pricing transparency 66 north 6th street pomeroy wa, 99347
TRANSCRIPT
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
Charge Master Code Description Price HCPCS Code
417040001 IBUPROFEN 200 MG TABLET 100 mg, 100 eaches $5.00
417040002 ACETAMINOPHEN 160MG/5ML ELIXIR $13.40
417040003 ACETAMINOPHEN 325MG SUPP $6.90
417040004 ACETAMINOPHEN 325MG TAB $5.00
417040005 ACETAMINOPHEN 500MG TAB $5.00
417040006 ACETAMINOPHEN 650MG SUPP $5.00
417040007 ACETAMINOPHEN/CODEINE 300/30MG TAB $5.00
417040008 ACETYLCYSTEINE 20% 6GM/30ML VIAL $99.45 J7608
417040009 ACTIVATED CHARCOAL 25GM $94.60
417040010 ADENOSINE 6MG VIAL $16.80 J0150
417040011 ALBUTEROL 2.5MG/3ML NEB SOLN $5.00
417040012 ALBUTEROL INHALER 90MCG $105.30
417040013 ALLOPURINOL 100MG TAB $5.00
417040014 ALPRAZOLAM 0.25MG TAB $5.00
417040015 AMIODARONE 200MG TAB $5.00
417040016 AMITRIPTYLLINE 25MG TAB $5.00
417040017 AMLODIPINE 5MG TAB $5.00
417040018 AMOXICILLIN 250MG CAP $5.00
417040019 AMOXICILLIN 500MG CAP $5.00
417040020 AMOXICILLIN 250MG/5ML SUSP 80ML $32.50
417040021 AMOXICILLIN/CLAVULANATE 500/125MG TAB $5.80
417040022 AMOXICILLIN/CLAVULANATE 875/125MG TAB $6.40
417040023 AMOXICILLIN/CLAVULANATE 250MG-62.5MG/5ML SUSP 75ML $153.50
417040024 AMPICILLIN/SULBACTAM 1.5GM VIAL $43.20 J0295
417040025 APIXABAN 2.5MG TAB $44.40
417040026 ARTIFICIAL TEARS $30.50
417040028 ASCORBIC ACID 500MG TAB $5.00
417040029 ASPIRIN 81MG CHEWABLE TAB $5.00
417040030 ASPIRIN ENTERIC COATED 325MG TAB $5.00
417040032 ATENOLOL 25MG TAB $5.00
417040033 ATORVASTATIN 10MG TAB $6.10
417040034 ATORVASTATIN 20MG TAB $7.70
417040035 ATORVASTATIN 40MG TAB $7.70
417040036 ATROPINE 0.4MG VIAL $46.25 J0461
417040037 ATROPINE 1MG VIAL $71.25 J0461
417040039 AZATHIOPRINE 50MG TAB $10.90
417040040 AZITHROMYCIN 250MG TAB $25.85
417040041 AZITHROMYCIN 500MG VIAL $47.00 J0456
417040042 AZITHROMYCIN 100MG/5ML SUSP 15ML $142.00
417040043 BACLOFEN 10MG TAB $8.00
417040044 BENZONATATE 100MG CAP $8.00
417040045 BETAMETHASONE 6MG VIAL $187.90 J0702
417040046 BISACODYL 10MG SUPPOSITORY $5.00
417040047 BISACODYL 5MG TAB $5.00
417040048 BISOPROLOL FUMARATE 5MG TAB $14.65
417040049 BUDESONIDE 0.5MG/2ML INHALATION SOLUTION $58.30 J7627
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417040050 BUPIVACAINE 0.5% 10ML VIAL $20.50
417040051 BUPROPION SR 150MG TAB $9.80
417040052 BUSPIRONE 10MG TAB $10.20
417040053 CALCIUM CARBONATE 500MG CHEWABLE TAB $5.00
417040054 CALCIUM CARBONATE WITH VITAMIN D 600/400MG TAB $5.00
417040055 CALCIUM CHLORIDE 10% SYRINGE $43.20
417040056 CALCIUM GLUCONATE 10% VIAL 10ML $57.30 J0610
417040057 CALCIUM POLYCARBOPHIL 625MG TAB $5.00
417040058 CARBIDOPA/LEVODOPA 25/100MG TAB $8.40
417040059 CARVEDILOL 6.25MG TAB $5.00
417040060 CARVEDILOL 12.5MG TAB $5.00
417040061 CEFAZOLIN 1G VIAL $12.50 J0690
417040062 CEFDINIR 250MG/5ML SUSP 60ML $212.50
417040063 CEFEPIME 2G VIAL $62.50 J0692
417040064 CEFTRIAXONE 1G VIAL $18.70 J0696
417040066 CEFUROXIME 500MG TAB $42.50
417040067 CEPHALEXIN 500MG CAP $13.50
417040068 CEPHALEXIN 250MG/5ML SUSP 100ML $117.50
417040069 CETIRIZINE 10MG TAB $20.50
417040070 CHOLECALCIFEROL 1000 UNIT TAB $5.00
417040071 CHOLECALCIFEROL 2000 UNIT TAB $5.00
417040072 CHOLECALCIFEROL 5000 UNIT TAB $5.00
417040073 CIPROFLOXACIN 400MG/200ML PREMIXED BAG $27.30 J0744
417040074 CIPROFLOXACIN 500MG TAB $26.50
417040075 CIPROFLOXACIN WITH HYDROCORTISONE OTIC DROPS 10ML $538.90
417040076 CITALOPRAM 10MG TAB $7.40
417040077 CITALOPRAM 20MG TAB $7.40
417040078 CLINDAMYCIN 150MG CAP $9.80
417040079 CLINDAMYCIN 600MG/4ML VIAL $30.50 S0077
417040080 CLONAZEPAM 0.5MG TAB $10.50
417040081 CLONIDINE 0.1MG TAB $5.00
417040082 CLOPIDOGREL 75MG TAB $16.90
417040083 CLOTRIMAZOLE CREAM 1% $57.50
417040084 COLCHICINE 0.6MG TAB $36.15
417040085 CYANOCOBALAMIN 1000MCG / ML VIAL $44.00 J3420
417040086 CYANOCOBALAMIN 1000MCG TAB $5.00
417040087 CYCLOBENZAPRINE 10MG TAB $7.80
417040088 CYCLOPENTOLATE OPTHALMIC SOLUTION $76.35
417040091 DANTROLENE 20MG VIAL $212.50
417040092 DAPTOMYCIN 500MG VIAL $326.50 J0878
417040093 DEXAMETHASONE ELIXIR 0.5MG/5ML $-
417040094 DEXAMETHASONE 10MG VIAL $34.00 J1100
417040095 DEXTROSE 50% 25GM SYRINGE $50.50
417040096 DIAZEPAM 5MG TAB $5.70
417040097 DIAZEPAM 5MG/ML 2ML CARPUJECT $133.75 J3360
417040098 DIGOXIN 0.125MG TAB $17.60
417040099 DIGOXIN 0.5MG AMPULE $86.75 J1160
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Pomeroy Wa, 99347
417040100 DILTIAZEM 25MG/5ML VIAL $-
417040101 DILTIAZEM 60MG TAB $5.00
417040102 DILTIAZEM CD 120MG CAP $6.60
417040103 DILTIAZEM CD 180MG CAP $6.60
417040104 DIPHENHYDRAMINE 25MG CAP $5.00
417040105 DIPHENHYDRAMINE 50MG VIAL $12.50 J1200
417040108 DONEPEZIL 10MG TAB $5.00
417040109 DOPAMINE 400MG/250ML PREMIX BAG $80.20 J1265
417040110 DOXAZOSIN 2MG CAP $12.20
417040111 DOXYCYCLINE 100MG VIAL $97.40
417040112 DOXYCYCLINE HYCLATE 100MG TAB $5.80
417040113 DULOXETINE 30MG CAP $32.50
417040114 ENOXAPARIN SODIUM 100MG/1ML SYRINGE $62.70 J1650
417040115 ENOXAPARIN SODIUM 40MG/0.4ML SYRINGE $50.10 J1650
417040116 ENOXAPARIN SODIUM 30MG/0.3ML SYRINGE $27.75 J1650
417040117 ENOXAPARIN SODIUM 80MG/0.8ML SYRINGE $62.70 J1650
417040118 EPINEPHRINE 1MG SYRINGE $35.80 J0171
417040119 EPINEPHRINE 1MG VIAL $92.25 J0171
417040120 EPINEPHRINE PEN 0.3MG $550.00 J0171
417040121 EPOETIN ALFA 3,000 UNIT VIAL $212.50 J0885
417040122 EPOETIN ALFA 20,000 UNIT VIAL $928.00 J0885
417040123 ERTAPENEM 1G VIAL $302.50 J1335
417040124 ETOMIDATE 20MG VIAL $39.80
417040125 FAMOTIDINE 20MG TAB $18.00
417040126 FAMOTIDINE 20MG/2ML VIAL $12.50 S0028
417040127 FENTANYL 100MCG/2ML VIAL $19.80 J3010
417040128 FENTANYL 25MCG PATCH $102.50
417040129 FENTANYL 50MCG PATCH $158.00
417040130 FERROUS GLUCONATE 324MG TAB $5.00
417040131 FERROUS SULFATE 325MG TAB $5.00
417040132 FINASTERIDE 5MG TAB $26.50
417040133 FISH OIL 1000MG CAP $5.00
417040134 FLUCONAZOLE 100MG TAB $46.30
417040135 FLUMAZENIL 0.5MG/5ML VIAL $43.10
417040136 FLUOXETINE 20MG CAP $5.00
417040137 FLUTICASONE PROPIONATE 50MCG NASAL SPRAY $212.50
417040138 FOLIC ACID 1MG TAB $5.00
417040139 FUROSEMIDE 20MG TAB $5.00
417040140 FUROSEMIDE 20MG/2ML VAIL $25.40 J1940
417040141 FUROSEMIDE 40MG/4ML VIAL $28.90 J1940
417040142 FUROSEMIDE 40MG TAB $5.00
417040143 GABAPENTIN 100MG CAP $5.00
417040144 GABAPENTIN 300MG CAP $5.00
417040145 GABAPENTIN 400MG CAP $5.00
417040146 GENTAMICIN 0.3% OPTHALMIC OINTMENT $144.25
417040147 GLIPIZIDE 5MG TAB $6.50
417040148 GLIPIZIDE XL 5MG TAB $9.70
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Pomeroy Wa, 99347
417040149 GLUCAGON 1MG $491.10
417040150 GLYCERIN SUPPOSITORY $5.00
417040151 GUAIFENESIN 600MG EXTENDED RELEASE TAB $5.00
417040152 GUAIFENESIN AND CODEINE 100MG/10MG PER 5ML $-
417040153 HALOPERIDOL 5MG/ML VIAL $38.30
417040154 HEPARIN SODIUM 25,000 UNITS/500ML PREMIX $40.40 J1644
417040155 HEPARIN SODIUM 5000 UNITS VIAL $26.50 J1644
417040156 HYDROCHLOROTHIAZIDE 25MG TAB $5.00
417040157 HYDROCODONE / APAP 10/325MG TAB $13.40
417040158 HYDROCODONE / APAP 5/325MG TAB $6.50
417040159 HYDROCODONE / APAP 7.5/325MG TAB $11.30
417040160 HYDROMORPHONE 2MG CARPUJECT $26.50 J1170
417040161 HYDROMORPHONE 2MG TAB $5.00
417040162 HYDROXYCHLOROQUINE 200MG TAB $25.15
417040163 HYDROXYUREA 500MG CAP $11.30
417040164 HYDROXYZINE HCL 25MG TAB $5.00
417040165 IBUPROFEN 100MG/5ML ELIXIR $11.20
417040166 IBUPROFEN 200MG TAB $5.00
417040167 INFLIXIMAB 100MG VIAL $2,104.00 J1745
417040168 INSULIN GLARGINE 100U/ML 3ML PEN $212.50
417040169 INSULIN HUMAN R 100U/ML 3ML VIAL $163.10
417040170 INSULIN LISPRO 100U/ML 3ML PEN $256.50
417040171 IPRATROPIUM 0.5MG/2.5ML NEBULIZATION SOLUTION $14.35
417040172 IPRATROPIUM/ALBUTEROL 0.5/2.5MG NEB SOL $20.50
417040173 IRON POLYSACCHARIDE 150MG CAP $5.00
417040174 IRON SUCROSE 100MG/5ML VIAL $182.50 J1756
417040175 KETOROLAC 30MG VIAL $12.50 J1885
417040176 KETOROLAC 60MG VIAL $15.80 J1885
417040177 LABETALOL 100MG/20ML VIAL $30.50
417040179 LACTOBACILLUS ACIDOPHILLUS CAP $5.00
417040180 LACTULOSE 10GM/15ML SOLUTION $26.35
417040181 LEVOFLOXACIN 500MG TAB $9.20
417040182 LEVOFLOXACIN 500MG/100ML PREMIX BAG $38.50 J1956
417040183 LEVOFLOXACIN 750MG TAB $15.00
417040184 LEVOFLOXACIN 750MG/150ML PREMIX BAG $68.50 J1956
417040185 LEVONORGESTREL 1.5MG TAB $158.50
417040186 LEVOTHYROXINE 100MCG TAB $8.10
417040187 LEVOTHYROXINE 25MCG TAB $6.90
417040188 LEVOTHYROXINE 50MCG TAB $7.40
417040189 LEVOTHYROXINE 88MCG TAB $8.00
417040190 LIDOCAINE 1% 20ML VIAL $27.30
417040191 LIDOCAINE 1% WITH EPINEPHRINE VIAL $15.90
417040192 LIDOCAINE VISCOUS 2% 15ML UDC $12.50
417040194 LIDOCAINE 2% 20ML VIAL $18.10
417040195 LIDOCAINE 2% WITH EPINEPHRINE VIAL $30.50
417040196 LIDOCAINE 2GM/500ML PREMIX BAG $47.00 J2001
417040197 LIDOCAINE 5% PATCH $53.80
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Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040198 LIDOCAINE-PRILOCAINE 2.5%-2% CREAM $42.50
417040199 LINEZOLID 600MG/300ML PREMIX BAG $212.50 J2020
417040200 LISINOPRIL 10MG TAB $13.55
417040201 LISINOPRIL 20MG TAB $14.35
417040202 LOPERAMIDE 2MG CAP $11.20
417040203 LORATADINE 10MG TAB $5.00
417040204 LORAZEPAM 0.5MG TAB $5.00
417040205 LORAZEPAM 1MG TAB $5.00
417040206 LORAZEPAM 2MG/ML CARPUJECT $8.70 J2060
417040207 LOSARTAN 25MG TAB $17.50
417040208 LOSARTAN 50MG TAB $20.50
417040209 MAG-AL-PLUS $24.75
417040211 MAGNESIUM OXIDE 400MG TAB $5.00
417040212 MAGNESIUM SULFATE 1GM/2ML VIAL $19.60 J3475
417040213 MECLIZINE 12.5MG TAB $5.00
417040214 MEGESTROL ACETATE 40MG/ML 10ML SUSP $30.50 S0179
417040215 MELATONIN 5MG TAB $5.00
417040216 METFORMIN 500MG TAB $5.00
417040217 METHADONE 10MG TAB $5.90
417040219 METHOCARBAMOL 1GM/10ML VIAL $140.90 J2800
417040220 METHOCARBAMOL 500MG TAB $6.70
417040221 METHOCARBAMOL 750MG TAB $8.40
417040222 METHYLPREDNISOLONE 125MG VIAL $60.60 J2930
417040223 METOCLOPRAMIDE 5MG TAB $5.00
417040224 METOCLOPRAMIDE 10MG TAB $5.00
417040225 METOCLOPRAMIDE 10MG/2ML VIAL $26.50 J2765
417040226 METOLAZONE 2.5MG TAB $26.50
417040227 METOLAZONE 5MG TAB $28.95
417040228 METOPROLOL TARTRATE 25MG TAB $5.00
417040229 METOPROLOL TARTRATE 50MG TAB $8.80
417040230 METOPROLOL TARTRATE 100MG TAB $8.80
417040231 METOPROLOL SUCCINATE 25MG TAB $12.50
417040232 METOPROLOL SUCCINATE 50MG TAB $12.50
417040233 METRONIDAZOLE 250MG TAB $9.20
417040234 METRONIDAZOLE 500MG TAB $10.70
417040236 METRONIDAZOLE 500MG/100ML PREMIX BAG $21.25 S0030
417040237 MIDAZOLAM 5MG/1ML VIAL $16.00 J2250
417040238 MILK OF MAGNESIA 30ML UDC $21.20
417040239 MINERAL OIL ENEMA $20.50
417040240 MINOCYCLINE 100MG CAP $14.35
417040241 MIRTAZAPINE 15MG TAB $26.50
417040242 MORPHINE SULFATE 15MG EXTENDED RELEASE TABS $19.15
417040243 MORPHINE SULFATE 30MG EXTENDED RELEASE TABS $19.15
417040244 MORPHINE 4MG/ML CARPUJECT $20.50 J2270
417040246 MULTIVITAMIN W/MINERAL TAB $5.00
417040247 NALOXONE 2MG/2ML SYRINGE $160.00 J2310
417040248 NAPROXEN 500MG TAB $5.00
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Pomeroy Wa, 99347
417040249 NICOTINE 14MG PATCH $20.50
417040250 NICOTINE 21MG PATCH $20.50
417040251 NITROFURANTOIN 100MG CAP $26.50
417040252 NITROGLYCERIN 0.4MG SL TAB $12.50
417040253 NITROGLYCERIN SUBLINGUAL SPRAY $338.50
417040254 NITROGLYCERIN 50MG/250ML BOTTLE $102.50
417040258 NYSTATIN ORAL SUSP 500,000 UNITS/5ML $13.05
417040259 OLANZAPINE 5MG TAB $19.95
417040260 OMEPRAZOLE 20MG CAP $26.50
417040261 ONDANSETRON ODT 4MG TAB $6.00
417040262 ONDANSETRON 4MG VIAL $8.00 J2405
417040263 OSELTAMIVIR 30MG CAP $38.50
417040264 OSELTAMIVIR 45MG CAP $42.50
417040265 OSELTAMIVIR 75MG CAP $79.75
417040266 OXYBUTYNIN ER 5MG TAB $19.15
417040267 OXYCODONE 5MG TAB $6.10
417040268 OXYCODONE-APAP 5/325MG TAB $6.10
417040269 OXYCONTIN 10MG TAB $30.50
417040270 OXYCONTIN 20MG TAB $44.65
417040271 OXYMETAZOLINE 0.05% NASAL SOLN $30.40
417040272 PANTOPRAZOLE 40MG TAB $7.00
417040273 PANTOPRAZOLE 40MG VIAL $32.50 S0164
417040274 PAROXETINE 20MG TAB $24.25
417040275 PENICILLIN VK 250MG TAB $12.85
417040276 PENICILLIN 250MG/5ML SUSP 100ML $53.70
417040277 PHENAZOPYRIDINE 100MG TAB $5.00
417040278 PHENOBARBITAL, HYOSCYAMINE, ATROPINE, SCOPALAMINE $162.50
417040279 PHENYTOIN 100MG CAP $9.80
417040280 PHENYTOIN 100MG/2ML VIAL $16.10 J1165
417040281 PHYTONADIONE 10MG AMPULE $130.50 J3430
417040282 PIPRACILLIN/TAZOBACTAM 3.375GM VIAL $94.80 J2543
417040283 POLYETHYLENE GLYCOL 17GM PACKET $24.75
417040284 POTASSIUM CHLORIDE 10MEQ $11.00
417040285 POTASSIUM CHLORIDE 20MEQ $11.80
417040286 POTASSIUM CHLORIDE 20MEQ VIAL $27.45 J3480
417040287 PREDNISONE 5MG TAB $5.00 J7506
417040288 PREDNISONE 10MG TAB $5.00 J7506
417040289 PREDNISONE 20MG TAB $5.00 J7506
417040290 PREDNISONE 5MG/5ML ORAL SOLUTION $30.50
417040291 PREDNISOLONE 15MG/5ML SYRUP $16.45 J7510
417040292 PREGABALIN 100MG CAP $47.05
417040293 PREGABALIN 75MG CAP $47.05
417040294 PROBIOTIC CAP $5.00
417040295 PROMETHAZINE 25MG TAB $5.00
417040296 PROMETHAZINE 25MG SUPP $91.00
417040297 PROMETHAZINE 25MG/ML VIAL $29.45 J2550
417040298 PROPRANOLOL 10MG TAB $5.00
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Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040299 PSYLLIUM FIBER PACKET $5.50
417040300 QUETIAPINE 25MG TAB $6.00
417040301 RACEMIC EPINEPHRINE 2.25% NEB SOL $12.50
417040302 RIFAMPIN 300MG CAP $14.35
417040303 RIVAROXABAN 10MG TAB $32.50
417040304 RIVAROXABAN 20MG TAB $32.50
417040305 RIZATRIPTAN 5MG TAB $20.50
417040306 SALINE ENEMA $5.00
417040307 SCOPALAMINE PATCH 1.5MG $102.50
417040308 SENNA 8.6MG TAB $5.00
417040309 SERTRALINE 50MG TAB $6.50
417040310 SERTRALINE 100MG TAB $12.00
417040311 SILVER ANTIMICROBIAL WOUND GEL (SILVASORB) $124.75
417040312 SILVER SULFADIAZINE 1% CREAM $47.20
417040313 SIMETHICONE 80MG CHEW TAB $5.00
417040314 SIMETHICONE 125MG CHEW TAB $5.00
417040315 SIMVASTATIN 10MG TAB $10.40
417040316 SIMVASTATIN 20MG TAB $10.80
417040317 SIMVASTATIN 40MG TAB $11.40
417040320 SODIUM CHLORIDE 1GM TAB $5.00
417040321 SODIUM POLYSTYRENE SULFONATE $58.75
417040322 SPIRONOLACTONE 25MG TAB $5.00
417040323 SPIRONOLACTONE 50MG TAB $5.00
417040324 SUCCINYLCHOLINE 200MG/10ML VIAL $102.50 J0330
417040325 SUCRALFATE 1GM TAB $5.80
417040326 SULFACETAMIDE SODIUM 10% OPTH SOL $185.50
417040327 SULFAMETHOXAZOLE/TRIMETHOPRIM 800/160MG TAB $18.95
417040328 SUMATRIPTAN 6MG/0.5ML VIAL $212.50 J3030
417040329 TAMSULOSIN 4MG CAP $7.20
417040330 TENECTEPLASE 50MG VIAL $10,553.85 J3101
417040331 TERAZOSIN 2MG CAP $15.45
417040332 TETANUS, DIPTHERIA, PERTUSSIS (TDAP) $162.50
417040333 TETRACAINE 0.5% 4ML OPTHALMIC DROPS $63.85
417040334 THIAMINE 200MG/2ML VIAL $64.65 J3411
417040335 TIOTROPIUM 18MCG INHALER $212.50
417040336 TRAMADOL 50MG TAB $11.20
417040337 TRAZODONE 50MG TAB $6.80
417040338 TRIAMCINOLONE ACETONIDE 40MG/ML VIAL $58.65 J3301
417040339 VALPROATE SODIUM 500MG/5ML VIAL $102.50
417040340 VANCOMYCIN 500MG VIAL $50.70 J3370
417040341 VANCOMYCIN 1GM VIAL $38.40 J3370
417040342 VERAPAMIL ER 240MG TAB $22.75
417040343 WARFARIN 1MG TAB $8.60
417040344 WARFARIN 2MG TAB $8.90
417040345 WARFARIN 2.5MG TAB $8.70
417040346 WARFARIN 5MG TAB $8.90
417040347 ZOLPIDEM 5MG TAB $5.00
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Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040086 CYANOCOBALAMIN 1000MCG TAB $5.00
417040224 METOCLOPRAMIDE 10MG TAB $5.00
417040124 ETOMIDATE 20MG VIAL $39.80
417040339 VALPROATE SODIUM 500MG/5ML VIAL $102.50
417040177 LABETALOL 100MG/20ML VIAL $30.50
417040284 POTASSIUM CHLORIDE 10MEQ $11.00
417040114 ENOXAPARIN SODIUM 100MG/1ML SYRINGE $62.70 J1650
417040164 HYDROXYZINE HCL 25MG TAB $5.00
417040120 EPINEPHRINE PEN 0.3MG $550.00 J0171
417040158 HYDROCODONE / APAP 5/325MG TAB $6.50
417040118 EPINEPHRINE 1MG SYRINGE $35.80 J0171
417040251 NITROFURANTOIN 100MG CAP $26.50
417040174 IRON SUCROSE 100MG/5ML VIAL $182.50 J1756
417040211 MAGNESIUM OXIDE 400MG TAB $5.00
417040007 ACETAMINOPHEN/CODEINE 300/30MG TAB $5.00
417040019 AMOXICILLIN 500MG CAP $5.00
417040100 DILTIAZEM 25MG/5ML VIAL $-
417040034 ATORVASTATIN 20MG TAB $7.70
417040264 OSELTAMIVIR 45MG CAP $42.50
417040342 VERAPAMIL ER 240MG TAB $22.75
417040309 SERTRALINE 50MG TAB $6.50
417040005 ACETAMINOPHEN 500MG TAB $5.00
417040091 DANTROLENE 20MG VIAL $212.50
417040209 MAG-AL-PLUS $24.75
417040040 AZITHROMYCIN 250MG TAB $25.85
417040280 PHENYTOIN 100MG/2ML VIAL $16.10 J1165
417040345 WARFARIN 2.5MG TAB $8.70
417040014 ALPRAZOLAM 0.25MG TAB $5.00
417040305 RIZATRIPTAN 5MG TAB $20.50
417040115 ENOXAPARIN SODIUM 40MG/0.4ML SYRINGE $50.10 J1650
417040037 ATROPINE 1MG VIAL $71.25 J0461
417040043 BACLOFEN 10MG TAB $8.00
417040223 METOCLOPRAMIDE 5MG TAB $5.00
417040149 GLUCAGON 1MG $491.10
417040312 SILVER SULFADIAZINE 1% CREAM $47.20
417040127 FENTANYL 100MCG/2ML VIAL $19.80 J3010
417040188 LEVOTHYROXINE 50MCG TAB $7.40
417040084 COLCHICINE 0.6MG TAB $36.15
417040125 FAMOTIDINE 20MG TAB $18.00
417040165 IBUPROFEN 100MG/5ML ELIXIR $11.20
417040268 OXYCODONE-APAP 5/325MG TAB $6.10
417040314 SIMETHICONE 125MG CHEW TAB $5.00
417040081 CLONIDINE 0.1MG TAB $5.00
417040082 CLOPIDOGREL 75MG TAB $16.90
417040253 NITROGLYCERIN SUBLINGUAL SPRAY $338.50
417040066 CEFUROXIME 500MG TAB $42.50
417040231 METOPROLOL SUCCINATE 25MG TAB $12.50
8 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040347 ZOLPIDEM 5MG TAB $5.00
417040327 SULFAMETHOXAZOLE/TRIMETHOPRIM 800/160MG TAB $18.95
417040228 METOPROLOL TARTRATE 25MG TAB $5.00
417040262 ONDANSETRON 4MG VIAL $8.00 J2405
417040279 PHENYTOIN 100MG CAP $9.80
417040157 HYDROCODONE / APAP 10/325MG TAB $13.40
417040061 CEFAZOLIN 1G VIAL $12.50 J0690
417040077 CITALOPRAM 20MG TAB $7.40
417040101 DILTIAZEM 60MG TAB $5.00
417040330 TENECTEPLASE 50MG VIAL $10,553.85 J3101
417040303 RIVAROXABAN 10MG TAB $32.50
417040215 MELATONIN 5MG TAB $5.00
417040153 HALOPERIDOL 5MG/ML VIAL $38.30
417040220 METHOCARBAMOL 500MG TAB $6.70
417040258 NYSTATIN ORAL SUSP 500,000 UNITS/5ML $13.05
417040225 METOCLOPRAMIDE 10MG/2ML VIAL $26.50 J2765
417040123 ERTAPENEM 1G VIAL $302.50 J1335
417040150 GLYCERIN SUPPOSITORY $5.00
417040241 MIRTAZAPINE 15MG TAB $26.50
417040346 WARFARIN 5MG TAB $8.90
417040260 OMEPRAZOLE 20MG CAP $26.50
417040074 CIPROFLOXACIN 500MG TAB $26.50
417040163 HYDROXYUREA 500MG CAP $11.30
417040208 LOSARTAN 50MG TAB $20.50
417040036 ATROPINE 0.4MG VIAL $46.25 J0461
417040265 OSELTAMIVIR 75MG CAP $79.75
417040190 LIDOCAINE 1% 20ML VIAL $27.30
417040004 ACETAMINOPHEN 325MG TAB $5.00
417040181 LEVOFLOXACIN 500MG TAB $9.20
417040321 SODIUM POLYSTYRENE SULFONATE $58.75
417040315 SIMVASTATIN 10MG TAB $10.40
417040094 DEXAMETHASONE 10MG VIAL $34.00 J1100
417040059 CARVEDILOL 6.25MG TAB $5.00
417040322 SPIRONOLACTONE 25MG TAB $5.00
417040067 CEPHALEXIN 500MG CAP $13.50
417040335 TIOTROPIUM 18MCG INHALER $212.50
417040097 DIAZEPAM 5MG/ML 2ML CARPUJECT $133.75 J3360
417040269 OXYCONTIN 10MG TAB $30.50
417040212 MAGNESIUM SULFATE 1GM/2ML VIAL $19.60 J3475
417040140 FUROSEMIDE 20MG/2ML VAIL $25.40 J1940
417040139 FUROSEMIDE 20MG TAB $5.00
417040085 CYANOCOBALAMIN 1000MCG / ML VIAL $44.00 J3420
417040108 DONEPEZIL 10MG TAB $5.00
417040187 LEVOTHYROXINE 25MCG TAB $6.90
417040013 ALLOPURINOL 100MG TAB $5.00
417040025 APIXABAN 2.5MG TAB $44.40
417040054 CALCIUM CARBONATE WITH VITAMIN D 600/400MG TAB $5.00
9 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040249 NICOTINE 14MG PATCH $20.50
417040008 ACETYLCYSTEINE 20% 6GM/30ML VIAL $99.45 J7608
417040080 CLONAZEPAM 0.5MG TAB $10.50
417040194 LIDOCAINE 2% 20ML VIAL $18.10
417040130 FERROUS GLUCONATE 324MG TAB $5.00
417040343 WARFARIN 1MG TAB $8.60
417040307 SCOPALAMINE PATCH 1.5MG $102.50
417040276 PENICILLIN 250MG/5ML SUSP 100ML $53.70
417040112 DOXYCYCLINE HYCLATE 100MG TAB $5.80
417040266 OXYBUTYNIN ER 5MG TAB $19.15
417040247 NALOXONE 2MG/2ML SYRINGE $160.00 J2310
417040250 NICOTINE 21MG PATCH $20.50
417040062 CEFDINIR 250MG/5ML SUSP 60ML $212.50
417040285 POTASSIUM CHLORIDE 20MEQ $11.80
417040070 CHOLECALCIFEROL 1000 UNIT TAB $5.00
417040202 LOPERAMIDE 2MG CAP $11.20
417040015 AMIODARONE 200MG TAB $5.00
417040326 SULFACETAMIDE SODIUM 10% OPTH SOL $185.50
417040298 PROPRANOLOL 10MG TAB $5.00
417040126 FAMOTIDINE 20MG/2ML VIAL $12.50 S0028
417040302 RIFAMPIN 300MG CAP $14.35
417040286 POTASSIUM CHLORIDE 20MEQ VIAL $27.45 J3480
417040259 OLANZAPINE 5MG TAB $19.95
417040199 LINEZOLID 600MG/300ML PREMIX BAG $212.50 J2020
417040135 FLUMAZENIL 0.5MG/5ML VIAL $43.10
417040316 SIMVASTATIN 20MG TAB $10.80
417040282 PIPRACILLIN/TAZOBACTAM 3.375GM VIAL $94.80 J2543
417040296 PROMETHAZINE 25MG SUPP $91.00
417040050 BUPIVACAINE 0.5% 10ML VIAL $20.50
417040131 FERROUS SULFATE 325MG TAB $5.00
417040116 ENOXAPARIN SODIUM 30MG/0.3ML SYRINGE $27.75 J1650
417040064 CEFTRIAXONE 1G VIAL $18.70 J0696
417040060 CARVEDILOL 12.5MG TAB $5.00
417040191 LIDOCAINE 1% WITH EPINEPHRINE VIAL $15.90
417040275 PENICILLIN VK 250MG TAB $12.85
417040176 KETOROLAC 60MG VIAL $15.80 J1885
417040239 MINERAL OIL ENEMA $20.50
417040301 RACEMIC EPINEPHRINE 2.25% NEB SOL $12.50
417040111 DOXYCYCLINE 100MG VIAL $97.40
417040016 AMITRIPTYLLINE 25MG TAB $5.00
417040146 GENTAMICIN 0.3% OPTHALMIC OINTMENT $144.25
417040044 BENZONATATE 100MG CAP $8.00
417040046 BISACODYL 10MG SUPPOSITORY $5.00
417040012 ALBUTEROL INHALER 90MCG $105.30
417040147 GLIPIZIDE 5MG TAB $6.50
417040261 ONDANSETRON ODT 4MG TAB $6.00
417040042 AZITHROMYCIN 100MG/5ML SUSP 15ML $142.00
10 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040333 TETRACAINE 0.5% 4ML OPTHALMIC DROPS $63.85
417040026 ARTIFICIAL TEARS $30.50
417040143 GABAPENTIN 100MG CAP $5.00
417040192 LIDOCAINE VISCOUS 2% 15ML UDC $12.50
417040053 CALCIUM CARBONATE 500MG CHEWABLE TAB $5.00
417040128 FENTANYL 25MCG PATCH $102.50
417040195 LIDOCAINE 2% WITH EPINEPHRINE VIAL $30.50
417040088 CYCLOPENTOLATE OPTHALMIC SOLUTION $76.35
417040216 METFORMIN 500MG TAB $5.00
417040141 FUROSEMIDE 40MG/4ML VIAL $28.90 J1940
417040105 DIPHENHYDRAMINE 50MG VIAL $12.50 J1200
417040313 SIMETHICONE 80MG CHEW TAB $5.00
417040035 ATORVASTATIN 40MG TAB $7.70
417040325 SUCRALFATE 1GM TAB $5.80
417040138 FOLIC ACID 1MG TAB $5.00
417040185 LEVONORGESTREL 1.5MG TAB $158.50
417040134 FLUCONAZOLE 100MG TAB $46.30
417040003 ACETAMINOPHEN 325MG SUPP $6.90
417040063 CEFEPIME 2G VIAL $62.50 J0692
417040201 LISINOPRIL 20MG TAB $14.35
417040162 HYDROXYCHLOROQUINE 200MG TAB $25.15
417040340 VANCOMYCIN 500MG VIAL $50.70 J3370
417040189 LEVOTHYROXINE 88MCG TAB $8.00
417040051 BUPROPION SR 150MG TAB $9.80
417040246 MULTIVITAMIN W/MINERAL TAB $5.00
417040104 DIPHENHYDRAMINE 25MG CAP $5.00
417040156 HYDROCHLOROTHIAZIDE 25MG TAB $5.00
417040078 CLINDAMYCIN 150MG CAP $9.80
417040117 ENOXAPARIN SODIUM 80MG/0.8ML SYRINGE $62.70 J1650
417040129 FENTANYL 50MCG PATCH $158.00
417040068 CEPHALEXIN 250MG/5ML SUSP 100ML $117.50
417040057 CALCIUM POLYCARBOPHIL 625MG TAB $5.00
417040336 TRAMADOL 50MG TAB $11.20
417040113 DULOXETINE 30MG CAP $32.50
417040233 METRONIDAZOLE 250MG TAB $9.20
417040102 DILTIAZEM CD 120MG CAP $6.60
417040030 ASPIRIN ENTERIC COATED 325MG TAB $5.00
417040039 AZATHIOPRINE 50MG TAB $10.90
417040344 WARFARIN 2MG TAB $8.90
417040020 AMOXICILLIN 250MG/5ML SUSP 80ML $32.50
417040329 TAMSULOSIN 4MG CAP $7.20
417040310 SERTRALINE 100MG TAB $12.00
417040110 DOXAZOSIN 2MG CAP $12.20
417040299 PSYLLIUM FIBER PACKET $5.50
417040098 DIGOXIN 0.125MG TAB $17.60
417040270 OXYCONTIN 20MG TAB $44.65
417040092 DAPTOMYCIN 500MG VIAL $326.50 J0878
11 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040334 THIAMINE 200MG/2ML VIAL $64.65 J3411
417040300 QUETIAPINE 25MG TAB $6.00
417040175 KETOROLAC 30MG VIAL $12.50 J1885
417040283 POLYETHYLENE GLYCOL 17GM PACKET $24.75
417040308 SENNA 8.6MG TAB $5.00
417040317 SIMVASTATIN 40MG TAB $11.40
417040297 PROMETHAZINE 25MG/ML VIAL $29.45 J2550
417040267 OXYCODONE 5MG TAB $6.10
417040076 CITALOPRAM 10MG TAB $7.40
417040032 ATENOLOL 25MG TAB $5.00
417040071 CHOLECALCIFEROL 2000 UNIT TAB $5.00
417040222 METHYLPREDNISOLONE 125MG VIAL $60.60 J2930
417040009 ACTIVATED CHARCOAL 25GM $94.60
417040132 FINASTERIDE 5MG TAB $26.50
417040006 ACETAMINOPHEN 650MG SUPP $5.00
417040159 HYDROCODONE / APAP 7.5/325MG TAB $11.30
417040041 AZITHROMYCIN 500MG VIAL $47.00 J0456
417040095 DEXTROSE 50% 25GM SYRINGE $50.50
417040167 INFLIXIMAB 100MG VIAL $2,104.00 J1745
417040338 TRIAMCINOLONE ACETONIDE 40MG/ML VIAL $58.65 J3301
417040341 VANCOMYCIN 1GM VIAL $38.40 J3370
417040096 DIAZEPAM 5MG TAB $5.70
417040274 PAROXETINE 20MG TAB $24.25
417040186 LEVOTHYROXINE 100MCG TAB $8.10
417040142 FUROSEMIDE 40MG TAB $5.00
417040033 ATORVASTATIN 10MG TAB $6.10
417040273 PANTOPRAZOLE 40MG VIAL $32.50 S0164
417040079 CLINDAMYCIN 600MG/4ML VIAL $30.50 S0077
417040324 SUCCINYLCHOLINE 200MG/10ML VIAL $102.50 J0330
417040047 BISACODYL 5MG TAB $5.00
417040281 PHYTONADIONE 10MG AMPULE $130.50 J3430
417040196 LIDOCAINE 2GM/500ML PREMIX BAG $47.00 J2001
417040311 SILVER ANTIMICROBIAL WOUND GEL (SILVASORB) $124.75
417040002 ACETAMINOPHEN 160MG/5ML ELIXIR $13.40
417040072 CHOLECALCIFEROL 5000 UNIT TAB $5.00
417040229 METOPROLOL TARTRATE 50MG TAB $8.80
417040166 IBUPROFEN 200MG TAB $5.00
417040048 BISOPROLOL FUMARATE 5MG TAB $14.65
417040328 SUMATRIPTAN 6MG/0.5ML VIAL $212.50 J3030
417040023 AMOXICILLIN/CLAVULANATE 250MG-62.5MG/5ML SUSP 75ML $153.50
417040119 EPINEPHRINE 1MG VIAL $92.25 J0171
417040028 ASCORBIC ACID 500MG TAB $5.00
417040238 MILK OF MAGNESIA 30ML UDC $21.20
417040069 CETIRIZINE 10MG TAB $20.50
417040252 NITROGLYCERIN 0.4MG SL TAB $12.50
417040099 DIGOXIN 0.5MG AMPULE $86.75 J1160
417040052 BUSPIRONE 10MG TAB $10.20
12 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040155 HEPARIN SODIUM 5000 UNITS VIAL $26.50 J1644
417040197 LIDOCAINE 5% PATCH $53.80
417040200 LISINOPRIL 10MG TAB $13.55
417040103 DILTIAZEM CD 180MG CAP $6.60
417040240 MINOCYCLINE 100MG CAP $14.35
417040137 FLUTICASONE PROPIONATE 50MCG NASAL SPRAY $212.50
417040087 CYCLOBENZAPRINE 10MG TAB $7.80
417040207 LOSARTAN 25MG TAB $17.50
417040337 TRAZODONE 50MG TAB $6.80
417040271 OXYMETAZOLINE 0.05% NASAL SOLN $30.40
417040011 ALBUTEROL 2.5MG/3ML NEB SOLN $10.50
417040017 AMLODIPINE 5MG TAB $18.07
417040021 AMOXICILLIN/CLAVULANATE 500/125MG TAB $28.95
417040022 AMOXICILLIN/CLAVULANATE 875/125MG TAB $32.50
417040049 BUDESONIDE 0.5MG/2ML INHALATION SOLUTION $58.30 J7627
417040055 CALCIUM CHLORIDE 10% 1 GM SYRINGE $43.20
417040056 CALCIUM GLUCONATE 10% 1GM VIAL $57.30 J0610
417040083 CLOTRIMAZOLE CREAM 1% 30GM $57.50
417040073 CIPROFLOXACIN 400MG/200ML PREMIXED BAG $27.30 J0744
417040173 IRON POLYSACCHARIDE 150MG CAP $5.20
417040306 SALINE ENEMA $12.95
417040136 FLUOXETINE 20MG CAP $10.20
417040144 GABAPENTIN 300MG CAP $14.85
417040145 GABAPENTIN 400MG CAP $20.50
417040154 HEPARIN SODIUM 25,000 UNITS/500ML PREMIX $40.40 J1644
417040170 INSULIN LISPRO 100U/ML 3ML PEN $256.50
417040161 HYDROMORPHONE 2MG TAB $9.60
417040172 IPRATROPIUM/ALBUTEROL 0.5/2.5MG NEB SOL $20.50
417040171 IPRATROPIUM 0.5MG/2.5ML NEBULIZATION SOLUTION $14.35
417040180 LACTULOSE 10GM/15ML SOLUTION $26.35
417040168 INSULIN GLARGINE 100U/ML 3ML PEN $212.50
417040182 LEVOFLOXACIN 500MG/100ML PREMIX BAG $38.50 J1956
417040184 LEVOFLOXACIN 750MG/150ML PREMIX BAG $68.50 J1956
417040198 LIDOCAINE-PRILOCAINE 2.5%-2% CREAM $42.50
417040203 LORATADINE 10MG TAB $9.40
417040204 LORAZEPAM 0.5MG TAB $9.40
417040214 MEGESTROL ACETATE 40MG/ML 10ML SUSP $30.50 S0179
417040236 METRONIDAZOLE 500MG/100ML PREMIX BAG $21.25 S0030
417040151 GUAIFENESIN 600MG EXTENDED RELEASE TAB $12.50
417040248 NAPROXEN 500MG TAB $13.50
417040254 NITROGLYCERIN 50MG/250ML BOTTLE $102.50
417040133 FISH OIL 1000MG CAP $27.95
417040272 PANTOPRAZOLE 40MG TAB $30.50
417040277 PHENAZOPYRIDINE 100MG TAB $21.70
417040295 PROMETHAZINE 25MG TAB $12.00
417040219 METHOCARBAMOL 1GM/10ML VIAL $140.90 J2800
417040031 ASPIRIN ENTERIC COATED 81MG TAB $5.00
13 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
417040029 ASPIRIN 81MG CHEWABLE TAB $5.00
417040038 ATROPINE 1MG / 10ML SYRINGE $35.20 J0461
417040065 CEFTRIAXONE 2G VIAL $26.50 J0696
417040193 LIDOCAINE 2% 100MG/5ML SYRINGE $29.60
417040027 ASCORBIC ACID 250MG TAB $5.00
417040318 SODIUM BICARBONATE 650MG TAB $5.00
417040319 SODIUM BICARBONATE 50MEQ SYRINGE $65.85
417040349 VESICARE 10 MG TABLET $75.25
417040348 TERAZOSIN 1 MG CAPSULE $15.45
417040351 CARBIDOPA-LEVO ER 50-200 TAB $16.70
417040352 RESTASIS 0.05% EYE EMULSION 0.05 ea, 30 eaches $460.89
417040106 DIVALPROEX 250MG CAP $14.65
40720396 L-IGM TITER $102.00 86788
40720047 L-LAB SPEC CHEM-LITHIUM $81.00 80178
40720329 L-CRP HIGH SENSITIVITY $119.00 86141
438220153 CL-IV INFUSION THERAP EACH ADD HOUR $76.00 96366
438220214 CL-NEW PATIENT 65 + YEARS $314.00 99387
438220008 CL-TRIM SKIN LESION, SINGLE LESION $186.00 11055
40720210 L-NATRIURETIC PEPTIDE $418.00 83880
438220007 CL-DEBRIDMENT SKIN/SUBCUTANOUS TISSUE $389.00 11042
307010030 A-WOUND VAC < 50 CM $246.00 97605
307010007 A-EXC B9 LES 2.1-3.0CM $710.00 11403
40720446 L-HEPC INFECT AGENT QUANTIF $251.00 87522
40720039 L-VALPROIC TOTAL ACID $163.00 80164
40720031 L-SCREENING FOR METHADONE $163.00 80358
40720434 L-GIARDIA $161.00 87329
40720493 L-IRON DEXTRAN 100MG/2ML $116.00 J1750
40720424 L-GRAM STAIN $74.00 87205
40720462 L-CYOPATHOLOGY $197.00 88112
405120011 CS-CATHETER, INFUSION, OTHER THAN HEMODIALYSIS $348.00 C1751
40720425 L-SMEAR FLORECENT ACID STA $87.00 87206
40720057 L-LAB SPEC CHEM-THEOPHYLINE $154.00 80198
438220146 CL-NEBULIZER TREATMENT $233.00 94640
405120026 CS-WALKING BOOT $141.00 L4361
40720239 L-PREGNANEDIOL $172.00 84135
438220174 CL-NEW PT LEVEL 5 $450.00 99205
40720451 L-MRSA SCREEN-PCR $157.00 87641
40720384 L-HEP B SURFACE ANTIBODY $127.00 86706
438220206 CL-TM CONF. W/O PT NON PHYS. $68.00 99368
40720241 L-PROLACTIN LEVEL $243.00 84146
40720140 L-LAB PROFILE-CARDIAC CKMB- MB FRATION ONLY $226.00 82553
40720337 L-ANIT N DNA $123.00 86225
40720167 L-GLUCOSE REAGENT STRIP $7.00 82948
40720420 L-LAB STOOL-OVA & PARASITES $37.00 87177
40720108 L-DIRECT BILIRUBIN $16.00 82248
438220179 CL-EST PT LEVEL 4 $175.00 99214
40720306 L-BLOOD CLOT FACTOR VIII $248.00 85246
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Pomeroy Wa, 99347
40720103 L-SERUM ACE LEVEL $82.00 82164
40720093 L-ALDOLASE $95.00 82085
307010034 A-GROUND MILEAGE PER MILE $16.00 A0425
40720470 L-CYTO/MOLECULAR REPORT $213.00 88291
40720466 L-CD4 EACH ADDL MARKER $108.00 88185
40720310 L-TOTAL PROTIEN S $244.00 85305
40720298 L-HEMOGRAM TEST $87.00 85027
40720249 L-PROTOPORPHYRIN RBC $70.00 84202
40720367 L-LYME ANTIBODY TOTAL $160.00 86618
40720355 L-IMUNOFIXATION STUDY;SERUM $89.00 86334
438220203 CL-HOUSE CALLS 40 MIN. $236.00 99349
40720012 L-ISTAT-IONIZED CALCIUM $22.00 82330
438220142 CL-EKG $252.00 93000
40720220 L-ORGANIC ACID QUANT. $109.00 83921
40720092 L-MICROALBUMIN URINE,QUANT. $40.00 82043
307010025 A-PORT-A-CATH ACCESS $239.00 96522
40720350 L-MONO $103.00 86308
40720189 L-TSH RECEPTOR ANTIBODY $223.00 83519
40720296 L-HGB $39.00 85018
40720236 L-POTASSIUM $36.00 84132
40720055 L-SALICYLATE $147.00 80196
40720187 L-IGF-1 $150.00 83519
438220074 CL-BLOOD OCCULT OTHER SOURCE $54.00 82271
40720377 L-H PYLORI $208.00 86677
40720028 L-RENAL FUNCTION PANEL $99.00 80069
438220033 CL-LACER. BODY 2.5 CM. $230.00 12001
438220156 CL-IV PUSH EA SEQTL. NEW MED $47.00 96375
438220025 CL-EXC LES .5 OR LESS $717.00 11440
40720419 L-PINWORM TEST $40.00 87172
40720119 L-CALCULUS SPECTOSCOPY $123.00 82365
438220067 CL-REM FB FROM EYE, SUPERFIC $341.00 65205
40720322 L-ANTI PARICTAL ANTI $137.00 86000
421190007 ST-ASSESS. OF APHASIA W/RPRT $200.00 96105
40720304 L-CLOTTING, FACTOR VIII STAGE ONE $138.00 85240
40720200 L-LEAD SCREEN $31.00 83655
438220006 CL-DEBRIDMENT, WOUND $611.00 11000
40720275 L-TRANSFERRIN $27.00 84466
40720065 L-DRUG SCREEN URINE $95.00 80307
438220160 CL-WOUND VAC < 50 SQ. CM. $212.00 97605
40720476 L-TISSUE EXAM LEVEL 5 $677.00 88309
40720182 L-HGB GLYCOSYLATED A1C $39.00 83036
438220163 CL-PHONE NON PHY 11-20 MIN $50.00 98967
40720378 L-HTLV I/II $213.00 86689
405120012 CS-CATHETER INFUSION, NON-HEMODIALYSIS $348.00 C1751
40720095 L-ANTITRYPSIN LEVEL $183.00 82103
40720074 L-METHADONE CONFIRMATION $103.00 80358
40720043 L-LAB SPEC CHEM-GENTAMICIN $199.00 80170
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Pomeroy Wa, 99347
405120018 CS-ANKLE AIR SPLINT 90 $385.00 L1906
40720282 L-TROPONIN QUALITATIVE $150.00 84512
307010014 A-CRYO B9 LESIONS 15+ $251.00 17111
438220211 CL-NEW PATIENT 12-17 YEARS $251.00 99384
40720487 L-CRYSTAL ID ANY BODY FLUID $117.00 89060
40720326 L-LAB (ANA) TITER $51.00 86039
40720068 L-AMPHETAMINES; 1 OR 2 $82.00 80324
405120003 CS-CPAP FACEMASK - LARGE $385.00 A7030
40720251 L-VITAMIN B6 $59.00 84207
438220017 CL-SHAVING OF EPIDERMAL OR DERMAL LESION $278.00 11310
40720109 L-COLORECTAL SCREEN; FECES $14.00 82270
438220010 CL-SKIN BIOSPSY, EA ADD LES. $172.00 11101
438220170 CL-NEW PT LEVEL 1 $65.00 99201
438220176 CL-EST PT LEVEL 1 $55.00 99211
307010042 A-EXC MALIG LES .6-1.0CM $615.00 11601
40720136 L-CHROMA/MASS SPEC, CL QUAN $101.00 82542
40720368 L-CHLAMYDIA TEST $118.00 86631
40720075 L-OPIATES 1 OR MORE $115.00 80361
438220196 CL-PHYS VISIT SNF LEVEL 4 $207.00 99310
40720365 L-BORDETALLA PERTUSSIS $147.00 86615
40720400 L-HEP C ANTIBODY CONFIRMATION $125.00 86804
405120027 CS-WALKING BOOT $141.00 L4361
40720442 L-INFECTIOUS AGENT DETECT $275.00 87449
40720395 L-VARICELLA Z ANTIBODY $16.00 86787
40720253 L-NON-ENDOCRINE $263.00 84238
40720316 L-VIPER VENOM UNDILUTED $185.00 85612
438220093 CL-ADMIN, EA ADDTL VACCINE , VFC $22.00 90472
40720461 L-CYTO CONCENT TECH $104.00 88108
438220061 CL-FINGER SPLINT $153.00 29130
40720414 L-CULTURE, SCREENING $102.00 87081
307010052 A-WOUND VAC > 50 CM $467.00 97606
40720056 L-ASSAY OF TACROLIMUS $448.00 80197
40720201 L-LIPASE $114.00 83690
307010027 A-WOUND CARE SIMPLE-NURSE $361.00 97602
438220002 CL-I&D SIMPLE SINGLE $235.00 10060
40720330 L-PHOSPHOLIPID ANTIBODY, EA $193.00 86147
405120007 CS-ENTERNAL FEEDING SUPPLY KIT $7.00 B4034
438220085 CL-INFLUENZA A & B EACH $60.00 87400
405120023 CS-WRIST & THUMB SPLINT $67.00 L3908
405120019 CS-ANKLE WALKER- MED. $326.00 L1930
40720398 L-ANTITHYROID ANTIBODIES $85.00 86800
40720135 L-CORTISOL, SERUM $82.00 82533
438220182 CL-CONSULT MID <30 $160.00 99242
421190003 ST-SPEECH EVALUATION 15 MIN $358.00 92522
40720086 L-HFE GENE ANALYSIS $283.00 81256
40720216 L-MOLECULE NUCLEIC AMPLI $198.00 83898
40720449 L-N.GONORRHOEAE,DNA,PROBE $127.00 87591
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40720288 L-ASSAY OF VITAMIN K $254.00 84597
40720051 L-DILANTIN LEV. (QUALITATIV $272.00 80186
40720439 L-RSV TEST $190.00 87420
40720217 L-MOLECULE NUCLEIC AMPLI 2 $106.00 83900
40720423 L-SUSPECT, VITEK $13.00 87186
438220043 CL-CRYO PREMALIG LES(1) $212.00 17000
40720010 L-ISTAT-BUN $7.00 84520
40720280 L-T3 REVERSE $161.00 84482
40720037 L-DESIPRAMINE $170.00 80160
40720475 L-TISSUE EXAM LEVEL 4 $325.00 88307
40720464 L-PAP $154.00 88175
40720430 L-INFLUENZA B QUICK STEP $94.00 87275
405120008 CS-ENTERAL PUMP KIT $12.00 B4035
41120003 EKG-CARDIAC MONITOR 1-3 LEADS $268.00 93040
40720456 L-RAPID STREP TEST $90.00 87880
40720273 L-AST $76.00 84220
40720234 L-PORPHOBILINOGEN $89.00 84110
405120010 CS-ENTERAL INFUSION PUMP $12.00 B9002
40720244 L-TOTAL PROTEIN, PLASMA $78.00 84155
40720457 L-DAT FOR MENINGITIS $104.00 87899
40720444 L-GARDNERELLA $77.00 87510
40720469 L-CHROMOSOME KARYOTYPE $194.00 88280
438220166 CL-POSTOPERATIVE FOLLOW-UP VISIT $132.00 99024
40720383 L-HEPATITIS B CORE ANTIBODY $184.00 86704
438220082 CL-MONO TEST $64.00 86308
40720126 L-ASSAY/ CERULOPLASMIN $108.00 82390
40720225 L-PTH $112.00 83970
438220005 CL-PUNCTURE ASPIRATION OF... $347.00 10160
307010040 A-OBS. ROOM PER HR OVER 4 $126.00 G0378
40720122 L-LAB SPEC. CHEM. - CEA $95.00 82378
405120021 CS-SHOE, POST OP FML - MED $16.00 L3260
40720114 L-VIT-D 250H $87.00 82306
40720072 L-CANNABINOIDS $48.00 80349
40720270 L-TSH $73.00 84443
40720215 L-NUCLEIC ACID PROBE, EACH $35.00 83896
40720048 L-NORTRIPTYLLINE LEVEL $131.00 80182
40720364 L-RPR/VDRL $64.00 86592
438220040CL-REPAIR, INTERMEDIATE, 2.5 CM OR LESS OF HANDS, FEET, NECK, OR
EXTERNAL GENITALIA $389.00 12041
40720004 L-ISTAT-CHLORIDE $8.00 82435
307010032 A-CRASH CART USED $60.00 99211
421190002 ST-LARYNGEAL FUNCTION TEST $158.00 92520
40720307 L-FACTOR X111 $139.00 85291
40720091 L-LAB CHEMISTRY-ALBUMIN $21.00 82040
405120006 CS-NON ELECTRIC SPIROMETER $21.00 A9284
40720121 L-CARBONMONOXIDE QUAN. $105.00 82375
40720020 L-SCOLIOSIS, 1 VIEW $416.00 72081
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438220004 CL-FB REMOVAL SUB.; SIMPLE $343.00 10120
40720441 L-EHEC EIA $40.00 87427
438220180 CL-EST PT LEVEL 5 $300.00 99215
40720359 L-MICROSOMAL ANTIBODY $94.00 86376
438220226 CL-ELEC. COMM PHYS ONLY $50.00 99444
438220014 CL-SHAVE BIOPSY 1.1 - 2.0 CM $181.00 11302
438220027 CL-DEBRIDEMENT OF NAIL(S) BY ANY METHOD 1 TO 5 $294.00 11720
421190004 ST-SWALOW DYSF/ORAL FUNC. TX $178.00 92526
405120025 CS-ANKLE BRACE $140.00 L4350
40720142 L-CREATININE, URINE $19.00 82570
40720342 L-MYASTHENIA GR PANEL SCREN $75.00 86255
40720436 L-HEPATITIS B SURF.ANTIGEN $44.00 87340
405120014 CS-BIPAP MACHINE $522.00 E0601
40720177 L-H. PYLORI ADULT BREATH TEST $213.00 83013
40720380 L-HERPES SIMPLEX VIRUS I/II, IGG $163.00 86695
438220154 CL-INJECTION, SUBQ/INTRAMSC $67.00 96372
438220222 CL-PREVENTIVE MEDICINE COUNSELING $158.00 99401
438220199 CL-PHYS DC NH > 30 MIN. $163.00 99316
40720063 L-HAIRSTAT 5 REFLEX PANEL $213.00 80302
40720102 L-LAB AMYLASE (AFP) $62.00 82150
40720036 L-CLOZAPINE $213.00 80159
438220094 CL-ADMIN, EA ADDTL VACCINE , VFC $22.00 90472
40720286 L-VMA VANILLYMANDELIC ACID $100.00 84585
40720214 L-MOLECULE GEL ELECTROPHOR $73.00 83894
40720308 L-ANTITHROMBIN ENZYMATIC $229.00 85300
40720422 L-SENSATIVITY URINE $110.00 87184
40720221 L-ASSAY OF OPIATES $133.00 83925
40720391 L-RUBELLA $100.00 86762
40720305 L-BLOOD CLOT FACTOR VIII $248.00 85245
40720150 L-ESTRADIOL LEVEL $86.00 82670
40720116 L-LAB CHEMISTRY-CALCIUM $19.00 82310
40720356 L-OTHER FLUIDS W/CONCENT $177.00 86335
40720258 L-SODIUM; OTHER SOURCE $58.00 84302
40720089 L-ACETONE, QUANT. $89.00 82010
40720248 L-ELECTROPHORETIC FRACT & Q $164.00 84166
438220200 CL-SNF ANNUAL ASSESSMENT $146.00 99318
307010018 A-DRAIN/INJ.JOINT/BURSA INT $287.00 20605
438220208 CL-NEW PATIENT INFANT<1 YR. $207.00 99381
40720346 L-GLUTEN SEN TITER $85.00 86256
40720118 L-CALCIUM - URINE (TIMED) $27.00 82340
40720468 L-CHROMOSOME ANALYSIS $907.00 88262
40720458 L-HEP C GENOTYPE DNA $860.00 87902
438220198 CL-PHYS DC NH < 30 MIN. $124.00 99315
438220064 CL-EPISTAXIS PACK. SIMPLE $157.56 30901
438220167 CL-SPECIAL REPORTS/INS. /L&I $51.00 99080
307010047 A-INJ. TENDON SHEATH/LIGAME $906.00 20550
40720053 L-PROCAINAMIDE (NAPA) $200.00 80192
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40720386 L-HEP A ANTIBODY $100.00 86709
438220228 CL-ADDITIONAL 30 MIN. ADVANCED CARE PLANNING $75.00 99498
438220092 CL-INJ VACC/TOXOID EACH ADD. $22.00 90472
40720129 L-LAB CHEMISTRY-CHOLESTEROL $19.00 82465
307010013 A-CRYO B9 LESIONS UP TO 14 $198.00 17110
40720478 L-SPECIAL STAINS $127.00 88312
40720267 L-T-4 PROFILE $41.00 84436
438220183 CL-CONSULT 40 MIN FACE TO FA $222.00 99243
40720081 L-UA MICRO ONLY $38.00 81015
40720492 L-L-PSA-YEARLY SCREEN $61.00 G0103
438220035 CL-REPAIR SIMPLE 7.6 TO 12.5 $242.00 12004
438220016 CL-SHAVE BIOPSY - 0.6 - 1.0 CM $209.00 11306
40720218 L-MOLECULAR DIAGNOTIC $158.00 83902
40720030 L-HEPATIC FUNCTON PANEL $36.00 80076
438220001 CL-EXC B9 LES 3.1-4CM $1,554.00 11404
40720405 L-DNA/PATERNITY $41.00 86910
40720176 L-HAPTOGLOBIN $50.00 83010
40720285 L-URIC ACID OTHER SOURCE $27.00 84560
40720071 L-CANNABINOIDS $126.00 80349
40720472 L-TISSUE EXAM PATHOLOGIST $104.00 88302
40720104 L-APOLIPOPROTEIN B ASSAY $98.00 82172
405120002 CS-FOREARM SPLINT, PADDED, MED $31.00 A4570
40720266 L-THYROGLOBULIN $168.00 84432
40720002 L-ED-ISTAT-SODIUM $8.00 84295
40720260 L-URINE INDICANS $215.00 84311
307010041 A-EXC, MALIGN LESION <.5CM $951.00 11600
40720428 L-HERPES CULTUR $108.00 87250
40720073 L-COCAINE CONFIRMATION $103.00 80353
40720125 L-CATECHOLAMINES, BLOOD $225.00 82383
40720084L-BCR-ABL1 QUALITATIVE WITH REFLEX TO BCR-ABL1 QUANTITATIVE $193.00 81206
438220202 CL-HOUSE CALLS 25 MIN. $143.00 99348
40720166 L-GLUCOSE; QUANT.BLOOD $19.00 82947
438220209 CL-NEW PATIENT 1-4 YEARS $223.00 99382
40720138 L-LAB PROFILE-CARDIAC CK $113.00 82550
40720117 L-CALCIUM, IONIZED $129.00 82330
40720052 L-PRIMIDONE LEVEL $11.00 80188
438220205 CL-TM CON PT. PRES. NON PHYS $80.00 99366
40720054 L-ASSAY OF SIROLIMUS $206.00 80195
438220044 CL-CRYO PREMALIG LES (2-14) $54.00 17003
438220050 CL-CARPEL TUNNEL INJECTIONS $334.00 20526
40720169 L-GLUCOSE TOL.TEST 3 SPECIM $150.00 82951
438220070 CL-DRUG SCREEN URINE $39.00 81001
40720090 L-ACETYLCHOLINESTERASE $43.00 82013
40720362 L-TB TEST QUANTIFERON GOLD $264.00 86480
40720015 L-ISTAT-ELECTOLYTE PANEL $11.00 80051
40720153 L-FAT/LIPIDS, FECES;QUALITA $84.00 82705
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40720160 L-GAMAGLOBULIN;IGA,D,G,M EA $26.00 82784
438220089 CL-ADMIN 1 VACCINE, VFC $69.00 90471
40720050 L-LAB SPEC CHEM-DILANTIN $224.00 80185
40720143 L-LAB URINE-CREATININE CLEA $110.00 82575
40720372 L-EPSTEIN BARR PANEL $92.00 86663
40720399 L-HEPATITIS C ANTIBODY $49.00 86803
307010001 A-SKIN BIOPSY (SINGLE LESION) $389.00 11100
40720007 L-ISTAT-POST GLUCOSE DOSE $8.00 82950
40720426 L-KOH WET MOUNT FUNGAL $66.00 87210
40720376 L-GIRDIA EIA $160.00 86674
40720250 L-ASSAY OF PROINSULIN $163.00 84206
438220149 CL-ALLERGY SHOT 2 + $46.29 95117
40720445 L-HCV RNA QUANT $201.00 87517
40720357 L-INHIBIN A $149.00 86336
40720443 L-CANDIDA $99.00 87480
40720477 L-DECALCIFY TISSUE $28.00 88311
438220162 CL-PHONE NON PHY 5-10 MIN $27.00 98966
307010029 A-WOUND CARE COMPLEX $536.00 97602
438220024CL-EXC. BEINIGN LESION SCALPL, NECK, HANDS, FEET, GENITALIA 1.1 TO
2.0 CM $1,512.00 11422
40720334 L-C1 INHBTR/COMP.RUNC ACTIV $139.00 86161
307010044 A-EXC MALIG LES 2.1-3CM $2,226.00 11603
40720299 L-RBC AUTOMATED $51.00 85041
405120001 CS-ARM SLING LARGE $54.00 A4565
40720242 L-PSA TOTAL $65.00 84153
438220036 CL-LACER. FACE 2.5 CM. $250.00 12011
40720131 L-CHROMIUM, SERUM $132.00 82495
40720404 L-BLOOD TYPE $132.00 86900
307010017 A-TRIGGER POINT INJECTIONS $794.00 20553
438220164 CL-PHONE NON PHY 21-30 MIN $74.00 98968
438220066 CL-PESSARY INSERTION $201.00 57160
40720347 L-CA 15-3 (27.29) $108.00 86300
40720038 L-LAB SPEC CHEM-DIGOXIN $207.00 80162
40720014 L-ISTAT-BASIC METABOLIC PANAL (IONIZED CA) $18.00 80047
40720431 L-INFLUENZA A QUICK STEP $89.00 87276
438220185 CL-CONSULT 60 MIN FACE TO FA $351.00 99244
40720024 L-COMP. METABOLIC PANEL $165.00 80053
40720335 L-COMPLEMENT TOTAL (CH50) $144.00 86162
40720292 L-HCG - QUALITATIVE $116.00 84703
40720107 L-TOTAL BILIRUBIN $54.00 82247
438220012 CL-REM. SKINTAGS EA.ADD 10 $36.00 11201
40720455 L-DAT FOR MENINGITIS $99.00 87802
40720344 L-MYASTHENIA GR PANEL TITER $85.00 86256
40720433 L-CRYPTOSPORIDIUM ANTIGEN BY EIA $163.00 87328
40720303 L-PERIPHERAL BLOOD SMEAR $100.00 85060
40720269 L-HYDRA IV ADL, TX IV, IM $131.00 84442
40720069 L-BARBITURATES CONFIRMATION $103.00 80345
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438220022 CL-EXC. BE.LES..5CM OR LESS $1,554.00 11420
40720058 L-TOBRAMYCIN $205.00 80200
40720197 L-LAB SPEC CHEM-TIBC $33.00 83550
307010048 A-INCISE EXTERNAL HEMORRHOI $320.00 46083
438220223 CL-PHONE CONSULT 5-10 MIN. $28.00 99441
40720165 L-GLUCOSE BODY FLUID OTHER THAN BLOOD $52.00 82945
40720440 L-ROTAVIRUS ANTIGEN $141.00 87425
40720154 L-FATS/LIPIDS/FECES/QUANT. $217.00 82710
307010010 A-TOE NAIL REM.>1 LIST EACH $86.00 11732
438220049 CL-REMOVAL FOREIGN BODY, SIMPLE $1,686.00 20520
438220058 CL-INCN DRNG BLW FACIA FOOT $1,688.00 28002
438220148 CL-ALLERGY SHOT $47.00 95115
438220207 CL-TEAM CONF W/PROVIDER >30 $157.00 99380
40720257 L-URINE SODIUM $22.00 84300
40720295 L-HCT $25.00 85014
40720034 L-LAB MISC.-CYCLOSPORINE $238.00 80158
40720412 L-CULTURE ISOLATE EXC BLOOD $158.00 84075
438220039 CL-INTERM. LAC REPAIR 7.6CM $389.00 12034
307010026 A-IRRIGATION OF FLUSH PICC, CENT LINE, PORT $233.00 96523
40720188 L-MYASTHENIA GR PANEL $223.00 83519
40720459 L-HEP C GENOTYPE $172.00 87902
40720361 L-RA FACTOR QUALITATIVE $37.00 86431
42330051 ED-GLUCOSE REAGENT STRIP $22.00 82948
307010005 A-EXC BEN LES 0.6-1.0 CM $710.00 11401
40720450 L-HPV DNA AMP PROBE $188.00 87621
40720247 L-ELECTROPHORESIS/MICROPROT $104.00 84165
40720278 L-TOTAL TT-3 $34.00 84480
40720045 L-LAMOTOGRINE $65.00 80175
40720360 L-RA FACTOR QUALITATIVE $62.00 86430
40720224 L-OXALATE (URINE) $108.00 83945
40720194 L-AUTOIMMUNE PANEL $157.00 83520
40720144 L-CRYOGLOBULIN $81.00 82595
307010002 A-SKIN BIOPSY EA. AD LESION $74.00 11101
40720044 L-GABAPENTIN $165.60 80171
40720402 L-DIRECT COOMBS $72.00 86880
40720314 L-FIBRINOGEN $35.00 85384
438220157 CL-IV PUSH EA SEQTL SAME MED $47.00 96376
307010036 A-AMB ALS ER TRANSPORT $865.00 A0427
438220165 CL-ELEC. COMM NON PHYS. $50.00 98969
40720435 L-H-PYLORI STOOL $183.00 87338
40720207 L-MERCURY, BLOOD $30.00 83825
438220220 CL-EST. PATIENT 40-64 YEARS $254.00 99396
40720276 L-IV-IM PUSH QNEW MED $19.00 84478
40720338 L-SSDNA $90.00 86226
438220045 CL-CRYO-WARTS < 15 $212.00 17110
40720452 L-TRICHOMONAS $80.00 87660
40720397 L-IGG $127.00 86789
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438220188 CL-PHYS H&P SNF LEVEL 2 $209.00 99305
40720351 L-ANTICARDIOLIPIN AB $69.00 86318
40720416 L-CULTURE,FUNGUS MOLD/YEAST $101.00 87101
307010022 A-INJ. LMBR SACRAL THERAPEU $1,497.00 62322
438220084 CL-H PYLORI $95.00 86677
40720301 L-LEUKOCYTE AUTOMATED $42.00 85048
40720082 L-HCG URINE TEST $88.00 81025
438220068 CL-REM FB FROM EYE, COMPLEX $210.00 65222
421190005 ST-SWALLOWING FUNCTION EVAL $224.00 92610
307010011 A-CRYO PREMALIG LES(1) $154.00 17000
40720284 L-URIC ACID BLOOD $19.00 84550
40720066 L-LAB CHEMISTRY-ALCOHOL $184.00 80320
40720175 L-HUMAN GROWTH HORMONE(HGH) $163.00 83003
438220190 CL-PHYS VISIT SNF LEVEL 1 $103.00 99307
40720336 L-ANTIBODY CCP $140.00 86200
40720226 L-PH BODY FLUID, EXC. BLOOD $89.00 83986
307010008 A-TOENAIL TRIM-HOSPITAL FAC $280.00 11719
307010012 A-CRYO PREMALIG LES(2-14) $15.00 17003
438220194 CL-PHYS VISIT SNF LEVEL 3 $167.00 99309
438220021 CL-EXCISION, BENIGN LESION 2.1-3 CM $577.00 11403
40720213 L-MOLECULE ISOLATE NUCLEIC $126.00 83891
41120004 EKG-CARDIAC MONITOR TO 48HR $210.00 93226
40720023 L-ELECTROLYTE $95.00 80051
40720407 L-BLOOD CULTURE $166.00 87040
40720340 L-JO-1 AB $30.00 86235
40720252 L-ASSAY OF PYRUVATE $108.00 84210
40720421 L-SENSITIVITY $44.00 87181
438220079 CL-HCT (SPUN) $23.00 85013
40720417 L-FUNGUS ID $157.00 87106
40720358 L-ANTI INTRINSIC ANTIBODY $129.00 86340
40720352 L-IMUNOELCTROPHORSEIS SERUM $245.00 86320
40720353 L-C3 TEST $156.00 86329
40720488 L-EOSINOPHILS, NASAL SMEAR $65.00 89190
438220197 CL-PHYS VISIT SNF LEVEL 4 $207.00 99310
40720185 L-ANTI-MAG AB $80.00 83516
40720283 L-BUN $19.00 84520
438220073 CL-COLORECTAL SCREEN; FECES $25.00 82270
40720373 L-EB AND EBNA $126.00 86664
40720321 L-EOSINOPHIL URINE $50.00 85999
40720192 L-ACHR BLOCKING $223.00 83519
40720016 L-ISTAT-TOTAL B-HCG $24.00 84702
40720406 L-CROSS MATCH $162.00 86920
438220150 CL-IV INFUSION HYDRTION 1 HR $263.00 96360
438220201 CL-HOUSE CALLS 15 MIN. $91.00 99347
40720318 L-SEDIMENTATION $58.00 85651
40720484 L-INSITU HYBRIDIZAT,MANUAL $337.00 88368
438220213 CL-NEW PATIENT 40-64 YEARS $304.00 99386
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Pomeroy Wa, 99347
307010024 A-CARDIOVERSION $2,614.00 92960
438220143 CL-CARDIAC MONITOR 1-3 LEADS $157.00 93040
40720229 L-ACID PHOSPHATASE $81.00 84060
307010019 A-DRAIN/INJ.JOINT/BURSA MAJ $339.00 20610
40720059 L-TOPAMEX LEVEL $145.00 80201
40720149 L-ERYTHROPOIETIN $176.00 82668
307010004 A-EX BENIGN LESION < .05 CM $710.00 11400
40720348 L-CA 19 $181.00 86301
40720287 L-ASSAY OF VASOPRESSIN $147.00 84588
40720099 L-AMINOACIDS, 6 OR MORE $216.00 82139
405120022 CS-SHOE, POST OP FML - LG $16.00 L3260
40720211 L-NEPHELOMETRY $64.00 83883
307010035 A-AMB ALS NON ER TRANSPORT $635.00 A0426
438220195 CL-PHYS VISIT SNF LEVEL 3 $167.00 99309
438220026 CL-TOE NAIL TRIM $137.00 11719
40720489 L-SEMEN ANALYSIS $99.00 89320
40720205 L-LDL CHOLESTEROL $34.00 83721
438220059 CL-SPLINT LONG ARM $229.00 29105
40720294 L-BLOOD SMEAR WBC DIFF MANUAL $59.00 85007
41120005 EKG-ECHOCARDIOGRAPHY, TRANSTHORACIC $608.36 93306
40720115 L-CALCITONIN $246.00 82308
438220042 CL-LAC REPR COMP. 2.6-7.5 CM $611.00 13121
438220151 CL-HYRATION IV, ADDL BY HR $73.00 96361
40720465 L-CD4 PANEL $270.00 88184
438220030 CL-TOE NAIL REM.>1 LIST EACH $79.00 11732
405120004 CS-CPAP HEADGEAR $164.00 A7035
438220029 CL-TOE NAIL PLATE REM (1) $294.00 11730
40720085 L-FACTOR V LEIDEN $213.00 81241
438220204 CL-HOUSE CALLS 60 MIN. $322.00 99350
438220169 CL-THERAPEUTIC PHLABOTOMY $210.00 99195
40720064 L-DRUG SCREEN SERUM $251.00 80307
438220184 CL-PRE-OP CONSULTATION $345.00 99244
40720390 L-SERUM TITRE RICKETTSIA $129.00 86757
40720191 L-ACHR BINDING $223.00 83519
40720394 L-TOXOPLASMA (ANTIBODY) IGM $148.00 86778
40720005 L-ISTAT-TC02 $8.00 82374
40720323 L-ALLERGY PANEL $17.00 86003
40720447 L-HSV DNA AMP PROBE $188.00 87529
40720128 L-LAB CHEMISTRY - CHLORIDE $49.00 82435
438220031 CL-TOENAIL REMV PART./COMPL $389.00 11750
438220056 CL-DRAIN/INJ.JOINT/BURSA MAJ $395.00 20610
438220062 CL-SPLINT LONG LEG $222.00 29505
438220020 CL-EXC BE LESION 1.1-2.0 CM $596.00 11402
438220009 CL-SKIN BIOPSY (SING.LESION) $345.00 11100
40720369 L-COCCIDIODES ANTIBODY $116.00 86635
40720313 L-D-DIMER QUANTITATIVE $170.00 85379
40720291 L-HCG - QUANTITATIVE $162.00 84702
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40720032 L-AMITRIPTYLINE LEVEL $352.00 80152
40720272 L-VITAMIN E $127.00 84446
40720463 L-CYTO EVAL FNA REPORT $150.00 88173
438220177 CL-EST PT LEVEL 2 $133.00 99212
438220192 CL-PHYS VISIT SNF LEVEL 2 $126.00 99308
40720393 L-TOXOPLASMA (TITRE) AB $136.00 86777
40720325 L-LAB (ANA) $51.00 86038
40720158 L-FOLIC ACID, SERUM $57.00 82746
438220057 CL-I&D FINGER COMPLEX $1,685.00 26011
438220186 CL-CONSULT 80 MIN FAC TO FAC $436.00 99245
438220041 CL-REPAIR, INTERMEDIATE 2.6CM TO 7.5CM $395.00 12042
40720232 L-PHOSPHORUS $19.00 84100
307010045 A-EXC MALIG LES 3.1-4CM $1,834.00 11604
438220060 CL-SPLINT SHORT ARM $212.00 29125
307010006 A-EXC BEN LES 1.1-2.0 CM $710.00 11402
40720479 L-SPECIAL STAINS $110.00 88313
307010038 A-AMB BLS ER TRANSPORT $624.00 A0429
40720389 L-ANTIBODY, MUMPS $122.00 86735
438220003 CL-I&D ABSCESS COMPLEX $436.00 10061
438220168 CL-CHS VISION SCREENING $49.00 99172
40720042 L-ETHOSUXIMIDE LEVEL $77.00 80168
40720438 L-INFLUENZA A/B AG, EIA $105.00 87400
438220011 CL-REMOVAL SKIN TAG<15 $216.00 11200
438220083 CL-TB SKIN TEST $22.00 86580
40720264 L-TESTOSTERONE TOTAL $93.00 84403
40720255 L-SEX HORMONE BINDING GLOBU $152.00 84270
40720370 L-CMV ANTIBODY $130.00 86644
307010028 A-WOUND CARE INTERMED-NURSE $472.00 97602
40720019 L-BLOOD DRAW (PORTA CATH) $158.00 36591
40720331 L-COLD AGGLUTININ $274.00 86156
40720228 L-CALPROTECTIN, FECAL $303.00 83993
40720013 L-ISTAT-HEMATOCRIT $4.00 85014
438220071 CL-DIPSTICK UA (NOT MICRO) $15.00 81002
40720164 L-ASSAY OF GASTRIN $154.00 82941
40720486 L-LEUKOCYTE ASSESMENT,FECAL $76.00 89055
40720162 L-IGG SUBCLASSES $159.00 82787
40720168 L-POST GLUCOSE DOSE $64.00 82950
40720245 L-URINE TOTAL PROTEIN $58.00 84156
40720040 L-VALPROIC FREE ACID $141.00 80165
40720172 L-GGT $23.00 82977
307010033 A-DRESSING CHANGE $66.00 99211
40720467 L-TISSUE CULTURE LYMP $508.00 88230
438220054 CL-DRAIN/INJ. SMALL JOINT OR BURSA $306.00 20600
40720202 L-LIPOPROTEIN A $152.00 83695
40720083 L-LAB URINE-VOLUME MEASURE $13.00 81050
405120009 CS-NUTRITION PUMP KIT $53.00 B4035
40720302 L-PLATELETS AUTOMATED $72.00 85049
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40720080 L-UA DIP W/MICRO $35.00 81001
40720345 L-CMV TEST $85.00 86256
438220069 CL-EAR IRRIGATION $70.00 69210
40720077 L-CLINICAL PATHOLOGY CONSUL $89.00 80500
40720111 L-NON COLORECTAL; FECES $16.00 82272
438220152 CL-IV INFUSION THERAPEUTIC UP TO 1 HOUR $287.00 96365
40720409 L-STOOL CULTURE PRESUMPTIVE $22.00 87046
40720067 L-ALCOHOL BIOMARKERS $32.00 80321
40720341 L-ACENTROMERE B ABS $30.00 86235
438220018 CL-EXC. BE.LES..5CM OR LESS $593.00 11400
40720332 L-COLD AGGLUTININ TITER $98.00 86157
405120028 CS-WALKING BOOT NON PNEUMATIC $141.00 L4387
40720088 L-LAB-ACETAMINOPHEN LEVEL $220.00 82003
40720098 L-URINE ALA $79.00 82135
40720418 L-MYCOBACTERIA CULTURE $31.00 87116
40720132 L-CITRATE (URINE) $207.00 82507
438220086CL-DECTECTION INFECTIOUS AGENT BY IMMUNOASSY WITH DIRECT
OPTICAL OBSERVATION INFLUENZA $60.00 87804
438220034 CL-LACER. BODY^2.5 CM. $242.00 12002
40720170 L-GLUCOSE TOLR.TEST EA.ADD. $127.00 82952
40720178 L-H. PYLORI, BLOOD $48.00 87338
40720401 L-HLA TYPING; A,B,OR C $306.00 86812
40720453 L-BK VIRUS, QUANTITATIVE BY PCR $173.00 87799
41120002 EKG $112.00 93005
40720061 L-QUANTITATION THERAPUTIC DRUG $177.00 80299
40720311 L-PROTEIN S, FREE $287.00 85306
438220159 CL-WOUND CARE $252.00 97602
40720289 L-ASSAY OF ZINC $95.00 84630
40720046 L-LEVETIRACETAM $213.00 80177
438220063 CL-SPLINT SHORT LEG $222.00 29515
40720454 L-DETECT AGENT NOS,DNA,QUAN $710.00 87799
40720474 L-TISSUE EXAM LEVEL 3 $195.00 88305
40720382 L-HIV1/HIV2 ANTBDY, SGL ASY $154.00 86703
40720186 L-GLUTEN SEN ANTIBODY $80.00 83516
40720374 L-EPSTEIN-BARR ANTIBODY $144.00 86665
438220015CL-SHAVE BIOPSY 0.5CM OR LESS OF SCALP, NECK, HANDS, FEET,
GENITALIA $209.00 11305
438220158 CL-ACTIVE WOUND CARE/20 CM< $365.00 97597
40720480 L-IMMUNOHISTOCHEMISTRY $270.00 88342
40720141 L-CREATININE, SERUM $19.00 82565
40720163 L-BLODD GASES, ANY COMBO $264.00 82803
40720195 L-INSULIN; TOTAL $73.00 83525
40720490 L-LAB MISC/HANDLING FEE $25.00 99001
405120029 CS-MEDE KAST ULTRA CASTING SYSTEM TCC2ULTR $213.00 Q4038
40720112 L-BLOOD OCCULT BY FECAL HEMAGLOBIN DETERMINATION $16.00 82274
438220075 CL-NON COLORECTAL; FECES $25.00 82272
40720049 L-LAB SPEC CHEM PHENOBARBIT $112.00 80184
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307010051 A-FITTING INSERT OF PESSARY $201.00 57160
438220181 CL-CONSULT LIMITED ,<15 MIN $76.00 99241
40720388 L-LEGIONELLA ANTIBODY $111.00 86713
40720320 L-VISCOSITY $81.00 85810
40720437 L-HIV ANTIGEN $154.00 87390
40720035 L-CYCLOSPORINE A $289.00 80158
438220161 CL-WOUND VAC > 50 SQ. CM. $467.00 97606
307010021 A-CENTRAL LINE DRAW $56.00 36592
438220048 CL-FACE LESION .6-1 CM $389.00 17281
40720315 L-PRO-TIME $68.00 85610
40720079 L-UA W/O MICRO (DIPSTICK) $9.00 81002
40720481 L-IMMUNOFLOR STDY,EA ANTIBO $139.00 88347
307010016 A-TRIGGER POINT INJECTIONS $220.00 20552
40720094 L-ALDOSTERONE $116.00 82088
405120013 CS-BIAP HEATED HUMIDIFIER $163.00 E0562
438220232 CL-H1N1 PANDEMIC ADMIN $0.10 G9141
40720148 L-ASSAY DIHDROXYVITAMIN D $246.00 82652
40720339 L-E.N.A. $30.00 86235
307010046 A-EXC MALIG LES >4.0CM $2,753.00 11606
40720379 L-HERPES SIMPLEX ANTIBODIES $108.00 86694
40720277 L-THYROXINE UPTAKE $86.00 84479
40720025 L-LAB-OB PANEL $362.00 80055
40720203 L-ASSAY LIPOPROTEIN PLA2 $186.00 83698
40720262 L-SUGARS, SINGLE, QUAL $274.00 84376
40720375 L-ANTIBODY - FUNGUS UNSPEC $100.00 86671
438220145 CL-NEBULIZER TREATMENT $233.00 94640
40720003 L-ISTAT-POTASSIUM $8.00 84132
40720219 L-GENETIC INTERP. & REPORT $85.00 83912
438220210 CL-NEW PATIENT 5-11 YEARS $237.00 99383
40720151 L-ESTROGEN $163.00 82672
438220191 CL-PHYS VISIT SNF LEVEL 1 $103.00 99307
40720392 L-RUBEOLA IGG $120.00 86765
438220178 CL-EST PT LEVEL 3 $158.00 99213
438220218 CL-EST. PATIENT 12-17 YEARS $192.00 99394
307010009 A-AVULSON NAIL PLATE SMPL 1 $388.00 11730
40720127 L-CHEMILUMINESCENT ASSAY $196.00 82397
438220225 CL-PHONE CONSULT 21-30 MIN. $81.00 99443
40720011 L-ISTAT-CREATININE $8.00 82565
40720100 L-LAB AMMONIA LEVEL $199.00 82140
438220013 CL-SHAVE SKIN LESION 0.6 TO 1.0 CM $181.00 11301
40720124 L-CATECHOLAMINES; TOT.URINE $200.00 82382
40720385 L-HEPATITIS A SURFACE ANTI $215.00 86708
40720145 L-MEGALOBLASTIC PANEL $163.00 82607
40720110 L-BLOOD OCCULT OTHER SOURCE $16.00 82271
40720087 L-MTHFR MUTATION $170.00 81291
40720256 L-SODIUM; SERUM $63.00 84295
40720482 L-TUMOR IMMUNOHISTO/MANUAL $270.00 88360
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438220046 CL-CRYO-WARTS > 15 $212.00 17111
40720235 L-PORPHYRIA SCREEN $152.00 84120
438220023 CL-EXC. BEN.LESION .6 - 1 $717.00 11421
405120024 CS-WRIST IMMOBILIZER $104.00 L3980
438220141 CL-HEARING TEST $132.00 92552
438220216 CL-EST.PATIENT 1-4 YEARS $176.00 99392
438220077 CL-GLUCOSE / REAGENT STRIP $22.00 82948
438220032 CL-WEDGE EXCISION FO THE SKIN OF THE NAIL FOLD $389.00 11765
40720193 L-IMMUNOASSAY,NOT SPECIFIED $157.00 83520
438220076 CL-BLOOD, OCCULT, BY FECAL $54.00 82274
40720184 L-IMMUNOASSAY, MULTI-STEP $80.00 83516
438220155 CL-IV PUSH MED INJECTION $195.00 96374
438220052 CL-TRIGG PTS 1+/1-2 MUS GRP $306.00 20552
307010015 A-CARPEL TUNNEL INJECTION $334.00 20526
40720147 L-DHEA SULFATE $27.00 82627
438220173 CL-NEW PT LEVEL 4 $317.00 99204
438220065 CL-PESSARY IRRIGATION $132.00 57150
40720243 L-PSA FREE $137.00 84154
40720179 L-HEAVY METAL SCREEN $32.00 83015
40720403 L-INDIRECT COOMBS $162.00 86885
438220037 CL-LACER. FACE ^2.5 CM. $317.00 12013
307010020 A-FINGER SPLINT-HOSP $153.00 29130
40720174 L-LH (LUTEINIZING HORMONE) $67.00 83002
40720230 L-PHOSPHATASE, ALKALINE $36.00 84075
40720198 L-LACTIC ACID $128.00 83605
438220080 CL-HEMATOCRIT; FINGERSTICK $34.00 85014
40720246 L-PROTEIN BODY FLUID $73.00 84157
40720106 L-ASSAY OF BETA 2 PROTEIN $141.00 82232
40720343 L-GLUTEN SEN SCREEN $75.00 86255
40720460 L-CYTO FLUIDS NONGYN SMEAR $85.00 88104
40720204 L-LAB CHEMISTRY-HDL CHOLEST $33.00 83718
40720181 L-HEMOGLOBIN EVALUATION $77.00 83021
40720133 L-COPPER SERUM $20.00 82525
40720324 L-ANCA $182.00 86021
40720333 L-COMPLEMENT; ANTIGEN $83.00 86160
40720123 L-CAROTENE $120.00 82380
40720274 L-ALT / ALANINE AMINOTRANSFERASE $59.00 84460
40720137 L-ESSENTIAL FATTY ACID PANE $389.00 82544
40720183 L-HOMOCYSTEINE $48.00 83090
40720171 L-G6PD QUALITATIVE $102.00 82955
40720222 L-OSMOLALITY SERUM $52.00 83930
40720300 L-RETICULOCYTES AUTO $25.00 85045
438220227 CL-FIRST 30 MIN. OF ADVANCED CARE PLANNING $90.00 99497
40720261 L-SPECIFIC GRAV NOT URINE $33.00 84315
40720097 L-CYSTINE (URINE) $314.00 82131
438220171 CL-NEW PT LEVEL 2 $150.00 99202
40720265 L-VIT B-1 $83.00 84425
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40720076 L-ACTH $261.00 80400
438220051 CL-INJECT TENDON SHEATH/LIGAMENT $306.00 20550
405120020 CS-SHOE, POST OP MENS-LG $16.00 L3260
438220221 CL-EST. PATIENT 65 + YEARS $264.00 99397
40720009L-ISTAT-GLUCOSE TOLLERANCE TEST, EACH ADDITIONAL BEYOND 3
SPECIMENS $7.00 82952
40720254 L-ASSAY OF RENIN $129.00 84244
40720155 L-FATTY ACIDS / PLASMA $265.00 82725
40720101 L-AFP $82.00 82150
438220028 CL-DEBRIDEMENT OF NAIL(S) 6 OR MORE $294.00 11721
438220078 CL-TROPONIN QUANTITATIVE $177.00 84484
40720159 L-RBC FOLIC $22.00 82747
40720022 L-GENERAL HEALTH PANEL $552.00 80050
438220047 CL-DES. OF BEIGN LESION 1-14 $212.00 17111
438220144 CL-UP TO 48 HRHOLTER MONITOR $205.00 93225
438220038 CL-CLOSURE OF SPLIT WOUND $611.00 12020
438220091 CL-ADMIN 1 VACCINE, VFC $69.00 90471
40720366 L-LYME DISEASE ANTIBODY $226.00 86617
438220090 CL-VACCINE/TOXOID 1ST INJ $69.00 90471
40720483 L-INSITU,HYBRIDIZ,(FISH) $230.00 88365
40720017 L-ISTAT-PROTHROMBIN TIME $7.00 85610
40720240 L-PROGESTERONE $82.00 84144
40720408 L-STOOL CULTURE PRELIMINARY $95.00 87045
40720206 L-LAB CHEMISTRY-MAGNESIUM $36.00 83735
40720161 L-GAMMAGLOBULIN IGE $45.00 82785
40720371 L-CMV ANITBODY IGM $145.00 86645
438220055 CL-DRAIN/INJ.JOINT/BURSA INT $338.00 20605
307010023 A-HEART LUNG RESUSITATION CPT $2,117.00 92950
307010037 A-AMB BLS NON ER TRANSPORT $414.00 A0428
40720139 L-CARDIAC ISOENZYMES $251.00 82552
40720387 L-INFLUENZA VIRUS; ANTIBODY $124.00 86710
40720327 L-ASO $99.00 86060
40720293 L-BLEEDING TIME $112.00 85002
40720237 L-POTASSIUM, URINE $56.00 84133
40720208 L-METANEPHRINE $104.00 83835
40720152 L-ASSAY OF ESTRIOL $128.00 82677
40720196 L-LAB SPEC CHEM-IRON $33.00 83540
438220229 CL-TOENAIL TRIM (DYSTROPHIC) $105.00 G0127
438220224 CL-PHONE CONSULT 11-20 MIN. $54.00 99442
405120015 CS-ADULT CERVICAL COLLAR $33.00 L0172
40720312 L-APC RESISTANCE $214.00 85307
40720309 L-TOTAL PROTEIN C $223.00 85302
40720134 L-URINARY FREE CORTISOL $66.00 82530
307010050 A-US URINECAP MEASURE $247.00 51798
40720233 L-PHOSPHATE (URINE) $27.00 84105
438220212 CL-NEW PATIENT 18-39 YEARS $295.00 99385
40720173 L-FSH $67.00 83001
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40720223 L-OSMOLALITY URINE $52.00 83935
438220053 CL-TRIGG PTS 1+/3+ MUSCLE GP $525.00 20553
40720199 L-LAB PROFILE-CARDIAC LDH $22.00 83615
421190006 ST-MOTION FLUORO SWALLOW $320.00 92611
40720130 L-CHROMATOGRAPHY, GL COLUMN $172.00 82491
421190001 ST-NASOPHARYNGOSCOPY $315.00 92511
40720096 L-URINE AMINO ACIDS $61.00 82128
40720146 L-LAB SPEC. CHEM B12 $57.00 82607
438220215 CL-EST. PATIENT INFANT< 1 YR $157.00 99391
438220147 CL-PULSE OXIMETER $29.00 94760
40720212 L-MOLECULE ISOLATE $210.00 83890
40720041 L-DOXEPIN LEVEL $74.00 80166
40720491 L-MILLENIUM LAB MISC/HANDLING FEE $25.00 99001
40720319 L-PTT, WHOLE BLOOD $74.00 85730
40720281 L-TROPONIN QUANTITATIVE $222.00 84484
40720026 L-LAB OB PANEL(INCLUDES HIV TESTING) $128.00 80081
40720427 L-TISSUE EXAM, KOH TEST $65.00 87220
40720429 L-VIRAL CULTURE $147.00 87252
40720259 L-SOMATOMEDIN $150.00 84305
438220087 CL-QUICK STREP TEST CLINIC $69.00 87880
307010003 A-REMOVAL OF SKIN TAGS $547.00 11200
438220187 CL-PHYS H&P SNF LEVEL 1 $162.00 99304
438220172 CL-NEW PT LEVEL 3 $206.00 99203
40720448 L-HIV-1, RNA QUANTIFICATION $293.00 87536
40720190 L-ANTI-MUSK ANTIBODY $223.00 83519
307010049 A-FOLY CATH INSERTION INIT $211.00 51702
40720473 L-HISTOPATHOLOGY $108.00 88304
438220193 CL-PHYS VISIT SNF LEVEL 2 $126.00 99308
40720113 L-CADMIUM, BLOOD $43.00 82300
40720432 L-C.DIFFICLE TOXIN A & B $120.00 87324
438220245 CL-SUTURE REMOVAL $78.00 S0630
40720231 L-ALP ISOENZYMES $170.00 84080
40720415 L-URINE CULTURE $78.00 87088
40720209 L-MYOGLOBIN $203.00 83874
405120005 CS-CPAP TUBING $168.00 A7037
307010043 A-EXC MALG LES 1.1-2.0CM $1,010.00 11602
438220189 CL-PHYS H&P SNF LEVEL 3 $265.00 99306
40720381 L-HIV AB $157.00 86701
438220072 CL-DIP PREG TEST $61.00 81025
438220019 CL-EXC. BE. LES. 0.6-1.0 CM $480.00 11401
438220217 CL-EST. PATIENT 5-11 YEARS $187.00 99393
438220219 CL-EST. PATIENT 18-39 YEARS $245.00 99395
40720485 L-CELL COUNT ANY BODY FLUID $74.00 89051
40720363 L-TB TEST $38.00 86580
40720120 L-CARBON DIOXIDE TEST $54.00 82374
40720070 L-BENZODIAZEPINES 13+ $103.00 80347
40720105 L-ARSENIC, BLOOD $138.00 82175
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40720180 L-HEMOGLOBIN ELECTROPHORESI $166.00 83020
40720290 L-C PEPTIDE $142.00 84681
40720078 L-UA W/MICRO $10.00 81000
40720029 L-ACUTE HEPATITIS PANEL $172.00 80074
40720227 L-PHENCYCLIDINE CONFIRMATION $103.00 80365
40720354 L-CITRULINATED PTIDE AB IGG $170.00 86332
40720062 L-OXYCODONE, URINE CONFIRMATION $103.00 80365
405120016 CS-ANKLE BRACE-LACER-L $134.00 L1902
40720349 L-CA 125 TEST $194.00 86304
40720238 L-PRE-ALBUMIN $93.00 84134
40720279 L-FT-3 $29.00 84481
40720317 L-VIPER VENOM DILUTED $145.00 85613
40720006 L-ISTAT-GLUCOSE $7.00 82947
40720263 L-FREE TESTOSTERONE $102.00 84402
417040399 methIMAzole 10 MG TABLET 10 mcg, 100 eaches $-
417040400 TOTAL B WITH VIT C CAPLET $5.00
417040401 amiodarone 150 MG/3 ML VIAL 150 mg, 3 mL $-
417040107 DOCUSATE SODIUM 100MG CAP $5.00
417040404 Protonix 40 MG SUSPENSION 40 mcg, 30 eaches $25.80
417040405 POTASSIUM CL 20 MEQ PACKET 20 mcg, 30 eaches $16.00
417040406 MOMETASONE FUROATE 50 MCG SPRY 50 mcg, 17 g $386.88
417040407 DESONIDE 0.05% OINTMENT 15 g $102.50
417040408 tiZANidine HCL 4 MG TABLET $18.30
417040179 LACTOBACILLUS ACIDOPHILLUS CAP $5.00
417040410 Advair 250-50 DISKUS 250 mcg $302.50
417040354 SODIUM CHLORIDE 0.45% SOLN 1000 mL $50.00
417040256 SODIUM CHLORIDE 0.9% SOLUTION 250 mcg, 250 mL $50.00
417040255 SODIUM CHLORIDE 0.9% SOLUTION 1000 mcg, 1000 mL $62.00
417040353 SODIUM CHLORIDE 0.9% SOLUTION 100 mcg, 100 mL $50.00
417040356 DEXTROSE 5%-0.45% NACL IV SOLN 1000 mL $62.00
417040358 DEXTROSE 5%-0.9% NACL IV SOLN 500 mL $62.00
417040089 DEXTROSE 5%-0.9% NACL IV SOLN 1000 mcg, 1000 mL $62.00
417040357 DEXTROSE 5%-LR IV SOLUTION 1000 mL $62.00
417040355 DEXTROSE 5%-WATER IV SOLN 250 mL $50.00
417040090 DEXTROSE 5%-WATER IV SOLN 1000 ML $62.00
417040178 LACTATED RINGERS 1000ML BAG $62.00
417040411 ARMOUR THYROID 30 MG TABLET $10.80
417040412 levETIRAcetam 250 MG TABLET $23.15
417040413 levETIRAcetam 500 MG/5 ML VIAL $49.80 J1953
417040414 DOPamine 400 MG-D5W 500 ML $96.00 J1265
417040415 dilTIAZem 125 MG/25 ML VIAL $70.75
417040416 DOCU LIQUID 50 MG/5 ML $5.00
307010031 A-NEGATIVE PRESSURE WOUND THERAPY <50 SQ CM $257.00 97607
307010031 A-WOUND VAC >50 CM $265.00 97606
417040417 HYDROmorphone 1 MG/ML CARPUJCT $26.40
41420101 X-ELBOW RIGHT COMPLETE $241.00 73080
41420134 X-KNEE LEFT 3 VIEW $241.00 73562
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41420165 X-ABODMEN-SINGLE VIEW $186.00 74018
41420128 X-FEMUR LEFT 2 VIEWS $226.00 73552
41420001 X-EYE FOREIGN BODY XRAY-LEFT $276.00 70030
41420078 X-SACRUM/COCCYX $297.00 72220
41420054 X-CERVICAL SPINE 4 OR 5 VIEWS $406.00 72050
41420024 X-SKULL 2 VIEWS $373.00 70250
41420018 X-ORBITS 4 VIEW $373.00 70200
41420076 X-SI JOINTS 3 VIEWS $311.00 72202
41420151 X-ANKLE RIGHT COMPLETE $235.00 73610
41420022 X-SINUS MIN 3 VIEW $377.00 70220
41420084 X-SCAPULA-RIGHT $233.00 73010
41420038 X-RIBS - UNILATERAL LEFT $228.00 71100
41420030 X-BILATERAL TMJS $377.00 70330
41420116 X-HAND RIGHT COMPLETE $225.00 73130
41420087 X-SHOULDER-RIGHT 1 VIEW $196.00 73020
41420154 X-FOOT RIGHT 2 VIEWS $215.00 73620
41420160 X-HEEL - RIGHT $215.00 73650
41420048 X-STERNUM XRAY $276.00 71120
41420106 X-WRIST LEFT 2 VIEWS $184.00 73100
41420050 X-SPINE 1 VIEW SPECIFIC $205.00 72020
41420118 X-FINGER LEFT $178.00 73140
41420147 X- ANKLE LEFT 2 VIEWS $197.00 73600
41420002 X-EYE FOREIGN BODY XRAY-RIGHT $276.00 70030
41420008 X-MASTOID $354.00 70120
41420163 X-TOES X-RAY-RIGHT $176.00 73660
41420010 X-MASTOIDS 3 VIEWS $354.00 70130
41420068 X-SPINE LUMBOSACRAL COMPLETE $412.00 72110
41420092 X-AC JOINTS 2 VIEWS $307.00 73050
41420113 X-HAND RIGHT 2 VIEWS $214.00 73120
41420086 X-SHOULDER-LEFT 1 VIEW $196.00 73020
41420169 X-ABDOMEN, COMPLETE VIEW $248.00 74021
41420097 X-ELBOW LEFT 2 VIEWS $198.00 73070
41420156 X-FOOT LEFT COMPLETE $230.00 73630
41420046 X-RIB BILATERAL 4 VIEW $324.00 71111
41420042 X-UNI RIB 3 VIEW W/PA CHEST-RIGHT $263.00 71101
41420175 X-SEGMENTAL PNEUMATIC PUMP $1,558.00 E0667
41420131 X-KNEE LEFT 1 OR 2 VIEW $228.00 73560
41420006 X-MANDIBLE 4 VIEW $354.00 70110
41420150 X-ANKLE LEFT COMPLETE $235.00 73610
41420100 X-ELBOW LEFT COMPLETE $241.00 73080
41420052 X-SPINE CERVICAL 2 VIEW $238.00 72040
41420028 X-UNILATERAL TMJS $377.00 70328
41420034 X-CHEST 1 VIEW $171.00 71045
41420121 X-HIP UNILATERAL WITH PELVIS WHEN PERFORMED $190.00 73501
41420036 X-CHEST 2 VIEWS $219.00 71046
41420115 X-HAND LEFT COMPLETE $225.00 73130
41420016 X-NASAL BONES $279.00 70160
31 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
41420142 X-KNEES BILATERAL VIEWS $269.00 73565
41420173 X-DOPPLER STUDY $378.00 93922
41420004 X-MANDIBLE LESS THAN 4 VIEW $268.00 70100
41420064 X-SPINE L BENDING VIEWS $386.00 72120
41420140 X-KNEE RIGHT 4 OR MORE VIEWS $260.00 73564
41420044 X-RIBS BILATERAL $261.00 71110
41420090 X-SHOULDER RIGHT COMPLETE $242.00 73030
41420162 X-TOES X-RAY-LEFT $176.00 73660
41420081 X-CLAVICLE - RIGHT $208.00 73000
41420139 X-KNEE LEFT 4 OR MORE VIEWS $260.00 73564
41420119 X-FINGER RIGHT $178.00 73140
41420074 X-SI JOINT $248.00 72200
41420107 X- WRIST RIGHT 2 VIEWS $184.00 73100
41420124 X-HIP RIGHT 2 VIEWS $252.00 73502
41420148 X-ANKLE RIGHT 2 VIEWS $197.00 73600
41420072 X-PELVIS COMPLETE $186.00 72190
41420145 X-TIBIA/FIBULA RIGHT $209.00 73590
41420056 X-CERVICAL SPINE COMPLETE $479.00 72052
41420094 X-HUMERUS LEFT 2 VIEWS $209.00 73060
41420026 X-SKULL 4 VIEW $413.00 70260
41420032 X-NECK SOFT TISSUE $195.00 70360
41420109 X-WRIST LEFT COMPLETE $241.00 73110
41420135 X-KNEE RIGHT 3 VIEW $241.00 73562
41420014 X-FACIAL BONES MIN 3 VIEWS (COMPLETE) $373.00 70150
41420157 X-FOOT RIGHT COMPLETE $230.00 73630
41420144 X- TIBIA/FIBULA LEFT $209.00 73590
41420110 X-WRIST RIGHT COMPLETE $241.00 73110
41420153 X-FOOT LEFT 2 VIEWS $215.00 73620
41420095 X-HUMERUS RIGHT 2 VIEWS $209.00 73060
41420020 X-SINUS LESS THAN 3 VIEWS $248.00 70210
41420039 X-RIBS - UNILATERAL RIGHT $228.00 71100
41420132 X-KNEE RIGHT 1 OR 2 VIEW $228.00 73560
41420080 X-CLAVICLE - LEFT $208.00 73000
41420058 X-THORACIC DORSAL 3 VIEWS $268.00 72072
41420089 X-SHOULDER LEFT COMPLETE $242.00 73030
41420083 X-SCAPULA - LEFT $233.00 73010
41420112 X-HAND LEFT 2 VIEWS $214.00 73120
41420129 X-FEMUR RIGHT 2 VIEWS $226.00 73552
41420123 X-HIP LEFT 2 VIEWS $252.00 73502
41420167 X-ABDOMEN, 2 VIEWS $255.00 74019
41420062 X-THORACIC/LUMBAR $262.00 72080
41420137 X-AP BILATERAL STANDING KNEES $593.00 73565
41420012 X-FACIAL BONES LESS THAN 3 $268.00 70140
41420171 X-ACUTE ABDOMEN $396.00 74022
41420066 X-SPINE LUMBOSACRAL AP/LAT $262.00 72100
41420070 X-PELVIS AP $209.00 72170
41420098 X-ELBOW RIGHT 2 VIEWS $198.00 73070
32 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
41420104 X-FOREARM RIGHT $203.00 73090
41420159 X-HEEL - LEFT $215.00 73650
41420126 X-HIP BILATERAL W/AP PELVIS $374.00 73521
41420103 X-FOREARM LEFT $203.00 73090
41420041 X-UNI RIB 3 VIEW W/PA CHEST-LEFT $276.00 71101
41420060 X-THORACIC 4 VIEWS $455.00 72074
438220230 CL-ANNUAL WELLNESS VISIT 1ST $200.00 G0402
438220231 CL-ANNUAL WELLNESS VISIT SUB $200.00 G0439
306100005 N-WOUND CARE COMPLEX $536.00 97602
306100006 N-DRESSING CHANGE $66.00 99211
306100008 N-WOUND VAC > 50 CM $467.00 97606
306100009 N-WOUND VAC < 50 CM $246.00 97605
306100011 N-HYDRATION IV INFUSION: EACH ADD HR $79.00 96361
306100012 N-TREATMENT IV INFUSION: #1 UP TO 1 HR $344.00 96365
306100007 N-WOUND CARE $252.00 97602
306100010 N-HYDRATION IV INFUSION:INT 31 MIN-1HR $229.01 96360
306100013 N-TREATMENT IV INFUSION:#1 EACH ADD HR $76.00 96366
306100014 N-TREATMENT IV INFUSION:#2 UP TO 1 HR $344.00 96365
306100015 N-TREATMENT IV INFUSION:#2 EACH ADD HR $76.00 96366
306100016 N-TREATMENT IV INFUSION:#3 UP TO 1 HR $344.00 96365
306100017 N-TREATMENT IV INFUSION:#3 EACH ADD HR $76.00 96366
306100018 N-TREATMENT IV INFUSION:#4 UP TO 1 HR $344.00 96366
306100019 N-TREATMENT IV INFUSION:#4 EACH ADD HR $76.00 96366
306100020 N-IV PUSH MEDICATION INJ-INITIAL #1 $149.00 96374
306100021 N-IV PUSH MEDICATION INJ-SEQ PUSH; EACH $88.00 96375
306100022 N-IV PUSH MEDICATION INJ-INITIAL #2 $149.00 96374
306100023 N-IV PUSH MEDICATION INJ-SEQ PUSH; EACH $88.00 96375
306100024 N-INJECTION(SUBQ,INTRMS) $75.50 96372
306100025 N-GLUCOMETRY READING $7.00 82943
306100027 N-PICC LINE FLUSH (W/O INJ OR INFUS) $233.00 96523
306100028 N-PICC LINE REMOVAL $233.00 36589
306100029 N-BATH $30.00
306100058 N-FRENCH FOLEY CATH 22" 2 WAY $27.00 A4344
306100059 N-FRENCH FOLEY CATH 18" 2 WAY $27.00 A4344
306100060 N-ENEMA KIT $48.00
417040418 MEXILETINE 150 MG CAPSULE $22.75
417040419 NITRO-BID 2% OINTMENT $24.50
417040420 DOXEPIN 75 MG CAPSULE $18.80
417040421 THP Cefdinir 250mg/5ml 60ml susp $162.00
417040331 TERAZOSIN 2MG CAP $15.45
417040323 SPIRONOLACTONE 50MG TAB $5.00
417040230 METOPROLOL TARTRATE 100MG TAB $8.80
417040423 MECLIZINE 25 MG TABLET $10.90
417040424 SODIUM CHLORIDE 1,000 MG TAB $14.11
417040425 TIMOLOL MALEATE 0.5% EYE DROPS 15 mL $50.45
417040426 heparin 50 UNITS/5 ML (10u/ML) $6.20
417040427 protamine 10 MG/ML VIAL 25 mL $162.50 J2720
33 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
307010039 A-OBS. ROOM PER HOUR 1-4 $126.00 G0378
417040169 INSULIN HUMAN R 100U/ML 3ML VIAL $20.00
417040210 MAGNESIUM CITRATE 10OZ BOTTLE $13.55
307010101 *************** $233.00 96523
10000000 NO CHARGE $-
41800001 I-BREATHING CAPACITY TEST $175.00 94010
53200007 D-DIABETES GROUP TRAIN UNIT $76.00 G0109
53200005 D-NUTRITION SUPPLEMENT-1500ML FEEDING BAGS $17.00 B4150
53200004 D-DIETARY CONSULT $92.00 99411
53200003 D-NUTRITION THER. GROUP $35.00 97804
53200002 D-NUTRITION RE-EVAL EA. 15 $43.00 97803
42330073 ED-ARM SLING LARGE $54.00 A4565
42330074 ED-FOREARM SPLINT, PADDED, MED $31.00 A4570
42330075 ED-CPAP FACEMASK - LARGE $385.00 A7030
42330076 ED-CPAP HEADGEAR $164.00 A7035
42330077 ED-CPAP TUBING $168.00 A7037
42330078 ED-ENTERNAL FEEDING SUPPLY KIT $7.00 B4034
42330079 ED-ENTERAL PUMP KIT $12.00 B4035
42330080 ED-NUTRITION PUMP KIT $53.00 B4035
42330081 ED-ENTERAL INFUSION PUMP $12.00 B9002
42330082 ED-CATHETER, INFUSION, OTHER THAN HEMODIALYSIS $348.00 C1751
42330083 ED-CATHETER INFUSION, NON-HEMODIALYSIS $348.00 C1751
42330084 ED-BIAP HEATED HUMIDIFIER $163.00 E0562
42330085 ED-BIPAP MACHINE $522.00 E0601
42330086 ED-ADULT CERVICAL COLLAR $33.00 L0172
42330087 ED-ANKLE BRACE-LACER-L $134.00 L1902
42330088 ED-ANLKE BRACE-LACER-M $134.00 L1902
42330089 ED-ANKLE AIR SPLINT 90 $385.00 L1906
42330090 ED-ANKLE WALKER- MED. $326.00 L1930
42330091 ED-SHOE, POST OP MENS-LG $16.00 L3260
42330092 ED-SHOE, POST OP FML - MED $16.00 L3260
42330093 ED-SHOE, POST OP FML - LG $16.00 L3260
42330094 ED-WRIST & THUMB SPLINT $67.00 L3908
42330095 ED-WRIST IMMOBILIZER $104.00 L3980
42330096 ED-ANKLE BRACE $140.00 L4350
42330097 ED-WALKING BOOT $141.00 L4361
42330098 ED-WALKING BOOT $141.00 L4361
42330099 ED-WALKING BOOT NON PNEUMATIC $141.00 L4387
42330100 ED-MEDE KAST ULTRA CASTING SYSTEM TCC2ULTR $213.00 Q4038
306100030 N-ARM SLING LARGE $54.00 A4565
306100032 N-CPAP FACEMASK - LARGE $385.00 A7030
306100033 N-CPAP HEADGEAR $164.00 A7035
306100034 N-CPAP TUBING $168.00 A7037
306100035 N-ENTERNAL FEEDING SUPPLY KIT $7.00 B4034
306100036 N-ENTERAL PUMP KIT $12.00 B4035
306100037 N-NUTRITION PUMP KIT $53.00 B4035
306100038 N-ENTERAL INFUSION PUMP $12.00 B9002
34 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
306100039 N-CATHETER, INFUSION, OTHER THAN HEMODIALYSIS $348.00 C1751
306100040 N-CATHETER INFUSION, NON-HEMODIALYSIS $348.00 C1751
306100041 N-BIAP HEATED HUMIDIFIER $163.00 E0562
306100042 N-BIPAP MACHINE $522.00 E0601
306100043 N-ADULT CERVICAL COLLAR $33.00 L0172
306100044 N-ANKLE BRACE-LACER-L $134.00 L1902
306100045 N-ANLKE BRACE-LACER-M $134.00 L1902
306100046 N-ANKLE AIR SPLINT 90 $385.00 L1906
306100047 N-ANKLE WALKER- MED. $326.00 L1930
306100048 N-SHOE, POST OP MENS-LG $16.00 L3260
306100049 N-SHOE, POST OP FML - MED $16.00 L3260
306100050 N-SHOE, POST OP FML - LG $16.00 L3260
306100051 N-WRIST & THUMB SPLINT $67.00 L3908
306100052 N-WRIST IMMOBILIZER $104.00 L3980
306100053 N-ANKLE BRACE $140.00 L4350
306100054 N-WALKING BOOT $141.00 L4361
306100055 N-WALKING BOOT $141.00 L4361
306100056 N-WALKING BOOT NON PNEUMATIC $141.00 L4387
306100057 N-MEDE KAST ULTRA CASTING SYSTEM TCC2ULTR $213.00 Q4038
307010056 A-ARM SLING LARGE $54.00 A4565
307010057 A-FOREARM SPLINT, PADDED, MED $31.00 A4570
307010058 A-CPAP FACEMASK - LARGE $385.00 A7030
307010059 A-CPAP HEADGEAR $164.00 A7035
307010060 A-CPAP TUBING $168.00 A7037
307010061 A-ENTERNAL FEEDING SUPPLY KIT $7.00 B4034
307010062 A-ENTERAL PUMP KIT $12.00 B4035
307010063 A-NUTRITION PUMP KIT $53.00 B4035
307010064 A-ENTERAL INFUSION PUMP $12.00 B9002
307010065 A-CATHETER, INFUSION, OTHER THAN HEMODIALYSIS $348.00 C1751
307010066 A-CATHETER INFUSION, NON-HEMODIALYSIS $348.00 C1751
307010067 A-BIAP HEATED HUMIDIFIER $163.00 E0562
307010068 A-BIPAP MACHINE $522.00 E0601
307010069 A-ADULT CERVICAL COLLAR $33.00 L0172
307010070 A-ANKLE BRACE-LACER-L $134.00 L1902
307010071 A-ANLKE BRACE-LACER-M $134.00 L1902
307010072 A-ANKLE AIR SPLINT 90 $385.00 L1906
307010073 A-ANKLE WALKER- MED. $326.00 L1930
307010074 A-SHOE, POST OP MENS-LG $16.00 L3260
307010075 A-SHOE, POST OP FML - MED $16.00 L3260
307010076 A-SHOE, POST OP FML - LG $16.00 L3260
307010077 A-WRIST & THUMB SPLINT $67.00 L3908
307010078 A-WRIST IMMOBILIZER $104.00 L3980
307010079 A-ANKLE BRACE $140.00 L4350
307010080 A-WALKING BOOT $141.00 L4361
307010081 A-WALKING BOOT $141.00 L4361
307010082 A-WALKING BOOT NON PNEUMATIC $141.00 L4387
307010083 A-MEDE KAST ULTRA CASTING SYSTEM TCC2ULTR $213.00 Q4038
35 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
405120017 CS-ANL;E BRACE-LACER-M $134.00 L1902
405120027 CS-WALKING BOOT $141.00 L4361
53200001 D-NUTRITION THERAPY 15 MIN. $54.00 97802
417040429 gentamicin 3 MG/ML EYE DROP 5 mL $32.50
42330001 ED-I&D ABSCESS SIMPLE $253.43 10060
42280008 OT-OCC. ADL. TRAINING 15"" $61.00 97535
42280007 OT-OCCU. THERAPY 15 MIN $61.00 97530
42280005 OT-MANUAL THERAPY 15 MIN"" $71.99 97140
42280004 OT-MASSAGE $17.00 97124
42280003 OT-NEUROMUSCULAR REDUCTION $58.00 97112
422180003 OT-NEUROMUSCULAR REDUCTION $58.00 97112
42400001 PR-LAC N/H/F 12.6-20 CM $611.00 12045
42280002 OT-OCC. THERAPUTIC EXERC $78.00 97110
422180002 OT-OCC. THERAPUTIC EXERC $78.00 97110
42280001 OT-OCC. THERAPY EVALUATION $175.00 97003
42400002 PR-LAC N/H/F 20.1-30 CM $611.00 12046
422180001 OT-OCC. THERAPY EVALUATION $175.00 97003
422180008 OT-OCC. ADL. TRAINING 15"" $61.00 97535
422180007 OT-OCCU. THERAPY 15 MIN $61.00 97530
42280006 OT-OCC. THERAPY RE-EVAL. $133.00 97168
422180006 OT-OCC. THERAPY RE-EVAL. $133.00 97168
422180005 OT-MANUAL THERAPY 15 MIN"" $71.99 97140
422180004 OT-MASSAGE $17.00 97124
424210001 PR-LAC N/H/F 12.6-20 CM $611.00 12045
424210002 PR-LAC N/H/F 20.1-30 CM $611.00 12046
42400003 PR-LAC N/H/F > 30 CM INTM $1,961.00 12047
424210003 PR-LAC N/H/F > 30 CM INTM $1,961.00 12051
42400004PR-WOUND INTERMEDIATE REPAIR OF F,E,E,N,L, AND OR MUCOUS
MEMBRANES 2.5 CM OR LESS $467.00 12051
424210004PR-WOUND INTERMEDIATE REPAIR OF F,E,E,N,L, AND OR MUCOUS
MEMBRANES 2.5 CM OR LESS $467.00 12051
42400005 PR-WOUNDS INTERMEDIATE REPAIR-LAC FACE 2.6-5.0 CM $467.00 12052
424210005 PR-WOUNDS INTERMEDIATE REPAIR-LAC FACE 2.6-5.0 CM $467.00 12052
42400006 PR-WOUND INTERMEDIATE REPAIR LAC FACE 5.1-7.5 CM $611.00 12053
424210006 PR-WOUND INTERMEDIATE REPAIR LAC FACE 5.1-7.5 CM $611.00 12053
42400007 PR-WOUND INTERMEDIATE REPAIR LAC FACE 7.6-12.5 CM INTM $611.00 12054
424210007 PR-WOUND INTERMEDIATE REPAIR LAC FACE 7.6-12.5 CM INTM $611.00 12054
42400008 PR-WOUND INTERMEDIATE REPAIR LAC FACE 12.6-20 CM INTM $611.00 12055
424210008 PR-WOUND INTERMEDIATE REPAIR LAC FACE 12.6-20 CM INTM $611.00 12055
42400009 PR-WOUND INTERMEDIATE REPAIR LAC FACE 20.1-30 $611.00 12056
424210009 PR-WOUND INTERMEDIATE REPAIR LAC FACE 20.1-30 $611.00 12056
42400010 PR-WOUND INTERMEDIATE REPAIR LAC FACE > 30 CM $1,961.00 12057
424210010 PR-WOUND INTERMEDIATE REPAIR LAC FACE > 30 CM $1,961.00 12057
42400011 PR-WOUND COMPLEX REPAIR TRNK 1.1-2.5 CM $611.00 13100
424210011 PR-WOUND COMPLEX REPAIR TRNK 1.1-2.5 CM $611.00 13100
42400012 PR-WOUND COMPLEX REPAIR LAC TRNK 2.6-7.5 CM $611.00 13101
424210012 PR-WOUND COMPLEX REPAIR LAC TRNK 2.6-7.5 CM $611.00 13101
36 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42400013 PR-WOUND COMPLEX REPAIR LAC S/A/L 1.1-2.5CM $611.00 13120
424210013 PR-WOUND COMPLEX REPAIR LAC S/A/L 1.1-2.5CM $611.00 13120
42400014 PR-WOUND COMPLEX REPAIR LAC S/A/L 2.6-7.5CM $611.00 13121
42400015 PR-WOUND COMPLEX REPAIR LAC N/H/F 1.1-2.5CM $467.00 13131
424210015 PR-WOUND COMPLEX REPAIR LAC N/H/F 1.1-2.5CM $467.00 13131
42400016 PR-WOUND COMPLEX REPAIR LAC N/H/F 2.6-7.5CM $611.00 13132
424210016 PR-WOUND COMPLEX REPAIR LAC N/H/F 2.6-7.5CM $611.00 13132
42400017 PR-WOUND COMPLEX REPAIR FACE,EAR,LIP,EYE 1.0 CM TO 2.5 CM $611.00 13151
424210017 PR-WOUND COMPLEX REPAIR FACE,EAR,LIP,EYE 1.0 CM TO 2.5 CM $611.00 13151
42400018 PR-WOUND COMPLEX REPAIR LAC FACE 1.1-2.5 CM $611.00 13151
424210018 PR-WOUND COMPLEX REPAIR LAC FACE 1.1-2.5 CM $611.00 13151
42400019 PR-WOUND COMPLEX REPAIR LAC FACE 2.6-7.5 CM $733.00 13152
424210019 PR-WOUND COMPLEX REPAIR LAC FACE 2.6-7.5 CM $733.00 13152
42400020 PR-PR-BURN INITIAL TX 1ST DEGR. $221.00 16000
424210020 PR-PR-BURN INITIAL TX 1ST DEGR. $221.00 16000
42400021 PR-BURN DBRD/DRSS SM<5% $300.00 16020
424210021 PR-BURN DBRD/DRSS SM<5% $300.00 16020
42400022 PR-BURN DBRD/DRSS MED 5-10% $370.00 16025
42400023 PR-BURN DBRD/DRSS LG > 10% $467.00 16030
424210023 PR-BURN DBRD/DRSS LG > 10% $467.00 16030
42400024 PR-DESTROY B9 LESION 1ST ONE $212.00 17000
424210024 PR-DESTROY B9 LESION 1ST ONE $212.00 17000
42400025 PR-WOUND EXPLORATION EXTREM $717.00 20103
424210025 PR-WOUND EXPLORATION EXTREM $717.00 20103
42400026 PR-RMV FRN BDY MSCL/TNDN SMP $1,686.00 20520
424210026 PR-RMV FRN BDY MSCL/TNDN SMP $1,686.00 20520
42400027 PR-CARPEL TUNNEL INJECTION $334.00 20526
424210027 PR-CARPEL TUNNEL INJECTION $334.00 20526
42400028 PR-TRIGGER POINT INJECTIONS $334.00 20552
424210028 PR-TRIGGER POINT INJECTIONS $334.00 20552
42400029 PR-TRIGGER POINT INJECTIONS $334.00 20553
424210029 PR-TRIGGER POINT INJECTIONS $334.00 20553
42400030 PR-DRAIN/INJ SM JOINT/BURSA $334.00 20600
42400031 PR-DRAIN/INJ MAJR JOINT/BURS $334.00 20610
42400032 PR-SHOULDER TX W/O ANESTHESA $323.00 23650
424210032 PR-SHOULDER TX W/O ANESTHESA $323.00 23650
42400033 PR-SHOULDER TX WITH ANESTHES $1,688.00 23655
424210033 PR-SHOULDER TX WITH ANESTHES $1,688.00 23655
42400034 PR-ELBOW TX WITH ANESTHESIA $1,688.00 24605
424210034 PR-ELBOW TX WITH ANESTHESIA $1,688.00 23655
42400035 PR-I&D FINGER COMPLEX $1,686.00 26011
424210035 PR-I&D FINGER COMPLEX $1,686.00 26011
42400036 PR-EXCISION OF CYST HAND/FIN $1,688.00 26160
424210036 PR-EXCISION OF CYST HAND/FIN $1,688.00 26160
42400037 PR-KNUCKLE TX W/OUT ANESTHES $358.00 26700
424210037 PR-KNUCKLE TX W/OUT ANESTHES $358.00 26700
42400038 PR-FINGER TX W/OUT ANESTHESA $1,688.00 26742
37 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
424210038 PR-FINGER TX W/OUT ANESTHESA $1,688.00 26742
42400039 PR-INCISION OF ABSCESS $2,907.00 27301
424210039 PR-INCISION OF ABSCESS $2,907.00 27301
42400040 PR-KNEE TX WITH ANESTHESIA $1,688.00 27552
424210040 PR-KNEE TX WITH ANESTHESIA $1,688.00 27552
42400041 PR-KNEECAP TX W/OUT ANESTHES $370.00 27560
424210041 PR-KNEECAP TX W/OUT ANESTHES $370.00 27560
42400042 PR-SPLINT LONG ARM $229.00 29105
424210042 PR-SPLINT LONG ARM $229.00 29105
42400043 PR-SPLINT SHORT ARM $212.00 29125
424210043 PR-SPLINT SHORT ARM $212.00 29125
42400044 PR-SPLINT LONG LEG $232.00 29505
424210044 PR-SPLINT LONG LEG $232.00 29505
42400045 PR-SPLINT SHORT LEG $222.00 29515
424210045 PR-SPLINT SHORT LEG $222.00 29515
42060164PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-
100% IMPAIRED $- G8995
420170164PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-
100% IMPAIRED $- G8995
42060163PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-80-
99% IMPAIRED $- G8995
420170163PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-80-
99% IMPAIRED $- G8995
42060162PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-60-
79% IMPAIRED $- G8995
420170162PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-60-
79% IMPAIRED $- G8995
42060161PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-40
-59% IMPAIRED $- G8995
420170161PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-40
-59% IMPAIRED $- G8995
42060160PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-20-
39% IMPAIRED $- G8995
420170160PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-20-
39% IMPAIRED $- G8995
42060159PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-1-
19% IMPAIRED $- G8995
420170159PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-1-
19% IMPAIRED $- G8995
42060158PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-
0% IMPAIRED $- G8995
420170158PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-
0% IMPAIRED $- G8995
42060157PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-100%
IMPAIRED $- G8994
420170157PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-100%
IMPAIRED $- G8994
38 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42060156PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-80-99%
IMPAIRED $- G8994
420170156PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-80-99%
IMPAIRED $- G8994
42060155PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-60-79%
IMPAIRED $- G8994
420170155PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-60-79%
IMPAIRED $- G8994
42060154PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-40 -59%
IMPAIRED $- G8994
420170154PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-40 -59%
IMPAIRED $- G8994
42060153PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-20-39%
IMPAIRED $- G8994
420170153PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-20-39%
IMPAIRED $- G8994
42060152PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-1-19%
IMPAIRED $- G8994
420170152PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-1-19%
IMPAIRED $- G8994
42060151PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-0%
IMPAIRED $- G8994
420170151PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-0%
IMPAIRED $- G8994
42060150PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-
100% IMPAIRED $- G8993
420170150PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-
100% IMPAIRED $- G8993
42060149PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-80-
99% IMPAIRED $- G8993
420170149PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-80-
99% IMPAIRED $- G8993
42060148PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-60-
79% IMPAIRED $- G8993
420170148PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-60-
79% IMPAIRED $- G8993
42060147PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-40 -
59% IMPAIRED $- G8993
420170147PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-40 -
59% IMPAIRED $- G8993
42060146PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-20-
39% IMPAIRED $- G8993
420170146PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-20-
39% IMPAIRED $- G8993
42060145PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-1-
19% IMPAIRED $- G8993
39 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
420170145PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-1-
19% IMPAIRED $- G8993
42060144PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-0%
IMPAIRED $- G8993
420170144PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-0%
IMPAIRED $- G8993
42060143PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-100%
IMPAIRED $- G8992
420170143PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-100%
IMPAIRED $- G8992
42060142PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-80%-
99% IMPAIRED $- G8992
420170142PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-80%-
99% IMPAIRED $- G8992
42060141PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-60%-
79% IMPAIRED $- G8992
420170141PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-60%-
79% IMPAIRED $- G8992
42060140PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-40%-
59% IMPAIRED $- G8992
420170140PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-40%-
59% IMPAIRED $- G8992
42060139PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-20%-
39% IMPAIRED $- G8992
420170139PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-20%-
39% IMPAIRED $- G8992
42060138PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-1%-19%
IMPAIRED $- G8992
420170138PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-1%-19%
IMPAIRED $- G8992
42060137PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-0%
IMPAIRED $- G8992
420170137PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-0%
IMPAIRED $- G8992
42060136PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-100% IMPAIRED $- G8991
420170136PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-100% IMPAIRED $- G8991
42060135PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-80%-99%
IMPAIRED $- G8991
420170135PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-80%-99%
IMPAIRED $- G8991
42060134PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-60%-79%
IMPAIRED $- G8991
420170134PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-60%-79%
IMPAIRED $- G8991
40 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42060133PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-40%-59%
IMPAIRED $- G8991
420170133PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-40%-59%
IMPAIRED $- G8991
42060132PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-20%-39%
IMPAIRED $- G8991
420170132PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-20%-39%
IMPAIRED $- G8991
42060131PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-1%-19% IMPAIRED $- G8991
420170131PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-1%-19% IMPAIRED $- G8991
42060130PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-0% IMPAIRED $- G8991
420170130PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-0% IMPAIRED $- G8991
42060129PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-100%
IMPAIRED $- G8990
420170129PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-100%
IMPAIRED $- G8990
42060128PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-80%-99%
IMPAIRED $- G8990
420170128PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-80%-99%
IMPAIRED $- G8990
42060127PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-60%-79%
IMPAIRED $- G8990
420170127PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-60%-79%
IMPAIRED $- G8990
42060126PT-PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-40%-59%
IMPAIRED $- G8990
420170126PT-PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-40%-59%
IMPAIRED $- G8990
42060125PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-20%-39%
IMPAIRED $- G8990
420170125PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-20%-39%
IMPAIRED $- G8990
42060124PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-1%-19%
IMPAIRED $- G8990
420170124PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-1%-19%
IMPAIRED $- G8990
42060123PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-0% IMPAIRED $- G8990
420170123PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-0% IMPAIRED $- G8990
42060122 PT-SELF CARE DISCHARGE-100% IMPAIRED $- G8989
420170122 PT-SELF CARE DISCHARGE-100% IMPAIRED $- G8989
42060121 PT-SELF CARE DISCHARGE-80%-99% IMPAIRED $- G8989
41 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
420170121 PT-SELF CARE DISCHARGE-80%-99% IMPAIRED $- G8989
42060120 PT-SELF CARE DISCHARGE-60%-79% IMPAIRED $- G8989
420170120 PT-SELF CARE DISCHARGE-60%-79% IMPAIRED $- G8989
42060119 PT-SELF CARE DISCHARGE-40%-59% IMPAIRED $- G8989
420170119 PT-SELF CARE DISCHARGE-40%-59% IMPAIRED $- G8989
42060118 PT-SELF CARE DISCHARGE-20%-39% IMPAIRED $- G8989
420170118 PT-SELF CARE DISCHARGE-20%-39% IMPAIRED $- G8989
42060117 PT-SELF CARE DISCHARGE-1%-19% IMPAIRED $- G8989
420170117 PT-SELF CARE DISCHARGE-1%-19% IMPAIRED $- G8989
42060116 PT-SELF CARE DISCHARGE-0% IMPAIRED $- G8989
420170116 PT-SELF CARE DISCHARGE-0% IMPAIRED $- G8989
42060115 PT-SELF CARE GOAL-100% IMPAIRED $- G8988
42060115 PT-SELF CARE GOAL-100% IMPAIRED $- G8988
420170115 PT-SELF CARE GOAL-100% IMPAIRED $- G8988
420170114 PT-SELF CARE GOAL-80%-99% IMPAIRED $- G8988
42060114 PT-SELF CARE GOAL-80%-99% IMPAIRED $- G8988
42060113 PT-SELF CARE GOAL-60%-79% IMPAIRED $- G8988
420170113 PT-SELF CARE GOAL-60%-79% IMPAIRED $- G8988
42060112 PT-SELF CARE GOAL-40%-59% IMPAIRED $- G8988
420170112 PT-SELF CARE GOAL-40%-59% IMPAIRED $- G8988
42060111 PT-SELF CARE GOAL-20%-39% IMPAIRED $- G8988
420170111 PT-SELF CARE GOAL-20%-39% IMPAIRED $- G8988
42060110 PT-SELF CARE GOAL-1%-19% IMPAIRED $- G8988
420170110 PT-SELF CARE GOAL-1%-19% IMPAIRED $- G8988
42060109 PT-SELF CARE GOAL-0% IMPAIRED $- G8988
420170109 PT-SELF CARE GOAL-0% IMPAIRED $- G8988
42060108 PT--SPT-ELF CARE CURRENT-100%IMPAIRED $- G8987
420170108 PT--SPT-ELF CARE CURRENT-100%IMPAIRED $- G8987
42060107 PT--SPT-ELF CARE CURRENT-80-99% IMPAIRED $- G8987
420170107 PT--SPT-ELF CARE CURRENT-80-99% IMPAIRED $- G8987
42060106 PT-SPT-ELF CARE CURRENT-60%-79% IMPAIRED $- G8987
420170106 PT-SPT-ELF CARE CURRENT-60%-79% IMPAIRED $- G8987
42060105 PT-SELF CARE CURRENT-40-59% IMPAIRED $- G8987
420170105 PT-SELF CARE CURRENT-40-59% IMPAIRED $- G8987
42060104 PT-SELF CARE CURRENT-20-39% IMPAIRED $- G8987
420170104 PT-SELF CARE CURRENT-20-39% IMPAIRED $- G8987
42060103 PT-SELF CARE CURRENT-1-19% IMPAIRED $- G8987
420170103 PT-SELF CARE CURRENT-1-19% IMPAIRED $- G8987
42060102 PT-SELF CARE CURRENT-0% IMPAIRED $- G8987
420170102 PT-SELF CARE CURRENT-0% IMPAIRED $- G8987
42060101PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-100%
IMPAIRED $- G8986
420170101PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-100%
IMPAIRED $- G8986
42060100PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-80%-99%
IMPAIRED $- G8986
42 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
420170100PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-80%-99%
IMPAIRED $- G8986
42060099PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-60%-79%
IMPAIRED $- G8986
420170099PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-60%-79%
IMPAIRED $- G8986
42060098PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-40%-59%
IMPAIRED $- G8986
420170098PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-40%-59%
IMPAIRED $- G8986
42060097PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-20%-39%
IMPAIRED $- G8986
420170097PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-20%-39%
IMPAIRED $- G8986
42060096PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-1%-19%
IMPAIRED $- G8986
420170096PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-1%-19%
IMPAIRED $- G8986
42060095PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-0%
IMPAIRED $- G8986
420170095PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-0%
IMPAIRED $- G8986
42060094PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-100% IMPAIRED $- G8985
420170094PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-100% IMPAIRED $- G8985
42060093PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-80%-99%
IMPAIRED $- G8985
420170093PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-80%-99%
IMPAIRED $- G8985
42060092PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-60%-79%
IMPAIRED $- G8985
420170092PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-60%-79%
IMPAIRED $- G8985
42060091PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-40%-59%
IMPAIRED $- G8985
420170091PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-40%-59%
IMPAIRED $- G8985
42060090PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-20%-39%
IMPAIRED $- G8985
420170090PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-20%-39%
IMPAIRED $- G8985
42060089PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-1%-19%
IMPAIRED $- G8985
420170089PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-1%-19%
IMPAIRED $- G8985
43 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42060088PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-0% IMPAIRED $- G8985
420170088PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-0% IMPAIRED $- G8985
42060087PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-100%
IMPAIRED $- G8984
420170087PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-100%
IMPAIRED $- G8984
42060086PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-80%-99%
IMPAIRED $- G8984
420170086PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-80%-99%
IMPAIRED $- G8984
42060085PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-60%-79%
IMPAIRED $- G8984
420170085PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-60%-79%
IMPAIRED $- G8984
42060084PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-40%-59%
IMPAIRED $- G8984
420170084PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-40%-59%
IMPAIRED $- G8984
42060083PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-20%-39%
IMPAIRED $- G8984
420170083PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-20%-39%
IMPAIRED $- G8984
42060082PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-1%-19%
IMPAIRED $- G8984
420170082PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-1%-19%
IMPAIRED $- G8984
42060081PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-0%
IMPAIRED $- G8984
420170081PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-0%
IMPAIRED $- G8984
42060080PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-100%
IMPAIRED $- G8983
420170080PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-100%
IMPAIRED $- G8983
42060079PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE- 80%-99%
IMPAIRED $- G8983
420170079PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE- 80%-99%
IMPAIRED $- G8983
42060078PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-60% -79%
IMPAIRED $- G8983
420170078PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-60% -79%
IMPAIRED $- G8983
42060077PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-40%-59%
IMPAIRED $- G8983
44 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
420170077PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-40%-59%
IMPAIRED $- G8983
42060076PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-20%-39%
IMPAIRED $- G8983
420170076PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-20%-39%
IMPAIRED $- G8983
42060075PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-1%-19%
IMPAIRED $- G8983
420170075PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-1%-19%
IMPAIRED $- G8983
42060074PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-0%
IMPAIRED $- G8983
420170074PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-0%
IMPAIRED $- G8983
42060073PT-CHANGING AND MAINTAINING BODY POSITION GOAL-100% IMPAIRED $- G8982
420170073PT-CHANGING AND MAINTAINING BODY POSITION GOAL-100% IMPAIRED $- G8982
42060072PT-CHANGING AND MAINTAINING BODY POSITION GOAL-80-99%
IMPAIRED $- G8982
420170072PT-CHANGING AND MAINTAINING BODY POSITION GOAL-80-99%
IMPAIRED $- G8982
42060071PT-CHANGING AND MAINTAINING BODY POSITION GOAL-60-79%
IMPAIRED $- G8982
420170071PT-CHANGING AND MAINTAINING BODY POSITION GOAL-60-79%
IMPAIRED $- G8982
42060070PT-CHANGING AND MAINTAINING BODY POSITION GOAL-40-59%
IMPAIRED $- G8982
420170070PT-CHANGING AND MAINTAINING BODY POSITION GOAL-40-59%
IMPAIRED $- G8982
42060069PT-CHANGING AND MAINTAINING BODY POSITION GOAL-20-39%
IMPAIRED $- G8982
420170069PT-CHANGING AND MAINTAINING BODY POSITION GOAL-20-39%
IMPAIRED $- G8982
42060068PT-CHANGING AND MAINTAINING BODY POSITION GOAL-1-19%
IMPAIRED $- G8982
420170068PT-CHANGING AND MAINTAINING BODY POSITION GOAL-1-19%
IMPAIRED $- G8982
42060067PT-CHANGING AND MAINTAINING BODY POSITION GOAL-0% IMPAIRED $- G8982
420170067PT-CHANGING AND MAINTAINING BODY POSITION GOAL-0% IMPAIRED $- G8982
42060066PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-100%
IMPAIRED $- G8981
420170066PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-100%
IMPAIRED $- G8981
45 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42060065PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-80-99
IMPAIRED $- G8981
420170065PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-80-99
IMPAIRED $- G8981
42060064PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-60-79%
IMPAIRED $- G8981
420170064PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-60-79%
IMPAIRED $- G8981
42060063PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-40-59%
IMPAIRED $- G8981
420170063PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-40-59%
IMPAIRED $- G8981
42060062PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-20-39%
IMPAIRED $- G8981
420170062PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-20-39%
IMPAIRED $- G8981
42060061PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-1-19%
IMPAIRED $- G8981
42060060PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-0%
IMPAIRED $- G8981
420170060PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-0%
IMPAIRED $- G8981
42060059 PT-MOBILITY DISCHARGE-100% IMPAIRED $- G8980
420170059 PT-MOBILITY DISCHARGE-100% IMPAIRED $- G8980
42060058 PT-MOBILITY DISCHARGE-80-99% IMPAIRED $- G8980
420170058 PT-MOBILITY DISCHARGE-80-99% IMPAIRED $- G8980
42060057 PT-MOBILITY DISCHARGE-60-79% IMPAIRED $- G8980
420170057 PT-MOBILITY DISCHARGE-60-79% IMPAIRED $- G8980
42060056 PT-MOBILITY DISCHARGE-40-59% IMPAIRED $- G8980
420170056 PT-MOBILITY DISCHARGE-40-59% IMPAIRED $- G8980
42060055 PT-MOBILITY DISCHARGE-20-39% IMPAIRED $- G8980
420170055 PT-MOBILITY DISCHARGE-20-39% IMPAIRED $- G8980
42060054 PT-MOBILITY DISCHARGE-1-19% IMPAIRED $- G8980
420170054 PT-MOBILITY DISCHARGE-1-19% IMPAIRED $- G8980
42060053 PT-MOBILITY DISCHARGE-0% IMPAIRED $- G8980
420170053 PT-MOBILITY DISCHARGE-0% IMPAIRED $- G8980
42060052 PT-MOBILITY GOAL STATUS-100% IMPAIRED $- G8979
420170052 PT-MOBILITY GOAL STATUS-100% IMPAIRED $- G8979
42060051 PT-MOBILITY GOAL STATUS-80-99% IMPAIRED $- G8979
420170051 PT-MOBILITY GOAL STATUS-80-99% IMPAIRED $- G8979
42060050 PT-MOBILITY GOAL STATUS-60-79% IMPAIRED $- G8979
420170050 PT-MOBILITY GOAL STATUS-60-79% IMPAIRED $- G8979
42060049 PT-MOBILITY GOAL STATUS-40-59% IMPAIRED $- G8979
420170049 PT-MOBILITY GOAL STATUS-40-59% IMPAIRED $- G8979
42060048 PT-MOBILITY GOAL STATUS-20-39% IMPAIRED $- G8979
420170048 PT-MOBILITY GOAL STATUS-20-39% IMPAIRED $- G8979
42060047 PT-MOBILITY GOAL STATUS-1-19% IMPAIRED $- G8979
46 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42060046 PT-MOBILITY GOAL STATUS-0% IMPAIRED $- G8979
420170046 PT-MOBILITY GOAL STATUS-0% IMPAIRED $- G8979
42060045 PT-MOBILITY CURRENT STATUS-100% IMPAIRED $- G8978
420170045 PT-MOBILITY CURRENT STATUS-100% IMPAIRED $- G8978
42060044 PT-MOBILITY CURRENT STATUS-80-99% IMPAIRED $- G8978
420170044 PT-MOBILITY CURRENT STATUS-80-99% IMPAIRED $- G8978
42060043 PT-MOBILITY CURRENT STATUS-60-79% IMPAIRED $- G8978
420170043 PT-MOBILITY CURRENT STATUS-60-79% IMPAIRED $- G8978
42060042 PT-MOBILITY CURRENT STATUS-40-59% IMPAIRED $- G8978
420170042 PT-MOBILITY CURRENT STATUS-40-59% IMPAIRED $- G8978
42060041 PT-MOBILITY CURRENT STATUS-20-39% IMPAIRED $- G8978
42060040 PT-MOBILITY CURRENT STATUS-1-19% IMPAIRED $- G8978
420170040 PT-MOBILITY CURRENT STATUS-1-19% IMPAIRED $- G8978
42060039 PT-MOBILITY CURRENT STATUS-0% IMPAIRED $- G8978
420170039 PT-MOBILITY CURRENT STATUS-0% IMPAIRED $- G8978
420170038 PT-ELEC.STIM.UNATT/ MEDICARE $39.00 G0283
42060037 PT-UNLIST.PT/REHAB/BY RPT $81.00 97799
420170037 PT-UNLIST.PT/REHAB/BY RPT $81.00 97799
42060038 PT-ELEC.STIM.UNATT/ MEDICARE $39.00 G0283
42060036 PT-ORTHOTIC MNGMT. 15 MIN $84.00 97760
420170036 PT-ORTHOTIC MNGMT. 15 MIN $84.00 97760
42060035 PT-P.T.PRFRM TEST/REPORT 15 $81.00 97750
420170035 PT-P.T.PRFRM TEST/REPORT 15 $81.00 97750
42060034 PT-WHEELCHAIR MNGT EA.15 MIN $135.00 97542
420170034 PT-WHEELCHAIR MNGT EA.15 MIN $135.00 97542
42060033 PT-COMMUNITY INTERGRATION $74.00 97537
420170033 PT-COMMUNITY INTEGRATION $74.00 97537
42060032 PT-SELF CARE/ADL $61.00 97535
420170032 PT-SELF CARE/ADL $61.00 97535
42060031 PT-PT SELF CARE/HOME ASSMT. $74.00 97535
420170031 PT-PT SELF CARE/HOME ASSMT. $74.00 97535
42060030 PT-THERAPEUTIC ACT. 15 MIN. $66.00 97530
42060029 PT-SCHOOL THERAPY 15 MIN. $66.00 97530
42060028 PT-PT. RE-EVAL PERIODIC $124.00 97164
42060027 PT-SCHOOL RE-EVALUATION $124.00 97164
420170027 PT-SCHOOL RE-EVALUATION $124.00 97164
42060026 PT-PHYSICAL THERAPY RE-EVALUATION $124.00 97164
42060025 PT-PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY $230.00 97163
42060024 PT-PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY $199.00 97162
42060023 PT-PHYSICAL THERAPY EVALUATION LOW COMPLEXITY $188.00 97161
42060021 PT-ULISTED THERAP PROC SPECI $81.00 97139
420170021 PT-ULISTED THERAP PROC SPECI $81.00 97139
42060020 PT-MASSAGE THERAPY 15 MIN $87.00 97124
420170020 PT-MASSAGE THERAPY 15 MIN $87.00 97124
42060019 PT-GAIT TRAINING $88.00 97116
42060018 PT-SCHOOL GAIT TRAINING $88.00 97116
420170018 PT-SCHOOL GAIT TRAINING $88.00 97116
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42060017 PT-NEUROMUSCULAR REEDUCATION $80.00 97112
42060016 PT-SCHOOL NEUROMUSCULAR REDU $80.00 97112
420170016 PT-SCHOOL NEUROMUSCULAR REDU $80.00 97112
42060015 PT-THERAPEUTIC EXERC. 15 MIN $93.00 97110
42060014 PT-SCHOOL THERAPEUTIC EXER. $65.00 97110
420170014 PT-SCHOOL THERAPEUTIC EXER. $65.00 97110
42060013 PT-ULTRASOUND,EACH 15" $52.00 97035
420170013 PT-ULTRASOUND,EACH 15" $52.00 97035
42060012 PT-CONTRAST BATH,EACH 15" $38.00 97034
420170012 PT-CONTRAST BATH,EACH 15" $38.00 97034
42060011 PT-IONTOPHORESIS 15 MIN. EA. $56.00 97033
420170011 PT-IONTOPHORESIS 15 MIN. EA. $56.00 97033
42060010 PT-ELECTRICAL STM ATTENDED $72.00 97032
420170010 PT-ELECTRICAL STM ATTENDED $72.00 97032
42060009 PT-WHIRLPOOL $40.00 97022
420170009 PT-WHIRLPOOL $40.00 97022
42060008 PT-PARAFIN BATH $18.00 97018
420170008 PT-PARAFIN BATH $18.00 97018
420170028 PT-PT. RE-EVAL PERIODIC $124.00 97164
420170026 PT-PHYSICAL THERAPY RE-EVALUATION $124.00 97164
420170025 PT-PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY $230.00 97163
420170023 PT-PHYSICAL THERAPY EVALUATION LOW COMPLEXITY $188.00 97161
42060004 PT-PT. EVAL INITIAL $195.00 97001
420170004 PT-PT. EVAL INITIAL $195.00 97001
418160001 I-BREATHING CAPACITY TEST $175.00 94010
42060007 PT-APP MOD VASOPNEUMATIC DEV $44.00 97016
420170007 PT-APP MOD VASOPNEUMATIC DEV $44.00 97016
42060006 PT-ELECTRICAL STIM(UNATTENDE $60.00 97014
420170006 PT-ELECTRICAL STIM(UNATTENDE $60.00 97014
42060005 PT-TRACTION MECHANICAL $40.00 97012
420170005 PT-TRACTION MECHANICAL $40.00 97012
42060003 PT-SCHOOL THERAPY EVAL. $195.00 97001
420170003 PT-SCHOOL THERAPY EVAL. $195.00 97001
42060002 PT-CANALITH REPOSITIONING $100.00 95992
420170002 PT-CANALITH REPOSITIONING $100.00 95992
42060001 PT-DYNAMIC FINGER SPLINTING $153.00 29131
420170001 PT-DYNAMIC FINGER SPLINTING $153.00 29131
42330002 ED-I&D ABSCESS, COMPLEX $389.00 10061
42330003 ED-REMOVE-FB SKIN $389.00 10120
42330004 ED-PUNCTURE ASPIRATE ABSCESS $389.00 10160
42330005 ED-DEBRID, SKIN-SUB Q TISSUE $389.00 11042
42330006 ED-SIMPLE-EXTREMITY H/N/T $212.00 12001
42330007 ED-SIMP REP H/N/T 2.6-7.5CM $212.00 12002
42330008 ED-WOUND, SUPERFICIAL, SIMPLE-FACE,L/E/E, FEET $212.00 12011
42330009 ED-LAC FACE 5.1CM-7.5CM $254.00 12014
42330010 ED-LAC FACE 7.6-12.5CM $254.00 12015
42330011 ED-LAC FACE 12.6 - 20. CM $467.00 12016
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42330012 ED-INTERMED-ARM,LEG,TRUNK,SC $467.00 12031
42330013 ED-INTERMED-NECK,HAND,FEET,G $467.00 12041
42330014 ED-INTERMED-FACE,EAR,LIP,EYE $467.00 12051
42330015 ED-COMPLEX-ARM,LEG,TRUN,SCAL $610.00 13100
42330016 ED-COMPLEX-NECK,HAND,FEET,G $467.00 13131
42330017 ED-COMPLEX-FACE,EAR,LIP,EYE 1.0 CM TO 2.5 CM $610.00 13151
42330018 ED-INITIAL BURN TX LOCAL $254.00 16000
42330019 ED-BURN DRESS/DEBRIDE P <5% $254.00 16020
42330020 ED-BURN DRESSY INTERMEDIATE 5-10% $254.00 16025
42330021 ED-BURN DRESSING COMPLEX $467.00 16030
42330022 ED-INJ.TENDON/LIGAMENT $368.00 20550
42330023 ED-TRMT SHOULDER DISLOCATION $323.00 23650
42330024 ED-ELBOW DISLOCATION W/CL RE $1,688.00 24605
42330025 ED-METACARPAL CLOSED W/REDUC $323.00 26700
42330026 ED-KNEE DISLOCATION W/CL RED $1,688.00 27552
42330027 ED-SPLINT ARM, LONG $229.00 29105
42330028 ED-SPLINT ARM, SHORT $212.00 29125
42330029 ED-SPLINT LEG, LONG $232.00 29505
42330030 ED-SPLINT LEG, SHORT $222.00 29515
42330031 ED-REMOVE-FB NASAL $158.00 30300
42330032 ED-EENT CONTROL NOSE BLEED $158.00 30901
42330033 ED-EENT CONT NOSE BLEED BILA $158.00 30901
42330034 ED-NOSE BLEED WITH PACKING $211.00 30905
42330035 ED-ENDOTRACHEAL INTUBATION $268.00 31500
42330036 ED-THORANCENTESIS-ASPIRATION $330.00 32554
42330037 ED-LAW ENFORCEMENT BLOOD DRA $25.00 36415
42330038 ED-CENTRAL LINE INSERTION $1,475.00 36556
42330039 ED-INSERT NEEDLE BONE CAVITY $429.00 36680
42330040 ED-GASTRIC INTUBATION $341.00 43753
42330041 ED-STRAIGHT CATHETERIZATION $158.00 51701
42330042 ED-CATHETERIZATION $210.00 51702
42330043 ED-INJ. SPINE L/S ER FAC. $1,497.00 62322
42330044 ED-REMOVE-FB EYE EXTERNAL $281.00 65205
42330045 ED-REMOVE-FB EYE COMPLEX $313.00 65222
42330046 ED-REMOVE-FB EAR $281.00 69200
42330047 ED-REMOVE IMPACTED CERUMEN $70.00 69210
42330048 ED-DRUG SCREEN URINE $251.00 80100
42330049 ED-HEMMOCULT BY RN $54.00 82270
423030049 ED-HEMMOCULT BY RN $54.00 82270
42330050 ED-CBG $22.00 82948
423030050 ED-CBG $22.00 82948
42330051 ED-GLUCOSE REAGENT STRIP $22.00 82948
423030051 ED-GLUCOSE REAGENT STRIP $22.00 82948
42330052 ED-QUICK STEP STREP TEST $69.00 87880
423030052 ED-QUICK STEP STREP TEST $69.00 87880
42330053 ED-INJECTION VACCINE/TOXOID $73.00 90471
423030053 ED-INJECTION VACCINE/TOXOID $73.00 90471
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42330054 ED-HEART-LING RESUSCIT CPR $2,532.00 92950
42330055 ED-CARDIOVERSION $2,614.00 92960
42330056 ED-HYDRATION IV INF, INITIAL $239.00 96360
42330057 ED-HYDRA IV ADL, TX IV, IM $79.00 96361
42330058 ED-TREATMENT-IV INF, INITIAL $344.00 96365
423030058 ED-TREATMENT-IV INF, INITIAL $344.00 96365
42330059 ED-TREATMENT IV INF, ADD-ON $76.00 96366
423030059 ED-TREATMENT IV INF, ADD-ON $76.00 96366
42330060 ED-TREATMENT IV INF SEQ $151.00 96367
423030060 ED-TREATMENT IV INF SEQ $151.00 96367
42330061 ED-TX CONCUR INF >1HR $151.00 96368
423030061 ED-TX CONCUR INF >1HR $151.00 96368
42330062 ED-INJECT TX -IM OR SQ $73.00 96372
423030062 ED-INJECT TX -IM OR SQ $73.00 96372
42330063 ED-IV PUSH, SINGLE/INIT. $239.00 96374
423030063 ED-IV PUSH, SINGLE/INIT. $239.00 96374
42330064 ED-IV-IM PUSH QNEW MED $56.00 96375
423030064 ED-IV-IM PUSH QNEW MED $56.00 96375
42330065 ED-IV PUSH SEQTL SAME MED $49.00 96376
42330066 ED-DEBRIDE SKIN PARTIAL<20CM $338.00 97597
423030066 ED-DEBRIDE SKIN PARTIAL<20CM $338.00 97597
42330067 ED-EMERGENCY ROOM LEVEL 1 $175.00 99281
42330068 ED-EMERGENCY ROOM LEVEL 2 $293.00 99282
42330069 ED-ED-EMERGENCY ROOM LEVEL 3 $663.00 99283
42330070 ED-EMERGENCY ROOM LEVEL 4 $930.00 99284
42330071 ED-EMERGENCY ROOM LEVEL 5 $1,474.00 99285
42330072 ED-ER ROOM CRITICAL CARE $1,964.00 99291
423030072 ED-ER ROOM CRITICAL CARE $1,964.00 99291
42400046 PR-CAST REMOVAL $297.00 29705
424210046 PR-CAST REMOVAL $297.00 29705
42400047 PR-REMOVAL FB FROM NOSE $158.00 30300
424210047 PR-REMOVAL FB FROM NOSE $158.00 30300
42400048 PR-NASAL HEMORRHAGE CONTROL $158.00 30901
424210048 PR-NASAL HEMORRHAGE CONTROL $158.00 30901
42400049 PR-NASAL HEMORRHAGE PAK/CAUT $212.00 30905
424210049 PR-NASAL HEMORRHAGE PAK/CAUT $212.00 30905
42400050 PR-THORACENTESIS PROC. $297.00 32554
424210050 PR-THORACENTESIS PROC. $297.00 32554
42400051 PR-CENTRAL LINE INSERTION $1,229.00 36556
424210051 PR-CENTRAL LINE INSERTION $1,229.00 36556
42400052 PR-REMOVAL TUNNELED CV CATH $766.00 36590
424210052 PR-REMOVAL TUNNELED CV CATH $766.00 36590
42400053 PR-INSRT NEEDLE BONE - PROFE $413.00 36680
424210053 PR-INSRT NEEDLE BONE - PROFE $413.00 36680
42400054 PR-NG INSERTION $413.00 43752
424210054 PR-NG INSERTION $413.00 43752
42400055 PR-GASTRIC INTUBATION/ASPIRATION $413.00 43753
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42400056 PR-GASTRIC INTUBATION/ASPIRATION $413.00 43754
424210056 PR-GASTRIC INTUBATION/ASPIRATION $413.00 43754
42400057 PR-FOLEY CATH INSERTION $211.00 51702
424210057 PR-FOLEY CATH INSERTION $211.00 51702
42400058 PR-FITTING INSERT OF PESSARY $201.00 57160
424210058 PR-FITTING INSERT OF PESSARY $201.00 57160
42400059 PR-SPINAL PUNCTURE, LUMBAR $680.00 62270
424210059 PR-SPINAL PUNCTURE, LUMBAR $680.00 62270
42400060 PR-INJ.SPINE L/S ER PROFEE $125.00 62322
424210060 PR-INJ.SPINE L/S ER PROFEE $125.00 62322
42400061 PR-REMOVAL FB EXTERNAL EYE $281.00 65205
424210061 PR-REMOVAL FB EXTERNAL EYE $281.00 65205
42400062 PR-REMOVAL FB FROM EAR $281.00 69200
424210062 PR-REMOVAL FB FROM EAR $281.00 69200
42400063 PR-EAR IRRIGATION $70.00 69210
424210063 PR-EAR IRRIGATION $70.00 69210
42400064 PR-PELVIS XRAY READING $144.00 72170
424210064 PR-PELVIS XRAY READING $144.00 72170
42400065 PR-PULSE OXIMETRY $12.00 94760
424210065 PR-PULSE OXIMETRY $12.00 94760
42400066 PR-DEBRIDEMENT SKIN PART<20C $338.00 97597
424210066 PR-DEBRIDEMENT SKIN PART<20C $338.00 97597
42400067 PR-CONSCIOUS SEDATION 1ST 30 $198.00 99144
424210067 PR-CONSCIOUS SEDATION 1ST 30 $198.00 99144
42400068 PR-CONSCIOUS SEDATION +15 MN $209.00 99145
42400069 PR-THERAPEUTIC PHLABOTOMY $210.00 99195
424210069 PR-THERAPEUTIC PHLABOTOMY $210.00 99195
42400070 PR-OBS D/C $157.00 99217
424210070 PR-OBS D/C $157.00 99217
42400071 PR-OBS H&P LEVEL 1 $150.00 99218
424210071 PR-OBS H&P LEVEL 1 $150.00 99218
42400072 PR-OBS H&P LEVEL 2 $208.00 99219
42400073 PR-OBS H&P LEVEL 3 $348.00 99220
424210073 PR-OBS H&P LEVEL 3 $348.00 99220
42400074 PR-PHYS. H&P LEVEL 1 $184.00 99221
424210074 PR-PHYS. H&P LEVEL 1 $184.00 99221
42400075 PR-PHYS H&P LEVEL 2 $243.00 99222
424210075 PR-PHYS H&P LEVEL 2 $243.00 99222
42400076 PR-PHYS H&P LEVEL 3 $313.00 99223
424210076 PR-PHYS H&P LEVEL 3 $313.00 99223
42400077 PR-SUBSQNT OBS CARE $66.00 99224
424210077 PR-SUBSQNT OBS CARE $66.00 99224
42400078 PR-SUBSQNT OBS CARE- MODERAT $117.00 99225
424210078 PR-SUBSQNT OBS CARE- MODERAT $117.00 99225
42400079 PR-SUBSQNT OBS CARE-HIGH $116.00 99226
424210079 PR-SUBSQNT OBS CARE-HIGH $116.00 99226
42400080 PR-PHYS HOSP VISIT LEVEL 1 $103.00 99231
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424210080 PR-PHYS HOSP VISIT LEVEL 1 $103.00 99231
42400081 PR-PHYS HOSP VISIT LEVEL 2 $130.00 99232
424210081 PR-PHYS HOSP VISIT LEVEL 2 $130.00 99232
42400082 PR-PHYS HOSP VISIT LEVEL 3 $200.00 99233
424210082 PR-PHYS HOSP VISIT LEVEL 3 $200.00 99233
42400083 PR-OBS/IP SAME DAY ADM/DC #1 $265.00 99234
424210083 PR-OBS/IP SAME DAY ADM/DC #1 $265.00 99234
42400084 PR-OBS/IP SAME DAY ADM/DC #2 $574.00 99235
424210084 PR-OBS/IP SAME DAY ADM/DC #2 $574.00 99235
42400085 PR-OBS/IP SAME DAY ADM/DC #3 $414.00 99236
424210085 PR-OBS/IP SAME DAY ADM/DC #3 $414.00 99236
42400086 PR-PHYS D/C SUMM. < 30 MIN. $146.00 99238
424210086 PR-PHYS D/C SUMM. < 30 MIN. $146.00 99238
42400087 PR-PHYS D/C SUMM > 30 MIN. $205.00 99239
424210087 PR-PHYS D/C SUMM > 30 MIN. $205.00 99239
42400088 PR-ER VISIT BRIEF $138.00 99281
424210088 PR-ER VISIT BRIEF $138.00 99281
42400089 PR-ER VISIT LIMITED $250.00 99282
424210089 PR-ER VISIT LIMITED $250.00 99282
42400090 PR-ER VISIT INTERMEDIATE $439.00 99283
424210090 PR-ER VISIT INTERMEDIATE $439.00 99283
42400091 PR-ER VISIT EXTENDED $712.00 99284
424210091 PR-ER VISIT EXTENDED $712.00 99284
42400092 PR-ER VISIT COMPREHENSIVE $1,042.00 99285
424210092 PR-ER VISIT COMPREHENSIVE $1,042.00 99285
42400093 PR-CRITICAL CARE 1 HOUR $1,964.00 99291
424210093 PR-CRITICAL CARE 1 HOUR $1,964.00 99291
42400094 PR-CRITCAL CARE EA AD 30 MIN $227.00 99292
424210094 PR-CRITCAL CARE EA AD 30 MIN $227.00 99292
42400095 PR-INITIAL NURSING FACILITY CARE - LOW (25MIN) $162.00 99304
424210095 PR-INITIAL NURSING FACILITY CARE - LOW (25MIN) $162.00 99304
42400096 PR-INITIAL NURSING FACILITY CARE - MODERATE (35 MIN) $189.00 99305
424210096 PR-INITIAL NURSING FACILITY CARE - MODERATE (35 MIN) $189.00 99305
42400097 PR-INITIAL NURSING FACILITY CARE - HIGH (45 MIN) $243.00 99306
424210097 PR-INITIAL NURSING FACILITY CARE - HIGH (45 MIN) $243.00 99306
42400098PR-SUBSEQUENT NURSING FACILITY CARE- STRAIGHT FORWARD (10 MIN) $103.00 99307
424210098PR-SUBSEQUENT NURSING FACILITY CARE- STRAIGHT FORWARD (10 MIN) $103.00 99307
42400099 PR-SUBSEQUENT NURSING FACILITY CARE - LOW (15 MIN) $124.00 99308
424210099 PR-SUBSEQUENT NURSING FACILITY CARE - LOW (15 MIN) $124.00 99308
42400100 PR-SUBSEQUENT NURSING FACILITY CARE - MODERATE 25 MIN) $162.00 99309
424210100 PR-SUBSEQUENT NURSING FACILITY CARE - MODERATE 25 MIN) $162.00 99309
42400101 PR-SUBSEQUENT NURSING FACILITY CARE - HIGH (35 MIN) $211.00 99310
424210101 PR-SUBSEQUENT NURSING FACILITY CARE - HIGH (35 MIN) $211.00 99310
42400102 PR-NURSING FACILITY DISCHARGE ( < 30 MIN ) $123.00 99315
424210102 PR-NURSING FACILITY DISCHARGE ( < 30 MIN ) $123.00 99315
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42400103 PR-NURSING FACILITY DISCHARGE (> 30 MIN) $163.00 99316
42400104 PR-ANNUAL NURSING FACILITY ASSESSMENT $146.00 99318
424210104 PR-ANNUAL NURSING FACILITY ASSESSMENT $146.00 99318
42400105PR-MEDICAL TEAM CONFERENCE WITH PATIENT OR FAMILY PRESENT (30
MIN) $80.00 99366
424210105PR-MEDICAL TEAM CONFERENCE WITH PATIENT OR FAMILY PRESENT (30
MIN) $80.00 99366
42400106PR-MEDICAL TEAM CONFERENCE WITHOUT PATIENT OR FAMILY PRESENT $157.00 99367
424210106PR-MEDICAL TEAM CONFERENCE WITHOUT PATIENT OR FAMILY PRESENT $157.00 99367
42400107 PR-PROVIDER CALL < 10MIN $23.00 99441
424210107 PR-PROVIDER CALL < 10MIN $23.00 99441
42400108 PR-PROVIDER CALL 11-20MIN $46.00 99442
424210108 PR-PROVIDER CALL 11-20MIN $46.00 99442
42400109 PR-PROVIDER CALL 21-30MIN $68.00 99443
424210109 PR-PROVIDER CALL 21-30MIN $68.00 99443
42400110 PR-SUTURE REMOVAL $78.00 S0630
424210110 PR-SUTURE REMOVAL $78.00 S0630
423037000 ED-ARM SLING LARGE $54.00 A4565
423037001 ED-FOREARM SPLINT, PADDED, MED $31.00 A4570
423037002 ED-CPAP FACEMASK - LARGE $385.00 A7030
423037003 ED-CPAP HEADGEAR $164.00 A7035
423037004 ED-CPAP TUBING $168.00 A7037
423037006 ED-ENTERNAL FEEDING SUPPLY KIT $7.00 B4034
423037007 ED-ENTERAL PUMP KIT $12.00 B4035
423037008 ED-NUTRITION PUMP KIT $53.00 B4035
423037010 ED-CATHETER, INFUSION, OTHER THAN HEMODIALYSIS $348.00 C1751
423037011 ED-CATHETER INFUSION, NON-HEMODIALYSIS $348.00 C1751
423037012 ED-BIAP HEATED HUMIDIFIER $163.00 E0562
423037013 ED-BIPAP MACHINE $522.00 E0601
423037014 ED-ADULT CERVICAL COLLAR $33.00 L0172
423037015 ED-ANKLE BRACE-LACER-L $134.00 L1902
423037016 ED-ANKLE AIR SPLINT 90 $385.00 L1906
423037017 ED-ANKLE WALKER- MED. $326.00 L1930
423037018 ED-SHOE, POST OP MENS-LG $16.00 L3260
423037019 ED-SHOE, POST OP FML - MED $16.00 L3260
423037020 ED-SHOE, POST OP FML - LG $16.00 L3260
423037021 ED-WRIST & THUMB SPLINT $67.00 L3908
423037022 ED-WRIST IMMOBILIZER $104.00 L3980
423037023 ED-ANKLE BRACE $140.00 L4350
423037024 ED-WALKING BOOT $141.00 L4361
423037025 ED-WALKING BOOT NON PNEUMATIC $141.00 L4387
423037026 ED-MEDE KAST ULTRA CASTING SYSTEM TCC2ULTR $213.00 Q4038
306107000 N-ARM SLING LARGE $54.00 A4565
306107002 N-CPAP FACEMASK - LARGE $385.00 A7030
306107003 N-CPAP HEADGEAR $164.00 A7035
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306107004 N-CPAP TUBING $168.00 A7037
306107006 N-ENTERNAL FEEDING SUPPLY KIT $7.00 B4034
306107007 N-ENTERAL PUMP KIT $12.00 B4035
306107008 N-NUTRITION PUMP KIT $53.00 B4035
306107010 N-CATHETER, INFUSION, OTHER THAN HEMODIALYSIS $348.00 C1751
306107011 N-CATHETER INFUSION, NON-HEMODIALYSIS $348.00 C1751
306107012 N-BIAP HEATED HUMIDIFIER $163.00 E0562
306107013 N-BIPAP MACHINE $522.00 E0601
306107015 N-ANKLE BRACE-LACER-L $134.00 L1902
306107016 N-ANKLE AIR SPLINT 90 $385.00 L1906
306107017 N-ANKLE WALKER- MED. $326.00 L1930
306107018 N-SHOE, POST OP MENS-LG $16.00 L3260
306107019 N-SHOE, POST OP FML - MED $16.00 L3260
306107020 N-SHOE, POST OP FML - LG $16.00 L3260
306107021 N-WRIST & THUMB SPLINT $67.00 L3908
306107022 N-WRIST IMMOBILIZER $104.00 L3980
306107023 N-ANKLE BRACE $140.00 L4350
306107024 N-WALKING BOOT $141.00 L4361
306107025 N-WALKING BOOT NON PNEUMATIC $141.00 L4387
306107026 N-MEDE KAST ULTRA CASTING SYSTEM TCC2ULTR $213.00 Q4038
306107027 N-FRENCH FOLEY CATH 22 2 WAY $27.00 A4344
306107028 N-FRENCH FOLEY CATH 18 2 WAY $27.00 A4344
306107029 N-ENEMA KIT $48.00 A4458
423037005 ED-NON ELECTRIC SPIROMETER $21.00 A9284
423037027 ED-FRENCH FOLEY CATH 22 2 WAY $27.00 A4344
423037028 ED-FRENCH FOLEY CATH 18 2 WAY $27.00 A4344
307017000 A-ARM SLING LARGE $54.00 A4565
307017001 A-FOREARM SPLINT, PADDED, MED $31.00 A4570
307017002 A-CPAP FACEMASK - LARGE $385.00 A7030
307017003 A-CPAP HEADGEAR $164.00 A7035
307017004 A-CPAP TUBING $168.00 A7037
307017005 A-NON ELECTRIC SPIROMETER $21.00 A9284
307017006 A-ENTERNAL FEEDING SUPPLY KIT $7.00 B4034
307017007 A-ENTERAL PUMP KIT $12.00 B4035
307017008 A-NUTRITION PUMP KIT $53.00 B4035
307017009 A-ENTERAL INFUSION PUMP $12.00 B9002
307017010 A-CATHETER, INFUSION, OTHER THAN HEMODIALYSIS $348.00 C1751
307017011 A-CATHETER INFUSION, NON-HEMODIALYSIS $348.00 C1751
307017012 A-BIAP HEATED HUMIDIFIER $163.00 E0562
307017013 A-BIPAP MACHINE $522.00 E0601
307017014 A-ADULT CERVICAL COLLAR $33.00 L0172
307017015 A-ANKLE BRACE-LACER-L $134.00 L1902
307017016 A-ANKLE AIR SPLINT 90 $385.00 L1906
307017017 A-ANKLE WALKER- MED. $326.00 L1930
307017018 A-SHOE, POST OP MENS-LG $16.00 L3260
307017019 A-SHOE, POST OP FML - MED $16.00 L3260
307017020 A-SHOE, POST OP FML - LG $16.00 L3260
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Pomeroy Wa, 99347
307017021 A-WRIST & THUMB SPLINT $67.00 L3908
307017022 A-WRIST IMMOBILIZER $104.00 L3980
307017023 A-ANKLE BRACE $140.00 L4350
307017024 A-WALKING BOOT $141.00 L4361
307017025 A-WALKING BOOT NON PNEUMATIC $141.00 L4387
307017026 A-MEDE KAST ULTRA CASTING SYSTEM TCC2ULTR $213.00 Q4038
307017027 A-FRENCH FOLEY CATH 22 2 WAY $27.00 A4344
307017028 A-FRENCH FOLEY CATH 18 2 WAY $27.00 A4344
307017029 A-ENEMA KIT $48.00 A4458
307010084 A-HYDRATION IV INFUSION:INT 31 MIN-1HR $229.01 96360
307010084 A-HYDRATION IV INFUSION:INT 31 MIN-1HR $229.01 96360
307010058 A-TREATMENT IV INFUSION: #1 UP TO 1 HR $344.00 96365
307010057 A-HYDRATION IV INFUSION: EACH ADD HR $79.00 96361
307010056 A-HYDRATION IV INFUSION:INT 31 MIN-1HR $229.01 96360
307010059 A-TREATMENT IV INFUSION:#1 EACH ADD HR $76.00 96366
307010060 A-TREATMENT IV INFUSION:#2 UP TO 1 HR $344.00 96365
307010061 A-TREATMENT IV INFUSION:#2 EACH ADD HR $76.00 96366
307010062 A-TREATMENT IV INFUSION:#3 UP TO 1 HR $344.00 96365
307010063 A-TREATMENT IV INFUSION:#3 EACH ADD HR $76.00 96366
307010064 A-TREATMENT IV INFUSION:#4 UP TO 1 HR $344.00 96365
307010065 A-TREATMENT IV INFUSION:#4 EACH ADD HR $76.00 96366
307010066 A-IV PUSH MEDICATION INJ-INITIAL #1 $149.00 96374
307010067 A-IV PUSH MEDICATION INJ-SEQ PUSH; EACH $88.00 96375
307010068 A-IV PUSH MEDICATION INJ-INITIAL #2 $149.00 96374
307010069 A-IV PUSH MEDICATION INJ-SEQ PUSH; EACH $88.00 96375
307010070 A-INJECTION(SUBQ,INTRMS) $75.50 96372
307010073 A-PICC LINE FLUSH (W/O INJ OR INFUS) $233.00 96523
307010075 A-PICC LINE REMOVAL $233.00 36589
306107001 N-FOREARM SPLINT, PADDED, MED $31.00 A4570
306107005 N-NON ELECTRIC SPIROMETER $21.00 A9284
417040109 DOPAMINE 400MG/250ML PREMIX BAG $80.20 J1265
417040430 Cathflo Activase 2 MG VIAL $302.50 J2997
101150008 SWING BED-SEMI PVT $230.00
101130008 SWING BED-SEMI PVT $230.00
101150020 SWING BED-PRIVATE $260.00
307010071 A-GLUCOMETRY READING $7.00 82943
306107014 N-ADULT CERVICAL COLLAR $33.00 L0172
532160001 D-NUTRITION THERAPY 15 MIN. $54.00 97802
532160002 D-NUTRITION RE-EVAL EA. 15 $43.00 97803
532160003 D-NUTRITION THER. GROUP $35.00 97804
532160004 D-DIETARY CONSULT $92.00 99411
532160005 D-NUTRITION SUPPLEMENT-1500ML FEEDING BAGS $17.00 B4150
532160006 D-DIABETES TRAINING (UNIT) $106.00 G0108
53200001 D-NUTRITION THERAPY 15 MIN. $54.00 97802
53200002 D-NUTRITION RE-EVAL EA. 15 $43.00 97803
53200003 D-NUTRITION THER. GROUP $35.00 97804
53200004 D-DIETARY CONSULT $92.00 99411
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53200005 D-NUTRITION SUPPLEMENT-1500ML FEEDING BAGS $17.00 B4150
532250001 D-NUTRITION THERAPY 15 MIN. $54.00 97802
532250002 D-NUTRITION RE-EVAL EA. 15 $43.00 97803
53200006 D-DIABETES TRAINING (UNIT) $106.00 G0108
532250003 D-NUTRITION THER. GROUP $35.00 97804
53200007 D-DIABETES GROUP TRAIN UNIT $76.00 G0109
325250006 D-DIABETES TRAINING (UNIT) $106.00
532250007 D-DIABETES GROUP TRAIN UNIT $76.00 G0109
325250004 D-DIETARY CONSULT $92.00
325250005 D-NUTRITION SUPPLEMENT-1500ML FEEDING BAGS $17.00
532250006 D-DIABETES TRAINING (UNIT) $106.00 G0108
532250004 D-DIETARY CONSULT $92.00 99411
532250005 D-NUTRITION SUPPLEMENT-1500ML FEEDING BAGS $17.00 B4150
41420003 X-EYE FOREIGN BODY XRAY-READING $25.00 70030
41420005 X-MANDIBLE LESS THAN 4 VIEW-READING $25.00 70100
41420007 X-MANDIBLE 4 VIEW-READING $25.00 70110
41420009 X-MASTOID-READING $25.00 70120
41420011 X-MASTOIDS 3 VIEWS-READING $25.00 70130
41420013 X-FACIAL BONES LESS THAN 3-READING $25.00 70140
41420015 X-FACIAL BONES MIN 3 VIEWS-READING $25.00 70150
41420017 X-NASAL BONES-READING $25.00 70160
41420019 X-ORBITS 4 VIEW-READING $25.00 70200
41420021 X-SINUS LESS THAN 3 VIEWS-READING $78.00 70210
41420023 X-SINUS MIN 3 VIEW-READING $78.00 70220
41420025 X-SKULL 2 VIEWS-READING $144.00 70250
41420027 X-SKULL 4 VIEW-READING $25.00 70260
41420029 X-UNILATERAL TMJS-READING $25.00 70328
41420031 X-BILATERAL TMJS-READING $25.00 70330
41420033 X-NECK SOFT TISSUE-READING $78.00 70360
41420035 X-CHEST 1 VIEW-READING $25.00 71045
41420037 X-CHEST 2 VIEWS READING $25.00 71046
41420040 X-RIBS-READING $25.00 71100
41420043 X-RIB UNI-READING $25.00 71101
41420045 X-RIB BILATERAL READING $25.00 71101
41420047 X-BILATERAL RIB 4 VIEW READING $25.00 71111
41420049 X-STERNUM READING $25.00 71120
41420051 X-SPINE 1 VIEW READING $25.00 72020
41420053 X-SPINE CERVICAL READING $25.00 72040
41420055 X-CERVICAL SPINE 4 OR 5 VIEWS-READING $25.00 72050
41420057 X-CERVICAL SPINE COMPLETE-READING $25.00 72052
41420059 X-THORACIC 3 VIEWS -READING $25.00 72072
41420061 X-THORACIC 4 VIEW-READING $25.00 72074
41420063 X-THORACIC/LUMBAR READING $25.00 72080
41420065 X-SPINE L BENDING VIEWS-READING $25.00 72120
41420067 X-SPINE LUMBOSACRAL AP/LAT-READING $25.00 72100
41420069 X-SPINE LUMBOSACRAL COMPLETE-READING $25.00 72110
41420071 X-PELVIS AP-READING $25.00 72170
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41420073 X-PELVIS COMPLETE-READING $25.00 72190
41420075 X-SI JOINT-READING $25.00 72200
41420077 X-SI JOINTS 3 VIEWS-READING $25.00 72202
41420079 X-SACRUM/COCCYX-READING $25.00 72220
41420082 X-CLAVICLE-READING $25.00 73000
41420085 X-SCAPULA-READING $25.00 73010
41420088 X-SHOULDER 1 VIEW-READING $25.00 73020
41420091 X-SHOULDER COMPLETE-READING $25.00 73030
41420093 X-AC JOINTS 2 VIEWS-READING $25.00 73050
41420096 X-HUMERUS 2 VIEWS-READING $25.00 73060
41420099 X-ELBOW 2 VIEWS-READING $25.00 73070
41420102 X-ELBOW COMPLETE-READING $25.00 73080
41420105 X-FOREARM-READING $25.00 73090
41420108 X-WRIST 2 VIEWS-READING $25.00 73100
41420111 X-WRIST COMPLETE-READING $25.00 73110
41420114 X-HAND 2 VIEWS-READING $25.00 73120
41420117 X-HAND COMPLETE-READING $25.00 73130
41420120 X-FINGER-READING $25.00 73140
41420122 X-HIP UNILATERAL WITH PELVIS -READING $25.00 73501
41420127 X-HIP BILATERAL W/AP PELVIS READING $25.00 73521
41420130 X-FEMUR 2 VIEWS-READING $25.00 73552
41420133 X-KNEE 1 OR 2 VIEW-READING $25.00 73560
41420136 X-KNEE 3 VIEW-READING $25.00 73562
41420138 X-KNEE AP BILATERAL STANDING SINGLE VIEW-READING $25.00 73565
41420141 X-KNEE 4 OR MORE VIEWS-READING $25.00 73564
41420143 X-KNEES BILATERAL VIEWS READING $25.00 73565
41420146 X-TIBIA/FIBULA READING $25.00 73590
41420149 X-ANKLE 2 VIEW READING $25.00 73600
41420152 X-ANKLE COMPLETE-READING $25.00 73610
41420155 X-FOOT 2 VIEWS-READING $25.00 73620
41420158 X-FOOT COMPLETE-READING $25.00 73630
41420161 X-HEEL READING $25.00 73650
41420164 X-TOES X-RAY- READING $25.00 73660
41420166 X-ABDOMEN , SINGLE VIEW READING $25.00 74018
41420168 X-ABDOMEN, 2 VIEWS READING $25.00 74019
41420170 X-ABDOMEN, COMPLETE VIEW- READING $25.00 74021
41420172 X-ACUTE ABDOMEN-READING $25.00 74022
423037029 ED-ENEMA KIT $48.00 A4458
438220234 CL-WELCOME TO MEDICARE $200.00 G0402
405127027 CS-FRENCH FOLEY CATH 22 2 WAY $27.00 A4344
405127028 CS-FRENCH FOLEY CATH 18 2 WAY $27.00 A4344
405127029 CS-ENEMA KIT $48.00 A4458
100010001 NSF CHECK FEE $25.00
42330019 ED-BURN DRESS/DEBRIDE P <5% $254.00 16020
42330021 ED-BURN DRESSING COMPLEX $467.00 16030
42330020 ED-BURN DRESSY INTERMEDIATE 5-10% $254.00 16025
42330055 ED-CARDIOVERSION $2,614.00 92960
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42330042 ED-CATHETERIZATION $210.00 51702
42330050 ED-CBG $22.00 82948
42330038 ED-CENTRAL LINE INSERTION $1,475.00 36556
42330015 ED-COMPLEX-ARM,LEG,TRUN,SCAL $610.00 13100
42330017 ED-COMPLEX-FACE,EAR,LIP,EYE 1.0 CM TO 2.5 CM $610.00 13151
42330016 ED-COMPLEX-NECK,HAND,FEET,G $467.00 13131
42330005 ED-DEBRID, SKIN-SUB Q TISSUE $389.00 11042
42330066 ED-DEBRIDE SKIN PARTIAL<20CM $338.00 97597
42330069 ED-ED-EMERGENCY ROOM LEVEL 3 $663.00 99283
42330033 ED-EENT CONT NOSE BLEED BILA $158.00 30901
42330032 ED-EENT CONTROL NOSE BLEED $158.00 30901
42330024 ED-ELBOW DISLOCATION W/CL RE $1,688.00 24605
42330067 ED-EMERGENCY ROOM LEVEL 1 $175.00 99281
42330068 ED-EMERGENCY ROOM LEVEL 2 $293.00 99282
42330070 ED-EMERGENCY ROOM LEVEL 4 $930.00 99284
42330071 ED-EMERGENCY ROOM LEVEL 5 $1,474.00 99285
42330035 ED-ENDOTRACHEAL INTUBATION $268.00 31500
42330072 ED-ER ROOM CRITICAL CARE $1,964.00 99291
42330040 ED-GASTRIC INTUBATION $341.00 43753
42330054 ED-HEART-LING RESUSCIT CPR $2,532.00 92950
42330049 ED-HEMMOCULT BY RN $54.00 82270
42330057 ED-HYDRA IV ADL, TX IV, IM $79.00 96361
42330056 ED-HYDRATION IV INF, INITIAL $239.00 96360
42330001 ED-I&D ABSCESS SIMPLE $253.43 10060
42330002 ED-I&D ABSCESS, COMPLEX $389.00 10061
42330018 ED-INITIAL BURN TX LOCAL $254.00 16000
42330043 ED-INJ. SPINE L/S ER FAC. $1,497.00 62322
42330022 ED-INJ.TENDON/LIGAMENT $368.00 20550
42330062 ED-INJECT TX -IM OR SQ $73.00 96372
42330053 ED-INJECTION VACCINE/TOXOID $73.00 90471
42330039 ED-INSERT NEEDLE BONE CAVITY $429.00 36680
42330012 ED-INTERMED-ARM,LEG,TRUNK,SC $467.00 12031
42330014 ED-INTERMED-FACE,EAR,LIP,EYE $467.00 12051
42330013 ED-INTERMED-NECK,HAND,FEET,G $467.00 12041
42330065 ED-IV PUSH SEQTL SAME MED $49.00 96376
42330063 ED-IV PUSH, SINGLE/INIT. $239.00 96374
42330064 ED-IV-IM PUSH QNEW MED $56.00 96375
42330026 ED-KNEE DISLOCATION W/CL RED $1,688.00 27552
42330011 ED-LAC FACE 12.6 - 20. CM $467.00 12016
42330009 ED-LAC FACE 5.1CM-7.5CM $254.00 12014
42330010 ED-LAC FACE 7.6-12.5CM $254.00 12015
42330037 ED-LAW ENFORCEMENT BLOOD DRA $25.00 36415
42330025 ED-METACARPAL CLOSED W/REDUC $323.00 26700
42330034 ED-NOSE BLEED WITH PACKING $211.00 30905
42330004 ED-PUNCTURE ASPIRATE ABSCESS $389.00 10160
42330052 ED-QUICK STEP STREP TEST $69.00 87880
42330047 ED-REMOVE IMPACTED CERUMEN $70.00 69210
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42330046 ED-REMOVE-FB EAR $281.00 69200
42330045 ED-REMOVE-FB EYE COMPLEX $313.00 65222
42330044 ED-REMOVE-FB EYE EXTERNAL $281.00 65205
42330031 ED-REMOVE-FB NASAL $158.00 30300
42330003 ED-REMOVE-FB SKIN $389.00 10120
42330007 ED-SIMP REP H/N/T 2.6-7.5CM $212.00 12002
42330006 ED-SIMPLE-EXTREMITY H/N/T $212.00 12001
42330027 ED-SPLINT ARM, LONG $229.00 29105
42330028 ED-SPLINT ARM, SHORT $212.00 29125
42330029 ED-SPLINT LEG, LONG $232.00 29505
42330030 ED-SPLINT LEG, SHORT $222.00 29515
42330041 ED-STRAIGHT CATHETERIZATION $158.00 51701
42330036 ED-THORANCENTESIS-ASPIRATION $330.00 32554
42330060 ED-TREATMENT IV INF SEQ $151.00 96367
42330059 ED-TREATMENT IV INF, ADD-ON $76.00 96366
42330058 ED-TREATMENT-IV INF, INITIAL $344.00 96365
42330023 ED-TRMT SHOULDER DISLOCATION $323.00 23650
42330061 ED-TX CONCUR INF >1HR $151.00 96368
42330008 ED-WOUND, SUPERFICIAL, SIMPLE-FACE,L/E/E, FEET $212.00 12011
42060007 PT-APP MOD VASOPNEUMATIC DEV $44.00 97016
42060002 PT-CANALITH REPOSITIONING $100.00 95992
42060095PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-0%
IMPAIRED $- G8986
42060096PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-1%-19%
IMPAIRED $- G8986
42060101PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-100%
IMPAIRED $- G8986
42060097PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-20%-39%
IMPAIRED $- G8986
42060098PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-40%-59%
IMPAIRED $- G8986
42060099PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-60%-79%
IMPAIRED $- G8986
424210031 PR-DRAIN/INJ MAJR JOINT/BURS $334.00 20610
424210030 PR-DRAIN/INJ SM JOINT/BURSA $334.00 20600
424210055 PR-GASTRIC INTUBATION/ASPIRATION $413.00 43753
41800001 I-BREATHING CAPACITY TEST $175.00 94010
424210103 PR-NURSING FACILITY DISCHARGE (> 30 MIN) $163.00 99316
424210072 PR-OBS H&P LEVEL 2 $208.00 99219
424210014 PR-WOUND COMPLEX REPAIR LAC S/A/L 2.6-7.5CM $611.00 13121
42400104 PR-ANNUAL NURSING FACILITY ASSESSMENT $146.00 99318
42400104 PR-ANNUAL NURSING FACILITY ASSESSMENT $146.00 99318
42400023 PR-BURN DBRD/DRSS LG > 10% $467.00 16030
42400021 PR-BURN DBRD/DRSS SM<5% $300.00 16020
42400027 PR-CARPEL TUNNEL INJECTION $334.00 20526
42400046 PR-CAST REMOVAL $297.00 29705
42400051 PR-CENTRAL LINE INSERTION $1,229.00 36556
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42400067 PR-CONSCIOUS SEDATION 1ST 30 $198.00 99144
42400094 PR-CRITCAL CARE EA AD 30 MIN $227.00 99292
42400093 PR-CRITICAL CARE 1 HOUR $1,964.00 99291
42400066 PR-DEBRIDEMENT SKIN PART<20C $338.00 97597
42400024 PR-DESTROY B9 LESION 1ST ONE $212.00 17000
42400031 PR-DRAIN/INJ MAJR JOINT/BURS $334.00 20610
42400030 PR-DRAIN/INJ SM JOINT/BURSA $334.00 20600
42400063 PR-EAR IRRIGATION $70.00 69210
40720328 L-CRP TEST $84.00 86140
40720060 L-VANCOMYCIN $215.00 80202
42400034 PR-ELBOW TX WITH ANESTHESIA $1,688.00 24605
42400088 PR-ER VISIT BRIEF $138.00 99281
42400092 PR-ER VISIT COMPREHENSIVE $1,042.00 99285
42400091 PR-ER VISIT EXTENDED $712.00 99284
42400090 PR-ER VISIT INTERMEDIATE $439.00 99283
42400089 PR-ER VISIT LIMITED $250.00 99282
42400036 PR-EXCISION OF CYST HAND/FIN $1,688.00 26160
42400038 PR-FINGER TX W/OUT ANESTHESA $1,688.00 26742
42400058 PR-FITTING INSERT OF PESSARY $201.00 57160
42400057 PR-FOLEY CATH INSERTION $211.00 51702
42400055 PR-GASTRIC INTUBATION/ASPIRATION $413.00 43753
42400056 PR-GASTRIC INTUBATION/ASPIRATION $413.00 43754
42400035 PR-I&D FINGER COMPLEX $1,686.00 26011
42400039 PR-INCISION OF ABSCESS $2,907.00 27301
42400097 PR-INITIAL NURSING FACILITY CARE - HIGH (45 MIN) $243.00 99306
42400095 PR-INITIAL NURSING FACILITY CARE - LOW (25MIN) $162.00 99304
42400096 PR-INITIAL NURSING FACILITY CARE - MODERATE (35 MIN) $189.00 99305
42400060 PR-INJ.SPINE L/S ER PROFEE $125.00 62322
42400053 PR-INSRT NEEDLE BONE - PROFE $413.00 36680
42400040 PR-KNEE TX WITH ANESTHESIA $1,688.00 27552
42400041 PR-KNEECAP TX W/OUT ANESTHES $370.00 27560
42400037 PR-KNUCKLE TX W/OUT ANESTHES $358.00 26700
42400003 PR-LAC N/H/F > 30 CM INTM $1,961.00 12047
42400001 PR-LAC N/H/F 12.6-20 CM $611.00 12045
42400002 PR-LAC N/H/F 20.1-30 CM $611.00 12046
42400105PR-MEDICAL TEAM CONFERENCE WITH PATIENT OR FAMILY PRESENT (30
MIN) $80.00 99366
42400106PR-MEDICAL TEAM CONFERENCE WITHOUT PATIENT OR FAMILY PRESENT $157.00 99367
42400048 PR-NASAL HEMORRHAGE CONTROL $158.00 30901
42400049 PR-NASAL HEMORRHAGE PAK/CAUT $212.00 30905
42400054 PR-NG INSERTION $413.00 43752
42400102 PR-NURSING FACILITY DISCHARGE ( < 30 MIN ) $123.00 99315
42400103 PR-NURSING FACILITY DISCHARGE (> 30 MIN) $163.00 99316
42400070 PR-OBS D/C $157.00 99217
42400071 PR-OBS H&P LEVEL 1 $150.00 99218
42400072 PR-OBS H&P LEVEL 2 $208.00 99219
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42400073 PR-OBS H&P LEVEL 3 $348.00 99220
42400083 PR-OBS/IP SAME DAY ADM/DC #1 $265.00 99234
42400084 PR-OBS/IP SAME DAY ADM/DC #2 $574.00 99235
42400085 PR-OBS/IP SAME DAY ADM/DC #3 $414.00 99236
42400064 PR-PELVIS XRAY READING $144.00 72170
42400087 PR-PHYS D/C SUMM > 30 MIN. $205.00 99239
42400086 PR-PHYS D/C SUMM. < 30 MIN. $146.00 99238
42400075 PR-PHYS H&P LEVEL 2 $243.00 99222
42400076 PR-PHYS H&P LEVEL 3 $313.00 99223
42400080 PR-PHYS HOSP VISIT LEVEL 1 $103.00 99231
42400081 PR-PHYS HOSP VISIT LEVEL 2 $130.00 99232
42400082 PR-PHYS HOSP VISIT LEVEL 3 $200.00 99233
42400074 PR-PHYS. H&P LEVEL 1 $184.00 99221
42400020 PR-PR-BURN INITIAL TX 1ST DEGR. $221.00 16000
42400107 PR-PROVIDER CALL < 10MIN $23.00 99441
42400108 PR-PROVIDER CALL 11-20MIN $46.00 99442
42400109 PR-PROVIDER CALL 21-30MIN $68.00 99443
42400065 PR-PULSE OXIMETRY $12.00 94760
42400061 PR-REMOVAL FB EXTERNAL EYE $281.00 65205
42400062 PR-REMOVAL FB FROM EAR $281.00 69200
42400047 PR-REMOVAL FB FROM NOSE $158.00 30300
42400026 PR-RMV FRN BDY MSCL/TNDN SMP $1,686.00 20520
42400032 PR-SHOULDER TX W/O ANESTHESA $323.00 23650
42400033 PR-SHOULDER TX WITH ANESTHES $1,688.00 23655
42400059 PR-SPINAL PUNCTURE, LUMBAR $680.00 62270
42400042 PR-SPLINT LONG ARM $229.00 29105
42400044 PR-SPLINT LONG LEG $232.00 29505
42400043 PR-SPLINT SHORT ARM $212.00 29125
42400045 PR-SPLINT SHORT LEG $222.00 29515
42400101 PR-SUBSEQUENT NURSING FACILITY CARE - HIGH (35 MIN) $211.00 99310
42400099 PR-SUBSEQUENT NURSING FACILITY CARE - LOW (15 MIN) $124.00 99308
42400100 PR-SUBSEQUENT NURSING FACILITY CARE - MODERATE 25 MIN) $162.00 99309
42400098PR-SUBSEQUENT NURSING FACILITY CARE- STRAIGHT FORWARD (10 MIN) $103.00 99307
42400077 PR-SUBSQNT OBS CARE $66.00 99224
42400078 PR-SUBSQNT OBS CARE- MODERAT $117.00 99225
42400079 PR-SUBSQNT OBS CARE-HIGH $116.00 99226
42400110 PR-SUTURE REMOVAL $78.00 S0630
42400069 PR-THERAPEUTIC PHLABOTOMY $210.00 99195
42400050 PR-THORACENTESIS PROC. $297.00 32554
42400028 PR-TRIGGER POINT INJECTIONS $334.00 20552
42400029 PR-TRIGGER POINT INJECTIONS $334.00 20553
42400006 PR-WOUND INTERMEDIATE REPAIR LAC FACE 5.1-7.5 CM $611.00 12053
42400011 PR-WOUND COMPLEX REPAIR TRNK 1.1-2.5 CM $611.00 13100
42400017 PR-WOUND COMPLEX REPAIR FACE,EAR,LIP,EYE 1.0 CM TO 2.5 CM $611.00 13151
42400018 PR-WOUND COMPLEX REPAIR LAC FACE 1.1-2.5 CM $611.00 13151
42400019 PR-WOUND COMPLEX REPAIR LAC FACE 2.6-7.5 CM $733.00 13152
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42400015 PR-WOUND COMPLEX REPAIR LAC N/H/F 1.1-2.5CM $467.00 13131
42400013 PR-WOUND COMPLEX REPAIR LAC S/A/L 1.1-2.5CM $611.00 13120
42400014 PR-WOUND COMPLEX REPAIR LAC S/A/L 2.6-7.5CM $611.00 13121
42400012 PR-WOUND COMPLEX REPAIR LAC TRNK 2.6-7.5 CM $611.00 13101
42400025 PR-WOUND EXPLORATION EXTREM $717.00 20103
42400010 PR-WOUND INTERMEDIATE REPAIR LAC FACE > 30 CM $1,961.00 12057
42400008 PR-WOUND INTERMEDIATE REPAIR LAC FACE 12.6-20 CM INTM $611.00 12055
42400009 PR-WOUND INTERMEDIATE REPAIR LAC FACE 20.1-30 $611.00 12056
42400007 PR-WOUND INTERMEDIATE REPAIR LAC FACE 7.6-12.5 CM INTM $611.00 12054
42400004PR-WOUND INTERMEDIATE REPAIR OF F,E,E,N,L, AND OR MUCOUS
MEMBRANES 2.5 CM OR LESS $467.00 12051
42400005 PR-WOUNDS INTERMEDIATE REPAIR-LAC FACE 2.6-5.0 CM $467.00 12052
42400068 PR-CONSCIOUS SEDATION +15 MN $209.00 99145
417040432 MUPIROCIN 2% OINTMENT 22 g $102.50
42280005 OT-MANUAL THERAPY 15 MIN"" $71.99 97140
42280004 OT-MASSAGE $17.00 97124
42280003 OT-NEUROMUSCULAR REDUCTION $58.00 97112
42280008 OT-OCC. ADL. TRAINING 15"" $61.00 97535
42280002 OT-OCC. THERAPUTIC EXERC $78.00 97110
42280001 OT-OCC. THERAPY EVALUATION $175.00 97003
42280006 OT-OCC. THERAPY RE-EVAL. $133.00 97168
OT-OCC. THERAPY RE-EVAL.OT-OCC. THERAPY RE-EVAL. $133.00 97168
42280007 OT-OCCU. THERAPY 15 MIN $61.00 97530
42060100PT-CARRYING, MOVING AND HADLING OBJECTS DISCHARGE-80%-99%
IMPAIRED $- G8986
42060081PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-0%
IMPAIRED $- G8984
42060082PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-1%-19%
IMPAIRED $- G8984
42060087PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-100%
IMPAIRED $- G8984
42060083PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-20%-39%
IMPAIRED $- G8984
42060084PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-40%-59%
IMPAIRED $- G8984
42060085PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-60%-79%
IMPAIRED $- G8984
42060086PT-CARRYING, MOVING, AND HANDLING OBJECTS CURRENT-80%-99%
IMPAIRED $- G8984
42060088PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-0% IMPAIRED $- G8985
42060089PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-1%-19%
IMPAIRED $- G8985
42060090PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-20%-39%
IMPAIRED $- G8985
42060091PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-40%-59%
IMPAIRED $- G8985
62 5/3/2019
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Pomeroy Wa, 99347
42060092PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-60%-79%
IMPAIRED $- G8985
42060093PT-CARRYING, MOVING, AND HANDLING OBJECTS GOAL-80%-99%
IMPAIRED $- G8985
42060060PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-0%
IMPAIRED $- G8981
42060066PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-100%
IMPAIRED $- G8981
42060062PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-20-39%
IMPAIRED $- G8981
42060063PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-40-59%
IMPAIRED $- G8981
42060064PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-60-79%
IMPAIRED $- G8981
42060065PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-80-99
IMPAIRED $- G8981
42060079PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE- 80%-99%
IMPAIRED $- G8983
42060074PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-0%
IMPAIRED $- G8983
42060075PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-1%-19%
IMPAIRED $- G8983
42060080PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-100%
IMPAIRED $- G8983
42060076PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-20%-39%
IMPAIRED $- G8983
42060077PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-40%-59%
IMPAIRED $- G8983
42060078PT-CHANGING AND MAINTAINING BODY POSITION DISCHARGE-60% -79%
IMPAIRED $- G8983
42060067PT-CHANGING AND MAINTAINING BODY POSITION GOAL-0% IMPAIRED $- G8982
42060073PT-CHANGING AND MAINTAINING BODY POSITION GOAL-100% IMPAIRED $- G8982
42060068PT-CHANGING AND MAINTAINING BODY POSITION GOAL-1-19%
IMPAIRED $- G8982
42060069PT-CHANGING AND MAINTAINING BODY POSITION GOAL-20-39%
IMPAIRED $- G8982
42060070PT-CHANGING AND MAINTAINING BODY POSITION GOAL-40-59%
IMPAIRED $- G8982
42060071PT-CHANGING AND MAINTAINING BODY POSITION GOAL-60-79%
IMPAIRED $- G8982
42060072PT-CHANGING AND MAINTAINING BODY POSITION GOAL-80-99%
IMPAIRED $- G8982
42060033 PT-COMMUNITY INTERGRATION $74.00 97537
42060012 PT-CONTRAST BATH,EACH 15" $38.00 97034
42060001 PT-DYNAMIC FINGER SPLINTING $153.00 29131
63 5/3/2019
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Pomeroy Wa, 99347
42060038 PT-ELEC.STIM.UNATT/ MEDICARE $39.00 G0283
42060006 PT-ELECTRICAL STIM(UNATTENDE $60.00 97014
42060010 PT-ELECTRICAL STM ATTENDED $72.00 97032
42060019 PT-GAIT TRAINING $88.00 97116
42060011 PT-IONTOPHORESIS 15 MIN. EA. $56.00 97033
42060020 PT-MASSAGE THERAPY 15 MIN $87.00 97124
42060039 PT-MOBILITY CURRENT STATUS-0% IMPAIRED $- G8978
42060045 PT-MOBILITY CURRENT STATUS-100% IMPAIRED $- G8978
42060040 PT-MOBILITY CURRENT STATUS-1-19% IMPAIRED $- G8978
42060041 PT-MOBILITY CURRENT STATUS-20-39% IMPAIRED $- G8978
42060042 PT-MOBILITY CURRENT STATUS-40-59% IMPAIRED $- G8978
42060043 PT-MOBILITY CURRENT STATUS-60-79% IMPAIRED $- G8978
42060044 PT-MOBILITY CURRENT STATUS-80-99% IMPAIRED $- G8978
42060053 PT-MOBILITY DISCHARGE-0% IMPAIRED $- G8980
42060059 PT-MOBILITY DISCHARGE-100% IMPAIRED $- G8980
42060054 PT-MOBILITY DISCHARGE-1-19% IMPAIRED $- G8980
42060055 PT-MOBILITY DISCHARGE-20-39% IMPAIRED $- G8980
42060056 PT-MOBILITY DISCHARGE-40-59% IMPAIRED $- G8980
42060057 PT-MOBILITY DISCHARGE-60-79% IMPAIRED $- G8980
42060058 PT-MOBILITY DISCHARGE-80-99% IMPAIRED $- G8980
42060046 PT-MOBILITY GOAL STATUS-0% IMPAIRED $- G8979
42060052 PT-MOBILITY GOAL STATUS-100% IMPAIRED $- G8979
42060047 PT-MOBILITY GOAL STATUS-1-19% IMPAIRED $- G8979
42060048 PT-MOBILITY GOAL STATUS-20-39% IMPAIRED $- G8979
42060049 PT-MOBILITY GOAL STATUS-40-59% IMPAIRED $- G8979
42060050 PT-MOBILITY GOAL STATUS-60-79% IMPAIRED $- G8979
42060051 PT-MOBILITY GOAL STATUS-80-99% IMPAIRED $- G8979
42060017 PT-NEUROMUSCULAR REEDUCATION $80.00 97112
42060036 PT-ORTHOTIC MNGMT. 15 MIN $84.00 97760
42060123PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-0% IMPAIRED $- G8990
42060124PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-1%-19%
IMPAIRED $- G8990
42060129PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-100%
IMPAIRED $- G8990
42060125PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-20%-39%
IMPAIRED $- G8990
42060127PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-60%-79%
IMPAIRED $- G8990
42060128PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-80%-99%
IMPAIRED $- G8990
42060130PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-0% IMPAIRED $- G8991
42060131PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-1%-19% IMPAIRED $- G8991
42060136PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-100% IMPAIRED $- G8991
64 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42060132PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-20%-39%
IMPAIRED $- G8991
42060133PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-40%-59%
IMPAIRED $- G8991
42060134PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-60%-79%
IMPAIRED $- G8991
42060135PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS GOAL-80%-99%
IMPAIRED $- G8991
42060137PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-0%
IMPAIRED $- G8992
42060138PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-1%-19%
IMPAIRED $- G8992
42060143PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-100%
IMPAIRED $- G8992
42060139PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-20%-
39% IMPAIRED $- G8992
42060140PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-40%-
59% IMPAIRED $- G8992
42060141PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-60%-
79% IMPAIRED $- G8992
42060142PT-OTHER PT/OT PRIMARY FUNCTIONAL LIMITATION DISCHARGE-80%-
99% IMPAIRED $- G8992
42060144PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-0%
IMPAIRED $- G8993
42060150PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-
100% IMPAIRED $- G8993
42060145PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-1-
19% IMPAIRED $- G8993
42060146PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-20-
39% IMPAIRED $- G8993
42060147PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-40 -
59% IMPAIRED $- G8993
42060148PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-60-
79% IMPAIRED $- G8993
42060149PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS CURRENT-80-
99% IMPAIRED $- G8993
42060158PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-
0% IMPAIRED $- G8995
42060164PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-
100% IMPAIRED $- G8995
42060159PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-1-
19% IMPAIRED $- G8995
42060160PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-20-
39% IMPAIRED $- G8995
42060161PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-40
-59% IMPAIRED $- G8995
65 5/3/2019
Pricing Transparency 66 North 6th Street
Pomeroy Wa, 99347
42060162PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-60-
79% IMPAIRED $- G8995
42060163PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS DISCHARGE-80-
99% IMPAIRED $- G8995
42060151PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-0%
IMPAIRED $- G8994
42060157PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-100%
IMPAIRED $- G8994
42060152PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-1-19%
IMPAIRED $- G8994
42060153PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-20-39%
IMPAIRED $- G8994
42060154PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-40 -59%
IMPAIRED $- G8994
42060155PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-60-79%
IMPAIRED $- G8994
42060156PT-OTHER PT/OT SUBSEQUENT FUNCTIONAL LIMITATIONS GOAL-80-99%
IMPAIRED $- G8994
42060035 PT-P.T.PRFRM TEST/REPORT 15 $81.00 97750
42060008 PT-PARAFIN BATH $18.00 97018
42060025 PT-PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY $230.00 97163
42060023 PT-PHYSICAL THERAPY EVALUATION LOW COMPLEXITY $188.00 97161
42060024 PT-PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY $199.00 97162
42060026 PT-PHYSICAL THERAPY RE-EVALUATION $124.00 97164
42060031 PT-PT SELF CARE/HOME ASSMT. $74.00 97535
42060004 PT-PT. EVAL INITIAL $195.00 97001
42060028 PT-PT. RE-EVAL PERIODIC $124.00 97164
42060126PT-PT-OTHER PT/OT PRIMARY FUNCT LIMITATIONS CURRENT-40%-59%
IMPAIRED $- G8990
42060018 PT-SCHOOL GAIT TRAINING $88.00 97116
42060016 PT-SCHOOL NEUROMUSCULAR REDU $80.00 97112
42060027 PT-SCHOOL RE-EVALUATION $124.00 97164
42060014 PT-SCHOOL THERAPEUTIC EXER. $65.00 97110
42060029 PT-SCHOOL THERAPY 15 MIN. $66.00 97530
42060003 PT-SCHOOL THERAPY EVAL. $195.00 97001
42060102 PT-SELF CARE CURRENT-0% IMPAIRED $- G8987
42060103 PT-SELF CARE CURRENT-1-19% IMPAIRED $- G8987
42060104 PT-SELF CARE CURRENT-20-39% IMPAIRED $- G8987
42060105 PT-SELF CARE CURRENT-40-59% IMPAIRED $- G8987
42060116 PT-SELF CARE DISCHARGE-0% IMPAIRED $- G8989
42060117 PT-SELF CARE DISCHARGE-1%-19% IMPAIRED $- G8989
42060122 PT-SELF CARE DISCHARGE-100% IMPAIRED $- G8989
42060118 PT-SELF CARE DISCHARGE-20%-39% IMPAIRED $- G8989
42060119 PT-SELF CARE DISCHARGE-40%-59% IMPAIRED $- G8989
42060120 PT-SELF CARE DISCHARGE-60%-79% IMPAIRED $- G8989
42060121 PT-SELF CARE DISCHARGE-80%-99% IMPAIRED $- G8989
42060109 PT-SELF CARE GOAL-0% IMPAIRED $- G8988
66 5/3/2019
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Pomeroy Wa, 99347
42060110 PT-SELF CARE GOAL-1%-19% IMPAIRED $- G8988
42060111 PT-SELF CARE GOAL-20%-39% IMPAIRED $- G8988
42060112 PT-SELF CARE GOAL-40%-59% IMPAIRED $- G8988
42060113 PT-SELF CARE GOAL-60%-79% IMPAIRED $- G8988
42060114 PT-SELF CARE GOAL-80%-99% IMPAIRED $- G8988
42060032 PT-SELF CARE/ADL $61.00 97535
42060108 PT--SPT-ELF CARE CURRENT-100%IMPAIRED $- G8987
42060106 PT-SPT-ELF CARE CURRENT-60%-79% IMPAIRED $- G8987
42060107 PT--SPT-ELF CARE CURRENT-80-99% IMPAIRED $- G8987
42060030 PT-THERAPEUTIC ACT. 15 MIN. $66.00 97530
42060015 PT-THERAPEUTIC EXERC. 15 MIN $93.00 97110
42060005 PT-TRACTION MECHANICAL $40.00 97012
42060021 PT-ULISTED THERAP PROC SPECI $81.00 97139
42060013 PT-ULTRASOUND,EACH 15" $52.00 97035
42060037 PT-UNLIST.PT/REHAB/BY RPT $81.00 97799
42060034 PT-WHEELCHAIR MNGT EA.15 MIN $135.00 97542
42060009 PT-WHIRLPOOL $40.00 97022
41420125 X-HIP UNILATERAL WITH PELVIS WHEN PERFORMED - READING $25.00 73502
42119 ST-SPEECH THERAPY GROUP $80.00 92508
421190008 ST-SPEECH THERAPY GROUP $80.00 92508
421190009 ST-FLEXIBLE ENDOSCOPIC EVAL OF SWALLOWING-BY VIDEO $479.00 92612
421190010 ST-SWALLOW CURRENT STATUS $- G8996
421190011 ST-SWALLOW GOAL STATUS $- G8997
421190012 ST-SWALLOW D/C STATUS $- G8998
421190013 ST-SPEECH THERAPY 15 MIN $149.00 92507
307010053 A-HEART-LING RESUSCIT CPR $2,532.00 92950
307010054 A-FRENCH FOLEY CATH 22" 2 WAY $27.00 A4344
307010055 A-FRENCH FOLEY CATH 18" 2 WAY $27.00 A4344
307010085 A-HYDRATION IV INFUSION: EACH ADD HR $79.00 96361
307010086 A-TREATMENT IV INFUSION: #1 UP TO 1 HR $344.00 96365
307010087 A-TREATMENT IV INFUSION:#1 EACH ADD HR $76.00 96366
307010088 A-TREATMENT IV INFUSION:#2 UP TO 1 HR $344.00 96365
307010089 A-TREATMENT IV INFUSION:#2 EACH ADD HR $76.00 96366
307010090 A-TREATMENT IV INFUSION:#3 UP TO 1 HR $344.00 96365
307010091 A-TREATMENT IV INFUSION:#3 EACH ADD HR $76.00 96366
307010092 A-TREATMENT IV INFUSION:#4 UP TO 1 HR $344.00 96365
307010093 A-TREATMENT IV INFUSION:#4 EACH ADD HR $76.00 96366
307010094 A-IV PUSH MEDICATION INJ-INITIAL #1 $149.00 96374
307010095 A-IV PUSH MEDICATION INJ-SEQ PUSH; EACH $88.00 96375
307010097 A-IV PUSH MEDICATION INJ-SEQ PUSH; EACH $88.00 96375
307010096 A-IV PUSH MEDICATION INJ-INITIAL #2 $149.00 96374
307010098 A-INJECTION(SUBQ,INTRMS) $75.50 96372
307010099 A-GLUCOMETRY READING $7.00 82943
307010102 A-PICC LINE REMOVAL $233.00 36589
101150029 HOSPITAL RESPITE-PRIVATE $295.00
307010101 A-PICC LINE FLUSH (W/O INJ OR INFUS) $233.00 96523
100010000 NO CHARGE $-
67 5/3/2019
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Pomeroy Wa, 99347
306100001 N-CENTRAL LINE DRAW $56.00 36592
306100002 N-PORT-A-CATH ACCESS $239.00 96522
306100003 N-WOUND CARE SIMPLE-NURSE $361.00 97602
306100004 N-WOUND CARE INTERMED-NURSE $742.00 97602
42330048 ED-DRUG SCREEN URINE $251.00 80100
417040402 VANCOMYCIN HCL 750 MG VIAL $60.60 J3370
40720018 L-BLOOD DRAW $25.00 36415
417040409 CULTURELLE HEALTH-WELLNESS CAP/lactobacillus $8.60
417040359 THP Acetaminophen 160mg/5ml #118ml bottle $15.00
417040361 THP Amox/clav 250-62.5mg #75ml Susp $141.60
417040364 THP Amoxi/clav 500-125mg tab #6 $102.50
417040365 THP Amox/clav 875-125mg tab #6 $123.70
417040366 THP Azithromycin 100mg/5ml #15ml susp $142.00
417040367 THP Azithromycin 250mg tab #6 $32.50
417040368 THP Benzonatate 100mg cap #6 $30.50
417040369 THP Cephalexin 250mg/5ml #100ml Susp $117.50
417040371 THP Ciprofloxacin 500mg tab #6 $20.50
417040374 THP Diphenhydramine 12.5mg/5ml sol #60ml $20.00
417040376 THP Doxycycline 100mg tab #6 $20.00
417040428 THP Gentamicin 0.3% Opth Sol $35.50
417040375 THP Diphenhydramine 25mg cap #6 $20.00
417040372 THP Cyclobenzaprine 10mg tab #6 $20.00
417040370 THP Cephalexin 500mg cap #6 $20.00
417040362 THP Amoxicillin 250mg cap #6 $20.00
417040360 THP acetaminophen/Codeine 300/30mg #6 $20.00
417040377 THP Guaifenesin/codeine #60ml $20.00
417040378 THP Hydrocodone/APAP 5/325mg tab #6 $20.00
417040380 THP Ibuprofen 200mg tab #24 $20.00
417040381 THP Levofloxacin 750mg tab #2 $20.00
417040382 THP Lorazepam 0.5mg tab #6 $20.00
417040383 THP MECLIZINE 25MG TAB #6 $20.00
417040384 THP Metronidazole 500mg tab #6 $20.00
417040385 THP Omeprazole 20mg cap #6 $20.00
417040386 THP Ondansetron ODT #6 $25.00
417040387 THP oxycodone/APAP 5/325mg tab #6 $20.00
417040388 THP Penicillin 250mg/5ml susp #100ml $53.70
417040389 THP Penicillin 250mg tab #6 $20.00
417040390 THP Phenazopyridine 100mg tab #6 $20.00
417040392 THP Prednisone 20mg tab #6 $20.00
417040393 THP Prednisone 5mg tab #6 $20.00
417040395 THP Promethazine 25mg tab #6 $20.00
417040396 THP Sulfa/TMP 800/160mg tab #6 $20.00
417040394 THP Prednisone 5mg/5ml liq #60ml $162.00
417040397 THP Sulfacetamide 10% opth sol 15ml $132.00
417040398 THP Tramadol 50mg tab #6 $25.00
417040292 PREGABALIN 100MG CAP $53.50
405120017 CS-ANKLE BRACE-LACER-M $134.00 L1902
68 5/3/2019
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424210112PR-SIMPLE SUPERFICIAL REPAIR WOUND S,N,A,EG,T, EX 2.6CM TO 7.5 CM $396.00 12002
424210111PR-SIMPLE SUPERFICIAL REPAIR WOUND S,N,A,EG,T, EX 2.5CM OR LESS $373.00 12001
424210113PR-SIMPLE SUPERFICIAL REPAIR WOUND S,N,A,EG,T, EX 7.6 CM TO 12.5
CM $464.00 12004
424210114PR-SIMPLE SUPERFICIAL REPAIR WOUND S,N,A,EG,T, EX 12.6 CM TO 20.0
CM $579.00 12005
424210115PR-SIMPLE SUPERFICIAL REPAIR WOUND S,N,A,EG,T, EX 20.1 CM TO 30.0
CM $719.00 12006
424210116PR-SIMPLE SUPERFICIAL REPAIR WOUND S,N,A,EG,T, EX OVER 30.0 CM $815.00 12007
424210117PR-SIMPLE REPAIR OF SUPERFICIAL FACE E,E,N,L,MM 2.5 CM OR LESS $394.00 12011
424210118PR-SIMPLE REPAIR OF SUPERFICIAL FACE E,E,N,L,MM 2.6 CM TO 5.0 CM $432.00 12013
424210119PR-SIMPLE REPAIR OF SUPERFICIAL FACE E,E,N,L,MM 5.1 CM TO 7.5 CM $144.00 12014
424210120PR-SIMPLE REPAIR OF SUPERFICIAL FACE E,E,N,L,MM 7.6 CM TO 12.5 CM $175.00 12015
424210121PR-SIMPLE REPAIR OF SUPERFICIAL FACE E,E,N,L,MM 12.6 CM TO 20.0
CM $218.00 12016
424210122 PR-INTERMEDIATE REPAIR WOUNDS S,A,T,EX 2.5 CM OR LESS $448.00 12031
424210123 PR-INTERMEDIATE REPAIR WOUNDS S,A,T,EX 2.6 CM TO 7.5 CM $629.00 12032
424210124 PR-INTERMEDIATE REPAIR WOUNDS S,A,T,EX 7.6 CM TO 12.5 CM $707.00 12034
424210125 PR-INTERMEDIATE REPAIR WOUNDS S,A,T,EX 12.6 CM TO 20.0 CM $876.00 12035
424210126 PR-INTERMEDIATE REPAIR WOUNDS S,A,T,EX 20.1 CM TO 30.0 CM $986.00 12036
424210127 PR-INTERMEDIATE REPAIR WOUNDS S,A,T,EX OVER 30.0 CM $1,140.00 12037
424210128 PR-INTERMEDIATE REPAIR WOUNDS N,H,F,EX 2.5 CM OR LESS $496.00 12041
423030002 ED-I&D ABSCESS, COMPLEX $389.00 10061
423030003 ED-REMOVE-FB SKIN $389.00 10120
423030004 ED-PUNCTURE ASPIRATE ABSCESS $389.00 10160
423030005 ED-DEBRID, SKIN-SUB Q TISSUE $389.00 11042
423030006 ED-SIMPLE-EXTREMITY H/N/T $212.00 12001
423030007 ED-SIMP REP H/N/T 2.6-7.5CM $212.00 12002
423030009 ED-LAC FACE 5.1CM-7.5CM $254.00 12014
423030010 ED-LAC FACE 7.6-12.5CM $254.00 12015
423030011 ED-LAC FACE 12.6 - 20. CM $467.00 12016
423030012 ED-INTERMED-ARM,LEG,TRUNK,SC $467.00 12031
423030013 ED-INTERMED-NECK,HAND,FEET,G $467.00 12041
423030014 ED-INTERMED-FACE,EAR,LIP,EYE $467.00 12051
423030015 ED-COMPLEX-ARM,LEG,TRUN,SCAL $610.00 13100
423030016 ED-COMPLEX-NECK,HAND,FEET,G $467.00 13131
423030017 ED-COMPLEX-FACE,EAR,LIP,EYE 1.0 CM TO 2.5 CM $610.00 13151
423030018 ED-INITIAL BURN TX LOCAL $254.00 16000
423030019 ED-BURN DRESS/DEBRIDE P <5% $254.00 16020
423030020 ED-BURN DRESSY INTERMEDIATE 5-10% $254.00 16025
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423030021 ED-BURN DRESSING COMPLEX $467.00 16030
423030022 ED-INJ.TENDON/LIGAMENT $368.00 20550
423030023 ED-TRMT SHOULDER DISLOCATION $323.00 23650
423030024 ED-ELBOW DISLOCATION W/CL RE $1,688.00 24605
423030025 ED-METACARPAL CLOSED W/REDUC $323.00 26700
423030026 ED-KNEE DISLOCATION W/CL RED $1,688.00 27552
423030027 ED-SPLINT ARM, LONG $229.00 29105
423030028 ED-SPLINT ARM, SHORT $212.00 29125
423030029 ED-SPLINT LEG, LONG $232.00 29505
423030030 ED-SPLINT LEG, SHORT $222.00 29515
423030031 ED-REMOVE-FB NASAL $158.00 30300
423030032 ED-EENT CONTROL NOSE BLEED $158.00 30901
423030033 ED-EENT CONT NOSE BLEED BILA $158.00 30901
423030034 ED-NOSE BLEED WITH PACKING $211.00 30905
423030035 ED-ENDOTRACHEAL INTUBATION $268.00 31500
423030036 ED-THORANCENTESIS-ASPIRATION $330.00 32554
423030037 ED-LAW ENFORCEMENT BLOOD DRA $25.00 36415
423030038 ED-CENTRAL LINE INSERTION $1,475.00 36556
423030039 ED-INSERT NEEDLE BONE CAVITY $429.00 36680
423030040 ED-GASTRIC INTUBATION $341.00 43753
423030041 ED-STRAIGHT CATHETERIZATION $158.00 51701
423030042 ED-CATHETERIZATION $210.00 51702
423030043 ED-INJ. SPINE L/S ER FAC. $1,497.00 62322
423030044 ED-REMOVE-FB EYE EXTERNAL $281.00 65205
423030045 ED-REMOVE-FB EYE COMPLEX $313.00 65222
423030046 ED-REMOVE-FB EAR $281.00 69200
423030047 ED-REMOVE IMPACTED CERUMEN $70.00 69210
423030054 ED-HEART-LING RESUSCIT CPR $2,532.00 92950
423030055 ED-CARDIOVERSION $2,614.00 92960
423030056 ED-HYDRATION IV INF, INITIAL $239.00 96360
438220249 CL-SPORTS PHYSICAL EXAM $53.00
417040431 APLISOL 5T UNITS/0.1 ML VIAL 1 unit, 1 mL $15.00
42060061PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-1-19%
IMPAIRED $- G8981
420170165PT-CHANGING AND MAINTAINING BODY POSITION CURRENT-1-19%
IMPAIRED $- G8981
424210068 PR-CONSCIOUS SEDATION +15 MN $209.00 99145
420170167 PT-MANUAL THERAPY 1 OR MORE REGIONS, EACH 15 MINS $103.00 97140
420170166 PT-THERAPEUTIC ACTIVITIES,DIRECT,EACH 15 MIN $90.00 97530
420170029 PT-SCHOOL THERAPY 15 MIN. $90.00 97530
42400016 PR-WOUND COMPLEX REPAIR LAC N/H/F 2.6-7.5CM $611.00 13132
42400022 PR-BURN DBRD/DRSS MED 5-10% $370.00 16025
42400052 PR-REMOVAL TUNNELED CV CATH $766.00 36590
424210129 PR-REMOVAL TUNNELED CV CATH $766.00 36590
424210130 PR-BURN DBRD/DRSS MED 5-10% $370.00 16025
424210131 PR-WOUND COMPLEX REPAIR LAC N/H/F 2.6-7.5CM $611.00 13132
42330081 ED-ENTERAL INFUSION PUMP $12.00 B9002
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423037030 ED-ENTERAL INFUSION PUMP $12.00 B9002
306107009 N-ENTERAL INFUSION PUMP $12.00 B9002
423030070 ED-EMERGENCY ROOM LEVEL 4 $930.00 99284
423030071 ED-EMERGENCY ROOM LEVEL 5 $1,474.00 99285
423030068 ED-EMERGENCY ROOM LEVEL 2 $293.00 99282
423030067 ED-EMERGENCY ROOM LEVEL 1 $175.00 99281
417040433 MIDAZOLAM HCL 1 MG/ML VIAL 5 mL $12.85 J2250
417040237 MIDAZOLAM 5MG/1ML VIAL $16.00 J2250
420170019 PT-GAIT TRAINING $88.00 97116
420170017 PT-NEUROMUSCULAR REEDUCATION $80.00 97112
423037031ED-MEASUREMENT OF POST VOIDING RESIDUAL URINE AND/OR
BLADDER CAP BY US, NON-IMAGING $662.00 51798
423030001 ED-I&D ABSCESS SIMPLE $254.00 10060
40720495L-CULTURE, FUNGI ISOLATION, WITH PRES IDENTIFICATION OF ISOLATES-
OTHER SOURCE(EXCEPT BLOOD) $110.00 87102
417040434 TENIVAC SYRINGE 0.5 mL $158.90 90714
417040332 TETANUS, DIPTHERIA, PERTUSSIS (TDAP) $162.50 90715
41120001 EKG $252.00 93000
423030069 ED-EMERGENCY ROOM LEVEL 3 $663.00 99283
423030057 ED-HYDRA IV ADL, TX IV, IM $79.00 96361
423030065 ED-IV PUSH SEQTL SAME MED $49.00 96376
417040439 FluZONE QUAD 2018-2019 SYRINGE 0.5 mL $25.00 90686
417040440 FluZONE HIGH-DOSE 2018-19 SYR , 0.5 mL $52.00 90662
420170024 PT-PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY $199.00 97162
420170015 PT-THERAPEUTIC EXERC. 15 MIN $93.00 97110
420170047 PT-MOBILITY GOAL STATUS-1-19% IMPAIRED $- G8979
420170041 PT-MOBILITY CURRENT STATUS-20-39% IMPAIRED $- G8978
438220246 CL-POLIOVIRUS VACCINE (STATE SUPPLY) $0.01 90713,SL
438220247 CL-HEPATITS A VACCINE (STATE SUPPLY) $0.01 90633,SL
438220248 CL-VARICELLA VIRUS VACCINE (STATE SUPPLY) $0.01 90716,SL
438220250 CL-HEPATITS A VACCINE (ADULT) $101.00 90632
438220252 CL-TDAP GREATER THAN 7 YEARS OF AGE $163.00 90715
438220253 CL-MMRV (STATE SUPPLY) $0.01 90710,SL
438220254 CL-HEPATITIS B (ADULT) $86.00 90746
438220255 CL- INFLUENZA VIRUS VACCINE $25.00 90686
438220256 CL- INFLUENZA VIRUS VACCINE(HIGH DOSE) $62.00 90662
417040438 INFANRIX DTAP SYRINGE 0.5 mL $35.50 90700
417040435 HAVRIX 1,440 UNITS/ML SYRINGE 1 mL $101.00 90632
417040437 PROQUAD VIAL 1 each $302.50 90710
417040436 Engerix-B 20 MCG/ML SYRINGE $85.70 90746
420170030 PT-THERAPEUTIC ACT. 15 MIN. $90.00 97530
405127030 CS-UNNA BOOT $88.00
306107030 N-UNNA BOOT $88.00
307017030 A-ACUTE CARE LEVEL 1 $1,055.00
307017031 A-ACUTE CARE LEVEL 2 $1,195.00
307017032 A-ACUTE CARE LEVEL 3 $1,485.00
307017033 A-ACUTE CARE LEVEL 4 $1,630.00
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307017033 A-ACUTE CARE LEVEL 4 $1,630.00
307017033 A-ACUTE CARE LEVEL 4 $1,630.00
307017033 A-ACUTE CARE LEVEL 4 $-
307010104 A-ACUTE CARE LEVEL 2 $1,195.00
307010105 A-ACUTE CARE LEVEL 3 $1,485.00
307010106 A-ACUTE CARE LEVEL 4 $1,630.00
405127034 CS-LINERS-SMALL $14.00
405127035 CS-LINERS-MED $14.00
405127036 CS-LINERS-LARGE $14.00
405127037 CS-PULL ONS-SM/MED $43.00
405127038 CS-PULL ONS-LARGE $38.00
405127039 CS-PULL ONS-XLARGE $38.00
405127040 CS-PULL ONS-XXL $25.00
405127041 CS-BRIEFS-MED $18.00
405127042 CS-BRIEFS-LARGE $24.00
405127043 CS-BRIEFS-XLARGE $25.00
405127044 CS-BRIEFS-XXL $35.00
40720496 L-CHAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH $163.00 87491
438220257 CL-PNEUMOCOCCAL 23 $110.00 90732
438220258 CL-INFLUENZA (PEDIATRIC 6-30 MONTHS) $0.01 90685,SL
438220258 CL-INFLUENZA (PEDIATRIC 6-30 MONTHS) $0.01 90685,SL
438220258 CL-INFLUENZA (PEDIATRIC 6-35 MONTHS) $0.01 90685,SL
438220259 CL-INFULENZA (36 MONTHS+) $0.01 90686,SL
438220251 CL-DTAP (STATE SUPPLY) $0.01 90700,SL
423030008 ED-WOUND, SUPERFICIAL, SIMPLE-FACE,L/E/E, FEET $212.00 12011
438220081 CL-PROTHROMBIN TIME; FINGERSTICK $- 85610
438220175 CL-SUTURE/STAPLE REMOVAL $78.00 99211
40720497 L-PROCALCITONIN (SEND OUT) $171.00 84145
596729 morphine SULFATE 10 MG/ML VIAL 10 mg, 1 mL $2.87
417040441 glipiZIDE ER 10 MG TABLET $11.25
417040442 ISOSORBIDE MONONIT 10 MG TAB $10.90
596730 glipiZIDE ER 10 MG TABLET 10 mcg, 100 eaches $0.24
596731 ISOSORBIDE MONONIT 10 MG TAB 10 mcg, 100 eaches $0.08
417040148 GLIPIZIDE ER 5MG TAB $29.50
417040443 morphine SULFATE 10 MG/ML VIAL 10 1 mL $20.90
417040444 PIPERACIL-TAZOBACT 2.25 GM VL $64.00 J2543
417040075 CIPROFLOXACIN WITH HYDROCORTISONE OTIC DROPS 10ML $538.90
417040363 THP Amoxicillin 250mg/5ml #80ml Susp $32.50
417040373 THP Dexamethasone 0.5mg/5ml elixir #60ml $83.50
417040293 PREGABALIN 75MG CAP $53.50
417040445 lithium carbonate 300 MG CAP $5.00
417040226 METOLAZONE 2.5MG TAB $26.50
417040447 FLUCAINE EYE DROPS 5 mL $70.00
417040448 levoFLOXacin 250 MG/50 ML-D5W $44.50 J1956
417040232 METOPROLOL SUCCINATE 50MG TAB $12.50
417040227 METOLAZONE 5MG TAB $28.95
417040093 DEXAMETHASONE ELIXIR 0.5MG/5ML $-
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417040152 GUAIFENESIN AND CODEINE 100MG/10MG PER 5ML $-
417040452 NYAMYC 100,000 UNITS/GM POWDER 15 g $31.65
417040453 I-VITE PROTECT TABLET 1 ea $5.00
417040290 PREDNISONE 5MG/5ML ORAL SOLUTION $30.50
417040451 SOLU-Medrol 1 GRAM VIAL $162.50 J2930
417040449 IBUPROFEN 400 MG TABLET $5.00
417040454 DEEP SEA 0.65% NOSE SPRAY 1 ea, 44 mL $20.00
417040122 EPOETIN ALFA 20,000 UNIT VIAL $928.00 J0885
417040121 EPOETIN ALFA 3,000 UNIT VIAL $212.50 J0885
417040455 HYDROmorphone 2 MG/ML VIAL mL $26.50
417040456 HYDROCORTISONE 1% CREAM 1 g, 28 g $26.85
417040450 INSTA-GLUCOSE GEL 31g $30.50
417040457 TRIAMCINOLONE 0.1% OINTMENT 15 g $32.50
417040459 SINUS RELIEF 1% NASAL SPRAY 30 mL $30.00
417040018 AMOXICILLIN 250MG CAP $5.00
417040217 METHADONE 10MG TAB $5.90
417040422 MAGNESIUM SULF 1 G/100 ML-D5W $46.90 J3475
417040460 VITAMIN D2 1.25MG(50,000 UNIT) 5,0000 unit cap $20.50
438220262
CL-DIPHTHERIA,TETNUS TOXOIDS,ACELLUAR PERTUSSIS VACCINE,
HAEMOPHILUS INFLUENZA TYPE B, AND INACTIVEATED
POLIOVIRUS(DTAP-IPV/HIB) FOR INTRAMUSCULAR USE $0.01 90698,SL
438220260 CL-HEPATITIS B VACC, PEDI/ADOL DOSAGE 3 DOSE SCHEDULE $0.01 90744,SL
438220261CL-PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13), FOR
INTRAMUSCULAR USE $0.01 90670,SL
417040462 CHOLESTYRAMINE PACKET 4 g, 1 each $26.50
417040263 OSELTAMIVIR 30MG CAP $38.50
417040234 METRONIDAZOLE 500MG TAB $10.70
417040278 PHENOBARBITAL, HYOSCYAMINE, ATROPINE, SCOPALAMINE $114.00
417040464 LISINOPRIL 2.5 MG TABLET $7.60
40720500L-AEROBIC ISOLATE, ADD METHODS REQ FOR DEFIN IDENT, EACH
ISOLATE $9.00 87077
40720498 L-URINALYSIS AUTOMATED W/O MICROSCOPY $21.00 81003
40720503 L-CARBAMAZEPINE:TOTAL $13.00 80156
40720502 L-TRANSFERASE:ASPARTATE AMINO (AST)(SGOT) $10.00 84450
40720505L-HIV-1 ANTIGEN(S),WITH HIV-1 AND HIV-2 ANTIBODIES,SINGLE RESULT $40.00 87389
40720506 L-ALPHA-FETOPROTEIN (AFP);SERUM $44.00 82105
40720507 L-ALKALOIDS, NOT OTHERWISE SPECIFIED $84.00 80323
40720504 L-CLOTTING,FACTOR V(ACG OR PROACCELERIN),LABILE FACTOR $133.00 85220
40720499 L-TREPONEMA PALLIDUM $4.00 86780
40720501 L-CULTURE, BACTERIAL, QUANTITATIVE COLONY COUNT, URINE $15.00 87086
417040465 lidocaine 4% patch (salonpas) $16.00
417040379 THP Hydrocodone/APAP 7.5/325mg tab #6 $20.00
417040466 PREVNAR 13 SYRINGE 0.5 mL $302.50
417040467 PNEUMOVAX 23 SYRINGE 0.5 mL $212.50
417040468 ketorolac 0.5% OPHTH SOLUTION 10 mL $56.50
417040469 ABILIFY 10 MG TABLET $113.65
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417040470 GEMFIBROZIL 600 MG tablet $12.94
417040471 ESTRACE 0.01% CREAM 1 ea, 42.5 g $443.00
417040472 PIOGLITAZONE HCL 30 MG TABLET $-
417040473 QUEtiapine FUMARATE 100 MG TAB $21.60
417040474 raNITIdine 150 MG TABLET $5.00
417040475 THP Metoprolol 50mg #6 $15.00
417040477 THP Oseltamivir 75mg capsule #4 $102.00
417040723 THP Oseltamivir 6mg/ml Susp 60ml $203.50
423037032 ED-DRUG SCREEN URINE $251.00 80307
423030048 ED-DRUG SCREEN URINE $251.00 80104
417040291 PREDNISOLONE 15MG/5ML SYRUP $16.45 J7510
417040461 Cortrosyn 0.25 MG VIAL 0.25 mg, 1 each $1,496.00
417040725 PROCRIT 10,000 UNITS/ML VIAL 10000 unit, 1 mL $275.00 J0885
417040724 OSELTAMIVIR PHOS 30 MG CAPSULE $32.50
438220263 CL-DOT/CDL PHYSICAL $110.00
307010103 A-ACUTE CARE LEVEL 1 $1,005.00
438220264 CL-NO CHARGE $-
306100026 N-IMMUNIZATION ADMINISTRATION $52.00 90471
307010100 A-IMMUNIZATION ADMINISTRATION $52.00 90471
438220088 CL-IMMUNIZATION INJECTION $30.00 90471
307010072 A-IMMUNIZATION ADMINISTRATION $52.00 90471
417040726 Farxiga 5 MG TABLET $79.20
417040727 CHLORTHALIDONE 25 MG TABLET $15.55
417040160 HYDROMORPHONE 2MG CARPUJECT $26.50 J1170
417040728 PREPARATION H CREAM 27 g $15.00
101150007 PERM SWING-SEMI PRIVATE $230.00
101150017 PERM SWING -PRIVATE $260.00
101130020 SWING BED-PRIVATE $260.00
417040729 LINEZOLID 600 MG TABLET $16.75
417040730 XYLOCAINE-MPF 1% VIAL 5 mL $21.45
417040731 VERAPAMIL 2.5 MG/ML VIAL 10 mg, 4 mL $162.50
417040732 THP Albuterol Inhaler $102.20
417040733 diphenhydrAMINE 25 MG/10 ML $5.00
417040183 LEVOFLOXACIN 750MG TAB $15.00
417040045 BETAMETHASONE 6MG VIAL $187.90 J0702
417040734 WARFARIN SODIUM 3 MG TABLET $9.00
417040242 MORPHINE SULFATE 15MG EXTENDED RELEASE TABS $19.15
438220266 CL-CLONIDINE HCL 1 MG $0.28 J0735
438220267 CL-DIPHENHYDRAMINE HCL, UP TO 50MG $1.54 J1200
438220268 CL-KETOROLAC TROMETHAMINE, 15MG $7.20 J1885
438220269 CL-METOCLOPRAMIDE HCL, UP TO 10MG $1.60 J2765
438220271 CL-ALBUTEROL MIX $1.20 J7620
438220272CL-PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALLENT(PCV13, FOR
INTRAMUSCULAR USE) $280.50 90670
438220273 CL-VACCINE/TOXOID 1ST INJ $30.00 G0008
438220274 CL-HOME VISIT NEW PATIENT $91.00 99341
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438220275CL-SPIROMETRY, INCLUDING GRAPHIC RECORD,TOTAL AND TIMED VITAL
CAPACITY, EXPIRATORY FLOW RATE $129.00 94010
40720508L-CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AMPLIFIED PROBE TECHNIQUE $31.00 87493
40720509 L-CYTOMEGALOVIRUS, QUANTIFICATION $84.00 87497
438220265 CL-CEFTRIAXONE SODIUM, PER 250 MG $26.50 J0696
417040058 CARBIDOPA/LEVODOPA 25/100MG TAB $8.40
417040735 THP Ofloxacin 0.3% otic solution $63.55
438220270 CL-TRIAMCINOLONE ACETONIDE 10MG (KENALOG) $13.48 J3301
438220276 CL-TRIAMCINOLONE ACETONIDE 40MG VIAL (KENALOG) $49.95 J3301
417040403 metoprolol tart 5 MG/5 ML VIAL $20.50
417040213 MECLIZINE 12.5MG TAB $9.50
40720033 L-CARBAMAZEPINE; TOTAL $185.00 80156
40720471 L-SURGICAL PATH GROSS $50.00 88300
417040206 LORAZEPAM 2MG/ML VIAL $26.50 J2060
417040244 MORPHINE 4MG/ML VIAL $20.50 J2270
417040288 PREDNISONE 10MG TAB $5.00 J7512
417040289 PREDNISONE 20MG TAB $8.00 J7512
417040287 PREDNISONE 5MG TAB $5.00 J7512
417040218 METHENAMINE HIPPURATE 1GM TAB $20.50
417040205 LORAZEPAM 1MG TAB $5.00
417040221 METHOCARBAMOL 750MG TAB $8.40
417040024 AMPICILLIN/SULBACTAM 1.5GM VIAL $43.20 J0295
417040391 THP Potassium 20mEq tab #6 $20.00
417040463 labetalol HCL 20 MG/4 ML CRPJ 20 mcg, 4 mL $43.05
40720021 L-BASIC METABOLIC PANEL-BMP $144.00 80048
40720297 L-COMPLETE BLOOD COUNT-CBC $137.00 85025
40720268 L-THYROXINE FREE-T4 $74.00 84439
40720156 L-FERRITIN $125.00 82728
40720494L-CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE-THROAT
CULTURE $171.00 87070
40720027 L-LIPID PANEL $68.00 80061
417040736 cranberry concentrate 500mg $5.00
417040257 SODIUM CHLORIDE 0.9% SOLUTION 500 mL $50.00
417040446 glipiZIDE ER 2.5 MG TABLET $13.20
417040458 XYLOCAINE-MPF 1% VIAL 2 mL $15.00
417040010 ADENOSINE 6MG VIAL $16.80 J0153
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