CDM Item Number Revenue Code Service ID Service Mod1 Service Mod2 Service Description Units Gross Charge Discounted Cash Price Minimum Negotiated Charge Maximum Negotiated Charge Payer Negotiated Charge: Aetna (Plan: Default) Payer Negotiated Charge: Blue Cross Blue Shield of LA (Plan: HMO) Payer Negotiated Charge: Blue Cross Blue Shield of LA (Plan: Traditional/PPO) Payer Negotiated Charge: Cigna (Plan: All) Payer Negotiated Charge: Gilsbar Inc (Plan: All) Payer Negotiated Charge: HealthPlus of Louisiana (Plan: All) Payer Negotiated Charge: Humana (Plan: Commercial) Payer Negotiated Charge: Multiplan Inc. for American Family (Plan: All) Payer Negotiated Charge: PPO Plus LLC (Plan: All) Payer Negotiated Charge: Tricare West UHC Military and Veterans (Plan: All) Payer Negotiated Charge: United Healthcare (Plan: Commercial) Payer Negotiated Charge: Vantage Health Plan Inc (Plan: Commercial) Payer Negotiated Charge: Vantage Health Plan Inc (Plan: PPACA Metal Tier Plans ) 450 ER ENCOUNTER - PER EPISODE 1 500.00 500.00 500.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 120 MEDICAL PER DIEM 1 " 1,200.00 " 408.00 " 1,000.00 " " 2,274.00 " " 1,800.00 " " 2,021.00 " " 2,274.00 " " 1,000.00 " N/A N/A N/A N/A " 1,100.00 " N/A N/A N/A N/A 120 SURGICAL PER DIEM 1 " 1,200.00 " 408.00 " 1,000.00 " " 3,121.00 " " 1,800.00 " " 2,330.00 " " 3,121.00 " " 1,000.00 " N/A N/A N/A N/A " 1,101.00 " N/A N/A N/A N/A 200 ICU PER DIEM 1 " 2,100.00 " 714.00 " 1,250.00 " " 2,274.00 " " 2,000.00 " " 2,021.00 " " 2,274.00 " " 1,250.00 " N/A N/A N/A N/A " 1,250.00 " N/A N/A N/A N/A 124 GERO PSYCH PER DIEM 1 " 1,500.00 " 510.00 482.00 " 1,000.00 " 875.00 482.00 482.00 N/A N/A N/A N/A N/A " 1,000.00 " N/A N/A N/A N/A 191 SWING BED PER DIEM 1 700.00 238.00 560.00 800.00 800.00 560.00 560.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 303077 270 CHAMBER HOLD AEROSOL 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 902164 370 SEDATION & MONITORING/RA 1 107.00 36.38 41.73 85.60 64.20 54.84 77.68 74.90 83.46 80.25 41.73 85.60 74.90 85.60 918828 360 LAPAROSCOPY 1 382.00 129.88 148.98 305.60 229.20 195.78 277.33 267.40 297.96 286.50 148.98 305.60 267.40 305.60 951705 761 OR SUPRAPUBIC CATH CHANGE 1 200.00 68.00 78.00 160.00 120.00 102.50 145.20 140.00 156.00 150.00 78.00 160.00 140.00 160.00 981972 360 ARTHROSCOPY 1 " 3,500.00 " " 1,190.00 " " 1,365.00 " " 2,800.00 " " 2,100.00 " " 1,793.75 " " 2,541.00 " " 2,450.00 " " 2,730.00 " " 2,625.00 " " 1,365.00 " " 2,800.00 " " 2,450.00 " " 2,800.00 " 983897 360 ENDOSCOPY ROOM O -60 MIN 1 415.00 141.10 161.85 332.00 249.00 212.69 301.29 290.50 323.70 311.25 161.85 332.00 290.50 332.00 1127002 710 RECOVERY EACH ADDITIONAL 15 MIN 1 48.00 16.32 18.72 38.40 28.80 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 1165941 710 PACU - 30 MINUTES 1 364.00 123.76 141.96 291.20 218.40 186.55 264.26 254.80 283.92 273.00 141.96 291.20 254.80 273.00 1200082 637 MECLIZINE (ANTIVERT) 12.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200088 637 MECLIZINE (ANTIVERT) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200138 637 BRETHINE 5MG TAB 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1200140 637 cloNIDine (CATAPRES) 0.1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200142 637 cloNIDine (CATAPRES) 0.2MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200149 637 "VITAMIN D (DRISDOL) 50,000 UNIT CAPSULE" 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200173 637 DANTROLEN (DANTRIUM) 25MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200241 637 metFORMIN (GLUCOPHAGE) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200262 637 WARFARIN SOD (COUMADIN) 3MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200280 637 IBUPROFEN (MOTRIN) 400MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200286 637 SIMETHICONE (MYLANTA-GAS) 80MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1200350 637 CLORAZEPATE 3.75MG (TRANXENE) TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1200352 637 Cephalexin (KEFLEX) 250MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200354 637 CEPHALEXIN (KEFLEX) 500MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200369 637 COLCHICINE (COLCRYS) 0.6MG TABLET 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 1200375 637 QUINIDINE SULFATE TAB : 200MG 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1200388 637 PHENobarbital (PHENobarbital) 32.4MG TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1200389 637 PHENobarbital 100MG TABLET 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1200397 637 METOLAZONE (ZAROXOLYN) 2.5MG TABLET 1 4.12 1.40 1.61 3.30 2.47 2.11 2.99 2.88 3.21 3.09 1.61 3.30 2.88 3.09 1200403 637 METOLAZONE (ZAROXOLYN) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200409 637 ALLOPURINOL (ZYLOPRIM ) 300MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200432 637 PROPYLTHIOURACIL (PTU) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200448 637 METHIMAZOLE (TAPAZOLE) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200544 637 DONEPIZIL (ARICEPT) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1200718 637 METHYL SALICYL (BEN GAY) 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 1200750 637 CLOTRIMAZOLE (LOTRIMIN) CRM 1% 15GM 1 7.20 2.45 2.81 5.76 4.32 3.69 5.23 5.04 5.62 5.40 2.81 5.76 5.04 5.40 1200774 637 BETAMETH/VAL (VALISONE) 0.1% LOT 60ML 1 280.00 95.20 109.20 224.00 168.00 143.50 203.28 196.00 218.40 210.00 109.20 224.00 196.00 210.00 1200798 637 NEO/POLY/HC (CORTISPORIN) OTIC SUSP 1 89.16 30.31 34.77 71.33 53.50 45.69 64.73 62.41 69.54 66.87 34.77 71.33 62.41 66.87 1200920 637 TETRAHYDROZ. (VISINE) O.S. 15ML BT 1 6.28 2.14 2.45 5.02 3.77 3.22 4.56 4.40 4.90 4.71 2.45 5.02 4.40 4.71 1200940 637 ZINC OXIDE OINT 20% 30GM 1 10.30 3.50 4.02 8.24 6.18 5.28 7.48 7.21 8.03 7.73 4.02 8.24 7.21 7.73 1201090 637 SODIUM BICARBONATE 650MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1201143 637 THIAMINE (VITAMIN B1) 100MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1201163 637 ISONIAZID 100MG TABLET 1 5.50 1.87 2.15 4.40 3.30 2.82 3.99 3.85 4.29 4.13 2.15 4.40 3.85 4.13 1201165 637 NEOMYCIN 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201296 637 CEPHALEXIN (KEFLEX) 250MG/5ML SUSP 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 1201307 637 CEPHALEXIN (KEFLEX) 125MG/5ML SUSP 1 44.25 15.05 17.26 35.40 26.55 22.68 32.13 30.98 34.52 33.19 17.26 35.40 30.98 33.19 1201314 637 GUIATUSS DM (ROBITUSSIN-DM) 5ML SYRUP 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 1201577 637 BACTRIM TAB 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 1201587 637 CARBID/LEVOD 25/250 TAB (SINEMET) 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201593 637 CARBID/LEVOD 10/100 (SINEMET) 10/100 TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201611 637 oxyCODONE IMMED REL (ROXICODONE) 5MG 1 6.50 2.21 2.54 5.20 3.90 3.33 4.72 4.55 5.07 4.88 2.54 5.20 4.55 4.88 1201635 637 SILVER SULFADIAZ. (SILVADENE) CR 400GM 1 125.00 42.50 48.75 100.00 75.00 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1201668 637 AMOXICILLIN (AMOXIL) 250MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201670 637 SINEQUAN CAP : 100 MG 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 1201686 637 CALAMINE LOTION 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201799 637 HYDROcod/HOMAT5MG/1.5MG/5ML(HYCODAN) 1 16.24 5.52 6.33 12.99 9.74 8.32 11.79 11.37 12.67 12.18 6.33 12.99 11.37 12.18 1201898 637 hydrOXYzine HCL (ATARAX) SYRUP 10MG/5ML 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1201908 637 SODIUM CHLORIDE 0.9% INHALATION 3ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201939 637 FLUDROCORTISONE (FLORINEF) 0.1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201963 637 VALPROIC ACID (DEPAKENE) 250MG/5ML SYRP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1201980 637 AMOXICILLIN (AMOXIL) 125MG/5ML SUSP 1 7.25 2.47 2.83 5.80 4.35 3.72 5.26 5.08 5.66 5.44 2.83 5.80 5.08 5.44 1201995 637 CILOSTAZOL (PLETAL) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202033 637 TRIAMCIN/DENT (KENALOG/ORABASE) 0.1% PST 1 150.00 51.00 58.50 120.00 90.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1202051 637 TRIAMCINOLONE (KENALOG) OINT .1% 15GM 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 1202063 637 TRIAMCINOLONE 0.1% CREAM 15GM 1 11.05 3.76 4.31 8.84 6.63 5.66 8.02 7.74 8.62 8.29 4.31 8.84 7.74 8.29 1202106 637 DOCUSATE SOD (COLACE) LIQ 10 MG/ML 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1202158 637 NYSTATIN (MYCOSTATIN) CREAM 15GM 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 1202181 637 NYSTATIN (MYCOSTATIN) PWDR 15GM 1 61.50 20.91 23.99 49.20 36.90 31.52 44.65 43.05 47.97 46.13 23.99 49.20 43.05 46.13 1202183 637 FEXOFENADINE (ALLEGRA ) 60MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202200 637 NIACIN 50MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1202201 637 PHENYTOIN (DILANTIN) SUSP 100MG/4ML UD 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1202265 637 BROMPHEN/PHENYLEP(DIMETAPP) ELX 5ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202266 637 PENICILLIN-VK 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202367 637 TELMISARTAN (MICARDIS) 40MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202404 637 HYDROXYUREA (HYDREA) 500MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202424 637 fluPHENAZine HCL (PROLIXIN) 1MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202475 637 MULTIVITAMIN (THERAGRAN) TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1202476 637 PERIACTIN (Cyproheptadine) SYRUP 2MG/5ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202512 637 PROMETHAZINE (PHENERGAN) 6.25MG/5ML SYRP 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1202528 637 chlordiazePOXIDE 10MG (LIBRIUM) CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202531 637 chlordiazePOXIDE 25MG (LIBRIUM) CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202533 637 DIAZEPAM 2MG (VALIUM) TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1202538 637 DIAZEPAM 5MG (VALIUM) TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1202540 637 DIAZEPAM 10MG (VALIUM)TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202541 637 CHLORDIAZ/CLIDIN 2.5/5 (LIBRAX) CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202628 637 BISOPROLOL (ZEBETA) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202629 637 TOLTERODINE LA (DETROL-LA) 4MG CAPSULE 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 1202630 637 MIRTAZAPINE ODT (REMERON SOLTAB) 15MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202702 637 FLUOROURACIL (EFUDEX)CRE 5% 40 GM TUBE 1 159.86 54.35 62.35 127.89 95.92 81.93 116.06 111.90 124.69 119.90 62.35 127.89 111.90 119.90 1202749 637 ARIPiprazole (ABILIFY) 15MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202791 637 FELDENE CAP : 20 MG 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1203065 637 FOLIC ACID (FOLIC ACID) 1MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1203100 637 TRIHEXYPHENIDYL (ARTANE) 2MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203137 637 acetaZOLAMIDE (DIAMOX SEQ) 500MG CAPS 1 12.75 4.34 4.97 10.20 7.65 6.53 9.26 8.93 9.95 9.56 4.97 10.20 8.93 9.56 1203141 637 acetaZOLAMIDE (DIAMOX) 250MG TABLET 1 9.25 3.15 3.61 7.40 5.55 4.74 6.72 6.48 7.22 6.94 3.61 7.40 6.48 6.94 1203283 637 ETHAMBUTOL (MYAMBUTOL) 400MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203293 637 NAVANE CAPS : 10MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203311 637 NAPROXEN SOD (ANAPROX) 275MG TABLET 1 4.71 1.60 1.84 3.77 2.83 2.41 3.42 3.30 3.67 3.53 1.84 3.77 3.30 3.53 1203376 637 ATENOLOL (TENORMIN) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203435 637 AMITRIPTYLINE (ELAVIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203437 637 INDOMETHACIN (INDOCIN) 25MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203446 637 HYDROCHLOROTHIAZIDE (HCTZ) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203448 637 PHYTONADIONE (MEPHYTON) 5MG TABLET 1 98.00 33.32 38.22 78.40 58.80 50.23 71.15 68.60 76.44 73.50 38.22 78.40 68.60 73.50 1203452 637 AMITRIPTYLINE (ELAVIL) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203470 637 CYPROHEPTADINE (PERIACTIN) 4MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203483 637 AMITRIPTYLINE (ELAVIL) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203507 637 METHYLDOPA (ALDOMET) 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203550 637 HYDROCORTISONE (CORTEF) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203555 637 BENZTROPINE (COGENTIN) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203754 637 HYDROCORTISONE 1% CREAM 30GM 1 23.30 7.92 9.09 18.64 13.98 11.94 16.92 16.31 18.17 17.48 9.09 18.64 16.31 17.48 1203957 637 CAPTOPRIL (CAPOTEN) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203966 637 TEMAZEPAM (RESTORIL) 15MG CAPSULE 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1204020 637 ASPIRIN EC (ECOTRIN) 325MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1204050 637 DESLORATADINE (CLARINEX) 5MG TABLET 1 6.75 2.30 2.63 5.40 4.05 3.46 4.90 4.73 5.27 5.06 2.63 5.40 4.73 5.06 1204155 637 chlorproMAZINE (THORAZINE) 25MG TABLET 1 11.28 3.84 4.40 9.02 6.77 5.78 8.19 7.90 8.80 8.46 4.40 9.02 7.90 8.46 1204158 637 THORAZINE TAB : 50 MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1204159 637 NAPHAZOLINE/PHENIR (NAPHCON-A) O.S. 5ML 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1204172 637 flavoxATE (URISPAS) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1204293 637 NIFEdipine ER (PROCARDIA-XL) 90MG TABLET 1 6.50 2.21 2.54 5.20 3.90 3.33 4.72 4.55 5.07 4.88 2.54 5.20 4.55 4.88 1204306 637 KETOCONAZOLE (NIZORAL) 200MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1204310 637 PROMETH/COD (PHENERGAN W/COD) SYRP 5ML 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1204360 637 PROMETHAZINE (PHENERGAN) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1204420 637 OXAZEPAM (SERAX) 10MG CAPSULE 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1204455 637 FLUTICASONE 220MCG (FLOVENT) MDI 1 815.00 277.10 317.85 652.00 489.00 417.69 591.69 570.50 635.70 611.25 317.85 652.00 570.50 611.25 1204914 637 CLARITHROMYCIN (BIAXIN) SUSP 250MG/5ML 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1205008 637 medroxyPROGESTERone (PROVERA) 10MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1205028 637 medroxyPROGESTERone (PROVERA) 2.5MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1205133 637 oxyCODONE EXT REL (oxyCONTIN) 10MG TAB 1 11.94 4.06 4.66 9.55 7.16 6.12 8.67 8.36 9.31 8.96 4.66 9.55 8.36 8.96 1205143 637 BACITRACIN OINTMENT 15GM 1 13.00 4.42 5.07 10.40 7.80 6.66 9.44 9.10 10.14 9.75 5.07 10.40 9.10 9.75 1205201 637 CLINDAMYCIN (CLEOCIN) 150MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1205454 637 GLIMEPIRIDE (AMARYL) 2MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1205509 637 DOXAZOSIN (CARDURA) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1205589 637 METOCLOPRAMIDE (REGLAN) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1206384 637 EYE VITAMIN (OCUVITE) TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1206669 637 TROLAMINE (MYOFLEX) CREAM 10% 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 1206687 637 ANTIPRN/BENZOCN(AURALGAN) OTIC 15ML 1 51.55 17.53 20.10 41.24 30.93 26.42 37.43 36.09 40.21 38.66 20.10 41.24 36.09 38.66 1206765 637 CALCIUM CITRATE + D3 (CITRACAL) TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1206770 637 FLUNISOLIDE (NASALIDE) NASAL SPY 0.025% 1 154.44 52.51 60.23 123.55 92.66 79.15 112.12 108.11 120.46 115.83 60.23 123.55 108.11 115.83 1206817 637 DIPHENOX/ATROP (LOMOTIL) TABLET 1 6.05 2.06 2.36 4.84 3.63 3.10 4.39 4.24 4.72 4.54 2.36 4.84 4.24 4.54 1206866 637 SUCRALFATE (CARAFATE) 1GM TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207086 637 SPIRONOLACTONE (ALDACTONE) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207104 637 metroNIDAZOLE (FLAGYL) 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207221 637 SILVER SULFADIAZ. (SILVADENE) CRM 25GM 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 1207282 637 AMILORIDE (MIDAMOR) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207303 637 ALPRAZolam 0.25MG (XANAX) TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1207304 637 ALPRAZolam 0.5MG (XANAX)TAB 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1207305 637 ALPRAZolam 1MG (XANAX) TAB 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1207336 637 NITROGLYCERIN 0.2MG/HR PATCH 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1207337 637 NITROGLYCERIN 0.4MG/HR PATCH 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1207378 637 CANDESARTAN (ATACAND) 16MG TABLET 1 12.50 4.25 4.88 10.00 7.50 6.41 9.08 8.75 9.75 9.38 4.88 10.00 8.75 9.38 1207496 637 TORSEMIDE (DEMADEX) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207497 637 FLUTICASONE 110MCG (FLOVENT) MDI PUFF 1 697.00 236.98 271.83 557.60 418.20 357.21 506.02 487.90 543.66 522.75 271.83 557.60 487.90 522.75 1207522 637 NIFEdipine (PROCARDIA) 10MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207662 637 TAMSULOSIN (FLOMAX) 0.4MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207677 637 VERAPAMIL (ISOPTIN) 80MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1207678 637 VERAPAMIL (ISOPTIN) 120MG I.R. TABLET 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 1207971 637 traZODone (DESYREL) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1208500 637 ATENOLOL (TENORMIN) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1208692 637 sulfaSALAzine (AZULFIDINE) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1208804 637 INDOMETHACIN ER (INDOCIN SR) 75MG CAP 1 7.15 2.43 2.79 5.72 4.29 3.66 5.19 5.01 5.58 5.36 2.79 5.72 5.01 5.36 1208925 637 GEMFIBROZIL (LOPID) 600MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1209189 637 B-COMP/FA (FOLGARD RX 2.2) TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1209270 637 NAPROXEN (NAPROSYN) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1209400 637 ALBUTEROL ( PROVENTIL) 2MG TABLET 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 1209617 637 CAPTOPRIL (CAPOTEN) 12.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1209913 637 PILOCARPINE 4% O.S. 15ML BTL(PILOCAR) 1 295.00 100.30 115.05 236.00 177.00 151.19 214.17 206.50 230.10 221.25 115.05 236.00 206.50 221.25 1210026 637 TORSEMIDE (DEMADEX) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1210326 637 DOXEPIN (SINEquan) 10MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1210329 637 DOXEPIN (SINEquan) 25MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1210599 637 HYDROCOD/CHLOR SUSP 5ML (TUSSIONEX) 1 14.20 4.83 5.54 11.36 8.52 7.28 10.31 9.94 11.08 10.65 5.54 11.36 9.94 10.65 1210792 637 LITHIUM CARBONATE 300MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1210824 637 AMANTADINE (SYMMETREL) 100MG CAPSULE 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1211202 637 METOCLOPRAMIDE (REGLAN) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1211306 637 HYDROCORT/PRAMOX (PROCTOFOAM-HC) FOAM 1 275.00 93.50 107.25 220.00 165.00 140.94 199.65 192.50 214.50 206.25 107.25 220.00 192.50 206.25 1211371 637 tiZANidine (ZANAFLEX) 4MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1212072 637 DYNACIRC CAP : 2.5 MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1212314 637 OXcarbazepine (TRILEPTAL) 300MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1212371 637 SULFACET/PREDNISOL (BLEPHAMIDE) OPH SUSP 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 1212576 637 SUDAFED (PSEUOEPHEDRINE) 60MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1212615 637 risperiDONE (risperDAL) 1MG/ML SOLN 30ML 1 155.00 52.70 60.45 124.00 93.00 79.44 112.53 108.50 120.90 116.25 60.45 124.00 108.50 116.25 1213110 637 VITAMIN E 1000 UNIT CAPSULE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1213111 637 PROMETH-DM (PHENERGAN DM) 5ML/UD 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1214033 637 PHENYLEPHRNIE (NEO-SYNEPHRINE) 1% NASAL 1 41.00 13.94 15.99 32.80 24.60 21.01 29.77 28.70 31.98 30.75 15.99 32.80 28.70 30.75 1214046 637 PHENYLEPHRINE (NEO-SYNEPHRINE) 0.25% NAS 1 15.45 5.25 6.03 12.36 9.27 7.92 11.22 10.82 12.05 11.59 6.03 12.36 10.82 11.59 1214053 637 PHENYLEPHRINE (NEO-SYNEPHRINE) .5% NASAL 1 15.45 5.25 6.03 12.36 9.27 7.92 11.22 10.82 12.05 11.59 6.03 12.36 10.82 11.59 1214121 637 HYDROXYCHLOROQUINE (PLAQUENIL) 200MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1214153 637 MODAFINIL 100MG (PROVIGIL)TAB 1 45.05 15.32 17.57 36.04 27.03 23.09 32.71 31.54 35.14 33.79 17.57 36.04 31.54 33.79 1214155 637 metFORMIN ER (GLUCOPHAGE XR) 500MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1214227 637 ESTRADIOL (ESTRACE) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1214732 637 DILTIAZEM IR (CARDIZEM) 60MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1214733 637 DILTIAZEM IR (CARDIZEM) 30MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1214880 637 DORZOLAMIDE (TRUSOPT) 2% O.S. 10ML 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 1215226 637 dimenhyDRINATE (DRAMAMINE) 50MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1215571 637 FLUTICASONE 44MCG (FLOVENT)INH MDI39476 1 520.75 177.06 203.09 416.60 312.45 266.88 378.06 364.53 406.19 390.56 203.09 416.60 364.53 390.56 1215912 637 DOMEBORO PWD PACKETS 12'S 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1216236 637 BUMETANIDE (BUMEX) 0.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1216237 637 BUMETANIDE (BUMEX) 1MG TABLET 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1216649 637 LISINOPRIL (ZESTRIL) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1216885 637 QUEtiapine (SEROquel) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1216888 637 CLOPIDOGREL (PLAVIX) 75MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1217250 637 MILK OF MAGNESIA SUSP 30ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1217934 637 oxyCODONE/APAP 5/325 (PERCOCET) TAB 1 45.00 15.30 17.55 36.00 27.00 23.06 32.67 31.50 35.10 33.75 17.55 36.00 31.50 33.75 1218364 637 IMIPRAMINE (TOFRANIL) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1218371 637 IMIPRAMINE (TOFRANIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1218404 637 carBAMazepine (TEGretol) 200MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1218406 637 IMIPRAMINE (TOFRANIL) 50MG TABLET 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1218442 637 PENTAZOCINE/NALOX (TALWIN NX) TABLET 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1218607 637 MAG-AL (MAALOX) SUSP 30ML 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1218695 637 PRANDIN (REPAGLINIDE) 1MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1218834 637 RANITIDINE (ZANTAC) 150MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1218901 637 CIPROFLOXACIN (CILOXAN) 0.3% O.S. 5ML BT 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1219150 637 CLOTRIMAZOLE TROCHE (MYCELEX) 10MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1219335 637 FOSINOPRIL (MONOPRIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1219600 637 METOCLOPRAMIDE (REGLAN) LIQ 5MG/5ML 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1219636 637 RAMIPRIL (ALTACE) 5MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1220332 637 CLEOCIN PED SUS : 75MG/5ML 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1220433 637 INDAPAMIDE (LOZOL) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1220676 637 risperiDONE (risperDAL) 0.25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1220954 637 NICOTINE GUM 2MG (NICORETTE) 20 PIECES 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1221042 637 BELLADONA/PB (DONNATAL) TABLET 1 33.00 11.22 12.87 26.40 19.80 16.91 23.96 23.10 25.74 24.75 12.87 26.40 23.10 24.75 1221048 637 ALBUT/IPRAT(COMBIVENT)RESPIMAT MDI.PUFF 1 866.05 294.46 337.76 692.84 519.63 443.85 628.75 606.24 675.52 649.54 337.76 692.84 606.24 649.54 1221143 637 CITALOPRAM (CeleXA) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1221147 637 GABAPENTIN (NEURONTIN) 300MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1221172 637 ROBAXIN TAB : 500 MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1221175 637 METHOCARBAMOL (ROBAXIN) 750MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1221239 637 GUIAFEN AC 100/10MG/5ML (ROBITUSSIN AC) 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1221438 637 PredniSONE 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1221467 637 quiNIDine 300MG TABLET 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 1221522 637 PrednisoLONE (PRED FORTE) 1% O.S. 5ML 1 152.20 51.75 59.36 121.76 91.32 78.00 110.50 106.54 118.72 114.15 59.36 121.76 106.54 114.15 1222103 637 DILTIAZEM IR (CARDIZEM) 90MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1222501 637 OCEAN NASAL SPRAY 0.65% 44ML 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 1222527 637 POVIDONE/IODINE (BETADINE) OINT 30GM 1 13.00 4.42 5.07 10.40 7.80 6.66 9.44 9.10 10.14 9.75 5.07 10.40 9.10 9.75 1222570 637 CARBAMIDE PEROX (CERUMENEX) OTIC 15ML 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1222588 637 SOD. CHLORIDE (MURO-128) O.S. 15ML BTL 1 57.60 19.58 22.46 46.08 34.56 29.52 41.82 40.32 44.93 43.20 22.46 46.08 40.32 43.20 1222629 637 NITROFURANTOIN (MACRODANTIN) 50MG CAP 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1222636 637 DIVALPROEX DR 12HR (DEPAKOTE) 500MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1222703 637 PHENOL (CHLORASEPTIC) THROAT SPRAY 1 6.32 2.15 2.46 5.06 3.79 3.24 4.59 4.42 4.93 4.74 2.46 5.06 4.42 4.74 1223021 637 FUROSEMIDE (LASIX) 80MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1223971 637 CARISOPRODOL 350MG (SOMA) TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1224749 637 OXYBUTYNIN ER (DITROPAN XL) 5MG TABLET 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1224997 637 SIMETHICONE (MYLICON) DROPS 40MG/0.6ML 1 8.52 2.90 3.32 6.82 5.11 4.37 6.19 5.96 6.65 6.39 3.32 6.82 5.96 6.39 1225001 637 LACTULOSE SOLN 10G/15ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1225002 637 metroNIDAZOLE (FLAGYL) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1225201 637 DOCUSATE CA (SURFAK) 240MG CAPSULE 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1225229 637 FUROSEMIDE (LASIX) 40MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1225302 250 RACEMIC EPI (VAPONEFRIN) INH SOLN 2.25% 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 1225344 637 POTASSIUM CHLOR 40MEQ/30ML SOLN ORAL 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 1225608 637 CHLORTHALIDONE 25MG (HYGROTON) TABLET 1 6.84 2.33 2.67 5.47 4.10 3.51 4.97 4.79 5.34 5.13 2.67 5.47 4.79 5.13 1226405 637 CARVEDILOL (COREG) 3.125MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1226679 637 HYDROcodone/APAP2.5/108/5ML(LORTAB) LIQ 1 12.05 4.10 4.70 9.64 7.23 6.18 8.75 8.44 9.40 9.04 4.70 9.64 8.44 9.04 1226740 637 glyBURIDE (MICRONASE) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1226809 637 LOTENSIN (BENAZEPRIL) 5MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1226854 637 DICLOFENAC (VOLTAREN) 0.1% O.S. 5ML BTL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1226893 637 buPROPion (WELLBUTRIN) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1226895 637 ACETAMINOPHEN (TYLENOL) 650MG SUPPOS 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1226917 637 risperiDONE (risperDAL) 0.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227622 637 CHLORHEXIDINE 4% 118ML (HIBICLENS) 1 18.76 6.38 7.32 15.01 11.26 9.61 13.62 13.13 14.63 14.07 7.32 15.01 13.13 14.07 1227677 637 HALDOL TAB : 0.5MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227678 637 HALOPERIDOL (HALDOL) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227683 637 HALDOL TAB : 2MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227685 637 HALOPERIDOL (HALDOL) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227734 637 ACETAMINOPHEN (TYLENOL) 325MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1227757 637 ACETAMIN w/CODEIN 300/30MG(TYLENOL#3) 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1227913 637 PRIMIDONE (MYSOLINE) 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227917 637 PRIMIDONE (MYSOLINE) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227938 637 PROPRANOLOL (INDERAL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1227941 637 INDERAL TAB : 40 MG 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1228034 637 ESTROGENS CONJ (PREMARIN) 1.25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228036 637 ESTROGENS CONJ (PREMARIN) 0.625MG TABLET 1 20.24 6.88 7.89 16.19 12.14 10.37 14.69 14.17 15.79 15.18 7.89 16.19 14.17 15.18 1228039 637 PREMARIN 0.3MG TABLET 1 20.24 6.88 7.89 16.19 12.14 10.37 14.69 14.17 15.79 15.18 7.89 16.19 14.17 15.18 1228091 636 LEVAQUIN IVPB 500MG/100ML 1 275.05 93.52 107.27 220.04 165.03 140.96 199.69 192.54 214.54 206.29 107.27 220.04 192.54 206.29 1228094 637 AMOXICIL/CLAV (AUGMENTIN) 875MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228116 637 glipiZIDE (GLUCOTROL) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228117 637 glipiZIDE (GLUCOTROL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228131 637 ERYTHROMYCIN (ERYPED) SUSP 200MG/5ML 1 635.00 215.90 247.65 508.00 381.00 325.44 461.01 444.50 495.30 476.25 247.65 508.00 444.50 476.25 1228138 637 glyBURIDE (MICRONASE) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228311 637 LOSARTAN (COZAAR) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228344 637 HYDROCORTISONE (ANUSOL-HC) SUPP 25MG 1 10.34 3.52 4.03 8.27 6.20 5.30 7.51 7.24 8.07 7.76 4.03 8.27 7.24 7.76 1228418 637 PHENAZOPYRID (PYRIDIUM) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228421 637 PHENAZOPYRIDINE (PYRIDIUM) 200MG TABLET 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 1228422 637 traMAdol (ULTRAM) 50MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1228648 637 IBUPROFEN (ADVIL) 200MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1228802 637 AMOXICIL/CLAV (AUGMENTIN) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228877 637 KETOROLAC 0.5% (ACULAR) O. S. 3ML BTL 1 35.84 12.19 13.98 28.67 21.50 18.37 26.02 25.09 27.96 26.88 13.98 28.67 25.09 26.88 1228879 637 CALCIUM CARB (CALTRATE) 600MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1228881 637 LABETALOL (NORMODYNE) 200MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1228893 637 CLOTRIM/BETAMETH (LOTRISONE) CRM 15GM 1 29.12 9.90 11.36 23.30 17.47 14.92 21.14 20.38 22.71 21.84 11.36 23.30 20.38 21.84 1229017 637 AMOXICIL/CLAV (AUGMENTIN) 125MG/5ML SUSP 1 7.25 2.47 2.83 5.80 4.35 3.72 5.26 5.08 5.66 5.44 2.83 5.80 5.08 5.44 1229018 637 AMOXICIL/CLAV (AUGMENTIN) 250MG/5ML SUSP 1 150.00 51.00 58.50 120.00 90.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1229264 637 LEVOTHYROXINE (SYNTHROID) 50MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1229290 637 LEVOTHYROXINE (SYNTHROID) 100MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1229349 637 LEVOTHYROXINE (SYNTHROID) 200MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1229358 637 ACYCLOVIR (ZOVIRAX) SUSP 200MG/5ML 1 8.48 2.88 3.31 6.78 5.09 4.35 6.16 5.94 6.61 6.36 3.31 6.78 5.94 6.36 1229400 637 PENTOXIFYLLINE (TRENtal) 400MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1229403 637 PEG3350/ELEC (GOLYTELY) 4L SOLN 1 40.64 13.82 15.85 32.51 24.38 20.83 29.50 28.45 31.70 30.48 15.85 32.51 28.45 30.48 1229498 637 GLYCERIN SUPP INFANT 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1229532 637 AZITHROMYCIN (ZITHROMAX) 100MG/5ML SUSP 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1229666 637 glipiZIDE ER (GLUCOTROL XL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1229669 637 glipiZIDE ER (GLUCOTROL XL) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1229857 637 TIMOLOL GEL (TIMOPTIC XE) 0.5% O.S. 5ML 1 232.40 79.02 90.64 185.92 139.44 119.11 168.72 162.68 181.27 174.30 90.64 185.92 162.68 174.30 1229918 637 TRIAMTER/HCTZ (MAXZIDE) 75/50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1230013 637 THIOTHIXENE (NAVANE) 2MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1230018 637 THIOTHIXENE (NAVANE) 5MG CAPSULE 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1230092 637 BISMUTH SUBSALIC (PEPTO-BISMOL) 5ML 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1230588 637 levoFLOXacin (LEVAQUIN) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1230724 637 morphine EXT REL (MS CONTIN) 30MG TABLET 1 7.50 2.55 2.93 6.00 4.50 3.84 5.45 5.25 5.85 5.63 2.93 6.00 5.25 5.63 1230790 637 ACYCLOVIR (ZOVIRAX) 200MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1231270 637 BUTALBIT/APAP/CAFF (FIORICET) 50/325/40 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1231495 637 PSEUDOEPH/LORTDN12H(CLARITIN-D12)120/5MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1231582 637 EPIVIR (lamiVUDine) 150MG TABLET 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 1231641 637 THYROID 30MG TABLET 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1231642 637 THYROID 1GRAIN (65MG) TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1231997 637 PredniSONE 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1232055 637 ASCORBIC ACID (VIT. C) 500MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1232112 637 OLOPATADINE (PATANOL) 0.1% O.S. 5ML BTL 1 120.00 40.80 46.80 96.00 72.00 61.50 87.12 84.00 93.60 90.00 46.80 96.00 84.00 90.00 1232133 637 PHENobarbital 20MG/5ML ELIXIR 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1232155 637 PredniSONE 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1232356 637 WARFARIN SOD (COUMADIN) 2MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1232359 637 WARFARIN SOD (COUMADIN) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1232368 637 WARFARIN SOD (COUMADIN) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1232370 637 WARFARIN SOD (COUMADIN) 7.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1232377 637 WARFARIN SOD (COUMADIN) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1232423 637 SIMETHICONE (PHAZYME) 125MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1232682 637 PERCOGESIC TAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1233052 637 FERROUS GLUC. (FERGON) 324MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1233646 637 DOXAZOSIN (CARDURA) 8MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1234297 637 PILOCARPINE 2% O.S.15ML BTL(PILOCAR) 1 295.00 100.30 115.05 236.00 177.00 151.19 214.17 206.50 230.10 221.25 115.05 236.00 206.50 221.25 1234369 637 ACETYLCHOL (MIOCHOL) O.S. 2ML BTL 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 1235042 637 IBUPROFEN (MOTRIN) 800MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1235206 637 LABETALOL (NORMODYNE) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1235211 637 DEXAMETHASONE (DECADRON) 0.75MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1235219 637 DEXAMETHASONE (DECADRON) 4MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1235275 637 cloNIDine 0.1 MG/DAY PATCH (CATAP.TTS-1) 1 33.00 11.22 12.87 26.40 19.80 16.91 23.96 23.10 25.74 24.75 12.87 26.40 23.10 24.75 1235277 637 cloNIDine 0.2 MG/DAY (7 DAY PATCH) 1 35.00 11.90 13.65 28.00 21.00 17.94 25.41 24.50 27.30 26.25 13.65 28.00 24.50 26.25 1235280 637 cloNIDine 0.3 MG/DAY PATCH (CATAP.TTS-3) 1 37.00 12.58 14.43 29.60 22.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 1235301 637 ASPIRIN ENTERIC COATED (ASA) 81MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1235428 637 MOEXIPRIL (UNIVASC) 15MG TABS 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1235478 637 buPROPion SR 12HR (WELLBUTRIN)150MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1236489 637 DIVALPROEX ER 24HR (DEPAKOTE ER) 500MG 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1237361 637 SUMAtriptan (IMITREX) 25MG TABLET 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1237365 637 CARBID/LEVOD ER 50/200 (SINEMET CR) TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1237395 637 FELODIPINE (PLENDIL) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1237935 637 FLECANIDE (TAMBOCOR) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1238022 637 TORSEMIDE (DEMADEX) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1238111 637 ARTIFICIAL TEARS (ISOPTO-TEARS) 15ML 1 8.25 2.81 3.22 6.60 4.95 4.23 5.99 5.78 6.44 6.19 3.22 6.60 5.78 6.19 1238420 637 LOPERAMIDE (IMODIUM) 2MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1238512 637 FLUTICASONE (FLONASE) NASAL SPRAY 16GM 1 92.00 31.28 35.88 73.60 55.20 47.15 66.79 64.40 71.76 69.00 35.88 73.60 64.40 69.00 1238890 637 guaiFENesin (BIDEX) 400MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1239363 637 EYEWASH SOLN (EYE STREAM) 30ML 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1239375 637 TOLTERODINE (DETROL) 2MG TAB 1 6.16 2.09 2.40 4.93 3.70 3.16 4.47 4.31 4.80 4.62 2.40 4.93 4.31 4.62 1239378 637 VALSARTAN (DIOVAN) 80MG TABLET 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1239417 637 SPS (KAYEXALATE) SUSP 15GM/60ML 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 1239420 637 NYSTATIN/TRIAMCIN. (MYCOLOG II) CRM 15GM 1 355.00 120.70 138.45 284.00 213.00 181.94 257.73 248.50 276.90 266.25 138.45 284.00 248.50 266.25 1239585 637 DOXYCYCLINE (VIBRATAB) 100MG TABLET 1 6.05 2.06 2.36 4.84 3.63 3.10 4.39 4.24 4.72 4.54 2.36 4.84 4.24 4.54 1239599 637 ENALAPRIL (VASOTEC) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1239801 637 AZELASTINE (ASTELIN) NASAL SPRAY 1 198.20 67.39 77.30 158.56 118.92 101.58 143.89 138.74 154.60 148.65 77.30 158.56 138.74 148.65 1240120 637 CLARITHROMYCIN (BIAXIN) 500MG TABLET 1 4.10 1.39 1.60 3.28 2.46 2.10 2.98 2.87 3.20 3.08 1.60 3.28 2.87 3.08 1240133 637 PRAVASTATIN (PRAVACHOL) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1240191 637 MEXILETINE (MEXITIL) 200MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1240199 637 AMIODARONE (CORDARONE) 200MG TABLET 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1240268 637 ENALAPRIL (VASOTEC) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1240488 637 CYANOCOBALAMIN (VIT B12) 100MCG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1240559 637 DIPYRIDAMOLE (PERSANTINE) 75MG TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1240673 637 ESCITALOPRAM (LEXAPRO) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1240728 637 ACETAMINOPHEN (TYLENOL) 80MG/0.8ML DROPS 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 1240750 637 PROLOPRIM (TRIMETHOPRIM) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1242073 637 DICYCLOMINE (BENTYL) 10MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1242305 637 OSELTAMIVIR (TAMIFLU) 75MG CAPSULE 1 31.56 10.73 12.31 25.25 18.94 16.17 22.91 22.09 24.62 23.67 12.31 25.25 22.09 23.67 1242594 637 QUEtiapine (SEROquel) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1243070 637 hydrOXYzine PAM (VISTARIL) 25MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1243072 637 VISTARIL CAP : 50 MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1243136 637 DILANTIN TAB 50MG (PHENYTOIN) CHEWABLE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1243363 637 FERROUS SULF (65MG) 325MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1243621 637 PHENYTOIN (DILANTIN) 100MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1243635 637 diphenhydrAMINE (BENADRYL) 50MG CAPSULE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1243701 637 diphenhydrAMINE (BENADRYL) 25MG CAPSULE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1243762 637 ASPIRIN (ASA) 325MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1243789 637 MOMETASONE (NASONEX) NASAL 50MCG 1 134.94 45.88 52.63 107.95 80.96 69.16 97.97 94.46 105.25 101.21 52.63 107.95 94.46 101.21 1244282 637 VENLAFAXINE ER (EFFEXOR-XR) 75MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1244295 637 BENAZEPRIL (LOTENSIN) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1244549 637 diphenhydrAMINE (BENADRYL) 12.5MG/5ML EL 1 3.20 1.09 1.25 2.56 1.92 1.64 2.32 2.24 2.50 2.40 1.25 2.56 2.24 2.40 1244701 637 KETOCONAZOLE (NIZORAL) 2% CRM 15GM 1 50.61 17.21 19.74 40.49 30.37 25.94 36.74 35.43 39.48 37.96 19.74 40.49 35.43 37.96 1245267 637 RIFAMPIN (Rifadin) 300MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1245355 637 ASPIRIN (ASA) 81MG CHEWABLE TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1245397 637 ISOSORBIDE MONONIT (IMDUR) 60MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1245434 637 OXYMETAZOLINE (AFRIN) NAS SPR 15ML BTL 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1245760 637 HYDROGEN PEROXIDE 3% SOLN 8OZ 1 2.50 0.85 0.98 2.00 1.50 1.28 1.82 1.75 1.95 1.88 0.98 2.00 1.75 1.88 1246091 637 ESTRADIOL PATCH (ESTRADERM) 0.1MG/24HR 1 38.12 12.96 14.87 30.50 22.87 19.54 27.68 26.68 29.73 28.59 14.87 30.50 26.68 28.59 1246094 637 ESTRADIOL (ESTRADERM) 0.05MG/DAY PATCH 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 1246488 637 POTASSIUM CHL ER (K-DUR) 20MEQ TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1246851 637 FAMOTIDINE (PEPCID) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1246852 637 FAMOTIDINE (PEPCID) 40MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1246997 637 AZITHROMYCIN (ZITHROMAX) 250MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1247005 637 QUINAPRIL (ACCUPRIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1247173 637 NICOTINE 21MG/DAY (PATCH) 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1247405 637 SCOPOLAMINE PATCH (TRANSDERM SCOP) 1 48.37 16.45 18.86 38.70 29.02 24.79 35.12 33.86 37.73 36.28 18.86 38.70 33.86 36.28 1247409 637 AMMONIUM LACT (LAC-HYDRIN) 12% LOTN 8OZ 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1247478 637 busPIRone (BUSPAR) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1247479 637 busPIRone (BUSPAR) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1248090 637 VERAPAMIL ER (ISOPTIN SR) 240MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1248143 637 SELENIUM SULF (SELSUN) SHAMPOO 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 1248258 637 TRANDOLAPRIL (MAVIK) 4MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1248946 637 TIMOLOL GEL(TIMOPTIC XE)0.25% O.S. 5ML 1 301.34 102.46 117.52 241.07 180.80 154.44 218.77 210.94 235.05 226.01 117.52 241.07 210.94 226.01 1249090 637 CALCIUM POLYCARB (FIBERCON) 625MG TAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1249196 637 IPRATROPIUM (ATROVENT) HFA INHALER 1 906.00 308.04 353.34 724.80 543.60 464.33 657.76 634.20 706.68 679.50 353.34 724.80 634.20 679.50 1249304 637 DILTIAZEM CD 24H (CARDIZEM CD) 180MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1249319 637 DILTIAZEM CD 24H (CARDIZEM CD) 240MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1249327 637 DILTIAZEM CD 24H (CARDIZEM CD) 300MG CAP 1 5.40 1.84 2.11 4.32 3.24 2.77 3.92 3.78 4.21 4.05 2.11 4.32 3.78 4.05 1249534 637 TOPIRAMATE (TOPAMAX) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1249606 637 VITAMIN E 400 UNIT CAPSULE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1249688 637 LACTOBACILLUS (BACID) TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1249690 637 OLANZapine (zyPREXA) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1249716 637 MAGNESIUM OXIDE (MAG-OX) 400MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1249811 637 guanFACINE (TENEX) 1MG TABLET 1 5.35 1.82 2.09 4.28 3.21 2.74 3.88 3.75 4.17 4.01 2.09 4.28 3.75 4.01 1250016 637 ZIPRASIDONE (GEODON) 60MG CAPSULE 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 1250202 637 SERTRALINE (ZOLOFT) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1250226 637 SERTRALINE (ZOLOFT) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1250253 637 NABUMETONE (RELAFEN) 500MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1250280 637 SIMVASTATIN (ZOCOR) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1250287 637 PRECOSE 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1250346 637 CAPSAICIN (ZOSTRIX)0.025% CR 60GM TB 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 1250569 637 ACETAMIN W/ COD LIQ 120/12MG/5ML 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1250828 637 THIORIDAZINE (MELLARIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1250833 637 THIORIDAZINE (MELLARIL) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1250916 637 TRANDOLAPRIL (MAVIK) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1251936 637 NEO/BAC/POL/HC (NEO-POLYCIN/HC)O.O. 3.5 1 195.00 66.30 76.05 156.00 117.00 99.94 141.57 136.50 152.10 146.25 76.05 156.00 136.50 146.25 1251944 637 DIGOXIN (LANOXIN) 0.125MG TABLET 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1251946 637 DIGOXIN (LANOXIN) 0.25MG TABLET 1 9.25 3.15 3.61 7.40 5.55 4.74 6.72 6.48 7.22 6.94 3.61 7.40 6.48 6.94 1252064 637 NEO/POLY/GRAM (NEOSPORIN) OPHTH SOL 1 180.00 61.20 70.20 144.00 108.00 92.25 130.68 126.00 140.40 135.00 70.20 144.00 126.00 135.00 1252065 637 NEO/POLY/BAC (NEOSPORIN) OINT UD PK 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1252067 637 NEO/POLY/BAC (NEOSPORIN) OINT 15GM TUBE 1 5.50 1.87 2.15 4.40 3.30 2.82 3.99 3.85 4.29 4.13 2.15 4.40 3.85 4.13 1252069 637 NEO/POLY/BAC (NEOSPORIN OPHT) OPHTH OINT 1 58.00 19.72 22.62 46.40 34.80 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 1252107 637 LOVASTATIN (MEVACOR) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252112 637 ALLOPURINOL (ZYLOPRIM) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252180 637 CEFUROXIME (CEFTIN) 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252201 637 IRON/C/B12/STOM (CHROMAGEN) CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252334 637 TERAZOSIN (HYTRIN) 1MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252335 637 TERAZOSIN (HYTRIN) 2MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252336 637 TERAZOSIN (HYTRIN) 5MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252438 637 ISOSORBIDE DINIT. (ISORDIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252445 637 ISOSORBIDE DINIT. (ISORDIL) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252470 637 ISOSORBIDE ER (ISORDIL TEMBIDS) 40MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252476 637 METHYLPHENIDATE 10MG (RITALIN)TAB 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1252484 637 BENZONATATE (TESSALON) 100MG CAP 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1252510 637 RALOXIFENE (EVISTA) 60MG TABLET 1 8.78 2.99 3.42 7.02 5.27 4.50 6.37 6.15 6.85 6.59 3.42 7.02 6.15 6.59 1252515 637 MOMETASONE CRM (ELOCON) 0.1% 15GM 1 16.80 5.71 6.55 13.44 10.08 8.61 12.20 11.76 13.10 12.60 6.55 13.44 11.76 12.60 1252544 637 hydrALAZINE (APRESOLINE) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252546 637 hydrALAZINE (APRESOLINE) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252740 637 CIPRO TAB : 750 MG 1 17.00 5.78 6.63 13.60 10.20 8.71 12.34 11.90 13.26 12.75 6.63 13.60 11.90 12.75 1252786 637 CIPROFLOXACIN 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252787 637 CIPROFLOXACIN (CIPRO) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252832 637 DIBUCAINE (NUPERCAINAL)1% OINT 28GM TUBE 1 17.25 5.87 6.73 13.80 10.35 8.84 12.52 12.08 13.46 12.94 6.73 13.80 12.08 12.94 1252994 637 TRIAMTER/HCTZ (DYAZIDE) 37.5/25 CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1252996 637 cloNIDine (CATAPRES) 0.3MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1253587 637 LISINOPRIL (ZESTRIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1253639 637 GENTAMICIN (GARAMICIN) 0.3% O.S. 5ML BTL 1 15.05 5.12 5.87 12.04 9.03 7.71 10.93 10.54 11.74 11.29 5.87 12.04 10.54 11.29 1253644 637 ETRAFON TAB 2-10 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 1253647 637 ETRAFON FORTE TAB 4-25 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1253687 637 CARBID/LEVOD ER 25/100 (SINEMET CR) TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1253696 637 FINASTERIDE (PROSCAR) 5MG TABLET 1 6.50 2.21 2.54 5.20 3.90 3.33 4.72 4.55 5.07 4.88 2.54 5.20 4.55 4.88 1253697 637 SENNA/DOCUS (SENOKOT-S) 8.6/50MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1253729 637 KETOCONAZOLE (NIZORAL) 2% SHAMPOO 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 1253840 637 ETHINYL ESTRADIOL 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1253852 637 BETAMETH VAL 0.1% (VALISONE) CRM 15GM 1 43.85 14.91 17.10 35.08 26.31 22.47 31.84 30.70 34.20 32.89 17.10 35.08 30.70 32.89 1253866 637 GENTAMICIN (GARAMINCIN) CR 0.1% 15 GM 1 87.65 29.80 34.18 70.12 52.59 44.92 63.63 61.36 68.37 65.74 34.18 70.12 61.36 65.74 1253871 637 GENTAMICIN (GARAMICIN) OINT 0.1% 15GM 1 20.00 6.80 7.80 16.00 12.00 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 1253874 637 GENTAMICIN OPHTH OINT 0.3% 3.5GM 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1253915 637 CHLORPHENIRAMINE (CHLOR-TRIMETON) 4MG 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1254167 637 FLUoxetine (PROzac) 20MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1254566 637 NAPROXEN SOD (ANAPROX DS) 550MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1255018 637 ERYTHROMYCIN OPHTH OINT 3.5GM TUBE 1 48.40 16.46 18.88 38.72 29.04 24.81 35.14 33.88 37.75 36.30 18.88 38.72 33.88 36.30 1255088 637 LEVOTHYROXINE (SYNTHROID) 150MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1255114 637 POTASSIUM PHOS (K-PHOS) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1255246 637 MUPIROCIN (BACTROBAN) 2% OINT 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1255522 637 CHOLESTYRAMINE (QUESTRAN) PWDR PKT 1 5.88 2.00 2.29 4.70 3.53 3.01 4.27 4.12 4.59 4.41 2.29 4.70 4.12 4.41 1255553 637 PRENATAL VITAMINS (NATALINS) TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1255565 637 DOCUSATE SOD (COLACE) 100MG CAPSULE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1255607 637 FER-IN-SOL DROPS (IRON DROPS) 15MG/ML 5 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 1256063 637 HIPREX TAB : 1 GM 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1256354 637 METOLAZONE (ZAROXOLYN) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1256566 637 CELECOXIB (CeleBREX) 100MG CAPSULE 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1256677 637 HYOSCYAMINE (LEVSIN) 0.125MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1256749 637 HYOSCYAMINE (LEVSIN) 0.125MG/5ML ELIXIR 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1256765 637 NITROGLYCERIN (NITROBID) OINT 30GM TUBE 1 96.00 32.64 37.44 76.80 57.60 49.20 69.70 67.20 74.88 72.00 37.44 76.80 67.20 72.00 1256767 637 MIRAPEX TABLETS : 1MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1256785 637 buPROPion SR 12HR (WELLBUTRIN SR)100MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1257084 637 TERCONAZOLE (TERAZOL 7) VAG CRM 1 52.00 17.68 20.28 41.60 31.20 26.65 37.75 36.40 40.56 39.00 20.28 41.60 36.40 39.00 1257674 637 DICLOFENAC (VOLTAREN) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1257675 637 DICLOFENAC (VOLTAREN) 75MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1257798 637 ADVAIR DISKUS 100/50 (FLUTIC/SALMETROL) 1 353.76 120.28 137.97 283.01 212.26 181.30 256.83 247.63 275.93 265.32 137.97 283.01 247.63 265.32 1257799 637 ADVAIR DISKUS 500/50 1 431.10 146.57 168.13 344.88 258.66 220.94 312.98 301.77 336.26 323.33 168.13 344.88 301.77 323.33 1257938 637 ACETAMINOPHEN (TYLENOL) 160MG/5ML SUSP 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1258071 637 ZIPRASIDONE (GEODON) 20MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1258141 637 ZIPRASIDIONE (GEODON) 40MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1258320 637 TOBRAMY/DEXAM (TOBRADEX) O.S. 1 149.25 50.75 58.21 119.40 89.55 76.49 108.36 104.48 116.42 111.94 58.21 119.40 104.48 111.94 1258628 637 OXYQUINOLN/BORIC A(TRIMO-SAN) JEL 4 OZ 1 79.00 26.86 30.81 63.20 47.40 40.49 57.35 55.30 61.62 59.25 30.81 63.20 55.30 59.25 1258641 637 BISACODYL (DULCOLAX) 5MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1258658 637 DIPYRIDAMOLE (PERSANTINE) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1258670 637 BISACODYL SUPPOSITORY (DULCOLAX) 10MG 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1258899 637 ALENDRONATE (FOSAMAX) 70MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1259369 637 MAGNESIUM CHLOR (SLOW-MAG) 64MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1259812 637 URSODIOL (ACTIGALL) 300MG CAPSULE 1 13.00 4.42 5.07 10.40 7.80 6.66 9.44 9.10 10.14 9.75 5.07 10.40 9.10 9.75 1260314 637 NITROGLYCERIN 0.6MG/HR PATCH 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1260460 637 PETROLEUM JELLY (VASELINE) 1.75OZ JAR 1 5.10 1.73 1.99 4.08 3.06 2.61 3.70 3.57 3.98 3.83 1.99 4.08 3.57 3.83 1261498 637 ENALAPRIL (VASOTEC) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1261652 637 ISOSORBIDE MONONIT (ISMO) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1261688 637 CEFPROZIL (CEFZIL) 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1261845 637 KETOROLAC (TORADOL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1262127 637 NiCARdipine (CARDENE) 20MG CAPSULE 1 6.22 2.11 2.43 4.98 3.73 3.19 4.52 4.35 4.85 4.67 2.43 4.98 4.35 4.67 1262561 637 ENSURE CLEAR 200ML BTL 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1262952 637 DILTIAZEM SR-12HR(CARDIZEM SR) 60MG CAP 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 1263067 637 NICOTINE PATCH 14MG/DAY 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1263069 637 LIDOC/PRILOC (EMLA) 2.5/2.5% CR 5GM TUBE 1 31.25 10.63 12.19 25.00 18.75 16.02 22.69 21.88 24.38 23.44 12.19 25.00 21.88 23.44 1263170 637 morphine EXT REL (MS CONTIN) 15MG TAB 1 7.50 2.55 2.93 6.00 4.50 3.84 5.45 5.25 5.85 5.63 2.93 6.00 5.25 5.63 1263176 637 MEGESTROL (MEGACE) 400MG/10ML SUSP UDC 1 20.00 6.80 7.80 16.00 12.00 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 1263456 637 HYDROCORT RECT CR (ANUSOL-HC) 2.5% 1 100.00 34.00 39.00 80.00 60.00 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 1263457 637 FUROSEMIDE (LASIX) 20MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1263458 637 PSYLLIUM (METAMUCIL) POWDER PKT 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1263464 637 SILVER SULFADIAZ. (SILVADENE) CRM 50GM 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1263497 637 SMZ-TMP (BACTRIM DS) 800-160 TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1263531 637 CLARITHROMYCIN (BIAXIN) SUSP 125MG/5ML 1 164.48 55.92 64.15 131.58 98.69 84.30 119.41 115.14 128.29 123.36 64.15 131.58 115.14 123.36 1263623 637 METOPROLOL SUCC ER (TOPROL XL) 50MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1263647 637 NITROFURANTOIN MONO (MACROBID) 100MG CAP 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1263665 637 AMOXICILLIN (AMOXIL) 500MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1263685 637 AMITRIPTYLINE (ELAVIL) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1263690 637 glyBURIDE (GLYNASE) 3MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1263727 637 CLOTRIMAZOLE (LOTRIMIN) 1% TOP SOLN 10ML 1 27.15 9.23 10.59 21.72 16.29 13.91 19.71 19.01 21.18 20.36 10.59 21.72 19.01 20.36 1263756 637 OXYBUTYNIN (DITROPAN) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1263766 637 PRAMOXINE (PROCTOFOAM) FOAM 15GM 1 178.00 60.52 69.42 142.40 106.80 91.23 129.23 124.60 138.84 133.50 69.42 142.40 124.60 133.50 1263794 637 VENLAFAXINE ER (EFFEXOR XR) 37.5MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1263830 637 DIPHENOX/ATROP LIQ (LOMOTIL)5ML 1 20.05 6.82 7.82 16.04 12.03 10.28 14.56 14.04 15.64 15.04 7.82 16.04 14.04 15.04 1263832 637 DEXAMETHASONE (DECADRON) .1% O.S.5ML 1 101.78 34.61 39.69 81.42 61.07 52.16 73.89 71.25 79.39 76.34 39.69 81.42 71.25 76.34 1263926 637 SORBITOL 70% SOLN 30ML UD 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1264082 637 BRIMONIDINE 0.15% (ALPHAGAN-P) OPHTH SOL 1 61.00 20.74 23.79 48.80 36.60 31.26 44.29 42.70 47.58 45.75 23.79 48.80 42.70 45.75 1264706 637 ISOSORBIDE DINIT. (ISORDIL) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1265653 637 MELLARIL TAB : 50 MG 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1266296 637 TERCONAZOLE (TERAZOL) 80MG VAG SUPP 1 39.96 13.59 15.58 31.97 23.98 20.48 29.01 27.97 31.17 29.97 15.58 31.97 27.97 29.97 1266713 637 ZINC SULFATE 220MG CAPSULE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1266714 637 EES (ERYPED)200MG/5ML ORAL SUSP 1 635.00 215.90 247.65 508.00 381.00 325.44 461.01 444.50 495.30 476.25 247.65 508.00 444.50 476.25 1267036 637 clonazePAM 0.5MG (KlonoPIN)TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1267533 637 LACTAID TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1267607 637 FERROUS SULF ELIXIR 220MG(44MG)/5ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1268153 637 MAGNESIUM CITRATE SOLN 300ML 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1269257 637 buPROPion (WELLBUTRIN) 75MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1269359 637 RANITIDINE 150MG/10ML SYRUP 1 6.50 2.21 2.54 5.20 3.90 3.33 4.72 4.55 5.07 4.88 2.54 5.20 4.55 4.88 1269548 637 GABAPENTIN (NEURONTIN) 100MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1269638 637 ATORVASTATIN (LIPITOR) 40MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1269696 637 ERYTHROMYCIN ETH SUC (EES-400) TABLET 1 22.50 7.65 8.78 18.00 13.50 11.53 16.34 15.75 17.55 16.88 8.78 18.00 15.75 16.88 1269715 637 GERI-TONIC VITAMIN LIQUID 30ML/UD 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1269769 637 PROPRANOLOL (INDERAL) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1269857 637 DIGOXIN (LANOXIN) ELX 0.05MG/ML 60ML BTL 1 159.71 54.30 62.29 127.77 95.83 81.85 115.95 111.80 124.57 119.78 62.29 127.77 111.80 119.78 1270411 637 NYSTATIN (MYCOSTATIN) SUSP 5ML 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1271118 637 DILTIAZEM CD 24H (CARDIZEM CD) 120MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1271122 637 AMLODIPINE (NORVASC) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1271123 637 AMLODIPINE (NORVASC) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1271452 637 FLUOROMETH. (FML) 0.1% O.S. 5ML 1 37.50 12.75 14.63 30.00 22.50 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 1272227 637 THEOPHYLLINE ER (THEODUR) 300MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1272369 637 NEO/POLY/HC (CORTISPORIN) OP.SUSP 1 322.50 109.65 125.78 258.00 193.50 165.28 234.14 225.75 251.55 241.88 125.78 258.00 225.75 241.88 1272540 637 HYOSCYAMINE ERV (CYSTOSPAZ-M) 0.375MG CA 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1272666 637 ZOLMitriptan (ZOMIG-ZMT) 2.5MG TDIS 1 36.00 12.24 14.04 28.80 21.60 18.45 26.14 25.20 28.08 27.00 14.04 28.80 25.20 27.00 1272949 637 NIFEdipine ER (PROCARDIA-XL) 30MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1272950 637 NIFEdipine ER (PROCARDIA-XL) 60MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1273102 637 SOTALOL (BETAPACE) 80MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1273846 637 IBUPROFEN (MOTRIN) 100MG/5ML SUSPENSION 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1274206 637 SINEQUAN CAP : 75 MG 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1274380 637 MOMETASONE LOTION (ELOCON) 0.1% 1 62.20 21.15 24.26 49.76 37.32 31.88 45.16 43.54 48.52 46.65 24.26 49.76 43.54 46.65 1275040 637 ZOLPIDEM (AMBIEN) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1275222 250 CHARCOAL/SORB (ACTIDOSE)25GM/120ML 1 55.75 18.96 21.74 44.60 33.45 28.57 40.47 39.03 43.49 41.81 21.74 44.60 39.03 41.81 1275489 637 DAPSONE 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1275527 637 FLUoxetine (PROzac) 10MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1275537 637 PARoxetine (PAXIL) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1276120 637 CALCITONIN (MIACALCIN) NASAL SPRAY 1 72.48 24.64 28.27 57.98 43.49 37.15 52.62 50.74 56.53 54.36 28.27 57.98 50.74 54.36 1276839 637 IRBESARTAN (AVAPRO) 150MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1276881 637 LORATADINE (CLARITIN) 10MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1277003 637 SIMPLE SYRUP (SYRPALTA) 5ML 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1277125 637 NITROGLYCERIN 0.1MG/HR PATCH 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1277615 637 HYDROCORTISN (CORT ENEMA)100MG/60ML 1 11.46 3.90 4.47 9.17 6.88 5.87 8.32 8.02 8.94 8.60 4.47 9.17 8.02 8.60 1277762 637 MEGESTROL ACET. (MEGACE) 40MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1278053 637 TERBINAFINE (LamISIL) 1% CREAM 15GM 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 1278375 637 CYCLOPENTOLATE (CYCLOGYL) 1% O.S. 2ML 1 45.40 15.44 17.71 36.32 27.24 23.27 32.96 31.78 35.41 34.05 17.71 36.32 31.78 34.05 1278411 637 CYCLOBENZAPRINE (FLEXERIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1278479 637 NORTRIPTYLINE (PAMELOR) 10MG CAPSULE 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1278480 637 NORTRIPTYLINE (PAMELOR) 25MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1278553 637 MICONAZOLE (MONISTAT-7) VAG CRM 2% 1 23.80 8.09 9.28 19.04 14.28 12.20 17.28 16.66 18.56 17.85 9.28 19.04 16.66 17.85 1278560 637 DISOPYRAMIDE (NORPACE) 150MG 1 6.05 2.06 2.36 4.84 3.63 3.10 4.39 4.24 4.72 4.54 2.36 4.84 4.24 4.54 1278567 637 TERBINAFINE (LamISIL) 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1278701 637 LORazepam 1MG (ATIVAN) TABLET 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1278762 637 BRINZOLAMIDE (AZOPT) O.S. 10ML BTL 1 536.34 182.36 209.17 429.07 321.80 274.87 389.38 375.44 418.35 402.26 209.17 429.07 375.44 402.26 1278786 637 SILVER NITRATE TOPICAL APPLICATOR 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1278988 637 PYRIDOXINE (VITAMIN B6) 100MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1278991 637 PEG3350 (MIRALAX) 17GM PKT 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1279045 637 CEPASTAT LOZENGE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1279279 637 TIMOLOL/DORZOL (COSOPT) OPHTH SOLN 1 84.60 28.76 32.99 67.68 50.76 43.36 61.42 59.22 65.99 63.45 32.99 67.68 59.22 63.45 1279610 637 BACLOFEN (LIORESAL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1279862 637 LEVOTHYROXINE (SYNTHROID) 112MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1279878 637 LEVOTHYROXINE (SYNTHROID) 125MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1280046 637 FUROSEMIDE ORAL SOLN 10MG/ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1280433 637 NIACIN ER (NIASPAN) 500MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1280434 637 TAMOXIFEN (NOLVADEX) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1280736 637 VALPROIC ACID (DEPAKENE) 250MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1280772 637 AMANTADINE (SYMMETREL) 50MG/5ML LIQ 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1280951 637 CETIRIZINE (zyRTEC) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1281320 637 ACETAMINOPHEN (TYLENOL ES) 500MG TAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1281458 637 NEO/POLY/HC (CORTISPORIN) OTIC SOLN 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1281539 637 THEOPHYLLINE ER (THEODUR) 200MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1281961 637 METOPROLOL TARTR (LOPRESSOR) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1281962 637 METOPROLOL TARTR (LOPRESSOR) 100MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1282076 272 BENZOIN TCT 1 38.00 12.92 14.82 30.40 22.80 19.48 27.59 26.60 29.64 28.50 14.82 30.40 26.60 28.50 1283409 637 MIRTAZAPINE (REMERON) 15MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1283592 637 PARLODEL TAB 2.5 MG 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 1283646 637 CARVEDILOL (COREG) 12.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1283986 637 guaiFENesin (ROBITUSSIN) 200MG/10ML SYR 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1283992 637 ISOSORBIDE MONONIT (IMDUR) 30MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1284139 637 TIMOLOL 0.5% O.S. 5ML BTL (TIMOPTIC) 1 33.84 11.51 13.20 27.07 20.30 17.34 24.57 23.69 26.40 25.38 13.20 27.07 23.69 25.38 1284140 637 TIMOLOL (TIMOPTIC) 0.25% O.S. 5ML BTL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1284153 637 MINERAL OIL 30ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1284586 637 NEPRO NUTR 240ML CAN 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1284587 637 OFLOXACIN (OCUFLOX) 0.3% O.S. 10ML BTL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1284609 637 TETRACAINE 0.5% O. S. 4ML BTL 1 41.26 14.03 16.09 33.01 24.76 21.15 29.95 28.88 32.18 30.95 16.09 33.01 28.88 30.95 1284872 637 ESTROGENS CONJ (PREMARIN) VAG CR 30GM 1 735.00 249.90 286.65 588.00 441.00 376.69 533.61 514.50 573.30 551.25 286.65 588.00 514.50 551.25 1285413 637 PANCRELIPASE (PANCREASE) CAPSULE 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1285492 637 LORazepam 0.5MG (ATIVAN)TABLET 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1285989 637 CLOTRIMAZOLE (GYNE-LOTRIMIN) CRM 45GM 1 35.00 11.90 13.65 28.00 21.00 17.94 25.41 24.50 27.30 26.25 13.65 28.00 24.50 26.25 1286375 637 BICLUTAMIDE (CASODEX) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1286376 637 PIOGLITAZONE (ACTOS) 30MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1286538 637 FLUVASTATIN (LESCOL) 20MG CAPSULE 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 1286863 637 SUCRALFATE (CARAFATE) 1GM/10ML SUSP 1 16.54 5.62 6.45 13.23 9.92 8.48 12.01 11.58 12.90 12.41 6.45 13.23 11.58 12.41 1286889 637 risperiDONE (risperDAL) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1287148 637 GLUCERNA 1.2 NUTR. LIQUID 240ML 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1287598 637 GABAPENTIN (NEURONTIN) 400MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1288027 637 EUCERIN CREAM TUBE 1 17.50 5.95 6.83 14.00 10.50 8.97 12.71 12.25 13.65 13.13 6.83 14.00 12.25 13.13 1288209 637 NAPROXEN (NAPROSYN) 375MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1288848 637 FLUCONAZOLE (DIFLUCAN) 100MG TABLET 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1288853 637 MISOPROSTOL (CYTOTEC) 200MCG TABLET 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1288881 637 NAPROSYN EC TAB : 500MG 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1289093 637 SMZ/TMP (BACTRIM) 800/160MG/20ML SUSP 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 1289386 637 levoFLOXacin (LEVAQUIN) 250MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1289430 637 METHADONE (DOLOPHINE) 5MG TABLET 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1289682 637 IBUPROFEN (MOTRIN) 600MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1290094 637 NEW-SKIN LIQUID BANDAGE 30ML BTL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1290249 637 metFORMIN (GLUCOPHAGE) 850MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1290255 637 CORGARD 40MG TAB 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 1291100 637 ATORVASTATIN (LIPITOR) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1291729 637 CARBID/LEVOD 25/100 (SINEMET) 25/100 TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1292155 637 MINOXIDIL (LONITEN) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1292427 637 MINOXIDIL (LONITEN) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1292547 637 ACETAMINOPHEN (TYLENOL SUPP) 120MG 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1293438 637 BETOPTIC S OPHTH SOLN 1 583.30 198.32 227.49 466.64 349.98 298.94 423.48 408.31 454.97 437.48 227.49 466.64 408.31 437.48 1293696 637 PROPAFENONE (RYTHMOL) 150MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1294255 637 DIPYRID/ASA 200MG-25MG (AGGRENOX ) CAP 1 13.31 4.53 5.19 10.65 7.99 6.82 9.66 9.32 10.38 9.98 5.19 10.65 9.32 9.98 1294840 637 PROPRANOLOL ER (INDERAL LA) 80MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1295451 637 ADVAIR DISKUS 250/50 1 437.96 148.91 170.80 350.37 262.78 224.45 317.96 306.57 341.61 328.47 170.80 350.37 306.57 328.47 1295452 637 RAMIPRIL (ALTACE) 1.25MG CAPSULE 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1295986 637 VERAPAMIL ER (ISOPTIN SR) 180MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1296819 637 POLYTRIM OPHTH DPS : 10ML 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 1296897 637 DIVALPROEX DR 12HR (DEPAKOTE) 250MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1296898 637 WARFARIN SOD (COUMADIN) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298242 637 LINEZOLID (ZYVOX) 600MG TABLET 1 8.76 2.98 3.42 7.01 5.26 4.49 6.36 6.13 6.83 6.57 3.42 7.01 6.13 6.57 1298261 637 MEMANTINE (NAMENDA) 10MG TABLET 1 20.00 6.80 7.80 16.00 12.00 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 1298262 637 MONTELUKAST (SINGULAIR) 10MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298263 637 GLUCOSAMINE/CHONDROITIN CAPSULE 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298264 637 AMOXICILLIN (AMOXIL) 250MG/5ML SUSP 1 7.25 2.47 2.83 5.80 4.35 3.72 5.26 5.08 5.66 5.44 2.83 5.80 5.08 5.44 1298265 637 BISOPROLOL/HCTZ (ZIAC) 5-6.25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298266 637 SALMETEROL (SEREVENT) DISKUS 50MCG 1 460.40 156.54 179.56 368.32 276.24 235.96 334.25 322.28 359.11 345.30 179.56 368.32 322.28 345.30 1298268 637 CALCIUM CARB (TUMS) 500MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298269 637 BIMATOPROST (LUMIGAN) O.S. 2.5ML BTL 1 391.18 133.00 152.56 312.94 234.71 200.48 284.00 273.83 305.12 293.39 152.56 312.94 273.83 293.39 1298270 637 PERATIVE 240ML CAN 1 4.15 1.41 1.62 3.32 2.49 2.13 3.01 2.91 3.24 3.11 1.62 3.32 2.91 3.11 1298271 637 PARoxetine (PAXIL-CR) CR 12.5MG TABLET 1 6.05 2.06 2.36 4.84 3.63 3.10 4.39 4.24 4.72 4.54 2.36 4.84 4.24 4.54 1298275 637 EZETIMIBE (ZETIA) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298280 637 buPROPion XL 24H (WELLBUTRIN XL) 300MG 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1298282 637 SIMVASTATIN (ZOCOR) 40MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298285 637 LIDODERM 5% PATCH 1 8.78 2.99 3.42 7.02 5.27 4.50 6.37 6.15 6.85 6.59 3.42 7.02 6.15 6.59 1298286 637 CETIRIZINE/PFED (zyRTEC D) TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298288 637 MELOXICAM (MOBIC) 7.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298289 637 MIDODRINE (PROAMITINE) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298290 637 LOPERAMIDE (IMODIUM) LIQ 2MG/15ML 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298295 637 LANSAPRAZOLE SOLUTAB (PREVACID) 15MG 1 38.00 12.92 14.82 30.40 22.80 19.48 27.59 26.60 29.64 28.50 14.82 30.40 26.60 28.50 1298297 637 PINDOLOL (VISKEN) 5MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298299 637 DIVALPROEX SPRINKLES (DEPAKOTE) 125MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298314 637 VERAPAMIL ER (CALAN SR) 120MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298320 637 OLMESARTAN (BENICAR) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298322 637 DULoxetine (CYMBALTA) 30MG CAPSULE 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 1298323 637 traMADol/APAP (ULTRACET) 37.5/325MG TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298325 637 buPROPion XL (WELLBUTRIN) 150MG 24HR TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298326 637 carBAMazepine (TEGRETOL) 100MG/5ML SUSP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298329 637 DULoxetine (CYMBALTA) 20MG CAPSULE 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1298330 637 OLANZapine ODT (zyPREXA ZYDIS) 10MG TAB 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1298331 637 MEMANTINE (NAMENDA) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298332 637 SERTRALINE (ZOLOFT) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298333 637 LEVOTHYROXINE (SYNTHROID) 75MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298334 637 PRAMIPEXOLE (MIRAPEX) 0.25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298335 637 risperiDONE ODT (risperDAL SubL) 0.5MG 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1298338 637 HALOPERIDOL (HALDOL) 2MG/ML ORAL CONC 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298339 637 BETHANECHOL (URECHOLINE) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298345 637 OLANZapine ODT (zyPREXA ZYDIS) 5MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298347 637 valACYclovir (VALTREX) 500MG TABLET 1 9.25 3.15 3.61 7.40 5.55 4.74 6.72 6.48 7.22 6.94 3.61 7.40 6.48 6.94 1298350 637 COLESEVELAM (WELCHOL) 625MG TABLET 1 4.10 1.39 1.60 3.28 2.46 2.10 2.98 2.87 3.20 3.08 1.60 3.28 2.87 3.08 1298353 637 CALCIUM ACETATE (PHOSLO) 667MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298355 637 GATIFLOXACIN (ZYMAXID) 0.5% O.S. 2.5ML 1 72.34 24.60 28.21 57.87 43.40 37.07 52.52 50.64 56.43 54.26 28.21 57.87 50.64 54.26 1298356 637 NAPROXEN SOD (ALEVE ) 220MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298365 637 JUVEN PACKET 1 9.75 3.32 3.80 7.80 5.85 5.00 7.08 6.83 7.61 7.31 3.80 7.80 6.83 7.31 1298369 637 LEVOTHYROXINE (SYNTHROID) 88MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298370 637 ROSUVASTATIN. (CRESTOR) 20MG TABLET 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 1298371 637 SUPRAX O/S 100MG/5ML 1 7.50 2.55 2.93 6.00 4.50 3.84 5.45 5.25 5.85 5.63 2.93 6.00 5.25 5.63 1298372 637 PREGABALIN (LYRICA) 75MG CAPSULE 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298373 637 PREGABALIN (LYRICA) 100MG CAP 1 32.28 10.98 12.59 25.82 19.37 16.54 23.44 22.60 25.18 24.21 12.59 25.82 22.60 24.21 1298376 637 VANCOMYCIN 125MG CAPSULE 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 1298380 637 ANASTROZOLE (ARIMIDEX) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298384 637 PARoxetine CR (PAXIL CR) 25MG TABLET 1 6.90 2.35 2.69 5.52 4.14 3.54 5.01 4.83 5.38 5.18 2.69 5.52 4.83 5.18 1298385 637 LOSARTAN (COZAAR) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298386 637 TIOTROPIUM 18MCG (SPIRIVA) INHALATION 1 425.00 144.50 165.75 340.00 255.00 217.81 308.55 297.50 331.50 318.75 165.75 340.00 297.50 318.75 1298387 637 LISINOPRIL (ZESTRIL) 40MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298388 637 MOXIFLOXACIN (AVELOX) 400MG TABLET 1 42.50 14.45 16.58 34.00 25.50 21.78 30.86 29.75 33.15 31.88 16.58 34.00 29.75 31.88 1298389 637 cycloSPORINE (RESTASIS) 0.05% O.S. 0.4ML 1 27.62 9.39 10.77 22.10 16.57 14.16 20.05 19.33 21.54 20.72 10.77 22.10 19.33 20.72 1298390 637 MULTIVITAMIN LIQUID 15ML UDC 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298392 637 CYANOCOBALAMIN (VIT B12) 1000MCG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298394 637 SEVELAMER (RENAGEL) 800MG TABLET 1 15.37 5.23 5.99 12.30 9.22 7.88 11.16 10.76 11.99 11.53 5.99 12.30 10.76 11.53 1298395 637 GUAIFEN/DM (BIDEX DM) 400/20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298397 637 DUTASTERIDE (AVODART) 0.5MG CAPSULE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298398 637 metroNIDAZOLE(METROGEL) 1% TOPICAL 1 884.00 300.56 344.76 707.20 530.40 453.05 641.78 618.80 689.52 663.00 344.76 707.20 618.80 663.00 1298401 637 PREGABALIN (LYRICA) 50MG CAPSULE 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 1298402 637 rOPINIRole (REQUIP) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298404 637 VORICONAZOLE (VFEND) 200MG TABLET 1 6.65 2.26 2.59 5.32 3.99 3.41 4.83 4.66 5.19 4.99 2.59 5.32 4.66 4.99 1298406 637 DRONABINOL (MARINOL) 2.5MG CAPSULES 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1298408 637 PROPRANOLOL ER (INDERAL LA) 60MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298409 637 CALCIUM W/ VIT D 600MG (CALTRATE-D) TAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298414 637 PARoxetine (PAXIL) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298417 637 TROPICAMIDE (MYDRIACIL) 1% O.S. 15ML BTL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1298419 637 METAXOLONE (SKELAXIN) 800MG TABLET 1 24.50 8.33 9.56 19.60 14.70 12.56 17.79 17.15 19.11 18.38 9.56 19.60 17.15 18.38 1298420 637 LANSAPRAZOLE SOLUTAB (PREVACID) 30MG 1 7.47 2.54 2.91 5.98 4.48 3.83 5.42 5.23 5.83 5.60 2.91 5.98 5.23 5.60 1298422 637 VARENICLINE (CHANTIX) 0.5MG TABLET 1 28.32 9.63 11.04 22.66 16.99 14.51 20.56 19.82 22.09 21.24 11.04 22.66 19.82 21.24 1298424 637 IBANDRONATE (BONIVA) 150MG TABLET 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 1298429 637 ORGANIDIN (guaiFENesin) 200MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298433 637 SODIUM CHLORIDE 1GM TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298434 637 VIT B COMP/C (ALLBEE/C) TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298435 637 ALFUZOSIN (UROXATOL) 10MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298438 637 hydrALAZINE (APRESOLINE) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298439 637 CHLORHEXIDINE ORAL (PERIDEX) SOLN 1 9.40 3.20 3.67 7.52 5.64 4.82 6.82 6.58 7.33 7.05 3.67 7.52 6.58 7.05 1298444 637 levETIRAcetam (KEPPRA) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298446 637 VENLAFAXINE (EFFEXOR) 37.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298458 637 PredniSONE LIQUID 5MG/5ML 1 5.15 1.75 2.01 4.12 3.09 2.64 3.74 3.61 4.02 3.86 2.01 4.12 3.61 3.86 1298463 637 METOPROLOL TARTR (LOPRESSOR) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298464 637 oxyCODONE EXT REL (oxyCONTIN) 40MG TAB 1 41.69 14.17 16.26 33.35 25.01 21.37 30.27 29.18 32.52 31.27 16.26 33.35 29.18 31.27 1298465 637 PYRAZINAMIDE 500MG TABLET 1 7.50 2.55 2.93 6.00 4.50 3.84 5.45 5.25 5.85 5.63 2.93 6.00 5.25 5.63 1298467 637 MOXIFLOXACIN (VIGAMOX) 0.5% OPHTH SOLN 1 41.68 14.17 16.26 33.34 25.01 21.36 30.26 29.18 32.51 31.26 16.26 33.34 29.18 31.26 1298468 637 SOLIFENACIN (VESICARE) 5MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298469 637 METOPROLOL SUCC ER (TOPROL XL) 25MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298471 637 FENOFIBRATE (TRICOR) 145MG TABLET 1 4.50 1.53 1.76 3.60 2.70 2.31 3.27 3.15 3.51 3.38 1.76 3.60 3.15 3.38 1298472 637 CARVEDILOL ER (COREG CR) 10MG CAPSULE 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1298473 637 NALTREXONE 50MG TAB 1 8.50 2.89 3.32 6.80 5.10 4.36 6.17 5.95 6.63 6.38 3.32 6.80 5.95 6.38 1298474 637 TRAVAPROST (TRAVATAN) 0.004% O.S. 5ML 1 393.50 133.79 153.47 314.80 236.10 201.67 285.68 275.45 306.93 295.13 153.47 314.80 275.45 295.13 1298478 637 RANOLAZINE (RANEXA) 500MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298479 637 SENNA (SENOKOT) 8.6MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298484 637 MONTELUKAST (SINGULAIR) 4MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298485 637 CETIRIZINE (zyRTEC) 5MG/5ML SYRUP 1 5.15 1.75 2.01 4.12 3.09 2.64 3.74 3.61 4.02 3.86 2.01 4.12 3.61 3.86 1298490 637 AMLODIPINE (NORVASC) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298494 637 PALIPERIDONE (INVEGA) 3MG TABLET 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 1298495 637 RIVASTIGMINE (EXELON) 4.6MG/24HR PATCH 1 18.80 6.39 7.33 15.04 11.28 9.64 13.65 13.16 14.66 14.10 7.33 15.04 13.16 14.10 1298496 637 OSELTAMIVIR (TAMIFLU) SUSP 6MG/ML 1 107.04 36.39 41.75 85.63 64.22 54.86 77.71 74.93 83.49 80.28 41.75 85.63 74.93 80.28 1298497 637 LUBIPROSTONE (AMITIZA) 24MCG CAPSULE 1 17.52 5.96 6.83 14.02 10.51 8.98 12.72 12.26 13.67 13.14 6.83 14.02 12.26 13.14 1298500 637 PANTOPRAZOLE (PROTONIX) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298501 637 PANTOPRAZOLE (PROTONIX) 40MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298513 637 levETIRAcetam (KEPPRA) 750MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298514 637 ESCITALOPRAM (LEXAPRO) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298516 637 guaiFENesin (MUCINEX) 600MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298517 637 ELETRIPTAN (RELPAX) 40MG TABLET 1 120.00 40.80 46.80 96.00 72.00 61.50 87.12 84.00 93.60 90.00 46.80 96.00 84.00 90.00 1298518 637 VITAMIN D 400 UNIT TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298520 637 DARIFENACIN (ENABLEX) 15MG TABLET 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 1298522 637 PREGABALIN (LYRICA) 25MG CAPSULE 1 28.01 9.52 10.92 22.41 16.81 14.36 20.34 19.61 21.85 21.01 10.92 22.41 19.61 21.01 1298524 637 PARICALCITOL (ZEMPLAR) 1MCG CAPSULE 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298525 637 RIVASTIGMINE (EXELON) 9.5MG/24HR PATCH 1 39.80 13.53 15.52 31.84 23.88 20.40 28.89 27.86 31.04 29.85 15.52 31.84 27.86 29.85 1298526 637 VITAMIN D 1000 (25MCG) IU TAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298530 637 VALSARTAN (DIOVAN) 320MG TABLET 1 20.50 6.97 8.00 16.40 12.30 10.51 14.88 14.35 15.99 15.38 8.00 16.40 14.35 15.38 1298532 637 FEXOFENADINE (ALLEGRA) 180MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298533 637 sitaGLIPtin (JANUVIA) 100MG TABLET 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1298534 637 GUAIFEN/DM (MUCINEX-DM) 600/30 TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298538 637 GLYCOPYRROLATE (ROBINUL) 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298540 637 metFORMIN (GLUCOPHAGE) 1000MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298542 637 LEVOTHYROXINE (SYNTHROID) 137MCG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298543 637 ARIPiprazole (ABILIFY) 5MG TABLET 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 1298544 637 LISINOPRIL (ZESTRIL) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298545 637 TOPIRAMATE (TOPAMAX) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298546 637 morphine ORAL LIQ 10MG/5ML 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1298549 637 BUDESONIDE/FORM (SYMBICORT) 160/4.5 MDI 1 427.50 145.35 166.73 342.00 256.50 219.09 310.37 299.25 333.45 320.63 166.73 342.00 299.25 320.63 1298550 637 LEVALBUTEROL INHALER(XOPENEX HFA) 1 199.20 67.73 77.69 159.36 119.52 102.09 144.62 139.44 155.38 149.40 77.69 159.36 139.44 149.40 1298552 637 SIMVASTATIN (ZOCOR) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298553 637 HYDROCHLOROTHIAZIDE (HCTZ) 12.5MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298554 637 MELOXICAM (MOBIC) 15MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298555 637 GLIMEPIRIDE (AMARYL) 4MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298557 637 FISH OIL (LOVAZA) 1000MG CAPSULE 1 7.25 2.47 2.83 5.80 4.35 3.72 5.26 5.08 5.66 5.44 2.83 5.80 5.08 5.44 1298563 637 DESVENLAFAXINE (PRISTIQ) 50MG TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298566 637 LUBIPROSTONE (AMITIZA) 8MCG CAPSULE 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 1298568 637 CIPRO XR 1000MG 1 22.22 7.55 8.67 17.78 13.33 11.39 16.13 15.55 17.33 16.67 8.67 17.78 15.55 16.67 1298569 637 LORATAD/PSEUDEP 10/240MG(CLARITIN D)24HR 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 1298571 637 DULoxetine (CYMBALTA) 60MG CAPSULE 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 1298572 637 DIVALPROEX ER 24HR (DEPAKOTE ER)250MG 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1298573 637 TOLTERODINE ER (DETROL LA) 2MG CAPSULE 1 22.50 7.65 8.78 18.00 13.50 11.53 16.34 15.75 17.55 16.88 8.78 18.00 15.75 16.88 1298575 637 VENLAFAXINE (EFFEXOR) 50MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298576 637 DARIFENACIN (ENABLEX) 7.5MG TABLET 1 10.63 3.61 4.15 8.50 6.38 5.45 7.72 7.44 8.29 7.97 4.15 8.50 7.44 7.97 1298577 637 PRAVASTATIN (PRAVACHOL) 40MG TABLET 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1298579 637 POTASSIUM GLUC (595MG) 99MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298580 637 LITHIUM CARBONATE 150MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298581 637 LURIDE 1MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298584 637 LEVOCETERIZINE (XYZAL) 5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298591 637 PSEUDOEPHED. (SUDAFED) 30MGTAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298592 637 CARBID/LEVO/ENTAC (STALEVO-100) TABLET 1 6.75 2.30 2.63 5.40 4.05 3.46 4.90 4.73 5.27 5.06 2.63 5.40 4.73 5.06 1298594 637 FERROUS SULF ER (SLOW FE) 45MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298596 637 CALCITRIOL (ROCALTROL) 0.25MCG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298598 637 PENTASA 500MG CAP 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1298599 637 PEPTO BISMOL TAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298600 637 NORPRAMINE 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298603 637 "NYSTATIN 500,000 UNIT TABLET" 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298604 637 PRAMIPEXOLE (MIRAPEX) 1MG TABLET 1 5.90 2.01 2.30 4.72 3.54 3.02 4.28 4.13 4.60 4.43 2.30 4.72 4.13 4.43 1298606 637 PROTEIN/VITAMINS (A/G PRO) TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298607 637 oxyCODONE EXT REL 15MG TAB (oxyCONTIN) 1 17.60 5.98 6.86 14.08 10.56 9.02 12.78 12.32 13.73 13.20 6.86 14.08 12.32 13.20 1298608 637 morphine ORAL CONC 20MG/ML 30ML BTL 1 40.40 13.74 15.76 32.32 24.24 20.71 29.33 28.28 31.51 30.30 15.76 32.32 28.28 30.30 1298609 637 ASPIRIN (ASA) 300MG SUPPOSITORY 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1298610 637 LISINOPRIL (ZESTRIL) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298611 637 MOMETASONE (ASMANEX) 220MCG INHALER 1 181.00 61.54 70.59 144.80 108.60 92.76 131.41 126.70 141.18 135.75 70.59 144.80 126.70 135.75 1298612 637 COLLAGENASE SANTYL OINTMENT 1 410.86 139.69 160.24 328.69 246.52 210.57 298.28 287.60 320.47 308.15 160.24 328.69 287.60 308.15 1298613 637 CARVEDILOL (COREG) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298614 637 CRANBERRY SUPPLEMENT (AZO) 450MG 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298616 637 LORazepam ORAL/CONC (ATIVAN) 2MG/ML 30ML 1 32.50 11.05 12.68 26.00 19.50 16.66 23.60 22.75 25.35 24.38 12.68 26.00 22.75 24.38 1298617 637 GI COCKTAIL 45 ML DOSE 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1298622 637 CARVEDILOL (COREG) 6.25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298623 637 NEBIVOLOL (BYSTOLIC) 5MG TABLET 1 10.50 3.57 4.10 8.40 6.30 5.38 7.62 7.35 8.19 7.88 4.10 8.40 7.35 7.88 1298627 637 LAMOTRIGINE (LaMICtal) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298639 637 MICONAZOLE (MONISTAT) VAG SUPP 200MG 1 105.14 35.75 41.00 84.11 63.08 53.88 76.33 73.60 82.01 78.86 41.00 84.11 73.60 78.86 1298640 637 CIPROFLOXACIN (CETRAXAL) OTIC SOL 0.2% 1 160.05 54.42 62.42 128.04 96.03 82.03 116.20 112.04 124.84 120.04 62.42 128.04 112.04 120.04 1298641 637 NYSTATIN (MYCOSTATIN) OINTMENT 15GM 1 35.20 11.97 13.73 28.16 21.12 18.04 25.56 24.64 27.46 26.40 13.73 28.16 24.64 26.40 1298642 637 TRIAMCINOLONE (KENALOG) 0.5% CR 15GM 1 22.60 7.68 8.81 18.08 13.56 11.58 16.41 15.82 17.63 16.95 8.81 18.08 15.82 16.95 1298644 250 CICLOPIROX (LOPROX) GEL 0.77% 30GM TUBE 1 109.76 37.32 42.81 87.81 65.86 56.25 79.69 76.83 85.61 82.32 42.81 87.81 76.83 82.32 1298645 637 CYCLOPIROX (LOPROX) CRM 15GM 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1298646 637 BACIT/POLYMIX (POLYSPORIN) OINT15GM 1 15.16 5.15 5.91 12.13 9.10 7.77 11.01 10.61 11.82 11.37 5.91 12.13 10.61 11.37 1298651 637 GLYCERIN SUPP ADULT 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298658 637 NEO/POLY/DEX (MAXITROL) O.O. 3.5GM TUBE 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1298661 637 MOUTHWASH (CEPACOL) 30ML CUP 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 1298662 637 LORATADINE (CLARITIN) 5MG/5ML SYRUP 1 5.15 1.75 2.01 4.12 3.09 2.64 3.74 3.61 4.02 3.86 2.01 4.12 3.61 3.86 1298664 637 NICOTINE PATCH 7MG/DAY 1 5.95 2.02 2.32 4.76 3.57 3.05 4.32 4.17 4.64 4.46 2.32 4.76 4.17 4.46 1298667 637 diphenhydrAMINE (BENADRYL) CRM 30GM 1 7.98 2.71 3.11 6.38 4.79 4.09 5.79 5.59 6.22 5.99 3.11 6.38 5.59 5.99 1298672 637 BENZOCAINE (HURRICAINE) SPRAY 20% 1 107.28 36.48 41.84 85.82 64.37 54.98 77.89 75.10 83.68 80.46 41.84 85.82 75.10 80.46 1298676 637 chlorproMAZINE (THORAZINE) 10MG TABLET 1 5.15 1.75 2.01 4.12 3.09 2.64 3.74 3.61 4.02 3.86 2.01 4.12 3.61 3.86 1298694 637 MEAT TENDERIZER 1 10.05 3.42 3.92 8.04 6.03 5.15 7.30 7.04 7.84 7.54 3.92 8.04 7.04 7.54 1298743 637 SUMAtriptan (IMITREX) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298778 637 AMOXICILLIN (AMOXIL) 875MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298818 637 SAXAGLIPTIN (ONGLYZA) 5MG TABLET 1 37.50 12.75 14.63 30.00 22.50 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 1298820 637 L-METHYLFOLATE FORTE (DEPLIN) 15MG CAP 1 13.50 4.59 5.27 10.80 8.10 6.92 9.80 9.45 10.53 10.13 5.27 10.80 9.45 10.13 1298858 637 FENOFIBRATE (TRICOR) 48MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298859 637 TOBRAMY/DEXAM (TOBRADEX) OPHTH OINT 1 495.00 168.30 193.05 396.00 297.00 253.69 359.37 346.50 386.10 371.25 193.05 396.00 346.50 371.25 1298861 637 DABIGATRAN (PRADAXA) 150MG CAPSULE 1 24.41 8.30 9.52 19.53 14.65 12.51 17.72 17.09 19.04 18.31 9.52 19.53 17.09 18.31 1298867 637 MUPIROCIN NASAL (BACTROBAN NAS) OINT 1GM 1 9.66 3.28 3.77 7.73 5.80 4.95 7.01 6.76 7.53 7.25 3.77 7.73 6.76 7.25 1298868 250 CHARCOAL/SORBIT PEDIATRIC (ACTIDOSE) 1 36.60 12.44 14.27 29.28 21.96 18.76 26.57 25.62 28.55 27.45 14.27 29.28 25.62 27.45 1298873 250 morphine IMMEDIATE RELEASE() 15MG TAB 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1298876 637 ROFLUMILAST (DALIRESP) 500MCG TABLET 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 1298880 637 PRASUGREL (EFFIENT) 10MG TABLET 1 37.50 12.75 14.63 30.00 22.50 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 1298881 637 HYDROcod/IBUPRO 7.5/200 (VICOPROFEN 7.5) 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298883 637 HYDROcodone/APAP10/325MG (NORCO 10MG)TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298884 637 HYDROcodone/APAP 7.5mg (NORCO 7.5MG)TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298885 637 RIFAXIMIN (XIFAXAN) 200MG TABLET 1 48.00 16.32 18.72 38.40 28.80 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 1298886 637 ALENDRONATE (FOSAMAX) 35MG TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1298887 637 carBAMazepine ER (TEGretol XR) 100MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298888 637 HYDROQUINONE HP (MELQUIN) 4% CR 30GM TB 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 1298890 637 DABIGATRAN (PRADAXA) 75MG CAPSULE 1 25.97 8.83 10.13 20.78 15.58 13.31 18.85 18.18 20.26 19.48 10.13 20.78 18.18 19.48 1298891 637 levETIRAcetam (KEPPRA) 500MG/5ML SOLN 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1298892 637 OMNICEF 125MG/5ML SUSP PER 100ML BTL 1 102.25 34.77 39.88 81.80 61.35 52.40 74.23 71.58 79.76 76.69 39.88 81.80 71.58 76.69 1298893 637 LETROZOLE (FEMARA) 2.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298894 637 MAGIC MOUTHWASH 30ML 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1298895 637 METHADONE INTENSOL 10MG/ML ORAL LIQ 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298896 637 traZODone (DESYREL) 100MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298897 637 FLUCONAZOLE (DIFLUCAN) 200MG TABLET 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1298898 637 FLUCONAZOLE (DIFLUCAN) 150MG TABLET 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1298904 637 METOPROLOL SUCC ER (TOPROL XL) 100MG TAB 1 5.50 1.87 2.15 4.40 3.30 2.82 3.99 3.85 4.29 4.13 2.15 4.40 3.85 4.13 1298905 637 HYDROcodone/APAP 5/325MG (NORCO 5MG) TAB 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1298906 637 TROSPIUM XR (SANCTURA-XR) 60MG CAPSULE 1 17.00 5.78 6.63 13.60 10.20 8.71 12.34 11.90 13.26 12.75 6.63 13.60 11.90 12.75 1298911 637 FORADIL INH 12 MCG/DOSE 12-DOSE UNIT 1 209.00 71.06 81.51 167.20 125.40 107.11 151.73 146.30 163.02 156.75 81.51 167.20 146.30 156.75 1298931 250 NITROGLYCERIN DRIP 400 MCG/ML 250ML 1 250.00 85.00 97.50 200.00 150.00 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 1298933 637 DICLOFENAC (VOLTAREN) GEL 1% 100GM TB 1 94.36 32.08 36.80 75.49 56.62 48.36 68.51 66.05 73.60 70.77 36.80 75.49 66.05 70.77 1298940 637 BIOTENE MOISTURIZING MOUTH SPRAY 1 12.46 4.24 4.86 9.97 7.48 6.39 9.05 8.72 9.72 9.35 4.86 9.97 8.72 9.35 1298941 637 POTASSIUM CHL ER (KLOR-CON) 10MEQ TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298947 637 RIVAROXABAN (XARELTO) 20MG TABLET 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 1298948 637 ALBUTEROL HFA (VENTOLIN HFA) INHALER 1 74.60 25.36 29.09 59.68 44.76 38.23 54.16 52.22 58.19 55.95 29.09 59.68 52.22 55.95 1298949 637 CEFPROZIL (CEFZIL) SUSP 250MG/5ML 1 150.00 51.00 58.50 120.00 90.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1298950 637 oxyCODONE/APAP 10/325 (PERCOCET) TAB 1 49.00 16.66 19.11 39.20 29.40 25.11 35.57 34.30 38.22 36.75 19.11 39.20 34.30 36.75 1298951 637 HYDROmorphone 2MG TAB (DILAUDID) 1 5.05 1.72 1.97 4.04 3.03 2.59 3.67 3.54 3.94 3.79 1.97 4.04 3.54 3.79 1298953 637 RESOURCE BENEPROTEIN (PROMOD)1 PKT 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298955 637 ALUMINUM HYDROX (AMPHOJEL) SUSP 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1298956 250 DOPamine 200MG/5ML VIAL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1298958 637 hydrOXYzine HCL (ATARAX) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298959 637 QUEtiapine ER (SEROquel-XR) 50MG TABLET 1 26.28 8.94 10.25 21.02 15.77 13.47 19.08 18.40 20.50 19.71 10.25 21.02 18.40 19.71 1298960 250 LEVAQUIN IVPB 250MG/50ML 1 150.05 51.02 58.52 120.04 90.03 76.90 108.94 105.04 117.04 112.54 58.52 120.04 105.04 112.54 1298961 250 LEVAQUIN IVPB 750MG/150ML 1 400.05 136.02 156.02 320.04 240.03 205.03 290.44 280.04 312.04 300.04 156.02 320.04 280.04 300.04 1298971 250 CIPRO IVPB 400MG/200ML 1 175.00 59.50 68.25 140.00 105.00 89.69 127.05 122.50 136.50 131.25 68.25 140.00 122.50 131.25 1298972 637 NITROGLYCERIN (NITROSTAT) 0.4MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298978 250 cefTAZidime (FORTAZ) 2GM VIAL 1 45.65 15.52 17.80 36.52 27.39 23.40 33.14 31.96 35.61 34.24 17.80 36.52 31.96 34.24 1298997 637 MELATONIN (MELATONIN 3MG) 3MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1299001 637 HYDROcodone/IBUPROF 10/200 TAB(IBUDONE). 1 17.00 5.78 6.63 13.60 10.20 8.71 12.34 11.90 13.26 12.75 6.63 13.60 11.90 12.75 1299002 637 BENAZEPRIL (LOTENSIN) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299004 637 METHOCARBAMOL (ROBAXIN) 500MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299005 250 MIDAZOLAM 2MG/ML SYRUP (VERSED) 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299006 637 hydrOXYzine HCL (ATARAX) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299008 637 clonazePAM 1MG (KlonoPIN) TABLET 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1299010 637 LEVOTHYROXINE (SYNTHROID) 25MCG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299011 637 MULTIVITAMIN WITH MINERALS TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1299013 250 HEPARIN DRIP 25000UN/250ML PREMIX 1 150.05 51.02 58.52 120.04 90.03 76.90 108.94 105.04 117.04 112.54 58.52 120.04 105.04 112.54 1299014 250 VANCOMYCIN ORAL SOLN 250MG/5ML 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 1299016 250 LIDOCAINE JELLY 2% 5ML TUBE 1 9.40 3.20 3.67 7.52 5.64 4.82 6.82 6.58 7.33 7.05 3.67 7.52 6.58 7.05 1299019 637 CHOLECALCIFEROL (VIT D3) 2000 UNIT TAB 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1299021 250 BUPIVACAINE (Marcaine) 0.25% 10ML VIAL 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1299022 250 BUPIVACAINE (Marcaine) 0.5% 30ML VIAL 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1299023 250 LIDOCAINE/EPI 2%-0.001% 50ML MDV 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 1299024 250 LIDOCAINE/EPI 1% (XYLOCAINE/EPI 1%)20ML 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1299025 250 LIDOCAINE 1% 2ML SDV 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299028 250 LIDOCAINE 1% 10ML MDV 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1299031 637 LINAGLIPTIN (TRADJENTA) 5MG TABLET 1 38.00 12.92 14.82 30.40 22.80 19.48 27.59 26.60 29.64 28.50 14.82 30.40 26.60 28.50 1299033 250 NiCARdipine (Cardene) 25MG/10ML SDV 1 115.00 39.10 44.85 92.00 69.00 58.94 83.49 80.50 89.70 86.25 44.85 92.00 80.50 86.25 1299040 637 PALIPERIDONE (INVEGA) 6MG TABLET 1 26.77 9.10 10.44 21.42 16.06 13.72 19.44 18.74 20.88 20.08 10.44 21.42 18.74 20.08 1299047 637 FIBERSOURCE HN TUBE FDG 250ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299058 637 MENTHOL/CAMPHOR (VICKS VAPORUB) OINTMENT 1 9.60 3.26 3.74 7.68 5.76 4.92 6.97 6.72 7.49 7.20 3.74 7.68 6.72 7.20 1299063 250 KCL RIDER 20MEQ/100ML 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299067 637 SILDENAFIL (REVATIO) 20MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299070 637 ARIPiprazole (ABILIFY) 2MG TABLET 1 26.50 9.01 10.34 21.20 15.90 13.58 19.24 18.55 20.67 19.88 10.34 21.20 18.55 19.88 1299090 637 RIVASTIGMINE (EXELON) 13.3MG/24HR PATCH 1 39.60 13.46 15.44 31.68 23.76 20.30 28.75 27.72 30.89 29.70 15.44 31.68 27.72 29.70 1299091 637 DRONEDARONE (MULTAQ) 400MG TABLET 1 30.45 10.35 11.88 24.36 18.27 15.61 22.11 21.32 23.75 22.84 11.88 24.36 21.32 22.84 1299094 250 LIDOCAINE 4% 5ML PF AMP 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1299096 637 ACYCLOVIR (ZOVIRAX) OINT 5% 15GM 1 143.60 48.82 56.00 114.88 86.16 73.60 104.25 100.52 112.01 107.70 56.00 114.88 100.52 107.70 1299099 250 CANDIDA SKIN TEST (CANDIN) 0.1ML DOSE 1 175.00 59.50 68.25 140.00 105.00 89.69 127.05 122.50 136.50 131.25 68.25 140.00 122.50 131.25 1299100 637 ALISKIREN (TEKTURNA) 150MG TABLET 1 14.50 4.93 5.66 11.60 8.70 7.43 10.53 10.15 11.31 10.88 5.66 11.60 10.15 10.88 1299109 637 DOCUSATE MINI-ENEMA (ENEMEEZ) 283MG 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 1299110 637 BRIMONIDINE 0.2% (ALPHAGAN) O.S. 5ML 1 54.75 18.62 21.35 43.80 32.85 28.06 39.75 38.33 42.71 41.06 21.35 43.80 38.33 41.06 1299111 637 LIDOCAINE URJT (ANESTACON) JLY 2% 5ML 1 18.65 6.34 7.27 14.92 11.19 9.56 13.54 13.06 14.55 13.99 7.27 14.92 13.06 13.99 1299116 637 IRON CARBONYL/VIT C (ICAR-C) TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299117 637 CLINDAMYCIN ORAL SLN 75MG/5ML 1 111.00 37.74 43.29 88.80 66.60 56.89 80.59 77.70 86.58 83.25 43.29 88.80 77.70 83.25 1299118 637 CLOTRIM/BETAMETH (LOTRISONE) CRM 45GM 1 61.64 20.96 24.04 49.31 36.98 31.59 44.75 43.15 48.08 46.23 24.04 49.31 43.15 46.23 1299124 637 CARVEDILOL ER (COREG CR) 40MG CAPSULE 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299127 637 RIVAROXABAN (XARELTO) 15MG TABLET 1 40.46 13.76 15.78 32.37 24.28 20.74 29.37 28.32 31.56 30.35 15.78 32.37 28.32 30.35 1299128 637 BRIMONIDINE 0.1% (ALPHAGAN-P) OPHTH SOL 1 170.12 57.84 66.35 136.10 102.07 87.19 123.51 119.08 132.69 127.59 66.35 136.10 119.08 127.59 1299134 637 ELMIRON 100MG CAPSULE 1 35.44 12.05 13.82 28.35 21.26 18.16 25.73 24.81 27.64 26.58 13.82 28.35 24.81 26.58 1299138 250 DOBUTamine (DOBUTREX)1 MG/ML 250ML PREMX 1 200.00 68.00 78.00 160.00 120.00 102.50 145.20 140.00 156.00 150.00 78.00 160.00 140.00 150.00 1299140 637 FLUTICASONE FUROATE (VERAMYST) NASAL SPR 1 68.56 23.31 26.74 54.85 41.14 35.14 49.77 47.99 53.48 51.42 26.74 54.85 47.99 51.42 1299142 637 MINOCYCLINE HYDRO (MINOCIN) 50MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299144 637 NISOLDIPINE (SULAR ER) 8.5MG TAB 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1299145 637 AMPICILLIN TRIHYDRATE 500 MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299146 637 SEVELAMER CARBONATE (RENVELA) 800MG TAB 1 4.39 1.49 1.71 3.51 2.63 2.25 3.19 3.07 3.42 3.29 1.71 3.51 3.07 3.29 1299147 637 LEFLUNOMIDE (ARAVA) 10MG TAB 1 125.00 42.50 48.75 100.00 75.00 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1299148 637 fluPHENAZine HCL (PROLIXIN) 5MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299149 637 SILODOSIN (RAPAFLO) 8MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299151 637 LAMOTRIGINE (LaMICtal) 25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299152 637 L-METHYLFOLATE FORTE (DEPLIN) 15MG CAP 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1299153 637 PERMETHRIN 1% CREAM RINSE (NIX) 1 39.05 13.28 15.23 31.24 23.43 20.01 28.35 27.34 30.46 29.29 15.23 31.24 27.34 29.29 1299154 637 ACYCLOVIR (ZOVIRAX ) 800MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299155 637 MEMANTINE HCL (NAMENDA XR) 28MG CAP 1 37.50 12.75 14.63 30.00 22.50 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 1299156 637 ASENAPINE (SAPHRIS) 5MG TAB 1 53.00 18.02 20.67 42.40 31.80 27.16 38.48 37.10 41.34 39.75 20.67 42.40 37.10 39.75 1299157 637 LOSARTAN/HCTZ (HYZAAR) 100MG/25MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299159 637 THEOPHYLLINE (THEODUR) 450MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299160 637 ZAFIRLUKAST (ACCOLATE) 20MG TAB 1 7.85 2.67 3.06 6.28 4.71 4.02 5.70 5.50 6.12 5.89 3.06 6.28 5.50 5.89 1299163 637 APIXABAN (ELIQUIS) 5MG TAB 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 1299164 637 FLUTICASONE PROP 115/21 (ADVAIR HFA)MDI 1 395.68 134.53 154.32 316.54 237.41 202.79 287.26 276.98 308.63 296.76 154.32 316.54 276.98 296.76 1299166 637 GUAIFEN/PSEUDOEPHED (ENTEX T) 375-60 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299167 637 ESTRO/METH (COVARYX HS) 0.625-1.25MG TAB 1 14.50 4.93 5.66 11.60 8.70 7.43 10.53 10.15 11.31 10.88 5.66 11.60 10.15 10.88 1299168 637 MIRABEGRON ER (MYRBETRIQ) 25MG TAB 1 31.75 10.80 12.38 25.40 19.05 16.27 23.05 22.23 24.77 23.81 12.38 25.40 22.23 23.81 1299169 637 VILAZODONE (VIIBRYD) 20MG TAB 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 1299170 637 ESTRADIOL (ESTRADERM) 0.025MG/24 HR PAT 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 1299171 637 TRIAMTER/HCTZ (MAXZIDE) 37.5/25MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299174 637 CALCIUM CARB (TUMS ES) 750MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299188 637 CEFADROXIL (DURICEF) 500MG/5ML SUSP 1 194.00 65.96 75.66 155.20 116.40 99.43 140.84 135.80 151.32 145.50 75.66 155.20 135.80 145.50 1299189 637 FLURBIPROFEN (OCUFEN) 0.03% 2.5ML O.S. 1 135.52 46.08 52.85 108.42 81.31 69.45 98.39 94.86 105.71 101.64 52.85 108.42 94.86 101.64 1299190 637 FESOTERODINE FURARATE (TOVIAZ) 4MG TAB 1 39.74 13.51 15.50 31.79 23.84 20.37 28.85 27.82 31.00 29.81 15.50 31.79 27.82 29.81 1299207 250 KCL (RIDER) 40MEQ/100ML 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299208 637 TETRACAINE 0.5% O.S. 15ML BTL 1 32.50 11.05 12.68 26.00 19.50 16.66 23.60 22.75 25.35 24.38 12.68 26.00 22.75 24.38 1299210 637 LIDOCAINE/PRILOCAINE (EMLA) 2.5%CR 30 GM 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 1299211 637 MICONAZOLE TOP CR 2% 30GM TUBE 1 7.50 2.55 2.93 6.00 4.50 3.84 5.45 5.25 5.85 5.63 2.93 6.00 5.25 5.63 1299212 637 PODOPHYLLUM (PODOCON) 25% 15ML 1 294.00 99.96 114.66 235.20 176.40 150.68 213.44 205.80 229.32 220.50 114.66 235.20 205.80 220.50 1299213 637 LOSARTAN/HCTZ (HYZAAR) 50MG-12.5MG TAB 1 7.74 2.63 3.02 6.19 4.64 3.97 5.62 5.42 6.04 5.81 3.02 6.19 5.42 5.81 1299214 637 IODINE/POT IOD (STRONG IODINE) 5% 1 90.05 30.62 35.12 72.04 54.03 46.15 65.38 63.04 70.24 67.54 35.12 72.04 63.04 67.54 1299218 637 LIDOCAINE (XYLOCAINE) JELLY 2% 30ML TUBE 1 152.82 51.96 59.60 122.26 91.69 78.32 110.95 106.97 119.20 114.62 59.60 122.26 106.97 114.62 1299258 637 DISULFIRAM (ANTABUSE) 250MG TAB 1 11.35 3.86 4.43 9.08 6.81 5.82 8.24 7.95 8.85 8.51 4.43 9.08 7.95 8.51 1299293 637 LURASIDONE (LATUDA) 40MG TAB 1 94.05 31.98 36.68 75.24 56.43 48.20 68.28 65.84 73.36 70.54 36.68 75.24 65.84 70.54 1299300 637 RIFAXIMIN (XIFAXAN) 550MG TABLET 1 90.00 30.60 35.10 72.00 54.00 46.13 65.34 63.00 70.20 67.50 35.10 72.00 63.00 67.50 1299311 637 DONEPEZIL (ARICEPT) 23MG TABLET 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1299324 637 DAPAGLIFLOZIN (FARXIGA) 5MG TAB 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1299325 637 MESALAMINE (ASACOL HD) 800MG DR TAB 1 20.28 6.90 7.91 16.22 12.17 10.39 14.72 14.20 15.82 15.21 7.91 16.22 14.20 15.21 1299326 637 ALPHA KERI BATH OIL 240ML 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 1299340 250 GLYCOPYRROL (ROBINUL) 0.2MG/1ML SDV 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1299358 637 TRIAMCINOLONE (NASACORT)55 MCG/SPRAY 1 41.10 13.97 16.03 32.88 24.66 21.06 29.84 28.77 32.06 30.83 16.03 32.88 28.77 30.83 1299359 637 METRONIDAZOL(METROGEL)0.75% TOP 45GM 1 395.00 134.30 154.05 316.00 237.00 202.44 286.77 276.50 308.10 296.25 154.05 316.00 276.50 296.25 1299360 637 MEMANTINE XR (NAMENDA XR) 7MG CAP 1 4.85 1.65 1.89 3.88 2.91 2.49 3.52 3.40 3.78 3.64 1.89 3.88 3.40 3.64 1299361 272 ISOSOURCE HN 1.2 CAL/ML TUBE FD 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1299363 637 "VIT A (SOLUBLE) 10,000 UNITS CAP" 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1299365 637 levETIRAcetam ER (KEPPRA) 500MG TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1299410 637 BUDESONIDE 90 MCG (PULMICORT) FLEXHALER 1 520.00 176.80 202.80 416.00 312.00 266.50 377.52 364.00 405.60 390.00 202.80 416.00 364.00 390.00 1299412 637 LIDOCAINE VISC 2% 15ML UD 1 4.65 1.58 1.81 3.72 2.79 2.38 3.38 3.26 3.63 3.49 1.81 3.72 3.26 3.49 1299500 637 LEFLUNOMIDE (ARAVA) 20 MG TAB 1 9.25 3.15 3.61 7.40 5.55 4.74 6.72 6.48 7.22 6.94 3.61 7.40 6.48 6.94 1299521 637 PENTASA 250MG CAPSULE 1 11.46 3.90 4.47 9.17 6.88 5.87 8.32 8.02 8.94 8.60 4.47 9.17 8.02 8.60 1299547 637 PERMETHRIN 5% CREAM 1 265.00 90.10 103.35 212.00 159.00 135.81 192.39 185.50 206.70 198.75 103.35 212.00 185.50 198.75 1299548 637 BENZOIN COMPOUND TN 2OZ 1 21.05 7.16 8.21 16.84 12.63 10.79 15.28 14.74 16.42 15.79 8.21 16.84 14.74 15.79 1299596 637 ONDANSETRON ODT (ZOFRAN) 4MG TAB 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1299943 250 ATROPINE S04 1MG/ML SDV 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1300024 637 GLUCOSE 15 (40%) 37.5 GM TUBE 1 13.60 4.62 5.30 10.88 8.16 6.97 9.87 9.52 10.61 10.20 5.30 10.88 9.52 10.20 1300028 637 LITHIUM CIT 300 MG/5ML LIQ 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1300279 637 CARBID/LEVO/ENTAC (STALEVO-200) TABLET 1 11.55 3.93 4.50 9.24 6.93 5.92 8.39 8.09 9.01 8.66 4.50 9.24 8.09 8.66 1300376 637 ROSUVASTATIN 10 MG TAB. (CRESTOR) 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1300447 250 ROCURONIUM (ZEMURON) 100MG/10ML MDV 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1300448 637 GALANTAMINE 8MG TABLET (RAZADYNE) 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 1300616 637 LIDOCAINE HCL/ HC ACET 3-0.5% CREAM 1 115.00 39.10 44.85 92.00 69.00 58.94 83.49 80.50 89.70 86.25 44.85 92.00 80.50 86.25 1300759 272 DIABETISOURCE AC 250ML 1 5.80 1.97 2.26 4.64 3.48 2.97 4.21 4.06 4.52 4.35 2.26 4.64 4.06 4.35 1300823 637 BOOST GLUCOSE CONTROL 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1301114 637 SACUBITRIL/VAL (ENTRESTO) TAB 24-26MG 1 29.00 9.86 11.31 23.20 17.40 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 1301171 637 MUPIROCIN (BACTROBAN) UD 1 GRAM OINTMENT 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1301210 258 NICARDIPINE/SOD CHLOR(CARDENE)20MG/200ML 1 322.00 109.48 125.58 257.60 193.20 165.03 233.77 225.40 251.16 241.50 125.58 257.60 225.40 241.50 1301264 637 CLOZARIL (CLOZAPINE) 25MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1301650 637 LINACLOTIDE (LINZESS) 145 MCG CAP 1 48.76 16.58 19.02 39.01 29.26 24.99 35.40 34.13 38.03 36.57 19.02 39.01 34.13 36.57 1301673 637 TETRACYCLINE 500MG CAPSULE 1 17.91 6.09 6.98 14.33 10.75 9.18 13.00 12.54 13.97 13.43 6.98 14.33 12.54 13.43 1301866 637 busPIRone (BUSPAR) 7.5MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1302002 258 AA5/D20/LYTES (CLINIMIX-E) 1000ML 1 135.84 46.19 52.98 108.67 81.50 69.62 98.62 95.09 105.96 101.88 52.98 108.67 95.09 101.88 1302186 637 PSEUDOEPHEDRINE HCL (SUDAFED) CHILD 4OZ 1 23.84 8.11 9.30 19.07 14.30 12.22 17.31 16.69 18.60 17.88 9.30 19.07 16.69 17.88 1302187 637 PHENYLEPHRINE HCL (LITTLE REMEDIES) .5OZ 1 16.08 5.47 6.27 12.86 9.65 8.24 11.67 11.26 12.54 12.06 6.27 12.86 11.26 12.06 1302199 250 GLYCOPYRROL (ROBINUL) 0.2MG/1ML SDV(OPS) 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1302214 250 LICE KILLING SHAMPOO TOP SHAMPOO 1 12.60 4.28 4.91 10.08 7.56 6.46 9.15 8.82 9.83 9.45 4.91 10.08 8.82 9.45 1302215 637 PRAZOSIN HCL CP 1MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1302676 637 NIACIN 100MG TABLET 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1302690 637 LUNESTA (ESZOPICLONE) 2MG TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1302860 637 AZITHROMYCIN 500 MG TAB 1 12.20 4.15 4.76 9.76 7.32 6.25 8.86 8.54 9.52 9.15 4.76 9.76 8.54 9.15 1302911 637 CEFDINIR 300MG CAP (OMNICEF) 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1302941 637 CYCLOSPORINE 25MG CAP 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1303140 637 COENZYME Q-10 200MG 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1303141 637 DESITIN OINTMENT 1 12.60 4.28 4.91 10.08 7.56 6.46 9.15 8.82 9.83 9.45 4.91 10.08 8.82 9.45 1303315 637 LITHIUM CARBONATE 450MG ER TAB 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1519001 450 ER LAC REPAIR LEVEL 1 SIMPLE 1 200.00 68.00 78.00 160.00 120.00 102.50 145.20 140.00 156.00 150.00 78.00 160.00 140.00 150.00 1519002 450 ER LAC REPAIR LEVEL 2 INTERMEDIATE 1 500.00 170.00 195.00 400.00 300.00 256.25 363.00 350.00 390.00 375.00 195.00 400.00 350.00 375.00 1519003 450 ER LAC REPAIR LEVEL 3 COMPLEX 1 800.00 272.00 312.00 640.00 480.00 410.00 580.80 560.00 624.00 600.00 312.00 640.00 560.00 600.00 1519004 450 ER LAC REPAIR LEVEL 4 COMPLEX MOUTH 1 " 1,700.00 " 578.00 663.00 " 1,360.00 " " 1,020.00 " 871.25 " 1,234.20 " " 1,190.00 " " 1,326.00 " " 1,275.00 " 663.00 " 1,360.00 " " 1,190.00 " " 1,275.00 " 1519087 450 ER PROC LEVEL 4 1 " 2,100.00 " 714.00 819.00 " 1,680.00 " " 1,260.00 " " 1,076.25 " " 1,524.60 " " 1,470.00 " " 1,638.00 " " 1,575.00 " 819.00 " 1,680.00 " " 1,470.00 " " 1,575.00 " 1519089 450 ER PROC LEVEL 3 1 " 1,500.00 " 510.00 585.00 " 1,200.00 " 900.00 768.75 " 1,089.00 " " 1,050.00 " " 1,170.00 " " 1,125.00 " 585.00 " 1,200.00 " " 1,050.00 " " 1,125.00 " 1519091 450 ER PROC LEVEL 1 1 500.00 170.00 195.00 400.00 300.00 256.25 363.00 350.00 390.00 375.00 195.00 400.00 350.00 375.00 1519094 450 ER PROC LEVEL 2 1 700.00 238.00 273.00 560.00 420.00 358.75 508.20 490.00 546.00 525.00 273.00 560.00 490.00 525.00 2276294 258 INTRAVIA EMPTY CONTAINER 250ML 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 2407044 278 ORTHOSORB 2.0 1 242.00 82.28 94.38 193.60 145.20 124.03 175.69 169.40 188.76 181.50 94.38 193.60 169.40 181.50 2417325 278 SURGICLIP 9.0 1 214.72 73.00 83.74 171.78 128.83 110.04 155.89 150.30 167.48 161.04 83.74 171.78 150.30 161.04 2423443 272 DRILL 2.1 CANN 1 404.00 137.36 157.56 323.20 242.40 207.05 293.30 282.80 315.12 303.00 157.56 323.20 282.80 303.00 2424659 278 CAROTID SHUNT 10FR 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 2427088 278 CAROTID SHUNT 12FR 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 2427089 278 CAROTID SHUNT 14FR 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 2429505 278 CEMENT RESTRICTOR FEM CA 1 71.00 24.14 27.69 56.80 42.60 36.39 51.55 49.70 55.38 53.25 27.69 56.80 49.70 53.25 2429506 278 CEMENT RESTRICTOR FEM CA 1 71.00 24.14 27.69 56.80 42.60 36.39 51.55 49.70 55.38 53.25 27.69 56.80 49.70 53.25 2429510 278 CEMENT RESTRICTOR FEM CA 1 71.00 24.14 27.69 56.80 42.60 36.39 51.55 49.70 55.38 53.25 27.69 56.80 49.70 53.25 2433110 272 PACEMAKER SAFE SHEATH 1 130.00 44.20 50.70 104.00 78.00 66.63 94.38 91.00 101.40 97.50 50.70 104.00 91.00 97.50 2436387 272 K-132 BLADE 1 72.00 24.48 28.08 57.60 43.20 36.90 52.27 50.40 56.16 54.00 28.08 57.60 50.40 54.00 2439616 272 K-133 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 2439620 272 K 136 BLADE 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 2454636 272 PACEMAKER DISP SURG CABL 1 62.50 21.25 24.38 50.00 37.50 32.03 45.38 43.75 48.75 46.88 24.38 50.00 43.75 46.88 2459434 278 GRAFT FASCIA LATA 1 730.00 248.20 284.70 584.00 438.00 374.13 529.98 511.00 569.40 547.50 284.70 584.00 511.00 547.50 2465640 278 HOWMEDICA 5231-1-140 1 205.00 69.70 79.95 164.00 123.00 105.06 148.83 143.50 159.90 153.75 79.95 164.00 143.50 153.75 2465642 278 HOWMEDICA 5231-3-145 1 678.00 230.52 264.42 542.40 406.80 347.48 492.23 474.60 528.84 508.50 264.42 542.40 474.60 508.50 2465643 278 HOWMEDICA 5231-3-140 1 678.00 230.52 264.42 542.40 406.80 347.48 492.23 474.60 528.84 508.50 264.42 542.40 474.60 508.50 2465644 278 HOWMEDICA 5231-3-135 1 678.00 230.52 264.42 542.40 406.80 347.48 492.23 474.60 528.84 508.50 264.42 542.40 474.60 508.50 2465645 278 HOWMEDICA 5231-3-130 1 678.00 230.52 264.42 542.40 406.80 347.48 492.23 474.60 528.84 508.50 264.42 542.40 474.60 508.50 2465646 278 HOWMEDICA 5231-3-450 1 678.00 230.52 264.42 542.40 406.80 347.48 492.23 474.60 528.84 508.50 264.42 542.40 474.60 508.50 2465664 278 HOWMEDICA 5231-3-445 1 678.00 230.52 264.42 542.40 406.80 347.48 492.23 474.60 528.84 508.50 264.42 542.40 474.60 508.50 2465694 272 LIGACLIP ENDO ROATING ER320 1 567.00 192.78 221.13 453.60 340.20 290.59 411.64 396.90 442.26 425.25 221.13 453.60 396.90 425.25 2466106 276 LENS PANOPTIX 1 " 1,492.00 " 507.28 581.88 " 1,193.60 " 895.20 764.65 " 1,083.19 " " 1,044.40 " " 1,163.76 " " 1,119.00 " 581.88 " 1,193.60 " " 1,044.40 " " 1,119.00 " 2477677 278 MICROVASIVE PRECISION TA 1 " 1,070.00 " 363.80 417.30 856.00 642.00 548.38 776.82 749.00 834.60 802.50 417.30 856.00 749.00 802.50 2479967 272 TUBE GASTROSTOMY 20FR 1 45.45 15.45 17.73 36.36 27.27 23.29 33.00 31.82 35.45 34.09 17.73 36.36 31.82 34.09 2484171 278 SEPRAFILM 1 290.00 98.60 113.10 232.00 174.00 148.63 210.54 203.00 226.20 217.50 113.10 232.00 203.00 217.50 2485015 278 SYNTHES 292.69 1 120.58 41.00 47.03 96.46 72.35 61.80 87.54 84.41 94.05 90.44 47.03 96.46 84.41 90.44 2485018 278 SYNTHES 351.76 1 163.68 55.65 63.84 130.94 98.21 83.89 118.83 114.58 127.67 122.76 63.84 130.94 114.58 122.76 2485020 278 SYNTHES 395.782 1 206.00 70.04 80.34 164.80 123.60 105.58 149.56 144.20 160.68 154.50 80.34 164.80 144.20 154.50 2485021 278 SYNTHES 395.784 1 206.00 70.04 80.34 164.80 123.60 105.58 149.56 144.20 160.68 154.50 80.34 164.80 144.20 154.50 2485022 278 SYNTHES 394.786 1 227.50 77.35 88.73 182.00 136.50 116.59 165.17 159.25 177.45 170.63 88.73 182.00 159.25 170.63 2485047 278 SYNTHES 294.772 1 227.50 77.35 88.73 182.00 136.50 116.59 165.17 159.25 177.45 170.63 88.73 182.00 159.25 170.63 2486105 272 NAIL SYNTHES 457.010 LOCKING SLEEVE 1 245.00 83.30 95.55 196.00 147.00 125.56 177.87 171.50 191.10 183.75 95.55 196.00 171.50 183.75 2486111 272 BLADE SYNTHES 474.911 LOCKING SPIRAL SLE 1 390.00 132.60 152.10 312.00 234.00 199.88 283.14 273.00 304.20 292.50 152.10 312.00 273.00 292.50 2486112 272 BLADE SYNTHES 456.100 SPIRAL 1 734.00 249.56 286.26 587.20 440.40 376.18 532.88 513.80 572.52 550.50 286.26 587.20 513.80 550.50 2487216 272 SHUNT LEVINE PERITONEAL 1 " 3,111.00 " " 1,057.74 " " 1,213.29 " " 2,488.80 " " 1,866.60 " " 1,594.39 " " 2,258.59 " " 2,177.70 " " 2,426.58 " " 2,333.25 " " 1,213.29 " " 2,488.80 " " 2,177.70 " " 2,333.25 " 2495488 278 CEMENT RESTRICTOR 17.0MM 1 232.00 78.88 90.48 185.60 139.20 118.90 168.43 162.40 180.96 174.00 90.48 185.60 162.40 174.00 2499470 278 SYNTHES 395.597 1 " 1,194.00 " 405.96 465.66 955.20 716.40 611.93 866.84 835.80 931.32 895.50 465.66 955.20 835.80 895.50 2506318 300 HC H PYLORI WAIVED 1 54.27 18.45 21.17 43.42 32.56 27.81 39.40 37.99 42.33 40.70 21.17 43.42 37.99 40.70 2585651 305 HC SEDIMENTATION RATE WAIVED 1 12.81 4.36 5.00 10.25 7.69 6.57 9.30 8.97 9.99 9.61 5.00 10.25 8.97 9.61 2586308 302 HC MONO SCR (HETEROPHILE) WAIVED 1 15.54 5.28 6.06 12.43 9.32 7.96 11.28 10.88 12.12 11.66 6.06 12.43 10.88 11.66 3000007 270 TRACTION CERVICAL OVER DOOR 1 35.00 11.90 13.65 28.00 21.00 17.94 25.41 24.50 27.30 26.25 13.65 28.00 24.50 26.25 3001299 272 CATHER BALLON 1 279.00 94.86 108.81 223.20 167.40 142.99 202.55 195.30 217.62 209.25 108.81 223.20 195.30 209.25 3002477 270 THORACIC VENT 1 398.00 135.32 155.22 318.40 238.80 203.98 288.95 278.60 310.44 298.50 155.22 318.40 278.60 298.50 3002568 270 GREEN FLUTTER VALVE 1 91.00 30.94 35.49 72.80 54.60 46.64 66.07 63.70 70.98 68.25 35.49 72.80 63.70 68.25 3002844 272 PROLENE 2-0 8833H 1 7.20 2.45 2.81 5.76 4.32 3.69 5.23 5.04 5.62 5.40 2.81 5.76 5.04 5.40 3002867 270 C-COLLAR PED 1 24.50 8.33 9.56 19.60 14.70 12.56 17.79 17.15 19.11 18.38 9.56 19.60 17.15 18.38 3002962 272 1PDSII Z880G 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 3003077 270 CHAMBER HOLD AEROSOL 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3003156 270 VALVE ANTI REFLUX TUBING 1 18.50 6.29 7.22 14.80 11.10 9.48 13.43 12.95 14.43 13.88 7.22 14.80 12.95 13.88 3003279 270 EXOFIN SKIN ADHESIVE 1 42.00 14.28 16.38 33.60 25.20 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 3003431 270 MOSS-TUBE 1 470.00 159.80 183.30 376.00 282.00 240.88 341.22 329.00 366.60 352.50 183.30 376.00 329.00 352.50 3003791 270 MESH MARLEX 10X14 1 250.00 85.00 97.50 200.00 150.00 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 3003848 272 DRESSING NON-ADHERENT 4 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3003850 272 DRESSING NON-ADHERENT 8 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3004173 270 PACK ARTHROSCOPY 1 255.00 86.70 99.45 204.00 153.00 130.69 185.13 178.50 198.90 191.25 99.45 204.00 178.50 191.25 3004312 272 DRAPE IOBAN 2 #6640 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 3004548 272 EYE DRAIN 1 372.00 126.48 145.08 297.60 223.20 190.65 270.07 260.40 290.16 279.00 145.08 297.60 260.40 279.00 3004597 272 PEEL AWAY INTRODUCER 1 56.00 19.04 21.84 44.80 33.60 28.70 40.66 39.20 43.68 42.00 21.84 44.80 39.20 42.00 3004608 270 TUBE ENDOTRACHEAL 3.5 W/CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3004674 270 CIR PED 36 2 CUFF 22TR 1 68.00 23.12 26.52 54.40 40.80 34.85 49.37 47.60 53.04 51.00 26.52 54.40 47.60 51.00 3004754 270 MASK PANDA MEDIUM 1 22.50 7.65 8.78 18.00 13.50 11.53 16.34 15.75 17.55 16.88 8.78 18.00 15.75 16.88 3005015 270 SET CATHETER SHEATH 8.0 F 1 293.00 99.62 114.27 234.40 175.80 150.16 212.72 205.10 228.54 219.75 114.27 234.40 205.10 219.75 3005135 270 DERMABOND PROPEN 1 59.00 20.06 23.01 47.20 35.40 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 3005401 272 GELFOAM SIZE 100 1 140.00 47.60 54.60 112.00 84.00 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 3005781 270 BARD PET DILATOR 6 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005782 270 BARD PET DILATOR 8 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005788 270 BARD PET DILATOR 10 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005789 270 BARD PET DILATOR 12 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005790 270 BARD PET DILATOR 15 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005791 270 BARD PET DILATOR 18 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005792 270 BARD PET DILATOR 20 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005793 270 BARD PET DILATOR 20 MM 1 197.50 67.15 77.03 158.00 118.50 101.22 143.39 138.25 154.05 148.13 77.03 158.00 138.25 148.13 3005843 272 PENCIL ELECT RG-BLADE 1 98.00 33.32 38.22 78.40 58.80 50.23 71.15 68.60 76.44 73.50 38.22 78.40 68.60 73.50 3005900 270 BARRIER SKIN 1-1/2 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3006528 270 BOOT CAST MEDIUM 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 3006579 270 DIAPER BABY LARGE 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3006694 270 TUBE ENDOTRACHEAL 3.5 W/O CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3006741 270 SUPPORT LUMBAR SACRAL FE 1 102.00 34.68 39.78 81.60 61.20 52.28 74.05 71.40 79.56 76.50 39.78 81.60 71.40 76.50 3006742 270 SUPPORT LUMBAR SACRAL FE 1 102.00 34.68 39.78 81.60 61.20 52.28 74.05 71.40 79.56 76.50 39.78 81.60 71.40 76.50 3006743 270 SUPPORT LUMBAR SACRAL FE 1 102.00 34.68 39.78 81.60 61.20 52.28 74.05 71.40 79.56 76.50 39.78 81.60 71.40 76.50 3006745 270 SUPPORT LUMBAR SACRAL FE 1 77.50 26.35 30.23 62.00 46.50 39.72 56.27 54.25 60.45 58.13 30.23 62.00 54.25 58.13 3007016 272 CATHETER URETERAL DILATING ACCESS SHEATH 1 205.00 69.70 79.95 164.00 123.00 105.06 148.83 143.50 159.90 153.75 79.95 164.00 143.50 153.75 3007081 270 PASTE STOMAHESIVE 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3007257 270 KIT CATH CENTRAL 16GA 20CM 1 171.00 58.14 66.69 136.80 102.60 87.64 124.15 119.70 133.38 128.25 66.69 136.80 119.70 128.25 3007456 272 PACK LAVH 1 145.00 49.30 56.55 116.00 87.00 74.31 105.27 101.50 113.10 108.75 56.55 116.00 101.50 108.75 3007724 272 SUTURE SA-64 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3008033 270 SHOULDER PACK 1 83.35 28.34 32.51 66.68 50.01 42.72 60.51 58.35 65.01 62.51 32.51 66.68 58.35 62.51 3008210 272 PERFIX PLUG M 1 256.00 87.04 99.84 204.80 153.60 131.20 185.86 179.20 199.68 192.00 99.84 204.80 179.20 192.00 3008511 272 NEEDLE SPINAL 22G X 1 1/ 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3009143 272 COLLAR CERVICAL RIDGID M 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 3009343 272 SUTURE J-422 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3009347 272 SUTURE SA-66 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3009679 272 "EXTRACTOR, STONE NITINOL TIPLESS" 1 383.00 130.22 149.37 306.40 229.80 196.29 278.06 268.10 298.74 287.25 149.37 306.40 268.10 287.25 3009684 272 CATH TROCAR 8FR 1 17.00 5.78 6.63 13.60 10.20 8.71 12.34 11.90 13.26 12.75 6.63 13.60 11.90 12.75 3009748 272 SUTURE J-371 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3010205 270 ARTHROSCOPIC KNEE HOLDER 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 3010206 270 ELEVATOR LEG 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 3010302 270 PACK HIP DISP 1 292.00 99.28 113.88 233.60 175.20 149.65 211.99 204.40 227.76 219.00 113.88 233.60 204.40 219.00 3010717 270 TUBE 7.0 LMA-FASTRACH ETT 1 168.00 57.12 65.52 134.40 100.80 86.10 121.97 117.60 131.04 126.00 65.52 134.40 117.60 126.00 3010721 270 SKIN TEMP PROBE 400 SERIES 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3010737 272 PACKING NASAL LARGE 1 51.00 17.34 19.89 40.80 30.60 26.14 37.03 35.70 39.78 38.25 19.89 40.80 35.70 38.25 3011119 272 SUTURE CO-13 1 54.00 18.36 21.06 43.20 32.40 27.68 39.20 37.80 42.12 40.50 21.06 43.20 37.80 40.50 3011413 270 UNIV LOW COLLAR 3IN 1 115.00 39.10 44.85 92.00 69.00 58.94 83.49 80.50 89.70 86.25 44.85 92.00 80.50 86.25 3011416 270 COLLAR UNIV 3 1/4 IN 1 22.00 7.48 8.58 17.60 13.20 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 3011426 272 FORCEP 3-PRONG GRASP TRIPOD 1 595.00 202.30 232.05 476.00 357.00 304.94 431.97 416.50 464.10 446.25 232.05 476.00 416.50 446.25 3011427 272 ENDO DISCET CURVED 1 239.00 81.26 93.21 191.20 143.40 122.49 173.51 167.30 186.42 179.25 93.21 191.20 167.30 179.25 3011428 272 ENDO BABCOCK 1 475.18 161.56 185.32 380.14 285.11 243.53 344.98 332.63 370.64 356.39 185.32 380.14 332.63 356.39 3011444 272 TRAY SPINAL 22 W/TELRA 1 78.00 26.52 30.42 62.40 46.80 39.98 56.63 54.60 60.84 58.50 30.42 62.40 54.60 58.50 3011622 272 GUIDEWR 59CM ST STY 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3011628 270 STOCKING THIGH XLG RG 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3011704 270 MOSS GASTROSTOMY TUBE 1 470.00 159.80 183.30 376.00 282.00 240.88 341.22 329.00 366.60 352.50 183.30 376.00 329.00 352.50 3011781 272 PACK CYSTOSCOPY 1 51.00 17.34 19.89 40.80 30.60 26.14 37.03 35.70 39.78 38.25 19.89 40.80 35.70 38.25 3011786 270 TUBE ENDOTRACHEAL 2.5 W/O CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3011891 270 TUBE HOLDER ENDO PEDI 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 3012814 272 CATH FOLEY SIMPLASTIC 24FR 3-WAY 30CC 1 52.00 17.68 20.28 41.60 31.20 26.65 37.75 36.40 40.56 39.00 20.28 41.60 36.40 39.00 3012869 270 DRAIN 1/4 S/C MID 1 118.00 40.12 46.02 94.40 70.80 60.48 85.67 82.60 92.04 88.50 46.02 94.40 82.60 88.50 3013325 278 SLING PUBOVAGINAL MONARC 1 " 1,194.00 " 405.96 465.66 955.20 716.40 611.93 866.84 835.80 931.32 895.50 465.66 955.20 835.80 895.50 3013733 272 TUBE J CK FLT 103/4 P 1 109.00 37.06 42.51 87.20 65.40 55.86 79.13 76.30 85.02 81.75 42.51 87.20 76.30 81.75 3013986 270 PAD FLOATATION DAILY 1 29.00 9.86 11.31 23.20 17.40 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 3014234 272 CLAMP OSTOMY BAG 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 3014301 272 SUTURE J-650 1 88.00 29.92 34.32 70.40 52.80 45.10 63.89 61.60 68.64 66.00 34.32 70.40 61.60 66.00 3014319 272 SUTURE SILK 2-0 1588H 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3014332 272 SUTURE X664H 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3014513 270 THERA BAND LYARD CHARGE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3014540 270 WICK FEMORAL CANAL 1 X 1 139.00 47.26 54.21 111.20 83.40 71.24 100.91 97.30 108.42 104.25 54.21 111.20 97.30 104.25 3014664 270 KIT ARTERIAL LINE FEMOR 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3014665 270 KIT RADIAL 20GA X 1 3/4 1 41.41 14.08 16.15 33.13 24.85 21.22 30.06 28.99 32.30 31.06 16.15 33.13 28.99 31.06 3014687 270 BOOT CAST X-SMALL 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3014699 270 CASTING MATERIAL PLASTER 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3014701 270 CASTING MATERIAL PLASTER 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3014996 270 EXERCISER CPM DAILY 1 135.00 45.90 52.65 108.00 81.00 69.19 98.01 94.50 105.30 101.25 52.65 108.00 94.50 101.25 3015331 270 UNDERPAD 36 X 36 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 3015431 270 KIT ENEMA ADMINISTRATION 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 3015882 272 DUODERM 6X7 CGF 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3016618 272 PROXMATE*CUTTER RELOAD U 1 426.00 144.84 166.14 340.80 255.60 218.33 309.28 298.20 332.28 319.50 166.14 340.80 298.20 319.50 3016809 270 SPONGE IV EXCILON 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 3017241 270 ACCURACOUNT 50 1 34.00 11.56 13.26 27.20 20.40 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 3017323 270 CATHETER URETERAL FLEXIBLE TIP DURAL LU 1 95.00 32.30 37.05 76.00 57.00 48.69 68.97 66.50 74.10 71.25 37.05 76.00 66.50 71.25 3017595 270 BARRIER SENSICARE 1 20.00 6.80 7.80 16.00 12.00 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 3018010 272 BANDAGE DATASCOPE 0683-0 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 3018307 272 GAUZE BANDAGE 2-1/4X108 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 3018398 270 ELBOW PAD SM 1 64.00 21.76 24.96 51.20 38.40 32.80 46.46 44.80 49.92 48.00 24.96 51.20 44.80 48.00 3018879 270 STYLET CHILD 6FR 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 3018880 270 ENDOTRACHEAL TUBE INTRODUCER 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 3019168 270 "SHEATH, FLEXOR URETERAL ACCESS" 1 240.00 81.60 93.60 192.00 144.00 123.00 174.24 168.00 187.20 180.00 93.60 192.00 168.00 180.00 3019502 272 DRNG UNDRWATR 1-2BTL 1 200.00 68.00 78.00 160.00 120.00 102.50 145.20 140.00 156.00 150.00 78.00 160.00 140.00 150.00 3019609 270 PAD TABLESS MAXIPAD 11 I 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 3020363 270 LIGHTED SPECULA SMALL 1 20.00 6.80 7.80 16.00 12.00 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 3020365 270 LIGHTED SPECULA MED 1 20.00 6.80 7.80 16.00 12.00 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 3020366 270 LIGHTED SPECULA LARGE 1 20.00 6.80 7.80 16.00 12.00 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 3020456 270 APRON CYSTO DISP UNIVERS 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 3020479 270 STYLET 14 FR 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3020662 272 GUAZE PACK VAG 2 X6' 1 27.00 9.18 10.53 21.60 16.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 3020742 272 VICRYL 3-0 J416 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3020743 272 VICRYL 2-0 J417 1 6.08 2.07 2.37 4.86 3.65 3.12 4.41 4.26 4.74 4.56 2.37 4.86 4.26 4.56 3020888 272 KALTOSTAT FLAT 3 X4 3/4 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3020937 272 PACK HEAD & NECK 1 47.00 15.98 18.33 37.60 28.20 24.09 34.12 32.90 36.66 35.25 18.33 37.60 32.90 35.25 3021309 270 FLEET ENEMA 4.5 OZ 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3021311 270 FLEET ENEMA 2.25 OZ 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3021312 270 FLEET MINERAL OIL 4.5 OZ 1 4.25 1.45 1.66 3.40 2.55 2.18 3.09 2.98 3.32 3.19 1.66 3.40 2.98 3.19 3021340 272 PDS ENDOLOOP EZ10G 1 44.50 15.13 17.36 35.60 26.70 22.81 32.31 31.15 34.71 33.38 17.36 35.60 31.15 33.38 3021394 272 BASKET SUR-CATH NT 2.2 FR 1 325.00 110.50 126.75 260.00 195.00 166.56 235.95 227.50 253.50 243.75 126.75 260.00 227.50 243.75 3021500 272 SUTURE CO-12 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 3022005 272 ENDO LINEAR CUTTER BLUE 1 839.00 285.26 327.21 671.20 503.40 429.99 609.11 587.30 654.42 629.25 327.21 671.20 587.30 629.25 3022123 272 SUTURE PDS II C CR/CT-1 Z740D 1 92.00 31.28 35.88 73.60 55.20 47.15 66.79 64.40 71.76 69.00 35.88 73.60 64.40 69.00 3022255 272 DRAPE IOBAN 2 #6648 1 59.00 20.06 23.01 47.20 35.40 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 3022468 270 TUBE ENDO BRONECHIAL 1 166.00 56.44 64.74 132.80 99.60 85.08 120.52 116.20 129.48 124.50 64.74 132.80 116.20 124.50 3022470 270 TUBE ENDO BRONE LEFT 37 1 162.00 55.08 63.18 129.60 97.20 83.03 117.61 113.40 126.36 121.50 63.18 129.60 113.40 121.50 3022920 270 TUBE ENDOTRACHEAL 5.0 W/CUFF 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3023084 272 DRAPE CASSETTE UNIVERSAL 1 41.00 13.94 15.99 32.80 24.60 21.01 29.77 28.70 31.98 30.75 15.99 32.80 28.70 30.75 3023539 270 TAPE CASTING 5 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 3023936 270 TUBE LEVINE 16FR 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3024237 272 ENDO STITCH 10MM SUTURING DEVICE 1 675.00 229.50 263.25 540.00 405.00 345.94 490.05 472.50 526.50 506.25 263.25 540.00 472.50 506.25 3024439 270 TUBE ENDO 5.5 W/O CUFF HILO MUR 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3024441 270 TUBE ENDOTRACHEAL 6.5 HILO MUR 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3024571 272 NOH SPINAL 25G X 3.5 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3025279 270 SPLINT LEG SHORT MEDIUM 1 77.50 26.35 30.23 62.00 46.50 39.72 56.27 54.25 60.45 58.13 30.23 62.00 54.25 58.13 3025286 270 SPLINT LEG SHORT SMALL 1 77.50 26.35 30.23 62.00 46.50 39.72 56.27 54.25 60.45 58.13 30.23 62.00 54.25 58.13 3025327 270 IMMOBILIZER ANKLE/WRIST 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 3025562 270 SENSOR SENSORMAT 1 163.00 55.42 63.57 130.40 97.80 83.54 118.34 114.10 127.14 122.25 63.57 130.40 114.10 122.25 3026067 272 DRESSING AIRSTRIP MED 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 3026144 272 CHLORAPREP SMALL 10.5ML CLEAR 1 15.50 5.27 6.05 12.40 9.30 7.94 11.25 10.85 12.09 11.63 6.05 12.40 10.85 11.63 3026693 270 CBDE KIT 1 990.00 336.60 386.10 792.00 594.00 507.38 718.74 693.00 772.20 742.50 386.10 792.00 693.00 742.50 3026748 272 DRESSING AQUACEL 6X6 AG 1 58.00 19.72 22.62 46.40 34.80 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 3026750 272 DRESSING AQUACEL AG 4X5 1 42.00 14.28 16.38 33.60 25.20 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 3026770 272 DUODERM 6X6 CGF 1 51.00 17.34 19.89 40.80 30.60 26.14 37.03 35.70 39.78 38.25 19.89 40.80 35.70 38.25 3027080 270 CANNULA NASAL PED 1 4.50 1.53 1.76 3.60 2.70 2.31 3.27 3.15 3.51 3.38 1.76 3.60 3.15 3.38 3027418 270 SENSICARE MOIST CREME 1 13.84 4.71 5.40 11.07 8.30 7.09 10.05 9.69 10.80 10.38 5.40 11.07 9.69 10.38 3027518 272 DRESSING DUODERM 4 X 4 E 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3028234 270 TRANSMITTER PACEMAKER PA 1 357.00 121.38 139.23 285.60 214.20 182.96 259.18 249.90 278.46 267.75 139.23 285.60 249.90 267.75 3028286 272 DRAIN BLAKE 15 FR. ROUND 1 62.00 21.08 24.18 49.60 37.20 31.78 45.01 43.40 48.36 46.50 24.18 49.60 43.40 46.50 3028293 272 DRAIN BLAKE 19 FR. ROUND 1 62.00 21.08 24.18 49.60 37.20 31.78 45.01 43.40 48.36 46.50 24.18 49.60 43.40 46.50 3028409 270 IMMOBILIZER SHOULDER UNI 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3029027 272 SYSTEM CLOSED TRACH 4.61 1 64.00 21.76 24.96 51.20 38.40 32.80 46.46 44.80 49.92 48.00 24.96 51.20 44.80 48.00 3029276 272 DRAPE LG MAGNA 16X20 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3029567 270 ENTROPHY SENSOR DISPOSABLE 1 42.00 14.28 16.38 33.60 25.20 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 3029569 270 ELECTRODE PACING EXTERNA 1 183.00 62.22 71.37 146.40 109.80 93.79 132.86 128.10 142.74 137.25 71.37 146.40 128.10 137.25 3030266 272 NDL INF 90D 20GX1.5 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3030426 272 SUTURE CO-66 1 52.00 17.68 20.28 41.60 31.20 26.65 37.75 36.40 40.56 39.00 20.28 41.60 36.40 39.00 3030430 270 DIAPER ADULT DISP L (5 PK) 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 3030432 272 INTRODUCER LEAD PERC 1 329.00 111.86 128.31 263.20 197.40 168.61 238.85 230.30 256.62 246.75 128.31 263.20 230.30 246.75 3030435 270 DIAPER ADULT DISP L 1 22.00 7.48 8.58 17.60 13.20 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 3030436 272 TRAY PED/INFT LUMB 22 GA 1 135.00 45.90 52.65 108.00 81.00 69.19 98.01 94.50 105.30 101.25 52.65 108.00 94.50 101.25 3030437 270 SUPPORT LUMBAR SACRAL FE 1 105.00 35.70 40.95 84.00 63.00 53.81 76.23 73.50 81.90 78.75 40.95 84.00 73.50 78.75 3030450 270 RESERVOIR J-VAC 300ML 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 3030788 270 CATHETER BIPOLAR PACING 1 183.00 62.22 71.37 146.40 109.80 93.79 132.86 128.10 142.74 137.25 71.37 146.40 128.10 137.25 3030944 272 GUIDE E-Z GLIDER STRAIGHT TIP 41BX 1 87.00 29.58 33.93 69.60 52.20 44.59 63.16 60.90 67.86 65.25 33.93 69.60 60.90 65.25 3030945 272 GUIDE E-Z GLIDER STRAIGHT TIP 42BX 1 87.00 29.58 33.93 69.60 52.20 44.59 63.16 60.90 67.86 65.25 33.93 69.60 60.90 65.25 3030947 272 LASERFIBER LIGHTGUIDE 270 MICRON 1 599.34 203.78 233.74 479.47 359.60 307.16 435.12 419.54 467.49 449.51 233.74 479.47 419.54 449.51 3030949 272 LASERFIBER LIGHTGUIDE 400 MICRON 1 599.34 203.78 233.74 479.47 359.60 307.16 435.12 419.54 467.49 449.51 233.74 479.47 419.54 449.51 3031475 272 SUTURE VICRYL 2-0 JJ42G 1 32.10 10.91 12.52 25.68 19.26 16.45 23.30 22.47 25.04 24.08 12.52 25.68 22.47 24.08 3031481 272 VICRYL J840D 1 34.58 11.76 13.49 27.66 20.75 17.72 25.11 24.21 26.97 25.94 13.49 27.66 24.21 25.94 3032946 270 COBAN WRAP 3 x 5 YARDS 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3033316 272 DRESSING ADAPTIC 3 X 3 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3033357 272 DRESSING ADAPTIC 3 X 16 1 14.00 4.76 5.46 11.20 8.40 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 3033373 272 DRESSING ADAPTIC 3 X 8 1 13.00 4.42 5.07 10.40 7.80 6.66 9.44 9.10 10.14 9.75 5.07 10.40 9.10 9.75 3033523 270 SPLINT LEG SHORT LARGE 1 77.50 26.35 30.23 62.00 46.50 39.72 56.27 54.25 60.45 58.13 30.23 62.00 54.25 58.13 3033639 272 GAUZE PETROLATUM 12 X 72 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3033654 272 GAUZE PETROLATUM 3 X 9 F 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 3033860 272 GAUZE PKNG 1 X 2 X 5 YD 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3033928 272 GAUZE PKNG IOD 1/4X5YD 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3033944 272 GAUZE PKNG IODOFORM 1/2X5YD 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3034355 270 SENSOR ADULT FOREHEAD 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3034357 270 SENSOR SP02 NEONATE/ADULT 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 3034360 270 SENSOR OXISENSOR MDL ADULT 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3034652 270 SPONGE 4 X 4 6PLYSTERILE 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3034736 272 SPONGE LAP 12 X 12 X-RAY 1 80.00 27.20 31.20 64.00 48.00 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 60.00 3034760 272 GUIDE E-Z GLIDER STRAIGHT TIP 36BX 1 62.75 21.34 24.47 50.20 37.65 32.16 45.56 43.93 48.95 47.06 24.47 50.20 43.93 47.06 3034762 272 GUIDE E-Z GLIDER ANGLE TIP 39BX 1 62.75 21.34 24.47 50.20 37.65 32.16 45.56 43.93 48.95 47.06 24.47 50.20 43.93 47.06 3034769 272 SPONGE LAP X-RAY DETECT 1 85.00 28.90 33.15 68.00 51.00 43.56 61.71 59.50 66.30 63.75 33.15 68.00 59.50 63.75 3034825 272 DRN DIRECT FLOW CNTRL 1 453.00 154.02 176.67 362.40 271.80 232.16 328.88 317.10 353.34 339.75 176.67 362.40 317.10 339.75 3034900 270 SPONGE OPTIPORE WOUND CLEANSING 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3035188 272 SURGICEL 4 X 8 STRIP 1 233.50 79.39 91.07 186.80 140.10 119.67 169.52 163.45 182.13 175.13 91.07 186.80 163.45 175.13 3035196 272 SURGICEL 2 X 3 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3035337 272 PAD ABDOM 7.5 X 8 ST 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 3035475 272 CATH TROCAR 12FR 9 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3035484 272 CATH THOR TROC 24 FR 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3035531 270 PACK VITRECTOMY PACK 1 343.00 116.62 133.77 274.40 205.80 175.79 249.02 240.10 267.54 257.25 133.77 274.40 240.10 257.25 3035686 270 TUBE 7.5 LMA-FASTRACH ETT 1 168.00 57.12 65.52 134.40 100.80 86.10 121.97 117.60 131.04 126.00 65.52 134.40 117.60 126.00 3035953 270 HOWMEDICA 702461 1 83.25 28.31 32.47 66.60 49.95 42.67 60.44 58.28 64.94 62.44 32.47 66.60 58.28 62.44 3036018 272 DRAIN BLAKE 10 FR. ROUND 1 62.00 21.08 24.18 49.60 37.20 31.78 45.01 43.40 48.36 46.50 24.18 49.60 43.40 46.50 3036173 270 TUBE ENDOTRACHEAL 4.0 W/O CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3036194 270 MASK LMA 1.0 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3036195 270 MASK LMA 2.0 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3036196 270 MASK LMA 1.5 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3036197 270 MASK LMA 2.5 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3036198 270 MASK LMA 3.0 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3036199 270 MASK LMA 4.0 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3036200 270 MASK LMA 5.0 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3036208 270 STETHOSCOPE ESOPHAGEAL 1 1 37.00 12.58 14.43 29.60 22.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 3036645 270 FOAM ALOE VESTA 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3037653 272 SUTURE 8-0 VIC ETH 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3038718 270 HOSE KNEE LENGTH MEDIUM SCD 1 64.00 21.76 24.96 51.20 38.40 32.80 46.46 44.80 49.92 48.00 24.96 51.20 44.80 48.00 3038720 270 HOSE KNEE LENGTH LARGE SCD 1 93.00 31.62 36.27 74.40 55.80 47.66 67.52 65.10 72.54 69.75 36.27 74.40 65.10 69.75 3038767 270 MIXER BONE CEMENT # 2 1 128.00 43.52 49.92 102.40 76.80 65.60 92.93 89.60 99.84 96.00 49.92 102.40 89.60 96.00 3038914 272 SPONGE 4 X 18 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3038928 270 SPONGE X-RAY 4X4 16 PLY 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3039005 270 CATHETER URETERAL FLEXIBLE TIP 5FR X 70 1 36.00 12.24 14.04 28.80 21.60 18.45 26.14 25.20 28.08 27.00 14.04 28.80 25.20 27.00 3039013 270 PAD FOREARM LEFT SMALL 1 89.00 30.26 34.71 71.20 53.40 45.61 64.61 62.30 69.42 66.75 34.71 71.20 62.30 66.75 3039015 270 SPLINT ARM YOUTH RIGHT 1 89.00 30.26 34.71 71.20 53.40 45.61 64.61 62.30 69.42 66.75 34.71 71.20 62.30 66.75 3039017 270 PAD FOREARM LEFT LG 1 89.00 30.26 34.71 71.20 53.40 45.61 64.61 62.30 69.42 66.75 34.71 71.20 62.30 66.75 3039020 270 PAD FOREARM RIGHT LG 1 89.00 30.26 34.71 71.20 53.40 45.61 64.61 62.30 69.42 66.75 34.71 71.20 62.30 66.75 3040352 272 CATH TROCAR 32FR 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3040381 270 TRI-FNNL RPLCMNT GAST TU 1 201.00 68.34 78.39 160.80 120.60 103.01 145.93 140.70 156.78 150.75 78.39 160.80 140.70 150.75 3040383 270 TUBE FEEDING GASTRO W/ Y PORT 28FR 1 201.00 68.34 78.39 160.80 120.60 103.01 145.93 140.70 156.78 150.75 78.39 160.80 140.70 150.75 3040386 272 CATH TROCAR 20FR 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3040394 272 CATH TROCAR 28FR 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3040527 272 CATH UMBILIC ARTERY 5FR 1 71.00 24.14 27.69 56.80 42.60 36.39 51.55 49.70 55.38 53.25 27.69 56.80 49.70 53.25 3041140 272 PACK PHACO (EYE) 1 232.00 78.88 90.48 185.60 139.20 118.90 168.43 162.40 180.96 174.00 90.48 185.60 162.40 174.00 3041274 270 CAST GUARD HALF LEG REG 1 41.00 13.94 15.99 32.80 24.60 21.01 29.77 28.70 31.98 30.75 15.99 32.80 28.70 30.75 3041278 272 CASTGUARD FULL LEG REG 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 3041480 272 CASTGUARD FULL ARM REG 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 3041754 270 TUBE MILR ABBT 14FR 1 158.00 53.72 61.62 126.40 94.80 80.98 114.71 110.60 123.24 118.50 61.62 126.40 110.60 118.50 3041766 272 PACK OB 1 226.00 76.84 88.14 180.80 135.60 115.83 164.08 158.20 176.28 169.50 88.14 180.80 158.20 169.50 3041956 272 NEEDLE SET EZ-IO 45MM 15GA 1 230.00 78.20 89.70 184.00 138.00 117.88 166.98 161.00 179.40 172.50 89.70 184.00 161.00 172.50 3041966 272 NEEDLE SET EZ-IO 25MM 15GA 1 230.00 78.20 89.70 184.00 138.00 117.88 166.98 161.00 179.40 172.50 89.70 184.00 161.00 172.50 3041970 272 NEEDLE SET EZ-IO 15MM 15GA 1 230.00 78.20 89.70 184.00 138.00 117.88 166.98 161.00 179.40 172.50 89.70 184.00 161.00 172.50 3042143 270 BELT ABDOMINAL 1 3.00 1.02 1.17 2.40 1.80 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 3042169 270 UTERINE MAIN-INJECT 1 190.00 64.60 74.10 152.00 114.00 97.38 137.94 133.00 148.20 142.50 74.10 152.00 133.00 142.50 3042324 271 "KIT, PLEURX DRAINAGE 1000ML" 1 182.00 61.88 70.98 145.60 109.20 93.28 132.13 127.40 141.96 136.50 70.98 145.60 127.40 136.50 3042631 272 5 ORTHO GLASS SPLINT 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3042635 272 3 ORTHO GLASS SPLINT 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3042639 272 4 ORTHO GLASS SPLINT 1 44.00 14.96 17.16 35.20 26.40 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 3042671 270 DIAPER ADULT DISP XXL 1 52.00 17.68 20.28 41.60 31.20 26.65 37.75 36.40 40.56 39.00 20.28 41.60 36.40 39.00 3042691 270 STOCKING JOBST KNEE LENG 1 198.00 67.32 77.22 158.40 118.80 101.48 143.75 138.60 154.44 148.50 77.22 158.40 138.60 148.50 3042871 270 POCKET FLOW METER UNIV 1 31.80 10.81 12.40 25.44 19.08 16.30 23.09 22.26 24.80 23.85 12.40 25.44 22.26 23.85 3042880 272 STRYKER BLADE 151 1 203.00 69.02 79.17 162.40 121.80 104.04 147.38 142.10 158.34 152.25 79.17 162.40 142.10 152.25 3042882 270 2-0 VICRYL J945H 1 6.36 2.16 2.48 5.09 3.82 3.26 4.62 4.45 4.96 4.77 2.48 5.09 4.45 4.77 3042918 272 MIXER BONE CEMENT #3 1 263.00 89.42 102.57 210.40 157.80 134.79 190.94 184.10 205.14 197.25 102.57 210.40 184.10 197.25 3043245 270 ESOPHAGEAL STETHOSCOPE W/TEMP PROBE 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 3043258 270 HOT BIOPSY FORCEPTS BARD 1 129.00 43.86 50.31 103.20 77.40 66.11 93.65 90.30 100.62 96.75 50.31 103.20 90.30 96.75 3043512 270 ENDO CLOSE 1 128.00 43.52 49.92 102.40 76.80 65.60 92.93 89.60 99.84 96.00 49.92 102.40 89.60 96.00 3043518 272 TROCAR ENDOPATH B5XT 1 121.50 41.31 47.39 97.20 72.90 62.27 88.21 85.05 94.77 91.13 47.39 97.20 85.05 91.13 3043627 272 STAPLER ENDOSCOPIC MULTIFEED EMS (20) 1 325.00 110.50 126.75 260.00 195.00 166.56 235.95 227.50 253.50 243.75 126.75 260.00 227.50 243.75 3043683 272 SUTURE PDS Z-879 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3043811 270 CIRCUIT NEWPORT VENTILATOR 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 3043843 270 TUBE ENDOTRACHEAL 3.0 W/CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3043844 270 SHOE CAST SMALL 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3043863 272 TRAY LUMBAR PUNCTURE INF 1 135.00 45.90 52.65 108.00 81.00 69.19 98.01 94.50 105.30 101.25 52.65 108.00 94.50 101.25 3043869 270 POST-OPSHOE FEMALE 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 3043914 270 TUBE ENDOTRACHEAL 8.0 W/CUFF 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3043916 270 TUBE ENDOTRACHEAL 4.0 W/CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3044148 270 T-DRAIN LONG #14 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 3045909 272 DRESSING UNNA BOOT 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3046136 270 SLING ARM SMALL 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046137 270 SLING ARM X-SMALL 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046177 270 SLING ARM MEDIUM 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046178 270 SLING ARM XXS 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046219 270 SLING ARM LARGE 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046250 270 SLING ARM X-LARGE 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046557 270 SPLINT FOREARM CHILD RT 1 86.00 29.24 33.54 68.80 51.60 44.08 62.44 60.20 67.08 64.50 33.54 68.80 60.20 64.50 3046601 270 SPLINT SCOTCHCAST 4 X 30 1 57.00 19.38 22.23 45.60 34.20 29.21 41.38 39.90 44.46 42.75 22.23 45.60 39.90 42.75 3046656 270 SPLINT CLAVICULAR SMALL 1 71.00 24.14 27.69 56.80 42.60 36.39 51.55 49.70 55.38 53.25 27.69 56.80 49.70 53.25 3046730 270 SPLINT CLAVICULAR MEDIUM 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046771 270 SPLINT CLAVICULAR LARGE 1 73.00 24.82 28.47 58.40 43.80 37.41 53.00 51.10 56.94 54.75 28.47 58.40 51.10 54.75 3046789 270 SPLINT CLAVICULAR X-LARG 1 71.00 24.14 27.69 56.80 42.60 36.39 51.55 49.70 55.38 53.25 27.69 56.80 49.70 53.25 3047156 272 SET GASTRIC LARGE 1 54.00 18.36 21.06 43.20 32.40 27.68 39.20 37.80 42.12 40.50 21.06 43.20 37.80 40.50 3047620 272 GUIDE WIRE .32(.8MM) X 23 5/8 (60C 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3047845 270 SPLINT BUCK TRACTION SM 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 3047886 270 SPLINT BUCK TRACTION MED 1 33.00 11.22 12.87 26.40 19.80 16.91 23.96 23.10 25.74 24.75 12.87 26.40 23.10 24.75 3048117 272 3-M CLIPPER ASSEMBLY 1 12.96 4.41 5.05 10.37 7.78 6.64 9.41 9.07 10.11 9.72 5.05 10.37 9.07 9.72 3048281 270 SPLINT AIR ANKLE FL RT 1 68.00 23.12 26.52 54.40 40.80 34.85 49.37 47.60 53.04 51.00 26.52 54.40 47.60 51.00 3048819 272 HYDRO THERMA BLUTOR 1 " 1,490.00 " 506.60 581.10 " 1,192.00 " 894.00 763.63 " 1,081.74 " " 1,043.00 " " 1,162.20 " " 1,117.50 " 581.10 " 1,192.00 " " 1,043.00 " " 1,117.50 " 3048843 272 PACK BARRIER LAPAROSCOPY 1 133.00 45.22 51.87 106.40 79.80 68.16 96.56 93.10 103.74 99.75 51.87 106.40 93.10 99.75 3049005 272 NEEDLE PNEUMO 120MM 1 122.00 41.48 47.58 97.60 73.20 62.53 88.57 85.40 95.16 91.50 47.58 97.60 85.40 91.50 3049007 272 NEEDLE PNEUMO 150MM 1 122.00 41.48 47.58 97.60 73.20 62.53 88.57 85.40 95.16 91.50 47.58 97.60 85.40 91.50 3049684 272 SUTURE 1667 4-0 BLK MONO PS-2 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 3049771 270 NM-4U INJECTOR NEEDLE 1 102.00 34.68 39.78 81.60 61.20 52.28 74.05 71.40 79.56 76.50 39.78 81.60 71.40 76.50 3049841 272 SUTURE ETHILON 3-0 BLK 1671H 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 3049916 272 SUTURE 490 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3050105 270 TRAY AMBILICAL VESSAL CA 1 139.00 47.26 54.21 111.20 83.40 71.24 100.91 97.30 108.42 104.25 54.21 111.20 97.30 104.25 3050113 270 PACK C-SECTION OB 1 128.00 43.52 49.92 102.40 76.80 65.60 92.93 89.60 99.84 96.00 49.92 102.40 89.60 96.00 3050758 270 FIBERGLASS SPLINT 3 X 12 1 21.74 7.39 8.48 17.39 13.04 11.14 15.78 15.22 16.96 16.31 8.48 17.39 15.22 16.31 3050762 270 FIBERGLASS SPLINT 4 X 30 1 38.19 12.98 14.89 30.55 22.91 19.57 27.73 26.73 29.79 28.64 14.89 30.55 26.73 28.64 3051110 272 3-0 ETHLON 642G 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 3051375 272 SUTURE 924 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3051747 272 MONOPTY NEEDLE 18GA 10CM 1 73.75 25.08 28.76 59.00 44.25 37.80 53.54 51.63 57.53 55.31 28.76 59.00 51.63 55.31 3051788 270 GEL HYPERGEL TUBE 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 3052293 272 SUTURE N862H 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3052696 272 SUTURE H-822 3-O PLAIN 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3053527 272 CATH DBL LUMEN #1 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 3054522 361 CATHETER LUBRI-FLEX 4.5 X22CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3054524 270 CATHETER LUBRI-FLEX 4.5 X24CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3054526 270 CATHETER LUBRI-FLEX 4.5 X26CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3054528 270 CATHETER LUBRI-FLEX 4.5X 28CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3054577 272 SUTURE 8682 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3055124 272 TRAY PEG 20FR REPLACEMENT 1 700.00 238.00 273.00 560.00 420.00 358.75 508.20 490.00 546.00 525.00 273.00 560.00 490.00 525.00 3055283 270 TUBE TRACH 2.5 W/ADAPTER 1 22.00 7.48 8.58 17.60 13.20 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 3055287 270 TUBE TRACH 3.0 W/ADAPTOR 1 22.00 7.48 8.58 17.60 13.20 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 3055288 270 TUBE TRACH 3.5 W/ADOPTER 1 22.00 7.48 8.58 17.60 13.20 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 3055419 270 DRAIN CLOSURE WOUND 1/4 1 118.00 40.12 46.02 94.40 70.80 60.48 85.67 82.60 92.04 88.50 46.02 94.40 82.60 88.50 3055776 270 MASK LARYNGEAL AMBU #3 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3055777 270 MASK LARYNGEAL AMBU #4 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3055779 270 MASK LARYNGEAL AMBU #5 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3056022 270 CATHETER LUBRI-FLEX 6.0 X22CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3056024 270 CATHETER LUBRI-FLEX 6.0 X24CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3056026 270 CATHETER LUBRI-FLEX 6.0 X26CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3056028 270 CATHETER LUBRI-FLEX 6.0 X28CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3056030 270 CATHETER LUBRI-FLEX 6.0 X30CM WO/GW 1 193.00 65.62 75.27 154.40 115.80 98.91 140.12 135.10 150.54 144.75 75.27 154.40 135.10 144.75 3056651 270 SLING ARM & SWATHE UNIVE 1 36.00 12.24 14.04 28.80 21.60 18.45 26.14 25.20 28.08 27.00 14.04 28.80 25.20 27.00 3057622 272 KIT MULTI 7FR. 3LUM 20CM. 0.25WIRE 1 292.00 99.28 113.88 233.60 175.20 149.65 211.99 204.40 227.76 219.00 113.88 233.60 204.40 219.00 3057737 272 NEEDLE SPINAL 18G X 3.5 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3057810 272 NEEDLE SPINAL 22G X 3 1/ 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3057826 272 NDL HUBER 19GA 1 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 3057831 272 NDL HUBER 20GA 1 1/2 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 3058694 272 NEEDLE BIOPSY 18GA 1 108.00 36.72 42.12 86.40 64.80 55.35 78.41 75.60 84.24 81.00 42.12 86.40 75.60 81.00 3060365 272 DRESSING DUODERM 6X6 1 14.00 4.76 5.46 11.20 8.40 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 3060367 272 DRESSING COMBIDERM 6X7 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3060647 270 CAST ARM SHORT 1 120.50 40.97 47.00 96.40 72.30 61.76 87.48 84.35 93.99 90.38 47.00 96.40 84.35 90.38 3060653 270 CAST LEG SHORT 1 138.25 47.01 53.92 110.60 82.95 70.85 100.37 96.78 107.84 103.69 53.92 110.60 96.78 103.69 3060659 270 CAST LEG LONG 1 184.50 62.73 71.96 147.60 110.70 94.56 133.95 129.15 143.91 138.38 71.96 147.60 129.15 138.38 3060688 272 TRAY THORACENTESIS 1 135.00 45.90 52.65 108.00 81.00 69.19 98.01 94.50 105.30 101.25 52.65 108.00 94.50 101.25 3060823 272 DRESSING AQUACEL 15X15CM 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 3061085 272 TRAY LUMBAR PUNCTURE 22G 1 118.00 40.12 46.02 94.40 70.80 60.48 85.67 82.60 92.04 88.50 46.02 94.40 82.60 88.50 3061296 270 AMNIHOOK DISP 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3062750 272 DRESSING OWENS 8 X12 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 3062753 270 STOCKINETTE STRL 4 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3062754 270 STOCKINETTE STRL 6 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 3063214 270 TUBE PENROSE DRAIN 1/4 X 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3063269 272 O TICRON 3386-62 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 3063277 270 PROXIMATE EXTRACTOR 1 36.00 12.24 14.04 28.80 21.60 18.45 26.14 25.20 28.08 27.00 14.04 28.80 25.20 27.00 3063284 270 CAST ARM LONG 1 138.25 47.01 53.92 110.60 82.95 70.85 100.37 96.78 107.84 103.69 53.92 110.60 96.78 103.69 3063296 272 SPONGE 4 X 4 STERILE 10' 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3063297 272 TUBE PENROSE DRAIN 5/8 X 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3063379 272 CUTTER LINEAR 75MM 1 207.00 70.38 80.73 165.60 124.20 106.09 150.28 144.90 161.46 155.25 80.73 165.60 144.90 155.25 3063537 270 TUBE RECTAL 24FR 20 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3063999 270 JEJUNAL TUBE 9 FRENCH 27 1 90.00 30.60 35.10 72.00 54.00 46.13 65.34 63.00 70.20 67.50 35.10 72.00 63.00 67.50 3064034 270 CAST LEG 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 3064149 272 TRAY AMNIOCENTESIS 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3064202 270 LOCATOR NERVE 1 102.00 34.68 39.78 81.60 61.20 52.28 74.05 71.40 79.56 76.50 39.78 81.60 71.40 76.50 3064220 270 TUBE T STERILE 12FR 1 39.00 13.26 15.21 31.20 23.40 19.99 28.31 27.30 30.42 29.25 15.21 31.20 27.30 29.25 3064394 270 TUBE TRACHEA SHILEY SIZE 1 169.00 57.46 65.91 135.20 101.40 86.61 122.69 118.30 131.82 126.75 65.91 135.20 118.30 126.75 3064408 272 DERMATONE CUTTING HEAD 1 80.00 27.20 31.20 64.00 48.00 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 60.00 3064412 272 PLUG CATHETER 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 3064415 272 KIT SUPRAPUBIC 12FR 1 219.00 74.46 85.41 175.20 131.40 112.24 158.99 153.30 170.82 164.25 85.41 175.20 153.30 164.25 3064448 272 CATH SWAN GANZ 7FR 1 655.00 222.70 255.45 524.00 393.00 335.69 475.53 458.50 510.90 491.25 255.45 524.00 458.50 491.25 3064723 270 STOCKING ANTI-EMB SM LNG 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3064724 270 STOCKING ANTI-EMB MED RE 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3064726 270 STOCKING ANTI-EMB MED LN 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3064727 270 STOCKING ANTI-EMB LG LNG 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3064728 270 STOCKING ANTI-EMB X-LG R 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3064729 270 STOCKING ANTI-EMB XLG-LONG 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3065365 270 IMMOBILIZER KNEE ON TRACK SYSTEM 1 230.00 78.20 89.70 184.00 138.00 117.88 166.98 161.00 179.40 172.50 89.70 184.00 161.00 172.50 3065470 272 GUIDE E-Z GLIDER STRAIGHT TIP 38BX 1 62.75 21.34 24.47 50.20 37.65 32.16 45.56 43.93 48.95 47.06 24.47 50.20 43.93 47.06 3065629 270 VEIN STRIPPER DISP 1 54.00 18.36 21.06 43.20 32.40 27.68 39.20 37.80 42.12 40.50 21.06 43.20 37.80 40.50 3065631 270 HOSE TED SCD KNEE LENTH MEDIUM (OLD) 1 133.00 45.22 51.87 106.40 79.80 68.16 96.56 93.10 103.74 99.75 51.87 106.40 93.10 99.75 3065656 270 HOSE TED SCD KNEE LENTH LARGE (OLD) 1 133.00 45.22 51.87 106.40 79.80 68.16 96.56 93.10 103.74 99.75 51.87 106.40 93.10 99.75 3065680 272 ADAPTER BANANA 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 3065707 272 SPONGE KLING FLUFF 1 34.00 11.56 13.26 27.20 20.40 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 3066845 270 BAG AST MED 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3066929 272 PACKING NASAL SMALL 1 35.00 11.90 13.65 28.00 21.00 17.94 25.41 24.50 27.30 26.25 13.65 28.00 24.50 26.25 3067407 272 GUIDEWIRE .025X12 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3067729 270 RING BARIUM ENEMA 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 3067751 272 SYNTHES BLADE 532.045 1 115.63 39.31 45.10 92.50 69.38 59.26 83.95 80.94 90.19 86.72 45.10 92.50 80.94 86.72 3067762 272 BAG BILE 19 OZ REGULAR D 1 37.00 12.58 14.43 29.60 22.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 3067793 272 SYNTHES BLADE 532.048 1 115.63 39.31 45.10 92.50 69.38 59.26 83.95 80.94 90.19 86.72 45.10 92.50 80.94 86.72 3067809 270 TUBE ENDOTRACHEAL 5.5 W/CUFF 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3067810 270 TUBE ENDOTRACHEAL 9.0 W/CUFF MURPHY 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3067812 270 TUBE ENDOTRACHEAL 10.0 W/CUFF MURPHY 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3067813 270 TUBE ENDOTRACHEAL 7.0 W/CUFF 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3067835 272 SYNTHES BLADE 532.047 1 115.63 39.31 45.10 92.50 69.38 59.26 83.95 80.94 90.19 86.72 45.10 92.50 80.94 86.72 3067890 272 TRAY TRACHEOSTOMY CARE D 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3067905 270 SPLINT WRIST RIGHT SMALL 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067906 270 SPLINT WRIST RIGHT MEDIU 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067907 270 SPLINT WRIST RIGHT LARGE 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067908 270 SPLINT WRIST RIGHT XLG 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067909 270 SPLINT WRIST LEFT SMALL 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067910 270 SPLINT WRIST LEFT MEDIUM 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067911 270 SPLINT WRIST LEFT LARGE 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067912 270 SPLINT WRIST LEFT XLG 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 3067918 272 SYNTHES BLADE 519.103 1 102.50 34.85 39.98 82.00 61.50 52.53 74.42 71.75 79.95 76.88 39.98 82.00 71.75 76.88 3068308 270 IMMOBILIZER KNEE MED 16 1 188.00 63.92 73.32 150.40 112.80 96.35 136.49 131.60 146.64 141.00 73.32 150.40 131.60 141.00 3068309 270 IMMOBILIZER KNEE LARGE 16 1 188.00 63.92 73.32 150.40 112.80 96.35 136.49 131.60 146.64 141.00 73.32 150.40 131.60 141.00 3068310 270 IMMOBILIZER KNEE X-LARGE 16 1 188.00 63.92 73.32 150.40 112.80 96.35 136.49 131.60 146.64 141.00 73.32 150.40 131.60 141.00 3068347 270 GASTRIC LAVAGE SYSTEM 1 112.00 38.08 43.68 89.60 67.20 57.40 81.31 78.40 87.36 84.00 43.68 89.60 78.40 84.00 3068405 270 CAPNOLINE SMART PLUS 02 1 44.00 14.96 17.16 35.20 26.40 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 3068443 272 CUFF TOURNIQUET 18 SINGLE 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3068444 272 CUFF TOURNIQUET 24 SINGLE 1 45.00 15.30 17.55 36.00 27.00 23.06 32.67 31.50 35.10 33.75 17.55 36.00 31.50 33.75 3068445 272 CUFF TOURNIQUET 30 SINGLE 1 49.00 16.66 19.11 39.20 29.40 25.11 35.57 34.30 38.22 36.75 19.11 39.20 34.30 36.75 3068446 272 CUFF TOURNIQUET 34 SINGLE 1 53.00 18.02 20.67 42.40 31.80 27.16 38.48 37.10 41.34 39.75 20.67 42.40 37.10 39.75 3069005 272 ARTHROSCOPY CANNULA 8MM SHOLDER 1 33.75 11.48 13.16 27.00 20.25 17.30 24.50 23.63 26.33 25.31 13.16 27.00 23.63 25.31 3069061 270 SPLINT POST TIB&FIB SM 1 149.00 50.66 58.11 119.20 89.40 76.36 108.17 104.30 116.22 111.75 58.11 119.20 104.30 111.75 3069062 270 SPLINT POST TIB&FIB MED 1 171.00 58.14 66.69 136.80 102.60 87.64 124.15 119.70 133.38 128.25 66.69 136.80 119.70 128.25 3069063 270 SPLINT POST TIB&FIB ADUL 1 201.00 68.34 78.39 160.80 120.60 103.01 145.93 140.70 156.78 150.75 78.39 160.80 140.70 150.75 3069065 270 SPLINT POST KNEE MED 1 136.00 46.24 53.04 108.80 81.60 69.70 98.74 95.20 106.08 102.00 53.04 108.80 95.20 102.00 3069077 272 TRAY BONE W/ASPNDL 1 386.00 131.24 150.54 308.80 231.60 197.83 280.24 270.20 301.08 289.50 150.54 308.80 270.20 289.50 3069099 270 SHOE POST-OP FEMALE LRG 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 3069101 270 SHOE POST-OP FEMALE SM 1 14.00 4.76 5.46 11.20 8.40 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 3069102 270 SHOE POST-OP MALE LRG 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 3069103 270 SHOE POST-OP MALE MED 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 3069108 270 BANDAGE NASO SELF ADH 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 3069125 270 SET DRN WOUND 3 1 103.45 35.17 40.35 82.76 62.07 53.02 75.10 72.42 80.69 77.59 40.35 82.76 72.42 77.59 3069345 272 NEEDLE GUIDE STERILE 21GA. 1 38.25 13.01 14.92 30.60 22.95 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 3069346 272 NEEDLE GUIDE STERILE 22GA. 1 48.00 16.32 18.72 38.40 28.80 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 3069347 272 NEEDLE GUIDE STERILE 18GA. 1 38.25 13.01 14.92 30.60 22.95 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 3069348 272 STATLOCK PICC PLUS 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 3069369 270 RING INVAL VINYL BLUE 1 36.00 12.24 14.04 28.80 21.60 18.45 26.14 25.20 28.08 27.00 14.04 28.80 25.20 27.00 3069377 270 DIAPER BABY MEDIUM 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3069450 270 DIAPER BABY NEWBORN 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3069495 272 DEVICE PURSTRNG*65 AUTOS 1 375.00 127.50 146.25 300.00 225.00 192.19 272.25 262.50 292.50 281.25 146.25 300.00 262.50 281.25 3069829 272 KIT PICC MICROINTRODUCER 5FR 1 112.50 38.25 43.88 90.00 67.50 57.66 81.68 78.75 87.75 84.38 43.88 90.00 78.75 84.38 3070130 272 CUFF TOURNIQUET 8 SINGLE 1 38.00 12.92 14.82 30.40 22.80 19.48 27.59 26.60 29.64 28.50 14.82 30.40 26.60 28.50 3070144 272 GAUZE 4.5 KERLIX 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3070191 270 WAFFLE CRADLE FOR HEEL/FOOT 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3070872 272 TROCAR 10/11 MM 1 140.00 47.60 54.60 112.00 84.00 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 3070906 272 ENDO STITCH W/POLYSORB 0 VILOET 48 ES-9 1 150.00 51.00 58.50 120.00 90.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 3070920 272 ENDO STITCH W/SURGIDAC 0 GREEN 48 ES-9 1 150.00 51.00 58.50 120.00 90.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 3070950 270 PROTECTOR HEEL/ELBOW MED 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 3070967 270 RESTRAINT MITT HAND 1 37.00 12.58 14.43 29.60 22.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 3071326 270 TUBE CORRA-TUBE 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 3071651 278 CEMENT SIMPLEX 61910 1 213.00 72.42 83.07 170.40 127.80 109.16 154.64 149.10 166.14 159.75 83.07 170.40 149.10 159.75 3071684 270 TUBE TRACHEOSTOMY #6 1 169.00 57.46 65.91 135.20 101.40 86.61 122.69 118.30 131.82 126.75 65.91 135.20 118.30 126.75 3072054 272 CUFF TOURNIQUET 42 SINGLE 1 57.00 19.38 22.23 45.60 34.20 29.21 41.38 39.90 44.46 42.75 22.23 45.60 39.90 42.75 3072112 272 REDUCER UNIVERSAL SEAL 1 27.00 9.18 10.53 21.60 16.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 3072133 270 TUBE CELESTINE (SZ) RUS 1 675.00 229.50 263.25 540.00 405.00 345.94 490.05 472.50 526.50 506.25 263.25 540.00 472.50 506.25 3072609 270 HOSE THIGH MEDIUM SCD 1 133.00 45.22 51.87 106.40 79.80 68.16 96.56 93.10 103.74 99.75 51.87 106.40 93.10 99.75 3072613 270 HOSE THIGH LARGE SCD 1 158.00 53.72 61.62 126.40 94.80 80.98 114.71 110.60 123.24 118.50 61.62 126.40 110.60 118.50 3073212 270 OINTMENT ANTIFUNGAL 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 3073875 272 DRAIN CHEST DUAL COL 1 189.00 64.26 73.71 151.20 113.40 96.86 137.21 132.30 147.42 141.75 73.71 151.20 132.30 141.75 3073880 272 CHEST SEAL ASHERMAN 1 33.00 11.22 12.87 26.40 19.80 16.91 23.96 23.10 25.74 24.75 12.87 26.40 23.10 24.75 3074058 270 CUSHION WAFFLE ADULT PRE-INFLATED 1 45.00 15.30 17.55 36.00 27.00 23.06 32.67 31.50 35.10 33.75 17.55 36.00 31.50 33.75 3074160 272 ENDOSCOPIC BLUNT TIP DISSECTORS 1 46.00 15.64 17.94 36.80 27.60 23.58 33.40 32.20 35.88 34.50 17.94 36.80 32.20 34.50 3074396 270 SPLINT NASAL #3 1 17.00 5.78 6.63 13.60 10.20 8.71 12.34 11.90 13.26 12.75 6.63 13.60 11.90 12.75 3074666 270 SIGMOIDOSCOPE DISP 1 49.00 16.66 19.11 39.20 29.40 25.11 35.57 34.30 38.22 36.75 19.11 39.20 34.30 36.75 3074742 272 RT ANGLE 28FR CHEST TUBE 1 33.00 11.22 12.87 26.40 19.80 16.91 23.96 23.10 25.74 24.75 12.87 26.40 23.10 24.75 3074743 272 RT ANGLE 30FR CHEST TUBE 1 33.00 11.22 12.87 26.40 19.80 16.91 23.96 23.10 25.74 24.75 12.87 26.40 23.10 24.75 3074911 270 KITTNER 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3075200 270 STOCKING THIGH SM RG 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3075218 270 STOCKING CALF SMALL -REG 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3075237 272 XEROFORM GAUZE 4 X 4 1 2.96 1.01 1.15 2.37 1.78 1.52 2.15 2.07 2.31 2.22 1.15 2.37 2.07 2.22 3075242 270 STOCKING THIGH MD REG 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3075254 270 IMMOBILIZER KNEE MED 1 188.00 63.92 73.32 150.40 112.80 96.35 136.49 131.60 146.64 141.00 73.32 150.40 131.60 141.00 3075259 270 STOCKING THIGH M D LONG 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3075267 270 SOCKING THIGHT LG REG 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3075283 270 STOCKING CALF LG REG 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3075291 270 STOCKING THIGH LG LNG 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3075366 270 SUPPORT ATHLETIC SMALL 1 44.00 14.96 17.16 35.20 26.40 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 3075390 270 SWAB LEMON-GLYCERIN 1 2.00 0.68 0.78 1.60 1.20 1.03 1.45 1.40 1.56 1.50 0.78 1.60 1.40 1.50 3075408 270 SUPPORT ATHLETIC MEDIUM 1 44.00 14.96 17.16 35.20 26.40 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 3075457 270 SUPPORT ATHLETIC LARGE 1 46.00 15.64 17.94 36.80 27.60 23.58 33.40 32.20 35.88 34.50 17.94 36.80 32.20 34.50 3075778 270 SHOE CAST LARGE 1 22.00 7.48 8.58 17.60 13.20 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 3075810 270 DRAIN CLOSED WND MD 1 204.00 69.36 79.56 163.20 122.40 104.55 148.10 142.80 159.12 153.00 79.56 163.20 142.80 153.00 3076241 272 PACK UNIVERSAL 1 122.00 41.48 47.58 97.60 73.20 62.53 88.57 85.40 95.16 91.50 47.58 97.60 85.40 91.50 3076606 270 ELECTRODE NERVE STIMULAT 1 42.00 14.28 16.38 33.60 25.20 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 3076715 272 CATH TROCAR 10FR 9 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3076779 270 TRAY CENTRAL LINE DRESSING 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 3076920 270 KIT EYE STANDARD 1 121.00 41.14 47.19 96.80 72.60 62.01 87.85 84.70 94.38 90.75 47.19 96.80 84.70 90.75 3076940 272 GUIDE E-Z GLIDER STRAIGHT TIP 35BX 1 62.75 21.34 24.47 50.20 37.65 32.16 45.56 43.93 48.95 47.06 24.47 50.20 43.93 47.06 3076962 272 PACK GYN 1 190.00 64.60 74.10 152.00 114.00 97.38 137.94 133.00 148.20 142.50 74.10 152.00 133.00 142.50 3077034 270 TRAY ANESTH EPIDURAL CON 1 164.00 55.76 63.96 131.20 98.40 84.05 119.06 114.80 127.92 123.00 63.96 131.20 114.80 123.00 3077101 270 CIRCUIT BIPAP VENTILATOR 1 31.05 10.56 12.11 24.84 18.63 15.91 22.54 21.74 24.22 23.29 12.11 24.84 21.74 23.29 3077399 272 KT SINGLE LUMEN CATH 14G 1 58.00 19.72 22.62 46.40 34.80 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 3077529 272 BLADE 5023-238 1 19.18 6.52 7.48 15.34 11.51 9.83 13.92 13.43 14.96 14.39 7.48 15.34 13.43 14.39 3077991 272 ENDOOPATH MULITFEED STAP 1 253.00 86.02 98.67 202.40 151.80 129.66 183.68 177.10 197.34 189.75 98.67 202.40 177.10 189.75 3077992 272 ENDO POUCH 4X4 RETRIEVAL 1 212.50 72.25 82.88 170.00 127.50 108.91 154.28 148.75 165.75 159.38 82.88 170.00 148.75 159.38 3078022 270 TUBE LEVINE PLASTIC DISP 14 FR 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3078067 270 TUBE LEVINE PLASTIC DISP 12FR 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3078148 272 CATHETER CHOLANGIOGRAM REDDICK SCOOP TIP 1 224.50 76.33 87.56 179.60 134.70 115.06 162.99 157.15 175.11 168.38 87.56 179.60 157.15 168.38 3078150 272 CATHETER CHOLANGIOGRAM O 1 76.00 25.84 29.64 60.80 45.60 38.95 55.18 53.20 59.28 57.00 29.64 60.80 53.20 57.00 3078160 272 CATHETER PERITONEAL INTRADUCER 1 58.00 19.72 22.62 46.40 34.80 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 3078165 272 CATHETER URETERAL DILATING ACCESS SHEATH 1 203.00 69.02 79.17 162.40 121.80 104.04 147.38 142.10 158.34 152.25 79.17 162.40 142.10 152.25 3078231 270 PACK BASIC I 1 49.00 16.66 19.11 39.20 29.40 25.11 35.57 34.30 38.22 36.75 19.11 39.20 34.30 36.75 3078295 272 NEEDLE INTRAOSSEOU C-DIN-16-3.0-T45-DKM 1 128.43 43.67 50.09 102.74 77.06 65.82 93.24 89.90 100.18 96.32 50.09 102.74 89.90 96.32 3078310 270 SPONGE DRAIN PRECUT 4X4 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3079218 272 SUTURE 661 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 3079356 272 DRESSING BIO-PATCH 4150 1 21.00 7.14 8.19 16.80 12.60 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3079401 272 AIR CAST RIGHT 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3079405 272 AIR CAST LEFT 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3079549 270 TRAY PUDENTAL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3079581 272 "KIT, NEPHROMAX DILATION KIT 30 FR." 1 617.50 209.95 240.83 494.00 370.50 316.47 448.31 432.25 481.65 463.13 240.83 494.00 432.25 463.13 3079589 272 SUTURE SA-65 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3080025 272 DRESSING AQUACEL 2X45 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 3080131 272 NEEDLE SPINAL 20G X 3 1/ 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3080384 272 CATH TROCAR 16FR 1 99.00 33.66 38.61 79.20 59.40 50.74 71.87 69.30 77.22 74.25 38.61 79.20 69.30 74.25 3080537 270 TUBE TRACH #8 1 169.00 57.46 65.91 135.20 101.40 86.61 122.69 118.30 131.82 126.75 65.91 135.20 118.30 126.75 3080539 270 TUBE TRACH SNGL #10 1 169.00 57.46 65.91 135.20 101.40 86.61 122.69 118.30 131.82 126.75 65.91 135.20 118.30 126.75 3080573 270 SUPPORT LUMBAR SACRAL XX 1 269.00 91.46 104.91 215.20 161.40 137.86 195.29 188.30 209.82 201.75 104.91 215.20 188.30 201.75 3080854 272 DRESSING GUAZE STERILE 2 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3080893 272 CATH THORACIC 40FR 1 42.00 14.28 16.38 33.60 25.20 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 3080985 270 SPLINT ELBOW POSTERIOR C 1 57.00 19.38 22.23 45.60 34.20 29.21 41.38 39.90 44.46 42.75 22.23 45.60 39.90 42.75 3080988 270 SPLINT ELBOW POSTERIOR A 1 70.00 23.80 27.30 56.00 42.00 35.88 50.82 49.00 54.60 52.50 27.30 56.00 49.00 52.50 3081014 270 SET FLUID DELIVERY 24 HR 1 133.00 45.22 51.87 106.40 79.80 68.16 96.56 93.10 103.74 99.75 51.87 106.40 93.10 99.75 3081442 272 7 MM DRAIN KIT 1 48.45 16.47 18.90 38.76 29.07 24.83 35.17 33.92 37.79 36.34 18.90 38.76 33.92 36.34 3081801 270 BELT RIB FEMALE UNIVERSAL 28 -50 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081802 270 BELT RIB FEMALE 27-33 M 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081803 270 BELT RIB FEMALE 33-37 L 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081804 270 BELT RIB FEMALE 37-44 X-L 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081806 270 BELT RIB MALE 32-36 S 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081807 270 BELT RIB MALE 36-40 M 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081808 270 BELT RIB UNIVERSIAL 28'-50 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081809 270 BELT RIB UNIVERSAL 50 -65 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 3081846 270 SPLINT CLAVICLE INFANT 1 71.00 24.14 27.69 56.80 42.60 36.39 51.55 49.70 55.38 53.25 27.69 56.80 49.70 53.25 3081867 270 SPLINT WRIST LEFT XS 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3081868 270 SPLINT WRIST RIGHT XS 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3082107 278 MESH COMPOSIX KUGEL MEDIUM 1 " 1,131.00 " 384.54 441.09 904.80 678.60 579.64 821.11 791.70 882.18 848.25 441.09 904.80 791.70 848.25 3082110 270 TUBE 8.0 LMA-FASTRACH ETT 1 168.00 57.12 65.52 134.40 100.80 86.10 121.97 117.60 131.04 126.00 65.52 134.40 117.60 126.00 3082145 272 NEEDLE SPINAL 22GA X 5 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3082584 272 COMBIDERM DRESSING 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3082585 272 DRESSING COMBIDERM 5 1/4 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 3082586 272 DRESSING AQUACEL 10X10CM 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 3082589 272 DRESSING AQUACEL 5 X 5CM 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3082757 272 CLIP MEDIUM MCM30 1 174.00 59.16 67.86 139.20 104.40 89.18 126.32 121.80 135.72 130.50 67.86 139.20 121.80 130.50 3082812 370 ANESTHESIA SUPPLY GENERA 1 361.00 122.74 140.79 288.80 216.60 185.01 262.09 252.70 281.58 270.75 140.79 288.80 252.70 270.75 3083056 270 TUBE ENDOTRACHEAL 4.5 W/CUFF 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3084531 270 CAST SOFT ARM 1 32.00 10.88 12.48 25.60 19.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 3085320 272 VACUUM OB DELIVERY KIT 1 57.00 19.38 22.23 45.60 34.20 29.21 41.38 39.90 44.46 42.75 22.23 45.60 39.90 42.75 3085709 272 LENS MORGAN CUP 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 3085775 272 CHLORAPREP LARGE 26ML CLEAR 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3086211 272 ENDO ETS CUTTER (CTS45) 1 512.00 174.08 199.68 409.60 307.20 262.40 371.71 358.40 399.36 384.00 199.68 409.60 358.40 384.00 3086225 272 ENDO ETS RELOAD 1 214.00 72.76 83.46 171.20 128.40 109.68 155.36 149.80 166.92 160.50 83.46 171.20 149.80 160.50 3086226 272 DYONICS SHOULDER KITS 1 93.38 31.75 36.42 74.70 56.03 47.86 67.79 65.37 72.84 70.04 36.42 74.70 65.37 70.04 3086311 270 ELECTRODE 3X5 NERVE STIM 1 36.00 12.24 14.04 28.80 21.60 18.45 26.14 25.20 28.08 27.00 14.04 28.80 25.20 27.00 3086370 270 TUBE ENDOTRACHEAL 7.5 W/CUFF 1 9.00 3.06 3.51 7.20 5.40 4.61 6.53 6.30 7.02 6.75 3.51 7.20 6.30 6.75 3086857 270 IMMOBILIZER KNEE 20 1 79.00 26.86 30.81 63.20 47.40 40.49 57.35 55.30 61.62 59.25 30.81 63.20 55.30 59.25 3086858 270 IMMOBILIZER KNEE 24 1 97.00 32.98 37.83 77.60 58.20 49.71 70.42 67.90 75.66 72.75 37.83 77.60 67.90 72.75 3087606 278 TRAY THORACENTESIS DISP 1 103.00 35.02 40.17 82.40 61.80 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 3087703 272 BRUSH INTRAMEDULLARY 1 41.00 13.94 15.99 32.80 24.60 21.01 29.77 28.70 31.98 30.75 15.99 32.80 28.70 30.75 3088345 272 SUTURE 1629 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 3088781 272 DRESSING SCARLET RED 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 3088918 270 BANDAGE ESMARK 4 X 9 FT (LATEX FREE) 1 42.00 14.28 16.38 33.60 25.20 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 3089417 272 SET TUR 2 C 4041 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 3089719 272 KIT CATHER MULTI 12FR 20CM 1 290.00 98.60 113.10 232.00 174.00 148.63 210.54 203.00 226.20 217.50 113.10 232.00 203.00 217.50 3089881 272 KIT PNEUMOTHORAX ARROW 1 139.00 47.26 54.21 111.20 83.40 71.24 100.91 97.30 108.42 104.25 54.21 111.20 97.30 104.25 3090235 272 PACK EXTREMITY 1 123.00 41.82 47.97 98.40 73.80 63.04 89.30 86.10 95.94 92.25 47.97 98.40 86.10 92.25 3090364 270 BINDER ABDOMINAL UNIVERS 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3090365 270 BINDER ABDOMINAL UNIVERS 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 3091140 270 MASK N-95 RESP TB MED/LARGE 1 14.00 4.76 5.46 11.20 8.40 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 3091141 270 MASK N-95 RESP TB SMALL 1 14.00 4.76 5.46 11.20 8.40 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 3091200 270 TUBE SUMP SALEM 18FR 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 3091210 270 TUBE SUMP SALEM 14FR 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 3091215 270 TUBE SUMP SALEM 16FR 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 3091672 272 DRESSING TEGADERM 10CM X 12CM 1 8.00 2.72 3.12 6.40 4.80 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 3091756 270 SET EPUMP TUBE FEEDING 1 121.00 41.14 47.19 96.80 72.60 62.01 87.85 84.70 94.38 90.75 47.19 96.80 84.70 90.75 3091787 272 DRESSING AQUACEL FOAM 4X4 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3091789 272 DRESSING VERSIVA 5.5 X 5.5 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 3091790 272 DRESSING VERSIVA 8.3 X 8.9 1 38.00 12.92 14.82 30.40 22.80 19.48 27.59 26.60 29.64 28.50 14.82 30.40 26.60 28.50 3091795 272 RETAINER VICSERA LARGE 1 68.83 23.40 26.84 55.06 41.30 35.28 49.97 48.18 53.69 51.62 26.84 55.06 48.18 51.62 3091810 270 TAPE CASTING 2 1 19.00 6.46 7.41 15.20 11.40 9.74 13.79 13.30 14.82 14.25 7.41 15.20 13.30 14.25 3091811 270 TAPE CASTING 3 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3091812 270 TAPE CASTING 4 1 26.00 8.84 10.14 20.80 15.60 13.33 18.88 18.20 20.28 19.50 10.14 20.80 18.20 19.50 3092461 270 DRESSING TEGADERM 2.375 X 2.75 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3092462 272 DRESSING VERSIVA 7.25 X 9.4 (DC) 1 31.00 10.54 12.09 24.80 18.60 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 3092496 272 DRESSING VERSIVA 7.5 X 7.5 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 3092520 270 BANDAGE CONFORM STRETCH 2 X 5 YARDS 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3092521 270 BANDAGE CONFORM STRETCH 3 1 21.63 7.35 8.44 17.30 12.98 11.09 15.70 15.14 16.87 16.22 8.44 17.30 15.14 16.22 3092522 270 BANDAGE CONFORM STRETCH 1 23.00 7.82 8.97 18.40 13.80 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 3093010 272 SUTURE 5-0 MONOCRYL PS-2 UND 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3093239 270 TUBE ENDOTRACHEAL 3.0 W/O CUFF 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3093241 270 TUBE ENDOTRACHEAL 4.5 W/O CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3093242 270 TUBE ENDOTRACHEAL 5.0 W/O CUFF 1 63.00 21.42 24.57 50.40 37.80 32.29 45.74 44.10 49.14 47.25 24.57 50.40 44.10 47.25 3093243 270 TUBE ENDOTRACHEAL 6.0 W/CUFF 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3093450 270 WAFER CONVATEC 0256-13 S 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 3094160 272 TROCAR XCEL ENDO 12MM OBTARATOR 1 372.00 126.48 145.08 297.60 223.20 190.65 270.07 260.40 290.16 279.00 145.08 297.60 260.40 279.00 3094161 272 ENDO RETRACTOR 10MM 1 222.00 75.48 86.58 177.60 133.20 113.78 161.17 155.40 173.16 166.50 86.58 177.60 155.40 166.50 3094162 272 TROCAR BLUNT TIP 10MM W/SYRINGE 1 450.00 153.00 175.50 360.00 270.00 230.63 326.70 315.00 351.00 337.50 175.50 360.00 315.00 337.50 3094165 272 TROCAR XCEL ENDO 12MM XT 1 372.00 126.48 145.08 297.60 223.20 190.65 270.07 260.40 290.16 279.00 145.08 297.60 260.40 279.00 3094535 272 DRESSING AIRSTRIP LG 1 16.00 5.44 6.24 12.80 9.60 8.20 11.62 11.20 12.48 12.00 6.24 12.80 11.20 12.00 3094673 272 TROCAR BLUNT 512B 1 161.00 54.74 62.79 128.80 96.60 82.51 116.89 112.70 125.58 120.75 62.79 128.80 112.70 120.75 3095096 272 MONOPTY NEEDLE 18GA 16CM 1 147.00 49.98 57.33 117.60 88.20 75.34 106.72 102.90 114.66 110.25 57.33 117.60 102.90 110.25 3095850 272 KIT CATHETERIZATN TRIPLE LUMEN 1 227.00 77.18 88.53 181.60 136.20 116.34 164.80 158.90 177.06 170.25 88.53 181.60 158.90 170.25 3096154 272 CUFF TOURNIQUET 12 SINGLE 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3096268 272 INTRO LEAD PERCUTONEOUS 1 80.00 27.20 31.20 64.00 48.00 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 60.00 3096500 272 TRAY GASTROSTOMY BARD #20 1 348.00 118.32 135.72 278.40 208.80 178.35 252.65 243.60 271.44 261.00 135.72 278.40 243.60 261.00 3096753 272 GUIDE WIRE ARROW #AW-042 1 43.00 14.62 16.77 34.40 25.80 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 3096771 272 ENDO TROCAL 3555 5MM 1 148.00 50.32 57.72 118.40 88.80 75.85 107.45 103.60 115.44 111.00 57.72 118.40 103.60 111.00 3096772 272 LONG TROCAR 5MM 1 148.00 50.32 57.72 118.40 88.80 75.85 107.45 103.60 115.44 111.00 57.72 118.40 103.60 111.00 3097836 272 CATH INTRA PRES (IUP) 1 65.00 22.10 25.35 52.00 39.00 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 3098095 272 PACKING KALTOSTAT 2 GM S 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 3098286 272 DRESSING AQUACEL FOAM 6 X 6 1 37.00 12.58 14.43 29.60 22.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 3098345 278 MESH LARGE OVAL 5.4 X 7.0 1 " 1,879.00 " 638.86 732.81 " 1,503.20 " " 1,127.40 " 962.99 " 1,364.15 " " 1,315.30 " " 1,465.62 " " 1,409.25 " 732.81 " 1,503.20 " " 1,315.30 " " 1,409.25 " 3098346 278 MESH SMALL CIRCLE VENTRIO HERNIA PATCH 1 " 1,097.00 " 372.98 427.83 877.60 658.20 562.21 796.42 767.90 855.66 822.75 427.83 877.60 767.90 822.75 3098347 278 MESH COMPOSIX KUGEL LARGE 1 " 1,447.50 " 492.15 564.53 " 1,158.00 " 868.50 741.84 " 1,050.89 " " 1,013.25 " " 1,129.05 " " 1,085.63 " 564.53 " 1,158.00 " " 1,013.25 " " 1,085.63 " 3098405 272 DRESSING LYOFOAM 4X4 1 18.00 6.12 7.02 14.40 10.80 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 3098431 272 SCISSORS CURVED ENDOPATH 1 410.50 139.57 160.10 328.40 246.30 210.38 298.02 287.35 320.19 307.88 160.10 328.40 287.35 307.88 3099272 272 LOOPS CUTTING 28FR 1 134.00 45.56 52.26 107.20 80.40 68.68 97.28 93.80 104.52 100.50 52.26 107.20 93.80 100.50 3099709 272 CUFF TOURNIQUET 24 DUAL 1 74.00 25.16 28.86 59.20 44.40 37.93 53.72 51.80 57.72 55.50 28.86 59.20 51.80 55.50 3603603 964 ANESTHESIA PROF FEE UNITS 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 6003801 270 O2 PER HOUR 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 6037482 270 O2 ER RM CHARGE 1 48.00 16.32 18.72 38.40 28.80 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 1200331 636 J2060 LORazepam (ATIVAN) 2 MG/ML 1ML SDV 1 15.00 5.10 0.71 12.00 0.71 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1200435 636 J0698 CLAFORAN PREMIX BAG : 1GM 1 121.00 41.14 2.36 96.80 2.36 62.01 87.85 84.70 94.38 90.75 47.19 96.80 84.70 90.75 1200447 250 J3490 CLINDAMYCIN (CLEOCIN) 600MG/4ML VIAL 1 46.00 15.64 17.94 36.80 27.60 23.58 33.40 32.20 35.88 34.50 17.94 36.80 32.20 34.50 1200496 636 J1940 FUROSEMIDE (LASIX) 100MG/10ML INJ 1 100.00 34.00 0.60 80.00 0.60 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 1200514 250 J3490 NITROPRUSSIDE (NIPRIDE) 50MG/2ML SDV 1 94.40 32.10 36.82 75.52 56.64 48.38 68.53 66.08 73.63 70.80 36.82 75.52 66.08 70.80 1200556 250 J3490 DOXYCYCLINE (VIBRAMYCIN) 100MG VIAL 1 194.00 65.96 75.66 155.20 116.40 99.43 140.84 135.80 151.32 145.50 75.66 155.20 135.80 145.50 1200618 636 J3370 VANCOMYCIN (Vancocin) VIAL 500MG 1 44.00 14.96 3.42 35.20 3.42 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1200717 250 J3490 ePHEDrine 50MG/1ML SD AMP 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1200908 637 J3490 SULFACETAMIDE (SULAMYD) 10% OPHT SOLN 1 185.00 62.90 72.15 148.00 111.00 94.81 134.31 129.50 144.30 138.75 72.15 148.00 129.50 138.75 1201650 250 J3490 SODIUM BICARB 8.4 50MEQ/50ML SYRINGE 1 81.00 27.54 31.59 64.80 48.60 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 1201730 636 Q9958 CYSTOGRAFIN 30% 300ML BT 1 75.00 25.50 0.08 60.00 0.08 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1201877 636 J1380 ESTRADIOL VAL (DELESTROGEN) 20MG/1ML 1 120.00 40.80 8.51 96.00 8.51 61.50 87.12 84.00 93.60 90.00 46.80 96.00 84.00 90.00 1201945 636 J0285 AMPHOTERICIN B (FUNGIZONE) 50MG VL 1 145.32 49.41 38.46 116.26 38.46 74.48 105.50 101.72 113.35 108.99 56.67 116.26 101.72 108.99 1201964 636 J2550 PROMETHAZINE (PHENERGAN) 50MG/1ML INJ 1 43.00 14.62 2.08 34.40 2.08 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 1202166 637 J8540 DEXAMETHASONE (DECADRON) 0.5MG/5ML ELIX 1 6.00 2.04 0.02 4.80 0.02 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1202325 637 J7510 PrednisoLONE (PRELONE) 15MG/5ML SYRP 1 4.00 1.36 0.09 3.20 0.09 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1202398 636 J3490 fluPHENAZine HCL (PROLIXIN) 2.5MG/ML INJ 1 54.00 18.36 21.06 43.20 32.40 27.68 39.20 37.80 42.12 40.50 21.06 43.20 37.80 40.50 1202746 636 J0153 ADENOSINE (ADENOSCAN) 90MG/30ML SDV 90 938.55 319.11 56.70 750.84 56.70 481.01 681.39 656.99 732.07 703.91 366.03 750.84 656.99 703.91 1202780 636 J3490 TENSILON AMP : 10MG 1 48.00 16.32 18.72 38.40 28.80 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 1202788 637 J1815 INSULIN LISPRO (HumaLOG) 100UNITS/ML 1 0.30 0.10 0.12 0.91 0.91 0.15 0.22 0.21 0.23 0.23 0.12 0.24 0.21 0.23 1202789 636 J3360 DIAZEPAM (VALIUM) 10MG/2ML INJECTION 1 98.36 33.44 9.52 78.69 9.52 50.41 71.41 68.85 76.72 73.77 38.36 78.69 68.85 73.77 1202929 637 J3490 TOBRAMYCIN (TOBREX) 0.3% O.O. 1 403.28 137.12 157.28 322.62 241.97 206.68 292.78 282.30 314.56 302.46 157.28 322.62 282.30 302.46 1203088 636 J7500 AZATHIOPRINE (IMURAN) 50MG TABLET 1 4.00 1.36 0.66 3.20 0.66 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1203138 636 J1120 acetaZOLAMIDE (DIAMOX) INJ 500MG 1 191.96 65.27 14.28 153.57 14.28 98.38 139.36 134.37 149.73 143.97 74.86 153.57 134.37 143.97 1203167 636 J8610 METHOTREXATE (RHEUMATREX) 2.5MG TABLET 1 8.25 2.81 0.23 6.60 0.23 4.23 5.99 5.78 6.44 6.19 3.22 6.60 5.78 6.19 1203261 636 J0690 ceFAZolin (ANCEF) 1GM VIAL 2 69.00 23.46 1.66 55.20 1.66 35.36 50.09 48.30 53.82 51.75 26.91 55.20 48.30 51.75 1203263 636 J0690 ceFAZolin (ANCEF) 500MG VIAL 1 52.00 17.68 0.83 41.60 0.83 26.65 37.75 36.40 40.56 39.00 20.28 41.60 36.40 39.00 1203438 636 J0610 CALCIUM GLUCONATE 10% INJ 10ML SDV 1 40.00 13.60 3.47 32.00 3.47 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1203461 250 J3490 metroNIDAZOLE (FLAGYL) 500MG PREMIX 1 83.00 28.22 32.37 66.40 49.80 42.54 60.26 58.10 64.74 62.25 32.37 66.40 58.10 62.25 1203691 636 P9047 ALBUMIN (ALBUMINAR-25) 25% 50ML 1 200.00 68.00 52.45 160.00 52.97 102.50 145.20 140.00 156.00 150.00 104.90 160.00 140.00 52.45 150.00 89.17 83.92 1203737 636 90707 MMR II VACCINE SDV 1 211.20 71.81 79.87 168.96 79.87 108.24 153.33 147.84 164.74 158.40 82.37 168.96 147.84 158.40 1203887 636 J3430 PHYTONADIONE 10MG/1ML (AQUAMEPHYTON) AMP 10 133.74 45.47 42.70 106.99 42.70 68.54 97.10 93.62 104.32 100.31 52.16 106.99 93.62 100.31 1203899 636 J3430 PHYTONADIONE (AQUAMEPHYTON) 1MG PED INJ 1 44.00 14.96 4.27 35.20 4.27 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1203913 636 J2001 LIDOCAINE DRIP 4 MG/ML 500ML PREMIX 1 62.00 21.08 0.03 49.60 0.03 31.78 45.01 43.40 48.36 46.50 24.18 49.60 43.40 46.50 1203937 636 J3010 fentaNYL (SUBLIMAZE) 100MCG/2ML AMP 1 25.00 8.50 1.00 20.00 1.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1203939 636 J0780 PROCHLORPERAZ. (COMPAZINE) 10MG/2ML SDV 1 50.00 17.00 8.73 40.00 8.73 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1203964 637 J3490 PROCHLORPERAZINE(COMPAZINE) SUPP 25 MG 1 10.00 3.40 3.90 8.00 6.00 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1203967 636 J7321 HYALURONATE (HYALGAN) 20MG/2ML 1 640.05 217.62 83.67 512.04 83.67 328.03 464.68 448.04 499.24 480.04 249.62 512.04 448.04 480.04 1203973 637 Q0164 COMPAZINE 5 MG TABLET 1 4.30 1.46 0.23 3.44 0.23 2.20 3.12 3.01 3.35 3.23 1.68 3.44 3.01 3.23 1203975 637 J8597 PROCLHLORPERAZ. (COMPAZINE) 10MG TAB 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1204140 637 J3490 TOBRAMYCIN (TOBREX) 0.3% O.S. 5ML BT 1 57.72 19.62 22.51 46.18 34.63 29.58 41.90 40.40 45.02 43.29 22.51 46.18 40.40 43.29 1204168 250 J3490 SMZ/TMP (BACTRIM) 800/160MG 10ML 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 1204289 636 J1980 HYOSCYAMINE (LEVSIN) 0.5MG/1ML INJ 2 112.54 38.26 43.89 90.03 63.82 57.68 81.70 78.78 87.78 84.41 43.89 90.03 78.78 84.41 1204315 636 J0561 BICILLIN L-A (PEN G BENZATH 1.2MU/2ML) 1 303.20 103.09 13.90 242.56 13.90 155.39 220.12 212.24 236.50 227.40 30.20 242.56 212.24 15.10 227.40 25.67 24.16 1204327 636 J0561 PEN G BENZATH (BICILLIN L-A) 600000U/1ML 6 257.22 87.45 83.40 205.78 83.40 131.83 186.74 180.05 200.63 192.92 181.20 205.78 180.05 90.60 192.92 154.02 144.96 1204343 636 J1644 "HEPARIN 10,000 UN/ML VIAL" 1 42.00 14.28 0.24 33.60 0.24 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 1204382 250 J3490 VERAPAMIL (ISOPTIN) 5MG/2ML INJECTION 1 36.89 12.54 14.39 29.51 22.13 18.91 26.78 25.82 28.77 27.67 14.39 29.51 25.82 27.67 1204445 636 J2550 PROMETHAZINE(PHENERGAN) 25MG/1ML IM ONLY 1 43.00 14.62 2.08 34.40 2.08 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 1204596 636 J2270 MORPHINE (Duramorph) 10MG/1ML PFS 1 45.00 15.30 2.05 36.00 2.05 23.06 32.67 31.50 35.10 33.75 17.55 36.00 31.50 33.75 1204612 637 J8498 PROMETHAZINE (PHENERGAN) 25MG SUPP 1 36.80 12.51 14.35 29.44 22.08 18.86 26.72 25.76 28.70 27.60 14.35 29.44 25.76 27.60 1204613 636 J2175 MEPERIDINE (DEMEROL)25MG/1ML 25MG SDV 1 42.05 14.30 4.77 33.64 4.77 21.55 30.53 29.44 32.80 31.54 16.40 33.64 29.44 31.54 1204620 636 J2175 MEPERIDINE (DEMEROL 100MG/1ML) 100MG INJ 1 47.00 15.98 4.77 37.60 4.77 24.09 34.12 32.90 36.66 35.25 18.33 37.60 32.90 35.25 1204622 636 J2175 MEPERIDINE (DEMEROL) 50MG/1ML SDV 1 42.05 14.30 4.77 33.64 4.77 21.55 30.53 29.44 32.80 31.54 16.40 33.64 29.44 31.54 1204627 636 J2175 MEPERIDINE (DEMEROL 75MG/1.5ML) 75MG AMP 1 44.05 14.98 4.77 35.24 4.77 22.58 31.98 30.84 34.36 33.04 17.18 35.24 30.84 33.04 1204653 636 J2930 "Solu-MEDROL (1GM) 1,000 MG VIAL" 8 350.00 119.00 51.04 280.00 51.04 179.38 254.10 245.00 273.00 262.50 136.50 280.00 245.00 262.50 1204760 636 J1170 HYDROmorphone (DILAUDID) 2MG/1ML AMP 1 43.05 14.64 3.13 34.44 3.13 22.06 31.25 30.14 33.58 32.29 16.79 34.44 30.14 32.29 1204798 636 J0290 AMPICILLIN VIAL 250MG 1 14.00 4.76 0.99 11.20 0.99 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 1204800 636 J0290 AMPICILLIN (OMNIPEN-N) 500MG INJ 1 15.00 5.10 0.99 12.00 0.99 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1204802 636 J0290 AMPICILLIN (OMNIPEN-N) 125MG INJ 1 14.00 4.76 0.99 11.20 0.99 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 1204807 636 J0290 AMPICILLIN VIAL 1GM 2 14.00 4.76 1.98 11.20 1.98 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 1204809 636 J0290 AMPICILLIN VIAL 2GM 1 14.00 4.76 0.99 11.20 0.99 7.18 10.16 9.80 10.92 10.50 5.46 11.20 9.80 10.50 1205019 637 J7509 methylPREDNISolone (MEDROL) 4mg 1 4.00 1.36 0.36 3.20 0.36 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1205136 636 J2930 MethylPREDNISolon (Solu-MEDROL)125MG/2ML 1 150.00 51.00 6.38 120.00 6.38 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1205301 636 J1030 METHYLPREDNIS (DEPO-MEDROL) 40MG/1ML 1 125.00 42.50 6.35 100.00 6.35 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1205341 636 J1040 MethylPREDNISolone(DEPO-MEDROL) 80MG/1ML 1 125.00 42.50 12.01 100.00 12.01 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1205397 636 J0153 ADENOSINE (ADENOCARD) 6MG/2ML INJ 6 80.00 27.20 3.78 64.00 3.78 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 60.00 1205805 636 J2720 PROTAMINE 50MG/5ML VIAL 1 48.28 16.42 1.10 38.62 1.10 24.74 35.05 33.80 37.66 36.21 18.83 38.62 33.80 36.21 1205824 636 J1720 HYDROCORTISONE (Solu-CORTEF) 100MG VIAL 1 54.00 18.36 13.18 43.20 13.18 27.68 39.20 37.80 42.12 40.50 21.06 43.20 37.80 40.50 1205887 636 J2930 Solu-MEDROL 500MG VIAL 4 250.00 85.00 25.52 200.00 25.52 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 1205918 636 J1720 HYDROCORTISONE (Solu-CORTEF) 250MG VIAL 3 100.00 34.00 39.00 80.00 39.54 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 1205922 636 J1720 HYDROCORTISONE (Solu-CORTEF) 500MG VIAL 5 250.00 85.00 65.90 200.00 65.90 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 1208049 636 J0461 ATROPINE 0.4MG/ML 20ML VIAL 1 118.40 40.26 0.08 94.72 0.08 60.68 85.96 82.88 92.35 88.80 46.18 94.72 82.88 88.80 1208431 636 J0171 "EPINEPHrine HCL 1:10,000 PFS" 1 75.00 25.50 0.83 60.00 0.83 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1208462 636 J2405 ONDANSETRON (ZOFRAN) 4MG/2ML VIAL 4 40.00 13.60 0.36 32.00 0.36 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1208488 636 J1442 FILGRASTIM (NEUPOGEN) 300MCG/1ML SDV 300 642.68 218.51 282.00 564.00 288.00 329.37 466.59 449.88 501.29 482.01 564.00 514.14 449.88 282.00 482.01 479.40 451.20 1208875 636 J3475 MAGNESIUM SULFATE 1GM/2ML INJ 2 40.00 13.60 1.28 32.00 1.28 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1209014 636 J1265 DOPamine 400MG/250ML PREMIX 10 175.00 59.50 7.30 140.00 7.30 89.69 127.05 122.50 136.50 131.25 68.25 140.00 122.50 131.25 1209424 636 J3490 NITROGLYCERIN INJ 50MG/10ML VIAL 1 125.00 42.50 48.75 100.00 75.00 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1209507 636 J2560 PHENobarbital () 65MG/1ML INJ 1 53.00 18.02 27.16 91.32 42.82 27.16 38.48 37.10 41.34 39.75 91.32 42.40 37.10 45.66 39.75 77.62 73.06 1209705 636 Q9968 METHYLENE BLUE 1% 1 41.00 13.94 6.20 32.80 16.80 21.01 29.77 28.70 31.98 30.75 12.40 32.80 28.70 6.20 30.75 10.54 9.92 1210032 636 J2020 LINEZOLID (ZYVOX) 600MG IVPB 1 117.76 40.04 5.61 94.21 5.61 60.35 85.49 82.43 91.85 88.32 45.93 94.21 82.43 88.32 1210396 636 J0744 CIPROFLOXACIN 400MG/40ML VIAL 2 186.00 63.24 2.34 148.80 2.34 95.33 135.04 130.20 145.08 139.50 72.54 148.80 130.20 139.50 1212099 637 J3490 fentaNYL 25MCG/HR (DURAGESIC) PATCH 1 38.00 12.92 14.82 30.40 22.80 19.48 27.59 26.60 29.64 28.50 14.82 30.40 26.60 28.50 1212107 637 J3490 fentaNYL 50MCG/HR(DURAGESIC)PATCH 1 44.00 14.96 17.16 35.20 26.40 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1212130 637 J3490 fentaNYL 75MCG/HR(DURAGESIC)PATCH 1 58.05 19.74 22.64 46.44 34.83 29.75 42.14 40.64 45.28 43.54 22.64 46.44 40.64 43.54 1212132 637 J3490 fentaNYL 100MCG/HR(DURAGESIC) PATCH 1 73.05 24.84 28.49 58.44 43.83 37.44 53.03 51.14 56.98 54.79 28.49 58.44 51.14 54.79 1212801 637 J3490 PETROLATUM (LACRILUBE) O.O. 3.5GM TUBE 1 27.00 9.18 10.53 21.60 16.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 1213682 636 90732 PNEUMOCOC. VACC. (PNEUMOVAX) 0.5ML 1 134.50 45.73 52.46 114.21 114.21 68.93 97.65 94.15 104.91 100.88 52.46 107.60 94.15 100.88 1214276 250 J3490 NOREPINEPHRINE (LEVOPHED) 4MG/4ML AMP 1 95.05 32.32 37.07 76.04 57.03 48.71 69.01 66.54 74.14 71.29 37.07 76.04 66.54 71.29 1215234 636 J1240 dimenhyDRINATE (DRAMAMINE) 50MG/ML INJ 1 44.00 14.96 7.00 35.20 7.00 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1215682 636 J1165 PHENYTOIN (DILANTIN) 100MG/2ML VIAL 2 75.00 25.50 1.98 60.00 1.98 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1215751 637 J3490 LIDOCAINE OINTMENT 5% 1 213.00 72.42 83.07 170.40 127.80 109.16 154.64 149.10 166.14 159.75 83.07 170.40 149.10 159.75 1216184 636 J3490 LIPOSYN 20% 500ML 1 175.00 59.50 68.25 140.00 105.00 89.69 127.05 122.50 136.50 131.25 68.25 140.00 122.50 131.25 1217376 636 J0558 BICILLIN C-R (PEN G BENZ/PROC C-R 1.2MU) 12 242.00 82.28 124.03 288.24 131.64 124.03 175.69 169.40 188.76 181.50 288.24 193.60 169.40 144.12 181.50 245.00 230.59 1218247 636 J2710 NEOSTIGMINE 10MG/10ML MDV ( 20 160.00 54.40 41.60 128.00 41.60 82.00 116.16 112.00 124.80 120.00 62.40 128.00 112.00 120.00 1218699 636 90714 TD VACCINE ADULT (TENIVAC) 0.5ML 1 75.60 25.70 25.11 60.48 25.11 38.75 54.89 52.92 58.97 56.70 29.48 60.48 52.92 56.70 1218701 636 J3411 THIAMINE (VIT-B1) 200MG/2ML SDV 2 40.00 13.60 3.34 32.00 3.34 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1219504 637 J8498 PROMETHAZINE (PHENERGAN) SUPP 12.5MG 1 28.40 9.66 11.08 22.72 17.04 14.56 20.62 19.88 22.15 21.30 11.08 22.72 19.88 21.30 1220517 637 J1815 INSULIN HUMAN REGULR(novoLIN R)100UNIT/M 1 0.25 0.09 0.10 0.91 0.91 0.13 0.18 0.18 0.20 0.19 0.10 0.20 0.18 0.19 1220519 637 J1815 INSULIN HUMAN NPH (HumULIN-N)100UNITS/ML 1 0.25 0.09 0.10 0.91 0.91 0.13 0.18 0.18 0.20 0.19 0.10 0.20 0.18 0.19 1221099 250 J7614 LEVALBUTEROL 0.63MG/3ML NEB (XOPENEX) 1 14.05 4.78 0.06 11.24 0.06 7.20 10.20 9.84 10.96 10.54 5.48 11.24 9.84 10.54 1221168 636 J2800 METHOCARBAMOL (ROBAXIN) 1GM/10ML INJ 1 170.00 57.80 8.35 136.00 8.35 87.13 123.42 119.00 132.60 127.50 66.30 136.00 119.00 127.50 1221266 637 J3490 LATANOPROST (XALATAN) O.S. 2.5ML BTL 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1221283 636 J3486 ZIPRASIDONE (GEODON) 20MG SDV (IM-ONLY) 2 125.00 42.50 36.28 100.00 36.28 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1222429 637 J3490 LIDOCAINE VISCOUS 2% 100ML BTL 1 1.00 0.34 0.39 0.80 0.60 0.51 0.73 0.70 0.78 0.75 0.39 0.80 0.70 0.75 1222582 636 J1265 DOPAMINE 200MG/5ML 5ML S 1 79.00 26.86 0.73 63.20 0.73 40.49 57.35 55.30 61.62 59.25 30.81 63.20 55.30 59.25 1222643 636 J1650 ENOXAPARIN (LOVENOX) 100MG SYRINGE 10 162.55 55.27 6.80 130.04 6.80 83.31 118.01 113.79 126.79 121.91 63.39 130.04 113.79 121.91 1225234 636 J1940 FUROSEMIDE (LASIX) 20MG/2ML INJECTION 1 20.00 6.80 0.60 16.00 0.60 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 1225395 636 J1050 medroxyPROGESTERone (DEPO-PROVERA) 150MG 150 385.00 130.90 85.50 308.00 85.50 197.31 279.51 269.50 300.30 288.75 150.15 308.00 269.50 288.75 1225547 637 J2370 PHENYLEPHRINE INJ 10MG/1ML 1 25.00 8.50 4.40 20.00 4.40 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1225712 636 J3105 TERBUTALINE (BRETHINE) INJ 1MG/1ML SDV 1 40.00 13.60 2.14 32.00 2.14 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1226481 250 J3490 VECURONIUM (NORCURON) 10MG VIAL 1 153.00 52.02 59.67 122.40 91.80 78.41 111.08 107.10 119.34 114.75 59.67 122.40 107.10 114.75 1226771 636 J3490 SUFentanil (SUFENTA) 50MCG/1ML AMP 1 70.00 23.80 27.30 56.00 42.00 35.88 50.82 49.00 54.60 52.50 27.30 56.00 49.00 52.50 1227396 250 J3490 METOPROLOL (LOPRESSOR) 5MG/5ML INJ 1 40.05 13.62 15.62 32.04 24.03 20.53 29.08 28.04 31.24 30.04 15.62 32.04 28.04 30.04 1227695 636 J1630 HALOPERIDOL (HALDOL) 5MG/1ML SDV (IM) 1 75.00 25.50 1.22 60.00 1.22 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1227954 636 J1410 ESTROGEN CONJ 25MG/PWVIAL 1 678.00 230.52 311.79 651.02 311.79 347.48 492.23 474.60 528.84 508.50 651.02 542.40 474.60 325.51 508.50 553.37 520.82 1228193 636 J3490 FLUORESCEIN (FLUOR-I-STRIP) EACH 1 4.05 1.38 1.58 3.24 2.43 2.08 2.94 2.84 3.16 3.04 1.58 3.24 2.84 3.04 1228302 636 J1800 PROPRANOLOL (INDERAL) 1MG/1ML SDV 1 50.00 17.00 1.90 40.00 1.90 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1228316 636 J0282 AMIODARONE (CORDARONE) 150MG/3ML SDV 5 120.00 40.80 2.55 96.00 2.55 61.50 87.12 84.00 93.60 90.00 46.80 96.00 84.00 90.00 1228673 636 J0171 EPINEPHrine 1MG/10ML SYRINGE 1 58.00 19.72 0.83 46.40 0.83 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 1228883 250 J3490 LABETALOL (NORMODYNE) 100MG/20ML INJ 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1230807 636 J3490 PANCURONIUM (PAVULON) 10MG/5ML INJ 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1230809 636 J2175 MEPERIDINE (DEMEROL) PCA 10MG/ML 1 180.00 61.20 4.77 144.00 4.77 92.25 130.68 126.00 140.40 135.00 70.20 144.00 126.00 135.00 1230818 636 J0696 cefTRIAXone (ROCEPHIN) 1GM VIAL 4 140.00 47.60 2.40 112.00 2.40 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 1230943 636 J1100 DEXAMETHASONE (DECADRON) 4MG/1ML VIAl 4 25.00 8.50 0.48 20.00 0.48 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1231062 272 B4154 PULMOCARE NUTR. LIQ 240ML 1 4.15 1.41 0.69 3.32 0.69 2.13 3.01 2.91 3.24 3.11 1.62 3.32 2.91 3.11 1231228 636 J0696 cefTRIAXone (ROCEPHIN) 500MG VIAL 2 84.00 28.56 1.20 67.20 1.20 43.05 60.98 58.80 65.52 63.00 32.76 67.20 58.80 63.00 1231277 636 J0696 cefTRIAXone (ROCEPHIN) 250MG VIAL 1 51.00 17.34 0.60 40.80 0.60 26.14 37.03 35.70 39.78 38.25 19.89 40.80 35.70 38.25 1231624 636 J3010 FENTANYL (SUBLIMAZE) 100MCG/2ML AMP 1 22.00 7.48 1.00 17.60 1.00 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 1232768 636 J2310 NALOXONE (NARCAN) 0.4MG/1ML INJ 1 57.80 19.65 13.41 46.24 13.41 29.62 41.96 40.46 45.08 43.35 22.54 46.24 40.46 43.35 1232839 636 J0133 ACYCLOVIR (ZOVIRAX) 500MG VIAL 100 89.00 30.26 5.00 71.20 5.00 45.61 64.61 62.30 69.42 66.75 34.71 71.20 62.30 66.75 1233964 636 J0592 BUPRENORPHINE (BUPRENEX) 0.3MG/1ML INJ 3 48.00 16.32 14.40 38.40 14.40 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 1234334 637 J3490 PHENYLEPHRINE (MYDFRIN) 2.5% O.S.15ML BT 1 90.00 30.60 35.10 72.00 54.00 46.13 65.34 63.00 70.20 67.50 35.10 72.00 63.00 67.50 1234381 636 J0713 cefTAZidime (FORTAZ) 1GM VIAL 2 150.00 51.00 4.10 120.00 4.10 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1237704 636 J0743 IMIPENEM/CILAST (PRIMAXIN) 500MG VIAL 2 250.00 85.00 11.48 200.00 11.48 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 1238075 637 J3490 ATROPINE O.S.(ISOPTO ATROPINE) 1% 1 160.05 54.42 62.42 128.04 96.03 82.03 116.20 112.04 124.84 120.04 62.42 128.04 112.04 120.04 1238124 637 J3490 EYEWASH SOLN (EYE STREAM) 118ML 1 12.00 4.08 4.68 9.60 7.20 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 1240201 250 J3490 ETOMIDATE (AMIDATE) 20MG/10ML INJECTION 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1240330 636 J0280 AMINOPHYLLINE 250MG/10ML UNIT 1 44.00 14.96 10.64 35.20 10.64 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1240336 636 J0280 AMINOPHYLLINE 500MG/20ML VIAL 2 44.40 15.10 17.32 35.52 21.28 22.76 32.23 31.08 34.63 33.30 17.32 35.52 31.08 33.30 1241333 636 Q9963 GASTROGRAFIN 120ML (O.B.I.=37%) 1 55.00 18.70 0.20 44.00 0.20 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 1241737 636 J2250 MIDAZOLAM (VERSED) 2MG/2ML SDV 1 45.05 15.32 0.12 36.04 0.12 23.09 32.71 31.54 35.14 33.79 17.57 36.04 31.54 33.79 1242320 637 J3490 NEO/POLY/DEX (NEO-DECADRON) OPHTH SUSP 1 61.00 20.74 23.79 48.80 36.60 31.26 44.29 42.70 47.58 45.75 23.79 48.80 42.70 45.75 1244095 636 J1162 DIGOXIN IMMUNE FAB 40MG/VL 1 " 7,171.26 " " 2,438.23 " " 3,675.27 " " 7,938.54 " " 3,817.99 " " 3,675.27 " " 5,206.33 " " 5,019.88 " " 5,593.58 " " 5,378.45 " " 7,938.54 " " 5,737.01 " " 5,019.88 " " 3,969.27 " " 5,378.45 " " 6,747.76 " " 6,350.83 " 1244269 636 J2540 PENICILLIN G POT 5MU VIAL 1 62.00 21.08 1.06 49.60 1.06 31.78 45.01 43.40 48.36 46.50 24.18 49.60 43.40 46.50 1244299 636 J0171 EPINEPHrine 1 MG/1ML AMP 1 50.00 17.00 0.83 40.00 0.83 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1244425 636 J2590 OXYTOCIN (PITOCIN) 10UN/1ML INJ 1 43.00 14.62 0.97 34.40 0.97 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 1244601 636 J1200 diphenhydrAMINE (BENADRYL) 50MG/1ML SDV 1 40.00 13.60 0.91 32.00 0.91 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1244622 636 J3490 VASOPRESSIN (PITRESSIN) 20 UNITS/1ML 1 540.66 183.82 210.86 432.53 324.40 277.09 392.52 378.46 421.71 405.50 210.86 432.53 378.46 405.50 1245812 250 J3490 DILTIAZEM (CARDIZEM) 25MG/5ML INJ 1 53.00 18.02 20.67 42.40 31.80 27.16 38.48 37.10 41.34 39.75 20.67 42.40 37.10 39.75 1247164 637 J1815 INSULIN HumuLIN(novoLIN 70/30)100UNIT/ML 1 0.25 0.09 0.10 0.91 0.91 0.13 0.18 0.18 0.20 0.19 0.10 0.20 0.18 0.19 1247992 250 J3490 FAMOTIDINE 20MG/2ML (PEPCID) SDV 1 35.00 11.90 13.65 28.00 21.00 17.94 25.41 24.50 27.30 26.25 13.65 28.00 24.50 26.25 1248328 636 J1364 ERYTHROMYCIN VIAL 500MG 1 183.00 62.22 71.37 146.40 75.98 93.79 132.86 128.10 142.74 137.25 71.37 146.40 128.10 137.25 1248813 250 J3490 AZTREONAM (AZACTAM) 1GM VIAL 1 120.00 40.80 46.80 96.00 72.00 61.50 87.12 84.00 93.60 90.00 46.80 96.00 84.00 90.00 1250438 636 J2680 fluPHENAZine DEC. (PROLIXIN) 25MG/ML INJ 1 64.05 21.78 10.08 51.24 10.08 32.83 46.50 44.84 49.96 48.04 24.98 51.24 44.84 48.04 1250933 636 J1110 DIHYDROERGOT (DHE-45) 1MG/1ML 1 410.00 139.40 54.99 328.00 54.99 210.13 297.66 287.00 319.80 307.50 159.90 328.00 287.00 307.50 1250974 636 J2210 METHYLERGON. (METHERGINE) 0.2MG/1ML AMP 1 25.00 8.50 9.75 20.00 18.22 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1251890 636 J0330 SUCCINYLCHOLINE (ANECTINE) 200MG/10ML VL 1 70.00 23.80 2.30 56.00 2.30 35.88 50.82 49.00 54.60 52.50 27.30 56.00 49.00 52.50 1251953 636 J1160 DIGOXIN (LANOXIN) 0.5MG/2ML SDAMP 1 50.00 17.00 5.64 40.00 5.64 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1252072 250 J3490 NEO/POLY/BAC GU IRRIG 1ML (NEOSPORIN GU) 1 25.50 8.67 9.95 20.40 15.30 13.07 18.51 17.85 19.89 19.13 9.95 20.40 17.85 19.13 1252102 636 J0295 UNASYN VIAL : 1.5GM 1 39.00 13.26 2.60 31.20 2.60 19.99 28.31 27.30 30.42 29.25 15.21 31.20 27.30 29.25 1252105 636 J0295 UNASYN VIAL : 3.0 GM 2 70.00 23.80 5.20 56.00 5.20 35.88 50.82 49.00 54.60 52.50 27.30 56.00 49.00 52.50 1252702 636 J1631 HALOPERIDOL (HALDOL) DEC 50MG/ML (IM) 1 75.05 25.52 16.44 60.04 16.44 38.46 54.49 52.54 58.54 56.29 29.27 60.04 52.54 56.29 1252785 636 J0360 hydrALAZINE (APRESOLINE) 20MG/1ML INJ 1 32.05 10.90 3.79 25.64 3.79 16.43 23.27 22.44 25.00 24.04 12.50 25.64 22.44 24.04 1254004 250 J3490 BUMETANIDE (BUMEX) 1MG/4ML VIAL 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1255435 636 J0558 BICILLIN C-R (PEN G BENZ/PROC 900/300) 12 251.60 85.54 128.95 288.24 131.64 128.95 182.66 176.12 196.25 188.70 288.24 201.28 176.12 144.12 188.70 245.00 230.59 1255493 250 J3490 ENALAPRILAT (VASOTEC) 2.5MG/2ML INJ 1 41.00 13.94 15.99 32.80 24.60 21.01 29.77 28.70 31.98 30.75 15.99 32.80 28.70 30.75 1256272 636 J2360 ORPHENADRINE (NORFLEX) 60MG/2ML AMP 1 52.50 17.85 7.42 42.00 7.42 26.91 38.12 36.75 40.95 39.38 20.48 42.00 36.75 39.38 1256472 636 J2310 NALOXONE (NARCAN) 2MG/2ML PFS 1 53.00 18.02 13.41 42.40 13.41 27.16 38.48 37.10 41.34 39.75 20.67 42.40 37.10 39.75 1258599 636 Q9967 ISOVUE-300 1 55.00 18.70 0.12 44.00 0.12 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 1262961 637 J2354 OCTREOTIDE (sandoSTATIN) 200MCG/1ML MDV 1 30.00 10.20 0.95 24.00 0.95 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 1263526 637 J3490 BENZOC/TETRAC SPRAY (CETACAINE) TOPICAL 1 107.00 36.38 41.73 85.60 64.20 54.84 77.68 74.90 83.46 80.25 41.73 85.60 74.90 80.25 1263691 636 J0702 BETAMETH SUSP (CELESTONE) 6MG/1ML MDV 1 44.00 14.96 7.14 35.20 7.14 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1263750 250 J3490 FOLIC ACID (FOLVITE) 5MG/ML 1ML 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 1263771 636 J2790 RHO-D IG (RHOGAM) 300MCG PFS 1 475.00 161.50 75.39 380.00 75.39 243.44 344.85 332.50 370.50 356.25 185.25 380.00 332.50 356.25 1263789 636 J3490 LIDOCAINE 2% (XYLOCIANE)100MG/5ML PFS 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1263795 636 J1650 ENOXAPARIN (LOVENOX) 60MG SYRINGE 6 97.50 33.15 4.08 78.00 4.08 49.97 70.79 68.25 76.05 73.13 38.03 78.00 68.25 73.13 1263882 636 J0461 ATROPINE 1MG/10ML PFS 100 60.00 20.40 8.00 48.00 8.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1263883 250 J3490 CALCIUM CHLORIDE INJ 1GM/10ML PFS 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1263887 636 J3490 SODIUM BICARB 8.4% 10ML PEDIATRIC 1 88.00 29.92 34.32 70.40 52.80 45.10 63.89 61.60 68.64 66.00 34.32 70.40 61.60 66.00 1265452 636 J2543 PIPERACIL/TAZO (ZOSYN) 3.375GM VIAL 3 196.00 66.64 5.61 156.80 5.61 100.45 142.30 137.20 152.88 147.00 76.44 156.80 137.20 147.00 1265666 250 J3490 KETAMINE(KETALAR) 50MG/ML 10ML MDV 1 24.04 8.17 9.38 19.23 14.42 12.32 17.45 16.83 18.75 18.03 9.38 19.23 16.83 18.03 1268113 637 J3490 TETRACAINE (PONTOCAINE) 0.5% 2ML BTL 1 22.00 7.48 8.58 17.60 13.20 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 1268154 250 J3490 CLINDAMYCIN (CLEOCIN) 900MG/6ML VIAL 1 64.00 21.76 24.96 51.20 38.40 32.80 46.46 44.80 49.92 48.00 24.96 51.20 44.80 48.00 1268160 636 J3420 CYANOCOBALAMIN (VIT B12) 1000MCG 1ML VIA 1 44.00 14.96 2.23 35.20 2.23 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1268379 636 J3480 KCL INJ 2 MEQ/ML 10ML VIAL 10 18.00 6.12 1.50 14.40 1.50 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 1268381 636 J3480 KCL INJ 2 MEQ/ML 20ML VIAL 20 18.00 6.12 3.00 14.40 3.00 9.23 13.07 12.60 14.04 13.50 7.02 14.40 12.60 13.50 1269906 250 J3490 HETASTARCH (HESPAN) 6% 500 ML 1 115.05 39.12 44.87 92.04 69.03 58.96 83.53 80.54 89.74 86.29 44.87 92.04 80.54 86.29 1270220 636 J3490 SODIUM PHOSPHATES 3 MMOL/ML INJ 1 48.00 16.32 18.72 38.40 28.80 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 1271536 637 J3490 METRONIDAZOLE (METROGEL) VAG 0.75% GEL 1 83.75 28.48 32.66 67.00 50.25 42.92 60.80 58.63 65.33 62.81 32.66 67.00 58.63 62.81 1272676 636 J0834 COSYNTROPIN (CORTROSYN) 0.25MG SDV 1 180.00 61.20 38.30 144.00 38.30 92.25 130.68 126.00 140.40 135.00 70.20 144.00 126.00 135.00 1273451 636 90744 HEPATITIS-B VACC (ENGERIX-B) 10MCG 1 75.00 25.50 26.90 60.00 26.90 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1273452 636 90746 HEPATITIS-B VACC (ENGERIX-B) 20MCG/1ML 1 209.92 71.37 67.06 167.94 67.06 107.58 152.40 146.94 163.74 157.44 81.87 167.94 146.94 157.44 1273633 636 J2704 PROPOFOL (DIPRIVAN) 200MG/20ML VIAL 20 50.05 17.02 2.20 40.04 2.20 25.65 36.34 35.04 39.04 37.54 19.52 40.04 35.04 37.54 1275118 250 J3490 DEXTROSE 50% 50ML SYRINGE 1 207.00 70.38 80.73 165.60 124.20 106.09 150.28 144.90 161.46 155.25 80.73 165.60 144.90 155.25 1275547 636 J3030 SUMAtriptan (IMITREX) 6MG/0.5ML INJ 1 87.32 29.69 34.05 69.86 66.19 44.75 63.39 61.12 68.11 65.49 34.05 69.86 61.12 65.49 1275609 636 J3490 NAFCILLIN VIAL 2GM 1 115.00 39.10 44.85 92.00 69.00 58.94 83.49 80.50 89.70 86.25 44.85 92.00 80.50 86.25 1276663 302 86580 PPD (APLISOL) 0.1ML 1 40.00 13.60 8.52 44.22 8.52 20.50 29.04 28.00 31.20 30.00 44.22 32.00 28.00 22.11 30.00 37.59 35.38 1278050 636 J1650 ENOXAPARIN (LOVENOX) 30MG SYRINGE 3 48.70 16.56 2.04 38.96 2.04 24.96 35.36 34.09 37.99 36.53 18.99 38.96 34.09 36.53 1278989 637 J7512 PredniSONE 1MG TABLET 1 4.00 1.36 0.01 3.20 0.01 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1279407 636 J0500 DICYCLOMINE (BENTYL) INJ 20MG/2ML 1 226.00 76.84 53.86 180.80 53.86 115.83 164.08 158.20 176.28 169.50 88.14 180.80 158.20 169.50 1279617 636 J0456 AZITHROMYCIN (ZITHROMAX) 500MG VIAL 1 94.00 31.96 2.62 75.20 2.62 48.18 68.24 65.80 73.32 70.50 36.66 75.20 65.80 70.50 1279784 636 J7131 SODIUM CHLOR CONC 23.4% 4 MEQ/ML 1 48.00 16.32 0.04 38.40 0.04 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 1280590 250 J3490 POTASSIUM PHOSPHATES 3 MMOL/ML INJ 1 70.00 23.80 27.30 56.00 42.00 35.88 50.82 49.00 54.60 52.50 27.30 56.00 49.00 52.50 1282020 272 A4216 STERILE WATER INJ (STERILE WATER) 10ML 1 6.00 2.04 0.37 4.80 0.37 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 1283945 636 J3490 LIDOCAINE (XYLOCAINE) 2% 20MG/ML MIN CHG 1 40.00 13.60 15.60 32.00 24.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1284379 636 J1940 FUROSEMIDE (LASIX) 40MG/4ML INJECTION 1 40.00 13.60 0.60 32.00 0.60 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1284642 636 J0595 BUTORPHANOL (STADOL) 2MG/1ML INJ 2 45.05 15.32 5.00 36.04 5.00 23.09 32.71 31.54 35.14 33.79 17.57 36.04 31.54 33.79 1284802 636 J1250 DOBUTamine (DOBUTREX) 250MG/20ML SDV 1 75.00 25.50 6.14 60.00 6.14 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1285417 636 J0694 cefOXitin (MEFOXIN) 1GM VIAL 1 80.00 27.20 5.34 64.00 5.34 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 60.00 1285419 636 J0694 cefOXitin (MEFOXIN) 2GM VIAL 1 188.00 63.92 5.34 150.40 5.34 96.35 136.49 131.60 146.64 141.00 73.32 150.40 131.60 141.00 1287217 636 J1642 HEPARIN FLUSH 100UNITS/ML 5ML PFS 1 21.05 7.16 0.33 16.84 0.33 10.79 15.28 14.74 16.42 15.79 8.21 16.84 14.74 15.79 1287989 636 Q9967 ISOVUE-370 1 75.00 25.50 0.12 60.00 0.12 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1288037 250 J3490 ROCURONIUM (ZEMURON) 50MG/5ML MDV 1 51.00 17.34 19.89 40.80 30.60 26.14 37.03 35.70 39.78 38.25 19.89 40.80 35.70 38.25 1288247 250 J7644 IPRATROPIUM (ATROVENT) 0.5MG/2.5ML NEB 1 15.05 5.12 0.21 12.04 0.21 7.71 10.93 10.54 11.74 11.29 5.87 12.04 10.54 11.29 1288850 636 J1450 FLUCONAZOLE 200MG/100ML PREMIX 1 150.00 51.00 4.73 120.00 4.73 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1289408 636 J2300 NALBUPHINE (NUBAIN) 20MG/1ML INJ 2 27.40 9.32 6.36 21.92 6.36 14.04 19.89 19.18 21.37 20.55 10.69 21.92 19.18 20.55 1289958 636 J2765 METOCLOPRAMIDE (REGLAN) 10MG/2ML VIAL 1 42.00 14.28 1.21 33.60 1.21 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 1291730 636 J3490 SODIUM BICARB 4.2% SYRINGE INFANT 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1292559 636 90716 VARICELLA VACC (VARIVAX) INJ 1 362.50 123.25 138.31 290.00 138.31 185.78 263.18 253.75 282.75 271.88 141.38 290.00 253.75 271.88 1294471 250 J3490 MULTIVITAMIN (MVI-12) INJ 10ML 1 47.10 16.01 18.37 37.68 28.26 24.14 34.19 32.97 36.74 35.33 18.37 37.68 32.97 35.33 1295431 636 J1885 KETOROLAC(TORADOL) 15MG/ML SDV 1 50.00 17.00 0.52 40.00 0.52 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1295432 636 J1885 KETOROLAC (TORADOL) 30MG/1ML INJ 2 38.00 12.92 1.04 30.40 1.04 19.48 27.59 26.60 29.64 28.50 14.82 30.40 26.60 28.50 1295433 636 J1885 KETOROLAC (TORADOL) 60MG 2ML INJ 4 43.00 14.62 2.08 34.40 2.08 22.04 31.22 30.10 33.54 32.25 16.77 34.40 30.10 32.25 1298192 250 C9399 HALFLYTE BOWEL KIT 1 55.00 18.70 21.45 44.00 33.00 28.19 39.93 38.50 42.90 41.25 21.45 44.00 38.50 41.25 1298212 636 J1956 levoFLOXacin(LEVAQUIN) 250MG/50ML PREMIX 1 150.05 51.02 0.67 120.04 0.67 76.90 108.94 105.04 117.04 112.54 58.52 120.04 105.04 112.54 1298213 636 J1956 levoFLOXacin(LEVAQUIN) 500MG/100ML PREMX 2 275.05 93.52 1.34 220.04 1.34 140.96 199.69 192.54 214.54 206.29 107.27 220.04 192.54 206.29 1298236 636 J3489 RECLAST 5MG/100ML INFUSION SOLN 5 " 2,618.00 " 890.12 626.35 " 2,094.40 " 626.35 " 1,341.73 " " 1,900.67 " " 1,832.60 " " 2,042.04 " " 1,963.50 " " 1,021.02 " " 2,094.40 " " 1,832.60 " " 1,963.50 " 1298243 636 J3480 KCL 20MEQ/D5NS 1000ML 1 140.00 47.60 0.15 112.00 0.15 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 1298244 636 J3480 KCL 40MEQ IN D5NS 1000ML 1 140.00 47.60 0.15 112.00 0.15 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 1298245 636 J3480 KCL 20MEQ IN D5-1/2NS 1000ML 1 155.00 52.70 0.15 124.00 0.15 79.44 112.53 108.50 120.90 116.25 60.45 124.00 108.50 116.25 1298246 636 J3480 KCL 30MEQ IN D5-1/2NS 1000ML 1 150.05 51.02 0.15 120.04 0.15 76.90 108.94 105.04 117.04 112.54 58.52 120.04 105.04 112.54 1298247 636 J3480 KCL 40MEQ IN D5-1/2NS 1000ML 1 150.05 51.02 0.15 120.04 0.15 76.90 108.94 105.04 117.04 112.54 58.52 120.04 105.04 112.54 1298248 636 J3480 KCL 20MEQ/NS 1000ML 10 140.00 47.60 1.50 112.00 1.50 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 1298249 636 J3480 KCL 40MEQ/NS 1000ML 20 140.00 47.60 3.00 112.00 3.00 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 1298250 636 J3480 KCL 20MEQ/D5W 1000ML 10 146.00 49.64 1.50 116.80 1.50 74.83 106.00 102.20 113.88 109.50 56.94 116.80 102.20 109.50 1298251 636 J3480 KCL 30MEQ/D5W 1000ML 1 146.00 49.64 0.15 116.80 0.15 74.83 106.00 102.20 113.88 109.50 56.94 116.80 102.20 109.50 1298252 636 J3480 KCL 40MEQ/D5W 1000ML 1 146.00 49.64 0.15 116.80 0.15 74.83 106.00 102.20 113.88 109.50 56.94 116.80 102.20 109.50 1298283 636 J2794 risperiDONE (risperDAL CONSTA) 25MG PFS 50 912.50 310.25 467.66 " 1,053.00 " 507.50 467.66 662.48 638.75 711.75 684.38 " 1,053.00 " 730.00 638.75 526.50 684.38 895.05 842.40 1298291 250 J1335 ERTAPENEM (INVANZ) 1GM VIAL 2 317.75 108.04 78.18 254.20 78.18 162.85 230.69 222.43 247.85 238.31 123.92 254.20 222.43 238.31 1298294 250 J2704 PROPOFOL (DIPRIVAN) 500MG/50ML VIAL 50 125.05 42.52 5.50 100.04 5.50 64.09 90.79 87.54 97.54 93.79 48.77 100.04 87.54 93.79 1298311 250 J3490 STERILE TALC 1 100.00 34.00 39.00 80.00 60.00 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 1298316 250 J3490 NITROGLYCERIN (NITROBID2) OINT U/D PKT 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 1298321 250 J7622 BECONASE AQ SPRAY 25 ML 1 118.00 40.12 0.03 94.40 0.03 60.48 85.67 82.60 92.04 88.50 46.02 94.40 82.60 88.50 1298340 637 J1815 INSULIN GLARGINE (LANTUS) 100UNIT/ML 1 1.05 0.36 0.41 0.91 0.91 0.54 0.76 0.74 0.82 0.79 0.41 0.84 0.74 0.79 1298341 250 S0017 AMINOCAPROIC ACID 5MG/20ML (AMICAR) INJ 1 20.00 6.80 7.80 16.00 7.87 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 1298346 250 J0278 AMIKACIN 1000MG/4ML SDV 10 75.00 25.50 12.90 60.00 12.90 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1298348 636 J0132 ACETYLCYSTEINE-IV 20%/30ML[Mucomyst-IV] 60 184.25 62.65 55.20 147.40 55.20 94.43 133.77 128.98 143.72 138.19 71.86 147.40 128.98 138.19 1298349 250 J2597 DESMOPRESSIN (DDAVP) 1 MCG INJ 1 15.00 5.10 7.69 21.14 11.64 7.69 10.89 10.50 11.70 11.25 21.14 12.00 10.50 10.57 11.25 17.97 16.91 1298360 250 J0515 BENZTROPINE (COGENTIN) 2MG/2ML AMP 2 140.00 47.60 35.82 112.00 35.82 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 1298366 250 J3490 PROTONIX 40MG IVPB 1 50.00 17.00 19.50 40.00 30.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1298374 250 J1650 ENOXAPARIN (LOVENOX) 40MG SYRINGE 4 125.00 42.50 2.72 100.00 2.72 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1298405 636 J1756 IRON SUCROSE (VENOFER) 100MG/5ML VIAL 100 138.00 46.92 21.00 110.40 21.00 70.73 100.19 96.60 107.64 103.50 53.82 110.40 96.60 103.50 1298412 636 J3364 "ABBOKINASE (UROKINASE) 5,000 UNIT" 1 22.00 7.48 8.58 17.60 10.36 11.28 15.97 15.40 17.16 16.50 8.58 17.60 15.40 16.50 1298415 250 J7620 ALBUTEROL/IPRATROP (DUONEB) UD 1 24.00 8.16 0.13 19.20 0.13 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 1298416 250 J7626 BUDESONIDE 0.25MG/2ML (PULMICORT) NEB 1 26.50 9.01 1.75 21.20 1.75 13.58 19.24 18.55 20.67 19.88 10.34 21.20 18.55 19.88 1298418 250 J7682 TOBRAMYCIN (TOBI) INHAL SOLN 1 127.00 43.18 40.33 101.60 40.33 65.09 92.20 88.90 99.06 95.25 49.53 101.60 88.90 95.25 1298448 636 J2997 ALTEPLASE (ACTIVASE) 50MG VIAL 50 " 4,730.00 " " 1,608.20 " " 2,424.13 " " 8,743.00 " " 4,436.50 " " 2,424.13 " " 3,433.98 " " 3,311.00 " " 3,689.40 " " 3,547.50 " " 8,743.00 " " 3,784.00 " " 3,311.00 " " 4,371.50 " " 3,547.50 " " 7,431.55 " " 6,994.40 " 1298450 636 J9260 METHOTREXATE (Trexall 50MG) 50MG/2ML INJ 1 25.00 8.50 2.51 20.00 2.51 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1298451 250 J2543 PIPERACIL/TAZO (ZOSYN) 2.25GM VIAL 2 40.00 13.60 3.74 32.00 3.74 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1298452 250 J2543 PIPERACIL/TAZO (ZOSYN) 4.5GM VIAL 4 85.00 28.90 7.48 68.00 7.48 43.56 61.71 59.50 66.30 63.75 33.15 68.00 59.50 63.75 1298456 636 90715 Tdap VACCINE (ADACEL) 0.5ML 1 95.00 32.30 33.64 76.00 33.64 48.69 68.97 66.50 74.10 71.25 37.05 76.00 66.50 71.25 1298460 636 J0840 CROFAB INJECTION 1GM 1 " 6,037.18 " " 2,052.64 " " 2,908.21 " " 5,816.42 " " 3,317.56 " " 3,094.05 " " 4,382.99 " " 4,226.03 " " 4,709.00 " " 4,527.89 " " 5,816.42 " " 4,829.74 " " 4,226.03 " " 2,908.21 " " 4,527.89 " " 4,943.96 " " 4,653.14 " 1298470 636 Q2009 FOSPHENYTOIN (CEREBYX) 100MG 2ML INJ 2 29.00 9.86 3.22 23.20 11.52 14.86 21.05 20.30 22.62 21.75 6.44 23.20 20.30 3.22 21.75 5.47 5.15 1298475 250 J1956 levoFLOXacin(LEVAQUIN) 750MG/150ML PREMX 3 400.05 136.02 2.01 320.04 2.01 205.03 290.44 280.04 312.04 300.04 156.02 320.04 280.04 300.04 1298476 250 J7613 ALBUTEROL .083% 2.5MG/3ML INH SOLN (3ML) 1 24.00 8.16 0.04 19.20 0.04 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 1298480 250 90736 ZOSTER VACC (ZOSTAVAX) SDV 1 770.00 261.80 216.92 616.00 216.92 394.63 559.02 539.00 600.60 577.50 300.30 616.00 539.00 577.50 1298493 250 C9399 DONEPEZIL (ARICEPT) 10MG TABLET 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298502 250 C9113 PANTOPRAZOLE (PROTONIX) 40MG VIAL 1 50.00 17.00 6.00 40.00 6.00 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1298503 636 J1327 EPTIFIBATIDE (INTEGRILIN) 20MG/10ML INJ 4 551.00 187.34 18.04 440.80 130.20 282.39 400.03 385.70 429.78 413.25 36.08 440.80 385.70 18.04 413.25 30.67 28.86 1298512 250 J3490 DANTROLENE (DANTRIUM) 20MG INJ 1 203.00 69.02 79.17 162.40 121.80 104.04 147.38 142.10 158.34 152.25 79.17 162.40 142.10 152.25 1298521 636 J2997 CATHFLO ACTIVASE 2MG VIAL 2 445.00 151.30 174.86 356.00 177.46 228.06 323.07 311.50 347.10 333.75 349.72 356.00 311.50 174.86 333.75 297.26 279.78 1298531 636 J2785 REGADENOSON (LEXISCAN) 0.4MG INJ 4 780.50 265.37 239.48 624.40 239.48 400.01 566.64 546.35 608.79 585.38 304.40 624.40 546.35 585.38 1298558 250 J7608 ACETYLCYSTEINE 20% INH/PO 30ML[MUCOMYST] 1 40.85 13.89 5.75 32.68 5.75 20.94 29.66 28.60 31.86 30.64 15.93 32.68 28.60 30.64 1298561 636 J0696 cefTRIAXone (ROCEPHIN) 2GM VIAL 8 250.00 85.00 4.80 200.00 4.80 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 1298564 637 J3490 fentaNYL 12MCG/HR (DURAGESIC) PATCH 1 45.05 15.32 17.57 36.04 27.03 23.09 32.71 31.54 35.14 33.79 17.57 36.04 31.54 33.79 1298582 637 Q0144 AZITHROMYCIN (ZITHROMAX) 200MG/5ML SUSP 1 23.00 7.82 8.97 29.13 29.13 11.79 16.70 16.10 17.94 17.25 8.97 18.40 16.10 17.25 1298618 250 J2185 MEROPENEM (MERREM) 1GM VIAL 10 61.00 20.74 8.00 48.80 8.00 31.26 44.29 42.70 47.58 45.75 23.79 48.80 42.70 45.75 1298621 636 J3101 TENECTEPLASE (TNKASE) 50MG KIT 50 " 11,988.72 " " 4,076.16 " " 6,144.22 " " 12,927.00 " " 6,333.50 " " 6,144.22 " " 8,703.81 " " 8,392.10 " " 9,351.20 " " 8,991.54 " " 12,927.00 " " 9,590.98 " " 8,392.10 " " 6,463.50 " " 8,991.54 " " 10,987.95 " " 10,341.60 " 1298624 250 J1644 "HEPARIN (HEPARIN) 5,000 UN/0.5ML INJ" 1 15.50 5.27 0.24 12.40 0.24 7.94 11.25 10.85 12.09 11.63 6.05 12.40 10.85 11.63 1298625 250 J3301 TRIAMCINALONE (KENALOG)10MG/1ML 5ML MDV 1 50.00 17.00 1.58 40.00 1.58 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1298626 250 J3301 TRIAMCINALONE(KENALOG-40) 200MG/5ML MDV 1 35.50 12.07 1.58 28.40 1.58 18.19 25.77 24.85 27.69 26.63 13.85 28.40 24.85 26.63 1298632 250 J7614 LEVALBUTEROL 1.25MG/3ML NEB (XOPENEX) 1 14.05 4.78 0.06 11.24 0.06 7.20 10.20 9.84 10.96 10.54 5.48 11.24 9.84 10.54 1298633 250 Q9958 CYSTOGRAFIN DILUTE 300ML 1 48.20 16.39 0.08 38.56 0.08 24.70 34.99 33.74 37.60 36.15 18.80 38.56 33.74 36.15 1298635 250 J1650 ENOXAPARIN (LOVENOX) 80MG/0.8ML SYRINGE 8 130.00 44.20 5.44 104.00 5.44 66.63 94.38 91.00 101.40 97.50 50.70 104.00 91.00 97.50 1298652 636 S0166 OLANZapine (zyPREXA) INJ 10MG VIAL 1 92.00 31.28 9.96 73.60 9.96 47.15 66.79 64.40 71.76 69.00 35.88 73.60 64.40 69.00 1298657 250 J3490 PROCALAMINE 3% 1000ML 1 62.06 21.10 24.20 49.65 37.24 31.81 45.06 43.44 48.41 46.55 24.20 49.65 43.44 46.55 1298665 250 J3490 ETHYL CHLORIDE SPRAY 1 127.00 43.18 49.53 101.60 76.20 65.09 92.20 88.90 99.06 95.25 49.53 101.60 88.90 95.25 1298668 250 J3490 POVID/IODINE (BETADINE) SOLN 120ML 1 5.20 1.77 2.03 4.16 3.12 2.67 3.78 3.64 4.06 3.90 2.03 4.16 3.64 3.90 1298671 250 J3490 GENTIAN VIOLET 2% SOLN 60ML/BTL 1 23.84 8.11 9.30 19.07 14.30 12.22 17.31 16.69 18.60 17.88 9.30 19.07 16.69 17.88 1298674 250 J0171 EPINEPHrine INJ 1MG/ML 30ML MDV 300 75.00 25.50 29.25 249.00 249.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1298678 636 J3243 TIGECYCLINE (TYGACIL) 50MG VIAL 50 384.40 130.70 59.50 307.52 82.50 197.01 279.07 269.08 299.83 288.30 119.00 307.52 269.08 59.50 288.30 101.15 95.20 1298681 250 J0171 EPINEPHrine 0.3MG/0.3ML PEN (66LB & UP) 3 456.00 155.04 2.49 364.80 2.49 233.70 331.06 319.20 355.68 342.00 177.84 364.80 319.20 342.00 1298695 637 J1815 INSULIN DETEMIR (LEVEMIR)100 UNIT/ML 1 1.11 0.38 0.43 0.91 0.91 0.57 0.81 0.78 0.87 0.83 0.43 0.89 0.78 0.83 1298711 250 J7050 NORMAL SALINE 10ML VIAL 1 5.50 1.87 0.65 4.40 0.65 2.82 3.99 3.85 4.29 4.13 2.15 4.40 3.85 4.13 1298784 636 J0885 "EPOETIN (PROCRIT) 40,000 UN/1ML INJ" 40 " 1,576.83 " 536.12 352.80 " 1,261.46 " 426.80 808.13 " 1,144.78 " " 1,103.78 " " 1,229.93 " " 1,182.62 " 705.60 " 1,261.46 " " 1,103.78 " 352.80 " 1,182.62 " 599.76 564.48 1298800 250 J3490 FLAGYL IVPB (metroNIDAZOLE) 250MG/50ML 1 83.00 28.22 32.37 66.40 49.80 42.54 60.26 58.10 64.74 62.25 32.37 66.40 58.10 62.25 1298869 250 J0712 CEFTAROLINE (TEFLARO) 400MG VIAL 40 535.00 181.90 128.40 428.00 128.40 274.19 388.41 374.50 417.30 401.25 268.00 428.00 374.50 134.00 401.25 227.80 214.40 1298870 250 J0712 CEFTAROLINE (TEFLARO) 600MG VIAL 60 535.00 181.90 192.60 428.00 192.60 274.19 388.41 374.50 417.30 401.25 402.00 428.00 374.50 201.00 401.25 341.70 321.60 1298878 636 J0878 DAPTOMYCIN (CUBICIN) 500MG VIAL 500 758.04 257.73 80.00 606.43 150.00 388.50 550.34 530.63 591.27 568.53 160.00 606.43 530.63 80.00 568.53 136.00 128.00 1298882 636 J1327 EPTIFIBATIDE (INTEGRILIN) 75MG/100ML 15 303.96 103.35 67.65 488.25 488.25 155.78 220.67 212.77 237.09 227.97 135.30 243.17 212.77 67.65 227.97 115.01 108.24 1298899 636 J3490 AA4.25/D25/LYTES (CLINIMIX-E) 1000ML 1 125.00 42.50 48.75 100.00 75.00 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1298901 250 S0077 CLINDAMYCIN 600MG/50ML PREMIX 2 51.00 17.34 3.36 40.80 3.36 26.14 37.03 35.70 39.78 38.25 19.89 40.80 35.70 38.25 1298907 250 J0744 CIPROFLOXACIN (CIPRO) 400MG/200ML PREMIX 2 175.00 59.50 2.34 140.00 2.34 89.69 127.05 122.50 136.50 131.25 68.25 140.00 122.50 131.25 1298909 636 J3370 VANCOMYCIN VIAL 1000MG 2 44.00 14.96 6.84 35.20 6.84 22.55 31.94 30.80 34.32 33.00 17.16 35.20 30.80 33.00 1298912 250 J1580 GENTAMICIN 80MG/2ML SDV 1 20.00 6.80 1.99 16.00 1.99 10.25 14.52 14.00 15.60 15.00 7.80 16.00 14.00 15.00 1298919 250 C9399 NUTREN 2.0 CAL/ML 250ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298920 250 C9399 RESOURCE 2.0 NUTR LIQ 2 CAL/ML 240ML 1 3.62 1.23 1.41 2.90 2.17 1.86 2.63 2.53 2.82 2.72 1.41 2.90 2.53 2.72 1298936 250 J1650 ENOXAPARIN (LOVENOX) 120MG SYRINGE 12 205.12 69.74 8.16 164.10 8.16 105.12 148.92 143.58 159.99 153.84 80.00 164.10 143.58 153.84 1298938 636 J0696 cefTRIAXone (ROCEPHIN) 1GM/50ML PREMIX 4 145.05 49.32 2.40 116.04 2.40 74.34 105.31 101.54 113.14 108.79 56.57 116.04 101.54 108.79 1298944 250 C9399 BOOST REG 1 CAL/ML 237ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298945 250 C9399 BOOST PLUS 1.5 CAL/ML 237ML 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1298952 250 J1650 ENOXAPARIN (LOVENOX) 150MG/1ML SYRINGE 12 243.94 82.94 8.16 195.15 8.16 125.02 177.10 170.76 190.27 182.96 95.14 195.15 170.76 182.96 1298954 250 S0077 CLINDAMYCIN (CLEOCIN) 900MG/50ML PREMIX 3 64.00 21.76 5.04 51.20 5.04 32.80 46.46 44.80 49.92 48.00 24.96 51.20 44.80 48.00 1298957 250 J1165 PHENYTOIN (DILANTIN) 250MG/5MLSDV 5 125.05 42.52 4.95 100.04 4.95 64.09 90.79 87.54 97.54 93.79 48.77 100.04 87.54 93.79 1298974 250 J1450 DIFLUCAN 100MG/50ML IVPB PREMIX 1 95.00 32.30 4.73 76.00 4.73 48.69 68.97 66.50 74.10 71.25 37.05 76.00 66.50 71.25 1298975 250 J2185 MEROPENEM (MERREM) 500MG VIAL 5 40.00 13.60 4.00 32.00 4.00 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1298981 258 J3490 SODIUM CHLOR 0.9% 50ML MBP 1 11.00 3.74 4.29 8.80 6.60 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 1298982 258 J3490 SODIUM CHLOR 0.9% 100ML MBP (NS) 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 1298983 258 J3490 SODIUM CHLOR 0.9% 50 ML BAG (NS) 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 1298998 250 J3490 BUMETANIDE (BUMEX) 2.5MG/10ML MDV 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1298999 636 J2997 ALTEPLASE (ACTIVASE) 100MG VIAL 100 " 16,965.34 " " 5,768.22 " " 8,694.74 " " 17,486.00 " " 8,873.00 " " 8,694.74 " " 12,316.84 " " 11,875.74 " " 13,232.97 " " 12,724.01 " " 17,486.00 " " 13,572.27 " " 11,875.74 " " 8,743.00 " " 12,724.01 " " 14,863.10 " " 13,988.80 " 1299003 250 J3230 chlorproMAZINE (THORAZINE) 50MG/2ML INJ 1 95.60 32.50 31.87 76.48 31.87 49.00 69.41 66.92 74.57 71.70 37.28 76.48 66.92 71.70 1299009 258 J3490 FAT EMULSION 20% (LIPOSYN) 250ML 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 1299015 250 J2704 PROPOFOL (DIPRIVAN) DRIP 1000MG/100ML 100 250.05 85.02 11.00 200.04 11.00 128.15 181.54 175.04 195.04 187.54 97.52 200.04 175.04 187.54 1299027 250 J1100 DEXMETHSN-DECADRON 20MG/5ML MDV 4MG/ML 20 25.00 8.50 2.40 20.00 2.40 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299043 250 J3490 LIDOCAINE 1% 10MG/1ML INJ 1 15.00 5.10 5.85 12.00 9.00 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1299053 250 J3480 KCL 20MEQ IN 1/2NS 1000ML 1 155.00 52.70 0.15 124.00 0.15 79.44 112.53 108.50 120.90 116.25 60.45 124.00 108.50 116.25 1299057 250 J7608 ACETYLCYCYSTEINE10% INH/PO30ML[MUCOMYST] 1 26.55 9.03 5.75 21.24 5.75 13.61 19.28 18.59 20.71 19.91 10.35 21.24 18.59 19.91 1299065 250 J2250 MIDAZOLAM (VERSED) 5MG/1ML VIAL 5 45.05 15.32 0.60 36.04 0.60 23.09 32.71 31.54 35.14 33.79 17.57 36.04 31.54 33.79 1299066 250 J2300 NALBUPHINE (NUBAIN) 10MG/1ML INJ 1 15.00 5.10 3.18 12.00 3.18 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1299068 250 J3490 FLUMAZENIL (ROMAZICON) 0.1MG/ML 5ML MDV 1 25.00 8.50 9.75 20.00 15.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299069 250 J1644 "HEPARIN 10,000UN/10ML (CAUTION) MDV" 1 15.00 5.10 0.24 12.00 0.24 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 1299102 636 J3010 fentaNYL (SUBLIMAZE) 250MCG/5ML INJ 2 25.00 8.50 2.00 20.00 2.00 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299120 636 J3489 ZOLEDRONIC ACID (RECLAST) 5MG/100ML 5 605.05 205.72 235.97 626.35 626.35 310.09 439.27 423.54 471.94 453.79 235.97 484.04 423.54 453.79 1299122 250 J7605 ARFORMOTEROL (BROVANA) 15MCG/2ML NEB 1 33.76 11.48 10.75 27.01 10.75 17.30 24.51 23.63 26.33 25.32 13.17 27.01 23.63 25.32 1299123 636 J2820 SARGRAMOSTIM (LEUKINE) 250MCG VIAL 5 487.90 165.89 219.70 488.30 219.70 250.05 354.22 341.53 380.56 365.93 488.30 390.32 341.53 244.15 365.93 415.06 390.64 1299125 636 J2794 risperiDONE (risperDAL CONSTA)12.5MG PFS 25 456.00 155.04 233.70 526.50 253.75 233.70 331.06 319.20 355.68 342.00 526.50 364.80 319.20 263.25 342.00 447.53 421.20 1299139 636 J0585 ONABOTULINUMTOXINA (BOTOX) 100 UN THER 100 " 1,050.00 " 357.00 538.13 " 1,212.00 " 618.00 538.13 762.30 735.00 819.00 787.50 " 1,212.00 " 840.00 735.00 606.00 787.50 " 1,030.20 " 969.60 1299141 636 J1953 levETIRAcetam (KEPPRA) 500MG SDV 50 125.00 42.50 5.00 100.00 5.00 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1299143 636 J2794 risperiDONE (risperDAL CONSTA) 50MG PFS 100 " 1,825.08 " 620.53 935.35 " 2,106.00 " " 1,015.00 " 935.35 " 1,325.01 " " 1,277.56 " " 1,423.56 " " 1,368.81 " " 2,106.00 " " 1,460.06 " " 1,277.56 " " 1,053.00 " " 1,368.81 " " 1,790.10 " " 1,684.80 " 1299161 250 J2250 MIDAZOLAM (VERSED) 50MG/10ML VL 50 45.00 15.30 6.00 36.00 6.00 23.06 32.67 31.50 35.10 33.75 17.55 36.00 31.50 33.75 1299165 274 L8606 DURASPHERE EXP INJ BULKING AGENT 1 ML 1 795.00 270.30 146.29 636.00 146.29 407.44 577.17 556.50 620.10 596.25 310.05 636.00 556.50 596.25 1299175 636 J1442 FILGRASTIM (NEUPOGEN) 480MCG/0.8ML SINGJ 480 914.90 311.07 451.20 902.40 460.80 468.89 664.22 640.43 713.62 686.18 902.40 731.92 640.43 451.20 686.18 767.04 721.92 1299202 636 J3490 AA4.25/D25 (CLINIMIX) 1000ML 1 125.00 42.50 48.75 100.00 75.00 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1299205 250 J0171 EPINEPHrine JR AUTOJECT 0.15MG 1 456.00 155.04 0.83 364.80 0.83 233.70 331.06 319.20 355.68 342.00 177.84 364.80 319.20 342.00 1299206 250 90713 POLIOMYELITIS VACC KILLED (IPOL) 5ML MDV 1 125.00 42.50 34.07 100.00 34.07 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 1299233 250 J3490 FAMOTIDINE (PEPCID) 40MG/4ML MDV 1 35.20 11.97 13.73 28.16 21.12 18.04 25.56 24.64 27.46 26.40 13.73 28.16 24.64 26.40 1299274 636 J2505 PEGFILGRASTIM (NEULASTA) 6MG/0.6ML INJ 1 " 12,000.00 " " 4,080.00 " " 3,079.49 " " 9,600.00 " " 4,299.67 " " 6,150.00 " " 8,712.00 " " 8,400.00 " " 9,360.00 " " 9,000.00 " " 6,158.98 " " 9,600.00 " " 8,400.00 " " 3,079.49 " " 9,000.00 " " 5,235.13 " " 4,927.18 " 1299279 636 J1569 IMMUNE GLOB (GAMMAGARD LIQ) 30GM/300ML 60 " 7,200.00 " " 2,448.00 " " 2,419.20 " " 5,760.00 " " 2,419.20 " " 3,690.00 " " 5,227.20 " " 5,040.00 " " 5,616.00 " " 5,400.00 " " 5,235.60 " " 5,760.00 " " 5,040.00 " " 2,617.80 " " 5,400.00 " " 4,450.26 " " 4,188.48 " 1299280 636 J1569 IMMUNE GLOB (GAMMAGARD LIQ) 1GM/10ML 2 320.00 108.80 80.64 256.00 80.64 164.00 232.32 224.00 249.60 240.00 174.52 256.00 224.00 87.26 240.00 148.34 139.62 1299303 636 90662 FLUZONE HIGH-DOSE PFS 1 162.00 55.08 56.01 129.60 56.01 83.03 117.61 113.40 126.36 121.50 63.18 129.60 113.40 121.50 1299309 250 J7626 BUDESONIDE 0.5MG/2ML (PULMICORT) NEB 1 32.65 11.10 1.75 26.12 1.75 16.73 23.70 22.86 25.47 24.49 12.73 26.12 22.86 24.49 1299310 636 90670 PNEUMOCOCCAL 13 (PREVNAR 13) 1 436.95 148.56 170.41 349.56 214.62 223.94 317.23 305.87 340.82 327.71 170.41 349.56 305.87 327.71 1299327 636 J1610 GLUCAGON 1 MG INJ 1 689.05 234.28 194.42 551.24 219.74 353.14 500.25 482.34 537.46 516.79 388.84 551.24 482.34 194.42 516.79 330.51 311.07 1299331 636 J2212 METHYLNALTRE (RELISTOR) 12MG/0.6ML PFS 1 250.00 85.00 1.16 200.00 1.16 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 1299332 250 J1071 TESTOSTERONE (DEPO-TEST) 200MG/ML VL 200 52.75 17.94 6.00 42.20 6.00 27.03 38.30 36.93 41.15 39.56 20.57 42.20 36.93 39.56 1299338 250 J0895 DEFEROXAMINE (DESFERAL) 500MG/VL SDV 1 40.00 13.60 7.99 32.00 7.99 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 1299339 250 J1380 ESTRADIOL VAL(DELESTRGN)40MG/ML 5ML MDV 4 130.15 44.25 34.04 104.12 34.04 66.70 94.49 91.11 101.52 97.61 50.76 104.12 91.11 97.61 1299346 250 J3490 VECURONIUM (NORCURON) 20MG VIAL 1 155.05 52.72 60.47 124.04 93.03 79.46 112.57 108.54 120.94 116.29 60.47 124.04 108.54 116.29 1299357 258 J7131 SODIUM CHLOR 3%(HYPER TONIC SALINE)500ML 1 50.00 17.00 0.04 40.00 0.04 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1299364 250 J3475 MAGNESIUM SULF 50% 20 ML SDV 1 25.00 8.50 0.64 20.00 0.64 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299411 250 J3490 AZTREONAM (AZACTAM) 2GM SDV 1 220.00 74.80 85.80 176.00 132.00 112.75 159.72 154.00 171.60 165.00 85.80 176.00 154.00 165.00 1299413 250 J3490 LIDOCAINE (EPIDURAL) 2% 5ML SDV 1 15.05 5.12 5.87 12.04 9.03 7.71 10.93 10.54 11.74 11.29 5.87 12.04 10.54 11.29 1299549 636 J2426 PALIPERIDONE PAL(INVEGA SUSTENNA)156MG/M 156 " 3,780.00 " " 1,285.20 " " 1,825.20 " " 3,781.44 " " 1,825.20 " " 1,937.25 " " 2,744.28 " " 2,646.00 " " 2,948.40 " " 2,835.00 " " 3,781.44 " " 3,024.00 " " 2,646.00 " " 1,890.72 " " 2,835.00 " " 3,214.22 " " 3,025.15 " 1299572 636 J0692 CEFEPIME (MAXIPEN) 1 GM VIAL 2 84.00 28.56 3.60 67.20 3.60 43.05 60.98 58.80 65.52 63.00 32.76 67.20 58.80 63.00 1299888 636 J3475 MAGNESIUM SULF/D5W RIDER 1GM/100ML 2 25.00 8.50 1.28 20.00 1.28 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1299942 636 J3490 ESMOLOL (BREVIBLOC) 100MG/10 ML SDV 1 30.00 10.20 11.70 24.00 18.00 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 1300071 636 J0692 CEFEPIME (MAXIPEN) 2GM VL 4 116.00 39.44 7.20 92.80 7.20 59.45 84.22 81.20 90.48 87.00 45.24 92.80 81.20 87.00 1300101 636 J0875 DALBAVANCIN (DALVANCE) 500MG/VIAL 100 " 5,714.60 " " 1,942.96 " " 1,521.00 " " 4,571.68 " " 1,521.00 " " 2,928.73 " " 4,148.80 " " 4,000.22 " " 4,457.39 " " 4,285.95 " " 3,078.00 " " 4,571.68 " " 4,000.22 " " 1,539.00 " " 4,285.95 " " 2,616.30 " " 2,462.40 " 1300170 636 90685 FLUZONE QUADRIVALENT (PED) PFS 1 60.00 20.40 20.34 48.00 20.34 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1300173 636 J3490 DILTIAZEM 5MG/ML 25ML SDV (CARDIZEM) 1 28.00 9.52 10.92 22.40 16.80 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 1300205 636 J3490 DILTIAZEM (CARDIZEM) 125MG/25ML SDV 1 75.00 25.50 29.25 60.00 45.00 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 1300549 636 J3490 ANTIVENIN BLACK WIDOW 2.5ML VL 1 150.00 51.00 58.50 120.00 90.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1300807 636 J2407 ORITAVANCIN (ORBACTIV PR) 400 MG VIAL 40 " 2,730.70 " 928.44 952.80 " 2,184.56 " 960.00 " 1,399.48 " " 1,982.49 " " 1,911.49 " " 2,129.95 " " 2,048.03 " " 1,905.60 " " 2,184.56 " " 1,911.49 " 952.80 " 2,048.03 " " 1,619.76 " " 1,524.48 " 1301042 636 J0881 DARBEPOETIN (ARANESP) 60 MCG/0.3ML SYR 60 " 1,720.00 " 584.80 213.60 " 1,376.00 " 231.60 881.50 " 1,248.72 " " 1,204.00 " " 1,341.60 " " 1,290.00 " 427.20 " 1,376.00 " " 1,204.00 " 213.60 " 1,290.00 " 363.12 341.76 1301043 636 J3490 VARICELLA ZOSTER (SHINGRIX) 50 MCG/0.5ML 1 530.00 180.20 206.70 424.00 318.00 271.63 384.78 371.00 413.40 397.50 206.70 424.00 371.00 397.50 1301128 636 J0881 DARBEPOETIN (ARANESP) 100MCG 1 ML SYR 100 " 2,865.00 " 974.10 356.00 " 2,292.00 " 386.00 " 1,468.31 " " 2,079.99 " " 2,005.50 " " 2,234.70 " " 2,148.75 " 712.00 " 2,292.00 " " 2,005.50 " 356.00 " 2,148.75 " 605.20 569.60 1301263 636 J0897 PROLIA (DENOSUMAB) 60 MG/ML 1ML SYRINGE 60 " 2,852.00 " 969.68 " 1,168.20 " " 2,413.20 " " 1,168.20 " " 1,461.65 " " 2,070.55 " " 1,996.40 " " 2,224.56 " " 2,139.00 " " 2,413.20 " " 2,281.60 " " 1,996.40 " " 1,206.60 " " 2,139.00 " " 2,051.22 " " 1,930.56 " 1301307 636 90375 HYPERRAB 300 U/ML 1 " 1,567.86 " 533.07 271.37 " 1,254.29 " 277.34 803.53 " 1,138.27 " " 1,097.50 " " 1,222.93 " " 1,175.90 " 542.74 " 1,254.29 " " 1,097.50 " 271.37 " 1,175.90 " 461.33 434.19 1301308 636 90675 RABAVERT PR (RABIES VACCINE) 2.5U 1 755.13 256.74 277.82 636.12 277.82 387.00 548.22 528.59 589.00 566.35 636.12 604.10 528.59 318.06 566.35 540.70 508.90 1301326 250 J3475 MAGNESIUM SULF 50% 10 ML SDV 1 25.00 8.50 0.64 20.00 0.64 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 1301498 636 90682 FLUBLOK 0.5 PFS 1 162.00 55.08 56.01 129.60 56.01 83.03 117.61 113.40 126.36 121.50 63.18 129.60 113.40 121.50 1301499 636 90686 FLUZONE QUADRIVALENT (ADULT) PFS 1 60.00 20.40 19.03 48.00 19.03 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1301688 636 90739 HEPATITIS-B VACC(HEPLISAV-B) 20MCG/0.5ML 1 327.04 111.19 127.55 261.63 131.10 167.61 237.43 228.93 255.09 245.28 127.55 261.63 228.93 245.28 1301886 637 J0571 BUPRENORPHINE 2MG TABLET 2 4.00 1.36 0.90 3.20 0.90 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 1301887 637 J0572 BUPRENORPHINE/NALOXONE (SUBOXONE)2-0.5MG 1 8.92 3.03 3.48 7.14 4.70 4.57 6.48 6.24 6.96 6.69 3.48 7.14 6.24 6.69 1301898 636 J3410 HYDROXYZINE HCL 50MG/ML 2 54.64 18.58 14.18 43.71 14.18 28.00 39.67 38.25 42.62 40.98 21.31 43.71 38.25 40.98 1301977 636 J1568 IMMUNE GLOB (OCTAGAM) 1000MG INJ 2 168.22 57.19 77.20 166.52 77.20 86.21 122.13 117.75 131.21 126.17 166.52 134.58 117.75 83.26 126.17 141.54 133.22 1302119 636 J2794 risperiDONE (risperDAL CONSTA)37.5MG PFS 1 " 1,368.80 " 465.39 10.15 " 1,095.04 " 10.15 701.51 993.75 958.16 " 1,067.66 " " 1,026.60 " 21.06 " 1,095.04 " 958.16 10.53 " 1,026.60 " 17.90 16.85 1302139 636 J3475 MAGNESIUM SULF/D5W RIDER 2GM/50ML 4 57.16 19.43 2.56 45.73 2.56 29.29 41.50 40.01 44.58 42.87 22.29 45.73 40.01 42.87 1302152 636 J3095 TELAVANCIN (VIBATIV) 750 MG INJ 75 608.50 206.89 311.86 891.00 426.00 311.86 441.77 425.95 474.63 456.38 891.00 486.80 425.95 445.50 456.38 757.35 712.80 1302155 636 J1561 IMMUNE GLOBULIN (GAMUNEX-C) 1000MG 2 133.82 45.50 68.58 174.68 81.50 68.58 97.15 93.67 104.38 100.37 174.68 107.06 93.67 87.34 100.37 148.48 139.74 1302156 636 J1561 IMMUNE GLOBULIN (GAMUNEX-C) 10000MG 20 " 1,338.26 " 455.01 685.86 " 1,746.80 " 815.00 685.86 971.58 936.78 " 1,043.84 " " 1,003.70 " " 1,746.80 " " 1,070.61 " 936.78 873.40 " 1,003.70 " " 1,484.78 " " 1,397.44 " 1302157 636 J1561 IMMUNE GLOBULIN (GAMUNEX-C) 20000MG 40 " 2,676.56 " 910.03 " 1,371.74 " " 3,493.60 " " 1,630.00 " " 1,371.74 " " 1,943.18 " " 1,873.59 " " 2,087.72 " " 2,007.42 " " 3,493.60 " " 2,141.25 " " 1,873.59 " " 1,746.80 " " 2,007.42 " " 2,969.56 " " 2,794.88 " 1302158 636 J0690 CEFAZOLIN/D5W 1GM / 50ML 1 19.75 6.72 0.83 15.80 0.83 10.12 14.34 13.83 15.41 14.81 7.70 15.80 13.83 14.81 1302200 636 J0690 CEFAZOLIN/D5W 1GM / 50ML (OPS) 1 19.75 6.72 0.83 15.80 0.83 10.12 14.34 13.83 15.41 14.81 7.70 15.80 13.83 14.81 1302201 250 J3490 FAMOTIDINE 20MG/2ML (PEPCID) SDV (OPS) 1 35.00 11.90 13.65 28.00 21.00 17.94 25.41 24.50 27.30 26.25 13.65 28.00 24.50 26.25 1302369 255 A9597 MULTIHANCE 529MG/ML 20ML SDV 1 125.69 42.73 49.02 " 1,250.00 " " 1,250.00 " 64.42 91.25 87.98 98.04 94.27 49.02 100.55 87.98 94.27 1302553 636 J0295 AMPICILLIN SULBACTAM 1.5 GRAM 1 33.42 11.36 2.60 26.74 2.60 17.13 24.26 23.39 26.07 25.07 13.03 26.74 23.39 25.07 1302567 636 J3370 VANCOMYCIN VIAL 750MG 2 28.48 9.68 6.84 22.78 6.84 14.60 20.68 19.94 22.21 21.36 11.11 22.78 19.94 21.36 1302568 636 J3370 VANCOMYCIN IVPB 1500MG/300ML 3 73.64 25.04 10.26 58.91 10.26 37.74 53.46 51.55 57.44 55.23 28.72 58.91 51.55 55.23 1302624 636 J1447 TBO-FILGRASTIM (GRANIX) 480MCG/0.8ML PFS 480 266.00 90.44 136.33 441.60 259.20 136.33 193.12 186.20 207.48 199.50 441.60 212.80 186.20 220.80 199.50 375.36 353.28 1302625 636 J1447 TBO-FILGRASTIM (GRANIX) 300MCG/0.5ML PFS 300 166.00 56.44 85.08 276.00 162.00 85.08 120.52 116.20 129.48 124.50 276.00 132.80 116.20 138.00 124.50 234.60 220.80 1302651 636 Q9963 GASTROGRAFIN 66-10% 30ML 1 28.00 9.52 0.20 22.40 0.20 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 1302859 636 J2540 "PENICILLIN G PROCAINE 600,000UNIT/ML 2ML" 2 104.00 35.36 2.12 83.20 2.12 53.30 75.50 72.80 81.12 78.00 40.56 83.20 72.80 78.00 1303032 636 Q5101 FILGRASTIM SNDZ(ZARXIO)300MCG/0.5 ML PFS 300 645.00 219.30 123.00 516.00 168.00 330.56 468.27 451.50 503.10 483.75 246.00 516.00 451.50 123.00 483.75 209.10 196.80 1303278 636 J3490 REMDESIVIR 100MG INJ 1 720.00 244.80 280.80 576.00 432.00 369.00 522.72 504.00 561.60 540.00 280.80 576.00 504.00 540.00 1303298 636 J3490 REMDESIVIR 200MG/250ML IVPB 1 720.00 244.80 280.80 576.00 432.00 369.00 522.72 504.00 561.60 540.00 280.80 576.00 504.00 540.00 1303314 636 J3370 VANCOMYCIN IVPB 1250MG/250ML 3 61.32 20.85 10.26 49.06 10.26 31.43 44.52 42.92 47.83 45.99 23.91 49.06 42.92 45.99 1410378 762 G0378 OBSV EACH ADDT HR 1 30.00 10.20 1.68 24.00 1.68 15.38 21.78 21.00 23.40 22.50 11.70 24.00 21.00 22.50 1420610 760 20610 OBSV ASPIRATION AND OR INJ MAJ JNT OR BU 1 702.09 238.71 234.06 561.67 497.00 359.82 509.72 491.46 547.63 526.57 468.12 561.67 491.46 234.06 526.57 397.90 374.50 1436568 760 36568 OBSV PICC LINE INSERTION AGE 4 AND UNDER 1 " 3,780.04 " " 1,285.21 " 497.00 " 3,024.03 " 497.00 " 1,937.27 " " 2,744.31 " " 2,646.03 " " 2,948.43 " " 2,835.03 " " 2,520.36 " " 3,024.03 " " 2,646.03 " " 1,260.18 " " 2,835.03 " " 2,142.31 " " 2,016.29 " 1436569 760 36569 OBSV PICC LINE INSERTION AGE 5 AND UP 1 " 3,780.04 " " 1,285.21 " 497.00 " 3,024.03 " 497.00 " 1,937.27 " " 2,744.31 " " 2,646.03 " " 2,948.43 " " 2,835.03 " " 2,520.36 " " 3,024.03 " " 2,646.03 " " 1,260.18 " " 2,835.03 " " 2,142.31 " " 2,016.29 " 1438221 760 38221 OBSV BONE MARROW BIOPSY 1 " 3,782.35 " " 1,286.00 " 497.00 " 3,025.88 " 497.00 " 1,938.45 " " 2,745.99 " " 2,647.65 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.88 " " 2,647.65 " " 1,260.95 " " 2,836.76 " " 2,143.62 " " 2,017.52 " 1449082 760 49082 OBSV ABD PARACENTESIS W/O IMAGING GUIDAN 1 " 2,176.40 " 739.98 666.00 " 1,741.12 " 666.00 " 1,115.41 " " 1,580.07 " " 1,523.48 " " 1,697.59 " " 1,632.30 " " 1,451.12 " " 1,741.12 " " 1,523.48 " 725.56 " 1,632.30 " " 1,233.45 " " 1,160.90 " 1449440 760 49440 OBSV PEG TUBE PLACEMENT 1 " 4,368.44 " " 1,485.27 " 666.00 " 3,494.75 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.91 " " 3,407.38 " " 3,276.33 " " 2,912.68 " " 3,494.75 " " 3,057.91 " " 1,456.34 " " 3,276.33 " " 2,475.78 " " 2,330.14 " 1451701 760 51701 OBSV INSERTION NON-INDWELLING URINE CATH 1 300.95 102.32 100.33 497.00 497.00 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 1451702 760 51702 OBSV INSERTION TEMP INDWELLING URINE CAT 1 300.95 102.32 100.33 497.00 497.00 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 1462270 760 62270 OBSV SPINAL TAP 1 " 1,705.93 " 580.02 497.00 " 1,364.74 " 497.00 874.29 " 1,238.51 " " 1,194.15 " " 1,330.63 " " 1,279.45 " " 1,137.44 " " 1,364.74 " " 1,194.15 " 568.72 " 1,279.45 " 966.82 909.95 1476937 402 76937 OBSV US GUIDANCE VASCULAR ACCESS 1 240.00 81.60 38.62 192.00 38.62 123.00 174.24 168.00 187.20 180.00 93.60 192.00 168.00 180.00 1480008 771 G0008 OBSV AF VACCINE FLU MCARE/MCARE PFFS 1 107.53 36.56 5.00 86.02 5.00 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1480378 762 G0378 OBSV INITIAL HR (NOT DIRECT) 1 300.00 102.00 1.68 240.00 1.68 153.75 217.80 210.00 234.00 225.00 117.00 240.00 210.00 225.00 1482962 301 82962 QW OBSV FSBS (ACCUCHECK) 1 9.84 3.35 3.28 7.87 3.83 5.04 7.14 6.89 7.68 7.38 6.56 7.87 6.89 3.28 7.38 5.58 5.25 1486580 302 86580 OBSV SKIN TEST TUBERCULOSIS INTRADERMAL 1 40.00 13.60 8.52 44.22 8.52 20.50 29.04 28.00 31.20 30.00 44.22 32.00 28.00 22.11 30.00 37.59 35.38 1490009 771 G0009 OBSV AF VACCINE PNEUMONIA MCARE/MC PFFS 1 107.53 36.56 5.00 86.02 5.00 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1490379 762 G0379 OBSV DIRECT INITIAL HR 1 " 1,403.58 " 477.22 44.59 " 1,122.86 " 44.59 719.33 " 1,019.00 " 982.51 " 1,094.79 " " 1,052.69 " 935.84 " 1,122.86 " 982.51 467.92 " 1,052.69 " 795.46 748.67 1490471 771 90471 OBSV AF VACCINE ONE 1 166.59 56.64 7.00 133.27 7.00 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1490472 771 90472 OBSV AF VACCINE EACH ADDITIONAL 1 150.00 51.00 7.00 120.00 7.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1496360 760 96360 OBSV AF HYDRATION INF INITIAL 31M - 1 HR 1 547.06 186.00 73.02 437.65 73.02 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1496361 760 96361 OBSV AF HYDRATION INFUSION EACH ADDT HR 1 107.53 36.56 19.79 86.02 19.79 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1496365 760 96365 OBSV AF IV INFUSION INITIAL UP TO 1 HR 1 547.06 186.00 88.53 437.65 88.53 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1496366 760 96366 OBSV AF IV INFUSION EACH ADDITIONAL HR 1 107.53 36.56 24.74 86.02 24.74 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1496367 760 96367 OBSV AF IV INFUSION ADDT SEQUENT TO 1 HR 1 166.59 56.64 39.63 133.27 39.63 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1496368 260 96368 OBSV IV INFUSION CONCURRENT 1 90.00 30.60 26.91 72.00 26.91 46.13 65.34 63.00 70.20 67.50 35.10 72.00 63.00 67.50 1496372 760 96372 OBSV AF INJ SC/IM 1 166.59 56.64 32.69 133.27 32.69 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1496374 760 96374 OBSV AF IV PUSH INITIAL 1 547.06 186.00 72.80 437.65 72.80 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1496375 760 96375 OBSV AF IV PUSH EACH ADDT DIFF DRUG 1 107.53 36.56 28.74 86.02 28.74 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1496376 260 96376 OBSV AF IV PUSH E ADDT SAME DRUG >30 MIN 1 10.00 3.40 3.90 19.28 19.28 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1503014 780 Q3014 G0 ER TELESTROKE FACILITY FEE 1 60.00 20.40 17.57 48.00 17.57 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1509612 300 P9612 ER BLADDER CATH URINE SPEC MCARE/PFFS 1 9.00 3.06 3.00 497.00 497.00 4.61 6.53 6.30 7.02 6.75 6.00 7.20 6.30 3.00 6.75 5.10 4.80 1531500 450 31500 ER INTUBATION ENDOTRACH-EMERG 1 568.83 193.40 189.64 497.00 497.00 291.53 412.97 398.18 443.69 426.62 379.28 455.06 398.18 189.64 426.62 322.39 303.42 1536568 450 36568 ER PICC LINE INSERTION AGE 4 AND UNDER 1 " 3,780.04 " " 1,285.21 " 497.00 " 3,024.03 " 497.00 " 1,937.27 " " 2,744.31 " " 2,646.03 " " 2,948.43 " " 2,835.03 " " 2,520.36 " " 3,024.03 " " 2,646.03 " " 1,260.18 " " 2,835.03 " " 2,142.31 " " 2,016.29 " 1536569 450 36569 ER PICC LINE INSERTION AGE 5 AND UP 1 " 3,780.04 " " 1,285.21 " 497.00 " 3,024.03 " 497.00 " 1,937.27 " " 2,744.31 " " 2,646.03 " " 2,948.43 " " 2,835.03 " " 2,520.36 " " 3,024.03 " " 2,646.03 " " 1,260.18 " " 2,835.03 " " 2,142.31 " " 2,016.29 " 1536591 450 36591 ER BLOOD SPECIMEN FROM PORT A CATH 1 300.95 102.32 30.56 240.76 30.56 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 1536600 450 36600 ER ARTERIAL PUNCTURE RN OR MD 1 300.95 102.32 100.33 240.76 180.57 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 1536620 450 36620 ER ARTERIAL CATHETER INSERT 1 740.00 251.60 288.60 592.00 497.00 379.25 537.24 518.00 577.20 555.00 288.60 592.00 518.00 555.00 1551701 450 51701 ER BLADDER CATH RESIDUAL/SPECIMEN 1 300.95 102.32 100.33 497.00 497.00 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 1551702 450 51702 ER INSERTION TEMP INDWELLING URINARY CAT 1 300.95 102.32 100.33 497.00 497.00 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 1551703 450 51703 ER BLADDER CATH COMPLICATED 1 375.14 127.55 125.06 497.00 497.00 192.26 272.35 262.60 292.61 281.36 250.12 300.11 262.60 125.06 281.36 212.60 200.10 1567825 450 99291 ER CRITICAL CARE FIRST 30-74 MINUTES 1 " 1,862.09 " 633.11 620.78 " 1,489.67 " " 1,117.25 " 954.32 " 1,351.88 " " 1,303.46 " " 1,452.43 " " 1,396.57 " " 1,241.56 " " 1,489.67 " " 1,303.46 " 620.78 " 1,396.57 " " 1,055.33 " 993.25 1576937 402 76937 ER US GUIDANCE VASCULAR ACCESS 1 240.00 81.60 38.62 192.00 38.62 123.00 174.24 168.00 187.20 180.00 93.60 192.00 168.00 180.00 1582271 301 82271 QW ER OCCULT BLOOD GASTRIC (GASTROCCULT) 1 15.96 5.43 5.32 12.77 5.32 8.18 11.59 11.17 12.45 11.97 10.64 12.77 11.17 5.32 11.97 9.04 8.51 1582272 301 82272 QW ER HEMACULT 1-3 SIMULTANEOUS 1 12.69 4.31 4.23 10.15 5.32 6.50 9.21 8.88 9.90 9.52 8.46 10.15 8.88 4.23 9.52 7.19 6.77 1582962 301 82962 QW ER GLUCOSE BLOOD METER (ACCUCHECK) 1 9.84 3.35 3.28 7.87 3.83 5.04 7.14 6.89 7.68 7.38 6.56 7.87 6.89 3.28 7.38 5.58 5.25 1589959 450 99281 ER LEVEL I 1 195.17 66.36 21.54 156.14 21.54 100.02 141.69 136.62 152.23 146.38 130.12 156.14 136.62 65.06 146.38 110.60 104.10 1589960 450 99282 ER LEVEL II 1 353.75 120.28 42.04 283.00 42.04 181.30 256.82 247.63 275.93 265.31 235.86 283.00 247.63 117.93 265.31 200.48 188.69 1589962 450 99283 ER LEVEL III 1 622.60 211.68 62.99 498.08 62.99 319.08 452.01 435.82 485.63 466.95 415.12 498.08 435.82 207.56 466.95 352.85 332.10 1589963 450 99284 ER LEVEL IV 1 977.82 332.46 119.60 782.26 119.60 501.13 709.90 684.47 762.70 733.37 651.96 782.26 684.47 325.98 733.37 554.17 521.57 1589964 450 99285 ER LEVEL V 1 " 1,403.58 " 477.22 176.73 " 1,122.86 " 176.73 719.33 " 1,019.00 " 982.51 " 1,094.79 " " 1,052.69 " 935.84 " 1,122.86 " 982.51 467.92 " 1,052.69 " 795.46 748.67 1589965 450 99281 25 ER LEVEL I WITH MOD 25 1 195.17 66.36 21.54 156.14 21.54 100.02 141.69 136.62 152.23 146.38 130.12 156.14 136.62 65.06 146.38 110.60 104.10 1589966 450 99282 25 ER LEVEL II WITH MOD 25 1 353.75 120.28 42.04 283.00 42.04 181.30 256.82 247.63 275.93 265.31 235.86 283.00 247.63 117.93 265.31 200.48 188.69 1589967 450 99283 25 ER LEVEL III WITH MOD 25 1 622.60 211.68 62.99 498.08 62.99 319.08 452.01 435.82 485.63 466.95 415.12 498.08 435.82 207.56 466.95 352.85 332.10 1589968 450 99284 25 ER LEVEL IV WITH MOD 25 1 977.82 332.46 119.60 782.26 119.60 501.13 709.90 684.47 762.70 733.37 651.96 782.26 684.47 325.98 733.37 554.17 521.57 1589969 450 99285 25 ER LEVEL V WITH MOD 25 1 " 1,403.58 " 477.22 176.73 " 1,122.86 " 176.73 719.33 " 1,019.00 " 982.51 " 1,094.79 " " 1,052.69 " 935.84 " 1,122.86 " 982.51 467.92 " 1,052.69 " 795.46 748.67 1589970 450 99291 25 ER CRITICAL CARE 1ST 30-74 MIN W MOD 25 1 " 1,862.09 " 633.11 620.78 " 1,489.67 " " 1,117.25 " 954.32 " 1,351.88 " " 1,303.46 " " 1,452.43 " " 1,396.57 " " 1,241.56 " " 1,489.67 " " 1,303.46 " 620.78 " 1,396.57 " " 1,055.33 " 993.25 1589971 450 99292 25 ER CRITICAL CARE E ADDT 30 MIN W MOD 25 1 600.00 204.00 234.00 480.00 360.00 307.50 435.60 420.00 468.00 450.00 234.00 480.00 420.00 450.00 1590008 771 G0008 ER AF VACCINE FLU MCARE/MCARE PFFS 1 107.53 36.56 5.00 86.02 5.00 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1590009 771 G0009 ER AF VACCINE PNEUMONIA MCARE/MCARE PFFS 1 107.53 36.56 5.00 86.02 5.00 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1590471 771 90471 ER AF VACCINE ONE 1 166.59 56.64 7.00 133.27 7.00 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1590472 771 90472 ER AF VACCINE EACH ADDITIONAL 1 150.00 51.00 7.00 120.00 7.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 1590760 450 96360 ER AF HYDRATION INF INITIAL 31 M -1 HR 1 547.06 186.00 73.02 437.65 73.02 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1590761 450 96361 ER AF HYDRATION INFUSION E ADDT HR 1 107.53 36.56 19.79 86.02 19.79 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1590768 450 96368 ER AF IV INFUSION CONCURRENT 1 90.00 30.60 26.91 72.00 26.91 46.13 65.34 63.00 70.20 67.50 35.10 72.00 63.00 67.50 1592950 450 92950 ER CARDIOPULMONARY RESUSCITATION 1 710.91 241.71 237.00 568.73 426.55 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 1593005 730 93005 ER EKG-12 LEAD 1 149.63 50.87 10.83 119.70 10.83 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 1593041 730 93041 ER RHYTHM STRIP W/O EKG 1 149.63 50.87 7.27 119.70 7.27 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 1596376 450 96376 ER AF IV PUSH E ADDT SAME DRUG > 30 MIN 1 10.00 3.40 3.90 19.28 19.28 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1599175 450 99175 ER IPECAC ADM AND OBSERVATION 1 50.00 17.00 19.50 40.00 21.50 25.63 36.30 35.00 39.00 37.50 19.50 40.00 35.00 37.50 1599180 450 96372 ER AF INJ SC/IM 1 166.59 56.64 32.69 133.27 32.69 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1599182 450 96374 ER AF IV PUSH INITIAL 1 547.06 186.00 72.80 437.65 72.80 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1599183 450 96365 ER AF IV INFUSION INITIAL UP TO 1 HR 1 547.06 186.00 88.53 437.65 88.53 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1599184 450 96366 ER AF IV INFUSION EACH ADDITIONAL HR 1 107.53 36.56 24.74 86.02 24.74 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1599185 450 96367 ER AF IV INFUSION ADDT SEQUENTIAL TO 1 H 1 166.59 56.64 39.63 133.27 39.63 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1599186 450 96375 ER AF IV PUSH EACH ADDT DIFF DRUG 1 107.53 36.56 28.74 86.02 28.74 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1599292 450 99292 ER CRITICAL CARE EACH ADDT 30 MINUTES 1 600.00 204.00 234.00 480.00 360.00 307.50 435.60 420.00 468.00 450.00 234.00 480.00 420.00 450.00 1700243 771 M0243 OP AF REGENERON INF AND POST MONITORING 1 932.25 316.97 278.49 745.80 559.35 477.78 676.81 652.58 727.16 699.19 556.98 745.80 652.58 278.49 699.19 473.43 445.58 1701180 761 96365 OP AF IV INFUSION INITIAL UP TO 1 HR 1 547.06 186.00 88.53 437.65 88.53 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1701183 260 96523 OP AF IRRIGATION PORT NO MEDS GIVEN 1 149.63 50.87 39.39 119.70 39.39 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 1701190 761 96366 OP AF IV INFUSION EACH ADDITIONAL HR 1 107.53 36.56 24.74 86.02 24.74 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1701191 761 96372 OP AF INJ SC/IM 1 166.59 56.64 32.69 133.27 32.69 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1701193 761 96374 OP AF IV PUSH INITIAL 1 547.06 186.00 72.80 437.65 72.80 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1701194 761 96375 OP AF IV PUSH EACH ADDT DIFF DRUG 1 107.53 36.56 28.74 86.02 28.74 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1701195 761 96367 OP AF IV INFUSION ADDT SEQUENT TO 1 HR 1 166.59 56.64 39.63 133.27 39.63 85.38 120.94 116.61 129.94 124.94 111.08 133.27 116.61 55.54 124.94 94.42 88.86 1703014 780 Q3014 OP TELEPSYCH FACILITY FEE 1 60.00 20.40 17.57 48.00 17.57 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1706135 510 GO463 OP NEW PATIENT CLINIC VISIT 1 100.00 34.00 39.00 80.00 60.00 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 1706136 510 99211 OP EST PATIENT CLINIC VISIT 1 100.00 34.00 39.00 80.00 60.00 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 1706140 780 Q3014 OP TELEHEALTH FACILITY FEE 1 60.00 20.40 17.57 48.00 17.57 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 1790760 761 96360 OP AF HYDRATION INF INITIAL 31 M - 1 HR 1 547.06 186.00 73.02 437.65 73.02 280.37 397.17 382.94 426.71 410.30 364.76 437.65 382.94 182.38 410.30 310.05 291.81 1790761 761 96361 OP AF HYDRATION INFUSION E ADDT HR 1 107.53 36.56 19.79 86.02 19.79 55.11 78.07 75.27 83.87 80.65 71.70 86.02 75.27 35.85 80.65 60.95 57.36 1790768 260 96368 OP AF IV INFUSION CONCURRENT 1 90.00 30.60 26.91 72.00 26.91 46.13 65.34 63.00 70.20 67.50 35.10 72.00 63.00 67.50 1796376 260 96376 OP AF IV PUSH E ADDT SAME DRUG > 30 MIN 1 10.00 3.40 3.90 19.28 19.28 5.13 7.26 7.00 7.80 7.50 3.90 8.00 7.00 7.50 1799211 761 99211 OP EST PATIENT VISIT LEV 1 1 100.00 34.00 39.00 80.00 60.00 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 1903014 780 Q3014 IP TELEPSYCH FACILITY FEE 1 60.00 20.40 17.57 48.00 17.57 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 20020020 915 90853 PROCESS GROUP THERAPY 1 100.00 34.00 39.00 80.00 41.20 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 20020022 915 90853 FOCUS GROUP THERAPY 1 100.00 34.00 39.00 80.00 41.20 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 20020026 916 90847 FAMILY THERAPY WITH PATIENT 1 175.00 59.50 68.25 140.00 84.46 89.69 127.05 122.50 136.50 131.25 68.25 140.00 122.50 131.25 20020027 916 90846 FAMILY THERAPY WITHOUT PATIENT 1 175.00 59.50 68.25 140.00 84.46 89.69 127.05 122.50 136.50 131.25 68.25 140.00 122.50 131.25 20020029 914 90832 PSYCHOTHERAPY 30 MIN 1 95.00 32.30 37.05 76.00 46.35 48.69 68.97 66.50 74.10 71.25 37.05 76.00 66.50 71.25 20020030 914 90834 PSYCHOTHERAPY 45 MIN 1 125.00 42.50 48.75 100.00 82.40 64.06 90.75 87.50 97.50 93.75 48.75 100.00 87.50 93.75 210004 361 10004 NS2 FINE NEEDLE ASP BX WO IMG E ADDT LES 1 367.00 124.78 143.13 497.00 497.00 188.09 266.44 256.90 286.26 275.25 143.13 293.60 256.90 275.25 210021 361 10021 NS2 FINE NEEDLE ASP BX WO IMG 1ST LESION 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 697.28 526.90 495.90 210060 361 10060 NS2 INC AND DRAINAGE ABSCESS SIMPLE OR S 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 210061 361 10061 NS2 INC AND DRAINAGE ABSCESS COMP OR MUL 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 697.28 526.90 495.90 211422 361 11422 NS2 EXC LESION H-F-NK-SP B9 1.1 - 2.0 CM 1 " 3,782.35 " " 1,286.00 " 497.00 " 3,025.88 " 497.00 " 1,938.45 " " 2,745.99 " " 2,647.65 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.88 " " 2,647.65 " " 1,260.95 " " 2,836.76 " " 2,143.62 " " 2,017.52 " 2211008 272 A4217 WATER STERILE FOR IRRIG 1000ML 1 65.00 22.10 2.60 52.00 2.60 33.31 47.19 45.50 50.70 48.75 25.35 52.00 45.50 48.75 2211014 272 A4217 WATER STERILE FOR IRRIG 2000ML 1 37.00 12.58 2.60 29.60 2.60 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2218940 258 J7030 SODIUM CHLOR 0.9% 250ML BAG 1 117.00 39.78 2.61 93.60 2.61 59.96 84.94 81.90 91.26 87.75 45.63 93.60 81.90 87.75 2219711 636 J7100 DEXTRAN-40 10% 500ML [NOT DEXTROSE 10] 1 156.00 53.04 31.84 124.80 31.84 79.95 113.26 109.20 121.68 117.00 60.84 124.80 109.20 117.00 2237024 636 J3490 AMINO ACIDS (TRAVASOL) 8.5% 1000ML 1 169.00 57.46 65.91 135.20 101.40 86.61 122.69 118.30 131.82 126.75 65.91 135.20 118.30 126.75 2248337 636 J3490 SOLUTION DEX 5% 100ML AV 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 2248339 258 J3490 0.9% NACL SOLUTION 50ML 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 2248341 258 J3490 0.9% NACL SOLUTION 100 ML 1 7.00 2.38 2.73 5.60 4.20 3.59 5.08 4.90 5.46 5.25 2.73 5.60 4.90 5.25 2249030 258 J3490 SODIUM CHLOR 0.45% 1000ML (1/2NS) BAG 1 117.00 39.78 45.63 93.60 70.20 59.96 84.94 81.90 91.26 87.75 45.63 93.60 81.90 87.75 2259867 258 J3490 ***LACTATED RINGERS IRR 5000ML 1 27.48 9.34 10.72 21.98 16.49 14.08 19.95 19.24 21.43 20.61 10.72 21.98 19.24 20.61 2263299 272 A4217 WATER STERILE IRR 3000ML 1 58.00 19.72 2.60 46.40 2.60 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 2265027 258 J3490 LACTATED RINGERS IRRIG 3000ML 1 58.00 19.72 22.62 46.40 34.80 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 2270509 636 J3490 MANNITOL 20% 500ML 1 150.00 51.00 58.50 120.00 90.00 76.88 108.90 105.00 117.00 112.50 58.50 120.00 105.00 112.50 2275990 272 A4217 SOD CHL IRRIG 0.9% 250ML 1 3.00 1.02 1.17 2.60 2.60 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 2278241 636 J3490 SODIUM CHLOR 0.45% 500ML BAG (1/2NS) 1 100.00 34.00 39.00 80.00 60.00 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 2280635 272 A4217 SODIUM CHLORIDE IRRIG 0.9% 1000 ML 1 56.00 19.04 2.60 44.80 2.60 28.70 40.66 39.20 43.68 42.00 21.84 44.80 39.20 42.00 2283832 258 J3490 D5-.2% NACL 500ML 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 2284400 636 J7121 D5LR 1000ML 1 119.00 40.46 5.96 95.20 5.96 60.99 86.39 83.30 92.82 89.25 46.41 95.20 83.30 89.25 2284509 636 J3490 D5 IN SOD CHL 0.9% 500ML 1 107.00 36.38 41.73 85.60 64.20 54.84 77.68 74.90 83.46 80.25 41.73 85.60 74.90 80.25 2284616 258 J7042 D5 IN SOD CHL 0.9% 1000ML 2 58.50 19.89 1.88 46.80 1.88 29.98 42.47 40.95 45.63 43.88 22.82 46.80 40.95 43.88 2284814 258 J3490 D5 IN SOD CHL 0.45% 500ML 1 107.00 36.38 41.73 85.60 64.20 54.84 77.68 74.90 83.46 80.25 41.73 85.60 74.90 80.25 2284822 258 J3490 D5-0.45NACL 1000ML BAG 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 2285043 258 J7060 DEXTROSE 5% 250ML BAG 1 81.00 27.54 1.84 64.80 1.84 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2285092 258 J7060 DEXTROSE 5% 500ML 1 100.00 34.00 1.84 80.00 1.84 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 2285324 258 J7070 DEXTROSE 5% 1000ML BAG 1 128.00 43.52 3.64 102.40 3.64 65.60 92.93 89.60 99.84 96.00 49.92 102.40 89.60 96.00 2285653 258 J3490 DEXTROSE 5% 100ML BAG 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 2285654 258 J3490 DEXTROSE 5% 50ML BAG 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 2285655 258 J3490 SODIUM CHLOR 0.9% 100 ML (NS) 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 2285951 258 J7120 LACTATED RINGERS 1000 ML BAG 1 82.00 27.88 2.38 65.60 2.38 42.03 59.53 57.40 63.96 61.50 31.98 65.60 57.40 61.50 2285983 258 J7120 LACTATED RINGERS 1000 ML BAG (OPS) 1 82.00 27.88 2.38 65.60 2.38 42.03 59.53 57.40 63.96 61.50 31.98 65.60 57.40 61.50 2286710 258 J7040 SODIUM CHLOR 0.9% 500ML BAG 1 117.00 39.78 1.31 93.60 1.31 59.96 84.94 81.90 91.26 87.75 45.63 93.60 81.90 87.75 2286819 258 J7030 SODIUM CHLOR 0.9% 1000ML BAG 1 117.00 39.78 2.61 93.60 2.61 59.96 84.94 81.90 91.26 87.75 45.63 93.60 81.90 87.75 2287090 636 J3490 D10W 500ML [NOT DEXTRAN] 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 45.00 2287650 636 J3490 GLYCINE 1.5% 3000ML BAG 1 58.00 19.72 22.62 46.40 34.80 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 2287895 272 A4217 SOD CHL IRRIG 0.9% 3000ML 1 58.00 19.72 2.60 46.40 2.60 29.73 42.11 40.60 45.24 43.50 22.62 46.40 40.60 43.50 2288047 636 J3490 NORMOSOL-R PH 7.4 1000ML 1 66.00 22.44 25.74 52.80 39.60 33.83 47.92 46.20 51.48 49.50 25.74 52.80 46.20 49.50 2288294 272 A4217 WATER STERILE IRRIG 250ML 1 3.00 1.02 1.17 2.60 2.60 1.54 2.18 2.10 2.34 2.25 1.17 2.40 2.10 2.25 231500 361 31500 NS2 INTUBATION ENDOTRACHEAL EMERGENCY 1 568.83 193.40 189.64 497.00 497.00 291.53 412.97 398.18 443.69 426.62 379.28 455.06 398.18 189.64 426.62 322.39 303.42 232554 361 32554 NS2 THORACENTESIS WO IMAGING 1 " 1,456.00 " 495.04 485.40 " 1,164.80 " 497.00 746.20 " 1,057.06 " " 1,019.20 " " 1,135.68 " " 1,092.00 " 970.80 " 1,164.80 " " 1,019.20 " 485.40 " 1,092.00 " 825.18 776.64 236556 361 36556 NS2 INSERT NON TUNNEL CV CATH 1 " 7,692.83 " " 2,615.56 " 497.00 " 6,154.26 " 497.00 " 3,942.58 " " 5,584.99 " " 5,384.98 " " 6,000.41 " " 5,769.62 " " 5,129.24 " " 6,154.26 " " 5,384.98 " " 2,564.62 " " 5,769.62 " " 4,359.85 " " 4,103.39 " 236569 361 36569 NS2 PICC LINE INSERTION 5 AND UP 1 " 3,780.04 " " 1,285.21 " 497.00 " 3,024.03 " 497.00 " 1,937.27 " " 2,744.31 " " 2,646.03 " " 2,948.43 " " 2,835.03 " " 2,520.36 " " 3,024.03 " " 2,646.03 " " 1,260.18 " " 2,835.03 " " 2,142.31 " " 2,016.29 " 2400358 278 C1713 SCREW SYNTHES 209.880 1 291.48 99.10 113.68 233.18 134.20 149.38 211.61 204.04 227.35 218.61 113.68 233.18 204.04 218.61 2400360 278 C1713 SCREW SYNTHES 209.870 1 291.48 99.10 113.68 233.18 134.20 149.38 211.61 204.04 227.35 218.61 113.68 233.18 204.04 218.61 2400366 278 C1713 SCREW SYNTHES 209.875 1 291.48 99.10 113.68 233.18 134.20 149.38 211.61 204.04 227.35 218.61 113.68 233.18 204.04 218.61 2400368 278 C1713 SCREW SYNTHES 202.820 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2400372 278 C1713 SCREW SYNTHES 201.814 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2400376 278 C1713 SCREW SYNTHES 219.98 1 41.25 14.03 16.09 134.20 134.20 21.14 29.95 28.88 32.18 30.94 16.09 33.00 28.88 30.94 2400377 278 C1713 SCREW SYNTHES 201.810 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2400645 278 C1713 SCREW CANCELLOUS 32MM X 3.0 1 370.00 125.80 134.20 296.00 134.20 189.63 268.62 259.00 288.60 277.50 144.30 296.00 259.00 277.50 2401094 278 C1713 PLATE SYNTHES 243.13 1 73.75 25.08 28.76 134.20 134.20 37.80 53.54 51.63 57.53 55.31 28.76 59.00 51.63 55.31 2401095 278 C1713 PLATE SYNTHES 243.14 1 81.25 27.63 31.69 134.20 134.20 41.64 58.99 56.88 63.38 60.94 31.69 65.00 56.88 60.94 2402717 278 C1713 SCREW LAG KEY FREE 3 1 470.00 159.80 134.20 376.00 134.20 240.88 341.22 329.00 366.60 352.50 183.30 376.00 329.00 352.50 2402723 278 C1713 SCREW LAG KEY FREE 3 1/4 1 439.00 149.26 134.20 351.20 134.20 224.99 318.71 307.30 342.42 329.25 171.21 351.20 307.30 329.25 2402726 278 C1713 SCREW LAG KEY FREE 3 1/2 1 470.00 159.80 134.20 376.00 134.20 240.88 341.22 329.00 366.60 352.50 183.30 376.00 329.00 352.50 2405769 636 Q4101 APLIGRAF NOVARTIS 1 " 2,100.00 " 714.00 30.86 " 1,680.00 " 30.86 " 1,076.25 " " 1,524.60 " " 1,470.00 " " 1,638.00 " " 1,575.00 " 819.00 " 1,680.00 " " 1,470.00 " " 1,575.00 " 2406218 278 C1713 PLATE SYNTHES 248.07 1 292.00 99.28 113.88 233.60 134.20 149.65 211.99 204.40 227.76 219.00 113.88 233.60 204.40 219.00 2406662 278 C1713 SCREW SYNTHES 206.022 1 28.00 9.52 10.92 134.20 134.20 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 2406664 278 C1713 SCREW SYNTHES 206.028 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2406665 278 C1713 SCREW SYNTHES 206.032 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2406667 278 C1713 SCREW SYNTHES 214.026 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2406668 278 C1713 SCREW SYNTHES 214.032 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2406670 278 C1713 SCREW SYNTHES 214.034 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2406718 278 C1713 SCREW SYNTHES 206.026 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2406808 278 C1713 SCREW SYNTHES 214.036 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2406809 278 C1713 SCREW SYNTHES 215.050 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407028 278 C1713 SCREW SYNTHES 207.040 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2407029 278 C1713 SCREW SYNTHES 207.050 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2407556 278 C1713 SCREW SYNTHES 214.016 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407557 278 C1713 SCREW SYNTHES 214.018 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407558 278 C1713 SCREW SYNTHES 215.025 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407620 278 C1713 SCREW SYNTHES 214.014 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407622 278 C1713 SCREW SYNTHES 214.020 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407623 278 C1713 SCREW SYNTHES 214.022 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407624 278 C1713 SCREW SYNTHES 214.024 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407625 278 C1713 SCREW SYNTHES 214.028 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407626 278 C1713 SCREW SYNTHES 214.038 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2407628 278 C1713 SCREW SYNTHES 214.040 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2407629 278 C1713 SCREW SYNTHES 214.042 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407630 278 C1713 SCREW SYNTHES 214.044 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407631 278 C1713 SCREW SYNTHES 214.046 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2407633 278 C1713 SCREW SYNTHES 214.048 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2407635 278 C1713 SCREW SYNTHES 214.056 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2407636 278 C1713 SCREW SYNTHES 214.060 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407637 278 C1713 SCREW SYNTHES 214.064 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407638 278 C1713 SCREW SYNTHES 214.070 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2407639 278 C1713 SCREW SYNTHES 215.030 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407641 278 C1713 SCREW SYNTHES 215.035 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407642 278 C1713 SCREW SYNTHES 215.040 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407643 278 C1713 SCREW SYNTHES 215.045 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407644 278 C1713 SCREW SYNTHES 215.055 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407645 278 C1713 SCREW SYNTHES 215.060 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407646 278 C1713 SCREW SYNTHES 215.065 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407648 278 C1713 SCREW SYNTHES 215.070 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2407649 278 C1713 SCREW SYNTHES 217.095 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2408266 278 C1713 SCREW SYNTHES 214.030 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2408342 278 C1713 PLATE SYNTHES 224.12 1 297.00 100.98 115.83 237.60 134.20 152.21 215.62 207.90 231.66 222.75 115.83 237.60 207.90 222.75 2408343 278 C1713 PLATE SYNTHES 226.14 1 282.00 95.88 109.98 225.60 134.20 144.53 204.73 197.40 219.96 211.50 109.98 225.60 197.40 211.50 2408411 278 C1713 SCREW SYNTHES 206.020 1 28.00 9.52 10.92 134.20 134.20 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 2408426 278 C1713 SCREW SYNTHES 200.807 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2408429 278 C1713 SCREW SYNTHES 200.808 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2408430 278 C1713 SCREW SYNTHES 200.809 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2408433 278 C1713 SCREW SYNTHES 200.811 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2408436 278 C1713 SCREW SYNTHES 200.814 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2408437 278 C1713 SCREW SYNTHES 200.816 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2408446 278 C1713 SCREW SYNTHES 202.806 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2408448 278 C1713 SCREW SYNTHES 202.810 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2408456 278 C1713 PLATE SYNTHES 243.34 1 73.75 25.08 28.76 134.20 134.20 37.80 53.54 51.63 57.53 55.31 28.76 59.00 51.63 55.31 2408457 278 C1713 PLATE SYNTHES 242.41 1 73.75 25.08 28.76 134.20 134.20 37.80 53.54 51.63 57.53 55.31 28.76 59.00 51.63 55.31 2408458 278 C1713 PLATE SYNTHES 243.33 1 73.75 25.08 28.76 134.20 134.20 37.80 53.54 51.63 57.53 55.31 28.76 59.00 51.63 55.31 2408459 278 C1713 PLATE SYNTHES 243.14 1 81.25 27.63 31.69 134.20 134.20 41.64 58.99 56.88 63.38 60.94 31.69 65.00 56.88 60.94 2408460 278 C1713 PLATE SYNTHES 243.41 1 73.75 25.08 28.76 134.20 134.20 37.80 53.54 51.63 57.53 55.31 28.76 59.00 51.63 55.31 2408463 278 C1713 SCREW SYNTHES 206.016 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2408464 278 C1713 SCREW SYNTHES 206.018 1 28.00 9.52 10.92 134.20 134.20 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 2408465 278 C1713 SCREW SYNTHES 206.024 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2408466 278 C1713 SCREW SYNTHES 206.036 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2408467 278 C1713 SCREW SYNTHES 206.040 1 28.00 9.52 10.92 134.20 134.20 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 2408469 278 C1713 SCREW SYNTHES 207.012 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408470 278 C1713 SCREW SYNTHES 207.014 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408471 278 C1713 SCREW SYNTHES 207.016 1 31.00 10.54 12.09 134.20 134.20 15.89 22.51 21.70 24.18 23.25 12.09 24.80 21.70 23.25 2408472 278 C1713 SCREW SYNTHES 207.018 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408473 278 C1713 SCREW SYNTHES 207.020 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408474 278 C1713 SCREW SYNTHES 207.022 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408476 278 C1713 SCREW SYNTHES 207.026 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408477 278 C1713 SCREW SYNTHES 207.028 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408478 278 C1713 SCREW SYNTHES 207.030 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408479 278 C1713 SCREW SYNTHES 207.035 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2408480 278 C1713 SCREW SYNTHES 207.045 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2409435 278 C1713 SCREW SYNTHES 207.024 1 37.00 12.58 14.43 134.20 134.20 18.96 26.86 25.90 28.86 27.75 14.43 29.60 25.90 27.75 2410704 278 C1713 WASHER SYNTHES 219.99 1 39.99 13.60 15.60 134.20 134.20 20.49 29.03 27.99 31.19 29.99 15.60 31.99 27.99 29.99 2411024 278 C1788 PORT HICKMAN #60215 W/CA 1 " 1,116.00 " 379.44 19.03 892.80 19.03 571.95 810.22 781.20 870.48 837.00 435.24 892.80 781.20 837.00 2411028 278 C1788 PORT HICKMAN POWERPORT 6F 1 " 1,116.00 " 379.44 19.03 892.80 19.03 571.95 810.22 781.20 870.48 837.00 435.24 892.80 781.20 837.00 2412009 278 C1713 SCREW CORTICAL SELF TAPP 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2412011 278 C1713 SCREW CORTICAL SELF TAPP 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2412012 278 C1713 SCREW CORTICAL TP 4.5MM 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2412015 278 C1713 SCREW CORTICAL SELF TAPP 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2412016 278 C1713 SCREW CORTICAL SELF TAPP 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2412017 278 C1713 SCREW CORTICAL SELF TAPP 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2412940 278 C1713 WIRE SYNTHES 291.05 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2412941 278 C1713 WIRE SYNTHES 291.06 1 69.00 23.46 26.91 134.20 134.20 35.36 50.09 48.30 53.82 51.75 26.91 55.20 48.30 51.75 2412942 278 C1713 WIRE SYNTHES 291.09 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2413673 278 C1713 PLATE SYNTHES 248.10 1 279.00 94.86 108.81 223.20 134.20 142.99 202.55 195.30 217.62 209.25 108.81 223.20 195.30 209.25 2413680 278 C1713 PLATE SYNTHES 241.23 1 353.00 120.02 134.20 282.40 134.20 180.91 256.28 247.10 275.34 264.75 137.67 282.40 247.10 264.75 2413681 278 C1713 PLATE SYNTHES 241.25 1 383.00 130.22 134.20 306.40 134.20 196.29 278.06 268.10 298.74 287.25 149.37 306.40 268.10 287.25 2416275 278 C1781 MESH 3DMAX 3.3 X 5.4 1 256.00 87.04 69.35 204.80 69.35 131.20 185.86 179.20 199.68 192.00 99.84 204.80 179.20 192.00 2416767 278 C1713 SCREW SYNTHES 280.65 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416768 278 C1713 SCREW SYNTHES 280.70 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416769 278 C1713 SCREW SYNTHES 280.75 LAG 1 410.00 139.40 134.20 328.00 134.20 210.13 297.66 287.00 319.80 307.50 159.90 328.00 287.00 307.50 2416770 278 C1713 SCREW SYNTHES 280.80 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416771 278 C1713 SCREW SYNTHES 280.85 LAG 1 410.00 139.40 134.20 328.00 134.20 210.13 297.66 287.00 319.80 307.50 159.90 328.00 287.00 307.50 2416772 278 C1713 SCREW SYNTHES 280.90 LAG 1 434.00 147.56 134.20 347.20 134.20 222.43 315.08 303.80 338.52 325.50 169.26 347.20 303.80 325.50 2416773 278 C1713 SCREW SYNTHES 280.95 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416774 278 C1713 SCREW SYNTHES 280.00 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416775 278 C1713 SCREW SYNTHES 280.05 LAG 1 410.00 139.40 134.20 328.00 134.20 210.13 297.66 287.00 319.80 307.50 159.90 328.00 287.00 307.50 2416776 278 C1713 SCREW SYNTHES 280.10 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416777 278 C1713 SCREW SYNTHES 280.15 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416778 278 C1713 SCREW SYNTHES 280.20 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416779 278 C1713 SCREW SYNTHES 280.25 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416780 278 C1713 SCREW SYNTHES 280.30 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416781 278 C1713 SCREW SYNTHES 280.35 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416782 278 C1713 SCREW SYNTHES 280.40 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416783 278 C1713 SCREW SYNTHES 280.45 LAG 1 482.00 163.88 134.20 385.60 134.20 247.03 349.93 337.40 375.96 361.50 187.98 385.60 337.40 361.50 2416810 278 L8699 ANCHOR IMPLANT 1 580.00 197.20 226.20 464.00 348.00 297.25 421.08 406.00 452.40 435.00 226.20 464.00 406.00 435.00 2417191 276 V2632 LENS TORIC IQ 1 " 1,125.74 " 382.75 90.43 900.59 90.43 576.94 817.29 788.02 878.08 844.31 439.04 900.59 788.02 844.31 2417671 278 L8610 OCULAR IMPLANT TUTOPLAST PERICARDIUM 1 510.00 173.40 198.90 441.00 441.00 261.38 370.26 357.00 397.80 382.50 198.90 408.00 357.00 382.50 2417673 278 C1783 OCULAR IMPLANT GLAUCOMA VALVE 1 " 1,190.00 " 404.60 368.68 952.00 368.68 609.88 863.94 833.00 928.20 892.50 464.10 952.00 833.00 892.50 2421850 278 C1713 ORTHOSORB 1.3 1 213.24 72.50 83.16 170.59 134.20 109.29 154.81 149.27 166.33 159.93 83.16 170.59 149.27 159.93 2421965 278 C1781 MESH VICRYL 12X12 1 354.00 120.36 69.35 283.20 69.35 181.43 257.00 247.80 276.12 265.50 138.06 283.20 247.80 265.50 2422193 278 C1713 SCREW CORTICAL SELF TAP 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2422194 278 C1713 SCREW CORTICAL SELF TAP 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2422846 278 C1713 SCREW SYNTHES 206.045 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2422848 278 C1713 SCREW SYNTHES 206.050 1 28.00 9.52 10.92 134.20 134.20 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 2422850 278 C1713 SCREW SYNTHES 206.055 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2422851 278 C1713 SCREW SYNTHES 206.060 1 34.00 11.56 13.26 134.20 134.20 17.43 24.68 23.80 26.52 25.50 13.26 27.20 23.80 25.50 2422852 278 C1713 SCREW SYNTHES 214.054 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2422853 278 C1713 SCREW SYNTHES 214.058 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2422863 278 C1713 SCREW SYNTHES 280.99 LAG 1 41.00 13.94 15.99 134.20 134.20 21.01 29.77 28.70 31.98 30.75 15.99 32.80 28.70 30.75 2425517 278 C1713 PLATE SYNTHES 281.24 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2425518 278 C1713 PLATE SYNTHES 281.25 1 667.00 226.78 134.20 533.60 134.20 341.84 484.24 466.90 520.26 500.25 260.13 533.60 466.90 500.25 2425526 278 C1713 PLATE SYNTHES 281.26 1 667.00 226.78 134.20 533.60 134.20 341.84 484.24 466.90 520.26 500.25 260.13 533.60 466.90 500.25 2425527 278 C1713 PLATE SYNTHES 281.34 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2425529 278 C1713 PLATE SYNTHES 281.35 1 832.00 282.88 134.20 665.60 134.20 426.40 604.03 582.40 648.96 624.00 324.48 665.60 582.40 624.00 2425530 278 C1713 PLATE SYNTHES 281.36 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2425532 278 C1713 PLATE SYNTHES 281.46 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2426168 278 C1713 ANCHOR MITEX 212393 1 265.00 90.10 103.35 212.00 134.20 135.81 192.39 185.50 206.70 198.75 103.35 212.00 185.50 198.75 2430304 278 C1713 PLATE SYNTHES 281.14 1 667.00 226.78 134.20 533.60 134.20 341.84 484.24 466.90 520.26 500.25 260.13 533.60 466.90 500.25 2430305 278 C1713 PLATE SYNTHES 281.15 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2430306 278 C1713 PLATE SYNTHES 281.16 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2430307 278 C1768 GRAFT GORE TEX 8MM 1 " 1,162.00 " 395.08 322.77 929.60 322.77 595.53 843.61 813.40 906.36 871.50 453.18 929.60 813.40 871.50 2430606 278 C1768 GRAFT GORE TEX 6MM 1 " 1,162.00 " 395.08 322.77 929.60 322.77 595.53 843.61 813.40 906.36 871.50 453.18 929.60 813.40 871.50 2430659 278 C1713 SCREW COMPRESSION HEX HE 1 67.00 22.78 26.13 134.20 134.20 34.34 48.64 46.90 52.26 50.25 26.13 53.60 46.90 50.25 2431233 278 C1713 SCREW SYNTHES 204.026 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431234 278 C1713 SCREW SYNTHES 204.028 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431235 278 C1713 SCREW SYNTHES 204.032 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431236 278 C1713 SCREW SYNTHES 204.036 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431240 278 C1713 SCREW SYNTHES 204.022 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431241 278 C1713 SCREW SYNTHES 204.024 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431242 278 C1713 SCREW SYNTHES 204.014 1 25.00 8.50 9.75 134.20 134.20 12.81 18.15 17.50 19.50 18.75 9.75 20.00 17.50 18.75 2431245 278 C1713 SCREW SYNTHES 204.010 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431246 278 C1713 SCREW SYNTHES 204.050 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431247 278 C1713 SCREW SYNTHES 204.045 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2431248 278 C1713 SCREW SYNTHES 204.040 1 29.00 9.86 11.31 134.20 134.20 14.86 21.05 20.30 22.62 21.75 11.31 23.20 20.30 21.75 2432209 278 C1713 PLATE SYNTHES 281.44 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2432213 278 C1713 PLATE SYNTHES 281.84 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2432216 278 C1713 PLATE SYNTHES 281.54 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2432217 278 C1713 PLATE SYNTHES 281.45 1 785.00 266.90 134.20 628.00 134.20 402.31 569.91 549.50 612.30 588.75 306.15 628.00 549.50 588.75 2432394 278 C1713 SCREW SYNTHES 280.50 1 338.00 114.92 131.82 270.40 134.20 173.23 245.39 236.60 263.64 253.50 131.82 270.40 236.60 253.50 2432395 278 C1713 SCREW SYNTHES 280.55 1 338.00 114.92 131.82 270.40 134.20 173.23 245.39 236.60 263.64 253.50 131.82 270.40 236.60 253.50 2432396 278 C1713 SCREW SYNTHES 280.60 1 263.00 89.42 102.57 210.40 134.20 134.79 190.94 184.10 205.14 197.25 102.57 210.40 184.10 197.25 2432398 278 C1713 PLATE SYNTHES 281.90 1 677.00 230.18 134.20 541.60 134.20 346.96 491.50 473.90 528.06 507.75 264.03 541.60 473.90 507.75 2432399 278 C1713 PLATE SYNTHES 281.92 1 763.00 259.42 134.20 610.40 134.20 391.04 553.94 534.10 595.14 572.25 297.57 610.40 534.10 572.25 2432400 278 C1713 PLATE SYNTHES 281.93 1 " 1,049.00 " 356.66 134.20 839.20 134.20 537.61 761.57 734.30 818.22 786.75 409.11 839.20 734.30 786.75 2432401 278 C1713 PLATE SYNTHES 281.94 1 816.00 277.44 134.20 652.80 134.20 418.20 592.42 571.20 636.48 612.00 318.24 652.80 571.20 612.00 2432404 278 C1713 PLATE SYNTHES 281.96 1 677.00 230.18 134.20 541.60 134.20 346.96 491.50 473.90 528.06 507.75 264.03 541.60 473.90 507.75 2432405 278 C1713 PLATE SYNTHES 281.98 1 721.00 245.14 134.20 576.80 134.20 369.51 523.45 504.70 562.38 540.75 281.19 576.80 504.70 540.75 2432407 278 C1713 PLATE SYNTHES 281.10 1 854.00 290.36 134.20 683.20 134.20 437.68 620.00 597.80 666.12 640.50 333.06 683.20 597.80 640.50 2432408 278 C1713 PLATE SYNTHES 281.11 1 854.00 290.36 134.20 683.20 134.20 437.68 620.00 597.80 666.12 640.50 333.06 683.20 597.80 640.50 2432410 278 C1713 PLATE SYNTHES 281.18 1 854.00 290.36 134.20 683.20 134.20 437.68 620.00 597.80 666.12 640.50 333.06 683.20 597.80 640.50 2432411 278 C1713 PLATE SYNTHES 281.40 1 854.00 290.36 134.20 683.20 134.20 437.68 620.00 597.80 666.12 640.50 333.06 683.20 597.80 640.50 2432413 278 C1713 PLATE SYNTHES 281.48 1 854.00 290.36 134.20 683.20 134.20 437.68 620.00 597.80 666.12 640.50 333.06 683.20 597.80 640.50 2433553 278 C1713 SCREW SYNTHES 218.025 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2433557 278 C1713 SCREW SYNTHES 218.030 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2433559 278 C1713 SCREW SYNTHES 218.035 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2433560 278 C1713 SCREW SYNTHES 218.040 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2434024 278 C1768 GRAFT GORE TEX 7MM 1 " 1,162.00 " 395.08 322.77 929.60 322.77 595.53 843.61 813.40 906.36 871.50 453.18 929.60 813.40 871.50 2434136 278 C1713 HOWMEDIC KWIRE1210-6-450 1 114.75 39.02 44.75 134.20 134.20 58.81 83.31 80.33 89.51 86.06 44.75 91.80 80.33 86.06 2434142 278 C1713 HOWMED G WIRE 702-3-365 1 284.40 96.70 110.92 227.52 134.20 145.76 206.47 199.08 221.83 213.30 110.92 227.52 199.08 213.30 2434542 278 C1781 MESH COMPOSIX E/X 1 " 2,425.00 " 824.50 69.35 " 1,940.00 " 69.35 " 1,242.81 " " 1,760.55 " " 1,697.50 " " 1,891.50 " " 1,818.75 " 945.75 " 1,940.00 " " 1,697.50 " " 1,818.75 " 2434686 278 C1713 ANCHOR ULTRAFIX 10282 1 430.00 146.20 134.20 344.00 134.20 220.38 312.18 301.00 335.40 322.50 167.70 344.00 301.00 322.50 2434687 278 C1713 ANCHOR ULTRAFIX 10175 1 352.80 119.95 134.20 282.24 134.20 180.81 256.13 246.96 275.18 264.60 137.59 282.24 246.96 264.60 2434948 278 C1713 SCREW STRYKER 3370-5-040 1 234.00 79.56 91.26 187.20 134.20 119.93 169.88 163.80 182.52 175.50 91.26 187.20 163.80 175.50 2434950 278 C1713 SCREW STRYKER 33702-090 1 419.40 142.60 134.20 335.52 134.20 214.94 304.48 293.58 327.13 314.55 163.57 335.52 293.58 314.55 2436054 278 C1713 NAIL HOWMEDICA 3370-7-035 1 " 1,404.00 " 477.36 134.20 " 1,123.20 " 134.20 719.55 " 1,019.30 " 982.80 " 1,095.12 " " 1,053.00 " 547.56 " 1,123.20 " 982.80 " 1,053.00 " 2436859 278 C1713 PLATE SYNTHES 242.03 1 87.50 29.75 34.13 134.20 134.20 44.84 63.53 61.25 68.25 65.63 34.13 70.00 61.25 65.63 2436860 278 C1713 PLATE SYNTHES 242.08 1 122.50 41.65 47.78 134.20 134.20 62.78 88.94 85.75 95.55 91.88 47.78 98.00 85.75 91.88 2436861 278 C1713 PLATE SYNTHES 242.05 1 100.00 34.00 39.00 134.20 134.20 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 2436872 278 C1713 PLATE SYNTHES 242.04 1 93.75 31.88 36.56 134.20 134.20 48.05 68.06 65.63 73.13 70.31 36.56 75.00 65.63 70.31 2436873 278 C1713 PLATE SYNTHES 242.07 1 115.00 39.10 44.85 134.20 134.20 58.94 83.49 80.50 89.70 86.25 44.85 92.00 80.50 86.25 2436877 278 C1713 PLATE SYNTHES 242.06 1 110.00 37.40 42.90 134.20 134.20 56.38 79.86 77.00 85.80 82.50 42.90 88.00 77.00 82.50 2436915 278 C1713 PLATE SYNTHES 240.007 1 " 1,186.00 " 403.24 134.20 948.80 134.20 607.83 861.04 830.20 925.08 889.50 462.54 948.80 830.20 889.50 2436916 278 C1713 PLATE SYNTHES 240.005 1 " 1,186.00 " 403.24 134.20 948.80 134.20 607.83 861.04 830.20 925.08 889.50 462.54 948.80 830.20 889.50 2436926 278 C1713 PLATE SYNTHES 240.004 1 " 1,186.00 " 403.24 134.20 948.80 134.20 607.83 861.04 830.20 925.08 889.50 462.54 948.80 830.20 889.50 2436927 278 C1713 PLATE SYNTHES 240.006 1 " 1,186.00 " 403.24 134.20 948.80 134.20 607.83 861.04 830.20 925.08 889.50 462.54 948.80 830.20 889.50 243752 361 43752 NS2 NASO OR ORO-GASTRIC TUBE PLACEMENT 1 " 1,090.77 " 370.86 242.17 872.62 666.00 559.02 791.90 763.54 850.80 818.08 484.34 872.62 763.54 242.17 818.08 411.69 387.47 2437570 278 C1768 GRAFT GORE TEX PATCH 002 1 420.00 142.80 163.80 336.00 322.77 215.25 304.92 294.00 327.60 315.00 163.80 336.00 294.00 315.00 2437571 278 C1768 GRAFT GORE TEX PATCH 004 1 520.00 176.80 202.80 416.00 322.77 266.50 377.52 364.00 405.60 390.00 202.80 416.00 364.00 390.00 2441335 278 C1781 MESH ETHICON VKMM 1 250.00 85.00 69.35 200.00 69.35 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 2441375 278 C1713 EASYCLIP 10 X 15 X 13 1 " 1,370.00 " 465.80 134.20 " 1,096.00 " 134.20 702.13 994.62 959.00 " 1,068.60 " " 1,027.50 " 534.30 " 1,096.00 " 959.00 " 1,027.50 " 2443431 278 C1713 ANCHOR ULTRAFIX 10211 1 316.80 107.71 123.55 253.44 134.20 162.36 230.00 221.76 247.10 237.60 123.55 253.44 221.76 237.60 2443736 276 V2630 LENS MTA5UO 1 552.00 187.68 90.43 441.60 90.43 282.90 400.75 386.40 430.56 414.00 215.28 441.60 386.40 414.00 2444750 278 C1781 MESH MARLEX 1 40.00 13.60 15.60 69.35 69.35 20.50 29.04 28.00 31.20 30.00 15.60 32.00 28.00 30.00 2445600 278 C1781 MESH ETHICON #PMS PROLEN 1 72.00 24.48 28.08 69.35 69.35 36.90 52.27 50.40 56.16 54.00 28.08 57.60 50.40 54.00 2446059 278 C1713 WIRE KIRSCHNER .045 X 4 1 21.00 7.14 8.19 134.20 134.20 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 2446062 278 C1713 WIRE KIRSCHNER .062 X 4 1 21.00 7.14 8.19 134.20 134.20 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 2446170 278 C1713 SCREW SYNTHES 202.824 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2446172 278 C1713 SCREW SYNTHES 200.806 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2448653 636 Q4106 DERMAGRAFT 1 " 1,264.50 " 429.93 32.84 " 1,011.60 " 32.84 648.06 918.03 885.15 986.31 948.38 493.16 " 1,011.60 " 885.15 948.38 2449204 278 C1713 SCREW LAG FREE-LOCK #118 1 401.00 136.34 134.20 320.80 134.20 205.51 291.13 280.70 312.78 300.75 156.39 320.80 280.70 300.75 2449206 278 C1713 SCREW LAG FREE-LOCK #118 1 401.00 136.34 134.20 320.80 134.20 205.51 291.13 280.70 312.78 300.75 156.39 320.80 280.70 300.75 2457108 278 C1781 MESH PROLENE 6X6 1 205.65 69.92 69.35 164.52 69.35 105.40 149.30 143.96 160.41 154.24 80.20 164.52 143.96 154.24 2457424 278 C1713 PLATE SYNTHES 245.06 1 575.00 195.50 134.20 460.00 134.20 294.69 417.45 402.50 448.50 431.25 224.25 460.00 402.50 431.25 2458501 278 C1768 GRAFT DEBAKEY #005222 1 " 1,349.00 " 458.66 322.77 " 1,079.20 " 322.77 691.36 979.37 944.30 " 1,052.22 " " 1,011.75 " 526.11 " 1,079.20 " 944.30 " 1,011.75 " 2458651 278 C1713 SCREW DARCO HEADLESS 14MM 1 360.00 122.40 134.20 288.00 134.20 184.50 261.36 252.00 280.80 270.00 140.40 288.00 252.00 270.00 245999 361 45999 NS2 UNLISTED PROCEDURE RECTUM 1 " 2,133.52 " 725.40 711.27 " 1,706.82 " " 1,280.11 " " 1,093.43 " " 1,548.94 " " 1,493.46 " " 1,664.15 " " 1,600.14 " " 1,422.54 " " 1,706.82 " " 1,493.46 " 711.27 " 1,600.14 " " 1,209.16 " " 1,138.03 " 2460256 278 C1713 WIRE SYNTHES 291.13 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2463019 278 C1713 PLATE SYNTHES 241.32 1 82.00 27.88 31.98 134.20 134.20 42.03 59.53 57.40 63.96 61.50 31.98 65.60 57.40 61.50 2463021 278 C1713 PLATE SYNTHES 241.34 1 96.00 32.64 37.44 134.20 134.20 49.20 69.70 67.20 74.88 72.00 37.44 76.80 67.20 72.00 2463022 278 C1713 PLATE SYNTHES 241.35 1 96.00 32.64 37.44 134.20 134.20 49.20 69.70 67.20 74.88 72.00 37.44 76.80 67.20 72.00 2463026 278 C1713 PLATE SYNTHES 241.38 1 103.00 35.02 40.17 134.20 134.20 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 2463235 278 C1764 REVEAL LINQ INSERTABLE CARDIAC MONITOR 1 " 7,943.00 " " 2,700.62 " " 3,097.77 " " 6,354.40 " " 4,126.13 " " 4,070.79 " " 5,766.62 " " 5,560.10 " " 6,195.54 " " 5,957.25 " " 3,097.77 " " 6,354.40 " " 5,560.10 " " 5,957.25 " 2466104 276 V2632 LENS REZOOM 1 " 1,342.50 " 456.45 90.43 " 1,074.00 " 90.43 688.03 974.66 939.75 " 1,047.15 " " 1,006.88 " 523.58 " 1,074.00 " 939.75 " 1,006.88 " 2467547 278 C1713 SCREW CANCELLOUS 18MM X 3.0 1 370.00 125.80 134.20 296.00 134.20 189.63 268.62 259.00 288.60 277.50 144.30 296.00 259.00 277.50 2468421 276 V2632 LENS ACRY SOF RESTOR SA60AT 1 " 1,342.50 " 456.45 90.43 " 1,074.00 " 90.43 688.03 974.66 939.75 " 1,047.15 " " 1,006.88 " 523.58 " 1,074.00 " 939.75 " 1,006.88 " 2468561 278 C1713 WIRE K 1.2 X 100 1 360.00 122.40 134.20 288.00 134.20 184.50 261.36 252.00 280.80 270.00 140.40 288.00 252.00 270.00 2468694 278 C1713 SCREW CANCELLOUS 6.5 THR 1 76.00 25.84 29.64 134.20 134.20 38.95 55.18 53.20 59.28 57.00 29.64 60.80 53.20 57.00 2468698 278 C1713 SCREW CANCELLOUS 6.5 THR 1 72.00 24.48 28.08 134.20 134.20 36.90 52.27 50.40 56.16 54.00 28.08 57.60 50.40 54.00 2468720 278 C1713 SCREW CANCELLOUS 6.5 THR 1 76.00 25.84 29.64 134.20 134.20 38.95 55.18 53.20 59.28 57.00 29.64 60.80 53.20 57.00 2471793 278 C1713 PLATE SYNTHES 245.04 1 532.00 180.88 134.20 425.60 134.20 272.65 386.23 372.40 414.96 399.00 207.48 425.60 372.40 399.00 2476027 278 C1713 WIRE KIRSH 1 17.00 5.78 6.63 134.20 134.20 8.71 12.34 11.90 13.26 12.75 6.63 13.60 11.90 12.75 2477438 278 C1713 SCREW SYNTHES 200.812 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2477446 278 C1713 SCREW SYNTHES 202.816 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2477453 278 C1713 SCREW SYNTHES 202.812 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2477461 278 C1713 SCREW SYNTHES 201.812 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2478621 278 C1713 SCREW CORTICAL 4.5MM X 2 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2478623 278 C1713 SCREW CORTICAL 4.5MM X 2 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2478628 278 C1713 SCREW CORTICAL 4.5MM X 3 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2478629 278 C1713 SCREW CORTICAL 4.5MM X 3 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2478630 278 C1713 SCREW CORTICAL 4.5MM X 3 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2478631 278 C1713 SCREW CORTICAL 4.5MM X 3 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2478632 278 C1713 SCREW CORTICAL 4.5MM X 4 1 59.00 20.06 23.01 134.20 134.20 30.24 42.83 41.30 46.02 44.25 23.01 47.20 41.30 44.25 2479592 276 V2632 LENS MA30BA 1 250.00 85.00 90.43 200.00 90.43 128.13 181.50 175.00 195.00 187.50 97.50 200.00 175.00 187.50 2481508 278 C1781 MESH 3D MAX LG LEFT 1 274.00 93.16 69.35 219.20 69.35 140.43 198.92 191.80 213.72 205.50 106.86 219.20 191.80 205.50 2482239 278 C1713 SCREW SYNTHES 217.045 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2482240 278 C1713 SCREW SYNTHES 217.050 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2482241 278 C1713 SCREW SYNTHES 217.055 1 64.00 21.76 24.96 134.20 134.20 32.80 46.46 44.80 49.92 48.00 24.96 51.20 44.80 48.00 2482242 278 C1713 SCREW SYNTHES 217.060 1 64.00 21.76 24.96 134.20 134.20 32.80 46.46 44.80 49.92 48.00 24.96 51.20 44.80 48.00 2482243 278 C1713 SCREW SYNTHES 217.065 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2482244 278 C1713 SCREW SYNTHES 217.070 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2482245 278 C1713 SCREW SYNTHES 217.080 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2482246 278 C1713 SCREW SYNTHES 217.090 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2482248 278 C1713 PLATE SYNTHES 222.04 1 93.00 31.62 36.27 134.20 134.20 47.66 67.52 65.10 72.54 69.75 36.27 74.40 65.10 69.75 2482249 278 C1713 PLATE SYNTHES 222.05 1 96.00 32.64 37.44 134.20 134.20 49.20 69.70 67.20 74.88 72.00 37.44 76.80 67.20 72.00 2482250 278 C1713 PLATE SYNTHES 222.06 1 103.00 35.02 40.17 134.20 134.20 52.79 74.78 72.10 80.34 77.25 40.17 82.40 72.10 77.25 2482254 278 C1713 PLATE SYNTHES 240.05 1 272.00 92.48 106.08 217.60 134.20 139.40 197.47 190.40 212.16 204.00 106.08 217.60 190.40 204.00 2482255 278 C1713 PLATE SYNTHES 240.24 1 283.00 96.22 110.37 226.40 134.20 145.04 205.46 198.10 220.74 212.25 110.37 226.40 198.10 212.25 2482256 278 C1713 PLATE SYNTHES 224.04 1 201.00 68.34 78.39 160.80 134.20 103.01 145.93 140.70 156.78 150.75 78.39 160.80 140.70 150.75 2482257 278 C1713 PLATE SYNTHES 224.05 1 201.00 68.34 78.39 160.80 134.20 103.01 145.93 140.70 156.78 150.75 78.39 160.80 140.70 150.75 2482258 278 C1713 PLATE SYNTHES 224.06 1 229.00 77.86 89.31 183.20 134.20 117.36 166.25 160.30 178.62 171.75 89.31 183.20 160.30 171.75 2482259 278 C1713 PLATE SYNTHES 224.07 1 297.00 100.98 115.83 237.60 134.20 152.21 215.62 207.90 231.66 222.75 115.83 237.60 207.90 222.75 2482260 278 C1713 PLATE SUNTHES 224.08 1 229.00 77.86 89.31 183.20 134.20 117.36 166.25 160.30 178.62 171.75 89.31 183.20 160.30 171.75 2482261 278 C1713 PLATE SYNTHES 224.09 1 229.00 77.86 89.31 183.20 134.20 117.36 166.25 160.30 178.62 171.75 89.31 183.20 160.30 171.75 2482262 278 C1713 PLATE SYNTHES 224.10 1 297.00 100.98 115.83 237.60 134.20 152.21 215.62 207.90 231.66 222.75 115.83 237.60 207.90 222.75 2482263 278 C1713 PLATE SYNTHES 226.06 1 265.00 90.10 103.35 212.00 134.20 135.81 192.39 185.50 206.70 198.75 103.35 212.00 185.50 198.75 2482264 278 C1713 PLATE SYNTHES 226.07 1 265.00 90.10 103.35 212.00 134.20 135.81 192.39 185.50 206.70 198.75 103.35 212.00 185.50 198.75 2482265 278 C1713 PLATE SYNTHES 226.08 1 262.00 89.08 102.18 209.60 134.20 134.28 190.21 183.40 204.36 196.50 102.18 209.60 183.40 196.50 2482266 278 C1713 PLATE SYNTHES 226.09 1 262.00 89.08 102.18 209.60 134.20 134.28 190.21 183.40 204.36 196.50 102.18 209.60 183.40 196.50 2482267 278 C1713 PLATE SYNTHES 226.10 1 370.00 125.80 134.20 296.00 134.20 189.63 268.62 259.00 288.60 277.50 144.30 296.00 259.00 277.50 2482784 278 C1713 SCREW ASNIS MICRO 3.0 X 16MM 1 332.00 112.88 129.48 265.60 134.20 170.15 241.03 232.40 258.96 249.00 129.48 265.60 232.40 249.00 2482811 278 C1781 MESH 3D MAX LG RIGHT 1 274.00 93.16 69.35 219.20 69.35 140.43 198.92 191.80 213.72 205.50 106.86 219.20 191.80 205.50 2482965 278 C1713 SCREW CORTICAL 4.5MM X 5 1 56.00 19.04 21.84 134.20 134.20 28.70 40.66 39.20 43.68 42.00 21.84 44.80 39.20 42.00 2483651 278 C1713 MESH PROLENE 3 X 6 1 178.10 60.55 69.46 142.48 134.20 91.28 129.30 124.67 138.92 133.58 69.46 142.48 124.67 133.58 2484087 278 C1713 SCREW SYNTHES 214.050 1 32.00 10.88 12.48 134.20 134.20 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 2484088 278 C1713 SCREW SYNTHES 214.052 1 27.00 9.18 10.53 134.20 134.20 13.84 19.60 18.90 21.06 20.25 10.53 21.60 18.90 20.25 2484090 278 C1713 SCREW SYNTHES 216.030 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484091 278 C1713 SCREW SYNTHES 216.035 1 69.00 23.46 26.91 134.20 134.20 35.36 50.09 48.30 53.82 51.75 26.91 55.20 48.30 51.75 2484092 278 C1713 SCREW SYNTHES 216.040 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484093 278 C1713 SCREW SYNTHES 216.045 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484094 278 C1713 SCREW SYNTHES 216.050 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484095 278 C1713 SCREW SYNTHES 216.055 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484096 278 C1713 SCREW SYNTHES 216.060 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484097 278 C1713 SCREW SYNTHES 216.065 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484098 278 C1713 SCREW SYNTHES 216.070 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484099 278 C1713 SCREW SYNTHES 216.075 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484100 278 C1713 SCREW SYNTHES 216.080 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484101 278 C1713 SCREW SYNTHES 216.085 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484102 278 C1713 SCREW SYNTHES 216.090 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484104 278 C1713 SCREW SYNTHES 216.095 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484105 278 C1713 SCREW SYNTHES 217.075 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2484106 278 C1713 SCREW SYNTHES 217.085 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2484107 278 C1713 WASHER SYNTHES 219.98 1 42.00 14.28 16.38 134.20 134.20 21.53 30.49 29.40 32.76 31.50 16.38 33.60 29.40 31.50 2484108 278 C1713 PLATE SYNTHES 222.07 1 109.00 37.06 42.51 134.20 134.20 55.86 79.13 76.30 85.02 81.75 42.51 87.20 76.30 81.75 2484109 278 C1713 PLATE SYNTHES 240.06 1 291.00 98.94 113.49 232.80 134.20 149.14 211.27 203.70 226.98 218.25 113.49 232.80 203.70 218.25 2484111 278 C1713 PLATE SYNTHES 240.16 1 332.00 112.88 129.48 265.60 134.20 170.15 241.03 232.40 258.96 249.00 129.48 265.60 232.40 249.00 2484112 278 C1713 PLATE SYNTHES 240.18 1 404.00 137.36 134.20 323.20 134.20 207.05 293.30 282.80 315.12 303.00 157.56 323.20 282.80 303.00 2484113 278 C1713 PLATE SYNTHES 240.23 1 283.00 96.22 110.37 226.40 134.20 145.04 205.46 198.10 220.74 212.25 110.37 226.40 198.10 212.25 2484114 278 C1713 PLATE SYNTHES 240.34 1 383.00 130.22 134.20 306.40 134.20 196.29 278.06 268.10 298.74 287.25 149.37 306.40 268.10 287.25 2484115 278 C1713 PLATE SYNTHES 240.44 1 325.00 110.50 126.75 260.00 134.20 166.56 235.95 227.50 253.50 243.75 126.75 260.00 227.50 243.75 2484116 278 C1713 PLATE SYNTHES 240.54 1 377.00 128.18 134.20 301.60 134.20 193.21 273.70 263.90 294.06 282.75 147.03 301.60 263.90 282.75 2484117 278 C1713 PLATE SYNTHES 241.02 1 96.00 32.64 37.44 134.20 134.20 49.20 69.70 67.20 74.88 72.00 37.44 76.80 67.20 72.00 2484118 278 C1713 PLATE SYNTHES 241.03 1 96.00 32.64 37.44 134.20 134.20 49.20 69.70 67.20 74.88 72.00 37.44 76.80 67.20 72.00 2484119 278 C1713 PLATE SYNTHES 241.04 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484120 278 C1713 PLATE SYNTHES 241.05 1 96.00 32.64 37.44 134.20 134.20 49.20 69.70 67.20 74.88 72.00 37.44 76.80 67.20 72.00 2484121 278 C1713 PLATE SYNTHES 241.06 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2484123 278 C1713 PLATE SYNTHES 241.08 1 109.00 37.06 42.51 134.20 134.20 55.86 79.13 76.30 85.02 81.75 42.51 87.20 76.30 81.75 2484124 278 C1713 PLATE SYNTHES 241.13 1 210.00 71.40 81.90 168.00 134.20 107.63 152.46 147.00 163.80 157.50 81.90 168.00 147.00 157.50 2484125 278 C1713 PLATE SYNTHES 241.14 1 219.00 74.46 85.41 175.20 134.20 112.24 158.99 153.30 170.82 164.25 85.41 175.20 153.30 164.25 2484131 278 C1713 PLATE SYNTHES 248.06 1 249.00 84.66 97.11 199.20 134.20 127.61 180.77 174.30 194.22 186.75 97.11 199.20 174.30 186.75 2484132 278 C1713 PLATE SYNTHES 248.08 1 190.00 64.60 74.10 152.00 134.20 97.38 137.94 133.00 148.20 142.50 74.10 152.00 133.00 142.50 2484327 278 C1713 SCREW SYNTHES 200.810 1 37.50 12.75 14.63 134.20 134.20 19.22 27.23 26.25 29.25 28.13 14.63 30.00 26.25 28.13 2486042 278 C1713 SCREW SYNTHES 202.808 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2486044 278 C1713 SCREW SYNTHES 201.820 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2486051 278 C1713 SCREW SYNTHES 202.818 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2486053 278 C1713 SCREW SYNTHES 201.816 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2486058 278 C1713 SCREW SYNTHES 200.807 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2486059 278 C1713 SCREW SYNTHES 202.822 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2486063 278 C1713 SCREW SYNTHES 201.818 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2486104 278 C1713 NAIL SYNTHES 474.336 TITANIUM CANNUL FEM 1 " 1,228.00 " 417.52 134.20 982.40 134.20 629.35 891.53 859.60 957.84 921.00 478.92 982.40 859.60 921.00 2486730 278 C1713 SCREW SYNTHES 216.100 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2486731 278 C1713 SCREW SYNTHES 216.105 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2486732 278 C1713 SCREW SYNTHES 216.110 1 81.00 27.54 31.59 134.20 134.20 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2486733 278 C1713 SCREW SYNTHES 217.100 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2486734 278 C1713 SCREW SYNTHES 217.110 1 75.00 25.50 29.25 134.20 134.20 38.44 54.45 52.50 58.50 56.25 29.25 60.00 52.50 56.25 2486884 278 C1713 PLATE SYNTHES 226.12 1 282.00 95.88 109.98 225.60 134.20 144.53 204.73 197.40 219.96 211.50 109.98 225.60 197.40 211.50 2488702 276 V2632 LENS MN60AC 1 835.00 283.90 90.43 668.00 90.43 427.94 606.21 584.50 651.30 626.25 325.65 668.00 584.50 626.25 2488703 276 V2632 LENS ACRYSOFT 1 300.00 102.00 90.43 240.00 90.43 153.75 217.80 210.00 234.00 225.00 117.00 240.00 210.00 225.00 2489686 278 C1713 SCREW SYNTHES 202.814 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2489689 278 C1713 SCREW SYNTHES 201.808 1 38.25 13.01 14.92 134.20 134.20 19.60 27.77 26.78 29.84 28.69 14.92 30.60 26.78 28.69 2489744 278 C1713 PLATE SYNTHES 242.33 1 73.75 25.08 28.76 134.20 134.20 37.80 53.54 51.63 57.53 55.31 28.76 59.00 51.63 55.31 2489745 278 C1713 PLATE SYNTHES 243.15 1 87.50 29.75 34.13 134.20 134.20 44.84 63.53 61.25 68.25 65.63 34.13 70.00 61.25 65.63 2492239 276 V2632 LENS IOL ALCON/CILCO MN3 1 552.00 187.68 90.43 441.60 90.43 282.90 400.75 386.40 430.56 414.00 215.28 441.60 386.40 414.00 2492252 276 V2632 LENS S140NB 1 240.00 81.60 90.43 192.00 90.43 123.00 174.24 168.00 187.20 180.00 93.60 192.00 168.00 180.00 2494514 278 C1713 SCREW SYNTHES 206.014 1 28.00 9.52 10.92 134.20 134.20 14.35 20.33 19.60 21.84 21.00 10.92 22.40 19.60 21.00 2499766 278 C1781 MESH GORE TEX 1 " 3,081.00 " " 1,047.54 " 69.35 " 2,464.80 " 69.35 " 1,579.01 " " 2,236.81 " " 2,156.70 " " 2,403.18 " " 2,310.75 " " 1,201.59 " " 2,464.80 " " 2,156.70 " " 2,310.75 " 2500010 305 85027 CBC AUTO W/O DIFF 1 19.41 6.60 6.47 15.53 10.57 9.95 14.09 13.59 15.14 14.56 12.94 15.53 13.59 6.47 14.56 11.00 10.35 2500011 305 85007 MANUAL DIFF 1 11.40 3.88 3.80 9.12 4.09 5.84 8.28 7.98 8.89 8.55 7.60 9.12 7.98 3.80 8.55 6.46 6.08 2500103 301 84153 PSA SCREENING TOTAL 1 55.17 18.76 18.39 44.14 30.07 28.27 40.05 38.62 43.03 41.38 36.78 44.14 38.62 18.39 41.38 31.26 29.42 2500358 300 81596 HEPATITIS C VIRUS (HCV) FIBROSURE 1 216.57 73.63 72.19 173.26 86.63 110.99 157.23 151.60 168.92 162.43 144.38 173.26 151.60 72.19 162.43 122.72 115.50 2500399 306 0099U "RESPIRATORY PATHOGEN PROFILE, PCR LAB CO" 1 826.05 280.86 275.35 660.84 495.63 423.35 599.71 578.24 644.32 619.54 550.70 660.84 578.24 275.35 619.54 468.10 440.56 2500400 306 0097U "GASTROINTESTINAL PROFILE STOOL, PCR" 1 390.00 132.60 199.88 726.08 234.00 199.88 283.14 273.00 304.20 292.50 726.08 312.00 273.00 363.04 292.50 617.17 580.86 2500479 302 86431 RA FACTOR QUAL 1 17.01 5.78 5.67 13.61 9.28 8.72 12.35 11.91 13.27 12.76 11.34 13.61 11.91 5.67 12.76 9.64 9.07 2500481 302 86800 THYROGLOBULIN ANTIBODY 1 47.73 16.23 15.91 38.18 26.00 24.46 34.65 33.41 37.23 35.80 31.82 38.18 33.41 15.91 35.80 27.05 25.46 2501403 310 81403 "JAK2 EXON 12,13,14,15 MUTATION ANALYSIS" 1 555.60 188.90 100.00 444.48 100.00 284.75 403.37 388.92 433.37 416.70 370.40 444.48 388.92 185.20 416.70 314.84 296.32 2502044 301 82044 HC MICROALBUMIN SEMI QUANT WAIVED 1 18.69 6.35 4.97 14.95 4.97 9.58 13.57 13.08 14.58 14.02 12.46 14.95 13.08 6.23 14.02 10.59 9.97 2502397 300 82397 PARATHYROID HORMONE RELATED PEPTIDE 1 42.36 14.40 7.58 33.89 7.58 21.71 30.75 29.65 33.04 31.77 28.24 33.89 29.65 14.12 31.77 24.00 22.59 2502570 301 82570 CREATININE UR WAIVED 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2502784 301 82784 "IMMUNOGLOBULIN G, QUANTITATIVE" 1 27.90 9.49 9.30 22.32 15.20 14.30 20.26 19.53 21.76 20.93 18.60 22.32 19.53 9.30 20.93 15.81 14.88 2503276 301 82024 "ACTH,QUANT" 1 115.86 39.39 38.62 92.69 63.13 59.38 84.11 81.10 90.37 86.90 77.24 92.69 81.10 38.62 86.90 65.65 61.79 2503294 302 86226 DNA ANTIBODY SINGLE 1 36.33 12.35 12.11 29.06 19.79 18.62 26.38 25.43 28.34 27.25 24.22 29.06 25.43 12.11 27.25 20.59 19.38 2503357 301 82330 CALCIUM IONIZED 1 41.04 13.95 13.68 32.83 22.36 21.03 29.80 28.73 32.01 30.78 27.36 32.83 28.73 13.68 30.78 23.26 21.89 2503433 301 82672 ESTROGEN TOTAL 1 65.10 22.13 21.70 52.08 35.47 33.36 47.26 45.57 50.78 48.83 43.40 52.08 45.57 21.70 48.83 36.89 34.72 2503457 301 82950 GLUCOSE 2 HR PPD 1 14.25 4.85 4.75 11.40 7.76 7.30 10.35 9.98 11.12 10.69 9.50 11.40 9.98 4.75 10.69 8.08 7.60 2503466 301 82670 ESTRADIOL 1 83.82 28.50 27.94 67.06 45.67 42.96 60.85 58.67 65.38 62.87 55.88 67.06 58.67 27.94 62.87 47.50 44.70 2503474 301 82951 GTT 3HR SPECIMENS 1 38.61 13.13 12.87 30.89 21.04 19.79 28.03 27.03 30.12 28.96 25.74 30.89 27.03 12.87 28.96 21.88 20.59 2503475 301 82951 GTT 5HR SPECIMENS 1 38.61 13.13 12.87 30.89 21.04 19.79 28.03 27.03 30.12 28.96 25.74 30.89 27.03 12.87 28.96 21.88 20.59 2503490 301 82941 GASTRIN 1 52.89 17.98 17.63 42.31 28.82 27.11 38.40 37.02 41.25 39.67 35.26 42.31 37.02 17.63 39.67 29.97 28.21 2503518 306 87210 SMEAR INDIA INK 1 17.46 5.94 5.82 13.97 6.98 8.95 12.68 12.22 13.62 13.10 11.64 13.97 12.22 5.82 13.10 9.89 9.31 2503519 300 83519 ACETYLCHOLINE RECEPTOR ANTIBODIES COMPLE 1 60.67 20.63 7.61 48.54 7.61 31.09 44.05 42.47 47.32 45.50 36.80 48.54 42.47 18.40 45.50 31.28 29.44 2503524 301 82784 GAMMAGLOBULIN;IGM 1 27.90 9.49 9.30 22.32 15.20 14.30 20.26 19.53 21.76 20.93 18.60 22.32 19.53 9.30 20.93 15.81 14.88 2503534 301 83605 LACTIC ACID 1 34.71 11.80 11.57 27.77 17.46 17.79 25.20 24.30 27.07 26.03 23.14 27.77 24.30 11.57 26.03 19.67 18.51 2503554 302 86308 MONO SCR (HETEROPHILE) WAIVED 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2503557 301 83930 OSMOLALITY BLD 1 19.83 6.74 6.61 15.86 10.81 10.16 14.40 13.88 15.47 14.87 13.22 15.86 13.88 6.61 14.87 11.24 10.58 2503565 301 83935 OSMOLALITY UR 1 20.46 6.96 6.82 16.37 11.15 10.49 14.85 14.32 15.96 15.35 13.64 16.37 14.32 6.82 15.35 11.59 10.91 2503607 301 84144 PROGESTERONE 1 62.58 21.28 20.86 50.06 34.10 32.07 45.43 43.81 48.81 46.94 41.72 50.06 43.81 20.86 46.94 35.46 33.38 2503615 301 83615 LDH (LD) SERUM 1 18.12 6.16 6.04 14.50 9.86 9.29 13.16 12.68 14.13 13.59 12.08 14.50 12.68 6.04 13.59 10.27 9.66 2503789 300 83789 IODINE UR 1 72.33 24.59 24.11 57.86 29.52 37.07 52.51 50.63 56.42 54.25 48.22 57.86 50.63 24.11 54.25 40.99 38.58 2503986 300 83986 PH STOOL 1 10.74 3.65 3.58 8.59 5.86 5.50 7.80 7.52 8.38 8.06 7.16 8.59 7.52 3.58 8.06 6.09 5.73 2504439 301 84439 THYROXINE FREE (T4) DIALYSIS MASS SPECTR 1 52.12 17.72 9.02 41.70 14.74 26.71 37.84 36.48 40.65 39.09 18.04 41.70 36.48 9.02 39.09 15.33 14.43 2504842 301 84315 SP GRAV BODY FLUID 1 9.84 3.35 3.28 7.87 4.10 5.04 7.14 6.89 7.68 7.38 6.56 7.87 6.89 3.28 7.38 5.58 5.25 2505610 300 85610 BA PROTHROMBIN TIME WAIVED 1 12.87 4.38 4.29 10.30 6.43 6.60 9.34 9.01 10.04 9.65 8.58 10.30 9.01 4.29 9.65 7.29 6.86 2506235 302 86235 ANTISCLERODERMA 70 ANTIBODIES 1 53.79 18.29 17.93 43.03 19.03 27.57 39.05 37.65 41.96 40.34 35.86 43.03 37.65 17.93 40.34 30.48 28.69 2506360 300 86360 CD4:CD8 RATIO PROFILE 1 140.94 47.92 46.98 112.75 65.80 72.23 102.32 98.66 109.93 105.71 93.96 112.75 98.66 46.98 105.71 79.87 75.17 2506418 305 85384 FIBRINOGEN ACTIVITY 1 29.16 9.91 9.72 23.33 13.88 14.94 21.17 20.41 22.74 21.87 19.44 23.33 20.41 9.72 21.87 16.52 15.55 2506622 302 86622 "BRUCELLA ANTIBODY IGM, EIA" 1 26.79 9.11 8.93 21.43 14.60 13.73 19.45 18.75 20.90 20.09 17.86 21.43 18.75 8.93 20.09 15.18 14.29 2506636 301 80170 "GENTAMICIN (GARAMYCIN),QUANT" 1 49.14 16.71 16.38 39.31 19.03 25.18 35.68 34.40 38.33 36.86 32.76 39.31 34.40 16.38 36.86 27.85 26.21 2506648 301 82042 ALBUMIN URINE QUANT 1 23.34 7.94 7.78 18.67 8.46 11.96 16.94 16.34 18.21 17.51 15.56 18.67 16.34 7.78 17.51 13.23 12.45 2506666 300 86666 E CHAFFEENSIS (HME) IGM TITER 1 30.54 10.38 10.18 24.43 16.64 15.65 22.17 21.38 23.82 22.91 20.36 24.43 21.38 10.18 22.91 17.31 16.29 2506672 301 82140 "AMMONIA,QUANT" 1 43.71 14.86 14.57 34.97 23.82 22.40 31.73 30.60 34.09 32.78 29.14 34.97 30.60 14.57 32.78 24.77 23.31 2506710 302 86710 INFLUENZA B ANTIBODIES QUANTITATIVE 1 121.95 41.46 13.55 97.56 22.15 62.50 88.54 85.37 95.12 91.46 27.10 97.56 85.37 13.55 91.46 23.04 21.68 2506735 302 86735 MUMPS ANTIBODY IgM 1 39.15 13.31 13.05 31.32 21.32 20.06 28.42 27.41 30.54 29.36 26.10 31.32 27.41 13.05 29.36 22.19 20.88 2506753 302 86753 BABESIA IGM 1 37.17 12.64 12.39 29.74 20.24 19.05 26.99 26.02 28.99 27.88 24.78 29.74 26.02 12.39 27.88 21.06 19.82 2506756 301 82340 CALCIUM UR QUANT 1 18.09 6.15 6.03 14.47 9.85 9.27 13.13 12.66 14.11 13.57 12.06 14.47 12.66 6.03 13.57 10.25 9.65 2506757 302 86757 ROCKY MTN SPOTTED FEVER GRP IGG 1 58.05 19.74 19.35 46.44 31.64 29.75 42.14 40.64 45.28 43.54 38.70 46.44 40.64 19.35 43.54 32.90 30.96 2506769 302 86769 SARS COV-2 TOTAL AB SMC INHOUSE 1 126.39 42.97 42.13 101.11 75.83 64.77 91.76 88.47 98.58 94.79 84.26 101.11 88.47 42.13 94.79 71.62 67.41 2506893 301 84702 "HCG INTACT,QUANT" 1 45.15 15.35 15.05 36.12 24.61 23.14 32.78 31.61 35.22 33.86 30.10 36.12 31.61 15.05 33.86 25.59 24.08 2507016 306 87252 CULTURE CMV 1 78.21 26.59 26.07 62.57 42.61 40.08 56.78 54.75 61.00 58.66 52.14 62.57 54.75 26.07 58.66 44.32 41.71 2507070 306 87070 CULTURE BRONCHIAL LAVAGE 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2507075 306 87075 CULTURE-ANAEROBIC BRONCH LAVAGE 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2507077 300 87077 AEROBIC IDENTIFICATION CHARGE EA ISOLATE 1 24.24 8.24 8.08 19.39 13.20 12.42 17.60 16.97 18.91 18.18 16.16 19.39 16.97 8.08 18.18 13.74 12.93 2507180 306 87040 CULTURE BLOOD #1 1 30.96 10.53 10.32 24.77 16.88 15.87 22.48 21.67 24.15 23.22 20.64 24.77 21.67 10.32 23.22 17.54 16.51 2507195 306 87186 "SUSCEPTIBILITY STUDIES,MICROBE,MIC" 1 25.95 8.82 8.65 20.76 14.14 13.30 18.84 18.17 20.24 19.46 17.30 20.76 18.17 8.65 19.46 14.71 13.84 2507205 306 87205 GRAM STAIN ABSCESS 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2507255 300 87255 HSV CULTURE HERPES SIMPLEX VIRUS TYPING 1 101.58 34.54 33.86 81.26 55.36 52.06 73.75 71.11 79.23 76.19 67.72 81.26 71.11 33.86 76.19 57.56 54.18 2507493 306 87493 C DIFF AMPLIFIED PROBE 1 111.81 38.02 37.27 89.45 57.36 57.30 81.17 78.27 87.21 83.86 74.54 89.45 78.27 37.27 83.86 63.36 59.63 2507804 300 87804 59 INFLUENZA B WAIVED 1 49.65 16.88 16.55 39.72 19.60 25.45 36.05 34.76 38.73 37.24 33.10 39.72 34.76 16.55 37.24 28.14 26.48 2507830 309 89310 SEMEN CT POST VASECTOMY 1 25.83 8.78 8.61 20.66 14.08 13.24 18.75 18.08 20.15 19.37 17.22 20.66 18.08 8.61 19.37 14.64 13.78 2508623 302 86235 NUCLEAR ANTIGEN ANTIBODY EACH ANTIBODY 1 53.79 18.29 17.93 43.03 19.03 27.57 39.05 37.65 41.96 40.34 35.86 43.03 37.65 17.93 40.34 30.48 28.69 2509994 301 82950 O SULLIVAN 1 14.25 4.85 4.75 11.40 7.76 7.30 10.35 9.98 11.12 10.69 9.50 11.40 9.98 4.75 10.69 8.08 7.60 2510307 300 80307 "DRUG SCREEN 11 W RELFEX CONFIRMATION,SER" 1 186.42 63.38 62.14 149.14 95.77 95.54 135.34 130.49 145.41 139.82 124.28 149.14 130.49 62.14 139.82 105.64 99.42 2510377 301 80377 DIURETIC ANALYSIS URINE (9) 1 156.00 53.04 0.01 124.80 0.01 79.95 113.26 109.20 121.68 117.00 60.84 124.80 109.20 117.00 2510432 300 87389 HIV-1 & 2 SCREENING 1 72.24 24.56 24.08 57.79 36.76 37.02 52.45 50.57 56.35 54.18 48.16 57.79 50.57 24.08 54.18 40.94 38.53 2512034 301 84157 "PROTEIN,TOTAL;CSF" 1 12.00 4.08 4.00 9.60 6.00 6.15 8.71 8.40 9.36 9.00 8.00 9.60 8.40 4.00 9.00 6.80 6.40 2512048 301 80061 LIPID PANEL 1 40.17 13.66 13.39 32.14 19.55 20.59 29.16 28.12 31.33 30.13 26.78 32.14 28.12 13.39 30.13 22.76 21.42 2512201 306 87252 CULTURE HERPES SIMP 1&2 1 78.21 26.59 26.07 62.57 42.61 40.08 56.78 54.75 61.00 58.66 52.14 62.57 54.75 26.07 58.66 44.32 41.71 2512397 300 82397 ADALIMUMAB + AB (SERIAL MONITOR) 1 42.36 14.40 7.58 33.89 7.58 21.71 30.75 29.65 33.04 31.77 28.24 33.89 29.65 14.12 31.77 24.00 22.59 2512417 301 82436 CHLORIDE UR 1 17.25 5.87 5.75 13.80 8.22 8.84 12.52 12.08 13.46 12.94 11.50 13.80 12.08 5.75 12.94 9.78 9.20 2512449 302 86000 AGGLUTINATION FEBRILE;EA ANTG 1 20.94 7.12 6.98 16.75 11.41 10.73 15.20 14.66 16.33 15.71 13.96 16.75 14.66 6.98 15.71 11.87 11.17 2512507 301 82480 "PSEUDOCHOLINESTERASE,SERUM" 1 23.61 8.03 7.87 18.89 12.88 12.10 17.14 16.53 18.42 17.71 15.74 18.89 16.53 7.87 17.71 13.38 12.59 2512527 302 86280 VIRAL STUDIES 1 24.57 8.35 8.19 19.66 13.39 12.59 17.84 17.20 19.16 18.43 16.38 19.66 17.20 8.19 18.43 13.92 13.10 2512528 302 86788 WEST NILE VIRUS IGM 1 50.55 17.19 16.85 40.44 27.54 25.91 36.70 35.39 39.43 37.91 33.70 40.44 35.39 16.85 37.91 28.65 26.96 2512530 302 83516 CCP 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2512570 301 82570 HC CREATININE UR WAIVED 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2512784 301 82784 IMMUNOGLOBULIN A QUANTITATIVE 1 27.90 9.49 9.30 22.32 15.20 14.30 20.26 19.53 21.76 20.93 18.60 22.32 19.53 9.30 20.93 15.81 14.88 2512902 302 86665 EBV CAPSID AB QUAL 1 54.42 18.50 18.14 43.54 29.14 27.89 39.51 38.09 42.45 40.82 36.28 43.54 38.09 18.14 40.82 30.84 29.02 2513148 301 80202 VANCOMYCIN QUANT 1 40.62 13.81 13.54 32.50 22.15 20.82 29.49 28.43 31.68 30.47 27.08 32.50 28.43 13.54 30.47 23.02 21.66 2513516 301 83516 TISSUE TRANSGLUTAMINASE (tTG) IGA 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2513835 306 87081 CULTURE LEGIONELLA 1 19.89 6.76 6.63 15.91 10.84 10.19 14.44 13.92 15.51 14.92 13.26 15.91 13.92 6.63 14.92 11.27 10.61 2514156 301 84156 PROTEIN TOTAL QN 24 HR URINE 1 11.01 3.74 3.67 8.81 6.00 5.64 7.99 7.71 8.59 8.26 7.34 8.81 7.71 3.67 8.26 6.24 5.87 2516001 302 86003 ALLERGEN BEEF IGE 1 15.66 5.32 5.22 12.53 8.53 8.03 11.37 10.96 12.21 11.75 10.44 12.53 10.96 5.22 11.75 8.87 8.35 2516002 302 86003 ALLERGEN CHICKEN IGE 1 15.66 5.32 5.22 12.53 8.53 8.03 11.37 10.96 12.21 11.75 10.44 12.53 10.96 5.22 11.75 8.87 8.35 2516009 302 86003 ALLERGEN PORK IGE 1 15.66 5.32 5.22 12.53 8.53 8.03 11.37 10.96 12.21 11.75 10.44 12.53 10.96 5.22 11.75 8.87 8.35 2516147 300 86147 "ANTICARDIOLIPIN ANTIBODIES IGG, QUAN" 1 76.35 25.96 19.01 61.08 19.01 39.13 55.43 53.45 59.55 57.26 50.90 61.08 53.45 25.45 57.26 43.27 40.72 2516235 302 86235 ANTI-JO-1 1 53.79 18.29 17.93 43.03 19.03 27.57 39.05 37.65 41.96 40.34 35.86 43.03 37.65 17.93 40.34 30.48 28.69 2516318 302 86769 SARS COV-2 TOTAL AB WK 1 126.39 42.97 42.13 101.11 75.83 64.77 91.76 88.47 98.58 94.79 84.26 101.11 88.47 42.13 94.79 71.62 67.41 2516666 300 86666 HGE IGG TITER 1 30.54 10.38 10.18 24.43 16.64 15.65 22.17 21.38 23.82 22.91 20.36 24.43 21.38 10.18 22.91 17.31 16.29 2516757 302 86757 TYPHUS FEVER GRP IGG 1 58.05 19.74 19.35 46.44 31.64 29.75 42.14 40.64 45.28 43.54 38.70 46.44 40.64 19.35 43.54 32.90 30.96 2516857 302 86774 TETANUS AB QUAL 1 44.40 15.10 14.80 35.52 16.00 22.76 32.23 31.08 34.63 33.30 29.60 35.52 31.08 14.80 33.30 25.16 23.68 2516860 306 87070 CULTURE ABSCESS 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2516963 301 80170 GENTAMICIN TROUGH 1 49.14 16.71 16.38 39.31 19.03 25.18 35.68 34.40 38.33 36.86 32.76 39.31 34.40 16.38 36.86 27.85 26.21 2517002 301 83615 LDH (LD) BODY FLUID 1 18.12 6.16 6.04 14.50 9.86 9.29 13.16 12.68 14.13 13.59 12.08 14.50 12.68 6.04 13.59 10.27 9.66 2517070 306 87070 CULTURE BRONCHIAL BRUSHING 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2517075 306 87075 CULTURE-ANAEROBIC BRONCH BRUSHING 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2517077 306 87077 AEROBIC BACTERIA ID (WK) 1 24.24 8.24 8.08 19.39 13.20 12.42 17.60 16.97 18.91 18.18 16.16 19.39 16.97 8.08 18.18 13.74 12.93 2517106 306 87106 FUNGUS ID YEAST (WK) 1 84.30 28.66 10.32 67.44 16.88 43.20 61.20 59.01 65.75 63.23 20.64 67.44 59.01 10.32 63.23 17.54 16.51 2517149 306 87149 NOCARDIA/STREPTOMYCES ID (WK) 1 235.10 79.93 20.05 188.08 32.78 120.49 170.68 164.57 183.38 176.33 40.10 188.08 164.57 20.05 176.33 34.09 32.08 2517186 306 87186 SUSCEPTIBILITY AFB RAPID GROWER (WK) 1 440.00 149.60 8.65 352.00 14.14 225.50 319.44 308.00 343.20 330.00 17.30 352.00 308.00 8.65 330.00 14.71 13.84 2517205 306 87205 GRAM STAIN BRONCHIAL LAVAGE 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2517590 301 84703 HCG QUALITATIVE SERUM 1 22.56 7.67 7.52 18.05 12.29 11.56 16.38 15.79 17.60 16.92 15.04 18.05 15.79 7.52 16.92 12.78 12.03 2517635 306 U0003 COVID-19 WK 1 300.00 102.00 75.00 240.00 180.00 153.75 217.80 210.00 234.00 225.00 150.00 240.00 210.00 75.00 225.00 127.50 120.00 2517798 306 87798 A PHAGOCYTOPHILUM PCR 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2518921 302 86804 HEPATITIS C CONFIRM 1 46.47 15.80 15.49 37.18 25.32 23.82 33.74 32.53 36.25 34.85 30.98 37.18 32.53 15.49 34.85 26.33 24.78 2519694 306 87207 SMEAR MALARIA 1 17.97 6.11 5.99 14.38 9.79 9.21 13.05 12.58 14.02 13.48 11.98 14.38 12.58 5.99 13.48 10.18 9.58 2521943 301 80329 "ACETAMINOPHEN,QUANT 1 OR 2" 1 120.00 40.80 0.01 96.00 0.01 61.50 87.12 84.00 93.60 90.00 46.80 96.00 84.00 90.00 2523516 301 83516 BULLOUS PEMPHIGOID 180 IGG AB 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2526147 300 86147 ANTICARDIOLIPIN ANTIBODIES IGM QUANT 1 76.35 25.96 19.01 61.08 19.01 39.13 55.43 53.45 59.55 57.26 50.90 61.08 53.45 25.45 57.26 43.27 40.72 2526445 301 84681 C-PEPTIDE 1 62.43 21.23 20.81 49.94 34.02 32.00 45.32 43.70 48.70 46.82 41.62 49.94 43.70 20.81 46.82 35.38 33.30 2526666 300 86666 HGE IGM TITER 1 30.54 10.38 10.18 24.43 16.64 15.65 22.17 21.38 23.82 22.91 20.36 24.43 21.38 10.18 22.91 17.31 16.29 2526757 302 86757 TYPHUS FEVER GRP IGM 1 58.05 19.74 19.35 46.44 31.64 29.75 42.14 40.64 45.28 43.54 38.70 46.44 40.64 19.35 43.54 32.90 30.96 2526826 302 86304 CA 125 1 62.43 21.23 20.81 49.94 34.02 32.00 45.32 43.70 48.70 46.82 41.62 49.94 43.70 20.81 46.82 35.38 33.30 2526827 302 86301 CA 19-9 1 62.43 21.23 20.81 49.94 34.02 32.00 45.32 43.70 48.70 46.82 41.62 49.94 43.70 20.81 46.82 35.38 33.30 2527070 306 87070 CULTURE BONE 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2527075 306 87075 CULTURE-ANAEROBIC BONE 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2527186 306 87186 SUSCEPTIBILITY AFB SLOW GROWER (WK) 1 457.60 155.58 8.65 366.08 14.14 234.52 332.22 320.32 356.93 343.20 17.30 366.08 320.32 8.65 343.20 14.71 13.84 2527202 301 83970 PARATHORMONE (PTH) 1 123.84 42.11 41.28 99.07 67.48 63.47 89.91 86.69 96.60 92.88 82.56 99.07 86.69 41.28 92.88 70.18 66.05 2527205 306 87205 GRAM STAIN BRONCHIAL BRUSHING 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2527635 306 U0003 COVID-19 LSU 1 300.00 102.00 75.00 240.00 180.00 153.75 217.80 210.00 234.00 225.00 150.00 240.00 210.00 75.00 225.00 127.50 120.00 2527798 300 87798 EHRLICHIA CHAFFEENSIS PCR 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2529077 301 82962 QW GLUCOSE BLD METER 1 9.84 3.35 3.28 7.87 3.83 5.04 7.14 6.89 7.68 7.38 6.56 7.87 6.89 3.28 7.38 5.58 5.25 2530545 302 86225 DNA ANTIBODY DOUBLE 1 41.22 14.01 13.74 32.98 22.45 21.13 29.93 28.85 32.15 30.92 27.48 32.98 28.85 13.74 30.92 23.36 21.98 2530918 301 84134 PREALBUMIN 1 43.77 14.88 9.12 35.02 9.12 22.43 31.78 30.64 34.14 32.83 29.18 35.02 30.64 14.59 32.83 24.80 23.34 2532275 302 86713 LEGIONELLA AB QUAL 1 45.90 15.61 15.30 36.72 25.02 23.52 33.32 32.13 35.80 34.43 30.60 36.72 32.13 15.30 34.43 26.01 24.48 2532397 300 82397 ANTI-MULLERIAN HORMONE (AMH)(ENDOCRINE S 1 84.00 28.56 7.58 67.20 7.58 43.05 60.98 58.80 65.52 63.00 28.24 67.20 58.80 14.12 63.00 24.00 22.59 2532855 302 83516 "IMMUNOASSAY NONANTIBODY,QUAL/SEMI;MULTI" 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2533516 301 83516 BULLOUS PEMPHIGOID 230 IGG AB 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2533520 300 83520 14.3.3 ETA RHEUMATOID ARTHRITIS 1 51.81 17.62 17.27 41.45 21.16 26.55 37.61 36.27 40.41 38.86 34.54 41.45 36.27 17.27 38.86 29.36 27.63 2533996 302 86160 COMPLEMENT ANTIGEN;C3 1 36.00 12.24 12.00 28.80 19.62 18.45 26.14 25.20 28.08 27.00 24.00 28.80 25.20 12.00 27.00 20.40 19.20 2534012 302 86160 COMPLEMENT ANTIGEN;C4 1 36.00 12.24 12.00 28.80 19.62 18.45 26.14 25.20 28.08 27.00 24.00 28.80 25.20 12.00 27.00 20.40 19.20 2534014 302 86000 BRUCELLA ABORT AGG 1 20.94 7.12 6.98 16.75 11.41 10.73 15.20 14.66 16.33 15.71 13.96 16.75 14.66 6.98 15.71 11.87 11.17 2534482 306 87491 DNA PROBE CHLAMYDIA 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2536003 302 86003 ALLERGEN IGE QUANT/SEMI EA (LAB EXP) 1 15.66 5.32 5.22 12.53 8.53 8.03 11.37 10.96 12.21 11.75 10.44 12.53 10.96 5.22 11.75 8.87 8.35 2536378 306 87430 STREP SCREEN GROUP A 1 50.43 17.15 16.81 40.34 19.60 25.85 36.61 35.30 39.34 37.82 33.62 40.34 35.30 16.81 37.82 28.58 26.90 2536520 306 87400 INFLUENZA B 1 42.39 14.41 14.13 33.91 19.60 21.72 30.78 29.67 33.06 31.79 28.26 33.91 29.67 14.13 31.79 24.02 22.61 2536522 306 87400 INFLUENZA A 1 42.39 14.41 14.13 33.91 19.60 21.72 30.78 29.67 33.06 31.79 28.26 33.91 29.67 14.13 31.79 24.02 22.61 2536805 302 86870 BB RBC ANTIBODY ID EA 1 782.98 266.21 44.59 626.38 44.59 401.28 568.44 548.09 610.72 587.24 522.06 626.38 548.09 261.03 587.24 443.75 417.65 2536976 301 80201 TOPIRAMATE TOPAMAX QN 1 35.76 12.16 11.92 28.61 19.49 18.33 25.96 25.03 27.89 26.82 23.84 28.61 25.03 11.92 26.82 20.26 19.07 2537070 306 87070 CULTURE BRONCHIAL WASHING 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2537075 306 87075 CULTURE-ANAEROBIC CNS 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2537186 306 87186 YEAST/MOLD SUSCEPTIBILITY PANEL (WK) 1 315.30 107.20 8.65 252.24 14.14 161.59 228.91 220.71 245.93 236.48 17.30 252.24 220.71 8.65 236.48 14.71 13.84 2537205 306 87205 GRAM STAIN BLOOD 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2537468 301 82565 CREATININE BLD 1 15.36 5.22 5.12 12.29 8.38 7.87 11.15 10.75 11.98 11.52 10.24 12.29 10.75 5.12 11.52 8.70 8.19 2537469 302 86780 FTA AB CONFIRM 1 39.72 13.50 13.24 31.78 21.64 20.36 28.84 27.80 30.98 29.79 26.48 31.78 27.80 13.24 29.79 22.51 21.18 2537798 306 87798 INF AGENT DET BORDETELLA PARAPERTUSSIS 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2537979 301 84133 POTASSIUM UR RANDOM 1 14.19 4.82 4.73 11.35 7.03 7.27 10.30 9.93 11.07 10.64 9.46 11.35 9.93 4.73 10.64 8.04 7.57 2538628 301 82435 CHLORIDE BLD 1 13.80 4.69 4.60 11.04 7.51 7.07 10.02 9.66 10.76 10.35 9.20 11.04 9.66 4.60 10.35 7.82 7.36 2540555 302 86644 CMV IGG QUANT 1 43.17 14.68 14.39 34.54 23.53 22.12 31.34 30.22 33.67 32.38 28.78 34.54 30.22 14.39 32.38 24.46 23.02 2540558 305 85018 HEMOGLOBIN 1 7.11 2.42 2.37 5.69 3.88 3.64 5.16 4.98 5.55 5.33 4.74 5.69 4.98 2.37 5.33 4.03 3.79 2540933 301 80170 GENTAMICIN PEAK 1 49.14 16.71 16.38 39.31 19.03 25.18 35.68 34.40 38.33 36.86 32.76 39.31 34.40 16.38 36.86 27.85 26.21 2543520 300 83520 INHIBIN B 1 60.00 20.40 17.27 48.00 21.16 30.75 43.56 42.00 46.80 45.00 34.54 48.00 42.00 17.27 45.00 29.36 27.63 2544812 307 81001 UA W/MICRO AUTO 1 9.51 3.23 3.17 7.61 5.18 4.87 6.90 6.66 7.42 7.13 6.34 7.61 6.66 3.17 7.13 5.39 5.07 2544815 301 82530 CORTISOL URINARY FREE 1 50.13 17.04 16.71 40.10 27.31 25.69 36.39 35.09 39.10 37.60 33.42 40.10 35.09 16.71 37.60 28.41 26.74 2544963 305 85660 SICKLE CELL SCREEN 1 16.53 5.62 5.51 13.22 9.01 8.47 12.00 11.57 12.89 12.40 11.02 13.22 11.57 5.51 12.40 9.37 8.82 2544964 302 86592 SYPHILIS TEST (RPR) 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2544977 306 87206 SMEAR CRYPTO MOD KINY-REF LAB 1 16.17 5.50 5.39 12.94 8.80 8.29 11.74 11.32 12.61 12.13 10.78 12.94 11.32 5.39 12.13 9.16 8.62 2544985 302 86618 LYME DISEASE AB 1 51.09 17.37 17.03 40.87 27.84 26.18 37.09 35.76 39.85 38.32 34.06 40.87 35.76 17.03 38.32 28.95 27.25 2544994 302 86850 "BB COOMBS,INDIRECT,QUAL" 1 133.77 45.48 6.25 107.02 6.25 68.56 97.12 93.64 104.34 100.33 89.18 107.02 93.64 44.59 100.33 75.80 71.34 2545524 302 87425 ROTAVIRUS ANTIGEN 1 90.00 30.60 11.98 72.00 19.60 46.13 65.34 63.00 70.20 67.50 23.96 72.00 63.00 11.98 67.50 20.37 19.17 2545966 302 86003 "ALLERGEN,IGE,QUANT/SEMI;EA" 1 15.66 5.32 5.22 12.53 8.53 8.03 11.37 10.96 12.21 11.75 10.44 12.53 10.96 5.22 11.75 8.87 8.35 2546247 305 85379 D-DIMER QUANT 1 30.54 10.38 10.18 24.43 16.64 15.65 22.17 21.38 23.82 22.91 20.36 24.43 21.38 10.18 22.91 17.31 16.29 2546337 302 86645 CMV IGM QUANT 1 50.55 17.19 16.85 40.44 27.54 25.91 36.70 35.39 39.43 37.91 33.70 40.44 35.39 16.85 37.91 28.65 26.96 2547070 306 87070 CULTURE CUTANEOUS 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2547075 306 87075 CULTURE-ANAEROBIC EYE 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2547205 306 87205 GRAM STAIN BONE 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2547610 306 87807 QW "RSV AG,EIA WAIVED" 1 39.30 13.36 13.10 31.44 19.60 20.14 28.53 27.51 30.65 29.48 26.20 31.44 27.51 13.10 29.48 22.27 20.96 2550425 301 82375 CARBON MONOXIDE QUANT 1 36.96 12.57 12.32 29.57 20.14 18.94 26.83 25.87 28.83 27.72 24.64 29.57 25.87 12.32 27.72 20.94 19.71 2550499 306 87070 CULTURE ROUTINE 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2551355 306 87230 C DIFFICILE TOXIN 1 59.22 20.13 19.74 47.38 32.28 30.35 42.99 41.45 46.19 44.42 39.48 47.38 41.45 19.74 44.42 33.56 31.58 2552314 306 87070 CULTURE CATHETER 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2553389 302 86713 LEGIONELLA AB IGM QUAL 1 45.90 15.61 15.30 36.72 25.02 23.52 33.32 32.13 35.80 34.43 30.60 36.72 32.13 15.30 34.43 26.01 24.48 2553390 302 86713 LEGIONELLA AB IGG QUAL 1 45.90 15.61 15.30 36.72 25.02 23.52 33.32 32.13 35.80 34.43 30.60 36.72 32.13 15.30 34.43 26.01 24.48 2553520 301 83520 HUMAN ANTIMOUSE ANTIBODIES 1 162.90 55.39 17.27 130.32 21.16 83.49 118.27 114.03 127.06 122.18 34.54 130.32 114.03 17.27 122.18 29.36 27.63 2554136 301 82746 "FOLATE (FOLIC ACID),SERUM" 1 44.10 14.99 14.70 35.28 24.04 22.60 32.02 30.87 34.40 33.08 29.40 35.28 30.87 14.70 33.08 24.99 23.52 2554137 301 82947 GLUCOSE BLD QUANT 1 11.79 4.01 3.93 9.43 6.42 6.04 8.56 8.25 9.20 8.84 7.86 9.43 8.25 3.93 8.84 6.68 6.29 2554138 301 82945 URINE GLUCOSE 1 11.79 4.01 3.93 9.43 6.42 6.04 8.56 8.25 9.20 8.84 7.86 9.43 8.25 3.93 8.84 6.68 6.29 2554164 306 87116 CULTURE AFB 1 32.40 11.02 10.80 25.92 17.65 16.61 23.52 22.68 25.27 24.30 21.60 25.92 22.68 10.80 24.30 18.36 17.28 2554173 309 89190 EOSINOPHIL COUNT(NASAL) 1 17.37 5.91 5.79 13.90 7.76 8.90 12.61 12.16 13.55 13.03 11.58 13.90 12.16 5.79 13.03 9.84 9.26 2554178 309 89125 FAT STAIN(FECES/UR/RESP) 1 17.64 6.00 5.88 14.11 7.06 9.04 12.81 12.35 13.76 13.23 11.76 14.11 12.35 5.88 13.23 10.00 9.41 2554180 301 80069 RENAL FUNCTION PANEL 1 26.04 8.85 8.68 20.83 14.20 13.35 18.91 18.23 20.31 19.53 17.36 20.83 18.23 8.68 19.53 14.76 13.89 2554184 301 83505 HYDROXYPROLINE TOTAL 1 72.90 24.79 24.30 58.32 39.74 37.36 52.93 51.03 56.86 54.68 48.60 58.32 51.03 24.30 54.68 41.31 38.88 2554220 301 83661 FETAL LUNG MAT;LS RATIO 1 65.97 22.43 21.99 52.78 35.94 33.81 47.89 46.18 51.46 49.48 43.98 52.78 46.18 21.99 49.48 37.38 35.18 2554755 301 84156 "PROTEIN,TOTAL;URINE" 1 11.01 3.74 3.67 8.81 6.00 5.64 7.99 7.71 8.59 8.26 7.34 8.81 7.71 3.67 8.26 6.24 5.87 2554790 301 80156 "CARBAMAZEPINE (TEGRETOL),TOTAL" 1 43.71 14.86 14.57 34.97 19.03 22.40 31.73 30.60 34.09 32.78 29.14 34.97 30.60 14.57 32.78 24.77 23.31 2554887 305 85410 ALPHA2ANTIPLASMIN 1 23.13 7.86 7.71 18.50 12.60 11.85 16.79 16.19 18.04 17.35 15.42 18.50 16.19 7.71 17.35 13.11 12.34 2554935 301 82105 AFP TUMOR MARKER 1 50.31 17.11 16.77 40.25 27.42 25.78 36.53 35.22 39.24 37.73 33.54 40.25 35.22 16.77 37.73 28.51 26.83 2555238 302 86665 EBV CAPSID IGG QUAL 1 54.42 18.50 18.14 43.54 29.14 27.89 39.51 38.09 42.45 40.82 36.28 43.54 38.09 18.14 40.82 30.84 29.02 2555240 302 86664 EBV NUCLEAR AB QUAL 1 45.87 15.60 15.29 36.70 25.01 23.51 33.30 32.11 35.78 34.40 30.58 36.70 32.11 15.29 34.40 25.99 24.46 2555241 302 86665 EBV CAPSID IGM QUAL 1 54.42 18.50 18.14 43.54 29.14 27.89 39.51 38.09 42.45 40.82 36.28 43.54 38.09 18.14 40.82 30.84 29.02 2555465 301 82607 VITAMIN B12 1 45.24 15.38 15.08 36.19 24.65 23.19 32.84 31.67 35.29 33.93 30.16 36.19 31.67 15.08 33.93 25.64 24.13 2555467 301 84270 SEX HORMONE BINDING GLOBULIN 1 65.19 22.16 21.73 52.15 35.53 33.41 47.33 45.63 50.85 48.89 43.46 52.15 45.63 21.73 48.89 36.94 34.77 2555470 301 84154 FREE PSA 1 55.17 18.76 18.39 44.14 30.07 28.27 40.05 38.62 43.03 41.38 36.78 44.14 38.62 18.39 41.38 31.26 29.42 2557070 306 87070 CULTURE FEMALE GENITAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2557075 306 87075 CULTURE-ANAEROBIC FEMALE GENITAL 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2557205 306 87205 GRAM STAIN BRONCHIAL WASHING 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2558346 301 80202 VANCOMYCIN TROUGH 1 40.62 13.81 13.54 32.50 22.15 20.82 29.49 28.43 31.68 30.47 27.08 32.50 28.43 13.54 30.47 23.02 21.66 2558347 301 80202 VANCOMYCIN PEAK 1 40.62 13.81 13.54 32.50 22.15 20.82 29.49 28.43 31.68 30.47 27.08 32.50 28.43 13.54 30.47 23.02 21.66 2559772 300 85018 QW HEMOCUE HBG 1 7.11 2.42 2.37 5.69 3.88 3.64 5.16 4.98 5.55 5.33 4.74 5.69 4.98 2.37 5.33 4.03 3.79 2560438 302 86695 AB HSV-1 IGG SPEC 1 39.57 13.45 13.19 31.66 21.56 20.28 28.73 27.70 30.86 29.68 26.38 31.66 27.70 13.19 29.68 22.42 21.10 2560439 302 86696 AB HSV-2 IGG 1 58.05 19.74 19.35 46.44 31.64 29.75 42.14 40.64 45.28 43.54 38.70 46.44 40.64 19.35 43.54 32.90 30.96 2560440 302 86695 AB HSV-1 IGM SPEC 1 39.57 13.45 13.19 31.66 21.56 20.28 28.73 27.70 30.86 29.68 26.38 31.66 27.70 13.19 29.68 22.42 21.10 2560444 302 86696 AB HSV-2 IGM 1 58.05 19.74 19.35 46.44 31.64 29.75 42.14 40.64 45.28 43.54 38.70 46.44 40.64 19.35 43.54 32.90 30.96 2561856 300 86900 BB ABO TYPE 1 300.95 102.32 4.88 240.76 4.88 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 2561870 302 86880 "BB COOMBS,DIRECT AHG" 1 149.63 50.87 8.80 119.70 8.80 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 2561877 301 82784 GAMMAGLOBULIN;IGA 1 27.90 9.49 9.30 22.32 15.20 14.30 20.26 19.53 21.76 20.93 18.60 22.32 19.53 9.30 20.93 15.81 14.88 2561881 301 82784 GAMMAGLOBULIN;IGG 1 27.90 9.49 9.30 22.32 15.20 14.30 20.26 19.53 21.76 20.93 18.60 22.32 19.53 9.30 20.93 15.81 14.88 2561883 302 86325 IMMUNOELECT CSF 1 69.39 23.59 23.13 55.51 36.56 35.56 50.38 48.57 54.12 52.04 46.26 55.51 48.57 23.13 52.04 39.32 37.01 2561885 301 82784 GAMMAGLOBULIN;IGD 1 27.90 9.49 9.30 22.32 15.20 14.30 20.26 19.53 21.76 20.93 18.60 22.32 19.53 9.30 20.93 15.81 14.88 2561889 301 82785 GAMMAGLOBULIN;IGE 1 49.38 16.79 16.46 39.50 26.92 25.31 35.85 34.57 38.52 37.04 32.92 39.50 34.57 16.46 37.04 27.98 26.34 2561890 302 86038 ANA W/REFLEX IF POS 1 36.27 12.33 12.09 29.02 19.76 18.59 26.33 25.39 28.29 27.20 24.18 29.02 25.39 12.09 27.20 20.55 19.34 2561891 302 86611 CAT SCRATCH FEVER 1 30.54 10.38 10.18 24.43 16.64 15.65 22.17 21.38 23.82 22.91 20.36 24.43 21.38 10.18 22.91 17.31 16.29 2561892 305 85302 PROTEIN C ANTIGEN 1 36.03 12.25 12.01 28.82 19.64 18.47 26.16 25.22 28.10 27.02 24.02 28.82 25.22 12.01 27.02 20.42 19.22 2561893 305 85305 PROTEIN S TOTAL 1 34.83 11.84 11.61 27.86 18.97 17.85 25.29 24.38 27.17 26.12 23.22 27.86 24.38 11.61 26.12 19.74 18.58 2561894 305 85306 PROTEIN S FREE 1 45.96 15.63 15.32 36.77 25.06 23.55 33.37 32.17 35.85 34.47 30.64 36.77 32.17 15.32 34.47 26.04 24.51 2561896 302 86148 ANTI PHOSPHOLIPID AB 1 48.21 16.39 16.07 38.57 19.01 24.71 35.00 33.75 37.60 36.16 32.14 38.57 33.75 16.07 36.16 27.32 25.71 2561897 305 85247 VON WILLEBRAND MULTIMETRIC(FACTOR VIII) 1 114.04 38.77 22.94 91.23 37.50 58.45 82.79 79.83 88.95 85.53 45.88 91.23 79.83 22.94 85.53 39.00 36.70 2561910 306 87102 CULTURE FUNGUS;OTHER SOURCE 1 25.23 8.58 8.41 20.18 13.74 12.93 18.32 17.66 19.68 18.92 16.82 20.18 17.66 8.41 18.92 14.30 13.46 2561927 301 80051 ELECTROLYTE PANEL 1 21.03 7.15 7.01 16.82 11.28 10.78 15.27 14.72 16.40 15.77 14.02 16.82 14.72 7.01 15.77 11.92 11.22 2562006 307 81025 PREG URINE QUAL WAIVED 1 25.83 8.78 8.61 20.66 10.33 13.24 18.75 18.08 20.15 19.37 17.22 20.66 18.08 8.61 19.37 14.64 13.78 2562099 310 Q0111 SMEAR WET PREP WO STAIN 1 45.36 15.42 6.98 36.29 6.98 23.25 32.93 31.75 35.38 34.02 30.30 36.29 31.75 15.15 34.02 25.76 24.24 2562129 301 82374 CARBON DIOXIDE BLD 1 14.64 4.98 4.88 11.71 7.99 7.50 10.63 10.25 11.42 10.98 9.76 11.71 10.25 4.88 10.98 8.30 7.81 2562135 301 82955 G-6-PD QUANT 1 29.10 9.89 9.70 23.28 15.85 14.91 21.13 20.37 22.70 21.83 19.40 23.28 20.37 9.70 21.83 16.49 15.52 2562222 391 36430 BB BLOOD ADMIN FEE PER DAY 1 " 1,067.39 " 362.91 355.85 853.91 497.00 547.04 774.93 747.17 832.56 800.54 711.70 853.91 747.17 355.85 800.54 604.95 569.36 2562383 301 82010 ACETONE BLD QUANT 1 24.51 8.33 8.17 19.61 13.36 12.56 17.79 17.16 19.12 18.38 16.34 19.61 17.16 8.17 18.38 13.89 13.07 2562384 301 82040 ALBUMIN SERUM 1 14.85 5.05 4.95 11.88 8.09 7.61 10.78 10.40 11.58 11.14 9.90 11.88 10.40 4.95 11.14 8.42 7.92 2562386 301 80320 ALCOHOL BLOOD 1 134.00 45.56 0.01 107.20 0.01 68.68 97.28 93.80 104.52 100.50 52.26 107.20 93.80 100.50 2562388 301 82085 "ALDOLASE,QUANT" 1 29.13 9.90 9.71 23.30 15.86 14.93 21.15 20.39 22.72 21.85 19.42 23.30 20.39 9.71 21.85 16.51 15.54 2562395 301 82150 AMYLASE BLOOD 1 19.44 6.61 6.48 15.55 10.60 9.96 14.11 13.61 15.16 14.58 12.96 15.55 13.61 6.48 14.58 11.02 10.37 2562400 301 82150 AMYLASE UR 1 19.44 6.61 6.48 15.55 10.60 9.96 14.11 13.61 15.16 14.58 12.96 15.55 13.61 6.48 14.58 11.02 10.37 2562401 301 82175 ARSENIC BLOOD 1 56.91 19.35 18.97 45.53 31.01 29.17 41.32 39.84 44.39 42.68 37.94 45.53 39.84 18.97 42.68 32.25 30.35 2562408 301 82248 BILIRUBIN DIRECT 1 15.06 5.12 5.02 12.05 5.68 7.72 10.93 10.54 11.75 11.30 10.04 12.05 10.54 5.02 11.30 8.53 8.03 2562414 301 82310 CALCIUM TOTAL 1 15.48 5.26 5.16 12.38 8.44 7.93 11.24 10.84 12.07 11.61 10.32 12.38 10.84 5.16 11.61 8.77 8.26 2562420 301 82390 CERULOPLASMIN 1 32.22 10.95 10.74 25.78 17.56 16.51 23.39 22.55 25.13 24.17 21.48 25.78 22.55 10.74 24.17 18.26 17.18 2562425 301 82465 "CHOLESTEROL BLD,TOTAL" 1 13.05 4.44 4.35 10.44 7.10 6.69 9.47 9.14 10.18 9.79 8.70 10.44 9.14 4.35 9.79 7.40 6.96 2562430 301 82525 COPPER BLD 1 37.23 12.66 12.41 29.78 20.28 19.08 27.03 26.06 29.04 27.92 24.82 29.78 26.06 12.41 27.92 21.10 19.86 2562433 301 82550 "CREATINE KINASE (CK),TOTAL" 1 19.53 6.64 6.51 15.62 10.64 10.01 14.18 13.67 15.23 14.65 13.02 15.62 13.67 6.51 14.65 11.07 10.42 2562434 301 82552 CK-ISOENZYMES 1 40.17 13.66 13.39 32.14 21.90 20.59 29.16 28.12 31.33 30.13 26.78 32.14 28.12 13.39 30.13 22.76 21.42 2562437 301 82570 CREATININE UR 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2562438 301 82575 CREATININE CLEARANCE 1 28.38 9.65 9.46 22.70 15.46 14.54 20.60 19.87 22.14 21.29 18.92 22.70 19.87 9.46 21.29 16.08 15.14 2562442 301 80162 DIGOXIN (LANOXIN) QN 1 39.84 13.55 13.28 31.87 21.71 20.42 28.92 27.89 31.08 29.88 26.56 31.87 27.89 13.28 29.88 22.58 21.25 2562445 301 80185 PHENYTOIN (DILANTIN) TOT 1 39.75 13.52 13.25 31.80 21.67 20.37 28.86 27.83 31.01 29.81 26.50 31.80 27.83 13.25 29.81 22.53 21.20 2562457 301 83010 HAPTOGLOBIN QUANT 1 37.74 12.83 12.58 30.19 20.56 19.34 27.40 26.42 29.44 28.31 25.16 30.19 26.42 12.58 28.31 21.39 20.13 2562460 301 82378 CEA 1 56.88 19.34 18.96 45.50 31.01 29.15 41.29 39.82 44.37 42.66 37.92 45.50 39.82 18.96 42.66 32.23 30.34 2562500 301 83001 GONADOTROPIN;FSH 1 55.74 18.95 18.58 44.59 30.37 28.57 40.47 39.02 43.48 41.81 37.16 44.59 39.02 18.58 41.81 31.59 29.73 2562505 301 84244 RENIN 1 65.97 22.43 21.99 52.78 35.95 33.81 47.89 46.18 51.46 49.48 43.98 52.78 46.18 21.99 49.48 37.38 35.18 2562517 301 84436 T4 TOTAL 1 20.61 7.01 6.87 16.49 7.91 10.56 14.96 14.43 16.08 15.46 13.74 16.49 14.43 6.87 15.46 11.68 10.99 2562520 301 83880 PRO BNP TYPE NATRIURETIC PEPTIDE 1 117.78 40.05 39.26 94.22 55.49 60.36 85.51 82.45 91.87 88.34 78.52 94.22 82.45 39.26 88.34 66.74 62.82 2562524 301 83550 IRON BINDING (TIBC) 1 26.22 8.91 8.74 20.98 14.29 13.44 19.04 18.35 20.45 19.67 17.48 20.98 18.35 8.74 19.67 14.86 13.98 2562529 301 83625 LDH ISOENZYMES 1 38.37 13.05 12.79 30.70 15.11 19.66 27.86 26.86 29.93 28.78 25.58 30.70 26.86 12.79 28.78 21.74 20.46 2562531 301 83655 LEAD BLOOD 1 36.33 12.35 12.11 29.06 19.79 18.62 26.38 25.43 28.34 27.25 24.22 29.06 25.43 12.11 27.25 20.59 19.38 2562533 301 83690 LIPASE 1 20.67 7.03 6.89 16.54 11.26 10.59 15.01 14.47 16.12 15.50 13.78 16.54 14.47 6.89 15.50 11.71 11.02 2562542 301 80178 LITHIUM (ESKALITH) QN 1 19.83 6.74 6.61 15.86 10.81 10.16 14.40 13.88 15.47 14.87 13.22 15.86 13.88 6.61 14.87 11.24 10.58 2562543 301 83735 MAGNESIUM BLD 1 20.10 6.83 6.70 16.08 10.94 10.30 14.59 14.07 15.68 15.08 13.40 16.08 14.07 6.70 15.08 11.39 10.72 2562545 301 83825 MERCURY BLD QUANT-REF-LAB 1 48.78 16.59 16.26 39.02 26.57 25.00 35.41 34.15 38.05 36.59 32.52 39.02 34.15 16.26 36.59 27.64 26.02 2562555 301 84030 NEWBORN SCREEN (PKU) 1 16.50 5.61 5.50 13.20 8.99 8.46 11.98 11.55 12.87 12.38 11.00 13.20 11.55 5.50 12.38 9.35 8.80 2562556 301 84060 "PROSPHATASE,ACID;TOTAL" 1 22.92 7.79 7.64 18.34 12.07 11.75 16.64 16.04 17.88 17.19 15.28 18.34 16.04 7.64 17.19 12.99 12.22 2562557 301 84066 "PHOSHATASE,ACID;PROST" 1 28.98 9.85 9.66 23.18 15.79 14.85 21.04 20.29 22.60 21.74 19.32 23.18 20.29 9.66 21.74 16.42 15.46 2562558 301 84075 "PHOS,ALK;(ALP)" 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2562559 301 84080 "PHOS,ALK;ISOENZYMES" 1 44.34 15.08 14.78 35.47 24.17 22.72 32.19 31.04 34.59 33.26 29.56 35.47 31.04 14.78 33.26 25.13 23.65 2562572 301 84132 "POTASSIUM BLD,SERUM" 1 14.28 4.86 4.76 11.42 7.51 7.32 10.37 10.00 11.14 10.71 9.52 11.42 10.00 4.76 10.71 8.09 7.62 2562576 301 84165 PROTEIN ELECTRO;SERUM 1 32.22 10.95 10.74 25.78 17.56 16.51 23.39 22.55 25.13 24.17 21.48 25.78 22.55 10.74 24.17 18.26 17.18 2562580 301 84165 BENCE JONES PROTEIN 1 32.22 10.95 10.74 25.78 17.56 16.51 23.39 22.55 25.13 24.17 21.48 25.78 22.55 10.74 24.17 18.26 17.18 2562584 301 82977 GAMMA GT 1 21.60 7.34 7.20 17.28 11.77 11.07 15.68 15.12 16.85 16.20 14.40 17.28 15.12 7.20 16.20 12.24 11.52 2562585 301 84157 "PROTEIN,TOTAL;BODY FL" 1 12.00 4.08 4.00 9.60 6.00 6.15 8.71 8.40 9.36 9.00 8.00 9.60 8.40 4.00 9.00 6.80 6.40 2562586 301 80190 "PROCAINAMIDE (PRONESTYL),QUANT" 1 180.00 61.20 27.38 144.00 27.38 92.25 130.68 126.00 140.40 135.00 120.00 144.00 126.00 60.00 135.00 102.00 96.00 2562599 301 84300 SODIUM UR RANDOM 1 15.18 5.16 5.06 12.14 7.96 7.78 11.02 10.63 11.84 11.39 10.12 12.14 10.63 5.06 11.39 8.60 8.10 2562606 301 82945 GLUCOSE CSF QUANT 1 11.79 4.01 3.93 9.43 6.42 6.04 8.56 8.25 9.20 8.84 7.86 9.43 8.25 3.93 8.84 6.68 6.29 2562612 301 84478 TRIGLYCERIDES 1 17.22 5.85 5.74 13.78 9.40 8.83 12.50 12.05 13.43 12.92 11.48 13.78 12.05 5.74 12.92 9.76 9.18 2562613 301 84466 TRANSFERRIN 1 38.28 13.02 12.76 30.62 20.87 19.62 27.79 26.80 29.86 28.71 25.52 30.62 26.80 12.76 28.71 21.69 20.42 2562614 301 84520 "UREA NITROGEN,QUANT(BUN)" 1 11.85 4.03 3.95 9.48 6.46 6.07 8.60 8.30 9.24 8.89 7.90 9.48 8.30 3.95 8.89 6.72 6.32 2562618 301 84560 "URIC ACID,OTHER SOURCE" 1 15.24 5.18 5.08 12.19 7.76 7.81 11.06 10.67 11.89 11.43 10.16 12.19 10.67 5.08 11.43 8.64 8.13 2562631 305 85002 BLEEDING TIME 1 14.46 4.92 4.82 11.57 7.37 7.41 10.50 10.12 11.28 10.85 9.64 11.57 10.12 4.82 10.85 8.19 7.71 2562632 305 85025 CBC AUTO W/AUTO DIFF 1 23.31 7.93 7.77 18.65 12.71 11.95 16.92 16.32 18.18 17.48 15.54 18.65 16.32 7.77 17.48 13.21 12.43 2562634 305 85048 "WBC COUNT BLD,AUTO" 1 7.62 2.59 2.54 6.10 4.15 3.91 5.53 5.33 5.94 5.72 5.08 6.10 5.33 2.54 5.72 4.32 4.06 2562641 305 85014 HEMATOCRIT 1 7.11 2.42 2.37 5.69 3.88 3.64 5.16 4.98 5.55 5.33 4.74 5.69 4.98 2.37 5.33 4.03 3.79 2562659 305 85049 "PLATELET COUNT,AUTO" 1 13.44 4.57 4.48 10.75 6.73 6.89 9.76 9.41 10.48 10.08 8.96 10.75 9.41 4.48 10.08 7.62 7.17 2562663 305 85610 PROTHROMBIN TIME 1 12.87 4.38 4.29 10.30 6.43 6.60 9.34 9.01 10.04 9.65 8.58 10.30 9.01 4.29 9.65 7.29 6.86 2562665 305 85044 RETICULOCYTE COUNT 1 12.93 4.40 4.31 10.34 7.03 6.63 9.39 9.05 10.09 9.70 8.62 10.34 9.05 4.31 9.70 7.33 6.90 2562669 305 85670 "THROMBIN TIME,PLASMA" 1 17.31 5.89 5.77 13.85 9.43 8.87 12.57 12.12 13.50 12.98 11.54 13.85 12.12 5.77 12.98 9.81 9.23 2562670 305 85730 PTT;PLASMA/WHOLE BLOOD 1 18.03 6.13 6.01 14.42 9.82 9.24 13.09 12.62 14.06 13.52 12.02 14.42 12.62 6.01 13.52 10.22 9.62 2562917 301 82088 "ALDOSTERONE,QUANT" 1 122.25 41.57 40.75 97.80 66.61 62.65 88.75 85.58 95.36 91.69 81.50 97.80 85.58 40.75 91.69 69.28 65.20 2563516 300 83516 MITOCHONDRIAL (M2) ANTIBODY 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2563520 301 83520 MYELIN ASSOC GLYCOPROTEIN (MGA) IGM AUTO 1 92.00 31.28 17.27 73.60 21.16 47.15 66.79 64.40 71.76 69.00 34.54 73.60 64.40 17.27 69.00 29.36 27.63 2563899 309 89310 SEMEN ANALYSIS/FERTILITY 1 25.83 8.78 8.61 20.66 14.08 13.24 18.75 18.08 20.15 19.37 17.22 20.66 18.08 8.61 19.37 14.64 13.78 2563922 301 84106 PORPHOBILINOGEN UR QUAL 1 17.46 5.94 5.82 13.97 7.00 8.95 12.68 12.22 13.62 13.10 11.64 13.97 12.22 5.82 13.10 9.89 9.31 2564117 301 84166 URINE PROTEIN ELECTRO URINE 1 53.49 18.19 17.83 42.79 29.15 27.41 38.83 37.44 41.72 40.12 35.66 42.79 37.44 17.83 40.12 30.31 28.53 2564127 301 80076 LIVER PROFILE 1 24.51 8.33 8.17 19.61 13.36 12.56 17.79 17.16 19.12 18.38 16.34 19.61 17.16 8.17 18.38 13.89 13.07 2564130 301 84100 PHOSPHORUS BLD 1 14.22 4.83 4.74 11.38 7.75 7.29 10.32 9.95 11.09 10.67 9.48 11.38 9.95 4.74 10.67 8.06 7.58 2564133 302 86000 SALMONELLA AGG 1 20.94 7.12 6.98 16.75 11.41 10.73 15.20 14.66 16.33 15.71 13.96 16.75 14.66 6.98 15.71 11.87 11.17 2564137 302 86000 TULAREMIA AGG 1 20.94 7.12 6.98 16.75 11.41 10.73 15.20 14.66 16.33 15.71 13.96 16.75 14.66 6.98 15.71 11.87 11.17 2564138 301 84550 URIC ACID BLD 1 13.56 4.61 4.52 10.85 7.39 6.95 9.84 9.49 10.58 10.17 9.04 10.85 9.49 4.52 10.17 7.68 7.23 2564140 301 84585 VMA URINE 1 46.50 15.81 15.50 37.20 25.33 23.83 33.76 32.55 36.27 34.88 31.00 37.20 32.55 15.50 34.88 26.35 24.80 2564471 306 87081 CULTURE GONOCOCCUS 1 19.89 6.76 6.63 15.91 10.84 10.19 14.44 13.92 15.51 14.92 13.26 15.91 13.92 6.63 14.92 11.27 10.61 2564633 301 82247 BILIRUBIN TOTAL 1 15.06 5.12 5.02 12.05 5.68 7.72 10.93 10.54 11.75 11.30 10.04 12.05 10.54 5.02 11.30 8.53 8.03 2564634 301 82247 NEONATAL BILIRUBIN 1 15.06 5.12 5.02 12.05 5.68 7.72 10.93 10.54 11.75 11.30 10.04 12.05 10.54 5.02 11.30 8.53 8.03 2564664 301 82600 CYANIDE 1 58.20 19.79 19.40 46.56 31.72 29.83 42.25 40.74 45.40 43.65 38.80 46.56 40.74 19.40 43.65 32.98 31.04 2564682 301 80184 "PHENOBARBITAL (LUMINAL),QUANT" 1 45.90 15.61 15.30 36.72 18.36 23.52 33.32 32.13 35.80 34.43 30.60 36.72 32.13 15.30 34.43 26.01 24.48 2564689 306 87172 PINWORM PREP-TAPE 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2564697 301 84403 TESTOSTERONE TOTAL 1 77.43 26.33 25.81 61.94 42.20 39.68 56.21 54.20 60.40 58.07 51.62 61.94 54.20 25.81 58.07 43.88 41.30 2565084 300 86922 BB CROSSMATCH AHG 1 400.98 136.33 38.49 320.78 38.49 205.50 291.11 280.69 312.76 300.74 267.36 320.78 280.69 133.68 300.74 227.26 213.89 2565621 301 83785 MANGANESE-REF.LAB 1 79.95 27.18 26.65 63.96 34.86 40.97 58.04 55.97 62.36 59.96 53.30 63.96 55.97 26.65 59.96 45.31 42.64 2565744 306 87205 "SMEAR,GRAM STAIN-STOOL(WBC)" 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2565949 301 82465 RHC CHOLESTEROL SERUM;TOTAL 1 13.05 4.44 4.35 10.44 7.10 6.69 9.47 9.14 10.18 9.79 8.70 10.44 9.14 4.35 9.79 7.40 6.96 2566153 302 86762 RUBELLA AB QUANT 1 43.17 14.68 14.39 34.54 23.53 22.12 31.34 30.22 33.67 32.38 28.78 34.54 30.22 14.39 32.38 24.46 23.02 2566155 302 86765 RUBEOLA AB 1 38.64 13.14 12.88 30.91 21.06 19.80 28.05 27.05 30.14 28.98 25.76 30.91 27.05 12.88 28.98 21.90 20.61 2566178 309 89051 CELL COUNT W DIFF CSF 1 16.80 5.71 5.60 13.44 9.00 8.61 12.20 11.76 13.10 12.60 11.20 13.44 11.76 5.60 12.60 9.52 8.96 2566180 301 84479 "T3,UPTAKE" 1 19.41 6.60 6.47 15.53 7.60 9.95 14.09 13.59 15.14 14.56 12.94 15.53 13.59 6.47 14.56 11.00 10.35 2566184 301 84443 TSH 1 50.40 17.14 16.80 40.32 27.47 25.83 36.59 35.28 39.31 37.80 33.60 40.32 35.28 16.80 37.80 28.56 26.88 2567065 305 85345 "CLOTTING TIME,LEE & WHITE" 1 14.07 4.78 4.69 11.26 7.03 7.21 10.21 9.85 10.97 10.55 9.38 11.26 9.85 4.69 10.55 7.97 7.50 2567070 306 87070 CULTURE MALE GENITAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2567075 306 87075 CULTURE-ANAEROBIC FLUID 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2567094 306 87591 GC DIRECT PROBE 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2567112 301 82945 GLUCOSE BODY FLD QUANT 1 11.79 4.01 3.93 9.43 6.42 6.04 8.56 8.25 9.20 8.84 7.86 9.43 8.25 3.93 8.84 6.68 6.29 2567113 301 83030 HEMOGLOBIN F CHEM 1 32.22 10.95 5.64 25.78 5.64 16.51 23.39 22.55 25.13 24.17 21.48 25.78 22.55 10.74 24.17 18.26 17.18 2567139 301 83586 "KETOSTEROIDS,17;TOTAL" 1 38.40 13.06 12.80 30.72 20.93 19.68 27.88 26.88 29.95 28.80 25.60 30.72 26.88 12.80 28.80 21.76 20.48 2567161 307 81003 PH UR AUTO 1 6.75 2.30 2.25 5.40 3.67 3.46 4.90 4.73 5.27 5.06 4.50 5.40 4.73 2.25 5.06 3.83 3.60 2567187 301 80329 SALICYLATE QUANT 1 OR 2 1 81.00 27.54 0.01 64.80 0.01 41.51 58.81 56.70 63.18 60.75 31.59 64.80 56.70 60.75 2567205 306 87205 GRAM STAIN CATHETER 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2568913 301 83540 IRON 1 19.41 6.60 6.47 15.53 8.77 9.95 14.09 13.59 15.14 14.56 12.94 15.53 13.59 6.47 14.56 11.00 10.35 2570545 301 84234 "RECEP ASSAY,PROGESTERONE(PR)" 1 194.64 66.18 64.88 155.71 106.06 99.75 141.31 136.25 151.82 145.98 129.76 155.71 136.25 64.88 145.98 110.30 103.81 2570654 306 87070 CULTURE WOUND 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2570655 306 87086 CULTURE URINE 1 24.21 8.23 8.07 19.37 13.20 12.41 17.58 16.95 18.88 18.16 16.14 19.37 16.95 8.07 18.16 13.72 12.91 2570656 306 87070 CULTURE SPUTUM 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2571089 301 82042 ALBUMIN URINE QUANT 1 23.34 7.94 7.78 18.67 8.46 11.96 16.94 16.34 18.21 17.51 15.56 18.67 16.34 7.78 17.51 13.23 12.45 2571090 301 82043 "MICROALBUMIN,QUANT" 1 17.34 5.90 5.78 13.87 9.44 8.89 12.59 12.14 13.53 13.01 11.56 13.87 12.14 5.78 13.01 9.83 9.25 2571093 301 82150 AMYLASE BODY FL 1 19.44 6.61 6.48 15.55 10.60 9.96 14.11 13.61 15.16 14.58 12.96 15.55 13.61 6.48 14.58 11.02 10.37 2571160 301 82271 OCCULT BLOOD GASTRIC 1 15.96 5.43 5.32 12.77 5.32 8.18 11.59 11.17 12.45 11.97 10.64 12.77 11.17 5.32 11.97 9.04 8.51 2571165 301 83986 PH BODY FLUID 1 10.74 3.65 3.58 8.59 5.86 5.50 7.80 7.52 8.38 8.06 7.16 8.59 7.52 3.58 8.06 6.09 5.73 2571192 307 81003 SPEC GRAV UR AUTO 1 6.75 2.30 2.25 5.40 3.67 3.46 4.90 4.73 5.27 5.06 4.50 5.40 4.73 2.25 5.06 3.83 3.60 2571196 300 36415 VENIPUNCTURE 1 9.00 3.06 3.00 7.20 4.35 4.61 6.53 6.30 7.02 6.75 6.00 7.20 6.30 3.00 6.75 5.10 4.80 2571745 301 84439 T4 FREE 1 27.06 9.20 9.02 21.65 14.74 13.87 19.65 18.94 21.11 20.30 18.04 21.65 18.94 9.02 20.30 15.33 14.43 2571803 301 83986 PH GASTRIC 1 10.74 3.65 3.58 8.59 5.86 5.50 7.80 7.52 8.38 8.06 7.16 8.59 7.52 3.58 8.06 6.09 5.73 2571896 301 84484 TROPONIN QUANT 1 37.41 12.72 12.47 29.93 16.08 19.17 27.16 26.19 29.18 28.06 24.94 29.93 26.19 12.47 28.06 21.20 19.95 2571907 302 86757 RICKETTSIA AB QUAL 1 58.05 19.74 19.35 46.44 31.64 29.75 42.14 40.64 45.28 43.54 38.70 46.44 40.64 19.35 43.54 32.90 30.96 2571920 301 83497 "HYDROXINDOL ACID,5-(HIAA)" 1 38.70 13.16 12.90 30.96 21.07 19.83 28.10 27.09 30.19 29.03 25.80 30.96 27.09 12.90 29.03 21.93 20.64 2571935 306 87206 EOSINOPHILS SMEAR 1 16.17 5.50 5.39 12.94 8.80 8.29 11.74 11.32 12.61 12.13 10.78 12.94 11.32 5.39 12.13 9.16 8.62 2572402 301 84120 PORPHYRINS UR QUANT 1 44.13 15.00 14.71 35.30 24.05 22.62 32.04 30.89 34.42 33.10 29.42 35.30 30.89 14.71 33.10 25.01 23.54 2572404 301 84146 PROLACTIN 1 58.14 19.77 19.38 46.51 31.68 29.80 42.21 40.70 45.35 43.61 38.76 46.51 40.70 19.38 43.61 32.95 31.01 2572406 301 84155 "PROTEIN,TOTAL;BLD" 1 11.01 3.74 3.67 8.81 6.00 5.64 7.99 7.71 8.59 8.26 7.34 8.81 7.71 3.67 8.26 6.24 5.87 2572414 301 84450 SGOT (AST) 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2572415 301 84460 SGPT (ALT) 1 15.90 5.41 5.30 12.72 8.66 8.15 11.54 11.13 12.40 11.93 10.60 12.72 11.13 5.30 11.93 9.01 8.48 2572420 301 84295 "SODIUM,SERUM" 1 14.43 4.91 4.81 11.54 7.87 7.40 10.48 10.10 11.26 10.82 9.62 11.54 10.10 4.81 10.82 8.18 7.70 2572433 302 86592 VDRL CSF QUAL 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2572439 301 82930 "GASTRIC ACID FREE OR TOTAL,EA" 1 20.13 6.84 6.71 16.10 7.56 10.32 14.61 14.09 15.70 15.10 13.42 16.10 14.09 6.71 15.10 11.41 10.74 2572852 306 87070 CULTURE GENITAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2572966 302 86787 VARIC ZOSTER IGG 1 38.64 13.14 12.88 30.91 18.34 19.80 28.05 27.05 30.14 28.98 25.76 30.91 27.05 12.88 28.98 21.90 20.61 2572968 302 86787 VARIC ZOSTER IGM 1 38.64 13.14 12.88 30.91 18.34 19.80 28.05 27.05 30.14 28.98 25.76 30.91 27.05 12.88 28.98 21.90 20.61 2573051 301 83002 GONADOTROPIN;LH 1 55.56 18.89 18.52 44.45 30.26 28.47 40.34 38.89 43.34 41.67 37.04 44.45 38.89 18.52 41.67 31.48 29.63 2573065 309 89325 SPERM ANTIBODIES 1 32.01 10.88 10.67 25.61 17.45 16.41 23.24 22.41 24.97 24.01 21.34 25.61 22.41 10.67 24.01 18.14 17.07 2573110 301 82415 CHLORAMPHENICOL 1 38.01 12.92 12.67 30.41 20.71 19.48 27.60 26.61 29.65 28.51 25.34 30.41 26.61 12.67 28.51 21.54 20.27 2573516 300 83516 CELIAC ANTIBODIES tTG IgA/IgG WITH DGP I 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2573520 301 83520 NEUROMYELITIS OPTICA IGG AUTOANTIBODIES 1 600.00 204.00 17.27 480.00 21.16 307.50 435.60 420.00 468.00 450.00 34.54 480.00 420.00 17.27 450.00 29.36 27.63 2574619 301 82668 ERYTHROPOIETIN QUANT 1 56.37 19.17 18.79 45.10 30.72 28.89 40.92 39.46 43.97 42.28 37.58 45.10 39.46 18.79 42.28 31.94 30.06 2574974 302 86317 PNEUMOCOCCAL AB 1 44.97 15.29 14.99 35.98 24.50 23.05 32.65 31.48 35.08 33.73 29.98 35.98 31.48 14.99 33.73 25.48 23.98 2575030 301 82728 FERRITIN 1 40.89 13.90 13.63 32.71 22.28 20.96 29.69 28.62 31.89 30.67 27.26 32.71 28.62 13.63 30.67 23.17 21.81 2575031 301 80307 DRUG SCREEN COMP UR 1 186.42 63.38 62.14 149.14 95.77 95.54 135.34 130.49 145.41 139.82 124.28 149.14 130.49 62.14 139.82 105.64 99.42 2575330 302 86684 H INFLU AB QUAL 1 47.52 16.16 15.84 38.02 25.90 24.35 34.50 33.26 37.07 35.64 31.68 38.02 33.26 15.84 35.64 26.93 25.34 2575383 301 80053 COMP METABOLIC PANEL 1 31.68 10.77 10.56 25.34 17.27 16.24 23.00 22.18 24.71 23.76 21.12 25.34 22.18 10.56 23.76 17.95 16.90 2577070 306 87070 CULTURE MUSCULOSKELETAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2577075 306 87075 CULTURE-ANAEROBIC MALE GENITAL 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2577205 306 87205 GRAM STAIN CNS 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2577450 300 87210 WET PREP 1 17.46 5.94 5.82 13.97 6.98 8.95 12.68 12.22 13.62 13.10 11.64 13.97 12.22 5.82 13.10 9.89 9.31 2577804 306 Q0112 KOH PREP 1 17.49 5.95 5.83 13.99 6.98 8.96 12.70 12.24 13.64 13.12 11.66 13.99 12.24 5.83 13.12 9.91 9.33 2578498 301 84119 PORPHYRINS UR QUAL 1 40.08 13.63 13.36 32.06 14.09 20.54 29.10 28.06 31.26 30.06 26.72 32.06 28.06 13.36 30.06 22.71 21.38 2578613 306 87880 HEP B S AG EIA 1 49.59 16.86 16.53 39.67 19.60 25.41 36.00 34.71 38.68 37.19 33.06 39.67 34.71 16.53 37.19 28.10 26.45 2579046 301 83835 METANEPHRINES FRACT-24HR URINE 1 50.82 17.28 16.94 40.66 27.68 26.05 36.90 35.57 39.64 38.12 33.88 40.66 35.57 16.94 38.12 28.80 27.10 2579521 306 87081 CULTURE DIPTHERIA 1 19.89 6.76 6.63 15.91 10.84 10.19 14.44 13.92 15.51 14.92 13.26 15.91 13.92 6.63 14.92 11.27 10.61 2579791 301 82693 ETHYLENE GYCOL 1 44.70 15.20 14.90 35.76 24.35 22.91 32.45 31.29 34.87 33.53 29.80 35.76 31.29 14.90 33.53 25.33 23.84 2579876 301 82553 "CK MB,FRACT ONLY" 1 34.65 11.78 11.55 27.72 18.88 17.76 25.16 24.26 27.03 25.99 23.10 27.72 24.26 11.55 25.99 19.64 18.48 2580002 306 U0003 "COVID-19 NOVEL CORONAVIRUS ,NAA LAB CORP" 1 300.00 102.00 75.00 240.00 180.00 153.75 217.80 210.00 234.00 225.00 150.00 240.00 210.00 75.00 225.00 127.50 120.00 2580003 306 U0003 COVID-19 WK MAYO 1 300.00 102.00 75.00 240.00 180.00 153.75 217.80 210.00 234.00 225.00 150.00 240.00 210.00 75.00 225.00 127.50 120.00 2580145 300 80145 ADALIMUMAB DRUG LEVEL 1 115.71 39.34 38.57 92.57 69.43 59.30 84.01 81.00 90.25 86.78 77.14 92.57 81.00 38.57 86.78 65.57 61.71 2580175 301 80175 LAMOTRIGINE (LAMICTAL) SERUM 1 39.75 13.52 13.25 31.80 21.67 20.37 28.86 27.83 31.01 29.81 26.50 31.80 27.83 13.25 29.81 22.53 21.20 2580177 301 80177 KEPPRA LEVEL 1 39.75 13.52 13.25 31.80 21.67 20.37 28.86 27.83 31.01 29.81 26.50 31.80 27.83 13.25 29.81 22.53 21.20 2580183 301 80183 OXCARBAZEPINE (TRILEPTAL) SERUM 1 39.75 13.52 13.25 31.80 21.67 20.37 28.86 27.83 31.01 29.81 26.50 31.80 27.83 13.25 29.81 22.53 21.20 2580188 301 80188 PRIMIDONE QUANT 1 49.77 16.92 16.59 39.82 24.58 25.51 36.13 34.84 38.82 37.33 33.18 39.82 34.84 16.59 37.33 28.20 26.54 2580197 301 80197 TACROLIMUSBY IMMUNOASSAY 1 55.00 18.70 13.73 44.00 22.45 28.19 39.93 38.50 42.90 41.25 27.46 44.00 38.50 13.73 41.25 23.34 21.97 2580198 301 80198 THEOPHYLLINE 1 42.42 14.42 14.14 33.94 23.12 21.74 30.80 29.69 33.09 31.82 28.28 33.94 29.69 14.14 31.82 24.04 22.62 2580203 301 80203 ZONISAMIDE SERUM OR PLASMA 1 39.75 13.52 13.25 31.80 21.67 20.37 28.86 27.83 31.01 29.81 26.50 31.80 27.83 13.25 29.81 22.53 21.20 2580235 301 80235 LACOSAMIDE 1 100.00 34.00 27.11 80.00 60.00 51.25 72.60 70.00 78.00 75.00 54.22 80.00 70.00 27.11 75.00 46.09 43.38 2580299 300 80299 AMIODARONE 1 55.92 19.01 18.64 44.74 22.37 28.66 40.60 39.14 43.62 41.94 37.28 44.74 39.14 18.64 41.94 31.69 29.82 2580318 300 83018 COBALT PLASMA 1 65.88 22.40 13.88 52.70 13.88 33.76 47.83 46.12 51.39 49.41 43.92 52.70 46.12 21.96 49.41 37.33 35.14 2580323 300 80323 NICOTINE METABOLITE QUANT URINE SCREEN 1 343.29 116.72 0.01 274.63 0.01 175.94 249.23 240.30 267.77 257.47 133.88 274.63 240.30 257.47 2580354 300 80354 FENTANYL AND METABOLITE 1 80.00 27.20 0.01 64.00 0.01 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 60.00 2580358 300 80358 METHADONE SERUM OR PLASMA 1 12.00 4.08 0.01 9.60 0.01 6.15 8.71 8.40 9.36 9.00 4.68 9.60 8.40 9.00 2580375 300 80375 DEXAMETHASONE (ENDOCRINE SCIENCES) 1 68.42 23.26 0.01 54.74 0.01 35.07 49.67 47.89 53.37 51.32 26.68 54.74 47.89 51.32 2580774 301 83718 HDL CHOLESTEROL 1 24.57 8.35 8.19 19.66 13.39 12.59 17.84 17.20 19.16 18.43 16.38 19.66 17.20 8.19 18.43 13.92 13.10 2581001 307 81001 HC UA W/MICRO AUTO 1 9.51 3.23 3.17 7.61 5.18 4.87 6.90 6.66 7.42 7.13 6.34 7.61 6.66 3.17 7.13 5.39 5.07 2581052 309 89050 CELL COUNT W DIFF BODY FLUID 1 16.00 5.44 4.72 12.80 7.73 8.20 11.62 11.20 12.48 12.00 9.44 12.80 11.20 4.72 12.00 8.02 7.55 2581162 306 87252 CULTURE VIRUS 1 78.21 26.59 26.07 62.57 42.61 40.08 56.78 54.75 61.00 58.66 52.14 62.57 54.75 26.07 58.66 44.32 41.71 2581206 310 81206 BCR/ABL1 TRANSLOCATION ANALYSIS MAJOR 1 491.88 167.24 163.96 393.50 268.02 252.09 357.10 344.32 383.67 368.91 327.92 393.50 344.32 163.96 368.91 278.73 262.34 2581207 310 81207 BCR/ABL1 TRANSLOCATION ANALYSIS MINOR 1 434.52 147.74 144.84 347.62 236.76 222.69 315.46 304.16 338.93 325.89 289.68 347.62 304.16 144.84 325.89 246.23 231.74 2581235 310 81235 EGFR GENE ANALYSIS 1 973.74 331.07 324.58 778.99 395.41 499.04 706.94 681.62 759.52 730.31 649.16 778.99 681.62 324.58 730.31 551.79 519.33 2581240 310 81240 FACTOR II (PROTHROMBIN) DNA ANALYSIS 1 197.07 67.00 65.69 157.66 80.44 101.00 143.07 137.95 153.71 147.80 131.38 157.66 137.95 65.69 147.80 111.67 105.10 2581241 300 81241 FACTOR V LEIDEN MUTATION ANALYSIS 1 220.11 74.84 73.37 176.09 99.89 112.81 159.80 154.08 171.69 165.08 146.74 176.09 154.08 73.37 165.08 124.73 117.39 2581256 300 81256 HEREDITARY HEMOCHROMATOSIS DNA ANALYSIS 1 196.08 66.67 65.36 156.86 106.85 100.49 142.35 137.26 152.94 147.06 130.72 156.86 137.26 65.36 147.06 111.11 104.58 2581257 300 81257 a-THALASSEMIA DNA ANALYSIS 1 570.16 193.85 102.26 456.13 129.70 292.21 413.94 399.11 444.72 427.62 204.52 456.13 399.11 102.26 427.62 173.84 163.62 2581270 301 80299 DISOPYRAMIDE NOPACE QN 1 55.92 19.01 18.64 44.74 22.37 28.66 40.60 39.14 43.62 41.94 37.28 44.74 39.14 18.64 41.94 31.69 29.82 2581291 300 81291 METHYLENETETRAHYDROFOLATE REDUCTASE 1 196.02 66.65 65.34 156.82 71.35 100.46 142.31 137.21 152.90 147.02 130.68 156.82 137.21 65.34 147.02 111.08 104.54 2581350 300 81350 UGT1A1 IRINOTECAN TOXICITY 1 702.00 238.68 82.93 561.60 82.93 359.78 509.65 491.40 547.56 526.50 468.00 561.60 491.40 234.00 526.50 397.80 374.40 2581698 301 84437 T4 NEONATAL 1 19.41 6.60 6.47 15.53 10.57 9.95 14.09 13.59 15.14 14.56 12.94 15.53 13.59 6.47 14.56 11.00 10.35 2582043 307 82043 MICROALBUMIN 24 HR URINE 1 17.34 5.90 5.78 13.87 9.44 8.89 12.59 12.14 13.53 13.01 11.56 13.87 12.14 5.78 13.01 9.83 9.25 2582044 301 82044 MICROALBUMIN SEMI QUANT WAIVED 1 18.69 6.35 4.97 14.95 4.97 9.58 13.57 13.08 14.58 14.02 12.46 14.95 13.08 6.23 14.02 10.59 9.97 2582103 300 82103 A-1 ANTITRYPSIN FECAL QUANTITATIVE 1 143.30 48.72 13.44 114.64 21.96 73.44 104.04 100.31 111.77 107.48 26.88 114.64 100.31 13.44 107.48 22.85 21.50 2582104 300 82104 A-1 ANTITRYPSIN; PHENOTYPE 1 43.38 14.75 14.46 34.70 23.64 22.23 31.49 30.37 33.84 32.54 28.92 34.70 30.37 14.46 32.54 24.58 23.14 2582131 301 82131 AMINO ACIDS SINGLE QUANT 1 68.94 23.44 22.98 55.15 27.58 35.33 50.05 48.26 53.77 51.71 45.96 55.15 48.26 22.98 51.71 39.07 36.77 2582157 300 82157 ANDROSTENEDIONE 1 87.84 29.87 29.28 70.27 47.86 45.02 63.77 61.49 68.52 65.88 58.56 70.27 61.49 29.28 65.88 49.78 46.85 2582172 300 82172 APOLIPOPROTEIN EACH 1 63.27 21.51 21.09 50.62 25.33 32.43 45.93 44.29 49.35 47.45 42.18 50.62 44.29 21.09 47.45 35.85 33.74 2582180 301 82180 VITAMIN C 1 29.67 10.09 9.89 23.74 13.85 15.21 21.54 20.77 23.14 22.25 19.78 23.74 20.77 9.89 22.25 16.81 15.82 2582232 301 82232 BETA 2 MICROGLOBULIN SERUM 1 48.54 16.50 16.18 38.83 26.45 24.88 35.24 33.98 37.86 36.41 32.36 38.83 33.98 16.18 36.41 27.51 25.89 2582270 301 82270 OCCULT BLD STOOL 1-3 SCREENING 1 13.14 4.47 4.38 10.51 5.32 6.73 9.54 9.20 10.25 9.86 8.76 10.51 9.20 4.38 9.86 7.45 7.01 2582272 301 82272 OCCULT BLD STOOL DIAGNOSTIC 1 12.69 4.31 4.23 10.15 5.32 6.50 9.21 8.88 9.90 9.52 8.46 10.15 8.88 4.23 9.52 7.19 6.77 2582300 300 82300 CADMIUM WHOLE BLD-REF LAB 1 70.92 24.11 23.64 56.74 37.82 36.35 51.49 49.64 55.32 53.19 47.28 56.74 49.64 23.64 53.19 40.19 37.82 2582306 301 82306 VITAMIN D25 HYDROXY (D3) 1 88.80 30.19 29.60 71.04 48.40 45.51 64.47 62.16 69.26 66.60 59.20 71.04 62.16 29.60 66.60 50.32 47.36 2582308 300 82308 CALCITONIN (THYROCALCITONIN) SERUM 1 80.37 27.33 26.79 64.30 43.79 41.19 58.35 56.26 62.69 60.28 53.58 64.30 56.26 26.79 60.28 45.54 42.86 2582360 301 82360 CALCULI URINARY WITH PHOTOGRAPH 1 38.61 13.13 12.87 30.89 21.04 19.79 28.03 27.03 30.12 28.96 25.74 30.89 27.03 12.87 28.96 21.88 20.59 2582374 301 82374 QW CARBON DIOXIDE BLD WAIVED 1 14.64 4.98 4.88 11.71 7.99 7.50 10.63 10.25 11.42 10.98 9.76 11.71 10.25 4.88 10.98 8.30 7.81 2582397 301 82397 ANTI-MULLERIAN HORMONE (AMH) 1 84.00 28.56 7.58 67.20 7.58 43.05 60.98 58.80 65.52 63.00 28.24 67.20 58.80 14.12 63.00 24.00 22.59 2582435 301 82435 QW CHLORIDE BLD WAIVED 1 13.80 4.69 4.60 11.04 7.51 7.07 10.02 9.66 10.76 10.35 9.20 11.04 9.66 4.60 10.35 7.82 7.36 2582495 301 82495 CHROMIUM 1 60.84 20.69 20.28 48.67 33.16 31.18 44.17 42.59 47.46 45.63 40.56 48.67 42.59 20.28 45.63 34.48 32.45 2582507 301 82507 CITRATE ASSAY 1 83.40 28.36 27.80 66.72 45.44 42.74 60.55 58.38 65.05 62.55 55.60 66.72 58.38 27.80 62.55 47.26 44.48 2582525 300 82525 COPPER UR 1 37.23 12.66 12.41 29.78 20.28 19.08 27.03 26.06 29.04 27.92 24.82 29.78 26.06 12.41 27.92 21.10 19.86 2582533 301 82533 CORTISOL BLOOD TOTAL 1 48.90 16.63 16.30 39.12 26.65 25.06 35.50 34.23 38.14 36.68 32.60 39.12 34.23 16.30 36.68 27.71 26.08 2582565 301 82565 QW CREATININE BLD WAIVED 1 15.36 5.22 5.12 12.29 8.38 7.87 11.15 10.75 11.98 11.52 10.24 12.29 10.75 5.12 11.52 8.70 8.19 2582570 301 82570 CREATININE 24 HR URINE 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2582626 301 82626 DHEA SERUM 1 75.81 25.78 25.27 60.65 41.30 38.85 55.04 53.07 59.13 56.86 50.54 60.65 53.07 25.27 56.86 42.96 40.43 2582652 301 82652 "VITAMIN D 1,25 DI-OH (D2)" 1 115.50 39.27 38.50 92.40 62.93 59.19 83.85 80.85 90.09 86.63 77.00 92.40 80.85 38.50 86.63 65.45 61.60 2582656 301 82656 "PANCREATIC ELASTASE, FECAL" 1 330.00 112.20 11.53 264.00 18.85 169.13 239.58 231.00 257.40 247.50 23.06 264.00 231.00 11.53 247.50 19.60 18.45 2582705 300 82705 "FECAL FAT, QUALITATIVE" 1 15.30 5.20 5.10 12.24 8.32 7.84 11.11 10.71 11.93 11.48 10.20 12.24 10.71 5.10 11.48 8.67 8.16 2582777 306 87070 CULTURE TRACHEA 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582784 301 82784 IMMUNOGLOBULIN SUBCLASSES 1 27.90 9.49 9.30 22.32 15.20 14.30 20.26 19.53 21.76 20.93 18.60 22.32 19.53 9.30 20.93 15.81 14.88 2582789 306 87070 CULTURE FLUID 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582790 306 87070 CULTURE CNS 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582791 306 87070 CULTURE GASTRIC 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582795 306 87070 CULTURE BRONCHIAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582797 306 87070 CULTURE THROAT 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582798 306 87070 CULTURE SINUS 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582799 306 87070 CULTURE VAGINAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582801 306 87070 CULTURE CERVICAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582803 306 87070 CULTURE EAR 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582804 306 87070 CULTURE EYE 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2582805 306 87045 CULTURE STOOL 1 113.28 38.52 9.44 90.62 15.43 58.06 82.24 79.30 88.36 84.96 18.88 90.62 79.30 9.44 84.96 16.05 15.10 2582947 301 82947 QW GLUCOSE BLD QUANT WAIVED 1 11.79 4.01 3.93 9.43 6.42 6.04 8.56 8.25 9.20 8.84 7.86 9.43 8.25 3.93 8.84 6.68 6.29 2582985 301 82985 FRUCTOSAMINE 1 50.28 17.10 16.76 40.22 24.65 25.77 36.50 35.20 39.22 37.71 33.52 40.22 35.20 16.76 37.71 28.49 26.82 2583018 301 83018 HEAVY METAL QUANTITATIVE EACH 1 65.88 22.40 13.88 52.70 13.88 33.76 47.83 46.12 51.39 49.41 43.92 52.70 46.12 21.96 49.41 37.33 35.14 2583021 301 83021 HEMOGLOBIN (Hb) FETAL QUANTITATIVE 1 54.18 18.42 18.06 43.34 29.52 27.77 39.33 37.93 42.26 40.64 36.12 43.34 37.93 18.06 40.64 30.70 28.90 2583036 301 83036 HC HEMOGLOBIN A1C GLYCOHGB WAIVED 1 29.13 9.90 9.71 23.30 15.86 14.93 21.15 20.39 22.72 21.85 19.42 23.30 20.39 9.71 21.85 16.51 15.54 2583498 301 83498 HYDROXYPROGESTERONE 1 81.51 27.71 27.17 65.21 44.41 41.77 59.18 57.06 63.58 61.13 54.34 65.21 57.06 27.17 61.13 46.19 43.47 2583506 305 85306 PROTEIN S FUNCTIONAL 1 45.96 15.63 15.32 36.77 25.06 23.55 33.37 32.17 35.85 34.47 30.64 36.77 32.17 15.32 34.47 26.04 24.51 2583516 301 83516 ACTIN (SMOOTH MUSCLE ANTIBODY) 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2583519 301 83519 GAD 65 AUTOANTIBODY 1 73.30 24.92 7.61 58.64 7.61 37.57 53.22 51.31 57.17 54.98 36.80 58.64 51.31 18.40 54.98 31.28 29.44 2583520 300 83520 IMMUNOASSAY QUANTITATIVE NOS 1 51.81 17.62 17.27 41.45 21.16 26.55 37.61 36.27 40.41 38.86 34.54 41.45 36.27 17.27 38.86 29.36 27.63 2583594 301 83036 HEMOGLOBIN A1C GLYCOHGB 1 29.13 9.90 9.71 23.30 15.86 14.93 21.15 20.39 22.72 21.85 19.42 23.30 20.39 9.71 21.85 16.51 15.54 2583595 301 83036 HEMOGLOBIN B1C GLYCOHGB 1 29.13 9.90 9.71 23.30 15.86 14.93 21.15 20.39 22.72 21.85 19.42 23.30 20.39 9.71 21.85 16.51 15.54 2583615 301 83615 LD BODY FLUID 1 18.12 6.16 6.04 14.50 9.86 9.29 13.16 12.68 14.13 13.59 12.08 14.50 12.68 6.04 13.59 10.27 9.66 2583631 301 83631 LACTOFERRIN FECAL QUANTITATIVE 1 84.00 28.56 19.63 67.20 32.09 43.05 60.98 58.80 65.52 63.00 39.26 67.20 58.80 19.63 63.00 33.37 31.41 2583695 301 83695 LIPOPROTEIN (A) 1 42.96 14.61 14.32 34.37 21.16 22.02 31.19 30.07 33.51 32.22 28.64 34.37 30.07 14.32 32.22 24.34 22.91 2583721 300 83721 LOW DENSITY LIPOPROTEIN CHOLESTEROL DIRE 1 31.50 10.71 10.50 25.20 13.97 16.14 22.87 22.05 24.57 23.63 21.00 25.20 22.05 10.50 23.63 17.85 16.80 2583735 301 83735 MAGNESIUM URINE 1 20.10 6.83 6.70 16.08 10.94 10.30 14.59 14.07 15.68 15.08 13.40 16.08 14.07 6.70 15.08 11.39 10.72 2583835 301 83835 METANEPHRINES FRAC PLASMA FREE 1 50.82 17.28 16.94 40.66 27.68 26.05 36.90 35.57 39.64 38.12 33.88 40.66 35.57 16.94 38.12 28.80 27.10 2583883 301 83883 NEPHELONETRY NOS 1 40.80 13.87 7.58 32.64 7.58 20.91 29.62 28.56 31.82 30.60 27.20 32.64 28.56 13.60 30.60 23.12 21.76 2583887 300 80323 NICOTINE LEVEL BLOOD 1 343.29 116.72 0.01 274.63 0.01 175.94 249.23 240.30 267.77 257.47 133.88 274.63 240.30 257.47 2583945 301 83945 OXALATE ASSAY 1 43.35 14.74 14.45 34.68 21.04 22.22 31.47 30.35 33.81 32.51 28.90 34.68 30.35 14.45 32.51 24.57 23.12 2583993 301 83993 CALPROTECTIN FECAL 1 182.50 62.05 19.63 146.00 32.09 93.53 132.50 127.75 142.35 136.88 39.26 146.00 127.75 19.63 136.88 33.37 31.41 2584105 301 84105 URINE PHOSPHORUS ASSAY 1 17.34 5.90 5.78 13.87 8.46 8.89 12.59 12.14 13.53 13.01 11.56 13.87 12.14 5.78 13.01 9.83 9.25 2584132 301 84132 QW POTASSIUM BLD SERUM WAIVED 1 14.28 4.86 4.76 11.42 7.51 7.32 10.37 10.00 11.14 10.71 9.52 11.42 10.00 4.76 10.71 8.09 7.62 2584140 301 84140 PREGNENOLONE MASS SPECTROMETRY 1 62.01 21.08 20.67 49.61 33.79 31.78 45.02 43.41 48.37 46.51 41.34 49.61 43.41 20.67 46.51 35.14 33.07 2584141 301 83525 INSULIN TOTAL 1 34.29 11.66 11.43 27.43 18.68 17.57 24.89 24.00 26.75 25.72 22.86 27.43 24.00 11.43 25.72 19.43 18.29 2584145 300 84145 PROCALCITONIN 1 165.00 56.10 27.22 132.00 43.79 84.56 119.79 115.50 128.70 123.75 54.44 132.00 115.50 27.22 123.75 46.27 43.55 2584153 301 84153 "PROS SPEC AG(PSA),TOTAL DIAGNOSTIC" 1 55.17 18.76 18.39 44.14 30.07 28.27 40.05 38.62 43.03 41.38 36.78 44.14 38.62 18.39 41.38 31.26 29.42 2584156 301 84156 PROTEIN ELECTRO 24 HR URINE 1 16.00 5.44 3.67 12.80 6.00 8.20 11.62 11.20 12.48 12.00 7.34 12.80 11.20 3.67 12.00 6.24 5.87 2584206 300 84206 PROINSULIN 1 80.07 27.22 26.69 64.06 29.11 41.04 58.13 56.05 62.45 60.05 53.38 64.06 56.05 26.69 60.05 45.37 42.70 2584207 300 84207 "VITAMIN B6, PLASMA (PYRIDOXAL PHOSPHATE)" 1 84.30 28.66 23.11 67.44 23.11 43.20 61.20 59.01 65.75 63.23 56.20 67.44 59.01 28.10 63.23 47.77 44.96 2584238 301 84238 SOLUBLE TRANSFERRIN RECEPTOR 1 109.71 37.30 36.57 87.77 59.78 56.23 79.65 76.80 85.57 82.28 73.14 87.77 76.80 36.57 82.28 62.17 58.51 2584255 302 86000 PROTEUS OX19 AGG 1 20.94 7.12 6.98 16.75 11.41 10.73 15.20 14.66 16.33 15.71 13.96 16.75 14.66 6.98 15.71 11.87 11.17 2584295 301 84295 QW SODIUM SERUM WAIVED 1 14.43 4.91 4.81 11.54 7.87 7.40 10.48 10.10 11.26 10.82 9.62 11.54 10.10 4.81 10.82 8.18 7.70 2584300 300 84300 SODIUM URINE 1 15.18 5.16 5.06 12.14 7.96 7.78 11.02 10.63 11.84 11.39 10.12 12.14 10.63 5.06 11.39 8.60 8.10 2584305 301 84305 IGF 1 1 63.78 21.69 21.26 51.02 32.10 32.69 46.30 44.65 49.75 47.84 42.52 51.02 44.65 21.26 47.84 36.14 34.02 2584392 301 84392 URINE SULFATE ASSAY 1 16.47 5.60 5.49 13.18 7.76 8.44 11.96 11.53 12.85 12.35 10.98 13.18 11.53 5.49 12.35 9.33 8.78 2584394 301 83915 NUCLEOTIDASE 5 1 33.45 11.37 11.15 26.76 18.23 17.14 24.28 23.42 26.09 25.09 22.30 26.76 23.42 11.15 25.09 18.96 17.84 2584402 301 84402 TESTOSTERONE FREE DIRECT 1 76.41 25.98 25.47 61.13 41.63 39.16 55.47 53.49 59.60 57.31 50.94 61.13 53.49 25.47 57.31 43.30 40.75 2584425 301 84425 VITAMIN B1 (THIAMINE) WB-FR 1 63.69 21.65 21.23 50.95 34.70 32.64 46.24 44.58 49.68 47.77 42.46 50.95 44.58 21.23 47.77 36.09 33.97 2584432 301 84432 THYROGLOBULIN ASSAY 1 48.18 16.38 16.06 38.54 26.26 24.69 34.98 33.73 37.58 36.14 32.12 38.54 33.73 16.06 36.14 27.30 25.70 2584443 301 84443 S-TSH 1 50.40 17.14 16.80 40.32 27.47 25.83 36.59 35.28 39.31 37.80 33.60 40.32 35.28 16.80 37.80 28.56 26.88 2584445 301 84445 THYROID STIMULATING IMMUNE GLOBULINS 1 152.58 51.88 30.10 122.06 30.10 78.20 110.77 106.81 119.01 114.44 101.72 122.06 106.81 50.86 114.44 86.46 81.38 2584446 301 84446 VITAMIN E 1 42.54 14.46 14.18 34.03 23.17 21.80 30.88 29.78 33.18 31.91 28.36 34.03 29.78 14.18 31.91 24.11 22.69 2584449 301 84449 TRANSCORTIN (CORTISOL BINDING GLOBULIN) 1 54.00 18.36 18.00 43.20 29.42 27.68 39.20 37.80 42.12 40.50 36.00 43.20 37.80 18.00 40.50 30.60 28.80 2584480 300 84480 TRIIDOTHYRONINE (T3) 1 42.54 14.46 10.49 34.03 10.49 21.80 30.88 29.78 33.18 31.91 28.36 34.03 29.78 14.18 31.91 24.11 22.69 2584481 301 84481 FREE T3 1 50.82 17.28 16.13 40.66 16.13 26.05 36.90 35.57 39.64 38.12 33.88 40.66 35.57 16.94 38.12 28.80 27.10 2584482 300 84482 TRIIODOTHYRONINE T3 REVERSE 1 47.28 16.08 7.60 37.82 7.60 24.23 34.33 33.10 36.88 35.46 31.52 37.82 33.10 15.76 35.46 26.79 25.22 2584520 301 84520 QW UREA NITROGEN QUANT (BUN) WAIVED 1 11.85 4.03 3.95 9.48 6.46 6.07 8.60 8.30 9.24 8.89 7.90 9.48 8.30 3.95 8.89 6.72 6.32 2584590 301 84590 VITAMIN A 1 34.83 11.84 11.61 27.86 18.97 17.85 25.29 24.38 27.17 26.12 23.22 27.86 24.38 11.61 26.12 19.74 18.58 2584597 300 84597 VITAMIN K1 1 84.00 28.56 13.72 67.20 22.43 43.05 60.98 58.80 65.52 63.00 27.44 67.20 58.80 13.72 63.00 23.32 21.95 2584630 301 84630 ZINC PLASMA OR SERUM 1 34.17 11.62 11.39 27.34 18.61 17.51 24.81 23.92 26.65 25.63 22.78 27.34 23.92 11.39 25.63 19.36 18.22 2584661 301 80150 AMIKACIN QUANT 1 45.24 15.38 15.08 36.19 19.03 23.19 32.84 31.67 35.29 33.93 30.16 36.19 31.67 15.08 33.93 25.64 24.13 2584789 306 87103 CULTURE FUNGUS BLOOD 1 61.38 20.87 13.85 49.10 13.85 31.46 44.56 42.97 47.88 46.04 40.92 49.10 42.97 20.46 46.04 34.78 32.74 2584890 302 86648 DIPHTHERIA AB QUAL 1 45.63 15.51 15.21 36.50 24.86 23.39 33.13 31.94 35.59 34.22 30.42 36.50 31.94 15.21 34.22 25.86 24.34 2584957 301 80164 VALPROIC ACID (DEPAKENE) 1 40.62 13.81 13.54 32.50 22.15 20.82 29.49 28.43 31.68 30.47 27.08 32.50 28.43 13.54 30.47 23.02 21.66 2585025 305 85025 HC CBC AUTO W/AUTO DIFF 1 23.31 7.93 7.77 18.65 12.71 11.95 16.92 16.32 18.18 17.48 15.54 18.65 16.32 7.77 17.48 13.21 12.43 2585041 300 85041 BLOOD COUNT RED BLOOD CELL (RBC) AUTOMAT 1 9.06 3.08 3.02 7.25 4.93 4.64 6.58 6.34 7.07 6.80 6.04 7.25 6.34 3.02 6.80 5.13 4.83 2585240 305 85240 FACTOR VIII ACTIVITY 1 53.70 18.26 17.90 42.96 29.27 27.52 38.99 37.59 41.89 40.28 35.80 42.96 37.59 17.90 40.28 30.43 28.64 2585300 305 85300 ANTITHROMBIN (AT) ACTIVITY 1 35.55 12.09 11.85 28.44 19.38 18.22 25.81 24.89 27.73 26.66 23.70 28.44 24.89 11.85 26.66 20.15 18.96 2585549 305 85549 LYSOZYME 1 56.25 19.13 18.75 45.00 30.65 28.83 40.84 39.38 43.88 42.19 37.50 45.00 39.38 18.75 42.19 31.88 30.00 2585598 305 85598 PHOSPHOLIPID NEUTRALIZATION HEXAGONAL 1 53.94 18.34 17.98 43.15 21.90 27.64 39.16 37.76 42.07 40.46 35.96 43.15 37.76 17.98 40.46 30.57 28.77 2585610 305 85610 HC PROTHROMBIN TIME WAIVED 1 12.87 4.38 4.29 10.30 6.43 6.60 9.34 9.01 10.04 9.65 8.58 10.30 9.01 4.29 9.65 7.29 6.86 2585613 305 85613 RUSSELL VIPER VENOM TIME; DILUTED 1 28.74 9.77 9.58 22.99 15.66 14.73 20.87 20.12 22.42 21.56 19.16 22.99 20.12 9.58 21.56 16.29 15.33 2585732 305 85732 THROMBOPLASTIN TIME PARTIAL PTT EACH 1 19.41 6.60 6.47 15.53 10.57 9.95 14.09 13.59 15.14 14.56 12.94 15.53 13.59 6.47 14.56 11.00 10.35 2585987 301 83070 HEMOSIDERIN QUAL 1 14.25 4.85 4.75 11.40 7.76 7.30 10.35 9.98 11.12 10.69 9.50 11.40 9.98 4.75 10.69 8.08 7.60 2586005 305 86005 QUALITATIVE MULTI ALLERGEN SCREEN 1 23.91 8.13 7.97 19.13 13.03 12.25 17.36 16.74 18.65 17.93 15.94 19.13 16.74 7.97 17.93 13.55 12.75 2586022 301 86022 PLATELET ANTIBODIES 1 55.11 18.74 18.37 44.09 30.02 28.24 40.01 38.58 42.99 41.33 36.74 44.09 38.58 18.37 41.33 31.23 29.39 2586140 302 86140 C-REACTIVE PROTEIN 1 15.54 5.28 5.18 12.43 8.46 7.96 11.28 10.88 12.12 11.66 10.36 12.43 10.88 5.18 11.66 8.81 8.29 2586141 300 86141 C-REACTIVE PROTEIN (CRP) HIGH SENSITIVIT 1 38.85 13.21 12.95 31.08 21.16 19.91 28.21 27.20 30.30 29.14 25.90 31.08 27.20 12.95 29.14 22.02 20.72 2586146 302 86146 "BETA 2 GLYCOPROTEIN 1 ANTIBODY, EACH" 1 76.35 25.96 19.01 61.08 19.01 39.13 55.43 53.45 59.55 57.26 50.90 61.08 53.45 25.45 57.26 43.27 40.72 2586147 302 86147 ANTICARDIOLIPIN ( IGA/G/M) 1 229.05 77.88 19.01 183.24 19.01 117.39 166.29 160.34 178.66 171.79 50.90 183.24 160.34 25.45 171.79 43.27 40.72 2586235 302 86235 ANTIHISTONE ANTIBODIES 1 53.79 18.29 17.93 43.03 19.03 27.57 39.05 37.65 41.96 40.34 35.86 43.03 37.65 17.93 40.34 30.48 28.69 2586256 300 86256 FLOURESCENT ANTIBODY TITER EACH 1 36.15 12.29 12.05 28.92 19.69 18.53 26.24 25.31 28.20 27.11 24.10 28.92 25.31 12.05 27.11 20.49 19.28 2586303 301 82103 A-1-ANTITRYPSIN TOTAL 1 40.32 13.71 13.44 32.26 21.96 20.66 29.27 28.22 31.45 30.24 26.88 32.26 28.22 13.44 30.24 22.85 21.50 2586316 302 86316 CHROMOGRANIN A 1 62.43 21.23 20.81 49.94 34.02 32.00 45.32 43.70 48.70 46.82 41.62 49.94 43.70 20.81 46.82 35.38 33.30 2586318 302 86318 H PYLORI WAIVED 1 54.27 18.45 18.09 43.42 21.16 27.81 39.40 37.99 42.33 40.70 36.18 43.42 37.99 18.09 40.70 30.75 28.94 2586331 302 86331 IMMUNODIFFUSION; GEL DIFFUSION QUAL EACH 1 35.94 12.22 11.98 28.75 19.58 18.42 26.09 25.16 28.03 26.96 23.96 28.75 25.16 11.98 26.96 20.37 19.17 2586332 302 86332 IMMUNE COMPLEX ASSAY 1 73.11 24.86 24.37 58.49 39.84 37.47 53.08 51.18 57.03 54.83 48.74 58.49 51.18 24.37 54.83 41.43 38.99 2586334 302 86334 IMMUNOFIX E-PHORESIS SERUM 1 67.02 22.79 22.34 53.62 36.53 34.35 48.66 46.91 52.28 50.27 44.68 53.62 46.91 22.34 50.27 37.98 35.74 2586335 302 86335 IMMUNOFIXATION (IFE) URINE 1 88.05 29.94 29.35 70.44 47.96 45.13 63.92 61.64 68.68 66.04 58.70 70.44 61.64 29.35 66.04 49.90 46.96 2586336 300 86336 INHIBIN A ULTRASENSITIVE 1 70.00 23.80 15.59 56.00 25.48 35.88 50.82 49.00 54.60 52.50 31.18 56.00 49.00 15.59 52.50 26.50 24.94 2586337 302 86337 INSULIN AUTOANTIBODIES (IAA) (ENDOCRINE 1 64.23 21.84 17.09 51.38 17.09 32.92 46.63 44.96 50.10 48.17 42.82 51.38 44.96 21.41 48.17 36.40 34.26 2586355 302 86355 B CELLS TOTAL COUNT 1 113.19 38.48 37.73 90.55 61.67 58.01 82.18 79.23 88.29 84.89 75.46 90.55 79.23 37.73 84.89 64.14 60.37 2586357 300 86357 NATURAL KILLER (NK) CELLS TOTAL COUNT 1 113.19 38.48 37.73 90.55 61.67 58.01 82.18 79.23 88.29 84.89 75.46 90.55 79.23 37.73 84.89 64.14 60.37 2586359 302 86359 T CELLS TOTAL COUNT 1 113.19 38.48 37.73 90.55 61.67 58.01 82.18 79.23 88.29 84.89 75.46 90.55 79.23 37.73 84.89 64.14 60.37 2586360 302 86360 T CELLS ABSOLUTE CD4 AND CD8 COUNT 1 140.94 47.92 46.98 112.75 65.80 72.23 102.32 98.66 109.93 105.71 93.96 112.75 98.66 46.98 105.71 79.87 75.17 2586376 302 86376 THYROID PEROXIDASE AB (TPO) 1 43.65 14.84 14.55 34.92 23.78 22.37 31.69 30.56 34.05 32.74 29.10 34.92 30.56 14.55 32.74 24.74 23.28 2586480 302 86480 QUANTIFERON TB GOLD PLUS NON INCUBATED 1 185.94 63.22 61.98 148.75 101.32 95.29 134.99 130.16 145.03 139.46 123.96 148.75 130.16 61.98 139.46 105.37 99.17 2586535 302 86000 PARATYPHOID A AGG 1 20.94 7.12 6.98 16.75 11.41 10.73 15.20 14.66 16.33 15.71 13.96 16.75 14.66 6.98 15.71 11.87 11.17 2586536 302 86000 PARATYPHOID B AGG 1 20.94 7.12 6.98 16.75 11.41 10.73 15.20 14.66 16.33 15.71 13.96 16.75 14.66 6.98 15.71 11.87 11.17 2586602 302 86602 ANTIBODY ACTINOMYCES 1 30.54 10.38 10.18 24.43 16.64 15.65 22.17 21.38 23.82 22.91 20.36 24.43 21.38 10.18 22.91 17.31 16.29 2586606 302 86606 ANTIBODY ASPERGILLUS 1 45.15 15.35 15.05 36.12 24.61 23.14 32.78 31.61 35.22 33.86 30.10 36.12 31.61 15.05 33.86 25.59 24.08 2586609 302 86609 ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFI 1 38.64 13.14 12.88 30.91 21.06 19.80 28.05 27.05 30.14 28.98 25.76 30.91 27.05 12.88 28.98 21.90 20.61 2586615 302 86615 ANTIBODY BORDETELLA 1 39.57 13.45 13.19 31.66 21.56 20.28 28.73 27.70 30.86 29.68 26.38 31.66 27.70 13.19 29.68 22.42 21.10 2586622 302 86622 "BRUCELLA ANTIBODY IGG, EIA" 1 26.79 9.11 8.93 21.43 14.60 13.73 19.45 18.75 20.90 20.09 17.86 21.43 18.75 8.93 20.09 15.18 14.29 2586628 300 86628 ANTIBODY CANDIDA 1 36.03 12.25 12.01 28.82 19.62 18.47 26.16 25.22 28.10 27.02 24.02 28.82 25.22 12.01 27.02 20.42 19.22 2586663 302 86663 EBV EARLY VIRUS ANTIGEN 1 39.36 13.38 13.12 31.49 21.44 20.17 28.58 27.55 30.70 29.52 26.24 31.49 27.55 13.12 29.52 22.30 20.99 2586666 300 86666 E CHAFFEENSIS (HME) IGG TITER 1 30.54 10.38 10.18 24.43 16.64 15.65 22.17 21.38 23.82 22.91 20.36 24.43 21.38 10.18 22.91 17.31 16.29 2586671 302 86671 ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED 1 36.75 12.50 12.25 29.40 20.03 18.83 26.68 25.73 28.67 27.56 24.50 29.40 25.73 12.25 27.56 20.83 19.60 2586677 300 86677 HELICOBACTER PYLORI ANTIBODIES IGM 1 50.55 17.19 16.85 40.44 19.01 25.91 36.70 35.39 39.43 37.91 33.70 40.44 35.39 16.85 37.91 28.65 26.96 2586701 301 86701 ANTIBODY HIV-1 1 26.67 9.07 8.89 21.34 14.53 13.67 19.36 18.67 20.80 20.00 17.78 21.34 18.67 8.89 20.00 15.11 14.22 2586702 302 86702 HIV 2 PANEL 1 40.56 13.79 13.52 32.45 17.26 20.79 29.45 28.39 31.64 30.42 27.04 32.45 28.39 13.52 30.42 22.98 21.63 2586710 302 86710 INFLUENZA A ANTIBODIES QUANTITATIVE 1 40.65 13.82 13.55 32.52 22.15 20.83 29.51 28.46 31.71 30.49 27.10 32.52 28.46 13.55 30.49 23.04 21.68 2586738 302 86738 MYCOPLASMA PNEUMONIAE ANTIBODIES IGM 1 39.72 13.50 13.24 31.78 21.65 20.36 28.84 27.80 30.98 29.79 26.48 31.78 27.80 13.24 29.79 22.51 21.18 2586753 302 86753 BABESIA IGG 1 37.17 12.64 12.39 29.74 20.24 19.05 26.99 26.02 28.99 27.88 24.78 29.74 26.02 12.39 27.88 21.06 19.82 2586757 302 86757 ROCKY MTN SPOTTED FEVER IGM 1 58.05 19.74 19.35 46.44 31.64 29.75 42.14 40.64 45.28 43.54 38.70 46.44 40.64 19.35 43.54 32.90 30.96 2586769 302 86769 SARS COV 2 IGG ANTIBODY WK 1 126.39 42.97 42.13 101.11 75.83 64.77 91.76 88.47 98.58 94.79 84.26 101.11 88.47 42.13 94.79 71.62 67.41 2586780 302 86780 TREPONEMA PALLIDUM ANTIBODIES 1 39.72 13.50 13.24 31.78 21.64 20.36 28.84 27.80 30.98 29.79 26.48 31.78 27.80 13.24 29.79 22.51 21.18 2586789 302 86789 WEST NILE VIRUS IGG 1 43.17 14.68 14.39 34.54 23.53 22.12 31.34 30.22 33.67 32.38 28.78 34.54 30.22 14.39 32.38 24.46 23.02 2586803 300 86803 HEPATITIS C VIRUS (HCV) ANTIBODY CASCADE 1 42.81 14.56 14.27 34.25 23.33 21.94 31.08 29.97 33.39 32.11 28.54 34.25 29.97 14.27 32.11 24.26 22.83 2586804 301 86804 HCV CONFIRMATION 1 46.47 15.80 15.49 37.18 25.32 23.82 33.74 32.53 36.25 34.85 30.98 37.18 32.53 15.49 34.85 26.33 24.78 2587015 300 87015 AFB CONCENTRATION 1 20.04 6.81 6.68 16.03 10.91 10.27 14.55 14.03 15.63 15.03 13.36 16.03 14.03 6.68 15.03 11.36 10.69 2587040 306 87040 CULTURE BLOOD #2 1 30.96 10.53 10.32 24.77 16.88 15.87 22.48 21.67 24.15 23.22 20.64 24.77 21.67 10.32 23.22 17.54 16.51 2587046 306 87045 "CULTURE STOOL,AEROBIC ADDT PATH E PLATE" 1 28.32 9.63 9.44 22.66 15.43 14.51 20.56 19.82 22.09 21.24 18.88 22.66 19.82 9.44 21.24 16.05 15.10 2587075 306 87075 CULTURE-ANAEROBIC ABSCESS 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2587076 306 87076 ANAEROBIC BACTERIA ID (WK) 1 50.00 17.00 8.08 40.00 13.20 25.63 36.30 35.00 39.00 37.50 16.16 40.00 35.00 8.08 37.50 13.74 12.93 2587077 306 87077 QW CULTURE H PYLORI (TISSUE) 1 24.24 8.24 8.08 19.39 13.20 12.42 17.60 16.97 18.91 18.18 16.16 19.39 16.97 8.08 18.18 13.74 12.93 2587081 306 87081 CULTURE GROUP A STREP 1 19.89 6.76 6.63 15.91 10.84 10.19 14.44 13.92 15.51 14.92 13.26 15.91 13.92 6.63 14.92 11.27 10.61 2587106 300 87106 CULT FUNGI DEF ID EA YEAST-M 1 30.96 10.53 10.32 24.77 16.88 15.87 22.48 21.67 24.15 23.22 20.64 24.77 21.67 10.32 23.22 17.54 16.51 2587107 300 87107 FUNGUS ID CULT ID PANEL A-M EA ORG MOLD 1 30.96 10.53 10.32 24.77 16.88 15.87 22.48 21.67 24.15 23.22 20.64 24.77 21.67 10.32 23.22 17.54 16.51 2587149 306 87149 MYCOBACTERIUM ID (WK) 1 235.10 79.93 20.05 188.08 32.78 120.49 170.68 164.57 183.38 176.33 40.10 188.08 164.57 20.05 176.33 34.09 32.08 2587153 300 87153 D2F CULT TYPE ID NUC ACD SEQ M 1 346.08 117.67 115.36 276.86 188.57 177.37 251.25 242.26 269.94 259.56 230.72 276.86 242.26 115.36 259.56 196.11 184.58 2587177 300 87177 OVA AND PARASITES CONCENTRATION AND ID 1 26.70 9.08 8.90 21.36 14.29 13.68 19.38 18.69 20.83 20.03 17.80 21.36 18.69 8.90 20.03 15.13 14.24 2587181 306 87181 ANAEROBIC BACTERIA SUSCEPT (WK) 1 118.22 40.19 4.75 94.58 7.76 60.59 85.83 82.75 92.21 88.67 9.50 94.58 82.75 4.75 88.67 8.08 7.60 2587186 306 87186 AEROBIC BACTERIA SUSCEPT (WK) 1 40.26 13.69 8.65 32.21 14.14 20.63 29.23 28.18 31.40 30.20 17.30 32.21 28.18 8.65 30.20 14.71 13.84 2587206 306 87206 SMEAR AFB 1 16.17 5.50 5.39 12.94 8.80 8.29 11.74 11.32 12.61 12.13 10.78 12.94 11.32 5.39 12.13 9.16 8.62 2587209 300 87209 SMEAR COMPLEX SP STAIN OVA AND PARASITE 1 53.94 18.34 17.98 43.15 29.39 27.64 39.16 37.76 42.07 40.46 35.96 43.15 37.76 17.98 40.46 30.57 28.77 2587210 301 87210 HC WET PREP 1 17.46 5.94 5.82 13.97 6.98 8.95 12.68 12.22 13.62 13.10 11.64 13.97 12.22 5.82 13.10 9.89 9.31 2587220 306 Q0112 HC KOH PREP 1 17.49 5.95 5.83 13.99 6.98 8.96 12.70 12.24 13.64 13.12 11.66 13.99 12.24 5.83 13.12 9.91 9.33 2587250 302 86708 HEP A AB IGG & IGM 1 37.17 12.64 12.39 29.74 19.03 19.05 26.99 26.02 28.99 27.88 24.78 29.74 26.02 12.39 27.88 21.06 19.82 2587252 302 86706 HB S AB 1 32.22 10.95 10.74 25.78 17.56 16.51 23.39 22.55 25.13 24.17 21.48 25.78 22.55 10.74 24.17 18.26 17.18 2587254 300 87254 VIRUS CULTURE RAPID VARICELLA ZOSTER VIR 1 58.68 19.95 19.56 46.94 31.98 30.07 42.60 41.08 45.77 44.01 39.12 46.94 41.08 19.56 44.01 33.25 31.30 2587255 301 83491 17 HYDROXYCORT (17OH) 1 53.70 18.26 17.90 42.96 28.64 27.52 38.99 37.59 41.89 40.28 35.80 42.96 37.59 17.90 40.28 30.43 28.64 2587256 305 85651 SEDIMENTATION RATE-NON AUTO WAIVED 1 12.81 4.36 4.27 10.25 5.80 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2587329 306 87329 GIARDIA LAMBLIA DIRECT DETECTION EIA 1 35.94 12.22 11.98 28.75 19.60 18.42 26.09 25.16 28.03 26.96 23.96 28.75 25.16 11.98 26.96 20.37 19.17 2587338 306 87338 HELICOBACTER PYLORI STOOL ANTIGEN 1 56.00 19.04 7.58 44.80 7.58 28.70 40.66 39.20 43.68 42.00 28.76 44.80 39.20 14.38 42.00 24.45 23.01 2587340 300 87340 HEP B S AG EIA 1 30.99 10.54 10.33 24.79 16.88 15.88 22.50 21.69 24.17 23.24 20.66 24.79 21.69 10.33 23.24 17.56 16.53 2587350 306 87350 HEP BE AG EIA 1 34.59 11.76 11.53 27.67 18.84 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2587389 306 87389 HIV-1 & 2 DIAGNOSTIC 1 72.24 24.56 24.08 57.79 36.76 37.02 52.45 50.57 56.35 54.18 48.16 57.79 50.57 24.08 54.18 40.94 38.53 2587426 306 87426 SARS ANTIGEN BY IMMUNOASSAY (SOFIA) 1 400.00 136.00 156.00 320.00 240.00 205.00 290.40 280.00 312.00 300.00 156.00 320.00 280.00 300.00 2587437 302 86812 "HLA B27,TYPING" 1 77.43 26.33 25.81 61.94 42.19 39.68 56.21 54.20 60.40 58.07 51.62 61.94 54.20 25.81 58.07 43.88 41.30 2587486 306 87486 INF AGENT CHLAMYDOPHILA/CHLAMYDIA PNEUMO 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587491 306 87491 CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587493 300 87493 "CLOSTRIDIUM DIFFICILE TOXIN GENE, NAA" 1 114.00 38.76 37.27 91.20 57.36 58.43 82.76 79.80 88.92 85.50 74.54 91.20 79.80 37.27 85.50 63.36 59.63 2587517 306 87517 HEPATITIS B VIRUS (HBV) QUANT DNA 1 146.62 49.85 42.84 117.30 70.02 75.14 106.45 102.63 114.36 109.97 85.68 117.30 102.63 42.84 109.97 72.83 68.54 2587521 306 87521 HEPATITIS C VIRUS (HCV) RNA QUAL NAA 1 109.14 37.11 35.09 87.31 57.36 55.93 79.24 76.40 85.13 81.86 70.18 87.31 76.40 35.09 81.86 59.65 56.14 2587522 306 87522 HEPATITIS C VIRAL LOAD 1 128.52 43.70 42.84 102.82 70.02 65.87 93.31 89.96 100.25 96.39 85.68 102.82 89.96 42.84 96.39 72.83 68.54 2587529 300 87529 INFECTIOUS AGENT DETECT BY NUC ACID 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587535 306 87535 HIV-1 PROBE & REVERSE TRANSCRP 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587536 306 87536 HIV-1 REVERSE TRANSCRIPTION AND QUANTIFI 1 255.30 86.80 85.10 204.24 139.10 130.84 185.35 178.71 199.13 191.48 170.20 204.24 178.71 85.10 191.48 144.67 136.16 2587581 306 87581 INF AGENT MYCOPLASMA PNEUMONIAE 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587591 306 87591 NEISSERIA GONORRHOEAE AMPLIFIED PROBE 1 94.45 32.11 35.09 75.56 57.36 48.41 68.57 66.12 73.67 70.84 70.18 75.56 66.12 35.09 70.84 59.65 56.14 2587633 306 87633 INF AGENT RESPIRATORY VIRUS 1 " 1,250.34 " 425.12 416.78 " 1,000.27 " 681.30 640.80 907.75 875.24 975.27 937.76 833.56 " 1,000.27 " 875.24 416.78 937.76 708.53 666.85 2587635 300 87635 STATE LAB COVID-19 1 153.93 52.34 51.31 123.14 92.36 78.89 111.75 107.75 120.07 115.45 102.62 123.14 107.75 51.31 115.45 87.23 82.10 2587640 306 87640 STAPHYLOCOCCUS AUREUS AMPLIFIED PROBE 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587641 306 87641 STAPHYLOCOCCUS AUREUS METHICILLIN RESIST 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587651 306 87651 STREP A DNA AMPLIFIED PROBE 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587661 300 87661 "TRICHOMONAS VAGINALIS, NAA" 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587798 306 87798 INFECTIOUS AGENT DETECT NOS DNA AMP E 1 105.27 35.79 35.09 84.22 57.36 53.95 76.43 73.69 82.11 78.95 70.18 84.22 73.69 35.09 78.95 59.65 56.14 2587801 300 87801 INFECTIOUS AGENT DETECTION NUCLEIC ACID 1 210.60 71.60 70.20 168.48 114.74 107.93 152.90 147.42 164.27 157.95 140.40 168.48 147.42 70.20 157.95 119.34 112.32 2587804 300 87804 INFLUENZA A WAIVED 1 49.65 16.88 16.55 39.72 19.60 25.45 36.05 34.76 38.73 37.24 33.10 39.72 34.76 16.55 37.24 28.14 26.48 2587880 300 87880 STREP SCREEN A WAIVED 1 49.59 16.86 16.53 39.67 19.60 25.41 36.00 34.71 38.68 37.19 33.06 39.67 34.71 16.53 37.19 28.10 26.45 2587894 301 82164 ANGIOTENSIN CONV ENZ 1 43.80 14.89 14.60 35.04 23.87 22.45 31.80 30.66 34.16 32.85 29.20 35.04 30.66 14.60 32.85 24.82 23.36 2587902 306 87902 HEPATITIS C VIRUS GENOTYPING NONREFLEX 1 772.35 262.60 257.45 617.88 420.83 395.83 560.73 540.65 602.43 579.26 514.90 617.88 540.65 257.45 579.26 437.67 411.92 2588112 310 88112 CYTOPATHOLOGY SELECTIVE 1 133.77 45.48 44.59 107.02 79.97 68.56 97.12 93.64 104.34 100.33 89.18 107.02 93.64 44.59 100.33 75.80 71.34 2588133 301 82131 "HOMOCYSTINE QUANT,QUANT" 1 68.94 23.44 22.98 55.15 27.58 35.33 50.05 48.26 53.77 51.71 45.96 55.15 48.26 22.98 51.71 39.07 36.77 2588160 310 88160 CYTOPATHOLOGY SMEARS ANY OTH SOURCE 1 66.32 22.55 22.11 80.45 80.45 33.99 48.15 46.42 51.73 49.74 44.22 53.06 46.42 22.11 49.74 37.59 35.38 2588173 310 88173 CYTOPATHOLOGY EVAL FINE NEEDLE ASPIRATE 1 133.77 45.48 44.59 172.83 172.83 68.56 97.12 93.64 104.34 100.33 89.18 107.02 93.64 44.59 100.33 75.80 71.34 2588175 310 88175 CYTOPATHOLOGY CERVICAL OR VAGINAL 1 79.83 27.14 26.61 63.86 30.08 40.91 57.96 55.88 62.27 59.87 53.22 63.86 55.88 26.61 59.87 45.24 42.58 2588184 310 88184 FLOW CYTOMETRY TC ONLY FIRST MARKER 1 782.98 266.21 81.31 626.38 81.31 401.28 568.44 548.09 610.72 587.24 522.06 626.38 548.09 261.03 587.24 443.75 417.65 2588185 310 88185 FLOW CYTOMETRY TC ONLY E ADDT MARKER 1 83.30 28.32 32.49 66.64 49.54 42.69 60.48 58.31 64.97 62.48 32.49 66.64 58.31 62.48 2588189 311 88189 FLOW CYTOMETRY INTERPRET 16 OR > MARKER 1 " 1,030.41 " 350.34 133.76 824.33 133.76 528.09 748.08 721.29 803.72 772.81 401.86 824.33 721.29 772.81 2588237 310 88237 TISSUE CULTURE BONE MARROW 1 431.25 146.63 104.47 345.00 104.47 221.02 313.09 301.88 336.38 323.44 287.50 345.00 301.88 143.75 323.44 244.38 230.00 2588262 300 88262 CHROMOSOME ANALYSIS COUNT 15-20 CELLS 1 376.47 128.00 125.49 301.18 203.75 192.94 273.32 263.53 293.65 282.35 250.98 301.18 263.53 125.49 282.35 213.33 200.78 2588264 310 88264 CHROMOSOME ANALYSIS 1 433.83 147.50 144.61 347.06 203.75 222.34 314.96 303.68 338.39 325.37 289.22 347.06 303.68 144.61 325.37 245.84 231.38 2588271 310 88271 CYTOGENETICS DNA PROBE 1 64.26 21.85 21.42 51.41 35.00 32.93 46.65 44.98 50.12 48.20 42.84 51.41 44.98 21.42 48.20 36.41 34.27 2588273 310 88273 CYTOGENETICS 10-30 1 104.43 35.51 34.81 83.54 52.52 53.52 75.82 73.10 81.46 78.32 69.62 83.54 73.10 34.81 78.32 59.18 55.70 2588275 310 88275 CYTOGENETICS 100-300 1 153.57 52.21 51.19 122.86 65.64 78.70 111.49 107.50 119.78 115.18 102.38 122.86 107.50 51.19 115.18 87.02 81.90 2588280 310 88280 CHROMOSOME KAROTYPE STUDY 1 100.41 34.14 33.47 80.33 41.03 51.46 72.90 70.29 78.32 75.31 66.94 80.33 70.29 33.47 75.31 56.90 53.55 2588291 310 88291 CYTOGENETICS INTERPRETATION AND REPORT 1 54.98 18.69 21.44 43.98 37.10 28.18 39.92 38.49 42.88 41.24 21.44 43.98 38.49 41.24 2588300 310 88300 LEVEL I SURG PATH GROSS EXAM ONLY 1 66.32 22.55 17.05 53.06 17.05 33.99 48.15 46.42 51.73 49.74 44.22 53.06 46.42 22.11 49.74 37.59 35.38 2588302 310 88302 LEVEL II SURG PATH GROSS AND MICRO EXAM 1 82.16 27.93 22.11 65.73 35.97 42.11 59.65 57.51 64.08 61.62 44.22 65.73 57.51 22.11 61.62 37.59 35.38 2588304 310 88304 LEVEL III SURG PATH GROSS AND MICRO EXAM 1 133.77 45.48 44.59 107.02 50.50 68.56 97.12 93.64 104.34 100.33 89.18 107.02 93.64 44.59 100.33 75.80 71.34 2588305 310 88305 LEVEL IV SURG PATH GROSS AND MICRO EXAM 1 133.77 45.48 44.59 107.02 82.94 68.56 97.12 93.64 104.34 100.33 89.18 107.02 93.64 44.59 100.33 75.80 71.34 2588307 310 88307 LEVEL V SURG PATH GROSS AND MICRO EXAM 1 782.98 266.21 261.03 626.38 340.86 401.28 568.44 548.09 610.72 587.24 522.06 626.38 548.09 261.03 587.24 443.75 417.65 2588309 310 88309 LEVEL VI SURG PATH GROSS AND MICRO EXAM 1 " 1,763.89 " 599.72 519.54 " 1,411.11 " 519.54 903.99 " 1,280.58 " " 1,234.72 " " 1,375.83 " " 1,322.92 " " 1,176.08 " " 1,411.11 " " 1,234.72 " 588.04 " 1,322.92 " 999.67 940.86 2588311 310 88311 DECALCIFICATION PROCEDURE 1 11.82 4.02 4.61 24.69 24.69 6.06 8.58 8.27 9.22 8.87 4.61 9.46 8.27 8.87 2588312 310 88312 SPECIAL STAINS GROUP I 1 133.77 45.48 44.59 108.08 108.08 68.56 97.12 93.64 104.34 100.33 89.18 107.02 93.64 44.59 100.33 75.80 71.34 2588313 310 88313 SPECIAL STAINS GROUP II 1 90.97 30.93 30.33 74.99 74.99 46.62 66.04 63.68 70.96 68.23 60.66 72.78 63.68 30.33 68.23 51.56 48.53 2588341 310 88341 IMMUNOHISTOCHEMISTRY E ADDT S ANTIBODY 1 107.68 36.61 42.00 98.75 98.75 55.19 78.18 75.38 83.99 80.76 42.00 86.14 75.38 80.76 2588342 310 88342 IMMUNOHISTOCHEMISTRY E ANTIBODY 1ST 1 400.98 136.33 118.14 320.78 118.14 205.50 291.11 280.69 312.76 300.74 267.36 320.78 280.69 133.68 300.74 227.26 213.89 2588360 310 88360 MORPHOMTRIC ANALYSIS TUMOR E S AB-MANUAL 1 400.98 136.33 133.68 320.78 135.32 205.50 291.11 280.69 312.76 300.74 267.36 320.78 280.69 133.68 300.74 227.26 213.89 2588361 310 88361 MORPHOMTRIC ANALYSIS TUMOR E S AB-COMPUT 1 782.98 266.21 165.58 626.38 165.58 401.28 568.44 548.09 610.72 587.24 522.06 626.38 548.09 261.03 587.24 443.75 417.65 2588377 310 88377 PROBE STAIN PROC EACH MULTIPLEX 1 400.98 136.33 133.68 445.99 445.99 205.50 291.11 280.69 312.76 300.74 267.36 320.78 280.69 133.68 300.74 227.26 213.89 2589060 300 89060 "CRYSTALS, SYNOVIAL /JOINT FLUID" 1 21.99 7.48 7.33 17.59 11.70 11.27 15.96 15.39 17.15 16.49 14.66 17.59 15.39 7.33 16.49 12.46 11.73 2589106 302 86704 HB CORE AB IGG & IGM 1 36.15 12.29 12.05 28.92 19.69 18.53 26.24 25.31 28.20 27.11 24.10 28.92 25.31 12.05 27.11 20.49 19.28 2589447 301 80048 BMP 1 25.38 8.63 8.46 20.30 13.82 13.01 18.43 17.77 19.80 19.04 16.92 20.30 17.77 8.46 19.04 14.38 13.54 2589452 301 80074 HEPATITIS PANEL 1 142.89 48.58 47.63 114.31 77.87 73.23 103.74 100.02 111.45 107.17 95.26 114.31 100.02 47.63 107.17 80.97 76.21 2590005 306 87205 GRAM STAIN EAR 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590006 306 87205 GRAM STAIN EYE 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590007 306 87205 GRAM STAIN FEMALE GENITAL 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590008 306 87205 GRAM STAIN FLUID 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590009 306 87205 GRAM STAIN MALE GENITAL 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590010 306 87205 GRAM STAIN MUSCULOSKELETAL 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590011 306 87205 GRAM STAIN ORAL 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590012 306 87205 GRAM STAIN PLATELETS (LBC) 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590013 306 87205 GRAM STAIN PROSTHESIS 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590014 306 87205 GRAM STAIN SINUS 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590015 306 87205 GRAM STAIN SPUTUM 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590016 306 87205 GRAM STAIN STOOL 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590017 306 87205 GRAM STAIN THROAT 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590018 306 87205 GRAM STAIN TISSUE 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590019 306 87205 GRAM STAIN URINE 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590020 306 87205 GRAM STAIN WOUND 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2590070 306 87070 CULTURE PACEMAKER 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2590071 306 87070 CULTURE PROSTHESIS 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2590072 306 87070 CULTURE TISSUE/BIOPSY 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2590073 306 87070 "CULTURE IC,CRL ENVIRONMENTAL" 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2590075 306 87075 CULTURE-ANAEROBIC PACEMAKER 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2590076 306 87075 CULTURE-ANAEROBIC PROSTHESIS 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2590077 306 87075 CULTURE-ANAEROBIC SINUS 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2590078 306 87075 CULTURE-ANAEROBIC TISSUE 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2590079 306 87075 CULTURE-ANAEROBIC URINE 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2590080 306 87075 CULTURE-ANAEROBIC WOUND 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2590151 301 83516 ANTI-SRP AB (RDL) 1 62.72 21.32 11.53 50.18 18.85 32.14 45.53 43.90 48.92 47.04 23.06 50.18 43.90 11.53 47.04 19.60 18.45 2590307 301 80307 DRUG SCREEN QUAL URINE 1 186.42 63.38 62.14 149.14 95.77 95.54 135.34 130.49 145.41 139.82 124.28 149.14 130.49 62.14 139.82 105.64 99.42 2591516 301 83516 DEAMINATED GLIADIN ANTIBODIES IgA 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2591894 301 82384 CATECHOL FRACTION UR 1 75.75 25.76 25.25 60.60 41.28 38.82 54.99 53.03 59.09 56.81 50.50 60.60 53.03 25.25 56.81 42.93 40.40 2592516 301 83516 DEAMINATED GLIADIN ANTIBODIES IgG 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2592533 301 82533 CORTISOL (DESAMETHASONE SUPPRESSION) 1 48.90 16.63 16.30 39.12 26.65 25.06 35.50 34.23 38.14 36.68 32.60 39.12 34.23 16.30 36.68 27.71 26.08 2592936 302 86674 GIARDIA AB QUAL 1 44.16 15.01 14.72 35.33 19.01 22.63 32.06 30.91 34.44 33.12 29.44 35.33 30.91 14.72 33.12 25.02 23.55 2592951 301 84702 HCG QUANT TUMOR 1 45.15 15.35 15.05 36.12 24.61 23.14 32.78 31.61 35.22 33.86 30.10 36.12 31.61 15.05 33.86 25.59 24.08 2593520 301 83520 THYROTROPIN RECEPTOR ANTIBODY SERUM 1 51.81 17.62 17.27 41.45 21.16 26.55 37.61 36.27 40.41 38.86 34.54 41.45 36.27 17.27 38.86 29.36 27.63 2594516 301 83516 TISSUE TRANSGLUTAMINASE (tTG) IgG 1 34.59 11.76 11.53 27.67 18.85 17.73 25.11 24.21 26.98 25.94 23.06 27.67 24.21 11.53 25.94 19.60 18.45 2594630 300 84630 ZINC WHOLE BLOOD 1 50.00 17.00 11.39 40.00 18.61 25.63 36.30 35.00 39.00 37.50 22.78 40.00 35.00 11.39 37.50 19.36 18.22 2595556 302 86803 HEPATITIS C AB 1 42.81 14.56 14.27 34.25 23.33 21.94 31.08 29.97 33.39 32.11 28.54 34.25 29.97 14.27 32.11 24.26 22.83 2595818 301 83874 MYOGLOBIN BLD 1 38.76 13.18 12.92 31.01 21.11 19.86 28.14 27.13 30.23 29.07 25.84 31.01 27.13 12.92 29.07 21.96 20.67 2596480 302 86480 QUANTIFERON TB GOLD PLUS INCUBATED 1 185.94 63.22 61.98 148.75 101.32 95.29 134.99 130.16 145.03 139.46 123.96 148.75 130.16 61.98 139.46 105.37 99.17 2596641 307 81002 UA W O MICRO AUTO 1 10.44 3.55 3.48 8.35 4.18 5.35 7.58 7.31 8.14 7.83 6.96 8.35 7.31 3.48 7.83 5.92 5.57 2597070 306 87070 CULTURE ORAL 1 25.86 8.79 8.62 20.69 14.09 13.25 18.77 18.10 20.17 19.40 17.24 20.69 18.10 8.62 19.40 14.65 13.79 2597075 306 87075 CULTURE-ANAEROBIC MUSCULOSKELETAL 1 130.00 44.20 9.47 104.00 15.48 66.63 94.38 91.00 101.40 97.50 18.94 104.00 91.00 9.47 97.50 16.10 15.15 2597205 306 87205 GRAM STAIN CUTANEOUS 1 12.81 4.36 4.27 10.25 6.98 6.57 9.30 8.97 9.99 9.61 8.54 10.25 8.97 4.27 9.61 7.26 6.83 2597682 301 80375 ACETALOZAMIDE QN 1 55.92 19.01 0.01 44.74 0.01 28.66 40.60 39.14 43.62 41.94 21.81 44.74 39.14 41.94 2599214 302 86780 MHA TP CONFIRM 1 39.72 13.50 13.24 31.78 21.64 20.36 28.84 27.80 30.98 29.79 26.48 31.78 27.80 13.24 29.79 22.51 21.18 27009016 390 P9016 BB RED BLOOD CELLS LEUKOCYTES REDUCED UN 1 350.00 119.00 6.58 280.00 6.58 179.38 254.10 245.00 273.00 262.50 136.50 280.00 245.00 262.50 2709035 390 P9035 BB PLATELET PHERESIS LEUKOCYTES RED UN 1 " 1,460.40 " 496.54 18.47 " 1,168.32 " 18.47 748.46 " 1,060.25 " " 1,022.28 " " 1,139.11 " " 1,095.30 " 973.60 " 1,168.32 " " 1,022.28 " 486.80 " 1,095.30 " 827.56 778.88 2762200 390 P9012 BB CRYOPRECIPITATE UNIT 1 239.55 81.45 22.86 191.64 22.86 122.77 173.91 167.69 186.85 179.66 159.70 191.64 167.69 79.85 179.66 135.75 127.76 2765587 300 86901 BB RH TYPE 1 90.97 30.93 4.88 72.78 4.88 46.62 66.04 63.68 70.96 68.23 60.66 72.78 63.68 30.33 68.23 51.56 48.53 2781288 390 P9017 BB FRESH FROZEN PLASMA 1 247.98 84.31 2.59 198.38 2.59 127.09 180.03 173.59 193.42 185.99 165.32 198.38 173.59 82.66 185.99 140.52 132.26 2784331 390 P9019 BB PLATELET CONC UN 1 213.87 72.72 71.29 197.44 197.44 109.61 155.27 149.71 166.82 160.40 142.58 171.10 149.71 71.29 160.40 121.19 114.06 292950 361 92950 NS2 CPR 1 710.91 241.71 237.00 568.73 426.55 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 3002684 270 66984 LENS TORIC 1 " 5,589.28 " " 1,900.36 " " 1,458.00 " " 4,471.42 " " 1,458.00 " " 2,864.51 " " 4,057.82 " " 3,912.50 " " 4,359.64 " " 4,191.96 " " 3,726.68 " " 4,471.42 " " 3,912.50 " " 1,863.34 " " 4,191.96 " " 3,167.68 " " 2,981.34 " 3002777 278 C1880 FILTER GREENFIELD VENA CAVE 1 " 2,184.00 " 742.56 57.08 " 1,747.20 " 57.08 " 1,119.30 " " 1,585.58 " " 1,528.80 " " 1,703.52 " " 1,638.00 " 851.76 " 1,747.20 " " 1,528.80 " " 1,638.00 " 3009383 274 L8499 CAST PADDING 6 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 3014697 274 L8499 CASTING MATERIAL PLASTER 1 4.00 1.36 1.56 3.20 2.40 2.05 2.90 2.80 3.12 3.00 1.56 3.20 2.80 3.00 3014698 274 L8499 CASTING MATERIAL PLASTER 1 5.00 1.70 1.95 4.00 3.00 2.56 3.63 3.50 3.90 3.75 1.95 4.00 3.50 3.75 3019032 274 L8499 CAST PADDING 2 1 6.00 2.04 2.34 4.80 3.60 3.08 4.36 4.20 4.68 4.50 2.34 4.80 4.20 4.50 3019035 274 L8499 CAST PADDING 4 1 24.00 8.16 9.36 19.20 14.40 12.30 17.42 16.80 18.72 18.00 9.36 19.20 16.80 18.00 3020595 272 A5063 SYS OST 2 W/2.75 FLNG 1 11.00 3.74 2.24 8.80 2.24 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3024100 278 L8641 KIT XCALIBER ARTICULATED ANKLE STERILE 1 " 3,768.00 " " 1,281.12 " 232.70 " 3,014.40 " 232.70 " 1,931.10 " " 2,735.57 " " 2,637.60 " " 2,939.04 " " 2,826.00 " " 1,469.52 " " 3,014.40 " " 2,637.60 " " 2,826.00 " 3027254 272 A5063 SYS OST 2W/225FL 1 13.00 4.42 2.24 10.40 2.24 6.66 9.44 9.10 10.14 9.75 5.07 10.40 9.10 9.75 3029930 278 C1894 KIT INTRO SHEATH W/SIDEP 1 77.00 26.18 0.82 61.60 0.82 39.46 55.90 53.90 60.06 57.75 30.03 61.60 53.90 57.75 3030377 278 C1751 KIT CENTRAL 5FR DUAL POWERPICC 1 420.00 142.80 7.08 336.00 7.08 215.25 304.92 294.00 327.60 315.00 163.80 336.00 294.00 315.00 3034131 278 C1751 KIT PICC MICROINTRODUCER 6FR 1 112.50 38.25 7.08 90.00 7.08 57.66 81.68 78.75 87.75 84.38 43.88 90.00 78.75 84.38 3043625 278 C1713 ENDOANCHOR FIXATION DEVICE 1 325.00 110.50 126.75 260.00 134.20 166.56 235.95 227.50 253.50 243.75 126.75 260.00 227.50 243.75 3057620 278 C1751 KIT CENTRAL 5FR TRIPLE POWERPICC 1 475.00 161.50 7.08 380.00 7.08 243.44 344.85 332.50 370.50 356.25 185.25 380.00 332.50 356.25 3061283 278 C1729 "KIT, PLEURX PERITONEAL CATHETER" 1 " 1,079.00 " 366.86 2.42 863.20 2.42 552.99 783.35 755.30 841.62 809.25 420.81 863.20 755.30 809.25 3081043 270 A4402 GEL DUODERM HYDROACTIVE 30G 1 32.00 10.88 1.33 25.60 1.33 16.40 23.23 22.40 24.96 24.00 12.48 25.60 22.40 24.00 3081045 272 A4408 WAFER CONVATEC 0217-12 S 1 21.00 7.14 8.18 16.80 8.18 10.76 15.25 14.70 16.38 15.75 8.19 16.80 14.70 15.75 3084805 274 L3927 SPLINT OVAL 8 1 15.00 5.10 5.85 21.37 21.37 7.69 10.89 10.50 11.70 11.25 5.85 12.00 10.50 11.25 3090981 272 A5063 SYS OST 2 W/1.5 FLNG 1 11.00 3.74 2.24 8.80 2.24 5.64 7.99 7.70 8.58 8.25 4.29 8.80 7.70 8.25 3094235 272 A4408 WAFER CONVATEC 0256-11 S 1 13.00 4.42 5.07 10.40 8.18 6.66 9.44 9.10 10.14 9.75 5.07 10.40 9.10 9.75 3094237 272 A5062 POUCH OSTOMY CONVATEC 02 1 8.00 2.72 1.85 6.40 1.85 4.10 5.81 5.60 6.24 6.00 3.12 6.40 5.60 6.00 3098349 278 C1781 MESH LARGE CIRCLE VENTRIO HERNIA PATCH 1 " 1,133.00 " 385.22 69.35 906.40 69.35 580.66 822.56 793.10 883.74 849.75 441.87 906.40 793.10 849.75 4000297 352 71271 CT LOW DOSE FOR LUNG CANCER SCREENING 1 217.47 73.94 72.50 173.98 130.48 111.45 157.88 152.23 169.63 163.10 145.00 173.98 152.23 72.50 163.10 123.25 116.00 4001275 352 71275 CTA CHEST THORACIC AORTA PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4003846 351 70481 CT ORBITS W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4005495 351 70486 CT FACIAL BONES WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4005497 351 70488 CT FACIAL BONES WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4005499 351 70487 CT FACIAL BONES W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4010699 351 70482 CT IAC WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4010700 351 70481 CT IAC W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4010701 351 70480 CT IAC WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4011275 352 71275 CTA CHEST AORTA PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4014031 351 70480 CT ORBITS WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4014032 352 71250 CT CHEST WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4020129 351 70481 CT SELLA TUR W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4022273 350 77012 CT GUIDANCE BIOPSY 1 921.00 313.14 300.00 736.80 300.00 472.01 668.65 644.70 718.38 690.75 359.19 736.80 644.70 690.75 4024134 351 70486 CT SINUSES WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4024137 352 71260 CT CHEST W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4024304 351 70482 CT SELLA TURCICA WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4025034 351 70487 CT SINUSES W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4025251 351 70480 CT SELLA TURCICA WO CONTRAST 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4028365 351 70450 CT BRAIN WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4040265 352 72192 CT PELVIS WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4041308 350 71270 CT CHEST WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4048794 350 77012 CT GUIDANCE ASPIRATION 1 921.00 313.14 300.00 736.80 300.00 472.01 668.65 644.70 718.38 690.75 359.19 736.80 644.70 690.75 4057230 352 73200 LT CT EXTREM UPPER LT WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4057231 352 73202 LT CT EXTREM UPPER LT WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4057232 352 73701 LT CT EXTREM LOW LT W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4057233 352 73200 RT CT EXTREM UPPER RT WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4057234 352 73702 LT CT EXTREM LOW LT WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4057235 352 73702 RT CT EXTREM LOW RT WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4057236 352 73701 RT CT EXTREM LOW RT W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4057237 352 73202 RT CT EXTREM UPPER RT WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4070496 351 70496 CTA HEAD PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4070498 351 70498 CTA CAROTID PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4071250 352 71250 CT CHEST WO CON HIGH RESOLUTION 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4071275 352 71275 CTA CHEST PE PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4072133 352 72133 CT SPINE LUMBAR WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4075635 350 75635 CTA ABD AORTA LOW EXT RUNOFF PER PROTOCO 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4078908 351 70486 CT SINUSES LIMITED 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4086202 352 72194 CT PELVIS WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4086208 352 70492 CT SOFT TISSUE NECK WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4086212 351 70488 CT SINUSES WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4086213 351 70482 CT ORBITS WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4087023 352 74170 CT ABDOMEN WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4087024 352 74160 CT ABDOMEN W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4087025 352 74150 CT ABDOMEN WO CONTRAST 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4087028 352 72132 CT SPINE LUMBAR W CON PER PROTOCOL 1 989.60 336.46 300.00 791.68 300.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4087029 352 72131 CT SPINE LUMBAR WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4087030 352 70491 CT SOFT TISSUE NECK W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4087031 352 73201 LT CT EXTREM UPPER LT W CON PER PROTOCOL 1 989.60 336.46 300.00 791.68 300.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4087032 352 73201 RT CT EXTREM UPPER RT W CON PER PROTOCOL 1 989.60 336.46 300.00 791.68 300.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4087033 352 73700 LT CT EXTREM LOW LT WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4087034 352 73700 RT CT EXTREM LOW RT WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4087035 352 70490 CT SOFT TISSUE NECK WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4087036 352 72125 CT SPINE CERVICAL WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4087040 352 72128 CT SPINE THORACIC WO CON 1 292.94 99.60 97.66 300.00 300.00 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4087041 350 76377 CT 3D RECON 1 206.00 70.04 80.34 300.00 300.00 105.58 149.56 144.20 160.68 154.50 80.34 164.80 144.20 154.50 4087050 352 74176 CT ABD PEL WO CON 1 618.64 210.34 206.24 494.91 300.00 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4087051 352 74177 CT ABD PEL W CON PER PROTOCOL 1 989.60 336.46 300.00 791.68 300.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4087052 352 74178 CT ABD PEL WWO CON PER PROTOCOL 1 989.60 336.46 300.00 791.68 300.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4090432 351 70460 CT BRAIN W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4090433 351 70470 CT BRAIN WWO CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4090443 352 72193 CT PELVIS W CON PER PROTOCOL 1 479.99 163.20 160.02 383.99 300.00 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4203080 320 73080 LT XR ELBOW LT COMPLETE 3 VIEWS OR > 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4203562 320 73562 LT XR KNEE LT 3 VIEW 1 217.48 73.94 42.53 173.98 42.53 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4203564 320 73564 LT XR KNEE LT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4203600 320 73600 RT XR ANKLE RIGHT 2 V 1 217.48 73.94 35.82 173.98 35.82 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4203620 320 73620 RT XR FOOT RT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4206188 320 73502 LT XR HIP LT AP LATERAL 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4206189 320 73502 RT XR HIP RT AP LATERAL 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4214126 320 76080 XR FISTULAGRAM 1 " 1,298.12 " 441.36 67.84 " 1,038.50 " 67.84 665.29 942.44 908.68 " 1,012.53 " 973.59 865.54 " 1,038.50 " 908.68 432.77 973.59 735.71 692.43 4216594 320 76000 XR C ARM UP TO 1 HOUR 1 618.64 210.34 56.25 494.91 56.25 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4219768 320 76098 XR SURGICAL SPECIMEN 1 " 1,298.12 " 441.36 20.54 " 1,038.50 " 20.54 665.29 942.44 908.68 " 1,012.53 " 973.59 865.54 " 1,038.50 " 908.68 432.77 973.59 735.71 692.43 4222348 320 73050 XR AC JOINTS BILATERAL W W 1 217.48 73.94 42.22 173.98 42.22 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4227509 320 73590 LT XR TIB FIB LEFT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4227515 320 73590 RT XR TIB FIB RIGHT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4234855 320 73070 RT XR ELBOW RT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4234856 320 73070 LT XR ELBOW LT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4234860 320 73501 RT XR HIP RT AP 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4234862 320 73501 LT XR HIP LT AP 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4234866 320 73560 RT XR KNEE RT AP LATERAL 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4234868 320 73560 LT XR KNEE LT AP LATERAL 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4239929 320 74246 XR UPPER GI SERIES WO KUB 1 479.99 163.20 152.17 383.99 152.17 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4244256 320 74018 XR ABDOMEN AP ONLY KUB 1 217.48 73.94 33.21 173.98 33.21 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4246340 320 70330 XR TMJ BIL OPEN CLOSED 1 217.48 73.94 56.06 173.98 56.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4246489 320 72170 XR PELVIS 1 OR 2 VIEW 1 292.94 99.60 37.93 234.35 37.93 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4246737 320 74220 XR ESOPHOGRAM 1 479.99 163.20 105.81 383.99 105.81 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4246790 320 74400 XR IVP W OR WO TOMOS 1 479.99 163.20 130.74 383.99 130.74 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4247167 320 77074 XR BONE SURVEY FOR METS 1 292.94 99.60 77.69 234.35 77.69 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4248493 320 72050 XR SPINE C COMPLETE 1 292.94 99.60 54.09 234.35 54.09 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4249614 320 72020 XR SPINE LUMBAR XTABLE ONLY 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4249620 320 72020 XR SPINE THORACIC 1V 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250345 320 73610 LT XR ANKLE LEFT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250377 320 73610 RT XR ANKLE RIGHT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250513 320 73000 LT XR CLAVICLE LT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250531 320 73000 RT XR CLAVICLE RT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250577 320 72220 XR COCCYX SACRUM AP LATERAL 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250694 320 70150 XR FACIAL BONES 3 VIEWS 1 292.94 99.60 49.56 234.35 49.56 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4250764 320 73630 LT XR FOOT LT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250766 320 73630 RT XR FOOT RT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250839 320 73140 F1 XR FINGER LT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250840 320 73140 F2 XR FINGER LT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250841 320 73140 F3 XR FINGER LT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250842 320 73140 F4 XR FINGER LT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250843 320 73140 F8 XR FINGER RT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250844 320 73140 F6 XR FINGER RT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250845 320 73140 F7 XR FINGER RT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250847 320 73140 F9 XR FINGER RT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250959 320 73090 LT XR FOREARM LEFT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4250960 320 73090 RT XR FOREARM RIGHT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4251102 320 73130 LT XR HAND LT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4251136 320 73130 RT XR HAND RT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4251563 320 73521 XR HIP AP LAT BILAT W PEL 2 V 1 292.94 99.60 47.28 234.35 47.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4251779 320 73060 LT XR HUMERUS LT AP LATERAL 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4251790 320 73060 RT XR HUMERUS RT AP LATERAL 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4252852 320 71100 LT XR RIBS LEFT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4252880 320 71100 RT XR RIBS RIGHT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4253050 320 71110 XR RIBS BILAT AP PA 2 OBL 3V 1 292.94 99.60 45.07 234.35 45.07 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4253396 320 72202 XR SACROILIAC JOINTS AP 2V 1 292.94 99.60 39.28 234.35 39.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4253501 320 73010 LT XR SCAPULA LEFT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4253525 320 73010 RT XR SCAPULA RIGHT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4253560 320 70240 XR SELLA TURCICA PA AP 1V 1 217.48 73.94 35.98 173.98 35.98 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4254311 320 72190 XR PELVIS 3 OR MORE VIEWS 1 292.94 99.60 45.58 234.35 45.58 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4254424 320 70110 XR MANDIBLE COMPLETE 4V 1 292.94 99.60 45.37 234.35 45.37 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4254517 320 74019 XR ABD AP FLAT ERECT 1 292.94 99.60 40.53 234.35 40.53 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4260405 320 73592 50 XR LOWER EXTREM INFANT 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4261238 320 77072 XR BONE AGE STUDY 1 292.94 99.60 28.13 234.35 28.13 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4261239 320 77073 XR BONE LENGTH STUDY EG S 1 292.94 99.60 43.56 234.35 43.56 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4261508 320 70190 LT XR OPTIC FORAMINA LEFT 1 217.48 73.94 42.69 173.98 42.69 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4261509 320 70190 RT XR OPTIC FORAMINA RIGHT 1 217.48 73.94 42.69 173.98 42.69 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4261521 320 70140 XR ZYGOMATIC ARCHES 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4261525 320 70360 XR SOFT TISSUE LAT NECK 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4261543 320 72040 XR SPINE C AP LAT 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4261617 320 74250 XR SMALL BOWEL SERIES 1 479.99 163.20 123.62 383.99 123.62 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4261619 320 74270 XR COLON BARIUM ENEMA 1 479.99 163.20 160.02 383.99 161.26 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4261620 320 74280 XR COLON B E AIR CONTRST 1 479.99 163.20 160.02 383.99 253.13 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4261676 320 70210 XR SINUSES 1 VIEW ONLY 1 217.48 73.94 35.46 173.98 35.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4261952 320 74022 XR ACUTE ABD SERIES 1 292.94 99.60 53.73 234.35 53.73 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4261964 320 74018 XR ABDOMEN LAT DECUBITUS 1 217.48 73.94 33.21 173.98 33.21 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262110 320 73660 LT XR TOES LT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262112 320 73660 RT XR TOES RT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262152 320 73140 FA XR FINGER LT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262157 320 73140 F5 XR FINGER RT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262281 320 73650 RT XR CALCANEUS RIGHT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262283 320 73650 LT XR CALCANEUS LEFT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262596 320 72110 XR SPINE LS COMPLETE 4V 1 292.94 99.60 58.64 234.35 58.64 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4262674 320 73030 LT XR SHOULDER LEFT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262675 320 73030 RT XR SHOULDER RIGHT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4262985 320 70134 XR INTERNAL AUDITORY MEATI 1 " 1,298.12 " 441.36 61.54 " 1,038.50 " 61.54 665.29 942.44 908.68 " 1,012.53 " 973.59 865.54 " 1,038.50 " 908.68 432.77 973.59 735.71 692.43 4263352 320 72020 XR SPINE C LAT ONLY 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4263845 320 73552 LT XR FEMUR LEFT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4263850 320 73552 RT XR FEMUR RIGHT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4263873 320 72070 XR SPINE THORACIC AP LAT 1 292.94 99.60 40.67 234.35 40.67 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4263993 320 72100 XR SPINE LS 2 3V 1 292.94 99.60 41.91 234.35 41.91 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4271010 324 71045 XR CHEST 1V PORTABLE 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271021 324 71047 XR CHEST 2V W APICAL LORDOTIC 1 217.48 73.94 47.38 173.98 47.38 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271035 324 71045 XR CHEST SPECIAL VIEW 1V 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271046 324 71046 XR CHEST PA LATERAL 2V PORTABLE 1 217.48 73.94 37.16 173.98 37.16 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271047 324 71047 XR CHEST 3V W OBLIQUE 1 217.48 73.94 47.38 173.98 47.38 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271191 320 70220 XR SINUSES 3V 1 217.48 73.94 44.96 173.98 44.96 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271198 320 73110 LT XR WRIST LEFT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271199 320 73110 RT XR WRIST RIGHT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271206 320 70160 XR NASAL BONES PA OR AP 2 OR 3V 1 217.48 73.94 38.76 173.98 38.76 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271216 320 70250 XR SKULL 1 TO 3 VIEWS 1 292.94 99.60 43.26 234.35 43.26 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4271219 320 70260 XR SKULL COMPLETE 4V 1 292.94 99.60 55.08 234.35 55.08 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4271239 320 71120 XR STERNUM 2 VIEWS MORE 1 217.48 73.94 35.62 173.98 35.62 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271290 320 71130 XR STERNOCLAV JNTS 2 OBLIQ 1 217.48 73.94 43.15 173.98 43.15 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4271300 320 70130 XR MASTOIDS PA 1 TOWN 2 STN 3V 1 292.94 99.60 65.40 234.35 65.40 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4271333 320 72040 XR SPINE C FLEX EX 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4272020 320 70200 XR ORBITS PA AP WATERS 4V 1 292.94 99.60 50.49 234.35 50.49 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4272048 320 74415 XR IVP W NEPHROTOGRAPHY 1 479.99 163.20 160.02 383.99 161.71 245.99 348.47 335.99 374.39 359.99 320.04 383.99 335.99 160.02 359.99 272.03 256.03 4272142 320 73020 LT XR SHOULDER AP LT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4272143 320 73020 RT XR SHOULDER AP RT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4272671 324 71045 LT XR CHEST DECUBITUS LEFT 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4272672 324 71045 RT XR CHEST DECUBITUS RIGHT 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4273080 320 73080 RT XR ELBOW RT COMPLETE 3 VIEWS OR > 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4273551 320 73551 LT XR FEMUR LT AP 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4273562 320 73562 RT XR KNEE RT 3 VIEW 1 217.48 73.94 42.53 173.98 42.53 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4273564 320 73564 RT XR KNEE RT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4273600 320 73600 LT XR ANKLE LEFT 2 V 1 217.48 73.94 35.82 173.98 35.82 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4273620 320 73620 LT XR FOOT LT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4275150 320 76100 XR TOMOGRAM SINGLE PLANE 1 292.94 99.60 97.66 234.35 111.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4275809 320 75809 XR SHUNT SERIES 1 292.94 99.60 97.66 234.35 118.66 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4276010 320 76010 XR CHILD FOREIGN BODY 1 217.48 73.94 31.38 173.98 31.38 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4277001 320 77001 XR CR GUIDANCE FOR PLACEMENT 1 635.00 215.90 84.19 508.00 84.19 325.44 461.01 444.50 495.30 476.25 247.65 508.00 444.50 476.25 4277076 320 77076 XR INFANT BABY GRAM 1 292.94 99.60 97.66 234.35 115.89 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4277178 320 72081 XR SPINE SCOLIOSIS SERIES 1 V 1 217.48 73.94 46.81 173.98 46.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4281542 320 76098 XR SPECIMEN SURGICAL 1 " 1,298.12 " 441.36 20.54 " 1,038.50 " 20.54 665.29 942.44 908.68 " 1,012.53 " 973.59 865.54 " 1,038.50 " 908.68 432.77 973.59 735.71 692.43 4283061 320 76000 XR FLUOROSCOPY UP TO 1 HOUR 1 618.64 210.34 56.25 494.91 56.25 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4283243 320 74455 XR CYSTOGRAM VOIDING NOT C 1 618.64 210.34 96.72 494.91 96.72 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4283520 324 71046 XR CHEST PA LATERAL 2V 1 217.48 73.94 37.16 173.98 37.16 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4283551 320 73551 RT XR FEMUR RT AP 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4284485 324 71045 XR CHEST AP ONLY 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4287042 320 73565 XR KNEES BILAT STANDING 1 217.48 73.94 42.42 173.98 42.42 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4287045 320 70140 XR FACIAL BONES 1 OR 2 VIEWS 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290000 320 73050 DC AC JOINTS BILATERAL WW 1 217.48 73.94 42.22 173.98 42.22 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290001 320 74019 DC AB AP FLAT ERECT 1 292.94 99.60 40.53 234.35 40.53 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290002 320 74018 DC ABDOMEN AP ONLY KUB 1 217.48 73.94 33.21 173.98 33.21 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290004 320 74022 DC ACUTE ABD SERIES 1 292.94 99.60 53.73 234.35 53.73 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290005 320 73610 LT DC ANKLE LEFT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290006 320 73610 RT DC ANKLE RIGHT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290007 320 73650 LT DC CALCANEUS LEFT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290008 320 73650 RT DC CALCANEUS RIGHT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290009 324 71045 DC CHEST AP ONLY 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290012 324 71046 DC CHEST PA LATERAL 2V 1 217.48 73.94 37.16 173.98 37.16 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290013 320 73000 LT DC CLAVICLE LT AP TANGENTIAL 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290014 320 73000 RT DC CLAVICLE RT AP TANGENTIAL 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290015 320 72220 DC COCCYX SACRUM AP LATERAL 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290016 320 73070 LT DC ELBOW L2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290017 320 73070 RT DC ELBOW R2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290018 320 70140 DC FACIAL BONES 1 OR 2 VIEWS 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290019 320 70150 DC FACIAL BONES 3 VIEWS 1 292.94 99.60 49.56 234.35 49.56 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290020 320 73552 LT DC FEMUR LEFT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290021 320 73552 RT DC FEMUR RIGHT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290022 320 73140 F1 DC FINGER LT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290023 320 73140 F2 DC FINGER LT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290024 320 73140 F3 DC FINGER LT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290025 320 73140 F4 DC FINGER LT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290026 320 73140 FA DC FINGER LT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290027 320 73140 F6 DC FINGER RT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290028 320 73140 F7 DC FINGER RT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290029 320 73140 F8 DC FINGER RT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290030 320 73140 F9 DC FINGER RT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290031 320 73140 F5 DC FINGER RT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290032 320 73630 LT DC FOOT LT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290033 320 73630 RT DC FOOT RT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290034 320 73090 LT DC FOREARM LEFT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290035 320 73090 RT DC FOREARM RIGHT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290036 320 73130 LT DC HAND LT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290037 320 73130 RT DC HAND RT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290038 320 73501 LT DC HIP AP LT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290039 320 73501 RT DC HIP AP RT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290040 320 73521 DC HIP AP LAT BILAT W PEL 2 V 1 292.94 99.60 47.28 234.35 47.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290041 320 73502 LT DC HIP AP LATERAL LEFT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290042 320 73502 RT DC HIP AP LATERAL RT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290043 320 73060 LT DC HUMERUS AP LATERAL LT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290044 320 73060 RT DC HUMERUS AP LATERAL RT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290045 320 73560 LT DC KNEE AP LATERAL LT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290046 320 73560 RT DC KNEE AP LATERAL RT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290047 320 73592 50 DC LOWER EXTREM INFANT 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290048 320 70110 DC MANDIBLE COMPLETE 4V 1 292.94 99.60 45.37 234.35 45.37 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290049 320 70130 DC MASTOIDS PA 1 TOWN 2 STN 3V 1 292.94 99.60 65.40 234.35 65.40 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290050 320 70160 DC NASAL BONES PA OR AP 2 OR 3V 1 217.48 73.94 38.76 173.98 38.76 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290053 320 70200 DC ORBITS PA AP WATERS 4V 1 292.94 99.60 50.49 234.35 50.49 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290054 320 72190 DC PELVIS 3 OR MORE VIEWS 1 292.94 99.60 45.58 234.35 45.58 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290055 320 72170 DC PELVIS 1 OR 2 VIEW 1 292.94 99.60 37.93 234.35 37.93 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290056 320 71110 DC RIBS BILAT AP PA 2 OBL 3V 1 292.94 99.60 45.07 234.35 45.07 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290057 320 71100 LT DC RIBS LEFT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290058 320 71100 RT DC RIBS RIGHT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290059 320 72202 DC SACROILIAC JOINTS AP 2 1 292.94 99.60 39.28 234.35 39.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290061 320 73010 LT DC SCAPULA LEFT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290062 320 73010 RT DC SCAPULA RIGHT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290064 320 73020 LT DC SHOULDER AP LT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290065 320 73020 RT DC SHOULDER AP RT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290066 320 73030 LT DC SHOULDER LEFT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290067 320 73030 RT DC SHOULDER RIGHT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290068 320 70220 DC SINUSES 3V 1 217.48 73.94 44.96 173.98 44.96 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290069 320 70210 DC SINUSES 1 VIEW ONLY 1 217.48 73.94 35.46 173.98 35.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290070 320 70250 DC SKULL 1 TO 3 VIEWS 1 292.94 99.60 43.26 234.35 43.26 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290071 320 70260 DC SKULL COMPLETE 4V 1 292.94 99.60 55.08 234.35 55.08 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290072 320 70360 DC SOFT TISSUE LAT NECK 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290073 320 72040 DC SPINE C AP LAT 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290074 320 72050 DC SPINE C COMPLETE 1 292.94 99.60 54.09 234.35 54.09 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290075 320 72040 DC SPINE C FLEX EXT 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290076 320 72020 DC SPINE C LAT ONLY 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290077 320 72100 DC SPINE LS 2 OR 3V 1 292.94 99.60 41.91 234.35 41.91 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290078 320 72110 DC SPINE LS COMPLETE 4V 1 292.94 99.60 58.64 234.35 58.64 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290079 320 72081 DC SPINE SCOLIOSIS SERIES 1 V 1 217.48 73.94 46.81 173.98 46.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290080 320 72070 DC SPINE THORACIC AP LAT 1 292.94 99.60 40.67 234.35 40.67 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290081 320 71130 DC STERNOCLAV JNTS 2 OBLIQ 1 217.48 73.94 43.15 173.98 43.15 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290082 320 71120 DC STERNUM 2 VIEWS MORE 1 217.48 73.94 35.62 173.98 35.62 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290083 320 73590 LT DC TIB FIB LEFT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290084 320 73590 RT DC TIB FIB RIGHT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290085 320 70330 DC TMJ BIL OPEN CLOSED 1 217.48 73.94 56.06 173.98 56.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290096 320 73110 LT DC WRIST LEFT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290097 320 73110 RT DC WRIST RIGHT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290098 320 70140 DC ZYGOMATIC ARCHES 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290099 320 77080 DC DXA BONE DENSITY STUDY 1 292.94 99.60 49.24 234.35 49.24 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290103 403 77067 DC MAMMO BILAT SCREEN 1 236.12 80.28 89.81 188.90 164.07 121.01 171.42 165.28 184.17 177.09 179.62 188.90 165.28 89.81 177.09 152.68 143.70 4290106 320 76098 DC MAMMO SPECIMEN SURGICAL 1 " 1,298.12 " 441.36 20.54 " 1,038.50 " 20.54 665.29 942.44 908.68 " 1,012.53 " 973.59 865.54 " 1,038.50 " 908.68 432.77 973.59 735.71 692.43 4290110 320 73660 LT DC TOES LT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290111 320 73660 RT DC TOES RT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290118 320 72020 DC SPINE THORACIC 1V 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290119 403 77067 RT 52 DC MAMMO UNILAT RT SCREEN 1 236.12 80.28 89.81 188.90 164.07 121.01 171.42 165.28 184.17 177.09 179.62 188.90 165.28 89.81 177.09 152.68 143.70 4290120 403 77067 LT 52 DC MAMMO UNILAT LT SCREEN 1 236.12 80.28 89.81 188.90 164.07 121.01 171.42 165.28 184.17 177.09 179.62 188.90 165.28 89.81 177.09 152.68 143.70 4290121 320 73551 LT DC FEMUR AP LT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290122 320 73551 RT DC FEMUR AP RT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290123 320 73620 LT DC FOOT LT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290124 320 73620 RT DC FOOT RT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290126 320 73564 LT DC KNEE LT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290127 320 73564 RT DC KNEE RT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4290128 324 71045 DC CHEST AP ONLY DIGITAL 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4290129 324 71046 DC CHEST PA LATERAL 2V DIGITAL 1 217.48 73.94 37.16 173.98 37.16 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291000 320 73050 NW AC JOINTS BILATERAL W/W 1 217.48 73.94 42.22 173.98 42.22 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291001 320 74019 NW AB AP FLAT ERECT 1 292.94 99.60 40.53 234.35 40.53 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291002 320 74018 NW ABDOMEN AP ONLY KUB 1 217.48 73.94 33.21 173.98 33.21 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291004 320 74022 NW ACUTE ABD SERIES 1 292.94 99.60 53.73 234.35 53.73 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291005 320 73610 LT NW ANKLE LEFT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291006 320 73610 RT NW ANKLE RIGHT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291007 320 73650 LT NW CALCANEUS LEFT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291008 320 73650 RT NW CALCANEUS RIGHT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291009 324 71045 NW CHEST AP ONLY 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291012 324 71046 NW CHEST PA LATERAL 2V 1 217.48 73.94 37.16 173.98 37.16 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291013 320 73000 LT NW CLAVICLE LT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291014 320 73000 RT NW CLAVICLE RT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291015 320 72220 NW COCCYX SACRUM AP LATERAL 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291016 320 73070 LT NW ELBOW LT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291017 320 73070 RT NW ELBOW RT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291018 320 70140 NW FACIAL BONES 1 OR 2 VIEWS 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291019 320 70150 NW FACIAL BONES 3 VIEWS 1 292.94 99.60 49.56 234.35 49.56 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291020 320 73552 LT NW FEMUR LEFT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291021 320 73552 RT NW FEMUR RIGHT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291022 320 73140 F1 NW FINGER LT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291023 320 73140 F2 NW FINGER LT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291024 320 73140 F3 NW FINGER LT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291025 320 73140 F4 NW FINGER LT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291026 320 73140 FA NW FINGER LT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291027 320 73140 F6 NW FINGER RT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291028 320 73140 F7 NW FINGER RT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291029 320 73140 F8 NW FINGER RT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291030 320 73140 F9 NW FINGER RT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291031 320 73140 F5 NW FINGER RT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291032 320 73630 LT NW FOOT LT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291033 320 73630 RT NW FOOT RT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291034 320 73090 LT NW FOREARM LEFT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291035 320 73090 LT NW FOREARM RIGHT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291036 320 73130 LT NW HAND LT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291037 320 73130 RT NW HAND RT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291038 320 73501 LT NW HIP AP LT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291039 320 73501 RT NW HIP AP RT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291040 320 73521 NW HIP AP LAT BILAT W PEL 2 V 1 292.94 99.60 47.28 234.35 47.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291041 320 73502 LT NW HIP AP LATERAL LEFT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291042 320 73502 RT NW HIP AP LATERAL RT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291043 320 73060 LT NW HUMERUS AP LATERAL LT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291044 320 73060 RT NW HUMERUS AP LATERAL RT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291045 320 73560 LT NW KNEE AP LATERAL LT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291046 320 73560 RT NW KNEE AP LATERAL RT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291047 320 73592 50 NW LOWER EXTREM INFANT 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291048 320 70110 NW MANDIBLE COMPLETE 4V 1 292.94 99.60 45.37 234.35 45.37 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291049 320 70130 NW MASTOIDS PA 1 TOWN 2 STN 3V 1 292.94 99.60 65.40 234.35 65.40 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291050 320 70160 NW NASAL BONES PA OR AP 2 OR 3V 1 217.48 73.94 38.76 173.98 38.76 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291053 320 70200 NW ORBITS PA AP W WATERS 4V 1 292.94 99.60 50.49 234.35 50.49 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291054 320 72190 NW PELVIS 3 OR MORE VIEWS 1 292.94 99.60 45.58 234.35 45.58 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291055 320 72170 NW PELVIS 1 OR 2 VIEW 1 292.94 99.60 37.93 234.35 37.93 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291056 320 71110 NW RIBS BILAT AP PA W 2 OBL 3V 1 292.94 99.60 45.07 234.35 45.07 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291057 320 71100 LT NW RIBS LEFT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291058 320 71100 RT NW RIBS RIGHT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291059 320 72202 NW SACROILIAC JOINTS AP 2 1 292.94 99.60 39.28 234.35 39.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291061 320 73010 LT NW SCAPULA LEFT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291062 320 73010 RT NW SCAPULA RIGHT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291064 320 73020 LT NW SHOULDER AP LT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291065 320 73020 RT NW SHOULDER AP RT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291066 320 73030 LT NW SHOULDER LEFT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291067 320 73030 RT NW SHOULDER RIGHT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291068 320 70220 NW SINUSES 3V 1 217.48 73.94 44.96 173.98 44.96 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291069 320 70210 NW SINUSES 1 VIEW ONLY 1 217.48 73.94 35.46 173.98 35.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291070 320 70250 NW SKULL 1 TO 3 VIEWS 1 292.94 99.60 43.26 234.35 43.26 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291071 320 70260 NW SKULL COMPLETE 4V 1 292.94 99.60 55.08 234.35 55.08 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291072 320 70360 NW SOFT TISSUE LAT NECK 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291073 320 72040 NW SPINE C AP LAT 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291074 320 72050 NW SPINE C COMPLETE 1 292.94 99.60 54.09 234.35 54.09 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291075 320 72040 NW SPINE C FLEX EX 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291076 320 72020 NW SPINE C LAT ONLY 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291077 320 72100 NW SPINE LS 2 OR 3V 1 292.94 99.60 41.91 234.35 41.91 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291078 320 72110 NW SPINE LS COMPLETE 4V 1 292.94 99.60 58.64 234.35 58.64 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291079 320 72081 NW SPINE SCOLIOSIS SERIES 1 V 1 217.48 73.94 46.81 173.98 46.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291080 320 72070 NW SPINE THORACIC AP LAT 1 292.94 99.60 40.67 234.35 40.67 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291081 320 71130 50 NW STERNOCLAV JNTS 2 OBLIQ 1 217.48 73.94 43.15 173.98 43.15 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291082 320 71120 NW STERNUM 2 VIEWS MORE 1 217.48 73.94 35.62 173.98 35.62 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291083 320 73590 LT NW TIB FIB LEFT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291084 320 73590 RT NW TIB FIB RIGHT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291096 320 73110 LT NW WRIST LEFT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291097 320 73110 RT NW WRIST RIGHT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291098 320 70140 NW ZYGOMATIC ARCHES 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291118 320 72020 NW SPINE THORACIC 1V 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291119 320 73660 LT NW TOES LT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291120 320 73660 RT NW TOES RT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291121 320 73551 LT NW FEMUR AP LT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291122 320 73551 RT NW FEMUR AP RT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291123 320 73620 LT NW FOOT LT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291124 320 73620 RT NW FOOT RT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4291126 320 73564 LT NW KNEE LT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4291127 320 73564 RT NW KNEE RT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292000 320 73050 BC AC JOINTS BILATERAL W/W 1 217.48 73.94 42.22 173.98 42.22 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292001 320 74019 BC AB AP FLAT ERECT 1 292.94 99.60 40.53 234.35 40.53 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292002 320 74018 BC ABDOMEN AP ONLY KUB 1 217.48 73.94 33.21 173.98 33.21 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292004 320 74022 BC ACUTE ABD SERIES 1 292.94 99.60 53.73 234.35 53.73 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292005 320 73610 LT BC ANKLE LEFT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292006 320 73610 RT BC ANKLE RIGHT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292007 320 73650 LT BC CALCANEUS LEFT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292008 320 73650 RT BC CALCANEUS RIGHT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292009 324 71045 BC CHEST AP ONLY 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292012 324 71046 BC CHEST PA LATERAL 2V 1 217.48 73.94 37.16 173.98 37.16 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292013 320 73000 LT BC CLAVICLE LT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292014 320 73000 RT BC CLAVICLE RT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292015 320 72220 BC COCCYX SACRUM AP LATERAL 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292016 320 73070 LT BC ELBOW LT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292017 320 73070 RT BC ELBOW RT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292018 320 70140 BC FACIAL BONES 1 OR 2 VIEWS 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292019 320 70150 BC FACIAL BONES 3 VIEWS 1 292.94 99.60 49.56 234.35 49.56 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292020 320 73552 LT BC FEMUR LEFT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292021 320 73552 RT BC FEMUR RIGHT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292022 320 73140 F1 BC FINGER LT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292023 320 73140 F2 BC FINGER LT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292024 320 73140 F3 BC FINGER LT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292025 320 73140 F4 BC FINGER LT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292026 320 73140 FA BC FINGER LT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292027 320 73140 F6 BC FINGER RT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292028 320 73140 F7 BC FINGER RT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292029 320 73140 F8 BC FINGER RT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292030 320 73140 F9 BC FINGER RT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292031 320 73140 F5 BC FINGER RT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292032 320 73630 LT BC FOOT LT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292033 320 73630 RT BC FOOT RT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292034 320 73090 LT BC FOREARM LEFT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292035 320 73090 RT BC FOREARM RIGHT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292036 320 73130 LT BC HAND LT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292037 320 73130 RT BC HAND RT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292038 320 73501 LT BC HIP AP LT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292039 320 73501 RT BC HIP AP RT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292040 320 73521 BC HIP AP LAT BILAT W PEL 2 V 1 292.94 99.60 47.28 234.35 47.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292041 320 73502 LT BC HIP AP LATERAL LEFT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292042 320 73502 RT BC HIP AP LATERAL RT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292043 320 73060 LT BC HUMERUS AP LATERAL LT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292044 320 73060 RT BC HUMERUS AP LATERAL RT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292045 320 73560 LT BC KNEE AP LATERAL LT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292046 320 73560 RT BC KNEE AP LATERAL RT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292047 320 73592 50 BC LOWER EXTREM INFANT 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292048 320 70110 BC MANDIBLE COMPLETE 4V 1 292.94 99.60 45.37 234.35 45.37 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292050 320 70160 BC NASAL BONES PA OR AP 2 OR 3V 1 217.48 73.94 38.76 173.98 38.76 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292053 320 70200 BC ORBITS PA AP W WATERS 4V 1 292.94 99.60 50.49 234.35 50.49 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292054 320 72190 BC PELVIS 3 OR MORE VIEWS 1 292.94 99.60 45.58 234.35 45.58 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292055 320 72170 BC PELVIS 1 OR 2 VIEW 1 292.94 99.60 37.93 234.35 37.93 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292056 320 71110 BC RIBS BILAT AP PA W 2 OBL 3V 1 292.94 99.60 45.07 234.35 45.07 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292057 320 71100 LT BC RIBS LEFT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292058 320 71100 RT BC RIBS RIGHT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292059 320 72202 BC SACROILIAC JOINTS AP 2 1 292.94 99.60 39.28 234.35 39.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292061 320 73010 LT BC SCAPULA LEFT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292062 320 73010 RT BC SCAPULA RIGHT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292064 320 73020 LT BC SHOULDER AP LT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292065 320 73020 RT BC SHOULDER AP RT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292066 320 73030 LT BC SHOULDER LEFT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292067 320 73030 RT BC SHOULDER RIGHT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292068 320 70220 BC SINUSES 3V 1 217.48 73.94 44.96 173.98 44.96 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292069 320 70210 BC SINUSES 1 VIEW ONLY 1 217.48 73.94 35.46 173.98 35.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292070 320 70250 BC SKULL 1 TO 3 VIEWS 1 292.94 99.60 43.26 234.35 43.26 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292071 320 70260 BC SKULL COMPLETE 4V 1 292.94 99.60 55.08 234.35 55.08 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292072 320 70360 BC SOFT TISSUE LAT NECK 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292073 320 72040 BC SPINE C AP LAT 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292074 320 72050 BC SPINE C COMPLETE 1 292.94 99.60 54.09 234.35 54.09 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292075 320 72040 BC SPINE C FLEX EX 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292076 320 72020 BC SPINE C LAT ONLY 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292077 320 72100 BC SPINE LS 2 OR 3V 1 292.94 99.60 41.91 234.35 41.91 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292078 320 72110 BC SPINE LS COMPLETE 4V 1 292.94 99.60 58.64 234.35 58.64 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292079 320 72081 BC SPINE SCOLIOSIS SERIES 1 V 1 217.48 73.94 46.81 173.98 46.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292080 320 72070 BC SPINE THORACIC AP LAT 1 292.94 99.60 40.67 234.35 40.67 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292081 320 71130 BC STERNOCLAV JNTS 2 OBLIQ 1 217.48 73.94 43.15 173.98 43.15 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292082 320 71120 BC STERNUM 2 VIEWS MORE 1 217.48 73.94 35.62 173.98 35.62 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292083 320 73590 LT BC TIB FIB LEFT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292084 320 73590 RT BC TIB FIB RIGHT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292096 320 73110 LT BC WRIST LEFT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292097 320 73110 RT BC WRIST RIGHT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292098 320 70140 BC ZYGOMATIC ARCHES 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292118 320 72020 BC SPINE THORACIC 1V 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292119 320 73660 LT BC TOES LT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292120 320 73660 RT BC TOES RT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292121 320 73551 LT BC FEMUR AP LT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292122 320 73551 RT BC FEMUR AP RT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292123 320 73620 LT BC FOOT LT 2V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292124 320 73620 RT BC FOOT RT 2V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4292126 320 73564 LT BC KNEE LT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4292127 320 73564 RT BC KNEE RT COMPLETE 4 VIEWS OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293000 320 73050 HC AC JOINTS BILATERAL W/W 1 217.48 73.94 42.22 173.98 42.22 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293001 320 74019 HC AB AP FLAT ERECT 1 292.94 99.60 40.53 234.35 40.53 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293002 320 74018 HC ABDOMEN AP ONLY KUB 1 217.48 73.94 33.21 173.98 33.21 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293004 320 74022 HC ACUTE ABD SERIES 1 292.94 99.60 53.73 234.35 53.73 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293005 320 73610 LT HC ANKLE LEFT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293006 320 73610 RT HC ANKLE RIGHT AP LAT W OBL 1 217.48 73.94 37.11 173.98 37.11 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293007 320 73650 LT HC CALCANEUS LEFT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293008 320 73650 RT HC CALCANEUS RIGHT AP LAT 1 217.48 73.94 32.51 173.98 32.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293009 324 71045 HC CHEST AP ONLY 1 217.48 73.94 24.49 173.98 24.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293012 324 71046 HC CHEST PA LATERAL 2V 1 217.48 73.94 37.16 173.98 37.16 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293013 320 73000 LT HC CLAVICLE LT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293014 320 73000 RT HC CLAVICLE RT AP TANGENTIA 1 217.48 73.94 32.93 173.98 32.93 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293015 320 72220 HC COCCYX SACRUM AP LATERAL 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293016 320 73070 LT HC ELBOW LT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293017 320 73070 RT HC ELBOW RT 2V 1 217.48 73.94 32.46 173.98 32.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293018 320 70140 HC FACIAL BONES 1 OR 2 VIEWS 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293019 320 70150 HC FACIAL BONES 3 VIEWS 1 292.94 99.60 49.56 234.35 49.56 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293020 320 73552 LT HC FEMUR LEFT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293021 320 73552 RT HC FEMUR RIGHT AP LATERAL 2V 1 217.48 73.94 38.81 173.98 38.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293022 320 73140 F1 HC FINGER LT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293023 320 73140 F2 HC FINGER LT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293024 320 73140 F3 HC FINGER LT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293025 320 73140 F4 HC FINGER LT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293026 320 73140 FA HC FINGER LT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293027 320 73140 F6 HC FINGER RT 2ND AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293028 320 73140 F7 HC FINGER RT 3RD AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293029 320 73140 F8 HC FINGER RT 4TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293030 320 73140 F9 HC FINGER RT 5TH AP LAT OBL 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293031 320 73140 F5 HC FINGER RT THUMB 3V 1 217.48 73.94 37.31 173.98 37.31 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293032 320 73630 LT HC FOOT LT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293033 320 73630 RT HC FOOT RT AP LAT W 1 OBL 1 217.48 73.94 34.63 173.98 34.63 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293034 320 73090 LT HC FOREARM LEFT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293035 320 73090 RT HC FOREARM RIGHT AP LATERAL 2V 1 217.48 73.94 30.86 173.98 30.86 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293036 320 73130 LT HC HAND LT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293037 320 73130 RT HC HAND RT PA LAT W 1 OBL 3V 1 217.48 73.94 36.70 173.98 36.70 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293038 320 73501 LT HC HIP AP LT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293039 320 73501 RT HC HIP AP RT 1V 1 217.48 73.94 35.51 173.98 35.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293040 320 73521 HC HIP AP LAT BILAT W PEL 2 V 1 292.94 99.60 47.28 234.35 47.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293041 320 73502 LT HC HIP AP LATERAL LEFT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293042 320 73502 RT HC HIP AP LATERAL RT 2V 1 217.48 73.94 49.34 173.98 49.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293043 320 73060 LT HC HUMERUS AP LATERAL LT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293044 320 73060 RT HC HUMERUS AP LATERAL RT 2V 1 217.48 73.94 34.58 173.98 34.58 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293045 320 73560 LT HC KNEE AP LATERAL LT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293046 320 73560 RT HC KNEE AP LATERAL RT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293047 320 73592 50 HC LOWER EXTREM INFANT 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293048 320 70110 HC MANDIBLE COMPLETE 4V 1 292.94 99.60 45.37 234.35 45.37 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293049 320 70130 HC MASTOIDS PA 1 TOWN 2 STN 3V 1 292.94 99.60 65.40 234.35 65.40 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293050 320 70160 HC NASAL BONES PA OR AP 2 OR 3V 1 217.48 73.94 38.76 173.98 38.76 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293053 320 70200 HC ORBITS PA AP W WATERS 4V 1 292.94 99.60 50.49 234.35 50.49 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293054 320 72190 HC PELVIS 3 OR MORE VIEWS 1 292.94 99.60 45.58 234.35 45.58 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293055 320 72170 HC PELVIS 1 OR 2 VIEW 1 292.94 99.60 37.93 234.35 37.93 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293056 320 71110 HC RIBS BILAT AP PA W 2 OBL 3V 1 292.94 99.60 45.07 234.35 45.07 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293057 320 71100 LT HC RIBS LEFT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293058 320 71100 RT HC RIBS RIGHT AP PA OBL 2V 1 217.48 73.94 39.44 173.98 39.44 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293059 320 72202 HC SACROILIAC JOINTS AP 2 1 292.94 99.60 39.28 234.35 39.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293061 320 73010 LT HC SCAPULA LEFT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293062 320 73010 RT HC SCAPULA RIGHT AP LATERAL 1 292.94 99.60 35.87 234.35 35.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293064 320 73020 LT HC SHOULDER AP LT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293065 320 73020 RT HC SHOULDER AP RT 1V 1 217.48 73.94 27.51 173.98 27.51 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293066 320 73030 LT HC SHOULDER LEFT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293067 320 73030 RT HC SHOULDER RIGHT AP LATERAL 1 217.48 73.94 34.68 173.98 34.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293068 320 70220 HC SINUSES 3V 1 217.48 73.94 44.96 173.98 44.96 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293069 320 70210 HC SINUSES 1 VIEW ONLY 1 217.48 73.94 35.46 173.98 35.46 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293070 320 70250 HC SKULL 1 TO 3 VIEWS 1 292.94 99.60 43.26 234.35 43.26 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293071 320 70260 HC SKULL COMPLETE 4V 1 292.94 99.60 55.08 234.35 55.08 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293072 320 70360 HC SOFT TISSUE LAT NECK 1 217.48 73.94 33.81 173.98 33.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293073 320 72040 HC SPINE C AP LAT 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293074 320 72050 HC SPINE C COMPLETE 1 292.94 99.60 54.09 234.35 54.09 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293075 320 72040 HC SPINE C FLEX EX 1 217.48 73.94 39.85 173.98 39.85 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293076 320 72020 HC SPINE C LAT ONLY 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293077 320 72100 HC SPINE LS 2 OR 3V 1 292.94 99.60 41.91 234.35 41.91 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293078 320 72110 HC SPINE LS COMPLETE 4V 1 292.94 99.60 58.64 234.35 58.64 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293079 320 72081 HC SPINE SCOLIOSIS SERIES 1 V 1 217.48 73.94 46.81 173.98 46.81 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293080 320 72070 HC SPINE THORACIC AP LAT 1 292.94 99.60 40.67 234.35 40.67 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293081 320 71130 HC STERNOCLAV JNTS 2 OBLIQ 1 217.48 73.94 43.15 173.98 43.15 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293082 320 71120 HC STERNUM 2 VIEWS MORE 1 217.48 73.94 35.62 173.98 35.62 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293083 320 73590 LT HC TIB FIB LEFT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293084 320 73590 RT HC TIB FIB RIGHT AP LAT 1 217.48 73.94 34.17 173.98 34.17 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293096 320 73110 LT HC WRIST LEFT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293097 320 73110 RT HC WRIST RIGHT 3V 1 217.48 73.94 42.06 173.98 42.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293098 320 70140 HC ZYGOMATIC ARCHES 1 217.48 73.94 35.56 173.98 35.56 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293118 320 72020 HC SPINE THORACIC 1V 1 217.48 73.94 26.68 173.98 26.68 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293119 320 73660 LT HC TOES LT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293120 320 73660 RT HC TOES RT AP LAT W OBL 1 217.48 73.94 33.60 173.98 33.60 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293121 320 73551 LT HC FEMUR AP LT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293122 320 73551 RT HC FEMUR AP RT 1V 1 217.48 73.94 33.34 173.98 33.34 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293123 320 73620 LT HC FOOT LT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293124 320 73620 RT HC FOOT RT 2 V 1 217.48 73.94 31.28 173.98 31.28 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293125 320 70330 HC TMJ BIL OPEN CLOSED 1 217.48 73.94 56.06 173.98 56.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4293126 320 73564 LT HC KNEE LT COMPLETE 4 VIEW OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4293127 320 73564 RT HC KNEE RT COMPLETE 4 VIEW OR > 1 292.94 99.60 46.87 234.35 46.87 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4299112 320 73560 LT NW KNEE AP LATERAL LT 1 217.48 73.94 37.06 173.98 37.06 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4403970 921 93970 US CV VEN DOP LOWER BIL 1 618.64 210.34 206.24 494.91 239.55 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4403971 921 93971 LT US CV VEN DOP LOWER UNI LT 1 292.94 99.60 97.66 234.35 155.85 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4406641 402 76641 LT US SP BREAST LT COMPLETE 1 292.94 99.60 97.66 234.35 130.09 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4406642 402 76642 LT US SP BREAST LT LIMITED 1 217.48 73.94 72.50 173.98 107.53 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4407540 402 76816 US OB PREG FU 1 292.94 99.60 97.66 234.35 178.53 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4412241 921 93931 LT US CV ART UPPER LT 1 292.94 99.60 97.66 234.35 167.41 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4412243 921 93926 LT US CV ART LOW UNI LT 1 292.94 99.60 97.66 234.35 197.80 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4412244 921 93925 US CV ART LOW BILAT 1 618.64 210.34 206.24 494.91 245.30 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4412245 921 93930 US CV ART UPPER BIL 1 618.64 210.34 206.24 494.91 247.11 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4412247 402 76936 US CV PSEUD COMP REPAIR 1 710.91 241.71 237.00 568.73 332.93 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 4413971 921 93971 RT US CV VEN DOP UPPER UNI RT 1 292.94 99.60 97.66 234.35 155.85 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4417716 402 76805 US OB PREG COMP >3RD TRI 1 292.94 99.60 97.66 234.35 219.29 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4418591 402 76705 US AB PYLORIC STENOSIS 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4423265 402 76705 US AB BLADDER 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4423971 921 93971 RT US CV VEN DOP LOWER UNI RT 1 292.94 99.60 97.66 234.35 155.85 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4427577 921 93880 US CV CAROTID DOP 1 618.64 210.34 206.24 494.91 246.95 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4440770 402 76815 US OB FETAL LIMITED 1 292.94 99.60 97.66 234.35 130.52 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4451798 402 51798 US AB BLADDER POST VOID 1 149.63 50.87 27.80 119.70 27.80 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 4453596 402 76536 US SP THYROID NECK 1 292.94 99.60 97.66 234.35 139.37 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4453620 402 76705 US AB LIVER 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4453622 402 76705 US AB GALLBLADDER 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4453628 402 76705 US AB PANCREAS 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4453630 402 76705 US AB SPLEEN 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4453633 402 76770 US AB AORTA 1 292.94 99.60 97.66 234.35 137.16 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4453653 402 76815 US OB PLACENTA LOC 1 292.94 99.60 97.66 234.35 130.52 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4457804 402 76830 US GYN TRANSVAGINAL 1 292.94 99.60 97.66 234.35 186.85 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4457805 402 76817 US OB TRANSVAGINAL 1 292.94 99.60 97.66 234.35 150.76 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4457806 402 76801 US OB PREG < 14W 1 292.94 99.60 97.66 234.35 190.80 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4457807 402 76805 US OB PREG >14W 1 292.94 99.60 97.66 234.35 219.29 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4457808 402 76805 US OB PREG 2ND TRIMESTER 1 292.94 99.60 97.66 234.35 219.29 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4458884 402 76882 LT US SP EXTREMITY LT 1 292.94 99.60 45.28 234.35 45.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4458885 402 76882 RT US SP EXTREMITY RT 1 292.94 99.60 45.28 234.35 45.28 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4458886 402 76999 US SP LOCALIZATION 1 217.48 73.94 72.50 173.98 130.49 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4472888 483 93306 US CV ECHO COMP 1 " 1,298.12 " 441.36 294.37 " 1,038.50 " 294.37 665.29 942.44 908.68 " 1,012.53 " 973.59 865.54 " 1,038.50 " 908.68 432.77 973.59 735.71 692.43 4476641 402 76641 RT US SP BREAST RT COMPLETE 1 292.94 99.60 97.66 234.35 130.09 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4476642 402 76642 RT US SP BREAST RT LIMITED 1 217.48 73.94 72.50 173.98 107.53 111.46 157.89 152.24 169.63 163.11 145.00 173.98 152.24 72.50 163.11 123.25 116.00 4476705 402 76705 US AB LIMITED 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4476706 402 76706 US AAA SCREENING 1 292.94 99.60 97.66 234.35 113.57 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4476775 402 76775 US AB RENAL LIMITED 1 292.94 99.60 71.35 234.35 71.35 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4476942 402 76942 US GUIDANCE FOR NEEDLE PLACEMENT IMG 1 217.00 73.78 75.28 173.60 75.28 111.21 157.54 151.90 169.26 162.75 84.63 173.60 151.90 162.75 4478911 402 76770 US AB RENAL COMPLETE 1 292.94 99.60 97.66 234.35 137.16 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4480502 402 76856 US PELVIC 1 292.94 99.60 97.66 234.35 168.51 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4486938 402 76942 US GUIDE NEEDLE PLACE SP BREAST CYST ASP 1 220.00 74.80 75.28 176.00 75.28 112.75 159.72 154.00 171.60 165.00 85.80 176.00 154.00 165.00 4487048 483 93320 US CV ECHO DOP 1 457.93 155.70 70.34 366.34 70.34 234.69 332.46 320.55 357.19 343.45 178.59 366.34 320.55 343.45 4487049 483 93325 US CV ECHO COLOR 1 457.93 155.70 32.41 366.34 32.41 234.69 332.46 320.55 357.19 343.45 178.59 366.34 320.55 343.45 4487210 921 93926 RT US CV ART LOW UNI RT 1 292.94 99.60 97.66 234.35 197.80 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4487211 921 93931 RT US CV ART UPPER RT 1 292.94 99.60 97.66 234.35 167.41 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4488206 402 76870 US SP TESTICULAR 1 292.94 99.60 82.96 234.35 82.96 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4490905 402 76700 US AB ABDOMEN COMPLETE 1 292.94 99.60 97.66 234.35 148.26 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4493970 921 93970 US CV VEN DOP UPPER BIL 1 618.64 210.34 206.24 494.91 239.55 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4493971 921 93971 LT US CV VEN DOP UPPER UNI LT 1 292.94 99.60 97.66 234.35 155.85 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4493975 921 93975 US AB RENAL ARTERY DOPPLER COMPLETE 1 618.64 210.34 206.24 494.91 271.54 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4493976 921 93976 US AB RENAL ARTERY DOPPLER LIMITED 1 292.94 99.60 97.66 234.35 211.79 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4497783 402 76705 US AB APPENDIX 1 292.94 99.60 97.66 234.35 110.63 150.13 212.67 205.06 228.49 219.71 195.32 234.35 205.06 97.66 219.71 166.02 156.26 4603218 610 73218 LT MRI EXT NON JT UPPER LT WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4603220 610 73220 LT MRI EXT NON JT UPPER LT WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4610408 612 72157 MRI SPINE THOR WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4613223 610 73223 LT MRI EXT JT UP LT WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4636688 610 70546 MRA HEAD WWO CONTRAST 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4641819 610 74181 MRI ABDOMEN WO CONTRAST 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4641821 612 72148 MRI SPINE LUM WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4641822 612 72146 MRI SPINE THOR WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4641824 612 72141 MRI SPINE CERV WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4646099 610 70540 MRI ORB FACE NECK WO CONT 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4648562 610 71550 MRI CHEST WO CONTRAST 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4660557 610 70542 MRI ORB FACE NECK W CONT 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4660559 610 70543 MRI ORB FACE NECK WWO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4666618 610 73721 RT MRI EXT JT LOW RT WO 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4666619 610 73721 LT MRI EXT JT LOW LT WO 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4666620 610 73221 LT MRI EXT JT UP LT WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4666621 610 73221 RT MRI EXT JT UP RT WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4666622 610 73723 LT MRI EXT JT LOW LT WWO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4666623 610 73723 RT MRI EXT JT LOW RT WWO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4666700 610 73718 RT MRI EXT NON JT LOW RT WO 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4666701 610 73718 LT MRI EXT NON JT LOW LT WO 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4666702 610 73720 RT MRI EXT NON JT LOW RT WWO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4666703 610 73720 LT MRI EXT NON JT LOW LT WWO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4673218 610 73218 RT MRI EXT NON JT UPPER RT WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4673220 610 73220 RT MRI EXT NON JT UPPER RT WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4673223 610 73223 RT MRI EXT JT UP RT WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4686653 610 70544 MRA HEAD WO CONTRAST 1 618.64 210.34 206.24 550.00 550.00 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4686655 610 C8902 MRA ABDOMEN W OR WO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4686659 610 70547 MRA NECK WO CON 1 618.64 210.34 206.24 550.00 550.00 317.05 449.13 433.05 482.54 463.98 412.48 494.91 433.05 206.24 463.98 350.61 329.98 4687179 610 70545 MRA HEAD W CONTRAST 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4687182 610 70548 MRA NECK W CONTRAST 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4687183 610 70549 MRA NECK WWO CONTRAST 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4693667 612 72142 MRI SPINE CERV W CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4693668 612 72147 MRI SPINE THOR W CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4693669 612 72149 MRI SPINE LUM W CONTR 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4693671 611 70552 MRI BRAIN W CONTRAST 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4695060 610 72195 MRI PELVIS HIPS WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4695062 611 70552 MRI IAC BILATERAL WCONT 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4695063 611 70551 MRI IAC BILATERAL WO CON 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4695064 611 70553 MRI IAC BILATERAL WWO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697702 611 70551 MRI BRAIN WO CONTRAST 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4697703 611 70553 MRI BRAIN WWO CONTRAST 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697704 610 71551 MRI CHEST WITH CONTRAST 1 " 1,922.58 " 653.68 550.00 " 1,538.06 " 550.00 985.32 " 1,395.79 " " 1,345.81 " " 1,499.61 " " 1,441.94 " " 1,281.88 " " 1,538.06 " " 1,345.81 " 640.94 " 1,441.94 " " 1,089.60 " " 1,025.50 " 4697705 610 71552 MRI CHEST WWO CONTRAST 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697706 612 72156 MRI SPINE CERV WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697707 612 72158 MRI SPINE LUM WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697710 610 72196 MRI PELVIS HIPS WITH CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697711 610 72197 MRI PELVIS HIPS WWO CON 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697720 610 74182 MRI ABDOMEN WITH CONTRAS 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697721 610 74183 MRI ABDOMEN WWO 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697725 610 70552 MRI PITUITARY W CONT 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4697730 610 70551 MRI PITUITARY WO CONT 1 820.70 279.04 206.24 656.56 550.00 420.61 595.83 574.49 640.15 615.53 412.48 656.56 574.49 206.24 615.53 350.61 329.98 4699780 610 70553 MRI PITUITARY WWO CONT 1 989.60 336.46 329.91 791.68 550.00 507.17 718.45 692.72 771.89 742.20 659.82 791.68 692.72 329.91 742.20 560.85 527.86 4801088 343 A9560 NMI TC99M LABELED RED BLOOD CELLS DOSE 1 475.00 161.50 112.08 380.00 112.08 243.44 344.85 332.50 370.50 356.25 185.25 380.00 332.50 356.25 4803017 341 78306 NM BONE SCAN WHOLE BODY 1 " 1,013.79 " 344.69 309.16 811.03 309.16 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4805738 341 78305 NM BONE SCAN MULT SPOTS 1 " 1,013.79 " 344.69 283.40 811.03 283.40 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4810808 344 A9517 NMI I-131 IODINE 100 MCI 1 62.07 21.10 20.12 49.66 42.84 31.81 45.06 43.45 48.41 46.55 40.24 49.66 43.45 20.12 46.55 34.20 32.19 4811253 341 78264 NM GASTRIC EMPTYING 1 " 1,013.79 " 344.69 337.97 811.03 407.61 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4812760 343 A9502 NMI MYOVIEW TETROFOSMIN REST STUDY DOSE 1 160.00 54.40 62.40 128.00 116.95 82.00 116.16 112.00 124.80 120.00 62.40 128.00 112.00 120.00 4812761 343 A9502 NMI TC99M TETROFOSMIN STRESS STUDY DOSE 1 160.00 54.40 62.40 128.00 116.95 82.00 116.16 112.00 124.80 120.00 62.40 128.00 112.00 120.00 4812805 636 J2805 NMI SINCALIDE SOLUTION STUDY DOSE 1 340.00 115.60 112.04 272.00 112.04 174.25 246.84 238.00 265.20 255.00 132.60 272.00 238.00 255.00 4819500 343 A9500 NMI TC99 SESTAMIBI PER STUDY DOSE 1 140.00 47.60 54.60 128.10 128.10 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 105.00 4819567 343 A9567 NMI TC99 PENTETATE AERSOL PER STUDY DOSE 1 520.00 176.80 3.40 416.00 3.40 266.50 377.52 364.00 405.60 390.00 202.80 416.00 364.00 390.00 4824044 343 A9516 NMI I 123 SODIUM IODINE 100 UCI 1 100.00 34.00 39.00 217.02 217.02 51.25 72.60 70.00 78.00 75.00 39.00 80.00 70.00 75.00 4826802 341 78803 NM LIVER SPL SPEC 1 " 3,510.68 " " 1,193.63 " 416.21 " 2,808.54 " 416.21 " 1,799.22 " " 2,548.75 " " 2,457.48 " " 2,738.33 " " 2,633.01 " " 2,340.76 " " 2,808.54 " " 2,457.48 " " 1,170.38 " " 2,633.01 " " 1,989.65 " " 1,872.61 " 4827183 341 78452 NM MYO SPECT REST STRESS 1 " 3,510.68 " " 1,193.63 " 578.95 " 2,808.54 " 578.95 " 1,799.22 " " 2,548.75 " " 2,457.48 " " 2,738.33 " " 2,633.01 " " 2,340.76 " " 2,808.54 " " 2,457.48 " " 1,170.38 " " 2,633.01 " " 1,989.65 " " 1,872.61 " 4828764 341 78278 NM GI BLEEDING SCAN 1 " 1,013.79 " 344.69 337.97 811.03 426.42 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4829131 343 A9541 NMI TC99M SULFUR COLLOID DIAG STUDY DOSE 1 305.00 103.70 64.17 244.00 64.17 156.31 221.43 213.50 237.90 228.75 118.95 244.00 213.50 228.75 4829442 343 A9540 NMI TC99M MACRO ALBUMIN STUDY DOSE 1 575.00 195.50 36.00 460.00 36.00 294.69 417.45 402.50 448.50 431.25 224.25 460.00 402.50 431.25 4835756 341 78803 NM BONE SPECT IMAG 1 " 3,510.68 " " 1,193.63 " 416.21 " 2,808.54 " 416.21 " 1,799.22 " " 2,548.75 " " 2,457.48 " " 2,738.33 " " 2,633.01 " " 2,340.76 " " 2,808.54 " " 2,457.48 " " 1,170.38 " " 2,633.01 " " 1,989.65 " " 1,872.61 " 4851884 341 78315 NM BONE SCAN 3 PHASE 1 " 1,013.79 " 344.69 337.97 811.03 424.10 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4861731 341 78215 NM LIVER AND SPLEEN SCAN STATIC 1 " 1,013.79 " 344.69 237.56 811.03 237.56 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4861742 341 78070 NM PARATHYROID SCAN 1 " 1,013.79 " 344.69 337.97 811.03 365.67 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4861745 341 78185 NM SPLEEN SCAN 1 " 1,013.79 " 344.69 257.58 811.03 257.58 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4861886 341 78451 NM MYO SPECT STRESS ONLY 1 " 3,510.68 " " 1,193.63 " 419.12 " 2,808.54 " 419.12 " 1,799.22 " " 2,548.75 " " 2,457.48 " " 2,738.33 " " 2,633.01 " " 2,340.76 " " 2,808.54 " " 2,457.48 " " 1,170.38 " " 2,633.01 " " 1,989.65 " " 1,872.61 " 4861888 341 78451 NM MYO SPECT REST ONLY 1 " 3,510.68 " " 1,193.63 " 419.12 " 2,808.54 " 419.12 " 1,799.22 " " 2,548.75 " " 2,457.48 " " 2,738.33 " " 2,633.01 " " 2,340.76 " " 2,808.54 " " 2,457.48 " " 1,170.38 " " 2,633.01 " " 1,989.65 " " 1,872.61 " 4864643 343 A9512 NMI TC99 PERTECHNETATE MCI 1 1.10 0.37 0.43 34.00 34.00 0.56 0.80 0.77 0.86 0.83 0.43 0.88 0.77 0.83 4871616 341 78708 NM RENAL SCAN WITH 1 " 1,315.62 " 447.31 216.75 " 1,052.50 " 216.75 674.26 955.14 920.93 " 1,026.18 " 986.72 877.20 " 1,052.50 " 920.93 438.60 986.72 745.62 701.76 4871620 341 78709 NM RENAL SCAN WWO 1 " 1,315.62 " 447.31 438.60 " 1,052.50 " 446.26 674.26 955.14 920.93 " 1,026.18 " 986.72 877.20 " 1,052.50 " 920.93 438.60 986.72 745.62 701.76 4871625 341 78707 NM RENAL SCAN WO 1 " 1,315.62 " 447.31 285.74 " 1,052.50 " 285.74 674.26 955.14 920.93 " 1,026.18 " 986.72 877.20 " 1,052.50 " 920.93 438.60 986.72 745.62 701.76 4875120 341 78472 NM MUGA 1 " 1,013.79 " 344.69 282.13 811.03 282.13 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4878014 341 78014 NM THYROID UPTAKE AND SCAN 1 " 1,013.79 " 344.69 294.17 811.03 294.17 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4878226 341 78226 NM HEPATO BIL GB WO CCK 1 " 1,013.79 " 344.69 337.97 811.03 404.31 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4878227 341 78227 NM HEPATO BIL GB WITH CCK 1 " 1,315.62 " 447.31 438.60 " 1,052.50 " 440.81 674.26 955.14 920.93 " 1,026.18 " 986.72 877.20 " 1,052.50 " 920.93 438.60 986.72 745.62 701.76 4878580 341 78580 NM LUNG SCAN PERFUSION ONLY 1 " 1,013.79 " 344.69 293.10 811.03 293.10 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4878582 341 78582 NM LUNG SCAN VENTILATION AND PERFUSION 1 " 1,315.62 " 447.31 410.47 " 1,052.50 " 410.47 674.26 955.14 920.93 " 1,026.18 " 986.72 877.20 " 1,052.50 " 920.93 438.60 986.72 745.62 701.76 4878803 341 78803 NM HEMANGIOMA LIVER SPL SPEC 1 " 3,510.68 " " 1,193.63 " 416.21 " 2,808.54 " 416.21 " 1,799.22 " " 2,548.75 " " 2,457.48 " " 2,738.33 " " 2,633.01 " " 2,340.76 " " 2,808.54 " " 2,457.48 " " 1,170.38 " " 2,633.01 " " 1,989.65 " " 1,872.61 " 4880863 341 78472 NM MUGA CARD BLD POOL 1 " 1,013.79 " 344.69 282.13 811.03 282.13 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4887050 341 78300 NM/BONE SCAN SINGLE SPOT 1 " 1,013.79 " 344.69 221.87 811.03 221.87 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4888891 341 78299 NM/GASTRIC DELAY SCAN 1 " 1,013.79 " 344.69 337.97 811.03 608.27 519.57 736.01 709.65 790.76 760.34 675.94 811.03 709.65 337.97 760.34 574.55 540.75 4889215 343 A9505 NMI THALIUM 201 MCI 1 39.60 13.46 15.44 182.89 182.89 20.30 28.75 27.72 30.89 29.70 15.44 31.68 27.72 29.70 4889216 343 A9503 NMI TC99M MEDRONATE DIAG STUDY DOSE 1 155.00 52.70 15.60 124.00 15.60 79.44 112.53 108.50 120.90 116.25 60.45 124.00 108.50 116.25 4891610 343 A9537 NMI TC99M MEBROFENIN HIDA STUDY DOSE 1 110.00 37.40 42.90 88.00 66.38 56.38 79.86 77.00 85.80 82.50 42.90 88.00 77.00 82.50 4895349 344 A9517 NMI I 131 IODINE CAP FIRST 1 62.07 21.10 20.12 49.66 42.84 31.81 45.06 43.45 48.41 46.55 40.24 49.66 43.45 20.12 46.55 34.20 32.19 4897477 343 A9562 NMI TC99M MERTIATIDE STUDY DOSE 1 " 1,025.00 " 348.50 399.75 929.73 929.73 525.31 744.15 717.50 799.50 768.75 399.75 820.00 717.50 768.75 4897480 343 A9569 NMI TC99M CERETEC 1 " 3,404.00 " " 1,157.36 " " 1,327.56 " " 2,723.20 " " 1,747.16 " " 1,744.55 " " 2,471.30 " " 2,382.80 " " 2,655.12 " " 2,553.00 " " 1,327.56 " " 2,723.20 " " 2,382.80 " " 2,553.00 " 5003005 730 93005 76 EKG 12 LEAD SUBQ 1 149.63 50.87 10.83 119.70 10.83 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 5003242 731 93242 RHC HOLTER MON >48 HRS - 7D CON INIT REC 1 90.97 30.93 30.33 72.78 54.58 46.62 66.04 63.68 70.96 68.23 60.66 72.78 63.68 30.33 68.23 51.56 48.53 5003246 731 93246 RHC HOLTER MON >7D-15D CONNECT INIT REC 1 149.64 50.88 49.88 119.71 89.78 76.69 108.64 104.75 116.72 112.23 99.76 119.71 104.75 49.88 112.23 84.80 79.81 5058340 730 93005 EKG 12 LEAD 1 149.63 50.87 10.83 119.70 10.83 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 5061986 482 93017 STRESS TEST ECG 1 710.91 241.71 49.51 568.73 49.51 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 5093005 730 93005 DC EKG - 12 LEAD 1 149.63 50.87 10.83 119.70 10.83 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 5093242 731 93242 HOLTER MON >48 HRS - 7D CONNECT INIT REC 1 90.97 30.93 30.33 72.78 54.58 46.62 66.04 63.68 70.96 68.23 60.66 72.78 63.68 30.33 68.23 51.56 48.53 5093246 731 93246 HOLTER MON >7D - 15D CONNECT INIT REC 1 149.64 50.88 49.88 119.71 89.78 76.69 108.64 104.75 116.72 112.23 99.76 119.71 104.75 49.88 112.23 84.80 79.81 5205782 740 95782 52 POLYSOMNOGRAM AGE < 6 YRS < 6 HRS REC 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " " 1,310.52 " " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5205783 740 95783 52 POLYSOMNOGRAM/CPAP < 6 YRS < 6 HRS REC 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " " 1,373.75 " " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5205811 740 95811 POLYSOMNOGRAM SPLIT N 6 YR UP 6 HRS OR > 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " 842.11 " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5213326 740 95811 POLYSOMNOGRAM/CPAP 6 YR UP 6 HRS OR >REC 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " 842.11 " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5213327 740 95805 MULTIPLE SLEEP LAT/MAINT 1 " 1,311.27 " 445.83 437.15 " 1,049.02 " 546.25 672.03 951.98 917.89 " 1,022.79 " 983.45 874.30 " 1,049.02 " 917.89 437.15 983.45 743.16 699.44 5215783 740 95783 POLYSOMNOGRAM SPLIT N < 6 YRS 6 HRS OR > 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " " 1,373.75 " " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5215811 740 95811 52 POLYSOMNOGRAM SPLIT N 6 YR UP < 6 HR 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " 842.11 " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5225783 740 95783 52 POLYSOMNOGRAM SPLIT N < 6 YRS < 6 HR 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " " 1,373.75 " " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5230444 740 95810 POLYSOMNOGRAM AGE 6 YRS UP 6 HRS OR >REC 1 " 2,472.70 " 840.72 801.21 " 1,978.16 " 801.21 " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5291384 740 95819 EEG AWAKE AND ASLEEP 1 710.91 241.71 237.00 568.73 528.36 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 5295782 740 95782 POLYSOMNOGRAM AGE < 6 YRS 6 HRS OR >REC 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " " 1,310.52 " " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5295783 740 95783 POLYSOMNOGRAM/CPAP < 6 YRS 6 HRS OR >REC 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " " 1,373.75 " " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5295810 740 95810 52 POLYSOMNOGRAM AGE 6 YRS UP < 6 HRS REC 1 " 2,472.70 " 840.72 801.21 " 1,978.16 " 801.21 " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 5295811 740 95811 52 POLYSOMNOGRAM/CPAP 6 YR UP < 6 HRS REC 1 " 2,472.70 " 840.72 824.34 " 1,978.16 " 842.11 " 1,267.26 " " 1,795.18 " " 1,730.89 " " 1,928.71 " " 1,854.53 " " 1,648.68 " " 1,978.16 " " 1,730.89 " 824.34 " 1,854.53 " " 1,401.38 " " 1,318.94 " 6003688 410 94640 IPPB TX INITIAL DAILY 1 505.07 171.72 23.28 404.06 23.28 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6003789 460 94060 PFT INCLUDE PRE & POST 1 710.91 241.71 78.32 568.73 78.32 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 6004375 460 94375 PFT FLOW VOL LOOP PRE /POST 1 710.91 241.71 51.43 568.73 51.43 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 6008120 410 94644 NEBULIZER CONT MED INITI DAILY 1 300.95 102.32 55.29 240.76 55.29 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 6029910 410 94660 CPAP INIT & MNGT 1 505.07 171.72 168.38 404.06 303.04 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6029911 410 94660 CPAP PER HOUR 1 505.07 171.72 168.38 404.06 303.04 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6035357 410 94640 MDI TX INITIAL DAILY 1 505.07 171.72 23.28 404.06 23.28 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6054502 410 94640 76 IPPB TX SUBSQ 1 505.07 171.72 23.28 404.06 23.28 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6054505 410 94640 76 HHN SUBSQ 1 505.07 171.72 23.28 404.06 23.28 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6056136 410 94640 SPUTUM COLLECTION 1 505.07 171.72 23.28 404.06 23.28 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6056164 361 36600 ARTERIAL PUNCTURE 1 300.95 102.32 100.33 240.76 180.57 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 6060891 410 94640 HHN INITIAL DAILY 1 505.07 171.72 23.28 404.06 23.28 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6064490 410 94002 VENTILATOR MGNT INIT DAY 1 " 1,304.50 " 443.53 131.20 " 1,043.60 " 131.20 668.56 947.07 913.15 " 1,017.51 " 978.38 869.78 " 1,043.60 " 913.15 434.89 978.38 739.31 695.82 6064760 410 94003 VENTILATOR MGNT SUBQ DAY 1 " 1,304.50 " 443.53 93.99 " 1,043.60 " 93.99 668.56 947.07 913.15 " 1,017.51 " 978.38 869.78 " 1,043.60 " 913.15 434.89 978.38 739.31 695.82 6065339 301 82803 ABG 1 78.21 26.59 8.53 62.57 8.53 40.08 56.78 54.75 61.00 58.66 52.14 62.57 54.75 26.07 58.66 44.32 41.71 6071427 480 92950 CPR 1 710.91 241.71 237.00 568.73 426.55 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 6072598 410 94668 CPT SUBSQ 1 300.95 102.32 36.78 240.76 36.78 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 6080136 460 94760 PULSE OX SINGLE 1 48.00 16.32 4.16 38.40 4.16 24.60 34.85 33.60 37.44 36.00 18.72 38.40 33.60 36.00 6080138 460 94762 PULSE OX CONTINUOUS 1 375.14 127.55 30.84 300.11 30.84 192.26 272.35 262.60 292.61 281.36 250.12 300.11 262.60 125.06 281.36 212.60 200.10 6080969 361 31500 INTUBATION ENDOTRACHEAL 1 568.83 193.40 189.64 497.00 497.00 291.53 412.97 398.18 443.69 426.62 379.28 455.06 398.18 189.64 426.62 322.39 303.42 6082785 460 94010 PFT BASIC 1 375.14 127.55 46.63 300.11 46.63 192.26 272.35 262.60 292.61 281.36 250.12 300.11 262.60 125.06 281.36 212.60 200.10 6082800 301 82800 VENOUS BLOOD GAS PH ONLY 1 33.00 11.22 11.00 26.40 13.84 16.91 23.96 23.10 25.74 24.75 22.00 26.40 23.10 11.00 24.75 18.70 17.60 6085271 410 94667 CPT INITIAL DEMO AND OR EVAL 1 300.95 102.32 33.22 240.76 33.22 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 6094375 460 94375 PFT FLOW VOL LOOP 1 710.91 241.71 51.43 568.73 51.43 364.34 516.12 497.64 554.51 533.18 474.00 568.73 497.64 237.00 533.18 402.90 379.20 6094640 410 94640 76 MDI TX INITIAL SUBSQ 1 505.07 171.72 23.28 404.06 23.28 258.85 366.68 353.55 393.95 378.80 336.76 404.06 353.55 168.38 378.80 286.25 269.41 6111056 761 11056 WCC PAIRING OR CUTTING 2-4 BENIGN LESION 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6116020 761 16020 WCC DRESSING OR DEBRID BURNS < 5% BODY 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6197597 761 97597 WCC DEBRIDE SELECTIVE 1ST 20 CM 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6220296 440 92526 GN SPCH SWALLOWING TX 1 224.24 76.24 84.68 179.39 116.43 114.92 162.80 156.97 174.91 168.18 169.36 179.39 156.97 84.68 168.18 143.96 135.49 6250850 444 92611 GN SPCH FLUOROSCOPIC EVAL 1 245.43 83.45 92.31 196.34 118.40 125.78 178.18 171.80 191.44 184.07 184.62 196.34 171.80 92.31 184.07 156.93 147.70 6261321 750 92610 GN SPCH SWALLOWING EVAL 1 227.27 77.27 84.58 181.82 136.36 116.48 165.00 159.09 177.27 170.45 169.16 181.82 159.09 84.58 170.45 143.79 135.33 6288105 440 92507 GN SPCH LANG TX 1 202.69 68.91 76.65 162.15 76.65 103.88 147.15 141.88 158.10 152.02 153.62 162.15 141.88 76.81 152.02 130.58 122.90 6292521 444 92521 GN SPCH EVALUATION OF SPEECH FLUENCY 1 355.13 120.74 107.39 284.10 107.39 182.00 257.82 248.59 277.00 266.35 268.78 284.10 248.59 134.39 266.35 228.46 215.02 6292522 444 92522 GN SPCH EVAL SPEECH SOUND PRODUCTION 1 301.01 102.34 89.76 240.81 89.76 154.27 218.53 210.71 234.79 225.76 226.16 240.81 210.71 113.08 225.76 192.24 180.93 6292523 444 92523 GN SPCH EVAL SOUND PROD W EVAL LANG COMP 1 608.80 206.99 187.34 487.04 187.34 312.01 441.99 426.16 474.86 456.60 461.88 487.04 426.16 230.94 456.60 392.60 369.50 6292524 444 92524 GN SPCH EVAL BEHAVIOR QUAL ANAL VOICE RESON 1 293.80 99.89 87.21 235.04 87.21 150.57 213.30 205.66 229.16 220.35 221.22 235.04 205.66 110.61 220.35 188.04 176.98 6292610 444 92610 GN SPCH SWALLOWING EVAL 1 227.27 77.27 84.58 181.82 136.36 116.48 165.00 159.09 177.27 170.45 169.16 181.82 159.09 84.58 170.45 143.79 135.33 6296105 444 96105 SPCH EVAL ASSESSMENT OF ASPHASIA 1 268.56 91.31 100.68 214.85 145.91 137.64 194.97 187.99 209.48 201.42 201.36 214.85 187.99 100.68 201.42 171.16 161.09 6297129 440 97129 GN SPCH COGNITIVE LIGUISTICS SKILL INIT15MI 1 62.08 21.11 23.36 49.66 37.25 31.82 45.07 43.46 48.42 46.56 46.72 49.66 43.46 23.36 46.56 39.71 37.38 6297130 440 97130 GN SPCH COGNITIVE LIGUISTICS SKILL ADDT15MI 1 59.36 20.18 22.67 47.49 35.62 30.42 43.10 41.55 46.30 44.52 45.34 47.49 41.55 22.67 44.52 38.54 36.27 6400283 420 G0283 GP PTA ES NONWOUND UNATT MEDICARE 1 34.23 11.64 12.96 27.38 13.23 17.54 24.85 23.96 26.70 25.67 25.92 27.38 23.96 12.96 25.67 22.03 20.74 6402829 420 97018 GP PT PARAFFIN 1 15.37 5.23 5.86 12.30 10.20 7.88 11.16 10.76 11.99 11.53 11.72 12.30 10.76 5.86 11.53 9.96 9.38 6402841 420 97039 GP PT ICE MASSAGE 15 MIN(1-1) 1 41.20 14.01 11.02 32.96 11.02 21.12 29.91 28.84 32.14 30.90 16.07 32.96 28.84 30.90 6402954 420 97022 GP PT W/P STERILE 1 46.02 15.65 17.46 36.82 21.76 23.59 33.41 32.21 35.90 34.52 34.92 36.82 32.21 17.46 34.52 29.68 27.94 6402981 420 97033 GP PT IONTOPHORESIS 15 MIN(1-1) 1 53.59 18.22 19.96 42.87 24.67 27.46 38.91 37.51 41.80 40.19 39.92 42.87 37.51 19.96 40.19 33.93 31.94 6403671 274 L3671 PTL SHOULDER ORTHOSIS 1 970.00 329.80 378.30 776.00 550.16 497.13 704.22 679.00 756.60 727.50 378.30 776.00 679.00 727.50 6403702 274 L3702 PTL ELBOW ORTHOSIS STATIC 1 310.00 105.40 120.90 248.00 176.32 158.88 225.06 217.00 241.80 232.50 120.90 248.00 217.00 232.50 6403720 274 L3720 PTL ELBOW ORTHOSIS DBL UPRIGHT DYNAMIC 1 792.00 269.28 308.88 633.60 463.27 405.90 574.99 554.40 617.76 594.00 308.88 633.60 554.40 594.00 6403763 274 L3763 PTL ELBOW/WRIST/HAND ORTHOSIS STATIC 1 792.00 269.28 308.88 633.60 427.47 405.90 574.99 554.40 617.76 594.00 308.88 633.60 554.40 594.00 6403808 274 L3808 PTL THUMB SPICA 1 401.00 136.34 156.39 320.80 204.04 205.51 291.13 280.70 312.78 300.75 156.39 320.80 280.70 300.75 6403900 274 L3900 PTL WRIST/HAND/FINGER DYNAMIC (CUSTOM) 1 " 1,567.00 " 532.78 611.13 " 1,253.60 " 798.13 803.09 " 1,137.64 " " 1,096.90 " " 1,222.26 " " 1,175.25 " 611.13 " 1,253.60 " " 1,096.90 " " 1,175.25 " 6403906 274 L3906 PTL WRIST COCK UP SPLINT 1 478.00 162.52 186.42 382.40 241.27 244.98 347.03 334.60 372.84 358.50 186.42 382.40 334.60 358.50 6403913 274 L3913 PTL HAND/FINGER SPLINT (CUSTOM) STATIC 1 291.00 98.94 113.49 232.80 165.37 149.14 211.27 203.70 226.98 218.25 113.49 232.80 203.70 218.25 6403923 274 L3923 PTL HAND/FINGER SPLINT (PRE-FAB) 1 105.00 35.70 40.95 84.00 53.12 53.81 76.23 73.50 81.90 78.75 40.95 84.00 73.50 78.75 6403933 274 L3933 PTL FINGER SPLINT STATIC 1 229.00 77.86 89.31 183.20 130.28 117.36 166.25 160.30 178.62 171.75 89.31 183.20 160.30 171.75 6403961 274 L3961 PTL SHOULDER/ELBOW/WR/HAND ORTHO STATIC 1 " 1,808.00 " 614.72 705.12 " 1,446.40 " " 1,025.82 " 926.60 " 1,312.61 " " 1,265.60 " " 1,410.24 " " 1,356.00 " 705.12 " 1,446.40 " " 1,265.60 " " 1,356.00 " 6404543 420 97112 GP PT NEURO RE-ED 15 MIN(1-1) 1 90.90 30.91 32.22 72.72 32.22 46.59 65.99 63.63 70.90 68.18 68.72 72.72 63.63 34.36 68.18 58.41 54.98 6407530 420 97530 GP PTA THERAPEUTIC ACTIVITIES 15 MIN(1-1) 1 100.55 34.19 33.02 80.44 33.02 51.53 73.00 70.39 78.43 75.41 76.18 80.44 70.39 38.09 75.41 64.75 60.94 6413156 420 97116 GP PT GAIT TRAINING 15 MIN(1-1) 1 78.59 26.72 27.14 62.87 27.14 40.28 57.06 55.01 61.30 58.94 59.42 62.87 55.01 29.71 58.94 50.51 47.54 6417110 420 97110 GP 95 PTT THER EX 15 MIN(1-1) TELEVIST THERAPI 1 78.59 26.72 29.71 62.87 30.95 40.28 57.06 55.01 61.30 58.94 59.42 62.87 55.01 29.71 58.94 50.51 47.54 6417680 420 97140 GP PT MANUAL THERAPY 15 MIN(1-1) 1 72.48 24.64 27.39 57.98 28.53 37.15 52.62 50.74 56.53 54.36 54.78 57.98 50.74 27.39 54.36 46.56 43.82 6427010 420 97010 GP PTA ICE PACK NON-MEDICARE 1 16.22 5.51 5.76 12.98 5.76 8.31 11.78 11.35 12.65 12.17 12.36 12.98 11.35 6.18 12.17 10.51 9.89 6429105 420 29105 GP PTM APPLICATION SPLINT SHOULDER TO HAND 1 379.53 129.04 126.53 303.62 227.72 194.51 275.54 265.67 296.03 284.65 253.06 303.62 265.67 126.53 284.65 215.10 202.45 6429125 420 29125 GP PTM APPLICATION FOREARM TO HAND STATIC 1 300.95 102.32 100.33 240.76 180.57 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 6429126 420 29126 GP PTM APPLICATION FOREARM TO HAND DYNAMIC 1 300.95 102.32 100.33 240.76 180.57 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 6429130 420 29130 GP PTM APPLICATION OF FINGER SPLINT STATIC 1 300.95 102.32 100.33 240.76 180.57 154.24 218.49 210.67 234.74 225.71 200.66 240.76 210.67 100.33 225.71 170.56 160.53 6429131 420 29131 GP PTM APPLICATION OF FINGER SPLINT DYNAMIC 1 149.63 50.87 49.88 119.70 89.78 76.69 108.63 104.74 116.71 112.22 99.76 119.70 104.74 49.88 112.22 84.80 79.81 6432194 420 97597 GP PT REM-DEV TISSUE LESS THAN 20 CM 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6432195 420 97598 GP PT REM-DEV TISSUE GREATER THAN 20 CM 1 90.00 30.60 35.10 497.00 497.00 46.13 65.34 63.00 70.20 67.50 35.10 72.00 63.00 67.50 6438818 424 97164 GP PTE RE-EVAL ESTABLISHED PLAN 1 179.75 61.12 53.17 143.80 53.17 92.12 130.50 125.83 140.21 134.81 135.96 143.80 125.83 67.98 134.81 115.57 108.77 6470628 420 97602 GP PT NON-SELECT DEB 1 482.67 164.11 48.75 386.14 48.75 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6470635 420 97605 GP PT NEG PRESS WOUND TX < 50 CM 1 482.67 164.11 160.91 386.14 289.60 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6470640 420 97606 GP PT NEG PRESS WOUND TX > 50 CM 1 929.70 316.10 309.94 743.76 557.82 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 697.28 526.90 495.90 6471440 420 97034 GP PT CONTRAST BATH 15 MIN(1-1) 1 39.59 13.46 14.65 31.67 17.16 20.29 28.74 27.71 30.88 29.69 29.30 31.67 27.71 14.65 29.69 24.91 23.44 6471511 420 97124 GP PT MASSAGE 15 MIN(1-1) 1 75.59 25.70 25.03 60.47 25.03 38.74 54.88 52.91 58.96 56.69 57.20 60.47 52.91 28.60 56.69 48.62 45.76 6471526 420 97035 GP PT ULTRASOUND 15 MIN(1-1) 1 37.89 12.88 12.40 30.31 12.40 19.42 27.51 26.52 29.55 28.42 28.66 30.31 26.52 14.33 28.42 24.36 22.93 6474450 420 97110 GP PT THER EX 15 MIN(1-1) 1 78.59 26.72 29.71 62.87 30.95 40.28 57.06 55.01 61.30 58.94 59.42 62.87 55.01 29.71 58.94 50.51 47.54 6482666 420 97012 GP PT MECH TX 1 39.09 13.29 14.76 31.27 15.42 20.03 28.38 27.36 30.49 29.32 29.52 31.27 27.36 14.76 29.32 25.09 23.62 6497010 420 97010 GP PTA HYDRO PACK NON-MEDICARE 1 16.22 5.51 5.76 12.98 5.76 8.31 11.78 11.35 12.65 12.17 12.36 12.98 11.35 6.18 12.17 10.51 9.89 6497012 420 97012 GP PTA MECH TX 1 39.09 13.29 14.76 31.27 15.42 20.03 28.38 27.36 30.49 29.32 29.52 31.27 27.36 14.76 29.32 25.09 23.62 6497014 420 97014 GP PTA E-STIM UNATTEND NON-MEDICARE 1 78.00 26.52 15.13 62.40 15.13 39.98 56.63 54.60 60.84 58.50 30.42 62.40 54.60 58.50 6497018 420 97018 GP PTA PARAFFIN 1 15.37 5.23 5.86 12.30 10.20 7.88 11.16 10.76 11.99 11.53 11.72 12.30 10.76 5.86 11.53 9.96 9.38 6497022 420 97022 GP PTA W/P STERILE 1 46.02 15.65 17.46 36.82 21.76 23.59 33.41 32.21 35.90 34.52 34.92 36.82 32.21 17.46 34.52 29.68 27.94 6497032 420 97032 GP PTA E-STIM 15 MIN(1-1) 1 39.09 13.29 14.76 31.27 18.27 20.03 28.38 27.36 30.49 29.32 29.52 31.27 27.36 14.76 29.32 25.09 23.62 6497033 420 97033 GP PTA IONTOPHORESIS 15 MIN(1-1) 1 53.59 18.22 19.96 42.87 24.67 27.46 38.91 37.51 41.80 40.19 39.92 42.87 37.51 19.96 40.19 33.93 31.94 6497034 420 97034 GP PTA CONTRAST BATH 15 MIN(1-1) 1 39.59 13.46 14.65 31.67 17.16 20.29 28.74 27.71 30.88 29.69 29.30 31.67 27.71 14.65 29.69 24.91 23.44 6497035 420 97035 GP PTA ULTRASOUND 15 MIN(1-1) 1 37.89 12.88 12.40 30.31 12.40 19.42 27.51 26.52 29.55 28.42 28.66 30.31 26.52 14.33 28.42 24.36 22.93 6497039 420 97039 GP PTA ICE MASSAGE 15 MIN(1-1) 1 41.20 14.01 11.02 32.96 11.02 21.12 29.91 28.84 32.14 30.90 16.07 32.96 28.84 30.90 6497110 420 97110 GP PTA THER EX 15 MIN(1-1) 1 78.59 26.72 29.71 62.87 30.95 40.28 57.06 55.01 61.30 58.94 59.42 62.87 55.01 29.71 58.94 50.51 47.54 6497112 420 97112 GP PTA NEURO RE-ED 15 MIN(1-1) 1 90.90 30.91 32.22 72.72 32.22 46.59 65.99 63.63 70.90 68.18 68.72 72.72 63.63 34.36 68.18 58.41 54.98 6497116 420 97116 GP PTA GAIT TRAINING 15 MIN(1-1) 1 78.59 26.72 27.14 62.87 27.14 40.28 57.06 55.01 61.30 58.94 59.42 62.87 55.01 29.71 58.94 50.51 47.54 6497124 420 97124 GP PTA MASSAGE 15 MIN(1-1) 1 75.59 25.70 25.03 60.47 25.03 38.74 54.88 52.91 58.96 56.69 57.20 60.47 52.91 28.60 56.69 48.62 45.76 6497140 420 97140 GP PTA MANUAL THERAPY 15 MIN(1-1) 1 72.48 24.64 27.39 57.98 28.53 37.15 52.62 50.74 56.53 54.36 54.78 57.98 50.74 27.39 54.36 46.56 43.82 6497161 424 97161 GP PTE EVALUATION LOW COMPLEXITY 1 266.70 90.68 79.21 213.36 79.21 136.68 193.62 186.69 208.03 200.03 198.84 213.36 186.69 99.42 200.03 169.01 159.07 6497162 424 97162 GP PTE EVALUATION MODERATE 1 265.85 90.39 79.21 212.68 79.21 136.25 193.01 186.10 207.36 199.39 198.84 212.68 186.10 99.42 199.39 169.01 159.07 6497163 424 97163 GP PTE EVALUATION HIGH COMPLEXITY 1 265.85 90.39 79.21 212.68 79.21 136.25 193.01 186.10 207.36 199.39 198.84 212.68 186.10 99.42 199.39 169.01 159.07 6497530 420 97530 GP PT THERAPEUTIC ACTIVITIES 15 MIN(1-1) 1 100.55 34.19 33.02 80.44 33.02 51.53 73.00 70.39 78.43 75.41 76.18 80.44 70.39 38.09 75.41 64.75 60.94 6497542 420 97542 GP PTA WHEELCHAIR MGMT 15 MIN 1 84.79 28.83 29.68 67.83 29.68 43.45 61.56 59.35 66.14 63.59 64.10 67.83 59.35 32.05 63.59 54.49 51.28 6497602 420 97602 GP PTA NON-SELECT DEB 1 482.67 164.11 48.75 386.14 48.75 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6497605 420 97605 GP PTA NEG PRESS WOUND TX < 50 CM 1 482.67 164.11 160.91 386.14 289.60 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 362.00 273.55 257.46 6497606 420 97606 GP PTA NEG PRESS WOUND TX > 50 CM 1 929.70 316.10 309.94 743.76 557.82 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 697.28 526.90 495.90 6497760 420 97760 GP PTA ORTHOTIC FIT & TRAIN 15 MIN 1 128.21 43.59 36.03 102.57 36.03 65.71 93.08 89.75 100.00 96.16 96.54 102.57 89.75 48.27 96.16 82.06 77.23 6497761 420 97761 GP PTA PROS TRAIN INITIAL UP/LOW EXTR 15 MI 1 108.71 36.96 31.58 86.97 31.58 55.71 78.92 76.10 84.79 81.53 82.32 86.97 76.10 41.16 81.53 69.97 65.86 6497763 420 97763 GP PTA PROS TRAIN SUBSQ ORTH/PROS USE 15 MI 1 140.75 47.86 52.75 112.60 64.29 72.13 102.18 98.53 109.79 105.56 105.50 112.60 98.53 52.75 105.56 89.68 84.40 6498020 420 G0283 GP PT ES NONWOUND UNATT MEDICARE 1 34.23 11.64 12.96 27.38 13.23 17.54 24.85 23.96 26.70 25.67 25.92 27.38 23.96 12.96 25.67 22.03 20.74 6499923 420 97760 GP PT ORTHOTIC FIT & TRAIN 15 MIN 1 128.21 43.59 36.03 102.57 36.03 65.71 93.08 89.75 100.00 96.16 96.54 102.57 89.75 48.27 96.16 82.06 77.23 6499924 420 97761 GP PT PROS TRAIN INITIAL UP/LOW EXTR 15 MIN 1 108.71 36.96 31.58 86.97 31.58 55.71 78.92 76.10 84.79 81.53 82.32 86.97 76.10 41.16 81.53 69.97 65.86 6499925 420 97763 GP "PT PROS TRAIN SUBSQ ORTH/PROS USE,15 MIN" 1 140.75 47.86 52.75 112.60 64.29 72.13 102.18 98.53 109.79 105.56 105.50 112.60 98.53 52.75 105.56 89.68 84.40 6499926 420 97014 GP PT E-STIM UNATTEND NON-MEDICARE 1 78.00 26.52 15.13 62.40 15.13 39.98 56.63 54.60 60.84 58.50 30.42 62.40 54.60 58.50 6499927 420 97542 GP PT WHEELCHAIR MGMT 15 MIN 1 84.79 28.83 29.68 67.83 29.68 43.45 61.56 59.35 66.14 63.59 64.10 67.83 59.35 32.05 63.59 54.49 51.28 6499928 420 97032 GP PT E-STIM 15 MIN(1-1) 1 39.09 13.29 14.76 31.27 18.27 20.03 28.38 27.36 30.49 29.32 29.52 31.27 27.36 14.76 29.32 25.09 23.62 6499929 420 97010 GP PT ICE PACK NON-MEDICARE 1 16.22 5.51 5.76 12.98 5.76 8.31 11.78 11.35 12.65 12.17 12.36 12.98 11.35 6.18 12.17 10.51 9.89 6499930 420 97010 GP PT HYDRO PACK NON-MEDICARE 1 16.22 5.51 5.76 12.98 5.76 8.31 11.78 11.35 12.65 12.17 12.36 12.98 11.35 6.18 12.17 10.51 9.89 7300108 942 G0108 DIAB OP SELF MGMT TRAIN INDIV PER 30 MIN 1 147.43 50.13 36.07 117.94 36.07 75.56 107.03 103.20 115.00 110.57 110.84 117.94 103.20 55.42 110.57 94.21 88.67 7300109 942 G0109 DIAB OP SELF MGMT TRAIN GRP 2 OR > 30 MI 1 40.79 13.87 9.68 32.63 9.68 20.90 29.61 28.55 31.82 30.59 30.80 32.63 28.55 15.40 30.59 26.18 24.64 732551 361 32551 ICU THORACOSTOMY - INSERT CHEST TUBE 1 " 3,780.04 " " 1,285.21 " 666.00 " 3,024.03 " 666.00 " 1,937.27 " " 2,744.31 " " 2,646.03 " " 2,948.43 " " 2,835.03 " " 2,520.36 " " 3,024.03 " " 2,646.03 " " 1,260.18 " " 2,835.03 " " 2,142.31 " " 2,016.29 " 732554 361 32554 ICU THORACENTESIS WO IMAGING 1 " 1,456.00 " 495.04 485.40 " 1,164.80 " 497.00 746.20 " 1,057.06 " " 1,019.20 " " 1,135.68 " " 1,092.00 " 970.80 " 1,164.80 " " 1,019.20 " 485.40 " 1,092.00 " 825.18 776.64 736556 361 36556 ICU INSERT NON TUNNEL CV CATH 1 " 7,692.83 " " 2,615.56 " 497.00 " 6,154.26 " 497.00 " 3,942.58 " " 5,584.99 " " 5,384.98 " " 6,000.41 " " 5,769.62 " " 5,129.24 " " 6,154.26 " " 5,384.98 " " 2,564.62 " " 5,769.62 " " 4,359.85 " " 4,103.39 " 736558 361 36558 ICU INSERT TUNNELED CV CATH 1 " 7,692.83 " " 2,615.56 " 666.00 " 6,154.26 " 666.00 " 3,942.58 " " 5,584.99 " " 5,384.98 " " 6,000.41 " " 5,769.62 " " 5,129.24 " " 6,154.26 " " 5,384.98 " " 2,564.62 " " 5,769.62 " " 4,359.85 " " 4,103.39 " 7397802 942 97802 MEDICAL NUTRITION THERAPY INITIAL ASSES 1 96.25 32.73 36.70 77.00 57.75 49.33 69.88 67.38 75.08 72.19 73.40 77.00 67.38 36.70 72.19 62.39 58.72 7397803 942 97803 MEDICAL NUTRITION THERAPY RE-ASSESSMENT 1 83.68 28.45 31.65 66.94 50.21 42.89 60.75 58.58 65.27 62.76 63.30 66.94 58.58 31.65 62.76 53.81 50.64 901750 361 11750 EXC NAIL AND NAIL MATRIX PART OR COMP RM 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 910004 361 10004 FINE NEEDLE ASPIRATION WO IMG E ADDT LES 1 367.00 124.78 143.13 497.00 497.00 188.09 266.44 256.90 286.26 275.25 143.13 293.60 256.90 293.60 910021 361 10021 FINE NEEDLE ASPIRATION WO IMG 1ST LES 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 910060 360 10060 INC AND DRAINAGE ABSCESS SIMPLE OR SINGL 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 910061 360 10061 INCISION AND DRAINAGE ABSCESS COMP OR MU 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 910080 360 10080 INCISION AND DRAINAGE PILONIDAL CYST SIM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 910120 360 10120 INCISION & REM FOREIGN BODY SUB TIS SIM 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 910121 360 10121 INC & REMOVAL FOREIGN BODY SUB TIS COMP 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 910140 360 10140 I & D OF HEMATOMA SEROMA OR FLUID COLL 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 910160 360 10160 PUNCTURE DRAINAGE OF LESION 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911004 360 11004 DEBRIDEMENT SKIN EXT GENITALIA PERINEUM 1 490.00 166.60 191.10 808.76 808.76 251.13 355.74 343.00 382.20 367.50 191.10 392.00 343.00 392.00 911005 360 11005 DEBRIDEMENT SKIN ABD WALL 1 490.00 166.60 191.10 " 1,100.08 " " 1,100.08 " 251.13 355.74 343.00 382.20 367.50 191.10 392.00 343.00 392.00 911042 360 11042 DEBRID SUBQ TISSUE 1ST 20 SQ CM OR LESS 1 929.70 316.10 309.94 743.76 666.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911043 360 11043 DEBRID MUSCLE/FASCIA 1ST 20 SQ CM OR < 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 666.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 911044 360 11044 DEBRID BONE 1ST 20 SQ CM OR LESS 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911045 360 11045 DEBRID SUBQ TISSUE EACH ADDT 20 SQ CM 1 380.00 129.20 148.20 497.00 497.00 194.75 275.88 266.00 296.40 285.00 148.20 304.00 266.00 304.00 911046 360 11046 DEBRID MUSCLE/FASCIA EACH ADDT 20 SQ CM 1 380.00 129.20 148.20 497.00 497.00 194.75 275.88 266.00 296.40 285.00 148.20 304.00 266.00 304.00 911055 361 11055 PARING OR CUTTING BENIGN HYPERKERATOTIC 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 911104 361 11104 PUNCH BIOPSY SKIN SINGLE LESION 1 929.70 316.10 309.94 743.76 557.82 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911105 361 11105 PUNCH BIOPSY SKIN E SEPARATE/ADDT LESION 1 265.00 90.10 103.35 497.00 497.00 135.81 192.39 185.50 206.70 198.75 103.35 212.00 185.50 212.00 911106 361 11106 INCISIONAL BIOPSY SKIN SINGLE LESION 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 497.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 911200 360 11200 REM SKIN TAGS ANY AREA UP TO & INC 15 LE 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 911201 360 11201 REM SKIN TAGS ANY AREA E ADDT 10 LESIONS 1 260.00 88.40 101.40 208.00 156.00 133.25 188.76 182.00 202.80 195.00 101.40 208.00 182.00 208.00 911300 361 11300 SHAVING SKIN LESION 0.5 CM OR LESS 1 929.70 316.10 309.94 743.76 557.82 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911302 361 11302 SHAVING SKIN LESION 1.1 - 2.0 CM 1 482.67 164.11 160.91 386.14 289.60 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 911307 361 11307 SHAVE EPIDERMAL LES S/N/H/F/G 1.1-2.0 CM 1 482.67 164.11 160.91 386.14 289.60 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 911313 360 11313 SHAVING LESION S/N/H/F/G > 2.0 CM 1 929.70 316.10 309.94 743.76 557.82 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911400 360 11400 EXC BENIGN LESION TRUNK-EXT 0.5CM OR < 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911401 360 11401 EXC BENIGN LESION TRUNK-EXT 0.6 - 1.0 CM 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911402 360 11402 EXC BENIGN LESION TRUNK-EXT 1.1 - 2 CM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911403 360 11403 EXC BENIGN LESION TRUNK-EXT 2.1 -3 CM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911404 360 11404 EXC LES B9 TRUNK ARMS LEGS 3.1 TO 4.0 CM 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911406 360 11406 "EXC BENIGN LESION TRUNK,ARMS,LEGS >4.0CM" 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911420 360 11420 EXC LESION H-F-NK-SP B9 0.5 CM OR LESS 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911421 360 11421 EXC LESION H-F-NK-SP B9 0.6-1 CM 1 " 1,671.99 " 568.48 557.41 " 1,337.59 " 666.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911422 360 11422 EXC LESION H-F-NK-SP B9 1.1-2.0 CM 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911423 360 11423 EXC LESION H-F-NK-SP B9 2.1 - 3.0 CM 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911424 360 11424 EXC LESION H-F-NK-SP B9 3.1- 4.0 CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911426 360 11426 EXC LESION H-F-NK-SP B9 > 4CM 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911441 360 11441 EXC LESION FACE-MM B9+MARG 0.6 -1 CM 1 " 1,671.99 " 568.48 557.41 " 1,337.59 " 666.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911442 360 11442 EXC LESION FACE-MM B9+MARG 1.1-2 CM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911443 360 11443 EXC LESION FACE-MM B9+MARG 2.1-3.0 CM 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911444 360 11444 EXC LESION FACE-MM B9+MARG 3.1-4.0 CM 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911446 360 11446 EXC LESION FACE-MM B9+MARG > 4.0 CM 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911450 360 11450 EXC SWEAT GLAND AXILLARY W/SIMPLE OR INT 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911451 360 11451 EXC SWEAT GLAND AXILLARY COMPLEX 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911470 360 11470 "EXC SWEAT GLAND PERIANAL,PERINEAL,UMBILI" 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911574 360 15574 "FORM SK PEDICLE FLAP FH,CHEEKS,CHIN MOU" 1 " 4,611.30 " " 1,567.84 " 762.00 " 3,689.04 " 762.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 911601 360 11601 EXC LESION TRUNK-EXT MAL+MARG 0.6-1 CM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911602 360 11602 EXC LESION TRUNK-EXT MAL+MARG 1.1-2 CM 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911603 360 11603 EXC LESION TRUNK-EXT MAL+MARG 2.1-3 CM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911604 360 11604 EXC LESION TRUNK-EXT MAL+MARG 3.1-4.0 CM 1 " 1,671.99 " 568.48 557.41 " 1,337.59 " 666.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911606 360 11606 EXC LESION TR-EXT MLG + MARG > 4CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911622 360 11622 EXC LESION H-F-NK-SP MLG + MARG 1.1-2 CM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911623 361 11623 EXC LESION H-F-NK-SP MLG + MARG 2.1-3 CM 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911624 360 11624 EXC LESION H-F-NK-SP MLG + MARG 3.1-4 CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911626 360 11626 EXC LESION H-F-NK-SP MLG + MARG > 4 CM 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911641 360 11641 EXC LESION FACE-MM MLG + MARG 0.6-1 CM 1 " 1,671.99 " 568.48 557.41 " 1,337.59 " 666.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911642 360 11642 EXC LESION FACE-MM MLG + MARG 1.1-2 CM 1 " 1,671.99 " 568.48 557.41 " 1,337.59 " 666.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 911643 360 11643 EXC LESION FACE-MM MLG + MARG 2.1-3 CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911644 360 11644 EXC FACE MM MAL 3.1 -4 CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 911646 360 11646 EXC LESION FACE-MM MLG + MARG > 4 CM 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911719 361 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER 1 149.64 50.88 49.88 119.71 89.78 76.69 108.64 104.75 116.72 112.23 99.76 119.71 104.75 49.88 119.71 84.80 79.81 911720 361 11720 DEBRIDEMENT NAILS ANY METHOD 1-5 1 149.64 50.88 49.88 497.00 497.00 76.69 108.64 104.75 116.72 112.23 99.76 119.71 104.75 49.88 119.71 84.80 79.81 911721 361 11721 DEBRIDEMENT NAILS ANY METHOD 6 OR MORE 1 149.64 50.88 49.88 497.00 497.00 76.69 108.64 104.75 116.72 112.23 99.76 119.71 104.75 49.88 119.71 84.80 79.81 911730 360 11730 AVULSION NAIL PLATE SIMPLE SINGLE 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 911732 360 11732 AVULSION NAIL PLATE SIMPLE E ADDT NAIL P 1 80.00 27.20 31.20 497.00 497.00 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 64.00 911750 360 11750 EXC NAIL AND NAIL MATRIX PART OR COMP OR 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 911770 360 11770 EXC PILONIDAL CYST 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911771 360 11771 EXC PILONIDAL CYST EXTENSIVE 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911971 360 11971 REM TISSUE EXPANDER(S) W/O INSERT PROSTH 1 " 6,371.16 " " 2,166.19 " 497.00 " 5,096.93 " 497.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 911980 361 11980 IMPLANT HORMONE PELLET SUBCUTANEOUS 1 726.42 246.98 242.17 581.14 497.00 372.29 527.38 508.49 566.61 544.82 484.34 581.14 508.49 242.17 581.14 411.69 387.47 911981 361 11981 INSERTION DRUG DELIVERY IMPLANT 1 300.96 102.33 100.33 497.00 497.00 154.24 218.50 210.67 234.75 225.72 200.66 240.77 210.67 100.33 240.77 170.56 160.53 911982 361 11982 REMOVAL DRUG DELIVERY IMPLANT 1 726.42 246.98 242.17 581.14 497.00 372.29 527.38 508.49 566.61 544.82 484.34 581.14 508.49 242.17 581.14 411.69 387.47 911983 361 11983 REMOVAL W REINSERTION DRUG DEL IMPLANT 1 726.42 246.98 242.17 581.14 497.00 372.29 527.38 508.49 566.61 544.82 484.34 581.14 508.49 242.17 581.14 411.69 387.47 912013 360 12013 SIMP REP WOUND F/E/E/N/L/M 2.6CM-5.0CM 1 482.67 164.11 160.91 386.14 289.60 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 912020 360 12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 497.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 912021 360 12021 TX SUPERFICIAL WOUND DEHISCENSE W PACKIN 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912031 360 12031 INTMD WND REP SC/TR/EXT 2.6 CM OR LESS 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912032 360 12032 INTMD WND REP SC/TR/EXT 2.6 CM TO 7.5 CM 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912034 360 12034 INTMD WND REP SC/TR/EXT 7.6 CM TO12.5 CM 1 929.70 316.10 309.94 743.76 666.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912035 360 12035 INTMD WND REP SC/TR/EXT 12.6 CM -20.0 CM 1 929.70 316.10 309.94 743.76 666.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912041 360 12041 INTMD WOUND REPAIR N-HG/GENIT 2.5 CM OR< 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912042 360 12042 INTMD WOUND REPAIR N-HG/GENIT 2.6-7.5 CM 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912044 360 12044 INTMD WOUND REPAIR N-HG/GENIT 7.5-12.5CM 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 666.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 912051 360 12051 REP INTMD WND FACE/MM 2.5 CM OR LESS 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912052 360 12052 INTMD WND REPAIR FACE /MM 2.6 - 5.0 CM 1 929.70 316.10 309.94 743.76 497.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912054 360 12054 REP INTMD WND FACE/MM 7.6 CM -12.5 CM 1 929.70 316.10 309.94 743.76 666.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 912055 360 12055 REP INTMD WND FACE/MM 12.6CM - 20 CM 1 929.70 316.10 309.94 743.76 666.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 913101 360 13101 REPAIR COMPLEX TRUNK 2.6 CM TO 7.5 CM 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 762.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 913102 360 13102 REPAIR COMPLEX TRUNK E ADDT 5CM OR < 1 720.00 244.80 280.80 576.00 497.00 369.00 522.72 504.00 561.60 540.00 280.80 576.00 504.00 576.00 913121 360 13121 REPAIR COMPLEX S/A/L 2.6 CM TO 7.5 CM 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 762.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 913122 360 13122 REPAIR COMPLEX S/A/L E ADDT 5CM OR LESS 1 257.25 87.47 100.33 497.00 497.00 131.84 186.76 180.08 200.66 192.94 100.33 205.80 180.08 205.80 913152 360 13152 REPAIR COMPLEX E/N/E/L 2.6 CM TO 7.5 CM 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 762.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 914020 360 14020 ADJ TIS TRANSFER S/A/L 10 SQ CM OR < 1 " 4,611.30 " " 1,567.84 " 762.00 " 3,689.04 " 762.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 914040 360 14040 ADJACENT TISSUE TRANSFER 10 CM OR < 1 " 4,611.30 " " 1,567.84 " 666.00 " 3,689.04 " 666.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 914041 360 14041 ADJACENT TISSUE TRANSFER 10.1 CM - 30 CM 1 " 4,611.30 " " 1,567.84 " 762.00 " 3,689.04 " 762.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 914060 360 14060 ADJ TIS TRANSFER E/N/E/L 10 SQ CM OR < 1 " 4,611.30 " " 1,567.84 " 762.00 " 3,689.04 " 762.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915002 361 15002 WOUND PREP TRK/ARM/LEG 1ST 100 SQ CM 1 " 4,611.30 " " 1,567.84 " 666.00 " 3,689.04 " 666.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915003 361 15003 WOUND PREP TRK/ARM/LEG E ADDT 100 SQ CM 1 " 1,660.00 " 564.40 497.00 " 1,328.00 " 497.00 850.75 " 1,205.16 " " 1,162.00 " " 1,294.80 " " 1,245.00 " 647.40 " 1,328.00 " " 1,162.00 " " 1,328.00 " 915004 360 15004 SURG WOUND PREP F/N/HF/G 1ST 100 CM 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 666.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 915005 360 15005 SURG WOUND PREP F/N/HF/G E ADDT 100 CM 1 " 1,660.00 " 564.40 497.00 " 1,328.00 " 497.00 850.75 " 1,205.16 " " 1,162.00 " " 1,294.80 " " 1,245.00 " 647.40 " 1,328.00 " " 1,162.00 " " 1,328.00 " 915100 360 15100 SKIN SPLIT GRFT TRNK/ARM/LEG 1ST 100 CM 1 " 4,611.30 " " 1,567.84 " 666.00 " 3,689.04 " 666.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915120 360 15120 SKN SPLT A GRFT FAC/NCK/HF/G 100 CM OR < 1 " 9,468.39 " " 3,219.25 " 666.00 " 7,574.71 " 666.00 " 4,852.55 " " 6,874.05 " " 6,627.87 " " 7,385.34 " " 7,101.29 " " 6,313.10 " " 7,574.71 " " 6,627.87 " " 3,156.55 " " 7,574.71 " " 5,366.14 " " 5,050.48 " 915121 360 15121 SKN SPLT A GRFT FAC/NCK/HF/G E ADDT 100C 1 " 1,660.00 " 564.40 647.40 " 1,328.00 " 762.00 850.75 " 1,205.16 " " 1,162.00 " " 1,294.80 " " 1,245.00 " 647.40 " 1,328.00 " " 1,162.00 " " 1,328.00 " 915220 360 15220 SKIN GRAFT SCALP/ARMS/LEGS 20 CM OR LESS 1 " 4,611.30 " " 1,567.84 " 666.00 " 3,689.04 " 666.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915240 360 15240 SKIN GRAFT FACE/GENIT/H/F20 CM OR LESS 1 " 4,611.30 " " 1,567.84 " 762.00 " 3,689.04 " 762.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915260 360 15260 SKIN GRAFT EEN AND LIPS 20 CM OR LESS 1 " 4,611.30 " " 1,567.84 " 666.00 " 3,689.04 " 666.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915576 360 15576 "FORM SKIN FLAP EYELID,N,EAR,LIP OR INT O" 1 " 4,611.30 " " 1,567.84 " 762.00 " 3,689.04 " 762.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915760 360 15760 GRAFT COMPOSITE FULL THICKNESS 1 " 4,611.30 " " 1,567.84 " 666.00 " 3,689.04 " 666.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915822 360 15822 BLEPHAROPLASTY UPPER EYELID 1 " 4,611.30 " " 1,567.84 " 762.00 " 3,689.04 " 762.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 915852 360 15852 DRESSING CHG NOT BURN U ANES (NOT LOCAL) 1 " 1,409.10 " 479.09 469.76 " 1,127.28 " 497.00 722.16 " 1,023.01 " 986.37 " 1,099.10 " " 1,056.83 " 939.52 " 1,127.28 " 986.37 469.76 " 1,127.28 " 798.59 751.62 916020 360 16020 DRESS/DEBRID P THICK BURN SM 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 916030 360 16030 DRESS/DEBRID P THICK BURN LG 1 929.70 316.10 309.94 743.76 666.00 476.47 674.96 650.79 725.17 697.28 619.88 743.76 650.79 309.94 743.76 526.90 495.90 916254 360 64721 CARPEL TUNNEL RELEASE 1 " 4,716.21 " " 1,603.51 " 666.00 " 3,772.97 " 666.00 " 2,417.06 " " 3,423.97 " " 3,301.35 " " 3,678.64 " " 3,537.16 " " 3,144.56 " " 3,772.97 " " 3,301.35 " " 1,572.28 " " 3,772.97 " " 2,672.88 " " 2,515.65 " 917000 361 17000 DEST PREMALIGNANT LESION 1ST LESION 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 917003 361 17003 DEST PREMALIGNANT LESIONS 2-14 LESIONS 1 80.00 27.20 31.20 497.00 497.00 41.00 58.08 56.00 62.40 60.00 31.20 64.00 56.00 64.00 917110 361 17110 DESTRUC BENIGN LESION 1-14 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 917250 360 17250 CHEMICAL CAUTERY GRANULATION TISSUE 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 917280 361 17280 DEST LESION MALIG FEENL 0.5 CM OR < 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 917999 360 17999 SKIN TISSUE PROCEDURE (UNLISTED) 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 918850 360 47562 LAPAROSCOPIC CHOLECYSTECTOMY 1 " 13,603.68 " " 4,625.25 " " 1,071.00 " " 10,882.94 " " 1,071.00 " " 6,971.89 " " 9,876.27 " " 9,522.58 " " 10,610.87 " " 10,202.76 " " 9,070.34 " " 10,882.94 " " 9,522.58 " " 4,535.17 " " 10,882.94 " " 7,709.79 " " 7,256.27 " 919020 360 19020 MASTOTOMY W EXPL OR DRAINAGE ABSC DEEP 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 919100 360 19100 BIOPSY BREAST PERCUTANEOUS WO IMAGING 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 919101 360 19101 BIOPSY BREAST OPEN INCISIONAL 1 " 8,488.77 " " 2,886.18 " 666.00 " 6,791.02 " 666.00 " 4,350.49 " " 6,162.85 " " 5,942.14 " " 6,621.24 " " 6,366.58 " " 5,659.94 " " 6,791.02 " " 5,942.14 " " 2,829.97 " " 6,791.02 " " 4,810.95 " " 4,527.95 " 919120 360 19120 EXC BREAST LESION OPEN M OR F 1 OR MORE 1 " 8,488.77 " " 2,886.18 " 762.00 " 6,791.02 " 762.00 " 4,350.49 " " 6,162.85 " " 5,942.14 " " 6,621.24 " " 6,366.58 " " 5,659.94 " " 6,791.02 " " 5,942.14 " " 2,829.97 " " 6,791.02 " " 4,810.95 " " 4,527.95 " 919303 360 19303 MASTECTOMY SIMPLE COMPLETE 1 " 14,876.55 " " 5,058.03 " 941.00 " 11,901.24 " 941.00 " 7,624.23 " " 10,800.38 " " 10,413.59 " " 11,603.71 " " 11,157.41 " " 9,919.04 " " 11,901.24 " " 10,413.59 " " 4,959.52 " " 11,901.24 " " 8,431.18 " " 7,935.23 " 920103 360 20103 EXPLORATION WOUND EXTREMITY 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 920200 360 20200 BIOPSY MUSCLE SUPERFICIAL 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 920205 360 20205 BIOPSY MUSCLE DEEP 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 920240 360 20240 BIOPSY BONE OPEN SUPERFICIAL ILIUM STERN 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 920600 361 20600 ARTHROCENTESIS ASP AND OR INJ SM JOINT 1 702.09 238.71 234.06 561.67 497.00 359.82 509.72 491.46 547.63 526.57 468.12 561.67 491.46 234.06 561.67 397.90 374.50 920605 361 20605 ARTHROCENTESIS AND/OR INJ MED JOINT/BURS 1 702.09 238.71 234.06 561.67 497.00 359.82 509.72 491.46 547.63 526.57 468.12 561.67 491.46 234.06 561.67 397.90 374.50 920610 360 20610 "ARTHROCENTESIS, ASP AND OR INJ MAJ JNT" 1 702.09 238.71 234.06 561.67 497.00 359.82 509.72 491.46 547.63 526.57 468.12 561.67 491.46 234.06 561.67 397.90 374.50 920612 360 20612 ASPIRATION AND/OR INJ GANGOLION CYST(S) 1 702.09 238.71 234.06 561.67 497.00 359.82 509.72 491.46 547.63 526.57 468.12 561.67 491.46 234.06 561.67 397.90 374.50 920670 360 20670 REMOVAL OF IMPLANT SUPERFICIAL 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 920680 360 20680 REMOVAL OF IMPLANT DEEP 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 920999 360 20999 UNL PROC MUSCUSKELETAL SYSTEM GENERAL 1 554.28 188.46 184.79 497.00 497.00 284.07 402.41 388.00 432.34 415.71 369.58 443.42 388.00 184.79 443.42 314.14 295.66 921044 360 21044 EXC MALIGNANT TUMOR OF MANDIBLE 1 " 13,672.53 " " 4,648.66 " 666.00 " 10,938.02 " 666.00 " 7,007.17 " " 9,926.26 " " 9,570.77 " " 10,664.57 " " 10,254.40 " " 9,116.24 " " 10,938.02 " " 9,570.77 " " 4,558.12 " " 10,938.02 " " 7,748.80 " " 7,292.99 " 921501 360 21501 I & D DEEP ABSCESS OR HEMATOMA NECKOR TH 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 921550 360 21550 BIOPSY SOFT TISSUE NECK OR THORAX 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 921552 360 21552 EXC TUMOR NECK OR ANT THORAX SC 3+CM 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 921555 360 21555 EXC TUM SOFT TIS NECK SUBCUTANEOUS < 3CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 921920 360 21920 BIOPSY SOFT TISSUE BACK OR FLANK SUPERFI 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 921931 360 21931 EXC TUMOR BACK/FLANK SUBCUTAN 3CM OR > 1 " 3,782.34 " " 1,286.00 " 762.00 " 3,025.87 " 762.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 921933 360 21933 EXC TUMOR BACK/FLANK SUBFASCIAL 5CM OR > 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 922901 360 22901 EXC TUMOR SOFT TISS ABD WALL 5CM OR > 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 922902 360 22902 EXC TUMOR S TISS ABD WALL SUBCUT< 3CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 922903 360 22903 EXC TUMOR SOFT TISSUE ABD WALL > 3 CM 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 922905 360 22905 RAD RESECT TUM S TISS ABD WALL 5CM OR > 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 923071 360 23071 EXC TUMOR SOFT TISS SHOU SUBC 3 CM OR > 1 " 3,782.34 " " 1,286.00 " 762.00 " 3,025.87 " 762.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 923076 360 23076 EXC TUM SOFT TISSUE SHOULDER <5CM 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 923700 360 23700 MANIPULATION SHOULDER JOINT 1 " 3,742.98 " " 1,272.61 " 497.00 " 2,994.38 " 497.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 924071 360 24071 EXC TUM SOFT TISS UP ARM ELBOW 3CM OR > 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 924076 360 24076 EXC TUMOR SOFT TIS ARM OR ELBOW < 5 CM 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 924079 360 24079 RESECTION TUMOR UP ARM OR ELBOW 5CM OR > 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 924105 360 24105 EXC OLECRANON BURSA (ELBOW BURSA) 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 925000 360 25000 INCISION EXTENSOR TENDON SHEATH WRIST 1 " 3,742.98 " " 1,272.61 " 762.00 " 2,994.38 " 762.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 925111 360 25111 EXC GANGLION WRIST (DORSAL OR VOLAR) 1 " 3,742.98 " " 1,272.61 " 762.00 " 2,994.38 " 762.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 926010 361 26010 DRAINAGE FINGER ABSCESS SIMPLE 1 482.67 164.11 160.91 386.14 289.60 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 926011 360 26011 DRAINAGE OF FINGER ABSCESS COMPLICATED 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 926055 360 26055 TENDON SHEATH INCISION 1 " 3,742.98 " " 1,272.61 " 666.00 " 2,994.38 " 666.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 926115 360 26115 EXC TUMOR OR VASC MALF HAND SC < 1.5 CM 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 926160 360 26160 EXC LESION TENDON SHEATH OR JOINT H OR F 1 " 3,742.98 " " 1,272.61 " 762.00 " 2,994.38 " 762.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 926236 360 26236 PARTIAL EXC DISTAL PHALANX OF FINGER 1 " 3,742.98 " " 1,272.61 " 762.00 " 2,994.38 " 762.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 926860 360 26860 ARTHRODESIS; INTERPHALANGEAL JOINT 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 927301 360 27301 DRAIN THIGH/KNEE LESION 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 927324 360 27324 BIOPSY SOFT TISS THIGH OR KNEE DEEP 1 " 6,371.16 " " 2,166.19 " 497.00 " 5,096.93 " 497.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 927337 360 27337 EXC TUM SOFT TISS THIGH OR KNEE 3CM OR > 1 " 6,371.16 " " 2,166.19 " 762.00 " 5,096.93 " 762.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 927345 360 27345 EXC OF SYNOVIAL CYST OF POPLITEAL SPACE 1 " 7,608.78 " " 2,586.99 " 941.00 " 6,087.02 " 941.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 927372 360 27372 REM FOREIGN BODY DEEP THIGH OR KNEE REG 1 " 6,371.16 " " 2,166.19 " " 1,486.00 " " 5,096.93 " " 1,486.00 " " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 927422 360 27422 REVISION UNSTABLE KNEECAP 1 " 16,841.70 " " 5,726.18 " " 1,486.00 " " 13,473.36 " " 1,486.00 " " 8,631.37 " " 12,227.07 " " 11,789.19 " " 13,136.53 " " 12,631.28 " " 11,229.30 " " 13,473.36 " " 11,789.19 " " 5,614.65 " " 13,473.36 " " 9,544.91 " " 8,983.44 " 927590 360 27590 AMPUTATION THIGH THROUGH FEMUR ANY LEVEL 1 " 42,657.33 " " 14,503.49 " " 1,249.20 " " 34,125.86 " " 1,249.20 " " 21,861.88 " " 30,969.22 " " 29,860.13 " " 33,272.72 " " 31,993.00 " " 28,442.04 " " 34,125.86 " " 29,860.13 " " 14,221.02 " " 34,125.86 " " 24,175.73 " " 22,753.63 " 927603 360 27603 I&D LEG OR ANKLE DEEP ABSCESS OR HEMATOM 1 " 6,371.16 " " 2,166.19 " 666.00 " 5,096.93 " 666.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 927641 360 27641 PARTIAL EXCISION BONE FIBULA 1 " 7,608.78 " " 2,586.99 " 666.00 " 6,087.02 " 666.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 927899 360 27899 UNLISTED PROCEDURE LEG ANKLE 1 554.28 188.46 184.79 497.00 497.00 284.07 402.41 388.00 432.34 415.71 369.58 443.42 388.00 184.79 443.42 314.14 295.66 928008 360 28008 FASCIOTOMY FOOT AND OR TOE 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928092 360 28092 EXC LESION TOE (S) EACH 1 " 3,742.98 " " 1,272.61 " 762.00 " 2,994.38 " 762.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 928108 360 28108 EXC OR CUR BONE CYST B9 TUMOR PHAL FOOT 1 " 3,742.98 " " 1,272.61 " 666.00 " 2,994.38 " 666.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 928110 360 28110 OSTECTOMY PARTIAL EXC 5TH METATARSAL HEA 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928119 360 28119 OSTECTOMY CALCANEUS FOR SPUR 1 " 7,608.78 " " 2,586.99 " 941.00 " 6,087.02 " 941.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928122 360 28122 EXC PARTIAL BONE TARSAL OR METATARSAL 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928124 360 28124 PARTIAL EXC BONE PHALANX OF TOE 1 " 7,608.78 " " 2,586.99 " 666.00 " 6,087.02 " 666.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928153 360 28153 RESECT CONDYLE DISTAL END PHALANX E TOE 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928160 360 28160 HEMIPHALANGECTOMY /PARTIAL REM TOE 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928232 360 28232 TENOTOMY TOE SINGLE TENDON 1 " 3,742.98 " " 1,272.61 " 666.00 " 2,994.38 " 666.00 " 1,918.28 " " 2,717.40 " " 2,620.09 " " 2,919.52 " " 2,807.24 " " 2,495.64 " " 2,994.38 " " 2,620.09 " " 1,247.82 " " 2,994.38 " " 2,121.29 " " 1,996.51 " 928270 360 28270 CAPSULOTOMY METATARSOPHALANGEAL JOINT 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928285 360 28285 HAMMERTOE CORRECTION 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928289 360 28289 HALLUX RIGIDUS CORR W CHEILECTOMY DEBR 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928292 360 28292 CORRECTION HALLUX VALGUS (BUNIONECTOMY) 1 " 7,608.78 " " 2,586.99 " 666.00 " 6,087.02 " 666.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928296 360 28296 CORR BUNION W METATARSAL OSTEOTOMY 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928299 360 28299 CORRECT BUNION BY DOUBLE OSTEOTOMY 1 " 16,841.70 " " 5,726.18 " " 1,071.00 " " 13,473.36 " " 1,071.00 " " 8,631.37 " " 12,227.07 " " 11,789.19 " " 13,136.53 " " 12,631.28 " " 11,229.30 " " 13,473.36 " " 11,789.19 " " 5,614.65 " " 13,473.36 " " 9,544.91 " " 8,983.44 " 928810 360 28810 AMPUTATION TOE AND METATARSAL 1 " 7,608.78 " " 2,586.99 " 666.00 " 6,087.02 " 666.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928820 360 28820 AMPUTATION TOE METATARSOPHALANGEAL JOINT 1 " 7,608.78 " " 2,586.99 " 666.00 " 6,087.02 " 666.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928825 360 28825 AMPUTATION TOE INTERPHALANGEAL JOINT 1 " 7,608.78 " " 2,586.99 " 666.00 " 6,087.02 " 666.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 928899 360 28899 DRAINAGE RT FOOT-UNLISTED PROC FOOR/TOES 1 554.28 188.46 184.79 497.00 497.00 284.07 402.41 388.00 432.34 415.71 369.58 443.42 388.00 184.79 443.42 314.14 295.66 929515 361 29515 APPLICATION OF SHORT LEG SPLINT 1 379.53 129.04 126.53 303.62 227.72 194.51 275.54 265.67 296.03 284.65 253.06 303.62 265.67 126.53 303.62 215.10 202.45 929870 360 29870 ARTHROSCOPY KNEE DIAG W OR W/O SYN BIOPS 1 " 7,608.78 " " 2,586.99 " 762.00 " 6,087.02 " 762.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 929875 360 29875 ARTHROSCOPY KNEE SYNOVECTOMY 1 " 7,608.78 " " 2,586.99 " 941.00 " 6,087.02 " 941.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 929877 360 29877 ARTHRO KNEE DEBRIDE/SHAVING ART CARTILAG 1 " 7,608.78 " " 2,586.99 " 941.00 " 6,087.02 " 941.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 929881 360 29881 ARTHROSCOPY KNEE W MENISCECTOMY 1 " 7,608.78 " " 2,586.99 " 941.00 " 6,087.02 " 941.00 " 3,899.50 " " 5,523.97 " " 5,326.15 " " 5,934.85 " " 5,706.59 " " 5,073.20 " " 6,087.02 " " 5,326.15 " " 2,536.60 " " 6,087.02 " " 4,312.22 " " 4,058.56 " 929999 360 29999 ARTHROSCOPY UNLISTED PROC 1 554.28 188.46 184.79 497.00 497.00 284.07 402.41 388.00 432.34 415.71 369.58 443.42 388.00 184.79 443.42 314.14 295.66 930901 360 30901 CONTROL NOSEBLEED LIMITED 1 300.96 102.33 100.33 497.00 497.00 154.24 218.50 210.67 234.75 225.72 200.66 240.77 210.67 100.33 240.77 170.56 160.53 931500 360 31500 INTUBATION ENDOTRACHEAL EMERGENCY PR 1 568.83 193.40 189.64 497.00 497.00 291.53 412.97 398.18 443.69 426.62 379.28 455.06 398.18 189.64 455.06 322.39 303.42 931624 360 31624 BRONCHOSCOPY WITH BRONCHIAL ALV LAVAGE 1 " 4,022.67 " " 1,367.71 " 666.00 " 3,218.14 " 666.00 " 2,061.62 " " 2,920.46 " " 2,815.87 " " 3,137.68 " " 3,017.00 " " 2,682.12 " " 3,218.14 " " 2,815.87 " " 1,341.06 " " 3,218.14 " " 2,279.80 " " 2,145.70 " 931899 360 31899 UNLISTED PROCEDURE TRACHEA BRONCHI 1 441.93 150.26 147.33 497.00 497.00 226.49 320.84 309.35 344.71 331.45 294.66 353.54 309.35 147.33 353.54 250.46 235.73 932551 360 32551 INSERTION OF CHEST TUBE 1 " 3,780.03 " " 1,285.21 " 666.00 " 3,024.02 " 666.00 " 1,937.27 " " 2,744.30 " " 2,646.02 " " 2,948.42 " " 2,835.02 " " 2,520.36 " " 3,024.02 " " 2,646.02 " " 1,260.18 " " 3,024.02 " " 2,142.31 " " 2,016.29 " 932554 360 32554 THORACENTESIS ASPIRATION WOUT GUIDANCE 1 " 1,455.99 " 495.04 485.40 " 1,164.79 " 497.00 746.19 " 1,057.05 " " 1,019.19 " " 1,135.67 " " 1,091.99 " 970.80 " 1,164.79 " " 1,019.19 " 485.40 " 1,164.79 " 825.18 776.64 932555 360 32555 THORACENTESIS ASPIRATION WITH GUIDANCE 1 " 1,455.99 " 495.04 485.40 " 1,164.79 " 497.00 746.19 " 1,057.05 " " 1,019.19 " " 1,135.67 " " 1,091.99 " 970.80 " 1,164.79 " " 1,019.19 " 485.40 " 1,164.79 " 825.18 776.64 932556 360 32556 PLEURAL DRAINAGE INSERT CATH W/O IMAGE 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 932560 360 32560 INSTILLATION VIA CHEST TUBE/CATH AGENT 1 " 1,455.99 " 495.04 485.40 " 1,164.79 " 666.00 746.19 " 1,057.05 " " 1,019.19 " " 1,135.67 " " 1,091.99 " 970.80 " 1,164.79 " " 1,019.19 " 485.40 " 1,164.79 " 825.18 776.64 936000 361 36000 INTRODUCTION NEEDLE OR INTRACATHER VEIN 1 60.00 20.40 23.40 48.00 36.00 30.75 43.56 42.00 46.80 45.00 23.40 48.00 42.00 48.00 936010 360 36010 INTRO CATH SUPERIOR OR INFERIOR VENA CAV 1 " 1,730.00 " 588.20 497.00 " 1,384.00 " 497.00 886.63 " 1,255.98 " " 1,211.00 " " 1,349.40 " " 1,297.50 " 674.70 " 1,384.00 " " 1,211.00 " " 1,384.00 " 936556 360 36556 INSERT NON TUNNEL CV CATH 1 " 7,692.84 " " 2,615.57 " 497.00 " 6,154.27 " 497.00 " 3,942.58 " " 5,585.00 " " 5,384.99 " " 6,000.42 " " 5,769.63 " " 5,129.24 " " 6,154.27 " " 5,384.99 " " 2,564.62 " " 6,154.27 " " 4,359.85 " " 4,103.39 " 936558 360 36558 INSERT TUNNELED CV CATH WO PORT AGE 5> 1 " 7,692.84 " " 2,615.57 " 666.00 " 6,154.27 " 666.00 " 3,942.58 " " 5,585.00 " " 5,384.99 " " 6,000.42 " " 5,769.63 " " 5,129.24 " " 6,154.27 " " 5,384.99 " " 2,564.62 " " 6,154.27 " " 4,359.85 " " 4,103.39 " 936561 360 36561 PORT A CATH INSERTION AGE 5 AND > 1 " 7,692.84 " " 2,615.57 " 762.00 " 6,154.27 " 762.00 " 3,942.58 " " 5,585.00 " " 5,384.99 " " 6,000.42 " " 5,769.63 " " 5,129.24 " " 6,154.27 " " 5,384.99 " " 2,564.62 " " 6,154.27 " " 4,359.85 " " 4,103.39 " 936569 360 36569 PICC LINE INSERTION AGE 5 AND UP 1 " 3,780.03 " " 1,285.21 " 497.00 " 3,024.02 " 497.00 " 1,937.27 " " 2,744.30 " " 2,646.02 " " 2,948.42 " " 2,835.02 " " 2,520.36 " " 3,024.02 " " 2,646.02 " " 1,260.18 " " 3,024.02 " " 2,142.31 " " 2,016.29 " 936571 360 36571 INSERT PERIPHERAL CVA DEV W SUB PORT 5 > 1 " 7,692.84 " " 2,615.57 " 762.00 " 6,154.27 " 762.00 " 3,942.58 " " 5,585.00 " " 5,384.99 " " 6,000.42 " " 5,769.63 " " 5,129.24 " " 6,154.27 " " 5,384.99 " " 2,564.62 " " 6,154.27 " " 4,359.85 " " 4,103.39 " 936578 360 36578 REPLACEMENT CATHETER ONLY CVA DEVICE 1 " 7,692.84 " " 2,615.57 " 666.00 " 6,154.27 " 666.00 " 3,942.58 " " 5,585.00 " " 5,384.99 " " 6,000.42 " " 5,769.63 " " 5,129.24 " " 6,154.27 " " 5,384.99 " " 2,564.62 " " 6,154.27 " " 4,359.85 " " 4,103.39 " 936582 360 36582 REPLACE TUNNELED CV CATH W SUBCUTA PORT 1 " 7,692.84 " " 2,615.57 " 762.00 " 6,154.27 " 762.00 " 3,942.58 " " 5,585.00 " " 5,384.99 " " 6,000.42 " " 5,769.63 " " 5,129.24 " " 6,154.27 " " 5,384.99 " " 2,564.62 " " 6,154.27 " " 4,359.85 " " 4,103.39 " 936584 360 36584 REPLACE PICC W/O SUBC PORT/PUMP SAME V A 1 " 3,780.03 " " 1,285.21 " 497.00 " 3,024.02 " 497.00 " 1,937.27 " " 2,744.30 " " 2,646.02 " " 2,948.42 " " 2,835.02 " " 2,520.36 " " 3,024.02 " " 2,646.02 " " 1,260.18 " " 3,024.02 " " 2,142.31 " " 2,016.29 " 936590 360 36590 PORT A CATH REMOVAL 1 " 3,780.03 " " 1,285.21 " 497.00 " 3,024.02 " 497.00 " 1,937.27 " " 2,744.30 " " 2,646.02 " " 2,948.42 " " 2,835.02 " " 2,520.36 " " 3,024.02 " " 2,646.02 " " 1,260.18 " " 3,024.02 " " 2,142.31 " " 2,016.29 " 937191 360 37191 INSERTION INTRAVASCULAR VENA CAVA FILTER 1 " 12,823.89 " " 4,360.12 " 762.00 " 10,259.11 " 762.00 " 6,572.24 " " 9,310.14 " " 8,976.72 " " 10,002.63 " " 9,617.92 " " 8,550.42 " " 10,259.11 " " 8,976.72 " " 4,275.21 " " 10,259.11 " " 7,267.86 " " 6,840.34 " 937609 360 37609 LIGATION OR BIOPSY TEMPORAL ARTERY 1 " 3,782.34 " " 1,286.00 " 666.00 " 3,025.87 " 666.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 938220 360 38220 BONE MARROW ASPIRATION 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 938221 360 38221 BONE MARROW BIOPSY NEEDLE OR TROCAR 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 938500 360 38500 EXC OR BIOPSY LYMPH NODES OPEN SUPERFICI 1 " 8,488.77 " " 2,886.18 " 666.00 " 6,791.02 " 666.00 " 4,350.49 " " 6,162.85 " " 5,942.14 " " 6,621.24 " " 6,366.58 " " 5,659.94 " " 6,791.02 " " 5,942.14 " " 2,829.97 " " 6,791.02 " " 4,810.95 " " 4,527.95 " 938510 360 38510 EXC OR BIOPSY LYMPH NODES OPEN DEEP CER 1 " 8,488.77 " " 2,886.18 " 666.00 " 6,791.02 " 666.00 " 4,350.49 " " 6,162.85 " " 5,942.14 " " 6,621.24 " " 6,366.58 " " 5,659.94 " " 6,791.02 " " 5,942.14 " " 2,829.97 " " 6,791.02 " " 4,810.95 " " 4,527.95 " 938520 360 38520 BIOPSY OR EXC LYMPH NODE(S) OPEN DEEP 1 " 8,488.77 " " 2,886.18 " 666.00 " 6,791.02 " 666.00 " 4,350.49 " " 6,162.85 " " 5,942.14 " " 6,621.24 " " 6,366.58 " " 5,659.94 " " 6,791.02 " " 5,942.14 " " 2,829.97 " " 6,791.02 " " 4,810.95 " " 4,527.95 " 938525 360 38525 BIOPSY OR EXC LYMPH NODE(S) DEEP AXILLAR 1 " 8,488.77 " " 2,886.18 " 666.00 " 6,791.02 " 666.00 " 4,350.49 " " 6,162.85 " " 5,942.14 " " 6,621.24 " " 6,366.58 " " 5,659.94 " " 6,791.02 " " 5,942.14 " " 2,829.97 " " 6,791.02 " " 4,810.95 " " 4,527.95 " 938531 360 38531 BIOPSY OR EXC LYMPH NODE(S) 1 " 8,488.77 " " 2,886.18 " 666.00 " 6,791.02 " 666.00 " 4,350.49 " " 6,162.85 " " 5,942.14 " " 6,621.24 " " 6,366.58 " " 5,659.94 " " 6,791.02 " " 5,942.14 " " 2,829.97 " " 6,791.02 " " 4,810.95 " " 4,527.95 " 940510 360 40510 EXCISION LIP TRANSVERSE WEDGE W PRIM CLO 1 " 7,356.06 " " 2,501.06 " 666.00 " 5,884.85 " 666.00 " 3,769.98 " " 5,340.50 " " 5,149.24 " " 5,737.73 " " 5,517.05 " " 4,904.70 " " 5,884.85 " " 5,149.24 " " 2,452.35 " " 5,884.85 " " 4,169.00 " " 3,923.76 " 940805 361 40805 REM FOREIGN BODY MOUTH COMPLICATED 1 " 1,216.05 " 413.46 405.41 972.84 666.00 623.23 882.85 851.24 948.52 912.04 810.82 972.84 851.24 405.41 972.84 689.20 648.66 941105 360 41105 BIOPSY OF TONGUE POSTERIOR 1/3 1 " 7,356.06 " " 2,501.06 " 666.00 " 5,884.85 " 666.00 " 3,769.98 " " 5,340.50 " " 5,149.24 " " 5,737.73 " " 5,517.05 " " 4,904.70 " " 5,884.85 " " 5,149.24 " " 2,452.35 " " 5,884.85 " " 4,169.00 " " 3,923.76 " 941112 360 41112 EXC LESION TONGUE W CLOSURE ANTERIOR 2/3 1 " 7,356.06 " " 2,501.06 " 666.00 " 5,884.85 " 666.00 " 3,769.98 " " 5,340.50 " " 5,149.24 " " 5,737.73 " " 5,517.05 " " 4,904.70 " " 5,884.85 " " 5,149.24 " " 2,452.35 " " 5,884.85 " " 4,169.00 " " 3,923.76 " 941113 360 41113 EXCISION LESION TONGUE POSTERIOR 1/3 1 " 7,356.06 " " 2,501.06 " 666.00 " 5,884.85 " 666.00 " 3,769.98 " " 5,340.50 " " 5,149.24 " " 5,737.73 " " 5,517.05 " " 4,904.70 " " 5,884.85 " " 5,149.24 " " 2,452.35 " " 5,884.85 " " 4,169.00 " " 3,923.76 " 941800 360 41800 "DRAIN ABSCESS CYST,HEMATOMA DENTALVEOLAR" 1 300.96 102.33 100.33 497.00 497.00 154.24 218.50 210.67 234.75 225.72 200.66 240.77 210.67 100.33 240.77 170.56 160.53 942100 360 42100 BIOPSY OF PALATE UVULA 1 " 3,636.63 " " 1,236.45 " 497.00 " 2,909.30 " 497.00 " 1,863.77 " " 2,640.19 " " 2,545.64 " " 2,836.57 " " 2,727.47 " " 2,424.74 " " 2,909.30 " " 2,545.64 " " 1,212.37 " " 2,909.30 " " 2,061.03 " " 1,939.79 " 942408 360 42408 EXCISION OF SUBLINGUAL SALIVARY CYST 1 " 7,356.06 " " 2,501.06 " 762.00 " 5,884.85 " 762.00 " 3,769.98 " " 5,340.50 " " 5,149.24 " " 5,737.73 " " 5,517.05 " " 4,904.70 " " 5,884.85 " " 5,149.24 " " 2,452.35 " " 5,884.85 " " 4,169.00 " " 3,923.76 " 943235 360 43235 EGD DIAGNOSTIC 1 " 2,176.41 " 739.98 497.00 " 1,741.13 " 497.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 943239 360 43239 EGD WITH BIOPSY SINGLE OR MULTIPLE 1 " 2,176.41 " 739.98 666.00 " 1,741.13 " 666.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 943245 360 43245 EGD DILATION GASTRIC OUTLET FOR OBSTRUC 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943246 360 43246 EGD W/PEG PLACEMENT 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943247 360 43247 EGD WITH REMOVAL FOREIGN BODY 1 " 2,176.41 " 739.98 666.00 " 1,741.13 " 666.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 943249 360 43249 EGD BALLOON DILATION ESOPHAGUS < 30MM 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943250 360 43250 EGD W REM TUM/POLYP/OR LES BY FORCEPS 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943251 360 43251 EGD W REM TUM/POLYP/OR LES BY SNARE TEC 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943255 360 43255 EGD FLEXIBLE CONTROL BLEEDING 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943270 360 43270 "EGD WITH ABLATION OF TUMOR,POLYP,OR LES" 1 " 4,368.45 " " 1,485.27 " 762.00 " 3,494.76 " 762.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943450 360 43450 DILATION OF ESOPHAGUS 1 " 2,176.41 " 739.98 497.00 " 1,741.13 " 497.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 943610 360 43610 EXC LOCAL ULCER OR BENIGN TUMOR STOMACH 1 " 6,240.00 " " 2,121.60 " " 1,467.82 " " 4,992.00 " " 1,467.82 " " 3,198.00 " " 4,530.24 " " 4,368.00 " " 4,867.20 " " 4,680.00 " " 2,433.60 " " 4,992.00 " " 4,368.00 " " 4,992.00 " 943762 360 43762 REPLACE GASTROSTOMY TUBE PERCUTANEOUS 1 715.44 243.25 238.51 572.35 497.00 366.66 519.41 500.81 558.04 536.58 477.02 572.35 500.81 238.51 572.35 405.47 381.62 943820 360 43820 GASTROJEJUNOSTOMY WITH OUT VAGOTOMY 1 " 7,800.00 " " 2,652.00 " " 2,011.80 " " 6,240.00 " " 2,011.80 " " 3,997.50 " " 5,662.80 " " 5,460.00 " " 6,084.00 " " 5,850.00 " " 3,042.00 " " 6,240.00 " " 5,460.00 " " 6,240.00 " 943830 360 43830 GASTROSTOMY OPEN WO CONST GASTRIC TUBE 1 " 4,368.45 " " 1,485.27 " " 1,038.68 " " 3,494.76 " " 1,038.68 " " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 943999 360 43999 UNLISTED PROCEDURE STOMACH 1 " 2,176.41 " 739.98 497.00 " 1,741.13 " 497.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 944005 360 44005 ENTEROLYSIS FREEING INTESTINAL ADHESION 1 " 4,450.00 " " 1,513.00 " " 1,486.00 " " 3,560.00 " " 1,486.00 " " 2,280.63 " " 3,230.70 " " 3,115.00 " " 3,471.00 " " 3,337.50 " " 1,735.50 " " 3,560.00 " " 3,115.00 " " 3,560.00 " 944130 360 44130 ENTEROENTEROSTOMY(BOWEL TO BOWEL FUS 1 " 5,000.00 " " 1,700.00 " " 1,950.00 " " 4,000.00 " " 1,966.95 " " 2,562.50 " " 3,630.00 " " 3,500.00 " " 3,900.00 " " 3,750.00 " " 1,950.00 " " 4,000.00 " " 3,500.00 " " 4,000.00 " 944140 360 44140 COLECTOMY PARTIAL W ANASTOMOSIS 1 " 6,240.00 " " 2,121.60 " " 2,010.13 " " 4,992.00 " " 2,010.13 " " 3,198.00 " " 4,530.24 " " 4,368.00 " " 4,867.20 " " 4,680.00 " " 2,433.60 " " 4,992.00 " " 4,368.00 " " 4,992.00 " 944180 360 44180 LAPARASCOPY SURGICAL ENTEROLYSIS 1 " 13,603.68 " " 4,625.25 " 762.00 " 10,882.94 " 762.00 " 6,971.89 " " 9,876.27 " " 9,522.58 " " 10,610.87 " " 10,202.76 " " 9,070.34 " " 10,882.94 " " 9,522.58 " " 4,535.17 " " 10,882.94 " " 7,709.79 " " 7,256.27 " 944320 360 44320 COLOSTOMY OR SKIN LEVEL CECOSTOMY 1 " 5,360.00 " " 1,822.40 " " 1,794.48 " " 4,288.00 " " 1,794.48 " " 2,747.00 " " 3,891.36 " " 3,752.00 " " 4,180.80 " " 4,020.00 " " 2,090.40 " " 4,288.00 " " 3,752.00 " " 4,288.00 " 944799 360 44799 UNLISTED PROCEDURE SMALL INTESTINE 1 " 2,176.41 " 739.98 497.00 " 1,741.13 " 497.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 944970 360 44970 LAP APPENDECTOMY 1 " 13,603.68 " " 4,625.25 " 762.00 " 10,882.94 " 762.00 " 6,971.89 " " 9,876.27 " " 9,522.58 " " 10,610.87 " " 10,202.76 " " 9,070.34 " " 10,882.94 " " 9,522.58 " " 4,535.17 " " 10,882.94 " " 7,709.79 " " 7,256.27 " 945100 360 45100 "BIOPSY RECTUM(ANORECTAL WALL, ANAL APP)" 1 " 6,568.41 " " 2,233.26 " 497.00 " 5,254.73 " 497.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 945110 360 45110 PROCTECTOMY; ABDOMINOPERINEAL W COLOSTOM 1 " 7,000.00 " " 2,380.00 " " 2,730.00 " " 5,600.00 " " 2,747.16 " " 3,587.50 " " 5,082.00 " " 4,900.00 " " 5,460.00 " " 5,250.00 " " 2,730.00 " " 5,600.00 " " 4,900.00 " " 5,600.00 " 945171 360 45171 EXC RECTAL TUMOR TRANSANAL APPROACH 1 " 6,568.41 " " 2,233.26 " 497.00 " 5,254.73 " 497.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 945190 360 45190 DESTRUCTION RECTAL TUMOR 1 " 6,568.41 " " 2,233.26 " 666.00 " 5,254.73 " 666.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 945300 360 45300 PROCTOSIGMOIDOSCOPY DIAGNOSTIC W OR WO 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 945330 360 45330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 945331 360 45331 SIGMOIDOSCOPY FLEXIBLE W BIOPSY S OR M 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 945337 360 45337 SIGMOIDOSCOPY FLEXIBLE W DECOMPRESSION 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 945399 360 45399 UNLISTED PROCEDURE COLON 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 945905 360 45905 DILATION ANAL SPHINCTER UNDER ANES 1 " 2,787.60 " 947.78 497.00 " 2,230.08 " 497.00 " 1,428.65 " " 2,023.80 " " 1,951.32 " " 2,174.33 " " 2,090.70 " " 1,858.64 " " 2,230.08 " " 1,951.32 " 929.32 " 2,230.08 " " 1,579.84 " " 1,486.91 " 945990 360 45990 ANORECTAL EXAM SURGICAL REQ ANES DIAG 1 " 6,568.41 " " 2,233.26 " 666.00 " 5,254.73 " 666.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 945999 360 45999 UNLISTED PROCEDURE RECTUM 1 " 2,133.51 " 725.39 711.27 " 1,706.81 " " 1,280.11 " " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 946040 360 46040 INCISION AND DRAINAGE RECTAL ABSCESS 1 " 2,787.60 " 947.78 762.00 " 2,230.08 " 762.00 " 1,428.65 " " 2,023.80 " " 1,951.32 " " 2,174.33 " " 2,090.70 " " 1,858.64 " " 2,230.08 " " 1,951.32 " 929.32 " 2,230.08 " " 1,579.84 " " 1,486.91 " 946050 360 46050 INCISION AND DRAINAGE PERIANAL ABSCESS 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 946060 360 46060 INCISION OF RECTAL ABSCESS W FISCULECTO 1 " 6,568.41 " " 2,233.26 " 666.00 " 5,254.73 " 666.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946083 360 46083 INCISION THROMBOSED HEMORRHOID EXTERNAL 1 715.44 243.25 238.51 572.35 497.00 366.66 519.41 500.81 558.04 536.58 477.02 572.35 500.81 238.51 572.35 405.47 381.62 946200 360 46200 FISSURECTOMY INCL SPHINCTEROTOMY IF DONE 1 " 6,568.41 " " 2,233.26 " 666.00 " 5,254.73 " 666.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946220 360 46220 EXCISION SINGLE PAPILLA OR TAG ANUS 1 " 2,787.60 " 947.78 497.00 " 2,230.08 " 497.00 " 1,428.65 " " 2,023.80 " " 1,951.32 " " 2,174.33 " " 2,090.70 " " 1,858.64 " " 2,230.08 " " 1,951.32 " 929.32 " 2,230.08 " " 1,579.84 " " 1,486.91 " 946221 361 46221 HEMORRHOIDECTOMY INTERNAL RUBBER BAND 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 946230 360 46230 EXC MULTIPLE EXTERNAL TAGS ANUS 1 " 6,568.41 " " 2,233.26 " 497.00 " 5,254.73 " 497.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946250 360 46250 HEMORRHOIDECTOMY EXTERNAL 2 OR > GRPS 1 " 6,568.41 " " 2,233.26 " 762.00 " 5,254.73 " 762.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946255 360 46255 HEMORRHOIDECTOMY INT AND EXT S COL/GRP 1 " 6,568.41 " " 2,233.26 " 762.00 " 5,254.73 " 762.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946260 360 46260 HEMORRHOIDECTOMY INT & EXT 2 OR MORE COL 1 " 6,568.41 " " 2,233.26 " 762.00 " 5,254.73 " 762.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946275 360 46275 SURGICAL TX OF ANAL FISTULA 1 " 6,568.41 " " 2,233.26 " 762.00 " 5,254.73 " 762.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946606 360 46606 ANOSCOPY AND BIOPSY SINGLE OR MULTIPLE 1 " 2,787.60 " 947.78 497.00 " 2,230.08 " 497.00 " 1,428.65 " " 2,023.80 " " 1,951.32 " " 2,174.33 " " 2,090.70 " " 1,858.64 " " 2,230.08 " " 1,951.32 " 929.32 " 2,230.08 " " 1,579.84 " " 1,486.91 " 946700 360 46700 ANOPLASTY ADULT 1 " 6,568.41 " " 2,233.26 " 762.00 " 5,254.73 " 762.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946922 360 46922 SURGICAL EXC ANAL LESION 1 " 6,568.41 " " 2,233.26 " 497.00 " 5,254.73 " 497.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946924 360 46924 DESTRUCTION ANAL LESION (s) 1 " 6,568.41 " " 2,233.26 " 497.00 " 5,254.73 " 497.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946947 360 46947 HEMORRHOIDOPEXY BY STAPLING 1 " 6,568.41 " " 2,233.26 " " 1,486.00 " " 5,254.73 " " 1,486.00 " " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 946999 360 46999 UNLISTED PROC ANUS--HEMORRHOIDECTOMY 1 " 2,133.51 " 725.39 497.00 " 1,706.81 " 497.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 947000 360 47000 BIOPSY OF LIVER NEEDLE PERCUTANEOUS 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 947379 360 47379 UNLISTED LAPAROSCOPIC PROC LIVER 1 " 13,603.68 " " 4,625.25 " " 1,071.00 " " 10,882.94 " " 1,071.00 " " 6,971.89 " " 9,876.27 " " 9,522.58 " " 10,610.87 " " 10,202.76 " " 9,070.34 " " 10,882.94 " " 9,522.58 " " 4,535.17 " " 10,882.94 " " 7,709.79 " " 7,256.27 " 947563 360 47563 LAPAROSCOPIC CHOLE W CHOLANGIOGRAPHY 1 " 13,603.68 " " 4,625.25 " " 1,071.00 " " 10,882.94 " " 1,071.00 " " 6,971.89 " " 9,876.27 " " 9,522.58 " " 10,610.87 " " 10,202.76 " " 9,070.34 " " 10,882.94 " " 9,522.58 " " 4,535.17 " " 10,882.94 " " 7,709.79 " " 7,256.27 " 947600 360 47600 CHOLECYSTECTOMY 1 " 4,130.00 " " 1,404.20 " 941.00 " 3,304.00 " 941.00 " 2,116.63 " " 2,998.38 " " 2,891.00 " " 3,221.40 " " 3,097.50 " " 1,610.70 " " 3,304.00 " " 2,891.00 " " 3,304.00 " 947605 360 47605 CHOLECYSTECTOMY W CHOLANGIOGRAPHY 1 " 4,130.00 " " 1,404.20 " " 1,071.00 " " 3,304.00 " " 1,071.00 " " 2,116.63 " " 2,998.38 " " 2,891.00 " " 3,221.40 " " 3,097.50 " " 1,610.70 " " 3,304.00 " " 2,891.00 " " 3,304.00 " 948260 360 49525 HERNIA INGUINAL 1 " 8,557.77 " " 2,909.64 " 941.00 " 6,846.22 " 941.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 948275 360 49560 HERNIA VENTRAL 1 " 8,557.77 " " 2,909.64 " 941.00 " 6,846.22 " 941.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 948288 360 49568 HERNIA IMPLANT MESH 1 " 2,300.00 " 782.00 897.00 " 1,840.00 " " 1,486.00 " " 1,178.75 " " 1,669.80 " " 1,610.00 " " 1,794.00 " " 1,725.00 " 897.00 " 1,840.00 " " 1,610.00 " " 1,840.00 " 949000 360 49000 "EXPLORATORY LAP, EXPLORATORY CELIOTOM" 1 " 2,940.00 " 999.60 941.00 " 2,352.00 " 941.00 " 1,506.75 " " 2,134.44 " " 2,058.00 " " 2,293.20 " " 2,205.00 " " 1,146.60 " " 2,352.00 " " 2,058.00 " " 2,352.00 " 949082 360 49082 ABDOMINAL PARACENTESIS WOUT IMAGING GUID 1 " 2,176.41 " 739.98 666.00 " 1,741.13 " 666.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 949418 360 49418 INSERTION TUN INTRAPERITONEAL CATH PER 1 " 8,557.77 " " 2,909.64 " 666.00 " 6,846.22 " 666.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 949440 360 49440 INSERT GASTROSTOMY TUBE PERCUTANEOUS 1 " 4,368.45 " " 1,485.27 " 666.00 " 3,494.76 " 666.00 " 2,238.83 " " 3,171.49 " " 3,057.92 " " 3,407.39 " " 3,276.34 " " 2,912.68 " " 3,494.76 " " 3,057.92 " " 1,456.34 " " 3,494.76 " " 2,475.78 " " 2,330.14 " 949550 360 49550 REP INITIAL FEMORAL HERNIA ANY AGE REDUC 1 " 8,557.77 " " 2,909.64 " " 1,071.00 " " 6,846.22 " " 1,071.00 " " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 949580 360 49580 REPAIR UMBILICAL HERNIA UNDER 5YR REDUCI 1 " 8,557.77 " " 2,909.64 " 941.00 " 6,846.22 " 941.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 949585 360 49585 REPAIR UMBILICAL HERNIA >5YR REDUCIBLE 1 " 8,557.77 " " 2,909.64 " 941.00 " 6,846.22 " 941.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 949587 360 49587 REPAIR UMBILICAL HERNIA >5YR BLOCK 1 " 8,557.77 " " 2,909.64 " 941.00 " 6,846.22 " 941.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 949590 360 49590 HERNIA REPAIR SPIGELIAN 1 " 8,557.77 " " 2,909.64 " 762.00 " 6,846.22 " 762.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 949650 360 49650 LAPAROSCOPY INITIAL INGUINAL HERNIA 1 " 13,603.68 " " 4,625.25 " 941.00 " 10,882.94 " 941.00 " 6,971.89 " " 9,876.27 " " 9,522.58 " " 10,610.87 " " 10,202.76 " " 9,070.34 " " 10,882.94 " " 9,522.58 " " 4,535.17 " " 10,882.94 " " 7,709.79 " " 7,256.27 " 949999 360 49999 "UNLISTED PROC ABDOMEN,PERIONEUM,OMENTUM" 1 " 2,176.41 " 739.98 497.00 " 1,741.13 " 497.00 " 1,115.41 " " 1,580.07 " " 1,523.49 " " 1,697.60 " " 1,632.31 " " 1,451.12 " " 1,741.13 " " 1,523.49 " 725.56 " 1,741.13 " " 1,233.45 " " 1,160.90 " 950386 360 50386 REMOVE URETERAL STENT VIA TRANSURETHRAL 1 " 4,819.98 " " 1,638.79 " 497.00 " 3,855.98 " 497.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 950961 360 50961 URETER ENDOSCOPY AND TX 1 " 11,865.63 " " 4,034.31 " 497.00 " 9,492.50 " 497.00 " 6,081.14 " " 8,614.45 " " 8,305.94 " " 9,255.19 " " 8,899.22 " " 7,911.48 " " 9,492.50 " " 8,305.94 " " 3,955.74 " " 9,492.50 " " 6,724.76 " " 6,329.18 " 951040 360 51040 CYSTOSTOMY WITH DRAINAGE 1 " 4,819.98 " " 1,638.79 " 941.00 " 3,855.98 " 941.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 951102 360 51102 ASPIRATION BLADDER W INSERT SUPRA CATH 1 " 4,819.98 " " 1,638.79 " 497.00 " 3,855.98 " 497.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 951610 360 51610 INJECTION FOR BLADDER XRAY 1 390.00 132.60 152.10 312.00 234.00 199.88 283.14 273.00 304.20 292.50 152.10 312.00 273.00 312.00 951700 360 51700 BLADDER IRRIG SIMPLE LAVAGE AND/OR INSTI 1 715.44 243.25 238.51 572.35 497.00 366.66 519.41 500.81 558.04 536.58 477.02 572.35 500.81 238.51 572.35 405.47 381.62 951701 361 51701 INSERTION NON INDWELLING BLADDER CATH 1 300.96 102.33 100.33 497.00 497.00 154.24 218.50 210.67 234.75 225.72 200.66 240.77 210.67 100.33 240.77 170.56 160.53 951702 360 51702 INSERTION TEMP INDWELLING BLADDER CATH 1 300.96 102.33 100.33 497.00 497.00 154.24 218.50 210.67 234.75 225.72 200.66 240.77 210.67 100.33 240.77 170.56 160.53 951715 360 51715 ENDOSCOPIC INJ IMPLANT MATERIAL 1 " 8,269.95 " " 2,811.78 " 762.00 " 6,615.96 " 762.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 952005 360 52005 CYSTOURETHROSCOPY W URETERAL CATHERI 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952204 360 52204 CYSTOSCOPY W/BIOPSY(s) 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952224 360 52224 CYSTOURETHROSCOPY W FULGURATION 1 " 8,269.95 " " 2,811.78 " 666.00 " 6,615.96 " 666.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 952260 360 52260 CYSTOURETHROSCOPY W DILATION BLADDER 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952276 360 52276 CYSTOURETHROSCOPY W INTERN URETHROTOMY 1 " 4,819.98 " " 1,638.79 " 762.00 " 3,855.98 " 762.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952281 360 52281 CYSTO W/CALIBRATION AND OR DILATION 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952282 360 52282 CYSTOURETHROSCOPY INSERT PERM STENT 1 " 8,269.95 " " 2,811.78 " 762.00 " 6,615.96 " 762.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 952287 360 52287 CYSTOURETHROSCOPY W INJ(S) FOR CHEMO BLA 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952310 360 52310 CYSTO WITH STENT REMOVAL 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952315 360 52315 CYSTOSCOPY AND TREATMENT COMPLICATED 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 952317 360 52317 REM BLADDER STONE SIMPLE OR SM <2.5CM 1 " 8,269.95 " " 2,811.78 " 497.00 " 6,615.96 " 497.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 952318 360 52318 REM BLADDER STONE COMP OR LG >2.5 CM 1 " 8,269.95 " " 2,811.78 " 666.00 " 6,615.96 " 666.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 952351 360 52351 CYSTOURETERO & OR PYELOSCOPE 1 " 8,269.95 " " 2,811.78 " 762.00 " 6,615.96 " 762.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 952352 360 52352 CYSTOURETHROSCOPY W REM OR MAN CALCULAS 1 " 8,269.95 " " 2,811.78 " 941.00 " 6,615.96 " 941.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 952353 360 52353 CYSTOURETHROSCOPY WITH LITHOTRIPSY 1 " 11,865.63 " " 4,034.31 " 941.00 " 9,492.50 " 941.00 " 6,081.14 " " 8,614.45 " " 8,305.94 " " 9,255.19 " " 8,899.22 " " 7,911.48 " " 9,492.50 " " 8,305.94 " " 3,955.74 " " 9,492.50 " " 6,724.76 " " 6,329.18 " 952354 360 52354 CYSTOURETHROSCOPY W BIOPSY AND OR FULGUR 1 " 11,865.63 " " 4,034.31 " 941.00 " 9,492.50 " 941.00 " 6,081.14 " " 8,614.45 " " 8,305.94 " " 9,255.19 " " 8,899.22 " " 7,911.48 " " 9,492.50 " " 8,305.94 " " 3,955.74 " " 9,492.50 " " 6,724.76 " " 6,329.18 " 952356 360 52356 CYSTOURETHROSCOPY W URETEROSCOPY 1 " 11,865.63 " " 4,034.31 " 941.00 " 9,492.50 " 941.00 " 6,081.14 " " 8,614.45 " " 8,305.94 " " 9,255.19 " " 8,899.22 " " 7,911.48 " " 9,492.50 " " 8,305.94 " " 3,955.74 " " 9,492.50 " " 6,724.76 " " 6,329.18 " 953020 360 53020 MEATOTOMY 1 " 4,819.98 " " 1,638.79 " 497.00 " 3,855.98 " 497.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 953446 360 53446 REMOVAL URETHRAL/BLADDER NECK SPHINCTER 1 " 11,865.63 " " 4,034.31 " 497.00 " 9,492.50 " 497.00 " 6,081.14 " " 8,614.45 " " 8,305.94 " " 9,255.19 " " 8,899.22 " " 7,911.48 " " 9,492.50 " " 8,305.94 " " 3,955.74 " " 9,492.50 " " 6,724.76 " " 6,329.18 " 953600 360 53600 DILATION URETHRAL STRICTURE MALE INITIAL 1 715.44 243.25 238.51 572.35 497.00 366.66 519.41 500.81 558.04 536.58 477.02 572.35 500.81 238.51 572.35 405.47 381.62 953899 360 53899 UNLISTED PROC URINARY SYSTEM 1 715.44 243.25 238.51 572.35 497.00 366.66 519.41 500.81 558.04 536.58 477.02 572.35 500.81 238.51 572.35 405.47 381.62 954055 360 54055 DEST LESION PENIS ELECTRODESICCATION 1 " 4,611.30 " " 1,567.84 " " 1,537.31 " " 3,689.04 " " 2,766.78 " " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 954060 360 54060 SURGICAL EXCISION LESION(S) PENIS 1 " 4,611.30 " " 1,567.84 " 497.00 " 3,689.04 " 497.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 954065 360 54065 DESTRUCTION OF LESION(S) PENIS 1 " 4,611.30 " " 1,567.84 " 497.00 " 3,689.04 " 497.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 954150 360 54150 CIRCUMCISION W/REGIONAL BLOCK 1 " 4,819.98 " " 1,638.79 " 497.00 " 3,855.98 " 497.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 954161 360 54161 CIRCUMCISON OLDER THAN 28 DAYS OF AGE 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 954162 360 54162 LYSIS OR EXC PENIL POST CIRC LESION 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 954163 360 54163 REPAIR INCOMPLETE CIRCUMCISION 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 954450 360 54450 FORESKIN MANIPULATION PREPUTIAL STRETCH 1 715.44 243.25 238.51 572.35 497.00 366.66 519.41 500.81 558.04 536.58 477.02 572.35 500.81 238.51 572.35 405.47 381.62 954700 360 54700 I&D EPIDIDYMIS TESTIS AND OR SCROTAL SP 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 954881 360 G0121 COLONOSCOPY 1 " 2,133.51 " 725.39 666.00 " 1,706.81 " 666.00 " 1,093.42 " " 1,548.93 " " 1,493.46 " " 1,664.14 " " 1,600.13 " " 1,422.54 " " 1,706.81 " " 1,493.46 " 711.27 " 1,706.81 " " 1,209.16 " " 1,138.03 " 954990 360 46270 ANAL FISTULOTOMY 1 " 6,568.41 " " 2,233.26 " 762.00 " 5,254.73 " 762.00 " 3,366.31 " " 4,768.67 " " 4,597.89 " " 5,123.36 " " 4,926.31 " " 4,379.54 " " 5,254.73 " " 4,597.89 " " 2,189.77 " " 5,254.73 " " 3,722.61 " " 3,503.63 " 955040 360 55040 EXCISION OF HYDROCELE UNILATERAL 1 " 8,557.77 " " 2,909.64 " 762.00 " 6,846.22 " 762.00 " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 955041 360 55041 EXCISION HYDROCELE BILATERAL 1 " 8,557.77 " " 2,909.64 " " 1,071.00 " " 6,846.22 " " 1,071.00 " " 4,385.86 " " 6,212.94 " " 5,990.44 " " 6,675.06 " " 6,418.33 " " 5,705.94 " " 6,846.22 " " 5,990.44 " " 2,852.97 " " 6,846.22 " " 4,850.05 " " 4,564.75 " 955100 360 21011 EXC SOFT TISSUE TUMOR FACE AND SCALP 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 955250 360 55250 VASECTOMY UNILATERAL OR BILATERAL 1 " 4,819.98 " " 1,638.79 " 666.00 " 3,855.98 " 666.00 " 2,470.24 " " 3,499.31 " " 3,373.99 " " 3,759.58 " " 3,614.99 " " 3,213.76 " " 3,855.98 " " 3,373.99 " " 1,606.88 " " 3,855.98 " " 2,731.70 " " 2,571.01 " 955500 360 55500 EXC HYDROCELE SPERMATIC CORD UNILATERAL 1 " 8,269.95 " " 2,811.78 " 762.00 " 6,615.96 " 762.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 955520 360 55520 EXC LESION SPERMATIC CORD 1 " 8,269.95 " " 2,811.78 " 941.00 " 6,615.96 " 941.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 955559 360 55559 LAPAROSCOPY PROC SPERMATIC CORD 1 " 13,603.68 " " 4,625.25 " 762.00 " 10,882.94 " 762.00 " 6,971.89 " " 9,876.27 " " 9,522.58 " " 10,610.87 " " 10,202.76 " " 9,070.34 " " 10,882.94 " " 9,522.58 " " 4,535.17 " " 10,882.94 " " 7,709.79 " " 7,256.27 " 956405 360 56405 I & D VULVA OR PERINEAL ABSCESS 1 756.69 257.27 252.26 666.00 666.00 387.80 549.36 529.68 590.22 567.52 504.52 605.35 529.68 252.26 605.35 428.84 403.62 956420 360 56420 I & D BARTHOLINS GLAND ABSCESS 1 457.86 155.67 152.64 497.00 497.00 234.65 332.41 320.50 357.13 343.40 305.28 366.29 320.50 152.64 366.29 259.49 244.22 956501 360 56501 DEST LESION (S) VULVA SIMPLE 1 " 4,611.30 " " 1,567.84 " 497.00 " 3,689.04 " 497.00 " 2,363.29 " " 3,347.80 " " 3,227.91 " " 3,596.81 " " 3,458.48 " " 3,074.62 " " 3,689.04 " " 3,227.91 " " 1,537.31 " " 3,689.04 " " 2,613.43 " " 2,459.70 " 956740 360 56740 EXCISION OF BARTHOLINS GLAND OR CYST 1 " 7,051.83 " " 2,397.62 " 762.00 " 5,641.46 " 762.00 " 3,614.06 " " 5,119.63 " " 4,936.28 " " 5,500.43 " " 5,288.87 " " 4,701.84 " " 5,641.46 " " 4,936.28 " " 2,350.92 " " 5,641.46 " " 3,996.56 " " 3,761.47 " 957061 360 57061 DEST VAGINAL LESION(s) SIMPLE 1 " 7,051.83 " " 2,397.62 " 497.00 " 5,641.46 " 497.00 " 3,614.06 " " 5,119.63 " " 4,936.28 " " 5,500.43 " " 5,288.87 " " 4,701.84 " " 5,641.46 " " 4,936.28 " " 2,350.92 " " 5,641.46 " " 3,996.56 " " 3,761.47 " 957240 360 57240 ANTERIOR COLPORRHAPHY REP CYSTOCELE 1 " 11,853.90 " " 4,030.33 " " 1,071.00 " " 9,483.12 " " 1,071.00 " " 6,075.12 " " 8,605.93 " " 8,297.73 " " 9,246.04 " " 8,890.43 " " 7,903.66 " " 9,483.12 " " 8,297.73 " " 3,951.83 " " 9,483.12 " " 6,718.11 " " 6,322.93 " 957250 360 57250 REPAIR RECTOCELE W OR WO PERINEORRHAPHY 1 " 11,853.90 " " 4,030.33 " " 1,071.00 " " 9,483.12 " " 1,071.00 " " 6,075.12 " " 8,605.93 " " 8,297.73 " " 9,246.04 " " 8,890.43 " " 7,903.66 " " 9,483.12 " " 8,297.73 " " 3,951.83 " " 9,483.12 " " 6,718.11 " " 6,322.93 " 957287 360 57287 REMOVAL OR REVISION SLING FOR STRESS IN 1 " 7,051.83 " " 2,397.62 " " 1,071.00 " " 5,641.46 " " 1,071.00 " " 3,614.06 " " 5,119.63 " " 4,936.28 " " 5,500.43 " " 5,288.87 " " 4,701.84 " " 5,641.46 " " 4,936.28 " " 2,350.92 " " 5,641.46 " " 3,996.56 " " 3,761.47 " 957288 360 57288 SLING OPERATION FOR STRESS INCONTINENCE 1 " 11,853.90 " " 4,030.33 " " 1,071.00 " " 9,483.12 " " 1,071.00 " " 6,075.12 " " 8,605.93 " " 8,297.73 " " 9,246.04 " " 8,890.43 " " 7,903.66 " " 9,483.12 " " 8,297.73 " " 3,951.83 " " 9,483.12 " " 6,718.11 " " 6,322.93 " 957410 360 57410 PELVIC EXAM UNDER ANESTHESIA 1 " 7,051.83 " " 2,397.62 " 666.00 " 5,641.46 " 666.00 " 3,614.06 " " 5,119.63 " " 4,936.28 " " 5,500.43 " " 5,288.87 " " 4,701.84 " " 5,641.46 " " 4,936.28 " " 2,350.92 " " 5,641.46 " " 3,996.56 " " 3,761.47 " 957500 360 57500 BIOPSY CERVIX SINGLE OR MULTIPLE LESION 1 " 1,702.77 " 578.94 497.00 " 1,362.22 " 497.00 872.67 " 1,236.21 " " 1,191.94 " " 1,328.16 " " 1,277.08 " " 1,135.32 " " 1,362.22 " " 1,191.94 " 567.66 " 1,362.22 " 965.02 908.26 957511 360 57511 CAUTERY CERVIX INITIAL OR REPEAT 1 756.69 257.27 252.26 605.35 497.00 387.80 549.36 529.68 590.22 567.52 504.52 605.35 529.68 252.26 605.35 428.84 403.62 958110 361 58110 ENDOMETRIAL BIOPSY IN CONJ W COLPOSCOPY 1 220.00 74.80 85.80 497.00 497.00 112.75 159.72 154.00 171.60 165.00 85.80 176.00 154.00 176.00 958120 360 58120 DILATION AND CURETTAGE DIAG AND OR THERA 1 " 7,051.83 " " 2,397.62 " 666.00 " 5,641.46 " 666.00 " 3,614.06 " " 5,119.63 " " 4,936.28 " " 5,500.43 " " 5,288.87 " " 4,701.84 " " 5,641.46 " " 4,936.28 " " 2,350.92 " " 5,641.46 " " 3,996.56 " " 3,761.47 " 958300 360 58300 INSERTION OF IUD 1 340.00 115.60 132.60 497.00 497.00 174.25 246.84 238.00 265.20 255.00 132.60 272.00 238.00 272.00 958301 360 58301 REMOVAL OF IUD 1 756.69 257.27 252.26 605.35 497.00 387.80 549.36 529.68 590.22 567.52 504.52 605.35 529.68 252.26 605.35 428.84 403.62 960500 360 60500 PARATHYROIDECTOMY OR EXPLORE PARATHYROID 1 " 13,672.53 " " 4,648.66 " " 1,486.00 " " 10,938.02 " " 1,486.00 " " 7,007.17 " " 9,926.26 " " 9,570.77 " " 10,664.57 " " 10,254.40 " " 9,116.24 " " 10,938.02 " " 9,570.77 " " 4,558.12 " " 10,938.02 " " 7,748.80 " " 7,292.99 " 962270 360 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC 1 " 1,705.92 " 580.01 497.00 " 1,364.74 " 497.00 874.28 " 1,238.50 " " 1,194.14 " " 1,330.62 " " 1,279.44 " " 1,137.44 " " 1,364.74 " " 1,194.14 " 568.72 " 1,364.74 " 966.82 909.95 962272 360 62272 SPINAL PUNC THERAP CEREBRO SPINAL FLUID 1 " 1,705.92 " 580.01 497.00 " 1,364.74 " 497.00 874.28 " 1,238.50 " " 1,194.14 " " 1,330.62 " " 1,279.44 " " 1,137.44 " " 1,364.74 " " 1,194.14 " 568.72 " 1,364.74 " 966.82 909.95 965731 360 52000 CYSTO 1 " 1,545.12 " 525.34 497.00 " 1,236.10 " 497.00 791.87 " 1,121.76 " " 1,081.58 " " 1,205.19 " " 1,158.84 " " 1,030.22 " " 1,236.10 " " 1,081.58 " 515.11 " 1,236.10 " 875.69 824.18 965750 360 52332 CYSTOURETEROSCOPY 1 " 8,269.95 " " 2,811.78 " 666.00 " 6,615.96 " 666.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 965775 360 52234 TUR 1 " 8,269.95 " " 2,811.78 " 666.00 " 6,615.96 " 666.00 " 4,238.35 " " 6,003.98 " " 5,788.97 " " 6,450.56 " " 6,202.46 " " 5,514.04 " " 6,615.96 " " 5,788.97 " " 2,757.02 " " 6,615.96 " " 4,686.93 " " 4,411.23 " 966183 360 66183 INSERTION ANTERIOR DRAINAGE DEVICE 1 " 10,531.83 " " 3,580.82 " 762.00 " 8,425.46 " 762.00 " 5,397.56 " " 7,646.11 " " 7,372.28 " " 8,214.83 " " 7,898.87 " " 7,022.16 " " 8,425.46 " " 7,372.28 " " 3,511.08 " " 8,425.46 " " 5,968.84 " " 5,617.73 " 966250 360 66250 REV/RPR OPRATIVE WOUND ANTERIOR SEGMENT 1 " 5,382.81 " " 1,830.16 " 666.00 " 4,306.25 " 666.00 " 2,758.69 " " 3,907.92 " " 3,767.97 " " 4,198.59 " " 4,037.11 " " 3,589.02 " " 4,306.25 " " 3,767.97 " " 1,794.51 " " 4,306.25 " " 3,050.67 " " 2,871.22 " 966840 360 66840 REMOVAL LENS MATERIAL ASPIRATION TECHNIQ 1 " 5,589.27 " " 1,900.35 " 941.00 " 4,471.42 " 941.00 " 2,864.50 " " 4,057.81 " " 3,912.49 " " 4,359.63 " " 4,191.95 " " 3,726.68 " " 4,471.42 " " 3,912.49 " " 1,863.34 " " 4,471.42 " " 3,167.68 " " 2,981.34 " 966850 360 66850 REM LENS MATERIAL PHACOFRAGMENTATION 1 " 5,589.27 " " 1,900.35 " " 1,486.00 " " 4,471.42 " " 1,486.00 " " 2,864.50 " " 4,057.81 " " 3,912.49 " " 4,359.63 " " 4,191.95 " " 3,726.68 " " 4,471.42 " " 3,912.49 " " 1,863.34 " " 4,471.42 " " 3,167.68 " " 2,981.34 " 966984 360 66984 PHACO IOL 1 " 5,589.27 " " 1,900.35 " " 1,458.00 " " 4,471.42 " " 1,458.00 " " 2,864.50 " " 4,057.81 " " 3,912.49 " " 4,359.63 " " 4,191.95 " " 3,726.68 " " 4,471.42 " " 3,912.49 " " 1,863.34 " " 4,471.42 " " 3,167.68 " " 2,981.34 " 967005 360 67005 VITRECTOMY REMOVAL OF VITREOUS PARTIAL 1 " 5,589.27 " " 1,900.35 " 941.00 " 4,471.42 " 941.00 " 2,864.50 " " 4,057.81 " " 3,912.49 " " 4,359.63 " " 4,191.95 " " 3,726.68 " " 4,471.42 " " 3,912.49 " " 1,863.34 " " 4,471.42 " " 3,167.68 " " 2,981.34 " 967700 360 67700 DRAINAGE EYELID ABSCESS 1 702.39 238.81 234.16 561.91 497.00 359.97 509.94 491.67 547.86 526.79 468.32 561.91 491.67 234.16 561.91 398.07 374.66 967840 360 67840 EXCISION LESION EYELID 1 " 2,176.23 " 739.92 666.00 " 1,740.98 " 666.00 " 1,115.32 " " 1,579.94 " " 1,523.36 " " 1,697.46 " " 1,632.17 " " 1,451.02 " " 1,740.98 " " 1,523.36 " 725.51 " 1,740.98 " " 1,233.37 " " 1,160.82 " 969000 360 69000 DRAINAGE EXT EAR ABSCESS OR HEMATOMA SIM 1 " 1,671.99 " 568.48 497.00 " 1,337.59 " 497.00 856.89 " 1,213.86 " " 1,170.39 " " 1,304.15 " " 1,253.99 " " 1,114.82 " " 1,337.59 " " 1,170.39 " 557.41 " 1,337.59 " 947.60 891.86 969100 360 69100 BIOPSY EXTERNAL EAR 1 568.83 193.40 189.64 455.06 341.30 291.53 412.97 398.18 443.69 426.62 379.28 455.06 398.18 189.64 455.06 322.39 303.42 969110 360 69110 EXCISION EXTERNAL EAR PARTIAL SIMPLE REP 1 " 6,371.16 " " 2,166.19 " 497.00 " 5,096.93 " 497.00 " 3,265.22 " " 4,625.46 " " 4,459.81 " " 4,969.50 " " 4,778.37 " " 4,248.00 " " 5,096.93 " " 4,459.81 " " 2,124.00 " " 5,096.93 " " 3,610.80 " " 3,398.40 " 969205 360 69205 REM FOREIGN BODY EXT AUD CANAL W ANES 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 969210 361 69210 REMOVE IMPACTED CERUMEN UNILATERAL 1 149.64 50.88 49.88 497.00 497.00 76.69 108.64 104.75 116.72 112.23 99.76 119.71 104.75 49.88 119.71 84.80 79.81 969399 360 69399 UNLISTED PROC EXTERNAL EAR 1 568.83 193.40 189.64 455.06 341.30 291.53 412.97 398.18 443.69 426.62 379.28 455.06 398.18 189.64 455.06 322.39 303.42 981746 360 31622 BRONCHOSCOPY FLEXIBLE FL 1 " 4,022.67 " " 1,367.71 " 666.00 " 3,218.14 " 666.00 " 2,061.62 " " 2,920.46 " " 2,815.87 " " 3,137.68 " " 3,017.00 " " 2,682.12 " " 3,218.14 " " 2,815.87 " " 1,341.06 " " 3,218.14 " " 2,279.80 " " 2,145.70 " 981747 360 57452 COLPOSCOPY 1 457.86 155.67 152.64 666.00 666.00 234.65 332.41 320.50 357.13 343.40 305.28 366.29 320.50 152.64 366.29 259.49 244.22 981765 360 57456 COLPOSCOPY WITH BIOPSY 1 756.69 257.27 252.26 605.35 497.00 387.80 549.36 529.68 590.22 567.52 504.52 605.35 529.68 252.26 605.35 428.84 403.62 981770 360 57461 COLPOSCOPY WITH LOOP ELECTRODE 1 " 7,051.83 " " 2,397.62 " 762.00 " 5,641.46 " 762.00 " 3,614.06 " " 5,119.63 " " 4,936.28 " " 5,500.43 " " 5,288.87 " " 4,701.84 " " 5,641.46 " " 4,936.28 " " 2,350.92 " " 5,641.46 " " 3,996.56 " " 3,761.47 " 982272 301 82272 HEMOCCULT 1 12.69 4.31 4.23 10.15 5.32 6.50 9.21 8.88 9.90 9.52 8.46 10.15 8.88 4.23 10.15 7.19 6.77 985100 360 55100 DRAINAGE OF SCROTAL WALL ABSCESS 1 " 3,782.34 " " 1,286.00 " 497.00 " 3,025.87 " 497.00 " 1,938.45 " " 2,745.98 " " 2,647.64 " " 2,950.23 " " 2,836.76 " " 2,521.90 " " 3,025.87 " " 2,647.64 " " 1,260.95 " " 3,025.87 " " 2,143.62 " " 2,017.52 " 997597 360 97597 DEBRIDEMENT REMOVE DEV TIS 20 CM OR LESS 1 482.67 164.11 160.91 497.00 497.00 247.37 350.42 337.87 376.48 362.00 321.82 386.14 337.87 160.91 386.14 273.55 257.46 997598 360 97598 DEBRIDEMENT REMOVE DEV TIS E ADDT 20 CM 1 140.00 47.60 54.60 497.00 497.00 71.75 101.64 98.00 109.20 105.00 54.60 112.00 98.00 112.00