.20$
6014022 CL-METOPROLOL TARTRATE (TOPROL) 5MG/5 ML 182.20$
6014023 CL-NITROSTAT (NITROGLYCERIN) 0.4MG TAB 67.20$
6014024 CL-ONDANSETRON (ZOFRAN ODT) 4MG TAB 6.80$
6014025 CL-ONDANSETRON HCl (ZOFRAN) 4MG/2ML INJ 28.30$
6014026 CL-PROLIA (DENOSUMAB) 60MG/ML 1,368.50$
6014027 CL-PROMETHAZINE (PHENERGAN) 25MG/ML INJ 12.60$
6014028 CL-PYRDIOXINE (VITAMIN B-6) 100MG/ML INJ 35.30$
6014029 CL-SANTYL (COLLEGENASE) 250U/GM 273.30$
6014030 CL-SENSORCAINE-MPF/EPINEPHRINE 20ML VL 23.80$
6014031 CL-SILVER SULFADIAZINE (SSD) 1% 50GM 54.10$
6014032 CL-SIMETHICONE (MYLICON) 80MG TAB 5.40$
6014033 CL-SODIUM CHLORIDE 0.9% 100 ML 24.70$
6014034 CL-SODIUM CHLORIDE 0.9% 1000ML 25.20$
Orchard Hospital Chargemaster
6014035 CL-SODIUM CHLORIDE 0.9% 50ML 25.40$
6014036 CL-SOLU-MEDROL 125MG/2 ML 32.60$
6014037 CL-SOLU-MEDROL 40MG/ML INJ 32.10$
6014038 CL-SOLU-MEDROL1,000MG/8 ML 94.80$
6014039 CL-SIMATRIPTAN (IMITREX) 6MG/0.5ML 62.10$
6014040 CL-SUPRANE (DESFLURANE) 240ML 240.90$
6014041 CL-TESTOSTERONE CYP( DEPO-TEST) 100MG/ML 36.30$
6014042 CL-VANCOMYCIN 1GM INJ 41.30$
6014043 CL-ZOLEDRONIC ACID (RECLAST) 5MG/100ML 309.80$
6014044 CL-DEPO PROVERA 150MG/ML INJ 56.00$
6014045 CL-DICYCLOMINE (BENTYL)10MG/5ML ORAL LIQ 15.00$
6014046 CL-MAG AL PLUS (MYLANTA) 30ML ORAL LIQ 11.00$
6014047 CL-LIDOCAINE VISC 2% ORAL LIQ 30ML 11.00$
6014049 CL-DALVANCE (DALBAVANCIN) INJ 1,575.00$
6070017 ACETAMINOPHEN (TYLENOL)160MG/5ML *PEDIA* 26.65$
6070018 IBUPROFEN (MOTRIN) 100MG/5ML *PEDIA* 10.70$
6070019 AMOXICILLIN (AMOXIL) 250mg/5ml *PEDIA* 10.70$
6070020 AZITHROMYCIN(ZITHROMAX)200MG/5ML *PEDIA* 194.07$
6070022 LIDOCAINE HCL INJ 1% 50MG/5ML SYR 44.00$
6070024 AMINOPHYLLINE 250MG/10ML INJ 58.00$
6070025 LIDOCAINE HCL 2% JELLY TOPICAL 30ML 37.00$
6070027 ACETAZOLAMIDE (DIAMOX) 500MG INJ 75.00$
6070029 CLINDAMYCIN (CLEOCIN) 900MG/6ML INJ 28.00$
6070030 CLINDAMYCIN (CLEOCIN) 300MG/2ML INJ 22.00$
6070031 3% SODIUM CHL(HYPERTONIC SALINE)500ML IV 22.50$
6070032 NS W/ 20MEQ KCL 1000ML IV 32.50$
6070033 KCL 10MEQ/100ML IVPB PREMIX 32.50$
6070034 ACETIC ACID 0.25% IRRIGATION 1000ML 29.00$
6070035 SODIUM CHL 0.9% 1000ML IRRIGATION BAG 35.50$
6070036 ATENOLOL (TENORMIN) 25MG TAB 7.50$
6070037 WATER STERILE FOR INJ 100ML VL 23.00$
6070038 LIDOCAINE (XYLOCAINE) 1% 20ML VIAL 19.00$
6070039 CHLORHEXIDINE GLUC (PERIDEX) ORAL RINSE 76.50$
6070040 MAGNESIUM SULF IVPB: 4GM / 100ML 48.50$
6070041 LIDOCAINE (XYLOCAINE) 0.5% 50ML VL 27.00$
6070042 BENZOCAINE (CEPACOL) LOZ 6.50$
6070043 POTASSIUM CHLOR 20MEQ/10ML 10ML VL 12.60$
6070044 XYLOCAINE (LIDOCAINE 1%) 30ML VL 28.60$
6070045 HURRICAINE ORAL SPRAY UD (unit dose) 140.48$
6070065 DICYCLOMINE (BENTYL) 10MG/5ML ORAL LIQ 15.00$
6070067 PROPOFOL (DIPRIVAN) 500MG/50ML IVPB *ER* 32.00$
6070156 NON VFC - ADACEL (T-DAP) 0.5ML VACCINE 107.00$
6070157 NON VFC - BOOSTRIX (T-DAP) 0.5ML VACCINE 101.00$
6070158 NON VFC-TUBERCULIN PURIFIED PROTEIN VAC 141.64$
Orchard Hospital Chargemaster
6070159 NON VFC-DIPH-TET-ACELL PERT VAC(ADACEL) 134.76$
6070160 NON VFC-VARICELLA VIRUS VACCINE(VARIVAX) 122.95$
6070161 NON VFC-HEPATITIS A VACCINE (HAVRIX) 119.04$
6070162 NON VFC-HEP B VAC RECOMB (ENGERIX B) 90.62$
6070163 NON VFC-HUMAN PAP VIRUS (GARDASIL 9) 100.90$
6070164 NON VFC-PNEUM STREPTOCOCCUS VAC 92.07$
6070168 CL- DEXMETHASONE (DECADRON) 4MG/ML INJ 8.97$
6070169 FluBlok Quad (18yr and older) 0.5ml 46.46$
6070185 DESMOPRESSIN 0.2MG 1.84$
6070200 NON VFC- ZOSTAVAX 218.66$
6070205 NON VFC- MEASLES-MUMPS-RUBELLA VACCINE 638.85$
6070212 CL-SILVER NITRATE APPLICATORS 0.53$
6070230 levophed 300mg/100ml 42.80$
7000001 KIT NEELDE GUIDE 21GA 115.83$
7000002 KIT NEEDLE GUIDE 20GA 105.60$
7000003 KIT NEEDLE GUIDE 18GA 141.24$
7000004 BIO PATCH DISK PROTECTIVE 78.07$
7000005 PICC DRESSING CHANGE KIT 93.75$
7000006 PICCLINE 5FR DL 712.50$
7000007 SIDESTREAM ACCESSORY KIT 450.45$
7000008 WARMING GOWN BAIR PAWS 113.12$
7000009 SUCTION CATHETER CLOSED VENTILATION 85.33$
7000010 AEROCHAMBER PLUS W/MED MASK 116.16$
7000011 AEROCHAMBER PLUS W/SM MASK 163.28$
7000012 OXY THERAPY KIT HIGH FLOW 7' 86.24$
7000013 SYSTEM CHEST DRAINAGE PLEUR-EVAC 292.50$
7000014 GASTRIC LAVAGE SYSTEM 547.72$
7000015 THORACENTESIS/PARACENTESIS TRAY CATHETER 164.88$
7000016 SPINAL TRAY PENCAN 99.82$
7000017 PRESSURE BAG INFU-SURG 80.92$
7000018 KNEE IMMOBILIZER 16 SM 93.30$
7000019 KNEE IMMOBILIZER 16 MED 93.30$
7000020 KNEE IMMOBILIZER 16 LG 93.30$
7000021 KNEE IMMOBILIZER16 XL 93.30$
7000022 KNEE IMMOBILIZER 20 SM 107.47$
7000023 KNEE IMMOBILIZER 20 MED 107.47$
7000024 KNEE IMMOBILIZER 20 LG 93.15$
7000025 KNEE IMMOBILIZER 20 XL 107.47$
7000026 KNEE IMMOBILIZER 20 XXL 107.47$
7000027 KNEE IMMOBILIZER 22 SM 109.87$
7000028 KNEE IMMOBILIZER 22 MED 109.87$
7000029 KNEE IMMOBILIZER 22 LG 109.87$
7000030 KNEE IMMOBILIZER 22 XXL 109.87$
7000031 KNEE IMMOBILIZER 22 XL 109.87$
Orchard Hospital Chargemaster
7000032 ANKLE BRACE UNI 78.07$
7000033 ANKLE BRACE SM 6 109.23$
7000034 ANKLE BRACE GEL 10 85.50$
7000035 ABD BINDER XXL 106.39$
7000036 ABD BINDER XL 106.39$
7000037 SKIN ADHESIVE LIQUIBAND 0.8ML 91.80$
7000038 UNNA BOOT 4 x10YD BANDAGE GELOCAST 38.99$
7000039 ELECTRODE ONESTEP COMPLETE ADULT 384.54$
7000040 ELECTRODE ONESTEP COMPLETE PEDI 316.68$
7000041 CATHETER FOLEY 12FR COUDE 106.76$
7000042 CATHETER FOLEY 14FR COUDE 42.07$
7000043 CATHETER FOLEY 16FR COUDE 106.76$
7000044 CATHETER IRRIGATION 24FR 30CC 3-WAY 115.96$
7000045 CATHETER TROCAR 24FR 16 L 108.10$
7000046 PLEURX DRAINAGE KIT 1000ML 446.60$
7000047 INJECTOR DOUBLE 102.97$
7000048 LUMBAR PUNCTURE TRAY PED/INFANT 86.55$
7000049 CATHETER KIT MULTI-MED TRIPLE LUMEN 7F 318.88$
7000051 CATHETER FOLEY 16FR 5CC COUDE 106.76$
7000052 FLOW STANDARD WARMING SET RANGER 80.32$
7000053 CATHETER FOLEY 16FR 30CC 3-WAY 116.09$
7000054 SKIN ADHESIVE SWIFTSET 95.62$
7000055 EGGCRATE BIOFOAM 2 3/4 164.70$
7000062 PICC LINE 4FR SL 675.00$
7000063 LAP CHOLE KIT 933.75$
7000064 ROPE, TEGADERM ALGINATE AG SILVER 1 X12 100.54$
9000001 99217 OP HOS OBSERVATION CARE DIS 233.78$
9000002 99218 INITIAL OP HOS OBS CARE - LOW 300.59$
9000003 99219 INITIAL OBS CARE - MOD 434.16$
9000004 99220 INITIAL OBS CARE - HIGH 567.73$
9000005 99221 INITIAL HOSPITAL CARE H&P LOW 333.95$
9000006 99222 INITIAL HOSPITAL CARE H&P MOD 434.16$
9000007 99223 INITIAL HOSPITAL CARE H&P HIGH 667.95$
9000008 99231 SUBSEQ CARE ROUNDS - LOW 133.57$
9000009 99232 SUBSEQ CARE ROUNDS - MOD 233.78$
9000010 99233 SUBSEQ CARE ROUNDS - HIGH 333.95$
9000011 99234 OBS OR IP CARE SERVICES - LOW 434.16$
9000012 99235 OBS OR IP CARE SERVICES - MOD 551.06$
9000013 99236 OBS OR IP CARE SERVICES - HIGH 718.03$
9000014 99238 HOSPITAL DISCHG SVCS -30/LESS 233.78$
9000015 99239 HOSPITAL DISCH SVCS > 30 MINS 350.68$
9000016 99291 CRITICAL CARE E&M 30-74 MINS 751.43$
9000017 99292 CRITICAL CARE E&M EA ADD'L 30M 378.52$
9000020 99281 E.R. CONSULT - LEVEL ONE 275.71$
Orchard Hospital Chargemaster
9000021 99282 E.R. CONSULT - LEVEL TWO 494.19$
9000023 99283 E.R. CONSULT - LEVEL THREE 598.23$
9000024 99284 E.R. CONSULT - LEVEL FOUR 1,420.15$
9000025 99285 E.R. CONSULT - LEVEL FIVE 1,976.76$
9000026 99304 INITIAL NURSING FACILITY CARE LOW 294.70$
9000027 99305 INITIAL NURSING FACILITY CARE MOD 425.65$
9000028 99306 INITIAL NURSING FACILITY CARE HIGH 556.50$
9000029 99307 SUBSEQ CARE ROUNDS LOW 130.95$
9000030 99308 SUBSEQ CARE ROUNDS MOD 229.20$
9000031 99309 SUBSEQ CARE ROUNDS HIGH 327.40$
9000032 99310 SUBSEQ CARE ROUNDS COMPLEX 425.00$
9000033 99315 HOSPITAL DISCHG SVCS -30 MINS/LESS 229.20$
9000034 99316 HOSPITAL DISCHG SVCS > 30 MINS 343.80$
9800001 99201 NEW PATIENT, LEVEL I 125.00$
9800002 99202 NEW PATIENT LEVEL 2 185.00$
9800003 99203 NEW PATIENT LEVEL 3 200.00$
9800004 99204 NEW PATIENT LEVEL 4 215.00$
9800005 99213 EST PATIENT LEVEL 3 170.00$
9800006 99211 EST PATIENT LEVEL 1 111.00$
9800007 99212 EST PATIENT LEVEL 2 155.00$
9800008 99214 EST PATIENT LEVEL 4 190.00$
9800010 99205 NEW PATIENT LEVEL 5 280.00$
9800011 99215 EST PATIENT LEVEL 5 240.00$
9800020 99304 INITIAL NURSING FACILITY CARE1 240.00$
9800021 99305 INITIAL NURSING FAC CARE II 340.00$
9800022 99306 INITIAL NURSING FAC CARE III 430.00$
9800023 99307 SUBSEQ NURSING FACILITY CARE I 115.00$
9800024 99308 SUBSEQ NURSING FACILITY CAREII 180.00$
9800025 99309 SUBSEQ NURSING FAC CARE III 235.00$
9800026 99310 SUBSEQ NURSING FAC CARE IV 350.00$
9800028 99315 NURSING HOME DISCHARGE 190.00$
9800075 INHALA-DUONEB0.5/3.0 7.90$
9800080 COAGUCHEK - POCT 80.00$
9800168 LACERATION / PROCEDURAL TRAY 185.00$
9800436 CHEMICAL CAUTERIZATI 50.00$
9801004 RMV IMPACT CERUMEN 46.00$
9801006 HEMOGLOBIN FINGER STICK 37.45$
9801007 EXCISION OF WART 26.00$
9801008 DIP STICK URINE 14.77$
9801010 TRAY LACERATION 197.95$
9801012 GLUCOSE SCAN - FINGERSTICK MSC 51.36$
9801014 HCG PREGNANCY URINE 108.07$
9801017 ANOSCOPY, PROCEDURE 50.00$
9801033 MIRENA IUD 2,181.00$
Orchard Hospital Chargemaster
9802003 INCISION & DRAINAGE 127.00$
9802004 TB MANTOUX 39.59$
9802005 STREP A RAPID 81.32$
9802020 INFLUENZA A/B - POCT 80.00$
9803000 VFC ADMIN. OF VACCINE 26.03$
9803001 ADMIN. OF VACCINE 109.00$
9803009 FLU VACCINE 70.62$
9803012 MYLANTA 30ML PO 9.63$
9803019 TDAP INJ 97.91$
9803022 VISTARIL IM 39.59$
9803050 IPRATROPIUM 0.02% INH 95.23$
9803052 HAND HELD NEB INT TX 112.35$
9805015 EXCISION,TUMOR,THIGH/KNEE<5CM 550.00$
9805016 HEARING TEST, SCREENING 75.00$
9805083 PROPHYLACTIC INJECTION 109.00$
9805500 99490 CHRONIC CARE MANAGEMENT 50.00$
9805560 99395 EST. PREVENTIVE 18-39 YRS 145.00$
9805565 99396 EST. PREVENTIVE E&M 40-64 YRS 145.00$
9809132 99204 PHYSICAL, DMV FCC 96.00$
9810008 BLINK REFLEX TEST 125.00$
9810028 I&D SEBACEOUS CYST 73.00$
9883104 GARDASIL 20-40-40-20 MCG/0.5ML 197.94$
9883112 HEPATITIS B VACCINE ADULT 85.59$
9883119 IPOL VACCINE INJ 52.42$
9883138 LIDOCAINE/EPINE 1%-1:100,000 13.38$
9883145 MARCAINE PF 0.25% 2.5MG/ML INJ 59.92$
9883156 MEASLES, MUMPS, RUB (VACCINE) 102.71$
9883183 PNEUMOVAX 25MCG/.5ML INJ 68.47$
9883230 APLISOL 5UN/0.1ML INJ 13.38$
9885077 CLONIDINE (CATAPRES) 0.1MG TAB 13.38$
9885420 DICYCLOMINE (BENTYL) 10MG/5ML LIQ 13.38$
9887040 SILVADENE CRM 400GM 189.02$
80000001 CATHETER FOLEY 14FR 5CC SILICONE COATED 38.10$
90000082 CRICOTHYROTOMY CATH SET MELKER 634.95$
90000101 DRESSING AG AQUACELL SURGICAL 3.5X13.75 230.04$
90000102 DRESSING AG AQUACELL SURGICAL 3.5X9.75 224.40$
90000113 ENDO JAW BIOPSY FORCEPS DISP 145.86$
90000114 ENDO JAW HOT BIOPSY FORCEPS DISP 105.46$
90000120 EZIO NEEDLE 45MM 512.25$
90000156 GRASPER 5MM X 35CM LAP 270.00$
90000182 LARYNGOSCOPE FIBER OPTIC W/MAC SZ 3 100.05$
90000229 PATIENT CIRCUIT BREATHPATH 93.75$
90000243 PREVENT FLOW SENSOR 851.25$
90000251 PUMP TUBE 154.96$
Orchard Hospital Chargemaster
90000295 SUTURE ETHIBOND 0 30 GREEN V-34 89.77$
90000299 SUTURE MONOCRYL 5/0 18 UNDYED 158.88$
90000357 THORACIC VENT TRAY 900.00$
90000379 T-TUBE DEAVER DRAINAGE 5 CROSSBAR 10FR 91.80$
90000380 T-TUBE DEAVER DRAINAGE 5 CROSSBAR 14FR 91.80$
90000381 T-TUBE DEAVER DRAINAGE 5 CROSSBAR 16FR 91.80$
90000382 T-TUBE DEAVER DRAINAGE 5 CROSSBAR 8FR 91.80$
90000383 T-TUBE DEAVER DRAINAGE 5 CROSSBAR 12FR 91.80$
90000395 URINE BELLY COLLECTION BAG 157.08$
90000431 MORGAN LENS DELIVERY SET 146.85$
90000432 NASAL PACKING RAPID RHINO 6.5CM 102.96$
90000433 NASAL PACKING RAPID RHINO 7.5CM 220.20$
90000434 NASAL PACKING RAPID RHINO 4.5CM 213.60$
90000435 NASAL PACKING RAPID RHINO 5.5CM 213.60$
90000450 VIREX II 256 GERMICIDAL J-FILL 2.5L 2/CS 164.07$
90000451 OXIVIR FIVE 16 J-FILL 2.5L 2/CS 207.48$
90000452 PROMINENCE H/D CLEANER J-FILL 2.5L 2/CS 293.65$
90000453 PERDIEM GP CLEANER J-FILL 2.5L 2/CS 190.80$
90000454 GOOD SENSE AIR FRESHENER J-FILL 2.5L 2/C 356.99$
90000455 GP FORWARD CLEANER J-FILL 2.5L 2/CS 163.08$
90000456 SPRAY BOTTLE 32OZ PLAIN W/GRADUATIONS 6.97$
90000457 TRIGGER ULTRA SPRAY 6.82$
90000458 SYRINGE 20ML LUERLOCK 66.07$
90000462 VENTRALEX ST LARGE CIRCLE MESH 1,646.25$
90000463 VENTRALEX ST MED CIRCLE MESH 1,496.25$
90000465 VENTRALEX ST SMALL CIRCLE MESH 1,158.75$
90000467 4 PORT MANIFOLD NEPTUNE 109.56$
90000471 BLADE RECIP DBLE SIDE 268.38$
90000473 SERFAS ENERGY PROBE CONTOUR 537.22$
90000474 ARTHRO PUMP FLOSTEADY DISP TUBE SET 364.18$
90000475 BLADE RESECTOR SHAVER 4.0MM 366.15$
90000476 BLADE RESECTOR SHAVER 3.5MM 334.83$
90000477 BLADE RESECTOR SHAVER 5.0MM 356.58$
90000478 CAPTIVATOR LX ROUND STIFF 236.94$
90000479 PNEUMOSURE HEATED TUBE SET 328.04$
90000480 PROLENE MESH 4 LARGE PHSL 886.23$
90000481 RETRIVAL SYSTEM 10MM 252.00$
90000482 SUCTION/IRRIGATOR FLOW DISP 275.76$
90000483 MIXING BOWL W/SPATULA DISP 89.77$
90000484 BLADE PRECISION OSCILL TIP SAW CART 581.25$
90000485 BIOMET BONE CEMENT R 417.93$
90000486 CLIP ENDO II 10MM APPLIER 421.54$
90000501 SHIELDED BLADE Kii 11 X 100 162.00$
90000502 SHIELDED BLADE Kii 5 x 100 112.20$
Orchard Hospital Chargemaster
90000504 BLADE FORMULA BARREL BUR 6 FLUTE 5.5MM 344.63$
90000505 MULTI ORIFICE TIP W/SOFTCONE SPLASH SHIE 66.68$
90000506 TOURNIQUET 24 X 4 SINGLE YELLOW 163.02$
90000507 TOURNIQUET 30 x 4 SINGLE ROYAL BLUE 160.14$
90000508 TOURNIQUET 34 X 4 SINGLE PURPLE 172.08$
90000509 TOURNIQUET 44 X 4 SINGLE NAVY BLUE 188.28$
90000510 TOURNIQUET 18 X 5.5 DOUBLE RED 215.70$
90000511 TOURNIQUET 24 X 5.5 DOUBLE YELLOW 239.70$
90000514 SUTURE GRASPER PASSOR PRO 105.27$
90000515 PULSE IRRIGATION SYSTEM W/MULTI ORIFICE 153.99$
90000516 DRAIN BLAKE HUBLESS FULL FLUTED 15FR 138.00$
90000517 HEMOVAC WOUND DRAIN 100ML 10MM X 20CM 164.34$
90000534 MASK LARYNGEAL SUPREME AIRWAY SZ 3 153.00$
90000570 EZIO NEEDLE 15MM 427.50$
90000571 PULSE OXIMETER FINGERTIP 345.85$
90000572 FACE MASK VENTED SM BIPAP 145.41$
90000590 PEG SYSTEM GASTMY INIT PLAC KIT 20FR 1,282.50$
90000598 VECTRA FLOOR FINISH 2.5L 113.81$
90000604 SUTURE GRASPER 105.27$
90000605 BUFFER FORMALIN 10% NEUT 90ML 90.43$
90000610 AIRWAY NASAL ROBERTAZZI LF 26F 259.98$
90000611 CAST SAW BLADES DESOUTTER CLEANCAST 5/PK 259.98$
90000612 BLOOD TRANSFER DEVICE 259.98$
90000621 BLADE MEDIUM MED 18.5MM X 9.0MM 239.82$
90000622 BLADE 239.82$
90000623 BLADE 239.82$
90000624 BLADE 239.82$
90000625 CUSHION ROHO 18 X 20 334.83$
90000626 TRAY SPINAL 25G WHITACRE NDL W/PHARM 150.80$
90000631 BLADE RESECTOR SHAVER 4.5 334.83$
90000636 EPIDURAL FULL TRAY PERIFIX CE18TKO 129.20$
90000637 INTRODUCER STYLET 15FR W/COUDE TIP 86.24$
90000638 PAPER RECORDING CHART BLOOD BANK TEMP 86.25$
90000642 SCISSOR LAPA EPIX 5MMX45CM 228.00$
90000645 SUSPENSORY W/LEG STRAP 0-2 LRG 105.96$
90000653 LEG PROTECTIVE SLEEVE WHT 115.96$
90000665 FACE MASK VENTED MED BIPAP 145.41$
90000666 FACE MASK VENTED LARGE BIPAP 145.41$
90000668 GLIDESCOPE BLADE #3 GVL 3 STAT 118.80$
90000669 GLIDESCOPE BLADE #4 GVL 4 STAT 118.80$
90000670 SHEET LARGE FAN-FOLDED 6.97$
90000671 EZIO NEEDLE 25MM 512.25$
90000673 INJECTOR FORCE MAX 25G 5MM 153.00$
90000676 RETRIEVAL DEVICE SPIDER NET 342.20$
Orchard Hospital Chargemaster
90000677 SURGICEL ABSORBABLE HEMOSTAT 4 X 8 231.50$