nch charge master 1 1 2019 - niobrarahospital.com · nch_charge_master_1_1_2019 charge master code...

NCH_Charge_Master_1_1_2019

Charge Master Code Description Price

100007 INTUBATION ENDOTRACHEAL EMERGENCY PROCED 639

100008 BLOOD OCCULT PEROXIDASE A CM_CTV QUAL FECES 50

100013 GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC 41

100014 IP IV INFUSION HYDRATION INITIAL 31 MIN-1 H 363

100015 IV INFUSION HYDRATION EACH ADDITIONAL HR 133

100016 IV INFUS THER/PROPHYLAXIS/DX 1ST TO 1HR 402

100017 IV INFUSION THERAPY PROPHYLAXIS/DX EA HR 143

100018 IP THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM 43

100021 INSJ NON-NDWELLG BLADDER CATHETER 182

100022 INSJ TEMP NDWELLG BLADDER CATHETER SIMPL 223

100024 SKIN TEST TUBERCULOSIS INTRADERMAL 44

100025 INCISION & DRAINAGE ABSCESS SIMPLE/SINGL 480

100026 ABDOM PARACENTESIS DX/THER W/O IMAG GUID 809

100032 IV INFUSION THER PROPH ADDL SEQ TO 1 HR 174

200010 FETAL NON STRESS TEST 272

200012 IRRIGATION IMPLANTED VENOUS ACCESS DRUG DELIVERY SYSTEM 117

200015 PRESSURIZED/NON PRESS. INHALATION TREATM 48

200018 FINE NEEDLE ASPIRATION; W/O IMAGING GUID 362

200020 ADMINISTRATION/PNEUMOCOCCAL VACCINE 22

200021 ADMINISTRATION/INFLUENZA VIRUS VACCINE 22

200023 DBRDMT OPEN WOUND EACH ADDL 20 SQ CM 203

200025 DBRDMT EXT ECZEMA/INFE CM_CT SKIN UP 10% BOD 243

200026 PARING/CUTTING B9 HYPERKERATOTIC LES 2-4 108

200027 EXC B9 LESION MRGN SCP SK TG .6-1.0CM 337

200028 ABDOM PARACENTESIS DX/THER W/IMAGING DEV 1478

200030 REMOVAL INTRAUTERINE DEVICE IUD 371

200031 FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR 202

200033 CHANGE CYSTOSTOMY TUBE SIMPLE 282

200040 APPLICATION CAST ELBOW FINGER SHORT ARM 232

200041 OP THER PROPH/DX INJX IV PUSH SINGLE/1ST SBST/DRUG 193

�1

200042 OP THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG 62

200043 OP THER PROPH /DX INJX EA SEQL IV PUSH SBST/DRUG FAC 150

200047 RMVL TUN CVC W/O SUBQ PORT/PMP 747

200048 RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 1096

300001 DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/I 118

300005 INFLUENZA A/B SCR EACH 98

300006 NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH 867

300011 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 345

300012 EXCISION NAIL MATRIX PERMANENT REMOVAL 824

300013 BLDR IRRIGATION SMPL LAVAGE&/INSTLJ 354

300018 INCISION & REMOVAL FOREIGN BODY SUBQ TIS 187

300026 BLOOD OCCULT PEROXIDASE A CM_CT QUAL FECES 1 47

300027 DRS &/ DBRDMT-THKNS BURNS 1ST/SUBQ MEDIU 367

300028 DRS &/ DBRDMT-THKNS BURNS 1ST/SUBQ SMALL 231

300029 DRS &/ DBRDMT-THKNS BURNS 1ST/SUBQ LARGE 545

300031 ARTHROCENTESIS ASPIRI&/INJ INTERM JT/BUR 415

300032 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA 245

300043 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE 43

300053 LARYNGOSCOPY INDIRE CM_CT W/REMOVAL FOREIGN 445

300060 AVULSION NAIL PLATE PARTIAL/COMPLETE SIM 302

300070 WOUND CLOSURE ADHESIVE ONLY (DERMABOND) 351

300079 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< 455

300080 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM 422


300082 REPAIR INTERMEDIATE S/A/T/E 12.6-20 CM 509


300086 REPAIR INTERM F/E/E/N/L&/MUC 2.5 CM/< 447

300087 REPAIR INTERM F/E/E/N/L&/MUC 2.6-5.0 429

300088 REPAIR INTERM F/E/E/N/L&/MUC 5.1-7.5 759

300093 CARDIOPULMONARY RESUSCITATION 878

300112 REMOVE FB CONJUN CM_CTIVAL SUPERFICIAL 309

300113 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP 315

300114 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP 352

�2

300115 CLOSED TX RADIAL SHAFT FX W/O MANIPULATI 229

300119 CLOSED TX RADIAL&ULNAR SHAFT FX W/O MANI 492

300122 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHE 223

300126 TRANSFUSION BLOOD/BLOOD COMPONENTS 875

300136 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ 201

300137 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA 470

300139 CLTX HIP DISLOCATION TRAUMATIC W/O ANEST 899

300143 CLOSED TX ANKLE DISLOCATION W/O ANESTHES 474

300145 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS 800

300154 APPLICATION LONG ARM SPLINT SHOULDER HAN 307

300155 APP SHORT ARM SPLINT FOREARM-HAND STATIC 282

300156 APPLICATION FINGER SPLINT STATIC 245

300158 REMOVAL IMPA CM_CTED CERUMEN INSTRUM UNILAT 201

300159 EMERGENCY DEPT VISIT LIMITED/MINOR PROB 266

300160 EMERGENCY DEPT VISIT LOW/MODER SEVERITY 369

300161 EMERGENCY DEPT VISIT MODERATE SEVERITY 612

300162 EMERGENCY DEPT VISIT HIGH/URGENT SEVERIT 991

300163 EMERG DEPT VISIT HIGH SEVERITY/THREAT 1443

300164 CRITICAL CARE ILL/INJUR PT INIT 30-74MIN 791

300165 CRITICAL CARE ILL/INJURED PT ADDL 30 MIN 348

300166 TRAUMA A CM_CTIVATION 1605

300170 APPLIC LONG LEG SPLINT THIGH ANKLE/TOES 302

300171 APPLICATION SHORT LEG SPLINT CALF FOOT 259

300190 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETA 490

300196 CLSD TX SHOULDER DISLC W/MANIPU REQ ANES 1464

300198 REPAIR INTERM N/H/F/XTRNL GENT 2.6-7.5CM 391

300199 CLTX CARPO/METACARPAL DISLOC THUMB WMANI 473

300200 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM 471

300201 TUBE THORACOSTOMY INCLUDES WATER SEAL 610

300209 INJE CM_CTION SINGLE/MLT TRIGGER POINT 1/2 M 490

300210 REMOVAL FOREIGN BODY PHARYNX 309

300211 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH D 1945

300216 CM_CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 394

�3

300217 CM_CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 334

300219 IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT 147

300220 CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/ 697

300221 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELET 1121

300222 CLSD TX SHOULDER DISLC W/MANJ W/O ANES 595

300224 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 136

300225 REPAIR INTERMEDIATE N/H/F/XTRNLGENT 2.5CM/< 550

400003 INCISION & DRAINAGE ABSCESS COMPLICATED/ 484

400005 REMOVAL FB INTRANASAL OFFICE PROCEDURE 352

400006 REMOVAL FB MUSCLE/TENDON SHEATH SIMPLE 422

400013 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE 255

400015 DEBRIDEMENT SUBQ TISSUE ADDL 20 SQ 116

400019 DEBRIDEMENT W/RMVL FM FX& DISLC 1863

400020 DEBRIDEMENT W/RMVL FM FX& DISLC 2298

400021 DEBRIDEMENT OPEN WOUND 20 SQ CM/< 172

400023 DEBRIDEMENT FX/DISLC SUBQ T/M/F BONE 3105

400024 DEBRIDEMENT SUBQ TISSUE 20 SQ CM/< 434

400025 DEBRIDEMENT MUSC FASCIA 20 SQ CM/< 932

400027 SIMPLE RPR SCALP/NECK/AX/GENI/TR 2.5CM/< 317

400028 SIMPLE RPR SCALP/NECK/AX/GE/TR 2.6-7.5CM 350

400029 SIMPLE RPR SCAL/NECK/AX/GE/TR 7.6-12.5CM 411

400030 SIMPLE RPR SCAL/NECK/AX/GE/TR 12.6-20.0C 545

400031 WOUND CLOSURE ADHESIVE ONLY (DERMABOND) 296

400032 SIMPLE REPAIR F/E/E/N/L/M 2.5 CM/< 327

400033 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM 370

400034 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM 444

400058 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM 970

400059 RPR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< 261

400067 TREATMENT CLSD ELBOW DISLOCATION W/O ANE 869

400073 CLOSED TX RADIAL SHAFT FRA CM_CTURE W/MANIPU 1310

400078 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MAN 927

400089 CLTX IPHAL JT DISCL W/MANJ W/O ANES 701

400097 CLTX FX GRT TOE PHLX/PHLG W/MANJ 428

�4

400107 RMVL FB XTRNL AUDITORY CANAL W/O ANES 168

400123 TREATMENT CLSD ELBOW DISLOCATION REQ ANE 1498

400126 CLOSED TX PATELLAR DISLOCATION W/O ANEST 513

400127 CLTX FEM FX DSTL END MEDIA/LAT CON W/MAN 1052

400189 CLTX BIMALLEOLAR ANKLE FRA CM_CTURE W/MANJ 1242

400191 PARING/CUTTING BENIGN HYPERKERATOTIC LES 121

400193 CLTX IPHAL JT DISLC W/MANJ REQ ANES 962

400199 I&D PERIANAL ABSCESS SUPERFICIAL 276

400207 AMP F/TH 1/2 JT/PHALANX W/NEURE CM_CT W/DIR 1913

400214 CLTX METACARPAL FX W/O MANIP EACH BONE 685

400217 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH 575

400218 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER:AGE 5 YEARS OR OLDER669

500002 INITIAL OBSERVATION CARE/DAY 30 MINUTES 282

500004 SBSQ HOSPITAL CARE/DAY 15 MINUTES 153


500007 OBSERVATION/INPATIENT HOSP 40 MINUTES 414

500008 OBSERVATION CARE DISCHARGE MANAGEMENT 226



500016 INITIAL HOSPITAL CARE/DAY 30 MINUTES 305




500023 OBSERVATION/INPATIENT HOSP CARE 50 MINUT 544

500025 OBSERVATION/INPATIENT HOSP CARE 55 MINUT 673

500029 HOSPITAL DISCHARGE MANAGEMENT 30 MIN/< 256

500031 HOSPITAL DISCHARGE MANAGEMENT > 30 MIN 319

500045 NURS FAC DISCHARGE MANAGEMENT 30 MIN 224

500047 NURS FAC DISCHARGE MANAGEMENT >30 MIN 280

500049 E/M NURS FAC ASSESS STABLE 30 MINUTES 277

500087 SBSQ OBSERVATION CARE/DAY 15 MINUTES 101

500088 SBSQ OBSERVATION CARE/DAY 25 MINUTES 193

500089 SBSQ OBSERVATOPM CARE/DAY 35 MINUTES 275

�5

500760 VITAL CAPACITY TOTAL SEPARATE PROCEDURE 72

700009 XR SKELETAL SURVEY 891

800485 EVACUATION OF SUBUNGUAL HEMATOMA 178

800886 DRAINAGE OF FINGER ABCESS 937

1000001 17 HYDROXYCORTICOSTEROID 111

1000004 ALKALINE PHOS ISOENZYMES 104

1000010 21-HYDROXYLASE ANTIBODY 157

1000011 RPR 30

1000013 CHLAMYDIA ANTIBODY IGG 74

1000014 CHLAMYDIA ANTIBODY IGM 64

1000022 EHRLICHIA ANTIBODY 133

1000023 ANTI SMITH ANTIBODY 100

1000025 EBV EARLY AG 96

1000027 CLIN CHEM TEST NOT LISTED 113

1000041 GASTRIN 133

1000051 URINE UREA NITROGEN 60

1000053 PTH INTA CM_CT 249

1000063 PROTEIN ELE CM_CTROPHORESIS SERUM 107

1000064 PROTEIN ELE CM_CTROPHORESIS URINE 117

1000066 PROT ELE CM_CT URINE 34

1000067 FLOW CYTO FIRST MARKER 56

1000068 FLOW CYTO EA ADD'L MARKER 56

1000069 FLOW CYTO INTERP >=16 MKR 172

1000076 5-HIAA 91

1000077 BB TYPING ABO 57

1000078 BB TYPING RH (D) 56

1000079 17 HYDROXYPROGESTERONE 134

1000082 ACE ANGIO CONVERT EN 114

1000088 ADRENOCORTICOTROPIC HOR 200

1000091 ALBUMIN 55

1000092 ALBUMIN BODY FLUID 58

1000094 ALDOSTERONE 204

1000095 ALKALINE PHOSPHATASE 60

�6

1000097 ALUMINUM 124

1000101 AMMONIA 142

1000102 IMMUNOASSAY QUANT OTHER 492

1000103 PHOSPHOLIPID AB 203

1000104 CHLAMYDIA/GC PROBE 261

1000106 AMYLASE 101

1000107 ANA 113

1000108 CULTURE ANAEROBIC 158

1000114 BB ANTIBODY SCREEN 108

1000120 PTT 86

1000121 MITOCHONDRIAL AB (M2) 158

1000122 ANTISTREPTOLYSIN O TITER 82

1000126 BMP 148

1000132 BILIRUBIN DIRE CM_CT 60

1000133 BILIRUBIN TOTAL 60

1000135 MEDICARE DRUG SCREEN (DEFINITIVE) 168

1000136 ALCOHOL (ETOH) 168

1000137 CULTURE BLOOD 170

1000138 LYME DISEASE B BURGDORF 201

1000139 BRUCELLA ANTIBODY 113

1000140 BUN 55

1000141 EIA QL SEMI QUANT MULTI 128

1000142 EIA QL CDIFF TOXIN MULTI 140

1000143 C-REA CM_CTIVE PROTEIN 82

1000144 C-PEPTIDE 114

1000145 CRP CARDIO 107

1000146 CA 125 68

1000147 ALPHA FETO PROTEIN 144

1000148 CA 15-3 150

1000149 CA 19.9 147

1000151 CALCITONIN 165

1000152 CALCIUM 57

1000153 CO2 46

�7

1000154 CARBON MONOXIDE 118

1000155 BRCA1 2766

1000156 BRCA2 2766

1000159 LEUKOCYTE ANTIBODY ID 174

1000160 URINE MICRO ONLY 42

1000161 URINE CATECHOLAMINES 172

1000162 CBC WITH PLATELETS REFLEX 79

1000163 CBC AUTO DIFF REFLEX 98

1000164 CEA 167

1000166 CERULOPLASMIN 91

1000167 COMPLEMENT TOTAL CH50 161

1000168 ASPERGILLUS GALA CM_CTOMANNAN AG 54

1000169 CALPROTE CM_CTIN FECES 89

1000170 CHLORIDE 46

1000171 CHOLESTEROL TOTAL 57

1000173 HERPES VIRUS 6 AB 346

1000174 CK(TOTAL) 82

1000175 CKMB 136

1000177 PARVOVIRUS AB 120

1000179 CMV AB IGG 113

1000180 CMV AB IGM 120

1000181 CMV UBS SCREEN 94

1000185 CMP 196

1000188 TRANSFERRIN 105

1000190 CORTISOL 148

1000194 CREATININE 59

1000195 URINE CREATININE RANDOM 60

1000196 URINE CREAT CLEARANCE 123

1000201 FUNGUS CULTURE 89

1000205 CYCLOSPORINE 182

1000208 D-DIMER 152

1000210 DHEA 167

1000211 DHEA-S 164

�8

1000213 MANUAL DIFFERENTIAL REFLEX 47

1000214 DIGOXIN 135

1000215 PHENYTOIN 146

1000219 DNA AB (DOUBLE STRAND) 120

1000226 GLUCOSE POST DOSE 62

1000236 EBV VCA IGG 113

1000238 EBV NUCLEAR AG 96

1000239 ERYTHROPOIETIN 67

1000240 ESR-SED RATE AUTOMAT 59

1000241 ESR-MANUAL 59

1000242 ESTRADIOL 194

1000243 ESTROGEN FRA CM_CTIONATED 165

1000245 ESTRONE 129

1000246 ETHOSUXIMIDE 144

1000249 COAG FA CM_CTOR VIII 208

1000250 FECAL FAT QUANTITATIVE 157

1000252 FECAL FAT QUALITATIVE 62

1000253 FERRITIN 131

1000262 FOLATE 126

1000265 FSH (FOLLICLE STIM HORM) 157

1000266 CRYPTOSPORIDIUM AND GIARDIA 146

1000267 FTA-ABS 92

1000268 CULTURE FUNGUS SKIN HAIR NAIL 104

1000269 CRYPTOSPORIDIUM AG EIA 90

1000270 THYROID STIMULATING IMMUNOGLOBINS 282

1000271 CYTOLOGY 190

1000276 GENTAMICIN LEVEL 164

1000277 GGT 77

1000278 ENTAMOEBA HISTOLYTICA AG 70

1000279 GIARDIA AG EIA 103

1000281 GTT 3 SPECIMENS 138

1000282 GTT EACH >3 SPECIMENS 44

1000285 GLUCOSE FINGER STICK 35

�9

1000287 GLUCOSE AUTOMATED 54

1000288 BODY FLUID PH 47

1000289 SODIUM OTHER SOURCE 56

1000291 GROWTH HORMONE (HGH) 112

1000292 H PYLORI 96

1000293 H PYLORI STOOL 149

1000296 HEP B CORE ANTIBODY 105

1000297 HEP B SURFACE ANTIGEN 100

1000298 HCG QUAL (SERUM) 112

1000299 HCG QUANTITATIVE 177

1000301 HEP C VIRAL LOAD 411

1000302 HDL DIRE CM_CT 77

1000303 ARSENIC 103

1000304 HEMATOCRIT 37

1000305 HEMOGLOBIN 37

1000306 HEMOGLOBIN A1C 98

1000307 HEMOGLOBIN S 101

1000315 HEP C VIRUS GENOTYPE 890

1000316 HEP C ANTIBODY 135

1000317 HEP C RIBA CONFIRMATORY 239

1000321 HEP A ANTIBODY IGM 106

1000322 HEP A ANTIBODY IGG/IGM 96

1000323 CADMIUM 204

1000324 HEP B SURFACE ANTIBODY 105

1000325 ACUTE HEPATITIS PANEL 365

1000326 HSV AB TYPE 1 82

1000328 HIV 1/2 CONFIRMATORY 168

1000333 HOMOCYSTEINE 154

1000334 HSV BY PCR 226

1000335 HEP B SURF AB QUANT 146

1000336 CHROMOGRANIN A 185

1000338 VITAMIN D 1.25 DEHYDROXY 239

1000339 IMMUNOGLOBULIN 94

�10

1000340 IMMUNOGLOBULIN E 123

1000342 IGF-1 SOMATOMEDIN 172

1000346 INSULIN 100

1000352 IRON 72

1000353 IB CM_CT 76

1000356 CLOBAZAM 117

1000357 LACOSAMIDE 219

1000358 OXCARBAZEPINE 157

1000359 LEVETIRACETAM 196

1000362 ENDOMYSIAL ANTIBODIES IGA 89

1000363 ALLERGY PANEL E-95 712

1000364 LDH 71

1000366 LDL DIRE CM_CT 73

1000367 LEAD 85

1000368 COPPER SERUM 29

1000373 LIPASE 104

1000375 LIPID PANEL 148

1000377 LITHIUM 90

1000378 HEPATIC FUN CM_CTION PANEL 147

1000382 MAGNESIUM 82

1000383 RUBELLA IGG OR IGM EACH 93

1000384 MERCURY 96

1000385 METANEPHRINE 182

1000389 METHYMALONIC ACID 179

1000390 MICROALBUMIN 81

1000393 MONOSPOT 82

1000394 MUMPS IGG OR IGM (EA) 96

1000396 MYCOPLASMA IGG OR IGM 105

1000398 MYOGLOBIN 125

1000401 NICOTINE 245

1000404 PORPHYRINS TOTAL PLASMA 37

1000405 PORPHOBILINOGEN URINE 51

1000406 XXX OBSTETRIC PANEL 250

�11

1000407 OCB GUAIAC CANCER SCR 45

1000409 OSMOLALITY BLOOD 89

1000413 BB PACKED RBC UNIT 610

1000416 PERIPHERAL SMEAR/PAT 41

1000419 BODY FLUID CELL COUNT 111

1000420 BODY FLUID GLUCOSE 70

1000423 PHENOBARBITAL 146

1000425 PHOSPHORUS 60

1000430 PLATELET COUNT AUTOMATED 60

1000434 POTASSIUM 55

1000435 PREALBUMIN 108

1000436 BNP 227

1000438 PROGESTERONE 150

1000439 PROLA CM_CTIN 174

1000444 COCCIDIOIDES AB 148

1000445 PT/INR 62

1000447 PSA TOTAL (SCREENING) 142

1000449 Q FEVER IGG/IGM (X2) 118

1000450 PSA TOTAL AND FREE 264

1000451 RICKETTSIA ROCKY MTN IGM 104

1000455 RBC AUTOMATED 30

1000456 RENAL FUN CM_CTION PANEL 154

1000457 BMP ISTAT 148

1000458 RENIN A CM_CTIVITY 134

1000460 XXX RETICULOCYTE COUNT MANUAL 62

1000461 VITAMIN A 80

1000462 HEMOGLOBIN ELE CM_CTROPHORESIS 124

1000463 RHEUMATOID FA CM_CTOR 74

1000464 THIAMIN 400

1000465 RISTOCETIN COFA CM_CTOR(VIII) 174

1000469 RSV 142

1000470 RUBEOLA IGG OR IGM (EA) 100

1000471 ARGININE VASOPRESSIN 291

�12

1000473 SALICYLATE 134

1000476 SEMEN PRESENCE OF SPERM 81

1000477 ROTAVIRUS AB 138

1000479 AST 62

1000480 ALT 62

1000484 SODIUM 54

1000487 STONE ANALYSIS (CALCULUS) 112

1000488 CULTURE STOOL 128

1000490 OVA & PARASITES 192

1000494 PEMPHIGOID BMZ IGG & IGA 190

1000496 BODY FLUID PROTEIN 78

1000498 THYROID FREE T3 151

1000499 THYROID T3 REVERSE 129

1000500 THYROID T3 TOTAL 129

1000501 THYROID T3 UPTAKE 81

1000502 URIC ACID OTHER SOURCE 61

1000503 THYROID FREE T4 114

1000504 URINALYSIS MISC 42

1000505 THYROID T4 TOTAL 86

1000506 URINE BA CM_CTERIA SLIDE SCRN 61

1000507 CARBAMAZEPINE (TEGRETOL) 156

1000508 TESTOSTERONE TOTAL 181

1000509 THEOPHYLLINE 134

1000513 THYROID TBG 105

1000517 PROTEIN TOTAL 56

1000523 HLA-DQB1 187

1000524 TRIGLYCERIDES 67

1000527 TROPONIN-I 207

1000528 BB TYPE AND SCREEN 217

1000529 THYROID TSH 152

1000530 BB ABO RH 109

1000531 URIC ACID 61

1000532 UA DIP (MANUAL) 31

�13

1000533 URINE CALCIUM 43

1000534 DIRE CM_CT COOMBS TEST 45

1000535 BB CROSSMATCHING 217

1000536 STOOL SMEAR WBC 60

1000537 UA DIP W/MICRO (MANUAL) 45

1000539 CULTURE URINE 105

1000540 PREGNENALONE 124

1000545 URINE POTASSIUM 62

1000546 URINE SODIUM 64

1000548 OSMOLALITY URINE 86

1000550 VALPROIC ACID 149

1000551 VANCOMYCIN 165

1000553 VZV IGG OR IGM (EACH) 107

1000555 SYPHILIS TEST NON TREP QU 61

1000558 VITAMIN B 12 131

1000559 VITAMIN B 6 152

1000560 VITAMIN D 25 HYDROXY 192

1000561 VANILLYLMANDELIC ACID UR 109

1000562 CULTURE VIRAL NONRESPIRATORY 202

1000563 FA CM_CTOR VIII VONWILLEBRAND 340

1000564 WET PREP (SAL- KOH) 62

1000565 WBC AUTOMATED 43

1000566 URINE CHLORIDE 62

1000567 ZINC 88

1000576 ELE CM_CTROLYTE PANEL 106

1000577 SUSCEPT AGAR DILUTION 48

1000579 UA W/MICRO (AUTO) REFLEX 70

1000580 URINE PHOSPHORUS 56

1000583 VITAMIN K 209

1000585 T CELL ABSOLUTE CD4 COUNT 151

1000586 THYROID PEROXIDASE AB 106

1000589 SIROLIMUS (RAPAMURE) 167

1000590 TACROLIMUS 207

�14

1000591 SUSCEPT DISK ID 78

1000592 SUSCEPT ENZ DETE CM_CTION 88

1000594 HIV-1 112

1000595 ALDOLASE 105

1000596 LH (LEUTINIZING HORMONE) 156

1000598 URINE PROTEIN 70

1000599 HIV 1/2 SCREEN 123

1000601 HUMAN METAPNEUMOVIRUS 108

1000602 RESPIRATORY SYNCYTIAL VIRUS 98

1000603 ADENOVIRUS 98

1000604 TESTOSTERONE FREE 159

1000605 LAMOTRIGINE 149

1000608 INFLUENZA B 98

1000609 INFLUENZA A 98

1000610 PARAINFLUENZA 98

1000613 HIV-1 VIRAL LOAD 434

1000615 RESPIRATORY VIRAL PANEL ASSAY 172

1000621 PSA FREE 118

1000622 SLIDE REVIEW BLOOD 34

1000623 STAIN SMEAR GRAM-WRIGHT 61

1000624 ACID FAST BACCILI CULTURE 138

1000625 XXX FOOD ALLERGY (DONT USE) 7

1000626 ACID FAST BACILLI STAIN 64

1000629 GC/CHLAMYDIA URINE 300

1000630 XXX GONORRHEA URINE 149

1000635 IMMUNOFIXATION URINE 162

1000637 LA CM_CTATE 124

1000639 CULTURE URINE 81

1000642 HSV AB NON SPECIFIC-CRMC 95

1000644 THYROID THYROGLOBULIN AB 101

1000647 GC/CHLAMYDIA SWAB 150

1000649 KOH PREP SKIN HAIR NAIL 59

1000650 THYROID THYROGLOBULIN TUM 114

�15

1000655 SENSITIVITY TEST 100

1000656 ID AEROBIC DEFINITIVE 74

1000659 ANDROSTENEDIONE SERUM 146

1000660 HIV-1 PCR 300

1000661 STREP A RAPID TEST 85

1000662 ARTERIAL BLOOD GAS 241

1000665 OCCULT BLOOD RF 47

1000666 UA DIP (AUTO) REFLEX 46

1000667 CALCIUM IONIZED 114

1000668 OCB GUAIAC OTHER SOURCE 55

1000700 CORTISOL FREE SERUM 137

1000709 ID ANAEROBIC 91

1000710 HSV AB TYPE 2 91

1000713 STOOL ELASTASE 288

1000715 TULARENSIS ANTIBODY 160

1000716 LEGIONELLA ANTIBODY 95

1000720 ASSAY OF SEROTONIN 163

1000722 SEX HORMONE BIND GLOBULIN 101

1000723 LEPTOSPIRA ANTIBODY 114

1000724 WEST NILE VIRUS IGM 107

1000725 WEST NILE VIRUS IGG 111

1000727 ID FUNGUS 88

1000728 ANA TITER 104

1000729 RETICULOCYTE COUNT AUTO 62

1000734 VITAMIN D 25 MASS SPEC 169

1000737 URINE HOMOVANILLIC ACID 101

1000739 CULTURE STL EA ADD' PATH 60

1000740 CDIFF 143

1000741 ID YEAST 91

1000742 PCR 258

1000753 IDTYPING IMMUNOLOGIC METH 48

1000755 BODY FLD CELL CM_CT W DIFF 106

1000756 CYCLIC CITRULLINATED PEPTIDE 125

�16

1000758 OVA & PARASITE STAIN 86

1000762 LA CM_CTOFERRIN (STOOL WBC) 96

1000764 CULTURE FUNGUS BLOOD 141

1000765 IMMUNOFIXATION SERUM 158

1000773 XYLOSE ABSORPTION 86

1000800 VITAMIN E 95

1000811 SERUM FREE LIGHT CHAIN 129

1000813 BETA 2 MICROGLOBULIN 143

1000901 COLLE CM_CTION DOT 45

1000902 COLLE CM_CTION NON-DOT 30

1000903 DRAW FEE ARTERIAL 78

1000904 DRAW FEE CAPILLARY 24

1000905 DRAW FEE CATHETER 60

1000906 DRAW FEE VENOUS 24

1000907 DNA SWAB COLLE CM_CT LABCORP 48

1000908 SPECIMEN HANDLING FEE 35

1000911 URINE TIMED VOLUME 26

1000912 SYNOVIAL FLUID CRYSTALS 77

1000913 HE4 43

1000914 DARKFIELD EXAM NO COLLE CM_CT 22

1000916 CONCENTRATE INF AGENT 49

1000918 CULTURE WOUND 168

1000920 LISTERIA AB BY CF 24

1000921 IGG SUBCLASSES 155

1000922 PSA MEDICARE/AID 177

1000923 CULT ANAER BA CM_CTERIAL 182

1000924 SHIGA TOXIN 2 107

1000925 CULTURE SCREEN GRP B STREP 127

1000926 CITRATE URINE 240

1000927 INSULIN FREE 137

1000928 HFE GENE ANALYSIS 30

1000929 FA CM_CTOR V LEIDEN 157

1000931 PROTHROMBIN G20210A MUTAT 210

�17

1000932 CYSTIC FIBR MUT ANALASIS 302

1000933 PML/RARA QUANT PCR 1077

1000934 FRAGILE X SYNDROME 554

1000935 ALPHA 1 ANTITRYPSIN DEF 124



1000938 MTHFR C677T MUTATION 274

1000939 QUAD SCREEN 2ND TRIMESTER 103

1000940 JAK2 GENE V617F MUTATION 255

1000943 RABIES RFFIT TITER 576

1000945 URICULT 98

1000946 HAPTOGLOBIN 114

1000949 COAGULATION FA CM_CTOR V ASSAY 113

1000980 VON WILLEBRAND FA CM_CTOR MULTIMER 228

1000981 DOPAMINE RECEPTOR D4 GENOTYPE 1088

1000982 URINE TOX SCREEN 157

1000983 URINE TOX SCREEN (MEDICAL) 172

1000984 LEGIONELLA ANTIGEN URINE 53

1000985 HEPATITIS B DNA QUANTITATIVE 185

1000986 METHEMOGLOBIN 34

1000988 PRIMIDONE 148

1000989 HEPARIN XA ASSAY LMW 152

1000994 HLA B27 163

1000995 ROTAVIRUS STOOL 112

1000996 C2 COMPLEMENT FUNCTIONAL 124

1000998 INFLUENZA IAADIADOO 49

1000999 ANCA TITER 112

1001011 CYTOLOGY BODY FLUID 290

1001017 INHIBINA 100

1001019 PROTEIN S ACTIVITY 242

1001020 PROTEIN C ACTIVITY 202

1001021 ANTI THROMBIN ANTIGEN 153

1001022 CHRONIC LYMPHOCYTIC LEUKEMIA, FISH 150

�18

1001023 GLUTAMIC ACID DECARBOXYLASE 121

1001024 CRYOGLOBULIN 83

1001025 CRYOFIBRINOGEN 89

1001026 VIT B3 NIACIN 54

1001027 T CELLS TOTAL COUNT 132

1001030 CK ISOENZYMES 101

1001031 INTERPRETATION AND REPORT CYTO 122

1001033 APOLIPOPROTEIN B 187

1001034 LIPOPROTEIN A 66

1001035 NMR LIPOPROTEIN W/IR MARKERS 234

1001036 ROHYPNOL 200

1001040 PATERNITY TESTING COLLECTION 45

1001045 BARTONELLA ANTIBODY PANEL 356

2000010 SPIROMETRY W/GRAPH 282

2000011 CPAP 551

2000013 MAX BREATHING CAPACITY 158

2000016 SPIROMETRY PRE/POST BROCHO TREAT 535

2100001 PT ELECTRICAL STIMULATION MANUAL/15 53

2100002 OT ELECTRICAL STIMULATION MANUAL/15 53

2100003 OT GAIT TRAINING/15 75

2100004 OT MECHANICAL TRACTION 51

2100005 OT MANUAL THERAPY/15 65

2100007 PT ADL/15 77

2100020 PT EVALUATION LOW 20 MIN 172

2100023 PT FUNCTIONAL ACTIVITY/15 74

2100024 PT GAIT TRAINING/15 MIN 75

2100025 PT EVALUATION MODERATE 30 MIN 172

2100026 PT EVALUATION HIGH 45 MIN 172

2100027 PT RE EVALUATION 20 MIN 117

2100034 PT MECHANICAL TRACTION 51

2100035 PT MANUAL THERAPY/15 65

2100038 PT NUEROMUSC RE-ED/15 83

2100041 OT ADL/15 77

�19

2100045 OT FUNCTIONAL ACTIVITY/15 74

2100047 OT NEUROMUS RE-ED/15 83

2100051 OT THERAPEUTIC EXERCISE/15 85

2100052 OT ULTRASOUND/15 MIN 52

2100064 PT THERAPEUTIC EXERCISE/15 85

2100065 PT ULTRASOUND/15 MIN 52

2100097 OT RE EVALUATION 30 MIN 110

2100098 OT EVALUATION HIGH 60 MIN 167

2100099 OT EVALUATION MODERATE 45 MIN 167

2100100 OT EVALUATION LOW 30 MIN 167

2100111 PT SWALLOW STUDY 493

2100115 ST SWALLOW TREATMENT 252

2190420 EVAL SPEECH SOUNDS PRODUCT LANG COMP 709

2190421 GN TX SPEECH LANG VOICE COMMJ & AUDITORY 186

3000003 ABD PADS 8 X 10 10

3000028 SALEM SUMP ANTI REFLEX VALVE 43.75

3000062 FOLEY CATH HOLDER 10

3000078 COBAN 4 X 5 YD 14

3000079 COBAN 6 X 5 YD 20

3000094 ENEMA BUCKET 16

3000095 EPISTAXIS CATHETER KIT 770

3000100 CATHETER KIT FEMALE 34

3000115 FOLEY CATHETER 22 FR 52

3000120 GAUZE STERILE 3 X 3 12 PLY (2/PK) 10

3000124 GRADUATE CONTAINER 10

3000127 HEALING SHOE SM WOM 60

3000137 IRRIGATION TRAY 12

3000152 DUO-THERM PAD 14 X 20 77

3000153 KERLIX 4.5 X 4.1 YD 10

3000165 GASTRIC LAVAGE KIT W/SPIKE 553

3000168 LEG BAG 1000 ML 28

3000181 MORGAN LENSES 275

3000183 DRAPE NON FENESTRATED 10

�20

3000184 SODIUM CHLORIDE 1000 ML 33

3000195 NU GAUZE PLAIN 1/4 X5' 33

3000205 RHINO ROCKET SLIM/XLG 150

3000207 RIB BELT WOMEN 77

3000212 SCOTCH CAST 3 64

3000218 STERISTRIP 1/2 X 4 10

3000219 STERILE WATER 1500ML 22

3000222 STERISTRIP 1/4 X 4 12

3000223 ANKLE SPRT STIRRUP REGULAR, LT 232

3000226 SUCTION CANISTER DISPOSABLE 26.25

3000236 SUTURE DERMABOND DB1 224.75

3000247 SUTURE PROLENE 6-0 P -1 DO NOT REORDER 131

3000265 THORACIC CATHETER 36FR 67

3000275 ENDO TRACH TUBE 6.5 UC 12

3000286 UNNA BOOT 105

3000291 URETHRAL CATH TRAY 22

3000304 ADAPTIC 5 X 9 13

3000307 YANKAUER SU CM_CTION 21

3000332 ORTHO GLASS 5 51

3000338 STRETCH BANDAGE NS 6 X 82 10

3000359 TED HOSE KNEE XLG 43

3000361 TED HOSE THIGH MED 106

3000362 TED HOSE KNEE LG REG 62

3000380 SUCTION TUBING NS 17

3000382 SODIUM CHLORIDE 500ML 12

3000390 SUTURE PROLENE 4-0 PS-2 DO NOT REORDER! 112

3000394 SUTURE ETHILON 3-0 FS-1 DO NOT REORDER! 17

3000402 STYLET 10 FR 41

3000403 SUCTION CATHETER 12FR 18

3000405 O2 TUBING 7 10

3000406 AEROSOL MASK ADULT 10

3000407 O2 CANNULA ADULT 7' 10

3000418 SPLASH GUARD - ZEROWET 18.25

�21

3000422 ADAPTIC 3 X 3 10

3000425 O2 CANNULA 25 28.25

3000428 HUMIDIFIER DISP 14

3000447 PERI WASH BOTTLE 16

3000455 O2 MASK SIMPLE ADULT 10

3000456 O2 MASK SIMPLE INF 39

3000457 O2 MASK NON REBREATHER 18

3000478 SUTURE VICRYL 3-0 32

3000493 O2 SENSOR PREMIE 126

3000496 O2 SENSOR INFANT I-20 163.75

3000497 O2 SENSOR PED D20 135

3000511 CRUTCHES CHILD 14


3000516 SKIN STAPLER DS-15 71.5

3000519 NASOPHARYNGE AIRWAY 34 FR 35

3000528 ABDU CM_CTION FINGER SPLINT- XLG. 109

3000540 SUTURE ETHILON 6-0 PS-3 DO NOT REORDER! 96

3000553 O2 CANNULA PED 16

3000572 CERVICAL COLLAR PHIL LG 228


3000575 SPIROMETER 28.5

3000587 PEAK FLOW METER 103

3000591 SUTURE MASTISOL 18

3000596 BAIR HUG BLANKET UP BODY 64

3000597 BAIR HUG BLANKET LOW BODY 108

3000608 OPTIHALER SPACER MD1 55

3000628 O2 CANNULA NASAL 7 INFANT 18

3000649 WOUND CLOSE FORCEPS 29

3000650 ELASTOPLAST 4 56

3000658 SUTURE ETHILON 3-0 PS-1 34

3000675 URINARY DRAIN BAG ANTI REFLUX 2000 ML 61

3000678 TOOMEY SYRINGE 39

3000681 SUTURE ETHILON 4-0 FS-2 16

�22

3000686 SUTURE VICRYL 3-0 PS2 34


3000697 SUTURE PLAIN GUT FST 6-0 64.5

3000720 NEBULIZER PEDIATRIC 68

3000729 NEBULIZER HI FLOW 59

3000730 MASK BI-FLO PED 24

3000731 O2 MASK BI- FLOW ADULT 20

3000736 FINGER SPLINT FROG SM 16

3000738 FINGER COT PADDED SM 20

3000759 KLING BANDAGE 4 X 75 STERILE 10

3000769 KANGAROO PUMP SET 48

3000773 THUMB SPIKA RT LG 164

3000782 QUIK COMBO READY PAK ADULT 513.75


3000795 ET TUBE HOLDER INFANT 93

3000797 C-COLLAR LAERDAL CHILD 88

3000798 ARM SLING ADULT LG 26.75

3000801 FOLEY TRAY 8FR PED 120

3000819 VENTILATION CIRCUIT 72

3000820 QUIK COMBO REDI PAK PED 488

3000833 OXYGEN PER DAY 441

3000834 OXYGEN PER HOUR 14

3000841 KNEE IMMOBILIZER MED 20 172

3000845 KNEE SPORTS BRACE SM 215

3000861 SHOE HORN 24 29

3000870 BATH SPONGE LONG HANDLE 35

3000873 COVADERM DRESSING 4 X 4 13

3000886 CHEST DRAIN VALVE 223

3000892 OXYGEN NOSE CLIPS LATEX FREE 10

3000901 ANKLE SUPPORT XXLG 41

3000903 INTRODUCER INTUBATOR ADULT MALLEABLE 67

3000909 SUTURE SOFSILK SIZE 0 72

3000914 DUODERM EXTRA THIN 4 X 4 20

�23

3000915 ANOSCOPE SPECULA DISP 15


3000920 MASK BI-PAP LG 192

3000921 CUSHION PRESSURE W/COVER 14.25

3000923 LARYNGOSCOPE GLV-3 169.25

3000924 KING LTSD KIT SIZE 4 441

3000929 COUDE CATH FOLEY 16FR 120

3000931 SAFETY SCAPEL #10 DISP STERILE 16

3000932 SAFETY SCAPEL #15 DISP STERILE 15.75

3000933 SAFETY SCAPEL #11 DISP STERILE 16

3000937 FLEXIBLE SOCK & STOCKING AID 139.75

3000939 PLEURAGUIDE DISP CHEST TUBE KIT 694

3000940 ACAPELLA FLUTTER-VALVE BLUE 432.25

3000941 ACAPELLA FLUTTER-VALVE GREEN 623.25

3000942 THORACIC CATHETER 12FR 37.5



3000945 REACHER, 31 BLUE 152.25

3000947 SURESITE 123 DRESSING 4 X 4.8 10

3000948 XTRAXORB SUPER ABSORB STERILE 4 X 5 37

3000950 MEDI HONEY NON-ADHESIVE HCS 4.3 X 4.3 84.5

3000951 MEDI HONEY CALCIUM ALGINATE 40

3000952 MEDI HONEY ADHESIVE HCS 2.8 X 2.8 48

3000954 MEPILEX HEEL FOAM DRESSING 5 X 8 71.75

3000956 RANGER PED/NEONATE DISP FLUID WARMING ST 256

3000957 RANGER STAND FLW DISP FLUID WARM ST W/EX 104.25

3000958 RANGER HIGH FLOW DISP FLUID WARM SET 567

3000959 SURGICAL AIRWAY KIT 343

3000960 LARYNGOSCOPE GVL-0 179

3000961 LARYNGOSCOPE GLV-1 179

3000962 LARYNGOSCOPE GLV-2 179

3000965 INSTANT COLD PACK 10.5

3000966 KING LTSD KIT SIZE 3 441.25

�24

3000967 KING LTD KIT SIZE 2 387

3000968 GLOVES 6.5 SENSICARE STERILE SURG 19

3000969 GLOVES 7 SENSICARE STERILE SURG 19

3000970 GLOVES 7.5 SENSICARE STERILE SURG 22.5

3000971 GLOVES 8 SENSICARE STERILE SURG 19

3000972 GLOVES 8.5 SENSICARE STERILE SURG 19

3000977 SUTURE CHROMIC 4-0 27 REVERSE CUTTING 28


3000979 SCOTCHCAST PLUS CAST TAPE 2 X 4YD 21



3000982 LMA UNIQUE SIZE 1.5 79

3000984 LMA UNIQUE SIZE 4 79


3000986 ENDO TRACH TUBE 6.5 CUFF 12


3000990 SPECULUM VAGINAL SMALL BUILT IN LIGHT 51

3000991 SPECULUM VAGINAL MEDIUM BUILT IN LIGHT 51

3000992 SPECULUM VAGINAL LARGE BUILT IN LIGHT 51


3000994 SPECIMEN PAN 10

3000995 COBAN 1 10

3000996 ANKLE WALKER SM STANDARD 248

3001004 BAIR HUG BLANKET TORSO 64

3001005 DUO-THERM PAD 18 X 24 77

3001009 EMESIS BASIN 10

3001010 WRIST SPLINT 8 LT MED 91


3001013 LUMBOSACRAL SUPPORT MD 187

3001014 FRACTURE PAN 12

3001015 RESUSCITATION ADU (HUD) 280.75

3001017 THORACENTESIS TRAY 246


�25

3001019 ENDO TRACH TUBE 4.5 UC 10.25


3001022 TRACH TUBE DIC 7.0 236


3001024 INTRODUCER INTUBATOR BOUGIE COUDE TIP 61.24

3001025 AIRWAY ORAL 100 MM 10

3001026 DIAGNOSTIC PEN 85

3001027 SCOTCHCAST PLUS 5 81

3001029 EYE PADS SM OVAL 10

3001032 ET TUBE HOLDER PEDIATRIC 72

3001033 CATHETER STABILIZATION DEVICE 12

3001034 DELEE SUCTION TUBE 10 FR 20

3001035 ENDO TRACH TUBE 4.0 UC 10.75




3001042 O2 CAPNOLINE 18

3001043 STERILE WATER 500ML *B BRAUN* 20.05




3001048 CATHETER FOLEY 3 WAY 35

3001050 LARYNGOSCOPE BLADE MIL 0 DISP 94


3001052 LARYNGOSCOPE BLADE MIL 2 DISP 101.5



3001055 LARYNGOSCOPE BLADE MAC 1 DISP 101.5

3001056 LARYNGOSCOPE BLADE MAC 2 DISP 94



3001060 ARGYLE SALEM SUMP 24

3001062 SODIUM CHLORIDE 500ML *B BRAUN* 14

�26

3001064 SUCTION TRANSFER TUBING 18


3001066 ENDO TRACH TUBE 7.0 CUFF 34.75

3001068 LMA MAD NASAL 65.75

3001069 SPLINT SAM ORANGE / BLUE STANDARD 36 RL 99.5

3001070 INSTANT HOT PACK 30.25





3001080 URINE STRAINER 10

3001082 LMA UNIQUE SIZE 3 77.5

3001083 CATHETER PLUG 10

3001084 SMART CAPNOLINE PLUS ADULT/INTERMEDIATE CO2 147.15

3001085 TED HOSE KNEE 2XL 33.75

3001086 THORA - PARA TRAY 292

3001088 DRESSING GEL FIBER OPTICELL 2 X 2 21.25

3001093 PORTA CATH KIT 10

3001094 IODOFORM PACKING STRIPS 1/4" X 15' 17

3001096 HEEL RAISER PRO II HEEL PROTECTOR 315

3001097 STOCKINGNET 2 10

3001098 BANDAGE TUBULAR MEDIGRIP SIZE F 1 YD 45.75




3001103 YANKAUER SUCTION W/ VENT 22.25

3001105 PESSARY RING W/SUPPORT SIZE 3 378

3001107 WATER/GEL FILLED WHEELCHAIR CUSHION 289.25

3001110 NEEDLE DECOMPRESSION 10G X 3.25" 151.75

3001112 TOURNI-COT FINGER/TOE MIXED BOX 48

3001113 GEL MEDIHONEY 1.5 OZ TUBE 107.5

3001114 SAM PELVIC SLING II 574.25

3001115 NASOPHARYNGE AIRWAY 14 FR 89.5

�27





3001120 LABOR & DELIVERY SURGICAL TRAY STERILE 262.5

3001121 BEDPAN BARIATRIC 35.87

3001122 POLIGRIP SUPER DENTURE ADHESIVE CREAM 2.4OZ 5.85

3001124 NASAL PACKING WITH STRING 4.5CM 44.75

3001125 LARYNGOSCOPE GVL-2.5 211.5

3001126 ISOLATION - SURGICAL GOWNS STERILE 24.75

3001128 FOAM LIMB HOLDER 32

3001129 SILICONE 18 FR 2-WAY CATHETER 91.5

3001131 CANISTER 500ML WITH GEL FOR INFOVAC 339.75

3001132 DRESSING MEDIUM VAC GRANUFOAM 404.75

3001133 DRAPE VAC KCI 30.5CM X 26CM 63.25

3001134 TED HOSE THIGH X-LARGE REGULAR 80

3001135 PLEURAGUIDE DISPOSABLE CHEST TUBE KIT W/OUT LIDOCAINE 728.25

3001136 STYLET PEDIATRIC GLIDERITE SINGLE USE 59.5

3001138 TUBING W/ CLAMP & CONNECTOR FOR WOUND VAC 168.5

3001139 BANDAGE SURGITUBE SZ 1 5/8" X 50Y 10

3001793 SUTURE ETHILON 5-0 P-3 126.25

3001794 SUTURE VICRYL 4-0 PS2 109.5

3001795 SUTURE PROLENE 6-0 P-3 188.25

3090002 TED HOSE KNEE MED-REG 43

3090003 TED HOSE THIGH LG REG 105.5

3090004 STERISTRIP 1/8 X 3 10

3090014 FOLEY CATHETER, 10 FR 77

3090015 FOLEY CATHETER, 16 FR 34

3090016 FOLEY CATHETER, 18 FR 50.75

3090017 FOLEY CATHETER 20 FR 2 WY 33.75

3090025 RHINO-ROCKET W/XLG 217.25

3090026 RHINO-ROCKET W/LG 195

3090027 RHINO-ROCKET W/MED 124

�28

3090028 TELFA 3 X 8 STERILE 10

3090033 SUTURE ETHILON 4-0 P-3 125.75

3090047 URINAL WITH COVER 10

3090048 LACERATION TRAY 48

3090058 O2 MASK SIMPLE PED 10

3090061 STYLET 14 FR 17.5

3090062 STYLET 6 FR 17.5

3090063 ET TUBE HOLDER 46





3090077 ENDO TRACH TUBE 6.0 C 18



3090083 LEVIN TUBE 16 FR 23.25

3090084 LEVIN TUBE 10 FR 23.25

3090085 LEVIN TUBE 12 FR 23.25

3090086 LEVIN TUBE 14 FR 23.25

3090087 SUCTION CATHETER 8 FR W/CONTROL PORT 10





3090093 CO2 DETE CM_CTOR EASY CAP 78.75

3090094 PENROSE DRAIN 1/4 X 12 10





3090102 ORTHO GLASS 2 23.75

3090103 ORTHO GLASS 3 35.5

3090104 ORTHO GLASS 4 42.5

�29

3090105 ORTHO GLASS 6 28.75

3090128 SCOTCH CAST 2 52

3090129 SCOTCH CAST 4 81.75

3090135 CLAVICLE SPLINT MED 50.75

3090143 CERVICAL COLL FOAM SM/LON 61.5

3090146 AB BINDER SMALL/MED 60.25

3090147 AB BINDER LG/XL 69.25

3090151 C-COLLAR LAERDAL ADULT 78.5

3090164 AIR WALKER XL 361.25

3090168 STAPLE REMOVAL KIT 16.25

3090182 KNEE SPORTS BRACE LG 240.5

3090196 RHINO ROCKET SM/SLIM 117.5

3090198 LMA UNIQUE SIZE 5 77.5


3090206 ARM BAND TENNIS ELBOW 71.5

3090208 MASK BI-PAP MED 248

3090212 CO2 DETE CM_CTOR PEDI 78.75

3090217 FOLEY CATHETER 24 FR 5CC 51.75

3090218 KLING BANDAGE 2 X 75 STERILE 10

3090220 RHINO-ROCKET SLIM MED 151.5

3090221 RHINO-ROCKET SLIM.LG 151.5

3090222 TED HOSE THIGH SM-SHORT 105.75

3090223 TED HOSE KNEE SM-REG 61.5

3090238 TIB FIB NON PADDED SM 7 IN 204


3090243 LEG BAG HOLDER 71.25

3090244 POUCH CONVATEC DRAINABLE 11.75

3090253 PANTS MESH 21

3090254 CATHETER TEXAS MALE EXTERNAL MED 10

3090255 COUDE TIP WOVEN 6 FR 575.25



3090258 EAR SYRINGE BLUE BULB 14.5

�30

3090259 PERINEAL COLD PACK 10.5

3090262 VASHE WOUND THERAPY 4OZ 69

3090268 SUTURE MERSILENE 3-0 FS-1 20

3090269 KNEE, WRAP AROUND SM 318.5

3090271 UNIV BUCK'S TRA CM_CTION W/FOOT PAD 112.5

3090272 SCOTCH CAST 5 81.75

3090282 DUO-THERM PAD 12 X 17 10

3090630 NEBULIZER MICROMIST HUD 1883 10

4000003 ACETAMINOPHEN W/CODEINE 30 MG TAB 11.7

4000006 ACETAMINOPHEN 160MG/5 ML DROPS 30 ML 6

4000008 ACETAMINOPHEN 120 MG SUPPOSITORY 11.95

4000010 ACETAMINOPHEN 650 MG SUPPOSITORY 13

4000011 ACETYLCYSTEINE ORAL SOLN 20% 10ML 86.67

4000022 ALPRAZOLAM 0.25 MG TAB 11.5

4000028 AMIODARONE 200 MG TAB 12.15

4000030 AMLODIPINE 5 MG TAB 11.45

4000032 AMOXICILLIN SUSP 400/5 ML, 75 ML BTL 18.1

4000033 AMOXICILLIN/CLAVULANATE 875 TAB 12.7

4000036 AMOXICILLIN 250 MG CAP 11.3

4000038 AMOXICILLIN 500 MG CAP 11.5

4000040 AMPICILLIN/SULBA CM_CTAM VL 1.5 GM 43

4000042 AMPICILLIN 1GM VIAL 42.8

4000046 ASCORBIC ACID 500 MG 12

4000050 ATORVASTATIN 20 MG TAB 12.4

4000056 AZITHROMYCIN 500 MG VIAL 47.55

4000057 AZITHROMYCIN SUSP 200 MG/5 ML 15 ML 47.55

4000068 BISACODYL 10 MG SUPPOSITORY 11.55

4000074 BUPIVACAINE 0.5% 50 ML 47

4000086 CAPTOPRIL 25 MG TAB 15.8

4000087 CARBAMAZEPINE 200 MG TAB 14

4000095 CEFAZOLIN 1 GM VIAL 39.7

4000105 MULTIVITAMIN TAB 32.65

4000106 CEPHALEXIN 250 MG CAP 11.65

�31

4000108 CEPHALEXIN 500 MG CAP 11.7

4000114 CIPROFLOXACIN 500MG TAB 11.8

4000118 CLINDAMYCIN 150 MG CAP 12

4000120 CLONIDINE 0.1 MG TAB 11.35

4000124 CYCLOBENZAPRINE 10 MG TAB 11.4

4000126 DEXAMETHASONE 4 MG TABLET 4 mg 15.45

4000127 DEXTROSE 50% 500 MG/ML 50 ML SYRINGE 71.55

4000128 DIAZEPAM 10 MG/2 ML SYRINGE 128.25

4000129 DIAZEPAM 5 MG TAB 11.35

4000131 DICYCLOMINE 20 MG TAB 12

4000133 DIGOXIN 125 MCG TAB 11.6

4000135 DIGOXIN 500 MCG/2 ML AMP 63.65

4000137 DILTIAZEM CD 120 MG CAP 12.75

4000138 DILTIAZEM HCL CD 180 MG CAP 12.2

4000140 DIPHENHYDRAMINE LIQUID 12.5 MG/5 ML UD 19.25

4000141 DIPHENHYDRAMINE 25 MG CAP 11.25

4000142 DIPHENHYDRAMINE 50 MG/ML SDV 37.15

4000147 DOCUSATE SODIUM 100 MG SOFTGELS 11.25

4000149 DOPAMINE 400 MG/250 ML PREMIX 112

4000155 ENOXAPARIN 30 MG/0.3 ML SYRINGE 56.4

4000158 RACEMIC EPI 2.5% NEB 0.5ML 16.95

4000165 ERYTHROMYCIN OPHTHALMIC 3.5 GM OINT 54.05

4000170 EYE IRRIGATING SOLN 120 ML BOTTLE 41

4000171 FAMOTIDINE 20 MG TAB 11.8

4000174 FENTANYL 25 MCG/HR PATCH 43.6

4000177 FERROUS SULFATE 324 MG TAB 11.55

4000179 FLUMAZENIL 0.5MG/5ML 50.45

4000180 FLUORESCEIN SODIUM OPHTH STRIPS 1EA 12

4000181 FLUOXETINE 20MG CAP 11.55

4000183 FLUTICASONE PROPRIONATE 50MCG NASAL SPRY 26.9

4000184 FOLIC ACID 1MG TAB 11

4000188 FUROSEMIDE 20MG TAB 11.35

4000190 FUROSEMIDE 40MG/4ML SDV 40.15

�32

4000203 GUAIFEN/CODEINE 10MG/ 5ML UD 16.7

4000208 HALOPERIDOL 5MG/ML AMP 61.75

4000209 HYDROCHLOROTHIAZIDE 25MG TAB 11.35

4000214 HEPATITIS-B 20MCG/ML SDV 239.6

4000218 HYDRALAZINE 20MG/ML SDV 46

4000219 HYDRALAZINE 25MG TAB 11.6

4000225 HYDROCORTISONE SODIUM SUCCINATE 100 MG 59.05

4000231 IBUPROFEN 800MG TAB 11.15

4000232 IBUPROFEN SUSPENSION 100MG/5ML SUSP UD 14.2

4000237 INSULIN 70/30 MDV 100 UNITS/ML 3ML VIA 16

4000239 KETOROLAC 10MG TAB 14

4000240 KETOROLAC 30MG/ML SDV 38.3

4000242 LABETOLOL 100MG TAB 13

4000249 LIDOCAINE HYDROCHLORIDE JELLY 2% 5ML TUBE 36

4000250 VISCOUS LIDOCAINE UD 15ML SYRUP UD 15.2

4000257 LORAZEPAM 1 MG TAB 11.4

4000258 LORAZEPAM 2 MG/ML SDV 37

4000259 LOSARTAN 50 MG TAB 12.55

4000262 MAG-AL PLUS SIMETHICON 120MG/30ML SUS UD 18.05

4000264 MAGNESIUM OXIDE 400 MG TAB 11.5

4000275 METFORMIN 500MG TAB 11.35

4000279 METHYLPREDNISOLONE 125MG SDV 72

4000284 METOCLOPRAMIDE 10MG/2ML SDV 39.4

4000285 METOCLOPRAMIDE 10MG TAB 11.55

4000293 MAGNESIUM HYDROXIDE 30 ML LIQUID UD 0.65

4000296 MORPHINE SULFATE 10 MG/ML CARP 43

4000301 MULTIVITAMIN W IRON TAB 12

4000305 NALOXONE 2 MG/2 ML SYRINGE 162.65

4000306 NAPROXEN 500 MG TAB 12.05

4000311 NEOMYCIN/POLYMYX/HYDROCORT 10 ML OTIC 208.15

4000314 NICOTINE PATCH 21 MG 26.5

4000318 NITROFURANTOIN 100MG CAP 25.6

4000320 NITROGLYCERIN OINTMENT ESP 1GM OINT 21

�33

4000321 NITROGLYCERIN 50MG/250ML IV PREMIX 156.05

4000329 ONDANSETRON HCL 4MG/2ML SDV 37.1

4000331 OXYBUTYNIN 5MG TAB 13.35

4000332 OXYCODONE/APAP 5/325MG TAB 12

4000334 OXYMETAZOLINE 15ML SPRAY 27.4

4000336 PAROXETINE HCL 20 MG TABLET 11.95

4000339 PENICILLIN VK 500MG TAB 11.75

4000343 PHENAZOPYRIDINE 100MG TAB 15

4000348 PHENYLEPHRINE HCL 0.5% 15ML SPRAY 27.4

4000349 PHENYTOIN 250MG/5ML SDV 48.05

4000350 PHENYTOIN ER 100MG CAP 13.4

4000351 PHYTONADIONE 10MG/1ML AMP 229.7

4000357 POTASSIUM CHLORIDE ER 10MEQ CAP 14.8

4000362 PRAVASTATIN 40MG TAB 15.05

4000365 PREDNISONE 20MG TAB 11.9

4000373 PROMETHAZINE 25MG/ML SDV 38.05

4000376 PROPOFOL 1% 200MG/20ML EACH 45.6

4000384 ROCURONIUM 10 MG SDV 58.35

4000387 SENNA 8.6MG TAB 11.3

4000388 SERTRALINE HCL 50MG TAB 12

4000390 SILVER SULFADIAZENE 20GM CREAM 50.45

4000391 SIMVASTATIN 20MG TAB 11.5

4000392 SODIUM POLYSTRENE 15GM/60ML SUSP UD 48.5

4000393 SODIUM BICARB 8.4% ADULT 50MEQ/50ML SYRG 74.55

4000394 SODIUM CHLOR 0.9% SDV 10ML 38.75

4000396 SOTALOL 80MG TAB 11.45

4000397 SPIRONOLACTONE 25MG TAB 11.65

4000398 SPIRONOLA CM_CTONE/H CM_CTZ 25/25 TAB 14.9

4000401 SULFACETAMIDE SODIUM OPTH SOL 15ML BTL 173.2

4000403 SULFAMETHOXAZOLE/TRMETHOPRIM 800MG TAB 11.45

4000405 SUMATRIPTAN SUCCINATE 6MG/0.5ML SDV 70.35

4000410 TERAZOSIN 2MG CAP 12

4000412 TERBUTALINE 1MG/ML SDV 53.95

�34

4000422 THIAMINE 200MG/2ML 63.9

4000425 TRAMADOL 50MG TAB 13.2

4000426 TRAZODONE 50MG TAB 11.6

4000427 TRIAMCINOLONE ACETONIDE 0.1% 15G CREAM 34.65

4000440 VERAPAMIL ER 240MG TAB 21

4000442 WARFARIN 5MG TAB 11.3

4000443 WARFARIN 2MG TAB 11.3

4000444 ZOLPIDEM 5 MG TAB 11.4

4000446 ALLOPURINOL 100 MG TAB 12.3

4000447 AZITHROMYCIN 250 MG TAB 14.35

4000460 LEVOTHYROXINE 75 MCG TAB 16.95

4000465 METOPROLOL TARTRATE 50 MG TAB 11.35

4000473 SUCCINYCHOLINE CHLORIDE 200 MG/10 ML SDV 111.8

4000479 DILTIAZEM HCL 30 MG TAB 13

4000482 BISACODYL 5 MG TAB 12

4000486 VENLAFAXINE HCL XR 75MG CAP 13.65

4000490 LEVOFLOXACIN 500MG/100ML PREMIX IV SOL 85.25

4000491 LEVOFLOXACIN 500MG TAB 12.25

4000495 DOXYCYCLINE 100 MG TAB 14.05

4000497 CLOTRIMAZOLE 1% CREAM 30 GM 33.25

4000509 SILVER NITRATE STICK EACH 13.35

4000526 IPRATROPIUM BROMIDE 0.5MG/2.5ML NEB 13.55

4000529 GEMFIBROZIL 600MG TAB 12.05

4000530 CITALOPRAM 20 MG TAB 11.4

4000538 ORPHENADRINE CITRATE 60 MG/2 ML AMP 50

4000540 CLOPIDOGREL 75 MG TAB 11.85

4000541 CEPHALEXIN 125 MG/5 ML 100 ML SUSP 79

4000545 LORATADINE 10 MG TAB 12.3

4000558 LISINOPRIL 20 MG TAB 11.4

4000574 GABAPENTIN 300MG CAP 13.4

4000575 GUAIFENESIN ER 600 MG TAB 15.25

4000585 NORTRIPTYLINE HCL 25MG CAP 13.4

4000592 BACITRACIN 0.9 GM PACKET 11.65

�35

4000597 IRBESARTAN 150MG TAB 11.7

4000603 SALINE NASAL SPRAY 45 ML 26.1

4000612 TOBRAMYCIN 0.3% OPTH SOLN BOTTLE 5 ML 39.3

4000618 METOPROLOL SUCCINATE 100MG TAB 18

4000618 metoprolol succ ER 100 MG TAB 100 mg, 100 eaches 13.1

4000620 glipiZIDE ER 5 MG TABLET 5 mg, 100 eaches 11.5

4000634 CLONAZEPAM 0.5 MG TAB 11.2

4000661 METHYLPREDNISOLONE 1GM SDV 214.05

4000667 NYSTATIN CREAM 15GM 27.4

4000687 HYDROXYZINE HCL 25MG TAB 12.15

4000688 NITROGYLCERIN 0.4MG *3 TAB/BOTTLE* 18.3

4000695 VALACYCLOVIR HCL 500 MG TAB 22.35

4000697 ASPIRIN ENTERIC COATED 325MG TAB 0.55

4000698 TAMSULOSIN 0.4MG CAP 12.5

4000705 GLUCOSE GEL 31G TUBE 17

4000710 CARBIDOPA/LEVODOPA 25/100 MG TAB 11.85

4000720 MONTELUKAST 10 MG TAB 12.7

4000728 SWI 10ML SDV 38.55

4000730 MUPIROCIN OINT 2% TUBE 52.45


4000743 TETRACAINE HCL OPTHALMIC SOL 2ML BOTTLE 48

4000749 AMITRIPTYLINE 10 MG TAB 11.7

4000752 LIDOCAINE 2% 20ML 40.3

4000771 D5 0.45% NS W/20 MEQ KCL 1000 ML 80

4000786 SODIUM CHLORIDE 0.9% NEBS 3 ML NEBULE 13.5

4000788 VANCOMYCIN 1G SDV 49.5

4000794 PROMETHAZINE HCL 25MG TAB 12

4000831 DEXTROSE 25% 250 MG/ML 10 ML SYRINGE 72.9

4000833 SODIUM BICARB 4.2% 10ML PFS 75

4000841 SIMETHICONE 80 MG TAB 7.5

4000852 ASPIR-LOW EC 81 MG TABLET 0.55

4000854 TENE CM_CTEPLASE 50MG VIAL 8392

4000868 OSELTAMIVIR PHOSPHATE 75MG CAP 54.35

�36

4000879 IRON GLUCONATE 62.5 MG/5 ML VIAL 93

4000920 CEREBYX 500 MG PE/10 ML VIAL 198

4000930 VALPROATE SODIUM 500MG/5ML SDV 67.15

4000951 CLARITHROMYCIN 500 MG TAB 14.5

4000956 METOPROLOL SUCCINATE 25MG TAB 14.15

4000962 POLYETHYLENE GLYCOL 17GM PACKET 16.4


4000996 ALBUTEROL SULF 0.083% NEB 2.5 MG/3 ML 13.85

4000999 ESCITALOPRAM 10 MG TAB 11.8

4001000 BUDESONIDE INH/NEB SUSP 0.5 MG/2 ML 23.1

4001001 FAMOTIDINE 20 MG/50 ML PREMIX 93.2

4001002 CEFTRIAXONE 2 GM SDV 46.25

4001003 EPINEPHRINE INJE CM_CTION 0.3 MG 643.7

4001004 MEPERIDINE 50MG/1ML SDV 35

4001010 Pedialyte (Electrolyte Solution) 1 Liter Oral Solution 5.5

4001012 MULTIPLE VITAMIN TAB (HEALTHY EYES) 1

4001013 LEVONORGESTREL 1.5MG TAB 175.8

4001014 LIDOCAINE 1% 300 MG/30 ML VIAL 40

4001015 HYALURONATE SODIUM 48 MG/6 ML PFS 2233

4001016 RAMIPRIL 5MG CAP 11.5

4001017 GLIPIZIDE XL 2.5MG TAB 11.95

4001018 SITAGLIPTIN PHOSHATE 50 MG TAB 72.95

4001019 NICARDIPINE HCL INJ 25 MG/10 ML 103.35

4001020 BACITRACIN/POLYMYXIN OPTH OINT 3.5 GM 54.55

4001021 APIXABAN 5 MG TAB 36.9

4001023 MORPHINE ORAL SOL 10 MG/5 ML UD 17.5

4001024 PRAMIPEXOLE 0.25 MG TABLET 11.45

4001027 CHOLECALCIFEROL 1000 IU TAB 11.3

4001028 NYSTATIN TOP PWD 15 GM 27.4

4001029 RISPERIDONE 0.5 MG TAB 12.15

4001032 ARTIFICIAL TEARS EYE DROPS 15 ML 66.45

4001033 PRAVASTATIN 10MG TAB 13.05

4001034 QUETIAPINE FUMARATE 25 MG TAB 20.9

�37

4001037 CALCIUM W/D 600 MG/400 MG TAB 11.72

4001039 GLYCERIN SUPPOSITORY FOR CHILDREN (FLEET) 12.05

4001044 OSELTAMIVIR PHOSPHATE SUSP 6MG/ML 60ML 490.92

4001045 POTASSIUM CHLORIDE 20 MEQ TAB 13.6

4001048 CIPROFLOXACIN 400MG/200ML PREMIX 76

4001051 miSOPROStol 200 MCG TABLET 200 mcg, 60 eaches 14.85

4001052 NIFEdipine ER 30 MG TABLET 30 mg, 100 eaches 12.4

4001054 LIQUACEL LIQUID PROTEIN CONCENTRATE ORAL LIQUID 17.95

4001076 ATROPINE ADULT 1 MG/10 ML SYRINGE 57.5

4001078 PANTOPRAZOLE SODIUM 40MG TAB 12

4001091 ERTAPENAM 1 GM VIAL 431.05

4001094 LIDOCAINE PATCH EACH 21.8

4001102 HEPARIN LOCK FLUSH 50 UNITS/5ML SYRINGE 20

4001103 PANTOPRAZOLE SODIUM IV 40MG SDV 58.9

4001105 PREDNISONE 5MG TAB 11.65

4001106 WARFARN 2.5MG TAB 11.3

4001108 THIAMINE 100MG TAB 11.2

4001117 ATENOLOL 25 MG TAB 11.75

4001131 NYSTATIN 500,000 UNITS/5ML LIQUID UD 17.7

4001138 CIPROFLOXACIN HCL OPTH 2.5ML BOTTLE 27.9

4001140 FOLIC ACID 5 MG/ML 133.8

4001145 BUMETANIDE 1 MG/4 ML SDV 42.9

4001150 LISINOPRIL 5 MG TAB 11.65

4001151 SPIRIVA 18 MCG CP-HANDIHALER 185.65

4001154 CALAMINE/ZINC OXIDE 113 GM TUBE 51

4001157 ETHYL CHLORIDE SPRAY 120 ML SPRAY 144.55

4001160 FLUTICASONE/SALMETEROL 250/50 DISKUS 443.4

4001165 RANITIDINE SYRUP 150MG/10ML UD 26.8

4001166 CLOTRIMAZOLE/BETAMETHASONE CREAM 15 GM 53.29

4001171 AMOXICILLIN/CLAVULANATE 400 MG/5 ML SUSP, 50 ML 30

4001174 LUBRICATING EYE DROPS 15ML BOTTLE 62.68

4001179 TUBERCULIN 5 TU/0.1ML MDV 10ML VIAL 71.25

4001190 METOPROLOL TARTRATE 25 MG TAB 10.65

�38

4001193 CAMPHOR MENTHOL 30 GM OINTMENT 36

4001194 PREDNISOLONE SODIUM PHOSPHATE 15mg/5ml SYRP 11.95

4001197 SERTRALINE HCL 25MG TAB 11.85

4001200 METRONIDAZOLE 500MG/100ML IV SOL 74.95

4001202 SOLIFENACIN 5MG TAB 56.45

4001203 PENICILLIN G 1.2 MU/2ML INJE CM_CTION 43.3

4001207 PIPERCILLIN AND TAZOBAC 2.25GM INJE CM_CTION 47.5

4001218 EPOETIN ALFA 20,000 UNIT/ML 462.65

4001219 FLUCONAZOLE 200MG/100ML PREMIX 85.65

4001226 DULOXETINE HCL DR 30 MG CAP 12.05

4001297 ONDANSETRON HCL 4 MG ODT 12.7

4001313 FENTANYL 100 MCG/2 ML SDV 37.15

4001314 DIPHENOXYLATE/ATROPINE 2.5 MG/0.025 MG TAB 13.8

4001315 LIDOCAINE/EPINEPHRINE/TETRACAINE EACH 57.2

4001317 NIFEREX 150 MG CAP 11.65

4001318 HYDROCODONE/APAP 5/325MG TAB 12.35

4001319 HYDROMORPHONE 2MG TAB 12

4001324 PROPARACAINE 0.5% 15ML BOTTLE 169.6

4001326 ISOSORBIDE DINITRATE 10MG TAB 13.4

4001327 CARVEDILOL 3.125 MG TAB 11.5

4001332 ALBUMIN 25% (25 GM IN 100 ML) 384

4001337 ACETAMINOPHEN CHILDREN 160 MG/5 ML SUSP UD 1.3

4001539 CARVEDILOL 12.5 MG TAB 11.45

4001548 FINASTERIDE 5 MG TAB 15.3

4001549 ISOSORBIDE MONONITRATE ER 30MG TAB 12.65

4001602 ALBUTEROL HFA (VENTOLIN) 8 GM 100.75

4001643 IPRATROPIUM/ALBUTEROL 3MG/0.5MG/3ML NEB 14.7

4001644 ATROPINE 1% OPTH 2 ML 128.75

4001646 HYDROMORPHONE 1MG/ML CARP 44

4001704 PREGALBIN 75MG CAP 37

4001732 OXYCODONE IMMEDIATE RELEASE 5 MG TAB 12

4001736 OXYCODONE ER 10MG TAB 26.35

4001737 METHADONE 5MG TAB 12

�39

4001738 HYDROCODONE/APAP 7.5/325MG TAB 12.55

4001742 BUMETANIDE 2 MG TAB 14.85

4001750 LEVOTHYROXINE 150MCG TAB 14.15

4001751 OXYBUTYNIN XL 10MG TAB 14.1

4001765 MAGNESIUM CITRATE SOLUTION 296 ML 29.75

4001766 ZOLEDRONIC ACID 5MG/100ML 408.85

4002000 DAPTOMYCIN 500 MG VIAL 512.3

4002009 GLYCERIN SUPPOSITORY PEDIATRIC 11.8

4002015 LEVETIRACETAM 750 MG TAB 11.75

4002016 LAMOTRIGINE 25 MG TAB 11.6

4002017 FLUCELVAX QUAD 2017-2018 (PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRINGE95.05

4002019 FLULAVAL QUAD 2017-2018 (PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRINGE105.85

4002020 DICLOFENAC SODIUM 1% GEL 141.95

4002022 CYCLOBENZAPRINE *TAKE HOME PACK* 10 MG TAB X 6 EA ORAL TAB 13

4002024 FUL-GLO 0.6 MG EYE STRIPS 11.6

4002025 DULOXETINE HCL DR 60 MG CAP 11.5

4002026 SHINGRIX VACCINE 461.75

4002028 XYLOCAINE-MPF 1% AMPUL 10 MG/ML, 10 ML 47

4002029 methIMAzole 10 MG TABLET 10 mg, 100 eaches 14.05

4002030 methylPREDNISolone 4 MG DOSEPK 4 mg, 21 eaches 38.95

4002031 TRIAMTERENE-HCTZ 75-50 MG TAB 1 unit, 100 eaches 11.7

4002032 OXYTOCIN 10 UNITS/ML VIAL 10 unit, 1 mL 37.5

4002033 DEBROX 6.5% EAR DROPS 1 unit, 15 mL 6.65

4002036 K-PHOS ORIGINAL TABLET 1 unit, 100 eaches 13.5

4002037 DULERA 200 MCG/5 MCG INHALER 200 mcg, 13 g 709.75

4002038 DOXEPIN 150 MG CAPSULE 150 mg, 50 eaches 15

4100019 NS 0.9% 1000 ML 104

4100021 D5 1000 ML 104

4100022 NS 0.9% 100 ML 62

4100023 NS 0.9% 50 ML 62

4100024 NS 0.9% 500 ML 62

4100025 LR 1000 ML 104

4100026 NS 0.9% 250 ML 62

�40

4100028 D5 250 ML 62

4100029 D5 NS 0.9% 1000 ML 104

4100030 D5 0.45% NS 1000 ML 104

4100031 NS 0.45% 1000 ML 104

4100050 ADDEASE BINARY CONNE CM_CTORS FOR 100ML NS 0.74

4100051 ADDEASE BINARY CONNE CM_CTORS FOR 250ML NS 0.98

4100052 PERIPHERAL STANDARD BORE EXT SET 21 10

4100054 SECONDARY ADMIN SETS 165.67

4100056 GRAVITY IV SET W/CARESITE INJ SITES 2.97

4100057 IV SPIKE ADAPTER VENTABLE 13

4100058 IV EXTENSION SET STD BORE 8 W/CARESITE 17.25

4100059 DRESSING BIOPATCH 1 DISK 4MM 96.75

4100061 D5 0.20% NS 250 ML 62

4100062 ARMBOARD SMALL 16

4100063 ARMBOARD MEDIUM 30.75

4100064 ARMBOARD LARGE 83.85

4100065 PICC LINE DRESSING KIT 148.5

4100070 T-CON EXT W/ MICRO FILTER 5.12

4100071 BURRETTE IV PUMP SET 113

4100072 20G CLOSED IV CATHETER SYSTEM 1.25 5.02

4100074 CUROS TIP STRIPS 0.35

4100075 CUROS JET STRIPS 0.35

4100077 VACUTAINER 21G 3/4 X 1/2 1.08

4100078 VACUTAINER 23G 3/4 X 1/2 1.79



4100082 CVC KIT 30 CM 202.75

4100083 IV CATHETER 14 X 1.75 1.64

4100084 IV CATHETER 16 X 1.16 1.59

4100085 IV CATHETER 18 X 1.16 19.7

4100086 IV CATHETER 20 X 1 19.75

4100087 IV CATHETER 22 X 1 1.87

4100088 IV CATHETER 24 X 3/4 1.59

�41

4100089 IV START KIT 50.25

4100091 IV STOPCOCKS DISCOFIX 0.46

4100092 IV ADAPTOR CLAVE MALE REPLACE W/4100053 0.81

4100093 NTG TUBING-PRMRY PLUMSET 12.04

4100094 IV PRIMARY PLUMSET 103 96.75

4100095 BLOOD PLUM SET 106.75

4100098 HUBER 20 X 3/4 SAFETY NEEDLESS CAP 59.75

4100099 EZ-IO NEEDLE 15MM 15GA 1062.5

4100100 EZ-IO NEEDLE 25MM 15GA 1062.5

4100101 EZ-IO NEEDLE 45MM 1062.5

4100102 EZ-IO STABILIZER 150.25

4100104 CVC KIT MULTI-LUMEN 7 FR 8" 756.5

4100105 PHLEBOTOMY KIT W/ 16G 500 ML 87.75

4100109 PUR INTROCAN SAFETY 3 20 G X 1" 16.5

4100122 PRESSURE INFUSER 1000 CC 177.5

4100123 CVC 3 LUMEN 30 CM 689.8

4100125 START KIT 27

4100130 PRESSURE ADMINISTRATION CUFF 1.24

5000003 BIOPSY EXTERNAL EAR 435

5000004 INCISION&DRAINAGE UPPER ARM/ELBOW BURSA 326

5000007 DRAINAGE EXT EAR ABSCESS/HEMATOMA SIMPLE 392

5000009 ACNE SURGERY 196

5000012 INCISION THROMBOSED HEMORRHOID EXTERNAL 455

5000018 NON INVASIVE EAR/PULSE OXIMETRY MULTI 54

5000019 NON INVASIVE EAR/PULSE OXIMETRY SINGLE 33

5000047 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA 120

5000072 TDAP VACCINE 7 YRS/> IM *RHC* 182.55

5000074 PNEUMOCOCCAL 23 VAC 2YR/ADULT *RHC* 231.5

5000077 HEPATITIS B VACCINE ADULT 3 DOSE IM *RHC 222

5000080 INSJ NON-BIODEGBRADABLE DRUG DELIVERY IM 252

5000081 REMV NON-BIODEGBRADABLE DRUG DELIVERY IM 252

5000090 INJE CM_CTION INTRALESIONAL UP TO 7 114

5000094 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE 34

�42

5000096 URINE PREGNANCY TEST VISUAL COLOR CMPRSN 97

5000103 PARING/CUTTING BENIGN HYPERKERATOTIC LES 67

5000110 SMPL REPAIR SCALP/NECK/AX/20.1-30.0CM 728

5000113 BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADD 77

5000116 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA 204

5000118 EXC B9 LESION SK TG S/N/H/F/G .5< 243

5000120 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 91

5000121 SHVG SKIN LESION 1 TRUCK/ARM/LEG DIAM 0. 155

5000122 BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 151

5000123 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM>2. 227

5000124 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 109



5000127 SHAVING SKIN LESION 1 S/N/H/F/G DIAM>2.0 239

5000128 EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3 418

5000129 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 C 225




5000133 EXC B9 LESION MRGN XCP STG F/E/E/N/0.6-1 381

5000135 EXCISION TUMOR THIGH/KNEE SUBQ<3CM 2221

5000136 EXCIS TMR SOFT TISSUE SHOULDER SUBQ 3CM1 1296

5000138 ASPIRATION&INJE CM_CTION GANGLION CYST 236

5000143 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER 27

5000148 WEDGE EXCISION SKIN NAIL FOLD 317

5000162 INSERTION INTRAUTERINE DEVICE IUD 413

5000180 PUN CM_CTURE ASPIRATION ABSCESS HEMATOMA 333

5000286 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DE 87

5000299 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTR 40

5000300 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTR 61

5000301 HLTH&BEHAV IVNTJ EA 15MIN FAM W/0 PT 29

5000407 DESTRU CM_CTION PREMALIGNANT LESION 1ST 164

5000409 DESTRU CM_CTION PREMALIGNANT LESION 2-14 EA 14

�43

5000412 DESTRU CM_CTION BENIGN LESIONS UP TO 14 199

5000413 DESTRU CM_CTION BENIGN LESIONS 15/> 249

5000541 TOBACCO USE CESSATION INTERMED. 3-10 MIN 46

5000542 TOBACCO USE CESSATION INTENSIVE >10 MIN 95

5000597 HOME VISIT EST PT SELF LIMITED/MINOR 15 157

5000598 HOME VISIT EST PT LOW-MOD SEVERITY 25 MI 236

5000631 ANNUAL WELL VISIT 65YRS&>SUBSEQ 128

5000632 ANNUAL WELL VISIT 65YRS&>INITIAL 334

5000641 BASIC LIFE AND/OR DISABILITY EXAMINATION 126

5000642 WORK RELATED/MED DBLT XM TREATING PHYS 123

5000676 WWC PRE EMPLOY PHYSI 123

5000677 WWC SCBA EVALUATION 123

5000678 WWC SCBA PHYSICAL 123

5000679 WWC YEARLY PHYSICAL 123

5000705 INJE CM_CTION SINGLE/MLT TRIGGER POINT 3/> M 125

5000737 SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1 193

5000745 EXCISION MAL LESION TRUNK/ARM/LEG .6-1.0 438

5000746 EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3. 538


5000748 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 289


5000760 VITAL CAPACITY TOTAL SEPARATE PROCEDURE 72

5000761 RESPIRATORY FLOW VOLUME LOOP 261

5000764 EXCISION MALIGNANT LESION TRUNK/ARM/LEG> 939

5000765 EXCISION MALIGNANT LESION F/E/E/N/L 3.1- 875

5000769 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE 149

5000771 IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT 21

5000772 IM ADM THRU 18YR ANY RTE ADDL VAC/TOX CO 21

5000773 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE 21

5000774 INJE CM_CTION 1 TENDON SHEATH/LIGAMENT APONE 116

5000779 COLOR VISION XM EXTENDED ANOMALOSCOPE/EQ 142

5000782 ADMINISTRATION OF HEPATITIS B VACCIN 22

5001030 DEPO-MEDROL 40MG RHC 64.2

�44

5001050 DEPO-PROVERA 150MG RHC 407.7

5001100 DEXAMETHASONE 10 MG/ML RHC 38.65

5003301 TRIAMCINOLO NE ACETONIDE 40 MG/ML RHC 78.85

5003420 VITAMIN B 12 INJE CM_CTION 9.5

5004000 MENINGOCOCCAL 4MCG/0.5ML SDV *RHC* 372.5

5004001 HEPATITIS A VACCINE 720ELU/0.5ML *RHC* 142.92

5004002 HUMAN PAPILLOMAVIRUS QUADRIVALENT *RHC* 565.95

5004003 PNEUMOCOCCAL 13 VAC PFS *RHC* 457.65

5004006 WOUND SEAL POWDER 4PK *RHC* 45.15

5004008 DIHYDROERGOTAMINE MESYLATE 1MG/ML *RHC* 353.35

5004013 HEPATITIS A VACCINE ADULT *RHC* 154.93

5004014 INFLUENZA VAC 0.25ML PFS 6-35 MO RHC 127.1

5004015 INFLUENZA VAC 0.5ML PFS 3 YR + RHC 105.8

5004016 RHO(D) 50 MCG RHC 184.05

5004017 ZOSTAVAX 0.65 ML SDV WITH STERILE DILUENT 0.7 ML SDV RHC 497.9

5069211 REMOVAL IMPA CM_CTED CERUMEN IRRIG/LVG UNIL 62

5099304 INT NURSING FAC CARE/DAY 25 MIN 236.5

5099305 INT NURSING FAC CARE/DAY 35 MIN 333

5099306 INT NURSING FAC CARE/DAY 45 MIN 426

5099307 SBSQ NURS FAC CARE/DAY E/M 10 MIN 113.5

5099308 SBSQ NURS FAC CARE/DAY MINOR COMP 15 MIN 174.5

5099309 SBSQ NURS FAC CARE/DAY NEW PROB 25 MN 229

5099310 SBSQ NURS FAC CARE/DAY UNSTABLE/NEW PROB 341.5

5099379 SWING BED CARE PLAN < 29 MIN 155

5099380 SWING BED CARE PLAN > 30 MIN 243

7000008 XR ABD ACUTE 547

7000011 XR AC JNTS BL LT 356

7000012 XR AC JNTS BL RT 356

7000015 XR ANKLE 2 VIEW LT 291

7000016 XR ANKLE 2 VIEW RT 291

7000018 XR ANKLE MIN 3 VIEW LT 352

7000019 XR ANKLE MIN 3 VIEW RT 352

7000028 XR C SPINE MIN 4 VIEWS 564

�45

7000029 XR C SPINE 2-3 VIEWS 391

7000030 XR C SPINE CMPLT OBL/ F/E 631

7000031 XR CLAVICLE CMPLT LT 322

7000032 XR CLAVICLE CMPLT RT 322

7000036 XR CHEST CMPLT MIN 4 VIEW 441

7000041 XR CHEST SPECIAL VIEWS 270

7000045 XR ELBOW 2 VIEWS LT 293

7000046 XR ELBOW 2 VIEWS RT 293

7000051 XR ELBOW CMPLT MIN 3 VIEW LT 360

7000052 XR ELBOW CMPLT MIN 3 VIEW RT 360

7000054 XR EYE FOREIGN BODY LT 289

7000055 XR EYE FOREIGN BODY RT 289

7000057 XR FACE BONES 1-2 VIEWS 339

7000058 XR FACE BONES MIN 3V 474

7000064 XR FINGER MIN 2 VIEWS LT 264

7000065 XR FINGER MIN 2 VIEWS RT 264

7000074 XR FOOT 2 VIEW LT 292

7000075 XR FOOT 2 VIEW RT 292

7000080 XR FOOT CMPLT MIN 3 VIEWS LT 349

7000081 XR FOOT CMPLT MIN 3 VIEWS RT 349

7000083 XR FOREARM 2 VIEW LT 321

7000084 XR FOREARM 2 VIEW RT 321

7000088 XR HAND 2 VIEW LT 293

7000089 XR HAND 2 VIEW RT 293

7000094 XR HAND MIN 3 VIEW LT 350

7000095 XR HAND MIN 3 VIEW RT 350

7000102 XR HUMERUS MIN 2 VIEW LT 330

7000104 XR HUMERUS MIN 2 VIEW RT 330

7000109 XR INFT LOW EXT MIN 2V L 263

7000113 XR KNEE 1-2 VIEWS LT 319

7000114 XR KNEE 1-2 VIEWS RT 319

7000119 XR KNEE CMPLT MIN 4 VIEWS 434

7000120 XR KNEE CMPLT MIN 4 VIEWS 434

�46

7000122 XR KNEE 3 VIEWS LT 382

7000123 XR KNEE 3 VIEWS RT 382

7000124 XR KNEE STANDING AP RT 269

7000125 XR KNEE BL STANDING AP 269

7000127 XR L SPINE 2-3 VIEWS 426

7000129 XR L SPINE CMPLT W/BEND 673

7000130 XR L SPINE MIN 4 VIEWS 608

7000133 XR MANDIBLE MIN 4 VIEWS 430

7000134 XR MANDIBLE 1-3 VIEWS 300

7000136 XR MASTOID 1-2V PER SIDE 226

7000137 XR MASTOID MN 3V PER SIDE 381

7000138 XR NASAL BONES MIN 3 VIEW 352

7000139 XR INF/CHLD NOSE-RE CM_CT FB 255

7000140 XR OPTIC FORAMINA LT 300

7000141 XR ORBITS CMPLT MIN 4 V LT 449

7000142 XR CALCANEUS MIN 2 V LT 294

7000143 XR OPTIC FORAMINA RT 300

7000144 XR ORBITS CMPLT MIN 4 V RT 449

7000145 XR CALCANEUS MIN 2 V RT 294

7000148 XR RIB UL 2 VIEWS 482

7000149 XR PELVIS 1-2 VIEWS 316

7000150 XR PELVIS CMPLT MIN 3 V 404

7000151 XR RIB UL W/PA CHST MIN 3 VIEWS 482

7000152 XR RIB BL 3 VIEWS 482

7000153 XR RIB BL W/PA CHST MN 4V 580

7000154 XR RIB 2 VW W/PA CHEST LT 419

7000155 XR RIB 2VW W/PA CHEST RT 419

7000156 XR RIB UL 2 VIEW LT 337

7000157 XR RIB 2 VIEW RT 337

7000158 XR SACRUM COCCYX MN 2V 362

7000159 XR SCAPULA CMPLT LT 335

7000160 XR SCAPULA CMPLT RT 335

7000164 XR SP SCOLIOSIS W/SUP ERE 444

�47

7000165 XR SCOLIOSIS 462

7000166 XR SELLA TURCICA 188

7000167 XR SHOULDER 1 VIEW LT 272

7000168 XR SHOULDER 1 VIEW RT 272

7000170 XR SHOULDER MIN 2 VIEW LT 373

7000171 XR SHOULDER MIN 2 VIEW RT 373

7000180 XR SACROILIAC JNT 1-2 V 299

7000181 XR SINUS PARANASAL 1-2V 294

7000182 XR SINUS PARANASAL MIN 3V 471

7000183 XR SKULL 1-3 VIEWS 360

7000184 XR SKULL CMPLT MIN 4 V 541

7000185 XR NECK SOFT TISSUE 306

7000186 XR STERNCLAV JNTS MIN 3V 308

7000188 XR T SPINE MIN 4 VIEWS 458

7000189 XR STERNUM MIN 2 VIEW 360

7000193 XR L SP BEND ONLY 2/3 VWS 398

7000194 XR T SPINE 1 VIEW 297



7000197 XR THORACOLUMBAR SPINE 2V 407

7000198 XR TIBIA FIBULA 2 VIEW LT 341

7000199 XR TIBIA FIBULA 2 VIEW RT 341

7000203 XR TMJ OPEN & CLOSED BL 453

7000204 XR TMJ OPEN & CLOSED UL 290

7000205 XR TOE(S) MIN 2 VIEW RT 263

7000206 XR TOE(S) MIN 2 VIEW LT 263

7000216 XR WRIST CMPLT MIN 3V LT 348

7000217 XR WRIST CMPLT MIN 3V RT 348

7000222 XR WRIST 2 VIEW LT 285

7000223 XR WRIST 2 VIEW RT 285

7000249 XR SACROILIAC JNT MIN 3V 369

7000250 XR HIPS BILAT MIN 5 VW W/WO PELVIS 593

7000251 XR HIPS BILAT 3-4 VW W/WO PELVIS 474

�48

7000252 XR HIPS BILAT 2 VW W/WO PELVIS 354

7000253 XR HIP RT MIN 4 VW W/WO PELVIS 474

7000254 XR HIP LT MIN 4VW W/WO PELVIS 474

7000255 XR HIP LT 2-3 VWS W/WO PELVIS 354

7000256 XR HIP RT 2-3 VWS W/WO PELVIS 354

7000257 XR HIP RT 1 VW W/WO PELVIS 264

7000258 XR HIP LT 1 VW W/WO PELVIS 264

7000259 XR ENTIRE SPINE C,T,L SPINE 2VW 391

7000260 XR ENTIRE SPINE C,T,L SPINE 1VW 297

7000261 XR FEMUR RT 1 VW 291

7000262 XR FEMUR LT 1 VW 291

7000263 XR FEMUR RT MIN 2VW 352

7000264 XR FEMUR LT MIN 2VW 352

7000300 XR CHEST 1 VIEW 279

7000301 XR CHEST 2 VIEW AP/L 346

7000302 XR CHEST AP/L API LORD 378

7000303 XR CHEST AP/L OBL PROJ 407

7000304 XR ABD AP I VIEW 309

7000305 XR ABDOMEN 2 VIEWS 366

7000306 XR ABDOMEN 3 OR MORE VIEWS 410

7100002 CM_CT C SPINE W/ CONTRAST 2627

7100003 CM_CT C SPINE W/O CONTRAST 2293

7100004 CM_CT C SPINE W/WO CONTRAST 3037

7100010 CM_CT THORAX W/ CONTRAST 2496

7100012 CM_CT THORAX W/O CONTRAST 2055

7100014 CM_CT THORAX W/WO CONTRAST 2911

7100020 CM_CT HEAD/BRAIN W/ CONTRAST 2250

7100021 CM_CT HEAD/BRAIN W/O CONTRAST 1883

7100023 CM_CT HEAD/BRAIN W/WO CONTRAST 2678

7100025 CM_CT ORBIT/FOSSA/EAR W/ CONTRAST 2236

7100026 CM_CT ORBIT/FOSSA/EAR W/O CONTRAST 2000

7100027 CM_CT ORB/FOSSA/EAR W/WO CONTRAST 2612

7100029 CM_CT L SPINE W/ CONTRAST 2699

�49

7100030 CM_CT L SPINE W/O CONTRAST 2328

7100031 CM_CT L SPINE W/WO CONTRAST 3072

7100032 CM_CT LOWER EXTREMITY W/O CONTRAST LT 2254

7100033 CM_CT LOWER EXTREMITY W/O CONTRAST RT 2254

7100035 CM_CT LOWER EXTREMITY W/ CONTRAST LT 1956

7100036 CM_CT LOWER EXTREMITY W/ CONTRAST RT 1956

7100038 CM_CT LOW EXTREMITY W/WO CONTRAST LT 2612

7100039 CM_CT LOW EXTREMITY W/WO COMTRAST RT 2612

7100040 CM_CT SOFT TISS NECK W/ CONTRAST 2348

7100042 CM_CT SOFT TISS NECK W/O CONTRAST 1954

7100045 CM_CT SFT TISS NECK W/WO CONTRAST 2660

7100047 CM_CT ABD/PELVIS W/ CONTRAST 2424

7100048 CM_CT PELVIS W/ CONTRAST 2391

7100049 CM_CT PELVIS W/O CONTRAST 2024

7100050 CM_CT ABD/PELVIS W/O CONTRAST 2033

7100051 CM_CT PELVIS W/WO CONTRAST 2779

7100052 CM_CT ABD/PELVIS W/WO CONTRAST 2839

7100054 CM_CT MAXILLOFACIAL W/ CONTRAST 2221

7100055 CM_CT MAXILLOFACIAL W/O CONTRAST 1862

7100056 CM_CT MAXILLOFACIAL W/WO CONTRAST 2585

7100057 CM_CT T SPINE W/ CONTRAST 2575

7100058 CM_CT T SPINE W/O CONTRAST 2221

7100059 CM_CT UPPER EXTREMITY W/ CONTRAST LT 2153

7100060 CM_CT T SPINE W/WO CONTRAST 2844

7100061 CM_CT UPPER EXTREMITY W/O CONTRAST LT 1925

7100062 CM_CT UPPER EXTREMITY W/O CONTRAST RT 1925

7100064 CM_CT UPPER EXTREM W/WO CONTRAST LT 2608

7100065 CM_CT UPPER EXTREM W/WO CONTRAST RT 2608

7100066 CM_CT ABDOMEN W/ CONTRAST 2532

7100070 CM_CT ABDOMEN W/O CONTRAST 2076

7100071 CM_CTA LOWER EXTREMITY RT 2571

7100072 CM_CT ABDOMEN W/WO CONTRAST 3003

7100073 CM_CTA ABD AORTA W/ CONTRAST 2830

�50

7100074 CM_CTA CHEST NONCORONARY(PE) 2948

7100075 CM_CTA HEAD 2518

7100076 CM_CTA LOWER EXTREMITY LT 2571

7100077 CM_CTA NECK 2497

7100078 CM_CTA PELVIS 2671

7100079 CM_CTA UPPER EXTREMITY LT 2360

7100080 CM_CTA ABDOMEN 2722

7100081 CM_CTA UPPER EXTREMITY RT 2360

7101000 IOPAMIDOL 300MG/ML 100ML 2

7200002 RHYTHM STRIP 139

7200003 TELE PER 48 817

7200008 CM_EKG TELEMETRY-PER 48 HRS 537

7200010 ECG W/LEAST 12 LEADS W/I&R 295

7200011 ECG W/LEAST 12 LEADS I&R ONLY 188

7200012 ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 226

10000968 MRSA SCREEN PCR 195

30000337 NORCO 5/325 6 TABS TAKE HOME PACK 18.45

30001016 LEVIN TUBE 18 FR 10

30001041 FOLEY CATHETERIZATION TRAY 16 FR 97

30900209 O2 MASK NON REBREATHER PED 13.5

30900212 LMA UNIQUE SIZE 2.5 81.25

30900214 RESUSCITATION PED 335.75

30900215 RESUSCITATION INFANT 232.5

30900580 BODY BAGS 83.75

30900625 LARYNGOSCOPE GLV-4 169.25

30900671 OPTIFOAM SACRUM 6X5.5 85.25

30900673 OPTIFOAM GENTLE 6X6 86.25

40000002 AMOXICILLIN 875 MG TAB 11.8

40000005 PSEUDOPHEDRINE HCL 30 MG TAB 12

40000006 IRON SUCROSE INJ 100 MG/5 ML SDV 176.8

40000007 FLUTICASONE/SALMETER 100/50 DISKUS 693.95

40000010 TRIPLE ANTIBIOTIC OINT 0.9 GM PACKET 12

40000012 BETAMETHASONE INJE CM_CTION *30 MG/5 ML* MDV 185.45

�51

40000014 TOBRAMYCIN/DEXAMETHASONE OPTH SUSP 2.5 ML 198.15

40000015 NICOTINE PATCH 7 MG 28

40000018 LIDOCAINE/EPI 2% 20 ML 42.1

40000020 EPINEPHRINE NASAL SOLN 30 MG/30 ML 597.1

40000021 SULFAMETHOXAZOLE/TRIMETHO ORAL SUSP 20 ML 31

40000022 GUAIFENESIN/DEXTROMETH SYRUP 10 ML UD 14

40000023 AMMONIA INHALANT PER EA 13.7

40000025 HEMORRHOIDAL OINT 30GM 55.35

40000032 ENEMA MINERAL OIL 133 ML FLEET 2.6

40000033 ACTIVATED CHARCOAL AQUEOUS 50 GM/240 ML 127.7

40000037 GLUCAGON 1MG INJ 563.5

40000044 BENZONATATE 100 MG CAP 12.7

40000047 LUTEIN 10 MG TAB 12

40000049 NICOTINE 2 MG GUM 13.95

40000050 HYDROGEL WOUND DRESSING 30GM 103.9

40000051 WOUND SEAL POWDER 4 PK 48

40000053 GABAPENTIN 100MG CAP 11.25

40000056 HEPARIN 5,000 UNITS/1ML SDV 38.9

40000062 SODIUM CHLORIDE 3% HYPERTONIC 500 ML IV 81.6

40000082 LIDOCAINE 2% INJ 100 MG/5 ML SYRINGE 46.75

40000084 STERILE WATER FOR INJECTION 20 ML 39.3

40000090 GUAIFENESIN 400MG TAB 12

40000091 GLYCERIN ADULT SUPPOSITORY 12.3

40000103 CALCIUM CARBONATE 1000 MG (400 MG Elemental Calcium) TAB 0.65

40000122 FLUCONAZOLE 150 MG TAB 19.6

40000144 O CM_CTREOTIDE ACETATE *SYRINGE* 30 MG 10355.6

40000147 RIVAROXABAN 10 MG TABLET 56.3

40000149 DOXAZOSIN 2 MG TAB 14.4

40000175 ETONOGESTREL IMPLANT 68 MG 1247

40000264 LEVETIRACETAM 500 MG TAB 11.9

40000265 DONEPEZIL 10 MG TAB 11.7

40000269 MELOXICAM ORAL TAB 15 MG 12

40000282 LOPERAMIDE HCL 2 MG CAP 14.05

�52

40000293 ACIDOPHILUS-PECTIN CAPSULE 1 unit, 100 eaches 11.25

40000296 IBUPROFEN 200MG TAB 0.55

40000298 GLYCERIN LIQUID SUPPOSITORY PED (FLEET) 2

40000336 LORAZEPAM 1 MG TAB TAKE HOME PACK 13

40000362 DENOSUMAB 60 MG/ML SYRINGE 2233.9

40000377 DIPHENHYDRAMINE, LIDOCAINE, MAALOX (FIRST/MAGIC MOUTHWASH)122.1

40000392 ACETAMINOPHEN 500 MG TAB 0.55

40000394 ACETAMINOPHEN 325 MG TAB 0.6

40000404 MAGNESIUM SULFATE PREMIX 2 GM/50 ML BAG 112.65

40000406 ALTEPLASE 100 MG KIT 16389.8

40000411 BENAZEPRIL 20 MG TAB 12

40000412 CEFDINIR 300 MG CAP 13.15

40000416 AMIODARONE 360 MG/200 ML BAG (1.8 MG/ML) 268.9

40000423 ENEMA SALINE 133 ML (FLEET) 1.7

40000468 CEFEPIME 1 GM SDV 46.7

40000470 MECLIZINE 12.5 MG TAB 13.3

40000482 ADENOSINE 6 MG/2 ML VIAL 6 mg, 2 mL 65.05

40000521 METRONIDAZOLE 500 MG TAB 13.45

40000526 MIDAZOLAM ORAL SYR 10 MG/5 ML UD 37.05

40000527 BACITRACIN OINT 28 GM TUBE 27.4

40000529 LIDOCAINE 1% 20 ML 39

40000556 FERRIC CARBOXYMALTOSE 750 MG/15 ML 1562.35

40000568 ONDANSETRON HCL 4 MG ODT TAKE HOME PACK 16.2

40000579 SULFAMETHOXAZOLE/TRMETHOPRIM 800MG TAB TAKE HOME PACK 13

40000580 AMOXICILLIN 500 MG 6 CAPS TAKE HOME PACK 13.45

40000581 CIPRO 500 MG 6 TAB *TAKE HOME PACK* 17

40000582 AZITHROMYCIN 250MG TAB TAKE HOME PACK 25.3

40000858 buPROPion HCL SR 150 MG TABLET 150 mg, 60 eaches 12

40001042 ACETYLCYSTEINE INJE CM_CTION SDV 6 GM/ 30 ML 293.05

41000115 IV START KIT W/OUT EXT 10

ECF DAILY ROOM ECF DAILY ROOM CHARGE 244

ER-OBS INITIAL HOURER-OBS INITIAL HOUR CHARGE 250

ER-OBS SUBSEQUENT HOURER-OBS SUBSEQUENT HOUR CHARGE 23

�53

IP DAILY ROOM IP DAILY ROOM CHARGE 2288

SWING DAILY ROOM SWING BED DAILY ROOM CHARGE 1494

�54

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